Ayurvedic management of Alopecia Areata - A Single Case Study

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CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 284 Ayurvedic management of Alopecia Areata - A Single Case Study Sushama Narlewad 1 , D.V. Hange 2 1 Post Graduate Scholar, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India. 2 Assistant Professor, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India. I NTRODUCTION A person's hair has a big impact on their appearance. Hair loss is a major issue in today's era, which is attributed to a variety of factors, including changed lifestyles, systemic diseases, sleep disorders, countless advertisements that promote hair growth, medications, a stressful life, and cold weather [1] Alopecia areata (AA) is considered a psychosomatic and complex autoimmune disorder. It causes a nonscarring pattern of hair loss. The typical presentation Address for correspondence: Dr. Sushama Narlewad Post Graduate Scholar, Department of Rog Nidan Evum Vikruti Vigyan, Govt Ayurveda College and Hospital, Nagpur, Maharashtra, India. E-mail: narlewadsushama@gmail.com Submission Date: 13/10/2023 Accepted Date: 19/11/2023 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.8.12.43 includes sharply demarcated spherical patches of hair loss, which may present at any age. There are fewer cases in children than in adults, but it has been found to be associated with emotional stress, family history, Down syndrome, and autoimmune disorders [2] In India, the lifetime risk of Alopecia Areata is 1.7% and its prevalence is 0.7% [3] According to signs and symptoms, the disease can be correlated with Indralupta in Ayurveda. In which, vitiated Vata, Pitta causes hair fall, and Kapha , Rakta blocks the opening of the hair follicle, so new growth of hair does not occur [4] In modern medicine, corticosteroids are used to treat this type of illness, but they have some drawbacks and side effects, so a harmless and effective medicine is expected from alternative medical sciences. Ayurveda plays a major role in treating this type of autoimmune disorder [5] In Ayurvedic texts, we have detailed studies of the Indralupta. Here is a case of Alopecia areata, which is successfully treated through Ayurvedic management by using Shaman, Shodhan (Jalaukavacharan), and Nidanparivarjan. A B S T R A C T Alopecia areata is defined as patches of hair loss on the scalp. It is considered a psychosomatic disorder in present era. Today, the young generation is more likely to be victims of Alopecia areata, based on clinical grounds. There are many causes of alopecia areata, such as fungal infection, dandruff, scalp psoriasis, seborrheic dermatitis, pediculosis, systemic disorders, autoimmune disorders, etc. It may also be seen as a side effect of chemotherapy or radiotherapy. A 16-year-old patient had patches of hair loss on his scalp. He had taken treatment with conventional modern medicine, but in vain. The patient was given Ayurvedic treatment for six months on an OPD basis, including Karanj oil for local application, Rakt Pachak Churna, Rasayan Churna, Aarogyavardhini Vati, and Jalaukavacharan (leech therapy). After a 3-months interval, regrowth of the hair was found. This study suggests that Shaman and Shodhan treatment can provide noteworthy relief in Alopecia areata, i.e., Indralupta. Key words: Alopecia areata, Indralupta, Ayurveda, Jalaukavacharan, Leech therapy

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[Find the meaning and references behind the names: Mala, Min]

Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 285 A IM AND O BJECTIVE To study the role of Shaman, Shodhan (Jalaukavacharan ) in Indralupta with special reference to Alopecia areata C ASE R EPORT A 16-year-old patient came to Rog Nidan OPD in Government Ayurveda College, Nagpur with the following complaints since 2 yrs. ▪ Patchy hair loss ▪ Dandruff ▪ Itching ▪ Constipation ▪ Weak appetite History of present illness After taking a detailed medical history of the patient, it was found that he suffered from typhoid fever, for which he received complete treatment in a private hospital and was completely cured. After that, he started losing hair in multiple patches. In addition to that, he was also suffering from dandruff. He was treated with corticosteroids and topical serum for 3 to 5 months in GMC Nagpur but got no relief, so he approached Rog Nidan OPD No. 4 in GAC Nagpur and was diagnosed with Indralupta (Alopecia areata), and treatment was started on an OPD basis Past medical history ▪ H/O of Typhoid 2 yrs ago ▪ No H/O any significant family history of autoimmune disorder and Alopecia areata. Personal history ▪ Diet - Mixed diet (Nonveg - two to three times a month) ▪ Addiction - Non specific ▪ Sleep - Regular sound sleep ▪ Occupation - Student Ashtavidha Pariksha ▪ Nadi - 80/Min ▪ Mutra - Niyamit ▪ Mala - Aniyamit (Malavshambh) ▪ Jivha - Alpa Saam ▪ Shabda - Spashta ▪ Sparsha - Samsheetoshna ▪ Druka - Prakruta ▪ Aakruti - Krusha ▪ Pulse - 80/Min ▪ BP - 120/80 mmhg Systemic examination R/S - Clear, AEBE CVS - S 1, S 2 normal, no added sounds. CNS - Conscious, well oriented Laboratory Investigation Haematological investigations carried out to exclude any other disease. CBC, B.T., C.T. and Serological investigations carried out to perform Jalaukavacharan. Table 1: Laboratory Investigations of Patient Hematological Hb% 14.0% Total R.B.C 5.14 mil/c.mm Total W.B.C 7000/cu.mm Neutrophil 56.8% Eosinophils 4.1% Basophil 1% Monocytes 3.5% Lymphocytes 34.1% ESR 05 mm/hr Bleeding time 1 min 26 sec

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[Find the meaning and references behind the names: Anna, Rasa]

Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 286 Clotting time 3 min 06 sec Biochemistry RBS 94 mg/dl Serological HIV test Negative HBsAg Test Negative VDRL test Negative Table 2: Thyroid profile T 3 168.5 ng/ml T 4 10.44 ug/dk TSH 2.50 u/U/ml Scalp Examination Inspection Frontal region: One large patch of 12×5 cm, Multiple small patches of 2×1 cm Parietal Region: Multiple patches of 4×2 cm Temporal Region: Both sides, 2 patches of 3×2 cm Occipital region: More than 3 patches of 3×2 cm Scalp: 3 to 4 boils on the scalp with intense itching. Samprapti Ghataka Dosha - Vata, Pitta, Kapha Dushya - Rasa, Rakta, Asthi Agni - Mandagni Srotas - Anna, Rasa, Rakta, Asthivaha Srotas Sroto Dushti - Sanga Adhisthana - Shirah and Shirah Kapala Sadhyasadhyata - Kriccha Sadhya M ATERIALS AND M ETHODS Clinical assessment made from classical symptoms and SALT score [3] Table 3: Following medicines were prescribed during the course of treatment. Medicine Dose & Duration Action 1. Aampachak vati 1 BD for first 7 days ( Aampachan) Digestion and Appetizer 2. Laghumalini Vasant Godanti Bhasm Gudvel Satwa Sitopaladi Churna 10 gm 32 parts 10 gm 10 gm 30 gm 1 part BD with milk for 16 days. Jwaraghn, Saptadhatuvardhak 2. Aarogyavardhini Vati 2 BD After meal, for 42 days Hepatoprotective, Blood purifier 3. Raktpachak Churna 1 gm BD After meal for 6 months. Blood purifier 4. Rasayana Churna 1 gm BD After meal for 6 months. Promote immunity 5. Yashtimadhu Churna 1 gm BD After meal for 6 months. Promote hair growth 6.Vidang Churna 1 gm BD After meal for 6 months. Krimighn , antifungal 7. Saptamrit Loha 1 BD After meal for 6 months. Raktadi Dhatuvardhak 8. Trivritt Avleh 5 gm at night with lukewarm water for 6 months. Sukhvirechak (purgative) 9. Karanj Tail Shirobhyanga (Local application), Twice a day for 6 months. Antiseptic, Antifungal, Antioxidant (boost overall hair health) 10. Aamlakichurna + Yashtimadhu Churna + Bhringraj Churna Shirolepa (L.A) Once a day, for 6 months Promotes hair regrowth 11. Bhringaraj Ghanvati 1 BD For 6 months Keshya

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[Find the meaning and references behind the names: Hamsa, Green]

Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 287 Panchakarma procedures ▪ 3 Setting of Jalaukavacharan , after 15 days interval. ▪ Snehan-Swedan was prescribed prior to leech therapy. ▪ Cleaning of part of the body to which Jalauka, is going to be applied. Mode of action of Jalauka [6] Wherever Shastra Karma is not appropriate, Anushastras like Jalauk a can be applied to human beings as well as animals. According to the type of disease, the patient, and the predominance of Doshas , many methods of bloodletting have been developed. Jalauka are primarily employed in Pitta and Rakta Dushti Vikar since they are Madhura Rasa Yukta and live in cold and fresh water, making them suitable for Pitta Prakriti people. In the same way that the Hansa bird separates milk from water and only consumes milk , Jalaukas sucks only impure blood first then pure blood. Shringa, Jalauka, and Prachhan, have localized action; only Siravedha has generalized action; hence, Jalauka can be used in many Pitta aggravated Raktaj disorders by applying it to the affected region locally. It contains not only hirudin but also a number of enzymes like bdellin apyrase, decrosin, collagenase, egilin, hementin, hyaluronidase, and orgelasel etc. It also has the action of vasodilaton and is an anesthetic. R ESULT After 6 months of treatment, there was marked improvement in the signs and symptoms of Alopecia areata. This was assessed by the SALT score, which is useful for the quantitative assessment of hair loss. After treatment, S 4 turns into S 0. Salt Score [3] Table 4: Scalp divided into 4 quadrant Top 0.4 × 80% = 32% Post 0.24 × 90% = 21.6% Right side 0.18 × 40% = 7.2% Left side 0.18 × 40% = 7.2% Total 68.0% Table 5: Severity of Scalp Hair loss was classified as [7] S 0 No Hair loss S 1 1 to 24% Hair loss S 2 25 to 49% Hair loss S 3 50 to 74% Hair loss S 4 75 to 99% Hair loss S 5 100% Hair loss Total = 68% Hair loss so score is S 3 Table 6: Pathya-Apathya Pathya Apathya ▪ Nidanparivarjan ▪ Laghu-Snigdha Ahar ▪ Fresh fruits, leafy green vegetables and sprouts ▪ Nidanparivarjan ▪ Meditation (Yoga, Pranayam) ▪ Regular exercise ▪ Spend time with positive people ▪ Atiushna, Tikshna, Amla, Lavanyukt Sevan ▪ Viruddha Ahar ▪ Vegavrodh ▪ Vatpitta Prakopak, Chinta, Bhaya, Krodha ▪ Divaswap, Ratrojagaran ▪ Street Food Table 7: Observation and Results Days Observation 1 Day Investigation done and medicine given 7 Days Constipation recovered and appetite increased. 15 Days Dandruff reduced 21 Days Mild Improvement in hair loss. 1 Month Improvement in hair fall and growing of some thin hair, from the bald patches.

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Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 288 1.5 Month Bald patches turn into black patch. 2 Month Improved growth of hair on the patches 3 Month All the patches fully covered with black hair 6 Month (Con.) No any new patches observed till date. Before treatment After 2 months of the treatment After 3 months of the treatment

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[Find the meaning and references behind the names: Bala, King, Roman, Ama, Roma, Kala]

Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 289 DISCUSSION The most crucial and first line of treatment in any Vyadhi is Nidana Parivarjana . Pathya Ahara Vihara plays a significant role in the Samprapti Bhang of the diseases. As Agnimandya is the root cause of all diseases, Deepana-Pachana Chikitsa is helpful. Aama Pachak Vati was administered as the patient had Mandagni in order to aid in the digestion of toxins [8] that move through Sira and impede the Roma-Koopa . Lukewarm water was administered at to Trivritt Avleh night for Nitya Virechana and Vatanulomana . After obtaining adequate Agni, Rasayana Chikitsa was initiated to work on the Dhatu level. Rasayana Churna , as portrayed by Acharya Vaghbhatta , predicts that someone will live with black hair for 100 years [9],[10] In addition to that, Saptamrita Lauha advertises Kesha by Dhatu Vardhana Karma . For local treatment, Aamalki, Yastimadhu, Bhringraj Churn for Shirolepa, and Karanja Taila for Darunaka (dandruff). According to Acharya Sharangdhara , Karanja Taila , when administered as Shirobhyanga , will quickly treat Indralupta [11] Laghumalini Vasant, Godanti Bhasm, Gudvel Satwa, Sitopaladi Churn, useful for Jirnjwar, and Dhatuvardhan, Bhringraj Ghan Vati, useful for Keshvardhan and Kesharanjanarth, Aarogyavardhini Vati and Raktpachak Churn act as hepatoprotective and blood purifiers. As the best Chikitsa for Rakta Dushti, Jalaukavacharan Karma was chosen as the Raktamokshana. [6] CONCLUSION Alopecia areata ( Indralupta ) is a difficult, complex condition with a poor prognosis. Ayurveda has its own principles for the diagnosis and treatment of diseases. In Ayurveda, treatment changes from individual to individual even though their disease is the same. Ayurveda treats every disease, considering diseases such as Prakriti, Desha, Kala, Avastha, and Bala . Nidanparivarjan , following Dincharya and Ritucharya as described in Ayurveda , is very essential to getting rid of any disease. Indralupta is considered Tridoshaj , but Vata Pitta is more predominant. In this case, we have given Aampachak Vati, Raktapachak Churna, Rasayan Churna and Aarogyavardhini Vati to this patient. As there was a previous history of enteric fever, we have given Laghumalini Vasant, Guduchil Satwa. Leech therapy was given with a 15-day regular interval; in this case, we observed a significant result within 3 months. REFERENCES 1 Misar S. Management of Khalitya (Hairfall) by Ayurvedic formulations - A Review. AyurPub. 2019;2(5):675-680. Available from: https://ayurpub.com 2 Khopkar U. Skin diseases and Sexually Transmitted Infections, 7 th Edition, Reprint 2019, Chapter 16, Page 187. 3 Kolalapudi S. Alopecia areata: An update. Indian Journal of Dermatology, Venereology, and Leprology. 2013 Sep- Oct;79(5). 4 Murthy KR. Astang Samgrah, Chaukhambha Orientalia, Varanasi. 2 nd edition; 2000. Uttarsthan, Adhyay 27, Page 242. 5 Gawai V. An Ayurvedic Management of Alopecia Areata (Indralupta) In Children: A Case study. European Journal of Pharmaceutical and Medical Research. 2021;8(9):657-659. 6 Kirti K. A Conceptual study of Jalaukavacharana. World Journal of Pharmaceutical and Medical Research. 2022;8(5):123-125. 7 King BA. Defining severity in Alopecia Areata: Current Perspectives and a Multidimensional Framework.

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[Find the meaning and references behind the names: Mar, Ayush, Nil, Med, April, Prakashan]

Sushama Narlewad et al. Ayurvedic management of Alopecia Areata ISSN: 2456-3110 CASE REPORT December 2023 Journal of Ayurveda and Integrated Medical Sciences | December 2023 | Vol. 8 | Issue 12 290 Published online 2022 Mar 31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC 9021 348/ 8 Motwani M. Ayurvedic Management of Indralupta (Alopecia Areata) with Raktamokshana (Pracchana Vidhi) and Shirolepa. Int J AYUSH Case Reports. April- June 2023;7(2). 9 Tripathi B. Ashtanga Hridaya Uttara Tantra 39/159, Choukhambha Surbharati Prakashan, Varanasi: 2017, p- 1202. 10 Das G. Bhaishajya Ratnavali, Pandurogadhikara 12/125, Choukhambha Surbharati Prakashan, Varanasi: 2017, p- 386. 11 Tripathi B. Sharangdhara Samhita Madhyam Khanda 9/156, Choukhambha Surbharati Prakashan, Varanasi: 2019, p-158. ******************************* How to cite this article: Sushama Narlewad, D.V. Hange. Ayurvedic management of Alopecia Areata - A Single Case Study. J Ayurveda Integr Med Sci 2023;12:284-290. http://dx.doi.org/10.21760/jaims.8.12.43 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2023 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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