ORIGINAL REASEARCH ARTICLE - CLINICAL...

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

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

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

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

ABSTRACT

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ORIGINAL REASEARCH ARTICLE - CLINICAL STUDY

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

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

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

Introduction:

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

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

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

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

JOAjournalofayurveda.in ISSN No:2321-0435


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

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

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

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

Need Of Study

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

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

Materials & Methods:

Aims and Objectives

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

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

Plan of Study

The study has been planned under two headings:

Epidemiological Study

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

Clinical Study

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

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

Selection Criteria

Inclusion Criteria-

1. Patient aged between 16 to 70 years.

2. Patient willing to participate in clinical study.

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

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


Exclusion criteria

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

2. Infected lipoma.

3. Calcified lipoma.

4. Ulcerated lipoma.

5. Lipoma with malignant change (liposarcoma).

6. Lipoma with myxomatousde generation .

7. Saponification in lipoma.

Withdrawal Criteria-

1. Intolerance to therapy.

2. Unwillingness to continue with the study.

3. Irregular patients.

4. Development of condition which may require other treatment.

Details

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

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

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

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

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

Group A: 15 Patients were intervened with Kanchanara-

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

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

Duration of clinical trial

45 days

Assessment

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

Follow up

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

ADR Study

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

Assessment criteria

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


Grade Size of Lipoma in cm2

0 <3 cm2

1 4-6 cm2

2 7-9 cm2

3 10-12 cm2

4 13-15 cm2



Observation And Results

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

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

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

Table no.III - Distribution of patient according to Gender

Table no.IV- Distribution of patients according to Prakriti

Age

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

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

Number of lipoma (whether solitary/multiple)

Gender

Prakriti

No of lipoma No of Patient % of Patient

Solitary 109 72.67

Multiple 41 27.33

Gender No. of patient % of patient

Male 125 83.33

Female 25 16.67

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

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

Prakriti No. of patient % of patient

Vata-Pitta 15 10

Vata-Kapha 110 73.33

Kapha-Pitta 25 16.67



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

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

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

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

Dietary Habit

Heredity

Occupation

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

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

Table no.VI - Distribution of patients according to Heredity

Table no.VII- Distribution of patients according to Occupation

Dietary habit No. of Patient % of Patient

Vegetarian 65 43.33

Mixed Diet 85 56.67

Heredity No. of patient % of patient

Familial History 45 30No familial history 105 70

Occupation No. of patient % of patient

Service 55 36.67

Business 40 26.67

Labor 10 6.67

Housewife 15 10

Student 30 20



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

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

Effect Of Therapies

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

Individual Analysis

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

Table no.VIII - Distribution of patient according to BMI

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

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

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

Underweight 0 0

Normal 55 36.67

Overweight 80 53.33

Obese 15 10

Lipid profile (Serum cholesterol)

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

Normal 75 50

Borderline high 40 26.67

High 35 23.33

S.N.

Objective parameter

Period Mean Diff.%

ReliefSD± SE± P value Result

1. Size of lipomaBT 2.000

0.1333 6.666 0.3519 0.0908 0.50 NSAT 1.867



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

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

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

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

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

Percentage Relief After Intervention

Inter-Group Comparison

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

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

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

S.N.

Objective parameter

Period Mean Diff.%

ReliefSD± SE± P value Result

1. Size of lipomaBT 2.000

0.267 13.33 0.4577 0.1182 0.1250 NSAT 1.733

S. No. Parameter Group A% Group B%

1Size of lipoma 6.66 13.33

Variable Groups(AT)

MeanSD± SE± P value S

Size of lipomaA 0.1333 0.3519 0.090

>0.05 NSB 0.2667 0.4577 0.1182

Discussion

Discussion on Epidemiological Study

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


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

Age

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

Number of Lipoma

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

Gender

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

Prakriti

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

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

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

Occupation

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

Diet Habit

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

Relation to Heredity

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

BMI (Body Mass Index)

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



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

Lipid Profile (Serum Cholesterol)

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

Discussion On Effect Of Therapies

Effect on size of Lipoma:

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

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

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

Conclusion1. Lipomas are the most common benign soft tissue

tumour of the subcutaneous tissue.

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

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

4. Exact etiology of lipoma is unknown.

5. Epidemiological study shows that entity is more

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

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

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

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

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

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




References

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

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

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

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

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

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

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

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

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

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