Risk Factors Affecting Khalitya (Hair Fall) As Per Deha Prakruti- A Case...

[Full title: Risk Factors Affecting Khalitya (Hair Fall) As Per Deha Prakruti- A Case Control Study Among Adults]

52 Journal of Ayurvedic and Herbal Medicine 2023; 9(2): 52-55 Research Article ISSN: 2454-5023 J. Ayu. Herb. Med. 2023; 9(2): 52-55 Received: 26-03-2023 Accepted: 26-05-2023 © 2023, All rights reserved www.ayurvedjournal.com DOI: 10.31254/jahm.2023.9204 *Corresponding author: Dr. Nakel Mahavir Pannalal Assistant Professor Department of Community Medicine, Dr. SCGMC, Nanded, Maharashtra, India Email: drmahavir 08@gmail.com Risk Factors Affecting Khalitya (Hair Fall) As Per Deha Prakruti- A Case Control Study Among Adults Shete AS 1 , Pawar Ujwala 2 , Nakel MP 3 1 Assistant Professor, Department of Rognidan and Vikruti Vigyan, Govt. Ayurved College, Nanded, Maharashtra, India 2 Department of Rognidan and Vikruti Vigyan, Govt. Ayurved College, Nanded, Maharashtra, India 3 Assistant Professor, Department of Community Medicine, Dr. SCGMC, Nanded, Maharashtra, India ABSTRACT Introduction- Ayurveda is the system of medicine for the concept of diseases and health. It is based on concept of Dosha, Dhatu and Mala. As we are following of western life style and food habits blindly, the equilibrium state of Doshas is rapidly disturbing and thus results in shortening of average life expectancy and also now prone towards the Khalitya (hair fall) in early age . Aim & Objectives- Aim - To assess risk factors associated with the Khalitya (Hair fall) in relation to different Deha Prakriti . Objectives- To define level of Khalitya (hair fall) in different Deha Prakriti with the use of hair pull test. To assess the effect of aharaj and viharaj factors in causing Khalitya. Material and Methods- Study design – It is an observational case control study. Male adults of age group between 20 to 50 years were selected. Convenient sampling was used. Cases (50) and controls (50) were selected in 1: 1 proportion. Results and Discussion- Age factor play an important role in Khalitya (p = 0.0365); as age increases the possibility of hair fall also increases. It is well known that, as the level of stress and anger increases, the propensity to develop Vata and Pitta also increases and thereby causes to hair fall. Conclusions- Age is the significant risk factor in causing Khalitya (hair fall); as age increases, there is increased tendency to have hair fall and thus in long run, this will contribute to increased proportion of male pattern baldness among adults Keywords: Lavana, Rasa, Vata Prakriti, Pitta Prakriti, Kapha Prakriti. INTRODUCTION Ayurveda is the system of medicine for the concept of diseases and health. It is based on concept of Dosha, Dhatu and Mala. Day by day our lifestyle is changing rapidly. As we are following of western life style and food habits blindly, the equilibrium state of Doshas is rapidly disturbing and thus results in shortening of average life expectancy and also now prone towards the Khalitya (hair fall) in early age . Therefore it is clear that modern life style with food transition and environment changes which would not be tolerated; hence it we are facing difficulties in maintaining good health. According to Ayurveda we can suggest to individual’s good life styles, food and drinking habits connecting to their Prakriti as well as for their healthy hairs. Accordingly individuals can judge the type of food and other healthy habis to maintain his hairs in respect to Daha Prakriti. Salt ( Lavana ) is an integral part of our diet. People consume salt in visible and non-visible way. World Health Organization recommended that, intake of dietary salt should be less than 5 gms/day [1] Healthy persons should consume salt and water to replace the amount lost daily through sweat and metabolism and to achieve a diet that provides sufficient amounts of other essential nutrients. Low salt intake improves blood pressure and can lower the risk of cardiovascular diseases and stroke. Proportion of salt consumption in India varies from state to state i.e. from 8.5 gm/day/person to 42.3 gm/day/person. Though the consumption of dietary salt in Indians is found minimum of 8.5 gm/day [2] As per report of Nutrition Committee of American Heart Association, normal daily salt intake is 1.6 to 3 teaspoons of sodium chloride (NaCl) in United States of America. This is equivalent to 7.6-10 g of NaCl. The current mean level of daily salt (NaCl) consumption is almost 9 g in U.S.A. It an urban study in India reported that, a mean dietary salt intake of 8.5 g/day among Indians. [3] Excessive consumption of salt is a common dietary practice among large proportion of people now a days. This is affecting the health of the people not immediately but steadily. In Charak samhita, Acharya Charaka had described the “Ati - upayunjit Lakshana” of “Lavana Rasa” [4] Acharya said that if people are consuming excessive salt and salty food for long duration, surely they will cause increased frequency of hair fall ( Khalitya ). According to Acharya Charaka salt is associated with hot and sharp properties.

53 Journal of Ayurvedic and Herbal Medicine|April-June|2023 It is neither very heavy nor very greasy. Salt is however responsible for the accumulation of Doshas if not used properly. In a small dose, salt can even be used continuously in the preparations of food items but such continuous use in large dose is harmful. According to Acharya Vagbhata, when salt used in excess, it causes to increase in ‘ Asra ’ (blood) and ‘ Pavana ’ ( Vata ), leading to frequent hair fall, baldness, graying of hair, wrinkles of the skin, thirst, leprosy (i.e. skin diseases), poison effect and diminution of strength of the body. [5] So, based on this background, it is a need of hour to explore the effect of aharaj and viharaj factors in causing Khalitya . Hence present study was undertaken to assess some risk factors affecting Khalitya (hair fall). Aim- To assess risk factors associated with the Khalitya (Hair fall) in relation to different Deha Prakriti . Objectives - • To define level of Khalitya (hair fall) in different Deha Prakriti with the use of hair pull test. • To assess the effect of aharaj and viharaj factors in causing Khalitya. MATERIAL AND METHODS Study design - A observational case control study. Study population- Male adults of age group between 20 to 50 years. Sampling and sample size : Convenient sampling was used. • This was a case control study undertaken to evaluate risk factors among cases and controls selected in 1: 1 proportion. • Case - subjects having hair fall (Positive result on hair pull test). • Control - Subjects without having hair fall (Negative result on hair pull test). • Total 100 subjects (50 cases and 50 controls) were interviewed (Marathi/Hindi questionnaire) using predesigned and pretested semi structured proforma. • The questionnaire includes topics related to socio-demographic information like age, occupation, details of deha prikriti and aharaj and viharaj factors among the study subjects. Inclusion and exclusion criteria- • Male adults of age group between 20 to 50 years and those given consent for interview were included in study. Other subjects who denied consent will be excluded from the study. Study plan- Assessment of Khalitya- Identification of Khalitya was done with the help of Hair pull test in the study subjects 1. Hair pull test- Approximately 20-60 hairs are grasped between the thumb, index and middle fingers from the base of the hairs near the scalp and firmly, but not forcefully, tugged away from the scalp. If more than 10 % hairs are pulled away from the scalp, this constitutes a positive pull test and implies active hair falling. This simple test measures the severity of hair loss. This is also known as the 'traction test' or 'Sabouraud's sign' or the 'pull-out sign. Pre-requisite is that, the patient must not shampoo for at least a day prior to the pull test. [6] 2 . Selection of cases having hair fall (positive on hair pull test) and controls without khalitya (Hair loss) on hair pull test - Cases were selected based on Hair pull test - Pull test-approximately 20-60 hairs are grasped from the proximal portion of the scalp and tugged from the proximal to the distal end. 3. Measurement of frequency of salt and salty food consumption- In present study as per questionnaire, approximate salty food consumption was asked with the help of sub questions in the form of average frequency (In a frequency of daily, weekly and monthly consumption) to get an approximate estimate of high salty food intake in an individual. 4 Measurement of frequency of junk food and spicy food consumption- In this study according to questionnaire, approximate salty food consumption was measured with the help of sub questions in the form of average frequency (In a frequency of daily, weekly and monthly consumption) to get an approximate estimate of junk food consumption in an individual. 5. First we assessed Khalitya (Hair fall) with the help of hair pull test and examination of the Prakriti of 100 subjects by Darshan (inspection), Sparsh (touch), and Prashna (question) with the structured questionnaire. Samples were divided in two groups according to age group to observe Prakriti for Khalitya in relation to hair fall. The questionnaire, which is prepared for the assessment of Prakriti based on distinctiveness described in standard textbooks of Ayurveda Statistical analysis – MS-Excel 2010 was used for data analysis. Appropriate tabular presentations were displayed wherever necessary. An effort was made to compare cases and controls according to different Deha Prakriti. Chisquare test was used to analyze association between Khalitya as a outcome and its risk factors. Level of significance was kept at 5 % (p=0.05) in Univariate analysis. RESULT AND DISCUSSION Table 1: Distribution of subjects as per classification of age and occupation Parameter Cases (50) Controls (50)  2 test and p Value Age (in completed years) 21 to 30 11 23  2 value 6.617, p value = 0.0365 31 to 40 21 13 41- 50 18 14 Occupation Private job 9 6  2 value 2.302, p value = Govt. employee 11 10

54 Journal of Ayurvedic and Herbal Medicine|April-June|2023 Business 12 16 0.6802 Farmers 5 8 Self employment 13 10 Total 50 50 100 Table 2: Distribution of study subjects as per Deha prakruti and development of Khalitya Deha prakruti Cases Controls  2 test and p Value Pitta 24 12  2 value 7.45, p value = 0.0241 Kapha 16 18 Vata 10 20 Total 50 50 Table 3: Distribution of study subjects as per aharaj factors causing Khalitya Parameter Frequency Cases (50) Controls (50)  2 test and p Value Type of food Veg 19 33  2 value=7.85, p value = 0.0050 Mixed 31 17 Junk food / Packaged food consumption Daily 21 11  2 value= 7.25, p value = 0.0266 Once in a week 17 15 Once in a month 12 24 Spicy food consumption Daily 22 27  2 value=1.16 , p value = 0.5583 Once in a week 15 11 Once in a month 13 12 Salty food consumption Daily 31 17  2 value= 8.78, p value = 0.0123 Once in a week 9 11 Once in a month 10 22 Salt consumption < 5 grams 8 39  2 value = 38.57 , p value < 0.00001 > 5 grams 42 11 Total 50 50 100 Table 4: Distribution of study subjects as per Viharaj factors causing Khalitya Parameter Frequency Cases (50) Controls (50)  2 test and p Value Atiushna Jal Snana Yes 33 14  2 value=14.49, p value = 0.0001 No 17 36 Ksharyukta Jal snana Yes 37 7  2 value 36.52, p value = 0.00001 No 13 43 Atap sevan Yes 7 4  2 value=0.91, p value = 0.3376 No 43 46 Dandruff/ Scalp infection Yes 42 23  2 value =15.86, p value = 0.00006 No 8 27 Addiction Yes 36 12  2 value 23.07, p value = 0.00001 No 14 38 Total 50 50 100 Note- Addiction includes (Smoking, Alcoholism, Tobacco product chewing etc.) This study was carried out 100 adult subjects with the objective to assess the risk factors associated with Khalitya (Hairfall). Table no. 2 shows that there is pitta predominance among the subjects showing significant difference among the study subjects as per the deha prakriti (p value = 0.0241) Vata properties like Ruksha, Khara and Parusha dominates in Vata Prakriti subjects; therefore their hairs are affected with above mentioned qualities of Vata dosha . These qualities may harm the hairs as well as scalp ‘(Keshbhumi)’. Subjects with Pitta prakriti have more ‘ Khalitya ’ (hair loss) compared to other two Prakriti . Age factor may be responsible for ‘ Khalitya’ (hair loss) as shown in table no.1. (p = 0.0365); as age increases the possibility of hair loss also increases. [7,8] Type of occupation was not found to have significant association with hair fall, as depicted in table 1 (p value = 0.6802). It is well known that, as the level of stress and anger increases, the propensity to develop Vata and Pitta increases and it finally causes to hair fall. There were many loopholes to understand nature and extent of hair loss in relation to Prakriti. Ayurveda has specific identification of individuals on the basis of physical and mental constitution as Prakriti. The study designated on a scale to examine the hair fall with the help of hair pull test on which ayurvedic theory of effecting hair fall can be proved of having higher proportion of hair fall in subjects with predominance of Pitta Prakriti as compared to Vata and Kapha Prakriti . Thus, it has been focused that, in Ayurveda, Pitta (fire) is considered to be the root factor that governs skin and hair health. An imbalance of the same (i.e. excess Pitta ) can lead to issues like premature hair loss and early greying Aacharya Charaka stated that the Paitik Prakriti individuals are having very aggressive mentality Sharangadhara had explained that these subjects are having more anger Aacharya

55 Journal of Ayurvedic and Herbal Medicine|April-June|2023 sushruta also commented that Pitta Prakriti is the leading cause of anger. All these attributes affects growth of hairs and thus results in Khalitya (Hair fall) In present study, it was seen that maximum proportion of subjects those consuming Mixed diet, Junk food, Packaged food, Salty food and Salt consumption more than 5 grams per day were found to have prominent impact on hair fall which was significantly contributing to male pattern baldness in future. It was also observed that, viharaj factors viz. Atiushna jal snan, Ksharyukta jal snan, frequent scalp fungal infections causing Dandruff and Addictions were significantly associated with increased frequency of hair fall. CONCLUSIONS - It was concluded that, age is the significant risk factor in progression of Khalitya (hair fall); as age increases, there is increased tendency to have hair fall and thus in long run, this will contribute to increased proportion of male pattern baldness among adult population. - It was also observed that, junk/packaged food, salt and salty food consumption were the leading food etiologies of Khalitya (hair fall) among study subjects. - Subjects with predominant Pitta prakriti who takes junk/ packaged food and salty food frequently, would aggravate hair fall and would be more prone to have excess hair fall in future; thus concluded that, the aharaj and viharaj factors in addition to deviant Deha prakruti are having an important etiological role in development of Khalitya (Hair fall). Thus, it also corroborates with the theory of Ayurveda that, Pitta Prakriti subjects with other contributing co-factors are more prone for developing Khalitya. Limitation- Manas hetus and hair fall could not be studied in detail as manas hetus are mostly subjective and detailed psychological scale assessment would be required to assess its role in relation to Khalitya (hair fall); there may be scope to explore these factors further. Conflict of interest None declared. Financial support None declared. Acknowledgement We are thankful to all the subjects for their support and co-operation throughout the study. We are also grateful to all concerned involved in this study and thanks are must for their valuable support during the study. ORCID ID Dr. Nakel Mahavir Pannalal: https://orcid.org/0000-0003-1285-230 X REFERENCES 1 Radhika G, Sathya RM, Sudha V, Ganesan A, MohanV. “Dietary salt intake And hypertension in an urban population south India population.” J of Asso of Physicians of india, June 2007 ;55:405-11. 2 Sohel Reza Choudhary. Technical working group Meeting on Regional action plan and targets for prevention and control of Non communicable diseases. Bankok, Thailand, 11-13 June 2013, Session 1 Salt / Sodium Intake. 3 Ragavendra R. Baliga & Jagat Narula /Salt never calls itself sweet/Indian J Med Res 129, May 2009, 473-74. 4 Ravi Dutta tripathi, 5 th edition 2005, Vimana Sthan, Rasaviman Adhyay , 18 th shlok , page no. 552-553 5 K R Shrikant Murti/ Astang. Hridayam /First volume/2013/ Chaukhambha prakashan / 10/ 13/ 145. 6 Francisco M. Camacho-Martinez. Hair loss in women. Semin Cutan Med Surg. 2009;28:19 – 32. 7 Mukesh Gupta. A study on anatomical characteristics of eye with reference to Deha Prakriti. Journal of Ayurveda. Vol-3 / July-Sep 2009. Jaipur/National institute of Ayurveda . 8 Drirk Kranz.Body image. Young men’s coping with Androgenetic alopecia-(HNS). Sept. 2011. Volume 8/issue 4/343-348 HOW TO CITE THIS ARTICLE Shete AS, Ujwala P, Nakel MP. Risk Factors Affecting Khalitya (Hair Fall) As Per Deha Prakruti- A Case Control Study Among Adults. J Ayu Herb Med 2023;9(2):52-55. DOI: 10.31254/jahm.2023.9204 Creative Commons (CC) License- This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. (http://creativecommons.org/licenses/by/4.0/).

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Dhatu, Dosha, Rasa, Ayurveda, Vata, Pitta, Kapha, Prakriti, Lavana, Mala, Age, Pittaprakriti, Vataprakriti, Khalitya, Dehaprakriti, Salt, Adult, Age factor, Type of food, Food habit, Hair loss, Addiction, Kapha Prakriti, Study design, Hair fall, Pitta predominance, Junk food, Case-control study, Deha Prakruti, Hair pull test, Risk factor, Western lifestyle, Dandruff, Mixed diet, Aharaj Factors, Viharaj Factors, Male pattern baldness, Salt consumption, Dietary salt, Observational case control study, Scalp infection, Convenient sampling, Study subject, Significant Risk Factor, Male adults, Packaged food, Salty food, Atap sevan.