€¦ · Vol.XII No.2 Apr-Jun 2018 Journal of Ayurveda 1 Journal of Ayurveda A Peer Reviewed...

Vol.XII No.2 Apr-Jun 2018 Journal of Ayurveda

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Journal of Ayurveda

A Peer Reviewed Journal

Vol.XII No 2 Apr-Jun 2018

Contents

Editorial

Editorial- Ayurveda Education at Graduate level ..... the Present Status 03

Prof. Sanjeev Sharma

Clinical Studies

A Clinical Study to Evaluate Effect of Agni Karma and Shuddha Guggulu 05

in the Management of Snayu Vikara w.s.r. Tennis Elbow

Dr. Pooja Arya, Dr. Suman Sharma, Dr. Anil Sharma, Prof. Sanjeev Sharma

Clinical evaluation of Dhatrykhadira Kwath on Shvitra 12

Dr. Ajay, Prof. Om Prakash Dadhich

A Comparative Clinical Study of “Rajah-Pravartani-Vati” and “Treivreita-Sneha 17

Anuvasan-Basti” on Kashtartava W.S.R To Primary Dysmenorrhoea

Dr. Diksha Khathuria, Dr. B. Pushpalatha

Management of Mutrashmari W.S.R. To Urolithiasis- A Comparative Study 23

of Varunadi Kwath and Trivikram Rasa

Dr. Prashant Saini, Dr. B.B.Pandey, Dr. Ashok Kumar, Dr. P. Hemantha Kumar, Dr. Ashish Pareek

Clinical study on the efficacy of an Ayurvedic compound and Panchakarma 29

procedure in the management of spasticity among children suffering

from spastic Cerebral Palsy-Dr. Sumeet Goel, Dr. Nisha Kumari Ojha

Effect of Batankura Ksheera (Ficus benghalensis latex) And Karpoora In The 40

Prevention of Recurrence of Arma (Pterygium) After Arma Chhedana (Pterygectomy)

Dr. Pankaj Kundal, Dr. Sanjeev Kumar Sharma, Dr. K.S. Dhiman

A clinical study to evaluate the efficacy of Kukkutand Ras and 45

Palandu Swaras in the management of Keshpatan

Dr. Anagha Unavekar, Dr. Pushpalata Ingale, Dr. Amol A. Deshmukh, Dr. Sheetal Chavan

Clinical Evaluation of Efficacy of ‘Rasnaguggulu’, ‘Rasnasaptak Kwath’ and 51

‘Abhyanga - Swedana’ in the Management of ‘Gridhrasi Roga’ (Sciatica)

Dr. Shilpi Kansal, Prof. Chandra Bhanu Sharma, Dr. Udai Raj Saroj

Journal of Ayurveda Vol.XII No.2 Apr-Jun 2018

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Evaluation of Pippali (Piper longum Linn.) and Lauha bhasma on 60

blood haemoglobin level

Dr. Swati Ugale, Dr. Madhav Borude, Dr. Sudipta Kumar Rath

Clinical Evaluation of Pippalyadi Gandusha and Phalatrikadi Kwatha In The 65

Management of Tundikeri W.S.R. To Tonsillitis

Dr. Anubha Jain, Dr. Shamsa Fiaz

Evaluation of antipyretic activity of Agnikumara Rasa in albino rats 71

Dr. Poornima Mansoria, Dr. Anita Sharma, Dr. Vinod Kumar Gothecha

Role of Ankoladi Taila In Childhood Seborrheic Dermatitis W.S.R. To Arumshika 78

Dr. Rajpurohit Kavita, Dr. Acharya Shrinidhi Kumar. K.

Pharmaceutical Study

Pharmaceutico- Analytical Study Of Agastyaharitakirasayana 85

Dr. Varsha Mundhra, Prof. K. Shankar Rao

Conceptual Studies

A Conceptual Study On Routine Skin Care In Ayurveda 91

Dr. Mahendra Dubey, Dr. Sarvesh Kumar Agrawal, Prof. Kamalesh Kumar Sharma

A Conceptual Study On Junk Food & Ayurveda 98

Dr. Nadira Khan, Dr. Bal Krishan Sevatkar, Prof. Pawankumar Godatwar

A Critical Study of Viruddhahara With Special Reference To Food Allergy 104

/Shreeram Kumawat, Archana Verma, Dr. Nisha Gupta

An Evidence Based Conceptual Review to Elicit the Prognosis of Prameha w.s.r. to DM 113

Dr. Konica Gera, Dr. Nellufar, Dr. Hetal H. Dave, Prof. Baldev Kumar

A Study On Roga Marga With Special Reference To Its Rachanatmaka 117

Adhyayana (Anatomical Aspect) - Dr. Kulkarni Pratibha Vijaykumar, Dr. Vaidya Shrinath Mayur

Survey Study

Dashwidha Pariksha and Tail Bindu Mutra Pariksha To Evaluate The Proneness, 122

Disease Status And Prognosis In Patients Of Madhumeha W.S.R. To Diabetes Mellitus

Dr. Neha Tiwari, Dr. Akhilesh Srivastva, Dr. Rajesh K. Manglesh, Dr. Y.K. Sharma

Literary Reviews

Raktamokshana In Shalakya Rogas : A Literary Review 128

Dr. Gulab Chand Pamnani, Dr. Itika Pamnani

Instructions for Authors 133

Short Communication

Ayurveda News & Views - Dr. Rizwana Parveen 146


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EDITORIAL

Clinical Practice on Ayurvedic principles….Ayurveda Education at Graduate level

..... the Present Status

“Ayurveda the science of life and erstwhile the main stream health system in India is presently facing asevere educational crisis and is at crossroads. Despite of the wide network of public and private Ayurvedic

educational institutions the quality of education is down and out. Govt. of India through its ministry of AYUSHis trying to improve the education system in the country but still the goal is far away. Ayurveda originated fromIndia having its roots in its neighbouring countries like Nepal, Srilanka, Bhutan, Pakistan and Bangladesh. In

ancient times the Ayurvedic education was through the Gurukula system which now has been transformed intoinstitutional system like other educational streams. But this carried a lot of problems resulting to poor qualityeducation. The problems are with every component of Ayurvedic education viz. Students, teachers, institutions,

management/Government and regulatory body.

Students generally come to Ayurvedic institutions as a second choice or under the parent’s pressure as acompulsion. It takes them lot of time to accept Ayurveda stream as a final destination. After admission they

continue to prepare for PMT/NEET for 2-3 years and usually abstain from the classes. By the time they acceptit from heart, already lot of damage in terms of time wastage and loss of studies is over. Another problem isthat when these students reach in 3rd or final year they start preparations for PG entrance or other competitive

examination which continues during and after the internship. These examinations generally are of objective type(MCQ type) and are memory based. So students do not focus on the real studies and remain deprived of actualpractical knowledge. So many students do not connect themselves to Ayurveda in real sense and remain depressed

and frustrated also.

Baring few exceptions there are problems with teachers and teaching also. Teachers generally join justafter completing their PG studies without any aptitude or any other kind of test. Because of lack of teachers

training programmes in Ayurveda such teachers most of the times have no knowledge about teaching and teachingmethodology. They are unable to connect with the students and deliver their lectures just mechanically withoutknowing that what student has gained out of his/her lecture or teaching. The institutions where PG studies are

going on the status of UG studies is much worse there. There remains a huge gap between the teachers andgraduate students. This is because the PG students are in direct contact of the teachers. Senior teachers avoidtaking classes of the UG students. Mid level or junior teachers although take classes but they also quite often

send PG students under them to take the classes. These PG students are not having complete subject knowledgeand cannot deliver to the students up to desired level. This severely compromises the quality of education. Onpaper teachers, recruitment of teachers without aptitude test, engagement of retired and tired teachers, lack of

teachers of particular subjects and frustration (due to various factors like low salary, pressure of management,no or less promotional avenues etc.) amongst teachers are some other causes of compromised and poor teaching.

In India mainly there are three types of institutions viz. Govt. of India institutions, State Ayurvedic

Colleges and Private organisations or colleges. Few Ayurveda Universities have also come up. This whole isconsisting of a big network of colleges or institutions. Govt. of India organisations are providing bestinfrastructural facilities and environment for teaching and research. Few state colleges and good number of

private colleges are also providing best infrastructural facilities and environment for teaching. But unfortunatelythe mushroom growth of substandard Private Ayurvedic colleges has resulted to most inferior Ayurveda educationand these colleges are more or less degree distribution shops.


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Governments /private managements are also not performing their duties up to full extent. So many stateGovernments are running Ayurvedic colleges half heartily and merely to keep the gist that this is Indian heritage

and has to run without linking it with its outcomes. Poor infrastructural facilities, low pay scales to teachers,low staffing and ignorant attitude are the main problems with managements or Governments. Privatemanagements are more interested in earning money from the organisation but do minimum investments. This

does not provide good environment for teaching and training.

Regulatory body in reference to Ayurvedic education is Central Council of Indian Medicine (CCIM). Onebiggest achievement of this body is the uniform Ayurveda education system throughout the country. But

imperfect and ever-changing curricula, top level politics, lack of perfect policies & vision, allowing sub-standardAyurvedic colleges to continue, and frequent corruption charges on the members of CCIM are the problems withthe CCIM.

So, to bring the Ayurvedic education at perfection level different measures at different levels need to beadopted. Students need to be motivated and encouraged for Ayurvedic education, perfect attendance system,proper assessment of students are the main requirements on students part. There is need of dedicated teachers

who should be the experts of subject, well aware about the teaching methodology, positive attitude and energetic.It is the need of the day to raise the existing institutes to excellent level with full infrastructure and congenialenvironment, Governments and managements need to be more sensitive and responsible for Ayurvedic education.

Prof. Sanjeev SharmaDirector

Contributions are invited in the form of :Research Papers–Randomized trials, intervention studies, studies of screening and diagnostic tests,

cohort studies, cost-effectiveness analyses, and case control studies.Short Communications– Brief accounts of descriptive studies, initial/partial results of a larger

trial, and a series of cases;Correspondence– Letters commenting upon recent articles in Journal of Ayurveda, other topics of

interest or useful clinical observations. Debate on important issues such as those raised in the editorialforum are most welcome.

Images in practice– Interesting and original images which are worth a thousand words and helpunderstand a particular concept. Images should accompany a certificate of ownership.

A major criteria for acceptance of an article will be addition to existing knowledge and as suchmanuscripts are required to include ‘what this study adds’.

2 copies of Books may be sent for book review section.


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A Clinical Study to Evaluate Effect of Agni Karma andShuddha Guggulu in the Management of Snayu Vikara

w.s.r. Tennis Elbow

*Dr.Pooja Arya, **Dr.Suman Sharma, ***Dr. Anil Sharma, ****Prof. Sanjeev Sharma

*P.G. Scholar Shalya Tantra Department, Rajiv Gandhi Govt. P.G. Ayurvedic College, Paprola - 176115 H. P. (India) **Sr. Lect. Shalya

Tantra Department, Rajiv Gandhi Govt. P.G. Ayurvedic College, Paprola - 176115 H. P. (India) ***Reader, Shalya Tantra Department,

Rajiv Gandhi Govt. P.G. Ayurvedic College, Paprola - 176115 H. P. (India), ****Director, National Institute of Ayurveda Jaipur - 302002

(Raj.)

Clinical Study

Abstract

Tennis elbow is likely to be common painful condition of elbow joint. Common extensor tendons(Extensor carpi radialis brevis and Extensor digitorum communis) originating from the lateral epicondyle of

the humerus get inflamed/degenerated by repetitive trauma and cause considerable pain. On the basis ofpathophysiology and symptomatology, it can be considered as Vatik Snayu Vikara, but there is no any nameddisease described in Ayurvedic texts. It has become a challenging medical condition now-a-days because it

affects the daily routine activities of a person. In modern medical science, NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), LAHC (Local Anaesthetic with Hydrocortisone) and surgery ar2e treatment of choicewith side effects. In Ayurvedic texts, Agni Karma has been mentioned for disorders of Snayu (ligaments and

tendons) and vata dosha. Patients fit under inclusion criteria with sample size 30 were included in the studyin three groups i.e. 10 patients in each group i.e. Agni Karma, Shudhha Guggulu and Agni Karma withShudhha Guggulu respectively. Agni Karma and Shudhha Guggulu gave statistically significant results in

Group I and II but on combination gave highly significant results in Group III. Agni Karma with ShudhhaGuggulu provides a better Ayurvedic treatment modality for Tennis elbow without any side effect.

Key words: Agni Karma, Snayu Vikara, Shudhha Guggulu, Tennis Elbow.

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Introduction:

Tennis Elbow is the most common insertionaltendinopathy of the human body resulting due tospecific occupations or repeated low intensity trauma.

Overuse of tendons of extensor origin or suddentrauma also leads to Tennis elbow. Cardinal symptomof Tennis Elbow is pain on the outer aspect of elbow

joint which may radiate to forearm and hand andaffects the daily routine work. Pathogenesis of TennisElbow is still debated but at the histopathological level

it is found that it is a degenerative disorder. Onexamination localised tenderness is felt over lateralepicondyle1 and pain is aggravated by dorsiflexion of

the wrist2. As far as management of Tennis Elbow isconsidered, no standard, safest, or perfect treatmentis available. Patients are generally managed

conservatively by NSAIDs and physical therapy;refractory patients are given steroid injections whichhave their side-effects in long run. Patients who do not

respond to injections may also have to go for surgicalinterventions3, which is a costly affair and can alsolead to various complications like postero-lateral

instability of elbow joint. Agni Karma therapy, a para-surgical procedure mentioned for the treatment of vatavyadhi and snayu vikara in the classics of Ayurveda4.

Agni Karma (cauterisation) is in practice as atherapeutic measure since vedic period and gainedsupremacy during the period of Acharya Sushruta.

Even in Charaka Samhita, which is a main treatise ofmedicine, Agni karma has been employed for variousailments as a line of treatment5. Guggulu was

considered agrya dravya for vata6. Vata is mainlyresponsible for pain, hence by reducing vata dosha, italleviate the pain. According to Bhavamishra,

Guggulu has anti inflammatory property, hence helpsin decreasing the inflammation over lateral epicondyle.Thus, helps in the relief from disease.

Aims and objectives:

1. To estimate the efficacy of Agni karma andShuddha Guggulu in Tennis Elbow.

A Clinical Study to Evaluate Effect of Agni Karma andShuddha Guggulu in the Management of Snayu Vikara

w.s.r. Tennis Elbow

Dr. Pooja Arya, Dr. Suman Sharma, Dr. Anil Sharma, Prof. Sanjeev Sharma

Clinical Study

2. To provide a cheap, safe and better modality oftreatment to the patients suffering from Tenniselbow in form of Agni karma and Shuddha

Guggulu.

Materials and methods:

All the patients fit under inclusion criteria

attending the O.P.D. of Asthi-sandhi unit of ShalyaTantra Department. of Rajiv Gandhi Govt. PostGraduate Ayurvedic College & Hospital, Paprola H.P.

were selected and registered in the study.

Ethical clearance:

Proposed protocol was submitted to the

Institutional Ethics Committee (IEC) and trial wasstarted after clearance of the IEC.

Inclusion criteria:

Willing patients for trial between the age of25-60 years of either sex having Pain (Vedna) on theouter (lateral) side of the elbow joint with radiation

towards forearm or hand, tenderness (sparshashyata)over the lateral condyle of humerus and positiveCozen’s7 & Mill’s manoeuvre test8 were selected.

Exclusion criteria:

Non-willing patients, below 25 years andabove 60 years of age, Pitta dominating Prakriti, Alpa

Satva, Antah Shonita, Vranita, unfit for Swedana,,with Anuddhrita Shalya, Avara Samhanana, Bhiru,9

pregnant women and patients having joint disorders

viz. rheumatoid arthritis, osteoarthritis, gouty arthritisof elbow joint, tuberculosis, diabetes or having otherconstitutional disorders were excluded.

Study Design:

Patients included in the study were divided inthree groups and assessment was done on the basis of

the specified parameters (before and after thetreatment). Sample size was 30 patients i.e. 10 patientsin each group.


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Interventions:

a) Agni Karma (Group I)

Total 3 sittings of Agni Karma were done withthe interval of 6 days between subsequent sittings fortotal duration of 21 days.

b) Shuddha Guggulu (Group II)

Shuddha Guggulu in the vati form (eachweighing 500mg), 2 vaties thrice a day for total

duration of 21 days.

c) Agni Karma and Shuddha Guggulu (GroupIII)

Both above mentioned treatment modalitieswere used for total duration of 21 days.

Agni Karma Methodology:

Patients were well counselled and explainedabout the procedure. Written, informed and witnessedconsent was taken before the procedure.

Agropaharaniya - Before starting the procedure,murchhit til-taila, cotton, a standardized electriccautery with pointed tip, Aloevera pulp, gauze pieces,

Madhuyasti churna etc. were kept ready. Most tenderspot of elbow joint was thoroughly cleansed and gentle

Abhyanga was done with murchhit til-taila for 10minutes in circular manner. Patients were kept in

supine position with elbow flexed across the chest.Electric Cautery with illumination source heated up tored-hot and seven Bindu (dot) type of Varna were

made in rosette pattern centralising most tender spotof the elbow joint i.e. lateral condylar area, till theappropriate features of superficial therapeutic burns

(samayaka twaka dagdha lakshanas) appeared i.e.shabda pradurbhava (sound production),durgandhata (foul smell) and twakasankocha (skin

contraction)10. Immediately after completion of theprocedure Ghritkumari (Aloevera) pulp applied overthe Vrana and gauze impregnated with Madhuyasti

(Glycyrrhiza glabra) churna kept. Patient wasadvised to take rest for about 10 minutes and assured.During the procedure patient was carefully observed

for any untoward complications. Patients were advisedto keep the area dry, clean, avoid exertion, trauma andunwholesome diet.

Criteria for Assessment-

Criteria for assessment was on subjective andobjective parameters. Subjective parameters were Pain,

Pricking sensations, Loss of function, Radiation of painand objective parameters were Tenderness, Cozen’s testand Mill’s manoeuvre test.

Therapeutic burn byelectric cautery

Local Snehan by Murchhit

Til tailaMarking of area to be burn


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Criteria Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Pain No Pain at work Mild at rest Moderate at Severe at _rest rest

Pricking No Occasionally Mild Moderate Severe _sensation constant constant constant

Loss of Can do Rest in Rest very Can’t do

function routine work between work often routine work _ _

Radiation No Forearm Forearm Up to _ _of pain occasionally continuously hand

Tenderness No Pain on deep Pain on light Don’t allow _ _palpation palpation to touch

Cozen’s No pain Pain against Pain against Pain against _ _

test against any hard moderate lightresistance resistance resistance resistance

Mill’s No pain Pain at Pain at Pain at _ _

maneuver on palmar full palmar mild palmar beginning oftest flexion flexion flexion palmar flexion

Verbal No pain Mild pain Un- Distressing Horrible Excruciating

descriptive comfortablescale (VDS)

Visual In this pain assessment tool patient indicates intensity of pain on a 10 cm. line

Analogue marked from no pain (0) at one end to pain as bad as it could possiblyScale (VAS) be (10) at he other end.

Ghritkumari application Madhuyasti churna

Criteria for Assessing the Total Effect -

1. Cured - 100% relief in signs and symptoms

2. Markedly Improved - > 75% relief in signs and symptoms.

3. Improved - 25-75% relief in clinical features.

4. Unchanged - Below 25% relief in clinical features.


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Observations - Maximum patients were in 41-45 yrsage group (13 pts.), females 72.50% (29 pts.), Hindus

97.50% (39pts.), married 100% (40 pts.), educated upto Middle or Matriculation level 72.50% (29 pts.),house wives 72.50% (29 pts.), rural 100%(40 pts),

belonging to middle class 97.50% (39 pts.), mixeddietary habits 90.00% (36 pts.), having averageworking life styles 77.50% (31). Maximum patients

were having habit of taking tea/coffee daily 77.50% (31pts.), vata Pradhana Prakriti 75.00% (30 pts.),1-2

month chronicity of the disease in 21 pts (52.50)normal mental status 53.33% (16 pts.), Madhyama

Sara 60.00% (24 pts.), Madhyama Samhanana77.50% (31 pts.), Madhyama Satva 87.50% (35 pts.),Madhyama Satmya 75.00% (30 pts.), Madhyama

Ahara Shakti 77.50% (31 pts.), Madhyama vyayamaShakti 60.00% (24 pts.) and Rajas Manas Prakriti80.00% (32 pts.).

Results

Table No. I Table showing the comparative study

of the results in all groups

Sr Assessment Group I Group II Group III

No parameter Mean M.D. % Mean M.D. % Mean M.D. %

BT AT relief BT AT relief BT AT relief

1. Pain 3.0 1.7 1.3 43.33 2.1 1.4 0.7 33.33 2.0 0.6 1.4 70.00

2. Pain Radiation 3.0 1.7 1.3 43.33 2.1 1.3 0.8 38.09 2.0 0.6 1.4 70.00

3. Pricking sensation 2.7 1.5 1.2 44.44 2.1 1.5 0.6 28.57 2.1 0.6 1.5 71.42

4. Tenderness 2.9 1.7 1.2 41.37 2.2 1.4 0.8 36.36 2.0 0.6 1.4 70.00

5. Loss of function 2.8 1.5 1.3 46.42 2.2 1.4 0.8 36.36 2.0 0.6 1.4 70.00

6. Cozen’s test 3.0 1.8 1.2 40.00 2.9 2.1 0.8 27.58 3.0 0.8 1.4 73.33

7. Mill’s manoeuvre 3.0 1.7 1.3 43.33 2.9 2.2 0.7 24.13 3.0 0.9 2.1 70.00

8. VAS 5.6 3.4 2.2 39.28 3.8 2.7 1.1 28.94 5.8 1.9 3.9 67.24

9. VDS 4.2 2.8 1.4 33.33 3.3 2.5 0.8 24.24 3.7 1.2 2.5 67.56

Table No. II Table showing the comparison of studyin term of p value

Assessment Group I Group II Group III

parameter SD+ SE+ ‘t’ ‘P’ SD+ SE+ ‘t’ ‘P’ SD+ SE+ ‘t’ ‘P’

Pain 0.949 0.300 4.333 <0.001 0.675 0.213 3.280 <0.05 0.516 0.163 8.573 <0.001

Pain Radiation 0.949 0.300 4.333 <0.01 0.789 0.249 3.207 <0.05 0.516 0.163 8.573 <0.001

Pricking sensation 0.789 0.249 4.811 <0.001 0.699 0.221 2.714 <0.05 0 . 7 0 7 0.224 6.708 <0.001

Tenderness 0.919 0.291 4.129 <0.01 0.789 0.249 3.207 <0.05 0.516 0.163 8.573 <0.001

Loss of function 1.075 0.340 4.118 <0.01 0.789 0.249 3.207 <0.05 0.516 0.163 8.573 <0.001

Cozen’s test 0.919 0.291 4.129 <0.01 0.789 0.249 3.207 <0.05 0.516 0.163 8.573 <0.001

Mill’s manoeuvre 0.949 0.300 4.333 <0.001 0.675 0.213 3.280 <0.05 0.738 0.233 9.000 <0.001

VAS 1.751 0.554 3.973 <0.01 0.994 0.314 3.498 <0.05 0.876 0.277 14.085 <0.001

VDS 1.075 0.340 4.118 <0.01 0.789 0.249 3.207 <0.05 0.850 0.269 9.303 <0.001


10

Table No. III Overall effect of therapy

Effect Group I Group II Group III

N %age N %age N %age

Cured 0 00.00 0 00.00 1 10.00

Markedly improved 1 10.00 0 00.00 2 20.00

Improved 7 70.00 6 60.00 7 70.00

Unchanged 2 20.00 4 40.00 0 00.00

Findings on Follow-up

Patients were followed up for three monthsafter the completion of the trial at monthly visits to see

the status of the disease. There was no any side effectreported.

Discussion

Tennis elbow is likely to be the most commoninsertional tendinopathy of the human body and it is

also common painful condition of elbow joint.

Common extensor tendons (Extensor carpi radialisbrevis and Extensor digitorum communis) originatingfrom the lateral epicondyle of the humerus get

inflamed by repetitive trauma and cause considerablepain. On the basis of pathophysiology andsymptomatology, it can be considered as Vatik Snayu

Vikara, but there is no any named disease describedin Ayurvedic texts.

Probable Samprapti of Tennis Elbow in Ayurveda


11

Probable mode of action of Agni Karma

the procedure and prevention of the causative factorsis essentially required.

Conclusion

It is a disease caused by Vitiated Vataaffecting the Snayu situated near Koorpara Sandhi(elbow joint). This disease is more common in people

involved in occupation involving manual work, femalesand age group 30-40 yrs. They should adopt suchmeasures so that the disease can be prevented. Agni

Karma and Shudhha Gugullu gave statisticallysignificant results in Group I and Group II respectivelybut on combination gave highly significant results in

Group III. So that, It can be concluded that Agni-Karma and Shuddha Guggulu gave additive effect inmanagement of Tennis Elbow. But there is need to

study on large scale and comparative study with mostpopular modern modality of treatment i.e. LAHC.

Probable mode of action of Shudhha Guggulu

Rasa-Madhura – helps in reducing vata dosha

Guna- Sukshma –helps in removing avarana afterreaching through sukshama srotas.

Pichilla guna is uplepkar and sandhankar so nourishes

the dhatu and updhatu i.e. snayu.

Veerya-Ushna -counteract the Sheeta guna of vata.

Properties- Vatahara- reduces pain and kshaya,

Shothhara- reduces inflammation.

Karma-Rasayana-nourishes the dhatu,Asthisandhanakar

Discussion on Follow-up examination

Recurrence of features in all groups was there.But recurrence after Agni Karma is contrary to the

textual references that “diseases cured by Agni Karmado not reoccur”11. Hence, some sort of modification in


12

Clinical evaluation of Dhatrykhadira Kwath on Shvitra

*Dr. Ajay, **Prof. Om Prakash Dadhich

Clinical Study

Abstract

A clinical trial was undertaken to evaluate the efficacy of the drug Dhatrykhadira Kwath in treatment

of Shvitra. In Dhatrykhadira Kwath content are Amlaki, Khadira and Bakuchi. The dose of trial drug wasfixed at Amlaki, Khadira Kwath 40ml which is made by 10 gram raw drug of Amalaki and Khadira as perKwath Vidhi after sieved mix 3 gram Bakuchi Churna. After 60 days of drug trial there was significant result

observed in number of patches (p value 0.0156) maximum size of patches (p value 0.0313) color of patches (pvalue 0.0156). Hence it can be concluded that Dhatrykhadira Kwath is use full in treatment of Shvitra.

Key words – Shvitra, dhatrykhadira kwath

‚Ê⁄Ê¢≥Ê-

∞∑§ ÁøÁ∑§à‚∑§Ëÿ ¬⁄ËˇÊáÊ Á‡flG ⁄Ùª ∑§ ©¬øÊ⁄ ◊ œÊGËπÁº⁄ `§ÊÕ ∑§Ë ¬˝÷Êfl∑§ÊÁ⁄ÃÊ ∑§Ê ◊ÍÀÿÊ¢∑§Ÿ ∑§⁄Ÿ ∑§ Á‹ÿ Á∑§ÿÊªÿÊ– œÊGËπÁº⁄ `§ÊÕ ◊ •Ê◊‹∑§Ë, πÁº⁄ ∞fl¢ ’Ê∑È§øË Œ˝√ÿ ‚Áê◊Á‹Ã „Ò– ÷Ù¡ŸÙûÊ⁄ ÁºŸ ◊ ºÙ ’Ê⁄ •Ê◊‹∑§Ë ∞fl¢ πÁº⁄ ∑§Ê `§ÊÕ40 Á◊‹Ë ‹Ë≈⁄ ¡Ù ∑§Ë 10 ª˝Ê◊ ∑§ìÊ Œ˝√ÿ ‚ `§ÊÕ ÁflÁœ ∑§ •ŸÈ‚Ê⁄ ’ŸÊÿÊ ªÿÊ– ©‚ ¿UÊŸŸ ∑§ ’Êº ©‚◊ 3 ª˝Ê◊ ’Ê∑È§øË øÍáÊ¸Á◊‹Ê∑§⁄ ÁºÿÊ ªÿÊ– 60 ÁºŸ ∑§ ÁøÁ∑§à‚∑§Ëÿ ¬⁄ËˇÊáÊ ∑§ ¬‡øÊÃ ø∑§ûÊÊ¥ ∑§Ë ‚¢ÅÿÊ, •Áœ∑§Ã◊ ’«U∏Ê ø∑§ûÊÊ ∞fl¢ ø∑§ûÊ ∑§ fláÊ¸◊ ‚ÊÕ¸∑§ ¬Á⁄áÊÊ◊ ¬˝Ê# „È∞– ß‚‚ ÿ„ ÁŸc∑§·¸ ¬˝Ê# „È•Ê Á∑§ œÊGËπÁº⁄ `§ÊÕ Á‡flG ⁄Ùª ∑§ ©¬øÊ⁄ ◊ ©¬ÿÙªË „Ò–

*P.G. Scholar, P.G. Department of SharirKriya, National Institute of Ayurveda,Mobile no. 9460229564 Email [email protected]

**Dean (Academic) & Professor and H.O.D. of P.G. Department of Sharir Kriya, National Institute of Ayurveda, Jaipur (Raj.) pin code

302002

References

1 . J. Maheshwari, Essentials of Orthopedics. 4th ed. Jaypee

Brother Medical Publishers. New Delhi: 2011, Reprint 2014.

P 293.

2. Allander E, Prevalence, incidence and remission rates of

some common rheumatic diseases or syndromes.Scand J

Rheumatology 1974; 3.P 145-53.

3. Chard MD, Hazleman BL. Tennis elbow-A reappraisal, Br J

Rheumatology 1989; 28. P186-90.

4. Kaviraj Dr.Ambikadutta shastri, Sushruta Samhita Part-1,

Chaukhambha Sanskrit Sansthan, Varanasi, 2nd Edition,

Reprint 2011, Sutra Sthan 12/10. p52.

5. Pt. Kasinatha Sastri & Dr. Gorakhanatha Chaturvedi, Charak

Samhita Part -2 Chaukhambha bharti academy, Varansi,

Reprint 2011, Chikitsha Sthan 5/55. p209.

6. Kaviraja Atrideva Gupta, Astangahrdayam, 3rd edition Reprint

2012, Chaukhambha Prakashan, Varanasi, uttar Sthan 40/48

p- 832

7 . G. Percival Mills; Treatment of Tennis Elbow. The British

medical Journal 12 Jan 7. 1928.

8. Kochar M, Dogra A. Effectiveness of specific physiotherapy

regimen on patients with tennis elbow: clinical study.

Physiotherapy, 2002; 88:341-341


Chaukhambha Sanskrit sansthan, Varanasi, 2nd Edition,

Reprint 2011, Sutrasthan 12/14. P-53.




11 . Kaviraj Dr.Ambikadutta shastri, Sushruta Samhita Part-1,




13

Introduction-

Shvitra has been described by all ancient

Acharya as a part of Kushtha. All the Acharya ofBrihattrayi has given individually definition anddescription of Shvitra. The description of Kushtha

Roga in texts covers almost all skin disease includingShvitra. The word Kushtha is a broad term whichinvolves a whole community of skin Disease.

Nidana of Shvitra - Charaka lay down;

Viruddhahar is the main causative factor and badbehavior causative factor of Kustha. But in referenceto Shvitra specific causative factor is Vachansi

Atathyani, Krutaghnabhava, SuranamNinda, GuruGharshanam, Papa Kriya, Purvakrutam Karma.1

Purvarupa- The complaints which appearbefore real indicator of the disease are known asPurvarupa2. Purvarupa of the disease Shvitra is not

clearly stated in the Ayurvedic texts, but because it isa type of Kustha, then Purvarupa of Kustha can beconsidered as Purvarupa of Shvitra. Purvarupa of

Kustha is Twaka Parushyam, Romharsha, Kandu,Sweda Bahulayam, Aswednam, Kshtavisrapa,Krishnata.3

Rupa-When the Purvarupa gets fully

demonstrated the state is called as Vyakta orRupavastha.4 Shvitra is of three varieties, namelyDaruna, Aaruna and Kilasa. All of them are generally

caused by all the three Dosha. If located in Rakta itis red in color, if in Mamsa it is of coppery (Tamram)color, and if located in Meda it is white in color. The

subsequent ones are more serious than the previousones.5

Samprapti-the three vitiated Dosha Vata,Pitta and Kapha, in turn vitiate the Twaka, Rakta,Mamsa and Ambu. These taken together, constitute

the seven fold pathogenic substance of Kushtha. Theseven and eleven varieties of Kushtha are caused by allof them. Kushtha are newer caused by the vitiation of

only one of the above mentioned pathogenic substance,i.e. all of them are necessarily involved in the causationof this disease.6

Management of Shvitra-Treatmentmentioned for Kushtha should also be applied for themanagement of Shvitra. Nidana Parivarjan,

Apakarshana (Snehana Karma, Svedana Karma,Virechana Karm, Rakta Mokshana Karma,Prachchhana Karma, Kshara Karm, Virukshana

Karma), Samprapti Vighatana (Shamana Therapy,Lepan)7

Drug- in this study Dhatrykhadira Kwath

contain Amalaki (Emblica Officinalis Gaertn),Khadira (Acacia catechu Willd), and Bakuchi(Psoralia corylifolia Linn.) is described by

Chakraduttawas applied to see the effect of the drugin shvitra.8

Aims and objective-

Ø To evaluate clinical efficacy of Ayurvedicmedicines Dhatrykhadira Kwath.

Material And Methods-

1) Selection of patients: - ten patients ofShvitra randomly selected from O.P.D/I.P.D. ofSharir Kriya National Institute of Ayurveda, Jaipur.

& Seth Surajmal Bombaiwala Hospital, Jaipur.

2) Criteria for Diagnosis- The detailinformation of selected patients was filled in the

Performa and based on it, the clinical diagnosis is doneand the result of the medicine has been evaluated.

Inclusion Criteria:-

1) Patient diagnosed as Shvitra on the basis ofclinical features mentioned in Ayurvedic texts.

2) Sex- either sex

3) Patient willing to sign the consent form.

4) Patient should be capable of obeying Pathya-apathya.

5) Female patient should not be pregnant or in thestage of lactation.

Clinical evaluation of Dhatrykhadira Kwath on Shvitra

Dr. Ajay, Prof. Om Prakash Dadhich

Clinical Study


14

Exclusion Criteria:-

1) Patient below 16 and above 70 years of age.

2) Patient with Albinism are excluded.

3) White non sensational spots, which arecharacteristic of leprosy.

4) Any systemic disease.

5) Any adverse reaction with treatment.

6) White spots by trauma and burn.

7) Patient suffering from any mental disease.

8) Patient suffering from Shvitra by birth.

Method of Preparation of drug- The

purchased drug was prepared in the pharmacy NIAJaipur. The prepared drug Dhatrykhadira Kwathcontain Amalaki (Emblica Officinalis Gaertn),

Khadira (Acacia catechu Willd) and Bakuchi(Psoraliacorylifolia Linn.)

Dhatrykhadira Kwatha is prepared by using

10 grams Kwath Dravya Churna (Amalaki and

khadira) in 160ml water and after boiling up to 40 mlas par Kwath Vidhi than sieved it and adds 3gm

Bakuchi Churna.

Treatment duration- The time limit formedication is not mentioned in the concerning text for

Shvitra, so the scholar, after consulting the seniorAyurvedic physicians, has decided time limit 60 daysfor trial with 20 day follow up.

Criteria for assessment:- Clinicalassessment of the Shvitra is done based on maximumsize of patches in diameter, number of patches, color

of patches and laboratory investigation CBC, LFT. Therelative extent of all these criteria was recorded in eachpatient at the initial stage and at subsequent follow

up.

Criteria for assessment -

A standard grading system is developed to

assess (maximum size of patches in diameter, numberof patches, color of patches) the improvement intreated cases based on assessment criteria of the

Shvitra. Which is maximum score are 9.

Grading for number of patches Absent of patches 0

1 to5 1

6 to 10 2

More then 10 3

Grading for size of patches Absent of patch 0

Less than 5 cm 1

5.1 to 15 cm 2

More than 15 cm 3

Grading for color of patches Normal skin color 0

Radish (Rakta) 1

Cupric(Tamram) 2

White (Shweta) 3

CBC, LFT


15

Results-

Objective No. Mean score % SD SE P Result

parameter BT AT Diff. Change

number of patch 10 2.3 1.3 1 43.48 0.8165 0.2582 0.0156 S

maximum size of patch 10 1.9 1.2 0.7 36.84 0.6749 0.2134 0.0313 S

color of patch 10 3 1.2 1.8 60.00 1.317 0.4163 0.0156 S

Hematological Mean score % SD SE t P Result

parameter BT AT Diff. Change value value

Hb% 13.49 14.08 -0.59 4.37 2.239 0.7081 0.8332 0.4263 N.S.

TLC 7090 6650 440 6.20 2597.1 821.27 0.5358 0.6051 N.S.

TRBC 4.81 4.683 0.127 2.64 0.7166 0.2266 0.5604 0.5889 N.S.

PCV 43.03 43.51 -0.48 1.11 7.034 2.224 0.2158 0.8340 N.S.

MCV 88.43 93.06 -4.63 5.23 8.218 2.599 1.782 0.1085 N.S.

MCH 29.02 30.13 -1.11 3.82 4.146 1.311 0.8467 0.4191 N.S.

Total protein 6.22 6.35 -0.13 2.09 0.3129 0.09894 1.314 0.2214 N.S.

Albumin 4.11 4.16 -0.05 1.21 1.132 0.3579 0.8661 0.4089 N.S.

Total bilirubin 0.69 0.8 -0.11 15.94 0.3143 0.09939 1.107 0.2971 N.S.

Direct bilirubin 0.21 0.28 -0.07 33.33 0.1337 0.04230 1.655 0.1323 N.S.

Indirect bilirubin 0.48 0.52 -0.04 8.33 0.2366 0.07483 0.5345 0.6059 N.S.

SGOT 39.117 38.2 0.917 2.34 11.152 3.526 0.2600 0.8007 N.S.

SGPT 26.055 27.1 -1.045 4.01 7.159 2.264 0.4616 0.6553 N.S.

Serum alkaline 209.01 193.7 15.31 7.32 85.665 27.090 0.5652 0.5858 N.S.phosphate

Discussion-

However most of the Dravyas in this Kwathare Kushthaghna, Krimighna, Rasayana, Rakta-

prasadana, Raktashodhaka, Deepana, Pachana &Shothahara.

Avyava Sthana in Shvitra is Twacha and

Rogmarga is Bahyarogmarga. DhatrykhadiraKwath act on Twacha and Bahya Roga Marga dueto their Prabhava. Because Kushtha Roga is a disease

of skin and Khadira in Dhatrykhadira Kwath hasKushthagna Prabhava, so due to this property itdirectly acts on Twacha. In Dhatrykhadira Kwath all

three drugs have Rasayana property, so there is bestquality of Dhatu formation occur and these Dhatu is

considred as Bahya Roga Marga.

The aim of the present study was to evaluatethe effect of Dhatrykhadira Kwath in patient of

Shvitra. Relief was found in number of patches (pvalue 0.0156) maximum size of patches (p value0.0313) color of patches (p value 0.0156) which is

significant.

Conclusion-

1) In the present study treated with Dhatrykhadira

Kwath showed significant results in number of


16

patches, maximum size of patches and color ofpatches suggesting its efficacy in normalization

skin discoloration.

2) There is not-significant result in the effect of drugon Hematological parameters like Hb%, TLC,

TRBC, PCV, MCV, MCH, Total protein, Albumin,Total bilirubin, Direct bilirubin, Indirect bilirubin,SGOT, SGPT, Serum alkaline phosphate.

Before treatment After treatment

Before treatment After treatment

References-

1 . Agnivesh, Caraka Samhita, Dr. Brahmanand tripathi, caraka

chandrika hindi commentary, Chaukhambha Surbharati

Prakashan, Varanasi, Re. Ed. 2009, chikitsasthan 7 sutra

177,partII page no. 334

2. Agnivesh, Caraka Samhita, Dr. Brahmanand tripathi,

carakachandrika hindi commentary, Chaukhambha Surbharati

Prakashan, Varanasi, Re. Ed. 2009, nidansthan 1 sutra 8 page

no. 481

3. Sushruta, Sushruta Samhita, Shastri AD, Ayurveda Tatva

Sandipika hindi commentary, Part I, Chaukhambha Sanskrit

Sansthan, Varanasi, Re. Ed. 2010; nidansthan 5 sutra 4 page

no. 320

4. Sushruta, Sushruta Samhita, Shastri AD, Ayurveda Tatva


Sansthan, Varanasi, Re. Ed. 2010; Sutra sthan 21 sutra 34

page no. 121

5. Agnivesh, Caraka Samhita, Dr. Brahmanand tripathi, caraka


Prakashan, Varanasi, Re. Ed. 2009, chikitsasthan 7 sutra 173-


6. Agnivesh, Caraka Samhita, Dr. Brahmanand tripathi, caraka


Prakashan, Varanasi, Re. Ed. 2009, chikitsasthan 7 sutra 9-


7 . Sushruta, Sushruta Samhita,Shastri AD, Ayurveda Tatva


Sansthan, Varanasi, Re. Ed. 2010; chikitsasthan 9 sutra 5

page no. 62

8. Chakradatta, Chakrapani Datta; Dr. Indradeva Tripathi,

Vaidyaprabha hindi commentary, Chaukhamba Sanskrit

bhawan, Varanasi (India),Re. Ed. 2004. Chakradatta 50 sutra

70 page no. 286


17

A Comparative Clinical Study of “Rajah-Pravartani-Vati”and “Treivreita-Sneha”Anuvasan-Basti” on Kashtartava

W.S.R To Primary Dysmenorrhoea

*Dr. Diksha Khathuria **Dr. B. Pushpalatha

Clinical Study

*Ayurveda Medical Officer, Ummewalam, Hanumangarh (Rajasthan Government) **Associate Proffesor, Department of Prasuti-Stree

Roga, NIA, Jaipur

Abstract:

Dysmenorrhoea is the most common gynaecological problem faced by women during their adolescencewhich causes significant discomfort & anxiety for the women. It may create the emotional distress brought on

by the pain and may result in missing work or school, inability to participate in sports or other activities. Inmodern medicine dysmenorrhoea is treated by oral contraceptive pills, non-steroidal anti-inflammatory drugs,antispasmodic, analgesics etc. Long term use of these causes side effects. So, it is a great scope of research to

find out safe, potent, cost effective remedy from Ayurveda for its management. Pain is the main feature ofKashtartava, so it has strong relation with Vata Dosha. Keeping this point in view, the present clinical trial,“A Comparative Clinical study of “Rajah-Pravartani-Vati” and “Treivreita-Sneha”Anuvasan-

Basti on Kashtartava w.s.r to Primary Dysmenorrhoea” was taken. The selected two drugs are Vatashamaka mentioned by the classics. In group A “Rajah-Pravartini-Vati” was given orally and in group B“Treivreita –Sneha Anuvasan-Basti” was given per rectum. Results were assessed on the basis of improvement

in the subjective symptoms. The study reveals that the Basti group showed better results than the oral group.

Key words: Dysmenorrhoea, Kashtartava, Anuvasan-Basti, Vata Dosha.

‚Ê⁄Ê¢‡Ê-

∑§c≈ÊÃ¸fl (Á«US◊ËŸÙÁ⁄ÿÊ) ◊Á„∂Ê•Ù¥ ◊¥ Á∑§‡ÊÙ⁄ÊflSÕÊ ∑§ ºÙÒ⁄ÊŸ „ÙŸ flÊ∂Ë ‚Ê◊ÊãÿÃ◊ √ÿÊÁœ „Ò– ¡Ù ∑§Ë ©Ÿ∑§Ë ’øÒŸË •ÊÒ⁄Áø¢ÃÊ ∑§Ê ∑§Ê⁄áÊ „Ò Á¡‚‚ ©Ÿ∑§Ë ºÒÁŸ∑§ ªÁÃÁflÁœÿÙ ¬⁄ ª„⁄Ê ¬˝÷Êfl ¬«UÃÊ „Ò ¡Ò‚ S∑Í§∂ ¡ÊŸ ◊¥ •‚◊¸ÕÃÊ, π∂ ◊¥ ÷Êª Ÿ ∂ŸÊ•ÊÁº– •ÊœÈÁŸ∑§ ÁøÁ∑§à‚Ê ◊¥ ∑§c≈ÊÃ¸fl ∑§Ë ºflÊ•Ê ∑§ ∂ê’ ‚◊ÿ Ã∑§ ¬˝ÿÙª ‚ ’„ÈÃ ‚ ºÈc¬˝÷Êfl „ÙÃ „Ò– •Ã— ß‚ √ÿÊÁœ ∑§Á∂ÿ •ÊÿÈfl¸º ◊ ß∂Ê¡ πÙ¡Ÿ ∑§Ê ÿ„ ‚ÈŸ„⁄Ê •fl‚⁄ „Ò– ºº¸ ∑§Ê flÊÃ ‚ ª„⁄Ê ‚ê’ãœ „Ò– •Ã— ß‚∑§ ÁŸflÊ⁄áÊ „ÃÍ flª¸ “•” ◊⁄¡— ¬˝flÁÃ¸ŸË fl≈UË ∞fl¢ flª¸ “’” ◊ GÒflÎÃ F„ •ŸÈflÊ‚Ÿ ’ÁSÃ ºË ªß¸– ‚¢Á„ÃÊ•Ê ◊¥ ºÙŸÙ „Ë ºflÊ∞¢ flÊÃŸÊ‡Ê∑§ ’ÃÊß¸ ªß¸ „Ò– ¬Á⁄áÊÊ◊∑§Ù √ÿÁQ§¬⁄∑§ ∂ˇÊáÊ ◊¥ ‚ÈœÊ⁄ ∑§ •ÊœÊ⁄ ¬⁄ ◊ÍÀÿÊ¢∑§Ÿ Á∑§ÿÊ ªÿÊ– •äÿÿŸ ◊¥ fl≈UË ‚◊Í„ ∑§Ë •¬ˇÊÊ ’ÁSÃ ‚◊Í„ ∑§ ’„Ã⁄¬Á⁄áÊÊ◊ •Êÿ–


18

Introduction:

With the advent of new millennium and the

herald of high-tech era, Women’s status was expectedto reach new horizons both socially and physically. Butsome of the physiological things trouble the lady to

make her slow down the race. Kashtartava is one ofthe important diseases among them. Kashtartava isamong the few diseases which can be attributed to

changed life styles. Not less than 50% of women aresaid to experience some discomfort in relation tomenstruation, and 5-10% of girls in their late teens

and early twenties are incapacitated for several hourseach month. For the present study, only primarydysmenorrhoea is taken with Kashtartava to exclude

the pathological cases. Pain is the main feature ofKashtartava, so it has strong relation with VataDosha.

The two drugs selected for the comparative

clinical study are; “Rajah-Pravartini-Vati” for oral and“Treivreita–Sneha Anuvasan-Basti” per rectum. Theselected two drugs are Vata shamaka mentioned by

the classics. Treivreita–Sneha Anuvasan-Basti, due tothe action (karma) of Anulomana and Vatahara mayit effectively brings down the Pratilomagati vata

which is mentioned in Charaka chikitsa 30 forUdavartini Yonivyapad.1 Which is one of the maindisease conditions come under Kashtartava (Primary

Dysmenorrhoea) and Rajah-Pravartini-Vati2 has adirect reference in Bhaishajya Ratnavali forKashtarvata.

Design Of The Study:

The method adopted in present study isRandomized, Clinical, Open study.

Aims & Objectives:

1. To study etiopathogenesis of Kashtartava and toexplore the clinical consequences.

2. To assess the efficacy of trial drugs in themanagement of Dysmenorrhea.

3. To compare the efficacy between Shaman and

Shodhan Chikitsa.

Material And Methods:

Total 50 clinically diagnosed and confirmed

cases of Primary Dysmenorrhoea were registered fromthe O.P.D. / I.P.D. N.I.A. Hospital, Jaipur after takinginformed consent.

Inclusion Criteria:

1. Subjects with chief complaint of Kashatartavawith scanty or average amount of menses along

with associated symptoms.

2. Subjects in age group of 16 to 30 years.

3. Subjects with H/O using analgesics during menses.

4. Subjects suffering with Kashtartava for more than

2 consecutive cycles.

Exclusion Criteria:

1. Subjects suffering from Secondary Dysmenorrhea.

2. Subjects suffering from Systemic diseases such asD.M., T.B.

3. Subjects using intra uterine contraceptive devices.

4. Subjects having pain abdomen associated withmenorrhagia, metrorrhagia.

5. Subjects with H/O hypothyroidism and

hyperthyroidism with DUB.

Posology:

Patients were randomly divided into following

two groups:

A Comparative Clinical Study of “Rajah-Pravartani-Vati”and “Treivreita-Sneha”Anuvasan-Basti” on Kashtartava

W.S.R To Primary Dysmenorrhoea

Dr. Diksha Khathuria, Dr. B. Pushpalatha

Clinical Study


19

TABLE NO. I

Group-A Group-B

Drug Rajah-Pravartini-Vati Treivreita-Sneha Anuvasan- Basti3 (Matra-asti).

Dose 500mg twice a day with 60 ml/day for 7 alternate days started 14lukewarm water days before onset of menstrual cycle

Route Oral Rectal

Duration 60 days 14 days

Investigations:

Laboratory investigations of blood, urine andUSG were carried out before treatment to rule out any

other pathological conditions.

Criteria of assessment:

A special scoring pattern was applied in

symptoms and associated complaints.

Statistical Evaluation of results:

The effect of the treatment of signs andsymptoms were analyzed statistically by Mean, SD,

and SE, paired Wilcoxon signed rank test andunpaired Mann-Whitney test for non-parametricstudy.

Results:

Table No : II Shows the % improvement of symptoms in both groups:

S.No. Cardinal Symptoms Result In Percentage

GROUP A GROUP B

1 Nausea 59.09% 65.22%

2 Vomiting 80.00% 90.00%

3 Fatigue 32.00% 43.48%

4 Headache 64.29% 73.91%

5 Fainting 62.50% 75.00%

6 Sweat 53.33% 77.78%

7 Diarrhoea 75.00% 100.00%

8 Constipation 55.56% 100.00%

9 Vaginal Discharge 66.67% 85.71%

10 Breast Tenderness 70.00% 88.89%

11 Pain Intensity 54.69% 58.46%

12 Pain Duration 53.97% 62.69%

13 Nature of Pain 56.92% 59.70%

14 Flow Duration -3.92% 3.70%

15 Flow Amount -25.00% -14.29%

16 Associated Symptoms 47.27% 68.52%

17 VAS Scale 47.95% 58.11%

18 FLACC Scale 53.23% 71.67%


20

19 Wong Baker Scale 40.91% 58.90%

Average % of relief 49.70% 64.60%

(Table No. III) Inter Group Comparison in Associated Symptoms of Kashtartava

by Mann-Whitney Test.

Symptoms Group Mean Dif. S.D.± S.E.± P Result

Nausea Grp A 0.59 0.50 0.11 <0.52 I.S.

Grp B 0.65 0.49 0.10

Vomiting Grp A 0.80 0.42 0.13 <0.01 S.

Grp B 0.90 0.32 0.10

Fatigue Grp A 0.32 0.48 0.10 <0.36 I.S.

Grp B 0.43 0.51 0.11

Headache Grp A 0.64 0.50 0.13 < 0.14 I.S.

Grp B 0.74 0.45 0.09

Fainting Grp A 0.63 0.52 0.18 <0.001 H.S

Grp B 0.75 0.46 0.16

Sweat Grp A 0.50 0.63 0.16 <0.001 H.S

Grp B 0.78 0.44 0.15

Diarrhoea Grp A 0.75 0.50 0.25 <0.001 H.S

Grp B 1.00 0.00 0.00

Constipation Grp A 0.56 0.51 0.12 <0.001 H.S

Grp B 1.00 0.00 0.00

Vaginal Discharge Grp A 0.67 0.49 0.11 <0.01 S

Grp B 0.86 0.36 0.10

Breast Tenderness Grp A 0.70 0.48 0.15 < 0.001 H.S.

Grp B 0.89 0.33 0.11

Table No. IV: Overall Effect Of Therapy :(Graph no.I)

S. Effect of therapy Result Group A Group B

No. No. % No. %

1 No relief (0%) 00 0.00% 00 0.00%

2 Mild (1 to ≤ 25%) 02 8.00% 00 0.00%

3 Moderate (>25 to ≤ 50%) 12 48.00% 04 16.00%

4 Significant (>50 to ≤ 75%) 10 40.00% 18 72.00%

5 Excellent (>75%) 01 4.00% 03 12.00%


21

(Table No. V) Inter Group Comparison in Subjective Parameters of Kashtartavaby Mann-Whitney Test

Symptoms Group Mean Dif. S.D.± S.E.± P Result

Pain Intensity Grp A 1.40 0.50 0.10 0.4 I.S.

Grp B 1.52 0.59 0.12

Pain Duration Grp A 1.36 0.70 0.14 0.18 I.S

Grp B 1.68 0.69 0.14

Nature of Pain Grp A 1.48 0.77 0.15 0.6 I.S.

Grp B 1.60 0.71 0.14

Flow Duration Grp A -0.08 0.57 0.11 0.40 I.S

Grp B 0.08 0.49 0.10

Flow Amount Grp A -0.36 0.49 0.10 0.34 I.S

Grp B -0.20 0.65 0.13

Associated Symptoms Grp A 1.04 0.61 0.12 0.02 S

Grp B 1.48 0.51 0.10

VAS Scale Grp A 1.40 0.58 0.12 0.06 I.S

Grp B 1.72 0.54 0.11

FLACC Scale Grp A 1.32 0.63 0.13 0.06 I.S

Grp B 1.72 0.68 0.14

Wong Baker Scale Grp A 1.08 0.49 0.10 0.001 H.S

Grp B 1.72 0.61 0.12


22

Discussion:

l In Group A- It is may be due to the fact that

“Rajah pravirtinivati” has Katu (pungent)- Tikta(bitter) Rasa, Laghu (light), Snighdha (unctuous)and Tikshna (sharp) Guna, Katu Vipaka and

Ushna Virya. Tikta (bitter) taste and Tikshna(sharp) property of drug removes theSrotoavarodha and facilitates flow of Vata; Katu

Vipaka and Ushna Virya pacifies the aggravatedVata and thus allows the painless flow of Artava.

l In Group B- It is may be due to fact that

Ingredients of “Treivreita-sneha” are mainlyMadhura (sweet) Rasa, Ushna Virya and havingSukshma (fine), Snigdha (unctuous) and Vikasi

Guna which are the properties of Vatanulomana(facilitator of downward movement of vata),Shoolaprashamana (colic pain reliever) and

Vedanasthapana. Spasm caused by vitiatedApana Vayu causes obstruction in the flow ofmenstrual blood is the general underlying

pathology of Dysmenorrhoea. Sneha by AnuvasanBasti enters into the Srotas and remove theSamkocha by virtue of its Madhura (sweet) Rasa

and Sukshma (fine), Vikasi Guna. Thus enablenormal flow of menstrual blood and reduces thepain resulting due to spasm. Basti having best

efficacy in the treatment of Vatika disorder; isconsidered here to be most beneficial in curative,preventive and rejuvenate aspects of Basti as a

whole. Sneha in general is Vatahara, producessoftness in the body and it destroys thecompactness of mala and removes the obstruction

in the Srotas, i.e. malaanam vinihanti sangham.As it is having Balya(strength promoting) propertymight have help to increase the strength of

Dhatus, thus increases pain threshold.

l Though Anuvasan Basti does not lead to profuseevacuation of Doshas, it eliminates faeces as well

as Vata situated in colon and as such comes underPanchkarma (Shodhana Therapy)4

Conclusion:

l Results of both the groups were encouraging butGroup B was better than Group A i.e. Shodhanachikitsa was better when compared with only

Shaman chikitsa. Shodana chikitsa is consideredto be more effective, since the disturbed doshas

are eliminated from the body whereas shaman willonly pacify the deranged doshas.

l It denotes that the Shodhana therapy is effectivein both pain as well as associated symptoms.Thus, the results suggest that Matra Basti can be

established as the single regimen which can relievemost of the ailments related to Kashtartava. Itsupports to fulfill the main objective of the study.

l Comparing the symptomatic improvement in bothgroups it was found that Average percentage ofrelief was higher in ‘Group B’ i.e. 64.60%,

followed by ‘Group A’ i.e. 49.70%. It showsthat effect of therapy was more in GroupB in comparison to Group A.

References:

1 . Agnivesha, 2004, Charaka Samhita, eds R.K.Sharma,

Bhagwan Dash, Choukhamba Sanskrit Series Office, Varanasi.

Vol.5, pp.36 (Ch./chi./30/115).

2. Govind das sen virchita, Bhaishjaya Ratnawali, hindi

commentary by Ambika data shastri, chaukhambha Sanskrit

series, 1996 edition, vol 1, pp. 420 strirogadhikara, 58-60.

3. Agnivesha, 2004, Charaka Samhita, eds R.K.Sharma,

Bhagwan Dash, Chowkhamba Sanskrit Series Office, Varanasi,

pp.857 (Ch./chi./30/110).

4. Agnivesha, Charaka Samhita edited with English translation

& critical exposition based on chakrapani datta’s Ayurveda

dipika by Dr.Ram Karan Sharma & Vaidya Bhagwan Dash

Reprint 2009 publishers chaukhamba Sanskrit series Office,

pp.678 (ch.si 1/16-17).


23

Management of Mutrashmari W.S.R. To Urolithiasis- AComparative Study of Varunadi Kwath And Trivikram Rasa

*Dr. Prashant Saini, **Dr. B. B. Pandey, ***Dr. Ashok Kumar****Dr. P. Hemantha Kumar, *****Dr. Ashish Pareek

Clinical Study

Abstract

Eight grave diseases which are difficult to treat and cause tremendous misery to sufferer has mentionedas Mahagada by Acharya Sushruta. Mutrashmari is one among these Mahagada. On the basis of symptoms,Urolithiasis described in modern surgical literature can be correlated with Ashmari. Treatment of Urolithiasis

is chiefly surgical but at times results are not satisfactory or there is major concern regarding recurrence. Medicaltreatment as a main treatment or as an adjuvant to overcome recurrence has always been under investigation.In Ayurveda there have been many formulations available for treatment of Ashmari among which Varunadi

Kwath and Trivikram Rasa has been indicated in the management of Ashmari. A clinical trial was planned toevaluate the efficacy in patients of Ashmari. Study was conducted according to special protocol designed forthis purpose and the same was approved by competent authorities prior to commencement of study. Thirty nine

patients were registered for the clinical trial and 30 patients completed trial and data obtained were used forinterpretation and for drawing conclusion.

Key words: -Mutrashmari, Mahagada,Urolithiasis, Varunadi Kwath, Trivikram Rasa

‚Ê⁄Ê¢‡Ê-

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*Ph.D Scholar & Corresponding Author, P.G. Deptt. of Shalya Tantra, N.I.A., Jaipur E-mail- [email protected], Mobile-

09785906793 **Professor, Deptt. of Shalya Tantra, S.S.S.B. Ay. College & Hospital, Renwal, Jaipur ***Associate Professor, P.G. Deptt.

of Shalya Tantra, N.I.A., Jaipur ****Professor & Head, P.G. Deptt. of Shalya Tantra, N.I.A., Jaipur *****Assistant Professor, Deptt. of

Shalya Tantra, S.S.S.B. Ay. College & Hospital, Renwal, Jaipur


24

Introduction

Ashmari has been considered as one amongthe ‘Astamahagada’ i.e. one of the deadly diseases1

because in this disease there is formation of stone,

exerting severe pain as given by enemy. Ashmarispecifically called as Mutrashmari, a disease ofMutravaha Srotasa. Mutrashmari can be correlated

with Urolithiasis because the symptoms ofMutrashmari go on in accordance with symptoms ofUrolithiasis of modern science. The cause of stone

formation is not yet fully understood but in majorityof the cases multiple factors are involved. Managementof various types of Ashmari has been described in

Sushruta Samhita in view of the fatality of thedisease.2 Due to possibility of treatment by medicines,treatment has been advised to be undertaken in the

early stages of the disease.3 Indications for the surgicalmanagement has been given along with a note ofcaution regarding its dangers and doubtful chances of

success. It was to be undertaken only on failure ofconservative treatment and when death was inevitableif not treated surgically.4 So, recurrence of stone even

after removal is becoming a great problem andconstant efforts are being made to evolve an effectivetreatment as well as prevention of recurrence of the

disease. There are various useful formulationsdescribed in Ayurveda classics for the management ofabove condition. Sushruta Samhita is the prime

literature in the field of Ayurveda surgical conditions.He broadly described the various conditions related tourogenital system. Acharya Chakrapani also

described many formulations for the management ofMutrashmari.5 Management for Urolithiasisis alsodescribed in the Laghutrayee.

Aims And Objective

l To compare the efficacy of Varunadi Kwath andTrivikram Rasa in the management of

Mutrashmari.

l To access the combined efficacy of Varunadi

Kwath and Trivikram Rasa in the management of

Mutrashmari.

Materials And Methods

Inclusion Criteria

1. Age between 18 to 60 years.

2. Ultrasonological evidence of single calculus /multiple calculi 10 mm, present in kidney(s)/

ureter(s) / urinary bladder.

3. Willing and able to participate for study.

4. All the patients presenting with either following

symptoms were selected for study-

l Increased frequency of micturition(Bahumutrata)

l Burning micturition (Mutradaha)

l Interrupted stream of urine (Mutravibandha)

l Nausea (Utklesh)

l Vomiting (Vamana)

l Fever (Jwara)

l Dysuria (Mutrakrichchha)

l Pain in flanks (Katishool)

l Haematuria (Rakta-Mutrata)

l Pyuria (Pooya-Mutrata)

Exclusion Criteria

l Age less than 18 years and more than 60 years.

l Patients with obstructive uropathy.

l Patients suffering from any major systemic diseaselike Diabetes Mellitus, Hypertension, Renal failureetc.

Sample Size: 30 Subjects diagnosed to haveMutrashmari fulfilling the Inclusion criteria.

Management of Mutrashmari W.S.R. To Urolithiasis- AComparative Study of Varunadi Kwath And Trivikram Rasa

Dr. Prashant Saini, Dr. B.B.Pandey, Dr. Ashok Kumar, Dr. P. Hemantha Kumar, Dr. Ashish Pareek

Clinical Study


25

Source: Subject selected from O.P.D. / I.P.D.at P.G. Department of Shalya Tantra, N.I.A. Jaipur.

Ethical Clearance: The study is approvedby institutional ethical committee of N.I.A.

Informed Consent: The study explained

clearly to the subjects & their signed, written informedconsent was taken before starting the trial.

Investigations: For the purpose of assessing

the overall condition of the patients complete urine(routine and microscopic), USG (KUB region) werecarried out before and after completing the course of

the treatment.

l In the present study total 39 patients wasregistered for study, out of which 30 patients

completed the trial. All the relevant data regardingthe clinical study were statistically studied on the30 patients who complete the study.

l Study was conducted over patients havingsymptoms of Mutrashmari divided into threegroups. The selected patients of Group A were

treated with 25 ml. of prepared Varunadi Kwathwith 500 mg. Yavkshara twice daily, Group Btreated with Trivikram Rasa 250 mg. twice daily

with Beejpoorak Mool Kwath and Group C treatedwith combined therapy of 25 ml. of preparedVarunadi Kwath with 500 mg. Yavkshara twice

daily and Trivikram Rasa 250 mg. twice withBeejpoorak Mool Kwath for a period of 45 daysand followed up every 3 rd week for further 6

months.

l The assessments were done on these parameters:Pain, Burning Micturition, Dysuria, Hematuria,

W.B.C. count of urine, Size of calculus and No. ofcalculus.

l For the assessment of the total effect of the therapy

following four categories were taken intoconsiderations by comparing assessment done on1st day with the assessment done on 45th day-

Good response –

75% and above relief in presenting signs andsymptoms of the disease.

Fair response–

50% to 74% Relief in presenting signs andsymptoms of the disease.

Poor response–

<50% Relief in presenting signs and symptoms

of the disease.

No response–

No Relief in presenting signs and symptoms of

the disease.

Drugs

1. Varunadi Kwath6

Ingredients: Varun, Pasanbheda, Shunthi,Gokshura, Yavakshar

2. Trivikram Rasa 7

Main Ingredients: Parad, Gandhaka,Tamra Bhasma

Other Ingredients: Aja Ksheera, Nirgundi

Anupana –Beejpoorak Mool Kwath

Observations And Results:

l It was found that Mutrashmari occurs in both

sexes but most commonly observed in the male inbetween 18-30 years age group.

l Upper middle class and sedentary life style of

persons were more prone to the disease.

l 61.54% of patients were complaining of Pain,66.67% of patients were complaining of Burning

micturition and 64.10% of patients werecomplaining of Dysuria.

l Maximum number of patients observed with Rt.

sided single renal calculus of size between 5.1-10mm.

l Group A (Varunadi Kwath) and Group B

(Trivikram Rasa) was found to have significanteffect on pain, burning micturition, dysuria,hematuria, W.B.C. count of urine, size of calculus

and no. of calculus.

l Group C (Varunadi Kwath and Trivikram Rasa)was found to have very significant effect on pain,

burning micturition, dysuria, hematuria, W.B.C.count of urine, size of calculus and no. of calculus.

l On inter-group comparison Group A (Varunadi

Kwath), Group B (Trivikram Rasa) and Group C(Varunadi Kwath and Trivikram Rasa) showed


26

not significant effect on pain, burning micturition,dysuria, hematuria, W.B.C. count of urine, size of

calculus and no. of calculus.

l None of patients were observed unchanged in thetrial groups.

l Observations obtained from the trial groups hadshown no side effects of the drugs.

l No recurrence was observed during the follow up.

l Overall effect of therapy in group A: 05 patients(50.00%) showed good response, 03 patients(30.00%) showed fair response, 02 patients

(20.00%) showed poor response and no patient(00.00%) showed no response.

l Overall effect of therapy in group B: 03 patients

(30.00%) showed good response, 04 patients(40.00%) showed fair response, 03 patients

(30.00%) showed poor response and no patient(00.00%) showed no response.

l Overall effect of therapy in group C: 07 patients

(70.00%) showed good response, 03 patients(30.00%) showed fair response, no patient(00.00%) showed poor response and no patient

(00.00%) showed no response.

l Overall effect of therapy in 30 patients:15 patients(50.00%) showed good response, 10 patients

(33.33%) showed fair response, 05 patients(16.67%) showed poor response and no patient(00.00%) showed no response.(Table and

Graph)

Table: Overall effect of therapy on 30 patients of Mutrashmari

Results Number of Patients % Relief

Good response 15 50.00

Fair response 10 33.33

Poor response 05 16.67

No response 00 00.00

Graph: Showing overall effect of therapy on 30 patients of Mutrashmari


27

Discussion

l The frequency of occurrence of acute and chronicrenal disorders has increased significantly in recent

years due to changes in the environmentalcondition and dietary habits. Medical treatment isnot satisfactory in many of the cases. Hence it

would be highly desirable to have nephroprotectivedrugs in the therapeutic armamentarium.Although many advances have been made in this

identification of risk factors for stone formation,there is as yet proven preventive or medicaltreatment. If we find out indigenous medicine that

simply dissolve or expel the stone, it will be greatachievement for a country like India. So thisproblem was selected for the present study taking

all these points into effective consideration.

l However, age has no direct relation with the

Mutrashmari formation but it is considered that3rd and 4th decades of life are more prone to thisdisease (Robbins Pathology Basis of Disease, 5th

Ed.).

l Relief in pain was observed might be due toVedana Sthapaka properties of Varun,Pasanbheda, Shunthi and Gokshura, Sothaharaproperties of Varun, Pasanbheda, Gokshura and

Nirgundi, Vatanulomana properties of Varun andShunthi, Ushna Virya of Varun, Shunthi,Nirgundi, Yavakshara, Parad, Gandhaka and

Tamra Bhasma.

l Relief in burning micturition was observed mightbe due to Madhura Rasa of Varun, Gokshura andBeejpoorak, Madhura Vipaka of Shunthi,

Gokshura, Parad and Beejpoorak and SheetaVirya of Pasanbheda, Gokshura, Aja Ksheera andBeejpoorak.

l Relief in dysuria might be due to Vatanulomanaproperties of Varun and Shunthi, Mutrala

properties of Varun, Pasanbheda, Gokshura andYavakshara, Mutra-krichchhrahara properties ofVarun, Pasanbheda and Yavakshara.

l The observed effect on hematuria and WBC count

of urine might be due to the Sheeta Virya ofPasanbheda, Gokshura, Aja Ksheera andBeejpoorak, Mutrala properties of Varun,

Pasanbheda, Gokshura and Yavakshara,Vranaropana Karma of Pasanbheda, Shunthi andTamra.

l The observed effect on size of calculus andno. of calculus might be due to the Lekhana

Karma of Yavakshara, Tamra, Bhedana Karmaof Varun, Yavakshara, AshmaribhedanaPrabhava of Varun, Pasanbheda, Gokshura.

l During follow up the patients were advised toattend the O.P.D. every 3rd week for further 6months. No recurrence was reported by the

patients within follow up period as they had beeninstructed to drink sufficient quantity of fluid anddietary regimen to maintain adequate hydration

and decrease chance of urinary super saturationwith stone-forming salts.

Probable mode of action of Varunadi Kwath:

The properties of the ingredients likeKaphahara, Lekhana, Vedanasthapana,Vatanulomana, Shoolaprashamana, Daha

Prashamana, Trishnahara, Bhedana, Shothahara,Mutrala, Mutra Virechaniya, Deepana, Pachana, acton The Dosha (Vata, Pitta and Kapha), Dushya

(Mutra), Srotasa (Mutravaha Srotasa) and Agni.

The ingredients of Varunadi Kwath pacifyKapha Dosha by virtue of their Ruksha Guna, Katu

Vipaka and Ushna Virya and also show “Lekhana”property due to Ushna Virya. The Lekhana Karma isagain enhanced by Famous Lekhana Dravya i.e.

Yavakshar, which is one ingredient in it.

The Vatanulomana, Shothahara and Mutralaproperties of ingredients help to relieve pain and

Sthanika Sotha. Deepana property of drug helps toincrease the Agni, which further check the formationof Ama at Jatharagni level itself. Pachana property

of ingredients helps in as similations of drug in thebody in case of Jatharagnimandya. Due to theAshmari Bhedana or Ashmari Hara property of

ingredients present in the drugs, stone might bedissolved.

Some compounds of the drug act as Mutrala

(diuretic) by virtue of their Sheeta Virya and MadhuraRasa.

All the ingredients of the drug by their

Bhedana, Ashmarihara and Kaphahara Karma alongwith Mutrala Karma, are helpful to reduce the size ofthe Ashmari and expelled it out from the body.

The ingredient (Gokshura, Pasanbheda etc.) in


28

good proportion with Yavakshara have cumulativeeffect as Ashmari Bhedana, Mutrala and Vrana

Ropana and Yavakshara with its Lekhana, Shodhanaetc. properties may have reduced the size of the stoneand Varunadi Kwath made them easy to expel out.

Thus in total this formulation has the capacityto disintegrate the pathogenesis of the diseaseMutrashmari and due to its diuretic action it flushes

out the disintegrated Mutrashmari by the process ofdiuresis.

Probable mode of action of Trivikram Rasa:

Trivikram Rasa mainly consists of drugs of

Vayu and Agni Mahabhuta. They are expected to actagainst vitiated Kapha Dosha, responsible forformation of stones which have dominance of Prithvi

and Jala Mahabhuta.

Ingredients of Trivikram Rasa have Vata

Kapha Hara properties. Vata Dosha is considered tobe main factor responsible for pain and vitiatedKapha Dosha responsible for formation of stones. So

due to Vata Kapha Hara properties of TrivikramRasa it is most likely to provide relief in pain and stopsformation of stones.

Constituents of Trivikram Rasa mainlyconsists Katu, Tikta Rasa, Laghu, Sukshma and

Snigdha Guna, Ushna Virya, Madhura and KatuVipaka. These pharmacological properties ofTrivikram Rasa induce Vatakapha Shamaka, Agni

Deepaka, Ama Pachaka, Lekhana, VranaropanaKarma, Shotha Hara effects.

Tamra have Deepana effect which regulatesJatharagni. Tamra and Gandhaka have Amapachana

properties. Tamra has a strong Lekhana effect andthus it is supposed to reduce the size of the Ashmariand expelled it out from the body. Parada and Tamra

Bhasma have Sroto Shodhana effect which mayrelieve Sanga in the Mutravaha Srotasa.

Conclusion

From the study, it can be concluded that-

ü Varunadi Kwath and Trivikram Rasa are effective

in patients suffering with Mutrashmari(Urolithiasis).

ü Combined therapy of Varunadi Kwath andTrivikram Rasa is more effective for the

management of Mutrashmari.

Referances

1 . Acharya Sushruta: Sushruta Samhita edited with Ayurveda

Tatva Sandipika Hindi Commentary by Kaviraj Ambikadutta

Shastri, Chaukhambha Sanskrit Sansthan, Varanasi, Edition:

Reprint 2010, Sootra Sthana Avaraniya Adhyaya Chapter 33/

4, P-163.

2. Acharya Sushruta:Sushruta Samhita edited with Ayurveda



Reprint 2010, Chikitsa Sthana Ashmari Chikitsa Chapter 7.

3. Acharya Sushruta:SushrutaSamhita edited with Ayurveda



Reprint 2010, Chikitsa Sthana Ashmari Chikitsa Chapter 7/

3, P-52.

4. Acharya Sushruta:Sushruta Samhita edited with Ayurveda



Reprint 2010, Chikitsa Sthana Ashmari Chikitsa Chapter 7/

29, P-54.

5. Chakrapanidatta:Chakradatta with Vaidyaprabha Hindi

Commentary by Dr. IndradevTripahi, Chaukhambha Sanskrit

Bhawan, Varanasi, Edition: Reprint 2008, Ashmari Chikitsa

Chapter 34.

6. Chakrapanidatta:Chakradatta with Vaidyaprabha Hindi

Commentary by Dr. IndradevTripahi, Chaukhambha Sanskrit

Bhawan, Varanasi, Edition: Reprint 2008, Ashmari Chikitsa

Chapter 34/29, P-212.

7 . Dr. Brahmanand Tripathi: Sharangadhar Samhita with DIPIKA

Hindi commentary, Chaukhamba Surbharti Prakashan,

Varanasi,Edition: Reprint 2011, Madhyama Khanda Chapter

12/172-174, P-305.


29

Clinical study on the efficacy of an Ayurvedic compound andPanchakarma procedure in the management of spasticity

among children suffering from spastic Cerebral Palsy

*Dr. Sumeet Goel, **Dr. Nisha Kumari Ojha

Clinical Study

Abstract

Aim: To conceptualize and evaluate the approach of Ayurvedic management in cerebral palsy (CP) inchildren and to improve quality of life by reducing spasticity thereby making the child able to do day to daywork.

Materials and Methods: 30 Children of the age group of 1 to 12 years were selected after evaluatingthem clinically for spastic CP as per the inclusion criteria, from O.P.D. and I.P.D. of PG Department Balroga,N.I.A. Jaipur, divided into two groups, group A (Trial group) received Ashtang Ghrita as oral medication and

Panchakarma therapy including Abhyanga with Prasarini taila, Shashtishali Pinda Sweda and Matra bastiwith Devdarubaladi taila. Group B (Control group) received physiotherapy, duration of study was three month.Assessment was done using Ashworth scale of spasticity.

Results: Significant improvement was seen in all four limbs at the end of trial, trial group shownsignificant gain over control group in Right upper limb.

Conclusion: Ayurvedic management with Panchakarma therapy have proved to be a better, safe and

cost effective treatment modality for managing and improving the quality of life by reducing the spasticity inpatients with Cerebral palsy.

Key words – Ashworth Scale, Ayurveda, Cerebral Palsy, Panchakarma, Spasticity

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¬Á⁄áÊÊ◊— ©ÑπŸËÿ ‚ÈœÊ⁄ ¬⁄ËˇÊáÊ ∑§ •¢Ã ◊¥ ‚÷Ë øÊ⁄ •¢ªÙ¥ ◊¥ ºπÊ ªÿÊ– ¬⁄ËˇÊáÊ ‚◊Í„ ◊¥ ÁŸÿ¢GáÊ ‚◊Í„ ‚ •Áœ∑§©ÑπŸËÿ ‹Ê÷ ŒπÊ ªÿÊ–

ÁŸc∑§·¸— ¬¢ø∑§◊¸ ÁøÁ∑§à‚Ê ∑§ ‚ÊÕ •ÊÿÈflÁº∑§ ÁøÁ∑§à‚Ê ◊ÁSÃc∑§ ¬ˇÊÊÉÊÊÃ ∑§ ⁄ÙÁªÿÙ¥ ◊¥ ≥ÊÊ⁄ËÁ⁄∑§ ¡«∏ÃÊ ∑§Ù ∑§◊ ∑§⁄∑§¡ËflŸ ∑§Ë ªÈáÊflûÊÊ ◊¥ ‚ÈœÊ⁄U ‹ÊŸ ∑§ Á‹ÿ ∞∑§ ’„Ã⁄U, ‚È⁄ÁˇÊÃ •ÊÒ⁄ ‹ÊªÃ ¬˝÷ÊflË ©¬øÊ⁄ ∑§ M§¬ ◊ ¬˝◊ÊÁáÊÃ „Èß¸ „Ò–

*Research Officer (Ayurveda), Central Council for research in Ayurvedic Sciences, Ministry of Ayush, New Delhi, **Asstt. Prof., P.G

Department of Balroga, National Institute of Ayurveda Jaipur Email- [email protected], Contact-09509031834


30

Introduction:

Cerebral palsy is the most common physicaldisability in childhood, occurring in 2.0 to 2.5 per1000 live birth, yet in numerous cases the cause

remains unknown.1 It presents with the groupdisorder of movement and posture due to a lesionpresent in the brain. Disorder manifests early in the

1st year of life and remains throughout as a permanentand non-progressive condition.

With the advancement in the mother child

care, its incidence is increasing and it has become thesecond cause of disability in children afterpoliomyelitis. The etiology of Cerebral Palsy mainly

related to the antenatal and perinatal causes, butneonatal causes such as septicemia, meningitis,encephalitis, head injury and infections are also

clinically equally important. Its pathology lies indeveloping brain mainly cerebrum, brain stem, gyri,middle cerebral artery, thalamus, basal ganglia,

cerebellum etc. Even with so many advances in theMedicine there is no cure for it and the child has tolead a miserable long life on the mercy of others.

Concept of spastic CP in Ayurveda:

Cerebral Palsy may also be considered as ShiroMarmabhigathaja Vata Vyadhi (VataVyadhi as a

consequence to the damage in CNS), which maymanifest itself in any of the following main clinicalpresentation such as Spastic Monoplegia (Ekanga

Roga), Hemiplegia (Pakshavadha), Spastic Diplegia(Pangu), Spastic Quadriplegia (Sarvanga Roga),which are described under Vata Vyadhi2 in the texts

and Marmaghata is described as one of the causes ofVata Vikara.3 Phakka roga4 have most of the clinicalfeature similar to the Cerebral palsy, in which the

child is not able to stand after 1 year of age, withsymptoms of incapability of walking, Jadatwa(inactive), Mookatwa (dumb) and Pangutwa (lame)

and nishchesta adharkay5 which signifies that the

Clinical study on the efficacy of an Ayurvedic compound andPanchakarma procedure in the management of spasticity

among children suffering from spastic Cerebral Palsy

Dr. Sumeet Goel, Dr. Nisha Kumari Ojha

Clinical Study

babies portion below the pelvis doesnot have enough

power to walk or stand properly.

Drugs acting on central nervous system knownas medhya drugs in Ayurveda along with

panchakarma procedures may help in themanagement of cerebral palsy in children with a betteroutcome. Therefore the present trial has been

conducted with following aims and objectives:

Aims And Objectives

Primary objective

l To conceptualize and evaluate the approach ofAyurvedic management in cerebral palsy inchildren.

Secondary objectives

l To improve quality of life by reducing spasticitythereby making the child able to do day to daywork.

Material and methods

Selection of Cases:

For the study, affected children of the age

group of 1 to 12 years were selected after evaluatingthem clinically, from O.P.D. and I.P.D. of PGDepartment Balroga, N.I.A. Jaipur.

Grouping and administration of drug

30 cases were registered for the study and wererandomly divided in two Group A and Group B.


31

Table no. I : Showing Grouping of Cases and their respective management.

Group Allocation Intervention Duration of

therapy

Group A Trial Group a. Oral Drug i. Ashtang Ghrita 1 ml/kg daily for(Ayurvedic Management) 3 months

b. Panchakarma i. Abhyanga with 15-20 min/day forProcedure Prasarini Taila 3 months

ii. Shashtika Shali 30-35 min/day for

Pinda Sweda 3 months

iii. Matra Basti with First 15 days ofDevdarubaladi Taila study

Group B Control group Physiotherapy i. Stretching Daily for 3 months

ii. Musclestrengthening

iii. Range of motionexercises

Inclusion Criteria

1. Age group of 1 to 12 years of either sex.

2. Diagnosed Case of cerebral palsy without seizures.

Exclusion Criteria

1. Progressive neurological disorder.

2. Any other serious systemic disease.

3. Patient with active seizure

Discontinuation Criteria

1. Parent/Guardian is not willing to continue thetreatment.

2. Patient develops life threatening complicationduring treatment.

3. Any other severe illness.

Assessment Criteria:

1. Spasticity – Modified Ashworth Scale6

Assessment was done using ‘Wilcoxon matchedpairs test’ for statistical improvement analysis in theclinical features of Cerebral palsy in single group and

‘unpaired Mann-Whitney Test’ for statistical status ofintergroup differences of clinical features.

Trial Duration: The trial was conducted forthree months.

Trial Drug: Ashtang Ghrita7

Drug dose and Duration:

Doses were according to the body weight of

the child (1 ml/kg/day) in two or three divided dosesfor 3 months with follow up at 30th day, 60th day and90th day respectively. Any discomfort or untoward side

effects were noticed.

Drug used for Matra Basti:

Devdarubaladi Taila8

Duration –

Once daily after the snehna swedana for firstfifteen days.


32

Observations

Table No.II: Showing incidences dominating with percentage status. (n=30)

Incidence Predominance Percentage (%)

Age in yrs. 5– 8 46.7

Sex wise division Male 70

Religion Hindu 70

Habitat Urban 70

Socio-economic status Middle lower 53.3

Family structure Joint 56.7

Consanguineous marriage Absent 96.7

Mothers Age of Conception Appropriate 73.3

Antenatal Care status of Mothers Proper 83.3

Birth Order First 60

Mode of Delivery Normal 83.3

Place of Delivery Hospital 73.3

Status of Foetus Presentation Vertex 76.7

Birth Maturity Wise Division Full term 83.3

Birth Weight wise division Normal 63.3

Birth Asphyxia Present 70

Antenatal Factors Normal 73.3

Perinatal Factors Birth asphyxia 70

Postnatal Factors Respiratory Distress Syndrome 26.7

Immunization status Proper 90

Presence of Associated Problems Drooling of saliva 60

Sub classification of Spastic CP Diplegia 60

Results - Ashworth Scale of spasticity

Table no. III: Showing effect on spasticity in right upper limb of Group A

Sr. Duration Mean (n=15) % S.D. S.E ‘p’ Result

no. B.T. A.T. Diff. Change (±) (±) value

1. 1 month 1.47 1.37 0.10 6.80 0.207 0.053 > 0.05 N.S.

2. 2 month 1.47 1.23 0.24 16.33 0.258 0.067 <0.01 **V.S.

3. 3 month 1.47 1.00 0.47 31.97 0.352 0.090 <0.01 **V.S.


33

Table no. IV: Showing effect on spasticity in right upper limb of Group B



1. 1 month 1.6 1.53 0.07 4.38 0.175 0.045 > 0.10 N.S.

2. 2 month 1.6 1.4 0.20 12.50 0.316 0.081 <0.05 S.

3. 3 month 1.6 1.3 0.30 18.75 0.387 0.100 <0.01 **V.S.

Table No. V: Showing intergroup comparison of Ashworth scale readings of effect onspasticity in right upper limb in both groups:

Sr. Group Mean N S.D. S.E Mann- ‘p’no. (±) (±) Whitney U Value Result

1. A 1.000 15 0.327 0.085 62.00 <0.05 *S.

2. B 1.300 15 0.368 0.095

Table no.VI: Showing effect on spasticity in left upper limb of Group A



1. 1 month 1.37 1.23 0.14 10.20 0.229 0.059 <0.05 S.

2. 2 month 1.37 1.19 0.18 13.14 0.258 0.067 <0.01 **V.S.

3. 3 month 1.37 1.10 0.27 19.71 0.481 0.124 <0.01 **V.S.

Table no. VII: Showing effect on spasticity in left upper limb of Group B



1. 1 month 1.50 1.40 0.10 6.67 0.207 0.053 >0.05 N.S.

2. 2 month 1.50 1.35 0.15 10.00 0.320 0.082 <0.05 S.

3. 3 month 1.50 1.20 0.30 20.00 0.423 0.109 <0.01 **V.S.

Table No. VIII: Showing intergroup comparison of Ashworth scale readings of effect onspasticity in left upper limb in both groups:


1. A 1.10 15 0.471 0.122 93.00 >0.10 N.S.

2. B 1.20 15 0.621 0.160


34

Table no. IX: Showing effect on spasticity in right lower limb of Group A



1. 1 month 1.83 1.73 0.10 5.46 0.280 0.072 > 0.10 N.S.

2. 2 month 1.83 1.60 0.23 12.57 0.320 0.083 <0.05 S.

3. 3 month 1.83 1.40 0.43 23.49 0.316 0.816 <0.01 **V.S.

Table no. X: Showing effect on spasticity in right lower limb of Group B



1. 1 month 1.83 1.70 0.13 7.10 0.229 0.060 < 0.05 S.

2. 2 month 1.83 1.67 0.16 8.74 0.244 0.063 <0.05 S.

3. 3 month 1.83 1.53 0.30 16.39 0.280 0.072 <0.01 **V.S.

Table No. XI: Showing intergroup comparison of Ashworth scale readings of effect onspasticity in right lower limb in both groups:


1. A 1.400 15 0.387 0.100 102.00 >0.10 N.S.

2. B 1.533 15 0.399 0.103

Table no.XII: Showing effect on spasticity inleft lower limb of Group A



1. 1 month 1.70 1.60 0.10 5.88 0.280 0.072 > 0.10 N.S.

2. 2 month 1.70 1.45 0.25 14.70 0.309 0.079 <0.01 **V.S.

3. 3 month 1.70 1.40 0.30 17.65 0.352 0.091 <0.01 **V.S.

Table no. XIII: Showing effect on spasticity in left lower limb of Group B



1. 1 month 1.83 1.70 0.13 7.10 0.229 0.060 < 0.05 S.

2. 2 month 1.83 1.67 0.16 8.74 0.244 0.063 <0.05 S.

3. 3 month 1.83 1.43 0.40 21.86 0.280 0.072 <0.01 **V.S.


35

Table No. XIV: Showing intergroup comparison of Ashworth scale readings of effect onspasticity in left lower limb in both groups:


1 A 1.40 15 0.387 0.100 91.50 >0.10 N.S.

2 B 1.43 15 0.417 0.108

Discussion

Spasticity of affected muscles was evaluated byusing internationally accepted Modified Ashworthscale.6 Spasticity was assessed in Upper and Lower

Limbs over ankle and knee joint. It consists of fivegrading level starting from 0 to 4. Change onAshworth scale for spasticity of Right upper limb

observed in group A after one month was non-significant (p>0.05). After second month gain of16.33% and after three month gain of 31.97% was

noted both were statistically very significant (p<0.01),in Group B the effect observed after 1st month was insignificant (p>0.10), the improvement at the end of

second month was 12.50% which was statisticallysignificant (p<0.05) while the result at the end of threemonth was very significant (p<0.01) with 18.75% gain.

Inter group comparison showed that Group A hadsignificant advantage over group B. (p<0.05). Changeon Ashworth scale for spasticity of Left upper limb

observed in group A after one month was significant(p<0.05) with 10.20% gain. After second month gainof 13.14% gain and after three month gain of 19.71%

both were statistically very significant (p<0.01), inGroup B after 1st month gain was insignificant(p>0.10), the improvement at the end of second month

was 10.00% which was statistically significant (p<0.05)while the result at the end of three month was verysignificant (p<0.01) with 20.00% gain. Inter group

comparison showed that Group A had no significantadvantage over group B. Change on Ashworth scale forspasticity of Right lower limb observed in group A at

the end of 1st month was statistically insignificant(p>0.10) with 5.46 % change in spasticity, at the endof 2nd month improvement was statistically significant

(p<0.05) with 12.57% change in spasticity and the endof 3rd month improvement was statistically verysignificant (p<0.01) with 23.49% change in spasticity.

In Group B at the end of 1st and 2nd monthimprovement was statistically significant (p<0.05) with

decrease of 7.10% and 8.74% spasticity, respectively.There was decrease of 16.39% spasticity at the end of3rd month which was statistically very significant (p<

0.01). Inter group comparison shows non-significantgain of Group A over group B (p>0.10). Change onAshworth scale for spasticity of Left lower limb

observed in group A at the end of 1st month wasstatistically non-significant (p>0.10) with decrease of5.88% spasticity. At the end of 2nd and 3rd month there

was decrease of 14.70% and 17.65% spasticityrespectively, which were statistically very significant(p< 0.01). In group B improvement at the end of 1st

and 2nd month was statistically significant (p<0.05)with decrease of 7.10% and 8.74% spasticity,respectively. There was decrease of 21.86% spasticity

at the end of 3rd month which was statistically verysignificant (p< 0.01). Post treatment inter groupcomparison shows non-significant gain of Group A

over group B (p>0.10).

In the upper limb examination group Ashowed no results at 1st month in right upper limb

while at the end of 3rd month very significant changesseen in both groups bilaterally at the end of trial rightupper limb responded quite extra in comparison to left

upper limb. Reason for same is one Right sidedhemiplegic case was there in group A, and overallspasticity was on higher side in right upper limb as

compared to left upper limb (though the differencewas statistically insignificant; p>0.10), thus givingbetter change in spasticity as compared to left upper,

but the change in both limbs were statistically verysignificant.

These changes in this group occurred due to

proper physiotherapy performed on patients whichwas not available to them prior to the treatment.Proper stretching relieved spasticity mildly in these

subjects.


36

In group A Ashtang Ghrita along withabhyanga with prasarinitaila, shashtika sali pinda

sweda and devdarubaladi taila matra basti hascontributed equally as compared to group B in leftlimb, but quite significant gain was seen in group A

as compared to Group B (p<0.05) in Right upperlimb, thus the Ayurvedic management was found tobe equally effective as physiotherapy in spasticity, but

Ayurvedic management have shown improvementquite earlier than physiotherapy, this can be attributedto mild stretching effect during abhyanga and Shashti

shali pinda sweda along with relaxed muscle due tooleation and sudation effect.

In the lower limb also improvement in both

groups were very significant bilaterally results wereobtained due to high level of spasticity and rigidity inweight bearing limbs.

Hence the mean before treatment was higherthan upper limb so the improvement was seen withmild change in mean, but found to be very significant

with p value near to the periphery of the minimumgain needed to be very significant.

In the intergroup comparison, Group A haveinsignificant gain over group B bilaterally in lower

limbs. In upper limb where muscle are comparativelysmaller than in lower limb have shown better resultsin Group A, but here muscle are larger hence active

stretching of muscle possible in physiotherapy haveshown earlier results in Group B, but active andcontinuous Ayurvedic management is equally effective

in long term as compared to physiotherapy showingefficacy of the management in spasticity.

Effect of Drug:

“Ashtang Ghrita”, it is mentioned for makingthe child dhanyam (Blessed, healthy), Aayushyam(long salubrious life), vaak (improves speech), Medha

(Improves intelligence), Smriti (Improves memory)and Buddhikrita (improves cognition, perception and/or comprehension).7

Studies have shown contents of AshtangGhrita have properties which help in the managementof cerebral palsy in many aspects (table no.14)

Table no.XV: Showing clinical effects of the ingredients of trial Drug (Ashtang Ghrita)

Sr. Clinical Effect Drug

1. Effect on cerebral ischemic injury, Neuro- Bakuchi,9 Vidhara,10 Guduchi11

inflammatory condition, Reperfusion, Healing

2. Neuro-protective effect; Nootropic Vacha,12 Bakuchi,13 Vidhara,14 Shankhpushpi,15

Shatavari,16 Mandukaparni,17 Brahmi,18 Guduchi19

3. Cognitive function Vacha,20 Vidhara,21 Shankhapushpi,22 Shatavari,23

Mandukaparni,24 Brahmi,25 Guduchi26

4. Neuronutrient effect and Vacha,27 Vidhara,28 Shankhpushpi,29

Anti-oxidative Brahmi,30 Guduchi31

5. Activation of neuronal stem cell Bakuchi32

6. Sedative effect, Anti-anxiety Vacha,33 Shatavari,34 Brahmi,35 Guduchi36

7. Anti Convulsant Vacha,37 Vidhara,38 Shankhpushpi39

8. Improve behavioral pattern and Mandukaparni,40 Guduchi41

general ability in Mental Retarded

9. Effective in brain Tumor Guduchi42

10. Effect on synaptic reconstruction, Mandukaparni,43-44 Vidhara45

nerve regeneration and elongation

11. Muscle relaxant Bakuchi46-47, Brahmi48


37

The above table shows that trial drug AshtangGhrita contains maximum number of the effects that

help in improving the lesion present in the brain dueto ischemic injury along with the neuronalregeneration; arborisation and synaptic reconstruction.

Other neuro-nutrient and neuro-protective effectproduce possible protection to the further damage ofthe neuron due to oxidant injury. Effect on cognitive

dysfunction and convulsion could improve theassociated complaints in CP. Muscle relaxant effectscan manage the spastic muscles to relax.

In this trial Devdarubaladi taila was used forMatra Basti, which is indicated as ‘sarvangvatajit’ i.e.it pacify vata dosha from all over the body.49

Effect of Abhyanga

The main part of abhyanga procedure is themechanical stimulation more precisely the pressure

application during massage therapy. Pressureapplication done in proper way can help in reductionof motor neuron hyper-excitability by reducing the

alpha motor neuron activity. Abhyanga procedure alsodecreases the release of the cortisone stress hormoneand leading to the relaxation of muscle.50

Effect of Shali Shashtika Pinda Sweda

Shashtishali pinda sweda enhance thephysical consistency, strengthens the nervous system

and reduce the spasticity in muscles.

Conclusion

The present study concludes that Ashtang

Ghrita along with Devdarubaladi Taila Matra Bastiand Abhyanga followed by Shashtishali pinda swedaprovided very significant improvement in Modified

Ashworth scale of spasticity. In intergroupcomparison, Group A has shown significant gain inAshworth scale of spasticity of Right upper limb over

group B, whereas no significant gain was seen inGroup A over Group B Ashworth scale of spasticity inLeft upper limb and right and left lower limbs. No

untoward side effect was noticed during the trial.

Hence it can be concluded that Ayurvedicmanagement with Ashtang Ghrita and Panchkarma

procedures including Abhyanga with Prasarini taila,Shashtishali pinda sweda and Matra basti withDevdarubaladi taila have proved to be a better, safe

and cost effective treatment modality for managing

and improving the quality of life by reducing thespasticity in patients with Cerebral palsy.

What is this study adds

The study provides evidence on the efficacy ofAyurveda in the management of CP.

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40

Effect of Batankura Ksheera (Ficus benghalensis latex) andKarpoora In The Prevention of Recurrence of Arma(Pterygium) After Arma Chhedana (Pterygectomy)

*Dr. Pankaj Kundal, **Dr. Sanjeev Kumar Sharma, ***Vaidya K. S. Dhiman

Clinical Study

Abstract:

Arma is the disease of Suklamandal of eyes. It is a chedan sadhya vyadhi which is described by theancient authors like Sushruta and Vagabhatta in the advance stage, while in the initial stages ancient authorshad advised application of Lekhan anjana i.e to cure the disease without shalya karma with the help of medicine

only.

Arma can be correlated with the Pterygium in modern science according to its signs and symptoms. Inthis clinical study we had used the medicine for lekhan karma in the form of Batankura ksheera and karpoora

locally in the prevention of Arma after Arma chedana. The patient were randomly divided into two groups with10 patient in each Standard group and Treated group. In Standard group surgical excision was carried outwithout the application of batankura ksheera and Karpoora but antibiotic with steroid and anti-inflammatory

drug were given in post operative care. In Treated group surgical excision was followed by application ofbatankura ksheera and Karpoora daily for 5 days.

The duration of trial was 1 month in both groups with follow up for 3 months to see recurrence of Arma.

A great relief was found in most of the symptoms and signs of Arma (pterygium) after the trial in Treated group.Statistically the medicine was found significant in most of the symptoms. Rate of recurrence of arma in Standardgroup was 40% and in Treated group it was 20%.

Key words: - Arma, Suklamandala, Batankur ksheera, karpoora, Lekhana

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*Assistant Professor, Dept. of Shalakya Tantra, AIIA, New Delhi, **Prof. and HOD, Dept. of Shalakya Tantra, R.G.G.A.C., Paprola (H.P),

***D.G., CCRAS, New Delhi


41

Introduction

Ayurveda the science of life is not only atreatise related to treatment but it considers abouthealthy man also. Thats why it has aimed at

maintaining the health of a person, then treatment ofthe diseased.

The Eye, organ of sight is of utmost

importance as for as one’s existence is concerned i.e.outside and inside world of human body. Eyes holdspecial status among all the senses.

In Ayurveda the science of life, Vaghbatta thegreat Physician has rightly described the importanceof eyes in the above verse. Without Eyes the day and

Night are equal so must be protected with utmostcare.1

Arma is described as a disease of shukla

mandal.2 Arma is meant for its progressive in nature,so the disease found its name due to its property ofgrowing. The muscular growth which goes from

kaninak or apaang sandhi towards krishna mandalais called Arma.

Arma is described among the Shukla gata

Roga, as a fibrous growth of various colours andthickness, according to the Dosha involved. From thedescription of Arma found in our holy tests, we can

compare the Arma, with the Pterygium of Modernophtalmology.

Pterygium is a wing shaped fold of conjunctiva

encroaching upon the cornea from either side with inthe interpalpebral fissure3 Pterygium is the Greek wordmeaning win like the butterfly it has got a head Neck

and Body The triangular apex of the pterygium overthe cornea is called the head, the main mass over thesclera is the body and the junction of the head and the

body at the limbus is the neck of the pterygium.4

Recurrence is the most common complicationof Pterygium surgery. Risk factors reported to have a

major impact on the recurrence rate are related toAge, Fleshiness of the fibro vascular tissue and the

bare sclera excision technique. The treatment ofPterygium is still controversial with various treatmentsbeing advocated in the scientific literature.

Our Acharyas were also well aware of thenature of its recurrence that’s why they have advocatedvarious types of lekhya Anjans for the remnants of

Arma5. Keeping all above facts in mind about thetreatment of Arma ( Pterygium) Ayurvedic mode ofcombating the Arma Shesha with latex of Ficus

benghalensis and fine powder of camphor was takenfor the study.

Aims and objectives:

Present study was done to see the effect ofBatankur Ksheera and Karpoora on the recurrence ofPterygium.

Materials And Methods

(1) Selection of Patients:

This clinical study was conducted on the

outdoor Patients of Netra Roga O.P.D. of ShalakyaTantra of R.G..G.P.G.A.C. Paprola. The patients formthe material which were selected for the trial

irrespective of their caste, creed, race and religion.

(2) Inclusion Criteria:

Patients diagnosed as suffering from Arma

having no other local or any major systemic diseasewere included in the trial.

(3) Exclusion Criteria:

Patients suffering from ocular diseases ofAnterior segment such as conjunctivitis, Keratitis,Kerato conjunctivitis, patients suffering from major

systemic diseases like Diabetes, Hypertension etc willalso be excluded from the study.

Effect of Batankura Ksheera (Ficus benghalensis latex) andKarpoora In The Prevention of Recurrence of Arma(Pterygium) After Arma Chhedana (Pterygectomy)

Dr. Pankaj Kundal, Dr. Sanjeev Kumar Sharma, Vaidya K. S. Dhiman

Clinical Study


42

(4) Investigational Criteria:

For ruling out Pathologies following

Investigations were performed in all selected Patients.

- Fasting Blood sugar

- Bleeding Time

- Coagulation time.

(5) Study Design:

20 patients were randomly selected and

divided in to two groups i.e. Standard Group andTreated Group. Each groups having 10 patients.

Standard Group:

Surgical Excision was carried out without theapplication of Batankur Ksheera and Karpura butAntibiotic with steroid drop and anti inflammatory

drugs were given.

Treated Group:

Surgical Excision was followed by application

of Batankur ksheera and Karpoor daily for 5 days forfive minutes. Fresh Batankura ksheera and Karpoorawas applied after rubbing on aseptic surface just after

the procedure for about five minutes.

Constituents of Drug:

(1) Batankura ksheera (Latex of Ficus benghalensis)

(2) Karpoora (Fine powder of camphor)

Method of Preparation:

The fine powder of camphor is mixed with

Latex of ficus benghalensis and applied on the baresclera area after Excision of the Pterygium tissue.

Trial duration:

Though the duration of trial was one month,but the patients were called for follow up for 3 monthsto see recurrence of Arma.

Methodology:

All patients selected for Trial were explainedthe nature of study and their consent was obtained on

the proforma before Inclusion in the study. Afterarriving at diagnosis, clinical proforma was filled upwhich incorporated all the signs and symptoms based

on both ancient and modern Literature. All points of

Dosha, Dushya etc. are also there in proforma.Complete physical, systemic and local examination was

carried out with specific investigations in all patients.

The reference of the use of Bata Latex and finepowdered camphor is taken from unpublished

Manuscript on Shata shloki. The traditional treatmentusing herbs is very popular in Villupuran District ofTamil Nadu6.

Patients of Arma of both the Groups wereexcised out by bare sclera Method. In Treated Groupexcision of Arma was followed by application of Latex

of Ficus benghalensis and fine powder of camphor.Routine post operative care was taken in both theGroups.

Follow Up:

Patients of both the Groups were advised forfollow up on 1st, 2nd, 3rd, 4th, 5th day and after 1

month, 2 months and 3 months to check therecurrence of Arma so as to compare the results.

(6) Assessment criteria:

Effect of treatment (Results) were assessed inregard to clinical sign and symptoms (on the basis ofgrading and scoring system) and overall improvement

and inter group comparison is also undertaken.

Results

Maximum Patients showed symptom of

Itching i.e. 30% and 20% showed symptom ofwatering. Both the symptom were present in 50 % ofPatients.


43

Table I Symptom wise distribution of 20 patients of Arma

S.No. Symptoms No. of Patients Percentage

1 Itching 6 30 %

2 Watering 4 20 %

3 Both 10 50 %

Total 20 100 %

Table II Summary of clinical profile of Group I

Symptom Mean Value Relief % SD SE T P

BT AT age (±) (±)

Itching 1.8 0.6 1.2 66.66 0.78 0.24 4.8 <.001

Lacrimation 1.4 0.3 1.1 78.5 0.73 0.23 4.72 <.001

Photophobia 1.2 0.4 0.8 66.66 0.63 0.23 4.70 <.001

FB Sensation 1.2 0.3 0.9 75 0.316 0.10 9.00 <0.01

Ropy Discharge 1.3 0.5 0.8 61.53 0.421 0.133 6.00 <.001

Sign

Congestion 1.9 0.4 1.5 78.94 0.707 0.233 6.7 <.001

Keratitis 1.2 0.3 0.9 75 0.316 0.10 9.00 <.01

Recurrence 2.99 1.6 1.39 46.48 1.35 0.42 3.247 <.01

Table III Summary of clinical profile of Group ll

Symptom Mean Value Relief % SD SE T P

BT AT age (±) (±)

Itching 1.9 0.4 1.5 78.94 0.527 0.166 9.00 <.001

Lacrimation 1.6 0.2 1.4 87.5 0.51 0.163 8.57 <.001

Photophobia 1.4 0.3 1.1 78.57 0.567 0.17 6.128 <.001

FB Sensation 1.2 0.1 1.1 91.66 0.31 0.10 11.00 <0.01

Ropy Discharge 1.4 0.3 1.1 78.57 0.567 0.179 6.128 <.001

Sign

Congestion 1.9 0.1 1.8 94.73 0.63 0.20 9.0 <.001

Keratitis 1.3 0.1 1.2 92.3 0.421 0.133 9.0 <.01

Recurrence 2.99 1.0 1.99 66.55 1.248 0.394 0.394 <.001


44

Discussion

It was seen that after 3 months Arma recurred

in two patients of the standard group. 2 patients oftreated group also showed recurrence of Arma. Rateof Recurrence of Arma in standard group were 40%.

Rate of Recurrence of Arma in Treated Group were20%. Other than recurrence it was also observed thatcongestion at the site of wound after excision

disappeared more early in the treated group ascompared to standard Group, where as it remained fora longer time.

Mode of action of the drug:

The constituents of Drug possess two types ofproperties. One type of constituents possess Ushan,

Ruksha, Tikshan, Laghu, Katu, Kashaya and Tiktaproporties and the other group is Sheeta, Madhur andSnigdha in Nature.

The first type of properties seems to cause lysisand scraping of the vitiated Dhatus and the secondtype of properties seem to protect the healthy Dhatus

and nourish them. So the Drug Powdered camphorand latex of Ficus benghalensis possess both lekhanaand shamaka properties.

Arma is a (Mansa Dhatu Dushta) Kaphapredominant Tridoshaja Vyadhi. The constituents ofTrial drug are mainly suppressants of Kapha

possessing lekhana (Scraping) qualities also.

According to modern concept also, we canassume that Antimitotic drugs act as fibrolytic agent

and cause scrapping of the left Pterygium tissue, trialdrug act as a Fibrolytic agent.

Conclusion

Batankura Ksheeara and Karpoora affect therecurrence of Arma to some extent. The Congestion atthe wound site and symptom like watering are relieved

more early with the application of Trial Drug. .Noadverse effect was observed during the treatment andafter treatment. It is concluded that the study should

be carried out on a large scale so that satisfactoryResults are gained.

References:

1 . Vriddha Vagbhatt, Ashtang Sangraha edited by K.R.Srikantha

Murthi, reprinted 2012, Varanasi, Chaukhambha Orientalia,

Uttar tantra, 16th Adhyaya, 91st verse, page no.148

2. Sushruta, Sushruta Samhita edited by Kaviraj Ambika Dutta

Shastri, reprinted 2015, Varanasi, Chaukhamba Sanskrit

Sansthan, Uttar tantra 4th Adhyaya, 3rd verse, page no.26

3. Comprehensive Ophthalmology, Editor - A.K. Khurana Sixth

Edition 2015, Jaypee Brothers Medical Publishers pvt ltd.

Page no.87

4. LC.Dutta, Modern Ophthalmology, Editor – 3rd Edition Vol.1

Edition 2005, Revise Reprint 2013, Jaypee Brothers Medical

Publishers pvt ltd. Page no.128, 129.

5. Sushruta, Sushruta Samhita edited by Kaviraj Ambika Dutta

Shastri, reprinted 2015, Varanasi, Chaukhamba Sanskrit

Sansthan, Uttar tantra 15th Adhyaya, 16th verse, page no.69


45

A clinical study to evaluate the efficacy of Kukkutand Rasand Palandu Swaras in the management of Keshpatan

*Dr. Anagha Unavekar, **Dr. Pushpalata Ingale, ***Dr. Amol A. Deshmukh, ****Dr. Sheetal Chavan

Clinical Study

Abstract-

In today’s fast life it is very difficult to maintain health and beauty of body and face. Hairs are veryimportant part of beauty. Individual’s personality depends on hair.

So patients with complaints of Keshpatan are selected for present study came in Shalakya OPD at

Arogyashala Rugnalaya, Nasik (Maharashtra). Hetu, Dosh, Dushya, and Samprapti of Keshpatan is studied.Two groups were prepared for the present study as Non Vegetarian (Group A) and Vegetarian (Group B) in whichKukkutand Ras and Palandu Swaras used for pratisaran to scalp respectively for four week and weekly follow-

up registered.

The effect of Kukkutand Ras and Palandu Swaras in Keshpatan was evaluated with Cumb test andFinger test.

Result- Both drug showed significant result in Keshpatan, Raukshtwa, Kharatwa, Keshdaran, Varna(Tej) and Sparsh. Kukkutand Ras showed slight better results than Palandu Ras.

Keywords- Keshpatan, Kukkutand ras, Palanduswaras, kesh-mul- Pratisaaran

‚Ê⁄Ê¢‡Ê-

„Ê‹ ∑§ ÷Êª◊-÷Êª ÷⁄Ë Á¡¢ºªË ◊ •¬Ÿ ≥Ê⁄Ë⁄ •ÊÒ⁄ ‚Í⁄Ã ∑§Ê SflSÕ •ÊÒ⁄ πÈ’‚Í⁄Ã ⁄πŸÊ ’„ÈÃ ◊ÈÁ‡∑§‹ „Ù ªÿÊ „Ò– ©‚◊÷Ë „⁄ √ÿÁQ§ ∑§ √ÿÁQ§àfl ∑§Ê ∑§≥Ê ∞∑§ ◊„àfl¬ÈáÊ Á„S‚Ê „Ò– ß‚Ë „ÃÈ ‚ •Ê⁄ÙÇÿ≥ÊÊ‹Ê L§ÇáÊÊ‹ÿ, ŸÊÁ‚∑§ (◊„Ê⁄UÊC) ∑§ ≥ÊÊ‹ÊÄÿÃ¢G(’Á„⁄X) Áfl÷Êª ‚ ∑§≥Ê¬ÃŸ ‚ ¬Ë«∏ËÃ ⁄ÙªËÿÊ¥ ∑§Ê øÿŸ ß‚ ÁøÁ∑§à‚Ëÿ ¬⁄ËˇÊáÊ ◊ Á∑§ÿÊ ªÿÊ „Ò– ß‚ ¬⁄UËˇÊáÊ ◊ ∑§≥Ê¬ÃŸ ∑§„ÃÈ, ºÙ·, ºÍcÿ, ‚¢¬˝ÊÁ# ßŸ∑§Ê •äÿÿŸ Á∑§ÿÊ ªÿÊ– ‚’ ⁄ÙªËÿÙ ∑§Ù ºÙ ‚◊Í„Ù ◊ ’Ê¢≈Ê ªÿÊ– ‚◊Í„ ∞ (◊Ê¥‚Ê„Ê⁄UË) •ÊÒ⁄ ‚◊Í„ ’Ë(‡ÊÊ∑§Ê„Ê⁄UË) ∑§Ù R§◊≥Ê— ∑È§PÈ§≈Ê¢«U ⁄‚ •ÊÒ⁄ ¬‹Ê¢«ÍU Sfl⁄‚ øÊ⁄ ‚#Ê„ ∑§ Á‹ÿ Á‚⁄ ◊ ‹ªÊŸ ∑§ Á‹ÿ ÁºÿÊ ªÿÊ– •ÊÒ⁄ ¬˝àÿ∑§ ‚#Ê„¬Á⁄ˇÊáÊ Á∑§ÿÊ ªÿÊ– ∑È§PÈ§≈Ê¢«U ⁄‚ •ÊÒ⁄ ¬‹Êã«ÈU Sfl⁄‚ ∑§ ÁøÁ∑§à‚Ëÿ ¬Á⁄áÊÊ◊ ¡Ê¢øŸ ∑§ Á‹ÿ “∑È¥§’” ¬⁄UËˇÊáÊ •ÊÒ⁄ “Á»¥§ª⁄U” ¬⁄UËˇÊáÊÁ∑§ÿÊ ªÿÊ–

¬⁄UËˇÊáÊ- ºÙŸÙ ‚◊Í„Ù ◊ ∑§≥Ê¬ÃŸ, L§ˇÊàfl, π⁄àfl, ∑§≥ÊºÊ⁄áÊ ◊¥ ∑§Ê»§Ë ∑§◊Ë •ÊÿË– fláÊ¸ •ÊÒ⁄ S¬≥Ê¸ ÖÿÊºÊ ’„Ã⁄ „È•Ê–‹Á∑§Ÿ ºÙŸÙ ‚◊Í„Ù ◊ ÃÈ‹ŸÊà◊∑§ ºÎÁC ‚ ‚◊È„ ∞ ◊ ÖÿÊºÊ •ë¿U ŸÃË¡ Á◊‹–

*Assi. Professor - Samhita siddhanta, **Assi. Professor, Dept. of Shalakyatantra ***Assi. Professor, Shalakyatantra ****Assi. Professor,

Dept. of Roga nidan, ASS Ayurveda Mahavidyalaya Nasik, Ganeshwadi Panchavati, Nasik, Maharastra, *Author for correspondence- Dr.

Anagha Rajesh Unavekar, Ph - 9422259436, E-mail – [email protected]


46

Introduction-

Beauty point of view hair is most importantpart of face in human being. But in today’s fast

moving world it is been very difficult to maintainDeenacharya explained in Ayurveda and due toAhitakar Ahar and Vihar, lots of patients of

Keshpatan are seen in daily Shalakya OPD1. So 60patients of Keshpatan were selected through a campheld during 13th feb 2017 to 18th feb 2017. These

patients were studied according to their Hetu,Dosh,Samprapti. These patients were given Ayurvedictreatment – Kukkutand ras and Palandu swaras,

Pratisaaran to scalp2. Observation noted. Result anddiscussion put forward.

Aims and objectives— Ayurvedic

management of keshpatan.

Material and Methods-

Present study was conducted on 60 clinically

diagnosed patients of Keshpatan. The selection ofpatient was made from OPD, IPD of Shalakyatantradepartment in Arogyashala Rugnalaya, Nasik

(Maharashtra).

Inclusion criteria-

- Patients between 5-60 years age group of either

sex

- Mal nourished patients.

- Patients consuming different medicines for various

disorders on regular basis3

- Patients with hypothyrodism and hyperthyrodism

- Patients with auto immune disorders

- Over weight and underweight patients

- Feeding mothers

- Diabetic patients

- Anaemic patients

A clinical study to evaluate the efficacy of Kukkutand Rasand Palandu Swaras in the management of Keshpatan

Dr. Anagha Unavekar, Dr. Pushpalata Ingale, Dr. Amol A. Deshmukh, Dr. Sheetal Chavan

Clinical Study

- HIV patients

- Patients with alopecia areata

- Patients with depression, anxiety, grief4

- Patients with moderate cumb test +ve wereincluded in present study

Exclusive criteria-

- Patients exposed to chemo and radiation therapy

- Total bald patients

- Patients more than 60 years of age

- Pregnancy

- Patients allergic to Kukkutand and Palandu

Administration of drug-

The patients reporting with symptoms offalling of hairs or loss of hairs5 were screened on the

basis of above inclusion criteria. All 60 patientsparticipating in study were grouped under two groups.

Group A-

Hairs are washed well by Lemon swaras, anddried completely. Then Kukkutand ras (by mixing eggwhite and egg yellow) applied over the scalp and wait

for two hours6. Then again hairs are washed withlukewarm water, and dried well. Then mixture ofJatyadi tail + Erand tail or only Vranaropak tail is

applied over scalp. On the second day hairs arecleaned with shikekai and lukewarm water. Thisprocedure is repeated twice a week, and observations

are noted at weekly basis.

Group B-

All the procedure is repeated as in Group A,

instead of Kukkutand ras7, Palandu swaras is used forapplication over scalp, in vegetarian patients.


47

1. Darunak

Chi Square 98.57 p <0.05 p<0.001

2. Kesha Raukshatwa


48

Chi Square 121.85 p <0.05 p<0.001

3. Kesha Patan

Chi Square 99.17 p <0.05 p<0.001


49

4. Kesha Snigadhatwa

Chi Square 84.40 p <0.05 p<0.001

Effect of the upkramas in group A and group

B are equal according to x2 test. But the effect onKeshpatan is more significant in group A than in groupB.

Chemical composition of egg – ( W- white Y-yellow)

Protein – 11 (W) 17 (Y)

Fat- 0.2 (W) 32.5 (Y)

Minerals- 0.8 2.0

Water- 88.0 48.0

Availability- easily

Palandu – Jalmahabhutpradhan, snigdh,madhurguna8

Chemical composition of palandu (100 gm)

Energy 166gm (40 cal)

Sugar 4.24 gm

Fiber 1.7 gm

Fat 0.1 gm

Vitamins-

Thiamin (B1) 4 %

Riboflavin (B2) 2 %

Niacin (B3) 1%

B6 9%

Vit. C 9%


50

Conclusion-

Both Group A and Group B got significant

result in Keshpatan, but Group A got slight betterresult than Group B. Patients from Group A got 50-60% relief in Keshpatan, and Daran, Kharatva

decreased by 30-40% at the end of 1st week. Mrudutvaand Tej (hair glow) seen in 2nd week. Those patientswho continued their treatment for four week they got

100 % result in Keshpatan and Daran3 even withforceful pulling of hair9.

Assessment of Keshpatan was done with C.T.

(cumb test) and F.T. (finger test).

In Group B also significant result was noted.But it was notedafter 2nd week. Mardavatva and Tej

were less significant as compare to Group A.Keshpatan and Keshdaran significantly reduced aftersix week. Palandu Swaras took slight more time (15

days) to get complete relief10.

Referances-

1 . Dr. Bramhanand Tripathi, Vghahat Nirmala Hindi

Commentry, Chaukhamba Sanskrit Prathisthan Delhi, Reprint

– 2007, Uttarstan – 23/24-25; P-1053.

2. Srivijayaraksita and Srikanthadatta, ‘Madhukosa’ Sanskrit

commentary, chaukhamba Sanskrit sansthan, Varanasi.31th –

Edition 2002, Uttarardha P-203, 55/28.

3. Dr. Brahamanand Tripathi, Chraksamhita, Poorvardh,

‘Charaka–Chandrika’ Hindi Commentry, Chaukhamba

Surbharti Prakashan Varanasi, 6th Edition, 1999. Sutrasthan

5/81-83 , P-133.

4. Shri Gangadhar–Virachiyata, ‘Jalpkalptaru’ Tika, Charaka-

Samhita, Kaviraj Shrinarendranath Sengupta,

kalikatangayyam Prakashan, Varanashi. 1st Edition; 1849;

sutrasthan 20/7-9, P-773.

5. Dr Brahamanad Tripathi Shrimad Vagbhat- Nirmal Hindi

Commentry, chaukhamba Sanskrit Pratisthan, Delhi, Reprint

2007, uttarsthan 23/7-9, P-1054

6. Dr.Anna Moreswar Kunte, Astangahrdya, Sarvangsundara of

Arundatta, Krishnadas Academy, Chaukhamba Sankrit Series,

Varanasi, Reprinted 1995, Sutrastha 11/22 ; P-186.

7 . Shri Satya narayana Sastri ‘Vidyotini’ Hindi Commentry By

Kasinatha Sastri, and Dr. Gorakha Chaturvedi, Caraka

Samhita, Chaukhamba Bharati Academy, Varanasi. Reprint –

2017, Sutrasthan – 27/175, P-545.

8. Vd. V.M. Gogate, Dravyagun-Vidnyan, Vaidyamitra

Prakashan, Pune,1st Edition, 11 Feb – 2008, P-499.

9. Shri. Bhavamisra, Commentary by Dr. K.G. Chunekar,

Bhavaprakasa Nighantu, Chaukhambha Bharati Academy,

Eighth Edition-1988, P -136.

10. K. Park’s, Preventive Medicine, by Dr. John Everett Park,

Nutrition & Health Banarsidas Bhanot, Publishers, Jabalpur.

Twenty – Third Edition, P-630.


51

Clinical Evaluation of Efficacy of ‘Rasnaguggulu’,‘Rasnasaptak Kwath’ and ‘Abhyanga - Swedana’ in the

Management of ‘Gridhrasi Roga’ (Sciatica)

*Dr. Shilpi Kansal, **Prof. Chandra Bhanu Sharma, ***Dr. Udai Raj Saroj

Clinical Study

*Ayurveda Chikitsa Adhikari, CHC, Nainwa, Bundi (Ra.), ** Professor, P. G. Department of Kayachikitsa, NIA Jaipur. *** Associate

Professor, P. G. Department of Kayachikitsa, NIA Jaipur.

Abstract

Ayurveda has taken the foremost place in the management of crippling diseases like Gridhrasi Roga

which can be correlated with Sciatica due to its clinical appearance. Due to wide spectrum of disease, muchprevalence in the society and lack of effective medicament, the disease is being chosen for the study. The studywas conducted in 30 clinically diagnosed patients of Gridhrasi Roga. These patients were divided into three

groups of 10 patients each. In group A patients were treated with Rasnaguggulu, 2 Tab. (each tab. of 500 mg)three times in a day and Rasnasaptak Kwath 30 ml two times in a day for 28 days. In group B patients weretreated with ‘Abhyanga’ (Dashamooladi Taila) and ‘Nadi Sweda’ (Dashmoola kwath-Vashpa) for 28 days. In

group C patients were treated with Rasnaguggulu 2 Tab. (each tab. of 500mg) three times in a day withlukewarm water and Rasnasaptak Kwath 30 ml two times in a day with Abhyanga (Dashamooladi Taila) andNadi Sweda (Dashmoola Kwath-Vashpa) for 28 days. From the observations and results it can be concluded

that better results were obtained in Group C than Group A and Group B on the basis of percentage relief.

Key word – Gridhrasi, Rasnaguggulu, Rasnasaptak Kwath, Dashmooadi Taila, Sciatica

‚Ê⁄Ê¢≥Ê-

•ÊÿÈfl¸º Ÿ ª¢÷Ë⁄ √ÿÊÁœÿÙ ∑§Ë ÁøÁ∑§à‚Ê ◊¥ •ª˝áÊËÿ SÕÊŸ ‹ Á‹ÿÊ „Ò– ŸÒºÊÁŸ∑§ ‹ˇÊáÊÙ ∑§ •ÊœÊ⁄ ¬⁄ ªÎœ˝‚Ë ⁄Ùª ∑§ËÃÈ‹ŸÊ Á‚ÿÊÁ≈∑§Ê ⁄Ùª ∑§ ‚ÊÕ ∑§Ë ¡Ê ‚∑§ÃË „Ò– ß‚ ⁄Ùª ∑§Ë √ÿÊ¬∑§ÃÊ ∑§ ∑§Ê⁄áÊ, ‚◊Ê¡ ◊¥ ÖÿÊºÊ ¬˝‚Ê⁄ •ÊÒ⁄ ¬˝÷ÊflË ºflÊ ∑§Ë∑§◊Ë ∑§ ∑§Ê⁄áÊ, ß‚ ⁄Ùª ∑§Ù •äÿÿŸ ∑§ Á‹∞ øÈŸÊ „Ò– ¬˝SÃÈÃ ÁøÁ∑§à‚Ëÿ •äÿÿŸ ◊¥ ªÎœ˝‚Ë ⁄Ùª ∑§ 30 ⁄ÙÁªÿÙ ¬⁄ ¬ÍáÊÊ¸flÁœ•äÿÿŸ Á∑§ÿÊ ªÿÊ– ©Ÿ∑§Ù ÃËŸ flªÙ¸ ◊¥ Áfl÷ÊÁ¡Ã Á∑§ÿÊ ªÿÊ ÃÕÊ A flª¸ ∑§ ⁄ÙÁªÿÙ ∑§Ù ⁄ÊFÊ ªÈÇªÈ‹È 2 ªÙ‹Ë (¬˝àÿ∑§ ªÙ‹Ë 500Á◊.ª˝Ê.) ÁºŸ ◊¥ ÃËŸ ’Ê⁄ •ÊÒ⁄ ⁄ÊFÊ‚#∑§ `§ÊÕ 30 Á◊‹Ë ÁºŸ ◊¥ ºÙ ’Ê⁄ ÁºÿÊ ªÿÊ flª¸ B ∑§ ⁄ÙÁªÿÙ ∑§Ù 28 ÁºŸ Ã∑§ º≥Ê◊Í‹ÊÁºÃÒ‹ ‚ •èÿX ∞fl¢ º≥Ê◊Í‹ `§ÊÕ ∑§Ë flÊc¬ ‚ ŸÊ«∏ËSflº ÁŒŸ Á∑§ÿÊ ªÿÊ ÃÕÊ flª¸ C ∑§ ⁄ÙÁªÿÙ ∑§Ù ⁄ÊFÊ ªÈÇªÈ‹È ªÙ‹Ë (¬˝àÿ∑§ªÙ‹Ë 500 Á◊.ª˝Ê.) ÁºŸ ◊¥ ÃËŸ ’Ê⁄, ⁄ÊFÊ‚#∑§ `§ÊÕ 30 Á◊‹Ë. ÁºŸ ◊¥ ºÙ ’Ê⁄ •ÊÒ⁄ º≥Ê◊Í‹ÊÁº ÃÒ‹ ‚ •èÿX ∞fl¢ º≥Ê◊Í‹ `§ÊÕ∑§Ë flÊc¬ ‚ ŸÊ«UËSflº 28 ÁºŸ Ã∑§ ÁºÿÊ ªÿÊ– ß‚ ÁøÁ∑§à‚Ëÿ •äÿÿŸ ◊¥ ÿ„ ¬ÊÿÊ ªÿÊ ∑§Ë flª¸ C ◊¥ flª¸ A fl B ∑§Ë ÃÈ‹ŸÊ◊¥ •Áœ∑§ ‚ÈœÊ⁄ ¬˝ÁÃ≥ÊÃ ∞fl¢ ’„Ã⁄ ¬Á⁄áÊÊ◊ Á◊‹–


52

Introduction

Ayurveda is an ancient system of medicine in

which imbalance of Dosha is termed as Roga. AmongTridosha, Vata is responsible for maximum diseasesand Gridhrasi Roga is one of them. It can be

correlated with Sciatica in modern medical sciencethrough its clinical appearance. It is one of the 2known crippling disorders claiming loss of daily

activities of the affected person.

Sciatica is a common debilitating disorder witha lifetime incidence varying from 13% to 40%. The

prevalence of sciatic symptoms reported in theliterature varies considerably ranging from 1.6% in thegeneral population to 43% in a selected working

population.1 Sciatica is most common in the third tosixth decades of life and occurs about one to threetimes more frequently in men than in women.2

In Ayurveda Gridhrasi is mentioned in eightytypes of Nanatmaja Vatavikara. So it is caused by themorbidity of Vata Dosha mainly Vyana and Apana.

Sometimes there may be involvement of Kapha asAnubandhi Dosha. So Acharya charak has mentionedtwo types of the Gridhrasi Roga i.e. Vataj and

Vatakaphaj and included it in SamanyajaVatavyadhi also. Stambha, Ruk, Toda and Spandanaare the distinctive features of Gridhrasi. It originates

from the Sphik pradesha and radiates downwardsthrough the Prishthabhaga of Kati, Uru, Janu,Jangha, and Pada.3

Acharya Sushruta says that the vitiated VataDosha afflicts the Kandara of Paarshni andPratyanguli producing Gridhrasi, where in the

patient finds difficulty in extending the leg.4

For the management purpose AcharyaCharak mentioned the line of treatment for

Vatavyadhi as some Upakramas i.e. Snehana,Swedana, Utsadana, Parisheka, Asthapana andAnuvasana Basti.5 As Vishesha Chikitsa of Gridhrasi

Clinical Evaluation of Efficacy of ‘Rasnaguggulu’,‘Rasnasaptak Kwath’ and ‘Abhyanga - Swedana’ in the

Management of ‘Gridhrasi Roga’ (Sciatica)

Dr. Shilpi Kansal, Prof. Chandra Bhanu Sharma, Dr. Udai Raj Saroj

Clinical Study

Agnikarma and Basti is mentioned by Acharya

Charak6 and Siravedha is mentioned by AcharyaSushruta.7

So, in the present study, a trial has been done

to study the various aspects of the disease in theperspective of Shamana drugs as Rasnaguggulu andRasnasaptak Kwath along with special procedure as

Abhyanga - Swedana.

Aims And Objectives Of Study

1. Conceptual and clinical study on ‘Gridhrasi Roga’

(Sciatica).

2. To evaluate the efficacy of ‘Rasnaguggulu’ and‘Rasnasaptak Kwath’ in the management of

‘Gridhrasi Roga’ (Sciatica).

3. To evaluate the efficacy of ‘Abhyanga-Swedana’in the management of ‘Gridhrasi Roga’ (Sciatica).

4. To evaluate the combined efficacy of‘Rasnaguggulu’, ‘Rasnasaptak Kwath ’ and‘Abhyanga-Swedana’ in the management of

‘Gridhrasi Roga ‘(Sciatica).

Material & Methods

v Selection of cases - The study was conducted

on 30 clinically diagnosed patients of ‘GridhrasiRoga’ (Sciatica) selected from Arogyashala OPD &IPD of National Institute of Ayurveda, Jaipur.

v Study Design – It was Single centre, Open labeland Randomized clinical trial.

Inclusion criteria

l Patients of age group 20 to 70 years of either sex.

l Patients having sign and symptoms of ‘GridhrasiRoga’ (Sciatica).

l Patients with Chronicity of less than 10 years.


53

l Patients willing to signature the consent form forthe clinical trial.

Exclusion criteria

l Patients below age of 20 years and over age of 70years

l Patients with chronicity of more than 10 years

l Patients suffering with T.B. spine, tumors of spine,focal neuropathy and any septic or infectious

disease of spine.

l Patients suffering with Diabetes or Diabeticneuropathy, Gout, Rheumatoid Arthritis and

fracture of hip bone.

Administration of drug

30 clinically diagnosed and registered patients

of Gridhrasi Roga (Sciatica) were divided randomly inthree groups. 10 patients were included in each group.

v Group A - 10 Patients were treated by

Rasnaguggulu 2 tab. (each tab. of 500 mg) three

times in a day with lukewarm water andRasnasaptak Kwath 30 ml two times in a day

for 28 days.

v Group B - 10 Patients were treated by ‘Abhyanga’(Dashamooladi Taila) and ‘Nadi Sweda’

(Dashmoola Kwath-Vashpa) for 28 days.

v Group C - 10 Patients were treated byRasnaguggulu 2 tab. (each tab. of 500mg) three

times in a day with lukewarm water andRasnasaptak Kwath 30 ml two times in a day withAbhyanga (Dashamooladi Taila) and Nadi Sweda

(Dashmoola Kwath-Vashpa) for 28 days.

Criteria for withdrawal

During the course of trial, if any seriouscondition or any serious adverse effects which requiredurgent treatment or if patient himself wants to

withdraw from trial.

Trial drugs

1. Rasnaguggulu8 (Table No. I)

S.No. Drugs Botanical Name Part Used Quantity

1 Rasna Pluchea lanceolata Leaf 4 Part

2 Shuddha Guggulu Commiphora mukul Resin 5 Part

3 Gau Ghrit As required

2. Rasnasaptak Kwath9 (Table No.II)

Kwath Dravya (Yavakut)

S. No. Drugs Botanical Name Part Used Quantity


2 Amrita Tinospora cordifolia Stem 1 Part

3 Aragvadha Cassia fistula Phalamajja 1 Part

4 Devdaru Cedrus deodara Heart Wood 1 Part

5 Gokshur Tribulus terrestris Moola 1 Part

6 Erand Ricinus communis Moola 1 Part

7 Punarnava Boerhavia diffusa Moola 1 Part

Prakshepa Dravya (Churna)

8 Shunthi Zingiber officinale Rhizome 2 gm


54

3. Dashamooladi Tail (Kalpit Yoga for Abhyanga) (Table No. III)

S. No. Drugs Botanical Name Part Used Quantity

1 Bilwa Aegle marmelos Moola 1 Part

2 Agnimanth Premna mucronata Moola 1 Part

3 Shyonak Oroxylum indicum Moola 1 Part

4 Patla Stereospermum suaveolance Moola 1 Part

5 Gambhari Gmelina arborea Moola 1 Part

6 Shalparni Desmodium gangeticum Moola 1 Part

7 Prishniparni Uraria picta Moola 1 Part

8 Brihati Solanum indicum Moola 1 Part

9 Kantakaari Solanum surattense Moola 1 Part

10 Gokshur Tribulus terrestris Moola 1 Part


12 Erand Ricinus communis Moola 1 Part

13 Tila Taila Sesamum indicum Seed’s Oil As require

1. Ruk (Pain)

2 . Toda (Pricking sensation)

3. Stambha (Stiffness)

4. Spandana (Twitching Sensation)

5. Tandra (Drowsiness)

6. Gaurav (Heaviness)

7. Arochak (Anorexia)

8. Suptata (Numbness)

9. Dehasya Pravakrata (Disturbed gait)

Grading of Pain - The assessment of painwas done under Visual Analogue Scale (VAS).

Duration of Clinical Trial & Follow up Study

l Duration of clinical trial was 28 days.

l Patients were followed once in a week regularly.

Criteria Of Assessment

During the trial patients were assessed onthese following parameters.

Subjective Criteria

All registered patient for clinical trial werelooked for any changes in their growing feeling of wellbeing or any improvement in the following sign and

symptoms of ‘Gridhrasi Roga’ (Sciatica) after thecourse of therapy.


55

Rest of the symptoms were assessed by following scoring system-

None (Symptom is not present at all) 0

Mild (Symptom is present but not bothering) 1

Moderate (Symptom is bothering, but tolerable & need medicine occasionally) 2

Severe (Symptom is not tolerable & need Continuous medication) 3

Very severe (Symptom is not relieved at all) 4

2. Objective Criteria

Following functional aspects andinvestigations were looked for any improvement after

the course of therapy

1) S.L.R. (Straight leg raising) test

Grades S.L.R. test

0 No pain at 90 degree

1 Pain at 71-90 degree

2 Pain at 51-70 degree

3 Pain at 30 -50 degree

4 Pain below 30 degrees

2) Walking time - Time taken to cover the distance

of 20 meters. It was measured in seconds.

3) Lab Parameters

For Exclusion of other diseases - CBC

(Complete blood count), RBS (Random blood sugar),X-Ray L-S Spine (AP & Lateral view).

For Assessment of disease or possible

side effects - ESR (Erythrocyte Sedimentation Rate),CRP (C -Reactive Protein), Serum Creatinine.

Observation & Results:-

In demographic profile we found thatmaximum number of patients were from 31-40 agegroup (40% patients), Female gender (73.33%

patients), High school (30% patient), Hindu religion(80.00% patients), lower middle class (36.66%patients), Married (76.66% patients), House wives

(53.33%), Vegetarian (76.66% patients), Vishamashan(56.66% patients) and with Tea addiction (60%patients).

In constitutional profile we found that

maximum number of patients were having Alpa Nidra(53.33% patients), Madhyama Koshtha (60.00%

patients), Vishamagni (50% patients), regularmenstruation history (50% patients), Vata-KaphajDeha Prakriti (60% patients), Rajas Manas Prakriti

7(0% patients), Madhyama Sara (3.73% patients),Madhyama Samhanan (60% patients), MadhyamaPraman (100% patients), Madhyama Satmya

(66.67% patients), Madhyama Satva (50% patients),Madhyama Aharshakti (56.66% patients),Madhyama Jaran Shakti (53.33%), Madhyama

Vyayam Shakti (60%) and Madhayama Vaya (70%patients).

In clinical profile we found that maximum

number of patients were having gradual onset (56.66%patients), chronicity between 1-2 years (46.6%patients) and Vataja type of Gridhrasi (86.66%

patients). In study of Nidana wise distribution we gotthat the Kriya Atiyoga (Prolonged Standing) asnidana was maximum in 80% patients, followed by

Ratri jagaran (63.33% patients), Vega Vidharan(60.00% patients), Katu, Tikta, Kashay Aahar Sevan(50% patients) and Ruksha, Sheeta and Laghu Aahar

Sevan (40% patients). In study of Chief complaintswise distribution we got that all the patients weresuffering with Ruk 100%, followed by Stambha, Toda

(both 63.33% patients), Suptata (46.66% patients),Arochak (33.33% patients), Gaurav (23.33% patients),Spandana, Dehasya Pravakrata (both 20% patients).

In study of X-Ray findings we got that theosteophytes were found in 33.33% patients. 16.66%patients were having reduced space in between L5-S1

disc. While 6.66% patients were having space reducedbetween L4-L5 disc level. 10% patients were found withreduced space in between both L4-L5 and L5-S1. There

was no radiological findings in 43.33% patients.


56

Table No. IV Showing effect of Therapy in Subjective Parameters (Wilcoxon MatchedPairs Signed Ranks Test)

Symptom Gr. Mean score Diff. % S.D S.E. P SBT AT relief (±) (±) value

Stambha A 1.55 0.55 1.0 64.51 0.8660 0.2887 < 0.05 S

B 1.60 0.50 1.1 68.75 0.9944 0.3145 < 0.05 S

C 2.0 0.2 1.8 90.00 1.135 0.3590 < 0.01 HS

Ruk A 6.9 3.7 3.2 46.37 1.033 0.3266 < 0.01 HS

B 6.7 4.5 2.2 32.83 0.6325 0.2000 < 0.01 HS

C 6.7 2.4 4.3 64.17 1.337 0.4230 < 0.01 HS

Toda A 1.5 0.4 1.1 73.33 0.9944 0.3145 < 0.05 S

B 1.6 0.7 0.9 56.25 0.8756 0.2769 < 0.05 S

C 2.2 0.1 2.1 95.45 1.197 0.3786 < 0.01 HS

Spandana A 0.60 0.20 0.4 66.66 0.8433 0.2667 > 0.05 NS

B 0.5 0.2 0.3 60.00 0.6749 0.2134 > 0.05 NS

C 1.7 0.1 1.6 94.11 1.265 0.400 < 0.05 S

Suptata A 1.3 0.4 0.9 69.23 0.9944 0.3145 < 0.05 S

B 0.70 0.60 0.1 14.28 1.663 0.5260 > 0.05 NS

C 1.4 0.3 1.1 78.57 0.9944 0.3145 < 0.05 S

Gaurav A 0.5 0.3 0.2 40.00 0.4216 0.1333 > 0.05 NS

B 0.4 0.1 0.3 75.00 0.6749 0.2134 > 0.05 NS

C 1.4 0.2 1.2 85.71 1.229 0.3887 < 0.05 S

Arochaka A 1.6 0.2 1.4 87.50 1.350 0.4269 < 0.05 S

B 0.4 0.1 0.3 75.00 0.6749 0.2134 > 0.05 NS

C 1.4 0.1 1.3 92.85 1.160 0.3667 < 0.05 S

Dehasya- A 0.60 0.20 0.4 66.66 0.8433 0.2667 > 0.05 NS

Pravakrta B 0.5 0.2 0.3 60.00 0.6749 0.2134 > 0.05 NS

C 1.7 0.1 1.6 94.11 1.265 0.400 < 0.05 S

Note: HS-Highly Significant, S- Significant, NS- Non Significant

Intergroup Comparison

Subjective Parameters

On intergroup comparison Ruk, Toda,Spandana, Dehasya Pravakrata and S.L.R. Test

showed statistically significant results (P < 0.05).

While Stambha, Suptata, Gaurav, Arochaka and CRPshowed nonsignificant results. (P > 0.05)

In Dunn multiple post comparisons tests

better results (significant, P<0.05) were found in


57

Table No. V: Showing Effect of Therapy on Objectives Parameters (Paired ‘T’ Test)

Variable Grp. Mean score Mean % S.D S.E. t P S

BT AT Diff. relief (±) (±) value value

S.L.R Grade* A 3.20 2.0 1.2 37.50 0.421 0.133 - < 0.01 HS

Test B 3.10 2.0 1.1 35.48 0.567 0.179 - < 0.01 HS

C 3.90 2.2 1.7 43.58 0.483 0.215 - < 0.01 HS

Value A 39.0 61.0 22.0 56.41 8.233 2.603 8.45 <0.0001 HS

B 35.5 60.0 24.5 69 8.317 2.630 9.316 <0.0001 HS

C 32.0 58.0 26.0 81.25 10.22 3.232 8.045 <0.0001 HS

Walking A 25.4 21.6 3.8 14.96 1.135 0.359 10.58 <0.0001 HS

Time B 27.3 26.0 1.3 4.76 0.948 0.300 4.333 < 0.01 HS

C 27.1 21.5 5.6 20.66 2.413 0.763 7.339 <0.0001 HS

ESR A 29.2 18.0 11.2 38.35 14.6 4.6 2.414 < 0.05 S

B 15.4 11.3 4.1 26.62 6.262 1.980 2.071 > 0.05 NS

C 20.8 6.5 14.3 68.75 17.44 5.518 2.592 < 0.05 S

CRP* A 0.50 0.3 0.2 40.00 0.421 0.133 - > 0.05 NS

(Grade) B 0.40 0.1 0.3 75.00 0.674 0.213 - > 0.05 NS

C 0.90 0.2 0.7 77.77 1.229 0.388 - < 0.05 S

Serum A 0.93 0.86 0.07 7.5 0.253 0.084 0.919 > 0.05 NS

Creatinine B 0.94 0.89 0.05 5.6 0.178 0.056 0.888 > 0.05 NS

C 1.05 0.90 0.15 6.0 0.28 0.08 1.695 > 0.05 NS

*(Wilcoxon Matched Pairs Signed Ranks Test)

Group C than Group B in Ruk, Toda, Spandana,Dehasya Pravakrata and S.L.R. Test while better

results (significant, P<0.05) were found in Group Cthan Group A in Spandana and Dehasya Pravakrata.

In intergroup comparison of objectiveparameters Walking Time showed statisticallysignificant difference (P < 0.05). In which on post

tests comparison better results (significant, P<0.05)were found in Group C than Group B.

Discussion

Probable mode of action of Rasnaguggulu:

It is a combination of two drugs, Rasna andGuggulu. The drug Rasna, by its Tikta Rasa, Katu

Vipaka and Ushna Virya, pacifies vitiated Kaphaand Aama Dosha and increases dhatvagni leading toproper nutrition of Dhatu. Guru Guna and Ushna

Virya pacifies Vata Dosha resulting in reduction ofToda, Shula and other related symptom.

Gridhrasi is a Vata Pradhan Vyadhi and

sometimes there may be Kaphanubandha. Rasna hasKaphavatahar action and Rasayan Prabhava,therefore it would be effective in the management of

both types of Gridhrasi Roga. According to Aacharya


58

Bhavmishra, Rasna has Shoolahar & Vayasthapanaeffect, so it will be effective in Ruk (main symptom)

in Gridhrasi due to Jarajanya Vataprakopa also.Study on this drug proves this as antipyretic, analgesic,laxative and nervine tonic10 and its anti-inflammatory

activity is established in a study done over the rats.11

The second drug in this combination isGuggulu which is also a known drug as

Vedanasthapak and Vatashamak. It pacifies KaphaDosha by its Katu, Tikta Rasa and Laghu Gunaand corrects Vatadosha through its Ushna Virya.

According to Doshkarma it works as TridoshaShamak and specially Vata-Kapha Shamak. Studyshows that individual herbal extract of Guggulu and

its combined extract as anti-inflammatoryand analgesic activities, which are beneficial for pain,stiffness and other related symptoms of sciatica.12

Probable mode of action of RasnasaptakKwath:

In Rasnasaptak Kwath 85.71% drugs have

Ushna Virya. Which pacify both Vata andKaphadosha. It has Ashupaka property through whichit acts quickly at minute channels.

Out of seven drugs 71.42% have Tikta Rasa,57.14% have Madhura Rasa and 14.28% having

Kashaya Rasa. It helps in digestion of Ama & inpacifying Vata Dosha. Madhura Rasa balances theUshna, Tikshna & Ruksha Guna of other drugs by its

Sheeta, Snigdha, Picchila and Guru Guna.

Maximum drugs (57.14%) have Guru Gunaand 71.42% drugs having Madhura Vipaka, whichhelps to control the Vata Dosha, which is main

causative factor for Gridhrasi Roga. As Doshkarma42.85% drugs are Vata-Kapha Shamak and 28.57%drugs are Tridoshshamak.

All these factors show Vatahar andKaphahara action of this Kwath along with

Strotoshodhan and Amahara properties. It breaks thepathogenesis behind Vatakaphaj Gridhrasi and workon the systemic symptoms like Gaurav, Tandra and

Arochak. Vatahar action reduces Ruk, Toda,Stambha and Spandana in Gridhrasi patients.

Various studies shows analgesic,13

antispasmodic,14 antinociceptive15 and

antinflammatory16 activities of contents ofRasnasaptak Kwath.

Probable mode of action of DashmoolaadiTaila and Abhyanga-Swedana:

Among the 12 Dravyas of Dashmoola 7Dravyas (58.33%) have Vata-Kapha Shamakproperty, 4 Dravyas(30%) have Tridosaghna property

and 1 Dravya(8.33%) has Vata-Pitta Shamakproperty. It means, in this drug all Dravyas(100%)have Vata Shamak property and 11 Dravyas(91.66%)

have Vata-Kapha Shamak property. Therefore, it willbe a potent Vata Shamak, Vata-Kaph Shamak andTridosaghna compound. In Ayurvedic texts, also

mentioned, “Dashmoolam TridoshaghnamKaphmarut Nashanam” and “Tailam Vataharamparam”.

Abhyanga makes the body sturdy andresistant to Vata disorders. It brings smoothness(Mardavata) in the body, depletes morbid Vata and

Kapha and replenishes all Dhatus. As Vata Dosha isSheeta, Ruksha in nature and Sweda being Ushna andwith prior Snehana, Snigdha in nature, alleviates

Vata Dosha. Swedana increases sweat and brings outMaladravyas (Kleda) along with sweat. Thus itdecreases in the body resulting in the reduction of

Gaurava , Ruk and Stambha, which are mostcommon symptoms of Gridhrasi.

So, above drugs and procedure possess almost

all the qualities required for a drug to treat GridhrasiRoga.

Conclusion

1. Gridhrasi is one of the Nanatamaja Vatavyadhiin which Vitiated Vata Dosha (especially Vyana &

Apana Vayu) is the main causative factor andmany times Kapha remains as Anubandhi Dosha.

2. On the basis of their clinical manifestations it canbe correlated with Sciatica described in modern

medical science.

3. Rasnaguggulu and Rasnasaptak Kwath were

effective drugs in all diagnosed cases of GridhrasiRoga (Sciatica).

4. Abhyanga and Swedana as local oleation therapyand fomentation showed quick relief in most of the

symptoms of Gridhrasi Roga.

5. Best therapeutic response was noted in combinedtherapy (oral drugs and Abhyanga - Swedana) on

the basis of percentage relief.


59

6. Thus Rasnaguggulu, Rasnasaptak Kwath andAbhyanga (Dashamooladi Taila), Swedana

(Dashmoola kwath Vashpa), is a safe and effectiveAyurvedic treatment and may be used separatelyor simultaneously in the management of Gridhrasi

Roga (Sciatica).

References

1 . Manish Kumar et al, Epidemiology, Pathophysiology and

Symptomatic Treatment of Sciatica: A Review, International

Journal of Pharmaceutical & Biological Archives 2011;

2(4):1050-1061

2. H. Houston et al, Textbook of Merritt’s Neurology, 10th

Edition, (June2000): Randy Rowland By Lippincott Williams

& Wilkins Publishers, Ch. 68th, Pg..no.349

3. Agnivesha, Charak Samhita, Vidyotini Hindi Commentry by

K.Shastri, G.N.Chaturvedi, Chaukhabha Bharati Academy

Varanasi. Year of reprint 2009, Chikitsasthana 28/56, Pg. No.

7 8 7 .

4. Sushruta, Sushruta Samhita, edited with Ayurveda Tatva

Sandipika hindi commentary, by Kaviraja Ambikadutta

Shastri Part I, Chaukhambha Sanskrit Sansthan, Varanasi, 12th

Ed. Year of reprint 2009, Nidanasthana 1/74, Pg.no.303

5. ibidem 3, Sutrasthana 20/13, Pg. No. 402.

6. ibidem 3, Chikitsasthana 28/101, Pg. No.795.

7 . Ibidem 4, Chikitsasthana 5/23, Pg. No.43.

8. Bhavamishra, Bhavaprakasha, edited with Vidyotini Hindi

commentary by Pandit Shri Brahma Sankara Mishra,

Published by Chaukhambha Sanskrit Bhavan, Varanasi,

Edition 11, Vol. 2, Year of reprint 2012. chapter 24/143, Pg.

No.244.

9. Ibidem 8, chapter 24/144, Pg. No.244.

10. Telang RS et al, Studies on analgesic and anti?inflammatory

activities of Pluchea lanceolata Linn. Indian Journal

Pharmacol.1999; 31: 363–6

11 . Bansod M S et al, Therapuetic effect of a poly-herbal

preparation on adjuvant induced arthritis in Wistar rats.

International Journal of Pharmacy and Pharmaceutical

Sciences. 2011, ISSN-0975-1-491.Vol 3, Suppl 2.

12. Su S,Wang T et al, Evaluation of the anti-inflammatory

and analgesic properties of individual and combined extracts

from Commiphora myrrha, Boswellia carterii.

Ethnopharmacol. 2011 Mar 24;134(2):251-8

13. Shinde UA, et al. Studies on the anti-inflammatory and

analgesic activity of Cedrus deodara (Roxb.) Loud. wood oil.

J Ethnopharmacol. Epub 1999 Apr; 65(1):21-7.

14. Sharma U et al, Immunomodulatory active compounds from

Tinospora cordifolia. J Ethnopharmacol. 2012;141:918–26.

15. Biol Pharm Bull.et al, Anti-allodynic effects of obtusifolin and

gluco-obtusifolin against inflammatory and neuropathic pain.

Epub 2014 Jul 25.37(10):1606-16.

16. Hiruma-Lima CA et al, The juice of fresh leaves

of Boerhaavia diffusa L. markedly reduces pain in mice. J

Ethnopharmacol. Epub 2000 Jul;71(1-2):267-74.


60

Evaluation of Pippali (Piper longum Linn.) and LauhaBhasma on blood haemoglobin level

*Dr. Swati Ugale, **Dr. Madhav Borude, ***Dr. Sudipta Kumar Rath

Clinical Study

Abstract

Introduction – Haemoglobin (Hb) deficiency is a global public health problem which has social aswell as economic consequences. Conventional and even Ayurvedic Iron supplements such as lauha bhasmasometimes fail to give desired results in the management of Hb deficiency. This might be attributed to improper

absorption and utilization due to agnimandya or srotoavarodha. This can be well addressed by adding a suitabledeepana- srotoshodhana (bioavailability enhancing) drug that can increase iron absorption and utilization. Thisclinical trial was thus designed to assess the role Pippali plays in enhancing the effect of luaha bhasma on Blood

Hb level.

Objectives - To evaluate efficacy of pippali and lauha Bhasma on blood haemoglobin level in adulthealthy volunteers.

Material and Method – (i) Design – Open, three arm, randomized and comparative clinical trial(ii) Settings – OPD registered volunteers, Participants – 30 Consenting Healthy volunteers(15-60 years ofage), of either sex, having Hb between 7-10 gm% in females and 8-12 gm% in males, Intervention – 3 groups,

Group A - Pippali 1gm dry powder b.d. with water after food, Group B - Louha Bhasma 125mg b.d. with waterafter food and Group C - Pippali 1gm and Louha Bhasma 125mg b.d. with water after food twice a day,Intervention Period - 45 Days, Outcome measures – Blood Hb level.

Results –Significant result in Group A, whereas highly significant results were observed in Group Band Group C. Most effective result - 18.93% improvement in Hb level in Group C as compared to Group A(13.59%) and B (14.20%).

Conclusion – Pippali enhances the efficacy of lauha bhasma in Hb deficiency.

Keywords- Ayurveda, Pippali, Lauha, Bhasma, Haemoglobin, Hb.

‚Ê⁄UÊ¥‡Ê-

¬Á⁄øÿ -„Ë◊ÙÇ‹ÙÁ’Ÿ (∞ø’Ë) ∑§Ë ∑§◊Ë ∞∑§ flÒÁ‡fl∑§ ‚Êfl¸¡ÁŸ∑§ SflÊSâÿ ‚◊SÿÊ „Ò Á¡‚∑§ ‚Ê◊ÊÁ¡∑§ •ÊÒ⁄ •ÊÁÕ¸∑§¬Á⁄áÊÊ◊ „ÙÃ „Ò– ‹ı„ ÷S◊ •Êÿ⁄Ÿ ∑§Ë •Ê¬ÍÁÃ¸ ∑§⁄ÃÊ „Ò ‹Á∑§Ÿ ∑§÷Ë ∑§÷Ë ∞ø’Ë ∑§Ë ∑§◊Ë ∑§ ÁøÁ∑§à‚Ê ◊¥ ‹Ù„ ÷S◊ flÊ¢Á¿UÃ¬Á⁄áÊÊ◊ ºŸ ∑§ Á‹∞ •‚»§‹ „ÙÃÊ „Ò– ß‚∑§Ê ∑§Ê⁄áÊ ‹Ù„ ÷S◊ ∑§Ê •ŸÈÁøÃ •fl≥ÊÙ·áÊ •ÊÒ⁄ ©¬ÿÙª „Ò,¡Ù •ÁªA◊Ê¢l ÿÊ dÙÃÙ⁄Ùœ„ÙŸ ∑§ ∑§Ê⁄áÊ „Ù ‚∑§ÃÊ „Ò– ß‚∑§ ‚◊ÊœÊŸ „ÃÈ ∞∑§ ºË¬Ÿ •ÊÒ⁄ dÙÃÙ≥ÊÙœŸ ∑§⁄Ÿ flÊ‹Ê (¡Òfl ©¬‹éœÃÊ ’…U∏ÊŸ flÊ‹Ê) Œ˝√ÿ ‹ı„÷S◊ ∑§ ‚ÊÕ ÁºÿÊ ¡Ê ‚∑§ÃÊ „Ò, ¡Ù ‹Ù„ ∑§ •fl≥ÊÙ·áÊ •ÊÒ⁄ ©¬ÿÙª ◊¥ flÎÁh ∑§⁄ ‚∑§ÃÊ „Ò– •Ã— ß‚ ÁøÁ∑§à‚∑§Ëÿ ¬⁄ËˇÊáÊ ∑§Ù„Ë◊ÙÇ‹ÙÁ’Ÿ (∞ø’Ë) SÃ⁄ ¬⁄ ‹ı„ ÷S◊ ∑§ ¬˝÷Êfl ∑§Ù ’…U∏ÊŸ ◊¥ Á¬å¬‹Ë ∑§Ë ÷ÍÁ◊∑§Ê ∑§Ê •Ê∑§‹Ÿ ∑§⁄Ÿ ∑§ Á‹∞ Á«U¡ÊßŸ Á∑§ÿÊªÿÊ ÕÊ–

©g‡ÿ -flÿS∑§ SflSÕ Sflÿ¢‚fl∑§Ù¥ ◊¥ ⁄Q§ ◊¥ „Ë◊ÙÇ‹ÙÁ’Ÿ SÃ⁄ ¬⁄ Á¬å¬‹Ë •ÊÒ⁄ ‹ı„ ÷S◊ ∑§Ë ¬˝÷Êfl∑§ÊÁ⁄ÃÊ ∑§Ê ◊ÍÀÿÊ¢∑§Ÿ∑§⁄Ÿ „ÃÈ ¬˝’¢œŸ–

*Lecturer, Dept. of Dravya Guna, Ashvin Rural Ayurveda College, Manchi Hills, Sangamner, Ahmednagar, Maharastra, E-mail:

[email protected] **Lecturer, Dept. of Swasth Vritt, Ashvin Rural Ayurveda College, Manchi Hills, Sangamner, Ahmednagar,

Maharastra, ***Asst.Prof., P.G. Department of Dravyaguna, National Institute of Ayurveda, Jaipur, Rajasthan, India. E-mail:

[email protected]


61

Introduction

Haemoglobin (Hb) deficiency is one of the

most important health issues concerning globalpopulation. Hb contains almost 65% of the body ironin humans.1 Therefore iron deficiency is a significant

cause for Hb deficiency. In developing countries likeIndia 30-70% of the population is iron deficient. Onan average 56% of adolescent girls are anaemic and

around 30% of adolescent boys are suffering fromanaemia. Nearly 50-80 percent of mothers suffer fromanaemia due to iron-deficiency in their diet. Puerperal

morbidity is higher among women with Hb level below6.5g/dl compared to women with normalHaemoglobin level.2 Anaemia is not confined to

pregnant women alone but also has effect on otherpopulation in the society. The Hellen Kellar Institutefor girls (1996) estimated that 83.9 percent girls of age

between 12 and 18 years in rural India were found tobe anaemic; the level is high among girls with noschooling (92.7 %).3 Adolescent girls require

continuous replacement of iron during menstruation(Brabin and Brabin, 1992).4

Although the aetiology of Iron deficiency

Anaemia (IDA) is multifaceted, it generally resultswhen the iron demands by the body are not met by ironabsorption, regardless of the reason. Individuals with

IDA have inadequate intake, impaired absorption ortransport, physiologic losses associated withchronological or reproductive age, or chronic blood

loss secondary to disease. In adults, IDA can result ina wide variety of adverse outcomes includingdiminished work or exercise capacity, impaired

thermoregulation, immune dysfunction, GIdisturbances, and cognitive impairment.

Usual line of treatment for Hb deficiency is

iron supplements. But iron supplements sometimes failto give desired results and also it has some unwantedeffects such as gastrointestinal irritation, nausea,

constipation, etc. Ayurvedic texts also have mentionediron supplements like lauha bhasma and mandura

Evaluation of Pippali (Piper longum Linn.) and LauhaBhasma on blood haemoglobin level

Dr. Swati Ugale, Dr. Madhav Borude, Dr. Sudipta Kumar Rath

Clinical Study

bhasma. But they also fail to increase Hb level in allpatients when used as a stand alone drug. This mightbe attributed to improper absorption and utilization

consequent to agnimandya or srotoavarodha. Hence,a suitable drug is needed to be administered which canincrease iron absorption and utilization by deepana

and srotoshodhana activity (bioavailability enhancers).Pippali (Piper longum) contains 62.8mg/100gm iron(NIN, Hydrabad) and it is also indicated in Pandu

roga chikitsa.5 Yakrit and pliha are moolsthans ofraktawaha srotas, which the site of the rakta dhatuformation. Hence it can be deduced that in Hb

deficiency there might be pathological changes inyakrit and pliha. Vagbhata has mentioned pippali isthe best medicine for the pliharoga.6 Thus pippali can

have a role in Hb deficiency states. Piperine, majorchemical constituent of pippali, is the bioavailabilityenhancer.7 Pippali enhances absorption of many

nutrients.8 Therefore the present study is planned tosee the efficacy of pippali and lauha bhasma on bloodhaemoglobin level. This clinical trial was thus designed

to assess the role Pippali plays in enhancing the effectof luaha bhasma on Blood Hb level.

Aims and Objectives

To evaluate efficacy of pippali and lauhaBhasma on blood haemoglobin level in adult healthyvolunteers.

Materials & Methods

Study Design – An open, three arm,randomized and comparative clinical trial was

designed to test the hypothesis of the current work.

Study Population – 30 consentingapparently healthy volunteers of 15 – 60 years of either

sex were enrolled for this trial after screening them asper the inclusion criteria. Volunteers were randomlydivided into 3 groups, each group having 10

volunteers.

Study Setting – Selected volunteers were


62

registered in the Out Patient Department of NationalInstitute of Ayurveda, Jaipur (N.I.A. OPD) for the

clinical trial.

Study Period – 12/9/2014 to 27/1/2015

Volunteers Inclusion criteria

Haemoglobin between 7-10 gm% in femalesand 8-12 gm% in males.

Volunteers exclusion criteria

l Pregnant ladies.

l Patients suffering from malignant diseases likeleukaemia.

l Patients suffering from serious diseases such asIschemic heart disease (IHD), congestive cardiacfailure (CCF), Diabetes mellitus (DM), renal

disorders, acute and chronic blood loss, bleedingdisorders, haemoglobinopathies.

l Patients suffering from chronic disorders like

Rheumatoid arthritis (RA), hypothyroidism andhyperthyroidism.

l Anaemia due to causes other than iron deficiency.

l Patients that have recently taken iron supplementtherapy.

Volunteers discontinuation/withdrawal

criteria

l Any Adverse/Serious adverse event is encountered,where continuation of study poses medical risk to

the Volunteer.

l Volunteers not complying with the protocol.

l Volunteers not turning up for assessment in time.

l Volunteers expressing desire to withdraw.

Trial Drug –

API directs that dried fruit of Piper longum

Linn. is the botanical source of the drug pippali.9

There is no controversy regarding the botanicalidentification of the pippali. Hence in the present

study fruits of Piper longum Linn. was selected as thetrial drug. It was collected by the scholar herself fromKochi, Kerala, after due botanical authentication

(Identification no-(Piper longum Linn.-RUBL211473).Powder was prepared by pulveriser. This powder was

passed through sieve size 80. This powder was packedinto soft gelatine capsules of 500 mg each.

Lauha bhasma was purchased from the GMPcertified company named Krishna Gopal AyurvedBhawan, Kalra. Lauha bhasma was packed into soft

gelatine capsules of 125 mg each by a capsule fillingmachine.

Both the drugs were subjected to

pharmacognostical and phytochemical investigationsfor quality assurance and found to be quality drugs foruse.

Dose, Duration & Administration –

Group A: Piper longum dry fruit powder –1 gm, 2 capsules of 500 mg each, with water after food

twice a day for 45 days

Group B: Louha Bhasma - 125 mg, 1 capsuleof 125 mg, with water after food twice a day for 45

days

Group C: Piper longum dry fruit powder –1gm, 2 capsules of 500 mg each and Louha Bhasma -

125 mg, 1 capsule of 125 mg, with water after foodtwice a day for 45 Days.

Criteria of Assessment:

The enrolled volunteers were assessed forBlood Hb % at baseline and after the end of the triali.e on 46th day.

Observations

Blood Hb % of the volunteers were assessedand recorded before and after treatment. The values

are given in Table I.


63

Table no. I- Observations of the change in Hb%

Volunteer Group A Volunteer Group B Volunteer Group C

BT AT BT AT BT AT

1 10 10.1 1 9.1 11.9 1 8.1 9.1

2 8.6 9.6 2 10 11.3 2 7.6 8.2

3 8.9 12.6 3 10 11 3 10 11.9

4 11.9 11.9 4 10 10.6 4 10 10.7

5 10 11.7 5 11.3 11.7 5 9.3 9.7

6 10 10.6 6 10.5 13 6 9 10

7 8.1 11.4 7 8.7 11.9 7 10 12.4

8 11.4 12.4 8 10 11.4 8 9.4 12.4

9 10.4 11 9 10.8 11 9 9.4 12.7

10 8.7 9 10 8.8 9 10 9 12.3

BT – Before Treatment, AT – After Treatment

Results- The recorded values were subjected to statistical analysis for their significance and results. Statistical

analysis was conducted by Graph pad prism-6 software. For obtaining results in individual group (before andafter treatment) paired ‘t’ test was applied while for intergroup comparison ANOVA test was applied. Obtainedresults are given in Table II and Table III.

Table No.II- Effect of trial drugs on Haemoglobin level

Group Mean D Change S.D. S.E. T P R

B.T. A.T. in %

A 9.8 11.03 1.23 13.59 1.2979 0.4104 2.9968 0.0150 S

B 9.92 11.28 1.36 14.20 1.1097 0.3509 3.8753 0.0037 H.S.

C 9.18 10.94 1.76 18.93 1.1635 0.3679 4.7834 0.0009 H.S.

BT – Before Treatment, AT – After Treatment, D – Difference, SD – Standard Deviation, SE – Standard Error, P – P value, R – Result, S

– Significant, HS – Highly Significant

Table no. III- Analysis of variance (ANOVA) Test for intergroup comparison

Group A Group B Group C P Value Significance

Hb % 1.23 1.36 1.76 0.5911 N.S.

Discussion

Significant result was observed in group A,while highly significant results were observed in group

B and group C. Although Pippali, lauha bhasma andpippali with lauha bhasma all were effective inincreasing Hb % as expected owing to high iron

content in both pippali and lauha bhasma along withthe bio availability enhancing property of pippali,quantitatively the most effective result (change in %

18.93) was seen in group C (pippali with lauhabhasma). Change in percentage in group A and group

B was 13.59% and 14.20% respectively. No significantintergroup variation was observed among all the threegroups. The results were in compliance with expected

hypothetical outcome of this trial.

Pippali increases Hb% owing to its deepana,srotoshodhana and rasayana properties. Lauha

bhasma contains iron (dravya samanya) and iteffectuated increase in iron level on the basis ofsamanya siddhanta. Hb contains most of the body

iron (65%), therefore increase in iron leads to increasein Hb%.


64

Pippali is bio availability enhancer hence whenadministered along with lauha bhasma it increases the

iron absorption, transportation and utilizationultimately increases in Hb%.

Probable Mode of the Action - The mode of action

of medicinal substances in Ayurveda is explained by

Charaka.10 The medicinal substances can act on thebasis of their guna (rasa, virya, vipaka, guna) and

their prabhava. Accordingly it may be postulated thatthe trial drugs did elicit their action and effect as givenin Table IV

Table No. IV - Probable mode of action of trial drugs

Drug Parameter Effect

Pippali

Rasa Katu Agni deepana and More intake of the diet (nutrientspachana e.g. iron), normalise digestion

Guna Tikshna Srotoshodhana Better absorption and transport of iron

Virya Ushna Deepana More intake of diet

Vipaka Madhura Dhatu poshana Nourishment of rakta dhatu

Prbhava Yogavahi Iron Increase bioavailability

Lauha bhasma

Prabhava and Rakta vridhi Rakta dhatu and iron Rakta dhatu vridhi

dravya samanya

Based on above table the sequence of drugaction of trial drugs can be described as follows-

Yat kurvanti (Karma)- Agni deepana,

Srotoshodhana, Dhatuposhana (Rasayana), increasebio availability of iron, Rakta vriddhi (increase inrakta dhatu, Hb %)

Yena kurvanti (Virya)-

Pippali- Rasa- Katu,

Guna- Tikshna,

Virya- Ushna,

Vipaka- Madhura,

Prabhava- Yogavahi.

Lauha bhasma- Prabhava-rakta vriddhi anddravya samanya- iron content

Yatra kurvanti (Adhikaran)- Jatharagni,

Rasadhatwagni, Rakta-dhatwagni, Rasavaha srotasand Raktavaha srotasa.

Yada kurvanti (Kala) - The trial drugs exert their

action in iron deficiency states.

Yatha kurvanti-(Upaya) - Pippali fruit powder

when used in the dose of 2 gm/day, in divided doseswith water and Lauha bhasma when used in the doseof 250 mg/day, in divided doses with water.

Yat sadhayanti-(Phalam)- Improvement theparameters assessed in the study.

Conclusion

1. Trial drugs Pippali (2gm/day) and lauha bhasma(250 mg/day) were clinically safe and increaseblood haemoglobin level in a statistically

significant manner when used for 45 days.

2. The combination of Pippali (2gm/day) and lauhabhasma (250 mg/day) when used for 45 days

increases blood haemoglobin level more thanpippali and lauha bhasma when used alone.

References

1 . K. Sembulingam and Prema Sembulingam; Essentials of

medical physiology; Jaypee brothers medical publishers; 6th

edition; 2013; chapter 11; page no. 82.

2 United Nations Children Fund; An Analysis of the Situation

of Children in India, UNICEF, New Delhi, 1984.

3 Hellen Kellar Institute for Girls; Annual Reports Gizi:

Intervensii Kepada Remaja Lokal di sckolah, 1996.


65

Clinical Evaluation of Pippalyadi Gandusha andPhalatrikadi Kwatha In The Management of Tundikeri

W.S.R. To Tonsillitis

*Dr. Anubha Jain, **Prof. Shamsa Fiaz

Clinical Study

Abstract

Tonsillitis though not is life threatening but troublesome and irritating disease reducing the quality of

life of an individual in day to day activity. It is an infectious condition but if left untreated, may leads up tosevere local and systemic complications like otitis media, sinus infections, peritonsillar abscess, Rheumatic fever,glomrulonephritis, etc. That’s why it is important to pay attention towards this difficult disease.

In present study 44 patients of Tundikeri (tonsillitis) were studied into two groups. In group-I, patientswere advised Pippalyadi Gandusha and in group-II, patients were advised Pippalyadi Gandusha andPhalatrikadi Kwatha orally. Better relief was observed in group II which received combined treatment followed

by group I which received only Gandusha therapy, except in case of Paka (where group-I showed better resultthan group-II).

Key Words : Tundikeri, Tonsillitis, Pippalyadi, Gandusha, Phalatrikadi.

‚Ê⁄Ê¢‡Ê —

ÃÈá«UË∑§⁄Ë ¬˝ÊáÊ„⁄ √ÿÊÁœ Ÿ„Ë¥ „Ò Á∑§ãÃÈ ÿ„ ∞∑§ ‚¢R§Ê◊∑§ •flSÕÊ „Ò Á¡‚∑§Ê ©¬øÊ⁄ Ÿ„Ë¥ ∑§⁄Ÿ ¬⁄ SÕÊŸËÿ ∞fl¢ ‚Êfl¸ºÒÁ„∑§©¬º˝fl ÿÕÊ ∑§áÊ¸dÊfl, ª∂Áflº˝Áœ, ‚Áãœ¡ Öfl⁄, ª∂‡ÊÙÕ, ¬Ê∑§ •ÊÁº „Ù ‚∑§Ã „Ò¥–

¬˝SÃÈÃ ‡ÊÙœ ∑§Êÿ¸ ◊¥ ÃÈá«UË∑§⁄Ë ∑§ 44 ⁄ÙÁªÿÊ¥ ∑§Ù ºÙ ‚◊Í„Ê¥ I ∞fl¥ II ◊¥ Áfl÷ÊÁ¡Ã ∑§⁄ Á¬å¬ÀÿÊÁº ªá«ÍU· ∞fl¢ »§∂ÁG∑§ÊÁº`§ÊÕ ∑§Ê ©¬‡ÊÿÊà◊∑§ •äÿÿŸ Á∑§ÿÊ ªÿÊ– Á◊ÁüÊÃ ÁøÁ∑§à‚Ê flÊ∂ ‚◊Í„ II ∑§ ⁄ÙÁªÿÊ¥ ◊¥ •Áœ∑§ ‚ÊÕ¸∑§ ¬Á⁄áÊÊ◊ ¬˝Ê# „È∞ ∞fl¢∑§fl∂ ¬Ê∑§ ◊¥ ªá«ÍU· ÁøÁ∑§à‚Ê (‚◊Í„ I) ‚ •Áœ∑§ ‚ÊÕ¸∑§ ¬Á⁄áÊÊ◊ ¬˝Ê# „È∞–

*Lecturer, Dept. of Shalakya Tantra, Dhanvantari Ayurveda Shashkiya Mahavidyalaya, Ujjain (MP), **Prof. and HOD, PG Department of

Shalakya Tantra, NIA – Jaipur.

4 Brabin, L. and B. J. Brabin; The cost of successful adolescent

growth and development in girls in relation to iron and

vitamin A status. American Journal of Clinical Nutrition, 55:

955-958, 1992.

5 Sushruta; Sushruta Samhita with Nibandha Samgraha

commentary of Dalhana; Ed. Y.T. Acharya; Chaukhamba;

2006; Uttara Tantra, 44th Chapter, Verse no. 20.

6 Vagbhata; Ashtang Hridaya with commentary

Sarvangasundara of Arunadatta & Ayurveda Rasayana of

Hemadri; Ed. Pandit Hari Sadashiv Sastri Paradakar,

Choukhamba Sanskrita Sansthana, 2010; Uttara Tantra; 40th

Chapter, Verse no. 48

7 Atal C.K., Zutshi, U., Rao, P.G. Scientific evidence of the role

of Ayurvedic herbals on bioavailability of drugs. J.

Ethnopharm. 4; 229-233, 1981.

8 Khanuja SPS, Arya JS, Shrivastava SK, et al. Antibiotic

Pharmaceutical composition with lysergol as bioenhancer

and method of treatment. United States Patent Number,

20070060604A1, 2007.

9 The Ayurvedic Pharmacopeia of India; Pub. Govt. of India,

Ministry of Health & F.W., Dept. of AYUSH, part 1st volume

IV pg. no.117.

1 0 Agnivesh; Caraka Samhita with Ayurveda Dipika commentary

of Chakrapani Dutta; Ed. Y.T.Acharya; Sutra Sthana, Chapter

26/13; Rashtriya Samskrita Samsthan;2006.


66

Introduction:

In daily practice we come across manypatients of Tundikeri i.e. tonsillitis. According toNHIS95 (National Health Interview Survey on

Disability)1 the occurrence rate of chronic tonsillitis is7 per 1000.

According to Sushruta Tundikeri is disease

which is characterized by Sthula Shopha, Toda,Daha, Paka in Talu Pradesha2 and involving Doshaand Dushya are Kapha and Rakta. According to

Acharya Vagbhata it is characterized by KathinaShopha, Manda Ruka, Pichchila Srawa and its shaperesembling to Karpasiphala3, and site of origin is

Hanusandhi AshritaKantha Pradesha i.e. root of thetemporo-mandibular joint.

A similar disease, which can be correlated to

Tundikeri based on the signs and symptoms in themodern system of medicine, is tonsillitis. This ismainly a disease of childhood but is also frequently

seen in adults. This is one of the diseases of the Mukhawhich compels the patient to feel uneasy, restless andsometimes bed-ridden if complications occur. It is

characterized by sore throat, difficulty in swallowing,fever, otalgia, trismus, halitosis (foul breath) andconstitutional symptoms such as anorexia, headache,

general body ache, malaise and constipation.4

A range of therapies from different medicalfaculties work on this disease, with either limited

success or time bond relief and also having variouslimitations, side effects, including allergic reactions. Ifall these measures fails otolaryngologist suggests

removing the tonsils i.e. tonsillectomy which alsohaving minimal results.

According to Acharya Vagbhata drug which

mainly includes Katu, Tikta Rasa and Ushna,Teekshna Guna can be use in Tundikeri.4 The drugsin this study are having these properties along with

analgesic & anti inflammatory effect. The procedure of

Clinical Evaluation of Pippalyadi Gandusha andPhalatrikadi Kwatha In The Management of Tundikeri

W.S.R. To Tonsillitis

Dr. Anubha Jain, Prof. Shamsa Fiaz

Clinical Study

Gandusha is also adapted to study the localized actionof drug.

Considering all these needs, it has beendecided to contribute little effort to manage thisproblem. Hence an attempt had been made to

evaluate the efficacy of Pippalydi Gandusha6 andPhalatrikadi Kwatha7 in Tundikeri.

So, the disease Tundikeri i.e. tonsillitis is

selected for the clinical trial.

Aims And Objectives:

Aims:

1. To find out an Ayurvedic medicinal treatment fortonsillitis.

2. To evaluate the efficacy of Pippalaydi Gandusha

and along with internal administration ofPhalatrikadi Kwatha in Tundikeri.

Objectives:

1. To explore the literature and to provide acorrelation between Tundikeri and tonsillitis.

2. To abolish tonsillitis.

3. To reduce the frequency and severity of recurrentthroat infection.

4. To avoid complications of tonsillitis.

5. To preclude for future surgery.

Material And Methods:

In the present study, 44 clinically diagnosed

patients of Tundikei (tonsillitis) were selected andrandomly divided into two groups. Patients attendingthe O.P.D. and I.P.D. of N.I.A. were screened having

the signs and symptoms of Tundikeri.


67

i) Inclusion criteria:

1. Clinically diagnosed patients of tonsillitis(Tundikeri)

2. Any individual above 8 yrs and below 50yrs of agewere selected irrespective of sex, occupation,

chronicity, caste etc.

ii) Exclusion criteria:

1. Patients with peritonsillar abscess, parapharyngealabscess, tonsillar lith, tonsillar cyst and other

complications were excluded from the study.

2. Patients having any severe systemic disease like

T.B., Diabetes and Hypertension etc. and tonsillitisassociated with malignancy were excluded.

3. Patients using any other systemic drugs which mayalter the result of the study.

iii) Grouping of patients:

In the present study 44 clinically diagnosedpatients of Tundikeri (Tonsillitis) were selected andrandomly divided into two groups (Group-I-21

patients, Group-II-23patients) out of these 44 patients40 patients completed the trial.

a) Group-I: Pippalydi Gandusha inrequired quantity twice daily on empty stomach.

b) Group-II: Pippalydi Gandusha inrequired quantity twice daily on empty stomach andPhalatrikadi Kwatha 30 ml twice daily after meal.

iv) Duration of Trial: 15 days

v) Follow up: All the patients were followedup once a week for a period of one month.

Criteria Of Assessment:

Both subjective and objective parameters wereemployed for the assessment of the effect of thetreatment.

Subjective criteria: It includes -

1) Daha / burning sensation in throat

2) Toda / pricking pain

3) Galoparodha / dysphagia

4) Halitosis (Bad Breath)

Objective criteria: It consists-

1) Paka/pus formation in tonsils

2) Ragatwa/congestion in anterior pillar andpharyngeal mucosa

3) Enlarged lymph nodes (jugulodigestric lymphnodes )

4) Shopha/pictogram presentation of tonsillarhypertrophy

C. Laboratory investigations:

Hb gm%, TLC, DLC and ESR were advised toall the patients to rule out any sever pathology and tonote the changes, if any.

After trial non significant results were

observed in maximum parameters and in inter groupcomparison insignificant results were found in allparameters.

Statistical Analysis

The information regarding demographic datawas given in percentage. The scoring of criteria ofassessment was analyzed statistically in terms of mean

values of B.T. (Before Treatment), A.T.(Aftertreatment), S.D. (Standard Deviation) and S.E.(Standard Error). The results obtained were considered

Extremely Significant for p value <0.0001, Verysignificant for<0.001, significant for p value <0.01 andinsignificant for p value>0.05.

In individual I and II group –

Wilcoxon matched pairs signed ranks test wereperformed for nonparametric data.

In intergroup comparison between I and IIgroup -

Mann Whitney test for nonparametric data.

Observation And Results:

Total 44 patients were registered in clinical

study; amongst them 40 patients completed thetreatment and 4 patients discontinued the treatment.So some important observation of 44 patients and

results of 40 patients are given below-

Observations:

l Maximum number of patients were in the of age

group of 22-29 years(38.63%), males (54.54%),unmarried(63.63%), Hindu(70.45%), educated upto Primary and secondary class (27.27%), belonged


68

to middle class (54.54%), students (56.81%), urban(72.72%) Majority of patients had Vata-

Kaphaja(52.27%), and Rajasika prakriti (56.81%).

l Majority of patients had Vishama Dietetic habits(65.90%) and sound sleep (65.90%).

l Maximum no. of patients showed MadhyamaVikriti, Sara, Samhanana, Pramana, Satva,Satmaya i.e. respectively 59.09, 63.63%, 56.81%,

54.54%, 59.09%, 65.90%.

l Majority of patients 65.90% had gradual onset ofdisease, 50% patients had disease from more than

one year, cold as a aggravating factor observed in61.36% patients.

l Fever were present in 25% patients, retraction oftympanic membrane present in 61.36% patients,

pain in ear found in 59.09% patients, loss ofappetite present in 43.16% patients and complainof malaise were found in 54.54% patients.

l Symptom of Shopha was found in 100% patients,79.54% patients had Daha, 81.81% patients hadToda, 45.45% patients had Paka, 88.63% patients

had Ragatwa, 79.54 patients had Galoparodha,61.36% patients had Hallitosis & only 31.81%patients had Jugluo-digastric lymphadenopathy.

Results:

Table No. I: Showing effect of therapy in subjective parameters in Group-I

S Symptoms Mean Dif. % of SD SE W P Results

No BT AT Change

1. Daha 1.4 0.55 0.85 60.71 0.587 0.131 120 <0.0001 ES

2. Toda 1.55 0.6 0.95 61.29 0.686 0.153 120 <0.0001 ES

3. Galoparodha 1.8 0.55 1.25 69.44 0.638 0.142 171 <0.0001 ES

4. Halitosis 0.8 0.3 0.5 62.5 0.607 0.135 45 0.0039 VS

Table No. II: Showing effect of therapy in objective parameters in Group-I


No BT AT Change

1. Raga 2.15 0.45 1.7 79.06 0.571 0.127 210 <0.0001 ES

2. Paka 0.5 0.2 0.3 60 0.47 0.105 21 0.031 S

3. Lymphadenopathy 0.45 0.25 0.2 44.44 0.41 0.091 10 0.125 NS

4. Shopha 1.95 0.8 1.15 58.97 0.366 0.081 210 <0.0001 ES

Table No. III: Showing effect of therapy in subjective parameters in Group-II


No BT AT Change

1. Daha 1.6 0.55 1.05 65.62 0.825 0.184 105 0.0001 ES

2. Toda 1.7 0.6 1.1 64.7 0.64 0.143 153 <0.0001 ES

3. Galoparodha 1.8 0.5 1.3 72.22 0.809 0.179 153 <0.0001 ES

4. Halitosis 0.8 0.1 0.7 87.5 0.656 0.146 78 0.0005 ES


69

Table No. IV: Showing effect of therapy in objective parameters in Group-II


No BT AT Change

1. Raga 1.95 0.3 1.65 84.61 0.67 0.15 190 <0.0001 ES

2. Paka 0.65 0.3 0.35 53.84 0.489 0.109 28 0.015 S

3. Lymphadenopathy 0.5 0.25 0.25 50 0.444 0.099 15 0.0625 NS

4. Shopha 1.8 0.55 1.25 69.44 0.638 0.142 171 <0.0001 ES

Table No.V: Intergroup comparison of subjective parameter of Tundikeri

S. Symptoms Mean SD SE U P Results

No GA

GB

GA

GB

GA

GB

1 Daha 0.85 1.05 0.587 0.825 0.131 0.184 228.5 0.4095 NS

2 Toda 0.95 1.1 0.686 0.64 0.153 0.143 223.5 0.4842 NS

3 Galoparodha 1.25 1.3 0.638 0.809 0.142 0.179 206 0.8703 NS

4 Halitosis 0.5 0.7 0.607 0.656 0.135 0.146 233 0.3262 NS

Table No. VI: Intergroup comparison of objective parameter of Tundikeri

S. Symptoms Mean SD SE U P Results

No GA

GB

GA

GB

GA

GB

1 Raga 1.7 1.65 0.571 0.67 0.127 0.15 203.5 0.9253 NS

2 Paka 0.3 0.3 0.47 0.489 0.105 0.109 200 0.9864 NS

3 Lymphadenopathy 0.2 0.25 0.41 0.444 0.091 0.099 210 0.7225 NS

4 Shopha 1.15 1.25 0.366 0.638 0.081 0.142 223 0.4474 NS

Table No. VII: Shows % wise improvement of signs and symptoms in both groups

S.N. Cardinal Symptoms Result In Percentage

GROUP-I GROUP-II

1 Daha 60.71 ES 65.62 ES

2 Toda 61.29 ES 64.7 ES

3 Galoparodha 69.44 ES 72.22 ES

4 Halitosis 62.5 VS 87.5 ES

5 Ragatwa 79.06 ES 84.61 ES

6 Paka 60 S 53.84 S

7 Lymphadenopathy 44.44 NS 50 NQS

8 Shopha 58.97 ES 69.44 ES

Average % of relief 62.05 68.49


70

Discussion:

Effect of therapy on assessment criteria:

Statistically Extremely Significant relief werefound in Daha, Toda, Galoparodha, Ragatwa,Shopha in both groups while in Paka significant result

was found in both groups. In halitosis Group-I showedvery significant result while Group-II showedExtremely Significant results. In lymphadenopathy not

significant results were observed Group-I while inGroup-II not quite significant results were observed.

Inter group comparison:

In comparative study over criteria’s ofassessment statistically insignificant difference wasobserved between two therapies in all assessment

criteria.

Average percentage of relief:

Comparing the symptomatic improvement in

both groups it was found that average percentage ofrelief was higher in ‘Group-II’ i.e. 68.49%, followed by‘Group-I’ i.e. 62.05%. It shows that effect of therapy

was a little more in Group-II in comparison to Group-I.

It is clear from the above description that in

Group-II where internal administration of drug wereused along with local treatment showed better results;it may be due to the drug administered internally

alleviate the generalized pathology in the Dhatus ofthe body as it gets circulated through vascular systemand there by nourished the depleted Dhatus anywhere

in the body.

Acharya Vagbhata said that the substanceswhich taste Katu is valuable in the treatment of

Galaroga. The disease Tundikeri is havingpredominant Kapha Dosha and vitiated Rakta Dhatu,we need to adopt Kapha Shamaka Chikitsa in the

management of Tundikeri. When we go through allproperties of raw materials used for preparation ofPippalyadi Kwatha Gandusha and Phalatrikadi

Kwatha there are dominance of Katu (pungent) Rasafollowed by Kashaya Rasa and Katu Vipaka whichare having Kapaha Shamaka properties. Kashya Rasa

also have Raktapitta Shamaka, Sheeta, Sanshamana,Vrana Ropaka therefore it is useful in RaktaShamana also.

As Gandusha is a local procedure and the drugapplied locally attains its maximum effect on the

disease site get absorbed easily and faster, showsspeedy recovery without exposing rest of the body.

Therefore these drugs showed there

effect on the disease tonsillitis.

Conclusion:

l The disease Tundikeri which is described in

Ayurvedic classics can be considered as tonsillitisan inflammatory condition of tonsils in whichmultifocal etiology combine together to lower the

immunity of the body and leads to tonsillitis.

l In comparative analysis insignificant results wereobserved in all assessment parameters which show

that there is no statistical difference in efficacy ofboth treatments.

l Comparing the symptomatic improvement in both

groups it was found that overall relief was highestin Group-II which received combine treatmentfollowed by Group-I which received only

Gandusha therapy, except in case of Paka (whereGroup-I shows better result than Group-II). Henceit can be concluded that combined use of

Pippalyadi Gandusha and Phalatrikadi Kwatha ismore effective for controlling the disease Tundikerithan the Gandusha therapy alone.

l The symptoms like Ragatwa, halitosis andGaloparodha showed considerable results. InShopha, Toda, Daha good improvement was

observed while Paka and lymphadenopathyshowed mild improvement.

l Thus it can be concluded that this formulation is

effective in management of Tundikeri.

References:

1 . www.rightdiagnosis.com›Diseases› Chronic tonsillitis

2. Sushruta; Sushruta Samhita with Ayurveda Tattva Sandipika

Hindi commentary by Kaviraj Ambikadutta Shastri, Part I,

published by Chaukhambha Sanskrit Sansthan, 2010 Nidan

Sthan.16/44 pg. no. 387

3. Vagbhata, Astangahrdayam with the Vidyotini Hindi

Commentary by Kaviraja Atrideva Gupta, Edited By Vaidya

Yadunandana Upadhayaya, Chaukhambh Prakashan

Varanasi,. Reprint edition 2009. Uttar Sthan 21/47 pg. no.

7 1 2


71

Evaluation of antipyretic activity of Agnikumara Rasain albino rats

*Dr. Poornima Mansoria, **Dr. Anita Sharma, ***Dr. Vinod Kumar Gothecha

Clinical Study

Abstract:

“Jwara is the foremost among the diseases”. It afflicts the body, the senses and the mind. It is the firstto be manifested among all the diseases. The present study intends to evaluate the scientific basis for theantipyretic efficacy of specific formulation Agnikumara Rasa. This study deals with the dose related efficacy of

Agnikumara Rasa. Three groups of albino rats named as test Group 1, test Group 2 and test Group 3 with agiven dose of 11.25 mg/kg, 22.50 mg/kg and 32.75 mg/kg respectively were studied with control and standardgroup (Paracetamol) by using yeast induced pyrexia method. Rectal temperatures were recorded before and after

inducing pyrexia at interval of one hour for four hours. The Ayurvedic formulation Agnikumara rasa at dose of32.75 mg / kg body weight was reported to have a maximum and safe antipyretic efficacy and showed similareffect to that of standard group Paracetamol.

Key words: Jwara, Agnikumara rasa, antipyretic efficacy, yeast induced pyrexia.

‚Ê⁄UÊ¥‡Ê-

Öfl⁄ ‚÷Ë ⁄ÙªÊ¥ ◊¥ •ª˝áÊË ⁄Ùª „Ò– ÿ„ ‡Ê⁄Ë⁄ ßÁãŒ˝ÿÊ¥ ÃÕÊ ◊Ÿ ∑§Ê GSÃ ∑§⁄ÃÊ „Ò– flÃ¸◊ÊŸ •äÿÿŸ ∑§Ê ‹ˇÿ •ÁªA∑È◊Ê⁄ ⁄‚∑§ Öfl⁄ŸÊ‡Ê∑§ ¬˝÷Êfl ∑§Ê flÒôÊÊÁŸ∑§ ◊ÍÀÿÊ¢∑§Ÿ ∑§⁄ŸÊ „Ò. ÿ„ •äÿÿŸ •ÁªA∑È◊Ê⁄ ⁄‚ ∑§Ë ◊ÊGÊ ‚’¢ÁœÃ ∑§Ê◊È¸∑§ÃÊ ‚ ‚¢’ÁœÃ „Ò–∞ÁÀ’ŸÊ¥ øÍ„Ê¥ ∑§ ÃËŸ ‚◊Í„ •, ‚◊Í„ ’ ÃÕÊ ‚◊Í„ ‚ ∑§Ù ∑˝§◊‡Ê— 11.25 Á◊ª˝Ê/Á∑§ª˝Ê, 22.50 Á◊ª˝Ê/Á∑§ª˝Ê ÃÕÊ 32.75 Á◊ª˝Ê/Á∑§ª˝Ê◊ÊGÊ ºË ªß¸ ÃÕÊ ßã„¥ ÿËS≈ ¬˝Á⁄Ã Öfl⁄ ∑§Ë ÁflÁœ ∑§ mÊ⁄Ê ∑¢§≈˛Ù‹ ‚◊Í„ (ÿËS≈) ÃÕÊ S≈á«U«¸U ‚◊Í„ (¬⁄ÊÁ‚≈Ê◊ÊÚ‹) ∑§ ‚ÊÕÃÈ‹ŸÊà◊∑§ •äÿÿŸ Á∑§ÿÊ ªÿÊ– Öfl⁄ ¬˝Á⁄Ã ∑§⁄Ÿ ‚ ¬Ífl¸ fl ©‚∑§ ’Êº 1-1 ÉÊ¢≈¥ ∑§ •¢Ã⁄Ê‹ ¬⁄ 4 ÉÊ¢≈ Ã∑§ ªÈºÊ ∑§Ê ÃÊ¬◊ÊŸ ◊Ê¬ÊªÿÊ– ÿ„ ◊Ê¬Ê ªÿÊ Á∑§ 32.75 Á◊ª˝Ê/Á∑§ª˝Ê ◊ÊGÊ •Áœ∑§Ã◊ Öfl⁄ŸÊ‡Ê∑§ ∑§Ê◊È∑§ÃÊ fl ‚È⁄ÁˇÊÃ ‚ÍÁøÃ ∑§Ë ªÿË ÃÕÊ ß‚Ÿ ◊ÊŸ∑§ ‚◊Í„∑§ ÃÈÀÿ ¬˝÷Êfl ÁºπÊÿÊ–

*Ayurveda Medical Officer, Govt. Ayurvedic College, Jabalpur (MP) email- [email protected], **Professor and HOD., Deptt of Agad

Tantra, N.I.A. Jaipur; ***Ex-Professor, Deptt of Agad Tantra, N.I.A. Jaipur

4. Dhingra PL, Dhingra Shruti; Diseases of ear, nose and throat

& head and neck surgery, assisted by Deeksha Dhingra, 6th

edition, Elsevier, a division of Reed Elsevier India Private

Limited, 2014, chapter 51, pg. no. 259.

5. Ibidem (iii) Uttar Sthan 22/63 pg no. 720

6. Yogaratnakara; Yogaratnakara, edited by Dr. Indradev

Tripathi, Dr, Dayashankar Tripathi sastri, 4th edition,

chowkhamba Krishnaa das acadmy, Varanasi, 2013,

Mukharogadhyaya/170 pg. no. 724.

7 . Bhatta Trimalla; Yogatarangini, 1st edition, edited by Dr.

Nirmal Saxena, Chowkhambha Sanskrit Bhawan, Varanasi,

69/4pg. no. 365


72

Introduction:

In most of the ayurvedic scriptures Jwara isconsiderd as “king of the disease”. In modern science

term pyrexia and fever are used in context of Jwara.According to modern science, there are also many typesof fevers described base upon the various etiological

factors like virus, bacteria, parasites, worms and whenetiolgy is not known it is termed as P.U.O. ( pyrexiaof unknown origin). There are group of symptoms

mentioned in each and every books of Ayurveda aswell as in modern texts and Jwara lakshana out ofthem so many symptoms difficult to observe always in

the sufferer, so that to avoid any confusion it has been

decided that ífl⁄USàfl∑§ ∞fl ‚¥ÃÊ¬‹ˇÊáÊ—1 and ífl⁄U¬˝àÿÊÁà◊∑¥§Á‹X¥ ‚¥ÃÊ¬Ê Œ„◊ÊŸ‚—2 keeping this sutra in our mind we

will take ¬˝àÿÊÁÃ◊∑¥§ Á‹X¥ ‚¥ÃÊ¬U means rise in body

temperature is only for a diagnostic point confirmedby thermometer.

In Indian system of medicine there are somany formulations are described for the treatment ofJwara. In Bhaisajya ratnawali a formulation named

by Agnikumara Rasa,3 indicated for the treatment ofJwara. This formulation contains Maricha(Pipernigrum) Vacha(Acorus calamus), Mustaka(Cyperus

rotundus), Kustha(Saussurea lappa) and Vatsnabha(Aconitum chasmanthum). As Vatsnabha is the majorcontent of Agnikumara rasa. It is well said by

Acharya Charaka that if Visha used in proper mannerthan it could be proves as nectar. As the Maatra playsan important role in the pharmaceutical action of any

formulation so Shaastrokta Maatra of AgnikumaraRasa which is told one Ratti i.e 125 mg seems to createa question mark that whether it could be effective or

not in present scenario. So keeping all these points inview effort was made to prove the dose related efficacyand possible antipyretic effect of the Agnikumara

Rasa on Jwara.

Aims & Objectives:

v To find out the antipyretic efficacy of Agnikumara

rasa in Brewer’s yeast induced pyrexia in lab

animals in different doses.

v To compare the efficacy of antipyretic efficacy ofAgnikumara rasa at different doses with that ofcontrol and standard.

Material and methods:

Test drug:

The test drug Agnikumara Rasa was collected

after manufacture from the rasayanshala, N.I.A.jaipur.

Strain : Albino Wistar Rats

Number : 52

Weight range : 55 to 220 gm.

The experimental protocols were approved by

the Institutional Animal Ethics Committee (IAEC) ofInstitute of Biomedical and Industrial Research,Jaipur in accordance with the guideline formulated by

CPCSEA, Government of India. CPCSEA RegistrationNo. 1737/PO/Rc/S/14/CPCSEA.

Mode of Administration: Oral route

Preparation of Paracetamol solution forStandard Group –

Paracetamol (150mg) was dissolved in 50ml of

distilled water and volume makeup the volume of100ml and stored in suitable sterile labelled(Paracetamol solution) container.

Preparation of Brewer’s Yeast solution forinducing Pyrexia –

Brewer’s yeast (20 gm) was mixed in 100 ml

normal Saline. Solution was stored in a suitable andsterile labelled (Brewer’s Yeast) container.

Evaluation of antipyretic activity of Agnikumara Rasain albino rats

Dr. Poornima Mansoria, Dr. Anita Sharma, Dr. Vinod Kumar Gothecha

Clinical Study


73

Housing and feeding conditions:

Table No. I Showing the Laboratory Conditions maintained as per OECD 423

S.No. Conditions Requirement

01. Room Temperature 22ºC (±3ºC)

02. Humidity 50 – 60%

03. Light and Dark Period 12/12 Hours

04. Bedding Clean Sterilized Husk

05. Oral Feed Conventional Laboratory Diets, Like Standard Pellet Chow

06. Distilled Drinking Water Unlimited Supply

Preparation of Agnikumar Rasa in Glycerinefor test group

For Antipyretic Study

Test Group 1 (11.25 mg/Kg): in 100 ml Glycerine

Test group 2 (22.50 mg/kg): in 100 ml Glycerine

Test Group3 (32.75 mg/kg): in 100 ml Glycerine

Inclusive criteria:-

- Adult healthy albino rats

- Rat weighing 55-220 gms

- Albino rats between 90-120 days were included.

Exclusive criteria:-

- Unhealthy albino rats.

- Weight below 55 gm and above 220 gms

- Albino rats of below 90 days and above 120 days

were excluded.

Acute toxicity study

Acute oral toxicity study was carried out

according to OECD guidelines 423. Acute toxicity forthe determination of LD50 value was performed withdifferent doses of Agnikumara Rasa according to the

Acute toxic class method.4 The animal groups wereobserved for appearance of toxic symptoms includingbehavioural changes, locomotion, muscle spasm, loss

of righting reflex, tremor, convulsions and mortalityfor 24 hrs and further supervised for a period of 14days for occurrence of toxic symptoms and mortality.

Antipyretic study:

The assessment of antipyretic efficacy wascarried out by using brewer’s yeast induced pyrexia

method. Pyrexia was induced by injecting 10 ml/kg ofa 20% w/v suspension of brewer’s yeast in 0.9% saline.The room temperature will be kept at 22-240C.

Immediately after injection the food withdrawn. 18hrpost challenge, the rectal temperature recorded usingdigital clinical thermometer. Only animals with a

rectal temperature at least 380 C will be taken into thetest and split into three subgroups (N=8). AgnikumaraRasa in dose of 11.5 mg/kg, 22.5 mg/kg, 32.75 mg/

kg body weight and Paracetamol in the dose of 150mg/kg body weight will be administrated orally tofevered animals, while control animals received only

distilled water (2ml/kg). Rectal temperature will berecorded again 30, 60, 120, 180 minute afteradministrating the drug.

This study was conducted following groups ofalbino rats.

A. Control group—Brewer’s yeast group. Only yeastwas injected to 8 albino rats.

B. Standard group—After producing Brewer’s yeastinduced pyrexia, dose of 150 mg/kg body wt. was

administered as antipyretic Control drug(paracetamol) orally in this group of 8 animals.

C. Dose of test drug: Agnikumar rasa in Brewer’syeast induced pyrexia in 8 rats of each group in these

doses,

Test group I:- 11.25 mg / kg body wt.

Test group II:- 22.5 mg / kg body wt.

Test group III:- 32.75 mg / kg body wt


74

Statistical Analysis:

The results are expressed as Mean ± SEM. The

difference between the groups was statisticallyanalyzed using the analysis of variance (ANOVA)

followed by Dunnett’s t multiple comparative post-testfor all the treated groups. P<0.05 was considered

statistically significant.

Table No. II showing the effect of Agnikumara Rasa on Brewer’s yeast induced pyrexia at

various time intervals in albino rats

Group Temperature(°F) Diffe-

Name Before At 17th Treatment Period rence

Yeast hr after AtAdmn. yeast 0hr 1hr 2hr 3hr 4hr 4th hr

admin

Control 98.36± 100.41± 100.51± 100.68± 100.70 100.67 100.49 0.02Group 0.7229 0.2899 0.2279 0.2202 ±0.169 ±0.1485 ±0.1767

Standard 98.15± 100.32 100.48 98.14 97.55 97.20 97.00 3.48

Group 0.4503 ±0.1943 ±0.2077 ±0.2939 ±0.2604 ±0.2070 ±0.1732

Test 97.35 100.35 100.98 100.35 98.87 98.55 98.29 2.69Group 1 ±0.1963 ±0.1802 ±0.2877 ±0.2405 ±0.3594 ±0.2745 ±0.3130

Test 97.42 100.03 100.60 99.27 98.41 98.36 97.68 2.92Group 2 ±0.4237 ±0.3183 ±0.2138 ±0.1424 ±0.4980 ±0.2751 ±0.3607

Test 97.28 100.03 100.56 99.13 98.06 97.65 97.41 3.15

Group 3 ±0.3602 ±0.3183 ±0.1861 ±0.2128 ±0.3514 ±0.2745 ±0.2635

P value 0.3034 <0.0001 <0.0001 <0.0001 <0.0001******** **** ****

Graph No. 1: Presentation of the Effect of Agnikumara Rasa on Brewer’s yeast inducedpyrexia at various time intervals in albino rats. Each column represents the Mean ± S.E.M.

of temperature of 8 animals


75

Table No. III showing Statistical Comparison of Test Group and Standard Group withControl Group at 0 hour

Dunnett’s multiple comparisons Mean Diff. P value Significanttest at 0 hr summary

Control vs. Standard Group 0.0300 >0.05 Ns

Control vs. Test Group 1 -0.4700 >0.05 Ns



Table No. IV showing Statistical Comparison of Test Groups and Standard Group withControl Group at 1 hour

Dunnett’s multiple comparisons Mean Diff. P value Significant

test at 0 hr summary

Control vs. Standard 2.542 <0.0001 ****

Control vs. Test Group 1 0.330 >0.05 Ns

Control vs. Test Group 2 1.410 < 0.001 ***

Control vs. Test Group 3 1.550 <0.001 ***

Table No. V Showing Statistical Comparison of Test Groups and Standard Group with

Control Group at 2 hour





Control vs. Test Group 3 2.640 <0.0001 ****

Table No. VI Showing Statistical Comparison of Test Groups and Standard Group withControl Group at 3 hour







76

Table No. VII showing Statistical Comparision of Test Groups and Standard Group withControl Group at 4 hour






Results:

The LD50 study showed that AgnikumaraRasa are safe at a dose of 2000 mg/kg body weight.

Agnikumara Rasa at a dose of 32.75mg/kg bodyweight has shown highly significant (P<0.0001)antipyretic activity, it has shown significant fall in

body temperature up to 4h following itsadministration. The antipyretic activity started as earlyas 1h and the effect was maintained for 4h. The

response was comparable to that of antipyretic activityof paracetamol a standard antipyretic drug.Agnikumara Rasa showed moderate antipyretic

activity at a dose of 22.5 mg/kg body weight same ata dose of 11.25 mg/kg body weight showed lessantipyretic activity.

Discussion:

Jwara is Rogaraja means king among all thediseases. It manifests mainly due to Agnimandya, the

main dosha involved is Pitta and main dushya isRasadhatu. pratyatma lakshana (chief complain) ofJwara is Santapa. That’s all indicates the significance

of Jwara in the field of treatment. Antipyretic areagents, which reduce the elevated body temperature.Regulation of body temperature requires a delicate

balance between production and loss of heat, and thehypothalamus regulates the set point at which bodytemperature is maintained. In fever this set point

elevates and a drug like paracetamol does notinfluence body temperature when it is elevated by thefactors such as exercise or increase in ambient

temperature. The interpretation above analysis suggestthat overall effect, dose was given in Test group 2 forsubsiding pyrexia is equal in response with Test group

1, at the same time Test group 3 compared to Testgroup 1 is very significant, that means the dose givenin Test group 1 is quite less effective as compared to

the dose given in Test group 3. So keeping all thesepoint in view, we can finally conclude that the dosegiven to Test group 2 can be taken as minimum, safe

and effective dose of Agnikumara Rasa as incomparison of the dose given to Test group 1 and Testgroup 3. Considering all above data, it may be

discussed that anti-pyretic activity of Test group 3 wasbetter than that of Test Group 1 & Test group 2,because Test group 3 shows much more significant

antipyretic effect from the early stage of the treatment.Test group 3 had similar antipyretic activity ascompared to that of Standard Group.

Mode of action of Agnikumara Rasa:

The main cause of Jwara is Agni mandya bywhich Srotorodha occurs and Vaikrita Pitta is

responsible for the rise in the temperature in body.Ayurvedic drugs works by Rasa, Guna, Virya, Vipakaor Prabhava. These properties of any drug work either

in single manner or in a synergetic or combinedmanner. The probable mode of action of AgnikumaraRasa can be described on the basis of these five

properties of the drugs present in Agnikumara Rasa.As decribed earlier, Agnikumara Rasa containsMaricha, Vacha, Kushtha, Musta and Vatsnabha as

the major component. Most of the content drugs inAgni Kumara Rasa are having Katu and Tikta rasaand acts as Deepana Pachana property by which they

help to remove Agni mandya and in Ama Pachanaalso. Katu Rasa having Margaana vivrinoti property,it relieves Sweda awarodha due to Srotovistarana

(clear the passage or channels).5

Thus shows antipyretic activity. Musta itselfis also considered as jwranashaka.6 Vatsnabha which

is a major content in Agnikumara Rasa is a Vishadravya, but dissimilar of other Visha dravya it hassome special properties like it is Madhura in Rasa and


77

Vipaka, due to these property if it is used intherapeutic dose it is Pitta shamaka. Vatsnabha

having Swedajanana property. It is the best medicineof Jwara.7 Its other properties like Tikshna, Laghu,Sukshma, Vyavayi etc. Guna help to remove the

Srotoavrodha. Its Yogvahi Property makes it to showthe synergic antipyretic effect with the other drugsused in Agnikumara Rasa.

Conclusion:

The present results show that AgnikumaraRasa at dose of 32.75 mg/kg possesses highly

significant antipyretic effect in yeast-provoked elevationof body temperature in rats, and its effect iscomparable to that of paracetamol (standard drug). As

we can say that dose of Test group 3 was fast actingin relieving pyrexia. The anti-pyretic effect ofAgnikumara Rasa showed dose and time period

relative efficacy. It means that the dose of drugAgnikumara Rasa increased, the anti-pyretic effectwas found early and prolonged comparative to less

dose.

References

1 . Agnivesa, Charaka Samhita, revised by Charaka and

Dridhbala, elaborated Vidyotini Hindi Commentary by Pt.

Kashinatha Shastri and Dr. Gorakhnatha Chaturvedi, reprint

edition 2005, Chaukhambha Bharti Academy, Varanasi,

Nidana sthana, 1/32 p-614.

2. Ibidem 1 Charakasamhita, Chikitsasthana, 3/31: p-99.

3. Govind Das, Bhaishajya Ratnavali, Hindi commentary

Vidhyotini, by Ambikadutta Shastri, edition 2002,

Chaukhambha Sanskrit Bhawan, Varanasi, 5/528-529; p-85

4. OECD/OCDE, Guidelines for the testing of chemicals. Revised

draft guidelines, 423, Acute oral toxicity Acute toxic class

method, Adopted document, 2001.

5. Ibidem 1, Charaka Samhita, 26/43/4; p- 506.

6. Bhava Mishra, Bhavaprakasha Nighantu (Indian Materia

Medica), commentary by Prof. K.C. Chunekar and edited by

Late Dr.G.S. Pandey, Revised and Enlarged edition 2010,

Chaukhamba Bharati Academy, Varanasi, Karpuraadi Varga;

p- 232.

7 . Dravyaguna Vigyana of Prof. P.V. Sharma, (reprint 2006),

Chaukhamba Bharati Academy, Varanasi, Vol. II ; p- 109.


78

Role of Ankoladi Taila In Childhood Seborrheic DermatitisW.S.R. To Arumshika

*Dr.Rajpurohit Kavita, **Dr. Acharya Shrinidhi Kumar. K.

Clinical Study

Medical Officer Ayush (NHM)@CHC Pachpadra, Balotra, Barmer (Raj.) *P.G.Scholar, **Assistant Professor, P.G. Department of

Kaumarbhritya, National Institute of Ayurveda, Jaipur.

Abstract

Background: Due to increasing incidence and prevalence of scalp skin and hair disorders such asSeborrheic Dermatitis in children, there is a need for effective and safe drug for management of childhood

Seborrheic Dermatitis. We can correlate Seborrheic Dermatitis with Arumshika in our text which is aShirokushtha. In Sahastrayogam texts, Ankoladi Taila has been mentioned a good remedy for Shiro Kushtha.A clinical trial was undertaken to evaluate efficacy of Ankoladi Taila in the management of Seborrheic Dermatitis

in paediatric practice. Methods: interventional, open label masking, control (randomized) trial, trial was carriedout on 40 patients (20 patients in each group) of either sex in between the infantile to 16 years of age at P.G.department of Kaumarbhritya, National Institute of Ayurveda. The duration of treatment was for 60 days.

Clinical evaluation done by assessment criteria and photography. Results: Result showed highly significantresults regarding subjective parameters – flaking/scaling, Redness, itching and discharge with % relief of 88.70%,97.01%, 93.28%, 97.29% and significant result in burning and boils with % relief of 95%, 73.17%. Conclusion:

It can be concluded that Ankoladi Taila is highly effective in the management of Seborrheic Dermatitis(Arumshika). The drug is quite safe and acts as anti-fungal, antibacterial, anti- inflammatory and anti-allergic.

Key words: Arumshika, AnkoladiTaila, Seborrheic Dermatitis.

‚Ê⁄UÊ¥‡Ê-

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79

Introduction

“A thing of beauty is joy forever.’’ So, theconcept of beauty (Saundarya) is gaining more and

more attention globally and hair plays an importantrole in it, as it has been said that hair is a barometerof one’s beauty. So, it has a great aesthetic value and

it is the crowning glory of any person. Therefore tokeep the healthy hairs in healthy state is entirely theduty of human beings. Even thousand years ago, in

Ayurvedic literature, so many types of daily regimensfor scalp skin care have been described in the chapterof Dinacharya and Ritucharya, which includes some

procedures like Moordha Taila, Nasya, Snana,Rasayana Sevan etc.

In the present world today people are more

conscious about their children’s health andappearance. Scalp skin and hair plays an importantpart in the personality or the appearance of the people.

Today, changed life style and junk food habitsresulting in such type of problems. Over consciousparents with increased awareness regarding hair care,

and indulgence in faulty treatment modality for fastcure might have been the cause for same.

Seborrheic dermatitis and pityriasis capitis

(cradle cap) are common in early childhood. Accordingto one survey of 1,116 children1, the overall age and sexadjusted prevalence of seborrheic dermatitis was 10

percent in boys and 9.5 percent in girls. The highestprevalence occurred in the first three months of life,decreasing rapidly by one year of age, and slowly

decreasing over the next four years. Most patients (72percent) had minimal to mild seborrheic dermatitis.Pityriasis capitis occurred in 42 percent of the children

examined (86 percent had a minimal to mild case).Prevalence estimates for older persons are consistentlyhigher than estimates for the general population2

The prevalence rate of Seborrheic Dermatitisis 3-5%, with a worldwide distribution. Dandruff, themildest form of this dermatitis, is probably far more

common and is present in an estimated 15-20% of the

population3. The prevalence of Seborrheic Dermatitisin HIV-positive and AIDS patients is between 34%4

and 83%5 as opposed to 3% in the general population.

Seborrheic Dermatitis is a common chronicinflammatory papulosquamous condition that usually

occurs in sebum rich areas, including the scalp, face,upper chest, trunk and back. Dandruff is a mild formof Seborrheic Dermatitis. It is also common during

infancy, known as cradle cap involving the scalp.Cradle cap usually resolves by eight to 12 months ofage. Intermittent, active phases of Seborrheic

Dermatitis manifest with burning, scaling, and itching,alternating with inactive periods.

In modern medicine Dandruff/SeborrheicDermatitis is treated by multiple antifungal or topical

steroidal anti-inflammatory agents but this line ofmanagement has limitations, due to the cost factor,poor cosmeticity, and adverse effects of steroidal

agents, relapsing nature of disease.

This generates a requirement to discover andemploy ancient knowledge of Ayurveda to locate

accurate solution of the disorder which is easy to usein children, preventive as well as curative, costeffective, long lasting, devoid of adverse effect. Because

ideal treatment is one which cures the diseasecompletely and does not give any side effects whichmay be the cause of another disease.

Due to discoloration and disfiguration of skinis basic requirement for categorization under Kushthapractically but predominantly it is occur over scalp

(Kapala/Murdha Pradesha) so it can be countedunder Shiro Kushtha. Review of different classicalreferences infers that, Arumshika can be classified

under the heading of Shiro Kushtha.

Trial drug (Ankoladi Taila) in present studywas taken from Sahastrayogam book a famous

clinical oriented reference book from Kerala written

Role of Ankoladi Taila In Childhood Seborrheic DermatitisW.S.R. To Arumshika

Dr. Rajpurohit Kavita, Dr. Acharya Shrinidhi Kumar. K.

Clinical Study


80

on the base of experiences of Astha Vaidhya’s ofKerela. (Phalashruti was given as “Shiro Kushtha

Vinashanam”). This book quote effectiveness ofAnkoladiTaila in Shirokushtha which can be better co-related with Arumshika. In the light of above

background the present study aimed to evaluation ofthe efficacy of Ankoladi Taila in the management ofSeborrheic Dermatitis in paediatric practice.

Aims & Objcetives –

Evaluation of the efficacy of Ankoladi Taila inthe management of Seborrheic Dermatitis in

paediatric practice

Material & Methods

The present clinical study was a randomized

control trial. 2 groups, Interventional study type, openlabel masking, sample size of 40 patients (20 in eachgroup).

Inclusion criteria

1. Patients of infantile age to 16 years was selected.

2. Patients with pigmentory changes in the scalp

region with associated with scalp infection.

3. Patients with secondary bacterial infection andcandidiasis localized scalp involvement and devoid

of systemic manifestation.

Exclusion criteria

1. Patients above 16 years of age.

2. Extensive involvements of deeper skin tissue andtendency towards Psoriasis was excluded.

3. Patients associated with other generalized skin

disorders of varied etiology and manifestationswas excluded from the study.

4. Skin disorders with hereditary, metabolic, other

chronic disorders and secondary lesions wasexcluded.

5. Patients who are on long term drug therapies was

excluded.

6. Patients with Seborrheic Dermatitis extending toface shoulder & back region was excluded.

Study design and duration

The present clinical study was a randomized

control trial. 2 groups, Interventional study type, openlabel masking, and sample size of 40 patients (20 in

each group). The duration of treatment was 60 days.

l Group A- In this group Trial drug Ankoladi Taila(Sahastrayogam Taila Prakarana) used for

External application, twice daily 10ml/day for theaffected part of the scalp after shaving the scalphairs.

l Group B- In this group control drug (coconut oil)used for external application twice daily 10ml/dayfor the affected part of the scalp after shaving the

scalp hairs.

Ankoladi Taila (Batch No.-A0069). Themedicine was manufactured at National institute of

Ayurveda pharmacy. The control drug (coconut oil)was also provided by pharmacy.

Assessment criteria:

l A Standard grading system was developed toassess the improvement in treated cases based onSymptomology of the Seborrheic Dermatitis.

l Photographic evidences were made to assess thepigmentory changes & overall improvement.

To grade dandruff/ Seborrheic Dermatitis

severity, the scalp is divided into six anatomicalsections (frontal, right parietal, left parietal, righttemporal, left temporal, occipital). Shaving of scalp or

a comb is used to part the hair in each area to give aclear view of the scalp. Each section was assessed for6 subjective parameters i.e 1) Flakes, 2) Redness, 3)

Itching, 4) Burning, 5) Discharge, 6) Boils that areadhering to the scalp skin using a 0 to 3 scale. Looseflakes in the hair are not considered in the grading.

The final, or total score is the sum of the grades forall six scalp sections, which results in a scale rangingfrom 0 to 18.


81

Table no. I Assessment criteria

S.No. Symptom Criteria Severity Grading

1. Flaking/Scaling No flaking No 0

slightly flaking Mild 1

flakes with erythema Moderate 2

scaly pimples appear severe 3

2. Redness No redness no 0

Mild redness at site Mild 1

Redness with elevated edge at the Moderate 2site and erythema

Redness with congestion and swelling Severe 3

3. Itching No itching No 0

Rarely itching mild 1

Itching subside after application of oil moderate 2

Itching doesn’t subside after Severe 3application of oil

4. Burning No burning No 0

Mild type of burning in localized area Mild 1

Burning in localized area & adjacent area Moderate 2

Continuously burning in generalized area Severe 3

5. Discharge No discharge No 0

Watery oozing from lesion Mild 1

Oozing with thick purulent discharge Moderate 2

Continuous thick purulent blood Severe 3mixed discharge

6. Boils No boil formation No 0

1-2 boils at site of itching Mild 1

Multiple boils (crops) with clear fluid Moderate 2

Multiple boils (crops) with exudate severe 3

Statistical analysis

l The information gathered on the basis ofobservation made about various parameters wassubjected to statistical analysis in terms of

Mean, Standard Deviation and Standard error

(SE). All the results calculated by using software:Graph Pad In Stat 3.

l All data was nonparametric so Wilcoxon matched-

pairs signed ranks test was used, and resultscalculated in each group.


82

l For calculating the inter group comparison, Mann-Whitney Test was used. The result was interpreted

as-

o Non-significant : P >0.05

o Significant : P <0.05

o Highly significant : P < 0.01, P < 0.001, P<0.0001

Observations and Results-

Ø 9-12 years age group was the most affected group.(55% )

Ø Males were more prone to Seborrheic Dermatitisas compared to females. (57.5% )

Ø Maximum number of cases were belonging tourban area, Hindu religion, vegetarian diet,

middle socio-economic status and graduatedfamily. (57% )

Ø Maximum number of cases exhibited Chronicity of1-2year, no family history, and aggravation in

winter season and relieved by local measures.(37.5% )

Ø Maximum patients of trial were Vata-Kaphaja

Prakriti, Mandagni, Madhyama Koshtha, andexcess intake of Lavana- Amla Rasa. (77.5% )

Ø Maximum patients of trial belongs to poor

personal hygiene, irregular head wash andfrequently change their hair oil for ShiroAbhyanga. (77.5% )

Ø The present study shows maximum patients werebelongs to positive history of Infantile Seborrheic

Dermatitis (Cradle Cap). (72.5% )

Ø Maximum patients done their first hair cut in lessthan one year of age. (67.5% )

Ø Maximum patients had flaking as a chiefComplaint followed by itching, redness dischargeand Boil. Incidence of flaking/scaling observed

maximum in left parietal area of scalp while Boilswas maximum in Right Parietal and occipital areaof scalp.(65% )

Ø Ruksha hair quality and occasionally hair fall was

observed in maximum patients of trial. (62% )

Ø Maximum patients were belongs to dry/Scaly

lesion, irregular border, normal to dull red incolour and rough skin texture. ( 57%)

Table No. II: Showing effect of therapy in subjective parameters.

(Wilcoxon matched paired single ranked test)

Variable Group Mean Mean Diff. % SD SE P S

BT AT Relief (±) (±)

Flaking Gr. A 6.20 0.70 5.50 88.70 2.14 0.47 <0.0001 HS

Gr. B 7.05 3.40 3.65 51.77 1.84 0.41 <0.0001 HS

Redness Gr. A 3.35 0.10 3.25 97.01 3.09 0.69 <0.0001 HS

Gr. B 3.25 1.25 2.00 61.53 1.85 0.41 <0.0001 HS

Itching Gr. A 7.45 0.50 6.95 93.28 3.22 0.71 <0.0001 HS

Gr. B 7.70 3.37 4.33 56.23 2.27 0.43 <0.0001 HS

Burning Gr. A 1.00 0.05 0.95 95 1.50 0.33 <0.05 S

Gr. B 0.45 0.20 0.25 55.55 0.63 0.14 >0.05 NS

Discharge Gr. A 1.85 0.05 1.80 97.29 2.62 0.58 <0.01 HS

Gr. B 2.60 1.20 1.40 53.84 2.03 0.45 <0.01 HS

Boil Gr. A 2.05 0.55 1.50 73.17 2.54 0.56 <0.05 S

Gr. B 2.10 1.15 0.95 45.23 1.57 0.35 <0.05 S


83

In intergroup comparison highly significantgain was seen in group A over group B at the level of

(P<0.01, <0.0001)) for flaking/scaling, redness, itchingand Discharge. Whereas non-significant (P>0.05) gainwas found in group A over B, for symptoms like

Burning and Boils.

Discussion-

Maximum content of Ankoladi Taila are

having Vata Kapha Shamaka property. Further Tailaitself having Vata-Kapha Shamaka effect due toLaghu and Snigdha Guna which helps to alleviate the

pathology of flaking.

Redness (Raga) is due to Pitta Prakopa andRakta Dushti. Arumshika is basically considered as

Shirogata Kushtha. In present study Arumshika ishaving involvement of Tridoshas with Rakta and Pittacontribute for redness. As Ankoladi Taila having Pitta

Shamaka and Rakta Shodhaka property.

Twak Avaddharana mediated by increasedVata and Kledatva of Pitta may be even contribute to

itching (Kandu). Kandu caused by vitiated Kapha6

and Pitta Dosha7, contents of Ankoladi Taila haveKandughna property due to Katu Rasa.

In Arumshika Daha symptom is due to Pittaand Raktadushti. Ankoladi Taila having

Dahaprashmana and Pittashamaka effect. Presenceof burning sensation is a one of the presentation ofArumshika which has been attributed to Pitta Dosha

and its relationship with Rakta. There will be localincrease in temperature with increased blood flow andscalp skin will be vitiated by abnormal Pitta causing

burning sensation.

Abnormal Kleda when collected in betweenhairs and not clean properly leads to further

consequences. Katu Rasa and Shoshaka properties inAnkoladi Taila stops the production of Mala RupaKleda (Upahanti Kleda) and Tikta Rasa dries up the

discharge (Kleda Upashoshana)8. As Ankoladi Taila ismore effective in relieving discharge symptom ofArumshika.

Drug Ankoladi Taila having Vranaropaka(Ankola, Kutha, Tila) and Grahi (Bakula) propertydue to Katu and Tikta Rasa. Study suggests Bakula

is anti-acne plant9.

Table no. III Pharmacological activities of content of Ankoladi Taila

S. no. Drug Part used Action and properties Indication

1. Ankola seed antifungal10 antibacterial Krimi, Sarpavisha, Swavisha,

activity11. Kushthaghna, Visarpa,Twagdosha, Jwara

2. Maricha seed antimicrobial agent12. Agnimandhya, Shula,

anti-inflammatory effect13 ShothavedanayuktaVikara, Krimi, Kushtha

3. Kushtha root anti-inflammatory14, Shotha, Shula, Kushtha,

anti-oxidant effect15. arnavikara, Agnimandhya

4. Bakula leaves anti-bacterial16, antifungal17, Visha, Krimiantimicrobial18.

5. Jambira Fruit juice antibacterial activity19, Krimi, Agnimandhyaantifungal activity20,cytotoxic effects21 antimicrobial

activity22. anti-dandruff activity23.

6. Tila Taila Seed oil wound contraction24. Khalitya, Palitya, KrimiInsecticidal Activity25

antioxidant activity26.


84

Conclusion

Hence it can be concluded that Ankoladi Taila

is effective in reducing the severity of symptoms ofSeborrhoea Dermatitis or Arumshika. Route ofadministration is easy, safe, and effective in children

and shaving of scalp or (Mundana) is extremelyhelpful for getting early and immediate effect of drug.Incidences of Arumshika is quite common in Kapha

Vataja Prakruti and with poor scalp hygiene. Thestudy drug “Ankoladi Taila” is effective in reducingmaximum symptoms of childhood Seborrheic

Dermatitis, as compared to control group (coconut oil).No adverse effect of the study drug was observedduring the study. Further double-blind placebo-control

study in a higher population is recommended.

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HPLC and LCMS: a method for isolating and identifying

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Naik SR (1990) Anti-inflammatory activity of piperine.

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pp. 95-100.

14 Gokhale AB, Damre AS, Kulkarni KR, Saraf MN (2002)

Preliminary evaluation of anti- inflammatory and

antiarthritic activity of S. lappa, A. speciosa and A. aspera.

Phytomedicine, Vol.9 (5), pp.433-437.

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Vishnuvardhan MVPS, Ramakrishna S, Madhavendra SS and

Rao JM (2010) Anti-inflammatory and cytotoxic activity of

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of Mimusopselengi against gram positive and gram negative

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pp. 458-462, August, 2009, Available online http://

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165. Antifungal activity of a known medicinal plant

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SesamumindicumL seed and oil in rats, Indian Journal of

Experimental Biology, Vol. 46 November 2008, pp. 777-782

Pharmaceutico- Analytical Study of Agastya HaritakiRasayana

*Dr. Varsha Mundhra, **Prof. K. Shankar Rao


Abstract:

Agastya Haritaki Rasayana(AH) is an important Ayurvedic Avaleha formulation containing

Dashamoola, Pippali, Bharangi, Kapikacchu and Haritaki, Apamarga, Bala, Pushkarmoola, Shati, ShankaPushpi, Chitraka, Pippali Moola, Gajapippli ingredients. Though AH is very effective medicine in the disordersof Respiratory tract and other allergic reactions but till date there has been no standards for this medicine either

pharmaceutically nor physico-chemically. Hence, the present study was undertaken to standardize the Poly Herbalformulation (AH) through pharmaceutical and physico-chemically evaluations. The sample was subjected forvarious physicochemical parameters like water soluble extractive, alcohol soluble extractive, ash value, loss on

drying, pH, Total Sugar value, HPTLC, Total Antioxidants etc. The results may provide guidelines forstandardization of formulation AH.

Key Words: Agastya Haritaki Rasayana, HPTLC, Physicochemical evaluation.

‚Ê⁄UÊ¥‡Ê-

•ªSàÿ „⁄UËÃ∑§Ë ⁄U‚ÊÿŸ ∞∑§ ◊„àfl¬ÍáÊ¸ •ÊÿÈfl¸ÁŒ∑§ •ÊÒ·œ „Ò, Á¡‚◊¥ Œ‡Ê◊Í‹ Á¬å¬‹Ë, ÷Ê⁄UXË, ∑§Á¬∑§ë¿ÈU, „⁄UËÃ∑§Ë,•¬Ê◊Êª¸, ’‹Ê, ¬Èc∑§⁄U◊Í‹, ‡Ê≈UË, ‡ÊW¬Èc¬Ë, ÁøòÊ∑§, Á¬å¬‹Ë ◊Í‹, ª¡ Á¬å¬‹Ë •ÊÁŒ ÉÊ≈U∑§ Œ˝√ÿ „Ò– ÿlÁ¬ •ªSàÿ „⁄UËÃ∑§Ë ∑§Ë∑§Ê◊È∑§ÃÊ ‡fl‚Ÿ ÃãòÊ ∞fl¥ ¬˝àÿÈ¡¸ÃÊ ‚¥’ÁãœÃ √ÿÊÁœÿÊ¥ ◊¥ Á‚h „Ò Á∑§ãÃÈ •ÊlÊ¬ÊãÃ ß‚ •ÊÒ·Áœ ∑§ ÷Ò·íÿ ÁŸ◊Ê¸áÊÊà◊∑§ ∞fl¥ ÷ÊÒÁÃ∑§-⁄UÊ‚ÊÿÁŸ∑§ ◊ÊŸŒá«U ÁŸœÊ¸Á⁄UÃ Ÿ„Ë¥ „È∞ „Ò– •Ã— ¬˝SÃÈÃ •äÿÿŸ ∑§ •ãÃª¸Ã ’„ÈŒ˝√ÿÊà◊∑§ •ÊÿÈfl¸ÁŒ∑§ •ÊÒ·œ •ªSàÿ „⁄UËÃ∑§Ë ∑§¬˝ÁÃŒ‡Ê¸ ∑§Ê ¡‹ Áfl‹ÿ •flÿflÊ¥‡Ê, ∞À∑§Ê„‹ Áfl‹ÿ •flÿflÊ¥‡Ê, ÷S◊ ¬˝ÊÁ#, •ÊŒ˝ÃÊ pH, ∑È§‹ ‡Ê∑¸§⁄UÊ ∑§Ë ◊ÊòÊÊ, ∞á≈UË•ÊÚÄ‚Ë«Uã≈U•ÊÁŒ ∑§Ê ÷Ò·íÿ ∑§À¬ŸÊà◊∑§ ∞fl¥ ÷ÊÒÁÃ∑§-⁄UÊ‚ÊÿÁŸ∑§ ◊ÊŸ∑§Ë∑§⁄UáÊ ∑§Ê ¬˝ÿÊ‚ Á∑§ÿÊ ªÿÊ „Ò–

*Lecturer, Deptt. Rasa Shastra & Bhaishajya Kalpana, Kalawati Ayurvedic Medical College, Kasganj (U.P.) **Professor and Head, Deptt.

Rasa Shastra & Bhaishajya Kalpana, NIA, Jaipur.*Author for correspondence: Dr. Varsha Mundhra, E-mail: [email protected]

25 Haller et al., (1942). Handbook of African medicinal plants /

Maurice M. Iwu / Google Books

26 Aladji Abatchoua MMI et al., Sch. Acad. J. Biosci., 2014;

2(5):318-325


86

Introduction :

Agastya Haritaki Rasayana is a poly herbalformulation whichcomes under avaleha kalpana. It is

widely used by the Ayurvedic physicians all over thecountry for various ailments such as Allergic reactionsand as well as Rasayana purpose. It is also useful in

Pranavaha Sroto Vikaras1 (Respiratory disorders) likeKasa (cough), Swasa (asthma), Hikka (hiccough) etc.AH contains Haritaki (Terminaliachebula Retz) as

one of the main ingredient which has ushna (hot inpotency), ruksha (dryness), rasayana(rejuvenative)and vata-kaphahara properties. It is also proved for

its immuno modulatory2 activity. Intake of two fruitsof Abhaya as Agastya Haritaki Rasayana every daycures wrinkling of the skin & graying of hair (process

of ageing) and promotes complexion, Longevity as wellas strength.3 It also cures five varities of Kasa, Ksaya,Visma Javara, Arsh, Grahni, Aruchi etc. This

excellent rejuvenating recipe propounded by the sageAgastya.

During past decades herbal medicinesmentioned in Ayurveda are getting recognitionglobally. Maintaining the quality standard of apoly

herbal formulation is a challenging task.Till date thereis no available information regarding scientificevaluation of AH. In the present study AH was

subjected to pharmacognostical (microscopic), HPTLCfinger printing and pharmaceutical (evaluation ofvarious physicochemical parameters) evaluationin

order to prepare a preliminary profile of theformulation.

Material & Method :

For the present study the formula “AgastyaHaritaki Rasayana” was procured from NIA, Jaipurwhich was prepared as per the reference of Astanga

Hridayam.4 The ingredients are mentioned in thetable1.

Pharmaceutico- Analytical Study OfAgastyaharitakirasayana

Dr. Varsha Mundhra, Prof. K. Shankar Rao


Table No.I Showing Ingredients of Agastya Haritaki Rasayana and their quantity

Sr. Drug Botanical Name (family) Part used Qty. of Drugno.

1 Haritaki Terminalia chebula Retz (Combretaceae) Fruit 100 fruit innumbering

2 Bilva Aegle marmelos Carr.( Rutaceae) Stem bark 2 pal (96 gm)

3 Agnimantha Premna mucranata Roxb (Verbenaceae) Stem bark 2 pal (96 gm)

4 Gambhari Gmelina arborea Roxb. (Verbenaceae) Stem bark 2 pal (96 gm)

5 Patala Stereospermum suaveolens DC. Stem bark 2 pal (96 gm)

(Bignoniaceae)

6 Shyonaka Oroxylum indicum Vent. (Bignoniaceae) Stem bark 2 pal (96 gm)

7 Shalaparni Desmodium gangeticum. (Leguminasae) Stem bark 2 pal (96 gm)

8 Prushniparni Uraria picta (Leguminasae) Stem bark 2 pal (96 gm)

9 Brihati Solanum indicum Linn. (Solanaceae) Stem bark 2 pal (96 gm)

10 Kantakari Solanum surattense (Solanaceae) Stem bark 2 pal (96 gm)


87

11 Gokshura Tribulus terrestris Linn. (Zygophyllaceae) Fruit 2pal(96gm)

12 Apamarga Achyranthes aspera Linn (Amaranthaceae) Whole plant 2pal(96gm)

13 Bala Sida rhombifolia L (Malvaeceae) Whole plant 2pal(96gm)

14 Bharngi Clerodendrum serratum Spreng Root 2pal(96gm)(Verbenaceae)

15 Kapikacchu Mucuna pruriens Bek (Fabaceae) Seed 2pal(96gm)

16 Pushkar Moola Inula recemosa Hook. f. Root 2pal(96gm)(Asteraceae)

17 Kachoor Curcuma zedoaria Zingiberaceae Rhizome 2pal(96gm)

18 Shanka Convolvulus pluricaulis Convolvulaceae whole plantPushpi 2pal (96gm)

19 Chitraka Plumbago zeylanica L (Plumbaginaceae) Root 2pal (96gm)

20 Pippali Piper longum Linn (Piperaceae) Fruit 1kudav (192gm)

21 Pippalimool Piper longum Linn (Piperaceae) Root 2 pal (96gm)

22 Pippali Piper longum Linn (piperaceae) Fruits 2 pal (96gm)

23 Yava Hordeum vulgare Linn (Gramineae) Seed 1 Aadhak(3.072kg)

24 Taila Sesamum orientale Linn Seed oïl 1 kudav (192gm)

25 Ghrita Ghee 1 kudav (192gm)

26 Madhu Honey 1 kudav (192gm)

27 Guda Jaggery 5 tulla (4.800kg)

28 Water 5 Aadhak(15.36 liter)

Pharmaceutical Preparation of AgastyaHaritaki Rasayana:

The ingredients listed under Kwatha group

made into coarse powder (Mesh 10/N) and weresoaked in the water (8 times) and kept for 12 hours.Next day fresh haritaki fruits were bundled in a clean

piece of cotton cloth (pottali) which was filled withbarley and immersed in the container where in themixture of kwatha dravyas were dissolved as

subjected to mild fire. When, the haritaki fruits boiledthe pottali was taken out and the rest unit was kepton fire till the initial volume of water reduced to ¼th.

Thereafter the decoction was strained. The seeds of theboiled haritaki were removed. Then the pulp wasmade into a paste and sieved to remain fibres.

Subsequently the pulp was processed with ‘yamaka’i.e. mixture of taila & and frying was continueduntilthe separation of yamaka from the pulp and the

colour of pulp alters to golden brown. Con-currentlythe jaggery base syrup (jaggery solution) wasprepared by utilizing the concentrate decoction. The

processed haritaki pulp was added and the unit wassubjected to mild fire till the appearance ofAvalehapaka characters.5 After appearance of paka

characters the container was removed from fire andPraksepadravyas and Madhu were added.


88

Table No.II Shows Result of Pharmaceutical study of Agastya Haritaki Rasayana

Material & Parameter Weight & Observations

Decoction 768 ml

Pisti of Haritaki 194 gms

Ghee 38.4 ml

Taila 38.4 ml

Jaggery 960 gms

Honey 38.4 gms

Prakshepa Dravya 38.4gms

Mean Temp 70-85° C

Total duration 2 hr 30 min

Total yield 1087 kg

Results And Discussion:

Table No.III Shows Organoleptic characters of Agastya Haritaki Rasayana sample

Sr. no. Parameters Agastya Haritaki Rasayana

1. Sparsha Soft

2. Rupa (Colour) Reddish brown

3. Rasa (Taste) Kashaya Madhura

4. Gandha (Odour) Sweetish Aromatic

5 Consistency Semisolid

Physico-chemical Analysis6 :

Table No. IV shows Physico-chemical Analysis of Agastya Haritaki Rasayana sample

Parametre AH Parametre AH

LOD 11.86 % Total Tannins 3.43

pH 4.5 Total sugars 64.5

Ash Value 2.2 Reducing Sugar 15.16

Acid insoluble Ash 0.38 Non Reducing Sugar 49.34

Water soluble Ash 1.56 Total Fat 1.14

Alcohol soluble extractive 44.93 Total Energy 3760.42

Water soluble extractive 71.01 Total Antioxidant 6.659

Total solids 87.94 Total polyphenol 1.28


89

High Performance Thin Layer Chromatography7

In HPTLC study of Agastya Haritaki Rasayana, methanol extract of sample was spotted on Pre-coated

silica gel 60 F254

Aluminium plate. The mobile phase consisted of Toluene: Ethyl acetate: Methanol: Glacial AceticAcid (6:2.5:1:0.5). all the chromatograms were sprayed with the reagents Anislaidehyde, Sulpuric acid for betterresolution and these were studied under UV light at 220, 240, 254, and 360 nm. Densitogram curve of HPTLC

of AH is given in figure a and b at 220nm.

Table No. V Shows HPTLC Results of Agastya Haritaki Rasayana

Agastya Haritaki Rasayana before Derivitization

Wave length No. of Spots Rf value

220nm 7 0.29, 0.34, 0.40, 0.47, 0.62, 0.72, 0.87

310nm 7 0.22,0.35,0.40,0.58,0.79,0.88, 0.98

Agastya Haritaki Rasayana after Derivitization

Wave length No. of Spots Rf value

540nm 9 0.41, 0.50, 0.59, 0.68, 0.71, 0.75, 0.79,0.82,0.86

Fig. A Shows peak on chromatogram of AH sample Before Derivatization (Rf versesWavelength)

Fig.B. show speak on chromatogram of AH sample after Derivatization (Rf verses Wavelength)


90

Discussion:

Organoleptic characters showed that of the

AH sample was Reddish brown in colour, KasayaMadhura in taste, sweetish aromatic in odour andsemisolid in consistency. Astringent taste of sample

may be due to presence of Haritaki in the formulation.LOD of the sample was 11.28%. Moisture contentshould be minimum to prevent degradation of product

since excess moisture encourage microbial growth inthe drug. pH of the sample was found to be 4.5showing the sample was slightly acidic. Ash values are

the criteria to judge the identity and purity of crudedrug. In the present study total ash was found to be2.2, acid insoluble ash 0.38 and water soluble ash 1.56.

Alcohol Soluble Extractive & Water Soluble Extractiveprocedure determines the amount of activeconstituents in a given amount of medicinal plant

extracted with solvents. In the present study watersoluble and alcohol soluble extractive values were44.93 and 71.01 respectively. Total solids were found

be 87.94. Values of total tannins, total sugars,reducing sugars, non reducing sugars, total fat andtotal energy were 3.43, 64.5, 15.16, 49.34, 1.14

respectively. Physicochemical values obtained in thepresent research work for AH may be useful in similarfuture research works as till date there is no standard

informations are available. The HPTLC showed that 7spots at 220nm and 310 nm each. Among them 2spots were of similar Rf at both 220 and 310nm which

shows thechemical moieties composition. Thepolyphenol content of the sample was found to be1.28. Studies have shown an inverse association

between the risk of chronic human diseases and theconsumption of polyphenol. It is well established thatpolyphenol may increase plasma antioxidant capacity.

There are increasing evidences that as antioxidants,Polyphenols may protect cell constituents againstoxidative damage and therefore, limit the risk of

various degenerative diseases associated with oxidativestress.

Conclusion:

Study on AH is a step towards physico-chemical standardisation of poly herbal formulation inAvaleha form. As there is no published information

available on physico-chemical profiles of AH thispreliminary information can be used for reference infuture for similar research works.

References:

1 . Yadavji Trikamji, editor. Charaka Samhita of

Charaka, Chikitsasthana, chapter 18, verse no.61-

62, 2nd edition, Varanasi, Chaukhambha Sanskrit

Series, 2011,p.533

2 . VaibhavAher, Arun Kumar Wahi,

Immunomodulatory Activity of Alcohol Extract of

Terminaliachebula Retz Combretaceae. Tropical

Journal of Pharmaceutical ResearchOctober 10 (5):

2011, p. 567-75.

3 . Agnivesha, Charaka Samhita, Vidyotinihindi

commentary by Pt. Kashinath Shastri & Dr.

Gorakhanatha Chaturvedi, Part-2, published by

Chaukhambha Bharti Academy Varanasi, 22nd

Edition 1996, Chikitsa-sthana 18/61-62, p.539-40.

4 . Shri Harishastriparadakara vaidya, editor. Astanga

Hridaya of Shri Vagbhata, Chikitsasthana, chapter

03, verse no. 127-132. 9thedition, Varanasi,

Chowkhambha Orientalia 2002, p.597

5 . Sharangadhara Samhita (M K 8/1)of Pt. Sharangadha-

racharya with Adhamalla’s ‘Dipika’ and Kashiram’s ‘Gudhartha

Dipika’ Sanskrit commentaries, Krishnadas Academy,

Varanasi, 4th edition, 2000,p.137-38

6. Ayurvedic Pharmacopoeia of India, Part I, Vol. I and II,

Govt. of India, Ministry of Health and Family Welfare, edition

2001.

7 . Stahl E; Thin-layer chromatography a laboratory hand

book.2nd edition. Springer-Verlag NewYork, 1969, p 125 -133


91

A Conceptual Study On Routine Skin Care In Ayurveda

*Dr. Mahendra Dubey, **Dr. Sarvesh Kumar Agrawal, ***Prof. Kamalesh Kumar Sharma

Conceptual Study

Abstract

The concept of skin care and cosmetics is as old as the human origin and civilization. The 5000 yearsold science of Ayurveda mentioned it in a vast context correlating with the wellness of whole body. But in thepresent 21st century, the fastest of all times, people mostly prefer chemical cosmetics in daily life due to lack of

time and easy approach. These may be harmful if used for a long term. These adverse effects can be overdrivenby using Ayurvedic skin care products and herbal cosmetics, which are naturally prepared and leave no sideeffects on skin. In this present work a complete and integrated module for safe routine skin care has been

developed keeping the concepts of both Ayurveda and modern skin care.

Keywords: Ayurvedic cosmetics, Cosmetology, skin care, Twak.

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*Lecturer, Pt. Shivnath Shastri Govt. Autonomous College, Burhanpur, M.P. **Asstt. Prof., ***Professor & HOD, P.G. Deptt. of

Swasthavritta, NIA, Jaipur


92

Introducton

The concept of skin care and cosmetics is as

ancient as mankind and civilization. People areobsessed to look beautiful, so they use various beautyproducts to look charming and young. Indian herbs

and their significance are popular worldwide. Herbalcosmetics are getting increased demand in the worldmarket and are invaluable gift of nature. There are

many procedures of skin care described in theAyurvedic classics, are purely natural and improveskin’s health without any adverse effect. As compared

to modern cosmetic products it is much economicaland safer to use Ayurvedic procedures for caring theskin. Safe solutions, no side effects, use of natural

herbs, long lasting impacts etc. have made Ayurvedaas most preferable cosmetology procedure.

Now-a-days people are comparatively much

more conscious about their skin care as it’s acompulsory part of their personality building. For thispurpose people are using a number of productsprepared chemically, which ultimately harms their

skin. Cosmeceuticals are one such product. Itrepresents the fastest growth segment in the skin caremarket, and a number of topical cosmeceuticals

treatments for conditions such as photosensitivity,ageing, hyper pigmentation and wrinkles have comeinto widespread use.1,2 In 2005, the U.S.

cosmeceuticals market was estimated to be $12.5billion and projected to grow to over $16 billion by2010.3

However, all these products are useful andeasily applicable in this fast world but their long termuse can cause several harms to the skin. So it is better

to follow the herbal care for the skin. Herbal skin careis good not only for the routine nourishing of skin butalso for treatment of skin disorders like eczema and

psoriasis. Most herbal skin care products don’t haveany side effects (the most important reason forpreferring them over synthetic products). Moreover,

herbal skin care drugs can be easily made at home,hence making them even more attractive. So, herbalskin care is the way to go.

Aims And Objectives

l To compile the literature of Ayurveda and otherancient text and other contemporary methods

regarding routine skin care.

l To include other natural skin care that is notmentioned in the classics but being used

publically.

l To establish a standard module for routine skincare, that is easily to use and practically

applicable.

Material & Methods:-

l The material of this study is the scattered matter

of Ayurvda and ancient literature; andcontemporary concept regarding skin care i.e.,Tailabhyanga, Padabhyanga, Snana, Anulepana,

Vastradharana, Shauch, Udvartana,Utsadanaetc.

l On the basic of all the above literature, a

conclusive routine skin care module have beenprepared for the use of common people, that willbe easily applicable, safe, effective, economical

and proven on scientific ground.

Review Of Literature:

It comprises of following milestones:

A. Dincharya:

It includes following procedures for routine skin care:

1. Netra and Mukhaprakshalana (Face wash)

Washing the face with cold water and somespecific drugs as Amlaki etc prevents or arrestshaemorrhagic disease, pimples, dryness and hyper

pigmentation.4

2. Nasya:

l Nasya indicated in Dincharya is “pratimarshanasya”.5

A Conceptual Study On Routine Skin Care In Ayurveda

Dr. Mahendra Dubey, Dr. Sarvesh Kumar Agrawal, Prof. Kamalesh Kumar Sharma

Conceptual Study


93

l Anu Taila is specially indicated as it is conductivefor minute channels (srotas).6 Acarya Bhavprakash

mentioned “Katu Taila” as daily routine.7 Itmakes skin free of wrinkles.8

3. Gandusha:

Gandusha with oil (Tila Taila) checks drynessof throat and cracking of the lips.9

4. Abhyanga:

It provides softness of the body, cleanliness,complexion and strength. 10

l Oil bath: Oil bath is best for the skin, so it shouldbe done daily. 11

l Padabhyanga: Massage of feet for softness skin ofsole.12

l Samvahana: Gentle rubbing promotes healthy

muscles, blood and brilliance of the skin.13

l Abhyanga is described as Twak dardhyakara and

Varna Balaprada. “Abhyanga should be resortedto daily; it wards off old age, exertion, bestowsgood vision, nourishment to the body, long life,

good sleep, good and strong skin.”

5. Vyayama (Exercise):

Regular exercise is essential for health and

vibrant beauty because it helps to clear the channelsof the body so that the entire tissues can thoroughlycleansed via sweat and other elementary channels and

be well supplied with nutrients. Exercise is especiallyhelpful for the skin in order to renew itself and befresh and clear. As a rule, exercise only to half of your

capacity (Balardha). 14

6. Udvartana:

Udvartana is a process which helps gives

excellent, clear and good complexion to the skin. 15

According to Aacharya Sushruta:

l Massage with powder of herbs without is

“Udgharsana” 16

l Massage with the paste of herbs along with oil is

“Utsadana” 17

According to Aacharya Vagbhata, Udvartanais massage with different powders of herbs, havingastringent taste. 18

Benefits

l It dilates the blood vessels, increase BhrajakaPitta. Rubbing with a brick piece stimulates tactile

heat, cleanses opening of blood vessels andremoves itching and allergic rashes. 19

l Utsadana enhance complexion of ladies, givepleasure, clearness and lightness in the body.20

7. Anulepana (smearing):

It provides complexion, cheerfulness, energyand strength and eliminates sweat, foul smell,abnormality of complexion and fatigue. Application of

cosmetics on face makes eyes firm, cheeks and facecorpulent, free from freckles and boils and handsomelike lotus.21

8. Snana:

Bathing with Amalaka, always will surely getrid of wrinkled skin and grey hairs and gives life of

hundred years. 22

B. Ritucharya

In context to cosmetic aspect some references

can be found e.g., in cold season (Hemanta andShishir) the local application of Agaru paste isdescribed to protect the skin against excessive cold.

Acharya Vagbhatt has prescriebed seasonal lepayogas as follows:

Hemant (Early Winter)- Paste of seeds of Ber, Vasakaroot, Savara lodhra, Sarson

Shishir (Late Winter) - Kateri root, Black Til, bark ofDaruhaldi, barley without husk

Vasant (Spring) - Paste of Dabh, Chandana, Khas,Shiris, Saunf, Chaval.

Grisma (Summer) - Kumud, Utpal, Khas, Durva,

Yastimadhu, Chandana.

Varsha (Rainy season) - Khaliyaka, Til, Khas,

Jatamansi, Tagar, Padmak.

Sharad (Autumn) - Talis, Etkat, Pundarik, Mulethi,Khas, Tagar, Agru.

Vagbhata mentioned the benefit ofMukhalepa, which signifies that the person who arethe habitual to application of paste of drug over face,

the vision become keen the face never becomes dulland glow like lotus flower. 23


94

C. Ayurvedic medicinal plants commonly used in cosmetics:

Latin name Use

Acorus calamus(Vacha) Aromatic, dusting powders

Aloe vera(Kumari) Moisturizer, sun screen, emollient

Avena sativa (Oat) Moisturizer, skin tonic

Azadirachta indica (Nimba) Antiseptic, reduce dark spots, antibacterial

Cucumis sativa (Tripush) Soothing, moisturising, natural sunscreen

Cichorium intybus (Kasni) Reduces skin blemishes

Curcuma longa (Haridra) Antiseptic, antibacterial, improves complexion

Ocimum sanctum (Tulsi) Anti-ageing, antibacterial & antiseptic

Rubia cordifolia (Bala) Wound healing & anti-ageing

Triticum sativum (Godhum) Antioxidant, skin nourishes, anti wrinkle

Cyperus rotundus (Musta) Reduces sun tanning

Crocus sativus (Kesar) Skin cleansing lotion

Moringa oliefera (Shigru) Astringent

D. Modern Review

(1) Cleansing

Regular cleansing serves to remove dirt, dustand grime, make-up and bacteria, remove excess oil on

the surface and skin pores, and aid the cell renewalprocess.

(2) Toning

Skin toning is the process of firming,tightening and improving the overall health of skin byusing lotion, powder etc.

(3) Moisturizing

It helps hydrate the skin and prevent it fromfurther moisture loss. It is very important for people

with dry skin, who have less sebum (the skin’s naturaloil) on their skin.

4. Sun Protection

Use of sunscreen agents and limiting theexposure to sun prevents tanning, early wrinkling andcancer of skin. Sunscreen agents are used to prevent

sunburns.

Cosmetics should be used according to skin

type. Various adverse effects of cosmetics, cosmeticsurgeries etc. are mentioned to introduce moderncosmetic science. Various modern treatments (like

chemical peeling etc.) are also in practice but adverseeffects, cost of therapy etc. necessitate searching for abetter remedy from the natural resources.

Adverse effects of modern cosmetics:

In general, adverse reactions due to chemicalcosmetics can be classified as follows:

1. Contact dermatitis- Irritant / Allergic / Photocontact / Immediate type reactions.

2. Pigmentary Changes- Hypo pigmentation / Hyper

pigmentation / Depigmentation / Acniformeruptions / Acne cosmetica / Pomade acne.

3. Nail abnormalities- Contact dermatitis / Chronic

paronychia / Nail discoloration / Subungualhematoma / Onycholysis.

Discussion:

Skin care is a vast subject related to manysubjects and objects. In present context, it has beendealt in relation to personality and beauty as both are

having socio-medical importance. Ayurveda has its


95

own approach for skin care, which is related withhealthy status of body as well as mind. There is a great

demand of Ayurveda in a field of cosmetology due toadverse effects and limitation of modern Cosmeticscience.

While selecting the drug for proper skin care,Ayurvedic as well as modern both the aspects aretaken into consideration. It should posses following

properties:

l The dravya should have Varnya property.

l The dravya should not increase Vata & Pitta

Dosha.

l The dravya should act on Rasa & Rakta Dhatu.

l The drug should contain de-pigmenting agent.

l The drug should have properties like emollient,astringent, demulcent etc. which enhance thebeauty of the skin.

l The dravya should not have any harmfulconstitute.

l The drug should not have irritant property.

l The dravya should be easily applicable.

l The dravya should be suitable for each type ofskin

Modules drawn on the basis of the literary review:

1. Daily routine module for skin care:

SN Procedure Method Benefit

1. Mukha- prakshalan Cold water Reduce hyper pigmentation,Panchvalkala, Kashaya maintains skin tone

2. Ushapana 2-3 glass water Rejuvenator, skin becomes wrinkle free

3. Pratimarsh Nasya Anu taila, Katu taila Skin becomes wrinkle free

4. Gandusha Tila taila Prevent lip cracking and dryness

5. Abhyanga and Katu taila Softness of skin, enhances complexion,Padaabhyaa nourishes skin, prevents cracking of heel

6. Vyayama Balardh Removing body toxins through skin

7. Udvartana Herbal powders Dilation of blood vessel, improve skin complexion

Utsadana With oil Dry skin

Udgharsana Without oil Oily skin

8. Snana Warm water Increases blood circulation; get rid of theCold water accumulated sweat and other wastes.

9. Anulepana Vatakapha type skin Improve skin complexion, warmth to body(Aguru, Kumkum etc.) Keep body coolPitta type (sandal,

camphor etc.)

10. Vastradhara Vata skin Sukla (white Prevent various skin disordersclothes) which are

neither warm nor cool

Pitta type Kasaya Reflect sun light and keeps body cool(saffron) clothes

Kapha type (dark Absorb sun light, keep body warmcolour, woollen)

11 Nidra 6-8 hour Reduces puffiness, dark circle around eyes


96

2. Seasonal routine skin care module:

S. Season Indications Containdication

N Aahara Vihara Aahara Vihara

1 Hemanta Rasa-Madhura, Vyayama, Udvartana, Aatapa Shita, Laghu Divashyana

and Amla, Lavana sevan, Abhyanga (Katu taila) Vatavardhaka Pravata

Shisira Guna- Snigdh, Vastradaharana (silk, printed, (Tevra

Ushna, Guru dark colour, woollen), Lepna vayusevan

(Aguru, Kumkum) Kateri,

Black Til, Daruhaldi, Barley

2. Vasanta Rasa-Katu, Kashaya Vyayama, Udgharsana Madhura, Divasyana

Guna-Laghu, Lepan: Dabh, Chandana, Amla, Lavana,

Ruksha, Ushna Khas, Shiris, Saunf Shnigdha, Guu

Ushnodak

3. Grisma Rasa-Madhura Divashayana, Anulepna Katu, Amla, Aatapa-

Guna-Snigdha, (chandana) Kumud, Utpal, Lavana sevana

Shita, Laghu, Khas, Durva, Yastimadhu, Vyayama

Drava Chandana, Chatadharana

4. Varsha Rasa-Amla, Lepna: Kaliyaka, Til, Khas, Katu, Divashayana

Lavana Jatamansi, Tagar, Padmk Kashaya

Guna-Snigdh, Udgharsana: Padtraddharana, Ruksha, Humid place

Laghu Chatradharana Vastradharana Guru

(Light, clean appreal)

5. Sharada Rasa-Madhura, Lepna:Talis,Etkat, Pundarik, Amla, Pragavata

Tikta, Kashya Mulethi, Khas, Tagar, Lavana, (Easterly

Guna-Shita, Agru. Vastradharana Ushna, wind)

Laghu (Amber Varna) Ruksha, Kshara

Conclusion:

1. Health is the one of the prime objective of theAyurveda. In which routine skin care is the way

to enhance the beauty of the skin and maintain ithealthy.

2. In modern cosmetology different lotion, cream,

powder etc. are used for cleansing, toning, andmoisturising and sun protection but some timethey so and adverse effect on the skin and also

increase the pollution in environment.

3. In Ayurveda different procedure likeMukhaprakhsalana, Gandhusha, Abhyanga,

Udvartana, Vyayama, Anulepana are used. Theyare safe, easily applicable, effective, economicallyand these products are environment friendly.

4. If a person using all of the above safe procedurehe can maintain is skin healthy and beautiful.

Refrence:

1 . Sadick NS, “Cosmeceuticals and their role in dermatology

practice”, J. Drugs Dermatol, 2003; 2(5):529–37.

2. Vermeer BJ and Gilchrest BA, “Cosmeceuticals: A proposal

for rational definition evaluation and regulation”, J. Drugs

Dermatol, 1996; 132(3):337–40.7. C

3. Choi CM and Berson DS, “Cosmeceuticals Semin Cutan” Med.

Surg. 2006; 25(3):163-8.

4. Bhavamishra, Bhavaprakasha hindi commentary by

Bramhashankar Mishra, 1st Edi., Chaukhambha Sanskrit Series,

Varanasi, Purva Khand, 5/45, pg no. 94

5. Charaka, Charaka Samhita hindi commentary by Prof.

P.V.Sharma; 8th Edi., Chaukhambha Orientalia, Varanasi,

2003, Siddhi sthana 9/117, pg no.962

6. Charaka, Charaka Samhita hindi Commentary by Indradev

Tripathi; 4th Edi. Chaukhambha Sanskrit series, Varanasi Sutra

Sthan. 5/36 pg no.132

7 . Bhavamishra, Bhavaprakasha hindi Commentary by


97

Bramhashankar Mishra, 1st Edi., Chaukhambha Sanskrit

series, Varanasi Purva Khand 5/47, pg no.94

8. Vagbhata, Astanga Hridaya hindi commentary by Kaviraj

Atridev Gupta, Edited byYadunandan Upadhyaya, 12th Edi.,

Chaukhambha Sanskrit series, Varanasi 1997, Sutra Sthan 3/

28 pg no.34


Atridev Gupta, Edited by Yadunandan Upadhyaya, 12th Edi.,

Chaukhambha Sanskrit series, Varanasi,1997, Sutra Sthana 3/

31 pg no.35

10. Sushruta, Sushruta Samhita, hindi commentary by Kaviraaja

Ambikadutta Shastri, 2007 Chaukhamba Sanskrit Sansthan,

Varanasi, Chikitsa Sthan 24/30, pg no.98

11 . Bhavamishra, Bhavaprakasha hindi commentary by

Bramhashankar Mishra, 1st Edi. Chaukhambha Sanskrit Series,

Varanasi, Purva Khand 5/56, pg no.96


Ambikadutta Shastri, Chaukhamba Sanskrit Sansthan

Varanasi, 2007, Chikitsa Sthana 24/70, pg no.101

13. Bhavamishra, Bhavaprakasha hindi commentary by

Bramhashankar Mishra, 1st Edi. Chaukhambha Sanskrit series,

Varanasi Purva Khand 5/189, pg no.108



Varanasi, 2007, Chikitsa Sthana 24/47. pg no. 100




15, pg no32.



Varanasi, 2007, Chikitsa Sthana 24/43, pg. no.100

1 7 . Sushruta, Sushruta Samhita, hindi commentary by Kaviraaja


Varanasi, 2007, Chikitsa Sthana 24/53 pg no.101

18. Vagbhata, Astanga Hridaya with Ayurveda rasayana

commentry by Hemadri; Krishnadas Academy, Varanasi,

commentary on Sutra Sthan 2/15, pg no.32



Varanasi, 2007, Chikitsa Sthana 24/54-56 pg no.101



Varanasi, 2007, Chikitsa Sthana 24/53 pg no.101



Varanasi, 2007, Chikitsa Sthana 24/65, pg no.101

22. Yogaratnakara, Yogaratnakara with Vidhyotini Hindi

commentary by Shri Laxmipati Shastri, Chaukhambha

Sanskrit series, Varanasi 8th Edi., 2004, Y.R.1/578-581




22, pg no.260.


98

A Conceptual Study On Junk Food & Ayurveda

*Dr. Nadira Khan, **Dr. Bal Krishan Sevatkar, ***Prof. Pawankumar Godatwar

Conceptual Study

*Lecturer, Prabuddh Ayurvedic College & Research Centre Lucknow, **Associate Professor, Dept. Roga & vikriti vijnana, NIA Jaipur

***Professor & Head, Department Roga & Vikriti Vijnana, NIA Jaipur

Abstract

In this era of modernization and civilization, status of living in every aspect of life is highly advanced.

Man is moving in life like a machine. Due to shortage of time, busy job schedule, rise in standard of living,convenience & influence of western countries, people are compelled to change their food habits & types of food.There has been a surprising rise in the demand of junk food because of drastic change in the life style of people.

In addition to these factors one is always under mental stress & physical labor is bothered. So people are livingwith sedentary life style. Hence list of life style generated disorders are increasing day by day. In this modernera the society is conscious enough about “What to eat?” but least about “how to eat?” The dietetic code or the

rules for diet intake are preserved in Ayurvedic classics, but there is a big question about their awareness intoday’s society.

Key words: Junk food, Life style disorders.

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„Ò– ‚◊ÿ ∑§Ë ∑§◊Ë, ∑§Êÿ¸ ◊¥ √ÿSÃÃÊ, ©ìÊ ¡ËflŸ ≥ÊÒ‹Ë •ÊÒ⁄ ¬Ê‡øÊàÿ ‚èÿÃÊ ‚ ¬˝÷ÊÁflÃ „ÙŸ ∑§ ∑§Ê⁄áÊ ÷Ù¡Ÿ ◊¥ •ÊÒ⁄ ÷Ù¡Ÿ∑§⁄Ÿ ∑§ Ã⁄Ë∑§Ù¥ ◊¥ ’„ÈÃ ¬Á⁄UflÃ¸Ÿ •Ê ªÿÊ „Ò– Á¡‚∑§Ë fl¡„ ‚ ‹ÊªÊ¥ ◊¥ ¡¥∑§ »Í§«U ∑§Ë ◊Ê¥ª Ã¡Ë ‚ ’…∏ ⁄U„Ë „Ò– ß‚∑§ •ÁÃÁ⁄UQ§◊ÊŸÁ‚∑§ÃÊ ‚ ‹Êª ¬˝÷ÊÁflÃ „Ò ‡ÊÊ⁄UËÁ⁄U∑§ üÊ◊ ∑§Ë ∑§◊Ë ∑§ ∑§Ê⁄UáÊ ⁄U„Ÿ-‚„Ÿ ‚ ‚¢’¢ÁœÃ √ÿÊÁœÿÊ¢ ’…∏ ⁄U„Ë „Ò¥– •Ê¡ ∑§ ß‚ ÿÈª◊¥ ‹ÙªÙ¥ ◊¥ •Ê„Ê⁄-ÁflÁœ-ÁflœÊŸ ∑§Ê ôÊÊŸ ‚¢ÁˇÊ# „Ò– •ÊÿÈflº ◊¥ •Ê„Ê⁄ •ÊÒ⁄ •Ê„Ê⁄-ÁflÁœ-ÁflœÊŸ ∑§Ê •àÿÁœ∑§ ÁflSÃÎÃ •ÊÒ⁄ ‚Èãº⁄fláÊ¸Ÿ Á∑§ÿÊ ªÿÊ „Ò •ÊÒ⁄ ß‚ ôÊÊŸ ∑§Ê ‹ÙªÙ¥ ◊¥ •÷Êfl „Ò •ÊÒ⁄ ÿ„ ÁøãÃÊ ∑§Ê Áfl·ÿ „Ò–


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Introduction

Junk food is a derisive slang term for food thatis of little nutritional value & often high in fat, sugar,

salt & calories. It is widely believed that the term wascoined by Michael Jacobson, director of the Centrefor Science in the public interest, in 1972.1 One may

be misguided that such an explanation regarding junkfood can’t be obtained in classical Ayurvedic textsbut this is not true. If we go into detail we will find

that the subject “junk food” was not new inAyurvedic Samhitas. The only difference is that theword junk food has not been utilized. Regarding its

knowledge, same explanation can be obtained inSamhitas as modern medicine has contributed to theword of junk food. In this era of modernization and

civilization the society is conscious enough about“What to eat?” The awareness about the food items,their quantity, quality and nutritional values etc. is

increasing gradually, mean-while also the popularityof fast food is greater due to the fast life. Due toshortage of time, busy job schedule, rise in standard

of living, convenience & influence of western countriespeople are compelled to change their food habits &types of food which adversely affect the health.2 The

people who are health conscious mostly know about“what to eat?” but least about “how to eat?” Thedietetic code or the rules for diet intake are preserved

by our traditions upto some extent, but there is a bigquestion about their awareness in today’s society.People basically know very little about them and they

who know are little bothered to obey such rules, eventhey do not have trust enough to consider the code ofdiet as an important health matter, the awareness is

needed regarding the subject.

Ahara is not only needed for the continuity oflife, but for Bala, Varna, Upacaya etc. also. The

proper diet, taken in proper manner can lead to betterhealth. On the contrary, proper diet if not taken inproper manner can lead to diseases.3 Ahara, as well

as the method of its intake both have equalimportance, according to Ayurveda. In other medicalsciences, food is considered important, but not the

A Conceptual Study On Junk Food & Ayurveda

Dr. Nadira Khan, Dr. Bal Krishan Sevatkar, Prof. Pawankumar Godatwar

Conceptual Study

manner of eating. It is the heritage of Indian culture

that can be clearly observed in Ayurvedic views. Junkfoods omit the proper diet & proper manner of foodintake as junk foods lack the essential nutrients & junk

food users not follow the proper method of food intakei.e. Aharavidhividhan.

Concept of Healthy Dietetic Rules

In Caraka Vimanasthana 1 (RasaVimanam), the eight factors of diet responsible forhealth and diseases are known as “Ahara Vidhi

Visesa Ayatanani”.

Ahara Vidhi - A system, method, manner,way, arrangement, rule, law, command, conduct,

condition or statement for diet intake (V.S. Apte).

Visesa- Speciality, special property,distinguished effect (of Ahara Vidhi).

Ayatana- Cause, hetu, etc.

Thus, Ahara Vidhi Visesa Ayatana means,the causative factors responsible for the wholesomeand unwholesome effect of the methods for diet

intake. These factors are-

(1) Svabhava: One should take the foodkeeping in view, the guru (heavy)-laghu (light) /

sheeta (cold potency)-usna (hot potency) / snigdha(unctuous)-ruksha (dry) characteristics of food stuff.Each & every individual has its own constitution &

accordingly digestive capacity, so one should take thefood that is suitable for digestive system. But junkfood is common for all, no consideration towards

individual constitution.

(2) Samyoga: Sometimes the action ofcombination of diet is different from the effect of

individual component. Ex. Milk & fruits individuallythey are beneficial but in shake form toxic to the body.

(3) Samskara: It refers to alteration /

modification in the qualities of food stuff by cooking,adding condiments, spices etc. Althoug samskara isdone to increase the properties yet disadvantages can


100

be seen if excess of spices are used to make the foodtasty or any food item is fried repeatedly although

once had been fried. Same is true in case of junk foodor fast food.

(4) Maatra: refers to the quantity of food to

be taken. It is usually advised to eat up to 3/4th of theneed. As fast foods are unbalanced food, one can’t besatisfied so there is no consideration towards the

quantity of food that is responsible for vitiation ofAgni.

(5) Desha: The effect of food on the body

depends upon the area/location from which the foodhas been collected & the geographical origin of theconsumer. Ex. Person belonging to Aanupdesha if

consumes spicy food excessively may suffer fromAmlapitta disease.

(6) Kaala: It refers to time of the year, time

of the day, stage of the disease, age of the consumer& the stage of digestion or indigestion of the previouslyconsumed food.

(7) Upyogavyavastha: Rules of takingfood. Acharya Caraka in Rasa Vimana chapter1 described the detailed description of Ahara-vidhi-

vidhana.

l One should eat only hygienic food.

l One should wash hands & feet before taking food.

l One should not eat the re-heated food.

l One should not consume cold food, very hot foodor burnt food.

l One should not eat in very early hours of themorning or very late hours in the evening.

l One should take freshly cooked food.

l One should eat neither too slowly nor too fast.

l One should avoid talking while taking food.

l One should concentrate on food & be in happy

mood while taking food.

What Is Junk Food

“Junk food is a slang word for foods with

limited nutritional value. Every person has their ownlist of foods that they call junk foods. Foods that arehigh in salt, sugar, fat or calories & low nutrient

contents are called as junk food.”4 Generally, a junkfood is given a very attractive appearance by adding

food additives & colors to enhance flavor, texture,appearance & increasing long self-life.5 A junk foodhas little enzyme producing vitamins & minerals &

contains high levels of calories. When we eat theseempty calorie foods, the body is required to produceits own enzymes to convert these empty calories into

usable energy. This is not desired as these enzymesproducing function in our body should be reserved forthe performance of vital metabolic reactions.6

Junk food means unhealthy food, too muchfat, sugar, chemicals & salts; not enough vitamins &minerals. Healthy food is turned into junk food by the

way it is prepared. If prepared differently some junkfood can become healthy. Second thing- junk food canprovide valuable nutrients if taken in moderate

quantity as a part of a balanced diet do little harm &can be of psychological benefit.

Junk Food In Ayurveda

In Ayurveda, food is considered not only asmixture of the basic ingredients like proteins,vitamins, fats & carbohydrates, but it directs to avoid

those food articles which are having oppositeattributes to be used at same time as per Ayurvedabecause continuous consumption of this sort of food

may induce the accumulation of toxins in the bodywhich may end up in chronic & grave disease like –GIT disorders, immune disorders, cancer etc.

A) Junk Food And Concept Of Apathya

¬âÿ¢¬ÕÙ˘Ÿ¬Ã¢ÿlìÊÙQ¢§◊Ÿ‚—Á¬˝ÿ◊˜–ÿìÊÊÁ¬˝ÿ◊¬âÿ¢øÁŸÿÃ¢ÃÛÊ‹ˇÊÿÃ˜––◊ÊGÊ∑§Ê‹ÁR§ÿÊ÷ÍÁ◊º„ºÙ·ªÈáÊÊãÃ⁄◊–¬˝ÊåÿÃûÊÊÁhºÎ‡ÿãÃÃÃ÷ÊflÊSÃÕÊÃÕÊ––(ø.‚Í./25/45)

According to Acharya Caraka- Matra,Kala, Kriya, Bhumi, Deha & Dosa are

Pathyapathya regulator.7 Wholesome or pathyameans – Foods & deeds that don’t cause any harm tothe body; maintaining the integrity of body channels

& give happiness to body & mind. Unwholesome orapathya means – Foods & deeds that are harmful tothe body; obstruct the body channels & have adverse

effect on body & mind. This wholesome orunwholesome foods have their effects according to-


101

l Dose

l Time

l Preparation

l Place

l Body constitution

l Pathology &

l Properties.

In a nutshell, any food that have no

consideration towards dose, time, place, preparation,body constitution & properties & ultimately leads toobstruction of body channels should be considered as

junk food.

B) Junk Food And Concept of ViruddhaAhara

According to Acharya Caraka

º„œÊÃÈ¬˝àÿŸË∑§÷ÍÃÊÁŸŒ˝√ÿÊÁáÊº„ œÊÃÈÁ÷Áfl¸⁄Ùœ◊Ê¬lãÃ—¬⁄S¬⁄ªÈáÊÁflL§hÊÁŸ∑§ÊÁŸÁøÃ∑§ÊÁŸÁøÃ ‚¢ÿÙªÊà‚¢S∑§Ê⁄Êº-¬⁄ÊÁáÊ º≥Ê∑§Ê‹◊ÊGÊÁº Á÷‡øÊ¬⁄ÊÁáÊ ÃÕÊSfl÷ÊflÊº¬⁄ÊÁáÊ

(Ca.Su.26/81)

The substances which are contrary to

dehadhatus behave with virodha (antagonism) tothem. This antagonism may be in terms of properties,combination, processing, place, time, dose etc. or

natural composition.8 Caraka under the caption of“Prakrititah Ahita Tama Ahara” has described 18types of viruddha, which run as under.9

So junk food should be considered asviruddhahara that may give rise to many chemicalreactions in our body which can’t be visualized;

affecting the cellular built & its chemical constituentsby affecting digestion directly or indirectly eitherinfluencing digestive enzymes or hormones.

Viruddhahara destroys the dhatvagni that causesdisturbance in equilibrium of dhatus with followingsymptoms which run as under.10

l Changed voice & complexion

l Development of body ceased

l Decrease in strength

l Desire for food is lost & not relished at meal time

l Improper digestion of food

l Disturbed sleep

l Appearance of abnormal dreams

l Delayed awakening

l Improper elimination of urine, feces & semen

l Equilibrium of mind, intellect & sense-organs

affected.

C) Junk Food And Concept Of Dushivisha

According to advanced researches, it have been

found that foods high in fat & sugar cause the brainto release many of the same pleasure chemicals thatproduce drug addiction as far as junk food is

considered as physically addictive as street drugs likeheroin.11

According to Acharya Caraka in Chi. 23-

intake of toxic drugs or foods which are less potent(Hinaveerya) remains in a dormant state within thebody for years together, without causing any harm to

the body. It remains in the latent stage due to covering(Avrita) of kapha. Chakrapani has commentedupon this statement of Acharya Caraka, that

“Dushivisha” vitiates the dhatus after the lapse ofa long time on obtaining a favourable conditions.Sushruta12 further explained that when causative

factors like Desha (place), Kala (time), Anna (diet)& Divaswapna (day sleep) are favourable fordushivisha, it will become more potent vitiating

dhatus leading to manifestation of a disease.

Sometimes intake of junk foods are notharmful to the body but when a person is addicted to

junk foods it slowly & slowly just like act as a poison& gets accumulated in the body as a toxins anddiminishing the fire (agni) of the body. After a long

time meeting with favourable conditions it producesmany digestive disorders & others.

D) Junk Food & Concept Of Agni

Acarya Susruta & Vagbhatta have indicatedthat organs called grahani is located betweenpakvasaya & amasaya & the relation exists between

agni & grahani is reciprocal that is agni supports thefunction of grahani & that supports the function ofagni. According to Acarya Caraka, grahani is the seat

of agni & it is situated above nabhi. It is not only theseat of agni but is also supported & strengthened byit.


102

As junk foods are guru, snigdha, abhishyandiin nature responsible for incomplete digestion. When

foods having different attributes in tastes, heating orcooling properties and post digestive effects are catchtogether function of agni is slowed down. The food can

then remain in stomach for seven to eight hours.weakagni (durbala) i.e. mandagni brings about vidaha (apart which is digested and the other part remaining

without digestion) of the food, which moves upwardsand downwards in the gastrointestinal tract. When thispartially digested food moves down wards, then it

leads to the grahani disease.

Thus aetiological factor of agnidushti are thecauses of grahaniroga. So agnidushti is the main

cause of grahani roga.13-14 The actual etiologicalfactors, which are stated to bring about agnidushti are,

1. Abstience from food (Abhojan)

2. Indigestion (Ajirna)

3. Over-eating (Atibhojan)

4. Ingestion of -

a) Unwhole some food (Asatmyabhojan).

b) Heavy or indigestible food (Atigurubhojan).

c) Cold and stale food (Shitabhojan).

d) Excessively dry and dehydrated food(Atiorukshabhojan).

e) Putrid food (Sandustabhojan).

All these dietetic indiscretions are commonly foundin junk food users & continuous consumption ofsuch type of food is predominant factor for agni

dusti.

E) Junk Food & Concept of Ama Dosa

The term “ama” literally means unripe,

undigested, immature etc. This is due to improperaction of a Agni. Here ama indicates that it is aconsequence of the impaired function of kayagni.

Ama may be produced at any level of digestion &metabolism due to hypo functioning of agni,. amaoriginates from improperly digested toxic particles that

clog the channels in our body.15 Vagbhatta mentionedin A.H. that ama has been defined as a condition inwhich the first dhatu, namely rasa is not properly

formed due to the lowered strength of usma (Agni)

Causes of Ama Production:-

Achayra Charaka elaborated etiological

factors responsible for production of ama dosha,which are as below.

l Ati Matrashana

l Guru Aahara

l Ruksha Shushka Aahara

l Sheeta Aahara

l Vistambhi Aahara

l Vidahi Aahara

l Ashuchita Aahara

l Akale Anna- Pana Sevana

All these etiological factors are responsible foraam production & these dietetic indiscretions are

commonly found in junk food users that ultimatelycauses agnimandya, dhatuagnimandya, malasanchaya & dosasammurcchana as follows-

l Agnimandya- Low digestive fire

l Dhatu agnimandya - Low tissue fire

l Mala sanchaya- Accumulation of waste products

l Dosasammurcchana- Interaction oramalgamation between vitiated dosas.16

Normal activity of digestive fire is essential for

the complete & proper digestion of food. But due tolow digestive fire, the food is not properly digested &toxic product is formed. Therefore its absorption

becomes sluggish & it gets retained in the intestine fora longer time. Due to this retention it becomesfermented or even putrefied. This toxic product

remains unabsorbed in the intestine because of itsincomplete digestion & it is the root cause of alldiseases.17

Conclusion:

Every day all of us are presented with a vastarray of food choices, and our modern world has

found some truly innovative ways to present food to usthat appeals to all our senses (smells great, looks great,tastes great). However, relying on our senses alone to

choose the nutrients, our body needs can lead us downto slow path of self-destruction, chronic diseases and


103

shortened lifespan for not just ourself but for futuregenerations as well.18

Nowadays, it truly does take an act of will totrain our body to recognize whole natural foods asdelicious and nutritious, when the alternative is food-

like substances that have been processed, designed,crafted and marketed to appeal to all of our senses andto our intellect. Ayurvedic classics describe about the

healthy foods along with dietetic code & conduct andevery human being should follow them so as to avoidchronic & grave disease like –GIT disorders, immune

disorders, cancer etc.

References

1 . www.en.wikipedia.org

2. www.food industry india.com. Majority of the working couple

inclined towards instant food posted at 11/01/11.

3. Agnivesha, Charaka, Charaka Samhita revised by Dridhabala,

edited by pt. Kashinath Sastri and Dr. Gorakhanath

Chaturvedi, 1st edi., Chaukhambha Sanskrit Sansthana,

Varanasi. 2005; Sutrastana, Yajjyapurushiyadhyaya chapter

25/29, P-313.

4. http://in.answers.yahoo.com/question/index.

5. http://sgtphoto.angelfire.com/junk_food_list.html

6. http://sgtphoto.angelfire.com/junk_food_list.html

7 . Agnivesha, Charaka, Charaka Samhita revised by Dridhabala,



Varanasi. 2005; Sutrastana, Yajjyapurushiyadhyaya chapter

25/45, P-324.




Varanasi. 2005; Sutrastana, Atreyabhadrakapyiyadhyaya

chapter 26/81, P-358.




Varanasi. 2005; Sutrastana, Atreyabhadrakapyiyadhyaya

chapter 26/86, P-362.




Varanasi. 2005; Vimanastana, Rogabhishagjitiya-

vimanadhyaya chapter 8/89, P-658.

11 . http://www.naturalnews.com/030815_junk_food_addiction,

December 23, 2010 by David Gutierrez.

12. Sushruta. Sushruta Samhita, Part II, edited by Anantaram

Sharma, Chaukhamba Sanskrit Sansthana, Varanasi, Edition:

Reprint 2008, Kalpasthana, Sthawarvishvigyaniyadhyaya 2/

23, P-521.


edited by Acharya Vidyadhara Shukla and Prof. Ravi Dutt

Tripathi, 1st edi., Chaukhambha Sanskrit Sansthana, Varanasi.

2007; Chikitsasthana, Grahanichikitsadhyaya chapter 15/57,

P- 369.


edited by Acharya Vidyadhara Shukla and Prof. Ravi Dutt

Tripathi, 1st edi., Chaukhambha Sanskrit Sansthana,Varanasi.

2007; Chikitsasthana, Arshachikitsadhyaya chapter 14/245,

P- 350.

15. ayurveda-foryou.com/index.

16. ayurveda-foryou.com/index.

1 7 . Vagbhata, Asthangahridaya edited by Dr. Brahmadatta

Tripathi, Chaukhamba Surbharati Prakashana, Varanasi,

Edition: Reprint 2007, Sutrasthana, Doshopakra-

maniyadhyaya chapter 13/23, P-188.

18. http/blogs.webmd.com/Pamela-peeke-md/2010


104

A Critical Study of Viruddhahara With Special Reference ToFood Allergy

*Dr. Shreeram Kumawat, **Dr. Archana Verma, ***Prof. Nisha Gupta

Conceptual Study

Abstract-

Now a day’s people eat for taste not for health. They are not aware about the things necessary for the

maintenance of psychosomatic fitness because they don’t know how to achieve benefits of Ahara. Our dieteticcodes and conducts are preserved in ancient Ayurveda texts but people don’t observe these dietetic rules andfollow fast food habits, take incompatible food items. These wrong eating habits are included in Viruddhahara.

Consumption of Viruddhahara gives rise to various diseases of acute and chronic nature. According to modernscience food allergies are immune-mediated disorders, most commonly due to IgE antibodies and type Ihypersensitivity reactions. Although in Ayurveda there is no clear depiction of allergy yet, this Food allergy can

be correlated with the concept of Viruddhahara. Such correlation could play a key role in the evaluation ofViruddhahara concept and explore a new line in the treatment of food allergy on the basis of Ayurvedicprinciples. Food allergy is an acute phenomena with rapid clinical manifestation where as Viruddhahara impacts

the health with its chronic practice due to accumulation of Amavisha within the body. Being different in thereonset behaviour still it is supposed that regular indulgence in Viruddhahara habits predisposes a person to thedisproportion of food allergy.

In today’s fast and forward life it is right time to explore our ancient knowledge and awareness regardingthe subject, on the basis of scientific methodology and observations.

Keywords:- Ahara, Amavisha, Food allergy, Viruddhahara.

‚Ê⁄UÊ¥‡Ê-

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•Ê¡ ∑§ •ÊœÈÁŸ∑§ ∞fl¢ ÃËfl˝ ªÁÃ ‚ ’…UÃ ¡ËflŸ ◊¥ flÒôÊÊÁŸ∑§ Á‚hÊãÃÙ ∞fl¢ ¬hÁÃÿÙ¥ ∑§ •ÊœÊ⁄ ¬⁄ •Ê„Ê⁄ ‚ê’ãœË ¬˝ÊøËŸôÊÊŸ ∞fl¢ ¡ÊªL§∑§ÃÊ ∑§Ù »Ò§‹ÊŸ ∑§Ê ÿ„ ©ÁøÃ ‚◊ÿ „Ò–

*Ph.D scholar, P.G. Department of Maulika Siddhanta, NIA, Jaipur. Email- [email protected], Mobile -09928373490 **

Asst. Professor, Department of Sharira Rachana, FAS, Jayotividyapeeth Women’s University, Jaipur. ***Professor, P.G. Department of

Maulika Siddhanta, NIA, Jaipur.


105

Introduction

Food has been recognised as an important

factor for human being both in health and diseasedstate. An ancient Ayurveda also mentioned Ahara intrayopastambha first.1 According to Sushruta food is

the sustainers of living beings and also the cause fortheir strength, complexion, and vigour2. For propermaintenance of positive health and to get maximum

benefits of diet, one should take it in proper quantitythat depends upon the digestive fire.3

Ayurveda have dealt the topic of

Viruddhahara or food incompatibilities that arise dueto unhealthy combinations, on the other hand theconcept of food incompatibility in modern science is

merely restricted to the chemical composition of fooditems which are consumed and their unhealthycombination with respect to the nutrient content of

food as fat, protein or carbohydrates and their effecton digestion and various interaction of food withdifferent medicines, it does not pay much importance

to the other aspect of food items which are describedin Ayurveda. Viewing the harmful effects caused bythese unhealthy combinations described in Ayurveda

texts, they must be kept away to avoid their harmfuleffects.

A survey was carried out on total number of

1000 patients based on self made detailed Performa.For this, samples were selected randomly from theO.P.Ds of N.I.A, Jaipur, from various schools, camps

and different population all over subjects of Rajasthan.It can be concluded that the approach of dietetics inAyurveda is much individualized, practical and easy

to prescribe, based on observation taken into accountdifferent incompatibilities and fulfils the needsaccording to age, Prakriti, desha and diseases.

Viruddhahara

Any Ahara dravya or padartha causes thedosha utklesha avastha and unable to eliminate from

sharira and resides in the sharira and causes vishakta

lakshana is known as Viruddhahara and ahitahara.4

Factors responsible for dietetic

incompatibilities5:-

Acharya Charaka has described the 18 factorsresponsible for dietetic incompatibility and said that

they are not wholesome for a person. 1. Desha 2. Kala3. Agni 4. Matra 5. Satmya 6. Dosha 7. Samskara 8.Veerya 9. Kostha 10. Avastha 11. Krama 12. Parihara

13. Upachara 14. Paka 15. Samyoga 16. Hrit 17.Sampat 18. Vidhi

Diseases caused by Viruddhahar6:-

Antagonistic or incompatible food is the causeof shandya, andhya, visarpa, dakodara, visphotaka,unmada, bhagandara, moorchha, mada, adhmana,

galagraha, pandu, kilasa, kushtha, grahani roga,shotha, amlapitta, jwara, peenasa, santana doshaand even mrityu.

Similarities Between Viruddhahara AndFood-Allergy

Similarities:-

Ø Both Viruddhahara and Food-allergy are relatedwith diet (food content) and both produceincompatible effect in body

Ø Both are specific for occurrence of clinicalmanifestation of food allergy and Viruddhahara.

A Critical Study of Viruddhahara With Special Reference ToFood Allergy

Dr. Shreeram Kumawat, Dr. Archana Verma, Dr. Nisha Gupta

Conceptual Study


106

Dissimilarities:-

Viruddhahara Food Allergy

1. Viruddhahara produces vitiation in the 1.This is altered reactivity of the immune systemSharira dhatus (Virodhamapadyate). It that results because of food allergens. This can alsoresults in the accumulation of doshas in called as the stupidity of the immune system because

the body without ejecting it out from the misidentification of food components by thethe body. immune system otherwise healthy in the normal

individual. This misidentification of food allergens

needs to the formation of specific antibodies in thepatient and results in the clinical manifestation offood allergy like vomiting, diarrhoea, abdominal

colic, abdominal discomfort etc.

2. This is generalized phenomenon. 2. This is highly personalized phenomenon thatoccurs individually as per the individual constitution

and the inheritance.

3. This produces homogenous effect in all the 3. This produces heterogeneous effect.individuals if applied uniformly altogether.

4. This can affect any of the srotasa of the 4. It usually effects upper respiratory tract (e.g.body. E.g. Annavaha srotasa, pranavaha allergic rhinitis etc.), lower respiratory tract (allergicsrotasa, raktavaha srotasa, mootravaha asthma, allergic cough, allergic bronchitis etc.), GIT,

srotasa, purishavaha srotasa. Skin (skin allergy like eczema, dermatitis, pruritis,urticaria etc.)

5. It involves all srotasa and forms vikrita 5. It results in Anaphylaxis, Celiac disease,

dhatus from rasa upto oja. That results in FPIES etc.various diseases like Shandhya, Aandhya,Visarpa, Dakodara etc.

6. There is no priming phenomenon in 6.Allergy have priming (hypersensitivity)Viruddhahara. phenomenon.

7. In Viruddhahara Ama dosha and Ama visha 7.In food allergy number of chemical mediators are

are produced successively. Initially there is produced like Histamines, Seretonins, Bradychinins,a production of Ama dosha but if a person cytokines, interleukins, leukotrines, anddoes constant practice of intake of prostaglandins etc.

Viruddhahara, they develop tendency oftransformation of Ama dosha into Amavisha. So in the initial stage Ama dosha is

curable but in later stage Ama visha isincurable due its Viruddhopakrama chikitsa.

8. Treatment of Viruddhahara is 8.Treatment of Food allergy is

a. Nidana parivarjana, a. Avoiding an allergenb. Samshodhana, and b. Epinephrinec. Purvamabhisamskara according to c. Antihistamine

Chakrapani which indicates the use of d. Steroids Rasayana. e. Desensitization


107

9. Viruddhahara effects nervous system and 9.This phenomenon is not seen in food allergy.generates diseases like Badhirya, Andhya,

Minaminatva etc.

10. Lakshanas due to Ama dosha are seen in 10.These Lakshana due to Ama dosha are not seenpatients taking Viruddhahara like Alasya, in Food allergy patients.

Gaurava, Stheevana, Klama, Tandra,Apankti, Aruchi, Agnisada, Amlika,Kanthadaha etc.

11. There is recurrence of attack due to Ama 11.No recurrence of attack.visha.

12. Skin allergy hypersensitivity test is always 12.Skin allergy hypersensitivity test is always

negative. positive.

13. IgE and eosinophill count seldom 13.IgE and eosinophill count increased in foodincreased in Viruddhahara taking patient. allergic patients.


108

Corelation Between Viruddhahara And FoodAllergy on Different Aspects of Triskandha

Viruddhahara As A Hetu (AetiologicalFactor):-

Ayurveda Viruddhahara is quoted as the most

important etiological factors for causation of mostnumerous diseases. Some examples according to typesof Viruddha:-

ØØØØØ Example of Agni Viruddha are-

1. Grahaniroga Nidana : •ÁÃ‚Ê⁄ ÁŸflÎûÊÊ˘Á¬◊ãºÊªA⁄Á„ÃÊÁ≥ÊŸ—–-‚È.©.Ã. 40/16

ØØØØØ Example of Matra Viruddha are –

1. Prameha nidaana- parigraha adhika

maatra, use of mash, audaka maansa, naveenadhanya, tila etc.

ØØØØØ Example of Satmya Viruddha are-

1. Unmada Nidana : Satmya Viruddha sevan - AH.

ØØØØØ Examples of Dosha/Prikriti Viruddha are-

1. Gulma Nidana : Vata provoking diet in Vataprakrti.

ØØØØØ Examples of Samskara Viruddha are-

1. Shosha Roga Nidana :

ÿºÊ ¬ÈL§·—....¬˝∑Î§ÁÃ ∑§⁄áÊ.....Áfl·◊ÊŸÊ‚flÃ––(ø.ÁŸ.6/10)

ØØØØØ Examples of Samyoga Viruddha are-

1. Raktapitta Nidana : Milk + Rohini Shaka-Ch.Ni. 2

ØØØØØ Examples of Avastha Viruddha are-

1. Jwara and Chardi Nidana :


109

üÊ◊ÊÃÙ ÷Ù¡Ÿ¢ ÿSÃÈ ¬ÊŸ¢ flÊ ∑È§L§Ÿ fl⁄—–Öfl⁄— ‚¢¡ÊÿÃ ÃSÿ ¿UÁº¸ flÊ ÃàˇÊáÊÊjflŸH

-„Ê.¬Õ◊-23/38

Ø Examples of Krama Viruddha are-

1. Kushtha nidana – Krama Viruddha sevana of

sheeta and ushna – Charaka

Ø Examples of Parihaara Viruddha are-

1. Kaphaja Gulma : Excess drinking of water after

excess intaking of meal.

Ø Examples of Upachara Viruddha are-

1. Jalodara Nidana: To drink cold water after

Snehapana, Vamana,Virechana, Anuvasana.

Ø Examples of Vidhi Viruddha are-

1. Amavisha- ajeernashana, adhyashana-

(Charaka)

Linga (Lakshana) Due To Viruddhahara:-

Intake of Viruddhahara (unwholesome food)

produces so many lakshana in body and is responsiblefor the causation of many diseases. Here, someexamples of Viruddhahara with their lakshana

according to different Acharyas:-

No. Examples Ch. Su. Ah As Linga(Lakshana)

1. Peacock’s Flesh roasted on a + Shighra Mrityu (Ch.)spit made of the castor plant

twigs, or prepared in castor oil, ifeaten, will cause immediate death.

2. Lony pepper (Pippali) and black + + Sighra Maraka (Ch.)

– night shade (Kakmachi)prepared in fish-oil, causesimmediate death.

3. Milk + Fish + Rakta dushti, Srotorodha

4. Milk+Chilchima fish + + + + Raktaj roga, Vibandhjanyavyadhi, Mrityu, Aamvishajanya vyadhi.(Ch)

5. The Flesh of domesticated, wet + + + + Badhirya, Andhya, Vepathu,land or aquatic Jadya, Kalamookata,creatures + honey, til, guda, milk, Minminatva, Mrityu.

black gram, garden redish, lotusstralks or sprouted grains.

6. Milk followed by garden reddish, + + + Kushtha.(Ch)

garlic, sahijana,large basil, holy basil, surasa.

7. Ripe lakoocha + mash soup, + + Dhatu Vairodhika

guda, sarpi

8. Kusumbha shaka + sugerwine, + + Vata-pakopamaireya + honey

9. Upodika prepared with til paste + + Atisara

10. Hot honey or honey consumed + Mrityuhot afflicted person


110

Aushadha Or Chikitsa For Viruddhahara7:-

For the treatment of Viruddhahara janita

vikara Acharya Charaka said that disease caused bythe intake of unwholesome diets and drugs can becured by

Ø vamana (emesis),

Ø virechana (purgation) or

Ø administration of antidotes and

Ø by prophylactic measures.

Etiological Factors, Symptoms And Treatmentof Food Allergy8:-

Etiological Factors:-

While any food can cause an adverse reaction,eight types of food account for about 90 percent of all

reactions: Eggs, Milk, Peanuts, Tree nuts, Fish,Shellfish, Wheat, Soy

Symptoms:-

Ø Vomiting and/or stomach cramps

Ø Hives

Ø Shortness of breath

Ø Wheezing

Ø Repetitive cough

Ø Shock or circulatory collapse

Ø Tight, hoarse throat; trouble swallowing

Ø Swelling of the tongue, affecting the ability to talkor breathe

Ø Weak pulse

Ø Pale or blue colouring of skin

Ø Dizziness or feeling faint

Ø Anaphylaxis, a potentially life-threatening reactionthat can impair breathing and send the body intoshock; reactions may simultaneously affect

different parts of the body (for example, astomach ache accompanied by a rash)

Management And Treatment

Ø The primary way to manage a food allergy is toavoid consuming the food that causes us problems.

Ø One should be extra careful when eating in

restaurants. Waiters (and sometimes the kitchenstaff) may not always know the ingredients of

every dish on the menu. Depending on sensitivity,even just walking into a kitchen or a restaurantcan cause an allergic reaction.

ØØØØØ Treatment for Anaphylaxis

ð Epinephrine

ð Antihistamines

ð Steroids

ð Desensitization

Aims And Objectives

ð To evaluate and re-establish the concept ofViruddhahara in the perspective of food allergy.

ð To find out similarities and dissimilarities between

Viruddhahara and food allergy.

ð To establish correlation between Viruddhaharaand Food allergy on different aspects of

Triskandha.

Selection Of The Patient:

The patients for the survey study were selectedfrom the O.P.D of the NIA hospital, Also the patientswere selected from the rural medical camps conducted

by NIA, Jaipur over the Rajasthan state and fromvarious schools and different population all oversubjects of Rajasthan.

A self made survey performa was designed

based on the classical references related to theViruddhahara and food allergy. The performaincluded the general, personal information and

histories. The performa was covered almost everyrelevant information beneficial for the assessment ofViruddhahara in Anurjata janya disorders. The

persons of different religion, age, sex, financial,educational and occupational status were selected toevaluate the incidence and prevalence rate of

Viruddhahara in allergies.

Materials And Methods:-

Literary study about Viruddhahara and foodallergy was carried out on the basis of literary matterpresent in Ayurvedic text books, modern text books,

previous work and different journals of Ayurveda andfrom library.


111

Inclusion criteria

ð All acute and chronic patients suffering from

different allergic disorders like allergic skindisorders, allergic asthma, allergic rhinitis etc.were selected.

ð The sample was between age 15 to 70 yrs.

Exclusion criteria

ð Patients with below age of 15 and above 70 years

of age.

ð Patients with any major psychiatric illness i.e.schizophrenia, depressive psychosis, epilepsy etc.

ð Same diseases occurring because of non allergiccauses.

Discussion

u Age wise data:- 30.6% patients were found inage group 15-19, 21.3% were found in age group20-24, 16.6% were found in age group 25-29,

14.5% were found in age group 30-39, 8.1% werefound in age group 40-49, 5.7% were found in agegroup 50-59, and 3.2% were found in age group

60-70.

u Sex wise:- 39.7% allergic patients were foundfemales while 60.3% were found males.

u Marital status wise:- 36.4% allergic patientswere found married while 63.6% were foundunmarried.

u Locality wise:- 67% allergic patients were foundfrom rural locality while 33% were found fromurban area.

u Occupation wise:- 4.8% allergic patients werein Govt.Job, 6.6% allergic patients werehousewife, 4.7% allergic patients were medico,

29.8% allergic patients were in Pvt. Job andmajority i.e. 54.1% allergic patients were student.

u Religion wise:- 94.9% allergic patients were

from Hindu religion while 4.0% allergic patientswere from Muslim religion and 0.1% from Sikh and0.1% from Christian religion, 0.9% from Jain

religion. Majority of the patients were from Hindureligion, because the area where survey wasconducted pervaded by Hindu community.

u Food habit wise:- 69.3% allergic patients werefound vegetarian while 30.7% were found non-

vegetarian.

u 317 patients were having Amlapitta, 300 patientswere having Peenasa, 235 patients were having

Aadhamana, 149 patients were having Dadru, 146patients were having Pandu, 295 patients werehaving Abnormal bowel habit, 189 patients were

having Asthma, 162 patients were havingUrticaria, 131 patients were having Fatigue, 93patients were having Joint and muscle pain, 623

patients were having Skin Allergy, 487 patientswere having Itching, 242 patients were havingSkin rashes, 237 patients were having Rhinitis,

235 patients were having Dyspnoea, 219 patientswere having Sneezing, 200 patients were havingDust Allergy, 124 patients were having Black spots,

98 patients were having Pricking pain, 699patients were having food habit milk with Lavana,650 patients were having food habit milk with

Garlic, 632 patients were having food habit milkwith Banana, 590 patients were having food habitmilk with Amla dravyas, 413 patients were having

food habit milk with Dadhi, 125 patients werehaving food habit Honey with hot water, 340patients were having food habit meat of domestic

/marshy/aquatic animals with milk, 226 patientswere having food habit Kukkut meat with Dadhi,254 patients were having food habit Kadali with

Curd, 128 patients were having food habit Kadaliwith Buttermilk, 755 patients were having fastfood habit of Cold drinks, 729 patients were

having fast food habit of Bread, 719 patients werehaving fast food habit of Fruit shakes, 599 patientswere having fast food habit of Preserved food, 112

patients were having fast food habit of Mock tail,97 patients were having fast food habit of Cocktail,880 patients were taking pungent & hot

substances in summer, 858 patients were takingcold & dry substances in winter, 439 patients werehaving Vishmagni, 258 patients were having

samagni, 147 patients were having Teekshnagni,144 patients were having Mandagni, 590 patientswere having Samyoga Viruddha by intake of sour

substances with milk, 467 patients with takingmeal in public, 286 patients were having KramaViruddha by intake of food without bowel and

urinary bladder are clear.


112

Conclusion

Viruddhahara specially acts as a causative

factor in diseases of Shakha and Annavaha,udakavaha, Purishavaha, swedavaha, Rasavahasrotasa. Mostly Viruddhahara induce pathology up to

3 initial stages of kriya kala, it produce prepathogeniccondition forming platform for disease production.There are also certain factors, which can nullify or

pacify the ill effects produced by Viruddhahara.Modern science also accepts the role of diet inpathogenesis of various diseases and various food

allergens, enzyme inhibitors and toxins have beenidentified. During preparation of food the proximateprinciple can be denatured. In ancient text three fold

treatment of diseases caused by Viruddhahara, isdescribed and same line of treatment was adopted inthe present work.

1. As per the title of the survey study Viruddhaharaw.s.r. to food allergy, it was found that both areentirely different concepts. However food allergy

can be branched as one part of Viruddhahara.

2. Both have different theories, pathologies, clinicalmanifestations and line of management.

3. Viruddhahara is a greatly vast and descriptivesubject of the Ayurveda that has enormous scopefor the research work in Ayurveda. Different

groups have been described in Viruddhahara.Each group can be justified by sequence ofexperimental studies and animal studies by

different researches and can be justify the textualevidences.

4. Viruddhahara does not have any diagnostic

evidence regarding laboratory findings whereasfood allergy is totally diagnosed by laboratorymeasures like IgE, TEC etc.

References:-

1 . Shastri Pt. Kasinatha, Chaturvedi Dr.Gorakhanatha, Caraka

Samhita of Agnivesha revised by Caraka and Dridhbala, with

introduction by Vaidya-Samrata Sri Satyanarayan Shastri

Padmabhushan with elaborated Vidyotini Hindi commentary,

edition 2009, Varanasi, Chaukambha Bharati Academy,

Varanasi. Pg.No.227, C.Su.11/35.

2. Shastri Kaviraj Dr.Ambikadutta, Sushruta Samhita

‘Ayurvedatatvasandipika’-hindi vyakhya-vaigyanika

vimarsha-tippanisahita, Pratham bhag(Purvardha), Edition

2066(Vikram Samvat), Varanasi, Chaukambha Sanskrit

Samsthan, Varanasi. Pg.No.10, S.Su.1/36.

3. Shastri Pt. Kasinatha, Chaturvedi Dr.Gorakhanatha, Caraka

















Varanasi. Pg.No.521, C.Su.26/86,87.






Varanasi. Pg.No.523, C.Su.26/102,103.

7 . Shastri Pt. Kasinatha, Chaturvedi Dr.Gorakhanatha, Caraka





Varanasi. Pg.No.523,524. C.Su.26/104,105,106.

8. https://en.m.wikipedia.org/wiki/food_allergy


113

An Evidence Based Conceptual Review to Elicit thePrognosis of Prameha w.s.r. to DM

*Dr. Konica Gera, **Dr. Nellufar, ***Dr. Hetal H. Dave, ***Prof. Baldev Kumar

*Asst. Prof., Dept. of Ayurveda Samhita & Siddhanta, Prakash Inst. of Ayurvedic Medical Sciences & Research, Dist. Bulandshehar, U.P.

([email protected]) (corresponding author) **Asst. Prof., Dept. of Kayachikitsa, Prakash Inst. of Ayurvedic Medical Sciences &

Research, Dist. Bulandshehar, U.P. ***Asst. Prof., Dept. of Prasuti and Striroga, NIA, Jaipur ****Vice Chancellor, Shri Krishna Ayush

University, Kurukshetra, (Haryana)

Conceptual Study

Abstract:

“ASRAVA” mentioned in Kaushika Sutra of Atharvaveda, interpreted by Sayana & Keshavabhattacommentaries as Mutratisara is considered to be the first available description of DM. Prameha means “to flow”

where “Meha” literally means to flow & prefix “Pra” means excess, in terms of quantity & frequency. Acharyahave listed 20 types of Prameha under a single heading along with their Purvaroopa, Dosha, Dushya &Lakshana (i.e. changes in the urine). Charaka Samhita & Sushruta Samhita served as the ancient compendia

for early detection & treatment of DM. 20 Subtypes of the disease are well explained along with the changesinduced in the quality of urine. Acharya Sushruta & Vagbhata characterized Prameha by copious & turbidurine although turbidity varies from type to type depending upon the proportions of involved dosha & dushya.

It is a common belief that these 20 are different forms of urinary/metabolic disorders out of whichMadhumeha is Diabetes Mellitus which is hence incurable. This conception lays the foundation for faultydiagnosis & prognosis and hence mismanagement of the disease. Successful management can be laid only on

the foundations of proper diagnosis through understanding of the pathophysiology of any ailment. In depththorough understanding & reading in between the lines is something that was found essential.

Present work deals with the critical analysis of the text to elicit the prognosis of prameha which will

further facilitate its proper management.

Keywords: Prameha, Diabetes Mellitus, Sadhya-asadhyata, Prognosis of DM, Madhumeha

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114

Introduction:

Prameha as a disease entity has beenrecognized since long in Ayurveda literature. All theavailable classics have described the disease in detail

along with its 20 subtypes where Acharya Charakahas mentioned it as one of the diseases resulting fromthe historical disruption of the Yagya organized by

Daksha Prajapati. Intake of havisha - a specialpreparation of food made of milk, sugar, rice & gheewhich is used for offering in the Yagya; is also counted

as one of the causative factors.1 Hence diets rich incarbs on a regular use were listed as a causative factorof prameha.

In the present era, it is a common belief thatthese 20 subtypes of Prameha, mentioned under asingle disease entity are different forms of urinary/

metabolic disorders out of which Madhumeha isDiabetes Mellitus hence incurable which does notseem rational.

Diagnosis of any disease plays a key role in itsplanning and management. A proper diagnosis leadsto proper prognosis and hence proper management

and vice-versa. Every successful treatment can be buildup on the foundation of proper diagnosis where mostof the physicians tend to fail & this leads to the

misconceptions about the prognosis of the disease andhence its management. To bridge this gap between thediagnosis & prognosis the present study was required.

Material & Methods:

References were collected from the classicalAyurvedic texts as well as from previous research

works/thesis, research articles, modern medical texts,internet etc. & analyzed to correctly predict theprognosis through proper diagnosis & its role in

effective management of Prameha.

Observations:

Prameha is a collective name of 20 sub types

of a disease entity mentioned in almost every text of

An Evidence Based Conceptual Review to Elicit thePrognosis of Prameha w.s.r. to DM

Dr. Konica Gera, Dr. Nellufar, Dr. Hetal H. Dave, Prof. Baldev Kumar

Conceptual Study

Ayurveda. The purvarupa mentioned for them are

common i.e. the 20 subtypes have almost similarprodromal symptoms in the early stages of the diseaseformation. Indu in his tika on the same clears that

these purvarupa of Prameha are the purvarupa of allthe 20 subtypes of Prameha.2 The nidana mentionedare also common and vary according to the doshika

predominance only i.e. the causative factors vary justin terms of the dominant dosha. The common dushyaare listed and they get affected as the disease

progresses. If observed carefully, all these factors pointtowards the fact that the samprapti is common for thegenesis of 20 subtypes of prameha and hence they are

listed under a common heading. It’s just theprogression of the disease to the deeper dhatu thatbrings the changes in the urinary symptoms.

Charaka Samhita elicits a distinct way ofdocumenting every adhyaya. The adjectives used toaddress are in context of the disease to be mentioned.

In Prameha Adhyaya adjectives like nirmoha,nirmana, niranushaya, nirasha (i.e. free fromdelusion, ego, anger, attachment) used for Punarvasu

Atreya clearly state the relationship between Prameha& manasikabhava (i.e. Stress & Impaired Mentalhealth3). Other factors like krodha in Paittikanidana,

udvega & shoka in Vatajanidana also point towardsthe psychosomatic relation of Prameha.4 According tothe view of certain scholars if it is believed that 20

types of Prameha are different form of urinary/metabolic disorders like udakameha as diabetesinsipidus or sandrameha as chyluria and many more,

then these must have stress as a major causative factorin their pathogenesis but it is not commonly seen inmost of them while Stress Related Diabetes Mellitus

is evident.

Acharya Charaka while listing the types ofDoshika Prameha has first listed the guna of the

doshas according to the dominance of which the“gauna” nomenclature is adopted for the subtypes ofPrameha. Madhura (Sweet) is listed among the ten


115

guna of Kapha not among the guna of Vata henceaccording to this Diabetes Mellitus should be

correlated to Kaphaja Prameha not Vataja.

Shitameha & ikshubalikameha are said topossess atyarthamadhura properties while

madhumeha is kashayamadhura in nature whichagain points to the fact that Diabetes Mellitus shouldbe more related to the kaphaja subtype.5 Ikshumeha

is compared with ikshurasa and is said to beatimadhura like ikshurasa by Acharya Vagabhatta.6

Acharya Sushruta clearly stated that if not

treated then all the subtypes of Prameha, in duecourse of time present as Madhumeha.7 If it isbelieved that these 20 subtypes are different forms of

urinary/metabolic disorders among whichMadhumeha is Diabetes Mellitus then these urinarydisorders must lead to DM, if left untreated but this

is not seen commonly. Hence there should be somelacunae in the interpretation & correlation of thesubtypes which needs to be highlighted.

On the samprapti of the prameha by AcharyaVagabhatta Indu clears the fact that in all thePrameha Kapha prakopa occurs. Even in the genesis

of Pittaja Prameha, first Kapha gets aggravated &presents swalpalakshana & with due course of timethe Pittakopa occurs. Similar is evident in the case of

Vatajameha. Description like kalavashata, kalena,evamkramena points towards the genesis of a singledisease which changes in severity with due course of

time due to involvement of deeper dhatu as dushya.It is clear that it is description of a single disease withsame pathophysiology that is getting severe, not

different diseases with different pathogenesis.8

In case of Vataja Prameha Vagabhata clearlystates it is of two types as per the pathogenesis. The

one resulting from the dhatukshaya are asadhyawhile those due to avarana are kricchsadhya as perIndu commentary.10 Hence it is clear that the one

occurring due to kshaya is the one caused followingthe gradual course from Kapha to Vataja Prameha.

The signs & symptoms mentioned by the

Acharya for the identification of these subtypes ofPrameha are solely the ones seen in the urine. Thechanges in the physical appearance like consistency,

turbidity etc. are mentioned. This certainly raises adoubt of these being some type of urinary disorders butthere is no binding that other systemic diseases do not

cause urinary symptoms viz. Kamala, Raktapitta etc.Regarding the clinical features of urinary changesAcharya Sushruta &Vagabhata stipulated that

instead of dosha & dushya being the same only dueto the difference in their proportion differentmanifestations are observed.11-12

In the genesis of the disease it appears as if itis a course of disease getting complicated as itprogresses. Acharya Sushruta a clearly listed the

involved dosha and dushya in different types ofprameha (Table-I).13 The listed pattern of involveddushya points towards the samprapti of the same

disease penetrating deeper in due course of time. It isnot possible that different diseases follow samesamprapti & result into two or more totally different

systemic diseases.

Table-I

Dosha & Dushya of Prameha

Types Causative Dosha Associated Dosha Dushya

Kaphaja Prameha Kapha Vata-Pitta Meda

Pittaja Prameha Pitta Vata-Kapha Shonita Meda

Vataja Prameha Vata Kapha-Pitta Vasa Majja Meda

Results & Discussion:

In an attempt to put an Ayurvedic frame to

Diabetes Mellitus, many practitioners misread it underthe heading of Madhumeha, a subtype of Prameha

while all the discussed points refer to the fact that each& every patient with raised blood sugar level is not

madhumehi and hence asadhya. So rejecting eachand every patient of DM from the list of curableconsidering them madhumehi is unfair.


116

In context of Prameha it is directed to firstcautiously diagnose the subtype of Prameha &

ascertain the sadhyata-asadhyata before planning thetreatment.14 This further magnifies the importance ofsadhyata-asadhyata of Prameha & the significance of

prognosis in treatment.

In popular practice most of the Ayurvedicphysicians prescribe a uniform kind of treatment to all

the patients of DM they come across considering itasadhya, which is not justified as Ayurvedikaprinciples of treatment are way too far from this

universal approach & every diabetic patient may notbe madhumehi (asadhya).

Bridging this gap between the diagnosis &

prognosis can help in the better management ofPrameha.

References

1 . CarakaSamhita of Agnivesh with Ayurvedadipika commentary

by Sri Cakrapanidatta, edited by

Vaidya Yadavji Trikamji Acharya, Chaukhaba Surbharti

Prakashan, Varanasi, India. Rep.2014., Nidanasthana 8/11,

p.227.

2. Ashtangsamgraha of VriddhaVagbhata with Shashilekha

Sanskrit commentary, edited by Shivprasad Sharma,

Chowkhamba Sanskrit series, Varanasi, India, Nidanasthana

10/9 (Indu commentary), p.392.

3. CarakaSamhita of Agnivesh with Ayurvedadipika commentary

by Sri Cakrapanidatta, edited by Vaidya Yadavji Trikamji

Acharya, Chaukhaba Surbharti Prakashan, Varanasi, India.

Rep.2014., Chikitsasthana 6/3, p.445.




Rep.2014., Nidanasthana 4/24 & 36, p.214 & 215.




Rep.2014., Nidanasthana 4/14 & 19, p.214.

6. Ashtangsamgraha of Vriddha Vagbhata with Shashilekha



10/10, p.392.

7 . Shastri Ambikadatta, “Ayurveda tattva sandipika”

commentary on Sushruta Samhita,Purvardha, Chaukhambha

Sanskrita Sansthana, Varanasi, India, Rep.2007,

Nidanasthana 6/30, p.255.




10/5 (indu commentary), p.392.




10/15, p.393.




10/15 (indu commentary), p.393.

11 . Shastri Ambikadatta, “Ayurvedatattvasandipika” commentary

on Sushruta Samhita,Purvardha, Chaukhambha Sanskrita

Sansthana, Varanasi, India, Rep.2007, Nidanasthana6/29,

p.255.




10/8, p.392.

13. Shastri Ambikadatta, “Ayurvedatattvasandipika” commentary

on Sushruta Samhita,Purvardha, Chaukhambha Sanskrita

Sansthana, Varanasi, India, Rep.2007, Nidanasthana 6/11,

p.253.

14. Vaidya Shri Lakshmipati Shastri commentary on Yogratnakar

with Vidyotaniteeka, Chaukhamba Sanskrita Series office.

Banaras, India, 1955. Uttarardha, Prameha Nidan, Verse 12,

p.557.


117

A Study On Roga Marga With Special Reference To ItsRachanatmaka Adhyayana (Anatomical Aspect)

*Dr. Kulkarni Pratibha Vijaykumar, **Dr. Vaidya Shrinath Mayur

Conceptual Study

Abstract;

The study of roga or disease involves its study from the point of nidaan panchaka and other factors

like agni saama, nirnama, vyakta sthana, Sadhyasadhyata and roga marga which are a part of sampraptighataka. So the study of roga marga is need of hour.

Three paths or margas of diseases were enumerated in charaka samhita as shakha, marmasthi sandhi

and koshtha, which have the synonyms of bahya, madhyama and abhyantara roga margas respectively. Themarga in this context refers to path way of disease.

Abhyantara roga marga is called as maha srotas and koshtha. Some disease and some organs were

illustrated for each roga marga which was approved by the brahatrayees.

The study undertaken revealed that roga marga is ashraya sthana of vyadhis, which is one of thesamprapti ghataka and is helpful in the prognosis of the disease. Thus it indicates the necessity of study on

roga marga in diagnosis. The study of roga marga was also found necessary in the prognosis as well astreatment of the disease and also common line of treatment for each roga marga has been narrated.

Key words : Roga, marga, bahya, madhyama, abhyantara, koshtha

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*Professor, Department of Kriya shareera, SDMCAH, Hassan, 9482175055 [email protected], **Professor, Department of

Moulika siddhanta samhita, SDMCAH, Hassan, 9448655364


118

Introduction ;

Different diseases have been included indifferent roga marga according to the samprapti and

udbhavasthana of the disease. For example thoughjwara may seem as a shakhagata vyadhi as itsvyaktatwa is seen on twacha it has been included in

the kostha marga. This has been done due to theudbhava sthana or samprapti formation in amashayawhich lies in the kostha marga.

After studying the different disease in thedifferent Roga marga and understanding the reasonsfor their inclusion in them the treatment of these Roga

marga should ideally have been studied. As rogamarga is one of the samprapti ghataka in themanifestation of disease and it is an important criteria

for the diagnosis, prognosis and treatment of diseases.The study of trividha roga marga is necessary, so thatthe proper and accurate treatment of diseases is dealt

with. Thus the present study is need of hour.

Marga of roga’s are 3 in number.1

1) Bahya roga marga

2) Madhyama roga marga

3) Abhyantara roga marga

1) Bahya Roga marga:

Rakta, mamsa etc dhatu and twacha comesunder bahya roga marga Bhagawan punarvasu has

named it as shakha Rasa raktaadi dhatus and twachathese are called as shakha. This is bahya marga ofrogas.2

Here in shakha Rasa dhatu is not included.From rasa dhatu all the dhatus utpatti takes placeSushruta has stated that from rasa dhatu uttarottara

all the dhatus manifests.3

From the word shakha Raktadi dhatu andtwacha should be considered. This is bahya Marga of

roga.4

The disease which takes place here are

Mashaka. Vyanga, Ganda, Alaji, Arbuda etc. Arsha

Gulma shopha etc roga are also called asBahirmargasa (These takes place in antar margaalso).5

Galaganda, pidaka, Alaji, Apachi,charmakeela Adhimamsa. Arsha, kushtha, Vyanga

etc. diseases and diseases which takes place in bahyamargas as visarpa, shotha. Gulma, Arsha, vidradhietc also becomes shakahanusaari. These are called as

rogas of bahya marga.6

ii) Madyama Roga marga :

Shira Hridaya and Basti organs are marma,

asthi and sandhi these all and snaayu, sira andkandara etc which are related with them all comesunder madhyama roga marga. 7

Mutrashaya, Hridaya, Moordha, kantha,

nabhi and Gnda these are called as Marma. AsthiSandhis, Snaayu. Kandaras attached to this areMadhyama roga marga.8

Of the one hundred and seven marmasmentioned under enumeration of body components

Basti, Hrudaya and Shiras are regarded as importantones because they are seat of vital signs, afflictingthem also affect the vital health.9 Marma sthanas are

107 in number but special praanaghataka are only 3.Charaka has stated that these 3 as main and used theword etc.9

By this it becomes clear that the main are 3

and has considered all other marmas as not main.Sandhis are 210 in number, dhamanis, siranaadi andkandaraas also are included under Madhyama roga

margaas roga marga.

Here marma and asthi snadhi these both are

considered as one because when dosha enters in thesemargas then roga becomes kasthasadhya.

Shira, Hridaya, Basti, etc marma and sandhisof asthis, sira, snaayu and kandara etc related with

them comes under madhyama roga marga.10

A Study On Roga Marga With Special Reference To ItsRachanatmaka Adhyayana (Anatomical Aspect)

Dr. Kulkarni Pratibha Vijaykumar, Dr. Vaidya Shrinath Mayur

Conceptual Study


119

Diseases which manifests here are yakshma,pakshavadha, Ardita, shiroroga, sandhi, asthi and

trik shoola accumulate in them are madhyama margagata rogas. Hanugraha, apatanaka, ardita,raajayakshma, guda bhramsha, shiroroga, nasaroga

etc jatrurdhwa diseases arises in this marga.11

iii) Abhyantara Roga marga:

Abhyantara roga marga has the following

synonyms They are Mahasrotass (because it is biggestchannel in the sharira), Sharira Madhya (It existsin the middle part of sharira, Mahanimna (Deepest)

and Ama pakwashayashraya (Amashaya andpakwashaya takes ashraya here) and Koshtha.12

Here from Koshtha:

Amashaya, Agnyashaya, Pakwashaya,mootrashaya, Rudhirashaya Hridaya, unduka, andphupphusa are considered.13 As these are the organs

located in Koshtha, they are called as Koshtangas.

Maha srota means from gala vivara uptoguda the longest channel is understood, Maha srota

is divided into 3 parts as

i) From galavivara upto amashaya

ii) From Grahani upto kshudrantra

iii) From unduka till guda bhaag.

These are called as urdhwa, Madhya andnimna bhaaga14 of mahasrotas. Fifteen are the

visceral organs such as navel, heart, kloma, liver,spleen, kidneys, urinary bladder, caecum, stomach,jejunum, rectum, anus, small intestine, large intestine,

omentum.15

In this roga marga jwara, atisaara, chardi,alasaka, visoochika, shvaasa, kaasa, anaaha,

udararoga and pleeha vikrati etc. diseases and shothaof inner part, Arsha, Anarvidhradhi, Anargulma,Antarvisarpa etc. diseases manifests. 16

The other diseases which manifests in thismarga are vamana, atisaara, kaasa, shwasa, udala,jwara, shosha, Arsha, gulma, visarpa, vidradhi

etc.17,18

Discussion

Certain organs are grouped under different

roga margas. The organic implication of each roga

marga can be discussed as follows – twacha raktadietc. under Bahya roga marga.

Chakrapaani clarifies that twacha, raktaadiall of the above bhava vishes has are to be includedin shakha. The interpretation of shakha as extremities

is not considered here. Thus to show the remotenessof these structures, they have been termed as shakha.These are the structures seen one after another in a

sequence like rasa, rakta, mamsa, meda, asthi, majjapertaining to the internal structures like liver, spleen,brain etc will not come under Bahya Roga marga.

For example: Hridaya gata rasa,yakratgata rakta should come under AbhyantaraRoga marga.

The accessory appendages of skin like hairs,nails, tactile cells, sebaceous glands etc should beconsidered under Bahya Roga marga. Mammary

glands, external ear, tonsils should also be consideredunder Bahya Roga marga. Thus looking to thestructures and diseases allotted to Bahya Roga marga,

it is evident that this marga is in direct contact to theexternal stimulus and these disease are such that itcan be visualized for palpable i.e. pratyaksha gamya.

Marma, Asthi, Sandhi are the structureswhich are considered under Madhyama Roga margain texts. The grouping of structures of madhyama roga

marga is quite different from that of other Rogamarga. These structures are not closely linked witheach other anatomically. They perform some vital

functions of the body and any damage to them willgive rise to serious consequences.

The Abhyantara Roga marga is termed as

koshtha. Hence all the koshthangas may be includedunder this Roga marga. While enumeratingkoshthangas basti, hridaya and vrikka included in

Koshtha, those all are to be included in AbhyantaraRoga marga. But in text these organs and diseaserelated to them are described in Madhyama Roga

marga.

In this aspect clarification is needed.

Koshthanga are mainly responsible for

nutrition and excretion of mala, for example hridayais considered as koshthanga as it is responsible fornutrition and excretion of blood and impurities. Same

is the case with vrakka and basti.


120

But the reason for not considering theseorgans under koshtha is that the structural disorders

of any of the organs may influence the materialflowing through them but not the organs of mahasrotas (Abhyantara Roga marga). But in case of the

diseases related to Abhyantara Roga marga theremay be indirect influence on the vahana of theseorgans: Ex: Rakta mutrata in pittaja jwara, hridaya

asuddhi in ama jwara, bahu mootrata in ajeerna etctakes place.

Thus being influenced by koshtha and their

diseases these might have been included inkoshthanga but when the point of Roga marga comesthese organs are to be studied under Madhyama Roga

marga as in texts.

The 3 germ layers and Roga Marga :

The germ layers are responsible for the

formation of different structures of the body duringthe embryonic stage. When we find no such statementin our texts regarding these layers while the formation

of Anga Pratyanga is dealt envisaged, one may doubtabout the scope of such a comparison. But as there aresome similarities between Roga marga and germ

layers, a brief study in this direction is attempted.

Similarities :

1) Number : Germ layers are 3 and Roga marga

are also 3

2) Nomenclature : of germ layers and Rogamarga is similar.

3) Structures : Structures ascribed to Roga margaresemble the germ layer derivatives.

Truly speaking, such a comparison is not

possible because hardly there is any organ thatoriginates entirely from one or even two germ layers.Second, if such a comparison is made, it requires to

be examined whether, there is any relationshipbetween the germ layers and the disease. According tomodern science, such a relationship can be shown in

case of certain Neoplastic diseases. But the diseasescaused by microbes and metabolic disorders do notshow any clear cut tendency of affecting tissues arising

from a particular germ layer. So, it is not possible tosay that this sort of a comparison is feasible.

Conclusions

Roga marga is the place where khavaigunya

does occur and acts as the point of ignition and directsthe samprapti to propogate in a definite pattern.Roga marga also can be appreciated as the

classification of diseases on the basis of theirprognosis. The vyadhi mentioned in AbhyantaraRoga marga are Jatharagni centered and can be

treated on the principle of jatharagni mandya. RogaMarga plays an inevitable role in the sub clinical,clinical and complicated clinical stages of Samprapti.

Like the ‘Portal of entry’ for infection in the modernscience, each Roga Marga has got its own defensemechanisms; either mechanical or chemical. When

this defense mechanism is superceded, the Kha-Vaigunya is rendered to set in. Roga Marga can alsobe appreciated as the classification of diseases on the

basis of their prognosis. If so, it is again specific andunique in comparison to the systemic classification ofdisease in the modern science.

The diseases coming under a particularRogamarga has common Kha-Vaigunya in theSamprapti and hence, the Samprapti Vighatana or

Chikitsa of the Vyadhi of a particular Roga Margacan be generated on common line of management. TheAbhyantara and Bahya Roga Marga has got the

direct axis of Dosha Sancara and hence the morbidhumours residing into them can be removed easily bySodhana.

References

1) Vagbhata, Ashtanga hrudaya, Sutrasthana; Dosha-

bhediyaadhyaya, 12/43, edited by Sri Vaidya Lalchandra,

Reprint edition, Motilal Banarasidas, New Delhi; 2005; 103

2) Agnivesha, Charaka, Drudhabala, Charaka samhita,

Sutrasthana, Trisraishaneeyaadhyaya, 11/48, edited by

Shastri Satyanarayana, 19th edition, Chaukambha bharati

academy, Varanasi; 1995;235

3) Sushrutha, Sushrutha samhita, Sutrasthana, Shonitavarna-

neeyaadhyaya, 14/10, edited by Vaidya Shastri Ambikadatt,

reprint edition, Chaukambha samskritasamsthana, Varanasi;

2005;49

4) Ibidem Ashtanga hrudaya (1), Doshabhediya-adhyaya, 12/44;

104


121


104

6) Ibidem Charaka samhita (1), Trisraishaneeya-adhyaya, 11/48;

235

7 ) Vagbhata, Ashtanga Sangraha, Sutrasthana, Roga-

bhediyaadhyaya, 22/15, edited by Vaidya Sharma.

Ramnarayan,3 rd edition, Baidyanath Ayurvediya Prakashana,

Nagpur; 1986; 662

8) Ibidem Charaka samhita (1),Trisraishaneeya-adhyaya, 11/48;

236

9) Agnivesha, Charaka, Dradhabala, Charaka samhita, Chikitsa

sthana, Trimarmeeya chikitsa adhyaya, 26/3 edited by

Vaidya. Tripathi. Brahmanand, Reprint edition, Chaukambha-

surabharati prakashana, Varanasi; 2009; 762

10) Ibidem Ashtanga hrudaya (1),Doshabhediya-adhyaya, 12/46;

104

11) Ibidem Ashtanga hrudaya (1),Doshabhediya-adhyaya, 12/47;

104

12) Ibidem Ashtanga Samgraha (1),Rogabhediya-adhyaya, 22/15;

662

13) Sushruta, Dalhana, Sushruta samhita, Chikitsa sthana,

Sadyovrana chikitsa adhyaya, 2/12, edited by Vaidya

Yadavaji .Trikramaji .Acharya, Reprint edition, Krishnadas

academy, Varanasi, 1998 ;409

14) Ibidem Ashtanga Samgraha (1),Rogabhediya-adhyaya, 22/15

;662

15) Agnivesha, Charaka, Dridhabala, Charaka samhita, Sharira

sthaana, Shareera sankhyashaareera-adhyaya, 7/10, edited

by Sharma. Priyavrat, fifth edition, Chaukambha orientalia,

Varanasi, 1998; 457


104

1 7 ) Ibidem Ashtanga Samgraha (1), Rogabhediya-adhyaya, 22/15;

662

18) Ibidem Charaka samhita (1), Trisraishaneeya-adhyaya, 11/48;

2 3 7


122

Dashwidha Pariksha And Tail Bindu Mutra Pariksha ToEvaluate The Proneness, Disease Status And Prognosis In

Patients Of Madhumeha W.S.R. To Diabetes Mellitus

*Dr. Neha Tiwari, **Dr. Akhilesh Srivastva, ***Dr. Rajesh K. Manglesh, ****Dr. Y.K. Sharma

*PG Scholar, **Sr. lecturer, ***Reader, ****Principal cum Dean, RGGPG Ayurvedic College & Hospital, Paprola, *PG Department of Rog

Nidan, RGGPG Ayurvedic College and Hospital, Paprola, Kangra, HP. Pin- 176115 Email- [email protected],

[email protected], [email protected], [email protected]

Survey Study

Abstract:

Madhumeha i.e. Diabetes mellitus is one of the burning health problems of present era resulting inserious long term complications. In- spite of many researches, very few prognostic models are available to predictprognosis of DM. This study is focused at determining the disease status, prognosis and proneness in the patients

of Madhumeha by Dashavidha pariksha and Tail Bindu Mutra Pariksha. Objectives: To evaluate theimportance of Dashwidha pariksha and Tail Bindu Mutra Pariksha in predicting the proneness, disease statusand prognosis in patients of Madhumeha. Materials and Methods: 100 patients of either sexin age group

of 20 – 70 years fulfilling the study criteria were included in the survey. Tail Bindu Mutra Pariksha andDashwidha Pariksha were done and analysed for the diagnostic and prognostic purpose. Data collected wasanalysed using standard statistical procedures. Results: It was observed that nature of spread of Tail Bindu

and its direction were significantly affected with increased FBS level, urine specific gravity, glycosuria anddiabetes associated complications. Conclusions: Tail Bindu Pariksha and Dashwidha pariksha were foundto be significant in predicting prognosis, proneness and disease status in patients of Madhumeha.

Key Words: Madhumeha, Examination, Prognosis, Dashwidha pariksha, Tail Bindu Mutra Pariksha.

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123

Introduction

Diabetes mellitus is one of the burning globalhealth problems alarming the world as a non-infectious pandemic. It is a leading cause of morbidity

and mortality over world owing to its seriouscomplications, especially end stage renal disease, IHD,gangrene of the lower extremities, and blindness in the

adults1. It is substantially prevalent in India and Indiais considered as capital of Diabetes. Changing lifestyle, lack of exercise, fast foods, improper unbalanced

diet and sedentary life style are showing upward trendin India.

In Ayurveda, Madhumeha (DM) is said to beKrichasadhya2 (difficult to treat) or Asadhya3

(incurable). Therefore, proper diagnosis with regularassessment of condition of patient is very important tohave a good prognosis in the patients of Madhumeha

(DM). So, proper examination of each and everypatient should be done and treatment should be givenaccordingly. Dashwidha Pariksha4 (Tenfold

Examination) described by Acharya Charaka is thevery significant as it helps in accessing the patient inall aspects. According to Dashwidha Pariksha, patient

should be examined in respect of Prakriti (constitutionof body), Vikriti (pathological examination), Sara(examination of elemental tissue & mind),

Samhanana (examination of compactness of body),Pramana (measurement), Satmya (suitability), Satva(examination of mental constitution), Ahara-Shakti

(examination of digestive power), Vyayama-Shakti(examination of strength by exercise) and Vaya(examination of age). Dashwidha Pariksha is a vital

diagnostic Ayurvedic tool for assessing the currenthealth of a patient and also tells about the pronenessof the patient to the complications of existing disease

and to other diseases too. It provides a basis fordiagnosis, treatment as well as prognosis.

Prognosis is also an important aspect oftreatment. Since ancient time predicting prognosis of

a disease has always been a big challenge to themedical profession. Few prognostic parameters are

presently used for assessing the disease outcome butmost of them are costly and not widely available. Incase of DM, the only prognostic models available to

know the disease status and prognosis are biochemicalinvestigations such as FBS, RBS, PPBS and HbA1c etc.But all these methods are invasive and a diseased

person, especially the older patients find it frustratingand painful to give blood again and again. In suchcases, non-invasive, easily available and cost effective

techniques are the demand of time. Tail Bindu MutraPariksha (Oil Drop Test) described by AcharyaYogratnakar under Astasthana rogi pariksha5 (Eight

parts to be examine) can be used as a tool forassessing the prognosis and severity of diseases.

Material And Methods

The present study was a survey study carriedout with an objective to evaluate the importance ofDashwidha pariksha and Tail Bindu Mutra Pariksha

in predicting the proneness, disease status andprognosis in patients of Madhumeha w.s.r. to DM.The study protocol was approved by the Ethical

Committee of RGGPG Ayurvedic College and Hospital,Paprola, HP (IEC/2015/1042). After obtaining writteninformed consent, 100 patients fulfilling the following

study criteria were included in the study.

Inclusion criteria

Individuals of either sex whether known case

or fresh case of diabetes in age group of 20 – 70 yearswho were willing and able to take part in survey studyand willing to reveal the desired information as per the

study proforma made the study group.

Exclusion criteria

Individuals below the age of 20 years and

above 70 years and individuals who were not willingto participate in the survey study were excluded. Anyother condition which the principal investigator thinks

Dashwidha Pariksha And Tail Bindu Mutra Pariksha ToEvaluate The Proneness, Disease Status And Prognosis In

Patients Of Madhumeha W.S.R. To Diabetes Mellitus

Dr. Neha Tiwari, Dr. Akhilesh Srivastva, Dr. Rajesh K. Manglesh, Dr. Y.K. Sharma

Survey Study


124

may jeopardize the study was also excluded.

Survey study

A detailed medical history, clinicalexamination, anthropometric measurements andbaseline laboratory investigations such as Hb %, TLC,

DLC, ESR, Urine routine and microscopic examinationwere also carried out in addition to blood sugar.Dashwidha Pariksha and Tail Bindu Mutra Pariksha

were done and data collected was standardized in theview of literary references with the help of laboratoryprofile.

Dashwidha Pariksha:

This was done with the help of specialproforma designed on the basis of Ayurveda

fundamentals and Dashwidha Pariksha incorporatingvarious details of study subjects.

Tail Bindu Mutra Pariksha:

Tail Bindu Mutra Pariksha was performed bydropping a drop of Til Tail (sesame oil) over thesurface of urine and findings were compared with the

biochemical findings of blood.

Equipment used:

Dry and clean glass petri dish of diameter 6

inch, micropipette, Til Tail (sesame oil), compass.

Method of collection of urine:

Patient was asked to collect the first morning

midstream urine in a urine container.

Procedure of Tail Bindu Mutra Pariksha:

Urine was taken in a petri dish and was kept

on stable surface. When the surface of urine becomestable and quite, then a drop of Til Tail was droppedout on the surface of urine with the help of a

micropipette. The changes in the oil drop werecarefully observed specially spread, direction andformation of different types of shapes.

The following points were noted:

i. Time/rate of spread- Immediate spread/latespread/sinking down of oil drop

ii. Direction of spread- Purva(East)/Pashchim(West)/Uttara (North)/Dakshin(South)/Ishana

(Northeast)/Vayavya(Northwest)/Nairutta(Southwest)/Agneya (South-east). The directionwas considered as uniform when the oil drop was

spreading uniformly in all directions, rest wereconsidered as non-uniform direction.

iii. Shape: Pattern of oil on urine surface.

Statistical analysis: Results obtained fromTail Bindu Mutra Pariksha and laboratory

examination were compared for the prognostic aspectand data obtained from Dashwidha Pariksha wasreviewed and analysed for its contribution in

predicting disease status and proneness. The variousparameters of Tail Bindu Mutra Pariksha like natureof spread and direction were compared statistically for

their prognostic value by Pearson’s chi square test.

Observation And Results:

1. Demographic Profile of the Patients:

Demographic profiles of the patients were as

follows: Out of 100 patients, 39% were in the agegroup of 60-70 years followed by 32% in the age groupof 51-60 years, 54% patients were female and 46%

were male, 99% were Hindu, 92% were married, 75%belonged to middle socioeconomic class, 43% ofpatients were educated from matric to 10+2, 48%

were doing non-specific type of work like house-worketc., 65% of patients were on mix dietary habits, 53%of patients were not having any addiction, 42%patients were living sedentary life, 62% of patients

were having adequate and normal sleep, 59% ofpatients were having normal appetite, 55% patientswere having normal regular bowel habits, maximum

number of patients i.e. 86% were having chronicdisease (>1 year), Maximum patients (85%) patientswere without complications.

2. Dashwidha Pariksha observations:

Deha Prakriti profile:

In present study, maximum numbers ofpatient i. e. 58% were of Vata-kaphaja prakriti

followed by 29% were of Kapha-pittaja prakriti. 13%patients were of Vata-pittaja-prakriti.

Vikriti profile:

Disease in 43% patient was found to be ofalpa bala (mild) while in 26% patients disease was ofmadhya bala (moderate). Nature of disease was

balavaan (severe) in 11% patients.

Sara profile:

34% patients were of medasara followed by


125

22% of mamsa-sara. 13% patients reflects features ofasthi-sarapurusha while 10% of majja-sara, 8% of

rakta-sara, 6% of tvacha-sara, 5% of satva-sara and2% of shukrasara.

Samhanana profile:

47% of patients possessed madhyambala(moderate strength) while 36% patients possessedalpabala (weak). 17% patients were balwana (good

strength).

Pramana profile:

Maximum numbers of patients i.e. 70% were

of Samapramana (normal body proportions) while19% patients were of heenpramana (short bodystature). 11% of patients were of adhikapramana

(abnormal body proportion).

Satmya profile:51% of patients were using all sixrasa (all six

tastes) in routine diet while 40% patients were using

mixrasa (mix taste). But 9% patients were used toeither onerasa (one taste).

Satva Profile:In present study, 46% of patients were found

to have madhyamsatva (moderate mental strength)

while 30% were having avarasatva (low mentalstrength). 24% were having pravarasatva (superior

mental strength)

Aahara Shakti:48% of patients were havingpravaraabhyvaranshakti (high ingestion capacity)while 30% were having madhya-mabhyvaran shakti

(moderate ingestion capacity) and 22% of patient werehaving avaraabhyvaran-shakti (lowingestioncapacity). Maximum number of patients i.e. 44% were

having madhyamjaranashakti (moderate digestioncapacity) followed by 36% were having avarajarana-shakti (low digestion capacity). Only 20% were having

pravarajaranashakti (good digestion capacity).

Vyayaamshakti profile: In present study

maximum patients i.e. 58% were having avaravya-yamashakti (poor exercise capacity) while 32% werehaving madhyamvyayama shakti (moderate exercise

capacity). Only 10% were having pravaravyayama-shakti (high exercise capacity).

Vaya Profile: In present study, maximumnumbers of patients i.e. 61% were of madhyamvaya

(middle age) while 37% were vriddha (old age). Only2% belonged to balavaya(childhood stage).

3. Tail Bindu Mutra Pariksha observations:

Table no. I, Nature of spread of Tail Bindu

Nature of spread No. of patients Percentage

Not spreading 25 25%

Spreading 74 74%

Slow spreading 19 19%

Moderate spreading 18 18%

Fast spreading 14 14%

Vary fast spreading 23 23%

Sinks to bottom 01 1%

Total 100 100%

Table no. II, Direction of spread of Tail Bindu

Direction No. of patients Percentage

Uniform direction 68 68%

Non-uniform direction 32 32%


126

In present study, the FBS level was <150mg/dl in 58% of patients. It was between 150-200 mg/dl in17% patients, between 151-200mg/dl in 14% patients, between 251-300 mg/dl in 6% patients. In 5% patients,

FBS level was >300mg/dl. Out of 100 patients, oil drop spread over the surface of urine in maximum numbersof patients i.e. 74% and did not spread in 25% of patients. It sinks to bottom in 1% patient. The direction ofTail Bindu was uniform in 68% patients, while it was non-uniform in 32% patients.

4. Comparison of Laboratory Findings and Tail Bindu Pariksha findings:

Table no. III, Tail Bindu Mutra Pariksha findings vs laboratory findings

Nature of Spread Direction of

of Tail Bindu Tail Bindu

Criteria Spread Not spread Uniform Non-uniform

Blood Sugar <150mg/dl 91.38% 8.62% 94.83% 5.17%

>151mg/dl 16.67% 83.33% 30.95% 60.05%

Urine sugar No- glycosuria 88.46% 11.54% 76.92% 23.08%

Glycosuria 32% 68% 36.36% 63.67%

Urine albumin No-albuminuria 75.56% 22.44% 67.78% 32.22%

Albuminuria 60% 40% 70% 30%

M/E of urine Absent 74.71% 25.29% 67.82% 32.18%

Present 69.23% 30.77% 69.24% 30.76%

S/g of Urine Normal 93.67% 6.33% 82.28% 17.72%

Increased 0% 100% 14.29% 85.71%

Table no. IV,Tail Bindu Mutra Pariksha findings vs Chronicity

Nature of Spread Direction Of of Tail Bindu Tail Bindu


Duration of disease Fresh cases 100% 0% 100% 0%

<1 year 91% 9% 72.73% 27.27%

>1 year 68.42% 31.58% 71.05% 28.95%

Table no. V, Tail Bindu Mutra Pariksha finding vs Complications

Nature of Spread Direction of

of Tail Bindu Tail Bindu


Complications Absent 83.53% 16.47% 76.47% 23.53%

Present 20% 80% 13.33% 86.67%

Table no. VI, Comparison between Prognostic aspects of Tail Bindu Pariksha

Criteria Sadhya Kashta-sadhya Asadhya P-Value

Nature of spread 74 25 1 0.199

Direction of spread 68 32 0


127

Conclusion

This survey study showed that Dashwidha

pariksha is helpful in accessing the disease status asdisease was found to be mild in patients with pravara(great) sara, samhanana, satmya, satva, aahara

shakti and vyayama shakti. Patients of kaphapredominant prakriti and mamsasara should be morecareful as they are more prone to complications if not

treated properly. Tail Bindu Pariksha (oil drop test)showed features of Kashta-sadhyata (difficult to treat)or Asadhyata (incurable feature) in complicated

Diabetics. Especially the nature of spread of TailBindu was found to be more accurate in predictingprognosis.

It can be concluded that Dashwidha Parikshaand Taila Bindu Pariksha have a valuable role in theassessment of prognosis, disease status and proneness

in the patients of diabetes mellitus. This present studywas a preliminary effort to access the utility of TailBindu Pariksha and Dashwidha Pariksha as a

prognostic and diagnostic tool in disease Madhumeha.More surveys should be conducted on larger sampleand in all other diseases because there are no

laboratory investigations available to instantly accessor forecast the prognosis of diabetes and any otherdisease. We can develop Tail Bindu Pariksha as a

simple and cost-effective procedure for predictingprognosis of diseases.

References

1 . Harsh Mohan. Textbook of Pathology.New Delhi; Jaypee

Brothers; Edi. 5th, The Endocrine System, p842

2. Pandit Kashinath Sastri and Dr. Gorakhnath Chaturvedi,

Charaka Samhita, Volume I, Chaukhamba Bharti Academy,

Varanasi, Edition: Reprint, 2011, Sutra Sthan 17/80, p242



Varanasi, Edition: Reprint, 2011, Nidan Sthan4/45, p508



Varanasi, Edition: Reprint, 2011, Vimana Sthana8/111, p771

5. Vaidya Lakshmipati Sastri, S. Yogaratnakar,Edition: 2013,

Varanasi: Choukhamba Prakashan; p5.

The comparison of the results of Tail BinduMutra Pariksha and laboratory findings, chronicity

and complications has shown in Tables III-VI.

Discussion

Diabetes mellitus has become a global

endemic with rapidly increasing in prevalence in bothdeveloping and developed countries. Epidemiologicaldata in India shows the upward trend from 33 million

diabetics in 2000 to 57 million in 2025. Madhumehais a disease known to mankind since Vedic period. Theword ‘Madhumeha’ is a combination of two terms

‘madhu’ and ‘meha’ meaning ‘honey’ and ‘excessiveflow’ respectively. On clinical manifestation,Madhumeha can be co-related with diabetes mellitus.

Madhumeha is said to be Krichasadhya (difficult totreat) or Asadhya (incurable). Therefore, regularassessment of condition of patient and disease is very

important to have a good prognosis and to prevent thecomplications of the disease.

This survey study showed that the patients

having mamsa-sara or meda-sara and kaphapredominant prakriti are more prone to Diabetes andits complications. Patients having pravara and

madhyamsamhanana, samapramana, sarva-rasasatmya, pravara and madhyam satva, pravaraand madhyam abhyvaran shakti and jarana shakti

are less prone to any disease and to the complicationsof the existing disease and disease can be controlledin such patients with proper medications and care.

The disease having avarabala (mild) is easy to controland have good prognosis than the disease havingmadhyam (moderate) and pravarabala (severe).

In present study, nature of spread of TailBindu, its direction and shape was considered. But notany particular type of shape was observed. Nature of

spread and direction of Tail Bindu showed thatmaximum number of patients were sadhya. Both thenature of spread and direction of Tail Bindu were

significantly affected in conditions with increased FBSlevel and urine specific gravity, glycosuria but not incase of albuminuria and presence of microscopic

elements in urine. Diabetic complications alsosignificantly affected the nature of spread of TailBindu and its direction but chronicity did not.

Although the statistical difference was not significantbut nature of spread was found to be more accuratein predicting prognosis than the direction of Tail

Bindu.


128

Raktamokshana In Shalakya Rogas : A Literary Review

*Dr. Gulab Chand Pamnani, **Dr. Itika Pamnani

Abstract

Raktamokshana is a type of shodhana therapy employed mainly in the diseases of Rakta and Pitta origin.Raktamokshana is a prime treatment procedure of various Mukharogas specially of Dantamulagata rogas andKanthagata rogas.

Now a days people are consuming so much alcohol, spicy, junk foods and their life style has becometoo much deranged. They do not get sleep in time and are not following the rules of Dinacharya -Ritucharya.Because of all these factors their pitta and rakta get vitiated and they get suffered with many diseases having

rakta, pitta origin. Acharyas has given prime importance to raktamokshana in healthy persons also for theprevention of various Raktaja and Pittaja diseases.

Keywords : Raktamokshana, Timira, Abhishyanda, Adhimantha, Puyalasa, Mukha-roga, Oshtharoga,

Jalaukavacharana.

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Literary Review

* Assistant Professor, Deptt. of Shalakya Tantra, National Institute of Ayurveda, Jaipur. ** Associate Professor, Deptt. of Roga Evam

Vikriti Vigyana Vibhaga, SSSB Ayurvedic College, Renwal, Jaipur.


129

Introduction :

Raktamokshana is a type of shodhana therapyemployed mainly in the diseases of Rakta and Pitta

origin. Acharya Vagbhatta and Sushruta hasincluded raktamokshana in Panchakarmas. Eventhough a number of methods are there for

raktamokshana, only two methods are used inShalakya Tantra i.e. Siravedha andJalaukavacharana. Sushruta has mainly adopted

Siravedha for raktamokshana purpose and he has notdescribed even a single disease indicated for Jalauka-vacharana in Uttaratantraa. Direct indications for

Jalaukavacharana are instructed only for Pittaja,Raktaja and Abhighataja Oshtharogas. Sushruta hasindicated Visravana for the disease Ekvrinda and this

Visravana is performed by Jalaukavacharanaaccording to Dalhana.

Raktamokshana in Shalakya can be described

under the following headings :

1. Raktamokshana in eye diseases.

2. Raktamokshana in oto-rhino-laryngeal diseases.

3. Raktamokshana in sirorogas.

Raktamokshana in eye diseases:

Sushruta has described the indications of

Siravedha in the chikitsapravibhagiyaadhyaya andout of 15 diseases indicated for Raktamokshana, 14 areSarvagatanetrarogas1-

•ÊºıÁ‚⁄ÊÁŸªÁºÃÊSÃÈ ÿÿÙ— ¬˝ÿÙª¬Ê∑§ı ø ÿı ŸÿŸÿÙ— ¬flŸÙ˘ãÿÃ‡ø –¬ÍÿÊ∂‚ÊÁŸ∂Áfl¬ÿ¸ÿ◊ãÕ‚¢ôÊÊ—SÿãºÊSÃÈ ÿÊãàÿÈ¬‡Ê◊¢ Á„ Á‚⁄Ê√ÿœŸ H

‚ÈÆ©Æ 8/8-9

The diseases indicated for Siravedha are:-

1. Sirotpatam

2. Siraharsham

3. Sashophaakshipaka

4. Ashophaakshipaka

5. Anyatovata

6. ataparyaya

7. Puyalasa

8 -11. Abhishyanda of four variety

12-15. Adhimantha of four variety

Apart from these, he has indicated

Raktamokshana in the disease Kukunaka also, whichis an infantile disease.

VatajaAbhishyanda and Adhimantha :

¬È⁄ÊáÊ‚Á¬¸·Ê ÁFÇœıSÿãºÊœË◊ãÕ¬ËÁ«U∏Ãı –SflºÁÿàflÊ ÿÕÊãÿÊÿ¢ Á‚⁄Ê◊ÙˇÊáÊ ÿÙ¡ÿÃ˜ H

‚ ÈÆ©Æ9/3

Pittaja Abhishyanda and Adhimantha :

Á¬ûÊSÿãº ¬ÒÁûÊ∑§ øÊÁäÊ◊ãÕ–⁄Q§ÊdÊfl— d¢‚Ÿ¢ øÊÁ¬ ∑§Êÿ¸◊˜ H

‚ÈÆ©Æ 10/3

KaphajaAbhishyanda and Adhimantha :

SÿãºÊÁäÊ◊ãÕı ∑§»§¡ı ¬˝flÎhı –¡ÿÃ˜ Á‚⁄ÊáÊÊ◊Õ ◊ÙˇÊáÊŸ H ‚ÈÆ©Æ 11/3

Kaphaja Abhishyanda, Adhimantha Sirotpata

and Siraharsha :

√ÿÊäÿÊÃÊZ‡øÃÈ⁄Ù˘åÿÃÊŸ˜ÁFÇœã∑§ıê÷Ÿ ‚Á¬¸·Ê –⁄‚ÒL§ºÊ⁄Ò⁄ÕflÊ Á‚⁄Ê◊ÙˇÊáÊ ÿÙ¡ÿÃ˜ H

‚ÈÆ©Æ 12/4

Sashophapaka and Ashophapaka :

‚‡ÊÙ»§‡øÊåÿ‡ÊÙ»§‡ø mı ¬Ê∑§ı ÿı¬˝∑§ËÁÃ¸Ãı–F„SflºÙ¬¬ãŸSÿ ÃG Áflº˜äflÊ Á‚⁄Ê¢ Á÷·∑§ H

‚ÈÆ©Æ 12/381

Raktamokshana In Shalakya Rogas : A Literary Review

Dr. Gulab Chand Pamnani, Dr. Itika Pamnani

Literary Review


130

Puyalasa :

¬ÍÿÊ‹‚ ‡ÊÙÁáÊÃ◊ÙˇÊáÊ¢ øÁ„Ã¢ ÃÕÒflÊåÿÈ¬ŸÊ„Ÿ¢ ø H

‚ÈÆ ©Æ 12/451

According to Vagbhatta2:-

Vagbhatta has described Raktamokshana inmany diseases of Jatrurdhva region. He has adoptedboth Siravedha and Jalaukavacharana for

Raktamokshana purpose. The indications ofSiravedha according to Vagbhatta are as below:-

1. Vartmagatarogas – Pittotklishta, Raktotklishta.

2. Sandhigatarogas – Puyalasa

3. Shuklagatarogas – All diseases depending uponconditions.

4. Krishnagatarogas – Kshtashukla, Shuddha-shukla, Sirashukla.

5. Drishtigata rogas – Timira (in selective

conditions)

6. Sarvagatarogas – Abhishyanda, Adhimantha,Sashopha and Ashophapaka.

Pittotklishta and Raktotklishta :

Á¬ûÊÊdÙÁàÄ‹CÿÙ— SflÊºÈS∑§ãœÁ‚hŸ ‚Á¬¸·Ê –Á‚⁄ÊÁfl◊ÙˇÊ— ÁFÇäÊSÿ ÁGflÎë¿˛UD¢ Áfl⁄øŸ◊˜ H

•ÆNÆ©Æ 9/16

Puyalasa :

¬Í‹Êÿ‚ Á‚⁄Ê¢ ÁfläÿûÊÃSÃ◊È¬ŸÊ„ÿÃ˜ H •ÆNÆ©Æ11/4

Shuklagatarogas :

ºÙ·ÊŸÈ⁄Ùœë¿ÈUR§·È ÁFÇäÊM§ˇÊÊ fl⁄Ê ÉÊÎÃ◊˜ –ÁÃÄÃ◊Íäfl¸◊‚ÎÄdÊflÙ ⁄∑§‚∑§ÊÁº øcÿÃ H

•ÆNÆ©Æ 11/29

Kshatashukla :

ÁGÁSGflÎmÊÁ⁄áÊÊ ¬`¥§ ˇÊÃ‡ÊÈR§ ÉÊÎÃ¢Á¬’Ã˜ –Á‚⁄ÿÊ˘ŸÈ „⁄Œ˝ÄÃ¢ ¡∂ı∑§ÊÁ÷‡ø ∂ÙøŸÊÃ˜ H

•ÆNÆ©Æ 11/30

Shuddhashukra :

ÁSÕ⁄ ‡ÊÈR§ ÉÊŸøÊSÿ ’„È‡ÊÙ˘¬„⁄º‚Î∑˜§ H •ÆNÆ©Æ 11/42

Sirashukla — Treatment like Savranashukla

Timira3 – Raktamokshana is advocated in

Pittaja, Kaphaja and Raktaja varieties of Timira. Itis contraindicated in Vataja Timira.

ºÙ·ÊŸÈ⁄ÙœŸ ø ŸÒ∑§‡ÊSÃ¢F„ÊdÁfldÊfláÊ⁄∑§ŸSÿÒ— H

•ÆNÆ©Æ13/47PittajaTimira–

Á¬ûÊ ¡ÁÃÁ◊⁄....ÁFÇäÊSÿ √ÿäÊÿÁà‚⁄Ê◊˜ H•ÆNÆ©Æ 13/63

Kaphaja Timira –

‡∂c◊Ùº˜÷fl ◊ÎÃÊ`§ÊÕfl⁄Ê∑§áÊüÊÎÃ¢ÉÊÎÃ◊˜– ÁfläÿÁà‚⁄Ê¢.........H•ÆNÆ©Æ 13/68

Raktaja Timira –

⁄ÄÃ¡ Á¬ûÊflÁà‚Áh— ‡ÊËÃÒ‡øÊd¥ ¬˝‚ÊºÿÃ H •ÆNÆ©Æ 13/73

Abhishyanda4 :

‚Á¬¸— ¬È⁄ÊáÊ¢ ¬flŸ, Á¬ûÊ ‡Ê∑¸§⁄ÿÊ˘ÁãflÃ◊˜ –√ÿÙ·Á‚h¢ ∑§»§ ¡¬ËàflÊ, ÿflˇÊÊ⁄ÊfløÍÁáÊÃ◊ HdÊflÿŒÈÁäÊ⁄¢...... H

•ÆNÆ©Æ 16/18

Sashophapaka and Ashophapaka :

‚‡ÊÙ»§ flÊ˘À¬‡ÊÙ»§ ø ÁFÇäÊSÿ √ÿäÊÿÁà‚⁄Ê◊˜–•ÆNÆ©Æ 16/31

Jalaukavacharana in eye diseases accordingto Vagbhatta5:-

1. Vartmagatarogas – Pakshmashata, Kukunaka

2. Krishnagatarogas – Kshtashukla

3. Drishtigatarogas – Kacha.

Pakshmashata :

¬ˇ◊áÊÊ¢ ‚ÃŸ ‚ÍëÿÊ ⁄Ù◊∑Í§¬ÊŸ˜ Áfl∑È§≈˜≈ÿÃ˜ –ª˝Ê„ÿmÊ ¡∂ÊÒ∑§ÙÁ÷— ¬ÿ‚ˇÊÈ⁄‚Ÿ flÊ H

•ÆNÆ©Æ 9/18-19Kukunaka :

Á‡Ê‡ÊÙSÃÈ Á‹ÁπÃ¢ flà◊¸, dÈÃÊ‚ÎÇflÊ˘ê’È¡ã◊ÊÁ÷— H •ÆNÆ©Æ 9/27


131

Kshtashukla :

ÁGÁSGflÎmÊÁ⁄áÊÊ ¬`§¢§ ˇÊÃ‡ÊÈR§ ÉÊÎÃ¢ Á¬’Ã˜–Á‚⁄ÿÊ˘ŸÈ „⁄Œ˝ÄÃ¢ ¡∂ı∑§ÊÁ÷‡ø ∂ÙøŸÊÃ˜H

•ÆNÆ©Æ 11/30Kacha :

∑§Êø˘åÿ·Ê ÁR§ÿÊ ◊ÈÄàflÊ Á‚⁄Ê¢, ÿãG ÁŸ¬ËÁ«UÃÊ— –•ÊãäÿÊÿ SÿÈ◊¸∂Ê ºlÊàÊ˜, ‚˝Ê√ÿ àflÊd ¡∂ı∑§‚— H

•ÆNÆ©Æ 13/81

Raktamokshana in the diseases of oto-rhino-laryngeal resion6:-

A. Karna – Nasagatarogas: Sushruta has not

mentioned a single disease indicated forRaktamokshana in Karna – Nasagatarogas.Vagbhatta has indicated the disease “Utpata” which

is a Karnapaliroga for Jalaukavacharana.

©à¬ÊÃ ‡ÊËÃ‹Ò‹¬Ù ¡‹ı∑§ÙNÃ˜‡ÊÙÁáÊÃ– •ÆNÆ©Æ 18/43

B. Mukhagatarogas :

The diseases of mukha, espetially those

pertaining to Oshtha, Dantamula and Kantha aremainly Kapharakta predominant and henceRaktamokshana can be done in all of them.

◊ÈπºãÃ◊Í∂ª∂¡Ê— ¬˝ÊÿÙ ⁄ÙªÊ— ∑§»§Êd ÷ÍÁÿDÊ—–ÃS◊ÊûÊ·Ê◊‚∑Î§º˜ L§ÁäÊ⁄¢ ÁfldÊflÿº˜ ºÈC◊˜ H

•ÆNÆ©Æ 22/108

According to Sushruta7:

Sushruta indicated Raktamokshana in thefollowing mukhagatarogas :-

1. Oshtharogas – Pittaja, Raktaja, Kaphaja andAbhighataja Oshthaprakopa.

Á¬ûÊ⁄ÄÃÊÁ÷ÉÊÊÃÙàÕ¢ ¡‹ı∑§ÙÁ÷L§¬Êø⁄Ã˜ H‚ÈÆÁøÆ 22/6

2. Dantamulagatarogas – Sheetada, Dantapupputa

(Taruna), Dantaveshtha, Shaushira andUpakusha.

‡ÊËÃÊº NÃ˜⁄ÄÃÃÈ.... H ‚ÈÆÁøÆ22/11

ºãÃ¬Èå¬È≈∑§ ∑§ÊÿZ ÃL§áÊ ⁄ÄÃ◊ÙˇÊáÊ◊˜H ‚ÈÆÁøÆ 22/13

ÁfldÊÁflÃ ºãÃflC..... H ‚ÈÆÁøÆ22/14

‚ÙÁ·⁄ NÃ˜⁄ÄÃÃÈ........H ‚ÈÆÁøÆ22/16

∑§Ê∑§ÙºÈê’Á⁄∑§ÊªÙ¡Ë¬GÒÁfl¸dÊflÿº‚Î∑˜§H ‚ÈÆÁøÆ 22/19

3. Jihwagatarogas – Pittakantaka.

4. Kantharogas – Rohini, Kanthashaluka and

Ekavrinda.

‚ÊäÿÊŸÊ¢ ⁄ÙÁ„áÊËŸÊ¢ ÃÈ Á„Ã¢ ‡ÊÙÁáÊÃ◊ÙˇÊáÊ◊˜ H‚ÈÆÁøÆ 22/49

ÁfldÊ√ÿ ∑§á∆‡ÊÊ∂Í∑¢§.... H‚ÈÆÁøÆ 22/64

According to Vagbhatta8 :

1. Oshtharogas – Pittaja, Raktaja and

Abhighatajaoshthaprakopa.

2. Dantamulagata rogas – Sheetada.

ÁfldÊÁflÃÊd ‡ÊËÃÊº ‚ˇÊıº˝Ò ¬˝ÁÃ‚Ê⁄áÊ◊˜H •ÆNÆ©Æ 22/27

3. Jihwarogas – Pittakantaka.

4. Kantharogas – All the diseases.

∑§á∆⁄Ùªcfl‚Î«˜U◊ÙˇÊSÃËˇáÊÒŸ¸SÿÊÁº ∑§◊¸ ø H •ÆNÆ©Æ 22/54

Raktamokshana in Sirorogas :-

Sushruta9 has described Siravedhana in one

disease only of this region i.e. Anantavata.

Á‚⁄Ê√ÿäÊ‡ø ∑§ûÊ¸√ÿÙ •ŸãÃflÊÃ¬˝‡ÊÊãÃÿ H ‚ÈÆ©Æ 26/37

Vagbhatta has described Raktamokshana inSuryavarta, Pittajasirastapa, Raktajasirastspa and

Shankhaka.

‚ÍÿÊ¸flÃ¸˘Á¬ ÃÁS◊¢SÃÈ Á‚⁄ÿÊ˘¬„⁄º‚Î∑˜§ –Á‡Ê⁄Ù˘Á÷ÃÊ¬Á¬ûÊÙàÕÁFÇäÊSÿ √ÿäÊÿÁà‚⁄Ê◊˜ H

•ÆNÆ©Æ 24/11

Vagbhatta has mentioned Raktamokshanain some Kapalagatarogas as well. These are:-

l Arunshika – Jalaukavacharana

l Darunaka – Siravedha

l Indralupta – Siravedha


132

Sites of Siravedha in Shalakya diseases:-

l Siroroga & Netraroga – Lalata Sira, Apanga

Sira, Upanasa Sira.

l Karnaroga – Sira near to karma.

l Nasaroga – Nasagra Sira.

l Peenasa – NasaSira, Lalata Sira.

l Mukharoga – Jihwa Sira, Hanu Sira, TaluSira.

Conclusion :

t Raktamokshana is a prime treatment procedure ofvarious Mukharogas specially of Dantamula-

gatarogas as described by Acharya Sushruta andVagbhatta.

t Raktamokshana is a main treatment of eye

diseases so that it is advocated in the prophylaxisof eye diseases as well.

ÁG»§∂Ê L§ÁäÊ⁄dÈÁÃÁfl¸‡ÊÈÁh—,◊Ÿ‚Ù— ÁŸflÎÁÃ⁄ •¢¡Ÿ¢ ‚ŸSÿ◊˜ –

‡Ê∑È§ŸÊ‡ÊŸÃÊ ‚¬Êº¬Í¡Ê,ÉÊÎÃ¬ÊŸ¢ ø ‚ºÒfl ŸGÊ⁄ˇÊÊ H

t The persons, used to purify their body by the

means of Raktamokshana time to time, they neverget suffered by the dushtashonitajanya diseasesviz. Mukhapaka, Akshiraga, Putighrana,

Asyagandhita, Pipasa, Siroruk, Sammoha,Lavanaasyta, Swarakshaya10.

àflÇºÙ·Ê ª˝ãÕÿ— ‡ÊÙ»§Ê

⁄ÙªÊ— ‡ÊÙÁáÊÃ¡Ê‡ø ÿ –⁄ÄÃ◊ÙˇÊáÊ‡ÊË‹ÊŸÊ¢

Ÿ ÷flÁãÃ ∑§ŒÊøŸ H‚ÈÆ‚ÍÆ 14/34

References :

1 . Vaidya Jadavji Trikamji Acharya and Narayan Ram Acharya

Kavyatirtha, Sushruta Samhita Shri Dalhanacharya-

virachitaya Nibandh sangraha vyakhya, 7th Edition, Published

by Chaukhambha Orientalia, Varanasi, 2002, Uttar Tantra 8/

9 page 610, 9/3 page 611, 10/3 page 612, 11/3 page 614, 12/

4 page 616, 12/38,45 page 618.

2. Dr. Brahmanand Tripathi, Astanga Hrdayam of Srimad

vagbhata, reprint Edition, 2009, Published by Chaukhamba

Sanskrit Pratishthan Delhi, Uttar Tantra 9/16, 11/4 page 952,

11/29 page 955, 11/30 page 955, 11/42 page 957.

3. Dr.Brahmanand Tripathi, Astanga Hrdayam of Srimad

vagbhata, reprint Edition, 2009, Published by Chaukhamba

Sanskrit Pratishthan Delhi, Uttar Tantra 13/47 page 971, 13/

63 page 973, 13/68 page 974, 13/73 page 974.

4. Dr.Brahmanand Tripathi, Astanga Hrdayam of

Srimadvagbhata, reprint Edition, 2009, Published by

Chaukhamba Sanskrit Pratishthan Delhi, Uttar Tantra 16/18

page 992, 16/31 page 993.

5. Dr.Brahmanand Tripathi, Astanga Hrdayam of


Chaukhamba Sanskrit Pratishthan Delhi, Uttar Tantra 9/18-

19 page 942, 9/27 page 944, 13/81 page 975.

6. Dr.BrahmanandTripathi, AstangaHrdayam of Srimadvagbhata,

reprint Edition, 2009, Published by Chaukhamba Sanskrit

Pratishthan Delhi, Uttar Tantra 18/43 page no. 1010, 22/108

page no. 1049.

7 . Vaidya Jadavji Trikamji Acharya and Narayan Ram Acharya

Kavyatirtha, Sushruta Samhita Shri Dalhanacharyavirachitaya

Nibandh sangraha vyakhya, 7 th Edition, Published by

Chaukhambha Orientalia, Varanasi, 2002, ChikitsaSthana 22/

6, 11,13,14,16,19, page no. 482, 22/59,64 page no. 484

8. Dr.Brahmanand Tripathi, AstangaHrdayam of


Chaukhamba Sanskrit Pratishthan Delhi, Uttar Tantra 22/27

page no. 1038, 22/54 page no. 1021.

9. Vaidya Jadavji Trikamji Acharya and Narayan Ram Acharya

Kavyatirtha, Sushruta Samhita Shri Dalhanacharyavirachitaya

Nibandh sangraha vyakhya, 7 th Edition, Published by

Chaukhambha Orientalia, Varanasi, 2002, Uttar Tantra 26/

37 page no. 658.

10. Vaidya Jadavji Trikamji Acharya and Narayan Ram Acharya

Kavyatirtha, Sushruta Samhita Shri Dalhanacharya

virachitaya Nibandh sangraha vyakhya, 7th Edition, Published

by Chaukhambha Orientalia, Varanasi, 2002, Sutra Sthana

14/34, page no. 64.


133

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134

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135

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136

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publication of a paper that overlaps substantially withone already published in print or electronic media.

Readers of primary source periodicals, whetherprint or electronic, deserve to be able to trust that whatthey are reading is original unless there is a clearstatement that the article is being republished by thechoice of the author and editor. The bases of thisposition are international copyright laws, ethicalconduct, and cost-effective use of resources. Duplicatepublication of original research is particularlyproblematic, since it can result in inadvertent doublecounting or inappropriate weighting of the results ofa single study, which distorts the available evidence.

This journal does not wish to receive paperson work that has already been reported in large partin a published article or is contained in another paperthat has been submitted or accepted for publicationelsewhere, in print or in electronic media. This policydoes not preclude the journal considering a paper thathas been rejected by another journal, or a completereport that follows publication of a preliminary report,such as an abstract or poster displayed at aprofessional meeting. Nor does it prevent the journalsconsidering a paper that has been presented at ascientific meeting but not published in full or that isbeing considered for publication in a proceedings orsimilar format.

When submitting a paper, the author mustalways make a full statement to the editor about allsubmissions and previous reports that might beregarded as redundant or duplicate publication of thesame or very similar work. The author must alert theeditor if the manuscript includes subjects about whichthe authors have published a previous report or havesubmitted a related report to another publication. Anysuch report must be referred to and referenced in thenew paper. Copies of such material should be includedwith the submitted paper.

III.D.3. Acceptable Secondary Publication

Certain types of articles, such as guidelines

produced by governmental agencies and professionalorganizations, may need to reach the widest possible

audience. In such instances, editors will choose topublish material that is also being published in other

journals. Secondary publication for various otherreasons, in the same or another language, especially inother countries and/or states, is justifiable, and can be

beneficial, provided all of the following conditions aremet.

1. The authors have received approval from theeditors of both journals; the editor concerned withsecondary publication must have a photocopy,reprint, or manuscript of the primary version.

2. The priority of the primary publication isrespected by a publication interval of at least oneweek.

3. The paper for secondary publication is intended fora different group of readers; an abbreviatedversion could be sufficient.

4. The secondary version faithfully reflects the dataand interpretations of the primary version.

5. The footnote on the title page of the secondaryversion informs readers, peers, and documentingagencies that the paper has been published inwhole or in part and states the primary reference.A suitable footnote might read: “This article isbased on a study first reported in the [title ofjournal, with full reference].”

Permission for such secondary publication shouldbe free of charge.

6. The title of the secondary publication shouldindicate that it is a secondary publication(complete republication, abridged republication,complete translation, or abridged translation) of aprimary publication. Of note, the National Libraryof Medicine does not consider translations to be“republications,” and does not cite or indextranslations when the original article waspublished in a journal that is indexed inMEDLINE.

III.D.4. Competing Manuscripts Based on theSame Study

Two kinds of competing submissions will beconsidered: submissions by coworkers who disagree onthe analysis and interpretation of their study, andsubmissions by coworkers who disagree on what thefacts are and which data should be reported.

Setting aside the unresolved question ofownership of the data, the following generalobservations may help editors and others dealing withthese problems.


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III. D.4.a. Differences in Analysis orInterpretation

If the dispute centers on the analysis orinterpretation of data, the authors should submit amanuscript that clearly presents both versions. Thedifference of opinion should be explained in a coverletter. The normal process of peer and editorial reviewof the manuscript may help the authors to resolve theirdisagreement regarding analysis or interpretation.

If the dispute cannot be resolved and the studymerits publication, both versions will be published.Options include publishing two papers on the samestudy, or a single paper with two analyses orinterpretations. In such cases it would be appropriatefor the editor to publish a statement outlining thedisagreement and the journal’s involvement inattempts to resolve it.

III.D.4. b. Differences in Reported Methodsor Results

If the dispute centers on differing opinions ofwhat was actually done or observed during the study,the journal editor will refuse publication until thedisagreement is resolved. Peer review cannot beexpected to resolve such problems. If there areallegations of dishonesty or fraud, editors will informthe appropriate authorities; authors will be notified ofeditor’s intention to report a suspicion of researchmisconduct.

III.D.5. Competing Manuscripts Based on theSame Database

Editors may sometimes receive manuscriptsfrom separate research groups that have analyzed thesame data set, e.g., from a public database. Themanuscripts may differ in their analytic methods,conclusions, or both. Each manuscript will beconsidered separately. Where interpretations of thesame data are very similar, it is reasonable but notnecessary for editors to give preference to themanuscript that was received earlier. However,editorial consideration of multiple submissions may bejustified in this circumstance, and there may even bea good reason for publishing more than onemanuscript because different analytical approachesmay be complementary and equally valid.

III.E. Correspondence

As a mechanism for submitting comments,questions, or criticisms about published articles, aswell as brief reports and commentary unrelated topreviously published articles. This will likely, but notnecessarily, take the form of a correspondence sectionor column. The authors of articles discussed in

correspondence should be given an opportunity torespond, preferably in the same issue in which theoriginal correspondence appears. Authors ofcorrespondence will be asked to declare any competingor conflicting interests.

Published correspondence may be edited forlength, grammatical correctness, and journal style.

Although editors have the prerogative to siftout correspondence material that is irrelevant,uninteresting, or lacking in cogency, they have aresponsibility to allow a range of opinion to beexpressed. The correspondence column will not beused merely to promote the journal’s, or the editors’,point of view. In all instances, editors will make aneffort to screen out discourteous, inaccurate, orlibelous statements.

In the interests of fairness and to keepcorrespondence within manageable proportions,journal may want to set time limits for responding toarticles and correspondence, and for debate on a giventopic. Journal has also set policy with regard to thearchiving of unedited correspondence that appears online. These policies should be published both in printand electronic versions of the journal.

III.F. Supplements, Theme Issues, andSpecial Series

Supplements are collections of papers thatdeal with related issues or topics, are published as aseparate issue of the journal or as part of a regularissue, and are usually funded by sources other thanthe journal’s publisher. Supplements can serve usefulpurposes: education, exchange of researchinformation, ease of access to focused content, andimproved cooperation between academic andcorporate entities. Because funding sources can biasthe content of supplements through the choice of topicsand viewpoints, this journal adopts the followingprinciples. These same principles apply to theme issuesor special series that have external funding and/orguest editors.

1. The journal editors take full responsibility for thepolicies, practices, and content of supplements,including complete control of the decision topublish all portions of the supplement. Editing bythe funding organization will not be permitted.

2. The journal editors will retain the authority to sendsupplement manuscripts for external peer reviewand to reject manuscripts submitted for thesupplement.

3. The journal editors will approve the appointment


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of any external editor of the supplement and takeresponsibility for the work of the external editor.

4. The sources of funding for the research,publication, and the products the funding sourcemake that are considered in the supplementshould be clearly stated and prominently locatedin the supplement, preferably on each page.Whenever possible, funding should come frommore than one sponsor.

5. Secondary publication in supplements(republication of papers previously publishedelsewhere) will be clearly identified by the citationof the original paper. Supplements will avoidredundant or duplicate publication. Supplementswill not republish research results, but therepublication of guidelines or other material in thepublic interest might be appropriate.

IV. Manuscript Preparation and Submission

IV.A. Preparing a Manuscript for Submission

Editors and reviewers spend many hoursreading manuscripts, and therefore appreciatereceiving with manuscripts that are easy to read andedit. Much of the information in journals’ instructionsto authors is designed to accomplish that goal in waysthat meet each journal’s particular editorial needs. Theguidance that follows provides a general backgroundand rationale for preparing manuscripts for anyjournal.

IV.A.1.a. General Principles

The text of observational and experimentalarticles is usually (but not necessarily) divided intosections with the headings Introduction, Methods,Results, and Discussion. This so-called “IMRAD”structure is not simply an arbitrary publication format,but rather a direct reflection of the process of scientificdiscovery. Long articles may need subheadings withinsome sections (especially the Results and Discussionsections) to clarify their content. Other types ofarticles, such as case reports, reviews, and editorials,are likely to need other formats.

Publication in electronic formats has createdopportunities for adding details or whole sections inthe electronic version only, layering information, cross-linking or extracting portions of articles, and the like.Authors need to work closely with editors in developingor using such new publication formats and shouldsubmit material for potential supplementary electronicformats for peer review.

Double spacing of all portions of themanuscript including the title page, abstract, text,

acknowledgments, references, individual tables, andlegends-and generous margins make it possible foreditors and reviewers to edit the text line by line, andadd comments and queries, directly on the paper copy.If manuscripts are submitted electronically, the filesshould be double spaced, because the manuscript mayneed to be printed out for reviewing and editing.

During the editorial process reviewers andeditors frequently need to refer to specific portions ofthe manuscript, which is difficult unless the pages arenumbered. Authors should therefore number all of thepages of the manuscript consecutively, beginning withthe title page.

IV.A.1.b. Reporting Guidelines for SpecificStudy Designs

Research reports frequently omit importantinformation. The general requirements listed in thenext section relate to reporting essential elements forall study designs. Authors are encouraged in additionto consult reporting guidelines relevant to their specificresearch design. For reports of randomized controlledtrials authors should refer to the CONSORTstatement. This guideline provides a set ofrecommendations comprising a list of items to reportand a patient flow diagram.

IV.A.2. Title Page

The title page should carry the followinginformation:

1. The title of the article. Concise titles are easier toread than long, convoluted ones. Titles that are tooshort may, however, lack important information,such as study design (which is particularlyimportant in identifying randomized controlledtrials). Authors should include all information inthe title that will make electronic retrieval of thearticle both sensitive and specific.

2. Authors’ names and institutional affiliations.

3. The name of the department(s) and institution(s)to which the work should be attributed.

4. Disclaimers, if any.

5. Corresponding authors. The name, mailingaddress, telephone and fax numbers, and e-mailaddress of the author responsible forcorrespondence about the manuscript (the“corresponding author;” this author may or maynot be the “guarantor” for the integrity of the studyas a whole, if someone is identified in that role.The corresponding author should indicate clearlywhether his or her e-mail address is to bepublished.


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6. The name and address of the author to whomrequests for reprints should be addressed.

7. Source(s) of support in the form of grants,equipment, drugs, or all of these.

8. Word counts. A word count for the text only(excluding abstract, acknowledgments, figurelegends, and references) allows editors andreviewers to assess whether the informationcontained in the paper warrants the amount ofspace devoted to it, and whether the submittedmanuscript fits within the journal’s word limits. Aseparate word count for the Abstract is also usefulfor the same reason.

9. The number of figures and tables. It is difficult foreditorial staff and reviewers to tell if the figuresand tables that should have accompanied amanuscript were actually included unless thenumbers of figures and tables that belong to themanuscript are noted on the title page.

IV.A.3. Conflict of Interest Notification Page

To prevent the information on potentialconflict of interest for authors from being overlookedor misplaced, it is necessary for that information to bepart of the manuscript. It should therefore also beincluded on a separate page or pages immediatelyfollowing the title page.

IV.A.4. Abstract and Key Words

An abstract should follow the title page. Theabstract should provide the context or background forthe study and should state the study’s purposes, basicprocedures (selection of study subjects or laboratoryanimals, observational and analytical methods), mainfindings (giving specific effect sizes and their statisticalsignificance, if possible), and principal conclusions. Itshould emphasize new and important aspects of thestudy or observations. Because abstracts are the onlysubstantive portion of the article indexed in electronicdatabase and the only portion many readers read,authors need to be careful that abstracts reflect thecontent of the article accurately.

3 to 10 key words or short phrases thatcapture the main topics of the article. These will assistindexers in cross-indexing the article and may bepublished with the abstract. Terms from the MedicalSubject Headings (MeSH) list of Index Medicus shouldbe used; if suitable MeSH terms are not yet availablefor present terms may be used.

IV.A.5. IntroductionProvide a context or background for the study

(i.e., the nature of the problem and its significance).

State the specific purpose or research objective of, orhypothesis tested by, the study or observation; theresearch objective is often more sharply focused whenstated as a question. Both the main and secondaryobjectives should be made clear, and any pre-specifiedsubgroup analyses should be described. Give onlystrictly pertinent references and do not include data orconclusions from the work being reported.

IV.A.6. Methods

The Methods section should include onlyinformation that was available at the time the plan orprotocol for the study was written; all informationobtained during the conduct of the study belongs inthe Results section.

IV.A.6.a. Selection and Description ofParticipants

Describe your selection of the observational orexperimental participants (patients or laboratoryanimals, including controls) clearly, includingeligibility and exclusion criteria and a description ofthe source population. Because the relevance of suchvariables as age and sex to the object of research is notalways clear, authors should explain their use whenthey are included in a study report; for example,authors should explain why only subjects of certainages were included or why women were excluded. Theguiding principle should be clarity about how andwhy a study was done in a particular way. Whenauthors use variables such as race or ethnicity, theyshould define how they measured the variables andjustify their relevance.

IV.A.6.b. Technical information

Identify the methods, apparatus (give themanufacturer’s name and address in parentheses), andprocedures in sufficient detail to allow other workersto reproduce the results. Give references to establishedmethods, including statistical methods see below;provide references and brief descriptions for methodsthat have been published but are not well known;describe new or substantially modified methods, givereasons for using them, and evaluate their limitations.Identify precisely all drugs and chemicals used,including generic name(s), dose(s), and route(s) ofadministration. Authors submitting reviewmanuscripts should include a section describing themethods used for locating, selecting, extracting, andsynthesizing data. These methods should also besummarized in the abstract.

IV.A.6.c. StatisticsDescribe statistical methods with enough detail

to enable a knowledgeable reader with access to the


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original data to verify the reported results. Whenpossible, quantify findings and present them withappropriate indicators of measurement error oruncertainty (such as confidence intervals). Referencesfor the design of the study and statistical methodsshould be to standard works when possible (withpages stated). Define statistical terms, abbreviations,and most symbols. Specify the computer softwareused.

IV.A.7. Results

Present your results in logical sequence in thetext, tables, and illustrations, giving the main or mostimportant findings first. Do not repeat in the text allthe data in the tables or illustrations; emphasize orsummarize only important observations. Extra orsupplementary materials and technical detail can beplaced in an appendix where it will be accessible butwill not interrupt the flow of the text; alternatively, itcan be published only in the electronic version of thejournal.

When data are summarized in the Resultssection, give numeric results not only as derivatives (forexample, percentages) but also as the absolutenumbers from which the derivatives were calculated,and specify the statistical methods used to analyzethem. Restrict tables and figures to those needed toexplain the argument of the paper and to assess itssupport. Use graphs as an alternative to tables withmany entries; do not duplicate data in graphs andtables. Avoid non-technical uses of technical terms instatistics, such as “random” (which implies arandomizing device), “normal,” “significant,”“correlations,” and “sample.”

Where scientifically appropriate, analyses ofthe data by variables such as age and sex should beincluded.

IV.A.8. Discussion

Emphasize the new and important aspects ofthe study and the conclusions that follow from them.Do not repeat in detail data or other material given inthe Introduction or the Results section. Forexperimental studies it is useful to begin the discussionby summarizing briefly the main findings, thenexplore possible mechanisms or explanations for thesefindings, compare and contrast the results with otherrelevant studies, state the limitations of the study, andexplore the implications of the findings for futureresearch and for clinical practice.

Link the conclusions with the goals of thestudy but avoid unqualified statements andconclusions not adequately supported by the data. In

particular, authors should avoid making statements oneconomic benefits and costs unless their manuscriptincludes the appropriate economic data and analyses.Avoid claiming priority and alluding to work that hasnot been completed. State new hypotheses whenwarranted, but clearly label them as such.

IV.A.9. References

IV.A.9.a. General Considerations Related toReferences

Although references to review articles can bean efficient way of guiding readers to a body ofliterature, review articles do not always reflect originalwork accurately. Readers should therefore be providedwith direct references to original research sourceswhenever possible. On the other hand, extensive listsof references to original work on a topic can useexcessive space on the printed page. Small numbers ofreferences to key original papers will often serve as wellas more exhaustive lists, particularly since referencescan now be added to the electronic version ofpublished papers, and since electronic literaturesearching allows readers to retrieve publishedliterature efficiently.

Avoid using abstracts as references. Referencesto papers accepted but not yet published should bedesignated as “in press” or “forthcoming”; authorsshould obtain written permission to cite such papersas well as verification that they have been accepted forpublication. Information from manuscripts submittedbut not accepted should be cited in the text as“unpublished observations” with written permissionfrom the source.

Avoid citing a “personal communication”unless it provides essential information not availablefrom a public source, in which case the name of theperson and date of communication should be cited inparentheses in the text. For scientific articles, authorsshould obtain written permission and confirmation ofaccuracy from the source of a personalcommunication.

Some journals check the accuracy of allreference citations, but not all journals do so, andcitation errors sometimes appear in the publishedversion of articles. To minimize such errors, authorsshould therefore verify references against the originaldocuments. Authors are responsible for checking thatnone of the references cite retracted articles except inthe context of referring to the retraction. For articlespublished in journals indexed in MEDLINE, theICMJE considers PubMed the authoritative source forinformation about retractions.


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IV.A.9.b. Reference Style and Format

The Uniform Requirements style is basedlargely on an ANSI standard style adapted by theNational Library of Medicine (NLM) for its databases.For samples of reference citation formats, authorsshould consult National Library of Medicine web site.

References should be numbered consecutivelyin the order in which they are first mentioned in thetext. Identify references in text, tables, and legends byArabic numerals in parentheses. References cited onlyin tables or figure legends should be numbered inaccordance with the sequence established by the firstidentification in the text of the particular table orfigure. The titles of journals should be abbreviatedaccording to the style used in Index Medicus.

This Journal requires that the references fromthe Ayurvedic classics should be cited withinparentheses in the text, i.e. ( Cha. Soo. 25/40).

IV.A.10. Tables

Tables capture information concisely, anddisplay it efficiently; they also provide information atany desired level of detail and precision. Includingdata in tables rather than text frequently makes itpossible to reduce the length of the text.

Type or print each table with double spacingon a separate sheet of paper. Number tablesconsecutively in the order of their first citation in thetext and supply a brief title for each. Do not useinternal horizontal or vertical lines. Give each columna short or abbreviated heading. Authors should placeexplanatory matter in footnotes, not in the heading.Explain in footnotes all nonstandard abbreviations.For footnotes use the following symbols, in sequence:

*,†,‡,§,||,¶,**,††,‡‡

Identify statistical measures of variations, suchas standard deviation and standard error of the mean.

Be sure that each table is cited in the text.

If you use data from another published orunpublished source, obtain permission andacknowledge them fully.

Additional tables containing backup data tooextensive to publish in print may be appropriate forpublication in the electronic version of the journal. Inthat event an appropriate statement will be added tothe text. Submit such tables for consideration with thepaper so that they will be available to the peerreviewers.

IV.A.11. Illustrations (Figures)

Figures should be either professionally drawn

and photographed, or submitted as photographicquality digital prints. In addition to requiring a versionof the figures suitable for printing, this Journal asksauthors for electronic files of figures in a format (e.g.,JPEG or GIF) that will produce high quality images inthe web version of the journal; authors should reviewthe images of such files on a computer screen beforesubmitting them, to be sure they meet their ownquality standard.

For x-ray films, scans, and other diagnosticimages, as well as pictures of pathology specimens orphotomicrographs, send sharp, glossy, black-and-white or color photographic prints, usually 127 x 173mm (5 x 7 inches). Letters, numbers, and symbols onFigures should be clear and even throughout, and ofsufficient size that when reduced for publication eachitem will still be legible. Figures should be made asself-explanatory as possible. Titles and detailedexplanations belong in the legends, however, not onthe illustrations themselves.

Photomicrographs should have internal scalemarkers. Symbols, arrows, or letters used inphotomicrographs should contrast with thebackground.

If photographs of people are used, either thesubjects must not be identifiable or their pictures mustbe accompanied by written permission to use thephotograph. Whenever possible permission forpublication should be obtained.

Figures should be numbered consecutivelyaccording to the order in which they have been firstcited in the text. If a figure has been published,acknowledge the original source and submit writtenpermission from the copyright holder to reproduce thematerial. Permission is required irrespective ofauthorship or publisher except for documents in thepublic domain.

IV.A.12. Legends for Illustrations (Figures)

Type or print out legends for illustrationsusing double spacing, starting on a separate page, withArabic numerals corresponding to the illustrations.When symbols, arrows, numbers, or letters are used toidentify parts of the illustrations, identify and explaineach one clearly in the legend. Explain the internalscale and identify the method of staining inphotomicrographs.

IV.A.13. Units of Measurement

Use only standard Units of Measurements. Ifsome new measurements or scoring patterns are usedthey should be explained in detail in the text.


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IV.A.14. Abbreviations and Symbols

Use only standard abbreviations; the use ofnon-standard abbreviations can be extremelyconfusing to readers. Avoid abbreviations in the title.The full term for which an abbreviation stands shouldprecede its first use in the text unless it is a standardunit of measurement.

IV.B Sending the Manuscript to the Journal

This Journal accepts electronic submission ofmanuscripts, whether on disk or attachments toelectronic mail. Electronic submission saves time aswell as postage costs, and allows the manuscript to behandled in electronic form throughout the editorialprocess (for example, when it is sent out for review).When submitting a manuscript electronically, authorsshould consult with the instructions for authors of thejournal they have chosen for their manuscript.

If a paper version of the manuscript issubmitted, send the required number of 6 copies of themanuscript and figures; they are all needed for peerreview and editing, and editorial office staff cannot beexpected to make the required copies.

Manuscripts must be accompanied by a coverletter, which should include the following information.

l A full statement to the editor about all submissionsand previous reports that might be regarded asredundant publication of the same or very similarwork. Any such work should be referred tospecifically, and referenced in the new paper.Copies of such material should be included withthe submitted paper, to help the editor decide howto handle the matter.

l A statement of financial or other relationships thatmight lead to a conflict of interest, if thatinformation is not included in the manuscriptitself or in an authors’ form

l A statement that the manuscript has been readand approved by all the authors, that therequirements for authorship as stated earlier inthis document have been met, and that eachauthor believes that the manuscript representshonest work, if that information is not provided inanother form; and

l The name, address, and telephone number of thecorresponding author, who is responsible forcommunicating with the other authors aboutrevisions and final approval of the proofs, if thatinformation is not included on the manuscriptitself.

The letter should give any additional

information that may be helpful to the editor, such asthe type or format of article in the particular journalthat the manuscript represents. If the manuscript hasbeen submitted previously to another journal, it ishelpful to include the previous editor’s and reviewers’comments with the submitted manuscript, along withthe authors’ responses to those comments. Editorsencourage authors to submit these previouscommunications and doing so may expedite the reviewprocess.

Copies of any permission to reproducepublished material, to use illustrations or reportinformation about identifiable people, or to namepeople for their contributions must accompany themanuscript.

V. Use of Standardized Ayurvedaterminologies and National AyurvedaMorbidity Codes in Research Publications

As you are aware, a huge corpus of medicalterminology is available in the classical literature ofAyurveda. In an era where the popularity of Ayurvedais reaching far and wide, time has come to developeffective communication about Ayurveda among allstakeholders to improve productive cooperation amongindividuals and nations having common interests withrespect to Ayurveda. Scientific writing plays a majorrole in communication among stakeholders and has animportant role to play in this regard. However, due toambiguities in the usage of terminologies, lack ofstandardization of terminologies and absence ofstandard guidelines, tendency to translate and useterminologies as per individual wish has become acommon parlance due to which the credibility ofAyurveda at large in the international scenario is beingaffected. If we compare the translations of the sameterm used in different journals, differences in thetranslation and meaning are found. This is moreimportant in case of diagnostic terms because thesame disease name in Ayurveda is translated indifferent ways by different authors. Thus in order tobring uniformity in the use of Scientific terminologyand also in translations of scientific terminology ofAyurveda, the Central Council for Research inAyurvedic Sciences, on the Directives of the Ministryof AYUSH has developed and published a documentof Standard Ayurveda Terminologies in two volumesas an initial step in this regard.

2. Standardized Ayurveda Terminologies (SAT)along with National Ayurveda Morbidity Codes(NAMC) has been made available in public domainthrough a portal named “National AYUSH Morbidityand Standardized Terminologies Portal (NAMSTP)”


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which is hosted at the following URL: http://namstp.ayush.gov.in.

3. The portal was launched by Hon’ble PrimeMinister of India on the occasion of 2nd Ayurveda Day(17th October 2017) at All India Institute of Ayurveda,New Delhi. The portal provides StandardizedTerminologies & Morbidity Codes for Ayurveda,Siddha and Unani systems of medicine along withW.H.O ICD-10/11 codes meant for dual coding andmorbidity reporting for Yoga, Naturopathy andHomoeopathy Systems. These are meant forunambiguous reporting, electronic data submissionthrough individual institutions and gradually movingtowards adopting Electronic Health Records (E.H.R.).

4. For effective implementation of the same,there is need for co-ordination and understandingamong the various stakeholders. The document hasbeen prepared after extensive deliberations andconsultations. Each term has been a specific alphanumeric code and the names of diseases hare beengiven a separate title National Ayurveda MorbidityCodes.

5. Ministry of AYUSH has also initiated effortsfor centralized collection of morbidity statisticspertaining to various systems of medicine under theMinistry viz. Ayurveda, Yoga & Naturopathy, Unani,Siddha and Homeopathy through the NAMSTP.

6. In this connection, please note that theusage of Morbidity codes and the portal has thepotential to revolutionize morbidity statistics datacollection and health care delivery reporting potentialpertaining to AYUSH systems and bring to light thecontribution of AYUSH systems to the health caredelivery system of our country on real time basis andthe benefits of sustaining such activity is expected tohave positive bearing on future policy making.

7. Keeping in view of the above. it is requestedto kindly go through the contents of the portal (http://namstp.ayush.gov.in) and explore the possibility ofmaking the usage of Standardized AyurvedaTerminologies (for translation of scientific terms) andNational Ayurveda Morbidity Codes (for translation ofdiagnostic terms as well as mentioning the Diseasecode against the names of the morbidity conditionsmentioned in the paper) mandatory for publication ofresearch papers.

V. References

A. References Cited in this Document

1 . Davidoff F for the CSE Task Force on Authorship. Who’s the

Author? Problems with Biomedical Authorship, and Some

Possible Solutions. Science Editor. July-August 2000:

Volume 23 - Number 4: 111-119.

2. Yank V, Rennie D. Disclosure of researcher contributions: a

study of original research articles in The Lancet. Ann Intern

Med. 1999 Apr 20;130(8):661-70.

3. Flanagin A, Fontanarosa PB, DeAngelis CD. Authorship for

research groups. JAMA. 2002;288:3166-68.

4. Peer Review in Health Sciences. F Godlee, T Jefferson.

London: BMJ Books, 1999.

5. World Medical Association Declaration of Helsinki: ethical

principles for medical research involving human subjects.

JAMA. 2000 Dec 20;284(23):3043-5.

6. Pitkin RM, Branagan MA, Burmeister LF. Accuracy of data in

abstracts of published research articles. JAMA. 1999 Mar 24-

31;281(12):1110-1.

7 . Patrias K. National Library of Medicine recommended formats

for bibliographic citation. Bethesda (MD): The Library; 1991.

B. Other Sources of Information Related to Biomedical

Journals

World Association of Medical Editors (WAME)

www.WAME.org <http://www.WAME.org>

Council of Science Editors (CSE)

www.councilscienceeditors.org <http://

www.councilscienceeditors.org>

European Association of Science Editors (EASE)

www.ease.org.uk <http://www.ease.org.uk>

Cochrane Collaboration www.cochrane.org <http://

www.cochrane.org>

The Mulford Library, Medical College of Ohio www.mco.edu/

lib/instr/libinsta.html <http://www.mco.edu/lib/instr/

libinsta.html>

“This is a reprint (with minor alterationsaccording to the need of this Journal ) of the

ICMJE Uniform Requirements for ManuscriptsSubmitted to Biomedical Journals. The editors ofthis Journals prepared this altered version. The

ICMJE has neither endorsed nor approved thecontents of this reprint. The ICMJE periodicallyupdates the Uniform Requirements, so this reprint

prepared on 1.1.2007 may not accurately representthe current official version at www.ICMJE.org<http://www.ICMJE.org>. The official version of

the Uniform Requirements for ManuscriptsSubmitted to Biomedical Journals is located atwww.ICMJE.org <http://www.ICMJE.org>.”


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Annexure I

Manuscript no. JOA/NIA/200 /

Authorship Criteria and ResponsibilityFinancial Disclosure, Acknowledgment and Copyright Transfer Form

Manuscript Title :

I/We certify that the manuscript represents valid work and that neither this manuscript nor one with

substantially similar content under my/our authorship has been published or is being considered for

publication elsewhere. For papers with more than 1 author, We agree to allow the corresponding author to

serve as the primary correspondent with the editorial office, to review the edited typescript and proof.

I/We have seen and approved the submitted manuscript. All of us have participated sufficiently in

the work to take public responsibility for the contents. All the authors have made substantial contributions to

the intellectual content of the paper and fulfil at least 1 condition for each of the 3 categories of contributions:

i.e., Category 1 (conception and design, acquisition of data, analysis and interpretation of data), Category 2

(drafting of the manuscript, critical revision of the manuscript for important intellectual content) and Category

3 (final approval of the version to be published).

I/We also certify that all my/our affiliations with or financial involvement with any organization or

entity with a financial interest in or financial conflict with the subject matter or materials discussed in the

manuscript are completely disclosed on the title page of the manuscript. My/our right to examine, analyze,

and publish the data is not infringed upon by any contractual agreement. I/We certify that all persons who

have made substantial contributions to the work reported in this manuscript (e.g., data collection, writing or

editing assistance) but who do not fulfil the authorship criteria are named along with their specific

contributions in an acknowledgment section in the manuscript. If an acknowledgment section is not included,

no other persons have made substantial contributions to this manuscript. I/We also certify that all persons

named in the acknowledgment section have provided written permission to be named.

The author(s) undersigned hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership,

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Annexure II

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146

Ayurveda News and Views

*Dr. Rizwana Parveen

*Sr. Research Fellow-Journal of Ayurveda, NIA, Jaipur

National & Internal Seminars & Fairs

l International Seminar on Multi-disciplinaryApproaches to Non-communicable Diseases,

organized by Banaras Hindu University, Varanasi. Date : 6th and 7th April 2018.

l 26th International Conference Ayurveda &

Women’s Health, organized at Best Western Hotel& Conference Center, Bethlehem.Date : 6th to 8th April, 2018.

l SHALYARNAVAHA-2018: National Seminar onShalyatantra, organized by Sumatibhai ShahAyurved Mahavidyalaya, Pune. Date:8/04/2018

l International Conference On Recent Advances andFuture Perspectives in Ayurveda and Yoga,organized by Banaras Hindu University, Varanasi.

Date : 8th and 9th April 2018.l Skill-cum-Technology Up-Gradation Programme

on “Cultivation and Primary Processing of

Economically Important Medicinal and AromaticPlants”, organized by CSIR-Central Institute forMedicinal and Aromatic Plants.

Date : 10th to 12th April, 2018.l National Seminar on Ayurvedic Approach to

Combat Skin Disorders, Their Clinical

Presentation & Treatment, organized by Major S.D.Singh PG Ayurvedic Medical College &Hospital, Farrukhabad. Date : 14th April, 2018.

l Ayurveda conference, organized at Portside Conference Centre, Sydney.Date : 14th and 15th April, 2018.

l 6th Edition Of International Conference OnPharmacognosy And Medicinal Plants,organized at Amsterdam, Netherlands.

Date : 16th and 17th April, 2018.l National Seminar on “Role of Basic Sciences to

Develop Diagnostic Tools for Srotodushti w.s.r to

Purvarupa of Metabolic Disorders, organized atBanaras Hindu University, Varanasi. Date : 16th and 17th April 2018.

l 14th Annual NAMA Conference: Ayurveda For AHealthy World, organized at Plano, Texas.Date : 20th to 22nd April, 2018.

l A National Conference on “Necessity of

Short Communication

Dinacharya” in Present Era, organized by IndianInstitute of Ayurved Research & Hospital, Rajkot. Date : 21st and 22nd April 2018.

l Nadi Vijnana Workshop, organized by NationalAyurveda Students & Youth Association,Rajasthan. Date : 23rd to 25th April 2018.

l 11th Annual Conference: Pre-conference Workshop2 Prescribing skills, Research, Training andAssessment, organized by South Asian College of

Clinical Pharmacology, Mumbai.Date : 30th April, 2018.

l Clinical Pharmacology: Contributing to Global

Health and Policies, organized by ICMR-NIRRH, Mumbai & MUHS, Nashik. Date : 29th April to 2nd May 2018.

l The Yogsala Expo 2018: International AyurvedaSeminar, organized at Pragati Maidan, NewDelhi. Date : 4th to 6th May, 2018.

l Cinical Yoga Therapy Workshop,organized by Morarji Desai National Institute ofYoga, New Delhi. Date : 5th May, 2018.

l Training Course on “Clinical and MolecularGenetics (2018)”, organized at ICMR-NationalInstitute for Research in Reproductive Health,

Mumbai. Date : 7th May to 1st June, 2018.l National Seminar “ANVESHANA-2018”,

organized by Pt. Dr. Shivshakti Lal Sharma

Ayurved Medical College, Ratlam. Date : 13th and 14th May, 2018.

l AyurGenica-2018: International Conference on

“Ayurveda and Holistic Healing”, organized by Arkashine Health Sciences, Satara.Date : 15th May, 2018.

l Regional Seminar Regional Seminar on Prospectsof Yoga & Naturopathy in Health Care System inPresent Era, organized by North Eastern Institute

of Ayurveda & Homoeopathy, Shillong. Date :29th to 31st May, 2018.

l Summer Yoga Workshop for Children - 2018,

organized by Morarji Desai National Institute ofYoga, New Delhi. Date:21st May-20th June, 2018.

l Seminar on “Latest Research & Practical Tips in


147

Panchakarma” & “Management of Life StyleDisorders”, organized by Pandith Taranath

Ayurveda Foundation, Karnataka. Date : 3rd June, 2018.

l Skill-cum-Technology Up-gradation Programme on

“Cultivation and Primary Processing ofEconomically Important Medicinal and AromaticPlants”, organized at Central Potato Research

Institute, Shimla. Date : 6th to 8th June, 2018.

l PRABHASHANAM - 2018, organized at

Ayurveda Academy, Bengaluru.Date : 6th to 10th June

l 2nd World Congress and Expo on Traditional and

Alternative Medicine, organized at Hotel MercureRoma West, Rome, Italy. Date : 14th to 16th June, 2018.

l 4th International Day of Yoga 2018, organized by Ministry of AYUSH. Date : 21st June, 2018.

l International Seminar by Vishwa Ayurved Parishad

& Vishva Hindi Manch, organized at Lal BahadurShastri Centre for Indian Culture, Uzbekistan. Date : 21st to 25th June, 2018.

l Workshop on Medical Varmalogy, organized by Ayurveda Medical Association ofIndia. Date : 22nd to 24th June, 2018.

l 3-Days National Workshop on Flow Cytometry, organized by ICMR-National Institute forResearch in Environmental Health, Bhopal.

Date : 27th to 29th June, 2018.l National Workshop Yogya-2018, organized at

Mahatma Gandhi Ayurved College, Hospital &

Research Centre, Wardha. Date : 29th June, 2018.

l National Workshop on “GRAHYA-18”,

organized by Shri B.M. Kankanwadi AyurvedaMahavidyalaya, Belagavi. Date : 29th June, 2018

CAMPUS NEWS:

1. World Yoga day was celebrated amid wide fanfareat National Institute of Ayurveda Jaipur. Threeday program was organized in the institute-

l 19.06.2018- from 6 to 7:30 a.m., yoga yatra wasorganized from institute to Ramgarh mod andthen back to the institute. 388 people participated

along with the chief guest Ramcharan Bohra, MPJaipur.

l 20.06.2018- from 2:30-4:30 p.m., yoga

demonstration on ‘yoga in pain management’.Participation of 428 people was witnessed.

l 21.06.2018- from 6 to 7:30 a.m.,yoga protocoldemonstration and co-ordination under ‘yoga forall’, involving 587 participants.

l Delegations led by Dr. Durgawati Devi and Dr.Kashi Nath Samagandi visited and instructed yogaevents at Budapest Hungary, Beijing China and

Geneva Switzerland.

l A workshop for mental and behavioural disordersin 40 plus women and their management by Yoga

was successfully organized in the NIA premises.

2. On the occasion of yoga unit completing 21 years,Sh. Girdhar Sharma (yoga instructor) and Sh.

Narendra Dhaneta (staff) were honored byDirector NIA for their dedicated services

3. Prof. Kamalesh Kumar Sharma nominated as

chairman of PG education committee and asmember of Textbook for Teacher’s TrainingCommittee in CCIM India.

4. Prof. Pawankumar Godatwar received AYUSHaward of CCRAS 2017 ‘’Best Teacher award ’’ inClinical category (Research Methodology ).

5. Dr. Asit K. Panja received AYUSH award ofCCRAS 2017 ‘’Young Scientist award’’ in LiteraryResearch

6. Four different Certificate course were organizedsuccessfully in the month of June by Departmentof Dravya Guna Vigyan.

7. National Innovation Foundation of Department ofScience and Technology presented various leadspertaining to Ayurvedic research in the NIA for

higher studies.

8. The first state level CME on ‘ Recent Advances inRetinal Diseases and its Management’ was

organized by Shalakya Tantra Department onApril 26th 2018.

NATIONAL AND INTERNATIONAL NEWS

EVENTS

Department of Ayurveda, Himachal PradeshRecruitment 2018: 100 Ayurvedic Medical

Officer Posts, Apply before 20th April 2018

April 7, 2018, Department of AyurvedaHimachal Pradesh Recruitment 2018 application

process to recruit 100 candidates for the post of


148

Ayurvedic Medical Officers has begun on its officialwebsite - hpayurveda.nic.in. Applications are invited

from candidates who are Bonafide Himachali. Theselected candidates will get Class-I Gazetteddesignation. Interested and eligible applicants must

apply for the post on or before 20th April 2018 whileapplicants residing in remote areas can submit theirapplications till 30th April 2018.

International Yoga Day celebrations begin inUS

Jun 17, 20, WASHINGTON/NEW YORK:

Hundreds of yoga enthusiasts gathered to flex theirbody at historic monuments of the US, including theCapitol Hill, kick-starting a host of events planned this

week to mark the fourth anniversary of theInternational Day of Yoga. n New York, peoplegathered at the Governors Island in the backdrop of

the iconic Statue of Liberty and the Manhattan skylineto participate in the Yoga Day commemorationorganised by the Consulate General of India. The two-

hour event ‘Let Yoga Govern Your Life’ organisedyesterday by the Consulate General of India in NewYork, included meditation and a guided yoga session

based on ‘Common Yoga Protocol’ conducted with thehelp of yoga demonstrators and teachers. People fromvarious backgrounds, accompanied with their families,

participated in the yoga sessions, performing the SuryaNamaskar, Pranayama, various yoga asanas andbreathing exercises. Among the highlights of the event

was an impressive Mallakhambh performance bychildren. Specially designed yoga kits and T-shirts weredistributed to those in attendance. Addressing the

gathering, Congresswoman Carolyn Maloney, the ChiefGuest for the event, said yoga is a “unique way” toapproach an individual’s health and well-being. A yoga

practitioner herself, Maloney said she considers theancient practice one of the best ways to exercise andrelax at the same time.

PM to lead Yoga Day celebrations inUttarakhand

June 21 , 2018, DEHRADUN: Prime Minister

Narendra Modi will lead fourth International Yoga Daycelebrations here in Uttarakhand on Thursday in thepresence of thousands of volunteers performing yoga

“asanas”. He will start the event from the lawns ofForest Research Institute when a series of yoga relatedevents will be organised around the world to mark the

occasion. In a statement, Modi on Wednesday greeted

yoga enthusiasts across the world, saying “yoga is notjust a set of exercises that keeps the body fit. It is a

passport to health assurance, a key to fitness andwellness”. “Nor is yoga only what you practice in themorning. Doing your day-to-day activities with

diligence and complete awareness is a form of yoga aswell,” he said. “In a world of excess, yoga promisesrestraint and balance. In a world suffering from

mental stress, yoga promises calm. In a distractedworld, yoga helps focus. In a world of fear, yogapromises hope, strength and courage.” Earlier, the

Prime Minister took to social media to share theintricacies of various yoga asanas and posted picturesof people performing yoga at various locations across

the world. The Prime Minister participated in yogacelebrations at Rajpath in New Delhi in 2015, theCapitol Complex in Chandigarh in 2016, and the

Ramabai Ambedkar Sabha Sthal in Lucknow in 2017.

1.50 lakh wellness centres to be set up by2022: JP Nadda

Jun 22, 2018, SHIMLA: Over 1.50 lakhwellness centres will be set up by 2022 across thecountry and each centre will have yoga facility,

Minister of Health and Family Welfare J P Nadda saidat an event to mark the fourth International Yoga Dayon Thursday. The Union minister along with

Himachal Governor Acharya Dev Vrat, Chief MinisterJai Ram Thakur, and Education Minister SureshBhardwaj participated at the event held in the historic

Ridge Ground here. It was organised by theDepartment of Ayurved. Speaking after the function,Nadda said, “1.50 lakh wellness centres would be set

up by 2022 and each centre would have facility foryoga.” He said that 1,50 lakh health sub centres andprimary health centres would be upgraded into

wellness centres with modern facilities for treatment.

Sources of information

1 . www.ayurvednews.com

2. www.ayurvista.net

3. www.ayurvedforum.com

4. www.ayurvedictalk.com

5. www.liveayurved.com

6. www.ians.in

7 . www.naturalproductsasia.com

8. http://expressbuzz.com

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