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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 17-20

Effect of Ayurveda interventions Vallibadara [Ziziphus oenoplia (L.) Mill.] and Avipattikara Churna in the management of Mukhadushika (acne) - a case report


1 Dravyaguna Department, ITRA, Jamnagar, Gujarat, India
2 Director General, Central Council for Research in Ayurvedic Sciences, New Delhi, India

Date of Submission11-Feb-2022
Date of Acceptance05-Apr-2022
Date of Web Publication04-Aug-2022

Correspondence Address:
Dr. Payal J Purohit
174 ved, opposite Mahalakshmi Residency, near Bandhani Palace, Valkeshwari Nagari, Jamnagar 361008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jras.jras_29_22

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  Abstract 

BACKGROUND: The spine of Vallibadara [Ziziphus oenoplia (L.) Mill.] of family Rhamnaceae are traditionally claimed to manage Mukhadushika (acne vulgaris). In Ayurveda, Avipattikara Churna is known for its Pitta Shamka and mild laxative action. The vitiation of Pitta Dosha and constipation are also contribute to manifestation of acne. PATIENT INFORMATION AND INTERVENTION: A 19 year old patient presented with complaints of papules and pustules, scattered all over her forehead and cheeks since last one year. The patient also reported constipation and heartburn since many months. She was diagnosed with Mukhadushika and was treated with the local application of the paste of powdered thorn of Z. oenoplia mixed with lemon juice and oral administration of Avipattikara Churna 4 gm twice daily with water for 21 days. RESULT: Considerable reduction was observed in the scattered papules and pustules on the forehead and cheeks of the patient. Constipation and burning sensation in the chest were relieved after one week. Complete relief in symptoms was noticed after 21 days of treatment. No recurrence of eruptions was observed during the follow-up after 30 days. CONCLUSION: The external application of spine of Z. oenoplia and internal administration of Avipattikara Churna are effective in the treatment of acne vulgaris.

Keywords: Acne vulgaris, Avipattikara Churna, Ayurveda, Mukhadushika, Vallibadara, Ziziphus oenoplia


How to cite this article:
Purohit PJ, Acharya R. Effect of Ayurveda interventions Vallibadara [Ziziphus oenoplia (L.) Mill.] and Avipattikara Churna in the management of Mukhadushika (acne) - a case report. J Res Ayurvedic Sci 2022;6:17-20

How to cite this URL:
Purohit PJ, Acharya R. Effect of Ayurveda interventions Vallibadara [Ziziphus oenoplia (L.) Mill.] and Avipattikara Churna in the management of Mukhadushika (acne) - a case report. J Res Ayurvedic Sci [serial online] 2022 [cited 2022 Aug 13];6:17-20. Available from: http://www.jrasccras.com/text.asp?2022/6/1/17/353408




  Introduction Top


Mukhadushika or Yovanpidaka, which resembles acne vulgaris,[1] is one of such disease conditions that affect the physical appearance of an individual and thereby can also have psychological manifestations in youngsters. Ayurveda defines Mukhadushika as a clinical condition where the vitiation of Pitta, Vata, and Rakta creates Shalamali Kantaka (Shalmali amalabarica Linn.) like eruptions over the face.[2],[3] In Ayurveda pharmaceutics, the local application of herbal paste and mild purgative therapy is recommended to treat acne vulgaris.[4]

The local traditional healers of the Gir forest area of Junagadh district of Gujarat traditionally use the spine of Vallibadara [Ziziphus oenoplia (L.) Mill.] of family Rhamnaceae in the treatment of acne vulgaris. Avipattikara Churna is an orally administered formulation in Ayurveda indicated for pacifying aggravated Pitta through mild purgation.[5] In view of the involvement of vitiated Pitta as well as constipation in the manifestation of acne vulgaris, the case was treated with local application of a paste of Z. oenoplia over the affected area and internal administration of Avipattikara Churna.


  Patient Information Top


A 19-year-old female patient came to the outpatient department (OPD) of the institute, with the chief complaint of papules and pustules on her forehead and cheeks along with complaints of pain, burning sensation, and itching for a year. She also had intermittent constipation and burning sensation in the chest region throughout this period. The patient was apparently normal before one year.


  Clinical Findings Top


On examination, the pulse of the patient was 72/min. Her blood pressure was 120/70 mmHg. The patient had a normal menstrual history and was otherwise healthy, and no other systemic illness was observed. No significant family or medical history of any significant illness was noted.


  Timeline Top


The patient came for the treatment on September 10, 2021, and the treatment was continued till October 1, 2021. The total duration of the treatment was 21 days ([Flow Chart 1]). The image of the affected area was taken at the time of the first visit [Figure 1](a) and (b).
Flow Chart 1: Time line

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Figure 1: (a) and (b) Images taken at the first visit to OPD

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  Diagnostic Assessment Top


According to Ayurveda, Pitta Dosha is dominant in Mukhadushika,[6] and on examination, it was observed that the patient was having Daha in Urahpradesha (burning sensation in the chest region) and constipation and was habituated to fast food and spicy food frequently. After clinical examination, the patient was diagnosed with Mukhadushika. Before treatment, a routine blood and urine investigation on all parameters was found within normal limits. By using the Global Acne Grading System, at the first visit, the patient was assessed as having mild acne [Table 1].
Table 1: Criteria for the assessment of score

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  Therapeutic Intervention Top


The treatment plan included external as well as internal medicines. The powder of Z. oenoplia (approximately 5 g) with lemon juice (15 mL) was given for the local application twice daily over the affected parts. For the complaints of constipation, heart burn, and pacifying Pitta, Avipattikara Churna 4 g twice a day with water was given orally. The patient was advised to avoid spicy, salty, sour diet, and excessive intake of tea.

In the present case, the main factor responsible for Mukhadushika was vitiated Tridosha along with the vitiation of Rakta and Meda and pain was due to Vata, itching due to Kapha, redness and suppuration due to Pitta and Rakta. So, for pacifying Rakta, Pitta, and Vata, Avipattikara Churna was given. To remove Kapha from the skin, external application of the powder of Z. oenoplia with lemon juice was given [Table 2].
Table 2: Therapeutic intervention

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  Follow-up and Outcome Top


Considerable relief was observed in the symptoms of acne vulgaris in the studied case. After 21 days of treatment, the patient came to the OPD with complete relief as she had no papulopustular lesions over the face [Figure 2](a) and (b). Scoring as per the Global Acne Grading also showed 100% improvement [Table 3]. The intermittent constipation and burning sensation in the chest region were relieved after one week of the treatment. Post-treatment follow-up was done after 30 days, and no recurrence of eruptions was noted within this duration.
Figure 2: (a) and (b) Images taken after 21 days of treatment

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Table 3: Changes in the score of the patient before and after treatment

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  Discussion Top


The ingredients of Avipattikara Churna is Madhura, Tikta, and Kashaya Rasa, and so pacify the vitiated pitta dosha. In Avipattikara Churna, the major ingredients are Trivrita [Operculina turpethum (L) Silva Manso], Lavanga [Syzygium aromaticum (Linn.) Merr M.], and sugar. Among these ingredients, Trivrita has mild laxative action, which play a crucial role in pacifying the Pitta and also in treating constipation. Avipattikara Churna is used in dyspepsia and hyper-acidity, and correction of the same was also expected in the reported case. Avipattikara Churna is traditionally used to remove excess Pitta Dosha from the stomach and intestines by its laxative action.[8]

Acne vulgaris is a chronic inflammatory disorder of the sebaceous follicle that manifests in adolescence. Mostly, the pathology is related to androgens. The hormonal stimulation increases the sebum production, clinically evident as seborrhoea (oily skin). The conventional treatment protocol of acne vulgaris is either topical, systemic, or both with drugs such as antibiotic, retinoids, antiandrogens having antimicrobial, anti-inflammatory, and anticomedonal properties.[9] On the other hand, Ayurveda principle for the management of Mukhadushika is based on cleansing the gastrointestinal tract, purifying blood and skin, and removing excess sebum (can be correlated to locally accumulated vitiated Kapha) from the sebaceous glands.

Z. oenoplia has been reported for its antimicrobial activity,[10] antibacterial activity,[11] and wound cleansing and healing activities.[12] It can be interpreted that the local application of the paste of Z. oenoplia soaked in lemon juice can aid in the desertification and removal of accumulated sebum from the skin. No adverse effects or hypersensitivity to the powder of Z. oenoplia was reported during the study period. The drug Z. oenoplia is traditionally used by the tribal people of Junagadh (Gujarat) to manage acne vulgaris, and there is a lack of evidence regarding the clinical utility of this herb. Further clinical studies on a large sample size are needed to evaluate and validate the therapeutic potential of this ethnomedicinal plant.


  Conclusion Top


Mukhadushika can be successfully managed by local application of Z. oenoplia powder with lemon juice and oral administration of Avipattikara Churna.

Declaration of the patient consent

Authors have obtained consent from the patient/caregiver for reporting the case along with the images and other clinical information 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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Anonymous. The Ayurvedic Pharmacopoeia of India (API). Part 1. Vol. 5, 6/61. New Delhi: Ministry of Health and Family Welfare, Government of India; 2006. p. 387.  Back to cited text no. 1
    
2.
Sushruta. Nidana sthana, 13/38. In: Kaviraj Shashtri AD, editor. Sushruta Samhita. Vol. 1. Varanasi: Choukhambha Sanskrit Sansthan; 2018. p. 372.  Back to cited text no. 2
    
3.
Vaghbhatta. Uttar sthana, 31/5. In: Brahmanand T, editor. Astanga Hridaya. Varanasi: Chaukhambha Sanskrit Pratishthan; 2017. p. 1113.  Back to cited text no. 3
    
4.
Sharangdhar. Uttarakhand, 11/1–2. In: Murthy KR, editor. Sharangdhar Samhita. Varanasi: Chaukhambha Orientalia; 2016. p. 236.  Back to cited text no. 4
    
5.
Das G Chap 56/25–29. Amlapitta. In: Bhishagaratna Mishra SBS, editor. Bhaishajya Ratnavali. Vol. 3. Varanasi: Chaukhambha Sanskrit Sansthana; 2009. p. 118.  Back to cited text no. 5
    
6.
Vaghbhatta . Sutra sthana, 1/7. In: Brahmanand T, editor. Astanga Hridaya. Delhi: Chaukhambha Sanskrit Pratishthan; 2019. p. 9.  Back to cited text no. 6
    
7.
Strauss JS, Krowchuk DP, Leyden JJ, Lucky AW, Shalita AR, Siegfried EC, et al; American Academy of Dermatology/American Academy of Dermatology Association. Guidelines of care for acne vulgaris management. J Am Acad Dermatol 2007;56:651-63.  Back to cited text no. 7
    
8.
Mangal A, Jadhav AD, Reddy RG Study on Avipattikar Churna and Kapardikabhasma in the management of hyperacidity (Amlapitta). Int J Ayurveda Res 2016;2:714-9.  Back to cited text no. 8
    
9.
Shah SN, Paul MA API Textbook of Medicine. 8th ed. Mumbai: Association of Physicians of India; 2009. p. 1418.  Back to cited text no. 9
    
10.
Tambekar DH, Tiwari BK, Shirsat SD, Jaitalkar DS Antimicrobial potential and phytochemical analysis of medicinal plants from Lonar Lake. Int J Life Sci Biotech Pharm Res 2013;2: 2003-11.  Back to cited text no. 10
    
11.
Ramalingam1 R, Bindu Madhavi1 B, Ravinder Nath1 A, Duganath N, Udaya Sri E, Banji D In-vitro anti-denaturation and antibacterial activities of Zizyphus oenoplia. Der Pharmacia Lettrer 2010;2:87-93.  Back to cited text no. 11
    
12.
Kuppast IJ, Satish kumar KV Wound healing activity of aqueous and alcoholic extracts of fruits of Zizyphus oenoplia. Int J Chem Sci 2012;10:1021-7.  Back to cited text no. 12
    


    Figures

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

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Patient Information
Clinical Findings
Timeline
Diagnostic Asses...
Therapeutic Inte...
Follow-up and Ou...
Discussion
Conclusion
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