Journal of Ayurvedajournalofayurveda.in/uploads/newissues/JOA-VII-July...Journal of Ayurveda Vol.VII...

Vol.VII No.3 Jul-Sep 2013 Journal of Ayurveda

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Journal of Ayurveda

A Peer Reviewed Journal

Vol.VII No.3 Jul-Sep 2013

Contents

Editorial

Editorial- Ayurvedic Management of Life Style Related Disorders 03

w.s.r. Madhumeha (Diabetes Mellitus) - Prof. Ajay Kumar Sharma

Clinical Studies

Clinical Evaluation Of The Efficacy Of A Herbal Preparation And Kati Basti 04

In The Management Of Gridhrasi Roga W.S.R. To Sciatica

Dr. Avneesh Kr. Dwivedi, Prof. Ajay Kr. Sharma

A Single Herbal Drug (Abutilon Indicum), For Complaints During Pregnancy 18

Dayani S, Mistry IU, Skandhan KP, Jyothishi H

Effect Of Panchokola Churna In Hypercholesteromia -A Clinical Study 25

Dr Surendra Kumar Sharma, Dr Loknath Sharma, Dr Ranjita Ekka

Clinical efficacy of Haridradi Taila Basti in Orthostatic Hypotension in 32

Diabetic Cardiac Autonomic Neuropathy

Vd. Mukesh B. Shukla, Vd. Surekha Abhale

Ayurvedic Diagnosis and treatment of Relapsed Malarial Fever in old aged patient 38

with Chloroquine Intolerance: A Case Study

Dr. Deshpande Shailesh V., Dr. Deshpande Vaishali S.

Chemical Study Of Madhu W.S.R. To It’s Aharaviruddha Swabhava 43

Dr. Shilpa Walkikar, Prof. N.S.Chundawat

The Appearance of lesions in Skin Disease w.s.r to Psoriasis. 52

Dr. Sisir Kumar mandal, Dr.Papri Nath, Dr. A.B.Thakar, Dr.M.S.Baghel

A Comparative Study of Punarnavadi Guggulu and Panchwalkaladi Kwatha 59

Uttarabasti with Panchwalkaladi Taila Pichu in the management of

Paripluta Yonivyapada w.s.r. to PID (Pelvic Inflammatory Disease)

Dr. Durgesh Nandini, Dr. Sarveshwer Prasad, Dr. Sushila Sharma

Clinical evaluation of Chitrakadi Churna combined with the 7 2

Kshar Vasti in the Management of Amavata (Rheumatoid Arthritis)

Dr Krishna Singh Napalchyal, Dr Sameer Shinde, Dr Jai Prakash Singh, Dr Daya Shankar Mishra.

Journal of Ayurveda Vol.VII No.3 Jul-Sep 2013

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Contributions are invited in the form of :

Research Papers–Randomized trials, interventionstudies, studies of screening and diagnostic tests, cohortstudies, cost-effectiveness analyses, and case control studies.

Short Communications– Brief accounts ofdescriptive studies, initial/partial results of a larger trial,and a series of cases;

Correspondence– Letters commenting upon recentarticles in Journal of Ayurveda, other topics of interest oruseful clinical observations. Debate on important issues suchas those raised in the editorial forum are most welcome.

Images in practice– Interesting and original imageswhich are worth a thousand words and help understand aparticular concept. Images should accompany a certificateof ownership.

A major criteria for acceptance of an article will beaddition to existing knowledge and as such manuscripts arerequired to include ‘what this study adds’.

2 copies of Books may be sent for book reviewsection.

A Study of the Vishaktata (Toxicity) of Madya (Ethyl Alcohol) on Oja Dhatu 81

in Human Body - Dr. Sharad Porte

Physiological Study

Menstruation & Prakriti 98

Dr. C.R. Yadav, Dr. Ashok Kumari, Prof. M.S. Meena

Pharmaceutical Studies

Toxicity Study of Lauha Bhasma W.S.R To Biochemical Parameters 104

Dr. Namrata Joshi Dash, Dr. Manoj Kumar Dash, Dr. G. D. Khilnani, Dr. L.K.Dwivedi

Evaluation of Ayurvedic Compound Formulation - Vidangadi Churna 111

Dr. Ashok Kumar Tiwari, Dr. Manoj Tripathi, Dr. Neelesh Dwivedi, Mr. Pushpendra Kumar Shukla

Dr. Anil Jaiswal, Ritu Mishra, Mr. Sharda Prasad Tripathi

Survey Study

A cross sectional survey based study on Shwetapradar (vaginal discharge) 118

in the women of reproductive age group.

Dr. Poonam choudhary, Dr. Laxmipriya Dei

Instructions for Authors 132

Short Communication

Institute News - N N Kutty 147

Subscription Details

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Demand draft to be made in favour of

“Director, NIA, JAIPUR


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EDITORIAL

Ayurvedic Management of Life Style RelatedDisorders w.s.r. Madhumeha

(Diabetes Mellitus)

The term Life Style incorporates Ahara (Food Habits) and Vihara (Life Style including conduct). Lastera represented the era of Communicable and infectious diseases whereas in this era various Life Style Related

Disorders are increasing in their incidence in our society at a very rapid pace. Some of the common ailmentsoccurring due to inappropriate indulgence in faulty dietary habits and Life Styles include – Sthaulya (Obesity),Medo Roga (Dyslipidemias), Madhumeha (Diabetes Mellitus), Vyan Bala Vikriti (Hypertension) and Hrid Roga

(Cardio-Vascular Disorders) etc. It is interesting to note that the Ayurvedic Classics have emphasized therole of faulty life style and inappropriate dietary habits in the causation and pathogenesis of these diseases,thousands of years ago. It is noticed that most of the life style related disorders may be prevented by

following modified life style and dietary habits as described in Ayurveda in terms of Dincharya, Ratricharya,

Ritucharya and Pathya-Apathya. Once these disorders establish themselves in the human body it becomesreally difficult to cure them inspite of every possible measure employed in their management. Ayurveda

has emphasized that for effective prevention and management of such disorders Nidana Parivarjana, Pathya-

Apathya (Modified – Dietary habits) and modified Vihara (Life Style modification including improved codes& conducts of life) play pivotal role.

Diabetes Mellitus has striking resemblance with Prameha Roga particularly Madhumeha as describedin Ayurvedic Classics. Diabetes Mellitus is defined as a disturbance of intermediary metabolism manifestingas chronic sustained hyperglycemia primarily due to either as absolute or a relative lack of insulin. This

may be accompanied by other biochemical disturbances and the presence of progressive diabetic tissuedamage with microvascular and macrovascular complications. In Ayurvedic classics detailed description ofPrameha – Mdhumeha is available which include its causes, clinical manifestations, principles of managements

and complications. The specific features of Samprapti of Prameha – Madhumeha include (a) Initiating Dosha

– Kaph, Bahu Drava Shleshma (b) Triggering Dosha – Vata (c) Ten dushyas – Meda, Mansa, Kleda, Shukra,

Shonita, Vasa, Majja, Lasika, Rasa & Oja (d) Depletion of Dhatwagni. The description of Prameha –

Madhumeha clearly depicts involvements of all body systems. Lot of emphasis has been given on thedepletion of Oja as a complication of Madhumeha.

Merely keeping Blood sugar level within physiological limits does not guarantee the cure of Diabetes

Mellitus. It is observed that although the blood sugar level may be within normal limits but the pathogenesisand the devastating effects of Diabetes / Madhumeha continue to manifest involving all the organs of thebody in the form of various complications.

The classical Ayurvedic principles of management of Diabetes/Madhumeha include Nidana

Parivarjana, Dietary modifications (Pathya-Apathya), modified life styles (Vihara), Sanshodhana

(Purificatory) chikitsa and Sanshamana (Palliative) chikitsa with great emphasis on the administration of

Naimittika Rayana Chikisa.

Prof. Ajay Kumar Sharma

Director


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Clinical Evaluation Of The Efficacy Of A Herbal PreparationAnd Kati Basti In The Management Of Gridhrasi Roga

W.S.R. To Sciatica

* Dr. Avneesh Kr. Dwivedi, ** Prof. Ajay Kr. Sharma

Clinical Study

Abstract

The study was conducted in 30 clinically diagnosed patients of Gridhrasi Roga(Sciatica) with anobjective of clinical evaluation of a CAP.PARIJAT PATRA GHANA and KATI BASTI in the management ofGridhrasi Roga(Sciatica). These patients were divided into three groups of 10 patients each. Patients of group-

A administered CAP.PARIJAT PATRA GHANA 500 mg BD with lukewarm water for 1 month, patients ofgroup-B were administered and KATI BASTI with Dashmoola Taila for 21 days and patients of group-C wereadministered CAP.PARIJAT PATRA GHANA 500 mg BD with lukewarm water for 1 month and KATI BASTI

with Dashmoola Taila for 21 days, simultaneously.

It was observed that the patients of Gridhrasi Roga(Sciatica) of group-C had shown maximumpercentage of improvement, whereas it was moderate in patients of group-B and patients of group-A had

shown mild improvement. No side effects were reported, in any of the patients in all the three groups, duringthe trial period.

Key Words :- Gridhrasi Roga, Sciatica, Kati Basti, Herbal Preparation

‚Ê⁄Ê¢‡Ê —-

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ÁøÁ∑§à‚Êà◊∑§ •äÿÿŸ ◊¢ flª¸ 3 ∑§ ⁄ÊÁªÿÊ¢ ◊¢ ©ûÊ◊ ¬Á⁄áÊÊ◊ ¬˝Ê# „È∞, ¡’Á∑§ flª¸ 2 ∑§ ⁄ÊÁªÿÊ¢ ◊¢ ◊äÿ◊ ¬Á⁄áÊÊ◊∞fl¢ flª¸ 1 ∑§ ⁄ÊÁªÿÊ¢ ◊¢ •fl⁄ ¬Á⁄áÊÊ◊ ¬˝Ê# „È∞–

ÁøÁ∑§à‚Êà◊∑§ •äÿÿŸ •flÁœ ∑§ ºÊÒ⁄ÊŸ ⁄ÊÁªÿÊ¢ ◊¢ Á∑§‚Ë ÷Ë ¬˝∑§Ê⁄ ∑§ ¬Ê‡fl¸ ¬˝÷Êfl Ÿ„Ë¢ ¬Êÿ ªÿ–

*P.G. Scholar, P.G. Deptt. of Kaya Chikitsa, N.I.A., Jaipur, ** Director, N.I.A., Jaipur


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Introduction

Human beings desire of having good livingwith healthy life. For this purpose they have beenvery keen and conscious in maintaining a disease

free society. In ancient time they followed nature’srule and lived freely without any stress in their life.But now-a-days people are busy in their routine

works and unaware to maintain their health.Consequently, they are being susceptible to variouskinds of life style disorders. Gridhrasi Roga (Sciatica)

is one of them.

The low back pain is common problem seenin persons, commonly, in modern era. Out of which

40% persons have radicular pain and this comesunder the umbrella of Sciatica-Lumbago-Syndrome.Such presentation was, also, common in olden periodand ancient science of life named it as Gridhrasi

Roga. It is considered as Shoola Pradhan VaatVyadhi. Many researches were conducted on thisdisease, but still the complete cure of this is mirage.

Gridhrasi indicates the typical gait thatresembles of a bird “Gridhra”i.e.vulture, which isoften seen in patients of Gridhrasi Roga.

The cardinal clinical features of GridhrasiRoga are –

l Ruka(Pain)-Toda(PrickingSensation)-Stambha

(Stiffness) - Muhurspandan in the Sphika – Kati– Uru – Janu – Jangha – Pada in order

l Sakthikshepan – Nigrah i.e.restricted lifting of

lower limb

In Kaphanubandh Tandra, Arochak andGaurav are also present.

The clinical features seen in Gridhrasi Rogacan be well correlated with Sciatica of modernmedicine. Sciatica is very painful condition, in which

pain begins in lumbar region and radiate along the

postero-lateral aspect of thigh and leg. Hencemovement of affected lower limb is restricted and

patient is not able to walk properly.

The incidence of back pain in world isunderscored by the following:-

l The annual societal cost of back pain in theUnited States is estimated to between $20 and$50 billion.

l Back Pain is the most common cause of disabilityin patients.

l 50% working adults, in one survey, admitted to

having a back injury each year.

l Approximately 1% of the U.S. population ischronically disabled because of back pain.

l According to a survey, Low Back Pain isextraordinarily common and second to commoncold.

l Lifetime prevalence of Low Back Pain rangesfrom 60% to 90% and annual incidence of 5%.

l Prevalence of Sciatica ranges from 11% to 40%.

No population appears immune although physicalfitness might maintain the health.

Since, medical science recognizes the gravity

of this problem , therefore a medicament whichrelieves the pain , improves the functional ability ,restores from functional disability and controls the

condition with cost effectiveness , is the need. Thisneed should be systematically evaluated for efficacyand safety.

Sequential administration of the Snehan,Swedan, Basti, Siravedh and Agnikarma are lines oftreatment of Gridhrasi as expounded in the

Ayurvedic literature. Apart from these procedures,the line of treatment that can be given at O.P.D.

Clinical Evaluation Of The Efficacy Of A Herbal PreparationAnd Kati Basti In The Management Of Gridhrasi Roga

W.S.R. To Sciatica

Dr. Avneesh Kr. Dwivedi, Prof. Ajay Kr. Sharma

Clinical Study


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level, very easy to administer and be very effective,is yet to be established.

Many herbs , for the management ofGridhrasi Roga, are described in Ayurvedicliterature and their therapeutic effect is yet to be

explored. On the quest of such an effective, ifpossible, radical management of Gridhrasi Roga, wecame across some very effective drugs , which have

been individually proven successful such as ParijatPatra and Kati Basti with Dashmoola Taila. Thesedrugs having very effective properties in Vatvyadhi

and given good result in various researches onclinical trials. For a better and stable result, acombination of both the drugs was selected for trial.

Materials And Methods

l Aims and Objectives Present research work hasbeen undertaken with following four main objectives-

1 . Conceptual and clinical studies on the GridhrasiRoga w.s.r. to sciatica.

2. To assess the efficacy of a HERBAL

PREPARATION and KATI BASTI in themanagement of Gridhrasi Roga w.s.r. to Sciatica.

3. To compare the relative efficacy of a HERBAL

PREPARATION and KATI BASTI in themanagement of Gridhrasi Roga w.s.r. to Sciatica.

4. To assess the combined efficacy of HERBAL

PREPARATION and KATI BASTI in themanagement of Gridhrasi Roga w.s.r. to Sciatica

l Materials and Methods :-

1) Selection of cases – The study was conducted on30 clinically, pathologically and radiologically

diagnosed patients of Gridhrasi Roga(Sciatica). Theselection of patients was made from O.P.D.\I.P.D.wing of P.G. Department of Kayachikitsa, N.I.A.,

Jaipur.

(2) InclusionCriterias -

l Apparentaly normal individuals in the age group

of 15-75years of either sex suffering from GridhrasiRoga.

l Vataj and Vata-Kaphaj both types of Gridhrasi

Roga.

l Sciatica(Gridhrasi Roga) due to discprolapsed(L4-5 or L5-S1).

l Sciatica(Gridhrasi Roga) due to AnkylosingSpondylitis.

l Sciatica(Gridhrasi Roga) due to Spinal Stenosis.

l Sciatica(Gridhrasi Roga) due to Spondylolisthesis.

(3) Exclusion Criterias –

l Gridhrasi Roga more than 10 years old.

l T.B. Spine, Tumours of Spinal Cord, Malignancyof Pelvis.

l Diabetic Neuropathy, Cauda-equina Syndrome.

(4) Trial Drugs- The HERBAL PREPARATION andDASHMOOLA TAILA were selected as trial drugs, forevaluating their role in the management of a series

of patients of Gridhrasi Roga.

A. HERBAL PREPARATION (Chakradatta,

Vatvyadhi 22/97)

lllll Ingredients:-

S.No. Drug Botanical Name Part Used

1 . Parijat Nyctanthes arbor-tristis Leaf

lllll Method of Preparation:-

Ghan Satva was made from the decoction of

the leaves of the Parijat. Ghan Satva was dried andfilled in the capsules in the dose of 250 mg in eachcapsule.

lllll Dose:- 2 Cap., Two times in a day, withlukewarm water, for 30 days.


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B. DASHMOOLA TAILA

lllll Ingredients:-

S.No. Drugs Botanical Name Parts Used

1 . Bilva Aegle mormelos Moola(Root)

2. Syonak Oroxylum indicum -do-

3. Patla Stereospermum suaveolens -do-

4. Agnimanth Premna mucronata -do-

5. Gambhari Gmelina arborea -do-

6. Salparni Desmodium gangeticum -do-

7 . Prisniparni Uraria picta -do-

8. Brihti Solanum indicum -do-

9. Kantkari Solanum surattense -do-

10. Gokshura Tribulus terestris -do-

11 . Tila Taila Sesamum indicum Seed’s Oil

l Method of Preparation:-

All the components of Dashmoola Taila,except Tila Taila were taken to form Kvath and Kalka.This Kalka and Kwath was mixed with Tila Taila and

boiled continuously till the sign of Samyak Pakappeared.

lllll Method of Administration of Kati Basti:-

A boundry was made, with flour paste ofUrada, in the lumbar region centering the site of painand then lukewarm Dashmoola Taila was poured and

retained there for approx. 45 minutes daily for 21days. The oil was changed frequently so as tomaintain the temperature of the oil to a particular

level. The oil for the Kati Basti was exchanged onevery 5th day.

(5) Administration of Drugs:-

The 30 patients of Gridhrasi Roga wereregistered and divided randomly into following threegroups. Each group have 10 patients.

Group- A:- 10 registered patients ofGridhrasi Roga were administered with HERBALPREPARATION in a dose of 500 mg two times in a

day with lukewarm water for a period of 30 days.

Group-B:- 10 registered patients ofGridhrasi Roga were administered with Kati

Basti(Dashmoola Taila) for a period of 21 days.

Group-C:-10 registered patients of GridhrasiRoga were administered with HERBAL

PREPARATION and Kati Basti(Dashmoola Taila)simultaneousely in the manner as discussed above.

(6) Duration of Clinical Trial and Follow-up

Study:-

l Duration of clinical trial was 30 days.

l All patients were followed up once in a week

regularly.

(7) Criterias of Assessment:-

During trial and follow up study the patients

were assessed on following parameters:-

l Subjective Improvement

l Objective Improvement

1. Subjective Improvement:- All the patientsregistered for present trial were looked for anychanges in their growing feeling of well being, if

any, produced after the therapy.

2. Objective Improvement:- Following Clinicaland Functional aspects were looked into before,

during and after completion of the trial:-

lllll Clinical Assessment :-

a. Features of Gridhrasi Roga according to

Ayurvedic Texts


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S. Clinical Manifestations Before After Treatment

No. Treatment 7th day 14th day 21st day 30th day

1 . Toda(Pricking type of pain)

2. Sphuran(Flickering Sensation)

3. Tandra(Lethargy)

4. Stambha(Stiffness)

5. Arochak(Tastelessness)

6. Agnimandya(Diminished Apetite)

7 . Praseka(Excessive Salivation)

8. Bhaktdwesha(Anorexia)

b. Features of Sciatica according to Modern Texts

S. Clinical Manifestations Before After Treatment

No. Treatment 7th day 14th day 21st day 30th day

1 . Pain

2. Tingling Sensation

3. Numbness

4. Burning Sensation

5. Weakness of Limbs

6. Gait Disturbances

7 . Walking Distance

8. Diminished\Absent ankle jerk

9. Diminished\Absent Pain Sensation

10. Diminished\Absent Touch Sensation

lllll Functional Assessment :-

a. S.L.R.(Straight Leg Raising ) Test :-

lllll Method of Examination of S.L.R.

Test:- First of all tell to patient to lie in supine

position on examination table. Now tell to raise his

both lower limbs, one by one, straight upward on theaxis of hip joint. Examine the angle (with the help of

Goniometer), between surface of examination tableand respective lower limb, at which the lowbackache starts. That is the angle for +ve S.L.R. Test.

If pain in low back is absent, S.L.R. Test will be –ve.

Grade S.L.R. Test Before After Treatment

Treatment 7th day 14th day 21st day 30th day

0 No Pain at 90 degree

1 Pain at 89-71 degree





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Walking Time :-

Before After Treatment

Treatment 7th day 14th day 21st day 30th day

Time taken to cover the distanceof 10 mts.

For the assessment of above mentioned Clinical and Functional aspects of the Gridhrasi Roga(Sciatica)the following symptom rating scale, developed by Prof. A.K. Sharma et.al.was used :-

• For the assessment of gravity of symptoms :-

S. N0. Grading of Symptoms

1 . Absent 0 00%

2. Mild + 25%

3. Moderate ++ 50%

4. Severe +++ 75%

5. Agonising ++++ 100%

l For the assessment of improvement in the symptoms :-

S. N0. Grading of Symptoms

1 . No Relief ++++ 00%

2. Mild Relief +++ 25%

3. Moderate Relief ++ 50%

4. Significant Relief + 75%

5. Excellent Relief 0 100%

(8) Criterias for Diagnosis :-

Diagnosis of Gridhrasi Roga(Sciatica) was

done on the basis of following factors :-

l Clinical Features available in Ayurvedic andModern Texts.

l With the help of following investigations-

l Hb%, T.L.C., D.L.C., E.S.R.

l R.A.Factor

l X-ray L-S spine(AP. & Lateral view)

l C.T.Scan(optional)

l M.R.I.(optional)

All the investigations were performed in allthe patients before starting clinical trial. Theinvestigations were repeated after the course of

therapy where ever needed.

Above mentioned criterias of diagnosis werehelpful in making differential diagnosis andconfirmation of diagnosis Gridhrasi Roga(Sciatica).

Statistical Methods Used in the Study :-

Various observations made andresults obtained were computed statistically to find

out the significance of the values obtained andvarious conclusions were drawn accordingly.

'p' Value was calculated with the help of

standard of charts on the basis of 't' value

P>0.05 Non significant (N.S.)

P< 0.05 Significant (S.)

P<0.01 More Significant (Mo.S.)

P< 0.001 Highly Significant (H.S.)


10

Observations And Results

The clinical study carried out in the present

seris of patients have revealed that maximumincidences were found in between 51-60 years of age,Female Sex, Hindu Religion, Household job workers,

Married, Urban area, Jangal Desha,Middle class,Vegetarian dietary habbit, Illiterate and Menopausalfemale.

Majority of patients were having MadhyamKostha, Sama Agni, Samyak Nidraand MadhyamSharira.

Maximum number of patients were havingVata-Kapha type of Sharirika Prakriti, Rajsik Type ofMansik Prakriti, Prakritisamsamvaya type of Vikriti,

Madhyam Sara-Samhanan and Pramana, PravaraStmya and Madhyam Satva-Ahara Shakti-VyayamaShakti and Vaya.

Maximum number of patients were of Vatajtype of Gridhrasi Roga, having b/l involvement oflimbs, of < 1year chronicity, of Sub-acute onset of

disease, having Slow progress of diseas and shownMarked improvement in the disease.

Ruka(Pain) and S.L.R.test +ve were found inall the patients,53.33% patients were having

complaint of Toda. Stambha was present in 60%patients whereas Sphurana was present in 80%patients. Arochak, Tandra, Agnimandya, Bhaktdwesh,

Tingling Sensation,Burning Sensation,and Numbnesswere present in 23.33%,10%, 10%, 6.66%, 86.66%,16.66%, 43.33% of patients, respectively.Dehasyapi

Pravakrta(Scoliosis) was found in 33.33% patientsand Praseka was absent in all the patients.DiminishedAnkle jerk was present in 46.66% patients,

Hypoasthesia was present in 16.665 patients andsame percentage of patients were having loss ofsensation in different dermatose in affected limb.

Subjective Improvement

After the completion of trial there was amarked improvement in the feeling of well being in

all the three groups but the incidence ofimprovement was higher in Group-C, moderate levelof improvement was observed in Group-B and the

patients of Group-A have shown mild level ofimprovement.

Clinical Improvement

TABLE No. 1 :- Showing the Effect of Therapy according to recovery in Signs and

Symptoms in 10 Patients of Group- A Treated with Cap. Parijat Patra Ghana

S. Signs n Mean Scores Diff. % S.D S.E ‘t’ p Result

No. and Symptoms B.T. A.T. Relief ± ± Value Value

1 . Toda (Pricking Pain) 5 1 . 2 0.8 0.4 3 3 . 3 3 0.51 0 .16 2 . 4 4 <0.05 S

2 . Sphurana 8 1 . 8 1 . 2 0.6 3 3 . 3 3 0.51 0 .16 3 . 6 7 <0.01 S

(Flickering Sensation)

3 . Tandra(Lethargy) 2 0.4 0 0.4 1 0 0 0.84 0.26 1 . 5 >0.10 NS

4 . Stambha(Stiffness) 7 1 . 5 0.9 0.6 4 0 0.51 0.16 3 . 6 7 <0.01 S

5. Arochak(Tastelessness) 2 0.4 0 . 1 0.3 7 5 0 . 6 7 0 . 2 1 1 . 4 0 >0.10 NS

6 . AgnimandYa 1 0.2 0.0 0.2 1 0 0 0.63 0.20 1 >0.10 NS

(Diminished Appetite0

7 . Praseka 0 - - - - - - - - ND

8 . Bhakta- Dwesha 1 0 . 1 0.0 0 . 1 1 0 0 0 . 3 1 0.10 1 >0.10 NS

(Anorexia)

9 . Pain 1 0 3 2 . 4 0.6 2 0 0.69 0.22 2 . 7 1 <0.05 S


11

1 0 . Tingling Sensation 9 3 . 0 1 2 . 1 2 0.89 29.56 0.89 0.28 3 . 1 2 <0.05 S

1 1 . Numbness 4 2 . 3 1 1 . 6 2 0.69 2 9 . 8 7 1 . 2 6 0.40 1 . 7 2 >0.10 NS

1 2 . Burning Sensation 2 1 . 6 1 1 . 4 2 0.19 1 1 . 8 0 0.80 0.25 0 . 7 4 >0.10 NS

1 3 . Weakness of Limbs 7 2 . 4 1 1 . 8 2 0.59 24.48 0.86 0 . 2 7 2 . 1 5 >0.05 NS

1 4 . Gait Disturbances 9 2 . 7 1 2.02 0.69 25.46 0.70 0.22 3 . 1 0 <0.05 S

1 5 . Walking Distance 9 1 . 8 1 . 3 0.5 2 7 . 7 7 0.52 0.16 3.00 <0.05 S

1 6 . Diminished or 5 0.8 0.5 0.3 37.50 0.48 0.15 1 . 9 6 >0.05 NS

Absent Ankle Jerk

1 7 . Diminished or Absent 0 - - - - - - - - ND

Touch Sensation

1 8 . Diminished or 0 - - - - - - - - ND

Absent Pain Sensation

1 9 . S.L.R. Test 1 0 3 . 1 2 . 4 0 . 7 22.58 0.48 0.15 4.58 <0.01 S

TABLE No.2 :- Effect of therapy according to recovery in Signs and Symptoms in 10

patients of Group- B treated with Kati Basti



1 . Toda(Pricking Pain) 5 1 . 2 0.3 0.9 7 5 1 . 1 0 0.34 2.58 <0.05 S

2 . Sphurana 8 2 0.4 1 . 6 8 0 1 . 0 7 0.33 4 . 7 0 <0.01 S

(Flickeringsensation)

3 . Tandra(Lethargy) 1 0.2 0 0.2 1 0 0 0.63 0.20 1 >0.10 NS

4 . Stambha(Stiffness) 9 2 . 1 0 . 1 2 95.23 0.81 0.25 7 . 7 4 <0.001 HS

5. Arochak(Tastelessness) 2 0.4 0 0.4 1 0 0 0.84 0.26 1.50 >0.10 NS

6 . Agnimandya 2 0.4 0 0.4 1 0 0 0.96 0.30 1 . 3 0 >0.10 NS

(Diminished Appetite)

7 . Praseka 0 - - - - - - - - ND

(Excessive Salivation)

8 . Bhaktadwesha 0 - - - - - - - - ND

(Anorexia)

9 . Pain 1 0 3 0.6 2 . 4 8 0 0.69 0.22 10.85 <0.001 HS

1 0 . Tingling Sensation 8 1 . 8 0 . 7 1 . 1 6 1 . 1 1 0 . 7 3 0.23 4 . 7 1 <0.01 S

1 1 . Numbness 4 0.8 0 . 1 0 . 7 87.5 0.94 0.30 2 . 3 3 <0.05 S

1 2 . Burning Sensation 1 0.2 0 0.2 1 0 0 0.63 0.20 1 >0.10 NS

1 3 . Weakness of Limbs 1 0 1 . 9 0.5 1 . 4 7 3 . 6 8 0.51 0.16 8.57 <0.001 HS


12

1 4 . Gait Disturbances 1 0 1 . 6 0.2 1 . 4 87.50 0.51 0.16 8.57 <0.001 HS

1 5 . Walking Distance 1 0 2 . 2 0.3 1 . 9 86.36 0 . 7 3 0.23 8 . 1 4 <0.001 HS

1 6 . Diminished or 4 0 . 7 0.2 0.5 7 1 . 4 2 0.70 0.22 2 . 2 3 >0.05 NS

Absent Ankle Jerk

1 7 . Diminished or Absent 1 0.3 0 . 1 0.2 66.66 0.63 0.20 1 >0.10 NS

Touch Sensation

1 8 . Diminished or Absent 1 0.2 0 0.2 1 0 0 0.63 0.20 1 >0.10 NS

Pain Sensation

1 9 . S.L.R. Test 1 0 3 . 1 0.5 2 . 6 83.87 0.51 1 . 6 15 .92 <0.001 HS

TABLE No.3:- Effect of Therapy according to recovery in Signs and Symptoms in 10

patients of Group- C treated with Cap. Parijat Patra Ghana AND Kati Basti



1 . Toda(Pricking Pain) 6 1 . 6 0.3 1 . 3 81.25 1 . 1 5 0.36 3.54 <0.01 S

2 . Sphurana 8 2 . 1 0.3 1 . 8 8 5 . 7 1 1 . 0 3 0.32 5.51 <0.001 HS

(Flickering sensation)

3 . Tandra(Lethargy) 0 - - - - - - - - ND

4 . Stambha(Stiffness) 3 0.6 0 0.6 1 0 0 0.96 0.30 1 . 9 6 >0.05 NS

5. Arochaka(Tastelessness) 3 0.6 0 0.6 1 0 0 0.96 0.30 1 . 9 6 >0.05 NS

6 . Agnimand Ya 0 - - - - - - - - ND

(Diminished Appetite)

7 . Praseka 0 - - - - - - - - ND

(Excessive Salivation)

8 . Bhakta- Dwesha 1 0.3 0 0.3 1 0 0 0.94 0.30 1 >0.10 NS

(Anorexia)

9 . Pain 1 0 3 0.5 2.5 83.33 0.52 0.16 1 5 <0.001 HS

1 0 . Tingling Sensation 9 2.40 0.50 1 .90 7 9 . 1 6 0.87 0 . 2 7 6.86 <0.001 HS

1 1 . Numbness 5 1 . 2 0 0.20 1 83.33 1.05 0.33 3 <0.05 S

1 2 . Burning Sensation 2 0.40 0 0.40 1 0 0 0.84 0.26 1.50 >0.05 NS

1 3 . Weakness of Limbs 8 1 . 6 0.3 1 . 3 81.25 0.82 0.26 4.99 <0.001 HS

1 4 . Gait Disturbances 1 0 2 . 2 0.2 2 90.90 0 . 4 7 0 . 1 4 1 3 . 4 1 <0.001 HS

1 5 . Walking Distance 1 0 2 . 2 0.3 1 . 9 86.36 0 . 3 1 0.10 1 9 <0.001 HS

1 6 . Diminished or 5 0.9 0 . 1 0.8 88.88 0.91 0.29 2 . 7 5 <0.05 S

Absent Ankle Jerk

1 7 . Diminished or Absent 4 1 . 1 0.8 0.3 2 7 . 2 7 0.48 0.15 1 . 9 6 >0.05 NS

Touch Sensation

1 8 . Diminished or Absent 4 0.9 0.4 0.5 55.56 0.70 0.22 2 . 2 3 >0.05 NS

Pain Sensation

1 9 . S.L.R. Test 1 0 3 . 4 0.5 2 . 9 85.29 0 . 7 3 0.23 1 2 . 4 2 <0.001 HS


13

Discussions

Probabale Mode of Action of Parijat

Parijat Patra possess,

Guna - Laghu, Ruksha Rasa - Tikta

Vipaka – Katu Veerya – Ushna.

With the help of its Gunas, Rasa, Vipak andVeerya it pacifies Kapha dosha while with the helpof its Veerya it pacifies Vata Dosha. So, on the basis

of its pharmacological properties, it can be concludedthat, it possess Kapha-Vatahar action. In Ayurvedicclassics, also it is mentioned as Kapha-Vatahara

dravya.

Since, the Gridhrasi Roga is of two types viz.Vataj and Vata-kaphaj, means in all its forms either

Vata or Vata and Kapha both Doshas will be vitiated.The selected drug has Kaph-Vatahar action, thereforeit should be effective in the management of all forms

of Gridhrasi Roga.

Further, in Chakradatta, decoction of itsleaves have been indicated to cure all forms of

Gridhrasi Roga (Chakra.Vaatavyadhi 22/97).

In the view of knowledge of modern science,the various chemicals like, Tannins,Glycosides,

Methyl Salisylate and Alkloids etc. present in leavesof Parijat possess Anti-inflammatory and Analgesicaction. Therefore, by the action of these constituents

it breaks the basic pathology i.e. inflammation ofdisease Sciatica, consequently helps in relieving itsclinical features.

Probable Modes Of Action Of Dashmoola Taila

Among the 10 dravyas of Dashmoola 5

dravyas(50%) have Vata-Kapha shamak property, 4dravyas(40%) have Tridosaghna property and 1dravya(10%) has Vata-Pitta shamak property. It

means, in Dashmoola all dravyas(100%) have Vatashamak property and 9 dravyas(90%) have Vata-Kapha shamak property.Therefore, it will be a potent

Vata shamak, Vata-Kaph shamak and TridosaghnaCompound. In Ayurvedic Texts, also mentioned,“Dashmoolam Tridoshaghnam Kaphmarut Nashnam”.

Since, the Gridhrasi Roga is of two types viz.

Vataj and Vat-kaphaj and Dashmoola has Kaph-Vatahar action, therefore it should be effective in allforms of Gridhrasi Roga.

In the view of knowledge of modern science,the various chemicals present in ghatak dravyas of

Dashmoola possess anti-inflammatory and Analgesicaction. Therefore, by the action of these constituentsit breaks the basic pathology i.e. inflammation,of

disease Sciatica, consequently helps in relieving itsclinical features.

Tila Taila possess,

Rasa - Madhura, Kashaya, Tikta,

Guna - Guru, Snigdha,

Veerya – Ushna

Vipak - Madhura,

Doshaghnta : Vata Shamak. Therefore, itshould be effective in Gridhrasi Roga.

Probable Modes Of Action Of Kati Basti

Kati Basti is a procedure in which both theproperties of snehana & swedana are incorporated .

The reason behind selection of Kati Basti is that itcomes under direct contact with painful region .Inthis disease, Samprapti is at Kati-region and is mostly

associated with structural changes of lumbarvertebral column. There is derangement in Lumbo-sacral joints & vertebrae, degeneration of

intervertebral disc and lubrication function ofShleshaka Kapha is affected, which results incompression, irritation or inflammation of Gridhrasi

Nadi i.e.Sciatic Nerve, resulting in severe pain.Therefore, local Snehana and Swedana is veryeffective and gives quick results because they act at

the site of Samprapti.

As Vata Dosha is Sheeta, Ruksha in natureand Sweda being Ushna and with prior Snehana,

Snigdha in nature, alleviates Vata, Swedana increasessweat and brings out Maladravyas along with sweat.Thus it decreases kleda in the body resulting in the

reduction of Gaurava (Heaviness) and Stambha(Stiffness) which are common symptoms ofVatavyadhies. After Swedana Romancha(Sizzling

Sensation), Toda(Pricking Pain), Vedana (Pain),Shotha (Oedema), Angagraha(Stiffness in organs),Ayam(Feeling of expansion) vanishes and the organs

become soft and elastic (Ch.chi.28/80). AcharyaCharak has pointed that when even dry wood can bemade to become soft and flexible with Snehana and


14

Swedana then why not the living organs? (Ch.chi.28/79 Ch.su.14/5). Gridhrasi Roga is clearly mentioned

in the list of Swedanarha vyadhies and also thecardinal and associated features of Gridhrasi Rogalike shool(Pain), Stambha(Stiffness), Sankocha

(Shrinking type of Feeling), supti(Numbness) havealso been mentioned. Gridhrasi Roga is a Vatavyadhiand sometimes Kaphanubandhi. Swedana is also

indicated in Vatavyadhies as well as VatakaphajaVyadhies. (Ch.su. 14/3). Gridhrasi Roga is aShoolapradhana Vatavyadhi and Shulavyuparama

(destruction of pain) is the sign of proper Swedana.(Ch.su.14/3). In Kati Basti the warm oil is retainedfor a long time(Approx. 45 minutes) at the site of

pathology the resultant effect of the procedureproduced according to the physiology is statedbelow:–

Thermal effect of warm oil –These are effectsarising from an increase in blood temperaturestimulation of thermo detector in the skin and local

temperature increase. Heat has been defined asincrease in the velocity of particles. In general thishas catalytic effect on all chemical process. Thus

application of heat results in an increase in the localmetabolism of the cell and increased transportthrough the cell membranes . For every increase of

one degree Celsius within the physiological limits,the metabolic activity increases by about 10%. Thelocal metabolic increase leads to an increase in the

oxygen partial pressure (po2), the carbon di- oxidepartial pressure (pco2) and acidity pH. These threefactor po2, pco2 & pH determine the local perfusion

by their effect on pre-capillary Sphincter and metaarterioles . The pre-capillary sphincter and the meta-arterioles in the tissue control the local homeostasis

by alternate contractions and relaxations. Thisalternate activity controls the perfusion of thecapillary bed. At the same time, the contraction

forces the blood in the capillaries forward . Thisprocess of auto-regulation is referred to as“vasomotion” which is principally determined by the

oxygen concentration.

An increase in the temperature of connectivetissue , in particular the collagenous tissue such as

skin , muscle , tendon , ligament or articular capsulewill be accompanied by an increase in the elasticity.Heat can improve the elasticity of fibrous tissue by

a factor of 2 to 10 . At the same time , the viscosity

of matrix decreases . Consequently connective tissuesuch as tendon tissue and ligament will also become

more elastic.

r The highest incidence of Gridhrasi Roga(Sciatica)was seen in between 51-60 years of age, in which

11 cases (36.66%), followed by the 31-40yearsand 41-50 years 6 cases (20%) in each group.This can be supported by the fact that middle

aged subjects(30-60 years of age) are moreexposed to strong biochemical force and heavywork in comparison to others, which may also

create this condition. Also the degenerativeprocess starts after the age of 30 years whichresults into different types of degenerative

changes in the vertebrae of Lumbo-sacral regioncausing Gridhrasi Roga(Sciatica). This(51-60years) is Vata Prakopaka Kala and according to

modern science, there is progressive decreasein degree of hydration of the inter-vertebral discwith age that leads to the cycle of degeneration

resulting in disc problems and causing GridhrasiRoga(Sciatica). Hence, prevalence of sciatica ishigh in middle age group of people which is

supported by the findings of the present study.

r In present study, maximum number of patientswere female i.e. 60% followed by male

(40%).Highest incidence was observed in femalesbecause the degenerative process of bone is veryhigh in menopausal women and it starts after the

age of 30 years .Male are at hard physical jobsand in particular frequent lifting of heavy weightand postural stress are known to increase the

risk of sciatica.

r In the present series of 30 registered cases ofGridhrasi Roga(Sciatica) the affliction of the

disease was found more in patients havinghousehold and labour job i.e. 15 (50%) and10(33.33%) subjects, respectively. The high

prevalence of Gridhrasi Roga(Sciatica) inHousewives and Labours seems to be due tofrequent involvement in wrong postures and

heavy physical work, respectively.

r The incidence of Gridhrasi Roga(Sciatica) washighest in the patients who belonged to Urban

area i.e. 22 (73.33%) while those who were fromRural area were 8 (26.67%). This is because of


15

fast, hectic and stressful life styles of the peoplewho belonged to urban area.

r The majority of cases registered for the currettrial, belonged to middle & lower classes, whichincludes 15 cases (50%) in each group. This data

reflects that, physical strain full activities arefound in the people who are from middle andpoor classes.

r Maximum number of patients i.e. 66.66% werevegetarians while remaining 33.33% patientswere taking mixed diet. This is because of most

patient were Hindus and Hindus are vegetarianin this area.

r The majority of cases registered for the current

trial were, either uneducated or primary leveleducated i.e. 50% and 30%, respectively. Thisdata reflects that, these subjects do more physical

strainful activities in comparision to others..

r Most of the female patients i.e. 61.11% werehaving menopausal history while 33.33% patients

were having regular menstrual history. Only 01patient reported for irregular menstruation. Thisreflects that after the menopause, chances of

occurrence of the disease increases.

r In the present study Maximum i.e. 80% patientswere found to have Madhyam Sharira and

patients of Sthoola and Krisha Sharira were 10%each.So, it is evident that, the prevalence ofGridhrasi Roga (Sciatica) is high in subjects

having Madhyam Sharira. This feature may be,because subjects having Madhyam Sharira havecapacity to do more physical work than others.

r All the patients of this study were havingDwandaja Prakriti. 80% patients were havingVata-Kapha Prakriti,13.33% patients were having

Vata-Pitta Prakriti and 6.66% of patients werehaving Pitta-Kapha Prakriti. This study suggeststhat Vata Dosha plays a major role in the

manifestation of the Gridhrasi Roga(Sciatica).

r In this study, 83.33% patients were having Rajsikprakriti and 16.66% patients were having Tamsik

prakriti. This data support the Vataj and Vat-kaphaj types of the disease and predominance ofVat Dosha in the disease, also.

r In this trial, all the patients were havingMadhyam Sara. It may be because, patients of

Pravara Sara, mostly free of disease and patientsof Hina Sara, mostly have so many diseases withsevere complications and these type of subjects

have been excluded from the study.

r In the present study, maximum number ofpatients i.e. 76.66% were of Madhyam Vaya

followed by Vriddha Vaya i.e.16.66% and only6.66% patients were of Vivardhman Vaya. Thisfeature may be, because Madhyam Vaya is the

period of maximum physical activity and inVriddha Vaya there is physiological vitiation ofVata Dosha and the rate of process of

degeneration is very high.

r In the trial, maximum no. of patients i.e. 86.66%were of Vatik type followed by Vat-Kaphaj type

i.e. 13.33%. It may be, because the GridhrasiRoga is Vaat Nanatmaj Vyadhi and sometimesAnubandh of Kapha Dosha may occur.

r Maximum number of the patients i.e. 53.33%were having less than 1 year of chronicity,16.66% were having above 2 years of chronicity,

and 30% were having 1 – 2 years of chronicity.This data reflects that, maximum number ofsubjects have chronicity less than 1year followed

by having 1-2 years, it may be because first thepatient goes to allopathic side when they haven’tsatisfactory response, then comes to Ayurvedic

treatment.

r Maximum number of patients i.e. 76.66% werehaving Sub-acute onset of disease followed by

Chronic onset i.e. 23.33% and no patient washaving Acute onset. This type of feature may be,because the maximum patients take analgesics by

self medication due to which the presentation ofthe disease becomes either Sub-acute or Chronic.

r In the trial, maximum no. of patients i.e. 76.66%

were having slow progress of disease followed byrapid progress i.e. 23.33% and no patient hadshown stationary form of the disease. This type

of feature may be due to degeneration ofvertebrae and inter-vertebral discs occurs slowlyand sometimes sudden trauma on the lumbo-

sacral region or sudden heavy weight liftingcause Rapid onset.


16

Ruka (pain in sciatic nerve distribution) and SLRtest were found positive in all the patients i.e.

100%. 53.33%% patients were having complaintof Toda(Pricking Pain). Stambha(Stiffness) waspresent in 60% patients whereas Sphurana

(Flickering Sensation) was present in 80%patients. Arochaka(Tastelessness), Tandra(Lethargy), Agnimandya (Diminished Appetite),

Bhaktadwesha (Anorexia),Tingling sensation,Burning sensation and numbness were present in23.33%, 10% , 10%, 6.66%, 86.666%, 16.66%,

43.33% of patients respectively.

Above data proves that maximum presence ofVataja type of symptoms, followed by Vata-

Kaphaja type of symptoms. Here, predominanceof Vataja type of Gridhrasi Roga (Sciatica) isagain being proved in present study.

r Diminished Ankle jerk was present in 46.66% ofthe patients. This observation showsinvolvement of 5th lumbar and 1st sacral root of

sciatic nerve.

r Data regarding X-ray findings suggestsinvolvement of lumbo-sacral spine in producing

the symptoms of Sciatic syndrome.

r In this trial, all the patients were having –ve R.A.Factor. This data reveals that no patient had

history of Rheumatoid Arthritis involvement.Although, we recommended C.T. Scan or M.R.I.to some of the patients of Gridhrasi Roga

(Sciatica), but none of the patients got it done,no observations are reported on theseparameters.

r In patients of Group A no patient had obtainedMarked Improvement while in patients of GroupB 70% and in patients of Group C 90% patients

had obtained Marked Improvement. In Group Ano patient had witnessed Moderate improvementand in patients of Group B 30% patients had

witnessed Moderate Improvement while inpatients of Group C 10% patients had witnessedModerate Improvement. In patients of Group A

100% patients had reported Mild Improvement,while no patient was reported to get Mildimprovement in patients of Groups B & C. None

of the patients was found unchanged and fullycured in all the three groups.

Conclusions

A close perusal of the observations and

inferences that can be drawn leads to the followingconclusions :-

1 . On the basis of their clinical manifestations

Gridhrasi Roga can be correlated with diseaseentity Sciatica, as described in modern medicalscience.

2. Clinical response in a series of patients ofGridhrasi Roga(Sciatica) treated with simply Cap.Parijat Patra Ghana was of milder type, although

there was a clinical trend of improvement ofvarious symptoms of disease, but it was notmarked.

3. Patients of Gridhrasi Roga(Sciatica) treated withKati Basti presented with moderate improvementin their symptoms of the disease.

4. The best result of combined therapies, withadministration of Cap. Parijat Patra Ghana andKati Basti, was noticed in majority of the patients

registered for the present clinical trial.

5. The initial response to Ayurvedic therapies inrespective groups was slow, which increased

significantaly as the duration of treatmentsteadily progressed.

6. In initial stages of starting of Ayurvedic

treatment modalities in respective groups someof the patients had to consume some brand ofmodern analgesic or anti-inflammatory drug. But

with the advancement of Ayurvedic treatmentmodalities the requirement of such drugsgradually decreased and most of the patients

registered for the present clinical trialdiscontinued any kind of modern analgesic oranti-inflammatory drug during the clinical trial.

7 . It was observed that those patients who followedthe dietary and lifestyle modifications asinstructed they responded very well to the

treatment given. In contrast, registered patientswho who didn’t follow the advice ofPathyapathya in reference to Ahara and Vihara

didn’t respond properly to the given treatment.

8. All the patients registered for the currentresearch project tolerated, Cap. Parijat Patra


17

Ghana and Kati Basti with Dashmoola Taila,verywell. No side/toxic effect were reported in any

of the patients registered for the trial.

On the basis of the various observations andresults obtained after completion of the current

research project, it can be concluded that, Cap.Parijat Patra Ghana and Kati Basti with DashmoolaTaila may be used separately or simultaneously in

the effective management of patients of GridhrasiRoga(Sciatica). The clinical response in terms ofimprovement in various symptoms of Gridhrasi

Roga(Sciatica) was milder in Cap. Parijat Patra Ghanatreated group, moderate in patients of Kati Bastigroup and the best results were obtained in patients

of Gridhrasi Roga(Sciatica) in group C, when Cap.Parijat Patra Ghana and Kati Basti administeredtogether, simultaneously.

Therefore, it can be concluded that,combined therapy in the form of administration ofCap. Parijat Patra Ghana and Kati Basti with

Dashmoola Taila is safe and effective Ayurvedictreatment modality in the management of GridhrasiRoga(Sciatica).

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18

A Single Herbal Drug (Abutilon Indicum), For Complaints During Pregnancy

Dayani S1*@, Mistry IU, Skandhan KP*2, Jyothishi H

Department of Kaumarabrithya & Striroga, Postgraduate institute of Ayurveda, Teaching and Research, Gujarat

Ayurveda University, Jamnagar 361 008, India, *Department of Physiology, Sri M.P.Shah Medical College, Jamnagar

361 008, India, Present Address, 1.Department of Prasuthithanthra Kaumarabrithya, Institute of Indigenous

Medicine, University of Colombo, Sri Lanka @ for Correspondence, 2.Department of Physiology, Sree Narayana

Institute of Medical Sciences, Chalakka 683 594, Kerala, India

Abstract

Ayurveda, has given special importance to pregnant women. Several herbs in individual or in

combination are prescribed for maintaining healthy pregnancy and prevention from any complications. Inthe present study a total number of 117 pregnant women were given a simple drug atibala (Abutilon indicum)(study group) or a combination of herbs was prescribed during pregnancy(control group). The study group

where atibala was given, women were relieved from pregnancy related complaints like backache, vomiting,nausea, giddiness, pain in abdomen, constipation, white discharge, loss of appetite and other symptoms witha short span of two weeks. No side effect was reported with the herbal medicine, atibala. (We advocate this

simple drug to pregnancy related complaints).

Key words: Indian mallow – Abutilon indicum – Pregnancy complaints – single drug

‚Ê⁄UÊ¥‡Ê-

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Clinical Study


19

Introduction

In medical practice antenatal care securesutmost importance. During pregnancy majority ofwomen experience physical and psychological

difficulties, such as backache, giddiness and anxiety.Different medicines are prescribed by gynecologistsfor relief from these. Indeed, one medicine each for

each complaint. In regular practice, ayurvedadoctors prescribe medicine(s) for maintenance ofpregnancy and for relieving the complaints during

the period. They have additional benefit of nutritiveand health promoting effects also. One of such herbsis atibala (Abutilon indicum Linn.), which is widely

prescribed mainly in compound form. Usage ofdifferent parts of atibala is reported by Dayani,Mistry and Skandhan (2013b) elsewhere.

The present study is for evaluating theefficiency of atibala (A. indicum) as a single drug forrelieving complaints during pregnancy.

Materials and Methods

The present study has been carried out on117 pregnant women who reported to the antenatal

clinic unit of the Institute for Postgraduate Trainingand Research in Ayurveda, Jamnagar. They weredivided into two groups. Details about groups

preparation and the treatment are given in Table 1.

The complaints reported by patients at theirfirst visit are given in Table 2.

Results

Patients were relieved from all complaints(Table 2) within 2 weeks after atibala treatment.

Though in control group the relief was present itrequired more time. Important results of the studyare given in Figure 1. Patients regularly followed the

atibala treatment, were benefited earlier thanpatients with control drug (Fig. 1). For example,backache was relieved by atibala in 6 weeks; whereas

control drug required 10 weeks time. Similar was

the case with all other conditions; nausea, requiredtwo weeks in case of atibala group and 6 weeks for

control group. Patients included in both groups didnot report any side effect.

Discussion

Atibala (A. indicum) is an annual or moreoften perennial, erect woody, branched herb orunder shrub belonging to malvaceae family. The

plant (popular name Indian mallow) is distributedthroughout the tropical parts of India. This speciesis found throughtout the tropics specially China

(Kuan Sha Yuan), Arabia (Deishar), Malay (BungaKisar), Hong Kong (Tung Kei), Persia(Darakhteshanah), Portugal (Fruta Jargantilha),

Srilanka (Vaddattutta) and in Burma (Bonkhoe). Thephyto chemical details of A.indicum- its general,aerial parts, leaves, seeds and roots are welldocumented (Wealth of India, 1948).

In Ayurveda, pregnant women are givenvery special care and importance. Classics ofAyurveda preferred to treat pregnant women with

the use of soft, sweet, cold, pleasing and gentledrugs, dietetic and behavior. The simile is a pot filledwith oil and the slightest oscillation of this pot causes

spilling of the content, similarly slightest excitementto a pregnant woman causes abortion (CharakSamhita).

Ayurveda emphasizes for prevention fromdiseases rather than cure (Suhrut sutra sthan). InPregnancy it starts from onset till the last. Strictly

following Ayurveda regimen could help the motherand the foetus from contracting any disease.Towards that, the pregnant woman should be

provided proper regimen by which she maintains herhealth,vigour and vitality as well. For achieving thisa systemic approach was advocated including the

rules and regulations of diet and behavior. One ofthe tonics prescribed for pregnant women in ourInstitution is a herbal compound (amalaki, godanti,

A Single Herbal Drug (Abutilon Indicum), For Complaints During Pregnancy

Dayani S, Mistry IU, Skandhan KP, Jyothishi H

Clinical Study


20

and garbhapal rasa. Table 1, control group)

The result of the present study showed that

the participants of study group were relieved fromall complaints (they presented at first visit) within aspan of 2 to 8 weeks after starting the treatment with

atibala. Whereas in case of control group, where theherbo mineral compound was prescribed more timewas required to get relief when compared to study

group. Figure 1 compares the relief given by twodrugs. It shows that where the, complaintspresented like giddiness, atibala acted in lesser time

to get relief from illness than the control drug. Sothe treatment with atibala during pregnancy wasfound to be more beneficial.

In modern medical practice too, muchimportance has been given to the antenatal care. Ithelps to screen out the high-risk cases, to prevent

or to detect medical obstetrical complication. Itcomprises of careful history taking, physicalexamination, laboratory investigations and lastly

advice to the pregnant women. It is believed that asuccessful obstetric outcome depends on chain of

careful supervision which starts in pregnancy andend in puerperal period.

In a detailed study it was observed thatatibala was very useful for pregnancy care includingthat of promoting growth of foetus (Dayani 2000).

In modern medical practice several medicines areprescribed for aliments during pregnancy, onemedicine for one each. Some of these may have no

health promoting or nutritive aspect and on thecontrary may have bad effects on pregnant womenand sometimes on foetus also. Few of them are

contraindicated in certain conditions. Taking care ofall aspects like safety during pregnancy and relief ofcomplaints atibala stands above these all.

We conclude that atibala could be safelyprescribed during pregnancy. A natural drug for anatural process.

Table 1. Details of durg preparations and treatment given in control and study group.

Group No.of Name of Drug Preparation Dosage Duration

Patients Sanskrit & Latin of Drug in weeks

Control 49 Amalaki (Embelica of Dried fruit powder of 0.5gms 1 2ficinals) Godanti Amalaki (E. officinalis), T.D.S with

(Gypsum) CaSO4, powder of Godanti luke warm

2H2O Garbhapalarasa* (Gypsum) and powder water

of Garbhapala Rasa

(Rasa chandanshu)each mixed to preparethe compound

Study 68 Atibala The fine powder of shade 3 gms T.D.S 1 2(Abutilon indicum) dried Atibala (whole

plant) was prepared and

presented in the formof tablets

*Ingredients of garbhapal rasa are given below (Bheshaj Samhita)


21

No. Sanskrit Latin Name Family Part used In part of

Name English Name

1 Hingula Cinnabar (Hgs) - - 1 part

2 Naga bhasma Ash of lead - - 1 part

3 Vangabhasma Ash of tin - - 1 part

4 Twak - Cinnamomum Lauraceae Stem, bark 1 part

Tejpat zeylanicum and leaves

6 Ela Elettatia Zingiberaceae Fruit 1 part(sukshma) cardamum

7 Sunthi Zingiber Scitaminae Rhizome 1 partofficinalis

8 Pippali Piper longum Piperaceae Fruit 1 part

9 Maricha Piper nigrum Piperaceae Fruit 1 part

1 0 Dhanyaka Coriandnum Umbelliferae Fruit, 1 partsativum Whole plant

1 1 Chavya Piper Piperaceae Fruit 1 partofficinarum

1 2 Devadaru Cedrus Pinaceae Stem bark 1 part

deodara Roxb

1 3 Krishna Carum Umbelliferae Fruit 1 partJeeraka bulbocastanum

1 4 Draksha Vitilis Vitaceae Fruit 1 partVinifera

1 5 Lauh bhasma Ash of ferrum - - - - ½ part

Table 2. The complaints reported by patients during their first visit.

Groups

No. Complaints Control (%) Study (%)

1 Backache 38.77 27.94

2 Pain in leg 55.55 7.35

3 Headache 6.12 7.35

4 Giddiness 14.28 23.52

5 Loss of appetite 30.61 29.41

6 Pain in abdomen 18.36 11.76

7 Nausea 18.36 11.76

8 Vomiting 16.32 11.76


22

9 Weakness 44.89 33.82

1 0 Burning micturition 4.08 7.35

1 1 Constipation 2.04 2.94

1 2 White discharge 6.12 5.88

1 3 Bleeding 2.04 2.94

1 4 Other symptoms 8.16 8.82

Table 3. Comparison of uses of atibala antenatal care with that of modern medicines.

No. Name of drug Used for Side effects Others

1 Atibala (A indicum) Maintenance of pregnancy, Not reported anyto promote growth of

foetus, relieving thecomplaints duringpregnancy (table 2)

2 Folic acid Treating anaemia

3 Calcium For maintaining healthy Anorexia, nauseastatus of heart, muscles and vomiting, dry mouth,

cell membrane of mother constipation, stupor,and for bone growth of comafoetus

4 Dried ferrous Anaemia Constipationsulpahate powder

5 Doxylamine succinate Hyperemesis graavidarum Drowsiness, vertigo, Contra indicated

G.I, disturbances in acuteasthematic attack

6 Metoclopramide HCI Hyperemesis gravidarum Drowsiness, epilepsy, Safety during

facial spasm pregnancy notestablished

7 Diclofenac sodium Aches Nausea, vomiting, Contra indicated

fluid retention, in 3rd trimesteroedema comparatively safe

8 Diclofenac Aches Nausea, vomiting, Contra indicatedpotassium fluid retention, in 3rd trimester

oedema comparatively

safe

9 Aspirin Aches, antiplatelet effect Epigastric distress, It should bevertigo, occult avoided in 3 rd

blood loss in stool trimester

1 0 Alprazolam Sedative anxiolytic - - Contra indiatedduring pregnancy


23


24

References

l Bheshaj Samhita. 1st edition 1996, Health Ministry

Gujarat State, Ahmedabad.

l Chraka Samhita. Part I, Varanasi, Chaukhambha

Bharati Academy (India) 2001.

l Dayani S, Mistry IU, Skandhan KP.

Standardization and preparation of choorna with

special reference to Atibala (Aindicum)

(Communicated) 2013a

l Dayani S, Mistry IU, Skandhan KP. Atibala:

proposal for standardization of drug and duration of

treatment. (communicated) 2013b

l Dayani S. Role of “garbha stapaca and: garbha

vruddhi kara[rabhava” in pregnancy with special

reference to atibala (Abutilon indicum) Ph.D thesis

submitted to Gujarat ayurveda University 2000.

l Dutta DC. Text book of obstetric including

perinatology and contraception. Calcutta, New

Central book of agency (P) Limited 1998.

l Indian drug review, medical publication, New Delhi.

Medi world house 2002.

l Kirtikan KR, Basu BD. Indian Medical plants.

Allahabad, L.M. Basu, Vol. I 1933

l Susurt samhita Part I Varanasi, Chakumbha

Sanskrit Sansthan, 1944.

l Sharma PV, Ahamad ZA, Sharma VV. Analgesic

constitute of abutilon indicum. Indian drugs

26:333, 1989.

l Vagbhatt’s Astanga Sangraha Vol. I Varanasi,

Krishnadas Academy, 1933.

l Wealth of India 1948. Abutilon indicum (Atibala)

CCRAS data base Part I, p50-58, CCRAS, 2003.


25

Effect Of Panchokola Churna In Hypercholesteromia-A Clinical Study

*Dr Surendra Kumar Sharma, **Dr Loknath Sharma, ***Dr Ranjita Ekka

Abstract

A clinical trial was under taken to evaluate the efficacy of the drug panchokola churna in treatmentof hypercholesteromia patient. The dose of the trial drug was fixed at 3 gram twice a day after meal with

leuk warm water for group A. Group-B was on only simvastin (hypolipidemic drug) and group-C was placebo.After 3 months of drug trial there was highly significant (p<0.001) result observed in group A. symptomaticrelief was also reported by the patients. Also no adverse effects were reported by group A patients during

the study. Hence it can be concluded that panchokola churna is useful in treatment of hypercholesteromia.

Key words: hypercholesteromia, panchokola churna, cholesterol, lipid profile

‚Ê⁄Ê¢‡Ê -

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*Corresponding author, Asst. Professor, Dept of Rog & Vikriti Vigyan, NIA Jaipur, **Retd. Professor, Dept of Rog &

Vikriti Vigyan, NIA Jaipur ***PhD Scholar, Dept of Rog & Vikriti Vigyan,NIA Jaipur, E.mail id:

d r s k s m 3 1 @ r e d i f f m a i l . c o m

Clinical Study


26

Introduction

Hypercholesteromia is the presence ofcholesterol in blood more than normal range. Over

a period of decades, chronically elevated serumcholesterol contributes to formation ofatheromatous plaques in arteries leads to stenosis or

occlusion of involved arteries and then tissueischaemia. Further this tissue ischemia leads to heartdisease, stroke like life threatening disease, which is

the major cause of death in present time. The diseasecan be correlated with medaroga in Ayurvedicliterature.

In this study the drug panchokola churnacontaining Pippali (Piper longum), Pippali mula (rootof Piper longum), chavya (Piper chaba), chitrak

(Plumbago zeylanica), and sunthi (Zingiber

officinale) is described by Bhavprakash was appliedto see the effect of the drug in hypercholesteromia.

The research work has been performed in 3 group.Patients of group were on purely panchokola churnaand has shown the most significant result.

Material And Methods

Selection of patients: 90 patients ofhypercholestermia (30 in each group) were selected

from the OPD/IPD of NIA hospital and SSBH Jaipur.All the cases were registered and recorded with thehelp of a special proform prepared for this purpose.

Patients were subjected to detailed case historytaking, physical examination and laboratoryinvestigations for the study.

Inclusion criteria

l Patients were selected on the basis of laboratoryinvestigation of patients having cholesterol

>240mg/dl

l Patients of age group between 15-65 yrs

l Patients of obesity , hypertension and IHD were

included.

Exclusion criteria

l Patients of age group below 15 yrs and above65yrs

l Diabetes mellitus patient (NIDDM or IDDM)

l Critically ill cardiac patient.

l Drug induced hypercholestermia like steroid ordiuretics drug

l Hypothyroidism patient

Method of preparation of drug:Thepurchaged drug were identified in the deptt. of

dravyaguna & prepaired in the pharmacy NIA Jaipur.The prepared drug panchokola churna containPippali (Piper longum), Pippali mula (root of Piper

longum), chavya (Piper chaba), chitrak (Plumbago

zeylanica), and sunthi (Zingiber officinale) in equalratio.

Method of drug trial: 3 groups wereplanned for the drug trial. 30 patient were ther ineach group. Patients of group A were given 3gms of

panchokola churna twice a day after meal with leukwarm water. Patients of group B were onhypolipidemic drug simvastin 10mg once after

dinner. Group C was placebo group given capsulecontains glucose.

Duration of study: Total duration of study

was 3 months with a follow up in every one monthfor the assessment of improvement and occurrenceof any adverse effect.

Subjective assessment criteria

In each group all the patients were assessedfor the subjective improvement as per the features

given in the table. All these symptoms were dividedin five grades (0-4) on the basis of severity andduration.

Effect Of Panchokola Churna In Hypercholesteromia-A Clinical Study

Dr Surendra Kumar Sharma, Dr Loknath Sharma, Dr Ranjita Ekka

Clinical Study


27

Table-I

Grading of subjective symptoms

Symptoms Score Grade Grading criteria for symptoms

Excessive hunger 0 Absent -Intake of proper amount of food

(Kshudhadhikya) 1 Mild -Craving for food more than twice

2 Moderate -3-4 times eating habit

3 Severe -Frequent craving for food

4 Very severe -Craving for food in night also

Excessive thurst 0 Absent -normal thurst

(Trishnadhikya) 1 Mild -upto 1lt more intake of water afterdesirable amount

2 Moderate - upto 2lt more intake of water afterdesirable amount

3 Severe -upto 3lt more intake of water after

desirable amount

4 Very severe -upto 4lt more intake of water afterdesirable amount


Boby smell 0 Absent -no smell

(Shareera Daurgandhya) 1 Mild -mild smell but can be avoided after

bath

2 Moderate -smell can be avoided by applicationof perfuming agent

3 Severe -smell from distance and cant beavoide by perfume

4 Very severe -Excessive smell creats discomfort to

patient itself

Excessive sleep 0 Absent -7 to 8 hrs sleep and freshness

(Nidradhikya) 1 Mild ->8 hrs sleep and feeling drowsy

2 Moderate ->8 hrs sleep, feeling drowsy andfrequent yawning

3 Severe ->10 hrs sleep and feels drowsy in day

time

4 Very severe ->10 hrs sleep and feels depressive


28

Libido 0 Absent -proper sexual performance

(Maithuna shakti) 1 Mild -mild dyspnoea after intercourse

2 Moderate -moderate dyspnoea after intercourseand weakness

3 Severe -Unable to complete sexual

intercourse and dyspnoea

4 Very severe - unable to perform sexual intercourse

Fatigue 0 Absent -normal work performance

(Kloma) 1 Mild -tiredness after heavy work

2 Moderate - tiredness after moderate work

3 Severe - tiredness after mild work

4 Very severe -tiredness after very mild work

Feeling of heaviness 0 Absent -no heaviness

(Gaurava) 1 Mild -feels heaviness but can perform

normal work

2 Moderate -difficult to perform normal work dueto heaviness

3 Severe - difficult in normal routine work dueto heaviness

4 Very severe -depression due to feeling heaviness

Moistureness of body 0 Absent -normal moisture

(Snigdhangata) 1 Mild -excess moisture in humidity

2 Moderate - excess moisture in dry climate

3 Severe -excess moisture in dry climate andmake discomfort

4 Very severe -excessive continuous moisture all

over the body


Excessive sweating 0 Absent -sweating after heavy work

(Swedadhikya) 1 Mild - sweating after moderate work

2 Moderate - sweating after mild work

3 Severe - excessive sweating after mild work

4 Very severe - sweating on rest and winter also


29

Objective assessment criteria

Under the objective parameters laboratory

findings were assessed as follows : lipid profile,fasting blood sugar, blood urea, serum creatinine,SGPT, Hb%, TLC, DLC, ESR of every patient was done

before and after treatment.

Statistical analyses for changes in allobjective criteria were assessed by p-paired test.

Observation And Results:

Under the study of demographic profile of 90patients it was noted that maximum number of patient

(40%) had 36-45 years age with a maximumprevalence of disease in middle age group. Genderdistribution of the disease found male (54.44%)were

more prone to the disease. 73.33% of cases registeredbelong to Hindu community. Maximum 26.66% ofhigher middle status group and minimum 6.66% lower

income group were registered indicating higher rateof prevalence of hypercholesteromia is in middle tohigher socio-economic group. 41.11% of cases were

found to have vata kapha predominant prakriti and

56.66% were belongs to rajasika manasika prakriti.Basal metabolic rate (BMI) was found that 92% were

above normal limit (>26 kg/m2).

Analytical observation found for fastingblood sugar in group A-5.19% (p<0.01), group B-

0.79% and group C-1.24% improvement. Changesfound in SGPT are – in group A it is 27.21%, in groupB-6.20% and in group C-1.35%. Improvements found

in BMI are group A-8.16%, group B-0.44%.

Similarly, improvement was seen insubjective assessment factor like in group A 50% in

moistureness of body, 45.65% in feeling of heaviness,35.29%in fatigueness , 34.48% in excessive sweating,34.88% in excessive hunger, 33.99% in fat movement

in breast & abdomen. In case of group B 18.75%improvement in fatigue, 16%in moistureness, 13.51%in excessive thirst, 12.77% in weakness, 11.54% in

excessive sweating, 10% in fat movement, 4.76% infeeling of heaviness. In case of group C 13.21% inexcessive sweating, 10.53% in fatigue, 9.62% in

moistureness, 8.06% in fat movement, 3.03% inexcessive hunger.

Result observed in Lipid profile: Group A

Lipid profile Mean Media % SD SE t p

B T A T ± ± Value Value

S.cholesterol 291.93 263.70 28.23 9.67 15.65 2.86 9.88 <0.001

S.triglyceride 237.47 219.13 18.33 7 . 7 2 24.22 4.42 4.15 <0.001

HDL 42.38 43.78 1.40 3.31 2.71 0.50 2.83 <0.001

LDL 171.98 137.39 34.58 20.11 21.96 4.01 8.63 <0.001

VLDL 43.09 37.52 5 .57 12.92 5.13 0.94 5.94 <0.001

LDL/HDL 4.15 3.21 0.94 22.61 0.62 0.11 8.26 <0.001

Result observed in Lipid profile: Group B



S.cholesterol 272.57 237.87 34.70 12.73 34.87 6.37 5.45 <0.001

S.triglyceride 236.90 208.97 27.93 11.79 29.47 5.38 5.19 <0.001

HDL 43.74 42.88 0.86 1.97 2.34 0.43 2.11 <0.1

LDL 158.82 130.40 28.42 17.90 21.69 3.96 7.18 <0.001

VLDL 45.73 42.08 3.65 7.98 6.84 1.25 2.92 <0.010

LDL/HDL 3.68 3.08 0.60 16.25 0.53 0.10 6.19 <0.001


30

Group C



S.cholesterol 288.77 282.63 6.13 2.12 1 6 . 7 7 3.06 2.00 <0.1

S.triglyceride 280.10 275.80 4.30 1.54 12.25 2.24 1.92 <0.1

HDL 42.83 4 1 . 7 7 1.05 2.46 2.93 0.54 1.96 <0.1

LDL 189.92 185.70 4.22 2.22 18.09 3.30 1.28 <0.1

VLDL 56.02 55.16 0.86 1.54 2.45 0.45 1.92 <0.1

LDL/HDL 4.47 4.47 0.00 -0.05 0.64 0.12 -0.02 -<0.01

Graphs showing changes observed in Lipid Profile in different group:

Changes found in serum triglycerides in different in group

0

50

100

150

200

250

300

A B C

mg/dl

BT AT

Changes found in srum cholesterol in different group

0

50

100

150

200

250

300

350

A B C

mg/dl

BT AT

Changes found in serum LDL in different group

0

20

40

60

80

100

120

140

160

180

200

A B C

mg/dl

BT AT

Changes found in serum HDL in different group

40.5

41

41.5

42

42.5

43

43.5

44

A B C

mg/dl

BT AT


31

Discussion

Different clinical trials have been established

as anti hypercholesteromia agent. The aim of thepresent study was to evaluate the effect ofpanchokola churna in patients of

hypercholesteromia.

Symptomatic relief was found in group A asp<0.001 which is highly significant than group B &

C as p<0.1 and p>0.1. the improvement in lipidprofile is found to be highly significant in group Aand group B i.e p<0.001 but not in group C (p<0.1)

Panchokola churna have highly significanteffect on BMI as in case of group A (p<0.001) wherein group B & C have no such effect.

Conclusion

Looking at the result it may be concludedthat panchokola churna is a potent

hypocholesteromic drug. However, further morecomprising larger group and experimental study onanimal is needed to reach the more definite

conclusion.

References

1 . Agnivesha, Charaka Samhita, Acharya Yadavaji

Trikamaji, Choukambha publication 2001,

V a r a n a s i .

2 . Madhavakara, Madhava nidana, shri vijaya

rakshita & Shrikanta dutta, Brahmananda tripati,

vol-1, Madhukosha, choukambha surbharati

prakashana, varanasi, 2nd edition,1998,

3 . Maharshi Sushruta, Sushruta Samhita, 7th ed,

Varanasi U.P, Sri DalhanaAcharya Sri Gayadas

Acharya, Vaidya Yadavaji Trikamaji Acharya

Chaukhambha Sanskrit Sansthan, 2002

4 . Vagbhatacharya Ashtanga Hridaya Dr Anna

Mereshwara kunte, Choukambha publication 2000

V a r a n a s i .

5 . Harrison’s Principles of Internal Medicine, Charles

Wiener, Anthony S. Fauci, Eugene Braunwald,

Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo,

J. Larry Jameson, Joseph Loscalzo, ISBN,

0 0 7 1 4 9 6 1 9 X / 9 7 8 0 0 7 1 4 9 6 1 9 3

6 . Triglyceride Profile in Dyslipidaemia of Type 2

Diabetes Mellitus Sohail Rafi Khan, Nishat Ayub,

Sohail Nawab and Tahir S. Shamsi

7 . Anderson JW, Davidson MH, Blonde L, et al. Long-

term cholesterol-lowering effects on Psyllium as an

adjunct to diet therapy in the treatment of hyper-

cholesterolemia. Am J Clin Nutr. 2000a; 71:1433-

1 4 3 8 .

8 . National Cholesterol Education Program. Executive

summary of the third report of the National

Cholesterol Education Program (NCEP) expert panel

on detection, evaluation, and treatment of high

blood cholesterol in adults (Adult Treatment Panel

I I I ) . J A M A . 2 0 0 1 ; 2 8 5 ( 1 9 ) : 2 4 8 6 - 2 4 9 7 .

9 . Nutrition Committee of the American Heart

Association. AHA Dietary Guidelines. Revision 2000:

A Statement for Healthcare Professionals. Circulation.

2000; 102:2284-2299.


32

Clinical efficacy of Haridradi Taila Basti in OrthostaticHypotension in Diabetic Cardiac Autonomic Neuropathy

*Vd. Mukesh B. Shukla, **Vd. Surekha Abhale

*M.D. (Kayachikitsa), Ph. D. (Panchakarma), Associate Professor & Head of Dept. of Panchakarma, Mobile :

9869041361, e-mail [email protected], [email protected] **(M.D. Ayu. Part II)-

Kayachikitsa, Research Place, Dept. of Panchakarma, Smt. K.G.M.P. Ayurveda Mahavidyalaya & Hospital, Netaji

Subhash Road, Mumbai –400 002.

Clinical Study

Abstract

The study was undertaken to study difference in Orthostatic Hypotension in diabetic neuropathy(cardiac autonomic neuropathy) by giving Haridradi Taila basti.

Haridradi Taila from Yogaratnakara Prameha – Chikitsadhikara is selected because uncontrolledDiabetes mellitus increases the risk of complications like diabetic – cardiac autonomic neuropathy. InAyurveda untreated / neglected prameha is said to progress to Prameha- Upadravas. This similar nature of

the disease facilitates their co- relation.

Orthostatic Hypotension is a cardinal symptom of Cardiac Autonomic Neuropathy Cardiacautonomic neuropathy leads to ischaemia or infarction by reducing the coronary perfusion pressure during

orthostatic hypotension so this symptom should be managed. The phenomenon of the reversibility of diabeticneuropathy syndromes has been appreciated in case of visceral manifestation like orthostatic hypotension.

The effect on Orthostatic Hypotension of the Cardiac Autonomic Neuropathy patients was assessed

along with other symptoms like lightheadedness, fading vision pallor, tremor, weakness or even syncope.All symptoms were given scoring depending upon their severity from 0 to 4. The scores were subjected to‘t’ test. Our experience with treatment modalities has been encouraging yet the response pattern is quite

different.

‚Ê⁄UÊ¥‡Ê-

ß‚ •äÿÿŸ ∑§ •ãÃª¸Ã «UÊÿ’ËÁ≈U∑§ ãÿÍ⁄UÊ¬ÕË •ÊÒ⁄U •ÊÕÊ¸S≈UÁ≈U∑§ «UÊ≈U¬Ê≈¥U‡ÊŸ ∑§ ’Ëø •ãÃ ∑§Ê „Á⁄UŒ˝ÊÁŒ ÃÒ‹ ’ÁËSÃŒ∑§⁄U ŒπÊ ªÿÊ „Ò–

ÿ„Ê° ÿÊª⁄U%Ê∑§⁄U ◊ ¬˝◊„ ÁøÁ∑§à‚ÊÁœ∑§Ê⁄U ◊¥ ∑§„Ê ªÿÊ „ÊÁ⁄UŒ˝ÊÁŒ ÃÒ‹ Á‹ÿÊ ªÿÊ „Ò ÄÿÊ¥Á∑§ •ÁŸÿÁãòÊÃ «UÊÿÁ’≈UË¡◊‹Êß≈U‚ ©¬Œ˝fl ∑§Ë ‚¥÷ÊflŸÊ ∑§Ê ’…∏ÊÃÊ „Ò ¡Ò‚- «UÊÿ’ËÃ≈U∑§ ∑§ÊÁ«U¸ÿ∑§ •Ê≈UÊŸÊÁ◊∑§ ãÿÍ⁄UÊ¬ÒÕË– •ÊÿÈfl¸ŒÊŸÈ‚Ê⁄U •‚Êäÿ ¬˝◊„,¬˝◊„ ©¬Œ˝fl ∑§Ê ©à¬ÛÊ ∑§⁄UÃÊ „Ò– √ÿÊÁœ ∑§Ë ÿ„ ‚Êêÿ ¬˝∑Î§ÁÃ ßŸ ŒÊŸÊ¥ ∑§ ’Ëø ‚„ ‚ê’ãœ ∑§Ê Œ‡ÊÊ¸ÃÊ „Ò–

•ÊÕÊ¸S≈UÁ≈U∑§ „Êß¬Ê≈¥U‡ÊŸ, ∑§ÊÁ«¸Uÿ∑§ •ÊÚ≈UÊŸÊÁ◊∑§ ãÿÍ⁄UÊ¬ÕË ∑§Ê ‹ˇÊáÊ „Ò ¡Ê ß‡øËÁ◊∑§ ÿÊ ßã»§Ê∑¸§‡ÊŸ ∑§Ê ©à¬ÛÊ ∑§⁄UÃË„Ò, ¡Ê Á∑§ •ÊÕÊ¸S≈UÁ≈U∑§ „Êß¬Ê≈¥U‡ÊŸ ∑§ ŒÊÒ⁄UÊŸ ©à¬ÛÊ ∑§ÊÁ«¸Uÿ∑§ •ÊÚ≈UÊŸÊÁ◊∑§ ãÿÍ⁄UÊ¬ÕË ∑§ ⁄UÊªË ◊¥ •ÊÕÊ¸S≈UÁ≈U∑§ „Êß¬Ê≈¥¥‡ÊŸ ∑§¬˝÷Êfl ∑§ ∑§Ê⁄UáÊ ¡Ê •ãÿ ‹ˇÊáÊ Á◊‹ fl „Ò - Á‚⁄UŒŒ¸, •Ê°πÊ¥ ◊¥ œÈ¥œ‹Ê¬Ÿ, ¬Ë‹Ê¬Ÿ ∑§ê¬, ∑§◊¡Ê⁄UË, •ÊÁŒ ßŸ ‚÷Ë ‹ˇÊáÊÊ¥∑§Ê 0-4 Ã∑§ ∑§Ë ªáÊŸÊ Œ∑§⁄U ‘t’-test Á∑§ÿÊ ªÿÊ– ÃÊ ß‚ ¬˝∑§Ê⁄U ∑§ •ŸÈ÷fl ¬Ê∞ ª∞ Á∑§ ⁄UÊªË mÊ⁄UÊ Á◊‹Ÿ flÊ‹ ¬Á⁄UáÊÊ◊∑È§¿U Á÷ÛÊ Õ–


33

Introduction

Diabetes Mellitus with its complications is animportant health concern worldwide. UncontrolledDiabetes mellitus increases the risk of complications

like diabetic - cardiac autonomic neuropathy. InAyurveda untreated / neglected Prameha (~DiabetesMellitus) is said to progress to prameha – upadravas.

This similar nature of the disease facilitates their co-relation.

Excess mortality of the diabetic patient has

been attributed predominantly to diabetic heartdisease. The main factors that contribute to theincreased incidence of cardiovascular disease in

diabetic patients are,

1 . The acceleration of atherosclerotic processleading to macro – vascular disease.

2. Development of specific cardiomyopathy due to

Diabetes Mellitus

3. Progressive micro-vascular disease.x

4. Development of diabetic autonomic neuropathy

which include Cardiac Autonomic

Neuropathy

The study was undertaken to evaluate the

difference in orthostatic Hypotension which is thecardinal symptom of cardiac autonomic neuropathyby Haridradi Taila Basti.

Definition of Orthostatic Hypotension

Orthostatic hypotension is defined as adecline of 20mm Hg or more in the systolic blood

pressure or 10mm Hg or more in the diastolic bloodpressure on the assumption of an upright posture for3 minutes.

Clinical efficacy of Haridradi Taila Basti in OrthostaticHypotension in Diabetic Cardiac Autonomic Neuropathy

Vd. Mukesh B. Shukla, Vd. Surekha Abhale

Clinical Study

Pathophysiology of Orthostatic Hypotension

Upright Posture

500 – 700 ml blood is pooled in the lower extremities & in the splanchnic and pulmonary circulation.

Decreases in the venous blood return to the heart

Transient reduction in cardiac out put

A reflex increase in sympathetic outflow by stimulation of the cardiopulmonary aortic and carotidbaroreceptors

Thereby increasing the heart rate and vascular resistance to maintain the systemic blood pressure

Orthostatic hypotension may result from an excessive reduction in blood volume, when the patient is

upright or as a result of inadequate cardiovascular compensation


34

Orthostatic Hypotension: - In Cardiac

Autonomic Neuropathy

In case of cardiac autonomic neuropathysymptoms are due to an unopposed sympatheticactivity due to parasympathetic denervation, which

is due to uncontrolled B.S.L. for longer time

Loss of parasympathetic activity is alsoresponsible for exaggerated and inappropriate

vasoconstriction.

Cardiac Autonomic Neuropathy leads toischemia or infarction reducing the coronary

perfusion pressure during orthostatic hypotension

Samprapti of Cardiac Autonomic Neuropathy

Dosha -

Vata - Prana-Ruksha, Laghu, Chala gunatahavruddhi

Vyana - Chala,Laghu gunataha kshaya

Apana - Ruksha gunataha vruddhi, karmataha vikruti

Pitta - Sadhak-Tikshnataha gunataha vruddhi &karmataha vikruti

Kapha - Kledak-Dravataha vruddhi

Avalambak-Gurutaha vruddhi

Dushya - Ojas, Rasa, Rakta, Mansa, Meda, Majja,

Kleda, Vasa, Lasika

Avastha - Majjagata Avastha

Strotas - Rasavaha,Majjavaha,Medovaha etc.

Dushti Lakshana - Sanga

Sthana - Hridaya & Vatanadi sansthana

Vyadhi Swabhav - Cheerkalin

Chikitsa Parinam - Yapya

Vyadhi Utpatti Sthanam - Pakwashaya

Vyadhi Marga – Abhyantara, Marmaasthigata

Rugna Vaya Sambandha - Old > Young

Sankramana - Non-infectious

Anuvansheekata - Anuvanshik

Dhatugata Prabhava - All dhatu kshaya

Aims & Objectives

1) Application of Ayurved Chikitsa Siddhanta to

Cardiac Autonomic Neuropathy

2) Detail study of ‘Orthostatic Hypotension’ as acardinal symptom of Cardiac Autonomic

Neuropathy.

3) To evaluate the clinical efficacy & mode of actionof Haridradi Taila Basti in the management of

orthostatic Hypotension of cardiac autonomicneuropathy.

Material & method

1) Name of Research PlaceIPD & OPD of Dept. of PanchakarmaSmt. K.G.M.P. Ayurveda Mahavidyalaya &

Hospital, Netaji Subhash Rd.Mumbai – 400 002

2) No. of patients : 20

3) Type of Study: Open group study

20 well diagnosed & established patients ofcardiac autonomic neuropathy having good

glycaemic control treated by Haridradi Taila Basti

4) Material Used

„Á⁄UŒ˝ÊÁŒ ÃÒ‹◊ÁŸ‡ÊÊ⁄U‚¥ øÃÈ—¬˝SÕ Ám¬˝SÕ ˇÊË⁄U‚¥ÿÈQ§◊˜–∑È§DÊ‡flªãœÊ‹‡ÊÈŸÁŸ‡ÊÊÁ¬å¬Á‹∑§ÊÀ∑§Ã◊˜––Áfl¬`¥§ ÁÃ‹¡¬˝SÕ¥ ◊„ÊŸÊ¥ Áfl¥‡ÊÁÃ ¡ÿÃ–ÿÊ–⁄U–

5) Method

Dose : 60 ml /day

Time : Pratahpaschatbhukta

Duration : 16 days

Route of Administration : Per Rectum (Basti)

Type of Basti : Matrabasti x 16 days

Ahara & Vihara : Hospital made or as per

Physician

Inclusion Criteria

1) Age : 30 to 70 years

2) Sex : No barrier

3) Race & Religion : No barrier


35

4) Established case of cardiac autonomicneuropathy

5) Patients with well controlled glycaemic status

Exclusion Criteria

1) Patients with infectious disease e.g. HIV, Koch’s

& Abdominal disorders

2) Renal disorders, Hepatic ailments

3) Patients with other complications of Diabetes

Mellitus

4) Anorectal diseases

5) Pregnancy

Criteria for Assessment

The effect on orthostatic hypotension was

assessed along with other symptoms of orthostatichypotension like lightheadedness fading vision,pallor, tremor, weakness syncope. All symptoms

were given scoring depending upon their severityfrom 0 to 4

Sr.No. Symptoms 0 1 2 3

1 Lightheadedness Absent Slight & Moderate Present mostinfrequently present bothersome of the time

to pt.

2 Fading Vision Absent Slight & Moderate Severeinfrequently present

3 Pallor Absent Slight Moderate Marked

4 Tremor Absent Slight Detectable Bothersome to pt.in daily activities

5 Weakness Absent Slight Moderate Marked

6 Syncope Absent Infrequent Frequent Very frequent

Difference in average B.P.

Systolic B.P. : ( After T/t - Before T/t)

Diastolic B.P. : (After T/t - Before T/t)

Efficacy of Haridradi Taila Basti ( Karmukatva)

Guna : Sukshma, Ushna, Laghu, Snigdha Sara

Rasa : Madhur, Katu, Tikta

Virya : Ushna

Vipaka : Madhur

Doshaghnata : Tridoshaghna

Rogaghnata : Pramehaghna

Prabhav: Rasayana, Balavarnakar

Ojavardhak, Agnivardhak

Dhatukarma Dhatusanrakshan, Dhatuvardhan/ Dhatupushti, Dhatugata Rasayan

Karma

Doshkarma Prakrutatva, Swasthan Gatatva

Chikitsa Parinam: Dhatugata Naimittik Rasayana

Probable Mode of Action :

Ayurveda consider basti as an effectivemodality to treat half of all diseases and disorders.

We have selected ‘Haridradi Taila Basti’ for themanagement of orthostatic hypotension in cardiacautonomic neuropathic from Yogratnakara. The

principal content is Haridra (Curcuma longa)

which is Rasayanakar, Agnivardhak, Tridoshoghna &Agrya Dravya for Pramehaghnata according to

Vagbhata.


36

Chikitsa Siddhanta

Chikitsa siddhanta says that Vataja prameha

can be treated with Sneha (Taila) incorporated withKaphahara dravyas.

While for the treatment of Upadravas

following principle can be useful

ÃòÊ ¬˝œÊŸÊ √ÿÊÁœ— √ÿÊœÒªÈ¸ª÷ÍÃ ™§¬Œ˝fl—–ÃSÿ ¬˝Êÿ— ¬˝œÊŸ ¬˝‡Ê◊ ¬˝‡Ê◊Ê ÷flÁÃ––

ø/Áø. 21/80

So in Vataj pramehopadravas we can useformulation which contains Haridra, as Kaphahara

dravya in large quantity along with Ashwagandha,Rasona. Pippali, Kushta and Godugdha.

It is proven that Curcuma longa hasNeuroprotective action. It has Rasayana karma

which can potentially reverse or delay thedegenerative changes. Thus this can be aneuroprotective therapy which may delay the rate

of its progression Haridra has been advocated asNaimittik Rasayana for prameha.

There is possible role of Naimittik Rasayanas

in preventing and reversing complications likely toreduce the rate of neurological degeneration inDiabetic Neuropathy and reduce its sympatomatic

manifestation.

Observations:

The result obtained and statistical processing is as follows :

Sr. No. Symptoms Graded Patients Symptoms relief

Before T/t After T/t in %

1 . Light headedness 3 1.3 56.67

2. Pallor 3 1 . 7 43.33

3. Fading Vision 2.45 1.2 51.02

4. Tremor 2.65 1.3 50.94

5. Weakness 3 1.4 53.33

6. Syncope 2.5 1.65 34

If Ho = µ1= µ2 i.e., There is no result in these symptoms. We have to reject Ho , if tcal > ttab for5% error, i.e., tcal > 2.09

tcal for these symptoms is 3.3951. Therefore Hypothesis is rejected. Thus, it is statistically proventhat this treatment thus show results for symptoms of Orthostatic Hypotension.

Sr. Signs Graded patients Relief in %

No. Before T/t After T/t

1 . Different in systolic B.P. 24 7 . 7 67.91

2. Different in Diastolic B. P. 15.8 5.1 67.72

tcal for systolic B.P. is 5.17,& for diastolic B.P. is 2.648; both are greater than ttab value i. e. 2.09 for5% error. Therefore Hypothesis that there is no difference in B. P. due to T/t is rejected.

It is proven statistically that there is difference in systolic & diastolic pressure.

After evaluating we can come to know that this difference is favorable.


37

Discussion :-

The clinical trial has been conducted in 20

patients. Basti was given with appropriatePurvakarma as mentioned in text for 16 days.Patients were assessed after & during treatment on

the basis of improvement in the signs & symptomsof Orthostatic Hypotension.

Conclusion :-

The clinical improvement provided byHaridradi Taila Basti presents window of opportunityin the management of orthostatic hypotension of

cardiac autonomic neuropathy. As per ourexperience we can give significant treatment. Werecommend that this procedure should be done in

cycles & should be evaluated scientifically using theprinciples of neurotransmitter.

References

1 ) STREETEN D HP : Orthostatic disorders of the

circulation mechanisms manifestations and

treatment. New York, Plenum, pp 114.118.1987

2 ) H.S. Wasir. Aging and Heart care. Vikas Publishing

House. 291,1993

3 ) Asbury A.K. understanding Diabetic Neuropathy

Engl. J. med. 319,577,1988

4 ) Kasture H. Ayurvediya Panchakarma Vignyan

Nagpur : Shri Baidyanath Ayurveda Bhavan 1999

5 ) Greene D.A. Lattimer s et all : Glucose induced

alterations in nerve metabolisms current perspective

on the pathogenesis of Diabetic Neuropathy and

future directions for research and therapy. Diabetes

care 9 : 290, 1985

6 ) Madhavakara – Madhava Nidanam – vol.2

Varanasi: chaukhamba – 2004, p – 18

7 ) Vagbhata, Ashtanga, Hridya, Varanasi,

Chaukhamba – 1993; p – 387

8 ) Vagbhata : Ashtanga Sangraha vol. 1 Varanasi:

Chaukhamba – 1993; p – 387

9 ) Vangasena : Chikitsa Sarsangraha; Chaukhamba –

1993; p – 387

1 0 ) Yogratnakara – vol. 2, Varanasi, Chaukhamba

2008; p 81

1 1 ) Vd. Vishnu Mahadeo Gogate – Dravya guna

Vignyana – Pune : Vaidyamitra – 2008, P 681


38

Ayurvedic Diagnosis and treatment of Relapsed Malarial Feverin old aged patient with Chloroquine Intolerance: A Case Study

*Dr. Deshpande Shailesh V., *Dr. Deshpande Vaishali S.

Clinical Study

*Department of Kayachikitsa, PDEA’s College of Ayurved and Research Centre, Sector 27, Akurdi, Pradhikaran, Pune

411040, Maharashtra Corresponding Author:Dr. Deshpande Shailesh Vinayak, Address: ‘Sonai’, Shri Adishakti

Co- op. Hsg. Soc. Sr. No. 28/8/5–6, Behind Bharati Hospital, Chaitanya Nagar, Dhankawadi, Pune 411043

(Maharashtra) Mobile No.: 9763104451 Phone No.: 020-24378088 E-mail: [email protected]

Abstract

Malaria is one of the commonest protozoal infections. Though complete cure of Malaria is possibleusing modern medicines, situation becomes difficult in patients showing intolerance to these drugs. This

patient (80 years old male) of relapsed P. vivax malaria was diagnosed as a case of rasa medogata tridoshajatrutiyaka vishama Jwara. In view of the age, bala and intolerance to chloroquine it was different case. Patientreceived no antimalarials and was treated with ayurvedic drugs - fresh paste of parijatak (Nyctanthus

arobortristis. Linn), combination of putapakva vishama jwarantaka loha, mahasudarshana ghana and guduchi(Tinospora cordifolia. Linn). This patient showed complete remission within six days with no recurrence tilldeath (up to 2.5 years). Ayurvedic medicines can be of great help in such cases and may be useful in not

only for treating malaria but also in avoiding recurrences.

Key Words: Relapsed malaria, Ayurvedic treatment of malaria, P. vivax, Ayurvedic Diagnosis ofJwara, Putapakva Visham Jwarantaka Loha, Parijatak, Nyctanthus arobortristis. Linn

‚Ê⁄Ê¢‡Ê-

◊‹Á⁄ÿÊ ‚Ê◊ÊãÿÃ— ¬Í⁄Ë ºÈÁŸÿÊ ◊¥ ¬Êÿ ¡ÊŸ flÊ‹Ë Öfl⁄Ù¥ ◊¥ ‚ ∞∑§ „Ò– •ÊœÈÁŸ∑§ ÁøÁ∑§à‚Ê ◊¥ ÿlÁ¬ ß‚ Öfl⁄ ∑§Ê¬Í⁄Ê ß‹Ê¡ ‚¢÷fl „Ò ÃÕÊÁ¬ •ÊœÈÁŸ∑§ ºflÊßÿÙ¥ ∑‘ ¬˝ÁÃ •‚ÊàêÿÃÊ „ÙŸ flÊ‹ M§ÇáÊÙ¥ ◊¥ •ÊÿÈfl¸Áº∑§ ≤ÁC ‚ ß‹Ê¡ ‚¢÷fl „Ò–ß‚ ∑§‚ S≈«UË ◊¥ ‡ÊÊÁ◊‹ 80 ‚Ê‹ ◊¥ flÎh M§ÇáÊ ◊¥ ◊‹Á⁄ÿÊ ∑§Ê ¬ÈŸ— ¬˝ÊºÈ÷Ê¸fl ÃÕÊ •ÊœÈÁŸ∑§ ºflÊßÿÙ¥ ∑‘ ¬˝ÁÃ •‚ÊàêÿÃÊ◊ı¡Íº ÕË– ß‚ M§ÇáÊ ◊¥ ¬ÊÁ⁄¡ÊÃ ¬G ∑§À∑§ ÃÕÊ ¬È≈¬`§§Áfl·◊Öfl⁄Ê¢Ã∑§ ‹ı„ ◊„Ê‚Èº‡Ê¸Ÿ ÉÊŸ ÃÕÊ ªÈ«ÍUøË ∑‘ •ë¿U ¬Á⁄áÊÊ◊Á◊‹ fl ◊‹Á⁄ÿÊ ∑‘ ‹ˇÊáÊ ¿U„ ÁºŸ ◊¥ ŸC „È∞ - ÿ„ M§ÇáÊ ◊¥ •Êª 2.5 ‚Ê‹Ù¥ Ã∑§ ◊‹Á⁄ÿÊ ∑§Ê ¬ÈŸM§jfl Ÿ„Ë¥ „È•Ê–


39

What This Study Adds:

Relapsed Malaria in an 80 years old patientwith intolerance to modern medicine is a complexcondition to treat. Integrative approach of using

ayurvedic parameters of diagnosis and treatmentmentioned in Jwara and modern medicines for fasterrelief from symptoms can help in such situation. Here

is a discussion about successful treatment of relapsedmalarial fever using integrative approach.

Introduction

Malaria is completely curable using modernmedicines. But in patients with intolerance to modernmedicines ayurvedic treatment can help. In

ayurvedic classics multi faceted explanation aboutvarious types of Jwara is seen that needs clinicalapplication for complete ayurvedic diagnosis. Thatmethod is used for ayurvedic diagnosis in this

patient. Ayurveda considers individual variationssuch as age, bala, agni of a patient for treatmenthence the treatment of same disease varies from

patient to patient. In this patient along with severepyrexia, old age, anaemia and intolerance to modernmedicines needed special attention. Hence it was a

challenge to reduce pyrexia and also maintain balaof patient without using modern antimalarials.Malaria due to P. vivax shows relapses due to

exoerythocytic phase and needs additionaltreatment. This patient received no modern medicinefor this purpose and no recurrence was seen even

after 2.5 years (till death).

Case Report

Male patient of eighty years, presented on

22.11.2010 with fever with rigors, anorexia, bodyache, increased thirst, constipation and weaknesssince four days. Physical examination revealed

severe pyrexia (axillary temperature 1040F),tachycardia (pulse 120 per minute) and tendernessin left hypochondriac region. Patient was admitted

in our hospital on same day. Blood and urine

examinations showed anaemia (haemoglobin 9.2gm%). White blood cell counts were within normal

limits (Total leucocytes – 8900/mm3, neutrophils77%, lymphocytes 23%). Smear did not show anyparasite. Urine analysis showed mild protein loss.

Platelets were 1,09,000/cmm. No other investigationlike rapid diagnostic test for malaria was done.

History revealed that patient had pyrexia

one month before. Blood examination done a monthbefore was positive for P. Vivax. Patient was advisedchloroquine as per schedule by local doctor. But

after receiving first dose, patient had severe pain inabdomen and vomiting so he discontinued thetreatment on his own and consulted local ayurvedic

practitioner. He was prescribed parijatak vati 250mgBid and paripathiadi kadha 15ml Bid for five days.Fever showed remission after five days, but patient

continued to suffer from weakness, anorexia. Bloodexamination repeated after three weeks, did notshow malarial parasites.

Diagnosis

In this patient malarial parasites were notseen in blood smear, so the differential diagnoses

considered were relapsed malaria, dengue, entericfever and pneumonia. In view of low platelet counts,dengue IgG, IgM and NS1 were done which were

negative. In enteric fever relative bradycardia androse spots with leucopenia are seen which wereabsent in this patient. Absence of symptoms related

with respiratory system and normal chest xray ruledout Pneumonia. History of P. vivax infection that wasnot adequately treated with antimalarials and fever

with severe rigors on alternate days pointed towardsMalaria.[1] It is known that sequestration of parasitesand partial treatment can be a reason for negative

microscopy in malaria[2]. P. vivax sequesterspreferably in pulmonary and splenicmicrovasculature which is reason of severe

anaemia[3], hence sudden fall in haemoglobin levelsfrom 12 gm% to 9.2 gm% seen in patient during the

Ayurvedic Diagnosis and treatment of Relapsed Malarial Feverin old aged patient with Chloroquine Intolerance: A Case Study

Dr. Deshpande Shailesh V., Dr. Deshpande Vaishali S.

Clinical Study


40

span of 12 days supported the diagnosis. Studies havedemonstrated thrombocytopenia as an important

indicator for malaria[4,5]. Hence the patient wasdiagnosed as a case of relapsed malaria due to P.vivax.

Considering parameters mentioned inayurvedic treaties the patient showed typicalparoxysms of Jwara on alternate days, hence it was

diagnosed as trutiyaka vishama Jwara[6]. Patient hadvarcho vinigraha (constipation) and increasedtrushna (thirst) seen in antarvegi Jwara[7].

Considering symptoms of dhatugata Jwara patienthad arochaka (anorexia), angamarda (body ache),bahistapa (heat in outer parts of body), mentioned

in rasagata Jwara[8] and tivra sweda (profusesweating), pipasa (feeling thirst), seen in medogataJwara. [9] Considering symptoms according to dosha,

patient showed gatra ruk (pain in body parts), baddhavitkata (constipation) which are seen in vataja Jwara,tikshna vega (severe pyrexia), seen in pittaja Jwara

and anga sada (feeling tiredness), aruchi (anorexia),seen in kaphaja Jwara.[10] Hence it was TridoshajaJwara. According to symptoms of saama,

pachyamana and niraama Jwara, aruchi (anorexia),malasanga (constipation), pointed towardssaamavastha.[11] So complete diagnosis of patient

according to ayurveda was saama rasagata medagataaagneya antarvegi vaikruta tridoshaja trutiyakavishama Jwara.

Treatment

Patient was given freshly prepared paste ofleaves of parijatak (Nyctanthus arobortristis. Linn),

5gm, three times with warm water after food.Combination of putapakva vishama jwarantaka loha125mg, mahasudarshana ghana 500mg and guduchi

(Tinospora cordifolia. Linn) 250mg was given thricedaily with honey. 5%dextrose, Ringer’s lactate wereused as intra venous fluids to maintain hydration for

first two days. Avil and Voveron were used as intramuscular injections to control rigors and body painas symptomatic treatment. Cold sponging was

advised to reduce pyrexia. No anti-malarials wereadvised.

Treatment Outcomes

Gradual remission in fever was seen. Feverspikes were seen on second, fourth and sixth day

after admission. Complete remission was seen aftersixth day (Figure1). Anorexia, body ache, weakness

significantly reduced on sixth and seventh day oftreatment (Figure2). Patient was discharged on 1/12/2012. Same medicines were continued for further 15

days. No recurrence of malaria was seen up to 2.5years after discharge. The patient expired in June2013 due to cardiac failure.

Discussion

Parijatak (Nyctanthus arobortristis. Linn) is

commonly found in all parts of India. Juice of leavesof parijataka is tikta and jwaraghna. Clinical studyconducted on paste of leaves of parijatak has shown

complete clinical and parasitic cure [12]. Crudeethanolic extract of leaves has shown modestpotency against P.falciparum [13]. Putapakwa

jwarantaka lauha is a mineral combination useful invishama Jwara [14]. As it contains suvarna, praval,mukta it helps in lowering the temperature rapidly

and helps in eliminating untoward effects andweakness due to pyrexia. Mahasudarshan choorna isherbal combination, useful in all types of Jwara for

pachana of doshas. Combination of these medicinesalong with guduchi helps in pachana as well asbruhana due to balya and rasayana properties of

guduchi[15]. The combination of putapakwa vishamajwarantaka lauha, mahasudarshan choorna andguduchi limits langhana effect of mahasudarshana

churna and adds bruhana effect.

Objectives of treatment were not only to treatcurrent pyrexia, but in view of recent history it was

also necessary to avoid recurrences. Langhana,pachana and swedana are the first line of treatmentin Jwara, but if such treatments are not done

considering vital parameters such as, bala, age etc.these treatments can turn out to be against prana[16].Considering age of patient and severity of fever it was

also necessary reduce pyrexia and maintain bala ofpatient, hence combination of medicines which arepachana, langhana and medicines which are bruhana

but still jwaraghna were used. Swedana, thoughuseful in jwara, in this patient considering severepyrexia (1040F) swedana could have further

increased body temperature initially and couldprovoke complications. Hence cold sponging waspreferred.


41

Ayurveda has always promoted tailor mademedicine according to need of the patient. Hence it

was an effort to frame medicines considering notonly malaria but also parameters such as bala, age,specific for this patient. Intravenous fluids, avil and

voveron used in this patient, are not known to haveantimalarial effects.

Antimalarials from modern medicine are

known to have mild to severe adverse events.Chlorouine, though generally well tolerated, canshow nausea, vomiting[17] and severe adverse events

as cardiac arrhythmias, neuropsychiatric reactions,also retinopathy after chronic use[1]. Researchers alsohave expressed their concern for more studies to

evaluate harmful effects of antimalarials[18]. But in a

case such as present patient, who has alreadyexperienced adverse events, it is absolute necessity

to find alternative treatment.

Numbers of cases resistant to conventionalallopathic treatment is becoming a matter of

concern[19]. Hence it is important to explore potentialof ayurvedic medicines for their antimalarialproperties. P. Vivax malaria requires additional

treatment to eliminate exoerythrocytic stage toavoid recurrences. In this patient no recurrence wasseen till death, hence ayurvedic medicines might

have helped in abolishing this stage; a thing thatneeds to be explored. This is an observation in singlecase. Sincere efforts in this direction may help in

exploring new ayurvedic treatment of malaria.


42

References

1 . White NJ, Bremen JG. Malaria. In: Longo DL, KasperDL, Jameson JL, Fauci AS, Hauser SL, Loscalzo J,editors. Harrison Principles of Internal Medicine. 18th

ed. New York: Mc Graw Hill; 2012. Volume I, pp.1 6 8 8 - 1 7 0 8 .

2 . Anvikar A, Arora U, Das B, Das AP, Dhillon GPS, DuaVK, et al. Guidelines for diagnosis and treatment ofmalaria in India 2009. New Delhi: National Instituteof Malaria Research; 2009. Pp 9. [serial on theInternet] 2009 Apr [cited 2014 Jan 8]; [about 6 p]Available from: http://nvbdcp.gov.in/Doc/Guidelines_for_Diagnosis___Treatment.pdf

3 . Manning L, Rosanas-Ugrell A, Laman M, Edoni H,McLean C, Muller I, et al. A histopathological studyof fatal paediatric cerebral malaria caused by mixedPlasmodium falciparum/ Plasmodium vivaxinfections. Malaria Journal [serial on internet] 2012Apr [cited 2014 Jan 7]; 11: [about 1 pm] Availablefrom: http://www.malariajournal.com/content/pdf/1 4 7 5 - 2 8 7 5 - 1 1 - 1 0 7 . p d f

4 . Faseela TS, Roche RA, Anita KB, Malli CS, Rai Y.Diagnostic value of platelet count in malaria.Journal of Clinical and Diagnostic Research [serialon internet] 2011 June [cited 2014 Jan 7]; 5(3):[about 1 pm] Available from: http://www.jcdr.net/art ic les/pdf/1338/2071 .pdf

5 . Patel U, Gandhi G, Friedman S, Niranjan S.Thrombocytopenia in malaria. Journal of nationalmedical association [serial on internet] 2004 Sep[cited 2014 Jan 7]; 96(9): [about 1 pm] Availablefrom: http://www.ncbi.nlm.nih.gov/pmc/articles/P M C 2 5 6 8 4 5 4 / p d f / j n m a 0 0 1 7 8 - 0 0 8 0 . p d f

6 . Acharya JT, editor, (4th ed.). Charak Samhita,Chikitsa Sthana; Jwara Chikitsa: Chapter 3, Verse67. Varanasi: Chaukhamba Sanskrit Sansthan,1994; 404.

7 . Ibid. Chapter 3, Verse 40.



1 0 . Acharya JT, Acharya NR, editors, (7th ed.). SushrutSamhita, Uttara Tantra; Jwara Chikitsa: Chapter39, Verse 29-34. Varanasi: ChaukhambaOrientalia, 2002; 673.

1 1 . Acharya JT, editor, (4th ed.). Charak Samhita,Chikitsa Sthana; Jwara Chikitsa: Chapter 3, Verse133-136. Varanasi: Chaukhamba SanskritSansthan, 1994; 408.

1 2 . Karnik SR, Tathed PS, Gidse CS, Vaidya RA.Antimalarial activity and clinical safety oftraditionally used Nyctanthes arbor-tristis Linn.Indian J Traditional Knowledge [serial on theInternet] 2008 Apr [cited 2013 March 12]; 7:[about 6 p] Available from: http://n o p r . n i s c a i r . r e s . i n / b i t s t r e a m / 1 2 3 4 5 6 7 8 9 / 1 5 9 6 / 1 /I J T K % 2 0 7 ( 2 ) % 2 0 3 3 0 - 3 3 4 . p d f

1 3 . Kumari P, Sahal D, Jain SK, Chauhan VS.Bioactivity Guided Fractionation of Leaves Extractof Nyctanthes arbor tristis (Harshringar) against Pfalciparum. PLoS ONE [serial on the Internet] 2012Dec [cited 2013 March 12]; 7(12) :[about 7 p]Available from: http://www.ncbi.nlm.nih.gov/pmc/art ic les/PMC3530506/pdf/pone .0051714 .pdf

1 4 . Shastri R, editor, (14 th ed). Bhaishajya Ratnavali;Jwara Chikitsa: Chapter 5, Verse 1162-1169.Varanasi: Chaukhamba Sanskrit Sansthan, 2001;1 2 4 .

1 5 . Mishra BS, Vaishya R, editors, (11th ed).Bhavaprakash of Bhavamishra, Nighantu;Guduchyadi Varga: Verse 8-10. Varanasi:Chaukhamba Sanskrit Bhavan, 2007; 269.

1 6 . Acharya JT, editor, (4th ed.). Charak Samhita,Chikitsa Sthana; Jwara Chikitsa: Chapter 3, Verse141-142. Varanasi: Chaukhamba SanskritSansthan, 1994; 409.

1 7 . Karnad DR. Malaria. In: Shah SN, Anand MP,Billimoria AR, Kamath SA, Karnad DR, Munjal YP,et al, editors. API textbook of medicine. 8th edreprint. Mumbai: The association of physicians ofIndia; 2009. Volume I, pp. 119-124.

1 8 . Allen EN, Chandler CI, Mandimika N, Pace C, MehtaU, Barnes KI. Evaluating harm associated with anti-malarial drugs: a survey of methods used by clinicalresearchers to elicit, assess and record participant-reported adverse events and related data. MalariaJournal [serial on internet] 2013 Sep [cited 2014Jan 7]; 12: [about 1 pm] Available from: http://w w w . m a l a r i a j o u r n a l . c o m / c o n t e n t / p d f / 1 4 7 5 - 2 8 7 5 -1 2 - 3 2 5 . p d f

1 9 . Parija SC, Praharaj I. Drug resistance in malaria.Indian Journal of Medical Microbiology [serial oninternet] 2011 Jul [cited 2014 Jan 10]; 29(3):[about 2 pm] Available from: http://www.ijmm.org/t e m p / I n d i a n J M e d M i c r o b i o l 2 9 3 2 4 3 -3 3 6 7 0 7 9 _ 0 9 2 1 1 0 . p d f


43

Chemical Study Of Madhu W.S.R. To It’sAharaviruddha Swabhava

*Dr. Shilpa Walkikar, **Prof. N.S.Chundawat

Clinical Study

Abstract

Madhu is the most important part of Ahara as well as medicine mentioned in Ancient Ayurvedic

texts, with its types and uses. In various types of Aharadravyas are contra indicated with Madhu like GhritaAntarikshajala, Pushkerbheeja etc. This contra indication is called viruddhahara. In this study the Viruddhaeffect of Madhu with Ghrita, Antarksha jala, Pushker beeja is carried out in my study. There is no evidence

of any physical and chemical changes were found in the chemical analysis of each samples i.e. Madhu : Ghrita,Madhu : Antarkshajala, Madhu:Pushkerbeeja in the ratio 1:1, 1:2. 2:1 respectively.

Keywords : Madhu, Viruddhahara, Ghirta, Antarksha Jala, Pushkerbeeja.

‚Ê⁄Ê¢‡Ê-

•ÊÿÈfl¸º ◊¢ •Ê„Ê⁄ ∞fl¢ •ÊÒ·Áœ ºÊŸÊ ◊¢ ◊œÈ ∑§Ê ◊„àfl, ÁflÁ÷ãŸ ÷º ÃÕÊ ©‚∑§Ë ©¬ÿÊÁªÃÊ ∑§Ê fláÊ¸Ÿ Á∑§ÿÊ „Ò–•ÊøÊÿÊ¥¸ Ÿ ◊œÈ ∑§Ê ÁflÁ÷ãŸ •Ê„Ê⁄ º˝√ÿÊ¢ ∑§ ‚ÊÕ ¡Ò‚ - ÉÊÎÃ, •ãÃ⁄ËˇÊ¡∂, ¬Èc∑§⁄’Ë¡, ßàÿÊÁº ÁŸÁ·h ’ÃÊÿÊ „Ò– ß‚ ÁŸÁ·hÃÊ∑§Ê ÁflM§hÊ„Ê⁄ ∑§„Ã „Ò– ◊ÒŸ ◊œÈ ∑§ •Ê„Ê⁄ÁflM§h Sfl÷Êfl ∑§Ê ÉÊÎÃ, •¢ÃÁ⁄ˇÊ ¡∂ •ÊÒ⁄ ¬Èc∑§⁄’Ë¡ ∑§ ‚ÊÕ •äÿÿŸ Á∑§ÿÊ „Ò–◊⁄ ‡ÊÊœ∑§Êÿ¸ ◊¢ ◊œÈ—ÉÊÎÃ, ◊œÈ—•¢Ã⁄ËˇÊ ¡∂, ◊œÈ—¬Èc∑§⁄’Ë¡ ∑§Ê 1—1, 1—2, 2—1, •ŸÈ¬ÊÃ ◊¢ ⁄Ê‚ÊÿÁŸ∑§ •äÿÿŸ Á∑§ÿÊ ªÿÊ,Á¡‚◊¢ ∑§Êß¸ ÷ÊÒÁÃ∑§ ∞fl¢ ⁄Ê‚ÊÿÁŸ∑§ ’º∂Êfl Ÿ„Ë¢ ¬Êÿ ªÿ–

*M.D.Scholar, P.G.Department of Swasthavritta & Yoga, N.I.A., Jaipur , **Prof. & Head, P.G.Department of

Swasthavritta & Yoga, N.I.A., Jaipur,


44

Introduction

Ayurveda is essentially the science of life. Itembraces in itself perfect principles for leading a

healthy life. Ayurveda envisages complete regimenfor both healthy and diseased one, guarding healthat all ages.

Ahara, Nidra and Brahmacarya are threesub-pillars, which support the body itself.

Here Ahara has been enumerated first, which

shows its importance. .

Food plays a decisive role in development,sustenance, reproduction and termination of life.

Through centuries, Food has been recognized as animportant factor for human beings, in health anddiseased state. Man has always been interested in

food and the history of man to a large extent hasbeen a struggle to obtain food.

Ahara supplies bio-energy to body. This bio-

energy is supplied by proper and adequate nutritionin the form of its essential constituent’s viz. proteins,carbohydrates, fats, minerals, vitamins and water.

The purpose of definition is to understandthe meaning of the subject with the use of minimumwords. While describing the meaning of

Viruddhahara to Agnivesa, Lord Atreya explains thatthe substances, which are contrary to Dehadhatus,behave as Viruddha (antagonism) to them. This

antagonism may be in terms of properties,combination, processing, place, time, dose, naturalcomposition etc. In other words, some substances

are antagonist to body tissue, some are exactlyopposite in properties, some are antagonists whenmixed together, some became antagonist.

Further he says that the diet which excitesthe Dosa but does not eliminate it out of the bodybecomes harmful. It definitely leads to some disease

or at least starts some disease process in the body.

Chemical Study Of Madhu W.S.R. To It’sAharaviruddha Swabhava

Dr. Shilpa Walkikar, Prof. N.S.Chundawat

Clinical Study

In Ayurveda a Novel concept ofViruddhahara has been condensed since the effect of

this Viruddha Ahara is indifferent from the AhitaAhara, this Viruddha Ahara may be included underthe Ahita Ahara group. Caraka has mentioned

“Whatever articles of food, which having

dislodged the morbid humors, do not

eliminate them from the body, are to be

regarded as unwholesome”2. Further he has said“Articles of diet that are inimical to the body-elements tend to disagree with the system (body).”

Viruddhahara is one potent causative factor forseveral diseases.

Diseases Caused By Viruddhahara

Antagonistic or incompatible food is thecause of Shandya (impotency,) Andhatva(blindness),Visarpa (erysipelas), Udara roga/ Jalodara (ascites),

Twak Vikara (pustules), Brama (insanity), Bhagandara(fistula in ano), fainting, narcosis, tympanitis, spasmin throat, Pandu (anaemia), Ama rasa, Pradara

(leucoderma), Kusta (leprosy), Grahaniroga, Shotha(oedema), Amla Pitta (gastritis), Jwara (fever),Genetic disorders and even Death3.

Exceptions of Viruddhahara

From the description of Viruddhahara and itsconsequences as described above, it becomes very

clear that the Viruddhahara acts as a triggering factorfor many diseases processes and is very importantetiological factor in many diseases. But some

exceptions to this rule are also mentioned in Carakasamhita. They are as follows.

If a person always take wholesome and

balanced diet, if a person is accustomed toantagonistic food due to its long-term use, if thequantity of incompatible food is very small, if the

person is young and his digestive capacity i.e. Agniis very strong and if he always consume Gritha4.


45

In all these conditions Viruddhahara doesnot show its adverse effects.

Aims And Objectives

1 . To study and evaluate the concept ofViruddhahara

2. To study the Madhu as Viruddhahara in dietetics.

3. To study Madhu as Viruddhahara throughchemical analysis.

4. To provide a preliminary basis for the furtherresearch work on the subject.

Material & Methods

Here an attempt is made to see, what might

be the chemical changes will occur when Madhu ismixed up with certain Aharadravya’s especiallywith Ghrita, Antariksha Jal, Pushkarbeeja8 in the

ratio of 1:1, 2:1, 1:2 respectively. Pure Madhu,Ghrita, Antariksh Jala, Pushkarbeeja were collectedfrom Pharmacy of National Institute of Ayurveda and

sent for the chemical analysis in a ratio of 1:1, 2:1,1:2, in the quantity 300 gm. each to ‘Oasis TestHouse Ltd., 22 Godam, Jaipur.

Observation & Results

Organoleptic Parameters

Table No. 1

S.no. Particulars Colour Odour Taste Touch

1 . Madhu:Ghrita (1:1) Dark Yellow Smell of Ghrita Mixed Smooth

2. Madhu:Ghrita (1:2) Light Brown Smell of Ghrita Taste of Ghrita Smooth

3. Madhu:Ghrita (2:1) Dark Brown Smell of Ghrita Sweet Smooth

4 Madhu:Antariksh Jal (1:1) Yellow Sweet Sweet Smooth

5 Madhu: Antariksh Jal (1:2) Light Yellow Sweet Sweet Smooth

6 Madhu: Antariksh Jal (2:1) Brown Sweet Sweet Smooth

7 Madhu: Pushkarbeeja Light Brown Sweet Sweet Smooth

Churna (1:1)

8 Madhu: Pushkarbeeja Dark Brown Sweet Sweet SmoothChurna (1:2)

9 Madhu: Pushkarbeeja Whitish Brown Sweet Sweet SmoothChurna (2:1)


46

Physico-Chemical Parameters

Madhu & Ghrita

Table No. 2

S. Parameters for Testing Madhu Combinations of Madhu & Ghrita

No. 1:1 1:2 2:1

1 pH 4.45 4.63 6.04 5.03

2 Total Solids 81.384 89.073 90.707 85.802

3 Total Ash (%) 0.249 1.44 1.43 1.60

4 Acidity (%) 0.109 0.24 0.12 0.23

5 Calcium (%) 0.031 0.095 0.032 0.055

6 Phosphorus (%) 0.004 0.0012 0.0013 0.0013

7 Glucose (%) 38.303 15.20 10.15 20.30

8 Fructose (%) 39.428 18.64 12.42 24.85

9 Sucrose (%) 3.145 1.36 0.90 1.80

1 0 Total Sugar (%) 80.876 35.20 23.47 46.95

1 1 Specific Gravity 1.44296 0.90628 0.91387 1.0317

1 2 Viscosity 46.0 2973 1 7 7 6 0 2443

Madhu & Antariksh Jala

Table No.3

S. Parameters for Testing Madhu Combinations of Madhu & Antariksh Jala

No. 1:1 1:2 2:1

1 pH 4.45 3.36 3.2 3.20

2 Total Solids 81.384 36.736 24.205 52.998

3 Total Ash (%) 0.249 0.82 0 . 7 7 1 . 0 7

4 Acidity (%) 0.109 0.18 0.34 0.24

5 Calcium (%) 0.031 0 . 0 7 7 0.062 0.085

6 Phosphorous (%) 0.004 0.0018 0.0012 0.0025

7 Glucose (%) 38.303 15.35 10.20 20.40

8 Fructose (%) 39.428 18.71 12.45 24.90

9 Sucrose (%) 3.145 1.36 0.92 1.82

1 0 Total sugar (% ) 80.876 35.42 23.57 47.12

1 1 Sp. Gravity 1.44296 0.88887 1.0892 0.93037

1 2 Viscosity 46.0 12.1 8.34 26.0


47

Madhu Pushkarbeeja Churna

Table No.4

S. Parameters for Testing Madhu Combinations of Madhu & Pushkarbeeja

No. 1:1 1:2 2:1

1 . pH 4.45 4.03 4.04 3.89

2. Total Solids 81.384 79.437 81.788 80.293

3. Total Ash (%) 0.249 0.37 0.62 0.32

4. Acidity (%) 0.109 1.97 1.45 1.64

5. Calcium (%) 0.031 0.062 0.047 0.031

6. Phosphorus (%) 0.004 0.109 0.073 0.097

7 . Glucose (%) 38.303 15.05 10.00 20.02

8. Fructose (%) 39.428 18.30 12.00 24.40

9. Sucrose (%) 3.145 1.30 0.85 1 .75

10. Total Sugar (%) 80.876 34.65 23.05 46.17

11 . Specific Gravity 1.44296 1.3396 1.0498 1.3392

12. Viscosity 46.0 - - -

Discussion

Organoleptic Study

Organoleptic Study doesn’t shows anyphysical changes related to Viruddhahara.

Analytical Study

1. pH

In present study (Table no.2), the 1:1 ratio

of Madhu & Ghrita reveals that pH is going moretowards Acidic, as compared to 2:1 & 1:2 ratio. Bythis, we can hypothetically conclude that prolong

intake of 1:1 ratio of Madhu & Ghrita will impair thebody physiology, alters the normal pH and end upin many ailments of Viruddhahara.

1:1 ratio of Madhu with Antariksh Jala &Pushkarbeeja (Table no.3&4) is going towards Acidic,even the ratio 1:2, 2:1 does the same thing. Here it’s

difficult to conclude that 1:1 ratio is fatal comparedwith 1:2 & 2:1. This part of study may be revealedby further animal study which may shows the subtle

interaction of these combinations with the cells ofbody and leads to Viruddhahara effect.

2. Acidity

In present study( Table no.2,3,4), the 1:1,1:2, 2:1 ratios of Madhu & Ghrita , Madhu & AntarikshJala, Madhu & Pushkarbeeja respectively reveals that

Acidity is going more towards Acidic. By this, we canhypothetically conclude that prolong intake of 1:1ratio of Madhu & Ghrita, Madhu & Antariksh Jala,

Madhu & Pushkarbeeja will impair the bodyphysiology, alters the normal pH and end up inmany ailments of Viruddhahara.

Here it’s difficult to conclude that 1:1 ratio isfatal, compared with 1:2 & 2:1 because the valueswhich we got in the 1:2 & 2:1 ration moves very

closely with the 1:1 ratio This part of study may berevealed by further animal study which may showsthe subtle interaction of these combinations of

Aahara Dravya’s with the cells of body and leads toViruddhahara effect.

3. Calcium

In Table no.2,3&4 the 1:1, 1:2 & 2:1 ratios ofMadhu & Ghrita, Madhu & Antariksh Jala, Madhu &Pushkarbeeja respectively reveals that Calcium is

going higher as compared to the Calcium present in


48

Honey. By this, we can hypothetically conclude thatprolong intake of 1:1 ratio of Madhu & Ghrita will

impair the body physiologically and leads toViruddhahara effect.

Here it’s difficult to conclude that 1:1 ratio is

fatal compared with 1:2 & 2:1. This part of study maybe revealed by further animal study which mayshows the subtle interaction of these combinations

with the cells of body and leads to Viruddhaharaeffect.

4. Phosphorus

In Table no.2, 3 & 4 the 1:1, 1:2 & 2:1 ratios

of Madhu & Ghrita, Madhu & Antariksh Jala & Madhu& Pushkarbeeja respectively reveals that Phosphorusis going higher as compared to the Phosphorus

present in Honey. By this, we can hypotheticallyconclude that prolong intake of 1:1 ratio of Madhu &Ghrita will impair the body physiologically and leads

to Viruddhahara effect.

Here it’s difficult to conclude that 1:1 ratio is

fatal compared with 1:2 & 2:1. This part of study maybe revealed by further animal study which mayshows the subtle interaction of these combinations

with the cells of body and leads to Viruddhaharaeffect.

5. Total Sugar

In Table no.2, 3&4 the 1:1, 1:2 & 2:1 ratiosof Madhu & Ghrita, Madhu & Antariksh Jala & Madhu& Pushkarbeeja respectively reveals that Total Sugar

is going lower as compared to the Total Sugarpresent in Honey.

This is happening so, because of dilution of

Madhu with Ghrita, Antariksh Jala & Pushkarbeejarespectively. We can hypothetically conclude thatprolong intake of 1:1 ratio of Madhu & Ghrita will

impair the body physiologically and leads toViruddhahara effect.

6. Total Solids

In Table no.2, the 1:1 ratio of Madhu & Ghritareveals that Total Solids is going higher as comparedto the Total Solids in Honey along with the ratios 1:2

& 2:1. By this, we can hypothetically conclude thatprolong intake of 1:1 ratio of Madhu & Ghrita willimpair the body physiologically and leads to

Viruddhahara effect.

In Table no.3, the 1:1 ratio of Madhu &Antariksh Jala reveals that Total Solids is going low

as compared to the Total Solids in Honey alongwiththe ratios 1:2 & 2:1. By this, we can hypotheticallyconclude that prolong intake of 1:1 ratio of Madhu &

Antariksh Jala will impair the body physiologicallyand leads to Viruddhahara effect.

In Table no.4, the 1:1 ratio of Madhu &Pushkarbeeja Churna reveals that Total Solids is

lower as compared to the Total Solids in Honey. Bythis, we can hypothetically conclude that prolongintake of 1:1 ratio of Madhu & Pushkarbeeja Churna

will impair the body physiologically and leads toViruddhahara effect.

7. Total Ash

In Table no.2, the 1:1 ratio of Madhu & Ghritareveals that Total Ash is going higher as comparedto the Total Ash in Honey. By this, we can

hypothetically conclude that prolong intake of 1:1ratio of Madhu & Ghrita will impair the bodyphysiologically and leads to Viruddhahara effect.

In Table no.3, the 1:1 ratio of Madhu &Antariksh Jala reveals that Total Ash is going higher

as compared to the Total Ash in Honey. By this, wecan hypothetically conclude that prolong intake of1:1 ratio of Madhu & Antariksh Jala will impair the

body physiologically and leads to Viruddhaharaeffect.

In Table no.4, the 1:1 ratio of Madhu &Pushkarbeeja Churna reveals that Total Ash is goinghigher as compared to the Total Ash in Honey. By

this, we can hypothetically conclude that prolongintake of 1:1 ratio of Madhu & Pushkarbeeja Churnawill impair the body physiologically and leads to

Viruddhahara effect.

8. Specific Gravity & Viscosity

In Table no.2, 1:1, 1:2&2:1 ratios of Madhu &

Ghrita, Madhu & Antariksh Jala and Madhu &Pushkarbeeja reveals that Specific gravity is goinglower and Viscosity going higher as compared to the

Specific gravity and Viscosity of Honey. In Table no.3, 1:1, 1:2&2:1 ratios of Madhu & Ghrita, Madhu &Antariksh Jala and Madhu & Pushkarbeeja reveals

that Specific gravity & Viscosity is going lower ascompared to the Specific gravity and Viscosity ofHoney.


49

As we know that honeybees collects nectarfrom various flowers, which may have more chance

of collecting nectar from poisons tree as well aspollens from the various plants. These pollens actsas allergens, which initiates the allergic

manifestations (Like Skin Allergy, Allergic BronchialAsthma).

Assimilation & absorption of each & every

nutrients, particles of food is possible in the presenceof lipid media more, compare to liquid media.Because each & every cells of our body is made up

of lipid bi-layer & lining of mucous membrane. Whenthe honey is mixed with the Ghrita (lipid), Specificgravity & Viscosity goes down, & ghee acts as media

for rapid absorption of the nutrients & otherparticles like pollen, allergens etc.

When the Specific Gravity & Viscosity as in

Table no.3 goes down, there may be rapidassimilation of these pollens & allergens into thelymphatic system first, then in blood circulation.

Then after, presence of the pollens or allergens actsas an antigens, intern to this our body producesantibodies to immune response. Same thing when

the Madhu is mixed up with the Antariksh Jala &Pushkarbeeja, Specific Gravity & Viscosity goesdown, because of dilution which assists in rapid

absorption of toxic particles if present in honey &there may be chance of producing Viruddhaharaeffect.

It is very difficult to conclude theViruddhahara effect of Madhu with Ghrita, Antarikshjala, Pushkarbeej Churna in the 1:1 ratio and the safer

effect of Madhu with Ghrita, Antariksh jala,Pushkarbeej Churna in the ratios 1:2 & 2:1respectively by Chemical Analysis. Parameters i.e.

physical & biological parameters did not showed anysignificant drastic changes in chemical values ofMadhu with Ghrita, Antariksh Jala & Pushkarbeeja

combination in the ratio of 1:1, 1:2 & 2:1respectively. So the Virudha effect of combinationsbetter understood in further animal study which

reveals the subtle interaction of these combinedAhara Dravyas at cellular level & metabolic level andalso we may hypothetically say that not only prolong

intake of these combination in ratio 1:1, produceViruddhahara effect but also other factors influencethis process. Other factors intern of factors like

quantity & quality of Aharadravya, physiologicalstatus of body, time of ingestion, immunity of the

person etc.

From my total study of research work, Ifound the above results. Other than these, it will be

good to recommend this topic for the animal study& Organic Study for better conclusion and outcome.

Conclusion

Chemical Analysis of Madhu alone &

Combination of Madhu with Goghrita, Antariksh Jala& Pushkarbeeja in the ratio of 1:1, 1:2 &2:1 werecarried out in Oasis Test House Limited, Jaipur.

Chemical Analysis which were undergone arePhysical parameters- pH, Total Solids, Total Ash,Acidity, Specific gravity& Viscosity, Biological

parameters –Glucose, Fructose, Sucrose, Total Sugar,Calcium, phosphorus.

Assessment of Virudhahara effect of Madhuwith various Aharadravyas viz. Antariksh Jala,Pushkarbeej & Goghrita on various (objective

criteria’s) parameters of chemical analysis, as follows:

1 . The Chemical Analysis which is done on variousparameters (Physical & Biological parameters) ofMadhu & its combinations with Ghrita, AntarikshJala, & Pushbarbeeja we got mild change in

values, but not significant difference in theirvalues by which it reveals that effect of Madhuas Viruddhahara in combination with Ghrita,

Antarikah Jala & Pushkarbeeja in the ratio 1:1.

2. Hypothetically we can justify that Viruddhaharaeffect of Madhu with Ghrita, Antariksh Jala &Pushkarbeeja in ratio 1:1 is may be due to

cellular interaction which takes place in ourbody.

3. Hypothetically we can also conclude that theremay be change in Agni i.e. Jatharagni &Dhatvagni status of the particular person when

it combined with Ghrita, Antarikah Jala &Pushkarbeeja because diseases caused byViruddhahara are particularly related to Agni.

4. Other than these we can conclude that may be

pollen toxicity of Madhu elevates afterchemically combined with Ghrita, Antariksh Jala& Pushkarbeeja.

5. It is very difficult to conclude the Viruddhahara


50

effect of Madhu with Ghrita, Antariksh jala,Pushkarbeej Churna in the ratio of 1:1 and the

safer effect of Madhu with Ghrita, Antariksh jala,Pushkarbeej Churna in the ratios 1:2 & 2:1 byChemical Analysis. Parameters i.e. physical &

biological parameters doesn’t showed anysignificant drastic changes in combination ofMadhu with Ghrita, Antariksh Jala &

Pushkarbeeja in the ratios 1:1, 1:2 & 2:1respectively. So the Viruddha effect ofcombinations better understood in further animal

study which reveals the subtle interaction ofthese combined Aharadravyas at cellular level &metabolic level and also we may hypothetically

say that not only prolong intake of thesecombination in ratio 1:1, produce Viruddhaharaeffect but also other factors influence this

process. Other factors intern of factors likequantity & quality of Aharadravya, physiologicalstatus of body, time of ingestion, immunity of

the person etc.

6. So all this shows that there are no any chemicalchanges in the combination samples directly; it’sall due to metabolic changes in the body. In theduration of 3 yr of Post-graduation, it’s very

tough to study completely on this vast topic ofViruddhahara. So for better results this topicshould go for further Animal study. Then only we

can confirm say about Viruddhahara effect inbody.

7 . From my total study of research work, I foundthe above results. Other than these, I want to

recommend this topic for the Animal study assaid above & Organic Study for further betterresults. In Animal study, we can conclude the

actual efficacy & metabolism of drug in the bodyof animal. In Organic Study, there may bechanges in the structure of Chemical formula of

Madhu when it combined with Ahardravyas i.e.Ghrita, Antariksh Jala, Pushkarbeeja Churna.

References

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Sanskrit Pratisthan, Delhi

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by Prof. K. C. Chunekar, Chaukhambha Publication,

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Indore Publication, 1986 second edition

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Lukhnow Publication, First edition 1969

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2 2 . Dhanvantari Nighantu by Jharkhandey Ojha &

Umapati Mishra, Adarsh Vidya Niketan, Varanasi,

1985 edition


51

2 3 . Raja Nighantu, Dravyagunaprakashika by

Commentator Dr. IndraDev Tripathi, Krishnadas

Academy, Varanasi, edition 1982

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Chandraraj Bhandari ‘Visharad’, Chaukhambha

Sanskrit Sansthan, Varanasi

2 5 . Kaiyadev Nighantu, Pathyapathyavibodhak by Dr.

Priyavat Sharma & Dr. Guru Prasad Sharma,

Varanasi Medicinal Plants

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K.C.Chunekar & C.L. Yadav

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Publication, Mumbai-4, 1995 edition

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Commentary of Bhanuji Dixit edited with the easy

Mani prabha Hindi commentary and noted by

Harigovinda Shastri, Chaukhambha Sanskrit series

office Varanasi.

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Chaukhambha Sanskrit Series office, Varanasi, 2nd

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Narendra Prakash Jain Motila Banarasidas, Delhi.

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Shastri Kamalavasa, Varanasi.

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Chaukhambha Sanskrit Pratishtan, Delhi.

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3 4 . Food & Nutrition – Dr.Swaminathan

3 5 . Davidson’s Principles and Practice of Medicine

eighteen edition 1999.

3 6 . Principles of Anatomy and Physiology: By Gerard J.

Tortora, Sandra, Reynolds Grabowski 8th edition.

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D.J. Weatherav.

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3 9 . Taber’s cyclopedic Medical Dictionary 18th edition by

F.A. Davis 1993.

4 0 . Advanced professional Skin care by Peter T.

Pugliese, M.D.

4 1 . Dravyaguna Vijyana, by P.V.Sharma

Choukhambha, Varanasi, 1993.

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4 5 . A.P.I. Text book of Medicine, 1992 Edition.

4 6 . Nanal Madhujeevan Magazine May 2010.

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4 9 . www.healthguidance.org/authors 1324/Jason-

Ladock.


52

The Appearance of lesions in Skin Disease w.s.r to Psoriasis.

*Dr. Sisir Kumar mandal, **Dr.Papri Nath, ***Dr. A.B.Thakar, ****Dr.M.S.Baghel

*Asstt. Professor, Rog Nidan NIA, **Lecturer J.B.Roy State Ay. Coll Kolkata, ***H.O.D & Reader IPGT & RA, ****Director

IPGT&RA, Jamnagar, Email. Id- [email protected]

Clinical Study

Abstract:

Skin is the largest organ of the body and it connected with both external and internal environmentof the body. So the nature of the lesions reflect by both directly. Deferent character of the lesions are

mentioned in the Ayurvedic text and that are the key point for diagnosis.

‚Ê⁄Ê¢≥Ê—

àfløÊ ≥Ê⁄Ë⁄ ∑§Ê ’«∏Ê •¢ª „Ò ¡Ù ≥Ê⁄Ë⁄ ∑‘ ’Ês fl •ÊèÿÊãÃ⁄ flÊÃÊfl⁄áÊ ∑‘ ‚ÊÕ ‚ê’ÁãœÃ ⁄„ÃÊ „Ò– ß‚Á‹∞ fl˝áÊ(Skin Lesions) ∑§Ë ¬˝∑Î§ÁÃ ßŸ ºÙŸÙ ∑‘ mÊ⁄Ê ¬˝àÿˇÊ L§¬ ‚ ¬˝⁄ÊflÃ¸ (Reflect) „ÙÃË „– fl̋áÊ (Lesions) ∑‘ ÁflÁ÷ÛÊÃÊ ∑‘ ’Ê⁄◊ •ÊÿÈfl¸º ‚¢Á„ÃÊ•Ê ◊ fláÊ¸Ÿ „Ò Á∑§ ©Ÿ ∑‘ (fl˝áÊ ∑§Ë ÁflÁ÷ÛÊÃÊ) •ÊœÊ⁄ ‚ àfl∑§ ⁄ÙªÙ ∑§Ê ÁŸÁpÃ ÁŸºÊŸ Á∑§ÿÊ ¡Ê ‚∑§ÃÊ„Ò–


53

Introduction-

Recognition & treatment of any diseasespecially the skin disease an important part of the

practice of Medicine1 and rightly it is mentioned fromthe Vedic Period2. The Appearance of skin lesions isproposed as a ‘field guide’ to the recognition of skin

disorders for the Ayurvedic Physician. The grossmorphological changes of the skin which in a formof skin lesions remains the hard core of dermatologic

diagnosis. The all the physicians are faces with thedifferent types of skin lesions in their carrier life. Thelesions are visible to the unaided eye; there are no

needs of imaging methods that are speciallyindicated to detect the lesion of the other organs. So,skin disorders themselves are intrinsically

fascinating. It is the fact that the progress both indevelopment and in relapse can be closely observedwith naked eye that may enable the young physician

to obtain a better overall view of the way diseaseprocess affect tissue.

Skin surface alterations :

The sensation which experienced bytouching or stroking normal skin is due in part to thenormal skin surface marking which vary to some

extent in different areas of body. It’s depends on thepresence of hair, sweat and sebum at the skin surfaceand to the overall mechanical properties of the skin

at that site. Horn cells are constantly being shed fromthe skin surface i.e. desquamation at a rate thatapproximates to the rate at which the epidermal cells

are being produced. When the process is disturbed,the horn cells tend to separate in clumps or scales.

The size, shape and thickness of skin lesions:

When a localized lesion no more thandiscolours the skin surface, it is known as a maculecommonly found over the chest and back in

pityriasis versicolor a fungal disorder. If theabnormal area is raised up above the skin surfaceand easily palpable, it is said a plaque commonly

found in Psoriasis. Some times lesions are very

The Appearance of lesions in Skin Disease w.s.r to Psoriasis.

Dr. Sisir Kumar mandal, Dr.Papri Nath, Dr. A.B.Thakar, Dr.M.S.Baghel

Clinical Study

considerably proud of the skin and are known asnodules or tumours. If the tumours are connectedwith the skin surface by a stalk, they are called

pedunculated, are present in the congenital conditioncalled neurofibromatosis. The edge of the lesions cangive some diagnostic help; well defined edges are

characteristic of psoriasis and ringworm.

The shape of skin lesions can also help indiagnosis. Some skin disorders start off a macular but

clear in the centre, making ring like or annularlesions. Ringworm, granuloma annulare anderythema multiforme are three conditions in which

the developed lesions tend to be annular. Some skindisorders often produced oval lesions, pityriasisrosea being the best example of this tendency.

Occasionally, lesions assume bizarre patterns on theskin surface that almost seem to be representing aparticular pattern of symbol. This is termed figurate,

and many disorder including Psoriasis, may producesuch lesions. For the most part, skin lesions are notusually angular and do not form squares or triangles.

However, one condition, lichen planus, does producesmall lesions that seem to have a roughly polygonalout line.

The primary division of particular lesion maybe Flat, elevated, depressed type. Among Flat type(usually in the plane of the skin) usually found as

Macular, Petechiae, Ecchymosis, Infarct, Sclerosis,Telangiectasis etc. Elevated lesion (above the planeof the skin) found as Papule, Plaque, Nodule, Wheal,

Vegetation, Papiloma, Vesicle and bulla, Pustule,Abscess, Cyst, Exudate (crusts), Scales, Scar,Lichenification, Hypertrophies etc. Depressed lesion

(below the plane of the skin) found as Atrophy,Sclerosis, Erosion, Excoriation, Fissure, Scar, Ulcer,Sinus, Gangrene, Sphacelus etc.

List of the Skin diseases (restricted as Kustha)as per Ayurvedic view where the skin surfacealteration is occur:


54

Stretched skin (Atatah / Ayamah)

Tvaka sthita kustha (C.S.Ci-28/30, M.N. 22/15).

Rough skin (Kharah / Parusah / Karkasah)

Carma kustha (C.S.Ci- 7/21, A.S.Ni-14/21,

A.H.Ni-14/20, M.N-49/18). Kapala kustha (C.S.Ni-5/7-1, M.N-49/10). Kitibha kustha (C.S.Ci-7/22, A.S.Ni-14/58, M.N-49/18). Kustha purvarupa (C.S.Ni-5/7,

Su.S.Ni-5/4, M.N- 49/8). Vatika kustha (C.S.Ni-5/10,M.N- 49/23). Mamsagata kustha (Su.S.Ni-5/24, M.N-49/27). Risyajihva kustha (C.S.Ni-5/704, A.S.Ni-5/

8, A.H.Ni-14/18, M.N- 49/13). Vatika svitra (Su.S.Ni-5/17).

Rough skin resembling callous or cicatrix

(Kina khara sparsam)

Kitibha kustha (C.S.Ci-7/22, M.N- 49/18).

Wet skin (Kledah, Upakleda, Vikleda)

Kardama visarpa (C.S.Ci- 21/38, A.H.Ni-13/63, M.N- 52/21). Mandala kustha (C.S.Ni-5/7-3).Paittika kustha (C.S.Ni-5/10). Kaphaja kustha

(C.S.Ci- 7/36, M.N- 49/24). Pama kustha (A.S.Ni-14/29). Risyajihva kustha (C.S.Ni-5/7-4, A.S.Ni-14/20,A.H.Ni-14./19). Udumbara kustha (C.S.Ni-5/7-2,

A.S.Ni-14/16).

Cracked skin (Avadaranam)

Pitta kustha (Su.S.Ni-5/18).,Medasthita

kustha (A.S.Ni-14/36). Kustha rista (Su.S.Su-33/9,M.N-49/32). Maha kustha (Su.S.Ni-5/9).Risyajihva

(C.S.Ni-5/7-4).

Heavy skin (Guru / Gauravam)

Mandala kustha (C.S.Ni-5/7-3, A.S.Ni-14/

17).Kaphaja svitra (A.S.Ni-14/40, A.H.Ni-14/38).


55

Putrification of skin (Kothah)

Paittika kustha (C.S.Ni-5/10, M.N- 49/24).Udumbara kustha (C.S.Ni-5/7-2, A.H.Ni-14/16).

Wheels on the skin (Kotah)

Bahya krimi (C.S.Vi-7/10, A.S.Ni-14/47,A.H.Ni-14/45, M.N- 7/3). Kustha purvarupa (C.S.Ci-

7/11, A.S.Ni-14/12, A.H.Ni-14/11, M.N- 49/8).Dusivisa (C.S.Ci- 23/31, Su.S.Ka-2/30, M.N- 69/30).

Fleshy on skin (Mamsankura)

Carmakila (Su.S.Ni-2/20, A.H.Ni-5/57).

Circular patch on skin (Mandalam,

Parimandalam)

Dadru kustha (Su.S.Ni-5/8, C.S.Ci-7/23,A.H.Ni-14/24, M.N- 49/20). Kaphaja kustha

(Su.S.Ni-5/8). Mandala kustha (C.S.Ni-5/7-3, A.S.Ni-

14/18, A.H.Ni-14/17, M.N- 49/12). Risyajihva kustha

(C.S.Ni-5/7-4). Vatika svitra (Su.S.Ni-5/17).

Scaly skin (Matsya sakala sannibham)

Ekakustha (C.S.Ci-7/21, A.S.Ni-14/22,A.H.Ni-14/20, M.N- 49/17).

Suppuration of skin (Pakah)

Kakana kustha (M.N- 49/16). Paittika kustha

(C.S.Ni-5/10, Su.S.Ni-5/18). Pundarika kustha

(C.S.Ni-5/75). Risyajihva kustha (C.S.Ni-5/7-4).Udumbara kustha (C.S.Ni-5/7-2). Visarpa kustha

(S.S.Ni-5/11).

Gives one fine dust when rubbed (Paridhvamsi,Ghristam rajah kiret)

Sidhma kustha (C.S.Ci- 7/19, A.S.Ni-14/13,

A.H.Ni-14/21, M.N- 49/15). Vatika svitra (Su.S.Ni-5/17).

Papules (Pidaka, Pidika, Pitaka)

Carmadala (A.S.Ni-14/31). Dadru kustha

(C.S.Ci- 7/23, Su.S.Ni-5/8, A.S.Ni-14/25, M.N-55/15).Kakana kustha (A.H.Ni-14/30). Marnsagata kustha

(Su.S.Ni-5/24, A.S.Ni-49/27). Pama kustha (C.S.Ci-7/

25, M.N- 49/21). Rakasa kustha (Su.S.Ni-5/15).Risyajihva (C.S.Ni-5/7-4). Vicarcika (C.S.Ci-7/26,M.N- 49/23). Visarpa kustha (Su.S.Ni-5/17).

Dryness of skin (Rauksyam, Sosah, Upasoah,Vikledah)

Kapala kustha (C.S.Ci- 7/14, A.S.Ni-14/14,

A.H.Ni-14/13, M.N- 49/10). Kitibha kustha (A.S.Ni-


56

14/22, A.H.Ni-14/21). Kustha purvarupa (A.S.Ni-14/13, A.H.Ni-14/13, M.N- 49/9). Vatika kustha (C.S.Ni-

5/7-10, M.N- 49/23). Tvakgata kustha (Su.S.Ni-5/22, A.S.Ni-14/35, A.H.Ni-14/13, M.N- 49/25).Sidhma kustha (A.S.Ni-14/23, A.H.Ni-14/21).Vatika

svitra (A.S.Ni-14/40, A.H.Ni-14/38, M.N- 49/38).

Contraction of skin (Sankochan, Kocah,Nikuncana)

Vatika kustha (Su.S.Ni-5/18). Maha kustha

(Su.S.Ni-5/9).

Cold skin (Sitah, Saityam, Himangata)

Kaphaja kustha (C.S.Ci- 7/36, M.N- 49/24).

Smooth skin (Slaksnah)

Kustha purvarupa (C.S.Ni-5/7, A.S.Ni-14/12,

A.H.Ni-14/11, M.N- 49/8). Mandala kustha (A.S.Ni-14/18).Sidhma kustha (A.S.Ni-14/23, A.H.Ni-14/22).

Skin covered by snayus (Snayu jalavatatah)

Kaphaja kustha (C.S.Ci- 7/36, M.N- 49/.24).Mabndala kustha (C.S.Ni-5/7-3, A.S.Ni-14/17, M.N-49/12). Kaphaja svitra (Su.S.Ni-5/17).

Oily skin inside the lesion (Snigdha antah)Sidhma kustha (C.S.Ni-5/76, A.S.Ni-14/23,

A.H.Ni-14/21).

Stable skin (Sthirah)

Mandala kustha (A.S.Ni-14/17, M.N- 49/12)

Kaphaja kustha (C.S.Ci- 7/36). Mamsa gata kustha

(Su.S.Ni-5/24, M.N- 49/27).

Solid or massive skin (Styanam)

Mandala kustha (A.S.Ni-14/17).

Numbness in skin (Suptata, Suptih, Svapah,Prasvapah Susuptih)

Aruna kustha (Su.S.Ni-5/8). Kapala kustha

(C.S.Ni-5/7-1, A.S.Ni-14/14, A.H.Ni-14/14). Kustha

purvarupa (C.S.Ci-7/4, Su.S.Ni-5/4, M.N- 49/8).

Vatika kustha (C.S.Ni-5/10, Su.S.Ni-5/18). Raktagata

kustha (Su.S.Ni-5/23, A.H.Ni-14/34, M.N- 49/26)Mahakustha (Su.S.Ni-5/9) Mandala kustha (C.S.Ni-5/

7-1, A.H.Ni-14/17).

Thin skin (Tanu, Abahalam)Arun kustha (Su.S.Ni-5/8). Kapala kustha

(C.S.Ni. 5/7-1, M.N- 49/10). Mamsastha kustha

(M.N- 49/27). Risyajihva (C.N. 5/7-4, A.S.Ni-14/20,

A.H.Ni-14/18). Sidhma kustha (C.S.Ci-7/19, Su.S.Ni-5/12, A.S.Ni-14/23, M.N. 49/15). Svitra (A.S.Ni-14/

42, A.H.Ni-14/40).

Feels as skin is coated (Upalepah,Upadehah,Upasnehah, Pralepah)

Kustha purvarupa (C.S.Ni-5/7). Kaphaja

kustha (C.S.Ni-5/10).Medogata kustha (Su.S.Ni-5/25).

Hot skin (Usnah, Usma, Ausnyam, Santapa,Tapah, Abhitaph)

Kustha purvarupa (C.S.Ni-5/7).

Elevated skin (Utsedham, Ucchunam, Udvrttam,Uccrayam, Utsanga, Uttundita, Udgata, Utsannam,Abhyunnata)

Dadru (A.H.Ni-14/24). Kapala kustha

(C.S.Ni-5/7-1). Kaphaja kustha (C.S.Ni-5/10, Su.S.Ni-5/8). Mandala kustha (A.H.Ni-14/17). Pundarika

kustha (C.S.Ni-5/7-5, A.H.Ni-14/26, M.N- 49/15).

Rsyajihva (A.S.Ni-14/20, A.H.Ni-14/18). Sataghni

(Su.S.Ni-16/7).

Wick like protuberance on skin (Vartih)

Sataghni (Su.S.Ni-16/57, A.H.Ut- 21/51).

Through the alteration of the physicalappearance of the skin may be found in deferentcondition but here the list has been restricted as

‘Kustha Roga’ which is usually two types Maha &Kshudra and again they are subdivided into differentnomenclature according the site, appearance, clinical

sign & symptoms. The disease Psoriasis may beenlisted as kustha because of its ugly appearance butwithout any critical analysis it is very difficult to say


57

what type of kustha it may be. The appearance of thelesions is one of main clinical manifestation the

disease kustha and the diagnosis of the any diseasemainly based on their clinical manifestation. For thatpurpose 112 patients were registered from the OPD

and IPD of IPGT&RA, GAU, Jamnagar. The result &observations were carried out (here restricted as thephysical appearance of the lesions) as bellows-

Table-1 Rupa wise distribution of 112 patients of Psoriasis:

Rupa (Chief Complain) No. of Patients Percentage (%)

Erythema (Mandala) 107| 95.54

Scaling (Matsyasakolopama) 112 100

Dryness (Asvedanam) 109 97.32

Itching (kandu) 1 1 0 98.21

Burning Sensation (daha) 52 46.43

Epidermal Thickening (bahalatva) 102 91.07

Elevation of lesion (unnata) 109 97.32

Table-2 Lesions distribution wise distribution of 112 patients of Psoriasis:

Lesion distribution No. of Patients Percentage (%)

Exposed area 7 0 62.5

Close area 69 61.61

Anterior surface 7 9 70.54

Posterior surface 4 7 41.96

Medial surface 59 52.68

Lateral surface 30 26.79

Unilateral surface 52 46.43

Bilateral 60 53.57

Local 92 82.14

Generalized 20 17.86

Table-3 Pattern of Lesion wise distribution of 112 patients of Psoriasis:

Pattern of Lesions No. of Patients Percentage (%)

Symetrical 53 47.32

Asymetrical 59 52.68

Linner 24 21.43

Annular 4 1 36.61

Polycyclicc 5 0 44.64


58

Table-4 Border of lesions wise distribution of 112 patients of Psoriasis:

Border of lesions No. of Patients Percentage (%)

Well demarcated 96 85.71

Diffuse 1 6 14.29

Total 112 100

Table-5 Colour of lesions wise distribution of 112 patients of Psoriasis:

Colour of lesions No. of Patients Percentage (%)

Skin 0 0

Red 93 83.04

Whitish 7 5 66.96

Yellow 6 5.36

Shiny 84 7 5

Table-6 Sensation of lesions wise distribution of 112 patients of Psoriasis:

Sensation of lesions No. of Patients Percentage (%)

Anesthesia 0 0

Hyperesthesia 3 2.68

Normal 109 97.32

From the above tables it is observed that

Psoriatic skin lesions are usually scaly, welldemarcated, elevated, dry, erythematous, circular,mostly localized, reddish lesions. The diseases like

Mandala kustha, Sidhma kustha, Charma dala,Kithibha and Ekakustha to some extend similar withthe clinical appearance of Psoriasis but the scaly

(mica or fish like glittering scale) dominant (100%)character mostly support with the disease Ekakustha.

Abbreviation used-

C.S- Charaka Samhita Su.S- Sushruta Samhita

M.N.- Madhava Nidana A.H- Astanga Hridaya

A.S- Astanga Samgraha Su- Sutra Sthana

Ni-Nidana Sthana Vi- Vimana Sthana

Ci- Chikitsa Sthana Ut- Uttara Tantra

Refferences & Bibliography:

1 . ÿSÃÈ ⁄ÙªÁfl‡Ê·ôÊ— ‚fl¸÷Ò·Öÿ∑§ÙÁflº—Hº‡Ê∑§Ê∂¬˝◊ÊáÊôÊSÃSÿ Á‚Áh⁄‚¢‡Ê◊˜H( C . S . S u - 2 0 / 2 2 )

2 . ibid-Atharva veda-1/23/1-2, 19/39/1

ŸQ¢§¡ÊÃÊÁ‚ •Ê·œ ⁄Ê◊ ∑Î§cáÊ •Á‚Á∑A§ ø–ßº¢ ⁄¡ÁŸ ⁄¡ÿ Á∑§‹Ê‚¢ ¬Á‹Ã¢ ø ÿÃ˜H1H (•Õfl¸ flº- 1/23/1)

Á∑§‹Ê‚¢ ø ¬Á‹Ã¢ ø ÁŸ⁄˜ ßÃÙ ŸÊ≥ÊÿÊ ¬Î·Ã˜–•Ê àflÊ SflÙ Áfl≥ÊÃÊ¢ fláÊ¸— ¬⁄Ê ≥ÊÈ∑£§ÊÁŸ ¬ÊÃÿ H2H(•Õfl¸ flº- 1/23/2)

∞ÃÈ ºfl‚˜ GÊÿ◊ÊáÊ— ∑ÈDÙ Á„◊flÃ‚˜ ¬Á⁄–ÃÄ◊ÊŸ¢ ‚flZ ŸÊ≥Êÿ ‚flÊ¸≥Ê˜ ø ÿÊÃÈœÊãÿ— H1H(•Õfl¸ flº- 19/39/1)

1 . Astanga Hrdayam with the commentaries of

Arunadutta and Hemadri edited by Vaidya Hari

Shastri Paradakar, 9th Edition, Chaukhambha

Orientalia, Varanasi - 2002.

2. Astanga Samgraha with the commentary of Indu,

Published by CCRAS, New Delhi - 1991.

3. Caraka Samhita with the Commentary of Cakrapani

Dutta, (Ayurveda Dipika) edited by Vaidya. Yadavaji

Trikamaji Acarya, Chaukhamba Sanskrit

Samthana, Varanasi 1994.

4 . Madhava Nidanam with Madhukosa Commentary

edited by Vaidya. Yadavaji Trikamaji Acarya, Sixth

Edition Chaukhambha Orientalia - 2001

5 . Susruta Samhita of Susruta with the

Nibandhasangraha Commentary of Shri

Dalhanacarya , Edited by Vaidya. Jadavji Trikamaji

Acarya, Chaukhambha Orientalia Seventh Edition

- 2002.


59

A Comparative Study of Punarnavadi Guggulu andPanchwalkaladi Kwatha Uttarabasti with PanchwalkaladiTaila Pichu in the management of Paripluta Yonivyapada

w.s.r. to PID (Pelvic Inflammatory Disease)

*Dr.Durgesh Nandini, **Dr. Sarveshwer Prasad, ***Dr. Sushila Sharma

Clinical Study

ABSTRACT:

The present study is aimed for the comparative study of Punarnavadi Guggulu and Panchwalkaladi

Kwatha Uttarabasti with Panchwalkaladi Taila Pichu in the management of Paripluta Yonivyapada w.s.r.to PID (Pelvic Inflammatory Disease). The clinical trial was carried out in three groups as

l Group A- Punarnavadi guggulu (1 gm B.D.) with milk.

l Group B- Uttarabasti with Panchawalkaladi kwatha & pichu with Panchawalkaladi

l Group C- Punarnavadi guggulu along with uttarabasti & pichu dharana.

Ten patients were taken in each groups and the trial was carried out for two months. The results

were evaluated on the basis of clinical findings. Group C was found to be more effective than group A andB.

Key words: Pelvic Inflammatory Disease, Paripluta Yonivyapada, Uttarabasti, Pichu.

‚Ê⁄UÊ¥‡Ê-

¬˝SÃÈÃ •äÿÿŸ ∑§Ê ◊ÈÅÿ ©g‡ÿ ¬ÈŸŸ¸flÊÁŒ ªÈÇªÈ‹È ∞fl¥ ¬@flÀ∑§‹ÊÁŒ `§ÊÕ ©ûÊ⁄U’ÁSÃ ∞fl¥ ¬@flÀ∑§‹ÊÁŒ ÃÒ‹ Á¬øÈ∑§Ê ¬Á⁄Uå‹ÈÃÊ ÿÊÁŸ√ÿÊ¬Œ ◊¥ ÁøÁ∑§à‚∑§Ëÿ ¬˝÷Êfl ∑§Ê •äÿÿŸ ∑§⁄UŸÊ „Ò– ÿ„ ÁøÁ∑§à‚∑§Ëÿ •äÿÿŸ ÃËŸ flªÊZ ◊¥ Áfl÷ÊÁ¡Ã„Ò– ª˝È¬ ∞ ◊¥ ¬ÈŸŸ¸flÊÁŒ ªÈÇªÈ‹È fl≈UË ∑§Ê •ÊèÿÊãÃ⁄U ‚flŸÊÕ¸ ©¬ÿÊª Á∑§ÿÊ ªÿÊ– ª˝È¬ ’Ë ◊¥ ¬@flÀ∑§‹ÊÁŒ `§ÊÕ ∑§Ë ©ûÊ⁄U’ÁSÃ∞fl¥ ¬@flÀ∑§‹ÊÁŒ ÃÒ‹ Á¬øÈ ÁŒÿÊ ªÿÊ– ª˝È¬ ‚Ë ◊¥ ¬ÈŸŸ¸flÊÁŒ ªÈÇªÈ‹È ∑§ •ÊèÿÊãÃ⁄U ¬˝ÿÊª ∑§ ‚ÊÕ ¬@flÀ∑§‹ÊÁŒ `§ÊÕ ∑§Ë©ûÊ⁄U’ÁSÃ ∞fl¥ ¬@flÀ∑§‹ÊÁŒ ÃÒ‹ Á¬øÈ ÁŒÿÊ ªÿÊ– ¬˝àÿ∑§ ª˝È¬ ◊¥ Œ‚-Œ‚ ⁄UÊªË Á‹∞ ª∞ Á¡Ÿ∑§Ê ‚é¡ÁÄ≈Ufl ∞fl¥ •Êé¡ÁÄ≈Ufl◊Ê¬Œá«UÊ¥ mÊ⁄UÊ ÁøÁ∑§à‚Ê ∑§ ¬˝÷Êfl ∑§Ê •Ê¥∑§‹Ÿ ∑§⁄UŸ ∑§ ’ÊŒ ª˝È¬ ‚Ë •ãÿ flªÊZ (ª˝È¬ ∞ fl ª˝È¬ ’Ë) ∑§Ë ÃÈ‹ŸÊ ◊¥ •Áœ∑§¬˝÷ÊflË ¬ÊÿÊ ªÿÊ–

*M.S.(Ayu.) Scholar, Deptt. of Prasuti- Stree Roga, National Institute of Ayurveda, Jaipur. **M.S., M.Ch. (CTVS),

Ram Manohar Lohia Hospital, New Delhi. ***M.D.(Ayu.), Ph.D (Ayu.), Associate Professor, Deptt. of Prasuti- Stree

Roga, National Institute of Ayurveda, Jaipur.


60

Introduction:

Ayurveda is a science of life. So far as the

procreation of human being is concerned womentakes most important part for the fulfillment ofbiological cycle, that’s why nari is said as

“apatyamula”. Women are the main root of pleasure,progeny of people; these are injured & obstructed bydiseases which affect their organ of generation.

Nidation of seed will grow only in favourableenvironment; likewise production of good offspringhighly depends on the woman’s reproductive health.

Hence women should be free from diseases. In ourclassics twenty yonivyapada have been describedwhich cover almost many gynaecological disorders.

Some of these yonivyapada are functional disorderswhile other involve pathology too, theseyonivyapada disturb the life of women.

In the present era, pelvic inflammatorydisease is a burning problem whose incidences areincreasing very fastly. Out of twenty yonivyapada,

some such as pittaja, kaphaja, sannipataja andparipluta yonivyapada show signs and symptomssimilar to pelvic inflammatory disease (PID) but

paripluta yonivyapada shows most convergencewith PID. Hence this topic was chosen for theircomparative study & to extract some facts about the

disease which may decrease its recurrence andincidence.

Acarya Caraka has described this disease due

to vitiation of pitta & vata. A woman of paittika

prakriti, withholds her urge of sneezing & eructationduring coitus, then vitiated pitta mixed with vata

reaches yoni (reproductive organs) & produces itsabnormalities & yoni becomes inflammed, tender,painful with yellow or bluish menstruation. She also

suffers from pain in waist, groin & back along withfever. Acarya Susruta characterized this condition

with complaint of dyspareunia with other pains &aches.

Pelvic inflammatory disease (PID) is an

infectious and inflammatory disorder of upper femalereproductive tract, including the uterus, fallopiantubes and adjacent pelvic structure. Although STD is

most common cause, other includes lymphatic,postpartum spread, post abortal, IUCD andhematogenous spread etc. WHO has determined that

STIs rank in the top five disease categories for whichadult seek care. Women in resource-poor countries,especially those in Sub-saharan Africa and Southeast

Asia, experience an increased rate of complicationsand sequelae.

Need Of Study:

This is very common problem which isincreasing rapidly. According to Centre for diseasecontrol (CDC), in United States, more than 1 million

women are estimated to experience an episode ofPID every year. The disease includes 125,000-150,000 hospitalization yearly. In present scenario

PID is one of the most serious infection facing womentoday. Untreated or unsuccessful treated womenmay develop life threatening consequences leading

to tubo-ovarian mass, ectopic pregnancy, infertilityetc., even adequately treated patients may havechances of recurrence. In modern medicine,

antibiotics are treatment for this disease, butexcessive & inadequate use of antibiotics may leadto produce micro-organisms resistant to them. Due

to this problem, we should think about somealternative methods to treat this disease. Sinceantimicrobials may destroy normal vaginal flora &

hence disturb the normal physiology of vagina, they(systemic antibiotics) also cause GIT disturbanceslike nausea, vomiting, diarrhoea (i.e. pseudo

A Comparative Study of Punarnavadi Guggulu andPanchwalkaladi Kwatha Uttarabasti with PanchwalkaladiTaila Pichu in the management of Paripluta Yonivyapada

w.s.r. to PID (Pelvic Inflammatory Disease)

Dr.Durgesh Nandini, Dr. Sarveshwer Prasad, Dr. Sushila Sharma

Clinical Study


61

diarrhoea because they destroy the normal intestinalflora). But while using ayurvedic drugs, these are free

from these side effects. These drugs mainly restorethe normal physiology of vagina so that pathogenicorganisms do not grow further. So, it is an effort to

search effective ayurvedic treatment for this disease.

Drugs Used For The Present Study:

For present study Punarnavadi guggulu is

selected from Bhaishajya Ratnavali shothachikitsa

(42/135) containing Punarnava, Devadaru,

Abhayaa, Guduchi, Guggulu, Gomutra prepared as

vati and Panchawalkaladi kwatha uttarabasti withPanchawalkaladi (Shallaki, Jinghini, Jambu, Dhava,

Twak, Vata, Ashwattha, Parisha, Udumbar,

Plaksha, Caraka Chikitsa 30/108) taila pichu wasused. Preparation of vati, curna, kwatha and taila

were done according to text.

Aims & Objectives:

v Clinical evaluation of the efficacy of Punarnavadi

guggulu in paripluta yonivyapada (PID).

v To study the role of uttarabasti withPanchawalkaladi kwatha & Panchawalkaladi

taila pichu in paripluta yonivyapada (PID).

v To compare the clinical efficacy of oraladministration of Punarnavadi guggulu with therole of Panchawalkaladi kwatha uttarabasti &

pichu with panchawalkaladi taila in paripluta

yonivyapada (PID).

v To study the combined effect of oral

administration along with uttarabasti & pichu ofabove mentioned drugs in paripluta

yonivyapada (PID).

v To study any side effects related to drugs.

Materials And Methods-

The trial was conducted on 30 clinically

diagnosed & confirmed cases of PID selected fromOPD/IPD of Prasuti- Stree Roga Deptt., NationalInstitute of Ayurveda, Jaipur.

Study Design –

It is randomized controlled single blindstudy. The clinical trial was done on 30 patients.

Three groups of 10 patients each were formed. Eachgroup of patients was administered the drug as per

schedule as Group A- Punarnavadi guggulu (1 gmB.D.) with milk; Group B- Uttarabasti (vaginal

douche) with Panchawalkaladi kwatha (once in aday for 7 days in two consecutive ritukala) & pichu

with Panchawalkaladi taila; Group C- Punarnavadi

guggulu along with uttarabasti & pichu dharana

(with Panchawalkaladi taila, 8 ml after every vaginaldouche for 12 hrs).

During the study all patients were advised tocome in OPD after every 15 days till the end of trial& changes were recorded in proforma. Laboratory

investigations were carried out before and after trialso that changes in subjective and objectiveparameters could be appreciated. The patient’s

undergone trial was assessed on the basis of scoringfor symptoms.

Criteria of selection of patients-

Patient aged >18 years to before menopausewho are sexually or reproductively active, patientsuffering from lower abdominal pain, abnormal

vaginal discharge, low backache, dyspareunia,menstrual disorders etc. were included in trial.

Patients of Ectopic gestation, pregnancy,

ovarian tumour, tubercular tubo-ovarian mass, acuteappendicitis, acute salpingitis, septic abortion, pelvicendometriosis, ovarian cysts, other systemic illness

like bronchial asthma, T.B., DM, hypertension,TORCH infection, patients with history of > 3episodes of PID/STD, patients who could not attend

follow up regularly were excluded in trial.

Objective diagnostic parameters-

Hb% (Haemoglobin), TLC (Total leucocyte

count), DLC (Differential leucocyte count), ESR(Erythrocyte sedimentation rate), CRP (C- Reactiveprotein), VDRL (Veneral disease & research

laboratory), RBS (Random blood sugar), Routine &microscopic urine analysis, USG whole/ lowerabdomen, Pap smear, Vaginal pH etc.

Subjective diagnostic parameters-

Pain in lower abdomen, dyspareunia,

abnormal vaginal discharges, adnexal tenderness,

irregular menstrual cycle, dysuria, fever andlassitude.


62

Scoring pattern-

0 – Nil, 1- Mild, 2- Moderate, 3- Severe

1. Pain in lower abdomen

0- No pain.

1- Mild pain throughout the day but relieved by

rest.

2- Moderate pain interfering physical activity &not relieved by rest.

3- Pain interfering physical activity & relievedby taking analgesics.

2. Dyspareunia

0- No pain.

1- Pain during forceful coitus.

2- Pain during coitus.

3- Patient tries to avoid marital relation due topain during coitus.

3. Backache

0- No pain.

1- Pain increase on exertion but relieved byrest.

2- Pain increase on exertion but not relievedby rest.

3- Pain relieved by analgesics.

4. Vaginal discharge

0- Absent.

1- Persistent vulval moistness.

2- Staining of undergarments.

3- Need to take vulval pads.

5. Character of vaginal discharge

0- Normal.

1- Watery without foul smell.

2- Excessive watery with foul smell.

3- Thick white discharge with or without foulsmell.

6. Fornices tenderness

0- No tenderness.

1- Pain during deep palpation.

2- Pain during palpation but cooperativepatient.

3- Patient becomes non-cooperative during P/V examination due to pain.

7. Amount of bleeding

0- 1-2 pads soaked per day.



3- >4 pads soaked per day

8. Fever (temperature)

0- Up to 98.4- 99°F.

1- 99- 100°F.

2- 100-101°F.

3- > 101°F.

9. Weakness

0- Occasionally on doing extra work.

1- After doing extra work.

2- After doing routine work.

3- Even without doing any work.

Statistical Analysis-

Data were analysed by using appropriatestatistical test. Wilcoxon matched pairs test was usedfor non- parametric data and paired ‘t’ test was used

for parametric data. Comparison between groupswere analyzed by using One-way Analysis of Variance(ANOVA- Kruskal Wallis test with post-test was used

for non- parametric data and Tukey-Kramer MultipleComparison test for parametric data). In additionage, personel history & other points were also

assessed.

The results were interpretated as-

v Insignificant or not significant - p>0.05

v Significant - p<0.05

v Very significant - p<0.01

v Extremely significant - p<0.001


63

Observations: Effect of the trial drugs of group A, B & C on various subjective and objectiveparameters are described below in the tables.

Table no.1, Illness history wise distribution of analyzed patients

Illness history Group A Group B Group C Total %age

a) Lower abdominal pain

Present 9 7 8 24 80%

Absent 1 3 2 6 20%

b) Vaginal discharge

Present 1 0 1 0 9 29 96.66%

Absent 0 0 1 1 3.34%

c) Low backache

Present 8 8 8 24 80%

Absent 2 2 2 6 20%

d) Dyspareunia

Present 6 6 8 20 66.67%

Absent 4 4 2 1 0 33.33%

e) Fever

Present 6 5 7 18 60%

Absent 4 5 3 1 2 40%

f) Lassitude

Present 6 6 6 18 60%

Absent 4 4 4 1 2 40%

g) Fornices tenderness

Present 9 1 0 8 2 7 90%

Absent 1 0 2 3 10%

h) Cervical motion tenderness

Present 6 9 8 23 76.66%

Absent 4 1 2 7 23.34%

i) Uterus size

Normal 8 8 8 24 80%

Bulky 2 2 2 6 20%

j) USG

PID 7 8 7 22 73.34%

PID with nabothian cyst 1 0 0 1 3.33%

PID with bulky uterus 2 2 3 7 23.33%


64

Table no.2, Effect of Punarnavadi guggulu on subjective parameters of group A

Parameters Mean Dif. % S.D. S.E. p w Sig.

B T A T relief ± ±

Lower abd. pain 1 . 7 0.5 1.2 70.53 0.9189 0.2906 0.0078 36 VS*

Dyspareunia 1.3 0.5 0.8 61.53 0.7888 0.2494 0.0313 2 1 S

Low backache 1.6 0.4 1.2 75.00 0.7888 0.2494 0.0078 36 VS*

Vaginal discharges 2.0 0.4 1.6 80.00 0.6992 0.2211 0.0020 5 5 VS*

Character of discharge 2.4 0.5 1.9 79.16 0.8756 0.2769 0.0039 45 VS*

Fornices tenderness 1.3 0.3 1.0 76.92 0.4714 0.1491 0.0039 45 VS*

Amount of bleeding 1.3 0.8 0.5 38.46 0.9718 0.3073 0.2500 6 NS

Fever 0.8 0.2 0.6 75.00 0.5164 0.1633 0.0313 2 1 S

Weakness 0.9 0.1 0.8 88.89 0.7888 0.2494 0.0313 2 1 S

S.D.- Standard deviation; S.E.- Standard error; W- sum of signed rank; VS –Very significant; S- Significant;NS- Not significant.

This table shows the effect of therapy on subjective parameters. Punarnavadi guggulu effect wasfound to be very significant (VS) in case of lower abdominal pain, low backache, vaginal discharges, characterof discharge, fornices tenderness (p<0.01) and significant in dyspareunia, fever, weakness (p<0.05) but non-

significant in amount of bleeding (p>0.05).

Table no.3, Effect of Uttarabasti with Panchawalkaladi kwatha & pichu with

Panchawalkaladi taila on subjective parameters of group B



Lower abd. pain 2.0 0.5 1.5 75.00 0.7071 0.2236 0.0039 45 VS*

Dyspareunia 1.5 0.4 1.1 73.34 1.197 0.3786 0.0313 2 1 S

Low backache 2.3 0.8 1.5 65.00 0.9718 0.3073 0.0078 36 VS*

Vaginal discharges 1.8 0.4 1.4 7 7 . 7 8 0.6992 0.2211 0.0039 45 VS*

Character of discharge 2.2 0 . 7 1.5 68.18 0.8498 0.2687 0.0039 45 VS*

Fornices tenderness 1.5 0.6 0.9 60.00 0.7379 0.2333 0.0156 28 S

Amount of bleeding 2.4 1.4 1.0 41.67 0.8165 0.2582 0.0156 28 S

Fever 0.5 0.2 0.3 60.00 0.4830 0.1528 0.25 6 NS

Weakness 0 . 7 0.5 0.2 28.57 0.4216 0.1333 0.5 3 NS

This table shows the effect of therapy on subjective parameters. Panchawalkaladi kwatha uttarabasti

& pichu with panchawalkaladi taila effect was found to be very significant (VS) in case of lower abdominalpain, low backache, vaginal discharges, character of discharge (p<0.01) and significant in dyspareunia,fornices tenderness & amount of bleeding (p<0.05) and non- significant in fever & weakness (p>0.05).


65

Table no.4, Effect of Punarnavadi guggulu & Panchawalkaladi kwatha uttarabasti& pichu

on subjective parameters of group C



Lower abd. pain 1.5 0.2 1.3 86.67 0.8233 0.2603 0.0039 45 VS*

Dyspareunia 1.3 0.1 1.2 92.30 1.229 0.3887 0.0313 2 1 S

Low backache 1.4 0.3 1.1 79.00 0.7379 0.2333 0.0078 36 VS*

Vaginal discharges 1.8 0.2 1.6 88.89 0.5164 0.1633 0.0020 5 5 VS*

Character of discharge 1.6 0.3 1.3 81.25 0.8233 0.2603 0.0039 45 VS*

Fornices tenderness 1.6 0.3 1.3 81.25 0.4830 0.1528 0.0020 5 5 VS*

Amount of bleeding 1.9 0.4 1.5 78.94 0.8498 0.2687 0.0078 36 VS*

Fever 0 . 7 0.1 0.6 85.71 0.5164 0.1633 0.0313 2 1 S

Weakness 2.0 0.2 1.8 90.00 1.135 0.3590 0.0078 36 VS*

This table shows the effect of therapy on subjective parameters. Punarnavadi guggulu &

panchawalkaladi kwatha uttarbasti & pichu effect was found to be very significant (VS) in case of lowerabdominal pain, low backache, vaginal discharges, character of discharge, fornices tenderness & amount ofbleeding (p<0.01) and significant in dyspareunia (p<0.05).

Graph showing percentage relief in subjective parameters of three groups A, B, C.


66

Table no.5, Effect of therapy on objective parameters of Group A:

Parameters Mean Dif. % S.D. S.E. p t


Hb% 11.21 11.86 0.65 5.79 0.8209 0.2596 0.0336 2.504 S

TLC 6710 6180 530 7.89 787.47 249.02 0.0622 2.128 NQS

Neut. 57.6 57.2 0.4 0.69 8.422 2.663 0.8839 0.1502 NS

Lymp. 35.8 31.1 4 . 7 13.12 8.982 2.84 0.1324 1.655 NS

Eosi. 3.5 3.2 0.3 8.57 3.02 0.9551 0.7606 0.3141 NS

Mono. 2.6 2.3 0.3 11.53 1.494 0.4726 0.5414 0.6348 NS

ESR 43.6 24.2 19.4 44.49 13.978 4.420 0.0017 4.389 VS*

O.temp 99.2 98.54 0.66 0.66% 0.5582 0.1765 0.0046 3.739 VS*

Vag.pH 5.2 4.45 0.75 14.42 0.6346 0.2007 0.0046 3.737 VS*

RBS 78.43 78.92 0.49 0.62 12.658 4.003 0.9053 0.1224 NS

This table shows the effect of therapy on objective parameters. Punarnavadi guggulu effect was found

to be very significant (VS) in case of ESR, oral temperature & vaginal pH (p<0.01) and significant inhaemoglobin percentage (p<0.05), not quite significant in TLC, & not significant in DLC & RBS (p>0.05).

Table no.6, Effect of therapy on objective parameters of Group B:



Hb% 11.13 11.53 0.4 3.59 1.352 0.4274 0.3738 0.9359 NS

TLC 7200 6700 500 6.94 535.41 169.31 0.0161 2.953 S

Neutr. 5 7 . 7 53.1 4.6 7 . 9 7 7.792 2.464 0.0948 1.867 NQS

Lymph. 36.4 33.2 3.2 8.79 6.356 2.010 0.1458 1.592NQS

Eosi. 3.8 2.9 0.9 23.68 2.767 0.875 0.3305 1.029 NS

Mono. 2.9 3.5 0.6 20.68 1.350 0.4269 0.1934 1.406 NS

ESR 36 26.6 9.4 26.11 8.262 2.613 0.0058 3.598 VS*

O.temp 98.7 98.4 0.3 0.303 0.7846 0.2481 0.2574 1.209 NS

Vag.pH 5.45 4.65 0.8 14.67 0.7888 0.2494 0.0107 3.207 S

RBS 76.76 7 7 . 1 1 0.35 0.455 6.792 2.148 0.8742 0.1630 NS

This table shows the effect of therapy on objective parameters. Panchawalkaladi kwatha uttarabasti

& pichu effect was found to be very significant (VS) in case of ESR (p<0.01) and significant in TLC & vaginalpH (p<0.05), not significant in DLC & RBS (p>0.05).


67

Table no.7, Effect of therapy on objective parameters of Group C:



Hb% 10.98 11.49 0.51 4.64 0.8117 0.2567 0.0782 1.987NQS

TLC 8310 5880 2430 29.24 2045.1 646.71 0.0045 3.757 VS*

Neutr. 65.7 62.5 3.2 4.87 8.176 2.585 0.2471 1.238 NS

Lymph. 31.4 32.5 1 .1 3.5 6.297 1.991 0.5941 0.5524 NS

Eosi. 2.8 2.2 0.6 21.42 1 . 7 7 6 0.5617 0.3133 1.068 NS

Mono. 2.5 1 . 7 0.8 32% 1.398 0.4422 0.1039 1.809 NS

ESR 54.5 29.2 25.3 46.42 12.184 3.853 0.0001 6.566 ES**

O.temp 99.1 98.54 0.56 0.56 0.594 0.1881 0.0155 2.977 S

Vag.pH 5.4 4.45 0.95 17.59 0.5986 0.1893 0.0007 5.019 ES**

RBS 81.69 7 7 . 5 4.19 5.1 9.508 3.007 0.1969 1.394 NS

This table shows the effect of therapy on objective parameters. Punarnavadi guggulu &

panchawalkaladi kwatha uttarabasti & pichu effect was found to be extremely significant (ES) in case ofESR & vaginal pH (p<0.0001) and very significant in TLC (p<0.01), significant in oral temperature (p<0.05),not significant in Hb, DLC & RBS (p>0.05).

Graph showing percentage relief in objective parameters of three groups A, B, C


68

RESULT:

Table no.8, Overall effect of therapy in 30 Patients:

Improvement Group A % age Group B %age Group C %age

(n) (n) (n)

Marked 4 40% 2 20% 7 70%

Moderate 5 50% 5 50% 3 30%

Mild 1 10% 3 30% 0 0%

No 0 0% 0 0% 0 0%

Out of three Groups studied, in Group A marked improvement was seen in the 4 patients, moderateimprovement in 5 patients and mild improvement in 1 patient. In Group B marked improvement was seen in2 patients, moderate improvement in 5 patients and mild improvement in 3 patients were observed. In Group

C maximum 7 patients showed marked improvement followed by moderate improvement in 3 patients.

Graph showing overall effect of therapy of groups A, B, C.

Table no.9, Total effect of therapy in 30 Patients (Subjective symptoms):

Groups Total effect (%)

Group A 72.19%

Group B 63.04%

Group C 84.80%

Subjective symptoms are found to be relieved to the maximum in Group C (84.80%), followed byGroup A (72.19%), Group B (63.04%).


69

Graph showing total effect therapy of Group A, B, C.

Discussion:

r 24 (80%) patients were complaining of lower

abdominal pain and low backache. 29 (96.66%)patients were complaining of excessive vaginaldischarges. 20 (66.67%) patients were

complaining of dyspareunia. 18 (60%) patientswere complaining of fever (i.e. rise oftemperature above normal but not always

equivalent to 101°F). Lassitude (weakness) wasobserved in 18 (60%) patients. 27 (90%) patientswere complaining fornices tenderness. 23

(76.66%) patients were complaining cervicalmotion tenderness.

r 22 (73.34%) were diagnosed as PID with USG

lower abdomen, 7 (23.33%) patients werediagnosed as PID with bulky uterus and 1(3.33%) patient was diagnosed as PID with

nabothian cyst.

r Per vaginal & per speculum examinations aremandatory as CDC guidelines are followed for are

followed for patient selection. And to exclude outother pathologies like tubo-ovarian mass, uterinefibroid etc.

r Oral temperature >101°F (acute PID) mentionedin CDC additional criteria is not justified becausein the present study maximum patients were

suffering from chronic PID hence oraltemperature > 98.6°F & pulse rate 90-100/min(fever) is more justified criteria.

r ESR above 15mm/hr, low Hb (<10gm%), lessacidic or alkaline vaginal pH (5 or more), USG oflower abdomen (fluid filled in pouch of Douglas),

inflammatory cytology observed through papsmear, on P/A exam tender lower abdomen, on

p/V bi/uni lateral fornices tender, cervicalmotion tenderness & on p/s examinationunhealthy condition of cervix including cervical

erosion & hypertrophy of cervix are morereliable markers to diagnose this disease ascompared to CRP, TLC, DLC mentioned in CDC

guidelines 2002 criteria for diagnosing PID.

r All the cases were HIV, VDRL, MT negative. Onlyone case was CRP positive but rest were

negative, 20% patients were having Hb%=10gm%, 13.34% patients were having TLC>10,000(th/µl).

r None of the cases were observed with IUCDassociated PID.

r After trial duration USG lower abdomen negative

(i.e, absence of fluid in POD) was considered forefficacy of trial along with symptomatic reliefassessed by scoring.

r In group C, 70% patients got marked relief and30% moderate relief, which was maximum ascompared to other two groups. In group C,

84.80% relief was found which was maximum ascompared to group A (72.19%) and group B(63.04%), because in group C, therapy used was

in combination of group A and group B, henceits effect was found to be more.

Comparative Analysis:

r Comparative analysis of three groups was doneon subjective parameters. It was found significant


70

between group A and C considering amount ofbleeding. On fever, very significant result was

found between group B and C. In rest ofparameters it was found non-significant.

r On the comparative analysis of three groups on

the objective parameter of TLC, very significantresult was found between group A & C and groupB & C. On ESR, significant result was found

between group B & C and in rest of parameters itwas found non-significant.

Probable mode of action of drugs:

Paripluta yonivyapada is vata-pittapredominant disease, hence doshakarma of drugsshould be vata-pitta pacifying or tridoshahara. The

drugs chosen for the present study has kashaya rasa(13 drugs), which itself is samshamana, sangrahi,stambhana, causes shoshana of kleda (absorbs the

excessive vaginal discharges), ropana (heals thevrana of vagina and cervix); tikta rasa (8 drugs) pittadosha shamaka, it alleviates aruchi, it is dipana-

pacana, kleda puya avashoshana (decreases theexcessive and foul smelling discharges, krimighna(bacteriocidal and bacteriostatic), kandughna (in

pruritis vulvae),jvaraghna. Katu rasa (3 drugs) causesagni dipana (decreases ama production and increasesbala or immunity leading to resistance to disease),

shothanashana (subsides inflammation of internalorgans), vrana ropana, kandughna; madhura rasa (6drugs) causes dhatu pushti, it is satmya, balya and

empower the whole body(reproductive system too)leading to decreased susceptibility towards disease.8 drugs were having ushna & 8 drugs were of shita

virya pacifying vata and pitta equally. 5 drugs werehaving madhura vipaka & 11 drugs were having katuvipaka. Comparing all things basically the drugs

selected were of vata-pitta shamaka property. Drugschosen for the present study were having propertiesas –shothahara, krimighna, kandughna, jvaraghna,

vatanuloman, rasayana, vranaropana, putihara,Mutrala, stambhana, yonidoshahara, tridoshaharamainly vata-pitta shamaka.

Drugs dosage is in the form of vati, uttarabastiand pichu form. Drugs were having anti-inflammatory, analgesic, bacteriocidal or

bacteriostatic, astringent, antipyretic etc. Along withthis the oral drugs were having medhya, rasayanaproperties which support the mental status of women

too. Since in ayurveda, for the treatment of anydisease psycho-somatic approach is followed. Both the

kwatha (for douching) and oil (for pichu) used in thepresent study were having pH compatible to vaginalpH, hence it helps to normalize the normal vaginal

physiology by maintaining its flora. The aboveprocedure was done under full aseptic precautions toavoid any iatrogenic infections. The antibacterial,

anti-inflammatory effect of kwatha, when given, itwashes out all the infections and discharges out as faras possible in the form of gush of vaginal pool

(through its hydrostatic pressure). It provides propershodhana of genital tract and prevents the ascendinginfections further. Shodhana cikitsa is most beneficial

in any disease because diseases treated bysamshodhana cikitsa cannot reoccur again.

From these observations, we can concludethat ayurvedic drugs are very effective to relieve the

symptoms. These drugs are vata-pitta shamaka, havebacteriostatic, bacteriocidal, anti-inflammatoryaction and inspite they cure the generalized weakness

by their rasayana property. They not only providesignificant relief in symptoms but they are alsocapable to increase the immunity of particularpatient against the disease.

Conclusions:

r On the basis of our classics, description ofparipluta yonivyapada is very much similar to

PID.

r Etiology given in our classics is very muchjustified with present etiology. Mithyacara(unhygienic mode of living, excessive coitus,

inconsistent or no barrier protection, impropersutika paricarya, deliveries conducted byuntrained dais) are the most important factors,

as also mentioned in modern sciences.

r PID is often asymptomatic or subclinical hence

it remain unnoticed many times & lead to itsdangerous late sequelae infertility, ectopicpregnancy etc.

r Patients complaining of symptoms (positively

found in the present study) are lower abdominalpain, low backache, dyspareunia, vaginaldischarges, painful or burning micturition, fever,

weakness. Similarly in ayurveda, lakshanamentioned are vedana in shroni, vankshanapristha; gramya dharma ruja; sarti nila


71

pitamasrika sraveta, shuna sparshakshama, jvaraetc.

r Main signs found in this disease are cervical

motion tenderness, fornices tenderness (duringp/v examination), eroded & or hypertrophiedcervix.

r Main victims were women of reproductive agegroups (more found in multigravida females)

with lower educational and economical status,unhygienic mode of living which makes themmore prone to infection.

r Risk factors found during study are unhygienic

condition of genitals, regular douching of vaginawith tap water, home deliveries via untraineddais, history of abortions, unsafe sexual practice.

r Although douche is a risk factor for PID but ifkwatha (boiled & used luke warm) having drugs

which have antimicrobial, anti-inflammatoryproperties with pH compatible to vagina if givenunder aseptic conditions, then it provides

therapeutic effects.

r Sexual activity plays an important role in itstransmission.

r Drugs used in the present study are manufacturedin the pharmacy of National Institute ofAyurveda on the basis of descriptions in our

classics. Drugs are found to be effective, as theyare shothahara, vedanasthapana, krimighna,kandughna, vrana ropana, tridoshahara especially

vata pitta shamaka. Probably drugs are used foruttarabasti does not destroy healthy tissue butcoagulates necrotic & pathological tissues.

Kwatha (for douching) & oil (for pichu) used forthe present study have pH comparable to vagina.Hence when it was administered it maintains the

normal vaginal flora & pH. Also with hydrostaticpressure it possibly washes out all the infectionsas far as possible in the form of gush of vaginal

pool. It provides proper shodhana of genital tract& indicates the importance of sthanika cikitsa.

r The result of present study i.e, group C is moreeffective than group A & B in subjective &objective parameters and help in improvement

of health of women & helpful to prevent thedisease's late sequelae.

References:

r Ayurvediya Prasuti tantra evum Stree Roga (Part-II), Prof. Premvati Tiwari, Published by ChaukhambaOrientalia, Varanasi.

r Bhavaprakash Nighantu – Acharya Bhavamishrawith hindi commentary by K.Chunekar,Chaukhamba Amar Bharti Academy, Varanasi.

r Charaka Samhita,Comm. Shri SatyanarayanShastri with vidyotini hindi commentary byPt.Kashinath Shastri & Dr.Gorakhnath Chaturvedi,Published by Chaukhamba Bharti Academy,V a r a n a s i .

r Charaka Samhita with Ayurveda Deepikacommentary by Chakrapani Dutta, edited byYadavji Trikamji, Chaukhamba subharti prakashan,V a r a n a s i .

r Dravyaguna Vigyan, Dr.Gyanendra Pandey,Chaukhamba Bharti Academy, Varanasi.

r Dravyaguna Vigyan (Vol. II), Prof.PriyavratSharma, Chaukhamba Bharti Academy, Varanasi.

r Sushruta Samhita with Ayurvedtatvasan deepikacommentary, edited by Kaviraj AmbikaduttaShastri, Purvardha, Published by ChaukhambaSanskrit Sansthan, Varanasi.

r Sushruta Samhita- Nibandhasangraha commentaryof Dalhanacharya, edited by Yadavji Trikamji,Chaukhamba subharti prakashan, Varanasi.

r Research in Ayurveda (A classified Directory of allIndia, P.G. and Ph.D. thesis of Ayurveda) -Dr.M.S.Baghel, 2007.

r Text book of Gynaecology including contraception,5th edition, D.C.Dutta, published by New CentralBook Agency (P) Ltd. Calcutta.

r Howkins & Bourne Shaw's Textbook of Gynaecology,14th edition, edited by V.G.Padubidri, Shirish NDaftary, published by Elsevier India Pvt. Ltd., Noida.

r Harrison's Principles of Internal medicine, vol.1,14th edition, edited by Anthony S.Fauci et al;Printed by McGraw-Hill companies.

r Gynaecology third edition, edited by RobertW.Shaw, W.Patrik Soutter, Stuart L. Stanton,Printed by Churchill Livingstone, an imprint ofElsevier Science limited.

r Infectious diseases in Obstetrics and Gynaecology,5th edition, Gilles R.G.Monif & David A.Baker, AcuteSalpingitis, Parthenon Publishing.

r Te Linde's Operative Gynaecology, 8th edition, editedby John A Rock and John D. Thompson, Lippincott-Raven Publishers, Philadelphia.

r Berek & Novak's Gynaecology, 14th edition, editedby Jonathen S. Berek, Lippincott William & WilkinsPublishers .

r Methods in Biostatistics by B.K.Mahajan, published

by Jaypee brothers, New Delhi.


72

Clinical evaluation of Chitrakadi Churna combinedwith the Kshar Vasti in the Management

of Amavata (Rheumatoid Arthritis)

*Dr Krishna Singh Napalchyal, *Dr Sameer Shinde, **Dr Jai Prakash Singh, ***Dr Daya Shankar Mishra.

Clinical Study

Abstract:

The changing life style of human being by means of dietetic and behaviour pattern plays a major

role in the manifestation of several disorders. Thus, this type of pattern may also lead to the developmentof the disease Amavata. The disease rheumatoid arthritis can be presented as very similar to Amavata. Thedisease R.A. is chronic in nature and affects mostly the middle aged group. It is one of the common

debilitating disease by virtue of its chronicity and implications. The onset of disease is frequent during 4th

and 5th decade of life with 80% of patients disease between 35-50 years of age. A total 30 patients of Amavatawere randomly selected for the present study, from the Kayachikitsa OPD and IPD of National Institute of

Ayurveda, Jaipur. Overall effect of therapy was excellent in group-A in which Chitrakadi Churna and KsharBasti were given to the patients.

Keywords: Amavata (Rheumatoid arthritis), Deepan, Pachan, Kshar Vasti, Chitrakadi Churna , Pain- score,

General functional capacity.

‚Ê⁄Ê¢‡Ê-

•ÊœÈÁŸ∑§ ¡ËflŸ ‡ÊÒ∂Ë ∑§ ’º∂Ã „È∞ πÊŸ¬ÊŸ ∞fl¢ ⁄„Ÿ ‚„Ÿ •Ÿ∑§ √ÿÊÁœÿÊ¢ ∑§Ë ©à¬ÁûÊ ◊¢ ¬˝◊Èπ ∑§Ê⁄áÊ „Ò– ß‚Á∂∞ß‚ Ã⁄„ ’º∂ÃË „Èß¸ ¡ËflŸ ‡ÊÒ∂Ë •Ê◊flÊÃ √ÿÊÁœ ∑§Ë ©à¬ÁûÊ ◊¢ ¬˝◊Èπ ∑§Ê⁄áÊ ’ŸÃË „Ò ß‚ •Ê◊flÊÃ √ÿÊÁœ ∑§ ∂ˇÊáÊ •ÊœÈÁŸ∑§M§◊≈Êß«U •ÊÕ¸⁄Êß≈Ë‚ √ÿÊÁœ ∑§ ∂ˇÊáÊÊ¢ ‚ ◊∂ πÊÃ „Ò– M§◊≈Êß«U •ÊÕ¸⁄Êß≈Ë‚ ∞∑§ ¡ËáÊ¸ √ÿÊÁœ „Ò– ¬˝Êÿ— 80 ¬˝ÁÃ‡ÊÃ ⁄ÊÁªÿÊ◊¢ ß‚ √ÿÊÁœ ∑§Ë ‡ÊÈM§flÊÃ ¡ËflŸ ∑§ øÊÒÕ ‚ ¬Ê¢øfl º‡Ê∑§ ∑§ ’Ëø ◊¢ ¬Êß¸ ¡ÊÃË „Ò– ß‚ ¬˝ÊÿÊÁª∑§ •äÿÿŸ ∑§ Á∂∞ 30⁄ÊÁªÿÊ¥ ∑§Ê ⁄Êc≈˛Ëÿ •ÊÿÈfl¸º ‚¢SÕÊŸ ∑§ ’Á„⁄¢ª fl •ãÃ⁄¢ª Áfl÷Êª ‚ øÈŸÊ ªÿÊ–

‚◊Í„ “•” ∑§ ⁄ÊÁªÿÊ¢ ∑§Ê ÁøG∑§ÊÁº øÍáÊ¸ fl ˇÊÊ⁄ ’ÁSÃ ‚ ©¬øÊ⁄ Á∑§ÿÊ ªÿÊ ∞fl¢ ©‚◊¢ ’„ÈÃ •ë¿U ¬Á⁄áÊÊ◊ ¬˝Ê#„È∞–

*M.D. Scholar, P.G. Department of Kayachikitsa,National Institute of Ayurveda, Jaipur **Lecturer, P.G. Department

of Kayachikitsa, National Institute of Ayurveda, Jaipur ***Associate Professor, P.G. Department of

Kayachikitsa,National Institute of Ayurveda, Jaipur


73

Introduction-

Ayurveda, the ancient system of Indianmedicine is a treasure of outputs and data obtained

through invasive research programmed of manythousands of years. Based on the remarkable theorypostulating man as a part of universe, the science has

placed its own unique protocol to make the worldhealthy and happy. More than a medical system, aculture or lifestyle of millions of people it always give

due importance to preventive aspects than curative.With the march of time, most of the dietary habits(Virrudhahara), social structure, life style, and

environment have been changing. Occurrence ofÀmavata on large scale is one of the outcomes of thismodification.

The changing life style of human being bymeans of dietetic and behaviour pattern plays amajor role in the manifestation of several disorders.

Thus, this type of pattern may also lead to thedevelopment of the disease Amavata. The diseaserheumatoid arthritis can be presented as very similar

to Amavata. The disease R.A. is chronic in natureand affects mostly the middle aged group. It is oneof the common debilitating disease by the virtue of

its chronicity and implications. The onset of diseaseis frequent during 4th and 5th decade of life with 80%of patients developing the disease between 35-50

years of age. Community prevalence study showsthat female are more sufferers than male and the ratioof occurrence between them is 3:1. It is also noted

that frequency is often associated with remission ofthe disease in last trimester with subsequent relapsesafter delivery.

The spectrum of disease that results due toAma ranges from acute conditions like Visuchika,Alsaka, Vilambika etc. to the chronic disorders like

Amavata, Grahani and Amatisara etc. In Amavata,Vata as a Dosha and Ama are chief pathogenicfactors. They are contradictory in nature and thus

possesses difficulty in planning the line of treatment.It is mostly the disease of Madhyama Roga Margaand having Chirkari Swabhava. Sometime it can also

be manifested as the acute case. Due to their similarmode of presentation, the disease rheumatoidarthritis can be broadly grouped under the heading

Amavata.

Aims and Objectives:

Clinical evaluation of Chitrakadi churna

combined with the Kshar Vasti in the managementof Amavata (Rheumatoid Arthritis) on the basis ofvarious scientific parameters:

Material and Method:

Selection of Cases

A total 30 patients of Amavata were

randomly selected for the present study, from theKayachikitsa OPD and IPD of National Institute ofAyurveda, Jaipur. The case selection was random

regardless of age, sex, occupation and socio-economic conditions. Both acute and chronic phaseof Amavata patients were taken for the study,

following the criteria of the diagnosis of rheumatoidarthritis in Modern Medicine and the clinical featuresof Amavata described in Madhava Nidana.

Inclusion Criteria:

Clinical features of the disease according toModern and Ayurveda.

Exclusion Criteria:

1 . Severe deformities.

2. Severe ankylosed joints

3. Major complications

4. Ankylosing spondylitis

5. Rheumatic arthritis, septic arthritis osteoarthritis

and gouty arthritis.

Clinical evaluation of Chitrakadi Churna combinedwith the Kshar Vasti in the Management

of Amavata (Rheumatoid Arthritis)

Dr Krishna Singh Napalchyal, Dr Sameer Shinde, Dr Jai Prakash Singh, Dr Daya Shankar Mishra.

Clinical Study


74

6. Rheumatoid Arthritis more then 5 years.

Clinical Assessment of the Disease:

1. Pain

0- No pain

1- Pain complaints but tolerable

2 - Pain complaints difficult to tolerate and takinganalgesic once a day

3 - Intolerable pain and taking analgesics two times

a day

4 - Intolerable pain and taking analgesics more thantwo times in a day.

2. Swelling

0 - No swelling

1 - Feeling of swelling + Heaviness

2 - Apparent swelling

3 - Huge (Synovial effusion) swelling

3. Stiffness

0 - No stiffness

1 - 20% limitation of normal range of mobility

2 - 50% limitation of mobility

3 - 75% or more reduction of normal range ofmovement

4. Deformity

0 - No deformity

1 - Feeling of deformity

2 - Mild deformity

3 - Multiple joint deformities

5. General Function Capacity

0- Complete ability to carry on all routine duties

1- Frequent normal activity despite slight difficultyin joint movement

2- Few activities are persisting but patient can takecare of him or herself

3- Few activities are persisting patient requires anattendant to take care him/herself

4- Patient is totally bed ridden

6. Tenderness

0- No tenderness

1- Mild tenderness

2- Moderate tenderness

3- Severe tenderness

General symptoms :

General symptoms of Amavata likeAngamarda, Aruchi, Trishna, Apaka, Alasya,

Gaurava, and Jwara and Sunatanga - nam werescored as mentioned below

· Complete relief after treatment 00

· Mild relief after treatment 0 1

· Moderate relief after treatment 02

· No improvement after treatment 03

Clinical assessment was also done to evaluatethe status of Agni and Kostha all the patients andwere regularly followed up.

Follow Up Studies

Every patient registered after fulfilling theinclusion criteria underwent assessment of

symptoms and also the assessment for differentcomponents of inflammatory index, walking time,grip power, pressing power.

30 patients of RA completed also the threefollow ups of which 15 patients in group ‘A’ hadreceived. Chitrakadi Churna in dose of 4 gms two

times a day with Kshar Basti for 16 days.

Treatment schedule for group ‘A’

a. Deepan -Pachan – ‘A’ Chitrakadi Churana 4 gms

two times a day with luke warm water

b. Snehana Karma as Abhyanga was followed byswedana karma starting from day 1st for 16 days

followed by Kshar basti (500-600 ml) andanuvasan basti (50 ml) alternatively.

Group B – Chitrakadi Churana

15 patients were provided ChitrakadiChurana in dose of 4 gms BD with luke warm waterafter meal and were regularly follow up 15 days

interval.


75

Preparation of trial drug-

Chitrakadi Churna is prepared by grinding the

fresh cleaned and dried chitraka mool, Endrayava,patha, kutaki, atish and haritaki.

Dosage

Chitrakadi Churana 4 gms two times a day

with luke warm water

Kshar Basti- 500-600 ml in the Kala bastikarma.

Effect Of Therapy

Table:1 Effect of Trial on Symptoms of Group A

Parameter B.T. A.T. Diff. % S.D. S.E. ‘t’ P Results

Pain 2.40 1 . 0 7 1.33 55.55 1.29 0.33 4.00 <0.01 S

Swelling 2.66 1.06 1.60 60.00 1.24 0.33 4 . 7 7 <0.001 HS

Stiffness 2.73 1.06 1.66 60.97 1.34 0.34 4.79 <0.001 HS

Angamarda 2.13 1.00 1.13 53.12 0.99 0.25 4.43 <0.001 HS

Gaurav 2.73 1.20 1.53 56.09 1.59 0.41 3.71 <0.01 S

Aruchi 2.53 1.00 1.53 60.52 1.06 0.27 5.60 <0.001 HS

Jwar 2.00 1.06 0.93 46.66 0.96 0.24 3.76 <0.01 S

Apaka 2.46 0.73 1 .73 70.00 1.27 0.33 5.24 <0.001 HS

Alasya 2.40 0.93 1.46 61.11 1.24 0.32 4.55 <0.001 HS

Table: 2 Effect of Trial on Symptoms of Group B


Pain 2.20 1.53 0.66 30.30 0.89 0.23 2.86 >0.05 NS

Swelling 2.20 1.40 0.80 36.36 1.14 0.29 2.70 >0.05 NS

Stiffness 2.26 1.13 1.13 50.00 1.35 0.35 3.23 <0.01 S

Angamarda 2.46 1.20 1.26 51.35 1.33 0.34 3.67 <0.01 S

Gaurav 2.00 1.00 1.00 50.00 1.06 0.27 3.62 <0.01 S

Aruchi 2.46 1.06 1.40 56.75 1.29 0.33 4.17 <0.001 HS

Jwar 2.00 1.13 0.87 43.33 0.91 0.23 3.66 <0.01 S

Apaka 2.33 0.80 1.53 65.71 0.99 0.25 5.99 <0.001 HS

Alasya 2.20 1.20 1.00 45.45 1.00 0.25 3.87 <0.01 S


76

Table: 3. Effect of Trial on Blood Investigations of Group A


Hb% 10.33 10.53 0.20 1.93 0.41 0.10 1.87 <0.05 NS

ESR 35.00 26.93 8.06 23.04 8.43 2.17 3.70 <0.01 S

TLC 8518.70 8510.10 8.53 0.10 14.39 3.71 2.29 <0.05 NS

Neutrophils 64.07 63.73 0.33 0.52 0.72 0.18 1.78 <0.05 NS

Lymphocytes 35.26 35.20 0.06 0.19 0.46 0.12 0.56 <0.05 NS

Eosinophils 1.33 1.20 0.13 10.00 0.35 0.09 1.46 <0.05 NS

Basophils 0.00 0.00 0.00 00.00 0.00 0.00 0.00 0.00 N.D.

Monocytes 1.46 1.33 0.13 9.03 0.35 0.09 1.46 <0.05 NS

Rheumatoid factor was found positive in 10patients in Group-A before treatment, but after thetreatment of one month, there is no changes. CRP

titer was found positive in 09 patients in Group-A

before treatment, but after the course of one month

two patients become negative. No significant changeswas found radiologically during my study in Group-A.

Table: 4 Effect of Trial on Blood Investigations of Group-B


Hb% 10.93 11.06 0.13 1.21 0.35 0.09 1.46 < 0.05 NS

ESR 30.00 31.33 3.86 11.04 5.27 1.36 2.83 <0.01 NS

TLC 8518.70 8511.70 6.93 0.08 13.87 3.58 1.93 < 0.05 NS

Neutrophils 63.73 63.55 0.2 0.31 0.41 0.10 1.87 < 0.05 NS

Lymphocytes 34.60 34.33 0.26 0 . 7 7 0.88 0.23 1.16 < 0.05 NS

Eosinophils 1.60 1.53 0.06 4.16 0.59 0.15 0.53 < 0.05 NS

Basophils 0.00 0.00 0.00 00.00 0.00 0.00 0.00 - -

Monocytes 1.46 1.33 0.13 9.03 0.35 0.09 1.46 < 0.05 NS

Rheumatoid factor was found positive in 06patients in Group-B before treatment, but after thetreatment of one month, there was no change. CRP

titer was found positive in 06 patients in Group-Bbefore treatment, but after the course of one monthno patients become negative. No significant change

was found radiologically during my study in Group-B.


77

Table:5.Comparision of clinical features in

Trial group A and Trial Group- B

Parameter Group- A Group- B

Pain 55.55 30.30

Swelling 60.00 36.36

Stiffness 60.97 50.00

Angamarda 53.12 51.35

Gaurav 56.09 50.00

Aruchi 60.52 56.75

Jwar 46.66 43.33

Apaka 70.00 65.71

Alasya 61.11 45.45

Pain: In Group A, relief in pain is 55.55 %and in Group B, it is 30.30% relief.

Swelling: In Group A, relief in swelling is60.00%,and in Group B, it is 36.36 % relief i.e. Reliefwas more in Group A in comparison to Group B.

Stifiness: Relief inStifiness in Group A is60.97% and in Group B it is 50.00 % relief.Relief wasmore in Group A in comparison to Group B.

Angamarda : In Group A, relief inAngamarda is 53.12 % and in Group B, it is 51.35 %relief. Relief was more in Group A in comparison to

Group B.

Gaurav: In Group A, relief in Gaurav is56.09 % and in Group B, it is 50 % relief. Relief was

more in Group A in comparison to Group B.

Aruchi: : In Group A, relief in Aruchi is60.52 % and in Group B, it is 56.75% relief. Relief

was more in Group A in comparison to Group B.

Jwar : : In Group A, relief in Jwar is 46.66% and in Group B, it is 43.33% relief. Relief was more

in Group A in comparison to Group B.

Apaka: In Group A, relief in Apaka is 70% and in Group B, it is 65.71% relief. Relief was more

in Group A in comparison to Group B.

Alasya: In Group A, relief in Alasya is61.11% and in Group B, it is 45.11% relief. Relief was

more in Group A in comparison to Group B.

Disscussion:

The effect of therapy was assessed on eachsign and symptom of the disease. These sign andsymptoms were given scoring pattern before

treatment and after treatment and were assessedstatistically to see the significance. The effect oftherapy in all the groups in each sign and symptom

is below.

i. Pain : In Group A, the mean score of painwas 2.40 before treatment which reduced up to 1.07

after treatment with 55.55 % relief, which wasstatistically significant (P<0.01). In Group B, Themean score of pain was 2.20 before treatment which

reduced up to 1.53 after treatment with 30.30%relief, which was statistically insignificant (P>0.05).This is clear from the above discussion that in the

two group therapies group A and group B reducedthe pain, but it was more in Group A in comparisonto Group B and Group A is significant in Pain.

ii. Swelling: In Group A, the mean score ofSwelling 2.66 before treatment which reduced up to1.06 after treatment with 60.00% relief, which was

statistically highly significant (<0.001). In Group B,the mean score of Swelling was 2.20 before treatmentwhich reduced up to 1.40 after treatment with 36.36

% relief, which was statistically insignificant(P>0.05). Relief was more in Group A in comparisonto Group B.

iii. Stiffness: The mean score of Stiffness

was 2.73 before treatment in Group A, whichreduced up to 1.06 after treatment with 60.97.17 %

relief, which was statistically highly significant(<0.001). The mean score of Stiffness was 2.26before treatment in Group B, which reduced up to

1.13 after treatment with 50.00 % relief, which wasalso statistically significant (P<0.01).Relief was morein Group A in comparison to Group B.

iv. Angamarda : It was reported that initialmean score of Angamarda in the Group A was 2.13and after treatment it reduced up to 1.00. This 53.12

% relief was statistically highly significant (P<0.001).The initial mean score of Angamarda was 2.46 beforetreatment in Group B, which reduced up to 1.20 after

treatment. So the relief was 51.35 %, which wasstatistically significant (P<0.01). Relief provided by


78

Group A is more than Group B.

v. Gaurav: In Group A, the mean score of

Gaurav was 2.73 before treatment and after thecompletion of the course it was decreased up to 1.20.This 56.09% relief was statistically significant

(P<0.01). In Group B, the mean score of Gaurav was2.00 before treatment and after the completion ofthe course it was decreased up to 1.00 and this

50.00 % relief was statistically significant (P<0.01).So relief provided by Group A is more than GroupB.

vi. Aruchi: The mean score of Aruchi was2.53 before treatment in Group A, which reduced upto 1.00 after treatment with 60.52 % relief, which

was statistically highly significant (<0.001). Themean score of Aruchi was 2.46 before treatment inGroup B, which reduced up to 1.06 after treatment

with 56.57 % relief, which was also statistically highlysignificant (P<0.001) but relief was more in GroupA in comparison to Group B.

vii. Jwar : It was reported that initial meanscore of Jwar in the Group A was 2.00 and aftertreatment it reduced up to 1.06. This 46.66 % relief

was statistically significant (P<0.01). The initialmean score of Jwar was 2.00 before treatment inGroup B, which reduced up to 1.13 after treatment.

So the relief was 43.33 %, which was statisticallysignificant (P<0.01). Relief provided by Group A ismore than Group B.

viii. Apaka: In Group A, the mean score ofApaka was 2.46 before treatment and after thecompletion of the course it was decreased up to 0.73.

This 70.00% relief was statistically highly significant(P<0.001). In Group B, the mean score of Apaka was2.33 before treatment and after the completion of the

course it was decreased up to 0.80 and this 65.71 %relief was statistically highly significant (P<0.001). Sorelief provided by Group A is more than Group B.

ix. Alasya: It was reported that initial meanscore of Alasya in the Group A was 2.40 and aftertreatment it reduced up to 0.93. This 61.11 % relief

was statistically highly significant (P<0.001). Theinitial mean score of Alasya was 2.20 beforetreatment in Group B, which reduced up to 1.20 after

treatment. So the relief was 45.45 %, which wasstatistically significant (P<0.01). Relief provided by

Group A is more than Group B.

Blood Investigations

Hb% was found to slightly increase in GroupsA and B, which was however statistically insignificantin the both groups Group A and B. The improvement

in Hb% is also indicative of disease modifying effectof trial therapy.

Even though a total mean reduction of ESR

value was seen in group A and slightly increase inthe Group B i.e Relief provided by Group A is morethan Group B.

Although slightly reductions were seen in thevalues of TLC, Neutrophils, Lymphocytes,Eosinophils, Basophils and Monocytes in both Groups

GroupA and B but it was insignificant improvement.

Rheumatoid factor was found positive in 10patients in Group-A and 06 patients in Group B

before treatment, but after the treatment of onemonth, there were no changes in seropositivity ofRheumatoid factor.

CRP titer was found positive in 09 patientsin Group-A before treatment, but after titer thecourse of one month two patients became negative

in CRP. In the case of Group-B CRP titer was foundpositive in 06 patients before treatment, but afterthe course of one month no patients became

negative.

No significant changes was foundradiologically during my study in Group-A and Group

B. Patient with recent onset of disease i.e. durationof illness upto 2yrs showed better improvementwhen compared to the relatively more chronic

patients.

Discussion On Abhyanga And Swedana

Here, by these processes the liquefied Dosha

dissolve in Sneha and make the path for excretionby bringing them to Kostha. Since, it is well knownthat sweating is one of phenomenon involved in

excretion of waste product thus, here inducedsweating help in similar fashion.

Heat which is given in the Swedana process

reaches subcutaneous region and through the bloodconveys heat to the whole body. Here, due to thisheat vasodilatation of subcutaneous blood vessels


79

take place. As a result of vasodilatation, there isincreased flow of blood through that area, so that

necessary oxygen and nutritive material are suppliedand waste products are removed.

In this study, Sarvanga Swedana was carried

out for this purpose Bashpa Sweda was followed afterthe Abhyanga.

Discussion On Basti

No other elimination therapy is equal toVasti because it expels the vitiated doshas rapidlyand easily from the body and also causes reducing

as well as nourishing the body very fastly.Vasti canbe given in all age group without any hesitation.Vasti is forcefully indicated in Amavata(Rheumatoid

arthritis) in Ayurvedic text.

Keeping the nature of disease i.e.Amavata,Kshar Basti was planned as per the principle told by

Acharya Chakradutta and it was given in the form ofShodhana Basti hence this Basti is Srotoshodhaka andvatanulomaka.

Probable Mode Of Action Of Basti

In the present study kshar Basti group hasprovided better relief in cardinal symptom,

associated symptoms and general symptoms of thedisease relative to Churana group. Kshar Vasti hasbeen clearly mentioned by Chakradutta in

Amavatarogadhikar. Here kshar Basti is given in theformat of Kala Basti. kshar Basti is the type of NiruhaBasti described in Chakradatta Niruhadhikara. It was

used in alternation with Saindhav mixed Tila TailaAnuvasana basti.

As a whole the qualities of kshar Basti can be

considered as Laghu, Ruksha, Ushna, Tikshna.Majority of the drugs are having Vata-kaphashamakaaction. Owing to this property, antagonism to Kapha

and Ama the Basti help in significant improvementin sign and symptom of disease. The Tikshna Gunaof Basti help in overcoming the Srotodushti resulting

due to ‘Sanga’.

Thus Basti Dravya after reaching to large andsmall intestine get absorbed from intestine, now due

to Laghu, Ushna, Tikshna and Ruksha Guna of ksharBasti Dravya, it breaks the obstructions and expelsout the morbid material from all over the body, thus

help in breaking down the pathogenesis of disease.

Here Anuvasana Basti is used so as to avoid thevitiation of Vata due to continuous use of kshar Basti.

Niruha Basti help in alleviating the Avarana of Vataby Kapha. Reduction in this Avarana was seen asthere was improvement of Kaphavrita Vyana

symptoms. Basti help in Vatanulomana thus helpingcorrecting the Apana. Basti therapy may bestimulator for many intra-luminal, luminal and whole

body functions.

Gomutra is Katu and tiksna property whichworks as Chedaka, Kapha Shamaka, Srotoshodhak

and Agnideepak. Acoording to Bhav- Prakash it actsas Rasayan so it is very useful for treating theAmavata disease and also maintaining the health of

the patients due to chronicity nature of the disease.It also improves the diminished agni due to aboveproperty.

Emali and Guda is also useful inagnimandya, vibandha, deepan, rochana, bhedan,shothahar and vedanasthapan in nature.

Total Effect of Therapy

l Group A : In Group A highly significantimprovement was seen on Swelling, Stiffness,

Angamarda, Aruchi, Apaka and Alasya. Butsignificant improvement was seen inGaurav,Pain and Jawar.

l Group B : In Group B highly significantimprovement was seen on Aruchi, Apaka andsignificant improvement was seen in Stiffness,

Angamarda, Gaurav Jawar and Alasya.

Conclusion

(1) The therapy is very useful for pain, swelling,

tenderness and stiffness, which were the chiefcomplaints of the patients.

(2) Patient who were seronegative and of chronicity

more than 3 yrs did not showed markedimprovement.

(3) The trial drug in this study is suppose to be very

good combination of Vedanashamak, Shothaghnaand Amapachak Dravyas.

(4) The only unwanted effect of the drug is mild

weight loss in patients.


80

Reference:

1 . Bhavprakash, Bhavprakash Uttrarardh Vidyotini

Hindi Commentry by Mishra Bramha Shanker

Amavatarogadhikar-26 Madhyamkhand

Chaukhabha Bharati Academy Varanasi. (2001)

2 . Madhav Nidan Shastri,Sudarsana, Vidyotini

Hindi Commentry, Chaukhabha Sanskrit Sansthan

Varanasi. (2006)

3. Kasper,Braunald,Fauci,Harrison’s Principles of

Internal Medicine 16th edition,McGraw-Hill, New

York (2005)

4 . Charak., Charak Samhita, Vidyotini Hindi

Commentry by Shastri, K. Chaturvedi, G.N

Chaukhabha Bharati Academy Varanasi. (2003)

5 . Chakradutta, Chakradutta, Vaidyprabha Hindi

Commentry by Tripathi, Indradev Chaukhabha

Sanskrit Sansthan Varanasi. (1997)

6. Medikonda PK and Singh RH Clinical Evaluation

of the therapeutic effect of Amavatari Rasa and

Swedan therapy in case of Rheumatoid Arthritis MD

(Ay.) Thesis (Kayachikitsa) IMS, BHU, Varanasi.

(1998)

7 . Barauh P, and Singh RH, Clinical Evaluation of

the effect ofAmrita and Pippali in treatment of

Amavata MD (Ay.) Thesis (Kayachikitsa) IMS, BHU,

Varanasi. (1999)

8 . Bhavaprakash Nighantu - Commentory (Hindi) by

K.C. Chunekar, edited by G.S. Pandey

(Chaukhamba Vidyabhavan Varanasi) (1969)

9. Gupta BC : Vanaushadhi Darpan 1990, Calcutta (ref.

from Siva Nighantu), Quoted in Sharma PV,

Ayurveda Ka Vaigyanic Ithihas, Chaukhambha

Orientalia, Varanasi, p. 407. (1975)

1 0 . FRLHT’s Clinically Important Plants of Ayurveda (CIPA)

Version 1.00 (2006)

11. Kirtikar,R. K. and Basu, B.D. Indian Medicinal

Plants. (1933)

12. Chopra RN, Nayar SL, Glossary of Indian medicinal

Plants, Delhi. CSIR (1956)

13. Sharma PV : Dravya Guna Vijnana. Vol. II,

Chaukhambha Bharti Academy, Varanasi. (1987)

14 . Indian Medicinal Plants - A compendium of 500

species Vol. I, II, III, IV and V editor Arya Vaidya

Sala Kottakal. (2000)

15. Prof. Singh, R.H., Panchkarma Therapy,

Chaukhabha Sanskrit Series office Varanasi. (2005)

16. Vidyanath,R.,Panchkarma Publish by Vijaya

Maruthi D.T.P.Vijayavada(2000)

17. Shah N. Siddartha. (Editor in Chief). API

Textbook of Medicine - VII edition (2003) Prof.

Singh, R.H., Panchkarma Therapy, Chaukhabha

Sanskrit Series office Varanasi. (2005)

18. Singh Vinod Kumar, Singh R.H. and Singh N.K.,

A Clinical study on the disease modifying effect of

certain Ayurvedic drug in Amavata vis-a-vis

Rheumatoid Arthritis M.D. (Ay) Thesis

(Kayachikitsa). (2000)

19. Shastri, Ambikadutta Susruta Samhita,

Ayurveda-Tattva-Sandipik Hindi Commentry by

Chaukhabha Sanskrit Sansthan Varanasi. (2001)


81

A Study of the Vishaktata (Toxicity) of Madya (Ethyl Alcohol)on Oja Dhatu in Human Body

* Dr. Sharad Porte

Abstract

Alcoholism is a burning issue in developing country like India, as it causes deep health affect in

human being along with social, economic & family disturbance. Hence both Modern Medicine &AyurvedicScience has been highlighted the Alcohol & Alcoholism in detail. Ayurveda mentioned that Alcohol act asnectar, if it consume in proper dose & manner as per suggestion by Ayurveda, but it act as a poison if

consume in inverse way.In this study conceptual & toxic effect were observed on 60 patients of Alcoholism(20 acute alcoholism and 20 chronic alcoholism and 20 patients of alcohol withdrawal syndrome) werestudied& toxic effect were observed on OjaDhatu. Study revealed that it vitiated Tridosha, Saptadhatu& various

Strotascausing serious illness, as all the properties are similar to poison. As the properties of Alcohol areopposite to the properties of OjaDhatu (Body Essence), it vitiated & causes Ojavyapad, Ojavistransa &Ojakshaya. This study revealed that Acute Alcoholism causes Ojavistransa& Chronic causes Ojakshaya while

Ojavyapad found in Alcohol Withdrawal. This study gives serious effort to determine Toxicity of Ethyl Alcohol(Madya) on OjaDhatu in Human Being.

Key Word - Alcoholism, Madya, Madataya, Oja Dhatu, Toxicity

‚Ê⁄UÊ¥‡Ê-

◊l •ÊÒ⁄U ◊ŒÊàÿÿ ÷Ê⁄UÃ ¡Ò‚ Áfl∑§Ê‚‡ÊË‹ Œ‡Ê ∑§ Á‹∞ ’„ÈÃ ’«∏Ë ‚◊SÿÊ „Ò ÄÿÊ¥Á∑§ ÿ„ ‡ÊÊ⁄UËÁ⁄U∑§ ∞fl¥ ◊ÊŸÁ‚∑§•Ê⁄UÊÇÿ ¬⁄U •‚⁄U «UÊ‹ÃÊ „Ò •ÊÒ⁄U ‚Ê◊ÊÁ¡∑§, •ÊÁÕ¸∑§ ∞fl¥ ∑§ÊÒ≈ÈUÁê’∑§ √ÿflSÕÊ Á’ªÊ«∏ÃÊ „Ò– ß‚Á‹∞ •ÊÿÈfl¸Œ ∞fl¥ •ÊœÈÁŸ∑§ŒÊŸÊ ÁflôÊÊŸÊ¥ Ÿ ß‚∑§Ê ÁflSÃÎÃ M§¬ ◊¥ fláÊ¸Ÿ Á∑§ÿÊ „Ò– •ÊÿÈfl¸Œ ∑§ •ŸÈ‚Ê⁄U ◊l ∑§Ê ‚flŸ ÁflÁœflÃ ∑§⁄UŸ ‚ ÿ„ •◊ÎÃ „Ò◊ª⁄U ÁflÁœflÃ ‚flŸ Ÿ„Ë¥ ∑§⁄UŸ ‚ ÿ„ ‡Ê⁄UË⁄U ◊¥ Áfl· ∑§Ê ∑§Êÿ¸ ∑§⁄UÃÊ „Ò– ß‚ •äÿÿŸ ◊¥ ‚¥∑§À¬ŸÊà◊∑§ ÃÕÊ •Ê¡ ¬⁄UÁfl·ÊQ§ÃÊ ∑§Ê •äÿÿŸ 60 (20 ◊Œ + 20 ¡ËáÊ¸ ◊ŒÊàÿ + ¬ÊŸÊ∑˝§◊) M§ÇáÊÊ¥ ◊¥ Á∑§ÿÊ ªÿÊ– ß‚∑§ ªÈáÊ Áfl· ◊¥ ‚◊ÊŸ „ÊŸ‚ ŒÊ·, œÊÃÈ ∞fl¥ ◊‹ ∑§Ê ŒÍÁ·Ã ∑§⁄U∑§ ⁄UÊªÊ¥ ∑§Ë ©à¬ÁûÊ ∑§⁄UÃÊ „Ò •ÊÒ⁄U ß‚∑§ ªÈáÊ •Ê¡ œÊÃÈ ‚ ÁflM§h „ÊŸ ‚ ©‚∑§Ê ŒÍÁ·Ã∑§⁄U∑§ •Ê¡ √ÿÊ¬Œ, •Ê¡ Áflù¥‚ ∞fl¥ •Ê¡ ˇÊÿ ∑§Ë ©à¬ÁûÊ ∑§⁄UÃÊ „Ò– ß‚ •äÿÿŸ ◊¥ Áfl∑§≈U ◊Œ ‚ •Ê¡ Áflù¥‚, ◊ŒÊàÿÿ◊¥ •Ê¡ ˇÊÿ •ÊÒ⁄U ¬ÊŸÊ∑˝§◊ ◊¥ •Ê¡ √ÿÊ¬Œ Á◊‹Ê– ÿ„ •äÿÿŸ ◊l ∑§Ê •Ê¡ œÊÃÈ ¬⁄U Áfl·ÊQ§ ¬˝÷Êfl ÁŸœÊ¸Á⁄UÃ ∑§⁄UÃÊ „Ò–

*Lecturer, Deptt. of Agadtantra, National Institute of Ayurveda, Jaipur

Clinical Study


82

Introduction

The harmful use of alcohol results inapproximately 2.5 million deaths each year. Harmfuldrinking can also be very costly to communities and

societies.Alcohol consumption and problems relatedto alcohol vary widely around the world, but theburden of disease and death remains significant in

most countries. Alcohol consumption is the world’sthird largest risk factor for disease and disability; inmiddle-income countries,it is the greatest risk.

Alcohol is a causal factor in 60 types of diseases andinjuries and a component cause in 200 others.Almost 4% of all deaths worldwide are attributed to

alcohol, greater than deaths caused by HIV/AIDS,violence or tuberculosis. Alcohol is also associatedwith many serious social issues, including violence,

child neglect and abuse, and absenteeism in theworkplace1. Alcohol consumption has been steadilyincreasing in developing countries like India anddecreasing in developed countries since the 1980s.

The pattern of drinking to intoxication is moreprevalent in developing countries indicating higher

levels of risk due to drinking. 62.5 million Alcoholusers estimated in India & Percapita consumption of

alcohol increased by 106.7% over the 15-year periodfrom 1970 to 19962.

The substance which produces toxic effect on

brain & mind after Ingestion is called as Alcohol(Madya). As Properties of Madya are similar toVisha& exactly opposite to OjaDhatu, it will be act

like Visha and create pathogenesis withinOjavahStrotas in human being by means ofOjoVyapad, Ojo Vistransa & OjoKshaya. As OjoDhatu

is important, essential essence of living cell, vikritiwithin causes severe harm to human being whichmay be physical, mental or both.

Conceptual Review of Literature

The mechanism of action of any drug ortoxicant depends on qualitative & quantitative

properties. Hence there is need to discuss & evaluatethe properties of Ethyl Alcohol (Madya) &Esence ofBody Tissue (OjaDhatu) to know the action.

A Study of the Vishaktata (Toxicity) of Madya (Ethyl Alcohol)on Oja Dhatu in Human Body

Dr. Sharad Porte

Clinical Study

Table No. 1 According to Various Acharyas Visha Guna (properties of poison)

Sr. Properties Charak3 Sushrut4/ Astang Astang

Yogratnakar5/ Hrudya7 Sangraha8

Bhavprakash6

1 Light (Laghu) ü ü ü ü

2 Dryness (Ruksha) ü ü ü ü

3 Hot (Ushna) ü ü ü ü

4 Sharp (Tikshna) ü ü ü ü

5 Fine (Sukshma) ü ü ü ü

6 Cleanness (Vishad) ü ü ü ü

7 Quick Absorption (Vyavayi) ü ü ü ü

8 Extensive (Vikasi) ü ü ü ü

9 Quick Acting (Ashukari) ü ü ü ü

1 0 Indefinable Taste Indigestible Indigestible Indigestible Unclear Taste

(AnirdeshyaRas) (Avipaki) (Avipaki) (Avipaki) (Avyakta Ras) andIndigestible (Avipaki)


83

Charak, sushrut, Vagbhat, Yogratnakarand Bhavprakash all are supposed to be ten properties ofpoison.Out of ten, nine properties are similar according to Charak, and Vagabhat, Yogratnakar and

Bhavprakash.Charaksupposed IndefinableTaste instead of Sushrut, Yogratnakar, Bhavaprakash andAstangsangrahsupporsed to be Indigestible, while Ashtanghrudya supposed both means,Unclear Taste andIndigestible.

Table No. 2 According to Various AcharyasMadyaGunas (properties of the ethanol)

Sr. Properties Charak9/ Ashtang Ashtang Sushrut14

Yogratnakar10/ Hrudya12 Sangraha13

Bhavprakash11

1 Light (Laghu) ü ü ü ü

2 Dryness (Ruksha) ü ü ü ü

3 Hot (Ushna) ü ü ü ü

4 Sharp (Tikshna) ü ü ü ü

5 Fine (Sukshma) ü ü ü ü

6 Cleanness (Vishad) ü ü ü ü

7 QuickAbsorption (Vyavayi) ü ü ü ü

8 Extensive(Vikasi) ü ü ü ü

9 Quick Acting (Ashukari) ü ü ü ü

1 0 Sour (Amla) ü ü ü —

It means that All Acharya including Charak, Vagbhat, Yogratnakar and Bhavprakash are supposed

10 properties of Madya mentioned above, but Sushrutsupposed only 9 properties, except Sour. Afteroverlooking and review of properties of Madya and Poison all the properties are similar except Sour in Madya

and illdefinable Taste or Indigestible of poison. Hence why Madya is act like poison on human body and

produce Toxic effect.

Table No. 3 OjaGunas (Properties of Oja) according to various Acharya

Sr. Properties Charak15 Shushrit16

1 Heavy (Guru) ü —

2 Cold (Shita) ü ü

3 Soft (Mrudu) ü ü

4 Smooth (Shlakshnam) ü —

5 Viscous (Bahalam) ü —

6 Sweet (Madhuram) ü —

7 Stable (Sthiram) ü ü

8 Clear (Prasanna) ü —

9 Slimy (Pichchhila) ü —


84

1 0 Unctuous (Snigdham) ü ü

1 1 Animate (Pranayatanam) — ü

1 2 Causing Move (Saram) — ü

1 3 Whitish (Shuklam) — ü

1 4 Cool (Somatmakam) — ü

1 5 Clay Like (Mrutsnam) — ü

1 6 Pure (Suddham) — —

1 7 Yellowish Red (Lohit-pitakam) — —

It means that in view of Ayurveda,Madya

(ethyl alcohol) is poison. All the properties of

Ojadhatu are exactly opposite to the properties ofMadya and Guru Gunas of Oja has destroyed byLaghugunas of Madya, Shita by Ushna, Madhur by

Amla, Mrudu by Tikshna, Nirmal by Ashuga, Snigdhaby Ruksha, Sthira by Vyavayi, Shlakshna by Vikasi,Pichchhila by Vishada and Bahala by Sukshmagunas

has destroyed17 & 18.Though the Madya is poison,when person drink it in an adequate dose, by propermanner with proper diet, it like as annectar. But if

it will be taken in over dose and by impropermanner, then it destroyed the Ojadhatu in humanbody.

OjaVikruti- There is three type ofOjaDhatuVikruti.

1. Oja-Vyapad – (Disorder of oja)

The condition relates to the change in ormodification of natural properties of OjaDhatu underthe influence of vitiated doshas is called as OjaDhatu

vyapad19.

2. Oja – Vistransa (Displacement of Oja)

The impairment of the distribution of

Oja Dhatu to the dhatu due to its leakage from thedhatuvahasrotansi is called as OjaDhatu Vistransa19.

3. Ojakshaya (loss of oja)-

The condition represents the out-come of lossand wasting of OjaDhatu is called as ‘Oja Dhatu-Kshaya19.

OjaDhatu in View of Modern Science

l Though Oja cannot be correlated with any other

chemical substance. The modern scientists are

co-related it with - Internal secretion of thetesticles, Internal secretion of ovary, Prostaticsecretion, Pitutrine Secretion, Vitamins,

Glycogen, Properdin, Albumin

l Properdin and Albumin are very similar toOjaDhatu in view of constitution, character,

quality, quantity and role in the human body.


85

Comparison of Oja with Properdin and Albumin

Table No. 4 Comparison between the physical qualities of shleshmik Oja,

properdin& Serum Albumin

Sr ShlaishmikaOjas Properdin Serum Albumin

1 Sthira (stable) A stable protein with large Single polypeptide with

molecular weight of 585 amino acid andover 1,000,000 molecular weight of 66,200 D

2. Mrutsna (Slimy) Colloidal and Slimy Colloidal and Slimy

3. Snigdha (viscous) Being a euglobiulin it is a ———————-lipo-protein and containover 77.7% of lipid.

4. In colour, it is stated to Whitish and tends to appear Yellowish white in colour.resemble ghee (whitish slightly yellow and red dueand yellowish red) to presence in it of trace

of carotenoids.

5. Ardhajali (1/2 Anjali) ——————— 30-40 gm/liter that mean 180-in quantity. 240 gm in human body.

6. AparOja are circulated in ——————— It circulated in the bodybody by DashavasaDhamani through blood stream and

lymph system.

7 . Oja is a strorable& reserve. There is no storage & reserve. There is no storage & reserve.The process of production The process of production && destruction is continuing. destruction is continuing.

2. The distribution of shlaishmikOjas with rasa-rakta as its medium of transport through the

arterial system and capillaries to the tissue whilealbumin cyclically leave through the endothelialbarrier at the level of capillaries, passes into the

interstitial and return to the blood streamthrough lymph system.

3. ShlaishmikOjas is like properdin a formed

substance and does not undergo anytransformation i.e. it is a final product becauseOja is anupdhatu while formation destruction of

serum albumin is continue.

4. It is a product of intermediary metabolism(dhatvagnipaka).

5. Like properdin& Albumin shlaishmikaOja confersprotection of the body, against disease anddegeneration.

6. Impairment of Shlaishmik Oja due to vyapad, it’sdue to kshaya, lead to the lowering of the body’s

innate resistance against various disease-both

infection or contagious and non-infectious.

Clinical Study

Aims and Objects

1 . To study the Vishaktata (toxicity) of Madya

(ethyl alcohol) on OjaDhatu in Human body.

2. To study the Vishaktata (Toxicity) of Madya

(ethyl alcohol) on OjaDhatu according to variousstages of Madya.

3. To study the Vishaktata (Toxicity) of Madya

(ethyl alcohol) on OjaDhatu in Acute & ChronicAlcoholism (Madatyaya).

4. To study the Alcohol Withdrawal Syndrome with

relative to OjaDhatu.

5. To study the Dhwansak & Vikshaya with relativeto OjaDhatu.


86

6. To study the OjaVikruti like OjaVyapad,OjaVistrans and OjaKshaya in case of Acute &

Chronic Madatyaya& Alcohol WithdrawalSyndrome.

Material & Method

In this study 60 patients of Alcoholism (20acute alcoholism and 20 chronic alcoholism and 20patients of alcohol withdrawal syndrome) were

studied& toxic effect were observed on OjaDhatu(Ojavyapad, Ojavistransa&Ojakshaya).These patientsare diagnosed with the help of sign and symptom,

described in the various text books of Ayurveda andModern Science. The patients were selectedrandomly irrespective of their age, sex, caste, and

religion, educational, social and economic status.The patient are taken only from out patentdepartment level, In beginning detailed medical as

well as surgical history and family history was takento exclude the possibility of Diabetic Mellitus,Hypertension, AIDS, VDRL, Koch and any other

prolong hospitalization. The general symptoms ofMadatyaya, Panapkram and Ojavikruti (vyapad,vistransa and kshaya) described in Samhitas were

considered to evaluate the patient, the detailedexamination of prakruti. Agni, Koshtha, Srotas anddhatuDushti was done.

Criteria of selection of the patients

The important factors which are necessaryfor the selection of patient are as follows.

1) Age – 18yrs and above 60 yrs. and below.

2) Sex- Both sexes.

3) patients are selected randomly irrespective ofsocio-economic status, education, religion andprofession

4) The patient of Alcoholism and withdrawal withsymptoms described in Ayurvedic Text alongwith Oja-vikruti were considered for the

proposed study.

Criteria of rejection of patients

While selecting 60 patients for this study

following criteria for refusal has been applied

1) Those patient who were below 18 and above 60yrs., of Age

2) Patient having AIDS, Koch, VDRL, ViralHepatitis, Typhoid and any other Acute andChronic Infection.

3) Patient having HTN, DM, Heart Disease, LungDisease, Renal failure, Hepatic failure (from othercause), cerebro-vascular episode any other acute

or chronic systemic disease

4) Prolong Hospitalization for any other medicaland surgical problem.

Criteria of Assessment

The total 60 patient of alcoholism andwithdrawal of ethyl alcohol on Ojadhatu were studied

in three group of Ojavikruti.

Table No. 5 OjaVikriti& Clinical Manifestation

Type of OjaVikriti Clinical Manifastation

1. OjaVyapad l Anasarca (Vatikshopha)

l Heaviness of body (Gaurav)

l Heaviness of extrimities (Gatra- stabdhata)

l Change of complexion (Varna-bheda)

l Fatigueness (Glani)

l Drowsiness (Tandra)

l Excessive Sleep (Nidra)


87

2. OjaVistransa l looseness of joint (Sandhi-vishlesha)

l Inertness of extrimities (Gatra-sadan)

l Displacement of dosha (Doshachyavan)

l Inco-ordination of Action (Ashmyak karma)

l Inco-ordination of speech (AsamyakWani)

l Inco-ordination of thought (Ashamyak man)

3. OjaKshaya l Fear (Bhiruta)

l Dryness of Skin (Rukshatva)

l Discolouration of Skin (Vivarnata)

l Wasting of Muscle (Mansa-Kshaya)

l loss of Strength (Bala-Kshaya)

l loss of Weight (Krushata)

l Delirium (Pralap)

l Impairment of Memory (Adnyan)

l Unconsiousness (Murchha)

l Stupor (Moha)

l Death (Maran)

The qualitative parameter (Clinical features) are used here for clinical study. Because to give thequantative parameter to Ojavikruti is not possible till.

Observations

The clinical feature of OjaVikruti and other Vikruti in case of Acute Alcoholism, Chronic Alcoholismand Alcoholic Withdrawal were observed.

Table No. 6 Group wise distribution as per type Madya in 60 Patients of Alcoholism

Sr. Type of Acute Alco. Ch.Alco. Alco.Withd. Total

no. Madhya No. % No. % No. % No %

1 Country 1 7 85% 1 2 60% 7 35% 36 60.00%

2 Wine 1 5% 2 10% 2 10% 5 8.33%

3 Rum 1 5% 1 5% 2 10% 4 6.66%

4 Whisky 1 5% 2 10% 3 15% 6 10%

5 Beer 0 0% 3 15% 4 20% 7 11.66%


88

Table No. 7Group wise distribution as per Dose of Madya in 60 Patients of Alcoholism

Sr. Dose of Acute Alco. Ch.Alco. Alco.Withd. Total

no. Madhya No. % No. % No. % No %

1 2 Unit 0 0% 4 20% 7 35% 1 1 18.33%

2 3 Unit 0 0% 4 20% 6 30% 1 0 16.66%

3 4 Unit 2 10% 1 0 50% 6 30% 18 30%

4 5 Unit 7 35% 2 10% 1 5% 1 0 16.66 %

5 6 Unit 6 30% 0 0% 0 0% 6 10%

6 7 Unit 1 5% 0 0% 0 0% 1 1.66%

7 8 Unit 4 20% 0 0% 0 0% 4 6.66%

Table No. 8 Group wise distribution as per Frequency of Madya in 60 Patients of

Alcoholism

Sr. Frequency Acute Alco. Ch.Alco. Alco.Withd. Total

no. of Madhya No. % No. % No. % No %

1 Day 0 0% 9 45% 9 45% 18 30.00%

2 Alt. Day 0 0% 3 15% 6 30% 9 15.00%

3 Biweekly 4 20% 4 20% 2 10% 1 0 16.66 %

4 Weekly 4 20% 3 15% 3 15% 1 0 16.66 %

5 Bimonthly 4 20% 0 0% 0 0% 4 6 .66 %

6 Monthly 8 40% 1 5% 0 0% 9 15%

Table No. 9 Group wise distribution as per Duration of Madya in 60 Patients of Alcoholism

Sr. Duration Acute Alco. Ch.Alco. Alco.Withd. Total

no. of Madhya No. % No. % No. % No %

1 0-5 Yrs 4 20% 0 0% 4 20% 8 13.33%

2 6-10 yrs 7 35% 9 45% 8 40% 24 40.00%

3 11-15 Yrs 2 10% 6 30% 4 20% 1 2 20%

4 16-20 Yrs 7 35% 5 25% 4 20% 1 6 26.66%


89

Table No. 10 Group wise distribution as per Type of OjaVikruti in 60 Patients of Alcoholism

Sr. Type of Acute Alco. Ch.Alco. Alco.Withd. Total

no. Ojavikruti No. % No. % No. % No %

1 Ojavyapad 1 2 60% 1 2 60% 1 1 55% 35 58.33%

2 OjaVistrans 18 90% 6 30% 0 0% 24 40.00%

3 OjaKshaya 1 5 75% 1 9 95% 9 45% 43 71.66 %

4 No Ojavikruti 2 10% 1 5% 8 40% 1 1 18.33 %

1. Ethyl Alcohol causes more toxic effect 71.66% inthe form of Ojakshaya followed by 58.33%OjaVyapad and 40% Ojavistransa. No toxic effect

on Ojadhatu found in 18.33%

2. Acute Alcoholism causes more toxic effect 90%in the form of OjaVistransa followed by 75%

Ojakshaya and 60% Ojavyapad.No toxic effect onOjadhatu found in 10% of Acute Alcolism.

3. Chronic Alcoholism causes more toxic effect 95%in the form OjaKshaya followed 60% Ojavyapadand 30% OjaVistransa. No toxic effect on

Ojadhatu found in 5% of chronic Alcoholic.

4. In Alcohol withdrawal syndrome I found thetoxic effect of alcohol on OjaDhatu is reduced.

No toxic effect found in 40%

Table No. 11 Group wise distribution of OjaVyapad in 60 Patients of Alcoholism

Sr. Clinical Acute Alco. Ch.Alco. Alco.Withd. Total

no. Feature No. % No. % No. % No %

1 Anasarca 1 5% 7 35% 5 25% 1 3 21.66%

2 Heaviness of body 2 10% 1 0 50% 1 0 50% 22 36.66%

3 Heaviness of Extremities 0 0% 5 25% 5 25% 1 0 16.66%

4 Change of Complexion 2 10% 6 30% 7 35% 1 5 25%

5 Fatigues 6 30% 1 1 55% 1 0 50% 2 7 45%

6 Drowsiness 1 2 60% 3 15% 0 0% 1 5 25%

7 Excessive Sleep 5 25% 0 0% 0 0% 5 8.33%


90

1) Alcohol causes more toxic effect in the form ofFatigues 45% and less in the form of ExcessiveSleep 8.33%.

2) Acute Alcoholism causes more toxic effect in theform of Drowsiness 60% Excessive Sleep 25% andless toxic effect in the form of Anasarca5% and

no toxic effect as a Heaviness of Extremities.

3) Chronic Alcoholism causes more toxic effect inthe form of Fatigues 55% Heaviness of body 50%and less in the form of Drowsiness 15% and No

as anExcessive Sleep.

4) Alcohol Withdrawal syndrome cause more toxiceffect in the form of Heaviness of body & Fatigues

50% No toxic effect in the form Drowsiness &Excessive Sleep.

Table No. 12 Group wise distribution of OjaVistrans

in 60 Patients of Alcoholism



1 Looseness of joint 7 35% 5 35% 0 0% 1 2 20.00%

2 Inertness of extremities 6 30% 8 40% 0 0% 1 4 23.33%

3 Inco-ordination of Action 1 3 65% 1 5% 0 0% 1 4 23.33%

4 Inco-ordination of speech 18 90% 1 5% 0 0% 1 9 31.66%

5 Inco-ordination of thought 1 7 85% 1 5% 0 0% 18 30%


91

1) Acute Alcoholism causes more toxic effect asaOjaVistrans in the form of Inco-ordination of

speech90% Inco-ordination of thought 85% andInco-ordination of Action65%.

2) Chronic Alcoholic causes toxic effect asanOjaVistrans in the form of Inertness of

extremities40% &Looseness of joint35%.

3) No Toxic effect found in Alcoholic withdrawalsyndrome as Ojavistrans.

Table No. 13 Group wise distribution of Oja Kshaya in 60 Patients of Alcoholism



1 Unconsciousness 7 35% 1 5% 0 0% 8 13.33%

2 Wasting of Muscle 4 20% 1 5 75% 5 25% 24 40.00%

3 Stupor 1 5% 3 15% 0 0% 4 6.66%

4 Delirium 9 45% 6 30% 7 35% 22 36.66%

5 Impairment of Memory 1 0 50% 1 0 50% 6 30% 26 43.33%

6 Loss of Strength 1 1 55% 18 90% 8 40% 3 7 61.66%

7 Loss of Weight 4 20% 1 5 75% 5 25% 24 40%

8 Dryness of Skin 7 35% 1 5 75% 8 40% 30 50%

9 Discoloration of Skin 2 10% 9 45% 2 10% 1 3 21.66%

1 0 Fear 2 10% 0 0% 1 5% 3 5%

1 1 Death 0 0% 1 5% 0 0% 1 1.66%


92

1 . Alcohol causes the more toxic effect as a Ojakshaya in the form of Loss of Strength 61.66 and less in theform of Death only one death (1.66%) found in clinical study of Alcoholism in 60 patient.

2. All the three type of OjaVikruti cause more toxic effect in the form of Loss of Strength.

Table No. 14 Group wise distribution of Symptom (other than Ojavikruti)

in 60 Patients of Alcoholism



1 Vomiting 7 35% 0 0% 1 5% 8 13.33%

2 Hiccup 7 35% 4 20% 3 15% 1 4 23.33%

3 Dysnea 4 20% 4 20% 4 20% 1 2 20%

4 Burning 1 1 55% 1 2 60% 6 30% 29 48.33%

5 Thrust 5 25% 5 25% 2 10% 1 2 20%

6 Loss of Appetite 0 0 1 2 60 9 45 2 1 35

7 Loss of Taste 1 5% 1 0 50% 8 40% 1 9 31.66%

8 Constipation 0 0% 1 0 50% 9 45% 1 9 31.66%

9 Hemoptysis 1 5% 2 10% 0 0% 3 5%

1 0 Fever 1 5% 1 5% 0 0% 2 3.33%

1 1 Hemataemesis 1 5% 1 5% 1 5% 3 5%

1 2 Insomnia 0 0% 8 40% 1 2 60% 20 33.33%

1 3 Nausea 7 35% 1 1 55% 5 25% 23 38.33%

1 4 Tingling Numbness 6 30% 9 45% 9 45 24 40%

1 5 Headache 7 35% 7 35% 8 40% 22 36.66%

1 6 Giddiness 2 10% 8 40% 1 2 60% 22 36.66%

1 7 Hallucination 7 35% 1 5% 1 5% 9 15%

18 Joint Pain 2 10% 6 30% 4 20% 1 2 20%

1 9 Impotency 0 0% 5 25% 2 10% 7 11.66%

20 Abdomen Pain 9 45% 5 25% 0 0% 1 4 23.33%

2 1 Ascites 0 0% 1 5% 0 0% 1 1.66%

22 Tremor 3 15% 7 35% 6 30% 1 6 26.66%

· Burning, Vomiting, Hiccups & Excessive Thrust these are the predominantmanifestations found in AcuteAlcoholism.

· Burning, Loss of Appetite, Loss of Taste, Nausea, Constipation, Insomnia, Giddiness& Kamp these are thepredominantmanifestations found in Chronic Alcoholism.

· Loss of Appetite, Loss of Taste, Constipation, Insomnia, Giddiness, Tingling Numbness, Headache & Tremor

these are the predominantmanifestations found in Chronic Alcoholism.


93

Table No. 15 Group wise distribution of Dosh Dushti in 60 Patients of Alcoholism

Sr. Dosh Acute Alco. Ch.Alco. Alco.Withd. Total

no. Dusthi No. % No. % No. % No %

1 Vataj 6 30% 4 20% 4 20% 1 4 23.33%

2 Pitaj 1 5% 4 20% 4 20% 9 15.00%

3 Kaphaj 0 0% 1 5% 0 0% 1 1.66%

4 Vat pittaj 5 25% 2 10% 5 25% 1 2 20%

5 Pit-Kaphaj 0 0% 1 5% 0 0% 1 1.66%

6 Vat-Kaphaj 2 10% 2 10% 2 10% 6 10%

7 Tridoshaj 6 30% 6 30% 5 25% 1 7 28.33%

· Maximum @30% in Acute & Chronic Alcoholism and @ 25% in Alcohol Withdrawal, while @ 28.33% inTotal 60 patient, found Tridoshajapredominant.

Table No. 16 Group wise distribution of Dhatu Dushti in 60 Patients of Alcoholism

Sr. Dosh Acute Alco. Ch.Alco. Alco.Withd. Total


1 Rasa 1 9 95% 1 9 95% 1 6 80% 54 90.00%

2 Rakta 2 10% 3 15% 1 5% 6 10.00%

3 Mansa 4 20% 1 6 80% 5 25% 25 41.66%

4 Meda 3 15% 1 3 65% 5 25% 2 1 35%

5 Asthi 2 10% 6 30% 3 15% 1 1 18.33%

6 Majja 18 90% 1 9 95% 1 6 80% 53 88.33%

7 Shukra 0 0% 5 25% 2 10% 7 11.66%


94

· Rasa & Majja Dhatu Vikriti found predominantly @ 90% & 88.33% in all 60 patient of Alcoholism.

· Mansa Dhatu Vikriti found predominantly in Chronic Alcoholism along with Rasa &Majja.

Table No. 16 Group wise distribution of Mala Dushti in 60 Patients of Alcoholism

Sr. Mala Acute Alco. Ch.Alco. Alco.Withd. Total


1 Purishha 0 0% 1 0 50% 9 45% 1 9 31.66%

2 Mutra 0 0% 1 5% 0 0% 1 1.66%

3 Sweda 1 1 55% 1 2 60% 8 40% 3 1 51.66%


95

· SwedaVikriti found predominantly @ 51.66% in all 60 patient of Alcoholism.

· PurishaVikriti found predominantly in Chronic Alcoholism & Alcohol Withdrawal along with Sweda.

Table No. 17 Group wise distribution of Srotas Dushti in 60 Patients of Alcoholism

Sr. Mala Acute Alco. Ch.Alco. Alco.Withd. Total


1 Rasavaha 1 9 95% 1 9 95% 1 6 80% 54 90%

2 Raktavaha 2 10% 3 15% 1 5% 6 10%

3 Mansavaha 4 20% 1 6 80% 5 25% 25 41.66%

4 Medovaha 3 15% 1 3 65% 5 25% 2 1 35%

5 Asthivaha 2 10% 6 30% 3 15% 1 1 18.33%

6 Majjavaha 18 90% 1 9 95% 1 6 80% 53 88.33%

7 Shukra 0 0% 5 25% 2 10% 7 11.66%

8 Pranavaha 7 35% 6 30% 3 15% 1 6 26.66%

9 Annavaha 0 0% 1 0 50% 7 35% 1 7 28.33%

1 0 Udakvaha 3 15% 5 25% 1 5% 9 15%

1 1 Purishvaha 0 0% 1 0 50% 9 45% 1 9 31.66%

1 2 Mutravaha 0 0% 1 5% 0 0% 1 1.66%

1 3 Swedavaha 1 1 55% 1 2 60% 8 40% 3 1 51.66%

1 4 Manovaha 18 90% 1 5 75% 1 2 60% 45 75%

· Rasavaha, Majjavaha & Manovaha Strotas Vikritifound predominantly @ 90%, 88.33% & 75% in

all 60 patient of Alcoholism.

· MansavahaStrotasVikriti found predominantly inChronic Alcoholism along with Rasavaha,

Majjavaha&Manovaha.

Discussion

The description of Madyaand Ojais found

since Vedic period. Most of the nominated scripturehas found the description of Madya and Ojaand alsotoxic effect of Madya on Ojadhatu, because the

properties of Madya are exactly opposite to theproperties of Oja. The predominant Mahabhut of theMadya has Agni, Vayu and Akash while the

predominant Mahabhut of Oja has jala and Pruthviwhich passes opposite properties to the Madya.

But as the subject Madya and Ojadhatu is

broad, it was difficult to study the toxicity of Madya

on Oja, in each and every point. It was found that

some patient were heavy drinker after interval of

some days of withdrawal but no one patient hassimilar to Dhwansak and Vikshaya clinically. Hencethis study is incomplete in view of Dhwansak and

vikshaya.

Till now the biochemistry and quantity of Oja

by international parameter not proved scientifically,

so it is not possible to give the quantitativeparameter to the OjaVikruti. Hence unfortunatelystudyhas to depend only on qualitative parameter in

the form of clinical feature of Ojavikruti in Alcoholicpatient. Thus this is study also incomplete in theview of quantitative parameter which is need of time.

The various Acharyas mentioned the twotype of Oja i.e. Para mean Ashtabindu and Aparmean Ardhanjali in quantity. It was also difficult to

distinguish the OjaVikruit like Ojovypad, Ojovistransand Ojokshaya in view of Para and AparOja. But itissupposed that the OjaVikruit is found in Alcoholism

in the form of AparOja. Because according to


96

Ayurveda, even loss of one drop of paraOja causesdeath.

At last it will be not true to give theconclusion of OjaVikruti in Alcohollism on the basisof 60 patients only and there is further need to

evaluate the toxicity of Madya on Ojaduatu in largesample.

On the basis of clinical study in 60 patients

1 . Ethyl alcohol causes more toxic effect 71.66 %in the form of OjaKshaya followed by 58.33 % inthe form of OjaVyapad and 40% in the form of

OjaVistransa. No toxic effect on Ojadhatuin18.33 %.

2. Most of the Acute alcoholic are illiterate 70 %

while literate 30 %& most of the Chronicalcoholic are Literate 70 % while illiterate 30%.

3. Most of the alcoholic withdrawal are literate 80 %

while illiterate 20 %

4. Most of the acute alcoholics are poor 65 % whilesome are middle 25 % and few rich 10%.

5. Ethyl alcohol causes more toxic effect onRasavahasrotas 90 %, Majjavahasrotas 80.33 %and Manovahasrotas 75 %.

6. I found 1 patient (1.66 %) had dead due tochronic alcoholism in my 60 patients.

7 . I found 1 lady (1.66 %) belonging to chronic

alcoholic in my 60 patients.

8. Most of the alcoholic in India drink Country(Deshi Madya) 60%.

Conclusion

The Toxicity of ethyl alcohol is more onRasavaha, Majjavaha and Manovahsrotas. The

OjaKshaya & OjaVikruti found in chronic Alcoholismis permanent while in Acute Alcoholism it istemporary.

Reference

1 . ‘Global status report on alcohol and health’ published

by WHO in WHO Library Cataloguing-in-Publication

Data page X, downloded on 04/05/2013 & Available

on http://www.who.int/substance_abuse/

publications/ global_alcohol_report/

msbgsruprofi les.pdf

2 . ‘Alcohol Related Harm in India – A Fact Sheet’

Published by INDIAN ALCOHOL POLICY ALLIANCE

Chenai, downloded on 04/05/2013 & Available on

http://www.addict ionindia.org/images-ttkh/alcohol-

related-harm-in-india-a-fact-sheet.pdf

3 . Agnivesha, Charak, Charak Samhita, Chikitsasthan

23/24 Hindi Commentary by PanditKashinath

Shastri, Dr. Gorakhnath Chaturvedi, Chaukhambha

Orientalia Publication Varanashi, 14 th edition in

1987, Page 629

4 . Sushrit, SushritSamhita, Kalpsthan 2/19 Hindi

Commentary by Kaviraj Ambikadatta Shastri,

Sanskrit Sansthan Publication Varanashi, Reprinted

in 2006, Page 24

5 . Yogratnakar Uttarardha Visha Chikitsa Adhikar

Visha Guna 1, Hindi Commentary by Lakshmipati

Shashtri, Chaukhambha Sanskrit Sansthan

Publication Varanashi, Reprinted in 2005, Page

4 6 0 .

6 . Bhavmishra, Bhavprakash Madhyam Khand,

Chikitsa Prakaran 8, VishaAdhikar 67/13 Hindi

Commentary by Shri Bramha Shankar Mishra 5 th

Edition, Chaukhambha Sanskrit Sansthan

Publication Varanashi, 5th Edition in 1993, Page739

7 . Vagbhat, AstangHrudaya, Uttarsthan 35/7 English

Translation by Prof.K.R. Srikanth Murthy,

Krishnadas Academy Publication Varanashi,

2ndEdition in 1997, Page 329.

8 . Vagbhat, Ashtang Sangraha Uttarsthan 40/12

English Translation by Prof.K.R. Srikanth Murthy,

Chaukhambha Orientalia Publication Varanashi,

2ndEdition 2000, Page 353.

9 . Agnivesha, Charak, Charak Samhita, Chikitsasthan

24/30 Hindi Commentary by Pandit Kashinath


Orientalia Publication Varanashi, 14 th edition in

1987, Page 671

1 0 . Yogratnakar Purvardha Panatyaya Nidan, Madya

Guna 6, Hindi Commentary by Lakshmipati

Shashtri, Chaukhambha Sanskrit Sansthan


4 7 2 .

1 1 . Bhavmishra, Bhavprakash Madhyam Khand,


97

Chikitsa Prakaran 8, Madatyaya Adhikar 20/11

Hindi Commentary by Shri Bramha Shankar Mishra

5 th Edition, Chaukhambha Sanskrit Sansthan


1 2 . Vagbhat, Astang Hrudaya, Sutrasthan Vol-I 5/62-

64 English Translation by Prof.K.R. Srikanth

Murthy, Krishnadas Academy Publication

Varanashi, 2ndEdition in 1997, Page 68.

1 3 . Vagbhat, AshtangSangrahaSutrasthanVol-I 6/109

English Translation by Prof.K.R. Srikanth Murthy,

Chaukhambha Orientalia Publication Varanashi,

2ndEdition 2000, Page 107

1 4 . Sushrit,SushritSamhita, Uttarardha Panatyaya

Pratishedha Adhyaya 47/3 Hindi Commentary by

Kaviraj Ambikadatta Shastri, Sanskrit Sansthan


3 2 3 .

1 5 . Agnivesha, Charak, Charak Samhita, Chikitsasthan

24/31 Hindi Commentary by Pandit Kashinath


Orientalia Publication Varanashi, 14th edition in

1987, Page 671

1 6 . Sushrit, Sushrit Samhita, Sutrasthan 15/26 Hindi



in 2006, Page 61.

1 7 . Agnivesha, Charak, CharakSamhita, Chikitsasthan

24/32-33 Hindi Commentary by Pandit Kashinath


Orientalia Publication Varanashi, 14th edition in

1987, Page 671

1 8 . Bhavmishra, BhavprakashMadhyam Khand, Chikitsa

Prakaran 8, Madatyaya Adhikar 20/13-14 Hindi

Commentary by Shri Bramha Shankar Mishra 5th

Edition, Chaukhambha Sanskrit Sansthan


1 9 . Sushrit, Sushrit Samhita, Sutrasthan 15/30 Hindi



in 2006, Page 61.


98

Menstruation & Prakriti

*Dr. C.R. Yadav, **Dr. Ashok Kumari, ***Prof. M.S. Meena

Abstract:

The menstrual cycle is a cycle of physiological changes that occurs in fertile females. A woman’s first

menstruation is termed as menarche, and occurs typically around the age of 12. The end of a woman’sreproductive phase is called the menopause which commonly occurs somewhere between the ages of 45and 55. The menstrual cycle can be divided into several different phases viz; Proliferative phase, Follicular

phase,Ovulation & the Luteal phase.

In Ayurveda, prakriti represents the physical and mental constitution of an individual. Ayurvedabelieves that the temperament of a human being is genetic in origin. Prakriti, or constitution, is formed at

the time of union of sperm and ovum inside the womb depending upon the predominance of ‘Tridoshas’, five‘elements’ and the three ‘gunas’.

According to Acharya Charak human beings are classified in to three categories, Vataj, Pittaj & Kafaj

prakriti. In this study total 200 healthy females were selected, 100 from the hot clemate & 100 from thecold climate. Each of the 100 females were divided in to further three categories i.e. in the first age groupof 12 years to 16 years, second group of 17 years to 40 years and the third group from 41 to 50 years.

First of all Prakriti of selected females were evaluated and then the relation of Prakriti with the quantity,color, duration and length of periods of menstruation cycle was established.

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•ÊøÊÿ¸ ø⁄∑§ ∑‘ •ŸÈ‚Ê⁄ ¬˝∑Î§ÁÃ ∑‘ ◊ÈÅÿ 3 ÷Œ Á∑§ÿ „Ò¥– flÊÃ¡, Á¬ûÊ¡, fl ∑§»§¡–

¬˝SÃÈÃ ‡ÊÙœ ◊¥ 200 SflSÕ ◊Á„‹Ê•Ù¥ ∑§Ê øÿŸ Á∑§ÿÊ ªÿÊ– ßŸ ◊¥ ‚ 100 ©cáÊ ¬˝Œ‡Ê fl 100 ‡ÊËÃ ¬˝Œ‡Ê ∑§Ë◊Á„‹Ê•Ù¥ ∑§Ê øÿŸ Á∑§ÿÊ ªÿÊ– ßŸ 100 ◊Á„‹Ê•Ê¢ ∑§Ù ¬ÈŸ— 3 ÷ÊªÙ¢ ◊¥ Áfl÷ÊÁ¡Ã Á∑§ÿÊ ªÿÊ–

flª¸ ∑§ - 12 ‚ 16 fl·¸, flª¸ π - 17 ‚ 40 flª¸ ª ◊¥ 41 ‚ 50 fl·¸ ∑§Ë ◊Á„‹Ê•Ù¥ ∑§Ù ⁄πÊ ªÿÊ– ßŸ ‚÷Ë∑§Ê ‚fl¸¬˝Õ◊ ¬˝∑Î§ÁÃ ÁŸœÊ¸⁄UáÊ Á∑§ÿÊ ªÿÊ fl Ãà¬‡øÊÃ˜ •ÊûÊ¸fl ∑§Ë ◊ÊGÊ, fláÊ¸, ∑§Ê‹ •ÊÒ⁄ •ãÃ⁄Ê‹ ∑§Ê ¬˝∑Î§ÁÃ ‚ ‚ê’ãœSÕÊÁ¬Ã Á∑§ÿÊ ªÿÊ–

Phisiological Study

*Asstt. Prof., Deptt. of Shareer Kriya **M.D. Scholar, Deptt. of Shareer Kriya, ***Dean (Adademic), Prof. & Head,

P.G. Deptt. of Shareer Kriya, N.I.A. JAIPUR


99

Introduction of Menstruation:

The menstrual cycle is a cycle ofphysiological changes that occurs in fertile females.Menstruation is also called menstrual bleeding,

menses, or a period. The menstrual cycle is underthe control of the endocrine system and is necessaryfor reproduction. During the reproductive years,

failure to menstruate is the first indication to awoman that she may have become pregnant.

A woman’s first menstruation is termed as

menarche, and occurs typically around the age of 12.The end of a woman’s reproductive phase is calledthe menopause, which commonly occurs somewhere

between the ages of 45 and 55. Follicles in the ovarybegin developing under the influence of hormones,and after several days one or occasionally two

become dominant (non-dominant follicles atrophyand die).

Whenever there is increase of Luteinizing

Hormone (LH), the dominant follicle releases anovum, or egg. This event is called as ovulation. Thelength of each phase varies from woman to woman,

though the average menstrual cycle is 28 days.

Under the influence of progesterone, theendometrium (uterine lining) changes to prepare for

potential implantation of an embryo to establish apregnancy. If implantation does not occur withinapproximately two weeks, the corpus luteum will

involutes, causing sharp drops in levels of bothprogesterone and estrogen. These hormone dropscause the uterus to shed its lining in a process known

as menstruation.

Cramps in the abdomen, back, or upperthighs are common during the first few days of

menstruation. The menstrual cycle is a cycle ofphysiological changes that occurs in fertile females.It is under the control of the endocrine system & is

necessary for reproduction.

Menstruation & Prakriti

Dr. C.R. Yadav, Dr. Ashok Kumari, Prof. M.S. Meena

Phisiological Study

Phases of Menstrual Cycle:

Name of phase Average start day Average

assuming a 28-day cycle end day

Menstrual phase (menstruation) 1 4

Proliferative phase (some sources 5 13

include menstruation in this phase)

Follicular phase 1 13

Ovulatory phase (ovulation) 13 16

Luteal phase (also known as Secretary phase) 16 28

Ischemic phase 27 28

Proliferative phase: - FSH causes the

lining of the uterus to grow, or proliferate, duringthis time. Due to rise in follicle stimulating hormone(FSH) during the first days of the cycle, a few ovarian

follicles are stimulated. Under the influence ofseveral hormones, all but one of these follicles will

stop growing, while one dominant follicle in theovary will continue to maturity. The follicle that

reaches maturity is called a tertiary, or Graafian,follicle, and it forms the ovum.

As they mature, the follicles secrete


100

increasing amounts of estradiol hormone. Theestrogens initiate the formation of a new layer of

endometrium in the uterus.

Ovulation: - During the follicular phase,estradiol suppresses production of luteinizing

hormone (LH). In the average cycle this LH surge(Increase) starts around 12th day of cycle and maylast 48 hours.

The release of LH matures the egg andweakens the wall of the follicle in the ovary, causingthe fully developed follicle to release its secondary

oocytes. The secondary oocytes immediately matureinto an ootid and become a mature ovum. Themature ovum has a diameter of about 0.2 mm.

Which of the two ovaries left or rightovulates is not certain; no co-ordination existsbetween the two ovaries. Occasionally, both ovaries

may release an egg; and if both eggs are fertilized, theresult is twin pregnancy. After being released fromthe ovary, the egg is taken into the fallopian tube.

Fertilization by a spermatozoon takes placein the ampulla, the widest section of the fallopiantubes. A fertilized egg immediately starts its

development. The developing embryo takes about 3days to reach the uterus and another 3 days toimplant into the endometrium.

Luteal phase: - The luteal phase is alsocalled the secretary phase.

Corpus luteum, the solid body formed in an

ovary after the egg has been released from the ovaryinto the fallopian tube. This body continues to growfor some time after ovulation and produces

significant amounts of hormones, particularlyprogesterone. Progesterone plays a vital role inmaking the endometrium receptive to implantation

of the blastocyst and supportive of the earlypregnancy; it also has the side effect of raising thewoman’s basal body temperature.

Fertile Period: - The most fertile period isthe second & third week of the menstrual cycle.

Fertility Monitors: - The three primary

fertility signs (basal body temperature, cervicalmucus, and cervical position) are known assymptoms-based methods. Urine test kits are

available that detect the increased level of LH that

occurs 24 to 36 hours before ovulation; these areknown as ovulation predictor

Cycle abnormalities: - Irregular ovulationis called oligoovulation. The absence of ovulation iscalled anovulation. Very little flow (less than 10 ml)

is called hypomenorrhea. Regular cycles withintervals of 21 days or fewer are polymenorrhea;frequent but irregular menstruation is known as

metrorrhagia. Sudden heavy flows or amountsgreater than 80 ml are termed as menorrhagia.

Prakriti in Ayurveda

In Ayurveda, prakrti represents the physicaland mental constitution of an individual. A state ofdisease occurs whenever there is a deviation from

the normal physical or mental constitution of ahuman being. Prakrti is employed to understand thenature of an individual and recognize the changes

that occur due to disease, when there is a deviationfrom prakrti.

Formation of Prakrti: - Ayurveda believes

that the temperament of a human being is genetic inorigin. Prakriti, or constitution, is formed at the timeof union of sperm and ovum inside the womb.

According to the predominance of ‘Tridoshas’ five‘elements’ and the three ‘gunas’ at the time offertilization, determines our physical and mental

traits. Different individuals have differentcombinations of these doshas and gunas and henceeach individual will have a unique prakrti, just like

each of us has a unique finger print.

Prakrti remains unchanged for everyindividual for his or her lifetime. This prakrti also

decides the disease tendency of an individual. Everyindividual is subjected to a constant interaction withhis or her environment, which will affect the person’s

constitution at any time. The body will try tomaintain a dynamic equilibrium with theenvironment.

Relation of Prakriti, Doshas & Gunas: -

The three Saareerika doshas are composed of thefive basic elements viz; Prithvi, Jala, Agni, Vaayu &

Aakaasa. On the other hand, the five elementspossess one or more of the three gunas, namelySatva, Rajas and Tamas.

According to Acharya Susruta, Aakaasa is


101

predominant of Satva Guna while Vaayu ispredominant of Rajas. Agni is predominant of Satva

and Rajas while Jala is predominant of Satva andTamas. Prthvi is predominantly Taamasic

Types of Prakrti: - Two types;

1. Saareerika - Bodily and

2. Maanaseeka – Mental Status

Based on the three doshas and their physicaland physiological qualities, the Saaeerika Prakrti has

again been classified into seven namely:

1.Vaata 2. Pitta 3. Kapha 4. Vaata – Pitta

5. Pitta – Kapha 6. Kapha – Vaata and 7. Tridoshaja

or Sannipaata

Table of Saareerika gunas: -

Saareerika Vaata Pitta Kapha

Body frame Thin Medium Flabby

Finger nails Cracked and weak Pinkish White and Thick

Hair Dry & Thin Grey or Bald Dense & Curly

Pulse 80 - 90 70 - 80 60 - 70

Weight Low Frame Medium Frame High Frame

Bowel movements Constipated & Hard Loose and Frequent Large Amountstools. stools

Forehead size Small Medium Large

Appetite Fairly Good Can not tolerate hunger. Good

Eyes Small Pink / Red Sclera is White & Largeenough

Lips Thin and cracking Medium and Soft Large & Smooth

It is difficult to find purely Vaatik, Pittaj or

the Kafaj Prakriti. So in general practice we find Vaatdominating, Pitta dominating or the Kaphadominating Prakriti. In Ayurveda a person having

equal composition of all the three Doshas has beenconsidered to be the best state of health which iscalled as Samdoshaa or the Tridosha Prakriti.

Maansik Prakriti: -

Depending upon the gunas and theiremotional behavior, and mental abilities the

Maanaseeka Prakrti has been classified into three:-

1. Saatvika 2. Rajasika and 3. Taamasika

Saatvika Prakriti: - The person is

vegetarian, God fearing, helpful to everybody, doesnot criticize, performing prayers regularly. Consumefewer amounts of food grains. Ingests more fruits

and vegetables.

Rajasika Prakriti: - The mind / thoughts goon changing every minute. More likings for dancing

& singing. Can not sit for a long time in the sameposture. Keep on changing his jobs / ideas /decisions frequently.

Taamasika Prakriti: - They have specialdialects for non-vegetarian diet. Does not believe somuch in God. They are of the principle ‘eat, drink &

be marry’ that is the way to be I say. Cruel inbehavior.

Aim of study:

To establish relationship between thePRAKRITI of healthy women with the menstruationespecially the color, quantity, duration and the

length of periods.


102

Plan of study:

1 . Compilation work, regarding formation of

prakriti, types of prakriti and the sign/symptomsfrom various texts of Ayurveda , was done.

2. According to the prakriti the scientific study of

menstruation was done with the help of anatomyand physiology.

3. Two hundred healthy women were selected for

this purpose.

4. Hundred women were selected from the Jaipur(Hot climate) & the hundred women were

selected from the Himachal Pradesh (Coldclimate).

Groupig of Individuals:

Hundred healthy females each from hot aswell as from cold climate were selected.

They were grouped in to 3 categories:

1 . 12 to 16 years — First Group (33+33)

2. 17 to 40 years —Second Group (33+33)

3. 41 to 50 years — Third Group (34+34)

The above females were evaluated accordingto the Performa of prakriti and the following resultwas concluded:

A. Vaatik Prakriti: 19 ¼9.5%½

B. Pittaj Prakriti: 14 ¼7%½

C. Kafaj Prakriti: 16 ¼8%½]

D. Vaat – Pittaj Prakriti: 44 ¼22%½

E. Vaat – Kafaj Prakriti: 29 ¼14.5%½

F. Pitt – Kafaj Prakriti: 78 ¼39%½

G. Sannipataj Prakriti: ZERO

No woman of Sannipataj prakriti was seen asis evident in the texts that samdhatuj prakriti is very

-2 difficult to find out.

Method of Study:

Detailed history of selected women regarding

menstruation and prakriti was taken after preparinga questionnaire Performa based upon BRIHAT TRAY.First of all in the family history the questions

regarding name, age, religion, full address etc. wereasked, then in the menstrual history color, quantity,

duration and length of periods were asked and lastlyASHATVIDH & DASHVIDH pariksha of all theselected women were done.

Inclusion Criteria:

1 . Hundred healthy women from hot climate andhundred healthy women from cold climate were

selected.

2. All the selected women were of 12 years to 50years only.

Exclusion Criteria:

1 . The females below the age of 12 years and abovethe age of 50 years were excluded.

2. The women suffering from any systemic diseaseswere also scrutinized.

Discussion:

1 . In the females, prakriti should be evaluated fromthe childhood so that its clinical value may begained by the individual as well as the Doctor

attending upon her.

2. If she adopts diet and life style in accordancewith her prakriti then only she can attain good

mental and physical health which is the sole aimof Ayurveda.

3. The concept of prakriti of Ayurveda be

correlated with the modern theories ofpersonality and thus be used to treat thediseases.

Summary and Conclusion:

A. Age of Menarche:

1 . In the evaluation of hot climate the menstruation

started in 12 to 14 years in most of the females.

2. In the cold climate environment themenstruation started in 14 to 16 years of age in

majority of the girls.

B. Color of Menstruation:

1 . Among the 19 females of Vaatik prakriti the

color of menstruation of 15 was red (78.2% ) and4 women (21.8%) were having brick red color.


103

2. Out of fourteen women of Pittaj prakriti all(100%) were having black color of

menstruation.

3. From the total 16 women of kafaj prakriti, 13women (81.2%) were having yellowish red, 2

(12.6%) with brick red color and 1 (6.2%) womenwith red color.

4. In the 44 Vaat – Pittaj prakriti females, 32

(72.7%) were of brick red, 7 (15.9%) of blackcolor and only 5 (11.4%) women were of redcolor.

5. Out of 29 Vaat – Kafaj women, brick red 53(67.8%), red color 11 (37.8%) and black colorwas found in 10 (34.3%) women.

C. Quantity:

1 . In Vaataj prakriti (Total 19) less in 15 (78.2%),more in 2 (10.9%) and normal amount of

menstruation was found in 2 (10.9%) women.

2. In Pittaj prakriti (14) the quantity was less thannormal in 14 women (100%).

3. In Kafaj prakriti (16) the quantity was more inall the 16 women (100%).

4. Vaat – Pittaj (Total 44) the quantity was less in

30 (65.8%), more in 7 (15.6%) and normal in 7(15.6) women.

5. In Vaat – Kafaj (29), less in 5 (17.5%), more in

13 (44.8%) and normal in 11 (37.7%) women.

6. In Pitt – Kafaj (78), less in 20 (25.4%), more in17 (21.9%) and normal amount was in 41 (52.7%)

women.

D. Duration of menstrual Cycle:

1 . Out of total 19 women of Vaataj prakriti, 4

(21.8%) women were having after 20 days, 13(68.3%) women after 28 days and 2 (10.9%) werehaving after 35 days.

2. In Pittaj prakriti (14), 4 (28.7%) women werehaving after 20 days, 7 (50%) after 28 days and3 (21.3%) were having irregular duration.

3. In Kafaj prakriti (16), 12 (75%) after 28 days, 3(18.75%) after 35 days and 1 (6.25%) womenwere having 20 days cycle.

4. In Vaat Pittaj prakriti (44), 25 (56.2%) after 28days, 10 (23.3%) after 35 days, 5 (11.6%) after

20 days and 4 (9.9%) women were havingirregular cycle.

5. In Vaat Kafaj (29), 15 (51.3%) after 28 days, 6

(20.7%) irregular, 5 (17.1%) after 35 days and 3(10.9%) after 20 days.

6. In Pitt Kafaj (78), 42 (53.6%0 after 28 days, 14

(17.5%) after 35 days, 14 (17.5%) irregular and8 (10.4%) women were having cycle after 20days.

Bibliography: -

Charka, Susruta, Wikipedia, the Hindu Folia Magazine8th Oct.2000 edition.


104

Toxicity Study Of Lauha Bhasma W.S.R ToBiochemical Parameters

*Dr. Namrata Joshi Dash, **Dr. Manoj Kumar Dash, ***Dr. G. D. Khilnani, ****Dr. L.K. Dwivedi

Pharmaceutical Study

*Lecturer, Dept. of R.S & B.K., Rishikul Govt. Ayu. College, Haridwar, Uttrakhand. **Lecturer, Dept. of R.S & B.K.,

Govt. Ayu. College, Raipur, Chhattisgarh. ***Ex.H.O.D., Dept. Of Pharmacology, S.M.S. Medical College, Jaipur,

Rajasthan. ****Prof. P.G Dept. of Rasashastra & Bhaishajya Kalpana, G.J. Patel institute of Ayurvedic Studies &

Research, Anand, Gujarat Address for correspondence: Dr Namrata Joshi, Lecturer, P.G Dept. of Rasashastra &

Bhaishajya Kalpana, Rishikul Ayurveda College, Haridwar, India; [email protected]

Abstract

The rationale of therapeutic index of Ayurvedic medicines specifically containing metals and mineralsis a burning matter of debate worldwide. On the basis of modern scientific knowledge it is claimed thatconsumption of such material is toxic for human biological system. But as in Ayurveda instead of using metal

in a purest form, a transmutation of process by means of Shodhana (purification), Marana (incineration),Amritikarana (Nectarization) etc. are advocated incorporating the metal with certain other substancesrendering it suitable for bodily assimilation as well as made them free from any toxic materials, if present.

These traditional facts are mentioned in classical treatise and needs to be validated for better acceptability.In the present research work, chronic toxicity study of Lauha bhasma has been carried out at varying doselevel viz. therapeutic dose ( T.D.), intermediate dose (5 times to T.D.) and highest dose (10 times to T.D.)

given for duration of 60 days in wistar strain of albino rats. In the chronic study it was observed that Lauha

bhasma was not found to be toxic to the biological system, however, a dose dependant altered physiologicalchanges were pronouncedly observed in the group treated with highest dose i.e. 10 times to T.D.

Key words: Lauha Bhasma, toxicity study, therapeutic dose, biochemical parameters.

‚Ê⁄UÊ¥‡Ê-

•ÊÿÈfl¸ÁŒ∑§ ÿÊªÊ¥ ◊¥ ¬Ê∞ ¡ÊŸ flÊ‹ œÊÃÈ fl πÁŸ¡ Œ˝√ÿÊ¥ ∑§Ê •ÊŸÈ¬ÊÁÃ∑§ ÁŸœÊ¸⁄UáÊ flÃ¸◊ÊŸ ¬Á⁄U¬ˇÿ ◊¥ Áfl‡flSÃ⁄UËÿflÊŒ-ÁflflÊŒ ∑§Ë Áfl·ÿflSÃÈ „Ò– •ÊœÈÁŸ∑§ ÁflôÊÊŸ ∑§ •ŸÈ‚Ê⁄U ß‚ ’ÊÃ ∑§Ê Á‚h Á∑§ÿÊ ªÿÊ Á∑§ ßŸ œÊÃÈ fl πÁŸ¡Ê¥ ∑§Ë ∑§Ê∞∑§ ◊ÊòÊÊ ‚ •Áœ∑§ ‡Ê⁄UË⁄U ◊¥ π¬Ã Áfl·ÊQ§ ¬˝÷Êfl ∑§Ê ©à¬ÛÊ ∑§⁄UÃË „Ò– ¬⁄UãÃÈ •ÊÿÈfl¸ŒÊŸÈ‚Ê⁄U ßŸ œÊÃÈ•Ê¥ ∑§Ê ÷Ë Áfl‡Ê·¬˝Á∑˝§ÿÊ •ÕÊ¸Ã˜ ‡ÊÊœŸ, ◊Ê⁄UáÊ •◊ÎÁÃ∑§⁄UáÊ mÊ⁄UÊ ‡ÊÈh Á∑§ÿÊ ¡Ê∞ ÃÊ ßŸ∑§Ê Áfl·ÊQ§ ¬˝÷Êfl ŸC „Ê ¡ÊÃÊ „Ò– •ÊÒ⁄U ÿ ‡Ê⁄UË⁄U ◊¥‚∑§Ê⁄UÊà◊∑§ ¬˝÷Êfl ©à¬ÛÊ ∑§⁄UÃ „Ò– ÿ ¬⁄Uê¬⁄UÊªÃ Ãâÿ ¬˝ÊøËŸ ‚ÊÁ„àÿÊ¥ ◊¥ ©¬‹éœ „Ò •ÊÒ⁄U •Ê‡flÿ∑§ÃÊ „Ò ßã„¥ ‚„Ë Ã⁄UË∑§ ‚SÕÊÁ¬Ã fl SflË∑§Ê⁄U ∑§⁄UŸ ∑§Ë– ß‚ •äÿÿŸ ∑§ •ãÃª¸Ã ‹ÊÒ„ ÷S◊ ∑§Ë Áø⁄U∑§Ê‹ËŸ Áfl·ÊQ§Ê ∑§Ê •‹ª-•‹ª ◊ÊòÊÊ ∑§ ‚ÊÕŒπÊ ªÿÊ „Ò– ¡Ò‚ - ÁøÁ∑§à‚∑§Ëÿ ◊ÊòÊÊ, ◊äÿSÕ ◊ÊòÊÊ, ©ûÊ◊ ◊ÊòÊÊ ¡ÊÁ∑§ 60 ÁŒŸ Ã∑§ Á’S≈U⁄U ¬˝¡ÊÁÃ ∑§ ‚»§Œ øÍ„Ê¥ ∑§Ê ŒËªß¸– ß‚ Áø⁄U∑§Ê‹ËŸ •äÿÿŸ ‚ ÿ ¬ÊÿÊ ªÿÊ Á∑§ ‹ÊÒ„ ÷S◊ ∑§Ê ∑§Êß¸ ÷Ë Áfl·ÊQ§ ¬˝÷Êfl ‡Ê⁄UË⁄U ◊¥ Ÿ„Ë¥ ÕÊ ¡’Á∑§ ©ûÊ◊◊ÊòÊÊ ŒŸ ¬⁄U ∑È§¿U ‡Ê⁄UË⁄U Á∑˝§ÿÊà◊∑§ ’Œ‹Êfl •fl‡ÿ „È∞–


105

Toxicity Study of Lauha Bhasma W.S.R ToBiochemical Parameters

Dr. Namrata Joshi Dash, Dr. Manoj Kumar Dash, Dr. G. D. Khilnani, Dr. L.K.Dwivedi


Introduction

In today’s era, horizons of the Ayurvedic

treatment has increased tremendously due toundesirable squeal of fast acting modern medicines

in terms of side effects encountered. Rasashastra isa boon of Ayurvedic therapeutics. The preparationsbased on mineral and metals became even more

common and were included in the main stream ofAyurvedic therapeutics due to their minimal dosesbut still possessing short acting pharmacokinetics

and easy palatability like that of modern medicinesbut without imparting any untoward effects. Animalexperimentation is one of the suitable ways for

understanding pharmacological action of any drugprior to its use in clinical subject to ensure betterefficacy with out any untoward effect. Thus it fulfills

desirable aspects of drug research i.e. Quality,Safety as well as Efficacy. Experiment on animal isnot a new phenomenon to Ayurveda. Ancient

Ayurvedic scholars have keenly observed the effectof drugs on lower animals. References regardingtesting toxic materials in animals have been quoted

in abundance in Sushruta samhita1. Such referencesare also mentioned in texts of Rasa Shastra denotingpharmaceutical or pharmacological action of a drug

like description of Shada lauha Drutikarna inRasadhyaya2 and Gandhaka kalpa as mentioned inAnandakanda etc. So, in the present research work

effect of Lauha bhasma has been studied onbiochemical parameters in animal trial.

Aim and Objectives

Screening of Chronic Toxicity of Lauha

bhasma (L.B.) on the basis of Ponderal changes andchanges observed in Biochemical parameters.

Materials & Methods

Animals

Wistar strain albino rats of either sex

weighing between 150-250g were selected for the

study. The animals were maintained on Navchakanoil mills “Amrut” brand rat pellets along with tap

water ad libitum was administered. Animals weremaintained in the animal house of S.M.S. medicalcollege and exposed to natural day and night cycles.

The Test Drugs

Lauha bhasma was selected in the presentresearch work was prepared in accordance to the

method depicted in Ayurvedic formulary of India3.Individual drugs used in pharmaceutical processingof lauha bhasma were purchased from local market

and the raw drugs and Iron was authenticated in thePharmacy. Authentication was done by evaluatingtheir quality by various parameters. Identification of

Herbs was done in Dravya Guna Dept.(Pharmacognosy division) National Institute ofAyurveda where they were proven authenticated as

per the standards of Ayurvedic Pharmacopeia ofIndia. All the pharmaceutical procedures viz.Shodhana, Bhanupaka, Sthalipaka, Putapaka and

Amritikaran were carried out in the pharmacy ofN.I.A., Jaipur.

Selection of the Dose

Dose of Lauha bhasma in human beings

- 1 Ratti B.D.4

Accepted dose - 250 mg/60 kg B.W/Day

- 4.16 mg/kg B.W

Since the dose of the experimental animals is about10 times more than human beings

There fore, dose for - 4.16×10

Experimental animals. - 41.16mg/kgB.W of animal

Therapeutic dose (T.D.) - 4.16mg/100gm of rat/day


106

Intermediate dose (5 T.D.) - 20.8mg/100gm of rat/day

Highest dose (10 T.D) - 41.6mg/100gm rat/day

Route of administration

The test drugs along with vehicle of Madhu

and Ghrita were administered by oral route througha surgical syringe of capacity 2ml attached with a

needle fitted with round ball.

Statistical analysis

All the values were expressed as Mean ± SEM

(Standard Error of mean) The data were analyzed byunpaired student’t’ test and ANOVA.

A level of 0.001 was considered to be highly

significant where as p<0.05, 0.02, 0.01 wereconsidered to be significant. Level of significance wasnoted and interpreted accordingly.

Study protocol

The selected animals were divided into fourgroups, with each group comprising of six animals

of either sex. The first group Group-I was kept ascontrol, whereas the other three groups viz.Group-II, Group-III and Group-IV were administered with

the test drug at different dose level as depicted intable no-1. The initial body weights of the animals ofall the four groups were recorded at the beginning

and at the end of the study.

Blood was drawn from retro bulbar spacewith the help of a capillary at the beginning of the

study and at the end immediately by jugular veinpuncturing and was sent for biochemicalinvestigations.

Biochemical analysis of serum samples wasperformed using an automatic chemistry analyzer(Earb Smart Lab). Biochemical parameters measured

were blood glucose, Serum bilirubin, Serum totalprotein, Serum glutamate oxaloacetate transaminase(SGOT), serum glutamate pyruvate transaminase

(SGPT), alkaline phosphatase (ALP) activity, Bloodurea, Serum creatinine, Total cholesterol, highdensity lipoprotein (HDL) cholesterol and serum

triglyceride.

Result

Effect on Ponderal changes

A considerable non-significant increase inbody weight was evident in all the four test drugtreated groups as evident in table no.-2

Effect on Biochemical parameters

Lauha bhasma, at varying dose levelundergone eleven biochemical parameters for

assessment. Out of these eleven parameters Lauha

bhasma exert a significant increase in blood urea(27.83%, p<0.01), serum creatinine (30.92%,

p<0.05), S.G.O.T. (15.09%, p<0.05), and serumalkaline phosphatase (27.5%, p<0.01) at higher doselevel. A significant increase in serum total protein

(6.04%, p<0.05) level was observed at intermediatedose. (Table no-3)

Discussion

On analyzing of the data pertaining to thebody weight in different groups treated with Lauha

bhasma, showed a considerable non-significant

increase in body weight. Because body weight isindicative of increase appetite and food intake, thusit shows normal well being status of the experimental

animals. Thus it can be presumed that Lauha

bhasma does not cause any deleterious effect on totalbody function as a whole.

With regard to ponderal change in the nineorgans studied it was found that none of the threegroups of Lauha bhasma was found to be toxic to

the biological system. (Table no-4)

Blood urea and Serum creatinine level

Urea contributes most of the body’s non-

protein nitrogen, accounting for about 45% of thetotal. It is major end product of protein catabolismsynthesized in liver, released in blood circulation and

excreted by the kidneys. It is a chief indicator ofrenal and hepatic integrity. Elevated serum urealevel may be due to pre renal, renal or post renal

etiology. Pre-renal causes could be cardiac relatedor due to increased protein catabolism. Renal causesinclude glomerulonephritis, chronic nephritis,

nephrotic syndrome or other kidney disease. Postrenal causes included obstruction of urinary tractetc.


107

Similarly Serum creatinine is a breakdownproduct creatin and phospho creatine, which are

important part of muscle. Creatinine is freely filteredand therefore the serum creatinine level depends onthe glomerular filtration rate. Renal dysfunction

diminishes the ability to filter creatinine and raisesthe serum level. If serum creatinine level doubles,the G.F.R. is considered to have been halved. A

three-fold increase in considered reflecting a 75% lossof kidney function. The only condition that causes asignificant increase in serum creatinine level is

damage to a large number of nephron. Serum leveldoes not rise until half of kidney nephrons aredestroyed or damaged. The increase in serum urea

and creatinine in higher dose of Lauha bhasma islikelihood of kidney damage even when absolutevalue were still in normal range. However, utmost

precautions are needed in prescribing higher toequivalent doses in human beings. This feature istotally dose dependent and result of excess of free

iron, which act as free radical and supposed to betissue toxic5.

Serum S.G.P.T. (APT) level and Serum

Alkaline Phosphatase (ALP)

Serum APT is done to determine the liver isdamaged or not. Low-level APT is normally found in

the blood. However, when the liver is damaged ordiseased, it releases APT into the blood streamcausing levels of the enzyme to rise. Although APT

is found in organs other than liver, most increase inAPT are due to liver damage. On the Other hand aserum alkaline phasphatase is an important attribute

in distinguishing hepato-biliary disease. The hepaticisoenzyme of alkaline phosphatase is considered tobe induced cholestatic enzyme and its production by

biliary epithelium and hepatocytes duringobstructive cholestasis. When bile concentrations inthe liver are increased ALP production triggered.

Significant but not marked increase in APT at H.D.level with simultaneous increase in ALP reflects astage of hepatobilliary damage, although again it is

a dose dependent finding. (Table no-5)

The total protein

The total protein measurement reflects

nutritional status of the body, kidney damage, andliver disease. Low total protein level is suggestive ofkidney disorder or disorder where protein is not

absorbed or digested properly. Thus, increase intotal body protein with out any untoward

histopathological findings is suggestive of anaboliceffect of test drugs. Thus inspite of a non-significantincrease in total protein in all groups except Lauha

bhasma I.D. which shows significant increase issuggestive of anabolic effect of the three trial drugs.

Conclusion

Experimental study reveals that Lauha

bhasma at therapeutic dose and at intermediatedose level i.e. 5 times to therapeutic dose, did not

alter any biochemical parameter in albino rats.Features suggestive of altered physiology (nottoxicity) were evident chiefly in Lauha bhasma

treated group at higher dose level (10T.D.) asevident by increase in level of Serum Creatinine,Serum Serum Urea and SerumAlkaline Phosphatase.

These changes were totally dose dependentindicative of need for utmost care in prescribinghigher dose to equivalent clinical dose.

References

1 . Susruta Samhita: Maharshi Sushruta, Hindi

Commentary by Dr.Bhaskar Govind Ghanekar,

Motilal Banarasidas, Delhi, Ed.-5th, and Reprint-

1997,kalpa sthana.

2 . Rasadhyaya: Acharya Champaka, with Rasaprabha

Hindi Commentary, Chaukhamba Sanskrit

Sansthan, Varanasi, Ed.-2nd,and V.S.-2039.1/56

3 . Ayurvedic Formulary of India, Part-I, ISMH, Govt.

of India, Ed.-2nd, 2003. Vol.1, 18:14, P.241

4 . Fundamentals of Experimental Pharmacology.

5 . Principles of Internal Medicine: Harrison, Published

at Mc-Graw-Hill, Medical Publishing division, Ed.-14th, 1998. Ed-14, P.670.


108

Table no-1

Showing dose selection for Chronic toxicity of Lauha Bhasma (L.B.)

S. Group No. of Dose Anupana

No. Animals ( mg) (Madhu +Ghrita) ml

1 . Group-I Control 6 - 0.5

2. Group-II Therapeutic Dose (T.D.) 6 4.16 0.5

3. Group-III Intermediate Dose (5 T.D.) 6 20.80 0.5

4. Group-I V Higher Dose ( 10 T.D.) 6 41.60 0.5

Table no- 4 Showing summary of Changes observed in Ponderal changes with regard

to total body weight and weight of different organs

S. Parameter Lauha Bhasma

No. T D ID HD

1 . Body weight N.S. N.S. N.S.

2 Liver weight N.S. N.S. N.S.

3 Spleen weight N.S. N.S. N.S.

4 Heart weight N.S. N.S. N.S.

5 Kidney weight N.S. N.S. N.S.

6 Brain weight N.S. N.S. N.S.

7 Testes weight N.S. N.S. N.S.

8 Lungs weight N.S. N.S. N.S.

9 Ovaries+uterus weight N.S. N.S. N.S.

Table no- 5 Showing summary of changes observed on biochemical parameters

S. Parameter Lauha Bhasma

No. T D ID HD

1 Blood Sugar N.S. N.S. N.S.

2 Cholesterol N.S. N.S. N.S.

3 Triglyceride N.S. N.S. N.S.

4 H.D.L. Cholesterol N.S. N.S. N.S.

5 Blood urea N.S. N.S. S. (27.83%)

6 Creatinine N.S. N.S. S. (30.92%)

7 Total Protein N.S. S. (6.04%) N.S.

8 Bilirubin N.S. ? N.S. N.S.

9 S.G.O.T. N.S. N.S. S. (15.09%)

1 0 S.G.P.T. N.S. N.S. N.S.

1 1 Alkaline Phosphatase N.S. N.S. S. (27.50%)

-Decrease, - Increase


109

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111

Evaluation of Ayurvedic CompoundFormulation - Vidangadi Churna

*Dr.Ashok Kumar Tiwari, **Dr.Manoj Tripathi,***Dr.Neelesh Dwivedi, ****Mr.Pushpendra Kumar Shukla,

*****Dr. Anil Jaiswal,******Ritu Mishra, *******Mr.Sharda Prasad Tripathi


Abstract-

Quality assurance is an integral part of all systems of medicine to ensure quality medicament. Thus,there is an urgent need to evaluate such parameters which can be adopted by the pharmaceutical industries.

In the communication, attempts have been made to evaluate Vidangadi C?rna, an ayurvedic compoundformulation. Five samples procured from different manufacturers were subjected to physico-chemicalanalysis, TLC finger printing, and botanical characterization, and compared using authentic ingredients as

reference. It was observed that the microscopic and chromatographic analyses compliment each other intheir findings, and can be used effectively for the identification of raw materials in the compound formulation.

Keywords: Vidangadi C?rna, Ayurvedic formulation, Drug standardisation, Pharrmacognosy

‚Ê⁄Ê¢‡Ê -

ªÈáÊflàÃÊ •Ê‡flÊŸ •ÊÒ·Áœ ∑§Ë ªÈáÊflàÃÊ ‚ÈÁŸÁ‡øÃ ∑§⁄Ÿ ∑§ Á‹∞ ÁøÁ∑§à‚Ê ∑§Ë ‚÷Ë ¬˝áÊÊÁ‹ÿÊ¥ ∑§Ê •Á÷ãŸ Á„S‚Ê„Ò– ß‚ ¬˝∑§Ê⁄, fl„Ê° ∞‚ ◊ÊŸ∑§Ê¥ ¡Ê ºflÊ ©lÊªÊ¥ mÊ⁄Ê •¬ŸÊÿÊ ¡Ê ‚∑§ÃÊ „Ò, ßŸ∑§ Ãà∑§Ê‹ ◊ÍÀÿÊVŸ ∑§Ë •Êfl‡ÿ∑§ÃÊ „Ò, ß‚‡ÊÊœ ¬G ◊¥ Áfl«∏XÊÁº øÍáÊ¸ ∑§ •ÊÿÈfl¸Áº∑§ ÿÊÒÁª∑§ ∑§ ◊ÍÀÿÊ¢∑§Ÿ ∑§⁄Ÿ ∑§Ê ¬˝ÿÊ‚ Á∑§ÿÊ ªÿÊ „Ò, ¬Ê°ø Ÿ◊ÍŸ ÁflÁ÷ãŸ ÁŸ◊Ê¸ÃÊ•Ù¥¢‚ π⁄Ëº ∑§⁄ ÷ÊÒÁÃ∑§, ⁄Ê‚ÊÿÁŸ∑§ Áfl‡‹ÊáÊ, ≈Ë.∞‹.‚Ë. Á»§¥ª⁄ Á¬˝Áã≈ª •ÊÒ⁄ flÊŸS¬ÁÃ∑§ ‹ˇÊáÊÊ¥ ∑§Ê •äÿÿŸ •ÊÒ⁄ ‚ãº÷¸ ∑§M§¬ ◊¥ ¬˝◊ÊÁáÊ∑§ ‚Ê◊ª˝Ë ∑§Ê ©¬ÿÊª Á∑§ÿÊ ªÿÊ „Ò– ÿ„ ºπÊ ªÿÊ ÕÊ Á∑§ ‚Íˇ◊ •ÊÒ⁄ ∑˝§Ê◊≈Êª˝ÊÁ»§∑§ Áfl‡‹·áÊ ∞∑§ ºÍ‚⁄ ◊¥•¬Ÿ ÁŸc∑§·Ê¸ ∑§ ¬Í⁄∑§ „Ò, •ÊÒ⁄ ¬˝÷ÊflË …U¢ª ‚ ÿÊÒÁª∑§ ‚ÍGË∑§⁄áÊ ◊¥ ∑§ìÊ ◊Ê‹ ∑§Ë ¬„øÊŸ ∑§ Á‹∞ ßSÃ◊Ê‹ Á∑§ÿÊ ¡Ê‚∑§ÃÊ–

*Scientist, Ayurveda Sadan, Arogyadham, **Scientist, Ayurveda Sadan, Arogyadham, ***Scientist, Ayurveda Sadan,

Arogyadham, ****Pharmacist, *****Scientist, Ayurveda Sadan, Arogyadham, ******PG Research Scholar,*******PG

Research scholar, JRD Tata Foundation for Research In Ayurveda and Yoga Sciences, Deendayal Research Institute,

Chitrakoot- Satna (M.P.)


112

Introduction

Standardized drug of well defined consistent qualityare needed for reliable benificial therapetic use. Totalinformation and controls are necessary to guarantee

consistency of composition. Due to lack of properqaulity, control methods, there are batch to batchvariations in the same product as well as variations

amongst the same product obtained from differentsources. The main problem encountered whileworking with compound formulations is that most of

them consist of several ingredients, and the presenceof each ingredient has to be confirmed in the finalproduct (Gauniyal et al, 2005). The study was

undertaken to develop methods for evalution ofanother ayurvedic compound formulation, viz.Vidangadi Churna as prescriebed in The Ayurvedic

Formulary of India claimed to be used as Krmi roga

and which consists of a moderately fine powder of100 gm each of Vidanga (Embelia ribes. fruit),

Kampillaka (Mallotus philippinensis. hairs in thefruit), Haritaki (Terminalia chebula. fruit pulp),Saindhava lavana and Ksãra (yavaksãra)

(Anonymous, 2000).

Material and Methods

1. Method of preparation of the Churna

All the ingredients were used of pharmacopoeialquality (Anonymous, 2000a). These were washed,dried and grinded individually passed through 180

µm separately then weighed separately, mixed inspecified ratio and passed through 355 µm toobtain a homogenous blend. It was stored in an

airtight container to protect from light and moisture.Five different batches of Vidangadi Churna (twosamples were taken from Chitrakoot Rasshala

Pharmacy, Chitrakoot and three samples wereprepared at research laboratory Ayurveda Sadan,Chitrakoot) were studied. Raw materials of one batch

each; prepared by different sources were procured.Atuthentic samples of Vidanga (Embelia ribes fruit),

Kampillaka (Mallotus philippinensis hairs in thefruit), Haritaki (Terminalia chebula fruit pulp),Saindhava lavana and Ksãra (yavaksãra) were used

as controls. The formulation of Vidangadi Churna isgiven in Table no. 1.

2. Physico-chemical parameters

Organoleptic characters and physico-chemicalanalysis of all the samples were carried out.Quantitative analysis for total ash, acid insoluble ash,

water soluble ash, extractive values in water solubleand alcohol soluble extractive, loss on drying at1050 C and pH of filtrate of 10% w/v aqueous

solution were checked in triplicate according to theprescribed Standard methods in IndianPharmacopoeia (Anonymous, 1996 and Lohar,

2007).

3. Microscopic characteristics

For microscopic analysis a small quantity represent

of the Churna, along with the genuine samples, i.e.Vidanga, Kampillaka, Haritaki, Saindhava lavana

and Ksãra (yavaksãra well mixed with water,

stained with iodine and mounted in Glycerin wereused to examine the starch grains and its type.Another small quantity of samples cleared by heating

with Chloral hydrate solution and mounted inGlycerin was used to identify diagnostic microscopiccharacters of the ingredients. Further small quantity

of the curnas cleared with dilute KOH (5%) and wasmounted in Glycerin; was subjected to microscopicexamination (Anonymous, 1996 and Lohar, 2007).

4. TLC (Thin Layer Chromatography) profile

For TLC, 5 g of coarsely powdered drug in 250 mlstoppered conical flask & extracted with 100 ml ethanol

for 24 hours by maceration technique with occasionalshaking. The extract was extracted and volume wasraised up to 100 ml in a volumetric flask. 25 ml of the

extract was taken from the above stock solution and

Evaluation of Ayurvedic CompoundFormulation - Vidangadi Churna

Dr. Ashok Kumar Tiwari, Dr. Manoj Tripathi, Dr. Neelesh Dwivedi, Mr. Pushpendra Kumar Shukla

Dr. Anil Jaiswal, Ritu Mishra, Mr. Sharda Prasad Tripathi



113

concentrated on a water bath to similarly, ethanolextracts were prepared for all 5 batches. TLC of extracts

of all the samples and the reference ingredients wascarried out on Silica Gel 60 F

254 precoated plates (0.2

mm thickness; from Merck India Limited). Camag

Linomat 5 applicator was used for band applicationand Desaga Video documentation Unit 3 was used fordocumentation of fingerprints profile. The mobile

phase used was Toluene: Ethyl acetate: Formic acid (7:2.5: 0.5). The plate was developed over a distance of10 cm in a saturated development chamber (Twin

trough chamber (10×10 cm with SS lid, and visualizedunder visible light, 254nm and 366nm. After sprayingwith 5% methanolic-sulphuric acid followed by heating

at 1050C for 5-7 min (Anonymous, 1996 and Lohar,2007).

Result & Discussion

A brownish fine powder with smooth texture, odourpungent and taste salty. The powder completelypasses through 355 µm IS Sieve (sieve number 44)

and not less than 50 percent passes through 180 µmIS Sieve (sieve number 85).

Groups of broad lumen sclereids, pentagonal to

hexagonal thick walled cells of epicarp in surfaceview with striated cuticle, dark brown coloured largepalisade like cells of endocarp, dark reddish coloured

cells of the perisperm, endosperm cells filled withfixed oil and proteinous masses (Vidanga); anumber of stellate trichomes containing reddish

resin, fragments of endosperm cells containingaleurone grains and cluster crystals of calcium-oxalare, isolated secretory cells (Kampillaka); thick

walled elongated sclereids of various shapes andsizes, pitted parenchymatous cells, epicarpcells,polygonal beaded epidermal cells, fibres with

pitted walls (Haritaki). (Figure 1, 2).

Physico-chemical data was subjected to variousanalytical parameters average value of total ash

content 7.35%, acid insoluble ash 3.60%, alcoholsoluble extractive 26.20%, water soluble extractive61.40%, loss and drying at 105 0C 3.70% and pH 5.7

(Table no.2).

Thin Layer Chromatography (TLC)

The TLC plate were examine under ultra violet light

at 254 nm; at 366 nm; at visible for both before andafter derivetisation with 5% methanolic-sulphuric

acid reagent (Figure 3,4,5). The Rf values and colours

of the bands obtained were recorded. It shows major

spots at visible light Rf 0.10, 0.22, (all spots brown),

0.47.0.57, 0.66, 0.89 (all spots yellow),0.95(orange) and at 366nm R

f 0.10 (blue), 0.22 (sky

blue), 0.49, 0.57, 0.68, 0.76, 0.80 (all spots black),0.86(sea blue), 0.90 (black), 0.95(brown). Afterspray the plate shows major spots at 366 nm R

f

0.10(brown), 0.22 (white), 0.30(pink), 0.34, 0.40(both spots white), 0.47 (brown), 0.60, 0.68, 0.76,0.80, 0.83, 0.89 (all spots black).

Conclusion

The ayurvedic system of medicines is prevalent inIndia since the Vedic period and as early as the dawn

of human civilization. Though ayurveda hasundergone many changes in the course of its longhistory, it still remains the mainstay of medical relief

to a large section of population of the nation. Due tourbanization and dwindling of forests, the Vaidya byand large is no longer a self contained unit collecting

and preparing his own medicines as before. He hasnow to depend on the newly developed agencies likeone collecting and supplying the crude drugs and the

other undertaking mass production of medicines inthe Ayurvedic Pharmaceutical units run on thecommercial scale (Anonymous, 2002). Thus, the

present study revealed that the characteristicmicroscopical features and the distinguished fingerprints in the TLC profiles may be utilized as marker

parameters for monitoring the quality of theformulation. Hence the physico-chemicalparameters, biochemical analysis, TLC finger print

profiles and the microscopical characteristic togethermay be used for quality evaluation and thestandardization of compound formulations. Spiking

of the formulations with the different genuineingredients further confirms the presence ofindividual components in them.

Acknowledgement

Authors are grateful to Dr. Bharat Pathak, GeneralSecretary, Deendayal Research Institute,

Arogyadham, Chitrakoot, for providing theinfrastructure and thankful to Department of AYUSH,Ministry of Health and Family Welfare, Government

of India, for financial support under the schemeCentre of Excellence.


114

References & Bibliography

1 . Gauniyal, A.K., Rawat, A.K.S.and Pushpangadan, P.

(2005). Interactive Meeting for Evidenced-Based

complementary and Alternative Medicines: a Report,

2 : 2 4 9 .

2 . The Ayurvedic Formulary of India Part II - 2000,

by Government of India, Ministry of Health and Family

Welfare, New Delhi, Publication the Controller of

Publication, Delh; 128.

3 . Indian Pharmacopoeia, Vol-2. 1996. Government of

India, Publication the Controller of Publication, Delhi;

A 5 3 - A 5 4 .

4 . Lohar, D.R. (2007). Protocol For Testing Ayurvedic

, Siddha & Unani medicines, Govt of India, Department

of AYUSH, Ministry of Health and Family Welfare, PLIM,

Ghaziabad; 40-108.

5 . The Ayurvedic Pharmacopoeia of India Part I, Vol-

Ist, 2000a. Govt. of India, Ministry of Health and Family

Welfare, Department of ISM &H, New Delhi;;47-

4 8 , 5 5 , 1 2 3 - 1 2 4 .

6 . Quality Control Methods for medicinal plants

materials, 2002.World Health Organization (WHO)

Genewa, A.I.T.B.S. Publishers & Distributors (Regd.),

Delhi; 63.

Table No. 1: Ingredients of Vidangadi Churna

Sr.no Common name Botanical name Part used

1 Vidanga Embelia ribes Burm. f. Fruit

2 Saindhava lavana - Rock Salt

3 Kshara (yavakshara) - Rock Salt

4 Kampillaka Mallotus philippinensis Muell Arg Hairs in the fruit

5 Haritaki Terminalia chebula Retz. Fruit Pulp

Table No. 2: Physico-chemical parameters of Vidangadi Churna

Sr.no Test Parameters Results

1 Loss on drying at 105°C 3.70 % w/w

2 Total Ash 7.35 % w/w

3 Acid Insoluble Ash 3.60 % w/w

4 Water Soluble Extractive 61.40 % w/w

5 Alcohol Soluble Extractive 26.20 % w/w

6 pH (10% aque.solution) 5 . 7


115

Kampillaka

Figure 1: Powder characteristics of Vidangadi Churna

Epicarp withstriated cuticleSclereids

Endosperm cellsfilled with fixed oil

and proteinousmasses

Dark-brown colouredcells of perisperm

Vidanga

Dark browncolouredpalisade like cells

of endocarp

Fragments of endosperm loaded

with aleurone grains and clustercrystals of calcium-oxalate

Trichomes

Isolated secretory cells


116

Haritaki

Figure 2: Powder characteristics of Vidangadi Churna

Groups of sclereid

Pitted parenchyma

Polygonal suberizedepicarp cells

Beaded epidermal cells

Fibres


117

A B C D E A B C D E

Figure 3: TLC Finger prints profiles of Figure 4: TLC Finger prints profiles ofVidangadi Churna at visible light Vidangadi Churna at 366 nm

(before derivatization) (before derivatization)

A B C D E

Figure 5: TLC Finger prints profiles ofVidangadi Churna at 366 nm (after

derivatization)

Note: A, B, C, D, E five batches of samples (A, B, C manufactured in Ayurveda Sadan Research Laboratory,

Chitrakoot and D, E manufactured in Chitrakoot Rasshala Pharmacy, Chitrakoot )


118

A cross sectional survey based study on Shwetapradar(vaginal discharge) in the women of reproductive age group.

*Dr.Poonam choudhary, ** Dr.Laxmipriya Dei

Survey Study

Abstract

Shwetapradar (Vaginal discharge) is an excessive secretion from the female reproductive tract

especially from the vagina or cervix or both. It is characterized by white to brown coloured, thin or thick,foul smelling fluid and itching, associated with considerable health and economic costs.

Aims & Objective: To know the prevalence and risk factors of Shwetapradar ( vaginal discharge)

among the reproductive age group women and the socio-demographic factors influencing the occurrence ofthe disease.

Design: A cross sectional descriptive qualitative and quantitative survey among 200 women of 20-

50 years, from the OPD of Stree Roga and Prasutitantra Department, I.P.G.T. & RA, GAU, Jamnagar. Theywere interviewed and observed in Stree Roga and Prasutitantra Department.

Method: Direct personal interviews using semi-structured questionnaires consisting of open and

closed ended questions and non-participatory observations were used to Collect data from informants.

Results: Thick, curdy white, and cottage cheese vaginal discharge (60%). yeasty smell of discharge(21%), Vaginal itching (90%) are the commonest vulvovaginal features. Vaginal douches (7.5%), Tampons

(2.5%), Antibacterial soaps (10%) & Perfumes (1%) Alpashan (31%), Atimatrabhojan (24.5%), Adhyashan

(27%), Chinta (88%) krodha in 67%, Shoka in 59%, Tanava in 48.5%, are the major risk factors forpathogenesis of vaginal discharge .

Interpretation & conclusion: The study showed high prevalence of vaginal discharge. Theasymptomatic women having discharge are less likely to seek treatment for the morbidity and thus are morelikely to acquire other STIs. Women attending various healthcare facilities should be screened and treated

for vaginal discharge to reduce the risk of acquisition of other STIs.

Keywords: Vaginosis bacterial, Shwetapradar, Trichomoniasis, Vaginal Discharge.

‚Ê⁄Ê¢≥Ê -

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*M.D scholar, SRPT Dept, IPGT & RA, Jamnagar. **Asso.Prof./Ic Head, SRPT Dept, IPGT & RA, Jamnagar.


119

Introduction

The problem of vaginal discharge is probablythe most frequently narrated complaint of woman of

reproductive age group. Vaginal discharge constitutea considerable problem for many women causingdiscomfort, anxiety affecting women’s quality of life

and consuming considerable resources. Some vaginaldischarges are normal and can vary with age, use ofcontraceptives, menstrual cycle and with the

oestrogen level. Unfortunately in our part of worldthere is culture of silence, hence in most of thepatients there is delay in seeking help. A pathological

discharge may be ignored by some where as normalphysiological discharge was considered as abnormalby some fastidious women.

Pathological discharge may also due to noninfective disease such as genital tract tumours orfistula and chemical vaginitis as result of the use of

perfumed soaps, bath additives, spermicides orantiseptic douche and foreign bodies in vagina(Hudson et al.,1998). Vaginal discharge is a

common, but neglected, health problem in women intheir reproductive age. It is therefore important toknow the exact prevalence of vaginal discharge in

women with genital tract infections. The presentstudy carried out to find the characteristics ofvaginal discharge, prevalence of pathogenic agents

causing vaginal discharge and the prevalence of puscells in relation to pathogenic agents.

Materials and Methods:

Aims & Objective:

To know the prevalence and risk factors ofShwetapradar (vaginal discharge) among the

reproductive age group women and the socio-demographic factors influencing the occurrence ofthe disease.

Selection of patients:

Total 200 patients having complaint of

Shwetapradar (Abnormal vaginal discharge) wereselected from the OPD of Stree Roga and Prasutitantra

Dept, I.P.G.T.Hospital, GAU, Jamnagar. A pretestedstructured proforma was used to interview thewomen about their socio-demographic, reproductive

history, current, and past abnormal vaginaldischarge symptoms, personal hygiene factors,Dietary & Behaviour practises.

Ethical clearance & CTRI registration

The Institutional Ethical Committee of theIPGT & RA Hospital, Gujarat Ayurved University,

Jamnagar, approved the study. An informed writtenconsent was taken from each patient who willing toparticipate in the study. Information about routine

hygienic practices, proper care during menstruation,number of sexual partners and contraceptive historywas collected. All women were properly counselledabout good hygiene and menstrual care so that these

factors could not act as risk factor in relapse.

Inclusion criteria of patient

l Females of 20 yrs to 50 yrs.

l The patient having clinical sign & symptoms ofShwetapradar.

Exclusion criteria of patient

l Females below 20 yrs and above to 50 yrs.

l Menstruating women.

l Pregnant women.

l Patients suffering from Tuberculosis, SexuallyTransmitted Diseases like VDRL, HIV,Gonorrhoea, etc. and genital malignancy,

Congenital and any other pathologies ofreproductive tract.

Criteria for diagnosis

l Patients were selected on the basis of

demographic, risk factor and clinical data werecollected using a structured questionnaire.

A cross sectional survey based study on Shwetapradar(vaginal discharge) in the women of reproductive age group.

Dr. Poonam choudhary, Dr. Laxmipriya Dei

Survey Study


120

Result &Discussion

l Age:

Maximum number of cases 49% was found inthe age group of 20-30 years & 32% in age group of31-40 years. Vaginal infections commonly occur in

women of reproductive age i.e between 25-30 yearsas noted in several other studies. ,,,, . Hence thepopulation studied was a low risk one attending the

gynaecologic clinic. Studies by some authors showthat the probability coefficients for all vaginalinfections depend on the type of population studied

and the prevalence in the population studied.,,,

l Habitat & Socio-Economic Status:

In the present study we found the

association between socio demographic profiles ofthe study population and prevalence of vaginaldischarge. The highest prevalence was seen in urban

areas (91 %) followed by rural community (09%) andurban lower middle class community (66%). In astudy conducted by Garg et al in ever-married

women belonging to an urban slum in Delhi,prevalence of bacterial vaginosis was 41 per cent.Higher prevalence reported in this study could be

because of more than one method used for thediagnosis of bacterial vaginosis. In a studyconducted in married rural women in Karnataka,

India, prevalence of bacterial vaginosis usingNugent’s criteria was reported to be 20.5 per cent.In another study from Haryana, India, bacterial

vaginosis was diagnosed in a high percentage (48.5%)of rural women. This shows that prevalence ofbacterial vaginosis varies widely among different

areas and communities within the country. Thecontrasting prevalence figures may be because ofvarious reasons such as differences in economic

status and educational background, study populationand method used for diagnosis of bacterial vaginosis.

Educational status:

Maximum 22% were educated up to middle& high schools followed by 20% cases were educatedup to primary school. It suggests that still less

education is found in females in our society. Thisclearly indicates the lack of knowledge aboutpersonal hygiene among less educated people. They

neglect it as a part of their routine life and finallyland up into a serious health hazard. Hence it is very

important to create health awareness among women.Although, the data can be taken as encouraging in

this sense that the people from each intellectual levelare coming to Ayurvedic clinics.

l Occupation:

In this study, out of 200 cases maximum(78%) were housewives, 6% were in Labour/Farmeroccupation. These data reflect that our society still

does not allow women to go outside for works evenif economical condition is not good. Also housewivesare more prone to emotional stress because they do

not have any extra activity to divert their mind. Itis a well known quotation that “Empty mind is adevil’s workshop”. Moreover the basic nature of

housewives is to engage them in taking care of theirhusbands and children due to whom she oftenneglects herself and her health. So, this negligence

and psychological state may affect the normalvaginal secretion. These factors are the part ofgeneral health and also causative factor of

Shwetapradar.

l Religion:

78% cases were Hindu followed by 20% were

Muslim and 2% were Sikh patient registered. Thisdata may be found due to geographical dominanceof Hindu people in this region (Jamnagar).

l Marital status:

95% of cases were married, reasons were thatafter marriage reproductive life starts and most of

the females adopt family planning measures likecondom, IUCD, pessaries etc. which produceexogenous pathogens as foreign body in vagina

which is an important cause of leucorrhoea. Thus, itis most frequently seen in married women.

l Parity:

The present clinical study reveals that, 60 %of the patients were multiparous, while 25% werefound parous and only 15 % were nulliparous.

l Dietary Habit:

In survey study, out of 200 cases 79% ofcases were vegetarian and 21% were non-vegetarian.

The predominance of vegetarianism only reflects thedietary habit of this region. So, it will not be rationalto conclude that the vegetarians are susceptible to

this disease.


121

l Addiction:

Maximum 94% number of cases had

addiction for tea & coffee followed by 06% addictedfor tobacco chewing & betel no cases had addictionfor alcohol & smoking. Smoking has also been

reported to be associated with bacterial vaginosis.However, no such association was found in thepresent study as number of smokers is nil.

l Previous history:

Regarding distribution of previous historypositive abnormal Pap test has been found out in 2%

cases ovarian cyst in 6%, uterine fibroids in 3%,uterine/vaginal abnormality in 00% cases, cervicalpolyp in 7.5% cases, Cystocele in 12.5% cases. 20%

cases having history of Anaemia, 2% having Asthma.Depression was found in 13.5% cases, Diabetes in 3%,Psoriasis in 01%, Eczema in 2.5%, Dermatitis in 01%,

Thyroid disorder in 01%, Urinary tract infection in20% vaginal bleeding in 04% cases. However whileour sample size lacked the power to test for the

significance of diabetic status as an appropriatequestion for our study, based on the literaturesupport ,, and clinical importance of checking for

appropriate management of this condition, thequestion of diabetic status was included in our finaldiagnostic flowchart. Non-infective conditions such

as dermatitis, psoriasis or a predisposition toallergies are possible differential diagnoses, whichcould make the diagnosis of VVC more difficult.

These were assessed for possible inclusion into ourstudy did not support the inclusion of this question.( Table-1)

l Current Vulvovaginal Signs and Symptoms:

Out of 200 cases 60% of cases have Thick,Curdy white, and cottage cheese vaginal discharge.

Regarding smell of the discharge 21% cases werehaving yeasty smell, 10% had Unpleasant “fishy” &1.5% had smell of other odour. In 4% cases smell

seem to be worse out of them all cases felt it afterthe intercourse. 5% cases felt smell seem to be worseat certain times related to menstrual periods out of

them 4% cases felt it after the period & 1% cases feltit during the period. A study by Shazia A Khan et.alshowed that the Colour of the discharge was also

related to the infectivity. Grey discharge wasassociated with maximum infectivity. The

consistency of discharge was also related to theinfection. Thick creamy discharge was the most

common presentation (58%) occurring in 90% of thecases of candida albicans. Watery discharge was thenext with an infection rate of 25%. Malodour of

discharge was significantly related to infection.Nearly 67% of patients complained of malodour. 86%of Trichomonas vaginalis and 62% of Candida

albicans infections reported malodour. Only 4% ofpatients complained of odour after intercourse andall had Gardnerella infection. In another study by S.

Rekha et.al concluded that treatment based on visualdiagnosis over treats 38.5% of BV and 9% ofCandidiasis whereas it under treats 6% of TV and

hence is discouraged. The most ideal approach is themicrobiological diagnostic approach for theetiological diagnosis of symptomatic vaginal

discharge. So the inclusion of this question in ourstudy was considered appropriate. ( Table-2)

l Vulvovaginal Signs and Symptoms:

Vulvovaginal Pruritis is a common anddisturbing Symptom, it occurred in only a few casesclassical heavy purulent yellow green offensive

discharge with severe pruritis., In the present studyvaginal itching was present in 90% cases and absentin 10% cases while vulval itching, vulval soreness &

redness of the vulva was present in 20% cases andabsent in 80% cases. ( Table-3)

l Vulvovaginal Signs and Symptoms:

Regarding distribution of Vulvovaginal Signsand Symptoms swelling of the vulva was present in15% cases and absent in 85% cases. 40% cases had

burning, pain and/or discomfort when go to passurine and it was felt over Vulva by 10% cases & overthe urethra by 20% cases & over both in 10% cases.

Pain at any time in relation to sexual intercourse waspresent in 15% cases and 14.5% cases felt it after thesex while 0.5% cases felt it during & after the sex.

Presence of inflammatory signs such as vulval and/or vaginal oedema, erythema, fissures, orexcoriations and other signs including dysuria and

dyspareunia having an association with candidiasis.,

So the inclusion of this question in our study wasconsidered appropriate. ( Table-4)

l Previous history of above symptoms:

Regarding distribution of Previous history


122

60% cases experienced these symptoms in the pastand in 55% cases it was diagnosed by a doctor and

they obtain treatment for it, out of them 14%, 2% &6.5% cases take treatment in the form of ayurvedicMedicine, Douche & both therapy respectively and

10%, 5% & 17.5% cases in the form of modernmedicine, Suppository/ cream & both therapyrespectively. This data concluded that reoccurrence

of the symptoms is quite common in Shwetapradar.A study by Thulkar et al: concluded that Bacterialvaginosis and mixed infection were found to be the

common type associated with recurrent vaginitis.Usage of male condom should be promoted andcombined with other contraceptive methods for

prevention of recurrent vaginitis. (Table-5)

l Personal Hygiene Factors:

Regarding distribution of Personal Hygiene

Factors 21% cases use any products in vaginal areain the form of Vaginal douches (7.5%), Tampons(2.5%), Antibacterial soaps,(10%) & Perfumes (1%)

cases respectively. 16% cases wear fitted, tight orconstrictive clothing out of them 2.5% wearregularly, 8.5% wear Occasionally & 5% cases wear

Rarely. Wearing material was made of synthetic in04% cases. The literature has reported that theseproducts have been implicated in allergic or irritant

vulvovaginitis., A major risk factor to increase G.

vaginalis infection is vaginal douching. Douchingleads to changes in the vaginal pH and altered

microbial flora. So the inclusion of this question inour study was considered appropriate. (Table-6)

l Aharaj nidan:

Regarding distribution of Aharaj nidan

Junk food consumption habit was present in 42%cases. 66% cases had used Spicy/ fried items in their

diet out of them 23% used Daily, 30% Occasionally& 13% used on excessive basis. 87% cases were takingaerated drink in the form of Fruit juice by 18% Soft

drinks by 25% Ice cream 19% & Butter milk by 75.5%cases. Regarding type of eating Alpashan was presentin 31% cases Atimatrabhojan in 24.5% & Adhyashan

was present in 27% cases. Regarding dominant rasain diet, madhur rasa dominancy was present in58.5% cases. Junk food is a kind of viruddha

ahara which prepared by the combination ofvarious rasa & veerya dravas mixing together andhaving high calories. Junk food and all other dietetic

forms & habits which had been asked in thisquestionnaire are kapha vata prakopak and play

an important role in the pathogenesis ofShwetapradar. (Table-7)

l Viharaj nidan:

Regarding distribution of Viharaj Nidan

maximum 48.5% cases not used any kind ofcontraceptives. Frequency of intercourse was daily

in maximum 55% cases. Neglect the urge ofdefecation or urination was found in 78.5% cases,out of them 67.5% cases neglect occasionally while

12% cases neglect the urge daily. Day sleep wasfound in 70% of cases. Out of them 10% cases sleepoccasionally in day time & 60% cases sleep daily in

day time. Risk factors for recurrent vaginitis are lackof proper health awareness and lack of properhygiene.Another study by Smart et al has shown that

consistent use of condom can reduce recurrence ofbacterial vaginosis. Neglect the urge of defecation orurination & divaswap vitiated vata & kapha

respectively which are the major key factor of thepathogenesis of Shweta pradara. (Table -8)

l Mansika hetu:

Regarding Mansika hetu chinta was found inmaximum 88% of cases followed by krodha in 67%,Shoka in 59%, Tanava in 48.5%, Bhaya in 18% &

dainya in 12% of cases. It is mentioned in Ayurvedicclassics that vitiation of Manasika doshas may leadeither to psychological or somatic or psychosomatic

disorders. So, these psychological factors mayproduce Shwetapradar directly or may interferewith the normal function of Jatharagni leading to

Agnimandya and thus forming Ama, which is theroot cause for all the disease.These bhavas alsoprovocate Vata and crucial triggers for initiation of

diseases. Modern science also accepts thatpsychological stress influences hormonal functions.So, this psychological state may affect the normal

vaginal secretion because normal vaginal defencemechanism is maintained under the influence ofoestrogen. And due to altered vaginal environment

women are more prone to infection. Moreoverpsychological factor is one of the causative factorsof vaginal discharge according to modern science.

Among Indian women, poor psychological well-beingis a strong risk factor for the complaint of abnormalvaginal discharge, but reproductive tract infection


123

(RTI) is not. (Table-9)

l Prakriti :

On considering the data of Sharira Prakriti,maximum i.e. 58.5% patients had Vata-Pitta Prakriti,28% had Vata-Kapha Prakriti and only 13.5%

patients had Pitta-Kapha Prakriti. Majority of thepatients i.e. 88.5% had Rajasika Manasa Prakriti

while remaining 11.5 % of the patients had Tamsika

Manasa Prakriti. It indicates that Pitta is found inhigh proportion which is supportive to thepredominance of the Pitta Dosha during this phase.

As per the concept of etiopathogenesis ofShwetapradar discussed earlier, several diseasesmentioned in various places can be co-related with

Shwetapradar. These disorders do not show anyinclination towards some particular Prakriti. Thus,this Prakriti Parikshana data cannot be interpreted

as a considerable data for the Prakriti of an individual

with Shwetapradar. The Rajodosha patients are wellknown for their negligence to body care and other

activities. So, they are not so much aware about theirpersonal hygiene, it may create disease. (Table-10)

l Conclusion

The study concluded that the prevalence ofthe vaginal discharge is high in the peoples of lowermiddle class society, unhygienic conditions,

excessive coitus & sexual transmission from infectedmale partner. Identification of risk factors i.e. junkfood, day sleep, vegavrodh, anemia, hyperacidity &

previous history of UTI and cervical polyp. Alongwith these factors we found that psychologicalconsequences like chinta, shoka plays vital role in

manifestation of Shwetapradar so every womenshould be screened and treated for vaginal dischargeto reduce the risk of acquisition of other STIs.

Table- 1:

Showing Distribution of Previous history in 200 Cases

of Shwetapradar (vaginal discharge).

History of No. of Cases Percentage

Abnormal pap test 02 01%

ovarian cyst 1 2 06%

uterine fibroids 06 03%

uterine/vaginal abnormality 00 00%

Cervical polyp 1 5 7.5%

Cystocele 25 12.5%

Rectocele 08 04%

Uterine prolapse 03 1.5%

Anaemia 40 20%

Asthma 04 02%

Bleeding disorder 00 00%

Blood transfusion 00 00%

Cancer 00 00%

Cryotherapy/Cauterization 0 7 3.5%

laser or LEEP treatment of cervix 00 00%


124

Depression 25 12.5%

Diabetes 06 03%

Eating disorder 00 00%

Endometriosis 00 00%

HIV / AIDs 00 00%

Kidney disease 04 02%

Liver disease 02 01%

Pelvic inflammatory disease 03 1.5%

Sexually transmitted disease 02 01%

Psoriasis 02 01%

Eczema 0 5 2.5%

Dermatitis 02 01%

Thyroid disorder 02 01%

Urinary tract infection 40 20%

Vaginal bleeding 08 04%

Table-2:

Showing Current Vulvovaginal Signs and Symptoms in 200 Cases


Sr. No. vaginal discharge No. of Cases Percentage

1 . Thin, off-white 25 12.5%

Thick, curdy white, cottage cheese 120 60%

Copious (plentiful) yellow-green 1 5 7.5%

(or discoloured)

Frothy 40 20%

Other 00 00%

smell of the discharge 65 32.5%

2. Unpleasant “fishy” 20 10.0%

Yeasty 42 21%

Other 03 1.5%

smell seem to be worse 08 04%


125

3. After sexual intercourse 08 04%

When standing or walking 00 00%

after sitting 00 00%

Other

No 3 7 18.5%

Unsure 20 10%

smell seem to be worse at certain 1 0 05% times related to menstrual periods

4. Before 00 00%

During 02 01%

After 08 04%

Table- 3: Showing Current Vulvovaginal Signs and Symptoms in 200 Cases of

Shwetapradar (vaginal discharge).

Sr. No. vaginal itching No. of Cases Percentage

1 . Present 180 90%

Absent 20 10%

vulval itching

2. Present 40 20%

Absent 160 80%

vulval soreness

3. Present 40 20%

Absent 160 80%

Redness of the vulva

4. Present 40 20%

Absent 160 80%


126

Table- 4: Showing Current Vulvovaginal Signs and Symptoms in

200 Cases of Shwetapradar (vaginal discharge).

S. No. Swelling of the vulva No. of Cases Percentage of Patient

1 . Present 30 15%

Absent 1 7 0 85%

Any burning, pain and/or discomfort when go to pass urine

2. Present 80 40%

Vulva 20 10%

urethra 40 20%

both 20 10%

Absent 120 60%

Any pain at any time in relation to sexual intercourse

3. Present 30 15%

during sex 00 00%

after sex 29 14.5%

both 1 0.5%

Absent 1 7 0 85%

bleeding after sexual intercourse

4. Present 00 00%

Absent 200 100%

Total 30 100%

Table-5: Showing Distribution of Previous history in 200 Cases of


S. Experienced any symptoms No. of Cases Percentage

No. in the past

1 . Present 120 60%

Absent 80 40%

was it ever diagnosed by a doctor

2. Yes 1 1 0 55%

No 1 0 5%

you obtain treatment for it

3. Yes 1 1 0 55%

No 1 0 5%


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What was the treatment

4. Ayurvedic 45 22.5%

Medicine 28 14%

Douche 04 02%

Both 1 3 6.5%

Modern 65 32.5%

Medicine 20 10%

Suppository/ cream 1 0 05%

BotH 35 17.5%

Table-6 : Showing Distribution of Personal Hygiene Factors in 200 Cases of


S. Use any products in the No. of Cases Percentage

No. vaginal area

1 . Vaginal douches 1 5 7.5%

Tampons 0 5 2.5%

Antibacterial soaps 20 10%

Perfumes 2 1%

Detergents 00 00%

Other 00 00%

Wear fitted, tight or constrictive clothing 32 16%

2. Regularly 5 2.5%

Occasionally 1 7 8.5%

Rarely 1 0 5%

Made of synthetic material 08 04%

3. Yes 08 04%

No 24 12%


128

Table-7: Showing Distribution of Aharaj nidan in 200 Cases of Shwetapradar (vaginal

discharge).

Sr. No. Junk food consumption No. of Cases Percentage

1 . Yes 84 42%

No 116 58%

Spicy/ fried items

2. Yes 132 66%

Daily 46 23%

Occasionally 60 30%

excessive 26 13%

No 68 34%

Take aerated drink

3. Yes 1 7 4 87%

Fruit juice 36 18%

Soft drinks 5 0 25%

Ice cream 38 19%

Butter milk 1 5 1 75.5%

No 26 13%

Type of eating

4. Alpashan 62 31%

Samashan 35 17.5%

Atimatrabhojan 49 24.5%

Adhyashan 54 27%

Dominant rasa in diet

5. Madhur 1 1 7 58.5%

Amla 34 17%

Lawan 18 09%

Katu 20 10%

Tikta 08 04%

Kashaya 03 1.5%


129

Table -8 : Showing Distribution of Viharaj nidan in 200 Cases


Sr. No. Contraceptive Devices No. of Cases Percentage

1 . Nil 9 7 48.5%

O.C.P. 1 7 8.5%

IUCD 18 09%

Condom 30 15%

T.L. 38 19%

Frequency of intercourse

2. Daily 1 1 0 55%

4-5 times/week 5 7 28.5%

1-3 times/week 33 16.5%

Having multiple partner

3. Yes 5 2.5%

No 195 97.5%

Neglect urge of defecation or urination

4. Yes 159 79.5%

Occasionally 135 67.5%

Daily 24 12%

No 4 1 20.5%

Diwaswaap

5. Yes 140 70%

Ocassionally 20 10%

Daily 120 60%

No 60 30%


130

Table-9: Showing Distribution of Mansika hetu in 200 Cases


Sr. No. Mansika hetu No. of Cases Percentage

1 . Chinta 1 7 6 88%

Shoka 118 59%

Bhaya 36 18%

Krodha 114 67%

Dainya 24 12%

Tanava 8 7 48.5%

Table-10: Showing Distribution of Prakriti of 200 Cases of Shwetapradar

(vaginal discharge).

Sr. No. Prakriti- Sharira No. of Cases Percentage

1 . Vata – Kapha 56 28%

Vata –Pitta 1 1 7 58.5%

Pitta – Kapha 2 7 13.5%

Manasa

2. Sattvika 00 00%

Rajasika 1 7 7 88.5%

Tamsika 23 11.5%

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Vishnubhatla, S., Indian J Med Res 2010, 131, 83-

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Jagadishchandra, K., Indian J Med Microbiol 2004,

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Xia, M., Maloney- Kitts, M. et al., Sex Transm Infect

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5 . Rao PS, Devi S, Shriyan A, Rajaram M,

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technique. Indian J Med Microbiol 2004; 22 : 47-50.

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Xia, M., Maloney- Kitts, M. et al., Sex Transm Infect

1998, 74, S95-105.

7 . Nugent, R.P., Krohn, M.A., Hillier, S.L., J Clin

Microbiol 1991, 29, 297-301.

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Junior, M.Q., Jardim, M.L., De Brito, A.M. et al., Sex

Transm Infect 1998, 74, S38-43.

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Karat, C., Arun, A., Cohen, C.R. et al., Indian J Med

Microbiol 2008, 26, 132-137.

1 0 . Garg S, Sharma N, Bhalla P, Sahay R, Saha R, Raina

U, et al. Reproductive morbidity in an Indian urban

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1 2 Aggarwal AK, Kumar R, Gupta V, Sharma M.

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vulvovaginal candidiasis. Am Fam Physician

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Gynecol 1983;26(1):186-202.

1 6 . Dennerstein G. The treatment of candida vaginitis

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Organisms Causing Vaginaldischarge J Ayub Med

Coll Abbottabad 2009;21(2)

1 8 . S. Rekha, S. Jyothi et.al Comparison of visual,

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age group Int J Pharm Biomed Res 2010, 1(4), 144-

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Clin 1993;1-6.

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Pharm Assoc (Washington) 1997;37:563-9.

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Fam Physician 2000;62:1095-104.

2 2 . Anderson MR, Klink K, Cohrssen A. Evaluation of

vaginal complaints. JAMA 2004;291:1368-79.

2 3 . Thulkar et al: Aetiology & risk factors of recurrent

vaginitis & its associationwith various contraceptive

methodsIndian J Med Res 131, Januray 2010, pp

8 3 - 8 7

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Ann Allergy Asthma Immunol 2000;85(4):253-65.

2 5 . Fischer G. Treatment of vaginitis and vulvitis. Aust

Prescr 2001;24:59-61.

2 6 . Zenilman J. Ethnicity and sexually transmitted

infections. Curr OpinInfect Dis 1998;11:47-52.

2 7 . Chen HB, Zhou LY , Li HQ, Liu HQ, Ding SQ, Zhao

M. Prevalence of bacterial vaginosis in married

women of reproductive age in the rural area of

Shandong province and its risk factors. Zhongguo Yi

Xue Yuan Xue Bao 2006; 28 : 378-81.

2 8 . Smart S, Single A, Mindel A. Social and sexual risk

factors for bacterial vaginosis. Sex Transm Infect

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2 9 . Ibidem, Cha. Chi. 28/15-18,pp-779

3 0 . Patel V et al., Why do women complain of vaginal

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132

Instructions for authors

I. Ownership of the Journal

The Journal of Ayurveda is the official

publication of the National Institute of Ayurveda,

Jaipur under Deptt. of AYUSH, Ministry of health &

FW, New Delhi.

It is published quarterly i.e. January-March,

April-June, July-September and October-December.

II. Authorship and Contributorship

II.A. Byline Authors

An “author” is generally considered to be

someone who has made substantive intellectual

contributions to a published study, and biomedical

authorship continues to have important academic,

social, and financial implications. (1) In the past,

readers were rarely provided with information about

contributions to studies from those listed as authors

and in acknowledgments. (2) Some journals now

request and publish information about the

contributions of each person named as having

participated in a submitted study, at least for original

research. Editors are strongly encouraged to develop

and implement a contributorship policy, as well as a

policy on identifying who is responsible for the

integrity of the work as a whole.

While contributorship and guarantorship

policies obviously remove much of the ambiguity

surrounding contributions, it leaves unresolved the

question of the quantity and quality of contribution

that qualify for authorship. The International

Committee of Medical Journal Editors has

recommended the following criteria for authorship;

these criteria are still appropriate for those journals

that distinguish authors from other contributors.

l Authorship credit should be based on 1)

substantial contributions to conception and

design, or acquisition of data, or analysis and

interpretation of data; 2) drafting the article or

revising it critically for important intellectual

content; and 3) final approval of the version to

be published. Authors should meet conditions 1,

2, and 3.

l When a large, multi-center group has conducted

the work, the group should identify the

individuals who accept direct responsibility for

the manuscript (3). These individuals should fully

meet the criteria for authorship defined above

and editors will ask these individuals to complete

journal-specific author and conflict of interest

disclosure forms. When submitting a group

author manuscript, the corresponding author

should clearly indicate the preferred citation and

should clearly identify all individual authors as

well as the group name. Journals will generally

list other members of the group in the

acknowledgements. The National Library of

Medicine indexes the group name and the names

of individuals the group has identified as being

directly responsible for the manuscript.

l Acquisition of funding, collection of data, or

general supervision of the research group, alone,

does not justify authorship.

l All persons designated as authors should qualify

for authorship, and all those who qualify should

be listed.

l Each author should have participated sufficiently

in the work to take public responsibility for

appropriate portions of the content.

Some journals now also request that one or

more authors, referred to as “guarantors,” be

identified as the persons who take responsibility for

the integrity of the work as a whole, from inception

to published article, and publish that information.


133

Increasingly, authorship of multi-center trials

is attributed to a group. All members of the group

who are named as authors should fully meet the

above criteria for authorship.

The order of authorship on the byline should

be a joint decision of the co-authors. Authors should

be prepared to explain the order in which authors

are listed.

II.B. Contributors Listed in

Acknowledgments

All contributors who do not meet the

criteria for authorship should be listed in an

acknowledgments section. Examples of those who

might be acknowledged include a person who

provided purely technical help, writing assistance, or

a department chair who provided only general

support. Editors should ask authors to disclose

whether they had writing assistance and to identify

the entity that paid for this assistance. Financial and

material support should also be acknowledged.

Groups of persons who have contributed

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such as “clinical investigators” or “participating

investigators,” and their function or contribution

should be described-for example, “served as

scientific advisors,” “critically reviewed the study

proposal,” “collected data,” or “provided and cared

for study patients.”

Because readers may infer their endorsement

of the data and conclusions, all persons must give

written permission to be acknowledged.

II.C. Conflicts of Interest

Conflict of interest exists when an author (or

the author’s institution) or reviewer has financial or

personal relationships that inappropriately influence

(bias) his or her actions (also known as dual

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influence judgment, and not all relationships

represent true conflict of interest. The potential for

conflict of interest can exist whether or not an

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identifiable conflicts of interest and the most likely

to undermine the credibility of the journal, the

authors, and of science itself. However, conflicts can

occur for other reasons, such as personal

relationships, academic competition, and intellectual

passion.

All participants in the peer review and

publication process must disclose all relationships

that could be viewed as presenting a potential

conflict of interest.

II.D.1. Potential Conflicts of Interest Related

to Individual Authors’ Commitments

When authors submit a manuscript, whether

an article or a letter, they are responsible for

disclosing all financial and personal relationships that

might bias their work. To prevent ambiguity, authors

must state explicitly whether potential conflicts do

or do not exist. Authors should do so in the

manuscript on a conflict of interest notification page

that follows the title page, providing additional

detail, if necessary, in a cover letter that accompanies

the manuscript.

Authors should identify Individuals who

provide writing assistance and disclose the funding

source for this assistance.

Investigators must disclose potential conflicts

to study participants and should state in the

manuscript whether they have done so.

II.D.2. Potential Conflicts of Interest Related

to Project Support

Increasingly, individual studies receive

funding from commercial firms, private foundations,

and government. The conditions of this funding have

the potential to bias and otherwise discredit the

research.

Scientists have an ethical obligation to submit

creditable research results for publication. Moreover,

as the persons directly responsible for their work,


134

researchers should not enter into agreements that

interfere with their access to the data and their

ability to analyze it independently, to prepare

manuscripts, and to publish them. Authors should

describe the role of the study sponsor(s), if any, in

study design; in the collection, analysis, and

interpretation of data; in the writing of the report;

and in the decision to submit the report for

publication. If the supporting source had no such

involvement, the authors should so state. Biases

potentially introduced when sponsors are directly

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biases of other sorts. Include Information about the

sponsor’s involvement in the methods section.

Sign a statement such as, “I had full access

to all of the data in this study and I take complete

responsibility for the integrity of the data and the

accuracy of the data analysis.”

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II. E.1. Patients and Study Participants

Patients have a right to privacy that should

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Identifying information, including patients’ names,

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Informed consent for this purpose requires that a

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Identifying details should be omitted if they

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the eye region in photographs of patients is

inadequate protection of anonymity.

Informed consent is a must in prospective

trials involving human beings. When informed

consent has been obtained it should be indicated in

the manuscript.

II.E.2. Authors and Reviewers

Manuscripts will be reviewed with due

respect for authors’ confidentiality. Confidentiality

may have to be breached if dishonesty or fraud is

alleged but otherwise will be honored.

Information about manuscripts (including

their receipt, content, status in the reviewing

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and reviewers. This includes requests to use the

materials for legal proceedings.

Reviewer comments should not be published

or otherwise made public without permission of the

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The reviewers’ identity will not be revealed

to the author or anyone else without the reviewer’s

permission.

Reviewers’ comments will be sent to other

reviewers of the same manuscript, which helps

reviewers learn from the review process, and

reviewers may be notified of the editor’s decision.

II.F. Protection of Human Subjects and

Animals in Research

When reporting experiments on human

subjects, authors should indicate whether the

procedures followed were in accordance with the

ethical standards of the responsible committee on

human experimentation (institutional and national)

and with the Helsinki Declaration of 1975, as revised

in 2000. If doubt exists whether the research was

conducted in accordance with the Helsinki

Declaration, the authors must explain the rationale

for their approach, and demonstrate that the

institutional review body explicitly approved the

doubtful aspects of the study. When reporting

experiments on animals, authors should be asked to

indicate whether the institutional and national guide

for the care and use of laboratory animals was

followed.


135

III. Publishing and Editorial Issues Related to

Publication in Biomedical Journals

III.A. Obligation to Publish Negative Studies

Editors will consider seriously for publication

any carefully done study of an important question,

relevant to readers, whether the results are negative

(that is, convincingly allow the null hypothesis to be

accepted) or positive (that is, allow the null

hypothesis to be rejected).

III.B. Corrections, Retractions and

“Expressions of Concern”

Editors assume initially that authors are

reporting work based on honest observations.

Nevertheless, two types of difficulty may arise.

First, errors may be noted in published

articles that require the publication of a correction

or erratum of part of the work. The corrections will

appear on a numbered page, be listed in the

contents page, include the complete original citation,

and link to the original article and vice versa online.

It is conceivable that an error could be so serious

as to vitiate the entire body of the work, but this is

unlikely and will be handled by editors and authors

on an individual basis. Such an error should not be

confused with inadequacies exposed by the

emergence of new scientific information in the

normal course of research. The latter requires no

corrections or withdrawals.

The second type of difficulty is scientific

fraud. If substantial doubts arise about the honesty

or integrity of work, either submitted or published,

it is the editor’s responsibility to ensure that the

question is appropriately pursued, usually by the

authors’ sponsoring institution. However, it is not

ordinarily the task of editors to conduct a full

investigation or to make a determination; that

responsibility lies with the institution where the work

was done or with the funding agency. The editor

should be promptly informed of the final decision,

and if a fraudulent paper has been published, the

journal will print a retraction. If this method of

investigation does not result in a satisfactory

conclusion, the editor may choose to conduct own

investigation. As an alternative to retraction, the

editor may choose to publish an expression of

concern about aspects of the conduct or integrity of

the work.

The retraction or expression of concern, so

labeled, will appear on a numbered page in a

prominent section of the print journal as well as in

the online version, be listed in the contents page,

and included in its heading the title of the original

article. It will not simply be a letter to the editor.

Ideally, the first author will be the same in the

retraction as in the article, although under certain

circumstances the editor may accept retractions by

other responsible persons. The text of the retraction

should explain why the article is being retracted and

include a full original citation reference to it.

The validity of previous work by the author

of a fraudulent paper cannot be assumed. Editors

may ask the author’s institution to assure them of the

validity of earlier work published in their journals or

to retract it. If this is not done editors may choose

to publish an announcement expressing concern that

the validity of previously published work is

uncertain.

III.C. Copyright

The copyright status of articles in a given

journal can vary: some content cannot be

copyrighted (articles written by employees of the

governments in the course of their work, for

example).

III.D. Overlapping Publications

III.D.1. Duplicate Submission

The Journal will not consider manuscripts

that are simultaneously being considered by other

journals.

III.D.2. Redundant Publication

Redundant (or duplicate) publication is

publication of a paper that overlaps substantially

with one already published in print or electronic

media.

Readers of primary source periodicals,

whether print or electronic, deserve to be able to


136

trust that what they are reading is original unless

there is a clear statement that the article is being

republished by the choice of the author and editor.

The bases of this position are international copyright

laws, ethical conduct, and cost-effective use of

resources. Duplicate publication of original research

is particularly problematic, since it can result in

inadvertent double counting or inappropriate

weighting of the results of a single study, which

distorts the available evidence.

This journal does not wish to receive papers

on work that has already been reported in large part

in a published article or is contained in another

paper that has been submitted or accepted for

publication elsewhere, in print or in electronic

media. This policy does not preclude the journal

considering a paper that has been rejected by

another journal, or a complete report that follows

publication of a preliminary report, such as an

abstract or poster displayed at a professional

meeting. Nor does it prevent the journals considering

a paper that has been presented at a scientific

meeting but not published in full or that is being

considered for publication in a proceedings or

similar format.

When submitting a paper, the author must

always make a full statement to the editor about all

submissions and previous reports that might be

regarded as redundant or duplicate publication of the

same or very similar work. The author must alert the

editor if the manuscript includes subjects about

which the authors have published a previous report

or have submitted a related report to another

publication. Any such report must be referred to and

referenced in the new paper. Copies of such material

should be included with the submitted paper.

III.D.3. Acceptable Secondary Publication

Certain types of articles, such as guidelines

produced by governmental agencies and professional

organizations, may need to reach the widest possible

audience. In such instances, editors will choose to

publish material that is also being published in other

journals. Secondary publication for various other

reasons, in the same or another language, especially

in other countries and/or states, is justifiable, and

can be beneficial, provided all of the following

conditions are met.

1 . The authors have received approval from the

editors of both journals; the editor concerned

with secondary publication must have a

photocopy, reprint, or manuscript of the primary

version.

2. The priority of the primary publication is

respected by a publication interval of at least one

week.

3. The paper for secondary publication is intended

for a different group of readers; an abbreviated

version could be sufficient.

4. The secondary version faithfully reflects the data

and interpretations of the primary version.

5. The footnote on the title page of the secondary

version informs readers, peers, and documenting

agencies that the paper has been published in

whole or in part and states the primary

reference. A suitable footnote might read: “This

article is based on a study first reported in the

[title of journal, with full reference].”

Permission for such secondary publication

should be free of charge.

6. The title of the secondary publication should

indicate that it is a secondary publication

(complete republication, abridged republication,

complete translation, or abridged translation) of

a primary publication. Of note, the National

Library of Medicine does not consider

translations to be “republications,” and does not

cite or index translations when the original article

was published in a journal that is indexed in

MEDLINE.

III.D.4. Competing Manuscripts Based on the

Same Study

Two kinds of competing submissions will be

considered: submissions by coworkers who disagree

on the analysis and interpretation of their study, and


137

submissions by coworkers who disagree on what the

facts are and which data should be reported.

Setting aside the unresolved question of

ownership of the data, the following general

observations may help editors and others dealing

with these problems.

III. D.4.a. Differences in Analysis or

Interpretation

If the dispute centers on the analysis or

interpretation of data, the authors should submit a

manuscript that clearly presents both versions. The

difference of opinion should be explained in a cover

letter. The normal process of peer and editorial

review of the manuscript may help the authors to

resolve their disagreement regarding analysis or

interpretation.

If the dispute cannot be resolved and the

study merits publication, both versions will be

published. Options include publishing two papers on

the same study, or a single paper with two analyses

or interpretations. In such cases it would be

appropriate for the editor to publish a statement

outlining the disagreement and the journal’s

involvement in attempts to resolve it.

III.D.4. b. Differences in Reported Methods or

Results

If the dispute centers on differing opinions of

what was actually done or observed during the study,

the journal editor will refuse publication until the

disagreement is resolved. Peer review cannot be

expected to resolve such problems. If there are

allegations of dishonesty or fraud, editors will inform

the appropriate authorities; authors will be notified

of editor’s intention to report a suspicion of research

misconduct.

III.D.5. Competing Manuscripts Based on the

Same Database

Editors may sometimes receive manuscripts

from separate research groups that have analyzed

the same data set, e.g., from a public database. The

manuscripts may differ in their analytic methods,

conclusions, or both. Each manuscript will be

considered separately. Where interpretations of the

same data are very similar, it is reasonable but not

necessary for editors to give preference to the

manuscript that was received earlier. However,

editorial consideration of multiple submissions may

be justified in this circumstance, and there may even

be a good reason for publishing more than one

manuscript because different analytical approaches

may be complementary and equally valid.

III.E. Correspondence

As a mechanism for submitting comments,

questions, or criticisms about published articles, as

well as brief reports and commentary unrelated to

previously published articles. This will likely, but not

necessarily, take the form of a correspondence

section or column. The authors of articles discussed

in correspondence should be given an opportunity

to respond, preferably in the same issue in which the

original correspondence appears. Authors of

correspondence will be asked to declare any

competing or conflicting interests.

Published correspondence may be edited for

length, grammatical correctness, and journal style.

Although editors have the prerogative to sift

out correspondence material that is irrelevant,

uninteresting, or lacking in cogency, they have a

responsibility to allow a range of opinion to be

expressed. The correspondence column will not be

used merely to promote the journal’s, or the editors’,

point of view. In all instances, editors will make an

effort to screen out discourteous, inaccurate, or

libelous statements.

In the interests of fairness and to keep

correspondence within manageable proportions,

journal may want to set time limits for responding

to articles and correspondence, and for debate on a

given topic. Journal has also set policy with regard

to the archiving of unedited correspondence that

appears on line. These policies should be published

both in print and electronic versions of the journal.

III.F. Supplements, Theme Issues, and Special

Series

Supplements are collections of papers that


138

deal with related issues or topics, are published as a

separate issue of the journal or as part of a regular

issue, and are usually funded by sources other than

the journal’s publisher. Supplements can serve useful

purposes: education, exchange of research

information, ease of access to focused content, and

improved cooperation between academic and

corporate entities. Because funding sources can bias

the content of supplements through the choice of

topics and viewpoints, this journal adopts the

following principles. These same principles apply to

theme issues or special series that have external

funding and/or guest editors.

1 . The journal editors take full responsibility for the

policies, practices, and content of supplements,

including complete control of the decision to

publish all portions of the supplement. Editing by

the funding organization will not be permitted.

2. The journal editors will retain the authority to

send supplement manuscripts for external peer

review and to reject manuscripts submitted for

the supplement.

3. The journal editors will approve the appointment

of any external editor of the supplement and take

responsibility for the work of the external editor.

4. The sources of funding for the research,

publication, and the products the funding source

make that are considered in the supplement

should be clearly stated and prominently located

in the supplement, preferably on each page.

Whenever possible, funding should come from

more than one sponsor.

5. Secondary publication in supplements

(republication of papers previously published

elsewhere) will be clearly identified by the

citation of the original paper. Supplements will

avoid redundant or duplicate publication.

Supplements will not republish research results,

but the republication of guidelines or other

material in the public interest might be

appropriate.

IV. Manuscript Preparation and Submission

IV.A. Preparing a Manuscript for Submission

Editors and reviewers spend many hours

reading manuscripts, and therefore appreciate

receiving with manuscripts that are easy to read and

edit. Much of the information in journals’ instructions

to authors is designed to accomplish that goal in

ways that meet each journal’s particular editorial

needs. The guidance that follows provides a general

background and rationale for preparing manuscripts

for any journal.

IV.A.1.a. General Principles

The text of observational and experimental

articles is usually (but not necessarily) divided into

sections with the headings Introduction, Methods,

Results, and Discussion. This so-called “IMRAD”

structure is not simply an arbitrary publication

format, but rather a direct reflection of the process

of scientific discovery. Long articles may need

subheadings within some sections (especially the

Results and Discussion sections) to clarify their

content. Other types of articles, such as case reports,

reviews, and editorials, are likely to need other

formats.

Publication in electronic formats has created

opportunities for adding details or whole sections in

the electronic version only, layering information,

cross-linking or extracting portions of articles, and

the like. Authors need to work closely with editors

in developing or using such new publication formats

and should submit material for potential

supplementary electronic formats for peer review.

Double spacing of all portions of the

manuscript including the title page, abstract, text,

acknowledgments, references, individual tables, and

legends-and generous margins make it possible for

editors and reviewers to edit the text line by line,

and add comments and queries, directly on the

paper copy. If manuscripts are submitted

electronically, the files should be double spaced,

because the manuscript may need to be printed out

for reviewing and editing.


139

During the editorial process reviewers and

editors frequently need to refer to specific portions

of the manuscript, which is difficult unless the pages

are numbered. Authors should therefore number all

of the pages of the manuscript consecutively,

beginning with the title page.

IV.A.1.b. Reporting Guidelines for Specific

Study Designs

Research reports frequently omit important

information. The general requirements listed in the

next section relate to reporting essential elements for

all study designs. Authors are encouraged in addition

to consult reporting guidelines relevant to their

specific research design. For reports of randomized

controlled trials authors should refer to the CONSORT

statement. This guideline provides a set of

recommendations comprising a list of items to report

and a patient flow diagram.

IV.A.2. Title Page

The title page should carry the following

information:

1 . The title of the article. Concise titles are easier

to read than long, convoluted ones. Titles that

are too short may, however, lack important

information, such as study design (which is

particularly important in identifying randomized

controlled trials). Authors should include all

information in the title that will make electronic

retrieval of the article both sensitive and

specific.

2. Authors’ names and institutional affiliations.

3. The name of the department(s) and institution(s)

to which the work should be attributed.

4. Disclaimers, if any.

5. Corresponding authors. The name, mailing

address, telephone and fax numbers, and e-mail

address of the author responsible for

correspondence about the manuscript (the

“corresponding author;” this author may or may

not be the “guarantor” for the integrity of the

study as a whole, if someone is identified in that

role. The corresponding author should indicate

clearly whether his or her e-mail address is to be

published.

6. The name and address of the author to whom

requests for reprints should be addressed.

7 . Source(s) of support in the form of grants,

equipment, drugs, or all of these.

8. Word counts. A word count for the text only

(excluding abstract, acknowledgments, figure

legends, and references) allows editors and

reviewers to assess whether the information

contained in the paper warrants the amount of

space devoted to it, and whether the submitted

manuscript fits within the journal’s word limits.

A separate word count for the Abstract is also

useful for the same reason.

9. The number of figures and tables. It is difficult

for editorial staff and reviewers to tell if the

figures and tables that should have accompanied

a manuscript were actually included unless the

numbers of figures and tables that belong to the

manuscript are noted on the title page.

IV.A.3. Conflict of Interest Notification Page

To prevent the information on potential

conflict of interest for authors from being overlooked

or misplaced, it is necessary for that information to

be part of the manuscript. It should therefore also

be included on a separate page or pages immediately

following the title page.

IV.A.4. Abstract and Key Words

An abstract should follow the title page. The

abstract should provide the context or background

for the study and should state the study’s purposes,

basic procedures (selection of study subjects or

laboratory animals, observational and analytical

methods), main findings (giving specific effect sizes

and their statistical significance, if possible), and

principal conclusions. It should emphasize new and

important aspects of the study or observations.

Because abstracts are the only substantive

portion of the article indexed in electronic database

and the only portion many readers read, authors

need to be careful that abstracts reflect the content

of the article accurately.


140

3 to 10 key words or short phrases that

capture the main topics of the article. These will

assist indexers in cross-indexing the article and may

be published with the abstract. Terms from the

Medical Subject Headings (MeSH) list of Index

Medicus should be used; if suitable MeSH terms are

not yet available for present terms may be used.

IV.A.5. Introduction

Provide a context or background for the

study (i.e., the nature of the problem and its

significance). State the specific purpose or research

objective of, or hypothesis tested by, the study or

observation; the research objective is often more

sharply focused when stated as a question. Both the

main and secondary objectives should be made clear,

and any pre-specified subgroup analyses should be

described. Give only strictly pertinent references and

do not include data or conclusions from the work

being reported.

IV.A.6. Methods

The Methods section should include only

information that was available at the time the plan

or protocol for the study was written; all information

obtained during the conduct of the study belongs in

the Results section.

IV.A.6.a. Selection and Description of

Participants

Describe your selection of the observational

or experimental participants (patients or laboratory

animals, including controls) clearly, including

eligibility and exclusion criteria and a description of

the source population. Because the relevance of such

variables as age and sex to the object of research is

not always clear, authors should explain their use

when they are included in a study report; for

example, authors should explain why only subjects

of certain ages were included or why women were

excluded. The guiding principle should be clarity

about how and why a study was done in a particular

way. When authors use variables such as race or

ethnicity, they should define how they measured the

variables and justify their relevance.

IV.A.6.b. Technical information

Identify the methods, apparatus (give the

manufacturer’s name and address in parentheses),

and procedures in sufficient detail to allow other

workers to reproduce the results. Give references to

established methods, including statistical methods

see below; provide references and brief descriptions

for methods that have been published but are not

well known; describe new or substantially modified

methods, give reasons for using them, and evaluate

their limitations. Identify precisely all drugs and

chemicals used, including generic name(s), dose(s),

and route(s) of administration.

Authors submitting review manuscripts

should include a section describing the methods used

for locating, selecting, extracting, and synthesizing

data. These methods should also be summarized in

the abstract.

IV.A.6.c. Statistics

Describe statistical methods with enough

detail to enable a knowledgeable reader with access

to the original data to verify the reported results.

When possible, quantify findings and present them

with appropriate indicators of measurement error or

uncertainty (such as confidence intervals).

References for the design of the study and statistical

methods should be to standard works when possible

(with pages stated). Define statistical terms,

abbreviations, and most symbols. Specify the

computer software used.

IV.A.7. Results

Present your results in logical sequence in

the text, tables, and illustrations, giving the main or

most important findings first. Do not repeat in the

text all the data in the tables or illustrations;

emphasize or summarize only important

observations. Extra or supplementary materials and

technical detail can be placed in an appendix where

it will be accessible but will not interrupt the flow of

the text; alternatively, it can be published only in the

electronic version of the journal.

When data are summarized in the Results


141

section, give numeric results not only as derivatives

(for example, percentages) but also as the absolute

numbers from which the derivatives were calculated,

and specify the statistical methods used to analyze

them. Restrict tables and figures to those needed to

explain the argument of the paper and to assess its

support. Use graphs as an alternative to tables with

many entries; do not duplicate data in graphs and

tables. Avoid non-technical uses of technical terms

in statistics, such as “random” (which implies a

randomizing device), “normal,” “significant,”

“correlations,” and “sample.”

Where scientifically appropriate, analyses of

the data by variables such as age and sex should be

included.

IV.A.8. Discussion

Emphasize the new and important aspects of

the study and the conclusions that follow from them.

Do not repeat in detail data or other material given

in the Introduction or the Results section. For

experimental studies it is useful to begin the

discussion by summarizing briefly the main findings,

then explore possible mechanisms or explanations

for these findings, compare and contrast the results

with other relevant studies, state the limitations of

the study, and explore the implications of the

findings for future research and for clinical practice.

Link the conclusions with the goals of the

study but avoid unqualified statements and

conclusions not adequately supported by the data.

In particular, authors should avoid making

statements on economic benefits and costs unless

their manuscript includes the appropriate economic

data and analyses. Avoid claiming priority and

alluding to work that has not been completed. State

new hypotheses when warranted, but clearly label

them as such.

IV.A.9. References

IV.A.9.a. General Considerations Related to

References

Although references to review articles can be

an efficient way of guiding readers to a body of

literature, review articles do not always reflect

original work accurately. Readers should therefore be

provided with direct references to original research

sources whenever possible. On the other hand,

extensive lists of references to original work on a

topic can use excessive space on the printed page.

Small numbers of references to key original papers

will often serve as well as more exhaustive lists,

particularly since references can now be added to

the electronic version of published papers, and since

electronic literature searching allows readers to

retrieve published literature efficiently.

Avoid using abstracts as references.

References to papers accepted but not yet published

should be designated as “in press” or “forthcoming”;

authors should obtain written permission to cite

such papers as well as verification that they have

been accepted for publication. Information from

manuscripts submitted but not accepted should be

cited in the text as “unpublished observations” with

written permission from the source.

Avoid citing a “personal communication”

unless it provides essential information not available

from a public source, in which case the name of the

person and date of communication should be cited

in parentheses in the text. For scientific articles,

authors should obtain written permission and

confirmation of accuracy from the source of a

personal communication.

Some journals check the accuracy of all

reference citations, but not all journals do so, and

citation errors sometimes appear in the published

version of articles. To minimize such errors, authors

should therefore verify references against the

original documents. Authors are responsible for

checking that none of the references cite retracted

articles except in the context of referring to the

retraction. For articles published in journals indexed

in MEDLINE, the ICMJE considers PubMed the

authoritative source for information about

retractions.

IV.A.9.b. Reference Style and Format

The Uniform Requirements style is based

largely on an ANSI standard style adapted by the


142

National Library of Medicine (NLM) for its databases.

For samples of reference citation formats, authors

should consult National Library of Medicine web

site.

References should be numbered

consecutively in the order in which they are first

mentioned in the text. Identify references in text,

tables, and legends by Arabic numerals in

parentheses. References cited only in tables or figure

legends should be numbered in accordance with the

sequence established by the first identification in the

text of the particular table or figure. The titles of

journals should be abbreviated according to the style

used in Index Medicus.

This Journal requires that the references from

the Ayurvedic classics should be cited within

parentheses in the text, i.e. ( Cha. Soo. 25/40).

IV.A.10. Tables

Tables capture information concisely, and

display it efficiently; they also provide information

at any desired level of detail and precision. Including

data in tables rather than text frequently makes it

possible to reduce the length of the text.

Type or print each table with double spacing

on a separate sheet of paper. Number tables

consecutively in the order of their first citation in the

text and supply a brief title for each. Do not use

internal horizontal or vertical lines. Give each

column a short or abbreviated heading. Authors

should place explanatory matter in footnotes, not in

the heading. Explain in footnotes all nonstandard

abbreviations. For footnotes use the following

symbols, in sequence:

*,†,‡,§,||,¶,**,††,‡‡

Identify statistical measures of variations,

such as standard deviation and standard error of the

mean.

Be sure that each table is cited in the text.

If you use data from another published or

unpublished source, obtain permission and

acknowledge them fully.

Additional tables containing backup data too

extensive to publish in print may be appropriate for

publication in the electronic version of the journal.

In that event an appropriate statement will be added

to the text. Submit such tables for consideration with

the paper so that they will be available to the peer

reviewers.

IV.A.11. Illustrations (Figures)

Figures should be either professionally drawn

and photographed, or submitted as photographic

quality digital prints. In addition to requiring a

version of the figures suitable for printing, this

Journal asks authors for electronic files of figures in

a format (e.g., JPEG or GIF) that will produce high

quality images in the web version of the journal;

authors should review the images of such files on a

computer screen before submitting them, to be sure

they meet their own quality standard.

For x-ray films, scans, and other diagnostic

images, as well as pictures of pathology specimens

or photomicrographs, send sharp, glossy, black-and-

white or color photographic prints, usually 127 x

173 mm (5 x 7 inches). Letters, numbers, and

symbols on Figures should be clear and even

throughout, and of sufficient size that when reduced

for publication each item will still be legible. Figures

should be made as self-explanatory as possible. Titles

and detailed explanations belong in the legends,

however, not on the illustrations themselves.

Photomicrographs should have internal scale

markers. Symbols, arrows, or letters used in

photomicrographs should contrast with the

background.

If photographs of people are used, either the

subjects must not be identifiable or their pictures

must be accompanied by written permission to use

the photograph. Whenever possible permission for

publication should be obtained.

Figures should be numbered consecutively

according to the order in which they have been first

cited in the text. If a figure has been published,

acknowledge the original source and submit written

permission from the copyright holder to reproduce


143

the material. Permission is required irrespective of

authorship or publisher except for documents in the

public domain.

IV.A.12. Legends for Illustrations (Figures)

Type or print out legends for illustrations

using double spacing, starting on a separate page,

with Arabic numerals corresponding to the

illustrations. When symbols, arrows, numbers, or

letters are used to identify parts of the illustrations,

identify and explain each one clearly in the legend.

Explain the internal scale and identify the method of

staining in photomicrographs.

IV.A.13. Units of Measurement

Use only standard Units of Measurements. If

some new measurements or scoring patterns are used

they should be explained in detail in the text.

IV.A.14. Abbreviations and Symbols

Use only standard abbreviations; the use of

non-standard abbreviations can be extremely

confusing to readers. Avoid abbreviations in the title.

The full term for which an abbreviation stands

should precede its first use in the text unless it is a

standard unit of measurement.

IV.B Sending the Manuscript to the Journal

This Journal accepts electronic submission of

manuscripts, whether on disk or attachments to

electronic mail. Electronic submission saves time as

well as postage costs, and allows the manuscript to

be handled in electronic form throughout the

editorial process (for example, when it is sent out for

review). When submitting a manuscript

electronically, authors should consult with the

instructions for authors of the journal they have

chosen for their manuscript.

If a paper version of the manuscript is

submitted, send the required number of 6 copies of

the manuscript and figures; they are all needed for

peer review and editing, and editorial office staff

cannot be expected to make the required copies.

Manuscripts must be accompanied by a

cover letter, which should include the following

information.

l A full statement to the editor about all

submissions and previous reports that might be

regarded as redundant publication of the same or

very similar work. Any such work should be

referred to specifically, and referenced in the

new paper. Copies of such material should be

included with the submitted paper, to help the

editor decide how to handle the matter.

l A statement of financial or other relationships

that might lead to a conflict of interest, if that

information is not included in the manuscript

itself or in an authors’ form

l A statement that the manuscript has been read

and approved by all the authors, that the

requirements for authorship as stated earlier in

this document have been met, and that each

author believes that the manuscript represents

honest work, if that information is not provided

in another form; and

l The name, address, and telephone number of the

corresponding author, who is responsible for

communicating with the other authors about

revisions and final approval of the proofs, if that

information is not included on the manuscript

itself.

The letter should give any additional

information that may be helpful to the editor, such

as the type or format of article in the particular

journal that the manuscript represents. If the

manuscript has been submitted previously to

another journal, it is helpful to include the previous

editor’s and reviewers’ comments with the submitted

manuscript, along with the authors’ responses to

those comments. Editors encourage authors to

submit these previous communications and doing so

may expedite the review process.

Copies of any permission to reproduce

published material, to use illustrations or report

information about identifiable people, or to name

people for their contributions must accompany the

manuscript.


144

V. References

A. References Cited in this Document

1 . Davidoff F for the CSE Task Force on Authorship.

Who’s the Author? Problems with Biomedical

Authorship, and Some Possible Solutions.

Science Editor. July-August 2000: Volume 23 -

Number 4: 111-119.

2. Yank V, Rennie D. Disclosure of researcher

contributions: a study of original research

articles in The Lancet. Ann Intern Med. 1999 Apr

20;130(8):661-70.

3. Flanagin A, Fontanarosa PB, DeAngelis CD.

Authorship for research groups. JAMA.

2002;288:3166-68.

4. Peer Review in Health Sciences. F Godlee, T

Jefferson. London: BMJ Books, 1999.

5. World Medical Association Declaration of

Helsinki: ethical principles for medical research

involving human subjects. JAMA. 2000 Dec

20;284(23):3043-5.

6. Pitkin RM, Branagan MA, Burmeister LF.

Accuracy of data in abstracts of published

research articles. JAMA. 1999 Mar 24-

31;281(12):1110-1.

7 . Patrias K. National Library of Medicine

recommended formats for bibliographic citation.

Bethesda (MD): The Library; 1991.

B. Other Sources of Information Related to

Biomedical Journals

World Association of Medical Editors (WAME)

www.WAME.org <http://www.WAME.org>

Council of Science Editors (CSE)

www.councilscienceeditors.org <http://

www.councilscienceeditors.org>

European Association of Science Editors (EASE)

www.ease.org.uk <http://www.ease.org.uk>

Cochrane Collaboration www.cochrane.org

<http://www.cochrane.org>

The Mulford Library, Medical College of Ohio

www.mco.edu/lib/instr/libinsta.html <http://

www.mco.edu/lib/instr/libinsta.html>

“This is a reprint (with minor alterations

according to the need of this Journal ) of the

ICMJE Uniform Requirements for Manuscripts

Submitted to Biomedical Journals. The editors of

this Journals prepared this altered version. The

ICMJE has neither endorsed nor approved the

contents of this reprint. The ICMJE periodically

updates the Uniform Requirements, so this

reprint prepared on 1.1.2007 may not accurately

represent the current official version at

www.ICMJE.org <http://www.ICMJE.org>. The

official version of the Uniform Requirements for

Manuscripts Submitted to Biomedical Journals is

located at www.ICMJE.org <http://

www.ICMJE.org>.”


145

Annexure I

Manuscript no. JOA/NIA/200 /

Authorship Criteria and ResponsibilityFinancial Disclosure, Acknowledgment and Copyright Transfer Form

Manuscript Title :

I/We certify that the manuscript represents valid work and that neither this manuscript nor one

with substantially similar content under my/our authorship has been published or is being considered for

publication elsewhere. For papers with more than 1 author, We agree to allow the corresponding author

to serve as the primary correspondent with the editorial office, to review the edited typescript and proof.

I/We have seen and approved the submitted manuscript. All of us have participated sufficiently in

the work to take public responsibility for the contents. All the authors have made substantial contributions

to the intellectual content of the paper and fulfil at least 1 condition for each of the 3 categories of

contributions: i.e., Category 1 (conception and design, acquisition of data, analysis and interpretation of

data), Category 2 (drafting of the manuscript, critical revision of the manuscript for important intellectual

content) and Category 3 (final approval of the version to be published).

I/We also certify that all my/our affiliations with or financial involvement with any organization

or entity with a financial interest in or financial conflict with the subject matter or materials discussed in

the manuscript are completely disclosed on the title page of the manuscript. My/our right to examine,

analyze, and publish the data is not infringed upon by any contractual agreement. I/We certify that all

persons who have made substantial contributions to the work reported in this manuscript (e.g., data

collection, writing or editing assistance) but who do not fulfil the authorship criteria are named along with

their specific contributions in an acknowledgment section in the manuscript. If an acknowledgment section

is not included, no other persons have made substantial contributions to this manuscript. I/We also certify

that all persons named in the acknowledgment section have provided written permission to be named.

The author(s) undersigned hereby transfer(s), assign(s), or otherwise convey(s) all copyright

ownership, including any and all rights incidental thereto, exclusively to the Journal of Ayurveda, in the

event that such work is published in Journal of Ayurveda.

Authors’ name(s) in order of appearance in the manuscript.

1 . Name Signatures (date)

2. Name Signatures (date)






146

Annexure II

Manuscript Submission Checklist

Submitted by: E-mail • Post • Both •

Covering letter and submission :

1 . Covering letter (in original) •

2. Copyright transfer form (in original) •

3. Illustrations (in original) •

4. Manuscript (E-mail/original) •

5. Category for which submitted •

Presentation and Format :

1 . Printed on A4 paper with 1" margins on all sides in double space. •

2. Abstract, text, acknowledgement, references, legends, tables starting on a new page. •

3. Title page contains the following:

- Full title of the paper •

- Initials, surname and highest degree of authors, affiliation •

- Name of Departments/Institution •

- Details of Corresponding Authors including e-mail •

- Numbers in Arabic numerals. •

4. Abstract (Hindi and English) and Key words provided. •

5. “What this study adds” Box (only for research papers and short communications). •

6. References. •

7 . Pages numbered consecutively. •

Language and Grammar :

1 . Uniform American English. •

2. Abbreviations spelt out in full for first time. •

3. Text arranged as per IMRAD format. •

4. Follows style of writing in Journal of Ayurveda. •

5. Conventional units used throughout manuscript. •

Tables and Figures :

1 . No repetition of data in Table/graphs and in text. •

2. Figures are black and white (except Images), good quality; with labels on back. •

3. Table numbers in roman numerals and Figure numbers in Arabic numerals. •

4. Correct symbols used for footnotes to tables. •

5. Figure legends provided. •

6. Patient privacy maintained •


147

INSTITUTE NEWS

N.N. Kutty*

Short Communication

*Administrative Officer, NIA, Jaipur

Shri Nilanjan Sanyal, Secretary, Departmentof AYUSH visited the Institute to see various

academic, patient care and other functions of theInstitute. He was taken to various Departments,Pharmacy, IPD, OPD, Central Laboratory,

Auditorium etc. and was shown various activities.He also interacted with Director and FacultyMembers on various matters.

The 49 th Meeting of Standing FinanceCommittee was held on 23-9-2013 under theChairmanship of Shri Bala Prasad, IFS, Joint

Secretary, Department of AYUSH and variousrecommendations were made for the developmentand progress of the Institute.


148

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