By Dr. Imlikumba
Acne is chronic inflammatory disease of the pilosebaceous glands present in the skin of the face .This disease is characterised by the formation of comedowns (blackheads), erythematous papules, and in a few cases, nodules or cyst and scarring. There are four major factors involved in the disease production viz, increased sebum production, cornification of pilosebaceous ducts, microbial involvement and production of inflammation .This condition is found commonly in puberty. In Ayurveda, this disease is described as “Mukhdushika‟‟or „Yuwan pidika”. Acne is a common chronic inflammatory condition of skin with significant cutaneous and psychological disease burden. Though, acne is not a life-threatening condition, the complications of acne such as permanent scarring effects on the quality of life and emotional well-being of person. Acne affects both males and females, although males tend to have more with onset of puberty. Acne vulgaris is a chronic inflammatory condition of skin in youth. In Ayurveda, acne has been elaborated as one of the Kshudra Rogas (minor ailments). Acne is called as Yuvanpidika and Tarunyapitika as it manifested in Yuva or Taruna (adolescence). As the disease has local spread over the face and due to the inflammatory and scarring nature of lesions, acne is also called as Mukhadushika. Yuvanpidika or Tarunyapitika or Mukhadushikais characterized by Saruja (mildly painful), Ghan (firm on touch), Medogarbha (filled with oil/sebum) and shape of Shalmali Kantaka (thorn of Salmalia malabarica). Several factors such as disturbed hormonal (androgen) production, excess sebum production, hyperkeratinization are involved in pathophysiology of acne. Accumulation of excess sebum, epithelial cells and keratin obstruct the pilosebaceous follicle.
- Ahara(Food)- Oily, Spicy, Fatty, Fast Food, Cold Drinks causes the disturbance of Tridoshas.
- Vihara(Regims)- Atapsevan(Sun Exposure), Diwaswapna(Day sleep), exertion immediately after meal.
- Kala-The Vata and Kapha are vitiated by sheet Guna of climate and Ushana Kala vitiated Rakta Dhatu.
- Vaya- Mostly occurs in Tarunya or Yuwa Avastha.
- Mansik Nidan- Krodh, Chinta causes Pitta Prkopa, Vata Vridhi.
- Antahstravi granthis – Endocrinal factor increased production of sex hormones. The sebaceous gland hyperactive androgen and progesterone are responsible for hyperplasia of oil glands.
PURVA-ROOPA (PREMONITORY SYMPTOMS/SIGNS) Yuwan Pidia‟s Poorva– Roopa are not specifically mentioned by any Granthakara. it may be as followed
- Kandu (itching)
- Vedna (pain)
- Shotha (swelling)
- Vaivarnya (skin discoloration)
ROOPA (SIGNS AND SYMPTOMS)-The following are clinically manifestations of Yuwanpidika
- Ruja (pain)
- Kandu (itching)
- Strava (discharge)
- Ghan (dense) and morphologically similar to Shalmali Kantaka (thorn of pigmentation).
- Pain (Vedana)
- Itching (Kandu)
- Swelling (localized Shotha)
- Skin discoloration (Vaivarnya)
- Acne (Pidika)
MANAGEMENT OF YUWAN PIDIKA- In Ayurvedic text mainly two types of Chikitsa are described so following therapies are to be advised for the disease as
- Shodhan therapy- Vaman, Virechan, Nasya, Rakta Mokshna etc.
- Vaman Karma (Emesis)- It is the best procedure to subside the Kaphaja abnormalities i.e Yuwanpidika.
- Virechana Karma (Purgation)- This therapy is indicated specially to subside Yuwanpidika. The purgative drugs expel the excess Pitta from the Guda Marga (anal route). Ayurvedic texts has explained Upvasa (fasting) , Virechana (Purgation), and Raktastrava(Blood-letting) as treatment modalities in Raktaja and Pittaja Vikara.
- Nasya Karma (Nasal Therapy) – Acharya Vagbhatta has also described this process in Mukhdushika.
- Shiravedha (Blood-Letting)- Raktamokhsana by Shirovedha is described in Mukhdushika.
- Shaman therapy- Internal medicine and external applications of drugs. For Shaman therapy many herbo minerals compounds are being advocated either as internal or external medication. Single or in compound. Formulations (Aushadh Yoga) as described may be summarised.
- Vati (Tablets)- Arogyavardhini Vati, Keshor Guggulu, Panchatiktaha Ghrut Guggulu, Amrita guggulu, Sarivadi Vati, Khadiradi Vati.
- Kwatha (Decoction)- Maha Manjisthadi Kwatha, Khadirashtak Kashaya, Patoladi Kwatha, Khadira Kwatha,Gudduchyadi KwathaAsavaAristha- Sarivadhyasava, Khadiraristha, Madhvasav, Manjisthadhyaristha.
- Churna (powder)-Aamalki churna, Manjistha churna, Panchnimbadi churn, Triphla churna, Giloya churna.
- Ghrita (medicated ghee)- Mahatikkta Ghruta, Panchatiktaka Ghruta, Tiktashatpala Ghruta, Triphla Ghruta.
- Rasa Aushdhi- Rasamanikya, Gandhak Rasayana.
- Bhasma- Praval Bhasma, Swarna Makshik Bhasma.
- Hot (Ushna), Spicy, Oily, Fried and Pungent Food, Junk Food, Fast Food and Outside Food.
- Virudha Ahara- Food that is incompatible to each other such as Milk with Fish Etc.
- Food items with Tikta Rasa (Bitter taste) like Patola, Giloya, Methika etc.
- Fresh green and leafy vegetables.
- Enough water intake (specially Luke warm water).
- Mental relaxation techniques like meditation and Yoga.
- Single Herbs- Lodhra (Symplocos racemosa), Manjistha (Rubiya cordifoliya), Usheer (Vetiveria zizaniodes), Padmakha (Prunus cerasoides), Haridra (Curcuma longa), Chandana (Santalum album), Sarsapa (Brassica campastris), Anantmula (Hemidesmus indicus).
YOGA AND MEDITATION- Yoga Therapy suggest Pranayama, Asana, Shatkarma, and Meditation. Stress, Increased toxin content, Disruption in bowel movements is some of the reasons for acne.
- Asanas- Bhujangasana, Matsyasana, Halasana, Sarvangasana, Trikonasana, and Balasan help increase blood circulation to the head and face area.
- Yoga Mudras- Varun Mudra/JalVardhak Mudra, Prithvi Mudra.
- Kapalabhat Pranayama on empty stomach. Antaranga and Bahiranga Kumbhaka and Mahabandha (Jalandhara, Uddiyana and Moola) may be integrated into the Pranayama practice. For persons, who usually gets more problematic in summer, especially with oily skin cooling Pranayamas, such as Sheetali and Sheetkari, can help proving effect to the skin and retain its glow.
- Shatkarma- Neti, Kunjal and Laghoo Shankhaprakshalana.
- Meditation- Meditate twice a day, every day. The more you do, the more you will radiate from within and then out.
CONCLUSION: In current era Yuwanpidika is the one of the most burning problem in youngsters. Modern text described Acne vulgaris as a chronic inflammatory disorder of sebaceous follicles characterized by the formation of comedone, papules and pustules, less frequently nodules or cysts. In Ayurveda number of remedies are available with marked success and benefit over conventional modern drugs. The Lepa and Pralapa are described as a Shamana Chikitsa in previous stages of Mukhadushika while in severe cases Shodhana Chikitsa should be applied. Moreover the Ayurvedic therapies have long lasting affects with nil side effects.
NOTE: Ayurvedic medicines and treatments should be taken under Qualified Ayurvedic Doctor/Physician. contact 9483328411. The drugs described in this article are for general information/educational purpose only. Anyone should not use these without consulting a qualified Ayurveda doctor/physician.
(Dr Imlikumba is a registered ayurveda practioner working as a Medical Officer(Ayur) in Bokajan Civil Hospital and the Chief Consultant of Health Naturally Clinic Kevijau Colony Dimapur. He can be contacted at firstname.lastname@example.org)