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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 69-73

Role of Pracchana Karma followed by Bibhitaki Lepa in Indralupta (Alopecia Areata)


1 Department of Shalakya Tantra, Akhandanand Ayurved College, Ahmedabad, Gujarat, India
2 Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Samsthan, New Delhi, India

Date of Submission04-Jan-2021
Date of Acceptance20-Jan-2021
Date of Web Publication05-Mar-2021

Correspondence Address:
Dr. Divyarani Kathad
Department of Shalakya Tantra, Akhandanand Ayurved College, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_8_21

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  Abstract 


Twenty-first century is the century of beauty and brain; so as a part of beauty, hair is very important. As hair is considered as a barometer of beauty, each one is over conscious about it and is in search for a better remedy for the maintenance and management of their reflection of beauty. Alopecia areata is an autoimmune disorder also known as “spot baldness,” which interferes beauty of a person, which can be compared with Indralupta. Since the limitations of modern medicine are obvious, there is the highest need of harmless, effective treatment from alternative medical sciences. The treatment of Indralupta can be divided in two parts – local and systemic. Ayurveda indicates use of Pracchana and Lepa in the treatment. The treatment planned was Pracchana followed by Bibhitaki Lepa. Raktamokshana is the ideal treatment when Dosha is vitiated with Rakta. Pracchana helps in clearing the obstructed Romakupas. The present case study has come out with promising results in Indralupta (alopecia areata) treated by Pracchana and Bibhitaki Lepa. A case of a 41-year-old female patient who presented with the complaint of Indralupta has been treated with Pracchana followed by Bibhitaki Lepa along with internal medicine. There was a significant improvement in symptoms such as decreased patch size and less hair fall. This case study on Pracchana followed by Bibhitaki Lepa shows that Indralupta can be successfully managed by Ayurvedic treatment modalities.

Keywords: Alopecia areata, Ayurveda, Bibhitaki Lepa, Indralupta, Pracchana Karma


How to cite this article:
Kathad D, Bariya SK, Varsakiya JN. Role of Pracchana Karma followed by Bibhitaki Lepa in Indralupta (Alopecia Areata). AYUHOM 2019;6:69-73

How to cite this URL:
Kathad D, Bariya SK, Varsakiya JN. Role of Pracchana Karma followed by Bibhitaki Lepa in Indralupta (Alopecia Areata). AYUHOM [serial online] 2019 [cited 2021 Jun 13];6:69-73. Available from: http://www.ayuhom.com/text.asp?2019/6/2/69/310854




  Introduction Top


Hair is considered as an essential part of overall personality, a consistent factor for the worry and pride. It is not just because many of us believe that appearances are important but also because our hair represents our personality, thoughts, and beliefs. Hence, the loss of hair is traumatic to a woman as well as man. Hair loss is one of the most common problems faced by people across all age groups. There are many conditions that lead to loss of hair. In modern medicine, hair loss, also known as alopecia or baldness, refers to a loss of hair from part of the head or body.[1] Baldness can refer to general hair loss or male pattern hair loss. Hair loss and hypotrichosis have many causes including androgenic alopecia, fungal infection, trauma (e.g., due to (trichotillomania), radiotherapy, chemotherapy, nutritional deficiencies (e.g., iron deficiency), and autoimmune diseases such as alopecia areata.[2] Hair loss severity occurs across a spectrum with extreme examples including alopecia totalis (total loss of hair on the head) and alopecia universalis (total loss of all hair on the head and body). Alopecia areata is an autoimmune disorder also known as “spot baldness” that can result in hair loss, ranging from just one location (alopecia areata monolocularis) to every hair on the entire body (alopecia areata universalis). Although thought to be caused by hair follicles becoming dormant, what triggers alopecia areata is not known. In most cases, the condition corrects itself, but it can also spread to the entire scalp (alopecia totalis) or to the entire body (alopecia universalis).

Since the limitations of modern medicine are obvious, there is the highest need of harmless, effective treatment. In Ayurveda classics, Indralupta is described under the heading of Kapalagata Roga[3] and Kshudra Roga[4] which is characterized by loss of hair. In the ancient text described, Pitta along with Vata by involving the Romakupas (roots of hair) causes fall of hair and thereafter Kapha along with Rakta obstructs the channel of Romakupas (roots of hair) leading to the blockage and stoppage of the regeneration of hair and this condition is known as Indralupta, Khalitya, or Ruhya.[5] In Ayurveda classics, It is mentioned that Vata-Pitta Dosha reached at the root of hair and leads to Khalitya (Indralupta).[6] Thus, Vata, Pitta, and Kapha Dosha and Rakta Dushya are the main internal causative factors of Indralupta. Also vitiated Rakta Dhatu aggravates the growth of Keshada Krimi.[7] The treatment of Indralupta can be divided in two parts – local and systemic. Acharyas mentioned Siravedh or Prachhan for the treatment of Indralupta. In the Samprapti of Indralupta Roga vitiated Rakta and Kapha obstruct the hair folicle and resulting into hair loss. Pracchana is indicated in Raktaj Vyadhi[8] and helps to drain the Vitiated Rakta ultimately break the pathogenesis.[9] Acharya Sushruta mentions that if Lepa is applied after Pracchana, then better hair growth is achieved.[10] Hence, following the principles of management, in this case study, patient advised for Pracchana followed by Bibhitaki Lepa in Indralupta.


  Case Report Top


A 41-year-old Hindu, female patient visited the outpatient department (OPD) of Government Akhandanand Ayurved Mahavidhyalaya, Ahmedabad, on March 1, 2019, with the chief complaint of patchy hair loss for the past 8 months associated with thinning of hair, hair fall, and mild itching on the scalp.

Case findings

The patient was said to be asymptomatic 8 months back. Gradually, she noticed thinning of hair, hair loss, and mild itching on the scalp. Later after few days, she started noticing the patch of baldness at the parietal region of the head. Then, it started worsening day by day with increase in size and loss of hair. Hence, she approached OPD of Government Akhandanand Ayurveda Mahavidhyalaya, Ahmedabad, for the same and started treatment. She had not any history of diabetes mellitus, hypertension, or any other auto-immune disorders. She was not taking any modern medicine for the any issues [Table 1] and [Table 2].
Table 1: Time line of events

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Table 2: Investigations before treatment

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On general examination of the patient, pulse is 72/min with 124/70 mmHg blood pressure, weight is 53 kg, respiratory rate is 18/min, temperature is normal, pallor is absent, with coated tongue, he is nonvegetarian in diet style, and he is moderately built with no other systemic illness. His appetite was good. Occupation is private job in MNC. Heart rate is 60/min with 120/80 mmHg. Bowel history is 1–2 times/day and frequency of bladder is 3–4 times/day, 1–2 times at night. Dasha Vidha Pariksha was done for patient assessment. The patient has Kapha Pradhaana Pittaj Prakriti, Tridhoshja Vikriti, Sama Pramana, Mamsa Sara with Avara Vyayam Shakti, and Avara Bala.

Evaluation of symptoms

Evaluation of the scalp and hairs over the scalp are based on the following criteria:

  1. Type - Patchy hair loss
  2. Size and pattern of patches - Asymmetrical, 3 cm × 4 cm
  3. Site of involvement - Parietal region of head
  4. Associated symptoms - Itching is present, redness is absent, no discharge, and scaling on scalp is present with generalized thinning of hair.


Nidana

The patient has excessive Amla and Lavana Rasa Sevana, dairy products, sweet food items. Patient have habit to take meal irregularly, use to sleep in daytime and have disturbed sleep also.

Samprapti

Pitta associated with Vata gets lodged in Romakupas and causes hair fall followed by Kapha Dosha associated with Rakta which causes obstruction to the hairs roots and limits regrowth.[11] Routine hematological and urine investigations were carried out to rule out systemic pathology, which were all within normal limits.

Treatment protocol

Treatment protocol followed was Pracchana Karma and Bibhitaki Lepa along with internal medicine [Table 3] and [Table 4].
Table 3: Details of procedures used during treatment

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Table 4: Posology of drugs used in the study

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Parasurgical protocol

Materials needed: Sterile surgical blade no. 11, disposable gloves, sterile gauze, cotton, Bibhitaki churna.

Purva Karma

Local area was cleaned with warm water and wipe with sterile gauze piece. Procedure was explained to the patient in her own language and consent was taken.

Pradhaana Karma

Firstly contentious close small incision was made over the scalp on the affected area with the surgical blade no-11. Care was taken so that the depth of these serial incisions should be neither too deep nor too superficial but should be sufficient enough for the blood to ooze out. When the blood started oozing out, before it gets clotted, Bibhitaki churna Lepa was done on the open wounds.

Paschat Karma

The Lepa was cleaned and wound was bandaged with sterile bandage and sticking plaster.

The patient was advised to not to take head bath till the hair growth is seen[12] and not to use any oils immediately after the hair wash or on the day of procedure. Hair should not be combed. She was advised to avoid spicy and oily food, cold water, and day sleeping.

Observation

During procedure, the patient experienced mild pain but cooperated with some anxiety. On the follow-up (April 2019), there was new and healthy hair growth at the site of patch as evident from the photograph [Table 5] and [Figure 1], [Figure 2], [Figure 3].
Table 5: Assessments obtained before and after treatment

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Figure 1: Before treatment

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Figure 2: After Prachhana Karma

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Figure 3: After treatment

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  Discussion Top


Nidana Sevana such as Viruddha Ahar, excessive Amla, and Lavana Rasa and Vihara-like Mano Abhighata such as mental stress, fright, anger, and shock may collectively increase the Pitta and Vata Dosha. The Ushna and Tikshna properties of Pitta get augmented, whereas the Vata suffers an aggravation in Ruksha, Khara and Chala properties. Here, an aggravated Pitta (Bhrajaka Pitta) supported by the vitiated Dehoshma burns the Keshabhoomi, whereas an increased Vata gives rise to more frequent and comparatively prolonged Shira Sankocha by its Ruksha and Khara Guna. The Snigdhatva and the Pichchhilatva of the normal Kapha Dosha are prevalent throughout the pores of the skin so as to keep it soft and moist. By the augmentation of the Ushna, Tikshna, Ruksha, and Khara properties of Pitta and Vata Doshas, respectively, the Sneha and the Pichchhilatva of the Kapha Dosha are dried up within the pores of the skin of the scalp, thus obstructing the growth of new hairs, causing Indralupta.

This case study has been designed as per the Ayurvedic principles of management of Indralupta, i.e., Raktamokshana and then Lepa application. Raktamokshana is stated as a modality in the treatment of Indralupta either by Siravedh or Prachhan. Pracchana helps in clearing the obstructed Romakupas[13] and vitiated Rakta is expelled out. Pracchana drains out the vitiated blood from the Strotas, and later, when Lepa is applied over the region, it facilitates easy and faster absorption of the drug. Lepa applied over the scalp by the effect is absorbed by the hair follicles which in turn causes the pores to open up. Bibhitaki itself is Kaphaghna and hence acts to relieve the obstruction of Kapha Dosha in Romkupaa. Further, Bibhitaki having Keshaya property promotes hair growth.[14] The oil from seeds with the fruit or its fruit paste is well known for its use in treating premature graying and also promoting hair growth.[15]

Along with this condition, as per classical reference, the vitiated Rakta Dhatu will give rise to Keshada Krimi which also contributes towards the ultimate hair loss along with Agnimandhya. Pathyadi Kwatha promotes digestive fire, clears body channels for the nutrients to reach to the tissues, balances fats in the body, and removes toxins by improving the digestive system. Arogyavardhini Rasa[16] causes Apatarpaan, which helps in opening the blockage of Strotasa. Acharya Sushruta advises Rasayana in Keshaya Vikara[17] and Rasayana acts as immunomodulators in Indralupta. With this benefit, the patient was advised to take Rasayana Vati as Rasayana Dravya to enhance the hair growth.


  Conclusion Top


The efficacy of Bibhitaki Lepa following Pracchana is said to be proven because of significant hair growth on the patch of Indralupta. The classical management of Indralupta has a strong possibility to breakdown the pathogenesis of this disease. The Local application of Bibhitaki Lepa clears the channels, enhance the peripheral blood circulation locally which resulting into strengthen the hair.

Declaration of patient consent

The authors certify that they have 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 understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hair Loss. NHS Choices. Retrieved 5 February 2020.  Back to cited text no. 1
    
2.
Hair Loss, Balding, Hair Shedding. DermNet NZ. Archived from the Original on 14 November 2007. Retrieved 2007-12-07.  Back to cited text no. 2
    
3.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Uttara Sthana 23/24-25. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 3
    
4.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Uttara Sthana 24/8-30. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 4
    
5.
Trikamji AY. Sushruta Samhita Nidana Sthana 13/32-33. Varanasi: Chaukhambha Krishanadas Academy Varanasi Reprint Edition; 2004.  Back to cited text no. 5
    
6.
Trikamji AY. Charaka Samhita Chikitsa Sthana 26/132. Varanasi: Chaukhambha Orientalia Varanasi Reprint Edition; 2004.  Back to cited text no. 6
    
7.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Nidaana Sthana 14/51. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 7
    
8.
Kaviraja Ambikadutta Shastri: Sushruta Samhita of Sushruta, Sutra Sthana-14/34. Varanasi: Chaukhamba Sanskrit Sansthan; 2010. p. 284.  Back to cited text no. 8
    
9.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Uttara Sthana 24/28-30. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 9
    
10.
Kaviraja Ambikadutta Shastri: Sushruta Samhita of Sushruta, Nidana Sthana-13/33-35. Varanasi: Chaukhamba Sanskrit Sansthan; 2010. p. 284.  Back to cited text no. 10
    
11.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Sutra Sthana 24/28-30. Varanasi: Chaukhambha Surbharati Prakashana; 2013. p. 862.  Back to cited text no. 11
    
12.
Paradakara HS, editor. Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Uttara Sthana 24/32. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 12
    
13.
Paradakara HS, editor. Vagbhatta, Ashtanga Hridaya Sarvanga Sundara Commentary of Arundatta and Ayurvedarasayana Commentary of Hemadri, Sutra Sthana 26/53. Varanasi: Chaukhambha Surbharati Prakashana; 2007.  Back to cited text no. 13
    
14.
Ganesh Nanal: Saartha Bhaavaprakaasha of Bhaavamishra, Purvakhanda, Haritakyadi Varga Verses 33-35. Rajesh Raghuvan-shi Rajesh Prakashana; 1939. p. 98.  Back to cited text no. 14
    
15.
Roy SK, Pal PK, Das AK. Propagation of a timber tree Terminalia bellirica Roxb. by tissue culture. Bangladesh J Bot 1987;16:125-30.  Back to cited text no. 15
    
16.
Anonymous. The Ayurvedic Formulary of India. India: Ministry of Health and Family Welfare, Government of India, Part I (20:4); 2000. p. 664-5.  Back to cited text no. 16
    
17.
Trikamji AY. Sushruta Samhita Chikitsa Sthana 20/25-26, Chaukhambha Krishanadas Varanasi: Academy Varanasi Reprint Edition; 2004.  Back to cited text no. 17
    


    Figures

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

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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