A Brief Overview of Panchanimba Churna: A Classical Ayurvedic Formulation for Skin Disorders

Abstract

Ayurvedic Churna is one of the most basic forms of Ayurvedic medicine and can be prepared easily. The Churna one will make should be referenced from an established Ayurvedic text or the Ayurvedic Formulary of India (AFI). Panchanimba Churna, an Ayurvedic formulation referenced in Bhaisajya Ratnavali and AFI (Part II), has attracted interest for its therapeutic potential in managing various health conditions, particularly skin disorders. This review examines the pharmacological properties, traditional uses, and contemporary research findings related to the Panchanimba churna. Sourced from the neem tree (Azadirachta indica), this churna possesses notable antimicrobial, anti-inflammatory, and antioxidant properties. Traditionally, it has been used to treat skin issues such as eczema, acne, and psoriasis, with modern research supporting its effectiveness in reducing inflammation, fighting microbial infections, and promoting skin healing. Additionally, Panchanimba churna shows promise in complementary therapies for dermatological conditions, highlighting its potential as a valuable alternative treatment in integrative medicine. This review consolidates current knowledge and emphasizes the therapeutic relevance and future research opportunities of Panchanimba churna in dermatological care.

Keywords

Introduction

Table 4: Various parts of the Neem tree (Stem bark, Root, Leaf, Flower, Fruit) along with their photographs and therapeutic effects

The neem tree is often called a "reservoir" of plenty of phytochemicals, with over 300 extracted and identified [50]. The isolated phytocompounds can be categorised primarily into two groups, i.e., isoprenoids, which include diterpenoids, triterpenoids, and limonoids, and non-isoprenoids, which contain proteins, polysaccharides, tannins, flavonoids, glycol-flavonoids, dihydrochalcone, coumarin, various aliphatic compounds, and phenolic acids [51, 52]. Every component of the neem tree, including its leaves, fruits, seeds, oil, roots, bark, and twigs, is a treasure of phytochemicals known for their antimicrobial, antiviral, antifungal, anti-inflammatory, anti-plasmodial, antiseptic, antipyretic, anti-diabetic, and anti-ulcer activities [41]. Nimbin was the first compound to be explored. Other significant phytochemicals obtained from neem include nimbolide, azadirachtin, azadiradione, gedunin, and azadirone. Azadirachtin comprises seven isomeric chemical entities, known as azadirachtin A-G, with azadirachtin E being the major. The most biologically potent triterpenoid, Nimbin, is found in neem seed oil and is recognised for its antipyretic, antiseptic, anti-inflammatory, fungicidal, and antihistamine effects [53, 54]. Neem Leaf Glycoprotein (NLGP), derived from neem leaves, is a purified protein known to decelerate tumour cell proliferation. Rather than directly killing cancerous cells, this protein alters immune cell behaviour within the cancerous environment and the bloodstream, effectively hindering cancer progression [55]. Table 5 lists some essential phytochemicals in the Neem plant and their bio-activity.

Plant Name	Brief overview
Haritaki (Terminalia chebula) Family: Combretaceae	Haritaki is a highly esteemed herb in Ayurvedic medicine, often called the 'king of herbs'. In the Ayurvedic formulation, 'Triphala churna', Haritaki, Amalaki, and Bibhitaki are the ingredients. The Haritaki tree is mainly found across India, Bangladesh, China, Myanmar, Iran, Egypt etc. In India, it predominantly grows in deciduous forests and areas with light rainfall, though it can also be found in moderately moist forests. The tree blooms between April and August, with fruits maturing from October to January. Its fruit is a drupe-like structure, measuring 2–4.5 cm in length and 1.2–2.5 cm in width, blackish with five distinct longitudinal ridges. Hydrolyzable tannins, chebulic acid, chebulinic acid, chebulagic acid, ellagic acid, gallic acid, etc., are the main phytoconstituents of Haritaki. Its pharmacological activities include Antibacterial, antioxidant, anticancer, antifungal, antiviral, antidiabetic etc. [61, 62].
Bibhitaki (Terminalia bellirica) Family: Combretaceae	Bibhitaki is an Ayurvedic herb and one of the three components of 'Triphala churna', formulation. It is widely distributed across the Indian subcontinent, Sri Lanka, and Southeast Asia. The Bibhitaki tree grows to a height of 60 to 80 feet. Its leaves are large, measuring around 15 cm in length. The colour of the flowers is either white or pale yellow. Its therapeutic effects are attributed primarily to glucoside, tannins, chebulanic acid, gallic acid, ellagic acid, ethyl gallate, etc. Its pharmacological activities include antioxidant, antimicrobial, antidiarrheal, anticancer, antidiabetic, antihypertensive, and liver-protective properties [63].
Amalaki (Emblica officinalis) Family: Phyllanthaceae	Amaiaki is an Ayurvedic herb known for its rejuvenating and nourishing qualities and one of the three components of 'Triphala churna', formulation. Amalaki trees grow across tropical and subtropical regions of India, primarily in dry deciduous forests and up to 1,400 meters in the Himalayas. They are generally found all over India. This deciduous tree is small to medium-sized, reaching an average height of 8-18 meters, with thin, light grey bark that peels off in small, irregular flakes. The fruit is fleshy, nearly globose, 2.1-2.4 cm in diameter, weighing 5.3-5.7 g. All parts of Amalaki help to treat various diseases, although fruit is the most important part. The fruits of Amalaki are extensively used in Ayurvedic preparation, increasing defence against diseases. Amalaki is beneficial in managing degenerative diseases such as cancer, diabetes, liver disorders, ulcers, anaemia, eye conditions, and heart issues. It is also a key ingredient in various hepatoprotective and rejuvenating formulations. Tannins, gallic acid, ellagic acid, emblicanin A & B, quercetin, ascorbic acid, etc., are the major phytochemicals present in Amalaki [64].
Ginger (Zingiber officinale) Family: Zingiberaceae	Ginger is one of the most important spices used in the kitchen and is known for its rich phytochemical composition that offers various health benefits. It is commonly used as a home remedy for ailments like the common cold and headaches, and it possesses pharmacological properties, including anti-inflammatory, antioxidant, antiemetic, antiulcer, anticancer, antiplatelet, anti-diabetic, and lipid-lowering effects. Gingerol, zingerone, shogaols are the main bio-active compounds present in ginger. and parasols. 6-gingerol and 6-shogaol exhibit pharmacological effects beneficial for antipyretic, analgesic, and hypotensive purposes [65].
Maricha (Piper nigrum) Family: Piperaceae	Piper nigrum, considered the 'King of spices', is a popular spice that imparts unique flavour and taste to dishes. It is commonly known as black pepper and is a flowering, woody perennial vine; it thrives in shaded environments and can climb on supporting trees, trellises, or poles, reaching heights up to 4 meters. Piperine, piperic acid, piperlonguminine, pellitorine, piperamide, piperettine, etc. are some active phytoconstituents present in P. nigrum. Piperine enhances the bioavailability of various drugs and nutrients by restricting several metabolizing enzymes. P. nigrum and its active compound, piperine, have a wide range of pharmacological effects, including antihypertensive, antioxidant, antitumor, analgesic, anti-inflammatory, anti-diarrheal, antispasmodic, antidepressant, immunomodulatory, antibacterial, antifungal, hepato-protective, as well as larvicidal and insecticidal activities [66, 67].
Pippali (Piper longum) Family: Piperaceae	Piper longum, commonly known as long pepper, is a perennial shrub or herbaceous vine. It is native to the Indo-Malaya region and is commonly found in tropical and subtropical areas, including the Indian subcontinent, Sri Lanka, the Middle East, and America. The fruits of this plant are primarily used as a culinary spice and preservative, as well as a potent remedy in various traditional medicine systems for conditions like bronchitis, coughs, colds, snake bites etc; it is also utilized as a contraceptive. The plant contains various bioactive phytochemicals, such as alkaloids, flavonoids, esters, and steroids. Extracts and essential oils from its roots and fruits have been reported to exhibit antimicrobial, antiparasitic, anthelminthic, anti-inflammatory, analgesic, antioxidant, anticancer, neuro-pharmacological, antihyperglycemic, hepatoprotective, immunomodulatory, antiarthritic, antiulcer, cardioprotective etc., properties. Many of these pharmacological activities are attributed to their antioxidative and anti-inflammatory effects, as well as their ability to modulate various signalling pathways and enzymes [68].
Brahmi (Bacopa monnieri) Family: Plantaginaceae	Brahmi is a highly valued Ayurvedic herb known for its wide-ranging benefits, particularly in supporting memory, reducing stress, and protecting brain health. Incorporating Brahmi into a wellness routine, with guidance from a healthcare provider, can be especially beneficial for enhancing cognitive function and mental well-being. The primary phytochemicals in B. monnieri are known as bacosides (triterpenoid saponins); there are 12 identified analogues of bacosides. The plant also contains several alkaloids, including brahmine, apigenin, herpestine, hersaponin, plantainoside B, monnierasides I–III, cucurbitacin etc. The methanolic extract of B. monnieri exhibits radical scavenging properties, which help protect against DNA cleavage. Additionally, it is believed to offer antioxidant, anti-stress, anti-inflammatory, cognition-enhancing, immunomodulatory, and anti-ageing effects [69].
Goksura (Tribulus terrestris) Family: Zygophyllaceae	Gokshura has long been utilized in both Indian and Chinese traditional medicine for treating a range of diseases. It grows widely across India, reaching elevations of up to 11,000 feet in Kashmir, and is also found in Ceylon and warm regions worldwide. This small shrub stands 10-60 cm tall with a hairy and silky texture. The fruits and roots of Gokshura are primarily used in folk medicine for various ailments. Various parts of Gokshura are rich in medicinal compounds, including flavonols, flavonoids, glycosides, steroidal saponins, and alkaloids. It possesses multiple therapeutic effects, such as diuretic, antiurolithic, immunomodulatory, antidiabetic, cardiotonic, hepatoprotective, anti-inflammatory, analgesic, antispasmodic, anticancer, antibacterial, anthelmintic, larvicidal, anticarcinogenic etc. properties [70].
Bhallataka (Semecarpus anacardium) Family: Anacardiaceae	Bhallataka, commonly referred to as the 'marking nut', is widely distributed across the sub-Himalayan regions, as well as tropical and central India. This medium sized, deciduous tree, growing up to 15-25 meters, is found in the outer Himalayas and warmer areas of India, up to 3500 feet elevation. It is particularly abundant in regions like Bihar, Assam, West Bengal, Odisha, central India, the western peninsula, the East Archipelago, and Northern Australia. The tree has grey bark that flakes off in small, irregular pieces and holds significant medicinal value in Ayurveda and Siddha. Chemical and phytochemical studies on its nut showed the presence of flavonoids, phenolics, bhilawanols, minerals, vitamins, and amino acids. Nut extract formulations effectively treat various health conditions, including arthritis, tumours, infections etc. [71].
Chitraka (Plumbago zeylanica) Family: Plumbaginaceae	Chitraka, a perennial herb, is often seen in areas like U.P, West Bengal, Maharashtra and South India. It is one of the oldest herbs reported to be used in Ayurveda for several disorders over thousands of years. It is rich in secondary metabolites like alkaloids, flavonoids, naphthoquinones, glycosides, saponins, steroids, terpenoids, coumarins, phenolic compounds, tannins, carbohydrates, fixed oils, fats and proteins. It possesses antibacterial, anti-plasmodial, antitumor, hepatoprotective, CNS-stimulating, antifungal, anti-inflammatory, antihyperglycemic anticancer and anti-atherosclerotic effects. Plumbagin, chitranone, 3-biplumbvagin, chloroplumbagin, elliptone, seselin, plumbaginic acid, ?-sitosterol etc. are the major compounds present in Chitraka, with plumbagin being the most significant bioactive compound [72].
Vidanga (Embelia ribes) Family: Myrsinaceae	Vidanga has long been valued in traditional medicine for its numerous therapeutic effects, including analgesic, antioxidant, anthelmintic, antibacterial, anticancer, antidiabetic, antihyperlipidemic, wound healing, and anti-spermatogenic activities. This plant is widely found in Southeast Asian countries like Cambodia, India, Laos, Malaysia, Sri Lanka, Thailand, Vietnam, South China etc. Embelin, a significant bioactive compound found in the Embelia genus, is noted for its hepatoprotective, anti-inflammatory, antioxidant, radioprotective, anticancer, antimitotic, contraceptive, anti-infective, antihyperlipidemic, anti-spermatogenic, antihyperglycemic, analgesic, antipyretic, and wound healing properties. Among its diverse biological effects, pharmacological studies have highlighted its potent anti-tumour, antioxidant, and anti-inflammatory activities [73].
Varahi (Dioscorea bulbifera) Family: Dioscoreaceae	Varahi, a tuberous rooted climber plant commonly called air potato, is an important medicinal plant used to treat many diseases. The tuber is edible when it is boiled or cooked. One teaspoon of tuber powder, when taken orally with water, is a single-dose cure for abdominal ailments. Known for its ability to lower the glycemic index, Varahi has a significant role in managing diabetes and obesity. In traditional Indian and Chinese medicine, it is widely used in the treatment of goitre, sore throat, gastric cancer and rectal carcinoma [74].
Guduchi (Tinospora cordifolia) Family: Menispermaceae	Guduchi, commonly known as Amrita or Giloy, is abundantly available all over India. Although nearly all plant parts are utilized in traditional medicine, the leaves, stems, and roots hold the greatest medicinal significance. Chemical investigations showed it contains alkaloids, terpenoids, lignans, glycosides, steroids, aliphatic compounds, essential oils, fatty acids, polysaccharides etc. Cordiofoliosides, tinosporine, tinosporide, ?-sitosterol, berberine, etc., are the major phytoconstituents of T. cordifolia. Its pharmacological activities include anti-cancer activity, anti-oxidant activity, immunomodulatory activity, inflammatory activity, antipyretic activity, anti-diabetic activity, etc. [75]
Haridra (Curcuma longa) Family: Zingiberaceae	Haridra, or turmeric, has a rich history of medicinal use in Unani and Ayurveda systems for conditions like hepatic disorders, jaundice, ulcers, and inflammation. The tuberous rhizome is the most important part of Haridra, which assumes a yellowish-brown colour with a dull orange on the inside upon maturation. It is also traditionally used for coughs, colds, dental issues, skin infections, blood purification, and other ailments. Curcumin, the key bioactive compound, is recognized for its therapeutic properties, such as antioxidant, anti-inflammatory, anticancer, hepatoprotective, neuroprotective, and cardioprotective effects [76].
Daruharidra (Berberis aristata) Family: Berberidaceae	Daruharidra is an upright, thorny, deciduous shrub that grows up to 3.6 meters tall and is native to the Himalayas, growing at elevations between 1,000 and 3,000 meters, and can also be found in the Nilgiri Hills of southern India at elevations ranging from 1,000 to 2,400 meters. This shrub is primarily used to treat eye diseases, skin disorders etc. Clinical and experimental research has demonstrated that B. aristata possesses anti-inflammatory, antioxidant, hepatoprotective, and immunomodulatory properties. Berberine, oxy-berberine, protoberberine, bis-isoquinoline, karachine, oxyacanthine, taxilamine, palmatine, tetrahydropalmatine, etc., are the major constituents of Daruharidra [77].
Bakuchi (Psoralea corylifolia) Family: Leguminosae	Bakuchi holds a significant therapeutic value in both Ayurveda and Chinese medicine. It is an annual, erect herb that grows to a height ranging from 30 to 180 cm, requiring a warm environment with ample sunlight. P. corylifolia exhibits cardiotonic, vasodilatory, antitumor, antibacterial, cytotoxic, and anthelmintic activities. Traditionally, it is used to treat conditions such as alopecia, inflammation, leukoderma, leprosy, psoriasis, and eczema. Approximately 100 bioactive compounds have been isolated from its seeds and fruits, predominantly belonging to the coumarin, flavonoid, and meroterpene groups. Psoralen, isopsoralen, corylin, corylifolin, psoralidin etc., are the major phytocompounds in Bakuchi [78].
Aragvadha (Cassia fistula) Family: Caesalpiniaceous	Cassia fistula is a medium-sized deciduous tree that grows up to 9 meters in height with spreading branches. Its bark is smooth and ranges from light to dark brown. Fistucacidin, barbaloin, rhein, Sennoside-A and B, sitosterol, fistulic acid, etc., are the major phytoconstituents in C. fistula. The plant exhibits various pharmacological activities, which include antifungal, antipyretic, analgesic, antioxidant, antitumor, antimicrobial, larvicidal, anti-inflammatory, hepatoprotective, hypo-glycaemic activities etc. [79].
Kustha (Saussurea lappa) Family: Asteraceae	Kustha, commonly known as Kuth root or costus, is well known for its traditional medicinal uses. It is a tall, sturdy, perennial herb that grows upright to a height of 1–2 meters with an erect stem. Costunolide, Isodihydrocostunolide, dehydrocostus lactone, cynaropicrin, (+)-germacrene A, lappadilactone, Saussureamine A-E, saussureal etc., are the major phytocompounds present in S. lappa. Its pharmacological activities include angiogenesis effect, anti-bacterial activity, anti-cancer activity, anti-convulsant activity, anti-inflammatory activity, anti-ulcer activity, anti-viral activity, anti-hepatotoxic activity, anti-microbial activity etc. [80].
IndraYava (Holarrhena antidysenterica) Family: Apocynaceae	IndraYava, commonly known as Kutaj, is mainly found in tropical and subtropical regions of the Asian and African sub-continent and India, mainly in the Himalayan ranges. In India, Kutaj holds significant traditional and folklore importance. Conarrhimine, conamine, conimine, conessimine, iso-conessimine, norconessine, kurchine, dimethyl conkurchine are the main phytoconstituents of Kutaj. Its pharmacological activities encompass anti-bacterial activity, antidiabetic activity, antihyperlipidemic activity, cytotoxic activity, anti-plasmodial activity, antidiarrheal activity etc. [81]
Patha (Cyclea peltata) Family: Menispermaceae	C. peltata, commonly known as Pata root in English, is a climbing shrub abundantly found in Southern India. Roots and leaves are the most useful parts of this plant. Cycleapeltine, cycleacurine, cycleadrine, cycleanorine, tetrandrine are the major phytoconstituents of C. peltata. Its pharmacological activities encompass anti-bacterial activity, anti-ulcerative effect, larvicidal, neuropharmacological effect etc. [82]
Khadira (Acacia catechu) Family: Fabaceae	It is a deciduous tree and has been extensively utilized in Ayurveda for years to treat and prevent various diseases and disorders. Protocatechuic acid, catechin, epicatechin, epicatechin gallate, taxifolin, epigallocatechin, gallic acid, procyanidin, L-arabinose, D-rhamnose, D-galactose, afzelechin, quercetin are the major phytoconstituents present in Khadira. Its pharmacological properties include antimicrobial, antidiarrheal, antinociceptive, antihyperlipidemic, antiulcer, antioxidant, antidiabetic, antiproliferative, haemolytic, and anti-inflammatory properties, which may be attributed to the presence of alkaloids, flavonoids, and tannins [83].
Asana (Pterocarpus marsupium) Family: Fabaceae	Asana is a deciduous tree which can grow up to 30 meters and has been extensively utilized in Ayurveda for years to treat and prevent various kinds of ailments. Pterosupin, pterostilbene, liquiritigenin, isoliquiritigenin, epicatechin, kinotannic acid, kinoin, marsupol, marsupinol, carpusin are the primary phytoconstituents of P. marsupium. Its pharmacological activities include anti-diabetic activity, antioxidant activity, inflammatory activity, cardiotonic activity, antibacterial activity, analgesic activity etc. [84]
Bhringraj (Eclipta alba) Family: Asteraceae	Bhringraj, also known as False Daisy, is well known for its diverse therapeutic applications. This medicinal plant is rich in phytochemical compounds that contribute significantly to health care. Coumestans, flavonoids, alkaloids, glycosides, triterpenoids, phenolic acids, saponins, sterols, sesquiterpene lactones, amino acids, proteins, carbohydrates, etc., are the major class of phytocompounds present in E. alba. Because of its rejuvenating effects on the mind and nervous system, it supports liver function, enhances body circulation, and promotes skin health. Its pharmacological activities include analgesic, antioxidant, anti-bacterial, anti-viral, anti-cancer, anti-myotoxic, antihyperglycemic, and immunomodulatory activities [85, 86].
Lauha Bhasma (Calcined iron)	Lauha Bhasma is a traditional Ayurvedic preparation created by purifying and incinerating iron through a process known as "bhasmikarana." This method involves extensive heating and purification, resulting in a fine, ash-like substance with high bioavailability, making it readily absorbable by the body. In Ayurvedic medicine, Lauha Bhasma is highly regarded for its therapeutic qualities, particularly as a hematinic that helps increase haemoglobin levels and red blood cell count. It is commonly used to address anaemia, fatigue, and general weakness. Additionally, it is valued for its rejuvenating, anti-inflammatory, and anti-diabetic properties, and it is often used to enhance immunity and promote skin health. Depending on the preparation, Lauha Bhasma contains trace amounts of iron and may include minerals like calcium and potassium, further supporting its health benefits [87].
Sharkara (Sugar)	Sugar, referred to as Sharkara in Ayurveda, has been a significant natural substance with medicinal and cultural relevance for centuries. It is utilized in preparations like syrups, tablets, and decoctions, acting as a binder, preservative, or main ingredient. Sugar is derived mainly from Saccharum officinarum (sugarcane) and involves processes like milling, heating, and crystallization. Chemically it is sucrose (C12H22O11) and other carbohydrates, contributing to its sweetness and energy content. [88]

       
           
       
Figure 2: HPTLC fingerprinting profile of PNC (Ref: Int J Pharm Chem Anal 2022; 9(4):174-183)

Table 11: R_f values

Clinical studies carried out with Panchanimba Churna

PNC is an Ayurvedic drug known for its potency to combat various kinds of skin ailments. Comprehensive clinical trials on PNC have not been widely performed and documented in medical databases. Ayurvedic formulations are often supported by traditional use and anecdotal evidence or folklore of their effectiveness; there is generally a lack of rigorous clinical trials that adhere to modern scientific standards. Below, we furnish a few case studies mentioned in some research articles to shed light on the clinical study carried out with PNC.

Clinical Study 1

Angadi and Gowda from Shri J. G. C. H. Society's Ayurvedic Medical College, Karnataka, India and Government Ayurvedic Medical College, Karnataka, India performed a clinical trial on the management of Vyanga (facial melanosis) with Arjunatwak Churna and PNC [92].  They used Arjunatwak Churna and PNC as trial drugs for tropical application and oral administration, respectively. A total of 30 patients with Vyanga were selected from the OPD and IPD of the Shalakya Tantra Department and randomly assigned to two groups. Group A patients received external application (lepa) of Arjunatwak Churna and honey for 3 weeks. Group B patients received PNC orally for 3 weeks in addition to the topical application of Arjunatwak Churna. The effect of the therapy on bluish-black pigmentation showed a 60% reduction in Group A and an 80% reduction in Group B. The clinical study demonstrated that combined therapy yields better results than topical treatment alone.

Clinical Study 2

The clinical trial was performed by Salunkhe et al. to assess the effectiveness of PNC and Gandhak Pishti in treating Vicharchika W.S.R to Eczema [93]. The study included 10 patients who were administered PNC internally with ghee and Gandhak Pishti externally with mustard oil for local application over a 60-day duration. The findings demonstrated substantial improvement in symptoms such as itching, lesions, and oozing. All patients experienced complete relief from itching, showcasing the efficacy of PNC, which, due to its hot potency (ushna virya) and bitter taste (tikta rasa), acts as an anti-itch (kandughna) and anti-skin disease (kushtaghna) agent. Likewise, Gandhak Pishti, with its hot and oily properties, also contributed to alleviating symptoms. The clinical study found that the combination of internal and external treatments significantly relieved the symptoms of Vicharchika, with no reported side effects.

Clinical Study 3

Thiyagaraj et al. reported that this clinical trial was performed on a 54-year-old male suffering from typical symptoms of plaque psoriasis covering his body for the last five years [94]. The treatment plan included Samshodhana (therapeutic purgation) followed by Sanshamana (specific internal medication) using Shuddha Gandhaka, PNC, Panchatikta Ghrita, and Aragvadha Phala-Majja Kwatha. The Psoriasis Area and Severity Index (PASI) score significantly decreased from 65.7 to 0.9, with no recurrence of symptoms even after discontinuing treatment for the past two years, showcasing the effectiveness of this approach.

Clinical Study 4

Dhurve et al. conducted a clinical trial to assess PNC and Arka taila's efficacy in treating Vicharchika (eczema) [95]. Participants were divided into three groups: Group A received PNC (3 grams twice daily with lukewarm water), Group B received Arka taila (applied externally twice daily), and Group C received both treatments and the treatment period lasted for 28 days, with weekly follow-ups. The study measured reducing Vicharchika symptoms, such as itching, discolouration, redness, pain, dryness, and bleeding. Results indicated that Group C, which received the combined treatment, showed the most significant improvement across all symptoms, with high statistical significance (p < 0>Arka taila was particularly effective in managing Vicharchika without causing adverse effects, highlighting the potential of these Ayurvedic treatments for skin conditions.

Clinical Study 5

Shivani et al. conducted this clinical study at the Institute of Post-Graduate Ayurvedic Education & Research at Shyamadas Vaidya Shastra Pith Hospital, India with 60 patients suffering from Vicharchika [96]. These patients were divided equally into two groups. Group A received treatment consisting of Shodhana Chikitsa (Virechana karma) using Trivrit Churna at a dose of 10 g, along with Shamana Chikitsa involving PNC and Amalaki Churna (2.5 gms each) taken twice daily after meals with lukewarm water. Local application of a mix of Gandhak (1 part), Tankan (1/4^th part), and Chalmoogra taila was also applied for 3 months. In Group B, patients were treated similarly but without Shodhana Chikitsa for the same period. The results showed significant improvement in patients in Group A. This study showcases that PNC and Amalaki have a role in symptom relief, with Virechana karma crucial for managing Vicharchika.

Clinical Study 6

Gupta et al. reported this report of a clinical study on a 60-year-old female patient suffering from Vicharchika (eczema) [97]. The patient experienced recurrent skin rashes, redness, skin edema, blistering, cracking, oozing, and bleeding on both hands for the last two years. Aarogyavardhini Vati, Panchatikta Ghruta Guggulu, Gandhak Rasayan, Vidangarista and Khadirarista, a decoction of Guduchi, Lodhra, Patol, Sariva, PNC, Kiratikta were given as internal medicine. In contrast, Prakshalana with Panchwalkal Kwath and Doshaghna pack (Anubhoot yoga) were prescribed as an external medicine. After eight days of treatment, the patient experienced significant relief from all symptoms, with only blackish discolouration remaining. The study concludes that PNC, with other ayurvedic medicines, can successfully manage eczema without complications and side effects.

Clinical study 7

Badeghar et al. reported this clinical study, which encompasses the investigation reports on the effectiveness of Avipattikara Churna and PNC in managing Amlapitta (hyperacidity) [13]. 40 patients were equally divided into groups A and B. Patients in group A received Avipattikara Churna, and those in group B received PNC. In both cases, the dosage is 6 g twice daily for a month (30 days). Group A patients used milk as anupan, and group B patients used cold water as anupan. The symptoms found in the patients are indigestion, heaviness, heartburn, etc. This treatment was continued for 30 days. Table 13 documents the results after 30 days of treatment.

Table 13. Effect of Avipattikara Churna and PNC

*  ?: reduction

Both treatments demonstrated significant improvements in symptoms but Avipattikara Churna was more effective than PNC in managing hyperacidity.

Side effects of Panchanimba churna

The amount of work done by researchers with PNC, whether pre-clinical or clinical studies, is much less. So, based on those reports, it is very difficult or baseless to conclude anything regarding the side effects of PNC. But at the end of the day, PNC is a drug/medicine which contains plenty of chemicals (phytochemicals) of different classes which might have some adverse effects if one takes it. So, some standard precautions should be taken to avoid any adverse situations. Following is the list of some precautions-

• Self-medication is strictly prohibited.
• Careful medical supervision should be followed.
• People with diabetes, high blood pressure, heart conditions, obesity, pregnant or breastfeeding women, and children should use this medication only under a doctor's supervision.
• Excessive use may cause gastritis, so doctor consultation is a must.
• Should be stored in a cool, dry place.
• Should be kept out of reach of children.

Conclusion And Future Planning

This review underscores the diverse therapeutic potential of PNC in addressing 'Kushta'. By thoroughly examining recent research and traditional Ayurvedic literature, it is clear that PNC possesses notable anti-inflammatory and antioxidant qualities. These characteristics affirm its effectiveness in treating skin disorders and highlight its value as a safe and natural therapeutic option. Nonetheless, additional clinical studies are needed to confirm these results and determine the best dosages form and long-term effects or side effects. PNC emerges as a promising candidate for further investigation, aiming to merge Ayurvedic principles with modern scientific practices. This study reinforces the confidence in herbal remedies derived from natural sources to combat infectious diseases and other ailments, suggesting they may be incorporated into future medications. The literature does not provide any report on the assay of marker compounds in the PNC formulation. Also, there is no report regarding the formulation's shelf-life study (accelerated or real-time). So, further investigation and research in this field are required to bridge these gaps and for proper scientific validation regarding the activities of PNC.

ACKNOWLEDGEMENT

The authors express their gratitude and appreciation to the Director General & Deputy Director General, CCRAS, New Delhi, for sanctioning this project (HQ-PROJ011/86/2024-PROJ) and providing the facilities at the Central Ayurveda Research Institute, Kolkata, to undertake it. Last but not least, the authors want to show their gratitude to all the supporting staff who directly and indirectly assisted in successfully executing this review article.

Financial support and sponsorship

Financial support from CCRAS HQ. is gratefully acknowledged.

Conflicts of interest

There are no conflicts of interest.

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