E-ISSN:2456-3110

Case Report

Ayurvedic management

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

Ayurvedic management of Alopecia Areata - A Single Case Study

Narlewad S1*, Hange D2
DOI:10.21760/jaims.8.12.43

1* Sushama Narlewad, Post Graduate Scholar, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India.

2 DV Hange, Assistant Professor, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India.

Alopecia areata is defined as patches of hair loss on the scalp. It is considered a psychosomatic disorder in present era. Today, the young generation is more likely to be victims of Alopecia areata, based on clinical grounds. There are many causes of alopecia areata, such as fungal infection, dandruff, scalp psoriasis, seborrheic dermatitis, pediculosis, systemic disorders, autoimmune disorders, etc. It may also be seen as a side effect of chemotherapy or radiotherapy. A 16-year-old patient had patches of hair loss on his scalp. He had taken treatment with conventional modern medicine, but in vain. The patient was given Ayurvedic treatment for six months on an OPD basis, including Karanj oil for local application, Rakt Pachak Churna, Rasayan Churna, Aarogyavardhini Vati, and Jalaukavacharan (leech therapy). After a 3-months interval, regrowth of the hair was found. This study suggests that Shaman and Shodhan treatment can provide noteworthy relief in Alopecia areata, i.e., Indralupta.

Keywords: Alopecia areata, Indralupta, Ayurveda, Jalaukavacharan, Leech therapy

Corresponding Author How to Cite this Article To Browse
Sushama Narlewad, Post Graduate Scholar, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India.
Email: 		Narlewad S, Hange D, Ayurvedic management of Alopecia Areata - A Single Case Study. J Ayu Int Med Sci. 2023;8(12):284-290.
Available From
https://jaims.in/jaims/article/view/2973

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-13 2023-10-18 2023-10-23 2023-10-30 2023-11-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.34%

© 2023by Narlewad S, Hange Dand 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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Introduction

A person's hair has a big impact on their appearance. Hair loss is a major issue in today's era, which is attributed to a variety of factors, including changed lifestyles, systemic diseases, sleep disorders, countless advertisements that promote hair growth, medications, a stressful life, and cold weather.[1]

Alopecia areata (AA) is considered a psychosomatic and complex autoimmune disorder. It causes a non-scarring pattern of hair loss. The typical presentation

includes sharply demarcated spherical patches of hair loss, which may present at any age. There are fewer cases in children than in adults, but it has been found to be associated with emotional stress, family history, Down syndrome, and autoimmune disorders.[2] In India, the lifetime risk of Alopecia Areata is 1.7% and its prevalence is 0.7%.[3]

According to signs and symptoms, the disease can be correlated with Indralupta in Ayurveda. In which, vitiated Vata, Pitta causes hair fall, and Kapha, Rakta blocks the opening of the hair follicle, so new growth of hair does not occur.[4] In modern medicine, corticosteroids are used to treat this type of illness, but they have some drawbacks and side effects, so a harmless and effective medicine is expected from alternative medical sciences. Ayurveda plays a major role in treating this type of autoimmune disorder.[5]

In Ayurvedic texts, we have detailed studies of the Indralupta. Here is a case of Alopecia areata, which is successfully treated through Ayurvedic management by using Shaman, Shodhan (Jalaukavacharan), and Nidanparivarjan.

Aim and Objective

To study the role of Shaman, Shodhan (Jalaukavacharan) in Indralupta with special reference to Alopecia areata

Case Report

A 16-year-old patient came to Rog Nidan OPD in Government Ayurveda College, Nagpur with the following complaints since 2yrs.

  • Patchy hair loss
  • Dandruff
  • Itching
  • Constipation
  • Weak appetite

History of present illness

After taking a detailed medical history of the patient, it was found that he suffered from typhoid fever, for which he received complete treatment in a private hospital and was completely cured. After that, he started losing hair in multiple patches. In addition to that, he was also suffering from dandruff. He was treated with corticosteroids and topical serum for 3 to 5 months in GMC Nagpur but got no relief, so he approached Rog Nidan OPD No. 4 in GAC Nagpur and was diagnosed with Indralupta (Alopecia areata), and treatment was started on an OPD basis.

Past medical history

  • H/O of Typhoid 2yrs ago
  • No H/O any significant family history of autoimmune disorder and Alopecia areata.

Personal history

  • Diet - Mixed diet (Nonveg - two to three times a month)
  • Addiction - Non specific
  • Sleep - Regular sound sleep
  • Occupation - Student

Ashtavidha Pariksha

  • Nadi - 80/Min
  • Mutra - Niyamit
  • Mala - Aniyamit (Malavshambh)
  • Jivha - Alpa Saam
  • Shabda - Spashta
  • Sparsha - Samsheetoshna
  • Druka - Prakruta
  • Aakruti - Krusha
  • Pulse - 80/Min
  • BP - 120/80mmhg

Systemic examination

R/S - Clear, AEBE

CVS - S1, S2 normal, no added sounds.

CNS - Conscious, well oriented


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Laboratory Investigation

Haematological investigations carried out to exclude any other disease. CBC, B.T., C.T. and Serological investigations carried out to perform Jalaukavacharan.

Table 1: Laboratory Investigations of Patient

Hematological
Hb%14.0%
Total R.B.C5.14mil/c.mm
Total W.B.C7000/cu.mm
Neutrophil56.8%
Eosinophils4.1%
Basophil1%
Monocytes3.5%
Lymphocytes34.1%
ESR05mm/hr
Bleeding time1min 26sec
Clotting time3min 06sec
Biochemistry
RBS94mg/dl
Serological
HIV testNegative
HBsAg TestNegative
VDRL testNegative

Table 2: Thyroid profile

T3168.5ng/ml
T410.44ug/dk
TSH2.50u/U/ml

Scalp Examination

Inspection

Frontal region: One large patch of 12×5 cm, Multiple small patches of 2×1 cm

Parietal Region: Multiple patches of 4×2 cm

Temporal Region: Both sides, 2 patches of 3×2 cm

Occipital region: More than 3 patches of 3×2cm

Scalp: 3 to 4 boils on the scalp with intense itching.

Samprapti Ghataka

Dosha - Vata, Pitta, Kapha

Dushya - Rasa, Rakta, Asthi

Agni - Mandagni

Srotas - Anna, Rasa, Rakta, Asthivaha Srotas

Sroto Dushti - Sanga

Adhisthana - Shirah and Shirah Kapala

Sadhyasadhyata - Kriccha Sadhya

Materials and Methods

Clinical assessment made from classical symptoms and SALT score.[3]

Table 3: Following medicines were prescribed during the course of treatment.

MedicineDose & DurationAction
1. Aampachak vati1BD for first 7 days(Aampachan) Digestion and Appetizer
2. Laghumalini Vasant
Godanti Bhasm
Gudvel Satwa
Sitopaladi Churna		10gm  32 parts
10gm
10gm
30gm
1part BD with milk for 16 days.		Jwaraghn, Saptadhatuvardhak
2. Aarogyavardhini Vati2BD After meal, for 42 daysHepatoprotective, Blood purifier
3. Raktpachak Churna1gm BD After meal for 6 months.Blood purifier
4. Rasayana Churna1gm BD After meal for 6 months.Promote immunity
5. Yashtimadhu Churna1gm BD After meal for 6 months.Promote hair growth
6.Vidang Churna1gm BD After meal for 6 months.Krimighn, antifungal
7. Saptamrit Loha1BD After meal for 6months.Raktadi Dhatuvardhak
8. Trivritt Avleh5gm at night with lukewarm water for 6 months.Sukhvirechak (purgative)
9. Karanj TailShirobhyanga (Local application), Twice a day for 6 months.Antiseptic, Antifungal, Antioxidant (boost overall hair health)
10. Aamlakichurna + Yashtimadhu Churna + Bhringraj ChurnaShirolepa (L.A) Once a day, for 6 months.Promotes hair regrowth.
11. Bhringaraj Ghanvati1BD For 6 monthsKeshya

Panchakarma procedures

  • 3 Setting of Jalaukavacharan, after 15 days interval.
  • Snehan-Swedan was prescribed prior to leech therapy.
  • Cleaning of part of the body to which Jalauka, is going to be applied.

Mode of action of Jalauka[6]

Wherever Shastra Karma is not appropriate, Anushastras like Jalauka can be applied to human beings as well as animals. According to the type of disease, the patient, and the predominance of Doshas, many methods of bloodletting have been developed. Jalauka are primarily employed in Pitta and Rakta Dushti Vikar since they are Madhura Rasa Yukta and live in cold and fresh water, making them suitable for Pitta Prakriti people. In the same way that the Hansa bird separates milk from water and only consumes milk, Jalaukas sucks only impure blood first then pure blood. Shringa, Jalauka, and Prachhan, have localized action; only Siravedha has generalized action; hence, Jalauka can be used in many Pitta aggravated Raktaj disorders by applying it to the affected region locally. It contains not only hirudin but also a number of enzymes like bdellin apyrase, decrosin, collagenase, egilin, hementin,


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hyaluronidase, and orgelasel etc. It also has the action of vasodilaton and is an anesthetic.

Result

After 6 months of treatment, there was marked improvement in the signs and symptoms of Alopecia areata.

This was assessed by the SALT score, which is useful for the quantitative assessment of hair loss.

After treatment, S4 turns into S0.

Salt Score[3]

Table 4: Scalp divided into 4 quadrant

Top0.4 × 80% = 32%
Post0.24 × 90% = 21.6%
Right side0.18 × 40% = 7.2%
Left side0.18 × 40% = 7.2%
Total68.0%

Table 5: Severity of Scalp Hair loss was classified as[7]

S0No Hair loss
S11 to 24% Hair loss
S225 to 49% Hair loss
S350 to 74% Hair loss
S475 to 99% Hair loss
S5100% Hair loss

Total = 68% Hair loss so score is S3

Table 6: Pathya-Apathya

PathyaApathya
§ Nidanparivarjan
§ Laghu-Snigdha Ahar
§ Fresh fruits, leafy green vegetables and sprouts
§ Nidanparivarjan
§ Meditation (Yoga, Pranayam)
§ Regular exercise
§ Spend time with positive people		§ Atiushna, Tikshna, Amla, Lavanyukt Sevan
§ Viruddha Ahar
§ Vegavrodh
§ Vatpitta Prakopak, Chinta, Bhaya, Krodha
§ Divaswap, Ratrojagaran
§ Street Food

Table 7: Observation and Results

DaysObservation
1 DayInvestigation done and medicine given
7 DaysConstipation recovered and appetite increased.
15 DaysDandruff reduced
21 DaysMild Improvement in hair loss.
1 MonthImprovement in hair fall and growing of some thin hair, from the bald patches.
1.5 MonthBald patches turn into black patch.
2 MonthImproved growth of hair on the patches
3 MonthAll the patches fully covered with black hair
6 Month (Con.)No any new patches observed till date.

Before treatment
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After 2 months of the treatment
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After 3 months of the treatment
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Discussion

The most crucial and first line of treatment in any Vyadhi is Nidana Parivarjana. Pathya Ahara Vihara plays a significant role in the Samprapti Bhang of the diseases. As Agnimandya is the root cause of all diseases, Deepana-Pachana Chikitsa is helpful. Aama Pachak Vati was administered as the

patient had Mandagni in order to aid in the digestion of toxins[8] that move through Sira and impede the Roma-Koopa. Lukewarm water was administered at to Trivritt Avleh night for Nitya Virechana and Vatanulomana. After obtaining adequate Agni, Rasayana Chikitsa was initiated to work on the Dhatu level. Rasayana Churna, as portrayed by Acharya Vaghbhatta, predicts that someone will live with black hair for 100 years.[9],[10]

In addition to that, Saptamrita Lauha advertises Kesha by Dhatu Vardhana Karma. For local treatment, Aamalki, Yastimadhu, Bhringraj Churn for Shirolepa, and Karanja Taila for Darunaka (dandruff). According to Acharya Sharangdhara, Karanja Taila, when administered as Shirobhyanga, will quickly treat Indralupta.[11] Laghumalini Vasant, Godanti Bhasm, Gudvel Satwa, Sitopaladi Churn, useful for Jirnjwar, and Dhatuvardhan, Bhringraj Ghan Vati, useful for Keshvardhan and Kesharanjanarth, Aarogyavardhini Vati and Raktpachak Churn act as hepatoprotective and blood purifiers. As the best Chikitsa for Rakta Dushti, Jalaukavacharan Karma was chosen as the Raktamokshana.[6]

Conclusion

Alopecia areata (Indralupta) is a difficult, complex condition with a poor prognosis. Ayurveda has its own principles for the diagnosis and treatment of diseases. In Ayurveda, treatment changes from individual to individual even though their disease is the same. Ayurveda treats every disease, considering diseases such as Prakriti, Desha, Kala, Avastha, and Bala. Nidanparivarjan, following Dincharya and Ritucharya as described in Ayurveda, is very essential to getting rid of any disease. Indralupta is considered Tridoshaj, but Vata Pitta is more predominant. In this case, we have given Aampachak Vati, Raktapachak Churna, Rasayan Churna and Aarogyavardhini Vati to this patient. As there was a previous history of enteric fever, we have given Laghumalini Vasant, Guduchil Satwa. Leech therapy was given with a 15-day regular interval; in this case, we observed a significant result within 3 months.

References

1. Misar S. Management of Khalitya (Hairfall) by Ayurvedic formulations - A Review. AyurPub. 2019;2(5):675-680. Available from: https://ayurpub.com


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2. Khopkar U. Skin diseases and Sexually Transmitted Infections, 7th Edition, Reprint 2019, Chapter 16, Page 187.

3. Kolalapudi S. Alopecia areata: An update. Indian Journal of Dermatology, Venereology, and Leprology. 2013 Sep-Oct;79(5).

4. Murthy KR. Astang Samgrah, Chaukhambha Orientalia, Varanasi. 2nd edition; 2000. Uttarsthan, Adhyay 27, Page 242.

5. Gawai V. An Ayurvedic Management of Alopecia Areata (Indralupta) In Children: A Case study. European Journal of Pharmaceutical and Medical Research. 2021;8(9):657-659.

6. Kirti K. A Conceptual study of Jalaukavacharana. World Journal of Pharmaceutical and Medical Research. 2022;8(5):123-125.

7. King BA. Defining severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework. Published online 2022 Mar 31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021348/

8. Motwani M. Ayurvedic Management of Indralupta (Alopecia Areata) with Raktamokshana (Pracchana Vidhi) and Shirolepa. Int J AYUSH Case Reports. April-June 2023;7(2).

9. Tripathi B. Ashtanga Hridaya Uttara Tantra 39/159, Choukhambha Surbharati Prakashan, Varanasi: 2017, p-1202.

10. Das G. Bhaishajya Ratnavali, Pandurogadhikara 12/125, Choukhambha Surbharati Prakashan, Varanasi: 2017, p-386.

11. Tripathi B. Sharangdhara Samhita Madhyam Khanda 9/156, Choukhambha Surbharati Prakashan, Varanasi: 2019, p-158.


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