Category: Skin Health

August 1, 2023

Capillary Hemangiomas Treatment in Ayurveda with Herbal Remedies

ABSTRACT

Hemangiomas or infantile hemangiomas are the non cancerous growth of the blood vessels which are found on the skin. The blood vessels are the components of the circulatory system which transports the blood throughout the body. It transports cells, nutrients and oxygen to the tissues of the body, sustains life as body tissues rely on functions. There are usually five types of blood vessels- arteries (which carry blood away from heart), The arterioles, Capillaries (where exchange of water and chemicals occurs), The venules, Veins (which carry blood from capillaries back towards the heart). Some structures such as cartilage, cornea of eye, lens and epithelium do not contain blood vessels and hence are avascular. The arteries and veins have three layers- The inner layer (is the thinnest layer), middle layer (thickest layer in arteries) and the outer layer (thickest layer in veins). Blood vessels connect to form a diffuse vascular supply known as anastomosis. Main function is to transport blood throughout the circulatory system. The arteries transport oxygenated blood from lungs to body and veins transport deoxygenated blood from body to lungs. Usually blood is propelled through the arteries and arterioles through pressure which is generated by heartbeat. In this article we are going to discuss its causes, treatment, and ayurvedic management of Capillary Hemangiomas.

Capillary Hemangioma

INTRODUCTION

Hemangioma is a benign vascular tumor which is derived from the blood vessels cells, and most commonly seen in infants so known as infantile hemangioma. It is also known as the Strawberry mark which is present at the birth time or usually in the first weeks of life. It can occur anywhere in the body such as on the face, scalp, chest and back. Hemangioma looks like a rubbery lump which is made up of extra blood vessels in the part of the skin. They are usually harmless and they tend to resolve on their own. It is made up of rapidly dividing cells of the blood vessels (endothelial cells). About 75% of people aged above 75 or older have cherry hemangioma. Hemangiomas are common, non cancerous tumors which can be removed by surgery and don’t come back. When a hemangioma disappears it leaves skin scarred and pigmented. It can grow anywhere in the body which are common and harmless. The size and appearance of the hemangioma varies as some are white, bluish soft mass under the skin. Infantile girls are more prone to this condition as compared to boys.

FACTS

  • It is the extra growth of blood vessels formed on the skin, scalp and any part of the body.
  • The main symptoms include are bright red color bumps and patches on the surface of the skin
  • It may include treatment such as beta blockers and laser dye to remove hemangiomas.
  • Capillary hemangioma is a vascular anomaly, which leads to overgrowth of small blood vessels in normal tissues.
  • Nearly 10% hemangioma is seen in children’s orbit and eyelids, an account of nearly one in ten cases.

TYPES OF HEMANGIOMAS

There are two types of hemangiomas

1. Capillary Hemangioma

Infantile hemangiomas (strawberry hemangioma)

These are common growth of the blood vessels and more commonly seen in childrens, 12% of the babies by their first year. They look like a red bulge on the skin which grows normally between 1 quarter to some inches in size. Sometimes they are related to some disorders such as in the nervous system or in the spine. It may also be seen in the liver and brain.

Cherry hemangiomas

They are small, dot-like red blood vessels found on the torso. They are very common in adults and they are found in groups of a few dozen.

2. Cavernous Hemangioma

They form in the deeper layers of the skin, often seen around the eyes. They look like clusters of wide blood vessels which appear red to dark blue under the skin. It can lead to various problems regarding eye development such as amblyopia, cataracts.

Histopathology of Infantile Hemangioma

It has triphasic evolution

  • Early proliferative or growth phase- There is rapid growth during the three months, deep infantile hemangioma tends to proliferate for a longer period of time.
  • Plateau Phase- This lesion remains stable and for some period of months.
  • Involution Phase- This phase is seen within the first year of life, continuing for several years. This hemangioma is softer, more compressible and the colour is red to purple. There are many residual changes such as fibrofatty tissue, skin laxity.

CAUSES

Hemangiomas are caused by the blood vessels which do not form properly. They grouped together into a dense clump.

SYMPTOMS

Hemangiomas of the skin usually appear as small red bumps, as they grow they look like burgundy color birthmarks. Sometimes the internal organs are present inside the body. It mainly affects gastrointestinal tract and liver such as

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fullness of the abdomen

In a child’s first year, red marks grow rapidly into spongy, rubber-like bumps which stick out of the skin. When hemangioma enters a rest phase it begins to disappear slowly.

DEVELOPMENT OF HEMANGIOMAS

1. On the skin

There is abnormal proliferation of blood vessels in one area of the body. It forms in the top layer of the skin or sometimes in the fatty layer which is a subcutaneous layer. They are not usually present at birth.

2. On the liver

They are hepatic hemangiomas, on the surface of the liver. The non infantile hemangiomas of the liver are sensitive to estrogen. The excess estrogen can spur the growth of the liver and during pregnancy it can increase the size of hemangiomas.

Besides the skin and liver hemangiomas can grow within body such as

  • Kidneys
  • Colon
  • Brain
  • Lungs

DIAGNOSIS

  • Ultrasound
  • MRI
  • CT Scan

DIFFERENTIAL DIAGNOSIS

  • Congenital hemangioma
  • Pyogenic granuloma
  • Venous malformations
  • Malignant tumors such as sarcoma, neuroblastoma
  • Tufted hemangioma
  • Port wine stain

TREATMENT

1. Beta Blockers Drugs

In small superficial hemangiomas a gel (Timolol) can be applied to the affected area, severe infantile hemangioma is treated with oral solution of propranolol.

2. Corticosteroid Medications

It is injected into the nodule and directly applied to the skin

3. Laser Surgery

It removes the thin hemangioma and treats the sore on hemangioma.

COMPLICATION

  • Ulceration it include anogenital area, axilla and neck
  • Ophthalmologic complication such as tear duct obstruction, amblyopia
  • Airway obstruction in nasal, subglottic passages
  • Difficulties in feeding
  • Cosmetic disfigurement include large facial area
  • PHACES syndrome
  • LUMBAR syndrome with lumbosacral hemangiomas, myelopathy, anorectal arterial and renal anomalies.

AYURVEDIC MANAGEMENT

In ayurveda Capillary hemangioma is correlated with Raktavahyanarbud. These arbud (tumors) are sehaj (congenital) and sudamarbud (benign tumors). The benign tumors are devoid of suppuration and formed by meda (tissues which involve fat), kapha (blood vessels which are primarily involved). They are steady in nature and have a cyst like appearance. As it has cutaneous appearance, the birthmark is related to nayagach, which is described as minor skin disorders which is congenital and has brown, black birthmarks which are black in color and are often painless. If the dhatus and body tissues are not in equal proportion it is meant to be diseases, and dhatus aggravate leads to imbalance. The imbalance of agni is the main reason for the disproportion of seven dhatus. In arbud attack the uncontrollable development of cells varies the growth and rate.

HERBS USEFUL FOR CAPILLARY HEMANGIOMA

HARIDRA

Haridra (Curcuma longa) is useful and famous ayurvedic herb which has tikta katu rasa, katu vipaka and ruksha guna which helps to remove the blocked pathway of blood vessels makes the circulation of blood and passage of nutrient easy, maintains the normal blood functioning. It has immune modulating action and has antioxidant properties. Haridra restores the haematopoietic functions and removes the blockage in the liver.

VARUNA

Varuna (Crataeva nurvala) is a famous diuretic herb which is useful in migraine, intestinal worms and in renal calculi. It has ushna veerya, balances kapha and vata dosha and is light (laghu) to digest. It is a useful herb in abdominal tumors and in blood disorders. Useful herb in vata disorders such as paralysis, neuralgia. Its bark is useful in the treatment of liver and spleen disorders and in various skin disorders.

TEJAPATRA

Tejapatra (Cinnamomum tamala) is an herb used in the treatment of bad odor from mouth, dental caries and in tuberculosis. It has katu (pungent), tikta (bitter) taste. Has ushna veerya and helps to reduce the vitiated kapha and vata dosha, and increases pitta dosha. It is helpful in rhinitis, anorexia and in itching. Helps to reduce palpitation, improve lung capacity and is used as an appetizer which improves digestion.

KANCHNAAR

Kanchnaar (Bauhinia variegata) is an ayurvedic herb used in the treatment of thyroid, cervical lymphadenitis. It has Laghu (light to digest), rooksha (dry) qualities. It has sheetal veerya and relieves kapha and pitta dosha. It is a useful herb in the treatment of bleeding disorders, menorrhagia, in various skin diseases. It helps to relieve worm infestation, in rectal prolapse condition.

HERBAL REMEDIES FOR CAPILLARY HEMANGIOMA BY PLANET AYURVEDA

Planet Ayurveda is a GMP certified clinic which formulates their own herbal remedies and is used in every health condition. These formulations are prepared under the strict guidance of M.D experts. These remedies are free from any preservatives, resins and any other artificial synthetic material. These remedies are 100% pure and are used without causing any side effects. For this purpose planet ayurveda provided many herbal remedies which provided great relief.

PRODUCTS LIST

  1. Kanchnaar Guggul
  2. Graviola Capsules
  3. Boswellia Curcumin
  4. Nirgundi Oil

Herbal Remedies for Capillary HemangiomaBuy Now: Herbal Remedies for Capillary Hemangioma

PRODUCTS DESCRIPTION

1. Kanchnaar Guggul

Kanchnaar Guggul are herbal tablets formulated by planet ayurveda using ingredients such as Kanchar Bark (Bauhinia variegata), Haritaki (Terminalia billerica), Cardamom (Elettaria cardamomum), Guggul (Commiphora mukul). These tablets help in reducing cancerous growth and provide nourishment to the affected area. Useful in Goitre, cysts, tumors and in various skin diseases.

Dosage- 1-2 tablets twice daily with lukewarm water.

2. Graviola Capsules

Graviola Capsules are single herbal capsules which are formulated by planet ayurveda using ingredients such as Graviola (Annona muricata). These capsules have various properties such as Anti bacterial, anti mutagenic, and have acetogenin constituent which is helpful against every cancer cell. Helps to boost the immune system and has an effect on tumors.

Dosage- 1-2 capsules twice daily.

3. Boswellia Curcumin

Boswellia Curcumin is polyherbal capsules which are formulated by planet ayurveda using ingredients such as Shallaki (Boswellia serrata), Curcumin (Curcuma longa). It is very helpful in treating joint disorders and in inflammatory diseases. It helps to pacify the doshas and helps in removing the toxins from the body, providing good blood functioning.

Dosage- 1 capsule twice daily with plain water after meals.

4. Nirgundi Oil

Nirgundi Oil is herbal oil formulation prepared by planet ayurveda using ingredients such as Tila Oil (Sesamum indicum), Manjistha (Rubia cordifolia), Kalahari (Gloriosa superba) and many more. This helps to treat many pain disorders and it has katu (pungent) Vipaka, with hot potency. Nirgundi oil acts as a analgesic, in female ailments and premenstrual syndrome. It is useful in many inflammatory conditions.

Method of applications- Apply over the affected people twice daily.

Contact Planet Ayurveda Support Team to provide you the costing / ordering and delivery information at – costing.planetayurveda@gmail.com or Call at 0172-521-4040 (India), +91-172-521-4040 (Outside India) or Whatsapp at (+91) 9915-593-604

CONCLUSION

Hemangiomas or infantile hemangiomas are the non cancerous growth of the blood vessels which are found on the skin. The blood vessels are the components of the circulatory system which transports the blood throughout the body. It is also known as the Strawberry mark which is present at the birth time or usually in the first weeks of life. It can occur anywhere in the body such as on the face, scalp, chest and back. Hemangioma looks like a rubbery lump which is made up of extra blood vessels in the part of the skin. Planet Ayurveda provides many herbal remedies which will provide great relief without causing any side effects and maintain a healthy living.

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August 1, 2023

Ayurvedic View on Gua Sha- A Traditional Chinese Healing Method

DESCRIPTION

Gua Sha is a traditional Chinese healing method that is used by professionals. It is a smooth-edged shaped tool which helps improve circulation. It scrapes the skin with short or long strokes which stimulates microcirculation and thus increases the flow of blood. It was first referred to in classical textbooks called Shang Han Lun dated 200 CE. In Chinese, it is commonly known as Gua Sha in Indonesia, it is Kerokan. Is a tool which is used to scrape the skin in order to lighten the Petechiae. The latest and greatest trend is the beautiful crystal which is one of the oldest treatments of Chinese medicine. It is helpful in treating chronic pain which is present all over the body and it is performed alongside various complementary treatments such as Herbal medicine, Acupuncture and Heat Therapy.

Gua Sha- Traditional Chinese healing method

HISTORICAL OUTLOOK- THE BEGINNING OF GUA SHA

Gua Sha was practiced in the Paleolithic Age when the hands and stones are rubbed over the various parts of the body to alleviate the pain and was widely used in the Ming Dynasty (1368-1644) by ancient Chinese. Depending upon the Socioeconomic status, the various materials are used as a scraper. In China, they use copper, horns of animals, pointed stones and different metals are used in the form of Gua Sha.

DEFINITION OF GUA SHA

Gua Sha is defined as the scraping of illness, which involves a variety of tools and includes Bian Stone, Jade, Ox Horn and rubbing different parts of the body in one direction over and over again. Its main goal is to activate the circulation of blood and relieve various ailments and diseases. The Term Gua refers to Stroke and the term Sha refers to Reddish petechiae which appears on the skin. In Gua Sha there are pathways where the blood and Vital energies flow to the network and connect to the internal organs, thus stimulating the flow of blood and removing coldness and negative energy and promoting the lymphatic fluid from the body. There is a Gua Massage Tool which is a common technique of applying oil to the surface of the skin and this tool gets repeatedly scraped in a downward motion.

BENEFITS OF GUA SHA

  • Stimulates Circulation- It is helpful in stimulating circulation, which is helpful in easing and lowering the retention of fluid.
  • Helps in producing collagen- Gua is helpful in decreasing puffiness and softening wrinkles and fine lines by producing more collagen and brightening the complexion.
  • Decreases Inflammation- Gua Sha is helpful in relieving pain and tightness in the various parts of the body. Has anti-inflammatory actions.
  • Diminishes Dark Circles- It is helpful in softening fine lines and stimulates the collagen and temporarily tightens the skin.
  • Sculpts Facial Muscles- Useful in the jawline and cheekbone area which is helpful in releasing the tight facial skin and provides the temporary appearance of a more sculpted face.

POTENTIAL BENEFITS

  • Hepatitis B- It is helpful in lowering the amount of inflammation in the liver which is caused by the Hepatitis B virus.
  • Migraines- Gua Sha which is helpful in easing the migraine pain
  • Tourette’s Syndrome- This commonly affects the nervous system and causes sudden twitches, so Gua Sha is useful in improving the symptoms.
  • Neck Pain- In chronic neck pain, Gua sha is useful in providing ease of pain.
  • Perimenopausal Symptoms- In these hot flashes, Sleep Issues, Mood Swings and many symptoms are felt, so Gua Sha is useful in improving the symptoms.
  • Breast Fullness- It is helpful in easing pain and tenderness and thus makes breastfeeding easier.

TECHNIQUE

  • It involves repeated pressed strokes over the lubricated skin with smooth edged and a blunt instrument.
  • Skin is firmly lubricated with massage oil, In China Ceramic spoon, Well Worn Coin and a simple metal cap with a Blunt rounded edge are used.
  • In case of fatigue or in heavy manual labour the piece of ginger which is soaked in rice used to rub from top to bottom.
  • On the Face- It is helpful in increasing circulation and produces anti-ageing molecules, Collagen and Elastin. A polished Tool which is made from quartz is useful for massaging. Collagen will decrease wrinkles and elastin and keep the face firm, helpful in detoxification. Promotes lymphatic drainage.

1. Reduces puffiness around eyes

  1. Lubricate the eye area with oil
  2. Then use gua sha over the under-eye area to the hairline part.
  3. Repeat this process thrice daily from the inside corner of the brow to the temple area.

2. Promotes lymphatic drainage

  1. Start from the chin, then move the gua sha along the jawline and move up to the ear region.
  2. Move it behind the ear and below the neck
  3. Daily repeat it three times a day.

3. To relieve Tension in Head Region

  1. Start from the middle region of the forehead and move outwards the temple and to the hairline
  2. Repeat it as many times as possible.

4. To Contour and De-puff Nose

  1. Move the Gua Sha tool up to the bridge of the nose
  2. Then bring it down along the side of Nose to the cheek region
  3. Repeat it thrice daily

5. To Contour and De-Puff the Chin

  1. Move the Gua sha tool from the middle of the chin to the jawline portion towards the ear
  2. Repeat it three times a day.

6. To Firm the Decolletage

  1. Start from the outer corner of the jaw near the ear lobes
  2. Then move it down to the neck above the collar region
  3. Repeat it three times a day.

ADVANTAGES OF APPLYING GUA SHA IN FACIAL TECHNIQUES

  1. Skin renewal
  2. Reduces inflammation and puffiness
  3. Smoothens the fine lines and wrinkles
  4. Boosts the collagen and elastin
  5. Promotes luminous skin tone
  6. Helpful in flushing out excess toxins and fluids

Sun and Liu both are advised by Gua Sha to form a self-care at home which is useful in stimulating the facial muscles and meridian which affects the blood flow and causes the bursting of the face which causes red and purple bruises. So Gua sha must be done with proper care in a sterile environment.

IN AYURVEDA

In ayurveda, Kansa is used as a healing metal. It is helpful in draining the lymph nodes which detoxifies and energises the skin. Gua sha which is made up of Kansa removes all the blockages, relieves stress and depuffs the facial muscles like a glass-like, glowing and sculpted face. If Copper is used in Gua Sha it has heat-releasing properties which balance all tridoshas of the body and removes dioxins from the body.

Regular Use

  1. Deeply restores and contours the face
  2. Lifts and provides tone to the facial muscles
  3. Increases elasticity and glass skin
  4. Treats Acne, Inflammation

KUMKUMADI TAIL

Kumkumadi Tailam is an Ayurvedic herbal oil preparation for face massage which is useful in improving the texture of the skin and relieves all the skin problems such as Acne, Scars. Kumkum is ‘Saffron’ which when sued with the Gua Sha tool balances the Tridoshas of the body as

  • Grounding, Nourishing and Warming of the Oil Balances The Vata doshas.
  • Cleaning, Cooling and a calming agent will be helpful in Balancing the Pitta doshas.
  • Energising, Motivating and activating are useful in balancing the Kapha doshas.

Kumkumadi Oil is a classical herbal oil formulation which contains various ingredients which are useful in improving the complexion and texture of the skin, when used with Gua Sha is useful in increasing the Circulation of blood and increases the production of collagen for youthful firmer skin.

VARIOUS INGREDIENTS ARE

No. Herb Used Latin Name Quantity

 No. Herb Used Latin Name Quantity
1. Rakta Chandan Pterocarpus santalinus 1.25%
2. Manjistha Rubia cordifolia 1.25%
3. Yashtimadhu Glycyrrhiza glabra 1.25%
4. Daruhaldi Berberis aristata 1.25%
5. Ushira Vetiveria zizanioides 1.25%
6. Padmaka Prunus puddum 1.25%
7. Vat Ficus benghalensis 1.25%
8. Kesar Crocus sativus 1.25%
9. Pipal Ficus religiosa 1.25%
10. Nagkesar Mesua ferrea 1.25%
11. Til Sesamum indicum 100%
12. Cow Milk 100%
13. Dashmool Powder 60%

Products List

  1. Rakta Chandan
  2. Manjistha
  3. Yashtimadhu
  4. DaruHaldi
  5. Ushira
  6. Padmaka
  7. Vat
  8. Kesar
  9. Pippali
  10. Nagkesar
  11. Til
  12. Cow Milk
  13. Dashmool Powder

PRODUCTS DESCRIPTION

1. Rakta Chandan

Rakta Chandan (Pterocarpus santalinus) is a heartwood powder useful in healing acne of skin and providing glowing skin. It helps balance the Kapha and Pitta Doshas and is useful in detoxifying the blood so useful in various bleeding disorders. Has Roopan property, rich in antioxidants which fight against free radicals and prevent gastric cell damage. Improves the skin complexion and stops the burning sensation thus clears wounds.

2. Manjistha

Manjistha (Rubia cordifolia) is a natural blood detoxifier which is useful in many skin diseases. It helps balance Kapha and Pitta doshas. Enhances the complexion of the skin, has healing properties and thus stimulates the liver and spleen. Boosts immunity and is useful in fighting against various infections. Improves the digestive fire as it has Deepan (appetiser) and Pachan (digestive) properties.

3. Yashtimadhu

Yashtimadhu (Glycyrrhiza glabra) helps promote longevity. Improves the complexion of the skin and colour. Heals ulcers and wounds. Enhances immunity which helps fight off viruses. Promotes longevity of life and heals wounds. Pacify the pitta and Rakta doshas. Has antimicrobial properties which fight against viral and bacterial infections.

4. DaruHaldi

Daruhaldi (Berberis aristata) has antifungal and antibacterial properties. Balances Pitta and Kapha doshas, Stimulates the digestive fire and heals wounds. Provides nourishment to the skin and regulates the metabolism of the body. Controls Heavy menstrual bleeding due to its astringent property.

5. Ushira

Ushira (Vetiveria zizanioides) is helpful in pacifying the Pitta doshas. Treats Gastric disorders improves the texture of the skin and makes skin glow. Relieves Ama doshas which dry the channels and are useful in various blood disorders such as abscesses. Provides strength to the stomach and removes all the impurities and toxins from the body.

6. Padmaka

Padmaka (Prunus puddum) manages various skin diseases and promotes skin to get brighter and makes it glow. Enhances Appetite and controls Nausea and vomiting. Useful in various skin disorders such as herpes and in discolouration of the skin. Alleviates the burning sensation and itching in the body.

7. Vat

Vat (Ficus benghalensis) commonly known as the Banyan tree is useful in various skin disorders and in Leucorrhea. It is helpful in reducing the vitiated Kapha and Pitta doshas. Improves skin tone and complexion and opens the blocked channels. It helps clean the cervix and uterus.

8. Kesar

Kesar (Crocus sativus) commonly known as Autumn crocus, is helpful in the functioning of the stomach and promotes its action. Has Antioxidants properties, which produce Red blood cells and controls the heart rate and blood pressure. It is helpful in Various skin disorders and is used for dressing bruises and superficial sores.

9. Pippali

Pippali is helpful in the treatment of skin diseases. Balances Vata and Kapha doshas. Improves digestion strength and is helpful with skin problems. Useful in various health conditions and fights against various bacterial infections. Oxygenates the body so it is good for various menstrual problems.

10. Nagkesar

Nagkesar (Mesua ferrea) is useful in various skin infections and in wounds. Has antiseptic and disinfectant properties which are useful in fading the dark marks for glowing skin. Prevents skin infections and reduces inflammation as it has anti-inflammatory properties. Improved Agni (digestive fire) reduces the effect of fever which indicates Ama doshas.

11. Til

Til (Sesamum indicum) is helpful in reducing swelling and increasing the healing of the skin. It makes the skin whiter by tone and makes you feel more youthful. It is a great moisturiser which nourishes the deep tissues and nourishes them. Rich in antioxidants as it has a thick texture. It has a powerful antioxidant property which prevents damage to cells.

12. Cow Milk

Cow Milk has lactic acid which is helpful in exfoliating the skin and reduces Tan, blemishes and various skin problems. Has anti-ageing properties which is a natural face cleanser. Treats dark spots treat various digestive issues. Relieves Dryness and Itchiness from the skin.

13. Dashmool Powder

Dashmool Powder is a natural cleanser which prevents dry skin. Has Anti-inflammatory and anti-oxidant properties and improves the functions which tone the muscle and soothe the nerves. Reduces swelling and balances tridoshas of the body. Neutralises the oxidative effect from the free radicals.

HOW TO USE

  • Take 3-4 drops of oil into your hands and apply the light coat of it on the facial and acne-prone area.
  • Do the gentle massage with fingers
  • Then leave it for 15-20 minutes and then wash it with lukewarm water.
  • Kumkumadi Oil is also used for face steaming and vapourisation.
  • 5-10 drops of oil are added to water then boil this water and steam is directed to the face for 10 minutes.
  • Then wash it with normal lukewarm water
  • It cleans the skin pores.

INDICATIONS

  • Dull and less complexion
  • Hyper-pigmentation
  • Blemishes
  • Freckles
  • Discoloured armpit

CONCLUSION

Gua Sha is a traditional Chinese healing method which is used by professionals. It is a smooth-edged shaped tool which helps improve circulation. There is a Gua Massage Tool which is a common technique of applying oil to the surface of the skin and this tool gets repeatedly scraped in a downward motion. In ayurveda, Kansa is used as a healing metal. It is helpful in draining the lymph nodes which detoxifies and energises the skin. Further, we discussed Kumkumadi Oil which are useful for all skin problems.

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