Management of Yovanpidaka by Vaman Karma

Abstract

Introduction: 

Yovanpidaka, also known as Mukhadushika, is described under Kshudra Rogas in Ayurveda Samhitas. It can be compared with acne vulgaris. It is self-limiting in the majority but severe forms, however, lead to disfiguring scars, which can be prevented. Hence, it is essential to look out for treatment modalities which would help prevent the disfigurement caused by acne.

Main Clinical Finding: 

A 20-year-old female presented with eruptions, pain, closed comedones, whiteheads, itching, and redness over her face for the past 2 years.

Diagnosis: 

Yovanpidaka.

Interventions: 

Administered Vaman with Madanphal Yoga along with milk and Yashtimadhu Phanta after proper internal oleation with Panchatikta Ghruta.

Outcome and Conclusions: 

Marked improvement after Vaman in the signs and symptoms of the patient. Improvement in complexion was also seen.Significant result was seen in Yovanpidaka after Vaman. In cases where local treatments prove to be futile, Shodhan Chikitsa can deliver wonderful results.

Introduction

Yovanpidaka or Mukhadushika is described as a Kshudra Roga^[1] in Ayurveda texts as Pidaka/Pitika (lesions) with resemblance to the shape of Shalmali Kantak, which are Ghana (bulky), Medogarbha (closed comedones) along with Ruja (pain) caused by vitiation of Vata and Kapha along with Rakta.^[2,3] It can be compared with acne vulgaris common in teenage (hence named Yovanpidaka), differences between individuals being a matter of severity and facility with which the scarring develops. Peak severity is in the late teenage years and beyond, particularly in females.

Humans, particularly women, are known to give immense importance to their looks and appearance. The face is perceived as the first indicator of an individual’s physical beauty and it is this acne which leads to the disfigurement of the face (hence named Mukhadushika). Women are the prime consumers of the cosmetic industry which promises different ways not only to enhance their beauty but also to achieve certain “self-defined beauty standards.” Even in ancient times, many remedies were used to achieve this clear and glowing skin.

Considering that the clarity of skin and confidence is directly proportional, there is a need to study and put to use such treatment modalities described in Ayurveda which would serve as a cure for the blemishes caused by Yovanpidaka and help to attain clear glowing skin.

Ayurveda texts have described both Shaman (Lepadi) and Shodhan (purificatory) treatment for Yovanpidaka.^[1] In the present case study, the management of Yovanpidaka by Vaman is elaborated.

Case Report

A 20-year-old female patient visited the outpatient department of Panchakarma with:

• Chief complaints – Pitika (eruptions), Ruja (pain), Medogarbha (closed comedones and whiteheads), Kandu (itching), and Raga (redness) over the face for the past 2 years
• Past history – Clindamycin, niacinamide application, and systemic antibiotics for acne 1 year back. No other history
• Family history – Not relevant
• Personal Habits:
• • Aahar – mixed diet; vadapav, samosas, pizza etc., – 4/7; curd and lassi–5/7; fruit salads and milkshakes – 1/7; fish – 2/7; paneer – 2/7; chocolates–1/7; untimely meals; Adhyashan (taking food before earlier meal is digested)
  • Vihar – Keeping awake at night and lack of exercise
  • Appetite – Moderate
  • Bowel pattern – Irregular and alternate days
  • Micturation – Normal (5–6 times/day)
  • Sleep – Insomnia/use of mobile phone/keeps awake late at night
  • Addiction – None.
• Occupation – Student.

Clinical findings

Temperature = 98.6°F; P. R = 74/min, B. P. =110/80 mm of Hg, height = 5 ft, weight = 50 kg, P/A–Gaurav, Adhman, Jivha– slightly coated

• L/E–The patient was assessed using CASS Assessment Scale (comprehensive acne vulgaris severity scale^[4] and was diagnosed as Grade 3 [Table 1, Figure 1].

Table 1: Assessment scale (comprehensive acne vulgaris severity scale)^{[ 4 ]}

Figure 1: Before treatment (Snehapan and Vaman) – Day 0

Therapeutic intervention

1. Nidan Parivarjan
2. Pachan Deepan
3. Snehapan
4. Vaman.

The patient indulged excessively and frequently in Vata, Kapha, and Rakta aggravating Hetus for the last 4–5 years. It was necessary to start Nidan Parivarjan gradually and slowly and give a detailed list of Pathya– Apathya [Table 2]. Furthermore, for Pachan and Malanuloman, treatment was advised for 7 days [Table 3]. After observing the high frequency of Hetusevan, which led to Bahudoshavastha (Pidaka, Kandu, etc) and the patient’s Bala, it was decided that Vaman shall be the line of treatment.

Table 2: Pathya Apathya

Table 3: Medications as Purvakarma for Snehapan (given for 7 days)

After ascertaining that Pachan was achieved, Abhyantar Snehapan for Vaman was started [Table 4].

Table 4: Abhyantar Snehapan with Panchatikta Ghruta

After 5 days, signs and symptoms of Samyak Snigdha were seen in the patient. A gap of 1 day was given when Sarvang Bahya Snehan with Murchit Tila Taila and Sarvang Bashpa Swedan with Dashamoola Kwath were done to the patient. The patient was advised to have Kapha Utkleshak Aahar (dahi vada and rasmalai) on the night of gap day.

Next morning, the patient was given Vaman in Kapha Kala after Sarvang Snehan Swedan. The patient was made to sit comfortably on the chair; Mangalvachan was done after which Godugdha was given for Akanthapana. This was followed by administering Vamak Yoga-a linctus made by mixing of Madanphal Pippali Churna (8 g) + Vacha Churna (4 g) + Pippali Churna (2 g) + Saindhav (2 g) + Honey (20 g). The patient was asked to sit comfortably while there was sweating (indicating liquefaction of Doshas), horripilation (indicating Doshas leaving their site of stagnation), abdominal distension (indicating movement of Doshas toward Koshtha), and nausea (indicating the upward direction of Doshas). For collecting vomitus, a tub was kept in front of the patient. Now, the patient was instructed to vomit when there was an urge without much straining by opening wide the lips, the palate, the throat, and by slightly bowing the upper part of the body. During the act of emesis when the actual bout was being thrown out, the forehead and chest of the patient were held, the umbilical region of the patient was pressed, and the back of the patient was gently massaged in the upward direction. In case if there was some difficulty for the bout to happen easily, the patient was asked to slightly tickle the uvula with her fingers. Pulse and B. P. examination was done periodically in between the bouts. During the procedure, after each Vega, Yashtimadhu Phanta was administered repeatedly to support the act of vomiting. When the patient was no more able to take Phanta but there was a slight feeling of Kapha in the throat and minor heaviness persisting in the abdomen, Lavana Jala was given till these Lakshanas were relieved and Samyak Vaman was achieved. Observations during Vamana Karma such as the record of input, output, counting of Vega, and Samyak Lakshanas were noted.

After completion of the procedure, the patient was asked to sprinkle some tap water over her face; Kavala was given warm water and she was advised to take rest in the recovery room. After about 15 min, the patient was given Dhoomapan with Vacha-Haridra Dhoomavarti. Samsarjan Krama and detailed postVaman Pathya-Apathya were advised.

Considering the assessment parameters of Vaman [Table 5], it was concluded that the patient had Uttam Shuddhi. Therefore, Peyadi Samsarjan Krama of 7 days was given to the patient.^[5]

Table 5: Vaman record

Follow-up and outcomes

Seventh Day, fifteenth Day.

The patient was examined after completion of Samsarjan Krama, i.e on 7^th day after Vaman [Figure 2]. She showed marked improvement in the symptoms. The Pitika were markedly vanished with complete relief from pustules (CASS grade 0). There was no pain or itching. The patient was again called for 2^nd follow-up after 15 days. She exhibited increased glow and clear complexion of the skin. There was no recurrence of eruptions. The patient was advised to avoid the causative factors as much as possible for future prevention of Yovanpidaka.

Figure 2: After Treatment (Vaman and Samsarjan Krama)

Discussion

Yovanpidaka is a burning problem for adolescents and adults nowadays. Acne vulgaris is a common skin disorder affecting societies worldwide with an estimated prevalence between the age of 12 and 24 being 85%.^[6] With such a large population getting afflicted by the disease, it becomes a necessity to explore and put to use treatment modalities which would eliminate the pathogenesis of the disease from its root and prevent its recurrence. Although some individuals get benefit by the use of conservative shaman treatment such as Lepa (topical therapies), Abhyantar Aushadhi, antibiotics, retinoids, hormonal therapy, and procedures such as chemical peels, lasers, and many others do not experience any change or their acne recur unless they undergo Shodhan treatment. This largely depends on the Hetu-Bala and Hetu-Abhyas (strength of causative factors and their frequency). Erratic dietary patterns and disturbed regimen of lifestyle are prime concerns. Apart from this, ignorance about their harmful effect on the body is the major culprit. If purificatory measures are given along with the following of Nidana Parivarjan, tremendous positive results are inevitable as they help to bring about Samprapti-Vighatan.

In the present case, the same protocol was followed. The patient indulged in habitual intake of Kleda Vruddhikar, Vidahi Aahar which led to the aggravation of Kapha, Pitta, and further vitiation of Vata and Rakta too. Vaman is a purificatory procedure which helps to eliminate vitiated Kapha and Pitta from the upper orifice (mouth). As a Purvakarma to this, Abhyantar Snehapan in Vardhaman Matra with Panchatikta Ghrita was done. It is a formulation of medicated Ghee made Siddha with Nimba, Guduchi, Vasa, Patol, and Nidigdhika. These herbs are Tikta, Laghu, and Ruksha in nature and have the property to pacify Kleda, alleviate Pitta-Kapha^[7] cause Rakta Prasadan. Nimba (Azadirachta indica) has nimbin and nimbidin which has anti-inflammatory action and anti-ulcer effect, Guduchi (Tinospora cordifolia) has berberine which acts as antioxidant, Vasa (Adhatoda indica) contains vascinone which has antihistaminic, anti-inflammatory, antioxidant property, Patol (Trichosanthes xanthocarpum) has antioxidant properties, and Nidigdhika (Solanum xanthocarpum) has antihistaminic property.^[8] These actions of herbs together help to relieve the inflammation and pain in acne and help to clear blemishes. Snehan helps to bring about Anila Hanan (Vata alleviation), Deha Mardav (softness in the body), and Malanam Vinihanti Sangam (dissociation of Doshas). A pinch of Saindhav was added while intake of Sneha daily to promote its Sroto-gamitva and hasten oleation.

The preprocedural Snehana-Swedana helps to bring Shakha-Koshtha Gati of vitiated Doshas. Madanphal Pippali is considered to the best emetic drug because of its property of “Anapaya.”^[9] Yashtimadhu, Pippali, Saindhav, and Vacha are Vamak Dravyas stated in Ashtang Hridayam.^[10]

Properties of Dravyas^[11] and their relevant action in the present study are enumerated in Table 6.

Table 6: Properties of Dravyas and their relevant action in present study

Vamak Dravyas which are Ushna, Tikshna, Sukshma, Vyavayi, and Vikasi, by the virtue of their own potency, reach the heart and circulate through the vessels. Because of their Agneya nature, they liquefy the compact Doshas, their sharpness separates the adhered Doshas located in the Sthula and Anu Srotas of the body. Because of the nature of Doshas (here, Kapha, Pitta Dosha) to move through Anu Srotas and to flow toward the Koshtha, it reaches Aamashaya and is propelled out by the Udana Vayu through the mouth.^[12]

In the present case, the elimination of vitiated Bahu Dosha by Vaman ensured that there is Koshtha Vishuddhi (purification of GIT), Agni Vardhan (ignition of digestive fire), and Vyadhi Upashaman (pacification of disease) along with Varna Prasadan (enhancement of complexion).

Conclusion

It can be concluded from the present study that in cases of Yovanpidaka where external treatment modalities have no or limited utility, where the Hetu Bala and Vyadhi Bala are high, Vaman Karma can deliver the best results.

Informed consent

Written informed consent was obtained from the patient for the publication of this case report and accompanying images.

Declaration of patient consent

The authors certify that they had obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.