“A CLINICAL STUDY OF VACHADI LEPA IN YOUVANA PIDAKA”

Introduction:

A search through the history of mankind reveals an important factor in the form of ‘beauty’ for which many battles were held. It is the natural instinct of mankind to possess every thing that is beautiful. Many stories of mythological origin depict the involvement of beautiful women in history. It is quite natural that human instinct of looking more and more beautiful lead to innumerable inventions, which form the base for modern cosmetology. Cosmetics are designed to beautify skin, hair or to improve complexion or to modify the overall appearance and presentation. The correction of deformities or treatments described for ‘Savarnikarana’ etc. can be included in it.

Ayurveda the science of life has its significant contribution in this regard. In the descriptions of ‘Dinacharya’ and ‘Ritucharya’ of Swasthavritta descriptions can be found for protecting one’s beauty from the day to day stress impacts and seasonal effects on the body. Abyanga; Udvartana; snana; Anulepana (3); are some of the procedures explained in the context of protection from skin disorders and for improving texture and complexion.

The disease ‘Youvana pidaka’ is aptly named ‘Mukhadooshika’ as it results in disfigurement of face. The disease produces swellings on the face that resemble like the thorns of the Shalmali (Bombax malabaricum DC) tree (1). They have the predominance of Kapha, Vata and Rakta and occur in adolescence age. The lesions will be filled with meda (fat) according to Vagbhata (2). The disease can be compared with the Acne vulgaris of the present medical literature.

Present treatment options like topical therapies; antimicrobials, hormones, surgery, U-V Irradiations; Intra lesions injections etc. have their own limitations. Ayurvedic management includes periodical Shodhana and lepa for curative and preventive aspect. Acharya Sushruta, Vagbhata have mentioned ’Vachadi lepa’ as one such preparation which will significantly cure this malady.

Hence the study effect of Vachadi lepa on Youvana pidaka is planned for trial.

Aims and objectives

1. To study the effect of Vachadi Lepa in relieving symptoms of Youvana pidaka.

2. To observe the extent of problem of Youvana pidaka in reporting at the skin OPD and IPD of SDM College of Ayurveda and Hospital Hassan.

Materials and methods

Study Design

This is an experimental study with pretest and post test design. 40 patients of Youvana pidaka were randomly selected for the study from the skin OPD of S.D.M. college of Ayurveda and hospital, Hassan based on the inclusion and exclusion criteria.

Inclusion criteria

Ø Patients complaining of Pidaka over the face with history of more than one year.

Ø Patients between the age group of 17 and 30 years.

Exclusion criteria

Ø Patients having Pidaka of other Kshudra Roga and Kusta.

Ø Patients who are not able to follow the prescribed treatment.

Ø Patients having Pidaka on places other than face.

Assessment Criteria

Assessment of the patients was done based on the relief in the symptomatic parameters. The symptoms and the grading are as follows.

Oiliness of the face

Normal skin	-	0
Requires face washing once in 3-4 hours	-	1
Requires face washing once in 1-2 hours	-	2
Feels oily even after face wash	-	3

Size of the Pidaka

No Pidaka	-	0
Less than 5 mm	-	1
In between 5 to 10 mm	-	2
More than 10 mm	-	3

Number of scars

No Scars	-	0
Less than 10 on one side	-	1
In between 11 to 30 on one side	-	2
More than 30 on one side	-	3

Vedana

No tenderness	-	0
Pain on deep pressure over the Pidaka	-	1
Pain on touch	-	2
Pain without touch	-	3

Number of pidaka

No Pidaka	-	0
Less than 10 on one side	-	1
In between 11 to 30 on one side	-	2
More than 30 on one side	-	3

The patients thus selected were divided into two groups of 20 patients each. Group A (experimental group) patients were given Vachadi lepa for external application and group B (control group) patients were given placebo tablets twice daily.

Materials Required for the Study

1. Vachadi Lepa

2. Placebo capsules, filled with 500mg of starch powder

3. Tissue paper, to assess the Snigdhata (oiliness) of skin

4. Scale, to measure the size of Pidaka

Vachadi lepa

Drugs: - (6)

1. Rhizome of vacha (Acorus calamus Linn.)

2. Bark of Lodhra (Symplocus racemosa Roxb.)

3. Sarshapa Beeja (Brassica nigra Linn.)

4. Saindava Lavana

Method of preparation of Lepa

The above mentioned drugs are powdered individually in a khalvayantra to get fine powder. Equal quantities of powders of individual drugs are taken in a vessel and mixed with normal water to make them into a lepa or paste form. This lepa is applied over the face.

Method of application of Lepa:

It is having three steps:

Poorva karma:

The patient was asked to wash the face with normal water prior to application of lepa.

Pradhana Karma:

Required quantity of choorna was taken and normal water was added in sufficient amount to convert the choorna in to Lepa form.

The patients were advised to apply Lepa in the opposite direction to hair roots, all over the face. (5)

The Lepa was applied with a uniform thickness of one fourth of once own thumb width (about 1/4th of an inch).(5)

Lepa was applied in morning (between 7 and 10 am) and it should be applied over the face for at least forty five minutes to one hour or until lepa gets dried up).

Paschat Karma:

After the drying up of the lepa, the patients were asked to wash the face with normal water and were advised to follow Pathya.

Follow-up

Patients of both the groups were asked to visit once in a week for the 15 days of treatment and for the next 30 days to assess the parameters.

OBSERVATIONS AND RESULTS

A total of 40 patients were selected for the study. Among them majority of the patients were from the age groups 20-22 (45%) followed by the age groups 17-19 (30%) (Table: 1). Female patients were 70% and male patients were 30%. (Table: 2). Among the total number of patients, 29 (72.50%) were having oily skin. (Table: 3) and the most predominant dosha in most of the patient is kapha 22 (55%).

Table 1: Showing distribution of patients according to Age

Age in years	Total No. of Patients	Total %
17 – 19	12	30.00
20 – 22	18	45.00
23 – 25	04	10.00
26 – 28	03	07.50
29 and above	03	07.50
Total	40	100

Table 2: Showing distribution of patients based on Sex

Sex	Group A	%	Group B	%	Total No. Of Patients	Total %
Male	04	20	08	40	12	30
Female	16	80	12	60	28	70
Total	20		20		40

Table 3: Table showing the distribution of patients based on the skin type

Skin type	Group A	%	Group B	%	Total No. Of Patients	Total %
Normal	01	05	06	30	05	17.50
Rooksha (Dry)	02	10	02	10	06	10.00
Snighda (Oily)	17	85	12	60	29	72.50
Total	20		20		40

Table 4: Showing distribution of patients based on Dosha

*Dosha*	Group A	%	Group B	%	Total No. Of Patients	Total %
Vata	02	10	08	40	10	25.00
Pitta	06	30	02	10	08	20.00
Kapha	12	60	10	50	22	55.00
Total	20		20		40

Results:

Table 5: Showing distribution of results of group-A

Value name	Skin type	Size of Pidaka	No. of Scar	*Vedhana*	No. of Pidaka
BTM	1.733	1.266	1.333	0.866	1.400
ATM	0.800	0.600	1.000	0.060	0.600
DM	0.933	0.466	0.333	0.806	0.800
% of improvement	53.75	43.39	15.38	93.02	57.14
SD	0.249	0.490	0.471	0.400	0.541
SE	0.060	0.120	0.211	0.103	0.139
t - value	15.65	3.833	1.572	7.802	5.75
p - value	< 0.001	< 0.001	> 0.100	< 0.001	< 0.001

BTM = Before treatment mean ATM = After treatment mean

DM = Difference of mean SD = Standard deviation SE = Standard error

Table 6: Showing distribution of results of group-B

Value name	Skin type	Size of Pidaka	No. of Scar	*Vedhana*	No. of Pidaka
BTM	1.133	1.266	1.400	0.533	1.666
ATM	0.666	1.200	1.333	0.400	1.600
DM	0.466	0.066	0.067	0.133	0.067
% of improvement	41.50	04.76	05.00	24.52	03.61
SD	0.489	0.257	0.249	0.339	0.249
SE	0.128	0.060	0.065	0.113	0.065
t - value	3.622	1.00	1.015	1.173	1.015
p - value	< 0.005	> 0.30	> 0.30	> 0.20	> 0.30

DISCUSSION ON RESULTS

Youvana pidaka is a most common disorder in the adolescent age because of the improper management of hygiene. This causes disfiguration of the body especially on the face. This proves to be a major cosmetic problem. This can be compared with the disease Acne vulgaris of the present medical literature.

In the present study conducted on 40 patients to know the efficacy of the Vachadi lepa it has been observed that the drug has shown statistically significant results in the management of Youvana pidaka. It was useful especially for the patients having the predominance of kapha and vata dosha. This is because of the ushna veerya of the drugs used in the formulation. The drugs used have the properties of vedana stahapana, shotha hara, vrana ropana and shodhana which help as cleansing, anti-microbial and anti-inflammatory agents.

In the pitta dosha predominant cases it was observed that the application of the lepa caused mild irritation indicating the pitta prakopa gunas of the drugs. So the drug is to be used with caution in pitta prakruti patients.

CONCLUSION

Overall effect of the Vachadi lepa proved to be significant in the management of the Youvana pidaka when compared to the results of the placebo drug.

Further research on large number of patients with this formulation is needed to prove the positive results of the formulation in the cases of Youvana pidaka.

References

1. Kaviraj Ambhikadutta Shastri. Sushruta’s Sushruta sahmita, nidana stana translation. Varanasi; Chaukambha Sanskrit Sanstana; 287.

2. Srikantamurthy KR. Vagbhata’s Astanga Hrudaya, uttara stana 31/5, Vol-III Translation. Varanasi, Krishnadas academy; 1995, 291

3. Raja Radhakanta Deva. Shabda kalpa druma, part IV. Nag Publishers; p68

4. Kaviraj Ambhikadutta Shastri. Sushruta’s Sushruta sahmita, Sutra stana translation. Varanasi; Chaukambha Sanskrit Sanstana; 74-75.

5. Kaviraj Ambhikadutta Shastri. Sushruta’s Sushruta sahmita, Cikitsa stana translation. Varanasi; Chaukambha Sanskrit Sanstana; 95.

Figure 2:		Figure 3:

Before Treatment		After Treatment
Figure 4:

During Treatment
Figure 5:		Figure 6:

Before Treatment		After Treatment