ACNE AND ITS AYURVEDIC MANAGEMENT

Ayurvedic Analysis of Acne

Acne is one of the first signs of disease because, according to Ayurveda, the skin is a direct reflection of what’s happening inside of the body. Ayurveda believes that yuvana pitaka is a disease that is caused due to improper diet and other internal factors.

This includes:

• Adhyashana – Consuming food at short intervals, due to which new food enters the body when the previous food is not digested
• Virudhashana – Consuming incompatible foods together such as fish and milk together, curds and milk together etc
• Vishamashana – Consuming food with disregard to the bodily cravings, such as eating when not hungry or fasting when hungry

If acne is present then there is an imbalance in all three of the Doshas: An aggravation of the Vata (hyperkeratinization), Pitta (inflamed acne lesions), Kapha (over-secretion of sebum) Doshas along with vitiation of the Rakta Dhatu (blood tissue). This may leads to small localised eruptions on the cheeks, chin, chest, back, etc

A Vata Dosha imbalance causes weakened digestion and a buildup of ama (toxins); imbalanced Pitta creates problems in the blood (Rakta Dhatu) and liver, resulting in inflammation; an excess of Kapha Dosha results in clogged pores because of the overproduction of oil. This negative combination of weak digestion, toxins and inflammation builds the ultimate environment for the growth of too much bacteria and consequently, chronic acne.

But diving deeper than that we must look at what is unbalancing the Doshas – ultimately, a diet and lifestyle that is creating toxins. Eating hot, spicy and very salty and sour foods aggravates Pitta, as well as consuming coffee, meat and alcohol. Staying up past 11pm and eating dry foods like crackers and salad aggravates Vata Dosha. Overeating, eating too much oily and sweet foods and excessive sleeping will throw Kapha Dosha out of balance. Taking medications, smoking and eating foods with preservatives will also negatively impact all three Doshas.

• Pitta Acne: The pitta dosha governs your metabolic system called the agni or digestive fire in a person. When digestion and metabolism are good, there is no metabolic waste generated. The metabolic waste formed when the Agni is weak is called Ama. This Ama penetrates all the Dhatus or tissues of the body. Rasa (plasma), Rakta (blood), Lasika (lymph), and Mamsa (muscle) Dhatus are all closely linked to skin issues. The more severe the problem the more Dhatus are involved. An aggravation of pitta can increase the heat in your body, that also leads to to inflammation. Redness, inflammation and pain are characteristic of Pitta acne. It is usually found on the cheeks. This is the first Dosha to focus on balancing when healing skin disorders. 
• Vata Acne : A Vata Dosha imbalance causes weakened digestion and a buildup of ama (toxins); This negative combination of weak digestion, toxins and inflammation builds the ultimate environment for the growth of too much bacteria and consequently, chronic acne. Dryness, pain and blackheads characterize Vata acne. It will typically be on the lower half of the face from the nose down. Bringing Vata back into balance is essential to balancing Pitta Dosha.
• Kapha Acne: An excess of Kapha Dosha causes overproduction of oil. It blocks the normal excretory function of skin and the waste material stagnates inside, producing symptoms like results in clogged pores, itching, pustules and nodules formation. You will have acne usually be on the forehead and upper cheeks.

Vitiated doshas produce toxins that block the Srotas (Microscopic channels) of the affected areas leading to pimple formation. The condition of acne can also be aggravated by excessive intake of oily, spicy, salty and sour foods, Constipation and Irritable Bowel Syndrome. Even if the Scalp has more Oil and that can lead to Acne and Pimples. 

Dermatological Analysis of Acne

A healthy pilosebaceous unit regulates sebum production and natural disposal of dead skin cells. An imbalance of the pilosebaceous unit usually due to hormonal changes can result in over-secretion of sebum and an increase in keratinocytes. This leads to the blockage of hair follicles giving rise to comedonal acne.

Non-inflammatory comedonal acne when infected by Propionibacterium acnes bacteria can turn into a severe form of inflamed acne (pustules, nodules). The pus within the hair follicle is due to an immune response which attracts white blood cells to the site of infection.

This disorder of the pilosebaceous unit causing acne can be triggered by one of the various factors that are mentioned below:

• Hormonal changes during puberty that leads to increased levels of the androgen hormone. Androgen levels also increase during early pregnancy. This is why some women experience acne problems till their second trimester.
• Changes in the levels of your estrogen and progesterone can play a role in acne formation. Hence, many women experience acne problems before or during their menstrual cycle.
• Genetic skin disorder.
• More common in women diagnosed with polycystic ovarian syndrome.
• Use of skincare products that are comedogenic.
• Consumption of oily, spicy foods or foods that have high sugar content.
• Stress leading to imbalances in metabolism and accumulation of toxins in the body.
• Over exposure to heat, friction and sun.
• Skin diseases leading to dry skin or skin barrier impairment.
• Lack of good hygiene and a proper skincare routine.
• Certain medicines (lithium, androgenic steroids, corticosteroids) can also trigger acne.

Modern day medicine follows an approach to get rid of acne by focusing on preventing an over-growth of bacteria in the skin, regulating the production of oil and managing hormone levels. However, this is a very superficial approach and most of the time it requires taking heavy dosages of medications: the chronic use of antibiotics and harsh (not to mention very expensive) lotions that do more harm than any good. Using broad-spectrum antibiotics will create an excess of the yeast Candida albicans – this infection will likely make the acne even worse and then must be treated with still more antibiotics – an unfortunate cycle (Kumar et al., 2005)!

We need to understand that excess of bacteria growth is just a symptom of the underlying problems that are actually the root cause of the breakouts. This is exactly why trying to get rid of acne with topical and oral antibiotics might never clear up your skin. Focusing on changing the chemistry within the body is what is needed to completely heal from the inside out and that is where the ayurvedic holistic healing protocols for the treatment are much more successful.

Chikitsa(treatment) in Ayurveda can be divided into two forms. The one being shodhan chikitsa and the other shaman chikitsa.

Shodhan Chikitsa consist of Vaman, Virechan, Nasya, Rakta Mokshna etc. Shaman chikitsa is the treatment through medication and application of drugs on the lesion for relief.

The Shodhan Chikitsa includes the panchakarma procedures and the Shaman Chikitsa has internal medication and external application of drugs. Line of treatment prescribed by different acharya’s is as follows:

• Sushruta samhita – Vamana, Lepan
• Ashtang Hridaya – Lepana, Vamana, Nasya, Siravyadh
• Bhavaprakasha- Lepana, Vamana, Abhyanga
• Yoga Ratanakara- Shiravedha, Pralepa, Abhyanga [
• Sarangadhara samhita- Lepana
• Bhaishajjya Ratnavali- Siravedha, Pralepa, Abhyanga
• Chakrapani: Siravedha, Vamana, Abhyang, Lepana

How to select treatment  protocol from various Shodhan Procedures:

Shodhan Chikitsa

• Vamana: Vaman Karma (emesis) is a procedure of removing vitiated Doshas through mouth. Both Acharya Sushruta and Vagbhata have mentioned Vamana Karma to cure the disease. As Vamana is the main therapy for Kaphaja abnormalities, Kapha is one of the main Dosha involved the pathogenesis. Vaman Karma is one of best therapy along with topical and oral Ayurvedic medication.
• Nasya: is the procedure of administering drugs through nasal passage. For treating Yuvanpidika, Tila taila as Pratimarsha nasya can be used. Vagbhata has indicated Nasya Karma for the treatment of Mukhadushika. Acharya Charaka has also advocated the Nasya Karma in Urdhva Jatrugata Vikara. Mukhadushika usually affects mukha which is in urdhavajatru part of body.
• Virechana Karma is used to remove the aggravated Pitta Dosha from the Guda Marga. Virechana is also useful in treating Raktaja Vikaras.
• Raktamokshan: Raktmoksana (bloodletting) is the preferred way of treatment in Raktaj disorders as per Ayurvedic texts. Raktamokṣana removes the vitiated blood and clears the Srotāvarodha (blockage in channels), thus breaking the samprapti (Evolution of disease)

For management of any disease, careful observation on Vyadhi Avastha (present condition of the disease) should be done. For Yuvanpidika/ Acne, it can be understood by knowing the involved Skin Layer. To understand this hypothetical classification of skin layers was made.

Classification of Skin

Sushruta Samhita (1000-500 BC), One of the main textbooks of Ayurveda describes the seven layers of the skin as follows:^[1]

• Avabhasini (reflective layer):Avabhasini in Sanskrit means “reflection.” This is the outermost layer which determines the beauty and complexion of an individuals’ skin. While it does not have its own color, it reflects the aura of the individual.
• Lohita(reddish layer): The color of this layer resembles the molten iron and hence the name Lohita, which in Sanskrit means “iron.” This layer indicates quality of the blood (raktadhatu).
• Shweta (white layer):Shweta means “white color” in Sanskrit. 
• Tamra (pigment layer):Taamra is the copper colored layer as the word Taamra in Sanskrit means “copper.” 
• Vedini (sensory layer):The word Vedini is derived from Vedana which in Sanskrit means “pain” as this level is responsible for the sensation of pain.
• Rohini (proliferating layer):The name Rohini has been derived from the word Rohana which in Sanskrit means “proliferation.” This layer is responsible for healing and regeneration. Any imbalance in this layer delays healing.
• Mamsadhara (muscle supporting layer):Mamsa in Sanskrit means “muscle” and Dhara means “support.” This layer provides firmness to the skin. The suppleness and youthfulness of skin depend on this layer of the skin. 

Based on the thickness of each layer mentioned in Ayurveda, these layers can be correlated with the layers of the skin described in modern medicine. The first four layers resemble the epidermis. As we know in modern science, the thickness of the epidermis is about 0.5 to 1.5 mm and the collective sum of Avabhasini (1/18th of a Vrihi: Vrihi is a small grain), Lohita (1/16^th of Vrihi), Shweta (1/12^th of Vrihi), and Tamra (1/6 of Vrihi) is around 0.5 to 1 mm.

The next two layers Vedini (1/5^th of Vrihi) and Rohini(1 of Vrihi) can be correlated to the papillary layer and reticular layer of the dermis respectively. Modern instruments measure the total thickness of the dermis around 2mm, although this can vary based on the anatomical site. The papillary layer is 1/5^th of the Dermis and 1 Vrihi is considered around 2 mm.

Ayurveda states that “Swedovaha Strotas” (channels for sweat) are in the skin, similar to Western anatomy. According to Ayurveda, the Bhrajak pitta dosha is responsible for skin color and its seat is the skin. This correlates to the melanocytes (the melanin pigment-producing cells that are responsible for skin color) situated in the skin.

In this way, we see lots of similarities in the description of the skin in both perspectives.

Avabhasini and Lohita have pitta pradhanta, as for Avabhasini, acharyas have said “sarva varna avabhasini panchavidhachhaya prakashayati”. In Lohita, the disorders like Tilkalaka,Nyaccha, Vyanga are seen and pitta is the common dosha among them

Shweta, Tamra, Vedini, and Rohini have diseases like Ajagallika, Mashak, Kilaskustha, Alaji, granthi etc. which possess Vata-Kapha Samprapti. Mamsadhara has diseases like Vidradhi, Arsha, Bhagandar which are Tridosha in nature. So this layer can be considered as “Tridosha Bhuyistha”.

So, while treating acne vulgaris, the following points should remain in mind:

• If the lesions show pitta dominant lakshanas like small pidika, pain, burning sensation etc., and are associated with kapha and rakta, it means avabhasini or lohita are involved then pittahara and raktaprasadan chikitsa should be done. Virechana and raktamokshan will be beneficial in these cases. Rasapachak and raktaprasasdana dravyas should be given for internal use.
• If the lesion show Kapha dominancy lakshan like big, deep rooted pidika, Ghana, puyaprachiti, medogarbhata, and is associated with vata and rakta, then kledohara kaphahara and rakta prasadana should be done. In these types of cases, vaman, nasya and raktamokshana will be beneficial.