A Study Effect of Shodhana and Shamana Chikitsa in Mukhadushika (Acne Vulgaris) A Case Study Case Study

Acne vulgaris is a chronic disease that occurs in young adults when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by both inflammatory (papules, pustules and nodules) and non-inflammatory (Comedones, open and closed) lesions.In Ayurvedic classics, in the context of Kshudra Rogas , it is mentioned that Mukhadushika occurs in yuvavastha and its signs and symptoms are similar to that of Acne vulgaris. It is due to vitiation of Vata, Kapha and Rakta having the Shalmali thorn like thick or hard painful eruptions which are impregnated with Meda . We hereby report a case of acne vulgaris which was treated under an allopathic physician with oral and topical antibiotics and found no relief so she came to Panchakarma OPD at Ch. Brahm Prakash Ayurved Charak Sansthan. According to chronicity and severity of disease, Shodhana Chikitsa and Shamana chikitsa was given. Vamana and Virechana karma ( Shodhana Chikitsa ) along with the topical application of lodhradi lepa and internal administration of Brihat Manjisthadi Kwath ( Shamana Chikits a) was administered for a period of 1month. Substantial clinical improvement was observed. During treatment, all the signs and symptoms of the patient were reduced.


Introduction
Acne vulgaris is one of the most common dermatologic condition that affects nearly everyone at some point in their lifetime. Once thought as a condition only affecting teenagers, prevalence in adulthood has been increasing, especially in women 25 years of age and older (1).It appears earlier in girls, but more boys are affected during the adolescence years; the average age for the onset of acne is 11 years in girls, affecting up to 82%, and 12 years in boys, affecting up to 95%. Recently, there has been a rise in the appearance of acne in those as young as 8 or 9 years of age. This increase at such a young age has been attributed to the decreasing age of puberty onset (2).It is characterized by the presence of lesions most commonly on the face, neck, chest, or back. Itoccurs when pores become blocked with Sebum which is made by the sebaceous glands that helps keep hair and skin moisturized. Hormone changes during the teenage cause the body to make more of this oily substance (sebum), thus are clogging the follicles. Bacteria can get inside the follicle or oil gland and cause redness, swelling, and pus. In A yurveda, it is described under the Mukhadushika which is a type of Kshudra Roga. It is due to vitiation of Kapha,V ata and Rakta having Shalmali thorn like eruptions on face(3). In Ayurveda, mainly two types of Chikitsa (treatments) have been used to treat Mukhadushika i.e. Shodhana (purification of body) and Shamana (conservative treatment by oral and topical medicines). In this case study, management of Mukhadushika (Acne vulgaris) has been elaborated with both Shodhana and Shamana Chikitsa.

History of Present Illness
The patient was asymptomatic 3 years back, since then she has been suffering from multiple papules, pustules with pain, itching and discharge.

Treatment history
Patient took allopathic medicines (topical and oral) for these Complaints but could not found significant relief. (4) and Lodhradi Lepa (5) Medicine for Vamana:

Procedure of Lepa Application
The patient was advised to apply Lepa once in a day. It was conducted in three steps, viz-

Poorva karma
The Patient was asked to wash the face with normal water prior to application of Lepa.

Pradhana karma
Required Quantity of Lodhradi churna was taken and normal water added in sufficient amount to convert the churna in Lepa form.
The patient was advised to apply Lepa in pratiloma gati all over the face.
The Lepa was applied with a uniform thickness of one fourth of patient's own thumb width (about 1/4 th of an inch).
Lepa was applied in morning / for at least 30min or until it dried.

Pashchat karma
After the drying up of the Lepa, the patient was asked to wash the face with normal water.
Patient was advised not to expose to sun during the period of treatment.

Discussion
The disease Mukhadushika is described under the head of Kshudra Roga, but it is one of the major cosmetic related problem of younger age group leading to maximum extent of Psycho-social trauma and lack of confidence regarding their personality and appearance as well. In present case study, patient got complete relief from signs and symptoms of Mukhadushika (acne vulgaris). V amana and V irechana (Shodhana Chikitsa) showed good results along with Shamana Chikitsa. It is the prime treatment of Mukhadushika as told by Acharya Shushrut ((9), and Vagbhatta (10). It helps in elimination of kapha from the body and Samprapti V ighatana of Mukhadushika. Virechana Karma is indicated specially to subsides Pitta Dosha or Pitta Sansargaja Dosha. The purgative drugs expel the excess Pitta from the Guda marga. Property of Rakta is analogous to Pitta Dosha, therefore, V irechana is also effective in Raktaja Vikara. In Ayurvedic texts Acharya Charaka has explained Virechana, as treatment modality in Raktaja and Pittaja Vikara (11).

Probable Mode of Action of Lodhradi Lepa
Lodhradi Lepa was selected for external application. It is described in Sharangdhara Samhita. It contains 3 drugs namely Lodhra, V acha and Dhanyaka. All the drugs except Lodhra are ushna veerya so they are V ata kapha shamaka and sheeta veerya of lodhra pacifies the dushita Rakta. V acha has lekhana property so it helps in Subsiding Medogarbha pidika. Thus, the combination of drugs helps in reversing the pathogenesis of Mukhadushika (Acne Vulgaris).

Probable Mode of action of Brihat Manjisthadi Kwath
The

Conclusion
Mukhadushika is a Kapha-Vata-Rakta Pradhana Vyadhi which has clinical features similar to Acne vulgaris. V amana andV irechana as shodhana chikitsa and Lodhradi lepa, brihat manjisthadi kwath as shamana chikitsa, when given together prove quite effective in managing the patients of Mukhadushika. It can be concluded that the patients of Mukhadushika can be managed effectively by A yurveda without any fear of side effects.