vyanga varnya samhita

i

“A STUDY ON THE CONCEPT OF VARNYA VIS-À-VIS CLINICAL

EVALUATION OF EFFICACY OF VARNYA GANA LEPA IN VYANGA”

By

Dr. PALLAVI.G, B.A.M.S.

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences,

Karnataka, Bangalore.

In the partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE (AYURVEDA)

in

AYURVEDA SIDDHANTA

Under The Guidance of

Dr. D.L. BALAKRISHNA M.D. (Ayu)

Professor and Head of the Department

Department of Panchakarma

Government Ayurveda Medical College,

Mysore – 570021

Co-Guide

DR.VASUDEV ANANDRAO CHATE M.D. (Ayu)

Lecturer,

Department of Post Graduate Studies in Ayurveda Siddhanta

Government Ayurveda Medical College,

Mysore – 570021

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA

SIDDHANTA,

GOVERNMENT AYURVEDA MEDICAL COLLEGE,

MYSORE.

2012

Ayurmitra

TAyComprehended

vii

ACKNOWLEDGEMENT

I bow to the sacred feet of Almighty, without the blessings of whom this study

would not have been completed.

I am highly thankful to Dr. Naseema K. Akhtar, Professor and HOD,

Department of PG Studies in Ayurveda Siddhanta, Government Ayurveda Medical

College, Mysore, for her constant guidance & continuous supervision at every stage

of this study.

I sincerely express my indebtedness and profound gratitude to my Former

Guide Late Dr. Shakunthala G.N, Professor and Former HOD, Department of PG

Studies in Ayurveda Siddhanta, Government Ayurveda Medical College, Mysore for

her constant guidance which helped me in selecting this study.

I sincerely express my indebtedness and profound gratitude to my Guide

Dr. D.L Balakrishna, Professor, Department of Panchakarma, Government

Ayurveda Medical College, Mysore whose, valuable guidance, timely remarks, and

helpful suggestions in this dissertation are beyond capacity of my words to reciprocate

with thankfulness

I sincerely convey my respect and gratitude to my Co-Guide Dr. Vasudev

Anandrao Chate , Lecturer ,Department of P.G Studies in Ayurveda Siddhanta ,

Government Ayurveda Medical College, Mysore, for his valuable guidance &

encouragement throughout my PG studies.

I am grateful to Principal Dr.B.A.Venkatesh, Professor, Department of Shalakya

tantra, Government Ayurveda Medical College, Mysore for his support and

encouragement.

I sincerely express my indebtedness and profound gratitude to Dr.Aruna

Mangalgi ,former Principal Government Ayurveda Medical College, Mysore for her

everlasting support and inspiration.

I sincerely express my indebtedness and profound gratitude to

Dr.K.Shivaram Prasad, Professor & Head of the Department, Department of

Panchakarma ,Shri Jagadguru Gavisiddeshwara Ayurvedic Medical College &

Hospital, Koppal, Karnataka who has extended enormous help in literary collection as

well as critical analysis.

viii

I owe my deep sense of gratitude to all my teachers Dr.T.D.Ksheerasagar,

Dr.Rajendra.V Dr.Shreevathsa ,Dr. Anand Katti and all other teaching faculty and

hospital staff for their support in this study.

I thank Dr.Lancy D’souza for his valuable help and guidance in the statistical

analysis and interpretations.

I am thankful to my senior colleagues Dr. Aparna, Dr.Geetha.P, Dr.Ranjith

Kumar Shetty, Dr.Ramesh Kumar. K.L ,Dr.Kalyani Bhusane & Dr. Kavitha.S. I owe

my special thanks to my classmates Dr.Aravind.B.S, Dr.Athika Jan, Dr.Rekha

Prabakar and Dr.Preetha R. .I thank my younger colleagues Dr. Divya Rani, Dr.

Arhanth Kumar, Dr. Atul Subramanian, Dr.Arun Chandran & Dr.Sapna.D,

Dr.Aloknath, Dr.Asha Gowda, Dr.Bhavana, Dr.Nagaraj, Dr.Megha for their timely

help.

I also owe my heartfelt gratitude to my teachers of under graduation who

initiated and instilled in me the knowledge of this holy science.

I convey my heartfelt thanks to Govindraj Shetty & Sons, Devraj urs Road

Mysore, G.Abdur Ravoof Pansari, Unani and Ayurvedic Druggists ,Lashkar Mohalla,

Mysore Jogappa Shenoy Pansari, Near Venkataramana temple, Rathabeedi Udupi

who have helped me in procuring the drugs for my dissertation.

This acknowledgement would not be complete without paying obeisance to

my parents Mr. Rama Mohan .G and Smt. Punyavathi. G.R. Their constant

encouragement and guidance propelled me to achieve my goal.

I convey my special thanks enveloped with affection to my beloved husband

Dr.K.L Virupaksha Gupta and beloved elder brother for their constant

encouragement and valuable guidance.

I wish to convey my thanks to U.G. and PG Librarian Smt Varalakshmi, Sri

Mahesh and Sri Somasundar ,for providing library facilities. I thank Madhu

Computers, Mysore, for bringing this work in a documented form.

Last but not the least, I express my thanks to everyone who helped me directly

or indirectly in my studies with apologies for my inability to identify and thank them

individually.

Date:

Place Dr. Pallavi.G

ix

LIST OF ABBREVATIONS

ACTH :-Adreno Cortico Trophic Hormone

AH:- Astanga Hridaya

AS :-Astanga Sangraha

AT :-After Treatment

B.P:- Bhavaprakasha

BR :- Bhaishajya Ratnavali

BST :- Baumann Skin Typing

BT :-Before Treatment

CD: Clinically deteriorated

CI :-Clinical Improvement

CS : Clinically Stable

CS : Charaka Samhita

CSC :-Constitutive Skin Colour

FU:-Follow up

FSC :-Facultative Skin Colour

HA:-Hyaluronic acid

HRT :–Hormone Replacement Therapy

HPA: –Hypothalamic Pituitary Adrenal

HS :–Haritha Samhita

KS:-Kashyapa Samhita

M.N :-Madhava Nidana

MASI :-Melasma Area Severity Index Score

MSH :-Melanocyt e Stimulating Hormone

NMF:- Natural Moisturising Factor

OCP :-Oral Contraceptive Pills

PIH:-Post Inflammatory Hyperpigmentation

SC:- Stratum Corneum

Sha.sam:- Sharangadhara Samhita

SS:-Sushruta Samhita

SPF:- Sun Protective Factor

SLE :-Systemic Lupous Eryhmatosus

UV, A/B:- Ultra Violet, Alpha/Beta

YR :- Yoga Ratnakara

x

KEY FOR TRANSLITERATION

अ a क ka ट ṭa ऩ pa

आ ā ख kha ठ ṭha प pha

इ i ग ga ड ḍa फ ba

ई ī घ gha ढ ḍha ब bha

उ u ङ ṅa ण ṇa भ ma

ऊ ū च ca त ta म ya

ऋ ṛ छ cha थ tha य ra

ऌ ḷ ज ja द da र la

ए e झ jha ध dha व va

ऐ ai ञ ् ñ न na श śa

ओ o ष ṣa

औ au स sa

ह ha

xi

CONTENTS

Particulars Page No.

Introduction 1

Objectives of the Study 3

Review of literature- Chapter 1

Historical review on Varṇa

4-7

Varṇa , Prabhā ,Chāyā ,Pratichāyā 8-10

Types of Varṇa 10-13

Varṇa adhiṣṭhāna 13-14

Varṇa māna, Varṇa utpatti 15

Factors governing formation of Varṇa

Factors contributing in the process of Varṇotpatti during foetal life

Factors contributing in the process of Varṇotpatti after birth

16

16-21

22-26

Anatomy & Physiology of skin 27-30

Complexion, Skin type classification, 31-37

Melanin 38-46

Chapter -2-Varṇya 47-56

Complexion Promoters 57-61

Disease review-Vyaṅga 62-69

Melasma 70-81

Drug Review -Varṇya Gaṇa 82-86

Materials and methods 87-97

Observations 98-112

Results 113-125

Discussion 126-164

Conclusion 165-166

Recommendations For Further Study 167

Summary 168-169

Bibliographic references 170-180

Annexure I, II, III, IV I-XV

xii

LIST OF TABLES

Table No Particulars Page No.

1 Types Of Chāyā 10

2 Types Of Prākṛta Varṇa 11

3 Subtypes Of Prākṛta Varṇa 12

4 Types Of Vaikṛta Varṇa 12

5 Similies For Vaikṛta Varṇa 13

6 Difference Between Bāhya Twcha &Anta Tvacā 13

7 Different Layers Of Skin And Their Respective Diseases. 14

8 Varṇa Utpatti Kāla 16

9 Mahābhūta Composition Of Different Varṇas 17

10 Different Varṇas With Similies 17

11 Relation Of Śārīrika Prakṛti & Varṇa 18

12 Relation Of Mānasika Prakṛti. &Varṇa 18

13 Relation Of Guṇa &Varṇa 18

14 Relation Of Śukra Varṇa & Garbha Varṇa 20

15 Relation Of Deśa & Varṇa 21

16 Relation Of Rasa & Varṇa 22

17 Relation Of Vihāra & Varṇa 23

18 Relation Of Dhātu Sāra Lakṣaṇas & Varṇa 25

19 Fitzpatrick‟s Skin Phototyping System 32

20 Baumann Skin Typing System 33

21 Various Events From Origin To Migration Of Melanocytes 38

22 The Difference Between Immediate And Delayed Tanning 45

23 Various Dinacharyā And Their Effect On Varṇa 48

xiii


24 Āhāra Vargās Which Are Varṇya 49

25 Different Types Of Lepa 53

26 Difference Between Types Of Lepa 53

27 Dietary Needs Of Different Skin Types 57

28 Classification Of Topical Formulations 59

29 Sāmānya Nidāna Of Vyaṅga 64

30 Rūpa Of Vyaṅga 64

31 Samprāpti Ghaṭakas Of Vyaṅga 67

32 Treatment Modalities Of Vyaṅga 69

33 Śamana Yoga In Vyaṅga 69

34 The Histological Types Of Melasma 76

35 Topical Applications And Their Probable Mode Of Action 80

36 Drug Review 82

37 The Grades Of MASI Score 96

38 Age Group Incidence 98

39 Sex Wise Distribution 98

40 Religion Wise Distribution 99

41 Educational Status Wise Distribution 99

42 Marital Status Wise Distribution 99

43 Socio Economic Status Wise Distribution 100

44 Nature Of Work Wise Distribution 100

45 Diet Wise Distribution 101

46 Koṣṭha Wise Distribution 101

47 Agni Wise Distribution 101

xiv


48 Appetite Wise Distribution 102

49 Sleep Wise Distribution 102

50 Bowel Habits Wise Distribution 102

51 Family History Wise Distribution 103

52 Contraceptive History Wise Distribution 103

53 Physical Aggravating Factors Wise Distribution 103

54 Psychological Aggravating Factors Wise Distribution 104

55 Cosmetics- Soap Wise Distribution 104

56 Cosmetics- Cream Wise Distribution 105

57 Menstrual History Wise Distribution 105

58 Age Of Menopause Wise Distribution 105

59 Prakrti Wise Distribution 106

60 Sattva Wise Distribution 106

61 Sāra Wise Distribution 106

62 Pattern Wise Distribution 107

63 Level Of Lesion Wise Distribution 107

64 Chronicity Wise Distribution 107

65 Skin Colour Wise Distribution 108

66 Distribution Of Chronicity Vs Level Of The Lesion 108

67 Distribution Of Skin Colour Vs Lesion Colour 113

68 Results Of Darkness Of Frontal Region 114

69 Results Of Darkness Of Chin Region 114

70 Results Of Darkness Of Left Malar Region 115

71 Results Of Darkness Of Right Malar Region 116

72 Results Of MASI Scores 116

xv


73 Results Of Dryness And Oilyness 117

74 Results Of Itching And Burning Sensation 118

75 Results Of Size And Number Of Lesions 118

76 Results Of Skin Lustre 119

77 The Assessment Of Clinical Improvement In All The Parameters. 119

78 Results Of Overall Assessment 120

LIST OF ILLUSTRATIONS

Ilustn.No Particulars P No.

1 Incidence Of Age And Sex 109

2 Incidence Of Sex 109

3 Incidence Of Marital Status 109

4 Incidence Of Family History 109

5 Incidence Of Contraceptive History 110

6 Incidence Of Physical Aggravating Factors 110

7 Incidence Of Psychological Aggravating Factors 110

8 Incidence Of Use Of Soaps 110

9 Incidence Of Menstual History 110

10 Incidence Of Age Of Menopause 110

11 Incidence Of Prakriti 111

12 Incidence Of Pattern Of Lesion 111

13 Incidence Of Level Of Lesion 111

14 Incidence Of Chronicity 111

15 The Distribution Of Skin Colour 111

16 The Distribution Of Chronicity Vs Level Of Lesion. 112

17 Distribution Of Skin Colour Vs Lesion Colour 121

18 Darkness Of Frontal Region And Chin 121

xvi

19 Darkness Of Right Malar Region And Left Malar Region 122

20 Means Of MASI Scores 122

21 Dryness And Oiliness 123

22 Itching And Burning Sensation 123

23 Size Of Lesions 124

24 Number Of Lesions 124

25 Skin Lustre 125

26 Overall Assessment Of The Study. 125

LIST OF FIGURES

Fig No. Particulars P.No.

1 Types Of Prākṛta Varṇas 11

2 Different Skin Types 37

3 Origin And Migration Of Melanocytes 39

4 The Transfer Of Melanosomes To Surrounding Keratinocytes 41

5 The Skin Colour Perceptions 46

6 The Mode Of Action Of Topical Applications 61

7 The Lakṣaṇas Of Vyaṅga 65

8 Ingredients Of Varṇya Gaṇa Lepa 86

9 Varṇya Gaṇa Lepa 88

10 Fairness Meter 89

11 Melasma Area Severity Index Scores 89

12 Patents with Melasma before and after treatment 112

13 Showing Sub types of Prākṛta Varṇa 132

14 Influence of Deśa on Varṇa 139

15 Capoid and Negroid races 140

16 Australoid and Mangoloid races 140

17 Caucasoid race 141

xvii

18 African Americans 141

LIST OF FLOW CHARTS

Sl. No. Particular P.No.

1 Showing Samprāpti of Vyaṅga 66

xviii

ABSTRACT

The concept of beauty is as old as mankind and civilization. A fair complexion

is a desirable and decisive component of beauty. The concept of Varṇa dealt in

Āyurveda is an innate entity of beauty .Varṇa represents all the parameters for healthy

and radiant skin. In this aesthetic era, people are getting more and more beauty

conscious, so to cope with their cosmetic demands, it becomes invariably essential to

resort to Varṇya upakramas. Vyaṅga is a Varṇa vikāra (hyper pigmentation) which

has been selected for this study. It accounts for a great deal of anxiety and stress.

Treatment modalities for hyper pigmentation are usually unsatisfactory due to its

frequent exacerbation and remission. Hence the need for its evaluation through

Varṇya upakramas. With this background the present study was undertaken so as to

analyze the concept of Varṇya and its application in the patients of Vyaṅga.

The 2 important objectives with which this study was designed were -To

systematically compile and review the literature on the concept of Varṇa, Varṇya

and Vyaṅga & To clinically evaluate the efficacy of Charakokta Varṇya Gaṇa Lepa

in Vyaṅga.

The study was a randomized single blind clinical trial with pre test, post test,

follows up assessment. 40 patients of Vyaṅga belonging to 16-60yrs of age group

were selected from OPD and IPD of GAMC & Hospital Mysore. They were assigned

into a single group. Varṇya Gaṇa Lepa was given for external application along with

luke warm water to all patients for 15 days twice daily in a sufficient quantity. The

different parameters of the study (Skin colour, Lesion colour, Skin texture-

dryness/oiliness, Skin lustre, Number and Size of the lesions, Darkness, Area and

Homogeneity of lesion, Itching, Burning sensation, MASI Score) were recorded

before treatment, after treatment, and after follow up.

xix

The data was analyzed by means of Descriptive statistics, Chi-square test,

Paired sample„t‟ test, Repeated measure ANOVA and Contingency Co efficient for

statistical significance.

There was statistically highly significant improvement in the MASI Scores but

in overall assessment 64.5% patients had mild improvement. Clinical improvement

was more evident in Darkness parameter when compared to other parameters.

Varṇa incorporates the entities like colour, texture, lustre, appearance and

nourishment (plumpness) . Dermatological parameters such as Skin hydration

(Dryness-Oiliness), Skin Pigmentation (Pigmented Non pigmented) , Skin Sensitivity(

Sensitive –resistant), Skin wrinkling (Wrinkled-tight) also come under the purview of

Varṇa. It is evident from the study that application of Varṇya Gaṇa Lepa in Vyaṅga

could bring a mild improvement in colour and texture parameters of Varṇa along with

other symptoms like itching and burning sensation. Greater extent of improvement

could have been expected in all the parameters if the duration of intervention is

extended.

Key words-

Varṇa

Varṇya

Varṇya gana lepa

Vyaṅga

Complexion

Melasma

20

A Study on the concept of Varṇya vis-à-vis clinical evaluation of efficacy of Varṇya gaṇa lepa inVyaṅga.

INTRODUCTION

The Concept of beauty is as old as mankind and civilization and it has been admired

since time immemorial. Beauty is that quality or combination of qualities which afford

keen pleasure to the senses or which charms the intellectual or moral faculties. The word

Sundara (Saundarya) is derived from the saṁskṛta word „ārdrīkaroti cittam iti’ which

means to please the mind. Skin colour is one of the most conspicuous ways in which

humans vary and has been widely used to define human races. Colour and complexion of

the individual are the innate entities of this beauty which is depicted by the term Varṇa in

Āyurveda. In a broader perspective it includes all the parameters of healthy and radiant

skin. It reflects the equilibrium of dhātus and is one among the signs of good health. Any

unhealthy state of the psyche or physique is reflected by the skin as beauty manifests

through the complexion of the skin. Importance of beauty and personality is at its bloom in

this era of aesthetics as it determines the social perceptions, value judgments and

interpersonal relationships.

Melasma is one such personality detrimenting hyper pigmentation disorder which is

selected for this study. It is a chronic, acquired cutaneous, relapsing hypermelanosis

characterized by hyperpigmented patches on sun-exposed areas of the face, neck, and

forearms. Exposure to UV radiation is believed to be the leading factor in its development.

Āyurveda refers this condition as Vyaṅga where in vāta pitta doṣa as well as mānasika

nidānas such as krodha, śoka, āyasa are the main culprits. Melasma should not be

dismissed as simply a cosmetic entity because it often evokes emotional distress.

21


Additionally, stigma may be associated, particularly in Asian cultures .It is known for

causing significant psychosocial stress. The treatment modalities and other management

strategies for hyper pigmentation are usually unsatisfactory as it shows exacerbation and

remission from time to time because of various influencing factors such as frequent

exposure to sun rays, pollution, stress and hormonal variations.

The task of enhancement of Varṇa (restoring the natural hue and tone of the skin) is

termed as Varṇya. Cosmetic science has caught the attention of majority of the population

since centuries. The whole of cosmetic science deals with the idea of promoting

complexion and appearance and thus is based on the principle of Varṇya karma. Hence it is

high time to resort to Varṇya upakramas of Āyurveda in order to discover a better

alternative.It mainly deals with the correction of innate entities responsible for maintanace

of Varṇa along with various mehods of bahi parimārjana cikitsā. Therefore it is the need

of the hour to fulfill the cosmetic demand of people.

In accordance with the preference attitude of the society, the present study was

aimed at building a concept on Varṇa and Varṇya and evaluating the efficacy of Varṇya

Gaṇa lepa in Vyaṅga.

22


OBJECTIVES OF THE STUDY

The study includes Conceptual and Clinical part.

The Conceptual part deals with the following objective

To systematically compile and review the literature on the concept of Varṇa,

Varṇya and Vyaṅga

The Clinical part deals with the following objective

To clinically evaluate the efficacy of Carakokta Varṇya Gaṇa Lepa in Vyaṅga.

23


HISTORICAL REVIEW ON VARNA

History forms the basis to remember and cherish the milestones achieved by

mankind from the time of evolution till the present era. Many evidences from the history

reveals the special attention paid towards the Concept of Varṇa. The Vedas Purāṇas

Upaniṣads, Saṁhitās, Epics form the main historical sources. The word Varṇa appears in

these literatures at various instances which can be understood as follows:-

Vedic Kāla - Atharvaveda

The Vedās are said to be the oldest treasure of knowledge. In Atharvaveda, many

mantrās highlight the significance of improving the Varṇa of the body. Use of

Maṇībandhana is indicated to purify the deranged colour and complexion, i.e. certain herbs

were used for restoring the beauty which is vitiated by Viṣa.

Rāmāyaṇa & Mahābhārata

An important reference states that, when Lakṣmaṇa was in unconscious stage,

Hanumān was advised to bring some drugs from Gandhamardana, where he found certain

Savarṇakarā drugs (drugs which brings the vitiated colour to normal one and which gives

normal features to abnormal one) among the drugs on Sanjīvanī Parvata

Saṁhitā kāla:- Caraka Saṁhitā:

Caraka Saṁhitā is the first and foremost Āyurvedic source for the detailed description of

this subject. Varṇa has been described from various view points, such as, as a sign of

health, as a parameter to evaluate the status of body elements and also as a premonitory

24


symptom as described in Indriyasthāna.A group of drugs known as„Varṇya Daśemāni‟ is

also described, which are known as complexion promoters.

The description of Dinacaryā, like Abhyaṅga , Snāna Anulepana, etc are stated to have an

effect on Varṇa. The concept of Rasāyana therapy is highly suggestive of its importance.

In „Astauninditīya adhyāya the description of Atigaura and Atikṛṣṇa explains its

significance

Suśruta Saṁhitā:

Suśruta Saṁhitā gives prime importance to Agni Mahābhūta in the manifestation of

Varṇa. Instead of a separate group of Varṇya dravyas , Elādi Gaṇa dravyas have been

described and are said to possess Varṇaprasādana karma .Under the heading of

„Vaikŗtāpaha‟, the ‟22 Upkramas‟ are explained, among them „Kṛṣṇa karma‟ and

„Pāndukarma‟ etc. directly suggests the importance of Varņaprasādana .

Saṁgraha Kāla:

In Aştāṅga Saṁgraha, Varṇa Māna has been described, which includes Āhāra,

Vihāra, Deśa, Kula, Jāti, Bhutādhikya. In both texts Aştāṅga Hṛdaya and Aştāṅga

saṁgraha, two groups of herbs labeled as „Rodhrādi Gaņa‟ and „Elādi Gaņa‟ are attributed

to „Varņya‟

Madhya Kāla: Cakradatta, Mādhava Nidāna, Vaṅgasena:

In all these texts certain Mukhakāntikara and Mukhasaundaryakara lepas, various

taila and ghṛta preparations are described for better colour and complexion .The Varṇa

vikāras like Vyaṅga ,Nīlikā, Tilakālaka, Maṣaka, etc. have been described with their

management in the chapter Kşudra Rogādhikāra .

25


Śārṅgadhara Saṁhitā:

Śārṅgadhara Saṁhitā explains about certain Varņya Lepas, which enhances the

colour and complexion. In Vraņopkramas, seventh and last Upkrama is named as

„Savarņakaraņa‟, which itself suggests the importance.

Vātsyāyana Kāmasūtra:

In Kāmasūtra, a chapter named Subhagaṁ karaṇam is described in which many

herbs are indicated for enhancing the Beauty. In this chapter anulepana, anjana,

tailābhyaṅga, saundaryavardhaka lepa etc. are stated.1.

Ādhunika Kāla:

Skin colour is a subject that throughout history has been shrouded in mystery,

misconception, mystique and misunderstanding since antiquity, people have sought

answers to questions such as where skin colour comes from? What was the colour of the

first humans and why humans developed different skin colours?

Myths about Skin Colour

Myth and religion provided the earliest explanations of skin colour. According to an

early African myth, early humans quarreled over the first ox slaughtered for food. The

colour of their descendants thus was determined by the distribution of the meat. Those who

ate the liver had black children, those who took the lungs and blood had red children, and

those who ate the intestines had white children.

Ultra violet Radiation and Skin Colour-Hypothesis

26


There is a close association between latitude and skin colour. The amount of UV

received at the earth's surface is inversely related to latitude - the higher the latitude, the

lower the UV. From a geographical standpoint the darker the skin pigmentation the greater

is the ambient UV.

Vitamin D hypothesis

According to this hypothesis human beings could only have survived the low UV

availability of northern climates by evolving a de-pigmented skin to enable the scant

available UV to traverse the stratum corneum (and beneath) and induce the formation of

Vitamin D. Hence arose fair-skinned people of Scandinavia and northern Europe.

Genetic hypothesis and Evolutionary time

Emergence of skin colour was based on evolution. Livingstone (1969) constructed a

computer model on the assumption that four genes were involved in the determination of

skin colour. According to it certain human physical characteristics such as skin colour have

been accomplished in a matter of 30 generations (750 years).2

Melanosome theory

Modern research has finally led to an understanding of the biological process that

produces skin colour. According to Fitzpatrick and Quevedo (2003), pigmentation of the

skin is related to four biologic processes: 3

Formation of melanosomes in melanocytes

Melanization of melanosomes in melanocytes

Secretion of melanosomes into keratinocytes

Transportation of melanosomes by keratinocytes to the epidermal surface.

27


VARNA

Introduction

The concept of beauty has an age old origin & one of the ways of expression of

beauty is through the skin. Complexion is the manifest form of beauty. Āyurveda refers it

as Varṇa. It is incorporated among the signs of health as it reflects the equilibrium of all the

dhātus & acts as a barometer of individual‟s health. Varṇa has various physiological and

pathological implications, hence the need for its extensive study and proper understanding.

Derivation

Varṇa is an Akārānta napuṁsakaliṅga śabda

uÉhÉï+ AcÉç -The word Varṇa is derived from the root Varṇa with suffix Ach. 4

Definition

It can be understood under 2 headings. They are Sāmanya artha and Viśeṣa artha

MÑüƒ¡ÓûqÉå | oÉëÉ¼hÉÉÌSeÉÉiÉÉæ zÉÑYsÉÉÌSÃmÉuÉhÉåï AMüÉUÉ±¤ÉUå cÉ | 5

Sāmanya Artha- The word Varṇa refers to Kuṁkuma, Brahmaṇādi Jāti, Śuklādi Rūpa and

Akārādyakṣara. The literal meaning of the word Varṇa is the outward appearance, exterior

form, figure, shape, colour, colour of the face, good colour or complexion, lustre beauty

etc.6

Viśeṣa Artha

uÉhÉïrÉÌiÉ mÉëÌiÉqÉÉÇ zÉÑYsÉÉÌSuÉhÉï MüUÉãiÉÏirÉjÉïÈ |

To colour any substance. 7

28


uÉhÉï xiÉÑiÉÉæ ÌuÉxiÉÉUå zÉÑYsÉÉÌSuÉhÉïMüUhÉå E±ÉåaÉå SÏmÉlÉå cÉ |8

The word Śuklādi Varṇa karaṇe refers to whiten or enlighten any substance.

uÉhÉï zÉoSålÉ uÉhÉï xÉWûcÉËUiÉÉ¶É¤ÉÑaÉëÉï½É UÉæ¤rÉÉSrÉÉåÅÌmÉ aÉ×½liÉå | 9

Varṇa refers to all those qualities which can be recognized by cakṣurindriya.

uÉhÉï zÉUÏUMüÉÎliÉÈ |10

Varṇa refers to the lustre of the body.

uÉhÉÉåï aÉÉæUÉÌS | 11

Varṇa refers to gaura śyāmādi Varṇa.

uÉhÉïpÉåSålÉ asÉÉÌlÉWûwÉïUÉæ¤rÉxlÉåWû urÉÉZrÉÉiÉÉÈ | 12

Varṇa refers to glāni, harṣa, raukṣya, sneha reflecting the health of the skin.

Samānārtha śabda

Rūpa, Śuklādi rūpa, Vilepana, Saṁsthāna, Kānti Ākṛti, Pramāṇa, Aṅgarāga, Prabhā. 13

Saṁbandhita śabda

Prabhā

pÉÉxiÉÑ uÉhÉï mÉëMüÉÍzÉlÉÏ |14

Prabhā is the highlighter of the complexion and it is recognizable from a distance .All

sorts of Prabhā are the components of tejo mahābhūta . It is said to be of 7 types. They

are Rakta, Pīta, Śyāva, Harita, Pāndura, Asita.

Chāyā

uÉhÉÉïlÉÉqÉÉ¢üqÉÌiÉ NûÉrÉÉ |

29


AÉxÉ³ÉÉ sÉ¤rÉiÉå NûÉrÉÉ |

NûÉrÉÉ uÉhÉïmÉëpÉÉ´ÉrÉÉ |15

Chāyā is the one which circumscribes Varṇa and which is recognizable from near (Short

distance). Chāyā depends on Varṇa and Prabhā 5 types of Chāyā have been explained.

They are Vāyavī, Āgneyī, Nābhasī, Āṁbhasī & Pārthivī.

Table 1:- Types of Chāyā

Chāyā Characteristics

Nābhasī Nirmala, nīla, sasneha, saprabhā.

Vāyavī, Rūkṣa, śyāva, aruṇa, hataprabhā.

Āgneyī Viśuddharakta, dīptābha, darśanapriya

Āṁbhasī Śuddha vaiḍūrya vimala, susnigdha

Pārthivī Sthira, snigdhāyata, ślakṣṇa, śyāma, śveta

Pratichāyā

mÉëqÉÉhÉ xÉÇxjÉÉlÉ xÉSØzÉiÉrÉÉ eÉsÉÉÌSwÉÑ rÉÉ NûÉrÉÉ xÉÉ mÉëÌiÉcNûÉrÉÉ | 16

The reflection of the body similar to its Pramāna & Saṁsthāna is termed as Pratichāyā

Types of Varna-

It is of 2 types

Prākṛta Varṇa

Vaikṛta Varṇa

Prākṛta Varṇa- It is defined as Deha samāna Varṇa or Sāhajika Varṇa.17

Caraka Saṁhitā

clearly states 4 different types of Prākṛta Varṇa of the body, 18

where as Aṣṭāṅga

saṁgraha explains 5 Prākṛta deha Varṇas .19

These are as follows:-

30


Table 2 :-Types of Prākṛta Varṇa

Varṇa

C.S

Meaning as per

Monier Williams

Varṇa Meaning as per

Monier Williams S.S A.S H.S

Kṛṣṇa Black, dark blue Gaura Gaura Gaura White/Yellowish

Śyāma Brown - Śyāma Śyāma Brown

Śyāma

avadāta

Blackish white/

dazzling black

Kṛṣṇa Kṛṣṇa Kṛṣṇa Black, dark, dark blue

Avadāta Dazzling white/

white

Gaura

Śyāma

Blackish

white/dazzling black

Kṛṣṇa

Śyāma

Blackish brown

Piṅgala Reddish brown, golden

Hārīta Saṁhitā explains about an additional one by name Piṅgala Varṇa which is

constituted by Pitta and Rakta. 20

Avadāta Varṇa Śyāma Avadāta Varṇa Śyāma Varṇa Kṛṣṇa Varṇa

Figure No1. Different types of Prākṛta Varṇas

31


The Sub types of the Prākṛta Varṇa have been explained in Indukara commentary on

Aṣṭāṅga Saṁgraha Śārīra sthāna. They are as follows21

Table 3:- Subtypes of Prākṛta Varṇa

Varṇa Gaura Śyāma Kṛṣṇa Gaura Śyāma Kṛṣṇa Śyāma

1 Padma Gaura Kapittha

Śyāma

Kajjala

Kṛṣṇa

Priyaṅgu Śyāma Atasī Kṛṣṇa

Śyāma

2 Candra

Gaura

Dūrvāṅkura

Śyāma

Kokoila

Kṛṣṇa

Jala Śyāma Tamāla Kṛṣṇa

Śyāma

3 Śara Gaura Nabha

Śyāma

Saṭpada

Kṛṣṇa

Ghṛta

Śyāma

Vaikṛta Varṇa

5 types of Vaikṛta Varṇa which manifests in the body have been described in Caraka

Saṁhitā22

and Aṣṭāṅga Saṁgraha with a slight difference in terminology.

Table 4 :-Types of Vaikṛta Varṇa

Varṇa-C.S A.S Meaning as per Monier Williams

Nīla Nīla Dye dark/Blackish

Śyāva Śyāva Dark brown/ brown

Tāmra Tāmra Coppery red

Harita Haridra Harita -Green /pale yellow Haridra - yellow

Śukla Śukla White/bright/whitish

Some similies have been quoted for each type of Varṇa in Indukara commentary of

Aṣṭāṅga Saṁgraha. They are:- 23

32


Table 5 :-Similies for Vaikṛta Varṇa

Varṇa Similie

Nīla Nīla

śyāva Aruṇa lohita sama

Tāmra Agni prakhya

Harita Haritāla sama

Śukla Śankhakundādi prakhya

Varṇa Adhiṣṭhāna

iuÉcÉÉ- iuÉcÉç xÉÇuÉUhÉå |

The word Tvacā is derived from Twach saṁvaraṇe dhātu 24

which means the covering of

body and it is the main basis for Sparśanendriya, Swedavaha srotas Roma & Romakūpa 25

Tvacā pramana is said to be Yava Pramāna 26

and Vāyu is the adhidevatā for tvacā.27

It is divided into 2- They are

Bāhya Tvacā &

Ābhyantara /Anta Tvacā28

Table 6 :-Difference between Bāhya Tvacā & Anta Tvacā

Bāhya Twcā- Anta Tvacā-

It is Tanu It is sthūla

Ādhāra for kṛṣṇa gaurādi Varṇa It does Śarīra Rakṣaṇa

33


It is the seat for diseases such as ploṣa and

Pidaka

It maintains the texture and compactness ie

it does Snehādi Karṣaṇa

Formation of Tvacā

The process of formation of Tvacā in the developing foetus is due to Pāka of Rakta Dhātu

by its dhātvāgni in the foetus, it dries up to form Tvacā just like the deposition of cream

over the surface of boiled milk.

Different layers of Tvacā

Caraka Saṁhitā29

and Suśruta Saṁhitā have described 6 and 7 layers of skin respectively

along with the diseases afflicting the respective layers of the skin.

Table 7 :-Different layers of skin and their respective diseases.

C.S S.S

Tvacā Roga Tvacā Roga

Udakadharā Avabhāsinī Kṛṣṇa Gaurādi Varṇa

Ādhāra, Sidhma Padma

Kaṇṭaka

Asṛkdharā Lohitā Tilakālaka Nyaccha Vyaṅga

Tṛtīyā Sidhma Kilāsa Śvetā Carmadala Ajagallī Maṣaka

Caturthī Dadhru Kuṣṭha Tāmrā Kilāsa Kuṣṭha

Pañcamī Alajī Vidradhi Vedinī Kuṣṭha Visarpa

Saṣṭhī Tama Praveśa

Aruṁṣi Parva Kṛṣṇa

Rakta Sthūlamūla

Rohiṇī Granthi Arbuda Ślīpada

Galagaṇḍa

Māṁsadharā Bhagandara,Vidradhi, Arśa

34


Avabhāsinī is the ādhāra for Kṛṣṇa and Gaurādi Varṇa.30

It manifests all the Varṇas and

highlights the 5 types of Chāyā.31

Varṇa Māna

The factors which determine/decides Varṇa significantly are Āhāra, Vihāra, Deśa, Kula,

Bhutādhikya. The various permutations and combinations among these factors result in

variation in Varṇa like Gaura, Avadāta, Kṛṣṇa32

Varṇa as Ārogya Lakṣaṇa

Ārogya lakṣaṇas are characterized by Annābhilāṣā, Sṛṣṭaviṇmūtravāta, Prasanna indriya,

Śarīra lāghava, Sukha swapna prabodhana etc. Varṇa lābha is also considered as an

important Ārogya lakṣaṇa

Shubha lakṣaṇa yukta Shareera

Śubha lakṣaṇa yukta śarīra is characterized by Snigdha Varṇa and Sthira Prabhā .33

Varṇa prabhava

Tejo dhātu is said to be prabhava or mūla for Varṇa utpatti.34

Varṇa Utpatti

The physiological phenomenon of Varṇa Utpatti is basically governed by many factors ie

some contribute in the formation of Varṇa in Garbhāvasthā and some others contribute in

the process after birth and later stages of life.

Varṇa Utpatti kāla

35


The Varṇa Utpatti kāla as per the Māsānumāsika Garbha Vṛddhi is considered to be as 6th

month by almost all authors. As per Caraka Saṁhitā & Kāśyapa Saṁhitā there is Varṇa

Upacaya /Varṇa Vṛddhi especially in the 6th

month when compared to other months and

hence the pregnant lady suffer from Varṇa hāni in the 6th

month. As per, Aṣṭāṅga Hṛdaya

there is Varṇa abhivyakti ie Manifestation of Varṇa in the 6th

month. As per Suśruta

Saṁhitā tejo dhātu is sarva Varṇa prabhava and Varṇa utpatti takes place at the time of

Garbhotpatti/ Garbhādāna kāla. 35 36 37 38

Table 8:- Varṇa Utpatti kāla

Kāla C.S , K.S A.H S.S

6th

month Varṇa upachya/Varṇa vṛddhi Varṇa abhivyakti -

Garbhādāna kāla/

Garbhotpatti - - Varṇa prabhava

Factors Governing the Formation of Varṇa

The general factors governing the formation of Varṇa includes Bīja, Ātma, Kāla, Āshaya ,

Āhāra and Vihāra 39

. Specific factors which are responsible for the formation of Varṇa can

be considered in 2 headings.

1. Factors contributing in the formation of Varṇa in Foetal life

2. Factors contributing in the process of Varnotpatti after birth

Factors contributing in the formation of Varṇa in foetal life

Role of Mahābhūta

Mahābhūtas play a major role in Varṇotpatti is accepted by all the authors.40

Dalhaṇa

commentary on Suśruta Saṁhitā states that tejo dhātu or agni mahābhūta is considered as

the originator of all Varṇas. The combination of agni mahābhūta with the other

36


mahābhūtas is responsible for the various Varṇas in the individuals such as gaura, kṛṣṇa

etc. 41 42

Table 9:- Mahābhūta composition of different Varṇas

C.S & A.S S.S H.S

Varṇa Mahābhūta Varṇa Mahābhūta Varṇa Doṣa

Gaura Teja+Ap+ Ākāśa Gaura Teja + Ap Gaura Pitta

Kṛṣṇa Teja +Vāyu +Pṛthvī Gaura

Śyāma

Teja+Ap+Ākāśa Kṛṣṇa Vāta+ Rakta

Śyāma Teja +Ap+ Vāyu

+Ākāśa +Pṛthvī

Kṛṣṇa

Śyāma

Teja+ Pṛthvī

+Ākāśa

Śyāma Kapha +Rakta

Kṛṣṇa Teja + Pṛthvī Piṅgala Pitta + Rakta

Gangādhara commentary on Caraka Saṁhitā narrates various combinations of

Mahābhūtas resulting in different Varṇas with similies.43

They are as follows:-

Table 10:- Different Varṇas with similies

Varṇa Mahābhūta

Haridrābha Gaura Udaka bahula panca bhūta

Palāśābha harita Ākāśa bahula panca bhūta

Pakva jaṁbūpama Kṛṣṇa Pṛthvī bahula panca bhūta

Rūkṣa /Kṛṣṇa/ Nīla Vāyu bahula panca bhūta

Kajjala Kṛṣṇa Pṛthvī + Vāyu bahula panca bhūta

Kṛṣṇa śyāma Pṛthvī + Ākāśa bahula panca bhūta

37


Role of Prakṛti

Prakṛti is one among the important factors influencing the formation of Varṇa in the

foetus. 44

45

46

47

Table 11:- Relation of Śārīrika Prakṛti & Varṇa

Prakṛti C.S S.S A.S H.S

Vāta

Paruṣa vadana

pāṇi, sphuṭita

avayava

Sphuṭita

karacaraṇa

Dhūsara Śyāma

Asita Chavi

Pitta

Sukumāra

avadāta

Tāmra pāṇi,

pāda

Gaura aṅga, tāmra

hasta

Gaura

Peeta prabha

Kapha Sukumāra,

avadāta, prasanna

snigdha

Dūrvā, indīvara

ariṣṭaka,

śarakanda Varṇa

Padmasu Varṇa,

priyaṅgu,

śarakanda,

indīvara gorocana

Snigdha,

śyāma

Sita, śyāma

Chavi

Varṇa of an individual is also determined by the Mānasika Prakṛti. The text Rāja nighaṇṭu

describes about the colour of individuals belonging to different Mānasika Prakṛtis in

Sattvādi Varga. 48

Table 12:- Relation of Mānasika Prakṛti. &Varṇa

Mānasika Prakṛti Varṇa

Sāttvika Gaura Śyāma Tanu

Rājasika Gaura kanakādi dīpti

Tāmasika Sita itara

Role of Guṇa

By virtue of a particular guṇa a specific Varṇa is attributed to the body 49

Table 13 Relation of Guṇa &Varṇa

38


Guṇa Varṇa

Mṛdu Sukumāra avadāta gātra

Accha Prasanna snigdha varṇa

Uṣṇa Gaura sukumāra avadāta gātra

Rūkṣa Rūkṣa apchita , vaivarṇya varṇa hāni

Paruṣa Paruṣa vadana pāṇi pāda

Viṣada Sphuṭita aṅga avayava

Snigdha Snigdha aṅga

Ślakṣṇa Ślakṣṇa aṅga

Drava Varṇa utkarṣa

Ūṣṇa, Tīkṣṇa, Sūkṣma, Laghu, Rūkṣa, Viṣada Prabhā prākāśa ,varṇa kara

Role of Garbhotpādaka bhāvas

Śadbhāvas are the most important prerequisite for the formation and development of

Garbha. Each one has its own role to play in the process of Garbha Utpatti. Amidst these

various factors Ātmaja and Sātmyaja Bhāvas are assigned for the manifestation of colour

and complexion in the foetus.

Ātmaja Bhāvas

Atma is responsible for the birth in a particular Yoni due to its past actions. Manas,

Preraṇa, Dhāraṇa Ākṛti, Swara and Varṇa in the foetus50

and are mainly due to Ātmaja

bhāvas. All the physical attributes are derived from the deeds of past life. Hence Ātma also

has a role on account of the karmas of the previous birth.51

Sātmyaja Bhāvas

Sātmyaja Bhāvas have an important role to play in the formation of Varṇa. Among various

Satmyaja Bhavas, Varṇa sampat is also one, hence the diet and regimen of pregnant

woman has a strong influence on the Varṇa of the offspring.52

39


Role of Śukra

The colour of the Śukra has an influence on the colour of the foetus. If the Śukra resembles

Ghṛta manda then it produces a progeny of Gaura Varṇa. If Śukra resembles Taila then

garbha would be of Kṛṣṇa Varṇa and if it resembles Madhu then it would produce a

progeny of Śyāma Varṇa. 53

Table 14 :-Relation of Śukra Varṇa & Garbha Varṇa

Śukra Varṇa Garbha Varṇa

Ghṛtamaṇḍābha /Śukla Gaura

Tailābha Kṛṣṇa

Madhvābha Śyāma

Role of manasthiti

Caraka Saṁhitā and Astaṅga Hṛdaya have clearly accepted the role of manah sthiti of

mother on the Varṇa of the offspring. Rūpa and Varṇa of the offspring born will be in

accordance with the thoughts of the lady during her pregnancy. 54

Role of Āhāra and Vihāra of the mother

Āhāra and Vihāra of the mother has a very evident influence on the colour and complexion

of the offspring as per Aṣṭāṅga saṁgraha. Excessive use of Madhura āhāra, Jala krīḍā

(moving around in water is the cause) produces Gaura Varṇa of the progeny. Excessive

intake of tila and vidāhi anna leads to Kṛṣṇa Varṇa and mixed diets leads to an offspring of

Śyāma Varṇa.55

. Nutrition of the foetus is mainly derived from the āhāra rasa which is

consumed by the mother and traverses the placenta. This āhāra rasa reaches the foetus

though Upasnehana and Upaswedana and thus provides strength and complexion to the

foetus56

. Caraka Saṁhitā and Suśruta Saṁhitā have established the relationship between

40


the Varṇa and Āhāra in the context of Puṁsavana saṁskāra, Putreṣṭi yajña and homa

vidhi are also said to bestow Varṇa .It is stated that Varṇa of the foetus is determined by

the Varṇa of the food consumed by the mother57

.

Among the various Garbha upaghātakara bhāvās the excessive use of kaśāya rasa

by the mother has been told to produce a progeny of Śyāva Varṇa. And thus it is advised

that the woman desiring excellent progeny should particularly abstain from the

unwholesome diet and behaviour. Along with the mother, the role of Puruśa has also been

justified in Suśruta Saṁhitā by the statement,- The āhāra and cheṣṭā into which the strī

,puruṣa indulge ,the offspring born will be endowed with similar qualities.

Role of Deśa

Deśa has considerable influence on the determination of Varṇa of the individual. Aṣṭāṅga

Saṁgraha states that the colour of the individual is determined by the geographical

condition58

.

Table 15 :- Relation of Deśa & Varṇa

Deśa Varṇa

Outtar Pathika Gaura Varṇa

Dakshina, āndhra draviḍa, uśara Deśa Kṛṣṇa Varṇa

Madhya Deśa Śyāva Varṇa

Role of Kula and Jāti

As per Aṣṭāṅga Saṁgraha, Kula and Jāti also have a key role in influencing Varṇa.

Indukara commentary on Aṣṭāṅga Saṁgraha states that based on various occupations such

as Śilpī etc colour of the individuals may vary accordingly ie Gaura, Kṛṣṇa, Śyāva. 59

41


Factors Contributing in the Process of Varṇotpatti after Birth

Many factors have been found to be influencing Varṇa after the birth of the offspring

Role of Jaṭharāgni

Caraka Saṁhitā and Aṣṭāṅga Saṁgraha describes the evident role of Jaṭharāgni as a

causative factor for Varṇa ,Bala ,Swāsthya,Utsāha, Upacaya, Prabhā ,Oja, Teja etc60

Role of Āhāra (Rasa)

Caraka Saṁhitā opines that Varṇa prasādana, suswara, jīvana, pratibhā, sukha are mainly

attributed to Āhāra. Suśruta Saṁhitā also considers Āhāra as mūla for bala Varṇa and

ojas.61

Madhura rasa is said to enhance Varṇa along with other functions like

strengthening the dhātus, indriya and enhances ojas and is suitable for bāla, vṛddha ,kṣata,

kṣīṇa62

.Specific rasās and types of food have certain effects on Varṇa,

Table 16:-Relation of Āhāra Rasa & Varṇa

Role of Āhāra Vidhi

Āhāra Rasa Varṇa

Kaśāya Śyāva 63

Lavana Vaivarṇya

Madhura Varṇa Prasādana 64

Asātmya Āhāra Varṇa hāni

Viruddha Āhāra Varṇa hāni

42


The dietary pattern also has equal importance as that of āhāra. Caraka Saṁhitā has

emphasised on rules for intake of food. Wholesome food consumed in the prescribed

manner is said to be a complexion promoter. Among the various rules of intake of food

Snigdham aśnīyāt is one such entity which is attributed to Varṇa prasādana guṇa along

with other benefits such as agni dīpana, vātanulomana, indriya dārḍhya, bala, vṛddhi etc.65

It has also been mentioned by Āchārya Caraka that the appropriate quantity of food

certainly helps the individual to maintain the Varṇa without disturbing the Prakṛti. Hence

āhāra vidhi also has an impact on Varṇotpatti. 66

Relationship with Vihāra

Table No 17 :-Relation of Vihāra & Varṇa

Vihāra Effect on Varṇa

Vāyu sevana Vaivarṇya

Ātapa sevana Vaivarṇya

Pravāta Vaivarṇya

Kṣudhā pipāsā vegadhāraṇā Varṇa hāni

Adhwa Varṇa vināśana

Varṇa and Vaya

Śārṅgadhara Saṁhitā explains about the Hrāsa of each entity after every decade of life

span. For example Bālya, Vṛddhi, Chavi, Medhā is lost in every subsequent decade. There

is Hrāsa of Chavi (natural complexion of the body) after 30 yrs of age. There is Hrāsa of

twak after 50 ys of age ie the tightness of the skin is lost leading to wrinkles. Texture of the

skin is lost and there is cracking of the skin. 67

Relation of Varṇa with Doṣa- Dhātu Mala

43


Contribution of doṣas in Varṇotpatti is considerably important. Caraka Saṁhitā quotes that

Tridoṣas in the state of eqillibrium brings about Upacaya, Bala and Varṇa.

Relationship with Vāta

Caraka Saṁhitā opines that a physician should admire the quality of Vāta as a promoter of

Varṇa Among the 5 types of Vāyu, Udāna Vāyu is responsible for Varṇa utpatti. 68

Udāna vāta

With complete effort, initiation (vega /utsāha) Udāna vāyu supplies anna rasa to all the

śarīra ghaṭakas or sūkṣma avayavas and nourishes it and hence endows the body with

Bala, Swara and Varṇa. It refers to the complete nourishment of the Rasa dhātu or

enrichment of rasa dhātu69

.

Relationship with Pitta

Pitta which is the main seat of agni in its normalcy and abnormalcy is responsible for

Prākṛta Varṇa (Utpatti/ Prākāśana) and Vaikṛta Varṇas.Along with other functions like

darśana, pakti, ūṣma, kṣudhā, tṛṣṇā 2 important functions are Deha mārdava- Maintains

the texture / softness of the body and Prabhā - the Complexion of the body70

. Prabhā is an

entity which is held responsible for the radiance in the skin which is expressed through

Varṇa.

Bhrājaka Pitta

The pitta seated in the tvacā is termed as Bhrājaka agni. This digests the auṣadha which is

applied on the skin in the form of Abhyaṅga, Pariṣeka, Avagāha, Ālepa and is responsible

44


for the luminescence or radiance. (Chāyā is Varṇa Prabhāśrayā – Chāyā depends on

Varṇa and Prabhā and hence Bhrājaka pitta determines Varṇa prākāśana.) It is

responsible for Varṇa utkarṣa ie which enhances Varṇa71

.

Relationship with kapha

In the context of Prakṛti lakṣaṇas it is clearly mentioned that individuals belonging to

Kapha Prakṛti possess Sukumāra, avadāta gātra and Prasanna snigdha varṇa which

indirectly proves that kapha has a major role in the utpatti of varṇa.

Relationship with Dhātu

Varṇa is basically an outcome of equilibrium of all the dhātus. Each dhātu has unique role

in the formation and maintenance of Varṇa.72

Table 18 :-Relation of Dhātu Sāra lakṣaṇas & Varṇa

Dhātu Sāra lakṣaṇas pertaining to Varṇa

Rasa Snigdha, ślakṣṇa, mṛdu, prasanna, saprabhā twak

Rakta Varṇa prasāda, Mukha pāni pāda, snigdha rakta varṇa

Meda Snigdha varṇa

Majja Mṛdu aṅga, snigdha varṇa

Śukra Prasanna snigdha ,varṇa

This clearly indicates that most of the dhātus are directly linked to varṇa and their

normalcy results in prākṛta varṇa utpatti

45


Relationship with Malas

These are the entities which does the śarīra dhāraṇa. Direct relationship between ,Purīṣa,

Mūtra and Varṇa is not identified where as some relationship between sweda and tvacā

/Varṇa is identified. Sweda is held responsible in maintaining the moisture and skin

texture/ softness of the body.73

Relationship with ojas

Ojas has a definite role in imparting Prākṛta Varṇa to the body. Ojas bestows strength,

imparts firm integrity to the māmsa, exercises unbounded conrol over all the acts of

vitality, improves Swara and Varṇa, helps both external and internal sense organs, in duly

performing their natural functions.

Relationship with Bala

Prākṛta karma of bala is Varṇa prasādana, Hence Varṇa is an indicator of the status of

health and strength of an individual. 74

46


ANATOMY OF SKIN

Skin is a large and complex tissue that interfaces with the hostile environment. It is

called the Integument which covers the entire surface of the human body.

The Skin is composed of three primary layers. They are Epidermis, Dermis,

Hypodermis/ Subcutaneous tissue.

Epidermis

Epidermis is the most superficial layer of the skin. It is very important from a cosmetic

standpoint because it is the layer that gives the skin its texture, moisture and contributes

to the skin colour.

The Epidermis is mainly divisible into 2 main systems.

o Keratinising or Malphigian system (keratinocytes) which forms the bulk and

o Pigmentary system (melanocytes which produces the pigment)

Interlaced among the keratinocytes at various levels are the immigrant resident cells –

Melanocytes, Langerhan Cells, Merkel Cells. Other cells such as lymphocytes are

transient inhabitants of the Epidermis.

The main layers of the Epidermis which can be made out microscopically in a section are

o Stratum Germinativum /Stratum Basale / Basal Layer

o Stratum Malpighi /Prickle Cell Layer / Stratum Spinosum

o Stratum Granulosum

o Stratum Lucidum

o Stratum Corneum.

47


Stratum Germinativum

This is the deepest portion of epidermis and, the whole of the epidermis germinates

from here hence the name Stratum Germinativum.

Keratinocytes also known as Corneocytes are the cells that comprise the majority of

Epidermis.

Stratum Spinosum

It is named for the spine like appearance of the cell margins in histological sections.

The spines of spinous cells are abundant desmosomes which are calcium dependent

cell surface modifications that promote adhesion of epidermal cells and resistance to

mechanical stress

Stratum Granulosum

Named for the basophilic keratohyaline granules that are prominent within cells at the

level of the epidermis and it is the site of the generation of the number of structural

components that form the epidermal barrier. It consists of fusiform cells which are 1 to

3 layer thick.

Stratum Lucidum

It is a pale, wavy-looking layer known as Stratum lucidum. It is formed by many

layers of flattened and closely packed cells. This is exclusively found in Palms &

Soles.

Stratum Corneum

It is the most superficial layer also called as horny layer which is on an average 15 cell

layer thick. It is thickest in the palms of the hands and soles of the feet but thinnest on

the outer aspect of the lips, glans penis and the eyes.

48


Dermis

The dermis is an integrated system of fibrous filamentous diffuse and cellular connective

tissue elements.

The dermis makes up the majority of the skin and provides its pliability, elasticity and

tensile strength.

The dermis is arranged into 2 major regions

o Upper pappilary dermis

o Deeper reticular dermis

Hypodermis

The hypodermis, or subcutis located beneath the dermis is composed mostly of fat and

one of the largest tissues in the human body which are mainly comprised of adipocytes

fibrous tissue and blood vessels.

It is important for dermatologists and cosmetically oriented physicians to pay close

attention to this tissue because it has many roles in cosmetic dermatology and general

appearance.

49


PHYSIOLOGY OF SKIN

Introduction

Skin is a dynamic complex, integrated arrangement of cells, tissues and matrix elements

that mediates a diverse array of functions. Three important functions with respect to this

study are

Barrier Functions - Epidermis and the Stratum Corneum as the Barrier

Prevents evaporative water loss from the aqueous interior cell layers and it also protects

against mechanical insults, foreign chemicals, micro organisms and Ultra violet light.

The knowledge of the skin as a barrier is important from the point of view of the

delivery of topical treatments for skin diseases to plan a logical approach to the

management.

Protection from Ultra-Violet Radiation

The skin has 2 barriers to U V radiation, a melanin barrier in the epidermis and a

protein barrier, concentrated in the stratum corneum. Both function by absorbing

radiation there by minimizing absorption by DNA and cellular constituents.

The mechanism of delayed tanning provides partial protection from U.V.

Percutaneous Absorption

The anatomically distinct layers have a different diffusion constant.

Healthy Adult human skin allows some-permeation of almost every substance .Rates of

permeation of different materials differs by 10,000 fold.

Other functions of skin include

Protection from Micro organisms, Mechanical Functions,Temperature Regulation

Immunological functions,Elimination/ Excretion,Sensory and Autonomic functions

50


COMPLEXION

The word "Complexion" is derived from the Late Latin complexi, which initially referred in

general terms to a combination of things, and later in physiological terms, to the balance of

humors. The four humours were four fluids that were thought to permeate the body and

influence its health. Contexually the term Complexion refers to the natural colour, texture

and appearance of the skin. These form an important basis for the classification of skin

Skin Type Classification

Human Skin (Homo Sapiens) has been classified into 3-6 racial taxons since the 18th

century before the development of Genetics and Evolutionary biology .These are based on

phenotypic characteristics, geographic origin and even psychological impressions. .

The modern races include:-

Caucasoid(Europians, Arabs, Indians, Pakistanis)

Mongoloid(Asians)

Australoid(Austalian,Aborigines)

Congoid/Negroid(Africans, Afro carribeans, African Americans)

Capoid(Kung san tribe of Africa)

Ethnic skin or skin of colour refers to the broad range of skin type and complexions

that characterize individuals with darkly pigmented skin.

Fitzpatrick Skin Typing System

The Fitzpatric Scale is a numerical classification scheme for determining the skin

colour based on a questionnaire related to an individuals genetic constitution, reaction to

sun exposure and tanning habits. The response to each question is measured on a scale of

http://en.wikipedia.org/wiki/Late_Latin

http://en.wikipedia.org/wiki/Humors

http://en.wikipedia.org/wiki/Fluid

51


0-4. The response for all questions is added to get the final score corresponding to the

Fitzpatrick Skin Type.

Table 19 :-Fitzpatrick’s Skin Phototyping System

Skin

Type

Typical Features Tanning Ability

I Pale white skin, blue/hazel eyes, blond/red

hair

Burns easily, sometimes tans

II Fair skin, blue eyes Always burns, does not tan

III Darker white/medium skin Sometimes burns, always tans

IV Light brown skin Burns minimally, tans easily

V Brown skin Rarely burns, always tans

VI Dark brown or black skin Never burns, always tans darkly

Uses of Skin Typing

1. It helps to predict the risk of photodamage and skin cancer.

2. To estimate the minimal erythema dose in Phototherapy.

3. Laser hair removal- Skin types IV-VI run a greater risk of potential epidermal adverse

events such as dyspigmentation, blistering, crusting, edema and subsequent scarring

with laser hair removal.

4. Chemical Peeling and dermabrasion – The higher the type and the degree of

pigmentation, the greater the risk of Post inflammatory hyperpigmentation.

5. Tolerance to topical bleaching agents is determined by skin type.

6. Hence it can also be used to evaluate the response of different skin types to commonly

used cosmetic procedures and is therefore useful tool in cosmetic dermatology.

52


The Baumann Skin Typing System (BSTS)- Is an innovative approach in classifying skin

type that is based on 4 main skin parameters.

1. Oily Vs Dry

2. Sensitive Vs Resistant

3. Pigmented Vs Non-Pigmented

4. Wrinkled Vs Tight (Unwrinkled)

These 4 parameters are not mutually exclusive, evaluating the skin based on all 4

parameters yields 16 potential skin type permutations.

The Baumann Skin Type classification is determined from a questionnaire designed to

ascertain baseline skin type identifications as well as assessments after significant life

changes, since skin type is not necessarily static.

Each of the 4 skin parameters has a separate set of questions and a score is assigned to

that parameter, once the score is known skin care advise can easily be given.

Table 20 :- Showing Baumann Skin Typing System

Skin Type Oily

Pigmented

Oily

Non-Pigmented

Dry

Pigmented

Dry

Non-Pigmented

Skin

Type

Sensitive OSPW OSNW DSPW DSNW Wrinkled

Sensitive OSPT OSNT DSPT DSNT Tight

Resistant ORPW ORNW DRPW DRNW Wrinkled

Resistant ORPT ORNT DRPT DRNT Tight

Ideal Skin

An ideal skin is typically characterized by intact Stratum corneum with an intact barrier,

sufficient NMF levels, normal levels of HA ,normal expression of Aquaporins and

balanced sebum secretion.

53


The Stratum corneum is composed of three primary groups of compounds

o Ceramides- constitute 40% of the Stratum corneum lipids in humans

o Fatty acids and

o Cholesterol.

Natural moisturizing factor (NMF) derived from the breakdown of the protein flaggrin,

is integral in maintaining water within skin cells.

Hyaluronic acid which can bind 1000 times its weight in water is another substance

found in the skin that may help in retain and maintaining water.

Aquaporins are members of homologous water channels that facilitate fluid transport in

various organs such as skin, renal tubules ,eyes, digestive tract and even the brain.

Amount of sebum production also determines the skin hydration by producing glycerol

which is necessary for an intact barrier

Skin Hydration- The spectrum of Oily to Dry (O) to (D)

Dry skin/ Oily Skin

Dry skin describes skin that is characterized by dull colour, rough texture and an

elevated number of ridges. Dry skin is characterized by either an impaired barrier , lack of

natural moisturizing factor or decreased sebum production whereas Oily Skin exhibits

increased sebum production.

Combination skin

It is characterized by dry on the cheeks and oily in the T-Zone.

A higher score in the BSTS corresponds with increased sebum production and low

score with decreased skin hydration.

Skin that falls in the middle of this range would be considered as normal skin.

54


Skin Sensitivity- The spectrum of Sensitive (S) and Resistant (R)

Sensitive Skin

Sensitive skin is characterized by inflammation and manifests as acne, rosacea,

burning and stinging, or skin rashes.

Resistant skin

Resistant skin is characterized by a robust stratum corneum (SC) that strongly

protects the skin from allergens, other environmental irritants, and water loss. Individuals

with resistant skin rarely experience erythema or acne. A high score on the S/R spectrum

correlates with sensitive skin while a low score represents resistant skin.

Skin Pigmentation-The Spectrum of Pigmented (P) to Non- Pigmented (N)

Skin Colour is not the focus here. Rather, the P/N parameter measures the tendency to

develop hyperpigmentation.

This segment of the BSTS determines those with a history or current presentation of

pigmentary alterations that can be prevented or improved with skin care products as

well as dermatologic procedures, and includes conditions such as melasma,

postinflammatory hyperpigmentation, and solar lentigos .

Although darker skin types are more likely to exhibit the P (pigmented) skin type, this

parameter does not refer to ethnicity.

The individual with a propensity to develop unwanted pigmentary changes is classified

as having the „P‟ Skin types in the BSTS system, a person not exhibiting this tendency

has Type N Skin.

55


Skin Aging- The Spectrum of Wrinkled (W) to Tight (T)

This portion of the BST‟s identifies the risk for wrinkles. The questionnaire deals about

habits such as sun exposure smoking etc, the skin of ancestors to ascertain the genetic

influence on wrinkled skin.

The „W‟ types may not necessarily have wrinkles at the time that they complete the

BST but in time they will need to begin prevention methods because they are at risk.

Individuals with lighter skin are more likely to manifest „W‟ type skin than those with

dark skin.

Utility of Baumann Skin Typing System

1. The BST‟s can lend valuable assistance in the process of treating particular skin

problems and selecting the most appropriate products as well as dermatologic procedures

for an individuals particular skin type.

2. It is recommended that individuals take a baseline BST questionnaire and retake the test

at times of stress, change or when experiencing cutaneous symptoms because skin types are

not necessarily static.

3. Skin type alterations can be elicited by stress and marked fluctuations in stress,

pregnancy, and menopause, exposure to variable climates or moving to different climate or

various other significant exogenous or endogenous changes.

56


Other Scales

Various other scales which are used are

Japanese Skin Type scale, Lancer Ethnicity Scale,

Pigmentation Scales- Taylor‟s hyperpigmentation Scale ,Melasma Area and Severity

Index, Skin Sensitivity- Acne Quality of Life Scale, Wrinkles and Photoaging Scales.

The ideal Scale is uncomplicated, easy to use and reliable with well defined categories.

An ideal Scale should also be reliable for use in daily practice in addition to clinical

trials.75

Figure No 2:-Different Skin types

57


MELANIN

Historical aspects of pigment cell biology

Human skin colour is predominantly based on the pigment melanin and influenced to a

minor extent by pigments such as carotene, reduced haemoglobin and oxyhaemoglobin.

Melanin is a term derived from the Greek word melas (black).

Robin is claimed to have been the first to use the term melanin when, in 1873, he

named the pigment in the pigment cells of animals 'pigment melanique’.

It was also revealed that tyrosine was the first compound in the melanin pathway and

that it was oxidized by the enzyme tyrosinase to dopa, which was then converted to

melanin through a series of intermediates.

Melanocytes- Origin and Migration

Melanocytes are neural crest derived, pigment synthesizing dendritic cells that reside

primarily in the basal layer.

Melanin is synthesized in the cytoplasm of specific dendritic cells which discharges

melanosomes into the surrounding keratinocytes through the dendrites.

Table 21 :- Various events from origin to migration of melanocytes 76

Time Event

8 weeks Melanoblasts arise from neural crest, they migrate along either side

of the spinal cord to the skin

10-12 weeks Population of melanocytes increase in the dermis

12-14weeks First appearance in the epidermis

16-20weeks Melanin synthesis starts

After 24 weeks They become established at the epidermal-dermal junction.

58


In addition to the skin, melanoblasts are disseminated from the neural crest to other

sites - most important of these are the uveal tract of the eye ,(which includes the iris but

not the retina), the inner ear, mucous membranes (particularly of the mouth) and

leptomeninges (membranes enveloping the brain and spinal cord).

The retinal pigment layer of the eye also contains melanocytes, but these derive from

the outer layer of the optic cup and not from the neural crest.

Figure No 3:-Origin and migration of melanocytes.

Abundance and distribution

The face and genital areas have a far greater melanocyte concentration than the trunk

and thigh. The 'regional variations' in melanocyte numbers appear to be both inherent

and sun-induced. 77

59


Melanosomes

The basic currency of mammalian pigmentation is a cytoplasmic organelle called as

melanosome which contains the enzyme tyrosinase. 78

Melanosomes in human skin undergo four stages of development while inside the

melanocyte. In stage I, premelansomes are characterized by their spherical structure and

amorphous matrix. During stage II, they become more oval shaped with no apparent

melanin. In stage III, following tyrosinase activity, melanin production starts and the

melanization continues to stage IV, at which point the organelle contains high

concentrations of melanin. The melanosomes are then transferred along microtubules to

the dendritic structures of melanocytes and transferred to the keratinocytes

Melanocyte-keratinocyte relationship

The association of melanocyte and keratinocyte constitutes a functionally-active

partnership. These two cell types are mutually dependent and are considered as

structural and functional units which are termed as the epidermal melanin unit.

An epidermal melanin unit consists of one epidermal melanocyte in association with

20-40 keratinocytes to which it donates melanosomes.

The process of melanosome transfer from melanocyte to keratinocyte is a crucial one

because skin will not appear pigmented unless melanosomes are present within the

keratinocytes.

The modus operandi of this transfer has been intensively studied, and several models

were proposed. A popular model states that the tip of a melanocyte dendrite (containing

melanosomes) becomes enfolded in the recipient keratinocyte. This tip is then nipped

off together with its clustre of melanosomes by a process similar to phagocytosis. The

60


melanosome clustre is buried in a cytoplasmic matrix, while the phagocytosed dendrite

is gradually decomposed with the eventual release and dispersal of its melanosomes.

In summary, skin colour is influenced by a spectrum of processes ranging from the

migration of melanoblasts to the disposal of melanin in the stratum corneum.

Basically, the intensity of skin colour is determined by

(a) The total number and size of melanosomes within the epidermal melanin unit,

(b) The rate of melanosome formation and melanization, and

(c) The rate of melanosome transfer to keratinocytes.

Other relevant factors include epidermal thickness, dermal blood supply and the

reflective and absorptive properties of skin.

Figure No 4:-The transfer of melanosomes to surrounding keratinocytes

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Biochemical control of Pigmentation

Plant melanins have a different biochemical derivation from animal melanins. The

animal melanins originate from the amino acid tyrosine, and they are characterized by a

brown-black colour, a high molecular weight and a polymeric structure.

Biochemistry- Melanogenesis

Tyrosinase is the enzyme responsible for the formation of melanin within the

melanosomes, a process which will be referred to as melanogenesis. It is a copper-

containing enzyme which is stimulated by ultraviolet (UV) radiation, and other factors

such as melanocyte-stimulating hormone

There are two main types of melanin important in human biology: –

o Eumelanin - is the black-brown compound, which is found in the skin, hair and all the

other melanocyte-bearing tissues

o Phaeomelanin.- is the yellow-to reddish- brown pigment which has been identified in

mammalian hair (including human red hair) and in the feathers of chickens

o The relative amounts of these two types determine hair colour and skin tone.

Individuals with darker skin tones have mostly eumelanin and a lesser amount of

pheomelanin, while the opposite is true in people with a light skin colour

Hormonal Control of pigmentation

MSH and ACTH causes increase in tyrosinase activity with resultant stimulation of

melanogenesis.

Melatonin- MSH darkens the skin, where as melatonin lightens. It apparently acts by

inhibiting the later stages of melanin biosynthesis without affecting tyrosinase itself.

62


Sex hormones- Oestrogen and progesterone have their strongest pigmentary impact on

the sexual skin and in the areolae.

Modifications in hormonal balance

Pregnancy- One of the early signs of pregnancy is darkening of the nipples and areolae

and, to a lesser extent, of the face, anterior abdominal wall and genitalia. These changes

are known collectively as the chloasma (or melasma) of pregnancy and they increase as

the pregnancy advances. During pregnancy there is a great increase in melanin

formation by the epidermal melanocytes, and melanocyte counts are higher than in

nonpregnant women of the same age group.

Oral contraceptives- The use of oral contraceptives has been associated with the

development of discolouration of the cheeks, forehead and nose similar to the chloasma

of pregnancy.

Menstrual cycle- There is some evidence that, like pregnancy, a similar but less marked

chloasma occurs during the menstrual cycle although menstrual chloasma is not an

established entity; the above evidence indicates that some skin discolouration does

occur in the premenstrual phase.

Other pigments responsible for skin colour- Melanoid- A pigment related to melanin

but having different absorption band of visible light.

Carotene- A yellow orange pigment is found in liquid rich areas such as stratum

corneum and the fat of the subcutaneous tissue.

Oxyhemoglobin- This imparts a red component to skin colour and is especially evident

in areas where there is a rich arterial supply, such as skin of the face, neck , palm , soles

and nipples.

63


Reduced hemoblobin -It contributes a bluish or purple character to skin colour and is

more evident in lower part of the trunk. Factors such as melanin concentration and skin

thickness tend to suppress the hemoglobin pigment colour component effect.

Ultraviolet Light and Skin Colour

UV irradiation is a major source of environmental influence and damage to the skin.

There are 2 types of skin colour with respect to UV radiations.They are

o Constitutive skin colour (CSC) -refers to the genetically influenced colour and

melanin production without the impact of UV light or environmental factors.

o Facultative skin colour (FSC) denotes the colour influenced by UV light and

hormones. When exposed skin is subjected to UV light, melanogenesis or “tanning”

occurs, representing the skin‟s major defense against further UV damage. This

darkening results when the UV radiation provides a positive signal to the exposed

epidermal melanin units.

o Subsequent to UVA exposure, the skin develops an immediate pigmentary darkening

provoked by the oxidation of the existing melanin. This effect appears within a few

minutes of exposure to UVA and lasts for approximately 6 to 8 hours.

o Both UVB and UVA are involved in the process of delayed tanning. It is seen in 2 to

3 days after exposure and lasts for approximately 10 to 14 days.

o In this process, tyrosinase enzyme activity and the number of melanocytes that are

actively producing melanin increase. In addition, melanosome transfer from the

melanocytes to the keratinocytes is enhanced. The resulting increase in melanin

protects against further UV damage by surrounding the cell nucleus and absorbing

UV photons and UV-generated free radicals before they can react with DNA and

64


other critical cellular components. It was also demonstrated that DNA damage or

DNA repair intermediates can stimulate melanogenesis in the absence of UV light.

Table 22 :- Difference between Immediate and Delayed tanning

Immediate Delayed

Onset Minutes 3-4days

Peak Intensity Minutes to a few hours 10-28days

Fading Within 24 hours Weeks

Mechanism Redistribution

of melanosomes

Increased Tyrosinase level and activity,

Melanin Synthesis, Melanocyte dendricity,

Melanosome number, Melanosome transfer,

Melanocyte proliferation

Photo

protection

Unchanged Increased

Change in skin

Colour

Undetectable in fair

skin

Obvious in most light skinned and all dark

skinned individuals

Skin Colour Perceptions

Visible light reaches the skin surface and is either reflected back to the eye from the

stratum corneum or enters the skin and is then reflected back to the eye from collagen

fibers, blood vessels, and melanosomes. In ethnic skin, the desquamating corneocytes

contain pigment. This brown skin scale appears grey when viewed, as a result of the air

interface behind the scale and gives rise to the term “ashy,” which is used to describe the

appearance of dry skin in darker complexioned population. Ashy skin is equated with dry

skin and is considered unattractive because of the suboptimal skin colour viewed as light

bounces off of the stratum corneum.

65


Visible light may also enter ethnic skin, which contains abundant pigment, for

subsequent reflection to the eye. If the pigment is evenly distributed, the skin appears an

even brown colour. If the melanin is present in clumps, the skin will appear unevenly

lighter and darker depending on the pigment distribution. In Fitzpatrick skin types I, II, and

III unevenness in skin colour is caused by the irregular distribution of vascular structures

and collagen, giving the skin undesirable red and yellow colours. The effects of collagen

breakdown and the formation of telangiectatic vascular structures are not of primary

concern in ethnic skin, making pigmentary change the single most important measure of

skin attractiveness. 79

Figure No 5 :-Skin colour perceptions –

Light is reflected from the skin surface and within the skin from hemoglobin, collagen,

and melanin.

66


VARNYA

Introduction

Complexion which is the manifest form of beauty is enhanced by various means.

This task of enhancement of complexion is termed as Varṇya. Various treatment modalities

such as Nasya, Raktamokṣana and Lepas have been mentioned by different authors which

are attributed to Varṇya Karma. Varṇya upakramas seems to be a ray of hope to fulfill the

cosmetic demands of this aesthetic era. Hence there is a need for its extensive study.

Definition

uÉhrÉï- uÉhÉÉïrÉ ÌWûiÉqÉç CÌiÉ uÉhrÉïqÉç || 80

That which is beneficial for Varṇa is said to be as Varṇya

uÉhrÉïÈ qÉÑZÉurÉ…¡ûÉÌSuÉhÉïMüU | 81

That which enhances Varṇa and which imparts physiological colour in mukha vyaṅga

uÉhrÉïÈ uÉhMïüUÈ |82

That which enhances Varṇa is termed as Varṇya

Synonyms

Varṇa prasādana, Varṇa vaiśadyakaram, Varṇa vaimalya, Varṇa śuddhi 83

, Varṇa karam,

Varṇa utkarṣa, Varṇa dārḍhya Varṇa upacaya, Varṇaprasannatvakara

84

Dinacaryā and their effect on Varṇa

Classical literature reveals that most of the procedures which are followed as a part of

dinacaryā are said to have an impact on the colour and complexion of the individual.

67


Table 23 :-Dinacaryā and their effect on Varṇa

Sl.No Dinacaryā Effect On Varṇa

1. Abhyaṅga Varṇa Balaprada, Sutvak, Twachya,

Upachita Aṅga

2. Śiro'bhyaṅga Mūrdhni Taila Sutvak

3. Vyāyāma Kānti Gātraanām

4. Udvartana Twak Prasādana

5. Tāṁbūla Sevana Kānti Sauṣṭhavakāraka

6. Utsādana Kāntimat Mṛjā

7. Udgharṣana Twak Gatasya Agni Tejana

8. Anulepana Varṇakaram , Vaivarṇyaghnam

9. Snāna Varṇya

10. Bāṇāvara Varṇa Vivardhana

11. Āsyā Varṇa Soukumāryakari

12. Kṣaura Karma Kāntikara

13. Chatra Dhāraṇa Varṇya

14. Puṣpa Dhāraṇa Pāṭalī, Punnāga,

Kunda Vāsantikā, Ketakī, Bakula,

Kunda

Kāntikarakam

15. Nidrā Varṇa Dīpti

16. Saṁvāhana Twak Prasādakaram

17. Valkala Dhāraṇa Kāntikaram

18. Kārpāsa Uṣṇīśa Twak Roukshyāhāram Varṇyam

19. Bhūṣaṇa Dhāraṇa Kāntidam

20. Mouktika Dhāraṇa Kāntidam

21. Phala Dhāraṇa - Uduṁbara,Kadalī

Sugandhī , Kapittha, Mātuluṅga

Kāntikaram, Varṇyam

22. Tāmra Pātra Bhojana, Kānta Pātra,

Roupya Pātra, Veṇu Pātra

Kanikaram, Varṇyam

23. Pāda Saṁvāhana Twak Prasādkaram

24. Nasya Prasanna Twak

25. Taila Gaṇḍūṣa Vadana Upacaya

68


Āhāra Vargās which are Varṇya

Certain Āhāra dravyās are said to promote the colour and complexion and are also

indicative of importance of food in creating and maintaining Varṇa.

Table 24 :-Āhāra vargās which are Varṇya

Sl. No Āhāra varga Dravya

1 Shāli varga Yava, lohita

2 Śiṁbivarga Makuṣṭha, masūra ,tila

3 Māmsa varga Barhi ,Rohita Tittira, haṁsa, mayūra , māmsa rasa

4 Shāka varga Tila

5 Phala varga Baddha kesara, āmra with kṣīra,Pakva āmra

6 Harita varga Rasona

7 Madhya varga Madhya, pakva rasa madhya, Apakva rasa madhya

8 Gorasa varga Kṣīra, kṣīrottha navanīta, Catu Sneha, ghṛta

9 Ikṣu varga Śarkara ,madhu , ikṣu

10 Taila varga Tila taila, Eraṇḍa taila

11 Kritānna varga Mantha, ghṛta taila pakva bhakṣya, yūṣa of sthavira

and jīraka

Dietary pattern:

It is mentioned that Diet taken in appropriate quantity certainly helps the individual in

bringing out complexion without disturbing the Prakŗti.Also the wholesome food

consumed according to rules is said to be complexion promoter 85

.It is stated that unctuous

food taken by an individual brings out the brightness of complexion. According to

Kashyapa Saṁhitā, Āhāra taken with Sneha dravya stimulates the „Varṇya‟ process. Lustre

of skin gets increased by the suitability of diet and regimen as per the season. Similarly;

„Anupāna‟ promotes the complexion.

69


Role of Rasās

Madhura rasa and kasāya rasa are said to possess Varṇa prasādana karma

Role of Guṇas

Mṛdu, Accha, Ūṣṇa, Snigdha, Ślakṣṇa, Drava guṇas play a major role. These result in

Sukumāra avadāta gātra, Prasanna snigdha Varṇa, Gaura, Snigdha, Ślakṣṇa aṅga

Trividha Cikitsā

Classical literature of Āyurveda basically deals with 3 types of Cikitsā. They are

Antah Parimārjana

Bahi Parimārjana

Śastra Praṇidhāna

Antah Parimārjana

Cikitsā which basically aims at entering the Antah śarīra and mainly cures the Āhāra jāta

vyādhi is termed as Antah Parimārjana Cikitsā

Antah parimārjana as Varṇya

Samśodhana Therapy

Caraka Saṁhitā states that Normal complexion is restored by Samśodhana therapy and

Basti given in a prescribed manner improves complexion and strength. Aṣṭāṅga Saṁgraha

and Astaṅga Hṛdaya also explains the role of Elimination therapy in promoting the colour

and complexion. 86

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Śamana Cikitsā

Rasāyana

The Rasāyana therapy improves both the lustre and complexion. The four herbs which are

mentioned as Medhya Rasāyana also improve colour and complexion.87

Some yogas like

Laśuna kalpa and Śatāvarī Rasāyana are prescribed for improving the Varṇa. 88

Similarly

in Bhāvaprakāśa Samhitā the Yogas such as Guḍāṣṭaka, Vidārī ghṛta are stated to have an

action on the Varṇa. Vṛṣya Ghṛta and Takrāriṣṭa are also said to promote complexion. 89

Yogas like Āmalaka ghṛta and Aindra rasāyana

90and other Yogas like Amrtaprāśa ghṛta

and Sarpirmodaka 91

are mentioned.

Bahi Parimārjana as Varṇya

Cikitsā which mainly aims to cure the diseases which are localized in the skin through

Abhyaṅga, Sweda, pradeha, pariśeka, unmardana etc is termed as Bahi Parimārjana

Cikitsā.

Varṇya Upakramas:

In „Vraṇa Śotha Cikitsā‟, under the heading of „Vaikṛtāpaha’ twenty two Upkramas are

explained, among them „Kṛṣṇakarma‟ and „Pāndukarma’ are meant to change the

abnormal colour of healed wound. 92

Gaṇas

The herbs belonging to these Gaṇas are said to promote complexion.

Varṇya Gaṇa,93

Elādi Gaṇa –Varṇya,

Rodhrādi Gaṇa- Varṇa prasādana

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Herbs which promote complexion mainly includes

Candana, Tuṅga ,Padmaka ,Uśīra ,Madhūka ,Mañjiṣṭhā ,Sāriva ,Payasya ,Sitā ,Latā

constitute Varṇya Gaṇa

Ela, Tagara, Kuṣṭha, Māṁsī, Dhyāmaka, Tvakpatra, Puṣpa, Priyaṅgu, Hareṇuka

Vyaghranaka, Śukti, Canda, Sthauṇeyaka, Śrīveṣṭaka, Coca, Coraka ,Vāluka, Guggulu

Sarja Rasa, Kunduruka, Taruṣka, Aguru, Spruk, Uśīra, Bhadradāru, Kumkuma

Punnāga, Kesara constitute Elādi Gaṇa.

Lodhra, Savara Lodhra, Palāśa Kuṭannaṭa, Aśoka, Phañjī, Kaṭphala, Elavāluka,

Śallakī Jiṅginī, Kadalī, Kadamba, Sāla constitute Rodhrādi Gaṇa.

Bahi Parimārjana producing Varṇya effect

Bahi parimārjana cikitsā as the name indicates is mainly intended for external use only.

Hence different forms of external applications are described in the context of treatment of

different diseases. They are Lepa Kalpanā Upanāha, Malahara kalpanā etc.

Lepa kalpanā

Synonyms: Ālepa, Lipta, lepa, Lepana.

Medicines in the form of a paste used for external application are called lepas. Wet

medicinal drugs are made into kalka (paste form), if drugs are in dry state they are

converted into kalka (paste) by adding little quantity of water and grinding. This kalka is

used as external application and is called lepa kalpanā. Water, cow‟s urine, oil and ghee

are some of the media used for mixing.

Pharmaceutically lepa kalpanā is a form of kalka kalpanā. While clinically lepa

kalpana is only meant for external application where as kalka is very commonly used for

internal administration.

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Various classical literatures of Āyurveda have explained different types of lepas on the

basis of the drugs used for preparation and mode of administration and its usage.

According to Suśruta Saṁhitā Lepa is of 3 varieties.

Śaraṅgadhara Saṁhitā categorises Lepa Kalpanā on the basis of the drugs used for the

preparation and their action. Śaraṅgadhara Saṁhitā also categorises lepa kalpanā into

varieties on the basis of mode of administration and its usage

According to Aṣṭāṅga Saṁgraha lepas are of 10 types. Among these first five lepas are

most useful formulations for the treatment of Vraṇa Śotha. Rest of the five lepas are

useful for the treatment of secondary stage of vraṇa.

Table 25:- Different ypes of lepa

S.S Sha.Sam A.S

Pralepa Doṣaghna Lepa Pralepa Snaihika Pācana,

Pradeha Viṣaghna Lepa Pradeha Nirvāpaṇa Pīḍana

Ālepa Varṇya Lepa Prasādana Śodhana

Staṁbhana Śoṣaṇa

Vilayana Savarṇīkaraṇa

Table 26 :- Difference between Types of lepa

Pralepa Pradeha Ālepa

Shīta lepa (with Shīta guṇa

dravyas) without heating

Uṣṇa lepa (with Uṣṇa

vīrya drayas)

The action, thickness etc of

this lepa will be moderate

(Madhyama ālepa)

Tanu lepa (thin) Bahala (thick) Useful in Rakta and Pitta

doṣa pradhāna twak vikāra.

May or may not be dry

(Viśoṣī or Aviśoṣī)

Aviśoṣī (Remains moist

for long ime)

Indicated in Pittadoṣa

Pradhāna Twak rogās

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Rules of Application of lepa and Mechanism of its absorption

1. Lepas should always be applied in the opposite direction of the hair follicles. The drugs

get absorbed through their hair roots, sweat glands and capillaries.

2. While applying the lepas Snehas are said to be added. Their quantity has to be decided

as per the doṣa vitiated.

Vātaja vyādhi- 1/4th

part of Sneha dravya

Pittaja Vyādhi-1/6th


Kaphaja Vyādhi-1/8th


3. The lepa should not be left in situ after drying. It must be removed as soon as it dries

up. Because lepās in wet state help to cure the diseases , where as on drying they lose

their potency and irritate the skin.

4. Lepas should be prepared freshly and used.

5. They should be used only once.

6. Over the previous lepa fresh one should not be applied.

7. Lepas should not be applied at night. If applied, it causes skin diseases by suppressing

the local temperature and disturbing the local circulatory system.

8. Pralepa should not be applied at nights nor should it be allowed to stay on after it dries

up. Where as Pradehas can be allowed to stay on in order to cause constriction or

pressure over the part of the body.

9. The thickness of the lepas is said to be of that of wet skin of buffaloes

General actionsof Lepa

1. Vraṇa Śodhaka

2. Vraṇa Ropaka

74


3. Dāha Śāmaka

4. Kaṇḍūhara

5. Sandhāna Kara

6. Śothahara

7. Śūlahara

8. Staṁbhaka (Ex-Niruddha lepana-A thick paste of drugs applied to check the

bleeding).

Preservation of Lepas:- Vegetable lepa churnas will preserve their potency for 30 days

if kept in airtight containers. Minerals and Metallic preparations last indefinitely.

Mode of action of Lepas

When an auṣadha or kriyā dravya is applied on the skin, it enters the romakūpa, reaches

swedavaha srotas and thus the rasa tarpaṇa occurs and the applied drug is metabolized

by the auśṇya of bhrājaka pitta present in the skin.94

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COMPLEXION PROMOTERS.

Complexion of an individual can be promoted by 2 ways. One is by oral administration of

dietary ingredients which are beneficial for skin and other way is by topical applications.

Nutritional Cosmetics

Nutritional cosmetics, more commonly referred to as nutricosmetics, embraces

the idea that beauty can be enhanced through the consumption of functional dietary

products that may support healthier and thus more beautiful skin. The term

nutricosmetics appears to borrow from the terms nutraceuticals and cosmeceuticals to

reflect the goal of these products, that is, to provide health and beauty benefits to the skin

via nutritional products consumed on a regular basis. This concept encompasses a unique

amalgamation of the nutrition and personal care industries. 95 It is said that “Let food be

your medicine and let medicine be your food”- It is from such a perspective that good

nutrition is a fundamental building block of good general health and healthy skin.

One of the more important aspects of healthy looking skin is a smooth

appearance. However, a smooth appearance can be difficult to maintain without a firm

foundation and proper hydration. A Variey of Natural dietary ingredients support a firm

skin foundation and proper skin hydration. The various skin types according to BST

classification have unique requirements. 96

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Table 27 :- Dietary needs of different skin types97

Skin Type Ingredient Source

Dry

Skin

Cholesterol,

Hyaluronic acid,

Omega 3 fatty acids,

Glucosamine,

Niacinamide(Vitamin B3 )

Animal fats,cheese, egg yolks, fish, shrimp, flax seeds

Fresh fruits vegetables,

Fish, flax seed, walnuts

Shells of shell fish

Peanuts, yeast, fish , meat

Oily &

Sesitive

Vitamin A

Omega 3 fatty acids,

Carrots, dried apricots, spinach, milk, oats

Fish, flax seed, walnuts

Resistant Nothing Specific -

Pigmented Glucosamine

Pycnogenol

Vitamin C

Shells of shell fish

Pomogranate, grapes Soy

Non

Pigmented

Nothing Specific

Wrinkled Mono unsaturated fatty acids

Co enzyme Q 10

Red meat ,olives, cashew

fish ,shell, fish, spinach , nuts

Asparagus, Garlic Spinach

Tight Nothing Specific -

Principles of Topical Therapy

Sensible topical drug therapy involves not only the selection of an appropriate agent, but

also a thoughtful consideration of the :-

Areas of the body affected,

The state of the diseased skin,

The concentration of the drug,

The type of vehicle (e.g ointment cream lotion)

The method of application and

77


A defined duration of use that both maximizes efficacy and minimizes adverse side

effects.

Cutaneous Drug Delivery

The therapeutic efficacy of a topical drug relates to both its inherent potency and the

ability of that drug to penetrate the skin. Percutaneous absorption necessitates passage

through the stratum corneum, epidermis, papillary dermis and into blood stream.

General Guidelines for Topical Therapy

Vehicle

The vehicle is the inactive part of a topical preparation that brings a drug into contact

with the skin.

The vehicle of a topical formulation often has beneficial non-specific effects by

possessing cooling, protective, emollient occlusive or astringent properties.

Rational topical therapy matches an appropriate vehicle that contains an effective

concentration of the drug.

The vehicle functions optimally when it is stable both chemically and physically and

does not inactivate the drug.

The vehicle also should be non irritating, non allergenic, cosmetically acceptable and

easy to use. Additionally the vehicle must release the drug into the pharmacologically

important compartment of the skin.

Finally the patient must accept using the vehicle or else compliance will be poor.

Dosage: An amount of topical medication sufficient to cover affected body surfaces in

repeated applications must be dispensed to the patient.

78


Regional Anatomic Variation

Permeability generally is inversely proportional to the thickness of the stratum

corneum. Drug penetration is higher on the face, in intertriginous areas, and especially in

the perineum. Consequently, the skin in these regions may be more susceptible to irritant

and allergic contact reactions.

Altered Barrier Function

In many dermatological diseases, such as psoriasis, the stratum corneum is

abnormal, and barrier function is compromised. In these conditions, percutaneous

absorption may be increased to the point that standard drug doses can result in systemic

toxicity (e.g., hypothalamic-pituitary-adrenal axis suppression can result from systemic

absorption of potent topical glucocorticoids).

Hydration

Drug absorption is increased with hydration, defined as an increase in the water

content of the stratum corneum that is produced by inhibiting transepidermal loss of

water. Methods of hydration include occlusion with an impermeable film, application of

lipophilic occlusive vehicles such as ointments, and soaking dry skin before occlusion.

Classification of Topical formulations

Table 28 :- Classification of Topical formulations

Powders

Jellies

Thickening

agents

Ointments-Hydrocarbon bases, Absorption

bases,Water in oil emulsions (creams) , Oil in water

emulsions, water soluble bases

Poultices

Cerates

Stabilisers

Liquids-Solutions, Suspensions, Shake lotions

Pastes Plasters

Aerosols-

79


Mode of action of Topical Applications98

Following the application of the drug to the skin surface, its subsequent passage through

the skin barrier into the underlying skin layers and its distribution into systemic

circulation is as follows.

Penetration pathways

The surface of the stratum corneum presents more than 99% of the total skin surface

available for percutaneous drug absorption. In order to undergo percutaneous absorption

the compound must penetrate the stratum corneum, diffuse into and through the viable

epidermis, into the dermis, finally gain access to the systemic compartment through the

vascular system. 3 Penetration pathways are possible. They are;-

Intercellular ( inside the lipid layers around corneocytes)

Follicular

Intracellular penetration.

The major steps involved in percutaneous absorption include

The establishment of a concentration gradient, which provides the driving force for

drug movement across the skin;

Release of drug from the vehicle (partition coefficient); and Drug diffusion across the

layers of the skin to reach the systemic circulation. (Diffusion coefficient).99

80


Figure No 6 :-The mode of action of topical applications

81


VYANGA

Introduction

Kṣudra Rogas are those group of disorders which are basically characterized by Alpa

rūpa or these are also termed as Alpa Vyādhi (Shabda kalpa druma) The diseases which

manifest in children are also termed as Kṣudra rogas. They are also known by the terms

Swalpa, Adhama or Krūra Vyādhis Diseases which are caused by Adharma are also

termed as Kṣudra rogas. Vyaṅga is a disease which belongs to Swalpa variety of Kṣudra

Roga Prakaraṇa.

Kṣudra roga swa rūpa

Kṣudrarogas are characterised by both mandavega or mahāvega & some are

alparujāyukta and others are adhika pīḍā yukta, some are mahān and some are alpa

vyādhis.

Vyaṅga

ÌuÉM×üiÉÉÌlÉ ½…¡ûÉÌlÉ rÉxrÉ |

ÌuÉaÉiÉ ÌuÉMüsÉ A…¡û mÉëÉÍkÉMüqÉï |

Any sort of deformity is termed as Vyaṅga

urÉ…¡ûÈ zrÉÉqÉuÉhÉï qÉhQûsÉÇ qÉÑZÉå| 100

The word Vyaṅga literally means - Spotted, speckled, freckles on the face, a blot or

blemish.- (Monier Williams Dictionary)

82


Historical Review

RigVeda

There is description of historical event - Śyāva Roga, (Discolouration) as a consequence

of kuṣṭha which was cured by Lord Indra and later he was blessed with a beautiful wife.

Saṁhitā kāla

CarakaSaṁhitā, Suśruta Saṁhitā, Astaṅga Hṛdaya

Vyaṅga has been described by all the bṛhat trayī. A detailed and separate description of

Vyaṅga in the chapter of „Kṣudra Roga’ is available in Suśruta Saṁhitā which includes

Nidāna, lakṣaṇa, samprāpti and sāpekṣa nidāna Both Caraka Saṁhitā and Suśruta

Saṁhitā considers Vyaṅga as a „Raktaja Roga’& a common samprāpti for Tilakālaka,

Piplu, Vyaṅga and Nīlikā in Triśothīya Adhyāya has been given.101

Individuals who

belong to Pitta Prakṛti are said to be prone to Vyaṅga. Social importance for the

appearance of the individual is also clear from the reference that the qualities of an ideal

Śiṣya and Dhātrī (wet nurse) are to be devoid of Vyaṅga. More elaborate description is

available in Astaṅga Hṛdaya Uttaratantra, in the „Kṣudra Roga Prakaraṇa where in the

Dośānusāra Lakṣaṇas of the disease are explained in detail.

Madhyakāla

Madhava Nidāna, Śarangadhara Saṁhitā, Bhavaprākāśa , Cakradatta, Yogaratnākar

have described about the disease Vyaṅga in the context of Kṣudra roga.

83


Sāmanya Nidāna

Table 29 :-Sāmanya Nidāna of Vyaṅga

Nidāna Vāta Prakopaka Pitta Prakopaka Kapha

Prakopaka

Rakta Prakopaka

Āhāraja Guṇa-Rūkṣa,Shīta

Rasa-Kaśaya,

Tikta, Apatarpaṇa

Tīkṣna, Uṣṇa,

Vidāhi

Kaṭu, Amla

Snigdha Uṣṇa, Lavaṇa,

Amla, Kśāra,Katu,

Virudhānna,

Asātmya Bhojana

Vihār ja Vyāyāma, Vega

Dhārana,

Jāgaraṇa, Pravāta

Ātapa Divāswapna-

Drava snigdha,

Guru bhojana

Mānasika Atiśoka , Harṣa Santāpa, Krodha

Āgantuja Abhighāta

Viśeṣa Nidāna

Vihāraja- Chardi Nigrahaṇa102

Mānasika- Krodha, Śoka, Āyāsa103

Pūrvarūpa:

Pūrvarūpa of Vyaṅga is not mentioned in any Ayurvedic classics.

Rūpa

Table 30 :- Rūpa of Vyaṅga104

105

106

107

Sl.No Lakṣaṇa S.S A.H M.N B.P Y.R

1 Śyāva + + + + +

2 Nīruja + - + + +

3 Tanu + + + + +

4 Maṇḍala + + + + +

84


Types

According to the Doṣa predominance, the disease Vyaṅga may be categorized into four

subtypes as,

(1) Vātika: The maṇḍalas are charecterised by Śyāva Varṇa. On sparśa maṇḍalas are

Khara or Paruśa.

(2) Paittika: The Varṇa of maṇḍalas may be either Tāmra or Nīla.

(3) Kaphaja: The maṇḍalas are of Śweta Varṇa and it may be associated with kaṇḍū

(4) Raktaja: The maṇḍalas are Rakta or Tāmra Varṇa and may be with dāha. 108

Figure No 7 :- Lakṣaṇas of Vyaṅga

Samprāpti

Due to the intake of Āhāraja, vihāraja, Mānasika nidāna (Āyāsa, Krodha), there is

vitiation of Vāta along with pitta. The vitiated doṣas lodge in the twak of mukha

producing Nīruja, tanu, śyāva maṇḍalas which is termed as Vyaṅga 109

85


Samprāpti-

Flow Chart No 1 :-Samprāpti of Vyaṅga

Āhāra ja, Vihāraja, Mānasika Nidāna Sevana

Dūṣya Doṣa Prakopa Agni vikṛti Sroto duṣṭi

Daurbalya

Vāta Pitta

Mano

vaha Srotas

Kha- vaiguṇya

Rasa duṣṭi Rasa vaha

Srotas

Rakta duṣṭi Rakta vaha

Srotas

Sthāna saṁśraya in Tvacā of Mukha &

Nīruja, Tanu, Śyāva maṇḍala

Vyaṅga

86


Samprāpti Ghaṭaka

Table 31 :-Samprāpti Ghatakas of Vyaṅga

Doṣa Vāyu (Udāna, Vyāna) ,Pitta (Bhrājaka)

Dhātu Rasa, rakta,

Upadhātu Tvak

Dūṣya Rasa, Rakta, Manas

Srotas Rasavaha , Raktavaha, Manovaha

Sroto duṣṭi prakāra Saṅga, Vimārgagamana

Adhiṣṭhāna Tvacā

Swabhāva Mṛdu

Agni Jatharāgni ,Dhatvāgni (Rasāgni, Raktāgni)

Roga Mārga Bāhya rogamārga (śākha)

Vyakta Sthāna Tvak

Rugviniścaya:

1. Nyaccha: Broad or small, grey or dark discoloured, painless patches on the skin of the

body are called Nyaccha.

2. Nīlikā: Similar black discolouration as Vyaṅga appearing in other parts of the body is

known as Nīlikā

3. Jatumaṇi:- A congenital, slightly elevated, even, smooth, slightly reddish in colour

and painless patch on the skin caused by kapha and rakta is known as Jatumaṇi.

4. Maṣaka: Painless, immovable, black, round nodules on the skin resembling blackgram

caused by Vāta is called Maṣaka.

5. Tilakālaka: Black, painless spots resembling sesamum seeds, not raised above the

level of the skin, caused by vāta, pitta and kapha together is known as Tilakālaka. 110

87


Cikitsā

Ayurvedic classics advocate the use of various formulations in the treatment of Vyaṅga in

addition to that certain formulations are indicated which alleviates the discolouration and

enhances the complexion of the face.

Mainly two types of the therapies are found to be advised for the disease Vyaṅga

A. Śodhana therapy like Vamana, Virecana, Nasya, Raktamokṣhana etc.

B. Śamana therapy in the form of internal medicines and external application of drugs in

the form of Lepa, Taila etc111

A. Śodhana Therapy

Though Vyaṅga is a Kṣudraroga and locally manifested disease, it also requires Śodhana

in chronic stage of the disease. Many classical texts indicated Śodhana therapy for the

disease Vyaṅga .112

B. Śamana Therapy

Various dosage forms are advocated for both external and internal use in Vyaṅga

Treatment Modalities of Vyaṅga mentioned by different Authors

88


Table 32 Showing Treatment modalities of Vyaṅga113

Treatment

Modalities

C.S S.S A.H A.S B.P Y.R B.R

Mukha prakṣālana - + - - - - -

Lepa - + + + + + +

Abhyaṅga - - + + + + +

Pradeha - + - - - - -

Pāna - - - - + - -

Nasya - - + + - - -

Raktamokṣana - + + + + + -

Vamana - - - + - - -

Virecana + - - + - - -

Śamana yoga

Table 33 Showing Śamana yogas in Vyaṅga

Ghṛta Nīlinyādi Ghṛta, Varṇaka Ghṛta

Ariṣṭa Abhayāriṣṭa, Paṭolāriṣṭa

Taila for Abhyaṅga Kuṅkumādi Taila, Kaṭu Taila, Abhyaṅga

Taila for Nasya Aṇu Taila

Cūrṇa for Udvartana Tribhuvanādi Chūrṇa

Lepa

Mukha Kāntikara lepa, Śaśa Asṛk lepa, Jātī Phala Kalka lepa

Sādhyāsādhyata-Vyaṅga is a Sādhya vyādhi. & it has has no upadravas.

Vyaṅga as Ariṣṭa lakṣaṇa- akasmāt prādurbhāva of Vyaṅga is considered as ariṣṭa

lakṣaṇa

89


MELASMA

Introduction

Acquired hyper pigmentation disorders of the skin are among the most common

complaints in a general dermatology clinic. Among those, melasma is known for causing

significant impact on quality of life, including a negative effect on the patients emotional

well being and social life .Despite the advent of powerful pigment-targeting lasers, the

treatment for melasma remains challenging. In the United States alone, approximately 5

to 6 million individuals are afflicted with melasma of which majority are females (90-

95%). In Asia, it is a common diagnosis in any dermatology clinic and can reach an

incidence of 0.25% to 4% of cases seen in any dermatology institution. Melasma should

not be dismissed as simply a cosmetic entity because it often evokes emotional distress.

Additionally, stigma may be associated with melasma, particularly in Asian cultures.

Hence there is need for its extensive study.

Definition

Melasma is a chronic acquired cutaneous hypermelanosis which is classically

characterized by symmetric facial hyperpigmented macules and patches commonly

affecting the forehead, malar eminences, periorbital areas, and the upper lip.

Synonyms

Melasma, Chloasma (derived from the Greek cloazein, meaning greenish), Mask of

Pregnancy.

90


Incidence

Melasma is much more commonly seen in women, although men can also be affected

(reported 10%), suggesting a hormone-related etiology.

This strong linkage between melasma and hormones is demonstrated by an increased

incidence in the onset of pregnancy, and is termed as chloasma, or “the mask of

pregnancy.”

In addition, the use of birthcontrol pills or estrogen replacement therapy, ovarian or

thyroid dysfunction, and ovarian tumors has also been associated with the onset of

melasma.

Although all skin types can be affected, melasma is seen at a much higher incidence

in darker skin phototypes (Fitzpatrick Skin Phototypes IV to VI) with extensive

ultraviolet radiation (UV) exposure.

Medications and other systemic illnesses have also been reported to be associated

with the onset of melasma, including phototoxic and photoallergic medications,

antiepileptic medications, cosmetics, altered nutrition, and hepatic disease.

Pathophysiology

Although the exact cause of melasma is unknown, it is strongly associated with 6 factors:

Hormonal influences,

Ultraviolet (UV) radiation,

Genetic predisposition

Immunology

Use of Cosmetics and

Use of Medication

91


Hormonal Influences

Melasma occurs commonly during pregnancy, with data suggesting an incidence of

50–70% in pregnant women.

It occurs frequently in women using oral contraceptives.

Women taking hormone-replacement therapy (HRT) that includes progestational

hormones may develop melasma.

Menopausal and postmenopausal women receiving HRT were found to have lesions

on the forearms.

It may be triggered by nutritional supplements, especially those that have estrogen-

and progesterone-like properties.

Although progesterone, estrogen, melanocyte-stimulating hormone (MSH), and

luteinizing hormone have been implicated as a trigger of melasma, levels have not

been consistently elevated in these patients.

Ultraviolet Radiation

Exposure to UV radiation is believed to be the leading factor in the development of

melasma. Supporting this observation is the predominance of melasma is observed in

geographic areas with high levels of UV light.

Patients whose melasma has improved or nearly resolved may relapse completely or

develop darkening of existing lesions from one episode of UV exposure (minimum 5-

15min).

Melasma lesions tend to improve or fade during winter months with less UV

exposure. It is well known that skin darkening is a result of UVA exposure and to a

lesser extent UVB, which trigger increased melanocyte activity and melanogenesis.

92


Genetic Predisposition

The common occurrence of melasma in families (ie 54% of the patients have a family

history of melasma) supports a hereditary component to this disorder.

It has been suggested that the increase in pigmentation following exposure to UV

radiation is a consequence of DNA repair.

Immunology

Immunohistochemical findings suggest that a strong immunoreactivity to α-MSH on

skin with melasma is one of the leading factors in the genesis of this disease.

There are evidences of a strong expression of α-MSH antigen in the keratinocytes of

the skin affected with melasma, suggesting that α-MSH plays a key role in the

hyperpigmentation of skin with melasma.

Use of Cosmetics

Ingredients in cosmetics that were selectively implicated as causative factors for

dermal melanoses include certain fatty acids, photoactive contaminants of mineral

oils, petrolatum, beeswax, certain dyes, para-phenylenediamine, and perfume

ingredients.

Use of Medication

A wide variety of medications produce hyperpigmentation. These include metals such

as arsenic, iron, copper, bismuth, silver, gold, phototoxic and antiseizure drugs.

Clinical features

The primary lesions of melasma are

Bilateral,

93


Symmetric,

Hyperpigmented macules and patches that may vary in colour from tan to blue-gray.

The colour variations are attributed to several factors, including the amounts of melanin

pigment produced, the size of the melanosomes, and the location of melanin and

melanophages within the epidermis and dermis.

Types

Melasma occurs most often on the upper lip, nose, cheeks, forehead, chin, mandible,

neck, chest, and forearm areas. Three patterns of facial melasma have been described:

1. Depending on the Site of the lesion

Centro- facial with lesions involving the cheeks, forehead, upper lip, nose, and chin.

This pattern was seen in the majority of patients (63%). Melasma on the upper lip

typicallyoccurs in women taking oral contraceptives.

Malar with lesions involving the cheeks and nose only, which is seen in 21% of

patients.

Mandibular with involvement of the ramus of the mandible, which is seen in 16%.

Less often, the perioral and mental areas are involved. 114

2. Depending on the natural history of lesions 115

Transient -The transient types disappear within 1 year of cessation of hormonal

stimuli like pregnancy or oral contraceptive pills.

Persistent types. -The persistent types continues to be present more than 1 year after

the hormonal stimulus is removed and is caused by the UV rays and other factors.

94


Histopathology of Melasma

Histologically, increased melanin can be seen in the basal and suprabasal

keratinocytes (epidermal pigmentation) and in the dermis (dermal pigmentation).

With the use of a Wood‟s lamp and light microscopy, Sanchez and colleagues

classified melasma into three histopathologic categories with the following features

1. Epidermal type (70–90% of all melasma cases)

Location of pigmentation: Melanin deposition in the basal and suprabasal layers through

the stratum corneum.

Woods lamp - Pigment is intensified

2. Dermal type

Location of pigmentation: Melanin deposition within the superficial dermis and in the

middermis. Imparts a blue grey colour to the overlying skin

Woods lamp- Pigment is not intensified under Wood‟s lamp

3. Compound (mixed) type

Features of both epidermal and dermal types (recently reported at 24% of all cases).

4. Indeterminate: inapparent under Wood's light

A Slight variation in the clinical features of these 3 histological types has been observed.

They are as follows

95


Table 34 :-Histological types of Melasma

Epidermal type Dermal type- Mixed Type

Well-defined border Ill-defined border Combination of light and

brown patches

Dark brown colour Light brown colour Partial improvement with

treatment

Appears more obvious

under black light

Unchanged under black

light

Responds well to treatment Responds poorly to

treatment

Ultrastructural Features of Melasma

Increased number of melanocytes, melanocyte activity, melanosome size,

melanosome formation, melanosome transfer

High percentage of melanosomes individually dispersed within the keratinocyte

Differential Diagnosis

Freckles: These are pigmented macules, usually with reddish tan, observed in

sunexposed area on the skin. Seen mostly in children scattered across their cheeks and

nose, and macules darken following exposure to ultraviolet light.

Solar lentigo: Patients with history of chronic sun exposure develop solar lentigines,

usually after puberty and after age of 40 years. These are called liver spots or old-age

spots.Lentigens are moderately dark brown and large. With irregular borders.They

occur on chronically sun exposed surfaces, on the face, and dorsum of hand.

Riehl’s melanosis: Histopathology demonstrates an inflammatory infiltrate at the

epidermal dermal junction. Favours sites of application of cosmetics causing contact

dermatitis especially cosmetics, May be reticulated, Brown–grey colour due to dermal

96


melanin deposits, Histologic features- vacuolar degeneration of basal layer and

lichenoid infiltrate in early lesions

Bilateral nevus of ota: This is a blue to gray-brown pigmented patch located on the

face, usually within the distribution of the ophthalmic and maxillary branches of the

trigeminal nerve. Discolouration may be limited to the zygomatic arch or forehead or

may cover half the face, Associated with ocular and mucosal melanosis.

Post inflammatory hyperpigmentation (PIH): Usually lacks the symmetric

component, and history reveals a preceding inflammatory or traumatic event such as

acne vulgaris or contact dermatitis.

Incontinentia pigmenti: May be associated with developmental defects of the eye,

skeletal system and central nervous system.

Hypermelanosis in Endocrinal disorders: such as Addison‟s diseases, Cushing‟s

syndrome, Hyperthyroidism etc.

Hypermelanosis in Systemic disorders: such as Chronic Infections, Systemic lupus

erythematosus, Renal failure, Hepatic failure etc.

Hypermelanosis due to Nutritional Deficiencies: such as in Vitamin A Deficiency,

Pellagra

Prognosis

The predominantly epidermal type of melasma responds better than the predominantly

dermal type. Melasma of pregnancy fades away within a few months of delivery.116

97


Treatment

Melasma is a chronic, relapsing disorder that can be managed effectively but not

cured. Effective treatment of melasma often has a prolonged course, and the patient

must be aware of the “long-term commitment” necessary to achieve a successful

outcome.

The goals of melasma therapy are basically twofold: the removal of existing pigments

and the prevention of the formation of new pigments.

Melasma therapy is based on four mechanisms of action

o Minimizing UV exposure

o Minimizing contributing hormonal Influences

o Preventing melanin production

o Removing melanin

Minimizing UV Exposure

Sun Avoidance

Geographic location often places a patient at risk for UV exposure from ordinary

daily activities. Avoidance of peak times of UV exposure, especially between the

hours of 10 a.m. and 3 p.m. should be emphasized. Sunbathing and sporting activities

are contraindicated, as are without sun-protective clothing and hats.

Sun Protection

Broad-spectrum sunblock with UVA and UVB protection and a skin protection factor

(SPF) of 30 or higher is a critically important adjunct to first-line melasma therapy

makeup.

98


Sun-protective clothing, especially broad-brimmed hats, high-collared shirts, and

sunglasses, add additional coverage for melasma patients.

Avoid Photosensitizers

Medications and supplements that have photosensitization characteristics should be

avoided

Some of the drugs which cause Photosensitivity include Acetominophen, Acyclovir,

Captopril, Chloroquine, Ibuprofen, Oral Contraceptive Pills, Doxycycline etc.

These induce Photosensitivity reactions that will trigger melasma and /or darken

existing lesions.

Minimizing Contributing Hormonal Influences

It is important to remove hormonal stimulus such as OCP‟s

Preventing Melanin Production & Removing Melanin

By Topical and Procedural therapies

Topical Therapy

Topical preparations of lightening agents for the treatment of melasma are numerous

and constitute first-line therapy either as monotherapy or as combination therapy.

A variety of topical agents are used to treat melasma.

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Table 35 :-Topical applications and their probable mode of action

Formulations Mode of action

Hydroquinone, Azelaic acid, Kojic

acid, Arbutin, licorice extracts,

mulberry, bearberry

These agents act as tyrosinase inhibitors, degrades

melanosomes and destroys melanocytes.

Nicotinic acid, Niacinamide, Soy,

Tretinion

It decreases the rate of transfer of melanosomes to

the keratinocytes.

Alphahydroxyacids,

Betahydroxyacids, tretinoin

These accelerate cell turnover in the epidermis,

Topical corticosteroids Suppresses melanin formation without destroying

the melanosomes.

Chemical peels such as Glycolic

acid, Salicylic acid, Trichloracetic

acid, Tretinoin

Keratinocyte removal.

Procedural Therapy

Melasma is a therapeutic challenge for a dermatologist. Since most patients with

melasma have both epidermal and dermal pigmentation. Topical therapy alone is often

insufficient to clear their melasma.

Chemical Peels-

The two most common peeling agents used in treating melasma are glycolic acid and

salicylic acid, but are to be used in lower concentrations for superficial peeling in order to

avoid risk of causing post inflammatory hyperpigmentation.

100


Other procedures include

Microabrasion

Vitamin C Iontophoresis

Laserss

Intense Pulse light along with topical Therapy

Melasma and Nurition

Vitamins C and E have been reported to suppress the spread of UV-induced

hyperpigmentation.

Oral Consumption of Pomogranate extract, grape seed extract, Pycnogenol (Pine

bark extract ) are said to be effective and safe nutritional supplements for melasma

by virtue of suppressing melanocyte proliferation and melanin production by

tyrosinase in melanocytes117

101


Varṇya Gaṇa includes 10 drugs- They are as follows118

Drug Latin Name Family English

Name

Habit Habitat Synonyms Parts

Used

Rasa

Candana Santalum

Album

Santalaceae White

Sandalwood

Tree Dry regions of

Peninsular

India

Gandhasāra, Malayaja

Ekāṅgī, Hima

,Śrīkanda,Mahara

,Bhadrapriya

Kānda,

Sāra

Tikta,

Madhura

Tuṅga Calophyllum

inophyllum

Guttiferrae Indian

Laurel,

Alexandrian

Laurel

Tree Coastal

regions,

Punnāga, Kimijalaka, Rāja

Campā, Nāga Campā,

Sultāna Campā

Kānda

twak

Kaśaya

Madhura

Padmaka

Prunus

cerasoides

Rosaceae Wild

Himalayan

Cherry, Bird

Cherry

Tree

The

temperate

Himalayas

from Garhwal

to Sikkim,

Padmagandhī ,Padmādya

Padmakāṣṭha

Kānda Tikta

Madhura

Uśīra Vetveria

zizanoides

Graminae Vetiver,

Khas

Densely

tufted

Grass

Rajasthan,

Uttar Pradesh

and West

coast.

Nalada,bahumūlaka

Āmranāla, Jalavāsa

Śaiśandhaka ,Haripriya

Indragupta,

Samagandhaka

Mūla Tikta ,

Madhura

Table No 36 :-Drug Review

102


Drug Latin Name Family English

Name

Habit Habitat Synonyms Parts

Used

Rasa

Madhūka Glycyrrhiza

glabra

Leguminac

eae

Licorice,

Liquorice

Herb/

Under

Shrub

Native to the

Mediterranean

regions.

Klītaka ,Madhuyaṣṭhī

,Jalayaṣṭhī, Madhūlika

Mūla Madhura

Mañjiṣṭhā Rubia

cordifolia

Rubiaceae Indian

Madder

Climber Throughout

India

Jinghinī ,Vastraranjinī

Vikāsa ,Raktāṅga

Mūla Madura

Tikta

Sāriva Hemidesmus

indicus

Asclepedia

ceae

Indian

Sarsaparilla

Semi-

erct

shrub

Bengal ,

Maharashtra

Anantā ,Anantamūla

Āsphoṭa, Gopī

Mūla Madhura

Tikta

Payasya Pureaeria

tuberosa

Leguminac

eae

Indian

kudze

Creeper Central India,

Punjab

Vidārī ,Svādugandhā

Ikṣugandhā ,Kandapalāśa

Kānda Madhura

Sitā Cynodon

dactylon

Poaceae Bermuda

Grass

Grass Throughout

India

Śataparva ,Dūrvā ,Anantā

Tiktaparvā

Pañchāṅg

a

Kaśaya

Madhura

Latā Cynodon

linearis

Poaceae Bermuda

Grass

Grass Throughout

India

Śataparva Dūrvā Anantā

Tiktaparvā

Pañchāṅg

a

Kaśaya

Madhura

103


Drug Guṇa Vīrya Vipāka Karma Doṣaghnatā Chemical Composition

Candana Laghu,Rūkṣa Shīta Kaṭu Dāhapraśamana

Raktaprasādana

Kaphapittahara Santalol, Santene, Santalenes,

Santelenon, Teresantalol, Nor

Tricyclockasantalal, 1-santenone ,

Teresantalic acid.

Tuṅga Laghu,Rūkṣa Shīta Madhura Dāhapraśamana Kapha

pittahara

Friedelin, Sitosterol,

Canopylol,Callophylloids,

Inophyllid, Inophyllum A, B &D ,

Calophylin B

Padmaka Laghu,

Snigdha

Shīta Kaṭu Garbhasthāpana

Vedanāsthāpanā

Vṛṣya , Varṇya

Kaphapittahara Pudumin A, Genistein, Pruneitin,

Genkwanin, Cerasinone, Cerasidin,

Cerasin.

Uśīra Ruksha Laghu Shīta Kaṭu Pācana,

Stabhana

Kapha

Pittahara

Allokhusiol, Benzoic acid,

Epizizanol,Eudesmol, Eugenol,

Isokhusenoloxide, Isovalenic acid,

Khusimis acetate, Vanilin, zizanol.

Madhūka Guru Snigdha Shīta Madhura Pācana

Stambhana

Rasāyana Vṛṣya

Cakṣuṣya

Tridoṣahara Glycyrrhiza, Glycyrrhizic acid,

Liquertin, Glabrin, Licuraside,

Hispaglabradin, Glabrene.

104


Drug Guṇa Vīrya Vipāka Karma Doṣaghnatā Chemical Composition

Mañjiṣṭhā Guru

Snigdha

Uṣṇa Kaṭu Svarya ,Varṇya Kapha pittahara Anti tumor cyclic hexapeptides,

Anthraquin,Munjistin,

Purpuroxantin, Rubiatriol,

Rubiofolic acid, Rubiadin,

Purpurin, Ruberythric acid.

Sāriva Guru

Snigdha

Shīta Madhura Grāhi ,Śukrala Tridoṣahara Hyperoside, Hexatriacontane,

Sitisterol, Hemidesminine

Payasya Guru

Snigdha

Shīta Madhura Balya ,Snehopaga

Bṛṁhaṇīya ,Varṇya

Kaṇṭhya

Vāta Pitta

Shāmaka

Purarin, Diadzein, Genestein,

Genistin

Tuberosin

Sitā Laghu Shīta Madhura Varṇya ,

Prajāsthāpana

Kapha pittahara Methoxy propionic acid,

Benzoic acid, Phytol, Sitosterol

Latā Laghu Shīta Madhura Varṇya

,Prajāsthāpana

Kaphapittahara Methoxy propionic acid,

Benzoic acid, Phytol, Sitosterol

105


106


MATERIALS AND METHODS

MATERIALS

The materials used for the study can be categorized as follows

1. Literary

2. Drugs

3. Assessment tools (Instruments)

Collection of Materials

1. Literary Sources:- The primary sources of literature were different classical texts

books of Ayurveda, related information was compiled from other sources such as

Vedic and Upaniṣad scripts,. Information was also gathered from the texts books of

contemporary medical science, other allied texts. Other sources include various

journals, research works and retrospective studies carried out at different universities

and other research centers. Information available on internet was also incorporated.

Drugs:- Candana, Tuṅga, Padmaka, Uśīra, Madhūka, Mañjiṣṭhā, Sāriva, Payasya,

Sitā, Latā are the 10 drugs which were used in the form of lepa (ālepa) with water as

the media for the present study. The raw drugs were procured from Govind Raj

Shetty and Sons, Devraj Urs Road, Mysore, Abdul Ravoof Pansari Shop, Mandi

Mohalla, Mysore and Jogappa Shenoy Pansari Shop, Rathabeedi, Udupi

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Varnya Gana lepa Churna Luke warm water

Varnya Gana lepa

Figure No 9 ;- Varnya Gana lepa

Assessment tools (Instruments)

o Colour Grading Scale- Fair and lovely fairness meter was used to measure the Skin

Colour as well as the Lesion colour. It comprises of 26 grades of colour

108

A Study on the concept of Varṇya vis-à-vis clinical evaluation of efficacy of Varṇya gaṇa lepa in Vyaṅga

Fig No 10:-Fairness Meter

o Melasma Area Severity Index Scores- The Melasma Area and Severity Index

(MASI),was developed by Kimbrough-Green et al, based on a scoring system devised

for psoriasis .The MASI score is calculated by subjective assessment of 3 factors:

Area (A), Darkness (D), and Homogeneity (H) of involvement where in Forehead(f)

constitutes 30%, Right malar region (rm)- 30%, Left malar region (lm) 30% and

Chin (c)-10% .

Fig No 11:- Melasma Area Severity Index Scores

109


METHODOLOGY

1. Literary- Literary materials for the study were collected from different classics and

were analysed critically and comparatively with the help of tantra yuki.

2. Method to assess the Skin Colour and Lesion Colour through the Colour

Grading Scale.

The Colour Grading Scale has 26 grades. The number corresponding to the skin

colour of each patient was noted and in the same way, the number corresponding to

the lesion colour was noted before treatment. Lesion colour was assessed after the

intervention period and follow up period. The difference between the grades were

analysed to assess the improvement.

3. Method to assess the Area and Severity of Melasma through MASI Score

MASI Scoring System is used to assess 3 parameters .They are Area (A), Darkness

(D), and Homogeneity (H) of involvement. The MASI score is calculated by adding

the sum of the severity ratings for darkness and homogeneity, multiplied by the value

of the area of involvement, for each of the 4 facial areas [frontal (f), left malar(lm),

right malar(rm), chin(c)]: The following formula is used for calculation.

MASI total score =0.3A (f)[D(f)+H(f)]+ 0.3A (lm) [D(lm)+H(lm)] + 0.3A(rm)

[D(rm)+H(rm)] + 0.1A (c) [D(c)+H(c) ]. The total score range is 0 to 48. Higher the

score, higher is the severity.

4. Selction of the drugs

Varnya gaṇa mahakashaya dravyas are selected and administered in the form of lepa

(bahi parimārjana cikitsā)

110


5. Method of Preparation of Lepa

The raw drugs were procured from the source. They were cleaned and fine powder of

all the 10 drugs was prepared using a pulveriser. Patient was advised to add sufficient

quantity of luke warm water to the powder (lepa chūrna) and a thick paste was

prepared out of it.

6. Method of Application

Patients were advised to apply lepa from medial to lateral direction (opposite to the

direction of hair follicles) in a sufficient quantity, so as to cover the affected areas

(moderate thickness) effectively. Patients were advised to apply freshly prepared

lepa, not to apply over the previous lepa, & not to apply at night times.Patients were

instructed to apply lepa twice daily (morning and evening).They were advised to

wash the face with luke warm water once the lepa gets dried (after about 15-20 min).

They were instructed not to go to sun during the period of treatment.cxix

METHODS

Aim

To analyze the concept of Varṇya by evaluating the efficacy of Varṇya Gaṇa Lepa in

Vyaṅga.

Objectives

1. To systematically compile and review the literature on the concept of Varṇa , Varṇya,

and Vyaṅga

2. To clinically evaluate the efficacy of Carakokta Varṇya Gaṇa Lepa in Vyaṅga

111


Source of Data

Sample

40 Patients irrespective of sex, caste, religion, and socio-economic status who were

diagnosed to have Vyaṅga were selected from the O.P.D and I.P.D of GAMC Hospital

Mysore and registered for the study. Out of 40 patients, 5 were drop outs and 35 patients

continued with the study.

Diagnostic Criteria

Objective Parameters

1. Syāma

2. Maṇḍala

3. Tanu

Inclusion Criteria

1. Patients with clinical signs of the disease Vyaṅga as per ayurvedic classics were

included.

2. Patients between age group 16-60years were selected for the study

3. Patients irrespective of sex, religion, occupation and chronicity were selected for the

study.

Exclusion Criteria

1. Hyperpigmentation caused due to any systemic diseases like Addison‟s disease,

Cushing Syndrome and SLE.

2. Hyperpigmentation since birth like Neavus.

3. Hyperpigmentation caused by tumors like malignant melanoma.

112


Sampling Method

Sampling Method was the simple random sampling technique.

3. Research Design

1. A Literary study of Ayurvedic literature on Varṇa, Varṇya, and Vyaṅga with current

updated view (western medicine) was undertaken.

2. The study design was a Clinical –Interventional Study with a pre , post and follow up

assessment.

3. Patients were selected incidentally and 35 patients were assigned to a single group

Intervention

1. Initially the patient was advised to clean the face with luke warm water.

2. Varṇya Gaṇa Lepa was given for application on the affected areas.

3. It was advised that Quantity and thickness of Lepa was sufficient enough to cover the

lesion completely.

4. Duration of Each Application -Until the Lepa gets dried and once it dries the patient

was asked to wash the face with warm water.

5. Intervention period- For 15 days twice daily

6. Post test assessment-After 15 days

Assessment Criteria

The improvrment provided by the therapy was assessed on the basis of following

parameters:-

113


Objective criteria

Skin /Lesion Colour

Texture (Dry/Oily)

Skin lustre

Number of Lesions

Size of Lesions

Darkness of the lesion

Area of involvement

Homogeneity of the lesion

Subjective criteria

Itching

Burning Sensation

Assessment Variables

The assessment of Clinical improvement was based on the assessment of individual

parameters which were framed as follows

Grading for the Objective Variables

1. Colour

Colour of Skin and lesion are graded with the help of Fair and Lovely Colour

Grading Scale .There are 1-26 grades

2. Texture- Dry Skin

Absent 0

Mild Dryness (Not seen but felt) 1

114


Moderate Dryness (Stretching of the skin that a person feels) 2

Severe dryness (Visible dryness chapping of skin (hardness of Skin) 3

Oily skin

Absent 0

Mild oiliness(Not seen with naked eye) 1

Oiliness felt by touch (No need to wash face frequently

only 1-2 times)

Moderate oiliness (Oiliness is visible on skin, 2

Need to wash face frequently)

Severe Oiliness (Excessive Oiliness, Formation of Acne 3

Need to wash face more frequently)

3. Skin Lustre

Poor Lustre 1

Mild Lustre 2

Moderate Lustre 3

Good Radiant Lustre 4

4. Number of Lesions

1-2 1

2-4 2

4-6 3

>6 4

115


5. Size of the lesions

0-2cm 1

2-4cm 2

4-6cm 3

>6cm 4

When lesions or patches are multiple, the size of the largest lesion is taken into

consideration

6. MASI Score – To assess Area of Involvement, Darkness and Homogeneity of the

lesions

Table 37 :-Grades of MASI Score

The area of involvement Darkness Homogeneity

0 = no involvement; 0 = absent 0 = absent

1 =10% 1 = slight 1 = slight

2 = 10%-29% 2 = mild 2 = mild

3 =30%-49% 3 =marked 3 =marked

4 = 50%-69% 4 = maximum 4 = maximum

5 = 70%-89%

6 = 90%- 100%.

116


Subjective variables

1. Itching

No itching 0

Mild Itching (Occasional itching, does not disturb routine) 1

Moderate itching (Frequent itching, disturbs routine activity but not sleep)- 2

Severe itching (Disturbs both routine and sleep) 3

2. Burning Sensation

No Burning 0

Mild Burning (Occasional Burning Sensation mostly when exposed to sun)- 1

Moderate Burning (Frequent Burning which increases when exposed to sun ) 2

Severe Burning (Continous Burning without sun exposure) 3

Assessment on Clinical Improvement

Overall assessment was done on the basis of following criteria.

CD- Clinically deteriorated ie increase in severity score against initial score

CS- Clinically Stable- Severity of Score remains same as against initial score

CI-1- Clinical improvement -Mild- 1 grade reduction against initial score

CI-2 – Clinical improvement Moderate -2 grade reduction against initial score

CI-3- Clinical improvement Good- 3 grade reduction against initial score

Statisical Analysis

The results of the present study will be analyzed statistically using Descriptive Statistics,

Frequencies and Percentages, Cross tabulation (Contingency Table Analysis), Chi-Square

test, Repeated measure ANOVA using SPSS for windows (version 16.0 ).

117


OBSERVATIONS AND RESULTS

OBSERVATIONS

The study registered 40 patients out of which 5 were drop outs and 35 continued with the

study. Observations of the patients are tabulated below.

Table 38 :-Age group incidence

Age in years Frequency Percent P. Value

21-30 9 25.7 0.122

31-40 14 40

41-50 8 22.9

51-60 4 11.4

Total 35 100.0

Out of 35 patients 14 patients (40%) were from the age group 31-40 yrs, 9 patients

( 25.7%) were from the age group 21-30 yrs, 8 patients (22.9%) were from the age group

41-50 yrs and only 4 patients (11.4%) were from the age group 51-60 yrs

Table 39 :-Sex wise distribution

Sex Frequency Percent P.Value

Male 4 11.4 0.000

Female 31 88.6

Total 35 100.0

Out of 35 patients 31 patients (88.6%) were females and only 4 patients (11.4%) were

males

118


Table 40 :-Religion wise distribution

Religion Frequency Percent P.Value

Hindu 30 85.7 0.000

Muslim 4 11.4

Christian 1 2.9

Total 35 100.0

Out of 35 patients 30 patients (85.7%) were Hindus, 4 patients (11.4%) were Muslims

and only 1 patient (2.9%) was a Christian

Table 41:- Educational Status wise distribution

Educational Status Frequency Percent P.Value

Primary School 4 11.4 0.001

Middle School 6 17.1

High School 17 48.6

Graduate 4 11.4

Post Graduate 4 11.4

Total 35 100.0

Out of 35 patients 17 patients (48.6%) were educated upto high school, 6 patients

(17.1%) middle school and 4 patients (11.4%) each upto primary school, Graduation and

Post Graduation.

Table 42 :-Marital Status wise distribution

Marital Status Frequency Percent P.Value

Married 33 94.3

0.000 Un married 2 5.7

Total 35 100.0

119


Out of 35 patients , 33 patients (94.3%) were married and 2 patients (5.7%) were

unmarried.

Table No 43 :-Socio Economic Status wise wise distribution

Socio-Economic Status Frequency Percent P.Value

Lower middle 14 40.0 0.000

Middle 19 54.3

Upper middle 1 2.9

Rich 1 2.9

Total 35 100.0

Out of 35 patients 19 patients (54.3%) were from middle class, 14 patients (40%) were

fom Lower middle class, and 1 patient (2.9%) each were from Upper middle class and

Rich class.

Table 44 :-Nature of Work wise distribution

Nature of work Frequency Percent P.Value

Hard manual 5 14.3 0.000

Mild 2 5.7

Moderate 19 54.3

Sendentry 9 25.7

Total 35 100

Out of 35 patients , 20 patients (51.4%) were doing moderate manual work, 8 patients,

(28.5%) were doing sedentary work, 5 patients (14.3%) patients were doing Hard manual

work, and 2 patients (5.7%) were doing mild manual work

120


Table 45 :-Diet wise distribution

Diet Frequency Percent P.Value

Mixed 27 77.1 0.001

Veg 8 22.9

Total 35 100.0

Out of 35 patients , 27 patients (77.1%) were following mixed diet, and 8 patients

(22.9%) were vegetarians.

Table 46 :- Koṣṭha wise distribution

Koṣṭha Frequency Percent P.Value

Mṛdu 1 2.9 0.000

Madhyama 34 97.1

Krūra 0 0

Total 35 100.0

Out of 35 patients, 1 patient (2.9%) had Mṛdu Koṣṭha, 34 patients (97.1%) had

madhyama Koṣṭha

Table 47 :-Agni wise distribution

Agni Frequency Percent P.Value

Samāgni 25 71.4 0.000

Mandāgni 9 25.7

Tīkṣṇāgni 1 2.9

Viṣamāgni 0 0

Total 35 100.0

Out of 35 patients, 25 patients ( 71.4%) had Samāgni, 9 patients had Mandāgni (25.7%),

and 1 patient( 2.9%) had Tīkṣṇāgni

121


Table 48 :-Appetite wise distribution

Appetite Frequency Percent P.Value

Poor 4 11.4 0.000

Moderate 5 14.3

Good 25 71.4

Extreme 1 2.9

Total 35 100.0

Out of 35 patients, 25 patients (71.4%) had Good Appetite, 5 patients (14.3%) had

moderate appetite, 4 patients (11.4%) had Poor Appetite, and 1 patient (2.9%) had

extreme appetite.

Table 49:- Sleep wise distribution

Sleep Frequency Percent P.Value

Satisfactory 23 65.7 0.063

Unsatisfactory 12 34.3

Total 35 100.0

Out of 35 patients, 23 patients (65.7%) had Satisfactory Sleep and 12 patients (34.3%)

had unsatisfactory sleep

Table 50:- Bowel Habits wise distribution

Bowel Habits Frequency Percent P.Value

Regular 27 77.1 0.001

Irregular 8 22.9

Total 35 100.0

Out of 35 patients, 27 patients (77.1%) had Regular Bowel Habits, 8 patients (22.9%) had

Irregular Bowel Habits.

122


Table 51:- Family History wise distribution

Family History Frequency Percent P.Value

Present 15 42.9 0.398

Absent 20 57.1

Total 35 100.0

Out of 35 patients, 20 patients (57.1%) had no Family History of vyaṅga, and 15 patients

(42.9%) had a Family History of vyaṅga

Table 52:- Contraceptive History wise distribution

Contraceptive History Frequency Percent P.Value

Present 3 8.6 0.000

Absent 28 80.0

Not Applicable 4 11.4

Total 35 100.0

Out of 35 patients, 28 patients (80%) had no Contraceptive History and 3 patients (8.6%)

had a positive Contraceptive History

Table 53 :-Physical Aggravating Factors wise distribution

Physical Agg.Factors Frequency Percent P.Value

Sun rays 16 45.7 0.000

Excessive work 2 5.7

Multiple AF 2 5.7

Nothing specific 15 42.9

Total 35 100.0

123


Out of 35 patients, 16 patients (45.7%) had Sun rays as Aggravating Factor, 15 patients

(42.9%) had no specific Aggravating factors, 2 patients (5.7%) had Multiple Aggravating

Factors and 2 patients (5.7%) had Excessive work as Aggravating Factor.

Table 54:- Psychological Aggravating Factors wise distribution

Psy. Agg. Factors Frequency Percent P.Value

Chintā 22 62.9 0.000

Śoka 3 8.6

Khinnatā 0 0

Multiple Agg.Fac 3 8.6

Nothing Specific 7 20.0

Total 35 100.0

Out of 35 patients, 22 patients (62.9%) had Cintā as Aggravating Factor, 7 patients (20%)

had no specific Aggravating factors, 3 patients (8.6%) each had Śoka and Multiple

Aggravating Factors.

Table 55:- Cosmetics- Soap wise distribution

Cosmetics-Soap Frequency Percent P.Value

Life boy 15 42.9 0.057

Others 15 42.9

Multiple 5 14.3

Total 35 100.0

Out of 35 patients, 15 patients (42.9%) were using life boy soap. 15 patients (42.9%)

were using other soaps (Santoor, lux etc) and 5 patients (14.3%) were using multiple

soaps (ie changing frequently)

124


Table 56 :-Cosmetics- Cream wise distribution

Cream Frequency Percent P.Value

Fair & lovely 22 62.9 0.000

Others 6 17.1

Multiple 5 14.3

Does not use 2 5.7

Total 35 100.0

Out of 35 patients, 22 patients (62.9%) were using Fair and Lovely, 6 patients (17.1%)

were using other creams (vico turmeric, everyuth etc ), 5 patients (14.3%) were using

multiple creams ( ie changing frequently ) and 2 patients ( 5.7%) were not using any

creams.

Table 57:- Menstrual History wise distribution

Menstrual History Frequency Percent P.Value

Regular 19 54.3 0.015

Irregular 5 14.3

Not applicapable 11 31.4

Total 35 100.0

Out of 35 patients, 19 patients (54.3%) had regular menses, 5 patients ( 14.3%) had

irregular menses and for 11 patients ( 31.4%) it was not applicable (males , those who

underwent Hysterectomy and post menopausal women )

Table 58 :-Age of Menopause wise distribution

Age of Menopause Frequency Percent P.Value

Attained 7 20.0 0.000

Not attained 23 65.7

Not Applicable 5 14.3

Total 35 100.0

125


Out of 35 patients, 23 patients (65.7%) had not attained menopause, 7 patients (20%) nad

attained menopause and for 5 patients (14.3% ) it was not applicable (males and women

who underwent Hysterectomy)

Table 59 :- Prakṛti wise distribution

Prakṛti Frequency Percent P.Value

Vpk 11 31.4 0.114

Pvk 17 48.6

Kpv 7 20.0

Total 35 100

Out of 35 patients, 17 patients (48.6%) were of Pitta prakṛti, 11 patients (31.4%)

were of Vāta prakṛti and 7 patients (20%) were of kapha prakṛti.

Table 60-Showing Sattva wise distribution

Sattva Frequency Percent P.Value

Pravara 14 40.0 0.000

Madhyma 20 57.1

Avara 1 2.9

Total 35 100.0

Out of 35 patients, 20 patients (57.1%) had Madhyama Sattva and 14 patients

(40%) had Pravara sattva and 1 patient (2.9%) had Avara Sattva.

Table 61 :- Sāra wise distribution

Sāra Frequency Percent P.Value

Pravara 5 14.3 0.000

Madhyma 30 85.7

Avara 0 0

Total 35 100.0

126


Out of 35 patients, 30 patients (85.7%) had Madhyama Sattva and 5 patients (14.3%)

had Pravara Sattva

Table 62 :-Pattern wise distribution

Pattern Frequency Percent P.Value

Centro facial 15 42.9 0.398

Malar 20 57.1

Mandibular 0 0

Total 35 100.0

Out of 35 patients, 20 patients (57.1%) had malar pattern and 15 patients (42.9%)

had Centro facial pattern.

Table 63 :-Level of Lesion wise distribution

Level of Lesion Frequency Percent P.Value

Dermal 21 60.0 0.237

Epidermal 14 40.0

Total 35 100.0

Out of 35 patients, 21 patients (60%) had Dermal Melasma and 14 patients (40%)

had epidermal melasma.

Table 64 :-Chronicity wise distribution

Chronicity Frequency Percent P.Value

0-4yrs 22 62.9 0.001

4-8yrs 7 20.0

>8 yrs 6 17.1

Total 35 100.0

127


Out of 35 patients, Chronicity of 22 patients (62.9%) was between 0-4 yrs, 7

patients ( 20%) was between 4-8 yrs and 6 patients ( 17%) was more than 8 yrs.

Table 65 :-Skin colour wise distribution

Skin colour Frequency Percent P Value

1-5 3 8.6 0.000

6-10 17 48.6

11-15 13 37.1

15-20 2 5.7

Total 35 100.0

Out of 35 patients, skin colour of 3 patients (8.6%) was between 1-5 grade, Skin

colour of 17 patients (48.6%) was between 6-10grade, Skin colour of 13 patients (37.1%)

was between 11-15grade and skin colour of 2 patients (5.7%) was between 15-20 grade.

Table 66 :-Distribution of Chronicity vs level of the lesion

Chronicity Level Total P. Value

Dermal Epidermal 0.294

0-4yrs 12 10 22

57.1% 71.4% 62.9%

4-8yrs 6 1 7

28.6% 7.1% 20.0%

>8 yrs 3 3 6

14.3% 21.4% 17.1%

Total 21 14 35

100.0% 100.0% 100.0%

Out of 35 patients, among the 22 patients whose chronicity was between 0-4yrs, 12

patients (57.1%) had dermal type of melasma, 10 patients (71.4%) had epidermal type,

128


Among the 7 patients whose chronicity was 4-8yrs, 6 patients (28.6%) had dermal type,

1 patient (7.1%) had epidermal type, Among the 6 patients whose chronicity was >8 yrs,

3 patients (14.3%) each had dermal and epidermal type of melasma.

Observation during intervention

Some of the patients complained of slight itching and tingling sensation after the

application of lepa which subsided within first 2 or 3 days of treatment.

Illustration No 1 & 2 :-Incidence of Age and Sex

Illustration 3 & 4 :-Incidence of Marital status and Family history

129


Illustration No 5 & 6 :-Incidence of Contraceptive history &Physical Aggravating

factors

Illustration No 7 & 8 :-Incidence of Psychological Aggravating factors & use of Soaps

Illustration No 9 & 10 :-Incidence of Menstual history and age of menopause

130


Illustration No 11 & 12 :-Incidence of prakṛti and Pattern of lesion

Illustration No 13 & 14 :-Incidence of Level of lesion and chronicity

Illustration No15 :-Distribution of skin colour

131


Illustration No 16 :-Distribution of Chronicity vs level of lesion.

Figure No 12:- Patients with melasma before and after treatment

132


RESULTS

Table 67 :-Distribution of Skin Colour Vs Lesion Colour

Skin Colour Mean Std. Deviation N

Lesion

Colour

BT

1-5 22.3333 2.08167 3

6-10 20.5294 4.37489 17

11-15 22.7692 2.20431 13

16-20 24.5000 2.12132 2

Total 21.7429 3.56736 35

Lesion

Colour

AT

1-5 19.6667 2.08167 3

6-10 16.7059 4.11954 17

11-15 18.3077 1.70219 13

15-20 20.5000 .70711 2

Total 17.7714 3.27275 35

Lesion

Colour

FU

1-5 19.6667 2.08167 3

6-10 16.7059 4.11954 17

11-15 18.3077 1.70219 13

16-20 20.5000 .70711 2

Total 17.7714 3.27275 35

Colour P.Value

Only Lesion Colour 0.000

Lesion colour vs Skin colour 0.735

The total mean of the Lesion colour before treatment was 21.7429 , and it was 17.7714

after treatment and follow up.

133


Table 68 :-Results of Darkness of Frontal region

Darkness-Frontal Region Total

Absent Slight Mild

Marked Maximum

BT 24 0 5 4 2 35

68.5% .0% 14.2% 11.4% 5.7% 100%

AT 24 1 6 3 1 35

68.5% 2.85% 17.14% 8.5% 2.85% 100%

FU 24 1 6 3 1 35

68.5% 2.85% 17.14% 8.5% 2.85% 100%

P Value-0.815

Out of 35 patients, 5 patients (14.2%) had mild darkness, 4 patients (11.4%) had marked

darkness, 2 patients (5.7%) had maximum darkness before treatment and 1 patient (2.85%) had

slight darkness, 6 patients (17.14%) had mild darkness, 3 patients (8.5%) had marked darkness

and1 patient (2.85%) had maximum darkness in the frontal region after treatment and after

follow up.

Table 69:- Results of Darkness of Chin region

Darkness-Chin Total

Absent Slight Mild

Marked

BT 29 3 2 1 35

82.8% 8.5% 5.7% 2.8% 100%

AT 29 5 1 0 35

82.8% 14.2% 2.8% 0% 100%

FU 29 5 1 0 35

82.8% 14.2% 2.8% 0% 100%

P Value-0.608

134


Out of 35 patients, 3 patients (8.5%) had Slight darkness, 2 patients (5.7%) had mild darkness, 1

patient (2.8%) had marked darkness before treatment and 5 patients (14.2%) had slight darkness,

1 patient (2.8% ) had mild darkness in the Chin region after treatment and after follow up.

Table 70:- Results of Darkness of Left Malar region

Darkness-Left Malar Total

Absent Slight Mild

Marked Maximum

BT 1 0 6 12 16 35

2.85% .0% 17.14% 34.2% 45.7% 100%

AT 1 4 8 20 2 35

2.85% 11.4% 22.8% 57.14% 5.7% 100%

FU 1 4 8 20 2 35

2.85% 11.4% 22.8% 57.14% 5.7% 100%

P Value-0.002

Out of 35 patients, 6 patients (17.14%) had mild darkness, 12 patients (34.2%) had marked

darkness, 16 patients (45.7%) had maximum darkness before treatment and 4 patients had

slight darkness , 8 patients (22.8%) had mild darkness, 20 patients (57.14%) had marked

darkness and 2 (5.7%) patients had maximum darkness in the Left malar region after treatment

and after follow up.

135


Table No 71 :-Results of Darkness of Right Malar region

Darkness-Right Malar Total

Absent Slight Mild

Marked Maximum

BT 1 0 6 12 16 35

2.85% .0% 17.14% 34.2% 45.7% 50.0%

AT 1 4 8 20 2 35

2.85% 11.4% 22.8% 57.1% 5.7% 50.0%

FU 1 4 8 20 2 35

2.85% 11.4% 22.8% 57.1% 5.7% 50.0%

P Value-0.002

Out of 35 patients, 6 patients (17.14%) had mild darkness, 12 patients (34.2%)had

marked darkness, 16 patients (45.7%) had maximum darkness before treatment and 4

patients(11.4%) had slight darkness, 8 patients (22.8%) had mild darkness, 20

patients(57.1%) had marked darkness and 2 patients (5.7%) had maximum darkness in

the Right malar region after treatment and after follow up.

No changes were found before treatment, after treatment and follow up in the other 2

parameters of MASI Score (Area of the lesion and Homogeneity of the lesion)

Table 72 :-Results of MASI Scores

MASI Mean N S.D F P

Before Treatment 11.6971 35 4.85505

77.500 .000 After treatment 10.3514 35 4.57823

Follow up 10.3514 35 4.57823

136


The mean of MASI Scores of 35 patients, before treatment was 11.69 and after treatment

and follow up it reduced to 10.8314

Table 73:- Results of dryness and oilyness

D/O Dryness Oilyness

Mild Mod Sev Total Mild Mod Sev Total

BT 5 10 8 23 3 6 3 12

21.7% 43.5% 34.8% 100.0% 25.0% 50.0% 25.0% 100.0%

AT 11 10 2 23 8 4 0 12

47.8% 43.5% 8.7% 100.0% 66.7% 33.3% 0% 100.0%

FU 11 10 2 23 8 4 0 12

47.8% 43.5% 8.7% 100.0% 66.7% 33.3% 0% 100.0%

P value-0.070 P Value-0.056

Out of 35 patients, 5 patients(21.7%) had mild dryness, 3 patients(25.0%) had mild

oilyness, 10 patients (43.5%) had moderate dryness, 6 patients(50.0%) had moderate

oilyness, 8 patients (34.8%) had severe dryness and 3 patients had severe oilyness

(25.0%) before treatment. After treatment and follow up duration 11 patients (47.8%)

had mild dryness, 8 patients (66.7%) had mild oilyness, 10 patients (43.5%) had

moderate dryness 4 patients (33.3%) had moderate oilyness, 2 patients (8.7%) had severe

dryness, none had severe oilyness.

137


Table 74 :-Results of itching and burning sensation

I/B Itching Burning Sensation

No Mild Mod Sev Total No Mild Mod Sev Total

BT 25 3 7 - 35 34 0 1 - 35

71.4% 8.57% 20.0% 100% 97.1% .0% 2.80% 100%

AT 32 3 0 - 35 34 1 0 - 35

91.4% 8.57% .0% 100% 97.1% 2.80% .0% 100%

FU 32 3 0 - 35 34 1 0 - 35

91.4% 8.57% .0% 100% 97.1% 2.80% .0% 100%

P value-0.02 P Value-0.368

Out of 35 patients, 25 patients (71.4%) had no itching, 3 patients (8.57%) had mild

itching,7 patients (20.0%) had moderate itching, 1 patient(2.80%) had moderate burning

sensation before treatment, and 32 patients (91.4%) had no itching, 3 patients (8.57%) had

mild itching, 1 patient (2.80%) had mild burning sensation after treatment and follow up.

Table 75 :-Results of size and number of lesions

Size Number

1-2cm 2-4cm 4-6cm >6 Total 1-2 2-4 4-6 >6 Total

BT 6 22 5 2 35 9 24 1 1 35

17.1% 62.9% 14.3% 5.7% 100.0% 25.7% 68.5% 2.9% 2.9% 100%

AT 6 22 5 2 35 9 24 1 1 35

17.1% 62.9% 14.3% 5.7% 100.0% 25.7% 68.5% 2.9% 2.9% 100%

FU 6 22 5 2 35 9 24 1 1 35

17.1% 62.9% 14.3% 5.7% 100.0% 25.7% 68.5% 2.9% 2.9% 100%

P Value-1.000 P Value-1.000

138


There was no change in the size and number of lesions before treatment, after treatment and after

follow up

Table 76 Results of Skin Lustre

Skin Lustre

Poor Mild Moderate Total

BT

15 18 2 35

42.9% 51.4% 5.7% 100.0%

AT

14 19 2 35

40.0% 54.3% 5.7% 100.0%

FU 15 18 2 35

42.9% 51.4% 5.7% 100.0%

P Value-0.999

Out of 35 patients, 15 patients(42.9%) had poor lustre, 18 patients (51.4%) had mild lustre

and 2 patients (5.7%)had moderate lustre before treatment and 14 patients (40.0%) had

poor lustre, 19 patients (54.3%) had mild lustre and 2 patients(5.7%) had moderate lustre

after treatment and follow up

Table 77:-The Assessment of Clinical improvement in all the parameters.

Criteria CD CS CI-1 CI-2 CI-3

Skin colour - - 51.4% 42.8% 5.7%

Skin Texture (Dryness) - 43.47% 56.5 - -

Oilyness - 33.3% 66.7% - -

Lustre - 97.14% 2.87% - -

No of Lesions - 100% - - -

Criteria CD CS CI-1 CI-2 CI-3

139


Size of lesions - 100% - - -

Itching - - 60% 40% -

Burning - - 100% - -

MASI SCORE - - 100% - -

Area - 99.28% 0.7% - -

Darkness - 60.7% 39.3% - -

Homogeneity - 100% - - -

Table 79 :-Results of overall assessment

The overall assessment of the study reveals that 10 patients (28.9%) were said to be

clinically stable, 23 patients (64.34%) had mild improvement, 2 patients (6.7%) had

moderate improvement.

Clinical Improvement No of Patients Percentage P.Value

Clinically Deteriorated 0 0% 0.000

Clinically Stable 10 28.9%

Mild improvement 23 64.34%

Moderate improvement 2 6.7%

Good improvement 0 0%

Total 35 100%

140


Illustration No 17 :-Distribution of Skin Colour Vs Lesion Colour

Illustration No 18 :- Darkness of Frontal region and Chin

0

5

10

15

20

25

1-5grade 6-10 grade 11-15grade 16-20grade

Mea

ns

Grades

Mean BT Mean AT Mean FU

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

BT AT FU BT AT FU

% o

f p

ati

ents

Darkness -Frontal region Darkness- Chin

Absent Sligt Mild Marked Maximum

141


Illustration No 19 :-Darkness of Right Malar region and Left Malar region

Illustration No 20:- Means of MASI Scores

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

BT AT FU BT AT FU

% o

f p

ati

ents

Darkness- Right Malar region Darkness-Left Malar Region

Absent Sligt Mild Marked Maximum

9.5

10

10.5

11

11.5

12

Before Treatment After treatment Follow up

Mea

n M

AS

I v

alu

es

Duration of treatment

142


Illustration No 21 :- Dryness and Oiliness Skin

Illustration No 22:- Itching and Burning Sensation

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

BT AT FU BT AT FU

% o

f p

ati

ents

Dryness Oilyness

Mild Moderate Severe

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

BT AT FU BT AT FU

% o

f p

ati

ents

Itching Burning sensation

Absent Mild Moderate

143


Illustration No 23 :-Size of lesions

Illustration No 24 :- Number of lesions

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

BT AT FU

% o

f p

ati

ents

Duration of treatment

1-2cm 2-4cm 4-6cm >6cm

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

BT AT FU

% o

f p

ati

ents

Duration of Treatment

1-2n 2-4n 4-6n >6n

144


llustration No 25-Showing the Skin Lustre

Illustration No 26 :-Overall assessment of the study.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

BT AT FU

% o

f p

ati

ents

Duration of Treatment

Poor Mild Moderate

0%

10%

20%

30%

40%

50%

60%

70%

Clinically Deteriorated

Clinally Stable Mild Imp Moderate Imp

Good Imp

% o

f P

ati

ents

Clinical improvement

% of Patients

145


DISCUSSION

Discussion is the platform to analyze the concept appropriately, to unveil the rationality

behind facts and finally to successfully accomplish the conceptualization. In this section

both conceptual study and clinical trial will be discussed.

Title

Skin is one of the important ways of expression of beauty. Complexion is the

manifest form of beauty .A fair complexion is a desirable component and indigenous

criterion for beauty since decades. In the present era it is the most decisive and the most

abused of all the attributes of mankind. It determines the social perceptions, value

judgements and interpersonal relationships and it can wreak havoc on individual‟s sense

of dignity and self esteem. Complexion and Colour in Āyurveda is referred to as Varṇa. It

represents all the parameters of healthy and radiant skin. From a physiological

perspective it is a barometer of an individual‟s health as it reflects the equilibrium of the

body entities.

The task of enhancement of Varṇa (or bringing back the abnormal colour

to normalcy or to improve the existing complexion) is termed as Varṇya .Various

treatment modalities such as Anu Lepana, Nasya, Virecana etc are said to be Varṇya. In

this era of aesthetics, it is the need of the hour to fulfill the cosmetic demand of people.

Āyurveda has its own detail and deeper sense regarding the subject but all the literature

concerned with Varṇa and Varṇya is scattered throughout and very minimum research

works have been done till date with this theme. So an attempt is made in this study to

analyse the relevant literature.

146


Among the various Varṇa Vikāras the prevalent and representative disorder

considered in this study is Vyaṅga (Melasma), a hyperpigmentation disorder which

accounts for a great deal of anxiety and stress. There are not many statistics to prove the

exact frequency of skin diseases in this country but the general impression is 10-20

percent of patients seek medical advise for skin diseases. Treatment modalities for

hyperpigmentation are usually unsatisfactory as it shows exacerbation and remission

from time to time. It has various side effects such as contact dermatitis and complete

depigmentation. Hence there is a need for its evaluation through an Ayurvedic

perspective.

Since a fairer complexion is the preference attitude of the society, Varṇya

upakramas may prove to be a ray of hope for those who are desirous of it .Hence the

present study was focused on this concept applied in Vyaṅga thus entitled as “ A Study

on the concept of Varṇya vis-a vis Clinical evaluation of Varṇya Gaṇa Lepa in Vyaṅga.”

Definition of Varṇa

The Sāmānya arthas of the term Varṇa include Brahmaṇādi Jāti, Śuklādi Rūpa and

Akārādyakṣara. By Padārtha tantrayuki it can be said that Śuklādi Rūpa is the most

relevant meaning in this context.

Viśeṣa artha- Varṇa can be interpreted and understood in the following way.

Varṇa as Skin Colour:-

By the definition Varno gaurādi the term Varṇa literally refers to the colour component

of skin health i.e. gaura, śyāma, avadāta etc colours of the skin.

147


Varṇa as Skin texture

By the definition Varṇa Śabdena Cakṣurgrāhya Raukṣādayopi Gṛhyante the term Varṇa

has been used to designate skin texture in this context. Raukṣādi refers to rūkṣa and

snigdha guṇas i.e. (dryness or oiliness of the skin) which are perceived by the

cakṣurindriya and are in association with Varṇa.

Varṇa as Skin Lustre/natural glow

By the definition Varṇaḥ śarīra kānti, Varṇa refers to the lustre or the radiance of the

skin. When the light falls on the skin, there is reflection (radiance) of light at the surface

of skin (caused by skin oil), and from the sub-layers under the skin from pigments such

as melanin and blood haemoglobin. This reflection produces kānti in the skin.

Varṇa as -Plumpness (sign of good nourishment)

By the definition Varṇa bhedena glāni harṣa raukṣya sneha vyākhyātā, it is clear that the

other parameters such as glāni, harsha, roukshya, snigdhata also refers to Varṇa. Here

glani refers to māṁsa apacaya and harsha refers to the māṁsa upacaya which can be

understood as plumpiness or the sign of good nourishment.

Varṇa as Appearance-

The term Prasanna Varṇa has been used in many contexts, for example, the individual

with kapha Prakṛti is said to possess Prasanna Varṇa. The term prasanna refers to clear,

bright and pure, hence Varṇa also refers to the appearance of skin.

148


In a broader perspective ,Varṇa mainly refers to skin colour, but the deeper

understanding of the term with the help of other contextual references reveals that Varṇa

is colour (śyāma, gaurādi), texture (rūkṣa, snigdhādi), lustre (kānti),

appearance/complexion (prasanna varṇa), Nourishment (harsha upacaya). In the context

of Vraṇa Upakrama Savarṇakaraṇa also refers to Māṁsa janana karma. In

dermatological parlance the parameters such as Skin hydration (Dryness-Oilyness), Skin

Pigmentation (Pigmented Non pigmented), Skin Sensitivity (Sensitive –resistant), Skin

wrinkling (Wrinkled-tight) also come under the perview of Varṇa. Therefore Varṇa can

be understood from different perspectives. Hence by ekavṛntagataphala dvaya nyāya it

can be said that Varṇa has wider dimensions.

Saṁbaṁdhita Śabda

Prabhā, Chāyā and Varṇa are used synonymously at different contexts. There is a very

narrow margin between these 3 entities and hence the exact difference between these 3

entities can be understood as follows.

Chāyā- Chāyā is a broader aspect which incorporates many entities into it. The 3 main

characteristic features of Chāyā include Varṇānāmākramati Chāyā, Āsannā lakṣyate

Chāyā, Chāyā Varṇaprabhāśrayā i.e. Chāyā circumscribes Varṇa ie Varṇa is not

perceived clearly when circumscribed by Chāyā, it is recognizable from near and Chāyā

is dependent on Varṇa and Prabhā. 5 types of Chāyā have been explained in classics.

Vāyavī, Āgneyī, Nābhasī, Āṁbhasī, Pārthivī ie classification of Chāyā are based on 5

mahābhūtas.

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It is said that Saṁsthāna Pramāṇa Varṇa Prabhā Rūpa Vividha Lakṣaṇāḥ120cxx

ie the

description of 5 types of Chāyā is mainly based on these 5 parameters

Samsthana refers to Ākṛti (form or appearance). It is of 2 types Suṣamā (Pleasant) and

Viṣamā (Unpleasant). Sthira Saṁsthāna is a lakṣaṇa of Pārthivī Chāyā.

Pramana is considered as (weight or the measure of physical strength) . It is classified

into Madhya, Alpa and Mahat Pramāṇa. Dīrgha āyata Pramāṇa is a lakshana of

Pārthivī Chāyā.

Varṇa refers to colour ie Gaurādi. Vāyavī Chāyā is characterized by shyāva aruṇa

Varṇa, Nābhasī Chāyā is characterised by Nīla Varṇa

Prabhā is the radiance or lustre which does the Varṇa prakāśaṇa. Āgneyī Chāyā as

dīptābha prabhā, but Vāyavī Chāyā has hata prabhā.

Rupa- It is the beauty (saundarya, cakṣurindriya gata bhāva) of an individual. Āṁbhasī

Chāyā is said to have śuddha vaiḍūrya vimalā rūpa where as Āgneyī Chāyā is said to

have viśuddha rakta rūpa

In a broader sense together these 5 entities constitute Chāyā Varṇa and Prabhā are the

important and significant contributory factors for Chāyā .

For example An individual has a dark skin type, but has a lustrous skin, good built,

impressive appearance. Inspite of having dark skin type it is masked by other personality

traits and still the overall personality of the individual remains unaffected. That is the

reason it is said that Varṇa is circumscribed by Chāyā (varṇānām ākramati

pratidvaṁdvībhūteva Varṇasya ātmānaṁ prakāśayati). Bahiparimārjana dravyās

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basically cause prakāśaṇa of neelādi Varṇa and sapta vidha prabhā which indirectly

refers to the Varṇa and Prabhā components of Chāyā

Prabhā -Prabhā is an entity which is characterized by prakāśana of Varṇa (bhāstu

Varṇa prakāśakaḥ). It is identified from a distance. It is the innate lustre which gives

radiance to the skin irrespective of the skin colour. It is said to be produced only because

of teja. It is divided into 7 types ie rakta, pīta, sita, śyāva, harita, pāndura, asita. All

these are grouped into śubha and aśubha varieties in the context of ariṣṭa lakṣaṇa .These

types of Prabhā when they are vikāsī ,vimala, āśuprasāriṇī then these are termed as

śubha Prabhā but when they are rūkśa malina saṁkliṣṭa & utpatita then they are

termed as aśubha.

Existence of Prabhā is completely independent of Varṇa (Skin colour) as

invariably individuals of either type of skin colours can have a good radiant and lustrous

skin. But the type of Prabhā out of these 7 types can be in accordance to the Varṇa. For

example gaura varṇa may be associated with sita or pāndura Prabhā , śyāma Varṇa with

śyāva Prabhā etc. An extensive study of the concept of Prabhā is necessary to

understand the practical application of the types of Prabhā .

Classification of Prākṛta Varṇa

It is observed that a tāratamyatā in avadāta varṇa is the basis for classification

i.e. (śyāmavadāta and avadāta) according to Caraka samhita and tāratamyatā in śyāma

varṇa i.e. (Gaura śyāma and Kṛṣṇa śyāma) according to Aṣṭāṅga Saṁgraha.

Hārīta saṁhitā has a unique explanation of prākṛta varṇas with an addition of piṅgala

varṇa to the 3 prākṛta varṇas i.e. (Gaura, Śyāma, Kṛṣṇa). In this classification the

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association of rakta is explained along with pittādhikya. As per the author, combination

of 2 doṣas produces prākṛta Varṇa and the classification is according to this idea. It is a

unique concept different from all other authors.

Hence 6 Prākṛta Varṇas are observed as per different authors. They are Kṛṣṇa, Śyāma,

Avadāta (Gaura), Gauraśyāma, Kṛṣṇa Śyāma, & Piṅgala

Sub types of Prākṛta Varṇa

The main basis for classification of Prākṛta Varṇas is the tāratamyatā among each type

of Varṇa. For example padma gaura, candra gaura and śara gaura are the tara tama

Varṇas of Gaura Varṇa. Similarly it can be understood for other Varṇas also. The

modern races such as Mongoloid, negroid etc correspond to the different varieties of

Prākṛta Varṇa. The different gradients of Varṇas can also be a guideline to design and

develop a standardized Colour grading scale useful for both diagnostic and therapeutic

purposes.

Figure 13- Sub types of Prākṛta Varṇa

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Vaikṛta Varṇa

5 Varṇas have been considered as Vaikṛta Varṇa according to both Caraka Saṁhitā and

Aṣṭāṅga Saṁgraha .They are nīla, śyāva ,tāmra ,harita, śukla. Ācārya Gangādhara’s

commentary on Vaikṛta Varṇa reveals that there are 3 Vaikṛta Varṇas. They are nīla

śyāma (nīlavat śyāma), tāmra, haritaśukla (palāśavad gaura). The similies given in

Indukara commentary for Vaikṛta Varṇas such as śankha kundādi prakhya (śukla), Agni

prakhya (taamra) helps to acquire clarity regarding the colours. A difference of opinion

exists with Ācārya Gangādhara.According to him nīla varṇa is produced by vāyu bahula

panca mahābhūta and is considered as rūkṣa kṛṣṇa (prākṛta varṇa). Haridrābha gaura

(Udaka bahula pancabhūta) and palāśābha harita (Ākāśa bahula pancabhūta) are

considered as prākṛta varṇas. It seems that there is a narrow margin between prākṛta

varṇa and vaikṛta varṇa. Vaikṛta Varṇa has significance in the context of diseases and

ariṣṭa lakṣaṇa. Prākṛta Varṇa can at times become vaikṛta varṇa, and if vaikṛta varṇa is

present since birth then it can be considered as prākṛta itself. Only a sudden shift from

prākṛta to vaikṛta can be considered under ariṣṭa lakṣaṇa.

When an individual who is basically of Śyāma Varṇa consumes rasāyana for some

duration and attains gaura varṇa, and after discontinuation of rasāyana therapy he again

attains śyāma varṇa, in this context, though gauratva is a different varṇa from that of his

original colour but it cannot be considered as doṣa and śyāvatva which is attained back is

not considered as ariṣṭa lakṣaṇa or vaikṛta varṇa.

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Tvacā

Tvacā is said to be the adhiṣṭhāna for Varṇa. The term avabhāsinī refers to the reflection

or presentation or manifestation of all the Varṇas, 5types of Chāyā and 7 types of

Prabhā. Avabhāsinī tvacā is main ādhāra for kṛṣṇa gaurādi Varṇa. Upto the 3 or 4th

layer of skin, it it can be included under bāhya tvacā and various Varṇa vikāras like

nyaccha, vyaṅga, maṣaka, kilāsa etc afflict the 3rd

or 4th

layer of skin which shows the

Varṇa takes adhiṣṭhāna in these layers.

The different layers of tvacā i.e. avabhāsinī, lohitā, vedinī etc can be co related to the 7

layers of skin as per the contemporary science (i.e. Stratum corneum, lucidum etc)

Varṇa Utpatti kāla

Varṇa utpatti occurs mainly in the garbhādāna kāla. And it is manifested in the 6th

month and according to Kāśyapa Saṁhitā and Caraka Saṁhitā Varṇa upacaya /Varṇa

vṛddhi takes place in 6th

month. The contemporary research on the skin colour reveals

that only after 24 weeks of gestation the melanocytes become established at the

epidermal-dermal junction, thus Āyurveda proves itself to be a most scientific science.

Factors responsible for the formation of Varṇa- General factors

Bīja, ātmā, āśaya, kāla, āhāra ,vihāra in general play a significant role in determination

of Varṇa. Bīja, ātmā & āśaya can be roughly considered as the hereditary factors and

kāla, āhāra &vihāra can be considered as influencing factors. But kāla has still more

significance since it is the factor which is completely out of the range of human control.

ṛtu also has a significant role to play,as per few studies, due to seasonal transformations

there is decreasing photo-period in autmn and early winter generates increased melatonin

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secretion which in turn has inhibitory effects on the pigmentary hormones of the

pituitary.

Factors of foetal life- Role of Pancamahābhūtas in the formation of Varṇa

Tejo dhātu is said to be mainly responsible for variation in Varṇa. It is a known fact that

Ap is said to possess ayvakta rasa similarly teja is said to possess Avyakta rūpa, any

colour is determined by the combination of other mahābhūtas with teja. Varṇa utpatti is

influenced by Pancamahābhūta during the avayava āraṁbha kāla .Any change in the

guṇas of mahābhūtas produces different variations in Varṇa. Teja alone or other

mahābhūtas alone cannot produce any colour thus the saṁyoga here plays an important

role. For example

The avyakta rūpa of tejas in combination with śuklatva of Ap and viśada guṇa of Ākāśa

produces Avadāta Varṇa

Teja (Avyakta)+ Ap (śukla) + Ākāśa(viśada)- Avadāta Varṇa

Variations in bāhulya –In the same combination if there is

Udaka bahula pancabhūta – It produces Haridrābha gaura

Ākāśa bahula pancabhūta –It produces Palāśābha harita

The avyakta rūpa of tejas in combination with Kṛṣṇatva of Pṛthvī and vishada guṇa of

Vāyu produces Kṛṣṇa Varṇa

Teja (Avyakta)+ Pṛthvī (Kṛṣṇa) + Vāyu (viśada)- Kṛṣṇa Varṇa

In the same combination if there is

Pṛthvī bahula pancabhūta – It produces Pakva jaṁbūpama kṛṣṇa Varṇa

Vāyu bahula pancabhūta – It produces Ruksh kṛṣṇa , Nīla Varṇa

Śyāma- śukla kṛṣṇa miśrī bhāva

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Similarly it should be understood for other Varṇas. Tāratamyatā in mahābhūtas will

result in rakta, pīta, aruṇādi varṇas.

Role of Guṇa

During the formation of varṇa, the guṇas play an important role and thus determine the

colour, The viśada guṇa of ākāśa mahābhūta produces avadāta varṇa, The khara and

cala guṇas produces kṛṣṇatva, snigdha guṇa is responsible for sukumara, snigdha aṅga

uṣṇa tīkṣṇa sūkṣma, laghu, rūkṣa, viśada physiologically are said to be responsible, for

Prabhā prākāśa and varṇa. But when these guṇayukta āhāra are consumed in excess

they produce varṇa vikṛti. For example increase in viśada guṇa causes sphuṭita aṅga,

excess of rūkṣa guṇa causes varṇa hāni and vaivarṇya.

Role of Śukra

Ghṛtamaṇḍābha, tailābha & madhvābha are the terms used to designate the śukra .

These correspond to Gaura kṛṣṇa and Śyāma Varṇa of the offspring. These similies are

used to depict the tāratamyatā in the Varṇa of śukra. On observation it also reveals that

similarity in mahābhautic composition also may be the reason for mentioning these

similies. The colour of healthy semen usually varies from a white to pale yellow colour.

A lighter colour of śukra would lead to a fairer complexion of the offspring and a darker

one leads to a dark coloured offspring. Similarly the quality of strī bīja may also

influence the varṇa of the foetus. But śukra alone cannot determine the colour of the

foetus.Only in combination of all other factors it may manifest its effect.

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Role of Garbhotpādaka bhāvas

Ātmaja bhāvas- These are the main determining factors. They include indriya preraṇa

dhāraṇa, swara Varṇa etc. All the ātmaja bhāvas are under the control of ātma

pratibaddha karmās as the karma and triguṇas of previous birth are carried by ātma

There are many instances where in the couples are kṛṣṇa or śyāma Varṇa but the

offspring is of avadāta varṇa or vice versa with a contrast colour of the offspring.

Though the answer for this may be the genetic control according to the modern scientists

but since even these factors are far from the control of humans, they can be included

under the ātmaja bhāvas. This is clear evidence of the effect of ātma pratibaddha karmās

and their effects are reflected by these bhāvas.

Sātmyaja Bhāvas.- Varṇa can be modulated to some extent by the intake of āhāra which

are varṇya and by rasāyana upayoga. The āhāra is pancabhoutic and the dominant

mahābhūta influences the corresponding varṇa. Here Sātmya refers to the āhāra vihāra

of mother before and during garbhāvasthā and āhāra, vihāra influences the quality of

śukra in males. For example excess kashāya rasa causes shyāvatva.

Out of these 2 factors, ātmaja bhāvas are far from control of humans where as sātmyaja

bhāvas are under the control of humans where in slight modulation of Varṇa is possible.

Role of Āhāra

Āhāra plays a very important role to determine the Varṇa of the individual. The careful

observation of garbhiṇī paricaryā reveals that the āhāra which is advised in the 6th

month of pregnancy is sarpi, since Varṇa upacaya takes place in the 6th

month, sarpi is

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said to be śreṣṭha varṇya dravya hence that may be rationality behind advising sarpi as

pathya in the 6 th month of pregnancy.

Role of vihāra

An important vihāra which is said to be as varṇya is Jala krīda.The reason for this may

be attributed to frequent contact with Jala (Ap mahābhūta) which is constituted mainly

by śukla guṇa.

Factors responsible for the formation of Varṇa after the birth.- Varṇa and Vaya

There is Hrāsa of Chavi after 30 yrs and Hrāsa of twak is seen after 50 yrs. Here the skin

attains śithilatā (wrinkling), since the parameters such as (wrinkling –tightness) (dryness-

oiliness) (pigmented-non pigmented) etc are included under the purview of varṇa it can

be said that vaya has a significant effect on maintenance and deterioration of varṇa.

Elderly people often display dry scaled skin. This is because of the loss of barrier

function that occurs with increasing age. Thus Roughness, wrinkling, and the appearance

of dark and light spots also affect the appearance and texture of aged skin.

Role of Deśa

Deśa has a significant influence on varṇa. A person from a colder region has a

characteristic varṇa in accordance to his deśa. But when he moves from the cold region

to the hotter regions his varṇa will definitely show a change to suit the climate there. The

same can be said about a person from a hot region migrating to a cooler region. But this

change will not be more than a particular degree from his normal colour. Hence though

the colour and complexion of a person is genetically determined, the deśa does influence

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it to a certain extent. So, the geographical conditions have their contribution in their

respect.

The close association between latitude and skin colour was confirmed in a recent

and more comprehensive survey which found a positive correlation of 0.82 between skin

reflectance and distance from the equator. The amount of U.V received at the earth‟s

surface is inversely related to latitude the higher the latitude the lower the U.V.It seems

that from a geographical stand point the darker the skin pigmentation the greater is the

ambient U.V.

Fig No 14:- Influence of Deśa on Varṇa.

Role of Kula and Jāti

Kula also has a significant role in the determination of Varṇa, It is a known fact that

prakṛti determines varṇa, among the various types of prakṛti, Kula prasaktā prakṛti

suggests the importance of Kulaja bhāvas in the determination of varṇa. Genetic factors

which really contributed to skin colour were also the ones that determined race-genetic

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differences. There is also uncertainty as to the differential genetic contribution to

pigmentation at unexposed and exposed areas but it was also found that tanning ability

was controlled to a lesser degree by genetic factors compared to natural pigmentation.

Jāti- Various prākṛta Varṇas explained in the classics correspond to different races of the

world population, Jāti prasakta prakṛti shows the importance of bhāvas specific to Jāti

The capoid and negroid races especially corresponds to kajjala kṛṣṇa and kokila

kṛṣṇa types.

Fig No 15:- Capoid and Negroid races

Australoid and mongoloid races correspond to the padma, candra gaura and śara

gaura varieties

Fig No 16:-Australoid & Mangoloid races.

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Caucasoids(Europians , Indians) correspond to kapittha, dūrvāṅkura ghṛta, nabha,

jala, priyaṅgu śyāma

Fig No 17:- Caucasoid Race

Congoid (African Americans) correspond to kṛṣṇa śyāma varieties (atasī and tamāla

kṛṣṇa śyāma varieties).

Fig No 18:- African Americans

This classification is an apt one so as to incorporate each and every race existing on this

earth.

DISCUSSION ON VARNYA

Any kriya which enhances varṇa, or which is conducive in maintenance of varṇa and

bringing back from abnormalcy to normalcy is termed as Varṇya. The major factors

which are involved in Varṇya karma include,

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Vāta - Udāna Vāta and Vyāna Vāta,

Pitta- Bhrājaka Pitta, Rañjaka Pitta,

Dhātu- Rasa, Rakta.

Srotas- Rasavaha Srotas, Raktavaha Srotas

Agni- Jatharāgni, Bhutāgni, Dhātvāgni.

The whole process of Varṇya karma and the probable mode of action of Varṇya dravyas

( Antah parimārjana) can be understood as follows.

2 important pre requisites for Varṇya karma include

1. Rasa tarpaṇa as it is said that rasa pūrnatvāt varṇasaṁpannaḥ

2. Rakta puṣṭi as it is mainly attributed to varṇa prasādana karma

Target action of both bahi parimārjana and antah parimārjana is the same but the

difference is that the aushadha dravya comes in contact with Jatharāgni, Bhutāgni,

Dhātvāgni., and later Rasa tarpaṇa & Rakta Prasādana are achieved in antah

parimārjana where as in bahi parimārjana there is direct entry of vīrya of auṣadha

through the tiryak gata dhamanis which ultimately does the Rasa tarpaṇa.

The process can be understood as follows:-

It is a well known fact that āhāra is said to be the mūla for varṇa. This āhāra which is

ingested is propelled to the āmaśaya with the help of doṣas and it undergoes the stage of

avasthā pāka. Then by the action of bhutāgni there is pachana of their respective guṇa

yukta āhāra. Then comes the role of dhātvāgni where there is sāra kiṭṭa vibhajana there

by achieving dhātu poṣana. The samyak vipakva āhāra rasa which is formed is the Anna

rasa, By the action of Rañjaka pitta there is pāka of anna rasa and rāga (red Colour) is

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attained. This is actually termed as Rasa Dhātu.121

Then the rasa vikṣepaṇa is carried out

to all parts of the body at a time with the help of Vyāna vāta and Udāna vata. This

completes the Rasa tarpaṇa. Rasa tarpaṇa in turn leads to Varṇa utkarṣa.

Rasa dhātu, though its colour is red it is still termed as Rasa dhātu in this stage. This

Rasa moves through the Rasavaha srotas (srotas which is defined as pūrva pūrva rasāadi

rūpata parityāgena uttarottara raktādi rūpatām āpadyamānānām122

) ie the srotas

transports the dhātus which are under the stage of trasition and transformation. After the

śarīra saṁcāra there is transformation of Rasa dhātu which is brought about by

śarīragata ūṣma (Rakta dhatvāgni can also be considered under this) and the entity which

is fomed is termed as Rakta dhātu. (sarva śarīra saṁcārānantaram vipākidbhavam

avasthānantaram rakta dhātusaṁjñayā parigaṇitamiti123

). It is termed so not because of

the colour but because of Prasparānurāgitvam. Which means the dravyagata paramānus

are under paraspara ākarṣana and hence the name. It becomes capable of saṁghāta

utpādana (needed for the formation of māṁsa) by virtue of the pacana karma which has

occurred. That is the reason it is considered that Rasa dhātu is capable of movement from

one place to another and not rakta dhātu. (rasatvameva abhisaraṇa kṣamam na tu

raktatvam 124

). In this way rakta dhātu is formed.

According to the kedāri kulya nyāya of dhātu pariṇāma, the nutrients specific to rakta

dhātu are transported to the yakṛt & plīha (mūla of rakta vaha srotas) and synthesized by

the Rakta dhātvāgni to form the rakta dhātu.

Therefore it is clear that Rañjaka pitta and rakta dhātvāgni are mainly responsible for the

formation of rakta dhātu which in turn is responsible for Varṇa prasādana.

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The Varṇa Prasādana of Rakta dhātu need not necessarily be linked to melanin or

melanogenesis. It may also be understood as the oxy hemoglobin pigment, a red

component which is especially evident in the areas where there is a rich arterial supply

such as skin of the face, neck palm and soles.

Paka of rakta dhatu in the foetal life produces twaca which is the seat for Bhrājaka

Pitta125

Bhrājaka Pitta- The quantitative and qualitative variations of ūṣma and Varṇa are the

main functions of bhrājaka pitta. This digests the auṣadha which is applied on the skin in

the form of abhyaṅga, pariṣeka, ālepa, avagāha and (Chāyā depends on Varṇa and

Prabhā and hence bhrājaka pitta determines Varṇa prākāśana)126

This ūṣma (Bhrājaka

Pitta) present in lasīkā, rasa, rakta, tvacā, maintains the dravatva in rasa and rakta

which in turn are responsible for Varṇa utkarṣa.

Rañjaka Pitta, by converting the rasa dhātu forms rakta, which in turn supplies to the

tvacā. It also nourishes the Varṇa, as tvacā is adhisthāna of Varṇa. Morever, rakta dhātu

is Varṇa prasādakara hence; it influences the Varṇa through forming the rakta. By virtue

of its function and colour it can be said to participate in the formation of Haemoglobin. It

is observed in the Vyādhi Pāńdu, where there is vitiation of the Rañjaka Pitta thus

causing Pāńduta or vaivarņya in the skin.

Role of Ojas

Ojas is the essence of all the dhātus. It is termed as Param teja or utkṛṣṭa teja or sāra.

Various references of ojas reveal that it can be considered as;-

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1. Sarva dhātu sneha,

2. Rasa dhātu

3. Jīva śoṇita

4. Śarīra ūṣma

When we keenly observe the dhātu sāra puruṣa lakṣaṇas it is very evident that except the

māṁsa and asthi sāra puruṣa lakṣaṇas. Mṛdu aṅga, ślakṣṇa aṅga snigdha varṇa prasanna

varṇa are the terms which are used in all the other dhātu sāra puruṣa lakṣaṇas This

snigdhata is mainly due to dhātu gata sneha. The combined effect of all the dhātu gata

sneha thus produces an utkṛṣṭa sneha or teja thus varṇa is very closely related to the status

of ojas. The role of Rasa dhātu, Jīva śoṇita, Śarīra ūṣma have already been dealt and Thus

every component of oja predominantly determines varṇa

Bala is a form of ojas whose normalcy produces prasanna varṇa and hence varṇa bheda

is a cardinal symptom which is mainly seen in Bala vyāpad lakṣaṇa.

Probable mode of action of Varṇya dravyās (bahi parimarjana)

All the kriyās such as Abhyaṅga, Pariṣeka, Ālepa, Avagāha, Snāna act mainly on the

bhrājaka pitta which resides in the tvacā.

Lepa is applied to the tvacā which is ādhāra for sparśanendriya, sweda vaha srotas

and romakūpa. Bāhya tvacā is the ādhāra for kṛṣṇa gaurādi varṇa also. The mode of

acttion can be analysed in 3 steps

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Step 1

Lepa comes in contact with the roma and romakūpa which in turn are connected to

the tiryak gata dhamanīs which perform the function of sweda vahana ie the active

drug enters the sweat ducts and hair follicles.

Hair follicles represent a reservoir that may store topically applied

substance.Differences in the follicular penetration were observed in different ethnic

groups. Hair follicles appear to present an important pathway for percutaneous

absorption in non diseased skin. Even solid particles may enter deep into the follicular

orifice, a phenomenon that lends itself to the concept of follicular targeting of drugs.It

was found that nano particles were stored 10 times longer in the hair follicles than in

the stratum corneum, it should be noted that when topically applied substances

penetrate into the hair follicles, they do not necessarily penetrate through the skin

barrier into the living tissue because hair follicles also have barrier properties.

Step 2

After the contact of the drug there is pāka of dravya in tvacā. Pāka refers to the

action of Bhrājaka agni and rasa dhātvāgni It occurs by virtue of uṣṇa guṇa of

bhrājaka pitta ie it takes up and metabolises the kriyā dravya (bahi parimārjana

dravya)

This ūṣma present in lasīkā, rasa, rakta, tvacā, maintains the dravatva in rasa and

rakta which in turn are responsible for Varṇa utkarṣa. 127

166


Pathway across stratum corneum

Stratum corneum-It is The Primary compartment that limits the percutaneous

absorption of compounds is the stratum corneum and it determines diffusion of

compounds across the skin.

Viable tissue

Although the primary barrier to percutaneous absorption of compounds is the stratum

corneum diffusion through viable tissue as well as metabolism and resorption also

influence the bio availability of compounds in specific skin compartments.The

passage of compounds from the stratum corneum into the viable epidermis results in

substantial dilution.

Skin Metabolism

Metabolism in skin compartments plays a significant role in determining the fate of a

topically applied active compound. Metabolic activity is found in skin surface,

appendages, the stratum corneum, viable epidermis. The level of many enzymes is

highest in the epidermis. The relatively large size of the dermal component may result

in a significant role in the metabolism of topically applied substances.

Step 3

These steps finally lead to Rasa tarpaṇa which is mainly achieved by Udāna Vāta &

Vyāna Vāta which supplies anna rasa to the concerned śarīra ghaṭaka or avayava

and Varṇa utkarṣa is thus achieved. Hence it is quoted that Varṇasaṁpannaḥ

rasapūrṇatvāt.

167


General concept of Varnya

Varṇya refers to enhancing the normal complexion (the terms Varṇa dārḍhya, Varṇa

prasādana Varṇa utkarṣa are used) and it also refers to bringing back the abnormal

colour to the normalcy which includes the pathological aspect ie( hyperpigmentation

and hypopigmentation) hence the synonyms Varṇa vaimalya, Varṇa vaiśadya, Varṇa

śuddhi are used. By these modalities just the modulation of Varṇa can be achieved,

where in the qualitative parameters can be improved such as the texture, radiance etc.

The colour parameter cannot be changed to a very significant extent such as from

kṛṣṇa to gaura varṇa by the usage of varṇya upakramas ( āhāra, vihāra, rasāyana

etc), but śyāma to gaura can be expected, that is the reason Ācārya Cakrapāṇi has

considered that when rasāyanas are used there may be change of varṇa from śyāma

to gaura (where as kṛṣṇa varṇa is not considered) but when discontinued the same

śyāma varṇa is attained back, and this is not included under the perview of vaikṛta

varṇas. A shift to a complete contrast colour is also not explained inspite of usage of

rasāyana. Hence varṇya upakramas help in modulation of Varṇa (parameters such as

colour (Skin pigmentation – Pigmented/ Non pigmented), texture (Skin Hydration –

Dry/Oily), appearance (Skin Sensitivity- Sensitive/Resistant), (Skin wrinkling –

Wrinkled/Tight) radiance, plumpness (sign of nourishment) to some extent.

The concept of varṇya thus incorporates the Correction of innate entities influencing

Varṇa. An oral administration of varṇya dravyas along with bahi parimārjana cikitsā

may definitely bring a marked improvement in all the parameters included under

Varṇa

168


DISCUSSION ON DISEASE- VYANGA/ MELASMA

Melasma is a disease in the general population that causes great impact on the

quality of life of patients and drives great efforts to clinical and pharmaceutical research

for the development of treatments. However, the knowledge of its physiopathogenesis is

still very limited.128

Incidence

An important factor in the etiology of melasma in females is female sex hormone

activity, usage of Oral Contraceptive pills, and hormonal changes in post menopausal

period, where as the main associated factors among men appear to be sun induced

aggravation and a significant family history of the condition129

.

Etiology/ Nidāna

Mānasika Nidāna for Vyaṅga is mainly stated to be as Krodha, and Āyasa which in turn

vitiate Pitta and Vāta respectively. An emotional stress is a prime factor in causation of

Vyaṅga, The main quality of life domains that showed to be affected by melasma were

social life, recreation, leisure, and emotional well being.130

Stress is an influential factor in pigmentary disorders and it can also precipitate or

contribute to the etiologic pathway of a cutaneous manifestation. Melanocyte stimulating

hormone (MSH) levels have been shown to be influenced by a rise in adrenocorticotropic

hormone (ACTH) levels, which increases with stress. Through this pathway, MSH may

play a role in aggravating melasma and other dyspigmentations in stressed patients.

Although the nature of the association between stress and the exacerbation of certain skin

conditions have not been fully elucidated.

169


Two traditional explanations have been offered. That is, the activation of two

stress axes, the hypothalamic-pituitary-adrenal (HPA) axis, which elevates cortisol levels,

and the sympathetic nervous system axis, which increases adrenaline levels, are thought

to alter immune balance and facilitate cutaneous manifestation. Recently, a third stress

axis has been suggested. Specifically, Pavlovic et al. have demonstrated that peripheral

neuropeptidergic nerve fibers transmit stress to the skin, exacerbating cutaneous

inflammation. The investigators showed that the number of cutaneous nerve fibers

containing the stress neuropeptide substance P was increased significantly by sound

stress.

Also the neural crest gives rise to different types of cells, including the dorsal root

ganglia of the spinal cord, the adrenal medulla and certain components of peripheral

nerve fibres (Schwann cells). The neural crest also generates those cells that are destined

to differentiate into the melanocyte series known as melanoblasts. Since both adrenal

medulla and the melanoblasts share a common origin, the influence of MSH by ACTH is

justified and thus causing hyperpigmentation.

Clinical features

The clinical features of Vyaṅga are mainly based on 4 parameters ie Shape of the lesion

(maṇḍala), Thickness of the lesion (macule- Tanutva), colour of the lesion ( Nīla, Syāva,

Kṛṣṇa) and Pain (nīruja -Painless)

Reason for involvement of specific sites

Melasma involves only specific sites of the body. Wade et al. 131

have suggested

the reason why only certain body areas, but not the entire body, are affected by

170


hyperpigmentation is that melanocytes in the areas affected are more sensitive to

hormonal stimulation. Another explanation may be the greater population of melanocytes

in the affected sites. One investigation showed that there is a greater population of

melanocytes in the skin of the face and forehead, with the population density of

melanocytes being 2–4 times greater than in the skin of the thigh and arms

Samprāpti / Pathogenesis

Mānasika nidānas such as krodha śoka āyasa & harṣa, basically vitiate vāta and pitta

doṣa significantly. Ātapa & anala sevana are also said to cause vaivarṇya or varṇa hāni.

By these nidānas there is duṣṭi of Rasa vaha srotas (aticintana) and Rakta vaha srotas

(ātapa and Anala) along with manovaha srotas (Krodhadi). All the nidānas mentioned,

have fourfold effect upon Doṣa, dūṣya, Agni and Srotas. The śyāva varṇa maṇḍala

indicate the involvement of vāta, and since there is derangement in bhrājaka pitta leading

to discolouration, it shows the involvement of Pitta. Though there is no direct

involvement of Kapha, it is evident from the fact that twacā is adhiṣṭhāna for varṇa as

well as site for rasa dhātu, so by āśraya āśrayī bhāva, it can be said that kapha is also

involved, Presence of associated features such as kaṇḍū shows the active involvement of

kapha. Direct involvement of jaṭharāgni is not recognized clinically. But only dhātvāgni

vikṛti can be recognised mainly. This is possible only after the jaṭharāgni vikṛti hence its

involvement can be inferred. The vitiated Vāta doṣa along with Rakta and Pitta doṣa

produces Syāva, (blackish) nīruja maṇḍala. At this stage exact clinical features of the

disease are evident according to the involvement of the doṣas

171


Pathogenesis of pigmentation

Melasma is more commonly seen in Pregnancy. Hyperpigmentation in pregnancy

is attributed by some investigators to an increased output of some combination of

placental, pituitary, and ovarian hormones.132

An increased amount of MSH of the

pituitary was postulated in the past to be the cause of hyperpigmentation. Other factors

which were suggested to be related to hyperpigmentation in pregnancy are progesterone

and estrogen, the levels of both of which are increased during pregnancy. 133

Blood levels

of progesterone increase throughout pregnancy, and estrogen production rises from the

eighth week and begins to decrease after the 30th week of pregnancy. This pattern

follows the progression of hyperpigmentation .Hyperpigmentation of the face occurs in

women taking oral contraceptives or during the menstrual cycle, supporting the idea that

estrogen and progesterone are involved. 134

Recently, investigators found that a lipid extraction from the placenta had a

pigment inducing activity both in vivo and in vitro. The placenta was found to be rich in

bioactive sphingolipids, which were found to induce melanogenesis by upregulating the

expression of various melanogenic enzymes – tyrosinase and tyrosinase-related proteins 1

and 2 at the translational and transcriptional levels. 135

Vyaṅga cikitsā

The treatment modalities which have been mainly explained for Vyaṅga other than bahi

parimārjana cikitsā basically aim at correcting the innate entities such as doṣā duṣṭi,

rakta duṣṭi, agni ,vikṛti & sroto vaiguṇya by which the whole system is cleansed paving

a way for better improvement in varṇa. This method of treatment of vyaṅga was not the

option till recent days as per the contemporary science inspite of the fact that there is a

172


systemic involvement such as hormonal imbalance which needs correction at first. They

mainly concentrated on the different modes of transdermal drug delivery system till

recent years. And now even they have emerged with the concept of Nutritional Cosmetics

somewhat mimicking the antah parimārjana cikitsā hence Āyurveda has a detailed and

deeper sense of understanding regarding the subject.

Vyaṅga Sādhyāsādhyatā

Vyaṅga is considered as a kṛcchrasādhya vyādhi. Though it is a kṣudra roga it could have

been a sukhasādhya vyādhi, but due to involvement of various factors such as the

mānasika nidāna, exposure to sun rays, hormonal disturbances from time to time, all

these cannot be controlled effectively at a time because of which the treatment becomes

difficult.

DISCUSSION ON DRUGS

The main chemical constituents of the Lepa of 10 drugs which were used include

Santalol, Genistein, glabridin, Liquertin, Glycyrrhizin, benzoic acid etc. Many studies

have been undertaken to evaluate the efficacy of these chemical constituents on various

skin parameters.

Candana - Santalol is the main chemical constituent of Candana -. It may be effective in

controlling the oxidative stress caused by ultraviolet radiation.136

Padmaka, Payasya- Genistein is an important chemical constituent of these 2 drugs.

Genistein, either topically applied or orally supplemented, has been shown to

substantially block the subacute and chronic UVB-induced cutaneous damage and

histologic alterations related to photoaging .Genistein is already included in various

173


products such as facial moisturizers, sunscreens, and several skin care formulations

claiming antiaging effects.

Madhūka- Glabridin and Liquertin are said to have tyrosinase inhibitory and anti

inflammatory properties. Polyphenols and polysaccharides possess antioxidant activities.

Uśīra ,sitā & latā- The compounds such as Benzoic acid helps in balancing the secretion

of sebum. It is also a useful antiseptic and is slightly stringent. It is used in lotions,

compresses and baths for the treatment of oily skin, acne and weeping sores 137

Sāriva :-The plant is used against various skin diseases and in the treatment of acne

vulgaris.The ethanolic extract was reported to be effective chemo protective agent and

prevented oxidative stress and tumour in skin. 138

Manjiṣṭha -Munjistin and purpurin are the important anthraquinones present in Manjiṣṭha

The cell culture preparation exhibits antiinflammatory activity, as well as wound healing

properties.-

Probable mode of action on Vyaṅga/Melasma

Varṇya mahākaṣāya dravyās are administered both for bahi parimārjana and antah

parimārjana ie (ubhaya parimārjana). The probable mode of action based on rasa, guṇa

vīrya, vipāka may be as follows.

Any rasa basically is said to possess 2 important karmas ie Chedana and

upaśamana. The drugs which are administered in the form of lepa mainly are of madhura

tikta, kaṣāya rasās. These rasās does the Chedana of prakupita vāta and pitta (chedanaṁ

doṣāṇāṁ bhāgaśaḥ karaṇam)139

and upaśamana (doṣānām anutkleśena samīkaraṇam )

174


which means does not allow the utkleśa of doṣas and maintains the equilibrium and thus

pacifies pitta which is the main culprit in the causation of vyaṅga.

Out of these 10 drugs some of drugs possess snigdha guṇa and others possess

laghu rūkṣa guṇas. Snigdha guṇa is responsible for mārdava and varṇa prasādana where

as laghu rūkṣa are the properties of āgneya dravya which in turn are responsible for

prabhā, prākāśa and varṇa.

Almost all the drugs selected are of śīta vīrya and śīta vīrya dravyās are endowed

with rakta prasādana karma. While explaining the direction of application of Lepa, it is

said that (sirā mukhaih vīryam prāpnoti) hence after the entry of the drug by virtue of

vīrya it enters the circulation.

The selected drugs mainly are of madhura vipāka. Vipāka is basically defined as

karma niṣṭhayā, here the term niṣṭhā incorporates jaṭharāgni dhātvāgni & bhūtāgni

irrespective of their order. Madhura vipāka by virtue of its snigdha guṇa and kapha

vardhana karma is responsible for Varṇa utkarṣa. By the term twaci vipakva it can be

said tha the drug is absorbed by virtue of vipāka into the circulation.

As per the modern paralance these drugs may be assumed to minimize pigmentation by

following mechanisms in Melasma.

1. Reducing tyrosinase activity

2. Copper chelation

3. Thining of Statum corneum

4. Keratinocyte proliferation and

epidermal turn over

5. Absorb U V B

6. Dop quinine to dopa transfer

7. Melanosome transfer

8. Free radical scavenger

CLXXV

A Study on the Concept of Varnya Vis-à-vis Clinical evaluation of efficacy of varnya gana lepa in vyanga

Water –Luke warm water has been used here as the vehicle, Water is the most

widely used and safest method to increase skin penetration .It is a non irritant and

is suitable for all skin types. It is cosmetically acceptable and easy to use. Luke

warm water also facilitates the thermodynamic activity and diffusion by vaso –

dilation and this temperature does not vitiate the pitta. The water content of the

stratum corneum is around 15 to 20% of the dry weight but can vary according to

humidity of the external environment. Additional water within the stratum

corneum could alter permeant solubility and thereby modify movement from the

vehicle into the membrane. In addition, increased skin hydration may swell and

open the structure of the stratum corneum leading to an increase in penetration,

although this has yet to be demonstrated experimentally. There is variation in

permeability in different regions of the body for example- The scrotum is

particularly permeable and the face forehead and dorsa of the hands may be more

permeable to water than the trunk arm and legs. The palms are particularly

impermeable to nearly all molecules except water

Water is well known to permeate through the lipid bilayers of epidermal skin.

Untilrecently, simple diffusion was the only presumed mechanism for water

conduction through epidermis. Aquaporins (AQPs), which are a form of water

channel, are integral membrane proteins that facilitate water transport in various

organs such as skin, renal tubules, eyes, the digestive tract, and even the brain

CLXXVI


DISCUSSION ON MATERIALS AND METHODS

Assessment tools

Colour grading scale-There are 26 grades in this scale, the skin colour is recorded in

the beginning, then the lesion colour of the patient was noted before, after treatment

and after follow up, the difference in the grades gives the extent of improvement.

Though darkness of the lesion is graded in MASI Score also, the rationality behind

using this scale is that the minor changes in the lesions can be noted due to wide range

of gradients in colour and the skin colour is also recorded, which enables us to analyse

whether people with fair or dark complexion are more prone to vyaṅga.

Lepa

3 important types of Lepa have been explained in the classics, they are Pradeha,

Pralepa and Ālepa. Pradeha, as per the definition it is characterized by śīta tanu

aviśoṣi or viśoṣi ex- Candana Lepa (śīta and tanu) . When piṇḍīkṛta kalka is placed

on the affected area then it is termed as Pradeha, and instead of piṇḍīkṛta kalka if

cūrṇa is used then it is termed as cūrṇa pradeha. It can be considered as prayoga

bheda of pradeha.

Pralepa- It is characterized by ūṣṇa bahala or abahu, viśoṣi. The thickness is said to

be as bahala or abahu, abahu is alpabahala (not very thick).

Here in this study the type of lepa used is ālepa. Ālepa is considered as the ādya

upakrama as it is śreṣṭha for both bahi parimārjana and antah parimārjana because

of its āśupīdāharatvāt guṇa (quick relief from the peeda). Ālepa is said to be agrya in

twak prasādana hence it is selected.cxl

CLXXVII


Method of application

Lepa should be applied in the opposite direction of the hair follicles so as to facilitate

the entry of auṣadha dravya through the roma kūpa, sweda vaha srotas and thus

reaches the sirā mukha. If the applied lepa dries and if still it is kept for some more

time, it yields no result. It is also said that yāvad ārdro bhavati tāvad vyādhiharo

bhavati .Until it is wet it is said to possess vyādhiharatva. Regarding the pramāna or

the thickness of the lepa it is said that mahiṣa ārdracarmavat, but this is considered as

the parama pramāna (highest thickness of lepa) since thickness of ālepa is between

pradeha and pralepa, hence the madhyama pramāna can be used.cxli

Inclusion criteria

The prevalence of the disease melasma is more in the child bearing age of the women,

but there are also few studies which reveal that, it occurs in young girls due to

menstrual irregularities and older women in post menopausal period. Hence the age

group 16-60yrs was selected.

Assessment Criteria

Skin/Lesion Colour ,Texture (Dry/Oily), Skin lustre, Number of Lesions, Size of

Lesions, Darkness of the lesion, Area of involvement, Homogeneity of the lesions are

the 8 parameters which have been assessed in the patients, in this study. Among these,

Darkness Area and Homogeneity constitute the Melasma Area Severity Index. All

these are assessed separately. Size of the lesions can be incorporated under the Area

of involvement; Number of lesions can be incorporated under the homogeneity of

involvement. Though they can be incorporated under these, they are assessed

separately so as to get accurate results and to analyse the exact extent and parameters

on which the formulation is effective.

CLXXVIII


DISCUSSION ON OBSERVATIONS

The observations were based on the clinical trial conducted on 35 patients registered

on the study.

Age- In the study maximum number of patients (40%) belonged to the age group 31-

40yrs followed by 21-30yrs (25.7%), 41-50yrs, 51-60yrs which suggests that melasma

is more prevalent in child bearing age where in there is maximum role of hormonal

influence which is the root cause for the disease.

Sex- In the study (88.6%) of patients (p value-0.000) were females of different age

groups which supports the fact of global incidence of melasma associated with

hormonal variations

Religion: In this study maximum numbers of patients (85..7%) were Hindus

indicating geographical predominance of Hindus among the selected population.

Educational Status- In this study (48.6%) of patients (P value-0.001) were educated

only upto high school, which shows the low level of literacy, because of which most

of them had to opt the labour job for living, which involves, excess of exposure to sun

and exertion which are the causes of melasma.

Marital Status- In the present study 94.3% of patients (P.Value 0.000) were married.

Though there is no direct link of the disease with Marriage, married women who had

children had a history of melasma during their pregnancy, which disappeared with

time, and in some others was persistent since years.

Socio economic status-In the study (54.3%) of patients were of middle class followed

by 40% of patients who belonged to lower middle class. Because of low levels of

immunity due to unaffordability to nutritional foods, this may be a cause for

prevalance of melasma in lower middle class.

CLXXIX


Diet -The present study revealed that, the patients who were consuming mixed diet

were more susceptible (77.1%) to melasma. The study however could not generalize

the fact that vegetarians are on safer side from the disease as the sample size taken

was very small.

Family history- In the present study 42.9% patients had a family history of melasma

which supports the presence of hereditary component in the manifestation of disease.

Contraceptive history- In the study though only 8.6% of patients had the history of

use of contraceptives still it supports the role of contraceptives in the causation of

melasma

Physical aggravating factors- In the study 45.7% of patients (P value-0.000) had

exposure to sun rays as Physical aggravating factor which suggests the important role

of Ultra violet radiation in the causation of melasma.

Psychological aggravating factors- In the study 62.9% of the patients (P value-

0.000) had stress and worries as aggravating factors which clearly suggests that Stress

is an important etiological factor in causation of melasma.

Use of soap- In the study 42.9% of the patients had the history of use of Lifeboy soap

since years even before the onset of the disease. There may be some association

between the causation of melasma and its usage; This cannot be confirmed by this

study because of small sample size.

Cosmetics-cream use-In the study 62.9% of the patients had the history of use of fair

and lovely cream since years even before the onset of the disease. Though the

ingredients prevent hyperpigmentation, there may be some association between the

causation of melasma and its usage, Use of Chemicals and artificial colours in the

preparation can trigger the causation of melasma. This cannot be confirmed by this

study because of small sample size.

CLXXX


Menstrual history- in the study 14.3% of the patients had irregular menstruation

accounting to the fact that hormonal disturbances are the causative factors for

melasma.

Age of menopause- In the study 20% of the patients had attained menopause

supporting the fact that post menopausal women are also prone to melasma to some

extent.

Prakṛti-In the study 48.6% patients were of pitta prakṛti followed by 31.4% patients

were of vāta prakṛti suggesting the fact that individuals of pitta prakṛti are more

prone to vyaṅga.

Patter of lesion- In the study 57.1% of the patients had malar type of melasma

followed by centro facial type (42.9%), suggesting the site of involvement and

somewhat supporting the global incidence to some extent.

Level of lesion- In the study 60% of the patients had dermal lesions which suggest the

severity of the disease and the depth of involvement.

Chronicity- In the study the chronicity of 62.9% patients (pvalue-0.001) was between

0-4 yrs. This may be because since melasma is an aesthetic disease which is a major

cause of concern to patients and before it becomes chronic they approach the hospital.

Skin colour- In the study the skin colour of 57.2% patients (p value-0.000) was

between 1-10 grade suggesting the fair complexion, supporting the fact that those

with fair complexion are more prone to melasma, but it cannot be told with certainity

due to small sample size.

Distribution of Chronicity vs level of the lesion- In the study 57.1% of patients had

dermal lesions in the group 0-4yrs ,28.6% patients had dermal lesions in the group 4-8

yrs and 14.3% patients had dermal lesions in the group 8 and above yrs chronicity.

The more and more chronic the lesions are, the deeper will be the level of

CLXXXI


involvement ie (dermal). The study does not signify this fact; it may be because of

smaller sample size and less number of patients in the very chronic group.

DISCUSSION ON RESULTS

Distribution of skin colour vs lesion colour – In the study the lesion colour is

compared with the skin colour with the help of fair and lovely colour grading scale.

The total mean of the Lesion colour before treatment was 21.7429, and it was

17.7714 after treatment and follow up. When only Lesion colour is observed, a mean

difference of around 4 is highly significant statistically (Pvalue-0.000) but in

comparison to skin colour is insignificant with P value 0.735. Duration of intervention

has a significant role in this disease, since the duration is 15 days the expected results

were not observed.

Darkness of the lesion- The subjective criteria of syāma maṇḍala is also assessed by

this parameter. Darkness of 4 regions were assessed, Frontal, left malar, right malar

and chin , among the 4 regions there was no statistically significant improvement in

frontal and chin regions where as in left malar and right malar regions there was

statistically significant improvement (P value-0.002) . Only one grade reduction was

observed after the treatment in most of the patients, this may be because of very less

duration of intervention period ie 15 days. For any of the dermatological changes to

appear it requires atleast a minimum of 30-45days duration, administration of external

application along with oral medicines. The disease is of a stubborn variety, and

because of the chronicity and influence of hormones which is variable from time to

time, all the causative factors cannot be controlled effectively and hence only one

grade reduction is observed.

CLXXXII


Area and Homogeneity of the lesions- There was no improvement in the area of

lesion as well as homogeneity of the lesions before treatment and after treatment and

follow up. This includes the size and number of lesions. It is assumed that a

minimium of 3 to 4 months duration is mandatory so as to observe significant

dermatological changes in number and size of lesions , as these are are influenced by

many factors such as exposure to sun, too much of stress and presence of other

physical and psychological aggravating factors which causes delay in relief.

MASI Scores:- The mean of MASI Scores of 35 patients, before treatment was 11.69

and after treatment and follow up it reduced to 10.8314 with a high statistical

significance (p value-0.000) MASI score is influenced by all the 3 factors. Since there

are no changes in area and homogeneity and only 1 grade improvement in darkness,

overall score is affected and thus only a mean difference of 0.9 is observed where in

really a difference of atleast 15 points is mandatory to assume a good clinical

improvement.

Dryness and oilyness- A statistically significant improvement was not found in

Dryness parameter where as statistically significant improvement was seen in oilyness

parameter. The formulation is said to have an evident effect on the texture (oilyness)

parameter of Varṇa. This may be because the formulation is in the form of chūrna

which is basically rūkṣa and moreover some of the drugs have rūkṣa guṇa which may

possibly have a role in reducing the oiliness of the skin. It is also clear that out of 35

patients 23 patients had dryness of different extent which supports the fact that

vyaṅga is a Varṇa vikāra with a deranged colour and texture component of Varṇa(

especially vātaja vyaṅga) .

CLXXXIII


Itching and burning sensation- These 2 parameters were evaluated to find out the

prevalence of kaphaja as well as raktaja vyaṅga where in kaṇḍū and dāha are

observed as associated symptoms. Only 20% of patients complained of kaṇḍū and

2.8% of patients complained of dāha and is not conclusive since the sample taken is

very less. The formulation also shows mild effect on the itching and burning

sensation. It may have a better effect possibly when the intervention period is

prolonged.

Skin lustre- There are no changes observed in the skin lustre before and after

treatment and follow up, It may be possibly because of the fact that lustre is not just a

physical entity where in a change can be brought about just by an external

application for 15 days, It is an innate entity influenced by numerous factors.

Results of overall improvement

The overall assessment of the study reveals 23 patients (64.34%) had mild

improvement,

CLXXXIV


CONCLUSION

1. Varṇa refers to different parameters of skin. They are colour (śyāma, gaurādi),

texture (rūkṣa, snigdhādi), lustre (kānti) , appearance/complexion (prasanna

varṇa), Nourishment (harśa upacaya) and dermatological parameters such as Skin

hydration(Dryness-Oilyness), Skin Pigmentation (Pigmented Non pigmented) ,

Skin Sensitivity( Sensitive –resistant), Skin wrinkling (Wrinkled-tight) also come

under the purview of Varṇa..

2. Though the terms Prabhā and Chāyā are used synonymously with Varṇa they are

different entities .Classification of Chāyā is mainly based on 5 important

parameters, They are Saṁsthāna Pramāṇa Varṇa Prabhā & Rūpa. Varṇa and

Prabhā are the important and significant contributory factors for Chāyā .

3. Existence of Prabhā is completely independent of Varṇa (Skin colour). But the

type of Prabhā out of 7 types can be in accordance with the Varṇa.

4. Various factors govern the formation of Varṇa. General factors include Bīja,

Ātma, Kāla, Āśaya, Āhāra and Vihāra. Specific factors contribute in the formation

of Varṇa in foetal life and in the process of varṇotpatti after birth. They are

Mahābhūta, Prakṛti, Guṇa, Garbhotpādaka bhāvas, Manasthiti, Āhāra and

Vihāra ,Deśa ,Kula and Jāti, Jaṭharāgni, Dośa- Dhātu Mala, Ojas.,Bala.

5. Varṇya refers to enhancing the normal complexion hence the terms Varṇa

dārḍhya, Varṇa prasādana Varṇa utkarṣa are used. It also refers to bringing back

the abnormal colour to the normalcy hence the synonyms Varṇa vaimalya, Varṇa

vaiśadya, Varṇa śuddhi are used.

6. Bhrājaka pitta has a major role in metabolizing the lepa which is applied to skin

,which takes entry through romakūpa, tiryakgata dhamanis and finally reaches the

circulation ending up with rasa tarpaṇa and Varṇa utkarṣa

CLXXXV


7. Rasa tarpaṇa and rakta puṣṭi are the major pre requisites in the enhancement of

Varṇa .These processes are aided mainly by udāna vāta, vyāna vāta, bhrājaka

pitta & rañjaka pitta

8. Varṇya upakramas does not completely change the Varṇa but they help in

modulation of physical & dermatological parameters of Varṇa to some extent.

9. Most of the drugs used had madhura tikta kaśāya rasa, snigdha guṇa, śīta vīrya,

and madhura vipāka which helps in pacifying vāta, pitta, rakta doṣa which are the

main culprits in causation of Vyaṅga.

10. In the study there was statistically highly significant improvement in the MASI

Scores but in overall assessment 64.5% patients had mild improvement. This

could be because of short intervention period.

11. Varṇya gaṇa lepa is a safe and effective formulation which can be prescribed in

Vyaṅga.

CLXXXVI


RECOMMENDATIONS FOR FURTHER STUDY

1. The various parameters for assessment of Varṇa needs to be tested for its

objectivity so as to evolve standard assessment parameters for Varṇa

2. An extensive study on Prabhā & Chāyā, are needed so as to differentiate and help

in conceptualization.

3. An extensive study on the Āyurvedic perspective of Transdermal Drug Delivery

System needs to be evaluated.

4. Study involving a combination of external application with oral administration of

Varṇya dravyas can be carried out to assess efficacy of combination.

5. The same study can be carried out in a larger sample size and an extended

intervention period for better accuracy in results.

6. The same formulation can be tried in other skin diseases to evaluate its effect on

the parameters such as skin hydration, skin pigmentation, skin sensitivity, skin

wrinkling.

CLXXXVII


SUMMARY

The present study entitled“ A Study on the concept of Varṇya vis-a vis

Clinical evaluation of Varṇya Gaṇa Lepa in Vyaṅga.” was aimed at understanding the

concept of Varṇa and Varṇya and its application in Vyaṅga in order to evaluate its

effect on pigmentation. MASI scores and other parameters were used to assess and

analyse the results.

The study had 2 components. The conceptual study included the analysis of

concept of Varṇa, and relevant concepts like Prabhā and Chāyā, Concept of Varṇya

,analysis of role of Varṇya yogas in improving the Varṇa in patients of Vyaṅga. The

Varṇa can be more likely compared with colour, texture, lustre, appearance,

nourishment (plumpness). The dermatological parameters such as Skin

hydration(Dryness-Oilyness), Skin Pigmentation (Pigmented Non pigmented) , Skin

Sensitivity( Sensitive –resistant), Skin wrinkling (Wrinkled-tight) also come under the

perview of Varṇa.The different factors influencing Varṇa, role of Varṇya yogas in

improving Varṇa, their mode of action etc were dealt in the conceptual part.

The second component of the study was a clinical study consisting of sample

size of 40 patients of Vyaṅga. All the patients were assigned to a single group

.Different parameters were used as assessment criterias . They were Skin colour,

Lesion colour, Skin texture-dryness/oilyness, Skin lustre, Number and Size of the

lesions, Darkness, Area and Homogeneity of lesion, Itching, Burning sensation,

MASI Score. Varṇya gaṇa lepa was administered for 15 days followed by same

duration of follow up. The different parameters of the study were observed and

recorded before treatment, after treatment and after the follow-up. The results were

CLXXXVIII


analyzed statistically based on the scores obtained from MASI and other assessment

parameters for statistical significance.

There was statistically highly significant improvement in the MASI Scores but in

overall assessment 64.5% patients had mild improvement. Clinical improvement was

more evident in Darkness parameter when compared to other parameters.

The conclusion derived on the basis of detailed observation & deep study is

submitted under the chapter on Conclusion. Future perspective of the study is

highlighted as an aid for the future research workers.

CLXXXIX


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CXCIX


ANNEXURE- CASE SHEET

DEPARTMENT OF POST GRADUATE STUDIES IN AYURVEDA SIDDHANTA

GOVERNMENT AYURVEDA MEDICAL COLLEGE,

MYSORE.

“A STUDY ON THE CONCEPT OF VARNYA VIS-À-VIS CLINICAL

EVALUATION OF EFFICACY OF VARNYA GANA LEPA IN VYANGA”

HEAD OF THE DEPARTMENT : Dr. Naseema Akhtar M.D. (Ayu)

GUIDE : Dr. Balakrishna D .L. M.D. (Ayu)

CO-GUIDE : Dr. Vasudev Anandrao Chate M.D. (Ayu)

RESEARCHER : Dr. Pallavi.G BAMS

Case No: Date:

Name of the patient : O.P.D. No:

Age : I.P.D No:

Sex : Ward. No.

Religion : Bed .No.

Education : Date of

Commencement: Occupation

Dateof Completion:

Socioeconomic status :

Marital Status :

Address :

Phone No:

CC


1. Chief complaints Duration

Vaivarnya (Shyaava)

Mandala

Others

2. Associated complaints

3. History of present illness

Aggravating factors:

Specific foods-

Physical :

Exposure to sunrays Heat

Cold Chemical contact

Frequent cleaning Rubbing

Excessive air Excessive work

Others

Pschychological

Krodha (anger) Harsha

Bhaya (fear) Chinta (Worries)

Shoka (Sorrow) Khinnata (Depression)

Others

H/o of use of cosmetics:

Chemical /Herbal

Frequency of use

Duration of use

CCI


Drug and Contraceptive history

4. History of past illness :

5. Family history :

6. Personal history :

a. Diet : ( ) Veg / ( ) Mixed

Frequency :

b. Ashana Prakara : Samasana / Visamasana / Adhyasana / Virudhasana

c. Pradhana rasa :

d. Appetite: Poor / Moderate / Good / Extreme

e. Sleep:

Nature: Satisfactory/ Unsatisfactory

Duration: Day: Night:

f. Habits- Coffee /Tea / Smoking / Alcohol/ Tobacco / Others

7. Occupational History

Nature of work:

Working conditions:

Working Hours:

Other Details:

8.Menstrual History :

Regularity : Reg. / Irreg.

Quantity : Scanty / Moderate / Excessive

Duration : ____days

Interval :_____ days

CCII


Asso. symps. :

Age of menarche :

Age of Menopause

9. Obstetric History :

No of pregnancies : ________ F.T.N.D/Ceaserian

GPALD

History of Hysterctomy, Tubectomy/Any other surgeries

10. Samanya Pareeksha

Asta sthaana Pareeksha

a. Nadi:

b. Mutra:

c. Mala:

d. Jihwa:

e. Shabda:

f. Sparsha:

g. Drik:

h. Akriti:

DashaVidha Pareeksha

Prakriti:-

Vikriti:

Sara: Pravara/ Madhyama/Avara

Sattva:- Pravara/ Madhyama/Avara

Samhanana:- Pravara/ Madhyama/Avara

Saatmya:- Pravara/ Madhyama/Avara

Ahara Shakti:- Pravara/ Madhyama/Avara

o Agni: Sama/Vishama/Manda/Teekshna

o Abhyavarana Shakti: Pravara( ) Madhyama( ) Avara( )

o Jarana Shakti: Pravara( ) Madhyana( ) Avara( )

o Koshtha: Mrudu( ) Madhyama( ) Krura( )

Vyayama Shakti: Pravara/ Madhyama/Avara

CCIII


Pramana:

Vaya : Bala/Madhyama/Vruddha

11. Vishesha Pareeksha

Anana

Darshana Pareeksha

Vyakta Sthana

Cheek-

Forehead-

Temporal region-

Nasal region-

Varna

Mandala Ayama (Pramana) – No of lesions____ Dimensions in _________cm

Lustre

Sparshana Pareeksha

Snigdha-Ruksha

Ushna-Sheeta

Sensory Examination

Touch sensation: Pain:

Pressure: Temperature:

CCIV


12. Chikitsa –

Bahya- Lepana chikitsa

Yoga- Varnya Gana lepa

Purvakarma- Patient is asked to wash face with luke warm water using chickpea

(Besan) flour.

Pradhana karma- Varnya Gana Lepa churna is mixed with appropriate quantity of

water and made into thick paste and applied externally on the affected areas.

Quantity- Quantity sufficient

Duration of each application-Retained until it gets dried.

Pashchat karma- After the lepa dries ,patient is asked to wash the face with luke

warm water.

Duration-15days, twice daily (morning and evening), From _________to

___________

Follow up-15days , From________to _________

Pathya- Avoid chemicals, soaps and patient is advised to use chickpea flour for

facewash.

Apathya- Exposure to sunlight

SIGNATURE OF RESEARCHER SIGNATURE OF OBSERVER

CCV


Scoring Systems

Visual assessment remains one of the „„gold standard‟‟ methods of assessing

skin color and a number of tools are currently available to reduce the inter observer

variability Dermatologists have the privilege of examining the largest organ of the

body. However unlike other organs, there are hardly any tests of clinical significance

that measure skin function. In dermatological practice methods of evaluating the

severity of skin diseasesare often crude, subjective and not reproducible, which

creates discrepancy in results and inter- individual variations. Hence to maintain

objectivity in observations,and to quantify the subsequent changes following

treatment, scores are used to evaluate the severity of skin diseases.

This is particularly important for monitoring the response to therapy and for

evaluating the efficacy of new drugs. Over the years scoring systems have been

developed for number of skin diseases. One among them is the Melasma Area

Severity Index (MASI) which has helped the cause of clinical practice and clinical

Research.

Melasma Area and Severity Index MASI

Melasma as already described, is a common, persistent disorder of

hyperpigmentation affecting a significant portion of the population, Conventional

treatment of melasma includes elimination of any causative factors coupled with the

use of sunscreens and hypopigmenting agents, often in combination with other

therapies. Despite the availability of these measures, melasma is often recalcitrant to

treatment and frustrating for both patients and clinicians. To develop new agents for

melasma, valid and reliable outcome measures are critical to determining clinical

severity of disease and the significance of treatment results when performing clinical

trials. These outcome measures should be easy to learn, responsive, inexpensive, and

applicable worldwide. Unfortunately, no such measure exists for melasma The

Melasma Area and Severity Index (MASI), an outcome measure developed to provide

a more accurate quantification of the severity of melasma and changes during therapy,

was developed by Kimbrough-Green et al,who based it on a similar scoring system

devised for psoriasis

206


The MASI score is calculated by subjective assessment of 3 factors:

Area (A) of involvement, Darkness (D), and Homogeneity (H),

Forehead(f), - 30%,

Right malar region (rm),- 30%,

Left malar region (lm), 30%, and

Chin (c), 10%

The MASI score is calculated by adding the sum of the severity ratings for darkness

and homogeneity, multiplied by the value of the area of involvement, for each of the 4

facial areas:

MASI total score

=0.3A (f)[D(f)+H(f)]+ 0.3A (lm) [D(lm)+H(lm)] + 0.3A(rm) [D(rm)+H(rm)] + 0.1A

(c) [D(c)+H(c) ]

The total score range is 0 to 48.

Grades of Assessment

The area of involvement Darkness

Homogeneity

0 = no involvement;

0 = absent

0 = absent

1 =10%

1 = slight

1 = slight

2 = 10%-29%

2 = mild

2 = mild

3 =30%-49%

3 =marked

3 =marked

4 = 50%-69%

4 = maximum

4 = maximum

5 = 70%-89%

6 = 90%- 100%.

CCVII


MASTER CHART

CCVIII


CCIX


CCX


CCXI


Key to Master Chart

1. SL.NO- Serial No

2. Age- 21-30yrs- 1

31-40yrs- 2

41-50yrs- 3

51-60yrs- 4

3. Sex Male- 1

Female- 2

4. Religion Hindu- 1

Muslim- 2

Christian- 3

5. Education Primary School- 1

Middle School- 2

High School-PUC-3

Graduate- 4

Post Graduate- 5

6. Socio-economic status-

Lower Middle Class-1

Middle Class- 2

Upper Middle Class-3

Rich Class- 4

7. Marital Status Married- 1 Unmarried- 2

8. Nature of work

Hard Manual- 1

Mild manual work- 2

Moderate manual work-3

Sedentary work- 4

9. Diet Mixed-diet- 1

Vegetarian- 2

212


10. Appetite

Poor- 1

Moderate- 2

Good- 3

Extreme- 4

11. Agni

Samagni- 1

Mandagni- 2

Teekshnagni 3

Vishamagni- 4

12. Koshtha

Mrudu Koshtha- 1

Madhyama koshtha- 2

Krura Koshtha 3

13. Sleep

Satisfactory- 1

Unsatisfactory-2

14. Bowel Habits (B.H)

Regular- 1

Irregular- 2

15. Family History (F.H)

Present- 1

Absent- 2

16. Contraceptive History (C.H)

Present- 1

Absent- 2

17. Aggravating Factors

a. Physical Aggravating Factors

Sun rays- 1

Chemical contact- 2

213


Excessive work- 3

Multiple Agg Fact- 4

Nothing specific- 5

b. Psychological Aggtng Factors

Chinta- 1

Shoka- 2

Khinnata- 3

Any2 or all 3- 4

Nothing specific- 5

18. Use of Cosmetics

a. Soap

Lifeboy- 1

Others(Santoor Lux etc)- 2

Multiple (Keeps Changing)-3

b. Creams

Fair and Lovely- 1

Others- 2

Multiple- 3

Do not Use creams- 4

19. Menstrual History

a. Regularity

Regular- 1

Irregular- 2

b. Age of Menopause

Attained- 1

Not attained- 2

Not Applicable- 3

20. Prakriti

VATA, pitta,kapha- 1

PITTA, kapha, vata- 2

KAPHA, pitta, vata- 3

214


21. Sattva

Pravara- 1

Madhyama- 2

Avara- 3

22. Sara

Pravara- 1

Madhyama- 2

Avara- 3

23. Skin Colour 1-26 Grades

24. Lesion Colour

BT-Before Treatment

AT-After Treatment

FU-Follow up

25. No of Lesions

1-2- 1

2-4- 2

4-6- 3

>6 4

26. Size of Lesions

0-2cm-1

2-4cm-2

4-6cm-3

>6cm-4

27. Pattern

Centro facial- 1

Malar- 2

Mandibular- 3

28. Level of Lesion

Dermal- 1

Epidermal- 2

29. Skin Lustre

215


Poor Lustre- 1

Mild Lustre- 2

Moderate Lustre- 3

Good Lustre- 4

30. Chronicity

0-4 years- 1

4-8 years- 2

>8 years- 3

31. Area of Discolouration

0%- No involvement

<10%- 1 Af-Area Frontal

10-29%-2 Alm-Area Left Malar

30-49%-3 Arm-Area Rt Malar

50-69%-4 Ac-Area Chin

70-89%-5

90-100%-6

32. Darkness of Discolouration

Absent-0 Df-Darkness frontal

Slight- 1 Dlm-Darkness lft Malar

Mild-2 Drm-Darkness Rt Malar

Marked-3 Dc- Darkness Chin

Maximum-4

33. Homogenesity of Discolouration

Absent-0 Hf- Hmgnsity frontal

Slight-1 Hlm- Hmgnsity lft Malar

Mild-2 Hrm- Hmgnsity Rt Malar

Marked-3 Hc- Hmgnsity Chin

Maximum-4

34. MASI Score- 1-48

35. Skin Texture

Dryness/Oiliness

216


Absent- 0

Mild- 1

Moderate- 2

Severe- 3

36. Other Symptoms

a. Itching

No itching- 0

Mild Itching- 1

Moderate itching- 2

Severe itching- 3

b. Burning Sensation

No burning - 0

Mild Burning- 1

Moderate Burning- 2

Severe Burning- 3

217


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