Symptoms
SAMPRAPTI OF YUVANA PIDAKA
The accurate knowledge of Samprapti not only helps in the understanding of the specific feature, but very essential for the line of treatment. Generally in the discussion of Samprapti of any disease, the component to be essentially considered are Doshas, Dushaya, Srotas, agni , Ama, Sthanasamshraya of Doshas at the point of Khavaigunya Producing a disease.
According to Shushruta and Vagbhata, the vitiated Kapha, Vayu, Rakta and Medas cause the development of pidakas on the face which resembles the Shalmalikantaka. These causative factors and symptoms have been accepted by other Achyaryas like Vangasena, Madhavakara, Kaiyadeva nighantu, Bhavaprakasha, But in Sharangdhara samhita Vaktra snigdhata and pidaka have been mentioned which are produced due to Shukradhatu mala.
In any of the Ayurvedic classics the exact samprapti of the disease Yuvana pidaka is not available. The Samprapti of the disase is formulated as follows.
Samprapti Ghataka
Dosha - Kapha, Vata
Dushya - Rasa, Rakta, Meda
Mala – Twaksneha
Srotas - Rasavaha, Rakta
Shrotodusti - Sanga
Agni - Jatharagni mandya
Adhisthana - Twak
Samutthana - Ama pakwashaya
Roga Marga - Bahya
Apart from multiple nidanas like Aharaja, Viharaja, Manasika and Kalaja, Bhavaprakasha has revealed that the swabhava indicates the Yuvavastha of the person, and the Shukra Dhatu is produced in excess quantity, which is a natural process. All the causative factors have their effects on Dosha, Dushyas, Agni and Srotas.
Kapha, Vata and Pitta vitiates due to their independent factors that inturn vitiate Rakta, Meda and Twak. Due to production of Ama there is Agnimandya. This vitiated Agni influences Dosha prakopa and Dushya dourbalyata. Due to Viprakristra nidana Khavaigunya takes place in Raktavaha srotas and twak of face,neck and back.
Sthanasamshrya of the doshas takes place due to dourbalya of Twacha, Rakta and Meda. Due to continuation of Nidanasevana, the disease process leads to srotodusti, where sanga occurs by the doshas. This vitiated Kapha and Medas get dried up due to Vata dosha and this stage is considered to be a Dosha-Dushya samurchana. In this stage the Purvarupas will be manifested. Symptoms like Vaktrasnigdhata, Medogarbhita Pidaka can be taken as purvarupas in this disease.
In Rupavastha stage the clinical features depend on the dosha and dushyas involved. Rupas like Shalmali kantakakara, Saruja, Ghana, medogarbhita pidaka will be seen. Among these sarujata is due to Vata dominance, Ghana, Medhogarbhita are due to Kapha predominance and brownish colored lesions and paka shows rakta dusti.
TYPES OF YUVANAPIDAKA
The types of Yuvana Pidaka have not been mentioned in our classics but on the basis of involvement of predominant Doshas and symptoms the disease can be classified. The eruption which is very painful, rough to touch and black in color can be considered as vataja variety. The eruption which predominantly has Kandu, aruna Varna, kathina, mild pain then it is of Kaphaja type. The lesions black or reddish in color, with reddish discharge then it is considered as Raktaja Yuvana pidaka. Symptoms that appear after the combinations of two doshas are considered to be Dwandwaja.
NIDANA
In the brief description available for the disease ‘Yuvan Pidaka’ all the Samhitas have mentioned Kapha, Vata, Rakta, as the causative factors of the disease while Bhavaprakasha mentioned swabhava (Bh.Pr.utt 61/31) as the cause of the disease. In Sarangdhara Samhita, Vaktra snigdhata and Pidaka have been mentioned which are produced due to Shukradhatu mala (Sa.S.Pr.Kh.5/13-15). So it may be concluded that the Swabhava of the particular age, Excess production of Shukra Dhatu and its mala along with the imbalanced state of doshas is the cause of the disease.
Here in this condition the main causative factors involved are Vata, Kapha dosha and Rakta. So nidanas which vitiate the same are considered here.
Kapha Prakopaka hetu (Aharajanya and Viharajyanya)
Gurudravya sevana, madhura,snigdha,pichilla,abhishandi dravya sevana, dugdha, dadhi, ikshurasadi dravya sevana, ghrutanirmita bhakshya padartha, payasa sevana, anupamamasa,audaka mamasa sevana, vasa, yavaka, masha, godhuma, tilakutha, krushara, madhura phala, navanna, shaskuli,amadugdha,kadaliphala, kharjura are the kapha prakopaka ahara.
Avyayama, alasya, ratrijalapana, adhika jala pana, vegadharana (chardi), virechana ayoga, asya sukha, ajeerna etc are the causative factors which are responsible for Kapha prakopa.
Vata Prakopaka hetu (Aharajanya and Viharajanya)
Rukshanna sevana, kashaya, tikta, katu dravya adhika sevana, shyamaka, mudgha sevana, adhaki, harena, kalaya, nishpava, vishthabi padartha sevana, ankurita anna sevana, tranadhanya, vishtambhi, heenabhojana, shushka bhojana, ativyama, aptarpana, langhana, bhagna, dhatukshaya, ratrijagarana, vegavidharana, atishoka, atishita, atibhaya, kshobha, ativyavaya, atiadhyashana, abhighata, bharaharana, anashana, vishamashana, adhyashana, chinta, rogajanya krushata, dukha shayana etc are the factors which aggravate the Vata Dosha.
Rakta Prakopaka hetu (Aharajanya and Viharajyanya)
The factors which are responsible for the vitiation of Pitta dosha also vitiate the Rakta dosha.
Lavana,kshara, amla, katurasa ati sevana, kulatha, masha, kalaya, the food stuff prepared with more amount of oil, mulakadi harita padartha sevana, jalachara pashu pakshi mamsa sevana, dadhi, kanji, dadhimanda, siraka,(vinegar), atimadyapana, dushita padartha sevana, drava, snigdha or gurubhojana paschat shayana, krodha, vamanadi vega dharana, ati divaswapna, vikrata Madya ati sevana are the predominant factors which vitiate Rakta dhatu.
Due to vitiation of Rakta dosha the symptoms like Kustha, Visarpa, Pidaka, Rakta-pitta, Asragdhara, Dadru, Charmadala, Switra, Pama, Kothasramandalam etc. are produced.
Kalaja factors also influence the disease such as Vasanta, Grishma, Mid day, Sharat kala, Swabhawa (avasthika kala)
Stress, tension, pollution and chemicals are also the major causes that aggravate the Pitta dosha and results in acne, boils, pimples and rashes.
PURVA RUPA
“Purvarupam pragutpattilakshanam vyadheh” (ch.ci.1/8)
The purva rupa is one which originates before the onset of a proper disease.
The disease Yuvana Pidaka is mentioned under the heading of kshudra rogas.
“Kshudra hetu lakshana chikitsitanam kshudraroganaam” (M.NI.64/1 madhukosh)
The exact Purva rupa of the disease is not available in most of the Ayurvedic granthas. Because we find minimal explanation regarding the disease Yuvanapidaka which is available under Kshudra roga. Here the meaning of Kshudra roga is small or laghu, means the disease is explained in very short manner. For each and every Kshudra roga the involvement of doshas and dushyas are not explained in detail but they have been understood according to their symptoms. Accordingly no purvarupas are mentioned in the disease context. Alpa avyakta lakshanas are reffered as purvarupas in general. Thus symptoms like toda, small pidakas, kandu etc. can be taken as purvarupas.
RUPA (signs and symptoms)
“pradurbhuta lakshanam punarlingam” (ch.chi.1/6)
When purva rupa sthita avyakta lakshanas shows its proper effects or symptoms, it is considered as Rupa. The purva roopa of the disease Yuvanpidaka is not available in most of the Ayurvedic classics but the rupavstha of the disease is explained by all Acharyas. Vata,Pitta,Kapha are the responsible factors for almost all the Nija Vyadhis but the signs and symptoms manifested depend on the predominant dosha.
After the completion of Dosha-Dushya Samurchana and Sthansamshraya, particular Signs and symptoms appear which are known as Rupa of the disease. Some time hidden features of the disease become fully manifested which is known as rupa (A.Hr.Ni.1/5)
No ancient classics have mentioned the signs and symptoms of the disease Yuvanpidaka under a separate heading, but there is mentioning of some characteristics during the brief description of the disease.The Pidaka resembling the Kantaka of Shalmali tree, which are found on the face of the young people due to deranged condition of Kapha, Vata, Pitta and Rakta are called as Yuvanpidaka (Su.Ni.13/37) In another context there is a mention of the time of occurrence which is usually in young people during their adolescence (Yuvan). Interestingly all the authors accepted that this disease occurs in adolescent age.
More detailed description regarding signs and symptoms of the condition is explained by the Acharya Vagbhata (A.Hr.Utt.31/6) than Sushrutacharya. The eruption packed with the Meda, similar to the thorn of Shalmali having thier site on the face and which is very painful on touch are called as Yuvanpidaka or Mukhadushika.
The signs and symptoms According to him are:
1) Shalmali Kantakakara- The eruption that is conical shape, found on the face, resembling the Kantaka of the shalmali tree, and having its base on the face is called as Yuvan Pidaka. It is also opined that there is similarity between shape of the thorn and eruption, but some believe that the pain experienced is same as pricking of the Shalmali Kanta. (Hansaraj Nidana Kshudra Roga, 22)
2) Pidaka- The lesion which appears in the form of eruption is known as Pidaka.
3) Saruja- The eruptions are painful. The pain may be severe or mild.
4) Ghana- The word Ghana means solid, hard, thick or indurated. The Pidaka which is ghan on touch is due to vitiated Kapha. (Kalyanakaraka, Kshu.Roga 57).
5) Yuna Mukhe- This disease affects usually an adult face. This word shows the site of origin of Pidaka and time of occurrence of the disease. i.e. Disease occurs in young age and affects the face. Mukha is the outer part of the face which includes cheeks, forehead, nose, chin etc. (A.Hr.utt.31/5 keraliya tika).
The disease which occurs in young age naturally is called as Yuvana pidaka. (Bh.Pr.Utt.61/31).
CHIKITSA
“Tatha chaturnam bhishagadinam shastanam dhatuvaikrute |
Pravruttihi Dhatusamyartha chikitsetyabhidiyate ||” Ch. Su 5
According to Charaka removing the causative factors of the disease may not always result in the total removal of the disease as such because, the effect of the disease may still continue to be functioning. “Hence in this view, chikitsa aims not only at the radical removal of the causative factors of the disease, but also the restoration of the dosha, dhatu, and mala samyata or equilibrium i.e homeostasis.
Mainly two types of Chikitsa have been mentioned in our classics i.e. Shamana and shodhana. With the shaman line of treatment the diseases are going to get cured but there will be every possibility of reoccurrence. Shodhana line of treatment cures the disease from its root and cures permanently. Yuvan Pidaka treatment is explained in different classics under these two headings, so Raktamokshana comes under the Shodhan chikitsa hence considered to be best.
The disease Yuvana Pidaka comes under the Kshudra roga hence Khsudra roga samanya sutra can be taken as Yuvana pidaka samanya Chikitsa sutra.
Kalyanakaraka, in the context of treatment of different kinds of Kshudra roga explained, the causative factor, symptoms, predominant Doshik involvement ,and treatment like Pradeha, Lepana, Rakta mokshana, Upanaha etc. for each and every Kshudra raoga separately (K.Ka. Kshudrarogadhikara 62)
Shodhana Karma in Yuvana Pidaka
Vamana Karma is considered as the best line of treatment in Yuvana Pidaka as per Shusrutas opinion. Even other classics like Ashtanga Sangraha, Ashtanga Hridaya, Chakradatta, Gadanigraha, Bhavaprakash, Bhaishjya Ratnavali, Rasakamadhenu considered Vamana karama as the best line of treatment in Yuvana Pidaka.
(su.chi. kshu. 37, A.H.32/3,A.S.37/5, A.S. 37/5 INDUTIKA, Rasakamadhenu 42, Bhaishajya Ratnavali 39)
Sira Vyadha in Yuvana Pidaka
The involvement of the Doshas in Yuvana pidaka is Kapha, Vata and Rakta. To get rid from these Vitiated Doshas, Raktamokshana is one of the best line of treatment explained in our classics. As per different classics, in Yuvan pidaka Siravydha must be performed over the frontal region (A.S.37/5, A.S. 37/5 INDUTIKA, A.H.32/3)
Lepadi Prayoga in Yuvana Piadaka
According to Shushruta the Lepa plays a very crucial role in curing the disease yuvana Pidaka. Here he mentions different kinds of the Lepas prepared from Vacha, Lodhra, Saindhava, Sarshapa and Dhanyak, which are beneficial in Acne as well as in improving the complexion .( su.chi. kshu. 37)
Astanga Hridaya mentions the application of Lepa prepared with the combination of Dhanyaka, Vacha, Lodhra in Yuvana Pidaka. (A.H.32/3)
He also mentions the application of Lepa prepared with the combination of Yava pistha, Rala, Lodhra, Khasha, Raktachndana churana, Madhu, Ghrita and Guda which are taken in equal quantity in a vessel and add 4 parts of gomutra and make a Paka, until it attains a semisolid state. Later take it out from the agni and cool it. This preparation can be applied over the Acne lesions.
Astanga hridaya mentions the application of the lepa prepared from Saindhava,vacha, Lodhra,Sidharthaka, Adhaki for the same. (A.S.37/5)
In Chakradatta following kinds of lepa preparations are indicated in Acne Vulgaris
- Application of the paste prepared from Lodra, Vacha, Dhanyaka, Gorochana with Marich over the Acne lesion
- Paste prepared from Sweta Sarshapa, Vacha, Lodhra and Saindhava Lavana.
- Lepa prepared Matulunga moola, Ghrita, Manashila and Gorasa.
- Lodhra, Vacha,Dhanya lepa, Gorochana, Maricha lepa, Sweta Sarshpa, vacha, Lodhra, Saindhava lepa, Vata pakwa patra, malati, Raktachandana, lodhra, Kustha, Pita chandana; with these combinations prepare a lepa and apply it . ( Bha.Pr.M.Kha 61/44)
Yogaratnakara also contributes some of the lepa preparations for the disease Acne.-Jayaphala,Chandana,Maricha powder.
Lepa prepared from Sweta sarshapa+Vacha+Lodhra+Saindhava lavana
Application of Gorochana+Maricha
Make a paste of Shalmali kantaka+Kshira and apply it.
Lepa prepared from Vata pakwa patra, Malati,Rakta chandan, Kustha, Kaliyaka, Lodhra.
Lepa preparation with Matulunga root, Ghrita,Manashila and Gorasa (Yogaratnakar Kshudra rogachikits)
In Arka Prakasha one more preparation is available i.e. Shalmali Kantaka paste is prepared with milk and the arka is to be extracted and then apply the same over the Acne lesion. (Arka prakasha Saptama Shataka).
Taila and Ghrita prayoga in Yuvana Pidaka
The Medicated Taila and Ghritas can be used internally as well as externally in the disease Yuvana Pidaka. Here some of the preparations are mentioned
-Haridra taila
-Manjista taila
-Kumkumadya Taila
-Dwaharidradi taila
-Sahachara Ghrita
-Kumkumadya Ghrita
-Maha pancha tikta ghrita
One more special treatment mentioned by the Vangasena is Tila taila Pratimarsha Nasya which is very beneficial in Acne.
Rasendra sara Sangrahakara gives the special preparation called Parada Bhasma Prayoga in Yuvana Pidaka
(1.Rasendra sara Sangraha Dwitiya Adhyaya.
2. Brahat Rasaraja sundaram Kshudra Roga Chikitsa)
PATHYA APATHYA IN YUVANA PIDAKA
According to Chakrapani Pathya means, the one which do not produce any kind of harm to the manas and sharira and opposite to that is called as apathya. (Ch.Su.25/45 Chakrapani)
Kshudra rogas produced by the vitiation of different kinds of Doshas like vata, pitta, kapha and dushyas like Rasa, Rakta, Rogavastha, Rogiavastha etc should be considered and pathya apathya should be planned accordingly. (Bhaishajya Ratnavali 60/184)
Basically the Kshudra roga Pathyapathya has been followed here because the disease Yuvana Pidaka comes under the Ksudra roga hence we can adopt the same modalities here. Here in Yuvana pidaka we can advise the pathyapathya on the basis of Doshas involved i.e. Vata, Kapha and Dushyas – Rakta and medas.
In Kaphaja roga pathya
Vamana, langhana, Anjana, Maithun,Swedana, Chinta, Ratrijagarana, Parishrama, Atyanta Gamana, Trusha vega dharana, Gandush, Pratisarana, Pradhamana, Dhumrapana,Pradhaman, Vyayama, Kshobha, Nasyakarma,Bhaya, Ruksha or Ushna sevana, Purana Shali dhanya, Truna Dhanya, Chanaka, Mudga, Kulatha, Yava,Kshara, Sarshapa taila, Ushnodaka, Rajika, Vartaka, Udumbara, karkotaka, Rasona, Surana, Nimba, Mulaka, Varuna, Kutaki, Trivrutta,Madhu, Tambula, Khasa jala, Purana Madhya, Trikatu, Triphala, Gomutra,Laja, Ushna sthana, Kamsya,Loha, Pearl, Tikta and Kashaya rasa are the pathya in Kaphaja roga.
Pathya in Vataja Roga
Abhayanga, Parimardana, Shamana Karta padartha, Snehakarma, Swedan, Atinidra, Basti,nasya, Vayu parityaga, Shirasnana, Shirobasti, Atapa sevana, Snana, Shyana, Madhya pana, Bhumi Shayan, Sukhpurva shaya, Lavan, Madhura,Amla rasa sevana, Majja, Taila,Vasa, Ghrita, Nvina Masha, kulatha, Tila, Godhuma, Shali dhanya, peya, Jala, Paya, Krushra,Manda, Sukhoshna Jala, Yava, Kurchika anupa desha mamsa.
Vartaka, Shigru, Rasona, Draksha, Amra, Amrataka, Amalaki, Dadima, Amlaveta, Kola, Kapitha, Haritaki, Shatavari, Gokshura, Wastuka, Kshirakakoli, Tambula patra, Bola, agaru, Devadaru, Guggulu, Pippali mula, Keshara, Sarva prakara snigdha and Ushna vidhis are pathya in Vataja roga.
Pathya in Raktaja Roga
In raktaja dusthi the Pathya pathya explained in pitta should be followed.
Ghrutapana, Virechana, Sita, Godhuma, Dhanya, Chanaka, Mudga, Masha, Yava, PAryushita, Manda, dugdha, Jangala Mamsa sevana, Shital jala pana,karkotaka, Kadali, Ptola, Kushmanda, Yervaruka, Tumbi, dadima,Amalak, Kahrjura and Udumbara are the pathya in raktaja roga.
As Yuvana Pidaka is considered as one of the raktadushtijanya twakroga, the pathyapathya mentioned in a similar disease kushta is also reffered in this context.
Pathya in kushta:
Apathya
Apathya in Kaphaja roga
Sneha karma, Anjana, Diwaswapna,Snana, Virudha bhojana, Navann pana, navina shali dhanya, Matsya, Mamsa, Ikshu, Dugdha Vikara, Drava Padarth, Peya, Panas, Khrjura, Chandanadi lepa, Dugdha, Narikela Jala, Payas, Amla, Lavana, Gurupadartha, Shitala or Truptikara drvyas are considered as Kaphakaraka. So these things are to be avoided in the Kaphaja roga
Apathya in Vataja Roga
Chinta, Ratrijagaran, atyadika bhashana,vaman, Langhan, Vyayama, Malamutradi Vega dharana, Kshobha, Shoka, Virudhabhojana, Ruksha, Alpa, Kashya, Tikta, Katu and Kshara padartha, Atishitala padarth sevana, sarvaprakara trana dhanya.
Shimbi dhanya, jambu, Raja msha, chanaka, Mudga, Kaseruka, Karkotak, Nadi jala, Kshara, Shitala jala, trivruta, katuki, karira phala, shushka mamsa, madhu these are the apthya and act like visha in vataja Roga.
Apathya in Raktaja roga
Dhumra pana, Swedana Karama, Vegassndharana, Krodha, Kshara Padartha, Dahadi tikshana karama, vyama, Dahakara anna, Tila, Rasona, Masha, Kulattha, Guda, Madhay, Atasi, Kanji,ushna jala, Hingu, Lakucha, Gomutra, Tambula, Dadhi, Sarshapa,Amala, Lavan and vidahi annapana etc. are apathya and act like visha in pitta prokopa rogas or Raktapradoshaj vikra. Apathya in kushta