E-ISSN:2456-3110

Case Report

Acne Vulgaris

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

Ayurvedic management of Mukhadushika (Acne Vulgaris) - Case Report

G Mathapati S1*, Venkatakrishna KV2
DOI:10.21760/jaims.8.11.28

1* Soubhagya G Mathapati, Final Year Post Graduate Scholar, Department Of Pg Studies In Swasthavritta, Government Ayurveda Medical College And Hospital, Mysuru, Karnataka, India.

2 Venkatakrishna KV, Professor and Head, Department of PG Studies in Swasthavritta, Government Ayurveda Medical College and Hospital, Mysuru, Karnataka, India.

Mukhadushika or acne vulgaris, is a common skin ailment with significant physical and psychological implications, particularly among adolescents. This study aimed to assess the efficacy of Ayurvedic treatments in managing Mukhadushika. A 21-year-old female patient suffering from facial pimples, pain, and related discomfort visited Panchakarma Hospital. Despite prior allopathic treatment, no relief was observed. Ayurvedic assessments revealed imbalances in Vata, Pitta, Kapha, Rasa, and Rakta doshas. The treatment protocol consisted of Virechana (purification therapy) followed by Jaloukavacharana (leech therapy) and Shamanoushadhi (internal medications). The results showed a substantial improvement in the patient's symptoms, with the absence of black and white comedones, reduced macules and papules, and complete resolution of nodules and tenderness. The treatment approach, including the use of Sanjeevini Vati, Virechana Karma, and Jaloukavacharana, proved effective without side effects.

Keywords: Mukhadushika, Acne Vulgaris, Virechana Karma, Jaloukavacharana

Corresponding Author How to Cite this Article To Browse
Soubhagya G Mathapati, Final Year Post Graduate Scholar, Department Of Pg Studies In Swasthavritta, Government Ayurveda Medical College And Hospital, Mysuru, Karnataka, India.
Email: 		G Mathapati S, Venkatakrishna KV, Ayurvedic management of Mukhadushika (Acne Vulgaris) - Case Report. J Ayu Int Med Sci. 2023;8(11):176-181.
Available From
https://jaims.in/jaims/article/view/2761

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-14 2023-09-25 2023-10-05 2023-10-15 2023-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.35

© 2023by G Mathapati S, Venkatakrishna KVand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Soubhagya G Mathapati et al. Ayurvedic management of Mukhadushika (Acne Vulgaris)

Introduction

Ayurvedic classics explain Mukhadhushika in the context of Kshudraroga, which is caused by the vitiation of Kapha, Vata, And Rakta featuring the formation of Shalmalikantakavat Pidaka or pimples on the face, along with Ruja (pain).[1] Mukhadhushika is also known as Yuvanapidaka or Tarunyapidaka.[2] Mukhadhushika conforms to acne vulgaris in contemporary science. Acne vulgaris is the formation of comedones, papules, pustules, nodules and/or cysts as a result of obstruction and inflammation of pilosebaceous units.[3] It is exclusively seen in juvenile and adolescents. The prevalence of acne vulgaris is 80%-90% in adolescence,[4] causes both physical and psychological scars to hurt social lives and self-esteem. The prevalence rate of this disease increases day by day due to excessive stress, hormonal imbalance, junk food intake, lifestyle, long-term use of cosmetics etc.

Aim

This work aimed to study the effect of Ayurvedic treatment in the case of Mukhadhushika (Acne Vulgaris)

Case Report

A 21-year female patient visited the Hi-tech Panchakarma Hospital Mysuru, with the following complaints; Pidaka on the face (B/L cheeks, on forehead, and chin), Todavat Peeda and Daha.

H/O present illness

A 21-year patient was normal two years back. But, since then patient has been suffering from pimples over bilateral cheeks, on forehead and chin. Simultaneously, she was suffering from constipation and physical and mental stress. She had taken treatment of allopathic medicine for years but did not get relief. There was no significant history of any type of illness found.

History of past illness - There was no significant history.

Personal History

Occupation - Student

Diet - Vegetarian

Appetite - Irregular

Bowel - incomplete evacuation

Micturition - Normal

Sleep - Sound

Menstrual history - Regular Menstrual Cycles

Family History - No significant family history

Nidana

Table 1: Nidanas

Aharaja Viharaja Manasika
Viruddhaahara - Fruit Milk ShakesVishamashana - Untimely intake of food, late night intake of food,AdhyashanaJunk FoodsDivaswapnaExposure to SunlightSheeta Vata SevanaChinta, Krodha

Roga Rogi Pariksha

General And local Examination

Asthavidha Pariksha

Nadi: Vaata Pitta

Mutra: Prakrita

Mala: Vibhandha

Jihva: Saama

Shabdha: Prakrita

Sparsha:Ruksha, Ushna

Drik: Prakrita

Akriti: Madhyama

Dashavidha Pariksha

Prakriti: Vata-Pitta

Vikriti:Pitta, Kapha, Rasa, Rakta

Saara: Raktasara

Samhanana: Madhyama

Pramana: Madhyama

Satmya:Katu,Amla,Lavana Rasa

Satva: Madhyama

Aharashakti: Madhyama

Vyayama Shakti: Madhyama

Vaya: Youvana

Local examination

Site - Face (both cheeks forehead and chin)

Type of lesion:


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Soubhagya G Mathapati et al. Ayurvedic management of Mukhadushika (Acne Vulgaris)

Macule - Present

Papule - Present

pustular nodule - Present

Comedones - open comedones

Size - 2-3mm

Discharge - Absent

Tenderness - Present

Samprapti

Due to improper Ahara and Vihara Doshas get aggravated and cause the disease like Mukhadushika. The detailed Samprapti of Mukhadushika is explained in chart no. 1.

Samprapti Ghataka

Dosha - Pitta Pradhana Tridosha

Dushya - Rasa, Rakta Meda Sweda

Ama - Jataragni Mandya

Agni - Jataragni, Dhatwagni

Srotas - Rasavaha, Raktavaha, Medavaha

Rogamarga - Abhyantara

Udbhavastana - Amashaya

Vyaktastana – Mukha

Chart 1: Samprapti of Mukhadushika
 Jaims_2761_01.jpg

Materials and Methods

Subjective Criteria

The patient was observed for improvement in Signs and symptoms and improvement in general condition.

Treatment Plan

Treatment was planned in two phases.

First phase

In the initial phase of the treatment, Samshodhana Karmas such as Virechana and Raktamokshana were done. The Virechana procedure was carried out using the classical method. Sehapana was administered with Tiktaka Grita in Arohana Krama for a period of 7 days. Subsequently, there was a 3-day Vishrama Kala, involving Sarvanga Abhyanga, Bhaspa Sweda, and Pathya (appropriate diet and lifestyle) for the Virechana karma. On the 4th day, the Virechana Karma was performed using Trivit Leha at a dosage of 60gm, with Ushna Jala (warm water) as an Anupama. Jaloukavacharana treatment was then administered on the 16th day following the Virechana Karma.

Second Phase

The second phase of treatment encompasses Nidana Parivarjana (avoidance of causative factors), Shamana Chikitsa, and Pathya-Apathya Paripalana. This phase aims to further address the patient's condition and promote their overall well-being.

Table 2: Treatment Schedule

Treatment Medicine Duration
Deepana Pachana Tab. Sanjeevini Vati TID BF3 days
Snehapana Tiktaka Grita 7 Days
Virechana Trivit Leha - 60 gmOne day
Raktamokshana Jalouka 16th day
Shamanoushadhi 1. Raktamrita Kwatha 2tsp BD after food2. Maha Tiktaka Ghrita 1tsp BD Before food3. Lodra Churna Lepa once daily1 month

Observations and Results

Figure no. 1 illustrates the patient's condition before undergoing Shodhana Chikitsa, while Figure no. 2 represents their status during treatment and 15 days after treatment. The details regarding the results showing changes in signs and symptoms before and after treatment can be found in Table 4.



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Table 3: Results showing changes before and after treatment

Signs and SymptomsBefore Treatment After Treatment
Daha (Burning)PresentAbsent
Ruja (Pain)PresentAbsent
Kandu (Itching)PresentAbsent
Shotha (Eruptions)PresentAbsent
Black comedonesPresentAbsent
White comedonesPresentAbsent
MaculesPresentReduced in number
PapulesPresentReduced
NodulesPresentAbsent
Postural rashPresentAbsent
TendernessPresentAbsent

Before Treatment

After Virechana Karma

During Jalaukavacharana
Jaims_2761_04.jpg

15 days after treatment
Jaims_2761_05.jpg

Discussion

Mukhadushika (Acne Vulgaris) is a major health issue in the younger age group, mainly 15-24 years. Skin being the largest integumentary organ of our body, fulfils a huge number of functions, all of which are designed to help our body work properly. Adverse factors like changing lifestyle, excessive use of cosmetics and skin care products, junk food habits, air pollution, UV rays, stress etc., damage the human skin, especially the facial skin, which is much thinner and more sensitive.

In the present case study, Virechana Karma was choosen as the treatment approach due to the predominance of Pitta symptoms such as Dahayukta Pidaka. Following the Virechana Karma procedure, a remarkable 70% reduction in symptoms was observed. Subsequently, on the 16th day after Shodhana (Virechana), the next phase of treatment, Jalaukavacharana, was carried out. This was followed by the administration of Shamanoushadhis was recommended.

Virechana, a purgative therapy, is preferred due to its broad applicability and relative simplicity with minimal risk of complications. Virechana not only aids in the elimination of Doshas from the body but also offers preventive and promotive benefits. Combining Shodhana (purification) with Shamana (palliative) therapy is considered more effective in treating this condition. In the case of Mukhdooshika, which is primarily associated with Pitta, Rakta Pradosha, and to some extent Kapha imbalances, Virechana therapy is considered the most suitable treatment option.



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Jalaukavacharana, as a purifying technique, eliminates deeply ingrained poisons by releasing blood, removing Srotasa,[5] and calming vitiated Dosha. In addition to drawing blood from the area, leech applications also inject biologically active chemicals that aid in treating several diseases. Like the anticoagulants Hirudin and Calin, which also suppress inflammation and promote sluggish wound healing.[6]

Sanjivani Vati may have the ability to improve the digestive system. Every content has one or two unique therapeutic actions apart from their other properties; Vidanga has Kriminasana quality; Sunthi is Amadosahara; Pippali Shulaprasamana; Haritaki Sarvadoshaprashamana and Anuloman; Amalaki Rasayana; Vibhitaki Kaphapittajita and Bhedaka; Vaca Medhya; Guduchi Jvaraghna, Rasayana and Raktasodhaka; Bhallataka Vatahara and Kaphahara; Vatsanabha Tridosahara. It is Kaphavatanut and Virechaka. Of these properties, Sanjivani Vati can be considered a common aid for digestion.[7]

Raktamrita Kwatha, which contains ingredients, Mahamanjistadi Kwatha, Mustha, Katuki, Ativisha and Bakuchi addresses skin issues, blood purifier and promotes overall skin health.

Mahatiktaka Ghrita contains a combination of bitter herbs with cooling and purifying properties, making it suitable for such conditions. The key ingredients in Mahatiktaka Ghrita include Nimba, Bakuchi, Haridra, Daruharidra, etc It helps to purify the blood and balances the Pitta Dosha.[8]

Lodra Churna Lepa, Lodra is having properties like Kashaya, Tikta Rasa, Sita Veerya and a Kapha Pitta and Raktapittahara property does the Raktaprasadana. This Lepa to face was advised once daily to eliminate the Stanika Doshas.[9]

Upon the completion of the entire treatment regimen, a significant total relief of 90% from both signs and symptoms was achieved, and notably, no side effects were observed.

Conclusion

Mukhadhushika is Pitta Kapha Pradana Rakta Dustijanya Vyadhi. This has similar attributes to acne vulgaris. Virechana and Jaloukavacharana followed by Shamanoushadhi provided significant relief in signs and symptoms. No adverse effect was noted during the follow-up

period. So, the conclusion is that Ayurveda can treat the Mukhadhushika without side effects.

Limitations of the study

In this Ayurvedic management, satisfactory relief was found in signs and symptoms of Mukhadhushika. As it was only a single case study, it may be adopted for other cases of Mukhadhushika with a greater sample size and for further research in the management of Mukhadhushika (Acne vulgaris).

References

1. Mishra B. Bhavaprakasha Vidyotini Tika. Madhya Khanda 61/31. Chaukhambha Sanskrit Sansthana, Varanasi; 11th edition, 2004.

2. Acharya YT. Sushruta Samhita. Nidanasthana 13/39. Choukhambha Publication Varanasi; 2005.

3. Diane T, John S. Diseases of the sebaceous glands. In: Fitzpatrick’s Dermatology in General Medicine. 6: 34-56; 2003.

4. Fauci AS, Braunwald E, Kasper DL. Alterations in the skin acne vulgaris. In: Harrison's Principles of Internal Medicine. 15th edition, vol 1. p. 314.

5. Sharma PV. Sushruta Samhita of Susruta, Vol, Sootra Sthana; Jalaoka Avcharniya: Chapter 13, Verse 11. Varanasi: Chaukhambha Visvabharati; 2010. p. 136.

6. Girdhar et al. Role of Jalaukavcharana in Mukh Dushika (Acne Vulgaris). September 2022; vol. 5(9):160-164.

7. Tewari D, Tewari V, Singh K, Chaudhary S. A Scientific Review on Sanjivani Vati with special reference to its Pharmacological Actions, Therapeutic Indications and Pharmaceutics. Int J Ayu Pharm Chem. 2018;9(3):82–92.

8. Vagbhata. Astanga Hrudaya, Sarvangasundari of Arunadatta, Ayurveda Rasayana of Hemadri. Chaukamba Surabharathi Prakashana, Varanasi; 2002. Chikitsa stana, kusta chikitsa 8-11; Pg-711.

9. Shastri JLN. Illustrated Dravyaguna Vijnana. 2017 edition, vol 2. Lodra, page no 828.


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