A Randomized Clinico-comparative Trial of Dwiharidradi Kalk Lepam and Kumkumadi Tailam in the Management of Mukhadushika w.s.r. to Acne Vulgaris – A Original Case Series

M.P

Acharya charakahas been not discussed Yuvanpidika but he has portrayed in pidikaas disease of "Bahya Roga Marga" in the same way he has also described pathophysiology of pidika. 1 Acharya Sushruta was the first person who described Mukhadushika under the heading of kshudraroga itis also known as Yuvanpidikaand Tarunyapidika. Mukhadushika(̴ Acne) is such a condition that disfigures the face during teenagers to younger age. According to Sushruta Samhita, Shalmali thorn like pidika on the face due to vitiation of Kapha, Vata, Shonita (̴ Rakta)and nature of puberty is known as Yuvanpidikaor Mukhadushika. 2 In Ashtang Samgrah 3 &Ashtang Hriday 4 , Madhav Nidaan 5 , Bhavprakash 6 etc., follow same pattern of Sushruta. Acharya Sharangadharahas listed the disease name under the caption of Khudraroga, but not described pathophysiology. Here he has mentioned yuvanpidikaas mala ofshukra dhatu. 7 Reason for publishing the case Series- Face is considered as an important part of the body as for as beauty and look is concerned. Hence every person in teenagers and youngsters in particular are very conscious about beauty of their face.Compared to the skin of the body, the skin of the face cannot always be kept covered and acne occurs mainly on the skin of the face.  It is papules, pustules and itching in predominant symptoms, which disturbed daily life style of the patients.  Patients often have problems with self-esteem. Self-confidence, social withdrawal, depression, anger and higher unemployment rate.  At present, increasing problems like adulterated things, oily, Chinese, eating more junk foods and applying cosmetics things.  In modern medicine, adverse drug reactions are more common.  Mukhadushika can be cure and prevented by Ayurveda treatment without any complication than modern medicine.  According to 85% of teenagers and adult persons every year suffering from Mukhadushikain India. So acne appears to be a big problem even though it is not such a serious disease. The main objective of Publishing Case Series of Mukhadushika was to make people aware of the causes of Mukhadushika, to avoid them and to advise them to get proper Ayurvedic treatment for Mukhadushika. Due to excessive consumption of oily, junk, unhealthy foods and excessive use of cosmetics and due to hormonal changes in the puberty, disease like acnevulgaris are becoming more prevalent in present times. Generally, there is a Kandu, Daha, Vedana, Srava,Medogarbha, Vaivarnayta, Raktima and Shothain the Mukhadushika. Roopa or symptoms are those that are completely exhibited and reflect a certain ailment. In Ayurvedicscriptures, various treatments are prescribed locally and internally.Local application is more useful in skin disorders as it acts directly on the wound. So, the drug can reverse the condition which has the property of Kaphapitta Shamaka and Raktashodhaka, and can be used for a long time on skin diseases without any harm. In the present study Dwiharidradi Kalk Lepam (̴ face pack) and Kumkumadi Tailam have been selected as local applicationand both have been selected to conduct comparative study in treatment of Mukhadushika. This study was conducted to evaluate the efficacy of the above subject.

Statistical analysis of the result-
The result having P value less than<0.05 were considered as statistically significant in this study. Criteria for assessment of overall effect-Overall effect of the therapy was assessed in terms of complete relief, excellent Improvement, marked Improvement, moderate Improvement, mild Improvement and no Improvement by adopting the criteria shown in table 1 OBSERVATIONS 20 patients were registered in Group A & 20 in Group B and all the 40 patients completed the treatment and none of the patients were dropout. Female patients were slightly higher than male patients 57.50%. Male patients were 42.50%. But the universal data is expounded about Acne vulgaris that women is prone for this disease. But after this study we can say that today"s life style & dietary habits are very dominating factor for the origin of Acne vulgaris than the gender. The maximum no. of patients (97.50%) were Hindus and only 2.50 % patients were Muslim. Maximum no. of patients were the Teenage and young age group persons of above 20 years of aged 60% followed by up to 20 years age group (40%).
12.50% patients were married and 87.50% patients were unmarried. This marital status shows only social norms because there is no specific role of marriage in the development of Acne vulgaris. 42.50% patients were graduated followed by high school 30%, post graduate 7.50% and 5% Illiterate. Education level does not have much effect on Mukhadushika.
In patients" study, 87.50% patients were students followed by 10% were house holder and only 2.50% patients were service. Occupation level does not have much effect on Mukhadushika. 77.50% patients were belonging to middle class, rich 17.50% were and 5% were poor class. Socio-Economic Status level does not have much effect on Mukhadushika. 65% patients belonging to urban area and 35% belonging rural area. Urban area people more prone to acne because more use junk food, oily food, fast food and false diet routine. Majority of the patients were having habit of Vishmashana(50%) followed by habit of Samshana37.50%, 7.50% having Aadhyashanaand 5% having Viruddhashana. Maximum no. of patients found in vegetarian diet class 72.50%), 25% were having mixed type of diet and 2.5% were having nonveg type of diet. 22.50% of patients having Guru guna dominancy in diet, 15% patients having Ushnaguna, 5% people were used to Rukshya, 5% people were used to Laghuguna and 2.50% people were used to Snigdhaguna dominancy. 50% of patients having Katu rasa dominancy in diet, 30% patients having Madhura type of rasa Satmyafollowed by 17.50% people were used to Sarvarasa and 2.50% patients having Madhura/Katu rasa dominancy in diet. Most of patients (55%) having Samagni followed by 40% were having Vishmagni and 5% of Mandagni. 65% patients were having Madhyamakoshtha, 30% patients belong to Mradukoshthaand 5% having of Krurakoshtha. In 65.50% patient"s regular bowel habits and 34.50% were irregular habits. In the study we found that 67.50% patents having Sound sleep, 25% were of Disturbed, 5% Moderate and 2.50% less sleep. We have observed that maximum no. of patients (62.50%) was Normal in mental status as well as 12.50% of Aggressive in nature. Followed by 10% were have Tensile, 7.50% were of Anxious, 5% Tensile/ Depressed and 2.50% were such kind of jolly in nature. In this research study observed that 60% of the patients having Vata-Pittajaprakruti. Followed by 37.50% having Vata-Kaphajaprakrutiand 2.50% were have Pitta-Kaphajaprakruti. Generally, according to the scriptures, patients with Kapha, Vata and Rakta nature suffer more from Mukhadushika, but during the trial, more patients with Vata, Pittaj Prakruti were found who had Mukhadushika. In the scriptures, the properties of Pitta are generally considered to be similar to that of Rakta. Hence, it is also true to some extent. 95% patients were Rajasikain nature and 5% were Tamasika  In all 40 patients were not found any specific risk factors. No any associate symptoms found in all (40) patients. 57.50% patients were suffering since 5 month-1 year of onset of Acne. 22.50% patients having history of Acne for 1-2 month followed by 20% patients having 1-3-year history of Acne.

RESULT-
All the results was calculated by using In Stat Graph Pad Prism 8 software. The"t" and pvalues for each of the group from the analysis result of "PAIRED T-TEST WITHIN GROUPS". The "F" and "p-values" in the row designated "Between group comparison: One-way ANOVA" have been come from "ANALYSIS OF VARIANCE BETWEEN GROUPS" Since between groups comparisons were non-significant for both-before and after treatment for all of the parameters, the POST-HOCK TEST comparisons showing significant difference are blank.

CONCLUSION-
Mukhadushika, described in Ayurveda can be nearly correlated with Acne vulgaris. Dwiharidradikalklep gives quick relief in acne of oily skin and gives better relief in acne of dry skin and no chance of recurrence but Kumkumadi tail works better in acne of dry skin and it has less chance of recurrence. Dwiharidradikalklep and Kumkumadi tail both effectively works on associated symptoms like Vyang, Nilika, Dark spot under the eye etc.Dwiharidradikalklep and Kumkumadi tail combine work better to manage the Mukhadushika (̴ Acne vulgaris). Both clinically and statistically, the therapy given in Group A works better than Group B for the management of Mukhadushika.