Therapeutic Role of AMV (Arjuna, Manjshtha and Vasa) Lepa and Panchanimbadi Churna in the Ayurvedic Management of Melasma: A Case Study
Therapeutic Role of AMV (Arjuna, Manjishtha and Vasa) Lepa and Panchanimbadi Churna in the Ayurvedic Management of Melasma: A Case Study
Authors: 1. Dr. Sabahat Anjum, PG Scholar
2. Dr. Shalini Varshney, Associate Professor
Affiliations: Department of Dravyaguna, A and U Tibbia College, Karol Bagh, Delhi 110005
Corresponding Author:
Name: Dr. Sabahat Anjum
Email: dranjum.sabahat17@gmail.com
Mobile:8376954818
Type of article: Case report
Running Title: Ayurvedic Case Report on Melasma Treatment
Conflict of Interest: None declared.
Funding: No external funding received.
Acknowledgement: We thank A and U Tibbia College for their academic support.
Abstract
Background
Melasma is an acquired pigmentary disorder presenting as asymptomatic, brownish macular lesions primarily affecting facial areas such as the cheeks, forehead, nose, and upper lip. Conventional management, including laser and topical corticosteroids, may incur cost and potential adverse effects. In Ayurveda, Melasma closely correspond to Vyanga, described under Kshudraroga (minor ailments) and is commonly treated with Lepa (external medicated applications).
Objective:
To evaluate the therapeutic efficacy of topical AMV (Arjuna, Manjishtha, Vasa) Lepa and oral administration of Panchanimbadi Churna in the management of melasma.
Case Presentation:
A 40-year-old female patient presented with chronic facial hyperpigmentation persisting for three years, unresponsive to standard topical therapies. No significant sun exposure or family history of pigmentary disorders was reported. Treatment included topical application of AMV Lepa and oral administration of Panchanimbadi Churna for 60 days.
Methods:
AMV Lepa, prepared by mixing AMV powder with honey, was applied topically twice daily in a uniform layer approximately 0.5 cm thick and removed before complete drying, while Panchanimbadi Churna was administered orally. Treatment response was evaluated using subjective clinical parameters of Vyanga including Mandalam Visṛjati (no. of circular lesions), Niruja Tanuka (painless thin lesions), and Shyava (degree of discoloration) along with objective assessment using the Melasma Area and Severity Index (MASI).
Results:
After 60 days, Mandalam Visṛjati reduced from 4 to 1, Niruja Tanuka from 3 to 1, and Shyava from 4 to 1, while the MASI score from 15.7 to 3.6. No treatment-related adverse effects were observed.
Conclusion:
Topical application of AMV Lepa and oral intake of Panchanimbadi Churna significantly reduced pigmentation and improved melasma, indicating a safe and cost-effective Ayurvedic interventions, warranting further validation through larger, controlled studies.
Keywords: Arjuna, Manjsjtha, Melasma, Panchnimbadi churna, Vyanga.
Introduction
Beauty holds considerable socio-medical relevance, increasingly impacted by environmental pollutants and faulty lifestyle practices, leading to rising demand for cosmetic enhancement and associated skin health challenges. Melasma is an acquired disorder of symmetric facial hyperpigmentation, typically involving the malar cheeks and forehead, and it disproportionately affects women and is aggravated by factors such as pollution-induced oxidative stress, ultraviolet radiation, and chronic corticosteroid use.[1] In modern dermatological practice, topical corticosteroids are frequently included as part of combination therapy for melasma.[2] Concurrently with these medical approaches, the cosmetology industry has expanded rapidly to meet consumer demand for aesthetic enhancement. While cosmetic products are widely used for skin protection and appearance improvement, excessive or inconsistent application may compromise natural aesthetics. Unlike therapeutic agents, cosmetics are primarily intended to enhance or maintain appearance rather than cure dermatological conditions.[3] In Ayurveda, melasma is correlated with Vyanga, classified under Kshudraroga, and is managed through herbal interventions such as medicated oils, topical Lepa applications,[4] and procedures like Raktamokshana (bloodletting) to enhance skin complexion and texture.[5] Ayurvedic interventions for skin disorders often utilize drugs characterized by Kusthaghna ( alleviate skin disorder), Kandughna (relieves itching), Raktashodhaka (purifies blood), Tvaka-Prasadaka (improves skin tone), and Varnyakara (complexion-enhancing) attributes. Classical references indicate that Arjuna, Manjishtha and Vasa lepa is useful in treating Vyanga,[6] so the present study employed AMV Lepa with honey for external application alongside internal administration of Panchanimbadi Churna.[7] These formulations are widely accessible and cost efficient.
Materials and Methods
A single-case study was conducted, with prior informed consent obtained from the patient. Treatment outcomes were assessed using subjective and objective parameters. The intervention consists of daily application of AMV Lepa and oral administration of Panchanimbadi Churna 2g twice daily with lukewarm water for 60 days.
Case Presentation
A 40-year-old female attended the Ekal Dravya OPD at A & U Tibbia College, Karol Bagh, Delhi, reporting persistent facial hyperpigmentation for three years, without pain or itching.
History of Present Illness:
The patient was apparently healthy until three years ago. As a working woman with frequent sun exposure, she initially developed hyperpigmented patches (Vyanga) on both cheeks, which gradually extended to the nose, forehead, and chin. She had previously sought treatment through other medical systems without significant improvement and subsequently presented to the Ekal dravya outpatient department seeking Ayurvedic management.
Past History:
No significant medical history was reported.
Clinical Examination
Bilateral thin, brownish hyperpigmented patches were observed on the malar regions, forehead, and nasal bridge, without associated pain or pruritus.
Personal History:
- Name: XYZ
- Age: 40 years
- Gender: Female
- Marital Status: Married
- Occupation: Anganwadi worker
- Religion: Muslim
- Diet: Samishra (Mixed)
- Appetite: Normal
- Sleep: Disturbed
- Bowel Habits: Constipation
- Micturition: Normal
- Habits: None reported
- Mental Status: Stress noted
- Height: 157 cm
- Weight: 72 kg
- Blood Pressure: 124/78 mm Hg
- Prakruti: Pitta-Kapha
Ashta Vidha Pareeksha:
- Nadi (Pulse): 78/min
- Mutra (Urine): Normal
- Mala (Stool): Baddha (constipated)
- Jihva (Tongue): Coated
- Shabda (Speech): Clear
- Sparsha (Touch): Normal
- Drik (Eyes): Normal
- Akruti (Build): Normal
Assessment of Clinical Presentation
The diagnostic findings, including history, signs, and symptoms, suggests melasma, which corresponds to the condition described as Vyanga in Ayurvedic texts. The methodology of assessment integrated both subjective and objective parameters, as summarized in Tables 1 and 2.
Subjective Parameter
Table 1: Subjective Paramater based on clinical sign & symptoms of Vyanga as per
Ayurveda
| S.N. | CLINICALFEATURE | GRADE0 | GRADE 1 | GRADE 2 | GRADE 3 | GRADE 4 |
| 1 | Mandalam Visrijati(No of circular lesions) | No such circular lesion present on face | 1 to 2 circular lesion present whole over face | 3 to 4 circular lesion present whole over face | 4 to 5 circular lesion present whole over face | More than 5 circular lesions present whole over face |
| 2 | Niruja Tanuka(Painless thin lesion) | Not present | Painless thin lesion present in cheek with malar prominence, smoothness on touch | Painless thin lesion present in cheek with malar prominence and bridge of nose, mild hardness on touch | Painless thin lesion present in cheek with malar prominence bridge of nose and forehead moderate hardness on touch | Painless thin lesion present in entire face severe hardness on touch |
| 3 | Shyava(Colour of lesion) | Normal skin | Faint dark brown color lesion over skin of face. | Light dark brown color lesion over skin of face | Moderate dark brown color lesion over skin of face | Deep dark brown color lesion over skin of face. |
Objective Parameter
The severity of melasma was evaluated using the Melasma Area and Severity Index (MASI), which assesses four facial regions (forehead (30%), right malar (30%), left malar (30%), and chin (10%)) based on three parameters: extent of involvement (A), intensity of pigmentation (D), and uniformity of pigmentation (H). For each region, the sum of darkness (D) and homogeneity (H) grades is multiplied by the area involved (A) and weighted according to its percentage contribution. The total score range is 0-48. The higher the score, the higher the severity. The total MASI score is calculated as:
MASI=0.3(D+H) A Forehead+0.3(D+H) A Right malar+0.3(D+H) A Left malar+0.1(D+H) A Chin
Table 2: MASI Score Assessment Criteria and Grading
| Parameters | Observations | Score |
| Area(A) | No involvement | 0 |
| 0-9 | 1 | |
| 10-29 | 2 | |
| 30-49 | 3 | |
| 50-69 | 4 | |
| 70-89 | 5 | |
| 90-100 | 6 | |
| Darkness(D) | Normal skin color without evidence ofhyperpigmentation; | 0 |
| Barely visible hyperpigmentation; | 1 | |
| Mild hyperpigmentation; | 2 | |
| Moderate hyperpigmentation; | 3 | |
| Severe hyperpigmentation. | 4 | |
| Homogeneity(H) | Normal skin color without evidence ofhyperpigmentation; | 0 |
| Specks of involvement; | 1 | |
| Small patchy areas of involvement <1.5 cmdiameter; | 2 | |
| Patches of involvement >2 cm diameter; | 3 | |
| Uniform skin involvement without any clear areas | 4 |
Figure 1. Schematic representation of the Melasma Area and Severity Index (MASI)
Therapeutic Intervention
The therapeutic regimen comprised topical AMV Lepa in combination with internal medication. [Table 3]
SOP (STANDARD OPERATING PROCEDURE) FOR TOPICAL APPLICATION
Pre Procedure – Before the application, the face should be washed and wiped well. Fine Powder of Arjuna, Manjishthaand Vasa taken in equal quantity (approx. 2-5 gms) is mixed with quantity sufficient of Madhu to form smooth paste like consistency.
Main Procedure – Lepa was applied on the affected part of face against the direction of hair follicles. The thickness ofthe lepa should be half angula (approx.0.5cm as 1 angula= 1.95 cm.) as mentioned in Vranya Lepa[8]. Allow it to dry for 15-20 minutes.
Post Procedure -Gently remove it before it is completely dried up with water or moist cotton.
| Intervention | Route of drug administration | Dose | Time of Administra tion/ Anupana | Duration | Follow up for drug compliance |
| 1. AMV Lepa with Madhu | External application | 0.5 cm thickness (approx (2-5 gms) as per surface area | Twice Daily | 60 days | Every 15thDay |
| 2. Panchnimbadi Churna | Oral | 2g | Twice Daily after meals with lukewarm water | 60 days | Every 15thday |
Table 3: SOP for DrugIntervention
Table 4. Ingredients ofPanchanimbadi Churna
| Sr. No. | SanskritName | Botanical Name | Part Used | Quantity (mg) |
| 1. | Nimba | Azadirachta indica A. Juss. | Stem bark | 115 |
| 2. | Pippali | Piper longum L. | Fruit | 7 |
| 3. | Marich | Piper nigrum L. | Fruit | 7 |
| 4. | Chitraka | Plumbago zeylanica L. | Root | 7 |
| 5. | Haritaki | Terminalia chebula Retz. | Fruit | 7 |
| 6. | Amlaki | Emblica officinalis Gaertn. | Fruit | 7 |
| 7. | Bakuchi | Psoralia corylifolia L. | Seed | 7 |
| 8. | Gokshura | Tribulus terrestris L. | Fruit | 7 |
| 9. | Vidanga | Embelia ribes Burm. F. | Fruit | 7 |
| 10. | Araghwada | Cassia fistula L. | Fruit pulp | 7 |
| 11. | Haridra | Curcuma longa L. | Rhizome | 7 |
| 12. | Chakramarda | Cassia tora L. | Seed | 7 |
| 13. | Sunthi | Zingiber officinale Rosc. | Rhizome | 7 |
| 14. | Bhallataka | Semecarpus anacardium L. | Fruit | 7 |
| 15. | Louhabhasma | Ash of iron (Fe2O3) | Incinerated iron | 5 |
| 16. | Sharkara | Saccharum officinarum L. | – | 7 |
| 17. | Bhringaraja | Eclipta alba Hassk. | Whole plant | 16 |
| 18. | Khadira | Acacia catechu willd. | Stem bark | 16 |
Observations and Results
The objective of this study was to assess the clinical efficacy of AMV Lepa and oral Panchanimbadi Churna in melasma management. Outcomes were evaluated pre- and post-treatment using both subjective and objective grading parameters. After 60 days of therapy, notable improvement was observed, with significant reductions in clinical signs and symptoms. The intervention produced beneficial outcomes at the administered dose and duration without any adverse effects, as presented in Table 5 and Figures 2 (A, B &C).
Table 5: Comparative assessment before and after treatment
| S. N. | Criteria | 0day (V1) | 15th day (V2) | 30th day (V3) | 45th day (V4) | 60th day (V5) |
| 1. | Mandalam visrijati(No of circular lesion) | 4 | 4 | 3 | 2 | 1 |
| 2. | Niruja tanuka (painless thin lesion) | 3 | 3 | 2 | 2 | 1 |
| 3. | Shyava (Colour of lesion) | 4 | 4 | 3 | 2 | 1 |
| 4. | MASI Score | 15.7 | 15.7 | 11.6 | 7.1 | 3.6 |
Fig 2. Reduction in number and pigmentation of patches from Visit 1 to Visit 5 after 60
days.
Discussion
Mode of action of AMV Lepa
Arjuna (Terminalia arjuna (Roxb. exDC.) Wight & Arn.) bark extracts exhibited significant inhibitory activity against protein glycation–induced cross-linking and tyrosinase, with these effects remaining largely stable under heat exposure. The methanolic extract showed greater efficacy than the ethanolic extract in preventing protein cross-linking. High antioxidant capacity, along with elevated phenolic and flavonoid content, was observed, with a strong positive correlation between antioxidant potential and polyphenolic compounds. These findings highlight the potential of Arjuna bark to counter oxidative stress, protein damage, and pigmentation processes associated with skin aging and pigmentary disorders.[9] The bark of Arjuna is described as having Kashaya (astringent) rasa, Laghu (light) and Ruksha (dry) gunas, and Sheeta (cold) veerya. These attributes make it primarily Pitta-shamaka (Pitta pacifying) and Rakta-prasadaka (blood-purifying). Through its Kashaya rasa, Arjunatwak mitigates vitiation of Pitta and Rakta dosha, thereby reducing twak vaivarnyata (skin discoloration) and supporting restoration of normal pigmentation. Its Sheeta veerya further pacifies Pitta dosha, while its prasadana action helps purify localized doshic accumulations. Together, the Rakta-prasadaka and Twak-prasadaka (promote healthy skin) actions of Arjuna contribute to its beneficial role in Vyanga (melasma).[10]
Manjishtha (Rubia cordifolia L.) exhibits potent antityrosinase activity, primarily due to purpurin and ellagic acid identified via TLC–MS bioautography. Molecular docking revealed strong purpurin–tyrosinase binding (−7.4 kcal/mol), surpassing kojic acid (−5.3 kcal/mol). Extraction was optimized using response surface methodology, and purpurin quantified by validated HPTLC.[11] Manjishtha (Rubia cordifolia L.) possesses Madhura (Sweet), Tikta (bitter), and Kashaya rasa, Ushna virya, and Guru (heavy), Ruksha guna, enabling it to pacify Vata and Pitta doshas. Madhura, Tikta and Kashaya rasa mitigate Pitta dosha involved in Vyanga (melasma), while Ruksha guna counters Pitta’s Snigdha gunaand Guru guna balances Vata’s Laghu guna, collectively disrupting Vyanga samprapti (pathology). Its Ushna viryastimulates Bhrajaka Pitta, aiding removal of rough, dark skin layers. Moreover, its Rakta shodhak, Kusthaghna (alleviates skin disorders), and Varnya (complexion-enhancing) actions collectively contribute to the improvement of skin tone and texture.[12]
The ethanolic extract of Vasa (Adhatoda vasica Nees.) (AVE) exhibited strong antioxidant activity across multiple in vitro assays including DPPH, ABTS, superoxide, hydrogen peroxide, nitric oxide (NO), and lipid peroxidation yielding IC₅₀ values ranging from approximately 40 to 340 µg/mL. In A549 cells, AVE (1–2 µg/mL) significantly scavenged NO radicals (11–28%), and its reducing power increased dose-dependently, confirming strong free-radical neutralizing potential. These findings suggest AVE may help mitigate oxidative stress and related melanogenic triggers, thus offering utility as a supportive agent in managing pigmentary disorders.[13] Vasa has Tikta and Kashaya Rasa, Laghu and Sheeta Guna, and pacifies excess Pitta. In Vyanga (melasma), where aggravated Pitta along with Vata dushti leads to dark skin patches, these properties are beneficial. Its Tikta and Kashaya Rasa help balance Vata and Pitta doshas and reduce excess pigmentation. The Sheeta Veerya further pacifies vitiated Pitta, often aggravated by the intake of Pitta-dominant foods, while the Laghu Guna supports better absorption when applied topically. Furthermore, Vasa possesses Kusthaghnaproperties, aiding in the reduction of discoloration and promoting restoration of an even skin tone.[14]
Madhu, through its Tridosha-pacifying and Yogavahi properties, enhances the activity of AMV (Arjuna, Manjishthaa and Vasa) Churna, provides targeted topical effects, improves skin complexion, and is safe for dermal application.[15]
Mode of Action of Panchnimbadi Churna
Panchanimbadi Churna contains Nimba as its key component, which inhibits melanin production and protects the skin from UV damage, while its antioxidant properties help enhance complexion. The formulation exhibits Rakta Prasadaka(blood-purifying) and Twak Doshahara (skin disorder–alleviating) effects.[16] Nimba, with its Tikta, Kashaya Rasa and Laghu, Snigdha properties, primarily pacifies Pitta. Other constituents, including Aragwadha, Amlaki, Maricha andHaridra possess Kusthaghna and Kandughna actions, supporting skin health and relieving itching.[17]
Conclusion
Melasma is a pigmentary disorder characterized by facial hyperpigmentation, which impacts appearance and quality of life. In this study, an AMV Lepa containing Arjuna, Manjishtha, Vasa Churna, and Madhu, combined with oral Panchanimbadi Churna, was evaluated for safety and efficacy in melasma management. The therapy was well tolerated, with no adverse effects observed during the prescribed dose and duration, and it produced a noticeable reduction in hyperpigmentation. Overall, this integrative Ayurvedic approach is effective, well tolerated, and therapeutically justified for managing melasma. Further, larger clinical studies are needed to validate these outcomes and establish standardized protocols.
Patient Perspective:
The patient noted visible reduction in pigmentation with good tolerability and expressed satisfaction with the Ayurvedic treatment.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his clinical information to be reported in the journal. The patient understand that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
References
Alzohairy MA. Therapeutic role of Azadirachta indica (Neem) and its active constituents in disease prevention and treatment. Evid Based Complement Alternat Med. 2016;2016:7382506. doi:10.1155/2016/7382506. PMID:27034694; PMCID:PMC4791507.
Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-82. doi:10.1590/abd1806-4841.20143063. PMID:25184917; PMCID:PMC4155956.
Jiryis B, Toledano O, Avitan-Hersh E, Khamaysi Z. Management of melasma: laser and other therapies-review study. J Clin Med. 2024;13(5):1468. doi:10.3390/jcm13051468. PMID:38592701; PMCID:PMC10932414.
Mehta G, Tyagi DR, Sachdeva M, Tripathi R, Tyagi H. An observational study on cosmetics use-related adverse effects: cosmetovigilance need of the day. Drug Res (Stuttg). 2024;74(4):164-70. doi:10.1055/a-2251-6655. PMID:38467158.
Shastri BB, editor. Yogaratnakar: Kshudraroga Chikitsa. 8th ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2004. p.283.
Murthy KR, editor. Sushruta Samhita, Chikitsa Sthana, Kshudraroga Chikitsa Adhyaya, 20/33. Reprint ed. Varanasi: Chaukhamba Orientalia; 2012. p.196-7.
Shastri B. Yogratnakar Vidyotini Hindi Commentary. 4th ed. Varanasi: Chaukhamba Sanskrit Sansthan; Kshudarogadhikar, Shloka 8, p.282.
Sharma PV. Dravyaguna Vijayanam. Vol.2. Reprint ed. Varanasi: Chaukhamba Bharati Academy; 2018. p.149, 162, 166, 170, 175, 186, 275, 331, 359, 362, 503, 632, 638, 753, 758.
Tripathi Brahmanand. Ashtang Hridaya Sutrasthana 22, Nirmala Hindi Commentary. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p.259-60.
Perera HKI, Jayasinghe JAVR, Lankarathna APCP, Nilmanel KG, Sivakanesan R. Protective effects of Terminalia arjuna bark extracts against glycation-induced protein damage, oxidative stress, and hyperpigmentation. Ceylon J Sci. 2024;53(3):389-97.
Angadi SS, Gowda ST. Management of Vyanga (facial melanosis) with Arjuna Twak Lepa and Panchanimba Churna. Ayu. 2014;35(1):50-3. doi:10.4103/0974-8520.141924. PMID:25364200; PMCID:PMC4213969.
Insaf A, Parveen R, Srivastava V, Samal M, Khan M, Ahmad S. TLC–MS-bioautographic identification of antityrosinase compounds and preparation of a topical gel formulation from a bioactive fraction of an RSM-optimized alcoholic extract of Rubia cordifolia L. stem. J AOAC Int. 2023;106(6):1598-606.
Mishra K, Shukla U, Garg KC, Sharma S. A comparative pharmaco-clinical study of Arjuna and Manjishtha w.s.r. to Vyanga. J Ayurveda Integr Med Sci. 2019;4:146-53.
Pant M, Basu S, Sindhu RK, Ramasamy R. Antioxidant and free radical scavenging potential of ethanolic fraction of Adhatoda vasica in A549 cell line. Asian J Pharm Clin Res. 2015;8(6):244-9.
Chunekar KC, editor. Bhavprakash Nighantu. Varanasi: Chaukhamba Bharati Academy; 2002. Guduchyadi Varga. p.306, 307
Hunasagi K, Patil U. A randomised comparative clinical study to assess the efficacy of Arjuna Twak Churna Lepa and Yastimadhu Churna Lepa along with Khadira Churna in the management of Vyanga with special reference to melasma. J Ayurveda Integr Med Sci. 2022;10:86-93.
Akihisa T, Noto T, Takahashi A, et al. Melanogenesis inhibitory, anti-inflammatory, and chemopreventive effects of limonoids from the seeds of Azadirachta indica A. Juss. (neem). J Oleo Sci. 2009;58(11):581-94. doi:10.5650/jos.58.581. PMID:19844073.