Chapter 5 DISCUSSION AND CONCLUSIONS. 5.1 Abpecia areata 5.2 Qrey hair

Transcription

1 Chapter 5 DISCUSSION AND CONCLUSIONS 5.1 Abpecia areata 5.2 Qrey hair

2 DISCUSSION AND CONCLUSIONS Alopecia areata and grey hair are very common nowadays. The life style and food habits play an important role to cause many diseases. Hence in the study, the investigator has also considered the life style and food habits of the patients. No specific etiological factors of hair diseases are mentioned in Ayurvedic classics. The general etiological factors of sirahkapalarogas (scalp diseases) are mentioned in Charaka samhita and Ashtanga hridaya. It is mentioned that non-application of hair oil is one of the causative factors of sirahkapalarogas which include alopecia areata and grey hair. In the course of the study, it was found that 39% of the patients having alopecia areata and 50% of the patients having grey hair were not in the habit of using any hair oil (Table 4.12 and 4.46 respectively). The importance of abhyanga especially siroabhyanga is given emphasize in Ayurvedic classics. Siroabhyanga is anointing the head with medicated oil, massaging the scalp mildly and then taking bath. In the classics of Ayurveda, it is mentioned that medicated oil applied on scalp helps in alleviating vata and improves general health. By using drugs having vatasamana property, due to their ushnaveerya, and having the capacity of channel clearing (srotosodhana), the obstruction of the channels (srotorodha) is overcome and proper nourishment of the hair is achieved. This fact is evidenced from the study as the drugs brhati, vibheetaki, bhringaraaja and tila are ushna in veerya and having srotosodhana 274

3 property. Hence the study indicates that ushnaveerya and srotosodhana property are the two factors closely associated with hair growth. 42% of the population in the study regarding alopecia areata was students (Table 4.3). 44% of the population in the study regarding grey hair was also students (Table 4.38). This attributes to the prevalence of diseases affecting hair in the student community. In this competitive world, adhi (stress) is an important problem particularly students are facing and this leads to vitiation of vata. Vatakopa is one of the reasons for sirahkapalarogas. In Ayurvedic view, body heat caused by anger, grief and exertion along with pitta located in head, subjects the hairs to severe heating which results in grey hair. The above observation supports this. Ayurveda advices the observance of Achara rasayana. It is emphasized that one who is interested in maintaining good health should have a proper control of emotions, stress etc. The study shows incidence of alopecia areata and grey hair in student community, who are especially susceptible for emotional disturbances and stress. The percentage of manual labourers in both studies (alopecia areata and grey hair) were 15% and 13% respectively (Table 4.3 and 4.38 respectively). According to Vagbhata, atisweda is a causative factor for sirahkapalarogas. This produces vatapittakopa and also causes dirt accumulation in the scalp which results in hair diseases. 275

4 Among the manual labourers, sirahkapalarogas were mostly observed in cement workers and paint workers. Cement workers constituted 60% of the manual labourers those who were having alopecia areata (Table 4.4). Similarly, 61% of the sufferers of grey hair were also cement workers those who fall in the category of manual labourers (Table 4.39). This is due to the inhalation of the cement powder or its direct contact with the scalp which induced hair diseases in them. According to Vagbhata, rajoghrana produces kshavadhu which creates pratilomatva of vata and thus vatavaigunya occurs. In the study of alopecia areata, 27% of the sufferers from the category of manual labourers were paint workers (Table 4.4). In the study of grey hair, the percentage was 23 (Table 4.39). According to Vagbhata, asatmyagandha is a causative factor of sirahkapalarogas. This is one of the asatmendriyarthasamyoga mentioned in the Ayurvedic classics and it produces vatakopa. This attributes to the prevalence of diseases affecting hair in paint workers. In Ashtanga hridaya, it is mentioned that desaviparyaya (using water for head bath from different places) causes vitiation of doshas. This is applicable to those who change their place of residence. 14% of the patients having complaints of alopecia areata and 9% of the patients having complaints of grey hair were from Indians working in Gulf countries (Table 4.2 and 4.37 respectively). They were in the habit of bathing in desalted 276

5 water. This gives a corroborative evidence of the fact that desaviparyaya causes vitiation of doshas in turn leads to the formation of sirahkapalarogas. According to Vagbhata, purovata (exposure to direct wind) and wind blows from sea can produce vitiation of vatadosha. In both the studies, 46 % of the patients were from coastal areas (Table 4.2 and 4.37 respectively). This attributes to the prevalence of sirahkapalarogas in the people living in coastal areas. In the study, 70% of the patients having alopecia areata and 62% having grey hair were nonvegetarians (Table 4.7 and 4.42 respectively). Nonvegetarian dishes that contain more amount of lavana and katu rasa can lead to sirahkapalarogas. In this study, it was found that 27.33% of the patients having complaints of alopecia areata and 28% having grey hair were fond of food having lavana rasa (Table 4.9 and 4.44 respectively). In Ashtanga hridaya, it is mentioned that excess use of lavana causes vitiation of asra (blood), baldness and greying of hair. It is also mentioned in Charaka samhita that people who are accustomed to excessive use of salt suffer from premature baldness, grey hair and wrinkles in skin. According to Vagbhata, amla rasa and amla vipaka produce pittaprakopa (vitiation of pitta). In the study, 17.33% having alopecia areata and 14% having grey hair were fond of amla rasa (Table 4.9 and 4.44 respectively). Prevalence of alopecia areata and grey hair was seen in the users of excessive salt and sour in the present study. This 277

6 finding goes in accordance with the classical description regarding excessive use of salt and sour. In the study, 66% of patients having complaints of alopecia areata and 62% of patients with grey hair had disturbed sleep (Table 4.15 and 4.49 respectively). According to Vagbhata, jagarana (sleeplessness during night time) produces rukshata and as a result vatakopa sets in. In the study of grey hair, 29% of the patients were office staff (Table 4.38). Among them 50% of the patients were teachers. According to Vagbhata, uchabhashana (speaking loudly) produces sirogatavatakopa. The prevalence of grey hair among teachers can be attributed to their uchabhasana that leads to the vitiation of sirogatavata. It was also seen that the use of cosmetics like, soap, shampoo, hair cream etc. tend to cause alopecia areata and grey hair. 93% of the patients having alopecia areata and 94% having grey hair were in the habit of using one or the other cosmetic on head (Table 4.13 and 4.47 respectively). From this, it can be understood that the use of cosmetics is also a reason for alopecia areata and grey hair. Daily use of toilet soap for head bath could be attributed for the development of alopecia areata and grey hair in certain cases. In patients who were in the habit of using soap for head bath, reticular type of alopecia areata was observed (Fig. 4.1a). Figure 4.6 shows grey hair in a man aged 22 who was a daily user of hair creams. 278

7 The type of water used for bath has got importance in the causation of alopecia areata. It was observed that 45% of the patients were the users of bore-well water for bathing whereas 4% were the users of river water for bathing (Table 4.11). This shall be interpreted in two ways:- (i) nowadays majority of the population is not in the habit of taking bath in rivers, (ii) The inorganic materials present in the bore-well water cause hair loss reaching to alopecia. According to Vagbhata, mrijadwesha (not cleaning the head properly) leads to accumulation of dirt, sweat etc. which leads to vitiation of vata and pitta and promotes hair fall. The stagnant water in the ponds contains many organic waste materials that cause health problems to the scalp and hair. It is evident from the study that using stagnant water for bath is one of the causative factors of alopecia areata. During the course of cunical trial, 10 % of the patients with alopecia areata had previous history of dandruff (Table 4.18). From the analysis of the causative factors of the diseases of the scalp and hair, it is seen that the sirahkapalarogas are multifactorial and most of the factors have been mentioned in Ayurvedic classics. As 10% of the patients were having the previous history of dandruff, it is understood that dandruff is also one among the causes of alopecia areata. Figure 4.5 shows alopecia areata in the parietal region in a girl aged 16, who had a previous history of dandruff. 279

8 The investigator had conducted a pilot study in grey hair. In the pilot study, 10 school students having premature grey hair, between years of age were selected. On examination, 70% of the participants were anaemic. The investigator had prescribed medicines to correct anaemia, without the application of any medicated oil. After 3 months of treatment, 90% of grey hairs showed definite improvement in all the students. Thus from the pilot study, it was seen that anaemia is also an important factor associated with premature greying of hair. 280

9 5.1 Alopecia areata Discussion on treatment The treatment was aimed at 1. the reduction of the vitiated doshas. 2. the removal of srotorodha 3. the increase of the strength of dhatus and integrity of srotas 1. The reduction of the vitiated doshas The pathological process involved in the formation of the disease alopecia areata is mentioned as follows. The pitta which is located in the root of hairs (romakoopa) gets vitiated by various etiological factors causing pittakopa. This vitiated pitta along with vitiated vata causes the fauing of hair. Following this the vitiated kapha and rakta obstruct the minute channels of hair follicles (romakoopa) preventing further growth of hairs. Among the 5 types of pitta, bhrajaka pitta is responsible for the health and colour of skin and hairs. Skin is the seat of bhrajaka pitta. Arunadatta, the commentator of Ashtanga hridaya has described that bhrajaka pitta is named so because it performs deepana and pachana of medicines applied in the form 281

10 of abhyanga, lepa, parisheka etc. Dalhana states that it is located in avabhasini layer of skin. Here the pitta which is mentioned as 'romakoopanugapitta' is nothing but the bhrajaka pitta. The vitiated pitta (bhrajaka) can be pacified by using medicines both externally and internally. External applications such as lepana, parisheka etc. alleviate pitta. Medicine which is to be taken internally should be pittasamana (reducing pitta). 2. Removal of srotorodha In the disease alopecia areata, the dosha dooshya samoorchana is occurring at the root of hairs. Here the root of hairs is obstructed by vitiated kapha and rakta. So the treatment should be adequate enough to remove the srotorodha. Since the rodha is in the bahya srotases, the external applications like lekhana is enough for removing the srotorodha. In Ayurvedic classics, there are descriptions about treatment of hair diseases. The main treatment procedures described in the classical texts for alopecia areata are raktamokshana and lepana. Instead of raktamokshana, investigator adopted the procedure of rubbing due to its simplicity and less complications (using coarse triphala chooma taken as 'kizhi'). Moreover this procedure is patient friendly. The ingredients of triphala are hareetaki. 282

11 amalaki and vibheetaki. These drugs are having laghuruksha guna. Due to this property, triphala acts as channel clearing. It has kesya as well as vranaropana (wound healing) property. After rubbing, lepana was done (using durva mixed with honey) for healing the bleeding spots formed due to rubbing. Durva has the special property of wound healing and bleeding arresting. Durva having laghu guna acts as srotosodhana drug (removal of srotorodha). Before performing the above mentioned procedures, poorva karma was done. In Ayurvedic classics, it is mentioned that the denatured poison (dooshee visha) causes falling of hairs. When dooshee visha is located in pakwasaya, the individual will have symptoms of vata and pitta vitiation. This tends to the hairfall. The treatment of dooshee visha is purification (sodhana). In the treatment of alopecia areata and grey hair, purification is indicated. In the study, every patient was subjected to purificatory procedures before proceeding to the application of oils. From this, it is evident that both the purificatory procedures along with application of oils were of great use in alleviating alopecia areata and grey hair. Poorvakarma is the procedure to be adopted before performing any treatment in Ayurveda. It prepares the body and mind to become conducive to receive the treatment. The procedure as such and the therapeutic agents used for poorvakarma have a combined action. In the study, snehana was the poorvakarma and the agent was mahatikthaka ghrita. The ghee itself is the 283

12 drug of choice in the increase of pitta. The ghee processed with drugs having tikta rasa is capable of increasing asthidhatu. The changes taking place in asthidhatu will also influence the hair. Based on these facts, it was evident from the study that, snehana using mahatikthaka ghrita promotes the growth of hair in its natural colour. Snehapana with sneha (mahatikthaka ghrita) having pittasamana property was done till samyaksnigdha lakshanas were seen. After proper snehana, kayasodhana (virechanakarma) was done for the expulsion of utklista doshas. This was to increase the strength of dhatus and integrity of srotas. After the removal of lepa mentioned previously, the patients were advised to use the A-oil. The ingredients of A-oil are brhati, vibheetaki, bhringaraaja, yastimadhu and tila. In the disease alopecia areata, kapha and rakta get accumulated in the empty hair follicle and thus produce rodha of romakoopa. So regeneration of hair from the follicle does not occur. According to Ayurveda the action of a drug or combination is generally attributed to its rasa, guna, veerya, vipaka and prabhava. Among these, veerya and guna are of prime importance especially in the case of drugs used for external appucation. Hence it is useful to analyze the properties of each ingredient of the combination. Brhati is having laghuruksha guna and ushna veerya. Drugs with these properties can act as srotosodhana (channel clearing). Moreover due to its 284

13 kaphavatasamana property, it prevents hair fall. Vibheetaki is also having laghuniksha guna and ushnaveerya. So it is channel clearing. It promotes hair growth due to its kaphapitta samana and kesya property. Bhringaraaja is known to therapeutics since very early times. Ayurvedic classics delineate bhringaraaja for its cosmetic as well as medicinal value. It is considered highly beneficial for hair, in fact, the Sanskrit name bhringaraaja means a plant that makes hair black and shining like a bumble bee. Moreover, due to its laghuniksha guna and ushna veerya, it is channel clearing. It mitigates deranged kapha and pitta and promotes hair growth. Yasti is having gurusnigdha guna and sheeta veerya. In alopecia areata, in the first stage, the vitiated pitta along with vata causes hair fall. Since yasti is a pittavata samana drug, it prevents hair fall. Its kesya property is also mentioned in Ayurvedic classics. The til oil (from seeds) is used as a base oil for floral oils and many perfumed oils meant for the hair. It mitigates vata and pitta and has kesya property. The samyoga guna (combined effect) of the above mentioned drugs used in A-oil preparation makes it a potential remedy for alopecia areata. Hence it was appropriate to choose these drugs for the preparation of A-oil. 285

14 Discussion on results The present investigation over a period of six years across 300 cases of alopecia areata was instrumental in consolidating enormous data and deriving dependable conclusions. Primary attempt was to find out an effective medicine for alopecia areata. For validation and substantiation in terms of evidence base, malatyadi taila (used for treatment of alopecia areata) mentioned in authentic texts was compared with the specific oil (A-oil) prepared by the investigator. The parameters and scales used for diagnosis of alopecia areata and assessment of improvement were fixed to the following entries. Diagnostic criteria The circumscribed patches of complete alopecia, without scarring, are easily recognized. The primary patch, which may appear anywhere but is usually on the scalp, is circumscribed and clearly defined, and often round or oval in shape. Characteristically, the skin is smooth, soft and ivory-white and totally devoid of hair. Increase in number of hairs The increase in number of hairs is counted by using a special device (a special device is that by which one can count hairs in 50 mm area) and with the help of a magnifying lens. The average number of hairs per 50 mm^ 286

15 area (from all affected areas) were recorded. Monthly follow up was carried out till six months. In a healthy individual, the average density is 1000 hairs per square inch and this leads to about hairs on the average head. From this data it is found that 80 hairs are there in 50mm^ area. In the present study it is considered that 75% and above hair growth as improvement for assessment purpose, that is, 60 hairs or more after 6 months of treatment. A comparative study of increase in number of hairs after one month and after each consecutive month for a period of 6 months is shown in graph 5.1. Graph 5.1 Comparison of increase in number of hairs after one month and after each consecutive month 1 St and 2nd 1 st and 3rd 1 st and 4th 1 st and 5th 1 st and 6th Period in months every month. From this data it is clear that the number of hairs was increasing in 287

16 The rate of increase in number of hairs in each month is shown in graph 5.2. Graph 5.2 Rate of increase in number of hairs in each month From this data it is seen that the rate of increase in number of hairs was almost the same. 288

17 A comparative study of increase in number of hairs after one month and after each consecutive month between trial group and control group is shown in graph 5.3. Graph 5.3 Comparison of increase in number of hairs after one month and after each consecutive month between trial group (TG) and control group (CG) TG CG m I st and 2nd 1st and 3rd 1st and 4th 1st and 5th 1st and 6th Period in months 289

18 The rate of increase in number of hairs per month is compared between trial group and control group and is shown in graph 5.4. Graph 5.4 Comparison of rate of increase in number of hairs per month between trial group (TG) and control group (CG) e «"5 k 2 E 3 C i S u s s & fi 4? 0 2nd 3rd 4th 5th 6th Period in months TG CG significant. Since p < in all the cases, the increase in number of hairs is 290

19 The percentage of improvement in number of hair in trial group was 80% (120 out of 150) and that of control group was 42% (63 out of 150) which is shown in graph 5.5. Graph 5.5 Result of treatment after six months (increase in number of hairs) I Improved I Not improved «5 c «o Q. Trial group Group Control group 291

20 In the case of increase in the number of hairs, females showed shghtly more improvement than males. This improvement can be attributed to the particular hair care methods usually adopted by the females. The improvement is shown in graph 5.6. Graph 5.6 Effect of treatment based on sex difterence I Female I Male 0) 3 c Q. Improved Not improved Improvement Hair growth in length The length of hairs was measured using a scale. The average of length of hairs per 50mm-^ area (from various parts of affected areas) was recorded. Monthly follow up was carried out. 292

21 In a healthy individual the average rate of growth of hair per month is 1.5 cm. Here the investigator considered a growth of 70% and above of normal length (9 cm) as improvement for the purpose of assessment, that is, 6 cm or more growth after 6 months of treatment. A comparative study of hair growth in length after one month and after each consecutive month is shown in graph 5.7. Graph 5.7 Comparison of hair growth in length after one month and after each consecutive month 1 St and 2nd 1 st and 3rd 1 st and 4th 1 st and 5th 1 st and 6th Period in months every month. From this data, it is clear that the length of hairs was increasing in 293

22 graph 5.8. The rate of growth of hair in length in each month is shown in Table 5.8 Rate of hair growth in length in each month E u 'a c E 1 ^ O) i- H «- O 0) *< (0 a nd 3rd 4th 5th Period in months 6th The assessment from this data is that the rate of hair growth in length per month was almost the same. 294

23 A comparative study of hair growth in length after one month and after each consecutive month between trial group and control group is shown in graph 5.9. Graph 5.9 Comparison of hair growth in length after one month and after each consecutive month between trial group (TG) and control group (CG) 6 TG CG 4 c i 3 a» c o 2 1 St and 2nd 1 st and 3rd 1 st and 4th 1 st and 5th 1 st and 6th Period in months 295

24 The rate of growth of hair in length per month is compared between trial group and control group and is shown in graph Table 5.10 Comparison of rate of hair growth in length per month between trial group (TG) and control group (CG) n nd 3rd 4th 5th 6th TG CG Period in months significant. Since p < in all the cases, the growth of hair in length is 296

25 Percentage of improvement in length of hair in the trial group was 78% (117 out of 150) and that of control group was 38% ( 57 out of 150). This is represented in graph Graph 5.11 Result of treatment after six months (hair growth in length) 5 c a> o w a> Trial group Group Control group I Improved I Not improved 297

26 In the case of hair growth in length also, females showed more improvement than males and is shown in graph This is attributed to the particular hair care methods adopted by females. Graph 5.12 Effect of treatment based on sex difference I Female I Male 0) u> S c u o a. Improved Not improved Improvement One of the main factors associated with the cure of alopecia areata is the age of the patient. In the clinical study of alopecia areata, among the patients who have shown increase in the number of hairs, 85% were in the age group and 15% were in the age group Among the patients who have shown improvement in length of hair, 78.63% were in the age group and remaining (21.37%) in the age group From this data it is evident that the treatment for alopecia areata is more effective in youngsters. 298

27 A Case report A male patient aged 23, Mr. X, who was a taxi driver, presented with complaint of loss of hair in a patch, over the side of scalp (Fig. 5.1). It was first noticed by his barber one month back. There was no associated pain, itching or any loss of sensation at that site. Initially it was small and later it had attained the size of a 50 paise coin. One month back when he first noticed the lesion, he had taken Allopathic medicine for 20 days, but there was no relief. He had a past history of dandruff one year back and was relieved completely by taking Ayurvedic medicine. He had no addictions. He had disturbed sleep. Appetite was normal. Bowel and bladder habits were normal. He used to wash hair with soap in every morning during bath. He was not in the habit of using any hair oil. There was no history of similar illness in his family. He was a non-vegetarian and was fond of lavana and katu rasas. On examination, the investigator found a round patch of loss of hair with 2 cm diameter in the parietal region of scalp. It was circumscribed and clearly defined. The skin was smooth, soft and ivory-white and totally devoid of hair. No abnormal colour or pigmentation of the site was noticed. On examination, his pulse rate was 74/minute, regular in rhythm and normal in volume and temperature was afebrile. All routine investigations of blood and urine were done and no abnormality was detected. 299

28 The case was diagnosed as alopecia areata and was given treatment in the following manner. The patient was given mahatikthaka ghrita 20 gms twice daily for snehana for 7 days. Virechana was performed on the 8th day. Avipathi chooma was used for virechanakarma. On the next day onwards, the affected area was cleaned with a piece of sterile cotton wool and rubbed with coarse triphala chooma taken as kizhi. The rubbing was continued till small bleeding spots were appeared. The part was wiped with sterile cotton and durva lepa mixed with honey was applied over the area and was left for one hour. This procedure was done in the morning and in the evening and was continued for 2 days. The patient was asked to avoid head bath during these two days. The lepa was removed and the area was wiped with sterile cotton after each application. The third day onwards the patient was advised to use A-oil on the affected area one hour before bath early in the morning. The improvement was assessed on the basis of the increase in number and length of the hair in every month after starting treatment, and the study was carried out for a period of 6 months. In this patient after 6 months of treatment, the average number of hairs in 50mm^ area was 70 and the average length of hair was 7.5cm. 300

29 LOSS OF HAIR IN CIRCUMSCRIBED PATCH IN THE PARIETAL REGION IN A MAN AGED 23 Fig. 5.1(a): Before treatment Fig. 5.1(b): After 6 months of treatment

30 5.2 Grey hair Discussion on treatment The main treatment procedures described in the classical texts for grey hair are:- In the beginning the patient should be given elimination therapies (emetic, purgation etc.) and thereafter be given inhalation therapy (nasya karma) with medicated oil and application of oil on scalp. In grey hair, all the three doshas are vitiated with the predominance of the vitiation of pitta. Hence the investigator selected pitta samana drugs and other pitta alleviating procedures. Snehana using mahatikthaka ghrita was done. Mahatikthaka ghrita is having pitta samana action. Hair is the mala of asthidhatu. The increase in asthidhatu will naturally increase the hair. The ghee prepared out of drugs having bitter taste is the ideal choice in hair diseases. Mahatikthaka ghrita is effective in hair diseases in two ways, (i) It is a preparation chiefly containing bitter drugs those alleviate pitta, (ii) Ghee is the most suitable agent that reduces pitta and vata. Due to these qualities, mahatikthaka ghrita was effective in alopecia areata and grey hair. After proper snehana, kayasodhana (virechanakarma using avipathi chooma) was done for the expulsion of utklista doshas. Among the sodhana therapy, virechana is specific for pitta rogas. Avipathi chooma is indicated in the treatment of pitta rogas. Hence the importance of virechana with avipathi chooma in pitta rogas is clear from the above reasoning. Thereafter nasya karma using anutaila was 301

31 done. It is used as pratimarsa nasya. It is stated in the classics that nasyakarma with anutaila especially strengthens the sense organs, improves the health of the hair, skin and throat, is nourishing and mitigates all the three doshas. Nasya using anutaila is capable of clearing the channels of circulation (srotas). Pratimarsa nasya as a procedure itself is capable of preventing greying. Anutaila is indicated in the treatment of grey hair. Hence nasya using anutaila is helpful in alleviating grey hair in a dual manner viz., preventive and curative. Both the medicine and the procedure chosen are highly suitable in clearing the channels. According to Ayurveda, srotorodha is one of the chief factors in the formation of diseases. Grey hair is no way an exception to this. Nasya using anutaila, by clearing the channels was capable of alleviating grey hair. From this it can also be understood that nasya with anutaila is capable of changing the colour of the hair. After the nasyakarma, the patients were advised to apply the specific oil (G-oil) on the scalp and hair. The ingredients of G-oil are neeli, musta, japa, lohachooma, khadira, and tila. In grey hair, all the three doshas are vitiated with the predominance of vitiation of pitta. While analyzing the pharmacological properties of each ingredient of G-oil, it is seen that neeli is a well known kesaranjana drug mentioned in Ayurvedic classics. It is useful for promoting the growth of hair and also for colouring the hair. It is an ingredient in many kesaranjana hair oils. Mustaka is having laghuruksha guna and sheeta veerya. It mitigates kapha and pitta. It is a colouring agent as well as a promoter of hair growth. 302

32 Studies conducted in the methanolic extracts of musta showed that it can stimulate the production of melanin in cultured melanocytes (Sastry, J.L.N: Vol. 2, 2005). Japa is having sheetaveerya. It is good for hairs and mitigates kapha and vata. In Chinese medicine also, japa petals are used for the preparation of hair dyes. Iron powder is cold in potency and is pittasamana. In Ayurvedic classics, iron powder is mentioned in many kesaranjana preparations viz., it is mentioned in Chakradatta that one who takes bath after applying the paste of iron-slag, amalaki and japa flowers becomes free from greying of hairs like one bathing in ganga from hell. Khadira is sheeta in veerya and mitigates pitta. It is a colouring agent mentioned in Ayurvedic classics. Tila is kesya as well as kesaranjana. The oil (from seeds) is used as a base oil for floral oils and many perfumed oils meant for the hair. The combined effect of all these drugs used in G-oil makes it an excellent preparation useful in grey hair. In the preparation of G-oil choice of these drugs was appropriate. According to Ayurveda, abhyanga should be practiced as routine especially on head. A-oil and G-oil used in the study contain drugs having different therapeutic properties. Abhyanga as a procedure itself promotes the health of hair. Because of the therapeutic agents in the oils used in the study, the combined effect of the procedure and the agents together was capable of influencing the growth of healthy black hair. Siroabhyanga has got a cumulative effect also on hair growth as this procedure is done daily. 303

33 Discussion on results The present investigation took a period 6 years to scrutinize over 300 cases of grey hair and compile enormous data thereof. To find out an effective medicine was a matter of primary concern in the research expedition. A standard Ayurvedic medicine (prapaundarikadya taila) was fruitfully compared with the specific oil (G-oil) prepared by the investigator on account of the evidences collected and consolidated. The number of grey hairs per 50nmi^ area was counted by using the special device and with the help of a magnifying lens. During the course of the study, the investigator could find that the change in colour occurred in a sequential manner from grey - fade - brownishblack - black. But there were individual variations. The improvement was assessed based on the changes in colour in every 3 months after starting treatment and the study was carried out for a period of 9 months. The percentage of various hair colours shown by patients after each consecutive 3 months is shown in graph 5.13, 5.14 and 5.15 respectively. 304

34 Graph 5.13 After 3 months TG CG 0) O) 3 c «o 0) Q. Grey Fade Brownish black Colour of hair Black Graph 5.14 After 6 months ITG ICG a> c o a> Q. Grey Fade Brownish black Colour of hair Black 305

35 Graph 5.15 After 9 months 80 n 70 TG 1 BCG 60 a> o> J2 c 0) a iw 10 n vh Grey Fade Brownish Black black Colour of hair 75% of the grey hair becoming brownish black was the criteria for the assessment of improvement. This assessment is based on the fact that in a person with grey hair, unless 75% of the hairs are changed into brownish black from grey colour, there will not be any visible change in the appearance of his hairs with respect to its colour. 306

36 After 3 months, 18% of the patients of trial group has shown improvement. But at the same time none of the patients in control group has shown improvement. This inference is shown in graph Graph 5.16 Result of treatment after 3 months Improved Not improved Trial group Group Control group 307

37 After 6 months, 70% of the patients of trial group has shown improvement but none of them in the control group has shown improvement. This is represented in graph Graph 5.17 Result of treatment after 6 months 100n ) I 60 g 50» i ^ ^.^H 1 ^ ^ " '"' HI Trial group Group Control group I Improved i Not improved 308

38 After 9 months, 84% of the trial group patients and 24% of the control group patients have shown improvement. This is shown in graph Graph 5.18 Result of treatment after 9 months «o> 5 c «u 0) Trial group Group Control group I Improved I Not improved Since p < in all the cases, there is significant difference. 309

39 In the clinical study of grey hair, males showed more improvement than females and this is shown in graph Graph 5.19 Effect of treatment based on sex difference 70 I Improved I Not improved O) S 30 Female Sex Male In the clinical study of grey hair, the number of patients who have shown improvement is 126 out of 150 in the trial group. Among the 126 patients, 110 were in the age group and 16 were in the age group In the control group, the number of patients who have shown improvement is 36 out of 150. Among the 36 patients, 26 were in the age group and 10 were in the age group

40 A Case report A male patient aged 24, Mr. G., who was a cement worker, presented with complaint of greying of hairs since one year (Fig. 5.2). He belonged to a lower middle class family. He had used medicated Ayurvedic hair oils since then. But there was no improvement. He had no history of any past illness and no family history of premature greying of hair. He was a non-vegetarian and preferred food with katu, amla and lavana rasas. He had sound sleep and his appetite was normal. He had no addictions. He was not in the habit of using any hair oil. He used to take bath at night. He used soap for head bath on alternate days. He belonged to pitta prakruti. On examination, his pulse rate was 80/minute, regular in rhythm and normal in volume. On local examination of scalp, grey hairs were seen in the frontoparietal region. All routine investigations of blood including thyroid function test were done and were found to be within normal limits. He was advised to use caps whenever he goes for job, as chemicals in the cement powder is a trigger factor for greying. Grey hairs in 50mm^ area were counted by using the special device and with the help of a magnifying lens. 311

41 The total number of grey hairs per 50mm area was 30 before starting treatment. He was given mahatikthaka ghrita 20 gms twice daily for snehana for 7 days. Virechana was performed on the 8th day. Avipathi chooma in a dose of logms was used for virechanakarma. On the 9th day onwards, pratimarsa nasya using anutaila was done. It was continued for a period of 7 days. After that, the next day onwards, he was advised to apply the specific oil (G-oil) on the scalp and hair daily an hour before bath. The improvement was assessed based on the changes in colour in every 3 months after starting treatment and the study was carried out for a period of 9 months. In this patient after 9 months of treatment, out of the 30 grey hairs in a particular area, 26 hairs turned to black colour. 86% of initial number of grey hairs showed definite improvement. 312

42 GREY HAIR IN THE FRONTOPARIETAL REGION IN A MAN AGED 24 Fig. 5.2(a): Before treatment Fig. 5.2(b): After 3 months of treatment ;. 5.2(c): After 6 months of treatment Fig. 5.2(d): After 9 months of treatment

43 Swasthavritta mentioned in Ayurveda as one of its fundamental principles is relevant even today. Regimen like siroabhyanga, bathing, nasya etc. have been given importance in swasthavritta. From the study it was seen that observance of swasthavritta regimen is also a factor which promoted the growth of healthy black hair. The preceeding discussion is a supporting evidence to the fact that the recommended method is undoubtedly superior to the traditional hair care management. Drawing out definite conclusion that is perceptibly related was made feasible by the outcome of this study. 313

44 CONCLUSION Research is the scientific and diligent study of investigations or experimentations in order to establish facts and analyse their significance. The present studies were conducted to evaluate the efficacy of certain Ayurvedic drugs on baldness and grey hair. Based on the clinical studies done, the following conclusions can be drawn. (a) The efficacy of A-oil in alopecia areata treatment and G-oil in grey hair treatment was validated. These specific oils prepared by the investigator were found to be more effective than conventional Ayurvedic medicines (Moil and P-oil) for alopecia areata and grey hair treatment. (b) In the diagnosis and assessment of progressive stages, the highly reliable tool was the special device. The most important evidence of improvement in treatment was the photographs taken. (c) It is a fact that routine life style including food habits is a causative factor for alopecia areata and grey hair. Before starting treatment, the physician instructed the patients to change the life style which is a causative factor for the above mentioned diseases. This change in the lifestyle increased the pace of attaining improvement. (d) One of the major findings from the study is that previous history of dandruff is one among the major reason for the occurrence of alopecia areata. 314

45 The findings from the studies conclude that the efficacy of specific oils prepared by the investigator are valid. These oils are cost effective. If these oils are popularized, it will be more beneficial to the society since these diseases are very common nowadays. 315