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Introduction

In today’s world beauty plays important role in which Hair plays major role in making body externally beautiful. Long,healthy and shiny Hair  enhances the personality of a human which contributes to persons  confidence and positive attitude. According to modern medicine Khalitya is known as Alopecia Arreata or Baldness, that is partial or total loss of Hair, particularly from scalp. Different types of chemical oils, shampoo, conditioner in the name of beauty products has made the condition worse. Hence Khalitya is becoming more common nowadays due to Unhealthy Lifestyles, Unhealthy Dietary Habbits, Systemic Diseases, Medications and Stressful Life also contribute to it. Charak has mentioned Khalitya in Trimarmachikitsa Adhyay. It is included in Urdhwajatrugata Roga [1] and also mentioned Khalitya as Updrava of Dustha Pratishyay.[2] In Sushruta Samhita, Indralupta as a synonym of Khalitya is mentioned under the heading of Kshudra Roga.[3] In Ashtanga Hriday and Ashtanga Sangraha, Vagbhat mentioned Khalitya as one of the Nine Sirah Kapala Vyadhi in Shiroroga Vigyaniya Adhyay [4] and Types of Khalitya, its Symptoms and Prognosis have also been mentioned. In modern science Khalitya is correlated with Alopecia. In India more than One Million Cases of Alopecia are found Per Year. The most affected group is 19-40 yrs (Young Adults) as well as 41-60 yrs (Adults).[5] Nowdays as Khalitya is one of the challenging issues. So, this topic is selected which will throw light on Khalitya and its treatment according to Ayurveda in detail.

AIMS AND OBJECTIVES: To study the review of Khalitya and its management in detail mentioned in Brihatrayee.

MATERIALS & METHODS: It is a review article and all the data is collected from respective Samhitas i.e. Brihatrayee and Journals,Articles and Books are also referred.

Etimology:[6]

Vachaspatyam: The literal meaning of the word Khalitya is falling of the hair. So, Khalitya is a disease in which the fall of hair occurs in various forms ie. the hair either fall out completely or incompletely or prematurely.

Vaidyaka Shabda Sindhu: It describes Khalitya as a synonym of Indralupta, means baldness.

Literature Review:

Nidana (Etiological Factor):

• There is no any clear explaination of Nidana (Etiological Factor) of Khalitya but by analysing the explaination of the pathogenesis of the disease and by collecting the scattered refrences from classic text of Ayurveda, an indirect knowledge of Nidana (Hetu) of Khalitya may be acquired.
• According to Charak Samhita, Khalitya is Updrava (complication) of Dustha Pratishyaya.
• Even Charak has mentioned excessive consumption of Kshar [11], Lavan and Viruddha Ahara results in Khalitya.He has also mentioned that Viruddha Ahara like Consumption of Lavana with Milk in Diet causes Khalitya, especially seen in the region of Saurashtra and Bahlika.[12]

  Purvaroop /Pragrupa: Purvaroop are said to be those symptoms which are manifested before the manifestation of the main disease.[16] In case of Khalitya, no specific Purvarupa is mentioned. But according to classic text, appearance of symptoms in mild form is considered as Purvarupa.In this way occasional loss of some hair is considered as purvarupa of Khalitya

  Rupa: Only those Signs and Symptoms which denotes a manifested disease are called Rupa.[17] Moreover Rupa of Khalitya has less explaination in Ayurvedic Classics.Hence cardinal symptoms of Khalitya is gradual loss of Hair. [18,19] Whereas various Acharyas have also mentioned some associated symptoms according to its type. Ashtanga Sangraha and Ashtanga Hridaya has classified Khalitya into Four Types i.e., Vataja, Pittaja, Kaphaj and Sannipataja Khalitya. Though there is Vitiation of all Three Doshas but its types depend on Dominancy of Individual Dosha.Rupa of Khalitya according to its type are as mentioned below.

  1.Vataja Khalitya – Here Keshabhoomi (Scalp) appears as Agnidagdha and its looks like Shyava and Aruna Varna

  2.Pittaja Khalitya – Here Keshbhoomi is Siravyapta i.e Surrounded by Siras (Veins) and Sweda (Sweat) is presented all over Scalp and colour of Scalp is Peeta,Neela and Harita Varna.

  3.Kaphaj Khalitya –In this type, Scalp appears Ghan and Snigdha and colour of the Scalp is Twak Varna i.e Same as Skin Colour.

  4.Sannipataj Khalitya –Here Lakshana (Characteristics) of all Three Doshas are seen and scalp looks like Agnidagdha and Nakha Prabha (Nail Colour) like appearance,Nirloma(Absolute Hair Loss) with Daha(Burning Sensation) is also present.[20,21]

  Samprapti:

• According to Acharya Charak, Teja Guna along with Vatadi Doshas scorches the Kesha Bhoomi (scalp) and produces Khalati. Acharya Chakrapani Commenting on this explains the word Teja in two perspectives i.e. One is Dehagni or Dehoshma -Pachaka Pitta and other is Pitta situated in the Scalp. Hence according to Charaka, Dehoshma along with Vatadi Tri-Doshas causes Khalitya.[22] Therefore it may be considered that Predominantly Two Doshas are involved i.e., Vata and Pitta Dosha.
• As per Sushruta, Vitiated Pitta Dosha along with Vata Dosha reaches into Romakoopa (Hair Follicle) and leads to Hairfall and then subsequently Shleshma along with Shonita (Rakta Dosha) obstruct the Romakoopa which leads to cessation of regeneration of new hair and this condition is known as Indralupta, Khalitya or Ruhya.[23] Thus Acharya Sushrut has mentioned all Three Doshas i.e Vatta,pitta And Kapha along with Shonita (Rakta Dosha) in the occurrence of Khalitya.
• Acharya Vagbhat has explained similar Samprapti as that of Sushruta but further he added one important point in Samprapti is falling of hair in Khalitya is Gradual, so as to differentiate Khalitya from Indralupta. [24,25]

• Sadhyaasdhyatva: There is no any explaination regarding Prognosis of Khalitya in Charak Samhita or Sushruta Samhita. But Ashtanga Hriday and Ashtang Sangraha has mentioned the Prognosis i.e. among Four Types of Khalitya, Ekdoashaja Khalitya are said to be Sadhya while Sannipataj Khalitya is considered as Asadhya and also adds that patient having Scalp with Dagdha (Burnt) like appearance,Nakha Prabha(Nail Colour) like appearance, Nirloma (Absolute Hair Loss) with Daha (Burning Sensation) are incurable to treat i.e Asasdhya.[26,27]

  Chikitsa Siddhant:

• Nidana Parivarjana: As Sushruta says “Sankshepataha Kriyayoge Nidana Parivarjana” i.e., in Brief Management mainly consist of avoidance of the causative factor (Nidana). Hence “NIDAN PARIVARJAN” is the first line of treatment in Ayurveda.[28] Here in Khalitya, patient should protect himself from all the Nidana of Shiroraga mentioned in Shiroroga. As Khalitya is mentioned under Shiroroga by some Acharyas.
• Acharya Charak mentioned Shodhana along with Nasya,Shiro Abhyanga and Shirolepa. He mentioned Vidharigandhadi Taila and Anu Taila for Nasya [29]and Tiladi Yoga for Shiro Lepa.[30] And Mahaneela Taila for Shiroabhyanga. [31]
• Acharya Sushruta says after Snehana and Swedana, Siravedha at the Site of Lalata (Forehead)should be done and even Prachana Karma is mentioned. Along with that Kasisadi Lepa, Kutannatadi Lepa,Gunja Lepa, Malatyadi Taila [Malati (Myristica fragrans), Karveer (Nerium indicum), Chitraka (plumbago zeylanica),and Karanja (Pongamia pinnata)] for Shiroabhyanga and also suggested Rasayan Chikitsa.Dalhana mentioned Ashta Dosha Somaraji Rasayana. [32] He also recommended Sairiyakadi tail and Neeldaladi tail for Shiroabhyanga. [33]
• In Ashtanga Hridaya, Vagbhat explains after the Shodhan of Doshas, whatever treatment mentioned in Indralupta and Palitya, should be done in Khalitya. He suggested after Shodhana, Nasya,Shiroabhyanga and Pralepa.[34] He mentioned Siravedha and Prachana Karma. Prachana is done before application of Lepa. He advised Kasisadi Lepa, Gunja Lepa, Bhallatakadi Lepa, Madhukadi Lepa, Dhatura Lepa, Hastidanta Mashi Lepa [35] Brihatyadi Taila or Jeevaniya Gana Siddha Taila and Nimba Taila for Nasya.[36] and also mentioned Malatyadi Taila for Shiroabhyanga. [37] Prapaundreekadi Taila for Nasya and Shiroabhyanga. [38]
• Ashtanga Sangraha has quoted that, application of various types of Pralepa should be done after Prachana Karma and Chikitsa of Indralupta And Palitya is applied for Khalitya as well.He advised Shodhana according to Doshas.He suggested Raktamoshan i.e Prachan Karma by Suchi and Kurchika before application of Lepa. He mentioned Chitrakadi Taila (Chitrak,Karanja,Karvira,Malati ) for Shiroabhyanga,[39]Agnimanthadi Lepa,Triphaladi Lepa(Param Romasanjanan), Jambhudya Taila for Nasya and Shiroabhyanga, Madhurvarga Siddha Taila for Nasya and Shiroabhyanga,[40]  Kapikacchu Taila for Nasya and Abhyanga. [41]
• Basti is the Main Chikitsa of Vata Vyadhi. Vata Vriddhi is responsible for Asthikshay. Basti cure the Asti Kshay as hair is Mala of Asti, thus Basti cures the Hair Problem also. [42]

• Preventive measures

• Shiro Abhyanga/Moordha Taila:[43] Regular Shiroabhyanga prevents Khalitya,Palitya. it nourishes Hair Follicle and provide Strength to it.
• Snana:[45] As per Acharya Vaghbta, Head and Hair should not be washed with hot                       water. Pouring hot water over Head reduces the Bala (Strength) of Hair and Eyes.
• Kshaurkarma: Hair Cutting and Samprasadana (Proper Care and Combing) of hair of                  Scalp, Beard should be done regularly [46] and Acharya Charak mentioned everybody should Haircut, Shave and Nail Cut thrice every forthnight.[47]
• Ushnisha:[48] Wearing of Ushnisa (Turban or Cap) protect the Hair from various environmental factor like Dust, Wind, Heat etc which is essential for protection of hair. As it is said Pavitra (Pious) and Keshya (Beneficial for Hair).
• Nasya: [49] Everybody should take Nasya like Anu Taila Nasya every year especially during Varsha(rainy)Sharad(autumn) and Vasanta (spring season) Ritu, when sky is free from clouds.As Nasya along with its various benefit it prevents Hair Fall and Accelerate Hair Growth.
• Dhoompana: [50] Acharya Charak explained Dhoompana Vidhi under the topic of Dinacharya along with its benefits. It is said that Dhoompana cures Vata Kapha Janya Urdwajatrugat Roga as well as it treats Khalitya,Palitya  and gives Strength to Head and Indriya (Senses).
• Yoga: [51] Yoga may act against Hair Loss and aids in Hair Growth.Excess stress can lead to Hair Loss. Yoga help to reduce inflmattaory markers in the body. It also encourages blood flow to the head which can reverse Hair Loss.Some of Yoga Poses are Sirsasana(Head Stand), Adho Mukha Sarvangasana (Downward -Facing Dog), Uttanasana (Forward Bending Pamel pose), etc.

Discussion

Khalitya (Hair Fall) is very common and challenging condition in young and old age. Nowdays due to faulty Dietary Habbits, Lifestyle and Stressful Living and inappropriate nutrition, leads to depletion of function of Hair Root. As concept of beauty i.e., Saundarya is gaining more attention globally and it is said hair is a barometer of one’s beauty. But in todays modernised era due to faulty habbits, Problem of hair fall is increasing day by day affecting the quality of life. Khalitya (Hairfall) closely resembles to Baldness or Alopecia in modern science. Millions of people are suffering from Hair Fall and the Prevalences of Hairfall found to be 60.3 % and Prevalence of Baldness was found to be 50.4%.

It is universal problem affecting both sexes of all races.[45] In Khalitya there is vitiation of Pitta and Vatta Doshas along with a Rakta and Kapha Dosha. Charak mentioned, excessive consumption of Amla, Lavan and Kshar Rasa as cause of Khalitya. These Rasa Vitiate Pitta and Rakta Dosha. Ati Atap Sevana, Raja and dhooma sevana without protection to head results in excessive sweating, blockage of Romakoopas and vitiation of vata and pitta doshas. Atiswapna and Ratri Jagrana leads to vitiation of Kapha and Vata doshas. Atimaithun increases Vata Dosha.Guru Sheeta Ahara leads to Kapha Prakopa, Dusta and Ama Bhojan leads to Amothpatti. Hence Rasa Dhatu Poshan to Kesha (Hair) is Hindered. Shiro Abhyanga is essential in preventing Khalitya.And absence of it, increases Vata dosha due to Rukshata.Khalitya is also afflicted by Manastapa(Stress)Hence by above analysis it is concluded that Khalitya is  caused by predominance of Pitta and Vata associated with Rakta and Kapha. In Shodhana Chikitsa, Nasya is the first choice of treatment. Nasya clears the obstruction of the hair roots by its Sookshma Strotogami property leading to the Roma Koopavishodhana. Virechana Karma pacifies Pitta Dosha which is Pradhan Dosha of Khalitya, it is also useful for elimination of Vata and Kapha Dosha. Raktamoskhan also clears the obstruction of Hair Roots and Pacifies Rakta and Pitta Dosha. Several types of oils and Lepa used in Khalitya improves the blood circulation to scalp thereby increasing nutrition of Hair Roots. In Shaman Chikitsa Rasyana is best Anti-Aging Therapy which helps in reversing aging process; hence it acts as immune modulator to Khalitya. Yoga plays major role in Khalitya,it increases blood flow to the Head and Prevents Hairfall.

Conclusion

Khalitya is a disease in which there is gradual loss of hair. Khalitya occurs due to Faulty habits and Lifestyle, Stress and use of Harmfull Shampoo and Poor Hygiene of Scalp. The Ayurvedic management of Khalitya has strong prospect to breakdown the Samprapti of Khalitya.

Ayurvedic Chikitsa includes Keshya,Balya and rejuvenating properties, so they will show an exceptional results on Khalitya.Beautiful, Long and Attractive Hair of Scalp enhances the personality but to maintain healthy hair in the healthy state is entirely the duty of human being. So in the treatment of Khalitya,Nidana Parivarjan,Shaman Chikitsa, Shodhana Chikitsa like Vamana, Virechana, Raktamokshan, Nasya, Shiro Abhyanga and various Lepa plays major role along with healthy food habits and lifestyle modification.