• Users Online: 102
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 236-239

Management of Indralupta (Alopecia areata) by Jaloukavacharana and Shamana Aushadh: A case report


Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India

Date of Submission29-Jun-2020
Date of Decision17-Aug-2020
Date of Acceptance07-Sep-2020
Date of Web Publication11-Nov-2020

Correspondence Address:
Dr. Neelam Kaalia
PG Scholar, Department of Panchakarma, All India Institute of Ayurveda, New Delhi.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_65_20

Rights and Permissions
  Abstract 

Background: Hair is one of the defining characteristics of mammals. Hair loss may not harm physically that much but it might lead to psychological impact and may cause depression. Alopecia areata (AA) is a condition resulting in localized, nonscarring hair loss. Patches are more common on the scalp without any scaling and inflammation. In Ayurveda texts, a similar condition is mentioned in Kshudrarogas known as Indralupta. The aim of this study was to assess the efficacy of Jalaukavacharana in Alopecia areata. Materials and Methods: It is a single case study of a 22-year-old female patient with a complaint of asymptomatic loss of hair at a single site over the scalp for 5 months. This case of Alopecia areata (Indralupta) was successfully treated with 12 sittings of Jalaukavacharana (leech therapy) for four and a half months and 3 months Ayurveda medication. Result: The patch was immensely filled with lustrous black hairs at the end of the follow-up period. Conclusion: Hence, it can be concluded that Ayurveda provides a promising result in the patient of Indralupta through Jaloukavacharana and Shamana Aushadh. It can be a choice of treatment, keeping in mind its cost-effectiveness and successful management as compared to conservative treatment.

Keywords: Indralupta, Jaloukavacharana, leech therapy, Alopecia areata


How to cite this article:
Bhatted SK, Dharmarajan P, Kaalia N, Kumar J. Management of Indralupta (Alopecia areata) by Jaloukavacharana and Shamana Aushadh: A case report. J Indian Sys Medicine 2020;8:236-9

How to cite this URL:
Bhatted SK, Dharmarajan P, Kaalia N, Kumar J. Management of Indralupta (Alopecia areata) by Jaloukavacharana and Shamana Aushadh: A case report. J Indian Sys Medicine [serial online] 2020 [cited 2020 Dec 1];8:236-9. Available from: https://www.joinsysmed.com/text.asp?2020/8/3/236/300500




  Key Messages: Top


Alopecia areata (AA) does not have sure-shot treatment in contemporary medicine. Leech therapy has very good results in AA. So, it can be a very good treatment option in cases of AA.


  Introduction Top


Alopecia areata (AA) is an auto-immune disorder affecting the hair-bearing areas of the body. The scalp is the most common site of involvement.[1] AA affects nearly 2% of the general population at some point during their lifetime; incidence is high among the younger age group. A typical patch is uninflamed, with no scaling, but with easily seen empty hair follicles. Histologically, T lymphocytes cluster like a swarm of bees around affected hair bulbs.[2] In Ayurveda, thiscondition can be correlated with Indralupta. Indralupta is a Raktapradoshaja Vikara[3] characterized by loss of hair and has been mentioned underneath the caption of Kshudraroga by Acharya Sushruta.[4] Corticosteroids are the preferred treatment in the form of topical, intraregional, or systemic therapy which has many side effects and does not ensure the regrowth of hair follicles. Hence, there was a need for cost-effective and successful treatment. In Ayurveda, Raktamokshana (Bloodletting) is one of the treatment modality mentioned for Raktapradoshaja Vikara. Leech therapy is one of the simplest techniques that can be used for Raktamokshana (Bloodletting), especially in old or a woman, or an infant, or a person of an extremely timid disposition, or a person of a delicate constitution.[5]


  Case Report Top


A female patient aged 22 years (UHID no. 239714) visited Panchakarma OPD at All India Institute of Ayurveda (AIIA), New Delhi, in June 2018 History of present illness. The patient was asymptomatic 6 months back. Then, she gradually started to have an asymptomatic loss of hair at a single site over the scalp. She also had vigorous hair fall for 6 months. Hair loss started spontaneously without any itching or dandruff. She took homeopathic treatment with some herbal oil for external application but did not get any relief.

Examination

A well-defined area of nonscarring alopecia in an oval pattern was present at the right parietal region of the scalp.

History of past illness

There was no history of similar illness in the family, no history of drug intake, and no history suggestive of any systemic illness.


  Personal History Top


  • Aahaara: Pitta Vardhak Ahara (like junk food)


  • Vyasana: None


  • Vyayama: No


  • Nidra Asamyaka, 6h at night, 1 hrs at daytime


  • Koshtha: Santushtha, 1 time/day, Madhyama


  • Mootra Pravritti: Samyaka


  • Artava Pravritti: Samyaka


  • Agni: Vishama


  • Ruchi:Yes


  • Jarana Shakti: Madhyama


  • Abhyavarana Shakti: Madhyama


  • Pramana: height 5′, weight 45 kg


  • Saatmaya: Pravara


  • Satva: Madhyama


  • Prakriti: Vata pittaj


Treatment

Treatment was done for 6 months including follow-up. Total 12 sittings of Jalaukavacharana (leech application six sittings with a gap of 7 days, followed by six sittings with a gap of 15 days) were done in a period of four and a half months. Follow-up period was one and a half months. Internal medicines [Table 1] were also administered during the first 3 months of the treatment. Avipattikar Churna[6] was administered for the first 2 months in the dosage of 3g empty stomach early in the morning. Punarnavasava[7] and Lohasava[8] were given 15mL each with lukewarm water two times a day after food. One capsule of Trichup was administered three times a day after food and later Narsimha Rasayana[9] was given 10g at bedtime with milk for the next 1 month.
Table 1: Internal medicines

Click here to view



  Method ofJalaukavacharana Top


Two leeches were kept in a plastic jar filled with water. Before application leeches were kept in turmeric mixed water for some time to make them active, until then bald patch was rubbed with Triphlachurna.[10] When the leech started to move fast and freely in water, it was assumed to be ready to use. Then the leech was held by wet cotton and made to adhere on a bald patch on the scalp. When the front portion of leech was seen slightly elevated, it indicated that leech had stuck and started sucking blood. Then it was covered with wet cotton and water was sprinkled on cotton during the whole procedure. Sucking of blood was confirmed by a pulsating wave seen in the body of leech. When that wave subsided, the swollen leech was removed after sprinkling some Haldi Churna on the mouth of a leech. Haldi Churna mixed with Madhu (honey) was applied to the area from where leech had sucked blood. Then leech was made to vomit the blood by putting its mouth in Haldi Churna. Then, it was held by the left hand in between the thumb and fingers and it was slowly and gently squeezed from the tail to the mouth by thumb and fingers of the right hand. The leech was made to vomit till complete emptying of blood. When the leech completely emptied of blood, it was left in a vessel of water.


  Result Top


When the treatment started the patient had one patch of hair loss in the left parietal area of the scalp [Figure 1]. After two sittings of Jalaukavacharana, very small white hairs started to grow from the hair follicles in that patch. Significant growth in the length of hairs was noticed after 6 sittings [Figure 2]. Also, the color of the hairs changed from white to black. After completion of Jalaukavacharana [Figure 3], the patch was completely covered with hairs. The patient was told to stop internal medicines during the follow-up period of one and a half months. The patch was not at all seen and was immensely filled with lustrous black hair at the end of the follow-up period [Figure 4].
Figure 1: First sitting of Jalaukavacharana

Click here to view
Figure 2: Sixth sitting of Jalaukavacharana

Click here to view
Figure 3: Twelfth sitting of Jalaukavacharana

Click here to view
Figure 4: At follow-up

Click here to view



  Discussion Top


In the present case diagnosis of AA or Indralupta was made based on clinical presentation. The patient was Vata Pittaj in Prakriti with Pitta Vardhak dietary habits. She was used to having junk food frequently and the patient had the habit of day sleeping. Indralupta is a condition mentioned by Acharya Sushruta in which the deranged Vata and Pitta having recourse to the roots of the hairs bring about their gradual falling off, while the deranged Rakta and Kapha of the locality fill up those pores or holes, thus barring their fresh growth and recrudescence.[11] Here Avipattikar Churna was given for its shamana effect on aggravated Pitta Dosha. Punarnavasava and Lohasava were chosen for their Raktashodhaka and Raktavardhaka effect, respectively. Poly Herbal Capsules contains ingredients like Bhringraja, Brahmi, Yashtimadhu, Japa Pushpa, etc. which are beneficial for hair growth and premature greying. Furthermore, as a Rasayana, Narsimha Rasayana was given keeping in view the Bala of patient for one month. Leech therapy is an ideal method for Raktamokshana (bloodletting) in blood vitiated by Pitta and also for females, children, and old age persons. Leeches have more than 20 bioactive molecules in their secretions. These molecules have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant, and thrombin regulatory functions, as well as extracellular matrix degradative and antimicrobial effects.[12] In AA leech therapy may have worked by increasing the microblood circulation through acetylcholine- and histamine-like molecule. Leech saliva also contains Destabilase and chloromycetin which have an antimicrobial effect.[13] When leech therapy is done on thinning or bald areas, the increase of blood circulation helps enhance the concentration and delivery of nutrients to that area on one side and removal of accumulated toxin, inflammatory substances on the other side thereby assisting in the promotion of hair growth.


  Conclusion Top


AA is a very common problem these days seen in youngsters. It can be correlated with Indralupta according to its signs and symptoms. According to the Avastha of the Doshas, Ayurveda medicines along with leech therapy sittings showed a promising effect on this case of AA of a female patient. Hence, if done on a large scale, this treatment can be a successful management for alopecia whose sure-shot management is not known till now.

Patient consent statement

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bansal M, Manchanda K, Pandey SS Annular alopecia areata report of two cases. Int J Trichol 2013;5:91-3.  Back to cited text no. 1
    
2.
Hunter JAA . Clinical Dermatology, Regional Dermatology, Chapter 13, 3rd ed. USA: Blackwell Publishing; p. 164.  Back to cited text no. 2
    
3.
Shashtri A Vyadhisammudeshiyam Adhyaya. Sutrasthana 24/11. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 132.  Back to cited text no. 3
    
4.
Shashtri A Kshudraroganamnidanam Adhyaya. Nidanasthana 13/34. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 368.  Back to cited text no. 4
    
5.
Shashtri A Jaloukavacharniya Adhyaya. Sutrasthana 13/3. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 57.  Back to cited text no. 5
    
6.
Govind Das Sen K Amlapittadhikara 56/24–8. In: Shri Siddhi Nandan Mishra, Bhaisajya Ratnavali. Siddhiprada Hindi Commentary, Chaukhamba Surbharati Prakashan, Varanasi; 2017. p. 903.  Back to cited text no. 6
    
7.
Govind Das Sen K Shothrogadhikara 42/191–5. In: Shri Siddhi Nandan Mishra, Bhaisajya Ratnavali. Siddhiprada Hindi Commentary, Chaukhamba Surbharati Prakashan, Varanasi; 2017. p. 786-7.  Back to cited text no. 7
    
8.
Govind Das Sen K Pandurogadhikara 12/125–9. In: Shri Siddhi Nandan Mishra, Bhaisajya Ratnavali. Siddhiprada Hindi Commentary, Chaukhamba Surbharati Prakashan, Varanasi; 2017. p. 386.  Back to cited text no. 8
    
9.
Tripathi SB Rasayanavidhiadhyaya Uttartantra 39/169–173. In: Vagbhata, Ashtanga Hridayam of Srimadvagbhata. Nirmala Hindi Commentary, Chaukhambha Sanskrit Pratishthan, Delhi; reprint 2015. p. 1203-4.  Back to cited text no. 9
    
10.
Shashtri A Jaloukavacharniya Adhyaya. Sutrasthana 13/19. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 59-60.  Back to cited text no. 10
    
11.
Shashtri A Kshudraroganidanaadhyaya. Nidanasthana 13/32–3. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 368.  Back to cited text no. 11
    
12.
Abdualkader A M, Ghawi A M, Alaama M, Awang M, Merzouk A. Leech Therapeutic Applications Indian J Pharm Sci. 2013 Mar;75(2):127-37.  Back to cited text no. 12
    
13.
Sig AK, Guney M, UskudarGuclu A, Ozmenet E Medicinal leech therapy—An overall perspective. Integr Med Res 2017;6: 337-43.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Key Messages:
Introduction
Case Report
Personal History
Method ofJala...
Result
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed128    
    Printed8    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal