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Introduction

Thousand years ago, in Ayurveda, there is clearly explain the several factors which imbalance the state of equilibrium of Doshas. This finally leads to produce various diseases. These factors are known as Nidan. So far as disease Khalitya is concerned there is no clear description regarding the causative factors of Khalitya, but by analysing the explanation of the pathogenesis of the disease in Ayurvedic granthas, an indirect knowledge of etiological factors may be acquired. Due to nidana sevan, digestive fire (Agni) may vitiate and result in to visham, Tikshna and Mand agni. [2] When the morbid state result in Agnimandya, it is produced Ama (undigested part of food) The Ama is the unwanted, harmful substance; when it circulates in the body, it blocked the channels (Strotodusti) and also Pachak Pitta, Saman, Vyan Vayu and Rakta dusti occurs. As per kedarikulya nyaya, the Strotodusti at Rasa dhatu level progresses in the Rakta dhatu. The vitiated Rasa, Rakta have bad effect in production of Asthi dhatu. [3] Hence, the vitiated Asthi dhatu which effects in the reduction in concerned dhatu i.e. Kesha. Then Bhrajak Pitta dusti occurs so that Pittoshma increases and there is romkupa paka which affects the hair follicles and Keshapatan occur. The second is that due to hetu sevan there is Kaphaprakop which leads to increase of Klinnatva. It causes the Strotorodha which affect the hair follicles and the Shirogat Romakup leading to Khalitya. [1]

Aim & Objective

To elaborate and discussion of etiological factors of Khalitya and its Pathogenesis from the different Samhita.

Material and Method

In Ayurvedic literature, reference regarding the causative factors of Khalitya described by Acharya Charak [4]and Vagbhata [5] under the heading of Shirogat Rog nidana. Acharya Chraka mentioned in Sutrasthan Lavan rasa have property of produce Khalitya.[6] He has described in Vimanasthan the etiological factor of Khalitya i.e. excessive use of Lavana and Kshara [7].  and also, in Sharirsthan, he mentioned of daily intake of lavana cause Khalitya. [8] Samgrahakara has mentioned shirogatarogas along with its pathogenesis. Under the heading of Urdhvajatrugatarogas it also further divided in kapalagat roga. Khalitya including in this rogas, So the general etiological factors of urdhavajatrugatarogas can be considered as an etiological factor of Khalitya [9] he has also declared that an intake of Lavana during pregnancy would be result in congenital hair loss (Khalitya) [10]. Sushruta has described it in Kshudra roga along with its pathogenesis in Nidan sthana [11] and he mentioned in Sushrut Samhita uttartantra increase vatadi doshas due to Viruddha Aharasevan which leads to disease.  Viruddha Aharasevan has also mentioned by Acharya Charaka in Sutrasthan. [12] Madhav has mentioned Khalitya likewise Acharya Sushrut. [13] The description of the pathogenesis of Khalitya given by Vangasena look like to Sushruta [14]and Bhava Prakasha has mentioned Khalitya in Khudraroga while describing the samprapti of Indralupta.[15]

Etiological factors can be classified as Aharaja (~Dietary), Viharaja (~Lifestyle), Manasika (~Mental) and agantuaj.

Aharaja (~Dietary)

1. Lavanrasa atisevan

Jala and Agni Mahabhuta dominance is present in Lavana Rasa. Excess intake of Lavan rasa create Kaphavriddhi, due to it obstruction in srotas leads to Khalitya. [6,7,8] Excessive consumption of lavana rasa during pregnancy cause khalitya early in child.[7]

1. Ksharaatisevan

Addiction to the intake of Kshara produces injurious effect on hair. It takes property of Usna and Tikshna guna. This guna are directly affect Pitta dosha, this vitiated pitta takes place in the keshabhoomi. [7]

1. Katu Aahara

It has vayu and agnimahabhuta dominance. It has laghu and ruksha guna. If it consumes in excess, it causes emaciation, vitiation of Pitta and Vata and aggravation of Rakta.

1. Aamla Aahara    

Amla Rasa used in excess will result in liquification of Kapha, aggravation of Pitta and vitiation of Rakta.

1. Kashaya rasa

Excessive consumption of Kashaya rasa leads to obstruction of srotas, because It is having properties ruksha, sheeta, and laghu. again, obstruction of srotas leads to agnimandya which is responsible to Khalitya.

1. Ushar Bhomi

This type of soil contains large amounts of Lavana and Kshara and it mix with water, water become hard. Hence, frequent hard water drinks and use in cooking or washing of hair then   people are more prone to Khalitya. [7]

1. Guru Aahara

Guru substances result in vitiation of Kapha with Rakta Dhatu.

1. Viruddha Aharasevan

Proper nutritive food if not taking in regular diet, then imbalance condition is producing in doshas. This Unhealthy food leads to Kapha and Pitta virddhi resulting in agnimandhaya. It is lead to Khalitya. [12]

1. Shitambupan

It has jala and vayumahabhuta dominance. It subsides pitta and aggravates vatakapha.

1. Atyambupan

Excessive milk items, water and liquid diet, all these substances are included under this group. These can be classified under the point 'Matravat'. Matra is applicable for all types of Ahara - solid and liquid. Besides this, these are the factor causing Agnimandya. Gorasa Sevanam - can be included under 'Singdha' Atisnigdha also causes Agnimandya.

Viharaja (~Lifestyle)

Vegadhaaran (~suppression of natural urges), Ratrijagaran (~vigil during the night), Divaswapa (~sleep during the day time), Meghagamanma (~advent of cloud), Aatapasevan (~exposure to sun), Tushar/Him (~snowfall), Dhum (~smoke), Atimaithuna (~sexual indulgence), Asatmyagandha (~inhalation of undesirable smell), Deshviparyaya (~regimen contrary) , Vatadi doshas get aggravated resulting in vitiation of raktadhatu in the head. this cause disease with various symptoms in the head.[4]

Manasa Hetus (~Mental)

Acharya Charaka says that, even though food is taken in proper quantity and quality and is wholesome, it is not digested properly if a person is afflicted by worry, fear, and grief and anger etc. [16] These Psychic factors are basically causative factors for pittaprakop. Thus, directly or indirectly this factor influences Dehoshma which disturb functioning of Agni and results in obstruction in srotas leading to agnimandya then it occurs Khalitya.

Samprapti (~Pathogenesis)

In the pathogenesis of Khalitya, as per Acharya Charaka, Teja with the help of the Vatadi humours mentions that the scalp rapidly so as to cause Khalati to a person [17].

Due to Nidana sevana               Vitiation of Pitta & Vata doshas                 These (pitta and Vata) gets lodged in scalp region                Burn the hair follicle                Causing early & severe hair loss                Khalati

Acharya Sushruta explained the deranged Vayu and Pitta having recourse to the roots of the hairs bring about their falling off, while the deranged blood and Kapha of the locality fill up those pores, thus barring their fresh growth and recrudescence. The disease is called Khalitya (hair fall). [11]

Due to Nidana sevana        Vitiation of Vata & Pitta doshas           Gets lodged into the hair follicle in Shiras         Causing hair fall (mainly in female)           Khalitya

Vagbhata has commensurate with the pathogenetically approach of Sushruta, but he further adds one main point to this pathogenesis so as to differentiate Khalitya from Indralupta that the falling of a hair in Khalitya is gradual.[1]

Due to Nidana sevana          Vitiation of Vata & Pitta doshas         Urdhwa aashrita in shiras         Again, with kapha & rakta dusti           Blocks the path of hair follicle         Causing severe hair         Khalitya.

Madhava opines that, the romakupagata bhrajaka pitta along with vata leads to hair fall and later the kapha along with rakta leads to obstruction of hair roots, thereby there will be no further production of hair. He regards the disease to be due to all the four doshas and the swabhava (~the nature) of the disease is aniyata (~unpredictable). According to this theory, the indulgence of Vata, Pitta and Kapha i.e. all three doshas has been held responsible for the production of Khalitya. [13]

According to Ashtanga Samgrahakara, there are four types of Khalitya i.e. Vataja, Pittaja, Kaphaja and Sannipataja, [18] Acharya Harita adds one more type Raktaja Khalitya. Amongst four types of Khalitya, Sannipataja type is considered as Asadhya and it is advised that such patient should be discarded.[19] This view is hold on by both Ashtanga Samgraha and Hridaya. [20]

Discussion

The long-term practice of etiological factors generates initially agnimandhya, immediately it produces Ama and Slesma in Annarasa, it directly vitiated Pitta. Here the basically Pachack and Bhrajak pitta affected and it again vitiated Vata, functionally Saman and Vyna vayu are affected. When both vata and pitta are aggravating together the resultant increasing Gunas are Laghu, Sukshm, Ruksha. Khara, and Ushna This gunas will have the direct action on Asthidhatu. Kesha (~big hair), and Loman (~small hair) are Mala (~waste product) of Asthi Dhatu. So, Vitiated asthidhatu starts the process of hair fall. [21] When this nidana continues it’s increased the localized temperature. The increased localized temperature will make the klinatva of kapha due to pichchhila guna which is create Kaphavriddhi. This kapha will make obstruction in Srotas i.e Rasa-raktavha and romakupa leads to agnimandya as well as malnourish in kesh, Agni literally translate to fire and mandya means weakness. Due to not having enough nutrition in Rasa-raktavaha Shrotas, rakta prasadana karm is affected and keshotpati does not proper take place gets resulting in Khalitya.

Conclusion

Observing the pathogenesis described by different Acharya, it can be said that the Vata, Pitta and Kapha Dosha and Rakta Dushya are the main internal causative factors of Khalitya. ‘Nidana Parivarjana’ forms the basis of the management and hence a close and detailed probing of etiological factors is necessary that’s why Intake of wholesome and unwholesome diet, lifestyle also behaviour plays an important role in the maintenance of health and production of diseases respectively.