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Evaluation of the efficacy of
THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH
SPECIAL REFERENCE TO MALARIAL FEVER
By
MANGALAVVA .B. PATIL
Dissertation submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the degree of
Ayurveda Vachaspati M.D.In
KayachikitsaUnder the Guidance of
Dr. V. Varada CharyuluM.D. (Ayu) (Osm)
Dr. R.V.ShettarM.D. (Ayu)
Department of Kayachikitsa
Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG
2002-2005
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE
TO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”
in partial fulfillment of the requirement for the post graduation degree of “Ayurveda
Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,
Bangalore, Karnataka.
Dr. V. VARADA CHARYULU
M.D. (Ayu) (Osm)Guide
Professor & HOD
Dept. of Kayachikitsa
PGS&RC
Date:
Place: Gadag
Dr. R V SHETTAR
M.D. (Ayu)Co- Guide
LECTURER IN KAYACHIKITSA
DGMAMC, PGS&RC, Gadag
Date:
Place: Gadag
J.S.V.V. SAMSTHE’S
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTERGADAG, 582 103
Endorsement by the H.O.D, Principal/ head of the institution
This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OF
THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE
TO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”
under the guidance of Dr. V. VARADA CHARYULU, M.D. (Ayu) (Osm), Professor & HOD
and Dr. R V SHETTAR, M.D. (Ayu), in partial fulfillment of the requirement for the post
graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi
University of Health Sciences, Bangalore, Karnataka.
.
(Dr. G. B. Patil)Principal,
DGM Ayurvedic Medical College,Gadag
Date:Place:
(Dr. V. Varada charyulu)Professor & HOD
Dept. of KayachikitsaPGS&RC
Date:Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “EVALUATION OF THE
EFFICACY OF THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL
REFERENCE TO MALARIAL FEVER” is a bonafide and genuine research work carried out
by me under the guidance of Dr.V.Varada Charyulu M.D.(Ayu) and Dr. R.V.Shettar, M.D.
(Ayu), lecturer in Kayachikitsa, DGMAMC, PGS&RC, Gadag.
Date
Place
MANGALAVVA .B. PATIL
Copy right
Declaration by the candidate
I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or
electronic format for the academic / research purpose.
Date
Place
MANGALAVVA .B. PATIL
© Rajiv Gandhi University of Health Sciences, Karnataka
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu), Professor and
H.O.D., for his timely advises and encouragement in every step of my success.
I express my gratefulness to my co-guide Dr R. V. Shettar, M.D (Ayu) lecturer in
Kayachikitsa, for his time to time help and critical suggestions associated with expert guidance at the
completion of this dissertation.
I express my thankfulness to beloved principal Dr. G. B. Patil, Principal for his
encouragement as well as providing all necessary facilities for this research work.
I express my profound sense of acknowledgement to various departments H.O.D.s, teachers
and colleagues of sister concern departments along with the ministerial and sub staff of the D.G.M.
Ayurvedic Medical College, Gadag.
I express my sincere thanks to Dr. K. Shiva Rama Prasad, Dr. Shashidar. H. Doddamani, Dr.
Kuber Sankh, Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Santhosh Belavadi, Dr. Mulkipatil and Dr
Kona. I express my sincere thanks to Mr. Nandakumar for his help in statistical analysis of results. A
special thanks on this regard to Dr. Danappagoudar for his valuable support at the preparation of the
drug.
I express my deepest gratitude to my beloved parents, Sri B.H.Patil and smt G.B. Patil, and
my husband Sri Shivkumargouda S.Patil, who supported me all the time. I express my sincere thanks
to one and all of my relatives and well wishers Dr. D.M.Patil, Dr. Meenakshi, Dr. Shankargouda,
Dr. Chetan, Dr. Joshi. D.P, All my colleagues and Harun Kowshik, Smt Valli Shree for their co-
operation at all times.
At first my sincere thanks to the subjects who co-operated at my dissertation, with out of
them it would have been not a success.
Place:
Date:Dr. MANGALAVVA .B. PATIL
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
Abstract
Vishamajwara vis-à-vis Malaria or a disease resembling malaria has been noted
for more than 4,000 years. Vishamajwara characterised by visamarambha (irregular
onset). Dalhana consider bhutas (Keetanu – Parasites) responsible to produce
Vishamajwara. Cough may be a presenting feature of malaria with severe anaemia can
be a presenting feature of malaria.
In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other
jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the
different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara,
Triteeyak jwara, Chaturthak jwara and Chaturthak jwara.
In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and
Kirata Tikta. Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara,
Deepaka, Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and Amahara
Dravyas are used in the Bharangyadi Ghana Vati.
Present study registers 30 patients, out of 68 approached patients. The remaining
26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive
criteria were included in the study.
The observation of the jwramukta Lakshana shows that the effect of the
Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is admissible.All the
parameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance..
Evaluation of the efficacy of the BharangyadiGhana Vati in Vishamajwara with special
reference to malarial fever
Dr. MANGALAVVA .B. PATIL
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
Table of contents
Heading Page number
Chapter - 1 Introduction 1 to 6
Chapter –2 Objectives 7 to 8
Chapter –3 Review of literature 9 to 87
Chapter –4 Methodology 88 to 107
Chapter –5 Results 108 to 139
Chapter –6 Discussion 140 to 157
Chapter –7 Conclusion 158 to 163
Chapter –8 Summary 164 to 164
Bibliographic References I to X
Annex – Case sheet 1 to 6
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
List of figures
Sno Figures heading Page
1 Photograph of Parvateeya Mashaka 10
2 Geographical distribution of the Malaria 13
3 Postal Stamp released by Government of India on the occasion of
Malaria control
24
4 Life cycle schematic diagram 37
5 Sporogonic and Erythrocytic cycles of Malaria 38
6 Exogenous and Endogenous Phases of Malaria 39
7 Ingredients of Bharangyadi Ghana Vati 68
8 Laboratory diagnosis of malaria fever 98
9 Finished Product of Bharangyadi Ghana Vati 108
List of Flow charts
Sno Flow charts heading Page
1 Classification of aetiology of Vishamajwara 46
2 Schematic diagram of Vishamajwara Samprapti 59
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
List of graphs
Sno Graph heading Page1 Distribution of patients by Age 109
2 Distribution of patients by Age- gender 111
3 Distribution of patients by Gender 112
4 Distribution of patients by Religion 113
5 Distribution of patients by Occupation 115
6 Economic status distribution Vs Vishamajwara vis-à-vis Malaria 116
7 Distribution of patients by Economic status 117
8 Distribution of patients by Hygienic Condition 119
9 Distribution of patients by Diet 120
10 Distribution of patients by presenting complaints 121
11 Distribution of patients by Associated features 123
12 Distribution of patients by type of Jwara 124
13 Distribution of patients by Pranavaha sroto dusti Lakshana 125
14 Distribution of patients by Rasavaha sroto dusti Lakshana 126
15 Distribution of patients by Annavaha sroto dusti Lakshana 127
16 Distribution of patients by Swedavaha sroto dusti Lakshana 128
17 Distribution of patients by Nidana 130
18 Distribution of patients by Poorva Roopa 131
19 Distribution of patients by Jwaramukta Lakshana 132
20 Aniyamita Jwara (mean) in Vishamajwara 133
21 Graph the temperatures (mean) in Vishamajwara 135
22 Distribution of patients by Result in Vishamajwara 137
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
List of tablesSno Table Heading Page1 Showing the Dosha pradhanyata in Malaria 55
2 Duration and vega in different jwaras 58
3 Showing the Vishamajwara vishista Lakshana 60
4 Distribution of patients by Age 109
5 Distribution of patients by Age- gender 110
6 Distribution of patients by Gender 112
7 Distribution of patients by Religion 113
8 Distribution of patients by Occupation 114
9 Distribution of patients by Economic status 117
10 Distribution of patients by Hygienic Condition 118
11 Distribution of patients by Diet 119
12 Distribution of patients by presenting complaints 121
13 Distribution of patients by Associated features 122
14 Distribution of patients by type of Jwara 123
15 Distribution of patients by Pranavaha sroto dusti Lakshana 125
16 Distribution of patients by Rasavaha sroto dusti Lakshana 126
17 Distribution of patients by Annavaha sroto dusti Lakshana 127
18 Distribution of patients by Swedavaha sroto dusti Lakshana 128
19 Distribution of patients by Nidana 129
20 Distribution of patients by Poorva Roopa 130
21 Distribution of patients by Jwaramukta Lakshana 132
22 Evaluation of Subjective Parameters 133
23 Evaluation of objective Parameters 134
24 Showing the temperatures (mean) in Vishamajwara 135
25 Distribution of patients by Result in Vishamajwara 136
26 Statistical analysis of the clinical parameters at the end of treatment (21days)
137
27 Statistical analysis of the objective parameters at the end of treatment(21 days)
138
28 Statistical analysis of the clinical parameters at the end of follow-up (36days)
138
29 Describing the pharmacological properties of Bharangyadi Ghana Vati 145
30 Describing the Chemical constituents and Indications of individualcomponents of Bharangyadi Ghana Vati
146
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
Chapter –1
Introduction
“ osquito makes man Eunuch”, is popular dialogue of the film actor.
Fact is that the mosquito really conquers the eco-symphony of the earth and disturbed much
and more of human life. Now a day an average spending of human on mosquito repellents
are sufficient to maintain a family. Asian, African, etc, tropical countries are badly effected
by this small tiny untidy creature and Governments are fallen because of the same.
Vishamajwara, a most popular Ayurvedic term in turn of modern medical
terminology co-related to malarial fever, is a protozoan disease caused by genus
plasmodium and transmitted to man by certain species of infected female anopheles
mosquito. India's geographic position and climatic conditions are favourable for the
transmission of malaria. Frequently people living in the endemic areas are prone for this
infection. Out of 300-500 million clinical cases around 100 countries and one million deaths
due to malarial malady are noticed globally.
The 38th world health assembly in 1985 recommended that, malaria control should
be developed as an integral part of the national primary health care systems. 1-2-3
Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset
commitment), kriya (action production of symptoms) and kala (time of appearance) and
possesses anushanga (persistence for long periods) 4-5-6. As on today, the malarial parasite
has developed resistance to chloroquine compounds, which are used vividly for the past
three decades.
The emergence of multiple-drug resistant strains of malaria, which has accompanied
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
each new class of anti-malarial drugs, is one of most significant threat to the health of people
in tropical countries. While there is widespread agreement that a fresh approach to the
prevention and treatment of malaria is urgently needed, solutions have tended to focus on
the development of new classes of drugs. More recently, there has been an emphasis on
promoting combination therapy of existing drugs as a means of preventing resistance.
Historically, however, local communities in tropical regions have used local flora as
a means of preventing and treating malaria (Kirby, 1997). It can be argued that these
traditional medicines, based on the use of whole plants with multiple ingredients or of
complex mixtures of plant materials, constitute combination therapies that may well combat
the development of resistance to anti-malarial therapy.
Resistance, synergism and traditional medicines
Medical science is beginning to recognise aspects of synergy, complexity and
potentiation in malaria therapy. At the same time, little significance is as yet being given to
the obvious point that all of the major anti-malarial have been derived from plants, often
based on traditional knowledge about the effects of the plants against fever, or specifically,
malaria. The call to combine anti-malarials overlooks the fact that combination existed in
the traditional formulations before the process of extraction took place. In view of this, it
must be asked whether any pre-existing synergism, and hence challenge to the development
of resistance, may have been lost in the process of extraction, isolation and synthesis of new
molecules.
For instance, the artemisinin drugs (artesunate, artemehter, dihydroartemisinin) are
derived from artemisia annua, used in traditional Chinese medicine as an antipyretic. An
examination of traditional Chinese medical knowledge and practice would reveal that it was
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
usual for this plant to be used in combination with others in the treatment of fevers. In the
development of the new artemisinin drugs, not only has this been overlooked, but the
complex of alkaloids in the plant itself have been sacrificed for the purpose of isolation of a
so-called single active ingredient. Indeed, flavinoids in Artemisia annua, which are
structurally unrelated to the anti-malarial drug artemisinin, enhance the in vitro
antiplasmodial activity of artemisinin 7.
Elsewhere, synergism has been observed between the alkaloids of the anti-malarial
plant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-
parasitic activity than any of the six alkaloids isolated subsequently. In studies on anti-
malarial plants from Madagsacar, the alkaloids bisbenzylisoquinoline , novel pavine and
benzyl tetrahydroisoquinolines all were found to potentiate the anti-parasitic activity of
chloroquine in vitro and, in some case, in vivo. Preparations of these plants are currently
being tested as adjutants to chloroquine therapy in Madagascar (Kirby, 1997). In Uganda,
there is data from clinical case reports that a traditional Ugandan herbal remedy is effective
against malaria. (Bitawha et. al., 1997)
Utilisation of traditional medicine is widespread in developing countries and the
efficacious of many traditional treatments have been well documented, including in skin
disease, malaria and other disorders. Despite growing policy interest in traditional medicine,
and the seminal 1997 Dakar meetings on malaria recommending research into herbal anti-
malarial, there has been almost no research into the clinical effectiveness of herbal remedies
as they are used in real life.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
The research initiative for traditional anti-malarial methods (RITAM)
To redress this situation, a partnership was established in December 1999 between
the Global Initiative For Traditional Systems (GIFTS) of Health, the Tropical Disease
Research Programme of WHO and individual scientists, traditional health practitioners and
others to investigate evaluate and, where appropriate, develop traditional herbal medicines to
combat malaria. It is the Research Initiative for Traditional Anti-malarial Methods (RITAM)
Many people live in malarious regions, traditional herbal medicines may be the only
course of treatment available. Therefore, research into, promoting and increasing the
understanding of the nature of crude plant derived medicines are key research priorities.
Plants are usually identified for study on the basis of a traditional reputation for
effectiveness, usually for treating or preventing malaria and other fever related conditions.
In designing new treatments, drugs and public health programmes in developing
countries, it can be considered unscientific to cast aside traditional knowledge and wisdom
after cursory review, on the assumption that modern methods of analysis and explanation are
superior.
RITAM members have developed four specialist groups to implement a research
strategy designed to make a significant contribution to malaria control programmes:
1. Policy, advocacy and funding
2. Pre-clinical studies
3. Clinical development
4. Repellence and Vector Control 8
The Indian Systems of Medicine & Homoeopathy is popular in a large number of
States in the country. There are separate Directorates of ISM&H in 18 States. Ayurveda,
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
Homeopathy, Unani, Yoga & Naturopathy and Siddha systems together called as Indian
Systems of Medicine. These systems have become part of the culture and traditions of our
country 9.
Drug resistance to chloroquine in P. falciparum was reported in India for the first
time from Assam in 1973. Since then the foci of resistance have spread to many more states
all over India. The situation has further deteriorated in the recent past due to parasite
becoming resistant to other available drugs in addition to chloroquine. Sulphadoxine-
pyrimethamine, a second line drugs for P. falciparum is not effective for P. vivax malaria.
Quinine is still effective but as oral monotherapy it has limited role in mild malaria because
of 7-day regimen. Mefloquine and artemisinin have specific indications. Therefore, new
drugs and treatment strategies need to be developed as a priority.
Development of new drugs involves extensive pre clinical and toxicological studies
followed by well-planned clinical trials. At MRC, a number of new drugs have been
screened in clinical trials for evaluation of safety and efficacy. Based on these data, the
drugs have been registered with Drugs Controller General of India for commercial
marketing and also for use in national programme under
A y u s h - 6 4
Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extract
of bark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata
(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seed
pulp–3 parts).
The drug was patented by the Central Council of Ayurveda and Siddha and to
confirm the efficacy in well designed scientific trial, open prospective, non-crossover,
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
randomised clinical trial was conducted in P. vivax malaria patients at the Centre in
collaboration with NAMP 10. Results showed that with Ayush-64 cure rate on Day 28 was
48.9% at a dose of 1 g three times a day for 5–7 days as against 100% with chloroquine
1500 mg over three days 11.
Ayurvedic herbs have an important role in the treatment of malarial fever. Even the
chloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogas
have been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,
low-priced and has no proved adverse effects 12 against malarial fever.
Thus the present study has been under taken as “Evaluation of the efficacy of the
Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. A few
numbers of clinical trials have been conducted in different Ayurvedic institutes in India,
regarding Vishamajwara. These are as follows -
Year / scholarname
Title Institute
1980 M.V. Chari Clinical and experimental study of medicinalplants in the treatment of malaria.
Gujrat Ayurvedauniversity, jamnagar.
1981 M.V. Chari A double blind clinical trial with ayush. 64 anAyurvedic drug in P. vivax malaria.
Do
1981 K.D. Sharma Clinical trial of ayush 64 in case of malaria C.C.R.A.&S. Newdelhi
1982 Kanaka rai dal A study of management of Vishamajwara G.A.U. Jamnagar
1982 Jagabandhudas
Clinical study of panchatikta ghaanabati onVishamajwara
G.A.M. Puri. (orissa)
1985 Kishore panda “therapeutic evaluation of Kiratatikta ghanabation Vishamajwara”
Do
1994 B. Baliarsingh “clinical trial on ajajiguda yoga inVishamajwara vis-à-vis malaria
Do
1991 Deshmukh 54 Anaetiopathological study on the managementof vishama jwara with bnuranggadi kwata
Kerala universitytrivendrum
1983 mahantdhaneshwar
Ushna jwara GovernmentAyurvedic collegehyderabad
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 7
Chapter -2
Objectivesresent study bears the following objectives -
1. To evaluate the efficacy of the Bharangyadi Ghanavati in
Vishamajwara (Malarial fever)
2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in
Vishamajwara (Malarial fever)
3. To evaluate the anti-malarial properties of Bharangyadi Ghanavati in
Vishamajwara (Malarial fever)
Detailed discussion of above mentioned objectives are as under –
1. To evaluate the efficacy of the Bharangyadi Ghana Vati in Vishamajwara (Malarial
fever)
Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to
pacify the Jwara, especially Vishamajwara. Ayurveda offers more importance to that of the
rise of temperature, which is a protective and also pathological identity of the any ailment
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 8
present in the body. The jwara called as fever may not be a big problem from the
contemporary but as par Ayurveda it is a primary symptom and a disease also some times a
complication. This particular condition needs through emphasis and management. In this
process a laboratory identified malarial parasite expression as fever i.e. Vishamajwara is
extensively studied and the efficacy of the Bharangyadi Ghana Vati in Vishamajwara is
emphasized.
2. To evaluate the antipyretic properties of Bharangyadi Ghana Vati in Vishamajwara
(Malarial fever)
The main aim of the study is to see the antipyretic effect of the selected drug,
Bharangyadi Ghana Vati in Vishamajwara. The fever is rise in body temperature. This
primary symptom which give the inconvenience is to be forbidden at the earliest to provide
comfort to the patient. Thus the antipyretic effect is specially studies under the guide lines of
Ayurveda in comparison with that of the contemporary medicine.
3. To evaluate the anti-malarial properties of Bharangyadi Ghana Vati in
Vishamajwara (Malarial fever)
The chosen drug Bharangyadi Ghana Vati is assumed as a best medicament at the
relieving the jwara i.e. fever by all means. Its antipyretic effects also a sure thing. But many
a times a doubt is raised is whether any Ayurvedic drug acts as anti-microbial, anti-viral or
anti-malarial? To achieve the answer for the above raised question and to strengthen the
Ayurvedic glory to establish Ayurvedic scientific grounds the evaluation of the anti-malarial
properties were under taken as one of the objectives of the study.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 9
Chapter -3
Literary review
yurveda is a perfect science of life and consists of a body of most
remarkable knowledge on the internal mechanism of human health and longevity, on
medicinal herbs and therapeutic roots, on the efficacious treatment of human ills by
eradicating from the human system the very sources of their causation. This great medical
science and humanity’s most ancient and finest preventive school of practical medicine,
which has been practised in India, century after century for over four thousand years, by
expert Vaidyas. To those who claim to have a knowledge of this ancient medicinal science
enriched by the happy results of the researches and advancement made by eminent Vaidyas
in succeeding ages, its superior merits over the Western systems of medicine, and its
immense value, do not need any delineation. Such names of the great pioneers who added to
the development of the science of Ayurveda, as Vagbhata, Madhava, Jivaka and Bhava
Mishra of Banaras are well known.
Ayurveda has a significant name. It is the knowledge of the science, which ensures
health and longevity. It is in no way inferior to other systems. The Ayurvedic doctors had
very great influence in the field of medicine. Charaka, Sushruta, Vagbhata, Madhava Nidhan
are the well-known scientific books on Indian Medicine. This glorious system of medicine
fell into disease owing to lack of State support and facilities for proper study, training and
research.
Susruta, while classifying different insects expands the mosquitoes as five varieties.
They are Samudra Mashaka, Parimandala Mashaka, Hasti Mashaka, Krishna Mashaka and
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 10
Parvateeya Mashaka. Out of these the last Parvateeya Mashaka are more toxic and fatal in
nature. The symptoms of this type resemble with the malarial fever of present discussion 13.
Figure –1Photograph of Parvateeya Mashaka
Malaria is a protozoal disease transmitted by the Anopheles mosquito, caused by
minute parasitic protozoa of the genus Plasmodium, which infect human and insect hosts
alternatively. It is a very old disease and prehistoric man is thought to have suffered from
malaria. It probably originated in Africa and accompanied human migration to the
Mediterranean shores, India and South East Asia. In the past it used to be common in the
marshy areas around Rome and the name is derived from the Italian, (mal-aria) or "bad air";
it was also known as Roman fever. Today some 500 million people in Africa, India, South
East Asia and South America are exposed to endemic malaria and it is estimated to cause
two and a half million deaths annually, one million of which are children.
Fishermen and traders, long before British colonisation, probably introduced the
disease into northern Australia and in the past malaria were not uncommon in the northern
parts of the country. In Western Australia an explosive outbreak of falciparum malaria
occurred at Fitzroy Crossing in 1934 which at first was mistaken for influenza and resulted
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 11
in 165 deaths. WHO declared Australia free of malaria in 1981, however since that time 9
patients have contracted locally acquired malaria.
The so called "airport malaria" has become a problem in recent years. A publican
working in an establishment close to London's Heathrow Airport became acutely ill and was
found to be suffering from falciparum malaria, he had never been out of the country. A lady
driving her car past the same airport became ill with malaria although she too had never
been out of the country. Four workers unloading a cargo plane at Amsterdam airport became
infected with malaria. It is assumed that infected mosquitoes were carried on planes from
Africa and released at the destination airport.
While it was recognised that the Anopheles mosquito played a key role in the
transmission of the disease it was not until 1948 that all the stages in its life cycle were
identified. The parasite undergoes a development stage in the mosquito and the female of the
species requires a blood meal to mature her eggs. She bites a human and injects material
from her salivary glands, which contains primitive malarial parasites called sporozoites,
before feeding. These sporozoites circulate in the blood for a short time and then settle in the
liver where they enter the parenchymal cells and multiply; this stage is known as pre-
erythrocytic schizogony. After about 12 days there may be many thousands of young
parasites known as merozoites in one liver cell the cell ruptures and the free merozoites
enter red blood cells. The blood stages of the four species of malaria can be seen in the
section on diagnosis. In the case of P. vivax, and P.ovale the liver cycle continues and
requires a course of primaquine to eliminate it. P.falciparum on the other hand does not have
a continuing liver cycle.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 12
In the red blood cells the parasites develop into two forms, a sexual and an asexual
cycle. The sexual cycle produces male and female gametocytes, which circulate in the blood
and are taken up by a female mosquito when taking a blood meal. The male and female
gametocytes fuse in the mosquito's stomach and form oöcysts in the wall of the stomach.
These oöcysts develop over a period of days and contain large numbers of sporozoites,
which move to the salivary glands and are ready to be injected into man when the mosquito
next takes a meal. In the asexual cycle the developing parasites form schizonts in the red
blood cells which contain many merozoites, the infected red cells rupture and release a batch
of young parasites, merozoites, which invade new red cells. In P.vivax, P.ovale and probably
P.malariae, all stages of development subsequent to the liver cycle can be observed in the
peripheral blood. However, in the case of P.falciparum only ring forms and gametocytes are
usually present in the peripheral blood. Developing forms appear to stick in the blood
vessels of the large organs such as the brain and restrict the blood flow with serious
consequences.
While all four species have a haemolytic component i.e. when a new brood of
parasites break out of the red blood cell this is usually of little consequence. The exception is
falciparum malaria where the parasites multiply very rapidly and may occupy 30% or more
of the red blood cells causing a very significant level of haemolysis. One reason for this is
that P.falciparum invades red cells of all ages whereas P.vivax and P.ovale prefer younger
red cells, while P.malariae seeks mature red cells.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 13
Figure –2Geographical distribution of the Malaria
History of malaria
Malaria or a disease resembling malaria has been noted for more than 4,000 years.
From the Italian for "bad air," malaria has probably influenced to a great extent human
populations and human history.
Ancient History (2700 BCE-340 CE)
The symptoms of malaria were described in ancient Chinese medical writings. In
2700 BC, several characteristic symptoms of what would later be named malaria were
described in the Nei Ching, (The Canon of Medicine. Nei Ching was edited by Emperor
Huang Ti). Malaria became widely recognised in Greece by the 4th century BCE, and it was
responsible for the decline of many of the city-state populations. Hippocrates noted the
principal symptoms. By the age of Pericles, there were extensive references to malaria in the
literature and depopulation of rural areas was recorded. In the Susruta, a Sanskrit medical
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 14
treatise, the symptoms of malarial fever were described and attributed to the bites of certain
insects. A number of Roman writers attributed malarial diseases to the swamps.
In China, during the second century BCE, the Qinghao plant (Artemisia annua L)
was described in the medical treatise, 52 Remedies, found in the Mawangdui Tomb. In 340
CE, the anti-fever properties of Qinghao were first described by Ge Hong of the East Yin
Dynasty. Chinese scientists isolated the active ingredient of Qinghao in 1971. Known as
artemisinin, it is today a very potent and effective anti-malarial drug, especially in
combination with other medicines.
Quinine (Early 17th Century)
Following their arrival in the New World, the Spanish learned of a medicine used for
the treatment of fevers. Spanish Jesuit missionaries in South America learned of a medicinal
bark from indigenous Indian tribes. With this bark, the Countess of Chinchón, the wife of
the Viceroy of Peru, was cured of her fever. The bark from the tree was then called Peruvian
bark and the tree was named Cinchona after the countess. The medicine from the bark is
now known as the antimalarial, quinine. Along with artemisinin, quinine is one of the most
effective antimalarial drugs available today.
Discovery of the Malaria Parasite (1880)
Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,
Algeria, was the first to notice parasites in the blood of a patient suffering from malaria.
This occurred on the 6th of November 1880. For his discovery, Laveran was awarded the
Nobel Prize in 1907.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 15
Differentiation of Species of Malaria (1886)
Camillo Golgi, an Italian neurophysiologist, established that there were at least two
forms of the disease, one with tertian periodicity (fever every other day) and one with
quartan periodicity (fever every third day). He also observed that the forms produced
differing numbers of merozoites (new parasites) upon maturity and that fever coincided with
the rupture and release of merozoites into the blood stream. He was awarded a Nobel Prize
in Medicine for his discoveries in neurophysiology in 1906.
Naming of Human Malaria Parasites (1890,1897)
The Italian investigators Giovanni Batista Grassi and Raimondo Filetti first
introduced the names Plasmodium vivax and P. malariae for two of the malaria parasites
that affect humans in 1890. Laveran had believed that there was only one species, Oscillaria
malariae. An American, William H. Welch, reviewed the subject and, in 1897, he named the
malignant tertian malaria parasite, P. falciparum. There were many arguments against the
use of this name, however, the use was so extensive in the literature that a change back to
the name given by Laveran was no longer thought possible. In 1922, John William Watson
Stephens described the fourth human malaria parasite, P. ovale.
Discovery That Mosquitoes Transmit Malaria Parasites (1897-1898)
On August 20th, 1897, Ronald Ross, a British officer in the Indian Medical Service,
was the first to demonstrate that malaria parasites could be transmitted from infected
patients to mosquitoes. In further work with bird malaria, Ross showed that mosquitoes
could transmit malaria parasites from bird to bird. This necessitated a sporogonic cycle (the
time interval during which the parasite developed in the mosquito). Thus, the problem of
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 16
malaria transmission was solved. For his discovery, Ross was awarded the Nobel Prize in
1902.
Discovery of the Transmission of the Human Malaria Parasites (1898-1899)
Led by Giovanni Batista Grassi, a team of Italian investigators, which included
Amico Bignami and Giuseppe Bastianelli, collected Anopheles claviger mosquitoes and fed
them on malarial patients. The complete sporogonic cycle of Plasmodium falciparum, P.
vivax, and P. malariae was demonstrated. In 1899, mosquitoes infected by feeding on a
patient in Rome were sent to London where they fed on two volunteers, both of whom
developed benign tertian malaria.
The Panama Canal (1905-1910)
The construction of the Panama Canal was made possible only after yellow fever and
malaria were controlled in the area. These two diseases were a major cause of death and
disease among workers in the area. In 1906, there were over 26,000 employees working on
the Canal. Of these, over 21,000 were hospitalised for malaria at some time during their
work. By 1912, there were over 50,000 employees, and the number of hospitalised workers
had decreased to approximately 5,600. Through the leadership and efforts of William
Crawford Gorgas, Joseph Augustin Le Prince, and Samuel Taylor Darling, yellow fever was
eliminated and malaria incidence markedly reduced through an integrated program of insect
and malaria control.
The U.S. Public Health Service (USPHS) and Malaria (1914-1942)
During the U.S. military occupation of Cuba and the construction of the Panama
Canal at the turn of the 20th century, U.S. officials made great strides in the control of
malaria and yellow fever. In 1914 Henry Rose Carter and Rudolph H. von Ezdorf of the
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 17
USPHS requested and received funds from the U.S. Congress to control malaria in the
United States. Various activities to investigate and combat malaria in the United States
followed from this initial request and reduced the number of malaria cases in the United
States. The USPHS established malaria control activities around military bases in the
malarious regions of the southern United States to allow soldiers to train year round.
The U.S. Tennessee Valley Authority (TVA) - The Integration of Malaria Control with
Economic Development (1933)
U.S. President Franklin D. Roosevelt signed a bill that created the TVA on May 18,
1933. The law gave the federal government a centralised body to control the Tennessee
river's potential for hydroelectric power and improve the land and waterways for
development of the region. An organised and effective malaria control program stemmed
from this new authority in the Tennessee River valley. Malaria affected 30 percent of the
population in the region when the TVA was incorporated in 1933. The Public Health Service
played a vital role in the research and control operations and 1947 essentially eliminated the
disease. Controlling water levels and insecticide applications reduced Mosquito breeding
sites.
Chloroquine (1934, 1946)
A German, Hans Andersag discovered chloroquine, in 1934 at Bayer I.G.
Farbenindustrie A.G. laboratories in Eberfeld, Germany. He named his compound resochin.
Through a series of lapses and confusion brought about during the war, chloroquine was
finally recognised and established as an effective and safe anti-malarial in 1946 by British
and U.S. scientists.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 18
Dichloro-diphenyl-trichloroethane (DDT) (1939)
A German chemistry student, Othmer Zeidler, synthesized DDT in 1874, for his
thesis. Paul Müller in Switzerland did not discover the insecticidal property of DDT until
1939. Various militaries in WWII utilised the new insecticide initially for louse-borne
typhus. DDT was used for malaria control at the end of WWII after it had proven effective
against malaria-carrying mosquitoes by British, Italian, and American scientists. Müller won
the Nobel Prize for Medicine in 1948.
Malaria Control in War Areas (MCWA) (1942-1945)
MCWA was established to control malaria around military training bases in the
southern United States and its territories, where malaria was still problematic. Many of the
bases were established in areas where mosquitoes were abundant. MCWA aimed to prevent
reintroduction of malaria into the civilian population by mosquitoes that would have fed on
malaria-infected soldiers, in training or returning from endemic areas. During these
activities, MCWA also trained state and local health department officials in malaria control
techniques and strategies.
CDC and Malaria (1946-present)
CDC's mission to combat malaria began at its inception on July 1, 1946. The
Communicable Disease Centre, as CDC was first known, stemmed from MCWA. Thus,
much of the early work done by CDC was concentrated on the control and eradication of
malaria in the United States. With the successful reduction of malaria in the United States,
the CDC switched its malaria focus from eradication efforts to prevention, surveillance, and
technical support both domestically and internationally. This is still the focus of CDC's
Malaria Branch today.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 19
Eradication of Malaria in the United States (1947-1951)
The National Malaria Eradication Program, a co-operative undertaking by state and
local health agencies of 13 Southeastern states and the CDC, originally proposed by Louis
Laval Williams, commenced operations on July 1, 1947. By the end of 1949, over 4,650,000
house-spray applications had been made. In 1947, 15,000 malaria cases were reported. By
1950, only 2,000 cases were reported. By 1951, malaria was considered eradicated from the
United States.
Eradication Efforts Worldwide: Success and Failure (1955-1978)
With the success of DDT, the advent of less toxic, more effective synthetic anti-
malarials, and the enthusiastic and urgent belief that time and money were of the essence,
the World Health Organisation (WHO) submitted at the World Health Assembly in 1955 an
ambitious proposal for the eradication of malaria world wide. Eradication efforts began and
focused on house spraying with residual insecticides, anti-malarial drug treatment, and
surveillance, and would be carried out in 4 successive steps: preparation, attack,
consolidation, and maintenance. Successes included eradication in nations with temperate
climates and seasonal malaria transmission. Some countries such as India and Sri Lanka had
sharp reductions in the number of cases, followed by increases to substantial levels after
efforts ceased. Other nations had negligible progress (such as Indonesia, Afghanistan, Haiti,
and Nicaragua). Some nations were excluded completely from the eradication campaign
(most of sub-Saharan Africa). The emergence of drug resistance, widespread resistance to
available insecticides, wars and massive population movements, difficulties in obtaining
sustained funding from donor countries and lack of community participation made the long-
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 20
term maintenance of the effort untenable. Completion of the eradication campaign was
eventually abandoned to one of control.
Fall of Roman Empire because of Malaria
Could ancient children's burial ground contain clues about how one of the world's
greatest empires came to an end? Andrew Thompson explores the theory that malaria was
the silent killer responsible for the fall of Rome.
A British scientist proved conclusively that the most dangerous type of malaria was a
killer in imperial Rome. The scientist relied on the latest DNA techniques that are
revolutionising the understanding of the role of disease in ancient times. The malarial DNA
from a Roman site, dating from around AD 450, is the oldest definite evidence of malaria in
history. The finding of malaria was a remarkable and complicated piece of detective work,
which spanned the last ten years.
At its height, the Roman Empire stretched from Scotland in the Northern
Hemisphere to the deserts of Africa in the south. The empire lasted for over 500 years,
although its eastern part, the Byzantine Empire, lasted for several more centuries. When the
empire collapsed, hordes of barbarian armies, including the infamous Vandal pirates invaded
Italy throughout the fifth century AD. Rome was transformed from a bustling city of
millions to a provincial town of a few thousand, surrounded by swamps. The anarchy of the
Dark Ages had begun.
Although there has been no shortage of theories, it has never been clear why Rome
became so vulnerable to foreign invaders at this time. Political instability, the collapse of
food supplies to Rome, and even the infamous lead in the water supplies have all been
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 21
implicated. Historians have generally agreed that Rome's downfall was due to a combination
of many factors 14.
Past and present of Malaria
Mosquitoes probably originated in Africa (along with mankind), and fossils of
mosquitoes up to 30 million years old, show that the malaria vector, the malaria mosquito,
was present well before the earliest history. Hippocrates, a physician born in ancient Greece,
today regarded as the "Father of Medicine", was the first to describe the manifestations of
the disease, and relate them to the time of year and to where the patients lived. Before this,
the supernatural was blamed. The association with stagnant waters (breeding grounds for the
Anopheles mosquito) led the Romans to begin drainage programs, the first intervention
against malaria.
The first recorded treatment dates back to 1600, when the bitter bark of the Cinchona
tree in Peru was used by the native Peruvian Indians. By 1649, the bark was available in
England, as "Jesuits powder," so that those suffering from "agues" might benefit from the
chemical substance quinine, which it contained. Not until 1889 was the protozoal (single
celled parasite) cause of malaria discovered by Alphonse Laveran working in Algeria, and
only in 1897 was the Anopheles mosquito demonstrated to be the vector for the disease by
Ronald Ross 15.
It was the army surgeon, Ronald Ross, who undertook the experimental testing of the
mosquito-theory, proposed by both Laveran and the investigator, Patrick Manson. The
solution came from India, while Ross was commissioned in the Indian Medical Service, and
in the late 1890s the mosquito hypothesis could be established.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 22
Malaria Control Operation
The discovery of the insecticide DDT in 1942, by Paul Müller the Nobel Prize
Laureate in Physiology or Medicine, 1948, and its first use in Italy in 1944, made the idea of
global eradication of malaria seem possible. Subsequently, widespread systematic control
measures such as spraying with DDT, coating marshes with paraffin (to kill Anopheles
mosquito larvae), draining stagnant water, and the widespread use of nets and cheap,
effective drugs such as chloroquine were implemented - with impressive results. Despite
initial success, there was a complete failure to eradicate malaria in many countries due to a
number of factors. Although technical difficulties such as mosquito and parasite drug
resistance have played a part, the main failure to reduce the disease is probably due to social
and political factors preventing efficient application of control measures.
Despite the setbacks, up until 1969, when the global eradication policy was finally
abandoned, the following European countries had managed to completely eradicate endemic
malaria by interrupting transmission: Hungary, Bulgaria, Romania, Yugoslavia, Spain,
Poland, Italy, Netherlands and Portugal.
From the early 1970s, the malaria situation has slowly and progressively deteriorated
and reduced control measures between 1972 and 1976, due to financial constraints, led to a
massive 2-3 fold increases in cases globally. Spraying never truly eradicated the mosquitoes
anywhere, and the reduction in the more persistent P. vivax infections were much less than
for P. falciparum - though the latter returned in much greater strength as control measures
waned. The growing interchange of populations between countries where malaria is
prevalent and malaria free countries is responsible for the continuous increase in the number
of imported malaria cases in European countries, and causes serious concern because of
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 23
possible epidemic focal resurgence in receptive areas such as the Mediterranean. Since
1976, several new pockets of malaria transmission have evolved, and a WHO 1980 report
recommended that countries, which had become non-malarious should maintain at least one
malaria vigilance unit.
The World Health Organization (WHO) warned about increased risk of vector-
borne diseases such as malaria and dengue fever across tsunami-affected areas in Southeast
Asia. Nearly four weeks after the disaster struck the region on 26 December, the
organization is strengthening its disease surveillance, as stagnant water conditions create
conditions for mosquito vectors to multiply to sufficient levels to potentially cause severe
public health problems.
Most affected countries in the region are endemic for dengue fever and malaria
except the Maldives, which has no malaria cases but does have dengue cases. With the onset
of the rainy season, particularly in Indonesia and Sri Lanka, a rise in the cases can be
expected at this time of the year 16.
According to the World Health Organisation, the following statistics reveal the
spread of malaria in the world. Africa: Ninety-seven million cases of malaria a year. The
tropical region’s leading killer of children claims five percent under five. Latin America:
One million cases a year. The settlement of people in mosquito-infested rain forests in Brazil
has exposed millions to the disease. Asia: Nine million cases a year. New, hard-to-treat
strains are rapidly gaining ground 17.
Malaria control – philately
It is fantasising for a researcher to observe in various angles, the topic chosen. The
Malaria, a disease caused by an insect placed it self in the philately because of its
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 24
importance. No other country other than India releases a stamp on a Mosquito. The Malaria
eradication programme is to be recollected and on the occasion 4 Annas (25 Paise) stamp is
released by the Indian Postal Department is shown below.
Figure – 3Postal Stamp released by Government of India on the occasion of Malaria control
Epidemiology
Malaria is primarily a disease of the tropics and subtropics and is widespread in hot
humid regions of Africa, Asia and South and Central America. The disease was also
common in many temperate areas including the USA, Europe and northern Eurasia and
Asia, but has been eradicated. In many areas, which previously had malaria under control,
are experiencing resurgence 18. The four human malarial species exhibit an overlapping
geographical distribution (Box). P. vivax and P. falciparum are the most commonly
encountered species with P. vivax being the most wisespread geographically. Mixed
infections are common in endemic areas. "Everything about malaria is so moulded by local
conditions that it becomes a thousand epidemiological puzzles." Hackett (1937)
The above quote emphasises the complexity of malaria and the many facets the
disease exhibits. Different communities will experience different malaria and consequently
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 25
different control and treatment strategies may be necessary. The intricate interactions
between host, parasite, and vector are the major factors in this epidemiological complexity.
The fundamental problem of developing drugs for tropical diseases are too expensive
for widespread use of poor countries. Ayurveda may contribute a lot for the utilisation of our
own resources. The Ayurvedic method of treatment in Vishamajwara has been claimed
effective either in single/compound drug therapy. Sudarsana Churna has been used for the
treatment of Vishamajwara since Sarangadhara period (1400 A.D). Even the contemporary
Ayurvedic practices the same is considered as very effective and potent treatment modality
in Vishamajwara of “all types”. It also claimed to be effective any kind of jwara including
malarial fever as diagnosed by modern clinical-parasitology.
Vishamajwara, literally meaning irregular fever, is very vast. It may be remittent
type or intermittent type as keetanu (micro-organisms) have been incriminated as one of the
causes of Vishamajwara. The major cardinal symptoms of Vishamajwara i.e. Fever with
chill and rigor have been observed to be present in other disease including Malaria, which is
a protozoal disease caused by plasmodia group of organism and transmitted to man
primarily by certain species of infected female anopheles mosquitoes 19.
Jwara (fever) and Vishamajwara (Malaria)
Ayurveda mentioned jwara as the synonym of the disease or a febrile condition.
“From among all disorders fever deserves to be described fist, it being the foremost of all
somatic diseases”. Charaka mentioned jwara afflicts body, mind and sense organs, regulates
the well being of life. Chakrapani described jwara as “jwarayati santapayati” i.e. disease
associated with burning manifestation is known as jwara 20-21.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 26
The disease Vishamajwara is included under the jwara roga in Ayurveda. Jwara is a
broad term, which has versatile meaning. If we analyse the etymological derivation of the
term we see that the word jwara is derived from the “jr” or “jya”. The jr. indicates vayohani
or loss of life span. It indicates the state of cellular destruction produces more temperature.
Vishamajwara characterised by visamarambha (irregular onset) 22 visama kriya
(alternative feeling of hot and cold) and visamakala (irregular duration of sufferings) 23 of
jwara. Susruta believed this to be caused by agantuka Karana or parahetu (external factor) 24.
This parahetu is more cleared by commentator Dalhana as bhutabhisanga. Bhutabhisanga 25
can be correlated with parasitic infection as discussed in modern medicine.
History and background of Vishamajwara
VAIDAIC PERIOD:
Jwara is the term originated by the anger of Rudra. Rudra is known as god of
destruction in Hindu mythology. Jwara is the king of all diseases and known by different
terms in various animals also i.e. Pakala for the jwara of elephants and abhitapan for horses’
etc. Vishamajwara is the varieties of jwara, which can be identified by its peculiarity of
visamata (irregularity) 26.
The description of Vishamajwara was known from ancient era. In “UPANISHAD”
(400B.C) visamajwara is described as “TAKMAN”. It is described that the jwara having
dahana and shosana properties, which attacks like fire (Agni) and they’re by the patient runs
like a mad. For it’s relief chanting of mantras has been described to pray God 27.
Atharva Veda has also described Vishamajwara causes that in the body like Agni (fire)
patients feels very much uneasiness and sometime comes in the state of pralapa (delirium)
and die. The attack of triteeyaka and santatajwara follows in sarat (autumn), varsa (rainy
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 27
season) and grishma kala (summer season) or in the state of sheeta and ruksha. Atharva
Veda described the following types of Vishamajwara 28. These are -
1. Triteeyaka
2. Chaturthaka
3. Satataka
4. Sharada
5. Grishmika
6. Varsakalika
Atharva-Veda is also described that takman is a periodic fever manifested with rigor,
trembling and pain particularly in head. It is accompanied by debility and cough and ends in
pallor or yellow-ness. It is endemic in particular places like Manjavan, Mahavrsa, Gandhara,
Anga and Magadha 29.
It is a clear picture of Vishamajwara of malarial origin. Sayana calls it sitajwara.,
sitajanka (chill fever) 30 and kricchra jivanakrit (making life troubled). Whitney translates it
as ‘fever’31.
Synonyms in Vedas
The synonyms of jwara are tapah, shushmi, Shoka, abhishoka, rudraha, papma,
amarthya vigadh, vyangah, sheersha, parbheta and sochi etc. mentioned in the Veda are said
to be developed due to rudrakopa 32.
Samhita & Sangraha kala
Wide description of Vishamajwara is found in Samhita granthas like, Charaka,
sushrut, bhela, harita, kashyapa, Madhava, sarangadhara, bhavaprakash, yogaratnaka etc.
Kashyapa considered that in the Vishamajwara specific properties of jwara are found in a
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 28
irregularity manner. He enumerated the Vishamajwara as follows santataka, satataka,
anyeduska, triteeyaka and chaturthaka considering the days of its onset. According to
Kashyapa the aetiology lies as - if one takes exercise, heavy meal, unsuitable diet, excess
drinking of water or milk, blackgram preparation, recent curd, paste of tila, village animal
flesh, virudhahara (incompatible food), day sleeping and takes much food before the
digestion during the period of jwara temperature goes on rising and attains the stage of
Vishamajwara. He also described not to take Kashaya during the Amavastha or
Tarunavastha of jwara etc. which may leads to Vishamajwara 33. Bhaluki considered that the
jwara that comes with cold or hot stage with temperature rise or low is uncertain in
Vishamajwara 34.
Charaka described that all the Vishamajwara are tridoshaja 35 in origin. Susruta
considered that the Vishamajwara occurs due to Tridosha but Vata is the dominant Dosha.
He considered the Agantuka Karana (external cause) of which bhutabhishanga constitute
one of the variety in the main aetiology for Vishamajwara 36.
Vagbhata defined Vishamajwara, as the jwara is irregular in respect to its onset,
suffering and symptoms. The mandagni during adanakala is one of the important causes of
Vishamajwara. He also advocated if an emaciated patient who takes irregular diet during
convalescent period in spite of residual of small quantity of Dosha may causes
Vishamajwara 37.
According to Hareeta 38 the Vishamajwara is five types such as vataja, ekaikajwara,
dwahieka jwara, triahika jwara, chaturthakjwara. Chakrapani opinions, the poisonous insects
may be considered under the word bhuta. Dalhana consider bhutas responsible to produce
Vishamajwara. Madhavkara 39 views as bhuta plays an important role for Vishamajwara too.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 29
In Amarkosh the bhuta means keetanu. Jejjata considered Vishamajwara as
tridoshaja in origin. Most of the authors considered five types of Vishamajwara.
Bhavamishra and Madhavakara have included pralepaka jwara also in the group of
Vishamajwara.
Clinical Features of Malaria
Fever is the commonest reason for hospital attendance in rural India. In recent past,
Malaria was the main reason for fever. Even today, probably malaria may rank first.
Outbreaks of fever are regularly reported from health workers and health institutions. Now-
a-days after malaria, dengue fever has become important cause of fever outbreaks 40.
Malaria is a febrile illness characterised by fever and related symptoms. However it
is very important to remember that malaria is not a simple disease of fever, chills and rigors.
In fact, in a malarious area, it can present with such varied and dramatic manifestations that
malaria may have to be considered as a differential diagnosis for almost all the clinical
problems! Malaria is a great imitator and trickster, particularly in areas where it is endemic.
All the clinical features of malaria are caused by the erythrocytic schizogony in the
blood. The growing parasite progressively consumes and degrades intracellular proteins,
principally haemoglobin, resulting in formation of the 'malarial pigment' and hemolysis of
the infected red cell. This also alters the transport properties of the red cell membrane, and
the red cell becomes more spherical and less deformable. The rupture of red blood cells by
merozoites releases certain factors and toxins (such as red cell membrane lipid, glycosyl
phosphatidyl inositol anchor of a parasite membrane protein), which could directly induce
the release of cytokines such as TNF and interleukin-1 from macrophages, resulting in chills
and high grade fever. This occurs once in 48 hours, corresponding to the erythrocytic cycle.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 30
In the initial stages of the illness, this classical pattern may not be seen because there could
be multiple groups (broods) of the parasite developing at different times, and as the disease
progresses, these broods synchronise and the classical pattern of alternate day fever is
established. It has been observed that in primary attack of malaria, the symptoms may
appear with lesser degree of parasitemia or even with sub-microscopic parasitemia.
However, in subsequent attacks and relapses, a much higher degree of parasitemia is needed
for onset of symptoms. Further, there may be great individual variations with regard to the
degree of parasitemia required to induce the symptoms.
The first symptoms of malaria after the pre-patent period (period between
inoculation and symptoms, the time when the sporozoites undergo schizogony in the liver)
are called the primary attack. It is usually atypical and may resemble any febrile illness. As
the disease gets established, the patient starts getting relapse of symptoms at regular
intervals of 48-72 hours. The primary attack may spontaneously abort in some patients and
the patient may suffer from relapses of the clinical illness periodically after 8-10 days owing
to the persisting blood forms of the parasite. These are called as short term relapses
(recrudescences). Some patients will get long term relapses after a gap of 20-60 days or
more and these are due to the reactivation of the hypnozoites in the liver in case of vivax and
ovale malaria. In falciparum and malariae infections, recrudescences can occur due to
persistent infection in the blood.
Atypical features
In an endemic area, malaria often presents with atypical manifestations.
Atypical features are more common in the following situations:
• Falciparum malaria
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 31
• Early infection
• Patients at extremes of age
• Patients who are immune-compromised (extremes of age, malnourished, AIDS,
tuberculosis, cancers, on immunosuppressive therapy etc.)
• Patients on chemoprophylaxis for malaria
• Patients who have had recurrent attacks of malaria
• Patients with end stage organ failure
• Last but not the least, pregnancy.
Atypical fever:
In an endemic area, it is rather unusual to find cases with typical fever pattern. Some
patients may not have fever at all and may present with other symptoms listed below. Many
present with fever of various patterns - low grade to high grade, with or without chills,
intermittent to continuous, or even as cases of prolonged fever. In the initial stages of the
illness, fever may be quotidian, with more than one spike per day and this is due to the
development of multiple broods of the parasite. As the disease progresses, these broods get
synchronised and the fever tends to be more uniform. However in cases of P. falciparum
malaria and mixed infections, this pattern of multiple spikes may continue.
Headache:
Headache may be a presenting feature of malaria, with or without fever. It can be
unilateral or bilateral. Some times the headache could be so intense that it may mimic intra-
cranial infections or intra-cranial space occupying lesions. It may also mimic migraine,
sinusitis etc. Presence of projectile vomiting, papilloedema, neck stiffness and focal
neurological signs would suggest other possibilities.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 32
Body ache, backache and joint pains:
These symptoms are fairly common in malaria. These can occur even during the
prodromal period and at that stage these are generally ignored and diagnosis of malaria is
impossible owing to lack of peripheral parasitemia. They are also common accompaniments
of the malaria paroxysm. Sometimes, malaria may present only with these symptoms,
particularly in cases of recurrent malaria.
Dizziness, vertigo:
Some patients may present with dizziness or vertigo, with or without fever. They
may also have associated vomiting and/or diarrhoea. This may mimic labyrinthitis,
Menniere's disease, vertebro-basilar insufficiency etc. Rarely patients may present with
swaying and cerebellar signs. Drugs like chloroquine, quinine, mefloquine and halofantrine
can also cause dizziness, vertigo, and tinnitus.
Altered behaviour, acute psychosis:
Patients may present with altered behaviour, mood changes, hallucinosis or even
acute psychosis, with or without fever. Malaria may be detected accidentally in such cases
and they improve completely with anti malarial therapy. Altered behaviour may also be due
to high grade fever or drugs. Antimalarial drugs like chloroquine, quinine, mefloquine and
halofantrine can cause restlessness, hallucinations, confusion, delirium or even frank
psychosis.
Altered sensorium:
Patients with P. falciparum malaria may present with altered sensorium due to severe
infection, hypoglycemia, electrolyte imbalance due to vomiting or diarrhoea (particularly the
elderly), hyperpyrexia, subclinical convulsions etc. Differential diagnosis will include acute
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 33
encephalitis, meningitis, metabolic encephalopathy etc. As a rule of the thumb, malaria
should be considered a possibility in all cases of acute neuropsychiatric syndromes and in
cases of proven malaria, other possibilities should be considered in the presence of
papilloedema, increasesd ICT, neck stiffness and focal deficits.
Convulsions, coma:
Patients with cerebral malaria present with generalised seizures and deep
unarousable coma. Sometimes one single fit can precipitate deep, unarousable coma. These
could also be due to hypoglycemia and all patients presenting with these manifestations
should be administered 25-50% dextrose immediately. Drugs like chloroquine, quinine,
mefloquine and halofantrine may also trigger convulsions.
Cough:
Cough may be a presenting feature of malaria, particularly P. falciparum infection.
Patient may have pharyngeal congestion and features of mild bronchitis. Patients who have
persistent cough and/or fever even after clearance of parasitemia should be evaluated for
secondary bacterial pneumonias/ bronchopneumonia and bronchitis.
Breathlessness:
In severe falciparum malaria, patients may present with history of breathlessness,
due to either severe anemia or non-cardiogenic pulmonary oedema. Secondary respiratory
tract infections and lactic acidosis are other rarer causes for tachypnoea and/or
breathlessness in these patients. Patients with pre-existing cardio-vascular or pulmonary
compromise may deteriorate or even die if they suffer from severe malaria.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 34
Chest pain:
Acute retrosternal or precordial pain may be presenting feature of malaria. It may
radiate to the left or right shoulder tips or arms. It is due to rapid increase in the splenic size
and perisplenitis. This pain may mimic acute myocardial infarction, pleurisy, neuralgia etc.
Coupled with breathlessness, sweating and hypotension (algid malaria), the picture will very
closely resemble that of acute MI.
Acute abdomen:
Patients can present with acute abdominal pain, guarding and rigidity, mimicking
bowel perforation, acute appendicitis, acute cholecystitis, ureteric colic etc.
Weakness:
Sometimes patients may present with history of weakness, malaise and prostration.
On examination they may have significant pallor, hypotension, dehydration etc. Algid
malaria may present like this and the patient may not have fever at all. Chloroquine is also
known to cause profound muscular weakness and a new disease called macrophagic
myofaciitis has been described in patients receiving chloroquine.
Vomiting and diarrhoea:
Malaria can present as a case of acute gastroenteritis with profuse vomiting and
watery diarrhoea (Choleraic form). Vomiting is very common in malaria and is due to high
grade fever, the disease itself or even drugs. Vomiting may pose problems in administering
antimalarial treatment. These could also be due to drugs like chloroquine and due to
secondary bacterial or amebic colitis.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 35
Jaundice:
Patients may present with history of yellowish discoloration of eyes and urine. Mild
jaundice is fairly common in malaria and may be seen in 20-40% of the cases. Deeper
jaundice with serum bilirubin of more than 3 mg/dL is seen in severe P. falciparum malaria
and is associated with anemia, hyperparasitemia and malarial hepatitis with elevated serum
enzymes. Malaria must be considered as a differential diagnosis for all cases of jaundice in a
malarious area.
Pallor:
Severe anemia can be a presenting feature of malaria. It is usually normocytic
normochromic. It may pose special problems in pregnancy and in children. Pre-existing
nutritional anemia may be aggravated by malaria.
Puffiness of lids:
Occasionally patients may present with puffiness of lids, with or without renal
dysfunction.
Secondary infections:
Malaria produces significant immune suppression and this can result in secondary
infections. Common among them are pneumonia, aspiration bronchopneumonia (in the
elderly), urinary tract infection, colitis etc. Meningitis and enteric fever have also been
reported. In falciparum malaria, severe infection can lead to septicaemic shock (algid
malaria). Persistence of fever, neutrophilic leucocytosis and focal signs of infection should
always alert the clinician to this possibility of secondary infections.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 36
Hepatosplenomegaly:
Patients can present with enlargement of liver and/or spleen, tender or non-tender,
with or without fever. Rapid enlargement of spleen or liver in malaria can cause acute pain
in the abdomen or chest. Generally, organomegaly is noticed in the second week of malarial
illness. However, in cases of relapse or recrudescence, it may be present earlier. Also, in
immune compromised patients splenomegaly may be absent. In pregnancy, particularly
second half, splenomegaly may be smaller or an enlarged spleen may regress in size due to
immune suppression. Although splenomegaly is a cardinal sign of malaria, absence of
splenomegaly does not rule out the possibility of malaria.
Combinations of the above:
Patients can frequently present with various combinations of the above mentioned
symptoms and signs, further confusing the picture.
This list is not exhaustive and malaria may present in many other ways. In all the
above listed situations, patients may not have associated fever, thus confusing the picture. In
some, fever may follow these symptoms. Therefore, one should not wait for the typical
symptoms of malaria to get a blood test done; it is always better to do a smear whenever
reasonable doubt exists.
Pathophysiology of Malaria:
The bite of an infected mosquito introduces asexual forms of the parasite, called
sporozoites, into the bloodstream. Sporozoites enter the hepatocytes and form schizonts,
which are also asexual forms. Schizonts undergo a process of maturation and multiplication
known as preerythrocytic or hepatic schizogony. In Plasmodium vivax and Plasmodium
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 37
ovale infection, some sporozoites convert to dormant forms called hypnozoites, which can
cause disease after months or years.
Preerythrocytic schizogony takes 6-16 days, and results in the host cell bursting and
releasing thousands of merozoites into the blood. Merozoites enter the erythrocytes and
initiate another asexual reproductive cycle, known as erythrocytic schizogony. The parasite
passes successively through the stages of trophozoite and schizont, ultimately giving rise to
several merozoites. On maturation of these merozoites, the erythrocyte ruptures, releasing
the merozoites and multiple antigenic and pyrogenic substances into the bloodstream. These
merozoites again infect new erythrocytes. After a few cycles of this erythrocytic schizogony,
some merozoites differentiate into the sexual forms: the male and female gametocytes. A
mosquito that takes a blood meal from a patient with gametocytemia acquires these sexual
forms and plays host to the sexual stage of the plasmodial life cycle.
Figure – 4
Life cycle schematic diagram
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 38
Figure –5
Sporogonic and Erythrocytic cycles of Malaria
Rupture of a large number of erythrocytes at the same time releases a large amount
of pyrogens, which causes the paroxysms of malarial fever. The periodicity of malarial fever
depends on the time required for the erythrocytic cycle and is definite for each species.
Plasmodium malariae needs 72 hours for each cycle, leading to the name quatrain malaria.
The other 3 species each take 48 hours for one cycle and cause fever on alternate days
(tertian malaria). However, this periodicity requires all the parasites to be developing and
releasing simultaneously; if this synchronization is absent, periodicity is not observed 41.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 39
Figure – 6
Exogenous and Endogenous Phases of Malaria
Life cycle of Malaria
The life cycle of all human malaria species consists of two phases a sexual phase
(sporogony), with development and multiplication in certain female anopheline mosquitoes
and an asexual phase (schizogony) with multiplication in man.
The asexual phase in man has two parts, schizogony in the cells of liver
(preerythrocytic schizogony or tissue phase) and schizogony in the red cells (erythrocytic
schizogony or erythrocytic phase).
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 40
Asexual phase in human host
Tissue phase
Sporozoites are inoculated by infected mosquito into the host and disappear from
circulation within half an hour. Some enter the parenchymal cells of liver where they
undergo development and multipication, known as pre-erythrocytic schozogony.
The tissue schizont which develops from the sporozoite enlarges and the nucleus and
cytoplasm divide to form many thousands of merozoites which after 6-16 days rupture the
liver cells and invade the circulation, where they enter the red cells by a process of
invagination. The prepatent period is the time from infection until the appearance of
parasites in the blood and varies with the species of parasite (P. vivax 6-8 days, P. malariae
2-16 days, P. ovale 9 days. P. falciparum 51/2 –7 days).
Exoerythrocytic schizogony
In P. vivax and the P. ovale malaria some of exacoythrocytic trphozortes orginating
from sporozoites lie dormant and are known as hypnozoites. After a period of up to 250 days
they they become active and mature, allowing merozoites to infect red cells and give rise to
an erythrocytic phase. This is the mechanism responsible for delayed prepatent periods and
relapses in P. vivax and P. ovale malaria.
Erythrocytic phase
To enter the red cell the merozoite binds to glycophorin, the major erythrocytic
glycoprotein, which is psecific for a particular species of parasite. The apex of merozoite
releases a substance which forms a deep pit in surface of red cells and, maintaining contact
bya contact ring, the merozoites are enveloped by the red cell in a vacuole (parasitophorous
vacuole) in which it is enclosed. In the red cell the merozoites develop into ringforms which
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 41
grow in size to trophozoites absorbing haemoglogin leaving a pigment (haematin or
haemazoin) – a combination of haemoglobin with protein which can be seen as dark
granules. The trophozoite multiplies by schizogony dividing into a number of small
merozoites varying with species to form mature schizont. The merozoites are released by
rupture of red cell membrane and enter new red cells, particularlyyoung red cells. The
erythrocytic phase called schizogonic periodicity, which differs according to the species of
parasite, is responsible for the febrile paroxysms. In the early stages of infection there may
be several broods of parasites developing at different times so that there is no regular
periodicity, but with development of immunity the periodicity settle down and becomes
regular.
Gametogony
After a period some merozoites give rise to two sexually differentiated forms of
gametocytes male (microgamete) and female (macrogamete) which differ in morphology in
the different species of parasite. These gametocytes are taken up by female anopheline
mosquitoes and they undergo development.
Sexual phase in anopheline mosquitoes
In the stomach of mosquito the female gametocyte forms a macrogamete and the
male a microgamete. The male gamete nucleus divides and forms a number of long slender,
thread like structure or flagellae (exflagellation). These enter the female gamete and fuse to
form a zygote, which becoming mobile as an olkinete and penetrating between the epithelial
cells leaving the stomach, comes to rest on the outer surface of the stomach wall to form an
oocyst, of which there may be several hundreds in one stomach. In the oocyst a large
number of slender sporozoites form which burst out into the body cavity and enter the
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 42
salivary glands ready to be inoculated into a new host at the next blood meal. The duration
of cycle in the mosquito is known as the extrinsic incubation period. It varies according to
the temperature being 8-10 days at 28°C, 16 days at 20°C and cannot be completed under
15°C.
Frequency:
• Internationally: Malaria is a major health problem in Africa, Asia, Central America,
Oceania, and South America. About 40% of the world's population live in areas
where malaria is common. Approximately 300-500 million cases of malaria occur
every year, and 1-2 million deaths occur, most of them in young children.
• In the US: Approximately 1000 cases are diagnosed every year, most of them
acquired outside the country. Only about 1% of patients acquires the infection in the
United States. Usually fewer than 10 deaths are reported in the United States
annually.
Mortality/Morbidity:
• Cerebral malaria: Most of the mortality of malaria is due to this complication of
Plasmodium falciparum malaria, an acute illness that is mostly observed in children
aged 6 months to 3 years. Early diagnosis and prompt treatment with a drug to which
the parasite is susceptible is important to save the life of the child.
• Anaemia: Anaemia is so common in malaria that it is considered almost a part of the
disease. The degree of anaemia is much greater than can be explained by destruction
of parasitized erythrocytes. Malarial anaemia can be quite severe, sometimes causing
death.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 43
• Repeated frequent seizures: Even without cerebral malaria, a child can experience
prolonged, frequent convulsions, which can lead to prostration and death.
Race: People of all races are affected, with some exceptions. People of West African origin
who do not have the Duffy blood group are not susceptible to P vivax malaria.
Sex: Malaria affects females and males equally.
Age: Children of all ages living in non-malarious areas are equally susceptible to malaria. In
endemic areas, younger children are repeatedly have and often serious attacks of malaria.
The survivors develop partial immunity. Thus, older children and adults often have
asymptomatic parasitemia, i.e., and presence of plasmodia in the bloodstream without
clinical manifestations of malaria. Most deaths resulting from malaria occur in children
younger than 5 years 42.
DIFFERENTIAL DIAGNOSIS
There are many other conditions that may mimic malaria fever. A careful history and
examination with the aid of the laboratory, when necessary, will often resolve the difficulty.
a. Malaria — This may be mistaken for typhoid in countries where both are endemic. A
history of previous attacks, the more rapid onset in malaria, the shivering and sweating, the
high early pyrexia, the relative infrequency of abdominal symptoms and signs, and a
positive blood slide all point to a diagnosis of malaria.
b. Influenza — Influenza may also be confused with typhoid, but is usually of much more
rapid onset with high temperature, severe sore throat, cough, and the absence of a palpable
spleen and rose spots.
c. Bacillary dysentery — This disease seldom causes much difficulty in diagnosis. The
onset is usually acute, with severe blood diarrhoea, although in mild cases the blood may be
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 44
absent. Diarrhoea with blood is rare in early typhoid. The signs and symptoms in dysentery
are usually abdominal and remain so, the mental state and chest being clear.
d. Typhus and other rickettsial infections — These conditions should be considered
important when considering the differential diagnosis. This is because both typhus and
typhoid can cause a febrile illness with delirium, chest signs, and abdominal discomfort. In
typhus, however, the onset is acute, and the temperature high at an early stage. Shivering
attacks are common at the onset, and prostration is rapid.
The rash is quite different (brownish red in colour, and much more profuse). It does
not fade on pressure, as does the rose spot in typhoid. There is a leucocytosis and the Weil-
Felix test becomes significantly positive at about the tenth day.
e. Pulmonary tuberculosis and atypical abdominal tuberculosis — These are probably
the most difficult diagnoses to differentiate from typhoid in economically poor countries.
The pyrexia and vague symptoms and signs may be very similar. A chest X-ray, or
laboratory confirmation of typhoid, may be the only sure method of diagnosis.
f. Brucellosis — This may cause difficulty, but the onset tends to be more insidious. The
patient is also alert, and a painful joint is frequently present.
g. Trypanosomiasis — This condition in endemic areas should also be considered in the
differential diagnosis.
h. There are numerous other diseases — Some other diseases could enter into the
differential diagnosis category and some of these are illustrated. Suffice to say that there are
few conditions that cannot mimic, or be mimicked by, typhoid fever.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 45
Nidana of Jwara: (Aetiology)
The causative factor may be sarnikristha Nidana (immediate cause) and/or
viprakristha Nidana (distant cause). So these two factors are responsible for vyadhijanaktva
as well as Vyadhi bodhakatva. On the basis of the above all the factors like Bahya (external)
as jeevanu, mithya Ahara vihara etc. and the internal factor is vitiated Dosha and dushya.
Gananath Sen described the external cause like abhighata (trauma). Jeevanu (parasite or
microbes) and mithya Ahara-vihara (defective food and habits) are causes for
Vishamajwara.
Role of Ahara and Vihara 43
Unsuitable food and drinks are provocative of Vata. Pitta and Kapha and ultimately
may cause the development of Vishamajwara. According to Vagbhata if Shodhana is given
in Nava-Jwara cases when there is Indigestion State, aggravated Dosha becomes the cause
of Vishamajwara. According to Yadvji Trikamji emaciated and weak patients if take ahita
Ahara-vihara in course of time it produces Vishamajwara. So aetiology of Vishamajwara is
discussed under following heads.
Factors relating to Ahara -
1. Kasaya Dravya sevana
2. Ruksha Dravya sevana
3. Ushna drvya sevana
4. Shitambu pana
5. Santarpan Dravya sevana
6. Anupamansa bhakshana
7. Pinaka bhojana
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 46
8. Asatmya Dravya bhojana
9. Virudha Padartha bhojana (antagonist food)
10. Ahita Ahara sevan
Factors relating to vihara
1. Visa ausadhi gandha sevan
2. Divaswapna (day sleeping)
3. Mithya vihar (the habits which is not good for health)
4. Sorrowfulness
Others –
1. Aupasargika Karana
2. Rutuparivartana
3. Kroda
4. Bhaya
Flow chart -1Classification of aetiology of Vishamajwara
Abhichara Abhishanga Abhighata Abhishapa
Ahara
Vihara
Dosha Bhutabhishanga Mahabhishanga
Kala
Prakruti Keetanu
Drushya Adrushya(Macroscopic) (Microscopic)
Nija (Internal) Agantuja (External)
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 47
Role of bhuta (Keetanu) in Vishamajwara
Susruta believed that Vishamajwara takes place due to agantuka Karana (external
cause). Agantuka is divided into 4 types i.e., abhighata, abhichara, abhishapa and abhisanga.
Dalhana considered abhisanga as bhutavisanga. Chakrapani stated poisonous insects may be
considered as bhuta. According Amarkosha it is keetanu. Therefore the keetanu introduced
the body by its corresponding portan entry and aggravates the doses. The time taken from
the entry to manifestation of disease is known as sanchaya kala (incubation period). After
sanchaya the doshas follow their normal pathway to travel for manifestation of diseases. But
in this instance which Dosha is principal may be considered on the type of keetanu and the
strain of keetanu 44. Regarding the vectors, Charaka mentions countries which abound
mashaka (mosquitoes), mooshaka (rats) and makshika (flies) as unhealthy 45. In Charaka, it
is stated that “unsanitary winds, unsanitary water, unsanitary countries and unsanitary
seasons are cause of catastrophes. Water is considered to be more important than wind, and
country more important than water and season yet more important than country by virtue of
their degree of indispensability 46. In this statement one can see the rudimentary concept of
germ theory and epidemiology.
Relation of Dosha in Vishamajwara
Ayurvedic doctrine based on the Tridosha theory. The three Doshas are responsible
for all diseases when they are deranged. The vitiated Dosha after localising in Dhatus of the
body are responsible to produce diseases. Through it is described in all classical texts that
Vishamajwara is tridoshaja but Vata plays an important role. Charaka described that
Vishamajwara is developed due to vitiation of Tridosha, but according to predominance of
Dosha different features of its varieties may be noticed 47.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 48
According to Susruta Vishamajwara is due to predominance of Vata and Kapha,
because patient feels chill and rigor during first stage. Vagbhata described due to vitiation of
three Doshas, five types of Vishamajwara occur. Jejjata described Vata plays an important
role in Vishamajwara where as Pitta and Kapha remain quiescent stage. According to
Hareeta predominance of Vata, Pitta and Kapha Dosha causes Vatolbana, Pittolbana and
Kaholbana Vishamajwaras in 14th, 18th and 22nd days respectively. According to Ayurvedic
scholars the seat of jwara is stated to Amashaya. The three doshas (samana vayu, pachahaka
Pitta, Kledakakapha remain in Amashaya in jwara the Pitta is mainly involved with
Samanavata and Kledakakapha. Jwara occurs in whole body by the circulation of blood with
the help of Vyanavata. Besides all the factors Pitta plays an important role for producing
jwara. So description of Pitta may not be out of place. Tapa (temperature) and daha (burning
sensation) are due to Pitta. Pitta regulates the normal body temperature along with other
functions also.
Role of dushya in Vishamajwara
In Vishamajwara the Doshas are not only localised in Rasa Dhatu like other jwara.
But Rakta, mamsa, meda asthi and majja Dhatu are also involved subsequently as stated by
Charaka, Susruta and Vagbhata in the following manner as regard its seat in particular
Dhatu.
1. Rasa Dhatu – Santata jwara
2. Rakta Dhatu- Satata jwara
3. Mansa Dhatu – Anyedushka jwara
4. Meda Dhatu – Triteeyak jwara
5. Asthi Dhatu – Chaturthak jwara
6. Majja Dhatu – Chaturthak jwara
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 49
Relation of vega in Vishamajwara 48
As a seed lies dominantin the soil and grows up in favourable time, Doshas stay in
Dhatus and get vitiated in opportune time. The Dosha having attained exacerbation and
timely strength due to weakening of the contracting factor gives to the tertian as well as the
quatrain fever. After the paroxysm, the Doshas being weakened stay in their respective
places and being reinforced in their opportune times again give rise to fever.
Role of Prakruti
Prakruti plays pivotal role in occurrence and prognosis of diseases. According to
deha Prakruti the Dosha kalpana is also considered. The Vishamajwara due to Kapha is
difficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are less
powerful. Similarly Pittolbana is difficult to cure in Pitta Prakruti and Vatolbana is difficult
to cure in Vata Prakruti. 49
Role of kala in Vishamajwara
The rise of temperature at the end of the day, end of the night is due to Vata dosha,
the same rises in the mid-day and mid night due to Pitta Dosha. The rise is during morning
and evening hours due to Kapha Dosha respectively. Besides these, same disease is
produced in particular season. According to the principles of Ayurveda Vata is aggravated in
varsa, Pitta in sharat and Kapha in vasanta. If a person takes “mithya ahar-vihar” in a
particular season the particular Dosha of that season is provacated. The aggravated doshas
interact Rasa and other Dhatu and ultimately produces Vishamajwara.
Samprapti (pathogenesis)
Jwara is defined as “santapo deha manasa” i.e., body and mind equally disturb in
fever along with derangement of Agni, Ama, srotaes and rogamargas etc.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 50
Role of Agni in Vishamajwara
Among the thirteen types of Agni, the Jataragni is most important 50. It digests the
food and controls all other pittas. The Pachakapitta remains in Grahani and stimulates
dhatwagni. If a person adopts mithya Ahara and vihara for a long time then the imbalance
Dosha localised in Amashaya, disturb the functions of the same and displace Agni.
Therefore, activity of Agni becomes impaired in Amashaya but enhances in Dhatu.
Ultimately there is formation, of Ama Rasa and obstruction of Rasavaha and swedavaha
srota giving rice to different clinical features known as jwara roga.
Role of Ama in Vishamajwara
Ama is defined as undigested food particles, which subjected to less amount of Agni
as desired. This Ama is produced in Amashaya as a result of aharapaka. Ama may be
grouped into two parts (1) local and (2) systemic. The systemic effects of Ama (Amarasa)
which sticky in nature obstruct the fine channels of swedavaha strotas as a result there is
elevation of body temperature. On the other hand in bhutabhisanga Vishamajwara, person
having Bhatubaisamya, Swabhava (immunity) and the Keetanu directly involved the Dhatu
and produces agantuka Vishamajwara. 51
Role of Srotas in Vishamajwara
In Ayurveda all diseases are produced by srotovaigunya. Jwara is due to Annavaha
srotavaigunya in general. But in Vishamajwara there is no clear description about particular
srotavaigunya. According to signs, symptoms and site of Dhatus it may be concluded that
udakavaha, swedavaha, rasavaha, raktavaha, mansavaha, medavaha, asthivaha, majja vaha
and manavaha Srotas are involved.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 51
Role of rogamarga in Vishamajwara
Ayurveda described the three rogamarga (pathway of disease) for the manifestation
of diseases. The seat of jwara is Amashaya and is one of the organs of kostha (thoraco-
abdmino-pelvic cavity). Therefore, jwara is considered as abhyantara rogamargaja Vyadhi.
Samprapti is classified in two parts.
1. Samanya Samprapti (general pathogenesis)
2. Visista Samprapti (specific pathogenesis)
Samanya Samprapti of Vishamajwara
It means six stages of development of disease according to Susruta 52
Sanchaya (stage of accumulation) – in this stage vitiated doshas are localised in
their principal site. On the other hand when a keetanu invade the host then it cannot produce
disease. Instantaneously this period may be compared with incubation period of modern
medical science.
Prakopa (stage of provocation) – due to lack of proper treatment in the previous
stages the Dosha leads this stage. The Pachakapitta being “unmarga gami” tries to migrate to
Rasa and swedavaha Srotas.
Prasara (stage of circulation) – after circulating throughout body by Vata, this
prakopita doshas accumulated depend on the “khavaigunya” only. Therefore production of
disease is possible only where the disorder of Srotas occurs.
Sthana sansraya (stage of localisation) – the vitiated Dosha become localised in
rasavaha and swedavaha Srotas owing to previous factors. The premonitory symptoms like
arati, shrama, vairasya are found.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 52
Vyakta – (manifestation of diseases) – during this stage the vitiated Pachakapitta
causes Ushna (hot) stage and Sheeta (cold) stage in the body associated with Vata Dosha
and Sheeta Guna of Kapha Dosha.
Bheda (stage of classification) – Santata etc, five type of jwara are manifested
owing to involvement of rasadi Dhatu and Kapha sthana.
Classification of Vishamajwara according to different Acharyas -
There are various opinions regarding the type of Vishamajwara. Primarily it can be
divided into two groups, viz. 53
(I) Arambhat visama – The Vishamajwara which is started as irregular
fever from the very onset ;
(II) Krita visamajwara – The Vishamajwara which occurs due to
apathya sebana (untous dietetics and regimens) of previous jwara. So
it is usually considered as relapsing fever.
There are mainly five types of Vishamajwara accepted now 54. But there are various
views on these types of Vishamajwara illustrated below.
1. Charaka described five types according to its vega and agamankala i.e., santata, satata,
anyeduska, triteeyak and chaturthaka 55
2. According to Vagbhata santataka, satata, triteeyaka, anyeduska, chaturthaka, and
chaturthaka viparyaya. Here be classified the viparjaya as vatadhikya, pittadhikya and
kaphadhikya. 56
3. Susruta advocates as santataka, satata, anyeduska, triteeyaka, chaturthaka, pralepaka
and also due to predominance of doshas (anupathyaka jwara madhya samudbhavan) and
Vata valasaka.57
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 53
4. Harita describe as kahika, dwahika, trayahika chaturthaka 58
5. According to Gananath Sen it is four types such as vatabalasaka, Sleepadika, kalajwara,
upadravikjwara.59
6. Kharanada described as viparita tikhanata santatajwara, anyeduska, triteeyak and
chaturthaka
7. Kashyapa described it as viparita tikshanata santatajwara, anyeduska, triteeyak and
chaturthaka.
8. Drudhabala described two types such as triteeyaka and chaturthaka
9. Madhavakara viewed that santata, satataka, anyeduska, triteeyaka, chaturthaka. Here
triteeyaka is again divided into three types according to predominance of Dosha like
kaphapitta. Vatakapha, vatapitta chaturthaka, two types as slesmika and anila. Besides
this he described another three types known as chaturthaka, viparjava, vatavalasaka and
pralepaka.60
Visista Samprapti of Vishamajwara 61
If the mithya Ahara Vihara taken in case of residual fever or during convalescent
period of jwara it causes Vishamajwara being localised in one or more Dhatu. On the other
hand keetanu may aggravate Dosha in according to balam kalamcha prapya (dependent on
the host strength and climate). But according to Susruta as well as supported by
Madhavakara about the pathogenesis of disease stated that if a weak person just after fever
adopts unsuitable food and drink, his residual doshas aggravated being afflicted by Vata
localised in kaphasthana (shira, kantha, hridaya, amasaya) to produce different of
Vishamajwara. The five types of Vishamajwara manifested after invading of Rasa, Rakta,
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 54
mansa, meda, asthi and majja dhatu and loges at shira, kantha, hridaya, amasaya and
rasavaha Srotas, as a result of which the following types of Vishamajwara are produced.
1. Santata – continuous fever – Rasa Dhatu – wall of Amashaya
2. Satata – double quotidian fever – Rakta Dhatu – Amashaya
3. Anyeduska – quotidian fever – mamsa and meda – Hrudaya
4. Triteeyaka – tertian fever – asthidhatu – kantha
5. Chaturthaka – quartan fever – majja Dhatu – shira
1) Samprapti of Santatajwara
The word santataja jwara means fever in continuos nature. Now it is under
controversy before the modern Ayurvedic scholar’s deviates from the definition of
Vishamajwara. But to overcome the controversy Charaka classified that the
“muktanubandhitvam visamatvam”, which means fever with relapsing nature. Then Dosha
circulating in body through rasavaha Srotas with the help of Vata and gets localised in the
Kapha sthana. The period of localisation may vary according to kala prakriti and
predominance of doshas. They also affect dhatus and malas to manifest the diseases. The
site of santatajwara is rasadhatu and its period is 7 days, 10 days, 12 days according to
predominant of Vata Pitta and Kapha respectively. During this period the jwara may either
subside or kill the patient without appropriate therapeutics intervention 62.
According to Harita the period of subsidence of jwara is 14, 18, 22 days in
Vatolbana, Pittolbana and Kapholbana respectively. During the period the fever may subside
or kill the patients.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 55
Dosha pradhanyata – 63
The doshapradhanyata in the Santata jwara is tabulated as below.
Table –1
Showing the Dosha pradhanyata in Malaria
Kala (Rutu) Dushya Prakruti Dosha
Vasanta Medas Kapha Kapha
Sharad Rakta Pitta Pitta
Varsha Asti Vata Vata
2) Samprapti of satatajwara
The satatajwara is said to be dwikalika (two times) in an ahoratra (24hr). The vitiated
doshas are localised in raktavaha Srotas and aggravated in a day and night. According to
kashyap this types of aggravation and remission depends upon the kala, Dosha and dushyas.
Dalhana considered jwara be twice in day. Once in a night, because the seat of satatajwara is
raktadhatu. Raktavaha Srotas is comparatively minute and more distant than rasavaha
Srotas. So Dosha gets longer time to enter in Srotas causing Vishamajwara. When doshas
more from rasavaha to raktavaha during this phase there will no be only febrile attack.
According to Vagbhata onset of jwara in Vata dosha is at early aparanha (afternoon)
and pratyusha (morning and last part of night). Pitta dosha aggravates in midday and
midnight and Kapha Dosha in purbanha (evening hours)
Vruddhi Kshayatmaka of satatajwara 64
The heavy Doshas spread all over the body through the channels carrying Rasa and
stiffened and give rise to santata jwara (remittent fever). Being unbearable and quick –
acting it gets subsides or kills the patients by the period of seven, ten or twelve days. Dosha
equal in respect of time, dushya, (affected tissue) and constituents and having no counter
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 56
acting factor causes the remitted fever and as such in quite unbearable. In remittent fever, as
a rule, Vata etc. also affect in urine and faeces simultaneously as the Dhatus. This fever gets
subsides or becomes fatal in periods of a week etc. according to the conditions whether Rasa
etc. have been purified completely or not. When they are not purified completely or entirely
the remitted fever gets lodged in the twelve entities (seven Dhatus, three Doshas, urine and
faeces). Thus even after remission on Twelfth Day, it continues hidden for a long time
without responding to any treatment. Considering all this, the physician should treat the case
of fever. Mostly in such management de-saturating remedy is administered at first.
3) Samprapti of Anyeduska jwara
Jwara vega occurs once in a whole day or night is called anyeduska jwara. Kashyapa
named it as anusargee and in Veda it is known as “anyeduha”. Vagbhatta considered that
manasvaha Srotas are very smaller (minute) than raktavaha Srotas. Therefore delay occurs
because of doshas have to reach a longer distance. This doshas circulated all over the body
slowly and ultimately reach mansavaha Srotas once in a whole day or night.
4) Samprapti of Triteeyak jwara
The jwara vega occurs once in every third day. Vagbhata considered that the sites of
vitiated doshas are medhadhtu and medavaha Srotas. Dosha gets longer time to enter
medavaha Srotas from rasavaha Srotas. So the paroxysm of fever is on every third day.
Doshanusara bheda – trika grahi – prusta grahi – shirograhi 65
Triteeyak jwara (Tertian fever) is of three types-
1. Due to Kapha and Pitta stating from trika (sacral region)
2. Due to Vata and Kapha starting from the back
3. Due to Vata and Pitta starting from head.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 57
Likewise, the quatrain fever has also two type of characters- one caused by Kapha
and starting from legs and other caused Vata and starting from head.
5) Samprapti of Chaturthaka jwara 66
Jwara comes on every fourth day having two days interval between the onset of
every attack. The site of Dosha in this jwara is said to be majja-Dhatu which is deeper than
other discussed above. So vitiated Dosha takes a longer period to reach there. Therefore
paroxysm of fever is an every fourth day.
According to Kasyapa the Dosha which have been localised in shirasthana moves
towards kanthas than in one day from kanthasthana to Hrudaya on next day and from
Hrudaya to rasadhatu or Amashaya to manifest the jwara on the fourth day. Dosha located in
shira and majja Dhatu being provocateur by kala prakriti. Dushya enters into amasaya and
produce Agnimandya. The produced Ama causes srotarodha and responsible for
vimargagamana of Jataragni.
According to predominance
Dosha it has been classified in two types.
1. Kaphadhikya chaturthak jwara
2. Vatadhikya chaturthaka jwara
Kaphadhikya chaturthakjwara originates from jangha pradesh and spread all over the
body and vatadhikya chaturbakajwara originates from shira and spread through out the body.
Viparijya jwara
If the fever comes in its remission period discussed above then it can be regarded as
viparjayajwara. The word viparjaya means virudhata/veniyama or parivartana (reverse).
Susruta considered it as viparjaya. Charaka and Vagbhata considered for chaturthaka as
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 58
“viparyaya jwara” are mainly according to the predominant of Doshas in the particular site
of vitiation. Here it is noted that the vitiated Doshas has no definite place to be localised in
any of the five Kapha sthana in Santatajwara, there is no viparyaya because the Dosha
remains in all five kaphasthanas. But in case of Anyeduskajwara, if it is comes in remission
period than it is known as Anyeduska viparyaya, in Chaturthaka viparyaya jwara vega
occurs continuously for three days and subside as fourth day. Also the similar process takes
place in Treetiyaka jwara.
Duration and vega in different jwaras
Table –2Name of jwara No. of vega Period
Santata Nirantara(whole time) 7,10 or 12 days
Satata Twice In ahoratra (24hr)
Anyeduska Once In ahoratra (24hr)
Triteeyaka Once An alternate day
Chaturthaka Once On every 4th day
Chaturthaka viparjaya Twice In between two days leaving
1st and 4th day
Purvarupa (premonitary symptoms)
Any specific premonitory symptoms of Vishamajwara are not found or described in
any Ayurvedic literature. As per the general principle the initial appearance of some of the
features of Vishamajwara is considered as its purvarupa.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 59
Flow chart –2Schematic diagram of Vishamajwara Samprapti
Nidan –nija
Agantuka (keetanu)
Dosha vaisamya
Agni mandya
Production of Ama
Tridosha being provocateur and mixed with
Ama first appeared in Amashaya
Srotorodha in Amashaya
Localisation of Pachakapitta
Circulating in Rasa and Rakta Dhatu
Localisation in Rasa and swedavaha Srotas
Development of Vishamajwara
Santata Satata Anyeduska Triteeyaka Chaturthaka
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 60
Table –3Showing the Vishamajwara vishista Lakshana
Lakshana Charaka SusrutaSitilathat (lethergy) + +Gurutha (heavyness) + +Udveg (excitement) + +Dinata (weakness) + +Gamana (movement) + +Jrumbha (yawning) +Angamarda (malaise) +Sa
ntat
a Jw
ara
Aruchi (anorexia) +Daha (burning sensation) + +Bhrama (vertigo) + +Pralapa (delirum) + +Pidika (pedicles) +Sthivana (spitting) + +Sveda pravriti (sweating) + +Sa
tata
Jw
ara
Vamana (vomiting) +Pindikidwevasthan (pedicles) +Murati pravriti (urination) +Angavisesa (myelgia) +Sweadadhikya (sweating) +Vamana (vomiting) +Aruchi (anorexia) +Glani (sorrow fullness) + +Pralapa (delirum) +Antardaha (internal burning) +A
nyed
yush
ka J
war
a
Malati pravruti (diarrhoea) +Atisara (diarrhoea) +Vedamntapida (pain) +Anga vikshepa (myelgia) +Abhyantara daha (internal burning) +Murcha (fainting) +Swedhikya (excessive sweating) +Pralapa (delirium) +Glani (sorrow fullness) +Dourgandha (foul smell) +Swasa (dyspnoea) +Kasa (cough) +
Tru
teey
aka
Jwar
a
Vamana (vomting) + +Vamana (vomting) + +Vedantaka pida (pedicles) + +Angavishada (malaise) + +Swasa (dyspnoea) + +Hikka (hie-cough) +Abhyathara daha (internal burning) +Asthi sankoch +C
hatu
rdha
kaJw
ara
Agnimanda (dyspepsia) + +
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 61
Sadhya sadhyata (prognosis)
Sadhya-sadhyata is very important to assess the prognosis of disease before starting
treatment. In a person who is strong, vitiation of Dosha is mild without any complication of
jwara is said to be sadhya.
If the jwara developed by strong positive factors which all the sign and symptoms
are present, function of indriya (sense organ) are derranged, the disease is considered to be
asadhya. If the jwaravega is antarvega, it is said to be kruchhara sadhya (curable with
difficulties) and vaheervega it is sukhasadhya. When the jwara associated with Bhrama,
durbala indriya, tikshna jwaravega, durbalata, prabahani, aruchi and function of Indriyas
become feeble then the jwara is said to be asadhya.
The santata jwara if one or two doshas are involved then it is curable but if more two
than kill the patient. The anyedushka, satata. Triteeyak are curable as the doshas lies in
superficial as in Rakta, mansa and meda Dhatu. Chaturthaka is difficult to cure because the
doshas lies in deeper dhatus like asthi, majja leaving to development of other diseases.
The bhutavisanga Vishamajwara depends upon baya, bala, Agni, prakriti and the
invovement of dhatus. The symptoms like swash, murcha, chharoli trishna, Atisara,
vatagraha hicca, kasha, angaveda are detected than it is said to be asadhya.
Management of Vishamajwara in Ayurveda
In Ayurveda removal of positive factors as well as measures adopted for the
maintenance of Doshic equilibrium is called as Chikitsa. There are 3 types of Chikitsa i.e.,
1. Daiva vyapasraya
2. Yukti vyapasraya and
3. Satwavajaya
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 62
Yuktivyapasraya joins its popularity now days because of its application of therapeutics
dilemmas in particular ailments. Again this is divided into three parts i.e.,
1. Antahparimarjan (internal purification)
2. Bahirparimarjan (external purification and
3. Sastra pranidhana (surgical measures)
For each one of those five fevers different kashayas (decoctions) are prescribed.
Though bitter drug is prescribed in any kind of fever, in the treatment of Vishamajwara
more emphasis is laid on biter drugs like kirata, guduchi, bharangi, nimba etc. The emphasis
on bitter medicine is due to the vitiated Dosha (Pitta) though other two Doshas also play
some important role. For Pitta shamana drugs, which are astringent, bitter and sweet are
useful. In high temperature and extreme burning sensation of the body, application of water
and milk externally are recommended for immediate relies. Some lauha preparations like
vishamajwarantaka lauha. Sarbajvarahar lauha chandanadilauha etc. will be highly useful in
case of anemia after malaria attack.
Perusal of various texts of Ayurvedic classics will indicate the following main mode
of treatment in Vishamajwara.
1. Kasaya (decoction) (Panchakashaya) 67
2. Ghritams (medicated ghee)
3. Suportive therapy like rasuna yoga
4. Anjana
5. Dhupana
The drug mentioned in the treatment of Vishamajwara can be classified as those.
1. Acting on doshas mainly on Pitta and Kapha (Dosha pratyaneek)
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 63
2. Acting on Dhatu and including organ like liver, spleen, etc.
3. Acting on the disease (Vyadhi pratyaneeka)
The drugs having Kashaya and Tikta Rasa by and large from jwaraghna Dravyas like
guduchi (tinospora cordifolia) nimba (azadirachta indica), chandana (santalumalbum),
murva (sansvieria roxburghiana), kiratatikta etc. full under the doshagna group.
Role of langhana
The treatment of ordinary fever, langhana (fasting) swedana (diaphoretics), kala
(time factor), yavagu (liquid diet) and tiktarasa (bitter medicines) are indicated. In
Vishamajwara, langhana and swedana are not recommended.
Preventive countermeasures in contemporary practice
Preventive countermeasures are divided into three sections:
1. Personal Protective Measures,
2. Chemo-prophylaxis, and
3. Management.
1) Personal Protective Measures
This section presents measures that prevent mosquitoes from biting and transmitting
malaria. Applications of personal protective measures are effective against a wide range of
disease vectors, not solely for prevention of malaria. In many military operations, they will
be the only means of protection against biting arthropods. They are the first line of defense,
are simple to teach and perform, and enable personnel to remain in endemic areas while
maintaining their operational capabilities. The major drawback of personal protective
measures is dependence on service member compliance. Persuasion by medical personnel,
and enforcement by NCOs and commanders is necessary for their continuous proper
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 64
application. Medical personnel must circulate among units teaching, examining, and
improving personal protective measure practice, and also reporting their findings to those in
charge. Commanders and NCOs must ensure compliance and lead via personal example.
DEET
Topical repellents are natural or synthetic compounds that repel arthropods. The use
of vapor-active skin repellents by U.S. Armed Forces has a long history. It began with the
use of oil of citronella in 1910, continued with the discovery of dimethyl phthalate during
WW II, and led to the development of diethyl toluamide or “DEET” in 1957. The duration
of a repellent’s effectiveness decreases with activity, heat, and humidity. Since Anopheles
mosquitoes inhabit warm tropical environments, military personnel need to re-apply
repellent frequently to prevent biting. These products were selected based on their
effectiveness. Contrary to public opinion, Avon Skin So Soft R and flea collars are not
effective.
Protective Clothing and Netting
The basic utility or camouflage uniform treated with permethrin and worn with
sleeves down, collars closed and trousers bloused over boots offers excellent protection from
mosquitoes. Other types of protective clothing and netting are also available.
2) Chemoprophylaxis
Choice of regimen is determined by two factors:
• Drug resistance in specific locations.
• Any allergic or other reaction to the anti-malarial drug of choice, or restriction by job
(mefloquine is not authorised for prophylaxis in aviators and divers).
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 65
Excellent primary sources of information on malaria drug resistance are the Medical
Environmental Disease Intelligence and Counter-Measures (“MEDIC”) compact disc, and
the Navy Environmental and Preventive Medicine Unit responsible for that area of the
world.
Prophylactics
Four regimens are set out below. The choice depends on the countries, which are to
be visited and possible drug sensitivity of the traveller
• Chloroquine can still be used in some regions but is of limited value in many parts of
the world. Treatment should be started one week before travelling to, and continued
for four weeks after leaving, a malaria endemic area. (Adult dose 300mg weekly
taken with a meal, at the same time and on the same day each week). It will suppress
but not cure an infection with P. vivax and symptoms may not appear for weeks or
months after the traveller has returned home. For children the dose is 5mg/kg base
given once a week on the same day each week. Since liquid suspensions for children
are no longer available, a tablet has to be divided to provide the appropriate dose.
Chloroquine has a bitter taste and should be given to children crushed in a strong
flavoured (sweet) drink. Prophylactic drugs in children should not be given without
advice from a medical practitioner, preferably one practising from a health travel
medical centre. 68
Chloroquine is considered a safe drug for pregnant and lactating women and
also for children. However, it is wise to discourage women who are pregnant from
travelling to areas where malaria is present because of the difficulties associated with
treatment and the risk to the mother and foetus should they get malaria.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 66
• Doxycycline is a suitable prophylactic anti-malarial agent to use in high risk areas
such as South East Asia. It must not be used in children under 8 years of age nor in
pregnant or breast-feeding women. Doxycycline may cause contraceptive pills to be
less effective so additional precautions should be taken. It may cause thrush in some
women but usually only when taken for long periods. It may cause severe skin
photosensitivity in some individuals. Doxycycline - Adult dose 100mg daily. Start 1-
2 days before travelling to a malarious area and continue for 2-4 weeks after leaving.
To ensure that the patient is not sensitive to doxycycline it is worthwhile starting
treatment 7 days before travelling. It is recommended that it is not taken for longer
than three months without a medical review.
• Mefloquine (Lariam) is still a widely used prophylactic. It has a long half life and the
convenience of a once weekly dose. For adults (more than 45 kg bodyweight) the
dose is 250mg base weekly, starting one week before arrival in a malarious area.
Side effects have been reported which are generally mild (e.g. Sleep disturbances,
gastrointestinal disturbances, dizziness or disturbed sense of balance). A rare but
important adverse reaction is acute brain syndrome which occurs in, one in 5,000-
20,000 of those taking the drug. It is not recommended for aircraft pilots or drivers of
public transport.
• MalaroneTM. This is a combination of atovaquone and proguanil and recent studies
have found it a safe and effective prophylactic agent with few side affects.
Unfortunately it is expensive and has to be taken daily. It is not suitable for those
sensitive to atovaquone or proguanil . Treatment should be started 2 days before
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 67
travel and continued for at least 7 days after a period of potential exposure to
malaria.
• Other possible regimens include daily azithromycin, daily high-dose primaquine and
short course tafenoquine.
Deterrence/Prevention:
• Avoid endemic regions.
• Take the proper prophylactic drugs at proper intervals if traveling to endemic
regions.
• Use topical insect repellent (30-35% diethyltoluamide [DEET]), especially from
dusk to dawn.
• Wear long-sleeved permethrin-coated clothing if not allergic to permethrin; spray
under beds, chairs, tables, and along walls.
• Sleep under fine-nylon netting impregnated with permethrin.
• Avoid wearing perfumes and colognes.
• Seek out medical attention immediately upon contracting any tropical fever or flulike
illness.
• Chemoprophylaxis is available in many different forms.
• The drug of choice is determined by the destination of the traveler and any
medical conditions the traveler may have that contraindicate the use of a
specific drug.
• Before traveling, people should consult their physician or call the CDC's
Malaria Hotline to determine the most appropriate chemoprophylaxis.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 68
3) Management
Blood schizonticides are the first-line drugs for the treatment of malaria and must be
started as soon as the diagnosis is made or even suspected. They act on the asexual forms in
the erythrocytes and interrupt clinical attacks. Delay in treatment of P falciparum malaria
can lead to development of severe malaria, which has a poorer prognosis than
uncomplicated malaria. Chloroquine, quinine, quinidine, mefloquine, halofantrine, and
artemisinin compounds are the rapidly acting drugs that can terminate an acute malaria
attack. While chloroquine acts rapidly, resistance is widespread and an accurate travel
history should be obtained before choosing the anti-malarial drug.
P vivax and P ovale have dormant stages (hypnozoites) in the liver, and the treatment
of an episode of malaria requires eradication of these forms also. The classic treatment is a
3-day course of chloroquine, followed by a 14-day course of primaquine. A shorter course
of 5 days of primaquine, started with chloroquine, has been described but is associated with
higher relapse rates.
Detailed Drug review
All the components of the Bharangyadi Ghanavati are explained as under.
1) BHARANGI – Clerodendrum Serratum 69-70
PLANT PART USED:
Roots and leaves.
DESCRIPTION:
A shrub 0.9-2.4 m high, slightly woody, not very branched, stems bluntly
quadrangular, young parts usually glabrous. It has pink white flower, numerous and striking.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 69
PHYTOACTIVE :
A sterolglucoside has been isolated. The root bark yields a glycosidic material,
phenolic in nature 71. D-mannitol was isolated from the root bark with a yield of 10.9%
72.The powdered stem contains D-mannitol, b-D glucoside of b-sitosterol,b-sitosterol and
cetyl alcohol 73. From the bark the sapogenin mixture contains three major triterpenoid
constituents-olconolic acid,queretaroic acid and serratagenic acid.
DIRECTIONS FOR USE :
An aqueous extract produced a graded block of the responses to histamine on
isolated guinea pig ileum. It blocked the histamine-induced contractions of the guinea pig
tracheal chain preparations without affecting the response to acetylcholine 74. The saponin
isolated from the root bark caused a release of histamine from rat lung tissue 75. Continuous
daily administration of the plant extract in the sensitised guinea pig causes a gradually
developing protection against anaphylaxis. The anticholinestrase activity of the saponin was
confirmed by acetylcholine responses on guinea pig tracheal chain preparation, isolated rat
ileum and frog rectus muscles 76. The saponin also disrupted the rat peritoneal mast cells and
blocked the effect of horse serum antigen 77.
A decoction of roots is used in asthma and bronchitis. The leaves are applied in the
form of poultice in skin suppurations. The drug is used in fever 78. It is also used in sinusitis.
It is recommended in inflammations of the eye.
CONTRAINDICATION :
In the doses used, no adverse reactions have been reported in man.
Larger doses are reactive.
FORMULATION AND DOSAGE : Churna : 0.5 - 1.5 gm
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 70
2) MUSTA - Cyperus rotundus Linn 79-86
PLANT PART USED :
Bulbous root.
DESCRIPTION :
The plant is a common weed represented by several types growing in India. The
blackish rhizomes are slightly fragrant and in Asia the essential oil they yield is used as a
perfume and to repel insects. The branches are long and with three edges. The flowers are
tiny.
PHYTOACTIVE :
The essential oil from C. rotundus contains at least 27 components comprising
sesquiterpene hydrocarbons,epoxides,ketones, monoterpene and aliphatic alcohols and some
unindentified constituents. (+) copadiene and (+) epoxyquaine have been detected. The
various characteristics of the essential oil obtained from the tubers have been studied
chromatographically and by spectroscopic methods.
DIRECTIONS FOR USE :
The petroleum ether extract of the roots showed anti-inflammatory activity against
carrageenin-induced oedema in albino rats. The active fraction was identified as a
triterpenoid. The antipyretic activity was demonstrated on pyrexia induced by Brewers yeast
in albino rats. A fraction tested on aconitine-induced writhing in mice showed mild
analgesic activity.Antihistaminic and antiemetic activities were shown in experimental
studies on dogs. Smooth muscle relaxant activity was demonstrated on rabbit ileum. Extracts
of rhizomes were inhibitory to the growth of fungi depending on species. Antibacterial
activities of oil and its fractions have been demonstrated against a number of organisms'.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 71
Clinical trials have shown efficacy of 2'1, solution of aqueous extract of C. rotundus
in 26 patients with conjunctivitis. Traditionally it has been used in the treatment of chronic
diarrhoea'. It is found useful in diarrhoea with mucus. It is commonly given in fever. It acts
as an antiperspirant and deodorant.
CONTRAINDICATION :
Safety: In the commonly used dose no adverse reactions have been reported. M
albino mice, no toxic effects of the plant were observed.
FORMULATION AND DOSAGE :
1. Mushtadi churna : 1 to 3 gms. b.i.d.
2. Mushtadi kwath : 30 - 60 ml. b.i.d.
3. Mushta kwath : 30 to 60 ml. b.i.d.
4. Mushta oil : topical use.
Medicinal Applications 87
Action
Alterative, anthelmintic, anti-fungal, anti-parasitic, anti-rheumatic, antispasmodic,
aphrodisiac, astringent, carminative, demulcent, diaphoretic, diuretic, emmenagogue,
galactagogue, refrigerant, stimulant, stomachic, tonic
Uses
(high) blood pressure
bloody stool, urine, and
vomiting blood
breast tumors
candida
colds and flu
colic
Fevers
gastritis
indigestion
mal-absorption
mental health (moodiness, and depression)
menstrual disorders (pain, cramps, and PMS)
menopause
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 72
convulsions
diarrhoea
dysentery
dysmenorrhea
palpitation
parasites
vomiting
The decoction of the roots and tubers are excellent antidote to all poisons. A paste of
the fresh tubers applied to the breasts acts as an effective galactagogue. The root is often
used for developing high memory. This herb also harmonizes the liver, spleen, and pancreas.
3) PARPATAKA - Fumaria officinalis Linn 88-95
PLANT PART USED : Whole plant
DESCRIPTION :
The plant is of a greyish yellow colour. Leaves greenish, thick and narrow, stems
greyish yellow, one or two inches long, furrowed and rather quadrangular. Fruit capsules are
very small greyish green, slightly compressed and with a transverse ridge scar to the apex.
Flowers are irregular, asymmetrical and either violet or white, seeds small and consist of
fleshy albumin'.
PHYTOACTIVE :
The plant contains fumaric acid and fumarine. Fumarine exists in irregular 6-sided
crystals or in monocionic prisms, insoluble in alcohol, chloroform, benzol and amyl alcohol
sparingly soluble in water and soluble in ether'. Seven alkaloids have been isolated from the
alcoholic extract of whole plant.
DIRECTIONS FOR USE :
The water-soluble portion of 90% ethanolic extract of stem and leaves of F
officinalis produced a marked relaxant effect on the isolated rabbit ileum, dog's intestine in
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 73
situ and on spontaneously contracting isolated uteri of rat, and- guinea pig. It had non-
specific spasmolytic action on isolated rat arid guinea pig uterus and dog's tracheal chain.
Protopine (5 mglkg iv) the major alkaloid of the plant produced marked relaxation of
intestine in situ of anaesthetized dog without producing any effect on the blood pressure. A
rise in biliary flow occurred in the anaesthetised dog4. It is often used in common cold and.
fever and also in certain skin disorders. With black pepper it is given in jaundice. It is given
to relieve vomiting and thirst in febrile conditions.
Remedies For: Diuretic, laxative, alterative, hepatic.
Fumitory has long been used in the treatment of skin problems such as eczema and
acne. Its action is probably due to a general cleansing mediated via the kidneys and liver.
Fumitory may also be used as an eyewash to ease conjunctivitis.
CONTRAINDICATION :
LD,0 is 1.95 gm/kg in the mouse and 1.28 gm/kg in the rat. When given orally for 3
months, it has no effect on the vital organs and produced no haematological disturbances. It
stimulated respiration in both the cat and dog".
FORMULATION AND DOSAGE :
Fumitory are often combined with Burdock, Cleavers or Figwort.
1. Parpatadikwath : 5 ml. b.i.d.
2. Parpatadyarishta : 5 ml. b.i.d.
3. Parpatachurna : 1 to 2 gms. t.i.d.
4. YAVASA (DANVAYAVASA) 96
Fagoina arabia
Fagoina arabia is amongst the widely used medicinal plants in Pakistan. It is known
by common names "Azghakhi" or "Damiya" in the rural areas of NWFP. Fagoina arabica
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 74
belongs to the family Zygophyllaceae (Hooker, 1882). Generally the plant is found on dry
calcareous rocks distributed throughout the Mediterranean region to South Africa,
Afghanistan, India, Pakistan especially Sindh, Punjab and NWFP (Rizvi et al., 1996). It is
the chief and popular fever remedial source of people in the hilly areas. Its infusion is
effective in sore mouth and for cooling mouth in stomatitis and also purifies the blood and
acts as a deobstruent (Said, 1996).
People of NWFP specially used it for skin diseases, small pox and for endothermic
reaction in the body (Watt, 1972). The twigs of the plant are used as remedy to snakebite
and also applied externally as paste on tumours and for the swellings of neck.
5) SHUNTI - Zingiber officinale 97-115
Other Names:
Ginger; Ardrakam; Shunthi; Adrak; Sunth; black ginger; race ginger; African ginger; sheng jiang;
PLANT PART USED : Rhizome
DESCRIPTION :
A herbaceous rhizornatous perennial, upto 90 cm in height when fully grown. The
herb develops several lateral shoots in clumps. Leazies are 15-30 cm long and 2-3 cm broad,
with sheathiiig bases, the blade gradually tapering to a point. The rhizomes are aromatic,
thick lobed pale yellow, bearing simple alternate (listichotis narrow, oblong lanceolate
leaves.
PHYTOACTIVE:
Ginger contains 1-2% volatile oil and 5-8% resinous matter, starch and iiiucilage.
The oil of ginger is a mixture of over 24 constituents, consisting of monoterpenes
(phellandrene,'(+) carnphene, cineolc,, citral and borneol) and sesquiterpenes etc
(zingiberine, and hisabolene). The pungent component is gingerol formed in the plant from
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 75
phenylalaanine, nialoiiate and hexanoate. Minor constituents of an extract are gingreniols,
methylgingediol, gingeryldiacetates and methyl gingediacetates.
DIRECTIONS FOR USE :
Anti-inflammatory activity in carrageenin-induced rat paw oedema has been shown'.
The active principles - gingerol, and dehydrogingerdione and gingerdione were shown to be
potent inhibitors of prostaglandin synthesis'- confirming the mechanism of anti-
inflammatory effect. The antirheumatic effects were further confirmed by other inves-
tigators. Antihistaminic activity has also been shown in vitroll. The plant inhibits the virion
toxic factor production in infected chorioallantoin membrane and also inhibits the growth of
W.M. - 25d malignant cell-line. Cardiac inotropic activity has been shown in, Dogs and
guinea pigs. Ginger was shown to have significant antiemetic and antivertigo effects like
dramamine". It has been lised effectively along with Piper nigrum and Piper longum in viral
hepatitis". Ginger forms an important constituent of many Ayurvedic formula- tions. It is
chiefy used as a home remedy for nausea and dyspepsia.
Remedies For:
For over 2,500 years, ginger has been an important herb in Asian medicine.
Traditionally it has been used to promote cleansing of the body through perspiration, to calm
nausea
Action: Aromatic, carminative, stimulant to the gastro- intestinal tract, diaphoretic,
expectorant, antiemetic, and stomachic, also sialagogue and digestive; Externally, a local
stimulant and rubefacient.
Ginger is used for:
Atherosclerosis, heart diseaseChemotherapy support
ConstipationIncontinence
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 76
Migraine headachesMorning sicknessMotion sicknessNausea and vomiting following surgeryRheumatoid arthritisBelchingLaryngitisVomiting
FlatulenceColicSpasmsFeverEye diseasesAsthmaColdsCough
Digestive System Actions:
Ginger is a classic tonic for the digestive tract. Classified as an aromatic bitter, it
stimulates digestion. It also keeps the intestinal muscles toned.
This action eases the transport of substances through the digestive tract, lessening
irritation to the intestinal walls. Ginger may protect the stomach from the damaging effect of
alcohol and non steroidal anti-inflammatory drugs (such as ibuprofen) and may help prevent
ulcers.
Allergies and asthma:
Dried ginger can help in the management of allergies and asthma by offsetting the
effect of the platelet-activating factor (PAP). PAP initiates inflammatory processes in
allergy and asthma. It was found to become more active after changes in blood chemistry
that occur in a high-fat diet.
Atherosclerosis and high cholesterol:
Arthritis, bursitis, fibrocystic breasts, lymphedema, and pain. Ginger inhibits the
production of immune-system components called cytokines. These chemicals are believed to
create a long-term tendency toward inflammation.
Ginger also stimulates blood circulation. These effects of ginger are taken advantage
of in treating a number of disorders marked by swelling and pain, such as arthritis.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 77
Studies have also shown that ginger can relieve pain without the side effects
typically found when using nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.
Anti-nausea/Anti-vomiting Actions:
Research is inconclusive as to how ginger acts to alleviate nausea. Ginger may act
directly on the gastrointestinal system or it may affect the part of the central nervous system
that causes nausea. It may be that ginger exerts a dual effect in reducing nausea and
vomiting.
Parasitic infection
Ginger contains a chemical called zingibain that dissolves parasites and their eggs. In
laboratory trials, ginger extracts have been shown to kill the anisakid worm (a parasite
occasionally found in raw fish) within sixteen hours. Ginger tea is useful as a supplement in
treating schistosomiasis, a parasitic disease.
Seizure disorders
Ginger protects the body from the hepatotoxic effects of valproic acid (Depakene), a
common treatment for seizure disorders. Ginger, when used on a daily basis, was found to
improve the elevated levels of the liver enzymes alanine amino- transferase (ALT) and
aspartate aminotransferase (AST).
Action and Uses in Ayurveda and Siddha
Ginger is an important herb used in Ayurveda. Ayurveda takes advantage of the
following medicinal properties for ginger: Analgesic, anti-emetic, aromatic, aphrodisiac,
carminative, diaphorelic, digestive, expectorant, nervine, sialagogue, stimulant.
Ayurvedic practitioners consider ginger to be a truly a wonder drug, having so many
healing properties. It was called the universal medicine. Taken with rock salt it reduces
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 78
vayu; with rock candy it reduces Pitta; with honey it reduces Kapha. Thus it can be used to
influence all tridoshas.
Ginger is used in the following ayurvedic remedies: katu rasam, ushna veeryam,
vata-kapha-haram, katu- vipaka, lagu, snigdam, pachanam, ruchyam, vrishyam, swaryam,
vibhanda haram, in grahani agnimanthyam. amavatham, chardhi, swasam, soolam, arsas,
anaham, hrith-rogam, udhara rogam. It is used externally in kapha, swellings, headache.
CONTRAINDICATION :
With the recommended doses and the use as spice, side- effects are hardly reported.
With large doses of some of the active principles CNS depression has been noted in
animals".
FORMULATION AND DOSAGE :
1. Adrakkhand : 1
2. Soubhagyasunthipak : 6 - 12 gm b.i.d.
3. Rhizome powder : 0.15 - 1.5 gm b.i.d. / t.i.d.
4. Ginger juice : 2 - 4 ml b.i.d. / t.i.d.
5. Panchasamachurna : 0.75 gm b.i.d. / t.i.d.
6. Samasharkarchurna : 250 - 750 mg t.i.d.
6. KIRATATIKTA (BHUNIBHA) Swertia chirata – 116
PLANT PART USED :
The whole plant is used medicinally, but the root is said to be the most powerful part.
DESCRIPTION :
The plants is an erect herb, stems are robust 0.6-1.5 m, branching leaves are
opposite, broadly lanceolate, acute, lower leaf often much larger, sometimes petioled. Calyx
and corolla are four-lobed. Corolla green-yellow and tinged with purple 117.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 79
PHYTOACTIVE:
The main chemical constituents of this plant are ophelic acid and chiratin. The plant
also contains resins, tannin, gum, carbonates, phosphates and 4 to 6 per cent ash 118-119. A
number of workers have shown that the drug contains bitter glycosidal components, chiratin
and amarogentin, swerchirin, phytosterol, also a number of acids and phenolic compounds
120-122.
DIRECTIONS FOR USE :
Anti-inflammatory activity of Swertia chirata has been shown 123. Islam et al also
noted such activity against acute inflammation, in rat hind paw 124. Chirata is much prized in
India as a powerful bitter tonic. Unlike most other medicines of this class it does not
constipate the bowels, but tends to produce a mild laxative affect. It promotes the flow of
bile. It is used as a tonic. In gastrointestinal disorders, like dyspepsia/anorexia it is used as
digestive, febrifuge and laxative. It is particularly useful in fever as a tonic and mild
febrifuge125. It is used to prevent malaria.
Medicinal Uses Bitter tonic, stomachic, febrifuge and anthelmintic, appetizer, laxative,
alterative, antidiarrhoeic and antiperiodic.
Action & Uses in Ayurveda
Tikta-rasam, metha veeryam, lagu, ruksham. In sannipatham, swasam, kasam,
raktadosham,
CONTRAINDICATION :
With the doses used no adverse reactions have been reported. No toxic effects in
animals are shown with reasonable doses126.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 80
FORMULATION AND DOSAGE :
1. Infusion : 10 - 15 ml b.i.d.
2. Root powder : 3 - 5 gms b.i.d.
3. Mahasudarshan Churna : 2 gms b.i.d.
4. Sudarshan ghanavati : 2 gms b.i.d.
7) KUSTA Saussurea lappa 127
PLANT PART USED : Roots.
DESCRIPTION :
It is a tall, stout herb with annual stem and perennial roots. The leaves are large and
heart shaped. Roots are used in medicine, which are dug up in autumn. The roots have a
pungent taste and a characteristic fragrant aromatic odour 128.
PHYTOACTIVE :
The root of .S. lappa contains essential oils, resins, inulin, tannins, potassium nitrate
and an alkaloid, which has been named 'saussurine'. From the etheral extract of the roots, a
liquid fraction named Kushtin has been isolated 129.
DIRECTIONS FOR USE :
The essential oil has antiprotozoal effect in vitro (1 in 10,000 dilution). It also has
antibacterial effects against streptococei and staphylococci. On the isolated heart of the
rabbit, the essential oil produces positive inotropic and chronotropic effects. The alkaloid
saussurine has a smooth muscle relaxant activity. On rabbit ileum in vitro, Saussurine
antagonized the contractions produced by histamine and acetylcholine. On peripheral vessels
(perfused car vessels of rabbit) the alkaloid produced initial dilatation followed by
subsequent constriction. The alkaloid did not block the effects of adrenaline and histamine
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 81
on the vessels. On guinea-pig tracheal chain, it did relax the broncho-constriction produced
by histamine in this preparation.
On systemic administration, under experimental conditions, saussurine has a positive
inotropic action on the myocardium. It is. Used as a bronchodilator and antispasmodic, and
also in skin diseases.
Medicinal Properties: Action
alterative, anthelmintic, antiseptic, antispasmodic, aphrodisiac, aromatic, astringent,
carminative, diuretic, expectorant, insecticidal, prophylactic, stimulant, tonic
Uses
Bronchial asthma
cholera
cough
dyspepsia
edema
gas
jaundice
leprosy
phlegm
rheumatism
skin diseases
hiccup
As an ointment it is applied externally to wounds, severe ulcerations, skin diseases,
and tumours.
CONTRAINDICATION :
Maximum tolerated doses were found to be 100 mg/kg in white mice and rats
respectively 130. Clinically, gastric irritation and dizziness are occasional side effects seen
only with large doses.
FORMULATION AND DOSAGE :
As an infusion of the dried root : 20 - 30 ml b.i.d.
Agnimukha churna : 5 - 10 gms b.i.d.
Root paste : Topical use.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 82
8) PIPPALI - Piper longum Linn. 131
PLANT PART USED :
Fruit, root and stem.
DESCRIPTION :
The erect shrub has a thick, jointed and branched rootstock. Leaves are numerous,
6.3 to 9.0 cm, broadly ovate or oblong-oval, dark green and shining above, pale and dull
beneath. Fruits are present in a solitary, pedunculate, fleshy spike 2.5 to 3.5 cm long, 5 mm
thick, ovoid, oblong, erect, blunt, blackish green in colour and shining. Odour is aromatic
and the taste is pungent. 132
PHYTOACTIVE :
The fruits contain 1% volatile oil, resin, alkaloids piperine and piperlonguminine, a
waxy alkaloid N-isobutyldeca-trans-2-trans-4-dienamide and a terpenoid substance. Roots
corain piperine, piperiongumine or piplartine. Dihydrostigmasterol has been isolated 133.
DIRECTIONS FOR USE :
Antiallergic activity of the fruit has been studied 134. It effectively reduced passive
cutaneous anaphylaxis in rats and protected guinea pigs against antigen-induced
bronchospasm; a 30% protection of mast cells was observed in an in-vitro study. Both
alcoholic extract and piplartine extracted from the stems showed significant inhibition of
ciliary movements of oesophagus of frog 135. Neogi et al studied the pharmacology of
piperine.Piperine decreased the rate and amplitude of respiration and showed nonspecific
blockade of acetylcholine,histamine and 5-hydroxytryptamine induced spasm on isolated
guinea pig and rabbit intestine 136. The oil of fruit has been found to possess significant
paralytic action on the nerve-muscle preparation of A. lumbricoides 137. The hepato-
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 83
protective effect has been shown in carbon tetrachloride-induced liver damage in rats138. A
common use of the fruit is in the prevention of recurrent attacks of bronchial asthma 139.
Another important indication is in chronic malaria 140. In a study of 240 children with a long
term use of fruit 58.3% had decreased severity of attacks 141. In another study 20 children
were studied for one year with the same treatment. Eleven had no recurrence. All patients
had strongly positive skin test which became negative in 6 and decreased significantly in 12
after five weeks of treatment 142. Along with Piper nigrum and C. officinale it has been
useful in viral hepatitis 143.
Uses
Abdominal tumoursAsthmaBronchitisColdsCoughsDigestionEpilepsy
FlatulenceGoutLaryngitisParalysisRheumatic painSciaticaWorms
Medicinal Applications - Action
Analgesic, anthelmintic, aphrodisiac, carminative and expectorant.
Seed used in cough and throat pain. Root used in paralysis, epilepsy, and stiff joints.
Both seeds and root are used for cough, rheumatism, leprosy, and consumption. The herb is
also believed to improve vitality.
CONTRAINDICATION :
Piper longum is in widespread use for many centuries. The standard doses are well
tolerated. No mortality was observed with the powder of the fruit boiled in milk and water
administered orally to albino rats in a dose of 1 gm/kg;. Acute toxicity studies with piperine,
piperlongumine and piperlonguminine were carried out in mice, rat and dog with oral and
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 84
intraperitoneal route. In mice, oral LD (50) was 56.2 + 8.0, 110.1 + 7.8 and 115.3 + 9.5 mg/kg
with piperine, piper- lonigumine and piperlonguminine respectively144
FORMULATION AND DOSAGE :
1. Fruit powder : 250 mg. to 500 mg. t.i.d.
2. Pippalyasava : 20 ml. b.i.d.
3. Chousastha Pippali : 125 - 500 mg b.i.d.
9) BRUHATI - Solanum Indicum Linn 145
PLANT PART USED :
Root, fruits, seeds.
DESCRIPTION :
A much branched shrub 0.3-1.5 m high, with large prickles. Stem stout,often
purple.Branches covered with minute stellate hairs. Leaves 5-15 by 2.5-7.5 cm ovate in
outline,acute,clothed with simple hairs. Flowers in racemose extra axillary cymes,purple
coloured,clothed with darker purple coloured hairs. Fruit berry 8 mm diameter globose, dark
yellow, when ripe. Seeds minutely pitted 146.
PHYTOACTIVE :
Fruit and root contain wax,fattyacids,and alkaloids solanine and solanidine 147
DIRECTIONS FOR USE :
Few drops of water extract of the whole plant are administered through nasal route
especially on 'Pushya Nakshatra' Prostaglandin content of the endometrium from ten women
was examined before and after 3 months of the drug administration. A significant increase in
prostaglandin E and F was observed. 17-oxysteroids in the urine of women patients also
increased on exposure to a nasal spray of the drug 148.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 85
It is described as useful in asthma, dry cough, and chronic febrile afflictions and also
in dysuria. The fruit is useful in leueoderma, pruritus and bronchitis. Juice of the leaves with
fresh juice of ginger is taken to stop nausea and vomiting.
CONTRAINDICATION :
In routine doses no untoward effect is found.
FORMULATION AND DOSAGE :
1. Bruhatyadikwatha : 15 - 30 ml b.i.d.
2. Dashamulakwatha : 15 - 30 ml b.i.d.
10) GUDUCHI - Tinospora cordifolia 149
PLANT PART USED :
Root, stem, leaves, and satwa (starch).
DESCRIPTION :
This plant is a glabrous, succulent, climbing shrub, often growing very tall. It sends
down long aerial roots, which resemble roots except for nodal swellings. The bark is creamy
white to grey, deeply cleft spirally, the space in between being spotted with large rosette like
lenticels.150
PHYTOACTIVE:
Different constituents reported include a glucoside, alkaloids, bitter principles,
crystalline components etc 151-152-153-154. The glycoside-giloin, and a non-glucoside-gilenin
and gilosterol have been found 155. The bitter principles have been identified as columbin,
chasmanthin and palmarin'. The alkaloid tinosporin 156, tinosporic acid, and tinosporol have
been identified in leaves, which are rich in proteins, calcium and phosphorus. Protoberberine
alkaloids are found as trace components in many plants of Tinospora spp.
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 86
DIRECTIONS FOR USE :
Studies on induced oedema and arthritis, and on human arthritis proved the anti-
inflammatory potency of the water extract of this plant 157. Phase I and Phase II of adjutant
induced arthritis were also inhibited. The anti-inflammatory activity of this plant resembles
that of nonsteroidal anti-inflammatory agents 158-159. It also has weak antipyretc action and is
a morphine potentiatorg. It also shows we diuretic action 160. The hypoglycaemic potential
of this plant has been studied, extensively. Administration of the aqueous extract to alloxan
induced hyper- glycaemic rats and rabbits in a dose of 400 mg/kg body weight induced
reduction in blood sugar". Reduction in blood sugar levels has been reported in adrenaline
induced hyperglycaemia in rates 161, as also a favourable glucose tolerance in this rodent
species on exposure to an aqueous extract of T. cordifolia 162-163-164. The aqueous extract of
the stem antagonises the effects of agonists such as 5-hydroxy- tryptamine, histamine,
bradyklnin, and prostaglandins El and E2, on the rabbit smooth muscle. This drug relaxes
the intestinal, uterine smooth muscle and inhibits the constrictor response of histamine and
acetylcholine on smooth muscle 165. Intravenous exposure, to aqueous extract of T.
cordifolia in doses of 5.0, 10.0 and 15.0 mg/kg body weight produces a temporary but
marked fall in blood pressure and bradycardia in anaesthetised dogs. Blood urea levels in
uraemic dogs and human subjects were also decreased by this drug 166. The hepato-
protective effect of T. cordifolia extract 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 in hepatic
tissue 167. Clinically, this drug has been tried as a therapeutic modality in rheumatoid
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 87
arthritis 168-169-17-171, jaundice 172-173 and in diabetes 174. Used in compound formulations for
treatment of jaundice, rheumatoid arthritis and diabetes.
Medicinal Properties - Action
Alterative, antiperiodic, bitter tonic, diuretic, febrifuge
Uses
This herb is used in seminal weakness and urinary affections. It is also a valuable
tonic. Other applications of this herb include: fever, gout, jaundice, torpidity of the liver,
skin diseases, secondary syphilis, rheumatism, constipation, tuberculosis, and leprosy. It is a
blood purifier and may be useful in AIDS and other immune diseases also. It is also being
proposed for cancer patients before and after chemotherapy.
CONTRAINDICATION :
Found to he nontoxic in acute toxicity studies.
FORMULATION AND DOSAGE :
1. Giloy satva : 5 - 15 rati (625-1875 mg)
2. Guduchyadi tailam : Topical use.
3. Guduchyadi kashaya : 60 - 100 ml b.i.d. / t.i.d.
4. Guduchyadi churna : 1 1/2 - 3 gm b.i.d. / t.i.d.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 88
Chapter –4
Methodology
“ ishamajwara in term of modern medical terminology co-related to
malarial fever, is a protozoan disease caused by genus plasmodium and transmitted to man
by certain species of infected female anopheles mosquito. India's geographic position and
climatic conditions are favorable for the transmission of malaria. Frequently people living in
the endemic areas are prone for this infection. Out of 300-500 million clinical cases around
100 countries and one million deaths due to malarial malady are noticed globally. The 38th
world health assembly in 1985 recommended that, malaria control should be developed as
an integral part of the national primary health care systems 175-176-177.
Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset
commitment), kriya (action production of symptoms) and kala (time of appearance) and
possesses anushanga (persistence for long periods) 178-179-180. As on today, the malarial
parasite has developed resistance to chloroquine compounds, which are used vividly for the
past three decades.
Ayurvedic herbs have an important role in the treatment of malarial fever. Even the
chloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogas
have been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,
low-priced and has no proved adverse effects 181 against malarial fever.
Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charaka
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 89
mentioned Vishamajwara and Chakrapani have commented on Vishamajwara as
bhutanubanda 182. Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware183.
Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected by
microorganism) 184. Hence infected female anopheline mosquito bite can be considered as
causative factor for Vishamajwara along with other etiological factors.
Thus the present study has been under taken as “Evaluation of the efficacy of the
Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. The
Ayurvedic practitioners use Bharangyadi Ghanavati in the management of Vishamajwara,
which is explained in Sahasrayoga in Kashaya kalpana.
Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.
Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati are
having antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So the
combination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus this
combination is chosen for the present study.
Materials and Methods
Method of Collection of data
1) Patients:
Patients suffering from Vishamajwara will be selected from department of
Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi
Ayurvedic medical college and Hospital by preset inclusion and exclusion criteria.
2) Literary:
Literary aspect of study will be collected from classical Ayurvedic and modern texts.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 90
3) Study design:
Prospective clinical study
4) Sample size:
A minimum of 30 patients
5) Exclusion Criteria –
v Patient below 15 years and above 65 years of the age
v Patient with complication like severe anaemia
v Renal failure
v Pulmonary oedema,
v Jaundice
v Spleenic rupture
v Pregnant women
v Cerebral Malaria
6) Inclusion criteria –
v Age of the patients between 15 to 65 years.
v Uncomplicated malarial fever
v Peripheral smear test for M P must be positive
7) Criteria of Diagnosis
1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be
the basic diagnostic criteria.
2) Peripheral smear for MP is taken as diagnostic criteria
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 91
8) Posology-
Internal - 3 gms in divided doses
1 vati =500 mg, 2 tab thrice a day with Ushna jala
9) Study Duration:
21 days and Follow up for 15 days
10) Assessment of Result
Subjective and objective parameters are taken for the assessment of result.
11) Subjective parameters
As designated in the classical texts.
12) Objective Parameters
1. Thick and thin blood film for malaria.
2. Peripheral smear test for MP
3. Erythrocyte Sedimentation Rate (ESR)
4. Haemoglobin (Hb %)
5. Temperature chart
13) Investigations -Diagnostic and Exclusion
1. Thick and thin blood film for Malaria.
2. Peripheral smear
3. Haemoglobin (Hb %)
4. Total Count (TC)
5. Differential Count (DC)
6. Erythrocyte sedimentation rate (E S R)
7. Widal test
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 92
14) Examination of a Vishamajwara Patient vis-à-vis Malaria
History: Most patients live in or recently have travelled to an endemic area; however, a few
cases are reported each year with no history of such travel.
• Determine the patient's immune status, age, allergies, other medical conditions, other
medications, and pregnancy status.
• The patient usually remains asymptomatic for a week or more after the infecting
mosquito bite.
• Clinical symptoms include the following:
• Cough
• Fatigue
• Malaise
• Shaking chills
• Arthralgia
• Myalgia
• Paroxysm of fever, shaking chills, and sweats
• The classic paroxysm begins with a period of shivering and chills, which lasts for
approximately 1-2 hours, and is followed by a high fever. Finally, the patient
experiences excessive diaphoresis, and the body temperature of the patient drops to
normal or below normal.
• Many patients, particularly early in infection, do not present the classic paroxysm but
may have several small fever spikes a day.
• Maintain a high index of suspicion for malaria in any patient exhibiting any malarial
symptoms and having a history of travel to endemic areas.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 93
• Less common symptoms include the following:
• Anorexia and lethargy
• Nausea and vomiting
• Diarrhoea
• Headache
Physical examination:
• Physical symptoms that may be noted with malaria include the following:
• Tachycardia
• Fever
• Hypotension
• Signs of anaemia
• Splenomegaly
Causes of Malaria tested:
There are four species of the genus plasmodium responsible for the malarial parasite
infections that commonly infect man, P.falciparum, P.vivax, P.malariae and P.ovale. The
most important of these is P.falciparum because it can be rapidly fatal and is responsible for
the majority of malaria related deaths.
Malaria occurs in most tropical regions of the world with P.falciparum
predominating in Africa, New Guinea and Haiti. P.vivax is more common on the Indian sub-
continent and Central America with the prevalence of these two infections roughly equal in
Asia, Oceania and South America. P. malariae is found in most endemic areas especially
sub-Saharan Africa but much less frequently. P. ovale is relatively unusual outside Africa
although some cases are now being identified in other regions (eg. Southern States of India).
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 94
It is also important to recognise that with the relative ease and speed of modern travel and
migration, "imported" cases of malaria may present in any country. Additionally so called
"airport malaria" (see History section) has now been identified in a number of countries
including the USA, UK, Belgium, and Switzerland. Airport malaria is particularly dangerous
since Clinicians may have little reason to suspect it, if the patient has had no recent travel to
areas where malaria is endemic. This may result in a delay before the correct diagnosis is
made and which may lead to death before appropriate treatment can be initiated. Small
outbreaks of malaria may occur in countries considered free of the disease, such outbreaks
are most likely the result of an infected person entering the country asymptomatic and where
suitable mosquito vectors are present.
• Malaria most often is caused by the bite of a female Anopheles species mosquito that
is infected with 1 of the 4 species of the protozoan genus Plasmodium.
• P vivax: If this kind of infection goes untreated, it usually lasts for 2-3
months with diminishing frequency and intensity of paroxysms. Of patients
infected with P vivax, 50% experience a relapse in a few weeks to 5 years
after the initial illness.
• P ovale: These infections are similar to P vivax infections, although they are
usually less severe. A P ovale infection often resolves without treatment.
• P malariae: Those infected with this species of Plasmodium remain
asymptomatic for a much longer period of time than those infected with P
vivax or P ovale. Recrudescence is common in those infected with P
malariae. It often is associated with a nephrotic syndrome, possibly resulting
from deposition of antibody-antigen complex upon the glomeruli.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 95
• P falciparum: The most malignant form of malaria is caused by this species.
Infection with P falciparum is not limited to RBCs of a particular age and,
hence, represents the highest level of parasitemia among the 4 Plasmodium
species. This species also causes vascular obstruction due to its ability to
adhere to endothelial cell walls. This property leads to most complications of
P falciparum infection. P falciparum can cause cerebral malaria, pulmonary
edema, rapidly developing anemia, and renal problems.
• Other less common routes of infection are through blood transfusion and maternal-
foetal transmission.
Dipstick tests
In recent years a number of new techniques based on the "dipstick" format, have
become available for the diagnosis of malaria. These include the ICT-Malaria Pf, OptiMALr
and the Kat-Quick kits. The methods are based on the principle of the detection of
plasmodial histidine rich protein-2 (HRP-2) or parasite-specific lactate dehydrogenase
(pLDH) which is present in P.falciparum infections. A number of reports claim sensitivities
and specificities approaching 100% while other reports have claimed up to 6% cross
reactivity with sera positive for rheumatoid factor. Some of these "dipstick" methods have
been extended to include screening for other forms of malaria but to date results have not
been quite so impressive.
Dipstick tests have the potential of enhancing the speed and also the accuracy of
diagnosing P. falciparum, particularly in non specialised laboratories where inexperienced
or junior staff may be involved, since very little training is required for these techniques. In
this laboratory we have found the dipstick kits to be very useful screening or confirmatory
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 96
tests, especially when there is difficulty in identifying scanty ring forms in blood films. They
have proved to be particularly useful out of hours when junior, less experienced staffs have
been on duty. However dipstick methods are unable to indicate parasite load and in some
countries the cost may be prohibitive. A potential problem with these methods is that the
circulating antigen may be detected for many days (up to 2 weeks in our laboratory) after the
elimination of viable parasites from the circulation. It must therefore be remembered that a
positive test may not always be due to an active infection. We would like to emphasise, that
we regard these dipstick methods as useful additional tests to the long established method of
examining thick and thin blood films (outlined below), which is still regarded as the "gold
standard", NOT as replacement methods. The highest density of malaria occurs in countries
least able to afford sophisticated and expensive diagnostic tools.
Antibodies to malaria can be detected using enzymatic immunoassays or
immunofluorescence techniques. The antibodies to the asexual blood stages appear days to
weeks after the infection and may persist for months. Although useful in survey work or for
screening blood donors and reducing wastage, they are of little value in the "acute" malaria
situation. 185
Other methods include the QBC II System, Becton-Dickinson's Quantitative Buffy
Coat (QBC) method. This involves centrifuging the patient's blood in special capillary tubes
precoated with Acridine Orange (AO) in which parasite DNA is stained with AO. A small
precision moulded plastic float presses the parasitised red cells (which occupy the upper
most part of the red cell column) against the wall of the tube, where they can be viewed by
ultra violet light microscopy. The sensitivity of this method is claimed to be very high with
experienced users, although some reports suggest that young trophozoites of P. falciparum
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 97
and P. vivax, could not be distinguished with any degree of certainty and that confirmatory
blood films should always examined. Additionally special equipment is required, which may
preclude the method from being used in smaller centres. 186
Another relatively new method is the polymerase chain reaction (PCR) which uses a
non-isotopically labelled probe following PCR amplification. It is possible to detect <10
parasites per 10uL of blood and PCR may yet prove to be a valuable addition to the
examination of blood films for the diagnosis and specification of malaria 187. Once again the
special equipment required precludes all but the larger centres. Some researchers have
claimed that PCR (and Elisa) techniques are as sensitive as blood films, however they are
infinitely more expensive, require specialised equipment and take a longer time to complete.
Examination of a thick blood film should be the first step since this has the
advantage of concentrating the parasites by 20 fold in comparison to a thin film, although
the parasites may appear distorted making species identification difficult. If parasites are
seen then the species should be confirmed by the examination of a thin film. Ideally blood
should be collected when the patient's temperature is rising.
Preparation of thick and thin blood films: -
Thick films:- place a drop of blood in the middle of a clean microscope slide and with the
corner of a second slide spread the drop until it is about 10-15mm in diameter. The thickness
should be such that it is just possible to see news print through it. Thin films are made in the
standard manner. Allow the films to dry, do not leave on the bench in a laboratory which is
not fly proofed otherwise the film will be eaten.
When the films are dry, fix and stain the thin films in the conventional manner but be
careful about the pH of the stain, a slightly alkaline stain is recommended (pH 7.2) as an
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 98
acid stain may fail to show the parasites. When only a few thick films are to be stained it is
best to use dilute Giemsa stain (1/20), using a staining jar so that the film is in an upright
position, this will allow any debris to fall to the bottom of the jar. Do not fix the sample
prior to staining. Stains for about 30 minutes, wash gently with clean water and allowed
drying. If available use a positive control. When a large number of thick films require
staining, Field's stain is preferred because it is very quick. Field's stain comprises two
solutions; a polychrome methylene blue (A) and eosin (B). The solutions are kept in covered
staining jars.
1. Dip the dry but unfixed film into solution A for 1 or 2 seconds.
2. Remove from solution A and immediately rinse in clean water ( a 250ml beaker with
water gently flowing into it is suitable)
3. Dip the film into solution B for 1 or 2 seconds.
4. Rinse in clean water for a few seconds.
5. Place in a vertical position to dry.
If films are old or too thick the red cells may not lyse completely in the brief staining
time. If this is likely dip the film in clean water for a few seconds or until the haemoglobin
has dispersed before staining. Instructions for preparing Field's stain can be found in many
laboratory textbooks.
Under the microscope examine the thick film first, using an oil immersion or high
dry lens to determine if parasites are present. Be aware of the patient's platelet and leucocyte
counts. Malaria is usually associated with a normal or reduced leucocyte numbers. A
leucocytosis is only found in terminal cases. Platelet numbers are moderately or markedly
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 99
reduced in some 80% of patients with malaria. Parasites may appear distorted if the patient
has been treated or has had inadequate or ineffective prophylaxis.
Diagnostic points of P. falciparum:-
1. Red Cells are not enlarged.
2. Rings appear fine and delicate and there may be several in one cell.
3. Some rings may have two chromatin dots.
4. Presence of marginal or applique forms.
5. It is unusual to see developing forms in peripheral blood films.
6. Gametocytes have a characteristic crescent shape appearance.
However, they do not usually appear in the blood for the first four weeks of
infection.
7. Maurer's dots may be present.
Diagnostic points P vivax:
1. Red cells containing parasites are usually enlarged.
2. Schuffner's dots are frequently present in the red cells as shown above.
3. The mature ring forms tend to be large and coarse.
4. Developing forms are frequently present.
Diagnostic points P. Malariae:-
1. Ring forms may have a squarish appearance.
2. Band forms are a characteristic of this species.
3. Mature schizonts may have a typical daisy head appearance with up to ten
merozoites.
4. Red cells are not enlarged.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)100
5. Chromatin dot may be on the inner surface of the ring.
Diagnostic points P ovale:
1. Red cells enlarged.
2. Comet forms common (top right)
3. Rings large and coarse.
4. Schuffner's dots, when present, may be prominent.
5. Mature schizonts similar to those of P. malariae but larger and more coarse.
Lab Studies:
• Helpful studies include a CBC, electrolyte panel, renal function tests, pregnancy test,
urinalysis, urine and blood cultures, and thick and thin blood smears.
• Laboratory diagnosis in the ED may be limited in hospitals that do not have
personnel who are well acquainted with malaria or special tests for rapid detection of
the disease.
Imaging Studies:
• A chest x-ray may be helpful if respiratory symptoms are present.
• If CNS symptoms are present, a CT scan of the head may be ordered once the patient
is stable.
Other Tests:
• Microhematocrit centrifugation
• Using this method with the CBC tube is a more sensitive method of detection
of malaria infection.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)101
• However, microhematocrit centrifugation does not allow the identification of
the species of Plasmodium. To determine that species, a peripheral blood
smear must be examined.
• Giemsa-stained thick and thin peripheral blood smears
• These smears are the criterion standard for malaria detection and should be
sent to the laboratory immediately, since malaria is a potentially life-
threatening infection.
• When reading the smear, 200-300 oil-immersion fields should be examined
(more if the patient recently has taken prophylactic medication, because this
temporarily may decrease parasitemia).
• One negative smear does not exclude malaria as a diagnosis; several more
smears should be examined over a 36-hour period.
• Fluorescent dyes: Several different dyes allow laboratory results to be obtained more
quickly. These methods require the use of a fluorescent microscope.
• Polymerase chain reaction
• Polymerase chain reaction (PCR) is a very specific and sensitive test for
determining if the species of Plasmodium are present in the blood of an
infected individual.
• PCR is also very effective at detecting the Plasmodium species present in-
patients with parasitemias as low as 10 parasites/ml of blood.
• ParaSight F (dipstick test)
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)102
• This test is useful in detecting only P falciparum infections. It is based on
antibody recognition of the HRP-2 antigen of P falciparum and, in most
cases, it has been found to be as specific as microscopy studies.
• It often is able to detect P falciparum in parasitemias that are below the
threshold of reliable microscopic species identification.
• The dipstick test is not as effective when parasite levels are below 100
parasites/ml of blood, and the test rarely is negative in those with high
parasitemias. For these reasons, always confirm ParaSight F test results with
a second type of screening test.
Special Concerns:
• Pregnancy
• Pregnant women, especially primigravid women, are up to 10 times more
likely to contract malaria than nongravid women. Gravid women who
contract malaria also have a greater tendency to develop severe malaria.
• Unlike malarial infection in nongravid individuals, pregnant women with P
vivax are at high risk for severe malaria, and those with P falciparum have a
greatly increased predisposition for severe malaria as well.
• For these reasons, it is important that nonimmune pregnant women in
endemic areas use the proper prophylaxis.
• If a pregnant woman becomes infected, she should know that many of the
antimalarial and antiprotozoal drugs used to treat malaria are safe for use
during pregnancy for both the mother and the foetus. Therefore, they should
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)103
be used, since the benefits of these drugs much outweigh the risks associated
with leaving the infection untreated.
• To obtain the latest CDC recommendations for malaria prophylaxis and
treatment, call the local Anti-malarial squad.
• Paediatrics
• In children, malaria has a shorter course, often rapidly progressing to severe
malaria.
• Children are more likely to present with hypoglycaemia, seizures, severe
anaemia, and sudden death, but they are much less likely to develop renal
failure, pulmonary oedema, or jaundice.
• Cerebral malaria results in neurologic sequelae in 9-26% of children, but of
these sequelae, approximately one half completely resolve with time.
• Most anti-malarial drugs are very effective and safe in children, provided that
the proper dosage is administered. Children commonly recover from malaria,
even severe malaria, much faster than adults.
Complications:
• Most complications are caused by P falciparum, and they may include the following:
• Coma (cerebral malaria)
• Defined as coma, altered mental status, or multiple seizures with P
falciparum in the blood, cerebral malaria is the most common cause
of death in malaria patients. If untreated, this complication is lethal.
• Even with treatment, 15% of children and 20% of adults who develop
cerebral malaria die.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)104
• The symptoms of cerebral malaria are similar to those of toxic
encephalopathy.
• Seizures
• Renal failure: As many as 30% of nonimmune adults infected with P
falciparum suffer acute renal failure.
• Haemoglobinuria (blackwater fever)
• Blackwater fever is the passage of dark, Madeira-colored urine.
• Haemolysis, haemoglobinemia, and the subsequent haemoglobinuria
and hemozoinuria cause this condition.
• Noncardiogenic pulmonary oedema: This affliction is most common in
pregnant women and results in death in 80% of patients.
• Profound hypoglycaemia: Hypoglycaemia often occurs in young children and
pregnant women. It often is difficult to diagnose since adrenergic signs are
not always present and since stupor already may have occurred in the patient.
• Lactic acidosis: This occurs when the microvasculature becomes clogged
with P falciparum. If the venous lactate level reaches 45 mg/dl, a poor
prognosis is very likely.
• Haemolysis resulting in severe anaemia and jaundice
• Bleeding (coagulopathy)
Consultations:
It is recommended that the emergency physician contact an infectious disease
clinician or the pathologist when confronted with a possible case of malaria based upon
history and physical examination to ensure proper identification and diagnosis.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)105
• To aid in identification of the species of Plasmodium, also notify the pathologist of
patient information, including the following:
• Determine where the patient has travelled and when the patient returned
home.
• Determine if the patient has been diagnosed with malaria ever before. If so,
find out which species of Plasmodium caused the previous infection.
• Determine what medication or prophylaxis the patient has taken, and find out
when the last dose was administered.
• Determine if the patient has a history of blood transfusion or of non-sterile
needle usage.
• Identify the date and time that the patient's blood sample was drawn and
determine what condition the patient was in at that time (eg, patient was
symptomatic, any periodicity of symptoms).
Prognosis:
• Most patients with uncomplicated malaria exhibit marked improvement within 48
hours after the initiation of treatment and are fever-free after 96 hours.
• Only P falciparum infection carries a poor prognosis with a high mortality rate if
untreated. However, if diagnosed early and treated appropriately, the prognosis is
excellent.
Uncomplicated malaria
The presentation of uncomplicated P. falciparum malaria is very variable and
mimics that of many other diseases. Although fever is common, it is absent in some cases.
The fever is initially persistent rather than tertian (spikes of fever on alternate days, Fig. 2).
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)106
The expectation that P. falciparum malaria should have a tertian fever pattern may lead to
the diagnosis of malaria being missed with a consequent delay in treatment. The fever may
or may not be accompanied by rigors. True rigors are relatively unusual in acute falciparum
malaria.
Severe malaria (Severe falciparum malaria)
Severe malaria is caused by Plasmodium falciparum infection and usually occurs as
a result of delay in treating an uncomplicated attack of falciparum malaria. Sometimes,
however, especially in children, severe malaria may develop very rapidly. Recognizing and
promptly treating uncomplicated P. falciparum malaria is therefore of vital importance.
A patient with severe falciparum malaria may present with confusion or drowsiness with
extreme weakness (prostration). In addition, the following may develop:
• Cerebral malaria defined as unrousable coma not attributable to any other cause in a
patient with falciparum malaria.
• Generalised convulsions.
• Severe normocytic anaemia.
• Hypoglycaemia.
• Metabolic acidosis with respiratory distress.
• Fluid and electrolyte disturbances.
• Acute renal failure.
• Acute pulmonary oedema and adult respiratory distress syndrome (ARDS).
• Circulatory collapse, shock, septicaemia ("algid malaria").
• Abnormal bleeding.
• Jaundice.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)107
• Haemoglobinuria.
• High fever.
• Hyperparasitaemia.
15) Trail Drug:
The combination and proportion of Bharangyadi Ghanavati is as follows.
1. Bharangi Clerodendrum serratum 1 Part
2. Musta Cyprerus rotundus 1 Part
3. Parpatak Fumaria officinalis 1 Part
4. Yavasa (danvayavasa) Fagonia arabica 1 Part
5. Shunti Zingeber officinale roscoe 1 Part
6. Kiratatikta (Bhunibha) Swertia chirata 2 Part
7. Kusta Saussurea lappa 1 Part
8. Pippali Piper longum 1 Part
9. Bruhati Solanum indicum 1 Part
10. Guduchi Tinospora cardifolia 1 Part
15) Preparation of Yoga
All the drugs will be identified and collected from local areas. Good manufacturing
practice will be followed for the preparation of Bharangyadi Ghana Vati. All the ingredients
are pondered and powered well to powder. Powder is tabulated and preserved in bottles till
to usage.
Drug Course powder is boiled with 16 parts of water over mild fire, till the liquid is
reduced to solid part of the quantity. 188-189
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)108
Chapter-5
Resultsresent study registers 30 patients, out of 68 approached patients.
Out this, 4 patients were discontinued hence their data has not been included in the
assessment. The remaining 26 patients of Vishamajwara viz. Malaria, fulfilling the criteria
of diagnosis and inclusive criteria were included in the study.
All the patients were examined before and after the trail, according to the case sheet
format given in the annex. Both the subjective and objective criteria were recorded. The data
recorded are presented under the following headings.
A. Demographic data
B. Evaluating disease Data
C. Result of the Bharangyadi Ghanavati in Vishamajwara viz. Malaria and
D. Statistical analysis of the clinical and objective parameters
A) Demographic data:
The details of Age, Gender, Religion, and Occupation etc. of the 30 patients is as
follows.
A1) distribution of patients by Age
Age – gender distributions Observation and Results:
An interval of 10 has considered from the ages 15 to 65 as discussed in the methods.
In the study it is revealed that malarial fever is common from the ages of 15 onwards and as
age advances the samples are settled. At the older age group of 45-65 no patients are
reported. Where in 15-25 and 25-35 age groups reported with maximum number of patients,
i.e. 14 (46.7%) and 10 (33.3%) respectively. The tabulations are depicted as under.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)109
Table- 4
Distribution of patients by Age
AgeC
ured
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Tot
alpa
tient
s %
15 –25 10 33.3 0 0 3 10 1 3.33 14 46.7
25-35 5 16.7 1 3.33 2 6.67 2 6.67 10 33.3
35-45 4 13.3 0 0 1 3.33 1 3.33 6 20
45-55 0 0 0 0 0 0 0 0 0 0
55-65 0 0 0 0 0 0 0 0 0 0
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
Graph – 1
Distribution of patients by Age
DISTRIBUTION OF PATIENTS BY AGE
55-650.00%
15 –2546.67%
35-4520.00%
25-3533.33%
45-550.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)110
Out of the 15-25 category we found that, 10 (33.3%) cured patients, 3 (10 %) not
responded patients and 1 (3.33%) patient discontinued. At the 25-35 category we found that,
5 (16.7%) cured patients, 1 (3.33 %) responded patient, 2 (6.67%) not responded patients
and 2 (6.67%) patients discontinued. In the 35-45 age group it is observed that 4 (13.3%)
cured patients, 1 (3.33%) not responded and 1 (3.33%) patient discontinued. No other
groups are reported in the study.
Another observation regarding the age and gender is made in the study. It is found
that the distributions of the ages in the genders are also gender dependent. Male gender is
predominant in the study and reveals that it is 24 (80%) and the rest females are only 6
(20%). Much of the categories that are subjected to the atmosphere with out time relevance
are exposed to the Vishamajwara vis-à-vis Malaria. The tabulations are depicted as under.
Table- 5
Distribution of patients by Age- gender
Male patients Female patients Total patientsAge
Number Percentage Number Percentage Number Percentage15-25 10 33.33 4 13.33 14 46.67
25-35 10 33.33 0 0 10 33.33
35-45 4 13.34 2 6.67 6 20
45-55 0 0 0 0 0 0
55-65 0 0 0 0 0 0
Total 24 80 6 20 30 100
At the male gender 10 (33.33%) patients are of 15-25 ages, 10 (33.33%) patients
belongs to 25-35 ages and the rest of 4 (13.34%) patients are in 35-45 age category of
Vishamajwara vis-à-vis Malaria.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)111
On the other hand the female populations are well protected and are in total only
20% in the study of Vishamajwara vis-à-vis Malaria. Out of 6 patients reported 4(13.33%)
patients are of 15-25 age group and the rest 2 (6.67%) patients are in 35-45 age group. No
patients are reported from the 45-55 and 55-65 age groups of either category.
Graph –2
Distribution of patients by Age- gender
A2) Distribution of patients by Gender
The male female ratio in the study is 4:1 patients. The percentage of the distribution
does not show any gender differentiation to get this protozoan-related disease. The
observations are 24 Patients i.e. (80%) male and 6 patients i.e. (20%) were female.
As the results observed, out of 24 (80%) males, 15 (50%) patients cured, 1 (3.33%)
patient responded, 4 (13.3%) patients not-responded and 4 (13.3%) patients are discontinued
from the study. On the other hand out of 6 (20%) female, 4 (13.3%) patients’ cured and 2
Distribution of patients by Age- gender
4
0
2
0
0
0
10
4
10
0
0 2 4 6 8 10 12
15-25
25-35
35-45
45-55
55-65Female
Male
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)112
(6.67%) patients not-responded in the study of Vishamajwara vis-à-vis Malaria. The
tabulations and depictions are as under.
Table- 6
Distribution of patients by Gender
Gender
Cur
ed
%R
espo
nded
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Tot
alpa
tient
s %
Male 15 50 1 3.33 4 13.3 4 13.3 24 80
Female 4 13.3 0 0 2 6.67 0 0 6 20
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
Graph - 3
Distribution of patients by Gender
DISTRIBUTION OF PATIENTS BY GENDER
Male80%
Female20%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)113
A3) distribution of patients by Religion
Table- 7
Distribution of patients by Religion
Religion
Cur
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Tot
alpa
tient
s %
Hindu 14 46.67 1 3.33 6 20 4 13.3 25 83.33
Muslim 4 13.34 0 0 0 0 0 0 4 13.34
Christian 1 3.3 0 0 0 0 0 0 1 3.3
Others 0 0 0 0 0 0 0 0 0 0
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
Graph- 4
Distribution of patients by Religion
Distribution of patients by Religion
Christian 3.33%
Hindu83.33%
Muslim13.33%
Others0.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)114
At the results observed 25 (83.33%) Hindus, 4 (13.33%) Muslims and 1 (3.33%)
Christians are observed in the study. Out of 25 (83.33%) of Hindu patients, 14 (46.66%)
patients are cured, 1 (24%) patient responded, 6 (20%) patients not-responded and 4 (13.3%)
patients are discontinued.
On the other hand the results observed at Muslim community are, out of 4 (13.33%)
all 4 (13.33%) patients are cured. 1 (3.3%) patient of Christian is also cured in the study of
Vishamajwara vis-à-vis Malaria.
A4) Distribution of patients by Occupation
Table- 8
Distribution of patients by Occupation
Occ
upat
ion
Cur
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d%
Tot
alpa
tient
s %
Labour 9 30 0 0 5 16.7 3 10 17 56.7
Agriculturist
2 6.67 1 3.33 0 0 0 0 3 10
Service 0 0 0 0 1 3.33 0 0 1 3.33
Student4 13.33 0 0 0 0 0 0 4 13.33
Business2 6.67 0 0 0 0 1 3.33 3 10
Housewife
2 6.67 0 0 0 0 0 0 2 6.6
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
Occupations are divided in to six groups basically. They are Labour, Agriculture,
student, Service, Business and Housewives. More of the patients reported are of labour
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)115
group, as they are not well protected and also expose to the unhygienic environment. The
observations on the basis of occupation are 17 (56.7%) labour, 3 (10%) Agriculture, 4
(13.33%) Students, 1 (3.33) Service candidates, 3 (10%) Business people and 2 (6.6%)
Housewives as tabulated above.
The results of the individual groups are as follows. The major group of labourers out
of 17 patients reported, 9 (30%) cured, 5 (16.7%) responded and 3 (10%) discontinued in the
study. Out of 3 reported Agriculturists 2 (6.67%) cured and 1 (3.33%) responded. At the 4
(13.33%) of students are cured and 1 (3.33%) service candidate is not responded to the
treatment. 2 (6.67%) patients of reported Business people are cured and 1 (3.33%)
discontinued. 2 (6.67%) Housewives reported are cured. The graphical representation is as
follows.
Graph - 5
Distribution of patients by Occupation
DISTRIBUTION OF PATIENTS BY OCCUPATION
Student13.33%
House wife 6.67%
Service3.33%
Labour56.67%
Agriculturist10.00%
Business10.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)116
A5) Distribution of patients by Economic Status
The economical condition is a key for the evaluation and prognosis. At the study it
is found that distributions are falling from the very poor to rich class people. As the
economical status is permitting to have more protection the incidences are smaller and
minimal. The observations are 15 (50%) very poor, 6 (20%) poor, 5 (16.7%) Lower Middle
class, 3 (10%) higher middle class and 1 (3.33%) of rich class. The tabulation is as under.
Graph - 6
Economic status distribution Vs Vishamajwara vis-à-vis Malaria
The results based on economical status are as under. Out of the 15 very poor patients,
8 (26.7%) cured, 5 (16.7%) responded and 2 (6.7%) discontinued. At the 6 reported poor
patients, 5 (16.7%) cured and 1 (3.33%) discontinued. At the 5 Lower middle class patients,
3 (10%) cured, 1(3.33%) not responded and 1 (3.33%) discontinued. Out of 3 Upper middle
class Vishamajwara patients 2 (6.67%) cured and 1 (3.33%) not responded. One (3.33%)
Economic status distribution Vs Vishamajwara vis-à-vis Malaria
15
0
13
5
6
-4
-2
0
2
4
6
8
10
12
14
16
Very Poor Poor LowerMiddle
UpperMiddle
Rich Aristocrat
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)117
patient reported from rich class is cured. The graph depicting the victims of Vishamajwara
vis-à-vis Malaria at the economical groups is as under.
Table -9Distribution of patients by Economic status
Eco
nom
ical
stat
us
Cur
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Tot
alpa
tient
s %
VeryPoor
8 26.7 0 0 5 16.7 2 6.7 15 50
Poor 5 16.7 0 0 0 0 1 3.33 6 20
LowerMiddle
3 10 1 3.33 0 0 1 3.33 5 16.7
UpperMiddle
2 6.7 0 0 1 3.33 0 0 3 10
Rich 1 3.33 0 0 0 0 0 0 1 3.33
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
Graph-7
Distribution of patients by Economic status
Distribution of patients by Economic status
Rich 3.33%
Lower Middle16.67%
Very Poor50.00%
Poor20.00%
Upper Middle10.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)118
A6) Distribution of patients by Hygienic Condition
Hygiene is a very important factor to protect health from external invaders. The
hygiene is categorised as Good, moderate and Mild. At the study it is observed that more
people are under mild category (23 patients – 76.7%). Moderate (6 patients – 20%) and
Good (1 patient – 3.33%) hygiene’s are recorded in addition to above. The tabulation is as
under.
Table –10
Distribution of patients by Hygienic Condition
Hyg
ieni
cC
ondi
tion
Cur
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%
Tot
alpa
tient
s %
Poor 14 46.7 0 0 6 20 3 10 23 76.7
Moderate 4 13.3 1 3.33 0 0 1 3.33 6 20
Good 1 3.33 0 0 0 0 0 0 1 3.33
Total 19 63.3 1 3.33 6 20 4 13.3 30 100
As the observations reveals that out of the 23 poor hygiene people attended the
study, 14 (46.7%) cured, 6 (20%) responded and 3 (10%) patients are discontinued. At the
moderate hygiene patients we found that 4 (13.3%) cured and 1 (3.33%) responded and 1
(3.33%) discontinued. The patient from the category of good hygienic conditions maintained
reported to (3.33%) cured in the study of Vishamajwara vis-à-vis Malaria. The graphical
representation is as follows.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)119
Graph-8
Distribution of patients by Hygienic Condition
A7) Distribution of patients by Diet
Table -11
Die
t
Cur
ed
%
Res
pond
ed
% Not
Res
pond
ed
%
Dis
cont
inue
d
%T
otal
patie
nts
%
Vegetarian 3 10 0 0 2 6.67 2 6.67 7 23.3
Mixed diet 16 53.3 1 3.33 4 13.3 2 6.67 23 76.7
Total 19 63.3 1 3.33 6 20 4 13.34 30 100
Diet is an important factor of Dosha provocation and their involvement with the
subjects is to be evaluated. At the present study is noticed that maximum subjects are mixed
food i.e. 23 (76.7%) and the vegetarians are only 7 (23.3%) patients. As we observe out of 7
Distribution of patients by Hygienic Condition
Good3.33%
Poor76.67%
Moderate20.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)120
vegetarians, 3 (10%) cured 2 (6.67%) not-responded and 2 (6.67%) patients discontinued.
On the other hand of mixed food consumers 16 (53.3%) patients are cured and 1 (3.33%)
responded. 4 reported not-responded and 2 (6.67%) discontinued from the same category.
The graphical representation is as follows.
Graph-9
Distribution of patients by Diet
B) Data related to the disease.
B1) Distribution of patients by presenting complaints
Many subjective parameters in the form of presenting complaints collected in the
study. They are listed in the following table. Out of the complaints it is found that a
Pratyatma Niyata Lakshana, Aniyamita Jwara (100%) is present along with Shira shoola
(100%) and Aruchi (100%) for the all patients.
Distribution of patients by Diet
3
16
0
1
2
4
2
2
7
23
0 5 10 15 20 25
Vegetarian
Mixed diet
discotinued
Not-Reson
Responded
Cured
Total
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)121
Table-12Distribution of patients by presenting complaints
Presenting complaints Total no of patients Percentage
Aniyamita Jwara 30 100
Vepana 28 93.33
Chardi 24 80
Shira shoola 30 100
Aruchi 30 100
Parshwa shoola 6 20
Tandra 5 16.7
Swasa 4 13.33
Anidra 20 66.7
Yakrut Vruddhi 2 6.67
Pleeha Vruddhi 4 13.33
Graph –10Distribution of patients by presenting complaints
Distribution by Presenting Complaints
30
28
24
30
30
6
5
4
20
2
4
0 5 10 15 20 25 30 35
Aniyamita Jwara
Vepana
Chardi
Shira shoola
Aruchi
Parshwa shoola
Tandra
Swasa
Anidra
Yakrut Vruddhi
Pleeha Vruddhi
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)122
28 (93.33%) patients reported with Vepana (Shivering), 24 (80%) patients with
Chardi, 6 (20%) parshwashoola, 5 (16.7%) Tandra, 4 (13.33%) Swasa, 4 (13.33%) Pleeha
Vruddhi and 2 (6.67%) of Yakrut Vruddhi in the study of Vishamajwara vis-à-vis Malaria.
The tabulation of the above is depicted as under.
B2) Distribution of patients by Associated features
Table-13
Associated features Total no of patients Percentage
Trushna19 63.33
Pralapa2 6.67
Anga Gourava24 80
Glani7 23.33
Asahishnuta1 3.33
Dravamala Pravrutti0 0
The associated features of the Vishamajwara vis-à-vis Malaria are Trushna, Pralapa,
Anaga gowrava, Glani., Asahishnuta and Drava mala Pravrutti. Out of these features in
Vishamajwara vis-à-vis Malaria, it was found that the Anga Gowrava is more in 24 (80%) of
patients. The next best complaint seen is Trushna with 19 (63.33%) patients. In further 7
(23.335) Glani, 2 (6.67%) Pralapa and 1 (3.33%) Asahishnuta were found. No patient
reported with the Drava Mala Pravrutti in the study of Vishamajwara vis-à-vis Malaria. The
tabulations are shown above and the graphical representation is as below.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)123
Graph –11
Distribution of patients by Associated features
B3) Distribution of patients by type of Jwara
Table-14
Distribution of patients by type of Jwara
Type of Jwara Total no of patients Percentage
Santata (continues)4 13.33
Satata (Twice in day)17 56.67
Anyedyushka (Once in day)6 20
Truteeyaka (Alternative day)3 10
Chaturthaka (on every 4th day)0 0
Viparyaya (Truteeyaka/Chaturthaka)0 0
Total30 100
Distribution by Associated features
19
2
24
7
1
0
0 5 10 15 20 25 30
Trushna
Pralapa
Anga Gourava
Glani
Asahishnuta
DravamalaPravrutti
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)124
The Vishamajwara is one of the Jwaras mentioned from the texts. Various Acharyas
classify the Vishamajwara vis-à-vis Malaria as different. The appearance of the Vishama
Arambhata, Vaga and Kala are noted here and classified. The divisional expression is as
below. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –56.67%) are
under the Satata Variety. It was found in the study as – 6 (20%) Anyedushka, 4 (13.33%)
Santata and 3 (10%) of Truteeyaka Vishamajwara vis-à-vis Malaria. No Chaturthaka and
Viparyaya patients were reported. The graphical representation is as follows.
Graph –12
Distribution of patients by type of Jwara
B4) Distribution of patients by Pranavaha sroto dusti Lakshana
In the study of Vishamajwara vis-à-vis Malaria various Srotas are involved. One by
one Srotas involvement is explored in the study of Vishamajwara vis-à-vis Malaria. At
present the Pranavaha Srotas bears the symptoms of – Kasa, Swasa, Swasa bheda, Chardi,
Distribution of patients by type of Jwara
Chaturdhaka (on every 4th
day)0.00%
Viparyaya (Truteeyaka/Chaturdhaka)
0.00%
Anyedyushka (Once in day)
20.00%
Santata (continues)
13.33%
Satata (Twice in day)56.67%
Truteeyaka (Alternative
day)10.00%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)125
Urah Shoola and Rakta steevana. As many as 24 (80%) patients reported with chardi in
association with Kasa (4 patients – 13.33%) and Swasa (4 patients – 13.33%). No patients
are observed with the Urah shoola, Swasa bheda and Rakta steevana. The tabulation and
graph is as follows.
Table-15Distribution of patients by Pranavaha sroto dusti Lakshana
Pranavaha sroto dusti Lakshana Total no of patients Percentage
Kasa4 13.33
Swasa4 13.33
Chardi24 80
Urah shoola0 0
Swasa bheda0 0
Rakta Shteevana0 0
Graph –13
Distribution of patients by Pranavaha sroto dusti Lakshana
Distribution of patients by Pranavaha sroto dusti Lakshana
0
0
24
4
4
0
0 5 10 15 20 25 30
Kasa
Swasa
Chardi
Urah shoola
Swasa bheda
Rakta Shteevana
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)126
B5) Distribution of patients by Rasavaha sroto dusti Lakshana
Table-16
Distribution of patients by Rasavaha sroto dusti Lakshana
Rasavaha sroto dusti Lakshana Total no of patients Percentage
Aruchi30 100
Hrullasa12 40
Shareera Gourava24 80
Anidra20 66.66
Jwara30 100
Tandra6 20
Graph –14
Distribution of patients by Rasavaha sroto dusti Lakshana
Distribution of patients by Rasavaha sroto dusti Lakshana
30
6
24
30
12
20
0
5
10
15
20
25
30
35
Aruchi Hrullasa ShareeraGourava
Anidra Jwara Tandra
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)127
In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the study
by all 30 patients. 24 (80%) of patients expressed that they possess the Shareera Gowrava
and 20 patients (66.66%) Anidra. 12 (40%) patients expressed Hrullasa and 6 (20%) patients
with Tandra. The tabulations and graph is shown as above.
B6) Distribution of patients by Annavaha sroto dusti Lakshana
Table-17Distribution of patients by Annavaha sroto dusti Lakshana
Annavaha sroto dusti Lakshana Total no of patients Percentage
Aruchi30 100
Chardi24 80
Anannabhilasha0 0
Annadwesha0 0
Shoola0 0
Graph –15Distribution of patients by Annavaha sroto dusti Lakshana
30
240
0
0
0 5 10 15 20 25 30
Aruchi
Chardi
Anannabhilasha
Annadwesha
Shoola
Distribution of patients by Annavaha sroto dusti Lakshana
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)128
Annavaha Srotas is one more major Srotas involved in Vishamajwara vis-à-vis
Malaria. All patients (100%) show the Aruchi and 24 patients (80%) Chardi as Lakshana in
Vishamajwara vis-à-vis Malaria. No other categories are recorded in the study. The table
and graph is as above.
B7) Distribution of patients by Swedavaha sroto dusti Lakshana
Table-18
Distribution of patients by Swedavaha sroto dusti Lakshana
Swedavaha sroto dusti Lakshana Total no of patients Percentage
Asweda30 100
Atisweda0 0
Daha20 66.67
Romaharsha22 73.33
Graph –16
Distribution of patients by Swedavaha sroto dusti Lakshana
Distribution of patients by Swedavaha sroto dusti Lakshana
20
30
0
22
0
5
10
15
20
25
30
35
Asweda Atisweda Daha Romaharsha
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)129
In Jwara or in Vishamajwara vis-à-vis Malaria, with out involvement of the sweda
vaha Srotas the jwara doesn’t appear. The sroto dusti Lakshana dictated in Samhitas are
observed here. In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported
with Atisweda and 20 (66.66%) patients even with the Daha. 22 (73.33%) patients expressed
with Romaharsha. The tabulation and pictorial expression is shown above.
B8) Distribution of patients by Nidana
The evaluation of the disease should and must be with the Pancha Lakshana Nidana.
Out of the first one is Nidana i.e. etiological factors. The aetiology explained is as under in
the table. Out of those 26 (86.67%) Ahita Bhojana, 24 (80%) Akala Bhojana and 18 (60%)
Dustajalapana are observed, which are of dietetic in origin. 16 (53.33%) Rutu Parivartana
and 11 (36.67%) Aupasargika Karana are expressed in the study Vishamajwara vis-à-vis
Malaria. Apart from the above 19 (63.33%) Krodha and 20 (66.33%) Bhaya also
enumerated as aetiology in the study. The tabulation and graph is as follows.
Table-19
Distribution of patients by Nidana
Nidana Total no of patients Percentage
Akala Bhojana24 80
Ahita Bhojana26 86.67
Dushita jalapana18 60
Aoupasargika Karana11 36.67
Rutu parivartana16 53.33
Krodha19 63.33
Bhaya20 66.67
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)130
Graph –17
Distribution of patients by Nidana
B9) Distribution of patients by Poorva Roopa
Table-20
Distribution of patients by Poorva Roopa
Poorva Roopa Total no of patients Percentage
Jrumbha13 43.33
Aruchi30 100
Romaharsha24 80
Sahreera Guruta23 76.67
Ashrupoorna netra10 33.33
The poorvaroopa is prodromal syndrome of the disease Vishamajwara vis-à-vis
Malaria. In this common jwara conditions are observed. All (100%) show the Aruchi in the
Distribution of patients by Nidana
20
16
19
18
24
26
11
0 5 10 15 20 25 30
Akala Bhojana
Ahita Bhojana
Dushita jalapana
Aoupasargika Karana
Rutu parivartana
Krodha
Bhaya
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)131
study. Apart from 24 (80%) Romaharsha, 23 (76.67%) Shareera Gowrava, 13 (43.33%)
Jrumbha and 10 (33.33%) of Ashrupoorva netrata are found in the Vishamajwara vis-à-vis
Malaria study. The graph is as follows.
Graph –18
Distribution of patients by Poorva Roopa
C) Result of the Bharangyadi Ghanavati in Vishamajwara viz. Malaria
C1) Distribution of patients by Jwaramukta Lakshana
The assessment of the Vishamajwara vis-à-vis Malaria with Bharangyadi Ghana Vati
is done by the subjective and objective parameter assessment. But in Ayurveda
jwaramuktata is an important assessment. The jwaramukta Lakshana are enumerated in the
study of Vishamajwara vis-à-vis Malaria. It is noticed that 20 (66.67%) patients show the
Sweda pravrutti and Shareera Laghavata. 16 (53.33%) patients expressed Kshudha and 4
(13.33%) with Shira kandu, a specific Lakshana of jwara muktata. 2 (6.67%) patients show
mukhapaka and 3 (10%) with the Trushna. The observation of the jwramukta Lakshana
Distribution of patients by Poorva Roopa
10
24
13
30
23
0 5 10 15 20 25 30 35
Jrumbha
Aruchi
Romaharsha
Sahreera Guruta
Ashrupoorna netra
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)132
shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is
admissible. The table and graph is as follows.
Table-21
Distribution of patients by Jwaramukta Lakshana
Jwaramukta Lakshana Total no of patients Percentage
Sweda pravrutti20 66.67
Shareera Laghavata20 66.67
Shirah Kandu4 13.33
Mukhapaka2 6.67
Trushna3 10
Kshudha16 53.33
Graph –19
Distribution of patients by Jwaramukta Lakshana
Distribution of patients by Jwaramukta Lakshana
3
16
4
20
20
2
0 5 10 15 20 25
Sweda pravrutti
ShareeraLaghavata
Shirah Kandu
Mukhapaka
Trushna
Kshudha
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)133
C2) Evaluation of Subjective Parameters (Bharangyadi Ghanavati in Vishamajwara)
The following symptoms of the Vishamajwara are considered for the evaluation of
the cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria.
Their mean grading values are drawn periodically to assess the effect is self explanatory.
Table -22Subjective parameter Before
Treatment7th day 14th day 21stday Follow Up
Aniyamita Jwara 2.84 1.61 0.53 0.30 0.19
Vepana 0.88 0.61 0.34 0.15 0.03
Chardi 1.38 1.07 0.57 0.26 0.11
Shira shoola 1.92 1.38 0.88 0.26 0.15
Aruchi 1.0 1.0 0.7 0.46 0.11
Parshwa shoola 0.19 0.07 0.07 0 0
Tandra 0.19 0.07 0.03 0 0
Swasa 0.34 0.19 0.07 0.07 0
Anidra 1.30 0.80 0.23 0.19 0
Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03
Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03
Graph –20Aniyamita Jwara (mean) in Vishamajwara
Evaluation of Aniyamita Jwara (Mean)
0.19
0.53
2.84
1.61
0.3
-1
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
BeforeTreatment
7th day 14th day 21stday Follow Up
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)134
As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect of
the Bharangyadi Ghana Vati for a period of stipulated usage has given relief effectively and
as follow up period is advanced fall to a minimal of 0.19 expected to reach absolute
normalcy with in a short while of the follow-up.
C3) Evaluation of Objective Parameters (Bharangyadi Ghanavati in Vishamajwara)
The following objective parameters of the Vishamajwara are considered for the
evaluation of the cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-
vis Malaria. Their mean grading values are drawn periodically to assess the effect.
Table -23Objectiveparameters
Before Treatment After Treatment Difference
MP smear (Positive) 26 7 19
Haemoglobin % 9.195385 9.513077 0.317692
E.S.R 15.65385 11.11538 4.53847
Total Count 6239.038 6080.192 158.846
Neutrofils 54.92308 60.57692 5.65384
Lymphocytes 38.34615 31.5 6.84615
Eosinophil 5.653846 5.769231 0.115385
Monocytes 1.461538 1.192308 0.26923
At the above tabulation various parameters are expressed with their mean values of
baseline data to that of final data. The most important parameter Malarial Parasite smear test
is positive for the all patients those are included in the study. Out of them 19 patients
(73.07%) are MP negative at the end of the treatment. Disease prognostic factors such as
ESR and Total counts are dropped their vales to normalcy. More over the haemoglobin
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)135
percentage is improved by 0.317692 mean value. At the differential count of blood
Neutrophills and Eosinophills show marginal increase and lymphocytes and Monocytes
show marginal decrease. The mean vale table is as above.
C4) Mean temperature variances
The mean temperature variances at the intervals of 7 days are depicted here under in
the form of table and graph.
Table –24
Showing the temperatures (mean) in Vishamajwara
0th day 7th day 14th day 21st day 36th day102.3346 100.7231 99.28462 98.94615 98.86154
Graph –21
Graph the temperatures (mean) in Vishamajwara
Patients were showed significant reduction in fever on 14th day. Nearly half the
number of patients came to normal temperature and remaining patient are at grade 1 on 21st
day cure rate was attained and much changes are not observed during fallow up period.
Evaluation of Temperature in (Mean)
98.6 98.6 98.6 98.6 98.6 98.698.94615
100.7231
102.3346
99.28462
98.86154
97
98
99
100
101
102
103
0th day 7th day 14th day 21st day 36th day
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)136
During the fallow up period there was no recurrence also. Linear and slow regression of
temperature were noted
C5) Distribution of patients by Result
Table-25
Distribution of patients by Result in Vishamajwara
Result Total no of patients Percentage
Cured19 63.33
Responded1 3.33
Not Responded6 20
Discontinued4 13.34
Total30 100
The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are
declared after through assessment of the subjective objective parameters. The results for the
sake of convenience classified as Cured, Responded, Not Responded and Discontinued. Out
of these the discontinued patients are the dropouts in the study. The cured are fulfilling the
satisfactory subjective and objective criteria and must be malarial parasite smear test
negative at the end of the schedule. The responded are satisfactory at the subjective
parameters and feel comfort by all means but their MP is still positive. The Not-Responded
patients are of either of the subjective or objective criteria non-fulfilled. Based on this the
results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4
(13.34%) discontinued. The picturesque is drawn is as below.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)137
Graph –22
Distribution of patients by Result in Vishamajwara
D) Statistical analysis of the clinical and objective parameters
D1) Statistical analysis of the clinical parameters at the end of treatment (21 days)Table -26
SN
SubjectiveParameter
Mean SD SE t-Value p-Value Remarks
1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS
2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS
3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS
4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS
5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS
6 Parshwa shoola 0.231 0.514 0.1 2.31 <0.05 HS
7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS
8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS
9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS
10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS
Distribution of patients by Result
Not Responded
20.00%
Cured63.33%
Responded3.33%
Discontinued13.33%
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)138
Al the parameters except Pleeha Vruddhi after 21 days of treatment show highly
significant. The parameter jwara shows more highly significant with high mean net effect.
The shira shoola shows more variations. (By comparing t value, p-value and SD).
D2) Statistical analysis of the objective parameters at the end of treatment (21 days)
Table -27S
N
Objective
Parameter
Mean SD SE t-Value p-Value Remarks
1 Haemoglobin % 0.313 0.293 0.057 5.49 <0.001 HS
2 Total Count 399.615 393.64 77.2 5.176 <0.001 HS
3 Neutrofils 6.346 3.52 0.69 9.197 <0.001 HS
4 Lymphocytes 6.461 3.022 0.592 10.913 <0.001 HS
5 Eosinophills 0.346 0.628 0.123 2.813 <0.05 HS
6 Monocytes 0.346 0.485 0.0951 3.638 <0.01 HS
7 ESR 4.192 2.953 0.579 7.24 <0.001 HS
D3) Statistical analysis of the clinical parameters at the end of follow-up (36 days)Table -28
SN
Parameter Mean SD SE t-Value p-Value Remarks
1 Jwara 2.461 0.646 0.126 19.53 <0.001 HS
2 Vepana 0.653 0.481 0.095 6.873 <0.001 HS
3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS
4 Sjhira shoola 1.576 1.0265 0.201 7.84 <0.001 HS
5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS
6 Parshwa shoola 0.230 0.514 0.1 2.3 <0.05 HS
7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS
8 Swasa 0.192 0.567 0.111 1.729 >0.05 NS
9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS
10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)139
All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high
significance. Assume that the drug is not responsible in curing the disease, to test the
hypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita Jwara shows more
significance than the others. The mean net effect of Aniyamita Jwara in subjective
parameters is more and the Yakrut Vruddhi is less in mean net effect.
The parameter Aruchi shows units mean net effect with zero variations i.e. response
in all patients of before to after study. The parameters Aruchi after the treatment have zero
variations. The parameter Chardi, have more net variation but kampa have less net effect.
The mean effect of the subjective parameters of Vishamajwara is more after the
treatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi having uniform
effect (by comparing mean SD and coefficient of variations) for the to know the effect of
drug after the 7 days of treatment. The Aniyamita Jwara again shows high significance with
more net mean effect.
The aruchi shows no significance with net less variation and with less net mean
effect as shown in the above table.
Among the objective parameters ESR shows high significance than the others, but
there is a least variation in haemoglobin percentage. Among the DC, lymphocytes show
more (high) significance than the others. The nets mean effect in Nutrophils is more with
more variation. But the Eosinophils and Monocytes have equal mean net effect with
difference in the variations (by comparing the “t” and “p” values).
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)140
Chapter –6
Discussion“ ever is unwanted rise in body temperature either because of disturbed
internal environment or invasion of exogenous origins. Vishamajwara, a most popular
Ayurvedic term in turn of modern medical terminology co-related to malarial fever, is a
protozoan disease caused by genus plasmodium and transmitted to man by certain species of
infected female anopheles mosquito. India's geographic position and climatic conditions are
favourable for the transmission of malaria.
The emergence of multiple-drug resistant strains of malaria, which has accompanied
each new class of anti-malarial drugs, is one of most significant threat to the health of people
in tropical countries.
Resistance, synergism and traditional medicines
Medical science is beginning to recognise aspects of synergy, complexity and
potentiation in malaria therapy. At the same time, little significance is as yet being given to
the obvious point that all of the major anti-malarial have been derived from plants, often
based on traditional knowledge about the effects of the plants against fever, or specifically,
malaria.
Elsewhere, synergism has been observed between the alkaloids of the anti-malarial
plant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-
parasitic activity than any of the six alkaloids isolated subsequently. In Uganda, there is data
from clinical case reports that a traditional Ugandan herbal remedy is effective against
malaria.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)141
Utilisation of traditional medicine is widespread in developing countries and the
efficacious of many traditional treatments have been well documented, including in skin
disease, malaria and other disorders.
The research initiative for traditional anti-malarial methods (RITAM)
It is the Research Initiative for Traditional Anti-malarial Methods (RITAM). Many
people live in malarious regions, traditional herbal medicines may be the only course of
treatment available. Plants are usually identified for study on the basis of a traditional
reputation for effectiveness, usually for treating or preventing malaria and other fever related
conditions.
Clinical development in Indian Systems of Medicine & Homoeopathy
The Indian Systems of Medicine & Homoeopathy is popular in a large number of
States in the country. Ayurveda, Homeopathy, Unani, Yoga & Naturopathy and Siddha
systems together called as Indian Systems of Medicine.
Drug resistance to chloroquine in P. falciparum was reported in India for the first
time from Assam in 1973. Sulphadoxine-pyrimethamine, a second line drugs for P.
falciparum is not effective for P. vivax malaria. Development of new drugs involves
extensive pre clinical and toxicological studies followed by well-planned clinical trials.
Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extract of
bark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata
(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seed
pulp–3 parts).
Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to
pacify the Jwara, especially Vishamajwara. The jwara called as fever may not be a big
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)142
problem from the contemporary but as par Ayurveda it is a primary symptom and a disease
also some times a complication. Ayurvedic herbs have an important role in the treatment of
malarial fever. In the treatment of Vishamajwara many yogas have been explained in
Ayurveda.
Vishamajwara vis-à-vis Malaria
Ayurveda has a significant name. The symptoms of this type resemble with the
malarial fever of present discussion. Malaria is a protozoal disease transmitted by the
Anopheles mosquito, caused by minute parasitic protozoa of the genus Plasmodium, which
infect human and insect hosts alternatively. It is a very old disease and prehistoric man is
thought to have suffered from malaria. WHO declared Australia free of malaria in 1981,
however since that time 9 patients have contracted locally acquired malaria. The exception
is falciparum malaria where the parasites multiply very rapidly and may occupy 30% or
more of the red blood cells causing a very significant level of haemolysis.
Malaria or a disease resembling malaria has been noted for more than 4,000 years.
The symptoms of malaria were described in ancient Chinese medical writings. A number of
Roman writers attributed malarial diseases to the swamps. Vedic literature possesses many
more references of this condition as Vishamajwara. Discovery of the Malaria Parasite in
1880 by Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,
Algeria, was the first to notice parasites in the blood of a patient suffering from malaria. An
American, William H. Welch, reviewed the subject and, in 1897, he named the malignant
tertian malaria parasite, P. falciparum. In 1922, John William Watson Stephens described
the fourth human malaria parasite, P. ovale. On August 20th, 1897, Ronald Ross, a British
officer in the Indian Medical Service, was the first to demonstrate that malaria parasites
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)143
could be transmitted from infected patients to mosquitoes. In further work with bird malaria,
Ross showed that mosquitoes could transmit malaria parasites from bird to bird. This
necessitated a sporogonic cycle (the time interval during which the parasite developed in the
mosquito). Thus, the problem of malaria transmission was solved.
Vishamajwara
The disease Vishamajwara is included under the jwara roga in Ayurveda.
Vishamajwara characterised by visamarambha (irregular onset).
Atharva Veda described the following types of Vishamajwara. It is a clear picture of
Vishamajwara of malarial origin. Susruta considered that the Vishamajwara occurs due to
Tridosha but Vata is the dominant Dosha. Vagbhata defined Vishamajwara, as the jwara is
irregular in respect to its onset, suffering and symptoms. According to Hareeta the
Vishamajwara is five types such as vataja, ekaikajwara, dwahieka jwara, triahika jwara,
chaturthakjwara. Dalhana consider bhutas responsible to produce Vishamajwara. Jejjata
considered Vishamajwara as tridoshaja in origin.
Malaria Control program
An organised and effective malaria control program stemmed from this new
authority in the Tennessee River valley. Controlling water levels and insecticide applications
reduced Mosquito breeding sites. DDT was used for malaria control at the end of WWII
after it had proven effective against malaria-carrying mosquitoes by British, Italian, and
American scientists.
Atypical fever - Malaria
Some patients may not have fever at all and may present with other symptoms listed
below. Many present with fever of various patterns - low grade to high grade, with or
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)144
without chills, intermittent to continuous, or even as cases of prolonged fever. As the disease
progresses, these broods get synchronised and the fever tends to be more uniform. However
in cases of P. falciparum malaria and mixed infections, this pattern of multiple spikes may
continue. The other symptoms are
Headache, dizziness or vertigo, with or without fever, may present with altered
behaviour, mood changes, hallucinosis or even acute psychosis. Due to severe infection,
hypoglycaemia, electrolyte imbalance - due to vomiting or diarrhoea (particularly the
elderly), subclinical convulsions etc. are also found in malarial fever. Cough may be a
presenting feature of malaria with severe anaemia can be a presenting feature of malaria.
Secondary infections:
Malaria produces significant immune suppression and this can result in secondary
infections. Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does not
rule out the possibility of malaria.
Vishamajwara and Ayurveda
The vitiated Dosha after localising in Dhatus of the body are responsible to produce
diseases. Besides all the factors Pitta plays an important role for producing jwara. In
Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other jwara, they
spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the different
Vishamajwara such as Santata jwara, Satata jwara, Anyedushka jwara, Triteeyak jwara,
Chaturthak jwara and Chaturthakviparyaya jwara. The Vishamajwara due to Kapha is
difficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are less
powerful. The aggravated doshas interacts Rasa and other Dhatu and ultimately produces
Vishamajwara. The heavy Doshas spread all over the body through the channels carrying
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)145
Rasa and stiffened and give rise to santata jwara (remittent fever). Considering all this, the
physician should treat the case of fever.
Drug discussion
The combination of the compound drug “Bharangyadi Ghana Vati” is discussed in
the literature. The collective properties of the Bharangyadi Ghana Vati with its probable
mode of action are discussed here. The following table describes the pharmacological
properties of the individual components.
Table –29
Describing the pharmacological properties of Bharangyadi Ghana Vati
Name of the
ingredient
Rasa Guna Veerya Vipaka Prabhava
1) Bharangi190-195
Tikta, KatuKashaya
Laghuruksha
Ushna Katu JwaraharaPeenasaharaKasaswasaharaShodhaghna
2) Musta196-201
Tikta, KatuKashaya
Laghuruksha
Sheeta Katu JwaraharaKrumiharaDeepanapachaka
3) Parpatak202-207
Tikta Laghusangrahi
Sheeta Katu JwaraharaRaktadoshaharaBhramaharaTrushnahara
4) Yavasa208-213
Tikta, Kashaya,Madhura
Laghu Sheeta Katu JwaraharaChardiharaBhramaharaTrushnahara
5) Shunti214- 219
Katu Guru,rooksha,tikshna
Ushna Katu Kapha haraAmavataharaHrudrogaharaGrahiPanduhara
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)146
Name of theingredient
Rasa Guna Veerya Vipaka Prabhava
6) Kiratatikta220- 225
Tikta Laghu,Rooksha
Ushna Katu JwaraharaVranaharaKrumighnaRaktadoshaharaTrushnaghanaSwasaghnaKasaghnasannipatajwarahar
7) Kusta226- 231
Tikta, Katu,Madhura
Laghu,rooksha,Teekshna
Ushna Katu RaktadoshaharaKustaghnaKasaghna
8) Pippali232- 237
Katu Laghu,Snigdha,tiksshna
Anushnasheeta
Madhura VatakaphaharaYogavahiDeepanaPachanaRechanaUdarahara
9) Bruhati238- 243
Katu, Tikta Laghu,Rooksha,teekshna
Ushna Katu JwaraharaKasaswasaharaAgnimandyaharaKustaghna
10) Guduchi244- 249
Tikta, Kashaya,Katu, Madhura
Guru,Snigdha
Ushna Madhura JwaraharaMootrakruchraharaHrudrogaharaTridoshaharaDeepakaSangrahiRasayanaPanduharaKamalaharaChardiharaAmahara
Table –30
Describing the Chemical constituents and Indications of individual components of
Bharangyadi Ghana Vati
Name of theingredient
Chemical constituents Indications Preparations
1. Bharangi Hispidulin 7.0 gluco-caronides, Scutellarrin,uncinatone, pctolinarigenin
Jwara, Swasa, kasa,shotha, krini, daha,peenasa
Bharangyadikwatha,bharangyadi guda
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)147
2. Musta Cineol +, copadiene,copaene, cyperen I & II,cypernone, isopathoulenone,cypertoperotundone, etc
Jwara, krimi, trushna,Atiusara, kandu, kasa,nidra nasha, Raktavikara etc
Musta rishta,mustadi kasaya,mustadi vati,shadungapaneeya
3. Parpataka Adlumidiceine (-)- adlumine,(+) bisculline, cocharinecoptisine, cryptopine,fumaromine, laharmine,parfemdine etc
Jwara, trushna, Bhrama,mada, Rakta Pitta,Atisara, charadi etc
Sadanga paneeyaparpatadyarista
4. Yavasa Galacto, catechin+catechin(-), epigallocatechin, andleucodelphnidin, B –phenethylamine etc
Jwara, kase, Raktapitta,trishna, medaroga,chardi brama, kusta etc
Agasthyavaleha,khatiradigutika,yasa sarkara,vasagrita,kalasyadi grutha
5. Shunti Dry Ness 80.9, protein 2.6,fat 0.9, fibre 2.4,carbohydrate 12.3, metals1.2%, calcium 20,phosphorus 60, iron 2.6 mg,each 100 gm other then theseiodine chlorine are alsopresent vitamin A,B,C arealso present
Jwara, Hrudourbaya,hrutshoola, shlipadha,shotha, amavata ,sheethaPitta, pandu, Atisara,kasa Swasa, Agnimamdhya etc
Ardrakakhand,panchasamaChurna,samasharkaraChurna, rasnadikwatha,soubhagyashunthi , shunthisura
6. Kiratatikta Amarogentin, gentiopicrin,isobellicifolin, decussatin,chiratol, swerchirin, 7-0methyl swertianin mangiferin, swertianin, kairatinolswertanone etc
Sanepata jwara, RaktaPitta, arsas, krimi, kusta,vruna, shotha, trishna,daha etc
Kiratadi kwata,sudharsanaChurna,kiratitiktadiChurna,kiratarista etc
7. Kusta Essential oil, castol ,taraxasterol, dehydrocostuhactone, sistosterol, ar-cuscumene, isodihydrocostuslactone costus– lactone etc
Jwara, kusta, hikka,kasa, prasava shoola,hrudroga, visarpa,kandu, Vata Rakta
Kustadi taila,kustadi curna,kusta rasayanam
8. Pippali Volatile oil – 0.8%Piperine – 4-5%Pipalatine and sesamine andpiplasterol- 0.15- 0.18% andpipalartin-0.13-0.20% piperlanguminon, steroid,glycoside
Hrudhadourbalya,pandu, raktavikara, kasa,Swasa, aruchi, Agnimandhya, kshata, jwara.
Guda pippali,pippali khada,pippalyasava,yakartlihari loha,yakrt pippaladiyoga.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)148
9. Brahati Glycoside, alkaloid, solanine,dulcunarin, carotene,carpesterol, solonocurpone,disogenin, solasodine, vit – Cetc
Jwara, Swasa, hrdroga,shoola, chardi, kushta,kandu, krimi etc
Brihatyadikasaya,pipapalyadi leha,dashamoolarista
10. Guduchi Tinosporide, cardifalide,tnosparidine, B- sitosterol,cardifol heptacosanol,octacasanol, magnoflarine,palmatine.
Jwara, trishna,Vatarakta, pandu,kamala, chardi, krimi,kandu, kasa, bhrama,jwaravyadhi
GuduchadiChurna,Guduchadikwata,amritarista,amrithadi,chandraprabhavati,PanchaTiktaGuggu grutametc
From the above tabulations, it is clear that the individual components of the
Bharangyadi Ghana Vati are effective antipyretic and also acts efficiently over the areas of
co-morbidity.
As all ingredients are “Jwaraghna” in its property, there is no discussion of doubt
about the embedded active principles of the individual components. Still it is a bound duty
to discuss its mode of action with regard in this concern.
Cumulative action of Bharangyadi Ghana Vati based on Rasa
The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa in
association with that of Katu Rasa. The other two Rasa dominant in the compound are
Kashaya and Madhura.
If the composition is to be brought in the form of formula it can be stated as - Tikta 8
Katu 7 Kashaya 4 Madhura 3. The main functions of the Tikta Rasa are – Soshaka,
Kantashodhaka and Prahladanakara. As the fundamental components are of Vayu and
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)149
Pruthvi Mahabhuta it possesses the Ruksha, Sheeta and laghu Guna, there by acts as Pitta
shamaka and Kapha shamaka.
Here in this topic of discussion it is very much needed as the disease basically a Pitta
dominant. The Rasavahasrotas and Rasa Dhatu, which are, predominant dushyas in
Vishamajwara subjects for the soshana (drying) under the influence of the Tikta Rasa. Thus
the importance of the Tikta Rasa in association with the other Rasa in the pacification of the
Vishamajwara is substantiated.
Cumulative action of Bharangyadi Ghana Vati based on Veerya
The components are with the Ushna Veerya in 60% and Sheeta in 30% and anushna
Sheeta in 10%. It is said as the Ahara Dravyas are of Rasa pradhana and the Aushadha
Dravyas are of Veerya pradhana.
Apart form the prabhava, which is a most important factor of the medicine, the
Veerya needs the discussion. The Bharangyadi Ghana Vati, with the 60% Ushna Veerya in
it, in a disease which is predominant with the Pitta Dosha (Agneya tatwa) is a pint of
discussion.
Here the Ushna Veerya Dravyas are specifically sweda janaka pravartakas by nature.
The swedavarodhata is the pratyatma niyata Lakshana of the jwara. Thus the
swedavarodhata is passified by the Ushna veeraya Dravyas and there by facilitates the
thermal regulations in the body.
As the thermo regulatory functions withstands the normal functions of the Pitta are
resumed. There by the deeptagni, Ama pachana etc, are visualised in the body.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)150
Cumulative action of Bharangyadi Ghana Vati based on Prabhava
Any compound action is difficult to assess with out noting the individual prabhava of
the Dravya. At the same time out of any compound medicine few are of prime and rest as
supportive.
In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and Kirata
tikta. The rest of the components are also have the Jwarahara prabhava. Thus the cumulative
action is a perfect Jwaraghna with the Bharangyadi Ghana Vati is witnessed.
As we see the prime drug – Bharangi, on which the name of the medicine is named
Bharangyadi Ghana Vati, has the specific Jwarahara (Anti-pyretic) Property in association
with the upper respiratory tract pacifying principles such as Peenasahara, Kasahara,
Swasahara and Shothahara. These are the relative areas of the disease predisposing and the
regulating the air hunger at the time of temperature rise makes the Pitta pacification along
with the Kapha.
The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in the
Vishamajwara needs pacification through medication. The Parpataka and Kusta are such
herbs embedded with the Raktadoshahara property. Parpataka in association is a
Bhramahara and Trushnahara. In the jwara trushna appears because of the water evaporation
due to BMI rise or the temperature rise.
This is nullifies by the parpataka. The second herb is Kusta, which is a Kasa and
Kusta hara. Kusta is a Rakta vikara, and any invasions over Rakta are capable of vitiating
Rakta. Apart from these the main function which is impaired at the Jwara is temperature rise
is a factor associated with the Twacha i.e. skin and it is a adhistana of the Kusta. Thus the
action over Twak is substantiated here. Bruhati is another herb, which is acting over the
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)151
skin area as kustaghna. Yavasa is chardihara, there by it pacifies the nausea of
Vishamajwara.
Shunti is Kapha hara, Amavatahara, Hrudrogahara, Grahi and Panduhara. Guduchi
is Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi,
Rasayana, Panduhara, Kamalahara, Chardihara and Amahara. Out of these herbs the
common of common is panduharatwatam. In Vishamajwara it is observed that the Rakta
Dhatu is vitiated and the destruction of the Rakta is witnessed. The destruction of the Rakta
leads to pandu in Vishamajwara and there by hepato-speenomegale is appeared. To rule out
the organomegale the Guduchi and sunti are used.
A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio-
availability of the drug to deep tissues faster and faster. Thus the association of the Pippali
makes that the drug acts faster in Vishamajwara and by its Rechaka property pacifies the
Pitta, which is a dominant Dosha in the pathogenesis of the Vishamajwara. Apart from the
Pippalai is Deppana and Pachaka Dravya thus the rectification of the Agni takes place.
Another important property of Guduchi is Rasayana along with Jwarahara,
Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi, Panduhara,
Kamalahara, Chardihara and Amahara properties. The disease penetrates in to the deep
tissues as it takes the different shapes of Vishamajwara. The Rasayana property of the
Amruta in association with the anti-pyretic property makes the sense at the management of
the Vishamajwara.
Krimiharatwa of Bharangyadi Ghana Vati based
In this combination we found Musta and Kiratatikta, as the Krimihara. The
probability of the action of these over the invaded malarial parasite is to be studied at
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)152
laboratory in vitro. Apart from Krimihara property Musta is even deepana and pachana
Dravya, there by it acts over Annavahasrotas and Agni. Kiratatikta is such a wonderful drug,
it has Jwarahara, Vranahara, Krumighna, Raktadoshahara, Trushnaghana, Swasaghna,
Kasaghna and sannipatajwaraharatwa as specific.
Cumulative action of Bharangyadi Ghana Vati based on chemical composition
v The antipyretic activity of Musta was demonstrated on pyrexia induced by
Brewers' yeast in albino rats'.
v Antibacterial activities of Musta oil and its fractions have been demonstrated
against a number of organisms'.
v People of NWFP specially used Yavasa for skin diseases, small pox and for
endothermic reaction in the body.
v Sunti was shown to have significant antiemetic and antivertigo effects like
dramamine". It has been listed effectively along with Piper nigrum and Piper
longum in viral hepatitis". Ginger forms an important constituent of many
Ayurvedic formula- tions. It is chiefy used as a home remedy for nausea and
dyspepsia.
v The hepato-protective effect of pippali has been shown in carbon tetrachloride-
induced liver damage in rats. A common use of the fruit is in the prevention of
recurrent attacks of bronchial asthma. Another important indication is in chronic
malaria.
v The hepato-protective effect of Guduchi extract has been studied in carbon
tetrachloride induced liver damage in rats.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)153
v Sunti contains a chemical called zingibain that dissolves parasites and their eggs.
In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a
parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful
as a supplement in treating schistosomiasis, a parasitic disease.
v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution).
It also has antibacterial effects against streptococei and staphylococci.
Observation of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
Present study registers 30 patients, out of 68 approached patients. Out this, 4 patients
were discontinued hence their data has not been included in the assessment. The remaining
26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive
criteria were included in the study.
Demographic data of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
v The male female ratio in the study is 4:1 patients. The percentage of the
distribution does not show any gender differentiation to get this protozoan-
related disease.
v More of the patients reported are of labour group, as they are not well protected
and also expose to the unhygienic environment.
v The economical condition is a key for the evaluation and prognosis. At the study
it is found that distributions are falling from the very poor to rich class people.
As the economical status is permitting to have more protection the incidences are
smaller and minimal.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)154
v At the study it is observed that more people are under mild category (23 patients
– 76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s
are recorded in addition to above.
v At the present study is noticed that maximum subjects are mixed food i.e. 23
(76.7%) and the vegetarians are only 7 (23.3%) patients.
Subjective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and
classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –
56.67%) are under the Satata Variety.
v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita
Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for
the all patients.
v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that
the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen
is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%)
Pralapa and 1 (3.33%) Asahishnuta were found.
v As many as 24 (80%) patients reported with chardi in association with Kasa (4
patients – 13.33%) and Swasa (4 patients – 13.33%).
v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the
study by all 30 patients and 24 (80%) of patients expressed that they possess the
Shareera Gowrava.
v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with
Atisweda and 20 (66.66%) patients even with the Daha.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)155
v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera
Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana
shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-
vis Malaria is admissible.
v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the
effect of the Bharangyadi Ghana Vati for a period of stipulated usage has given
relief effectively and as follow up period is advanced fall to a minimal of 0.19
expected to reach absolute normalcy with in a short while of the follow-up.
Objective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
v At the above tabulation various parameters are expressed with their mean values
of baseline data to that of final data. The most important parameter Malarial
Parasite smear test is positive for the all patients those are included in the study.
Out of them 19 patients (73.07%) are MP negative at the end of the treatment.
Disease prognostic factors such as ESR and Total counts are dropped their vales
to normalcy. More over the haemoglobin percentage is improved by 0.317692
mean value. At the differential count of blood Neutrophills and Eosinophills
show marginal increase and lymphocytes and Monocytes show marginal
decrease. The mean vale table is as above.
v Patients were showed significant reduction in fever on 14th day. Nearly half the
number of patients came to normal temperature and remaining patient are at
grade 1. On 21st day cure rate was attained and much changes are not observed
during fallow up period. During the fallow up period there was no recurrence
also. Linear and slow regression of temperature were noted.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)156
Result of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
v The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are
declared after through assessment of the subjective objective parameters. The
results for the sake of convenience classified as Cured, Responded, Not
Responded and Discontinued. Out of these the discontinued patients are the
dropouts in the study. The cured are fulfilling the satisfactory subjective and
objective criteria and must be malarial parasite smear test negative at the end of
the schedule. The responded are satisfactory at the subjective parameters and feel
comfort by all means but their MP is still positive. The Not-Responded patients
are of either of the subjective or objective criteria non-fulfilled. Based on this the
results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and
4 (13.34%) discontinued respectively.
Mean effect of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria
v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high
significance. Assume that the drug is not responsible in curing the disease, to test
the hypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita
Jwara shows more significance than the others. The mean net effect of Aniyamita
Jwara in subjective parameters is more and the Yakrut Vruddhi is less in mean
net effect.
v The parameter Aruchi shows units mean net effect with zero variations i.e.
response in all patients of before to after study. The parameters Aruchi after the
treatment have zero variations. The parameter Chardi, have more net variation
but kampa have less net effect.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)157
v The mean effect of the subjective parameters of Vishamajwara is more after the
treatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi
having uniform effect (by comparing mean SD and coefficient of variations) for
the to know the effect of drug after the 7 days of treatment. The Aniyamita Jwara
again shows high significance with more net mean effect.
v The aruchi shows no significance with net less variation and with less net mean
effect as shown in the above table.
v Among the objective parameters ESR shows high significance than the others,
but there is a least variation in haemoglobin percentage. Among the DC,
lymphocytes show more (high) significance than the others.
v The nets mean effect in Nutrophils is more with more variation. But the
Eosinophils and Monocytes have equal mean net effect with difference in the
variations (by comparing the “t” and “p” values).
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)158
Chapter – 7
Conclusion
v Utilisation of traditional medicine is widespread in developing countries and the
efficacious of many traditional treatments have been well documented, including
in skin disease, malaria and other disorders.
v Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to
pacify the Jwara, especially Vishamajwara. Ayurvedic herbs have an important
role in the treatment of malarial fever.
v Malaria or a disease resembling malaria has been noted for more than 4,000 years.
The symptoms of malaria were described in ancient Chinese medical writings.
v In 1922, John William Watson Stephens described the fourth human malaria
parasite, P. ovale. In further work with bird malaria, Ross showed that mosquitoes
could transmit malaria parasites from bird to bird.
v The disease Vishamajwara is included under the jwara roga in Ayurveda.
Vishamajwara characterised by visamarambha (irregular onset).
v It is a clear picture of Vishamajwara of malarial origin. Dalhana consider bhutas
(Keetanu – Parasites) responsible to produce Vishamajwara.
v Jejjata considered the Vishamajwara is as tridoshaja in origin.
v Cough may be a presenting feature of malaria with severe anaemia can be a
presenting feature of malaria.
v Malaria produces significant immune suppression and this can result in secondary
infections.
v Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does not rule
out the possibility of malaria.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)159
v In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other
jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the
different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara,
Triteeyak jwara, Chaturthak jwara and Chaturthak jwara. The aggravated doshas
interact Rasa and other Dhatu and ultimately produces Vishamajwara.
v The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa in
association with that of Katu Rasa.
v Present study registers 30 patients, out of 68 approached patients. The remaining
26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and
inclusive criteria were included in the study.
v In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and
Kirata Tikta. The rest of the components are also have the Jwarahara prabhava.
Thus the cumulative action is a perfect Jwaraghna with the Bharangyadi Ghana
Vati is witnessed.
v Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka,
Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and Amahara Dravyas
are used in the Bharangyadi Ghana Vati.
v The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in the
Vishamajwara needs pacification through medication.
v The destruction of the Rakta leads to pandu in Vishamajwara and there by hepato-
speenomegale is appeared. To rule out the organomegaly the Guduchi and sunti
are used.
v A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio-
availability of the drug to deep tissues faster and faster. Thus the association of the
Pippali makes that the drug acts faster in Vishamajwara and by its Rechaka
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)160
property pacifies the Pitta, which is a dominant Dosha in the pathogenesis of the
Vishamajwara.
v Apart from all Deppana and Pachaka Dravyas are used for the rectification of
Agni.
v In this combination we found Musta and Kiratatikta, as the Krimihara. The
probability of the action of these over the invaded malarial parasite is to be studied
at laboratory in vitro.
v The antipyretic activity of Musta was demonstrated on pyrexia induced by
Brewers' yeast in albino rats'.Antibacterial activities of Musta oil and its fractions
have been demonstrated against a number of organisms'.
v Sunti was shown to have significant antiemetic and antivertigo effects like
dramamine". It has been listed effectively along with Piper nigrum and Piper
longum in viral hepatitis". Ginger forms an important constituent of many
Ayurvedic formula- tions. It is chiefy used as a home remedy for nausea and
dyspepsia.
v The hepato-protective effect of pippali has been shown in carbon tetrachloride-
induced liver damage in rats. A common use of the fruit is in the prevention of
recurrent attacks of bronchial asthma. Another important indication is in chronic
malaria. The hepato-protective effect of Guduchi extract has been studied in
carbon tetrachloride induced liver damage in rats.
v Sunti contains a chemical called zingibain that dissolves parasites and their eggs.
In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a
parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful
as a supplement in treating schistosomiasis, a parasitic disease.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)161
v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution). It
also has antibacterial effects against streptococci and staphylococci.
v The male female ratio in the study is 4:1 patients. The percentage of the
distribution does not show any gender differentiation to get this protozoan-related
disease.
v More of the patients reported are of labour group, as they are not well protected
and also expose to the unhygienic environment.
v The economical condition is a key for the evaluation and prognosis. At the study
it is found that distributions are falling from the very poor to rich class people. As
the economical status is permitting to have more protection the incidences are
smaller and minimal.
v At the study it is observed that more people are under mild category (23 patients –
76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s are
recorded in addition to above.
v At the present study is noticed that maximum subjects are mixed food i.e. 23
(76.7%) and the vegetarians are only 7 (23.3%) patients.
v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and
classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –
56.67%) are under the Satata Variety.
v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita
Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for
the all patients.
v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that
the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)162
is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%)
Pralapa and 1 (3.33%) Asahishnuta were found.
v As many as 24 (80%) patients reported with chardi in association with Kasa (4
patients – 13.33%) and Swasa (4 patients – 13.33%).
v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the
study by all 30 patients and 24 (80%) of patients expressed that they possess the
Shareera Gowrava.
v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with
Atisweda and 20 (66.66%) patients even with the Daha.
v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera
Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana
shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis
Malaria is admissible.
v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect
of the Bharangyadi Ghana Vati for a period of stipulated usage has given relief
effectively and as follow up period is advanced fall to a minimal of 0.19 expected
to reach absolute normalcy with in a short while of the follow-up.
v At the above tabulation various parameters are expressed with their mean values
of baseline data to that of final data. The most important parameter Malarial
Parasite smear test is positive for the all patients those are included in the study.
Out of them 19 patients (73.07%) are MP negative at the end of the treatment.
Disease prognostic factors such as ESR and Total counts are dropped their vales
to normalcy. More over the haemoglobin percentage is improved by 0.317692
mean value. At the differential count of blood Neutrophills and Eosinophills show
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)163
marginal increase and lymphocytes and Monocytes show marginal decrease. The
mean vale table is as above.
v Patients were showed significant reduction in fever on 14th day. Nearly half the
number of patients came to normal temperature and remaining patient are at grade
1. On 21st day cure rate was attained and much changes are not observed during
fallow up period. During the fallow up period there was no recurrence also.
Linear and slow regression of temperature were noted
v The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are
declared after through assessment of the subjective objective parameters. The
results for the sake of convenience classified as Cured, Responded, Not responded
and Discontinued. Out of these the discontinued patients are the dropouts in the
study. The cured are fulfilling the satisfactory subjective and objective criteria and
must be malarial parasite smear test negative at the end of the schedule. The
responded are satisfactory at the subjective parameters and feel comfort by all
means but their MP is still positive. The Not-Responded patients are of either of
the subjective or objective criteria non-fulfilled. Based on this the results are 19
(63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4 (13.34%)
discontinued.
v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high
significance. Among the objective parameters ESR shows high significance than
the others, but there is a least variation in haemoglobin percentage. Among the
DC, lymphocytes show more (high) significance than the others. (by comparing
the “t” and “p” values).
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)164
Chapter -8
Summary1. Malaria or a disease resembling malaria has been noted for more than 4,000 years.
2. The disease Vishamajwara is included under the jwara roga in Ayurveda.
3. Vishamajwara is characterised by visamarambha (irregular onset).
4. Dalhana consider bhutas (Keetanu – Parasites) responsible to produce
Vishamajwara.
5. Cough may be a presenting feature of malaria with severe anaemia.
6. In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other
jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the
different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara,
Triteeyak jwara, Chaturthak jwara and Chaturthak jwara.
7. Present study registers 30 patients, out of 68 approached patients. The remaining
26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and
inclusive criteria were included in the study.
8. In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and
Kirata Tikta.
9. It is noticed that the Sweda pravrutti and Shareera Laghavata as Jwaramukta
Lakshana are observed shows that the effect of the Bharangyadi Ghana Vati over
Vishamajwara vis-à-vis Malaria is admissible.
10. All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high
significance.
11. Thus it is concluded that the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis
Malaria is established.
Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) I
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45) Gupta KRL, Hindu practice of medicine, 2nd ed, 1986, Sri Satguru publications, NewDelhi, p 1-7
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Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA D.G.M.A.M.C.GADAG
SPECIAL CASE SHEET FOR EVALUATION OF THE EFFICACY OF
THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER
Guide: Dr. V. VaradaCharyulu, M.D (Ayu),
Professor & H.O.D. Kayachikitsa
Co-guide: Dr. R.V. shettar, M.D (Ayu),
1) Name of the Patient Sl.No
2) Gender Male Female OPD No
3) Age Years IPD No
4) Religion Hindu Muslim Christian Other
Student Service House wife5) Occupation
Labour Agriculturist Business
6) Economical status Very
Poor
Poor Lower-
Middle
Upper
Middle
Rich
7) Address
Pin
8) Birth data Place of Birth
AMDate Month Year Time
Hours Minutes PM
9) Hygienic stautus Poor Moderate Good
10) Selection Included Excluded
11) Schedule Initiation Date Completion Date
Cured Responded12) Result
Not responded Discontinued
13) INFORMED CONSENT
I Son/Daughter/Wife of am
exercising my force power of choice here by giving my consent to be included as a subject in this study.
I have been informed to my satisfaction, by the attending physician the clinical trail and nature of the
drug treatment and its follow-up. I am also aware of rights to quit out the trail at any time during the
course of total without giving reasons.
Patient's Signature
Scholar: Dr. Manga;a B. Patil
Annexure
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
14) Pradhana Vedana
DurationNo Complaints
Fresh < 3 days < 5 days > 5 days
1 Aniyamita Jwara2 Vepana (shivering)3 Agnimandya4 Chardi5 Shira shoola6 Aruchi7 Parshwa shoola8 Tandra9 Swasa10 Anidra
15) Anubandha Vedana
Before treatmentNo ComplaintsFresh < 3 days < 5 days > 5days
Aftertreatment
1 Trushna2 Pralapa3 Dravamala Pravrutti4 Anga Gowrava5 Glani6 Asahishnuta
16) Poorva Vyadhi Vruttanta
17) Chikitsa Vruttanta
18) Vayaktika Vruttanta
a) Ahara Vegetarian Mixed foodb) Vihara Adhika Vyayama Diwaswapnac) Nidra Normal Disturbed Excessd) Vyasana Tobacco Pan-chewing Smoking Alcohole) Vyayama shakti Heena Madhyama Uttama
Regular Constipated Dravamala pravruttif) Mala pravrittiColour Frequency
g) Mutra pravrutti Normal BurningColour Odour Frequency
h) Raja Pravrutti Regular Irregular AmenorrhoeaPainful Menopause
i) Mental State
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
19) Astastana PareekshaNadi Dosha Pravrutti
Gati VarnaPurnata GandhaSpandanaKathinya
Mutra
Jihwa Ardra Sushka Sama NiramaLepa Nirlepa
Mala
Shabda Sparsha Sheeta Ushna
Ast
asth
ana
Drik Akruti
20) Sroto pareekshaSrotas PareekshanaPranavaha sroto dusti Lakshana
KasaSwasaChardi
Urah shoolaSwasa bheda
Rakta ShteevanaRasavaha sroto dusti Lakshana
AruchiHrullasa
Shareera GouravaAnidraJwara
TandraAnnavaha sroto dusti Lakshana
AruchiChardi
AnannabhilashaAnnadwesha
ShoolaSwedavaha sroto dusti Lakshana
AswedaAtisweda
DahaRomaharsha
21) General examination
Pulse /min Temp °F Respiration rate /min
Weight /kgs Height heart rate /min
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
22) Systemic examination
Srotas Darshana Sparshana Sravana Akotana
Prana (RS)
Rasa (CVS)
Anna (GIT)
Any other
23) Examination of Organomegale
Day 0 Day 7 Day 14 Day 21 Day F1 Day F21. Palpable in
finger2. Tenderness3. Edge/ Border4. Nodularity5. Sharpens6. RoundedY
akru
t (L
iver
)
7. Leafy1. Palpable2. Tenderness3. Enlargement4. Mild5. Moderate6. Massive7. Surface8. Smooth
Ple
eha
(Spl
een)
9. Hard24) Nidana evaluated
Akala Bhojan Rutu ParivartanaAhita Bhojana KrodhaDooshita jalapana BhayaAupasargika Karana25) Poorva Roopa
Jrumbha Shareera GurutaAruchi Ashrupurna netraRomaharsha26) Roopa (Lakshana) of Vishamajwara
Aniyamita Jwara ChardiAgnimandya Parshwashoola
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
Aruchi Shiroshoola27) Samprapti ghatakaDosha Sroto dusti prakaraDooshaya UdbhavastanaAgni Sanchara stanaSrotas Vyakta stana28) Jwaramukta LakshanaSweda pravrutti Mukha pakaShareera laghuta TrushnaShira kandu Kshudha29) Assessment
Day 0 Day 7 Day 14 Day 21 Day F1 Day F2Aniyamita JwaraVepana (shivering)AgnimandyaChardiShira GowravaAruchiParshwa shoolaTandraSwasaSu
bjec
tive
par
amet
ers
AnidraHaemoglobin %Total countDifferential count
LymphocytesNutrophils
EosioniphilsBasophils
MonocytesErythrocytesedimentationRateO
bjec
tive
par
amet
ers
Peripheral smear(MP)
30) Investigator’s note:
Guide signature Scholar signature
Co-Guide signature
Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
Tem
pera
ture
and
Blo
od P
ress
ure
char
t
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.Name of the candidate and
address
: MANGALAVVA .B. PATIL
M. B. PATIL W/O S.S. PATIL
4TH CROSS PANCHAKSHARI NAGAR,
GADAG -582 101
2. Name of the institution : Post Graduate Studies and Research center,
Dept of Kayachikitsa,
D.G.M. Ayurvedic Medical College, Gadag.
3.Course of study and
Subject
: Ayurveda Vachaspathi M D (Kayachikitsa)
4. Date of Admission : September 2002
5. Title of the Topic : EVALUATION OF THE EFFICACY OF THE
BHARANGYADI GHANAVATI IN
VISHAMAJWARA WITH SPECIAL REFERENCE
TO MALARIAL FEVER
6. Brief Review of Intended Work
6.1 Need for the Study.
Vishamajwara in term of modern medical terminology co-related to malarial fever, is a
protozoan disease caused by genus plasmodium and transmitted to man by certain species
of infected female anopheles mosquito. India's geographic position and climatic conditions
are favorable for the transmission of malaria. Frequently people living in the endemic areas
are prone for this infection. Out of 300-500 million clinical cases around 100 countries and
one million deaths due to malarial malady are noticed globally. The 38th world health
assembly in 1985 recommended that, malaria control should be developed as an integral
part of the national primary health care systems 1.
Vishamajwara is irregular (inconsistent) in it's arambha (nature of onset commitment),
kriya (action production of symptoms) and kala (time of appearance) and possesses
anushanga (persistence for long periods) 2-3-4. As on today, the malarial parasite has
developed resistance to chloroquine compounds, which are used vividly for the past three
decades.
Ayurvedic herbs have an important role in the treatment of malarial fever. Even the
chloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogas
have been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,
low-priced and has no proved adverse effects 5 against malarial fever.
Thus the present study has been under taken as “Evaluation of the efficacy of the
Bharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”.
6.2 Review of Literature
Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charaka
mentioned Vishamajwara and Chakrapani have commented on Vishamajwara as
bhutanubanda6. Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware7.
Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected by
microorganism) 8. Hence infected female anopheline mosquito bite can be considered as
causative factor for Vishamajwara along with other etiological factors.
The Ayurvedic practitioners use Bharangyadi Ghanavati in the management of
Vishamajwara, which is explained in Sahasrayoga in Kashaya kalpana.
Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.
Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati are
having antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So the
combination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus this
combination is chosen for the present study.
6.3 Objectives of the study
1. To evaluate the efficacy of the Bharangyadi Ghanavati in Vishamajwara
2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara.
3. To evaluate the antimalarial properties of Bharangyadi Ghanavati in Vishamajwara
(Malarial fever).
7) Materials and Methods
7.1 Source of data.
a) Patients:
Patients suffering from Vishamajwara will be selected from department of
Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi Ayurvedic
medical college and Hospital by preset inclusion and exclusion criteria.
b) Literary:
Literary aspect of study will be collected from classical Ayurvedic and modern texts.
c) Trail Drug:
The combination and proportion of Bharangyadi Ghanavati is as follows 9 -10-11.
1. Bharangi Clerodendrum serratum 1 Part
2. Musta Cyprerus rotundus 1 Part
3. Parpatak Fumaria officinalis 1 Part
4. Yavasa (danvayavasa) Fagonia arabica 1 Part
5. Shunti Zingeber officinale roscoe 1 Part
6. Kiratatikta (Bhunibha) Swertia chirata 2 Part
7. Kusta Saussurea lappa 1 Part
8. Pippali Piper longum 1 Part
9. Brahati Solanum indicum 1 Part
10. Guduchi Tinospora cardifolia 1 Part
d) Preparation of Yoga
All the drugs will be identified and collected from local areas. Good manufacturing
practice will be followed for the preparation.
7.2 Method of Collection of data
a) Study design:
Prospective clinical study
b) Sample size:
A minimum of 30 patients
c) Exclusion Criteria –
v Patient below 15 years and above 65 years of the age
v Patient with complication like severe anemia
v Renal failure
v Pulmonary oedema,
v Jaundice
v Spleenic rupture
v Pregnant women
v Cerebral Malaria
d) Inclusion criteria –
v Age of the patients between 15 to 65 years.
v Uncomplicated malarial fever
v Peripheral smear test for M P must be positive
e) Criteria of Diagnosis
1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be the basic
diagnostic criteria.
2) Peripheral smear for MP is taken as diagnostic criteria
e) Posology-
Internal - 3 gms in divided doses
1 vati =500 mg, 2 tab thrice a day
Anupanam- ushnajala
f) Study Duration:
21 days and Follow up for 15 days
g) Assessment of Result
Subjective and objective parameters are taken for the assessment of result.
h) Subjective parameters
As designated in the classical texts.
i) Objective Parameters
1. Thick and thin blood film for malaria.
2. Peripheral smear test for MP
3. Erythrocyte Sedimentation Rate (ESR)
4. Hemoglobin (Hb %)
5. Temperature chart
7.3 Investigations
Diagnostic and Exclusion
1. Thick and thin blood film for Malaria.
2. Peripheral smear
3. Hemoglobin (Hb %)
4. Total Count (TC)
5. Differential Count (DC)
6. Erythrocyte sedimentation rate (E S R)
7. Widal test
7.4 ETHICAL CLEARANCE : Obtained
8 List of Reference
1. a) Park’s Text book of Preventive and social medicine, Page no 189 Published by M/s
Banarasidas Bhanot ,16th Edition, Nov 2000.
b) Davidson’s principles and practice of medicine, Page no 148-153, Edited by
Haslett,chilvers,Hunters,boon, Published By Churchill lingstone international 18th Edition
1999.
c) Harrison’s principles of internal medicine, 14th Edition 1998 Volume 1, Page 1180
2. Astanga Hridayam Nidan stana 3rd chapter slk no 69, Krishnadas Ayurveda series no 27,
Published by Krishnadas Academy Varanasi, 2nd edition 1995.
3. Yogaratnakar with Vaidyprabhahindu commentary Vishamajwara prakaran slk No 1
krishnadas Ayurveda series no 54, Published by Krishnadas academy, 1st edition 1998.
4. Bhavprakash By Bhavmishra uttararda Vishamajwara prakaran slk No. 722, shri Kashi
Sanskriti series 130,published by chaukhamba Sanskrit sanstan Varanasi 5th edition
1980.
5. Sahasrayoga – Kashaya Prakarana, Page 6,edited by Ramnivas Sharma and Surendra
sharma, pakshini prakashan Hyderabad,2nd edition oct 1990
6. Charaka Samhita Chikitsa stana 3rd Chapter slk no 74, Chakrapanidatta Ayurveda Deepika
shri Kashi Sanskrit series no 194,edited by Dr.Gangasahaya pandeya, published by
chaukhambha Sanskrit sanstan varanasi.
7. Sushruta Samhita Uttara Tantra Dalhanacharya commentary chapter 39 slk no 56,
Jaikrishnadas Ayurveda series no34, edited by Vaidya Jadavi Trikanji Acharya Narayan
Ram,Acharya Kavytirtha,published by Chaukhmba Orientalia Varanasi,4th edition 1980.
8. Madhava Nidana Madhukosha commentary, Jwara Nidana 2 Chapter Slk no.26,36,kashi
sanskrit series no 158, edited by Yadunandana upadhyaya, published by chaukhambha
Sanskrit sanstan varanasi 26th edition 1996.
9. Indian Materia Medica Volume I – Dr. K M Nadakarni, published by popular Prakashan Pvt.
Ltd Bombay 3rd Edition 1982, page no’s 354,428,560,533,1308
1184,1108,965,1149,1120.
10. Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, published by
chaumkhamba Bharati Academy varasnasi, 7th Edition 1984, page no’s 102, 243, 223,
411,13,72,91,15,288,269.
11. Dhanavantari nighantu, Jaykrishana Ayurvedic Series No 40,edited by priyavrut sharma ,
published by Chaukhmaba Orientalia Varanasi 1st Edition 1982 Page no’s
25,23,24,20,85,22,99,83,32,16.
9 Signature of the candidate
(M B Patil)
10 Remarks of guide
The Medicament Bharangyadi Ghanavati for the proposed study, Evaluation of
efficacy of the Bharangyadi Ghanavati in Vishamajwara with special reference to malarial
fever will be very useful because of its availability, efficacy and economical in nature. Hence
it is recommended.
11. Name and Designation
11.1 Guide: Dr V VARADACHARYULU
M. D (Ayu)
PROFESSOR AND H.O.D. D G M A M C
PGS&RC, DGMAMC, GADAG
12.2 Signature
12.3 Co Guide: Dr R V SHETTAR
M.D (Ayu)
11.4 Signature
11.5 Head of the Department Dr V VARADACHARYULU
M D (Ayu)
PROFESSOR AND HOD D G M A M C
PGS&RC, DGMAMC, GADAG.
11.6 Signature
12. Remarks of Chairman & Principal:
12.1 Signature : Dr. G.B.Patil (Principal/C.M.O.)
K
“Evaluation of the efficacy of
THE BHARANGYADI GHANAVATI IN
VISHAMAJWARA WITH SPECIAL
REFERENCE TO MALARIAL FEVER”
Mangalavva.B.Patil. By
Dissertation submitted to the RajivGandhi University of
Health Sciences,Bangalore, In partial
fulfillment of Regulations for the
award of the Degree
Department of Kayachikitsa Postgraduate Studies and Research
D.G. Melmalagi Ayurvedic Medical CollegeGadag - 582 103
GuideDr. Vangipuram Varadacharyulu
Co-GuideDr. R.V.Shettar
Introduction• Mosquito makes man Eunuch.
• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever, is a protozoan disease caused by genus plasmodium and transmitted to man by certain species of infected female anopheles mosquito.
• India's geographic position and climatic conditions are favourable for the transmission of malaria.
Objectives of the study: -• To evaluate the efficacy of the Bharangyadi
Ghanavati in Vishamajwara (Malarial fever)
• To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara(Malarial fever)
• To evaluate the anti-malarial properties of Bharangyadi Ghanavati in Vishamajwara(Malarial fever)
Life cycle
• "
Role of bhuta in Vishamajwara• Susruta believed that Vishamajwara takes place due to agantuka karana (external cause).
• Agantuka is divedid in to four types
Abhighata
Abhichara
Abhishapa
Abisanga
• Dalhana considered Abhisanga as bhutavisanga
• Chakrapani stated that poisones insects may be cosidered as Bhuta .
• According to Amarkosha it is Keetanu.
Composition of the trail drug “BHARANGYADI GHANAVATI”
1. BharangiClerodendrum serratum 1 Part
2. Musta Cyprerus rotundus 1 Part
3. Parpatak Fumaria officinalis 1 Part
4. Yavasa (danvayavasa) Fagonia arabica 1 Part
5. Shunti Zingeber officinale roscoe 1 Part
6. Kiratatikta (Bhunibha) Swertia chirata 2 Part
7. Kusta Saussurea lappa 1 Part
8. Pippali Piper longum 1 Part
9. Bruhati Solanum indicum 1 Part
10. Guduchi Tinospora cardifolia 1 Part
Chemical Composition of Bharangyadi Ghana Vati
Name of the
ingredient
Chemical constituents
Indications Preparations
1.Bharangi Hispidulin 7.0 glucocaronides,scutellrrin,uncinatone,
pctolinarigenin
Jwara,Swasa,kasa, shotha,krimi,daha,peenasa.
Bharangyadi kwatha,
Bharangyadi guda.
2.Musta Cineol+,copadiene,
Copaene,cyperen I&II,cypernone,isopathoulenone,cypertoperotundone,etc
Jwara,krimi,trushna,Atiusara,kandu,kasa,nidra nasha,rakta vikara
Musta rishta, mustadi kasaya,mustadi vati.shadungapaneeya
3.Prapataka Adlumidiceine(-)-adlumine,(+)bisculline,cocharine coptisine,cryptopine,fumaromine,laharmine,parfemdine etc
Jwara,trushna,Bhramamada,Rakta pitta,Atisara,charadi etc
Sadanga paneeya parpatadyarista
4.Yavasa Galacto,catechin+catechin(-),epigallocatechin,andleucodelphnidin,B-phenethylamine etc
Jwara,kase,Raktapitta,trishna,medaroga,chardi brama,kusta etc
Agasthyavaleha,khatiradigutika,yasa sarkara,vasagrita,kalasyadi grutha
5.Shunti Dryness 80.9,protein 2.6,fat 0.9,fibre 2.4,carbohydrate 12.3,metals1.2%,calcium 20, phosphorus 60,iron 2.6mg,each 100gm other than these iodine chlorine are also present vitamin A,B,C also present.
Jwara,Hrudourbaya,hrutshoola,shilpadha,shotha,amavata,sheetha,pitta,pandu,atisara,kasaswasa, agni mamdhya etc
Ardrakakhand,panchaasama churna,samashrkara churna,rasnadi kwatha,soubhagya shunthi,shunthisura.
6.Kiratatikta Amarogentin,gentiopicrin,isobellicifolin,decussatin,chiratol,swerchirin,7-0methyl swertianian,kairatinol swertanone etc
Sanepata jwara, Rakta pitta, arsas krimi, kusta. Vruna, shotha, trishna.daha etc
Kiritadi kwata,sudharsana churna,kiratitiktadi churna,kiritarista etc
7.Kusta Essential oil,castol,taraxasterol,dehydrocostuslactone,sistosterol, arcuscumene,iso dihydrocostuslactone costus-lactone etc
Jwara,kusta,hikka, kasa,prasava shoola,hrudroga,visarpa,kanduvata rakta.
Kustadi taila,kustadi curna,kusta rasayanam
8.pippali Volatile oil-0.8%,piperine-4.5%,pipalatine and sesamine andpipalsterol-0.15-0.18% and pipalartin 0.13-0.20%,piper languminon,steroid,glycoside
Hrudhadourbalya,pandu,raktavikara,kasa,swasa,aruchi,agni mandhya,kshata, jwara
Guda pippali,pippali khada,pippalayasava,yakartlihari loha,yakrt pippaladi yoga.
9.Brahati Glycoside,alkaloid,solanine,dulcunarin,carotene,carpesterol,solonocurpone,disogenin,solasodine,vit-C etc
Jwara,swasa,hrdroga,shoola,chardi,kushta,kandu, krimi etc
Brihatyadi kasaya, pipapalyadi leha,dashamoolarista
10.Guduchi Tinosporide,cardifalide,tnosparidine,B-sistosterol,cardifol heptacosanol,octacasonol,magnoflarine,palmatine.
Jwara, trishna,vatarakta,pandu, kamala,chardi,krimi,kandu,kasa,bhrama,jwaravyadhi
Guduchadi churna,Guduchadi kwata,amritarista , amrithadi chandra prabhavati, pancha tikta , Guggu grutam etc
MATERIAL AND METHODSSource of data Post graduation and research center
of Sri D.G.M. Ayurvedic medical college and hospital, Gadag.
Sample size 30 patientsResearch Design simple Random clinical Trail Duration 21 daysFollow-up 15 daysPosology Internal - 3 gms in divided doses
1 vati =500 mg, 2 tab thrice a day
Anupanam- ushnajala
Inclusion criteria
Inclusion criteria –
• Age of the patients between 15 to 65 years.
• Uncomplicated malarial fever
• Peripheral smear test for M P must be positive
Exclusion criteria
• Exclusion Criteria –• Patient below 15 years and above 65 years of the • Patient with complication like severe anemia• Renal failure • Pulmonary oedema,• Jaundice• Spleenic rupture• Pregnant women• Cerebral Malaria
Criteria for withdrawals
• Deterioration of condition, which needs hospitalization
• Subsequent diagnosis of associated diseases
• Indulgence in concomitant therapy
Special instruction/advice given to patients
• To stop smoking, alcohol and other habits
• Not to indulge in strenuous exercise• Not to take any other medication except
the trial medication.• Not to indulge in sex• To take regulated food and not to have
food out side the house.
• As designated in the classical texts.
Objective parameters
• Thick and thin blood film for malaria.
• Peripheral smear test for MP
• Erythrocyte Sedimentation Rate (ESR)
• Hemoglobin (Hb %)
• Temperature chart
Assessment criteria
• Subjective and objective parameters are taken for the
assessment of result.
Distribution of patients by Age
DISTRIBUTION OF PATIENTS BY AGE
55-650.00%
15 –2546.67%
35-4520.00%
25-3533.33%
45-550.00%
Distribution of patients by Gender
DISTRIBUTION OF PATIENTS BY GENDER
Male80%
Female20%
Distribution of patients by Occupation
DISTRIBUTION OF PATIENTS BY OCCUPATION
House wife 6.67%
Service16.67%
Labour56.67%
Agriculturist10.00%
Business10.00%
Distribution of patients by Religion
Distribution of patients by Religion
Christian 3.33%
Hindu86.67%
Muslim10.00%
Others0.00%
Data related to presenting complaints
Presenting complaints Total no of patients Percentage
Aniyamita Jwara 30 100
Vepana 28 93.33
Chardi 24 80
Shira shoola 30 100
Aruchi 30 100
Parshwa shoola 6 20
Tandra 5 16.7
Swasa 4 13.33
Anidra 20 66.7
Yakrut Vruddhi 2 6.67
Pleeha Vruddhi 4 13.33
Evaluation of Subjective Parameters(Bharangyadi Ghanavati in Vishamajwara )
Parameter Before 7th day 14th day 21stday Follow Up
Aniyamita Jwara 2.84 1.61 0.53 0.30 0.19
Vepana 0.88 0.61 0.34 0.15 0.03
Chardi 1.38 1.07 0.57 0.26 0.11
Shira shoola 1.92 1.38 0.88 0.26 0.15
Aruchi 1.0 1.0 0.7 0.46 0.11
Parshwa shoola 0.19 0.07 0.07 0 0
Tandra 0.19 0.07 0.03 0 0
Swasa 0.34 0.19 0.07 0.07 0
Anidra 1.30 0.80 0.23 0.19 0
Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03
Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03
Aniyamita Jwara (mean )
Evaluation of Aniyamita Jwara (Mean)
0.190.53
2.84
1.61
0.3
-1
-0.5
0
0.5
1
1.5
2
2.5
3
3.5
BeforeTreatment
7th day 14th day 21stday Follow Up
Evaluation of Subjective Parameters
(Bharangyadi Ghanavati in Vishamajwara)
parameters Before Treatment
After Treatment Difference
MP smear (Positive) 26 7 19
Haemoglobin % 9.195385 9.513077 0.317692
E.S.R 15.65385 11.11538 4.53847
Total Count 6239.038 6080.192 158.846
Neutrofils 54.92308 60.57692 5.65384
Lymphocytes 38.34615 31.5 6.84615
Eosinophil 5.653846 5.769231 0.115385
Monocytes 1.461538 1.192308 0.26923
RESULTS
Distribution of patients by Result
Not Responded
20.00%
Cured63.33%
Responded3.33%
Discontinued13.33%
Statistical analysis of the clinical parameters at the end of treatment (21 days)
S/n subjective parameter
Mean SD SE t-value P-value Remarks
1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS
2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS
3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS
4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS
5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS
6 pasrswashoola 0.231 0.514 0.1 2.31 <0.05 HS
7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS
8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS
9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS
10 Pleeha vruddhi 0.038 0.196 0.038 1.0 >0.05 NS
Discussion• The fever is unwanted rise in body temperature
either because of disturbed internal environment or invasion of exogenous origins.
• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever.
• Vishamajwara vis-à-vis Malaria
• Vishamajwara and Ayurveda
Effect of Bhrangyadi Ghanavati on Vishamajwara
• Cumulative action of Bharangyadi Ghana vati based on Rasa.
• Cumulative action of Bharangyadi Ghana vati based on Veerya.
• Cumulative action of Bharangyadi Ghana vati based on Prabhava.
• Krimiharatwa of Bharangyadi Ghana vati based
• Cumulative action of Bharangyadi Ghana vati based on chemical compositions
• Observation of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
• Demographic data of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
• Subjective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
• Objective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
• Result of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
• Mean effect of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
Recommendations for further study
• Same yoga can be repeated by taking a large number of samples with randomized control groups.
• The effect of Bharangyadi Ghanavati can be studied along with Shodhana therapy.
• The effect of Bharangyadi Ghanavati can be studied on long duration to avoid the reoccurrence of Vishamajwara.
Limitations of the study
• Sample size is small to generalize the result.
• Samples are selected incidentally. • As chosen drug is a compound form it is
difficult to specify the action of any individual herb and or to cumulative mode of action.
Conclusion
• Vishamajwara is the condition, which is almost, resembles the disease Malaria
• The etiology of Vishamajwara and Malaria are similar.
Conclusion
• The Bharangyadi Ghanavati found effective in Vishamajwara.
• Bharangyadi Ghanavati Highly effective on P.Falciparum and P.vivax
• Bharangyadi Ghanavati is effective in chronic cases of Vishamajwara and more effective in fresh reported cases.
Thank you sir