An Evaluation of the Efficacy of

Phalatrikadiyoga in Kamala (Jaundice)

By

Gangadhar. S. Hadimani

As partial fulfillment of post graduation degree M.D.(Ayurveda Vachaspati) Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka

Guide

Dr. K. Siva Rama Prasad M.A. (Jyotish) M.D. (Ayu) (Osm)

Assistant Professor / Reader in Kayachikitsa Department of Kayachikitsa

Post Graduate Studies and research

D.G. Melmalagi Ayurvedic Medical College Gadag - 582 103

Post graduation and research center Kayachikitsa

2000-2003

This is to certify that GANGADHAR. S. HADIMANI has carried out present work

entitled An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice)

under close guidance and supervision. He did this clinical study very sincerely and

methodically. His study, which is presented as a dissertation for the award of M.D.

(Ayurveda Vachaspathi) Kayachikitsa from Rajiv Gandhi University of Health Sciences,

Bangalore is satisfactory.

This study bears ample evidences of original thoughts and expressions and this

dissertation is not an ersatz and has not been formed previously for the award of any

Degree /Diploma or titles in the field of research in Ayurveda.

This dissertation is recommending to be submitted before the adjudicators for

assessment, approval and awarding the M.D. (Ayurveda Vachaspathi) Kayachikitsa.

Date:

Place:

Guide Dr. Siva Rama Prasad Kethamakka

M.D. (Ayu) (Osm) M.A (Jyotish)

Assistant Professor / Reader in Kayachikitsa

Department of Kayachikitsa

Post graduate Studies and research,

D.G. Melmalagi Ayurvedic Medical College

Gadag - 582 103

Acknowledgement I express my deep sense of gratitude to my guide Dr. Siva Rama Prasad

Kethamakka, M.D (Ayu) MA (Astro) Reader / Assistant Professor, Department of

Kayachikitsa, Post Graduate studies and Research, D.G.M Ayurvedic Medical Collage,

Gadag for his much valued guidance, constant support and encouragement throughout

the study.

I acknowledgement my sincere gratitude to Dr. V. Varadacharyulu H.O.D

Department of Kayachikitsa, Post Graduate studies and Research, D.G.M.A.M.C Gadag

for his experts comments critical analysis and affectionate encouragement throughout

the study.

I am very extremely thankful to Dr. G. B. Patil Principal D.G.M Ayurvedic Medical

College and Post Graduate studies and Research, Gadag for his support to post

Graduation study and providing all necessary facilities for this research works.

It gives me pleasure to express my gratitude Dr. S. H. Doddamani,

Dr. R. V. Shetter, Dr. A. K. Panda lecture’s of post graduation research studies in

Kayachikitsa, D.G.M.A.C Gadag for his valuable suggestions and moral support through

the study.

I extend my immense gratitude to Dr. M. C. Patil professor P. G. Rasashastra &

Dr. Kuber Shank, Lecturer in Dravyaguna, Post Graduation studies and research center

D.G.M Ayurvedic Medical College Gadag.

I sincerely remember to my all under graduate professors, Assistant Professors

and lecturers of D.G.M Ayurvedic Medical College, Gadag for there help and

suggestions during my post graduate studies.

The grace of God and blessings of Shree Jagadguru Abhinava Shivananda

Swamiji, it is pleasure to express my thankful to the management committee. Shri

S.B.Sanshi Chairman and members Shri M. S. Mulkipatil, Shri B. S. Patil, Shri. B. C.

Patil, Matoshri Girijamma Melmalagi for providing M.D seat and also helping during

study.

I sincerely thanks to my beloved colleagues Dr. Srinivasreddy CM, Dr. Yasmin

PA, Dr. B.G. Swamy. I am also thankful to all my postgraduate collegues Dr.

B.M.Mulkipatil, Dr. Anil Baccha, Dr. V.N. Kulkarni, Dr. Seetaramaprasad, Dr. G.S.

Hiremath, Dr. Suresh.R.D, Dr. C.V.Rajashekhar, Dr. Shankaragouda, Dr.

Hanumanthagouda, Dr. Shayju, Dr. U. V. Purad for their constant co-operation and help

in the PG study.

My sincere thanks to Shri V.M.Mundinamani, beloved librarian and Mr. S. B.

Sureban for supplying me essential reference in the study. I am thankful to Mr.

Basavaraj, S. Tippanagoudar, and Lab Technician, Dr. Rajashekhar Pawadashettar

pathologist in Gadag who extended his co-operation on investigations.

I thanks to Mr. P. M. Nandakumar for his help in the statistical evaluate. I thank to

Mr. Anjaneyappa. B,, Mr. Shivakumar.G, Dr. Chandahussain, Dr. Girish. N. D,, Dr.

Anand. K. P, Dr. S. S. Patil, Dr. B. K. Hiremath and Dr. P.S.Chavadi support to the

completion of this work.

I express my deep affectionate love to my father Shri. Sadashivappa. G.

Hadimani, Smt. Shantavva, Brother’s, Sisters and my all-family member and relatives for

their love and affection rendered throughout my career.

With deep sense to gratitude I thank all the subjects who participated in this

study.

Gangadhar. S. Hadimani

Ayurveda is a Science it deals with the study of knowledge of life. The aim of this

science is to protect the Human being from various diseases, which acquire by not following

the swasthavritha, The prevention of the disease and curative aspect of disease knowledge

Explanation available in the ancient period. Ayurveda is the Upaveda of Atharvaveda. In

Vedas there is a vivid description of a Vyadhi, which has characterized by yellowish

pigmentation of sclera, tongue, nails, urine and skin etc and with suitable treatment also

explained.

Ayurvedic healthcare system has perfected efficient methods and herbal preparations

to keep the physical, mental and emotional health of a person in its prime throughout life. It is

contrary to current practice of seeking treatment when disease strikes, or waiting to get

medical help till the symptoms manifest. It is a mind, body Medicare system evolved to help

human beings and get maximum benefit out of their lives in a perfectly natural healthy way.

Ayurveda instills in you a view of life that is holistic and congenial to enjoy the

pleasures of life in a sustainable way. This can be achieved without disturbing the rhythm of

your life.

Ayurveda favors administration of natural health care products (of plant, animal,

mineral origin) and their preparations. Generally Ayurvedic Medicare products cause no toxic

or side effects, and hence are totally safe. These are time-tested preparations, which have

been used by many generations. There is no question of tolerance, resistance or addiction

with Ayurvedic health care products.

Day today practice receives number of patients suffering from Kamala (Jaundice)

and its complications as the negligence of Kamala management.

I inspired to take up the Kamala and its management as the dissertation topic as this

ailment is prevalent in this province. Even though there are innumerable recipes in Ayurvedic

literature apart from the contemporary management, I have selected the Phalatrikadiyoga, as

it seems as classical, authentic, economical and easily available mentioned in Bhishajya

Introduction 1

Ratnavali. So the attempt is made in this thesis to evaluate the efficacy of Phalatrikadi yoga

in Kamala on scientific basis.

The Phalatrikadi yoga, contents are, Triphala, Katuki, Nimba, Guduchi, Vasa,

Bhrugaraja, Bhumyamalaki and Chirayata are some of the very frequently these drugs used

in Kamala. In contemporary medical system jaundice is the word analogous with Kamala.

The present study comprise of two parts, the first part is mainly concerned with the

review of the literature regarding Kamala and various aspects of the diseases such as

history, nirukti, paribhasha, Nidana panchaka and Chikitsa etc reviewed and discussed. The

second part consists of details of clinical trial of the efficacy of Phalatrikadi yoga in Kamala. It

comprises of the materials and the methods used for the study and the observations and

results, of the study with detailed discussion over them.

Historical aspect:

Before preceding the subject, it will be very much worth to have a brief historical review

of the individual diseases, understand the subject in better manner. Here historical review

has been classified under four heading they are as follows:

1. Vedic period

2. Samhita period

3. Sangraha period

4. Adhunika period

1.Vedic Period:

Vedas are the oldest testimonials of information regarding to the particular disease

and use of medicinal plants. Atharvaveda is most important Veda among other four Veda. It

is an authentic source of Ayurveda. We found some of the scattered information in mantras

as such diseases of Hridaya, kloma, mastiska, pleeha and Yakrit. It is significantly noticed

about Yakrit vikara’s and explanation of “Yakrit” as well as the disease engendered in

connection with it with elaborated management 1.

Introduction 2

The disease, which is, characterised by the colour pigmentation such as greenish,

yellowish and white etc, Kamala and Pandu appear to have been studied. The term “Harita”

and Halima vilohitawa is referring to Kamala disease. The Atharvaveda mentions turmeric

and yellow birds in which Kamala is charmed to enter, leaving the human by receiving the

mantras. Right therapy also explained in Atharvaveda, the rays of the raising sun in the

morning care the disorders. It may be implicated here it is adopted to cure the diseases like

Hridroga, Harima etc, the colour change is predominantly found.

In Garuda purana and Agni purana there are references of Kamala. Garuda Purana is

at the consideration of that the Kamala as Harima is one of the Nidanarthakara Roga of

Pandu. Red coloured cow milk is very beneficial to disease of Harima 2. Anjana Chikitsa also

explained the management of Kamala 3.

2.Samhita Period:

This is the scientific age of Indian system of Medicine. In this period Charaka

Samhita, Susruta Samhita and Astanga Hridaya are the great literatures. Major literatures of

Ayurveda explain the disease Kamala and it’s management. In Charaka Samhita Kamala is

mentioned as Nidanarthakara Roga of Pandu. The later author Vagbhata explained about

Swatantra Kamala apart from the Paratantra Kamala, which was explained by the Charaka

and Susruta. Kashyapa Samhita author Vrudda Jeevaka also mentioned as the Pitta is the

causative Dosha and the disease is prominent with yellowish discoloration of conjunctiva and

skin.

However the predominant Dosha in both Swatantra and Paratantra Kamala is the

Pitta Dosha. It is significantly noticed that as edification advanced the conditional

management of the disease and draws the attention to words its management by prominent

prophylactic measures by seasonal regimens and adaptations of sequential seasonal

Panchakarma eliminative measures.

Introduction 3

3. Sangraha Kala:

This is the period of commentators and laghutrayees. In this period many of good

compilation works are done, laghutrayees are Madhava Nidana, Bhava Prakasha and

Sharanghadar Samhita, The latter authors like Yogaratnakara, Vangasena explained Nidana,

Lakshana and Chikitsa of Kamala.

Charaka Samhita commentator, Chakrapani in his commentary on Chikitsa 16th

chapter discussed the two-word ruddha marga or rudda patha. He elaborated the patho-

physiological aspect of swetha varchata under the heading kosta shakhashrita Kamala,

where in Shakashrita Kamala is established.

Dalhana, Susruta Samhita commentator, in his ideology on Kamala enrolled the term

Panaki as a variety of Kamala. This term has not been used by any other ancient Acharyas.

Dalhana used synonyms like Kamala, Apanakya, Kumbhavya, Lagharaka, Laghavaka, Alasa,

and Alasakya according to its severity and stages 4. Arunadutta and Hemadri the

commentators of Vagbhata have also commented on the description of shakhashrita Kamala

explained in the Nidana sthana of Astanga Hridaya. Madhavakara included and explained

Kamala and its patho-physiology in the chapter Pandu, considering it as the late stage of

Pandu.

4. Adhunika kala:

The period of after 18th century is called as adhunika kala, many authors such as Dr.

Rama Rakshaka patak, Dr. Ranajit Roy Desai, Dr. Vidhyadhara Shukla etc have compiled

materials from classical texts. In contemporary medicine called it as jaundice, is one of the

liver disorders in modern medical area. Comprehensive studies in this field are made and

they have discovered and established new diseases relating to the liver.

The modern and Ayurvedic concept of Kamala is similar. It is characterised by the

yellowish pigmentation in the conductive, skin and urine etc. both systems explained in

curative method in details certain causative factors, which are responsible for producing the

Introduction 4

varieties of jaundice. The present days more researches are done more and more about the

liver disorders with their management.

The liver is the largest glandular organ in the body, and has more functions than any

other human organ. A person's entire blood supply passes through the liver several times a

day, and at any given time there is about a pint of blood there.

The Liver has a pivotal role in human metabolism.

• The liver produces and secretes bile (to be stored in the gallbladder until needed)

that is used to break down and digest fatty acids.

• It also produces prothrombin and fibrinogen, both blood-clotting factors, and

heparin, a mucopolysaccharide sulfuric acid ester that helps keep blood from

clotting within the circulatory system.

• The liver converts sugar into glycogen, which it stores until the muscles need

energy and it is secreted into the blood stream as glucose.

• The liver synthesises proteins and cholesterol and converts carbohydrates and

proteins into fats, which are stored for later use.

• It also produces blood protein and hundreds of enzymes needed for digestion

and other bodily functions.

• The liver also produces urea, while breaking down proteins, which it synthesises

from carbon dioxide and ammonia. The kidneys eventually excrete it.

• The liver also stores critical trace elements such as iron and copper, as well as

vitamins A, D, and B12.

• The liver is also responsible for detoxifying the body of poisonous substances by

transforming and removing toxins and wastes. There are five main sources of

body toxins and wastes that the liver deals with: toxins from food (traces of

pesticides, preservatives)and alcohol; toxins from outside (drugs, adulterants,

Introduction 5

and environmental pollutants); internally produced chemicals, such as hormones,

that are no longer needed; nitrogen-containing waste left over from protein re-

use; and energy production.

• These toxins and wastes are converted into less harmful substances by the liver

and then eliminated from the body.

Because of the significant role the liver plays in maintaining our health, we must do all

we can to keep it functioning properly.

The liver is a large chemical factory; the heat produced by the chemical changes

taking place in it contributes greatly to the general warming of the body. The liver secretes

bile, which comprises salts and pigments, and aids the digestion of fats. It stores the

substance necessary for the proper functioning of the bone marrow, which manufactures red

blood corpuscles.

It also manufactures the fibrinogen of the blood, stores iron and copper, and

detoxicates the noxious products, which are made in the intestines and absorbed into the

blood. It stores carbohydrates in the form of glycogen.

The liver is one of the largest organs in the body and one of the five major organs,

which are vital to life. A malfunctioning of the liver may not become apparent immediately,

unless, of course, the blood flow through it is impeded or the bile ducts are obstructed. Nor

does it recover quickly once it suffers from a disorder. (Indiangyan.com, Diseases of THE

LIVER &THE CARDIO-VASCULAR SYSTEM)

Kamala (Jaundice)

Jaundice or Kamala is a condition in which there is discoloration of the skin because

of deposition of bile pigment in its deeper layers.

KAMALA VYUTPATTI

The term Kamala is derived by the root ‘kamu’ which means kanti by suffixing Nhin’’

pratyaya is substituted by kalaha thus the term Kamala is kumu + Nhin (kalaha) 5

Introduction 6

Nirukti:

The word Kamala developed and explained as “ kamam kantim harati haridra varnam

lati iti Kamala’”. Here kamam means desire and kanti is the luster, both are diminished in

case of Kamala. Haridra is yellowish discoloration, lati means Runaddati or to get yellowish

discoloration, In other words Kamala is a disease in which an individual looses interest in all

aspects and gets the yellowish discoloration 6.

Klama glano dhatunam nispanna

Kamala shabda shareerendriya glanayati ’’Dhaturupa manjari” 7

Paribhasha:

The term Kamala translated by Sir Monier Williams to give certain meanings

libidinous, luster, dry and sterile soil, desert, a form of Jaundice, excessive secretion of bile or

obstruction of bile etc.

“ Atha kamalati kama shabda

Ayam sadharana shabda vesheshati

Swalpe baktadabhilasha pravartate tam latoti kamala”

The Kamala would be point out to a disease conditions in which hunger and appetite

for food are diminished, simple meaning of Kamala is a disease where there is little or no

desire for food according to Harana Chandra 8.

In sabdha sthoma maha nidhi defined as “kamam Kanthim lunathi iti Kamala”

which means and indicate the diseased condition in which the changes of colour are

visualized. And the term kanthi means to be luster or natural colour of the skin. Haridra and

Harita colours are manifested in the normal skin colour bringing kanthi or luster of the skin in

to abnormal state i.e. yellowish discoloration.

Introduction 7

Yellowish discoloration of the skin, selera, mucous membranes, and excretions due to

hyper biliruibinemia and deposition of bile pigment’s 9 are seen in Kamala i.e. jaundice.

PARYAYA

In classics the different terminology are used for the Kamala.

In Atharvaveda Kamala was known as Harima, Harita, vilohitatwa and Haridraka.

Dalhana while commenting on Susruta reviewed the different stages of Pandu Roga and

declared that Kamala with terminology such as panaki, apanaki, kumbha Kamala,

lagharaka, Alasa, Alasakya etc. These nomenclature gives expression as different stages

of Pandu Roga and therefore all these words even though looks like synonyms of Kamala 10

they are different stages of Kamala. Astanga Hridaya 11 used the word lothara as synonyms

of Kamala.

Chakrapani has used the term “Bahu Pitta Kamala as the synonyms of

kostashkhastrita Kamala and alpa Pitta Kamala as the synonyms of “shakhashrita Kamala 12.

BHEDA 13,14

Charaka has classified the disease Kamala in two types. They are as follows:

1. Kostha shakhashrita Kamala

2. Shakhasharita Kamala

Kamala is considered as a paratantra vyadhi and by some others as swatantra

Vyadhi. Susruta has stated the Kamala is a later stage of Pandu Roga and kumbha Kamala,

lagharaka, Alasa and Haleemaka are it’s different stages.

Thus Kamala can be classified according to the dispersal of Pitta in the body as -

1) Bahu Pitta Kamala or kostha shakhashrita Kamala

2) Alpa Pitta Kamala or shakhashrita Kamala.

Classification of jaundice 15

The classification of jaundice in modern medical science is based on the basis of patho-

physiology and etiology.

Introduction 8

1. Hemolytic jaundice

2. Hepato cellular jaundice

3.Chole static jaundice

4.Congenital non-hemolytic hyper bilirubinaemia.

i. Hemolytic jaundice- Increased bilirubin load from the liver cells.

ii. Hepato cellular and cholestatic jaundice liver disease and large duct obstruction.

Congenital non- hemolytic hyper bilirubinaemia defects in conjugation 16

This dissertation is divided into six chapters, Viz.

1. Introduction

2. Literary Review

3. Drug Review

4. Material and Methods

5. Observations and Results

6. Discussion and Conclusion

This dissertation is appended with References, Bibliography, Master Charts and

Case Sheet at the end.

Introduction 9

The Disease Kamala is Nidanarthakara Roga of Pandu. The Nidana generally

speaking word applied to the etiological factors for the concerned diseases the word Nidana

refers specially to the cause that brings about disease.

The causation of disease considered in many ways:

Nidana has been defined as “sethi karthavyathakar and rgathapadaka hetu”

which means that all such another factors which by deranging dynamic state of doshic un-

equilibrium. All the disease factors to causes the Dosha imbalance and produce disease

“Rogasthu Dosha vaishamyam (Vagbhata)

The etiological factors of Kamala broadly explain in the classics. In fundamental the

indulgence of habits which vitiate Pitta in a person who is already suffering from Pandu

Roga. Susruta and Vagbhata also at the same opinion about etiology for the Kamala106,107.

Chakrapani has expressed affirmation with the above view point he has made a

reference to an unknown author who makes a distinction kosta shakhasritha Kamala, which

represents only an aggravated condition of Pandu Roga and shakhasrita Kamala according

to him some times is an independent disease entity 108.

The below mentioned are the conditions of kosta shakhashrita Kamala and

shakhashrita Kamala can occur in different situations. They are -

a) during Pandu Roga

b) during any other disease of Pitta

c) without any other perceptible diseases

Literary review 10

These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In such

cases all causative factors play their role in vitiating Pitta. This condensation of Pitta of

functional and sensible hyper activity may result in to Kamala from the following Pitta

vitiating ahara, vihara etc109.

Table No:1 Pitta Prakophaka Karan110,111,112.

Charaka Susruta Vagbhata

Ahara Ati amla rasa sevana “ Lavana “ “ Katu “ “ Ushna “ “ Teekshna “ “ Kara “ “ Ajeernabhojana “ “ Vishana ahas “ “ Deergya kala shita “ “ Madya “

Ati katu sevana “ Amla “ “ Lavana “ “ Ushna “ “ Vidagdha “ “ Tilatiala “ “ Peenyaka “ “ Vidahi “ “ Kulatta “ “ Athasi “ “ Harika shakha “ “ Godha matsya “ “ Javika Mamsa “ “ Dadhi,Takra,Kurchika Masthu, sowveeraka,suravikara, Amlapala,Katwa

Ati katu sevana Amla “ Ushna “ Teekshna “ Lavana “ Vidahianna “

Vihara a) Manasika krodha b) Shareerika

Shrama, atapa, Agni Santapa, Ushnavasa

Krodha Shoka Bhaya Ayasa Atimaithunam

Krodha

Acharya Upavasa Dhoomapana Kala

Upavasa Ushnakala Meghante Madhyante Ardharathri Jeetyanne

Sharatrutu Madyanha Ratrayardha Vidaaha Samayeshu

Literary review 11

Tabel No: 2 Katu Rasa Atisevana113,114,115.

Charaka Sushruta Vagbhata

Pumsaptva hrasa

Moha

Glani

Avasada

Datu shithilla

Murcha

Bhrama

Daha, tapa

Balabrasa

Trushna

Shrira kampa

Pricking pain and Roga

utpatti

Bhrama

Mada

Gala, talu and ostasotha

Daha santapa deha

balanasha

Kamphana

Pricking pain

Hasta pada parsha &

Udarashoda

Trushna balakshaya

Murcha

Akunchana

Kampha kati and prusta

Vyapad etc.

Tabel No: 3 Amla Rasa Atisevana116,117,118. Charaka Sushruta Vagbhata

Danta harsha, Trushna,

Romanchana, Kapha

Vilayana, Pitta uruddi,

Mamsa vidahati, Ksheena,

Kshata, Dourbalya, Rakta

dusti, Kshataathihata,

Dagda, Bhagna, Mutrila

Prisarpita, chinna bhima,

Knatha, Urho, Hridayam

paridhaha

Dantaharsa, Nayana

samilana, Roma,

Samavegana, Kapha

vilayana, Sharira saithilya,

Kshata, Abhihata dagda,

dasta Bhagna, rugna,

shoon, prachyatava, motrita

visarpita, chinna,

bhinnavidhota, paridahati,

kantam, urhi, hridayam etc.

Shaithilya, Timira,

Bhrama, Kandu, Pandu

vispra,a Shopha visphata,

Trushna, Jwara

Literary review 12

Tabel No: 4 Lavana Rasa Atisevana119,120,121

Charaka Susruta Vagbhata

Pitta Kopayati Rakta Vardana Pipasa Utapatti Murcha Utapatti Tapa Vruddi Twacha vidar Manisa Pesivikrutti Visha Vruddi Kusta roga Sotha, danta patan Ramsatva Shaktiprasa Indriya Shakti prasa Palita, Khalitya RaktaPitta , Amlapatta Visarpa, vatarakta Vicharachika, Indralupta

Gatra Kondhu Kotha Shopha Vaivanya Punsatva upaghata Upatapa Mukha, Akshipaka Rakta Pitta Vatashanita Amlika etc.

Asrapavana Khalirya Palitya(Kaphala roga) Valeem Trishna Kushta Visha Visarpa Balakshaya etc.

Tabel No: 5 Rakta Prakopaka Hetu122,123.

Charaka Sushruta Ati Teekshna Ati Ushna Madyasevan Ati Lavan Ati Skhara Ati Amlarasa Ati Katurasa Ati Kulatha Ati Udada Ati Tila taila Pidalu Moolika Jalaja Manasa Anupmamsa Dahi, Kanjji Sura, Soaveera Durgandita ahara Diva Svapna Doopa and Atapasevan Vamana Vegadharana

Pitta Prakopaka ahar Ati drava ahara Ati Snigda ahara Ati Guru ahara Diva Svapna Krodha Amala and Atapa sevana Shrama Abhighata Ajeerna Virudda bhojana Adhyasana etc.

Literary review 13

The above mentioned etiological factors provoke Pitta, with their specific qualities.

“Agnireva shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid

having Ushna and teekshna properties enough and sufficient to digest the food.

With the above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing

the functions of liver where mala roopa Pitta is discharged. When hypo functioning of Pitta

(Agni) consequently in turns produce Ama or Amavisha. This Ama corresponds with Rakta

and may produce Kamala.

Pitta has its seat in Rakta has the Ashrayashrayee bhava because are of same

qualities i.e. “Samavaguna”. Some of the above said aetiological factors may adversely act

on Rakta Dhatu with its similar qualities, which can also vitiate of Pitta.

These factors probably disturb Rakta Dhatwagni and when vitiated the prasadamsha

of Rakta Dhatu is not nourished properly. The by-product of Rakta i.e. Pitta is produced in

excess consequently producing bahu Pitta, with results in to “kostashakhashrita Kamala”

According to modern concept, certain bacterial, protozoan infection such as

pneumonia, syphilis, septicemia, typhoid, relapsing fever, damage liver cells. With this liver

cells become inefficient thus favoring the retention of bile pigment and bile salt in the blood.

Some chemical poisons such as arsenic, phospherous, Arosono-benz derivatives

nitrobenzyme lead etc also capable to damage the liver cells. Toxemia of this nature some

times occurring in pregnancy and certain chronic heart disease with congestion may be

because of liver disease and ensuring the jaundice.

Shakhashrita Kamala nidana124

The careful appraisal of distinct clinical features of shakhashrita Kamala would be of

ruddapatha resulted from Kapha occupying the Pitta vaha srotas. The development of this

condition implicated as a result of sroto vimarga gamana. Charaka narrating aetiological

factors of shakhashrita Kamala as under-

Literary review 14

1. Excessive intake of rooksa guna ahara,

2. Sheeta, guru, madura rasa ahara

3. Ati Vyayam and

4. Vega dharana

These Nidana narrated in the Charaka Samhita is represented as below,

Vimargagamana

Srotorodha Srotovaigamya

Kamala a disease of elevated bile in the blood is visualized in so many roots. Out of

them some are due to mechanical obstruction and others are of infectious in origin.

Rudhapatha is of obstructive variety develops because of Pitta vaha Sroto vaigunya

develops from different aetiology is classified and considered as under.

Mechanical obstruction

The excessive intake of ushna, teekshna, katu,madhura and vidhahi ahara provoke

the Pitta . Thus the Pitta is altered in its quality and quantity. The sara and drava gunas of

Pitta diminished and fluid become thickened even hard. This may perhaps be correlated to

the inflammatory condition of the mucosa of bile canaliculae in infective hepatitis.

The obstruction of Pitta marga possible by the intestinal warms and other parasites

there is no reference to obstruction from the krimis. Srotorodha it is a certain pathological

conditions. Created in the stricture of bile duct. It may happen by external pressure or any

growth either inside of out side the passage.

According Charaka causative factors to augment Kapha exchanging in the role to

block the passage. These Doshas when provoked by such causative factors. Vata

preparedly its rooksha guna it dries the Kapha, thus making soft and hard to block the Pitta

vaha marga resulting on vimarga gamana of Pitta. This results in to the shakhashrita

Kamala.

Literary review 15

Samprapti

Samprapti it means the description of pathology of disease. In detail of all the morbid

process that take place in different stages of the disease .It is the periods of Nidana sevana

to the period of Vyadhi janana and continues along with signs and symptoms.

“Tasmada vyadhi janaka dosha vyapar visheshayuktam

Vyadhi janmeha samprapti “125

The disease manifests by Dosha dushya sammurchana when the all evading

Doshas in their provoked state, come into contact with an organ or Srotas that is suffered

Vaigunya, This manifestation of disease preceded the other evaluative stages. The

abnormal increased state of Pitta this is outcome of disturbance in paka of Rakta.

Elsewhere a reference was made to Rakta when it was noted, that a constituent of whole

Rasa and homologue of Pitta.

The ingested food particle digested by Pachakapitta produce ahara-rasa this ahara-

rasa, digested by rasagni after it devised sarabhaga and kittabhaga. arabhaga of Rasa

circulate all over the body by the help of Vyanavata .The ahara Rasa gets colour of

digested by raktagni, Rasa colour will be change and Rakta Dhatu utapatti takes place to

Yakrit and Pleeha “rasad raktam prajayate” In the case of mitya ahara and vihara it vitiate

the Dosha and dushyas Ama rasa obtained if the Rasa carrying Ama visha, along with the

provoked Pitta Dosha get vitiated the moola of Raktavaha Srotas Yakrit and Pleeha, it

produces Rakta pradusaja Vyadhi on combination with Rakta in which Kamala is one out of

such disease. Pitta vriddhi at the level of Rakta paka independently causes Pandu. The

Pitta becomes prominent its ushna and teekshna qualities, thus vitiated Pitta circulate all

over the body when it comes in the contact with the Srotas that has already suffered

vaigunya gets into the circulatory system and mixed with blood this turn with the cause of

Kamala125,126. Because of Pitta ushna and teekshna guna’s of Pitta more of Rakta will be

Literary review 16

take place127, consequently it turns the effect of Yakrit and Pleeha are the main organ’s of

Rakta Dhatu. During the destruction of the Rakta there may from mala of Rakta i.e. Pitta

abnormally in its quantity. This is spread in the all over the body and having lodged in space

between twacha and mamsha, it produces characteristic features like peeta netrata, peeta

twacha and peeta mootrata etc.

Samprapti of kostashakhashrita Kamala

Intake of Pitta vardhaka ahara, viharas and pandurogi

Pitta Sanchaya in kosta

Panchakagni vikruti by increased of teekshna and ushna gunas

Amarasa utapatti

Vitiate the Kapha and Vata Dosha

Circulate all over the body through Rasa Rakta complex

Saman gunas Rakta and Pitta aggravated

Vitiated Pitta Rakta not digest by mamsagni.

Vidagdata takes place in mamsa dhatu vitiated Pitta Rakta and mamsa it leads to yellowish

discolouration of neetra. Twach. Nakha.

Reduction of jeevana kriya of Rakta it leads sharira, dourbalya and indriya dourbalya.

Increased mala rupi Pitta in kosta it gives yellowish and redness of feaces and urine.

Kamala Roga

Literary review 17

Shakhashrita Kamala Samprapti:

Acharya Charaka and Vagbhata described the shakhashrita Kamala. Can be of

either ruddhapatha or vimargagamana128,129.

The sleshma occupying biliary passage prevents the Pitta from entering the kosta

and hence cause Ruddha Pitta, the other hand when Vayu due to it’s conjunction with

Sleshma(Kapha Sammurchitha) dries up the biliary passage. There occurs the

Vimargagamana of Pitta. This is regulation of Jaundice. If the sara and dravagunatas of

Pitta are diminished, the fluid becomes thickened and even hard. A note has to be made in

connection of the responsible factor or predominant factor of asmari. Where the asmari term

used according to Susruta, that the adhistana dosha, or all types of asmaris as Sleshma. It

is associated with Pitta Dosha is becomes hard and get increased size it blocks the marga

and adversly affecting. However the Tridosha are involved in the process. This process

development of asmaris takes place it refer to the one of the factors of Pitta margavarodha

i.e. gallstone.

In shakhashrita Kamala Vata and Kapha are predominant. And not only Pitta is

prevented from passing into the gut but also regurgitated this is vimarga of Pitta. It is taken

back to Rasa Rakta this Pitta not being eliminated in sufficient qualities is found deposited in

the skin conjunctiva, nails and tongue the colour of the feaces is swetha or tilapistanibham.

Samprapti Ghataka

Dosha : Pachakapitta and Ranjakapitta Vyanavata and Kostastha Kapha

Dushya : Rakta, mamsa, twaka,

Agni : Jatharagni and dhatwagni,

Srotas : Raktavaha srotas,

Srotodusti prakar : Sanga and vimargagamana.

Udbhava sthan : Amashaya.

Vyakta sthan : Netra, twaka, Mootra, pureesha, Nakha,etc

Adisthana : Yakrit,

Marga : Bhahya and Abhyantara.

Literary review 18

Ati Rookhsa, sheeta, Guru, swadu, Vyayama, Bala nigraha

Vata and kapha Sanchaya

Agnimandya

Ama Utapatti—it not proper digested by rasagni

Chalaguna of vata and pichala guna of Khapa increased in Kosta,

Vitiated vata vitiates the kapha

Vitiated vata and kapha circulated through the Pitta vaha srotas,

Avarodha of Pitta vaha srotas by the vitiated kapha

Raktagni and Ranjaka Pitta not nourishing the forth coming dhatu.

‘Absence of ranjaka Pitta in kosta due to the avarodha of Pitta vaha Srotas by Kapha-

Samurchana.

Vitiated Pitta due to the avarodha of Kapha circulates on the shakha rather than coming to

the kosta by vitiated Vata.

Peeta netra, nakha, Mootra, Anana and sweta pureesha passed.

Shakhashrita Kamala

POORVA ROOPA

Poorva roopa are the prodromal symptoms which occur before complete

manifestation of the disease poorva roopa appears in the stage of chaturtha Kriyakala which

is said as sthana samshraya.130 The vitiated Doshas at the stage of sthana samashraya will

Literary review 19

manifest the sings and Symptoms of the forth coming disease. Such signs and symptoms

are called premonitory symptoms.

The poorva roopa of Kamala may be fall under the latter category. Since they are

not distinctly pronounced to indicate the same or it at all they may be present in obscure

form Kamala premonitory symptoms not visible.

Roopa131,132.

The roopa stage actual symptoms commences from vyaktavastha this is the fifth

stage of disease. The clear manifestation of the prodromal itself is called as roopa.

Most of all Ayurvedic classics given explanation about disease Kamala is a resultant

of untreated or Chronic Pandu Roga. Later authors give more information about Kamala.

They believe that the Kamala is resultant of untreated Pandu, and further they told that the

Kamala might manifest in normal person also by the excessive in take of Pitta vardhaka

ahara and vihara.

Table No 6 Roopa of Kosta shakhashrita and shakhashrita Kamala133,134.

Kosta shakhashrita Shakhashrita__

Haridra Netra Haridra Netra

Haridra twacha Haridra twacha

Haridra mukha Haridra mootrata

Haridra Nakha Swetha varchastwam

Bhekha varnata Atopa

Rakta peeta mootra Vistambha

Rakta peeta mala Hrudgraha

Daha Parswharti

Avipaka Hikka

Dourbalya Swasa

Sheetalata Aruchi

Aruchi Jwara

Angasada Dourbalya

Literary review 20

Table No 7

The summarization of laxanas according to various text’s. 135, 136, 137, 138, 139, 140.

Sl. No_Lakshanas_ Ch Su AHR MN BP YR

1 Haridra netra_ + + + + + +

2 Haridra twacha + + + + + +

3 Haridra mukha + + + + + +

4 Haridra nakha + + + + + +

5 Haridra mutra +

6 Rakta peeta mutra + - + + +

7 Rakta peeta mala + - + + +

8 Daha + + + + +

9 Avipaka + + + + + +

10 Dourbalya + + - + + +

11 sheetalata +

12 Aruchi + + - + + +

13 Krusha - + - - - +

14 Tandra - + - - - -

15 Balakshaya - + - - - -

16 Trushna - - + - - -

17 Indriyadourbalya + - + + + +

18 Bhekavarana + - + + + +

19 Panduvarnata - + - - - -

Literary review 21

The disease manifestation sites are specifically liver and spleen. Thus it needs to

know about the physiological conditions and possible pathology in accordance with

contemporary medicine.

Shareeram

Kamala according Ayurveda is a disease of Rakta Dhatu, it is explain under context

of Rakta ruddi laxana and Charaka explain under the Rakta pradusaja Vyadhi, Kamala

related organ is a Yakrit, it is a moola of Rakta vaha Srotas all Acharyas has same opine

regarding Srotas 17.

In Kamala the Dosha vitiated is Pitta. The prime symptoms of Kamala is yellowish

discoloration of Netra, twacha, mootra etc because of vitiated Pitta Dosha, Ranjakapitta is

mainly contributory of above-mentioned symptoms. In classic also mentioned Yakrit is a

seat of Ranjakapitta 18,19.

The diagnostic symptoms of shakashrita Kamala is tilapistanibha varchas, which is

due to the absence of Pitta in kosta. The samprapti of shakashrita Kamala is clearly

mentioned in classics, that Kapha obstructs Pitta. So Pitta will not reaches the kosta

resulting tila pistanibham. From above explanation we conclude the Yakrit and Pitta Dosha

involved in disease of Kamala20.

Niukti of Yakrit

The word Yakrit grammatically made up of ‘yaj dhatu, shakerutin pratya in which it

mean dakshinabhaga mamsa khanda. YAJ + SHAKERUTTIN = YAKRIT

Synonyms of Yakrit

Karanda, Kalakam, Kalakhanja, Kalakhanda, Kaleam21 In modern the synonym of

liver is Hepar22. The liver develops from hallow endodermal bud from the foregut during the

3rd week of gestation, from the matruja bhava it is developed.

The utapatti of Yakritis from shonita23

Yakrin is a composition of liver = Medas24

Literary review 22

Yakrit is located at right upper part of the abdomen, which is described by Susruta

and Modern science also. It is consider one of the kostanga it is a largest gland in the body,

it is situated in the upper and right part of the abdominal cavity, it occupying almost whole

right hypochondrium, greater part of epigastrium and extending to the left hypochondrium25.

1. It is exocrine and excreting bile, which goes to the second part of the

duodenumvia the biliary passage.

2. Endocrine by secreting glucose going to blood 26

In the male it commonly weight from 1.4 to 1.8 kg. In female from 1.2 to 1.4 kg with

however, a range of 1.0 to 2.5 kg. It is relatively much larger in the fetus than in the adult. It

is somewhat wedge-shaped, reddish in colour27.

It has five surfaces they are:

1) Anterior surface

2) Posterior surface

3) Superior surface

4) Inferior surface

5) Right surface

Peritoneal relations:

Most of the liver covered by the peritoneum. The areas not covered by peritoneum are

as follows.

a) A triangular ‘bare area on the posterior surface of the right lobe, limited by

the upper and lower layers of the coronary ligament and the right

triangular ligament.

b) The groove for the inferior venacava on the posterior surface of the right

lobe of the liver, between the caudate lobe and the bare area.

c) The fossa for the gall bladder, which lies on the inferior surface of to right

lobe of the quadrate lobe.

Literary review 23

d) The porta hepatis,

e) Along the lines of reflection of peritoneum. A number of peritoneal folds

are attached to the liver, although these folds are called ligaments each of

them is made up only of two layers of the peritoneum, these are as

follows.

The falciform ligament is connected with the antero superior surface of the liver to the

anterior abdominal wall and to the under surface of the diaphragm. The left triangular

ligament connecting the superior surface of the left lobe of the liver to the diaphragm. The

right triangular ligament connects the lateral part of the posterior surface of the right lobe of

the liver to the diaphragm. The coronary ligament having superior and inferior layers, which

enclose the bare area of the liver and the lesser omentum27.

Embryology:

The liver develops from an endodermal bud that arises from the ventral aspect of the

gut, at the point of junction between foregut and midgut, this bud grows into the ventral

mesogastrium and passes through into the septum transversum. It enlarges and soon

shows a division into a larger cranial part called the pars hepatica and a smaller caudal

portion called the pars cystic. The pars hepatica divides into right and left parts each of

which forms one lobe of the liver.

As the right and left divisions of the pars hepatica enlarge and extend into the

septum transeversum. The cells arising from them are broken up into interlacting columns

called hepatic trabeculae. In this process, the umbilical and vitelline veins that lie in the

septum transeversum are broken up to forms the sinusoids of the liver. Sinusoids are also

formed form the mesechyme of septum transeversum.

The endodermal cells of the hepatic bud give rise to the parenchyma of the liver and

to bile capillaries. The mesoderm of the septum transversum forms the capsule and fibrous

tissue basis of the liver.

Literary review 24

The foetal liver is an important center for blood formation large aggregations of blood

forming cells are present between hepatic cells and blood vessels.

Bile formation begins when the fetus is about three months old. The bile is

responsible for the black colour of the first stools (meconium) passed by the new born28.

HISTILOGY OF LIVER30

The liver is both a secretary and excretory glands, it is solid organ consisting of

several lobes. Each lobe is made up of numerous lobules, under the microscope, each

lobule is found to composed of row of polygonal cells radiating from the center. Like the

spokes of wheel the periphery of the lobule being delineated by the presence of portal

triads. The control vein occupies the center. The portal duct and hepatic vein emerge out of

the liver through a connective tissue sheath (Glisson’s capsule). After entering they branch

repeatedly there is frequent hepatic artery and portal vein in the interlobular region, recent

studies the liver cells are arranged in the form of plates having a thickness of single cells

diameter which provide, which provide a honey comb or sponge like structure. Through out

this structure, the cell plates are tunneled by a communicating system of cavities or lacunae.

The lacunae of endothelica cells and phagocytic cells of the RE system are called Kupffer

cells. Electron microscope reveals that kupffer cells may contain phagocytosed substance

and they are elongated structures haveing an irregular outline created nucleus, few

mitochondria and varying separating the sincesaidal wal from the liver cells plates is known

as ‘Disses space.

The flow through the sinusoids is guarded by inlet and outlet sptrincters and the

intermittent flow of is mostly due to presence of these sphincters. In the lover lobule the

sinusoids are drained in the central vein. The interlobular branches of the hepatic artery

also end in the sinusoids directly. The central vein while passing through the long axis of

the lobule, constantly receives sinusoids from all and ultimately leaves the lobule, constantly

Literary review 25

leaves the lobule at it’s base there it join with central vein of the neighboring lobules thus

ends in the large hepatic vein.

Bile is formed and discharged through fine intercellular canaculi into the bile

capillaries, hepatic cells are polygonal in shape and on the average 25 inches in size. 85 %

of hepatic cells being parenchymal type has a clear cells membrane and often binucleated,

and mitosis is rare normally. The cytoplane contains stored glycogen and fat, also

basophilic materials, mitochondria, galgi apparatus granular and agranular material,

mitochendsa endoplasmic reticula and lysosomes are present. Two or more liver cells

separate the excretory system of the liver starts with bile canaliculi, which are lined by single

membrane and the membrane. The membrane is protruded into canaliculus in the form of

microvilli which increases the area for interchanges partial removal of liver in man and

animals results rapid regulation by cell replication. Some hormonal regulations may be

present in the mechanism of rapid regeneration.

Mitochodria contain mostly cytochrome oxidase, suclinoxidase and phospholipids in

large amounts. They can oxides numerous substance substrates including fatty acids and

intermediates of TCA cycle. Mitochondria transport energy releasing in the form of ATP.

The rough surface endoplasmic reticula contain granules, ribosome’s with RNA and

are the seat of protein synthesis. These granules are responsible for basophilia. The

smooth surface endo plasmic reticula are the sites of detoxification of drug conjugation of

bilirubi, synthesis of steroid hormones and enzymes.

The liver cell lysosomes, adjacent to bile canaliculi, are the sites of deposition of

ferrition, lipofuseion, bile pigment and copper and contain many hydralytic enzymes,

pericanalicular dense bodies and pinocyltic vacuoles are also seen.

FORMATION OF BILE AND BILIRUBIN

Bile is both a product of secretion as well as excretion of the liver minute droplets of

bile collect inside the tiny vacuoles of the liver cells and are discharged into the bile

Literary review 26

capillaries through the intercellular canaliculi. The primary bile capillaries start from between

hepatic cells as blind tuloules. They join together repeatedly and form bigger channels and

ultimately come out of the liver as the right and left hepatic ducts. The two ducts unite and

form into the duodenum through the ampulla of Vater, through the same ampulla also the

pancreatic duct commences the cystic duct. Formation of bile by the liver is an active

process but entry of bile into duodenum is intermittent and takes place only after meal31.

Bile secreted continuously from the liver cells and stored in the gall bladder. Bile

contains water, nuclein, pigments neutral fat, fatty acids, ophospholipids, cholesteral and in

organic ions, cholesterol is synthesized in the liver from active acetate, cholesterol is also

excreted from the liver. Bile acids chalic have been considered to be the derivations with

glycine and tausrine. From the compounds glycocholic acid and tourocholic acid

respectively bile salts are the Na- salts of taurocholic acid and glycocholie acid. Bile salts

house got important functions on absorption of fats and also for the emulsification of fats

with concurrent production of a great surface area to enable lipase and other enzymes to act

more efficiently.

Bile pigments are the biliwerdion and bilirubin, these are the excretory products of

hemoglobin of broken down RBC and are formed in the RE system in the various parts of

the body. Bone marrow liver and spleen have been considered to be the site or formation of

the bile pigments32. Bile is essential for life. Although if does not contain any enzyme. Yet

it as a very important digestive juice.

Digestion:

The complete digestion of fats and to some extent of protein and carbohydrates is

done in liver.

Reducing surface tension:

So that fats are converted into exclusion.

Literary review 27

Activating action:

The bile salts by virtue of the cholic acid radical acts as specific activator for different

lipase.

Solvent action:

It serves as a good medium of the interacting fats and fat splitting enzymes.

Absorption:

Bile helps to in the absorption of various substances due to presence of bile salts like

fats iron calcium and lipid soluble vitamin A.D E and K and provitamion carotene.

Excretion:

Certain substances are excreted through bile for instance as some metals like

(a) copper, zinc, mercury

(b) Toxins, bacteria

(c) Bile pigments

(d) Cholesterol and lecithin are probably chiefly excretory products33.

The majority of bilirubin is delivered from the destruction of Red blood cells

Hemoglobin is the iron containing pigment of the red blood cells. The red colour of the R &

C and the blood is due to the presence of the hemoglobin. In normal condition life span of

Red cells are only few months they destroyed by the phagocytosis. The hemoglobin of

these cells broken down into haemosiderin and haemotoidin.

Normally it is also present in certain amount in phagocytes of spleen, liver and bone

marrow and the quantity increased during rapid destruction of RBC on diseased state a

green rise to a yellow brown pigment bilirubin. Haematidins a break down product of

hemoglobin during destruction of RBC and identical to bilirubin34. It is derived from turn over

of the hepatic proteins and from premature distinction of newly formed erythrocytes into the

bone narrow whatever the source of hepogenase oxidized heam to biliverdin. Biliverdina is

first formed and which by reduction forms beliverdina. Beliverbin and biliverdina probably

Literary review 28

combine with plasma and globulin and circulate through the blood stream and enter the

liver. In the diver cells bilirubin and biliverdin are separated from globulin and conjugate with

uridine diphosphate glucuronate to produce monobilirubin and bilirubin glucoronide, the

uridine diphosphate is set free. These compounds enter the duodenum through the bile

duct and then to the intestine. In the large intestine by bacterial action they are changed

into stercobilinogen. Some of urobilinogen is reabsorbed and excreted in the urine as

urobilinogen. The rest is excreted in the faeces as stercobilinogen and stercobilin, which

are responsible for the brown colour of the stool35.

FUNCTIONS OF LIVER 36

Liver is an essential organ of the body. Its functions are numerous which are briefly

summarized below.

I. In connection with blood and circulation

i) Formation of RBC in foetal life

ii) Destruction of RBC in adult life

iii) Store house of the blood and regulates the blood volume

iv) Relation with blood clotting

a) Manufacturing prothrombin and fibrinogen and thus

essential for clotting.

b) Most cells from heparin and prevent intra vascular

clotting

v) It transfers blood from portal to systemic circulation

vi) Manufactures all plasma proteins

vii) Stores the iron, haematinic factor also known as Vit-B12 and

copper and thus helps in the formation of red cells and

hemoglobin.

Literary review 29

II. Manufactures of bile:

Bile is secreted continuously from the liver cells and stored in the gall

bladder.

III. Relation with carbohydrate metabolism

i) Converts honglucose monosacharides into glucose

ii) Converts lactiacid, pyruvic acid and glyceral into glucose and

also glycogen.

iii) Store carbohydrate in the form of glycogen and when the

blood sugar tends to below it mobilizes glycogen

iv) Takes an important part in blood sugar regulations

v) It is the seat of neogulcogenesis

vi) Manufactures fats from carbohydrates.

VI. Relation with fat metabolism

i) It stores fats liver contains about 3% of fat

ii) It helps in the oxidation of fat, releasing energy in the form of

ATP.

iii) Site of synthesis of cholesterol from acetate

iv) Synthesis of phospholipids

v) Synthesises of fats from corbohydrates and proteins

vi) It is the seat of ketone body formation

vii) Unused free fatty acid released from fat depot is converted to

triglycerides and other lipids to meet energy requirement.

V. Relation with protein metabolism:

Main seat of urea and uric acid formation, synthesis of some amino

acid takes place plasma protein manufactured Coagulation factors, in

addition to fibrinogen and prothrombin, are manufactured here.

Literary review 30

VI. Hormone metabolism:

Reduce the circulating adrenal cortical and sex hormones by

digression and conjugation.

VII Relation with vitamins:

i) Manufactures prothrombin with the help of vitamin K

ii) It forms vitamin A from carotene and stores vitamin A and D

iii) Chronic liver disease is always associated with folic acid

deficiency. It is known that the liver converts folate to its active

form tetrahydrofolate.

iv) It is the principal storage organ for Vitamin B12 and in condition

of hepato cellular disease.

VIII Excretory functions

Certain heavy metals are temporarily fixed by the liver cells, which are then excreted

in the bile various toxins, bacteria and drugs are excreted through bile. Cholesterol and bile

pigments are excreted in the bile.

Concept of Pitta in KAMALA:

Kamala is a one of the Pitta predominant disease. It was pointed in Pitta vruddhi

lakshana, it is the responsible colouring factor of peeta in the sense that abnormal colours

such as peeta, Haredra manifestation, they become he characteristic feature of the Kamala

disease, it is recognized due to Pitta vruddhi 37,38,39. While discussing about nanatmaja

vyadhi, Acharyas consider the Kamala as one of the Pittaja nanatmaja vyadhi40.

The production of colour as well as its appreciation brought by Teja mahabhoota, its

chief functioning of paka or transform action. Tejas is the one of the quality of Pitta. Brief

review of physiological functions and quality of this teja mahabhoota vis-a-vis Pitta. It is

necessary to secure an intimate knowledge of prakruta gnana before to the study of

vikrutha41.

Literary review 31

The term Pitta is derived from the root of “Tapa” it is having 3 meaning 42.

1. Tapa santhape- production of heat.

2. Tapadahe – Burning of food particles.

3. Tapacishwarya (sid kammadi) – gaining of powers.

These are represents the functions of Pitta in the body. “Tapa” means to generate

the heat, it refers the burning the ingested (food) materials.

Synonyms of Agni:

Agni, Anala, ushma, Teja etc, These are synonym of Pitta.

Importance of Agni and it’s functions in the body are clearly mentioned in Charaka

Chikitsa sthana Grahini chapter, the commentator of Chakrapani on Agni clearly explain that

the Agni which present in our body is in the form of Pitta.

Agni is under stood as Antaragni that the Agni which is internal to the body.

Antaragni, does not indicates only it is already stated that the Agni which does the function

of paka, dahana etc Charaka has clearly stated that the Agni are Pitta it is digest the food

particle and controls the other Agni.

The questionnaire Pitta and Agni are identical or different has been raised and

answered by Susruta himself, that Pitta is identical to Agni in view of the fact that such

actions as dahana pachana and similar actions performed by fire hence Pitta is known as

Antaragni 43.

According to bruhatraye composition of Pitta is dominated by Agni bhoota the quality

of Pitta are sneha teekshna, ushna, laghu, visra, saram and drava 44,45,46.

Drava and saram which are the quality are predominance of Apa-bhoota, sneha is a

pruthvi mahabhoota, ushna and Teekshna are Teja mahabhoota, laghu is the vaya

mahabhoota, visra is the Akasha mahahoota vagbhat clearly mentioned Pitta is

panchabhouthika and drava consistancy.

Qualities of Pitta:

Literary review 32

Table no: 8

Acharya clearly explain qualities Pitta, varna, gandha, ruchi and sandrata. The

summarization of Pitta guna dharma according to various text’s 47,48,49,50,51,52.

Varna Sandrata Rasa Gandha Guna’s

Charaka Sukla Drava Amla Katu

Visra Ushna, teeksna, sneha.

Sushruta Neela, peeta Drava Amla Katu

Puti Ushna, teeksna

Vagbhata Drava, sneha Amla Katu

Vaigandha Ushna, teeksna, laghu, sara.

Kashyapa Sukla, Aruna Snehayukta Amla Katu

Visra Ushna, teeksna, laghu.

Bhavaprakasha Sukla, Neela Drava

Amla Katu

Ushna, sara.

Sharanghadar Peeta neela

Drava Amla Ushna,Laghu,Snigdata

Seat of Pitta

The Pitta occupies the entire systems of the body. Its location particularly between

Hridaya and Nabhi in general other seats of Pitta presumed sweda, laskiha, rudira,

amasaya, druk, twacha. Among all Nabhi is found to be the particular and specific seat of

Pitta 53.

Charaka and Vagbhata described Amashaya not only as the seat of Kapha it is also

seat of Pitta. Susruta stated clearly that Amashaya is a seat of kapha54. All that is eaten food

will be digested and absorbed in stomach 55.

Amashaya:

According to Chakrapani Ado-Amashaya is the seat of Pitta 56.

Nabhi:

This does not indicates any organ but some authorities consider that Nabhi

represents the “Agnyashaya” which may refer to pancreas which takes a major part in the

Literary review 33

continuance and completion of the digestion in the small intestine. The pancreas because

of its participation in both the digestive and metabolic process may be truly called

Agnyashaya in the locality of Nabhi.

Pavamasaya Madhyaga

This is actually the seat of Pachakapitta one of the five sub divisions of Pitta and also of

Pitta dharakala or grahani57. Pakvamashaya madhyaga- Dalhana widely explains Yakrit

pleeha, Hridaya, druka twacha these are all organs’ seats for Pitta.

Lasika 58:

It is a part of udaka (Apyadravya) which is capable of coagulation. According to

Hemadri lasika is the Rasamala it is located in twak59. Sweda,(sweat) Chakshu and

sparspanendriya (Both sense organs). Chandranandana’s commentary is that Nabhi is

considered as a special seat of Pitta because of its association with Samanavata.

The word Amashaya indicates two meanings

1. It is the seat of immature or unripe or incompletely or partially digested

food even though the ingested food digestion takes from Amashaya.

2. It is the site where in the Ama is generated.

The word “Pakwashaya” denotes the place of completed digestion. Since the Pitta is

located in Amashaya and Pakwashaya, the Rasa of Pitta in Amashaya is Amla and in

Pakwashaya katu Rasa. The anatomical organs located in the umbilical region are the small

intestines, where the digestion is completed. It has to be born in mind that any pain caused

in the small intestine is usually referred and felt in the umbilical region60.

Functions of Pitta

The general functions of Pitta can be summarized as below, and abnormal function

of Pitta we assess by Pitta vruddi lakshana and Kshaya lakshana bases.

Literary review 34

Some of the abnormal conditions are Aruchi, Avipaka, Ajeerna, Abnormal body

temperature, abnormal colour of the body courage, fear, anger, confusion, impairment of

vision etc such are the abnormal function of Pitta.

I. Biological functions

Ruchi ,trishna, pakti, vshala crelish food thirst (digestion and metabolism) (production

of norma body temparature) shut (appetite and hunger) darshana (visual perception) ragkrit

(imparting colour of the rasadhatu converting in to Rakta dhatu and also normal colour to

the skin) prabha (lustre) deha mardhvam (softness of the body) ojakrit (production of ojas)

I. Psychological

II. Medhakrit, buddhi and dhi (aids, intellectual functions, understanding)

III. Prasada (happiness)

IV. Shauryam (courage and valor)

V. Krodham (anger)

VI. Moham (infatuation) 61,62,63,64

In brief above mentioned biological and psychological functions of Pitta. It is

classified into five main categories on the basis of functions and its seat.

Pachakapitta:

Pachana is avikruta Pitta karma this is one of the five varieties of Pitta and an

important one. The life span, complex in vitality good health, enthusiasm, and plumpness

glow vital essences luster heat and the life breaths are derived from the dehagni65.

When this Agni is extinguished, the man dies when a man is endowed with it

adequately, he lives long in good Health, when it is deranged he falls sick therefore the

function of the Agni is said to be the main stay of life66. All other Pitta is originated from Agni,

therefore the increase and decrease of Pitta causes the waxing and waning of the other

Pitta 67.

Literary review 35

The Pachakapitta is produced from the Pittadharakala by the stimulation of

Samanavata, based on the concept of Adharadheya bhana, the integrity of Grahani

depends on the proper function of Agni68. There fore any impairment of Pachakapitta

involves the integrity of the Grahani and vice versa.

Pittadharakala, the source of Pachakapitta is stated to be located in both Amashaya

and Pakwashaya there fore the Pachakapitta secreted in these two places possesses two

different tastes.

1. secreted into Amashaya, it has the Amlarasa that is vidagdha state

2. Secreted in to Pakwashaya it has the katurasa the natural taste of Pitta.

This difference in the Rasa of Pachakapitta secreted into Amashaya and

Pakwashaya is indicated the amlavastha and katu avastha in the process of the digestion of

food. The secretion of Pachakapitta from the Pitta dharakala is controlled by two

mechanisms.

1. Neural through the stimulation by the samanvata

2. Humaral There is abundent production of clear Pitta in the Amlavastha or

pachamanavasta of the digestion the partly digested food stimulates a copious

secretion of the digestive juices.

For a successful completion of the digestion of food, the pachaka Pitta requires the

support of other factors in adition to the action of samanavata 69,70,71.

Malarupa Pitta:

Even through not produced by the kalas of the kostha, but being excreted in to the

kostha to help the digestive processes, this is discussed here mala rupi Pitta is the product

of dhatu parinama from the kittapaka of raktagni on Rakta Dhatu and released from the

Rakta sthana yakrit72.

Since the dhatuparinama / dhatuposhan is a continuos process. The mala rupa Pitta

or bile is produced in liver continuously. The chief biliary components are bile salts and bile

Literary review 36

pigments cholesterol and lecithin, these organic materials make up over 60% of the total

biliary solids. Only bile salts are use full in digestion. These salts aid in digestion and

absorption of fat largely because of their property of lowering the surface tension and the

ability to form chemical compound with fatty acids, thus increasing their solubility bile salts

stimulate peristalsis and there fore have a mild laxative action.

Bile acts as the own stimulant, bile salts are the strongest chologogues. The

malarupi Pitta is also known as malaranjaka Pitta since it imparts colour to the faeces.

The Ancient authorities have not made any mention of the colour, taste, smell and

den0sity of Pachakapitta. The only physical quality of these substances, to which there is

reference, is its dravatva of liquidity. Concept of Pachakapitta pointed to some internal

secretion secreted by the Agnidharakala, in the Grahani (corresponding to the mucosal

glands of duodenum) some of them exercise a regional influence and others systemic,

particularly metabolic. A suggestion was, then made to the secretogogue influence of food,

which had attained amlabhava (acidification) resulting in the secretion and discharge of the

achapita. [Corresponding to combined hepatic bile and pancreatic juice]

Such tests have yielded fairly accurate information as regards their physical qualities

and chemical composition. These are significant in the present context. The secretion,

relevant to the present discussion is bile, which is a yellowish, reddish brown or green fluid

according to the relative preponderance of its two chief pigments. It has a characteristic

musk like odor, a bittersweet taste and alkaline reaction 73.

The physical characteristics and qualities of the Pitta described in ancient Ayurveda

classics striking resemblance to hepatic bile (better still the combined bile and pancreatic

juicy. The payments of bile the bilirubin and biliverdin are essential constituents of the

haemoglobin complex. From this point of view, it may be stated that, Rakta is the seat of

Pitta the bile pigments is also the waste products or mala of the blood. Rakta and Pitta have

identical colour. The truth of this statement will become evident by taking in to consideration

Literary review 37

of the fact that, though bright red in colour if undisturbed. The blood separates into two

parts the lower contains the cells and is opaque and red. While the upper is a clear pale

yellow liquid the plasma. Under the microscope, an enormous numbers of pale yellows disk

the red blood corpuscles floating in a clear colorless fluid can be seen. It is the setting down

of these red cells, which brings about the separation of the blood into two parts, although

yellow when seen individually, they appear red in bulk.

The colour of the hepatic bile is golden yellow this is largely due to its pigments,

when set free into the blood. The bilirubin contributes to the normal colour of the plasma,

both blood and bile have nearly the same characteristics fleshy smell. In addition to the two

factors are initially correlated to the liver and spleen. Pitta may refer to the hepatic bile or

possibly, to the combined bile and pancreatic juice.

This conclusion is further supported by authoritative references made to conditions

caused by abnormal states of functioning of Pitta for example according to Vagbhata an

increase of Pitta cases yellowness of urine, feaces, eyes and skin, increased appetite, thirst

burning sensatioin in the body and insomnia. These signs and symptoms, especially, the

yellowish urine, feaces, skin and eyes are known today, to be due to circulation in excess of

the bile pigments bilirubin a condition described in bilirubinaemia.

The Chakrapani in his commentary reference to shakhaashrita Kamala says that, the

non-excretion of the Pitta, which imparts to feces its characteristic colour mala ranjaka in to

Rakta, is responsible for the swetha varchas or whiteness, among others of the pureesha

(faeces). In this condition this allusion would lend additional support to the thesis that Pitta to

which the physical characteristics and qualities.

RANJAKA PITTA:

Susruta coated Yakrit and pleeha are main seat of Ranjakapitta, in function he has

stated, that it74 confers colour to Rasa i.e., Rasa ragakrit. Vagbhata has on the other hand

identified its location in Amashaya and ascribed to it the same function as Susruta has done.

Literary review 38

According to Ayurvedic view, rasadhatu is stated to contribute to the formation of

Rakta with the help of Ranjakapitta, which is claimed to impart to Rasa, its colour75. In

treatment aspect Susruta coated goat liver with raw drug, together with the Pitta contained

in it, in the treatment of loss of blood in Rakta Pitta. The fact that between them, the

stomach and liver contributes an identical factor the Ranjakapitta essential for formation of

that element which makes the blood appear red, visualized by Susruta and Vagbhata round

about the 4th century BC and 5th Century A.D respectively. Modern workers have

experimentally confirmed it in the late twenties of the present century, during 1926 Minot

and Murphy showed that the liver was the most effective ingredient in the diet for the

treatment of pernicious anemia patients.

Susruta has given Rakta a special place of importance in the physiological and

pathological process. Two points 76 may also recognize the importance of Rakta.

i. Its function of jeevankriya Hemadri on Astanga Hridaya sutra 11/3

transporting and supplying a visista vayu known as prana through the

Rakta (haemoglobin)

ii. Even a minor deficit in the above stated function can initiate the

pathological processes.

In view of the important function of Rakta, a separate Pitta necessarily required for

the production of it. In the formation of raktadhatu, Ranjakapitta assists the raktagni which

synthesis the cellular structure from rasadhatu.

The factor in the liver, which is essential for the maturation of erythrocytes has, since

been demonstrated to be associated with the non protein fraction of the liver substance,

which is known as the antianaemic or haematenic principle. Smith reported that isolation of

an amorphous red principle from proteolised liver, which was effective in pernicious anemia

in very small doses around half a milligram. This material now referred to as B12 has since

Literary review 39

been shown to be a cobalt complex, this is obviously the erythrocyte naturation factor in

pure or nearly pure form.

In text’s we see the seat of Rakta and Ranjakapitta are Yakrit and ‘Pleeha’ both.

Pleeha is a storage house of the erythrocytes and its functions and blood supplies through

its sinuses (spleenic sinuses)

The chemical factor essential for the maturation of erythrocytes has been as already

noted as the liver principle viz. B12, a red cobalt linked enzyme corresponding to

Ranjakapitta.

BHRAJAKA PITTA:

The importance of the skin in the maintenance of the body temperature and colour of

its recognized in Ayurveda and a separate subdivision of Pitta is a located for this function.

Charaka describing under the heading of general function of Pitta, the product of normal and

abnormal temperature and color of the skin is due to the Pitta 85

Susruta and Vagbhata directly mentioned Ranjakapitta its seat and functions. It’s

seat is twak, production of normal and abnormal temperature of body, normal and abnormal

colour, luster etc this is by the paka of substance used for Abhyanga 86,87,88, parisheka lepa

etc. Pitta classified under different groups not only under the five headings they are maturity

quality functions etc89.

1. Based on the state of Maturity:

As immature state in Amashaya with Amlarasa, mature state in pakvasaya with

katurasa.

2. Based on its qualities:

Which is drava and snigdha conducting the normal physiological functions in the

body, Nirdrava and ruksha which is the cause of jwara and other disease.

3. Based on its Paka stage:

a) The prakrita Pitta present in the body with the normal functions.

Literary review 40

b) Malarupa Pitta: waste product produced in the dhatwagni paka by the action of

raktagni on Rakta dhatu, it is excreted into Pakvasaya supporting the digestion in

that region. This malarupa Pitta is an excretion from Yakrit seat of Rakta dhatu

and imparts colour to pureesha and therefore it is also known as malaranjaka

Pitta.

3. Based on the metabolic process:

There is another important classification of the Pitta in the body based on their

function particularly metabolic processes

4. The Anabolic process:

This group consists of 13 types of Pitta, which are concerned with the digestion of

the food, absorption of nutrients and assimilation in the Dhatu the fundamental tissue of the

body.

a) Pachakapitta also known as Jatharagni, Kayagni etc.

b) Bhutagnis – these are four in number, which acts on their own corresponding

bhoutic components of the ingested food.

c) Dhatwagnis: there are seven in number, which incorporate the respective

nutrients into the respective dhatus for their nourishment or replenishment.

d) The Catabolic processes: these are the Amasas of kayagni mentioned only by

Vagbhata. These moieties are distributed in all the dhatus since these are the

amsasa of kayagni their function is similar to that of kayagni i.e. effecting

sanghatabheda the kayagni is located.

PITTA Vs RAKTA

Apart from three Doshas Susruta explain Rakta as 4th dosha90. Susruta as he is one

of the expert surgeon, he has given more importance to Rakta Dhatu. Pitta is mala of rakta

dhatu91 Vata, Pitta, Kapha and Rakta these are essential factors for sharira Utpatti, sthiti and

Nasa92.

Literary review 41

Rakta panchabhoutikatwa : Table No 9

Mahabhuta Gunadarma

1 Prutvi mahabhoota Amagandha

2 Jala “ Dravatva

3 Teja “ Varna

4 Vayu “ Spandana

5 Akasha “ Laghuta

Above-mentioned gunadarma is evidencing of the Rakta panchabhoutikata.

The causative factors for all the diseases are Tridosha mainly they are Vata Pitta and

Kapha. They are susceptible to imbalance and vitiation along with structural and functional

impairment Dhatu.

Rakta Dhatu is the group of organs concerned with the production and maintenance

of Rakta Dhatu. Charaka enumerated Yakrit and pleeha as the root or moola of Rakta vaha

srotas. In addition Acharyas recognized Yakrit and Pleeha as Rakta sthana.

Yakrit is closely related with Rakta Dhatu and Pitta Dosha. It is the origin of

raktavaha srotas and seat of Ranjakapitta. After absorption Rasa is conveyed to Yakrit and

Pleeha, there it is acted upon Ranjakapitta and it is converted into Rakta dhatu93

Charaka has described Sonitaja Roga i.e. disease caused by Rakta there Kamala

has not been included94.charaka sutra sthana and further 28th chapter sutra sthana. Charaka

has described the disease caused by the Doshas when they are situated in morbid state

even Dhatus. Kamala has been included in the disease caused due to the situation of

morbid Doshas in Rakta dhatu95. It is clear from the above observations that Kamala is not a

Raktaja Roga but when morbid Pitta Dosha involves the Rakta then Kamala may be

produced. Rakta is particularly involved in the Samprapti of kosthashrita Kamala96.

Literary review 42

It would be seen the Pitta to which the physical characteristics and qualities of

under discussion are attributed might refer to liver bile and not others. This view find support

from the description of Pitta as the kitta of Rakta “ asrujapittam” and also reference made

by Charaka, Pitta and Rakta possess nearly identical smell and colour. in addition, the

location of these two factors of Yakrit and Pleeha.

The Asruja Pitta m finds direct correlation from modern physiological views it

regards blood. Bile relationships, which can be summarized, are as follows.

1. The pigments of bile, bilirubin and biliverdin are the essential Constituents of

Haemoglobin complex of the erythrocytes from this point of view. It may be

stated that Rakta is the seat of Pitta. This bile Pigments are also of the waste

products or the mala’s of Rakta.

2. Rakta and Pitta are stated to have identical colour. The truth of this Statement

will become the evident by taking into consideration the fact that, though bright

red in colour. If left undisturbed, the blood separates into two parts. The lower

part is opaque and red. While the upper part is yellow liquid plasma, under the

microscope on enormous number of pale yellow discs, the RBC pleasant in a

colorless fluid can be seen. Although yellow when seen individually. The

erythrocytes appear to be red in colour the colour of the hepatic bile is golden

yellowish which is largely due to its pigments bilirubin constituent to the normal

colour of the plasma. Both bile and blood have nearly the same characteristic

fleshy smell. In addition both blood and bile are intimately connected with the

liver and exists.

3. The coloration of Pitta and Rakta may represents the assumption of the normal

relationship that exists between the blood and some of the important constituents

of bile. This can be seen from the fact that the formation of bile consists in the

removal of bilirubin from blood its conversion in the liver its exertion in the bile

Literary review 43

conalienlai. re-absorption of it from the intestine in the form of colorless

compounds the stereto bilonogen, which later is utilised by liver cells for the

production of fresh haemoglobin. The spleen has disposal of red blood

corpuscles can be seen from the fact, that the macrophages present in it convert

the fragmented dust of degenerated red cells into bilirubin, which is transported

to the liver where it is utilised for purposes mentioned above.

Bhutagni

A review of Pitta may refer to Agni. Agni classified Jataragni, Bhutagni and

dhatwagnis. All the Ayurvedic classics have described them-Charaka has described

bhutagni under the process of normal digestive events. In his view, the digestion of food by

Jatharagni leads to the break down sanghatabheda of the former in to five distinct physico-

chemical groups. The Agni mostly present in substances belonging to each group is then

stated to digest the substance of that group, leading to a radical change in their qualities-

vilakshanaguna. Thus food substance are rendered fit for being assimilated into and built up

as part of the corresponding bhutas class of substances present in the Dhatus. This

process of assimilation is stated to be mediated as it was by the seven dhatwagnis, present

in each species of dhatus97.

According Susruta “This animated organism is composed of five Mahabhuta’s and

the food of living organic being necessarily partakes the character of its corporeal

components”. The food, which consists of the five mahabhutas, is digested, in its turn by

the five bhutagnis and each of its principles proceeds to argument it’s own analogue in the

human organism98.

The modern physiology and bio-chemistry that the main purpose of digestion of food

in the elementary Canal is to render it’s different basic components viz starches, fats,

proteins, which are entirely foreign to the body.

Literary review 44

That is ‘Vijatiya’, fit for being converted and utilised by the body as organism.

Specific carbohydrates, fats and proteins that is ‘Sajatiya’ thus the vegetable starch or

cellulose is first broken down in to its elemental form. The glucose towards the end of

intestinal digestion, before the same is rebuilt in the body as organism.

In the same way, fats derived from various plants and animal sources viz. oils, Ghee

etc. are first broken down into their elemental forms viz. fatty acids and glycerol. Before they

are re-synthesized as organism specific lipids, like wise, animal and vegetable protein

derived from external source are also broken down in first into their elemental form viz., the

aminoacids. Before to they are rebuilt in the body as the organism specific proteins viz.,

albumin, fibrinogen most of the globulin and non-essential amino acids. The above part,

some of the aminoacids are also utilised for functional use viz., the Synthesis of enzymes

and some of the hormones.

The bhutagni paka takes place in the Amashaya, actually speaking, the available

descriptions of this paka resemble, in some respects, the events that take place in the Yakrit

and Jatharagnipaka in the adho-Amashaya. The Yakrit it self is functionally and

anatomically related to anthakoshta. The inclusion of it as one among the koshtangas, is

significant. Apart from the fact the Yakrit is located in the kostha interpreted as Mahanimna

or great cavity, in the Madhyasharira or the trunk99. Which in turns it also considered to be

a Kostha, the fact remains, as shown by modern researches on embryology, that it arises as

a diverticulam below the stomach from the region of the intestine which is destined to

become the duodenum.

The endodermal diverticulam grows into a thick walled vesicle from which the liver

tubules and hepatic duct arise. The endodermal duct grows to splanchnic desaderm, which

provides the connective tissue of the liver and its capsule.

The view advanced in the foregoing that, reactions comparable to bhutagnipaka take

place in the Yakrit and not in the Amashaya, derives additional support from some of the

Literary review 45

important, post-digestive functions and metabolic event’s which modern advances have

showed on physiology and biochemistry to takes place in Yakrit. Liver is imediately

concerned with carbohydrates, lipid and protein metabolism. Is so far as the Carbohydrate

metabolism is concerned it converts the Glucose to Glycogen. Segments of Carbon skeleton

portion of total aminoacids metabolized in the body are converted into substances which, in

turn, may be employed for glucose and Glycogen Synthesis. Gluco-neogenesis, fatty acid

are synthesized de novo in this organs, and released to circulation for being deposited in the

adipose tissues, there also, fatty acids of the diet are transformed into a mixture more

closely resembling that of the species. These functions of the liver are important, in the

context of bhutagnipaka. The liver synthesizes cholesterol and esters. In the cause of it’s

steroid metabolism-the liver elaborates cholic acid and couples it with glycine and taunine to

make the bile acids. It activates in the metabolism of individual aminoacids, liver also

fabricates a number of plasma proteins including albumin, fibrenogen , prothrombin and a

major protein of globulins.

Finally there is the secretary role of the liver concerned with the formation of bile. In

this role, the liver prepares the bile salt’s separates bilirubin from proteins with which it is

associated in the plasma, re synthesizes cholesterol and pours these, with other bile-

components, into the biliary capillaries and hence via the connecting duct of the gall bladder.

This has also proved to the route for excretion of serum phosphatase. Vilakshana gunas can

apply only to a complete change over the qualities of ahara dravyas ingested, which do not,

takes place in the adho Amashaya.

Bhutagnipaka is required to process and convert them suitably as pre-homologues of

substances, which compose of the seven Dhatus.

Haemoglobin

Haemoglobin is the iron containing pigment of the red blood corpuscles. The red

coloured of RBC and the blood as well is due to the presence of the haemoglobin. In

Literary review 46

normal condition the life span of red cells are only few months as they are destroyed by

phagaeytes. The haemoglobin of these cells is broken down into haemosiderin and

haemotidin100.

Haemosiderin is desposed in the cytoplasm of phagoutes as granules or an irregular

mass normally it is also present in certain amount in phagocytes of spleen. Liver and bone

marrow and the quantity is increased state. A green pigment, biliverdin is the breakdown

product of haemoglobin on reduction biliverdin gives rise to a yellow brown pigment.

Bilirubin haemotoidine is a breakdown to productions of haemoglobin during reduction of

RBC and its identical to bilirubin. Bilirubin does not contain iron and a very soluble for this

reason it is dissolved in the blood and not stored in the cells and thus it continuously

removed from the liver cell into the bile101.

The loss of haemoglobin will reduce the oxygen carrying capacity of blood thus

producing the anoxia and acidosis. Bile pigments will be produced in larger amount by R E

Cells from the released haemoglobin and in this way additional pressure will be put upon

the liver to deal with them102.

Destruction of RBC103:

When red blood cells are delivered from the bone marrow into the circulatory

system. They normally circulate an average of 120 days before being destroyed. Even

though mature red blood cells do not have nucleus, mitochondria or endoplasmic reticulum,

they do have erythroplasmic enzymes that are capable of metabolizing glucose and forming

small amount of adeasine tri-phosphate. These enzymes also

a. Maintain the pliability of cell membrane.

b. Maintain membrane transport of ions

c. Keep the iron of the cell haemoglobin in the ferrous form rather than the ferric

form.

Literary review 47

d. Prevent the oxidation of the proteins in the red cells even so, with aging the

metabolic systems of the red cells becomes progressively less active, and

the cells become more and more fragile presumably because their life

processes wear out.

Once the red cell membrane becomes fragile the cell rupture during passage

through some tight spot of the circulation. Many of the red cells self distract in the spleen,

where they squeeze through the red pulp of the spleen. Where they squeeze through the

structural trabeulae of the red pulp, through which most of the cells must pass, are only 3

micrometers wide in comparison with the 8-micrometer diameter of the red cell. When the

spleen is removed the number of abnormal red cells and old cells circulating in the blood

increases considerably.

Destruction of Haemoglobin104:

When red blood cells burst and release their haemoglobin the haemoglobin is

phagocytized almost immediately by macrophages in many parts of the body. But especially

by the dupffer cells of the liver and macrophages of the spleen and bone marrow, during the

next few hours to days. The macrophages release the iron from the haemoglobin and pass

it back into the blood to be carried by transferrin either to the bone marrow for production of

new red blood cells or to the liver and other tissues for storage in the form of ferritin. The

porphyrin portion of the haemoglobin molecule is converted by macrophages through a

series of stages, into the bile pigment bilirubin, which is released into the blood and later

secreted by the liver into the bile.

Bilirubin Metabolism105

Bilirubin is an end product of haem coming from haemoglobin and from myglobin

and many respiratory enzymes. Approximately 35 gm haemoglobin are broken down daily

and 300 mg bilirubin are formed production takes place in reticulo endothelial cells.

Literary review 48

These enzymes that converts haem to bilirubin is microsomal haem oxygenase

which has absolute requirements for oxygen and NADPH, cleavage of the prophyrin ring

occurs selectively at the alpha Methane Bridge. The alpha bridge carbon atom is converted

to carbon monoxide and two oxygen atoms, which are derived from molecular oxygen,

replace the original bridge function. The resulting inear tetrapyrrole has the structure of the

IX alpha biliverdin. This is converted further to IX alpha bilirubin by an enzyme, biliverdin

reductase, such a linear pyrole should be water soluble, where as bilirubin is lipid soluble.

The lipid solubility is explained by the structure of IX alpha bilirubin, which has six intra

molecular stable hydrogen bonds. This bonding can be broken by alcohol in the diazo

reaction converting unconjugated bilirubin to conjugated reacting bilirubin. In vivo the stable

hydrogen bonds are altered by asterification of the propionic groups by glucoronic acid.

About 20% of circulating bilirubin is not formed from the haem of mature

erythrocytes. A small portion comes from immature cells in spleen and bone marrow. This

component is increased in haemolytic states. The remainder is formed in the liver from

haem protein such as myoglobin, cyto chromes and unknown sources this component is

increased in pernicious anaemia.

Spleen as Sroto moola

The spleen develops as a collection of mesenchymal cells in the dorsal

mesogastrium some of these cells are contributed by the coelomic epithelium lining the

mesogastrium. The mesenchymal cells differentiate into lymphobyasts and other blood

forming cells.

As the mesenchymal cell proliferate, they form a mass which projects to the left, and

is covered by peritoneum. The dorsal mesogastrium in this region, can now divided into a

part extending from the stomach to the spleen (gastrospleenic ligament) and another part

extending from the spleen to the posterior abdominal wall. The latter part fuses with

posterior abdominal wall with the result that a fold of peritoneum now passes from the

Literary review 49

spleen to the left kidney (lineorenal ligament). As a consequence of this fussion, and as

result of a change in the orientation of the stomach, the spleen comes to lie on the left side

and takes part in forming the left boundary of the lesser sac of periforneum28.

UPADRAVA IN KAMALA

The occurrence of another disease in the wake of a primary disease as a

complication is termed as upadrava 143. It occurs along with manifestations of the disease in

it times other. After Vyadhi prasaman it is develops in some times. Upadravas may prove to

be more trouble some to the patient as they occur when he is in a debilitated condition

hence it is stated that at time updrava is to be treated first.

The upadrava of Kamala as not explain in our classic under Separate and

independent heading When the patient not taken proper treatment and neglecting the

disease. After develops the Kumbha Kamala, it is considered as upadrava of Kamala roga.

it shows sixth kriyakala of the disease Pitta not only remains between the disease Pitta not

only remains between the Twacha and mamsa at external level but it gets into the deeper

dhatus and spreads completely on internal organs particularly in kosta.

The fundamental idea of Anu Sushirata of earthen pots to that of the internalSrotas

as of the organs especially that of Mahasrotas according to Susruta opinion Kumbha

Kamala is a type of Kamala. 144

Astanga Hridaya explained that untreated Kamala leads to the next stage called

Kumbha Kamala. 145

KumbhaKamala lakshana as Follows 145

1. Krishna Peeta Mala

2. Krishna Peeta Mootra

3. Shareera Sotha

4. Charadi

5. Murcha

6. Daha

7. Aruchi

8. Trushna

9. Anaha

10. Tandra

11. Moha

Literary review 50

ARISTA LAKSHANAS

Certain symptoms produced in a disease suggest bad prognosis of the disease.

Description regarding Arista Lakshanas either of Kostashakha Shrita Kamala is not

available in Brahatrayas or in lingutrayas Madhavakar for the first time mentioned Arista

Lakshana of Kumbha Kamala.

Table No 10. 146, 147

Lakshana Ma,ni Bh,Pr

Vomiting + +

Anorexia + +

Nausea + +

Fever + +

Fatigue + +

Dysponea + +

Cough + +

Diarhoea + +

Bhava Prakash has followed Madhavakar and in 8th Chapter of Bhava Prakash,

Uttarardha he has explained Arista lakshana of Kumba Kamala. Here Asadhya Lakshanas

of Kumbha Kamala considered as Arista lakshanas of Kamala.

SADHYASADHYATA 148, 149

The Sadhyasadhyata of a disease would be established before the commencement

of the treatment. It suggests the prognosis of a disease. A disease is called Sukasadhya

when it is new one, having minimum Nidana poorvarupa Roopa, on the otherhand if the

disease is chronic and present with the complication then it is called as Asadhya. The

Literary review 51

complications of Kamala are Krishna Peeta Mala, Mootra, Raktakshi, Mukha, Chardi, Rakta

Vinmutra, Tandra, Moha, Anaha etc.

Upadravayukta Kamala is a kastasadhya and asadhya.

Kumbha Kamala is kastasadhya.

CHIKITSA IN GENERAL

The first obvious requirement before proceeding to treatment is the diagnosis of the

clinical Varity to which a given case of Kamala belong to careful inquiry has to be made to

as certain causes responsible for the disease.

The importance of Chikitsa lies in breaking up Samprapti and the integral factor of it,

Ama is prevalence of all somatic diseases together extent hence every disease must be

examined in greater detail in order to dislodge.

Chikitsa Sutra

Chikitsa Sutra explained in different classic are as fallow –

Mrudhu virechana by using a Tiktarasa dravyas 150. For Kamala adopt a Pitta hara

Chikitsa and also advised Anjana Chikitsa. 152 According to Susruta, It is Considered

Kamala as one of the Pandu Roga and so he advised the same line of treatment for

Kamala. 153

According to yogaratnakar snehana, virechana, Nasya and anjana are the basic line

of treatment for Kamala. From the above classical references we can conclude that the line

of treatment of Kamala.

1. Pachana

2. Snehana

3. Virechana

4. Nasya

5. Anjana

6. Shamana aoushadas

Literary review 52

PACHANA:

One of the main aim of treatment is to bring back the Agni to normal so deepana and

pachana should be done before the proceeding the main line of treatment. This measure is

essential when the treatment is aimed to cure Kostashakashrita Kamala primarily, where as

in case of shakhastrita Kamala the initial phase to bring shakashrita Pitta to kosta Pitta

vardhaka and kaphakar ahara dravya used.

SNEHANA:

Snehana is to be done as a preparative procedure for Virechana. According to

classical text snehapana is continued until alpasnigdha laxanas are produced. In Kamala,

the doshas are adhered in the shaka, so to bring back the Doshas to the kosta the poorva

karma is adopted. The Snehan is one of the Poorva karma by which the Doshas will get

vilayana, so the snehana is to be done before the Virechana karma.

1) Mahatiktaka Ghruta Cha.chi 16/43

2) Panchagavya Ghruta Cha.chi 16/43

3) Kalyanaka Ghruta Cha.chi 16/43

4) Draksha Ghruta Cha.chi 16/52

5) Haridradi Ghruta Cha.chi 16/53

VIRECHANA:

The Ayurvedic classics advised to undertake mrudhu Virechana in Pandu and

Kamala Roga. Virechana therapy specially in Pitta pradhana and Rakta pradushaja

vikaras.Kamala is one of the Pitta pradhan roga. For the Virechana medicine explain in the

classics are Gomutra and Go-dugdha 153

NASYA AND ANJANA:

These therapies are mainly indicating when the Ranjakapitta, gets sthansashraya in

urdwajatruga mainly netra, jivha and becomes too stagnant even after the Virechana in

these conditions Nasya and anjana helps to normalize the Ranjakapitta.

Literary review 53

Nasya : 154 Karkotakamoola, devadhali

Arka mula, Tandulodhaka

Anjana :155,156 Dronapuspi swaras

Nisha, Gairika, dhatri choorna

SHAMAN OUSHADHAS

1. Mandur vataka Y R Panduroga /39,40

2. Phalatrikhadi Kwath Y R Panduroga /30 B/R12/22

3. Navayasa Choorna Y R Panduroga 32 B/R12/22

Cha.Datta 8/11,12

4. Dharvyadhi choorna Y R Panduroga /59

5. Yoshadhi choorna Y R Panduroga/63,64

6. Dhatryadhi Yoga Y R Panduroga/61

7. Lohachurnadi Yoga Y R Panduroga/62

8. Eladi Choorna Y R Panduroga/65

9. Nisha Choorna Y R Panduroga/66

10. Vishalya Prayoga Y R Panduroga/69,70

11. Yogaraja Cha.datta 8/13-19

12. Yoga Panchaka Cha.datta8/28

13. Tryusanadya Mandoor Cha.datta8/36-41

14. Dhatryarista Cha.datta 8/49-51

15. Punarnavadi Mandoor Bha Ma 8/30-34

16. Vasadhi Kashaya B R 12/23

17. Navayasha Loha B R 12/28

18. Nisha Loha B R 12/29

19. Dhatri Loha B R 12/30

20. Vidangadhi Loha B R 12/33

Literary review 54

21. Darvyadhi Loha B R 12/37

22. Trikatrayadhi Loha B R 12/38-43

23. Kamalantaka Loha B R 12/44-51

Pathya Apathya in Kamala 157

Pathyam means that which is compatible to the body. This term used as synonyms

of Chikitsa. Which is not conductive to health is called Apathya.

Charaka Samhita description regarding Pathya for Kamala Puran shali, Yava,

Gudha, Godhuma, Yusha, Mudga, Adhaki, Masoor, Meat juice of jangal creators. Ghruta,

Dugda pathya, Lavana apathya.

Pathya in Shakhashrita Kamala: 158

Charaka has considered certain pathyas to bring back to the vimarga Gamita Pitta

from shaka to kosta by eliminating the avarodha caused by Vata and Kapha. The rice diet

should be given with meat juice of peacock, partridge, Shuskamoolaka yusha,Kulathya,

Matulunga swarasa, Madhu, Trikatuchurna

Literary review 55

The Phalatrikadiyoga is selected from Baishajya Ratnabavali in Pandu Roga

Chikitsa is said as a phalatrikadi kwatha in classic we added two more drugs

Bhrungaraja and Bhumyamalaki. It reduces the Hepatato toxicity. The medicine

described was fortfilled reactionary and reformulated contains the following ingredients:-

Ingredients Parts in ratio

1) Haritaki I part

2) Bibhitaki I part

3) Amalaki I part

4) Guduchi I part

5) Vasa I part

6) Kiratatikta I part

7) Katuki I part

8) Nimbatwaka I part

9) Bhumyamalaki I part

10) Bhrungaraja Swaras Quantity sufficient

The above drugs from 1 to 9 are prepared into powder form separately and then

mixed in above ratio properly all drugs taken in one ratio, after one bhavana given by the

“Bhungaraja Swarsa” well mixture dried and powdered into fine powder. Lastly made

into capsule form. Each capsule containing 500mg of medicine.

Trail drug description 56

HARITAKI 159, 160

Sanskrit : Haritaki

Latin : Terminalia Chebula

Family : Combertaceae

Synonyms : Abhaya, Pathya, Vijaya, Bhishakpriya

Gana : Amalakyadi, Purushakadhi(Su) Prajashtapana,

Jwaragna(Cha)

Vernacular Names:

English : Chebulic Myrobalan

Hindi : Harada, Harre

Kannada : Alalekai

Habitat: This tree is wild in forest of northern India, Central Provinces and Bengal

common in Madras and Mysore.

Pharmacological properties:

Rasa : Kashaya Pradhana(lavanavarjita) Pancharasa

Guna : Laghu, Ruksha

Veerya : Ushana

Vipaka : madhur

Prabhava : Tridhoshahara

Chemical constituent: 161

Important source of tannin, the fruits collected from Madras are very rich in

tannin and large amount of Gallic acid and Chebulic acid.

Pharmacological Action:

Myrobalams are safe and effective purgative, Rashayana, Swas, Kasa,

Prameha, Eye diseases, Kusta, Vruna, Chardi, Sopha, Vatarkata and Cardiac diseases.

Trail drug description 57

Astringent, Stomachic, Purgative.162 Rasayana Netraroga, Twakaroga Kamala, Grahani,

Hikka, Pleeharoga, Gulma Yakritrog, Asmari.163, 164

Part used: Phala

Uses:The fruits are used as a medicine for sore throat by Paris and Sikim Rubbing the

fruits on a rough stone with water mix and carron oil of the Pharmocophia and applied to

the burns and scalds. Scalds rapid cure than when carron oil alone is used.Fruits kept in

a water for night is considered a very cooling wash for the eyes. The ashes mixed with

butter form a good ointment for sores.165

Trail drug description 58

VIBHITAKI 166, 167

Latin : Terminalia Belerica

Synonym : Kalidrum, Bhutavasa, Karsaphala

Gana : Jwarahara,Virechanophaga(Cha) Triphala, Mustadi(Su)

Vernacular Names :

English : Belerica Myrobalans

Sanskrit : Bibhitaki

Hindi : Bhaira, Bahera

Kannada : Tarekai

Habitat: All over Indian forest

Pharmacological properties

Rasa : Kashaya

Guna : Ruksha, Lagu

Veerya : Ushna

Vipaka :madhur

Chemical constituents: The fruits contain about 20 to 30% of tannin and 40 to 45% of

water-soluble extractive. It contains galic acid, ellagic acid, phyllemblen, ethyle gallate

and galloyl glucose. 168

Pharmacological action:

Astringent, tonic, expectorant and laxative.169 Fruits are useful in cough,

hoarseness, eye disease, scorpion sting. Salt and long pepper pulp of the fruits is given

in the form of expectorant in cough, hoarseness, sore through. It is constituent of

triphala prescribed in diseases of liver and gastrointestinal tract and in a large verity of

diseases.170.

Compound I isolated from fraction TB5 of Terminalia belerica and finally

identified as 3,4,5-trihydroxy benzoic acid (gallic acid) was evaluated for its

Trail drug description 59

hepatoprotective activity against carbon tetrachloride (CCl4) - induced physiological and

biochemical alterations in the liver. Administration of compound I led to significant

reversal of majority of the altered parameters. Our results confirm the presence of

hepatoprotective activity in altered parameters. Our results confirm the presence of

hepatoprotective activity in Compound (Anand KK, Singh B, Saxena AK, Chandan BK,

Gupta VN, Bhardwaj V. 3,4,5-Trihydroxy bezoic acid (gallic acid), the hepatoprotective

principle in the fruits of Terminalia belerica-bioassay guided activity. Pharmacol Res

1997 Oct; 36(4):315-321).

Part used: Fruits

Uses: kasa, netra, keshya, madakaraka. Anti microbial activity of Terminalia bellerica

triterpenoids.171

Trail drug description 60

AMALAKI 172, 173

Latin : Embelica officinalis

Synonym : Dhatriphala, sriphala, vayashya, Vrushya

Gana :Vayastaphana, shirovirechana (cha) Triphala, parushakhadi (Su)

Vernacular Names :

English : Embelica Myobalan

Sanskrit : Amalaki

Hindi : Amala

Kannada : Nellekai

Habitat: Uttara bharath, Himalaya parvata, Kashmir, Malaya dveepa

Pharmacological properties

Rasa : Amla pradhana lavana varjita pancharasa

Guna : Ruksha Guru sheeta

Veerya : Sheeta

Vipaka : madhur

Chemical constituents: Amla fruit is a rich natural source of vitamin C, 5% of tannin

and rich in mineral matter like Phosphorus, Iron calcium. The presence of tannin which

relates oxidation of vitamin C.173 The amount of vitamin C in fresh fruits 500mg to 970mg

per 100gm and dry fruits having 256 to 421 mg per 100gm. 174

Pharmacological Action 175: Dried fruits is useful in hemorrhage, diarrhea and

dysentery with iron it is a valuable remedy in anaemia, Jaundice and dyspepsia, a

fermented liquor prepared from root is used in Jaundice, dyspepsia, cough etc.

Part used: Phala

Uses: Activity of Emblica officinalis is said as Raktapitta, daha, chardhi, prameha,

rasayana and shopa. Antimutagenic and anticarcinogenic 176. Antioxidative activity of

Tamarind extract prepared from the seed coat .177, 178

Trail drug description 61

GUDUCHI 179, 180

Latin Name :Tinospora Cardifolia.

Family : Menispermaceae.

Gana :Vayastapan, Dahaprasaman, Truptignagana, StanyaShodhana (Cha)

Patoladi, Guduchyadi, Aragvadhadi, kakolyadi, valli panchamoola(su)

Guduchyadi ( Dha Ni)

Synonyms : Madhuparni, Amruta, chinnaruha.

Varnacular name’s:

English : Gulancha

Hindi :Giloya.

Kannada : Amrutaballi.

Habitat : Occurs in almost all districts of Madras Presidency.

Pharmacological properties:

Rasa : Tikta kashaya,

Guna : Guru, Snigda

Veerya :Ushna

Vipaka :Madhur

Chemical -constituents: Berberine , bitter substance,

Pharmacological action

Antiperiodic, alternative diuretric, stem and root are bitter.It stimulates the bile

secretion, causes constipation tonic', allays thirst, fever, burning sensation, Vomitting

enriches the blood, cures Jaundice, useful in skin diseases the Juice is useful in

diabetes, vaginal and urethral discharges. Low fever and enlarged spleen.181

Outstanding results in people suffering from jaundice have been obtained using a herb

called Tinospora Cordifolia: In 1993, Rege et al. (ibid) used the herb in malignant

obstructive jaundice: half of the group received conventional treatment - drugs and

Trail drug description 62

drainage - the other half were treated with drainage plus T. Cordifolia. After conclusion of

treatment, 50% of the drug-treated group were found to have blood poisoning while none

of the herb treated group developed this problem. After surgery, only 40% of the drug-

treated group survived, whereas an amazing 92.4% 0f those treated with the herb lived.

The hepatoprotective effect of T. Cordifolia has been studied in carbon tetrachloride

induced liver damage in rats. While acute damage was enhanced by prior exposure to

the drug, it proved effective in the prevention of fibrosis, and in stimulating regeneration

of hepatic tissue (Rege, N. et al.: Ind. Drugs Sept. 544 (1984).

Part Used: kandha.

Uses: daha, prameha, kasa, pandu, kamala, kusta, vatarakta, Jwara, krimi 182

Studies:

1. Tinospora Cardifolia and cytotoxic Chemotherapy.183

2. Immuno Modilatory Com pound from Tinospora cardifolia. 184

3. Tinospora Cordifolia induces colony-stimulating activity in serum. 185

4. Study of anti pyretic activity of Guduchi. 186

5. The potential Role of Tinospora cardifolia in cancer therapuetics. 187

Trail drug description 63

VASA 189, 190

Latin : Adhatoda vasica.

Family : Acanthaceae,

Synonyms : Vasaka,vasika, Sinhashya, vrusha,

Gana : Satavahadivarga (R.Ni) Guduchyadivarga (Dha.Ni)

Vernacular names:

English : Malabar rut.

Hindi : Adusa

Kannada : Adasoge.

Habitat : This plant grows in most parts of India, especially in the lower

Himalayan ranges.

Pharmacological Properties:

Rasa : Tikta, kashaya

Guna : laghu Ruksha

Veerya : Sheeta

Vipaka : katu

Chemical Constituents: An odorous volatile principles probably of the nature of

essential oil, fat, resin, a bitter non volatile alkaloid called vasicine, an organic acid

adhotodic acid" sugar, gum, colouring Matter and salt's largest amount of vasicine

Contained in the root bark, and to the extent of 0.25 percent in the leaves. 191

Pharmacological action: Expectorant, diuretric, antispasmodic and alternative Vasiane

has no marked action on the alimentary canal on the Circulation. 192. Adhatoda vasica

acts as a Cholagogue and can be employed in some types of Jaundice. 193

Part used: leaves, roots, bark and flowers.

Uses: Kshaya swasa, Kasa, Rakta pitta,raktapradar, chardhi, kustham, and Jwara, 194

Trail drug description 64

KIRATATIKTA195, 196

Latin :Swerita Chirayata.

Synonyms :Kirat, Kiratatikta, Bhunimba (Mad Ni)

Gana :Tiktagandha, stanyashodhan, Trushnanigrahana(cha)

Aragwadhadi (su)Haritakyadi gana ( Bha Ni )

Vernacular names:

English :Chireta

Hindi :Chirayata

Kannada :Nelabevu

Habitat: It is abundantly available in north India, Kashmir, nephal, Simla, himalaya

and South India.

Pharmacological properties:

Rasa :Tikta

Guna :laghu, ruksha.

Veerya :Ushna

Vipaka :Katu

Chemical constituents: Chiratin a yellow bitter glucoside, resins, gum, carbonates and

phosphates of potash, lime and magnesia, ash 4 to 6 % no tannin. Bitter yellow acid

known as ophelicacid.197 Two bitter glycosides chiratin and amarogentin. 198

Pharmacological action: Bitter tonic, stomachic, febrifuge and anthelmintic

Sannipathajwara, swasam, kasam,raktashodana, thrishnasodhan, kustam, krimi.

Part used : Panchanga

Uses : The plant is bitter, cooling antihelmintic, antipyretic, antiperiodic,

laxative, galactagogue, cures thirst, leucoderma, inflammation, burning sensation, pain

in the body, urinary discomfort, asthama, bronchities. Marphological and

Chromatographic comparison of certain Indian spaces of swerita. 199, 200.

Trail drug description 65

KATUKI 202, 203

Latin : Picrorhiza kurrora.

Family : Scrophulariaceae

Synonym : Katuka, Tikta, Kandharuha, Chakrangi.

Gana : Bhedaniya. lekhaniya, sfanyashodhan, Tiktashandha ( cha)

Patoladi , pippalyadi, mustadi (Su)

Vernacular Names:

English :Picrorhiza.

Hindi : Katuka

Telagu :alam.

Kannada : Katuk Rohini.

Habitat : Common on the Northwestern Himalayas from Kashmir to sikkim.

Pharmacological properties:

Rasa :Tikta.

Guna :Ruksha, laghu.

Veerywa :Sheeta.

Vipaka :Katu

Chemical Constituents: Root contains a glucoside called picrorrhizin, a fairly large

percentage of soluble bitter substances with an acid reaction.

Pharmacological action: In small doses, it is a bitter stomachic and laxative and in

large doses, a cathartic, It is reputed as an antiperiodic and chalagogue.

Picrorrhiza Kurroa is one of the herbs they recommend to support the liver not

only in everyday situations, but in cases where severe viral infections attack: a 1996

study by Vaidya found protection against viral hepatitis, and other studies have

demonstrated its helpfulness in protecting against alcohol (Vaidya (Better Nutrition June

1999 p. 29).

Trail drug description 66

The hepatoprotective activity of picroliv, the irridoid glycoside mixture from

Picrorhiza kuroa, was determined in adult male albino rats. Pretreatment with picroliv

prevented the hepatotoxic effects of paracetamol and galactosamine as evidenced by

varios biochemical and histopathological observations. Maximum hepatoprotective effect

was observed with daily oral doses of 6 and 12 mg/kg for 7 or 8 days. The

antihepatotoxic action of picroliv seems likely due to an alteration in the

biotransformation of the toxic substances resulting in decreased formation of reactive

metabolites (Visen PK, Shukla B, Patnaik GK, Dhawan BN. Andrographolide protects rat

hepatocytes against paracetamol-induced damage. J Ethnopharmacol 1993

Oct;40(2):131-136.

Part's used : Dried rhizome.

Uses : Deepana, bedhana, hridhyam, swasam. Jwaram, Prameha, kasam,

krimi, kustam, laxative. Two dranchms of powdered root given with sugar and warm

water acts as a mild purgative. Picrorrhiza is used as a valuable bitter tonic, antiperiodic,

febrifuge and stomachic, it is laxative in large doses. Alcoholic extract of the root is

found to have antibacterial effect. The drug is found useful in treatment of Jaundice203

Hiccough, blood troubles, burning sensations, leacoderma, Jaundice204

1) Katuki protects against liver disorders205

2) Picroliv protects against alcohol induced chronic hepatotoxicity in Rats206

3) Effect of picroliv on liver regeneration in Rats207

4) Protective effect of picroliv, active constituent of picrorhiza kurrora, against

oxytetracycline induced Hepatic damage208.

5) Studies on indian traditional medicine, picrorhizakurrora and peptic ulcer209.

6) Antiallergic activity of picrorhiza kurrora210.

Trail drug description 67

NIMBA211,212

Latin : Azadirachta Indica

Family : Meliaceae.

Synonyms : Pichumardha,Arista,

Gana : Kandhugna, Tiktaskandha (cha)

Aragwadhadi, Guduchyadi, laksadi (Su)

Varnacular Names:

English : Margosa tree.

Hindi : Neem.

Kannada : Bevu.

Habitat : Indegenous to and cultivated nearly all over india and in Burma.

Pharmacological properties:

Rasa : Tikta. kashaya.

Guna : laghu.

Veerya : Sheet.

Vipaka : Katu.

Chemical constituents: Nimbin, Nimbidin, Nimbosterol , Tanin these are the main

constituent present in Neem.

Pharmacological action: Vomiting, burning sensation near the heart, fatigue, fever,

thirst, bad taste in the mouth, cough. Cures ulcers and inflammations are good for

leprosy. Blood complaints, urinary discharges. Skin disease, tumors etc.,

Part used : Puspha, patra,, twaka, beeja, Taila

Uses: Intermittent fever and general debility, Slight antiseptic, Carbolic lotion in

washing wounds and ulcers. Dried leaves powdered are applied locally to the

anus of children suffering from intestinal worms. Vruna kusta, Netraroga, kasa swasa

kamala.

Trail drug description 68

1) Evaluation of deoiled neem seed kernel extract and neem leaf suspension as growth

regulators for Aedes egypt214

2) Role of Nimba patra swarasa in kamala213.

3) Development of enzyane linked immuno Absorbant Assasy for Azadiracthins215.

4) Influence of Azadiratchta indica leaf extract on the Immunotoxicity of stress and

xenobiotic in experimental animals216.

5) Anti fertility effects of aqueous and steroidal extract of neem leaf in Male wistar rats217

Trail drug description 69

BHUMYAMALAKI218,219

Lantin :Phyllanthus niruri

Family :Euphorbiaceae.

Synonyms : Bahupatra, Bahudhatri.

Gana : Kasahara. Swasahara (cha) Guduchyadivarga (Bha Ni)

Vernacular Names:

Hindi : Jaramla.

Kannada :Guggare kasa.

Habitat : Common in central and southern India, extending to Ceylon.

Pharmacological properties:

Rasa : Tikta , kashauya, Madhura.

Guna : Laghu, Ruksha.

Veerya : Sheeta.

Vipaka : Madhura.

Chemical Constituents: It is having phyllentin

Pharmacological Action: The plants is considered de-obstruent, diuretic, astringent

and cooling. A decoction of plant is administered in Jaundice. liver Stimulant thrust

controls, prameha etc220,221, 221a. Phyllanthus Amaris has been researched for its effects

on hepatitis, and in 1988 Thyagaran et al. (ibid) reported that 22 of 37 cases of Hepatitis

B lost their "carrier" status after using the herb for a month. In the placebo control group

only 1 person out of 23 had equivalent results.

Part used : Panchanga

Uses : Pipasa, kasa, pittaroga, kandhu, kusta222

1) A New receptor liver injury223

2) Efficacy of phyllanus amarus treatment in acute viral Hepatitis A , B and Non

A , Non B an open clinical trial224

Trail drug description 70

BHRUNGARAJA 225,226:

Latin : Eclipta alba.

Family : Compositae.

Synonyms : Markava kesaranjan, kesaraka

Guna : Karaveradhyavarga ( Dha Ni) Guduchyadivarga ( Bha Ni )

Vernacular Names:

English : Kadimulb inta

Hindi : Bhangara.

Kannada : Kadigaraga.

Habitat: This herb is found abundantly throughout India in wet places and plentiful on

the Himalayas.

Pharmacological properties :

Rasa : Katu. tikta

Guna :Ruksha laghu.

Veerya : Ushna.

Vipka :Katu.

Chemical constituents 227: Alkaloids ecliptine.

Pharmacological action: Roots and leaves are largely used alone as in combination

with ajawan seeds in derangement’s of the liver and gall bladder. They have also been

used as substitutes for Taraxacum a reputed and popular liver tonic.

The hepatoprotective effect of the ethanol/water (1:1) extract of Eclipta alba was

studied at subcellular levels in rats against (CCl4) -induced hepatotoxicity. The loss of

hepatic lysomal acid phosphatase and alkaline phosphatase by (CCl4) was significantly

restored by Ea. The study shows that hepatoprotective activity of Ea is by regulating the

levels of hepatic microsomal drug metabolising enzymes.[(Chandan BK, Sharma AK,

Trail drug description 71

Anand KK. Boerhavia diffusa: a study of its hepatoprotective activity. J Ethnopharmacol

1991 Mar;31(3):299-307).

Part used Panchanga.

Uses: keshya, twacharoga, krimi, kasa, Shotha, Pandu, dantaroga, Rasayana,balya,

Netraroga, Siroroga. This fresh plant is applied with sesamun oil in elephantiasis, and

the expressed Juicein affections of the liver and dropsy, when used in large doses, it

acts as an emetic. The Juice of the leaves is given one teaspoonful doses in Jaundice

and fevers. The root is given to relieve the scalding of urine228. Hepatoprotective activity

of Taiwan Folk medicine, eclipta prostrata linn. Against various Hepato toxins indduced

acute Hepato toxicity229

1) A New recipe for liver injury230

2) Chemical Constituents and anti hepxtotoxic activity of Eclipta alba231

PREPARATION OF MEDICINE AND DISPENSING

All the said herbs are collected fresh and pondered well in to fine powder. Later it

is capsulated and bottled in close container. They were made 60 capsules dispensing

packs and distributed to the selected patients periodically.

Trail drug description 72

This clinical study was taken up with the proper understanding of the classical

explanation observation and management of the Kamala. Among the causes of the

Kamala more emphasis and the clinical symptoms of the Kamala are taken in to

consideration.

Objectives of the study:

1) To study the efficacy of "Phalatrikadiyoga " in Kamala

2) To study and evaluate safety and efficacy of Phalatrikadiyoga on certain

biological factors relevant to Kamala and Jaundice.

The material are studied as under:

1) Literary : literary aspects of the study were collected from various Ayurvedic

classics,

2) Magazines and Journals. The information regarding the disease is updated

from Internet search along with above said.

3) Drug:

Materials and Methods 73

The Phalatrikadiyoga is selected from Baishajya ratnavali, in classics in this yoga

under the naming of phalatrikadikwatha. I add two more drugs Bhrungaraja and

Bhumyamalaki these drugs also very beneficial to reduce hepatotoxicity explain in

Indian medicinal plants. (Page No 1362 & page No 949). Here reformulated the

contents of the ingredients.

Ingredients Part in ratio

1) Haritaki 1 part

2) Bibhitaki 1 part

3) Amalaki 1 part

4) Guduchi 1 part

5) Vasa 1 part

6) Kiratatikta 1 part

7) Katuki 1 part

8) Nimbatwaka 1 part

9) Bhumyamalaki 1 part

10)Bhrungaraja quantity sufficient

The above mentioned drugs from 1 to 9 are prepared in to powder separately

and then mixed in above given ratio. One bhavan with Bhrungaraja swaras was given to

the mixture dried and grind into fine powder. At the end it was made into capsule form,

each capsule consists of 500mg of medicine.

All the herbal purchased form Dr Khajarekar Ayurvedic pharmacy, Belgum

preparation was done in DGM Ayurvedic pollege pharmacy under depratmental

guidance. The 500mg capsule are filled in plastic bottles with a label attached.

Mentioning name of the compound in number of capsules, dose of medicine and

Anupana.

3) Patients:

Materials and Methods 74

The patients with the conformed diagnosis of Kamala clinically as well as

laboratory investigations are selected for the study. Patients were selected from the

DGM Ayurvedic medical collage and Hospital Gadag incidental and camp conducted

specially for the disease Kamala.

Methods of collection of Data:

The main criteria for selection of the patients were symptomatolagy and

laboratory (investigation) evidences of the serum bilirubin and other liver function test

values.

A) Inclusion criteria:

The patients of both sexes presenting with the following lakshanas were

selected.

1. Yellowish discoloration of sclera,

2. Yellowish discolouration of urine,

3. Loss of appetite

4. General weakness

5. Body ache

The patients presenting above lakshans two or more were considered clinically

with laboratory evidences of urine bile salts and bile pigments along with liver function

values.

B) Exclusion criteria:

1. The patient below the age of 10 year and above the age of 60 years

2. Drug induced Jaundice

3. Surgical Jaundice

4. Pregnant women

5. Lactating mother

Severe Jaundice patients, complications of Jaundice, who will not agree for the

study also excluded.

C) Study Design:

Prospective open clinical trial

Materials and Methods 75

D) Sample size:

Minimum 20 patients are selected irrespective of sex.

E) Posology :

500mg capsule 2 TDS or 3gms/24hours

Anupan:

Sukoshna jala – Lukewarm water

F) Duration of treatment:

30 days

Assessment of results:

The result of this study will be assessed on the following parameters.

a) Subjective parameters

b) Objective parameters

a) Subjective parameters: The clinical signs and symptoms of Kamala.

1. Netra peetata.

2. Mutra peetata

3. Peeta twakha.

4. Peeta Nakha

5. Aruchi

6. Angasada

7. Dourbalya

8. Daha

9. Hrullasa

10. Chardi

11. Sweta varchata

12. Avipaka.

13. Hruta peeda

14. Hikka

15. Swasa

16. Jwara

17. Kandu

Materials and Methods 76

18. Parswa peeda.

B) Objective Criteria:

The Hematological investigations and urine examination also included before

and after treatment

1) Hb %

2) Serum bilirubin (direct and total)

3) SGPT

4) Serum Alkaline Phosphate

5) Serum total protein

6) Serum Albumin

7) Serum Globulin

8) Urine Bile salts and Bile pigments.

Investigation:

The laboratory investigations are very important for the diagnosis of the

diseases. For the Kamala disease diagnostic purpose

1) Liver function test

2) Hb%

3) Urine bile salts and bile pigments

1) Haemoglobin Estimation:

This is the important one for diagnosing a patient it is anaemia is not. In

Ayurvedic classics also explain under the concept of Pandu Roga adhyaya the

estimation of haemoglobin.

Materials and Methods 77

This is based on conversion of haemoglobin to acid haematin. Which has a

brown colour, fill haemoglobin tube till 20 mark with N/10 Hcl. To this add blood sucked

till the specific mark (20ml) on the haemoglobin pippete and wait for 5-45 minutes.

During this time keep string the mixture, of acid blood in the tube. Add distilled water

until a match is obtained with the brown glass standard provided. Read the lower level

of fluid meniscus on grm % side of blood. Report haemoglobin in grm / 100 ml of

Blood231

Liver function tests232

To confirm the clinical diagnosis and to assess the type of Jaundice laboratory

investigation such as Bio chemical tests are required.

1) Serum Bilirubin: Jaundice will develop bilirubin is excessively reduced produced or

there is impaired hepatic up take and conjugation of bilirubin or it is insufficiently

excreted in to the duodenum normally total serum bilirubin is 0.2 to 0.8 mg/dl. Here total

bilirubin is accumulation or a sum of conjugated and un-conjugated bilirubin.

In hyper bilirubin conditions:

a) If conjugated bilirubin level more than un-conjugated bilirubin level, then its

suggests the jaundice has resulted, either due to hepetic causes or due to post

hepatic cause.

b) Un-conjugated bilirubin level is more then conjugated bilirubin level , then it

Suggests the Jaundice, has resulted due to pre heplatic cause.

c) Test to assess the damage of hepatocytes.

2) Tests to Assess the damage of Hepatocytes:

a) Serum Glutamate pyruvate transminase ( SGPT)

b) Serum Glutamate Oxaloacetate transminase (SGOT)

It is a mitochondrial enzyme released from heart, liver, skeletal muscle and

kidney SGPT - is a cytosalic enzyme also present in liver, Although the absolute amount

of is less than SGOT a greater proportion is present in liver compared with heart and

skleletal muscles.

Materials and Methods 78

SGOT –

It is a mitochondrial enzyme present in large quantities in hearts, liver, skeletal

muscle and kidney and the serum level increase when ever these tissues are acutely

destroyed, presumably due to release from damaged cells.

The Normal values of SGPT 5 - 35 IU/L and SGOT Normal values 5-40 IU/L232

3) Serum Alkaline phosphatese:

Many tissues produce the serum alkaline phosphatese, it rises in cholestasis and

to a lesser extent when liver cells are damaged. The mechanisms of increase are

complex. Synthesis of the alkaline phosphatese by the hepatocytes is increased and

this depends on intact protein and RNA synthesis. Secretion into serum may arise

through linkage from conaliculies in to the sinusoid because of leaky tight junction.

Increased release of phosphatese into sinusoids from the haepatocytes plasma

membrane may. Contribute. The normal value of serum alkaine phosphatase 35 -130

IU/L233

Serum Proteins:

This measurement, in itself, is of little value, serum Albumin and Globulin. The

globulin fraction consist of many proteins that can be separated on electrophoreisis, a

raised globulin fraction, seen in liver disease, is usually due to increased circulating

immunoglobulins. The Albumin is a microsomal enzyme that is present in many tissues

as well as the liver. Its activity can be induced by such drugs as phentyoin and by

alcohol.

If the alkaline phosphate is normal, a raised serum δ-Glutonyl trans peptidase is

a good guide to alcohol intake and can be used as a screening test. Mild elevation of δ-

Glutanyl is common with small alcohol consumption and does not necessarily indicate

liver disease if the other liver bio-chemical tests are normal. In cholestasis the δ-GT

Materials and Methods 79

rises in parallel with the ALP as it has a similar pathway of excretion. This is also true of

the 5-nucleotidase, another microsomal enzymes that can be measured in blood.

Other test’s in this disease like viral markers.

Viruses are a major cause of liver disease. Virological studies have a key role in

diagnosis, maker are available for most common viruses that cause hepatitis234.

Urinary Excretion of Bile Salts and Bile Pigments:

The bile salts are not absorbed in the jejunum, so that the introluminal

concentration in upper gut is high. They pass down the intestine to be observed in the

terminal ileum and are transported back to the liver. This entero hepatic circulation

prevent excess loss of Bile Salt’s235

When liver is damaged, urobilinogen reabsorbed from the intestine, fails to pass

through the liver cells and appears in the urine in a larger amount. Under such

conditions, urine contains considerable amounts of urobilinogen and urobilin, presence

of urobilinogen in urine in excess, there fore, indicates functional deficiency of liver236

OVERALL ASSESSMENT:

For the assessment grades were fixed depending upon the condition. Overall

assessment is made taking into consideration both subjective and objective parameters.

Considering all the above parameters patients are graded in to four groups

depending upon the response to Phalatrikadiyoga. The over all score was considered as

32 based on the subjective (20 symptoms) and objective parameters (12 including visual

scores) excluding the Dosha assessments. Out of 32 scores depending upon the scoring

of individual patient the grading was done is as follows.

Grade Score range Cured Major improvement Minor improvement Unchanged Discontinued

25 to 32 17 to 24 09 to 23 00 to 08 Not appeared for evaluation

Materials and Methods 80

Table No 11. Demographic data of evaluation of the efficacy of Phalatrikadiyoga

Sl. No.

OPD No.

Age (Years)

Sex Udyoga-II Dharma Socio-EconomicStatus

Result

M F a b c d a b c d a b c d a b c d e1 934 38 + - - - - + - + - - + - - - + - - - -2 1056 35 - + - - - + + - - - + - - - + - - - -3 1537 45 + - - - - + - + - - + - - - - + - - -4 1885 11 + - - - + - + - - - - - + - + - - - -5 850 35 - + - - - + - + - - + + - - - + - - -6 885 46 - + + - - - + - - - - + - - - - + - -7 1343 35 + - - - - + + - - - - + - - + - - - -8 4692 22 + - - - + - + - - - - + - - + - - - -9 2023 21 + - - - - + + - - - - + - - + - - - -

10 223 35 - + + - - - + - - - - + - - + - - - -11 3017 11 - + - - + - + - - - - - + - + - - - -12 4885 32 - + - - - + + - - - + - - - + - - - -13 3778 30 - + - - - + - + - - + - - - + - - - -14 2895 42 + - - - - + + - - - - + - - + - - - -15 6950 57 + - - - - + + - - - + - - - + - - - -16 7166 50 - + + - - - + - - - - + - - + - - - -17 3251 27 + - - - - + + - - - - + - - + - - - -18 4563 55 + - - - - + + - - - - + - - + - - - -19 6574 51 + - - + - - + - - - - - + - + - - - -20 5124 48 + - - + - - + - - - - - + - + - - - -

Total 12 8 2 2 3 12 16 4 0 0 7 10 4 0 17 2 1 0 0I. a- Male, b= Female

II. a= House wife , b= Service c= Student d= Labour III. A= Hindu b= Muslim c= Christian d= Other

IV. A= Poor b= Middle c= Rich d= Aristocrat V. A= Cured b= Major improvement c= Minor improvement d-Unchanged e= Discontinued

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Table No.12 Vedana samuchyaya of evaluation of the efficacy of Phalatrikadiyoga

Sl.No.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A

1 + - + - + - + - + - - - - - + - + - + - + - + - - - + - - - - - + - - - - - - 2 + - + - + - + - + - - - + - + - + - + - + - + - + - - - - - - - - - + - - - + -3 + - + - + - + - + - + - - - + - + - + - + - - - - - - - - - - - - - - - + + + +4 + - - - - - + - + - - - - - + - + - - - + - - - + - + - - - - - - - + - + - - - 5 + - + - - - + - + - - - + - + - - - + - + - - - + - + - - - - - - - + - + - - -6 + + + - + - + + + - + - + - + - + + + - + - + - - - - - - - + + + - - - + - - -7 + - - - - - + - + - - - + - + - + - + - + - - - - - - - - - - - - - + - + - - -8 + - - - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - + - - -9 + - + - - - + - + - - - + - + - + - + - + - - - - - - - - - - - + - - - - - - -

10 + - + - + - + - + - - - + - + - + - - - + - - - + - - - - - - - - - - - - - - -11 + - - - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - + - - -12 + - - - + - + - + - - - + - + - + - + - + - - - - - - - - - - - - - + - + - - -13 + - - - - - + - + - - - + - + - + - + - + - - - - - + - - - - - - - - - - - - -14 + - + - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - - - - -15 + - - - - - + - + - - - - - + - + - + - + - - - - - + - - - + - - - - - + - - -16 + - - - + - + - - - - - - - + - + - + - + - + - - - - - - - + - - - - - - - - -17 + - - - + - + - + - - - - - + - + - + - + - - - - - + - - - - - + - - - + - - -18 + - - - + - + - + - - - - - + - + - + - + - - - - - + - - - - - - - - - + - - -19 + - - - + - + - + - - - + - + - + - + - + - + - + - + - - - + - + - - - - - - -20 + - - - + - + - + - - - - - + - + - + - + - + - - - + - - - + - + - - - + - - -

1= Peeta Netrata, 2=Peeta twakha 3=Peeta Nakha 4=Peeta Mutrata 5= Peeta Purisha 6=Peeta Mukha 7=Daha 8=Avi Paka 9=Dourbalya 10-Angasada 1=Aruchi 12=Sweta Varchata 13=Hruta Peeda 14=Parswa Peeda 15=Hikka 16=Swasa

17=Jwara 18=Chardi 19=Hrullasa 20=Khandu

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Chart - 13 Vayaktika Vruttant

Sl.No. Ahara Vihara Nidra Vyasana Jataragni Kosta

a b a b c d a b a b c a b c d a b c1 - + + - + - - + + + + + - - - + - -2 - + + + + - - + - - - - - + - - + -3 - + + + + - - + - - - - + - - - + -4 + - - - - - + - - - - - - + - - + -5 - + + - + - + - - - - - - + - - + -6 - + + + - - + - - - - - - + - - - +7 - + + + - - + - + + + - - + - - + -8 + - - + + - + - - - - - - + - - + -9 - + + - + - - + + + + - - + - - + -

10 + + + + + - - + - - - - - + - - + -11 + - - - + - - + - - - - - + - - + -12 - + + - + - + - - - - - - + - - - +13 + - + - + - + - - - - - + - - + -14 - + + + + - - + + - + - - + - - + -15 + - - + + + - + - + - - - + - - + -16 + - + + - - + - - - - - - + - - + -17 - + + + - - + - - + + - - + - - + -18 + - - + + - - + - - - - - + - - + -19 + - + - + - - + - - - - - + - - + -20 + - + + + - - + - - - + - + - + - -

Ahara a=Vegitarian, b=Mixed Vihara a=Adhika Vyayama, b=Divaswapna c=Vegadharana d=Adhika Vyavaya

Nidra a=Nidra adhika b=Alpa Vyasana a= Smoking b=Tobacco Chewing c=alcohol

Jataragni a=Vishamagni b=Tikshnagni c=Mandagni d=Samagni

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Table No 14. VIKRUTI PARIKSHA (NIDANA)

Sl.No. Aharaja Karan Viharaja Karana Manasika Karana Nidanart

hakara Karan

A1 A2 A3 A4 A5 A6 A7 A8 A9 B1 B2 B3 B4 C1 C2 C3 C4 C5 C6 d1 1 + - + + - - - + - + + - + - - - - - - -2 + + + - - - - + - + + - + - + - - + - -3 + - + + - - - - - + + - + - - - - + - -4 + + - + - - - - - - - - - - - - - - - -5 + + + - - - - + + + - - - - - - + - -6 - + + - - + + - - + + - - - - - + + - -7 + - + + - - - + + + + - + - - - - - - -8 + + - + - - - + - + - - + - - - - + - -9 + - + + - - - + + - + - + - + - - + +

10 - + + + - - - - - + + - + - - - + + - +11 + - + + - - - + - - - - + - - - - - - -12 + + + - - - - + - + + - - - - - - + - +13 + + + + - - - - - - + - + - - - - - - -14 + - + - + + - + + + + - + - - - - - - -15 + + + + - - - + - + - - + - - - - + - +16 + - + + - - - - - - - - - - - - - - - -17 + - + + - - - - - + + - - - - - - - -18 + - + + - - - - - + - - + - - - - - - -19 + - + + - - - + - + + - + - - - - - - -20 + + + + - - - + - + + - + - - - - - - -

A1=Amla Rasa A2=Lavanarasa A3=Katu Rasa A4=Madhura Rasa A5=Udada A6=Masha A7=Beans A8=Atyusna

A9=Madhyapana B1=Divaswapna B2=Adhika Vyayama B3=Adhika Vyavaya B4=Vegadharan

C1=Kama C2=Krodha C3=Bahaya C4=Shoka C5=Chinta C6=Lobha

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Table No 15

ROOPA OF KOSTA SHAKHASHRITA KAMALA

Sl. No.

OPD 1 2 3 4 5 6 7 8 9 10 11 12

B A B A B A B A B A B A B A B A B A B A B A B A1 934 + - - - + - + - + - + - - - + - - - + - + - + -2 1885 + - - - - - - - + - + - - - - - + - + - + - + -3 850 + - + - + - - - + - + - - - - - - - + - + - + -4 + 1345 - - - - - - - + - + - - - + - - - + - + - + -5 4692 + - - - + - - - + - + - - - - - + - + - + - + -6 223 + - + - + - - - + - + - - - + - - - + - + - + -7 3107 + - - - + - - - + - + - - - - - - - + - + - + -8 4885 + - - - + - - - + - + - - - + - + - + - + - + -9 3778 + - - - - - - - + - + - - - + - + - + - + - + -

10 2895 + - - - + - + - + - + - - - - - - - + - + - + -11 6590 + - - - - - - - + - + - - - - - + - + - + - + -12 3251 + - - - + - - - + - + - - - - - + - + - + - + -13 4563 + - - - + - - - + - + - - - - - - - + - + - + -14 1557 + - + - + - + - + - + - + - + - + - + - + - + -

1=Haridra Netra 2=Haridra Twaka 3=Haridra Nakha 4=Haridra anana 5=Raktapeeta mala 6=Rakta Peetamootra 7=Bhekha Varnatwacha 8=Daha

9=Indriya Dourbalya 10=Avipaka 11=Dourbalya 12=Aruchi

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Table No 16 ROOPA OF SHAKHASHRITA

Sl.No. OPD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

A B B BA B A B A B A B A B A B A A B A B A B A B A A B A B1 1056 + - + - + - + - - - - - + - + - + - - - - - - - - - + - + -2 2023 + - + - + - + - - - - - - - + - + - + - - - - - - - + - + -3 885 + + + + + - + - - - - - - - + + + - - - - - - - + - - - - -4 7166 + - + - - - + - - - - - - - + - + - - - - - - - + - + - - -5 6574 + - + - + - + - - - - - + - + - + - + - - - - - - - + - + -6 5124 + - + - + - + - + - - - + - + - + - + - - - + - + - + - + -

1=Haridra Netra 2=Haridra Mootra 3=Haridra Twaka 4=Sweta Varchata 5=Atopa 6=Vistamba 7=Hrudgraha 8=Dourbalya 9=Agnimandya 10=Parswasoola 11=Hikka 12=Kasa

13=Swasa 14=Aruchi 15=Jwara

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Table No 17. LABORATORY INVESTIGATION MASTER CHART

OPD 1 2 3 4 5 6 7 8

B A B A B A B A B A B A B A B A1 934 1.2 1 1 0.8 45 38 220 204 6.2 6 4.2 4.1 4 3 10.5 12.5 2 1056 9.5 0.889 8.5 0.655 140 35 790 120 6.8 6.5 4.5 4.5 2.3 2 12 113 1537 16.5 1.06 15 1 940 40 570 175 5.8 6 4 4.5 1.8 1.5 10 124 1885 4.6 0.81 2.6 0.654 210 50 260 200 6.5 6.2 4 4 2.5 2.2 11 135 850 11.6 8.5 11.1 7.9 315 39 302 90 9 5.8 5.5 3.5 5 2.3 11.5 126 885 12 8 11 4 300 40 350 261 6 4.9 4 2.7 2 2.2 10 8.447 1343 2.8 0.91 1.5 0.7 100 25 105 92 6.5 6.8 4.2 4.5 2.3 2.3 11 12.58 4692 2.8 0.9 2.1 0.7 42 25 131 128 6.4 6.5 7.6 4 2.5 2.5 12 149 2023 11 2 6.6 1.6 572 75 123 90 5.8 6 3.9 4 1.7 2 11.5 12.5

10 223 1.9 0.8 1.6 0.4 39 15 285 107 5.8 5 4 3.5 1.5 1.5 4.2 5.511 3107 8.3 0.5 5.3 0.2 48 14 271 260 7.5 7.5 4.5 4.2 2.8 2.8 11 1212 4885 1.5 0.89 1.2 0.7 25 15 98 78 6 6.5 3.5 4 2.5 2.5 6.4 813 3778 1.6 0.765 1 0.66 28 20 112 90 6.2 6.6 4 4.6 2.2 2 12.9 12.8 14 2895 2.6 0.6 1.8 0.3 60 22 290 123 5.1 4.2 4 3.8 2.2 2.2 11 1215 6950 3 0.8 2.6 0.7 46 25 138 95 7.8 6.5 5 4 2.9 2.5 7 816 7166 1.6 0.91 1 0.7 25 20 110 75 6 6.5 3.5 3.8 2.5 2 10 1117 3251 4.7 1.5 3.8 0.9 44 42 115 102 6 6 4.8 4.5 2 2 11.8 1318 4563 2.2 0.66 1.1 0.06 186 25 397 81 4.3 6.3 2.2 3.6 2.6 2.7 11 12.6619 6574 4 0.8 2.3 0.7 45 35 240 120 5.2 6 2.8 4 2.4 2 11 1220 5124 3.3 0.9 2 0.6 53 40 120 95 6 5.6 3.4 3 2.6 3 14 13

Total 106.7 33.194 83.1 23.929 3263 640 5027 2586 124.9 121.4 83.6 78.8 50.3 45.2 209.8 227.9

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Table No: 18

Assessment of subjective parameter Evaluation of the Efficacy of Phalatrikadiyoga in Kamala BT

AT BT AT BT AT BT AT BT AT BT ATa a b b c c d d e e f f

1 1 0 1 0 0 0 0 0 1 0 1 02 2 0 1 0 1 0 1 0 1 0 1 03 3 0 3 0 2 0 2 0 2 0 2 04 1 0 1 0 0 0 0 0 2 0 2 05 3 0 2 0 2 0 2 0 2 0 2 06 3 1 3 1 3 0 3 0 3 0 3 07 1 0 1 0 0 0 0 0 2 0 2 08 1 0 1 0 - 0 1 0 1 0 1 09 3 0 3 0 1 0 2 0 3 0 3 0

10 1 0 1 0 1 0 1 0 1 0 2 011 2 0 2 0 1 0 1 0 1 0 2 012 1 0 1 0 0 0 1 0 2 0 2 013 1 0 1 0 0 0 0 0 2 0 1 014 1 0 1 0 1 0 1 0 2 0 1 015 1 0 1 0 0 0 0 0 2 0 2 016 1 0 1 0 0 0 1 0 1 0 2 017 1 0 1 0 0 0 1 0 2 0 2 018 1 0 1 0 0 0 1 0 1 0 2 019 1 0 1 0 0 0 0 0 3 0 2 020 1 0 1 0 0 0 1 0 1 0 2 0T 30 1 28 1 4 0 19 0 35 0 37 0

a=Haridra Netra

c= Peeta Twakha e= Avipaka

b= Haridra Mootrata d= Peeta Nakha

f= Aruchi

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Table No: 19 Assessment of objective parameter

Sl No.

OPDNo Bile Salt Bile Pigment Bile salt Bile pigment Bile Salt Bile Pigment Bile Salt Bile Pigment

1 934 1 1 1 1 0 0 0 02 1056 2 2 1 1 0 0 0 03 1537 3 3 2 2 1 0 04 1885 2 2 0 0 0 0 0 05 850 2 3 2 2 1 0 0 06 885 3 3 2 2 2 0 1 17 1343 0 0 0 0 0 1 0 08 4692 2 2 2 1 0 0 0 09 2023 2 2 2 2 1 0 0 0

10 223 0 1 0 0 0 0 0 011 3107 2 2 1 1 0 0 0 012 4885 0 0 0 0 0 0 0 013 3778 0 0 0 0 0 0 0 014 2895 2 2 1 0 0 0 0 015 6950 1 1 0 0 0 0 0 016 7166 0 0 0 0 0 0 0 017 3251 2 2 1 1 1 0 0 018 4563 2 2 1 0 0 0 0 019 6574 2 2 2 1 1 0 0 020 5124 2 2 2 1 1 0 0 0

Total 30 32 20 15 8 1 1 1

Assessment of Urine Bile salts and Bile Pigment based on +=1,

++=2, +++= 3,

0=Nil

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Table No: 20

Statistical Assessment of parameters of evaluation of the efficacy of Phalatrikadiyoga in Kamala parameters Before

Treatment mean + S.D

After Treatment mean + S.D

Net Mean differenc

e

Net S.D S.E T Value P. Value Remarks C.V. BRx. C.V. A.Rx

Haridra netra 1.85 + 0.745 0.05 + 0.223 1.45 0.759 0.169 8.579 < 0.001 H.S 39.25 43.58

Haridra mootrata

1.A + 0.753 0.05 + 0.223 1.35 0.671 0.15 9 < 0.001 H.S 52.48 43.58

Peeta Twakha 0.6 + 0.883 ------- 0.6 0.883 0.197 3.04 < 0.01 H.S 143.37 -------

Peeta Nakha 0.95 + 0.825 ------- 0.95 0.825 0.184 5.163 < 0.001 H.S 84.70 -------

Avipaka 1.75 + 0.716 ------- 1.75 0.716 0.160 10.937 < 0.001 H.S 39.89 -------

Aruchi 1.85 + 0.587 ------- 1.85 0.587 0.131 14.122 < 0.001 H.S 30.92 --------

Total Bilirubin 5.335 + 4.475 1.659 + 2.278 3.6928 3.8018 0.85 4.34 < 0.001 H.S 81.76 133.829

Direct Bilirubin

4.155 + 4.124 1.196 + 1.772 2.9585 3.409 0.762 3.88 < 0.01 H.S 96.74 24.67

SGPT 163.15 + 229.19 32.5 + 15.059 131.15 221.165 49.45 2.652 < 0.01 H.S 136.92 45.16

SALP 251.35 + 176.72 129.3 + 58.418 122.05 169.161 37.825 3.27 < 0.01 H.S 68.52 44.03

Total Protein 6.27 + 0.957 6.07 + 0.732 0.7 0.773 0.173 4.05 < 0.001 H.S 148.85 117.54

Serum Glb 2.515 + 0.783 2.26 + 0.4185 0.345 0.6039 0.315 1.095 > 0.1 N.S 30.36 18.04

Serum Alb 4.18 + 1.084 3.94 + 0.5 0.73 0.86 0.193 3.78 < 0.001 H.S 25.27 12.39

Hb % 10.395 + 2.145 11.523 + 2.146 1.256 0.427 0.095 13.22 < 0.01 H.S 20.11 18.15

Bile Salt 1.5 + 1.00 0.05 + 0.223 1.45 0.9445 0.211 6.86 < 0.001 H.S 64.97 43.58

Bile Pigment 1.6 + 0.995 0.05 + 0.223 1.55 0.9445 0.221 7.35 < 0.001 H.S 60.59 43.58

HS = Highly Significant, NS = Not significant

Master charts

90

The present clinical trial was meant for “An evaluation of the efficacy of

Phalatrikadiyoga” in Kamala (Jaundice). The patient selected for the age of 10 years to 60

years irrespective of sex.

Total 24 patients were diagnosed as a Kamala out of them, 20 patients were

selected for the clinical trial. All are assessed before and after treatment. Both objective and

subjective changes were recorded.

Age and Sex

Out of 20 patients more number of Patients i.e. 7 (35%) were in the age group of 30-

40 years and 2 (10%) were in the age group of 10-20 years. Male patients are more in this

study that is 12 (60%) were female are 8 (40%) in number. Tabular and graphical

representations are shown as under in table-21 and graph-1.

Observations & Results 91

Table No 21 Table describes the distribution based on Age and Sex.

Sl No.

Age in years

Male % Female % Total %

1 10-20 01 5 01 5 02 10

2 20-30 03 15 00 0 03 15

3 30-40 02 10 05 25 07 35

4 40-50 03 15 01 5 04 20

5 50-60 03 15 01 5 04 20

Total 12 60 08 40 20 100

Below depicted graph describe the above statement distribution based on Age and Sex. Graph No. 1

Observation

An at

present study

of Kamala. I

under went h

belonging to

graphical rep

Female40%

Male60%

based on Religion

tempt was made to under stand the religious influence in this disease, the

explain Hindu & Muslim Communities patient’s are reported with the disease

t doesn’t mean others don’t have this disease. The area in which the study

as this group of populations out of 20 patients recorded 16 (80%) patients

Hindu religion and only 4 (20%) patient belonging to Muslim. Tabular and

resentations are shown as under in table-22 and graph-2.

Observations & Results 92

Table No 22

Table showing the Observation based on Religion

Sl No. Religion No of Patients Percentage 1 Hindu 16 80

2 Muslim 04 20

3 Christian 00 00

4 Other 00 00

Total 20 100

Graph No. 2 Below depicted graph describe the above statement.

Occupation

In this s

study out of 20

Patient each 3

service group.

graph-3.

Christian0%

Muslim20%

Other0%

Hindu80%

tudy we considered four categories of occupations for the convenience of the

patient Maximum 12 (60%) were labour group are affected with disease. 3

(15%) were students and house wife respectively remaining 2 [10%) were

Tabular and graphical representations are shown as under in table-23and

Observations & Results 93

Table No 23

OBSERVATION OF PATIENTS ACCORDING TO THEIR OCCUPATION

Sl No. Occupation No of Patients Percentage 1 Housewife 03 15

2 Service 02 10

3 Student 03 15

4 Labour 12 60

Total 20 100

Graph No.3

Student15%

Service10%

Housewife15%

Labour60%

Socioeconomic status

Economical status had an impact over this disease process as dietetic influences

and food habits make a difference here. In this study most of the patients 9 (45%) in the

Observations & Results 94

Middle class 7 (35%) patients belonging to poor class and 4(20%) patients belonging to

Rich. Tabular and graphical representations are shown as under in table-24and graph-4.

Table No 24. Observation of patients according to the socioeconomic status

Sl No Economical Status

No of patients Percentage

1 Poor 07 35

2 Middle 09 45

3 Rich 04 20

4 Aristocrat 00 00

5 Total 20 100

Graph Distribution based on socioeconomic Condition.

Graph No.4

Diet:

Diet

study as ob

vegetarian

Rich20%

Middle45%

Poor35%

Aristocrat0%

regimen is another important factor for the production of the diseases in the

served with that of economical status. It was observed that the incidence of

and mixed diet users when compared looks resembling. Out of the 20 patients,

Observations & Results 95

10 (50%) were vegetarian and 10 (50%) patients are with mixed diet. Tabular and graphical

representations are shown as under in table-25and graph-5.

Table No 25.

Observations of patients based on diet.

Sl.No. Diet No. of Patients Percentage 1 Vegetarian 10 50

2 Mixed 10 50

Total 20 100

Graph No.5

Observations of patients based on diet.

Habits

Incidence o

Alcohol and Tobac

patients alcohol, s

smoking. Tabular a

Mixed50%

Vegetarian50%

f habits shows that 05(25%) of patients were having the drinking of

co chewing, 04(20%) of patients exposure to the smoking, 03(15%) of

moking and tobacco chewing, 01(5%) of patients tobacco chewing and

nd graphical representations are shown as under in table-26and graph-6.

Observations & Results 96

Table No 26

Observation of patients based on Habits.

Sl.No Habits No of

patients %

1 Alcohol 05 25%

2 Smoking 04 20%

3 Tobacco Chewing 05 25%

4 Alcohol, smoking & Tobacco

Chewing

03 15%

5 Alcohol, Tobacco Chewing 01 05%

6 Smoking, tobacco chewing 00 00%

Graph No.6

Observation of patients based on Habits.

Alcohol27%

Smoking22%

Tobacco Chewing

28%

Alcohol, Tobacco Chewing

6%

Smoking, tobacco chewing

0%

Alcohol, smoking & Tobacco Chewing

17%

Agni In Ayurveda Antaragni Chikitsa is undertaken. More over bhutagni paka is performed

in the liver, the organ related to the disease development. Thus to know the state in the

disease is necessitate. The state of Agni in 18 (90%) patients observed as mamdagni,

Observations & Results 97

01(5%) patient each were in the criteria of vishamagni and tikshnagni. This observation

states that the mandagni causes the disease. Tabular and graphical representations are

shown as under in table-27and graph-7.

Table No 27

Observations of patients based on Agni.

Sl.No. State of Agni No of Patients Percentage 1 Vishamagni 01 5%

2 Tikshnagni 01 5%

3 Mandagni 18 90%

4 Samagni 00 00%

Graph No.7

Kosta:

were b

represe

Vishamagni5%

Tikshnagni5%

Mandagni90%

Samagni0%

The madhayama kosta was present in 16 (80%) of patients, 02 (10%) of each patient

elonging to the kroora and mrudu kosta respectively. Tabular and graphical

ntations are shown as under in table-28and graph-8.

Observations & Results 98

Table No 28 Observations of patients based on Kosta

Sl.No. Kosta No of patients Percentage

1 Kroora 02 10%

2 Mrudu 16 80%

3 Madhayama 02 10%

Total 20 100%

Graph No.8

Madhayam

Nidanartha

Pan

Out of 20 p

patients do

shown as u

K roora10%

Mrudu80%

a10%

kara Roga

du Roga is one of the etiological factors for Kamala as Nidanarthakara Roga.

atients 4 (20%) of patients were with the history of Pandu. Rest of the 16 (80%)

esn’t give any such information. Tabular and graphical representations are

nder in table-29 and graph-9.

Observations & Results 99

Table No 29

Observation of patients based on Nidanarthakara Roga

Sl.No Nidhanrthakhara karan

No of patients Percentage

1 Pandu Roga 4 20 2 None 16 80

Graph No.9

Kamala symptom

Assessme

of these study rev

Mutra, Avipaka a

(70%) patients we

(45%) were parsw

were complained

(20%) patients we

No patients have

shown as under in

None80%

Pandu Roga20%

s

nt of the symptom in Kamala is the subjective parameter study. Symptoms

eals that all the 20 (100%) patients were complained peeta Netrata, Peeta

nd Aruchi. 18 (90%) were complained dourbalya and Angasada and 14

re complained peeta purisha and peeta nakha. 13 (65%) were hrullasa 9

a peeda and 07(35%) were peeta twakha and khandu. 6 (30%) patients

avipaka, sweta varchata and 6 (30%) were Hrutapeeda and chardi. 4

re complained swasa and 2 (10%) patients suffered with peeta mukham.

shown the complaint Hikka. Tabular and graphical representations are

table-30 and graph-10.

Observations & Results 100

Table No 30 Data related to the disease,

Showing the presenting complaints of the patients

Complaints No of patients Percentage 1 Peeta Netrata 20 100 2 Peeta Mutrata 20 100 3 Avipaka 20 100 4 Aruchi 20 100 5 Dourbalya 18 90 6 Angasada 18 90 7 peeta Nakha 14 70 8 peeta Purisha 14 70 9 Hrullasa 13 65 10 Paraswa Peeda 09 45 11 Daha 08 40 12 Peeta Twakha 07 35 13 Khandu 07 35 14 Sweta varchata 06 30 15 jwara 06 30 16 Hrutapeeda 05 25 17 Chardi 05 25 18 Swasa 04 20 19 Peeta Mukha 02 10 20 Hikka 00 00

Graph No.10

Hikka0%

Aruchi9%

Angasada8%

Dourbalya8%

Avipaka9%

Daha4%

Peeta Mukha1%

peeta Purisha6%

Peeta Mutrata9%

peeta Nakha6%

Khandu3%

Chardi2%

jwara3%

Hrullasa6%

Swasa2%

Paraswa Peeda4%

Hrutapeeda2%

Sweta varchata3%

Peeta Twakha3%

Peeta Netrata9%

Observations & Results 101

Types of Kamala

As we have taken randomized study of Kamala the types of Kamala also assessed

here. Out of 20 patients 14 patients are having kostha shakhashrita Kamala and reaming 6

were with shakhashrita Kamala. Tabular and graphical representations are shown as under

in table-31 and graph-11.

Table No 31 Showing the types of kamala

Sl.No Types of Kamala No of patients Percentage 1 Kosta shakhashrita 14 70%

2 Shakashrita 06 30%

Total 20 100%

Graph No.11

Subjec

Here in

texts a

Mutrata

Grade

Shakashrita30%

Kosta shakhashrit

70%

tive parameters

Subjective parameters are the essential readings of the any Ayurvedic research.

this research it was found that all the subjective parameters took from the classical

re standard and seems to be quintessential even in this era. Peeta Netrata, Peeta

, Peeta Twakha, Peeta Nakha, Aruchi and Avipaka are dealt in different grades as

0 =Nil, Grade 1=Mild, Grade 2 = Moderate, Grade 3 = Severe. The grade wise

Observations & Results 102

observations are dealt as under. Tabular and graphical representations are shown as under

in table-32.

Table No 32 Observations and Assessment of subjective parameter

Sl.No Symptoms Gr 3 % Gr 2 % Gr 1 % G 0 % 1 Peeta

Netrata 4 20 2 10 14 70 - -

2 Peeta Mutrata

2 10 3 15 15 73 - -

3 Peeta Twakha

1 05 2 10 5 25 9 45

4 Peeta Nakha

1 05 3 15 10 20 06 30

5 Aruchi 2 10 12 60 6 30 6 Avipaka 3 18 9 45 8 40

Results of Phalatrikadiyoga in Kamala

Results are declared based on the subjective and objective parameters. The data of

the patients in the trail is as under.

Table No 33

Cured Major improvement

Minor improvement

Unchanged Discontinued

1 934 + - - - - 2 1056 + - - - - 3 1537 - + - - - 4 1885 + - - - - 5 850 - + - - - 6 885 - - + - - 7 1343 + - - - - 8 4692 + - - - - 9 2023 + - - - -

10 223 + - - - - 11 3017 + - - - - 12 4885 + - - - - 13 3778 + - - - - 14 2895 + - - - - 15 6950 + - - - - 16 7166 + - - - - 17 3251 + - - - - 18 4563 + - - - - 19 6574 + - - - - 20 5124 + - - - -

17 2 1 0 0

Observations & Results 103

The results cumulatively declared under five headings as, presumed initially. They

are cured, improvements in the major and minor categories and lastly unchanged and

discontinued. The result cured is declared to the patients those who have totally cleared with

the presenting symptoms and free from abnormal or deviated lab investigations such as liver

profile. The number patients under this category with are 17 i.e. 85%. There is no patient

who doesn’t respond to the treatment. Rests of three patients are under major improvement

and minor improvement cadres as 2 and 1 patient respectively. The finalised and

summarized result sheet is as under. Tabular and graphical representations are shown as

under in table-33, 34 and graph-12.

Table No 34 s.No Result Number of patients Percentage 1 Cured 17 85 2 Major improvement 2 10 3 Minor improvement 1 5 4 Unchanged 0 0 5 Discontinued 0 0 Total 20 100

Graph-12 Results of Phalatrikadiyoga in Kamala

Major

improvement10%

Discontinued0%

Unchanged0%

Minor improvement

5%

Cured85%

Observations & Results 104

The main aim of these work lies in collecting the Concept of Kamala including it’s

Paribasha, Nidana panchaka and it’s management. Ayurveda claims to a number of

effective remedies infract most of the people suffering from the different varieties of

Kamala, many of etiological factors are mentioned for the Jaundice, but till today the

exact cause was not find out.

As a resultant day today practice receives number of patients suffering from

Kamala (Jaundice) and its complications as the negligence of Kamala management. In

contemporary medical system jaundice is the word analogous with Kamala. The

disease, which is, characterised by the colour pigmentation such as greenish, yellowish

and white etc, Kamala and Pandu appear to have been studied.

In Ayurveda it was clearly mentioned that Agni mandya and Pitta vikruti are the

main Causative factor for the Kamala, in this clinical study it was observed that all the 20

patients are shown Agni vikruti, in terms of Pitta vikruti.

Major literatures of Ayurveda explain the disease Kamala and it’s management.

In Charaka Samhita Kamala is mentioned as Nidanarthakara Roga of Pandu. The later

author Vagbhata explained about Swatantra Kamala apart from the Paratantra Kamala,

which was explained by the Charaka and Susruta. However the predominant Dosha in

both Swatantra and Paratantra Kamala is the Pitta Dosha. Dalhana, Susruta Samhita

commentator, in his ideology on Kamala enrolled the term Panaki as a variety of

Kamala.

Total 24 patients were diagnosed as a Kamala out of them, 20 patients were

selected for the clinical trial. The Kamala Roga is seen to independently and also as a

sequel to Pandu Roga. In the present study we have observed that out of 20 patients 6

patients were having Pandu Roga.

Discussion and conclusion 105

In this study it is observed that out of 20 patients, 12 were male and 8 are female

patients. So was concluded that the Male are more prone for the Kamala, the study was

limited to only 20 patient, so for that, this ratio may not amend when it is observed in

large number.

Mentioned etiological factors provoke Pitta, with their specific qualities. “Agnireva

shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid having Ushna

and teekshna properties enough and sufficient to digest the food. With the above-

mentioned Nidana person with vitiated Pitta and Agni is unbalancing the functions of

liver where mala roopa Pitta is discharged. When hypo functioning of Pitta (Agni)

consequently in turns produce Ama or Amavisha. This Ama corresponds with Rakta and

may produce Kamala.

The Alcohol is Considered as one of the etiological factor for the jaundice, in

classes it was explained that ati-madhyapana is one of the causative factor for Kamala.

In this clinical study that was also observed that most of the patient are alcohol habitual.

Aharatmaka karana:

Asatmya ahara sevana, excessive intake of Amla, lavana, katu and madhura

rasa pradhan ahara dravya, rooksha, Guru, sheeta guna ahara padarthas vitiates the

Jatharagni, the hypo functioning of Jatharagni leads to the Kamala. All above-mentioned

etiological factors are responsible on the vitiation of the Pitta. In turn vitiated Pitta,

vitiates the Rakta thus the samprapti of the Kamala begins, As the vitiation of Rakta is

the major step in the pathogenesis, So for it has been counted in the Rakta vaha sroto

vyadhi.

Asatmya sevena means that which is non compatible to the body. Here we can

consider alcohol, smoking and Tobacco chewing are harmful to the body can cause

Kamala.

Discussion and conclusion 106

Thus the asatmya ahara like rooksha and Guru, Guna, Madhur, lavana, Amla

and katu rasa pradhanahara if taken regularly excessive causes Kamala. These are

non-homologous and Causes Rakta and Pitta prakopa. Thus cause Pandu Roga before

to Kamala and Pandu Roga is the causative factors of the Kamala Roga that’s why

Pandu Roga is said as nidanarthakara karan for the Kamala.

Ativyayama:

Excessive vyayama leads to Pitta and Vata Dosha prakopa takes place further it

leads to dhatukshaya, simultaneously impaired the kayagni.

Divaswapana:

Excessive day sleep aggrivates the vata and kapha, it leads to agnimandya.

Vegadharana:

The natural urges like mala, mootra it forcefully control, aggravates Vata Dosha,

vitiated Vata cause Kayaagni vikruti, and leads to mandagni. In this study it was advised

the many patients be reported with divaswapna, adhika vyayama, An advice to the

patients to avoid. Thus shows an improvement in kayagni.

Mansika Karana:

Manasika karanas like stress and strain are not observed in the present study.

So it was concluded that there is no role in the Kamala.

The specific samprapti of Kamala is not mentioned in the classics. Only

shakhashrita Kamala Nidana and samprapti explained from above etiological factors one

can establish the process of pathogenesis as under Pandu Roga in this conditions, the

patient not taken proper medication and indulgence of excessive amount of Pitta

vadhaka aharas are vitiate the Pitta. Dahana, pachan, vivechan karma unbalancing and

not proper nourishing the rasa, raktadi dhatu.

In shakhashrita Kamala excessive intake of Guru, sheeta, Rooksa, Madura rasa

ahara, aggravates the Kapha Vata Dosha, and diminishes the Pitta. Increased slesma

Discussion and conclusion 107

obstruct in the Pitta marga resulting on vimarga gamana of Pitta, this results the

shakhashrita Kamala.

The management of Kamala, more single drug therapy and compound drugs

explained in our classics, about the supremely and relevancy of phalatrikadhiyoga

explained in text, but these drugs are Kamala hara properties and individual drugs

katuki. Bhumyamalaki, Bhrungaraja, Nimba, Guduchi, Haritaki, katuki vasa are also

studied for their hepato-protective properties and the result are encouraging.

Considering the above fact the combination of the drugs given desired effect.

Kamala was successfully, treated with Phalatrikadiyoga. The medicine combination is

also showed the hepato-protective property.

Phalatrikadiyoga is a potent combination to treat Kamala based on it’s

properties and pharmacological action. It is predominately Tikta and Katu rasa, laghu,

rooksha Guna’s Ushna Veerya, Madhura vipaka and Pitta shamaka properties. The

composition is as follows.

1) Haritaki 1 part

2) Bibhitaki 1 part

3) Amalaki 1 part

4) Guduchi 1 part

5) Vasa 1 part

6) Kiratatikta 1 part

7) Katuki 1 part

9) Bhumyamalaki 1 part

10)Bhrungaraja quantity sufficient

The contents of Phalatrikadiyoga drugs were selected by the classical reference

in Baishajya Ratnavali. In this reference Phalatrikhadi kwath was mentioned but the

same ingredients are taken in the form of choorna.

Discussion and conclusion 108

The patients with the conformed diagnosis of Kamala clinically as well as

laboratory investigations are selected for the study. The main criteria for selection of the

patients were symptomatolagy and laboratory (investigation) evidences of the serum

bilirubin and other liver function test values. The patients presenting above lakshans two

or more were considered clinically with laboratory evidences of urine bile salts and bile

pigments along with liver function values. Severe Jaundice patients, complications of

Jaundice, who will not agree for the study also excluded.

The Haritaki is also used as rasayan, safe and anulomana, Astringent,

Stomachic, tonic and anti helmentic. It is also indicated in Kamala, Grahani, Shoola,

Anaha, Pleeha, Bleeding and external ulcers etc.

The Bibhitaki is used as a Astringentum, tonic and laxative,it prescribed in

disease liver and gastro intenstinal tract.

The Amalaki, its best rasayana, Ruchya Deepana, Anulomana, yakridduttejaka

and a good antioxidant used in dyspepsia, Jaundice, Vertigo and prameha.

The Guduchi is a rasayana, it stimulates the bile secretion, thirst, fever burning

Sensation, vomitting, enriches the blood, cures the Jaundice.

The vasa, is a best appetizer, bitter in taste, used in bronchitis, asthma, fever,

blood impurities, cardiac problem and jaundice.

The kiratatikta is bitter, cooling, antihelmintic, antipyretic, laxative,

antiinflammation, burning sensation.

The katuki is Deepana, bedhana, Kasa, krimi, kustam, laxative. Alcoholic extract

of the root is found to have antibacterial effect. The drug is found useful in treatment of

jaundice.

The Nimba is best Pitta shamaka. Used in burning sensation, fever, thirst, ulcers

and inflamation, Raktashodhaka, Netraroga, Kasa and Kamala.

Discussion and conclusion 109

The Bhumyamalaki is considered de-obsruent, diuretic, astringent and cooling.

A decoction of plant is administered in jaundice, liver stimulant thrust controls, prameha.

The Bhrungaraja leaves largely used in liver diseases, it is a keshya, krimi,

kasa, Sotha, Pandu, Rasayana, Kamala and Hepato protective activity.

Synergetic effect of Phalatrikadiyoga on Kamala

i. Deepana and Amapachana.

ii. It restore the Agni vyapara eliminates the vitiated Pachakapitta,

Ranjakapitta, saman and vyanvata and Kledakakapha.

iii. Capable to relieving the ashruka and mamsha dagdata.

Criteria for the selection of Phalatrikadiyoga in Kamala

i. Phalatrikadiyoga is very effective in Kamala.

ii. The ingredients are easily available in the market.

iii. Method of preparation is simple & economical.

iv. Many of the ingredients of Phalatrikadi drugs are clinical proved as

hepato-protective.

Probable mode of action of Phalatrikadiyoga in Kamala

The pharmaco dynamics in Ayurveda is mainly based on the fundamental

doctrine of phanchamahabuta and Tridosha theory, which govern the physico-chemical

and biological phenomena respectively.

Phalatrikadiyoga can reduce the symptoms as well as disease process due to

the various actions of the individual drugs, in the mechanism and action is confined in

the Rasa, Guna, Veerya, Vipaka and Prabhava of the individual drugs.

The Veerya as the potency of drug by which the action is carried out

commentator Chakrapani Explain that the Veerya is two types, chintyam and achintyam,

chintayam which can be inferred and understood, Achintyam which is beyond the

inference of human imagination. Achintya Veerya is known as the prabhava,this special

Discussion and conclusion 110

property which produces action in different forms ascribed audits of Rasa, Guna,

Veerya, Vipaka and Prabhava.

All the drugs of Phalatrikadiyoga have some similarities with respect to their

Rasa, Guna, Veerya and Vipaka. All have katu, tikta rasa and katu vipaka with respect to

guna it can observe that rooksha and laghu are common in these ingredients of the

formulation.

Statement gives clear idea about Karmukata of the drugs. Which have a specific

role to play in this disease.

The Kamala is one of the Pitta and Rakta produshaja vyadhi here Pitta is vitiated

and the help of Tashaya, Tikta and Madura rasa prodhan dravya normalizes it, and

Phalatrikadiyoga is best deepana, Amapachan, Pitta prasaman, and srotovishadhan.

The management of Kamala, more single drug therapy and compound drug’s

explained on our classics, about the supremacy and relevancy of Phalatrikadiyoga

explained in text. These drugs are Kamala hara properties, and individual drugs katuki,

Bhoomyalaki, Bhrungaraja, Nimka, Guduchi are also studied for their hepato protective

properties and the result are encouraging.

Considering the above fact the combination of the drugs given desired effect.

Kamala was successfully, treated as Phalatrikadiyoga. The medicine combination is

also showed the hepto-protective property.

Conclusion

1. Based on the literature a close perusal of the observation and interference the

conclusion drawn from the present study can be presented here, Kamala is

characterised by the yellowish discoloration of sclera, skin, nails, urine and stool.

2. Diagnosis of the disease based on the yellowish discoloration sclera, urine, faeces

and Nails.

Discussion and conclusion 111

3. It is a disease in which Pitta Dosha effect over Rakta and mamsadhatu. It leads to

Kamala.

4. Kamala explains in the classics under the Pandu Roga chapter.

5. Kamala mainly classified two types.

a) Kastashakhastrita b) shakhastrita

6. It is depending upon the dispersal of Pitta in the body.

7. Kasta shakhashrita Kamala is manifested as a sequel Pandu and shakhastrita

Kamala Vata and Kapha Dosha and dushya Rasa, Rakta, which obstructs the

passage of Pitta varga.

8. Kamala may occur independently and sequel of Pandu Roga.

9. The Pitta is in abnormal production during the paka of Rakta Dhatu. Pitta formed,

during the phatu paka of Rakta, it passes through the Rakta sthan of Yakrit and

enters kosta. The bhutagni paka take place in the Yakrit, it derives additional support

from some of the important post digestive functions and metabolic event’s which

have been shown by modern advances on physiology and bio-chemistry to takes

place in Yakrit. The vilakshana gunas can apply to a complete change over the

qualities of ahara dravyas ingested which do not take place in the adho Amashaya,

Bhutagnipaka is required to process and convert them suitably homologues of

substances which compose of the seven dhatus.

10. The Phalatrikadiyoga it repair the Agni vikruti and restore the normally of Agni

vyapar.

11. The probable mode of action of Phalatrikadiyoga acts as a deepana, panchana, and

Pitta prasamana along with Kapha hara quality.

The statistical evaluation of Phalatrikadiyoga in Kamala has shown highly

significance in both the parameters. The parameters studied are shown in table number

20.

Discussion and conclusion 112

Haridra netra, Haridra mootrata, Peeta Nakha, Avipaka, Aruchi, Total Bilirubin

Total Protein, Serum Albumin, Bile Salt and Bile Pigment has shown highly significance

with the P-Value as <0.001.

Haemoglobin percentage, SGPT, Serum Alkaline phosphate, Peeta Twakha and

Direct Bilirubin has shown P-value as <0.01, which is significant. Only Serum Globulin is

not significant with the P-value as > 0.1.

The result cured is declared to the patients those who have totally cleared with

the presenting symptoms and free from abnormal or deviated lab investigations such as

liver profile. The number patients under this category with are 17 i.e. 85%. There is no

patient who doesn’t respond to the treatment. Rests of three patients are under major

improvement and minor improvement cadres as 2 and 1 patient respectively. The

finalised and summarized result is as under.

Results of Phalatrikadiyoga in Kamala

So

can be e

satisfactor

thus the Phalatrikadiyoga is very economical, safe and effective drug hence it

mployed safely in Kamala (Shakashrita and Kostashrita), which gives

y results.

Major improvement

10%

Discontinued0%

Unchanged0%

Minor improvement

5%

Cured85%

Discussion and conclusion 113

Summary

• The modern and Ayurvedic concepts of Kamala are similar.

• The term Kamala is derived by the root ‘kamu’ which means kanti by suffixing Nhin’’

pratyaya is substituted by kalaha thus the term Kamala is kumu + Nhin (kalaha)

• The word Kamala developed and explained as “ kamam kantim harati haridra

varnam lati iti Kamala’”. Haridra is yellowish discoloration, lati means Runaddati or to

get yellowish discoloration, In other words Kamala is a disease in which an individual

looses interest in all aspects and gets the yellowish discoloration.

• The Kamala would be point out to a disease conditions in which hunger and appetite

for food are diminished, simple meaning of Kamala is a disease where there is little

or no desire for food according to Harana Chandra.

• Yellowish discoloration of the skin, selera, mucous membranes, and excretions due

to hyper biliruibinemia and deposition of bile pigment’s are seen in Kamala i.e.

jaundice.

• In classics the different terminology are used for the Kamala.

• In Atharvaveda Kamala was known as Harima, Harita, vilohitatwa and Haridraka.

Dalhana while commenting on Susruta reviewed the different stages of Pandu Roga

and declared that Kamala with terminology such as panaki, apanaki, kumbha

Kamala, lagharaka, Alasa, Alasakya etc. Astanga Hridaya used the word lothara as

synonyms of Kamala.

• Chakrapani has used the term “Bahu Pitta Kamala as the synonyms of

kostashkhastrita Kamala and alpa Pitta Kamala as the synonyms of “shakhashrita

Kamala.

Summary of Phalatrikadiyoga on Kamala 114

• Charaka has classified the disease Kamala in two types.

1. Kostha shakhashrita Kamala

2. Shakhasharita Kamala

• Susruta has stated the Kamala is a later stage of Pandu Roga and kumbha Kamala,

lagharaka, Alasa and Haleemaka are it’s different stages.

• Bahu Pitta Kamala or kostha shakhashrita Kamala Alpa Pitta Kamala or shakhashrita

Kamala are the varieties of Kamala.

• Acharya Charaka and Vagbhata described the shakhashrita Kamala.

• The Disease Kamala is one of Nidanarthakara Roga of Pandu. The etiological

factors of Kamala broadly explain in the classics.

• The below mentioned are the conditions of kosta shakhashrita Kamala and

shakhashrita Kamala can occur in different situations.

• These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In such

cases all causative factors play their role in vitiating Pitta. This condensation of Pitta

of functional and sensible hyper activity may result in to Kamala from the following

Pitta vitiating ahara, vihara etc.

• The above mentioned etiological factors provoke Pitta, with their specific qualities.

“Agnireva shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid

having Ushna and teekshna properties enough and sufficient to digest the food.

• With the above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing

the functions of liver where mala roopa Pitta is discharged. When hypo functioning of

Pitta (Agni) consequently in turns produce Ama or Amavisha. This Ama corresponds

with Rakta and may produce Kamala.

Summary of Phalatrikadiyoga on Kamala 115

• Pitta has its seat in Rakta has the Ashrayashrayee bhava because are of same

qualities i.e. “Samavaguna”. The by-product of Rakta i.e. Pitta is produced in excess

consequently producing bahu Pitta, with results in to “kostashakhashrita Kamala”

• Kamala a disease of elevated bile in the blood is visualized in so many roots.

Created in the stricture of bile duct. This results in to the shakhashrita Kamala.

• The abnormal increased state of Pitta this is outcome of disturbance in paka of

Rakta. Pitta vriddhi at the level of Rakta paka independently causes Pandu.

Because of Pitta ushna and teekshna guna’s of Pitta more of Rakta will be take

place, consequently it turns the effect of Yakrit and Pleeha are the main organ’s of

Rakta Dhatu. During the destruction of the Rakta there may from mala of Rakta i.e.

Pitta abnormally in its quantity.

• There occurs the Vimargagamana of Pitta. In shakhashrita Kamala Vata and Kapha

are predominant. And not only Pitta is prevented from passing into the gut but also

regurgitated this is vimarga of Pitta.

• The disease manifestation sites are specifically liver and spleen.

• The liver is the largest glandular organ in the body, and has more functions than any

other human organ. The Liver has a pivotal role in human metabolism.

• The liver secretes bile, which comprises salts and pigments, and aids the digestion

of fats.

• Kamala according Ayurveda is a disease of Rakta Dhatu, it is explain under context

of Rakta ruddi laxana and Charaka explain under the Rakta pradusaja Vyadhi,

Kamala related organ is a Yakrit, it is a moola of Rakta vaha Srotas all Acharyas has

same opine regarding Srotas .

• In Kamala the Dosha vitiated is Pitta. The prime symptoms of Kamala is yellowish

discoloration of Netra, twacha, mootra etc because of vitiated Pitta Dosha,

Summary of Phalatrikadiyoga on Kamala 116

Ranjakapitta is mainly contributory of above-mentioned symptoms. The samprapti of

shakashrita Kamala is clearly mentioned in classics, that Kapha obstructs Pitta. So

Pitta will not reaches the kosta resulting tila pistanibham. From above explanation

we conclude the Yakrit and Pitta Dosha involved in disease of Kamala.

• The mala rupa Pitta or bile is produced in liver continuously. Only bile salts are use

full in digestion. Bile acts as the own stimulant, bile salts are the strongest

chologogues. The malarupi Pitta is also known as malaranjaka Pitta since it imparts

colour to the faeces.

• The physical characteristics and qualities of the Pitta described in ancient Ayurveda

classics striking resemblance to hepatic bile (better still the combined bile and

pancreatic juicy. The payments of bile the bilirubin and biliverdin are essential

constituents of the haemoglobin complex. From this point of view, it may be stated

that, Rakta is the seat of Pitta the bile pigments is also the waste products or mala of

the blood. Rakta and Pitta have identical colour. The blood separates into two parts

the lower contains the cells and is opaque and red. The bilirubin contributes to the

normal colour of the plasma, both blood and bile have nearly the same

characteristics fleshy smell. Pitta may refer to the hepatic bile or possibly, to the

combined bile and pancreatic juice.

• Susruta coated Yakrit and pleeha are main seat of Ranjakapitta, in function he has

stated, that it confers colour to Rasa i.e., Rasa ragakrit. In treatment aspect Susruta

coated goat liver with raw drug, together with the Pitta contained in it, in the

treatment of loss of blood in Rakta Pitta. In view of the important function of Rakta, a

separate Pitta necessarily required for the production of it.

• Charaka describing under the heading of general function of Pitta, the product of

normal and abnormal temperature and color of the skin is due to the Pitta.

Summary of Phalatrikadiyoga on Kamala 117

• Susruta and Vagbhata directly mentioned Ranjakapitta its seat and functions. Pitta

classified under different groups not only under the five headings they are maturity

quality functions etc.

• This malarupa Pitta is an excretion from Yakrit seat of Rakta dhatu and imparts

colour to pureesha and therefore it is also known as malaranjaka Pitta.

• There is another important classification of the Pitta in the body based on their

function particularly metabolic processes

• Apart from three Doshas Susruta explain Rakta as 4th dosha. Pitta is mala of rakta

dhatu Vata, Pitta, Kapha and Rakta these are essential factors for sharira Utpatti,

sthiti and Nasa.

• The causative factors for all the diseases are Tridosha mainly they are Vata Pitta and

Kapha. Rakta Dhatu is the group of organs concerned with the production and

maintenance of Rakta Dhatu. In addition Acharyas recognized Yakrit and Pleeha as

Rakta sthana.

• Yakrit is closely related with Rakta Dhatu and Pitta Dosha. Kamala has been

included in the disease caused due to the situation of morbid Doshas in Rakta dhatu.

It is clear from the above observations that Kamala is not a Raktaja Roga but when

morbid Pitta Dosha involves the Rakta then Kamala may be produced. Rakta is

particularly involved in the Samprapti of kosthashrita Kamala.

• It would be seen the Pitta to which the physical characteristics and qualities of under

discussion are attributed might refer to liver bile and not others. This view find

support from the description of Pitta as the kitta of Rakta “ asrujapittam” and also

reference made by Charaka, Pitta and Rakta possess nearly identical smell and

colour.

Summary of Phalatrikadiyoga on Kamala 118

• The Asruja Pitta m finds direct correlation from modern physiological views it regards

blood. It may be stated that Rakta is the seat of Pitta. This bile Pigments are also of

the waste products or the mala’s of Rakta.

• Rakta and Pitta are stated to have identical colour. If left undisturbed, the blood

separates into two parts. The lower part is opaque and red. The erythrocytes appear

to be red in colour the colour of the hepatic bile is golden yellowish which is largely

due to its pigments bilirubin constituent to the normal colour of the plasma. Both bile

and blood have nearly the same characteristic fleshy smell. In addition both blood

and bile are intimately connected with the liver and exists.

• A review of Pitta may refer to Agni. Liver is imediately concerned with carbohydrates,

lipid and protein metabolism. The liver synthesizes cholesterol and esters. Finally

there is the secretary role of the liver concerned with the formation of bile.

• Haemoglobin is the iron containing pigment of the red blood corpuscles. Liver and

bone marrow and the quantity are increased state. Bilirubin does not contain iron

and a very soluble for this reason it is dissolved in the blood and not stored in the

cells and thus it continuously removed from the liver cell into the bile.

• When red blood cells are delivered from the bone marrow into the circulatory

system. Maintain the pliability of cell membrane.

• Keep the iron of the cell haemoglobin in the ferrous form rather than the ferric form.

• Once the red cell membrane becomes fragile the cell rupture during passage

through some tight spot of the circulation. When the spleen is removed the number

of abnormal red cells and old cells circulating in the blood increases considerably.

• When red blood cells burst and release their haemoglobin the haemoglobin is

phagocytized almost immediately by macrophages in many parts of the body. The

porphyrin portion of the haemoglobin molecule is converted by macrophages

Summary of Phalatrikadiyoga on Kamala 119

through a series of stages, into the bile pigment bilirubin, which is released into the

blood and later secreted by the liver into the bile.

• This measure is essential when the treatment is aimed to cure Kostashakashrita

Kamala primarily, where as in case of shakhastrita Kamala the initial phase to bring

shakashrita Pitta to kosta Pitta vardhaka and kaphakar ahara dravya used.

• Virechana therapy specially in Pitta pradhana and Rakta pradushaja vikaras.Kamala

is one of the Pitta pradhan roga.

• To study the efficacy of "Phalatrikadiyoga " in Kamala

• Drug composition

1) Haritaki 1 part

2) Bibhitaki 1 part

3) Amalaki 1 part

4) Guduchi 1 part

5) Vasa 1 part

6) Kiratatikta 1 part

7) Katuki 1 part

9) Bhumyamalaki 1 part

10)Bhrungaraja quantity sufficient

• The patients with the conformed diagnosis of Kamala clinically as well as laboratory

investigations are selected for the study. The main criteria for selection of the

patients were symptomatolagy and laboratory (investigation) evidences of the serum

bilirubin and other liver function test values.

• The patients presenting lakshans two or more were considered clinically with

laboratory evidences of urine bile salts and bile pigments along with liver function

Summary of Phalatrikadiyoga on Kamala 120

values. Severe Jaundice patients, complications of Jaundice, who will not agree for

the study also excluded.

• Objective Criteria for assessing Kamala are -

1) Hb %

2) Serum bilirubin (direct and total)

3) SGPT

4) Serum Alkaline Phosphate

5) Serum total protein

6) Serum Albumin

7) Serum Globulin

8) Urine Bile salts and Bile pigments.

• As a resultant day today practice receives number of patients suffering from Kamala

(Jaundice) and its complications as the negligence of Kamala management. In

contemporary medical system jaundice is the word analogous with Kamala.

• In Ayurveda it was clearly mentioned that Agni mandya and Pitta vikruti are the main

Causative factor for the Kamala, in this clinical study it was observed that all the 20

patients are shown Agni vikruti, in terms of Pitta vikruti.

• Major literatures of Ayurveda explain the disease Kamala and it’s management. In

Charaka Samhita Kamala is mentioned as Nidanarthakara Roga of Pandu. However

the predominant Dosha in both Swatantra and Paratantra Kamala is the Pitta Dosha.

Dalhana, Susruta Samhita commentator, in his ideology on Kamala enrolled the term

Panaki as a variety of Kamala.

• Total 24 patients were diagnosed as a Kamala out of them, 20 patients were

selected for the clinical trial. The Kamala Roga is seen to independently and also as

Summary of Phalatrikadiyoga on Kamala 121

a sequel to Pandu Roga. In the present study we have observed that out of 20

patients 6 patients were having Pandu Roga.

• Mentioned etiological factors provoke Pitta, with their specific qualities. With the

above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing the

functions of liver where mala roopa Pitta is discharged. This Ama corresponds with

Rakta and may produce Kamala.

• The specific samprapti of Kamala is not mentioned in the classics. In shakhashrita

Kamala excessive intake of Guru, sheeta, Rooksa, Madura rasa ahara, aggravates

the Kapha Vata Dosha, and diminishes the Pitta. Increased slesma obstruct in the

Pitta marga resulting on vimarga gamana of Pitta, this results the shakhashrita

Kamala.

• The management of Kamala, more single drug therapy and compound drugs

explained in our classics, about the supremely and relevancy of phalatrikadhiyoga

explained in text, but these drugs are Kamala hara properties and individual drugs

katuki. Kamala was successfully, treated with Phalatrikadiyoga. Phalatrikadiyoga is

a potent combination to treat Kamala based on it’s properties and pharmacological

action. It is predominately Tikta and Katu rasa, laghu, rooksha Guna’s Ushna

Veerya, Madhura vipaka and Pitta shamaka properties.

• The patients with the conformed diagnosis of Kamala clinically as well as laboratory

investigations are selected for the study. Severe Jaundice patients, complications of

Jaundice, who will not agree for the study also excluded.

• The Nimba is best Pitta shamaka. The Bhrungaraja leaves largely used in liver

diseases, it is a keshya, krimi, kasa, Sotha, Pandu, Rasayana, Kamala and Hepato

protective activity.

Summary of Phalatrikadiyoga on Kamala 122

Synergetic effect of Phalatrikadiyoga on Kamala

i. Deepana and Amapachana.

ii. It restore the Agni vyapara eliminates the vitiated Pachakapitta,

Ranjakapitta, saman and vyanvata and Kledakakapha.

iii. Capable to relieving the ashruka and mamsha dagdata.

• The Kamala is one of the Pitta and Rakta produshaja vyadhi here Pitta is vitiated and

the help of Tashaya, Tikta and Madura rasa prodhan dravya normalizes it, and

Phalatrikadiyoga is best deepana, Amapachan, Pitta prasaman, and srotovishadhan.

• Kamala was successfully, treated as Phalatrikadiyoga. It leads to Kamala.

• Kamala explains in the classics under the Pandu Roga chapter.

• Kamala mainly classified two types.

• Kasta shakhashrita Kamala is manifested as a sequel Pandu and shakhastrita

Kamala Vata and Kapha Dosha and dushya Rasa, Rakta, which obstructs the

passage of Pitta varga.

• Kamala may occur independently and sequel of Pandu Roga.

Results of Phalatrikadiyoga in Kamala

The statistical evaluation of Phalatrikadiyoga in Kamala has shown highly

significance in both the parameters. The parameters studied are shown in table number

20.

Haridra netra, Haridra mootrata, Peeta Nakha, Avipaka, Aruchi, Total Bilirubin

Total Protein, Serum Albumin, Bile Salt and Bile Pigment has shown highly significance

with the P-Value as <0.001.

Haemoglobin percentage, SGPT, Serum Alkaline phosphate, Peeta Twakha and

Direct Bilirubin has shown P-value as <0.01, which is significant. Only Serum Globulin is

not significant with the P-value as > 0.1.

Summary of Phalatrikadiyoga on Kamala 123

The result cured is declared to the patients those who have totally cleared with

the presenting symptoms and free from abnormal or deviated lab investigations such as

liver profile. The number patients under this category with are 17 i.e. 85%. There is no

patient who doesn’t respond to the treatment. Rests of three patients are under major

improvement and minor improvement cadres as 2 and 1 patient respectively. The

finalised and summarized result is as under.

Results of Phalatrikadiyoga in Kamala

So

can be e

satisfactor

Major improvement

10%

Discontinued0%

Unchanged0%

Minor improvement

5%

Cured85%

thus the Phalatrikadiyoga is very economical, safe and effective drug hence it

mployed safely in Kamala (Shakashrita and Kostashrita), which gives

y results.

Summary of Phalatrikadiyoga on Kamala 124

References

1. Atharvaveda 1/22/3

2. Atharvaveda 1/22/3

3. Atharvaveda 4/9/3

4. Sushruta Uttaratantra 44\6

5. Shabdakalpadruma Page No

6. Sushruta Uttara Tantra 44\4

7. Dhaturupamanjari

8. Sushruta Uttartantra 44/5

9. Dorlands Medical Dictionary Page No 431

10. Sushruta Uttaratantra 44/6

11. Astanghahrudayanidana 13/19

12. Charakachikitsa 16/36

13. Charaka Sutra 19/3

14. Charaka Sutra 19/7

15. Devidsonsmedicine7th Edition Page No 498

16. Clinical Medicinekumarandclarks 4th Edition Page No 298

17. Charaka Vimana 5/27

18. Sushruta Sutra 21/9

19. Sushruta Sutra 14/5-6

20. Charaka Chikitsa 16/124

21. Bhava Prakash Poorva Khanda 8/48

22. Grays Anatomy Page No 1374

References I

23. Sharangadara Poorva Khanda 5/82

24. Monier Monier Willams Sanskruta Dictionary Page No 838

25. Grays Anatomy Page No 1374

26. Samar Mitra 1st Part Page No

27. Samar Mitra 1st Part Page No

28. Human Embriology 7th Edition

29. Human Embriology 7th Edition

30. Human Physiology 1st Part Page No 58

31. Human Physiology 1st Part Page No 455/456

32. Human Physiology 1st Part Page No 657

33. Human Physiology 1st Part Page No 446-447

34. Human Physiology 1st Part Page No 21

35. Human Physiology 1st Part Page No 153

36. Human Physiology 1st Part Page No 655-562

37. Charaka Indriya Sthana 1/8

38. Astangha Sangraha Sutra 11/13

39. Sushruta Sutra 15/13

40. Charaka Sutra 12

41. Charaka Chikitsa 15/3

42. Sushruta Sutra 21/5

43. Sushruta Sutra 21/9

44. Charaka Sutra 20/5

45. Sushruta Sutra 42/5

46. Ashtanga Hrudaya Sutra 1/

47. Charaka Sutra 1/60

48. Sushruta Sutra 21/11

49. Sharangadara Poorva 3/120

50. Kasyapa Samhita

51. Charaka Sutra 20/18

52. Sushruta Sutra 21/13

53. Charaka Vimana 2/17

54. Charaka Sutra 20/8

55. Sushruta Sutra 21/6

56. Charaka Sutra 20/8 Chakrapani

References II

57. Astangha Hrudaya Sutra 12/2

58. Essential Basic Ayurvedic Concept Page No 28

59. Charaka Sutra 18/50

60. Charaka Sutra 22/11

61. Ashtangha Hrudaya Sutra 11/23

62. Sushruta Sutra 15/2

63. Charaka Chikitsa 15/3

64. Ibid 15/4

65. Ibid 15/39

66. Sushruta Uttara Tantra 40/170

67. Astangha Hrudaya Sutra 12/10-12

68. Sushruta Sutra 21/9

69. Charaka Chikitsa 15/10

70. Bhavaprakash Poorva 2/178

71. Introduction To Kaya Chikitsa Page No 133

72. Sushruta Sutra 21/10

73. Charaka Chikitsa 15/28

74. Sushruta Sutra 15/6

75. Charaka Sutra 12/11

76. Sushruta Sutra 21/10

77. Astangha Hrudaya Sutra 12/13

78. Bhela Shareera 4/3-5

79. Charaka Sutra 12/11

80. Sushruta Sutra 21/10

81. Ashtanga Hrudaya Sutra 12/14

82. Ashtanga Sangraha Sutra 20/6

83. Essential Basic Concept Of Ayurveda Page No 30-31

84. Sushruta Sutra 21/3

85. Charaka Chikitsa

101. A. Hrudaya Nidana 13/15

102. Charaka Chikitsa 16/34-38

103. Ibid 16/33

104. Charaka Nidana 1/22

References III

105. Sushruta Sutra 21/22

106. Astangha Hrudaya Nidana 1/16

107. Charaka Sutra 25/43 (4)

108. Sushruta Sutra 42/9 (4)

109. Astangha Hrudaya Sutra 10/19

110. Charaka Sutra 26/43

111. Sushruta Sutra 41/9 (2)

112. Astangha Hrudaya Sutra 10/11

113. Charaka Sutra 26/42 (3)

114. Sushruta Sutra 42/14

115. Astangha Hrudaya Sutra 10/13

116. Charaka Sutra 24/5-10

117. Sushruta Sutra 42/14

118. Charaka Chikitsa 16/125

119. Charaka Nidana 1/9 Chakrapani

120. Charaka Chikitsa 16/9-11

121. Ibid 16/34

122. Ibid 16/125-126

123. Astangha Hrudaya Chikitsa 16/46-48

124. Sushruta Sutra 21/33

125. Ibid 21/34

126. Charaka Nidana 1/9

127. Charaka Chikitsa 16/35-37

128. Ibid 16/126-127

129. Ibid 16/35-37

130. Astangha Hrudaya Nidana 13/16

131. Madhava Nidana 8/16-18

132. Bhavaprakasha Madhyama 8/19-20

133. Yogaratnakara Panduroga 18-19

134. Sushruta Uttara Tantra 44/10

135. Charaka Chikitsa 21/40

136. Sushruta Uttara 44/12

137. Astangha Hrudaya Nidana 13/18

138. Charaka Chikitsa 16/37

References IV

139. Madhava Nidana 8/21

140. Bhavaprakash Uttara

141. Charaka Chikitsa 16/37-38

142. Ibid 16/42

143. Ibid 16/40

144. Astangha Hrudaya Chikitsa 16/40

145. Sushruta Uttara 44/15

146. Charaka Chikitsa 16/55

147. Yogaratnakara Panduroga 67

148. Bhavaprakasha Madhyama 8/40

149. Chakradatta 8/26

150. Yogaratnakara Panduroga 71

151. Charaka Chikitsa 16/128

152. Bhavaprakasha Nighantu Page No 7

153. Dravyaguna Vignana 2nd Part Page No 754

154. Kirtikara And Basu Page No 1021

155. Pharmacognosy Page No 215-216

156. Madanapala Nighantu

157. Bhavaprakasha Nighantu Page No 5

158. Kirtikara And Basu Page No 1021

159. Bhavaprakasha Nighantu Page No 9

160. Dravyaguna Vignana 2nd Part Page No 239

161. Pharmacognosy Page No 217

162. Indian Medicinal Plants Page No 1204

163. AAMRA volume 2 Issue 1& 2 1998 Page No 24

164. Bhavaprakasha Nighantu Page No 38 To 41

165. Dravyaguna Vignana 2nd Part Page No 758

166. Pharmacognosy Page No 225

167. Medical & Aromatic Plants Abstract Vol 24/1,02 Page No 16

168. Indian Materia Medica Page No 82

169. AAMRA Vol 1st Issue 3rd Oct, Dec 1997 Page No 76

170. Ibid Page No 92

171. Ibid Page No 92

172. Dravyaguna vignana 2nd part Page No.758

References V

173. Pharmacognosy Page No.225

174. Medical and Aromatic plants abstract vol 24/No.1 2002 Page No.16

175. Indian Materia Medica Page No.82

176. AAMRA vol 1st Issue 3rd Oct-Dec 1997 Page No.76

177. Ibid Page No.92

178. Ibid Page No.92

179. Bhavaprakash Nighantu Page No.270

180. Dravya Guna Vignana 2nd part Page No.761

181. Indian Medicinal plants Page No.78

182. Bhavaprakash Nighantu Page No.269

183. Medicinal & aromatic plants abstract vol.24 No.1 2002 Page No.32

184. Ibid Page No.98

185. AAMRA Vol.2 Issue 1st & 2nd Jan-Jun 1998 Page No.34

186. AAMRA Vol.2 Issue 3rd Jul-Sep 1998 Page No.151

187. AAMRA Vol.2 3rd Issue Jul-Sep Page No.144

188. Bhavaprakash Nighantu Page No.320

189. Dravyaguna Vignana 2nd part Page No.241 to 247

190. Indian Materia Medica Page No.41

191. Ibid Page No.40 to 43

192. Bhavaprakash Nighantu Page No.320

193. Capsule Himalaya Health Digest Oct-Dec 2001 Page No.3

194. Bhavaprakash Nighantu Page No.73

195. Dravyaguna Vignana 2nd part Page No.691

196. Indian Materia Medica Page No.1184

197. Pharmacognosy Page No.207

198. AAMRA 2nd / 3 Jul-Sep 1998 Page No.128

199. Heritage Healing Jan-2002 Page No.6 to 7

200. Bhavaprakash Nighantu Page No.70

201. Dravyaguna vignana 2nd part Page No.441

202. Pharmacognosy Page No.206

203. Indian Medicinal plants Page No.1825

204. Ayurved Vikas Jul-Aug 2001 Page No.58

205. AAMRA 1/3 Octy-Dec 1997 Page No.83

206. Ibid Page No.82

References VI

207. Ibid Page No.90

208. AAMRA 1/3 Jul-Sep 1998 Page No.50

209. AAMRA II / 1st & 2nd Jan-Jul 1998 Page No.9

210. Bhavaprakash Nighantu Page No.329

211. Dravyaguna Vignana 2nd part Page No.141

212. Govt Ayurvedic Medical College Mysore

213. Medicinal & aromatic plants abstract vol.24 No.1 2002 Page No.94

214. AAMRA Vol.II/Issue 3rd Jul-Sep 1998 Page No.118

215. AAMRA Vol II / Issue 1st & 2nd Jan-Jun 1998 Page No.12

216. Ibid Page No.24

217. Bhavaprakash Nighantu Page No.460

218. Dravyaguna Vignana 2nd part Page No.640

219. Indian Materia Medica Page No.949

220. Raja Nighantu Page No.263

221. Bhavaprakash Nighantu Page no.461

221a. Visen PK, Shukla B, Patnaik GK, Dhawan BN. Andrographolide protects rat

hepatocytes against paracetamol-induced damage. J Ethnopharmacol 1993 Oct;40(2):131-

136

222. AAMRA 1 / 3 Oct-Dec 1997 Page No.94

223. Ibid Page No.98

224. Bhavaprakash nighantu Page No.429

225. Dravyaguna Vignana 2nd part Page No.123

226. Indian Materia Medica Page No.469

227. Indian Medicinal Plants Page No.1362

228. AAMRA 1/3 Oct-Dec 1997 Page No.77

229. Ibid Page No.94

230. Medicinal & aromatic plants abstract Vol.24, 1 2002 Page No.69

231. Medicinal Laboratory Technology Page No.173

232. Disease of the biliery system of Sheila Sherlock Page No.20

233. Ibid Page No.19

234. Kumar & Clark Clinical Medicine Page No.293

235. Ibid Page No.248

236. Human physiology 1st part Page No.452

References VII

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