Journal of Ayurveda...Dr. Rashmi J. Ulli, Vaidya Shrinath M. New insights of Ayurveda formulation...

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan 1 Journal of Ayurveda A Peer Reviewed Journal Vol. XIII No 3 JUL - SEP 2019 CONTENTS Editorial Clinical Studies Editorial - Ethics in Clinical Practice Prof. Sanjeev Sharma Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In Shvitra. Dr. Saroj Choudhary, Dr. Rameshwar dudi , Dr. Sisir. Kumar Mandal, Prof. Pawan kumar Godatwar, Dr. S. K. Khandel A Conceptual And Clinical Study To Understand The Principle Of Sharira-Shaithilyata And Udakavaha Srotodushti W.S.R. To Kaphaja Prameha (Type II Diabetes Mellitus) Dr. Deepak Rahangdale, Prof. Baldev Kumar, Dr. Hetal H. Dave Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and Arka Tail’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial. Dr. Devesh Jaiman, Dr. Harish Bhakuni, Dr. Ajay Kumar Sahu, Dr. Puneet Bhargava Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu Dr. Jolly Sharma, Prof. Shshila Sharma A Comparative Study On Effect Of Bilvadi Yogaashchyotana And Haritaki Vidalaka In The Management Of Vataja Abhishyanda W.S.R. To Simple Allergic Conjunctivitis Dr. Kirti Kumar Akhand, Prof. Shamsa Fiaz A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma) Dr. Surendra kumar Sharma, Dr.Shrinidhi K.Acharya, Dr. Piyush Mehata Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma Efficacy of Sariva Ghanavati in Yuvan Pidaka Dr. Shveta Sahu, Dr. P. hemantha Kumar, Dr. Narinder Singh Dr. Anupama Shukla, Dr. Pankaj Kothari, Dr. C. R. Yadav, Prof. Om Prakash Dadhich 3 5 14 22 32 39 50 58 68

Transcript of Journal of Ayurveda...Dr. Rashmi J. Ulli, Vaidya Shrinath M. New insights of Ayurveda formulation...

Page 1: Journal of Ayurveda...Dr. Rashmi J. Ulli, Vaidya Shrinath M. New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian

Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan1

Journal of AyurvedaA Peer Reviewed Journal

Vol. XIII No 3 JUL - SEP 2019

CONTENTS

Editorial

Clinical Studies

Editorial - Ethics in Clinical PracticeProf. Sanjeev Sharma

Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In Shvitra.

Dr. Saroj Choudhary, Dr. Rameshwar dudi , Dr. Sisir. Kumar Mandal, Prof. Pawan kumar Godatwar, Dr. S. K. Khandel

A Conceptual And Clinical Study To Understand The Principle Of Sharira-Shaithilyata And Udakavaha Srotodushti W.S.R. To Kaphaja Prameha (Type II Diabetes Mellitus)

Dr. Deepak Rahangdale, Prof. Baldev Kumar, Dr. Hetal H. Dave

Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial.

Dr. Devesh Jaiman, Dr. Harish Bhakuni, Dr. Ajay Kumar Sahu, Dr. Puneet Bhargava

Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu

Dr. Jolly Sharma, Prof. Shshila Sharma

A Comparative Study On Effect Of Bilvadi Yogaashchyotana And Haritaki Vidalaka In The Management Of Vataja Abhishyanda W.S.R. To Simple Allergic Conjunctivitis

Dr. Kirti Kumar Akhand, Prof. Shamsa Fiaz

A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to

Vitiligo (Leucoderma)

Dr. Surendra kumar Sharma, Dr.Shrinidhi K.Acharya, Dr. Piyush Mehata

Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma

Efficacy of Sariva Ghanavati in Yuvan Pidaka

Dr. Shveta Sahu, Dr. P. hemantha Kumar, Dr. Narinder Singh

Dr. Anupama Shukla, Dr. Pankaj Kothari, Dr. C. R. Yadav, Prof. Om Prakash Dadhich

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5

14

22

32

39

50

58

68

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A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea)

Dr. Monika Kumari, Prof. K. L. Meena, Prof. Sushila Sharma, Dr. Prabhakar Vardhan

Analytical Studies

Literary Reviews

Survey Studies

Case Studies

Evaluation Of Meditation On Agya Chakra To Modify Human Attitude

Dr. Shalini Thakur, Dr. Umesh Shukla

Pharmaceutical And Analytical Exploration Of Sanjivani Vati-An Ayurvedic Formulation

Dr. Vimal Tewari, Dr. Deepika Tewari, Dr. Amit Kumar Dixit

Suvarna Prashana Prepared With Suvarna Patra (Spp) – A Safety Profile

Vd. Sagar Bhinde, Vd. Abhishek Patalia, Vd. Sonam Bhinde, Vd. Malhari Sirdeshpande

Recent Efforts In Popularizing Manuscriptology

Dr. Rashmi J. Ulli, Vaidya Shrinath M.

New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review

Dr. Manoj Kumar Dash, Dr. Namrata Joshi, Dr. D. N. S Gautam

A Critical Review On Immunomodulatory Effect Of Swarna (Gold) Bhasma In ChildrenDr. Nisha Kumari Ojha, Dr. Rashmi Pareek

Early To Bed And Early To Rise: An Ayurvedic Perspective

Dr. Punit Chaturvedi, Dr. Manoj Kumar Patel, Dr. Durgawati Devi

Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush

Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study

A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study

Dr. Durgesh Nandini Sharma, Dr. Hemraj Meena

Dr. Ankita Agarwal, Dr. Asit K Panja

Dr. Anil Kumar Soni, Dr. Gopesh Mangal

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95

102

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Pharmaceutical Studies

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EDITORIAL

Ethics in Clinical Practice

Ethics can be defined as a moral philosophy and concerned with what is morally good or bad. These are integral part of each sphere of life may it be personal, social or professional life. In each profession there are certain ethical issues which need to be addressed essentially for the sake of professional and personal integrity. In medical profession particularly in clinical practice various such issues are confronted that are perplexing, emotional and drain lot of time and discombobulate. Just to be a good human being or professionally sound does not serve the purpose rather a clinician should have an in-depth knowledge of such issues. In each system of medicine these issues has been pontificated by the pundits. I always find an undercurrent of ethics and ethical behaviour throughout Ayurveda literature. Similarly in conventional system of medicine there is great deal of ethics in clinical practice and clinicians are supposed to abide by these.

In medical profession patient is universal centre point and whole profession revolves around the patient. Our each effort

should be for the benefit of the patient and his autonomy must be maintained throughout. When a clinician encounters some patient first time it is essential to explain him about the steps or process of examination, required investigations, possible treatment interventions and of course prognosis. It is better to obtain informed consent from the patient before we proceed for examination, investigations or intervention/s except in emergent conditions. Patient may have so many doubts, anxieties, and worries in his mind regarding his disease, investigations or treatment. Sometimes patient may have information about his disease through internet sources, social media, print or electronic media. These information or too much information at once, medical jargon and needless complicated explanations may overwhelm the patient. So his all doubts, anxieties, and worries must be addressed altruistically.

The information obtained from the patient through history or examination, findings of the investigation, treatment modality and prognosis must be kept confidential and there should be non disclosure of the information. “Physicians may consider with-holding a serious diagnosis, misrepresenting it, or limiting discussion of prognosis or risks because they fear that patient may develop severe anxiety or depression or refuse needed care. Patients should not be forced to receive information against their will”(Harrison’s Principles of Internal Medicine; 15th edition; pg 2) .

This is the era of high advancement in medical science so far as investigations, technical and surgical interventions are

concerned. No doubt these hi-tech investigations and interventional techniques have revolutionised the medical science. We are now able to diagnose the disease at early stage and get finer details resulting into early and accurate treatment and better prognosis. A wide range of investigations are available and clinicians have become more investigation oriented and there is least application of clinical sense. Similarly, patients are also being forced to take un-necessary medication and surgical interventions. Sometimes patients themselves force for particular investigation or treatment modality. But it is the clinician who should decide judiciously and is not under the obligation of patient for any such investigation or treatment which are not relevant or required.

On the other hand patients sometimes refuse for some investigation and treatment. To agree with the refusal of the

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patient in the name of respecting autonomy seems morally constricting. Here, clinicians can elicit the issues with patient and can make him to understand the seriousness of the matter for his beneficence.

So, a clinical practitioner should do his best for the benefit of the patient by conserving his autonomy, for his beneficence and maintaining the confidentiality. He should be professionally competent, morally strong and of course a good human being with all ethical values.

Prof. Sanjeev SharmaDirector

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JOAjournalofayurveda.in ISSN No:2321-0435

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd)

Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In Shvitra

*Dr. Saroj Choudhary, **Dr. Rameshwar dudi , ***Dr. Sisir. Kumar Mandal, ****Prof. Pawan kumar Godatwar, *****Dr. S. K. Khandel

*Government Medical Officer (Raj. Govt.), Government Ayurved Aushdhalaya, Pachar, Jaipur, **Assistant Prof., Dept. of Basic Principles, Jyoti Vidyapeeth Women Univercity, Jaipur, ***Associate Professor, Dept. of Roga Nidana & Vikrti Vijnana, AIIA New

Delhi, ****Professor, *****Ex.Professor, Dept. of Roga Nidana & Vikrti Vijnana, NIA Jaipur

ABSTRACT

Keywords : Shvitra, Churna, Lakshana

Address of Correspondence: Dr. Saroj ChoudharyGovernment Medical Officer (Raj. Govt.), Government Ayurved Aushdhalaya, Pachar, Jaipur

Email ID : [email protected]

Contact No : 9413209943

How to Site the Article : Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In Shvitra, JOA XIII-3, 2019; 5 - 13

This study was conducted to evaluation of the pathogenesis of shvitra. It was randomized controlled study on 60 number of patients and was divided into three groups named Group A, Group B, Group C. Haridra churna was given to Group A, dose of Haridra churna 6gm twice a day with Luke warm water. Khadira churna was given to Group B, dose of Khadira churna 6gm twice a day with Luke warm water. Aragvadha churna was given to Group C, dose of Aragvadha churna 6gm twice a day with Luke warm water. After completion the treatment it was assessed by the use of subjective criteria like as percentage of area, colour of affected area, colour of hair of affected part, number of patches, maximum size of patches, Mandalotpatti, Shwetavarnta, Rasa, Rakta, Mamsa & Meda vaha srota dushti lakshana, itiching by giving different grades for its severity and objective criteria was used Hb%, ESR, RBS, SGOT, SGPT, LDL. Separate questionnaire was prepared to assess the clinical features of ‘Shvitra’. Observations were recorded before & after treatment of 45 days with follow up at every 15 days. After treatment showed that the Rasa dusti lakshana 12.50%, 64.71% and 58.14%, Rakta dushti lakshana 12.50%, 55% and 68.57%, Mamsa dushti lakshana 0.00%, 14.29%

and 54.55% , Meda dushti lakshana 5.88%, 10.53% and 76.19% was reduced by respectively in Group A, B & C. Finally it was observed that group B was more effective than Grop A and C.

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

Introduction:

Ayurveda, the science of life uses natural resources in fulfilling the fundamental objectives i.e. Swasthya Rakshanam and Vyadhi Prashamanam. Skin is like mirror that reflects external and internal pathology, and thus helps in diagnosis of disease.

All the skin diseases in Ayurveda have been described under heading of Kushtha, which are further divided into Maha Kustha and Kshudra Kushtha. However Shvitra has not been counted among various types of Kushtha in Brihattrayi. Later on this has been included under types of Kushtha by various Acharyas. Though Shvitra is mentioned along with other types of Kushtha, but the difference between Shvitra and Kushtha is based on non-secretary and non-infectious nature of disease, involvement of Twaka only, peculiarity of Nidana, Asadhya Lakshana and chronicity.

According to Modern dermatology, Shvitra can be correlated with Vitiligo and Leucoderma.Vitiligo is a common disorder of unknown etiology even today[1].Worldwide prevalence of Vitiligo is observed as 1% of the world population[2]. Based on dermatological out patient record, it is estimated between 3-4% in India, although an incident as high as 8.8% has also been reported[3], irrespective of the races especially to dark skinned people.

There is no definite line of treatment is given in the classics but the Acharyas have described Shvitra in the chapter of Kushtha Chikitsa and mentioned that the treatment should be done like Kushtha. The pathogenesis of Shvitra is not found separately in texts except Harita Samhita. According to Harita Samhita the vitiation of Vata along with the Pitta Dosha spoil the Rakta Dhatu and create the spot of Pandura Varna that is called Shvitra. In this way the specific line of treatment is alone given by Acharya Harita[4]. Acharya Charaka has mentioned that Samshamana therapy can be administered to patient after Sodhana therapy in this disease[5].

Need Of Study:

All previous research works considered that disease must be treated for long time, means shvitra is a disease which takes much more time to get cure. So it is the need of today to find out the treatment which cures to the particular disease shvitra in reasonable period.

In Ayurveda the disease comprise of dosa dusya & srotas as internal factor but there variation of involvement may change the nature as well as treatment protocol of the disease. For example, in case of 'Atisara disease' physician should more concentrate about the involvement of srotas, unlikely for the dhatus (dusyas) or dosha. In various times it is also observed that different physician also choose the different line of treatment with success but their duration of complete remission or rate of cure are different. Samprapti vighatana is known as chikitsa. It may be anywhere of the chain but the time is also a major factor. Especially those which are chronic in nature. So comparative trial among the drugs which are acting on dosas, dhatus and srotas may give a clear-cut ratio of involvement of the internal factors (dosha, dusya & srotas) of a particular disease. Though there are no such drug which only have the particular property as dosha pratyanika etc, but after reviewing the most pointed effect over the particulars pathogenic elements, the above mentioned drugs have been chosen.

Aims and Objectives:

The current research project entitled “Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In Shvitra”was undertaken with following aims and objectives-

1. To prepare a treatment protocol for the shvitra.

2. To evaluate the involvement of the vitiated dosha, dhatu and srotas in the particular disease shvitra.

Materials & Methods:

Following materials and methods was employed for conducting the present research project-Ethical Approval- The present research work was

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

approved by IEC (Institute Ethical Commite) of National Institute of Ayurveda, Jaipur vide latter No.F10(5)/EC/2014/7276; dated 07.11.2014,before starting the clinical trial on patients of EHT.

1) Selection of cases:- The patients for the clinical study were selected from O.P.D. and I.P.D. of NIA Hospital, Roga Nidana Evam Vikrti Vijnana department. Selection was carried out on the basis of relevant history, signs, symptoms and laboratory investigations.

Grouping:- In this present study, total 66 patients were registered, 60 patients completed the trial while 02 patients from Group A , 01 patient from Group B and 03 patient from Group C Left Against Medical Advice (LAMA). Out of 66 patients, 60 patients were divided into 3 groups namely A, B & C

Group A: Haridra Powder 6gm twice a day with Luke warm water.

Group B: Khadira Powder 6gm twice a day with Luke warm water.

Group C: Aragvadha Powder 6gm twice a day with Luke warm water.

Total duration of Treatment was 45 days with the regular follow up in an interval of 15 days for observing any side effect of drugs. All the patients were advised to take light, easily digestible diet & to avoid incompatible food.

2) Inclusion Criteria:-

1. Patients were randomly selected irrespective of sex, religion, occupation, and economic status after due process of informed consent.

2. Patients presenting with symptom of shvitra were included in the study.

3) Exclusion Criteria:-

1. Uncooperative & immuno suppressive patients

2. The patient of Shvitra were excluded those are Asadhya in nature (as per classical text of Ayurveda}

3. Patients below 18 years and above 50 years

4. Patients suffering from major illness.

5. Pregnant Women

6. Patients with history of trauma & burn

Plan of Work:-The study was carried out as follows-

1) Detailed Performa: A special performa was prepared to maintain the records of all findings regarding the patients.

Laboratorial Investigation

The following laboratory criteria were used on investigation ground:

● Hematological – Hb% & ESR

● Biochemistry –RBS, SGOT, SGPT, LDL

Drug Schedule:-

Group A: 20 registered patients of Shvitra wad administered Haridra Powder 6gm twice a day with Luke warm water.

Group B: 20 registered patients of Shvitra wad administered Kadhira Powder 6gm twice a day with Luke warm water.

Group C: 20 registered patients of Shvitra wad administered Aragvadha Powder 6gm twice a day with Luke warm water.

Criteria for Assessment of Drug efficacy

Both subjective and objective parameters were taken into consideration for assessment of drug efficacy.

Subjective and Objective Assessment

More emphasis was given on subjective parameters like No. of Patches, Patches size, Colour of affected area, Kandu (Itching), Site of Involvement, Colour of hair in the affected area etc. which were classified into grades. The improvement in grade was recorded at different levels. The affected area was assessed by photography.

Grading of Shvitra patients with reference to different symptoms:-

Assessment criteria

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

Percentage of area

Number of Patches:

Percentage of area Score1% 12% 23% 34% 4

>4% 5

Number Of Patches Score1 12 23 34 4

>4 5

Size of Patches:

Colour of Patches:

Kandu (Itching):

Size Score1 cm 12 cm 23 cm 34 cm 4

>4 cm 5

Colour of area ScoreNormal Skin color 1

Red colour 2White to reddish 3

Red to whitish 4White 5

Scale ScoreNo itching 0Mild / Occasional itching 1Moderate (tolerable) infrequent 2Severe itching frequently 3Very severe itching disturbing sleep and other activities 4

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

Colour of hair in the affected part

Colour ScoreBlack 0Gray (Pinjara) colour 1Reddish 2White 3

The result was remarked as;

● Complete improvement- 100% relief

● Marked relief - Above 75% improvement

● Moderate relief - Above 50% Improvement

● Mild relief - Above 25% Improvement

● Minimal relief - Below 25% Improvement

● No relief - No improvement

Observation and Results:- The observation and Re-

sults have been made in the present work under the fol-lowing headings.1) Demographic Profile.

a) Demography of general profile - According to observed data Maximum patients were from the age Group of 18-30 yrs, female, service class, Hindu in religion, married, middle upper class etc.

b) Demography of clinical profile - Maximum patients (41.26%) were having >2 year of duration

Assessment of Therapy -

Table: I Effect Of Group A Drug Haridra (Curcuma Longa Linn.) Churna On Subjective Parameters

Subjective ParametersMean

Diff. Diff. % S.D. S.E. W P value ResultsBT AT

% of area 4.35 4.05 0.3 6.90 0.57 0.12 15 0.625 NS

Colour of Affected Area 5.00 4.5 0.5 10.00 1.05 0.23 10 0.125 NS

Itching 0.95 0.3 0.65 68.42 0.67 0.15 66 0.001 VS

colour of hair of affected part 1.35 1.25 0.1 7.41 0.30 0.06 3 0.500 NS

Number Of Patches 3.35 3 0.4 11.94 0.82 0.18 15 0.0625 NS

maxi.Size of patch 3.35 3 0.35 10.45 0.58 0.13 21 0.0313 S

Mandalotpatti 5.00 4.5 0.5 10.00 1.05 0.23 10 0.1250 NS

Shwetavarnta 5.00 4.5 0.5 10.00 1.05 0.23 10 0.1250 NS

Bahalata 0.2 0.2 0 0.00 0 0 - >0.05 NS

Rasavaha sroto dushti lakshana 1.6 1.4 0.2 12.50 0.52 0.11 6 0.2500 NS

Raktavaha sroto dushti lakshana 1.6 1.4 0.2 12.50 0.52 0.11 6 0.2500 NS

Mamsavaha sroto dushti lakshana 1.5 1.5 0 0.00 0 0 - >0.05 NS

Medavaha sroto dushti lakshana 1.7 1.68 0.1 5.88 0.44 0.1 1 >0.05 NS

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

Table: II Effect of Group B drug Khadira (Acacia catechu (Linn. f.) Willd churna on Subjective parameters

Table: III Effect of Group C drug Aragvadha( Cassia fistula Linn.) churna on Subjective parameters

Subjective ParametersMean

Diff Diff % S.D. S.E. W P Value ResultsBT AT

% of area 3.45 1.7 1.75 50.72 1.019 0.22 210 <0.0001 VS

Colour of Affected Area 5 1.7 3.3 66.00 0.73 0.16 210 <0.0001 VS Itching 0.2 0.05 0.15 75.00 0.36 0.08 6 0.2500 NScolour of hair of affected part 1.05 0.55 0.5 47.62 0.68 0.15 36 0.0078 VSNumber Of Patches 3.3 2 1.6 48.48 1.14 0.25 171 <0.0001 VSmaxi.Size of patch 3.2 1.55 1.65 51.56 0.81 0.18 210 <0.0001 VSMandalotpatti 5 1.75 3.25 65.00 0.71 0.16 210 <0.0001 VSShwetavarnta 5 1.75 3.25 65.00 0.71 0.16 210 <0.0001 VSBahalata 0.3 0.3 0 0.00 0 0 --- >0.05 NSRasavaha sroto dushti lakshana 1.7 0.6 1.1 64.71 0.78 0.17 136 <0.0001 VSRaktavaha sroto dushti lakshana 1 0.45 0.55 55.00 0.51 0.11 11 <0.0001 VSMamsavaha sroto dushti lakshana 0.7 0.6 0.1 14.29 0.30 0.06 6 0.0313 SMedavaha sroto dushti lakshana 0.95 0.85 0.1 10.53 0.30 0.06 6 0.0002 VS

Subjective ParametersMean

Diff Diff % S.D. S.E. W P Value Results

BT AT% of area 3.7 3.2 0.5 13.51 0.68 0.15 17 0.0078 VSColour of Affected Area 4.7 3.84 1.05 22.34 1.60 0.35 210 0.0234 SItching 0.35 0.2 0.15 42.86 0.36 0.08 51 0.2500 NScolour of hair of affected part 1.75 1.4 0.35 20.00 0.58 0.13 11 0.1250 NSNumber Of Patches 2.7 1 0.35 12.96 0.81 0.18 36 0.156 NSmaxi.Size of patch 3.35 2.8 0.55 16.42 0.88 0.19 210 0.0156 SMandalotpatti 4.7 3.84 1.05 22.34 1.60 0.35 71 0.0234 SShwetavarnta 4.7 3.84 1.05 22.34 1.60 0.35 6 0.0210 SBahalata 0.25 0.25 0 0.00 0 0 11 >0.05 NSRasavaha sroto dushti lakshana 2.15 0.9 1.25 58.14 0.71 0.16 121 <0.0001 VSRaktavaha sroto dushti lakshana 1.75 0.55 1.2 68.57 0.69 0.15 33 <0.0001 VSMamsavaha sroto dushti lakshana 0.55 0.25 0.3 54.55 0.47 0.10 11 0.0313 SMedavaha sroto dushti lakshana 1.05 0.25 0.8 76.19 0.69 0.15 4 0.0002 VS

Results of the Therapeutic Trial-

¾ Effect of trial drug Haridra (Curcuma longa Linn.) churna on subjective parameters showed that there was a statistically very significant improvement was found on Itching (P=0.001), statistically

significant improvement was found on maxi. Size of patch (P=0.0313). % of area (P=0.625), Colour of Affected Area (P=0.125), colour of hair of affected part (P=0.500), Number Of Patches (P=0.0625), Mandalot patti (P=0.1250), Shwetavarnta

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

(P=0.1250), Bahalata (P=>0.05), Rasa (P=0.2500), Rakta (P=0.2500), Mamsa (P=>0.05) & Medavaha sroto dushti lakshana (P=>0.05) considered statistically not quite significant.

¾ Effect of trial drug Khadira ( Acacia catechu (Linn. f.) Willd churna on subjective parameters showed that there was a statistically very significant improvement was found on % of area (P=<0.0001), Colour of Affected Area (P=<0.0001), colour of hair of affected part (P=0.0078), maxi.Size of patch (P=<0.0001), Number Of Patches (P=<0.0001), Mandalotpatti (P=<0.0001), Shwetavarnta (P=<0.0001), Rasa (P=<0.0001), Rakta (P=<0.0001), Medavaha sroto dushti lakshana (P=0.0002) and statistically significant improvement was found on Mamsa (P=0.0313). Itching (P=0.2500), & Bahalata (P=>0.05) considered statistically not quite significant.

¾ Effect of trial drug Aragvadha (Cassia fistula Linn.) churna on subjective parameters showed that there was a statistically very significant improvement was found on % of area (P=0.0078), Rasa (P=<0.0001), Rakta (P=<0.0001), Meda vaha sroto dushti lakshana (P=0.0002). Statistically significant improvement was found on Colour of Affected Area (P=0.0234), maxi. Size of patch (P=0.0156), Mandalotpatti (P=0.0234), Shwetavarnta (P=0.0210), and Mamsa (P=0.0313). Itching (P=0.2500), colour of hair of affected part (P= 0.1250), Number Of Patches (P= 0.156), & Bahalata (P=>0.05) considered statistically not

quite significant.

Comparison Of The Effects Of Therapy:

" The effect of therapies, Khadira churna proved more effective to control % of affected area, colour of affected area, colour of hair of affected part, number of patches, maximum size of patches, Mandalotpatti, Shwetavarnta.

" The effect of therapies, Aragvadha churna proved more effective to dhatu dushti lakshana i.e. Rasa, Rakta, Mamsa & Meda dushti.

" The effect of therapies, Haridra churna proved more effective on doshic clinical features like itching etc.

" Overall effect of the therapy on clinical features of Svitra reflect that Dhatu produshana pathological event is more prominent, followed by obstruction of micro channels (dhatu vahi Srotasamsi dushti), though doshas are considered as prime cause for any disease progression but in this particular disease Shvitra it is active up to the event of doshadushya samurcchana. After that some scattered clinical features like itching etc. may govern by morbid doshas and that may prevent though dosha shamaka Group, i.e. Group A- Haridra churna. Otherwise dhatu promoting drugs and drugs those are act through micro channels (Rasayana) having more dominant effect to cure the disease Shvitra. The study was conducted with short duration as a upashayatmaka trial, result just give a clue to make a treatment protocol that may able to cure the disease successfully within a reasonable time.

Patient Registration No.51057

Before Treatment After Treatment

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

Probable Mode Of Action Of Drug:

Effect On Dosha:

1) Haridra churna

Hence Shvitra is Tridoshaja vyadhi, Kapha dosha is the most dominant Dosha in shvitra. Haridra being Tikta and Katu Rasa, Katu Vipaka & Ushna Virya and Kapha & Pitta Shamaka . These properties facilitate to improve the doshic status, which is involved in shvitra i.e. chiefly morbid kapha. Apart from these it has also varnya, tvakadosha shamaka, vranapaha, kushtha nashaka properties. So, by guna prabhabha it directly acts in dosha and by dravya prabhava it indirectly helps in samprapti vighatana. Also Haridra consider as dosha pachana in context to Amadosha[6].

Effect On Dushya:

2) Khadira churna

Rasa, Rakta, Mamsa, Meda and Lasika are the dushyas of Shvitra. Tvaka and Lasika are related with Rasadhatu. Symptoms of Rasavriddha are similar to Kaphavriddha[7]. Langhana is mentioned for treatment of Rasa Dushti. By virtue of Tikta, Kashaya Rasa, and sheeta virya of Khadira, it corrects Pitta. Pitta, specially Pachaka Pitta helps in proper formation of Raktadhatu and thereby combating Rakta Dushti. Pachaka Pitta also controls other Pitta including Bhrajaka Pitta which is also vitiated in Shvitra. Tikta, Kashaya Rasa of Khadira which causes Lekhana of Pravrddha Malarupa Mamsa Dhatu and stop the production of Mala Rupa Kleda (Upahanti Kleda). But the foremost action of Khadira, it is a rasayana, it correct the vitiated dhatus (rasa & rakata etc.) and maintain the pure one. That is why Khadira consider as a best kushthagna drugs and mentioned abundantly in Kushtha chikitsa with different mode of application.

Effect On Srotas:

3) Aragvadha churna

Rasavaha, Raktavaha Srotasa gets vitiated in shvitra. Aaragvadh is having, Madhura rasa, Guru, Snigdha,

Mridu guna, Sheeta virya, Madhura Vipaka. So it helps in pacification of Vayu. Thus it rescues the normal activities of Srotas. Apart from these Aragvadha does Amashodhana which removes Sanga from Srotasa and does Srotomukha Visodhana. Due to this Vata becomes channelized; remove Avarana and helps in Samprapti Vighatana.

Effect On Vyadhi:

Haridra, Khadira & Aragvadha has Kushthaghna property. So it directly effects on Shvitra. According to Ayurveda doctrines, the assimilation of Dosha & Dushya leads to formation of disease only when the Agni is reduced and quality of Dhatu become deteriorated (Shithilakarana). Shvitra is the disease which develops when Rakta, Mamsa, Meda, Lasika become Shithila. Katu Rasa of Khidra maintains the Agni and improves the quality of Rasadi Dhatu and gives strength to them and produces Sthairya. Khadira have Kasaya Rasa which does Ropana & Samdhanakara Karma, thus prevent the disease formation.

Conclusion

¾ Group A drug Haridra (Curcuma longa Linn.) churna is effective in the signs & symptoms like – Itching & maxi.Size of patch.

¾ Group B drug Khadir (Acacia catechu (Linn. f.) Willd churna is effective in % of area, Colour of Affected Area, colour of hair of affected part, maxi.Size of patch, Number Of Patches, Mandalotpatti, Shwetavarnta, Srotho dusti lakshna of Rasa,Rakta, mamsa, medavaha srotas and not effective in Bahalata , Itching.

¾ Group C drug Aaragvadha (Cassia fistula Linn.) churna is effective in % of area, Colour of Affected Area, maxi.Size of patch, Mandalotpatti, Shwetavarnta, Srotho dusti lakshna of Rasa, Rakta, mamsa, meda srotas and not effective in Number Of Patches, colour of hair of affected part, Bahalata, Itching.

¾ The result of these therapies shows that statistically

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Choudhary S, Dudi R, Mandal SK, Godatwar PK, Khandel SK, Clinical Evaluation The Therapeutic Effect Of Haridra (Curcuma longa Linn.) Churna On Dosha, Khadira (Acacia catechu Linn. f. Willd) Churna On Dhatu And Aragvadha (Cassia fistula Linn.) Churna On Srotas In

Shvitra JOA XIII-3, 2019; 5 - 13

highly significant result in Group B who were treated with Khadira Churna. Thus it reflects that dhatus are deeply involved in present study. It can be concluded that in chronic diseases dhatu prasadana chikitsa is more effective than dosha prashamana Shamana therapy etc.

¾ On srota dushti lakshana Group C shows better result which was treated with Aaragvadha Churna. Aaragvadha Churna bring back the normalcy of srotas by push out the malas from involved srotas .

¾ Aaragvadha Churna and Khadira Churna show significant result on the clinical features % of area, colour of affected area, Mandoltpatti, Shweta Varnata, and rasa, rakta. Mamsa, Medavaha srota dushti lakshana.

¾ On itching the trial drug Haridra Churna shows significant result.

¾ No trial drug is not effective in Laboratory parameters like- Hb%, ESR., RBS, SGOT,SGOT,LDL

¾ No side/toxic effects of drugs were noted. So, all the trial drugs are safe.

¾ All the trial drugs are cost effective and easily available.

References

1. Robbins, Cotran, Kumar ed. Pathologic basis of disease, 27nth Chapter, W.B.Saunders company.pp.1274.

2. John A.A.Hunter ed, Davidson’s principles and practice of medicine, 19th ed, 2002, 21st chapter, Churchill Livingstone. pp 1086, 1087.

3. R.G.Valia ed. Text book and atlas of dermatology 22nd chapter 1st ed, 1994, Bhalani publishing house Bombay, pp. 518,519.

4. Harita samhita, ‘Haree hindi vyakhya’ edited by pandit Harihar Prasad Tripathi, Chaukhambha Krishnadas acadamy, Varanasi print, 2009. Tritiya Sthana 39/50,51.

5. Aacharya Agnivesha, Charaka Samhita edited by Vaidya Yadavaji Trikamji Chaukhambha Subharati prakashan, Varanasi reprint 2011, Chikitsasthana 7/162, pp. 458.

6. P.V. Sharma, Dravyaguna Vidnyana, Vol II, Chaukhamba Bharti, Varanasi (India), 2006; p.162-164.

7. Dr. Brahmanand Tripathi, Astanga Hridayam, Chaukhamba Sanskrit pratishthan, Delhi 2007, sutrasthana 11/8

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan14

How to Site the Article : Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

ABSTRACTBackground: Ayurveda is a science of life and more than just a medical system. Ayurveda has taken the

foremost place in the management of crippling disease. Prameha can be compared with Diabetes mellitus- II due to its clinical appearance. The disease was chose for the study due to much prevalence in the society and lack of effective medicine. Prevalence of Diabetes mellitus- II is approx.0.8% of the population. Aims: To understand concept of Sharira shaithilyata in Samprapti of Kaphaja Prameha and to evaluate Ayurvedic fundamental principles of Udakavaha Strotodushti in its treatment. Methods and Material: 40 Registered and clinically diagnosed cases were divided into 4 groups; Group A- patients having symptom of Kaphaja Prameha and Udakavaha Srotodushti (Trishnahar yoga), Group B- cases of Kaphaja Prameha only excluding symptoms of Udakavaha Srotodushti (Trishnahar yoga), Group C (Shaithilyahara yoga) and Group D (Sarva Prameha hara yoga). Result: Statistically significant improvement was observed in objective and subjective parameters in all 4 groups after completion of the course of treatment. Conclusion: Acharya have mentioned the Moolas of Srotas, so that while treating the disease we can pay attention to the treatment of Srotodushti and its Moola also. It seems that, it is an effective therapeutic regimen in the management of uncomplicated cases of Kaphaja Prameha . Keywords : Kaphaja Prameha, Udakavaha Srotas, Sharirshaithilya, Diabetes mellitus-II, Sroto Moola.

A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja

Prameha (Type II Diabetes Mellitus)*Dr. Deepak Rahangdale, **Prof. Baldev Kumar, ***Dr. Hetal H. Dave

*Lecturer, Dept. of Samhita and Siddhant, M. S. Ayurved medical college, Gondia, Maharashtra, **Vice-chancellor, Shri Krishna Ayush University, Kurukshetra, Haryana, ***Assistant Professor, Dept. Of Prasuti & Stri Roga, National Institute of Ayurveda, Jaipur

Introduction:

JO

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Address of Correspondence:

Dr. Deepak RahangdaleLecturer., Dept. of Samhita & Siddhant, M. S. Ayurved medical college, Gondia, Maharashtra.

Email ID : [email protected]

Contact No : 8302203962

JOAjournalofayurveda.in ISSN No:2321-0435

Ayurveda recognized, Prameha as a disease entity in distant past. Among several health problems Prameha, is considered as one of the arch enemy of the mankind. Prameha comprises a number of diseases with various physical and chemical changes

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

in urine. The manifestation of the disease is described as “Prabhutavilmutrata,” which means frequent and copious urine with turbidity[1][2]. It is also believed that, if not cured or treated properly in due course of time, Prameha changes in Madhumeha, which is very similar to diabetes mellitus, the most debilitating disease.[3]

Diabetes mellitus is a metabolic disorder characterized by polyuria, polydipsia, hyperglycemia, glycosuria, and generalized weakness may be associated with weight loss. This is the disease that affects every tissue and every organ of the body and is responsible for significant morbidity, reduced life expectancy, and diminished quality of life. It has been seen that there is no any organ or system spared from the diabetic complications, such as nephropathy, neuropathy, retinopathy, and so on. So there is a need for effective drugs for controlling Diabetes and preventing undesirable complications. Although the introduction of many oral hypoglycemic agents and insulin in modern medical science have great importance in the management of Diabetes, the hazardous effects of these drugs after long term use are incurable or proves many times fatal, hence an ideal therapy is still obscure. Ayurvedic management of Diabetes aims not only to achieve a glycemic state but also to treat the root cause of disease. There are many medicinal plants mentioned in Ayurvedic texts, particularly in Nighantus and Samhitas having Prameha hara property. In the present work, with the concept of Srotodushti hara, shaithilyahara and Vyadhi pratyatmika chikitsa drugs have been used for the management of Kaphaja Prameha.[4]

Aims and objectives:

A Conceptual and clinical study on Kaphaja Prameha to understand Sharira shaithilyata in its Samprapti and to evaluate Ayurvedic fundamental principles of Udakavaha Strotodushti in treatment of Kaphaja Prameha.

Drug review:

The drug Trishnahara yoga (powder in dose of 5 gm daily in 2 divided doses) from bhaishjya ratnawali trishna chikitsa was selected. It has Pitta shamaka property (mainly), Deepana Pachana, It also enhances digestive

power (appetizer effect), enhances food absorption consequently it rectify the vitiation of Udakavaha Srotas. The second drug Shaithilyahara yoga (Shilajatu 3 gm powder daily in 2 divided doses) was selected from Charak Chikitsasthana 1:3/48-65 and the third drug Sarva Prameha hara yoga (40 ml kwatha twice a day) was selected from Charak Sutrasthana 23/10.[5] All the drugs were purchased and prepared through pharmacy of NIA, Jaipur.

Materials and Methods:

The study was approved by institutional ethics committee (IEC) having later number-F10 (5)/EC/2014/7225 on dated 07/11/2014.

A series of 40 patients with Diabetes Mellitus were selected from the Outpatient Department (OPD) and Inpatient Department (IPD) of NIA Hospital, Jaipur. Most of these cases were known diabetics while some were diagnosed for the first time when they came with other complaints.

Inclusion criteria:

y Patients between the age group of 20 – 60 years.

y Presence of cardinal symptoms of Udakavaha Strotodushti in Poorvaroopa or Roopa of Kaphaja Prameha described in Ayurveda texts.

y Presence of cardinal symptoms of Kaphaja Prameha described in Ayurveda texts.[6]

y Confirmed cases of DM type II on the basis of laboratory investigations and observed sign and symptoms.[7]

Exclusion criteria:

y Patient having age below 20 and above 60 years.

y Patient suffering from complication of DM.

y Patient having Type-I DM (IDDM).

y Patient having Type-II DM with any other serious systemic disease.

y Patient having a FBS more than 150 mg/dl and PPBS more than 200 mg/dl.

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

Grouping of the patients:

Registered patients were divided into 4 groups as follows-

Group A: Patients were Kaphaja pramehi symptoms of Udakavdaha Strotodushti in Poorva Roopa or Roopa of Kaphaja Prameha has been given the Trishnahara yoga.

Group B: Patients were Kaphaja pramehi without the presence of cardinal symptoms of Udakavdaha Strotodushti in Poorvaroopa or Roopa of Kaphaja Prameha has been given the Trishnahara yoga.

Group C: Patients were Kaphaja pramehi described in Ayurveda texts and they have been administered with Shaithilyahara yoga.

Group D: Patients were Kaphaja pramehi and they have been administered with Sarva Prameha hara Yoga kwatha.

Criteria to assess the effect of trial drugs

All the selected patients have been advised to come for the follow-up for 2 months at regular intervals of 15 days. The clinical grades were decided as follows:

A. Subjective Criteria

1. Clinical parameters for Assessment of Kaphaja Prameha :

1. Prabhoot mutrata (Polyuria) Score

� 3-6 times/day, rarely at night 0

� 7-9 times/day, 0-2 times/night 1

� 10-12 times/day, 2-4 times/night 2

� >12 times/day, >4 times/night 3

4. Kshudhadhikya (Polyphagia) Score

� 2 chapati/per meal 0

� 3-4 chapati/per meal 1

� 4-5 chapati/per meal 2

� > 5chapati/per meal 3

6. Shithilangata Score

� Absence of Chalatva 0

� Little visible movement (in waist areas) after rapid

movement 1

� Little visible movement (in waist areas) after Moder-

ate/mild movement 2

� Movement (in the areas) even after changing pos-

ture 3

5. Karpaddaha (Burning sensation in hands &

feet) Score

� Absent 0

� Occasional 1

� Continuous with tolerance 2

� Continuous without tolerance 3

3. Pipasaadhikya (Polydipsia) Score

� 3-6 glass of water daily 0

� 7-9 glass of water daily 1

� 10-12 glass of water daily 2

� unable to have sound sleep due to excessive thirst 3

2. Aavil mutrata (Turbidity in urine) Score

� Clear urine (can be visible through glass) 0

� Get turbid on keeping 1

� Turbidity seen on collection 2

� Very turbid 3

Objective assessment:

It was assessed mainly on the basis of biochemical investigations before and after completion of treatment in terms of percentage relief and statistical evaluations.

A.) Blood Examinations -

� CBC

� Lipid profile

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

� FBS (Fasting Blood Sugar) in mg/dl

� PPBS (Post Prandial Blood Sugar) in mg/dl

B.) Urine Examination

� Routine examination - Colour, Smell, Specific gravity

� Microscopic examination - Epithelial Cells, Albumin, Sugar, Cast

Observation and Results:

The observations and results in the study are made on the basis of demographic, constitutional, and clinical profiles of 40 patients having type II diabetes mellitus. Maximum cases reported in the study were male (72%). Maximum

cases (40%) were of the age group 40–50 years. Most cases (about 75%) were from middle socioeconomic group and maximum cases (about 28%) were housewives. 40% cases registered were from above higher secondary education group. The study revealed that higher incidence was found in urban dwellers (82.5%), and incidence in dietary habits was found more in persons with vegetarian diet (72.5%). Regarding incidence in physical activities, more patients are mild active (49%). About 52.5% cases belonged to Tamasa Prakriti, and about 65% cases were belonging to Kapha Vata prakriti. Maximum cases were reported with a positive family history (40%), and the duration of illness was less than 1 year in maximum cases (about 77.5%).

Table I: Therapy wise details of the groups Group

Table II: Mean change in Prabhoota mutrata

Table III: Mean Change in Aavila mutrata

Group Completed Lama DrugGroup-A 10 0 Trishnahara yogaGroup-B 10 0 Trishnahara yogaGroup-C 10 0 Shaithilyahara yogaGroup-D 10 0 SarvaPrameha ra yoga

Variable Gr.Mean Mean

Diff.Relief

% SD SE P SBT AT

Prabhoota mutrata

A 2.20 0.90 1.30 37.38 0.674 0.2134 0.0039 <0.01 VSB 2.20 1.40 0.80 36.36 0.632 0.20 0.0156 <0.05 S

C 2.30 1.60 0.70 30.43 0.823 0.260 0.0625 >0.05 NS

D 2.50 1.50 1 40 0.66 0.21 0.0078 <0.001 HS

Variable Gr.Mean

Mean Diff.

Relief % SD SE P S

BT AT

Aavila mutrata

A 2.10 1.30 0.80 38.09 0.632 0.200 0.0165 <0.05 SB 2.10 1.20 0.90 42.85 0.316 0.10 0.0039 <0.01 VSC 2.10 1.40 0.70 33.33 0.483 0.152 0.0156 <0.05 SD 2.10 1 1.10 52.38 0.66 0.21 0.0078 <0.01 VS

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

Table IV: Mean Change in Pipasaadhikya

Table V: Mean Change in Kshudhadhikya

Table VI: Mean Change in Karpadtala daha

Table VII: Mean Change in Shithilangata

Variable Gr.Mean

Mean Diff.

Relief % SD SE P S

BT AT

Pipasaadhikya

A 1.90 1 0.90 47.36 0.316 0.100 0.0039 < 0.01 VSB 2.10 1.40 0.70 33.33 0.483 0.528 0.0156 < 0.05 SC 1.80 1.30 0.50 27.77 0.527 0.166 0.0625 > 0.05 NSD 1.80 0.80 1 55.55 0.816 0.258 0.0078 < 0.01 VS

Variable Gr.Mean Mean

Diff.Relief

% SD SE P SBT AT

Kshudhadhikya

A 1.60 0.90 0.70 43.75 0.483 0.152 0.0156 < 0.05 S

B 1.60 1 0.60 37.5 0.516 0.163 0.0313 < 0.05 SC 1.90 1.30 0.60 31.57 0.516 0.163 0.0313 < 0.05 SD 1.80 1.10 0.70 38.88 0.483 0.152 0.0152 < 0.05 S

Variable Gr.Mean Mean

Diff.Relief

% SD SE P SBT AT

Karpadtala daha

A 1.90 0.70 1.20 63.15 0.421 0.133 0.002 <0.01 VSB 1.90 0.70 1.20 63.15 0.632 0.200 0.0039 <0.01 HSC 1.70 1 0.70 41.17 0.674 0.213 0.0313 <0.05 SD 2.10 0.90 1.20 57.14 0.421 0.133 0.002 <0.01 VS

Variable Gr.Mean

Mean Diff.

Relief % SD SE P SBT AT

Shithilangata

A 2.10 1.30 0.80 38.09 0.788 0.249 0.0313 <0.05 SB 2.10 1.70 0.40 19.04 0.516 0.163 0.1250 >0.05 NSC 2.20 1.30 0.90 40.90 0.737 0.233 0.0156 <0.05 SD 2.10 0.90 1.20 57.14 0.632 0.200 0.0039 <0.01 VS

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

Table VIII: Effect of treatment on fasting blood sugar

Table IX: Effect of treatment on post prandial blood sugar

Variable Gr.Mean Mean

Diff.Relief% SD SE T P S

BT AT

FBS

A 134.9 123.0 11.90 8.821 13.22 4.183 2.845 0.019 SB 140.7 129.3 11.40 8.102 9.442 2.986 3.818 0.004 VSC 136.8 135.6 1.20 0.877 1.549 0.489 2.449 0.036 SD 129.2 108.9 20.30 15.71 13.65 4.318 4.701 0.001 VS

Variable Gr.Mean Mean

Diff.Relief% SD SE T P S

BT AT

PPBS

A 182.6 154.3 28.30 15.49 19.72 6.236 4.538 0.001 VSB 178.8 164.1 14.70 8.221 11.04 3.493 4.208 0.002 VSC 187.9 182.3 5.600 2.980 7.121 2.252 2.487 0.034 SD 172.5 138.3 34.2 19.82 10.66 3.372 10.14 0.0001 HS

Effect of treatment as per wilcoxon signed ranks test and paired t test in all the 4 groups (group A, B, C and D) showed statistically significant results in the above-mentioned subjective and objective parameters.

Group A showed significant relief on Prabhutmutrata (37.38%), Avilamutrata (38.09%), Pipasadhikya (47.36%), Kshudhadhikya (43.75%), Karpadataladaha (63.15%) and Shithilangata (38.09%). Group B showed significant result on Prabhutmutrata (36.36%), Avilamutrata (42.84%), Pipasadhikya (33.33%), Kshudhadhikya (37.5%), Karpadataladaha (63.15%) and Shithilangata (19.04%). Group C also showed significant relief on Prabhutmutrata (30.43%),

Avilamutrata (33.33%), Pipasadhikya (27.77%), Kshudhadhikya (31.57%), Karpadataladaha (41.17%) and Shithilangata (40.9%). Group D also showed highly significant relief on Prabhutmutrata (40%), Avilamutrata (52.38%), Pipasadhikya (55.55%), Kshudhadhikya (38.88%), Karpadataladaha (57.14%) and Shithilangata (57.14%) [Tables 2 to 7].

In case of subjective parameters, in FBS maximum percentage relief showed by group D (15.71%) followed by group A (8.82%), group B (8.10%) and group C (0.87%). In PPBS relief showed by group D (19.82%), group A (15.50%), group B (8.22%) and group C (2.3%) respectively [Tables 8-9].

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

Probable mode of action of drugs:

On analysis of the pharmacological properties of all the contents of Trishnahara yoga illustrates that the maximum of the drugs were of Katu, Tikta and Madhura Rasa. Maximum Guna of the drugs were Laghu and Ruksha. Maximum of the drugs were of Shita Veerya and Madhura Vipaka. Katu Rasa and Ruksha Guna of drug helped in the Upshoshana of Sweda, Kleda and Mala along with Shamana of Kapha. Likewise Tikta Rasa normalized the excess Kleda , Meda, Vasa, Majja, Sweda, Mutra and Purisha. Shadaindriya effect of Madhura Rasa prevented patients from early incidence of complications. Thus the drug (Trishnahara yoga) appeared successful in breaking the Dosha- dushya sammurchana. Dipana and Pachana effect of Katu and Tikta Rasa would have acted upon Dhatvagnimandya and helped in normalizing the body metabolism. On the other hand the Shaithilyhara yoga contains Shuddha Shilajatu itself. It is having Kashaya Rasa, Madhura Rasa and Tikta Rasa predominately. The Guna of Shilajatu are Laghu , Sheeta Virya and Madhura Vipaka along with Kapha doshahara property. Kashaya and Tikta Rasa of drug would have helped in the Upshoshana of Sweda, Kleda and Mala along with Shamana of Kapha. The srotorodha due to vitiated Kapha and Vata aggravation, Srotoavrodha again vitiates the Medo dhatu which leads to increase in Shithilatva, the Kaphahara karma and Dardhtvya property of Shilajatu helps to counter the pathogenesis and stops the further progress of disease Kaphaja Prameha . The drug sarva Prameha ra yoga (kwatha) contains 10 drugs – Triphala, Argvadha, Patha, Saptaparna, Vatsaka (Kutaja), Musta, Madanphala and Nimb. On analysis of the pharmacological properties of all the contents of yoga illustrates that the maximum of the drugs were of Tikta , Kashaya and Madhura Rasa including remaining Rasa in small proportion except Lavana Rasa. Maximum Guna of the drugs are Laghu and Ruksha. Maximum of the drugs were of Shita Veerya and 50% of drugs had Madhura Vipaka and 50% of drugs are had Katu Vipaka in property. This drug has shown wonderful effect on the symptoms of Kaphaja Prameha. Tikta , Kashaya Madhura Rasa and Shita

Veerya, pacified the Sara and Ushna Guna of Pitta. Kashya Rasa acted as Sthambhana along with effect of. Tikta Rasa would have normalized the excess Kleda, Meda, Vasa, Majja, Sweda, Mutra and Purisha. Thus the drug would have shown noteworthy effects against Kaphaja Prameha.

Discussion:

The maximum improvement in the group D (Sarva Prameha ra yoga), implied that the group having absolutely Kaphaja pramehi patients showed better results than all other groups. The reason can be due to that, the Kaphaja Prameha Vyadhi is Santarpanjanya also the yoga is indicated in classical text for Santarpanjanya Vyadhi so it’s obvious that the drug Sarva Prameha ra yoga showed better results on the other hand in case of group A and group B which were taken in this clinical study with the concept that they will act on Udakavaha Srotodushti also showed better results. Group A showed better results than group B. In case of group C, the drug countered the pathogenesis (Samprapti vightana) so that further progress of disease might not occurred also showed significant results. The drugs were used in this trial, acted on Sroto Moola as well as disease. Results were found good in that group of patients which had taken medicine prescribed for vitiated Sroto Moola. Most of the symptoms were also subsided in that same group (group A). So on the basis of results of subjective parameters; it may be concluded that Sroto Moola Chikitsa might give better response to cure of any Sroto-Dushti-janya Vyadhi if this aspect is taken into account.

Conclusion:

Acharya have mentioned the Moolas of Srotas, so that while treating the disease we can pay attention to the treatment of Moola also. Hence Srotodushti and pathogenic factor need to be kept in consideration while treating the diabetic patients, so that while treating the disease we can pay attention to the treatment of Srotodushti and its Moola also. It seems that, it is an effective therapeutic regimen in the management of uncomplicated cases of Kaphaja Prameha.

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Rahangdale D, Kumar B, Dave HH, A Conceptual and Clinical Study to Understand The Principle of Sharira-Shaithilyata and Udakavaha Srotodushti w.s.r. to Kaphaja Prameha (Type II Diabetes Mellitus) JOA XIII-3, 2019; 14 - 21

References

1. Vagbhata, Ashtanga Hridyam of Vagbhata Vidyotini Hindi Commentary by Kaviraja Atrideva Gupta, Vaidya YU, editor. Varanasi, India: Chowkhamba Sanskrit Sansthan; 2005. pp.254.

2. Madhava, Madhava Nidana: Vidyotini Hindi Commentary by Shastri S, Upadhyaya YN. Vol. 2, 31st edition. Chapter 33/6. Varanasi, India: Chaukhambha Sanskrit Sansthan; 2002. pp. 8.

3. Sushruta, Sushruta Samhita with AyurvedaTattva Sandipika-Hindi commentary, Kaviraj A S. editor, 13th edition. Purvardha, Nidanasthana 6/30. Varanasi, India: Chaukhambha Sanskrit Sansthan; 1996. pp. 255.

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vxz.kh LFkku ys fy;k gSA Áesg dh rqyuk viuh uSnkfud mifLFkfr ds dkj.k Mk;fcfVt esSykbVl-II ds lkFk dh tk ldrh gSA lekt

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ds ikBÓØe ds iwjk g¨us ds ckn lÒh 4 lewg¨a esa mÌs'; vkSj O;fäijd ekinaM¨a esa euk;k x;kA fu"d"kZ: vkpk;¨± usa L=¨r¨ ds ewy¨a dk

o.kZu fd;k gS fd ftlls ;g Kkr g¨rk gS fd O;kf/k esa mndog L=¨r¨nqf"V vkSj mlds ewy ds mipkj djus ds fy, Òh /;ku ns ldrs

gSaA ,slk yxrk gS fd] ;g dQt Áesg dh lh/kh ekey¨a ds Áca/ku esa ,d ÁÒkoh fpfdRlk g¨ ldrh gSA

4. Charaka, Charaka Samhita with Vidyotini Hindi Commentary. Vol. 1 and 2. Sastri KN, Chaturvedi GN. (Sashtri RP, et al. editor). Reprint: 1998 Sutrasthana 5/2, Varanasi, India: Caukhambha Bharati Academy; pp. 72

5. Charaka, Charaka Samhita with Vidyotini Hindi Commentary. Vol. 1 and 2. Sastri KN, Chaturvedi GN. (Sashtri RP, et al. editor). Reprint: 1998, Vimanasthana 8/139, Varanasi, India: Caukhambha Bharati Academy; pp. 789

6. Kirtikar KR, A”D Basu BD. Indian Medicinal Plants (VoI 1-1975, VoI3-1984). Delhi-32: Periodical Expert Book Agency; 1984.

7. Harrison, Harrison’s Principles of Internal Medicine. Vol. 2.ed. Chapter 333, (Diagnostic criteria for Diabetes Mellitus). U.S.A: Mc Graw-Hill Medical Publishing House; 2005. pp. 2111.

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan22

Due to ignorance towards dietetic, seasonal and daily regimen people are more prone to various kinds of skin disorders. Vicharchika (Atopic dermatitis) is the most common skin disorders. Due to wide spectrum of disease, much prevalence in the society and lack of effective medicament, so disease being chosen for the study.

The study was conducted in 50 clinically diagnosed patients of Vicharchika (Atopic dermatitis) and randomly divided into two groups. In group A patients were treated with Avalguja Beeja Churna (6 gms) ) with Ghrita, before meal twice daily for 30 days and Arka Tail twice daily for 30 days, on the lesion for local application.

In group B patients were treated with Cetrizine tab. (oral 10mg in night) and Clobetasol ointment twice daily for 30 days, on the lesion of Atopic dermatitis. Conclusions: ‘Avalguja Beeja Churna’ and ‘Arka Tail’ is safe, cost effective and free from any side effects in the management of Vicharchika [Atopic dermatitis]”. It also prevents the relapse considerably.

Keywords : Vicharchika, Atopic dermatitis, Avalguja Beeja Churna, Arka Tail, Cetrizine tab., Clobetasol ointment

ABSTRACT

Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail’ in the management of Vicharchika [Atopic Dermatitis]”-

A Randomized controlled trial*Dr. Devesh Jaiman, **Dr. Harish Bhakuni, ***Dr. Ajay Kumar Sahu, ****Dr. Puneet Bhargava

* Ph.D. Scholar, **Assistant Professor, ***Assistant Professor, Dept. of Kayachikitsa, National Institute of Ayurveda, Jaipur, ****Professor, Dept. of Skin & Venerology, SMS Medical College & Hospital, jaipur

JO

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Address of Corespondence:

Dr. Devesh JaimanPh.D. Scholar,Dept. of Kayachikitsa, NIA, Jaipur.Email ID : [email protected] No : 9414854839

How to Site the Article : Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

JOAjournalofayurveda.in ISSN No:2321-0435

Introduction:

Skin is the largest protective organ of the body. A healthy skin is the mirror image of a good health. The colour of the skin is important biologically, cosmetically and socially. It acts as an effective barrier against the entry of diseases.

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

Skin is the first organ of the body interacting with the environmental agents like physical, chemical & biological agents. Skin ailments affects all ages from the neonates to the elderly & cause harm in a number of ways, such as discomfort, disfigurement, disability etc.

Majority of the skin diseases in Ayurveda have been described under the broad heading of ‘Kushtha’, which are further divided into Maha Kushtha & Kshudra Kushtha. Vicharchika one of the Kshudra Kushtha[1] runs a chronic course generally considered difficult to cure & even if it is cured relapses are common. Vicharchika has been simulated with the diseases ‘Eczema’/ Dermatitis by most of the scholars. Atopic dermatitis is a type of dermatitis, an inflammatory, relapsing, non contagious and itchy skin disorder.[2]

The global burden of diseases (GBD) Study 2010 estimated the GBD attributable to 15 categories of skin disease from 1992 to 2010 for 187 countries and eczema fell in to top 50 diseases. Globally eczema affected approximately 230 million people (3.5% of population as of 2010).

Though many studies have been carried out for this burning problem, still there is need of evaluation of certain drugs clinically on various scientific parameters which could be safe, effective, cheap & readily available in the management of Vicharchika, so this clinical trial has been selected.

Aims and Objectives –

1. Clinical evaluation of the efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail’ in the management of ‘Vicharchika’.

2. Comparative study of safety and efficacy of ‘Avalguja Beeja Churna & Arka Tail & Tab.Cetrizine and Clobetasol Ointment’ in the management of Vicharchika with special reference to Atopic Dermatiti

Material and Methods:

[A] Selection of Cases

A total 50 patients of Vicharchika (Atopic Dermatitis)

were randomly selected for the present study, from the Kayachikitsa OPD and IPD of NIA, Jaipur and Department of Skin and Venereology, SMS Hospital, Jaipur.

[B] Inclusion criteria:

1. Patients willing for trial.

2. The patients who ages in between 16 – 70 years were selected.

3. The patients having clinical signs and symptoms of Vicharchika (Atopic dermatitis).

4. The patients having complained less than 5 year duration.

[C] Exclusion criteria:

1. Patients below the age of 16 years and above 70 years.

2. Patients with illness >5 year.

3. Patients with long term Steroid and cytotoxic treatment.

4. Patients having concomitant illness like HTN, DM-II, and Chronic Atopic dermatitis.

5. Patients with evidence of malignancy.

6. Smoker/ alcoholics and/or drug abusers.

7. Pregnant or lactating women.

[D] Study design: Interventional, Randomized controlled trial, Open label

Ethical clearance: This study was approved by Institutional Ethical Committee (IEC) of National Institute of Ayurveda, Jaipur vide letter No. IEC/ACA/2015/47; dated 21.05.2015, before starting the clinical trial on patients of Vicharchika (Atopic dermatitis)

[E] Grouping and Administration of Drug -

50 clinically diagnosed and registered patient of Vicharchika were divided randomly into two group. Each group have 25 patients.

[1] GROUP A - 25 clinically diagnosed and registered patient of Vicharchika were treated by Avalguja Beeja

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

Churna (6 gms) ) with Ghrita, before meal two times in a day for 30 days and Arka Tail twice in a day for 30 days, on the lesion of Atopic dermatitis.

[2] GROUP B - 25 clinically diagnosed and registered patient of Vicharchika were treated by Cetrizine tab. (oral 10mg in night), Clobetasol ointment twice daily for 30 days, on the lesion of Atopic dermatitis.

Trial Drugs -

In the present study, for internal use and for external application. ‘Avalguja Beeja Churna’[3] has been selected for oral route and ‘Arka Tail’[4] has been selected for topical application. Keeping all above points in mind the two compound drugs were selected to know their effect in treating Vicharchika (Atopic dermatitis).

1. Avalguja Beeja Churna:

2. Arka Tail:

Table I - Quantity of ingredients taken for preparation of Avalguja Beeja Churna

Table II- Quantity of ingredients taken for preparation of Arka Tail

S. no. Sanskrit Name Botanical Name Part Used Quantity

1. Avalguja Psoralia corylifolia Linn. Seed 1 Part

Preparation of Avalguja Beeja Churna:

Churna of the drug was prepared according to the instruction given in “Churna kalpana” (Sharangadhara Samhita). The drug was prepared in GMP certified N.I.A. Pharmacy, Jaipur. (Batch no. A0097)

S. no. Sanskrit Name Botanical Name Part used Quantity

1. Arka Calotropis procera Linn. Leaf 16 part

2. Haridra Curcuma longa Linn. Rhizome 1 part

3. Sarshapa Brassica campestris Linn. Seed oil 4 part

Preparation of Arka Tail:

All ingredients of Arka Tail were taken as above mention ratio and the Arka tail was made as per the Sharangadhara Tail Pak Kalpana. The drug were prepared in GMP certified N.I.A. pharmacy, Jaipur. (Batch no. A0097)

Follow-up Study :–

y Follow-up of patient was done on 15th and 30 th days of treatment. Improvement in the symptoms if any and other effects were noted down.

y Laboratory investigations were repeated in Group A and Group B after completion of the treatment.

[G] Criteria For Assessment

1. Subjective parameters:For statistical analysis, following signs and symptoms of Vicharchika[5][6] adopted:-

Scoring criteria

1. Kandu (Pruritis)

0 - No itching

1 - Mild itching not disturbing normal activity

2 - Occasional itching disturbs normal activity

3 - Itching present continuously & even disturbing sleep

2. Daha (Burning)

0 - No burning sensation

1 - Mild type of burning not disturbing normal activity

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

2 - Occasionally burning disturbing normal activity

3 - Burning present continuously & even disturbing sleep

3. Strava (Oozing)

0 - No discharge

1 - Occasional discharge after itching.

2 - Occasional oozing without itching.

3 - Excessive oozing making clothes wet

4. Rukshata (Dryness)

0- No dryness

1- Dryness with rough skin (Ruksha)

2- Dryness with scaling (Khara)

3- Dryness with cracking (Parusha)

5. Pidikotpatti (Eruption)

0 - No eruption in the lesion

1 - Scanty eruptions in few lesions

2 - Scanty eruptions in at least half of the lesion

3 - All the lesions full of eruption

6. Vaivarnyata (Discolouration)

0 - Nearly normal skin colour

1 - Brownish red discoloration

2 - Blackish red discoloration

3 - Blackish discoloration

7. Rajii (Thickening of skin)

0 - No thickening of skin

1 - Thickening of skin but no criss-cross marking

2 - Thickening with criss-cross marking

3 - Severe lichenification

EASI (Eczema Area and Severity Index) score:

A representative area of eczema is selected for each body region. The intensity of redness (erythema), thickness (induration, papulation, oedema), scratching (excoriation) and lichenification (lined skin) of the eczema is assessed as none (0), mild (1), moderate (2) and severe (3). Half scores are allowed.

Area of involvement

0 1 2 3 4 5 6No eruption < 10% 10-29% 30-49% 50-69% 70-89% 90-100%

Erythema (E)0 None1-Mild Faintly detectable erythema: very light pink2- Moderate Dull red clearly distinguishable3-Severe Deep/ dark redInfiltration/ papulation (I)0 None1-Mild Barely perceptible elevation2- Moderate Clearly perceptible elevation but not extensive3-Severe Marked and extensive elevationExcoriation (Ex)0 None1-Mild Scant evidence of excoriation with no sign of deeper skin damage (erosion,crust)

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

2- Moderate Severe linear marks of skin with showing evidence of deeper skin injury (erosion,crust)

3-Severe May erosive or crustly lesionLichenfication (L)0 None

1-Mild Slight thickening of the skin dissemble only by touch and with skin marking minimally exaggerated

2- Moderate Define thickening of the skin with skin marking exaggerated so that they form a Criss-cross pattern

3-Severe Thickened indurated skin with skin marking visibly portraying an exaggerated Criss – cross pattern

Calculation of EASI Score

Head/ Neck E+I+Ex+LxAreax0.1 ( + + + )x x0.1Upper limb E+I+Ex+LxAreax0.2 ( + + + )x x0.2

Trunk E+I+Ex+LxAreax0.3 ( + + + )x x0.3Lower limb E+I+Ex+LxAreax0.4 ( + + + )x x0.4

EASI Sum of all above body area Total score

Maximum Score-70 Minimum Score-0

Hamilton Depression Scale:

(B). Objective parameters:

1] Heamatological Test: Hb%, TLC, DLC, ESR.

2] Biochemical Investigation: RBS

3] Renal Function Test (Blood urea, Sr. Creatinine),

4] Liver Function Test (SGOT, SGPT)

Observation-

In the present study maximum 34% patients were belonging to 16-30 years of age group, 64 % of the patients were female, 66% patients from Hindu community, 72% were married, maximum number of patients (42%) were found graduate educational status, maximum patients 66 % were belonged to middle socio-economic status, maximum number of patients (32%) were doing Business works, 74 % of patients were not having any particular history of Atopy, maximum patients (50%) were having this disease from 1-3 years, maximum number of patients (64%) had gradual onset, maximum number of patients

(30%) were suffered more itching in lesion in winter, maximum number of patients (68%) in this study were having Sravi type of Vicharchika, maximum number of patients (26%) had lesions on upper extremities, maximum 62% patients were vegetarian type of diet, maximum number of patients (62%) were having disturbed sleep. maximum 74% patients were having Vatakaphaja prakriti, maximum number of patients (58%) were of madhyama sara, 64% were of madhyama samhanana and 68% patients were of madhyama pramana, maximum number of patients (62%) from madhyama satmya, maximum number of the patients (62%) were having madhyama satva, 58% patients were having madhyama ahara shakti, 60% were having madhyama jarana shakti, 62% patients were having madhyama vyayama shakti.

Results -

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

Table No. III: Showing Effect Of Therapy On Subjective Parameters (Wilcoxon Matched Pairs Single Ranked Test)

Variable Gr.Mean Mean

Diff. % Relief SD± SE± p value SBT AT

KanduGr. A 2.20 1.76 0.44 20 % 1.044 0.208 > 0.05 NS

Gr. B 2.24 1.40 0.84 37.5 % 0.47 0.094 < 0.0001 HS

DahaGr. A 0.96 0.76 0.20 20.8 % 0.408 0.081 >0.05 NS

Gr. B 1.00 0.36 0.64 64 % 0.489 0.097 < 0.0001 HS

SravaGr. A 1.56 0.56 1.00 64.1 % 0.957 0.191 < 0.0001 HS

Gr. B 2.12 1.40 0.72 33.96% 0.458 0.091 < 0.0001 HS

RukshataGr. A 0.84 0.20 0.64 40.3% 0.757 0.151 < 0.0001 HS

Gr. B 0.60 0.40 0.20 33.33% 0.816 0.163 > 0.05 NS

PidikaGr. A 1.20 0.20 1.00 83.33% 0.912 0.182 < 0.0001 HS

Gr. B 0.88 0.60 0.28 31.81% 0.458 0.091 < 0.05 S

VaivaranyataGr. A 1.96 1.16 0.80 68.96% 0.50 0.10 < 0.0001 HS

Gr. B 1.76 1.08 0.68 38.63% 0.69 0.138 < 0.0001 HS

RajiiGr. A 0.96 0.24 0.72 75 % 0.678 0.135 < 0.0001 HSGr. B 1.36 1.04 0.32 23.52% 0.802 0.16 > 0.05 NS

EASI ScoreGr. A 10.15 4.06 6.08 59.9 % 4.339 0.867 < 0.0001 HS

Gr. B 10.43 4.74 5.69 54.55% 4.31 0.861 < 0.0001 HS

Hamilton D.S.Gr. A 3.64 0.92 2.72 74.72% 1.173 0.234 < 0.0001 HS

Gr. B 2.16 0.48 1.68 77.77% 1.464 0.292 < 0.0001 HS

(HS: Highly Significant (NS: Non Significant(S: Significant

In Group A, patients were treated with Avalguja Beeja Churna in a dose of 6 gm with Ghrita two times in a day before meal and Arka Tail for local application twice in a day, shown highly significant results (p value : P < 0.01, P < 0.001, P<0.0001) regarding subjective parameters; EASI Score, Srava, Rukshta, Pidika, Vaivarnyata, Rajii, Hamilton depression scale with percentage relief of 59.9%, 64.1%, 40.3%, 83.33%, 68.96%, 75%, 74.72%. In Kandu and Daha shown no significant result (p value >0.05) with percentage relief of 20%, 20.8%.

In Group B, shown highly significant results (p value : P < 0.01, P < 0.001, P<0.0001) regarding subjective parameters; Kandu, Daha, Srava, Vaivarnyata, EASI Score and Hamilton depression scale with percentage relief of 37.5%, 64%, 33.96%, 38.63%, 54.55%, 77.77%. In Pidika shown significant result (p value <0.05) with percentage relief of 31.81% and Rukashta and Rajii have shown no Significant Result.

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

Table No. IV: Showing Effect Of Therapy On Laboratory Parameters (Objective Parameters): (Paired ‘T’ Test)

Variable Gr.Mean Mean

Diff. % Relief SD± SE± p value SBT AT

KanduGr. A 2.20 1.76 0.44 20 % 1.044 0.208 > 0.05 NS

Gr. B 2.24 1.40 0.84 37.5 % 0.47 0.094 < 0.0001 HS

DahaGr. A 0.96 0.76 0.20 20.8 % 0.408 0.081 >0.05 NS

Gr. B 1.00 0.36 0.64 64 % 0.489 0.097 < 0.0001 HS

SravaGr. A 1.56 0.56 1.00 64.1 % 0.957 0.191 < 0.0001 HS

Gr. B 2.12 1.40 0.72 33.96% 0.458 0.091 < 0.0001 HS

RukshataGr. A 0.84 0.20 0.64 40.3% 0.757 0.151 < 0.0001 HS

Gr. B 0.60 0.40 0.20 33.33% 0.816 0.163 > 0.05 NS

PidikaGr. A 1.20 0.20 1.00 83.33% 0.912 0.182 < 0.0001 HS

Gr. B 0.88 0.60 0.28 31.81% 0.458 0.091 < 0.05 S

VaivaranyataGr. A 1.96 1.16 0.80 68.96% 0.50 0.10 < 0.0001 HS

Gr. B 1.76 1.08 0.68 38.63% 0.69 0.138 < 0.0001 HS

RajiiGr. A 0.96 0.24 0.72 75 % 0.678 0.135 < 0.0001 HSGr. B 1.36 1.04 0.32 23.52% 0.802 0.16 > 0.05 NS

EASI ScoreGr. A 10.15 4.06 6.08 59.9 % 4.339 0.867 < 0.0001 HS

Gr. B 10.43 4.74 5.69 54.55% 4.31 0.861 < 0.0001 HS

Hamilton D.S.Gr. A 3.64 0.92 2.72 74.72% 1.173 0.234 < 0.0001 HS

Gr. B 2.16 0.48 1.68 77.77% 1.464 0.292 < 0.0001 HS

(Hb- Haemoglobin; TLC- Total Leucocytes Count; ESR- Erythrocyte Sedimentation Rate)

In Group A, ESR and Eosinophill shown highly significant result regarding objective parameters with giving (percentage of decreased) an improvement of 32.99%, 45.94%. TLC shown significant result 20.67% and Hb, Blood Urea, S. Creatinine, SGOT, SGPT have shown no significant result. In Group B, all objective parameters have no significant result except Eosinophill (highly significant result)

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

Table No. V: Intergroup Comparison In Subjective Parameters Of Group A & B (Mann-Whitney Test)

Variable Group (AT-BT ) Diff. mean SD± SE± P S

KanduA 0.44 1.044 0.2088

> 0.05 NSB 0.84 0.4726 0.0945

DahaA 0.20 0.3742 0.0748

< 0.001 HSB 0.64 0.5066 0.1013

SravaA 1 0.9345 0.1869

> 0.05 NSB 0.72 0.4583 0.0916

RukshataA 0.64 0.8981 0.1796

< 0.001 HSB 0.20 0.8165 0.1633

PidikaA 1 0.9129 0.1826

< 0.001 HSB 0.28 0.4583 0.0916

VaivaranyataA 0.80 0.5 0.1

> 0.05 NSB 0.68 0.6904 0.1381

RajiiA 0.72 0.6782 0.1356

> 0.05 NSB 0.32 0.8021 0.1604

EASI ScoreA 6.08 4.339 0.8679

> 0.05 NSB 5.69 4.310 0.8619

Hamilton D.S.A 2.72 1.173 0.2347

< 0.001 HSB 1.68 1.464 0.2928

Table No. VI: Intergroup Comparison In Lab Investigation (Objectives Parameters) Of Both Groups: (Unpaired‘t’ Test)

Variable Gr. (AT-BT) Diff. mean SD± SE± t value P S

Hb%A 0.176 1.866 0.3733

0.3875 > 0.05 NSB 0.02 0.4041 0.0808

TLCA 1748 3273.1 654.62

2.618 < 0.05 SB 45.2 857.69 171.54

ESRA 6.48 9.068 1.814

2.411 < 0.05 SB 1.56 3.906 0.7812

EosinophillA 2.72 2.626 0.5251

3.425 < 0.001 HSB 0.72 1.137 0.2274

RBSA 5.56 22.74 4.549

0.4416 > 0.05 NSB 0.96 2.432 0.4865

SGOTA 5 12.407 2.481

1.331 > 0.05 NSB 1 3.606 1.653

SGPTA 0.24 8.266 0.678

0.5149 > 0.05 NSB 1.04 3.391 1.755

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Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

B. UreaA 0.52 5.072 1.014

1.356 > 0.05 NSB 2.76 6.891 1.378

S. Creat.A 0.028 0.2769 0.0553

10.165 < 0.0001 HSB 0.02 0.2363 0.0472

Discussion:

Probable Modes Of Actions Of The Drug:-

1. Avalguja Beeja Churna:-

• Avalguja Beeja Churna containing only Bakuchi. Drug Bakuchi[7] has Katu, Tikta Rasa and Laghu, Ruksha Guna which act on vitiated Kapha dosha. Vicharchika is Kapha predominant disease so drug Avalguja Beeja Churna works as Doshapratyanika Chikitsa. Bakuchi act as Kushthaghna i.e. Vyadhipratyanika Chikitsa.

• Bakuchi has Kaphavatahara property and directly acts on the causative doshas. By virtue of its Rasayana property Bakuchi supposed to increase both qualitative and quantitative improvement of all dhatus of the body.

• Bakuchi has Kushthaghna, Kandughna, Raktashodhaka, Twagdoshahara, Krimighna, Balya and Rasayana properties, which clearly explain its mode of action in Vicharchika.

• Modern research proved that Bakuchi has hepatoprotective activity, anthelmintic effect, anti-inflammatory, pesticidal activity, antitumor activity, antibacterial, antifungal activity, so breaks pathology[8]

2. Arka Tail:-• Arka Tail containing drug Arka, Haridra, Sarshapa

tail.• Arka[9] has Katu-Tikta rasa, Laghu-Ruksha-Tikshna

guna, Ushna veerya, it act as Bhedana, Deepana, Krimighna, Sophahara, Vatahara, Vranahara, Vishaghna, Kusthaghana, Kandughna.

• Haridra[10] has Katu-Tikta rasa, Laghu-Ruksha guna, Ushna veerya, it act as Kushthaghna, Kandughna, Raktaprasadana, Raktavardhaka, Vishaghna, Anulomana, Shothahara, Varnya, anti-

inflammatory activity.[11]

• Sarshapa tail has Katu-Tikta rasa, Tikshna, Snigdha guna, Ushna veerya, it act as Lekhana, Varnya, Krimighna, Jantughna, Kushthaghna. Oil is a skin and mucous membrain irritant, Emetic stimulant, digestive stimulant, antipruritic, and sporostatic, antifungal.[12]

Upon topical application, the active principle of the Tail reaches to the deeper tissues through Siramukha & Swedavahi srotas by virtue of its stains it with its Sukshma and Tikshna property. Due to its Ushna, Laghu, Ruksha properties it removes the obstruction in Swedavahi srotas and allows the local toxins to flow out through the Sweda, thus clearing out the micro channels. In most of the patients Kandu was relieved significantly due to the Kusthaghna and Kandughna properties of drugs of Arka Tail

Conclusion:

� Avalguja Beeja Churna and Arka Tail providess very good result in symptoms of Sravi Vicharchika (wet eczema) like, Srava, Pidika, etc.

� The study has revealed that there was no adverse effect on renal and liver functions, with which it can be concluded that the drug Avalguja Beeja Churna is safe for oral use in the patients of Vicharchka (Atopic dermatitis).

� The Ayurvedic medicine Avalguja Beeja Churna is non sedative as Cetrizine has sedative effects; on the other hand Clobetasole on prolonged application causes dry skin which is not evident in the application of Arka Tail.

� The patients of Vicharchika without treatment showed the recurrence of symptoms which confirms that Vicharchika is a Chirakari vyadhi (difficult to treat).

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan31

� This Clinical study proves that most of the Ayurvedic drugs used in this research project possess blood purifier, anti-inflammatory, antihistaminic, antifungal, antibacterial and immunomodulator properties.[13]

� Thus, finally we can conclude that ‘Avalguja Beeja Churna’ and ‘Arka Tail’ are safe, cost effective and free from any side effects in the management of Vicharchika [Atopic dermatitis]”. It also prevents the relapse considerably.

Jaiman D, Bhakuni H, Sahu AK, Bhargava P, Clinical evaluation of safety and efficacy of ‘Avalguja Beeja Churna’ and ‘Arka Tail ’ in the management of Vicharchika [Atopic Dermatitis]”- A Randomized controlled trial, JOA XIII-3, 2019; 22 - 31

References

1. Agnivesha, Charaka Samhita, revised by Charaka & Dridabala with Elaborated vidyotini Hindi commentary by Pt. Kashinath shastri Dr.Gorakhanath chaturvedi Edition 2009 Chaukhambha Bharati Academy, Varanasi, Chikitsa Sthana.7/13, pp. 249 - 250

2. Harrison’s Principle of Indian Medicine, 18th Edition, Edited by; Asui, Brauneald, Iselbachar, Wilson, Martin, Kasher Hauser and Lango, New York, Part-2, Chapter no. 71, pp. 344.

3. Chakrapanidatta, Chakradatta, with Vaidyaprabha Hindi commentary by Dr. Indra dev Tripathi, Edited by Prof. Ramanath Dwivedi, Published by Chaukhambha Publications, Varanasi, Year of reprint 2010, Kushthachikitsa 50/58, pp. 284

4. Bhavamishra, Bhavaprakash edited with the Vidyotini commentary by Pandit Sri Brahamasankar Mishra 11th Edition 2012 Vol.-2, Madhyam khanda Kusthachikitsa 54/13, pp. 541

5. Agnivesha, Charaka Samhita, revised by Charaka & Dridabala with Elaborated vidyotini Hindi commentary by Pt. Kashinath shastri Dr.Gorakhanath chaturvedi Edition 2009 Chaukhambha Bharati Academy, Varanasi, Chikitsa Sthana 7/26, pp. 252

6. Sushruta, Sushruta Samhita, Edited with ayurveda tatva sandipika by Kaviraja Ambikadutt shastri, edition 2011 Chaukhamba Sanskrit samsthana, Varanasi, Nidana Sthana 5/15, pp. 322.

7. Ayurvedic Pharmacopoeia of India, Published by Ministry of Health & Family Welfare, 1st Edition, 2003.

8. Bina Gidwani *1 et.al. Anti-inflammatory AND antimicrobial activity of hexane extract of seed of psoralea corylifolia : IJPRD/2010/PUB/ARTI/VOV-2/ISSUE-10/DEC/017ISSN 0974 – 9446

9. Rasa Chandanshu of Bhairavanatha, Purva Khanda 2/193,1st edition, Hindi Translation by Jnanendra Pande, Chaukhambha Krishnadas Academy, Varanasi, 2010, pp. 34.

10. Database on Medicinal Plants Used in Ayurveda, Published by The central council of Research in Ayurveda & Siddha, New Delhi, Year of publication 2001, Volume-1, pp. 152.

11. Compendium of Indian medicinal plants, Edited by R.P.Rastogi & B.N.Mehrotra, Year of publication 1985-1989, Volume 3, pp no.221

12. http://www.essential oils.co.za/essential_oils/mustard.htm#oil properties.

13. Sangeeta Srinivasan and D.V.L. Sarada Antifungal Activity of Phenyl Derivative of Pyranocoumarin from Psoralea corylifolia L. Seeds by Inhibition of Acetylation Activity of Trichothecene 3-O-Acetyl transferase (Tri101), J Biomed Biotechnol. 2012; 2012: 310850).

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¼,sV¨fid MesZVkbfVl ½ lkekU; Ropk fodkj gSA bl j¨x dh O;kidrk] lekt esa T;knk Álkj vkSj ÁÒkoh nok dh deh ds dkj.k] bl j¨x

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ejge d¨ fnu esa 2 ckj] 30 fnu¨a ds fy, Á;qä fd;k x;kA fu"d"kZ:- fopfpZdk ¼,sV¨fid MesZVkbfVl½ ds Áca/ku esa voYxqt cht pw.kZ

vkSj vdZ rSy lqjf{kr] ykxr ÁÒkoh vkSj fdlh Òh i{k ÁÒko ls Lora= gSA ;g j¨x ds lqj{kkRed Áca/ku esa Òh mi;¨xh gSA

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan32

Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu

*Dr. Jolly Sharma, **Prof. Sushila Sharma

*Assistant Prof., Dept. of Prasuti-Stree Roga, Tantia University Campus, Hanumangarh Road , Sri Ganganagar, **Prof., Dept. Of Prasuti-Stree Roga, National Instiute of Ayurveda, Jaipur.

ABSTRACT

JO

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Address of Corespondence:Dr. Jolly SharmaP. Assitant Professor Department of Prasuti-Stree Roga,Tantia University Campus, Sri GanganagarEmail ID : [email protected] No : 7726859001

Anemia is one of the most commonly encountered medical disorders during pregnancy. Besides many other adverse effects on the mother and the fetus it contributes significantly to high maternal mortality. Despite the measures taken to control anemia in pregnancy in the last two decades the severity of iron deficiency anemia continues to remain a public health issue of great magnitude suggesting that the measures have been largely ineffective. The present study was carried out to compare the efficacy of Padmadi lauham , an Ayurvedic herbomineral compound and iron folic acid tablets in diagnosed cases of anaemia in pregnancy. Two groups of 15 patients were randomly selected based on the inclusion criteria. Group A was given trial drug padmadi lauham while group B was given iron folic acid tablets. In the present study percentage of relief in clinical symptoms of anaemia was found more in group A(60.28%) then group B(40.34%) which proved that Padmadi Lauham was more effective than iron folic acid therapy in this trial.

Keywords: iron deficiency anaemia, padmadi lauham, iron folic acid.

How to Site the Article : Sharma J, Sharma S, Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu, JOA XIII-3, 2019; 32 - 38

Introduction: Anemia is one of the most commonly encountered medical disorders during pregnancy. In developing countries it is a cause of serious concern as, besides many other adverse effects on the mother and the fetus it contributes significantly high maternal mortality. According to United Nation declaration 1997, anemia is a major public health problem that needs total elimination.

WHO has estimated that prevalence of anemia in developed and developing countries in pregnant women is 14 per cent in developed and 51 per cent in developing countries and 65-75 per cent in India.[1] Prevalence of anemia in all the groups is higher in India as compared to other developing countries.[2] Iron containing drugs are widely used in modern medicine as hematinics. These

JOAjournalofayurveda.in ISSN No:2321-0435

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Sharma J, Sharma S, Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu, JOA XIII-3, 2019; 32 - 38

drugs are known to induce some adverse drug reactions - gastro intestinal symptoms as nausea, vomiting, epigastric pain, eructation, colic pain, flatulence, constipation, black feces, and diarrhea.[3] Despite the measures taken to control anemia in pregnancy in the last two decades the severity of iron deficiency anemia continues to remain a public health issue of great magnitude suggesting that the measures have been largely ineffective. Hence it is the need of the hour to search some alternative from other systems of medicine like Ayurveda.

Lauha Kalpas mentioned in Ayurveda are unique dosage forms which possess Lauha Bhasma as the major ingredient along with the other herbal ingredients.

Padmadi lauham is one such lauha kalpa mentioned in the text Rasendra Sara Sangraha.[4] Even though it is mentioned in netrarogadhikara considering its ingredients vis triphala, yasti madhu, padma and loha bhasma it has been selected for the present study.

Aims & Objectives

1. To assess the efficacy of Padmadi lauham in the management of garbhini pandu.

2. To compare the relative efficacy of Padmadi lauham and iron folic acid tablets.

3. To assess complication of Padmadi lauham if any.

Materials & Methods

The patients were selected from the O.P.D. & I.P.D. wing

of the Prasuti & Striroga, Arogya Shala, N.I.A., Jaipur. Two groups of 15 patients were randomly selected based on the inclusion criteria.Group A was given trial drug padmadi lauham 500mg bd with takra as anupana while group B was given iron folic acid tablets (ferrous sulphate 100mg+folic acid .5mg) 1 tab bd.

Patients were examined for the change in the signs and symptoms after every month for a period of 3 months. Pregnant women aged between 18-35 years of life,who were willing to participate in the trial and who were having anaemia in second trimester pregnancy, Hb less than 10gm/dl, Haematocrit less than 30%. Were included in the study. Patients of age less than 18 and above 35 years of life, having Anaemia other than Iron deficiency anaemia. whose Hb % was less than 6gm/dl and patients suffering from systemic diseases (high BP, diabetes etc) were excluded.

Subjective symptoms like pallor, anorexia, faigue, tachycardia, dyspnoea, edema, tinnitus, leg cramps, pica and palpitation a were scored following the standard methods. For the purpose of diagnosis certain routine and specific investigations were performed in every patients viz. Peripheral Blood Smear (PBS), Haemoglobin (Hb), Total red blood cell counts (TRBC), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular haemoglobin Concentration (MCHC), Serum Iron and Total Iron Binding Capacity (TIBC)

Results

Table - I Showing effect of therapy ( Padmadi lauha) in subjective parameters in group A (Wilcoxon matched-pairs signed ranks test)

VariableMean Mean

diff.% change SD± SE± P value S

BT ATPallor 1.733 0.667 1.067 61.5 0.59 0.153 <.001 HS

Anorexia 1.188 0.437 0.75 63.1 0.577 0.144 <.001 HSIndigestion 1.50 0.50 1.00 66.6 0.632 0.158 <.001 HSGiddiness 1.267 0.60 0.667 52.6 0.617 0.159 <.05 S

Fatigue 1.60 0.667 0.933 58.3 0.883 0.228 <.001 HSTachycardia 1.33 0.667 0.667 50.03 0.723 0.186 <.05 S

Dyspnoea 1.13 0.466 0.667 59.02 0.723 0.186 <.05 S

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Sharma J, Sharma S, Comparative Study Of Padmadi Lauham & Iron Folic Acid Tablets In The Management Of Garbhini Pandu, JOA XIII-3, 2019; 32 - 38

Edema 1.056 0.444 0.611 57.85 0.607 0.143 <.05 STinnitus 0.0133 0 - - - - - -

Leg cramps 1.059 0.444 0.588 55.52 0.939 0.227 <.05 SLeg pain 1.33 0.466 0.866 65.11 0.915 0.236 <.05 S

Pica 0.2667 - - - - - - -Palpitation 1.20 0.40 0.80 66.66 0.774 0.20 <.05 S

Table - II Showing effect of therapy ( iron folic acid tablet) in subjective parameters in group B (Wil-coxon matched-pairs signed ranks test)

Table - III Showing effect of therapy( Padmadi lauha) in objective parameters in group A (Paired‘t’ Test )

VariableMean Mean

diff.% change SD± SE± P value S

BT ATPallor 1.60 0.533 1.067 66.68 0.593 0.153 <.001 HS

Anorexia 0.80 0.466 0.333 41.62 0.723 0.186 >.05 NSIndigestion 0.933 0.666 0.266 28.51 0.457 0.118 >.05 NSGiddiness 0.733 0.600 0.133 18.14 0.516 0.133 >.05 NS

Fatigue 1.40 0.733 0.666 47.57 0.899 0.232 <.05 STachycardia 1.33 1.067 0.266 19.95 0.457 0.118 >.05 NS

Dyspnoea 1.20 0.666 0.533 44.4 0.833 0.215 <.05 SEdema 0.800 0.533 0.266 33.25 0.457 0.118 >.05 NS

Tinnitus 0.067 0.067 - - - - - -Leg cramps 0.933 0.733 0.20 21.43 0.774 0.200 >0.5 NS

Leg pain 1.00 0.466 0.533 53.3 0.639 0.165 <.05 SPica 0.067 0.067 0 - - - - -

Palpitation 0.866 0.40 0.466 53.81 0.516 0.133 <.05 S

VariableMean Mean

diff.%

changeSD± SE± t value P value S

BT AT

Hb 9.640 9.953 -0.313 3.24 0.515 0.133 2.355 <0.05 S

TRBC 3.679 3.921 -0.242 6.57 0.312 0.080 3.008 <0.001 S

PCV 28.887 30.140 -1.253 4.33 1.377 0.345 3.630 <0.001 S

MCV 80.90 83.687 -2.787 3.44 7.238 1.869 1.491 >0.05 NS

MCH 26.40 26.36 0.040 0.15 2.34 0.605 0.066 >0.05 NS

MCHC 32.813 32.767 0.046 0.14 4.43 1.145 0.040 >0.05 NS

Serum iron 68.98 72.09 -3.106 4.50 18.40 4.753 0.653 >0.05 NS

TIBC 0.311 0.286 0.025 8.03 0.049 0.012 1.956 >0.05 NS

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Table - IV Showing effect of therapy( Iron folic acid) in objective parameters in group B

VariableMean Mean

diff.%

changeSD± SE± t value P value S

BT ATHb 10.113 10.847 -0.733 7.24 0.797 0.205 3.564 <0.001 HS

TRBC 3.574 3.839 -0.265 7.41 0.394 0.101 2.603 <0.05 SPCV 29.807 32.280 -2.473 8.297 3.626 0.936 2.642 <0.05 SMCV 82.613 88.680 -6.067 7.34 6.826 1.763 3.422 <0.05 SMCH 28.06 28.18 -0.120 0.42 2.275 0.587 0.204 >0.05 NS

MCHC 33.470 32.30 1.173 3.50 2.268 6.812 1.722 >0.05 NSSerum iron 93.85 72.513 21.382 29.4 27.33 7.05 3.03 <.001 HS

TIBC 0.283 0.317 -0.034 12.01 0.028 0.007 4.676 <.001 HS

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Discussion

On subjective criteria padmadi lauha showed maximum percentage of improvement in indigestion (66.6%) followed by palpitation (66.6%) , leg pain (65.11%), anorexia (63.1%), pallor (61.5%), fatigue (58.3%), tachycardia (50.3%), dyspnoea (59.2%), oedema (57.8%) leg cramps (55.52%) and (giddiness (52.6%). On subjective criteria padmadi lauha showed highly significant result in symptoms like pallor, anorexia, indigestion and fatigue, while significant results were observed in symptoms like giddiness, tachycardia, oedema , dyspnoea, leg cramps, leg pain and palpitation.Maximum percentage relief in group B was seen in pallor(66.68%) followed by palpitation (53.81%), leg pain (53.3%), fatigue (47.57%), dyspnoea (44.4%), anorexia (41.62%), edema (33.25%), indigestion (28.51%), leg cramps (21.43%), tachycardia (19.95%) and giddiness (18.44%). On subjective criteria in group B iron folic acid showed highly significant result in pallor and significant result in symptoms fatigue, dyspnoea and leg pain. In other symptoms result was non significant.

The data shows that considerable relief was observed in symptom pallor in both the groups after the therapy. Maximum percentage of relief i.e. 66.68% was observed in group B which was statistically highly significant followed by group A in which percentage of relief was 61.5% which was also statistically highly significant.

The most important presenting sign of pandu roga is panduta. This sign is the most conclusive sign of the disease because whenever any patient come across, the thing first observed is the appearance.. The reason for good results in group A may be due to the presence of lohabhasma in the trial drug. The trial drug consists of ingredients like haritaki which are having deepana pachana guna resulting in relief of the symptom anorexia and indigestion. The reason for good result group A on the symptom giddiness may be due to the deepana , pachana effect of triphala which would have corrected Jatharagni and Dhatvagni upto normal level and its rasayana property whould have toned up Dhatu nirman process which results ultimately to Dhatu pushti

and prasadana. Fatigue is one of the most prominent symptom in pandu. This is again due to rasa raktadi dhatu kshaya, raktalpata etc. Trial drug was more effective in the condition since it contain Rasayana drugs like Triphala and Loha bhasma. Dyspnoea is observed in anaemic patients due to raktalpta, more load of work and lack of proper nourishment to heart. Hence heart becomes weak and symptom of dyspnoea occurs . Presence of lohabhasma in trial group which caused increase in Hb, would have inturn increased the oxygen carrying capacity of heart. How ever in group A a better result was seen, may be due to the combined action of the Padmadi Lauha. Due to dhatukshya, Vata dosha gets provoked resulting in to pain and cramps at the site of its location.

Once the dahatukshaya got corrected by the effect of trial drug relief was seen in the symptom. In palpitation more relief was found in group A. In Ayurvedic terminology palpitation can be co-related with Hrid Dravatva which is caused by Rasakshya. In padmadi lauha individual ingredients are having Rasayana property acting against rasakshya.

In objective parameters of Group A significant results were seen in Hb(3.24%) TRBC(6.57%), and PCV( 1.37%) while in all other parameters results were insignificant.In Group B highly significant result was seen in Hb(7.24%), followed by significant results in TRBC(7.41%), PCV(8.29%), MCV(7.3%). In other objective parameters results were in significant. One common reason for iron therapy treatment failure is ineffective iron intake. This may be due to non compliance , under dosing or failure to absorb iron from the supplement. Certain food also inhibit the iron absorption. Patients were advised to take padmadi lauha along with takra as anupana, but many of the patients may not have properly followed the advice. Not keeping proper gap between the meals and medicine may have also hamper the iron absorption.

The overall clinical improvement was highly significant in both groups. But percentage of relief was more in Group A (60.28%) than Group B (40.34%). The probable cause of the best response in clinical improvement of Group A can be attributed to the rasayana effect of the trial drug

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Conclusion

Anaemia can be compared to pandu which is described in detail in all the Samhitas. In Ayurvedic text garbhini pandu is not described exclusively . Acharya Kashyapa mentions that like all other disorders Pandu is also a common disease in Garbhini. There is disproportionate haemoglobin mass and marked demand of extra iron during pregnancy, specially in the second half. Even an adequate diet cannot provide the extra demand of Iron. Thus, there always remain a physiological iron deficiency state during pregnancy. In the present study Percentage of relief in clinical symptoms of anaemia was found more in group A(60.28%) then group B(40.34%) . i.e. Padmadi Lauha proves more effective than iron folic acid therapy in this trial.

The probable cause of the best response in clinical improvement of Group A can be attributed to the rasayana effect of the trial drug . It may have overcome the impaired immune function reported in iron deficient subjects, thus improving the clinical symptoms of anemia even though the blood indices did not show any considerable improvement. No side effect of the trial drug was observed in the present study. So the drug can be considered safe for the anaemia in pregnant women.

References

1. K. Kalaivani Prevalence & consequences of anaemia in pregnancy, Indian J Med Res 130, November 2009, pp 627-633

2. K. Kalaivani Prevalence & consequences of anaemia in pregnancy, Indian J Med Res 130, November 2009, pp 627-633

3. Milman N, Byg KE, Bergholt T, Eriksen L. Side effects of oral iron prophylaxis in pregnancy--myth or reality. Acta Haematol. 2006;115:53–7.

4. Gopalakrishnabhatt, Rasendra Sara Sangraha, Edited by Narendranath Mitra, Chaukhambha Orientalia,,New Delhi, Reprint 2007, Chapter 2, Netra roga chikitsa pp. 597

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JO

A

XII

I-3

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple

allergic conjunctivitis.*Dr. Kirti Kumar Akhand, **Prof. Shamsa Fiaz

*RMO, Govt. Dhanvantari Ayurvedic Medical College & Hospital, Ujjain ( M.P.),**Professor & H.O.D., Dept. of Shalakya Tantra, National Institute of Ayurveda, Jaipur,

ABSTRACT

Acharya Sushruta has explained the disease Netra Abhishyanda as one of the Aupasargika Rogas. It is the root cause of all eye diseases. Acharyas have explained Vataja Abhishyanda as Sarvagata Vyadhi. The numbers of Sarvagata Rogas are seventeen according to Sushruta Samhita. Vataja Abhishyanda is produced when the vitiated Doshas are situated in all parts of the eyes, particularly in the ocular surface. The sign and symptoms like Nistoda(Pain), Stambha(Stiffness of lids), Sangarsha (Foreign body sensation), Parushya, Vishushkabhava(Feeling of dryness), Shishirashruta(Cold lacrimation) described in Vataja Abhishyanda seems to be similar to the characteristic features of the simple allergic conjunctivitis viz. watery discharge, foreign body sensation, pricking pain etc. The clinical study was done on 30 patients of Vataja Abhishyanda in two different groups. Group A was treated with Bilvadi yogaashchyotana and Group B was treated with haritakividalaka. After the registration of patients for this study sign and symptoms such as Nistoda, Stambha, Sangarsha,Vishushkabhava, Shishirashruta, Kandu and Raga were recorded before, during and after the treatment.

Keywords : Vataja Abhishyanda, Simple allergic conjunctivitis, Bilvadi yoga ashchyotana, haritakividalaka, Abhishyanda, Sarvagata Vyadhi, Nistoda, Stambha, Sangarsha, Vishushkabhava, Shishirashruta

Address of Correspondence: Dr. Kirti Kumar AkhandRMO,Govt. Dhanvantari Ayurvedic Medical College & Hospital, Ujjain ( M.P.)

Email ID : [email protected]

Contact No : 9713163156

Introduction:

Shalakya Tantra is an important branch which dealing with diseases of Urdha Jathru (above the clavicle) and Netra Rogas are hence described in detail. Abishyanda is a Sarvagata Netara Roga which is derived from two words viz. “Abhi” and “Syandana”.

How to Site the Article : Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

JOAjournalofayurveda.in ISSN No:2321-0435

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Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

“Abhi” means profuse and “Syandana” means discharge or secreation and combined meaning is profuse discharge from all parts of the eye. Netra Abishyanda is considered as ‘root cause’ for almost all affections of the eyeball[1]. Netra Abishyanda is classiofied into four types according to Dosha predominance viz. Vataja, Pittaja, Kapaja and Raktaja Abishyanda[2]. Vataja Abishyanda is characterized by Nistoda (Pricking Pain), Sangarsha (Foreign body sensation), Shishirashruta (Watering discharge/ Cold lacrimation), Alpa Shopa (Mild Chemosis), Vishushkabhava (Feeling of dryness), Parushya (Dryness)[3] etc. which are very similar to the most singns and symptoms of the simple allergic conjunctivitis. Hence Vataja Abishyanda can is correlated with simple allergic conjunctivitis.

Allergic conjunctivitis is the most common type of eye allergy and is widely experienced by the global population. The incidence appears to be increased, possibly due to air pollution and wide spread allergens worldwide[4]. The basic reason behind the allergic reactions in the body is altered immunity of hypersensitivity. The most common causes for allergic reactions are because of constant exposure to external environment. It is proved that conjunctival mucous membrane is nearly ten times more exposed in comparison to other parts of the body. When our eyes are exposed to any allergens like dust, smoke, animal-dander, mites, pollens etc. then histamine is released and the blood vessels in conjunctiva become swollen.

Allergic conjunctivitis is the most prevalent disease and has an equal distribution more or less throughout the world, without any exception to the developed and under developed countries. It has a prevalence rate of 5-22% in general population and a recurrence rate of 41-62%. No such effective drug is available in the modern ophthalmology which can cure the disease allergic conjunctivitis completely. Moreover after stopping the treatment symptoms of the disease re-occur. Hence keep in all these points in mind it was decided to evaluate the efficacy of Bilvadi yoga Aschyothana and Haritaki Vidalakaon Vataja Abishyanda with

special reference to simple allergic conjunctivitis.

Aims and Objectives:

• To explore the disease Vataja Abhishyanda and simple allergic conjunctivitis as Ayurveda and Modern parlance.

• To assess the efficacy of Bilvadi yoga Aschyotna and Haritaki Vidalaka in the management of Vataja Abhishyanda

• To provide an effective, economic and easily available regime for the Vataja Abhishyanda.

Materials and Methods

Selection of patients:-

Patients attending the O.P.D. and I.P.D. of Netra Roga unit of Shalakya department of N.I.A. Hospital with signs and symptoms of Vataja Abhishyanda or Simple Allergic Conjunctivitis, between the age group of 15– 70 years were selected for the present study. A total number of 30 patients were selected and divided into two groups with 15 patients in each group.

Exclusion Criteria:-

1. Patients not willing for trial.

2. Abhishyanda associated with Corneal Ulcer.

3. Abhishyanda associated with Trachoma.

4. Simple Allergic conjunctivitis with other forms of allergy like skin rash and allergic Asthma.

5. Any individual above 70 years and below 15 years of age either of any sex.

6. Cases complicated with dacryocystitis.

7. Patients suffering from other systemic disorders.

Method of study:

Total 30 patients were selected for present study who fulfilled the criteria of diagnosis and consented for study. They all were treated with Bilvadi Ashchyotana and Haritaki Vidalaka for local application.

Grouping of patients:

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Group A: Bilvadi Yoga Ashchyotana

Drug: Bilvadi Yoga

Dose: 2 drops five times daily for local application.

Duration: 15 days

Group B: Haritaki Vidalaka

Drug: Haritaki Bhristha choorna with Ghrita

Dose: 5 gm of Haritaki Churna(Powder) and fried with 1 tea spoon of Ghrita for each eye.Duration: 15 days

Duration of the Trial:-

The trial of the therapy was carried for 15 days.

Follow Up

The follow up study was done once in 15 days after treatment for month.

Preparations of drug:

Bilvadi Yoga Ashchyotana[5]:

Bilva, Agnimantha, Shyonaka, Gambhari, Patala, Eranda, Brihati, Madhu Shigru

Bilvadi Yavkuta Churna was taken in one part (10gm) to that ten times water (100ml) was added and boiled till one fourth quantity (025 ml) remains and then filtered. When Kwatha becomes luke warm then filtered solution was transferred in sterile plastic bottles of 5 mlunder aseptic conditions. Plugging and capping was also done in aseptic condition then instillation of 10 drops was done with eye drops bottle from 2 Angula heights in Kaninikasandhi (Inner canthus area).

Haritaki Vidalaka[6]:

Haritaki, Ghrita

One tea spoon full (tsf) of Haritaki Churna is taken and mixed with a tea spoon full (tsf) of Ghrita and fried in a fry pan for 2 minutes at Kriyakalpa unit of PG Department of Shalakya Tantra N.I.A. Jaipur. The paste was applied on closed eyes leaving eye lashes and left it in place for 15 minutes and later removed it gently with Luke warm water and cotton.

Criteria for Assessment:

The signs and symptoms were assessed by adopting suitable scoring method. The details are as follows:

1. Nistoda (Pricking sensation)

2. Stambha (Stiffness of lids)

3. Sangharsha (Foreign body sensation)

4. Vishuskabhava (Feeling of Dryness)

5. Shishirashruta (Cold lacrimation)

6. Kandu (Itching)

7. Raga (Congestion)

Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

1. Nistoda (Pricking sensation):

● Absent – no pain 0

● Occasionally present and mild 1

● Intermittently present and moderate 2

● Present almost all the time severe 3

2. Stambha (Stiffness of lids)

● Absent (No Stambha ) 0

● Occasionally feeling of Stambha of lids. 1

● Intermittently and mild feeling of Stambha

of lids 2

● Feeling of Stambha of lids & Eye ball almost

all the time. 3

3. Sangharsha (Foreign body sensation)

● Absent 0

● Occasionally present 1

● Intermittently present 2

● Present almost all the time, continuously 3

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Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

4. Vishushka Bhava (Feeling of Dryness)

● Absent – no feeling of dryness 0

● Occasionally present and mild 1

● Intermittently present and moderate 2

● Almost all the time and severe 3

5. Shishirasruta (Cold lacrimation)

● Absent 0

● Mild and occasionally needs to wipe 1

● Moderate and needs to wipe frequently 2

● Severe and needs to wipe almost all the

time. 3

6. Kandu (Itching)

● No Itching 0

● Occasional sensation of itching not requiring to rub

eye 1

● Intermittent sensation of itching requiring to rub

eye 2

● Continuous itching which requires rubbing. 3

7. Raga (Congestion of conjunctiva)

● No congestion 0

● Congestion in Palpebral Conjunctival 1

● Congestion in Bulbar Conjunctival 2

● Congestion in Both Palpebral & Bulbar 3

Statistical analysis

The information regarding demographic data was given in percentage. The scoring of assessment criteria was analyzed statistically in terms of mean values of B.T. (Before Treatment), A.T. (After treatment), S.D. (Standard Deviation), and S.E.M (Standard Error of Mean).

The results obtained were considered significant if p-value ≤ 0.05 and non-significant if p-value > 0.05.

For non-parametric data in individual group wilcoxan

matched pairs signed-ranks test was applicable to check the statistical significance level and for intergroup comparison Mann-Whitney test was applied.

Observations and Results

Description of demographic status

Age:

In the present study maximum number of patients i.e. 62.5%(20 patients) belonged to agegroup of 15-30 years, followed by 34.37% (11) patients to 31-45 years of age group and 3.33% (1) patients were related to the age group of 46-60 years.

Sex:

In the present study, maximum numbers of patients i.e. 71.87% and comparatively male ratio is more thanfemale.

Religion:

It is evident from present study that maximum i.e. 93.75 % (30) patients were Hindus while others were Muslims.

Occupation:

On considering the nature of occupation, it was observed that maximum i.e. 34.38% (11), patients were students and 15.62% (5) patients were housewives.

Marital Status:

There is equal percentage 50% (16) of both married and unmarried

Socioeconomic status:

In the present study, maximum i.e. 84.38% (27) patients were belonged to middle -class while 15.62% (5) patients were from lower class society. This indicates the general middle class trend of patients attending the government hospital. In lower middle and poor socio-economical persons, low calorie diet and unhygienic conditions may play a key role in manifestation of Netra Rogas as well as Vataja Abhishyanda– Simple Allergic Conjunctivitis.

Education:

The educational status of the present series reveals that amongst 32 patients maximum numbers of patients

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Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

i.e. 78.13%were Literate, and 21.87% (3) patients were illiterate.There are no direct relation between education and the disease Vataja Abhishyanda–Simple Allergic Conjunctivitis mentioned in the text, but it can be said that education is not sufficient to become aware about disease Vataja Abhishyanda–Simple Allergic Conjunctivitis.

Habitat:

It was observed in the present clinical study that maximum number of patientsi.e. 78.13 % (25) belonged to urban area and 21.87% (7) patient’s belonged to rural area. This may be due to thelocation of the hospital where the study was performed.

Onset of disease:

The present study reveals that the Onset of disease Vataja Abhishyanda– Allergic Conjunctivitis was of sudden onset in i.e. 90.62% (29) and of gradual onset disease in 9.38% (3) patients. It shows that if patients are not taking proper care for avoidance of contact with the allergen to the ocular surface, the conjunctiva becomes sensitive and reacts immediately

Diet:

It was found that maximum i.e. 53.12 % (17) patients were taking vegetarian diet,while 46.88 % (15) were taking mixed type of diet. The dietary habit of a person is based on the choice, availability and religious customs of the person. So, this cannot be inferred that persons taking vegetarian diet are more prone to Vataja Abhishyanda– Allergic Conjunctivitis. This shows the prevalence of vegetarian diet in Jaipur.

Bowel habit:

In the present study, it was observed that most of the patients i.e. 84.37% (27) were having regular bowel habits, while 15.63% (5) patients were having irregular bowel habits. As we know that Apana Vikriti causes Asamyaka Mala Pravritti and Apana is that Vayu which controls the other four Vayu. Thus, the Apana Vikriti produces Samana Vikriti leading to Asamyaka Pachana and leading to Asamyaka Dhatu and Ama Utpatti.

It was observed that maximum patients had normal

bowel habit in contrast to the pathogenesis of maximum diseases which can be attributed to abnormal bowel habit. Thus, it can be concluded from the above mentioned data that irregular bowel or constipation may promote the manifestation of disease Vataja Abhishyanda –Simple allergic Conjunctivitis as they cause Vatadi Doshavitiation in some of selected patients.

Micturition:

In the present study, it was observed that maximum i.e. 81.25% (27) patients werehaving normal micturition while 18.75% (6) patients were having irregular micturitionhabits.

It was observed that some patients had varied micturation habit. Thus, it can be understood from the above mentioned data that irregular micturition is probably involved in the manifestation of disease Vataja Abhishyanda – Simple Allergic conjunctivitis as they causing Vata Dosha vitiation.

Addiction:

In the present study 6.25% (2) patients were having habit of Tea/coffee, 12.5% (4) patients were having habit of smoking, 6.25% (4) patients were having habit of tobacco chewing, 18.75% (2) were having habit of Alcohol and no addiction was found in 71.87% (23) patients.

The patients habituated with Tea/Coffee, Smoking, Alcohol and tobacco found in the series may be taken as indicative of the general addiction and habits of the people of that particular area. Dhuma Nishevanam (smoking) as a risk factor has been depicted by Acharya Sushruta in Uttartantra. The modern medical science also has considered the smoking and alcohol as the risk factors for the manifestation of ocular disorders.

Sharira Prakriti:

In the present study that maximum i.e. 56.25% (18) patients had Vata-Pitta Prakriti and 28.12% (9) patients had Vata-Kapha Prakriti and 15.63% (5) had Pitta-Kapha Prakriti. This study has been carried out on Vata predominant condition of the Abhishyanda, and it occurs due to aggravation of Vata as depicted in

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Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

Ayurvedic texts. Above data supports the Vata Pradhana Prakriti of the patients. As this sample is very small, no definite correlation between Sharira Prakriti and Vataja Abhishyanda –Simple allergic conjunctivitis occurrence of could be established.

Sara:

The data shows that maximum i.e. 84.38% (27) patients were of Madhyama Sara, 12.5%(4)were of Avara Sara and 3.12% (1) were of Pravarasara. Sarata is the indicator of the Bala Pramana i.e. 84.38% (27) patients had Madhyama Bala Pramana. From the above facts it cannot be inferred that the less the Sara of patient the more he is prone to the disease Vataja Abhishyanda–Simple Allergic Conjunctivitis. As incidence of Madhyama Sara is more as compared to Avara Sara in general in the present study hence maximum percentage was found in Madhyama Sara.

Samhanana:

Samhanana wise distribution shows that 3.12% (1) patients were Pravara in Samhana, 78.13 % (25) patients were Madhyama in Samhanana and 18.75%(6) patients were Avara in Samhanana. In the present study maximum patients had Madhyama Samhanana.

Satmya:

The data suggests that maximum i.e. 90.62% (29) patients were of Madhyama Satmya, 6.25% (2) patients were of Avara Satmya and 3.13% (1) patients were of Pravara Satmya. A good number ofpatients were accustomed to diet having dominance of Katu and Amla Rasa, the excessive use of which is said to be Vatavardhaka and Achakshushya by the Acharyas. Such persons may have more chances of developing Vataja Abhishyanda –Simple Allergic Conjunctivitis.

Satva:

Maximum number of patients i.e. 68.75% (22) patients had Madhyama Satva. There is no close relation between the Satva of individuals and the disease Vataja Abhishyanda– Simple Allergic Conjunctivitis.

Abhyaharana, Jarana Shakti:

Maximum no. of patients showed Madhyama Abhyavaharana and Jarana Shakti i.e. respectively 65.62% (21) and 59.37% (19). Abhyaaharana Shakti means the assimilation capacity of the person. Jarana Shakti means the digestive capacity of the person.

Vyayama Shakti:

75% (24) patients were having Madhyama Vyayama Shakti, 21.88% (7) patients had Avara Vyayama Shakti followed by Pravara Vyayama Shakti i.e. 3.12% (1). Vyayama Shakti (Bala) means power of body. In any disease if Bala of Sharira is less, then the progress of the disease in that Sharira gets fast. The lesser the Sharira Balat he lesser will be the immunity and hence likelihood of the disease.

Vaya:

65.62% (21) patients were having Balavaya and 34.38% (11) were having Madhyama Vaya. Now a days young age and children mainly affected from this disease due to pollution, dust and wind. Children were having less immunity power so they mainly affected.

Sign of Simple Allergic conjunctivitis on Palpebral Conjunctiva

The data shows that in signs of Simple Allergic Conjunctivitis in Palpebral Conjunctiva 3.12% (1) patients had Normal conjunctiva, 96.87% (31) patients had Congestion, 50% (16) had Follicles, 25 % (8) had Papillae and 9.37% (3) had Concretion. This shows that Congestion, Follicle and Papillae and concretions are commonly seen in patients of Simple Allergic Conjunctivitis in Palpebral Conjunctiva.

Sign of Simple Allergic conjunctivitis on Bulbar Conjunctiva:

The data shows that in Signs of Simple Allergic Conjunctivitis in Bulbar Conjunctiva 21.87% (7) patients had Normal conjunctiva, 78.12% (25) patients had Congestion, 6.25% (2) had Chemosis of Bulbar Conjunctiva. These indicate that Congestion and Chemosis are seen commonly in Simple Allergic Conjunctivitis.

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Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

Symptoms of Vataja Abhishyanda:

The data shows that 93.75% (30) patients were having Nistoda, 46.87 % (15) were having Stambha, 100% (32) were having Sangarsha, 43.75% (14) were having

Vishushkabhava, 100% (32) were having Shishirashruta and 100% (32) were having Kandu, 100% (32) patients were having Raga.

Effect of Therapy

Table No I. The effect of therapy on Clinical Features in Group-A (Wilcoxon matched paired signed ranked test)

Table No II. The effect of therapy on clinical features in Group-B (Wilcoxon matched paired signed ranked test)

S.

No.

Clinical Features

Mean Score% 0f

ReliefSD SEM p-value ResultsBefore

TreatmentAfter

TreatmentDifference

1 Nistoda 1.467 1.000 0.466 31.81% 0.639 0.165 ≤0.05 S

2 Stambha 0.533 0.333 0.200 37.50% 0.414 0.106 >0.05 NS

3 Sangarsha 2.000 1.200 0.800 40% 0.560 0.144 ≤0.001 S

4 Vishushkbhava 0.666 0.133 0.533 79.99% 0.743 0.191 ≤0.05 S

5 Shishirashruta 1.467 0.666 0.800 54.53% 0.560 0.144 ≤0.001 S

6 Kandu 1.933 1.133 0.800 41.38% 0.560 0.144 ≤0.001 S

7 Raga 2.267 1.133 1.133 49.97% 0.915 0.236 ≤0.001 S

n= 30, S: Significant, NS: Not significant, SD: Standard deviation, SEM: Standard error of mean

S.

No.

Clinical Features

Mean Score

% 0f Relief

SD SEM p-value Results

Bef

ore

Trea

tmen

t

Aft

er

Trea

tmen

t

Diff

eren

ce

1 Nistoda 1.667 0.800 0.866 51.99% 0.516 0.133 ≤0.001 S

2 Stambha 0.8000 0.066 0.733 91.66% 0.883 0.228 ≤0.05 S

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3 Sangarsha 1.933 1.533 0.400 20.69% 0.507 0.130 ≤0.05 S

4 Vishushkbhava 0.533 0.400 0.133 24.99% 0.351 0.090 >0.05 NS

5 Shishirashruta 1.667 1.133 0.533 31.99% 0.516 0.133 ≤0.01 S

6 Kandu 2.067 1.533 0.533 25.80% 0.516 0.133 ≤0.01 S

7 Raga 2.733 1.867 0.866 31.71% 0.743 0.191 ≤0.01 S

n=30, S: Significant, NS: Not significant, SD: Standard deviation, SEM: Standard error of mean

Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

Table No III. Intergroup comparison of Subjective Parameter of Vataja Abhishyanda (Mann Whitney test)

Table No IV. Intergroup comparison of objective parameter of vataja abhishyanda (Mann Whitney test)

S NoSymptoms

Mean of Group

SD of Group SEM of GroupU p-value Results

A B A B A B

1 Nistoda 0.466 0.866 0.639 0.516 0.165 0.133 148 0.087 NS

2 Stambha 0.200 0.733 0.414 0.883 0.106 0.228 148.50 0.077 NS

3 Sangarsha 0.800 0.400 0.560 0.507 0.144 0.130 153 0.058 NS

4 Vishushkbhava 0.533 0.133 0.743 0.351 0.191 0.090 144.50 0.091 NS

5 Shishirashruta 0.800 0.533 0.560 0.516 0.144 0.133 139 0.208 NS

6 Kandu 0.785 0.571 0.578 0.513 0.154 0.137 116 0.347 NS

n=30, S: Significant, NS: Not significant, SD: Standard deviation, SEM: Standard error of mean

S. No

SymptomsMean of Group

SD of Group SEM of GroupU P Results

A B A B A B

1 Raga 1.133 0.866 0.915 0.743 0.236 0.191 130 0.452 NS

n=30, S: Significant, NS: Not significant, SD: Standard deviation, SEM: Standard error of mean

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Table No V. The % wise improvement of Signs and Symptoms in both groups

Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

Discussion

Vataja Abhisyanda can be correlated to simple allergic conjunctivitis based on the symptoms like Nistoda (Pricking Pain), Sangarsha (Foreign body sensation), Shishirashruta (Watering discharge/ Cold lacrimation), AlpaShopa (Mild Chemosis), Vishushkabhava(Feeling of dryness), Parushya(Dryness)[3].

In present study Raja and Dhuma Sevana (90.62% of the patients) are found to be predominant causes of Vataja Abhishyanda or simple allergic conjunctivitis. Burden of studies in young children, pollution (two wheeler riders) and field work may also be a cause in those patients exposed to outdoor atmosphere as 34.38% trial subjects were students, service class, business etc.

The gravity of this disease was very well depicted by our ancient Acharyas by considering it as a cause for all Netrarogas and same is seen if conjunctivitis is not treated in time can result into serious complication like keratitis, iritis, iridocyclitis, glaucoma, chorioretinitis, and retinal degeneration etc.

In present study shows that there was congestion in palpebral conjunctiva in 87% patients, 50% had Follicles, 25 % had Papillae and 9.37% (3) had concretion. This shows that congestion, follicle and papillae and concretions are

commonly seen in patients of simple allergic conjunctivitis in palpebral conjunctiva. The data also shows that there was congestion in bulbar conjunctiva in 78.12% patients, chemosis 6.25% which indicates congestion and chemosis are seen commonly in simple allergic conjunctivitis. The data shows that 93.75% patients were having Nistoda, 46.87 % were having Stambha, 100% were having Sangarsha, 43.75% were having Vishushkabhava, 100% were having Shishirashruta and 100% were having Kandu, 100% patients were having Raga hence Shishirashruta and Vishushkabhava are clinical features in Vataja Abhishyanda.

In Group A, relief in the symptom of Nistoda was observed in 15 patients with 31.81% of improvement which is Significant at the level of p value ≤0.05 and in Group B, relief in the symptom of Nistoda was observed in 15 patients with 51.99% improvement which is extremely significant at the level of p value ≤0.001. Relief in the symptom of Nistoda is better in group B than group A which was treated with Haritaki Vidalaka. Haritaki is Tridoshashamaka and Vishesha Vata Shamaka and after it is fried in ghee its Vatashamana property increases and hence the pain subsides which is the main symptoms of Vata. More ever the medicine which is applied in the form of Vidalaka greater and retention time hence better

S.N. Cardinal SymptomsResult In Percentage

Group-I Group-II

1 Nistoda 31.81% S 51.99% S

2 Stambha 37.50% NS 91.66% S

3 Sangarsha 40% S 20.69% S

4 Vishushkabhava 79.99% S 24.99% NS

5 Shishirashruta 54.13% S 31.99% S

6 Kandu 41.38% S 25.80% S

7 Raga 49.97% S 31.71% S

Average Percentage of relief 47.82% 39.83%

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bioavailability which also shows better relief in symptoms of Nistoda than Bilvadi Aschyotana. Ushana Veerya and Madhura Vipaka of Haritaki Shows Vatashamaka effect and subsided the symptom of Nistoda. In Vidalaka the tissue contact time is more and is applied in closed eye so due to increase tissue contact time the symptoms of pain in eye was easily subsided the symptoms of Nistoda.

In Group A relief in the symptom of Stambha was 37.50% which is non significant at the level of p value >0.05.In Group B relief in the symptom of Stambha was 91.66% which is Significant at the level of p value ≤0.05.

In Group A, relief in the symptom of Sangarsha was 40% which is extremely significant at the level of p value ≤0.001.In Group B, relief in the symptom of Sangarsha was 20.69% which is significant at the level of p value ≤0.05.In Group A, relief in the symptom of Vishushkabhava was 79.99% which is Significant at the level of p value ≤0.05.In Group B, relief in the symptom of Vishushkabhava was observed 24.99% which isnon significant at the level of p value >0.05. In Group A, relief in the symptom of Shishirashruta was observed 54.13% which is extremely significant at the level of p value ≤0.001.In Group B, relief in the symptom of Shishirashruta was observed 24.99% which is significant at the level of p value ≤0.01.

In Group A, relief in the symptom of Kandu was 41.38% which is extremely significant at the level of p value ≤0.001.In Group B, relief in the symptom of Kandu was observed in 25.80% which is significant at the level of p value ≤0.01. In Group A, relief in the symptom of Raga was 49.97% which is extremely significant at the level of p value ≤0.001.In Group B, relief in the symptom of Raga was 31.71% which is significant at the level of p value ≤0.01. Ragata is seen as a result of frequent rubbing which produces an inflammatory response vitiating the Pitta dosha and hence most of the medicines like Patala, Gambhari etc. have Tikta, Kashaya and Madhura rasa which pacify Pitta and Rakta and also promote healing action. Hence this drug has shown improvement in reducing conjunctival congestion, concretions and follicles in group A patients treated with Bilvadiyoga.

All the drugs in Bilvadi Yoga Aschyotana are Ushna

Veerya hence possess Vata Shamaka property and as Vata is the main Dosha involved in the disease. All the drugs also possess Shothahara property which helps in subsiding features like Alpa-shopha (mild chemosis). The Vednasthapana property of the contents helps in relieving Nistoda (pricking pain). Laghu, Rukshaguna of the drugs helps in better penetration and boavailability. Kashaya rasa promotes healing (Ropana) and reduces the discharges. Hence significant there was relief of the symptom Shishirashruta i.e. watery discharges. Tannins present in Bilva have astringent properties form complexes with macromolecules particularly with proteins (digestive and other enzymes, fungal or viral proteins).Tannin containing drugs will precipitate protein and have been used traditionally as styptics & used for the protection of inflamed surfaces. They also have a vasoconstrictor effect on small superficial vessels thus limiting fluid loss and preventing external aggregations and regeneration in case of superficial wounds or burns and tocopherol related compounds promote anti- oxidative activity at local site.

Haritaki has Pancharasa Vishesha Kashaya rasa and due to Kashaya Rasa promotes healing (Ropana) and reduces the discharges. So it is helpful in the relief of the symptom of Shishirashruta i.e. watery discharges. Ghritahas Madhura rasa which shows the Vatasham ana effect. Ghritahave Varnya karma so it helps in Ropana in Abhishyanda. Haritaki has Ushna Veerya and does Vata Shamaka which is the main Dosha involve in the disease VatajaAbhishyanda. The Vednasthapana property of Haritaki helps in relieving Nistoda (pricking pain).Laghu, Rukshaguna of Haritaki helps in better penetration of the drug. Snigdha, Mridu Guna of Ghrita helps to reduce Stambha (Stiffness of lids) in Vataja Abhishyanda. Haritaki and Ghrita both have Madhura Vipaka shows Vata Shamka karma which is the main Dosha involved in the disease Vataja Abhishyanda. Haritakiand Ghrita both have Vatashamka Karma and Chakshushya property.

Conclusion

Bilvadi Yoga Aschyotana and Haritaki Vidalaka

Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 -49

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formulation gave better results in the clinical features like Nistoda (Pain in eyes), Stambha (Stiffness in lids), Sangarsha (Foreign body sensation), Vishushkabhava (feeling of dryness), Shishirashruta (Cold lacrimation), Kandu (Itching), Raga (Congestion). Noadverse effects were observed during the study in both of formulations viz Bilvadi Yoga Aschyotana and Haritaki Vidalaka.

Comparing the symptomatic improvement in both groups it was found that average percentage of relief was higher in ‘Group-A’ i.e. 47.82%, followed by ‘Group-B’ i.e. 39.83% which shows that effect of therapy was better in Group-A in comparison to Group-B. Hence Bilvadi Yoga Aschyotanas howed better results in comparison to Haritaki Vidalaka.

Akhand KK, Fiaz S, A comparative study on effect of bilvadi yogaashchyotana and haritaki vidalaka in the management of vataja abhishyanda w.s.r. to simple allergic conjunctivitis. JOA XIII-3, 2019; 39 - 49

References

1. Sushruta, Sushruta Samhita with Nibandha Sańgraha commentary. Chowkhamba Samskritha Samsthan; 2013. Uttarastana 6, 5:603

2. Sushruta, Sushruta Samhita with Nibandha Sańgraha commentary. Chowkhamba Samskritha Samsthan; 2013. 6, 3:603

3. Sushruta, Sushruta Samhita with Nibandha Sańgraha commentary. Chowkhamba Samskritha Samsthan; 2013. 6, 6:603

4. http://www.research and markets.com/research/cf675c/allergic conjunctivitis download on 14/09/15

5. Indradeva Tripathi. Cakradatta of Shri Chakrapanidatta “Sansksrit, with Vaidhyaprabha Hindi commentary. Chaukhamba Sanskrit Bhavan, Varanasi: 2005, 59,13 :348

6. Indradeva Tripathi. Cakradatta of Shri Chakrapanidatta “Sansksrit, with Vaidhyaprabha Hindi commentary. Chaukhamba Sanskrit Bhavan, Varanasi: 2005, 59,10 :347

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JO

A

XII

I-3

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9

ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

A Study on Efficacy of Virechana and Gajalinda Kshara on Shwitra w.s.r. to Vitiligo (Leucoderma)

*Dr. Surendra kumar Sharma, **Dr.Shrinidhi K.Acharya, *** Dr. Piyush Mehata*Medical Officer, APHC, Pragapura, Jaipur, **Assistant Professor, ***Ex. Professor, Dept. of Kaumarabhritya, National Institute of Ayurveda,

Jaipur.

ABSTRACTObjectives: - A Study on Efficacy of Virechana and Gajalinda Kshara on Shwitra w.s.r. to Vitiligo (Leucoderma)

Design: interventional, open label masking, randomized trial, Setting:- Hospital based Participants:- children of age group 5-15 yrs. Intervention:- Gajlindalepa and Virechana with Gajalindalepa in two groups A & B for advised to apply the trail drug Gajlindalepa provided to them at early morning preferably at the time of sun- rise hours once in day for the duration of six months for patients were followed-up on every fifteen days. Outcome measures:- Clinical Features- no. of black spot in observed patch, color change in the observed patch, reducing size of the observed patchResults: - Highly significant improvement in both the groups Conclusion:-Both the trial drugs are effective in the management of Shwitra but Virechana with Gajalindalepa is more effective than Gajalindalepa without Virechana.

Address of Correspondence: Dr. Surendra Kumar SharmaMedical Officer (AYUSH), APHC, Pragapura, Jaipur.

Email ID : [email protected]

Contact No : 8209389214

How to Site the Article : Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

Keywords : Shwitra, Vitiligo, Gajalindalepa and Virechana

JOAjournalofayurveda.in ISSN No:2321-0435

Introduction

As color of the skin plays a very important role in cosmetic world and trying to be more beautiful and attractive is natural tendency of human being, although Shwitra don’t produces pain, ulcer or discomfort, but eventually creates an inferiority complex in individual which later lead to disturbances in his social, personal and educational life.

Based on the symptoms, Shwitra can be correlated with Vitiligo where we find improper distribution of melanocyte pigment (Vitiligo). Vitiligo a hypopigmentation disorder may be of genetic or acquired cause. The disease may start at any age but usually seen in child hood at 10 years of age or in second decade of life. Based on some dermatological out patient records it is roughly estimated to be between 3 – 4% in India. The Vitiligo affects the estimated 1% of world population. we find many hidden cases of Shwitra due to certain misbeliefs and myths related to this disease. Of course all the hypo pigmented cases are not Vitiligo as

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Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

Colour of skin depends on many other factors.

But any cause which disturbs the color of skin is called as Kusta in Ayurveda. Shwitra is considered amongst the varieties of Kusta in the classics,[1] due to vitiation of Dhatus like Rasa, Rakta, Mamsa and Meda[2], Seven Dushyas, Tridoshas. Depending upon the duration of the disease and the involvement of Dhatus, the disease becomes prognostically bad. Meantime among the Raktha pradosha javikara, also Shwitra has been counted.[3]

In the present day context there is no significant and satisfactory remedy which effectively and permanently cure this disease. General public is still searching for the alternative treatment which can provide safe, effective and permanent solution for this cosmetic problem, which directly interfere with overall personality of an individual. Ayurveda explains Shwitra in detail with certain treatment principles which lit some light of hope in an attempt to provide an alternative. This study is an attempt to find an effective remedy for Shwitra based on Ayurvedic principles. In the present study in order to cure the disease from root, the Samshodhan Karma will be followed in the form of Virechana similarly Kshara prepared by Gajalinda will be applied with Gajamutra externally for discoloured patches along with internal administration of Gajamutra in a fixed dose.[4]

In the present study Virechana has been planned and internal Snehapana with Goghrita after Deepana, Pachana Chikitsa. Bahya Abhyanga will be carried out by Panchanana taila which is indicated for Shwitra.[5] A Sramsana Virechana drug Aragwadha Phalamajja has been selected for inducing Virechana as mentioned in classics. Gajamutra and Gajalinda which has been quoted for its Shwitrahara property has been taken in this study.

Drug Matrial Taken For The Study Include –

1. Bala-Chaturbhadra

2. Moorchita Goghruta

3. Panchanan Taila

4. Aragvadha Phala Majja

5. Gajlindalepa (Gajalinda kshara + Gajmutra + Bakuchi Beeja Churna)

6. Bala-Chaturbhadra:

For the purpose of the study Bala-Chaturbhadra Churna prepared from NIA Hospital, Jaipur was taken.

Moorchita Goghruta:

For the purpose of the study Murchita Goghruta prepared from NIA Hospital, Jaipur was taken.

Panchanan Taila

For the purpose of the study Panchanan Taila prepared from NIA pharmacy, Jaipur was taken.

Aragvadha Phala Majja[6]:

Aragvadha Phala Majja was taken NIA pharmacy, Jaipur and was used for the study.

Gajalinda, Gaja Mutra and Bakuchi Beeja

Churna[7]

The Gajalinda and Mutra for the preparation of Gajalinda kshara was collected personally from Hathi Ganva, Amer in Jaipur and Bukuchi Churna was supplied from NIA Pharmacy, Jaipur was used for the study. The compound of these drugs for the purpose of external application was got prepared in Bhaishajya kalpana department of NIA College Jaipur discussed in the chapter on drug review.

Grouping & Trial Of The Study

The present study was planned as interventional, open label masking, randomized trial, and patients were randomly in two groups divided as group A and group B with 15 patients in each. The cases registered for the 1 patients of group A and 2 patients of group B were dropped from study.

Group A: Treated with Gaajlind lepa.

Group B: Treated Sanshodhana (Virechana) followed by Gajlindlepa.

All patients between the age group of 5 – 15 years attending the Kaumarabhritya OPD and I P D of NIA

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Hospital, Jaipur with complaints of Shwitra were taken up for the study after following the criteria laid as above. Their age, sex, religion, socioeconomic status, food habits, family history, etc. were noted as given in master chart. Where there is more than one patch of vitiligo in any patient only one patch was selected for the study. However where improvement was found in that particular patch, patient was advised to treat other patches also with the same drug. The size of the observed patch was approximately measured in square centimeters by multiplying its breadth and length.

Complete history and clinical examination of all these patients was carried out and recorded in a specially designed Performa by the Post Graduate Department of Kaumarbhrithya of NIA college of Ayurveda, Jaipur. Their findings are given in the enclosed master chart.

Mode Of Administration Of Drug:

All patients of both the groups were administered the drugs as follows –

1. Balchaturbadra Churna in a dose of 100mg/Kg body wt. twice daily with Ushnodaka as Anupana was administered before food for three days prior to Snehapana for Pachana of any existing Ama and for Agnideepana.

2. Starting from 15-3oml (According to body wt.) ml per day Moorchita Goghruta was administered for Snehana by increasing it by another 15-30ml (According to body wt.) per day until the appearance of kosta Snigdha Lakshanas as evidenced from oily and loose stools.

3. Abhyanga was then carried out with Panchanan Taila daily followed by Sarvanga Swedana (for five minutes) for three-five days.

4. 20 gram of Aragvadha Phala Majja was then administered with warm ksheera on third day after Abhyanga and Swedana, in the morning in empty stomach.

A watch was made for kosta Shuddi by observing the number of stools till after noon. After this patients of

group B were advised to apply the Gajlindalepa in the morning on the vitiligo patches with water and were advised to expose the patches to sun light for the 30 minutes. Patients of group A were also advised to apply the Gajlindalepa daily in the morning with water and were advised to expose the patches to sun light for 30 minutes because psoralin present in Bakuchi has a photosensitive action.

Duration Of The Treatment:

Patients of both the groups were advised to apply the trail drug Gajlindalepa provided to them at early morning preferably at the time of sun- rise hours once in day for the duration of six months for patients were followed-up on every fifteen days.

Diagnostic Criteria

A. Inclusion Criteria

1. Age between 5-15 years

2. Children diagnosed as Shwitra as per clinical features mentioned in Ayurvedic texts.

B. Exclusion Criteria

1. Children below 05 and above 15 years of age.

2. Children with Albinism were excluded.

3. White anesthetic spots, which are characteristic of leprosy.

4. Old refractory cases not responding after extensive use of modern medicine.

5. Patches in genital area are excluded from the study.

6. Vitiligo patches complicated by eczema.

C. Assessment Criteria:

Criteria for assessment:

A standard grading system was developed to assess the improvement in treated cases based on symptomology of the Shwitra.

Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

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Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

Grading for no. of black spot in observed patch

1. Black spot no appear 0

2. If one to two spot appear 1

3. If three to five spot appear 2

4. If more than five spot appear 3

Grading for color change in the observed patch

1. No change in color (white spot) 0

2. Pink 1

3. Black 2

4. Normal skin Color 3

Grading for size of the observed patch

1. If size increase 0

2. If size same 1

3. 10% reducing size 2

4. More than 10% reducing size 3

Photography:- recorded periodically

Assessment Of Results

The clinical study was analyzed after the treatment for the effect of clinical features. Results of effect on clinical features by using non parametric test Wilcoxon matched Test and intergroup comparison by Mann-Whitney Test.

Parent’s Consent / Child Assent

A voluntary, signed witnessed informed consent / assent was obtained from the participant / parent’s / Guardians prior to the start of clinical trial. (Annexure- III).

IEC Approval

Clinical study was approved by IEC, order no. F10 (5)/EC/2014/7220 dated 7/11/2014.

Observations

y 11-15yrs age group was the most affected group.

y Female were more prone to Shwitra as compared to male.

y Maximum number of cases were belonging to urban area, Hindu religion, vegetarian diet, middle socio-economic status.

y Maximum numbers of cases exhibited chronicity of 1month -3 yrs, no family history.

y Maximum patients of trial were Vata-Pitta Prakriti, Mandagni, Madhyama Koshtha, Madhyama Satva.

y Maximum patients of trial were immunized and earlier treatment history present.

y Patients were found with maximum 6-10 Patches.

y Maximum patients were found with no black spot in observed patches.

y Maximum patients were found with white color patches.

y Maximum patients were found with less than 10 square cm size of lession.

Results:

Table No. I: Effect of therapy on number of black spots in both groups:

Signs Group Mean Mean difference

% Of improve

mentS.D S.E P –

value Infere

nceBT AT

Number of black spots A 0.53 1.33 0.80 60.15% 0.86 0.22 0.0078 Very

significant

Number of black spots B 0.80 2.33 1.5 64% 1.12 0.29 0.0010 Extremely

significant

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Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 -57

Number of black spot in group A with mean score before treatment was 0.53 which was increased to 1.33 after treatment, with SD+_0.86 giving a relief of 60.15% which was statistically very significant (P value 0.0078) and In group B the mean score before treatment was 0.80 which increased to 2.33 after treatment, with SD+_1.12 giving a relief of 64% which was statistically extremely significant (P value 0.0010). Intergroup comparison P value is 0.2349 which is statistically not significant which shows that there is no statistically difference in efficacy of both treatment on black spot in observed patches.

Graph No. 1: Effect of therapy on number of black spots in both groups:

Table No. II: Effect of therapy on Color of observed patches in both groups:

Signs Group

Mean Mean difference

% Of improve

mentS.D S.E P –

value InferenceBT AT

Color of observed patches

A 0.46 1.2 0.73 60.83% 0.88 0.22 0.0078 Very significant

Color of observed patches

B 0.26 1.13 0.86 76.10% 0.91 0.23 0.0039 Very significant

Color of observed patch in group A with mean score before treatment was 0.73 which was increased to 1.73 after treatment, with SD+_0.84 giving a relief of 57.80% which was statistically extremely significant (P value 0.0010) and in group B the mean score before treatment was 0.53 which increased to 2.2 after treatment, with SD+_0.89 giving a relief of 72.72% which was statistically extremely significant (P value 0.0001). Intergroup comparison P value was 0.2825 which was statistically not significant which shows that there was no statistically difference in efficacy of both treatment on black spot in observed patches.

Graph No. 2 :Effect of therapy on Color of observed patches in both groups:

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Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

Decrease in size in group A with the mean score before treatment was 0.73 which was increased to 1.73 after treatment, with SD+_0.84 giving a relief of 57.80% which was statistically extremely significant (P value 0.0010) and in group B the mean score before treatment was 0.53 which increased to 2.2 after treatment, with SD+_0.89 giving a relief of 72.72% which was statistically extremely significant (P value 0.0001). Intergroup comparison P value was 0.2068 which was statistically not significant which shows that there was no statistically difference in efficacy of both treatment on black spot in observed patches.

Table No. III: Effect of therapy on Size of observed patches in both groups:

Signs Group Mean Mean

difference

% Of impro

vementS.D S.E P –

value Inferen

ceBT AT

Size of observed patches

A 0.73 1.73 1.00 57.80% 0.84 0.21 0.0010Extremely signifi

cant

Size of observed patches

B 0.53 2.2 1.6 72.72% 0.89 0.23 0.0001Extremely signifi

cant

Graph No. 3: Effect of therapy on Size of observed patches in both groups:

Discussion:

The effects of therapy on the symptoms of 30 patients (15 patients in each group) of Shwitra/vitiligo

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Number of black spot in observed patches

In the present study the patient were evaluated for number of black spot appeared in observed patches and grading of same was done on completion of trial of six month. Very significant result (P value-0.0078) in group A with the 60.15% extremely significant (P value 0.0010) result in group with 64% has been observed. This clearly suggest the effect of trail drug at the level of skin and melanocytic cells stimulating production of melanin pigment. Appearance of blackish spots also suggests the deposition of melanin pigment secreted by melanocytes cells of skin production of which has been governed in melanocyte secreting hormones of the Pituitary and Pineal gland. This result suggests that hormonal influences of Virechana Karma in the correction of pathology.

Color changes in observed patches

In the present study the patient of the both groups were evaluated for change in color in observed patches and graded at the completion of trial of six month. After statistical analysis very significant result (P value-0.0078) was obtained in group A with the 60.83% relief and very significant (P value 0.0039) result with 76.10% relief in group B. After administration of the trail drug the whitish patches turn pink within few days followed by appearance of blackish spots. This process is faster in group B, which is priory administrated with VirechanaKarma: although both groups has shown significant results. Ushna, Teekshna property of the drug leading to irritation and increasing blood supply to the spot and correction of Bhrajakapitta might have been responsible for this. Further prior conditioning of body by Virechana, removes all the hurdles in correction of defaults in function Pitta and helps for easy correction.

Size decrease in observed patches

In the present study the patient of both groups evaluated for decrease in size of the observed whitish patches and same is graded to get a statically data at the completion of six months trial. Extremely significant result (Pvalue-0.0010) was obtained in group A with the 57.80% relief. However in group B extremely significant

(P value 0.0001) result with 72.72% relief with rapidly appearing blackish spot and color changes which may be due to prior conditioning of body by Virechana therapy. These finding suggest high efficacy of trail drug in group A i.e. Gajalindalepa on patients of Shwitra. However extremely significant results in both the groups shows effects of Shodhana (Virechana) which is best for Pitta dominant disorder, followed by Gajalindalepa in reducing the whitish patches and normalizing the skin.

Conclusion:

On the present study efficacy of Virechana and Gajalinda Kshara and-Mutra on Shwitra w.s.r. to vitiligo (leucoderma) which was interventional, open label masking, randomized trial, conducted in 30 patients equally divided in 2 groups for period six months. Following conclusions are drawn can up:

1. Shwita is Tridoshaja in nature with dominance of Pitta Dosha along with vitiation of Rakta Dhatu associated Rasa Mamsa and Meda Dhatu Dushti.

2. In the present study it is concluded that the most striking feature of Shwitra was presence of whitish patches over the skin.

3. In the present study it is concluded that certain Virudha-Aharas like Masha (Black gram), Mulaka (raddish), Dadhi (curd), Amla Rasa Sevena (sour substances) and irregular food habits are the most common causative factors for Shwitra.

4. In present study it can be concluded that correction or healing of hypo-pigmented patch usually followed by itching and appearance of blisters at the site of lesion which is, later converted in to normal pigmented patches of the skin.

5. In the present study group A treated with Gajalindalepa has showed very significant results suggesting its efficacy in normalization skin discoloration.

6. In the present study group B which is treated with Shodhana (Virechana) followed by Gajlindalepa has shown extremely significant result on reducing

Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan57

symptomology of Shwitra.

7. Group B as shown extremely significant results in comparison to group A on appearance of black spot, change of color to normalization and fast reduction in the size of patches showing its high efficacy in correction of pathological changes extremely of Shwitra.

8. However advanced study with larger sample size has been recommended to draw the final conclusion.

Sharma SK, Acharya SK, Mehata P, A Study on Efficacy of Virechana and Gajalinda Kshara and Mutra on Shwitra w.s.r. to Vitiligo (Leucoderma), JOA XIII-3, 2019; 50 - 57

References

1. Susruta-Samhita, By Kaviraja Abmibikadutta Shastri, A.M.S. Published By Chaukhambha Sanskrit Sansthan, Varanasi, Edition 2011 Part-1, Nidan-Sthan Chapter-5/17

2. Charaka Samhita, Gorkhanath Chaturvedi, Kasinatha Sasatri, Choukhambha Bharti Academy, Edition 2011, Chikista-Sthan 7/174, pp. 161

3. Charaka Samhita, Gorkhanath Chaturvedi, Kasinatha Sasatri, Choukhambha Bharti Academy, Edition 2011, Sutra-Sthan 28/12, pp. 701

4. Bhaishjya Ratnawali-“Sidhdiprada”, By Kaviraj Shri Govind Das Sen, Published By Chaukhamba Surabharati Prakasan Varanasi. Edition 2012 Bala Roga Chikitsa Parkaran 54/48-49

5. Bhaishjya Ratnawali-“Sidhdiprada”, By Kaviraj Shri Govind Das Sen, Published By Chaukhamba Surabharati Prakasan Varanasi,Edition 2012 Bala Roga Chikitsa Parkaran54/256-266

6. Dravyaguna-Vijnana, Prof. P.V. Sharma Published By Chaukhambha Bharati Academy, Varanasi. (Reprint-2006), Vol.-2

7. Dravyaguna-Vijnana, Prof. P.V. Sharma Published By Chaukhambha Bharati Academy, Varanasi. (Reprint-2006), Vol.-2

lkjka'k%

mÌs';:- fÜo= (Vitiligo (Leucoderma) ) esa xtfy.M {kkj dk ckg~; ysi o fojspu dh ÁÒkodkfjrk ij ,d v/;;u

fMtkbu%- vkS"k/kh; Á;¨x] vksiu yscyekfLdax] js.Me Vªk;y ijh{k.k] LFkkiuk:- vLirky ¼jk"Vªh; vk;qosZn laLFkku t;iqj½ ds cfgjax

¼vks.ih.Mh.½ ds vk/kkj ij ÁfrÒkfx;¨a dk p;u] vk;qoxZ 5 ls 15 o"kZ ds cPp¨a ijA vks"k/kh; Á;¨x:- n¨ lewg , o ch cuk;s x;s gS lewg

, esa xtfyaM{kkj dk cká ysi Á;¨x vkSj ch esa fojspu ls la"k¨/ku ds ckn xtfy.M {kkj dk cká ysi Á;¨x lewg ,%- esa xtfy.M {kkj

fÜo= ij cká ysi yxkdj rhl feuV rd lqcg ¼Ákr%dky½ lw;Z ds Ádk'k esa cSBk;k vkSj ;s fof/k yxkrkj N% ekg rd Á;¨x dh x;h]

lewg ch%- ess fojspu djkdj ;gÈ ÁfØ;k dh x;h vkSj gj iUæg fnu ds ckn tkap dh xÃ] ifj.kke ds mik;:- voy¨du fd;s gq,

fÜo= ds /kCcs ij fdrus dkys /kCcs cus dh tkap] voy¨du fd;s gq, fÜo= ds /kCcs ds o.kZ dh tkap] voy¨du fd;s gq, fÜo= ds

/kCcs ds vkdj esa deh dh tkap ifj.kke:- n¨u¨ lewg esa vfregRoiw.kZ lq/kkj gq, x.kuk:- fÜo= ij

xtfy.M {kkj ds cká ysi dh rqyuk esa fojspu djkus ds ckn xtfy.M {kkj dk cká ysi vf/kd ÁÒkoh gSA

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan58

Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma

*Dr. Shveta Sahu, **Dr. Prof. P. hemantha Kumar, ***Dr. Narinder Singh

*P.G. Scholar, ** Professor & Head, ***Associate Professor, Dept. of Shalya Tantra, National Institute of Ayurveda, Jaipur.

ABSTRACT

JO

A

XII

I-3

2

01

9

ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Address of Corespondence:Dr. Shveta SahuP.G. ScholarDept of Shalya Tantra,National Institute of Ayurveda, JaipurEmail ID : [email protected] No : 8742056264

Keywords: Arbuda, Tumour, Lipoma, Granthi, Medohara, Lekhan, Kanchanara Guggulu.

How to Site the Article : Sahu S, Kumar PH, Singh N, Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja - Arbuda With Special Reference To Lipoma JOA XIII-3, 2019; 58 - 67

Introduction:

Arbuda is one of the surgical diseases explained in detail in the Sushruta Samhitain Nidan[1] and Chikitsasthan[2]

in chapters named Granthi-Apachi-Arbuda-Galgand in respective segments. Acharya Sushruta has classified Arbuda in six type viz. Vataja, Pittaja, Kaphaja, Mamsaja, Medoja and Raktaja. Character wise Vataja, Pittaja, Kaphaja and Medoja-Arbuda resemble granthi[3]

and are curable, whereas Raktaja and Mamsaja Arbuda are incurable. Lipomas are the most common soft tissue tumour[4][5]. It is benign (non-cancerous) growth of adipose tissue (cluster of fat cells) which becomes over active and so distended with fat that it produces a palpable swelling. This is the commonest tumour of the subcutaneous tissue. It may occur anywhere in the body,

Acharya Sushruta described six types of Arbuda. As per the clinical features lipoma can be correlated to Medoja-Arbuda. Lipomas are the most common soft tissue tumour. According to contemporary science treatment available for its management is surgical excision, liposuction and lipolysis with steroids. But surgery too has its own limitations say as in case of multiple lipomatosis, outcome of scar formations or financial/psychological burden. Epidemiological study shows that entity is more common in males, in the age group of 26 to 45 year of age, having Vata-Kaphaj Prakriti, occupation wise maximum number of patients were having sedentary life style, with mixed variety of dietary habit, hereditary presentation in few cases, BMI range 25.0-29.99 with lipid profile within normal range in maximum number of patients. On thorough Statistical analysis and analysis done on the criteria framed for the overall assessment, the study showed that on intervention of trial drugs, neither Kanchanara Guggulu with lukewarm water nor Kanchanara Guggulu with Kanchanara Chaal Kashaya provided significant relief.

JOAjournalofayurveda.in ISSN No:2321-0435

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Sahu S, Kumar PH, Singh N, Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma JOA XIII-3, 2019; 58 - 67

hence it is known as universal tumour or ubiquitous tumour. They may remain the same size or grow larger when an individual gains weight. They do not, however, generally decrease in size with weight loss.

According to the clinical features Lipoma can be correlated to Medoja-Arbuda as mentioned in Sushruta Samhita under the heading of Arbuda Roga. The constituent of this Medoja-Arbuda are Kapha and Meda.[6] Occurring in 1 in 1000 inhabitants, lipoma is not a commonly reported condition, the incidence being around 0.1%. The exact aetiology of lipoma/multiple lipomatosis is not known. Some incidences suggest that it may be due to obesity, alcoholism, heredity, trauma[7]or sedentary[8]type of life style.

Lipomas are the most common soft-tissue tumour, and usually are solitary lesion. Approximately 5% to 8% of patient of lipoma have multiple tumour i.e. multiple lipoma. Multiple lipomas are 3 times as common in man as women.It may occur anywhere in the body, but mostly seen in the subcutaneous tissue of trunk, nape of neck, and limbs. These tumors can occur at any age, but are most common in middle age, often appearing in people from 40 to 60 years old.Lipomas are usually relatively small with diameters of about 1–3 cm, but in rare cases they can grow over several years into "giant lipomas" that are 10–20 cm across and weight up to 4–5 kg.

Need Of Study

In order to have a rational management, the pattern of entity is required to be understood in more elaborate way. According to contemporary science treatment available for its management is surgical excision, liposuction and lipolysis with steroids[9]. But surgery too has its own limitations say as in case of multiple lipomatosis, outcome of scar formations or financial/psychological burden. So in current scenario a contribution by Ayurveda in management of lipoma/multiple lipomatosis could be of worth mention. In Ayurvedic classics there are many drugs which have Medohara and Lekhana properties mentioned by different Acharya. Acharya Sharangdhar has quoted the role of Kanchanara Guggulu in this context. Keeping in to consideration this reference,

the present study named “Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma” has been planned.

Materials & Methods:

Aims and Objectives

� To study the prevalence of Medoja-Arbuda (lipoma/Multiple-lipomatosis) in relation to Heredity / Prakriti / Gender / Age / Dietary habits / Physical activity/ lipid profile/ B.M.I. (body mass index).

� To evaluate the efficacy of Kanchanara Guggulu alone or with Kanchanara Chaal Kashaya in management of Medoj-Arbuda (lipoma).

Plan of Study

The study has been planned under two headings:

Epidemiological Study

Occurring in 1 in 1000 inhabitants, lipoma is not a commonly reported condition, The incidence being around 0.1% so to study the pattern of entity in terms of age, gender, heredity, dietary habit, physical activity, lipid profile and BMI epidemiological study has been conducted over 150 subjects.

Clinical Study

The protocol was approved by the Institutional Ethics committee atNational Institute of Ayurveda, Jaipur and the ethical approval letter’s ref. number is F10 (5)/EC/2014/3318, dated: 14/07/2014.

Out of total 150 patient 30 patients were randomly selected for clinical trial.

Selection Criteria

Inclusion Criteria-

1. Patient aged between 16 to 70 years.

2. Patient willing to participate in clinical study.

3. Patient not taking any other medicine for Medoja-arbuda (lipoma).

4. Patients who are not suffering from any systemic disorders.

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Exclusion criteria

1. Patient below the age 16 years and above 70 years.

2. Infected lipoma.

3. Calcified lipoma.

4. Ulcerated lipoma.

5. Lipoma with malignant change (liposarcoma).

6. Lipoma with myxomatousde generation .

7. Saponification in lipoma.

Withdrawal Criteria-

1. Intolerance to therapy.

2. Unwillingness to continue with the study.

3. Irregular patients.

4. Development of condition which may require other treatment.

Details

(1) Sample size - Total 150 patients suffering from Medoja-Arbuda (lipoma) fulfilling the inclusion criteria are selected for epidemiological study & out of these 30 patients were randomly selected for clinical trial

(2) Source - The patients were selected from O.P.D. section of NIA, Jaipur.

(3) Informed consent- The study was explained clearly to the subjects and their signed, written informed consent was taken before starting the trial.

(4) Study Design - Details concerning the pattern of Medoja-Arbuda are recorded in specifically designed

performa for Epidemiological study. For clinical study 30patients were selected and randomly divided in to two groups on the basis of Anupaan.

Group A: 15 Patients were intervened with Kanchanara-

Guggulu 1gm thrice in a day with lukewarm water as Anupaan for 45 days.

Group B: 15 Patients were intervened with Kanchanara-Guggulu 1gm thrice in a day with Kanchanara Chaal Kashaya as Anupaan for 45 days.

Duration of clinical trial

45 days

Assessment

All the patients was assessed for the size of Medoja-Arbuda (lipoma) at the 15th day, 30th day and 45th day.

Follow up

The trial subjects has been advised & taken for the regular follow up every 4th week for next 6 months.

ADR Study

The subjects were also observed for ADR during the study & period of follow

Assessment criteria

The only parameter taken was the size of lipoma. The size of Medoja-Arbuda (lipoma) was measured by multiplication of maximum diagonal dimensions with the help of measuring tape i.e. l x b = cm2 (l= length b= breadth).

Sahu S, Kumar PH, Singh N, Epidimio-Clinical Study Of Kanchanara Guggulu On Medoja- Arbuda With Special Reference To Lipoma JOA XIII-3, 2019; 58 - 67

Grade Size of Lipoma in cm2

0 <3 cm2

1 4-6 cm2

2 7-9 cm2

3 10-12 cm2

4 13-15 cm2

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Observation And Results

Epidemiological study is conducted over 150 patient having lipoma/multiple lipomatosisto observe the pattern of the condition on the following heads:

Table no.I- Showing distribution of patient according to the age

Table no.II- Distribution of patient according to Number of lipoma

Table no.III - Distribution of patient according to Gender

Table no.IV- Distribution of patients according to Prakriti

Age

Age No of patient %of patient16-25 year 35 23.33

26-35 year 55 36.6736-45year 40 26.6746-55 year 10 6.67>56 year 10 6.67

Number of lipoma (whether solitary/multiple)

Gender

Prakriti

No of lipoma No of Patient % of Patient

Solitary 109 72.67

Multiple 41 27.33

Gender No. of patient % of patient

Male 125 83.33

Female 25 16.67

Out of 150 patients, maximum number of patients i.e 109 (72.67%) presented with solitary lipoma and 41 patients (27.33%) had multiple lipomas.

In this study maximum patients i.e. 125 (83.33%) were males and remaining 25 patients (16.67%) were females.

Prakriti No. of patient % of patient

Vata-Pitta 15 10

Vata-Kapha 110 73.33

Kapha-Pitta 25 16.67

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On assessing Prakriti, it was found that maximum 110 patients (73.33%) %) were of Vata-kapha Prakriti, 25 patients (16.67%) were of Pitta-Kapha, Prakriti and 15 patients (10%) were of Vata-pitta Prakriti.

In this study 65 trial subjects (43.33%) were vegetarian while remaining 85 trial subjects (56.67%) were taking mixed type of diet.

In this series, a maximum 105 patients (70%) not have positive familial history and remaining 45 patients (30%) were having the familial history of this disease.

In this series maximum 55 patients (56.67%) were from service, followed by 40 patients (26.67%) were belonging to business class, 30 patients (20%) student, 15 patients (10%) was housewife, minimum i.e. 10 patients (6.67%) was labor.

Dietary Habit

Heredity

Occupation

B.M.I. (Body Mass Index):

Table no.V- Distribution of patients according to dietary habit

Table no.VI - Distribution of patients according to Heredity

Table no.VII- Distribution of patients according to Occupation

Dietary habit No. of Patient % of Patient

Vegetarian 65 43.33

Mixed Diet 85 56.67

Heredity No. of patient % of patient

Familial History 45 30No familial history 105 70

Occupation No. of patient % of patient

Service 55 36.67

Business 40 26.67

Labor 10 6.67

Housewife 15 10

Student 30 20

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On assessment of BMI it was found that maximum number of trial subjects i.e. 80 (53.33%) were overweight, 55 pa-tients (36.67%) were having normal range, and 15 (10%) patient were obese.

On assessment of lipid profile (serum cholesterol) it was found that maximum number of trial subjects i.e. 75 (50%) were having their lipid profile within normal range, 40 (26.67%) were having border-line high lipid profile & 35 (23.33%) were having high levels when assessed for their serum cholesterol level.

Effect Of Therapies

Out of 150, 30 trial subjects having Medoja-Arbuda (lipoma) are randomly divided into 2 groups with 15 patients in each group. Group Atrial subjects were intervened with Kanchanara Guggulu with lukewarm water. Group B trial sub-jects were intervened with with Kanchanara Guggulu with Kanchnara Chaal Kashaya as Anupaan. The group wise results in detail are being described under the separate headings.

Individual Analysis

A-Individual Variable Wise Analysis In Group-A By Wilcoxon Rank Sum test

Table no.VIII - Distribution of patient according to BMI

Table no.IX- Distribution of patient according to lipid profile

Table No.X- Results of Objective Parameter in Group- A

BMI (body mass index) No. of patient % of patient

Underweight 0 0

Normal 55 36.67

Overweight 80 53.33

Obese 15 10

Lipid profile (Serum cholesterol)

Lipid profile(serum cholesterol) No. of patient % of patient

Normal 75 50

Borderline high 40 26.67

High 35 23.33

S.N.

Objective parameter

Period Mean Diff.%

ReliefSD± SE± P value Result

1. Size of lipomaBT 2.000

0.1333 6.666 0.3519 0.0908 0.50 NSAT 1.867

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Effect on size of lipoma: Kanchanara Guggulu with lukewarm water as Anupaan provided non-significant relief on the size of lipoma with percentage relief of 6.66% only.

Effect on size of lipoma: Kanchanara Guggulu with Kanchanara Chaal Kashaya as Anupaan provide not significant (p>0.05) relief on the size of lipoma with percentage relief of 13.33% only.

Kanchanara Guggulu with lukewarm water shows 6.66% relief (reduction) in the size of lipoma, whereas. Kanchanara Guggulu with Kanchanara Chaal Kashaya showed 13.33% relief (reduction) in the size of lipoma

After comparing after treatment data of both groups by above mentioned test. This showed there is no significant variation in data of both groups after treatment for the criteria, in size of lipoma (p>0.05).

A - Individual Variable Wise Analysis In Group-B by Wilcoxon Rank Sum Test

Percentage Relief After Intervention

Inter-Group Comparison

Table No.XI -Results of Objective Parameter in Group- B

Table No.XII- Percentage difference in Group -A and Group –B

Table No.XIII: Intergroup Comparison of group A and Group B by Mann-Whiteny Test

S.N.

Objective parameter

Period Mean Diff.%

ReliefSD± SE± P value Result

1. Size of lipomaBT 2.000

0.267 13.33 0.4577 0.1182 0.1250 NSAT 1.733

S. No. Parameter Group A% Group B%

1Size of lipoma 6.66 13.33

Variable Groups(AT)

MeanSD± SE± P value S

Size of lipomaA 0.1333 0.3519 0.090

>0.05 NSB 0.2667 0.4577 0.1182

Discussion

Discussion on Epidemiological Study

Occurring in 1 in 1000 inhabitants, lipoma is not a commonly reported condition,The incidence being around 0.1%.

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Solitary lipomas were found more prevalent in comparison to multiple lipomas. This incidence is almost similar to the incidences reported in the previous studies. But no attributable reason could be assigned for this prevalence.

Age

In this study, inclusion criteria, for age was 16-70 year. It is observed that maximum number of patients 55 (36.67%) belonged to age group of 26-35 years, 40 (26.67 %) patients belonged to 36-45 years, 35(23.33%) belonged to 16-25 years, 10 (6.67 %) belonged to 46–55 years and 10 ( 6.67%) belonged to age above 56 year. This incidence is almost similar to the incidences reported in the previous studies. The condition couldbe found in any age group but with the peak incidence is reported in 26 - 45 year of age. No reason could beassigned for this incidence seen in the present study.

Number of Lipoma

Out of 150 patients, 109 patients were having solitary subcutaneous lipoma while 41 patients were having, multiple subcutaneous lipomas. Solitary lipomas were found more prevalent in comparison to multiple lipomas.

Gender

The more prevalence of lipoma/lipomatosis in males could be attributed to the gender specific physiology owing to various factors in particular the endocrinal aspectwhich might be the reason of this prevalence in males in comparison to the females. The other reason could be the intake of alcohol which was there when asked about it while taking personal history. The similar prevalence is also found in the previous studies.

Prakriti

On assessing Prakriti, it was found that maximum 110 (60%) patients were of Vata-KaphaPrakriti, 25 (16.66%) patients were of Kapha-Pitta Prakriti and 15(10%) patients were of Vata-Pitta Prakriti.

The entity lipoma/multiple-lipomatosis is related with Medoja-Arbuda which is found more prevalent in the subjects having Kapha Dosha predominance.The person having this Dosha predominance in Prakriti are found

more prone to develop Kaphaj Vyadhi like lipoma/multiple-lipomatosis.

Occupation

The least prevalence of the lipoma/lipomatosis in labor class indicates the owing to strenuous physical activity, there are least chances of development of disorders which are having any sort of relation with excessive body weight. On the contrary 125 subjects belong to a service/student/business class used to possess the sedentary life style resulting in to excessive body weight, aberrant fat deposition and various other conditions secondary to it.

Diet Habit

The condition of lipoma/multiple-lipomatosis is found to be more prevalent among the subjects having mixed variety of dietary habit. But nothing conclusive could be said that whether mixed / non-vegetarian diet / or any particular diet or dietary combination could be held responsible for the lipoma/multiple-lipomatosis.In present study dietary habits of the trial subjects were found to be irregular and unhealthy;concerning the schedule & type of food stuffs. In the current study habit of having fast and junk foodsin both vegetarians/ mixed variety dietary habit were of worth mention. Particularly these sorts of food habits are definitely affecting the overall metabolism resulting into excessive body weight as per the height & weight ratio. Again leading to localized abnormal fat deposition, hence leading to the conditions that might be there as the secondary complications, say lipoma/multiple-lipomatosis in the present study.

Relation to Heredity

In this series, only 45(30%) patients were having the familial history of this diseasebut 105(70%) patients were not having any familial history.So the genetic constitution of the individual could also be attributed to have some influence concerning the occurrence of lipoma/multiple-lipomatosis

BMI (Body Mass Index)

More prevalence of lipoma/multiple lipomatosis in the patient which are either over weight (as per BMI), or

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progressing towards being obese. More prevalence of lipoma/multiple lipomatosis in the patient which are either over weight (as per BMI), or progressing towards being obese could be due to inebriant fat metabolism & aberrant localized fat deposition.

Lipid Profile (Serum Cholesterol)

On assessment oflipid profile (serum cholesterol) it was found that maximum number of patients 75(50%) were having normal serum cholesterol level, 40(26.67%) were having borderline high serum cholesterol level and remaining 35(23.33%) were having high serum cholesterol levels.So out of total 75 patients either having borderline high or high level of circulating lipids, showing prevalence of flawed fat metabolism and its related consequences.

Discussion On Effect Of Therapies

Effect on size of Lipoma:

In Group A Kanchanara Guggulu with luke warm water as Anupaan provided in-significant (p >0.05) relief in reducing the size of lipoma with percentage relief of 6.66% only.

In Group B Kanchanara Guggulu with Kanchanara Chaal Kashyaas Anupaan also showed no significant (p>0.05) relief in reducing the size of lipoma with percentage relief of 13.33% only.

Study shows that group B has slightly better effect in reduction of size of lipomathat may be due to some synergistic effect of Kanchanara Guggulu when used with Kanchanara Chaal Kashaya as anupaan.

Conclusion1. Lipomas are the most common benign soft tissue

tumour of the subcutaneous tissue.

2. The incidence of lipomas is about one in 1000 inhabitants.

3. According to the clinical features Lipoma can be correlated to Medoja-Arbuda.

4. Exact etiology of lipoma is unknown.

5. Epidemiological study shows that entity is more

common in males, in the age group of 26 to 45 year of age, having Vata-Kaphaj Prakriti, occupation wise maximum number of patients were having sedentary life style, with mixed variety of dietary habit, hereditary presentation in few cases, BMI range 25.0-29.99 with lipid profile with\ in normal range in maximum number of patients.

6. Intervening Kanchanara Guggulu with lukewarm water as Anupaan yielded relief of 6.66% in concern to the reduction of size of lipoma in Group A.

7. Intervening Kanchanara Guggulu with Kanchanara Chaal Kashayaas Anupaan provided the relief of 13.33% in concern to the reduction of size of lipoma in Group B.

8. group B has slightly better effect in reduction of size of lipoma that may be due to some synergistic effect of Kanchanara Guggulu when used with Kanchanara Chaal Kashaya as anupaana.

9. On thorough Statistical analysis and analysis done on the criteria framed for the overall assessment, the study showed that on intervention of trial drugs, neither Kanchanara Guggulu with lukewarm water nor Kanchanara Guggulu with Kanchanara Chaal Kashaya provided significant relief.

10. No ADR of interventions was reported in any group during study or period of follow up.

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References

1. SushrutaSamhita with Ayurveda tatvasandipika commentaries, Edited by AmbikaDuttaShastri, published by Chaukhambha Sanskrit Sansthan part-1, Edition- 2008,Nidansthan 11,

2. Sushruta Samhita with Ayurveda Tatvasandipika commentaries, Edited by AmbikaDuttaShastri, published by Chaukhambha Sanskrit Sansthan part-1, Edition- 2008,Chikitsasthan 18,

3. Sushruta Samhita with Ayurveda tatvasandipika commentaries, Edited by AmbikaDuttaShastri, published by Chaukhambha Sanskrit Sansthan part-1, Edition- 2008,Nidansthan 11/15,

4. Somen Das, A concise text book of surgery, published by Dr. S. Das, Kolkata, 7th edition 2012.[ page no-114-116 ],Pathologic basis of disease 5th edition by Robbins [page no-1262]

5. Textbook of pathology Harsh Mohan 5th edition [27th chapter]

6. Enzinger and Weiss's Soft Tissue Tumors By John R. Goldblum, Sharon W. Weiss, Andrew L. Folpe.

7. http://en.wikipedia.org/wiki/lipoma

8. Pathologic basis of disease 5th edition by Robbins [page no-1262]

9. Salam GA(March 2002) “lipoma excision” Am Fam Physician65(5):901-4PMID11898962

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Efficacy of Sariva Ghanavati in Yuvan Pidaka*Dr. Anupama Shukla, **Dr. Pankaj Kothari, ***Dr. C. R. Yadav, **** Prof. Om Prakash Dadhich

*Assistant Professor, Dept. of Kriya Sharir, UAU, Harrwala, Dehradun, **Assistant Professor, Dept. of Kriya Sharir, SSSB Ayurvedic College, Kishangarh, Renwal, Jaipur, ***Associate Professor, Dept. Of Kriya Sharir, NIA, Jaipur, **** Prof. & HOD, Dept. Of Kriya

Sharir, NIA, Jaipur

ABSTRACT

JO

A

XII

I-3

2

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9

ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Address of Corespondence:

Dr. Anupama ShuklaAssistant Professor,Dept. of Kriya Sharir, UAU, Harrwala, DehradunEmail ID : [email protected] No : 8058572749

Face is the Index of mind”. It affects the joy, sorrow, anger, excitement & all the experience. Beauty is a matter of Socio-medical importance; it is that quality or combination of qualities which afford keen pleasure to the senses especially that of sight or which charms the intellectual of moral faculties. Whole beauty of the body depends on the face. Minor problem leads to non- attractive look to a permanent disfigurement of the face which may result in inferior complexity sometimes isolation in the social life. The commonest cause for disfigure the face in youths is Yuvana Pidaka/Acne which is caused by vitiation of Kapha, Vata and Rakta.

Keywords: Yuvan Pidaka, Kapha, Vata, Rakta Introduction:

It is the natural instinct of mankind to have a healthy and glamorous skin with attractive personality. But very few are blessed with naturally perfect skin. People always have great concern about their health and beauty (i.e. good looking).

Face is the most important and beautiful organ. It affects the joy, sorrow, anger, excitement & all the experience. Beauty is a matter of Socio-medical importance, it is that quality or combination of qualities which afford keen pleasure to the senses especially that of sight or which charms the intellectual of moral faculties. Whole beauty of the body depends on the face. Minor problem leads to non-attractive look to a permanent disfigurement of the face which may result in inferior complexity sometimes isolation in the social life. The commonest cause for disfigure the face in youths is Yuvana Pidaka/Acne.

Yuvan Pidaka means that the disease almost takes place in young age. Among the Ayurvedic amenities, Acharya

How to Site the Article : Shukla A, Kothari P, Yadav CR, Dadhich OP, Efficacy of Sariva Ghanavati in Yuvan Pidaka, JOA XIII-3, 2019; 68 - 72

JOAjournalofayurveda.in ISSN No:2321-0435

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Shukla A, Kothari P, Yadav CR, Dadhich OP, Efficacy of Sariva Ghanavati in Yuvan Pidaka, JOA XIII-3, 2019; 68 - 72

Sushruta was the first and foremost to mention awhole group of such skin disease which have an adverse effect on the appearance and personality of an individual and having surgical or parasurgical measures as its cure. He named these ailments as “KshudraRoga”. Yuvan Pidaka[1] is one of them, which affects the beauty as well as personality and it has a cosmetic importance. The features of the disease Yuvan Pidaka are similar to those of acne vulgaris.

Acne Vulgaris is a common human skin disease, characterized by areas of skin with seborrhoea (scaly red skin), Comedones (blackheads and whiteheads), Papules (pinheads), Pustules (large papules) and possibly scarring[2]. Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms[3]. The lesions are caused by changes in Pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation

Various systems of medicines come up with various remedies and therapeutic procedures starting from simple topical applications till the extensive

management like use of X-ray, antibiotics, multi vitamins, hormones, corticosteroids etc. In spite of their therapeutic values, these procedures posses temporary relief, limitation and several health hazards on the body.

Nature has taught the various dimensions of beauty to man, with the gradual development of human mind, since the creation of the Universe. Ayurveda is an ancient science of indigenous medicine, which is special in respect that, it is not only a medical science but it, is an art of living in human beings. A great demand from Ayurveda in the field of cosmetology has been established due to its unique concept about beauty and effective, cheaper and long lasting beauty therapy without any side effect.

A lot of remedies are mentioned in Ayurvedic classics to cure the disease. There are some remedies which are said not only to cure the disease but also to increase the beauty, complexion and lustre of the face. Different line of treatment prescribed by different Acharya such as Lepana, Vamana, Siravedha, Nasya, and Abhyanga.

Taking all thses into consideration a study was planned to appraise the efficacy of Sariva Ghanvati in Yuvan Pidaka.

Aims & Objective:

To evaluate the efficacy of Sariva Ghanvati in Yuvan Pidaka.

Materials & Methods:

Ethical Approval - The present research work was approvd by IEC (Institute Ethical Commite) of National Institute of Ayurveda, Jaipur vide latter No. F10(5)/EC/2014/7223; dated 07.11.2014, before starting the clinical trial on patients of EHT.

Materials:

¾ Source of data: The study was conducted over 10 patients of OPD of Arogyashala N.I.A. Jaipur and SSBH Jaipur.

¾ Sample size: 10 clinically diagnosed patients of Yuvan Pidaka.

¾ Drug used in the study: Sariva Ghanvati was procured from National Institute of Ayurveda Pharmacy, Jaipur.

Methods:

Research design: 1 group for observational study.

Duration: 1month

Inclusion Criteria

¾ Age between 12 – 30 year

¾ Both male and female

¾ Patients complaining of Pidaka with the history of less than one year

¾ Pidaka resembling with the features as explained in classics.

Exclusion Criteria

¾ Patients having ulcerated Pidaka

¾ Patients suffering from other types of Kushtha.

¾ Patients having allergic history on Herbal drugs.

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¾ Patients suffering from other systemic diseases like Diabetic Mellitus and Tuberculosis

Assesment Criteria

Shukla A, Kothari P, Yadav CR, Dadhich OP, Efficacy of Sariva Ghanavati in Yuvan Pidaka, JOA XIII-3, 2019; 68 - 72

The cardinal features of Yuvan Pidaka like size & number of Pidaka, number of scar, Vedana of Pidaka, Oiliness of face, dryness of face, ithiching & burning sensation were graded and assessed accordingly.

Table No. I - Effect on size of Pidaka

Table No. II- Effect on number of Pidaka

Table No. IV- Effect on Vedana of Pidaka

Table No. V- Effect on Oiliness of Face

Table No. III- Effect on number of scars

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 1.8 0.50 1.30 72.2% 0.48 0.15 0.002 VS

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 2.1 1.1 1 47.6% 0.47 0.14 0.0039 VS

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 0.90 0.50 0.40 44.4% 1.26 0.40 0.4375 NS

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 0.80 0.20 0.60 75% 0.84 0.26 0.1250 NS

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 0.40 0.10 0.30 75% 0.48 0.15 0.2500 NS

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Shukla A, Kothari P, Yadav CR, Dadhich OP, Efficacy of Sariva Ghanavati in Yuvan Pidaka, JOA XIII-3, 2019; 68 - 72

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 0.40 0.20 0.20 50% 0.42 0.13 0.5000 NS

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 1.4 0.60 0.80 57.14 0.78 0.24 0.0313 S

GroupNo.

Mean score%

ChangeSD

±

SE

±P Re-

sultBT AT Diff.

A 10 1.0 0.10 0.90 90% 0.87 0.27 0.0313 S

Table No. VI- Effect on dryness of face

Table No. VII- Effect on Itching

Table No. VIII- Effect on Burning Sensation

Discussion:

Discussion on observation:

Age:

According to age wise distribution of 10 patients of Yuvan Pidaka it was observed that, maximum number of patients i.e. (70%) were from the age group of 20-30 years. This emphasises that the occurrence of Yuvana Pidaka is more prevalence in the adolescent age as well as in young age. Because in this age under the influence of androgenic hormones sebaceous glands hypertrophy and increase the production of sebum leads to the onset of acne.

Sex:

The sex wise distribution of the patients reveals that among 10 patients 70% were male. Actual acne incidence rate is more in males than females[4].

Dietary habits:

The dietary habit of 10 patients showed that 60% patients were vegetarian. The maximum patients prefer Madhura, Lavan, Amla and Katu Rasa in their diet. Excessive intake of Madhura, Amla & Lavan Rasa vitiates Kapha and produce Ama, where as Amla & Lavana Rasa vitiates Rakta Dhatu and Katu Rasa vitiates Vata Dosha which in turn leads to the manifestation of Yuvan Pidaka.

Mode of action of Sariva Ghanvati: ● Effect on Size & number of Pidaka- due to Tikta Rasa

& Kusthahara Karma[5].

● Effect on itching- due to Tikta Rasa, Kanduhara Karma[6].

● Effect on burning sensation- due to Madhura-Tikta Rasa & Sheeta Veerya, Dahaprashamana,Vishapaha Karma[7][8].

Conclusion:

¾ In this trial, total 10 patients of Yuvan Pidaka, with classical symptoms were treated for 30 days

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan72

administering Sariva Ghanavati.

¾ Sariva Ghanavati provided statistically very significant relief in symptoms like size & number of Pidaka; statistically significant result in symptoms of itching & burning sensation. But there was statistically non significant result in symptoms like number of scars, Vedana of Pidaka, oiliness & dryness of face. This may be because of short trial period and small sample size the action of drug can not be determined properly.

¾ Sariva possess qualities like Tridoshahara, Rakta shodhaka, Kusthahara, Kanduhara, Vranahrita, Ama doshahara, Vishapaha etc. so to evaluate the efficacy of Sariva in case of Yuvan Pidaka further research is required under large sample size for long duration.

Shukla A, Kothari P, Yadav CR, Dadhich OP, Efficacy of Sariva Ghanavati in Yuvan Pidaka, JOA XIII-3, 2019; 68 - 72

1. Kaviraj Ambika dutta Shastri, Sushruta Samhita Nidansthana, Part I, Chaukhmbha Sanskrita Sansthana, Chaukhambha Bharti Academy, 2007, 13/38, P- 287

2. B Adityan et al; Scoring systems in acne vulgaris; Indian Journal of dermatology 2009; 75 (3): 323–6

3. Julie C Harper “Acne Vulgaris” article; eMedicine 2009-08-06. Retrieved 2009-12-21.

4. B Adityan et al; “Profile of acne vulgaris, A hospital-based study from south India” Indian Journal of dermatology, Venereology, and Leprology 2009; 75 (3): 272-3

5. Pt. Kashinath Shastri & Dr. Gorakh Nath Chaturvedi, Charaka Samhita of Agnivesha- Sutrasthana, Vi,dyotinihindi commentary, Part-I, Chaukhambha Bharti Academy 26/43 (5), p 507

6. Pt. Kashinath Shastri & Dr. Gorakh Nath Chaturvedi, Charaka Samhita of Agnivesha- Sutrasthana, Vidyotinihindi commentary, Chaukhambha Bharti Academy, Part-I, 26/43 (5), p 507

7. Pt. Kashinath Shastri & Dr. Gorakh Nath Chaturvedi, Charaka Samhita of Agnivesha- Sutrasthana, Vidyotinihindi commentary, Part-I, Chaukhambha Bharti Academy, 26/43 (5), p 507

8. Prof. Priyavrata Sharma, Kaideva Nighantu, Chaukhmbha Orientalia-Varanasi, 2009, p184

References

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psgjk fnekx dk lwpdkad gSA ;g [kq'kh] nq[k] ب/k] mÙkstuk vkSj lÒh vuqÒoks d¨ ÁÒkfor djrk gSA l©an;Z lkekftd-fpfdRlk egRo dk

fo"k; gS] ;g xq.k o;fäd xq.k¨a dk la;¨tu gS t¨ bafæ;¨a d¨ fo'ks"k :i ls –f"V ds fy, mRlqdrk Ánku djrk gS ;k t¨ uSfrd ladk;

ds c©f)drk d¨ vkdf"kZr djrk gSA 'kjhj dh iwjh lqanjrk psgjs ij fuÒZj djrh gSA ekewyh ls ekewyh leL;k Òh psgjs d¨ vkd"kZd ghu

cuk ldrh gS vFkok LFkk;h fo#irk dh vksj ys tk ldrh gS] ftlds ifj.kke Lo:i ghuÒkouk ;k lkekftd thou ls vyxko mRié

g¨ ldrk gSA ;qokvksa esa psgjs d¨ vkd"kZdghu djus dk lcls vke dkj.k ;qokufiMdk / eq¡gkls gS t¨ dQ] okr vkSj jä dh fo"kerk ds

dkj.k g¨rk gSA

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan73

JO

A

XII

I-3

2

01

9

ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata

Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea)*Dr. Monika Kumari, **Prof. K. L. Meena, ***Dr. Prabhakar Vardhan

*Research Officer, MS Regional Ayurveda Research Institute for Endocrine Disorders, Jaipur, **Professor & Head, Dept. of Maulik Siddhant and Samhita, NIA, Jaipur, ***Assistant Professor, Dept of Shalakya Tantra, NIA,

Jaipur.

Keywords : Apana Vata, Udavartini, Anulomana, Matrabasti, Dysmenorrhea

Address of Correspondence: Dr. Monika KumariResearch Officer (Ayurveda), MS Regional Ayurveda Research Institute for Endocrine Disorders, Jaipur.

Email ID : [email protected]

Contact No : 7597117008

Introduction:

In present era, faulty diet and life style has become very common, as people are unaware of the

How to Site the Article : Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

JOAjournalofayurveda.in ISSN No:2321-0435

ABSTRACTBackground: Due to personal, social or professional obligations, the people inadvertently are adopting faulty diet and lifestyle. These abnormal diet and regimen factors closely resemble to apana vata vitiating factors. Probably because of this shift in lifestyle many diseases due to apana vata vitiation are emerging. One of such illness is udavartini yonivyapada (Primary Dysmenorrhea). Aims and objectives: The present research work aims at normalization of ap-ana vata by anulomana karma. In this regard, to evaluate and compare the effects of Erandbhrishta Haritaki churna and Trivrit taila matra basti in the management of Udavartini Yonivyapada (Primary Dysmenorrhea), the clinical study was conducted. Materials and Methods: It was a two armed prospective, non controlled, open label Randomized Clinical Trial in which 107 patients of Udavartini Yonivyapada (Primary Dysmenorrhea) were enrolled. In group A, Erandabhrishta haritaki churna was given and in group B, Matra basti with Trivritadi Taila in was given. The assess-ment was done every 4 weeks. Results and conclusions: In both the groups, extremely significant results were observed in all the cardinal parameters with P value less than 0.001. Hence the study concludes that both the formulations were effective in managing the illness but Matrabasti with Trivritadi Taila was found more effective.

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

importance of healthy lifestyle as told by our ancient acharyas thousands of years back. Increasing desires and engagements in fulfilling them without thinking their bad impacts on health is one of the contributory issues. Therefore, not following the rules of healthy living, untimely waking and sleeping (late night working hours) and suppression of the natural urges, not able to follow the healthy rules of dietetics and excessive travelling and increasing stress disturb the homeostasis and produce many illnesses. Many of these factors resemble to those mentioned in apana vata vitiation[1]. Thus Apana vata once vitiated affects the main vata dosha that leads to the diseases of other systems of body viz. as Arsha roga[2], Udavarta[3], Udara roga[4], Udavartiniyonivyapada[5] etc.

Female reproductive system is the functional site of Apana Vata[6]. Menstrual disorders are inherently associated with Apanavaigunya. Udavartini yonivyapada (painful menstruation) is one of the commonest ailments of female reproductive system that incapacitates the women from their day to day activities during menstrual phase. The foremost etiological factor of udavartini is adhovatadi vegadharana[7]. In modern science the udavartini disease can be interpreted as primary dysmenorrhoea. Dysmenorrhoea is a major medical problem not only for women but also for their families and health services[8]. The ranges of prevalence of dysmenorrhoea from 51% to 80% have been reported by many other studies.[9]

In recent times, George and Bhaduri concluded that dysmenorrhoea (87.87%) is a common problem in India[10].

Studies show the self-medication pattern in primary dysmenorrhoea among urban Indian women. The authors have highlighted the high prevalence (42%) along with inappropriate self-medication practices in a large number of participants[11]. Inappropriate self-medication practices inadvertently pose the patient to both the risk of lack of efficacy in case of sub-therapeutic dose as well as adverse events in case of excess than recommended dose. It is important to point out some

of the reported findings related respiratory, renal and gastrointestinal safety of modern medications[12]. Other treatment options e.g. Oral contraceptive pills therapy is needed for long duration and is associated with its own potential side effects.

Hence there is need for seeking safe management options in Ayurveda to facilitate the patient to lead a qualitative life with a good acquiescence to treatment.

Therefore considering the magnitude of this entity, the problem was selected for present research work. Anulomanakarma has been indicated to regulate apanavaigunya[13]. In present research work to achieve anulomana in the patients of Udavartini yonivyapada, Erandbhrishta haritaki churna and Trivrittadi taila in the form of matra basti was chosen. Haritaki has anulomaka effect[14]. Taila is appraised as the best medicine for vata dosha[15. Eranda taila is antagonistic to vata dosha and due to its innate qualities has pakvashaya shodhaka action[16]. Basti therapy has been given prime importance for alleviation of increased vata dosha[17]. Hence Matrabasti, a subtype of anuvasana basti is considered[18]. Anuvasana basti results in expulsion of feces and pakvashayastha vata and has anulomaka effect[19].

Aims & Objectives

1. To evaluate efficacy of Erandbhrisht Haritaki churna in the management of Udavartini Yonivyapada (Primary Dysmenorrhea).

2. To evaluate the efficacy of Trivrit taila matra basti in the management of Udavartini Yonivyapada (Primary Dysmenorrhea).

3. To compare the efficacy of two treatment modalities in the management of Udavartini Yonivyapada (Primary Dysmenorrhea).

Material & Methods

107 Patients of Udavartini were registered from O.P.D. and I.P.D. of Arogyashala, National Institute of Ayurveda, Jaipur and randomly divided in two groups, in which Erandabhrishta Haritaki and Trivrita taila

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

matrabasti were given respectively. A detailed research Performa was prepared for the diagnosis and assessment of the patients. The study was randomized prospective longitudinal comparative clinical study in which clinical features of selected patients were assessed before and after the intervention. All the patients completed the treatment. Due clearance was obtained for the study from the Institutional ethics committee.

Inclusion Criteria:

1. Patients of Udavartini Yonivyapada on the basis of signs and symptoms as detailed in ayurvedic and modern literature were taken for study.

2. Age: 14 to 50 years

Exclusion Criteria:

1. Patients suffering from any other systemic illness or organic illness

2. Patients in whom Haritaki is contraindicated, e.g. langhankarshita, balavarjita, vimuktarakta etc[20].

3. Patients in whom anuvasan basti is contraindicated[21]

Investigations:

Following laboratory investigations were carried out before the study to rule out any other pathological conditions

1. Complete blood count

2. Urine – routine and microscopic examination.

3. Blood sugar fasting, wherever required.

4. USG pelvic organs, wherever required.

Method Of Study

The method adopted in present study was Double armed non-controlled open randomized clinical trial. Due clearance was obtained for the study by the Institutional Ethics Committee (Ref. No.: F-10(5)/EC/2014/7225 dated 07.11.2014).

Informed consent: The purpose of the study, nature of the study drugs, the procedures to be carried

out and the potential risks and benefits were explained to the patients in details in non technical terms. Thereafter their written consent was taken before initiating the procedure.

Posology:

Group 1

Drug: Erandbhrishta Haritaki churna

Dose: 3gm–5gm BD

Route of administration: Oral

Anupana: Ushnodaka

Kala: After taking meals.

Duration: 11 days/cycle for two cycles

Group 2

Drug: Trivritadi Taila

Dose: 60ml

Route of administration: Matrabasti

Anupana: Ushnodaka

Kala: Rituvyateeta kala

(from 16th day of periods onwards)

Duration: 11 days/cycle for two cycles

Follow Up

During clinical study patients were followed up after 15 days for two months. After completion of study patients were followed up after 15 days for one month. During the follow up study, further improvement or deterioration or no change in the signs and symptoms were recorded.

Criteria of Assessment

The improvements in the patients were assessed mainly on the basis of relief in the signs and symptoms of the disease. To assess the effect of therapy objectively, all the signs and symptoms were given scoring depending upon their severity.

Parameters for assessment:

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Following cardinal parameters were used to assess the effect of the therapies in two groups:

Sr. No. Cardinal Parameters1 Pain intensity2 Duration3 Nature of pain4 Menstrual blood flow duration5 Amount of blood loss6 VAS scale7 FLACC scale8 Wong Baker facial grimace scale

A specific scoring pattern was applied to assess overall symptoms with parameters like Duration of Pain and Menstrual Flow Duration measured in days and Amount of Menstrual Blood Loss counted in pads used. Rest of the parameters were graded as follows:

Some pain scales were used to detect the severity of pain:

And further it is assessed as follows

No Pain Worst Pain

Visual Analog Scale (VAS)

Pain Intensity: GradeAbsent 0

Mild (Pain do not interfere with daily activity) 1Moderate (Daily activity hampers, relieves with analgesics) 2

Severe (do not relieved by analgesics) 3Nature of Pain Grade

Absent 0Occasional 1

Dull 2Spasmodic 3

0 1 2 3 4 5 6 7 8 9 10

7 - 10 Severe Pain

6 - 4 Moderate Pain

1 - 3 Mild Pain

0 No Pain

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Each of the three categories F (FACE), L(LEG), A(ACTIVITY), C (CRY) and C (CONSOLABILITY) is scored from 0—2. The scale is scored in a range of 0–10 with 0 representing no pain. The scale has five criteria, which are each assigned a score of 0, 1 or 2 and further it is assessed as follows

Associated Complaints:

Total 10 associated complaints were noted as given below which were further graded to assess the severity of the illness-

FLACC Scale

Wong Baker Facial Grimace Scale:

CATEGORY 0 1 2

FACENo particular expression or

smileDistressed apperence,

wrinkled browFearful expression, clenched

jaw

LEG Normal position or relaxed Uneasy, restless, tense Kicking or Legs drawn up

ACTIVITYLying quietly, Normal position, moves easily

Shifting back and forth, tense

Arched, rigid or jerking or rubbing body parts

CRY No cry (awake or asleep)Moans or whimpers, occasional complaint

Crying steadily, screams or sobs, complaining

frequently

CONSOLABILITY Content, relaxedReassured by occasional

hugging or being talked to, distractible

Difficult to console or comfort

7 - 10 Severe Pain6 - 4 Moderate Pain1 - 3 Mild Pain

0 No Pain

1 Nausea2 Vomiting3 Fatigue4 Headache5 Fainting6 Sweat7 Diarrhoea8 Constipation9 Vaginal discharge

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10 Breast tenderness

Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Grading of associated complaints:

Grading of associated complaints:

Table No I: Effect of therapy on cardinal parameters in Group A

No symptom 0Mild symptom 1

Moderate symptom 2

Severe symptom 3

Statistical Analysis

Various observations were made and the results obtained were computed statistically using Wilcoxon matched-pairs signed-ranks test, Mann-Whitney test on graphpad-Instat software. The results obtained were considered extremely significant for p value ≤0.001, very significant for p value ≤0.01, significant for p value ≤0.05 and non-significant for p value >0.05.

Individual A and B group: Wilcoxon matched pairs signed ranked test for nonparametric data.

Intergroup comparison between A and B group: Mann Whitney test for nonparametric data.

Criteria for the overall assessment of the therapies:

The total effect of the therapy was assessed considering to the overall improvement in signs and symptoms. For this purpose, following categories were maintained.

● Complete remission: 76%-100% relief in the signs and symptoms were considered as complete remission.

● Moderate improvement: 51%- 75% relief in the signs and symptoms were considered as markedly improvement.

● Mild improvement: 26%-50 % relief in the signs and symptoms were considered as mildly improved.

● No improvement: Below 25% relief in the signs and symptoms were considered as unchanged

Results

In this study 107 patients were registered out of which 100 completed the trial. The pattern of clinical improvement in various subjective and objective parameters were recorded and measured statistically in two groups, by using Graph Pad Instat 3and the obtained results are as follows:

S. No.

Parameters MeanDiff. %

relief SD SE W NP PES/ S/ NSBT AT

1 Intensity of pain 2.40 1.02 1.38 57.50 0.49 0.07 1275.00 50 <0.0001 ES2 Duration of pain 3.04 0.92 2.12 69.74 0.94 0.13 1275.00 50 <0.0001 ES3 Nature of pain 2.96 1.12 1.84 62.16 0.42 0.06 1225.00 49 <0.0001 ES

4 Menstrual flow duration 4.84 4.00 0.84 17.36 1.04 0.15 276.00 23 <0.0001 ES

5Amount of

menstrual blood loss

8.62 7.04 1.58 18.33 1.55 0.22 561.00 33 <0.0001 ES

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

6 VAS 2.34 0.88 1.46 62.39 0.50 0.07 1275.00 50 <0.0001 ES7 FLA CC 2.32 1.00 1.32 56.90 0.47 0.07 1275.00 50 <0.0001 ES

8Wong Baker

facial grimace scale

2.38 1.04 1.34 56.30 0.48 0.07 1275.00 50 <0.0001 ES

In group A, extremely significant results were observed in all the cardinal parameters with P value less than 0.0001.

In Associated parameters, extremely significant results were observed in nausea, fatigue, headache, fainting, constipa-tion and vaginal discharges. Significant results were observed in vomiting and breast tenderness whereas insignificant results were observed statistically in sweating and diarrhoea.

Effect Of Therapy On Associated Parameters In Group A

Effect Of Therapy Oncardinal Parameters In Group B

Table No. II: Effect of therapy on associated symptoms in Group A

Table No. III: Effect of therapy in cardinal parameters in Group B

S. No.

Parameters MeanDiff. %

reliefSD SE W NP P ES/

S/ NSBT AT

1 Nausea 0.54 0.10 0.44 81.48 0.54 0.08 231.00 21 <0.0001 ES2 Vomiting 0.18 0.04 0.14 77.78 0.35 0.05 28.00 7 0.0156 S3 Fatigue 1.22 0.36 0.86 70.49 0.40 0.06 903.00 42 <0.0001 ES4 Headache 0.33 0.02 0.31 93.87 0.51 0.07 105.00 14 0.0001 ES5 Fainting 0.64 0.12 0.52 81.25 0.54 0.08 325.00 25 <0.0001 ES6 Sweating 0.06 0.02 0.04 66.67 0.20 0.03 3.00 2 0.5 NS7 Diarrhoea 0.08 0.02 0.06 75.00 0.24 0.03 6.00 3 0.25 NS8 Constipation 0.72 0.08 0.64 88.89 0.75 0.11 300.00 24 <0.0001 ES

9 Vaginal discharge 0.34 0.16 0.18 52.94 0.39 0.05 45.00 9 0.0039 ES

10 Breast tenderness 0.14 0.02 0.12 85.71 0.33 0.05 21.00 6 0.0313 S

S. No. Parameters

MeanDiff. %

relief SD SE W NP P ES/ S/ NSBT AT

1 Intensity of pain 2.54 0.96 1.58 62.20 0.50 0.07 1275.00 50 <0.0001 ES

2 Duration of pain 3.36 0.92 2.44 72.62 1.07 0.15 1275.00 50 <0.0001 ES

3 Nature of pain 2.94 0.98 1.96 66.67 0.28 0.04 1275.00 50 <0.0001 ES

4 Menstrual flow duration 4.74 4.08 0.66 13.92 0.92 0.13 210.00 20 <0.0001 ES

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

5Amount of menstrual blood loss

8.90 7.32 1.58 17.75 2.16 0.31 378.00 27 <0.0001 ES

6 VAS 2.42 0.90 1.52 62.81 0.58 0.08 1275.00 50 <0.0001 ES7 FLA CC 2.48 0.92 1.56 62.90 0.54 0.08 1275.00 50 <0.0001 ES

8Wong Baker

facial grimace scale

2.56 0.92 1.64 64.06 0.53 0.07 1275.00 50 <0.0001 ES

Extremely significant results were observed in all the cardinal parameters in group B with P value less than 0.0001.

Extremely significant results were observed in group B in nausea, fatigue, headache, fainting and constipation whereas very significant result was obtained in vomiting. In sweating, there were significant improvement and insignificant re-sults were seen in diarrhoea, vaginal discharge and breast tenderness.

Most of the variables are nonparametric, some parameters were of nominal series, but they didn’t pass the normality test. Therefore Mann-Whitney Test (for analysis of two independent samples non parametric data) was used. The re-sults are as follows:

Effect Of Therapy On Associated Parameters In Group B

Table No. IV: Effect of therapy on associated symptoms in Group B

S. No.

Parameters MeanDiff. %

reliefSD SE W NP P ES/

S/ NSBT AT

1 Nausea 0.96 0.32 0.64 66.67 0.48 0.07 528.00 32 <0.0001 ES2 Vomiting 0.24 0.06 0.18 74.49 0.44 0.06 36.00 8 0.0078 VS3 Fatigue 1.38 0.60 0.78 56.52 0.42 0.06 780.00 39 <0.0001 ES4 Headache 0.54 0.08 0.46 85.19 0.50 0.07 276.00 23 <0.0001 ES5 Fainting 0.80 0.10 0.70 87.50 0.51 0.07 595.00 34 <0.0001 ES6 Sweating 0.14 0.02 0.12 85.71 0.33 0.05 21.00 6 0.0313 S7 Diarrhoea 0.04 0.02 0.02 50.00 0.14 0.02 1.00 1 >0.9999 NS8 Constipation 0.62 0.06 0.56 90.32 0.61 0.09 325.00 25 <0.0001 ES

9 Vaginal discharge 0.16 0.06 0.10 62.50 0.30 0.04 15.00 5 0.0625 NS

10 Breast tenderness 0.04 0.02 0.02 50.00 0.14 0.02 1.00 1 >0.9999 NS

Intergroup Comparisons

Table No. V: Intergroup comparison on cardinal parameters

S NoSymptoms Mean SD SE U P ES/ S/

NSGA GB GA GB GA GB

1 Intensity of pain 1.38 1.58 0.49 0.50 0.07 0.07 1000.0 0.0469 S2 Duration of pain 2.12 2.44 0.94 1.07 0.13 0.15 1059.0 0.1615 NS

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

On intergroup comparison, there was very significant difference in Wong Baker facial grimace scale with group B pro-viding 7.76% more relief than group A. Statistically significant differences were observed in intensity of pain and FLA CC scale with group B providing 4.7% and 6.0% more relief respectively than group A. In other cardinal parameters, statistically there were no significant differences in two groups.

On comapring the effects of therapy in two groups, significant difference was observed on nausea with group A provid-ing 14.81% more relief than group B. In all other associated parameters, statistically there was no significant difference between two groups

Intergroup Comparison On Associated Parameters

Table No. VI: Intergroup comparison of associated parameters

Table No. VII: Overall effect of therapy on cardinal parameters

3 Nature of pain 1.84 1.96 0.42 0.28 0.06 0.04 1127.0 0.1196 NS4 Menstrual flow duration 0.84 0.66 1.04 0.92 0.15 0.13 1144.5 0.4189 NS

5 Amount of menstrual blood loss 1.58 1.58 1.55 2.16 0.22 0.31 1144.0 0.4472 NS

6 VAS 1.46 1.52 0.50 0.58 0.07 0.08 1202.0 0.7072 NS7 FLA CC 1.32 1.56 0.47 0.54 0.07 0.08 967.0 0.0237 S

8 Wong Baker facial grimace scale 1.34 1.64 0.48 0.53 0.07 0.07 891.5 0.0045 VS

S NoSymptoms Mean SD SE U P ES/

S/ NSGA GB GA GB GA GB

1 Nausea 0.44 0.64 0.54 0.48 0.08 0.07 991.0 0.0404 S2 Vomiting 0.14 0.18 0.35 0.44 0.05 0.06 1221.5 0.7552 NS3 Fatigue 0.86 0.78 0.40 0.42 0.06 0.06 1155.5 0.3503 NS4 Headache 0.30 0.46 0.51 0.50 0.07 0.07 1036.5 0.08 NS5 Fainting 0.52 0.70 0.54 0.51 0.08 0.07 1029.5 0.0791 NS6 Sweating 0.04 0.12 0.20 0.33 0.03 0.05 1150.0 0.1444 NS7 Diarrhoea 0.06 0.02 0.24 0.14 0.03 0.02 1200.0 0.3148 NS8 Constipation 0.64 0.56 0.75 0.61 0.11 0.09 1211.0 0.7683 NS

9 Vaginal discharge 0.18 0.10 0.39 0.30 0.05 0.04 1150.0 0.2538 NS

10 Breast tenderness 0.12 0.02 0.33 0.14 0.05 0.02 1125.0 0.0522 NS

Overall Effect Of Therapy On Cardinal Parameters

Effect of therapy Group A Group BNo. of

patientsPercentage No. of patients Percentage

Complete remission 1 2.0% 1 2.0%Moderate improvement 38 76.0% 47 94.0%

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Mild improvement 11 22.0% 2 4.0%No improvement 0 0% 0 0%

On overall assessment, 76% patients in Group A and 94% patients in Group B were moderately improved whereas 22% patients in Group A and 4% patients in Group B reported mild improvement. One patient each in both the groups re-ported more than 75% relief in cardinal parameters.

Follow Up

After completion of the trial, a follow up of one month was observed in which none of the patients reported deterioration in any of the parameters.

Discussion

In Udavartini yonivyapada, vata gets aggravated primarily due to vegadharana of flatus etc. and moves in reverse direction, then settles in yoni and produces the pain, initially pushes raja in upward direction, then discharges it with difficulty. The woman feels relief immediately after the discharge of menstrual blood. Since in this condition the rajah moves in upward direction, it is termed as Udavartini.

Pelvic area is the native place of vata dosha hence diseases occurring there are due to vata dosha vitiation. Among the types of vata dosha the apana vata is designated as the regulator of female reproductive system. Therefore apana vata dosha is the prime responsible dosha in the manifestation of various yonivyapada of which Udavartini is a part. Though association of other dosha i.e. pitta and kapha is also associated in yonivyapada yet apana vaigunya has special importance in Udavartini as normal function of excretion of menstrual blood is accomplished by apana vata hence any discrepancy in it is obviously due to vitiation of apana vata dosha.

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Pathogenesis of Udavartini Yonivyapada

Etiological factors

AmadoshaPhysical activitiesDiet

Ruksha Vegadharana

Lamghana

Ativyayama

Abhighata etc.

Dhatukshaya Margavarana

ApanavataVaigunya

Raja Udavartana

Rajah Kruchhrata

Udavartini

RajahSanga

Artavavahastrotasodushti (Sanga, Vimarga Gamana)

Sheeta

Laghu

In Ayurveda, the udavrtini yonivyapada represents the version of primary dysmenorrhoea while the painful menstruation in other yonivyapada such as vatika yonivyapada, vataja rajodushti, vipluta, sannipatika yonivyapada etc. represent the state of secondary dysmenorrhoeal manifestation. In Ayurveda the basic pathological factors of vata vitiation are margavarodha and dhatukshaya[22]. Abnormal psychological factors cause dhatukshaya by not rendering proper digestion. Abnormal synthesis of prostaglandins and hormonal imbalance also results due to faulty dietary habits and life style.

It is a condition in which the menstruation is painful. It is one of the common menstrual disorders and the type of pain associated with menstruation varies with the cause. While most women experience minor pain during menstruation, dysmenorrhoea is diagnosed when the pain is so severe as to limit normal activities, or require medication.

Management principle of apana vata vitiation is regulation of apana vata which is achieved by anulomana karma. Anulomana karma has been defined as the one which breaks the abnormal doshic complex, propagates the malas and doshas downwards after their appropriate

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digestion and excretes them out from the body through adhomarga. Ideal example of dravya that executes anulomana is Haritaki. In present research work, to achieve anulomana in the patients of Udavartini yonivyapada, Erandbhrishta haritaki churna and Trivrittadi taila in the form of matra basti were chosen.Haritaki is deepana, pachana , strotoshodhaka, due to ushna virya and laghu guna, performs the anulomana karma due to amla rasa, madhura vipaka, is vedanasthapaka due to ushna virya[23]. As margaavarodha due to adhovatadi vegadharana is appreciated a more significant cause of udavartini yonivyapada therefore the potent anulomana is achieved by the addition of erandataila in it. Taila is appraised as the best medicine for vata dosha. Eranda taila is antagonistic to vata dosha due to its innate qualities and is also regarded as the best vata pacifier and dhatuposhaka (vaya sthapaka, rasyana, vrushya) has pakvashayashodhaka action due to which it is the drug of choice in udavarta roga. Thus it accentuates the properties of haritaki and formulation becomes more powerful in performing the function of anulomana of apana vata and treating the udavartini yonivyapada.

The formulation trivritadi taila has been selected from Ashtamga Samgraha text described to treat udavarta yonivyapada[24]. Its contents are drugs of dashamoola, trivrita in equal proportion and tila taila. It has been named so as prime anulomana function is performed by trivrita.Trivrita is sukhavirechaka and pacifies kapha and pitta dosha[25], hence it manages apanavaigunya by removing obstruction caused by pitta and kapaha i.e. breaks the margavrodha type of pathogenesis as already explained in udavartini yonivyapada. Virechaka action cleans the native place of apana vata. Though it is said to be vatakara but the distinctive addition of dashmula and tila taila nullify it’s this effect.

Dashmula is tridoshashamaka and amapachaka thus aids in its function of digestion of metabolic products leading to obstruction of various strotas and easing the vitiated tridosha[26]. Tila taila has all the qualities that are opposite to vata dosha e.g. it is guru, snigdha, madhura,

madhura and ushna. Taila is also regarded as the best vata pacifier. So, all these qualities of tila enable it to regulate the vitiated vata when its obstruction is removed by the trivrita ingredient.

The procedure i.e. basti by which this formulation is induced is best vatahara and has rasayana effects. Once vata is treated other dosha are also managed. By the beauty of this therapy the essence of drugs used in this formulation which have tridoshahara benefits directly reach in every part of body and all the vitiated dosha are regulated[27]. Hence not only the management of udavartini yonivyapada is obvious but other yoniyapada may also get cured. Therefore it treats primary as well as secondary dysmenorrhea.

In this study matrabasti with trivritadi taila was found more effective in relieving pain. Pain occurs due to vata vitiation and formulation of drugs used in this group was such that trivrita cleans the vata sthana while dashmoola have vata pacifying property and tila taila is the best among oils to treat the vata vitiation. The direct systemic absorption of the drug by basti procedure also contributes to the better effects in pain intensity in group B.

Conclusion

Faulty life style and dietetics lead to manifestation of many illnesses e.g. Arsha roga, Udavarta, Udara roga etc. Among these Udavartini yonivyapada (dysmenorrhea) is a very common entity which leads to deterioration of quality life of the women during menstrual period. The self medication and side effects of the allopathic medicines lead to further complexity in managing the illness. The present study shows that the holistic approach of Ayurveda science on its own valued principles can be an alternative to deal the problem.

Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

1. Sharma Shivprasad (ed.) Ashtangsamgraha of VriddhaVagbhata with Shashilekha Sanskrit commentary, Nidanasthana: 16/21. Chowkhamba Sanskrit series, Varanasi, p. 419.

2. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by

References

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

Chakrapanidutta, Chikitsa sthan: 14/08. Chaukhamba Surbharati Prakashan, Varanasi; p.501.

3. Ibid. Chikitsa sthan: 26/5. p.597

4. Ibid. Chikitsa sthan:13/10. p.491

5. Sharma Shivprasad (ed.) Ashtangsamgraha of VriddhaVagbhata with Shashilekha Sanskrit commentary, Uttara: 38/36. Chowkhamba Sanskrit series, Varanasi, p.829.

6. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by Chakrapanidutta, Chikitsa sthan: 30/115. Varanasi: Chaukhamba Surbharati Prakashan; 2005; p.639.

7. Sharma Shivprasad (ed.) Ashtangsamgraha of VriddhaVagbhata with Shashilekha Sanskrit commentary, Uttara: 38/36 Shashilekha commentary. Chowkhamba Sanskrit series, Varanasi, p.829.

8. Khodakrami Nahid, The Effect of an Iranian Herbal Drug on Primary Dysmenorrhea: A Clinical Controlled Trial Journal of Midwifery & Womens Health 2009; 1526-9523)

9. Pullon S, et al. Prevalence of dysmenorrhoea in Wellington women. N Z Med J 1988; 101: 52–54.

10. George A, Bhaduri A. Dysmenorrhea among adolescent girls – symptoms experienced during menstruation. Health Promotion Educ. 2002;17:4.

11. R, Krishnaiah V, Channaveera GS, Mruthyunjaya S. Comparison of the pattern, efficacy, and tolerability of self-medicated drugs in primary dysmenorrhea: A questionnaire based survey. Indian J Pharmacol. 2013; 45:180-183).

12. Segasothy M, Thyaparan A, Kamal A, Sivalingam S. Mefenamic acid nephropathy. Nephron. 1987;45:156-7.

13. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by Chakrapanidutta, Chikitsa sthan: 28/219. Varanasi: Chaukhamba Surbharati Prakashan; 2005.p.626

14. Dr. Brahmanand Tripathi: Sharangadhar Samhita with DIPIKA Hindi commentary, Chaukhamba Surbharti Prakashan,

Varanasi,Edition: Reprint 2011, Pu. Khanda Chapter 4/3.

15. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by Chakrapanidutta, Siddhi sthan; 1/29. Varanasi: Chaukhamba Surbharati Prakashan; 2005.p.682

16. Ibid. Chikitsa sthan ;26/30. p.599

17. Ibid. Sutra sthan;25/40. p.131

18. Ibid. Siddhi sthan; 4/52-54. p.701

19. Ibid. Sutra sthan; 2/15. p.25

20. Shri. Bhavamisra, Commentary by Dr. K.G. Chunekar, Bhavaprakasa Nighantu, Chaukhambha Bharati Academy, Eighth Edition-1988, Haritakyadi varga 20.

21. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by Chakrapanidutta, Siddhi sthan; 25/40. Varanasi: Chaukhamba Surbharati Prakashan; 2005. p.593

22. Ibid. Chikitsa sthan;28/59. p.619

23. Dr. Brahmanand Tripathi: Sharangadhar Samhita with DIPIKA Hindi commentary, Chaukhamba Surbharti Prakashan, Varanasi,Edition: Reprint 2011, Pu. Khanda Chapter 4/3 Dipika commentary,

24. Sharma Shivprasad (ed.) Ashtangsamgraha of VriddhaVagbhata with Shashilekha Sanskrit commentary, Uttara: 41/29 Shashilekha commentary. Chowkhamba Sanskrit series, Varanasi, p.861.

25. Bhava Prakasha of Sri Bhava Mishra by Brahmasankara Mishra and Rupalalji Vaisya, Part-I 11 th Edition, The Kashi Sanskrit Series130. Purva khanda 4/ 166-168.

26. Trikamji Acharya (ed.) Sushruta samhita Nibandha Samgraha commentary of Dalhana. Sharira sthana;10/9. 4th ed. Varanasi: Chaukhamba Orientalia, 1980, p. 388

27. Trikamji Acharya (ed.) Charaka samhita Deepika commentary by Chakrapanidutta, Siddhi sthan;1/39. Varanasi: Chaukhamba Surbharati Prakashan; 2005.p.683

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Kumari M, Meena KL, Sharma S, Vardhan P, A Randomized Clinical Study to Compare the Effect of Eranda Bhrishta Haritaka Churna Orally and Trivrita Taila Matrabasti for Apana Vata Anulomana in Udavartini Yonivyapada (Primary Dysmenorrhea), JOA XIII-3, 2019; 73 - 86

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan87

JO

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XII

I-3

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

Evaluation Of Meditation On Agya Chakra To Modify Human Attitude*Dr. Shalini Thakur, **Dr. Umesh Shukla

*P.G. Scholar Final Year, ** Sr. Lecturer, Deptt. of Swasthvritta & Yoga, R.G.G.P.G. Ayu. College & Hospital, Paprola, Kangra, H.P.,

Keywords : Meditation on Agya Chakra, Attitude change, Likert Scale, Intensity of meditation criteria.

Address of Correspondence: Dr. Shalini ThakurP.G. Scholar Final Year, Deptt. of Swasthvritta & Yoga, R.G.G.P.G. Ayu. College & Hospital, Paprola, Kangra, H.P.

Email ID : [email protected] No : 7018248015

Introduction:

An attitude[1] is a part of human behavior which includes a settled way of thinking or feeling about something. It involves the ideas, values and beliefs of a person which ultimately lead to his way of thinking, inclinations, habits and finally manifest in his behavior.

How to Site the Article : Thakur S, Shukla U, Evaluation Of Meditation On Agya Chakra To Modify Human Attitude, JOA XIII-3, 2019; 87 - 94

JOAjournalofayurveda.in ISSN No:2321-0435

ABSTRACT

Although standard of living is increasing globally but there is a clearcut decline in the quotient of life and happiness quotient with a surge in psychosomatic,behavioral as well as mental health disorders. Main reason behind all these is negative attitude of persons due to which lack of optimism, right vision and inability to cope up with the stressors is prevalent. Stressors are always there but it’s the ability of humans to handle the stress which protects them and it comes from positivity in the attitude. In Yogsutra, Maharshi Patanjali clearly mentions that person becomes like his attitudes so one should control the attitude through meditation. Taking this as baseline, a study was conducted on 20 apparently healthy volunteers to assess the effect of meditation practice on Agya Chakra to see its transformational efficacy in increment in positivity of Mental Attitude. For this, volunteers were selected randomly and to measure their attitude, LIKERT SCALE is framed and evaluation of attitude was done before and after meditation trial of 21 days. For medita-tion evaluation, a seven scale criteria is formed to evaluate intensity with which volunteers performed meditation and to record the evidence. After statistical analysis, this meditation practice was found highly significant in changing the human attitude and increasing its positivity. This result is quite encouraging after such a short duration of trial and may be a landmark in maintaining mental health and quality of life if practiced regularly. It is a nondrug therapy advisable for masses requiring no vigorous training as indicated by the fact that no volunteer was practicing any spiritual practice earlier, they all were novice.

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Thakur S, Shukla U, Evaluation Of Meditation On Agya Chakra To Modify Human Attitude, JOA XIII-3, 2019; 87 - 94

A person with negative attitude faces so many problems in all aspects of life be it personal, professional or social. Negative mind never yields anything positive. In this new age of modernization, the society is becoming ill. Intolerance, violence, nonacceptance, hatred, communalism, anxiety, depression & psychosomatic disorders are in full bloom , crimes based on caste, sex, races are also increasing due to increase in negative attitude of persons. World is deteriorating empathically and society is becoming value neutral. The only possible ray of hope is through changing negative attitudes to positive and holding and increasing their positivity. This is not easy yet possible to do and Meditation is one such method of control the attitude.

Maharshi Patanjali conceptualized Ashtang Yoga and gave a concept of controlling attitudes through meditation practices when he says

/;kugs;kLr~no`Ÿk;%A

o`fŸklk:I;ferj=AA

(Patanjali Yogasutra 2/11)[2]

(Patanjali Yogasutra 1/4)[2]

Means we should control and curb the attitudes of mind through meditation because these are the attitudes which make the basis of behavior.

Means person becomes like his Vrittis or attitudes.

Taking this as reference,a study was done and 20 volunteers were subjected to do meditation and assessment of their meditation practice was done on the fixed seven scale criteria.

Aims & Objectives:To evaluate the effect of meditation practices on Agya Chakra[3] in the modification of human attitude and increasing its positivity.

Plan Of Study: This research trial was approved by IEC in RGGPG Ayu.College Paprola (H.P.) by no.Ayu/IEC/2016/1129.

Selection of patients - For clinical study 20 apparently healthy volunteers attending the OPD of the Rajiv Gandhi Government Post Graduate Ayurvedic College & Hospital, Paprola, Kangra (Himachal Pradesh) were selected on

the basis of inclusion criteria.

Selection Criteria:

Consent- Written and informed consent of apparently healthy volunteers was taken before inclusion in the trial.

Inclusion Criteria

1. Apparently healthy volunteers willing for trial.

2. Group of 18 - 30 years irrespective of sex, race, religion and socio-economic status.

Exclusion Criteria

1. Volunteers not willing for the trial.

2. Volunteers below 18 and above 30 years.

3. Volunteers having any associated chronic ailments like D.M., Cardiac disorder, Renal disorder and Alcoholic liver disease, Chronic hemolytic anemia, Psychiatric disease.

4. Pregnant and Lactating mothers.

Laboratory investigations:

The routine hematological examination was done before the clinical trial to rule out any other pathological condition.

Blood– Hbgm%, TLC, DLC, ESR, FBS, B. Urea, S. Creatinine, S. Uric acid, S. Cholesterol, SGOT, SGPT

Study Design:

Prospective and retrospecive - Prospective

Randomised or not - Randomised

Number of volunteers for trial - 20

Duration of trial - 3 weeks

Meditation Technique:

Each volunteer has practised the given meditation

technique as follows -

Technique of (Meditation)[3]

Dharana –It is taken in two terms-Thought & Place.

1. Thought taken - All the men and women of the

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world are mine brothers & sisters.

2. Place (Desha) - Place (Desha) is Agya Chakra

It was chosen to meditate on Agya Chakra (glabellar region) which is very popular among practitioners [In accordance to meditation on one Desha as described in( Patanjali Yogasutra 3/1,2)[4][5].

The process of meditation was divided into two parts-

1. Focus at night- Volunteers were asked to take suggestion & Meditate on their choosen Pradesha i.e. Agya Chakra with the same thought as given in Dharna at night before going to sleep.

2. Cleaning at morning- Volunteers were asked to clean their Pradesha (Place where they were meditating ) with the thought that “All the impurities, grossness & heaviness are melting and going out in the form of smoke from the front” and imagine that as this process is going on, the structures behind are glowing”. This was advised to done in the morning earliest. This was a kind of active meditation.

Evaluation of Intensity of Meditation Practices:

A seven point criteria was made to measure the intensity of meditation practice during whole duration of trial, the points were viz. willingness, sincerity etc.

The intensity of meditation practice was being assessed on the basis of VAS on following parameters from the first day of starting of meditation practice up to end of trial.

1. WILLINGNESS - (during meditation)

2. SINCERITY - (during meditation)

3. FOCUS - (during meditation)

4. ACCEPTANCE - (for meditation)

5. DEVOTION - (for the practice)

6. FEELING - (arising during meditation and its continuation up to next meditation session)

7. LOVE - (for overall practice)

This should be recorded just after completion of every

session except point no 6 i.e. feeling which’ll be assessed just before beginning of next session.

Time of practice - 10 minutes morning and 10 minutes at night.

Follow up - After 3 weeks (on the day of completion of Individual meditative practice)

Total duration of trial - 3 weeks

Assessment was done on the basis of subjective and objective criteria for intensity of meditation and grading pattern of LIKERT SCALE adopted before & after practicing the technique of meditation to assess the attitude.

Criteria for assessment of Attitude

It was done on the basis of LIKERT SCALE.[6][7] Likert scale is a sementic scale to measure the attitude .It

consists of following steps:

1. Statement Collection: In this various statements are framed on all the aspects touching human lives like self, family, education, society, learnings, love etc.

2. Direction Judging: For this, a questionnaire was made of 365 questions and was distributed to judges. Judges were selected from all the fields like politics, administrstion, army, medical, Ayurveda, police, acedemics, engineering, students, business community etc. The eminent personalities from the above said fields were selected and they were requested personally to be the part of work and contribute as a judge. They were requested to judge the statement in terms of positive and negative.

(Questionnaire)

Evaluation Of Meditation Practices To Modify Mental Attitude Judges Copy To Develop Likert Scale

1) Life is very complicated and painful.Tkhou cgqr tfVy ,oa ihM+knk;d gSA

2) Family members, friends, relatives are not supportive.

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ifjokj ds lnL;] fe= ,oa fj”rsnkj lgk;d ugha gksrs gSaA

3. Discarding The Neutral Statements: After collection of questionnaires from various judges, all of them are compiled to find the only direct + or – are kept ,neutral, not attempted, ambiguous, unclear statements are discarded and if one of the judges has attempted any of the questions in these terms, such questions were considered invalid from the whole compilation.

4. Formatting The Items To Measure Intensity: In order to measure the intensity of the statement judged, percentage of positive or negative is calculated. Percentage was calculated as

No of positive or negative questions ÷ total no of valid questions x100

After % calculation, only those statements are kept finally whose % score was 90% or above to it. In this order, total questions were reduced to 134. Now this was the LIKERT SCALE ready to be given to the volunteers under trial.

Final Likert Scale Questionnaire

1. Life is very complicated and painful.Tkhou cgqr tfVy ,oa ihMknk;d gSA

(a)Strongly agree (b) Agree (c) Neutral (d) Disagree (e) Strongly Disagree

2. Family members, friends, relatives are not supportive.ifjokj ds lnL;] fe= ,oa fj”rsnkj lgk;d ugha gksrs gSaA

(a) Strongly agree (b) Agree (c) Neutral (d) Disagree (e) Strongly Disagree etc.------Q.134

5. Scoring:-Now each question is given 5 options and

each option carries a score corresponding to it in order of increasing positivity. For example , in a positive statement the score with options are-

Strongly agree-5, Agree-4, Neutral-3, Disagree-2, Strongly disagree-1

Now this questionnaire was given to volunteers before starting the meditation practice and they were requested to attempt the questions instantly and naturally and honestly. After that the formats were collected and data was noted down in a table as before trial score. Now all

the volunteers were subjected to meditation practices for 21 days with duration of 10 minutes in the evening and morning. Again after 21 days, on the day of completion of trial, again LIKERT SCALE questionnaire was given to them and requested to attempt simultaneously as requested before. And all the data was noted down as after trial score of the individuals. Alongwith the difference between before and after trial score was noted down.

Final Assessment Of Results:

The improvement was assessed on the basis of increment of the positive attitude score. Volunteers were assessed before and after meditation for positive inclination of attitude on the basis of scoring pattern and percentage increment in positivity was calculated.

Statistical Analysis:

y The data collected & compiled from this clinical trial was sorted out, processed further by subjecting to statistical method i.e. WILCOXAN SIGN RANK TEST.

y This test was done on the two sets of observations in trial group.

f One is on the criteria of meditation intensity which signifies the role of them in doing meditation and relationship of each factor with meditation.

f Secondly on evaluation of increment in positivity of attitude after meditation process, it incorporates the after trial and before trial values indicating change in attitude & increment in positivity.

y The obtained result were interpreted as: Highly significant at p<0.001, Moderately significant at p<0.01, Significant at p<0.05, Insignificant at p>0.05

Presentation Of Data:

The data collected & compiled from this clinical trial was sorted out, processed and presented in the following sections:

1. Demographic profile

2. Effect of meditation practices

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Demographic Profile

Effect Of Meditation Practices

Status of completion Maximum Percentage%Age 13(20-25) 65Sex 17(females) 85

Marital Status 18(unmarried) 90Socio economic status 12(Uppermiddle) 60

Habitat 16(Rural) 80Mental status 12(Normal) 60

Religion 20(Hindu) 100

Table No.I- Overall intensity of meditation practices before and after study:

A table consisting of seven criteria to measure intensity of meditation was framed and data was collected for 3 weeks in the morning and evening both times and average was calculated before and after trial as shown below-

Criteria for overall intensity of meditation

practices for 20 volunteers

Average before trial=Total

BT score /20

Average after

trial=total AT score/ 20Willingness 62.3 72

Sincerity 59 67.5Focus 36.35 66.35

Acceptance 43.75 63.6Feeling 42.1 56.75

Devotion 47.5 71.45Love 43.1 70.1

Total average % of intensity of meditation 47.7 66.8

Table No. II - Statistical analysis of criteria of Intensity of meditation before & after trial and whole average% of it, during trial period

Sr.

No.

Criteria of

Intensity of

meditation

Average %

during

Trial

Wcritical WStat

Significance(value)

P valueSignificance

1. Willingness 66.6 40 50.0 Willingness p=0.130 Insignificant

2. Sincerity 64.76 46 58.5 Sincerity p=0.145 Insignificant

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Table No. III - Before Trial (BT) and After Trial (AT) score of Positivity in Attitude of 20 volunteers on Likert scale:

VOLUNTEERSSCORE on Likert Scale

DIFFERENCE% CHANGE

()100BT AT

V1 587 604 17 2.8V2 564 567 3 0.53V3 526 559 33 6.27V4 589 614 25 4.24V5 525 542 17 3.23V6 569 604 35 6.15V7 509 566 57 11.1V8 521 528 7 1.34V9 546 550 4 0.73V10 583 595 12 2.05V11 618 622 4 0.64V12 618 628 10 1.61V13 587 584 -3 -0.51V14 585 590 5 0.85V15 600 627 27 4.5V16 562 585 23 4.09V17 582 610 28 4.8V18 583 589 6 1.02V19 565 581 16 2.83V20 538 572 34 6.31

3. Focus 54.62 5211.5

Focus p=<0.001 Highly significant

4. Acceptance 58.75 46 30.5 Acceptance p=0.007Moderately

significant

5. Feeling 59.167 46 40 Feeling p=0.026 Significant

6. Devotion 55.624 40 13 Devotion p=<0.001Highly

Significant

7. Love 60.018 40 12.5 Love p=<0.001Highly

Significant

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Here Wcritical > Wstat , so null hypothesis is rejected & alternate hypothesis is accepted i.e. meditation practices are highly significant in increasing the positive inclination of mental attitude in apparently healthy volunteers.

Discussion

Table No.I

Overall, there is incremental change of 19% in all criteria.Thus we can say that Meditation was greatly significant in change in criteria involved in meditation, and if 100% intensity is there, it can produce far better results which is a matter of further exploration.

Table No.II

1. Willingness-

Even if one is not 100% willing but is sitting to do meditation, he is going to get good results. Meditation is needed to be done even if less Willingness is there.

2. Sincerity-

It may be concluded that sincerity has cast no deciding impact on Meditation process. People just need to sit and try to meditate.

3. Focus-

Focus is found highly significant factor for meditation, without it no Meditation is possible.

4. Acceptance-

Obviously one takes time to accept new process, in this trial what we found that even if acceptance % is less, the process or practice is going to cast its impact.

5. Feeling-

To feel what you are doing is the core or soul of any practice. Needless to say, meditation is a self-experiencing process,

if one feels by heart it definitely yields good result.

6. Devotion-

A feeling like devotion takes time to cultivate still in a short span of trial, it was found to cast high impact.

7. Love-

Love is the highest energy. It propels the strong feeling of interest.

Table No. III

Meditation And Change In Attitude:

As shown in Table No. 4, highly significant effect as indicated by p< 0.0001115 in this trial , was observed on change of attitude after doing Meditation i.e. Meditation process was found to be significant as changing human attitude. The overall (among 20 volunteers) change in positive inclination of attitude was highly significant.

Conclusion:

The following conclusions can be drawn from this research work:

1. Meditation practices have shown significant effect on the change of attitude or increase in the positivity of attitude of volunteers .Though time and duration of the trial was very short still it was proved highly significant and there was marked change in attitude in this trial. This establishes the transformational quotient of Meditation on behavioral patterns.

2. In the present research work ,the average VAS for criteria of intensity of Meditation was initially 47.7 % and at the end of study after expensing only 10 minutes morning & 10 minutes evening for meditation ,it improves up to 66.8% which is quite impressive and establishes the fact that by practicing meditation regularly, it intensifies the intensity of Meditation also.

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lkjka'k%

thouLrj esa oSf”od rkSj ij mUufr gksus ds ckotwn thou esa xq.kork ,oa gSIihuSl D;ks”ksaV (Happiness quotient) esa lkQrkSj ij fxjkoV

gks jgh gS vkSj fofHkUu ekufld] euksnSfgd ,oa O;ogkfjd jksxksa esa o`f) gks jgh gSA bu lcdk eq[; dkj.k O;fDr dh udkjkRed ekufld

o`fŸk] udkjkRed n`f’Vdks.k ,oa ruko ls ikj u ikus dh {kerk gS D;ksafd O;fDr dh ldkjkRed o`fŸk gh mls ruko dks >syus dh ,oa ikj

ikus dh “kfDr nsrs jgs gSaA ;ksxlw= esa egf’kZ ikratfy us lkQ rkSj ij dgk gS fd O;fDr viuh o`fŸk @ n`f’Vdks.k dh rjg cu tkrk gS

vr% /;ku ds }kjk O;fDr dks viuh o`fŸk dks fu;af=r djuk pkfg,A blh dks vk/kkj eku dj 20 LoLFk O;fDr;ksa ij 21 fnu rd ,d

vuqla/kkukRed v/;;u fd;k x;k tgk¡ vkKkpØ ij /;ku ds ek/;e ls mudh o`fŸk;ksa esa ldkjkRed cnyko dks ekik x;kA o`fŸk ijh{k.k

gsrq Likert scale vkSj /;ku ijh{k.k gsrq lkr fcanqvksa dk ekud cuk;k x;kA bl ijh{k.k ds i”pkr O;fDr;ksa dh ldkjkRed o`fŸk esa o`f)

ns[kh xbZ tks fd brus de le; esa fuf”pr gh mRlkgo/kZd gS vkSj ekufld LokLF; ,oa thou dh xq.kork cuk, j[kus esa ,d ehy dk

iRFkj lkfcr gks ldrk gSA ;g fo/kk nok jfgr gS ftls vizf”kf{kr O;fDr Hkh lkekU; vH;kl ls fl) dj ldrk gSA

References

1. Attitude (in psychology) available at https://en.m.wikipedia.org>wiki.attitude.

2. Omanand Teerath, Patanjala Yoga pradeep,Samvat2059 21stedition, Gorakhpur, Geeta Press, Samvat 2059, Page No.154,291

3. Sudhanshu ji Maharaj, Shreemad Bhagvad Geeta,1st edition-January 1999,Delhi,Vishwa Jagriti Prakashan,1999,Page No113

4. B.K.S. Iyenger, The Illustrated Light on Yoga, 22nd Impressions 2016, United Kingdom,Harper Collins Publishers Limited, 2016,Page No.178,179

5. I.K.Taimini,The Science of Yoga,13th reprint 2015,Chennai,The

Theosophical Publishing House,2015,Page No.278,279

6. Likert scale available at https://www.surveymonkey.com>Likert

7. Likert scale available at https://en.m.wikipedia.org>wiki.likert

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ORIGINAL REASEARCH ARTICLE - PHARMACEUTICAL STUDY

Pharmaceutical and Analytical Exploration Of Sanjivani Vati -An Ayurvedic Formulation

*Dr. Vimal Tewari, **Dr. Deepika Tewari, ***Dr. Amit Kumar Dixit

*R.O.(Ayu.), **R.O.(Ayu.), RARIID, Patna, CCRAS, Ministry of AYUSH, Government of India, Patna,***R.O.(Ayu.), RARIMD, CCRAS, Ministry of AYUSH, Government of India, Bengaluru.

ABSTRACT

Sanjivani vati is a common Ayurvedic polyherbal formulation described in Ayurvedic formulary of India and widely used for various communicable diseases and other ailments i.e. fever especially infectious (Visham jwara), cold, cough, urinary tract infections, indigestion (Ajirna), and helps to strengthen the immune system and hence re-juvenate the body. Sanjivani vati comprise equal parts of Vidanga, Sunthi, Pippali, Haritaki, Amalaki, Vibhitaki, Vaca, Guduchi, Bhallataka and Vatsanabha. Gomutra (Cow urine) a very essential component is used to levigate the ingredients which helps to bind the pills. It has tremendous effects on fever, indigestion (Ajirna) and upper respiratory tract infection. Vatsnabha and Bhallataka are the two poisonous drugs among the components that increase its quality tremendously. In the present study, an attempt has been made to congregate the various reference of Sanjivani vati to show diversity in formulary and therapeutic indications. Sanjivani vati has been prepared in the pharmacy by follow-ing the standard operative procedures and Qualitative and Quantitative characterization of the drug was evaluated by using standard guidelines. The data generated in the present study may serve as a beneficial tool to maintain the quality aspects of Sanjivani vati.

Keywords : Sanjivani vati; Physicochemical; Polyherbal; Gomutra; Ayurveda

Address of Correspondence: Dr. Vimal TewariR.O. (Ayu.),CCRAS, Ministry of AYUSH, GoI, Patna

Email ID : [email protected]

Contact No : 8840816388

Introduction:

Ayurvedic system of medicine is one of the most ancient sciences that have holistic approach towards patients. It is full of fundamental principles for better health and longevity of life. Its empirical guidelines help in maintaining a balance in the body, mind and consciousness through disciplined lifestyle and in

How to Site the Article : Tewari V, Tewari D, Dixit AM, Pharmaceutical and Analytical Exploration Of Sanjivani Vati - An Ayurvedic Formulation, JOA XIII-3, 2019; 95 - 101

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treating ailments as well. Ayurvedic medicines help the body by its two principle i.e. enhancing body’s inbuilt ability of fighting and treat the illness itself. Sanjivani vati have unique combination of various herbal drugs and Cow urine helps to rejuvenate and strengthen the body so increases immune power to counteract the adverse conditions and treat the ailment also. Since many decades Sanjivani vati have been recommended in the treatment of diseases of diverse origin as it has very balanced and appropriate combination of those herbal drugs that affect almost all body tissues and make them strong to endure adverse condition.

First time Saragdhar wrote this formulation in his book under vati kalpana. In this formulation, the powder of Vidang (Embelia ribes), Nagara (Zingiber officinale), Pippali (Piper longum), Haritaki (Terminalia chebula.), Amalaki (Phyllanthus emblica), Vibhitaka (Terminalia bellirica), Vaca (Acorus calamus), Gudduci (Tinospora cordifolia), Bhallataka (Semecarpus anacardium), and Vatsanabha (Aconitum ferox) in equal amount have been taken & levigate them with Cow urine (Gomutra). After levigation pills of the weight of ‘Gunja’ is made. It has been indicated in Ajirna, Gulma, Visuchika, Sarpadansta and Sannipata. Sarangdhar mentioned ‘Adraka swarasa’ as anupana in all aforesaid disorders[1].

In routine practice it is used in high grade fever like typhoid, malaria and other of unknown origin. It is helpful in allergic rhinitis and arrests loose motions in intestinal infections & worm infestation. In general way it is always used to alleviate the symptoms found in gastro intestinal disturbances. It corrects the Vata, Kapha and Vata-Kapha dominant conditions. It is stated that the recommendation of Sanjivani vati in Pitta predominant

Prakruti and Pitta predominant diseases should be in strict surveillance. The reference of Sarandhar samhita has been quoted by Ayurvedic formulary of India (AFI) also and is supposed to be used by either manufacturer[2].Proper validation and standardization of herbal preparations is utmost important in developing era. This is an important step for the establishment of a consistent biological activity, a consistent chemical profile, or a quality assurance for production and manufacturing of drugs. Therefore, the present was undertaken to set some important parameters for the standardization of widely used Ayurvedic herbal formulation Sanjivani vati.

Material & Methods

Literature review

A comprehensive review has been made to compile the various reference of Sanjivani vati to show diversity in formulary and therapeutic indications. The data available is presented in a systematic manner with reference to their ingredients, therapeutic uses, dose, dosage form and anupana.

Procurement of ingredients

For a standard finished product, the raw materials of acceptable variety & standards have been obtained from N.I.A. Pharmacy where certification of identity & purity is done by well-established standardization shell. Fresh cow urine was collected from nearby cowshed. Among the ingredients Bhallataka and Vatsanabha are two poisonous herbal drugs used, so purification of its part is necessary before using in preparation of Sanjivani vati. The table 1 exhibits the desirable part of the plant and its weight that have been used in the preparation of Sanjivani vati.

Table I. Contents, part used and their quantity used in the preparation of Sanjivani vati.

S. No. Name of Drug Part used Form of

Part usedWeight

(Powder)Vidanga Fruit Powder 15gmSunthi Rhizome Powder 15gmPippali Fruit Powder 15gm

Haritaki Fruit rind Powder 15gm

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Amalaki Fruit rind Powder 15gmVibhitaki Fruit rind Powder 15gm

Vaca Root Powder 15gmGuduchi Stem Powder 15gm

Bhallataka Fruit Powder 15gmVatsanabha Root Powder 15gmCow urine Urine Urine Quantity sufficient

Purification of Bhallataka

The fruit of Bhallataka has Tary oil in his pericarp that contains Anacardic acid which causes blisters when it comes in contact to the skin so it is utmost necessary to purify before use. Conventionally brick powder (Istika churna) is used to adsorb the oil from exposed fruit[3].

A big bag containing brick powder (Istika churna) was made for the procedure. After removal of thalamus, the black and slightly hard top part of the fruits, the fruits were kept in deep of brick powder. Safety measures were followed to avoid any skin interaction. The whole arrangement was leaved for seven days. At the end of seventh day all fruits were rubbed rigorously in brick powder very safely. There after fruits were recollected and washed in water to remove adhered brick powder and dried in shade. The whole process has taken eight days to complete.

Purification of Vatsanabha

The process that is used for purification of Vatsanabha is called Swedana (Fomentation in sun). Vatsanabha is also a poisonous herbal drug. It is stated in the classic that it can be used orally after proper purification. Cow urine is stated for its purification[4].

Fresh and dried roots of Vatsanabha were cut in small pieces and bundled in thin cloth. Knot was made very loose. Each bundle was kept in utensil full of cow urine. This whole arrangement was kept in sharp sun rays for three days and each day, cow urine was replaced totally. At the end of third day every bundle was taken out and all pieces of Vatsanabha were collected. There after roots were washed with fresh water. Further the whole pieces were kept in shade to dry completely. The whole process

was taken four days to complete.

Preparation of Sanjivani vati

Sanjivani vati was prepared by following standard guidelines mentioned by Ayurvedic Formulary of India. (AFI-1, Section 12/35, P.No.154 (Sha. S. M. K. 7th Ch.18-21). Fresh and dried part of every plant were powdered and sieved through 100 mesh sieve separately. Fine powder of all plants part of exact quantity 15 gm, were taken in a big steel utensil and mixed together properly. There after the whole mixture was kept in mortar. Fresh and measured quantity (500 ml) of cow urine, Bhavana Dravya, was taken and poured in mortar very gently. Sufficient quantity of cow urine is necessary whereby lump could not form during levigation. To blend the mixers uniformly and make homogenous, powders were levigated continuous. When mass was become dry, whole arrangement was kept in shade for next day activity. Next day cow urine was admixed again and the whole process was repeated. At the end of process (3rd day), when mass was become slightly thick, pills of appropriate shape and measurement was made and kept in shade for one or two days to dry. Here gummy contents of Bhallataka and cow urine played a role of pill binder. Dried pills was collected and stored in a suitable container.

Oraganoleptic and physicochemical study

The finished product is evaluated for organoleptic and various physicochemical characters. Organoleptic characters such as color, odor, taste, and texture were analyzed and recorded. Physicochemical characteristics were analyzed by quantitative analysis of total ash, water soluble ash, acid-insoluble ash, water soluble extractive, alcohol-soluble extractive, and pH as per the standard

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techniques.

Results & Discussion

Review on Sanjivani vati

The various authors of different time quoted the Sanjivani vati in his texts also. By literary exploration of various classical books, some differences have been scrutinized that are summarized in selected points in Table No. II given below.

As shown in table Basavarajiyam and some other authors have been used Chitraka in place of Amalaki in their formulation. Authors of Siddha yoga sangraha and Rasatantra sara have mentioned some more indications other than described in Sarangdhara such as Jwara, Krimi, Udar shoola and Kasa. Warm water and honey may be options as Anupana apart from Ardraka swarasa. Gunja could be assumed its measurement which is equivalent to 125 mg and it has been accepted by Ayurvedic formulary of India.

Table II. Characteristic of Sanjivani vati in different texts

S. No.

Name of Text Ingredient Therapeutic

Use Doses Pills Size & Shape Anupana Remarks

1 Sh.S.

Vidanga, Nagara, Pippali, Haritaki,

Amalaki, VibhitakiVaca, Guduchi,

BhallatakaVatsanabha, Gomutra

Ajeerna Gulma Visuchii

SarpadanstaSannipata

1-tab.

2-tab3-tab4-tab

Gunja AdrakaSwarasa

The authors of V.R.[5],

Y.C.[6], Y.R. [7], N.R.[8], S.Y.S [9],

A.S.S.[10],R.T.S.[11]

quoted this reference in their

books

2 Bs. [12]

Used Chitraka in place of Amalaki.

rest contents areSimilar as in

Sharangdhar Samhita

- Do - - Do - - Do - - Do -

The authors of V.C.[13], V.Y.T.

[14], Y.T. [15], V.N.R. [16], have written similar composition in

their books.

3 AFI As Sharangadhara - Do - 125mg

Regular size of 125mg

Adraka Swarasa,

Warm Water

Sh.S. Sharangdhar Samhita;V.Y.T.- Vrihat Yoga Tarangini; N.R.-Nighantu Ratanakar, V.C.- Vaidya Chintamani; Y.C.- Yoga Chintamani; Y.R.- Yoga Ratanakar; V.R.- Vaidya Rahasya; Bs.- Basavragiyam;V.N.R- Vrihat Nighantu Ratanakar, A.F.I.- Ayurvedic Formulary of India; P.S.A.F- Pharmacoepial Standard of Ayurvedic Formulation; S.Y.S.- Sidha Yoga Sangraha; A.S.S.- Ayurveda sara Sangraha; R.T.S.-Rasa tantra Sara

In general during determination of drug dose, a common guideline is followed. Desha, Dushya, Bala, Kala, Anala, Prakriti, Vaya, Satva, Satmya, and Ahara of an individual are assessed before drug administration[17]. Sharangadhara has recommended drug dose according to diseases along with general guidelines as one pill for Ajirna, Gulma, two pills for Visuchi, three in Sarpadansta & four in Sannipata condition with the Anupana of Ardraka swarasa. Pandit Shri Harishastri dadhichi, wrote in his book Sanjeevani Samragiyam that dose of Sanjivani vati should be as per age i.e. between 0-2 year-

1 pill, 3-10 year- 2 pills, 11-32 years- 3 pills and >32 years- 4 pills. Sanjivani vati is a drug that can be used in almost every disease if a specific Anupana is taken during drug administration[18].

Bhallataka shodhana

It is observed that, purified Bhallataka fruits were become comparatively light in weight. Table 3 shows the measurements of Bhallataka fruit during and after the completion of Shodhana process.

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Table III. Measurements during purification of Bhallataka

Table IV. Measurements during purification of Vatsanabha.

Table V. Measurements during preparation of Sanjivani vati

S.No. Detail Measurement Remark

1 Weight of Bhallataka fruit (before process) 50gm

Process & handlingloss is also included

2 Weight of Bhallataka fruit (after process) 46 gm.

S.No. Detail Measurement Remark

1 Weight of Vatsanabha (before process) 25 gm

Process & handlingloss is also included

2 Weight of Vatsanabha (after process) 19 gm.

Vatsanabha shodhana

It is observed that, purified Vatsanabha were very soft. After drying, shodhita Vatsanabha was having intense smell of cow urine (Gomutra). Table IV shows the measurements of Vatsanabha during and after the completion of Shodhana process.

Preparation of Sanjivani vati

The colour of mixers was brownish black and there was an intense smell of cow urine during the preparation of Sanjivini vati. Table V shows the measurements during the preparation of sanjivini vati.

S. No. Detail Measurement Remark

1 Total weight of herbal drug (before preparation)

150 gm

Process & handlingloss is also included 2 Cow urine used

(for levigation)1000ml

(total in two days)

3 Total weight of powder (after preparation) 167 gm

Analytical, organoleptic and physiochemical characterization

Some preliminary and basic quality controlling parameters are important to assess the quality & genuineness of the formulation. General organoleptic character and other physicochemical parameters such as, loss on drying, total ash, acid insoluble ash, pH, of Sanjivini vati have been assessed. The finished product was brownish black in colour, smell of cow urine with bitter taste and soft texture.

Physicochemical parameters such as moisture

content, ash value, acid insoluble ash, water soluble ash, pH of the drug and alcohol soluble extract of Sanjivani vati (quantitative analysis) has been find out through validated methods (Table VI).

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Table VI. Organoleptic and Physicochemical properties of prepared Sanjivani Vati

S. No. Character Finding

1 Colour Brownish black

2 Odour Urine Smell3 Taste Bitter4 Texture Soft5 Moisture Content 5.79% w/w6 Ash 6.55% w/w7 Acid Insoluble Ash 0.424% w/w8 Water Soluble Ash 5.11% w/w9 PH Of 5.0% W/V Slurry 4.27

10 Alcohol Soluble Extract 11.27 w/w

Conclusion

Sanjivani vati may be used in most of the diseases if one would use a particular anupana during drug administration. During preparation of Sanjivani vati a homogenous mixture with intense urine smell has been attained and sticky substance of Bhallataka and cow urine both helped in tablet formation. The tablet was regular, black in color and devoid of any cracks. All ingredients make this formulation very efficient and notable. Purified Bhallataka, Vatsanabha and cow urine enhances its effect manifold. Qualitative and Quantitative characterization of the drug has been evaluated by using standard guidelines. In conclusion the present study may serve as a beneficial tool to maintain the quality aspects of Sanjivini vati.

Conflict of Interest

The authors declare no conflict of interest.

Acknowledgements

We are grateful to Prof. Laxmikant Dwivedi, Ex. HOD, Rasashatra and Bhaishajya Kalpana deptt. , National Institute of Ayurveda, Jaipur for their support and suggestion to make this work.

References

1. Sharngadhar. Sharngadhar Samhita with Jiwanprada Hindi commentary by Dr. Smt. Shailaja Srivastava. Chaukhambha Orientalia Varanasi. 2nd Edition 1998. Madhyam Khanda, Ch .7, Sl .18-21.

2. The Ayurvedic Formulary of India. Published by the Controller Of Publications Delhi. First English Edition 2000.Vol. -2, Section 12 Vati Prakarana, pp.154.

3. Prof. P.V.Sharma. Dravyaguna Vijnana. Published by Chaukhambha Bharti Academy Varanasi. Edition 1995. 4th Khand, 4th Ch., pp.-344

4. Basavaraju Nilakantha Kotturu. Basavarajiyam with English translation by Dr. A. Narayana. Published by NIIMH Hyderabad. First edition 2013. Ch. 25, pp. 888.

5. Vidyapati. Vaidya Rahasya edited with Hindi commentary by Dattaram Chaturvedi. Published by Khemraj Shrikrishan Das Mumbai. Edition 1934. Ch. Agnimandha Chi., Sl. 15-17.

6. Harsh Kirti .Yoga Cintamani with Ayurveda Dipika Hindi commentary by Chaturveda Narayan Datt Pathole. Published by Bombay Bhushan Press.Ch.3, Sl.1-4.

7. Mayurapada Bhiksu. Yogratnakara with Vidyotini Hindi commentary by Vaidya Laksmipati Sastri edited by Bhisagratna Brahmasankar Sastri. Published by Chaukhamba Sanskrit Sansthan Varanasi. 7th Edition 1999. Ch. Ajirna Chi., Sl.1-3.

8. Vishnu Vasudev Godbole. Nighantu Ratnaker with Marathi commentary by Ganesh Ramchandra Shastri Dattar, Bhasker Anant Shastri Thomnekar, Krishna Shastri Mahabal and Vishwanath Vinayak Patil. Published by Mumbai Orientalia. Edition 1847. Part 3, Ch. Ajirna, pp. 406.

9. Vaidya Yadavji Trikamji Acharya. Sidha Yoga Sanghra. Shree

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Baidyanath Ayurveda Bhawan Limited, Patna. 10th Edition (2000). Ch .1/pp. 5

10. Ayurveda Sara Sangraha. Shri Vaidyanatha Ayurveda Bhawana Limited Calcutta. Ninth Edition 1999. Gutika-Vati Prakarana/pp. 469.

11. Rasa Tantra Sara. Krishna Gopal Ayurveda Bhawan Kaleida Ajmer. 13th Edition 1999. Part 1, Gutika Prakarana, pp. 613.

12. Basavaraju Nilakantha Kotturu. Basavarajiyam with English translation by Dr. A. Narayana. Published by NIIMH Hyderabad. First edition 2013. Ch. 12, pp. 433.

13. Vallabhacharya .Vaidya Cintamani edited by Dr. Ramnivas Sharma. Dakshin Publishers Hyderabad. 1st Edition 1994. Ch .14, pp. 406.

14. Trimall Bhatta. Vrihat Yoga Targini edited by Hanumant Padheya Shastri. Published by Aanand Aashram, Pune. Part 1, Ch.71, Sl.42-44.

15. Trimall Bhatta .Yoga Tarngini with Hindi commentary by Sri. Dattaram Mathur. Published by Laxmi Vanketeshwar Press Kalyan Mumbai. Edition 1923. Ch. 24, Sl.10-11.

16. Vishnu Vasudev Godbole. Vrihat Nighantu Ratnakar edited with Hindi commentary. Published by Khemraj Shrikrishan Das Publishers. Edition 1891. Part 5, Ch. 1, pp. 23.

17. Vagbhata. Astanga Hradayam with the commentaries Sarvangasundra of Arundutta & Ayurved Rasayana of Hemadri edited by Pt. Bhisagacharya Harishastri Paradkar Vaidya. Krishnadas Academy Varanasi. Reprint 2000. Ch.12, Sl. No.67-68.

18. Pt. Shri Harishastri Dadhichi. Sanjeevani Samrajiyama with Hindi Commentary by Vaidya Madana Gopal Sharma translated by Vaidya Vachaspati Sharma. Published by Shri Ashwani Ayurveda Bhawan Jaipur (Raj.). First Edition. Ch.2, pp. 41-42.

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ORIGINAL REASEARCH ARTICLE - ANALYTICAL STUDY

Suvarna Prashana Prepared With Suvarna Patra (Spp) – A Safety Profile

*Vd. Sagar Bhinde, **Vd. Abhishek Patalia, *** Vd. Sonam Bhinde, **** Vd. Malhari Sirdeshpande

*Assistant Prof, Department of Kaumarbhritya, IPGT&RA, GAU, Jamnagar, **Medical officer - Ayurveda (Class 2), Govt Ayurveda dispensary, Ahima, Anand., *** Assistant Professor, Dept. of Rasa Shastra, Bhargava Ayurveda College and Hospital, Dahemi, Anand.,

**** The Principal, Professor and Head, Department of Dravyaguna, GJPIASR, Anand.

ABSTRACT

Suvarna Prashana (SP) is mentioned in Kashyapa Samhita, Sutra Sthana, Lehadhyaya only. But use of Suvarna (Gold) is unanimously mentioned by every Acharya during neonatal age. Samhita have not mentioned identical preparation method, time, ingredient and dose. Hence currently there are many Suvarna Prashana available in market with different name, different ingredients and with different method of preparation. However, at present the use of metallic preparations has raised concerns in scientific community. These reports raised safety concerns on Ayurvedic medicines, particularly those of metallic /mineral / herbo-mineral in origin for containing considerable levels of heavy metals like lead, mercury and / or arsenic etc. If the drug is for pediatric use, then safety concern increases by many folds.This paper will deal with the Standard operating procedure (SOP) of Suvarna Prashana prepared with Suvarna Patra (Gold leaf) (SPP) along with efficacy and safety of the same with literary elaboration and survey study. Analysis of gold foil and prepared SPP with sophisticated instruments were also carried out to substantiate the safety of SPP. Hence this article is aimed to develop SOP of the Suvarna Prashana for cost effective large scale use with safety and efficacy.

Keywords : Suvarna Prashana, Suvarna Patra, Gold leaf, Heavy metal analysis, Survey Study

Address of Correspondence: Vd. Sagar BhindeMedical officer - Ayurveda (Class 2),Tapibai Govt Ayurveda Hospital, Bhavnagar.

Email ID : [email protected]

Contact No : 9662512158

How to Site the Article : Bhinde S, Patalia A, Bhinde S, Sirdeshpande M, Suvarna Prashana Prepared With Suvarna Patra (Spp) – A Safety Profile, JOA XIII-3, 2019; 102 - 110

Introduction :

Word ‘Suvarna Prashana’ (SP) is mentioned in Kashyapa Samhita, Sutra Sthana, Lehadhyaya only. But use of Suvarna (Gold) is unanimously mentioned by every Acharya during early neonatal age. Samhita did not mention the identical time, ingredient, dose and method of preparation. Hence currently there are many

JOAjournalofayurveda.in ISSN No:2321-0435

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SP available in market with different name, different ingredients and with different method of preparation.

The therapeutic indication of gold are common feature of approximately all Ayurveda classics i.e. Charak Samhita (1500BC), Sushruta Samhita (1000BC), Ashtanga Hridaya (400AD) in general. But Suvarna has been addressed with detailed therapeutics and pharmaceutics after development of Rasa Shastra, around 4th century and onwards. The gold is most costly and precious metal and is placed under Shuddha Lauha (pure metals[1] while classifying the Lauha. Medicinal use of gold is mentioned in the form of Suvarna Bhasma, Suvarna Parpati, Suvarna Patra or as red colloidal solution.[2] Gold has been used in various ailments like tuberculosis, anemia, cough, debility, sterility, muscular dystrophy.[3] It is considered as best rejuvenator promotes longevity and prevents ageing.[4]

However, at present the use of metallic preparations has raised concerns in scientific community.[5][6][7] These reports raised safety concerns on Ayurvedic medicines, particularly those of metallic /mineral / herbo-mineral in origin for containing considerable levels of heavy metals like lead, mercury and / or arsenic etc. Safety concern increases by many folds if such drug is for pediatric use.

This paper has elaborated the Standard operating procedure (SOP) of Suvarna Prashana prepared with Suvarna Patra (Gold leaf) (SPP) along with efficacy and safety of the same with literary review and a systemic survey study with detailed survey proforma. Heavy metal

analysis of gold foil and prepared SPP with sophisticated instruments were also carried out which also suggest the safety of SPP.

Aim and Objectives:

1. To establish the safety of Suvarna Prashana prepared with Suvarna Patra (SPP) through survey study and Analytical Study.

2. To develop the SOP of cost effective SPP for large scale camp purpose.

Material and Method:

Preparation of SPP:Preparation starts 2 days prior to Pushya Nakshatra (constellation). Firstly Kapada Chana Churna of each Kashthaushadhi (Brahmi, Shankhapushpi, Vacha) should be made. Smaller the particle size, better the absorption. This procedure takes 2 hours approximately. Than this powder should be mixed In Khalva Yantra with gold foil (100 g Churna : 1 gold foil) and start Mardana for at least 6-8 hours to mix herbo-mineral compound with each other completely. On the day of Pushya Constellation, final product should be prepared freshly. Honey should be taken first (100 g Churna: 2 kg honey) in an adequate size of vessel, then powder mixture should be added and stir it till it become homogenous. Then ghee (100g Churna: 200g ghee) should be added to it and once again stir till it become homogenous. Mixing of ghee into honey mixture, takes some more time as hydrophilic honey doesn’t mix with hydrophobic ghee easily. Now this SPP is ready to use.

Table I - Formula preparation of SPP for approximately 1500 children

Ingredient Botanical Name Amount Proportion

Honey Honey 2000 g 200

Herbalpowder

Brahmi Bacopa moonnieri (L.) 40 g

100 g 10Shankhapushpi Convolvulus pluricaulis Choisy 40 g

Vacha Acorus calamus (Linn.) 20 g

Suvarna Patra Gold leaf 0.110 g*2 = 220 mg 0.022

Cow Ghee Ghee 200 g 20

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Fig 1 – EDAX appearance of Suvarna Patra (Gold leaf)

Drug Collection: Brahmi, Shankhapushpi and Vacha were collected from pharmacy, G J P I A S R, New Vidyanagar. Ghee (Amul cow ghee) and honey (Uttarakhand honey) were procured from local vendor. Gold leafs were procured from Ahmedabad.

Posology of SPP:

Dose was determined by using classical reference of Sharngadhara Samhita. [8] 1 Masha=1 g [9] Adult Dose of Swarna Bhasma [10] [11] = 1/8 to ¼ Ratti (15 – 30 mg)

Table II – Posology of SPP

Age in Year Masha g Age in

Year Masha g

0 - 1 1 1 5 - 6 6 61 - 2 2 2 6 - 7 7 72 - 3 3 3 7 - 8 8 83 - 4 4 4 8 - 9 9 94 - 5 5 5 9 - 10 10 10

Anupana: NothingDuration: One dose on every Pushya constellation

Analytical Study:

Gold leaf alone and final product (SPP) were tested by ICP OES (Inductive Coupled Plasma – Optical Emission Spectrometer) at SICART institute, Vallabh Vidyanagar, Gujarat.

Survey Study:

SPP is administered in children aged 0-10 years of both

gender once in 28 days (on every Pushya constellation). Preformed detailed survey proforma were given to the parents who are coming regularly at least for 6 doses.

Result:

Analytical study of Suvarna Patra (Gold leaf):

To authenticate the safety of gold leaf as gold supplement

and to know the % of gold in that, EDAX (Energy

dispersive X-ray spectroscopy) test was carried out.

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Fig 1 shows that, gold leaf has fine fibers of metal. Many metallic structures are visible in the area of 50um.

Fig 2 shows that, gold leaf has 71.87% of gold, 21.55% of Oxygen, 5.13 % silver and 1.44% Copper.

As per API, acceptable permissible limit of heavy metals in herbo-mineral drug is as below.

*Inductive coupled plasma – optical emission spectrometer #Model: optima 3300 RL

Fig 2 – EDAX weight % of metals in Suvarna Patra (Gold leaf)

Table III – Heavy metal analysis of Suvarna Patra (Gold Leaf)

Table IV – Permissible limit of heavy metals in herbo-mineral drug[12]

Sample ID Test Parameter Testing method / Procedure

Name of Instrument Results (ppm)

Gold Leaf

Arsenic In house ICP – OES * Not detected

Cadmium In house ICP – OES * 1.3195

Mercury In house ICP – OES * Not detected

Lead In house ICP – OES * 1.4825

Metal Permissible limit (ppm)

Arsenic 3

Cadmium 0.3

Mercury 1

Lead 10

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* #Model: optima 3300 RL

As per table VII, out of 41 subjects, Infants were 5, toddlers were 16, preschool children were 16 and School age chil-dren were 4.

Fig 3 indicates that out of 41 survey subjects, 21 parents are doing job, 7 are labor worker, 8 are farmer, 1 is doctor and 4 are teacher. This indicates that almost all strata of people believe in SPP and satisfied with its effect without any side effect.

Table V – Heavy metal analysis of SPP (Test drug)

Table VII - Age wise classification of 41 SUBJECTSSurvey Study:

Table VI –Inductive coupled plasma optical emission spectrometer’s metal detection limit

Sample ID Test Parameter Testing method / Procedure

Name of Instrument Results (ppm)

SPP

Arsenic In house ICP – OES * Not detected

Cadmium In house ICP – OES * Not detected

Mercury In house ICP – OES * Not detected

Lead In house ICP – OES * Not detected

Test Parameter Instrument detection limit (ppm)Arsenic 0.0530

Cadmium 0.0027Mercury 0.0610

Lead 0.0420

Age (yr) No. of Subject %0 – 1 5 12.191 – 3 16 39.033 – 6 16 39.036 - 10 4 9.75Total 41 100

Fig 3 - Parents occupation wise distribution

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Table VIII – ADR Wise Distribution

Table IX – References of Pushya Constellation in Ayurveda Samhitas

Fig 4 - Duration of SPP

ADR of SPP Short term (Immediate) Long TermYes 0 0No 41 41

Total 41

Table VIII shows, 41 (100%) patients noticed that, this SPP did not produce any adverse effects. This data proves that parents are satisfied with SPP without any side effect. Even infants are taking this SPP without any clinical manifesta-tion of side effect.

This fig 4 shows that 10 children are taking this SPP since less than 1 year and 31 children are taking this SPP since more than 1 year.

As per Table IX, it could be infer that drug collection, preparation or use on Pushya Nakshatra always increases the potency of respective drugs.

Discussion:

Why on Pushya Nakshatra?

Pushya constellation is said to have Pushti (Strengthening) and Poshana (Nourishing) qualities. Hence this constellation is chosen to administer this Suvarna Prashana. In Samhita many drugs are called to be collected or prepared on Pushya Nakshatra.

Drugs Collection / Preparation / Use Indication References

Dhatura root if embedded with waist during intercourse Collection Prevents conception --

Nagabala Collection Rasayana A.H.U.39/54Shunah Pitta Collection Apasmaraghna Ch.Chi.10/50Anjanvarti Preparation Kukkunaka Ka.Khi.13/31

Phalaghrita Use Helps in conception Sha.Ma.9/83

Reference of SPP formulation:

During Navajata Shishu Paricharya, Prashana prepared from Endri, Brahmi, Vacha and Shankhapushpi are told to be given to newborn with ghee and honey.[13] Out of these four, Endri is controversial and not easily available at local

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periphery; hence it is not included in SPP. In addition to above remaining Kashthoushadhi, Suvarna Patra is added. As use of gold in children is told to have nootropic, immunomodulatory effect, so gold is intended to add in this mixture.

Hence gold along with Shastrokta Medhyaprashana was combined to prepare test drug.

In Samhita period, basically in Charaka Samhita[14] the properties of gold and its compound formulations such as Lauha Rasayana are mentioned. Sushruta Samhita[15] has included Suvarna under Parthiva Dravya and has mentioned the properties of Suvarna as Tridoshahara, Vishapaham, Brumhaniya, Chakshushya, Rasayana, Hrudya, Madhura Rasa and Sheeta Veerya. In Ashtangahridaya, Suvarna is included under Madhuragana.[16]

Analytical study of Suvarna Patra (Gold leaf):

Use of Suvarna Patra is mentioned in many Samgraha Kalina Grantha of Ayurveda. Though to establish the safety of that we had under gone for heavy metal analysis. The relation between Hiranya (gold) and Surya (sun) is available in Rig-Veda where it is mentioned that Wheel of Chariot of Sun[17] is made by gold. As per Ayurveda basics Yatpinde Tatha Brahmande, Sun represents Agni of our body. Sadhaka Pitta is mainly related with brain function. Immunity (Bala) depends upon the normalcy of Agni (Pitta).

EDAX is a popular technique used nowadays for the estimation of macro-elements in a herbo-mineral formulation. In the present work, this sophisticated instrumentation technique was effectively applied for estimation of gross elements.

As per fig 1 and 2, it is confirmed that gold leaf contains 71.87% gold and 21.55% oxygen. Oxygen being natural gas, it could be said that gold leaf have 93.42% of gold in it. Rest of 6.58% is making up by silver and copper, 5.13% and 1.44% respectively.

It is also studied that Suvarna Bhasma prepared with media of mercury was shown to contain 92% gold by

atomic absorption spectroscopy. However mercury was not detected in sample.[18]

By this it could be inferred that Suvarna Patra could be used in place of Suvarna Bhasma as far as purity concern.

Heavy Metal Analysis of Gold leaf and SPP:

As per table III and IV, gold leaf have cadmium content more than permissible limit. And hence if it is used alone as medicine, then could cause heavy metal toxicity. So to check the safety of test drug we once gain gone through the same test. (Table V)

Table V shows that final prepared SPP does not contain any heavy metal in detectable limit. Minimum limit of detection of Inductive coupled plasma – optical emission spectrometer are shown in table VI.

Survey Study:

As per Table - VII, out of 41 subjects Infant were 5, toddlers were 16, preschool children were 16 and school age children were 4. Majority of children benefited in the age, in which there is higher chance of infections. Statistical data shows that 6.9 million child deaths occur during first 5 years of life. According to UNICEF, most child deaths (and 70% in developing countries) result from one of the following five causes or a combination i.e. acute Respiratory infection, Diarrhea, Measles, Malaria, and Malnutrition.[19]

According to a “Save the Children” paper, children from the poorest households in India are three times more likely to die before their fifth birthday than those from the richest households.[20] In this survey we found that, majority of below 5 yr children were benefited with this Suvarna Prashana, which is a good indicator for the purpose of preventive medication.

This fig 4 shows that 10 children are taking this SPP since less than 1 year and 31 children are taking this SPP since more than 1 year. Parents are bringing their children for longer period is also a marker of efficacy and safety of test drug.

It was observed in this survey that 22 parents have come

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to know about this SPP camp through their relatives, friends or neighbor. This indicates that mouth to mouth publicity is the major part of awareness which is only possible if the treatment is effective and without any side effect.

In this survey it was also observed that benefits of SPP are vast and it varies from child to child. Never hospitalization, improvement in weight and height, improved IQ, improved immunity, increase in memory, reduction in anger, improvement in speech etc. are the answers of parents for the questions of benefit of SPP.

Conclusion:

It is now believed that different essential trace elements serve many critical roles in living body at a molecular level. They participate as catalysts or cofactors in a wide range of enzymatic processes, with roles ranging from relatively weak, non specific ion effects (metal-ion activated enzymes) to highly specific associations (metalloenzymes) in which the metals are potentially bound to protein (apoenzyme) in a certain stoichiometryIt could be concluded that importance of Pushya constellation for SP might be come in to existence in common practice due to its good effect on immunomodulator, Medhya drugs.

With the help of many researches and references on gold, role of gold in developmental age is very clear. It helps to enhance immunity and brain function as a whole.

As per the results of EDAX and ICP-OES, it is clear that test drug (SPP) is safe to use in pediatric patients. Survey study also helps use to confirm the clinical efficacy and safety of SPP.

Bhinde S, Patalia A, Bhinde S, Sirdeshpande M, Suvarna Prashana Prepared With Suvarna Patra (Spp) – A Safety ProfileJOA XIII-3, 2019; 102 - 110

References

1. Acharya Yashodhara, Rasaprakashasudhakara, Siddhiprada Hindi Commentory by Dr. Siddhinandan Mishra,Reprint edition 2009, Chaukhambha Orientalia,Varanasi,Adhyaya -4/2-6,66.

2. Singh Neetu, Chaudhri Anand, Swarna Bhashma and Gold compounds: an innovation of pharmaceuticals for illumination of therapeutics, IJRAP, 3 (1), Jan Feb 2012.

3. Vagbhatacharya, Rasa Ratna Samucchaya, edited by Indradeva Tripathi, Second Edition-2007, Chaukhambha Publications, Varansi, Adhyaya, Chapter 5/139, 5/1, 5/10-21

4. Acharya Sadanada Sharma, Rasa Tarangini, Translated by Shri Kashinatha Shastri, 11th Edition, Reprint 2009, Motilala Banarsidas, New Delhi, Chapter 15/70, 15/11-116

5. Robert B. Saper, Stefanos N. Kales, Janet Paquin, Michael J. Burns, David M. Eisenberg, Roger B. avis,Russell S. Phillips, Heavy Metal Content of Ayurvedic Herbal Medicine Products, JAMA 2004;292:2868-73

6. Robert B. Saper, Russell S. Phillips, Anusha Sehgal, Nadia Khouri, Roger B. Davis, Janet Paquin, Venkatesh Thuppil, Stefanos N. Kales, Lead, Mercury, and Arsenic in US and Indian Manufactured Ayurvedic Medicines Sold via the Internet, JAMA 2008;300:915-23

7. Paromita Hore, Munerah Ahmed, Jacqueline Ehrlich, Lourdes Steffen, Slavenka Sedlar et al, Lead Poisoning in Pregnant Women Who Used Ayurvedic Medications from India - New York City, 2011–2012, Centre for Disease Control and Prevention (Morbidity and Mortality Weekly Report), 61 (33) August 24, 2012

8. Acharya Sharangadhara, Sharngadhara Samhita, Commented by Adhamalla and Kashiram, 6th Edition, Chaukhambha Orientalia, Varanasi, 2005, Purva Khanda 6/14-17

9. Anonymous, The Ayurvedic Pharmacopoeia of India, e-book, appendix 8: weight and measures. page no 7

10. Acharya Sadananda Sharma, Rasa Tarangini, Translated by Shri Kashinatha Shastri, 11th Edition, Reprint 2004, Motilala Banarsidas, New Delhi, 14th Taranga-15/18-19,

11. Acharya Sadananda Sharma, Rasa Tarangini, Translated by Shri Kashinatha Shastri, 11th Edition, Reprint 2004, Motilala Banarsidas, New Delhi, 14th Taranga -15/81,pg-

12. Anonymous, The Ayurvedic Pharmacopoeia of India, e-book, Appendix 2.3

13. Vagbhatta, Ashtanga Hridaya, 3rd Edition, Chaukhambha

Orientalia, Varanasi, 2007, Vol III, Uttarasthana, chapter 1

14. Agniveshacharya, Charaka Samhita, Elaborated by Charaka and Drudhabala with Ayurveda Dipika Commentary by Chakrapanidatta, Edited by Yadavaji Trikamaji Acharya, Reprint Edition-2008, Chaukhamba Surbharti Prakashana, Varanasi, Chikitsa Sthāna-1/3/15-23,pg-384.

15. Sushrutacharya, Sushruta Samhita with Nibandhasangraga of Gayadasacharya, Sutra Sthana- 46/328

16. Vagbhatacharya, Ashtanga Hridayam, with Sarvangasundara Sanskrit Commentary by Arunadatta and Ayurvedarasayana by Acharya Hemadri, Annotated by Dr. Anna Moreshwar Kunte and Krishna Ramachandra Shastri Navre,Edited by Hari Sadashiva

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Shastri Paradakara,Reprint Edition 2007,Chaukhambha Surabharati Prakashan,Varanasi, Sutrasthana 10/22-24,pg-177.

17. Biswajoti Patgiri et al, A pharmaceutical and toxicity study of Makaradhwaja prepared by Ashtasamskarita Parada, Discussion, PhD thesis, Dept. of RS and BK, IPGT & RA, Jamnagar,2005,pg-25,-Rig-Veda M.-1.S. 35-8.

18. Singh Neetu, Chaudhri Anand, Swarna Bhashma and Gold compounds: an innovation of pharmaceuticals for illumination of therapeutics, IJRAP, 3 (1), Jan Feb 2012.

Bhinde S, Patalia A, Bhinde S, Sirdeshpande M, Suvarna Prashana Prepared With Suvarna Patra (Spp) – A Safety ProfileJOA XIII-3, 2019; 102 - 110

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19. Vagbhatacharya, Rasa Ratna Samucchaya, edited by Indradeva Tripathi, Second Edition-2007, Chaukhambha Publications, Varansi, Adhyaya, Chapter 5/139, 5/1, 5/10-21

20. Acharya Sadanada Sharma, Rasa Tarangini, Translated by Shri Kashinatha Shastri, 11th Edition, Reprint 2009, Motilala Banarsidas, New Delhi, Chapter 15/70, 15/11-116

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ORIGINAL REASEARCH ARTICLE - LITERARY REVIEWS

Recent Efforts In Popularizing Manuscriptology*Dr. Rashmi J. Ulli, **Vaidya Shrinath M.

* Assistant Prof., Shri Vijaya Mahantesh Ayurveda Medical College, ilkal, Karnataka, **Professor & HOD, Dept. of Ayurveda Samhita and Siddhanta, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka.

ABSTRACT

Manuscripts are the basic historical evidence and have great research value. Collection, conservation, digitization & critical editions are the steps in the study of Manuscripts. The science of studying manuscripts is known as manuscriptology. Manuscripts are the hand written or manually written original documents which are 65 years old or even more. Study of manuscripts helps in attaining the hidden knowledge through various steps told above. The different steps in manuscriptology e.g. collection, conservation, cataloguing, digitization, critical edition and publication of manuscripts will help in popularizing manuscriptology.

These includeeven seminars, workshops, courses related to manuscriptology. As these are historical evidence and also hidden form of ancient medical knowledge,several treatment methods and medical formulations are yet to be discovered from the manuscripts. So manuscriptology helps in attaining the important aspects of research in Ayurveda. A large number of manuscripts are scattered all over India and these are available in personal collections and are unaware of their value & knowledge. So, it is our duty to preserve the knowledge and make it available to the future generation.

Keywords : Manuscriptology, critical-edition, manuscripts, conservation, digitization, popularize etc.

Address of Correspondence: Dr. Rashmi J UlliAssistant Prof., Shri Vijaya Mahantesh Ayurveda Medical College, ilkal, Karnataka, 587-125

Email ID : [email protected]

Contact No : 8050781073

How to Site the Article : Ulli RJ, Shrinath M., Recent Efforts In Popularizing Manuscriptology, JOA XIII-3, 2019; 111 - 116

Introduction :

JOAjournalofayurveda.in ISSN No:2321-0435

The transmission of knowledge from the Sanskrit scholars descended through media of Guru shishya parampara, in that guru teaches and shishya listens. This tradition came from ancient time- As the days progressed the knowledge transmitted started storing in the written form. They wrote on palm leaves, on stone, on metals etc. The matter which are written by hand and

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having thought in them, with more than 65 years are called as manuscript. Material preserved in manuscript form is the primary source databank of written material from the ancient days. Manuscripts provide not only the most authentic witnesses to life, but also a record of what aspects of life were led by ancestors in rational manner/unique manner. In an era of only partial literacy, when the transmission of written knowledge was laborious, the value of that knowledge to society can be evaluated by the care and elegance of its recording or even by the fact that it was recorded at all.

Research defines as systematic investigation into and study of materials and source in order to establish facts and reach new conclusions.[1] In the same way manuscriptology is being one among the research which can be studied based on the systematic investigation of the manuscripts and their sources with conclusion as in the publishable form which can reach to society and the knowledge hidden in the manuscripts can spread everywhere.

Manuscriptology means the science that deals with the study of manuscript. It also specializes in procurement, preservation and documentation of various kinds of manuscripts.[2] The word manuscript derived from Latin word 'manuscriptus', manu means 'hand' and scriptus means 'written'. This Latin word has been used for 'A document written with a person's own hand'[3] Manuscripts are considered as one of the knowledge and cultural resource of humankind. Various efforts are carried out to represent the research in the area of manuscriptlogy which can reflect all over the world in present scenario.

The knowledge of ancient tradition is hidden in the form of manuscripts which is practiced by many seers since long time which has led down by our ancestors. Manuscripts are available throughout the world and those are in many languages and scripts which cover religious, philosophical, historical, literary and scientific subjects. India possesses a rich cultural heritage of manuscripts since ancient period and these manuscripts scattered at various places of India, many of

them are misplaced, lost or not recognized or ignored by unknown peoples and improper preservation techniques etc. These all are must needed at present day to search through conducting survey and unlock their inherited knowledge to every human kind and keep the knowledge alive by conserving and preserving them properly.

Efforts of survey, is to creating awareness about manuscripts and to collect the manuscripts which are stored by various academicians, research institutes, libraries, temples, maths and personal collections. After collection, preserving them with at most care and protection is must. Conservative techniques are needed and to be incorporated to repair the damaged manuscripts to protect the ancient knowledge. After preservation and conservation of manuscripts another effort is the process of digitization, it helps us to reach original knowledge of a manuscript through digitized copy and it minimizes the mishandling/handling of manuscripts. Next part is critical edition of manuscript and it plays an important role in popularization of manuscriptology as science or knowledge which is hidden in the text being edited. The text can be uncovered by this process and publication of such critically edited manuscripts are going to give great contribution to the world which can reveal various form of science that has come through the seers. It is the duty of each scholar and student to take care of manuscripts asthey are a source of knowledge. Constitution of India states, under Fundamental Duties in Article 51 A suggests that, "It shall be the duty of every citizenof India to value and preserve the rich heritage of our composite culture"[4]

One of the efforts done as 'The introduction to the critical edition of the Mahabharata' by V. S.Suktankar published by Bhandarkar oriental research institute, Poona was a pioneer work in this direction. The editors of Vedic and Sanskrit texts of the first generation worked hard for establishing the manuscriptology as an important subject of indology.[5] The various efforts are done for the popularizing manuscriptology through seminars, workshops, courses related manuscriptology, critical edition of manuscripts and publishing them for the benefit of mankind. These efforts are needed to protect and spread the precious knowledge which is

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contributed by the ancient people. So this effort is being made to highlight the various efforts that can be done in popularizing the manuscriptology in recent scenario.

Aims & Objectives:

1. To list out the efforts that helps in popularize the manuscriptology

2. To understand the efforts with their stages

Materials & Methods:

Manuscripts are available throughout the world among them India has rich number of manuscripts available in different languages and scripts, there are about 50 lakh manuscripts scattered over the country, in them 67% are Sanskrit manuscripts, 25% manuscripts are of other languages such as Kannada, Telugu, Hindi, Oriya, etc. Various organizations like National mission for manuscripts (NMM), New Delhi has did huge survey studies for availability of manuscripts all over India (categories language wise and script wise).[6]

Various efforts that are contributes in popularizing manuscriptology are

1. Collection of the manuscripts

2. Preservation of manuscripts

3. Conservation of manuscripts

4. Digitization of manuscripts

5. Cataloguing of manuscripts

6. Critical edition of manuscripts

7. Publication of critically edited manuscripts

8. Workshops, seminars, short and long time courses related to manuscript studies can help in serving the fulfillment of popularizing the manuscripts.[7]

Results & Discussion:

1. Collection of manuscripts: Manuscripts are as hand written, are in several languages, scattered and lost with time. 1/10 of available manuscripts are being collected and stored by various old libraries, colleges, museums, palace, temples and personal collection from generation to generation. Collection

of manuscripts and taking their care is not a simple job; it needs trained people as well as trained hands. Collection can be of several ways as

a. Sacred collection- religious institutes, monasteries, homes of people considered as sacred.[8]

b. Academic collection- research institutes, libraries, archives, museums.[9] So creating awareness about the manuscripts and their importance by various methods such as workshops, seminars, related surveys are needed. This can help in extracting the scattered science at one place and will help in reaching to the society by applying further efforts.

Collection of the manuscripts needs certain steps such as

- Primarily finding of places where the manuscripts are available

- Their status. After searching the availability of manuscripts, approaching those places and collection is done under rules and regulations. In this area, Government of India has established a mission called as national mission for manuscripts in 2003, [10] having the primary objective as collection of scattered manuscripts all over India by survey method. Collection of manuscripts is not a process of one day and one hand; it needs many hands and lots of time in joining and discovering the lost knowledge.

1. Preservation of manuscripts: preservation means not only storing the manuscripts, it indicates taking care and protecting them at most by various distracting agents such as external as well as internal factors & environment where they are being stored. Manuscripts are channel of knowledge which carry thoughts and ideas of our ancestors and their precious discoveries. They should be protected at most care after collecting them because ancient scholar's contribution should not go in vain.

Some of the factors which can cause destruction of manuscripts and preservation

Techniques are explained as follows-

y According to passage of time changes are inevitable

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in the manuscripts materials such as paper or palm leaf or any other, they will lose their potency to with stand against environment factors such as humidity, water, fire, air etc and other external causes as dust, pollution. So there is need to take care of this by arranging the artificial suitable environment to store and protect them.

y As the materials which is used to write manuscripts are very much distracted by insects, worms and pests etc, so care need to be taken by various methods such as use of chemicals, insect repellants, fumigation etc to avoid destruction.

y As the manuscripts are handled carefully because mishandling of these may lead to missing of certain part of mss that leads to loss of manuscript, so every movement and placing mss need to be taken care.

2. Conservation of manuscripts: After collection and preservation, the stage comes where conservation need to take up. Conservation has two steps preventive conservation and curative conservation (repair of manuscripts etc).

• Preventive conservation

� Periodic dusting,

� fumigation and

� inking etc care preventive conservation, which has to be done at regular interval

• Curative conservation

When the manuscripts are in critical condition such as the written matterhasbecome illegible, torn manuscripts etc need to be taken care and are to be repair accordingly using various methods.

- Palm leaves became breakable after some time; they need to repair by using glue to join together with tissue papers (Japanese tissue paper, banana fiber tissue).

- Lamination of the manuscripts comes under preventive conservation; this has been done by various organizations and seems old at present scenario.

- Mechanical reproduction of the manuscripts is the

method where the manuscripts are reproduced by microfilming, photocopying and digitized method.[11]

4. Digitization of manuscripts: It is also one of the preservation methods. Digitization as it leads to easy accessibility of content of manuscripts without touching the original manuscripts and will avoid destruction of manuscripts by repeated handling. This includes scanning of manuscripts with more than 600 dpi scanner and restoring them in CD/ DVD-ROM and accession will be in easy mode.

A digitized image is an electronic photograph of the original manuscript document,[12] which can be changeable to various forms and size as pdf or document etc so the documents can be carried to anywhere and stored in very less data store.

This digitization includes various steps and needs various tools as computers, scanners, digital cameras with required resolution, software, advanced scanners etc.

5. Cataloguing of manuscripts: After collecting the manuscripts from various places, they need to arrange according to the languages, scripts, subjects and various sciences. So cataloguing is being done to fulfill these all aspects. Cataloguing means process of classifying and arranging objects in particular order[13] This method help in easy accession of manuscripts in short time.

y Types of catalogue are as simple catalogue and descriptive catalogue, card catalogue, book catalogue, sheaf catalogue.

y This preparation of catalogues needs certain requirements, such as the catalogues are prepared under the heading and subheading of particular manuscripts such author, date, title etc.

y Manuscripts have to be classified in shelves according to the available manuscripts materials such as paper manuscripts in separate shelves and palm manuscripts in other shelves according to their size and content.[14]

6. Critical edition of manuscripts: Critical edition is not a new word, it has been introduced long

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before by ancient Indian scholars through thorough classification of various vedas, upanishads etc. As once collection of particular manuscripts, examination of the content and source is done then next step is its analysis and after analyzing them, critical edition has to be carried out.

This can be adopted in two methods,

y Lower criticism: Presenting the text as close as possible to original work on the basis of available material.

y Higher criticism: Editing the text taking in to consideration of question about authorship, date of the author, influence of the works in the field that could influenced the other author in the field etc.[15]

Critical edition should contain following steps as

● Collection of the all extant of copies of text in original or mechanized form

● Decide the mutual relationship and trustworthy copies of manuscripts by drawing their genealogy and secondary evidences of the particular manuscripts.

● Collation of decided copies

● Constitute the critical recension: Critical recension means editorial revision of as literary work based on critical examination of the text and source used.

● Accept the one, out of the decided copies as original

● Present to the world critical recension, description of contents and criticism.[16]

7. Publication of the critically edited manuscripts: Once the manuscript edited critically has to be publish because knowledge which is hidden in the manuscript should reach the society and become useful.

Publication is a process of publishing the transliteration of the critically edited text which will help in attaining the new knowledge which adds up to the existed science. This may help in taking new researches in the particular science.

Conclusion: The efforts are done to achieve target,

in the same manner to popularize the manuscriptology needs certain efforts. These efforts will make spread the importance of manuscriptology all over the globe. As popularizing of manuscriptology includes few steps right from collection to the publication of manuscripts.

Each and every step having their own importance in giving their part to spread the manuscript's knowledge everywhere. As these steps are not one day process, they need several days, months, years and dedication of research scholars who decide to work for it. The Government of India taken initiation by establishing a mission called National mission for manuscripts. It is also contributing their part in popularizing the field or area of manuscriptology.

Ulli RJ, Shrinath M., Recent Efforts In Popularizing Manuscriptology, JOA XIII-3, 2019; 111- 116

References

1. Definition of research in English by oxford dictionaries. Available from URL- http://en.oxforddictionaries.com/definition/research.

2. S Suresh Babu. Comprehensive research methodology for Ayurvedic scholars. Varanasi: Chaukambha Orientalia; 2013. p.57.

3. Nandi S, Palit P. Manuscripts and Manuscriptology of India. New Delhi: Kaveri books; 2010. p.183

4. Basic minimum standards for conservation of manuscripts. National Mission of Manuscripts. p. 9.

5. Chubey B.B. Lectures on Manuscriptology. Hoshiarpur: Katyayanasahitya prakashana; july 4 2004. p.30.

6. Nandi S, Palit P. Manuscripts and Manuscriptology of India, New delhi. Kaveri books: 2010; p.273.

7. Chubey B.B. Lectures on Manuscriptology. Hoshiarpur: Katyayanasahitya prakashana; july 4 2004. p.30.

8. Basic minimum standards for conservation of manuscripts. National Mission of Manuscripts. p.6.

9. Ibid. p.7.

10. National mission of manuscripts. Available from - URL-http://www.nmm.org.

11. Vaidya Shrinath M. Basics of Manuscriptology and An entrance to medical manuscripts, Varanasi: Chaukhambha orientalia; 2018. p.111.

12. Handbook of Medical Manuscriptology, Bangalore. Institute of Ayurveda and integrative medicine (IAIM) and Foundation for revitalization of local health traditions (FRLHT); 2010. p. 103.

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13. Handbook of Medical Manuscriptology, Bangalore. Institute of Ayurveda and integrative medicine (IAIM) and Foundation for revitalization of local health traditions (FRLHT); 2010. p.107.

14. Ibid. p.110.

15. Vaidya Shrinath M. Basics of Manuscriptology and An entrance to medical manuscripts, Varanasi: Chaukhambha orientalia; 2018. p.133.

16. Handbook of Medical Manuscriptology, Bangalore. Institute of Ayurveda and integrative medicine (IAIM) and Foundation for revitalization of local health traditions (FRLHT); 2010. p.137.

Ulli RJ, Shrinath M., Recent Efforts In Popularizing Manuscriptology, JOA XIII-3, 2019; 111- 116

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la'k¨/ku es fofo/k vuqØe mYys[k fd;s x;s gS tSls - laxzg.k] laj{k.k] uke lwfpi=] x.kdhdj.k] leky¨pu leh{kkRed v/;;u vkSj

laiknu] ;s lc gLrÁfr la'k¨/ku d¨ Áfl) djus es lgk;rk djrs gSA rFkk t¨ gLrÁfr la'k¨/ku lEcaf/k ifjlaokn] dk;Z'kkyk] ikBÓØe

Òh bles lgk;rk djrs gSA tSls ;s gLrfyf[kr Áfr ,frgkfld lk{; gS vkSj Ákphu oS| 'kkL= dk fuxw< :i Òh gSA gLrkf[kr Áfr ls

t¨ vÒh rd ugh fd;k x;k] vusd fpfdRlk fo/kku vkSj fpfdRlk ;¨x¨a dk vkfo"dkj djus dk volj ÁkIr dj ldrs gSA bl Ádkj

vk;qosZn es vuqla/kku dk lEcf/kr eºRoiw.kZ fo"k;¨a ds tkuus ds fy, gLrÁfr la'k¨/ku lgk;rk djrk gSA lEiw.kZ Òkjr ns'k] lÒh rjQ ls

vf/kd la[;k dk gLrfyf[kr Áfr;¨a ls Òjk gqvk vUke¨y [ktkuk gSA ;s lc O;fäxr laxzg.k es fey tkrs gS tgk buds Kku vkSj ewY; dk

irk ugh jgrk gSA blls gLrfyf[kr Áfr dks Kku dk laj{k.k djuk vkSj Òkoh ih<h ds fy, bls miyC/k djkuk gekjk drZO; curk gSA

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ORIGINAL REASEARCH ARTICLE - LITERARY REVIEWS

New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer:

A review*Dr. Manoj Kumar Dash, ** Dr. Namrata Joshi, ***Dr. D. N. S Gautam

*Lecturer, Dept. of Rasashastra & Bhaishajya Kalpana, Govt. Ayurveda College Raipur, Chhattisgarh, **Associate Professor, ***Associate Professor, Dept. Of Rasashastra, Faculty of Ayurveda, IMS, BHU, Varanasi,

ABSTRACTIntroduction: Pushpadhanwa rasa is a formulation described under Aphrodisiac, has been used for centuries.

It has been shown that minerals & herbal ingredients present in Pushpadhanwa rasa have been reported for their significant effects on different cell lines like HT-29, MMP-9, HeLa, HepG2, 5-FU, MCF-7, UWOV2, HCT-116 cells, relating to female reproductive organs. Aim of the study: In this study an attempt has been made to critical review the ovarian Cancer regression property of Herbo mineral preparation, Pushpadhanwa rasa (PDR) Materials & methods: Thirty one ingredients of herb-mineral-animal origin were searched from various authoritative texts and worldwide accepted scientific databases with regard to their use in female reproductive organs for cancer claims including the ovarian cause. Result: A total of 31 ingredients were evaluated for their anti-tumour activities in eight human cancer cell lines. Of these G. glabra, P.betel, C. sativa exhibited promising apoptosis activity, G. glabra exhibited anti proliferative & anti angiogenic, G. glabra, P. betel, T.Myrobalan, P. betel, exhibited anti oxidant, P. betel, Z.officinale exhibited anti metastatic, P.betel, Honey shows cytotoxic , C. sativa cell cycle arrest activity in many cancer cells. Bhasmas present in Pushpadhanwa rasa like Rasasindoora, Lauha bhasma, Abhraka Bhasma, Naga Bhasma, Manahshila are considered as biologically produced nano drugs. Conclusion: Above data shows that the formulation Pushpadhanwa Rasa possess strong potential in treatment of ovarian cancer. as biologically produced nano drugs. Conclusion: Above data shows

Keywords : Pushpadhanwa Rasa; Anti- cancer ; Apoptosis; Cytotoxic; Nano particle; Antioxidant.

Address of Correspondence: Dr. Manoj Kumar DashLecturer, Dept. of RS & BKGovt. Ayurveda College Raipur, Chhattisgarh.

Email ID : [email protected]

Contact No : 8817708049

How to Site the Article : Dash MK, Joshi N, Gautam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review JOA XIII-3, 2019; 117 - 131

JOAjournalofayurveda.in ISSN No:2321-0435

that the formulation Pushpadhanwa Rasa possess strong potential in treatment of ovarian cancer. Randomized controlled trials of high quality with larger sample size and longer follow-up are needed to have significant evidence on the clinical use of Pushpadhanwa rasa on ovarian cancer.

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Dash MK, Joshi N, Gautam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review JOA XIII-3, 2019; 117 - 131

Introduction :Ovarian Cancer is the most lethal among all other gynecological Cancer amongst the women. Globally, nearly 2, 50,000 patients diagnosed with ovarian Cancer each year with more than 1, 40,000 Cancer specific death[1]. Only 20% of the ovarian cancer is diagnosed at first stage when the disease is limited to the ovary, 90% of the patient responds well with existing therapy. Stages divided in to 3 more categories, i.e., Stage 2 When the disease metastasized to both the ovaries and the pelvic region; stage 3, after the disease has metastasized to the intraperitoneal abdomen region or Stage 4 beyond the peritoneal cavity cure rate decrease substantially[2]. The century-old embryonal/gametogenesis theory of tumors proposed that tumors arise from germ cells and thus are in some way similar to the formation of gametes and fertilization[3][4]

Ovarian Cancer known to originates by imbalances in

hormone production and abnormal cell division in basic

epithelial cells, germ cells, mesenchymal tissue developing Cystic mass in ovary. Mutation and loss of TP 53 function is one of the most frequent genetic abnormalities in ovarian cancer and is observed in 60-80% of both sporadic and familial cases[5]. Ovarian Cancer patients present with dull abdominal pain, distention of abdomen from no apparent cause. In advanced stage patient developes ascites, palpable lower abdominal masses, gastro intenstinal symptoms and weight loss. Surgery is the primary treatment of choice, regardless of the histological type or stages of the Cancer. Total abdominal hysterectomy, with bilateral salpingo-oophorectomy and omentectomy, is the accepted standard treatment. Conservation of the uterus and contralateral ovary in young women desirous of bearing children may be considered only if the disease is limited to stage 1a ( Cancer limited to one ovary : ascites not present). In Stage 1 (when tumor confined to the ovary), Herbomineral formulations like Pushpadhanwa rasa may be helpful in improving the quality of life with existing anticancer drugs. In Ayurvedic concept,

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according to ‘Charaka’ and ‘Sushruta Samhitas’ cancer is described as inflammatory or non-inflammatory swelling and mentioned either as ‘Granthi’ (minor neoplasm) or ‘Arbuda‘ (major neoplasm)[6].

Shukra is the most excellent term to explain the thing that nourishes both the male and female reproductive tissues and its secretions. Its main function is Garbhotpadana – reproduction[7].

Gananatha sen has explained Physiology of Shukradhatu in female as Antah-Shukra and Bahi-Shukra[8]. Shukradhatu is formed Antah-Shukra and Bahi-Shukra. Antah-Shukra operate as in both sexes in Bala Varana Upachaya, growth of secondary sexual character, reproductive organ and individual sex spermatogenesis in male and growth of breast, oogenesis in woman. Bahi-Shukra acts as formation of sperm with spermatic fluid in male and secretions of bartholin, cervical glands during coitus in female. Artav or Raja is Updhatu of Rasadhatu.Vrishya are drugs that enhances “Shukra dhatu” in order to increase the reproductive capacity and health in both male and female[9]. Gynacecological problems like irregular menses, PCOD, unovulation, etc causes are due to improper functioning of of Shukra dhatu schematic detail about role of shukra dhatu in male & female reproductive organ is as below[10].

As oocytes contribute to reproduction[11] it will be of interest to assess the functional relevance of the acquisition of oocyte-like cells during tumor progression[12]. It has been reported that both parthenogenetic activation of oocyte in ovary[13] and preimplantation embryos have tumorigenicity potential[14] both cancer cells and oocytes display strong independence and survival ability.

Pushpadhanwa rasa, is a formulation described under Vrishya- Vajikaran (Aphrodisiac) Rogadhikar and has been used for centuries to treat various types of ovararian disorders[15]. It exhibits a number of health benefits in gynaecological disorders. It has also been clinically trialled and was found to be effective in the management of Polyctstic ovarian disorder (PCOD) - a clinical condition which may be included under Granthi[16].

In that study, it was found that the formulation is not only beffective in regression of the size of the cyst but also enhances the chances of conception in such patients[17]. Pushpadhnwa Rasa contains mainly five bhasmas viz. Rasa sindoor (Red sulphide of mercury); Abhraka bhasma (Incinerated mica); Lauha bhasma (Incinerated iron); Naga bhasma ( Incinertaed lead); Vanga bhasma (Incinerated tin) and five herbs namely Dhatura (Dhatura metal); Bhanga (Cannabis sativa); Madhuyashti (Glycyrrihiza glabra; Nagaavalli (Piper betel) and Shalamali (Salmalia malbarrica). Literally the word Aphrodisiac (Vrisya) denotes, the drugs, which potentiate sexual vigor or promote artava (ovarian parameters) or both. Aphrodisiac (Vrisya) drugs are those, which can enhance the oogenesis and sexual vitality in females. The Physiology of female sexual act and oogenesis are interpreted with aphrodisiac (Vrisya) Karma, in connection to this, their pathological aspects which is Vandhyatva (female infertility) are dealt in detail with their respective management. Loss of artava is the fore most characteristics of Vandhyatwa (infirtility), which is seen in Ovarian Cancer. As it includes multiple groups of symptoms, single drug formulations might cover only a fraction of the treatment, hence the search for a group of drugs, particularly, such a group of drugs which are having aphrodisiac (Vrishya) anti oxidant (Rasayana) and other multimodal pharmacological actions might be highly beneficial in changing the quality of life. Such formulations, being very beneficial in symptoms arising due to "Tridosha vitiation" (mainly vata) have been selected for the present study.

Materials & Methods:

In this review, Ayurvedic fundamentals and Modern counterpart that includes Vrishya (aphrodisiac) and Rasayana (anti oxident) effect; Rasapanchka (Rasa, Guna,Virya,Vipaka, Prabhav) of the formulation; Anti tumor mechanism like inducing apoptosis in tumor cells, anti-proliferation, arrest cell cycle, anti angiogenic, anti metastasis activity of herbal ingriedients and Nanodrug delivery system, in terms of Ayurvedic biological nano particals that may affect the progression of cancer, are

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critically analyzed. For this, Compilation and tabulation of properties of Pushpadhanwa rasa like aphrodisiac activity (Vrisya =which potentiate sexual vigor or promote artava or both), Garbhadosahara (regularizing the female hormones) activity, Rasayana (anti oxident) activity present in Jangama (animal), Audhbiha (Pertaining to plants), and Parthiva (Pertaining to Earth) dravyas in the pharmaceutical processing of Pushpadhanwa rasa has been complied from Charak samhita, Sushruta samhita and Rasashastriya litreture. Compilation & tabulation of Rasa Panchak (Pharmacodynamics) viz. Rasa (taste), Guna (quality), Virya (Bio potency) Vipaka (drug metabolism), action on doshas were also complied from relevant sources and tabulated. Referencs from various journals are collected for various mechanism involved for their anti tumor activity. The tabulated data is then analyzed critically.

Results:

Analysis of total 31 different ingredients of Jangama (animal), Audhbiha (Pertaining to plants), and Parthiva (Pertaining to Earth) origin present in the pharmaceutical processing of Pushpadhanwa rasa have been made with their role in accordance with Ayurvedic perspective and recent researches undergone.

Discussion:

Pushpadhanwa rasa can be an option as a palliative therapy for the patients suffering from Ovarian cancer. The formulation has been clinically tested for its role in regression of cyst size in patients of PCOD[17]. Not only this, it is also proved to be effective in psychological imbalances cognitive behavioural therapy suffering from PCOD[18]. Saddhatwamtaka Sharira needs a preparation for ovarian cancer which found to interfere with mitosis, DNA synthesis and the DNA repair system.

Formulations like Pushpadhanwa Rasa, which may involved mechanisms like apoptosis (form of programmed cell death), anti proliferative ( prevent or retard the spread of cells), cell cycle arrest (ensure proper division of the cell.), angiogenic inhibitor (substance that inhibits the growth of new blood vessels), anti metastasis

( substance that inhibits the spread from an initial or primary site to a different or secondary site within the host's body), anti oxidant (compounds that inhibit oxidation), cytotoxicity (quality of being toxic to cells), Cellular penetration , Catalytic (process of increasing the rate of a chemical reaction ), anti tumour , Inhibitors of Fatty acid synthesize activity, Inhibition of growth of tumour cell in ovarian and other reproductive carcinoma may be helpful in improving the quality of life in ovarian cancer patients as shown in table no 2.

Ingredients of Pushpadhanwa rasa may play their role by acting on following mechanism:

Apoptosis

Apoptotic potential effect of Glycyrrihiza glabra is by restricting enzymes connected to cancer progression and enhancing cancer suppressor enzymes or Caspase-independent pathways may be involved in the apoptotic mechanism in inhibition of Endometrial, Ovarian HT-29 cancer cells[19]. Glycyrrhizin also induced apoptosis in cervical cancer cells by exerting mitochondrial depolarization, glycyrrhizin induced cell cycle arrest in G0/G1 phase of cell cycle[20] .Piper betel apoptotic potential effect by transient increase of mitochondrial derived reactive oxygen species followed by persistent increase of nitric oxide[21]. Dhatura metel promotes apoptosis of cancerous cells by the phenolic agents or by Loss of mitochondrial membrane potential, DNA fragmentation and nuclear chromatin condensation, strongly support the ability to induce the cancer cell apoptosis though the mitochondrial pathway[22]. Cannabis sativa to persuade apoptosis by means of or devoid of cell cycle arrest via mitochondrial pathway. Cannabinidiol present in cannabis sativa reduces mitochondrial membrane potential, triggers the translocation of BID to the mitochondria, the release of cytochrome c to the cytosol, and, ultimately, the activation of the intrinsic apoptotic pathway in breast cancer cells[23]. Cannabinidiol in Cannabis sativa increased the generation of reactive oxygen species (ROS), and ROS inhibition blocked the induction of apoptosis[24].

Anti proliferation activity

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Anti proliferation activity of Glycyrrihiza glabra by activating JNK (c-Jun N-terminal kinase) signals in cancer cells. The (JNK) pathway is one of the major signaling cassettes of the mitogen-activated protein kinase (MAPK) signaling pathway functions in the control of a number of cellular processes, including proliferation, embryonic development and apoptosis[25]. Cell cycle study showed that glycyrrhizin induced cell cycle arrest in G0/G1 phase of cell cycle significantly reduced the cell viability of HeLa cells with a concomitant increase in nuclear condensation and DNA fragmentation[26]. Three myrobalan suppressed proliferation independent of p53 status in cancer cells HCT116 and in HCCSCs (Human colon cancer stem cells). Three myrobalan also induced p53-independent apoptosis in HCCSCs as indicated by elevated levels of cleaved PARP. Three myrobalan suppressed protein levels of c-Myc and cyclin D1, key proteins involved in proliferation, and induced apoptosis through elevation of Bax/Bcl-2 ratio. Furthermore, triphala inhibited HCCSCs colony formation[27]

Anti - angiogenesis

Angiogenesis study indicates that mast cell infiltration can enhance carcinogenesis and they have also long been known to drive angiogenesis and tumour growth[28] Glycyrrihza glabra has been studied for its Antiangiogenic potential[29]. Triphala exerts its biological effectiveness in human colon cancer cells while self-regulating their p53 status. p53 is considered the “the guardian of the genome” and it plays a critical role in tumor suppression by inducing growth arrest, apoptosis, and senescence, as well as by blocking angiogenesis[30]. Metastatic potential of Hydroxychavicol of Piper betel component effectively suppressed the adhesion of oral KB carcinoma cells to FN ( Fibro nectin) and collagen, suggesting that the anti-carcinogenic effects of piper betel may involve the differential stages of tumor invasion and metastasis[31] . Metastastic potential of zingiber officinalis showed that When ginger powder is dissolved in a solution containing ovarian cancer cultures, the mutant cells died[32].

Anti oxidant

Glycyrrihiza glabra exhibited maximum scavenging

activity against DPPH and nitric oxide free radicals, inhibited cancer cells HeLa and HepG2 considerably for its anti oxidant activity[33]. Maximum ferric dropping action and radical scavenging actions in opposition to DPPH, superoxide anion and nitric oxide radicals. Highest phenolic content implying the potential contribution of phenolics towards the antioxidant activities[34]. Immunostimulatory potential of bioactive fraction-10 from Dhatura stramonium that boosts the immune cells in breast cancer. Recent studies on three myrobalan showed significant decrease in MDA and increase in GSH & SOD in breast homogenate in breast cancer[35]. Piper betel Extracts exhibit cytotoxic effect on the breast cancer cell line MCF-7. The cytotoxic effect of piper betel extract was through the formation of electrophilic metabolites—quinone, quinone methide, and imine methide—via the oxidative metabolism of piper betel[36]

Cytotoxic activity

Cytotoxic activity of Three myrobalan (Triphala) effective in cell lines like human (MCF-7) and mouse (S115) breast cancer cell line, a human osteosarcoma cell line (HOS-1), a human prostate cancer cell line (PC-3) and a nontumorigenic, immortalized human prostate cell line (PNT1A) by inhibiting the rate of cell proliferation and inducing cell death in breast cancer[37]. Cell penetration effect of three myrobalan showed Nano size easily transported into cell nucleus and to specific target sites, Mild to moderated growth inhibitory activity on prostate cancer cell lines[38]. Salmalia Malbarica showed Inhibitors of Fatty acid synthesize activity preferentially repress cancer cell proliferation and induce cancer cell apoptosis without affecting nonmalignant fibroblasts[39]. The withonilides which are steroidal lactones present in the plant Dhatura metel have been reported to have a high anticancer activity against colorecto carcinoma (HCT-116) cell line[40]. Ginger extract considerably reduced the important expression of NF kappa B and TNF-alpha in rats. Ginger can act as an anti-cancer and anti-inflammatory agent through inactivating NFkappaB in the course of the suppression of the pro-inflammatory TNF-alpha[41]. Bee venom was correlated with an increase

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in the levels of various proliferative and antiapoptotic gene products, including Bcl-2, cIAP-2, XIAP, iNOS, COX-2, and cPLA2, which are regulated by NFκB. Their immune histochemical examination of the tumor part by H&E, and the increase antigens adjacent to PCNA along with Ki-67 discoloration information revealed to facilitate bee venom inhibited tumor cell enlargement in a dose-dependent approach in ovarian cancer.[42]

Biological Nano particles and Bhasma

Bhasma are claimed to be biologically produced nanoparticles, which are prescribed with several other medicines of Ayurveda[43]. Realger shows inhibition of growth and survival of tumour cell[44] preventing tumour growth by transdermal delivery along with suppression of B16 cell proliferation. Nano particles size (~20nm) of Rasa sindura, with material characterisation of Single phase α-Hgs with free of Hgo and organic molecules[45], Lauha bhasma of particle size Smaller than ~45 µm with sub seive size distribution range between 1.7 and 10.4 µm[46] , Vanga bhasma of particle size inbetween 12 to 53 nm showed higher levels of accumulation in tumours and high degree of penetration behaviour[47]. Naga bhasma a nano-crystalline (~60 nm) lead sulfide form (Pb2+) associated with the organic contents showed high degree of penetration behaviour[48]. Mercurial preparations aimed to restore the homeostasis thus reversing the proliferation of neoplastic cells in bone marrow[49]. Rasasindura increases the efficacy of the contents of the medicine pushpadhanwa rasa by its catalytic effect[50]. Abhrak Bhasma shows concentration dependent positive in vitro anticancer activity on prostate cancer cell lines. Anticancer activity of Abhrak Bhasma is in the order 100 Puti > 50 Puti > 20 Puti. Shataputi Abhrak Bhasma had maximum activity on prostate cancer cell lines almost equivalent to positive control drug adriamycin[51]. Nano technologies can increase the potency of traditional small molecules of drugs in addition to potentially providing a mechanism for treating previously incurable diseases like cancer[52].

Rasa panchaka and its role

Sweet taste (Madhura Rasa) is considered to be useful for the physiological tissue growth and regeneration of skeletal muscles (mamsa), adipose tissue (meda), and marrow and nervous tissue (majja). Bitter (Tikta rasa) phytonutrients (e.g., polyphenols, flavonoids, isoflavones, terpenes, and glucosinolates) appear to lower the risk of cancer by downregulation of glucose transporter 1 (GLUT1) and inhibition of glycolysis (via hexokinase 2, pyruvate kinase M2, and lactate dehydrogenase A), leading eventually to apoptosis. Several bitter compounds (chloroquine, quinidine, bitter melon extract, and cucurbitacins B and E) were described as inhibitors of tumour growth and proapoptotic agents in cancer cells[53]. Based on relevant references from classical tests and modern tests of dravyaguna, Sweet taste ( Madhura rasa) is seen in 15 dravyas, Astringent (Kashaya rasa) in 14 dravyas, Bitter taste ( Tikta ) in 12 dravyas, Katu ( Pungent) rasa in 9 dravyas, and Amla ( Sour) rasa in 5 dravyas as shown in table no 4. Among Guna (property), Rukshya (Dry) guna is found in 13 dravyas; Laghu (Light) in 10 dravyas; Guru (Heavy) in 8 dravyas; Snigdha (Unctous) in 7 dravyas; and Tikshna (Sharp) in 6 dravyas. Vipaka (transformation) has been found as Katu (Pungent) in 15 dravyas and Madhura (Sweet) in 14 dravyas. The Virya (Bio potency) of most of the dravyas is Ushna (Hot) that is 18 incomparison to 9 in Sheeta (Cold) Virya dravyas. Bitter taste (Tikta rasa), Katu ( Pungent) Vipaka, Ushna Virya and Laghu and Ruksha Gunas, so it acts as good Lekhana Dravya - a scraping agent on Apachit Meda. The drug Pushpadhawa rasa due to it Laghu guna, Katu ( Pungent) rasa and Ushna Virya acts as deepana and pachana and regulates the Agni. Katu, Tikta, Kasaya Rasa (bitter, pungent, and astringent taste), Ushna Virya (e.g., hot biopotency), and Katu Vipaka (catabolic active metabolites), and herbs with dry, coarse, light, and sharp biophysical properties have significantly greater possibilities of producing anticancer effects[54]. Vrisya activity is seen in 14 dravyas; Balya in 7 dravyas; Rasayana in 10 dravyas; Yoni Doshahara in 4 dravyas; and Putraprada in 2 dravyas as shown in table no 1 & 4. The formation of dhatu from rasa to sukra or artava is by the Sweet taste ( Madhura rasa)and vipaka,

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snigdha guna and sheeta Virya. These properties of the preparation of Pushpadhawa rasa act by Rasayana, Vrisya, Balya, Vayasthapaka, and Vata Samaka Karma. Various ingredients of Pushpadhanwa rasa are having Vata-Kapha Shamaka , Tridoshashamaka properties, which help to bring the affected Doshas in normal level. As a result, the symptoms like ovarian cancer may subside.

Estrogens (E2) are concerned in the etiology of ovarian cancer. Estrogens make production and anti-estrogens slow down ovarian cancer growth in vitro and in vivo. Estrogen deprivation and estrogen receptor (ER) blockade cause cell cycle arrest in susceptible ovarian cancers by increasing the cell cycle inhibitor, p27. A better understanding of Estrogen signaling in ovarian cancer will permit refinement of combinations of targeted therapy like Rasasindura, Abhraka Bhasma, lauha bhasma & Vanga bhasma with standard hormonal agents to improve treatment[55]. Abhraka Bhasma and Loha Bhasma improve the excellence of Rasa and Rakta Dhatu which in turn improve the rest of Dhatus and thus improve the general situation of the patient. The Bhasmas are biologically formed nanoparticles and are in use along with milk, butter, honey, or clarified butter thus; this makes these elements simply assimilable, eliminating their injurious effects and enhancing their biocompatibility. The size and shape of nano drugs is directly propoertional to the activity in desired disease.

The different nano size and thieir morphology as shown in table no III is direcly helped in increasing apoptosis[56].Evidences shows bhasmas present in Pushpadhanwa Rasa are nearer to nano crystalline materials can be effective in ovarian cancer as shown in table no III.

Treatment aspect of Ayurveda is divided into four categories as Prakritisthapani chikitsa (health maintenance), Rasayana chikitsa, (restoration of normal function), Roganashani chikitsa (disease cure) and Naishthiki chikitsa (spiritual approach)[57]. Pushpadhnwa Rasa may provide new avenues and paradigms for cancer by its biological active substances as well as targeting the involved mechanisms like apoptosis, anti proliferative, cell cycle arrest, angiogenic inhibitor, anti metastasis, anti oxidant, cytotoxicity, Cellular penetration , Catalytic, anti tumour , Inhibitors of Fatty acid synthesize activity, Inhibition of growth of tumour cell.

Conclusion

The therapeutic use of cancer chemotherapy in ovarian carcinoma has been restricted due to its non-specific or dose limiting cellular toxicity and development of multidrug resistance. In the direction of overcome this limitation various drug delivery system are being studied. Drugs mentioned in Pushpadhanwa rasa have multifarious pharmacological properties. From the above discusson it indicates that pushpadhanwa Ras may be used with a combination of anti cancerous drugs to enhance the quality of life in Ovarian Cancer.

Table no. I Rasapanchaka ( Pharmacodynamics) of Drugs used in the pharmaceutical processing of Puspadhanwa Rasa

S. No.

Ingredient Utility in preparing

Pushpadhanwa rasa

Pharmacodynamic / Pharmacological application

1 Madhu (Honey)

Anupana (vehicle) of pushpadhanwa

Ras

Madhura, Kasaya, Ruksha, Seeta , Madhura,Vata bardhak, Vrisya,

Virya bardhak, Antioxidan, Increase reproductive hormones, Fertility

enhancer

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2. Godugdha (Cow milk)

Samanya Shodhana

ofAbharaka,

Shodhana of Dhatur, Bhanga

Madhura, Guru, Snigdha, Abhisyandi, Madhura, Vata pitta nasak, Balya, Vrisya, Prajasthapana, Vandhya,

Rasayana, Vajikara, Rasabardhaka, Improving egg quality

3. Goghrita (Cow’s clarified butter)

Anupana ofPuspadhan

wa rasa,Amritikarana

of Lauha

Madhura, Visahara, Virya Bardhaka, Oja, Rasayana, Vrisya, General Debility

4. Gomutra (Cow urine)

Samanya Shodhana of Naga, Vanga and Louha

Katu ( Pungent),Tiksna,Usna, Katu ( Pungent),Pitta bardhak, Pacana,

Gulma, Sula, Vrishya, Rasayana, Utility in ovarian caner

5. Takra (Buttermilk)

Samanya Shodhana of

Naga,Vanga, and Louha, Abhraka

Madhura, Amla, Laghu, Usna, Kapha pitta nasak, Garbhavisa nasak, Vrisya,

Higher antioxidant and Radical Scavenging activity.

6. Til Sesamum indicum L. Taila

Samanya Shodhana of Naga,Vanga,

Louha, Abhraka

Madhura, Kasaya, Sukhma, Guru,Usna, Madhura vipaka , Pitta bardhaka,

Vrisya, Garbhasaya sodhaka, Bruhana, Yoni sula nasak, Balya, Anti oxidant

7. Kanji (Rice gruel)

Samanya Shodhana of Naga,Vanga,

Louha, Abhraka

Bhedi, Tiksna, Ushna, Pitta , bardhaka, Sula nasaka, Garbhasaya Sodhaka,

Vrisya, Enhancing LH secretion

8.Kulatha Kvatha Decoction of

Macrotyloma uniflorum (Lam.) Verdc.

Samanya Shodhana of

Naga, Vanga, Louha,Abhraka

Kasaya, Usna, Katu ( Pungent), Pitta vardhka, Sukrasmari nasak, Gulma

nasak, Vrisya, Anti oxidant effect

9.Haritaki

Terminalia chebula Retz.

Visesa shodhana of Louha, Trividha

paka of Louham

Pancharasa, Kasaya pradhana, Laghu Ruksha,Ushna, Vipaka Madhura,

Tridosa nasaka, Rasayana, Vrisya.

10

AmalakiPhyllanthus emblica L

Emblica officinalis Gaertn.

Visesa shodhana of Louha, Trvidha

louha paka, amruti karana of Louha.

Pancharasa, Guru, Ruksha, Sheeta, Madhura, Tridosa nasaka,Vrisya,Rasayana,

Garbhsayasotha26

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11

BibhitakiTerminalia bellirica (Gaertn.)

Roxb. Visesa shodhana of Louha, Abhraka

Kashaya, Ruksha, Laghu

12Nimbu

Citrus medica L.

Marana of vanga bhasma,Trividha

louha paka,Abhraka amruti karana

Ushna, Madhura, Kapha pitta nasaka, Balya, Amla, Laghu, Anusna, Madhura,Pitta bardhaka, Deepana,

Pachana, Pradara, Atyartava, Garbhasrava, Yoni vishodhana

13

Adraka

Zingiber officinale RoscoeShodhana of Manashila

Katu(Pungent),Tikshna,Rukshya,Guru, Ushna, Madhura, Kapha vata nasak,

Hridya,Vrisya, Increases the secretion of melatonin and serotonin phytochemicals

14

ArkaCalotropis procera (Aiton) Dryand.

Calotropis gigantea (L.) Dryand.Marana of

Abhraka bhasma

Katu (Pungent), tikta, Laghu, Ruksha, Tikshna, Sara, Ushna, Katu ( Pungent),

Vata bardhak, Balya, Rasayana, Increase the plasma secretion levels of

LH & FSH, Immuno modulator

15.Vata

Ficus indica Willd. Bhavana dravya of

Rasasindoora

Kasaya, Madhura, Rukshya, Seeta, Katu( Pungent), Kapha Pitta nasak,

Yonidoshanasaka,Vrisya Putradam, ,

Garbhakara, Vandhyanasaka , anti oxidant activity, Estrogenic activity

16. HaridraCurcuma longa L.

Visesa shodhan

Of Vanga

Katu ( Pungent),Tikta, Laghu, Rukshya, Ushna, Vipaka

Katu(Pungent),Kaphavatahara, Garbhastapaka, Garbhasaya raktata ,

Aphrodisiac, Menorrhagia

17.Chincha Tamarindus indica L.

Jarana dra-vya for Naga

& Vanga bhasma

Amla, Madhura, Laghu, Ruksha, Ushna, Katu( Pungent), Kaphavata nasak, Hridya, Swelling on the breast, Anti

oxidant

18. AswathaFicus religiosa L.

Jarana dravya for Naga & Vanga

bhasma

Kasya, Madhura, Ruksha, Guru, Seeta, Katu( Pungent), Kaphapittahara,Yoni

vishodhana, Rasayana, Vrishya, Balya.

19.Dhattura

Datura metel L.

Bhavana dravya of pushpadhan-

wa RasMadhura.kasaya, Tikta, Guru, Tikshna,

Balya, Rasayana

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20.Bhanga

Cannabis sativa L.

Bhavana dravya of pushpadhan-

wa Ras

Ruksha, Ushna, Katu ( Pungent), Kapha Vatahara. Garbhasaya sankocaka,

Vajikarana, Rasayana and Vajikrana, Garbhadhana , Vandhya

21.Yastimadhu

Glycyrrhiza glabra L.

Bhavana dravya of Pushpadhanwa

Ras

Madhura, Tikta, Guru, Snigdha, Seeta, Katu ( Pungent), Tridosa hara, Balya.

Rasayana

22.

SalmaliSalmalia malabarica (DC.) Schott

& Endl

Bhavana dravya of pushpadhanwa

Ras

Madhura, Kasaya, Pichilla, Guru, Seeta, Madhura, Pitta Vatahara, Brihana, Rasayana Balya, Rasayana, Vrisya,

Garbhasaya Chutihara.

23.Nagavalli Piper betle L.

Bhavana dravya of pushpadhanwa

Ras

Katu ( Pungent),Tikta, Kasaya, Laghu, Tikshna, Ushna, Katu ( Pungent), Vata hara, Srama nasaka, Vrisya,

Rasayana, Putraprad, Pragyabodhi, Dhatubardhaka

24. Rasa Sindoor (Red sulphide of Mercury)Preparation for Rasasindoora

Sadrasa, Snigdha, Guru, Ushna, Madhura,Tridosa nasaka,Vrisya, Balya,

Rasayana

25.Shuddha Gandhaka

(Purified/ processed Sulphur)Preparation for Rasasindoora

Madhura, Snigdha, Sara, Ushna, Katu ( Pungent), Tridosha Nasak, Rasayana,

Virya Vridhi.

26.Shuddha Manashila

(Purified/ processed Realgar)

Marana dravya of Naga bhasma

Tikta, Katu (Pungent), Ushna, Vatakapha nasak, Sarbasrestha

Rasayana.

27Shuddha Haritala (Purified/ processed

Orpiment)Marana dravya of

Vanga bhasma

Katu ( Pungent), Snigdha, Kasaya, Snigdha, Ushna, Katu ( Pungent), Kapha nasak, Virya Vridhikara

28. Naga bhasma(Calcined Lead)Preparation of

Puspadhanwa rasa

Tikta, Laghu, Sara, Rukshya, Ushna, Katu ( Pungent), Vata kapha nasak,Kamavala, Naga sata tulya

balam.

29.Vanga bhasma (Calcined Tin)

Prepa-ration of Pus-

padhanwa rasa

Tikshna, Ushna, Rukshya, Laghu, Sara, Ushna, Katu ( Pungent), Vata prakopa,

Balya, Vrisya, Prajakara.

30.Abhraka

Bhasma (Calcined Mica)

Prepa-ration of Push-

padhanwa rasa

Guru, Snigdha, Seeta, Madhura, Vata Kapha Nasak, Pragya bodhi, Khya nasak, Vrisya, Ayusya, Putraprada

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31. Louha bhasma (Calcined Iron)

Preparation of Puspadhanwa rasa

Guru, Rukshya, Seeta, Madhura Tridosa Nasak, Putraprada, Bala Kara, Vrisya,

Vayastambhna.

Dash MK, Joshi N, Gautam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review ,JOA XIII-3, 2019; 117 - 131

Table no. II List of drugs present in Pushpadhanwa rasa with their mechanism of action on cancer cells

Name of the drug

Class Mechanism of action Cell line studied

Glycyrrhiza glabra

ApoptosisCaspase-independent pathways

Endometrial Carcinoma, Ovar-ian Carcinoma.

Anti-proliferation Activating JNK signals

Colon cancer Cells

Antiangiogenic Regulates metastasis-relating protein MMP-9 Colon cancer

Anti oxidant Scavenging activity against DPPH and nitric oxide

Piper betel

Apoptosis Release of cytochrome C from mito-chondria Chronic Myeloid leukaemia

Anti metastasis Inhibiting the growth Colon cancer cells

Anti oxidant Ferric reducing activity and Radical scavenging activities Breast cancer

Cyto toxic activity Extracts exhibit cytotoxic effect Breast Cancer

Anti oxidant Immunostimulatory potential of bio-active fraction-10 Breast Cancer

ApoptosisLoss of mitochondrial membrane potential, DNA fragmentation and nuclear chromatin condensation

Breast cancer

Cannabis sativa

Cell cycle arrest Via Mitochondrial pathway.Cervical cancer cells

ApoptosisReduces Mitochondrial membrane

potential.Breast Cancer

Triphala

(Three Myrobal-an)

CytotoxicInhibiting the rate of cell

proliferation.Breast cancer

Anti oxidant Significant decrease in MDA and increase in GSH & SOD Breast cancer

Cellular penetrationEasily transported into cell nucleus

and to specific target sites Prostrate Cancer

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Adraka

Zingib-er offici-nale Ros-

coe

Anti cancer Inactivating NF kappa B Liver Cancer

Anti metastasis Inhibition of NF-kB Ovarian cancer

Rasa Sindoor (Red sulphide of

Mercury)Catalytic Increase the efficacy of the contents of

the medicine. Cancer

Manahshila ( Realger)

Inhibition of growth Suppression of B16 cell Skin cancerAnti tumour effect Inhibiting DNA synthesis. Ovarian carcinoma cells

Honey Cyto toxic effectIncrease in the levels of various

proliferative and antiapoptotic genesOvarian cancer

Dash MK, Joshi N, Gautam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review ,JOA XIII-3, 2019; 117 - 131

Table no. III List of Biological Nano Particle ~Bhasma present in Pushpadhanwa rasa

Table no. IV Rasa panchaka (Pharmacodynamics) of Pushpadhanwa Rasa

Name of the Nano bhasma Analysis reported Nano dimensional Partile sizeRasa Sindura

(Red sulphide of Mercury)Single phase α-Hgs , Free of Hgo and

organic moleculesNano particles size (~20nm)

Lauha Bhasma (Calcined Iron)Irregular shaped aggregates.

Nano dimensional particles (~28nm) Smaller than ~45 µm with sub seive size distribution range between 1.7

and 10.4 µmVanga Bhasma (Calcined Tin)

Agglomerised 12 to 53 nm

Naga Bhasma (Calcined Lead) Agglomerised ~60 nm

Rasa(Taste)

Number

Guna(Proper

ty)

Number

Vipaka(Final

transformation)

NumberVirya(Bio

potency)

Number

Dosaha prabhav

()Number

Madhura( Sweet )

15Rukshya

( Dry)13

Katu( Pungent)

15Ushna(Hot)

18Tridosha Shamak

6

Kasaya(Astringent)

14Laghu(Light)

10Madhura( Sweet )

14Sheeta(Cold) 9

Kapha Pitta

Shamak4

Tikta ( Bitter)

12Guru

(Heavy)8 - - - -

Kapha Vata

Shamak7

Katu ( Pungent)

9Snigdha(Unctuous )

7 - - - - -

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Dash MK, Joshi N, Gautam DNS, New insights of Ayurveda formulation Pushpadhanwa rasa as a palliative therapy to improve the quality of life in ovarian Cancer: A review, JOA XIII-3, 2019; 117 - 131

Amla(Sour)

5Tikshna(Sharp )

6 - - - - - -

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56. Ruhila. A., et al. 2018. Review of Anti-cancer Activity of Metals and Minerals. J Ayu Med Sci. 3(3):405-12. http://www.jayumedsci.com/article/2018/3/3/105530 jams 2018320.

57. Thatte. U., et al. 1991. Ayurveda, the natural alternative. Sci Today. 2001:12–8.

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ORIGINAL REASEARCH ARTICLE - LITERARY REVIEWS

A Critical Review On Immunomodulatory Effect Of Swarna (Gold)Bhasma In Children

*Dr. Nisha Kumari Ojha, **Dr. Rashmi Pareek*Associate Professor & Head, ** Ph.D. Scholar, Department of Kaumarbhritya, National Institute of Ayurveda, Jaipur

ABSTRACT

Recurrent illness during childhood period is a great obstacle in development of a child.Although so many vaccines and antibiotics are successfully fighting the infections but so many painful vaccine shots and emergence of antibiotic resistance is a great challenge in the present era.

Also frequent use of antibiotics create a lot of side-effects which also adversely affect the growth and development of the child. In Ayurveda Swarna (gold) Bhasma is having both preventive and protective qualities. Various evidences from experimental and clinical studies are also available to validate the effect of Swarna (Gold) Bhasma as immunomodulator.

Keywords : Swarna bhasma, Immunomodulaor, children

Address of Correspondence: Dr. Nisha Kumari OjhaAssociate Professor & Head,Department of Kaumarbhritya, NIA, Jaipur

Email ID : [email protected]

Contact No : 9468650449

How to Site the Article : Ojha NK, Pareek R, A Critical Review On Immunomodulatory Effect Of Swarna (Gold) Bhasma In Children, JOA XIII-3, 2019; 132 - 137

Introduction :

JOAjournalofayurveda.in ISSN No:2321-0435

Childhood is fragile age and also very critical period for growth and development. Under 5 mortality rate according to UNICEF is 39.4 per 1,000 live birth in India.[1] Nearly 6.3 million children died in year 2017 under the age of 15 years. Most of these deaths are due to conditions that could be prevented or treated with access of simple and affordable interventions.[2] Although so many vaccines are available for infectious diseases and antibiotics are successful in fighting the infections but emergence of antibiotic resistance is a great challenge in the present era. Also frequent use of antibiotics create lot of side-effects which also adversely affect the growth and development of the child. Childhood is a fragile age and too many vaccine shots and antibiotics may result in dangerous side effects in children.

In Ayurveda some of the drugs are categorized into Rasayana (rejuvenator) which helps in improving the overall resistance of body against common infections and pathogen.[3] They are supposed to protect the body against

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Ojha NK, Pareek R, A Critical Review On Immunomodulatory Effect Of Swarna (Gold) Bhasma In Children, JOA XIII-3, 2019; 132 - 137

external factors that induce disease. Gold is such a noble metal, which is having substantial outcomes in the human body. Ayurveda, has explained many references of gold pertaining to its medicinal properties and uses at different contexts. Gold is categorized under Shuddha Loha (pure metal), which is having both preventive and protective qualities. It is indicated for internal use because it possess Rasayana (rejuvenator) and Vajikarana (aphrodisiac) properties.[4] It is also being recommended to be given alone or along with various herbal drugs for procuring better Agni (digestive power and metabolism), Bala (physical strength and immunity), Medha (intellect), Varna (color and complexion), Ayu (lifespan).[5][6][7]

Swarnaprashana[8]

Acharya Kashyapa has introduced the term Swarnaprashana in lehadhyaya. Lehana is a unique combination of various Ayurveda herbal drugs, ghee preparations, and gold. The specific benefits ascribed to

Swarnaprashana are Medha Agni Bala, Vardhanam (improvement of intellect, digestion, metabolism, immunity, and physical strength), Ayushyam (promoting lifespan), Mangalam (auspicious), Punyam (righteous), Vrushyam (aphrodisiac), Varnyam (enhancement of color and complexion), Grahapaham (protection from evil spirits and microorganisms). Moreover, the baby will become Parama Medhavi (highly intelligent) and Vyadhibhir Na Cha Drusyate (will not be affected by any disease) if administered for 1 month and Srutadhara (will be able to remember the things, which are just heard) after administration for 6 months. Swarna Prashana administered on the day of Pushya Nakshtra of every month because this is holy star for all auspicious procedures, and also helps maintain the periodicity of administration and even respects religious belief of the parents. Some other references of gold formulations available in various Ayurveda texts are mentioned in Table no. I-

Table no. I. - Formulations of Swarna (Gold) available in different Ayurveda texts

S. No. Reference Formulation Vehicle

(Sahapana)Dose

(Matra)Duration

(Kala)

1. Charaka[9] Madhu+Ghrita - - At birth (Single dose)

2. Sushruta[10] Swarna Madhu+Ghrita 1 Gunja(Dalhana) As above

3.Ashtanga Samgraha[11]

(Ashtang Samgraha Uttartantra 1/8)

Andri, Brahmi, Vacha &

Shankhpushpi with Swarna spoona

Madhu+Ghrita 1 Harenu/ 1 Kalaya

At birth (Single dose)

Swarna, Brahmi, Bala, Shatavari Madhu+Ghrita 1 Harenu/ 1

KalayaAt birth (Single

dose)

Swarna Madhu+Ghrita 1 Gunja(Dalhana)

At birth (Single dose)

Swarna & Vacha Madhu+Ghrita Alpa Matra Till 1 year

4.Ashtang Hriday[12]

(Ashtang Hriday Uttartantra 1/9)

Swarna, Brahmi, Vacha, Tapya &

HaritakiMadhu+Ghrita 1 Harenu/ 1

KalayaAt birth (Single

dose)

Swarna and Amalaki Madhu+Ghrita 1 Harenu/ 1

KalayaAt birth (Single

dose)

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Ojha NK, Pareek R, A Critical Review On Immunomodulatory Effect Of Swarna (Gold) Bhasma In Children, JOA XIII-3, 2019; 132 - 137

5. Sushruta[13] & Ashtang Hriday [14]

Swarna, Bala vacha, Kushtha, Kaidarya, Vacha

Madhu+Ghrita 1 Harenu/ 1 Kalaya Till 1 year

Swarna & Arkapushpi Madhu+Ghrita 1 Harenu/ 1

Kalaya Till 1 year

Swarna, Matsyakshaka &

ShankhaMadhu+Ghrita 1 Harenu/ 1

Kalaya Till 1 year

Swarna, Kaidarya, Vacha Madhu+Ghrita 1 Harenu/ 1

Kalaya Till 1 year

6. Sharangdhara [15] Swarna churna Madhu+Ghrita 1 Gunja As Above

8. Bhaishajya Ratnavali[16]Swarna, Kushtha, Haritaki, Vacha,

BrahmiMadhu+Ghrita 1 Ratti -

Evidences

Absorption of Swarna(Gold)

Some of the studies evidenced that Gold nanoparticles (28-35nm)exhibit size dependent absorption through rat skin and intestine.[17] Nanoparticle can also be absorbed through sublingual route directly into blood stream.[18]

Immune Response-

A Pharmacological study in Swarna Bhasma treated mice showed nonspecific immune responses and it also had a stimulatory effect on peritoneal macrophages which fight against infections.[19] Some other study indicated that AuNPs are effective anti-schistosomal and antioxidant agents.[20] Swarnaprashana exibhited good humoral immune response and non-significantly influenced T–cell activity which in turn increases vascular permeability, induce vasodilatation, macrophage accumulation and activation, and which finally result in the increase in the paw volume which promotes phagocytic activity.[21]

Another study archives that both specific and nonspecific safe reactions were adjusted in a positive way in Swarna bhasma treated mice. Swarna bhasma demonstrated a trigger impact on peritoneal macrophages to battle against infection.[22] It also had stimulatory effect on macrophage, immunomodulatory activity-increase in the

serum IgG level[23] Swarna Prashana exhibited dramatic immunomodulatory effects in SRBC sensitized rats. Platelets count was significantly increased in drug treated group compared with Sheep red blood corpuscles group.

Swarna Prashana non-significantly influenced T–cell activity which in turn increases vascular permeability, induce vasodilatation, macrophage accumulation and activation, and which finally result in the increase in the paw volume which promotes phagocytic activity. Swarna Prashana produces good humoral immune response. Histopathological studies show that Swarna Prashana increased the cellularity in spleen and lymph node.[24]

Antioxidant Activity-

The antioxidant and restorative effects of Swarna bhasma in rat have been indicated. Two antioxidant enzymes : superoxide dismutase (SOD) and catalase were estimated after oxidative insult with acetic acid in Swarna bhasma.[25] Another examination evidenced that high aspect ratio Gold (Au) nano-rods can act as successful antioxidant and antibacterial agent.[26]

Effect on Brain

Gold diminishes the impact of depression as well as enhances the ability to focus. Gold can have balancing and harmonizing impact on the body especially with regards to unstable mental and emotional state.[27] It is supposed that the nanometer sized particles in colloidal gold affect the electrical charges that are produced in neurons. It enhances the normal synaptic communication that takes place betweenthe nerve cell.[28]

Free radical scavenging activity

Study using global and focal models of ischaemia in albino rats. Enzymatic parameters (lipid peroxidase,

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reduced glutathione, catalase, glutathione reductase, glutathione-S-transferase, glutatione peroxidase, superoxide dismutase, and glucose-6-phosphate dehydrogenase) were employed to assess ischaemic brain damage and its modulation. Significant restoration of altered values to near normal levels by Ayurvedic Swarna Bhasma and Unani Kushta Tila Kalan (25 mg/kg, orally for 10 days), suggest potentials for gold preparations in cerebrovascular diseases.[29] Qualitative analyses indicated that Swarnabhasma contained not only gold but also several microelements (Fe, Al, Cu, Zn, Co, Mg, Ca, As, Pb, etc.). Infrared spectroscopy showed that the material was free from any organic compound. The metal content in the bhasma was determined by atomic absorption spectrometry.

Acute oral administration of Swarnabhasma showed no mortality in mice (up to 1 ml /20 g b.w. of Swarnabhasma suspension containing 1mg of drug). Chronic administration of Swarnabhasma also showed no toxicity as judged by SGPT, SGOT, serum creatinine and serum urea level and histological studies. Chronic Swarnabhasma-treated animals showed significantly increased superoxide dismutase and catalase activity, two enzymes that reduce free radical concentrations in the body.[30]

Analgesic activity

Calcined gold preparations, Ayurvedic Swarna Bhasma (SB) and Unani Kushta Tila Kalan (KTK) were investigated for analgesic effects in rats and mice using four types of noxious stimuli. Auranofin (AN) used in modern medicine was also studied for comparisons. The test drugs SB and KTK (25-50 mg/kg, p.o.) and AN (2.5-5.0 mg/kg, p.o.) exhibited analgesic activity against chemical (acetic acid induced writhing), electrical (pododolorimeter), thermal (Eddy's hot plate and analgesiometer) and mechanical (tail clip) test.[31]

Safety efficacy

Acute oral administration (for 8 weeks on albino mice; 1ml/20gm b.w.//day) of swarnabhasma had not reported any toxic effects as assessed by liver function tests and histological investigations.[32] According to some blood

Ojha NK, Pareek R, A Critical Review On Immunomodulatory Effect Of Swarna (Gold) Bhasma In Children, JOA XIII-3, 2019; 132 - 137

compatibilitystudies they were non-cytotoxic size of gold nanoparticles 28-35nm and was 90% pure as visible from X-ray diffraction and elemental analysis and did not induce any blood cell aggregation or any protein adsorption.[33] Evidence based safety and efficacy of Ayurvedic herbo-metallic preparations containing gold, iron and mercury w.s.r. to pediatrics[34] Result: no any adverse or toxic effect of any of these formulations was noticed. Toxicity study of swarna bhasma, an Ayurvedic medicine containing gold, in Wistar Rats.[35] Study indicates 13.5 mg /kg body weight as NOEL (No Observed Effect Level) for swarnabhasma in Wistar Rats. No abnormality in clinical signs, during neurological examinations, no change in body weight, feed and water consumption, organ weights, biochemical and hematological parameters and no mortality was observed. Hyperspectral images revealed that after breaking, the small agglomerates have different spectral properties in cells, compared to the original aggregates, suggesting that size of particles is instrumental for the subcellular interaction with the human cells.[36]

Conclusion:

Gold has always been widely used in medicinal preparation since ancient times also helps in enhancing strength and vigour in children.Swarna bhasma can improve quality of life and can be safely administered as a recipe for immunomodulation in children. Its benefits can be achieved at various levels as it is beneficial for their physical,mental and intellectual well-being.

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3. Agnivesha, Charaka Samhita, commentary by Chakrapani ‘ayurveda Dipika’, edited by Vaidya Jadavaji Trikamji Acharya, Chaukhambha Sanskrit Sansthan. Varanasi: reprint 2004, Chikitsasthana, chapter 01, shloka 1/4, 1/7-8, 1/23, 4/6.

4. Dalhana, Commentator. Susrutha Samhita, Chikitsa Sthana, Kshudraroga Chikitsa, 28/10-21, reprint ed. Chaukhamba Orientalia, Varanasi, 2005; 501-2.

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5. Vridha Jivaka, Kashyapa Samhita, Sutra Sthana, Leha Adhyaya, edited by Shri Satyapal Bhishagacharya, 10th ed. Chaukhambha Sanskrit Sansthan, Varanasi, 2005; 4-5.

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7. Vagbhata, Ashtanga Hridaya, Uttara Sthana, Balopcharniya Adhyaya, 1/9, 47-48, edited by Hari Shastri Paradkar, 9th ed. Chaukhambha Orientalia, Varanasi, 2002; 778-781.

8. Vridha Jivaka, Kashyapa Samhita, Sutra Sthana, Leha Adhyaya, edited by Shri Satyapal Bhishagacharya, 10th ed. Chaukhambha Sanskrit Sansthan, Varanasi, 2005; 4-5.

9. Agnivesha, Charaka Samhita, commentary by Chakrapani ‘ayurveda Dipika’, edited by Vaidya Jadavaji Trikamji Acharya, Chaukhambha Sanskrit Sansthan. Varanasi: reprint 2004, Sharirsthana, 8/46.

10. Dalhana, Commentator. Susrutha Samhita, Sharira Sthana 10/13-15, 68-70,reprint ed. Chaukhamba Orientalia, Varanasi, 2005; 388-95.

11. K.R.Srikantha Murthy, Asthanga Samghra Uttartantra Asthang Sangraha Chaukhambha Orientala, published-1999, Uttartantra Adhaya 1/8.

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14. Vagbhata, Ashtanga Hridaya, Uttara Sthana, Balopcharniya Adhyaya, 1/9, 47-48, edited by Hari Shastri Paradkar, 9th ed. Chaukhambha Orientalia, Varanasi, 2002; 778-781.

15. Sharangadhara, Sharangdhara Samhita, Purva Khanda. In: 6/14-17,27. 5th ed. Murthy KR, editor. Varanasi: Chaukhambha Orientalia; 2003. p. 29.

16. Govind Das, Bhaishajya Ratnavali, Balarogachikitsa . In: 71/8. 19th ed. Brhmashankar Tripathi., editor. Varanasi: Chaukhamba Prakashan; 2009. p. 1073.

17. Sonavane G, Tomoda K, Makino K.(2008) Biodistribution of colloidal gold nanoparticles after intravenous administration: effect of particle size. Colloids Surf B Biointerfaces. 2008 Oct 15;66(2):274-80. doi: 10.1016/j.colsurfb.2008.07.004. Epub 2008 Jul 15.

18. L.Sheihet, P.Chandra, P.Batheja, D.Devore, J.Kohn, B.Michniak (2008) Tyrosine-derived nanospheres for enhanced topical skin penetrationInternational Journal of PharmaceuticsVolume 350, Issues 1–2, 28 February 2008, Pp. 312-319

19. Augmentation of non-specific immunity in mice by gold preparations used in traditional systems of medicine.Bajaj S, Ahmad I, Raisuddin S, Vohora SBIndian J Med Res. 2001 May;

113():192-6.

20. Mohamed A Dakhil, Amira A Buomy, Marwa SM Diab, Saleh Al-Quraishy, Antioxidant and hepatoprotective role of gold nanoparticles against murine hepatic schistosomiasis, International Journal of Nanomedicine, 2015;10:7467-7475.

21. Sanjay Khedekar, AnuPriya,Patgiri B,Nariya M, Prajapati PK.Immunomodulatory Activity of SwarnaPrashana in Charle’s Foster Albino Rats. J Ayu Med Sci 2016;1(2):90-6. DOI:10.5530/jams.2016.1.12

22. Soma Bajaj, I. Ahmad, Masroor Fatima, S. Raisuddin & S. B. Vohora (1999) Immunomodulatory Activity of a Unani Gold Preparation used in Indian System of Medicine, Immunopharmacology and Immunotoxicology, 21:1, 151-161, DOI: 10.3109/08923979909016400

23. Khedekar, S., Rukkudin, G., Ravishankar, B., & Prajapati, P. (2016). Anti-diabetic activity of traditional Indian gold containing preparation: Shadguna Balijarita Makaradhwaja on streptozotocin induced diabetic rats. Journal of intercultural ethnopharmacology, 5(2), 162–167. doi:10.5455/jice.20160214120304

24. Khedekar, S., Rukkudin, G., Ravishankar, B., & Prajapati, P. (2016). Anti-diabetic activity of traditional Indian gold containing preparation: Shadguna Balijarita Makaradhwaja on streptozotocin induced diabetic rats. Journal of intercultural ethnopharmacology, 5(2), 162–167. doi:10.5455/jice.20160214120304

25. Keisuke Hashimoto, Charles E. Whitehurst, Tsukasa Matsubara, Kazushi Hirohata,t and Peter E. Lipsky (1992)Immunomodulatory Effects of Therapeutic Gold Compounds Gold Sodium Thiomalate Inhibits the Activity of T Cell Protein Kinase C, The American Society for Clinical Investigation, Inc. 0021-9738/92/06/1839/10 ,Volume 89, June 1992, 1839-1848

26. Sharma, S. & Manhar, A.K. & Bora, Pritom Jyoti & Dolui, S.K. & Mandal, Manabendra. (2015). Evaluation of antioxidant and antibacterial activity of various aspect ratio gold (Au)nanorods. Advanced Materials Letters. 6. 235-241. 10.5185/amlett.2015.5629.

27. Walter Vogel, John Bradley, Oliver Vollmer, and Ingo Abraham, (1998) Transition from Five-Fold Symmetric to Twinned FCC Gold Particles by Thermally Induced Growth, J. Phys. Chem. B 1998, 102, 10853-10859

28. Mitra A, Chakraborty S, Auddy B, Tripathi P, Sen S, Saha AV, Mukherjee B(2002) Evaluation of chemical constituents and free-radical scavenging activity of Swarnabhasma (gold ash), an ayurvedic drug.J Ethnopharmacol. 2002 May;80(2-3):147-53.

29. Paul, W., & Sharma, C. P. (2011). Blood compatibility studies of Swarna bhasma (gold bhasma), an Ayurvedic drug. International journal of Ayurveda research, 2(1), 14–22. doi:10.4103/0974-7788.83183

30. A Mitra, SChakraborty, BAuddy, SSen, A.VSaha, B Mukherjee(2002) Evaluation of chemical constituents and free-radical scavenging activity of Swarnabhasma (gold ash), an ayurvedic drug,Journal of Ethnopharmacology, Volume 80, Issues 2–3, May 2002, pp. 147-153

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herbo-metallic preparations containing gold, iron, and mercury with special reference to pediatrics. MedJ DY Patil Univ 2017;10:222-8

35. Pallavi Shrirang Jamadagni , Shrirang B. Jamadagni , Arjun Singh , Rajendra Kumar Singh , Sachchidanand N. Upadhyay , Sudesh N. Gaidhani , Jayram Hazra Toxicity Study of Swarna Bhasma, an Ayurvedic Medicine Containing Gold, in Wistar Rats

36. Kashani AS, Kuruvinashetti K, Beauet D, Badilescu S, Piekny A, Packirisamy M. Enhanced Internalization of Indian Ayurvedic Swarna Bhasma (Gold Nanopowder) for Effective Interaction with Human Cells.J Nanosci Nanotechnol. 2018 Oct 1;18(10):6791-6798. doi: 10.1166/jnn.2018.15503.

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ORIGINAL REASEARCH ARTICLE - LITERARY REVIEWS

Early To Bed And Early To Rise: An Ayurvedic Perspective*Dr. Punit Chaturvedi, **Dr. Manoj Kumar Patel, ***DR. Durgawati Devi

*P.G. Scholar, **P.G. Scholar, ***Associate Professor, Dept. of Swasthavritta and Yoga, National Institute of Ayurveda, Jaipur

ABSTRACT

Ayurveda maintains the balance and harmony between individuals and his environment. For this purpose various principles has been described and dinacharya is one of those. Dinacharya starts with getting up from sleep in the Brahma muhurta. Westerners regard Benjamin Franklin’s quote “Early to bed and early to rise makes a man healthy, wealthy and wise” as the best advice for success. Classical Ayurvedic literature contains detailed description of Brahmamuhurta jagarana, nidra (sleep), and its constructive effects on health. People who maintain balance between sleeping and waking time, destroy all his pains and sorrows, means no disease remain left or able to produce. Adopting the principles of Ayurveda and guideline for Brahmamuhurta Jagarana are the best ways to encourage healthy life. it is essential to lead quality of life we have to follow Ayurvedic regimen and have to start our day with Brahma Muhurta Jagarana, So this concept need to be elaborated and explained from the Ayurveda as well as justified with modern views for which this study has been planned.

Keywords : Brahmamuhurta Jagrana, Dincharya, Nidra, Ayurveada

Address of Correspondence: Dr. Punit ChaturvediP.G. Scholar, Dept. of Swasthvritta & Yoga, National Institute of Ayurveda Jaipur.

Email ID : [email protected]

Contact No :9024458253

How to Site the Article : Chaturvedi P, Patel MK, Devi D, Early To Bed And Early To Rise: An Ayurvedic Perspective, JOA XIII-3, 2019; 138 - 142

Introduction:

Ayurveda, the science of life is not merely a system of medicine, while it is the one and only medical system which gives the way of perfect living with nature. Even before the WHO (World Health Organization) gave the definition of total health, Ayurveda had clearly indicated that this involves physical, mental, moral and spiritual well being.[1] Since the time immemorial healthy and happy life of hundreds of years is a cherished wish of human being. For this wish Ayurveda gave some rules regarding our life style. According to Ayurveda one can get disease prevention and healthy life by following Ayurvedic regimen.[2] Ayurveda maintains the balance and harmony between individuals and his environment. For this purpose various principles has been described and dinacharya is one of those. Principle of dinacharya basically focuses on day to day adjustment of body

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towards time. It is an ideal day time routine recommended for health maintenance. Ayurveda regards nidra (sleep) as one of the most essential factors responsible for a healthy and fulfilling life. It is one of the trayopastambha (three great subsidiary pillars) on which a person’s health is firmly balanced.[3] Sound sleep at night is a natural and nourishing phenomenon, so it is also called bhutdhatri (nourishes all living beings).[4] Early morning is known as "Brahma Mahurat" in the Hindu Mythology. It is regarded that prayers made at this time reach directly to the God. Westerners regard Benjamin Franklin’s quote "Early to bed and early to rise, makes a man healthy, wealthy and wise." As the best advice for success. There is also the expression: “The early morning has gold in its mouth.” We as Indians are well aware of the merits of early awakening. Ayurveda preaches us about this virtue in its own unique way. Dinacharya is a wonderful concept gifted by Ayurveda to the whole world. Dinacharya starts with getting up from sleep in the Brahma muhurta. A person who is interested in preserving the health and longevity should get up early in the morning in Braahma-muhurta.[5] The present generation of mankind always

tries to know all concepts on basis of all logic and facts. Time is the factor which engulfs or pervades all the creatures so it is essential to lead quality of life we have to follow Ayurvedic regimen and have to start our day with Brahma Muhurta Jagarana, So this concept need to be elaborated and explained from the Ayurveda as well as justified with modern views for which this study has been planned.

Material & Methods -

Present work has been done based on critical review of classical information, published research works, modern literature and research works conducted at various institutes. The possible correlation has been made between collected information and has been presented in systematic way.

Result-

Aggravated dosha are able to produce diseases. Days and nights are connected with doshas, dosha cycle regulated as follows-[6]

First cycle (Day), second cycle (Night)

Kapha Morning 6-10 Evening 6-10

Pitta Afternoon 10-2 Midnight 10-2

Vata Afternoon 2-6 Night 2-6

1. Night 6-10 o’clock is time of Kapha and during this time Kapha is dominating dosha especially. Kapha is compared with “tama” and “tama” production is helpful in inducing sleep. Hence this is right time for sleep.

2. And if person does’t go to sleep during this time after that 10pm-2pm is a dominating time for pitta dosha. And pitta dosha is responsible for “Sattva” guna which is responsible for making person awake hence according to Ayurveda this is not ideal period for inducing sleep.

3. In early morning before sunrise means at last prahar of night, vatadosha predominates, which is responsible for “Rajas” guna.

6pm - 10pm Kapha Tama Sleep

10pm - 02am Pitta Sattva Abolish Sleep

After 02am Vata Rajas Ideal time for wake up

In complete night cycle whatever kapha and pitta dosha predominance is there, the best time is this to remove all. If person doesn’t wake up at this time then vata doesn’t progress in right direction and produces diseases.

Means in proper condition vata dosha which flow in body is known as “prana.” All activities took place in body depend upon vata.[7] In improper condition when vata flow in body then it produces different diseases and also cause of death.

Hence early morning, which is vata predominant kala

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(time) and for its proper flow in body channels Brahma Muhurat jagran is very essential.

In whole night due to less pollution, morning atmosphere is clean and refreshing and we get more oxygen that’s why by wake up in early morning and morning walk helps to have more oxygen for breathing.

During this time if evacuation of faecal matter doesn’t go properly then faecal matter which has reached to the rectal region, get start to be dried due to “Ruksha” guna of vata because faecal matter is present in place of vata predominance and time of vata predominance. Hence due to these reason many painful diseases get produced.

Constipation that is root of many diseases, if faecal matter remains in intestine for longer duration then it starts putrefaction and produces foul odour and gases. Through blood all these toxins get distributed to whole body and produce diseases.

If evacuation of faecal matter is not proper, then in body many different diseases start to flourish for example- anorexia, indigestion, laziness, constipation, flatulence, insomnia etc.

Along these if person doesn’t wake up in early morning and evacuation of faecal matter and urine is not done then it cause “Apanavayu” aggravation then this apanavayu cause many diseases to grow.

Brahama Muhurat Jagran should follow in “Dincharya" (daily regimen) by using “Padanshik karma” (step by step). Those people who always wake up late in morning and it becomes their habit, so after making those people aware about its evil circumstances, this habit should be gradually removed. Means for intelligent people it is good to gradually move away from all these habits which are not good for health, by interchanging with good habits by gradually following them.Example-

Time for sleep at night Wake up time in morning1 am 8 am

12:30 am 7:30 am12 am 7 am

11:30 pm 6:30 am11 pm 6 am

10:30 pm 5:30 am10 pm 5 am

9:30 pm 4:30 am9 pm 4 am

In this way gradually person may schedule his table of sleep pattern.

In this way gradually removed dosha doesn’t reproduce in body and gradually introduced guna will never elevate. This way by following Ayurvedic daily regimen of primary and most important event of Brahama Muhurat Jagrana helps to prevent from lifestyle disorders. By following rules of nature we prevent our self from disorders which occurs due to imbalances, and after removing imbalances and maintaining balance between mind and body, we are able to get complete health. Means those people who maintain balance between sleeping and

waking time, destroy all his pains and sorrows, means no disease remain left or able to produce. For complete health, prosperity, attaining knowledge and for praise of God, this Brahama Muhurat is most ideal time. This time one should wake up and try to attain knowledge and wisdom. In the same way importance is given in “Jyotish” (astronomy) and “Tantra Siddhi” as for example- here in following stanza importance of Brahmamuhurat at fixed time a fixed place can be seen- In this stage the Sadhak (practitioner) merely chants the mantra and repeats it in mechanical manner just as my other words. If this is done in systematic way that is Brahma muhurata i.e., from 4-6 am, at a fixed place time then it would give some peace to

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Sadhak.

Discussion-

Scientists have discovered that certain brain structures and chemicals produce the states of sleeping and waking. Understanding these control mechanisms helps doctors pinpoint what can go wrong and plan effective treatments. A pacemaker-like mechanism in the brain regulates the circadian rhythm of sleeping and waking. Circadian means about a day. This internal clock, which gradually becomes established during the first months of life, controls the daily ups and downs of biological patterns, including body temperature, blood pressure, and the release of hormones. The classic phase markers for measuring the timing of a mammal's circadian rhythm are:

● Melatonin secretion by the pineal gland.

● Core body temperature.

● Plasma level of cortisol.

The average human adult's temperature reaches its minimum at about 05:00 (5 a.m.), about two hours before habitual wake time. Melatonin is absent from the system or undetectably low during daytime. It is secreted more in darkness. Its major metabolite can also be measured in morning urine. This hormone plays a little role in regulating the sexual functions in human being. A third marker of the human pacemaker is the timing of the maximum plasma cortisol level (life protecting hormone). It helps to withstand the stress and trauma in life. This is secreted from adrenal cortex under the influence of ACTH from hypothalamus. The rate of secretion of ACTH is high in the morning and low in the evening. Other physiological changes which occur according to a circadian rhythm include heart rate and production of red blood cells. Importance of getting up in BrahmaMuhurtaEarly morning is vata dominating period. Vatadosha is helpful in promoting body movements both internal and external and thus helps in easy evacuation of bowel. Physical activities such as exercises and yogasanas can be performed well in vatakala. Meditation also needs the help of undisturbed vata which can be found early in the morning. This time is hailed as the best time

to learn, especially learn and realize subtler aspects of philosophy and spiritual growth. If one tries to find out the secret underlying this then one can realize that there are probably several changes in physical chemical and biological atmosphere at around this time, which probably catalyzes spiritual blossoming of an individual. This is indeed a rejuvenating time as the whole universe begins to wake up at around this time. The circadian rhythms have been studied in vast details by biologists and physiologists and probably this period is associated with hormonal changes conducive to blossoming of mind. Study of variety of electromagnetic radiations ozone effects of other planets and stars and so on, on the various biological and psychological parameters reveals a lot of new insights in the interrelationship of man and theuniverse.

Conclussion-

Classical Ayurvedic literature contains detailed description of Brahmamuhurta jagarana, nidra (sleep), and its constructive effects on health along with the deleterious consequences of get up late. Many of these facts have been proven with modern scientific research, but additional work is certainly required to understand the entire phenomenon. Adopting the principles of Ayurveda and guideline for Brahmamuhurta Jagarana are the best ways to encourage healthy life. So everyone must be getting up in the Brahma Muhurta to have healthiest life and should not sleep in the day nor keep late hours in the night. Having known all these acts to be injurious, the wise should observe moderation in sleep. A conventionality to this rule of conduct is rewarded with health, good humour, strength, healthful complexion, virility and beauty, with a frame which is neither too fat nor too thin, wealthy and a long life.

References

1. Sushruta. Sushruta Samhita. Yadavji Tikramji Acharya, Editor. Varanasi: Chaukhamba Orientalia, 2018. Sutra Sthana 15/41, pp. 75.

2. Bhava Mishra. Bhavaprakasha. Brahma Sankara Mishra, Editor. Varanasi: Chaukhamba Sanskrit Bhawan, 2016. Purvakhanda 5/13, pp. 110

3. Sushruta. Sushruta Samhita. Yadavji Tikramji Acharya, Editor.

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Chaturvedi P, Patel MK, Devi D, Early To Bed And Early To Rise: An Ayurvedic Perspective, JOA XIII-3, 2019; 138 - 142

Varanasi: Chaukhamba Orientalia , 2018. Chikitsa Sthana 24/88, pp.491.

4. Agnivesha. Charaka Samhita. Yadavji Tikramji Acharya, Editor. Varanasi: Chaukhamba Orientalia, 2015. Sutra Sthana 21/59, pp.119

5. Vagbhatta. Ashtanga Hridayam. Bhiagacharya Harishashtri Paradakara Vaidya , Editor. Varanasi: Chaukhamba Orientalia, 2017. Sutra Sthana 2/1, pp.24

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czkãeqgwrZ esa mBdj djuh pkfg;sA blfy;s czkãeqgwrZ dky esa tkxj.k dh vo/kkj.kk d¨ foLrkj ls crk;k tkuk pkfg;s vkSj

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6. Vagbhatta. Ashtanga Hridayam. Bhiagacharya Harishashtri

Paradakara Vaidya , Editor. Varanasi: Chaukhamba Orientalia, 2017. Sutra Sthana 1/8, pp.7

7. Sharangadhar. Sharangadhar Samhita. Dr. Sahilja Shivastav, Editor. Varanasi: Chaukhamba Orientalia, 2013. Purvakhanda 5/25, pp.40

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ORIGINAL REASEARCH ARTICLE - SURVEY STUDY

Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush

*Dr. Durgesh Nandini Sharma, **Dr. Hemraj Meena*Ph.D. Scholar, **Ex. Professor, Department of Sharir Kriya (Ay.Physiology), National institute of Ayurveda, Jaipur.

ABSTRACT

The Sara is considered to be an important concept of Ayurveda among Dashavidha Pareeksha which is done to understand life span of an individual, degree of strength possessed by person and to rule out morbidity. By assessing the Sara one can identify the present health status of an individual. Therefore, considering these prospects a demographic study was carried with 100 (16-40 years of age group) Rakta Sara Purushas. In the study Subjective parameters of the Rakta Sara were converted in the objective parameters which can be used to grade Rakta Sara in Pravara, Madhyam and Avara categories. In results Rakta Sara persons were found with good quality of blood including Hb, RBC, PCV and blood indices. So we can say that, they have good immunity or disease Free State means Arogyavan and Sukhi. Considering these facts this study can be used as model for standardization of other Sara, where examination is based on subjective parameters.

Keywords : Sara Pariksha, Rakta Sara, Blood Indices

Address of Correspondence: Dr. Durgesh Nandini SharmaPh.D. Scholar, Department of Sharir Kriya (Ay.Physi-ology), National institute of Ayurveda, Jaipur

Email ID : [email protected]

Contact No : 7878029602

Introduction:

The Sara is considered as an important concept of Ayurveda, which is responsible for assessing strength (Bala) and stability (Sthiratva)[1]. It is a good mirror to assess properties and function of Dhatu. Sara is one among Dashavidha Pareeksha which is done to understand life span of an individual, degree of strength possessed by person and to rule out morbidity[2]. Sara means the excellence and the purity of virtuous state of Dhatu and mind[3]. By assessing the Sara one can identify the present status of health of an individual.

Jeevana[4] is the main function of Rakta Dhatu. The efficiency of Rakta Dhatu is known by assessing the Rakta Sara. According to Charaka a Rakta Sara person have bright red and lustrous elegant appearance of the ears, eyes, face, tongue, nose, lips, palmand sole of foot, nails, forehead and genitals. These persons are endowed with happiness, elevated or best intelligence, mental tranquillity and delicacy or tenderness to the person[5].

How to Site the Article : Sharma DN, Meena H, Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush, JOA XIII-3, 2019; 143 - 148

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Acharya Sushruta proposed that Rakta Dhatu is equivalent to Tridosha[6]. Acharya stated that all the other Dhatu are dependent on Rakta Dhatu for their nourishment. Acharya Charaka considered Rakta as one among the Dashapranayatam[7]. Acharya said that the living creature is endowed with Bala, Varna, Sukha and Ayu due to Shudhha Rakta[8].

It is obvious from the above discussion that the views of ancient Acharyas about the detection of status of Rakta (blood) directly in the persons were very scientific. They mentioned the organs especially the Akshi (palpebral conjunctiva), Jihva (tongue), Mukha (mucus membrane of oral cavity), Oshtha (lips), Talu (palate), Panitala and Padatala (palms and soles with their creases) in the physical examination of Rakta Sara. Even today, these sites are used to detect the status of blood in clinical examination. The color of skin and mucus membrane, depends upon the thickness of skin, amount and quality of blood (Hutchison’s). The color of mucous membrane of eyelids and mouth and so does the color of the creases in the palms are better indication of anemia than is the color of the skin (Hutchison’s). This indicates, the concept of Rakta Sara examination is made for the detection of status of blood, indirectly in the patient. It is also supported from the view that these parts becomes pale in the anemic patients and reddened in the persons endowed with good quality and quantity of blood (Rakta Sara).

Ayurveda is a vast storehouse of knowledge relevant to human health, disease, medicines and general health-

care. However, mutual incomprehensibility of the terms and concepts has been a major impediment in meaningful dialogue between modern scientific medicine and Ayurveda. Rakta Dhatu can be compared with blood. Assessment of Sara is much subjective so it would be much helpful if we can find the better laboratory parameter to assess Rakta Sara. At this time if a method is developed or reintroduce from the treasure of Ayurveda, it would be a boon in the field of Ayurvedic physiology.

Aims & Objectives Of Study

The present research study was planned to conduct with

following main objectives.

1. Demographic survey regarding Rakta Sara Purush.

2. To assess Hb and blood indices in Rakta Sara Purush.

Institutional Ethics Committee Clearance

Proposed study was approved by IEC, Order No. F10 (5)/EC/2014/7223 Dated 07/11/2014.

Material And Method

¾ Selection Of Cases

The study was conducted on 522 peoples randomly selected from O.P.D/I.P.D., all college students, staff of National Institute of Ayurveda, Jaipur and Shri Shiridi Sai Baba Ayurveda College & Hospital, Renwal, Jaipur (Rajasthan) and people living around the colleges. 100 Rakta Sara individuals were found fit for further detailed survey study.

Inclusion Criteria Exclusion Criteria

1. Peoples aged between 16 to 40 years of either sex. 1. Peoples below 16 and above 40 years of age.

2. Healthy individual. 2. Person with severe or chronic diseases.

3. Person willing to participate in the study 3. Person with any stress or cognition deformity.

¾ Assessment Criteria

(1) Sara Pareeksha -

Phase 1: A standard short Sara Pareekshan format was prepared to find out Rakta Sara people among all eight

Sara peoples (522).

Phase 2: A detailed Sara Pareekshan format was prepared to categorize Rakta Sarata in Pravara, Madhyam and Avar types (100).

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To fulfill the above aims, a preformat was designed incorporating the sign and symptoms of Rakta Sara persons as described in Samhitas and the hematological laboratory parameters. Questionnaires of the survey proforma were divided into many parts like, history taking, physical examination by visual analogue scale, psychological assessment, metabolic or functional assessment and also the laboratory assessment of the blood indices. These parameters of the survey were based on Sara Lakshanas described in Charaka Samhita Vimana Sthana.[9] According to Charaka, a Rakta Sara person has following characteristics in him – Sukham, Uddhatam, Medha, Manasvita, Saukumaryata, Anatibala, Aklesh Sahishnuta, Ushna Asahishnuta and the four parameters like unctuousness (Snigdhata), redness (Rakta Varnta),

Sharma DN, Meena H, Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush, JOA XIII-3, 2019; 143 - 148

lustureness (Shrimad), and radiance (Bhrajishnuta) are present in 9 body parts of a Rakta Sara person namely, Earpinna (Karna), eyes (Akshi), face (Mukh), tongue (Jihwa), nose (Nasa), lips (Oshtha), palms and soles (Pani-Paad Tal), nails (Nakha), forehead (Lalaat). On the basis of these features all Rakta Sara individuals were divided into three catagories i.e Prava Sara, Madhyam Sara and Avar Sara.

(3) Laboratory Investigation - Each person falling in any of these categories of Rakta Sara was then assessed for their laboratory parameters (hematological). CBC was performed in 100 peoples to know about Hb, TLC, DLC, PCV, MCV, MCH, MCHC, TRBC and TPLC values.

Observations & Results

Table no.I: Showing demographic observation of the survey study.

Table no. II: Showing distribution of Sarta categories and Mean Hb gm%.

S.N. Finding Predominance Percent1. Sex Male 61%2. Age group 21-25 years 48%3. Religion Hindu 93%4. Socio-economic status Middle higher 66%5. Prakriti Pitta-Kapha 44%6. Oxford Happiness Questioner Score 41-45 40%7. Klesh Asahishnuta(Anger tolerance) 2 Marks 36%8. Manasvita(Generosity) 5 Marks 62%9. Saukumaryata/Anatibala(Tiredness) 5 Score 51%10. Ushna Asahishnuta(Warm Intolerance) 0 Score 52%11. Metabolic functions 10 Marks 81%12. Visual Analogue Scale Score 51-60 61%13. Rakta Sara Category Madhayam 55%

S.No. Score Rakta Sarta Mean Hb gm% No. of Subjects %1 90-110 Avara 13.37 10 102 111-130 Madhyam 13.57 55 553 > 130 Pravara 13.82 35 35

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Sharma DN, Meena H, Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush, JOA XIII-3, 2019; 143 - 148

S.No. Male FemaleHb gm% No. % Hb gm% No. %

1 <13.5 14 22.95 <11.5 7 17.942 13.5-15.5 36 59.01 11.5-13.5 24 61.533 >15.5 11 18.03 >13.5 8 20.51

Total 61 100 39 100

S.No. Male FemalePCV% No. % PCV% No. %

1 <38 5 8.19 <36 12 30.762 38-50 56 91.8 36-45 27 69.273 >50 0 0 >45 0 0

Total 61 100 39 100

Table no. III: Showing the distribution of Hb gm% in Male and Female Subjects.

Table no. IV: Showing the distribution of PCV in Male and Female Subjects of Survey.

Table no. V: Showing the distribution of MCV in Subjects of Survey study.

Table no. VI: Showing the distribution of MCH in Subjects of Survey study.

Table no. VII: Showing the distribution of MCHC in Subjects of Survey study.

Table no. VIII: Showing the distribution of TLC in Subjects of Survey study.

S.No. MCV No. of Subjects %1 <74 5 52 74-95 78 783 >95 17 17

S.No. MCVpg No. of Subjects %1 <27 18 182 27-32 64 643 >32 18 18

S.No. MCHC % No. of Subjects %1 <30 3 32 30-36 87 873 >36 10 10

S.No. TLC/mm3 No. of Subjects %1 <4000 1 12 4000-11000 98 983 >11000 1 1

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Table no.IX: Showing the distribution of TRBC in Subjects of Survey study.

Sharma DN, Meena H, Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush, JOA XIII-3, 2019; 143 - 148

S.No. TRBC (mill/mm3) No. of Subjects %1 <4 10 102 4-5.5 85 853 >5.5 5 5

Discussion

Hb Status: In this survey study at the level of Hb gm% laboratorial value maximum males 36 (59.01%) were found within the range of 13.5-15.5 followed by 14 (22.95%) subjects with below normal range (<13.5) than 11 (18.03%) subjects with >15.5 gm% value. In females maximum 24 (61.53%) were found within the range of 11.5-13.5 followed by 8 (20.51%) with >13.5 gm% value than 7 (17.94%) with <11.5 gm% value. Results show that male have higher level of Hb than females. May the variability in Hb status of male and females due to estrogenic predominance in females which produce inhibitory effect on secretion of erythropoietin and androgen predominance in male which stimulates erythropoietin secretion.[10] It also show that Maximum Rakta Sara people of study were from Average and above average range because their physical characteristics shows more red colour of body organs than other Sara Purush. Mean Hb gm% were found in increasing order i.e Avara Rakta Sara 13.37, Madhyam Rakta Sara 13.57, Prava Rakta Sara 13.82 shows effectiveness of Sara Pareekshan format.

PCV: In this survey study at the level of PCV laboratorial value maximum males 56 (91.8%) were found within the range of 38-50% followed by 5 (8.19%) subjects with below normal range (<38%). In females maximum 27 (69.27%) were found within the range of 36-45% followed by 12 (30.76%) with <36% value. No male or female had crossed the upper limits. It is a simple but accurate test for determining the presence of anemia or polycythemia, as it is more accurate than the Red blood cell count or Hb. It is also employed for determining various absolute, corpuscular values. It shows that maximum survey subjects have quality blood. So we can say Rakta Sara Purush have better quality of blood than others.

MCV: At the estimation of MCV examination maximum

78% subjects were found between ranges 74-95. It shows that maximum Rakta Sara person have good quality of RBC.

MCH & MCHC: In this survey study MCH examination shown that maximum people (64%) belongs between level 27—32 and at MCHC % examination maximum students (87%) were found between range of 30-36. MCHC is most reliable and useful value for estimation of Hb concentration. It shows that actual Hb concentration in RBC of Rakta Sara person is good.

TLC: The survey study shown that maximum subjects were found in normal TLC limit (4000-11000/mm3) that was 98%. It shows that maximum were healthy in laboratorial values also. It also prove that Rakta Sara Purush have Uttam Bala (immunity)[11]. Reason may be Sukha is one of the characteristics for Rakta Sara Purush[12]

TRBC: In this survey study maximum subjects were found in normal limit (4-5.5 mill/mm3) that were 85%. It shows that maximum Rakta Sara Purush have good total count of RBC, which is responsible for more oxygen transportation.

Conclusions ¾ In the conceptual part, the subjective parameters of

the Rakta Sarata were converted in the objective parameters, which can be used to grade Rakta Sarata in Pravara, Madhyam and Avara categories.

¾ Physical character like Rakta Varnata, Snightata are more reliable to access Rakta Sarta than psychological characters like Sukha, Klesh Asahishnuta, Manasvita, Anatibala etc.

¾ Rakta Sara persons have good quality of blood including Hb, RBC, PCV and blood indices.

¾ Rakta Sara persons have good immunity or disease

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free State means Arogyavan and Sukhi.

¾ This study can be used as model for standardization of other Saras and other areas of Ayurveda where examination is based on subjective parameters.

Sharma DN, Meena H, Demographic Study Of Hb Status And Blood Indices In Rakta Sara Purush, JOA XIII-3, 2019; 143 - 148

References

1. Lewis rice, Amara kosha of Amara simha, 2nd ed.Mysore: Mysore University; 1989. p.218.

2. Shastri KN, Chaturvedi GN, CharakSamhita, reprint ed. Varanasi: Chaukambha Bharati Academy; 2001.Viman Sthan Rogbhishagajitiya Adhyaya; chapter 8 verse 115. p.771.

3. YT. Charakasamhita by Agnivesa with Ayurveda deepikateeka of Chakrapanidatta. Reprint ed. Varanasi: ChaukhambhaOrientalia; 2011.Viman Sthan Rogbhishagajitiya Adhyaya; chapter 8 verse 102-115 p.278

4. Paradakara HSS, Ashtangahrudaya with Sarvangasundara commentary of Arunadutta and Ayurvedarasayana commentary of Hemadri. 9th ed. Varanasi (India): Chaukambha Orientalia; 2005.Sutrasthana Doshadivigyaneeya Adhyaya; Chapter 11 verse 4 p. 183.

5. Bhagwan Dash. Agnivesa's Caraka Samhita based on Cakrapanidatta's Ayurveda Dipika. Reprint ed. Varanasi. The chaukhamba sanskrit series; 2005,Viman Sthan Rogbhishagajitiya Adhyaya; chapter 8 verse 104p-336

6. YT, Susrutha Samhita with Nibandhasangraha commentary of Dalhana. Reprint ed. Varanasi (India): Chaukambha Sanskrit Sansthan; 2010. Sutrasthana Vranaprashnam Adhyaya; Chapter 21 verse 3 -4 p. 99.

7. YT, Caraka Samhita with Ayurveda Dipika commentary of Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia; 2009. Sutrasthana Dhashapranayataneeya Adhyaya; Chapter 29 verse 3 p. 181

8. YT, Caraka Samhita with Ayurveda Dipika commentary of Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia; 2009.Sutrasthana Vidhishoniteeya Adhyaya; Chapter 24 verse 4 p. 124.

9. Satya Narayan Shastri (Part 1) Charak Samhita with elaborated Vidhyotini Hindi commentary; Varanasi Chukhambha Bharty academy 2008. Viman Sthan Rogbhishagajitiya Adhyaya; chapter 8 verse 104; p 776.

10. A Text book of Practical Physiology by C.L. Ghai; 8th Edition; Jaypee publications; p.g 39.

11. Satya Narayan Shastri (Part 1) Charak Samhita with elaborated Vidhyotini Hindi commentary;Varanasi Chukhambha Bharty academy 2008. Sutra Sthan Tasyashitiya Adhyaya; chapter 24 verse 4; p 443.

12. Satya Narayan Shastri (Part 1) Charak Samhita with elaborated Vidhyotini Hindi commentary; Varanasi Chukhambha Bharty academy 2008. Viman Sthan Rogbhishagajitiya Adhyaya; chapter 8 verse 104; p 776.

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ORIGINAL REASEARCH ARTICLE - CASE STUDY

Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study

*Dr. Ankita Agarwal, **Dr. Asit K Panja

*SRF, **Associate Prof., Department of basic Principles, National institute of Ayurveda, Jaipur.

ABSTRACT

Goitre is an abnormal enlargement of thyroid gland whichpresents as a swelling around the neck. Goitre occurs due to different causes such as iodine deficiency, over- or underproduction of thyroid hormones or to nodules that develop in the gland itself. A very long course of treatment is required in modern science. Apart from the serological markers other clinical signs and symptoms sometime persist for long period. However, Ayurveda modalities have proved useful in this aforesaid manifestation. A case of goitre with hypothyroidism is presented herewith which was treated for two months with panchkarma procedures along with oral medication. The aim of the treatment was to alleviate patient's symptoms and prove worth-fullness of local applications in galganda. Patient had complained of swelling around neck and hoarseness of voiceand low appetite. There was visible nodular swelling around neck on clinical examination. On the basis of patient's symptoms, diagnosis was made as vatajagalganda with medo association. Patient was treated with the line of treatment of galgandachikitsa. Lepa (local ointment), nasya (nasal drops) were used for two months with oral ayurvedic drugs. Patient's condition was assessed according to the classical symptoms of galganda, WHO goitre grading scale, dysphonia gradingscale and thyroid hormone values. This case study shows that outer applications and panchkarma procedures are also effective along with internal administration in galganda case.

Keywords : Goitre, galganda, hypothyroidism,panchakarma procedure.

Address of Correspondence: Dr. Ankita AgarwalSRF, Department of basic Principle, National institute of Ayurveda, Jaipur

Email ID : [email protected],

Contact No : 7976760966

Introduction:

Goitre is a swelling around neck due to enlargement of thyroid gland.[1] Goitre can be associated with hypothyroidism or hyperthyroidism.[2] Hypothyroidism is a condition in which thyroid gland doesn't produce enough hormones crucial for the body's metabolism. Symptoms of goitre with hypothyroidism include fatigue,

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Agartwal A, Panja AK, Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study, JOA XIII-3, 2019; 149 - 154

hoarseness of voice, thinning hair, enlarged thyroid gland (goitre), etc. Treatment of above said disease involve routine use of synthetic thyroid hormone levothyroxine and other oral administrations and surgical procedures[3] However these treatment are symptomatic and also required medicines over a long duration for maintaining the normal thyroid status[4] Prevalence of hypothyroidism in India is around 11% and growing each year.[5]

However, dependence upon the symptomatic treatment and side effects of long time medication lead to encourage research of this disease through other clinical sciences.

Here, a case is being presented diagnosed with goitre associated hypothyroidism and was treated according to Ayurveda guidelines. The aim of the treatment was to resolve the patient's symptoms and prove the efficacy of Ayurveda therapy in goitre associated hypothyroidism. Patient was treated on the line of treatment of Ayurvedamodalities of galganda(vata, kapha disorder).

Brief Presentation of Case

A 28 years old female patient diagnosed with

‘goitre associated hypothyroidism’came to OPD, Dept. of Basic Principles, National Institute of Ayurveda, Jaipur. She presented with the symptoms like hoarseness of voice (svarabhramsha) and swelling around neck (shotha),

low appetite (mandagni) for last 3 to 4 months. After explaining the prognosis clearly, Ayurveda Treatment was started on 25/10/2018.

Clinical finding

Previously patient had experienced similar swelling, low appetite and was diagnosed with goitre with hypothyroidism. On examination, visible unctuous (snigdha) glandular swelling (shotha) was noted with no pain (ruja). She had dryness on the skin of other part of body (rukshta) and a low appetite (mandagni), incomplete bowel movement (krurakostha). Patient was feeling difficulty in speaking and hoarseness of voice (svarabhramsha), dryness in mouth. Patient had avarasara and avarsamhanan and avaraaharashakti and jaranshakti. Thyroid hormone investigation was done on 16-11-18 which revealed high TSH 11.07uI/ml and normal T3 and T4 level.

Diagnostic Focus and Assessment

Patient's symptoms such as swelling around neck can be compared with the classical symptoms of galganda.[6] Dryness of skin, svarabhramsha are the manifestation of aggravated vata.[7] On the other hand swelling with no pain and dryness of mouth are the manifestation of medo associated vatavradhi.[8] Low appetite was the result of mandaagni.[9] Patient was considered suffering from vatajagalganda along with meda association.[10]

Table I: Timeline of the case

Time and date Clinical events and intervention

2008

¾She visited hospital with the complaint of swelling around neck. ¾Blood investigation was done and T3, T4, TSH hormone level were found 130ng/dL,

2.40ug/dL, 150uIU/mL respectively. ¾Subsequently THYROID SCAN was done on 26/06/2008which revealed moderately

enlarged thyroid gland with high uptake- total 15.7%. ¾Other vitals were normal. No DM, HTN and bronchial asthma were noted. ¾She was diagnosis as goitre associated hypothyroidism and eltroxin 150mcg OD was

started.

13.11.10

¾She started having complains like anorexia, persistent neck swelling, not gaining weight and visited modern hospital.

¾Blood reports revealed high cholesterol 225mg%, cholesterol HDL-DIRECT 70.10mg%. ¾Medicines such as tab. eltroxin 125mcg OD was given.

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2010 to 2018 ¾She experienced similar symptoms and used to get similar kind of treatment.

16-11-18 ¾Patient stopped medicines by her own and blood investigation reported high TSH 11.07uIU/ml,

Agartwal A, Panja AK, Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study, JOA XIII-3, 2019; 149 - 154

Patient was not willing to continue modern therapy and approached ayurveda. So ayurveda treatment was started.

Therapeutic focus and assessment

In this case, procedures mentioned in galganda chikitsa were continued up to 2 months. Shiropichu, karnpurana with sessme oil were given as patient was showing the symptoms of aggravated vata.[11] Simultaneously, nasya with nirgundi oil[12] (mentioned in galgandachikitsa) and kottamchukyadilepa[13] containing sarshapa, rajika, lehsuna was given as local application for reducing the swelling result handed of vata and medovradhi in neck region. Panchakola powder[14] was given as oral medicine for agnidipana and vatakaphanashana. varunadikwatha[15] tablets and gomutraharitaki[16] were given for alleviating excessive meda and vata.

Follow up and outcome

A significant improvement was noted in this case in both classical signs and symptoms as well as in blood investigations. There were improvement in symptoms such as swelling (shotha), svarabhramsha (hoarseness of voice). TSH value went down and came in normal limit as mentioned below. Patient was not on any modern medication during treatment. WHO goitre grading system was followed to analyse the features of goitre and voice scale also was used.

Table II: Treatment Given

Table III: BT and AT comparison and Assessment

Treatment & intervention Details of treatment given Dose Anupana Duration

Shamanchikitsa

Panchkola powder 5grm BD with food 2months Aamlaki swarasa 20ml in morning 2months

Varunadi kwatha tab 2tab/BD warm water 2monthsGomutra haritaki powder with

jaggery 5gm OD at night warm water 2months

Dashmool decoction 50ml BD 2monthsPanchakarma

procedure

¾Lepa Kottamchukyadi lepa for local application around neck region As per need

with butter milk and mustard

powder2months

¾Nasya Nirgundi oil 2drops (nasal drop) 2months

¾Shiropicchu Sesame oil As per need 6months

¾Karnpurna Sesame oil 2drops (in each ear) 6months

The WHO Goitre Grading System Grading

BT Grade 2Goitre visible when neck is in the normal position

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Agartwal A, Panja AK, Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study, JOA XIII-3, 2019; 149 - 154

Table IV: BT and AT comparison and Assessment

Table V: BT and AT comparison and Assessment

AT Grade 0This is when the goitre is not palpable or visible even when the neck is extended.

Scale for analyzing dysphonia Grading

BTGrade 3

Moderate dysphonia

AT Grade 1Subjectively normal voice

TSH VALUE Value

Before treatment (16-11-18) 11.07uI/ml

After treatment (dated 07-03-2019) 4.43uIU/ml

Discussion

When vata and kapha along with meda are aggravated separately or in association with each other in neck and carotid region, then they produce glandular swelling gradually and show symptoms accordingly. This disease is known as galganda.[17]

Characteristics of galganda[18] depend upon the condition of dosha and its association. If vata associates with meda then the swelling becomes unctuous and painless, develops slowlyanddoes not suppurate.[19] In addition to that, due to association of vata, tastelessness in mouth and dryness of palate and throat occur accordingly.[20]

In this case, patient developed glandular swelling slowly. Most of the patient’s symptoms namely dryness of mouth specially palate, thirst,dryness of skin and

krurakosthatha etc. we recorrespond to vata vitiation[21] Swelling was painless, unctuous and non- suppurative which was showing symptoms of vata and meda associated galganda. Patient had mandaagni, avara ahara and jaran shakti which signifies low digestive capacity due to medo, vata andkapha association.Therefore, panchkola was given for alleviating excessive meda andopen up the channels of vata and kapha andis having dipana property also. Patient had avarasara, so, was not able to tolerate stronger medicines. Therefore external application such as lepa and nasya were used which don't need to take orally and also have been said to use profoundly in galgandaroga. Aamlakisvarasa was given as a namitikarasayana.

Conclusion

The above-mentioned case study shows that the

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symptoms of goitre associated hypothyroidism can be successfully treated in accordance with the basic principles of Ayurveda. This study can support in further research of the treatment of goitre associated hypothyroidism with the help of Ayurveda principles.

Declaration of the patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given consent for clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Agartwal A, Panja AK, Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study, JOA XIII-3, 2019; 149 - 154

1. https://en.wikipedia.org/wiki/Goitre

2. https://en.wikipedia.org/wiki/Goitre

3. https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

4. https://www.mayoclinic.org

5. https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(14)70208-6.pdf

6. Acharya, Vaidya Jadavji Trikamji &Kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 22, pp 246

7. Vagbhaṭa: Astanghrdayam: Commentaries Sarvangasundara of Arundatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Sutrasthana; 11/ 5-6, pp 183

8. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 23, pp 246

9. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Sutrasthana; 1/ 8 ,pp 7

10. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram

Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 23, pp 246

11. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000;Sutrasthana; 2/ 8,pp 26

12. Anonymus: Yogaratnakara Vaidya Lakshmipati Shastri with vidyotini Hindi commentary by Bhaisagratna Brahmasankar Sastri, Chaukhambha prakashana, Varanasi, Gandamala-Apachi Chikitsa/68, pp 588

13. Anonymus: Sahasrayogam Hindi commentary by Dr. Ramnivas Sharma. Dr Surendra Sharma; Chaukhambha Sanskrit Pratisthan, Varanasi, Revised Edition 2012, TailaPrakarana , Pp295

14. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Sutrasthana; 6/ 166, pp 120

15. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Sutrasthana; 15/ 22, pp 236

16. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Chikitsasthana; 17/ 3, pp 705

17. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 22, pp 246

18. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 22, pp246

19. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 23, pp 246

20. Acharya, Vaidya Jadavji Trikamji & kavyatirtha, Narayan Ram Acharya: Susruta Samhita With Commentries Nibandhasamgraha Of Dalhana And Nyayacandrika Panjika Of Gayadasa On Nidana Sthana; Chowkhamba Orientaliya,Varanasi, 7th Edition, 2002, Nidanasthana 11/ 24, pp 246

21. Vagbhaṭa: Aṣṭanghṛdayam: Commentaries Sarvangasundara of Aruṇdatta and Ayurvedarasayana of Hemadri: Edited by Pt. Bhisagacharya Harishashtri Paradkar Vaidya :Krishnadas Academy , Varanasi: Reprint 2000; Sutrasthana;11/ 5-6, pp 18

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Agartwal A, Panja AK, Ayurveda Management of Goitre with Hypothyroidism – A Single Case Study, JOA XIII-3, 2019; 149 - 154

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ORIGINAL REASEARCH ARTICLE - CASE STUDY

A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study

*Dr. Anil Kumar Soni, **Dr. Gopesh Mangal

*P.G.Scholar, **Associate Professor, Department of Panchkarma, National institute of Ayurveda, Jaipur.

ABSTRACT

All type of skin disease is described under broad heading Kushtha, no any disease can exactly have correlated with psoriasis, but Mandala Kushtha type of Maha Kushtha can be correlated with psoriasis. Psoriasis is chronic papulo-squamous disorder characterized by well-defined erythematous plaque with silvery, large loose scales, accentuated by grating the lesions. It affects patient physically, socially as well as economically. Treatment available on contemporary system is only suppressive but not curative. It affects 2.5% of world’s population. Acharya Carak mentioned Shodhan therapy for expulsion of morbid Dosha of Kushtha Rogi. For present study, a 40 years old Hindu male patient having history, ofwell-defined erythematous scalylesion over the scalp, Trunk, back, bilateral upper limband lower limb with itching since last 3 year was registered. Considering the signs and symptoms of patient was treated in the lines of Kushtha Vyadhi Chikitsa. Classical Vamana & Virechana Karma was done for the management of disease along with Pathya-Apathya. Patient had significantly relieved in lesion with this line of treatment.

Keywords : Mandala Kushtha, Psoriasis, Shodhana therapy.

Address of Correspondence: Dr. Anil Kumar SoniP.G.Scholar, Department of Panchkarma, National institute of Ayurveda, Jaipur

Email ID : [email protected]

Contact No :9589835035

Introduction:

In present scenario majority of patients comes to the hospitals are suffering from Skin disease. Psoriasis is one of the main skin disease from patient suffers a lot, due to its relapse and incurable condition. All type of skin disease is described under broad heading Kushtha, no any disease can exactly have correlated with psoriasis, but Mandala Kushtha type of Maha Kushtha[1] can be correlated with psoriasis due to similarity of its sign & symptoms. Psoriasis is chronic papulo-squamous disorder characterized by well-defined erythematous plaque with silvery, large loose scales, accentuated by grating the lesions. It affects patient physically, socially as well as economically. It affects 1-3% of thepopulation.[2] It shows up anywhere- on the eyelids, ears, mouth and lips, skin folds, hands and feet, and nails[3]. Overall incidence of Psoriasis among total skin patients is 1.02% in India

How to Site the Article : Soni AK, Mangal G, A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

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Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

and Treatment available on contemporary system is only suppressive but not curative, thus whole world concern towards Ayurveda to establish safe & effective treatment for psoriasis. Acharya Caraka mentioned Shodhan Chikitsa for Kushtha Rogi[4], thus in this present study we planned Vamana with Jeemutaka Yoga[5] followed by Virechana with Trivritadi Yoga[6] for the management of this disease.

Further discussed patient is known Case of psoriasis showing classical symptoms with positive Auspitz sign. Patient had history of small papules appear on scalp & trunk and itching starts first before 3 year than it gradually spread onwhole over body surmounted with silvery scales and severity of itching increase day by day. Patient taking a lot of medication but he had no significant relief. Patient

was diagnosed as a case of Mandal Kushtha and was treated according to principal of treatment of Kushtha (Mandal Kushtha). He received Vaman with Jeemutaka Yoga followed by Virechana with Trivritadi Yoga[7] for Shodhan treatment. Remarkable improvement was noticed in scaling, induration and itching just after Vaman and Virechan treatment and residue only demarcation & blackish lesion.

Case Report:

A 40 yrs. old male registered by the O.P.D. No. 38827122018 on the date of 27/12/2018 came to O.P.D. No. 02 of National Institute of Ayurveda.

Basic information of patient:

Age 40 yrs. Pulse 80/minuteSex Male B.P. 110/70 mmHg

Region Hindu Appetite Decreased Socio-economic

status Lower-middle class Bowel habit Irregular

Diet Vegetarian Urination Normal, 4-5 times in a day

Marital Status Married Sleeping pattern Sound

There is no any abnormality found in haematological investigation.

Pradhanvedana (chief complain)

• Lesion on scalp, lower back, abdomen, bilateral upper arm, and lower leg with well demarcation.

• Lesion surmounted with silvery scales and falling after rubbing

• Severe itching present

• Patient suffer from last 3 years

Proper systematic examination and finding with positive Auspitz sign decided that patient suffer from psoriasis and treatment protocol were decided Shodhana Chikitsa, for complete purification. For this we planned Vamana with Jeemutaka Yoga followed by Virechana with Trivritadi yoga along with Pathya- Apathya.

Treatment Protocol:

All explain about Vamana and Virechana Procedure and its necessity for the treatment given to the Patient fristly. We first administered Vamana with Jeemutaka Yoga than Virechana with Trivritadi Yoga for complete purification with the aim ofsignificant relief.

Intervention:

Patient was admitted in I.P.D. ward of National Institute of Ayurveda Hospital and consent was obtained from patient on standard protocol followed in our hospital.

Purvakarma: (27/12/18-07/01/19)

Deepan & Pachana:

Panchkol Churna[8] 5 gm two times in a day for five days (27/12/18-31/12/18) with the aim of Ama Pachana and enhancing the Digestive Power.

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan157

Abhyanter Snehpana (01/01/2019-05/01/2019): Abhyantar Vardhamana Snehpana with Go-Ghrit was administered till Samyak Snigdha Lakshana achieved. During Snehpana, Sneha-Jiryamana and Jirna Lakshana were observed for assessment of next day’s dose of Sneha.

1st day – Test dose of 30ml Go-Ghrit given at 7:00 AM to patient

2nd day – 60ml

3rd day – 90ml

4th day – 120ml

5th day – 150ml

Snehpana was completed after obtaining Samyak Snigdha Lakshan. Hot liquid and light diet (easy to digestible) were advised in this period and regularly vitals were checked.Vishrama-Divasa (06/01/2019): In 6th day which is known as rest day, patient was advised Sarwanga Abhyanga & Vashpa Swedana in the morning. In same night Kaphotkleshaka Ahara like rice with curd, and Dalaof black gram was advised.

Pradhankarma (07/01/2019):In next morning of rest day, he was advised to came after taking bath & relief from natural urges. Sarvanga Abhyanga and Vashpa Swedan was done in the morning. Than Vamana Yoga- Jeemutaka Phant was ingested just after full of stomach (Akanthpana) with Yavagu (rice soup) with rock salt and Go-Ghrita. After ingestion of this Vamana Yoga wait till Vamana Vega not started. Once were started Vamanopaga-Yashtimadhu Phanta was given repeatedly till Samyak Shudhi Lakshan was not achieved.

VamanaYoga:

Preparation: Dry Fruit of Jeemutaka-12 soaked with 150 ml hot water at night. At morning-soaked fruit were properly squeeze than it filtered with sieve & before administration it warmed up to lukewarm than mixed honey & Saindhava Lavana in it.

Dose: Jeemutaka Phanta- 120 ml, Madhu- 50 ml,

Saindhava Lavana - 2 gm.

Vamana Karma observation: after assessment of Vamana Karma, patient achieved Uttam Shuddhi. In accordance of Vaigiki- 7 Vega, Antaki- Pittant, & Laingiki-Pravara Shuddhi were achieved.

Paschatakarma: After taking some rest patient were advised to clean his face hand & feet. After 20-minute Dashmoola Dhoompana was given to the patient. Samsarjan krama (07/01/2019-13/01/2019) was advised for the 7 days considering to Pravara Suddhi for candling the Agni.

Virechanakarma:

Purvakarma(15/01/2019-20/01/2019):

Abhyantara Snehpana: Abhyantara Snehapana

was given with Go-Ghrita after one day of completion of Samsarjana Karma in gradually increasing dose from 50 ml on 1st day to 150 ml on 3rd day respectively. After assessing Samyaka Snigdha Lakshana, Snehpana was completed and he was advised Sarwang Abhyanga with Dashmoola Taila and Vashpa Swedana for 3days. He was advised hot, liquid & lightdiet in this period. Patient was advised Snigdha Yusha with Daliya (coarse wheat granules) in previous night of Virechana Karma.

Pradhanakarma(21/01/2019):

After three rest day, in the next morning patient was advised to came after taking bath and pass natural urges and Sarvanga Abhyanga and Vashpa Swedana was given in the Morning. Virechana Yoga was administered after Kapha Kala - 10:30 AM in empty stomach.

Virechana Yoga:

Dose: Tripha Kwatha- 150 ml, Trivrita Churna-15gm, Danti Churna- 10gm.

Anupana- Draksha Panaka.

Patient was advised to had sips of Draksha Panaka and sudation of abdomen with hot water bag to continue the motion. Proper monitoring of vitals is done frequently to prevent any possible adverse effect.

Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

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Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

Table no. I - Observations:

Time Vega Consistency Blood Pressure Pulse11:50 p.m. 1 Semisolid 120/80 mm of Hg 84/minute12:30 p.m. 2 Semiliquid 112/80 mm of Hg 88/minute01:00 p.m. 2 liquid 116/80 mm of Hg 94/minute01:20 p.m. 1 liquid 112/74 mm of Hg 90/minute02:30 p.m. 2 liquid 114/76 mm of Hg 88/minute03:15 p.m. 1 liquid 110/74 mm of Hg 88/minute04:40 p.m. 1 liquid 110/76 mm of Hg 82/minute06:10 p.m. 1 liquid 112/74 mmof Hg 78/minute09:00 p.m. 1 liquid 110/70mm of Hg 80/minute

Emergency medicines provided to the patient for any type of emergency conditions.

Paschatkarma:

Samsarjan krama was advised for 5 days according to Madhyama Shuddhi. He was advised for Parihar Vishaya (strict diet and rest) for some time to get homeostasis.

Follow up: Patient was advised about Pathya-Apathya & visited after 15 days of completion of Samsarjana Krama.

Assessment: assessment was done on the basis of PASI score.

Table no. II –The Psoriasis Area and Severity Index (PASI) is a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance.

Plaque Characteristic Lesion score Head Upper

Limbs Trunk Lower Limbs

Erythema 0 = None1 = Slight

2 = Moderate3 = Severe

4 = Very severe

Induration/ Thickness

Scaling

Add together each of the 3 scores for each body region to give 4 separate sums (A).Lesion Score Sum (A)

Percentage area affected Area score Head Upper

Limbs Trunk Lower Limbs

Area Score (B) Degree of involvement

as a percentage for each body region

affected (score each region with score

between 0-6

0= 0%1 = 1% - 9%

2 = 10% - 29%3 = 30% - 49% 4 = 50% - 69% 5 = 70% - 89%

6 = 90% - 100%

Multiply Lesion Score Sum (A) by Area Score (B), for each body region, to give 4 individual subtotals (C).Subtotals (C)

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Journal of Ayurveda Official publication of National Institute of Ayurveda, Jaipur, Rajasthan159

Multiply each of the Subtotals (C) by amount of body surface area represented by that region, i.e. x 0.1 for head, x 0.2 for upper body, x 0.3 for trunk, and x 0.4 for lower limbs.

Body Surface Area x 0.1 x 0.2 x 0.3 x 0.4Totals (D)Add together each of the scores for each body region to give the final PASI Score.

Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

Table no. III -Results:

Sr. No. BeforeTreatment After SamsarjanaKrama of VamanaKarma

After follow up (15 days after VirechanaKarma

Date 27/12/2018 14/01/2019 09/02/2019PASI Score 23.7 20.1 8.4

After assessment of patient’s condition, considerable improvement observed in his symptoms gradually specially in induration, scaling and itching after Vamankarma. But moderate improvement was observed after Virechana Karma but after 15th day of Virechana Karma itching subside and good improvement observed in Skin lesion with residue of only peripheral demarcated line & blackish discolouration.

Discussion: � According to Acharya Caraka Kushtha is a

Bahudoshaja and Kleda Pradhana Vikara. He also emphasized the importance of Sapta Dravya (Tridosha and Twak, Rakta, Mamsa, & Ambu), these Sapta Dravya are Sannikrishta Hetu for Kushtha Rogi.[9] It means Kushtha is Tridoshaja Vyadhi[10].Whenever the Dosha-Dushya-Sammurchchana occurs at Twak Dhatu, Kushtha will be appeared. Thus, Acharya Caraka mentioned Vamana & Virechana in Bahudosha Avastha of Kushtha Rogi. After expulsion morbid Dosha, Samprapti Vighatana occurred because Tridosha were also be a part of Samprapti. Samshodhana cause for Kleda Harana & also correcting Agni, which are also cause for Kushtha.

Probable mode of action:

Purvakarma: Purva Karma[11], Dipana-Pachana, Snehana and Swedana are essential for Shodhana Karma. Dipana candling the Agni,[12] & Pachana digest

Ama,[13] Snehana[14] does Vridhi (increasing fluidity) & Vishyandana (liquification) of Dosha and Mardavata (softening) of body tissue (Dhatu) & Channels (Shrotasa) and Swedana[15] causes disintegrate the complex (Sangha) with its Ushna Guna. It means Purvakarma helps in mobilization of Dosha from Shakha to Koshtha for expulsion from nearest possible rout through Shodhana Chikitsa.

Pradhanakarma: Pradhanakarma means Vamana and Virechana was given with the aim of complete evacuation of morbid Dosha because all type of Kushtha are Tridosaja in nature. Mandala Kushtha is Kapha dominant Tridoshaja Vyadhi. Acharya Caraka mentioned Vamana and Virechana in the management Kushtha in Bahu-Doshavastha.[16] After Vamana and Virechana patient got good relief in his symptom.

Samsarjankrama:

Samsarjana Krama means strict diet regimen which was planned after Shodhana Chikitsa as per type of Shuddhi for candling Agni, which was diminished due to Sanshodhana Chikitsa. In Samsarjana Krama light and easy to digest food was are prescribed to restore appetite.

Conclusion:

Psoriasis which is a type of Skin disease correlated with Mandala Kushtha, was managed according to Kushtha Vyadhi and planned Vamana with Jeemutaka & Virechana Karma with Trivritadi Yoga in this study.

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Soni AK, Mangal G,A Significant Effect of Shodhana therapy on Mandala Kushtha: w.r.s. Psoriasis: A Single Case study, JOA XIII-3, 2019; 155 - 160

After completion of treatment significant result observed, thus we can say further study in huge scale will be conducted for establishment of management of psoriasis.

References

1. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, ,Chikitsasthana chapter no. 07 verse no. 16 Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 451.

2. Consuelo Huerta, MD, MPH; Elena Rivero, MD, MPH, FISPE: Luis A. Garcia Rodriguez, MD, MScIncidence and Risk Factors for Psoriasis in the General population,

3. www. Psoriasis.org/about-psoriasis.

4. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 7 verse no. 41, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 452.

5. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Siddhisasthana chapter no. 11 verse no. 12, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 727.

6. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 07 verse no. 44, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 452.

7. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 7 verse no. 44, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 452.

8. Shrivastava Shailja, Sarangadhar Samhita of Acharya Sarangadhar, Jiwanpradahindi commentary, Madhyam Khanda, Chapter no. 6 verse no. 13-14, Chaukhambhaorientalia, Varanasi Fourth edition

2005, p. 175.

9. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 07 verse no. 09, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 450.

10. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Nidanasthana chapter no. 05 verse no. 04, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 216.

11. Tripathi Bramhan and, Srimad vagbhata, Astanga Hridayam, Nirmala Hindi Commentory, Sutra Sthana chapter no.13, verse no-29. Reprinted 2014; Chaukhamba Sanskrit Pratishthan Delhi, p. 188.

12. Shrivastava Shailaja, Sharangadhar Samhita of Acharya

Sarangadhar, Jiwanpradahindi commentary, Purva Khanda Chapter no. 04, verse no. 01, Chaukhambha Orientalia, Varanasi, 4th Edition, p. 30.

13. Shrivastava Shailaja, Sharangadhar Samhita of Acharya Sarangadhar, Jiwanpradahindi commentary, Purva Khanda Chapter no. 04, verse no. 02, Chaukhambha Orientalia, Varanasi, 4th Edition, p. 30.

14. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Sutrasthana chapter no. 22 verse no. 11, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 120.

15. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Siddhisthana chapter no. 01 verse no. 07-08, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 678.

16. Vaidya Yadavji Trikamji Acharya, Caraka Samhita of Agnivesha, Ayurveda Dipika commentary- Sri Cakrapanidatta, Chikitsasthana chapter no. 7 verse no. 41, Chaukhamba Surbharati Prakashan, Varanasi Edition 2016, p. 452.

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