It is the general opinion that smooth and glowing skin of face not only enhances the beauty of a person but it also provides tremendous self- confidence. One of the leading cosmetic problems which affect the facial skin is Acne Vulgaris and it is affecting 85% of teenagers of the world population. So there is a need for potential well tolerated treatment which can limit the disease and thus reduce psychological impact of condition. In Ayurvedic Classics in the context of Kshudra rogas, there is a description on Mukhdushika occurring in yuvavastha and its signs and symptoms are similar to that of Acne Vulgaris. In Ayurvedic classics many internal medicines such as Vati, Kashay, Ghruta and various Lepas are considered to be the effective treatment of Mukhdushika. But, now-a-days, many Ayurvedic companies are manufacturing many new medicines based on classical Ayurvedic texts. So, there is a need of validation of these new medicines for the use of all Ayurvedic practitioners in day to day practice. Liquid Rubyclin is also a new medicine manufactured by GMP certified Ayurvedic Company. Hence, the present study was carried out with an objective to compare the efficacy of Liquid Rubyclin with that of Mahamanjishthadi Kashayin Mukhdushika.

The study was ‘Single Blind Comparative Study’ conducted on 60 patients of Mukhdushika of either sex. Patients were advised randomly recruited to trial group and standard group of 30 each. The trial group patients were advised Liquid Rubyclin and the standard group prescribed Mahamanjishthadi Kashay, 20 ml twice in a day after meal with external application of Rodhradi Lepa same for both groups one time a day for 30 days.

Liquid Rubyclin showed significant response in Kandu (Itching), Vaivarnya (Discoloration), Pitika Kshetra (Area occupied by Pitika), Pitika Sankhya (No. of Pitika) and moderate type of Acne, hence proved that Liquid Rubyclin is more effective in moderate Acne while Mahamanjishthadi Kashay is effective in mild Acne.

Keywords: Mukhdushika, Acne vulgaris, Liquid Rubyclin, Mahamanjishthadi Kashay, Rodhradi Lepa.

Introduction:

All the diseases, be it physical or mental, act as major impediment in life and reduce the joy of a happy life, self-confidence and social standing. The most common ailment that a teen suffers in his age is Acne.

Acne is a chronic inflammatory disease of the pilosebaceous glands present in the surface of the skin. This disease is characterized by the formation of comedones (blackheads), erythematous papules, and in a few cases, nodules or cysts and scarring. There are four major factors involved in the disease production viz, increased sebum production, cornification of pilosebaceous duct, microbial involvement and production of inflammation. This condition is found commonly in puberty.

In Ayurveda, this disease is described as “Mukhdushika” or “Yuvan pidika” or “Tarunya pidika”. According to Ayurveda, the shalmali kantaka like eruptions on the face due to vitiation of Kapha, Vata and Rakta which are found in adolescents are called “Mukhdushika”.

Need and Significance of the Research Work:

Wide range of treatment exists for Acne vulgaris- which includes both topical application and oral medicine. But side effects like skin irritation, contact dermatitis, photo sensitivity by topical applications and gastro-intestinal disturbance and other systemic disorders by oral medication are often noticed. So, there is an intense need for potential, well tolerated treatment which can limit the disease without affecting the beauty and reduce its psychological impact. While mentioning the treatment modalities for disease Mukhdushika all the Acharyas of Ayurveda have given importance on various Lepas as well as internal medicines such as Vati, Kashay and Ghruta.

Now-a-days, many Ayurvedic companies are manufacturing of many Ayurvedic medicines based on classical Ayurvedic texts. These are new medicines in Ayurveda. There is a need of validation of these new medicines for the use of all Ayurvedic practitioners in day to day practice. The safety, efficacy and cost effectivity of these new products must be tested. In present study, Liquid Rubyclin is selected which is also a new product in market. It is used by Ayurvedic practitioners for last many years but the clinical study of this product has not been recorded anywhere in the past. So, it was decided to study the efficacy of Liquid Rubyclin in the management of Mukhdushika w.s.r. to Acne vulgaris.

Aims and Objectives:

Aim:

To study the efficacy of Liquid Rubyclin in the management of Mukhdushika with special reference to Acne vulgaris.

Objectives:

1. To study the disease Mukhdushika in detail with Ayurvedic and modern aspect.

2. To compare the efficacy of Liquid Rubyclin and Mahamanjishthadi Kashay in the symptoms of Mukhdushika such as Kandu, Daha, Ruja, Srava, Vaivarnya, etc.

Materials and Methods:

1. Patients
2. Medicines: Internal and External

• For Trial Group:

Internally: Liquid Rubyclin

External Application: Rodhradi Lepa

Liquid Rubyclin:

Main Contents:

Each 20ml contains extracts of:

Sr.No.	Drug Name	Latin Name
1	Khadira	Acacia catechu	444mg
2	Sariva (Shweta)	Hemidesmus indicus	“   “
3	Munditika	Sphaeranthus indicus	“   “
4	Madayanti	Lawsonia inermis	222mg
5	Sahachara	Barleria prionitis	“   “
6	Karanja	Pongamia pinnata	“   “
7	Nimba	Azadirachta indica	“   “
8	Chakramarda	Cassia tora	“   “
9	Vidanga	Embelia ribes	“     “
10	Daruharidra	Berberis aristata	“     “
11	Manjishtha	Rubia cordifolia	“     “
12	Dhataki	Woodfordia fruticosa	“     “
13	Katuka	Picrorrhija kurroa	“     “
14	Aragvadha	Cassia fistula	“     “

Prakshep Dravya:

Sr.No.	Drug Name	Latin Name
1	Amalaki	Emblica officinalis	44.333mg
2	Bibhitaka	Terminalia belerica	“     “
3	Haritaki	Terminalia chebula	“     “
4	Jaipatra	Jasminum officinale	44mg
5	Maricha	Piper nigrum	44.333mg
6	Pippali	Piper longum	“     “
7	Shunthi	Zingiber officinale	“     “
8	Ela (Sthoola)	Amomum subulatum	44mg
9	Twakpatra	Cinnamomum tamala	44mg
10	Twak	Cinnamomum zeylanicum	22mg
11	Nagakeshar	Mesua ferrea	22mg
12	Guda		q.s.

 Preservatives: Sodium methyl paraben

                        Sodium Propyl Paraben

                        Sodium Metabisulphite

The medicine Rubyclin was purchased from the G.M.P. certified drug manufacturing company.

Quantity of Liquid Rubyclin: Daily requirement of Liq. Rubyclin per patient is 40ml. So, for 30 days total requirement of Liq. Rubyclin is 36 litre.

For Standard Group:

Internally: Mahamanjishthadi Kashay

External Application: Rodhradi Lepa

Main Contents:

Sr.No.	Drug Name	Latin Name
1	Manjishtha	Rubia cordifolia
2	Musta	Cyperus rotundus
3	Kutaja	Holarrhena antidysenterica
4	Guduchi	Tinospora cordifolia
5	Kulanjana	Alpinia galangal
6	Shunthi	Zingiber officinale
7	Bharangi	Clerodendrum serratum
8	Kantakari	Solanum xanthocarpum
9	Vacha	Acorus calamus
10	Nimba	Azadirachta indica
11	Haridra	Curcuma longa
12	Daruharidra	Berberis aristata
13	Patola	Trichosanthus dioica
14	Katuka	Picrorrhija kurroa
15	Murva	Marsdenia tenacissima
16	Vidanga	Embelia ribes
17	Asana	Pteroarpus marsupious
18	Chitraka	Plumbago zeylanica
19	Shatavari	Asparagus racemosus
20	Triman	Gentiana Kurroa
21	Pippali	Piper longum
22	Indrayava	Holarrhena antidysenterica
23	Vasa	Adhatoda vasica
24	Bhringaraja rasa	Eclipta alba
25	Devdaru	Cedrus deodara
26	Patha	Cissumpelos pareira
27	Khadira	Acacia catechu
28	Raktachandana	Pterocarpus santalinus
29	Trivrut	Ipomoea turpethum
30	Varuna	Crateva nurvula
31	Kiratatikta	Swertia chirata
32	Bakuchi	Psoralia corylifolia
33	Argvadha	Cassia fistula
34	Shakchaal	Tctona grandis
35	Nimba	Azadirachta indica
36	Karanja	Pongamia pinnata
37	Ativisha	Aconitum heterophyllum
38	Ushira	Vetivera zizanioides
39	Indravaruni	Cotrullus colocynthis
40	Sariva (Shweta)	Hemidesmus indicus
41	Sariva (Krushna)	“ “
42	Parpata	Fumaria parviflora
43	Dhataki	Wodfordia fruticosa
44	Amalaki	Emblica officinalis
45	Bibhitaka	Terminalia belerica
46	Haritaki	Terminalia chebula

Prakshep Dravya:

Sr.No.	Drug Name	Latin Name
1	Ela (Sookshma)	Elettaria cardamomum
2	Tvakpatra	Cinnamomum tamala
3	Nagakeshar	Messua ferrea
4	Tvak	Cinnamomum zeylanicum
5	Pippali	Piper longum
6	Guda	Jaggery

 

Preservatives: Sodium methyl paraben

                       Sodium Propyl Paraben

                        Sodium Metabisulphite

Rodhradi Lepa:

Contents:

Sr.No.	Drug Name	Latin Name	Quantity
1	Rodhra (Lodhra)	Symplocos racemosa	3kg
2	Kustumbaru (Dhanyak)	Coriandrum sativum	3kg
3	Vacha	Acorus calamus	3kg
4	Jala	Water	q.s.

 

Sample Choorna of above drugs was sent for standardization in the department of Rasashastra and Bhaishajya –Kalpana.

Quantity of Lepa Dravya:

Daily requirement of choorna per patient is 5gm, so for 30 days total requirement of choorna is 150gm.

Methodology:

A] Selection of Patients

Source of Data: The patients who attended the O.P.D. of Kayachikitsa Department during the period of year 2015 and 2016. Among these, 60 patients who fulfilled the below mentioned criteria of inclusion were taken for the study.

Inclusion Criteria:

1. Age group between 16-30 years.
2. Patients of either sex were taken.
3. Diagnosed patients of Mukhdushika with classical signs and symptoms such as Kandu, Daha, Ruja, Srava, Vaivarnya, No. Pitika and Area occupied by Pitika.

Exclusion Criteria:

1. Patients having age below 16yrs and above 30yrs.
2. Pitika (Comedone/Papules/Pustules) on other parts (Chest, Back) of body except on Mukha (Face).
3. Patients suffering from other skin diseases and other systemic disorders.
4. Female patients of menstrual irregularities due to hormonal imbalance, taking OCPs, pregnant women, lactating mothers.

Investigation:

1. Complete Blood Count (CBC)
2. Erythrocyte Sedimentation Rate (ESR)

Clinical Study:

Clinical Study Carried Out On Randomly Selected 60 Patients By Lottery Method Of Randomization Showing Signs And Symptoms Of Mukhdushika (Acne Vulgaris). They Were Randomly Divided Into Two Groups: Group A And Group B.

Group A:

Randomly selected 30 patients were treated with internally Liquid Rubyclin and external application of Rodhradi Lepa.

The prepared Liquid Rubyclin was purchased from GMP certified Ayurvedic Manufacturing Company.

Liquid Rubyclin:

Matra: 4 tsf (20ml) twice in a day

Anupan: Jala

Kala: Adhobhakta (After lunch and dinner)

Duration: 30 Days

Follow Up: DAY-0, DAY-10, DAY-20 and DAY-30.

Rodhradi Lepa:

Coarse Choorna of Rodhra Twak, Dhanyak Beeja and Vacha Kanda was taken in equal quantity then mixed with water.

Particle size of choorna = 80 mesh

External Application of Rodhradi Lepa:           

-      ¼ Anguli Pramana = 5mm (Indian Pharmacopeia)

-      15 to 20 minutes

-      Once in a day time

-      30 Days.

For our clinical study total 60 liters of Liquid Rubyclin and 15kg choorna of Rodhradi Lepa was used.

Group B:

Randomly selected 30 patients were treated with internally Mahamanjishthadi Kashay and external application of Rodhradi Lepa.

The prepared Mahamanjishthadi Kashay was purchased from GMP certified Ayurvedic Manufacturing Company.

Mahamanjishthadi Kashay:

Matra: 4 tsf (20ml) twice in a day

Anupan: Jala

Kala: Adhobhakta (After Lunch and Dinner)

Duration: 30 Days

Follow Up: DAY-0, DAY-10, DAY-20 and DAY-30.

Rodhradi Lepa:

Preparation and method of application of Lepa was same as Group A.

Criteria for Assessment of Results:

A)    Subjective Criteria:

1. Kandu (Itching):

Grade	Score	Feature
0	0	No itching
+	1	Occasionally ithing
++	2	Frequent itching
+++	3	Continuous itching

 

2. Daha (Burning):

Grade	Score	Feature
0	0	No Burning
+	1	Occasionally Burning
++	2	Frequent Burning
+++	3	Continuous Burning

3. Ruja (Pain):

Grade	Score	Feature
0	0	No Pain
+	1	Pain on pressure
++	2	Pain on simple touch
+++	3	Pain without touching

4. Srava (Discharge):

Grade	Score	Feature
0	0	No Srava
+	1	Very less need to mob
++	2	Needs mobbing
+++	3	Profuse

5. Vaivarnya (Discolouration)

Grade	Score	Feature
0	0	No Discoloration
+	1	At the center of lesion
++	2	Surrounding the lesion
+++	3	Over all face

 

 

6. Area occupied by Pitika (Pitika Kshetra)

Grade	Score	Feature
0	0	No
+	1	1 to 2cm
++	2	3 to 4cm
+++	3	>5cm

7. No. of Pitika (Pitika Sankhya)

Grade	Score	Feature
0	0	0
+	1	6 to 10
++	2	11 to 20
+++	3	>20

 

Objective Criteria:

Objective assessment was done on basis of Acne scale.

Acceptable Global Evaluation Scale for Acne Vulgaris Trials:

1- Healthy clear skin with no evidence of acne vulgaris.

2-Almost clear; rare non inflammatory lesions present

Rare no inflamed resolving papules (may be hyper pigmented but not pink red) some non- inflammatory lesions present; few inflammatory lesions (papules/pustules only; no no dulocystic lesions)

3-Non inflammatory lesions predominant; multiple inflammatory lesions present; several too many comedones & papules /pustules; one small no dulocystic lesion.

4-inflammatory lesions predominant; many comedones and papules/pustules; May / may not be a few no dulocystic lesion.

5- Highly inflammatory lesions predominant; variable numbers of comedones; many papules/pustules and nodulocystic lesions.

The Global Acne Grading System:

Location	Factors
Forehead	2
Right Cheek	2
Left Cheek	2
Nose	1
Chin	1

 

Note: Each type of lesion is given a value depending on severity

No lesions=   0

Comedones= 1

Papules= 2

Pustules= 3

Nodules= 4

The score for each area (local score) is calculated using the formula:

Local score=Factor × Grade (0-4).

The Global score is the sum of local scores & Acne severity was graded using the global score. A score of 1-18 is considered mild; 19-30 Moderate; 31-38 Severe; >39 very severe.

Assessment of the patients was done according to above scale before and after treatment.

Observations and Results:

The general observations and results are given below:

The assessment criteria are Quantitative and Qualitative. Paired and unpaired test and ‘Chi’ square test are applied.

Age: All the patients presented were within 30 years of age. Active hormonal changes taking place during this age may be the reason for this.

Sex: Out of 60 patients, 61.65% (37) are female and 38.35% (23) are male. Females suffer from hyper androgenesis more and therefore are more prone to Acne.

Marital status:In the present study, 54 (90%) patients were married and only 6 (10%) patients were unmarried in the groups. The mental stress along with hormonal instability before marriage may be possible reasons.

Occupation:There were 46 (76. 67%) students, 10 (16.67%) patients were in service and 6.67% ladies were housewives. In students Adhyashana, Ratrijagaran, Diwaswap and Mental stress may be cause of prevalence of disease in students due to Vata, Kapha prakopa.

Diet: Out of 60 numbers of patients, 20 (33.33%) patients had vegetarian diet while remaining i.e. 66.67% patients had mixed diet. Eating more non-vegetarian causes pitta prakopa, Malavashtambha (constipation) and Agni dushti which are responsible factor in pathogenesis of Mukhdushika.

Prakruti: The data suggests that 31.66% patients were of Kapha-pittaja prakruti. 23.33% of patients were of Kapha-vataja prakruti. Pitta-kapahaja prakruti was found in 20% patients, followed by 16.66% Pitta-vataja, 6.66% Vata-kaphaja 1.66% patients of Vata-pittaja prakruti.

Total Effect of Therapy:

Subjective parameter	Group A	% Relief	Group B	% Relief
Kandu (Itching)	24	80	19	63.33
Daha (Burning)	20	66.67	21	70
Ruja (Pain)	21	70	23	76.67
Srava (Discharge)	20	66.67	16	53.33
Vaivarnya (Discoloration)	20	66.67	15	50
Pitika Kshetra (Area occupied by pitika)	25	83.33	20	66.67
Pitika Sankhya (No. of pitika)	23	76.67	20	66.67

 

As table and graph showed, in comparision between the groups. Group A is more significant in relieving symptoms like Kandu (itching), Vaivarnya (Discoloration), Pitika kshetra (area occupied by pitika) and Pitika Sankhya (No. of pitika) in comparison with group B.

There is no significant findings between the groups in other parameters namely- Daha (burning), Ruja (Pain) and Srava (Discharge).

In group A, 80% patients showed marked response and 75% patients showed moderate improvement. Whereas, in group B, 65% patients showed marked response and only 50% patients showed moderate improvement.

So, by comparing the overall assessment of treatment for subjective criteria we can say that group A showed marked improvement than group B.

Distribution of patients according to Severity of Acne on the basis of Scale of Acne:

Before Treatment:

Severity of Acne	Group A	% of Patients.	Group B	% of Patients
Mild (1-18)	4	13.33	12	40
Moderate (19-30)	22	73.34	17	56.67
Severe (31-38)	4	13.33	1	3.33
Very severe (>39)	0	0	0	0
Total	30	100	30	100

 

In this proportional bar graph, severity of Acne is being compared. The left (vertical) axis represents % of patients and the right (horizontal) axis represents severity of Acne on the basis of scale of Acne before treatment. The blue bar represents the % of patients included in Group A and the red bar represents the % of patients included in Group B on the basis of scale of Acne before treatment.

Graph shows: Severity of Acne on the basis of scale of Acne before treatment, from Group A 13.33% patients have mild and severe Acne while 73.34% have moderate Acne. Whereas from Group B 40% patients have mild Acne, 56.66% patients have moderate Acne and 3.33% patients have severe Acne.

After Treatment:

Severity of Acne	Group A	% of Patients	Group B	% of Patients
Mild (1-18)	20	66.67	23	76.67
Moderate (19-30)	10	33.33	7	23.33
Severe (31-38)	0	0	0	0
Very severe (>39)	0	0	0	0
Total	30	100	30	100

 

After treatment graph shows that: Severity of Acne on the basis of scale of Acne, from Group A 66.67% patients have relief in mild Acne whereas 33.33% patients have relief in moderate Acne. Also, from Group B 76.67% patients have relief in mild Acne and 23.33% patients have relief in moderate Acne.

So, from above graphic presentation, Liquid Rubyclin is more effective in moderate Acne while Mahamanjishthadi Kashay is effective in mild Acne.

Discussion:

The study was aimed to evaluate the efficacy of “Liquid Rubyclin” in Mukhdushika with special reference to Acne vulgaris, for assessing the results of following symptoms for subjective criteria Kandu (Itching), Daha (Burning sensation), Ruja (Pain), Srava (Discharge), Vaivarnya (Discolouration), Pitika Kshetra (Area occupied by pitika) and Pitika Sankhya (No. of pitika) were selected. For objective criteria Scale of Acne recommended by The Global Acne Grading System (GAGS). {theacneproject.com/severe-acne-scales}

As it was a clinical evaluation, symptoms of Mukhdushika were correlated with Acne vulgaris included in assessment criteria.

Every patient was examined on 1^st day and again day 10^th, 20^th and day 30^th.

The distribution of patient according to age, sex, education, socio-economic status, marital status and religion mainly reflects the age and marital status of the population from which the sample was taken. Maximum of the patients had Kapha-vataja and Kapha-pittaja prakruti. The habit for tea was found in 50% patients while habit for Coffee in 28.33% people act as a precipitating factor for Pitta prakopa. 33.33% patients had vegetarian diet while remaining i.e. 66.67% patients had mixed diet. Eating more non-vegetarian food causes Pitta-prakopa, which leads to Malavashtambha (Constipation) and Agni dushti which are responsible factors in pathogenesis of Mukhdushika.

Statistical analysis of the efficacy of study group Liquid Rubyclin and control group Mahamanjishthadi Kashay in Mukhdushika was done by applying Chi-square test and “t” test.

The qualitative data subjected to c²test (Chi square test) compared the efficacy of Liquid Rubyclin with that of Mahamanjishthadi Kashay. All the patients of study group and control group showed improvement in symptoms of Mukhdushika. The c² values on day 30 were found to be greater than c² table value for the symptoms area occupied by pitika and no. of pitika. Hence rejecting H0 (Null Hypothesis), there was significant difference in efficacy of both the drugs. The c² values on day 20   found to be greater than c² table values for the symptoms Kandu and Vaivarnya. So rejecting H0 (Null Hypothesis), there was significant difference in efficacy of both the drugs. The c² values for the symptoms Daha, Ruja and Srava were found to be less than c² table value. Hence accepting H0 (Null Hypothesis), there was no significant difference in efficacy of both the drugs for above symptoms.

The observed “t” value for difference in Scale of Acne on DAY-0 and   DAY-30 is significant. It suggests that the value of these objective criteria was significantly deranged due to treatment in comparison with Group A and Group B (i.e. paired “t” test).

On comparing the relief in Scale of Acne by Unpaired “ t” test the value was t=2.36 at df (58) and p>0.05. This value showed that there was statistically significant difference observed between the efficacy of Liquid Rubyclin and Mahamanjishthadi Kashay, thus Liquid Rubyclin was more effective for relief in Scale of Acne.

Also, by using Proportional Bar Graph, Severity of Acne on the basis of Scale of Acne is being compared before and after treatment.

Before treatment graph shows that: Severity of Acne on the basis of scale of Acne, from Group A 13.33% patients have mild and severe Acne while 73.34% have moderate Acne. Whereas from Group B 40% patients have mild Acne, 56.66% patients have moderate Acne and 3.33% patients have severe Acne.

After treatment graph shows that: Severity of Acne on the basis of scale of Acne, from Group A 66.67% patients have relief in mild Acne whereas 33.33% patients have relief in moderate Acne. Also, from Group B 76.67% patients have relief in mild Acne and 23.33% patients have relief in moderate Acne.

So, from above graphic presentation, Liquid Rubyclin is more effective in moderate Acne while Mahamanjishthadi Kashay is effective in mild Acne.

Mode of action of the drug:

The drug used for trial group was Liq. Rubyclin which contains 14 main drugs and 11 drugs used as a prakshep dravya. Rodhradi Lepa was also given as an external application same for the both groups. As described in Samhita in Samprapti of Mukhdushika Doshas involved are Kapha and Vata while Dushyas are Rasa, Rakta and Meda. Also the word ‘Yunam’ in the definition of Mukhdushika indicates Yuva Avastha. In this Avastha physiologically the dominance of Pitta dosha is seen. Pitta is associated with Rakta causing Rakta dushti. Most of the drugs included in Liq. Rubyclin have Kapha-Vataghna and Kapha Pittaghna due to Tikta, Kashay and Madhura Rasa. All the drugs except Argvadha have Katu vipak. As described in Charaka Samhita Katu rasa acts as Kandughna and Vrana Avasadak, Tikta rasa acts as Kandughna and Kushthaghna and gives stability (Sthirikaran) to Twak and Mansa while Kashay rasa acts as Kledopshoshak and Vranaropaka. Most of the drugs containing in Liq. Rubyclin described in Kushthaghna, Kandughna and Varnya Mahakashaya of Charaka Samhita. Sheeta veerya act as a Dahaprashaman while Ushna veerya eliminates Srotoavarodha. In short, all the drugs included in Liq. Rubyclin have Raktashodhak, Raktaprasadak, Kandughna, Kushthaghna, Varnya, Shothhar properties.

1. Khadira: Raktaprasadan, Shothahar, Kushthaghna
2. Sariwa (Shweta): Raktahodhak, Shothahar
3. Munditika: Raktashodhak, Shothahar, Kushthaghna, Krumighna.
4. Madayanti: Raktaprasadan, Shothahar, Kushthaghna
5. Sahachara: Raktashodhak, Shothahar, Kandughna, Kushthaghna, Vishghna.
6. Karanja: Raktaprasadan, Shothahar, Raktashodhak, Kandughna, Kushthaghna, Krumighna.
7. Nimba: Raktashodhak, Kandughna, Kushthaghna, Dahaprashaman.
8. Chakramarda: Raktaprasadan, Kushthaghna, Krumighna, Vishghna.
9. Vidanga: Raktashodhak, Varnya, Kushthaghna, Krumighna.

   10. Daruharidra: Raktashodhak, Varnya, Kandughna

   11. Manjishtha: Raktashodhak, Varnya, Raktaprasadak, Vranaropan, Kushthaghna, Vishghna.

     12. Dhataki: Kushthaghna, Krumighna, Vranaropak, Vishghna

     13. Argvadha: Raktashodhak, Shothahar, Vedanasthapan, Kushthaghna, Kandughna.

According to modern science:

1. Khadira: Astringent, Antioxidant, Skin lightening property.
2. Sariwa: Antioxidant, Skin whitening property.
3. Munditika: Antioxidant, Hepatoprotective.
4. Madayanti: Anti-inflammatory, Anti-bacterial, Antioxidant
5. Karanja: Antibacterial.
6. Nimba: Antibacterial, Antioxidant.
7. Daruharidra: Anti-inflammatory, Antioxidant.
8. Manjishtha: Make complexion even and lighten dark spots.

From the above information it is concluded that, Liq. Rubyclin (Ruby-Bloody red) has following properties which are useful in treatment of Mukhdushika (Acne vulgaris).

Rubyclin

1. Eliminates toxins from blood stream and purifies blood.
2. Reduces sero-sanguineous, purulent discharge.
3. Antiseptic, astringent, antibacterial, antifungal.
4. Improves microcirculation in the skin tissues.
5. Antihistaminic and anti-inflammatory.
6. Soothes irritation and itching.      

As compared to modern treatment Liq. Rubyclin has cost affectivity because in modern treatment the cost per patient is about Rs.1500 for one month whereas in this study the cost for one patient is approximately Rs.300/ month. Modern treatment for Acne contains antibiotics, steroids, creams, gel, etc. which have various side effects on our body system. There were no side effects observed in the patients taking Rubyclin. In some patients symptoms like Malavashtambha (Constipation) were relieved. Digestive power was also increased. So Rubyclin is also useful for maintenance of general health is our additional observation in this study.

In Ayurvedic texts Mukhdushika is considered as a disease of the face but if modern science is considered and evidence of the disease is considered the parts of the body should be considered.

Only local treatment for this disease is not sufficient. Internal treatment is also important. In this study we have compared the internal treatment of Liquid Rubyclin and Mahamanjishthadi Kashay.

In this study Shodhan Chikitsa of Vamana, Virechana or Raktamokshana was not given as well as the duration of treatment was short. The topic is open for further study on large number of subjects and for a long duration- for observing. According to the study Rubyclin used after proper Shodhan Karma was more effective. In future such clinical trials can be conducted. Multicentric trials can also be organized.

Conclusions:

On the basis of statistical tests of significance, Liquid Rubyclin is more effective than Mahamanjishthadi Kashay in reducing Vaivarnya (Discolouration), Pitika Kshetra (Area occupied by Pitika), and Pitika Sankhya (No. of pitika) observed on face in Mukhdushika. The Proportional Bar Graph proved that the results on severity of Acne on the basis of scale of Acne, Liquid Rubyclin is more effective in moderate Acne while Mahamanjishthadi Kashay is effective in mild Acne.

*Associate Professor , Kayachikitsa Department.

** M.D. Ayu. (Sch.)

*** HOD and Professor , Kayachikitsa Department,

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App:

Skin conditions and Treatment

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