Ayurvedic Management of Vyanga Patient with Jalaukavacharana

Background: A Beautiful face is often one which is in perfect proportion related to eyes, nose, lips and mouth. To maintain beautiful and flawless healthy skin people are being attracted towards cosmetic products, treatments, and surgeries. Painless bluish black patches ( Niruja shayava varna mandalas ) due to prakopa of Vata, Pitta and Rakta dhatu are the characteristic features of the Kshudraroga called as Vyanga . This is mostly seen in childbearing age. Virechana and Raktamokshana are the best treatment modalities for Rakta dushit janya vikaras . Aim & Objectives: To evaluate the efficacy of Jalaukavacharana (Leech application therapy). Material : A 40-year-old female patient reported to Panchkarma O.P.D. with complaints of dark brown blackish colored patches on face mainly on cheeks, nose and above the eyebrows region since 2 yrs. No pain, itching, burning sensation. Methods: Jalaukavacharana sitting on 1 st , 7 th , 14 th and 21 st day. Two Jalauka’s were applied over cheeks and one leech was applied over forehead. Discussion:


INTRODUCTION
A Beautiful face is often one which is in perfect proportion related to Eyes, Nose, Lips and mouth.To maintain beautiful and flawless healthy skin people are being attracted towards cosmetic products, treatments, and surgeries.Vyanga commonest skin condition which decreases glowing complexion of facial skin which is mentioned under Kshudraroga (minor disease).Acharya Sushuruta explained Mansika Nidanas for Vyanga like krodha, [Anger]  As per the classical texts of Ayurveda, observed symptoms which are presented in this case can be correlated with Vyanga.In this case, after two sitting of Jalaukavacharaṇa, patches on face mainly on cheeks, nose and above the eyebrows region was reduced and color shades of lesion were disappeared after three sitting of jalukavacharana.Method of applying of Jalauka: Jalaukavacharana sitting on 1 st , 7 th , 14 th and 21 st day.Two Jalauka's were applied over cheeks and one leech was applied over forehead.

PURVA KARMA
• Purification of leech by pouring the leech in water mixed with turmeric powder.
• Part preparation -Wipe the affected part with cotton gauge piece.Cleaning of part of body with luke sterile warm water to which leech is going to be applied.

PRADHANA KARMA
Leech will be grasp with wet gauge piece; it will catch damaged skin better way and will adhere at that place.If leech is not able to adhere and bite.If leech does not bite by doing so, then prick the skin with a sharp and sterile needle and apply the leech through its oral sucker and cover the leech by wet gauge piece.

Observation of leech -
When Jalauka bites the affected area and start sucking, then anterior sucker makes the shape of a horse shoe (Ashwakhurawatananam, Unnabhyavaskandham).When feeling of itching and pain occurs at the site of application, it indicates that Jalauka started to suck the shudha rakta, then leech will be removed.

Removal of leech
After 30-70 minutes the leech is removed by itself, or by application of turmeric powder on the leech's mouth.

PASCHATA KARMA Care of Wound :
After detachment of leech there is triangular wound created by the leech's mouth.
The blood comes out from the wound.The bleeding from wound is checked by application of Yastimadhu or turmeric powder.

OBSERVATIONS AND RESULTS :
Before Treatment: Dark patches .
After 15 days Treatment: The patient was photographed before and after Jalauka application.After leech application, patches on face was reduced and then disappeared after 3 sitting.The patient was advised to avoid diet which is predominant of kaṭu (pungent), amla (sour), lavaṇa (salty) tastes as they would, vitiate rakta and pitta.

DISCUSSION:
As vyanga is produced due to rakta dhatu dushti so raktamokshana is necessary.Raktmokshana is the main part of line of treatment of skin diseases.So raktamokshan by jalukavacharana (leech application) is done to remove rakta dhatudushti.After jalukavacharana color of patches on face is lightened in first 2 setting and after 3 setting patches was disappeared.Amongst various type of raktmokshana, jalaukavacharana seems best for vyanga patients.Because it is easy to apply on any area and for those who had only 1 or 2 small patches on face.

CONCLUSION:
However, this case study shows that the success of Ayurvedic therapy in vyanga without any adverse effect.After 3 sitting of jalukavacharana it was reported that patient get relief frown dark brown blackish patches.There raktaprasadaha, available for the skin diseases in Ayurved which gives better results than modern medicines but the shodhana therapy gives immediate result.Also, modern medicines may develop some side effects which are hazardous.Ayurvedic medicines are safe and it gives complete relief in critical condition like hyperpigmentation.It can be considered as Vyanga mentioned in Raktapradoshaja vikar and can be successfully treated by using rakatavsechana.

Table 1 -Showing nidana of Vyanga
shok,[Grief] Aayas, vitiate Vata dosha, Pitta dosha, Rakta dhatu and symptoms comes on Mukha [Face] especially on cheeks, forehead, upper lips, chin and temporal region.Cardinal features of Vyanga are Niruja Tanu Shavavarna Mandalas [Painless thin and bluish-black patches].Ayurveda has mentioned Shamana, Shodhana and Bahya Chikitsa for Vyanga which have no any • Email: editor@ijfmr.commakes the face soft, smooth and enhances the complexion.Bloodletting (Raktavsechana) is also related as Rakatashodhaka, Pittahara, Vatanulomaka and Agnidiptikar which helps for removal of toxin from skin and help for glowing.
IJFMR240426100Volume 6, Issue 4, July-August 2024 2 side effects on skin and affordable too.Treatments includes Raktashodhana, Varnyakarana, Abhayanga[ oil application] with herbal medicated oils, Lepa, [face mask] Nasya (nasal instillation with herbal oils)etc.whichSAMPRAPTIThepathogenesis of Vyanga in different Ayurvedic text is described below: Sushruta Samhita: Vyanga is a type of Kshudra roga described by acharya sushruta in Kshudra roga nidana.It is caused by vitiated vata-pitta dosha due to krodha and aayasa and characterised by presence of niruja, tanu, shyava varna, mandala on the skin of face.KRODHA AND AAYASA (Nidana sevana) VITIATION OF VATA AND PITTA DOSHA REACHES MUKHAPRADESHA APPEARANCE OF NIRUJA, TANU, SHYAVA VARNA MANDALA CASE REPORT On Sep 19, 2023 a 40-year-old female patient reported to Panchkarma O.P.D. with complaints of dark brown blackish colored patches on face mainly on cheeks, nose and above the eyebrows region.No pain, itching, burning sensation.History of present ilness:Patient was quiet asymptomatic 2 year ago,then she had gradually developed dark brown blackish colored patches on face mainly on cheeks, nose and above the eyebrows region.She took allopathic treatment for above mentioned complaint, which gave her temporary relief but as soon as she stopped the medication her problems arises again.History of past illness:No H/O of DM/HTN/T3/T4/TSH Family history: not any significant history.O/E: Dark brown blackish colored patches on face mainly on cheeks, nose and above the eyebrows.Personal history• Diet -vegetarian • Addiction -NIL • Sleep -not-disurbed • Bowel -not constipated• Micturition -normal SYSTEMIC EXAMINATION P/A: Soft, non tendered R/S: Adequate air entry B/L,no added sound CVS: S1,S2 heard normal Vitals: Pulse: 82/min, B.P.: 110/70 mm of Hg, temp.-98.6FInvestigations: Hb-11gm% CT-6min BT-2min.