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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Case report
Full Version
Management of Vyanga (Melasma) with Vyanganashak Lepa: A Case Report
Correspondence Address :
Dr. Mrunal Sunil Bole,
Postgraduate Scholar, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Salod (Hirapur), Sawangi, Wardha-442107, Maharashtra, India.
E-mail: bolemrunal02@gmail.com
Melasma is a widespread acquired symmetrical hypermelanosis characterised by irregularly shaped but clearly defined dark brownish maculae on photo-exposed areas, particularly the forehead, temples, nose, eyelids, chin, and upper lips. It is a major cosmetological issue that can also affect a person’s psychological well being. Melasma can be correlated with Vyanga in Ayurveda. Vyanga is one of many Kshudra Rogas and Raktapradoshaj Vikaras. According to modern medicine, local application of corticosteroids is preferred for the management of melasma. However, due to the relapse of the disease and the side effects of steroids, an Ayurvedic approach is beneficial. Ayurveda mentions Shaman Chikitsa in the form of Lepa, which has Vatapittahara, Varnya, Twachya, Kushthaghna, and Raktaprasadaka properties as the line of treatment. Hereby, the authors present a case report of a 46-year-old female who reported to the Outpatient Department (OPD) of Kayachikitsa, complained of brownish discolouration on her face for six months, which was diagnosed as Vyanga (melasma). Ayurvedic treatment was planned according to the classical principle of Shaman Chikitsa, with a local application of Lepa containing depigmenting and skin rejuvenating drugs, along with lifestyle modifications. Due to the recurring nature of the disease, a proficient treatment approach was required. Vyanganashak Lepa has skin resurfacing and revitalising properties that act efficiently on the disease. In present case, Vyanganashak Lepa was found to be highly effective and showed remarkable results with continuous usage in a short period.
Hyperpigmentation, Kshudrakushtha, Rakta pradoshaja vikara, Twachya
A 46-year-old female patient presented to the Outpatient Department (OPD) of Kayachikitsa with chief complaints of prominent, moderately dark brownish hyperpigmented lesions on her bilateral cheeks, nose, forehead, and chin for the past six months. The condition was associated with occasional itching at the sites. The patient was pre-menopausal and had experienced prolonged and irregular menstrual cycles. She was also a known case of hypertension for three years and was on regular medication. There was no family history of any skin disease. The lesions gradually increased in size and darkened in colour. She was stressed due to cosmetic concerns and therefore requested immediate intervention.
On dermatological examination, there were moderately dark brown lesions on the bilateral malar region, nose, forehead, and chin, which were symmetrically distributed, irregular in shape, but clearly defined, leading to the diagnosis of Vyanga (Melasma) (Table/Fig 1).
The elements of pathogenesis (Samprapti Ghatak) that explain the manifestation of the disease are as follows:
Dosha: Vata (Udaana), Pitta (Bharajaka)
Dushya: Rasa, Rakta
Adhishthana: Mukhagata Twaka (bilateral cheeks, nose, forehead, and chin)
Vyadhi Marga: Bahya
Srotasa: Rasavaha, Raktavaha
Strotodushti: Vimargagamana
Doshagati: Tiryaka, Vriddhi
Agni: Vishamagni
Sadhya-Asadhyata: Sadhya
Swabhava: Chirkari
According to arbitrary grading on the symptom-Shyavata (Table/Fig 2) and assessment of grading and severity of lesions (Table/Fig 3), it was observed that the patient had a moderate dark brown lesion on the face with a score of 3 and Grade 3 (severe) (1).
The treatment was initiated by making a thick paste of Vyanganashak Lepa (Table/Fig 4). This Lepa was applied locally to the face daily and scrubbed off with cold water after 20 minutes for 30 days. Along with this, lifestyle modifications and an exercise regimen were advised. Dietary modifications included restrictions on spicy foods, hot garlic, masalas, chillies, excessive salty and sour food items, pickles, fried items, fermented foods, and yogurt. The patient was advised to consume green gram khichdi, seasonal fruits, and foods with less oil and salt. In addition to the dietary changes, the patient was encouraged to practice Pranayama early in the morning.
After 15 days, during the first follow-up, the scoring reduced to two, with light dark brown lesions on the face and Grade 2 (moderate). After 30 days of treatment, the scoring decreased to one, with faint dark brown lesions on the face and Grade 1 (mild) (Table/Fig 5).
Vyanga is one of many Kshudra Rogas and Raktapradoshaj Vikaras (2),(3). It is a significant cosmetological issue that can also affect a person’s psychological well being. Vyanga can be correlated with melasma in modern medicine. According to Ayurveda, Shoka (sadness), Krodha (anger), and Ayasa (fatigue) are the causative factors of Vyanga (4). As per modern science, ultraviolet rays and stress lead to the majority of cases of melasma. Vagbhattacharya explained that vitiated Pitta and Vata generate Mandalas of Shyava Varna on the face, known as Vyanga (5). Acharya Sushrut explained that Vyanga is a skin disease in which Vata and Pitta are aggravated by Shoka (sadness), Krodham (anger), and Ayasa (fatigue), which ultimately leads to sthanasamshraya (accumulation) in the Mukhapradesha (face) and produces patches that are Tanu, Shyava, and Niruj (6). Melanocytes produce melanin, and the transfer of melanosomes to nearby keratinocytes results in cutaneous pigmentation (7). Melanosomes differ in number and size in different individuals, while the number of melanocytes remains the same.
Melasma is a widespread acquired condition characterised by symmetrical hypermelanosis, presenting as irregularly shaped but clearly defined dark brownish macules on photo-exposed areas, particularly the forehead, temples, nose, eyelids, chin, and upper lips. The two types of treatments (Chikitsa) used in Ayurvedic treatment for Vyanga are Shodhana and Shamana. Various treatments such as Lepa (external application), Siravyadha (bloodletting), Abhyanga (oil massage), Nasya (nasal therapy), Pana (drinking), Vamana (emesis), Virechana (purgation), and Udwartana (powder massage) are mentioned (8).
Lepa is regarded as one of the easiest and most efficient methods among these treatments. Panigrahi M et al., conducted a study on Vyanga and provided Mukhakantivardhaka Lepa, which is already mentioned in the Sharangdhar Samhita (9). Lekshmi AG et al., also highlighted the use of Lepa for the management of melasma, noting that its use is well-documented in classical texts. The incorporation of manjishtha in Lepa is well known due to its Twakprasadak (skin-enhancing) properties (10). In present study, manjishtha churna is used in combination with other effective drugs to accelerate the results in such severe cases. Kumari D et al., mentioned the use of Jatiphala churna along with milk, which aligns with present study, as it possesses properties that help scrape away the rough, dark patches of melasma (11).
When multiple drugs with such remarkable properties are used together, significant changes can be observed in a short time span, as demonstrated in this case study.
Several Lepas, such as Varnya Gana Lepa mentioned in the Charak Samhita (12), Manjishthadi Lepa (13), and Jatiphala Churna Lepa (14), are referenced in classical texts, with many studies conducted on them. Some Lepas provide temporary relief. However, in present case, after addressing and understanding the foundations of Ayurvedic classics, a combination of new formulations was created to treat the underlying root causes and eliminate the recurrence of the disease.
The formulation includes easily available ingredients found at home, such as red lentils, which have significant results when used in a specific manner. Each ingredient has a contributing action towards treating pigmentation and revitalising the skin. By combining commonly available drugs with classically mentioned Varnya and Kushthaghna drugs, a beneficial outcome is achieved.
Along with the Lepa, lifestyle modifications were advised, including practicing Pranayama early in the morning, which reduced stress and simultaneously addressed the root cause of the disease. The patient was advised to follow a healthy diet regimen and to perform Pranayama and exercises (15). The patient was instructed to apply the Lepa daily for 30 days. The ingredients of the Lepa (face pack) each possess different properties that have a combined effect on skin rejuvenation and depigmentation.
Masoor Dal (Red Lentils), being the main ingredient, has exfoliating properties and helps to remove blackheads. It has a bleaching effect that makes the skin lighter and more toned. Additionally, it removes tan, fine lines, blemishes, and dark spots (16). Manjishtha (Rubia cordifolia) is known for its blood-purifying (Raktashodhak), anti-inflammatory (Shothahara), wound-healing (Vranaropaka), and skin disease-fighting (Kushtaghna) properties. It balances Kapha and Pitta shamaka, acts as an antihelminthic (Krimighna), and enhances metabolism (Deepana) and digestion (Pachana) (17).
Yashtimadhu (Glycyrrhiza glabra) acts as a heat pacifier, analgesic, and anti-inflammatory agent. It is also beautifying (Varnya), alleviates itching (Kandughna), rejuvenates, and balances skin doshas (Tvacha Doshahara). Due to its unctuous nature, it pacifies Vata, and because of its sweet and cooling properties (Madhura Sheeta Guna), it pacifies vitiated Pitta (18).
Rakta Chandan (Pterocarpus santalinus) has blood-purifying (Raktashodhaka), heat-pacifying (Dahashamaka), Kapha-pittashamaka balancing, anti-inflammatory (Shothahara), antihelminthic (Krimighna), beautifying (Varnya), and skin-dosh balancing (Twakdoshahara) properties (19). Jatiphala Churna (Myristica fragrans) possesses exfoliating properties that help in the formation of new, fresh, healthy skin by removing unhealthy layers (20),(21).
Kumkumadi Taila reduces pigmentation and brightens the skin. This oil contains compounds that modify immunological and melanocyte activity, leading to reduced hyperpigmentation. It works against inflammation, hyperpigmentation, and free radicals, likely reducing the amount of melanin pigment released (22).
Rose water balances Vata and Pitta doshas. It acts like an elixir by maintaining skin tone, cleansing and nourishing the skin, subduing blemishes and dark spots, and functioning as an exfoliant. It also has anti-aging and antioxidant properties (23).
A significant portion of the medications used in the Lepa (paste) have Vata-Pitta pacifying properties, which favour the effective treatment of the condition. The ingredients of the Lepa are recommended to be used with raw cow milk, which also helps calm vitiated Pitta and Vata. Local application and lifestyle modifications showed significant results after 30 days of treatment in this case. The patient was later followed up for recurrence. After 30 days of treatment, local application of only Kumkumadi Taila was advised to avoid relapse and maintain the results.
Vyanga is not only a cosmetic concern but also a physiological skin disease. Various treatment options are available for its management, but the recurring nature of the disease is notable. Therefore, if the root cause of the disease is not targeted, it may relapse. Vyanganashak Lepa has depigmenting and skin rejuvenating properties; hence, it is considered highly effective and has shown remarkable results with continuous use in a short period for the management of melasma.
DOI: 10.7860/JCDR/2024/71441.20278
Date of Submission: Apr 23, 2024
Date of Peer Review: May 24, 2024
Date of Acceptance: Aug 22, 2024
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 24, 2024
• Manual Googling: May 27, 2024
• iThenticate Software: Aug 21, 2024 (4%)
ETYMOLOGY: Author Origin
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