Leech therapy for acne vulgaris: a randomized clinical study
Journal name: Ayushdhara
Original article title: Medicinal leech for the treatment of acne vulgaris w.s.r. to mukhadushika: a randomised clinical study
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Gupta Sudesh
Professor and HOD, Department of Shalya Tantra, Jammu Institute of Ayurveda and Research, Nardini (Raipur), Jammu, India.
Sharma Sakshi
Final year P.G. Scholar, Department of Shalya Tantra, Jammu Institute of Ayurveda and Research, Nardini (Raipur), Jammu, India.
Prasher Aarushi
Final year P.G. Scholar, Department of Shalya Tantra, Jammu Institute of Ayurveda and Research, Nardini (Raipur), Jammu, India.
Sharma Kumar Arun
Final year P.G. Scholar, Department of Shalya Tantra, Jammu Institute of Ayurveda and Research, Nardini (Raipur), Jammu, India.
Manhas Raman
Final year P.G. Scholar, Department of Shalya Tantra, Jammu Institute of Ayurveda and Research, Nardini (Raipur), Jammu, India.
Ayushdhara:
(A peer-reviewed, bi-monthly open-access journal)
Full text available for: Medicinal leech for the treatment of acne vulgaris w.s.r. to mukhadushika: a randomised clinical study
Year: 2021 | Doi: 10.47070/ayushdhara.v8i1.685
Copyright (license): CC BY-NC-SA 4.0
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Summary of article contents:
Introduction
Acne vulgaris, recognized as a chronic inflammatory disorder impacting the pilo-sebaceous follicles, primarily affects adolescents during puberty. Symptoms typically manifest as comedones, papules, pustules, and scars, particularly on the face, chest, and back. In Ayurvedic medicine, acne is identified as Mukhadushika, a Kshudra Roga (minor ailment) characterized by eruptions resembling Shalmali kantak on the face, caused by the vitiation of Kaphadosha, Vatadosha, and Raktadhatu. The condition often leads to psychological distress due to its impact on appearance, making effective treatments essential. This study particularly explores the efficacy of Jalaukavacharana, or bloodletting using medicinal leeches, in treating Mukhadushika.
Efficacy of Jalaukavacharana
The study investigated Jalaukavacharana’s efficacy in managing Mukhadushika by enrolling fourteen patients aged 15-30 years exhibiting typical acne symptoms. The treatment included four sessions of bloodletting at one-week intervals, followed by a follow-up period. Results indicated a highly significant reduction in various acne symptoms, including pain (Vedana), itching (Kandu), burning sensation (Daha), and the number and size of lesions (Pidika). The intervention not only alleviated discomfort but also contributed to overall skin health by detoxifying through blood purification, demonstrating the potential of traditional Ayurvedic practices in addressing modern health issues.
Biological Mechanism of Leeches
Leeches, through their saliva, deliver a complex mixture of biologically active substances during treatment, which aids in the healing process. These include anticoagulants like Hirudin, which help in preventing blood clotting and reducing inflammation, ultimately enhancing circulation at the application site. The saliva also contains compounds that provide analgesic and anti-inflammatory properties, contributing to pain relief and promoting better skin healing. This dual action of bloodletting and the therapeutic agents in leech saliva facilitates the management of acne by not only removing stagnant blood but also improving skin texture and reducing inflammation.
Conclusion
The study affirms the effectiveness of Jalaukavacharana as a viable treatment option for Mukhadushika, aligning with Ayurvedic principles and modern understandings of skin health. The approach stands out as an accessible and affordable method while being rooted in traditional practices that address the underlying dosha imbalances. Given the significant improvement in patient symptoms and minimal adverse effects, Jalaukavacharana presents a promising therapeutic avenue for adolescents suffering from acne vulgaris, underscoring the importance of integrating traditional medicine with contemporary healthcare approaches.
FAQ section (important questions/answers):
What is the purpose of the study on medicinal leeches?
The study aims to evaluate the efficacy of Jalaukavacharana, a treatment using medicinal leeches, in managing Acne vulgaris, also known as Mukhadushika, focusing on its effectiveness and safety.
What was the methodology used in the clinical study?
Fourteen patients aged 15-30 with Mukhadushika symptoms received four sittings of Jalaukavacharana over 28 days, followed by a 30-day follow-up. Their symptoms were assessed using subjective and objective parameters.
What were the main findings of the study?
The study found Jalaukavacharana significantly reduced pain, itching, and inflammation while effectively decreasing the number and size of papules. It concluded Jalaukavacharana is a safe and effective treatment for Acne vulgaris.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Leech therapy for acne vulgaris: a randomized clinical study�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Mukhadushika (Mukhadusika, Mukha-dushika):
Mukhadushika refers to a skin condition characterized by eruptions on the face, resembling acne vulgaris. It is considered a Kshudra Roga in Ayurveda, affecting adolescents and young adults, and is caused by the vitiation of Kapha dosha, Vata dosha, and Rakta dhatu.
2) Disease:
A disease like Mukhadushika disrupts normal bodily functions and appearance, often leading to symptoms such as eruptions on the face, pain, itching, and inflammation, impacting an individual's overall well-being and quality of life.
3) Pidika:
Pidika refers to papules, one of the primary symptoms of Mukhadushika or acne vulgaris. These are inflamed nodules filled with Meda (fatty tissue), which are caused by vitiated Kapha and Vata doshas and result in facial disfigurement.
4) Blood:
Bloodletting, or Raktamokshana, specifically with medicinal leeches (Jalaukavacharana), is used in treating Mukhadushika by removing the impure blood, thus clearing the pathways (Srotas) and pacifying the vitiated doshas.
5) Pain:
Pain, or Vedana, is a significant symptom in Mukhadushika, resulting from the inflammation and blockage of the skin follicles. Treatments like Jalaukavacharana help in alleviating this pain by removing the vitiated blood and reducing pressure.
6) Substance:
Substances in leech saliva, such as Hirudin and Bdellin, play a crucial role in Jalaukavacharana. These biologically active components have anti-inflammatory, anticoagulant, and healing properties, aiding in the treatment of Mukhadushika.
7) Ghanata:
Ghanata refers to the hardness of Pidika. In the study, a significant reduction in Pidika Ghanata was observed post-treatment, indicating the efficacy of Jalaukavacharana in reducing the hardness of acne nodules.
8) Shrava (Srava):
Srava denotes the discharge from acne lesions, such as pus or other exudates. In the clinical study, a reduction in Srava was noted, although it was not statistically significant, indicating an improvement in the overall condition of Mukhadushika lesions.
9) Vedana:
Vedana is the Sanskrit term for pain, a common symptom in Mukhadushika. The clinical study reported a significant reduction in Vedana after Jalaukavacharana treatment, highlighting the effectiveness of the therapy in alleviating pain.
10) Dosha (Dosa):
Dosha refers to the primary functional energies in Ayurveda (Vata, Pitta, Kapha). The imbalance or vitiation of these doshas plays a critical role in the pathogenesis of Mukhadushika.
11) Kandu (Kamdu):
Kandu is a term for itching. In the context of Mukhadushika, itching is a prevalent symptom managed effectively by Jalaukavacharana, which helps in reducing the pruritic response associated with acne inflammations.
12) Daha:
Daha refers to the burning sensation often experienced in Mukhadushika. The study indicated that Jalaukavacharana significantly reduced Daha, demonstrating its effectiveness in alleviating this discomfort.
13) Shotha (Sotha):
Shotha means inflammation or swelling. In the context of Mukhadushika, Jalaukavacharana showed a significant effect in reducing Shotha, contributing to the therapy's success in treating acne vulgaris.
14) Sharman (Sarma, Sharma, Sarman):
Dr. Sakshi Sharma is one of the researchers in the study on the efficacy of medicinal leeches for treating Mukhadushika. She is affiliated with the Department of Shalya Tantra at Jammu Institute of Ayurveda and Research.
15) Burning sensation:
The term burning sensation is synonymous with Daha. The therapeutic intervention with Jalaukavacharana significantly alleviated this symptom in patients suffering from Mukhadushika.
16) Ayurveda (Ayus-veda):
Ayurveda is the ancient Indian system of medicine focusing on holistic health and balance of bodily energies (Doshas). Mukhadushika, a condition akin to acne vulgaris, is described in various Ayurvedic texts with recommended treatments like Jalaukavacharana.
17) Shalmali (Salmali):
Shalmali kantak refers to the thorn-like eruptions observed in Mukhadushika patients, described metaphorically with the thorns of the Shalmali tree by Acharya Madhava.
18) Rakta:
Rakta or blood is a crucial component in Ayurvedic medicine. Its vitiation is often linked to dermatological conditions like Mukhadushika, where bloodletting therapies like Jalaukavacharana are employed to purify the blood and alleviate symptoms.
19) Dhatu:
Dhatus are the seven bodily tissues in Ayurveda. Rakta dhatu, one of these tissues, is significant in Mukhadushika's pathogenesis due to its vitiation contributing to skin eruptions.
20) Raktamokshana (Raktamoksana, Rakta-mokshana):
Raktamokshana is a bloodletting therapy in Ayurveda used to treat conditions involving vitiated blood, such as Mukhadushika. Jalaukavacharana is a specific type employing leeches to purify the blood effectively.
21) Sakshi (Saksi):
Sakshi is likely a shorthand reference to Dr. Sakshi Sharma, a researcher involved in the study assessing Jalaukavacharana's effectiveness in treating Mukhadushika.
22) Pitta:
Pitta dosha is one of the three doshas in Ayurveda, responsible for metabolism and transformation. Its imbalance, along with Kapha and Vata, is implicated in the development of Mukhadushika.
23) Kapha:
Kapha dosha, a bodily energy in Ayurveda, plays a role in bodily structure and fluid balance. Its vitiation, combined with Vata and Pitta doshas, contributes to Mukhadushika.
24) Roga:
Roga means disease in Ayurveda. Mukhadushika is classified as a Kshudra Roga, indicating its prominence as a minor yet impactful skin ailment requiring specific therapeutic interventions.
25) Shalyatantra (Salyatantra, Shalya-tantra, Shalyatamtra):
Shalya-tantra is the Ayurvedic discipline of surgery and procedural treatment. The department focused on this field undertook the study to evaluate Jalaukavacharana for Mukhadushika.
26) Kshudraroga (Kshudra-roga, Ksudraroga):
Kshudra-roga refers to minor diseases in Ayurveda. Mukhadushika is classified under this category, highlighting its perceived relative minor status yet significant cosmetic and psychological impact.
27) Inflammation:
Inflammation, known as Shotha in Ayurveda, is a key symptom in Mukhadushika. The clinical study showed that the anti-inflammatory properties of leech saliva significantly reduced inflammation.
28) Swelling:
Swelling, another term for Shotha, is commonly observed in Mukhadushika. The treatment with Jalaukavacharana effectively reduced swelling, as noted in the clinical results.
29) Kshudra (Ksudra):
Kshudra means minor, and in Ayurveda, Kshudra Rogas are minor diseases. Mukhadushika, while common and impactful, is categorized this way reflecting its manageable nature with appropriate treatments.
30) Jalauka:
Jalauka refers to medicinal leeches used in Jalaukavacharana, an Ayurvedic bloodletting therapy. These leeches help treat Mukhadushika by sucking impure blood and injecting healing substances.
31) Tantra (Tamtra, Tantrism):
Tantra in Ayurveda refers to the body of knowledge concerning specific practices and treatments. Shalya-tantra includes surgical and procedural treatments like Jalaukavacharana for Mukhadushika.
32) Shalya (Salya):
Shalya translates to surgery in Ayurveda. Shalya-tantra encompasses surgical techniques and related treatments, including Jalaukavacharana, used in managing Mukhadushika.
33) Pitika:
Pitika refers to acne nodules or eruptions that characterize Mukhadushika. These lesions are addressed effectively through bloodletting therapies like Jalaukavacharana.
34) Medas (Meda, Medash):
Meda, or fatty tissue, is implicated in the pathology of Mukhadushika. The acne lesions (Pidikas) filled with Meda are targeted by treatments like Jalaukavacharana to reduce their severity.
35) Vata:
Vata dosha is one of the three bodily energies in Ayurveda. Its imbalance, along with Kapha and Pitta doshas, leads to the development of Mukhadushika symptoms.
36) Vitiation (Vitiated):
Vitiation refers to the imbalance of bodily energies (Doshas). In Mukhadushika, the vitiation of Kapha, Vata, and Rakta dhatu is central to the disease's pathogenesis.
37) Vagbhata:
Acharya Vagbhata is an ancient Ayurvedic scholar whose texts detail various diseases and treatments. His insights on Mukhadushika include the role of dosha vitiation and recommended therapies like bloodletting.
38) Samhita:
Samhita refers to classical Ayurvedic texts. Works like Sushruta Samhita and Madhava Nidana provide detailed descriptions of diseases like Mukhadushika and their treatments.
39) Haridra:
Haridra, or turmeric, is used in preparing leeches for Jalaukavacharana by keeping them in Haridra-jala. Its antimicrobial properties help in the activation and purification of leeches.
40) Cotton:
Cotton is used in the Jalaukavacharana procedure for cleaning the patient's skin and managing post-treatment bleeding, ensuring proper hygiene and healing.
41) Karma (Karman):
Karma in this context refers to specific procedural steps. For Jalaukavacharana, Purva Karma, Pradhana Karma, and Paschata Karma outline the preparation, main action, and post-care.
42) Shukradhatu (Sukradhatu, Shukra-dhatu):
The development of Shukradhatu or reproductive tissue during adolescence is linked with hormonal changes that can lead to Mukhadushika, underscoring the connection between puberty and acne.
43) Raktadhatu (Rakta-dhatu):
Raktadhatu is the Ayurvedic term for blood tissue. Its impurity or vitiation is a key factor in the development of Mukhadushika, making blood purification crucial in treatment.
44) Jatharagni (Jathara-agni):
Jatharagni refers to digestive fire in Ayurveda. Mandagni (low digestive fire) is often associated with various diseases, including Mukhadushika, as it disrupts metabolism and toxin removal.
45) Kaphadosha (Kaphadosa, Kapha-dosha):
Kaphadosha, one of the three primary doshas, is responsible for structure and lubrication in the body. Its vitiation, combined with Vata and Pitta doshas, leads to conditions like Mukhadushika.
46) Vatadosha (Vatadosa, Vata-dosha):
Vata-dosha governs movement and regulation in the body. Its imbalance, along with Pitta and Kapha, contributes to the symptoms and development of Mukhadushika.
47) Education:
Education plays a vital role in understanding and managing conditions like Mukhadushika. The study involved experts from educational institutions like Jammu Institute of Ayurveda and Research.
48) Mandagni (Manda-agni, Mamdagni):
Mandagni refers to low digestive fire, a common factor in many diseases. In Mukhadushika, inadequate digestion and metabolism (Mandagni) contribute to toxin accumulation and acne formation.
49) Prakriti (Prakrti):
Prakriti refers to the body's constitution or inherent nature. The study observed that Mukhadushika was more prevalent in individuals with Pitta-Kapha Prakriti, indicating a link between constitution and disease susceptibility.
50) Madhava:
Acharya Madhava is an Ayurvedic scholar whose work, Madhava Nidana, outlines the symptoms and treatment of diseases like Mukhadushika, providing a classical Ayurvedic perspective.
51) Apathya:
Apathya refers to dietary and lifestyle patterns that aggravate diseases. For Mukhadushika, avoiding oily, spicy, and junk foods is recommended to prevent worsening of symptoms.
52) Pathya:
Pathya denotes beneficial dietary and lifestyle habits that support healing. For Mukhadushika, recommended Pathya includes consuming green grams, rice, vegetables, and maintaining good sleep hygiene.
53) Shukra (Sukra):
Shukra, related to reproductive tissue, is crucial during puberty when Mukhadushika is most prevalent. Hormonal changes involving Shukra-dhatu contribute to acne development.
54) Srotas (Shrotas):
Srotas are channels in the body that transport nutrients and wastes. In Mukhadushika, impurities in these channels lead to blockages and acne, which treatments like Jalaukavacharana aim to clear.
55) Vataja (Vata-ja):
Vataja symptoms in Mukhadushika include pain (Vedana), often due to blockage and inflammation in the channels. While less common, these symptoms were noted in specific patients.
56) Nature:
Nature in Ayurveda relates to the inherent constitution (Prakriti) of individuals. It affects susceptibility to diseases like Mukhadushika and determines the appropriate therapeutic approaches.
57) Bhiru:
Bhiru refers to individuals who are delicate or fearful. Jalaukavacharana is recommended for Bhiru patients due to its relatively painless application, making it suitable for treating Mukhadushika.
58) Manda (Mamda):
Manda signifies dullness or sluggishness. Mandagni, or weak digestive fire, is often associated with conditions like Mukhadushika, where poor digestion contributes to toxin buildup.
59) Mala:
Mala refers to waste products in Ayurvedic medicine. Accumulation of Mala, particularly in the form of oily substances, in facial skin pores is linked to the development of Mukhadushika.
60) Shri (Sri, Sr):
Shri is likely a respectful title, and in this context, may refer to the institutions or individuals in the study, such as Shri Sain Charitable Trust for higher Education and Research.
61) Food:
Food plays a critical role in managing Mukhadushika. Pathya foods like green grams, rice, and vegetables support healing, while Apathya foods like oily and spicy items aggravate the condition.
62) Diet:
Diet directly impacts the occurrence and management of Mukhadushika. The study emphasizes the need for a balanced diet avoiding aggravating substances to manage acne effectively.
63) Sushruta-samhita (Susruta-samhita):
Sushruta-samhita is a foundational Ayurvedic text by Acharya Sushruta, detailing surgical practices and treatments like Jalaukavacharana for Mukhadushika and other conditions.
64) Pradhana-karma:
Pradhana-karma refers to the main procedure in Ayurvedic treatment. In Jalaukavacharana, it involves the application of leeches to affected sites for bloodletting and therapeutic benefits.
65) Madhavanidana (Madhava-nidana):
Madhava-nidana is an Ayurvedic text detailing disease diagnostics and treatment. It provides descriptions of Mukhadushika and its management through Ayurvedic therapies.
66) Disfigurement:
Disfigurement associated with Mukhadushika involves visible skin changes like papules and scars, which treatments like Jalaukavacharana aim to reduce, restoring the affected individual's appearance.
67) Tuberculosis:
Patients with conditions like tuberculosis are excluded from the study on Mukhadushika treatments due to potential complications and differing treatment requirements.
68) Purification:
Purification, or Shodhana, is a central concept in Ayurveda aimed at detoxifying the body. Jalaukavacharana serves as a purification method by removing impure blood and alleviating Mukhadushika.
69) Prakshalana (Praksalana):
Prakshalana refers to the cleansing process. In preparation for Jalaukavacharana, patients undergo Ushanodaka Prakshalana to ensure cleanliness and efficacy of the bloodletting therapy.
70) Pittadosha (Pittadosa, Pitta-dosha):
Pitta-dosha, responsible for metabolic processes, is one of the doshas involved in the pathogenesis of Mukhadushika. An imbalance leads to symptoms like inflammation and Pidika formation.
71) Purvakarma (Purvakarman, Purva-karman):
Purva-karma encompasses preparatory steps in Ayurvedic treatments. For Jalaukavacharana, it includes preparing the patient and leeches to ensure an effective and hygienic bloodletting procedure.
72) Green gram:
Green gram, recommended as Pathya, is a dietary item beneficial for managing Mukhadushika due to its light and easy-to-digest nature, which supports overall health and reduces acne symptoms.
73) Discussion:
The discussion section in a study reviews the results, significance, and implications of the findings. In the context of Mukhadushika, it evaluates the efficacy of treatments like Jalaukavacharana.
74) Abhyanga (Abhyamga):
Abhyanga is a form of self-massage using oils. Patients undergoing Jalaukavacharana for Mukhadushika were advised to perform Abhyanga on the face as a preparatory step to enhance blood flow.
75) Shodhana (Sodhana):
Shodhana, meaning purification, involves detoxifying the body. Jalaukavacharana acts as a Shodhana therapy by removing vitiated blood, thereby helping in the management of Mukhadushika.
[Note: The above list is limited to 75. Total glossary definitions available: 106]
Other Science Concepts:
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Vedana, Shodhana, Daha, Kandu, Medas, Ropana, Kshudraroga, Raktadhatu, Apathya, Mukhadushika, Raktamokshana, Jalaukavacharana, Vatadosha, Kaphadosha, Pidika, Bioactive substances, Acne vulgaris, Yuvanapidika.