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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 21-28

Comparative study of Lodhradi Lepa with and without Arogyavardhini Vati in the management of Yuvanpidika


1 Department of Kayachikitsa, ASPM Ayurved Medical College, Buldhana, India
2 Department of Swasthavritta, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission29-Mar-2020
Date of Decision23-Apr-2020
Date of Acceptance04-May-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Sadhana D Misar Wajpeyi
Department of Swasthavritta, Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_20_20

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  Abstract 

Background: Yuvanpidika can be correlated with acne vulgaris of modern medicine due to the resemblance of symptoms. It is not a serious health problem, but it affects the social and emotional health of an individual. It is self-limiting but requires treatment to avoid scarring and relapse. Aim and Objectives: This comparative research was carried out with the aim to evaluate the efficacy of Lodhradi Lepa with and without Arogyavardhini Vati in the management of Yuvanpidika. Materials and Methods: A total of 30 patients between the ages of 16 and 36 years of both sexes with typical symptoms of Yuvanpidika were selected from Kayachikitsa outpatient department. They were divided equally into two groups by lottery method. Lodhradi Lepa was topically applied with rose water to patients in Group A twice daily, whereas Group B was given Arogyavardhini Vati (500mg) twice a day along with Lodhradi Lepa for 30 days. Pain, itching, burning sensation, swelling, redness, and the number of papules were assessed before and after treatment in both groups. Results: In this study, moderate, mild, and poor improvements were observed in five (33.33%), two (13.33%), and eight (53.33%) patients of Group A, respectively, whereas in Group B, moderate, mild, and poor improvements were observed in eight (53.33%), four (26.66%), and three (20%) patients, respectively. Marked improvement and complete remission were not observed in this study. This might be due to a short duration of treatment. Conclusion: This study proved that the use of Lodhradi Lepa and Arogyavardhini Vati is effective in the treatment of Yuvanpidika. But combined treatment is more beneficial and combination of various protocols and formulations need to be adopted for better results.

Keywords: Acne, Arogyavardhini Vati, Lodhradi Lepa, Mukhadushika, Yuvanpidika


How to cite this article:
Ambhore KP, Misar Wajpeyi SD. Comparative study of Lodhradi Lepa with and without Arogyavardhini Vati in the management of Yuvanpidika. J Indian Sys Medicine 2020;8:21-8

How to cite this URL:
Ambhore KP, Misar Wajpeyi SD. Comparative study of Lodhradi Lepa with and without Arogyavardhini Vati in the management of Yuvanpidika. J Indian Sys Medicine [serial online] 2020 [cited 2020 Aug 14];8:21-8. Available from: http://www.joinsysmed.com/text.asp?2020/8/1/21/288806




  Introduction Top


Minor skin diseases are described in all classics of Ayurveda such as Brihatrayi and Laghutrayi. Acharya Sushruta was the first who explained Yuvanpidika under the heading of minor skin diseases.[1]Mukhadushika (acne vulgaris) by the name indicates that it is the disease affecting the face and Yuvanpidika (acne vulgaris) explains its onset during the period of young age.[2]

No specific causative factors are mentioned in Samhita for Yuvanpidika. Due to aggravation of Kapha, Vata, and Rakta,[3] papules resembling the sprouts on the bark of Shalmali tree (Salmalia malabarica) appearing on the face of adolescents are known as Yuvanpidika, which make the face ugly.[4] Excessive pungent, sweet, heavy, unctuous diet, consumption of alcohol, suppression of natural urges, exposure to heat, anger, grief, and stress can lead to vitiation and imbalance of Doshas. Yuvanpidika can be compared with acne vulgaris of modern medicine due to the resemblance of symptoms. Chronic inflammation of the pilosebaceous glands present in the skin is called acne vulgaris. Acne is a common dermatological disorder mainly manifested with “seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules), and possibly scarring.”[5] Acne vulgaris mainly affects the facial region, the upper chest, back, and the shoulders.[6]

Previous studies on Acne suggested prevalence of 50.6% in boys and 38.13% in girls between age group of 12 to 17 years in India.[7],[8] Acne is not a serious health problem, but complications of it like everlasting scars on the social and emotional health of an individual.[9],[10]

Acne is chronic in nature and, although it is self-limiting, it requires treatment to avoid scarring and relapse.

In Ayurveda, elimination therapy, and oral and topical medicines are described to treat acne. Internal drugs and topically various local drugs, poultice, and alkaline/caustic applications are used in the management of Yuvanpidika.[11],[12],[13]

In Ayurveda, various Lepas for external use and herbomineral formulations are described for skin disorders. This comparative research was carried out with the aim to evaluate the efficacy of Lodhradi Lepa described in Bhavprakash[14] with and without Arogyavardhini Vati mentioned in Rasaratna Samuchchaya[15] in the management of Yuvanpidika.


  Materials and Methods Top


Study Design

This was an open randomized clinical comparative study.

The research commenced after taking approval from the “Institutional Ethical Committee” (reference no. DMIMS (DU)/IEC/2014–15/1252) on March 31, 2015.

Sources of Material

  1. Clinical source: The subjects were recruited randomly from Kayachikitsa outpatient department of Mahatma Gandhi Ayurved College, Hospital and Research Centre (MGACH & RC), Salod (H), Wardha, Maharashtra.


  2. Pharmaceutical source: Lodhradi Lepa was prepared in the Dattatreya Pharmacy affiliated with MGACH & RC. The raw materials were procured from reliable sources. Arogyavardhini Vati was purchased from Dhutapapeshwar Pharmaceuticals at Panvel, Maharashtra, India.


Inclusion Criteria

The inclusion criteria of the study included the following:

  1. Patients having more than five papules on the face were selected for the study.


  2. Subjects of both sexes with the age group of 16–36 years.


  3. Chronicity less than 5 years.


Exclusion Criteria

The exclusion criteria of the study included the following:

  1. Subjects on antitubercular drug therapy.


  2. Subjects having acne fulminans, folliculitis, acne conglobata, seborrheic dermatitis, sebaceous hyperplasia, tropical acne, tuberous sclerosis, keratosis pilaris, chloracne, rosacea, acne keloidalis nuchae, and other long-term diseases or noninfectious diseases (diabetes mellitus, hyperlipidemia, and cancer).


Investigations

Complete blood count and erythrocyte sedimentation rate (ESR) were carried out to exclude other systemic diseases.

Follow-up

Follow-up was taken on day 15 and day 30 after completion of treatment.

Methodology

In this pilot study, a total of 30 patients were selected randomly with the lottery method irrespective of gender, caste, and occupation. Consent was taken from each patient before contributing to the research study. Fifteen patients were included in each group (Group A and Group B) as per the inclusion criteria by the lottery method. In total, 30 patients were screened and all had completed the treatment with no dropouts.

Treatments given to both the groups are shown in [Table 1].
Table 1: Intervention in both groups

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Grouping

The patients enrolled in the study were grouped in two and were administered with following medications as described in [Table 1].

Arogyavardhini Vati[18] was purchased with permission from Dhutapapeshwar Pharmaceuticals. The ingredients used in trial drug are described in [Table 2].
Table 2: Ingredients of Lodhradi Lepa

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Application of Lodhradi Lepa Method

Lepa was applied as per the guidelines mentioned in Sharangdhara Samhita Uttarkhanda.[19] First, it was advised to clean the face appropriately. Then Lodhradi Lepa was prepared by mixing all fine-powdered ingredients mentioned in [Table 2] with a sufficient quantity of rose water and topically applied on the affected area (mainly on cheeks, forehead, nose, and chin). It was advised to apply it against the hair follicular direction to facilitate quicker and better absorption with thickness of ¼ angul (0.48cm). It was advised to remove soon after it dried which approximately takes 15–20min. After that, it was advised to wash the face properly with plain water.[20]

Diagnostic and Assessment Criteria

Diagnostic criteria like papules, pain, swelling, burning sensation, itching and redness are considered.

Overall Improvement of Patients

  1. Complete remission: 100% reduction in the assessment criteria.


  2. Marked improvement: 75% to less than 100% reduction in the assessment criteria.


  3. Moderate improvement: 50% to less than 75% reduction in the assessment criteria.


  4. Mild improvement: 25% to less than 50% reduction in the assessment criteria.


  5. Poor improvement: 0% to less than 25% reduction in the assessment criteria was considered unchanged.



  Observations and Result Top


Student’s paired t test and unpaired t test were used for statistical analysis. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) software program, version 17.0 and GraphPad Prism, version 6.0; GraphPad Software, La Jolla, CA, USA. A value of P < 0.05 was considered statistically significant.


  Discussion Top


In this study, majority of patients (83.33%) were between the age group of 16 and 25 years. Acharya Charak has mentioned this age group as an unstable and progressive stage of Dhatu (bodily tissue). So, in this stage, imbalance status of Dhatu causes the production of excessive Mala (excretory) part, which results in excessive oil on face and manifestation of papules as Mala of Shukra (semen).[21]

Modern science considered hormonal imbalance, specifically of androgen, as one of the important causative factors, which in turn stimulates the sebaceous glands to produced excess sebum.[22] In this study, the number of females (67%) was higher than males. In the literature, it is mentioned that Yuvanpidika is more common and severe in males than in females due to androgenic activity.[23]

Statistical analysis as per gradation of subjective parameters [Table 3] and objective parameters [Table 4] was carried out after completion of treatment, which showed a significant improvement in pain [Table 5], itching [Table 6], burning sensation [Table 7], number of papules [Table 8], swelling [Table 9], and redness [Table 10]. Better improvement was seen in Group B treated by Lodhradi Lepa[24] with Arogyavardhini Vati[25] as compared with Group A [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17] and [Table 18] treated with only topical application of Lodhradi Lepa. This might be due to the internal action of Arogyavardhini Vati in balancing vitiated Doshas and Rakta Dhatu (blood tissue). Comparison of CBC and ESR showed no any significant change after treatment in both groups as shown in [Table 19].
Table 3: Gradation of subjective parameters

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,
Table 4: Gradation of objective parameters: number of papules

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,
Table 5: Comparison of pain in both the groups with 0th day (baseline)

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,
Table 6: Comparison of Kandu (itching) in both the groups with 0th day (baseline)

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,
Table 7: Comparison of burning sensation in Groups A and B with 0th day (baseline)

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Table 8: Comparison of number of papules in both the groups with 0th day (baseline)

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,
Table 9: Comparison of swelling in the groups with 0th day (baseline)

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Table 10: Comparison of redness in both the groups with 0th day (baseline)

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,
Table 11: Comparison of pain in both the groups

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Table 12: Comparison of itching in Groups A and B

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Table 13: Comparison of burning sensation in Groups A and B

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Table 14: Comparison of number of papules in both the groups

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Table 15: Symptom wise distribution of 30 patients of Yuvanpidika

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Table 16: Effects on symptoms in Group A

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Table 17: Effect on symptoms in Group B

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,
Table 18: Overall effect of therapy in both groups

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Table 19: Comparison of CBC parameters in two groups

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Ranasinghe et al.25 conducted a comparative clinical study on the effect of Lodhradi Lepa on Mukhadushika (acne vulgaris), in which they treated one group with Lodhradi Lepa and the other with placebo for 35 days and observed that 96.3% of the patients reported complete or partial relief from symptoms. They stated that the ingredients of Lodhradi Lepa are rich in flavonoids and tannins. It has been proved that flavonoids possess good antioxidant properties. Antioxidants help in the protection of the skin from the oxidative damage. Tannins promote the healing process by increasing capillary formation. They stated that Lodhradi Lepa containing Lodhra, Dhanyak, and Vacha causes alleviation of Kapha and Pitta, reduction of burning, enhancement of skin complexion, and healing of wound.[26] Another study conducted by Kathait et al.27 stated that ingredients of Lodhradi Lepa are having anti-inflammatory, analgesic, and antibacterial actions. Due to the anti-inflammatory action, it helps in reducing local features of inflammation such as pain, swelling, and redness.

Probable Mode of Action of Lodhradi Lepa

Lodhra has Kapha Pitta alleviating, antidermatitis, wound healing, astringent, and drying properties. The cold potency of Lodhra helps in the alleviation of the aggravated Rakta and Pitta.[28] It is a drug having cold potency, so it relieves the Pittaj symptoms such as burning sensation, suppuration, and redness. Its wound healing property promotes healing and fast recovery. Acharya Sushruta mentioned the complexion-enhancing property of Lodhra.

Vacha has Kapha and Vata alleviating, scraping, subtle (fineness), and sweat induction properties.[29] Due to these properties, it penetrates into deep micropores and causes scraping of accumulated sebum inside and opens the blocked pores. Thus, it eventually helps in reducing the number of acne. It has analgesic and anti-inflammatory properties that help in reducing pain, swelling, and redness. Modern pharmaceutical studies have also identified the hyperemic, antibacterial, analgesic, antisecretory, and antiulcerogenic activity in Vacha.[30]

Mustard is bitter in taste, is hot in potency, and has Kaphavata alleviating property. It has scraping, sweat induction, analgesic, and anti-inflammatory properties, when used topically it helps to reduce symptoms of Yuvanpidika.[31]

Saindhava has a salty taste, unctuous, pungent, penetrating, light, and subtle properties. It has an appetite-stimulating property. All these help in balancing Tridosha.[32] It helps in exfoliating dead skin cells, cleansing skin pores, and protecting the natural skin layer to produce healthy and energized skin types. It also helps in strengthening skin tissue to rejuvenate the skin to make it look younger and firm.[33] Ingredients of Lodhradi Lepa have dominance of pungent, bitter, astringent taste, and have light and hot properties, which help in alleviating Kapha Dosha. Topical application of Lodhradi Lepa helps in pacifying vitiated Vata Dosha by sweet, unctuous, and hot properties. Sweet, bitter, astringent taste, unctuousness, and cold properties help to alleviating Pitta Dosha. Dry, absorbent, and healing properties help in drying and healing of the papules. Deep penetration property helps in fast action of the drug as well as scraping property helps in squeezing out the pus inside.

Detoxification property of astringent drugs leads to purification of vitiated blood; thus, it cures the skin disorders. It also enhances the skin complexion. The drugs possess anti-inflammatory, analgesic, wound healing, and antibacterial properties.[34] Thus, Lodhra, Vacha, Mustard, and Saindhava––the ingredients of Lodhradi Lepa––by their aforesaid properties help in breaking pathogenesis by pacifying vitiated Doshas and purifies the blood by detoxification.

Probable Mode of Action of Arogyavardhini Vati

Arogyavardhini Vati contains ingredients having bitter, astringent, sweet taste with dominancy of light, dry, and combination of hot and cold properties.

It has the ability of balancing Tridosha, destroying all types of skin disorders, analgesic, wound healing, and antipruritic properties, which helps in reducing symptoms of Yuvanpidika. Pungent drugs are beneficial for reducing burning sensation and itching.[35] Bitter taste is believed to be useful in destroying all skin disorders. Its dry and light properties help to exude secretions formed in large quantity and pus in Yuvanpidika.[36] It possesses appetizer and digestive properties, so it enhances digestive power and improves metabolism at cellular level, thereby reducing the formation of undigested or partially digested food which leads to arrest progression in weakening of bodily tissues. Dominance of hot potency in the composition of Arogyavardhini Vati helps to pacify aggravated Vata and relives symptoms such as pain and improves digestive fire.

Complexion-strengthening action of sweet property improves complexion of the skin and bestow ideal skin texture. Astringent property promotes wound healing and reduces secretions. Thus helps in reducing symptoms of Mukhadushika.


  Conclusion Top


Yuvanpidika can be correlated with acne vulgaris as per modern medicine. Lodhradi Lepa and Arogyavardhini Vati both are effective in reducing pain, itching, swelling, burning sensation, redness, and papules of acne vulgaris. This proved that Lodhradi Lepa and Arogyavardhini Vati both are effective in the treatment of Yuvanpidika. But combine treatment is more beneficial and combination of various protocols and formulations need to be adopted for better results.

Recommendation

This study can be carried out by taking a large sample size and for a longer duration. Analytical study of prepared formulations should be carried out for safety. Lodhradi Lepa in the form of ointment can be prepared for easy application.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18], [Table 19]



 

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