Datta Meghe Institute of Higher Education and Research

(Deemed to be University)
Re- accredited by NAAC (4th cycle with “A++” GRADE (CGPA 3.78)
Mahatma Gandhi Ayurved College, Hospital & Research Centre,
Salod (H), Wardha

CLINICAL RESEARCHES
IN
AYURVEDA
CLINICAL ADVANCES IN AYURVEDA

e- Book

EDITORS
Dr.Arun Wankhede
Dr.Bhushan Mhaiskar
Dr.Sushama Khirodkar
Constituent Unit of

ISBN: 978-936039-103-4
 Of

The Chapters included in this volume were part of the book cited on the
cover and title page. Chapters were selected and subject to review by the
members of the scientific committee. The Chapters published in this book reflect
the work and thoughts of the authors and are published green as submitted. The
publishers are not responsible for the validity of the information or for any
outcomes resulting from reliance thereon.
Editors
Dr. Arun Wankhede
MD (Rognidan) Fellowship in Panchkarma [Sch], PhD [Sch]
Professor and Head Dept. of Rognidan,
Mahatma Gandhi Ayurved College Hospital and Research Centre,
Salod (H), Wardha, Maharashtra

Dr. Bhushan Mhaiskar

MD (Samhita and Siddhant), Fellowship in Panchkarma [Sch], PhD [Sch]
Associate Professor, Dept. of Samhita and Siddhant,
Mahatma Gandhi Ayurved College Hospital and Research Centre,
Salod (H), Wardha, Maharashtra

Dr Sushama R Khirodkar
M.D. Ayurved (Swasthvritta), Ph.D. (Scholar),
Associate Professor Department of Swasthvritta
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod (H),
Wardha

Published by
The Registrar,
Datta Meghe Institute of Higher Education and Research
(Deemed To Be Univerity)
 A Datta Meghe Institute of Medical science currently as a Datta Meghe
Institute of Higher Education and Research (Deemed to be University) was
granted the status of Deemed to be University by University Grants Commission,
on 24th May, 2005. Immediately after getting the Deemed to be University status,
the DMIHER DMIMS (DU), has opted for inspection by National Assessment &
Accreditation Council, and accordingly Peer Team from NAAC inspected the
DMIHER DMIMS (DU), campus and its constituent units and accredited the
DMIHER DMIMS (Deemed to be University) with ‘A’ Grade, in March 2007.
Thereafter, Datta Meghe Institute of Medical Sciences (Deemed to be University)
was conferred ‘A’ Grade status by the Ministry of HRD, Government of India
amongst the Deemed Universities in the Country, in the month of May 2013. It
has been reaccredited with the ‘Grade A’ by the National Assessment and
Accreditation Council (NAAC) for a period of fiveyears, in March 2013.
Thereafter, in the 3rd cycle of re-accreditation by the NAAC, the University
hasbeen re-accredited with “A+” Grade making it a unique Health Sciences
University in the County to have such a unique distinction, in the 3rd cycle of its
re-accreditation, in the year 2017. In the 4rth cycle of re-accreditation by the
NAAC, the University has been re-accredited with “A++” Grade making
remarkable position of distinction, in the 4rth cycle of its re-accreditation, in the
year 2023 with 3.78 CGPA grade. The university topped in NIRF & Times
Higher Education Impact Rankings 2022 rankings.
Subsequently, it was placed in ‘Category-I Deemed to be University’ as
per University Grants Commission (Categorisation of Universities only) for grant
of graded autonomy, regulations 2018. It has also been included in the list of
Deemed to be Universities under 12 B of UGC act, 1956. The University is also
received the prestigious Dr. B.C. Roy Award for Institutional Research. The
constituent Units of Deemed University are located in a 125 acre campus in
Sawangi (Meghe), Wardha about 80 kms from Nagpur, Maharashtra, India,
which is the geographic centre of India. It is located away from the hustleand
bustle of the city amidst serene surroundings in a self sustaining complex with an
excellentacademic ambience. It is very well connected by road, rail and air (via
Nagpur) to all the major cities inthe country and abroad.
 Preface

This book is addresses the clinical researches in Ayurveda, identifies the research
hunting potential of faculties which requires an understanding of how political, social and
scientific factors intersect to express Ayurveda in today’s era as a unique science. The
content of this book is according updates in research and advances in clinical methods. All
the types of clinical researches are covered in this book regarding case reports, original
research and clinical research review.
Along with the book also included one special 35 chapters regarding current and
emergent medicinal cases, dermatology cases, rare cases, pre clinical studies, new lifestyle
disorders, I hope the book will fulfill the need of every research scholar, and Post graduate
students & faculties in Ayurveda.

Acknowledgements:
First we thank all our family members specially our 14 yrs daughter Ku. Nakshtra for her
unconditional love, immense support and encouragement. Without her help it would not
have been possible for us to finish the task smoothly. We express my sincere thanks to our
Mahatma Gandhi Ayurved College Management Team specially our inspiration Our
Honorable Chancellor Shri. Dattaji Meghe, Respected Honorable Shri. Sagarji Meghe sir,
Shri. DR.Abhyuday Meghe sir, Shri. Ravi Meghe sir and I also express sincere thanks to our
DMIHER executives Pro-chancellor, Dr Vedprakash Mishra sir, our V.C. Dr. Lalit Waghmare
sir, Pro-V.C. Dr. Gaurav Mishra sir, Our Deputy general Dr.Rajiv Borle sir, Chief Co-
coordinator Dr.S.S. Patel sir, Respected Registrar Dr.Shweta Kale-Pisulkar, We also express
our sincere thanks to Mahatama Gandhi Ayurved college teachers and collogues specially
our Dean Dr.Vaishali Kuchewar madam, Dean Academics Dr. Anita Wanjari madam, sir, Vice
Dean Dr.Gaurav Sawarkar sir. We immensely thankful to Dr. Bhushan Mhaiskar who and
make all necessary techno support for making this book.

Dr.Arun Uttam Wankhede

Dr. Bhushan Deoraoji Mhaiskar
Dr.Sushama R Khirodkar
Wardha l 29 Sept 2023
 Dr. Vaishali Kuchewar
Dean
MGACH&RC

Message

Warm and Happy greeting to all.

I am immensely happy that Clinical Researches In Ayurveda; e-book was published online.
online

Every year, Our DMIHER University offers some academic enriching activities like Seminar,
workshop, Quiz etc. and promoting publishing books and research articles to enhance the
knowledge of Faculties, Postgraduates
ostgraduates Undergraduates under
nder the able guidance of our
management, MGAC continues to walk on the way of success with confidence.

I also congratulate editors,, authors and chapter contributors for their chapter publishing in
this e book.

Dr. Vaishali Kuchewar

Dean
MGACH&RC
Salod (H), Hirapur, Wardha.
 Section Sr. No Chapter Name Chapter Author Page
No.
1. CONTRIBUTION OF AYURVEDA FOR THE Dr.Sawarkar 1-12
MANAGEMENT OF Gaurav
AVABAHUK(ADHESIVE CAPSULITIS) -A Dr.Sawarkar
CASE REPORT Punam
2. A COLLABORATIVE APPROACH OF Dr.Sawarkar 13-20
PANCHAKARMA & PANCHAGAVYA Punam,
CHIKITSA FOR THE MANAGEMENT OF Dr.Sawarkar
ATOPIC DERMATITIS INDUCED BY Gaurav,
DUSHTA STANYA IN MALE CHILD- Dr. Bhojaraj
A CASE REPORT Nandini
3. THERAPEUTIC CARDIO PROTECTIVE Dr.Bhushan 21-28
EFFECT OF ARJUNA DECOCTION AND Mhaiskar,
JATAMANSI SHIRODHARA IN ESSENTIAL Dr. Rutuja
HYPERTENSION -A CASE REPORT Mhaiskar

4. AYURVEDIC MANAGEMENT ON Dr.Shweta Parwe, 29-39

PAKSHAGHAT W.S.R TO Vivek Kumar
HAEMORRHAGIC HEMIPLEGIA A CASE Verma,
REPORT Dr. Milind
Case Reports

Nisargandha
5. BLOODLETTING AS AN AYURVEDIC Dr.Chakole Dipika 40-48
TREATMENT PRINCIPLE IN Arun, Dr.Manyala
MANAGEMENT OF DISEASE: A CASE Shanti
REPORT
6. IMPORTANCE OF LEKHAN KRAMA IN Dr .Pratapwar 49-51
ULCER- A CLINICAL CASE STUDY Aniket,
Dr. Desai Rajdatta,
Dr Tasare Prashant,
7. EFFICACY OF AYURVEDA Dr.Renu Bharat 52-58
INTERVENTIONS IN A CHILD WITH Rathi,
AUTISM CUM DEVELOPMENTAL DELAY- Dr.Bharat J. Rathi
A PEDIATRIC CASE STUDY
8. A CASE STUDY ON AYURVEDIC Dr.Deshmukh 59-68
MANAGEMENT OF KITIBHAKUSHTA Sourabh
Gyanranjan
Dr.Thakare Trupti
Ishwardas
9. SUCCESSFUL MANAGEMENT OF Dr.Sadhana Misar 69-79
DIABETES MELLITUS TYPE II (Wajpeyi)
(MADHUMEHA) WITH MADHUTAILIK
BASTI-A CASE STUDY
10. AYURVEDA MANAGEMENT OF TIRYAK Dr. Khedekar 80-88
RAKTAPITTA WITH SPECIAL REFERENCE Sumod
TO IDIOPATHIC THROMBOCYTOPENIC Dr. Rathi Renu
PURPURA Dr. Nayak Meghna
– A CASE REPORT Dr. Hattikar
Heramb

Clinical Researches in Ayurveda Page 1

 11. AYURVEDA MANAGEMENT OF Dr Prasad Gajanan 89-95
GADGET ADDICTION IN PEDIATRIC Yewale,
PATIENT: A SINGLE CASE STUDY Dr. Renu Rathi,
Dr. Swapnali Mate
12. AN AYURVEDIC LOOM FOR Dr.Pargaonkar 96-101
INDRALUPTA (ALOPECIA AREATA) Akshay Sudhir,
Dr.Jibkate
Bhagyashree Ratan
13. MANAGEMENT OF KATISHOOLA (LOW Dr. Seema 102-108
BACK PAIN) THROUGH AYURVEDA – A Himmatrao
CASE REPORT Thakare
14. POLYCYSTIC OVARIAN SYNDROME Dr. Shanti 109-115
FROM AYURVEDIC VIEWPOINT- A CASE Manyala
STUDY. Dr. Nishigandha
Kubade
15. THE THERAPEUTIC EFFECTIVENESS OF Dr.Roshna Bhutada 116-125
KHADIRADI GUTIKA IN THE Saniya Khan
MANAGEMENT OF PITTAJA
MUKHAPAKA (RECURRENT
ULCERATIVE STOMATITIS)-A CASE
REPORT
16. EFFICACY OF PANCHATIKTAKSHEER Dr. Ankush D 126-135
BASTI IN THE MANAGEMENT OF Dikondwar,
ANUKTA VYADHI VANKSHANAGATA Dr. Geeta Sathvane
VATA ( AVASCULAR NECROSIS ) – A
CASE STUDY
17. EFFECT OF TILA TAILA ABHYANG AND Dr. Maheshwari D 136-142
GHRITAPANA IN VICHARCHIKA Joshi,
: A CASE STUDY Vd. Sumant M
Pande
18. AYURVEDA MANAGEMENT OF Dr Prasad Gajanan 143-149
GADGET ADDICTION IN PEDIATRIC Yewale,
PATIENT: A SINGLE CASE STUDY Dr. Renu Rathi,
Dr. Swapnali Mate

19. STUDY ON THE EFFICACY OF Dr. Kanchan 150-159

KARVEERADI TAIL IN THE Dr. Sonali Chalakh,
MANAGEMENT OF PAMA W.S.R TO
SCABIES
20. EVALUATION OF ANTICANCER Dr Mujahid B. 160-167
Original Research

ACTIVITY OF KUKKUTNAKHI GUGGULA Khan,

ON LUNG CANCER- IN VITRO STUDY
21. THE ROLE OF TRIPHALADI KWATHA IN Dr Wankhede Arun 168-172
THE MANAGEMENT OF MADHUMEHA: U
CLINICAL STUDY
22. OBSERVATIONAL STUDY TO EVALUATE Dr Wankhede Arun 173-181
ASSOCIATION BETWEEN STHULA AND Dr.Khirodkar
KRUSH PRAMEHI WITH UNCONTROLLED Sushama
DIABETES MELLITUS
23. THE ROLE OF DASHANG LEPA IN ACNE- Dr Wankhede Arun 182-185
A CLINICAL STUDY U
24. RANDOMIZED CONTROL TRIAL TO Dr.Dnyanesh 186-194
ASSESS THE EFFICACY OF SNIGDHA Joshi1
SWEDA AND RUKSHA SWEDA ON

Clinical Researches in Ayurveda Page 2

 VATA-KAPHAJ GRIDHRASI
25. SIGNIFICANCE OF RASAYANAS IN Dr. Shanti 195-200
PREVENTION OF LIFESTYLE DISORDERS. Manyala,
Dr. Dipika Chakole
26. AETIOPATHOGENESIS OF HRIDROG (IHD) Dr.Girbide 201-206
ACCORDING TO AYURVEDA Santosh

27. CLINICAL STUDY OF PRAMEHA Dr Wankhede Arun 207-216

COMPLICATIONS WITH SPECIAL U,
REFERENCE TO DIABETES MELLITUS Dr.Khirodkar
Sushama
28. EFFECT OF YOGA ON MENOPAUSE IN Dr.Khirodkar 217-220
MENTAL HEALTH Sushama R
29. MEDOVAH SROTASJANYA Dr Wankhede Arun 221-230
VIKAR-STHOULYA: CLINICAL REVIEW Dr.Khirodkar
Sushama
30. MANAGEMENT OF PREDIABETES WITH Dr.Gharge Archana 231-237
AHAR AND VIHAR (LIFESTYLE Rajaram, Dr.
Clinical Review study

MANAGEMENT) WITH SPECIAL Mundane Rajiv.

REFERENCE TO PRAMEHA
PURVARUPAVASHTHA- A REVIEW
ARTICLE
31. ROLE OF UTTAR BASTI IN INFERTILITY: Dr.Desai Rajdatta, 238-240
A CASE REPORT Dr Pratapwar
Aniket
Dr Tasare Prashant
32. STEPS FOR QUESTIONNAIRE TOOL Dr PreetiBorkar 240-244
DEVELOPMENT Dr. Pavithra. S
33. THERAPEUTIC ANTIVIRAL POTENTIAL Dr.Bhushan 245-256
OF HERBAL DRUGS ON VIRAL Mhaiskar,
INFECTIONS Dr. Rutuja
Mhaiskar
34. CLINICAL REVIEW ON TESTING TISSUE Dr.Kanchan 257-264
REGENERATION BY AYURVEDA Mhaishkar,
MEDICATION (AMALAKI PATRA MASHI Dr.Pradnya
OINTMENT) AND SILVER SULFADIAZINE Dandekar
IN DAGDHA VRANA (BURN WOUND)
35. CLINICAL IMPORTANCE OF Vd. Sumant M 265-272
VYADHIKSHAMTVA IN PATHOGENESIS Pande,
OF DISEASE Vd.Maheshwari
D Joshi,
36. MANAGEMENT OF LUMBAR Dr.Shweta Parwe, 273-
RADICULOPATHY THROUGH Dr.Milind
PANCHAKARMA & SHAMANA CHIKITSA Nisargandha,
-A CASE REPORT Dr.Anita Wanjari,
Dr.Sheetal Asutkar

Clinical Researches in Ayurveda Page 3

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1.
CONTRIBUTION OF AYURVEDA FOR THE MANAGEMENT OF
AVABAHUK (ADHESIVE CAPSULITIS) -A CASE REPORT
* 1Dr.Sawarkar Gaurav ,2Dr.Sawarkar Punam
*1 Professor, Department of Rachana Sharir, 2Associate professor, Department of
Panchakarma Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod,
Wardha, Datta Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.),
Maharashtra, India.

ABSTRACT
Adhesive Capsulitis (Frozen shoulder) is a clinical condition that causes pain and
restrictedshoulder joint movement. It puts a massive strain on patients in their most productive
years. The etiology of frozen shoulder is unknown, but diabetic patients may suffer more
frequently. To date, no definite treatment is available for Adhesive Capsulitis. In classical texts
of Ayurveda, Avabahukis aUrdhwaJatrugataVikaraoccurring due to Dhatukshayajanya Vata
Prakopahas been correlated with Adhesive Capsulitis that different modalities can be treated in
Ayurveda such as Nasya or Patra-PindaSwedana,etc. This case report aims to assess the
efficacy of Ayurvedic management for a patient with adhesive capsulitis.A single case study of
a 70 years old female presented with pain in the right shoulder with limited range of motion
(R.O.M.) and headache fortwo months. The Patient has been prescribed an external therapy
consisting of local Snehana with DhanvantarTaila, local PatraPottali Sweda, and Marsh
Nasya with KsheerbalaTaila for seven consecutive seven days. Simultaneously, internal
therapy (RasnasaptakKwatha, AsthiposhakVati, Chandraprabha Vati) was also advised for 21
days.After successfully combining intervention with Shodhana and Shaman Chikitsa, the
Patient demonstrated increased shoulder R.O.M., decreased pain, reduction in stiffness &
improvement in muscle power, and various diagnostic signs. Utilizing the basic concepts of
Ayurveda (Nidanpanchaka), drugs with properties such as Vata-Kaphahara, Snigdha, Guru,
and Bruhana, but UshnaVeerya were used to manage this condition which showed promising
results. Ayurvedic management with Shodhana & Shamana Chikitsa based on the
fundamentals of Ayurveda is effective in managing Avabahuka (Adhesive Capsulitis).
Keywords- Adhesive Capsulitis, Frozen shoulder, Avabahuka, Nasya,
UrdhwJatrugataVikara, Dhatukshaya, KsheerbalaTaila, Snehana, Swedana.

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Introduction:
Adhesive capsulitis is a nonspecific chronic inflammatory reaction of tissues in the
glenohumeral joint which causes synovial thickening. This thickening results in a limited range
of motion (R.O.M.) of the shoulder joint, especially its abduction and external rotation. Other
signs and symptoms include severe pain at night that is aggravated by palpation of the
anterolateral aspect of the shoulder[1].Adhesive capsulitisis also termed frozen shoulder
syndrome, periarticular adhesions, pericapsulitis, irritative capsulitis, periarthritis of the
shoulder, scapulohumeralperiarthritis, humeroscapularfibrositis, bursitis calcerea, Duplay' s
syndrome, the shoulder portion of the shoulder-hand syndrome, and stiff and painful
shoulder[2].
People with frozen shoulders have limitationsin both active and passive ranges of motion. They
also tend to have the most trouble rotating their arm or shoulderoutward, away from their body,
and putting the affected arm behind their back.
The onset of this clinical entity can be insidious or occurs after an injury. Secondary adhesive
capsulitis can result from a shoulder pathology such as a dislocation, fracture, osteoarthritis, or
a neurological condition leading to muscular imbalances[3].Its risk factors include Diabetes,
trauma, hypertriglyceridemia, and thyroid disease[4].The incidence of adhesive capsulitis in the
general population is 2-5% and 10-20% in patients with diabetes[5].It affects females slightly
more than males and is usually seen in ages 40-70[6,7].The non-dominant arm is more likely to
[5,6]
be involved . About 12% of individuals affected develop the condition bilaterally.
Recurrence is rare in the same shoulder [8].Diabetes can alter collagen formation and delay
healing following traumatic events or surgery. Individuals with adhesive capsulitis
generally progress through 4 stages: Pre-freezing (1-3 months), Freezing (3-9 months), Frozen
(9-14 months), and Thawing (12-14 months)8. Treatment measures for adhesive capsulitis in
conventional medicine include Painkillers, Non-steroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen to reduce inflammation and alleviate mild pain; hot or cold compression
packs, and subsides pain and swelling.
Moreover, corticosteroid injections routinely advised for such patients are discouraged due to
their specific adverse effects, including further damage to the shoulder.Transcutaneous
electrical nerve stimulation (TENS) is one of the treatment modalities in physiotherapy, which
works to manageadhesive capsulitisby numbing the nerve endings in the spinal cord to
controlthe pain. Other techniques in physical therapy consist of some exercises& specific
manipulationskills, and those maintain the mobility and flexibility of the joint up to the
maximum extent without straining the shoulder or causing too much pain. Surgical measures
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such as anesthesia and Shoulder arthroscopy are rarely used in a small percentage of cases to
enhance the joint's mobility due to their invasive nature [9].However, all these measures have to
be used cautiously or have limited use in geriatric Patients considering their high chances of
side effects and contraindications.
Therefore, various treatment measures in Ayurveda can become a ray of hope for such patients
due to their non-invasive nature. According to the classics ofAyurveda, Avabahuk is a disease
that can be correlated with Frozen Shoulder.This paper aimsto focus on the efficacy of
Panchakarma & Shamana Chikitsa for a patient with adhesive capsulitis.
Patient's Information:-
A 70-year-old female patient was clinically diagnosed as Avabahuk, whopresented with chief

S. N. Nature of complaint of Patient Duration

1. Pain in right shoulder during shoulder abduction and flexion Two months
2. Constant pain in the backside of the neck and upper back region Two months
3. Stiffness in the right shoulder Two months
Restricted movement of the right shoulder (especially abduction
4. Three days
and flexion)
5 Headache( due to lack of sleep ) Three days
complaints mentioned in table no.1.

Table No 1: Chief complaints

Progression of disease:-
The Patient was well for two months. Later, she complained about chief complaints such as pain in the
right shoulder, the backside of the neck, and restricted movement of the right shoulder. Recently for
three days, she had a headachedue to disturbed sleep. She visited many allopathic physicians and
orthopedic surgeonsbut did not get significantand complete relief. Therefore, she visited Mahatma
Gandhi Ayurveda College Hospital and Research Centre, Salod, Wardha, Maharashtra, for
Panchkarma& further treatment.After going through the history; the Patient was diagnosed with a
case of Avabahuk.
HISTORY OF THE PATIENT:
Details of the Patient‘s history are given in table no.2.

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Table No.2: History of Patient

S. N. Past History Duration
K/c/o/ Hypertensionfor two years
1. Medical history
No history of Diabetes mellitus
 H/o-Cataract surgery before two years
2. Surgical history  Angiography before one year
 No history of falls or trauma
3. Familyhistory History of Diabetes mellitus from the maternal side
4 Ahara(Diet) Pure veg( Poor appetite )
5 Vihara (Lifestyle) Daily exercise (Brisk walking for half-hour), Ratrijagran
6 Sleep 6-7 hours but disturbed
7 Addiction Nil
CLINICAL FINDINGS:
The Patient was diagnosed with adhesive capsulitis based on the clinical findings mentioned in
table no.3, 4; 5.The diagnosis of adhesive capsulitis was made based on clinical examination
and evaluation. The details of the general & systemic Examination of the Patient are mentioned
in table no.3. At the same time, local examinations specific to the disease diagnosisare
provided in table no.4. A decrease in a particularrange of motionsof shoulder Jointsis depicted
in table no.5.Specific examinations to assess the musclestrengthoftheshoulderjoints are tabulated
in table no.6.
Table No.3: General &systemic Examination of the Patient
S.N. Examination Finding
1. Pulse rate 74/min
2. Respiratory rate 16/min
3. Blood pressure 110/80mm hg
4. Bodyweight 53kg
5. Built Moderate
6. Pallor Absent
7. Icterus. Absent
8. Cyanosis & Clubbing Absent
9. Lymphadenopathy Absent
10. Tongue coating Mild coated
11 CVS S1 & S2 audible
12 RS NVBS, No added sound
13 P/A No organomegaly & No tenderness
14 C.N.S. No detected clinically

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Table No. 4: Local examinations specific to the diagnosis of the disease

S. N. Type of Examination Findings

 The swelling was present over the affected site.
 Decreased range of motion, especially abduction and external
rotation of the right shoulder joint
 Decreased Functional external rotation of the right shoulder
joint
 + Spurling's sign (cervical compression test) on the right side
 + Apley scratch test on right shoulder joint
Inspection  + Empty can test
1.
 + Neer's Impingement
 No redness & any demonstrable deformities over the local
region.
 - ve Drop arm sign
 - ve Hawkin's Kennedy
 - ve coracoid impingement
 - ve cross-arm
 - ve apprehension tests
 Tenderness is present at the right scapular region &along the
Palpation
right biceps tendon and coracoid process +++
2.
 Tenderness over right shoulder ++
 No raised local temperature.

Table No. 5: Range of Motion of Shoulder Joint

S.N. Specific Motion of Shoulder joint Right Left
1 Flexion 155 degree 155 degree
2 Functional External rotation C6-C7, pain T4
3 ExternalRotation 50 degrees with Pain 90 degrees (Active)
4 Functional InternalRotation T12, pain T12
5 Abduction 120 degrees with Pain 170 degree

Table no.6: Examinations of Muscle strength of the shoulder joint

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S.N. Motion of Shoulder Right Left

1 Flexion ¾ 4/4
2 External Rotation 1/3 3/3
3 Internal Rotation ½ 2/2
4 Abduction 1/3 3/3

INVESTIGATIONS:-
The Patient was advised for radiological investigations such as a Plain X-ray and U.S.G. of the
right shoulder joint.However, the Patient was not willing to undergo these investigations.
DIAGNOSIS:-
Frozen shoulder- Frozen state (Avabahuk)
Therapeutic interventions:-
The line of treatment adopted in this Patient is given in Tables’ no. 7& 8.
Table No. 7:- Type of Panchakarma procedures adopted

S.N. Name of procedure Material Duration

1. Local Snehana Dhanvantar Taila 07 days
2. Local Swedana Patra Pottali Swedana 07 days
3. Marsha Nasya Ksheerbala Taila (8 drops in each nostril) 07 days

Table no.8: Shamana Chikitsa

S.N. Name of drug Dose& Time of Anupana Duration
frequency administration
1. Asthiposhak Vati 250 mg 1 B.D. After food Lukewarm Milk 21 days
2. Rasnasaptak Kwath 10 ml B.D. 1 hour before the food Lukewarm water 21 days
3. Punarnavadi 250 mg 3 BD After food Lukewarm water 21 days
Guggulu

THERAPEUTIC OUTCOME:
The therapeutic outcome of the adopted afore-said Panchakarma and Shamana Chikitsa are
given in Table no.9.

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Table no.9: Therapeutic Outcome with Comparative assessment of

signsandsymptomsofthePatient
S.N. Assessment of signs and Before After treatment
treatment After After 21 days
symptoms of the Patient sevendays
A Symptoms of thePatient

1 Pain in right shoulder 8(VAS) 2 0

during shoulder abduction
and flexion
2 Constant pain in the back 6 (VAS) 1 0
side of the neck and upper
back region
3 Stiffness in the right +++ Absent Absent
shoulder
4 Headache( due to lack of 3 (VAS) Absent Absent
sleep )
B Signs of the Patient

1 Tenderness at the right +++ Absent Absent

scapular region &along the
right biceps tendon and
coracoid process
2 Tenderness over the right ++ Absent Absent
shoulder
3 Swelling over the right Present Absent Absent
shoulder joint and
surrounding region
4 Spurling's sign(cervical Positive Negative Negative
compression test) on the
right side
5 Apley scratch test onright Positive Negative Negative
shoulder joint
6 Empty can test Positive Positive Negative

7 Neer's Impingement Positive Positive Negative

C Restricted movement of
right shoulder

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1 Flexion 155 degree 155 degree 155 degree

2 Functional External C6-C7, pain C6-C7, without T4 9 No pain)
rotation pain
3 ExternalRotation 50 degrees 60 degrees 90degree(Active)
with Pain without Pain
4 Functional T12, pain T12, without pain T12
InternalRotation
5 Abduction 120 degrees 140 degrees 170 degrees
with Pain without pain without pain
D Muscle strength of the
shoulder joint
1 Flexion ¾ 4/4 4/4
2 ExternalRotation 1/3 3/3 3/3
3 InternalRotation ½ 2/2 2/2
4 Abduction 1/3 3/3 3/3

DISCUSSION:
The shoulder joint has the greatest range of motion among all joints in the body and is vital to
daily activities. Adhesive capsulitis is oneof the painful clinical conditions occurring in this
joint.There are three phases of frozen shoulder, i.e., Freezing, Frozen, and Thawing. The
pathogenesis of Avabahuk in the context of Ayurveda is described in fig no. 1.
Figures:-
NidanaSevana

MithyaAhara&Vihara, Old age

Provocation of Vyana Vata

Sthansanshraya in Amsa Pradesh

Shleshak Kapha Shosha

The affliction of Sira, Snayu, Mamsa, Asthi, Kandara

BahuCheshtahara

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Fig No.1: Samprapti of Avabahuk

The specific SampraptiGhataka involved in its pathogenesis is tabulated in table no.10.

Table no.10: Samprapti Ghataka of Avabahuk

S. N. Component of Samprapti Findings

1. Dosha Vyana Vata, Shleshak Kapha
2. Dushya Asthi , Mamsaas Dhatu &Sira ,Snayu, Kandaraas
Upadhatu
3. UdbhavaSthana Pakwashaya
4. VyaktaSthana Bahu
5. SancharaSthana Amsa Pradesh
6. Strotas Mamsavaha, Asthivaha
7. Marga MadhyamaRogaMarga

The Patient in the current study, diagnosed witha Frozen state of frozen shoulder, was
approached at the Panchkarmacenter. There was a greater extent of stiffness and persistent
limitations for the right shoulder joint motion due to inflammation. Therefore, treatment was
primarily focusedon reducing pain,stiffness, and residual inflammation with the help of
specific Panchakarmaprocedures and drugs having analgesic and anti-inflammatory
properties.A mild form of procedure i.e. Local Patra-PindaSwedana and Marsha Nasya were
used along with minimum internal medicinesconsidering the old age of the Patient,
Local Snehana & Patra-Pinda Swedana was selected first for her. As Swedana is an excellent
procedure to reduce stiffness, Patra-PindaSwedana having RukshaSnigdha properties was
preferred. It helps to restore the normal range of motion and shoulder functions.
Patra-PindaSwedana&local Snehana with Dhanavanatara Oil [10] have corrected restrictions
in the hand's range of motion and strength.Local Snehana&Swedanareduces pain intensity and
induces improved extremity arm movement, which is also supported by our previous clinical
[11].
trials Both of these procedures may enhance drug absorption by increasing blood
circulation. As the efferent vasodilator nerves are spread to the superficial surface of the face,
they receive stimulation by fomentation and may increase the blood supply to the brain.
Dhanvantaram Taila, used for local Snehana purposes, has excellent analgesic and
anti-inflammatory effects that subsides muscle cramps, numbness, pain, and swelling [12].

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According to Ayurveda, Avabhauk is considered one of the NanatmajaVatavyadhi. Therefore,

BruhanaChikitsa was selected here in the form of Marsha Nasya.Nasya is considered the best
therapy for all Urdhwajatrugata and BahuShirshagataVatavikara[13].It can be administered in
the old age group also.So,Marsha Nasyawith KsheerbalaTailaoffers significant and
encouraging results to correct any degenerative pathology in the cervical region, associated
musculature, and joints. It yields excellent resultsin adhesive capsulitis by strengthening
muscular tissues &facilitating the mobilization of the joint due to the lubricant action of
KsheerbalaTaila.Raj GA et al. 2020[14] prove its role in the frozen shoulder.Bala
(Sidacordifolia) is the main ingredient of KsheerbalaTaila. It is generally popular in clinical
practice due to its properties, such as Vata Shamak, Balya, Rasayana, Indriyaprasadana,
Jeevana, Brumhana, and Vata Shamana[15].This oil provides the optimum nutrition to the
muscle tissues involved in the pathogenesis of the frozen shoulder due to its Madhura Rasa and
MadhuraVipaka, Guru, Snigdha, PichchilaGuna, along with Vata-Kaphahara properties.
Vata-Pitta Shamak property of Goksheer used in the preparation of KsheerbalaTaila reduces
the inflammation and other degenerative processes in the shoulder joint. Its penetrating
capacity at the deeper tissue, such as Mansa, Asthi, and Sandhi, is increased due to Sukshma
and AshukariGuna of TilTaila. It helps all essential herbs to penetrate the ten systems. The
Vata-Kaphahara action of Ksheerbala Taila may positively impact either Kaphavruta Vataor
Vata directly involved in the Samprapti of Avabahuka. It also acts as an anti-inflammatory
drugand nourishes, helping the early recovery of the symptoms of a frozen shoulder.
Asthiposhak Vat i& Punarnavadi Gugguluis helpful in the frozen shoulder due to its
anti-inflammatory nature [16, 17]. Rasnasaptak Kwath reduces the stiffness and pain that occur as
a result of Samavastha.It induces Niramavastha due to its Dipana-Pachana properties.It also
offers a significant role in reducing pain and stiffness due to its pain-relieving and
anti-inflammatory properties. According to Ayurveda’s perspective, Avabahuka is a disease
characterized by morbid Vata-Dosha localizing around the shoulder joint, thereby causing
constriction of the Siras at this site, leading to loss of movements of the arm. Rasnasaptak
Kwath induces encouraging results in this clinical condition due to its excellent Vata Shamaka
property [18].
CONCLUSION:
The collaborative treatment approach consists of Local oleation, sudation (Patra-Pottalli
Swedana) & Nasya Karma with KsheerbalaTaila added with specific shaman Chikitsa
Ayurveda is a very easy, safe, and effective modality that can be adopted in the treatment of
Avabahuka. Due to the same intervention, the Patient witha frozen shoulder was cured entirely
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without any adverse effects. The appropriate selection of procedures & drugs in Ayurveda can
offer significant results in pain, stiffness in frozen shoulders, and improvement in the range of
motion of shoulder joints without physiotherapy. The Patient can benefit from the treatments at
O.P.D. levels with no extra burden over the Patient's pocket. Further clinical trials with a large
sample size should be planned to enhance its wide use and generate clinical evidence.
ACKNOWLEDGEMENT: I am very thankful to the Research team, Mahatma Gandhi
Ayurved College and Research Centre, Salod (Hirapur), Wardha, for encouraging me to write
this case report.
CONFLICTS OF INTEREST: There are no conflicts of interest.
SOURCE OF FINDING: Datta Meghe Institute of medical sciences, Deemed to be
University, Wardha, Maharashtra.

REFERENCES:
1. Brenner, Haley, "A Case Report: Adhesive Capsulitis and Physical Therapy Intervention"
(2019). Physical Therapy Scholarly Projects.668
2. Adhesive capsulitis: a case report: Mohsen Kazemi, RN, DC, F.C.C.S.S. (C) Assistant
Clinical Professor, Canadian Memorial Chiropractic College, 1990 Bayview Avenue,
Toronto, Ontario M4G 3E6.C J.C.C.A. 2000; 44(3):169-176
3. Agarwal S, Raza S, Moiz JA, Anwer S, Alghadir AH. Effects of two different mobilization
techniques on pain range of motion and functional disability in patients with adhesive
capsulitis: A comparative study. Journalof Physical Therapy Science. 2016;28(12):3342
3349
4. Malik S, Pirotte A. Shoulder. In: Sherman SC. eds. Simon's Emergency Orthopedics, 7e
New York, NY: McGraw-Hill; 2014.
5. Grubbs N. Frozen shoulder: A review of the literature. JOSPT 1993; 18(3):479-487.
6. Naviaser RJ Naviaser TJ. The frozen shoulder diagnosis and management. ClinOrthop and
Related Research 1987; 223:59-64.
7. Wadsworth CT. Frozen shoulder. Phys Therapy 1986; 66(12):1878-1883.
8. Chapter 16. The Shoulder. In: Dutton M.eds.Dutton's Orthopaedic Examination,
Evaluation, and Intervention, 3e New York, NY: McGraw-Hill; 2012.
http://accessphysiotherapy.mhmedical.com.ezproxy.undmedlibrary.
9. Frozen shoulder:Review by William Morrison, M.D. — Written by Caroline Gillott on
December 5, 2017,https://www.medicalnewstoday.com/articles/166186

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10. Sawarkar P, Sawarkar G. Management of scapular dyskinesia through a comprehensive

approach-A case study. Journal of Indian System of Medicine. 2018 Oct 1; 6(4):218.
11. Sawarkar P, Deshmukh M, Sawarkar G, Bhojraj N. A Comparative Efficacy Study of the
PanchtiktaGhritaMatraVasti and PanchtiktaGhrita Marsha Nasya in Cervical Spondylosis.
International Journal of Ayurvedic Medicine. 2020 Jul 3; 11(2):218-27.
12. https://www.google.com/search?q=Dhanvanatar+Oil&rlz=1C1OKWM_enIN790IN790&
oq=Dhanvanatar+Oil&aqs=chrome..69i57j0i13l6j69i60.436j0j7&sourceid=chrome&ie=
UTF-8 accessed on June 28, 2021.
13. Bhatted SK. Management of Vishwachi through Ayurveda wsr to Parsonage-Turner
Syndrome-A Case Report. Journal of Ayurveda and Integrated Medical Sciences. 2020
Dec 31; 5(06):360-4.
14. Raj GA, Mohan K, Anjana R, Rao PN, Shailaja U, Viswaroopan D. Biological Effects of
Ayurvedic Formulations. Ayurveda in the New Millennium 2020 November 10 (pp.
135-160). C.R.C. Press.
15. Dhiman K, Sharma U. Ksheerbala tail and its different routes of administration.
International Journal of Research in A.Y.U.S.H. and Pharmaceutical Sciences. 2017:89-91.
16. https://www.ayurmedinfo.com/2012/08/01/asthiposhak-tablets-benefits-dosage-ingredient
s-side-effects/accessed on June 28, 2021
17. Hedaoo MM, Bhole TP. A narrative review of Guggulu formulations of Ayurveda
reflecting their percentage of Guggulu, pharmaceutics, and pharmacology. I.P.
International Journal of Comprehensive and Advanced Pharmacology. 2021 Jan 15;
5(4):151-7.
18. Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to
sciatica: a case report. Journal of Indian System of Medicine. 2019 Apr 1; 7(2):131.

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2.
A COLLABORATIVE APPROACH OF PANCHAKARMA &
PANCHAGAVYA CHIKITSA FOR THE MANAGEMENT OF ATOPIC
DERMATITIS INDUCED BY DUSHTA STANYA IN MALE CHILD-
A CASE REPORT
*1Dr.Sawarkar Punam, 2Dr.Sawarkar Gaurav, 3Dr. Bhojaraj Nandini
*1
Associate professor, Department of Panchakarma 2Professor, Department of Rachana Sharir,
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.
3
Chief Ayurvedic Consultant, Go, Anusandhana Kendra, Deolapar, Maharashtra, India.

Abstract
Atopic dermatitis is a common dermatological condition in children consisting of ongoing skin
pathological changes that cause dry, red, itchy skin. At least one in 10 children has such type of
eczema. Its prevalence is 2–5% in children and young adults. In Ayurveda, this clinical
condition can be correlated with Vicharchika, i.e., type of Kustha. A single case study of 2.5
years old male child presented himself predominantly with Pidaka, Kandu, Vedana,
Vaivarnyata, and Srava & Rukshata. Those started at the age of 1 and a half months. He was
anxious & and uncomfortable with mental irritation due to these lesions. After examination,
treatment was started with (Gomutra Asava, Gomutra Arka, Raktashodhaka Kadha,
Janmaghuti internally & Matravasti with Panchtikta Ghrita. The patient was asked to apply
Gomutra+Panchgavya Ghrita externally. After the successfully combined intervention of
Shaman Chikitsa, including Panchgavya formulations, Matra Vasti & local application for a
consecutive one & half years, the patient got complete relief from all complaints. Utilizing the
basic concepts of Ayurveda (Nidanpanchaka), drugs with properties such as Stanyashodhak,
Kaphaghna, Vatanulomaka, Raktaprasadak, Twachyya, Bruhana but Ushna Veerya were
utilized to manage this condition which showed the promising result. Ayurvedic management
with Shodhana & Shamana Chikitsa based on the fundamentals of Ayurveda is effective in
managing Vicharchika (Atopic dermatitis) in children.
Keywords: Atopic dermatitis, Vicharchika, Dushta Stanya, Unwholesome, food,
Panchagavya, Matravasti, Gomutra Arka, Bahya Chikitsa.
Chapter
Introduction
Eczema is an inflammatory, pruritic, chronic, relapsing skin disease. Its prevalence is 2–5% in
children and young adults [1]. It severely affects the quality of the child and his mother due to

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its irritating nature of pain & itching, which ultimately affects the overall nutrition & growth of
the child. Suppose it is not treated in the early stages. In that case, it can induce social stigma
due to the appearance of lesions, discomfort & recurrent attacks, which prevents the patient
from mingling with society. Children with eczema have more sensitive skin than other people.
In Ayurveda, there is some satisfactory answer to tackle such entities. This paper reflects that
treatment based on fundamentals in Ayurveda can effectively and safely treat such challenging
skin disorders, even in pediatric cases where modern science has some limitations.
Material & Methods-
It is a single Case study. Demographic details of the patient are given in the table. No. 1.
Table No.1. : Demographic detail of the patient

S.N. Name- X.Y.Z. S.N. Phone no. :- ******6807

1 Sex:- Male 4 Socioeconomic status:- Middle Class
2 Age :- 2 ½ ( 30 months ) 5 O.P.D. No. :- 5673/2017
3 Address :- Nagpur 6 Phone no. - ******6807

Chief complaints of the patient with duration are described in table no.2.

Table No.2. : Chief complaints

S.N. Nature of Complaint Duration

1 Pidaka ( Rashes), Multiple eruptions overhead, face .leg & At the birth &
hands aggravated after one &
2 Kandu ( Itching) half months of the birth
3 Vedana (Pain)
4 Vaivarnyata ( Discoloration of Skin)
5 Srava ( Secretions)
6 Rukshata ( Dryness)
7 Recurrent indigestion or constipation
8 Sticky motions At the age of 2 months
9 Breathlessness after exposure to the cold environment Five times nebulization
done

 History of the present illness:

At the time of birth, the child had dyspnea, so he nebulized & then he turned to normal.
However, the sudden onset of multiple eruptions overhead, face .leg & hands & was diagnosed
as atopic dermatitis. However, the severity of the symptoms was getting worsened day by day.
The patient was quite irritable & restless due to itching & pain. He & his mother couldn't sleep

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well due to that itching & pain. These symptoms were usually worsened due to exposure to a
cold environment & after touching with both cold & hot water at bath time. Therefore, the
parents preferred allopathic treatment followed by homeopathic treatment but received
temporary relief, so they started it. That's why they approached Govidnyan Anusandhana
Kendra Deolapar, Maharashtra. The detailed history of the patient is narrated in table no.3.
Table No.3: History of patient

1 Birth History  L.S.C.S. Oligo-hydramnios.Amniotic fluid washed out

 History of nebulization at the time of birth
2 Past Medical history History of breathlessness at the time of birth
3 Personal history  Intake of milk (4-5 times daily, even at the age of 2.5 years)
 Intake of solid food is less
 Negligible intake of vegetables
4 Drug History Use of steroid for nebulization (episodes of 5-6times since birth)
5 Family history  Father K/C/O Bronchial asthma & Hypertension (On regular Rx of
only H.T.N.)
 Mother & father –Both obese
 Mother-K/C/O/Hypothyroidism on regular R.X.
6 Garbarini Paricharya Intake of jack Fruit & papaya twice in A.N.C.
Intake of Nagavalli Patra (ripened) betel leaves daily after meals.

 Clinical examinations
● The general condition of the patient was fair
● No Icterus /swelling found
● Pallor +
● Weight – 9.5 kg
● Height- cm
● Prakriti- Vata pradhana Pitta Prakriti
 Ashtavidha Parikshana:
Ashatavidha Parikshana of the patient is given in Table No. 4.
Table No. 4: Ashtavidha Parikshana

S.N. Head Observation S.N. Head Observation

1 Nadi (Pulse) 82/min 5 Shabda (Speech) Clear

2 Mala Sam- sticky 6 Sparsha (Touch) Ruksha, Khara, Krishnabh, stsutira

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3 Mutra(Urine) Samyak 7 Druka (Vision) -

4 Jivha(Tongue) Niram 8 Akruti (Posture) Krisha

 Diagnosis
Eczema (Dushta Stanyajanya Vicharchika)
 Treatment prescribed
All types of treatment prescribed to this patient are given in the table no.5. & 6
Table No. 5: Bahya & Panchkarma Chikitsa prescribed

S.N. Type of Chikitsa Drug Duration

1 Bahya Chikitsa Gomutra Ark + Panchgavya B.D. after bath &evening

Ghrita
Panchagavya Ghrita +Vasti after breakfast weekly
Taila twice
2 Panchkarma Chikitsa Panchgavya Ghrita (5ml) After breakfast Weekly
(MatraVasti) twice regularly for seven
months

Table No. 6: Type of Shamana Chikitsa prescribed

S. Internal Dose Anupana Time of Duration
N. medication administration
1 Gomutra Arka Five 5ml Luke warm B.D. after food 10months
drops water
2 Gomutra Asava 2.5ml 5ml Luke warm B.D. after food Ten
water months
3 Raktashodhaka 250mg 2-3- drops of empty stomach 5 Months
Kadha (Freshly 2BD Gomutra Arka
prepared with
coarse powder)
4 Janma Ghuti 5ml Luke warm water O.D. Morning 6 Months
(Freshly prepared)
5 Panchtikta Ghrita 2.5 Luke warm water B.D. before each food 8 Months
ML

 Result & observations (Therapeutic outcome)

The therapeutic outcome obtained in the patient after the treatment administration is elaborated
in table no.7. After starting the treatment, itching significantly decreased within 2-3 days. The
total E.A.S.I. score showed a considerable reduction of up to 100% and the S.C.O.R.A.D. The
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index was also significantly reduced by 100% [2, 3, 4, and 5]. After the successfully combined
intervention of Shaman Chikitsa, including Panchgavya formulations, Matra Vasti & local
application for a consecutive one & half years, the patient got complete relief in all complaints.
Table No. 7: Assessment of Subjective & objective variables

S.N. Type of Objective Before After two After eight After

variables treatment months months one
1/2/Yr
1 Ruja /Vedana (Pain)VAS 7 3 2 Absent

2 E.A.S.I./Eczema index 8.83 6.8 2.62 0

Burning Sensation 1.10 0.70 0.13 Absent

scratching 3.1 2.4 1.2 Absent

Lichenification 3.2 2.6 0.89 Absent

% of area 1.43 1.1 0.40 Absent

3 SCORAD Index 28.07 21.71 8.28 0

Extent criteria 4.8 3.5 1.19 Absent

intensity criteria 10.55 4.30 1.89 Absent

subjective symptoms 12.72 6.7 2.1 Absent

4 Dermatology Life Quality 9.74 7.21 3.1 1.1

Index((DLQI))

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Figure No.1. Improvement after treatment

Discussion
Vicharchika is Kapha dominant Trodoshaja & Raktapradoshaja Vyadhi with involvement
of vitiation of Dushya like Rasa, Rakta, Mamsa, and Kleda. Utilizing the basic concepts of
Ayurveda(Nidanpanchaka), drugs having as Kaphaghna, Vatanulomaka, Rakta Shodhaka &
Rakta Prasadak properties with Ushna Veerya were used to manage this condition which
showed promising result due to their vivid actions, e.g., Krimighna(antibacterial/antifungal),
Stanyashodhak, Kushthaghna, Kandughna(anti-pruritic), Twachyya, Shothhar, Shulahar,
Vranashodhaka (wound cleaning), Vranaropaka (wound healing) Bruhana.
Raktashodhaka Kadha is prepared from various drugs such as Daruharidra, Manjistha, Sariva,
Amalaki, Gokshura, Guduchi, Khadir, Haridra, Chopchini, and Neem seeds. All these herbs
have Kushthaghna, Raktaprasadan, Raktashodhak, and Jantughna properties which help treat
all Tvakavikara [6].
Janma Ghuti, prepared from drugs, e.g., Kharjura, Almond, Vacha, Vidanga, Haridra,
Ativisha, Aavartani, and Raktachandana, acts as a cooling and soothing agent for the stomach
and has high nutritional value. It also acts as an expectorant, laxative, and blood purifier. It is
useful in fever and colds arising due to thrush in children [7].
All drugs in the Panchtikta Ghrita (Guduchi, Vasa, Nimba, and Kantakari & Patola)
have Tikta Rasa, Laghu, and Ruksha Guna, which helps to break Samprapti of Vicharchika by
reducing Kleda and Vikrut Meda & brings Vrana Ropana. It has Kandughna (antipruritic)
action.It causes a reduction in increased Kleda, Lasika (plasma), Rakta (blood), Pitta,
and Shleshma due to its Tikta Katu Rasa and Ruksha Lekhana properties. Nimb (Azadirachta
indica) has phytochemicals such as Nimbin and Nimbidin having antimicrobial and
anti-inflammatory activity. Guduchi (Tinospora cordifolia) contains phytochemicals such as
tinosporin and berberine, anti-oxidative and immune-modulatory [8, 9, 10, 11].
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Gomutra Asava is Kaphaghna in nature, which removes the obstruction of Strotasas and
normalizes Pachaka Pitta's function. Ultimately, Ranjaka Pitta and Bhrajaka Pitta are also
corrected due to their Katu Rasa, Katu Vipaka, and Ushna Virya. It decreases the Kandu
(Itching) & discoloration in Vicharchika through its internal and external application. Local
application with Gomutra Arka induces the scrapping of morbid tissues & reduces pruritus by
pacifying Kapha [12].
Matra Vasti with Panchgavya Ghrita induces Vata Anulomana and Kapha-Pitta Shamana
[13]. The antioxidant property of Panchgavya Ghrita is proved by Athavale A et al.2012 that it
helps heal lesions & controls the symptoms of Vicharchika by rejuvenating skin over the
affected part [14].
In a nutshell, the Combination of Matravasti & Panchagavya formulations alleviates all
symptoms of Vichachika by balancing all Tridoshas as a result of their antioxidant, antifungal,
anti-inflammatory, and antimicrobial properties that help in scavenging free radicals that help
in the alleviation of symptoms of Vichachika[ [1]. Significant improvement in the patients may
occur due to cumulative effects, e.g., Kushthaghna, Krimighna
(antibacterial/antifungal), Kandughna (anti-pruritic), Rakta Shodhana, Shothhara,
Shulahara, Vranashodhaka (wound cleaning), Vrana Ropaka (wound healing),
and Tridoshaghna properties of the drugs used for the treatment. These properties balance
all Tridoshas & result in the subsidence of signs & symptoms.
Conclusion
Ayurvedic management with Matra Vasti & Shamana Chikitsa based on the fundamentals of
Ayurveda is effective in children Vicharchika (Atopic dermatitis). The overall planned
treatment induces significant relief in all clinical symptoms of Vicharchika (eczema) with
sustained relief. Administration of Shamana (pacifying) drugs significantly increases the cure
rate and prevents recurrence. Administration of Shamana Dravya, including Panchagavya
formulations, substantially increases the cure rate and prevents the recurrence of Vicharchika
(Atopic dermatitis. Further clinical trials with a large sample size are expected to plan to
flourish the Ayurvedic practices in pediatric dermatology.
Acknowledgment

I offer sincere gratitude to Govidnyan Anusandhana Kendra, Deolapar, Maharashtra.

The Conflict Of Interest-Nil

The source of any support received: NIL
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1. Nimbhorkar AU, Misar S. Role of Shaman and Nitya Virechan in managing

Vicharchika (eczema): a case study. Journal of Indian System of Medicine. 2020 Apr 1;
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68–72.
5. Manoj L. Sonaje1, Dhiman K. S2, Bhuyan C3, Gupta S. K4, Dudhamal T.
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Ayurvedic Medicine, 2011, 2(4), 2
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Chaukhamba Sanskrit Bhavan; 2006. p. 145.
11. Rajput SH, Dhangarmali VD, Dhaval B, Phatak AA, Choudhari PD. Use of Karanj oil
(Pongamia glabra) in a topical formulation. Res J Pharmaceut Biol Chem Sci
2014;5:546-
12. Belge R.S., Belge AR. Clinical evaluation of the efficacy of gomutra aasava in shvitra
vis-a-vis vitiligo. I.O.S.R. J Pharm Biol Sci. 2012; 2(3):10-3.
13. Dhama K, Rathore R, Chauhan RS, Tomar S. Panchgavya (Cowpathy): an overview.
International Journal of Cow Science. 2005; 1(1):1-5.
14. Athavale A, Jirankalgikar N, Nariya P, Des S. Evaluation of in-vitro antioxidant
activity of panchagavya: a traditional ayurvedic preparation. Int J Pharm Sci Res. 2012
Aug 1;3:2543-9.

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3.
THERAPEUTIC CARDIO PROTECTIVE EFFECT OF ARJUNA
DECOCTION AND JATAMANSI SHIRODHARA IN ESSENTIAL
HYPERTENSION -A CASE REPORT
*1Dr.Bhushan Mhaiskar, 2Dr. Rutuja Mhaiskar
*1
Associate professor, Department of Samhita and Siddhant 2Associate Professor,
Department of Samhita and Siddhant , Mahatma Gandhi Ayurved College Hospital and
Research Centre, Salod, Wardha, Datta Meghe Institute of Higher Education and Research
Centre, (D.M.I.H.E.R.), Maharashtra, India.
2
Dr.Gunwantrao Sarode Ayurveda Medical College Hospital and Research Centre, Jalgaon
(Kh), Jalgaon, Maharashtra, India.

Abstract:
Despite significant improvements in our knowledge of its pathophysiology and the availability
of efficient treatment options, essential hypertension continues to be a significant modifiable
risk factor for cardiovascular disease (CVD). Millions of individuals worldwide are at an
increased risk of CVD due to high blood pressure (BP), and there is evidence that the issue is
only growing worse. Age-adjusted rates of stroke incidence have increased during the past ten
years, whereas the slope of the age-adjusted rate of reduction in coronary disease has flattened
off. Heart failure is more common, and end-stage renal illness is becoming more common.
Lack of BP control in the hypertensive population is a significant factor in these changes.
Pitta-dominant Raktagat Avrutta Vaat is Raktapradoshaja Vyadhi with participation of
Dushya-vitiating Rakta and Kleda. Using the fundamental principles of Ayurveda
(Nidanpanchaka), medications with properties such as pittavirachak, mruduvirechak, mansa
doshhar, Vatanulomaka, Rakta gat vatshamak & bharamhar with sheet Veerya were used to
manage this condition. These medications showed promising results because of their vivid
actions, such as Hrudya (cardio protective). Arjun qwath is made from the raw churna of Arjun
Twak and has the qualities Manadoshhar (Brain Calming Activity), Hridya (Cardio Protective
Activity), and Raktashodhak to help treat all hriday vikar.
Keywords: Raktapradoshaja Vyadhi, Hridya, Raktashodhak, Raktagat Avrutta Vaat

INTRODUCTION:
1
Cardiovascular diseases (CVD) are the number one cause of death worldwide In addition to
mortality, poorly managed CVD can lead to significant long term disability from their
complications. In the past quarter century, much progress has been made in understanding the

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molecular and cellular processes that contribute to CVD, leading to the development of
effective therapies. Natural products due to their chemical diversity are receiving increased
attention from scientific and pharmaceutical communities. The newer work on medicinal
plants is mostly the rediscovery of traditional effects at cellular and molecular levels 2

Prevalence rate of Essential hypertension

Essential hypertension is high blood pressure that doesn't have any known etiopathology. Most
of sufferers (85%) are asymptomatic and as per available reports, in more than 95% cases of
hypertension under lying cause is not found. It is estimated that 600 million people are affected
worldwide. Hypertension is a major risk factor for the development of cardiovascular diseases
(CVD).3
Essential hypertension remains a major modifiable risk factor for cardiovascular disease
(CVD) despite important advances in our understanding of its patho-physiology and the
availability of effective treatment strategies. High blood pressure (BP) increases the risk of
CVD for millions of people worldwide, and there is evidence that the problem is only getting
worse. In the past decade, age-adjusted rates of stroke incidence have risen, and the slope of the
age-adjusted rate of decline in coronary disease has leveled off. The incidence of end-stage
renal disease and the prevalence of heart failure have also increased. A major contributor to
these trends is inadequate control of BP in the hypertensive population. 43 million people in the
United States have hypertension or are taking antihypertensive medication, which is ≈24% of
the adult population. This proportion changes with (1) race, being higher in blacks (32.4%) and
lower in whites (23.3%) and Mexican Americans (22.6%); (2) age, because in industrialized
countries systolic BP rises throughout life, whereas diastolic BP rises until age 55 to 60 years
and thus the greater increase in prevalence of hypertension among the elderly is mainly due to
systolic hypertension; (3) geographic patterns, because hypertension is more prevalent in the
southeastern United States; (4) gender, because hypertension is more prevalent in men (though
menopause tends to abolish this difference); and (5) socioeconomic status, which is an
indicator of lifestyle attributes and is inversely related to the prevalence, morbidity, and
mortality rates of hypertension.4
Drug Review:
Terminalia Arjuna (T. Arjuna, -Family: Combretaceae), is an important medicinal plant widely
used in medicinal formulations for several ailments. It is used in traditional medicine for
treating ulcers, wound healing, and also for antibacterial, anti mutagenic/ anti carcinogenic,
antioxidant and hypocholesterolemic activities 5
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The use of T. Arjuna bark in the management of cardiovascular diseases has been widely
reported 6
Case Report:
A 45-Year-old male patient came to Panchkarma OPD of Mahatma Gandhi Ayurved College
Hospital and research centre, Department of Samhita and Siddhant, Salod Hirapur, Wardha,
Maharashtra, India, constituent unit of Datta Meghe Institute of Medical Sciences (DU), with
the chief complaints of Headache dizziness and insomnia since 7 days with no associated
symptoms. His Hypertension was diagnosed before 8 years ago when blood pressure measured
on the routine medical check-up around 170/100 mm Hg on three checks up sessions and a
pulse recorded 84 bpm.
Patient was initially on therapy of propanolol 5 mg daily for 4 years than he advised on
treatment of combination of Telemsartan 50 mg and Hydrochlorothiazide 12.5 mg. Yet his BP
is not responded to new drugs. On examination His family history is positive for Hypertension.
Physical assessment is unremarkable except for the presence of moderate obesity (145.4 cms &
122 kg.) On Biochemical laboratory investigations and vital signs were abnormal as he had
hypercholesterolemia from past 3 year.

Vitals before Treatment:

Clinical examination:
Table No.1. : Demographic detail of the patient
S.N. Name- X.Y.Z. S.N. Phone no. :- ******6985

1 Sex:- Male 4 Socioeconomic status:- Middle Class

2 Age :- 57 Years 5 O.P.D. No. :- 5687/2023
3 Address :- Wardha 6 Phone no. - ******6985

Table No.1 General examination:7

Clinical Condition:
Weak
Height 145.4 cms
Weight 122 kg
BMI 57.7 kg/m2
Tongue Mild coated

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Blood pressure 170/100 mmHg

Pulse Rate 82/ minute
Temperature - 98.9 F, Afebrile
Respiratory Rate - 22/ minute
Edema/ pallor/ icterus/ Spleen/ Absent
Liver/focal lymphadenopathy
General condition Normal
Systemic Examination: NAD
Rest of the systemic examination NAD

Dashvidh Pariksha:

1. Prakriti Kapha Pittaj

2. Vikriti Vata pittaj
3. Saar Meda Rakta
4. Samhanan Madhyama
5. Satmaya Vyamishra
6. Satva Pravara
7. Pramaan Madhyama
8. Aahar Sakti Madhyama
9.Vyayaam Shakti Avar
10. Vaya Prodhavastha H/O Past Illness: NAD, ICU Stay:
NAD

MATERIALS AND METHODS:

Source of Data: A diagnosed case of was selected from Kayachikitsa-OPD of Jain AGM
Ayurvedic Medical College and Hospital, Varur (Karnataka). Written consent was taken from
the patient to conduct and to publish the work”
Sr. Drug Name Dose Anupaan Days Time Specific
No. /Sahpan
1 Arjun Twak 10gm Milk (As 15 days OD In
Choorna Ksheer Paak) Breakfast
Decoction
2 Jatamansi Phant 300 ml -- Every Three At At Morning
Shirodhara day Once

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He had given mild purgation with Almond oil8 50ml with hot milk on 1st day. Patient had been
followed up every 3 days for 3 months.

Table 2: Biochemical Laboratory Investigation

S.No. Biochemical Parameters Before Treatment After Treatment

1 S. Cholesterol 221 mg/dl 160 mg/dl
2 Triglyceride 151 mg/dl 138 mg/dl
3 HDL 39 mg/dl 31 mg/dl
4 LDL 132 mg/dl 119 mg/dl
5 VLDL 31 mg/dl 28 mg/dl
6 Blood Urea 38.5 mg/dl 24.6 mg/dl
7 S. Creatinine 1.0 mg/dl 0.1 mg/dl
8 Uric Acid 7.4 mg/dl 5.8 mg/dl

Table 3: Vitals during treatment

Biochemical Laboratory Investigations and parameters were becomes normal after the
treatment of Jatamansi Shirodhara
Chief complaints
Case Report:
A 57-Year-old male patient came to Panchkarma OPD of Mahatma Gandhi Ayurved College
Hospital and research centre, Department of Samhita and Siddhant, Salod Hirapur, Wardha,
Maharashtra, India, constituent unit of Datta Meghe Institute of Medical Sciences (DU), with
the chief complaints of Headache dizziness and insomnia since 7 days with no associated
symptoms.
 History of the present illness:
 His Hypertension was diagnosed before 8 years ago when blood pressure measured on the
routine medical check-up around 170/100 mm Hg on three checks up sessions and a pulse
recorded 81 bpm.
Table No.3: History of patient
1 Birth History  NAD
2 Past Medical history History of Trauma and hospitalization for uncontrolled Hypertension
3 Personal history  Intake of milk (4-5 times daily, even at the age of 2.5 years)
 Intake of solid food is less
 Negligible intake of vegetables

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4 Drug History Use of Antihypertensive and Sleeping pills

5 Family history  Father NAD & Hypertension (On regular Rx of only H.T.N.)
 Mother & father –Both obese
 Mother-K/C/O/ Hypertension on regular R.X.

 Clinical examinations
● The general condition of the patient was moderate
● No Icterus /swelling found
● Pallor +=
● Weight – 81 kg
● Height- 153 cm
● Prakriti- Vatapradhana Kapha Prakriti
 Ashtavidha Parikshana:
Ashatavidha Parikshanaof the patientis given in Table No. 4.
Table No. 4: Ashtavidha Parikshana
S.N. Head Observa S.N. Head Observation
tion
1 Nadi (Pulse) 81/min 5 Shabda (Speech) Clear

2 Mala Sam- 6 Sparsha (Touch) Ruksha, Khara,

sticky Krishnabh, stsutira
3 Mutra(Urine) Samyak 7 Druka (Vision) -

4 Jivha(Tongue) Niram 8 Akruti (Posture) Krisha

 Diagnosis
Siratgat avrutta vaat (Essential Hypertenstion)
 Treatment prescribed
All types of treatment prescribed to this patient are given in the table no.5. & 6
Table No. 5: Bahya & Panchkarma Chikitsa prescribed
S. Variables 0 3 day 6 day 9 day 12 day 15 18 day
No. day day
1 Blood pressure 170/100 160/90 150/90 140/80 134/80 125/82 110/72
(SystolisBP /Diastolic
BP in mmHg)
2 Pulse rate (bpm) 82 83 72 82 81 70 72
3 Pulse Pressure (in 70 70 60 60 46 43 38

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mmHg)
4 Respiratory Rate (per 20 20 22 18 18 20 18
Minute)

Result & observations (Therapeutic outcome)

The therapeutic outcome obtained in the patient after the treatment administration is elaborated
in table no.7. After starting the treatment, itching significantly decreased within 2-3 days. The
total SLEEP scale score showed a considerable reduction of up to 91% and the Hypertanstion
scale the index was also significantly reduced by 100% [2, 3, 4, and 5]. After the successfully
combined intervention of Shaman chiktsa including panchkaram shirodhara formulations,
local application for consecutive one & half years, and the patient got complete relief in all
complaints.
Discussion
Raktagat avrutta vaat is pitta dominant vataj & Raktapradoshaja Vyadhi with involvement of
vitiation of Dushya like Rakta and Kleda. Utilizing the basic concepts of Ayurveda
(Nidanpanchaka), drugs having as pittavirachak, mruduvirechak, mansa doshhar,
Vatanulomaka, Rakta gat vatshamak & bharamhar properties with sheet Veerya were used to
manage this condition which showed promising result due to their vivid actions, e.g., Hrudya
(cardioprotective),. Manadoshhar (Brain calming activity), Hridya (Cardio protective
activity),
Arjun qwath is prepared from raw churna of Arjun Twak, this herbs haveHridya,
Raktaprasadan, Raktashodhak; properties which help treat all hriday vikar
The drug Jatamnsi in shirodhara in the helps to break Samprapti of raktasiragat avrutta vaat
by reducing vaat dosha and Vikrut kapha & pitta. It has mansa doshhar activity
(antipsychotic action). It causes a reduction in increased Pitta and raktagat vaat,
jatamansi (Narodotrachys Jtamansi) has phytochemicals such as jatamansin having brain
calming effects activity.

Conclusion
Ayurvedic management with jatamansi Shirodhara & Shamana Chikitsa based on the
fundamentals of Ayurveda is effective in treating hypertension The overall planned treatment
induces significant relief in all clinical symptoms of Raktgat avutta vaat with sustained relief.
Administration of Shamana (pacifying) drugs significantly increases the cure rate and prevents
recurrence. Administration of shamana Dravya substantially increases the cure rate and

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prevents the recurrence of Raktgat avutta vaat. Further clinical trials with a large sample size
are expected to plan to flourish the Ayurvedic medical practices.
Acknowledgment- I offer sincere gratitude to DMIHER (Sawangi Meghe), Wardha

The Conflict Of Interest-Nil

The source of any support received: NIL
References:
1. Ara S. A Literature Review of Cardiovascular Disease Management Programs in
Managed Care Populations. J Manag Care Pharm 2004; 10(4): 326–344.
2. Shailasree S, Ruma K, Kini KR, Niranjana SR, Prakash HS. Potential
anti-inflammatory bioactives from medicinal plants of Western Ghats, India.
Pharmacogn Commun. 2012;2(2):71-..
3. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. The lancet.
2017 Mar 25;389(10075):1238-52.
4. (00) (00) Carretero OA, Oparil S. Essential hypertension: part I: definition and
etiology. Circulation. 2000 Jan 25;101(3):329-35.
5. Amalraj A, Gopi S. Medicinal properties of Terminalia arjuna (Roxb.) Wight & Arn.: a
review. Journal of traditional and complementary medicine. 2017 Jan 1;7(1):65-78.
6. Dwivedi S, Chopra D. Revisiting Terminalia arjuna–an ancient cardiovascular drug.
Journal of traditional and complementary medicine. 2014 Oct 1;4(4):224-31.
7. Hutchinson”s clinical methods edited by Michael swash and Michael, glynn. 22nd ed.
reprinted
2007.2009. Published by Edin burgh-lonndon, Newyork; (sec-3, basic systems) pp
53-178, p 547.
8. Hashem Dabaghian F, Taghavi Shirazi M, Amini Behbahani F, Shojaee A.
Interventions of Iranian traditional medicine for constipation during pregnancy. Journal
of Medicinal Plants. 2015 Mar 10; 14(53):58-68.

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4.
AYURVEDIC MANAGEMENT ON PAKSHAGHAT W.S.R TO
HAEMORRHAGIC HEMIPLEGIA A CASE REPORT
1
Shweta Parwe, 2Vivek Kumar Verma, 3Dr. Milind Nisargandha
1
Professor and Head, Department of Panchakarma
2
PG Scholar, Department of Panchakarma, Mahatma Gandhi Ayurveda College Hospital and
Research Centre, Salod (H), Wardha. Datta Meghe Institute of Medical Sciences, Nagpur.
3
Department of Physiology, Ashwini Rural Medical College, Hospital and Research Centre
Kumbhari, University of Health Sciences, Nashik, Maharashtra, India.

Abstract-
Pakshaghata is a Vatavyadhi of Nanatmaja vatavyadhi and Mahavatavyadhi. The term
Pakshaghata implies loss of motion of one portion of the body.
A 50 years male patient residing at Sawangi Meghe,Wardha, visited the O.P.D. of
Panchakarma M.G.A.C.H. With a wheelchair and a history of R.T.A. 1 ½ years before. First,
he was treated at a medical hospital, and afterward, he was shifted to an Ayurvedic hospital for
further treatment. He was successfully managed by Panchakarma therapy and shaman chikitsa
for 15 days, and he could stand and walk with support with the help of this procedure.
Keywords: Pakshaghata, Hemiplegia, Vatavyadhi, Nanatmaja Vatavyadhi, Mahavatavyadhi

Introduction:
Pakshaghata is a Vatavyadhi of Nanatmaja vatavyadhi and Mahavatavyadhi. The term
Pakshaghata implies loss of motion of one portion of the body. The impedance of
Karmendriyas, Gnyanendriyas, and Manas was seen. Gnyanendriyas is viewed as a
component of the tangible framework, and Karmendriyas are viewed as a piece of the engine
framework. Pakshaghata can correspond with Hemiplegia, which results after a head injury or
stroke
The terminology of Pakshaghata indicates the main symptom of the disease.
प्ቌस्य देहस्य घातम् ििनाशनाम् यस्मात य्ቔ िा। (शब्दकल्प्ቖुम)

Here, the word “paksha” stands for

1) Flank or side or half of anything
2) One side of body 3) Shareerardham And Considering the word “Aghata,” The Ghata
depicts different meanings, they are 1) Vadha 2) Hanana
Synonyms “प्ቌिध” according to Acharya Charak and Vagbhat, according to Acharya

Sushruta “प्ቌाघात”
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Nidan of Pakshaghat, according to Acharya Charak, is

The Same nidana of Vata Vyadhi is mentioned as Nidana for Pakshaghata like Aharaj Nidan
Ruksha, Sheeta, Laghuguna, ALPA Ahara, etc. Vihara Nidan
Ati Vyavay, Ratri Jagran, Ati Langhana, Plavana, Vyayama, Diwa Swapna, Ushtra, Ashwa,
Gaja, Shighra Yana, Abhighataj Nidanis Abhighata, Marmaghata, Manash Nidan is
Krodha, Chinta, Shoka Vega Sandharana, [1]
Samprapti According To Acharya Charak
The prakupit vayu will take place in half of the body, and by the vishoshana of Shira & Snayu
present there, it will produce Sankocha and Toda in one Hand and Leg. If the same symptoms
are limited to one part only, then called Ekanga Roga & if the whole body is affected is called
Sarvanga Roga. [2]
Nidan sevan aharaj and viharajadi nidan Vayu prakupit Vayu take the place of half of
the body Vishoshana of Shira & Snayu Sankocha and Toda Uttpatti of rupa Pakshavadh
(ekang, sarvang)
According to Acharya Sushruta:
According to Acharya Sushruta, when prakupita Vayu reaches Urdhvagami, Adhogami, and
Tiryaggami Dhamani, this prakupit vayu will destroy any one half of the body, and the
sandhibandhana also will be affected.[3]
Prakupita Vayu Sthansanshraya in Urdhva, Ado, Tiryaga gami Dhamani
Vimoksha of sandhi bandhana of any one half of the body loss of function of half part of
body Pakshaaghat
According to Acharya Vagbhatta:
According to Ashtanga Hrudaya Nidan Sthana, due to its nidana, the prakupita Vayu will
take place in half of the body. It will do Shithilan of Sandhi Bandhana and Vishoshana of Shira
& Snayu of that part. By this, Kriya and Chetana will be affected in half part of the body. It may
be of two types 1) Sarvanga or 2) Ekanga. [4]
Nidana sevana Vata Prakopa Sthana Sanshraya in Shira & Snayu
Vishoshana of Shira & Snayu Shithilan of Sandhi Bandhana half part of the
body will not be able to work in Pakshavadh appropriately
Samprapti Ghataka Dosha: Dosa - Vata Pradhana Tridosha, Dushya- Rasa, Rakta,
Mansa,Meda ,Adhisthana- Shariardha Bhaga,sarwang bhaga Srotas- Rasavah, Raktavaha,
Mansavaha, Pranvaha ,Srotodushti Prakara- Sang ,Agni- Vishmagni
Vyadhi Swabhava- Chirkari, Ashukari, Sadhy/Asadhyata- Krucchasadhya, Asadhya
According to Acharya Charak Poorvarupa:

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Purvarupa of Pakshaghata is not described in any Ayurvedic text. But purvarupa represents
the initial stage of disease manifestation, one among the vata-vyadhis, so that we can take
purvarupa of Vata vyadhis, i.e., “Avyakta Lakshana,” as purvarupa of pakshaghata.[5]
Case Presentation:
A 50 years male patient residing at Sawangi Meghe, Wardha, visited the O.P.D. of
Panchakarma in M.G.A.C.H. with a wheelchair and a history of R.T.A. 1 ½ years before a
check-up. After the clinical examination, the following symptoms were noted, unable to walk,
slurred speech and muscle wasting in the upper and lower limb with stiffness upper shoulder
joint, elbow joint, wrist and fingers joint unable to catch any object with the left hand, stiffness
in left knee common and ankle weakness of the facial muscles involving the left side of face
and Deviation of Mouth.

History of illness: The patient was asymptomatic before 1 ½ year. After 1 ½ year, he had
R.T.A. (road traffic accident), a history of head injury. The patient was unconscious at the time.
He was brought to the hospital, a C.T. scan of the Brain was done, and his report finding was
(the right frontal and temporal lobes caused a diffuse mass effect in the form of sulcogyral
effacement of the right cerebral hemisphere) in head injury. He was taken previous treatment in
an Allopathic hospital. He received conventional treatment but got relief from very few
symptoms of hemiparalysis. Because of upper and lower limb weakness unable to walk, and he
came to Panchakarma O.P.D. with the symptoms mentioned earlier. For further management,
he was admitted to the I.P.D. section.
Personal history: The patient was habituated to spicy and dry food. No record of any addiction
was found. He had disturbed sleep due to illness.
Clinical Examination:
Pulse – 72/min
B.P. – 125/80 mmHg
R.R.- 20/min
Temperature – 98 F
Weight - 65 kg
Asthavidha Pariksha:
Nadi – Vaat-kaphaja
Mala – Samyak Malapravritti, Niraama Mala
Mutra – 5-6 times a day, Samyak Pravritti
Jivha – Niraam

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Shabda – Aspashta (slurred speech)

Sparsha – Anushna Sheet
Drik – Samyak
Akruti – Madhyama
Specific examination
Inspection: - both upper and lower limb
Discoloration: -absent
Muscle wasting: - present upper and lower limb
Deformity: -absent
Palpation: -
Stiffness: -present at left. The shoulder joint, elbow joint, wrist joint, and multiple
finger joints
Temperature: -absent
Pain: -not feel
Investigation: C.T. –Head three times

Progress of Treatment and Assessment: In this case study, we administered the treatment with
a list of internal Medicines with Panchakarma Therapy with doses and duration As in Table 2
and Table 3

Table No 2: Shaman Aushadhi - Treatment administered with a list of internal medicines with
dose and duration, and time and Anupana

Table No. 2

Sr. Medicine Dose and Frequency Duration Anupana

No.
1 Cap Neuron Plus 250 mg twice a day after a 15 days water
meal
2 Tab. Simhanada 250 mg 2 tabs thrice a day 15 days Lukewarm water
Guggulu after a meal
3 Tab. Amavatari Rasa 250 mg twice a day after a 15 days Lukewarm water
meal
4 Tab. Ashwagandha 250mg twice a day after a 15days Lukewarm milk
meal

Table No 3:Panchakarma Therapy: Treatment administered with the list of Panchakarma

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therapy

Sr. No. Procedure Drugs used Duration

1 Abhyanga Dashamula Taila + Mashadi Taila 15 days

2 Mukha Abhyanga Navneet 15 day

2 Patra Pinda Swedana Eranda Patra, Bela Patra, Nirgundi Patra 15 days
Left upper and lower and Dashmoola Taila
limb
3 Nasya Karma Anu Taila 6 -6 drops in each nostril Seven days

4 Matra Basti Ashwagandha Taila (50ml) Three days

5 Niruha Basti Guduchi Ashwagandha Dashmoola (800ml Seven days

Kwath)+Saindhav 10 gram+ Honey 50gram
+Sahchar tail 30ml
6 Matra Basti Ashwagandha Taila (50ml) Three days

Table No 4: Physiotherapy for 15 Days

Result Before treatment After treatment

Gait Poor Improved

Speech Poor Improved

Table No 5:Muscle power

Date Muscle power Right side Muscle power Left side

1st day 25-1-2021 05 02

4th day 28-1- 2021 05 02

8th day 1-2-2021 05 03

12th day 5-2-2021 05 04

16th day 9-2-2021 05 04

Table No 6: Changes in Deep tendon reflexes

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Deep tendon Side Date

reflexes
1st day 4th day 8th day 12th day 16th day
1-2-2021 5-2-2021 9-2-2021
25-1-2021 28-1- 2021

Biceps Right Brisk Brisk Brisk Brisk Brisk

Left Very Low Very Low Very Very Low Very Low
Brisk Brisk Low Brisk Brisk
Brisk
Triceps Right Brisk Brisk Brisk Brisk Brisk

Left Low Brisk Low Brisk Low Low Brisk Low Brisk
Brisk

Brachioradialis Right Brisk Brisk Brisk Brisk Brisk

Left Low Brisk Low Brisk Low Low Brisk Low Brisk
Brisk

Quadriceps Right Brisk Brisk Brisk Brisk Brisk

Left Low Brisk Low Brisk Low Low Brisk Low Brisk
Brisk

Achillies Right Brisk Brisk Brisk Brisk Brisk

Left Low Brisk Low Brisk Low Low Brisk Low Brisk
Brisk

Table No 7: Mode of Action

SR. Shaman Aushdhi Mode of Action

NO and Panchakarma
Therapy
1. Cap Neuron Plus Acts as vatshamak, balya to the nervous system.

2. Simhanada Guggulu Vedanasthapana, Deepana-Pachana,

Rasayana and Medhya Karma.Vatakaphashamaka,
Amapachaka, Srotoshodhaka
3. Amavatari Rasa Vata Dosha, deepaka, pachaka
Rasayana, anulomana
4. Dashamula Taila Vaatshamak, hrudya, vatnadi balprad.
5. Mashadi Taila Vataghna, chronic vatvyadhi, pakshaghat, hanustambh
6. Anu Taila Twakaraukshya, Palita, Urdhvajatrugata roga , Skandha
suskata , Griva suskata , Vaksa suskata

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7. Ashwagandhachurna Balya vat kaphaj vicar me labhadayak, pushtikarak

8. Guduchi fevers, skin diseases, Rheumatoid arthritis, Jaundice
(Liverdisorders), Gout, Diabetes, Bleeding piles,
Rejuvenator, Guduchi Sattva is a highly nutritious and
digestive
9. Saindhav Rochan, Dipana, Vrushya, Chakchushya
Avidahi , Hrudya, Hikkanashak
10. Honey Honey is madhurandkashay, Chedan, and ruksha
In guna and ushna, Virya It is kaphahara
And vran shodhana
11. Sahchar tail Stambha, Shotha, Kushta, Kandu, Kampa ,Vatadosha,
Nasaroga
12. Patra Pinda Swedana stiffness, and Pain, Asthi Sandhi Vikriti or degenerative
Left upper and lower condition
limb
13. Nasya Karma Kaphahar,Kaphavilayan, urdhwajatrugat rog har,
ma-nasdoshahar, shirorogahar
14. Matra Basti This can balance vaat dosha, aajnama maranam shastam
(It can be used from birth to death) for vaatpradhan vyadhi

15. Niruha Basti stimulates the enteric nervous system and regulates the
serotonin level, which is produced by the gut and
responsible for various neurological and psychological
activities
The Sneha added in Basti will lubricate the colon, Soften
the malas and help to eliminate it without strain.

Image : 1 Image : 2

First day of O.P.D. 15th day of I.P.D.

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Discussion:
This case study was diagnosed as vatavyadhi “pakshaghat” due to a high at in Shiro-murdha
Pradesh Vata dosa Prokop, prakupita Vayu takes place in half part of the body. Shithilan of
Sandhi Bandhana and Vishoshana of Shira & Snayu of the left part of the body. Increased
ruksha guna causes rukshata and parushta; this is mainly one crucial reason for the samprapti
of pakshaghat.
So, according to dosha, we started shaman and shodhana Panchakarma therapy.
By Abhyanga, the force of muscle is increment, solidness eliminate, and muscle tone improves.
Swedana is additionally best for the Vata problem; it mitigates the solidness of muscle and
achieves the ordinary working of the veins, muscles, and ligaments. Spasticity, for example,
Sankocha, is an element of Vata - the Dosha technique for treating Vata vitiation is by
Abhyanga and Swedana. Masha (Udad) makes a total mix of nourishment for powerless
muscles. Pratiloma kind of back rub renders Vyana and Udana to a typical utilitarian state. In
this manner, all Srotas load up with the applied Sneha, which supports the body after
processing by Bhrajaka Pitta [6].
Nasya is beneficial in Pakshaghata to nourish the Brain. According to Charak, Nasa is the
portal gateway of Shiras. The drug administrated through the nose reaches the Brain
(Shringataka Marma) [7].
The primary source of Hemiplegia is vitiated Vata. In the Ayurveda text, the decision to treat
Vata Dosha is Basti, and Avarana is the principal causative factor in the pathophysiology of
Pakshaghata. Hence, breaking this interaction of Avarana needs first thought in its
administration. Charaka has focused on Srotoshudhhi, Vatanulomana, and Rasayana, the
overall way of Avarana. Basti accomplishes both objectives, for example, Vatanulomana and
Srotoshudhhi. Basti is the treatment of decision for Madhyama Marga and to ensure Marmas.
The spot of activity of the medication is (Pakvasaya) gut [8].
By giving treatment through Basti, irritation is diminished, and the muscles' fit is calmed. This
decrease in anger and fit encourages better blood flexibility and improved nerve conduction to
the influenced territory, prompting further suggestive improvement [9].
Ashwagandha is Neuroprotective, Immunomodulatory, and Anti-inflammatory [10].
Ashwagandha is the best drug in kevalavata, Krurakoshta, Dhatu kshaya, and Vridha in Apan
Vayu Dushti. It can be given the best relief and overall improvement of patients' health.
Ashwagandha Taila is with Madhur, Tikta Rasa, Snigdha Guna, Ushna Virya, and Madhura
Vipaka having Vatapitta Shamak, Vatanulomana Balya, Brumhana, Rasayana. [11]
Sahachar –is commonly used in Neurological disorders and vatakaphahara.
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Masha (Udad) is an Anti-inflammatory and Nervine tonic [12].

According to Acharya, Charak Basti is the primary therapy of Vata vyadhi. It pacifies the
vitiated Vata. It nourishes and strengthens the nervous system; Nasya karma gives significant
results in pakshaghat, matra, and sahsneha niruha Basti, which offers very influential work in
Pakshaghat vatshamak shaman aushadhi also gives very effective results.
Conclusion:
Based on clinical findings, it can be concluded that Shamana aushdhi with Sinhanad
Guggulu, Amavatari Rasa and Cap Neuron Plus and Dashamula Taila, Mashadi Taila, Anu
Taila Ashwagandhachurna, Guduchi, Saindhav, Honey and Sahchar tail is very effective for
Pakshaghat. Panchakarma therapy such as Sthanik Abhyanga, Patrapinda Swedana, Nasya
karma, Matra Basti, and Niruha Basti is highly effective in curing all symptoms of Pakshaghat
Hemiplegia. This management was found to be effective in the patient.

Funding Support: The authors declare that they have no funding support for this study
Conflict of Interest: The authors declare that they have no Conflict of Interest in this study

References:
1. Acharya Agnivesha: Charaka Samhita with Ayurveda Dipika commentary of
Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukhambha
Surbharati Prakashan, Varanasi, Reprint Edition 2000, Chikitsastana Chapter 28/15 -18, pg.
No. 779.
2. Acharya Agnivesha: Charaka Samhita with Ayurveda Dipika commentary of
Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Published by Chaukhambha
Surbharati Prakashan, Varanasi, Reprint Edition 2000, Chikitsastana Chapter 28/53 -55, pg.
No. 787.
3. Acharya Sushruta: Sushruta Samhita with Nibandhasangraha commentary by
Dalhanacharya, edited by Vaidya Yadavji Trikamji Acharya & Narayan Ram Acharya
“Kavyathirtha”, Published by Chaukhambha Orientalia, Varanasi, 8th Edition 2005;
Nidanasthana chapter no. 1/60-63, pg. no. 302.
4. Vagbhata Astanga Hrdayam Sutrasthan chapter No. 15/38-39 ,Vagbhata, Astanga
Hrdayam with Vidyotini hindi commentary of kaviraj Atrideva gupt; Editor yadunandan
upadhyay Chaukambha Orientalia; Varanasi; Reprint 2018;pg.no. 379.
5. Acharya Agnivesha: Charaka Samhita with Ayurveda Dipika commentary of
Chakrapanidatta, edited by Vaidya Yadavji Trikamji Acharya, Published by- Chaukhambha

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Surbharati Prakashan, Varanasi, Reprint Edition 2000, Chikitsastana Chapter 28/19 , pg. no.
780.
6. Singh N, Dubey S. EVALUATE THE EFFICACY OF SHASHTIK-SHALI PINDA
SWEDA AND ABHYANGA IN MANAGEMENT OF PAKSHAGHATA ALONG WITH
VIRECHANA WSR TO HEMIPLEGIA. International Journal of Ayurveda and Pharma
Research. 2020 Jul 12:1-2.
7. Salve VR, Salve VR, Pandya MR, Roy KB. ROLE OF AYURVED IN THE
MANAGEMENT OF PAKSHAGHAT WITH SPECIAL REFERENCE TO ACUTE
NON-HEMORRHAGIC INFARCT HEMIPLEGIA–A CASE REPORT.
8. Shweta Dadarao Parwe, Vaishali Vasantrao Kuchewar, Milind Abhimanyu Nisargandha,
Dhiraj Singh Rajput. Clinical evaluation of the effect of Ayurvedic oil enema therapy in
managing Cervical Radiculopathy. ijrps [Internet]. 2020Sep.29 [cited
2020Oct.13];11(4):5763-7. Available from:
https://pharmascope.org/ijrps/article/view/3222
9. Bhende SV, Dadarao Parwe S, Patil M, Waigi R. Evaluate the effectiveness of Madhura and
Amla Dravya Matravasti in Katigraha.
10. Parwe S, Kuchewar V, Nisargandha M, Patil M, Choudhari SS. Comparative study of
manjishtadi oil and ashwagandha oil matrabasti on vishwachi (cervical radiculopathy). Int J
Cur Res Rev. 2020 Nov;12(22):75.
11. Parwe S, Nisargandha M, Bhende S. Comparative effect of Ashwagandha (Withania
Somnifera) and Chincha (Tamarindusindica) Matrabasti in Katigraha (Low backache): A
study Protocol.
12. Parwe S, Kuchewar V, Nisargandha M, Patil M. Comparative evaluation of effective route
of administration of MASAM oil in Vishwachi (Cervical Radiculopathy): A Study Protocol.
Indian Journal of Forensic Medicine & Toxicology. 2020 Oct 1;14(4):6765.

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5.
BLOODLETTING AS AN AYURVEDIC TREATMENT PRINCIPLE IN
MANAGEMENT OF DISEASE: A CASE REPORT
1
Chakole Dipika Arun, 2Manyala Shanti
1. Assistant Professor, Department of Kayachikitsa, Mahatma Gandhi Ayurved College
Hospital and Research centre, Salod(H), Wardha, Datta Meghe Institute of Higher education,
Nagpur, Maharashtra, India.
2. Assistant Professor, department of Agadtantra, Mahatma Gandhi Ayurved College Hospital
and Research centre, Salod (H), Wardha, Datta Meghe Institute of Higher education, Nagpur,
Maharashtra, India.

ABSTRACT:
Background- Bloodletting is gaining popularity through various measures. In various disease
conditions this procedure can be done as part of treatment. In various ayurvedic reference
books, there are many condition in which bloodletting is used. Bloodletting can be done with
different methods. In ayurvedic samhita, there are methods like Shruna, alaboo, siravedh and
jalaukavcharana are mentioned in different disease according to conditions. There are
detailed description bloodletting methods like Jalaukavcharan and siravedh found in
Sushruta samhita and Ashtanghrudaya samhita. Now-days sirveda and jalaukavcharan i.e.
medicinal leech therapy is gaining popularities. These methods are commonly used in many
disease condition specially skin disease. Aim and objective- To use bloodletting principle in a
particular disease condition. To assess the effect of bloodletting with leech therapy in condition
of knee joint osteoarthritis. Observation- There is significant instant effect observed in patient
in Knee joint pain and tenderness after leech therapy. Conclusion- This case report conclude
that, bloodletting principle is effective in any disease according to disease condition.
INTRODUCTION:
“Donate blood to save life” is one of popular quote among the common people. Now-a-days
bloodletting is being useful in two ways and this bloodletting term can be coined as blood
donation. Donating blood helps to donor as well as receiver also. Donated blood can be useful
in various conditions like thalassemia disorders, major surgery or any trauma cases.
Moreover bloodletting helps donor to evacuating unwanted waste product in circulatory
system through it. In covid-19 pandemic, many times blood plasma of covid-19 cured patient is
used to treat another covid-19 suffered patient as plasma therapy. Bloodletting is now gaining
in various streams also. Medicinal leech therapy is now commonly used is conventional
medicine for various purpose. According ayurvedic treatment principles, bloodletting is one
of the Panchakarma procedure explained. This bloodletting can be done with help of various

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measures like siraved, alaboo, shrunga, jalauka etc. Sushruta samhita have more gathered and
detailed information bloodletting and its various types. In sushruta samhita sutrasthana, there
is separate chapter dedicated for various raktamokshan procedures, detailed procedure and
related diseases and complications. Also in Ashtang hrudaya sutrasthana, there are two
different chapters dedicated siravedh and leech therapy. Bloodletting procedures are getting
importance now-a-days in most of the skin disease conditions. This procedure is regularly used
by many ayurvedic physicians but only is skin condition. There are various disease conditions
like arthritis, wound, haemorrhoids etc. in which bloodletting principle can be used and found
effective. Bloodletting is commonly done in Rakta dhatu and pitta dosha born disease and
related strotas is raktavaha srotas. The origin of this strotas is Yakruta (liver) and Pliha
(spleen)1. Thus all disease in which all above factors involved combined or solely bloodletting
principle can readily use as treatment principle.

METHODOLOGY
Material:
1. A brief collective information of Raktamokshana in various disease conditions from charak
samhita.
2. A case report of knee joint arthritis patient in which bloodletting used in pain management.
 Importance of blood and blood letting

“तििशु्ቍं िह रुिधरं बलिर्णसुखायुषा|

युनिि ्ቚािर्नं ्ቚार्ः शोिर्तं ्ቨनुितणत|े ”
This shlok is quoted in charak samhita sutrasthana 24th chapter named ‘vidhishonitiya
adhyay’. This shlok state that, “Pure blood is responsible for bala (strength),
Varna(complexion), Sukha(Happiness) in whole life of person. Thus humans’ vital force
(Prana) is depending on Rakta.2
 Factors vitiating blood and caused disease3
This is well quoted in Charak Samhita. In charaksamhita sutrasthana chapter no 24,
there is a list some common factors which cause ‘rakta vitiation’ and ultimately
causing a genre of rakta vitiated disease.
1. Following factors are quoted in ‘rakta vititation factors synonymy called as “Rakta
Dushti hetu”
- A different types of wine which is Sharp in nature or improperly made’
- A verity types of food made with excessive Salt, alkalis, acidic factors

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- A food grains like black lentils, sesame oil etc.

- A green leafy vegetables
- A meat from aquatic animals, pork meat, red meat,
- Curd, A water from curd, a special wine called sura.
- Eating combination food with different properties.
- A daytime sleep just after eating
- Working near fire, in sun
- Having anger issues
- Not having body toxins removal through Panchakarma procedure time to time
- Recurrent indigestion.
- In winter, blood becomes some extent to impure naturally.

 Diseases listed as shonitaja vyadhee in Charak Samhita4

- Stomatitis
- Redness in eyes
- Disease related to Mouth, nose.
- Gulma
- Visarpa
- Raktapitta
- Pramilak
- Vidradhee
- Raktameha
- Vaivarnya
- Agnisada and deformities related to Agni
- Mada, Kampa, Swarakshaya
- Tandra, Atinidra (Excessive sleep)
- Skin disease like Kandu, kotha, Pidaka, etc.

So In this, all spectrum of disease are mentioned. Also there is various condition in
systemic diseases in which we can sue
 Blood letting in Fever5

In charak samhita chikitsasthana, there is chapter dedicated for fever, its causative and various
treatments in different conditions. There is reference for bloodletting when there is no proper
relief in jwar condition by using drugs of properties like sheeta (Cold), ushna (hot), snigdha
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(unctuous) ruksha (dry) etc. Then use various bloodletting procedures like siraved (removing
blood from vein)
There is quote “Rakatsya soavasekat prashamyati”
 Bloodletting in Gulma6

Gulma is one specific disease mentioned ayurved samhitas which is cause due
tridosha vitiation and manifested in ‘abdominal area’. There is reference for Bloodletting when
there is not relief by treatment by of vitiated dosha then raktamokshan i.e. bloodletting must be
with different measure like shrunga, siravedha etc. Also there is reference for bloodletting
pittaj gulma with Daha condition. Bloodletting is also mentioned in ‘raktaj gulma as
‘raktapittahari kriya’
 Bloodletting in Skin disease7

Bloodletting is one of the important treatment principles in skin disease. According ayurvedic
principle, every skin has involvement of vitiated rakta i.e. blood in etiology of every skin
condition. The main treatment principle of Skin disease i.e. Kushta have raktamokshan. There
are several references for bloodletting in various conditions. Some of conditions are as follows:
1. Using leech therapy in rough, rounded and stable skin condition.
2. Leech therapy in pittaj kushtha condition.
 Bloodletting in Rajyakshma8

There is reference for bloodletting by different measures in this disease condition. There is
reference for bloodletting by ‘shrunga’ in condition of parshvashool, ansashool and
shirashoola.
 Bloodletting in Arsha9

Bloodletting is also stated in disease condition like arsha where surgical treatment is
commonly used. There is common principle stated regarding bloodletting in arsha as
procedure used when there is no proper result of medicinal treatment. With this, there is special
reference for various bloodletting measures for process. Ex.- shrunga, jalauka and siravedh.
 Bloodletting in Visarpa10

Bloodletting is one main treatment in visarpa. There are following reference for
raktamokshana in visarpa treatment.1. Raktamokshan in pittasthanagata visarpa
2. Various bloodletting procedures like shrunga, alaboo, siraved and jalauka (leech therapy
etc.)
 Bloodletting and related Published research articles

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There are many research articles published regarding bloodletting in various disease
conditions. There is systemic review articles present for Bloodletting therapy and its effect in
hypertension11. There is randomised clinical trial present on bloodletting (leech therapy) in
Vicharchika (eczema) which shows highly effectiveness of this process12. Sarvesh kumar et al
published a review article regarding history, use and biomedicine information regarding it.13
Case report:-

 A 52-year-old female patient reported the symptoms of pain in knee joints at our
Kayachikitsa O.P.D. of Institute. Having Chief complaints of :
 Chronic pain in the right knee
 Stiffness in the joint is noticeable upon awakening.
 Tenderness when applying light pressure to it.
 Loss of flexibility.
 Swelling on the joints.
 Crackling sound from the joints when functioning.

- Medicinal and other History

1. The Patient gives an h/o of trauma to the right knee.
2. H/O Hysterectomy (8yrs before)
3. No k/c/o – DM / HTN or Thyroid Disorders.

 Family History:-No any family history.

 Observation
On observation, movement patterns become limited owing to discomfort both at rest and
when performing daily tasks like getting up and down from a chair.
Due to pain, using walking assistance is necessary since the knee joints are inflexible.

 General Examination

The Patient was afebrile, with blood pressure 130/80 mmHg, pulse 94/min, and respiratory rate
20/min.
 Systemic Examination

In the respiratory system, the chest is clear B/L AEBS; in the cardiovascular system, S1 S2

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audible and no abnormal sounds are detected. She was conscious and well-oriented.
 Ashtavidh parikshana
(This is a general examination given Ayurvedic Principles.)
1. Nadi –Vata-pittadhya 5. Shabda- Spashta
2. Mala- Malavashthabha (Irregular bowel Habit) 6. Sparsha- Ushna
7. Druk- Prakruta
3. Mootra- Samyak Pravatana 8. Aakruti- Madhyam
4. Jivha- Sama

 Local Examination
On local examination of both knee Joints, minimal swelling over the right knee joint was
observed with mild tenderness.
(Parameter of Patient assessment is given in Table no. 1)
 Diagnosis: Knee Joint Osteoarthritis

Patient Assessment
Parameter Graduation
Grade 0 Grade 1 Grade 2 Grade 3 Grade 4
Tenderness Absent Tenderness with Tenderness with a Tenderness with Non-noxious
no physical grimace, wince, and/ withdrawal (positive stimuli
response or flinch jump sign)
Pain
(VAS Scale)

Table 1: Assessment criteria used in Patient

 Treatment Given in this Patient
- In this Osteoarthritis patient internal medicine given with local oleation and sudation
therapy.
- After 10 days of there is no effective relief observed in patient thus local leech therapy
was planned in this patient.

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Procedure:-
The jalaukavacharana procedure was done on the local site of the pain.
Step1 - Inspection was done of knee joint.
Step 2 – comfortable position was given to the patient.
Step 3 – A nirvish and hungry jalauka had chosen the jalauka who speedily swim in water.
This jalauka put in sarshapchurnajala to make her potential to suck blood
Step 4 – By palpation, maximum tenderness area was located and prick was taken with the help
of sterile needle.
Step 5 – jalauka’s mouth was put over the part of prick where blood was coming. Step 6 – 30
min was taken by jalauka for bloodletting. It removed herself after sufficient amount of blood
sucking. About 25ml of bloodletting was done.
Step 7 – dressing was done at jalaukavacharana site.
Step 8 – Jalauka’s vaman was done with the help of turmeric powder. And it is kept in new
fresh water bottle.
 Assessment done in Patient.

Before Jalaukavacharan After Jalaukavacharan On next day

Parameter Pain Tenderness Pain Tenderness Pain Tenderness
Observed 6 3 4 2 2 1
Value (grade)
Table 2: Assessment and Observation in Patient.
Result: - In this above case report, medicinal leech therapy was used in management of pain in
knee joint osteoarthritis. In above table 2 shows significant effect in reduction of pain and
tenderness gradation. In this, Pain reduced from grade 6 to grade 4 just after leech therapy and
reduced to grade 2 i.e. overall 66% effect was observed. Also tenderness gradation is reduced
from grade 3 to grade 0 i.e. 70% effect was observed. This case report shows that,
Raktamokshana treatment principle significantly used in pain management.
Discussion:-
This article is collective information of important reference for raktamokshana in various
disease conditions from charak samhita and a case report of Raktamokshana used in pain
management in knee joint osteoarthritis. This treatment is one the panchakarma treatment
mentioned. This raktamokshana i.e. bloodletting having subtypes like shrunga, alaboo
,jalaukavcharan and siravedha according to the removal method of blood. Shrunga is a
method of bloodletting in which local blood is removed with the help of horns by creating

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suction. Alabu is a method of bloodletting the same as above but with the help of halo pumpkin.
Jalakukavcharan is mainstream method of bloodletting in which leech are used to remove
vitiated blood. This is conventionally called medicinal leech therapy. There are plenty of study
published regarding its properties and biomedical properties. Siravedh is one type of
raktamokshana in which bloodletting is done through main veins in limbs. This is common
done to remove vitiated dosha from system. Now-a-days blood donation is getting popularity
among people for saving needful life. Bloodletting is most commonly used in skin conditions.
In kushtha chikitsa there is detailed description regarding use of bloodletting in various skin
conditions. This bloodletting can do within different measures as mentioned above.
Bloodletting is also mentioned in different disease conditions also. These diseases are fever,
gulma, rajyakshma, vatarakta, visarpa, vidradhi, arsha etc. A bloodletting treatment is
effective used in pain management. In a complied review of various treatment modalities in
pain management of various disease condition have reference quoted for bloodletting from
charak samhita13. All various references for bloodletting in different disease in ayurvedic
reference book are connectively linked to rakta dushti and its treatment principle explained in
charak samhita sutrasthana. In this, there is a reference for using bloodletting as a treatment
when simple medicinal treatment didn’t shows any significant result in patient’s condtion14.
This bloodletting principle is frequently used by many ayurvedic physicians in day to day
practice and shows significant effect in disease condition.

REFERENCE:
1. Sawarkar, Gaurav & Sawarkar, Punam & Desai, Priti. (2021). Raktamokshana - A
Systemic Review. International Journal of Ayurvedic Medicine. 12. 23-34.
10.47552/ijam.v12i1.1724.
2. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha, sootrasthana.Ch.24,
ver. 3, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.124
3. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha, sootrasthana.Ch.24,
ver. 5-10, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.124
4. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha, sootrasthana.Ch.24,
ver. 11-16, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016.p.124
5. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.03,
ver.289, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.425
6. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.05,
ver.32, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.437
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7. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.07,

ver.50-52, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.452
8. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.08,
ver.82, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.462
9. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.14,
ver.504, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.437
10. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha chikitsasthana. Ch.21,
ver.68-69, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016. p.563
11. Xiong XJ, Wang PQ, Li SJ. Blood-Letting Therapy for Hypertension: A Systematic
Review and Meta-Analysis of Randomized Controlled Trials. Chin J Integr Med. 2019
Feb;25(2):139-146. doi: 10.1007/s11655-018-3009-2. Epub 2018 Jun 25. PMID:
29959751.
12. Raval HN, Thakar AB. Role of Raktamokshana by Jalaukavacharana and Siravedhana in
the management of Vicharchika (Eczema). Ayu. 2012;33(1):68-72.
doi:10.4103/0974-8520.100314
13. Chakole D. Compilation of various references for pain management all through charak
samhita. World Journal of Pharmaceutical Research; Vol 11, Issue 5, 2022.p 277-282
14. Acharya Yadavji Trikamjee, editor. Carak-Samhita of Agnivesha, sootrasthana.Ch.24,
ver.17, Reprint edition. Varanasi: Chaukhamba Surbhartati Prakashan; 2016.p.125

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6.
IMPORTANCE OF LEKHAN KRAMA IN ULCER- A CLINICAL CASE
STUDY
1
Dr .Pratapwar Aniket, Dr. Desai Rajdatta,3Dr Tasare Prashant,
2
1
Associate Professor, Dept.of Rognidan, M.A.D. Ayurveda college,Yevla
2
Associate Professor, Dept.of Rognidan, Annasaheb dange Ayurved college Ashta.
3
Associate Professor, Dept.of Kriya sharir, M.A.D. Ayurveda college, Yevla.

Introduction: Many times it is observed that when there is gross tissue loss, especially skin
egburn / lacerated wounds (more than 10 cm area), in spite of all proper treatment there is a
formation of unhealthy, granulation tissue on floor and edges get fibrotic in such cases of
wounds or ulcers. Because of desolating agent microcirculation get damaged which can be
also responsible for such condition. In Ayurveda such signs & symptoms are described as
3
Dusta Verna

Fibrotic edges & unhealthy granulation tissue is one of the main cases of non- healing ulcer.
According to Ayuvirveda Ulcer having sign symptoms like Ativistrut- More
dimensions, Unnatmasa, ShwetaPidika, Proud flesh granulation tissue with less blood
supply, TshulavrittaOstha- Thick circular edges described in the DustaVrana1,2can be
co-relate withnon- healing ulcer. Sushrutahas advised ShastiUpakram for Dusta Verna.
Lekhan Karma is one of the ShastiUpakrama. Lekha Karma means scrapping of unhealthy,
dead, bad tissues from the ulcer with the help of LekhanShalaka (Scoop like instrument)
Lekhan Karma helps to improve the circulation of ulcer and heals the ulcer.

Clinical Features

A 32 years female having ulcer of size 14 cm X 12 cm on lateral aspect of right leg just 3 fingers
above the lateral malleolus since 3 months. There is not discharge, no swelling or other
systemic and local sign, symptoms except non-healing with very mild dull aching pain. Patient
does not have history of any other systemic disease. All blood reports and X-ray reports are
within normal limits. Ulcer was due to burn by silencer of bike and she was advised skin
grafting. On examination for ulcer

Site: - 4 finger above lateral malleolus of right leg

Size: - 14cm X 12cm X ¼ cm Shape: - Elliptical

Discharge: - No Discharge
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Edges: -
 Fibrotic, hard, pale pink & blackish color
 Floor: - Covered with fibrotic unhealthy granulates tissue
 Base:- Freely movable with mild induration
 Smell: - No specific smell noted.
 Surrounding: - Mild hyperpigmentation with slight edema, No varicosity or local skin
disease.
 Lymphadenopathy: - no inguinal Lymphadenopathy.
Treatment
After complete history and examination Lekhan karma was advocated in
patient. For following setting and observation were noted below

Treatment Observation

Day 1- Scrapping of 50% of fibrotic edges Fibrotic edematous edges unhealthy

and unhealthy granulation tissue granulation tissue and hyperpigmentation
TriphalaKwath L.A. for dhawan around ulcer.

Day 2 - Scrapping of 90 % of fibrotic edges Floor clear and new formation of granulation
and unhealthy granulation tissue tissue edematous reduced slopping edges
TriphalaKwath L.A. for dhawan
Floor Covered with healthy granulation
Day 16- Mild Scrapping done tissue, edges slopping pearly blackish in
color.

Day 25- Only Triphala Kawath Dhawan Healthy from edges noted. Floor-healthy
granulation tissue covered with shiny
mucosa size 12 X10cm Ulcer Size 8 X 6cm
No inflammation.
Day 40- Only Triphala Kawath Dhawan Hyperpigmentation reduced Ulcer healed
completely with mild hyperpigmentation
Day 60- Only Triphala Kawath Dhawan Normal pigmentation

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Discussion
Non healing ulcer can be co-related with Dustavastha of Vrana. According to Charak and
Sushruta many causes are responsible for non-healing of ulcers5.unhealthy tissue and also
increase and develops new blood circulation i.e. Raktaprasadan which ultimately helps to heal
ulcer.

In present case there was vitiation of vata and kaphdosha. Triphala is having Kashaya rasa
Tridoshagnha activity vranropak and shodhak karma because of triphala vitiated dosha
decreased which also helps for healing of ulcer.

With the help of proper hygienic dressing and just simple ayurvedic drug i.e. triphala and
procedure Lekhan Karma the goal of healing is achieved.

Conclusion

With above mentioned treatment patient was fully cured and ulcer healed completely
without any complications during the period of 2 months and skin grafting is avoided.
Simple Lekhan Karma if done properly and timely non-healing ulcer can be cured, healed
successfully by ayurvedic management

References
1. Kaviraj Dr. Ambikadatta shastri, Sushrut Samhita, Purvardha, Sutrasthan, Chukhamba
Sanskrit sansthan Varanasi, Reprinted edition2005, chapter22/7.
2. Kaviraj Dr.Ambikadatta shastri, Sushrutsamhita, Purvardha, Chikithastha, Chukhamba
Sanskrit sansthanVaranasi, Reprinted edition2005,chapter1/38,39,40.
3. Kaviraj Dr.Ambikadatta shastri, Sushrutsamhita, Purvardha, Chikithastha, Chukhamba
Sanskrit sansthan Varanasi, Reprinted edition2005,chapter1/38,39,40..
4. Kaviraj Dr.Ambikadattashastri, Sushrutsamhita, Purvardha, Chikithastha, Chukhamba
Sanskrit sansthanVaranasi, Reprinted edition 2005,chapter1/8.
5. Kaviraj Dr.Ambikadatta.shastri, Sushrut Samhita Purvardha, Chikithastha, Chukhamba
Sanskrit sansthan Varanasi, Reprinted edition 2005,chapter 23/7.

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7.
EFFICACY OF AYURVEDA INTERVENTIONS IN A CHILD WITH AUTISM CUM
DEVELOPMENTAL DELAY- A PEDIATRIC CASE STUDY
1
Renu Bharat Rathi,2* Bharat J. Rathi
1*
Professor, Head, Dept of Kaumarbhritya, 2Professor, Dept of Rasashastra & Bhaishajya
Kalpana, Mahatma Gandhi Ayurved College Hospital & Research Centre, Salod, Datta Meghe
Institute of Higher Education & Research, Deemed to be University, Wardha.

Abstract:
Background: Autism comes under autism spectrum disorder (ASDs) which is characterized
by a pervasive but restricted range of activities and behavioral functioning in the child. Autism
is a heterogenous developmental neurological disorder characterized by discrepancies in social
communication and interaction. Aim and Objectives: To propagate the need of early
diagnosis and start of multimodal Ayurveda/CAM-Complementary and Alternative medicinal
interventions in Autistic children. Objectives are to highlight the efficacy of Ayurveda
management in context to augment the quality of life and reduce the dependency on parents to
lead an independent life ahead. Material and Methods: This is an autistic, hyperactive case of
2 years old boy also suffering from delayed milestones treated by Ayurveda treatment
modalities and other multimodal interventions. As he received fantastic results, hence
presenting it as a case report. Observations and Results: At the end of 2nd sitting only within
three months of short span, the patient was able to stand on his own and started a supportive
walk. Simultaneously, due to early and multiple interventions, his understanding, non-verbal
and slightly verbal communication started which provided immense satisfaction to his parents.
Earlier they did not get any results after allopath treatment for around one year. Discussion:
Ayurved is a life science having natural, herbal, safe medicines and a holistic approach towards
the treatment of any disease with a focus on diet (Ahara), lifestyle change (Vihara), stress relief
by yog, Panchakarma and Sattvavajaya chikitsa (Ayurved psychotherapy), Marmatherapy and
many more. Resulting the good relief in multiple aspects of such autistic children.
Conclusion: Autistic child has multiple issues in various aspects of personal, social,
behavioral, motor, and cognitive domains. We received good improvement in each and every
milestone in this case. Therefore, it may prove a torch-bearer to researchers and practitioners.
The uniqueness of this case was a multi-dimensional approach which provides a synergistic
and quick effect.
Keywords: Autism, communication, developmental neurological disorder, pervasive,
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hyperactive, behavioral, Ayurved, Yog

Introduction: The term autism, is derived from the Greek word autos (self) and ismos (action).
Autism spectrum disorder is a neurological and developmental disorder in which the child is
unable to communicate, remains engaged in swinging movements, has no or very poor
concentration, has repetitive, hyperactive behavior, and has gastric upset [1-2]. Most teens and
adults having autism have less severe symptoms as they get older. Not every adult gets better.
Especially those with mental retardation may get worsen. ASDS has a tendency to flow in the
family but the inheritance pattern is still unknown.[3]
Autism is caused by genetic factors, marriage between blood relations, the advanced age of
parents, consumption of alcohol or drugs, exposure to metals and environmental toxins by an
expecting mother, and some viral infections or many times by unknown etiology.[4] ASD can
involve a wide range of symptoms and skills. Autism can affect one out of 54 children in US
with boys being 4 times more prone to have autism than girls. About 40% of autistic children
do not speak. It is the fastest-growing developmental disorder. Autism is not a hopeless
condition. It is treatable but early prevention is key [2]. An early prevention plan for children
with autism is found effective for improving IQ, language ability & social interaction. In
addition, children with autism are prone to have sensory abnormalities, and lack of
verbal-nonverbal communication too. They generally engaged in lonely play rather than with
peers. Gender, family income and household structure are related to activity scores. The
financial burden and lack of opportunities may be faced to undergo available treatment options
[3]. Some researchers show a very low rate of symptomatic relief in delayed diagnosed cases
than in cases in which early interventions started. Autism is a lifelong condition however,
many children diagnosed with ASD go on to live self-dependent, fulfilling, productive and
successful lives. As in Ayurveda, the range of medications and treatments can augment the
quality of life of the child too much extent [4].
Case report: A mother of a 2-year-old boy came to Balrog OPD with complaints of delayed
milestones, difficulty in communication and repetitive, hyperactive behavior of her child with
lack of reactions while doing any activity. Due to such strange behavior of her Child, the
mother has approached for further treatment. On examination, the boy was found with
pervasive movements and lack in eye contact, not listening to his parent’s instructions and poor
in either verbal or nonverbal communication. Therefore, the case was diagnosed as Autism as
per DSM IV &V criteria.[5]
Personal history:
Sleep-Disturbed
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Bowel-Irregular
Appetite-Lost, moody, not liking combination patterns of eating like for example-chapati with
curry or lentil soup with boiled rice.
On examination:[6]
General- Patient has vitiated TriDoshas with Weight-9kg, Height-81cm and head
circumference 45 cm. Not able to speak, stand and walk, power is 3/5, and reflexes were
normal.
Systemic Examination:
1) CVS-S1,S2 Audible
2) RS-Bilateral Air Entry, H/o recurrent respiratory infections.
3) CNS-Not well oriented, alert, and conscious but having behavioral & speech issues
4) GIT-Irregular Bowel Movement, Abdomen-Slightly tender and distended
Treatment In Ayurveda:
Autism can be managed by 3 treatment categories according to Ayurveda
5) Yukti Vyapashraya ie. Medical Interventions
6) Daiva Vyapashraya ie. Psychological and Spiritual Method
7) Sattvavajaya- counselling, assurance, meditation, manonigraha (Ayurveda
psychotherapy)
Observation & result: The patient was suffering from gastrointestinal upset, so the treatment
was initiated with formulations to boost Agni and improve bowel movements. [6] The internal
as well as external interventions are depicted in Table no. 1 & 2
Table no 1 depicts the medicinal and procedural treatment interventions given for 2
months in 2 sittings
Sr. Type of treatment & Drug Does & Duration
No. purpose Anupana
1. Oral medication to boost Trikatu, Triphala & Hingwashtak 125 mg each Twice a day
Agni & Medha churna+Rajanyadi churna yoga-RY with RY-175 mg before meal
Bramhi ghrit & 5 ml
Suvarnaprashan[7-9] 10 drops
2. For speech stimulation [10] Yashtimadhu+Vacha+Trikatu+Kantakari Paste with Twice a day
honey 100 mg before a
each meal
3. Sattvavajaya chikitsa [4, Counseling to parents, Once or as per Twice a day
11-13] play therapy, Marma therapy (slowly need a day
increase and release of pressure till 1 min
on marma points of brain & vertebral
column), clapping hands and feet & om
chanting
4. Procedures-Nasya and With Biiiii tail,
Shiropichu, With Dhanvantar tail
Sarvang abhyanga Dashmool kwath steam,
Sweda, Matrabasti [14-18] With Sahachar tail
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Table no 2 showing the effect of treatment on gastric upset

Sr.no. Clinical features Before treatment After treatment
1. Loss of appetite ++ Gained average
2. Constipation ++ --
3. Gases, bloating ++ --

The above treatment was given for 7 days the patient was asked to revisit on the 14th day & later
medicine was given for 14 days and the patient is called after one month.
Discussion: The patient has many complex complaints like delayed and difficult speech,
engagement in swinging movements, sleeplessness, constipation, lack of appetite, and gases.
Autism is considered under Sahaj vyadhi including vitiation of all the three sharirik Doshas
and dwi manas Doshas-Raja and Tama. [4]
Trikatu, Triphala, and Hingavashtaka like Agnideepak-pachak drugs are given as there
is a first need to improve the digestive power of the children as these are kapha-Vatahara and
provokes pitta. Rajanyadi churna balances Vata and pitta Doshas. It treats gastric upset, and
improves strength, weakness, and immunity.[7]
Vatadushti (vitiation) is the principal etiological factor in the pathology of autism which later
vitiates to both the manas Doshas-Raja and Tama. Ultimately there is an abnormality of Dhee
(grasping), Dhruti(capacity to hold) Smruti (memory), communication, and behavior.
Therefore, to reduce the Vata dushti, not only medication (Shamanaushadhis) but external
procedures such as Abhyanga/Bahya snehan (body massage), Sweden (hot fomentation) along
with Matra Basti (oil insertion into the rectum) by Dhanvantar tail are important panchakarma
procedures to calm the Vatadushtijanya behavioral changes, constipation, irritability and
hyperactivity of patient which in turn leads to Vatashaman.[16-17] As the brain and
involvement of Majjadhatu in autism, Nasya and Shiro Pichu with Brahmi tail improve brain
functioning and intelligence.[14] It calms Vata and redirects the flow of Vata downwards as
Brahmi revitalizes the nerves and brain cells, and improves mental performance and long and
short-term memory.[8] Table no 3 depicted the action mechanism of different panchakarma
procedures useful in the management of Autism. [18-20]

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Table no. 3 showing the efficacy of panchakarma procedures in the management of

Autism
No. Procedure Mode of Action

1 Talapothichhil The calm and cooling effect, mood regulation, Vasodilatation, a

/shirolepa tranquilizing effect due to an increase in brain circulation,
Cognition, improved memory, sleep & Relieves irritability
2 Nasya-medicated Stimulant action on the brain and its sensory-motor centers.
oil instillation Relieved symptoms of ADHD, Autism, stimulant efficacy to brain
3 Snehan-Sweden Nourishment to skin, muscles, and nerve endings, Vata pacifier
action by increased circulation & vasodilatation leads to improve
motor function, bulk and strength. Relieves pain, and stiffness &
stops stereotyped movements.
4 Matrabasti Vatashaman, microbiota-gut-brain axis, stimulates brain function
Suvarnaprashan improves the brain’s higher functions like thinking, communication, physical
and mental developmental ability and corrects digestion too.[9] The only thing is that there is a
need to continue these Ayurvedic modalities till improvement in all complaints. Proper
counseling, motivation, assurance, and guidance are parts of Ayurved psychotherapy.
Panchakarma procedures act directly on multiple systems of our body with the pacification of
dominant Dosha and augmentation of recessive Dosha thereby making an equilibrium and
results in the good relief in multiple aspects of such autistic children. Autism like a brain
disorder is a neurobehavioral developmental disability that needs lifelong care. As an adjuvant,
play therapy, Marma therapy-acupressure, Om chanting, music therapy, and counseling which
come under Sattvavajaya chikitsa (Ayurvedic psychotherapy-all non-pharmacological
measures) have a pivotal role in the improvement of quality of life. [11-12] Marma therapy-
was regularly done as acupressure with slow increase and release of pressure till 1 min on
marma points of the brain & vertebral column to stimulate all nerves coming out from the
vertebral column. Play therapy and Clapping hands and feet to arouse points of all organs for
their better functioning. [13, 18, 19] Music therapy and Om chanting help to calm the patient
with an increase in focus on any work or task. [20-21] Mother was asked to make the
environment of sleep and hug the child with love and secure feeling to reduce loud screaming
and sleeplessness at night with uttering Omkar and moving right palm of the mother on a
vertebral column to induce sleep. [13, 22] Nasya and Shiropichu also stimulate all brain

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functions. [23-24] at the end of 2nd sitting only, the patient was able to stand on his own and
started a supportive walk. Simultaneously, due to early and multiple interventions, his
understanding, non-verbal and slightly verbal communication was started which provided
immense satisfaction to parents thereby they could know the feeling of their child what is in his
mind and what he want to convey to them.
Conclusion: From this study, it can be concluded that Autism is a congenital and incurable
disease so, any medicine cannot destroy it from its roots, but we can at least improve the quality
of life of the child by using long-term holistic Ayurvedic treatment modalities.
Reference:
1. A Parthasarathy. IAP Text Book of Paediatrics 4 edition 2009 Vol. II Jaypee Brothers
Medical Publisher New Delhi, Chapter 18. Page no. 1053
2. Kliegman, Stanton, Stgeme. Nelson Textbook of Pediatrics. Asian edition, 20th edition.
Philadelphia: ELSEVIER Company; 2015. Chapter 30th autism spectrum disorder;
P.177
3. Rathi R, Rathi B, Khatana R, Sankh S. A case study on management of Rett’s
syndrome by Wholistic approach. International Journal of Ayurvedic Medicine,
2020:11(2);351-357
4. Rathi R, Rathi B. Role of Ayurveda and Multimodal Therapy in Prevention and
Management of Autism Spectrum Disorder (ASD)-The Whole System Approach.
Indian Journal of Forensic Medicine & Toxicology. 2020 Oct 1; 14(4):6789-95
5. Deshmukh A, Rathi R, Rathi B. A comparative study on the efficacy of adjuvant
Brahmi ghrita with CBT (cognitive behavioral therapy) in management of autism in
children-A Protocol study. Annals of RSCB. 2021; 25(1):3275-3282
6. Rathi B, Rathi R. Principals of ethical Ayurveda prescription writing in clinical
practice: A literature review. J Datta Meghe Inst Med Sci Univ 2019;14:S97-102
7. Sushruta, Dalhana, Sushrutasamhita, Nibandhasangraha Commentary, Uttartantra,
Chapter 62, Shalok no-12-16 Verse 4, edited by VaidyaJadavjiTrikamjiAcharya, 9th
ed.Varanasi: ChaukambhaOrientalia; 2003.
8. Pusadkar SS, Rathi B, Topare SG. MEDHYA ACTIVITY OF BRAHMYADI
GHRITA. World Journal of Pharmacy and Pharmaceutical Sciences 2020;9(5) DOI:
10.20959/wjpps20205-16062
9. Rathi R, Rathi B. Efficacy of Suvarnaprashan in Preterm infants-A Comparative Pilot
study. Journal of Indian System of Medicine. 2017 Apr 1;5(2):91.

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10. Rudey M, Rathi R, Rathi B. A comparative study of Guduchyadi Leha and Kalyanak
Leha in management of Gadgada (Stuttering): A Study Protocol. Annals of RSCB.
2021; 25(1):3255-62
11. Rathi R, Rathi B. Ayurveda perspectives towards Prevention and Management of
Nicotine and Alcohol Dependence. Journal of Indian System of Medicine. 2020 Jan
1;8(1):14-28
12. Murthy, R.H.Singh. The concept of Psychotherapy in Ayurveda with special reference
to Satvavajay Chikitsa. Ancient Science of life, 6(4) 1987, 255-261
13. Rathi R, Rathi B. Application of Ayurveda principles in Prevention & Management of
Behavioral problems in children-A Review. IJAM, Oct-Dec 2020, 11(4):636-643
14. Sastri Kashinath; Chaturvedi G CharakSamhita, Agnivesh. 19th edition, Chikitsasthan
15. Unmad Chikitsaadhyaya 9/10-17, Chaukhambha Bharati Academy, Varanasi, 1993;
p-305
16. Khatana R, Rathi R, Khatana A. Role of Ayurveda in Unmada Concerning ADHD –A
Case Study. 2020;11(3):4800-4806, https://doi.org/10.26452/ijrps.v11i3.2774
17. Arun Kute et al, Role of Ayurvedic medicinal plants in childhood neuropsychiatric
disorders: An Evidence-based approach, International Journal of Ayurveda and pharma
Research.5(12) 2017,1-7
18. Tripathi JS. Dimensions of Satvavajay Chikitsa (Ayurvedic psychothrerapy) & their
clinical applications. J Annals of Ayu Med. 2012;1(1):31-38
19. Sastri Kashinath; Chaturvedi G CharakSamhita, Agnivesh. 19th edition, Chikitsasthan
Unmad Chikitsaadhyaya 9/91-94, Chaukhambha Bharati Academy, Varanasi,1993;
p-308
20. Naderi FA, Heidarie et al. The efficacy of Play therapy on ADHD, Anxiety, and social
maturity in 8-12 years aged Clientele children of Ahwaz metropolitan counseling
clinics. Journal of Applied Sciences, 2010, 10(3):189-195
21. Sharda M et al. Music improves social communication and auditory–motor
connectivity in children with autism. Transitional Psychiatry 2018; 8: (231)2-13
22. Telles et al. Autonomic changes during ‘OM’meditation. Indin J Physiol
Pharmacol.1995;39:418-20
23. Gulhane P, Rathi R, Rathi B. Assessment of Prevalence and Psychosocial behavior of
Tobacco Addictive School going Children with Awareness for Deaddiction.
International Journal of Ayurvedic Medicine, 2020:11(2);300-305

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24. Sharma Brahm Dutta, Chouhan Kaushal. Prevention and Management of Autism-An
Ayurvedic perspective, J.res.tradit.medicine, 2016, 2(4)117-121
25. Agnivesh, Satyanarayan Shastri, Charak Samhita, Siddhisthan, 1/53, Chaukhambha
Bharti Academy, Varanasi, 19th edition, 1998, p-975.

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8.
A CASE STUDY ON AYURVEDIC MANAGEMENT OF
KITIBHAKUSHTA
1
Deshmukh Sourabh Gyanranjan , 2Thakare Trupti Ishwardas
1
Associate Professor Department of Kayachikitsa, 2Assistant Professor Department of
Kaumarbhritya Mahatma Gandhi Ayurved College, Hospital and Research Center, Constituent
College of Datta Meghe Institute of Higher Education and Research (Deemed to be
University), Wardha, Maharashtra, India-442001

Abstract
The most prevalent disorder that affects people of all ages due to improper living choices is
skin disease. It is one of the worrying problems with a significant societal impact. One of the
earliest documented human diseases is kushta. In Ayurveda, the all skin diseases are referred to
as Kushta, which is further divided into Maha Kushta and Kshudra Kushta. One variety of
Khudra Kushta is Kitibha Kushta. Ayurveda offers long-lasting, irreversible treatments for
skin conditions that reduce the likelihood of illness recurrence. Aim and Objectives: The
present study was conducted to perceive the effect of combination of Ayurvedic modalities on
Kitibha Kustha. Material and Method: A 30-year-old male patient having lesions on the
chest, abdomen and back region that were reddish in colour, rough to the touch, hard and dry in
nature, and that had been itching for the previous three years, were effectively treated with
Shodhan Chikitsa (Vaman), in addition to Shaman Chikitsa. The disease was treated with
combination of Ayurveda Modalities like Shodhan and Shaman chikitsa. In Shaman chikitsa
we given internal medicines like Gandhakrasayan and Panchatiktaghrita followed by
Shodhan chikitsa with Samsarjana karma was given along with Vetapalai oil and Atrisor
cream for local application was continue for 1 month. Observation: The PASI score was 5.4
before treatment which was 0 after the treatment. Result: In the present case study after
giving the Shodhan and Shaman chikitsa the patient got complete relived from the symptoms.
Conclusion: By using the Ayurveda modalities we can find much better result in case of
KitibhaKushta.
Keywords: Kitibha, Guttate Psoriasis, Shodhan chikitsa, Shaman chikitsa.

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Introduction:
Psoriasis is a terrible and chronic, multisystem and non contagious disease. The incidence rate
is 2.8% seen in India affects the majority of people. The most common clinical type of guttate
psoriasis is more frequently observed in adolescents and young adults [1]. Eruptive psoriasis is
another name for guttate psoriasis. Approximately 2% of people with psoriasis have guttate
psoriasis. Topical dermal steroids, anthralin, and UVB phototherapy are the most frequently
used treatments for guttate psoriasis [2]. Skin conditions like Kushtaroga are reportedly one of
the chronic diseases that are very challenging to diagnose and manage. The pathogenesis of
Kushta and psoriasis is thought to be heavily influenced by behavioural, immunological,
genetic, dietary, and environmental variables [3].Kushta is among the oldest known disorder to
[4]
mankind . The skin diseases in Ayurveda has been broadly classified under the heading
Kushta and Acharya Charaka has told it as one of the Ashta Mahagada that is difficult to treat
[5]
.Kushta is further classified as Kshudra Kushta and MahaKushta in which all kinds of skin
[6]
disease mentioned in Ayurveda are involved . The KitibhaKushta is the type of Kshudra
Kushta having symptoms like Kharasparsha, Shyava, Rukshapidika, Kandu and kina [7]. The
manifestation of Kitibha Kushta is due to seven factors including four Dhatu (mamsa, rakta,
lasika, twaka) and three Doshas (vata, pitta, kapha). [8].
Case study:
A 30-year-old male patient approached with chief complaints of reddish colour lesions rough
to touch hard and dry in nature with itching for 3 years.
Brief history of patient
A 30 years old male patient was apparently well before 3 years. But suddenly started
complaining about the skin lesions over the chest, abdomen and scapular region which was
rough and hard to touch and dry in nature associated with itching. He was a worker belonging
to lower socioeconomic class, Hindu family background. He went to local physician before a
year but got only symptomatic and temporarily relief. When he was consulted to our
institutional OPD of Kayachikitsa, he underwent some clinical assessment like PASI score and
then he advised to take Shodhan and Shamanchikitsa. No family history was found; on
examination it was found that the lesions were hard rough in nature with dark brown colour.
The patient had the habit of taking very spicy and oily food, intake of nonvegetarian food with
consumption of alcohol sometimes.
Skin examination:
1. Inspection
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 Size shape: well defined, scaly, erythematous small round lesions on lower limb
 Colour: reddish
 Lesion: small reddish
2. Palpation
 Moisture: dry ness
 Temperature: warm to touch
 Texture: Rough and hard

Material and Method:

Shodhan chikitsa (Vaman) along with that Shamanchikitsa was given. In the Shodhanchikitsa
Vaman therapy was planned followed by Samsarjan krama of 5 days, sequencing of Purva
Karma, Pradhan karma and Paschayatkarma as shown in Table No.1. After the
Shodhanchikitsa, Shamanchikitsa was started using Antarparimarjanchikitsa including
Panchatiktaghrita, Gandhakrasayan (after interval of 7 days) for 15 days and
Bahirparmarjanchikitsa using Atrisor cream and Vetapalaioil for1 month as given in Table
No. 2.
Observation:
The severity of the area is determined by the three clinical indicators.
The severity characteristics are rated on a scale of 0 to 4, with 0 being the least severe and 4 be
ing the most severe. The body of human being is bifurcated in to following sections-
• HEAD (10 percent of the person skin)
• Arm (Arm) (20 percent)
• Trunk (T) is a slang term for a trunk (30 percent)
• Legs (40 percent)
Each of these areas is rated separately, and the total score of all four is used to calculate the
PSAI score. The percentage of the skin area engaged in each segment is calculated and then
graded on a scale of 0 to 6. (Table no. 3-5)
Result:
In Kushtaroga, one of the types of Kshudra Kushta is Kitibha Kushta, a Twacha vikara.
Shyava, Kina Kharasparsha, and Parushya are its manifestations. After the completion of the
Shodhan chikitsa (Vaman therapy) patient received temporary relief in symptoms. Then after
Shodhan, Shaman chikitsa was started which gives better result in recovery of patient by
symptomatically as shown in Figure No 1.

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Discussion:
In this case study Vaman was choose for the Shodhanchikitsa because Vaman have the efficacy
of removing the vata and kapha dosha which are the main doshas involved in the skin disorder
such as Kitibha Kushta. After this therapy sansarjankrama was planned for 5 days to increase
the Sharirbala and Agni. After that Shaman therapy was started in which Panchatiktaghrita,
Gandhakrasayan for internal use and Atrisor cream and Vetapalai oil for local application.
Action of Gandhakrasayan:
The Gandhakrasayan have the Kushtaghna, Kandughna, and Dahapra. Shaman,
Raktashodhak, Vranaropaka, Twachya, Krumighna mode of action. It is a most common
formulation used in Kushtaroga. Some studies showed that it having the prosperities of
antiviral, antibacterial and antifunal. The purified sulphur is used in all types of Twacharoga. It
is helpful in reducing the itching. It is mainly used externally and internally for skin disorder.
The oil is helpful in reducing the itching and increases the complexion along with improvement
in digestion [9].
Action of Panchatiktaghrita:
The ghrita is used for Shodhan treatment in purvakarma as internal snehana and in
Shamanchikitsa for oral intake. The ingredients of the Panchatiktaghrita have tikta (Bitter),
Madhura (sweet), Ruksha (rough), Katu (pungent), Kashaya (astringent), Sheeta (cold) and
Snigdha (oily) properties along with Ushnavirya that helps to pacify the Tridosha involved in
the disorder. The pacification of Vatadosha is responsible to reliving the symptoms such as
Kharasparsh, Kina, Parusha, as well as the Shyavavarna in the KitibhaKushta. The
pacification of the Pitta Dosha helps in reducing the Daha and Srava. And lastly the
Kaphadosha pacification is responsible for decreasing Kandu, Vruttanvruddhimanthi [10].
Action of Abhyanga with Marichyadi tail:
For performing the abhyanga procedure Marichyadi tail was used. The dravya which are
present in the oil have the properties such as Katu, Kasahaya and Tiktarasa which are
responsible for the Shaman of Vata and Kaphadosha. The Snigdhaguna of the tail is
responsible for reducing the Rukhsta, Khartva and Parushta. The tail has antifungal,
anti-inflammatory, antiseptic hence this oil is effectively used in disorder like Kitibhakushta
[11].

Action of Vetapalai oil

Vetapalai oil is the Twachya oil and is having qualities such as Kushtaghna, antibacterial,
antifungal, antioxidant, and antimicrobial, anti-inflammatory. It is used in skin disorders,
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itching, pruritus, and psoriasis. It is responsible for improving the complexion, relieving pain
and is capable of wound healing.
Action of Atrisor cream:
The cream is used as the topical application. It is an herbal anti-psoriatic cream which is
responsible for reliving the symptoms like itching, dryness. The cream is indicated in all types
of twacharoga. The cream helps in bringing back the normal texture of the skin.
Mode of Action of Vaman Therapy:
As per the Ayurveda, the process of Vaman karma starts with deepanpachana which are
responsible for reducing the aamdosha and increasing the Agni. KitibhaKushta in which the
kaphais predominant and hence Vaman is performed.
The vamadravyas have the properties like tikshna, sukhshma, vyavayi, ushna and vikasi which
get absorbed and come to heart due to the virya it has. The drug acts on the sites where the
vitiated doshas are found. The drugs are responsible for liquefaction of the complex material.
The liquefied molecules reach to amashaya. The udanvayu gets stimulated and the molecules
march in upward direction to remove the vitiated doshas. By the process of Vaman therapy the
vitiated doshas gets pacified and symptoms gets subsided (12).

Conclusion:
Kitabh Kushta which is one of the types of Kshudra Kushta can be correlated with the guttate
psoriasis in modern medicine. The present study concluded that from Ayurvedic treatment that
contains Shodhan and Shamanchikitsa psoriasis can be treated successfully where the chances
of reverences are very less. Panchkarma treatment can expel the harmful accumulates in the
affected part and clears the body channels. This is a very effective way of treating psoriasis.

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References:
1. Asumalahti, K., Ameen, M., Suomela, S., Hagforsen, E., Michaelsson, G., Evans, J.,
Munro, M., Veal, C., Allen, M., Leman, J. and Burden, Genetic analysis of PSORS1
distinguishes guttate psoriasis and palmoplantar pustulosis. Journal of investigative
dermatology A.D. 2003:120(4):627-632.
2. https://www.healthengine.com.all/info/psoriasis
3. Ling, A.L.M., Yasir, S.M., Matanjun, P. and Bakar, M.F.A., International Journal of
Pharmaceutical and Phytopharmacological Research 2003:7-9
4. Singh, S. and Rai, P.B.N., 2015. Concept of Dermatological Disorders in Ayurveda.
Medicine; p 4-5.
5. Agnivesh, , Chakrapani Commentary, Chapter 9, shloka 8, Indriyasthan, Shukla and
Ravi Dutt Tripathi, Charak samhita ,Varanasi:Chowkhamba Sanskrit Pratishthan;
2009,p 90-99
6. Agnivesha, Nidansthan Chapter 5/4. Vidyadhar shukla Dutt Tripathi, Charak-Samhita,
Delhi, Chaukambha Sanskrit Pratisthan. 2019Pg.514.
7. Venkatesh, P. and Belavadi, S.N. Management of Kitibhakushta (Psoriasis): A Case
Study. International Journal of Ayurveda and Pharma Research. 2018:34
8. Asthana Alok Kumar, Asthana Monika and Sahu Renu. Prevention and cure of
Kushtaroga through ayurveda”, International Journal of Development Research, 2019;
09, (04), 27160-27164.
9. Saokar, R.M., Sarashetti, R.S., Kanthi, V., Savkar, M. and Nagthan, C.V. Screening of
antibacterial and antifungal activity of GandhakaRasayana—an ayurvedic formulation.
International Journal of Recent Trends in Science and Technology, 2013; 8(2);
134-137.
10. Gunarathna, E.P. and Kulathunge, R.D.H. Effect of Panchatikta Ghrita and
GandhakadiTaila in the Management of Kitibha (Psoriasis)-A Case study. International
Journal of AYUSH Case Reports:2018; 2(3), pp.9-17.
11. Bramhashankar Mishra, Bhaishajya Ratnavali,Vol-IIl edition 1st, 54/301- 302, New
Delhi: Chaukhamba Sanskrit Bhavan: 2006;92.
12. Mukherjee, A., Khuje, S.M.R., Dwivedi, O.P. and Jain, J. Potency of Nasya Karma.
Journal of Drug Delivery and Therapeutics;2019:261-266.

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Acknowlegement: I convey my sincere thanks to Dr.Saurabh Deshmukh, Associate

Professor Dept. of Kayachikitsa for providing necessary support and help to successfully
complete this case study. All authors of this manuscript declared no Conflict of interest. There
is no funding required for this Case Study.

Figure No- 1

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Shodhan chikitsa:
Table no. 1: The table showing Shodhanachikitsa by following Purva Karma, Pradhan
karma, Paschyatkarma.
Karma Formulation Dose Period Route

Purvakarma Dipan and Trikatu 3 gm twice a 3 days Oraly

For Vaman Pachana churna day with
lukewarm
water
Ghritpana Panchatikta Dose startrs For 7 days Oral with
ghrita from empty
30 ml – 1st stomach at
Day morning
2nd day- 60ml
3rd – 90ml
4th – 120ml
5th – 160 ml
6th- 180ml
7th- 220ml
Sarvanga Marichyadi Quantity After External
snehana Taila sufficient completion application
F/B of 7days of
Dashmool Snehapana
Nadi Kwath Quantity On 8th day
Swedana sufficient Abhyanga
is done
Pradhankarma Vaman Madanphal Antarakha On 9th day Oral
Followed by Yoga mushti at Morning
Samsarjan matra time after
Karma for 5 Snehana &
days Swedana
Paschyatkarma Dhoompan Aguru Stick 5 min By each
Nostril
Sansarjana 5 Days Oral
Karma after
Vaman

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Shaman Aushadi and Bahirparimarjana Chikitsa:

Table no. 2: Table showing medication given after samsarjana karma
Medicine Dose Anupan Route Duration
Panchatikta 10 ml (morning Luke warm Oral 15 Days
Ghrita at 7 AM with water
empty stomach)
Gandhakrasayan 2 BD With water Oral 15 Days with 7
Days of interval
in between
Atrisorcream Quantity - External 1 month
sufficient application
Twice a Day
Vetapalaioil Quantity - External 1 month
sufficient application
Twice a Day

 Table no. 3:
Table Showing the area involved in involvement with gradation:
No involved area Grade:0
<10% of involved area Grade:1
10-29% of involved area Grade:2
30-49% of involved area Grade:3
50-69% of involved area Grade:4
70-89% of involved area Grade:5
90-100% of involved area Grade:6

 Table no. 4:
Table showing assessment criteria:
Chest (L)
Before First follow up Second follow
Treatment up
Skin area involved Grade - A 3 2 1
Erythema (Redness) 3 1 0
In duration (Thickness) 3 1 0

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Desquamation (scaling) E, I, D, B 3 1 0
Total PASI Score 5.4 1.8 0

 Table no. 5:
Table showing overall result:
Before Treatment First follow up Second follow up
Area involved 30-49% 10-29% <10%
Erythema (Redness) Moderate Mild Absent
In duration Moderate Mild Absent
(Thickness)
Desquamation Moderate Mild Absent
(scaling)

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9.
SUCCESSFUL MANAGEMENT OF DIABETES MELLITUS TYPE II
(MADHUMEHA) WITH MADHUTAILIK BASTI-A CASE STUDY
1
Dr.Sadhana Misar (Wajpeyi), MD, PhD Kayachikitsa,
1
Professor, Dept. of Kayachikitsa, Mahatma Gandhi Ayurved College & Research Centre,
Salod(H),Wardha, Datta Meghe Institute of Higher Education and Rresearch, Sawangi
(M),Wardha

ABSTRACT-
Introduction: Diabetes mellitus is a non-communicable metabolic illness. Raised blood
glucose levels that are caused by absolute or relative insulin insufficiency, insulin resistance, or
both are its defining feature. The most prevalent type of diabetes is type 2, which is usually
brought on by leading an unhealthy lifestyle. Madhumeha is a type of Vatika Prameha.
Acharya Charaka mentioned Madhutailika Basti in Yapana Basti. It has both Rasayana as well
as Shodhana effects and indicated in Prameha. Hence here a case is treated with Madhutailika
Basti. Case Report- A 56 years female came with chief complains of bodyache, Sweet taste
in mouth, Burning sensation at sole, excess hunger, excess sleep, polyurea and lethargy for
more than 3 to 4months was treated with Madhutailika Basti 8 days followed by Nishamalaki
Churna and lifestyle modification for 21 days. Patient was assessed on 7th and 15th and 30th day.
Result and Observations- Improvement in subjective parameters and reduction in blood
glucose level was observed. Discussion- Madhutailika Basti is a Yapana Basti which includes
Madhu, TilTaila, Saindhava, Shatapushpa, Erandmool which showed reduction in all
parameters and also the reduction was observed after Nishamlaki and lifestyle management.
Conclusion- Madhutailika Basti is effective in reducing symptoms and Blood Glucose level
due to its Shodhana, Rasayana and Antidiabetic property. Nishamaklaki and lifestyle
management helps in improving symptoms and maintaining Blood Glucose level to normal.

Keywords- Blood Glucose level, Diabetes mellitus, Madhutailika Basti, Madhumeha,

Metabolic disorder, Nishamalaki, Prameha.

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INTRODUCTION –

Diabetes mellitus is a non-communicable metabolic illness. Raised blood glucose levels that
are caused by absolute or relative insulin insufficiency, insulin resistance, or both are its
defining feature (1). The most prevalent type of diabetes is type 2, which is usually brought on
by leading an unhealthy lifestyle. The American Diabetes Association states that exercise,
dietary and lifestyle changes should be used as the initial treatments for type 2 diabetes (2). If,
however, lifestyle changes are not enough to control it, oral hypoglycemic medications and
insulin will be required. Damage to the heart, blood vessels, kidneys, eyes, peripheral nerves,
digestive system, ability to heal wounds, and sexual response are among the major problems of
diabetes 2, also causes issues during pregnancy (3). According to the International Diabetes
Federation (IDF), the number of individuals with diabetes worldwide is predicted to rise from
451 million (18-99 year olds) in 2017 to 693 million by 2045(4).

In Ayurveda it can be correlated with Madhumeha. In all Brihattrayi, there is a description of

diabetes under the head of Prameha. The term Prameha means increased frequency of urine.
Madhumeha (Madhu+Meha), a type of Vatika Prameha is the disease condition in which the
urine becomes sweet, viscid and smells as honey. There are 2 different types, one is
Dhatukshyajanya caused due to Vata aggravation and the other avaranajanya caused due to
Kapha Meda Avarana (Blockage of channel) along with Vata prakopa. Management of
Diabetes mellitus according to Ayurveda includes Nidanparivarjana, Shamana and Shodhana
chikitsa. In sthul pramehi (Type 2 Diabetes, Obese patients) having good strength and severe
increase Dosha, Shodhana chikitsa (purification) is advised. Exercise and life style
modification is also indicated in the management (5). Acharya Charaka mentioned
Madhutailika Basti under Yapana Basti. It has Rasayana as well as Shodhana effects and
indicated in Prameha. Hence here a case is treated with Madhutailika Basti after taking consent
of patient.

CASE REPORT –

A 56 years female came with chief complains of bodyache, sweet taste in mouth, burning
sensation at sole, excess hunger, excess sleep, polyurea and lethargy for more than 3 to
4months.

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History of Chief Complaints- Patient was alright 4 years back. Then she slowly started above
said complaints forwhich she was investigated by her family physician. Her fasting and
postprandial blood glucose was raised so she was advised to take Metrformin, an antidiabetic
drug. But patient was not taking regular medicine hence her complaints get worsened and she
wanted to shift on Ayurveda drugs so she visited to our Hospital.

Past History- Patient was given no significant past history.

Family History-Mother was suffering from Diabetes mellitus type II.

Personal History- Patient was pure vegetarian, having moderate stress with no addiction. Her
sleep was adequate but interrupted and given history of taking daytime sleep for 2 hours daily
after meal. She was not practicing any type of exercise.

Ashtavidha Pariksha-

Table no. 1 Ashtavidha Pariksha-

Nadi 78/min
Mala Samyak
Mutra 8-9 times during day and 3-4 times at night
Jivha Niraam
Shabda Spashta
Sparsha Anushnasheet
Druk No pallor, No icterus
Akruti Sthul(Overweight)

General examinations –General condition of patient was good. All vital parameters were
within normal limit. Her pulse was 78/min, BP-130/80mmHg, respiratory rate-18/min and
body temperature-980F. She was overweight with weight 72 kg, height 168 cm and BMI of
25.5 Kg/m2.

Systemic examination- of Respiratory, Gastro-intestinal, Cardiovascular, Central Nervous

System and Locomotor were within normal limits.

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Blood investigations - showed Fasting Blood sugar level as 176 mg/dl, Post prandial Blood
Sugar level as 274 mg/dl and Glycosylated hemoglobin (HbA1c) as 8.4%.

Diagnosis-From above findings, diagnosed as Madhumeha (Diabetes mellitus type-II).

Table no. 2- Treatment Given

1 Madhutailika Basti
Duration 8 days
Dose 530 ml
Kala Prataha (Abhakata)
Type of Basti Niruha (Yapan Basti)
Parihara Kala 16 days
2 Nishamalaki Churna – started after Basti from 9th day
5gm twice a day with lukewarm 21 days
water before meal
3 Dietary modification 21 days
Avoid fatty, salty, and sugary food products.
Increase the intake of high fibrous diet such as whole grain, green
vegetables, and fruits
4 Exercise 21 days
Daily brisk walking 30 min.
Avoidance of daytime sleep.
Meditation-15 min.

Table no. 3 Ingredients of Madhutailika Basti-

SN Ingredients Quantity
1 Madhu (Honey) 4 Pala - 160 gms
2 Erandamool Kwath (Ricinus communics) 8 Pala - 320 ml
3 Til Taila (Sesamum Indicum) 4 Pala - 160 ml
4 Shatapushpa Kalka (Anethum sowa) 3 Karsha – 30 gms
5 Saindhava Lavana 1 Karsha - 10 gms

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Preparation of Madhutailika Basti -

All the ingredients of Madhutailika Basti as shown in table no. 3 were collected. Initially
Madhu and Saindhava Lavana were taken in the Khalva Yantra and triturated to form a
homogenous mixture.Then Tila Taila was added and mixed properly till it get emulsified to
become homogeneous. After that Shatapushpa Kalka was added and mixed so that Kalka
particles remain uniformly distributed. At last Erandamula Kwatha was added and mixed until
it properly mixes with oil globules. Finally prepared mixture was assessed for homogeneity
with certain features under the heading Suyojitha Niruha Lakshana. Before administration
quantity of 530 ml Basti formulation was measured (6).
Assessment –Patient was assessed on Day 8, 15, 30 for both subjective and objective
parameters (as shown in table no.4).

RESULT AND OBSERVATION-

Assessment of Subjective parameters- On the first follow up (after 8 days Basti) patient
reported reduction in previous mentioned symptoms. Moderate improvement was observed in
symptoms like bodyache, sweet taste in mouth, burning sensation at sole, excess hunger,
excess sleep, polyurea and lethargy. On the second follow up (15th day) patient had little more
improvement in above symptoms. On third follow up (30th day) patient felt lightness and
energetic in routine activity, mental stress and burning in feet was also reduced and frequency
of urine was 0-1 times during night and 4-6 times during day.
Table no 4.-Assessment of Objective parameters-
Follow up Medicine FBS mg/dl PPBSmg/dl Weight in kg
0 day No medicine 176 284 72
1st follow up (8 days) Madhutailika Basti 124 194 70
2nd follow up (15 Nishamalaki Churna + Dietary 114 178 70
days) modification and Exercise
3rd follow up (30 Nishamalaki Churna + Dietary 102 164 69
days) modification and Exercise

DISCUSSION- Acharya Charaka mentioned Madhutailika Basti in Yapana Basti. The main
components of this Basti are Madhu (Honey) and Til Taila (Sesame oil), hence the name
Madhutailika. Yapana Basti enhances lifespan and can be used for a longer period of time. It
can be given to both healthy and sick people, does not require purvakarma, and does not result

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in the creation of atiyoga or ayoga. Acharya Charaka mentioned Yapana Basti's Rasayana and
Shodhana qualities (7).

Madhutailika Basti -
The major ingredients in this basti are Madhu (Honey) and Til taila (Sesame Oil), both in equal
amounts. Its primary attributes are Rasayana (rejuvenating). Also, it includes qualities that
make it useful for Krimi, Kushtha Arsha, Pliha Roga, and Prameha. It acts as Brihana, Dipana,
Medohar, Vatakaphashamaka, Amapachana, and Strotoshodhana. It boosts the digestive power
(Agni), cleanses all of the body's channels, and also aids in restoring normal function of
Rasavaha, Medovaha, and Mootravaha Srotasa. Thus it helps in breaking pathogenesis by
balancing Vitiated dosha, opening obstructed channels and improving metabolism by
correcting deranged Agni. Thus it has Shodhana and Rasayana effects (8).
Concept of Shodhana-
By removing vitiated doshas from the body and preserving the balance of the Tridosha,
Madhutailika Basti aids in the purification of the body. The removal of vitiated Pitta, Kapha,
and Kleda from the body aids in clearing clogged channels and restores Vayu's regular flow.
Shodhana also helps in Agnidipti (digestive fire enhancement), Vataanuloman (downward
movement of Vayu), Sukhen malapravriti (defaecation with ease), Vyadhinigrah (reducing the
symptoms), and Viviktatata pavitrata-glani rahita (feel energetic after passing stool, no
lethargy) Madhutailika Basti cleanses the Srotorodha thereby enhancing nourishment to all
dhatus.
Rasayana effect of Madhutailika Basti-
Due to Rasayana (rejuvenating) property of Madhutailika Basti, healthy bodily tissues are
produced. All body tissues are nourished by the Brihana (nourishing) and Dhatuvardhana
(strenghtening body tissues) property, which maintains tissue regeneration. It strengthens
defence mechanisms without raising blood sugar levels. It improves physical strength
(adaptogenic activity), the health of neurological tissues, and microcirculation via regulating
macrophage activity (9,10). All above action of Basti drugs help in breaking pathogenesis as it
possess antidiabetic activity. It might be useful in modifying the fat and carbohydrate
absorption from the gut.

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Mode of action of drugs in Madhutailika Basti:

Madhu (honey) (11) has Yogavahi property which increases potency of Basti. Sesame oil has
the Tikshna (Deep penetration), Vyavayi (quickly Spreading in all the body), and Sukshma
(capability to enter tiny pore) property. TilTaila causes Lekhana (scraping) and Karshan
(emaciation) due to Tikshna, Ushna, and Ruksha guna. Due to its Sukshma guna, TilTaila
penetrates all Strotasa. Moreover, it nourishes all bodily tissues and pacifies
vitiated Vatadosha. The smooth, heavy properties of TilTaila (12, 13) calm the dry, rough
qualities of Vata and improve cell membrane permeability. Saindhava's molecular, fast, and
smooth characteristics allow it to penetrate microchannels, dissolve dosha, and break down
unhealthy mala. Shatapushpa (14) and Eranda Moola (15) cause addition of Vata pacification,
appetite improving, purification, restoration of health property to this. Because of all these
properties, Madhutailika Basti aids in digestion of Ama (undigested food), and Vata Kapha
pacification leading removal of blockage from channels thus maintaining proper functioning of
Vayu and breaking pathogenesis.
Modern view of mode of action-
Modern science asserts that Madhutailika Basti immediately enters the systemic circulation
through the rectum, has a quicker absorption rate, and produces benefits quickly. Honey can
dissolve lipids and water because it is ambiphilic in nature (hydrophilic and lipophilic). In
addition to lowering surface tension, salt also changes honey's gel state to liquid. Added oil
will then quickly dissolve in this mixture. Kalka may dissolve readily and provide Basti Dravya
potency. Along with its other effects, Kwatha will expand the surface area for absorption. The
aforementioned reactions will be facilitated by temperature and constant stirring. In the end,
the drug will take on a very unstable colloidal form that will enable chemical interaction
between the vast intestine lumen and circulation through semi permeable membranes.
Niruha Basti is hyper osmotic, facilitating elimination of morbid factors, i.e. endo toxins into
the solution, and produces detoxification during elimination. Enteric nervous system (ENS)
usually communicate with the CNS-central nervous system through the parasympathetic (eg.
via the Vagus nerve) and sympathetic (e.g. via the Prevertebral ganglia) nervous system. The
GIT's pressure and chemical changes are both monitored by sensory neurons in the ENS.
Smooth muscle in the GI tract contracts, and GI tract endocrine cells are active, owing to
enteric motor neurons. The majority of the neurotransmitters used by the ENS, including
acetylcholine, dopamine, serotonin, and others, are the same as those of the central nervous
system. The enteric nervous system has the ability to change its response depending on
parameters like as quantity and nutrient composition. Considering the complete nervous
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system is interrelated therefore this regular stimulation to ENS may have some good effect
over the CNS too and in this way the neuro-endocrine control may take place. The ENS works
with the CNS, specifically the hypothalamus and brain stem, to maintain glucose homeostasis
(16). This helps in maintaining blood glucose level normal.
Basti balances the Vata Dosha and, owing to the drugs' lekhana properties, Madhutailika Basti
also cleans the channels, clears of the Medasa Avarana, and normalizes the movement of
Vatadosha. Thus it helps in reducing the symptoms of Madhumeha.

Effect of Nishamalaki-
Nishamalaki is an polyherbal formulation made from Amlaki (Emblica officinalis) and
Haridra (Curcuma longa) with the method mentioned in texts (17). Both drugs in it
individually have hypoglycaemic, neuro-protective and anti-oxidant action (18). Nishamalaki
is recommended in prameha by Acharya Vagbhata. Haridra has Raktashodhaka (blood
purifing) while the Amalaki is a potent Rasayana effect (19). There are many studies based on
Nishamalakichurna and its anti-diabetic action, and there is convincing evidence for its
long-term success in the treatment of Diabetes mellitus and the avoidance of complications.
(20-24). Prior researches on Nishamalaki also imply that when combined into a compound
formulation, the two medicines Haridra and Amalaki may have an additive or synergistic
impact (25-26).
Effect of lifestyle intervention -
To manage weight, glycemic control, blood pressure, and lower the risk of deadly
consequences in T2DM patients, lifestyle intervention is an efficient, non-invasive method
(27,28)
The primary goal of treatment for diabetes management is glycemic control because it is
attributed to better health outcomes and lower rates of serious complications and
co-morbidities. Diabetes management demands for patient commitment to adhere to regular
drug therapy, blood glucose monitoring, and medical checkups in addition to pharmacological
treatment. Commitment to lifestyle treatments and patient self-care practises is crucial for the
management of T2DM and improves glycemic control, lipid profile, BMI, blood pressure, and
the risk of complications from diabetes (29).
Conclusion- Madhutailika Basti is effective in reducing symptoms and Blood Glucose level
due to its Shodhana, Rasayana and Antidiabetic property. Nishamaklaki and lifestyle
management helps in improving symptoms and maintaining Blood Glucose level to normal. As
this is a single case study it is recommended to carry out study on large sample size to prove
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their efficacy in the management of Diabetes mellitus.

Acknowledgement –I am thankful to our Institute for providing environment and facilities to
conduct this study.

REFERENCES-
1. Harrison’s principle of Internal medicine, Volume II, 19th International edition;
2002.
2. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL,
Tsapas A, Wender R, Matthews DR. Management of hyperglycemia in type 2 diabetes,
2015: a patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes care. 2015
Jan 1;38(1):140-9.
3. Ceriello A, Prattichizzo F. Variability of risk factors and diabetes complications.
Cardiovascular Diabetology. 2021 Dec; 20(1):1-1.

4. Cho N.H., Shaw J.E., Karuranga S., Huang Y., da Rocha Fernandes J.D., Ohlrogge A.W.,
et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections
for 2045. Diabetes Res Clin Pract. 2018 Apr; 138:271–281.
doi: 10.1016/j.diabres.2018.02.023. Epub 2018 Feb 26. PMID: 29496507. [PubMed]
5. Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Prameha
ChikitsaAdhyay, 6/ 8, edited by Vaidya Yadavji Trikamji Acharya, reprint 2009,
Chaukhamba Surbharati Prakashan, Varanasi, 2009; 445.
6. Kasture Haridas, Ayurvediya Panchakarmiya Vijnana, Reprint Edition, 2006

7. Charaka samhita of Agnivesh (Original Sanskrit with Chakrapani commentary) published

by Munshorama manoharlal Publishers New Delhi, 4th Edition 1981 page no 72210.
8. Kaviraj Kunjalalal, Jyotir Mitra Sushruta Samhita (English Edition) Published
Chaukhambha Sanskrit Series office, Varanasi (U.P.) 1998 Vol-1 page no 5
9. Savrikar SS Lagad CE Study of Preparation and Standardization of 'Maadhutailika Basti'
with special reference to Emulsion Stability. Ayu. 2010 Jan; 31(1):1-6.

10. Neha Kaushik, NR Singh. Yogesh K. Pandey, Rasayana Therapy in Diabetic Neuropathy,
Wjas Vol 2 Issue 4 July 2017 Pg.No. 272, www.wjas.in.

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11. Baladi Yapana Vasti in Diabetic Peripheral Neuropathy- A Case Study, International
Ayurvedic Medical Journal,IAMJ: Volume 1; Issue6;Nov-Dec2013, www.iamj.in]
12. Brahmasankara Mishra editor, Bhavaprakasa Nighantu, First Part Dhanya Varga 63-65;
11th edition; Chaukhambha Sanskrit Sansthan; Varanasi. - 2007, pg 651
13. Sharma, PC, Yelne MB, Dennis TJ. Database on Medicinal Plants used in Ayurveda, Vol.
5. Central Council for Research in Ayurveda & Siddha, New Delhi, 2007: pg 417
14. Brahmasankara Misra editor, Bhavaprakasa Nighantu, First Part Haritakyadi Varga 89-92
11th edition; Chaukhambha Sanskrit Sansthan; Varanasi. 2007, pg 35.
15. Brahmasankara Misra editor, Bhavaprakasa Nighantu, First Part Guduchyadi Varga 60-66
11th edition; Chaukhambha Sanskrit Sansthan; Varanasi. 2007, pg 29.
16. Guyton A. Gastrointestinal Physiology Unit XII (62). In: Text book of Medical Physiology.
Philadelphia, Pennsylvania: Elsevier Saunders; 2899. p. 774.
17. Singh RH. Charak Samhita of Agnivesha, chikitsa sthan / Prameha Chikitsa Adhyaya,
6/289 , Chawkhambha Surabharati Prakashana, Varanasi, 1st edition, reprint. 2011;

18. JayShree Shriram Dawane, ViJaya anil PanDit, maDhura ShiriSh Kumar BhoSale, Pallawi
ShaShanK KhataVKar, Evaluation of Effect of Nishamalaki on STZ and HFHF Diet
Induced Diabetic Neuropathy in Wistar Rats, Journal of Clinical and Diagnostic Research,
2016 Oct, Vol-10(10): FF01-FF05
19. Yadav RK, Mishra R, Chhipa RP, Audichya KC. Clinical trial of an indgenous compound
drug nishaamalki in the management of madhumeha vis-à-vis diabetes mellitus. Anc Sci
Life. 2001 Jul;21(1):18-24. PMID: 22557029; PMCID: PMC3331030.
20. Prashant Bedarkar B et al. Antihyperglycemic Activity of Nishamalaki-An Ayurvedic
formulation of Turmeric and Emblica Officinalis. European Journal of Biomedical and
Pharmaceutical sciences. 2017; 4(9):853-856.
21. T. K. G. Punchihewa1 , R. V. Ekneligoda2 , P. P. Uyanege, Evaluation Of The Acute Effect
Of Nishamalaki Churna In The Management Of Blood Glucose Level In Diabetes Mellitus
Type 2 International Journal of Scientific Research and Engineering Development-– Vol
4 Issue 1, Jan-Feb 2021;
22. Nanda GC, Chopra KK, Sahu DP, Padhi MM. Nisha Amalaki in Madhumeha (NIDDM):
A Clinical Study. Journal of Research in Ayurveda and Siddha. 1998; 19(1- 2):34-40.
23. Yadav RK et al. clinical trial of an indgenous compound drug Nishaamalaki in the
management of Madhumeha (diabetes mellitus).Ancient Sci. of Life, 2001; XXI(1):18-24

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24. Jayshree Shriram Dawane et al. Preventive and Protective Effect of Nisha Amalaki in STZ
Induced Diabetic Complications in Wistar Rats. Journal of Clinical and Diagnostic
Research. 2016; 10(6):FF01-FF04.])

25. Katiyar VC et al. Further studies on the phenomenon of Madhumeha and its management
with Haridra Amalaki churna and Devadarvyadi Ghanavati”, PG thesis, dept of
Kayachikitsa, IPGT &RA, GAU, Jamnagar, 1984.
26. Guruprasad Rao. Effect of treatment with ‘Nishamalaki’ Powder on Glycemic Control
and Markers of Erythrocyte Oxidative Stress in Diabetic Rats Compared to Troglitazone.
International Journal of Pharmaceutical Sciences Review and Research. 19(2):127-134
27. Kumari G, Singh V, Jhingan AK, Chhajer B, Dahiya S. Effectiveness of lifestyle
modification counseling on glycemic control in type 2 diabetes mellitus patients. Current
Research in Nutrition and Food Science. 2018 Apr 1;6(1):70.
28. Mann I, Khubber M, Gupta AK et al. Assessment of the health related quality of life in
patients suffering from hypertension and diabetes mellitus: A cross sectional
study. Bangladesh Journal of Medical Science; 15(1) : 84-89: (2016)
29. Goldhaber Fiebert JD, Goldhaber-Fiebert SN, Tristan ML, Nathan DM. Randomized
controlled community-based nutrition and exercise intervention improves glycemia and
cardiovascular risk factors in type 2 diabetic patients in rural Costa Rica. Diabetes Care
;26: 24-29 : (2003)

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10.
AYURVEDA MANAGEMENT OF TIRYAK RAKTAPITTA WITH SPECIAL
REFERENCE TO IDIOPATHIC THROMBOCYTOPENIC PURPURA
– A CASE REPORT
*1
Dr. Khedekar Sumod Dr. Rathi Renu 3Dr. Nayak Meghna 4Dr. Hattikar Heramb
2
*1
PhD Scholar, 2Professor, Department of Kaumarbhritya, Mahatma Gandhi Ayurved
College, Hospital and Research Centre, Salod (H). Wardha, Datta Meghe Institute of
Medical Sciences, Wardha, India.
3
Intern, Gomantak Ayurveda Mahavidyalaya and Research, Centre, Shiroda- Goa,
India.
4
Assistant Professor, Department of Shalyatantra, Gomantak Ayurveda Mahavidyalaya
and Research, Centre, Shiroda- Goa, India.

Abstract

Rakta-pitta is one among the Raktavaha sroto dushtijanya vikara which if not managed
properly can be fatal. It is known to be caused as a result of vitiation of “rakta” dhaatu and
“pitta” dosha together. Depending upon the nature, causes, degree of vitiation and its
spread; there is spontaneous bleeding occurring from different orifices of the body. Tiryak
rakta-pitta can be thought on the lines of ITP for better parallel Pathophysiological
understanding on the basis of signs and symptoms and general clinical presentation which
highlights subcutaneous manifestation with the basic complaint of low to extremely low
platelet levels during blood screening. Although, new contemporary treatment options have
been able to improve the prognosis to some extent, these therapies have their share of
associated adverse effects.

In this case, an attempt was made to treat a 5-year-old pediatric patient who was
pre-diagnosed with chronic ITP, having symptoms of small reddish black patches on skin,
especially on the lower limbs, bleeding gums with associated complaints such as a sudden
increase in weight. Ayurveda treatment was prescribed after analyzing the detailed history
given by the patient’s mother from birth to till date. Taking into account the
Pathophysiology and etiological factors, treatment was planned which showed the
promising result. Rare clinical conditions like ITP can be managed successfully with the
help of Ayurveda way of diagnosis and treatment.

Keywords- Ayurveda, Kaumarbhritya, Raktapitta, ITP, Children, Ayurveda intervention,

Case Report

Introduction

Rakta-pitta is one among the raktavaha sroto dushtijanya vikara which has been included
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in one of the Mahagada (fatal disease) [1,2,3]. The disease manifests itself rapidly, invades
the body in all possible directions and spreads like fire. There is the involvement of
raktavaha srotas moola that is pleeha and yakrita and raktavahini dhamanis as explained in
samhitas [4]. Thus, it’s the cumulative involvement of all these entities leads to
raktaja-vyadhi which requires immediate attention and prompt treatment. “Raktam jeeva iti
sthiti”- highlighting that it may prove to be fatal if not managed at the earliest [5]. In
rakta-pitta, depending upon the nature, causes, degree of vitiation and its spread; there is
spontaneous bleeding occurring from different orifices of the body. When all the doshas are
vitiated and are circulating in the bloodstream, the manifestation takes place through all the
roma-kupas (skin pores) of the entire body subcutaneously, this is tiryak rakta-pitta [6].
Tiryak rakta-pitta can be thought on the lines of ITP- Idiopathic/ Immune
thrombocytopenic Purpura for better parallel Pathophysiological understanding on the
basis of signs and symptoms and general clinical presentation which highlights
subcutaneous manifestation[7]. It is one of the exceptional auto-immune disorders with the
basic complaint of low to extremely low platelet levels (thrombocytopenia) during blood
screening with no known cause so there is easy bleeding and coagulopathy which may
make it fatal. Although new contemporary treatment options have been able to improve the
prognosis to some extent, these therapies have their share of associated adverse effects. ITP
has an incidence of up to 6.4 per 100000 children and 3.3 per 100000 adults per year [8, 9].
In ITP, usually petechial haemorrhages, easy bruising more over the lower limbs, and
mucosal bleeding such as menorrhagia in women, nasal bleeding, bleeding from gums, and
hematuria are found. Although no permanent medical treatment is available to date apart
from using steroids, anti RH (D) globulin, high dose IV gamma globulin, platelet
transfusions, immunosuppressants etc; Ayurvedic Management in Pratyakhyeya form
when administered at the earliest is known to show better results without any adverse
effects.

Case Report

A 5-year-old female patient along with her parents came to Ayurveda Pediatric OPD. She
was diagnosed case of ITP. A Hindu by religion, born to a lower middle class,
non-consanguineous parents. The pediatric patient is having symptoms of small reddish
black subcutaneous patches, especially on the lower limbs, bleeding gums and an increase
in weight. The child is the 1st offspring, delivered through FTND-vaginally with a 3.33 kg
birth weight, born with less spacing (within 2nd month) post her mother’s miscarriage (at

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2.5 months). At 1.5 months of pregnancy, the mother had per uterine bleeding for about a
week for which she was advised total bed rest and was given injections for a period of 2
weeks. Since 3rd month of pregnancy, she was taking medicines for hyperglycemia. No
other significant pre-natal, natal & post-natal birth history was noted. In the last 1 year, the
parents of the patient started noticing those patches. In between; she got wounded over the
lips while playing where prolonged bleeding and delayed healing were seen. She was then
taken to Tertiary Healthcare Centre where she was diagnosed with chronic ITP and was
prescribed steroids, post certain blood investigations. Dosage was – 6 mg/ night after food
in March 2022 which was reduced to 4 mg/ night in April 2022, to 2mg / night in May and
finally tapered down to 1 mg/ alternate night after food in June. Initially, there was a
transient increase in platelets for a few days which soon started decreasing. She then
developed adverse effects of steroids as associated symptoms like an increase in weight,
refusal to play, increased appetite, and marked facial and body puffiness. No other evident
history of past illness was given. No specific family history or consanguinity has been
found. Chances of genetic disorders were partially ruled out through repeated questioning
based on the patient’s history. The patient was immunized as per the schedule. The child
was breastfed exclusively till 6 months of age, thereafter milk, cerelac; soft rice and
egg-white were given till 1year of age.

Examination

General: The patient was stable, afebrile and conscious during all the follow-ups. She has
heena Sara- Satva. Her weight had increased from 17 kg to 22kg (5 kg) within a span of 3
months as of May 2022 and was not very alert and interactive. P/A was soft-non tender.
Pulse rate, respiratory rate and body temperature were within normal range. Pallor- was
present while icterus, cyanosis, and clubbing were absent. Bowels were passed every
alternate day, were of hard consistency and frequency of urination was around 6-7
times/day. Sometimes reddish-coloured urine was noticed by parents. There was a marked
increased appetite with normal sleep pattern.

Systemic: CNS, CVS, RS examination showed normal findings.

Local: Small reddish black subcutaneous patches especially on the lower limbs.
Predominantly dry- rough-dull skin, pallor was present and face and full body puffiness.

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INVESTIGATIONS

Table no. 1 shows Platelet count pre-treatment

Date Reading in (thousand/ cumm)

1/4/2022 30,000

22/4/2022 20,000

Bone marrow aspiration report (11/2/22)

Myeloid series is mildly hyperplastic. Eosinophils are increased and form 30% of myeloid
cells. Normal maturation was seen. Erythroid series- was normal. Megakaryocytes- are
increased. Some are immature with round nucleus and blue cytoplasm. Iron- was absent in
marrow. Final impression- features of ITP with Latent Iron Deficiency Anemia (Hb-normal)
with moderate increase in eosinophils.

Treatment protocol

The patient and her parents were counselled first, and the prognosis was explained.
Pratyakhyeya chikitsa in the shamana form was adopted.

Table No. 2 is depicting Medicinal treatment and periodic prescription changes

Date Day Formulation Dose Anupana Duration

of
treatment
29 Day 0 1) Syrup Aptilift 5ml-TDS ------ After
April 1dose3times With food
2022 2) (powder Syrup After
Combination) Aptilift food
Raktapachak
Churna-125mg
Rasapachak
Churna-125 mg 5 ml/ 1 tsp
Yashtimadhu
churna-150 mg Before
Sariva churna - sleeping
100 mg
Manjistha churna-
100 mg
Panchatiktaghruta
guggulu -50mg
3)Triphala ghruta

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Medicines were given for 21 days and Called for follow up

20 May Day 22 1. Syrup Bal 5 ml TDS After

2022 Rasayana 1 dose 3 food
times With After
2. (Powder Syrup food
Combination) Bal
Raktapachak-125 mg Rasayana
Rasapachak-125mg
Yashtimadhu -150mg
Sariva Churna- 100 mg, 5 ml/ 1 tsf
Arogyavardhini- 100 Before
mg sleeping
Manjistha- 100 mg
Panchatikta ghruta
guggulu- 50 mg,
3. Triphala ghruta
Medicines were given for 21 days and called for follow up
10 June Day 42 1. Syrup Bal 7 ml TDS After
2022 Rasayana food

Medicines were given for 30 days

Results: Table No. 3 showing pre-post treatment effect on sign & symptoms
Signs and symptoms Before After
Petechial haemorrhage (reddish +++ +
black patches) on lower limbs
Dryness (rukshata) +++ ++
Bleeding Gums +++ ++
Red color Urination +++ +

Table No. 4 shows the After-treatment effect on Platelet count.

Date Readings in (thousand/ cumm)

19/05/2022 74000
09/06/2022 130000

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Figure No.1 & 2 Showing the Difference of petechial Haemorrhage Before and After
treatment

Before After

DISCUSSION

There are no direct references of ITP, but similar signs and symptoms are found in rakta-pitta
disease mentioned in various classics. Pinpointing towards its symptoms and pathogenesis, it
may be specifically linked with tiryak rakta-pitta [10, 11]. Due to probable beeja dushti and
hetu-sevana, pitta prakopa takes place in Amashaya leading to rakta swa-pramanatah vrudhhi
or directly affects the rakta and does its dushti. Further, mamsadi dhatus syandana with guru
guna vruddhi and gets pravruddha loha gandh due to dushita rakta (compared to altered or loss
of clotting mechanism due to destruction of platelets) and pradushta pitta. Due to ushna-
teekshna guna, syandana increases so there’s dravansa mixing with pitta dushita rakta. It leads
to continuous dilatation –constriction (samvruta-vivruta) of blood vessels due to increase in
blood volume. Since the vessels cannot hold on to excessively increased volume, they break
open and sub-cutaneous bleeding occurs.

The modern science stresses on use of steroids and platelet transfusions for ITP which are
temporary relief. The definite treatment available is bone-marrow transplant which is not
feasible for all and has its own limitations. The evident history given by the patient’s parent of
immediate conception post miscarriage, highlights stree-artava beeja and kshetra dushti.
Initially problem encountered was due to the parents being reluctant to give the detailed history
which later was sorted once doctor-patient relation was established, and parents started
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believing in the treatment. Per-uterine bleeding at 1.5 months of pregnancy may have had an
impact on the fetus in the womb. Anti-hyperglycemic drugs which were started since 3rd month
of pregnancy may have caused some undesired changes in the fetal system. The cumulative
effect of history given may have adversely affected the mother which in turn would have leads
to major changes in the baby.

Syrup Aptilift (Madifal rasayana) contains drugs which do deepana, pachana and Agni
sandukshana which will act on Agni as well as on the pachaka pitta, samana- vyana vayu
vikruti. It is hrudya and anulomaka as well. Triphala ghruta will act excellently on the Agni and
will do away with malavrodha because it is one of the best anulomaka [12].
Rasa-raktapachaka will do prakruta dhatu-pachana kriya and prasadana of rasa and rakta
dhatu for uttama dhatu sthiti as Rasayan [13]. Considering the point that rakta gets formed in
meda-swaroopi majja, Panchatikta ghruta guggulu worked wonders as rakta prasadaka and
asthi-majja pachaka for dhatu niyamana [14]. Yashtimadhu is guru, swaduh and yet acts on
kapha-pitta-vata-asra [15]. Manjistha has a synonym as vikashi so it can be interpreted as vikas
or growth of rakta through rakta-prasadan [16]. Sariva mainly reduces pitta and does bala
vrudhhi [17]. The Bal Rasayan Syrup is an excellent tonic for Rasavaha and Raktadoshaja
vikara which helped in Sustained relief of symptoms. The treatment on a whole focus on
correcting the Agni and anulomana kriya, reducing mainly the pitta-rakta dushti by using rakta
prasadaka-pitta shamaka dravya and increasing dhatu bala and sharira bala of the patient
[18]. Arogyavardhini is a rasa-kalpa mainly correcting the liver metabolism and since kutaki is
present in a comparatively higher amount than the other ingredients, it will help in samyak mala
pravartana as well [19, 20].

CONCLUSION

This case study is an effort to understand the concept of Tiryak raktapitta applied in ITP.
Marked improvement was seen in all the signs and symptoms of the disease and there was
marked increase in Total platelet count. Going by the results of this case study, we can
conclude - Ayurveda modality of treatment is highly effective for management of Tiryak
raktapitta especially in early stages on the not so common yet one of the most important
crises in pediatric patients.

Conflict of interest-None

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REFERENCES

1. Charaka Samhita, Chikitsa Sthana, Chapter- 4, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi, 2004;428-435
2. Drushtartha Sushruta Chintana, Vd. Pa. Ga. Athawale, Uttara Tantra, Chapter-45, , 2nd
Edition, Shri Dhanvantari Book Publishers, Nagpur, Part-2,2017; 552-557
3. Charaka Samhita, Sutra Sthana, Chapter- 28, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi, 2004; 179
4. Charaka Samhita, Vimana Sthana, Chapter- 5, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi,2004;250
5. Drushtartha Sushruta Chintana, Vd. Pa. Ga. Athawale, Sutrasthana, Chapter-14, 2nd
Edition, Shri Dhanvantari Book Publishers, Nagpur, Part-2,2017;129
6. Charaka Samhita, Chikitsa Sthana, Chapter- 4, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi, 2004;429
7. O P Ghai, Essential Paediatrics, Hematological Disorders- ITP, Vinod K Paul, Arvind
Bagga editor, Edition 7, CBS Publishers & Distributors Pvt Ltd, 2009, Reprint:
2012,;319
8. Terrel DR, beebe LA, vesley SK, neas BR, segal JB, George JN. “the incidence of ITP
in children and adults- a critical review of published reports.” AmJ Hematol 2010;
85:174-180
9. Terrel DR, Beebe LA, Vesley SK, Neas BR, Segal JB, George JN. “The Incidence of
ITP in Children and Adults- A Critical Review of Published Reports.” AmJ Hematol
2010; 85:174-180
10. Charaka Samhita, Chikitsa Sthana, Chapter- 4, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi, 2004;428
11. Charaka Samhita, Nidana Sthana, Chapter- 2, Vd. Y.T Acharya, editor. 1st Edition,
Chowkhamba Orientalia- Delhi, 2004;206
12. Bharat Bhaishajya Ratnakar, Compiled by Shri Nagodas Chaganlal Shah Rasavaidya,
With Bhavaprakasika Commentary In Hindi By Vd. Gopinath Bhishagratna, Vd.
Madhukant Bhogi Lal Shah, Vd. Prabodh Vasant Lal Shah, B. Jain Publishers (P) Ltd-
Delhi, Reprint:1995, Part 2; 367

13. Deshmukh A, Rathi R, Rathi B Concept of Rasayana: Unique Ayurvedic Approach in Preventing
Infectious Diseases with Special Emphasis on COVID-19. Int. J. Res. Pharm. Sci., 2020, 11
(SPL)(1), 938-941, https://doi.org/10.26452/ijrps.v11iSPL1.3216

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14. Rathi B, Rathi R, Khobragade P. Relevance of Ayurveda Antiviral herbal wisdom from the
perspective of current research. Int. J. Res. Pharm. Sci,2020:11(SPL 1);175-182
15. Rathi B, Rathi R. Ethno Medicinal documentation of plants used in the treatment of skin diseases by
the tribal’s of Karanja Ghadge Tahsil of Wardha District Jr of School of Adv studies, Jan
-June2019;2(1);22-26

16. Dravyaguna Vigyan, Prof P V Sharma, Chaukhambha Bharati Academy- Varanasi,

Reprint:2003, Audhbhit Aushadh Dravya (Part 2);253-256
17. Dravyaguna Vigyan, Prof P V Sharma, Chaukhambha Bharati Academy- Varanasi,
Reprint:2003, Audhbhit Aushadh Dravya (Part 2);800-802
18. Rathi B, Rathi R. Principals of ethical Ayurveda prescription writing in clinical practice: A
literature review. J Datta Meghe Inst Med Sci Univ 2019;14: S97-102
19. Ayurvediya Aushadhi Guna Dharma Shastra, Vd. Panchanana Gangadharshastri
Gopalrao Gune, Sau. La Pa Vaidya- Vaidyak Grantha Bhandar, Pune, Edition: 2001,
Part 2; 27-30
20. Dravyaguna Vigyan, Prof P V Sharma, Chaukhambha Bharati Academy- Varanasi,
Reprint:2003, Audhbhit Aushadh Dravya (Part 2); 441-443

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11.
AYURVEDA MANAGEMENT OF GADGET ADDICTION IN
PEDIATRIC PATIENT: A SINGLE CASE STUDY
1
Dr Prasad Gajanan Yewale, 2Dr. Renu Rathi, 3Dr. Swapnali Mate
1
Assistant Professor, 2Professor, Dept. of Kaumarbhritya, 1Assistant Professor Dept. of
Kriyasharir Sharir, Mahatma Gandhi Ayurved college hospital & research center, Salod (H),
Datta Meghe Institute of Higher Education & Research (DU).

ABSTRACT
Aim- To study the effect of Ayurveda treatment on Gadget addiction in children. Objective –
the study of Gadget addiction in detail. Discussion-Gadget addiction is related to
Asatmeindriyartha Samyoga & Pradnyaparadh. It affects the normal growth and development
of children as well as the structure of the brain. It is the necessity of time to deaddict children
from Gadget addiction as early as possible. Result- In the present case study Ayurveda
principles are used to treat the patient and a good outcome is noted. Conclusion– The
application of Ayurveda treatment modalities in the treatment of Gadget addiction gives a good
result.
Keywords - Ayurveda, Gadget addiction, Kaumarbhritya, Satvavajaya, Yoga.

INTRODUCTION
Addiction can be described as a process in which behavior, which has the potential to both
bring about pleasure and provide relief from internal discomfort, is used in a pattern that is
marked by a repeated inability to control the behavior (powerlessness) and persistence in the
behavior despite grave negative effects (un-manageability). (1) The term "gadget addiction"
includes excessive mobile use, online gaming, online gambling, excessive internet browsing,
and excessive social media use. Addiction to Gadgets is negatively correlated with
(2)
psychosocial issues in adolescents Addictions to gadgets causes a decrease in physical
activity, which causes early fat deposition. According to research, stressful environments
encourage people to get addicted. (3) Gadget addiction is a behavioral type of addiction and
(4)
there are similarities between Gadget and drug addiction . The Ayurveda concept of
(5)
Asatmeindriyartha Samyoga (Indulgence in unhealthy subjects of sensory organs) and
Pradnyaparadh (6) goes much equivalent to today's Gadget addiction.

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AIM – To study the effect of Ayurveda treatment principles in the management of Gadget
addiction in children
OBJECTIVE –
1. Study of Gadget addiction in detail
2. Study of the pathology of Gadget addiction in detail
3. Study of the efficacy of Ayurveda treatment principles in Gadget addiction in detail

PRESENT COMPLAINTS (In Chronological Order)

1. Spending excessive time on a smartphone, video games
2. Less communication with family and friends
3. No interest in playing and surroundings

The patient had these complaints for 1 year.

Associated complaints
 Eye pain
 Eye irritation
 Gaining weight abnormally for 1 year
History of present illness:
The patient had a history of disease for 1 year. She was spending a lot of time on mobile and
video games. As well as having poor scholastic performance with low social contact with peers
and family. Hence came for the Balroga OPD
History of past illness: admitted for U.T.I. Last year
Family history: [h/o- dm/htn/ihd/tb/leprosy /asthma/genetic disorders] - no
Hereditary disorders – no
Dietary history

Type of Food- Rukshanasevan (daily biscuit & other bakery product consumption),
Ushna Tikshna Ahar (fast food consumption)
Appetite: Good
Personal history-
Bowel Movements- Constipation
Micturition- Normal Sleep- sleeps only for 5 hours.
Hygiene- Good Habits- Bed Wetting/
PICA/Nail Biting- no

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GENERAL EXAMINATION
Built: obese
Gait: Normal Pulse: 80 / min
Temperature: 98.4f B.P: 105/ 76mmhg RR: 28/ min

No e/o - Icterus/Organomegaly/Lymphadenopathy/Oedema
Anthropometry
Weight – 29 kg, height – 142 cm,
Ashtavidh parikshana –

A. Nadi (pulse) = 80/min.

B. Mala (stool) = Malavashmbha (constipation),

C. Mutra (urine) = Normal.

D. Jivha (tongue) = Saam (coated).

E. Agni = Normal

F. Shabda (speech) = Prakrut (Normal).

G. Sparsha (Skin) = Prakrit (Normal).

H. Druk (Eyes) = Netradaha ( eye irritation)

I. Bala (Strength) = Madhyama (Medium).

DOSHA DUSHYA INVOLVED –

Manas dosha: clinical features of gadget addiction are related to Raj Guna and Tamo Guna is
predominance features (7).
Deha dosha:
Vata: controlling the mind is the function of Vata Dosha (8), in gadget addiction, the restraining
power of the mind is delayed.
Pitta: intellect is delayed in gadget addiction, which related to Sadhaka pitta (9)
Dushya:
Buddhi - intellect, restrain, and memory of a person are affected which are the function of
buddhi. From the above clinical feature we could conclude that buddhi is the main dushya in

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gadget addiction.
Adhishthan – man
ASSESSMENT TOOLS:
1) Young’s Internet Addiction test scale
2) DSM-V criteria for social behavior
MANAGEMENT –
Sr.No. Intervention Details of method Duration & Frequency
1 Counseling Counseling about hazardous effects of fortnight 1 session with
mobile and benefits of mobile deaddiction parents and child
separately
2 Yoga therapy Surya Namaskar, Dhyana Daily

3 Encouragement The patient was counseled to play In and Daily for 1 hour
for in &outdoor Outdoor games daily
games
4 Encouragement Parents were guided to the engagement of ‘Si-opus sit’ Whenever
towards children in learning new things, in group required &feasible
attending social activities with peers, etiquette
programs
5 Encouragement Parents advised spending time with Minimum 2 hours of
of parent-child children quality time daily by
relationship To give a reward for non using mobile parents
6 Targeted Reduced time was used for adventure, By Padanshik krama i.e
reduction in bravery cognitive skill-oriented things, reduce Gadget use time by
Gadget use time sports, and yoga. ¼ part each week

The patient and her parents were educated by PPT presentations.

Initial training of Surya namaskar and the method of Dhyana was given.
The patient was asked to do the proposed Suryanamaskara and Dhyana on the assessment day.
Total treatment was advised for 90 days and follow-up was taken on the 91st day

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OBSERVATION -
the
Complaint Before treatment After treatment on
91st
Day
Screen time 7 hours daily Reduced to 1 hour
Communication with friends and No or minimal Spend much time with
family communation family and friends
playing Not interested Interested in outdoor
activities
Young’s Internet Addiction test 78 18
scale score
DSM-V criteria for social behavior 8 2
score

DISCUSSION –
The frequent use of gadgets causes, sensory overload, enlivening the mind for subjective
experience, and the affinity of these experiences causes adverse effects. Addiction (of any
kind) impairs a person's mental capacity, which makes it difficult for them to make morally
sound decisions. The mind needs regulating ability to make any decisions, According to
Ayurveda, Dhee is the component that controls the action of the mind(10) Direct management of
any addiction is not mentioned anywhere in the literature of Ayurveda, but by comprehending
the role of dosha dushya in Gadget addiction, we can come to the conclusion that management
of gadget addiction can be done based on Manasa Roga treatment principles which are proper
(11)
counseling, assurance, memory enhancing, providing knowledge and meditation.
Ashwasana (reassuring and explaining), Suhritvakya (guidance and suggestion), and
Dharmartha Vakya (educating the individual and family) are the types of satvavajaya chikitsa
that were used in treating this case. Yoga has the power to cleanse our mind, soul, and body as
well as to control our emotions; this phenomenon is helpful in conditions such as addiction,
yearning, compulsive behavior, tolerance, and relapse. A consistent yoga practice activates the
alpha, beta, and theta brainwaves, which have been related to improvements in memory, mood,
and anxiety. Mental tension and depression are typical causes of addictive behavior (12).
The easy way to switch from unwholesome things to adopting wholesome things by 1/16th part
(13)
is by using the Padamshik Krama. In Pada karma, bad habits or objects should be

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abandoned and good habits should be adopted. To effectively treat Gadget addiction, daily time
spent on gadgets was reduced to 1/16th of that amount, and replaced with beneficial habits or
creative endeavors. N addition to being helpful to patients, Ayurvedic interventions like
Satvavajaya (psychotherapy), Yoga, and Aachar Rasayana require nothing in the way of
infrastructure and the majority of these treatments are completely free. It will be simple for the
patient to adopt such measures because the importance and method of yoga are widely known
among Indians and are commonly practiced.
CONCLUSION – In this study, we used Ayurveda treatment principles which show good
improvement in a patient without any side effects.
SOURCE OF FUNDS – No
CONFLICTS OF INTEREST – Nil

Reference
1. GOODMAN, A. (1990), Addiction: definition and implications. British Journal of Addiction,
85: 1403-1408. https://doi.org/10.1111/j.1360-0443.1990.tb01620.x.
2. Tripathi A: Impact of Internet Addiction on Mental Health: An Integrative Therapy Is Needed.
Integr Med Int 2017; 4:215-222. Doi: 10.1159/000491997.
3. Alcaro A, Brennan A and Conversi D (2021) The SEEKING Drive and Its Fixation: A
Neuro-Psycho-Evolutionary Approach to the Pathology of Addiction. Front. Hum. Neurosci.
15:635932. DOI: 10.3389/fnhum.2021.63593
4. Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral
Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological
Views. Int J Prev Med. 2012 Apr; 3(4):290-4. PMID: 22624087; PMCID: PMC3354400.
5. Gupta G, Yadav SS. Insight of trividha roga ayatana (three principal causes of diseases)
mentioned in Ayurveda. Int J Health Sci Res. 2021; 11(12):42-47. DOI:
https://doi.org/10.52403/ijhsr.20211206
6. Patil Asmita: The Concept Of Pradnyapradh With Respect To The Factors That Cause Life-
Style Disorders.International Ayurvedic Medical Journal {online} 2018 {cited January, 2019}
7. Kumar S, Mehra D, Raole VV, Nikhate SP. A conceptual study on Medha, Buddhi, Dhee,
Dhruti, Smruti, and Manas.The Pharma Innovation Journal 2019; 8(6): 567-572
8. Baronia, C., Husain, M., & Raole, V. (2019). A critical Review on dominant Vata dosh in
Tridosh siddhant. Ayurline: International Journal of Research in Indian Medicine, 3(02).
https://doi.org/10.52482/ayurline.v3i02.221

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9. Panda SK. Basic Principles of Kriya Sharira. New Delhi: Chaukhamba Orientalia. 2006.
10. Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed. Varanasi: Chowkamba
Orientalia, 2003, 500.
11. Samudrudu K, Negalur VB. Role of Ayurveda in Mental Health wsr to Manasika Swasthya.
AYUSH: International Research Journal of Ayurveda Teachers Association. 2021 Jul 26;
1(01).
12. Nanthakumar, C. . . Intervention of Yoga in Stress, Anxiety and Depression. In:
Bernardo-Filho, M., Taiar, R., de Sá-Caputo, D. C., Seixas, A., editors. Complementary
Therapies [Internet]. London: IntechOpen; 2021 [cited 2022 Nov 10]. Available from:
https://www.intechopen.com/chapters/79736 doi: 10.5772/intechopen.101619
13. Dr. Shruthi S. Shet, Dr. Venkatakrishna K.V., & Dr. Asha S.A. (2021). A critical review on
Padamshika Krama - A transition technique. Journal of Ayurveda and Integrated Medical
Sciences, 6(02), 121-127. Retrieved from https://www.jaims.in/jaims/article/view/1258

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12.
AN AYURVEDIC LOOM FOR INDRALUPTA (ALOPECIA AREATA)
1*
Pargaonkar Akshay Sudhir, 2Jibkate Bhagyashree Ratan
1
Assistant Professor, Department of Dravyaguna,
2
Assistant Professor, Department of Rasashastra and Bhaishajya kalpana, Mahatma Gandhi
Ayurved College, Hospital & Research Centre, Salod (H), Wardha - 442001. Datta Meghe
Institute of Medical Sciences (DU), Nagpur, Maharashtra, India.

Abstract:
Background: Hair is one of the significant characters of an individual. Hair loss may not hurt
physically but it may lead to a psychological impact. Alopecia areata is an autoimmune disease
in which the patient experiences patchy hair loss commonly on the scalp and facial area. A
similar condition is mentioned in Ayurveda in terms of Indralupta which is classified
under Kapalgat roga. This study aimed to assess the efficacy of shaman chikitsa,
Jalaukavacharan, and Prachhana karma in Alopecia areata.
Materials and Methods: The present case is a single case study of 22 years old female patient
who came with complaints of asymptomatic hair loss at a single site over the scalp for 5
months. With Shaman chikitsa, Jalaukavacharana, and Prachhana karma this case of
Alopecia areata (Indralupta) was successfully treated in 3 months. Result: The patch was
immensely filled with glossy black hairs at the end of the follow-up period. Conclusion: It can
be concluded that Ayurveda provides a promising result in the patient
of Indralupta through Jaloukavacharana, Prachhana karma, and Shamana chikitsa. It can be
a choice of treatment, by observing its cost-effectiveness and successful management as
compared to conservative treatment.
Key words: Alopecia areata, Indralupta, Pracchankarma, Jalaukavcharan, Shaman Chikitsa.
Introduction
Alopecia areata is an autoimmune disease in which the patient experiences patchy hair loss
commonly on the scalp and facial area. Males are frequently suffered from Alopecia aerata
than females and children. It can occur at any age. The utmost occurrence is between 30-59 yrs
of age. Its prevalence was 0.7% in India (1). It affects 8.7-20% of cases to family members (2).
It creates more emotional problems in females and children due to hesitation and cosmetic
concern. In Ayurveda, Alopecia areata can be correlated with Indralupta. Indralupta is
described as Kapalagat roga in Ayurveda (3). Ayurveda has given
both shaman (Disease-specific internal medications) and shodhan (Internal and external
cleansing procedures) treatment for this disease. The present case of Alopecia areata was

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successfully treated with Ayurvedic shaman chikitsa along with lepa, Jalaukavcharan,
and Prachhana karma.
Materials & Methods:
Patient Information
The patient was a 22-year-old unmarried girl in Wardha, Maharashtra. Her height was 172 cm,
and her weight was 58 kg.
Present Medical History
22 years old female patient visited with a history of present illness. The patient was
asymptomatic 10-11 months back. Then, she progressively started to have an asymptomatic
hair loss at a single site over the scalp. She also had a history of hair fall for 6 months. There are
no complaints of dandruff and itching. She applied some herbal oil and also took some
homeopathic treatment but did not get relief.
History of past illness
the patient had no history of systemic illness, drug allergies, and no similar illness in the
family.
Inspection:
Two bald patches with imprecise margins, longitudinal (2.5cmX5cm approx) & circular
(2cm radius approx) were found on right parietal & vertex (Figure 1,2) respectively
over the scalp.
Palpation:
There was no local rise in temperature, notenderness/induration.
Personal History

1. Ahar : Pitta Vardhak Ahara 8. Ruchi: Yes

2. Vyasana: None 9. Jarana Shakti: Madhyama
3. Vyayama: Intermediate 10. Abhyavarana Shakti: Madhyama
4. Nidra: Asamyaka, 7h at night, sometimes 1 – 11. Pramana: height 172 cm, weight 58 kg
2 hrs at daytime.
5. Koshtha: Santushtha, 1 time/day, 12. Saatmaya: Pravara
Madhyama
6. Mootra Pravritti: Samyaka 13. Satva: Madhyama
7. Artava Pravritti: Samyaka 14. Prakriti: Vata pittaj

Treatment
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Treatment was done for 3 months including follow-up. Total 3 sittings

of Jalaukavacharana (leech application three sittings with a gap of 7 days, followed by three
sittings with a gap of 15 days), two sittings of Bloodletting was done with a gap of 15 days,
Hasti danta mashi and Jaypal lepa (paste of Croton tiglium)applied locally once in 3 and 15
days respectively for 3 months. All the medicines were administered as given in table no. 1.
Result
When the treatment started, the patient had one patch over the scalp (fig. 1 and Fig 2). After
starting bloodletting and leech therapy and lepa, small hairs started to grow (Fig. 3 and Fig. 4).
Significant growth in the length of hairs was noticed after 3 sittings of leech therapy (Fig. 5).
After completion of leech and bloodletting therapy, the patch was completely covered with
hairs. Internal medicines were stopped during the follow-up period. The patch was filled with
glossy black hair at the end of the follow-up period (Fig. 6 and Fig.7).
Discussion
The diagnosis of Alopecia areata (Indralupta) was made on clinical presentation. The patient
was used to eat fast food and packed food and also had a habit of day sleep. According to
Acharya Sushruta, due to the deranged Vata and Pitta there is gradual falling of hair while
deranged Rakta and Kapha barring their new growth and recurrence (4). Here Amrutashtak
kwath was given for its shamana effect on aggravated Pitta Dosha. It was given with ardra
(wet) Guduchi which helps pachan of pitta dosha. Indralupta kashay and Krumikuthar rasa
were chosen for their Raktashodhaka, Raktavardhaka and yakrut uttejaka effect, respectively.
Indralupta kashay contains ingredients like Amruta, Musta, Chandan, ushir, Brungraj, Sariva
etc. which regulates disturbed rakta dhatu and pitta dosha and also are beneficial for hair
growth and premature graying. Furthermore, to get scrapping and stimulating effect to hair
follicles Jayapal lepa prepared in lemon juice was applied once in 15 days locally and
Hastidanta mashi lepa with coconut oil was applied once in 3 days locally. Leech therapy is an
ideal method for Raktamokshana for vitiated Pitta. There are more than 20 bioactive molecules
present in Leeches secretions. They act as an anti-inflammatory, analgesic, platelet inhibitory,
anticoagulant as well as having extracellular matrix degradative and antimicrobial effects (5).
In alopecia areata, leech and bloodletting therapy may have worked by increasing the micro
blood circulation through acetylcholine- and histamine-like molecule (6). When leech and
bloodletting therapy is done on bald areas, the increase of blood circulation helps enhance the
concentration and delivery of nutrients to that area on one side and removal of accumulated
toxin, inflammatory substances on the other side thereby assisting in the promotion of hair

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growth. Recently alopecia areata is becoming a universal problem, especially in youngsters.

According to its signs and symptoms, it can be correlated with Indralupta. Internal medicine
(shaman chikitsa), local application, Leech therapy and bloodletting showed potential results
on this case of alopecia areata of a female patient. Hence, if done according to Dosha, Avastha,
and Prakruti of the patient, this can be successful management for alopecia.

Acknowledgment:

I would express my sincere gratitude to Dr. Bhagyashree Jibkate for her generous support.

References
1. Seetharam K. Alopecia areata: An update. Indian journal of dermatology, venereology and
leprology. 2013 Sep 1; 79(5):563.
2. Sharma VK, Dawn G, Kumar B. Profile of alopecia areata in Northern India. International
journal of dermatology. 1996 Jan; 35(1):22-7.
3. Vagabhata, Astanga Hrdayam. Dr. Brahmanand Tripathi, Uttarsthan 23/24-25,
Chaukhambha Sanskrit pratishthan, Delhi, Reprint 2015, p. 1053
4. Shashtri A Kshudraroganidanaadhyaya. Nidanasthana 13/32–3. In: Shri Dalhanaacharaya,
Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi
Commentary, Chaukhamba Sanskrit Sansthan, Varanasi; 2010. p. 368.
5. Abdualkader A M, Ghawi A M, Alaama M, Awang M, Merzouk A. Leech Therapeutic
Applications Indian J Pharm Sci. 2013 Mar;75(2):127-37
6. Sig AK, Guney M, UskudarGuclu A, Ozmenet E Medicinal leech therapy—An overall
perspective. Integr Med Res 2017;6: 337-43

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Images

Fig. 1: Day 1 Fig. 2: Day 1

Fig. 3: First sitting Fig. 4: Lepa therapy

of Jalaukavacharana
(Leech application)

Fig. 5: Hair growth started Fig. 6: Significant growth in Fig. 7: Final Outcome
the length of hairs -Significant growth in the
length of hairs

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Table 1: Treatment advised

Sr. Drug Name Dose Duration
no.
1. Amrutashtak kwath with adra 20 ml Twice a day
Guduchi
2. Indralupta kashay 20 ml Twice a day
3. Krumikuthar rasa 500mg Twice a day
4. Jaypal + Lemon Lepa QS for local once in 15 days
application
5. Hastidanta Mashi mixed with QS for local Once in 3 days
coconut oil application
6. Jalaukavchara (Leech therapy) -- Once in 7 days X 3
sitting
7. Pracchan Karma (Bloodletting) -- Once in 15 days X 2
sitting

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13.
MANAGEMENT OF KATISHOOLA (LOW BACK PAIN) THROUGH
AYURVEDA – A CASE REPORT
1
Dr. Seema Himmatrao Thakare,
1
Assistant Professor, Department of Rognidan & Vikruti Vigyana, Mahatma Gandhi Ayurved
College, Hospital & Research Centre, Salod (H), Wardha - 442001. DattaMeghe Institute of
Medical Sciences (DU), Nagpur, Maharashtra, India.

Abstract:
In current scenario, the changing lifestyle hastening the process of degeneration and leading to
the emergence of degenerative disorders, the most prevalent of which include arthritis,
spondylosis, PID, low back pain, etc. Low back pain (katishoola) is a common complaint
among the individuals visiting hospitals for medical care. Nearly 84% of individuals will have
low back pain (LBP) at some point in their lives, and up to 50% of those people will experience
it more than once. According to Ayurveda, in katishoola there is vitiation of vata that result in
pain (shoola). It is characterized by Katipradeshi vedana (pain in lower back region), Kati
shunyata (numbness in lower back), Kriya hani (loss of functions), Hasta-padasuptata
(numbness in hands & legs). In the present article, a case of katishoola was treated with some
ayurvedic treatment principles. A 65 years old female patient, having chief complaints of lower
back pain, pain in both legs, difficulty during walking & unable to stand for longer duration
since few months was treated with procedures like snehana, swedana, katipichu, matrabasti
along with oral medications like Trayodashanga guggula, Ashwagandha churna, Dashamoola
kwatha, Saraswatarishta, Eranda taila for one month. Effect of treatment was assessed before
and after the treatment on presenting complaints. After one month treatment, significant relief
in the pain & restricted movements is observed which was assessed by visual analogue scale &
SLR test respectively.
Keywords: Ayurveda, Low back pain, Katishoola, Matrabasti, Shamana chikitsa
INTRODUCTION:
Aging is a gradual and irreversible pathophysiological process and related with reductions in
tissue and cell function. It increases risk of various aging-related diseases like musculoskeletal
diseases, cardiovascular diseases, immune system diseases and neurodegenerative diseases etc.
(1) Ageing is also associated with various degenerative changes in body. In current scenario,
the changing lifestyle hastening the process of degeneration and leading to the emergence of
degenerative disorders, the most prevalent of which include arthritis, spondylosis, PID, low
back pain, etc. (2) Low back pain (LBP) is a common disease. Up to 84% of individuals will
have low back pain (LBP) at some point in their lives, and up to 50% of those people will

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experience it more than once. The degree of symptoms severity in LBP varies widely. Some
LBP episodes are self-limiting may get resolve without any specific therapy, but some
LBP-related conditions may be so painful that they require treatment in an emergency hospital.
(3) LBP may contribute significantly to functional restrictions, make it difficult to carry out
everyday tasks, and be a risk factor for incapacity and invalidity. LBP is one of the most
common and debilitating musculoskeletal condition frequently reported by older people. In
approximately 85% of patients LBP is idiopathic (no identified cause are known) & considered
as non-specific type. (4) (5)
According to Ayurveda, in older people there is predominance of Vata dosha (one of
the three basic humors). (6) Total 80 types of vatavyadhi known as Nanatmaja-vatavyadhi are
described by Achrya Charak, katishoola (Low back pain) is one among them. It is
characterized by Katipradeshi vedana (pain in lower back region), Kati shunyata (numbness in
lower back), Kriya hani (loss of functions), Hasta-padasuptata (numbness in hands & legs).
Procedures like Snehana, Patra-pindaswedan, Matrabasti, and Katibasti are considered as
first line of treatment for vatavyadhi. In the present case study, the patient is treated with local
snehana & swedana, matrabasti, katipichu & some oral medication.
Case Presentation:
A 65 years old female patient, having chief complaints of lower back pain, pain in both legs
since last six months came to OPD at Naliniprakash clinic, Sainagar Wardha. She was
complaining difficulty during walking & unable to stand for longer duration since last few
months. She also complains about unsatisfactory bowel movements & having disturbed sleep
during night. She had trouble in sleeping due to low backache. Meanwhile she took some
conservative treatment for the same but only get temporary relief & the pain again gets
aggravated after discontinuing the medicine. She had no any previous history of back injury.
Personal history: Personal history revealed that, the patient was housewife, Vegetarian &
used to take green chilli chutney in her meals daily. She had no any history of addiction.
Past history: No history of Hypertension, Diabetes or any major illness in past but diagnosed
with mild osteoporosis three years back.
Examination: On examination, the vitals of the patients were within the normal limits. No any
abnormal finding was noted in systemic examination. The findings of Ashtavidha pariksha
(Eight fold examination) are given in Table no. 1
Assessment Criteria The assessment of pain was done with the help of Visual Analogue Scale
(VAS) (7) & straight leg raising test (SLR test) was used for assessment of restricted lumbar
movements.
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Table No. 1 Ashtavidha Pariksha

Sr. No Examination Observation
1 Nadi (Pulse) 72/min
2 Mutra (Urine) Samyaka (Normal)
3 Mala (stool) Asamyaka (Unsatisfactory sometimes hard stool )
4 Jivha (Tongue) Sama (Coated)
5 Shabda (Speech) Spashta (Clear)
6 Sparsha (Touch) Sheeta (cold)
7 Druka (Vision) Samyaka
8 Akriti (Built) Madhyam (Medium)

Table No. 2 Treatment given to the patient

Karma Snehana Local snehana was done with sahacharadi taila
Swedana Local swedana was done with nadi sweda
Katipichu Dhanvantar taila was used
Matra basti Sahacharaditaila – 60 ml was administered for 7 days
Internal Drug name Dose Administration Duration Anupana
treatment time
Trayodashanga 500 mg Twice a day after 30 days Luke warm
Guggula meal water
Ashwagandha 1 gm twice a day 30 days Luke warm
Churna before food water/milk
Dashamoola 20 ml each twice a day after 30 days Luke warm
kwatha + meal water
Sarawatarishta
Eranda Taila 10 ml at bed time 15 days Luke warm
water

Table No. 3 Pain assessment through Visual Analogue Scale (VAS)

Sr. No Score Before treatment After treatment
1 0-10 9 4

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Table No. 4 assessment of restricted lumbar movements by SLR test

Before treatment After treatment
Right leg 45 degree 55 degree
Left leg 40 degree 45 degree

Discussion:
According to Ayurveda, Katishoola (low back pain) is produced due to provocated vata dosha
at lumbar region. Vata provocation mainly occurs due to either dhatu kshaya (depletion of
dhatu) or margavrodha (obstruction in vata movements). In the present case, the patient
complaints about back pain, pain in both legs, difficulty in walking & sitting. Here in this case
vata gets provocated due to dhatu kshaya & hence snehana, swedana, katipichu, matrabasti
are used along with some oral medication to alleviate the provocated vata & thereby to reduce
the pain.
In shamana chikitsa, Trayodashanga guggula, Ashwagandha churna, Dashamoola
kwatha, Saraswatarishta, Eranda taila was prescribed to the patient. Trayodashanga
guggula is mainly described for treatment of katigraha. It also used in conditions like,
Sandhiashritvata, Asthiashritvata, Majjaashritvata & snayuashritvata. As Katishoola is an
Asthi-sandhiashrita vikara hence trayodashanga guggula is used for the patient. Ashwagandha
due to its madhur vipak & ushnavirya alleviates vitiated vata dosha. It also has rasayana,
balya, vedanashamaka properties & helps to improve the rasadi dhatu. It also acts as analgesic,
sedative & helps in improving the sleep quality. (9) (10) here in present case the patient is old
age & also have disturbed sleep hence Ashwagandha is used to improve sleep quality & to
improve the strength of patient. Dashamoola contains root of ten different plants. It is well
known ayurvedic medicine used by Ayurveda practitioner to treat various painful,
inflammatory musculoskeletal disorders. It is described as an analgesic, anti-arthritic and
anti-rheumatic combination. The 10 constituents in Dashamoola are thought to have a variety
of functions, including adjuvant, carrier agent, stabilizer, etc. Dashmoola kwath is
tridoshahara (alleviating all deranged doshas), vedanasthapana (pain killer), and shothahar
(subside inflammation) & thus helpful in present case. (11)(12) Saraswatarishta is used in
conditions like anxiety, insomnia, stress etc. Here in present case it is used to improve sleep
quality & reduce the anxiety due to pain. (13) Eranda taila is madhur (sweet), katu (pungent),
kashaya (astringent) & having ushna virya (hot in potency). Virechana has an important role in

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chronic LBP. Eranda taila helps in pacification of vata & kapha dosha & acts as a
vatanulomaka & mridu virechaka. (14) Considering the feasibility of patient, local snehana
with shacharadi taila & nadi sweda was given to the patient for 7 days. Snehana helps in
reducing pain & numbness while swedana helps in reducing stambha (stiffness), gourava
(heaviness) of body. Kati pichu helps to retain warm oil in the low back area & thus exerts
direct local Snehana (oleation) and Swedana (sudation) properties & thereby alleviates the
vitiated Vata Dosha & results in relief from pain and muscle spasm, stiffness. Dhanwantar
taila was used externally for katipichu. It is considered one of the best medicines for all vata
vydhi. Its effects are more observed on pain and numbness as sesame oil is used as a base in it.
The taila possess bruhan properties thus cause nourishment of tissues & reduce degeneration.
It helps to increase circulation in lumbo-sacral region. Most of ingredients of this taila show
vatahara properties. Its application helps to reduce stiffness & restricted movement caused due
to aggravated vata dosha. (15) (16) Basti is considered as best than any other remedy to treat
the vitiated vata dosha or vatapradhan vyadhi. Matra basti, a vikalpa of anuvasana basti when
given reaches up-to pakvashaya which is the main site of vata dosha. It promotes strength &
administered in all seasons without specific diet plan. It promotes easy elimination of Mala &
Mutra. As per Acharya Charak, matra basti acts as bruhan, overcomes dhatukshaya and
reduces vata prakopa. Here in present case, sahacharadi taila is used for matra basti. Its most
of the ingredients have katu rasa and ushna virya and thus helps to alleviates Vata and Kapha,
and reduce the pain and swelling.
Conclusion:
Katishoola (low back pain) is a common complaint experience by individual at some point in
their lives. It is vata predominant condition. Due to its high prevalence & high rate of disability
it serves as leading problem especially in elderly. Both shaman & shodhan chikitsa are used for
the treatment of katishool. In the present case, procedures like snehana, swedana, katipichu,
matrabasti are used to treat the alleviated vata dosha along with oral medications like
Trayodashanga guggula, Ashwagandha churna, Dashamoola kwatha, Saraswatarishta,
Eranda taila. Significant relief in the pain & restricted movements is observed with assessment
by visual analogue scale & SLR test respectively.

Financial support: None

Conflict of Interest: None

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References:
1. Guo J, Huang X, Dou L, Yan M, Shen T, Tang W, Li J. Aging and aging-related diseases:
From molecular mechanisms to interventions and treatments. Signal Transduction and
Targeted Therapy. 2022 Dec 16;7(1):391.
2. Verma P, Latika SB. The Management of Katishoola (vertebral Compression fracture)
through Panchakarma-A case study. Journal of Ayurvedic and Herbal Medicine.
2022;8(3):156-9.
3. Shemshaki H, Nourian SM, Fereidan-Esfahani M, Mokhtari M, Etemadifar MR. What is
the source of low back pain?. Journal of Craniovertebral Junction and Spine. 2013 Jan;
4(1):21.
4. De Souza IM, Sakaguchi TF, Yuan SL, Matsutani LA, do Espírito-Santo AD, Pereira CA,
Marques AP. Prevalence of low back pain in the elderly population: a systematic review.
Clinics. 2019 Oct 28;74.
5. Sakai Y, Wakao N, Matsui H, Watanabe T, Iida H, Watanabe K. Clinical characteristics of
geriatric patients with non-specific chronic low back pain. Scientific Reports. 2022 Jan
25;12(1):1286.
6. Thakare SH. Assessment of role of diet, life style & stress in the etiopathogenesis of
constipation in geriatric patients. International Journal of Modern Agriculture.
2020;9(3):137-41.
7. Ogon M, Krismer M, Söllner W, Kantner-Rumplmair W, Lampe A. Chronic low back pain
measurement with visual analogue scales in different settings. Pain. 1996 Mar
1;64(3):425-8.
8. Shastri R (editor), Bhaishajyaratnavali of Shri Govind Das with Vidyotini Hindi
commentary by Shri Ambikadatta Shastri, Chapter 26 Verse 98-101. Varanasi:
Choukhamba prakashan; Reprint 2017. p539-540.
9. Sharma P. V, Dravyaguna vijnana Vol. II. Varanasi: Chaukhamba Bharti Academy;
Reprint 2011, p.763-765
10. Deshpande A, Irani N, Balkrishnan R, Benny IR. A randomized, double blind, placebo
controlled study to evaluate the effects of ashwagandha (Withaniasomnifera) extract on
sleep quality in healthy adults. Sleep medicine. 2020 Aug 1;72:28-36.
11. Parekar RR, Bolegave SS, Marathe PA, Rege NN. Experimental evaluation of analgesic,
anti-inflammatory and anti-platelet potential of Dashamoola. Journal of Ayurveda and
integrative medicine. 2015 Jan;6(1):11.
12. Nanda GC, Tiwari RK. Shothahara Activities of Dashamoola Dravyas as an
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Anti-Inflammatory Formulation with Special Reference to Charak-A Review.

AYUSHDHARA. 2016;3(1):479-85.
13. Kharat M, Parulkar G. Saraswatarishta; A Miraculous Rasayana. World Journal of
Pharmaceutical Research. 2016;5(11):358-61.
14. Singh R, Kakade R, Gulhane J. Therapeutic aspects of Eranda Tail (Oil of Ricinus
Communis). Journal of Ayurveda and Integrated Medical Sciences. 2023 May
25;8(4):158-65.
15. Kaalia N, Bhatted SK, Acharya SH. Effect of Panchatikta Ksheera basti with Kati basti in
Katishoola ws r lumbar disc degeneration–A clinical study. Indian Journal of Health
Sciences and Biomedical Research kleu. 2021 Jan 1;14(1):108-12.
16. Jaykrishan B, Rout S. Ayurvedic management of Kati shoola (Lumbar spondylolisthesis):
A case report. Journal of Medicinal Plants. 2021;9(5):126-30.

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14.
POLYCYSTIC OVARIAN SYNDROME FROM AYURVEDIC
VIEWPOINT- A CASE STUDY.
1
Dr. Shanti Manyala 2Dr. Nishigandha Kubade, Assistant Professor, Department
of Agadtantra Vyavhar Ayurved Evum Vidhi Vaidhyak , Shubhdeep Ayurved
College and Hospital, Indore. 2Assistant Professor, Department of Stri Rog and
Prasuti Tantra, L.N. Ayurved College and Hospital, Bhopal.

Abstract:
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of
reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or
excess male hormone (androgen) levels. The ovaries may develop numerous small collections
of fluid (follicles) and fail to regularly release eggs. Women with PCOS have a hormonal
imbalance and metabolism problems that may affect their overall health and appearance. PCOS
is also a common and treatable cause of infertility. High levels of Androgens and Insulin are
one of the major contributing factors to PCOS. Many women with PCOS have insulin
resistance, especially those who have overweight or obesity, have unhealthy eating habits, do
not get enough physical activity, and have a family history of diabetes (usually type 2
diabetes). Ayurved emphasizes on the preventive aspect of any disease. Also it focusses on the
overall well- being of the individual both physical as well as mental. There are various dietary
principles as well as treatment modalities in Ayurved , which are very effective in treating and
preventing Obesity, insulin resistance and increased levels of Male hormone, which play a
major role in occurance of Polycystic ovarian syndrome.
Keywords- Hormonal, Infertility, Androgens, Modality.

Introduction:
Ayurveda is a holistic and Indian System of Medicine. It not only emphasizes on the curative
aspect, but also focusses on the preventive aspect of the disease. Polycystic ovarian syndrome
is a condition, which affects about 6- 10 % of the overall women population. PCOD is a very
common endocrinal disorder, which is mainly arising due to the prevalent hitech urbanisation
and unhealthy lifestyle. This condition generally affects women in the age group of 15 to 30
yrs. Polycystic ovarian disease is a syndrome, which is the outcome of hormonal balance and
consist of symptomps like irregularities in menstruation, facial hair growth, acne, skin oiliness,
obesity and over production of androgens. Stein Leventhal Syndrome is the other name for
PCOS.
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Ayurveda considers vitiation and imbalance of Tridoshas as the causative factor for any
disease. Ayurveda considers Vitiation of kapha dosha as the main hetu for PCOS. The vitiation
of kapha dosha causes agnimandaya and subsequently results in production of ‘Ama”. This
agnimandaya and production of ‘Ama”, causes rasa dushti, subsequently resulting in
“Pradushta Artava”, as artava is the upadhatu of Rasa dhatu. At the same time, Stress or
disturbance in Mansik doshas is also one of the contributory factors for Pradushta Artava
( PCOD) .
The 20 Yonivyapadas, which are elaborated in “Ashtang Hrudayam “ are due to improper and
bad eating habits. Thus Dushit ahar, vihar and dinacharya are the major contributing factors
leading to this condition.
Now- a- days, because of the busy and sedentary daily routine schedules , lifestyle disorders are
increasing at its peak. Lifestyle disorders affect the overall well- being of the individuals. In
women, this unhealthy lifestyle affects both physical as well as fertility aspects also.
Many established conventional medications are there for the treatment of this disease. With the
advent and excess use of modern drugs, resistance is being developed as well as patient is
having many adverse effects, because of the synthetic molecules present in the modern drugs.
Thus the people are showing a positive trend towards Ayurveda and natural treatment. This
positive trend towards traditional medicine is not only because of its least side effects.
The Ayurvedic treatment modalities not only emphasizes on the curative aspect but also on the
overall well- being and lifestyle changes in the Individual, along with promoting female
reproductive health and support hormonal balance.
Aims and Objectives:
 To assess the efficacy of Ayurvedic medications in symptoms related to menopausal
syndrome
 To assess the effectiveness of alternative treatment modalities in symptomps related to
PCOS.
Literary Review:

Pradushta artava consist of 2 words: Pradushta and artava.

Pra means utkarshena, Dushta means Kud, which means vaikalya. Pradushta means utkarshena
vaikalya i.e. abnormality in excess. Pradushta artava means excessive abnormality of artava.
Pradushta artava is one among the causes of 20 Yonivyapadas according to Acharya Charakh,
Shushrut and Madhavnidan. Acharya Charakh has explained artava in the context of “Bija” and

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“Rajah”. Acharya Shushrut has explained eight artava dushtis, abnormality in ritusrava and
rajodushti.
Pathophysiology:
Increased Insulin in blood

Stimulates

Androgen secretion of ovary

SHBG (Sex-Hormone Binding Globulin) decreases

Increased level of free testosterone

Masculine features & Disturbed HPO axis

Causes

Anovulation & Infertility

AgnimandyaApakvata of aadya rasa→

Aama→

Saama rasa →

Pradushtaartava.
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Exact pathophysiology of PCOD is not clearly understood. It may be discussed as

1. Hypothalamic-pitutary compartment abnormality.org acq) aszuber2

2. Androgen excess.
3. Anovulation.
4. Obesity and insulin resistance.
5. Long term consequences.

 Material and method:

Case description
A 27 years old female patient, visited with complaints of Irregular menses,Oligomennorhoea,
Weight gain, oily skin, acne, Hyperpigmentation on neck and face , Hirsutism since 4 months.
Patient had visited a private clinic 15 days back, but had no relief. Then after that patient visited
to OPD of Streeroga-Prasuti tantra of MGACH & RC for further management.
 Chief Complaints:
Irregular menses, Oligomennorrhoea, Weight gain, oily skin, acne, Hyperpigmentation on
neck and face, Hirsutism since 4 months.
Past medical history: No H/O DM/ HTN/ Bronchial asthma/ Hypothyroidism.
Past surgical history: No h/o any past surgical illness.
Past H/O allergy: No H/o any past allergy
Family history: Nil
Menstrual history:
Menarch -at 14 yrs
LMP-01/05/2021
Irregular cycle was 60 days with scanty menstrual bleeding (1 pad/day)
1-2 days bleeding/each menstrual cycle.
Marriage History:The patient was unmarried
General examination findings: G.C.– stable
Temperature- afebrile
Pulse– 74/ min
BP- 110/70 mm hg
Height– 5ft
Weight- 54kg
Per Abdomen Examination: Soft, no tenderness, no organomegaly
Systemic Examination:
RS – AE=BS Clear

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CVS - S1S2 Normal

CNS – conscious, oriented
Ashtavidha pariksha:
 Nadi - 78 bpm
Mala - twice in a day
Mootra - 3-4 times/day & 1-2 times in night
Jiwha - saam
 Shabda - spashta
 Sparsha - anushna
 Drika - alpa shwetabh
 Akriti – madhyama
Dasavidha pariksha
Prakriti–VataKapha
Vikriti – Kapha
Satva – Madhyama
Satmya – Madhyama
Sara–Madhyama
Aharashakti – Madhyama
VyayamaShakti–madyama
Samhanana – Madhyama
Pramana – Madhyama
Vaya –Madyama.
Investigations Done:
1. USG (abdomen and pelvis)
2. Serum insulin
3. CBC
4. Thyroid profile (T3, T4, TSH)
5. LH and FSH Ratio.
6. ESR
7. Blood sugar levels.

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Treatment Given:
1. Kanchanar Gugghul 500 mg BD for 1 month.
2. Ashokarishta 20ml BD (after meals with equal water)
3. Arogyavardini Vati 500mg BD(aftermeals)
4. Triphala Churna 5gm HS (With warm water)
5. Amree plus powder 10gm BD (1/2 hour before meals)

Panchakarma-
1. Abhayanga with bala tail
2. Matra basti ksheerbala tail -50 ml

Food advised- Tila, lashun, matsya etc.

Yoga Procedures-
Surya namaskar, Sarvangasan, Paschimottanasan, Ardhamatsyendrasan, Matsyasan were
advised to do regularly.
Dietary Recommendations:
1. Low glycemic index foods were advised.
2. Oily foods, junk foods, dietary products and red meat should be avoided.
3. Regular consumption of green leafy vegetables, fresh seasonal fruits are beneficial.

Duration of Management –
The treatment was prescribed for duration of 3 months from September 2021 to November
2021.

Follow- up:
Follow- up was done for 3 months at interval of 2 weeks.

Discussion:
Ayurveda suggests that Pradushta artava (PCOS) is a disorder of Apan Vayu. Also there is
involvement of other doshas. There is vitiation of Vata, which involves manifestation of
symptomps like painful mensus, severe menstrual irregularity. Pitta vitiation involves clinical
features such as hair loss, acne, painful mensus, clots and heart problems. Similarly vitiation of
kapha dosha includes increased weight gain, infertility, hirsutism and Diabetic tendencies .

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PCOS ( Pradushta artava) is a gynecological condition , which involves vitiation of pitta ,

kapha , medas, ambhuvahasrotas and shukra dhatu.
Ashokarishta , Til, Rajapravartini vati and Pushpadhanva ras regulates the Artava dhatu and
has ovulatory effect. Kanchanar gugghul helps in reducing fat and clearing the obstruction by
dissolving the cysts. Amree Plus powder helped in regulating the blood sugar level . Triphala
churna assists in cleansing the bowel. Arogyavardini vati normalizes metabolism by improving
hepatic activity.

Conclusion :
The given treatment modality regularized the menstrual cycle, reduced hirsuitism and
reduced the weight. The Ayurvedic treatment diet was very beneficial in the control of vitiation
of kapha dosha. Meditation and gentle excercises are beneficial in bringing the vitiation pitta to
normalancy.

References:
1. Shukla V,Tripati R, charakasamhita, uttararardha Yonivyapadac hikitsaadhyay 30,shloka
no.25,26Varanasi: ChuakhambaSurbharatiPrakashan; 2017. Page no.754.
2. Shashtri A, Sushrut Samhita, UttartantraYonivyapadpratishedhAdhyaya 38, Shloka no.
9,11Varanasi: ChuakhambaSurbharatiPrakashan; 2015. Page no.......
3. Dutta DC. Textbook of Gynaecology. Dutta DC. Textbook of Gynaecology. 7th ed. Delhi,
India: New Central Book Agency; 20016, page no.147.
4. Tiwari P, PrasutuTantraandStrirog1, Shloka no.9,11,Varanasi:
ChuakhambaSurbharatiPrakashan; 2018.Page no.3

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15.
THE THERAPEUTIC EFFECTIVENESS OF KHADIRADI GUTIKA IN
THE MANAGEMENT OF PITTAJA MUKHAPAKA (RECURRENT
ULCERATIVE STOMATITIS)-A CASE REPORT
, 1Roshna Bhutada 2Saniya Khan
1
Professor and head, Department of Shalakya, 2Intern,
Mahatma Gandhi Ayurved College, Hospital & Research Centre, Salod (H), Wardha - 442001.
Datta Meghe Institute of higher Education and Research (DU) Wardha, India.

Abstract:-

Background: 'Mukhpaka’or ‘Sarvasar Rog’ is a recurrent mouth ulcer or Stomatitis and is also
termed as Aphthous ulcer.In Ayurveda the disease is characterised as the paka-avastha of oral
mucosa & produces ulcers in the oral cavity. Pittadosha, Bodhakkapha, rakta & mamsa are
the main dushyas in Mukhapaka. In pittaja mukhapaka the entire oral cavity is studded with red
or yellow coloured, slender eruptions with burning sensation ,feeling of heat locally, bitter taste
in the mouth .The eruption exhibit pain similar to caustic alkali .The general line of treatment
as explained in Ayurvedic text are mukhadhavana, kavalgraha , kashayapana, and some
internal medications .
Acharya Sushruta has specifically mentioned about shodhanakarma/Cleaning of entire body
(vamana,virechana) along with siravedha should be done followed by all pitta
pacifying/madhura and sheeta veerya drugs .
Over consumption of extremely pungent and spicy food, consuming and chewing of chemical
agents like Tobacco-Gutakha, Insomnia, Vitamin deficiency, many life threatening disease like
Malignancy, Submucosal fibrosis, Skin disease and disturbances in GI tract like Constipation,
Dysentery are the main causative factors responsible for this most common ailment.
In modern medicine, several mouth paints and mouth gargles are used for the treatment for
Aphthous ulcer adjuvant to steroids, B'Complex group of drugs, injection placentrex (sub
mucosal) which have their own limitations and there is no successful, satisfactory and cost
effective treatment available.Corticosteroids are widely used to control aphthous lesions;
however , even their topical application may be associated with some side effects.Hence in
such cases Ayurvedic treatment is useful.
Key Words-Recurrent Ulcerative Stomatitis, Burning sensation, Pricking pain,Slender
eruptions, Constipation.

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Introduction:-
Pittaja Mukhapaka or the Aphthous ulcer is a painful and often recurrent inflammatory process
of the oral mucosa that can appear secondary to various well-defined disease processes.
Idiopathic recurrent aphthous stomatitis is referred to as recurrent aphthous stomatitis.
Mukhapaka often called as “Sarvasara roga” is disease of oral cavity characterised in Ayurveda
as the paka-avastha of oral mucosa & produes ulcer in oral cavity. Pitta dosha, Bodhak kapha,
rakta & mamsa are the main dushya in Mukhapaka.¹Based on Sankhya samprapti there are 3
types of mukhapaka according to Sushruta,Bhavprakasha and Yogratnakara these are -
Vataj,pittaja (raktaja) and kaphaj mukhapaka.2 According to Ashtang Hridaya/Ashtang
samgrha 8 types of mukharogas are explained these are -Vataj, pittaja, kaphaja, raktaja,
sannipataj, Urdhvagada (Asadhya), arbuda, and pootyasyata.3The diseases ; spread
upon/involving all the 7 parts of mukha like Oshtha,dantamula etc; are called"
Sarvasara/Mukhapaka" . (Generalised disease of oral cavity).2 Theclinical symptoms of
mukhapaka are comparable with stomatitis. To break this samprapti pitta doshahar, rakta
prasadak, vranashodhak, vranaropak, shothahar chikitsa is essential.3
In Mukhapaka Acharya Charaka has explained sarvadehik shodhana karma which include
shirovirechan, kayavirechana then in local measures he has explained mukhadhavan,
charwana, pratisarana, kashayapana, kavalgraha& some internal measures.4
Acharya Yogratnakara has explained khadiradigutika for internal use which constitutes
khadira, jati, karpora, tamalpatra ,nagkeshara, to cure tongue, lip, tooth, pharynx & palatine
disorders. 5
In pittaja mukhapaka the entire oral cavity is studded with red or yellow coloured , slender
eruptions with burning sensation,feeling of heat locally,bitter taste in mouth and osha
i.e.dragging sensation.The eruption exhibit pain similar to application of caustic alkali on
wound and the disease is called 'pittaja sarvasara/mukhapaka'.6
Acharya sushruta specifically mentioned about shodhana karma /Cleaning of entire body
(vamana,virechana) along with siravedha should be done followed by all pitta
pacifying/madhura and sheet remedial measures in pittaja mukhapaka.7
Ashtanga samgraha has mentioned the use of Gandusha/Kavala by Milk ,sugarcane juice or
water added with sugar is used for Gandusha.
Kakolyadi madhura ingredients are used for processing milk. Such milk either consumed or
used for Kavala and nasya.
Nasya karma is done by ghruta processed with padmaka, samanga, manjishtha, rodhra, dhataki
is used.
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Charvana by madyantika (mahendi) leaves should be chewed and spitted out. These are the
general measures used for the management of pittaj mukhapaka.8
In modern medicine , the etiological factors for the causation of recurrent ulcerative stomatitis
are Vitamin deficiency ,viral infection, gastric reflux.etc are described.
The modern treatment in such condition's are Analgesic lozenges given to relieve pain.Local
use of steroid lozenges or paste may also be useful.Acidity should be controlled . Vitamin
supplements should be given and the patient is advised to maintain oral hygiene.9

Patient Information(Case history):-

Name:-Ms. Xxx. , Age:-26 yrs, Address-Wardha , Patient has visited Shalakya OPD; On
dated:-10/5/2021
Present complaints:-
Patient is having complaint of constipation since 15 days; Reddish - yellow coloured small
blisters/ulcers found in Oral cavity with pricking pain and difficulty in chewing food since 7
days.
Past complaint:-No any past history found in patient.
Family history:- No any family history of ulcers.

Clinical findings:-
Physical examination- A comphrensive physical examination is necessary to diagnose the case
of stomatitis .the examination findings may include:-
1.Appearance:- Patient was thin built .On examination of oral cavity red and yellow
coloured small vescicles/ulcers are seen on the surface of tongue .Mucosa of the tongue is
swollened and of red coloured.
2.Vitals:- 120/80mmhg ( Blood pressure are within normal limit) ;
Pulse -72 beats /min;
3.Gastrointestinal:-Patient is having acute history of constipation (since 15days).
Patient is also complaing of mild acid eructations since 5-6 days
4.Cardiovascular examination:- S1 & S2 audible.
Local examination:-
Number of ulcers- 8-10 no. Of ulcers are seen on the surface of tongue
Shape of ulcers- Round or oval shaped ulcers.
Size of ulcers- 0.5-1 mm
Margin of ulcer-Smooth
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Color of ulcer:-Red and Yellow colored ulcers seen.

Oral mucosa: - Over all mucosa of mouth is swollened.
Any pain:-Pricking pain is experienced by patient in over all oral cavities.
.
Environmental factors:-
Any physical trauma-No any history of trauma.
Diet- Non-veg diet ; Spicy and oily foods, Contradictory foods .
Emotional stress- emotional stress +.

Ayurvedic examination:-
Nidan panchak:-
Hetu: Ushna, tiksha , katu ahara atisevana; viruddha ahara sevana.
Purvaroopa: Agnimandya , aruchi, Malavasthambha
Rupa: Malavasthambha, mukhadaha ,mukhashotha ,lalima, mukhavrana.
Upashaya:Sheeta veerya drugs.
Anupshaya: Ushna , teekshna ahara ,viruddha bhojana.
Samprapti: Ati ushna teekshna ,viruddha ahara sevana -
Agnimandya-Ajeerna-malavasthambha - Rakta, pitta and mamsa dhatu dushti -Pitta prakopa
-Ushnata in the body increases-Daha and Shotha in mukha- Mukhavrana.
Ashtavidha pariksha:-
Nadi-72 beats/min
Mala-1/day ;not clear
Mutra-4-5 times /day & 1/night.
Jivha-Saam ,reddish ulcers ,swollen tongue.
Shabda-Spashta
Sparsha-Anushnasheeta
Drik-No pallor
Aakriti-Hina
Clinical findings:-
On examination of oral cavity it is found that yellow or red coloured small ulcers are seen on
the surface of tongue , patient is complaining of burning sensation all over the oral cavity+++
and difficulty in eating food+++ . Patient also complaint of not having clear bowels since a
week+++.

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Timeline: - Patient was suffering from Constipation since 15 days ; pricking pain and burning
sensation through out the oral cavity and difficulty in chewing food Since 7 days .

Diagnostic Assessment:- Patient was investigated for complete blood count.

1.Blood test(CBC):-Result are within normal limits
Therapeutic Intervention:- Small tablets each of 250 are prepared from dense mixture each
of powdered Jatipatra,karpura,puga/supari,chaturjataka.i.e. Tvak, tejapatra, nagkeshar,Ela;and
kasturi.GMP And FDA approved Dattatrya Ayurved Rasashala Wardha(MS). Each capsules
was of 250 mg was advised to take two gutikas in morning and two gutikas at night after food.
And Triphala churna for Constipation 5 gms twice a day with Lukewarm water Daily for a
period of 7 days.
Sr.no Name of drug Dose of drug Kal Frequency and
Anupana
1. Khadiradi gutika 250mg(2Tab) After food Twice a day with
lukewarm water
2. Triphala churna 5 gms After food Twice a day with
lukewarm water

Follow-up and Outcomes: - On zero day of treatment patient was Suffering from pricking
pain in the oral cavity+++ and burning sensation+++, Difficulty to engulf food+++ ,
Constipation+++; In 1st visit(After 2 days of taking treatment) the pricking pain , burning
sensation in mouth , difficulty in chewing the food , constipation is mildly reduced .on 2nd
follow up visit (After 3 days ) ) Pricking pain, burning sensation , difficulty in chewing food ,
Constipation is reduced greatly.And On 3rd visit (7 day of treatment) All the symptoms are
completely reduced.
Sr.No. Symptoms On zero day 1st follow 2nd follow 3rd follow
before up after 2 up after 3 up after 7
treatment days days days of
treatment
1. Today(pricking +++ ++ + -
pain)
2. Daha(Burning +++ ++ + -
sensation)
3. Difficulty to +++ ++ + -
engulf food
4. Constipation +++ ++ + -
5. Mukhavrana +++ ++ + -

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Materials and Methods:-

Shaman chikitsa-
Khadiradi gutika/lozenges-4kg of khadira bark is mixed with 16 litres of water.The mixture is
boiled till 1/8th of total decoction is left.It is further cooked to make it dense after mixing 10
gms .each of powdered Jatipatra,karpura,puga/supari,chaturjatak .i.e.(tvak,tejapatra,nagkeshar,
ela) ;and kasturi.Small tablets each either of 250 gms are prepared from this dense
mixture.Sucking of this tablet/lozenges takes care of all diseases of tongue,lips,teeth ,mouth
and palate(Yoga ratnakara).
Shodhana chikitsa-
Triphala churna:-5 gms of Triphala churna with lukewarm water is advised to patient
morning and at bed time (H.S) after food for a period of 7 days to treat constipation.

Observation:- Burning sensation all over mouth and difficulty in chewing the food and
constipation is greatly reduced.

Conclusion:- Triphala churna is a powerful polyherbal formulation Patient got relief from
Constipation in 2nd follow up visit(After 3 days of treatment) by taking 5 gms of the churna
with Lukewarm water and in third visit (After 7 days of taking treatment), patient got complete
relief from Constipation.In third visit pricking pain & burning sensation in mouth and
difficulty in chewing the food is also relieved completely by internal use of khadiradi gutika
within a week.

Discussion:-
Mukhapaka is the disease of Oral cavity; it is the paka of oral mucosa and produces ulcers in
the oral cavity. In mukhapaka pitta dosha prakopa is seen and there is a Rakta and Mamsa dhatu
10
dushti , localizing in oral cavity . Hence the line of treatment should be pittashamak ,
shothahara , vedanasthapana , vranashodhana ,vranaropana , rakta prasadak and mamsa dhatu
pushtikar.11
Various treatment modalities from the modern medical faculties are available for the treatment
of Recurrent Ulcerative Stomatitis such as local applications of gels and ointments such as
orabase. The gels application at the affected area heals the ulcers, Tetracycline mouthwashes
are also available for mouth ulcers . Supplementation of Vitamins and iron is also
recommended . Oral and systemic antibiotics are also administered if necessary.12 But these
treatments have very limited or unsatisfactory results. During the study result of Khadiradi
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gutika is assessed on the basis of shool, mukhadaha , shotha, lalima..etc. I have selected
Khadiradi gutika which proved to be very effective to treat mouth ulcers.It contains Tvak
(Cinnamomum zeylanicum) , the ayurvedic properties of Tvak as per Bhavprakash nighantu is:
it is Ruksha (dry) , laghu (light) and tikshna (sharp) in gunas ,it's Rasa is Katu (pungent), tikta
(bitter) and madhura(sweet). It’s Vipaka.i.e. post digestive effect is Katu (pungent); it is Kapha
Vata shamaka.Tvak is commonly known as Cinnamomum bark ,is one of the main spice in
India.Phytoconstituents naturally found in Cinnamomum zeylanicum like aldehydes, acetates,
flavonoids, alkaloids,phenols, saponins,tannins, hydrocarbons and steroids-it is aromatic in
nature, it improves quality of shukradhatu,strength of and complexion of body hence it is
immunity booster ; it relieves dryness of mouth and thirst , pacifies Vata and it is absorbent,
appetizer, digestant and is antimicrobial in action because of all these properties in mukhapaka
it is used to relive constipation .13
Tejpatra(Cinnamomum tamala) is another valuable herb mentioned by bhavprakash , it is
having madhura,katu and tikta rasa ,it is teekshna,laghu and snigdha in gunas ,ushna veerya
and madhura in vipaka, it is deepana and anulomana ;hence used in Agnimandya,ajeerna and
shoola.leaves and bark is aromatic and has astringent taste.it is stimulant and has carminative
properties hence used in dental carries and oral problems.14
Ela (Elettaria cardamomum Maton) is another useful herb it is madhura and Katu rasatmaka it
is laghu and sheets veerya it balances kapha and Vata dosha.It is useful in digestion and hence
relives constipation and hence useful in repeated oral ulcers. it helps to relieve burning
sensation and gastritis.it is a mouth freshner and removes bad taste from mouth(xerostomia).
Nagakeshar(Mesua ferra.Linn) is having Kashaya and tikta rasa,It is laghu and rooksha in
gunas , Alpaushna in veerya and katu in vipaka .It is pittaghna due to it's Kashaya and tikta
rasa.Due to it's Kashaya rasa and ushna veerya it is a binding agent (sangrahi).Hence it should
be used in Agnimandyaleaves and ajeerna.It is raktasthambhana (styptic).It eliminates
mukhadaha,mukhadurgandha and atitrishna resulting from aggravation of Pitta. It's stamens
contain mesuoferin A and B and mesuone which are bactericidal.
Kasturi(Moschus mociferus) has Katu,tikta rasa and ushna veerya ,it is guru gunatmak ,it is
kapha-vata shamak . 15It's fragrance is just like ketaki pushpa/kevda if it is pure musk.hence it
is used in Daurgandhya(Feotid smell).16
Jatipatra(Myristica fragrans.) Is having katu,tikta rasa;Laghu, teekshna and snigdha in gunas ,
Ushna veerya and katu vipaka. It's paste is applied locally on Shotha, Shoola and vedana.it
should be used as a mouth freshner.
Karpoora(Cinnamomum camphora) it is having tikta,katu and madhura rasa,it is laghu and
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teekshna in gunas ,it is sheet veerya and katu in vipaka.it is tridoshaghna as it balances all the
three doshas of body.being tikta it is kaphaghna,being madhura it is vataghna and pittaghna
being sheeta veerya . Being teekshna it is vedanasthapana.Karpooradi oil is used in nervine
pain eg.tootache.It should be used in mukharogas as it is mouth freshner being sugandhi and
mukhashodhana due to it's tikta rasa .
Puga (Areca catechu) it is Kashaya and madhura in rasayanadhyaya, it is rooksha and guru
gunatmak ,it is sheet veerya and madhura in vipaka.it is kapha pitta shamaka.Being stambhana
and vranaropana gargling with it's decoction should be done in mukhapaka and pittakaphaja
galarogas.Its powder is applied to vrana as vranaropana.it is used in aruchi and
Agnimandya.being mukhavaishadyakara it is used in mukhadurgandha.17
Triphala churna contains Amalaki ,Vibhitaki and Haritaki these 3 fruits are mentioned by
Charaka in rasayanadhyaya of Charaka samhita . Amalaki and haritaki is said to destroy all the
diseases (Sarwaroga shamaka) .And are considered as a best rejuvenator drugs .18 Acharya
charak in matrashitiyadhyaya has mentioned to consumed Amalaki daily for protection of
health and avoidance of diseases.19
Amalaki (Embelica officinalis) is having all the five rasa except lavana rasa.Amla is main rasa
in it. It is laghu and ruksha in gunas ,sheet in veerya and Madhura in vipaka(Post digestive
effect).It is tridoshaghna in action as it is having all the rasa hence it balances all the three
doshas in the body. Being amla it is Vataghna,being Madhura and sheets it is Pittaghna and
being rooksha and kashaya it is kaphaghna.Its swaras should be used in daha and it's decoction
is used as a vranashodhana and ropana. Internally it's action on Anna and Pureeshavaha srotas
are : It's juice with sugar is used for Amlapitta, Agnimandya,aruchi .It is used in Malanulomana
when there is associated malavasthambha hence used in Vibandha. The fruit contains tannic
acid,gallic acid ,sugar,cellulose,calcium,minerals and plenty of Vit.C which is heat resistant
hence it is very useful in mukhapaka.
Vibhitaki (Terminalia belerica) is having Kashaya rasa ,rooksha in gunas ,ushna veerya and is
katu in vipaka.beign Kashaya it is kapha and pittaghna.This fruit is having Kashaya as a main
rasa and is used in Shotha and vedana.It is deepana and pachana being ushna.It acts as a
laxative and is useful in Vibandha.being Kashaya it is used in bleeding disorders .It's powder is
indicated to arrest bleeding from traumatic wound. Chemically it contains
tannin,B-sistesterol,gallic and chebulic acid,mannitol, glucose, fructose and galactose.hence in
mukhapaka it is used to suppress pain and odema ,it arrest bleeding from ulcers in mouth.
Haritaki (Terminalia chebula) is also having all the five rasas except lavana rasa.kashaya is
main .It is laghu and rooksha in gunas,ushna in veerya and madhura in vipaka.it is tridoshahara
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in prabhava.being Kashaya it is vranashodhana and ropana hence it's decoction should be used
for vrana dhavana,it is used in all the painful conditions,being madhura it is pittaghna and being
laghu and rooksha gunatmaka it is kaphaghna.Gargling with it's quatha is indicated in
mukhapaka.Hence triphala churna is very effective in the management of mukharogas.20

Patient Perspective:- :- Patient was very happy as she got complete relief from pricking pain
and burning sensation in the mouth , without using modern medicine and side effects of
modern medicine was avoided.

Conflict of interest:- Nil

Source of Funding:- Self
Consent of Patient:- Taken
References:-
1.Sushruta samhita ,Nidanasthana chapter no.16, Chaukhamba Sanskrit sansthana, Verse no
.66/391
2.Shiro-Karna-Nasa & Mukha-Dantaroga Vidnyana(Shalakya-2) A textbook of E.N.T &
Oro-dental diseases by proof.Dr.Narayan J. Vidwansa; Vimal Vision Publication,Pune(M.S.)
.(Dalhana.Su.Ni.1664 ; Madhukosha.Madhava Nidan.Uttarardha .650 ; pg.no.247)
3.Atext book of E.N.T & Oro-dental diseases (Volume-2) by proof.Dr.NarayanJ.Vidwansa;
Vimal Vision Publication ,Pune (M.S.).(Ashtanga hridaya/Ashtanga sangraha ; Sharangdhara
samhita.
4.Charaksamhita, Chikitsasthana,26,204.
5.Yogratnakara , 2, 515.
6.Shiro-Karna-Nasa & Mukha-Dantaroga Vidnyana (Shalakya-2) byproof.Dr.Narayan
J.Vidwansa; Vimal Vision Publication,Pune(M.S.).(Ashtanga.samgraha.25/61;pg.no: 250)
7.A textbook of E.N.T & Oro-dental diseases. (Volume-2)by proof.Dr.Narayan J.Vidwansa;
Vimal Vision Publication, Pune (M.S.).(Sushruta samhita.Chi.2272;pg.no:251).
8.Shiro-Karna-Nasa & Mukha-Dantaroga Vidnyana (Shalakya-2)byproof.Dr.Narayan
J.Vidwansa; Vimal Vision Publication, Pune (M.S.).
(Ashtanga.samgraha.Uttarardha.26178-26181).
9.A short book of E.N.T Diseases by K.B. Bhargava, S.K. Bhargava,T.M.Shah Eleventh
edition ;Usha publications , Mumbai (Chapter.32;pg.no:214).
10.Sushruta samhita , Nidana sthana chapter no.16,Chaukhamba Sanskrit sansthana ,Verse
no.66/391
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11.A textbookof E.N.T& Oro-dental diseases (Volume-2) by proof. Dr.Narayan J.Vidwansa;

Vimal Vision Publication, Pune (M.S.). (Ashtangahridaya/ Ashtangasangraha;
Sharangdharasamhita.)
12. A short book of E.N.T Diseases by K.B. Bhargava, S.K.Bhargava, T.M.Shah Eleventh
edition; Usha publications, Mumbai (Chapter.32; pg.no:214).
13. Dravyaguna vijnyana, a textbook of Ayurvedic Medicinal Plants (Part 1&2) by
Prof.Dr.A.P.Deshpande & Prof.Dr.Subhash Ranade; Proficient Publishing House, Pune
411030. (Bhavprakash nighantu;pg.no.801.)
14. Dravyaguna vijnyana, A textbook of Ayurvedic Medicinal Plants (Part1&2) by
Prof.Dr.A.P.Deshpande & Prof. Dr. Subhash Ranade ; Proficient Publishing House, Pune
411030. (Bhavprakashnighantu;pg.no.364.)
15.Kaiyyadeva.nighantu Aushadhi varga 1292.
16.Dr.Amrit pal singh, Dhanwantari Nighantu, Chandanadi varga, pune 1925,p.p-95-96.
17.Dravyaguna vijnyana ,A textbook of Ayurvedic Medicinal Plants (Part1&2) by
Prof.Dr.A.P.Deshpande & Prof. Dr.Subhash Ranade; Proficient Publishing House, Pune
411030. (Bhavprakashnighantu)
18.Agnivesha ,Charaka samhita,1 ed.Varanasi : Chaukhamba surabharati prakashana 2000.
19.Charaka,Chakrapani commentator, Matrashitiyadhyaya Acharya Y.R T(ed). Charaka
samhita of Agnivesha,5 ed. Varanasi Chaukhamba Sanskrit Sansthana;2003. p.p.38
20. Dravyaguna vijnyana, A textbook of Ayurvedic Medicinal Plants (Part1&2) by
Prof.Dr.A.P.Deshpande & Prof.Dr.Subhash Ranade; Proficient Publishing House, Pune
411030. (Bhavprakashnighantu.

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16.
EFFICACY OF PANCHATIKTAKSHEER BASTI IN THE
MANAGEMENT OF ANUKTA VYADHI VANKSHANAGATA VATA (
AVASCULAR NECROSIS ) – A CASE STUDY
1
Dr. Ankush D Dikondwar, 2Dr. Geeta Sathvane
1
Assistant Professor 2Associate Professor, Department of Rognidan Avum Vikritivigyan,
Department of Rognidan Avum Vikritivigyan Datta Meghe Ayurved Medical College,
Hospital & Research Centre, Wanadongari, Nagpur.

Abstract
Avascular necrosis is the pathological process encounters due to hampering in blood supply to
the bone (Death of the bone tissue). Avascular necrosis is also called as Osteonecrosis or Bone
Infarction. Most commonly hip joint (Head of Femur) is involved but avascular necrosis of hip
joint is poorly understand. But this process is the common pathway of traumatic or non-
traumatic factor that comprise the already precarious circulation of the femoral head. Long
term use of steroid medication and heavy intake of alcohol can lead to avascular necrosis.
Clinical picture of avascular necrosis is quite similar to Vankshanagata Vata but in Ayurveda
classical text it is called as Anukta Vyadhi as this disease is not clearly mentioned in the
Ayurveda classical text. Rectal administration of medications or medicated oils or decoction
is called as Basti. Basti is very elite to encounter the aggrevated Vata dosha which is the main
aetiological factor for the manifestation of disease. Asthi are important site of Vata Dosha.
Hence medication given rectally affects all the tissue up to bone tissue that’s why Basti is
selected for the present case; along with Basti Panchakarma treatment patient was on oral
Ayurveda medication and physiotherapy. Patient was hospitalized for duration of 2 months 18
days and showed substantial improvement.

Keywords – Anukta Vyadhi, Vankshanagata Vata, Panchatiktaksheer Basti, Avascular

Necrosis

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Introduction
Ayurveda is the most ancient healing science present on this planet. Ayurveda deals with the
health of wellbeing. Ayurveda has holistic approach towards the life of individual. In Sanskrit
language Ayurveda means ‘The science of life’. Main motto of Ayurveda is to keep healthy
individual healthier and to improve the quality of life of an individual and treatment of diseased
one with help of medicinal herb and Panchakarma procedure which one is suitable as per the
sign and symptom of the disease. [1] Ayurveda classical text was written in Sanskrit language in
which many diseases are explained in detailed with their treatment.
According to Ayurveda the three principle energies of life is called as Tridosha or three pillers
of life i.e. Vata Dosha, Pitta Dosha, and Kapha Dosha. Vata Dosha is subtle energy associated
with movement. Pitta Dosha expresses the body metabolic system where as Kapha Dosha is
the energy that forms the body structure. Balanced condition of three Doshas reflects good
health. But any vitiation in any in one of above Doshas due to Hetusewan leads to disease
condition.
Ayurveda classical text includes Charaksamhita, Sushrutsamhita, and Vagbhatsamhita out of
which Charaksamhita is Chikitsa oriented granth in which Acharya Charaka describes
Vatavyadhi in detail along with treatment. Acharya Charaka describe two types of Vyadhi i.e.
Nanatmaja and Samanyaja Vyadhi. Out of which 80 Vyadhis are of Vata Dosha, 40 Vyadhis
are of Pitta Dosha, 20 Vyadhis are of Kapha Dosh.[2]
In the present study Avscular necrosis of femoral head; more common and most important
symptom is Vankshana Sandhishool (Predormal symptom of Vata vitiation).[3] Avscular
necrosis means death of Bone tissue due to impairment in the blood supply due to trauma
(joint and bone marrow ), fatty deposits in the vessels, due to underlying medical condition
such as sickle cell anemia, Gaucher’s disease can cause diminished blood flow to the bone
tissue. In 25% of cases cause is unknown. Anyone can be affected but the condition is more
common between the age group from 30 to 50 years.
Steroid use ,excessive heavy intake of alcohol, Biphosphonate use ( Long term use to improve
bone density), Certain medical treatment modalities such as radiation therapy for the cancer
patient, organ transplant especially kidney transplant are at higher risk to develop Avascular
necrosis.
Many people have no sign and symptoms in early stage of Avascular necrosis as it develops
gradually. As the condition worsen patient’s affected joint might hurt only when you put
weight on it. Eventually patient might feel pain even on lying down. Pain can be mild or severe
and increase gradually. Pain associated with avascular necrosis of the hip joint might center on
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the groin, thigh or buttock. Besides the hip, the areas likely to be affected are shoulder, knee,
hand, foot. Some people develops avascular necrosis on both sides (bilaterally) such as hips or
knee.[4,5]
However there is no disease explained or found in Ayurveda classical texts resembling
avascular necrosis such a Vyadhi are termed as Anukta Vyadhi. But according to Ayurveda
principle stated by Acharya charaka physician can diagnose on basis of Hetu ( Cause ), Sthan
(Place) and also treat the disease condition.[6] In Vankshanagata Vata vitiation of Vata Dosha
occurs as per Ashrayashrayi Bhava Asthi are Ashraya and Vata is Ashrayi.[7] According to
Acharya Charaka for the treatment of Asthi Ashrayi Vyadhi’s physician can administer Basti as
Panchkarma procedure in addition to this Ksheer and Ghrit can be use which is made up of
Tikta Rasatmak herbs.[8]
So according to principle stated by Acharaya charaka patient received Panchatiktaksheer
Basti and got relief from pain and the main aim of study is to explain the efficacy of
Panchatiktaksheer Basti in Vankshanagata Vata.
Case Study
A 45 years male patient was fit, fine and healthy before 2.5 years then he went to private
hospital for the treatment of complaints which he was encountering includes pain in both hip
joints, pain in both knee joints for the same complaint he went under the routine investigation,
MRI and diagnosed as Avascular Necrosis of both femur. After treatment for avascular
necrosis got some relief from pain but symptoms relapse after 1-2 months period with more
intensity and addition of difficulty in walking, difficulty in movement of hip joints, pain during
movements for which he took treatment from private hospital but didn’t get relief so he came
and admitted in the Ayurveda Hospital.

Past History
No H/O Hypertension, Diabetes Mallitus, Bronchial Asthama,
Pulmonary Tuberculosis, Thyroid Disorder
No H/O Thyroid, Malaria, Dengue, Jaundice.
No H/O Fall, Trauma, RTA
No H/O Any Surgery
No H/O Blood Transfusion
No H/O Any drug allergy

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On Examination
G.C. - Moderate Weight -58Kg
Temp – Afebrile
Pulse- 80/Min
BP- 130/80 mm of Hg

Clinical Examination
Inspection of Hip Joint
No signs of inflammation
No Oedema observed
No dislocation

Table No -1
Range of motion of Hip joint examination (Before Treatment)
Joint Flexion Extension Abduction Adduction Internal External
Rotation Rotation
Right Hip 100 00 Painful 150 Painful 150 Painful Absent Absent
Joint Painful with with
Support Support
Left Hip 900 150 400 200 Normal Normal
Joint Painless

Gait –
Limping Gait
Walk with Support of Stick

MRI Impression –
 F/S/O B/L Avascular Necrosis both Femoral head, Gr III on Right side and Gr ii on Left
side.
 Right Hip joint effusion noted with minimal volume.

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I. Medicinal Treatment –
1. Kaishor Guggulu 10gm (40Tabs) 42 Packets
Mahavatavidwansa Rasa 05gm (20Tabs) 1 Pack. BID
Gulwel Satwa 10gm with Dugdha
Chopchinyadi Churna 40gm (Cow Milk)

2. Maharasnadi Kwath 20ml BID with Koshnajal

3. Abha Guggulu 10gm (40 Tabs) 42 Packets
Tab. Calcipral 10gm (40 Tabs) 1 Pack. BID
Kukkutandtwak Bhasma 10gm with Koshnajala

Date Medicine Dose Fre

q
22/7/2019 A.Kaishor Guggulu 10gm(40Tabs) 1 Pack. BID
42 With Dugdha
Mahavatavidwansa Rasa 05gm (20Tabs) Pack ( Cows Milk)
Gulwel Satwa 10gm
Chopchinyadi Churna 40gm
BID
B.Maharasanadi Kwath
C.Sarvang Snehan OD
D.Sarvang Nadisweda
20ml OD
28/7/19 Panchatiktaksheer Basti (1st Set.) 125 ml / Daily OD
13/8/19 Panchatiktaksheer Basti (2nd Set ) 125 ml / Daily OD
15/8/19 Sunthisidhha Erandsneha 5ml HS
02/09/19 Panchatiktaksheer Basti (3rd Set ) 125 ml / Daily OD
(With Addition of Physiotherapy ,Exercise, Cycling)
06/09/19 Abha Guggulu 10gm (40 Tabs) 1 Pack with BID
42 Koshnajala
Tab. Calcipral 10gm (40 Tabs)
Pack
Kukkutandtwak Bhasma 10gm
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Amalaki Rasayan 50gm
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Amalaki Rasayan 50gm

II. Panchakarma Treatment –

1. Sarvang Snehan
2. Sarvang Nadiswedan
3. Panchatiktaksheer Basti (16 basti in 1Set)

Table No – 2 Intervention

Table No 3 – Observation after Intervention

On Admission After 1st Set of After 2nd Set of After 3rd Set of Basti
22/7/19 Basti 12/8/19 Basti 28/8/19 17/9/19
Pain in Right Hip +++ ++ + Slight pain
Joint
Pain in Left Hip ++ + + Relief
Joint
Pain in Both Knee ++ Relief Relief Relief
Joint
Difficulty during +++ +++ Sit without pain Relief
movements of Hip
Joint
Difficulty during ++ ++ Sit without pain Sit without pain
sitting
Walking with + With Stick + With Stick Walk without Walk without
support support support

Table No 4 – showing changes in gait

Gait of patient
Early stage without treatment Painful walking with help of stick
After 1st set of Basti Pain reduce walk with support of stick
After 2nd set of Basti Walk without stick
After 3rd set of Basti Can walk Staircase

Table No 5 – Showing AT and BT changes of range of motion of Hip joint

Before Treatment
Joint Flexion Extension Abduction Adduction Internal External
Rotation Rotation

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Right 10o 00 150 150 Absent Absent

Hip Joint Painful Painful With support With support
Painful Painful
Left Hip 900 150 400 200 Normal Normal
Joint

After Treatment
Right 450 100 400 100 Painful Painful
Hip Joint Painless Painless Painless Painless

Left Hip 900 150 400 200 Normal Normal

joint

Materials and Methods

In this present case we are using one of the finest procedure amongst Panchakarma i.e. Basti
(Rectal Administration of Medicated decoction or medicated Ghrit ). In this case we are giving
Panchatiktaksheer Basti. For the preparation of this Basti Physician needs Panchatikta.[9]

I. Panchatikta Dravya
 Guduchi (Tinospora cordifolia)
 Vasa (Adhatoda vasaca)
 Nimb (Azadirachta indica)
 Patol (Trichosanthes dioica Roxb)
 Kantkari (Solanum surratense Burm.)

II. Ghrit
III .Ksheer (Cow’s Milk)
IV. Madhu (Honey)
V. Saindhav (Salt)
VI. Basti pot (Enema pot)
VII. Rubber Catheter No 10.

Preparation of Panchatiktaksheer Basti –

Take 5ml Madhu and 1 pinch of Saindav, mix it properly up to 5-10 mins. (Till those two
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substances become one).

Add 20ml Ghrit in the above mixture again stirrer properly.
Add 50 ml Ksheer after proper mixing addition of 50 ml Kwath in it.
(Preparation of Kwath from the Panchatikta Dravyas)

Administration of Panchatiktasheer Basti –

Basti is administer rectally when patient was on left lateral position with right leg folded in
knee near abdomen. Total 125 ml of Panchatiktaksheer Basti was administered to patient.

Discussion
In this present case as per the sign and symptoms of this patient, we can correlate Anukta
Vyadhi Vankshangata Vata with Avascular necrosis of femur. Vankshangata Vata Vyadhi falls
under the heading of VataVyadhi because vitiation of Vata Dosha occurs due to Hetu sewan
(Mitthya Ahar) and occupies the Rikta Srotas of body which is the main factor for
manifestation of disease (Vankshangata Vata). Srotas Rukshata and Parushata observed due
to increased Ruksha Guna of Vata Dosha which is the key point of Pathogenesis of
VataVyadhi.[10] So to redress the Ruksha Guna of VataVaydhi we used Snehan. Snehan should
have to be used in form of Basti. Basti is one of the Panchakarma procedure have capability to
eradicate the Vata Dosha completely at the same time provides nutrition to tissue also. Vata
Dosha is mainly located in Pakwashaya (Colon) but bone tissue (Asthi) is also site of Vata.[11]
Hence medication administer rectally effects Asthi Dhatu.
As stated earlier Vankshangata Vata is not clearly mentioned the Ayruveda classical texts but
Vankshan Sandhi Shool is the main and common symptom of the patient. We can also say that
this is Asthyashrayi Vyadhi so to treat the root cause we can use Panchakarma procedure
(Basti), Ksheer, Sarpi made up of Tikta Rasayukta Dravyas.[12] In Panchatiktaksheer Basti,
there are 5 herbs which have principle Rasa as a Tikta Rasa, Katu Viapaka, Ushana Virya are
Guduchi, Vasa, Patol. Nimb, Kantkari.
Panchatiktaksheer Basti is basically Vatashamaka due to its principle Rasa,Vipaka, Virya also
ksheer is Snigdha, Madhur, Vatapittaghna.[13] Ghrit is also Pittanilahara and Balawardhan.[14]
Saindhav is Tikshna, Ushna, Sukshma and Vatavikarnashak.[15] From all angles the contents of
Panchatiktaksheer Basti are Vata Doshahar which is the main factor in the manifestation of
VataVyadhi. Also due to the Sukshma Guna of Saindhav and Snehgunyuktata of Ghrit this
Snehan Basti (Panchatiktaksheer Basti) reaches VankshanSandhi and Asthi Dhatu and
effectively reduce intensity of Shool (Pain) which is due to aggrevated Vata Dosha of that
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region. Vata Dosha is mainly located in Pakwashaya (Colon) but bone tissue (Asthi) is also site
of Vata. Hence medication administer rectally effects Asthi Dhatu.
Conclusion –

In this present case on the basis of observation and assesment we can conclude that
Panchatiktaksheer Basti play effective role in the management of Anukta Vyadhi
Vankshangata Vata (Avascular Necrosis).

Reference
1. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume I; Edited with Charakchandrika Hindi
Commentary ; 2004; Chukhamba Surbharti Prakashan, Varanasi; 2004; Sutrasthaan;
Chapter No. 30; Verse No. 26; Page No. 565
2. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala volume I; Edited with Charakchandrika Hindi
Commentary ; 2004; Chukhamba Surbharti Prakashan, Varanasi; 2004; Sutrasthaan;
Chapter No. 20; Verse No. 10; Page No. 389
3. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume II; Edited with Charakchandrika Hindi
Commentary; 2004; Chukhamba Surbharti Prakashan, Varanasi;
2004;Chikitsasthaan; Chapter No. 28; Verse No. 20-23; Page No. 938
4. http://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/s
yc-20369859
5. http://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/s
yc-20369859
6. Dr Anantram Sharma forewarded by Acharya Priya Vrat Sharma; Sushrutsamhita of
Maharshi Sushrut Edited with Sushrutvimarshini Hindi Commentary Volume I; 2017;
Chukhamba Surbharti Prakashan, Varanasi ; 2017; Sutrasthaan; Chapter No. 24; Verse
No. 10; Page No. 206
7. Dr Brahmanand Tripathi; Ashtanghrudayam of SrimadVagabhta edited with Nirmala
Hindi Commentary; 2017; Chukhamba Surbharti Prakashan, Varanasi; 2017;
Sutrasthaan; Chapter No. 11; Verse No 26; Page No 165
8. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume I; Edited with Charakchandrika Hindi

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Commentary ; 2004; Chukhamba Surbharti Prakashan, Varanasi; 2004; Sutrasthaan;

Chapter No. 28; Verse No. 27; Page No. 550
9. Pandit Kashinathshastri; Rasatarangini of Pranacharya Shri Sadanand Sharma; 2012;
Motilala Banarasidas Publisher; Chapter No. 2; Verse No. 18; Page 14
10. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume II; Edited with Charakchandrika Hindi
Commentary; 2004; Chukhamba Surbharti Prakashan, Varanasi;
2004;Chikitsasthaan; Chapter No. 28; Verse No. 18; Page No. 937
11. Dr Brahmanand Tripathi; Ashtanghrudayam of SrimadVagabhta edited with Nirmala
Hindi Commentary; 2017; Chukhamba Surbharti Prakashan, Varanasi; 2017;
Sutrasthaan; Chapter No. 12; Verse No 01; Page No 170
12. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume I; Edited with Charakchandrika Hindi
Commentary ; 2004; Chukhamba Surbharti Prakashan, Varanasi; 2004; Sutrasthaan;
Chapter No. 28; Verse No. 27; Page No. 550
13. Dr Brahmanand Tripathi; Ashtanghrudayam of SrimadVagabhta edited with Nirmala
Hindi Commentary; 2017; Chukhamba Surbharti Prakashan, Varanasi; 2017;
Sutrasthaan; Chapter No. 05; Verse No 20; Page No 68
14. Dr Brahmanand Tripathi and Dr Ganga Sahay Pandey, Charaksamhita of Agnivesha
Elaborated by Charaka and Dridhabala Volume I; Edited with Charakchandrika Hindi
Commentary ; 2004; Chukhamba Surbharti Prakashan, Varanasi; 2004; Sutrasthaan;
Chapter No. 14; Verse No. 15; Page No. 82
15. Dr Brahmanand Tripathi; Ashtanghrudayam of SrimadVagabhta edited with Nirmala
Hindi Commentary; 2017; Chukhamba Surbharti Prakashan, Varanasi; 2017;
Sutrasthaan; Chapter No. 06; Verse No 143; Page No 116.

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17.
EFFECT OF TILA TAILA ABHYANG AND GHRITAPANA IN
VICHARCHIKA
: A CASE STUDY
1
Vd. Maheshwari D Joshi, 2Vd. Sumant M Pande,
1
Assistant Professor, Department of Swasthavritta and Yoga, Dr. Rajendra Gode Ayurved
College, Hospital & Research Center, Amravati.
2
Associate Professor, Department of Rognidan, Mahatma Gandhi Ayurved College,
Hospital & Research Center Wardha.

Abstract:
Life style means a pattern of individual practices and personal behavioral choices
that are related to elevated or reduced health risk with regard to health. It refers to dietary
habits.
The important diseases that mainly arise from wrong dietary habits are skin
diseases. Skin diseases are correlated with different types of kushth in Ayurveda.
Vicharchika is one of the types of kshudrakushtha. The clinical features of vicharchika
represents relapse and seasonal variation and definitely, changes as per diet variation.
Some procedures with or without main line of treatment for vicharchika, are found to have
good symptomatic effect for vicharchika; abhyang and ghritpana are some of them.
Present case study is an attempt to observe the efficacy of til tail abhyang and
ghritpana in vicharchika.
Key words :Vicharchika, Rasayan ,Ghritapana ,Til tail Abhyang
Introduction:
According to Ayurveda, the basic cause of all skin diseases is virudha aahar and vihar
that is altered life style and faulty food habits .Today’s life style is completely changed
because of faulty job profile and deranged dincharya.1
According to Ayurveda vicharchika is rakta pradoshaj vikar having involvement of three
doshas with
Dominance of kapha dosha and vat dosha though it is kshudra kushtha it runs a chronic
course. Skin rashes characterized by redness of skin, edema itching and dryness .2
In maximum number of cases, no satisfactory treatment is available in contemporary
medical practices except antihistaminic and topical steroids. The Prevalence of eczema is
22%.the skin is the largest organ in the body which protect the body from physical and

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chemical attack, skin rich in immune cells, forming a complex network called the skin
immune system, Abhyang helps to maintain immunity of skin and rasayasna (ghritpana)
improves glow upon skin .7
In Ayurveda for kustha , shodhan , shaman, are the main treatments .In both treatments
snehan is included in the form of abhyantara and bahya snehan .According to Ayurveda ,those
who are desirous of health and happiness should do abhyang to the body .Abhyang is one
among the dincharya and is an ancient Indian ayurvedic approach adopted for healing
relaxation and treating various diseases. Tila taila improves the quality of skin .3
Acarya caraka has described rasayana as the means of obtaining the best qualities of
rasadi dhatus ,it is believed ,in ayurveda that the qualities of the rasa dhatu influence the health
of other dhatus of the body hence any medicine that improves the quality of rasa should
strengthen or promote the health of all tissues of the body. Rasayan drug s acts inside the
human body by moduling the neuro-endocrine systems and have been found to be a rich source
of antioxidant ,rasayana is not a drug therapy ,but is a specialized dietary regimen.Goghrita is
one of the best rasayana for skin.
Aim : To study the effect of tila taila abhyang with ghrutpan as a rasayan in vicharchika.
Objectives :
1. To study the effect of abhyang.
2. To study the action of Ghritapana in vicharchika .

Material and method:

Case report:
A 26 year young female, Doctor by profession, approached in opd presenting with the
complaints of
1) Itching (Kandu) : 5yr
2) Blackish discoloration : 2yr
(Vivarnata)
3) Dryness(Raukshya) : 5yr

All these symptoms appeared on the dorsal side of Right palm.

There were no previous history of any known allergy in patient and also no family history
of any known skin diseases.
On examination:
History taken for hetu sewan (etiological factor ) was almost same as described in
Ayurvedic text as follows :

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Hetu :
Aaharaj hetu: Millk, pickles ,fruit salad , ice creams ,oily foods like papad , curd , spicy
vegetables,
viharaj hetu :soaps and detergents, increases in dry weather, frequently washing of hands
with soap.

Manas hetu : stress, extreme emotions like anger.

Doshas: kapha, vat
Dushya :Rasa, Rakta
General condition of patient was moderate as vital were stable

General examination:
1) Nadi :80/Min
2) Mala :Malabadha

3) Mutra : Prakrut

4) Jiva : Alpsam

5) Shabda : Spashta

6) Sparsha :Ushna
,Ruksha
7) Druk :Samanya

8) Aakruti :Madhyam

General examination:

1) Pulse: 72/min
2) BP : 110 /70mm/Hg
3) Pallor :absent
R/S: air entry equal on both side
CVS: normal function, S1 ,S2 normal
CNS : conscious oriented
P/A : soft sometimes distended
Bladder habit was regular

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Patients detail history: no past history of any chronic illness.

Personal history:
Dincharya : wake up at around 8 o‟clock am, no regular exercise, ruksha spicy green
chilly in food, virrudha anna sewan vihar as per mention above hetus .late night sleep
,stress
Occupation: medical student

Past history:
Patient was all right before 5yr ,patient taken allopathic treatment for the same but after
discontinuing the treatment the symptoms were aggravated, patient was came to
swasthyarakshan opd before 3 months .
After clinical examination patient was recruit for the treatment of vicharchika through
life style management and rasayana sewan that is goghrut.
Local examination:
Fissured erythematous lesions on dorsal aspect of right hand and blackish discolouration with
the thin serous discharge.
Ruksha +++,
khara ++, sparsha
Doshas: kapha ,vata
Dushya : Rasa, Rakta

Treatment protocol:
 Ghritapan 10 ml in rasayana kal.
 Local application of tila taila for 3times in a day.
 Diet regimen and life style modifications.
 Diet do‟s and don‟ts (pathya pathya)
 Ghrutpan in rasayana kal.
 Avoid extra salt intake and fruit salads
 Hot and spicy foods bakery products.
 Food and fruits with milk ,curds
 Eat fresh and normal food
 Avoid more water while taking food.

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 Life style modifications:

 Live stress free life.
 Do regular exercise and dhyan and yoga.
 Avoid diwaswap ,late night sleep ,lying down position after dinner
 Do not hurry while taking food.
 Avoid application soaps and detergent on skin ,herbal neem soap must used
 After bath skin must not allow to remain wet.
 Avoid sweating as much as possible,
Observation:
Observation table showing symptoms before and after treatment
Symptoms Before T/t Day30 Day60 Day90
Itching(kandu) ++++ +++ ++ Complete relief
Blackish +++ ++ + Complete relief
(shyawata)Discolouration
Oozing(bahustrawa) +++ ++ + Complete relief

Result:
On comparison with pre intervention condition of the patient ,there was a marked difference in
patient post treatment the featured which showed the marked difference in all symptoms and
complete relief .
Discussion:
In this study , observation was done before and after treatment based on symptoms
gradation and result obtained are the itching before treatment was 4+after treatment reduced
to 0, blackish discolouration BT is 3+ and AT is 0, oozing BT is 3+ and AT is 0,. Above
result shows mark reduction in the symptoms, effect of tila taila abhyang and ghrutpan as
arasayan with diet and life style modifications.
Itching in vicharchika is causes due to vitiation of kapha and vitiation of vata by ruksha guna
snehpan and abhyang both possesses vathara properties pacifying vruddha vata in
vicharchika also taila possesses vat kaphaghna property hence tila taila abhyang nullifies
vitiated kapha and thereby relieves symptoms of itching.
Discolouration in vicharchika cause due to vitiation of vata dosh,a snehpan and abhyang
both possesses vathara properties paseifying vruddha vata in vicharchika hence tila taila
abhyang nullifies vitiated kapha and thereby relieves symptoms discolouration as til taila has

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varnya property which helps to decrease discolouration .

The world rasayana addresses the optimizing of circulating the nourishing food through
tissues and cells. In this case, used Goghrut as a rasayann helps to get adequate quantity and
quality of aahar rasa with its proper circulation .which helps to relieve the symptoms.
Mode of action of Til Tail Abhyang in Vicharchika :
In Vicherchika mainly Vat Kapha Doshas are vitiated in Kushtha Chikitsa for vat Pradhan
Kustha Ghrutpan is indicated ,as Ghrutpan is Rasayan Chikitsa ,and Abhyang improves blood
circulation facilitates removal of toxins from the tissues , Bhrajak Pitta is located in the skin it
impacts the characteristics of color and luster ,in given patient til tail is applied on the skin
Abhyang is digested by Bhrajak Pitta ,due to Tail Abhyang the Vata Kapha Doshas are brings
to normal thereby decreasing symptoms of vicharchika ,due to Abhyang the hardness and
roughness of skin is diminished. Abhyang helps to improve quality of skin and brings to
normal appearance reliving the symptoms of Vicharchika.7
Conclusion: Thus present case study conclusdes that tila taila abhyang and internally
goghrutpan as a rasayan in vicharchika with life style modification and diet regimen gives
relief to the patient .there were no adverse effect was found.

Day Day
01 15

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After 1 After 2
month months

References:
1. Aacharya Vidyadhar Shukla and professor Ravidatta Tripathi, Caraksamhita, Volume
2,chaukhamba Sanskrit pratishthan Delhi ,Chikitsasthanadhyay Kushthachikitsa
chapter no 7,verse no 26,Page no 185.
2. Kawiraj Ambikadatta Shastri ,Shusrutsamhita edited with Ayurvedatatvasandipika
hindi commentary , chaukhamba Sanskrit pratishthan Delhi Nidanasthan chapter no 5.
3. Kaviraj Atridev Gupta Ashtanghrdayam edited with the vidyotini hindi
commentary edited by vaidya Yadunandan Upadhyay volume 1, waranasi,
chaukhamba prakashan 2007 Nidan sthanam kusthanidan 14/17,page no 272.
4. Kaviraj Atridev Gupta Ashtanghrdayam edited with the vidyotini hindi
commentary edited by vaidya Yadunandan Upadhyay volume 1, waranasi,
chaukhamba prakashan 2007 Chikitsa sthanam kusthachikitsa 16/1,84page no 412.
5. Dr Madham Shetty Suresh Babu ,Yoga Ratnakara volume 1 ,chaukhamba Sanskrit
series Varanasi 7
6. Ashwini patil,IAMJ ISSN:23205091,Psoriasis (Ekkushtha) through Ayurveda A case
study.
7. Dudhamal Tukaram, IJAMY ijamy.0974.6986.9116.5Mnagement of Vicharchika
(Eczema) with Securinega Leucopyrus and Sesame oil A case study.
8. Elizabeth R.Mann, Kathryn M.Smith , Review :Skin and the immune system
9. Lahange Sandip Madhukar, Bhagare Archana Nivrutti,Madhukar et al;J Tradit Medclin
nature 2018,7:1 DOI:10.4172/2573-4555.1000252,A Review article
Physio-Anatomical Explanation of Abhyang :An Ayurvedic massage technique for
Healthy Life.

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18.

AYURVEDA MANAGEMENT OF GADGET ADDICTION IN

PEDIATRIC PATIENT: A SINGLE CASE STUDY
*1Dr Prasad Gajanan Yewale1, 2Dr. Renu Rathi, 3Dr. Swapnali Mate
1
Assistant Professor HOD & 2Prof. Dept of Kaumarbhritya, 3Assistant Professor
Dept of Kriya Sharir Mahatma Gandhi Ayurved college hospital & research center, Salod(H),
Datta Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.

ABSTRACT
Aim- To study the effect of Ayurveda treatment on Gadget addiction in children. Objective :
the study of Gadget addiction in detail. Discussion:Gadget addiction is related to
Asatmeindriyartha Samyoga & Pradnyaparadh. It affects the normal growth and development
of children as well as the structure of the brain. It is the necessity of time to deaddict children
from Gadget addiction as early as possible. Result: In the present case study Ayurveda
principles are used to treat the patient and a good outcome is noted. Conclusion:The
application of Ayurveda treatment modalities in the treatment of Gadget addiction gives a good
result.
Keywords- Ayurveda, Gadget addiction, Kaumarbhritya, Satvavajaya, Yoga,
INTRODUCTION
Addiction can be described as a process in which behavior, which has the potential to both
bring about pleasure and provide relief from internal discomfort, is used in a pattern that is
marked by a repeated inability to control the behavior (powerlessness) and persistence in the
behavior despite grave negative effects (un-manageability). (1) The term "gadget addiction"
includes excessive mobile use, online gaming, online gambling, excessive internet browsing,
and excessive social media use. Addiction to Gadgets is negatively correlated with
psychosocial issues in adolescents(2) Addiction to gadgets causes a decrease in physical
activity, which causes early fat deposition. According to research, stressful environments,
encourage people to get addicted. (3) Gadget addiction is a behavioral type of addiction and
there are similarities between Gadget and drug addiction(4). The Ayurveda concept of
Asatmeindriyartha Samyoga(5) (Indulgence in unhealthy subjects of sensory organs) and
Pradnyaparadh(6) goes much equivalent to today's Gadget addiction.
AIM – To study the effect of Ayurveda treatment principles in the management of Gadget
addiction in children

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OBJECTIVE –
4. Study of Gadget addiction in detail
5. Study of the pathology of Gadget addiction in detail
6. Study of the efficacy of Ayurveda treatment principles in Gadget addiction in detail
PRESENT COMPLAINTS (In Chronological Order)
4. Spending excessive time on a smartphone, video games
5. Less communication with family and friends
6. No interest in playing and surroundings
The patient had these complaints for 1 year.
Associated complaints
Eye pain
Eye irritation
Gaining weight abnormally for 1 year
History of present illness:
The patient had a history of disease for 1 year. She was spending a lot of time on mobile and
video games. As well as having poor scholastic performance with low social contact with peers
and family. Hence came for the Balroga OPD
History of past illness: Admitted for U.T.I. last year
Family history: [H/O- DM/HTN/IHD/TB/Leprosy /Asthma/Genetic Disorders]- No
Hereditary disorders – No
Dietary history
Type of Food- Rukshanasevan (daily biscuit & other bakery product consumption), Ushna
Tikshna Ahar ( fast food consumption )
Appetite: Good
Personal history-
Bowel Movements- Constipation
Micturition- Normal Sleep- sleeps only for 5 hours.
Hygiene- Good Habits- Bed Wetting/
PICA/Nail Biting- no
GENERAL EXAMINATION
Built: obese
Gait: Normal Pulse: 80 / min
Temperature: 98.4f B.P: 105/ 76mmhg RR: 28/ min

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No e/o - Icterus/Organomegaly/Lymphadenopathy/Oedema
Anthropometry
Weight – 29 kg, height – 142 cm,
Ashtavidh parikshana –
1) Nadi (pulse) = 80/min.
2) Mala (stool) = Malavashmbha(constipation),.
3) Mutra (urine) = Normal.
4) Jivha (tongue) = Saam(coated).
5) Agni = Normal
6) Shabda (speech) = Prakrut (Normal).
7) Sparsha (Skin) = Prakrit(Normal).
8) Druk (Eyes) = Netradaha ( eye irritation)
9) Bala(Strength) = Madhyama(Medium).

DOSHA DUSHYA INVOLVED –

Manas dosha: clinical features of gadget addiction are related to Raj Guna and Tamo Guna is
predominance features(7).
Deha dosha : Vata: controlling the mind is the function of Vata Dosha (8), in gadget addiction,
the restraining power of the mind is delayed.
Pitta: intellect is delayed in gadget addiction, which related to Sadhaka pitta(9)
Dushya : Buddhi - intellect, restrain, and memory of a person are affected which are the
function of Buddhi . From the above clinical feature we could conclude that Buddhi is the main
dushya in gadget addiction.
Adhishthan – Man

ASSESSMENT TOOLS:
1) Young’s Internet Addiction test scale
2) DSM-V criteria for social behavior
MANAGEMENT –

No. Intervention Details of method Duration &

Frequency

1 Counseling Counseling about hazardous effects of fortnight 1 session with

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mobile and benefits of mobile parents and child

deaddiction separately

2 Yoga therapy Surya Namaskar, Dhyana Daily

3 Encouragement for The patient was counseled to play In Daily for 1 hour
in &outdoor games and Outdoor games daily

4 Encouragement Parents were guided to the engagement ‘Si-opus sit’ Whenever

towards attending of children in learning new things, in required &feasible
social programs group activities with peers, etiquette

5 Encouragement of Parents advised spending time with Minimum 2 hours of

parent-child children quality time daily by
relationship To give a reward for non using mobile parents

6 Targeted reduction Reduced time was used for adventure, By Padanshik krama
in Gadget use time bravery cognitive skill-oriented things, i.e reduce Gadget use
sports, and yoga. time by ¼ part each
week

The patient and her parents were educated by PPT presentations.

Initial training of Surya namaskar and the method of Dhyana was given.

The patient was asked to do the proposed Suryanamaskara and Dhyana on the assessment day.

Total treatment was advised for 90 days and follow-up was taken on the 91st day

OBSERVATION –

Complaint Before treatment After treatment on the

91st
Day
Screen time 7 hours daily Reduced to 1 hour
Communication with friends No or minimal Spend much time
and family communation with family and
friends

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playing Not interested Interested in outdoor

activities
Young’s Internet Addiction 78 18
test scale score
DSM-V criteria for social 8 2
behavior score

DISCUSSION –
The frequent use of gadgets causes, sensory overload, enlivening the mind for subjective
experience, and the affinity of these experiences causes adverse effects. Addiction (of any
kind) impairs a person's mental capacity, which makes it difficult for them to make morally
sound decisions. The mind needs regulating ability to make any decisions, According to
Ayurveda, Dhee is the component that controls the action of the mind(10) Direct management of
any addiction is not mentioned anywhere in the literature of Ayurveda, but by comprehending
the role of dosha dushya in Gadget addiction, we can come to the conclusion that management
of gadget addiction can be done based on Manasa Roga treatment principles which are proper
(11)
counseling, assurance, memory enhancing, providing knowledge and meditation.
Ashwasana (reassuring and explaining), Suhritvakya (guidance and suggestion), and
Dharmartha Vakya (educating the individual and family) are the types of satvavajaya chikitsa
that were used in treating this case. Yoga has the power to cleanse our mind, soul, and body as
well as to control our emotions; this phenomenon is helpful in conditions such as addiction,
yearning, compulsive behavior, tolerance, and relapse. A consistent yoga practice activates the
alpha, beta, and theta brainwaves, which have been related to improvements in memory, mood,
and anxiety. Mental tension and depression are typical causes of addictive behavior(12).
The easy way to switch from unwholesome things to adopting wholesome things by 1/16th
part(13)is by using the Padamshik Krama. In a Pada karma, bad habits or objects should be
abandoned and good habits should be adopted. To effectively treat Gadget addiction, daily time
spent on gadgets was reduced to 1/16th of that amount, and replaced with beneficial habits or
creative endeavors. n addition to being helpful to patients, Ayurvedic interventions like
Satvavajaya (psychotherapy), Yoga, and Aachar Rasayana require nothing in the way of
infrastructure and the majority of these treatments are completely free. It will be simple for the
patient to adopt such measures because the importance and method of yoga are widely known

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among Indians and are commonly practiced.

CONCLUSION – In this study, we used Ayurveda treatment principles which show good
improvement in a patient without any side effects.
SOURCE OF FUNDS – No
CONFLICTS OF INTEREST – Nil

Reference
1) GOODMAN, A. (1990), Addiction: definition and implications. British Journal of
Addiction, 85: 1403-1408. https://doi.org/10.1111/j.1360-0443.1990.tb01620.x.
2) Tripathi A: Impact of Internet Addiction on Mental Health: An Integrative Therapy Is
Needed. Integr Med Int 2017;4:215-222. doi: 10.1159/000491997.
3) Alcaro A, Brennan A and Conversi D (2021) The SEEKING Drive and Its Fixation: A
Neuro-Psycho-Evolutionary Approach to the Pathology of Addiction. Front. Hum.
Neurosci. 15:635932. DOI: 10.3389/fnhum.2021.63593
4) Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M. Behavioral
Addiction versus Substance Addiction: Correspondence of Psychiatric and
Psychological Views. Int J Prev Med. 2012 Apr;3(4):290-4. PMID: 22624087;
PMCID: PMC3354400.
5) Gupta G, Yadav SS. Insight of trividha roga ayatana (three principal causes of diseases)
mentioned in Ayurveda. Int J Health Sci Res. 2021; 11(12):42-47. DOI:
https://doi.org/10.52403/ijhsr.20211206
6) Patil Asmita: The Concept Of Pradnyapradh With Respect To The Factors That Cause
Life- Style Disorders.International Ayurvedic Medical Journal {online} 2018 {cited
January, 2019}
7) Kumar S, Mehra D, Raole VV, Nikhate SP. A conceptual study on Medha, Buddhi,
Dhee, Dhruti,
8) Smruti, and Manas.The Pharma Innovation Journal 2019; 8(6): 567-572
9) Baronia, C., Husain, M., & Raole, V. (2019). A critical Review on dominant Vata dosh
in Tridosh siddhant. Ayurline: International Journal of Research in Indian
Medicine, 3(02). https://doi.org/10.52482/ayurline.v3i02.221
10) Panda SK. Basic Principles of Kriya Sharira. New Delhi: Chaukhamba Orientalia.
2006.

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11) Acharya YT, Acharya NR. Sushruta Samhita of Sushruta. 7th Ed. Varanasi:
Chowkamba Orientalia, 2003, 500.
12) Samudrudu K, Negalur VB. Role of Ayurveda in Mental Health wsr to Manasika
Swasthya. AYUSH: International Research Journal of Ayurveda Teachers Association.
2021 Jul 26;1(01).
13) Nanthakumar, C.Intervention of Yoga in Stress, Anxiety and Depression. In:
Bernardo-Filho, M. , Taiar, R. , de Sá-Caputo, D. C. , Seixas, A. , editors.
Complementary Therapies [Internet]. London: IntechOpen; 2021 [cited 2022 Nov 10].
Available from: https://www.intechopen.com/chapters/79736 doi: 10.5772/
intechopen.101619
14) Dr. Shruthi S. Shet, Dr. Venkatakrishna K.V., & Dr. Asha S.A. (2021). A critical
review on Padamshika Krama - A transition technique. Journal of Ayurveda and
Integrated Medical Sciences, 6(02), 121-127. Retrieved from
https://www.jaims.in/jaims/article/view/1258.

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19.
STUDY ON THE EFFICACY OF KARVEERADI TAIL IN THE
MANAGEMENT OF PAMA W.S.R TO SCABIES
*1 Dr. Kanchan Gaidhani, 2 Dr. Sonali Chalakh,
1
PG Scholar, Dept. of Agadtantra, 2 Professor, Dept. of Agadtantra, Mahatma Gandhi
Ayurved College Hospital & RC, Wardha, Datta Meghe Institute of Higher Education and
Research Centre, (D.M.I.H.E.R.), Maharashtra, India.

Abstract:
Background:Pama is a Tridoshaj, Pitta, Kapha predominant disease. There are eighteen kinds
of kushdra-kustha in Ayurveda. Out of these pama is one of the types of kustha.Due to
similarities of signs and symptoms, pama can be correlated with Scabies. In Ayurveda,
Nidanparivarjana, Shodhana and Shamana Chikitsa are described for pama kustha. In
Chakradatta, karveeradi Tail is indicated in the management of Pama (Scabies). Hence , this
study was conducted to compare the effectiveness of Karveeradi Tailin the management of
Pama with special reference toScabies. Methodology - Total 40 patients were enrolled and
randomly divided into two equal groups. Group A was treated with Karveeradi Tailand Group
B with Permethrin for 21 days. Patients were assessed for Kandu, Toda, Daha, Pidika and
Strav duringtreatment 3rd and 7thday and after treatmenton 14th and 21th day.Results
-Significant improvement was observed in Group A . Conclusion - Karveeradi taila is
effective in the management of pama.
Key words:Pama, Kushdra-kustha,KarveeradiTail, Scabies, Permethrin
Introduction:
As per Ancient seers skin has seven layer1,2 and in ancient literature all skin disorders are
categorized under the term “Kustha” .which are mainly produced by seven factors Tridoshas and
four dushyas viz.twacha, mass,rakta,lasika3. Kustha is categorized into “Mahakushta” (7) and
“Kshudrakushta” (11). Pama is one of the kushta among eighteen types of Kshudrakushta according
to “Charaksamhita”4.which is caused by preponderance of pittadosa and kaphadosa5. Symptoms of
pama is kandu (itching), Toda (pain), Daha (burning), Pidika (eruption) and Strava (discharge) 6,
7
.Which resembles with Scabies, one of the skin disorders as per contemporary science.
Scabies is an infestation caused by the mite, “Acarusscabiei”. It occurs in individuals at all
ages. It is transmitted from one individual to other and sometimes from pet animals such as dogs,
cats, horses or any other pet animal (Animal scabies) by close physical contact.Infestation occurs
when the pregnant female mite burrows into skin and lays eggs. The incubation period is 2-4 weeks,
after which patient’s starts experiencing severe itching and diffusely scattered papules and

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papules-vesicles. Patients with scabies complain of itching, which is most severe at night 8.
The exact number of infected casesof Scabies in world-wide are estimated to be up to 300 million9. A
study conducted in ruler area among young people notify that rate of scabies was 70%10.
Several medications are indicated for scabies but the side effects are much more such as irritant
dermatitis in hot and humid climate, CNS toxicity, and convulsion. Some medications are
contraindicated in infants and pregnant patients and some are most expensive11.
Even after successful treatment, the itching can be continues and nodular tension persist. It may
persist for weeks even through the mite are gone. However itching beyond six weeks
indicatestreatment failure.So, there is a need to evaluate the efficacy of newAyurveda drug
which will have best-antiscabietic action, within a short period, with negligible side-effect,
economical and decreasing the incidence of recurrence of disease.
In context of Agadtantra, karveera is categorized under upvishavarga12. (Low potency
poison). It has ‘kushthghna’properties13. In Samhita, so many medications are mentioned for
the treatment ofPama. ‘Karveeradi tail’ is one of formulation mentioned in ‘Chakradatta’ 14.So
to evaluate efficacy of ‘karveeraditail’, this study was conducted.

Material and Methods:

Material: The raw material was collected from herbal garden and authenticated by
department of Dravyaguna M.G.A.C.H and R.C Salod (H), Wardha.
Ingredients of Karveeradi oil (Table no 1)
Table No. 1;
Sr.No Ingredients Latin Name Part used Quantity
1 Karveera (shweta) Neriumindicum mill Leaf 500gm
2 Sarshap Brassica Campestrisl-invar Seed oil 2lit

Methodology :
Preparation of Karveerdi Tail : The trial drug was prepared according to procedure given in
SharangdharSamhita15.Fresh leaves of Karveer were collected from Bhamishra Vatika of
Mahatama Gandhi Ayurved Mahavidyalaya. The leaves Grinded properly and fine paste was
made.16 times water was added to this drug and heated on mandagni till it is reduced to1/4
quantity to prepare a quath.4 times sneha (Mustard oil) was taken.Kalk and Quath was added in
the sneha (Mustard oil) Again, heated on mandagni, till all water content gets
evaporated.When all snehasiddhilakshanas was attained, filter the oil properly, collect and
store in air tight container and dispatched in plastic bottle measuring 50 ml each.

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Analysis of Karveeradi Oil : The formulation was first tested for organo-leptic character such
as odour and colour. (Table no 2). Physicochemical analysis includes loss on drying at 1050C,
total ash, Acid insoluble ash, Alcohol soluble extractives, water soluble extractive, pH, (Table
no 4). Colour. Analysis of sample was done as per API standards.

Clinical Study:

Source of Data: After getting IEC approval from Mahatama Gandhi Ayurved College,
Hospital and Research centre. , Total 40 patients reported to OPD of Kayachikitsa department,
MGACH & RC were enrolled in the study, divided into two groups. Group a & Group B (20
patients in each group) Groups a: Trial group- 20 patients, Group B Controlled group – 20
patients

Study design: Single Arm.

Study Type: Interventional Clinical Study.

Inclusion criteria:
1. Diagnosed cases of PamaKustha/Scabies with Kandu, Toda, Daha, Pidika, Strav
2. Patient between the age group of 15 to 60 years.
Exclusion Criteria:
1. Patients suffering from any other systemic disorders such as Skin Tuberculosis,
Leprosy etc.
2. Scabies with complication crust or hyperkeratosis and Secondary infection.
3. Pregnant and lactating women.

Intervention
Group A- Treated externally with Karveeradi Tail.
Group B- Treated externally with permethrin lotion.
Posology:
Group A –Karveeradi Tail onsufficient amounttwo times in a day on affected region.
Group B – Permethrin lotionon sufficient amounttwo times in a day on affected region.
Study Duration: 21 days.
Follow Up Period: On 3rd day and 7thday (Before treatment)
14th day and 21st day (After treatment)
Assessment criteria-
Subjective Criteria: Kandu (Itching) Toda (Pain) Daha (Burning)
Objective Criteria: Pidika (Eruption) Strav (Discharge)
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Gradation of Assessment criteria:

Table 2. : Subjective criteria:
Sr.no Symptoms Present Absent
1 Kandu(Itching) + -
2 Toda(Pain) + -
3 Daha(Burning) + -
Table 3: Objective criteria:
Sr.no Symptoms Present Absent
1 Pidika(Eruption) + -
2 Strava(Discharge) + -

Statistical analysis –
The obtained data was analysed statistically. Chi-square Test and Fishers Exact Test used to
test the hypothesis of the study. P value of < 0.05 was considered as statistically significant and
p value < 0.01 and < 0.001 were considered as highly significant. Level of significance was
noted and interpreted accordingly.
Observation and Results:
Pharmaceutical Study:
Table 4: Organoleptic character of Karveeradi Taila
Sr No. Organoleptic character Remark
1 Colour Pale greenish
2 Odour characteristic

Table 5: Physicochemical property of Karveeradi Taila

Sr no. Test parameter Result
1 Refractive index 1.4640
2 Iodine value 14.93%
3 Saponification value 194.87%
4 Acid value 5.86%
5 Peroxide value 0.72%
6 Free fatty matter 0.95%

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Clinical Study:
Table 6 : Comparison of Kandu(Itching) in two groups at Day 0, day 3, day 7, day 14 and
at day 21
Group A Day 0 Day 3 Day 7 Day 14 Day 21
Present 20(100%) 14(70%) 7(35%) 4(20%) 4(20%)
Absent 0(0%) 6(30%) 13(65%) 16(80%) 16(80%)
Comparison with Day 0 in group A(Fisher’s Exact Test)
p-value - 0.020,S 0.0001,S 0.0001,S 0.0001,S
Group B
Present 20(100%) 11(55%) 5(25%) 2(10%) 2(10%)
Absent 0(0%) 9(45%) 15(75%) 18(90%) 18(90%)
Comparison with Day 0 in group B(Fisher’s Exact Test)
p-value - 0.001,S 0.0001,S 0.0001,S 0.0001,S
Comparison between group A and group B(Fisher’s Exact Test)
p-value - 0.51,NS 0.73,NS 0.66,NS 0.66,NS

In group A, Kandu (itching) before treatment it was 20(100%) and after treatment it was
4(20%) by using fishers exact test statistically significant result was found (p=0.0001S).
In group, Kandu (itching) before treatment 20(100%) and after treatment was 2(10%).By
usingFishers exact test statistically significant result was found (P=0.0001S).
Table 7: Comparison of Toda (Pain) in two groups at Day 0, day 3, day 7, and day 14 and
at day 21
Day 0 Day 3 Day 7 Day 14 Day 21
Group A
Present 18(90%) 10(50%) 6(30%) 4(20%) 4(20%)
Absent 2(10%) 10(50%) 14(70%) 16(80%) 16(80%)
Comparison with Day 0 in group A(Fisher’s Exact Test)
p-value - 0.013,S 0.0002,S 0.0001,S 0.0001,S
Group B
Present 20(100%) 10(50%) 3(15%) 2(10%) 2(10%)
Absent 0(0%) 10(50%) 17(85%) 18(90%) 18(90%)
Comparison with Day 0 in group B(Fisher’s Exact Test)
p-value - 0.0004,S 0.0001,S 0.0001,S 0.0001,S
Comparison between group A and group B(Fisher’s Exact Test)
p-value 0.48,NS 1.00,NS 0.45,NS 0.66,NS 0.66,NS

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In group A, Toda (pain) before treatment was 18(90%) and after treatment it was 4(20%) by
using fishers exact test spastically significant result was found. (p = 0.0001S).
And in, group B Toda before treatment 20(100%) and after treatment it was 2(10%). By using
fishers exact test spastically result was found (p= 0.0001S).Showing significant effect of
karveeradi Tail in comparision in pama.
Table 8: Comparison of Daha (Burning) in two groups at Day 0, day 3 day 7, day 14 and
at day21
Day 0 Day 3 Day 7 Day 14 Day 21
Group A
Present 10(50%) 8(40%) 5(25%) 3(15%) 3(15%)
Absent 10(50%) 12(60%) 15(75%) 17(85%) 17(85%)
Comparison with Day 0 in group A(Fisher’s Exact Test)
p-value - 0.75,NS 0.19,NS 0.04,S 0.04,S
Group B
Present 12(60%) 9(45%) 3(15%) 2(10%) 2(10%)
Absent 8(40%) 11(55%) 17(85%) 18(90%) 18(90%)
Comparison with Day 0 in group B(Fisher’s Exact Test)
p-value - 0.52,NS 0.007,S 0.0022,S 0.0022,S
Comparison between group A and group B(Fisher’s Exact Test)
p-value 0.75,NS 1.00,NS 0.69,NS 1.00,NS 1.00,NS

In group A, Daha (Burning) before treatment was 10(50%) and after treatment it was 3(15%)
by using fishers exact test spastically significant result was found (P=0.04 S).
And in group B, Daha before treatment 12(60%) and after treatment it was 2(10%).by using
fishers exact teststatistically significant result was found (P=0.0022S).
Table 9: Comparison of Pidika (Eruption) in two groups at Day 0, day 3, day 7, and day
14 and at day 21
Day 0 Day 3 Day 7 Day 14 Day 21
Group A
Present 5(25%) 3(15%) 1(5%) 0(0%) 0(0%)
Absent 15(75%) 17(85%) 19(95%) 20(100%) 20(100%)
Comparison with Day 0 in group A(Fisher’s Exact Test)
p-value - 0.69,NS 0.18,NS 0.04,S 0.04,S

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Group B
Present 8(40%) 5(25%) 5(25%) 2(10%) 2(10%)
Absent 12(60%) 15(75%) 15(75%) 18(90%) 18(90%)
Comparison with Day 0 in group B(Fisher’s Exact Test)
p-value - 0.50,NS 0.50,NS 0.06,NS 0.06,NS
Comparison between group A and group B(Fisher’s Exact Test)
p-value 0.50,NS 0.69,NS 0.18,NS 0.48,NS 0.48,NS

In group A, Pidika (eruption) before treatment was 5(25%) and after treatment it was 0(0%) by
using fishers exact test statistically significant result was found (P=0.04S).
And in group B, pidika before treatment 8(40%) and after treatment it was 2(10%) by using
fishers exact test statistically not significant result was found (P=0.06NS).
Table 10: Comparison of Strav (Discharge) in two groups at Day 0, day 3, day 7, and day
14 and at day 21
Day 0 Day 3 Day 7 Day 14 Day 21
Group A
Present 3(15%) 2(10%) 0(0%) 0(0%) 0(0%)
Absent 17(85%) 18(90%) 20(100%) 20(100%) 20(100%)
Comparison with Day 0 in group A(Fisher’s Exact Test)
p-value - 1.00,NS 0.23,NS 0.23,NS 0.23,NS
Group B
Present 3(15%) 2(10%) 0(0%) 0(0%) 0(0%)
Absent 17(85%) 18(90%) 20(100%) 20(100%) 20(100%)
Comparison with Day 0 in group B(Fisher’s Exact Test)
p-value - 1.00,NS 0.23,NS 0.23,NS 0.23,NS
Comparison between group A and group B(Fisher’s Exact Test)
p-value - - - - -

In group A, Strav (discharge) before treatment was 3(15%) and after treatment it was 0(0%) by
using fishers exact test spastically not significant result was found (P=0.23NS).
And in group B, strav before treatment 3(15%) and after treatment it was 0(0%).by using
fishers exact test not spastically significant result was found (P=0.23NS), both drugs showing
equal effect.
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Table 11: Relief in subjective parameters in group A

Symptoms Before treatment After treatment Relief Score % relief
Kandu 20 4 16 80%
Toda 18 4 14 77.77%
Daha 10 3 7 70%
Pidika 5 0 5 100%
Strav 3 0 3 100%

In group A, kandu (itching) before treatment score was 20 & after treatment was 4 there was
80% relief.Toda(pain) before treatment score was 18 & after treatment 4, there was
77.77%relief,Daha(burning) before treatment score was 10 & after treatment 3, there was
70%relief,Pidika(eruption) before treatment score was 5 & after treatment 0, there was
100%relief, Strav(discharge) before treatment score was 3 & after treatment 0, there was
100%relief.
Table 12: Relief in subjective parameters in group B

Symptoms Before treatment After treatment Relief Score % relief

Kandu 20 2 18 90%
Toda 20 2 18 90%
Daha 12 2 10 83.33%
Pidika 8 2 6 75%
Strav 3 0 0 100%

In group B, kandu (itching) before treatment score was 20 & after treatment was 2 there was
90% relief. Toda(pain) before treatment score was 20 & after treatment 2, there was 90%relief,
Daha (burning) before treatment score was 12 & after treatment 2, there was 83.33%relief,
Pidika(eruption) before treatment score was 8 & after treatment 3, there was 75% relief, Strav
(discharge) before treatment score was 3 & after treatment 0, there was 100%relief.
Table 13: Comparison of group wise and overall percentage improvement in patients
Assessment Group A Group B Total
Complete Remission 0(0%) 0(0%) 0(0%)
Markedly Improvement (>75%) 1(5%) 3(15%) 4(10%)
Moderate Improvement (51-75%) 11(55%) 7(35%) 18(45%)

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Mild Improvement (25-50%) 8(40%) 10(50%) 18(45%)

Unchanged (<25%) 0(0%) 0(0%) 0(0%)
Total 20(100%) 20(100%) 40(100%)

Overall improvement seen in Group A is (51-75%) which shows moderate improvement as

compared to Group B is (>75%) shows markedly improvement.
Discussion:
All the drugs of karveeradiTail are having Tikta,and katurasa which are having
Aampachak,Raktaprasadak,kusthaghna,dahaprashamak and kaphahara properties so it is
considered be very much effective in the treatment of pama-kustha.Laghu, Tikshna and
rukshaguna subsides kapha thereby increasesagni which helps in removing Agnimadya and
clears tiny strotas by removing Aam. All the drugs have Antibacterial, Antiviral, and
Anti-inflammatory, Ant allergic and antimicrobial activities. Karveera has wound healing and
Anti-inflammatory properties16. Sarshap has properties of quickly healing wound due to its
antibacterial activity17. And has excellent drying quality which relieves moisture. Its oil
applied externally can instantly relieve pain and inflammation.
Conclusion –
Karveeradi tails shows significant result .No adverse effect of Karveeradi Tail was observed in
the study. Hence it is concluded that karveeradi taila is as effective as permethrin in the
management of Pama.
References:
1.Susrutasamhita of MaharshiShusruta, Hindi commentary, Ayurveda- Tattva- Sandipika by
KavirajAmbikaduttashastri , part 1 sharirsthan, Ch. 4/4, chaukhambha Sanskrit sansthan
Varanasi 2017 , P.37.
2. AstangHrdayam of Srimadvagbhata, Hindi commentary, Nirmala by BrahmanandTripathi,
sharirsthan, ch.3/8, chaukhamba Sanskrit pratishthan Delhi 2017 P. 367
3.Charaksamhita of Agnivesh, Hindi commentary, Vaidyamanorama by
AcharyaVidyadharshukla& Prof. Ravi duttaTripathi, vol 1 Nidanshan, chi. 5/3 ,Chaukhamba
Sanskrit pratishthan Delhi 2017 ,P . 513
4.Charaksamhita of Agnivesh, Hindi commentary, Vaidyamanorama by
AcharyaVidyadharshukla& Prof. Ravi DuttaTripathi , vol 1 sharirsthan, ch.7/4 , Chaukhamba
Sanskrit pratishthan Delhi 2017 , P.763.
5. Susrutasamhita of MaharshiShusruta, Hindi commentary, Ayurveda- Tattva- Sandipika
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byKavirajAmbikaduttashastri, part 1 Nidansthan, Ch. 5/16, chaukhambha Sanskrit sansthan

Varanasi 2017, P.322.
6. AstangHrdayam of Srimadvagbhata, Hindi commentary, Nirmala by BrahmanandTripathi,
sharirsthan, ch.3/8, chaukhamba Sanskrit pratishthan Delhi 2017 P. 367
7.Susrutasamhita of MaharshiShusruta, Hindi commentary, Ayurveda- Tattva- Sandipika by
KavirajAmbikaduttashastri , part 1 sharirsthan, Ch. 4/4, chaukhambh 1a Sanskrit sansthan
Varanasi 2017 , P.37.
8.Pasricha J.S., Gupta R., Illustrated Textbook of Dermatology 3rd edition new Delhi , J .P
Brothers 2006 P.67
9.R.J. Hay , A.C. Steer , D.Eegaman&S.Waiton , Clinical microbiology and Infection ,Volume
18 , 2012 P .313
10.R.J. Hay , A.C. Steer , D.Eegaman&S.Waiton , Clinical microbiology and Infection
,Volume 18 , 2012 P .313
11.Mathew K.G ,Praveen Aggarwal , Prep manual for Undergraduates 5th edition New Delhi ,
Elsevier , 2016, 17 . P. 309
12. Aachal A., Agadtantra, shree Samarth printer’s lavhly prakashan Nagpur, page no.80.
13. The Bhavprakash nighantu with elaborated Hindi commentary by padmshri
prof.K.C.chunekar, edited by late G.S.pandey: edition of 1998: gudchyadivarga, verse 82-84,
page no- 314-316.
14. Chakradattasamhita Chikitsasangraha of Chakrapanidatta by. G .Prabhakara Roa, chi
.50/49, Chaukhambha Orientalia 2014, P. 459
15. SharandharSamhita Hindi commentary, Jivanprada by Shailaja Shrivastav,
Madhyamkhand 9/1, Snehakalpana, P .215
16. The Bhavprakash nighantu with elaborated Hindi commentary by padmshri
prof.K.C.chunekar, edited by late G.S.pandey: edition of 1998: gudchyadivarga, verse 82-84,
page no- 314-316.
17. Sharma P.V., Draya Guna vijyana, vol.2.Reprint, 2001, chaukhamba vishwa Bharti oriental
publication, Varanasi.

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20.
EVALUATION OF ANTICANCER ACTIVITY OF KUKKUTNAKHI
GUGGULA ON LUNG CANCER- IN VITRO STUDY
1
Dr Mujahid B. Khan,
1
Associate Professor, Dept of Rasashastra & Bhaishajya Kalpana, Mahatma Gandhi
Ayurved College Hospital and Research Centre, Datta Meghe Institute of Higher
Education and Research Centre, (D.M.I.H.E.R.), Maharashtra, India.

Introduction:
The discovery of new therapeutic medications is facilitated by the various types of natural
secondary metabolites produced by the plant kingdom and tested for their anticancer
properties (1). The increase of cancer cases worldwide is a significant hindrance to human
development and wellbeing in the modern day (2). The number of new cases of cancer
annually will rise to 22 million by 2030. Lung cancer is the 2nd most common cancer
worldwide and there were more than 2.2 million new cases of found in 2020 (3). Research
and scientific documentation are required for newly discovered or conventionally used herbal
drugs. Ayurvedic medicine is a glimmer of hope due to the shortcomings of contemporary
medicine & therapies. The Materia Medica of Ayurveda was documented by Acharyas using
folklore and tribal sources. (4, 5) In the Sahyadri foothills, a herb known as Kukkutnakhi is
grown during the monsoon and wet seasons.(6,7) Its botanical name is Aspidium cicutarium
Sw., and it belongs to the Drypteridaceae family.(8,9) It is referenced in the manuscript
"Gharguti Aushadhe" at first, and it is also known as Bichava, Waghchavdi, Kombadnakhi,
Nirvishi (10,11). This plant's rhizomes are successfully utilized as a folk cure to treat
conditions like Shula, Arbuda, and Shotha etc (12). In the field of Ayurvedic medicine,
Guggula Kalpana, or medications made from the exudates of Commiphora mukul, has its
own significance (13). According to a retrospective literary analysis of numerous books and
scientific journals, Kukkutnaki Guggula was chosen as a study drug because it is prescribed
for abscess, tonsillitis, tumors, cysts, elephantiasis, etc (14). For a number of Mansavaha
Strotas diseases, it was first mentioned in the text "Chikitsa pradeep"(15). However, the
preparation process and constituent proportions are described in the textbook "Guggula
Kalpana" (16). According to this document, the research medication was developed using
purified Guggul and authenticated Kukkutnakhi in the same ratio for oral administration (17).
The current in-vitro anticancer study used the SRB assay to examine the anticancer activity of
Kukkutnaki Guggula on Human Lung Cancer cell lines-A549 and HOP62.

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Material and Methods:

Material:
The selected cancer cell lines A549 and HOP62 of Lung were procured from American Type
Culture Collection (ATCC), USA and NCCS Pune. For In vitro study instruments like SRB
Calorimeter, 96 well plate, 25 cm2 tissue culture flasks, Liquid nitrogen container, 15 ml
centrifuge tubes, CO2 incubator , Millipore disposable filters, Laminar flow hood , Biological
Microscope, Electronic balance, Haemocytometer, Multichannel automated pipette, Drug
dispensing machine, Elisa reader were used. In the current study, chemicals including SRB
dye, ethanol, TCA liquid nitrogen, DMSO, RPMI medium, and DMEM were utilized.
Method:
The advanced center for treatment, research, and education in cancer (ACTREC), Kharghar,
Navi Mumbai, was the site of the current in vitro research. The study drug's activity was
monitored using the Sulforhodamine B (SRB) Assay procedure, and Adriamycin
(Doxorubicin) was employed as a positive control.
In-Vitro Study: The chosen cancer cell lines underwent quality control screening before being
cryopreserved in a liquid nitrogen container with DMSO (5%–10%) and liquid nitrogen
vapors. Cell lines were cultured in 25 cm2 tissue culture flasks using RPMI 1640 media, which
contains 10% fetal bovine serum and 2 nM L-glutamine, and its single cell suspension was
produced. For the purpose of cell division, tissue culture flask was then incubated in a CO2
incubator at 37.50C for 24-48 hours. Using a hemocytometer, cells were counted, and the cell
count was adjusted (to about 1 x 105 cells/ml) based on the titration results. To prevent
bacterial contamination, this cell culture was carried out inside a laminar flow hood in strict
aseptic conditions. Then, 96-well Micro-Tier plates were filled with the prepared cell
suspension (90 l), with 5 X 103 cells placed into each well. The plates were then incubated for
24 hours at 370°C, 95% air, 5% CO2, and 100% relative humidity before the administration of
the experimental medicines. Prior to usage, the study medication was stored frozen after being
solubilized in DMSO (Dimethyl Sulfoxide) at a concentration of 100 mg/ml and diluted to 1
mg/ml with water (18). By using Drug dispensing machine, aliquots of 10µl of the study drug
dilution were added to 96-well plates that had previously held 90µl of triplicate cell
suspension. Each negative-control well received 10 ml of 10% v/v DMSO, while each
positive-control well received 10 ml of Adriamycin. Drug dosage levels of 40, 80, 120, and 160
g/ml were tested. Three times each experiment was conducted. Then, 25 μl cold 50% (wt/vol),
Trichloroacetic acid was used to fix the cells, and the plates were incubated for 1 hour at 4 °C.
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The plates were then stained for 15 minutes with 50 l of a 0.04% (wt/vol) SRB solution added
to each well. The plates were then washed with tap water to remove the SRB color. After plates
were dried, 1% acetic acid was used to wash away the unbound dye. After 30 minutes, the
protein-bound dye was dissolved in Tris base solution. The Elisa-Plate Reader was then used to
measure absorbance at 540 nm with reference to 690 nm. Graphs were plotted and results were
given in terms of GI50, TGI, LC50 values. After that, the optical densities of drug-treated and
control cells were examined, and growth inhibition was estimated as percentage values. The
percentage growth at each of the four drug concentration levels was computed using the six
absorbance measurements [time zero (Tz), control growth (C), and the test growth in the
presence of drug at the four concentration levels (Ti)]. For test wells in comparison to control
wells, percentage increase was calculated plate by plate. The ratio of the average absorbance of
the test well to the average absorbance of the control wells was used to express percent
increase. For concentrations where Ti >/= Tz (Ti-Tz) positive, it was calculated as [(Ti-Tz)/
C-Tz) x 100, while for concentrations where Ti /= Tz (Ti-Tz) negative, it was computed as
zero. In order to determine the drug concentration that would result in a 50% reduction in the
net protein increase (as shown by SRB staining) in control cells during the drug incubation, the
growth inhibition of 50% (GI50) was calculated from [(Ti-Tz)/C-Tz)] x 100= 50. Ti=Tz was
used to calculate the medication concentration that resulted in total growth inhibition (TGI).
Calculated from [(Ti-Tz)/Tz)] x 100= -50, the LC50 (concentration of drug resulting in a 50%
drop in the measured protein at the conclusion of the drug treatment as opposed to that at the
beginning) indicates a net loss of cells after treatment (19, 20).

Observation and Results:

The results of anticancer study on selected cancer cell lines are as follows:
Table no 1:% Control growth of human lung cell line A549:

Human Lung Cancer Cell Line A549

% Control Growth

Drug Concentrations (µg/ml)

Experiment 1 Experiment 2 Experiment 3 Average Values

40 80 120 160 40 80 120 160 40 80 120 160 40 80 120 160

KG 100.0 100.0 100.0 91.5 96.4 96.3 91.8 82.1 97.9 93.2 83.9 83.4 98.1 96.5 91.9 85.7

ADR 8.5 5.8 2.6 2.4 6.1 4.1 3.6 3.4 -5.2 -6.0 -7.1 -14.0 3.1 1.3 -0.3 -2.7

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Graph no 1: Growth curve of human lung cell line A549:

Table no 2:% Control growth of human lung cell line HOP62:

Human Lung Cancer Cell Line HOP62

% Control Growth

Drug Concentrations (µg/ml)

Experiment 1 Experiment 2 Experiment 3 Average Values

40 80 120 160 40 80 120 160 40 80 120 160 40 80 120 160

KG 100.0 100.0 100.0 93.4 100.0 100.0 100.0 95.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 96.3

ADR -0.5 -3.7 -11.3 -21.3 -2.3 -4.3 -4.9 -15.5 -7.1 -17.7 -19.7 -25.2 -3.3 -8.6 -12.0 -20.6

Graph no 2: Growth curve of human lung cell line HOP62:

KG: Kukkutnakhi guggul, ADR: Adriamycin

Discussion:
Prior to conducting in vivo studies to assess their efficacy, in-vitro mechanism-based screening
of plant drugs is required in the early stages of plant drug research. Due to its widespread use in
tribal communities and by senior Vaidyas in clinical practice for conditions like Granthi (cyst),
Arbuda (tumor) and Galaganda (enlargement of the neck glands) etc, Kukkutnakhi Guggul was

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chosen for study of its anticancer efficacy. This proprietary medication is made in a teaching
pharmacy utilizing authentic Kukkutnakhi and Guggula in an exact ratio for oral use.
Organoleptic analysis revealed that the product's color was dark brown, its Rasa (taste) was
Tikta (bitter), Katu (bitter), Kashaya (astringent), and its fragrance was distinct, resembling a
Guggula-like aroma. This is because one of the main ingredients is Guggula, which contains a
small number of volatile phyto-constituents with a distinct odor. Triphala kwath (decoction),
which has demonstrated anticancer potential, was utilized to purify crude guggul. It possesses
Tridoshas shaman and Lekhana (Scraping) characteristics that embed with pure Guggula to
improve the impact and eliminate the undesirable effect. Sulphorhodamine B (SRB) assay
was used to test the anticancer activity of the study medication, and each experiment was run in
triplicate at four different dose levels (40, 80, 120, and 160 g/ml). SRB is a bright pink anionic
protein staining dye that binds to the basic amino acids of cellular proteins. Based on the
assessment of cellular protein content, it is primarily used to determine cell density (21).
The calculated values from the optical density were listed in the table as experiment 1,
experiment 2, and experiment 3 respectively, along with the average of the observed values for
each plate. On the basis of the average value obtained from each experiment, graphs were
drawn to show the interaction between the study treatment and the control drug on a number of
cancer cell lines. By measuring absorbance at 564 nm to estimate the dye concentration, the
surviving cell count in treated samples was compared to untreated (control) samples to
calculate the percentage of growth inhibition. According to table and graph no. 1, study drug
findings were in the range of 82 to 91 in terms of percentage control growth and line
inclination. As the drug concentration rises, it suggests moderate activity at 160 g/ml, which is
the maximal drug concentration. According to table and graph numbers 2, the research drug
produced results in the 93–100 range for the percentage control growth and showed very little
to no inclination in the graph at the highest concentration level, which was 160 g/ml. This
shows that there is minimal activity, even when the medication concentration is raised. When
compared to the positive control group, the study drug's LC50, TGI, and GI50 values were all
higher than 160 g/ml. Given that the study drug's LC50 values were determined to be larger
than 160 g/ml, Kukkutnakhi Guggula is safe for oral administration and non-toxic at the
cellular level. SRB assay is particularly helpful for qualitative analysis since it is very sensitive
and gives greater linearity with cell number than other assays. Other advanced in-vitro
screening techniques include MTT, Clonogenic assay, Fluorescent assays, and Dye Exclusion
Test (22). SRB assay is frequently employed in cell-based investigations to look into
cytotoxicity and is also a highly cost-effective screening method. It was used to assess the
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possible anticancer medicines' selectivity of activity (23, 24). The SRB assay has certain
drawbacks, such as being less sensitive with non-adherent cells, requiring multiple wash steps
but fixing nonetheless, and being challenging to conduct if the drug is insoluble in solvent
(25-27). This preclinical study had shown encouraging result in the parameter of growth
inhibition i.e. GI50 on particular cell lines which shows the efficacy of the drug. But there was
negligible activity seen on some cell line which suggests that inactivity of the study drug on
cancer cell lines of particular organ.
Conclusion:
Based on a review of the literature, the proprietary herbal preparation Kukkutnakhi Guggula is
assessed for its anticancer efficacy in two cancer cell lines of Lung organ. According to the
SRB assay technique, Kukkutnakhi Guggula was found to be safe for oral administration,
non-toxic at the cellular level (LC50 values were > 160), and to have moderate action on A549
cancer cell lines and negligible activity on HOP62 cell lines. This work provides scope to study
its effect on targeted cancers, specific in vivo scientific studies, and human clinical trials for
further researchers.
Conflict of interest- Nil
Acknowledgement- Nil

References

1. Greenwell M, Rahman PK. Medicinal plants: their use in anticancer treatment.

International journal of pharmaceutical sciences and research. 2015 Oct 1; 6(10):4103.
2. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D,
Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in
GLOBOCAN 2012. International journal of cancer. 2015 Mar 1; 136(5):E359-86.
3. Sharma R. Mapping of global, regional and national incidence, mortality and
mortality-to-incidence ratio of lung cancer in 2020 and 2050. International Journal of
Clinical Oncology. 2022 Apr; 27(4):665-75.
4. Acharya YT. Sushruta Samhita of Acharya Sushruta. Reprint edi. Varanasi; Chaukhambha
Orientalia publishers; 2009. 159p
5. Tripathi RD. Charaka Samhita of Agnivesha; (editor), reprint edi. Varanasi; Chaukhambha
Orientalia publishers; 2007. 358p

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6. Ghoghari AM, Bagul MS, Anandjiwala S, Chauhan MG, Rajani M. Free radical
scavenging activity of Aspidium cicutarium rhizome. Journal of Natural Remedies. 2006
Jun 1; 6(2):131-4.
7. Hardik M, Nishteswar K, Patel BR, Harisha CR. Detailed Pharmacognostical Evaluation
on Rhizome of Tectaria Coadunata (Wall. Ex Hook & Grev.) C. Chr.-A FOLKLORE
HERB. Global Journal of Research on Medicinal Plants & Indigenous Medicine. 2013 Aug
1; 2(8):582.
8. Dubal KN, Ghorpade PN, Kale MV. Studies on bioactive compounds of Tectaria
coadunata (Wall. Ex Hook. & Grev.) C. Chr. Asian J Pharm Clin Res. 2013; 6(2):186-7.
9. Kulkarni M, Tambe R, Bhise K. Preliminary phytochemical screening and HPTLC studies
of extracts of dried rhizomes of Aspidium cicutarium. Journal of Pharmacognosy and
Phytochemistry. 2013 Sep 1; 2(3):50-4.
10. Sathe AP. Gharguti Aushadhe. 1st ed.Girgaon Mumbai; Ayurved Bhavan; 1922. 65p
11. Desai VG. Aushadhi Sangrah.2nd ed. Kothrud Pune; Rajesh Prakashan; 1975. 281p
12. Pade SS. Vanoushadhi Gunadarsh. 2nd ed. Ghatkpoar Mumbai; Raghuvanshi prakashan;
1982. 306p
13. Khan MB, Sathe N, Chavan R. Commiphora mukul Engl.–“Divya”: A Review. Ayurlog:
National Journal of Research in Ayurved Science-2015.; 3(2):1-2.
14. Gordiya RH. Ayurved patrika-Katemulee or Kombadnakhi. Nashik; Ayurveda Sewa
Sangha; 1967. 115p,
15. Gokhale BV. Chikitsa pradeep.1st ed. Sadashiv Peth Pune; Vaidyamitra Prakashan; 1989.
74p.
16. Prabhu N. Guggul kalpana. 1st ed. Dombivali Mumbai; Karyavaha Maharashtra Ayurved
Sammelan; 1999. 88p
17. Khan Mujahid B., Sathe Ninad, Deshmukh Ashwini, Rathi Bharat. Pharmaceutical study of
Kukkutnakhi Guggul and its modified dosage form as tablet. Joinsysmed; 2017, vol 5(1),
pp-15-20.
18. Gaidhani SN, Singh A, Kumari S, Lavekar GS, Juvekar AS, Sen S, Padhi MM. Evaluation
of some plant extracts for standardization and anticancer activity. Indian Journal of
Traditional Knowledge; October 2013; Vol. 12 (4), pp. 682-687
19. Skehan P, Storeng R, Scudiero D, Monks A, McMahon J, Vistica D, Warren JT, Bokesch
H, Kenney S, Boyd MR. New colorimetric cytotoxicity assay for anticancer-drug
screening. JNCI: Journal of the National Cancer Institute. 1990 Jul 4; 82(13):1107-12.

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20. Vichai V, Kirtikara K. Sulforhodamine B colorimetric assay for cytotoxicity screening.

Nature protocols. 2006 Aug; 1(3):1112-6...
21. Lovitt CJ, Shelper TB, Avery VM. Advanced cell culture techniques for cancer drug
discovery. Biology. 2014 Jun;3(2):345-67
22. Chanda S, Nagani K. In vitro and in vivo methods for anticancer activity evaluation and
some Indian medicinal plants possessing anticancer properties: an overview. Journal of
pharmacognosy and phytochemistry. 2013 Jul 1; 2(2).
23. Patil LE, Kulkarni KI, Khanvilkar VI, Kadam V. In vitro evaluation of herb–drug
interactions: a review. Int J Pharm Pharm Sci. 2014; 6:9-12.
24. Itharat A, Houghton PJ, Eno-Amooquaye E, Burke PJ, Sampson JH, Raman A. In vitro
cytotoxic activity of Thai medicinal plants used traditionally to treat cancer. Journal of
ethnopharmacology. 2004 Jan 1; 90(1):33-8.
25. Houghton P, Fang R, Techatanawat I, Steventon G, Hylands PJ, Lee CC. The
sulphorhodamine (SRB) assay and other approaches to testing plant extracts and derived
compounds for activities related to reputed anticancer activity. Methods. 2007 Aug 1;
42(4):377-87.
26. Chavan R, Khan M, Sathe N, Mankar NA. A Review: SRB Assay for Screening Anticancer
Activity of Herbal drugs (in-Vitro). International Ayurvedic Medical Journal. 2016;
4(2):66-70.
27. Keepers YP, Pizao PE, Peters GJ, van Ark-Otte J, Winograd B, Pinedo HM. Comparison of
the sulforhodamine B protein and tetrazolium (MTT) assays for in vitro chemosensitivity
testing. European Journal of Cancer and Clinical Oncology. 1991 Jul 1; 27(7):897-900.

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21.

THE ROLE OF TRIPHALADI KWATHA IN THE MANAGEMENT OF

MADHUMEHA: CLINICAL STUDY
1
Dr Wankhede Arun U
1
Professor, Dept of Rognidan , Mahatma Gandhi Ayurved College Hospital and
Research Centre, Datta Meghe Institute of Higher Education and Research Centre,
(D.M.I.H.E.R.), Maharashtra, India.

Abstract:
Ayurveda is useful to get swasthya-health either by preventing the diseases invading human
body or by curing man from disease. Ayurveda emphasized on prevention rather than cure. In
today’s fast running world human being is inviting many diseases because of sub-standard
quality of food, eating more than requirement, sleeping during day time, eating fast food and
increased stress in society. Madhumeha can be correlated with Diabetes mellitus in modern
medicine, is attracting the whole world as a non-infectious epidemic/pandemic. The prevalence
of diabetes is on the rise, more alarmingly in the developing countries. Besides multiplying the
risks for coronary heart diseases, diabetes enhances the incidence of cerebrovascular strokes.
Moreover, it is the leading cause of acquired blindness and accounts for over 25% of cases with
end stage renal failure as well as 50% of non-traumatic lower limb amputations. Inspite of
achieving new horizons in technology and getting all facilities and comforts with the help of
such technology we are losing health status of our body and mind. The WHO defines ‘Health’
as a state of complete physical, mental, social, spiritual well being and not merely an absence of
diseases and infirmity. Mithyaahar, mithyavihar and pradnyaparadha are the main etiological
factors for any diseases. Madhumeha /Diabetes mellitus has become a favorite and fascinating
subject for the researchers of various medical fields now a day. In this present study ‘Triphaladi
Kwatha’ is used for the treatment of Madhumeha, to understand the effectiveness of this
compound in control and prevention of diabetes and its complications.

Keywords: Madhumeha, Diabetes mellitus, amputation, cerebrovascular stroke

Introduction:

Madhumeha is the incurable and advanced stage of prameha, characterized by excretion of

urine which resembles the honey is taste and characteristics and also accompanied by
sweetness of whole body of the patient. Because of difficulty in treatment, seriousness and
complications, prameha has been considered as one of the eight ‘maharogas’.
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Prameha is one of the chronic diseases described in Aurvedic texts. Prameha has been
mentioned as ‘anushangiroga’ by Charakacharya and santarpanjanyavyadhi by Ashtanga
Hridaya. Chakrapanidatta, the commentator of charaksamhita further elaborated the term
Anushangi as anushangipunarbhavi which indicates the recurrent tendancy of disorder. That is
why madhumeha is regarded as a yapya disease i.e. needs treatment regularly and throughout
life and symptom aggravated hen treatment is stopped and when the conditions favorable to the
disease. Twenty types of prameha are enumerated in classical texts/samhitas and Madhumeha
is considered as a subtype of vataj category. Sushruta described Madhumeha as
Medo-dushtijanyavikara. In modern medicine Diabetes mellitus is the synonymous disease
with Madhumeha.

Diabetes is widely regarded as a syndrome rather than a single disease. It comprises of a

group of common metabolic disorder that shares the phenotype of hyperglycemia. DM is a
heterogeneous chronic metabolic disorder characterized by hyperglycemia from defect in
insulin action and / or deficiency of insulin secretion. Insulin is the only anabolic hormone and
it has profound effects on metabolism of carbohydrate, fat and protein. Insulin is secreted from
pancreatic beta cells into the portal circulation, with a risk increase in response to rise in blood
glucose after meals. A glucose sensor has been identified in the portal vein which modulates
insulin secretion via neural mechanism. Insulin lowers blood glucose by suppressing hepatic
glucose production and stimulating peripheral glucose uptake in skeletal muscle and fat,
mediated by glucose transporter GLUTE-4.

In this present study Triphaladi kwatha is used for the treatment of Madhumeha, to
understand the effectiveness of this compound in control and prevention of diabetes and its
complications. In this study the role of Triphaladi kwatha was studied in 25 patients of
Madhumeha and its effectiveness is compared with standard/ established drug metformin.

AIMS & OBJECTIVES:

Present study is planned keeping in view following aims and objectives,
1. To explore the classical texts for the description of Madhumeha in relation to Diabetes
mellitus in modern science.
2. To study whether Triphaladi Kwatha is effective in relieving sighns and symptoms in
patients with Madhumeha.
3. To see the effects of Triphaladi Kwatha on laboratory parameters of DM i.e. blood glucose
level, urine sugar etc.
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MATERIALS AND METHODS:-

A comparative clinical study done on 50 patients of both sexes, between age group of 30-70
years randomly selected in two groups. Triphaladi kwatha was administered to trial group and
Tab. Metformin was administered to control group. Assessment was done after completion of
therapy.
Drug Triphaladi Kwatha Tab. Metformin
Route Of Administration Oral Oral
Dose 15-30ml BD Before Meal 500 Mg
Kala Before Meal After Meal
Duration 8 Weeks 8 Weeks
Follow Up Every 2 Weeks Every Week

Selection Criteria:-

1. Patients willing to participate in the trial

2. Age 30-70 years
3. Patients belonging to any socioeconomic class.
4. Presence of sugar in urine

Symptoms: Patients having the classical symptoms of Madhumeha as described in

Ayurvedic texts.

Exclusion criteria:-
1. Patients unwilling to participate in the trial.
2. Patients with IDDM/ Juvenile diabetes
3. Diabetic retinopathy, IHD, Severe Hypertension, diabetic ketoacidosis, coma
and Liver dysfunction.
4. BSL- FASTING > 170mg/dl and Post meal> 270mg/ dl.

Assessment criteria: - Assessment is done on the basis of following symptoms,

1. Prabhutmutrata
2. Avilmutrata
3. Dantadinammaladhyatwam
4. Panipadayo daha
5. Chikkanatadehe
6. Trut
7. Swaduasyata
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8. Angagandha
9. Shlathangatwam
10. Kshudhadhikya
Group a (Triphaladi kadha):

Sr. No. Clinical Features BeforeTreatment After Treatment

Relief No relief
No. % No. % No. %
1 Prabhutmutrata 25 100 16 34 9 36
2 Avilmutrata 22 88 15 68.18 7 31.82
3 Dantadinam 3 12 2 66.67 1 33.33
maladhyatwam
4 Panipadayo daha 23 92 17 73.91 6 26.09
5 Chikkanatadehe 20 80 13 65 7 35
6 Trut 25 100 17 68 8 32
7 Swaduayata 17 68 10 58.82 7 41.18
8 Angagandha 20 80 13 65 7 35
9 Shlathangatwam 24 96 14 58.33 10 41.67
10 Kshudhadhikya 7 28 5 71.42 2 28.58

Group B (Tab. Meformin):

Sr. No. Clinical Features BeforeTreatment After Treatment

Relief No relief
No. % No. % No. %
1 Prabhutmutrata 25 100 20 80 5 20
2 Avilmutrata 20 80 15 75 5 25
3 Dantadinam 2 8 0 0 2 100
maladhyatwam
4 Panipadayodaha 24 96 14 58.33 10 41.67
5 Chikkanatadehe 22 88 12 54.54 10 45.46
6 Trut 25 100 20 80 5 20
7 Swaduayata 19 76 13 68.42 6 31.58

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8 Angagandha 22 88 12 54.54 10 45.46

9 Shlathangatwam 23 92 17 73.91 6 26.09
10 Kshudhadhikya 6 24 5 83.33 1 16.67

Discussion:

In the present study it is found that incidence of Madhumeha is more in 5th & 6th decades of life.
Stress may also playing important role in it, for most the men were in service. There is no
specific relation between religion and Madhumeha was observed. Result of study support the
classical description that sedentary lifestyle is an important etiological factor for madhumeha.
In symptom wise statistical analysis, it is found that Triphaladi kwatha is significantly effective
in the symptoms of madhumeha but the onset of action of Metformin is earlier than Triphaladi
kwatha. Triphaladi kwatha has significant hypoglycemic action and it is more on post meal
blood sugar level. Metformin is more effective in treating the hyperglycemia than Triphaladi
kwatha.

References:
1. Charak samhita with Ayurvediya Deepika editor Vd.Jadhavaji Trikamaji Acharya
Choukhambha prakashan, Varanasi, reprint edition 1991.

2. Sushrut samhita Nimbandha sangraha commentary editor Vd. Yadhavaji Trikamaji

Acharya Choukhambha Oriental Varanasi 1st edition 1991.
3. Ashtang Hriday 7th edition 1982.
4. Sanskrit English Dictionary byV.S. Apate.
5. API text book of medicine.

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22.
OBSERVATIONAL STUDY TO EVALUATE ASSOCIATION
BETWEEN STHULA AND KRUSH PRAMEHI WITH UNCONTROLLED
DIABETES MELLITUS
1
Dr Wankhede Arun U, Professor & HOD,Dept of Rognidan & VV,
2
Dr.Khirodkar Sushama R, Associate Professor,Dept of Swasthvritta,
1,2
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.

Abstract:
Ayurveda is recognized as life science and describes ways to prevent and manage lifestyle
disorders. Ayurveda concepts of universal interconnectedness, the body’s prakriti, and life
forces are the primary basis of ayurved medicine. Sushruta has described 2 types of Prameha,
i.e. Sahaja and Apathyanimittaja. While describing the treatment Acharya Charak has classified
the Prameha in two types especially on the basis of body constitution and other causative factors
i.e. Sthula Pramehi and Krisha Pramehi and Santarpanjanya & Aptarpanjanya Prameha .Sthula
pramehi is a type of santarpanajanyavyadhi (disease due to over nutrition) which has been
included in classification of prameha roga. Two varieties of diabetics (pramehi) as classified in
Ayurveda comprise, obese - strong (sthula and balavan) and thin-weak (krisha). Aim: To
establish an association between Sthula-Krusha Pramehi and Uncontrolled. Objective: To study
Sthoulya and Karshya in Prameha to study relation between Uncontrolled Diabetes Mellitus
with sthula-krusha pramehi. Besed upon the above observation and results in the presents study
sthulata and krushata concept in Ayurveda is having great role for the controlled and
uncontrolled status of dibeties. By statistical analysis Sthula Pramehi showed significant
association with Uncontrolled Diabetes Mellitus.
Key words: Diabetes Mellitus, Sahaja, Apathyanimittaja, Sthula Pramehi, Krusha Pramehi
Introduction:
Prameha has been described in most of the available classics of Ayurved.
According to Ayurved, Prameha is the disease which affects several systems; it depends on
genetic and environmental factors and leads to complications if not controlled in the appropriate
way. Ayurveda have invariably given detailed description of disease Prameha, like its causes,
types, pathology along with complication, and line of treatment from both preventive and
curative aspects. Life style disorders collectively increases Kapha, Meda and Kleda which
contributes in the pathogenesis of Prameha. Acharya Sushruta has described two types of
Prameha, i.e. Sahaja and Apathyanimittaja. While describing the line of treatment Acharya
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Charak has classified the Prameha in two types especially on the basis of body constitution and
causative factors i.e. Sthula Pramehi (seen in obese person) and Krisha Pramehi (seen in lean
and thin person) and Santarpanjanya meha & Aptarpanjanya meha Sthula pramehi is a type of
santarpanajanyavyadhi (disease due to over nutrition) which has been included in classification
of prameha roga. Two varieties of Pramehi as classified in Ayurveda are sthula or balavan and
krisha. Treatment for obese diabetics begins with bio-cleansing procedures (panchakarma)
which is aimed at reducing the obesity of the apatarpana chikitsa. Lean diabetics can undergo
milder cleansing

procedures followed by the treatment to nourish the body with specific

management santarpana chikitsa.Both types of diabetics successively treated with distinct
therapy and diet regimen. Sthula Pramehi with clinical features of obesity along with excessive
frequency of urination. In the second variety, Vata may be dominantly involved, and such
patients are lean and termed as Krusha Pramehi. Diabetes mellitus is an important global
health concern of the present era and needs Immediate attention. Diabetes Mellitus
described as metabolic disorder of multiple etiologist characterized by insulin resistance,
relative insulin deficiency, and hyperglycemias with disturbances of carbohydrate, fat & protein
metabolism. According to International Diabetes Federation (IDF), total number of diabetes
subjects to be around 40.9 Million in India. In Ayurveda Diabetes Mellitus can be interpreted
under the broad clinical entity described as Prameha. Both the concepts of Diabetes Mellitus &
Prameha go hand in hand at the level of etio-pathology & management. In brief Acharya Charak
has mentioned that as the birds are attracted towards the trees where their nest lies, similarly
Prameha affects persons who are voracious eater, less enthusiastic, have aversion to bath,
physical as well as mental exercise, over corpulent (atisthoulya), over unctuous (atisnigdha).
There is a lot of scope of research in Ayurveda including the fundamental, literary, clinical and
the therapeutics. Keeping the Ayurveda fundamentals intact, it is mandatory and obligatory to
pursue scientific research in this probably the oldest system of medicine still practiced and
followed by millions across the globe. Despite of recent progression in medical science, several
challenges still exist in the management of diabetes that requires special attention to develop
unexplored fields of medical knowledge. Ayurveda offers comprehensive safe and effective
approaches to manage such conditions. Ayurveda looks like a mesmerizing sleeping beauty for
the modern medical.
AIM
To establish an association between Sthula-Krusha Pramehi and Uncontrolled
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Diabetes Mellitus.
OBJECTIVE
1) To study pathology of Prameha
2) To study Sthoulya and Karshya in Prameha
3) To study relation between Uncontrolled Diabetes Mellitus with sthula-krusha pramehi
MATERIALS & METHOD
METHODOLOGY
Type of study- Cross sectional study
Sample size- 200 Patients
Study sampling- Purposive sampling
Materials and methods-
Known case of Diabetes Mellitus attending the OPD’s,IPD’S of Dr.D.Y.Patil Ayurvedic
Hospital, Nerul, Navi Mumbai, fulfilling criteria for the selection irrespective of their gender,
Age, Religion, Caste etc. were selected for the study.

INCLUSION CRITERIA
• Age group 30 to 60 years
• Chronicity >1 year
• Under treatment (OHA)>1year
EXCLUSION CRITERIA
• Patients having Diabetes in association with other endocrinopathies like, Acromegaly,
Cushing’s syndrome, Hyperthyroidism etc.
• Patients with genetic syndromes like Down’s syndrome, klinefilter’s syndrome, Turner’s
syndrome etc.
• Patients taking drugs like corticosteroids, Tricyclic anti depressant, Cycloheptadine which
leads to weight loss or weight gain.
• Patients of carcinoma or any other systemic diseases affecting multiple body systems and
pregnant woman etc
Assessment of Sthoulya and Karshya by BMI
Assessment of BMI _______ Kg/m2
Metric BMI Formula: BMI = (Weight in kilogram/Height in meters × Height in meters)
Category BMI Range-kg/m2
Severely Underweight Less than 16.0
Underweight from 16.0 to 18.5
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Normal from 18.5 to 24.9

Overweight From 25 to 29.9
Obese class | from 30.0 to 34.9
Obese class || from 35 to 35.9
Obese class ||| OVER 40

2) Assessment of Waist to Hip ratio

WHR=Waist measurement/Hip measurement (measures different optimal values for both
women and men)
Criteria Male Female
Low 0.95 or below 0.80 or below Moderate 0.96 to 1.0 0.81 to 0.85 High 1.0+ 0.85 +
) Assessment of HbA1C & Mean Blood Sugar
HbA1C score (%)
Mean Blood Sugar (mg/dl)
Remark
12 345 11 310 10 275 UNCONTROL 9 240 8 205 FAIR CONTROL 7
170 6 135 GOOD CONTROL 5 100

According to ASSESSMENT CRITERIA, patient were consider as STHULA PRAMEHI

when patient fulfill two out of following three criteria
1) Symptoms scores of sthoulya are more than 16
2) Waist to Hip ratio is Moderate to High
3) BMI is more than 25
Similarly, patient were considered as KRUSHA PRAMEHI when patient fulfill two out of
following three criteria
1) Symptoms scores of karshya are more than 12
2) Waist to Hip ratio is Low
3) BMI is less than 18.5
OBSERVATION & RESULT
AGE WISE DISTRIBUTION:
According to this distribution, maximum no. of patients’ i.e. 80(40 %) patients was in the age
group of 41 – 50 yrs. There were 70patients (35%) of the age group 51 – 60 yrs & 50patients
(25%) of the age group 30-40 yrs.
GENDERWISE DISTRIBUTION:
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Out of the 200 subjects, there were 87 (44%) Male and 113 female (57.0 %) subjects.

OCCUPATION WISE DISTRIBUTION:

Housewife 40% , Businessmen 30%, Service 25% ,labour work 5% .
DISTRIBUTION OF CONTROLLED AND UNCONTROLLED DM:
In the present study were 200 subjects were taken into consideration, among them maximum of
115 patients 58% had Uncontrolled Diabetes Mellitus and 85 patients (42%) had controlled
Diabetes Mellitus.
Association of Akruti and DM:
Among 200 patients, 129 patients were found fulfilling the sthaulya criteria among which
33(39%) patients had controlled DM and 96(83.5%) patients had uncontrolled DM. 71
patients were found fulfilling the karshya criteria among them 52 (61%) patients had
controlled DM and 19(16.5%) patients had uncontrolled DM.
RESULT:
Out of the 200 participants, 115 subjects had HbA1c between 10-12 (58%). 113 Female (57%),
overweight/obesity (83.5% ), housewife (40%) and sedentary habits (55%), higher monthly
income (42%), longer duration of DM were the significant determinants of uncontrolled DM.
There was a significant positive correlation of uncontrolled DM with sthaulya . However, a
significant positive correlation exists between sthaulya and increasing HbA1c. Aggravated
kleda (liquid element of the body), medas (adipose tissue) and kapha are responsible for the
causation of prameha. Keeping this in view, the physician, in the beginning, should administer
depletion therapies to patients suffering with kapha and pitta dominant types of prameha
Discussion: The observations noted in 200 subjects and displayed in tables, graphs and
supplementary notes are critically discussed hereafter.
Discussion on pathophysiology of Diabetes Mellitus:
Diabetes is a common life-long health condition. Diabetes is a condition where the amount of
glucose in your blood is too high because the body cannot use it properly. This is because
pancreas doesn’t produce any insulin, or not enough insulin, to help glucose enter body’s cells –
or the insulin that is produced does not work properly (known as insulin resistance).
Diabetes mellitus is of two principal forms:
- Type 1diabetes (iddm) the pancreas fails to produce the insulin which is essential for
survival. This form develops most frequently in children and adolescents, but is being
increasingly noted later in life. - Type 2 diabetes (niddm) results from the body's inability to
respond properly to the action of insulin produced by the pancreas .this is much more common
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and accounts for about 90-95% of all diabetes cases worldwide. This form of diabetes occurs
almost entirely in adults.
Discussion on Prameha:
Patients suffering from Prameha can be classified into two categories:
1. Sthula Pramehi - These who are obese and having good strength. They are given shodhan
(cleansing purification treatment).
2. Krush Pramehi - These that is emaciated and weak. They are given nourishing treatment -
Bramhan therapy (Bramhan therapy is aimed to improve nutrition level of the body.
Age:
85 patients(42%) of registered patients belonged to the age group of 30–40 years and 65patients
(33%) of the age group 41 – 50 yrs .This data favour the view of modern science that Diabetes
is primarily a disease of middle and old age, but obese population may get it at an earlier
age.The prevalence of Diabetes increases markedly with age and unfortunately the age of onset
has moved down into younger adults and even adolescents in recent decades, especially in the
countries where a major imbalance between energy intake and expenditure has emerged and
India is one such country.
Gender:
It shows that Prameha can occur in either sex but highlighting its prevalence in females113
(57%) subjects because they have a stressful life style. Moreover, some feminine factors like
pregnancy, use of oral contraceptives, menopause etc. was predominant factors, which makes
Female an Obese and finally Prameha condition occurs. Females are more conscious about their
look or appearance; hence they may report more for Obesity to the clinician and try to control
weight gain.
Diet:
According to Ayurvedic text patient indulged in particular diet has important relation in the
etiological factor of Prameha. Acharya Sushrut enlightens Apathyanimitaj Prameha. Out of 200
patients included in the study were having Mix Ahar is 120 [60%] and vegetarian is 80 [40%].
In mixed type the patient taking more non vegetarian food stuff like chicken, mutton, fish and
egg are more possibility to gain weight and body get tendency towards obesity that’s why this
result are observed.
Occupation:
Types of Occupations have significant association with Prameha. In this study it was found that
40% patients were Housewife, 30% were businessmen, 25% were in service and 5% were
labourers. Decreased physical activities and sedentary life due to the occupation is one of the
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important causes of uncontrolled Diabetes. Occupations have direct role in level of physical
activities.
Discussion on Assessment Criteria:
In Ayurveda, Acharya Charaka, has classified Prameha into two types, i.e.
Sthula Pramehi and Krisha Pramehi or Santarpanajanya and Apatarpanajanya Pramehi. It can
also be correlated with the classification given by Acharya Vagbhata, i.e. Dhatu Kshayajanya
and Avaranajanya Prameha, respectively.
Ayurveda explains obesity as ‘Sthula’ – a condition of excessive deposition of fat
muscle in buttock and breasts, development of different body parts unequally and lack of
enthusiasm. Obesity leads to Prameha. The role of Medas (fat/adipose tissue) is of great
importance in the pathogenesis of Prameha. This form of Medas has been described as acting on
Mamsa (muscle tissue), thereby increasing the volume of body fluid. This has been described as
Sharira-Kleda (body fluid) in Ayurveda. Thus, excess water in the blood causes increased
diuresis. This is how the Sharira Kleda is converted into urine which discussed in Charak
Samhita. This route of pathogenesis for Prameha is closely related to obesity. Abdominal
Obesity: Extra weight around the middle and upper parts of the body (central obesity). This
body type may be described as "appleshaped.
Factors affecting sthula and krusha pramehi

controll

enhancing effect of Agni and to reducing effect of Meda and Kleda. Modern science uses the
principle of low calorific value and low Glycemic index for diet application. Ayurveda
prescibes Ahara Dravyas with Katu, Thikta and Kashaya in Rasa; Laghu, Rooksha and
explains if a
person consumes such food and uses the regimen for maintaining the equilibrium / homogenous
state of the dhatus, he will never suffer from Prameha, excluding Jata prameha
Factors to prevent life style disorders :
Balanced and Balancing Ahara and Vihara

Maatraavat Bhunjeeta (Cha. Su.5). Vihaara and Life style – Dinacharya (Daily Routine), Early
to bed & Early to rise (Braahma Muhoorte uttishtet), Vyaayaama (Exercise ), Ritucharya

– Asanaas & Pranaayama

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The prevalence of Life style disorders like Diabetes is due to unawareness and neglect of
genuine Food habits and lack of physical exercise. The many Ahara Dravyas mentioned in
Ayurveda are still available in India which can be included in our present day diet. Diseases
like Diabetes and Obesity are more prone to develop due to bad adoption of life style and diet.
So some other ill health conditions and Diabetes can be prevented with the adoption of proper
Diet and Regimen.
Discussion on Sthula Pramehi and Uncontrolled DM
Among 200 patients, 129(64%) were sthula pramehi patients 96(83.5%) patients had
uncontrolled DM.
Prameha is said to be one of the complications of obesity. Physical inactivity and excessive
intake of food results in to Agni dushti that causes formation of Ama. In Ayurveda, Ama is the
toxic intermediary product of digestion and metabolism, result from improperly digested food.
Improper Agni (digestive metabolic activity) causes accumulation of Ama. Ama leads to
additional formation of Medas (fat) that causes increase in adipose tissue in the body and
becomes overweight.
The multifactor involvement of Medas (fat), Kapha, Vata, and Agni (digestive metabolic
activity) is common path physiologic phenomenon of both Prameha and obesity. In obese
individuals carbohydrate is largely converted to fatty acids.
Discussion on Krusha Pramehi and Uncontrolled DM
71 patients were found fulfilling the karshya criteria among them 52 (61%) patients had
controlled DM and 19(16.5%) patients had uncontrolled DM. Daurbalya-One may faint if he or
she stands up hurriedly. The heart may beat too fast. If these symptoms are noticed suddenly or
accompanied with shortness of breath, chest pain, indistinct speech, or vision loss, it is a highly
complicated case. This occurs due to slowing of or clogged blood flow to the heart or brain
Fluctuations in Sweating One may not sweat even in extreme hot climate; others may sweat too
frequently especially while eating or at nights. This is an indication that a person’s sweat glands
aren’t functioning properly.
Deteriorated Sex Life An uncontrolled diabetic man may feel like finding hard to get and/or
maintain an erection. Women may experience vaginal dryness and loss of stimuli while in
aroused state, and they face difficulty in facing orgasms as well. Discussion on HbA1C
Glycoselated Hemoglobin (HbA1c)<br />HbA1c is a test that measures the amount of glycated
hemoglobin in blood. Glycatedhemoglobin is a substance in red blood cells that is formed
when blood sugar (glucose) attaches to haemoglobin
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We found a significantly high prevalence (83.8%) of uncontrolled DM in the study population.

There seems to be a trend of poor glycaemia control among the population, which portends
danger for their health.
CONCLUSION:
Out of 200 patients 129 patients were found sthula pramehi among which 33 patients
i.e. 39% had controlled DM and 96 patients i.e. 83.8% had uncontrolled DM so it is suggests
that sthaulaya (Obesity) is interfering in glucose contrled of dibiates, this might be due to
avaranajanya samprampti.
Among 200 dibetic patients 71 patients were found krusha prameshi among which 52
patients i.e. 61% had controlled DM and 19 patients i.e. 16.5% had uncontrolled DM, Based
upon the above observation and results in the presents study sthulata and krushata concept in
Ayurveda is having great role for the controlled and uncontrolled status of dibeties. So it
indicates that stulata and krushata is interfering the gucose regulation in dibetes mellitus which
is responsible for controlled and uncontrolled status of dibetes. According to Ayurveda this
might be due to Avaranajanya samprapti because of vitiation of Dashavidha Dushyasangraha.
We have found a significantly high prevalence (83.8%) of uncontrolled DM among the
patients, possibly attributable to overweight/obesity, sedentary living, higher income and lack
of information on diabetes. Addressing these determinants will require re-engineering of
primary healthcare in the district. By statistical analysis Sthula Pramehi showed significant
association with Uncontrolled Diabetes Mellitus.
The subjective symptoms were found more in the subjects with Kaphapradhan or
Kaphaanubandhitva prakruti.
According to Chikitsa point of view, nidanaparivarjana is the ultimate remedy in this disease.
References:
1. Dixit b, Amarakosha satika, ChaukhambaSanskrit Sansthan, Varanasi, 1970
2. Shastri K, Charaka samhita, Chaukhamba Bharati Academy, Reprint 2002
3. Jadavaji Trikaji Acharya, Chakrapani tika on Charaka samhita, Chaukhamba surbharti,
Edited in 2000
4. Sharma Anantram, Sushruta samhita, Chaukhamba surbharti, Edited in 2001
5. Yadavaji trikaji, Sushruta samhita, Chaukhamba Varanasi, 1980, 4th edition
6. Gupta A, Ashtanga Hridayam, Chaukhamba Sanskrit Sansthan, Varanasi, 3rd edition
7. Murthy R, Sharangadhara samhita, Chaukhamba Sanskrit, Edition 1984
8. Upadhyay S, Madhavanidana, Chaukhamba Sanskrit Sansthan, 3rd edition.

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23.
THE ROLE OF DASHANG LEPA IN ACNE- A CLINICAL STUDY
1
Dr Wankhede Arun U, Professor & HOD,Dept of Rognidan & VV,
1,2
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.

Abstract:
Though Ayurveda is India’s ancient traditional medicine written Thousands years back, its
concepts and principles are useful in todays era also . My small research work can be one of
example of it. Mukhdushika also known as Yuvanpeetika is common health problem found in
Adolescence which disturbs physical psychological and social health. Mukhdushika known as
acne vulgaris is classical stigma of adolescence and inflammation of sebaceous glands which
1
produces physiological and psychological scarring. Dashang lepa is commonly used for
shotha in clinical practice, but when it was applied as lepa on face , its effectiveness was
observed in mukhadushika.2 So after considering effective experience in mukhadushika I
decided to go for its systematic study through this small research work , to study effect of
dashang lepa in mukhadushika.
Keywords:Mukhadushika, Dashang Lepa, Shoth, Yuvanpitika

INTRODUTION:
Though Ayurveda is India’s ancient traditional medicine written Thousands years back, its
concepts and principles are useful in today’s era also. My small research work can be one of
example of it. Mukhdushika also known as Yuvanpeetika is common health problem found in
Adolescence which disturbs physical psychological and social health. Mukhdushika known as
acne vulgaris is classical stigma of adolescence and inflammation of sebaceous glands which
1
produces physiological and psychological scarring. Dashang lepa is commonly used for
shotha in clinical practice, but when it was applied as lepa on face, its effectiveness was
observed in mukhadushika.2 So after considering effective experience in mukhadushika I
decided to go for its systematic study through this small research work, to study effect of
dashang lepa in mukhadushika.
Aims & Objectives:
 To Study Mukhdushika
 To Study the effect of Dashanglepa

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Hypothesis :- Dashang Lepa is effective in Mukhdushika

Null Hypothesis:- Dashang Lepa is not effective in Mukhdushika
Alternate Hypothesis:- Dashang Lepa may be or may not be effective in Mukhdushika
Review of Literature:
Mukhdushika also known as yuvanpeetika are abnormality found on face in the form of
thrones of Shalmali due to kapha , vata and rakta dushti.
Dashang lepa:
Dashang Lepa consists of 10 drugs, when applied with ghrita reduces Visarpa, Kushtha,
Jwara and Shotha.
1. (Albizia Lebbeck)
2. (Valeriana Officinalis)
3. (Glycyrrhiza glibra)
4. (Santanlum Album)
5. (Elettaria Cardamomum)
6. (Nardostachus Jatamansi)
7. (Curcuma Longa)
8. (Berbaris Aristata)
9. (Saessurea Lappa)
10. (Vetiveria zizanioidis)
Acne Vulgaris
Human Skin contains 3 types of glands Sudorifeous glands, Sebaceous glands , and
Ceruminious glands. Sebaceous glands secrets a oily secretion called sebum a mixture of
Triglycerides, Cholesterol, Proteins and inorganic salts.Sebum nourishes skin hairs, prevent
exercise evaporation of water from skin, keeps skin soft and pliable, inhibits growth of certain
bacteria.
Androgens from testes , ovaries and adrenal gland stimulate sebaceous glands to secret sebum
.
Acne Vulgaris is inflammation of sebaceous glands that begins at puberity. In Acne Vulgaris
sebaceous glands grow in size and increase their production of sebum. Causes of Ace Vulgaris
includes:
1. Increase sebum production
2. Abnormality of microbial flora
3. Hyperkeritinisation of sebaceous ducts.
4. Inflammation
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Acne is a polymorphic disease characterized by comedones, papules, pustules, nodules and

cysts occurring on the face and sometimes on back and chest.
Mental stress and Menstruation increases severity of the disease. Treatment includes washing
face 2 to 3times a day, topical antibiotics, oral antibiotics.5
Materials & Methods
1. References from Brihattrayi Laghutrayi was observed
2. Study was done in English language and necessary references in Sanskrit were noted.
3. This is randomized, Clinical, Interventional, Perspective study.
4. Dashang lepa was prepared in my own clinic.

Plan of work (Selection of Pataients:

1. Patients visited OPD and diagnosed as mukhadushika and sicking treatment for
mukhdushika was randomly selected for study.
2. Patients ready to undergo clinical trial.
3. Patients do not have other any disease.
4. Plan of work
5. Clinical examination of patients was thoroughly done which includes Dosha
Dhatu MalaStrotasa Prakriti Koshtha Pariksha.
6. Patients was advised for dashang lepa mixed in whrat powder and water, during
night after face wash after lepa get dry and gandharva Haritki 2 tab. In night was
given for koshthashudhdhi.
7. Patients were called for follow up after 7 days to observe improvement.
8. Patients were called for follow up for 3 weeks to note recurrence.
Conclusions
1. Out of total 30 patients 10 were male and 20 were female patients. But This data is
so small that we cant say that Mukhadushika can be only in female patients.
2. Out of total 30 patients all were from age group 15 to 26. that is all were from
young group. So we can say that Mukhadushika is disease ofadolescence.
3. Out of total 30 pataients Mrudu Koshtha is 15 Madhyama koshtha is 9 Krura
Koshtha is 6. This indicates that any koshtha can suffer Mukhadushika .
4. Mukhadushika is observed in all rutus.
5. Out of total 30 patients 18 patients were cured in 7 days, 6 patients were cured in 14
days , 5 patients were cured in 21 days , and 1 patient was cured in 28 days.
6. Out of 6 patients cured in 2 weeks, 3 patients were female patients and has
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menstrual cycle during first week 3 patients were having mental stress for which
these patients was providedcounselling.
7. Out of 5 patients cured in 3rd weeks and 1 patient in 4th week , all 6 patients was
having krura Kostha
8. Dashang lepa is found effective in Mukhdushika though it is not maintened on
text. Mukhadushika should be considered as shotha of sebaceous glands
Dashang lepa shown cure in shotha that is mukhdushika.
9. Period of cure is depends on Menstruation,Koshtha, Rutu , Mental Stress.

References:
1. Principles Of Anatomy And Physiology ; Gerard J. Tortora; 11th edition;
2. Charak Samhita; Edited Marathi commentary by dr. Vijay Shankar Kale;
Chaukhamba Surbharti Prakashan, Delhi, 2016
3. Madavnidan, Edited Hindi commentary by Bramanand Tripathi, Chaukhamba
Prakashan, Delhi,2013.
4. Bhaishjyaratnavali, Edited Hindi commentary by Dr. P.T. Latchandra vaid;
Chaukhamba Surbharti Prakashan, Varansi 2013.
5. Principles Of Anatomy And Physiology ; Gerard J. Tortora; 11th edition

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24.
RANDOMIZED CONTROL TRIAL TO ASSESS THE EFFICACY OF SNIGDHA
SWEDA AND RUKSHA SWEDA ON VATA-KAPHAJ GRIDHRASI
Dnyanesh Joshi1
*1 Professor, Department of Samhita and Siddhant, Mahatma Gandhi Ayurved College
Hospital and Research Centre, Salod, Wardha, Datta Meghe Institute of Higher Education and
Research Centre, (D.M.I.H.E.R.), Maharashtra, India.

ABSTRACT
Background:- Ghridrasi is one of the most common disorders of Vatai. Acharya Charakhas
explains Vataj Ghridrasi and Vata-Kaphaj Ghridrasi.Which closely resembles with sciatica,
which is characterized by pain or discomfort associated with sciatic nerve. Aim and
Objectives:-This Comparative research was carried out with the aim to compare efficacy of
Snigdha sweda (Nadi Sweda) and Ruksha Sweda (Valuka Pottali Sweda) on theVata-kapha type
of Gridhrasi. Materials and Method:- A total of 60 patients were selected randomly with the
lottery method and divide into groupA & group B were advised Snigdha swedan (Nadi Sweda)
andValuka Pottali Sweda respectively for 15 days.Results: - On comparing the mean Ruja,
Group A (28.35%) is more effective than Group B (12.90%).On comparing the mean Gauravta,
GroupA (46.93%)ismoreeffectivethanGroupB(13.5%).Oncomparing the mean Tandra, Group
A(39.58%) is more effective thanGroup B (15.15%).On comparing the mean Arochakta, Group
A (44.44%) is more effective than Group B(17.5%). On comparing the mean of SLR Test, Group
A (35.59%) is more effective thanGroup B (10.76%). Complete remission was not observed in
this study. This may be due to ashort duration of treatment. Conclusion:- On comparison
between the two groups on thebasis of statistical analys is is non-significant which indicates that
effects of both sweda types are almost equal in Vata-Kaphaj Ghridrasi. But on the basis of relief
per followup, in every followup Nadi Sweda gives more relief than valuka pottali sweda. Hence,
Group A therapy is more effective than Group B therapy.
KEYWORDS: Ghridrasi, Snigdha Sweda, Ruksha Sweda, Valuka pottali Sweda, Nadi
Sweda, Scietica,etc.

INTRODUCTION

Nature performed his work very well but due to modifying the lifestyle, human being made
itfast. Due to which it goes oppositeto the rules by nature. So by whichnow a days diseasesare
turns more complicated as well as dangerous and Ghridrasi is one of this.Ghridrasi is one of
the most common disorders of Vata, which closely resembles with sciatica, which is
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characterized by pain or discomfort associated with sciatic nerve1.As Ayurveda devoted for the
Swastha Rakshanarth and Vyadhi Prashamanarth2, with the use of Adhyatma as well as Ahara,
Vihara, and Aushadhi, all of which are quite helpful today.
Sciatic Nerve is one of the longest and largest nerves in the body which having two
branchesfrom buttock region to tip of the fingers of both legs. It helps in the movements of calf
as wellaslegmusclesandprovidessensationtothecalftolegregion.3Sciatic nerve compression is
the actual reason of gridhrasi (sciatica).This compression may be caused due toherniationofthe
diskat level of lumbervertebraeresults in theswelling.
As Ghridrasi is one of theVataVyadhi. Acharya Charak has given the two forms of this Vyadhi,
Vataj Ghridrasi and Vata-Kaphaj Ghridrasi.4
In Vataj type Ruja (Pain) which runs downward fromkati-prushta-uru-janu-jangha-pad is the
prominent symptoms. But in Vata-Kaphaj type, it is associated with Tandra, Gaurav, Arochak
which are kaphaj lakshana.5
Acharaya Charakamentioned list of Swedanartha vyadhi and Ghridrasi is one of
them.6Acharya has advised Swedanain this vyadhi.
This study compared the effects of Snigdha Sweda (Nadi Sweda) and Ruksha Sweda
(Valuka Pottali Sweda) on the Vata-kaphaj kind of Gridhrasi.

MATERIALSANDMETHOD

Study design:

It was a randomized comparative clinical study.

Source of Material

 Clinical Source: - The subjects were recruited randomly from Kayachikitsa outpatient
department of Shree Ayurved College, Hospital, Nagpur.
 Pharmaceutical Source: -The Dravyas named as Dashmoola includes Brihat
Panchamoola and Laghu Panchamool for the preparation of Snigdh sweda and Tilataila
for Snehana purposewereprocured from reliablesources.

Inclusioncriteria

 Patients who have maximum classical symptoms of Vata-Kaphaj Ghridrasi like

Radiating Pain associated withTandra, Gaurav, Arochak, etc.
 Age group in between 30-60 years irrespective of sex, caste, Educational
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Qualification, Social Status, etc

 Patients who registered under OPD or admitted as IPD with aproper consent taking.
 Patients other than fracture, TB of lumber spine, etc excluded by the X-ray of
Lumber Spine of every patient.

Exclusion criteria
 Subjects with age group below 30 years and above 60 yrs.
 Subject having Fracture of Lumber Spine, TB of Lumber spine, CA of
Lumber spine, conditions like Kyphosis or Scoliosis, Fracture &
Avascular necrosis of femurneck, etc.
 Pregnant Women
 Subject having serious systemic diseases.
 Subject having muscle atrophy.
 Subjects depending on regular steroids and analgesic drug for instant relief.

Investigations

X-Ray–Lumber Spine, HB, TLC, DLC, ESR, etc.were carried out to exclude other systemic is
fore study.

METHODOLOGY

In this Pilot study, a total of 60 patients were selected randomly with the lottery method
irrespective of gender, caste and occupation. Consent was taken from each patient before
contribution to the research study. Thirty patients were included in each group (Group A and
Group B) as per inclusion criteria. In total, 60 patients were screened and all had
completedthetreatment with no dropouts.

Diagnostic criteria

Patients with the classic signs and symptoms, such as Radiating Pain from
Kati-Prushta-Uru-Jangha-Pad, Stabdhata, Tandra, Aruchi, Gauravata of Vata-Kaphaj
Gridhrasi, and Patients with positive SLR test, Sciatic Notch deep tenderness test, and Pump
Handle test were selected for the study.

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Grouping & Intervention

The patients enrolled in the study were grouped in two and were administered with
medicationas described in following table,

Table no 1.

Group –A Group –B
 Snigdha Swedan(Nadi Sweda)  Valuka Pottalisweda
 No.of Patients – 30  No.ofPatients – 30
 Swedan Dravya– Dashmool  From– Kati to Padatala
 Snehana– Tila taila  For– 15min
 From– Kati to Padatala  Duration–15days
 For– 15min
 Duration–15days

Assessment of therapy:
The general conditions of the Subjects were thoroughly assessed through the classical
lakshanas of Ghridrasi and objective criteria such as SLRTest. The detailed history,
examination findings and subjective assessment were noted verbally and objective assessment
were measured on 0 day (before trial, BT), 5th day (during trial, DT), 10th day (during trial,
DT), 15th day (after trial, AT) and the changes in observations were documented in a specially
designed case Performa. Before starting treatment and after it was finished, a comprehensive
assessment of the therapy was conducted using statistical analyses and measures of percentage
alleviation.

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GRADING FOR VARIABLES

Table no 2: Subjective.

Subjective
Grade0 Grade1 Grade2 Grade3
Parameter
Pain While Pain After and
Ruja (Pain) NoVedana All time Pain
Movement While movement
Gaura No Heaviness after Heaviness After
All time heaviness
(Heaviness) Heaviness food Food 3-4hours
Arochak No Sometimes not No feeling to take Complete aversion
(Nausea) Arochak Feeling to take food food Towards the food
Tandra After
Tandra No Tandra Tandra after food All Time Tandra
food3-4hours

Table no 3:Objective

Objective Parameter Grade 0 Grade 1 Grade 2 Grade 3

Less than 750– Less Than 600–
SLR Test 750≤ Less Than 450
up to 600 up to 450
more

OBSERVATIONANDRESULT

Kruskal-Wallis test was used for statistical analysis. Data were analysed by using Statistical
Package for the Social Science (SPSS) software program, version 17.0 and GraphPad Prism,
version 6.0; GraphPad Software, La Jolla, CA, USA, A value of P < 0.05 was considered
statistically significant.

Table no 4: Comparison of Ruja in Group A and Group B.

EffectOf Std. Std.Error

Group N Mean p-value
Therapy Deviation Mean
GroupA 30 2.333 0% 0.56 0.10 NA
0th day

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GroupB 30 2.067 0% 0.69 0.12 NA

5th day GroupA 30 1.8 19.40% 0.77 0.13 >0.05,NS
GroupB 30 2.03 1.61% 0.66 0.12 >0.05,NS
10th day GroupA 30 1.7 23.88% 0.66 0.11 <0.05,S
GroupB 30 2 3.22% 0.69 0.12 >0.05,NS
th
GroupA 30 1.6 28.35% 0.56 0.10 <0.01,S
15 day
GroupB 30 1.8 12.90% 2 0.14 <0.05,S

Tableno5: Comparison of Gauravta in Group A and Group B

EffectOf Std. Std.Error
Group N Mean p-value
Therapy Deviation Mean
GroupA 30 1.63 0% 0.80 0.14 NA
0th day
GroupB 30 1.23 0% 0.77 0.14 NA
5th day GroupA 30 1.33 18.36% 0.88 0.88 >0.05,NS
GroupB 30 1.23 0% 0.77 0.77 >0.05,NS
10th day GroupA 30 1 38.77% 0.78 0.78 <0.05,S
GroupB 30 1.33 8.10% 0.81 0.81 >0.05,NS
15th day GroupA 30 0.87 46.93% 0.62 0.62 <0.01,S
GroupB 30 1.06 13.5% 0.78 0.78 <0.05,S

Table no 6: Comparison of Tandrain Group A and Group B.

Effect Of Std. Std.Error

Group N Mean p-value
Therapy Deviation Mean
GroupA 30 1.6 0% 0.62 0.11 NA
0thday
GroupB 30 1.1 0% 0.71 0.13 NA
5thday GroupA 30 1.37 14.58% 0.61 0.11 >0.05,NS
GroupB 30 1.07 3.03% 0.69 0.13 >0.05,NS
10thday GroupA 30 1.06 33.33% 0.63 0.11 <0.05,S
GroupB 30 1.03 6.06% 0.71 0.13 >0.05,NS
15thday GroupA 30 0.96 39.58% 0.61 0.11 <0.01,S
GroupB 30 0.93 15.15% 0.73 0.13 <0.05,S

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Tableno 7: Comparison of Arochak in Group A and Group B.

Effect Std. Std.
Group N Mean p-value
Of Deviation Error
Therapy Mean
GroupA 30 1.5 0% 0.68 0.12 NA
0thday
GroupB 30 1.33 0% 0.66 0.12 NA
5thday GroupA 30 1.26 15.55% 0.63 0.11 >0.05,NS
GroupB 30 1.3 2.5% 0.65 0.11 >0.05,NS
10thday GroupA 30 1 33.33% 0.74 0.13 <0.05,S
GroupB 30 1.23 7.5% 0.74 0.11 >0.05,NS
15thday GroupA 30 0.83 44.44% 0.59 0.10 <0.01,S
GroupB 30 1.1 17.5% 0.60 0.11 <0.05,S

Table no 8: Comparison of SLR TestingroupA and group B.

Effect Of Std. Std.Error

Group N Mean p-value
Therapy Deviation Mean
GroupA 30 1.96 0% 0.61 0.11 NA
0thday
GroupB 30 2.16 0% 0.69 0.12 NA
5thday GroupA 30 1.76 10.16% 0.67 0.12 >0.05,NS
GroupB 30 2.16 0% 0.69 0.12 >0.05,NS
10thday GroupA 30 1.43 27.11% 0.77 0.14 <0.05,S
GroupB 30 2.1 3.07% 0.71 0.13 >0.05,NS
15thday GroupA 30 1.26 35.56% 0.63 0.11 <0.01,S
GroupB 30 1.93 10.76% 0.69 0.12 <0.05,S

On comparing the effects of therapy on Ruja, there is a statistically highly significant difference
between these groups (p<0.05). On comparing the mean Group A (28.35%) is more effective
than Group B (12.90%). (Table no.4) On comparing the effects of therapy on Gauravta, there is
a statistically highly significant difference between these groups (p<0.05).On comparing the
mean GroupA (46.93%) is more effective than GroupB (13.5%). (Table no.5) On comparing

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the effects of therapy on Tandra, there is a statistically highly significant difference between
these groups (p<0.05). On comparing the mean GroupA (39.58%)is more effective than Group
B (15.15%). (Table no.6) On comparing the effects of therapy on Arochakta, there is a
statistically highly significant difference between these groups (p<0.05).On comparing the
mean Group A (44.44%) is more effective than Group B (17.5%). (Tableno.7). On comparing
the effects of therapy on SLR Test, there is a statistically highly significant difference between
these groups (p<0.05).On comparing the mean Group A (35.59%) is more effective than Group
B(10.76%).(Tableno.8).

DISCUSSION
Swedana having – Ushna, Tikshna, Sara, Snigdha, Drava, Sthira, Guru guna.7Grossly these
properties are opposite ofVata dosha hence Swedana pacifies vitiated Vata dosha.Inthe same
way – Tikshna, Ushna properties are opposite to Kapha dosha hence it pacifies Kapha dosha
also. Shortly we can say thatSwedana pacify Vata dosha increases Pitta Dosha &
decreasesKapha Dosha. It results proper functioning of Vata Dosha which triggers Pitta Dosha
and liquefies Kapha Dosha. Which further results in establishment of equilibrium state of
Tridosha.
As per modern Concept, Cellular Fluid contains Sodium Chloride, Potassium, Urea,
LacticAcid, etc.It nourishes tissues & cells. Basic Composition of Sweat alsocontents these
nutrients.Over sweating results in the loss of nutrients from the body.Which further responsible
for the Joint Pain, Cramp, weakness, etc.But continuous sweating also helps toresume
impurities from body fluids. Swedan affects deep tissue which results proper blood circulation
which gives nourishment to Skin and deep tissue which gets good immunity.

Mechanism of Action of Swedana

Swedana specially perform four functions in the body, Stambhagna by Swedana

relievesstambha (stiffness)8. It is mainly due toShita guna and Swedana relieves it by
Ushnaguna. Gauravghna by Swedana results in the sweating which excrete watery or liquid
portionfrom the body results in relieving from Gauravata (Heaviness). Shitaghna by Swedana
pacify Shitata due to its Ushna Guna. Swedkarkta due to sweating, impurities & toxins from
bodyget expel out.

CONCLUSION

Manifestation of Grighrasi is irrespective of age, sex and prakruti, but predominantly seen in

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madhyama vaya, females and vata kapha prakriti persons respectively. Kala (Time), desha
(Place), vihara (Lifestyle) play san important role in manifestation of Ghridrasi. On
comparison between the two groups on the basis of statistical analysis is non-significantwhich
indicates that effects of both sweda types are almost equal in Vata-Kaphaj Ghridrasi.But on the
basis of relief per follow up, in every follow up Nadi Sweda gives more relief than valuka
pottali sweda.Hence, GroupA therapy is more effective than Group Btherapy.

REFERENCES
1. Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to
sciatica: a case report, J Indian sys Medicine 2019;7;132-8

2. Charak,Sutra Sthana;30/26;Tripathi B.etal.;Charak Samhita of Agnivesh; Varanasi;

Chukhamba Surabharti Prakashan, 2017; 565.
3. Human Anatomy; Editionseventh;Sec.1;Chaurasiya BD.; Reprintedition by Krishna
Garg; new Delhi; CBS Publishers & Distributors,2016; 182.
4. Charak, Sutra Sthana;19/7; Tripathi B.etal.;Charak Samhita of Agnivesh; Varanasi;
Chukhamba Surabharti Prakashan, 2017; 383.
5. Charak,Chikitsa Sthana;28/56-57; Tripathi B.etal.; Charak Samhita of Agnivesh;
Varanasi;Chukhamba Surabharti Prakashan, 2017; 947.
6. Charak,Sutra Sthana;28/22; TripathiB.etal.; CharakSamhitaof Agnivesh; Varanasi;
Chukhamba Surabharti Prakashan, 2017; 291.
7. Charak,SutraSthana;22/16; Tripathi B.etal.;Charak Samhita of Agnivesh; Varanasi;
Chukhamba Surabharti Prakashan, 2017; 414.
8. Charak, SutraSthana;22/11; Tripathi B.etal.;Charak Samhita of Agnivesh;Varanasi;
Chukhamba Surabharti Prakashan, 2017; 412.

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25.
SIGNIFICANCE OF RASAYANAS IN PREVENTION OF LIFESTYLE
DISORDERS.
*1
Dr. Shanti Manyala, 2 Dr. Dipika Chakole
*1
Assistant professor, Department of Agadtantra, 2Assistant professor, Department of
Kaychikitsa, Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod,
Wardha, Datta Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.),
Maharashtra, India.

Abstract
Rasayana therapy is one of the eight specialties of Ayurveda. Aim of Ayurveda is to provide
complete healthphysical, social and spiritual. Rasayana therapy ensures the same by promoting
health, immunity and in turn longevity. The main purpose of rasayana therapy is to maintain
the health of healthy individual and cure the diseases of diseased one.1 Rasayana acts at the
level of cellular metabolism and hence improves the metabolic activities of the body. Rasayana
therapy consists of certain drugs which aim ata) Preserve and promote the health of healthy
individual. b) Improves the status of dhatus c) Management of diseases d) Prevents ageing and
provides longevity e) Boost immunity f) Rejuvenate the system It is not only a single drug
treatment but also a specialized therapeutic procedure practiced as a major specialty in
Ayurvedic medicine. Properly and timely use of rasayana drugs promotes youthfulness,
memory, intelligence, complexion, body glow and best physical strength. Rasayanadravyas
acts at various level i.e. rasa-dhatu, agni, and srotas. Various research works is done in the field
rasayana so here an effort is made to review all classical knowledge and its implementation to
achieve the goal of ayurveda “Swasthasyaswastharakshanamaaturasyavikarprasamanamch”.
KEYWORDS: Rasayana, immunity, longevity, ageing, naimitika, kamya, vatatapika

Introduction:
Ayurveda science of life having two aims, one is to maintain the health of healthy person and
the second is to cure diseases of diseased person. 1 The current modern definition of health is
“Health is a state of complete physical, mental and social well being and not merely absence of
disease (WHO). Ayurveda has best provision to achieve good healthy life. Rasayana therapy
works for it; to promote healthy life by preventing the diseases. Rasayana means the science of
Rejuvenation. Rasayanachikitsa consist of certain dietary & therapeutic measures which are to
correct as well as improve dhatus immunity by a proper nutrition.
The word Rasayana is composed of two words Ras + Ayan. ‘Rasa’ means fluid or juice &

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’Ayan’ means pathway. Hence the literal meaning of rasayana is ‘fluid pathway.’ Rasa is the
vital fluid produced by the digestion of food. Rasa provides nutrition, enhances the immunity,
and sustains life. Rasayana is the method of treatment through which the rasa is maintained in
the body. The purpose of rasayana is to give strength, immunity, ojus, vitality, will power and
determination. It also attains longevity, memory, intelligence, excellence ofluster, complexion
and voice, optimum strength of physique and sense organs. Today is the era of erroneous
lifestyle in which people are not able to follow the rules of healthy and happy living due to
unawareness or due to their personal, social or professional obligations like intake of
substandard diet, viruddha, vidahi, abhishyandi diets and abandoning the rules of dietetics as
described in texts.[1]
Rasayana appears to have been practiced as an important specialty aiming at rejuvenation,
geriatric care, mental competence, increased immunity, etc to possess a long and healthy life.
Thus it was the key for maintaining positive health and longevity. Rasayana deal with
preservation and promotion of health and vigor and thereby is more for promotional health.[2]
Lifestyle of a person is the cumulative byproduct consisting of physical activities , which are
co-ordinated with psychological functioning. The combination of physical activity and
psychological functioning is displayed in the form of habits, behaviour, dietary and living
pattern , which is based on training sought from childhood.
Lifestyle disorders occurance depends upon the daily habits of people. The main factors
contributing to the lifestyle disorders include wrong dietary habits, physical inactivity and
disturbed biological clock. Ayurveda focuses on various methodologies like Dincharya,
Ritucharya, Ratricharya, Panchakarma and Rasayanas.[3]
Rasayanas play a very vital role in improving the jatharagni, dhatwagni, which ultimately
improve the strength, immunity, ojus and vitality. Also the metabolic functions of the body are
improved, which is very beneficial in preventive and curative aspects of Lifestyle disorders. [4]

Aims and objectives:

1. To explore the classical Ayurveda and allied literature for understanding the fundamental
concept of Rasayana Therapy and its benefits.
2. To identify the practical utility of Rasayana Therapy for the Prevention of Lifestyle
Disorders.

Materials and Methods:

Classical Ayurveda texts, modern literature and journals pertaining to Rasayana Therapy were
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analyzed for comprehensive understanding of concept of Rasayana Therapy, its historical

review, types, mode of action, need, benefits and uses.

Historical Review:
Rasayana in CharakaSamhita: The 1st chapter of chikitsasthan is devoted to Rasayana
Therapy, which indicates the importance of rasayana therapy as acknowledged by
Acharyacharaka due to its marvelous effects and also having role in alleviation of diseases.
Acharyacharaka has described various Rasayana Yoga viz. as 6 yogas in Ch.Chi 1-1, 37 yogas
in Ch. Chi 1-2, 16 yogas in Ch.Chi 1-3,4 Rasayanayogas in Ch. Chi. 1-4. It shows that at that
time maintenance of health was the priority for which Rasayana therapy was at its peak.
Rasayana in SushrutSamhita: Sushruta has described Rasayana in chikitsasthan in four
chapters i.e. from 27th to 30th, which indicates that Rasayana therapy was not emphasized
much by AcharyaSushruta. This is probably due to the fact SushrutaSamhita is primarily
dealing with surgical discipline. He has given comprehensive, systematic and scientific
classification of Rasayana therapy. New Rasayana drugs and yogas have been added by
AcharyaSushruta.
Rasayana in VagbhattaSamhita: The description of Rasayana Therapy in last chapters of
Uttaratantra i.e. 49th chapter of AshtangSamgraha and 39th of Ashtanghrudaya indicates the
fact that at that time Rasayana therapy was less admired, as aim of curing the diseases would
have been more essential. The description of Rasayana resembles close to CharakaSamhita.
Definition, types, modes of administration, age of administration and various Rasayanayogas
have been described in detail. Numerous details of Rasayana therapy is available in
SharangadharSamhitaPurvakhand 4th chapter, Kalpasthana of Kashyapasamhita.
Rasayana drugs for specific dhatus or tissue.[5]
DHATUS SUITABLE DRUGS
RASA Khajur,draksha,
(plasma) kashmari
RAKTA Amalaki,bhringraj,
(blood) palandu,lauha
MASA Bala,nagabala,
(muscle) ashwagandha
MEDA Guggulu,shilajit,
(adipose) amrita,haritaki

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ASTHI(bone) Laksha,shukti,shankha
MAJJA(bone Vasa,majja,lauha
marrow)
SHUKRA
(reproductivetissue) shatavari,musli.

A unique decade wise description of ageing process is given by Acharya Sarangdhara.[6]

AGE AGEING PROCESS SUITABLE DRUGS

0-10 Balya (Childhood) Vacha,Suvarna Bhasma
11-20 Vriddhi (Growth) Bala, Aswagandha
21-30 Chhavi Amalaki,Louha Bhasma
31-40 Medha (Intellect) Shankhapushpi, Jyotismati, Brahmi
41-50 Twaka (Health of skin) Bhringaraj, Priyal, Jyotismati
51-60 Drushti (Vision) Triphala, Shatavari, Jyotismati
61-70 Shukra(Sexual Ability) Ashwagandha, Kappikacchu
71-80 Vikrama Bala, Amalaki
(Physical ability)
81-90 Buddhi (Wisdom) Brahmi, Shankhapushpi
91-100 Karmendriya Ashwagandha, Bala.
(Locomotor
Activity)

Selected Naimitika Rasayana Drugs For Following Disease [7 & 8]

Sr. No Diseases Naiimitika Rasayana Drugs

1. Eye Jyotismati, triphala,shatavri, yastimadhu
2. Heart Shalparni
3. Skin Gandhak rasayan, vidanga
4. Grahni & gulma Pippali,bhallataka

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5. Tuberculosis Rasona,nagabala, shilajatu,pippali

6. Anemia Louha
7. Asthma Agastya rasayana, bhallataka
8. Neuromuscular, diseases Rasona, guggulu,
bala, nagabala
9. Diabetes Shilajatu,amalaki, haridra
10. Obesity, lipid disorders Guggulu,haritaki
11. Hypertension Rasona, bala, rasna, medhya rasayana drugs
12. Hypotension Kasturi,kupilu
13. Allergic diseases Haridra

Discussion:
Rasayana therapy is very useful in today’s era. Due to unhealthy food, unhealthy living,
increased mental stress, physical exertion, not having control over mental urges, the body
tissue is going under degeneration very early. To overcome this problem, as people finds very
difficult to adopt all ancient fundamentals, so along with dietetics and following some
principles, we can use rasayana therapy to keep them healthy, happy, stress free and bring
control over their mental urges which in turn disturbs tridoshas of body. All these factors can
play a very crucial role in prevention of Lifestyle disorders.

Conclusion:
Rasayana is novel concept. Hardly any of health sciences is found to have put thrust as huge as
Ayurveda has. It gives an insight about what the treatment aim at establishment of Dhatu
Samya should. Hence treatment of any disease would not be complete without using Rasayana.

References:

1. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,

ayurveddipikahindi commentary, chikitsasthaan 1st chapter; 1st pada, verse 4. volume
2, 1st edition 2009, varanasichaukhambhaorientalia;p.no 1.
2. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 1st pada, verse 7-8; volume

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2, 1st edition 2009, varanasichaukhambhaorientalia;p.no 2

3. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 1st pada, verse 16-24;
volume 2, 1st edition 2009, varanasichaukhambhaorientalia; p.no 4
4. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 1st pada, verse 62-74;
volume 2, 1st edition 2009, varanasichaukhambhaorientalia; p.no 11
5. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 1st pada, verse 75; volume
2, 1st edition2009, varanasichaukhambhaorientalia; p.no 12
6. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 2nd pada, verse 3 ; volume
2, 1st edition 2009, varanasichaukhambhaorientalia;p.no 15
7. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 2nd pada, verse 5--7;
volume 2, 1st edition 2009, varanasichaukhambhaorientalia;p.no 16
8. Vd. Harish chandrasinghkushwala, editor-translator charaksamhita, chakrapanidutta,
ayurveddipikahindi commentary, chikitsastaan 1st chapter; 3rd pada, verse 9-14;
volume 2, 1st edition 2009, varanasichaukhambhaorientalia;p.no 27

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26.

AETIOPATHOGENESIS OF HRIDROG (IHD) ACCORDING TO

AYURVEDA
*1
Dr.Girbide Santosh
*1
Professor & HOD, Dept of Rognidan & VV, RA Podar Ayurved college, Mumbai

ABSTRACT:
Ayurveda is knowledge of life.Ayurveda is not just a system of medicine but it also emphasises
a healthy & enlightened lifestyle. The major causes of cardiovascular diseases are modified
lifestyles in modern era like, tobacco usage, physical inactivity & unhealthy diet. Now days,
the lifestyle is changing. Everything is running very fast like, bicycle, cars, trains, aeroplanes
which gives speed to human & internet, mobiles which give speed to human work. But people
have no time for food, sleep & other necessary daily routine work. These factors are causes of
many diseases & specially Hridrog. (Ischemic Heart Disease)According to estimation of WHO
20 million people would die from cardiovascular diseaseby the year 2015. World health
federation was organized on 26th September 2000. Based on the survey in the world, 97 crore
people per year are suffering from different types of heart diseases. It may reach up to 156 crore
by the year 2025. In India 1.7 crore people per year are dragged in to the heart diseases People
do not take proper diet, sleep on proper time. Due to this Rasa dhatu is not formed in required
quantity & quality. Hriday is mulsthana of RasavahaStrotas. So the change in lifestyle is
naturally making the heart prone to disease. Now day’s competition is increased & that is the
main cause of stress. This is one of the main hetu of hidrog. Addictions like smoking,
consumption of alcohol are the causes of hridrog. Ayurveda is the only science which gives
importance to avoid the disease, more than treating the disease. For the avoidance of disease
hetus of hridrog are important factor.
KEY WORDS: Ayurveda, Hridrog, Hetu,Ischemic Heart Disease

INTRODUCTION: Different types of disease Ayurveda have explained different types of

chikitsa. Nidanparivarjan is one of the types of chikitsa. It includes avoidance of causative
factors of disease. Prevention of disease is always better than cure. Ayurveda is the only
science which gives importance to avoid the disease more than eradication of disease. Nidanis
the most important factor of Nidanpanchak.Pathyaapathya is also important factor after
formation of disease, which avoids further complication as well as progress of samprapti in
disease. Disturbance in dinacharya, ratricharya, rutucharya, aacharrasayan,
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sadavruttapalanmay leads todisturbance inaahar, vihar, regularities & improper rest to mind.
In literature there are many references concern to hriday, sira & dhamanies. Amongst
dashapranayatanas, hriday is most important. Hriday is also the most prominent marma in
threesadyapranaharamarmas i.e. shira, basti&hriday. Hridayis seat of chetana.

AIM
Aim is to review the lifestyle, as hetu of Hridrog.
OBJECTIVES
1. To review the literature of Hridrog.
2. To review the lifestyle.
METHODOLOGY
Review of Hridrog: The earliest description of hridrog is available in charaksamhita,
followed by sushrutsamhita & ashtanghriday. Charak&vagbhatahas describedhridrog as a
part of other chapter while sushruta has devoted a separate chapter to deal with the disease.
Sushruta has described hritshulaseperately in Gulmapratishedh adhyaya of uttartantra.
Various types of acute pains have been described which occurs either as a complications of
gulma or appear independently. Hritshula has put under the latter category of shula.
Types of Hridrog
Five types of hridrog viz. Vataj, pittaj, kaphaj, sannipatik&krimija have been
described by charak[1]&vagbhata.[2]Sushruta has omitted sannipatik variety. [3]
General causesof Hridrog: According to Ayurveda, the etiological factors of hridrog
revolve around the types as well as mode of food intake & the way of living one’s life.
Excessive exercise, atiyoga of virechana & bastikarma, excessive grief, fear, stress,
excessive consumption of poisonous materials, excessive vomiting, suppression of the
natural urges relating to urine, faeces, semen, flatus,vomiting,sneezing, eructation, yawning,
hunger, thirst, tears, sleep and breathing caused by over exertion, decreased
sharirbala, injury these are the general causes of hridrog.[4] Also excessive
consumption of rukshaahar, foods prepared by mixing incompatibles, eating more quantity
of foods, eating food before digestion of previous food, use of articles of food which are not
congenial to one’s own temperament these also causes hridrog.[5]
Nidan of Vataj Hridrog
An over-indulgence in grief, fasting, inordinate physical exercise, food which have no
moisture at all, foodconsumed in very low quantity, because of these factors vitiated

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vata definitelygenerates vatajhridrog creating pain whichis difficult to tolerate.[6]

Nidan of Pittaj Hridrog
Over-indulgence in food which isvery hot, sour, salty, alkaline, pungent,uncooked, alcohol,
anger produces pittaprakopa& causes pittajhridrog.[7]
Nidan of Kaphaj Hridrog
Excessive consumption of fatty & heavy to digest food materials, notdoing worries &
body movements,excessive sleep & easy living these factorsproduces vitiation of kapha
& causes kaphajhridrog.[8]
Nidan of Sannipatik & Krimij Hridrog
Combined hetus of vataj, pittaj & kaphaj are observed in sannipatikhridrog.Excessive
consumption of tila, gud, alkaline food causes formation of granthi. If consumption of these
factors persists krimis are developed & this causeskrimijhridrog.[9]Vagbhata has stated that,
the etiological factors of hridrog are similar togulma.[10]
Samprapti of Hridrog
Doshas are aggravated be etiological factors. These aggravated doshas vitiates rasa dhatu
present in hriday. This causes abnormal functioning of hriday. This is known as hridrog .[11]
Review of Lifestyle
Life is a long journey from conception to death. Ayurveda considers four factors which
constitutes life 1. Sharir(body), 2.Indriya (senses), 3.Satva (mind), 4.Atma(soul).Ayurveda see
the living body as a sensitive instrument affected by everything in environment, first at subtle
& eventually at physical level. As long as these factors functions in harmony is health. But as
one or more component is out of balance, affliction & sorrow develops.
Lifestyle means a set of attitudes, habits or possessions associated with particular person or
group. Such attitudes are regarded as fashionable or desirable. Interms of Ayurveda lifestyle is
a catch of allwords meant to encompass all things that produce effects over our body, mind &
spirit. It is our way of living, everything we eat, the people we encounter, activities we do,
things we create & even our desires. Actions that are done repeatedly or things that exists in
environment for a longtime are the most important part of lifestyle because both have a greater
impact on person.
Practically speaking, lifestyle includes what we eat regularly of course, but also includes, when
we typically eat & the condition what we eat. It includes the condition of place that we live or
spends a lot of time like our work places. It includesour habitual thoughts &beliefs as activities
like exercise, sleep, driving, and works even live making.Lifestyle is something that we are

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actively engaged in. However it sometimes seems that we are not in control of it. Work
schedules can be out of our controls. As the pace of life increases, demands on our time make
taking care of ourselves seems like utopian dream. Often we find the healthiest way to live in an
inconvenient world or make plans tochange in the future when we are able.
We are often responsible for ourlifestyle. Our choice about how we live ourlives is the input we
have. Therefore it is quite clear that the output or result either health or disease is directly
related to goodor bad lifestyle.
DISCUSSION
In today’s world when every good quality about health is on thedecline, the age group of 45 to
60 can be considered as the vata prone age group. Younger age group is more prone tohave
effect on lifestyle because of work pressure & as a general rule little careless attitude towards
health issues. Male are more affected bythe modern lifestyle because they are more exposed
to it. It is also commonly seen thatthe male is more prone to addiction, sooccurrence of hridrog
is more in male.
The modern day lifestyle mostly revolves around utilisation of the day, mostly driven by
earning money or in the activities of entertainment.
The least thought is given to sleep. In this situation waking up at brahma muhurta seems like
impossible task. When the person gets up at brahmamuhurta, the first assigned task i.e. mala
pravrutti takes place during natural kala of vata. But when a person skips it,the mala pravrutti
takes place in kaphakala, which is unnatural. If it happens over a long period of time, thekapha
which is guru &shita opposes the movement of apanvayu. This ultimately leads to
pratilomagatiapanvayu, purishasanchiti&agnivikriti. This helps in the samprapti process of
udavarta&rasadushti which are the fundamental causes ofhridroga.
Ratrijagaran is hetu ofvataprakopa; more specifically it vitiates prana,
udan&apanvayu. Also it leads to agnivikruti as well as rasadushti. These factors are
contributed to hridrog.
Use of air conditioner may produce hridrog because air produced by it is
shita&rukshagunatmak. So frequently using air conditioner might be cause ofhridrog.
Just as the pot, leather & the axleof hole of the cart become strong & afflicted by oiling them,
similarly the body becomes strong, stable & skin becomes good by anointing it with oil.
Trouble caused by vatasubsides & become capable of withstandingfatigue&exercise. But now
a day’s people do not take daily abhyang that causes vatavruddhi. So it might be cause of
hridrog. Ignoring abhyang has become hallmark of modern lifestyle.

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In samhitas it is explainedthat, vyayam is agnidipak, sharirlaghavkar& gives freshness to all

indriyas. Avyayam causes agnivikruti, ajirna& later leads to amlotpatti, kaphavikruti. It may
causes hridrog. Avyayam causes medovruddhi. It leads to abnormality in sira because sira are
nourished by mrudupaka of sneha of medadhatu. If meda is formed apakwa state, the sneha
from such meda will leads to abnormal nourishment of sira. It leadsto possible blocking of sira
& this is a major cause of hridrog.
Improper & irregular meal timing is very common in today’s lifestyle. Intake of meal is
depends upon strength of agni. Taking meal improperly & irregularly for long time causes
agnivikruti, ajirna& later leads to amlotpatti&kaphavikruti.As hriday is
kaphapradhanavayava & seat of sadhakagniit may causes hridrog.
Charak has described the treatment of hridrogin trimarmiychikitsaadhyaya of chikitsasthana.
This adhyaya begins with the treatment of udavarta.Charak clearly underlines the role of
udavarta innidan&chikitsa of hridrog. Vegavrodha is root cause of udavarta. This explains the
importance of vegavrodha in the samprapti of hridrog. Consumption of alcohol is causative
factor of hridrog. Madya causes ojakshay, raktadushti, dhatukshay,
tridoshprakopa&manadushti. The heat produced by alcohol leads to abnormal nourishment of
sira which contributes to the formation of hridroga.
CONCLUSION
Modern lifestyle plays major role in the genesis of hridrog & is responsible as hetus of
hridrog.

BIBILIOGYAPHY
1. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by
Dr.Kashinath Shashtri, Sutra Sthana Chapter 17, Verse No. 6, Page.
330, Chaukhambha Sanskrut Sansthan, Varanasi, Reprint 2009.
2. Vagbhat “AstangHridayam” with Arundatta Sarvangsundar Hindi
commentary by Dr. Anna Moreshwar Kunte, Nidan Sthan,
Chapter 5, Verse No. 38, Page. 482, Choukhambha Sanskrut Pratishthan, Varanasi,
Reprint 2006.
3. SushrutaSamhita”, with DalhanNibandhasangrah Hindi commentary, by
Dr.Kaviraj Yadavji Trikamji Acharya Uttar Tantra, Chapter 43, Verse No. 5, Page.
727, Chaukhambha Orientalia, 8th edition 2005.
4. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by

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Dr.KashinathShashtri, ChikitsaSthana Chapter 26, Verse No. 77. Page. 731,

ChaukhambhaSanskrutSansthan, Varanasi, Reprint 2009. “SushrutaSamhita”, with
Dalhan Nibandhasangrah Hindi commentary, by Dr.Kaviraj Yadavji
TrikamjiAcharya, Uttar Tantra, Chapter 43, Verse No. 3, Page.727,
ChaukhambhaOrientalia, 8th edition 2005.
5. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by
Dr.Kashinath Shashtri, Sutra Sthana Chapter 17, Verse No. 30, Page.
336, Chaukhambha Sanskrut Sansthan, Varanasi, Reprint 2009.
6. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by
Dr.KashinathShashtri, Sutra Sthana Chapter 17, Verse No. 32, Page.
336, Chaukhambha Sanskrut Sansthan, Varanasi, Reprint 2009.
7. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by
Dr.KashinathShashtri, Sutra Sthana Chapter 17, Verse No. 34, Page.
8. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini
commentary, by Dr.KashinathShashtri, Sutra Sthana Chapter 17, Verse No. 36&
37, Page. 337, Chaukhambha Sanskrut Sansthan, Varanasi, Reprint 2009.
9. Vagbhat “AstangHridayam” with ArundattaSarvangsundarHindi
commentary by Dr. Anna Moreshwar Kunte, Nidan Sthan,
Chapter 11, Verse No. 33-38, Page. 510, Choukhambha Sanskrut Pratishthan,
Varanasi, Reprint 2006.
10. “SushrutaSamhita”, with DalhanNibandhasangrah Hindi commentary, by
Dr.KavirajYadavjiTrikamjiAcharya Sutra Sthan, Chapter 43, Verse No. 4, Page. 184,
ChaukhambhaOrientalia, 8th edition 2005.
11. Agnivesha, “CharakSamhita”, with Ayurveddeepika vidyotini commentary, by
Dr.KashinathShashtri, ChikitsaSthana Chapter 26, Verse No.78. Page. 732,
Chaukhambha Sanskrut Sansthan, Varanas.

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27.
CLINICAL STUDY OF PRAMEHA COMPLICATIONS WITH SPECIAL
REFERENCE TO DIABETES MELLITUS
1
Dr Wankhede Arun U, Professor & HOD,Dept of Rognidan & VV,
2
Dr.Khirodkar Sushama R, Associate Professor,Dept of Swasthvritta,
1,2
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.

Abstract:
Ayurved is one of the most ancient systems of the medicine in the world. It is highly evolved
and codified system of life and health sciences based on its own unique and original concept
and fundamental principle. Upadrav are complication which manifests after the manifestation
of diseases. When the disease is not treated properly and indulging in the same nidan, in the
vyakta stage of the disease, upadrav manifests. Upadrav’s plays very important role in
Diagnosis, Prognosis and Treatment of the diseases. Diabetes mellitus is a group of metabolic
diseases characterized by hyperglycemia which occurs due to defects in insulin secretion.
Hence considering the fast increasing trend of Diabetic complications and its associated
morbidity and mortality levels, it is very crucial to focus on Prameha and its Upadrava’s for
effective treatment and management. So an attempt is made to analyse and understand the
Upadrav in this study.
Key words: Prameha, Upadrav, Diabetes mellitus, hyperglycemia.

Aim:
Clinical study of Prameha complications with special reference to Diabetes
mellitus.

Objectives:
1) To study pathology of Prameha and DM

2) To study Prameha Upadrava’s

3) To study the relation between blood sugar levels and Prameha Upadrava’s

4) To study the relation between HbA-1c and Prameha Upadrava’s

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Materials and Methods:

Inclusion criteria-
- Age group- 30 to 60 yrs
- HbA1c- >7
- Chronicity of type 2 Diabetes Mellitus more than 5 years

Exclusion criteria-
- Hba1c- <7
- Chronicity of type 2 Diabetes Mellitus less than 5 years
- Type 1 Diabetes Mellitus patients
- Patients having drug or chemical induced Diabetes Mellitus like
glucocorticoids induced Diabetes Mellitus or thyroid hormone induced
- Patients having malignancy
- Patients having any other systemic disease affecting multiple body
systems andpregnant women

1) Type of study-cross sectional study

2) Study population-

Patients having Diabetes for more than 5 years with HbA1c above 7

3) Sample size-100

4) Place of study-

5) Sampling method-purposive sampling

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Subjective Assessment:

S.N Upadrava’s Grade 0 Grade 1 Grade2 Grade3

o
1. Trisha 8 to 10 10 to 15 glass 15 to 20 >20 glass of
(Thirst) glass of of glass water/p
water/p water/per of erday
er day water/
per
2. Atisara No 2-3 times per 3-10 times >10 times per
(Diarrhea) 24 hrs. per 24 hrs. 24 hrs.

3. Jwara No (97.7 Mild fever (99.6 Moderate fever ( Daily >102f

to99.5f
(Fever) to 100f) 101 to 102f)
4. Daha No Burning sensation Constant Constant burning
burning
(Burning Occasionally sensation requiring
(mild) sensation
5. Daurbalya No Mild Tired Work with
weakne after great
(weakness)
ss little difficulty
work
6 Arochaka No after work Feeling test Anorexia[ha
Feeling test less less but tefood]
(Loss of taste)
but eating not
complete eating
meal complete meal
7 Avipak No Occasionally Happening Continuous
(Indigestion) regularly for
few
8 Shwas No Shortness Stops while Unable to
trouble in of breath walking for do walk
(Dyspnoea)
breathing while breathing due to
except walking on a Dyspnea
strenuous level ground
9. Aalasya Active Hesitate to Starts but Don’t have
(Laziness) start does desire to
work but not work
once complete
started work
complete
10 Pratishyay No Occasiona Frequently Always
(Running nose) lly
11. Kaphpraseka No Wet lips Wet lips Dribbling
(Excess salivation by and chin by of saliva
salivation) salivation salivation on clothes

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12 Hrudrog(Heart Absent - - Present

disease)
13 Shool No Body ache Body ache Continuou
(Body ache) but doing but s Body
normal limitation ache and
movement to unable to
s movement do normal
movement
14 Chardi(vomit) No 1-2 times 2-4 times >4 times
vomit per day per day
per day

15 Nidra(Excess 6 to 8 hrs 8 to 10 hrs 10 to 12 hrs >12hrs

sleep) sleep per sleep per sleep per sleep per
day day day day
16 Vrushanaavadar No Cracks on Cracks with Cracks,ble
na testis bleeding ed
testis with pus
from testis
17 Bastibhed (Pain NO pain Mild pain pain at Pain at
in at pubis pubis
pubis) pubis area bairly area
area,no walk unable to
difficulty walk
in walk
18 Mendhratod No pain Mild pain Pain at Severe
(Pain in genital attention genital area pain at
area) towards but genitals
pain continue all unable to
activities move or
walk
19 Hridshoola(Car No pain Mild chest Continuous Severe
dia c pain) pain paining but pain
attention able to all unable to
move or
breath
20 Amlika(Sore No 2-3 times Sometimes Continuou
belching) in a week in a day s
throughout
the
21 Moorcha(Fainti No Fainting Fainting Fainting after
ng) fainting by after few routine activities
by strenuous minute
strenuous work or walk
running
22 Nidranash 6 to 3 to 6 hrs 1to3hrs Unable to
(Insomnia) 8hrs sleep sleep sleep

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23 Pandurog(Anemi 12 to 7.0 to 7.0to9.9 Less than

a) 17.5g/dl 9.9g/dl g/dl 7g/dl
24 Laulya No Craving to Craving to Unable to control
Craving eat but not eat but wait hunger instant eat
eating for few hrs.
25 Stambha(Stiffnes No anything Stiffness something
s) Stiffness Mild with pain Stiffness in
stiffness while walk whole
able to body
unable to
move
26 Baddhapurishatv NO Daily Passing of Passing of
a (constipation) Passing of stool stool with
stool with with use of use of
laxative laxative >
after
27 PutimaunsaPidik No Carbuncle Carbuncle Forms
a( carbuncle) that goes it cures again and
himself after again after
treatment treatment
28 Kampa No Tremors Object falls Unable to
tremors at after few grab
picking seconds objects
object
,holds
29 Kasa Absent Cough Cough with Cough
(Cough) less than expectorati with
15 days on expectorati
more that on
15 more than
15
30 Shaithilya Absent - - Present

Objective assessment

 HbA1c

HbA1c Mmol/ml %
Normal Below 42 Upto 6
Prediabetes 42 to 47 6.1 to 6.4
Diabetes 48 &above 6.5 & above

 Blood sugar levels –Fasting & PP

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Blood sugar Fasting Postprandial

classification Mg/dl Mg/dl
Normal 80-100 80-140
Prediabetes 101-125 141-160
Diabetes >125 >160

Overall Assessment:

Discussion on Demographic Study

 Diet: - Maximum number of patients i.e. 60(60%) were taking vegetarian diet
& 40(40%) patients were taking mixed diet. Most of the patients were on irregular diet
pattern. It might be of alpashana, Samashana, Vishamashan. These irregular dietary patterns
lead to the Kopa of vata dosha progressively. Analysis on the basis of dominant rasa consumed
showed that maximum patients had inclination towards madhur ras. Madhur ras is included
in the rasas which provocates the kapha dosha. Irregular diet pattern and consumption of
Madhur rasa in an excessive manner can be effectively considered in the predisposing factors
of Prameha and later it results into updravas.
Due to sedentary lifestyle intake of Mithyahara (improper diet) is a common phenomenon in the
pathogenesis of Prameha. All these aharajanidana (causative factor related to diet) are
responsible for vitiating and development of prameha upadravas that reflect in Blood sugar
level in the body. Discussion on Prameha Updravas vis-a-vis type 2 Diabetes mellitus
Type-2 diabetes mellitus is one of the most prevalent life style disorders in today's era.
Ayurveda, the science of life mentions Apathyanimittaja Prameha which resembles type- 2
diabetes mellitus in terms of aetiology, pathogenesis and presentation of the disease.
Upadrava’s are those which develop after the manifestation of main disease or during the
disease process itself, which implies upadrava manifests in the disease process itself but at the
end of it. Upadrava’s are the complications which arise after the improper treatment of the
vyadhi. Early treatment to the disease itself prevents from the manifestation of upadrava. Once
the upadrava develops means the vyadhi is incurable or difficult to cure. Life style and diet
style factors such as sedentary habits, high sugar content food articles such as simple
carbohydrates, milk products, and sweets, which make an individual prone for the incidence of

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type-2 diabetes mellitus, mentioned in Ayurvedic texts as predisposing factors for

Apathyanimittaja Prameha.
Despite the efforts of the healthcare community to improve the quality of diabetes care, about
50% of people with type 2 diabetes do not reach their treatment targets, increasing the risk of
future micro-and macro-vascular complications. Excessive sleeping, desire for sleeping during
the day time, indulgence in long- term sitting, lack of exercise (sedentary life style) , lack of
thinking, Atistulata (Obesity), Laziness, Heaviness of the body, Indriyas and Srotas filled with
Mala, Difficulty in concentration of mind, Thoughtfulness, Edema and other related conditions
- (CS.Su.23.21).
Upadrava of prameha (complications of Diabetes)- In this condition, the formation of urine is
hampered due to vitiation of vata dosha, resulting in minimal or no urine production in the
body.

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Statistical Discussion of Parameters of HbA1C, BSL-Fasting and PP

In healthy people, the HbA1c level is less than 6% of total haemoglobin. A level
of 6.5% signals that diabetes is present. Studies have demonstrated that the
complications of diabetes can be delayed or prevented if the HbA1c level can be kept
below 7%. It is recommended that treatment of diabetes be directed at keeping an
individual's HbA1c level as close to normal as possible (<6%) without episodes of
hypoglycemia (low blood glucose levels).
Discussion on Association of score of Upadrava’s and HbA1c
In the present study the subjects where HbA1c level was 7-8% were considered in Group one.
While conducting present study maximum of 32 patients were found in Group 1 among them
26 were in Grade one, 5 grade two, 1 grade three of Upadrav score. Total 16 patients were
noted in Group two. In the subjects where HbA1c level was between 8.1 -9% were considered
as Group two. The 11 patients were in Grade two, 5 patients in grade three of Upadrav
scoreTotal 28 patients were noted in Group three. In the subjects where HbA1c level was
between 9.1 -10% were considered as Group three. The 13 patients were in Grade two, 15
patients in grade three of Upadrav score. Total 24 patients were noted in Group four. . In the
subjects where HbA1c level was between -11% were considered as Group four. The 2 patients
were in Grade two, 22 patients in grade three of Upadrav score. By The application of
Chi-Square test it was found that p-value less than that of 0.05 indicated significance of
association between HbA1C and upadrava grading. HbA1c levels depend on the blood glucose
concentration. That is, the higher the glucose concentration in blood, the higher the level of
HbA1c. Levels of HbA1c are not influenced by daily fluctuations in the blood glucose
concentration but reflect the average glucose levels over the prior six to eight weeks.
Therefore, HbA1c is a useful indicator of how well the blood glucose level has been controlled
in the recent past (over two to three months) and may be used to monitor the effects of diet,
exercise, and drug therapy on blood glucose in people with diabetes
Discussion on Association of score of Upadrava’s and BSL-Fasting and PP
The blood sugar level-fasting and PP: The pancreas makes enough insulin but the cells
have trouble using it properly, causing blood glucose levels to rise. This is called insulin
resistance and is the hallmark of type 2 diabetes. High sugar degrees gradually deteriorate the
ability of cells in pancreas to earn insulin. The body organ overcompensates and also insulin
degrees remain too expensive. Over time, the pancreas is completely harmed. In the subjects
where BSL-Fasting level was <100 mg/dl were considered in Group one. In the present study 5

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patients were found in Group 1 among them 4(15.4%) were in Grade one and 1(3.2%) patient in
grade two Upadrav score. Total 50 patients maximum were noted in Group two. In the subjects
where blood sugar level –fasting was between 101-150 mg/dl were considered as Group two.
The 18 patients were in Grade one, 13 patients in grade two and 19 patients in grade three of
Upadrav score.Total 45 patients were noted in Group three. In the subjects where blood sugar
level –fasting was >150mg/dl were considered as Group three. The 4 patients were in Grade
one, 17 patients in grade two and 24 patients in grade three of Upadrav score. The Chi-Square
test interpreted p-value less than that of 0.05 indicate significance of association between
BSL-fasting and upadrav score.
Conclusions
1. The prameha (type 2 DM) updravas and symptoms are more when biochemical
parameters are on higher side
2. When biochemical parameters are on higher side and uncontrolled state of type
2 DM, some upadravas as like hrudroga, daha , moorcha, shawas, putimamamsa
peedika are seen more significantly
3. It is necessary to see biochemical parameters of type 2 DM for diagnostic and
prognostic value of Prameha vyadhi.
4. The complications of Prameha vyadhi are directly proportional to chronicity of
uncontrolled state of type 2 DM.
5. If nidan sevan of Prameha is continued by the diabetic patient, the symptoms and
complications are developed with reference to treatment of type 2 DM.
6. These biochemical analyses are objective indicators related to Diabetes Mellitus and
timely assessment could help to prevent further development of type 2 diabetes.
7. Thus, the association between these biomarkers a n d c o m p l i c a t i o n s i n type 2 8.
DM could provide insight into the association of Prameha Upadrav’s.

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BIBLIOGRAPHY

1. Vaidya Jadavaji Trikamji Acharya, 1981, The Charakasamhita of Agnivesha, with

Ayurveda Dipika commentary, new Delhi, Munshiram Manoharlal Publishers Pvt. Ltd.
2. Agnivesha: Charakasamhita, Text with English translation by R.k. Sharma and
Bhagavandas volume II, Published by Chowkhamba Sanskrit series, Varanasi. Nidana
sthana chap 4
3. Agnivesha: Charakasamhita, Text with English translation by R. k. Sharma and
Bhagavandas volume II, Published by Chowkhamba Sanskrit series, Varanasi. Cikitsa
Sthana Chapter 6.
4. Vagbhata: Ashtanga Hridayam with commentaries of Arunadatta and Hemadri by PV
Sharma, Chowkhamba Orientalia, 9th Edition, Nidana sthana Chapter 11.
5. Vagbhata: Ashtangasamgraha, Text with English translation by Srikantamurthy KR, Vol.
II, 4th ed. Varanasi: Chaukhambha Orientalia; Nidana sthana Chapter 10.
6. Susruta: Susruta Samhita, with English Translation of text and Dalhana's commentary
along with critical notes, Voll.II, Edited & translatedby Pria Vrat Sharma, Chowkhamba
Visvabharati Oriental Publishrt & Distributors. Chikitsa sthanam Chapter 11

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28.

EFFECT OF YOGA ON MENOPAUSE IN MENTAL HEALTH

1
Dr.Khirodkar Sushama R, Associate Professor, Dept of Swasthvritta,
1
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra, India.

Abstract:
Permanent cessation of menstruation at the end of reproductive life due to loss of ovarian
follicular activity. Complete stoppage of menstruation for twelve consecutive months without
any other pathology. Around 45 to 55 yrs averages. But now a days the age of menarche and
menopause is changing to 12 yr to around 40 to 45 yrs due to changing life style of females.
Pranayama serves as the link between the consciousness and the mind .it is breating technique
which help in stress and relaxation. This helps the women to focus on the simplicity of
movement and get about work responsibility and demands thus reduce anxiety as well as
depression.
Key words: Rajonivruti, Pranayam, Dhyana, Asan, Mental health

Introduction:
Rajonivruti” means permanent cessation of Rajakal at the end of reproductive life due to loss of
ovarian follicular activity i.e Artavnash, “Rajonivruti” duration female is suffering from mental
health problems like Insomnia, Depression and mood swings,lack of
concentration.„Pranayam‟ means extension of the prana (breath of life force) or breath
control.Prana –meaning life force Ayam- to restrain or control the prana, implying a set of
breathing techniques where the breath is internationally altered in order to produce Specific
result. Management of Rajonivruti lakshan, yogic lifestyle is away of living which aims to
improve the body ,mind and day to day life of individuals .The most commonly performed
yoga practice are posture (Asan) controlling. Breathing (Pranayam) and mediation (Dhyana)
.Pranayam has been utilized tool. To achieve position health and control and cure disease.

AIM: to study the effect of yoga on menopause in mental health

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OBJECTIVE:

1. To study the mental health issue in women during menopause.

2. To study Ayurvedic rajonivrutti.
3. To study Pranayama
METHOD: Conceptual study
MATERIAL:
1. Literature regarding the Rajonivruti, Pranayama will be reviewed from
Ayurvedic classics.
2. Modern review of Menapause will be taken for study from modern text books.
3. Internet data and various research papers will be reviewed.

OBSERVATION:
1.RAJONIVRUTI:
Permanent cessation of menstruation at the end of reproductive life due to loss of ovarian
follicular activity. Complete stoppage of menstruation for twelve consecutive months without
any other pathology. Around 45 to 55 yrs averages. But now a days the age of menarche and
menopause is changing to 12 yr to around 40 to 45 yrs due to changing life style of females.

2.SYMPTOMS IN RAJONIVRUTI:
1. Depletion of ovarian follicle
2. Fall in level of serum estradiol 50 -300 pg /ml to 10-20 pg/ml
3. Distrubed follicogenesis
4. Sustained level of oestrogen ,Decrease in level Oestrogen :Androgen ratio
5. Trace amount of progesterone.
6. Enhance responsiveness of pituitary to GNRH
7. Changes in organ
8. Risk in cardiovascular system after menopause
9. Physiological and mental and mental health changes:
10. Insomnia :Problem in sleeping
11. Depression and mood swings : Feeling of irritability, mood swings i.e extreme high to
sever low in a short period of time.

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PRANAYAM:
Pranayam is an ancient Indian practice concened with controlling your breath. Pranayam is a
word alternatively transalated as extension of the prana or breath control.The word composed
from two Sanskrit word ,Prana meaning life force and eighter Ayam ,The prana implying set of
breathing techniques where the breath is internationally altered in order to produce specific
result or the negative form may meaning to extend or draw out.Anulom vilom pranayam and
benifits,excellent breathing exercise for improving Blood circulation. Remove heart blockages
,releases stress anxiety and depression .importance and benefits of practicing Pranayam in
Yoga .The word„Prana‟ stands for life force and this is believed to be the vital energy or life
force that encompasses the body .This also serves as the link between the consciousness and the
mind .it is breating technique which help in stress and relaxation

RESULT:
 Practice of Pranayam develops a steady mind, strong willpower and sound judgment.
Pranayam strengthens the lungs, improve their function and enhances the lung power.
 It improve the defence mechanism of the body slow down mental chatter and infuse
positive thinking
 Meditation is a process where by consciousness looks in and acts upon itself The aim of
meditation is a process whereby consciousness looks in and acts upon itself .The aim of
meditation is to help still the mind and to practice some form of contemplation or
introspection. which is helpful in preventing impaired memory and concentration, mood
swings also.
 Meditation is simply and eassy meditation techniques can be source of relief When their is
overload during stressful time Meditation still the mind of excessive through and can give
the clearly and focus needed to cope with mood swings and mental imbalance, It restores a
sense of inner peace and balance and renews focus and control Irritability, depression and
mood swings .can be greatly eased by regular meditation which will help to stabilize the
emotion.
 Meditation has been found to be associated with increased plasma melatonin level and
improved sleep quality particularly if done in the evening before rest.
 The exact mechanism as to how yoga helps in various disease status is not Known. It has
been suggested that there could been neuroharmonal pathway With a selective effect in
each pathological situation.

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DISCUSSION:
 It is possible that Yogic exercises about normalization of the pathological state by
control of counter regulatory hormone or by increased receptor sites .it has been also
been suggested that yogic practices creates a hypothermic state and an alternation in
the symptho- parasympathetic axis.
 Yoga practices may provide a source of distraction from daily life and enhancement of
self easteem. Helping woman to focus on the simplicity of movement and get about
work responsibility and demands thus reduce anxiety as well as depression.
CONCLUSION:
Thus from all qualities of Pranayam a free of cost, non invasive method is fairly effective and is
strongly recommended to all women of menopausal age. Pranayam dose have the potential to
provide physical, mental, emotional health benefits to those who practice it with proper
guidelines.

REFERENCES:
1. Ch.Chi Prof.Vd Ya ,Go Joshi,AyurveddipikaShri Chakrapanidatta Commentry on
Charaksamhita,701, Sadashiv Peth , Pune-411030, Reprint 2011.
2. Cha.Su. , Dr. Kashinathshastri, Dr.Gorukhanath Chaturvedi, Vidyotini commentary on
Charak Samhita,Chaukhamba publications, Varanasi, Reprint.
3. Ma.Ni. Acharya Narendranath Shastri,commentary on Madhavnidana,
MotilalBanarsidas, 1979, Reprint 1994.
4. Sarth.Yo.43/12,Vaidyaraj Datta Ballad Borakar,Commentary on Sarth Yogratnakar,
Part 2,Shri Gajanan Book Depo Prakashan Pune-3o,Reprint-1984.
5. Sarth .Yo.43/11 Vaidya-raj Datta Ballad Borakar ,commentary on sarth
6. Yogratanakar, part 2, Shri Gajanan Book Depo Prakashan Pune 30, Reprint 1984.
7. Sha.Sh.Ma.Kha.1/6, Acharya Shri. Radha krishna Parashar, commentary on
Sharangdhar Samhita, Reprint 1994.

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29.
MEDOVAH SROTASJANYA VIKAR-STHOULYA:
CLINICAL REVIEW
1
Dr Wankhede Arun U, Professor & HOD,Dept of Rognidan & VV,
2
Dr.Khirodkar Sushama R, Associate Professor,Dept of Swasthvritta,
1,2
Mahatma Gandhi Ayurved College Hospital and Research Centre, Salod, Wardha, Datta
Meghe Institute of Higher Education and Research Centre, (D.M.I.H.E.R.), Maharashtra,
India.

Abstract:
Ayurveda, the Indian system of medicine can be aptly defined as the “Science of life”. Today,
in spite of development of various techniques in the field of diagnosis and medicine, Due to the
artificial living life-style, Persons have got so many disorders for themselves. Sthaulya
(obesity) is one of them.Obesity is due to the modern age of using more machines and more
materialism. It is mostly physiological, psychological and also social disorder. Obesity is such
a disorder which provokes other diseases like hypertension, Ischemic heart disease, diabetes
osteoarthritis and also psychological disorders like stress, anxiety, depression etc. Obesity
with hyperlipidemia also being the most common problems in all age group. Acharya Charaka
quoted that Sthaulya under the eight varieties of impediments which designated as
“Astha-Nindita Purusha “(Cha.su.21). It represents the inceptive stage of disease when the
Doshas are stagnated in their own natural abodes. According to Sushruta Sthaulya is „Rasa
Nimittaja Vyadhi‟. The Samprapti of Sthaulya begins with the Sanchay of Kapha Dosha .The
causes by which Medovaha srotas gets vitiated are excessive intake of fatty food,day sleep,lack
of exercise etc. these are similar to that of Kapha Vriddhikar Bhav. Sanchay of Kledak Kapha
in Amashaya because of excessive consumption of Guru, sheet, snigdha, Madhur Ahar and
Kaphakar Vihar leads to formation of Ama- annarasa.Charak has stated that Meda Dhatu,
Kapha dosha sitted in Medo Dhatu and hence,a Vriddhi of Kapha dosha occurs in the site of
Meda Dhatu.Therefore Kapha sanchaya and Meda Dhatu vriddhi are the footsteps of
Sthaulya.Due to Kapha Sanchaya the person feels Alasya and Gaurav. In Sanchaya avastha,
there is formation of Ama-Annarasa because Pittadhara Kala is unable to secrete Pachaka
Rasa which results in Jatharagnimandya leading to Strotovaigunya. In this stage the
Dravyatah Vriddhi or quantitative increase is seen.
Key Words: Sthaulya, Obesity, Medovaha srotas, Kapha Sanchaya, Ama

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Introduction:
Ayurveda, the Indian system of medicine can be aptly defined as the “Science of life”. Today,
in spite of development of various techniques in the field of diagnosis and medicine, Ayurveda
is in high profile in saving mankind. Now a day, No one have time to think and act for the
healthy life and not able to follow the proper Dinacharya, Ritucharya, Dietic Rules and
Regulations. Due to the artificial living life-style, Persons have got so many disorders for
themselves. Sthaulya (obesity) is one of them Sthaulya (obesity) is one of them.Obesity is due
to the modern age of using more machines and more materialism. It is mostly physiological,
psychological and also social disorder. Obesity is such a disorder which provokes other
diseases like hypertension, Ischemic heart disease, diabetes , osteoarthritis and also
psychological disorders like stress, anxiety, depression etc. Obesity with hyperlipidemia also
being the most common problems in all age group. Acharya Charaka quoted that Sthaulya
under the eight varieties of impediments which designated as “Astha-Nindita Purusha
“(Cha.su.21).. The present day society expects peak physical and mental performance from
each of its member and obese person is unable to find out him physical and mental fit for it. It
occurs as a result of lack of physical activities with increased intake of daily diet results into the
clinical entity, which can be called as obesity. Obesity is such a disorder which provokes other
diseases like hypertension, Ischemic heart disease, diabetes , osteoarthritis and also
psychological disorders like stress, anxiety, depression etc Obesity and Hyperlipidemia being
the most common problems in all age group. Acharya Charaka has quoted Sthaulya under the
eight varieties of impediments which designated as “Astha-Nindita Purusha “(Cha.su.21).
Ati-sthaulya comprises one of them. Acharya Charaka also lists this problem under
Samtarpanajanita vyadhi (Ch. Su. 23). According to Ashtanga Hridya (A. HNi.12/1),
derangement of Agni or digestive power leads to production of Ama, which disturbs tissue fire
of meda dhatu and blocks the proper formation of further dhatus.Hetu/Nidana is one of the most
important factor for every disease. In nidansthana 8/24-25, Acharya Charka has mentioned
that a single Hetu (etiological factor) may produce single disease or group of diseases or many
factors together produces single disease or group of diseases. Many etiological factors
mentioned in the Ayurvedic texts but Diwaswapna is observed commonly in all housewives
which cause obesity.
According to various Acharyas; Diwaswapna (Day time sleeping) is one of the cause of
Sthaulya. It Aggrevates the Kaphadosha. Kapha and Meda have similar properties. Sthaulya is
counted as a disorder of Sleshma Dosha seated in Medodhatu (A.S.Su.19/26). On the basis of
“Ashrayashrayeebhava”, vitiation of Kapha leads to vitiation of Medodhatu.
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Ethymology (Vyutpatti) of word “STHAULYA” :-

The word “Sthaulya” is derived from Mula Dathu “Sthu” with suffix “ach”respectively which
means “Sthaulya”.
According to Amarkosha, it means excessive growth of the body.
Accrding to Hemachadra stated that it is of over nutrition of the body or dullness of intellect.
Meda Nirukti -
According to Amarkosha :
Meda: Medastu Vapa Vasa (2/6/64 Manushya Varga)
Medaha: Na, Vapa, Vasa (2- Stri), Charvi
|| Trini Sudha Mamsa Snehasya ||
Vapa Vivira Medosoha iti Hemaha 2/303.

HISTORICAL REVIEW
SAMHITA KALA (200B.C. - 800A.D.) :
Charak Samhita (200 B.C.): In Samhita kala, Charak Samhita has described Sthaulya in
broad aspect. Charak described 20 type of Kapha Nanatmaja Vikara. He counted„
Atisthaulya„or (Medoroga) is one of them. Again Charak explained Atisthaulya in Sutrasthana,
21st chapter. Amongst these, the too obese and too lean physical appearances are considered the
most undesirable ones. The excessively obese have eight inherent defects in them: reduced
lifespan, constricted or limited movement (hampered due to loose, tender and heavy fats),
reduced sexual activities or impotence (due to small quantity of semen produced and
obstruction of the channel of semen by meda dhatu, debility , emit bad smell, profuse sweating,
and excessive hunger and thirst . Excessive obesity is caused due to over-nourishment as a
consequence of the intake of a heavy, sweet, cold and fatty diet, lack of physical exercise,
abstinence from sexual intercourse, sleeping during the day, uninterrupted cheerfulness, lack of
mental activities, and hereditary/genetic defects. These consequences may lead to an excess of
fat (with further accumulation of only fat) and consequent depletion of dhatu. Due to the
obstruction of body channels by meda dhatu, the movement of vata is specially confined
to koshtha (abdominal viscera) resulting in the stimulation of digestive power and absorption
of food. Hence,the person digests food quickly and becomes a voracious eater. By not
following rules of taking meals at specific times during the day, he is afflicted by dreadful
diseases. Agni (pitta component responsible for digestion) and vata are the two most
troublesome factors from the standpoint of obesity. These factors blight an obese person as
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wildfire destroys a forest. As the body gains excessive fat, vitiated dosha suddenly cause severe
diseases resulting in rapid deterioration of life. The person is considered too obese when there
is an excessive increase in fat and muscle tissue in the regions of buttocks, abdomen, and
breasts, which become pendulous and suffer from deficient metabolism and energy. These are
the causes, signs, and symptoms of an obese person.

Sushruta Samhita (2 A.D.):

In Sushruta Samhita (Su.Su.15), Sushruta narrated the etiopathogenesis of Sthaulya Roga
on the basis of an endogenous entity being caused due to "Dhatvagni Mandya". Further, the
course and complication of the disease with some different line of treatment are discussed at
various places in Sushruta Samhita. Sthaulya is considered as the physical condition of the
body (Su.35/40), result of vitiated Meda Dosa (Su. 24/13), as symptom of disrupt Medo
Vaha Srotas (Sa. 9/12), Rasa Nimitaja disorders (Su. 15/37). A new synonym Jatharya has
been used in Chi 12/11 for Sthaulya.

Ashtanga Sangraha (600A.D.):

In 24th chapter of Sutrasthana, Vriddha Vagbhatt described the different aspects of
Sthaulya. He explained that Sthaulya is because of excessive Brihan in 19th chapter of
Sutrasthana, which results in Atisthulata.
Ashtang Hridaya (700 A.D.):
In 14th chapter of Sutrasthan Vaghbatt has explained the Atisthaulya and the treatment
of Atibrihana etc. Kashyapa Samhita (600 – 700 A.D.) :
Kashyapa Samhita is more related with “Kaumarbhritya” and “Prasuti Tantra”. Kashyapa
has given some new aspect of “Medasvi Dhatri Chikitsa”. In Dhatri Chikitsa Adhyaya of
Chikitsasthana he described Sira Karma (Raktamokshana) as one of the best treatment for
Medasvi Dhatri i.e. obese frostier mother.
Bhel Samhita:
Bhel is one of the six brilliant disciples of Atreya. In 12th chapter of Sutrasthana he described
Sthaulya as a disorder of vitiated meda.

Madhava Nidana (700 A.D.):

He is the first author who elaborates this disease under the separate chapter called
“MEDOROGA NIDANAM” in 34th chapter of Uttartantra. Madhava Nidana has described
the pathophysiology of this disease on the basis of fat tissue and fat depot site. He has
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mentioned Hetus, Symptomatology, Causes of Bubhuksha Vriddhi, Asadhya condition in

respect of Medovriddhi (Ma.Ni. 34/1-4).
Sharangadhara Samhita (13th Century):
In 7th chapter of Madhyama Khanda Sharangadhara described the treatment of Medoroga.
Jatharastha meda(Fat in abdomen and omentum) is nourished by Vrikka was first time
observed by him. According to him Sthaulya is narrated as a characteristic of Shleshma
prakriti.

Vangasena Samhita:
In 16th chapter of “Medovikar”, Vangasena has explained the treatment of Medoroga. In this
chapter he described the Nidana, Lakshana, Samprapti and Chikitsa. Samprapti and Chikitsa
are almost same as mentioned in Charak Samhita.

Chakrapani (11th century) :

Chakrapani is commentator of Charak Samhita.In 36th chapter,”Sthaulyadhikarah” he
described the treatment of Sthaulya. In this chapter he has commented that Apatarpana
property helps to reduce Meda and Guru property helps to alleviate Kshudha.

Dalhana (12.th Century) :

Dalhana is commentator of Sushrut Samhita, he explained the phenomenon of Ama
formation in Tikshna- Agni condition. He also gives line of treatment by Chhedaniya as
Strotovishodhana and interpreting Virukshana as Medoghna.
Indu (13th Century) :
He has given explanation of Saktu, Lohodaka Pulaka etc. words used in the line of treatment
of Sthaulya, in his Shashilekha commentary on (AS. Su. 24/20).
Arundatta (13th Century) :
Arundatta is commentator of Ashtang Hridaya and Sangraha.In his Sarvang Sunadari
Commentry he has used the word “Sthvima” for Sthaulya and explained it on the basis of
etymology. Hemadri (13th Century): Hemadri is commentator of Ashtanga Hridaya Samhita.
In his Ayurveda Rasayana Commentry he has advised to take Agnimantha as Tarkari,
Dantahata as Takra, Madhukajalam as Madhumishritaudaka, and Kshara as Yavakshara while
describing management of Sthaulya.

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Shrikanthadatta and Vijay Rakshita (12th Century) :

According to them in broad aspect, Medodusti word is indicated for Sthaulya and Madhura
Annarsa is explained as Madhura Praya Ama Iva Annarasa i.e. Madhura rasa dominant
vitiated Annarasa, Shrikanthadatta has indicated Vishamagni in place of Tikshnagni as main
pathology in genesis of Sthaulya (Ma.Ni.34/1-9).
Bangasena (12th century), In Medorogadhikara Sodhala (11thcentury), in 36th Chapter of
Gadanigraha and Vrunda (7th century), in 34th Chapter of Siddhyog. They have elaborated
the management side of the disease and narrated various remedies for it.
Bhava Prakash (16th Century):
In 36th Chapter of Madhya Khanda, Bhavamishra has given more emphasis on morbidity,
risk factor and behavioral therapy. Furthermore he has explained distressing symptoms like
Abdominal Adiposity, Svedabadha and Gatra-Daurgandhya.

Yoga Ratnakara (17th Century):

In Uttarardha of Yogaratnakar; Medoroga is explained under separate chapter. He has
mentioned Medoroga Nidanam, Chikitsa and Pathyapathya separately
(Yo.Ra.Ut/Me/p.N.1-3). He has mentioned Tikta Rasa as Meda Pravardhaka, drink water
after meal is also a cause of increasing Sthaulya and so seat after meal is mentioned as
predisposing factor for development of Tunda (Abdominal Adiposity).

Bhaishajya Ratnavali:
Bhaishajya Ratnavali is written by Govind Das Sen. In 55th chapter “Sthaulyadhikarah” he
has described; Sthaulya Chikitsa, Arishta, Pathyapathya etc. (Bh.Ra.55|5/1).

Adhmalla (14th century) and Kashiram (17th Century):

In Dipika commentary of Sharangdhara Samhita, Adhamalla has thrown light on
consideration of Meda as Dosha, due to” Karya Karan Bhava “concept and the efficacy of
Meda to obstruct the channel and to produce the disease independently (Sha. Pu. 7/65). In
Gudhartha Dipika commentary, Kashiram Vaidya has tried to explain about controversy and
given solution that Medodosha is enumerated of one type due to aggravation and dominancy
of Vata Dosha hence, Meda is not considered as Dosha.
SAMPRAPTI -
The physiological consequences from commencement fill manifestation of any disease are
known as „Samprapti‟. Though Sthaulya is mostly dushya dominant disorder, in which
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pathogenesis of Sthaulya, all the three doshas are vitiated especially Kledaka Kapha, Saman
and Vyana Vayu, Pachak pitta which are responsible factor for proper metabolism and
digestion of food at the level of alimentary tract. Sushruta has explained a general
pathogenesis of all diseases in six stages. In healthy individual, the Tridoshas are in
equilibrium in respect to their Guna, Karma, Pramana. When the equilibrium is disturbed
due to this Doshas decreses or increases quantitatively, qualitatively or functionally, the
disease is formed. Sushruta has explained this process in six stages known as
„Shatakriyakala‟. They are –Chaya, Prakopa, Prasara, Sthanasanshraya, Vyakti and Bheda.
Sanchayavastha :
It represents the inceptive stage of disease when the Doshas are stagnated in their own
natural abodes. According to Sushruta Sthaulya is „Rasa Nimittaja Vyadhi‟. The Samprapti
of Sthaulya begins with the Sanchay of Kapha Dosha .The causes by which Medovaha srotas
gets vitiated are excessive intake of fatty food,day sleep,lack of exercise etc. these are similar
to that of Kapha Vriddhikar Bhav. Sanchay of Kledak Kapha in Amashaya because of
excessive consumption of Guru, sheet, snigdha, Madhur Ahar and Kaphakar Vihar leads to
formation of Ama- annarasa.Charak has stated that Meda Dhatu, Kapha dosha sitted in Medo
Dhatu and hence,a Vriddhi of Kapha dosha occurs in the site of Meda Dhatu.Therefore
Kapha sanchaya and Meda Dhatu vriddhi are the footsteps of Sthaulya.Due to Kapha
Sanchaya the person feels Alasya and Gaurav. In Sanchaya avastha, there is formation of
Ama-Annarasa because Pittadhara Kala is unable to secrete Pachaka Rasa which results
in Jatharagnimandya leading to Strotovaigunya. In this stage the Dravyatah Vriddhi or
quantitative increase is seen. Prakopavastha :
Dalhana has said that an increase in Dosha due to liquefaction is known as Prakopa. While
undergoing through these Kriyakala Kapha Dosha in Sanchaya stage is accumulated in its
chief site i.e.‟Urapradesh‟. In Prakopavastha it spreads to its other site i.e. Rasa, Meda,
Amashaya, Sheera, kloma,Kantha etc. In this stage there is increased vitiation of Kapha
Dosha leading to its morbidity in the site of Medo Dhatu. This Prakopa is of two types,
Achaya and Chaya. Achaya Purvak Prakopa is due to Viharatmaka causes i.e. sleeping at day
time and lack of physical exercise. Chaya Purvak Prakopa it‟s due to frequently eating habits
and excessive consumption of Sleshmahar.
Prasaravastha:
According to Sushruta in this Aavstha, the vitiated Doshas expand and overflow the limits of
their respective location. In the next „Prasar‟ stage Kapha is so increased that it occupies the
site of other Doshas. Here the Kapha Dosha increases qualitatively as well as quantitatively.
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During these first three Shatkriyakala, two major incidences occur.Medadhatu is

continuously being produced in more amounts and gets deposited mainly at its original sites
Vapavahana and Kati, Kapha from normal stage, reaches upto Prasar stage. At the same
time, excessive production and deposition of Medadhatu leads to sthanavaigunya in
Medovaha strotas.Charak has explained 4 types of vitiation of strotas. They are Atipravrutti,
sanga, siragranthi and vimarga Gamana. In Sthaulya, the Khavaigunya is produced by
Atipravrutti‟ (excessive production) and Sanga (deposition).

Sthanasanshrayavastha :
In this stage of Kriyakala, the pathogenesis becomes more morbid and Medovaha strotas
gets vitiated functionally. The Kha- vaigunya exists at Medovaha strotas and Dosha-Dushya
sammurchhana occurs.Meda-Kapha sammurchhana resuts in Ama which is neither similar
to kapha nor Meda. It is sticky, raw like and possesses very bad odour. This Ama disturbs the
metabolism of Medo dhatu and Apakva, Apachit Meda is formed, which only gets deposited
and has no fate in the body. This excessive deposition leads to strotasavarodha. Due to
strotasavarodha, vimarga gamana of Vayu take place and it accumulates in Koshta resulting
in Jatharagni Pradeepana. The deposited undigested raw Meda dhatu is not in a position to
supply nutrition to Asthi Dhatu. So, the further Dhatus deprived of nutrition. The Medovaha
strotas which was vitiated functionally now also vitiated structurally. This takes place at the
Strotas level and represents the prodormal phase or the phase of Purvarupa (Su.Su.21/33).

Vyakti Avastha:
In this stage the manifestation of all the signs and symptoms of a disease occurred
(Su.Su.21/34). Hence , this stage is also called as “Rupa Avastha‟. All the symptoms (Rupa)
of Sthaulya are seen in this Avastha. Daurbalya, Daurgandhya, Kshudrashwas, Atisthaulya,
Atisweda, Kshudhadhikya, Pipasatiyog etc.

Bheda Avastha:
This stage marks the chronicity of the disease where it becomes incurable or sub-acute
(Su.Su.21/35). The pathology of disease becomes more and more morbid as chronicity
increases. At this stage the patient still follows the Nidanas. According to Khalekapot
nyaya only meda Dhatu gets inadequate nutrition. The excessive Meda Dhatu formation
goes on increasing and this vicious cycle continues. Over nutrition Meda dhatu and at the
same time poor nutrition of other Dhatus is a basic pathology of Sthaulya.
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Samprapti Ghataka:
Samprapti of Sthaulya.
Dosha:
- Vata : Samana, Vyana
- Kapha : Kledaka
- Pitta : Pachaka

o Dushya : Meda, Rasa Dhatu

o Strotas :-
- Medovaha Strotas
- Rasavaha Strotas
o Strotodushti :-
- Margavarodha (Ch.Su.21/5-9)
- Sanga
- Amatah (A.H.13/25)
o Agni :
- Jatharagni
- Rasa and Meda Dhatvagni
- Parthiva, Apya Bhutagni
o Udbhavasthana : Amashaya
o Roga Marga : Bahya
o Prasara : Rasayani
o Ama
- Dhatvagni Mandyajanita Ama

- Jatharagni Mandyajanita Ama

o Adhisthsana:
- Udara, sphika and stana.
- Particular Vapavahana and Medodhara Kala
o Vyaktisthana : Sarvanga
DISCUSSION
In the present era, today‟s lifestyle includes less exercise, use of machineries‟ for each and
every small work , changed regular diet which contains junk food, high calorie food and non-
vegetarian food and sedentary habits. In concern with H.W. lot of time for relaxing at home, no
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outdoor workloads, less time and energy consuming machineries for household work, these
groups of ladies are more prone to Sthaulya. The disease Sthaulya is a well recognized disease
from the Samhita period. It has been mentioned by Acharya Charaka in
Ashtauninditapurushadhyaya (Cha.Su. 21). In today‟s era we observe growing popularity to
Ayurveda globally. The need is to provide modern parameters for everything which we study.
Dosha, Dhatu, Mala, Agni are no exception to this. The first line treatment advised by
Ayurveda is the “Nidana Parivarjana‟ which is one of the best methods to stop further
progress of the disease (Su.U.1/25).

CONCLUSION
Kaphavataj Prakriti H.W. were found more prone to Sthaulya so they should be advised proper
diet regimens with exercise and made awareness about proper sleeping habits. Excessive
indulgence of non-veg diet, nuclear family type, sedentary type of work, decreased awareness
regarding exercise and food, faulty sleeping habits, Harshyanitya plays a major role in
etiopathogenesis of Sthaulya. With continuing the habit of Diwaswapna, there is no reduction
on sthaulya parameters. This shows that Diwaswapna is an aggrevating factor for Sthaulya and
dislipidemia.

References:
1) Pt. Ram Swaroop Sharma Gaud: Atharva Veda Samhita, Chaukhamba Vidyabhavan
Varanasi: Vol – 5: edited with Hindi Trans. Revi.edi.2003.
2) Joshi V.M., Joshi H.N: Ayurveda Shabdakosha, Maharashtra Rajya
Sahitya and Sanskrit Mandal Mumbai : 1968.
3) Radhakant Dev: Shabdakalpadruma, Jain S. Jawahar Nagar Delhi: 1961.
4) Ramgopal Shastri: Vedon me Ayurveda, Madanmohanlala Ayu Trust Delhi 19563.
5) Dr. Bramhanand Tripathi: Charak Samhita, Ashtauninditiyadhyay. Chaukhamba
Surbharati Prakashan, Varanasi: Vol.-I: Reprint 2004 : Page No- 397-411.
6) Kaviraj Dr. Ambikadatta Shashtri : Sushruta Samhita, Doshdhatumala Vidhnyan,
Garbhavyakaran Shariram Chaukhamba Prakashan, Varanasi: Vol.-I : Reprint 2011:
Page 81 - 83, 44-45.
7) Dr. Ananatram Sharma: Madhav Nidanam, Medorog Nidanam. Chaukhamba
Sanskrit Pratishthan Delhi: Vol-II: 1st Edition 2007 : Page No - 26-30.
8) Dr. Ravidatta Tripathi: Ashtanga Sangraha, Chaukhamba Sanskrit Pratishtan Delhi:
199.
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30.
MANAGEMENT OF PREDIABETES WITH AHAR AND VIHAR
(LIFESTYLE MANAGEMENT) WITH SPECIAL REFERENCE TO
PRAMEHA PURVARUPAVASHTHA- A REVIEW ARTICLE
*1
Dr.Gharge Archana Rajaram, *2. Dr. Mundane Rajiv.
1.
M.D.,Ph.D.(Sch.),Professor & HOD (Rognidan & Vikruti Vigyan department), Y.M.T.
Ayurvedic Medical College & Hospital, Kharghar, Navi Mumbai.
2.
M.D., Professor, HOD (Rognidan and Vikriti Vigyan Dept.) & Dean, D.M.M.Ayurvedic
Mahavidyalaya,Yavatmal.

ABSTRACT
Pre-diabetes is an early stage of diabetes.Diabetes Mellitus type 2 is a metabolic
disorder caused due to insulin resistance.It is basically a lifestyle disorder caused due to habits
of eating unhealthy food and sedentary lifestyle. Due to modernization in society, the
prevalence of consumption of junk food has been increased and people are lacking of exercise
due to busy schedule. Pre-diabetes is a condition in which patients blood glucose level is higher
than normal but not high to be labelled as Diabetes. Overweight and physical inactivity are the
lifestyle risk factors for pre-diabetes. Now it is recognized as a reversible condition. In
samhitas,the purvarupas of prameha are also mentioned which can be considered as an early
stage of prameha. Prameha and diabetes simulate with each other upto some extent. Some of
Prameha purvarupa are also similar to pre-diabetes symptoms. So an attempt of understanding
the importance of ahar-vihar changes in reverting pre-diabetes through literature is made.
Aims: To discuss about the management of pre-diabetes with ahar and vihar (lifestyle
management) with special reference to Prameha purvarupavastha. Objectives: To study the
aharjanit and viharjanit changes in pre-diabetic patients as lifestyle management.
Observations and discussion: The dietary changes and physical activities are recommended
in various literatures. Conclusion: Risk of conversion of Pre-diabetes to diabetes can be
reduced by 58% by physical activity, healthy diet and weight loss in people with IGT.Final
conclusion: The changes in the diet and lifestyle can be helpful to revert pre-diabetes.
Keywords: Pre-Diabetes, Prameha purvarupavastha, ahar, vihar, lifestyle management.
INTRODUCTION
Diabetes is characterized by polyuria and glycosuria with high blood sugar levels. Diabetes is
now a days becoming a severe silent threat to human mankind.Pre-diabetes is an early stage of
diabetes and is also considered a major risk factor for heart diseases mainly coronary artery
disease (CAD) due to atherosclerosis. India today is the second highest country to have diabetic
patients. Sedentary life style, lack of exercise and unhealthy food eating habits are playing an
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important role in the metabolism changes. Prediabetes is a condition in which people have
blood glucose levels higher than normal but not as high as required for the diagnosis of
diabetes. American Diabetes Association has given the diagnostic criteria for pre-diabetes as
fasting plasma glucose level (100 mg/dl to 125 mg/dl), plasma glucose level after an oral
glucose tolerance test (140–199 mg/dl) and the glycated haemoglobin (HbA1C) value of 5.7%
to 6.4%.
Diagnostic criteria for normal glucose, prediabetes, and diabetes according to the
American diabetic association:
Diagnostic test Normal Pre-diabetes Diabetes

HbA1C % < 5.7 5.7–6.4 ≥ 6.5

Fasting blood glucose, mg/dl < 100 100–125 > 125

Oral glucose tolerance, mg/dl < 140 140–199 > 199

As per American Diabetes Association, diabetes testing should be started from age 45 years for
all overweight adults having body mass index [BMI] ≥ 25 kg/m2 and having any of the
following additional risk factors.The risk factors are as follows: People having physical
inactivity, low levels of high-density lipoprotein cholesterol, high triglycerides, hypertension
or history of cardiovascular disease, history of previous elevated blood glucose level or
HbA1C, first-degree relative with diabetes, women with polycystic ovarian disease, history of
gestational diabetes or giving birth to a baby having weight more than 4.082 kg,an ethnic or
minority racial group member.
Prameha in Ayurveda has been described as Santarpanajanaya vyadhi which is mostly caused
due to excessive, unhealthy nourishment. Prabhutmutrata (Excessive urination) and
avilmutrata (turbid urination ) are its chief symptoms.Santarpan which vitiates kaphadosha is
a major cause of Obesity which in turn leads to many metabolic disorders. Obesity also known
as Sthaulya which is Asthaunindit vyadhi as mentioned by Acharya Charaka. Acharya
Charaka clearly indicates that jatharagnimandya and dhatwagnimandya caused in sthaulya
vyadhi leads to many diseases. Viruddha aharasevan is also one of the common factors
resulting in jataharagni vikruti, causing Dhatu agnimandhya.Now a day’s mental stress has
been also increased due to fast growing instability in socio economic area,causing anxiety
which in turn causes many disturbed sleep patterns and digestion related problems.
Prameha Purvarupas are Dantadi maladhyata,kara-pada-tal-daha,alasya,tandra,sweda,deha
chikkanata, Trushna, Sharir-mutra visragandhata, Kantha-talu-mukha shosha. So according
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to Ayurveda theearly stage of prameha can be identified by examining the purvarupas in

patients. Prediabetes is an intermediate state of hyperglycaemia with blood sugar levels above
normal but low to be labelled as diabetic.Prediabetes can be diagnosed with blood tests. Fasting
Blood Sugar of 110 to 125 mg/dl (6.1mmol/L to 6.9 mmol/L) WHO criteria. Fasting Blood
Sugar of 100 to 125 mg/dl (5.6 mmol/L to 6.9 mmol/L) ADA criteria and Glucose tolerance
test: Blood sugar level of 140 to 199 mg/dl (7.8 t0 11.0 mmol/L) 2 hours after ingesting a
standardized 75 gram glucose.

AIMS: To discuss about the management of pre-diabetes with ahar and vihar (lifestyle
management)with special reference to prameha purvarupavastha.

OBJECTIVES:
1.To study the aharjanit(dietary) and viharjanit (physical activity related)changes in the
lifestyle of pre-diabetic patients for management fromliterature.
2. The primary aim of lifestyle interventions is to prevent diabetes and its complications by
targeting obesity and physical inactivity.The goal for prediabetes treatment should be to
normalize blood glucose levels.

MATERIAL AND METHODS: To study the review of literature from ayurvedic and modern
text and internet literature.

OBSERVATION AND DISCUSSION

The best way to prevent diabetes is by eating a balanced diet that includes plenty of dark green
leafy vegetables, tomatoes, beans, berries, whole grains, nuts and seeds, garlic.
Energy balance equation is linked with energy intake and energy expenditure, the former
linked to diet and the latter to physical activity. Excess energy intake levels has shown the
evidence of increasing risk of diabetes by 11% to 26%, and adequate levels of physical activity
reduces risk of diabetes by 8% to 30%.A positive energy balance, in which energy intake is
more than energy expenditure, results in overweight or obesity, ultimately increasing diabetes
risk.
Obesity and physical inactivity results in insulin resistance by increasing the pathological
deposition of fat in visceral, hepatic, and muscle tissues. Insulin resistance is also caused by
intracellular sequestration of glucose transporter-4 (GLUT-4) in unexercised
muscle. Visceral, particularly intrahepatic fat, is responsible for insulin resistance and lipid
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accumulation in muscle cells. Glucose transport signalling is affected by the excess adipose
tissue, mainly by sending toxic messages in the form of free fatty acids, cytokines, and
oxidative stress. It impairs the ability of insulin to regulate glucose production by the liver and
glucose uptake by the muscle.

Lifestyle changes are often advised for people at higher risk of diabetes and those who are
newly diagnosed with prediabetes. The lifestyle interventions recommended by NICE are as
follows:
1.Patients are asked to take moderate intensity physical activity for 2 ½ hours each week or
high intensity exercise for 1 ¼ hours.
2.They are advised to achieve a healthy body mass index by losing weight gradually.
3.They are advised to replace refined carbohydrates with whole grain foods and increase intake
of vegetables and other foods high in dietary fibre.
4.They are also asked to reduce the amount of saturated fat in the diet.

Physical activity
The physical activities of moderate intensity included are cycling, brisk walking, hiking, water
aerobics, roller blading, using a manual lawnmower.The vigorous physical activities included
are skipping, football, swimming, jogging, gymnastics and cycling either rapidly or over steep
terrain.

Weight loss

NICE has recommended that the overweight person should aim to lose weight gradually with a
target to reduce weight by 5 to 10% over a period of a year to achieve a healthy BMI i.e. in 18.5
to 24.9 range. This reduces the risk of developing diabetes.It can also enable people with
existing pre-diabetes to better control blood glucose levels.

Dietary changes

According to NICE the risk of type 2diabetes is decreased by reducing intake of fats,
carbohydrates and increasing intake of dietary fibre. Overweight people are also advised to eat
smaller portions so as to consume fewer calories.

According to Ayurveda, laghu santarpan like Java, honey as well as cutting of madhur,
snigdhakaphaprakopak ahar is said to be avoided. Nidan parivarjan i.e. the hetus like
Asyasukham, Swapnasukham i.e. physical inactivity also should be avoided.

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We may be able to develop a strategy to prevent pre-diabetes from progressing to diabetes by

screening and risk-stratifying individuals as pre-diabetic.We should not accept a pre-diabetic
state but should actually try to convert prediabetes to a normal glucose state.By achieving a
normal glucose state of pre-diabetics can prevent its conversion to diabetes and its
complications.
The identification and treatment of pre-diabetics is very important to make health care
affordable, prevent preventable disease, and save lives. Present case report in this article
suggests that prevention of progression of pre-diabetes to diabetes and conversion of
pre-diabetes to a normal glucose state is possible. On the basis of a literature review, it can be
concluded that physicians should screen and risk-stratify individuals pre-diabetes with
FBS.PPBS, HbA1C and BMI. All prediabetics’ patients should be given: 1) lifestyle
modification guidance, 2) physical activity of 150 minutes per week, and 3) If BMI exceeds 25
kg/m2, then 7% weight loss.
Diabetes develops progressively as a result of the complex interaction between insulin
resistance and β-cell dysfunction. Insulin resistance triggers a compensatory response, where
the β-cells increase insulin secretion to maintain glucose homeostasis. The degree of insulin
resistance and the extent of β-cell dysfunction influence the development of glucose
intolerance and progression to diabetes. People with insulin resistance will not necessarily
develop glucose intolerance, nor will all people with prediabetes necessarily progress to
diabetes. However, it is important to note that physical inactivity increases diabetes risk by
20%, and each additional kilogram of weight gained translates into a 4.5% increase in diabetes
risk. Considering the high obesity and physical inactivity rates and poor diets among people,
promoting lifestyle changes among at-risk adults before they develop the disease is imperative.

CONCLUSION
Diabetes risk can be reduced by 58% by physical activity, healthy diets, and weight loss in
people with IGT. In populations with high BMI, weight loss is the main factor for diabetes risk
reduction. Risk of obesity and diabetes can be reduced with a diet rich in fibre, whole grains
and low saturated fat. Diet with low to moderate fat (10%-45%), high proteins, low
carbohydrate, and low glycemic index is helpful in weight reduction and improving diabetes
risk factors. Lifestyle interventions achieve reductions in IFG, post prandial glucose levels and
HbA1C, among individuals with IGT and promote regression of pre-diabetes to
normoglycemia. It also promotes clinically meaningful weight reductions. The effects of genes
on diabetes risk can be mitigated by lifestyle changes.
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Moderate to vigorous physical activity is associated with the enhanced β-cell function,
insulin sensitivity, and glucose regulation. Combined diet and physical activity programs
decreased diabetes incidence and improving cardio-metabolic risk factors among high risk
patients. The kaphaprakopak ahar (Santarpanjanya) and vihar (Physical inactivity) should be
avoided (Nidanparivarjan).
Recommendations:
Prediabetics should be given intensive diet and physical activity guidance for a weight loss of
7% and increasing moderate intensity physical activity for at least 150 min/week.They should
give follow-up for counselling regarding maintenance of lifestyle changes.They should engage
in 150 minutes of moderate intensity or 75 minutes of vigorous intensity physical activity (or a
combination of these) per week.

REFERENCES
1) Vd. Yadavji trikamji Acharya, Sushruta Samhita with Nibandhsangraha commentary of
Sri Dalhanacharya, chaukhamba publications, Varanasi – reprint 2015, Nidan sthan-6 .
2) Vd.Ganesh Krushna garde, Sartha vagbhat (vagbhatkrut ashtang hridaya and
bhashantar). Prophicent Publishing house, Pune, reprint 2012, Sutra sthan- 11.
3) Vd. Yadavji trikamji Acharya, Sushruta Samhita with Nibandhsangraha commentary of
Sri Dalhanacharya, Chaukhamba publications, Varanasi – reprint 2015, Nidansthan – 6.
4) Kaviraja Ambikadutta Shashtri, Sushruta Samhita with ayurvedtatva sandipika hindi
commentary, part – 1, Chaukhamba Sanskrit Sansthan, Varanasi – reprint 2018,
nidansthan -6.
5) Vd. Harishchandra Singh Kushwah, Charaka Samhita with ayurved dipika hindi
commentary, part -1, Chaukhamba Orientalia, Varanasi- reprint 2018, nidansthan-6.
6) Kaviraja Ambikadutta Shashtri, Sushruta Samhita with ayurvedtatva sandipika hindi
commentary, part-1, Chaukhamba Sanskrit Sansthan, Varanasi – reprint 2018,
nidansthan-6.
7) Vd. Yadavji trikamji Acharya, Charaka Samhita with Chakrapani hindi commentary,
part -1, Chaukhamba Orientalia, Varanasi- reprint 2009, nidansthan 4.
8) Prof. Jyotir Mitr a, edited by- Dr Shivprasad Sharma, Astangasamgraha of Vrddha
Vagbhata with Sasilekha Sanskrit Commentary, Chaukhamba Sanskrit series office,
Varanasi, Sutrasthan - 1/22.
9) Vd. Harishchandra Singh Kushwah, Charaka Samhitawith ayurveddipika hindi
commentary, part -2, Chaukhamba Orientalia, Varanasi- reprint 2018, Chikitsasthan-6.
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10) Vd. Harishchandra Singh Kushwah, Charaka Samhitawith ayurveddipika hindi

commentary, part -2, Chaukhamba Orientalia, Varanasi- reprint 2018, Chikitsasthan-6.
11) Vd. Harishchandra Singh Kushwah, Charaka Samhitawith ayurveddipika hindi
commentary, part -2, Chaukhamba Orientalia, Varanasi- reprint 2018, Sutrasasthan
28/4,.
12) Vd. Harishchandra Singh Kushwah, Charaka Samhita with ayurveddipika hindi
commentary, part -2, Chaukhamba Orientalia, Varanasi- reprint 2018, Chikitsasthan-6.
13) Adam G Tabak, Christian Herder, Wolfgang Rathmann, Eric J Brunner, Mika Kivimaki
, Prediabetes: a high risk state for diabetes development PMID :22683128,PMICID
:PMC 3891203,DOI 10.1016/S0140-6736(12)60283-9
14) Rakesh M Parik, Viswanathan Mohan, Changing definitions of metabolic syndrome,
Indian journal of Endocrinology and metabolism Volume 16,Issue 1 2012
15) 15.https://www.cdc.gov/diabetes/basics/prediabetes.html6https://www.euro.who.int/en/
health- topics/ disease-prevention,WHO
16) American Diabetes Association (2019). "2. Classification and Diagnosis of Diabetes:
Standards of Medical Care in Diabetes—2019". Diabetes Care. 42(Supplement 1): S13–
S28.doi:10.2337/dc19-S002. ISSN 0149-5992. PMID 30559228

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31.
ROLE OF UTTAR BASTI IN INFERTILITY:
A CASE REPORT
1
Dr Desai Rajdatta, 2.Dr Pratapwar Aniket, 3.Dr Tasare Prashant ,
Associate Professor, Dept. of Rognidan, Annasaheb dange Ayurved college Ashta.
Associate Professor,Dept. of Rognidan, M.A.D. Ayurveda college,Yevla

Introduction:
As per Ayurveda, four basic factors are required in healthy form for human reproduction i.e.
Rutu, Kshetra, Ambu and beej. Abnormality among any of these factors may lead to infertility.
All anatomical and physiological diseases of female genital organs are described as yoniroga
(yonivyapada) in ancientAyurvedic texts. It is also mentioned that not a single yonivyapada can
occur without Vatadosha1. Hence first line of treatment for yonivyapada should be basti karma
as it is best remedy for vatarogas2. Garbhashayagat uttar basti is another modality to treat yoni
rogas3.
Vandhya yoni vyapad (infertility) is defined as cessation of artava4 .Where the word artava
stands for menstruation as well as ovum. So for the treatment of infertility, correcting artava
vikruti and strengthening of reproductive organs can be achieved by utter basti by til taila.
Properties of til taila are described as it is madhur, ushna, teekshna, vyavayi, brihana, vrishya
and garbhashaya shodhan 5. It is best among vaatashaman dravyas. Hence it cures diseases of
vata and corrects most of the yonirogas.
Case History:
A 42-year-old woman had come for treatment of secondary infertility. She had obstetric history
of two full term normal deliveries having both female, 13 years and 7 years before respectively.
Her younger daughter died accidently before six months i.e. at the age of six and half years. So
patient was emotionally disturbed and strongly willing for another child. She was suffering
from heavy menses too. During this period of time she didn’t conceive in spite of not using any
contraceptive. Her ultrasound report revealed small left hemorrhagic ovarian cyst with normal
uterus. Related serological and radiological investigations were done. In which no
abnormality found except low hemoglobin.

Treatment protocol:

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Shatavari, Gokshur and Latakaranj churna in combination 10 gm. Bid with milk as
anupana was given along with iron supplementation.
Yoga basti was given from 5th day of menstrual cycle. For anuvasana basti 60 ml. luke warm
Til taila was used while for niruha basti Dashmoola kwatha 500 ml. was given.
Starting with anuvasan, both were given alternately for six days and ending with two anuvasan.
Such yoga basti was given for three consecutive menstrual cycles.
Garbhashayagat uttarbasti was given for next three consecutive menstrual cycles.
For uttarbasti Til taila 10 ml was used under all aseptic precautions in operation theatre.
The uttarbasti was started on 5th day of menstrual cycle, after cessation of menstrual bleeding,
daily for five days.
In the third month of treatment, follicle got ruptured on 14th day of menstrual cycle and patient
conceived.
The patient was examined by regular follow-ups and routine antenatal care was given and
patient delivered normally a full term healthy male baby.

Discussion:
Even though female reproductive age considered from menarche to menopause i.e. 16 to 45
years but after age of 35 years, chances of conception becomes low. The patient was of 42 years
of age but strongly willing for child due to her own reasons. So this case has considered for
treatment.
All necessary investigations have done. All of them found to be within normal limits except
mild anemia of Hb
Gm/dl. After examination, the fact came to know that there was age related dhatu daurbalya and
dhatukshaya janya vata prakopa. As patient was in premenopausal age and had secondary
infertility. Hence patient was diagnosed as a case of Vandhya yonivyapada. The Basti is mainly
indicated in vata prakopa janya diseases.
Use of anuvasana basti and niruha basti is also beneficial in all kinds of ailments implicating
vaata adhishthanas. Charaka explained that the woman, who is unable to conceive due to vata,
should be treated with basti6. Uttarbasti is one of the efficacious remedies in Ayurveda and
proved in tackling the yonivyapada successfully.
Til taila with its enormous properties has excellent vatashamak effect. Til taila is easily

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absorbed through mucous membranes, provides nutrition, performs vata shaman and may
potentiate the ovarian and endometrial physiological functions. Hence it empowers the
reproductive organs especially fallopian tubes and uterus.

Conclusion:
Balya, bruhaniya Ayurvedic medicines along with iron supplementation also played an
important role in improvement of general health of the patient. By applying all the above
Ayurvedic measures the patient is treated. Thus, she conceived successfully, antenatal period
was uneventful, and she gave birth to a healthy baby by normal delivery in her premenopausal
age. Hence the case has been reported.

References:
1. Charak samhita of Agnivesha, Part II, by Shree Satyanarayana Shastri, Chaukhamba
Vishwa Bharti Publications, Varanasi, 2007, Chikitsa sthan 30/115, page no.858.
2. Ibid Charak samhita, Part II , Siddhi sthan 1/39, page no.971.
3. Sushruta samhita Part II, Kashiraj Dr Ambikadatt Shastri, Chakhamba Sanskrit
Sansthan, Varanasi, 2006, Uttar tantra 38/10, page no.157.
4. Sushruta samhita Part I, Kashiraj Dr Ambikadatt Shastri, Pranjeewan Manikchand
Mehta, Chakhamba Sanskrit Sansthan, Varanasi, 2007, Sutra sthan 45/112, page no178.
5. Ibid Charak samhita, Part II, Siddhi sthan 1/34, page no. 970.

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32.
STEPS FOR QUESTIONNAIRE TOOL DEVELOPMENT
Dr PreetiBorkar* Dr. Pavithra. S **
*
Prof and Head, ** PhD Scholar,
Dept of Samhita and Siddhanta, 2Mahatma Gandhi Ayurved College Hospital and Research
Centre, Salod, Wardha, Datta Meghe Institute of Higher Education and Research Centre,
(D.M.I.H.E.R.), Maharashtra, India

ABSTRACT:
Survey is used in many fields of research for data collection. And questionnaire is the
commonly employed method in medical educational researches. Despite of its widespread use
there is very limited availability of information of the protocol for tool development. Therefore
many surveys fails to adopt rigorous methodologies in survey questionnaire design, which
results in inadequate reliability and validity of data collected by the survey. This leads to a
poorly designed survey which do not meet the adequate information needed by the researcher.
This chapter reviews the current methodology for the development and validation of
questionnaire tools and proposes to incorporate this in the field of research.
INTRODUCTION: Identification of the clinically presented symptom and diagnosis of the
disease is a vital part of clinical practice. Disease manifestation, diagnosis and various clinical
finding are identified and documented during clinical practice as per the reasoning and
knowledge of the practitioner. This process can bring discrepancies among clinicians, with
regards to the application and assessment. In research studies, this poses a disadvantage and the
accomplishment of reproducibility would be compromised. Yet the accuracy of clinically
presented signs and symptoms becomes a query, a standard tool for appropriate documentation
is the answer for this question. Diagnostic research provides more opportunity, due to less
availability of standardised diagnostic tool. Questionnaire and Interviews are the most
frequently used methods of organizational diagnosis and in assessment of attributes. And
Questionnaires are more commonly used type of diagnostic tool. Questionnaire can be defined
as a set of appropriately set questions to collect a particular data from the respondent. The main
objective to obtain the appropriate information / research data from the respondent from a set of
question which is easily understandable. It is a mean of data collection for a qualitative data and
converts the qualitative data to a qualitative data so the data is internally consistent and

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coherent for analysis. This process of data collection ensures the standardization and
comparability of data across large population.
The research work on tool development for measurement of any criteria must be concerned
with accuracy, also called as reliability tests. Reliability tests helps to find whether the
developed tool is able to collect the data to yield interpretable statement above individual
differences. Likewise the tool development involves various steps which will be discussed in
details in next session.
MATERIALS AND METHODS: Before initiation of a research work on tool development
the identification of the problem and stating the Aims and objectives becomes an important
step. This helps in proper formation of blue print or road map for the study. The type of tool to
be developed, the rating scale is also the important point before the initiation of the work.
Example: Questionnaire, interview, Survey tool, self-assessed of examiner assessed tool. A
methodical, survey scale/tool development design involves seven-step.

Sly no Steps of tool development

1. Conduct a literature review
2. Item generation
3. Synthesize the literature review and interviews/focus groups followed by Item
Selection/Reduction
4. Item wording, sequencing & formatting
5. Expert validation
6. Pre-tests and pilot study
7. Administering on sample population and Measuring reliability and validity

Step 1. Conduct a literature review: This is the primary step and helps to evidently define the
construct and also to determine if the measure of construct previously exists. Literature review
should be carried out through all the available literature. A proper literature review helps to
solve the research problem better.
Step 2. Item generation: The process of development of tool start with identification of the
criteria to be assessed through the developed tool. Before setting in towards item generation the

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boundaries and the measurability of the variables has to be determined which is called as
conceptualization and operationalization? At this stage the identified and generated items has
to be clarified into various domains which further helps in simplification of the calculation and
conclusion of the final tool. The set of such identified criteria will be listed and stated in the
form of questions. This is the process of item generation.
Step 3. Synthesize the literature review and interviews/focus groups followed by Item
Selection/Reduction: Further to ensure the conceptualization of the construct the focus group
discuss has to be conducted. The expert for focus group should be from the field of interest and
further modification in the tool will be based on the expert group suggestions.
Step 4. Item wording, sequencing & formatting: The generated Questions have to measure
the variable but this sometimes may result in bias. The bias may be usually due to guess
responses, no responses and inclination towards socially desirable response. The measures to
minimize such bias are taken in these steps. The generated statements/questions will be
formatted and presented in better sequence in this step. Generally the item has to be modified
to be easily understandable to a teenager.
Step 5. Pre-tests or Expert validation: this step helps to ensure the clarity,
comprehensiveness of the items in accordance with contemporary practices. In this stage of
tool development the developed questionnaire is presented or circulated to a sample of expert
in the concerned field. The review from the expert will be further considered for better
modification in the developing tool. Here the experts can comment on the logical sequence of
item, comprehensiveness of the tool.
Step 6. Pilot study: The developed tool has to be tested on a small sample of subjects which is
called as Pilot study. The sample size for pilot study must be around 50 subjects. The data
reduction after pilot study will further refine the tool. The variability of item has to be noted
and the item which are highly skewed and reported as difficult to answer has to be reduced.
Step 7. Administering on sample population and tests of reliability and validity: thus
developed tool has to be administered to large population and the sample size must be
calculated with the help of statistic expert. Further reliability analysis tests like Cranach’s
alpha, item correlation has to be done. The Cranach’s alpha above 0.70 is acceptable and the
statements/questions having less than .070 can be deleted to maintain alpha value significantly.
The validity tests involve content validity, face validity, criterion validity and construct

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validity.
Content validity and face validity can be certified by expert opinion. Content validity gives the
idea of completeness and ensured the range of coverage that is possible by the developed tool.
Whereas of the related topic of the tool. Criterion validity is the step of correlation with the
gold standard. Whereas construct validity helps us to find the result generated from the
developed tool is in accordance to present theories.
The reliability tests involve test retest reliability, inter-observer reliability, and internal
consistency reliability. These reliability tests help to assess the consistency of the tool on
repeated administration after a gap period. The response must have consistency of more than
90% to fall into acceptance zone. Similarly the tool must exhibit a better consistency rate when
assessed by two observers with in short interval.
IMPORTANCE OF QUESTIONNAIRE TOOL:
This type of tool is a boon for collection of qualitative and subjective data in a standard format.
It provides a standardized research insight towards the data collected thus results in generating
a Standardized, quantifiable and empirical data. It is easier method to research larger
population and also allows comparison. The confidentiality and anonymity of data can be well
maintained during collect of data.

CONCLUSION:
In this small chapter a brief description of tool development and the steps involved in tool
development is presented. Many topics of survey tool development, KAP studies fall outside
this topic of diagnostic tool development. Questionnaire tool development is an Empirical
work and helps in development of various other fields of research. There is a vast scope for
such research works in the field of Medicine, Education, Pharmacy, Industries etc. thus a
standard protocol for various tool development is the need of the hour and this chapter is a
small contribution.
Acknowledgement: I express my heartfelt gratitude to my Guide Dr Arun Wankhede; he is the
one driving me towards my writing. I express my Gratitude to my esteemed institution
DMIHER, Dr Patel Sir, Dr Ved Prakash Mishra Sir, and Deans and all Faculties of DMIHER,
MGACH&RC for providing me the opportunity and platform for this manuscript.

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33.
THERAPEUTIC ANTIVIRAL POTENTIAL OF HERBAL DRUGS ON
VIRAL INFECTIONS
*1Dr.Bhushan Mhaiskar, 2Dr. Rutuja Mhaiskar
*1
Associate professor, Department of Samhita and Siddhant 2Associate Professor,
Department of Samhita and Siddhant , Mahatma Gandhi Ayurved College Hospital and
Research Centre, Salod, Wardha, Datta Meghe Institute of Higher Education and Research
Centre, (D.M.I.H.E.R.), Maharashtra, India.
2
Dr.Gunwantrao Sarode Ayurveda Medical College Hospital and Research Centre, Jalgaon
(Kh), Jalgaon, Maharashtra, India.

Abstract
Background:
Ayurved, an ancient system of medicine with rich heritage and antiquity, is well known
since Vedic period. Viral infections are responsible for many illnesses, and recent outbreaks
have raised public health concerns.
Viral infections are being managed therapeutically through available antiviral
regimens with unsatisfactory clinical outcomes. The refractory viral infections immune to
available antiviral drugs are alarming threats and a significant health concern. For hepatitis, the
interferon and vaccine therapies solely aren't ultimate solutions thanks to recurrence of
hepatitis C virus. Owing to the growing incidences of viral infections and particularly of
resistant viral strains, the available therapeutic modalities got to be improved, complemented
with the invention of novel antiviral agents to combat refractory viral infections. It is widely
accepted that medicinal plant heritage is nature gifted, precious, and fueled with the valuable
resources for treatment of metabolic and infectious disorders. The aims of this review are to
assemble the facts and to conclude the therapeutic potential of medicinal plants within the
eradication and management of various viral diseases such as influenza, human
immunodeficiency virus (HIV), herpes simplex virus (HSV), hepatitis, and coxsackievirus
infections, which have been proven in diverse clinical studies.
The scientific literature mainly focusing on plant extracts and herbal products with
therapeutic efficacies against experimental models of influenza, HIV, HSV, hepatitis, and
coxsackievirus were included in the study. Pure compounds possessing antiviral activity were
excluded, and plants possessing activity against viruses other than viruses in inclusion criteria
were excluded. Hundreds of plant extracts with antiviral effect were recognized. On the basis
of the work of several independent research groups, the therapeutic potential of medicinal

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plants against listed common viral diseases in the region has been proclaimed. In this context,
the herbal formulations as alternative medicine may contribute to the eradication of
complicated viral infection significantly. The current review consolidates the data of the
various medicinal plants, holding promising specific antiviral activities scientifically proven
through studies on experimental animal models. Consequently, the original research
addressing the development of novel nutraceuticals based on listed medicinal plants is highly
recommended for the management of viral disorders.
Keywords: Ayurved, COVID 19, Virus,
Introduction
SARS-COV2 is the causative agent of the potentially fatal disease known as
Coronavirus Disease (COVID-19), which is a major issue for worldwide public health. It is
hypothesised that this is probably the COVID-19 zoonotic origin due to the high number of
affected individuals who were exposed to the wet animal market in Wuhan City, China.
Patients who contracted the COVID-19 infection from another person had to be isolated and
then received a range of therapies. To contain the present outbreak, numerous steps have been
put in place to lessen Covid-19 transfer from person to person. Children, healthcare workers,
and the elderly are among the sensitive populations that require special protection or
transmission-reduction measures. We emphasise the symptoms, epidemiology, transmission,
pathophysiology, and Phylogenetic research and upcoming strategies to stop the spread of this
deadly illness. [1]
Due to growing worries about the emergence of medication resistance and slow
progress in the creation of antiviral drugs, there has recently been a notable advancement in the
field of herbal antiviral therapy. Due to their vast therapeutic range and few to no side effects,
medicinal plants have been utilized extensively throughout history in almost all nations for the
treatment of illnesses and infections as traditional healing treatments. Since most viral agents
cannot be treated with synthetic antiviral, every effort has been made to find new medications
and complementary/alternative treatments derived from various herbal preparations.[2]
Surprisingly little overlap exists in the research on the several hundred plant and herb species
with potential as novel antiviral agents. Flavonoids, terpenoids, lignans, sulphides,
polyphenolics, coumarins, saponins, furyl compounds, alkaloids, polyines, thiophenes,
proteins, and peptides are just a few of the many active phytochemicals that have been found. A
significant amount of antiviral activity has also been seen in several volatile essential oils of

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frequently used culinary herbs, spices, and herbal teas. The majority of the pharmacopoeia of
chemicals in medicinal plants with antiviral action, however, remains unknown due to the few
classes of compounds examined. Many of these phytochemicals act in ways that are
complementary to one another and overlap, such as having antiviral effects by preventing the
synthesis of viral DNA or RNA or by preventing the activity of viral reproduction.
Multiple-arm trials, randomised crossover studies, and more compromising designs including
nonrandomized crossovers and pre- and post-treatment analyses are examples of assay
methods to determine antiviral activity.[3]

Literature Review of Novel antiviral agents:

Medicinal plant viewpoint Methods are required to connect laboratory-based studies on

antiviral efficacy/potency. Despite this, there is reason for optimism regarding the long-term
effectiveness of phyto-antiviral agents given the recent relative success obtained using
medicinal plant/herb extracts of various species that can act therapeutically in various viral
infections. This review highlights the vast array of potentially beneficial medicinal plants and
herbs that are awaiting evaluation and use for therapeutic applications against genetically and
functionally varied virus families like Retroviridae, Hepadnaviridae, and Herpesviridae. [4].

Materials and Methods:

Through searches on various websites and web pages like Google Scholar, Medscape,
BMC Medicine, the MEDLINE database, ScopeMed, and other relevant information was
found using keywords like COVID 19, potential antiviral herbal remedies, relevant literature
was gathered to investigate NG. Literature was also taken from a variety of Ayurvedic
treatises, Ayurvedic textbooks, and available dissertations and theses, and a number of research
publications were looked into literature was also taken from a variety of Ayurvedic treatises,
Ayurvedic textbooks, and available dissertations and theses, and a number of research
publications were looked into.
Antiviral agents:
Antiviral drugs are a class of medication used specifically for treating viral
infections rather than bacterial ones.[5] Most antivirals are used for specific viral infections,
while a broad-spectrum antiviral is effective against a wide range of viruses.[6] Unlike most
antibiotics, antiviral drugs do not destroy their target pathogen; instead they inhibit their
development. [7] Antiviral drugs are one class of antimicrobials, a larger group which also

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includes antibiotic (also termed antibacterial), antifungal and antiparasitic drugs [8] or antiviral
drugs based on monoclonal antibodies.[9]The majority of antivirals are thought to be generally
safe for the host, making them useful for treating infections. It is important to separate them
from viricides, which aren't medications but instead deactivate or kill virus particles either
inside the body or outside it. Some plants, including Australian tea trees and eucalyptus,
naturally produce viricides.[10]
Virus life cycle
Viruses are made up of a genome and occasionally a small number of enzymes that are
kept in a protein capsule called a capsid and occasionally wrapped with a lipid coating known
as a "envelope." Since viruses are unable to reproduce on their own, they spread by controlling
a host cell to make copies of themselves, giving rise to the following generation. [11]
[Researchers trying to create antivirals using such "rational drug design" techniques have
attempted to combat viruses at every stage of their life cycles. It has been discovered that some
types of mushrooms contain several antiviral compounds that work together in a similar
manner.[12]
Compounds broad-spectrum antiviral properties when isolated from fruiting bodies and
filtrates of different mushrooms, but it will be a considerable time before these substances can
be produced and made readily available as frontline antivirals. [13]
1. The specifics of viral life cycles vary based on the type of virus, but they all follow the
same fundamental pattern:
2. Attachment to a host cell.
3. Release of viral genes and possibly enzymes into the host cell.
4. Replication of viral components using host-cell machinery.
5. Assembly of viral components into complete viral particles.
6. Release of viral particles to infect new host cells.

Anti-viral targeting
The main goal of current antiviral medication development is to find viral proteins or
segments of viral proteins that can be inhibited. To lessen the possibility of adverse effects,
these "targets" should typically be as unlike to any proteins or portions of proteins found in
humans as feasible. In order for a single treatment to be effective across a wide range of virus
strains, or even across distinct species of virus within the same family, the targets must also be
shared. For instance, a researcher may focus on a vital enzyme that is produced by all strains of

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the virus but not by the patient and investigate what can be done to prevent it from functioning.
[14]
Candidate medications can be chosen once targets have been identified, either by
choosing ones that are already known to have the desired effects or by actually designing the
candidate at the molecular level using a computer-aided design program. [15]
By introducing the gene that produces the target protein into bacteria or other types of
cells, the target proteins can be produced in the lab for testing with potential treatments. The
protein is subsequently produced in large quantities by the cells, which can then be exposed to
different treatment options and assessed using "rapid screening" methods.[16]
Before cell entry
Interfering with a virus' ability to enter a target cell is one anti-viral tactic. To
accomplish this, the virus must first bind to a certain "receptor" molecule on the surface of the
host cell, and then it must follow a series of steps that culminate in the virus "uncoating" inside
the cell and releasing its contents. Before they may uncoat, viruses with lipid envelopes must
fuse their envelope with the target cell or with a vesicle that carries them there. [17]
This stage of viral replication can be inhibited in two ways
1. Using substances that attach to the cellular receptors and mimic the virus-associated protein
(VAP). This could include anti-receptor antibodies, natural receptor ligands, and VAP
anti-idiotypic antibodies
2. Using substances that bind to the VAP and mimic the biological receptor. This comprises
synthetic receptor mimics, exogenous receptors, anti-VAP antibodies, and antibodies against
receptor idiotypes. [18]
During viral synthesis
The processes that create virus components after a virus infects a cell are the focus of a
second strategy. [19]
Reverse transcription
Creating analogues of the nucleotides and nucleosides that make up RNA and DNA and
disable the enzymes responsible for RNA and DNA synthesis is one technique to achieve this.
As opposed to "normal" transcriptase (DNA to RNA), reverse transcriptase inhibition is more
frequently linked to this method. [20]
Long dsRNA helix targeting
Long dsRNA helices are produced by the majority of viruses during transcription and

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replication. Contrarily, during transcription, uninfected mammalian cells often create dsRNA
helices with less than 24 base pairs. A class of investigational antiviral medications known as
DRACO (double-stranded RNA activated caspase oligomerizer) was first created at the
Massachusetts Institute of Technology. DRACO was discovered to be effective against
influenza in vivo in weanling mice, in addition to being claimed to have broad-spectrum
activity against several infectious viruses in cell culture, including dengue flavivirus, Amapari
and Tacaribe arenavirus, Guama bunyavirus, H1N1 influenza, and rhinovirus. According to
reports, it selectively causes fast apoptosis in virus-infected mammalian cells while sparing
uninfected cells. DRACO causes cell death through one of the final stages of the apoptosis
pathway, where complexes with intracellular apoptosis signals are involved. bind many
procaspases at once. The procaspases kill the cell by cleaving a variety of cellular proteins,
activating other caspases in the cascade, and transactivating other caspases.[21]

Immune system stimulation

Another type of virus-fighting strategies encourages the body's immune system to
combat viruses rather than directly attacking them. Some of these antivirals stimulate the
immune system to attack a variety of pathogens rather than concentrating on a single pathogen.
[22]
Interferons, which prevent the generation of viruses in infected cells, are among the most
well-known medications in this group.[23] "Interferon alpha" is a well-known kind of human
interferon that is frequently used in the standard care for hepatitis B and C and other interferons
are also being investigated as treatments for various diseases. [24] A more specific approach is
to synthesize antibodies, protein molecules that can bind to a pathogen and mark it for attack by
other elements of the immune system. Once researchers identify a particular target on the
pathogen, they can synthesize quantities of identical "monoclonal" antibodies to link up that
target. A monoclonal drug is now being sold to help fight respiratory syncytial virus in
babies,[25].and antibodies purified from infected individuals are also used as a treatment for
hepatitis B.[26]

Acquired resistance
Antiviral resistance is characterised by a diminished treatment response brought on by
variations in viral genotypes. Drugs' effectiveness against their intended virus is reduced or

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absent in cases of antiviral resistance Since the problem has evolved to almost all specific and
powerful antimicrobials, including antiviral agents, it inevitably remains a significant barrier to
antiviral therapy. [27]
Herbal Antiviral agents:
Preliminary screening by the CPE inhibition assay was carried out against BVDV-1,
HSV-1, HSV-2, and influenza A to ascertain the antiviral activity of 15 medicinal plants. The
samples that decreased the viral CPE by 2 logs at the MNCC were deemed to be active; their
activity was verified using the MTT technique for influenza or the plaque reduction assay for
BVDV-1, HSV-1, and HSV-2. For all of the active plant extracts, the Selective Index
(SIextract=CC50 extract/EC50 extract), or the ratio between the cytotoxic cell concentration
(CC50) and the effective concentration (EC50), was computed. S. molle (E and I), Cor.
didymus (E), M. ilicifolia (I), Phyllantus spp. (E), Er. japonica (I), N. glauca (E and I), Pa.
debilis (E), and L. alba (E) were the only plants in this study that were not effective against the
tested viruses. High SI values were displayed by the H. bonariensis (I and E), Ce. pachystachya
(E), and Cor. didymus (I), all of which were active against BVDV-1 in the screening (Table 2).
Only the infusion of J. australis (E and I) and Er. japonica (E) was effective against HSV-1 and
2. [28]

List of Herbal Antiviral drugs :

1. Aegle Marmelos 1. (Rutaceae), Linn. Numerous traditional uses of A. marmelos, such as its
antibacterial, antiviral, antidiarrheal, gastroprotective, anti-ulcerative colitis,
hepatoprotective, antidiabetic, cardioprotective, and radioprotective properties, have been
supported by scientific research. This plant has recently attracted interest as a potential
anticancer drug for the treatment of various malignancies. This study therefore
concentrates on the scientific data supporting A. marmelos's significant pharmacological
activity, including its antioxidant, antidiabetic, antibacterial, hepatoprotective,
cardioprotective, and anticancer effects.. [29]
2. The star anise plant, Illicium verum It is also the source of the shikimic acid precursor
molecule, which is used in the production of the antiviral drug oseltamivir (Tamiflu®), a
treatment for influenza A and influenza B. Moreover, the same plant has yielded a number
of additional molecules, some of which have been reported to have biological advantages,
such as antiviral effects. Aside from its antiviral potential, star anise also has

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anti-inflammatory, anti-nociceptive, anti-microbial, anthelmintic, secretolytic,

anti-inflammatory, gastroprotective, sedative, expectorant, spasmolytic, and estrogenic
properties. [30]
3. Ayurveda uses a comprehensive methodology to create its descriptions of illness rather
than just concentrating on microbiological aetiology. [31]
4. For the prevention of COVID-19, Ayurveda theory offers straightforward natural methods
(daily regimens), herbal combinations, herbsmineral formulations, and activities like yoga.
The rejuvenating therapy known as Swasthya Urjaskara Chikitsa includes rasayana
therapy. Rasayana is proven to be a very useful instrument in the prevention of any disease
since it acts at the level of the Dhatus (tissues) in a Swastha person and administration of
Rasayana Aushadi. [32]
Schematic Diagram of Action of Antiviral herbal drug in cell

Results and Discussion:

A variety of biochemical and bioactive components found in medicinal plants can be extracted
and used to treat or prevent viral illnesses and infections. Although medicinal plants and
natural products have been used for a very long time, scientific evidence and research into their
prophylactic, therapeutic, and other health-related uses have only recently begun to pick up
steam. Numerous scientific investigations have been made, covering everything from the
identification of active ingredients to understanding the therapeutic mechanisms of antiviral
herbs, to clinical trials and their effective use in neutralizing viral pathogens. As a result,

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hundreds of herbs and plant metabolites have been screened, identified, and evaluated for their
antiviral actions; thankfully, some of these have demonstrated notable therapeutic
effectiveness in the amelioration or prevention of viral diseases. HIV/AIDS and Ayurveda
In Ayurveda, the tridosha Siddhanta, where tridosha affects the Dushya, i.e. dhatus & malas,
generating a particular quite pathologies, all the diseases mentioned in Ayurveda are frequently
well understood. The discomfort, another ageing sign, a change in complexion, and other
damaged organs are frequently used as the names for these illnesses. It is inevitable due to
changes in environment and lifestyle; more recent conditions are gaining ground. As a result,
they must be treated in accordance with the tridosha principle outlined in classical Ayurvedic
texts.

Conclusion: This review discusses the importance of various herbal preparations made from
various medicinal plants and their extracts in treating diseases brought on by various viral
pathogens, including newly emerging and reemerging viruses that affect people, animals,
poultry, and fish. This review certainly helps the approach of COVID 19 and related viral
infections. Any remedies medicinal plants helps in fighting viral infections. Antiviral herbs
fight with enhancing immune system and induced passive immunity.

Financial support and sponsorship - Nil.

Conflicts of interest- There are no conflicts of interest.

References
[1] Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease
(COVID-19) outbreak. Journal of autoimmunity. 2020 May 1;109:102433.
[2] Dhama K, Karthik K, Khandia R, Munjal A, Tiwari R, Rana R, Khurana SK, Ullah S, Khan
RU, Alagawany M, Farag MR. Medicinal and therapeutic potential of herbs and plant
metabolites/extracts countering viral pathogens-current knowledge and future prospects.
Current drug metabolism. 2018 Mar 1;19(3):236-63.
[3] Jassim SA, Naji MA. Novel antiviral agents: a medicinal plant perspective. Journal of applied
microbiology. 2003 Sep 1;95(3):412-27.

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[4] Ogbole OO, Akinleye TE, Segun PA, Faleye TC, Adeniji AJ. In vitro antiviral activity of
twenty-seven medicinal plant extracts from Southwest Nigeria against three serotypes of echoviruses.
Virology journal. 2018 Dec;15:1-8.
[5]"Medmicro Chapter 52". Archived from the original on 18 August 2000. Retrieved 21
February 2009.
[6] Welch SR, Scholte FE, Flint M, Chatterjee P, Nichol ST, Bergeron É, Spiropoulou CF.
Identification of 2′-deoxy-2′-fluorocytidine as a potent inhibitor of Crimean-Congo
hemorrhagic fever virus replication using a recombinant fluorescent reporter virus. Antiviral
research. 2017 Nov 1;147:91-9.
[7] Kausar S, Said Khan F, Ishaq Mujeeb Ur Rehman M, Akram M, Riaz M, Rasool G, Hamid
Khan A, Saleem I, Shamim S, Malik A. A review: Mechanism of action of antiviral drugs.
International journal of immunopathology and pharmacology. 2021
Mar;35:20587384211002621.
[8] Daniels R, Nicoll LH. ‘Pharmacology-Nursing Management. Contemporary
Medical-Surgical Nursing. Cengage Learning. 2011:397.
[9] Ko K, Tekoah Y, Rudd PM, Harvey DJ, Dwek RA, Spitsin S, Hanlon CA, Rupprecht C,
Dietzschold B, Golovkin M, Koprowski H. Function and glycosylation of plant-derived
antiviral monoclonal antibody. Proceedings of the National Academy of Sciences. 2003 Jun
24;100(13):8013-8.
[10] Schnitzler P, Schön K, Reichling J. Antiviral activity of Australian tea tree oil and
eucalyptus oil against herpes simplex virus in cell culture. Die Pharmazie. 2001 Apr
1;56(4):343-7.
[11] Fenner F, Bachmann PA, Gibbs EP, Murphy FA, STUDDERT MJ, WHITE DO. Structure
and Composition of Viruses. Veterinary Virology. 1987:3.
[12] Lara HH, Ayala-Nuñez NV, Ixtepan-Turrent L, Rodriguez-Padilla C. Mode of antiviral
action of silver nanoparticles against HIV-1. Journal of nanobiotechnology. 2010
Dec;8(1):1-0.
[13] Seo DJ, Choi C. Antiviral bioactive compounds of mushrooms and their antiviral
mechanisms: a review. Viruses. 2021 Feb 23;13(2):350.
[14] Lessells RJ, Avalos A, de Oliveira T. Implementing HIV-1 genotypic resistance testing in
antiretroviral therapy programs in Africa: needs, opportunities, and challenges. AIDS reviews.
2013 Oct;15(4):221.

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[15] Walkey AJ, Sheldrick RC, Kashyap R, Kumar VK, Boman K, Bolesta S, Zampieri FG,
Bansal V, Harhay MO, Gajic O. Guiding principles for the conduct of observational critical
care research for coronavirus disease 2019 pandemics and beyond: The Society of Critical Care
Medicine Discovery Viral Infection and Respiratory Illness Universal Study Registry. Critical
care medicine. 2020 Nov;48(11):e1038.
[16] Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Studying gene expression
and function. InMolecular Biology of the Cell. 4th edition 2002. Garland Science.
[17] Villanueva RA, Rouillé Y, Dubuisson J. Interactions between virus proteins and host cell
membranes during the viral life cycle. International review of cytology. 2005 Jan
1;245:171-244.
[18] Maginnis MS. Virus–receptor interactions: the key to cellular invasion. Journal of
molecular biology. 2018 Aug 17;430(17):2590-611.[19] Maginnis MS. Virus–receptor
interactions: the key to cellular invasion. Journal of molecular biology. 2018 Aug
17;430(17):2590-611.
[20] Patel PH, Zulfiqar H. Reverse transcriptase inhibitors. InStatPearls [Internet] 2022 May
19. StatPearls Publishing.
[21]Price AM, Steinbock RT, Di C, Hayer KE, Li Y, Herrmann C, Parenti NA, Whelan JN,
Weiss SR, Weitzman MD. Adenovirus prevents dsRNA formation by promoting efficient
splicing of viral RNA. Nucleic acids research. 2022 Feb 22;50(3):1201-20.
[22]Mims C, Dockrell H, Goering R, Roitt I, Wakelin D, Zuckerman M. Medical
microbiology. Structure. 2004;7(7).
[23] Samuel CE. Antiviral actions of interferons. Clinical microbiology reviews. 2001 Oct
1;14(4):778-809.
[24] Mueller S, Millonig G, Seitz HK. Alcoholic liver disease and hepatitis C: a frequently
underestimated combination. World journal of gastroenterology: WJG. 2009 Jul
7;15(28):3462.
[25] Berkley JA, Munywoki P, Ngama M, Kazungu S, Abwao J, Bett A, Lassauniére R,
Kresfelder T, Cane PA, Venter M, Scott JA. Viral etiology of severe pneumonia among
Kenyan infants and children. Jama. 2010 May 26;303(20):2051-7
[26] Berkley JA, Munywoki P, Ngama M, Kazungu S, Abwao J, Bett A, Lassauniére R,
Kresfelder T, Cane PA, Venter M, Scott JA. Viral etiology of severe pneumonia among
Kenyan infants and children. Jama. 2010 May 26;303(20):2051-7.

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[27] Strasfeld L, Chou S. Antiviral drug resistance: mechanisms and clinical implications.
Infectious Disease Clinics. 2010 Sep 1;24(3):809-33.
[28]Visintini Jaime MF, Redko F, Muschietti LV, Campos RH, Martino VS, Cavallaro LV. In
vitro antiviral activity of plant extracts from Asteraceae medicinal plants. Virology journal.
2013 Dec;10(1):1-0.
[29] Manandhar B, Paudel KR, Sharma B, Karki R. Phytochemical profile and
pharmacological activity of Aegle marmelos Linn. Journal of integrative medicine. 2018 May
1;16(3):153-63.
30]Patra JK, Das G, Bose S, Banerjee S, Vishnuprasad CN, del Pilar Rodriguez‐Torres M, Shin
HS. Star anise (Illicium verum): Chemical compounds, antiviral properties, and clinical
relevance. Phytotherapy Research. 2020 Jun;34(6):1248-67.
[31] Snehal V. Kukade, Prashant S Bhokardankar,Namrata Chauragade,Bhushan Mhaiskar
Journal of Critical Review 7 (10), 579-581
[32] Bhivgade V, Tirpude S, Mhaiskar B, Parwe S. A review on janapadoddhvamsa with
special reference to current scenario of covid-19 outbreak. International Journal of Research in
Pharmaceutical Sciences. 2020 Jan 1;11(Special Issue 1).

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34.
CLINICAL REVIEW ON TESTING TISSUE REGENERATION BY
AYURVEDA MEDICATION (AMALAKI PATRA MASHI OINTMENT)
AND SILVER SULFADIAZINE IN DAGDHA VRANA (BURN WOUND)
1
Kanchan Mhaishkar, 2Pradnya Dandekar
1
PhD Scholar, Assistant Professor, Department of Rachana Sharir, Shalinitai Meghe Ayurved
Medical College, Bhandara, India.
2
Professor, Department of Kriya Sharir, Mahatma Gandhi Ayurved College, Salod, Datta
Meghe Institute of Medical Sciences, Wardha, India.

ABSTRACT
Background:
Skin is the largest organ in the body and performs a wide variety of different function. It play
an important role in the injury of the skin. Burns (Dagdha Vrana) are significant health
challenge and healing can result in scar formation. Within the herbal medicine tradition the
concept of Tonification and Trophorestoration is well established. Concepts of regeneration
and Trophorestoration in Ayurveda provide another dimension to the area of regenerative
medicine. Acharya Charaka suggests using drugs of Amalaki to prevent Vrana. Amalaki and
Silver Sulfadiazine (SSD) are the two comparative drugs chosen to evaluate the
Trophorestoration concept through Dagdha Vrana in Albino rabbits.
Materials and Methods: After identification and phytochemical study of test drugs 18 adult
Albino rabbits will be divided into 3 groups with six Albino Rabbits in each group. The burn
wound will be induced by using metal disc, three groups have been taken in which first is
control group, second is standard control, third is experimental group. Before applying
experimental drugs to respective group the tissue sample will be taken from each of albino
rabbits and from one of the healthy tissue sample of normal skin will be taken by Punch Biopsy

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for histopathalogical assay. Examination of wound area, swelling, redness, oozing will be
observed. Macroscopic and Microscopic assessment of wound will be done on day 0th, 4th,
8th, and 15th, 21st day after burn. Simultaneously on 0th day and 21st day SOD and MDA test
will be done. The remaining animals will be returned to the animal house for their reuse.
Expected Results: Whether Amalaki Patra Mashi ointment has more effect on
troporestoration property of Twacha in Dagdha Vrana (Burn wound) than Silver Sulfadiazine.
Keywords: Dagdha Vrana; Sapta twacha; Trophorestoration; Amalaki.

1. INTRODUCTION
Burns (Dagdha Vrana) are significant health challenge and healing can result in scar formation
[1]. “Burn is defined as tissue damage caused by a variety of agents such as heat, chemicals,
electricity, sunlight, or nuclear radiation. The most common are burns caused by scalds,
building fires and flammable liquids and gases. Thermal burn and related injuries have
remained a major cause of death and disability. Although small burns are not usually life
threatening, they need the same attention as large burns, in order to achieve functional and
cosmetic outcome” [2]. “Wound is defined as disruption of cellular, anatomical, and functional
continuity of a living tissue. It may be produced by physical, chemical, thermal, microbial, or
immunological insult to the tissue. When skin is torn, cut, or punctured it is termed as an open
wound and when blunt force trauma causes a contusion, it is called closed wound, whereas the
burn wounds are caused by fire, heat, radiation, chemicals, electricity, or sunlight” [3].
“Wound closure represents a primary goal in the treatment of very deep large wounds, for
which mortality rate is particularly high. However, the spontaneous healing of skin eventually
results in the formation of epithelized scar and scar contractures (repair) which might distort
the tissues and cause lifelong deformities and disabilities. These clinical evidences suggest that
wound closure attained by means of skin regeneration instead of repair, should be the true goal
of burn wound management” [4].
“Mashi Kalpana is an important pharmaceutical preparation mentioned in Ayurveda
Pharmaceutics. Mashi Kalpana is the form of medicine which can be prepared by heating
herbal or animal content upto transfer into carbonized form. It is used externally as well as
internally. It is cost effective, less time consuming preparation and having quick result” [5].

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Rasa -Tarangini, Rasashastra treatise 20th century enumerated various types of Malahar
Kalpana based on Yogratnakar mentioned Malahar Kalapana, it removes Mala (residue) etc.
from wounds etc. this is similar to ointments in modern pharmaceutics Malahar Kalpana.
Malahar has a property like Snehan (Oleation), Cleansing, Ropan (Healing), Lekhan
(Scarping) and Varnya (Beautifying) [6]. It has its own therapeutic advantages like easy
pharmaceutical procedure ease of mode of application and higher shelf-life period [7].
The various Dravyas are used for applications to cure Dagdha Vrana. Bhavaprakash and
Acharya Charak suggested that Out of all Rasa Kashay Rasatmak Dravyas are useful for Vrana
Ropan [8]. Amalaki (Emblica officinalis) (EO) is a rich source of vitamin C, which is a potent
antioxidant [9]. “It is foremost amongst the anti-aging drug (Vayasthapan) or best amongst the
rejuvenating herbs; it has properties like Rasayana (adaptogenic), ajara (usefulness in
pre-mature aging), Ayushprada (prolongs cell life), Sandhana karaka (improves cell migration
and cell binding), Kantikara (improves complexion)” [10]. According to Acharya Charaka,
Kashay Rasa also having the properties of Sanshaman (palliative), Sangrahi, Sandhan (to
hold), Pidan (Pain killer), Ropan (Healing property of Vrana), Shoshan (to absorb), Kledan (to
provide moisture). It also pacifies the Pitta and Kapha Dosha [11]. “Many researches are found
the extractions of the Amalaki leaves are used for wound healing purpose. Leaves contains
gallic acid, chebulic acid, ellagic acid, chebulinic acid, chebulagic acid, amlic acid, alkaloids
phyllantine and phyllantidine etc. These phyto-Chemicals having capacity of biological
activities like antioxidant, antimicrobial, anti-inflammatory, antidiabetic, antitissuive,
anti-radio protective, chemo preventive, wound healing activities and so on” [12]. “Traditional
system of medicine like Ayurveda which are known for their healing capabilities can offer a lot
more to the science of regenerative medicine. Trophorestaration is the path to repair and
regeneration. Within herbal medicine tradition notion of tonification and trophorestoration are
well established” [13]. The present study will be carried out to explore the concept of
trophorestoration of tissues by the test ointment with and without the treatment in second
degree thermal burns and compare it with ointment Silver Sulfadiazine.

MATERIALS AND METHODS

Materials
This study will be conducted under following headings.

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Experimental animal
All 18 albino rabbits weighing 3 to 3.5 kg will be used in this study. All albino rabbits will keep
in a temperature-controlled (25 ± 1°C) environment with a 12-h light/dark cycle and kept in
individual cages. They will feed with fresh hay, water, and fresh vegetables and given water ad
libitum will be obtained from Central Animal House of DMIMS [14]. All experimental
protocols involving the use of animals will be conducted in accordance with the CPCSEA
guidelines after the approval of institutional animal ethical committee.

Selection of material/drug
The plant of Amalaki and other material will be identified authenticated and from Dravyaguna
Department of Mahatma Gandhi Ayurved College Hospital and Research Centre, Wardha.

The material/Drug: (Both the experimental drugs will be freshly prepared)

 Amalaki Patra in the form of Mashi
 Coconut oil- 100% standard virgin pure oil
 Silver sulphadiazine1% 25 gm will be used which is procured from AVBRH pharmacy

Methods
Experimental Study
Preparation of animal models
The albino rabbits will be acclimatized to laboratory conditions for one week prior to the
experiment. The albino rabbits will be anesthetized with single intramuscular injections,
xylazine 2.5-10 mg/kg IM, ketamine 22-50 mg/kg IM.

Thermal injury
1. The area on the back of the rabbit was shaved and animal kept for fasting overnight. The next
day the animal was anaesthetized using Ketamine in the dose of 50 mg/Kg of body weight I.M.
(1 ml/kg of body weight). A metal disc of wt. 50 gm, diameter 2.5 cm (25mm), thickness 1.1cm
(11mm) and area 4.910 sq. cm (491.07 sq. mm) was heated in the blue portion of the flame of
spirit lamp for 5 minute and then immediately kept on the shaved part for 30 seconds with
minimal pressure. This method was found to be more accurate and convenient in producing the

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second degree burns in comparison with the molten wax method. The scientific paper in this
regard was presented in 56th annual national conference of physiologist and pharmacologist of
India, APPICON 24th December 2010, JNMC, Sawangi, Maharashtra.
2. Administration and Application of Drugs: Standard Ointment Silver Sulfadiazine and
New Herbal Ointment was applied daily on the burn wound.
3. Fluid resuscitation: All animals will be immediately resuscitated with lactated Ringer’s
solution (2 ml/100 g body weight) applied intraperitoneally to prevent dehydration.
4. Cooling effect: After Burn the area of burn will immediately cooled by Running water and
cold water. (2 to 15°C).
5. Local anesthesia: To prevent pain Novocain 5 % ointment will be used.
6. The burn should subsequently be covered with a sterile, occlusive, non-adherent dressing to
reduce pain, limit contamination, and prevent further trauma.
2.2.3 Preparation of the material/drug
Preparation of Amalaki Patra Mashi will be done on the basis of classical methods given the
text of Ayurveda.
 Amalaki Patra Mashi ointment
Preparation of the ointment will be done as per Malhar Kalpana.
2.2.4 Anatomical assessment criteria for burn wound
Microscopic assessment of Dagdha Vrana
1. According to ayurveda parameters and Grades
-Varna (colour)
-Strav (secretions)
-Gandha (smell)
-Akriti (Floor & Granulations)
2. Assessment according to Vrana on the day 0th, 4th, 8th, 15th and 21st
3. Wound contraction rate will be calculated according to formula-
Wound contraction rate =
Original wound area - specific day wound area/ Original wound area ×100.
4. Criteria for grading of epithelial regeneration
Microscopic Assesment of Dagdha Vrana-
1. Histopathology: Punch biopsy [15].
2. Parameters of histological assessment of wound.

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3. Parameters of histological assessment of Ayurvediya Twacha.

4. Blood investigations -SOD and MDA levels.
2.3 Method of Data Collection
Data will be collected by laboratory reports and 2.4 Statistical Analysis
The thickness of granulation tissue will be examined at the center of each wound and recorded.
The data were expressed as means ± standard errors (SEM). Differences between group means
and between days four, nine, and 14 were estimated using a one-way analysis of variance
(ANOVA) and a Duncan test was performed for multiple comparisons using the SPSS 12.0 for
Windows. Results were considered as statistically significant at P < 0.001.
Expected Results
To find out better drug in Dagdha Vrana (Burn wound) though Trophorestoration concept of
Ayurveda wrt Twacha Sharir.
DISCUSSION
The healthy regeneration of tissues is based on the fundamental concepts of Ayurveda which
encourages tissue regeneration Santarpan (nourishing), Jivaniya (life promoting), Bruhan
(Bulk promoting), Ropan (Healing), Sandhan (Unifying), Tarpan (Nutrient Provider), Preenan
(Nutrient Provider) [15-17]. Amalaki acts as a both Vayasthapan and Rasayan Herb which
having restoration property [18]. The concept of Trophorestoration which is the path to repair
and regeneration is well established in Ayurveda through herbal medicine through herbal
medicine [19]. Modern medicine is yet to explore conceptual aspects of the regenerative
medicine. Hence it is need to explore Trophorestoration concept of Ayurveda based on
fundamental modalities in case of Dagdha Vrana compare with modern medicine [20]. 4.
CONCLUSION
Conclusion will be made on the basis of result of Statistical Analysis and histopathology
reports.
CONSENT
It’s not applicable.
ETHICAL APPROVAL
Protocol is approved by institutional animal ethics committee.
COMPETING INTERESTS
Authors have declared that no competing interests exist.
REFERENCES

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1) Wiley online library. Ruthm Baxter. Journal of Biomedical Materials Research, Part A.
2013;101(2);340-348.
2) NIH: National Institute of General Medical Sciences, Medline plus, Burn, National Library
of Medicine 8600 Rockville Pike, Bethesda, MD 20894 U.S. Department of Health and
Human Services National Institutes of Health.; 2016.
3) Robert HD. Burn and other thermal injuries. In: Current Surgical Diagnosis and Treatment.
Lawrence WW, Gerard MD, 11th Ed; Large Medical Books/McGraw Hill. 2003;267.
4) Audrey Lin, Akishige Hokugo, Ichiro Nishimura. Wound closure and management. Cell
Adhesion & Migration, Taylor & Francis. 2010;4(3):396-399.
5) Prabhakar Rao. A textbook of Bhaishajya Kalpana Vigyanam, Chapter 5, Chawk-hamba
Sanskrit Samsthan, Reprint. 2016;183.
6) Dubey Somil. Review Malhar Kalpana of Rasa Tarangini. J. Ayurveda Inegr. Medicine.
S.C. 2019;79-84.
7) Prabhakar Rao. A textbook of Bhaishajya Kalpana Vigyanam, Chapter 5,Chawkhamba
Sanskrit Samsthan, reprint -2016;183
8) Rajeshwardatta Shastri, Charak Samhita, Sutrasthan, Vol-1, Chapter 26, verse 42,
Chawkhamba Bharti Academy Prakashan, Varanasi. 2005;507
9) W. Dnyaneshwar, C. Preeti, J. Kalpana, and P. Bhushan, “Development and Application of
RAPD-SCAR Marker for Identification of Phyllanthus emblica Linn,” Biological and
Pharmaceutical Bulletin.. 2006;29(11):2313–2316.
10) Sharma L, Agarwal G, Kumar A. “Medicinal Plants for skin and hair care.” Indian Journal
of Traditional Knowledge. 2003;2: 62–68.

11) Rajeshwardatta Shastri, Charak Samhita, Sutrasthan, Vol-1, Chapter 26, verse 42,
Chawkhamba Bharti Academy Prakashan, Varanasi. 2005;507.

12) Rubaiyat Hasan, Md. Nasirul Islam and Md. Rokibul Islam International Current
Pharmaceutical Journal. “Review article phytochemistry, pharmacological activities and
traditional uses of Emblica Officinalis”, Department of Biotechnology and Genetic
Engineering, Islamic University, Kushtia-7003, Bangla. January 2016;5(2): 14-21.

13) Vincent Di Stefeno. Towards Regeneration. Australian Journal of Medical Herbalism

1990;2(3):55-58.

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14) Jari Olavi Summanem. A chemical and ethnopharmacological study on Emblica officinalis.
1999;951-45-8677-8.

15) Han SH, Lee JH. An overview of peak-to-average power ratio reduction techniques for
multicarrier transmission. IEEE Wireless Communications. 2005; 12(2):56-65.

16) Hostutler RA, Luria BJ, Johnson SE, Weisbrode SE, Sherding RG, Jaeger JQ, Guilford
WG. Antibiotic‐responsive histiocytic ulcerative colitis in 9 dogs. Journal of Veterinary
Internal Medicine. 2004;18(4):499-504.

17) Weydert CJ, Cullen JJ. Measurement of superoxide dismutase, catalase and glutathione
peroxidase in cultured cells and tissue. Nat Protoc. 2010;5(1):51–66.

18) Vinaya PN, Prasad JSRA. Concepts of tissue regeneration in Ayurveda: Their significance
to the science of regenerative medicine. J Pharm Sci Innov. 2014;3(3): 192-19.

19) Vincent Di Stefeno. Towards Re-generation. Australian Journal of Medical Herbalism

1990;2(3):55-58.
20) Durmus Z, Kavas H, Toprak MS, Baykal A, Altınçekiç TG, Aslan A, Bozkurt A, Coşgun S.
L-lysine coated iron oxide nanoparticles:
21) Synthesis, structural and conductivity characterization. Journal of Alloys and Compounds.
2009;484(1-2):371-6.

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35.
CLINICAL IMPORTANCE OF VYADHIKSHAMTVA IN PATHOGENESIS
OF DISEASE
1
Vd. Sumant M Pande,2Vd. Maheshwari D Joshi,
1
Associate Professor, Department of Rognidan, Mahatma Gandhi Ayurved College,
Hospital & Research Center Wardha.
2
Assistant Professor, Department of Swasthavritta and Yoga, Dr. Rajendra Gode Ayurved
College, Hospital & Research Center, Amravati.

Abstract:
Introduction:
For prevention and cure of diseases, Ayurveda had advocated the adherence to concepts
like dinacharya, ritucharya, sadvritta, vega dharan etc. These measures are useful in
preventing the lifestyle disorders and to maintain health. For prevention of
the Aupsargik roga (communicablediseases), Janapadodhwansa roga (epidemic diseases),
Krumij Roga (Infectiousdiseases), Asatmyaj roga (allergic disorders), the concept
of Vyadhikshamtva (Immunity) is propagated by the Ayurvedic science. According to the
concept of Ojas or Vyadhikshamatva or Bala (immunity), the body’s resistance is of
tremendous importance in the daily welfare of living beings not only for disease prevention but
also for rapid recovery after disease affliction. Ayurveda propounds that prevention is an
equally important aspect of disease management as cure and thus, strengthening the immune
system, is a natural way to help the body fight against the disease-causing pathogens.
Acharyas promoted the use of Rasayana (Rejuvenation) to enhance ojas and vyadhikshamatva
(immunity). Aim: To critically analyze the core ayurvedic concept of vyadhikshamatva in
prevention and cure of disease Objectives: 1.To study the concept of vyadhikshamatva in
ayurvedic perspective 2.To study the correlation between Bala and vyadhikshamatva.3.To
study the role of vyadhikshamatva in prevention and cure of disease. Material and method:
This is a pure literary study, done only from the original ayurvedic classical texts. Result:
Results are drawn on the basis of all references Discussion: Discussion is done on every aspect
of vyadhikshamatva.
Keywords: Vyadhikshamatva, Immunity, Rasayana, Janapadodhwansa Roga, Pathogenesis
Of Disease.

Introduction:

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्िाधी्ቌमणॎिं नाम ्िाधीबलििरोिधणॎिं ्िाध्युणॎपाद्ቚितबधॎधकणॎििमित याित्!

Vyadhikshamatva is one of the fundamental concepts of ayurved. The ability of a body
to prevent and resist the development of disease is called as vyadhikshamatva. The word
vyadhi means to harm, to injure or to damage and the word kshamatva means to compose, to
suppress or to resist. The term vyadhikshamatva was first coined by chakrapani in a very
scientific manner, as Vyadhibalavirodhitva (्िाधीबलििरोिधणॎि) an ability of body to fight

against the manifested disease. Vyadhyutpadpratibandhakatva (्िाध्युणॎपाद्ቚितबधॎधक) an ability

of the body to prevent the disease to develop in the body. [1]
The term vadhikshamatva is not a frequently used term in ayurvedic literature but it is
well explained in terms of bala and Oja. Certain factors in the body such as Agni, Sarata,
Prakriti, Ahar, Vihar, etc. influence the vyadhikshamatva more or less. Disturbances in the
normal course of vyadhi ghataka i.e. Dosha, Dushya, Aam, Srotorodh and agnimandya are
considered as the major foctors in the invasion and development of disease in the body. In
today’s era awareness about ayurveda is increasing day by day within general population.
People are excited to receive ayurvedic treatment for well being and also for the diseases.
Hence it becomes mandatory for all ayurvedic physicians to think upon fundamental principles
of ayurveda once more. This chapter is an attempt of critical analysis of the concept
Vyadhikshamatva. It is more highlighted in COVID 19 period. Aim: To critically analyze the
core ayurvedic concept of vyadhikshamatva in prevention and cure of disease.
Aim: To critically analyze the core ayurvedic concept of vyadhikshamatva in prevention and
cure of disease.

Objectives:
1. To study the concept of vyadhikshamatva in ayurvedic perspective
2. To study the correlation between Bala and vyadhikshamatva
3. To study the role of vyadhikshamatva in prevention and cure of disease.

Material and method:

This is a pure literary study, done only from the original ayurvedic classical texts; hence
the material used is only classical texts of ayurved. All the references of Vyadhikshamatva are
gathered together and and light is focused on each and every angle of vyadhikshamatva.
Discussion is done on every aspect of vyadhikshamatva.

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Review and Literature search:

Immune reaction in ayurvedic perspective:
देहधातू ्ቚणॎयिनकभूतािन ्ቖ्िािर् देहधातुिभर्िणरोधमाप्ቕधॎते II

परस्परगुर् ििरु्ቍािन कािनिित् कािनिित् संयोगात् संस्कारादपरािर्

देश काल मा्ቔाऱदिभ्ीापरािर् तथा स्िभािादपरािर्II

ि. सु. 26/81
Charakacharya has explained the exact phenomenon of immune reaction in ayurvedic
view. Dehadhatu pratyanik dravyas (Antigens) face resistance from the dehadhatus
(Antibodies from cells) because of Paraspar Gunavirodha (factors like antagonistic properties
of each other), sanyoga (Unexpected and sensitive contact), sanskara (improper processing),
deshavirodha (unsuitability to geographical distribution), Matravirodha (Abnormal dose),
Swabhavat ( as a natural defensive reaction against antigens)
The asatmya dravyas (Incompatible substances) constitute to the antigens to the body
as its contact leads to the allergic manifestation in the body. These asatmya dravyas may be
food items or microbes. This leads to the manifestation of disease and hence vyadhikshamatva
comes into its role.[2]
Bala and oja are the major components of vyadhikshamtva.
Bala: Bala is classified into three types; sahaj, kalaja and yuktikrit.
ि्ቔििधं बलिमित सहजं कालजं युििकृ तं िI

सहजं सच्छरीरसणॎियोः ्ቚाकृ तं I

कालकृ तमृतुििभागजं ियःकृ त ि I

युििकृ तं पुनस्त्ቕदाहारिे्ቖायोगजम्I

ि. सु. 11/36

Sahaj: It means Bala (the physical and mental strength) which is present by birth. It is an
inherent Characteristic property of an individual present since birth. Sahaj Bala is a result of
equilibrium state of Sharir and manas doshas.
Kalakrit Bala: It is also called as kalaja Bala. This type of bala depends upon Seasonal and
age related changes. Visarga kala offers more strength to entire population and hence this is a
season In which there are less chances to have disease.

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Yuktikrit Bala:
This is acquired type of strength. Strength can be acquired from healthy diet and Activities.
Chakrapani says that performing exercise with appropriate methods by giving rest in Between
can increase strength. Also rasayan therapy is useful to increase strength.There are certain
factors which are described by charakacharya; these things Directly favor the promotion of
strength (Bala enhancing factors).[3]
बलिृि्ቍकरािस्णॎिमे भािा भििधॎत!

त्ቕथा बलिणॎपुरुषे देशे जधॎम, बलिणॎपुरुषे काले ि,

सुख्ी कालयोगः बीज्ቌे्ቔगुर्संप्ሴ आहरसंप्ሴ

शरीरसंप्ሴ साणॎ्यसंप्ሴ सणॎिसंप्ሴ स्िभािसंिसि्ቍ्ी

यौिनं ि कमं ि संहषण्ीेित !

ि. शा. 06/13
1. Birth of a person in a country where people are strong by means of their natural
configuration for e.g. in Punjab and sindha region, people are naturally strong.
2. Time factor which helps and promots dhatu poshan for example a person born in visarga
kala, is stronger than one in aadan kala.
3. Good quality of sperm, Ovum (beeja) and healthy uterus (Kshetra) Promote strength of the
offspring.
4. Good quality and timely diet with appropriate nutritional values.
5. Excellency in physique
6. Wholesomeness and suitability of diet and environment.
7. Superior mental status, stress free life
8. Natural mechanism, good going daily routine.
9. Younger age
10. Physical activities and time bound exercise
Combination of all these factors exerts positive cumulative effect on bala and ultimately on
vyadhikshamatva.
Birth place is a factor which one can achieve by virtue of one’s destiny only; but the other
factors are definitely in the patients hand to improve the strength.[4]
शरीरािर् िाितस्थूलाधॎयितकृ शाधॎयिनिि्ቖमांस शोिर्तािस्थिन

दुबणलाधॎयसाणॎ्याहारोपििताधॎयल्पाहाराण्यल्पसणॎिािन ि

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भिधॎणॎय्िािधसहािन, ििपररतािनपुन्िाणिधसहािन!

ि. सु. 28/07
In above quotation, Charakacharya has explained which person is vyadhiksham and which is
not. That means who can resist the disease well and who cannot.
1. Obese individual
2. Over emaciated individual
3. Whose rakta (Blood) and mamsa (Muscles) are deprived or deteriorated.
4. Very weak and debilitated person
5. Who consumes unwholesome food
6. Who consumes less amount of food
7. Whose mental status is weak, or weak moral
All these individuals are very prone to have disease on the other hand opposite to this
type physical and mental constitution is capable of resisting diseases.[5]
एषां खल्िपरे षां ि िैरोिधकिनिम्ቈानां ्िाधीनां इमे भािाः ्ቚितकारा भििधॎत I

त्ቕथा ििधैः ि ्ቖ्िैः पूिणमिभसंस्काराः शरीरस्य इित I

ि. सू 26/104
Body should be preconditioned for fighting against the asatmya dravyas (allergic or
incompatible) like food or microbes by slow sensitization of body with low dose of allergens or
antigens at regular intervals. [6]
Hemadri in his commentary on Ashtang Hriday classifies vyadhhikshamatva as
Krutrim (Artificial) and Akrutrim (Natural)
Oja:
ओजः सोमणॎमकं ििग्धं शुक्लं शीतं िस्थरं सरम्

िििििं मृद ू मृणॎिं ि ्ቚार्ायतनमु्ቈमं I

सु.सू.15/21
Oja plays pivot role in expressing vyadhikshamatva against vyadhi. Oja is considered as the
essence of all the dhatus in the body. Its, ununctus, whitish, cold, soft fluid. The body
complexion and lusture depends upon the Oja.[7] Oja is classified into Para and apara Oja.
Para Oja: Para Oja is a prime ojas where prana –the life resides. It’s only 8 drops in quantity;

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white and yellowish red in colour and partial destruction or little decrease in its quantity lead to
death.
Apara Oja: Apara Oja is half anjali in quantity. Its less important than para oja.
ओजोिििृ्ቍौ देहस्य तुि्ቖ पुि्ቖ बलोदयः ! अ हृ सू 11/37
Ojovriddhi means quantitative increase in Oja causes strengthening of body. It is so much
intimately responsible for bala (Strength) of the body that the two terms Ojas and Bala can be
used as synonyms. There is no bala without adequate quantity of Ojas.[8]
Oja also undergoes Vriddhi (Increase) and Dushti (Vitiation)by indulgence of food and
activities which are similar opposite to its qualities respectively. Increase of Ojas bestows
tushti (contentment or satisfaction), Pushti (Good nourishment) and Balodaya
(Improvement-physical and mental capacity to resist diseases) hence Oja vriddhi improves
health and prolongs life. So it considered as ideal to health and to be cherished.
Ojakshaya on other hand weakens the body allows deases to develop, shortens the
lifespans and even kills the patient hence this is considered as serious abnormality and should
be prevented from taking place.
Causes of Ojakshaya:
Important causes which bring about decrease of ojas are ativyayam (excessive physical
activities), Anashana (excessive of starvation), Alpashana (Very little food intake), Ruksha
anna (intake of Dry food), madyapaan (Excessive alcohol consumption), Atichinta (Excessive
thinking or Worry), shoka (Grief), Krodha (Anger), Bhaya (Fear), and such other mental
emotions. Prajagara (loss of sleep), Abhighata (Injury), Abhishanga (Assault by evil spirit,
microorganism), Dhatukshaya (Depletion of dhatus), Excessive excretion of kapha, shonita
(Blood), shukra (semen), and malas (waste products), Ingestion of visha, (poisons ) etc.
The pathological condition of oja reduce vyadhikshamatva, There are three types of
vitiation of Oja-
1. Ojovyapat
2. Ojovisramsa
3. Ojakshaya
स्तब्ध गुरुगा्ቔता िातशोफो िर्णभेदो ग्लािनस्तधॎ्ቖा िन्ቖा ि ्िाप्ቐे I
सिधॎध िि्ቨेषो गा्ቔार्ां सदनं दोषच्यिनं ऱियासि्ቐरोध्ी I
मुच्छाण मांस्ቌयो मोहः ्ቚलापो मरर्िमित ि ्ቌयेI
सु. सू.15/24

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Ojovyapat: When vitiated doshas contaminate Oja, symptoms like stabdhata (Stiffness),
Gurugatrata (Heaviness in body), Vata Shopha (Oedema due to vata origin), Varnabhed
(Discolouration), Glani (Exaustion), Tandra (Stupor) are produced; This condition is called as
Ojovyapat.
Ojovisransa: Dislodgement of Oja from its original site is called as ojovisransa. This is a
mild stage characterized by sandhivishlesha (Looseness of joints), gatrasadan (General
debility), Doshachyavan (Dislodgement of doshas from their normal sites), Kriya sannirodha
(Obstruction to physical and mental activities).
Ojakshaya: This is third type of ojodushti which is characterized by serious menifestations
like Murcchha (Fainting or loss of consciousness), Moha (Delusion), Pralapa (Irrelevent talks),
Mamsakshaya (Wasting of muscles), Atidourbalya (Severe debility), Bhaya (Fear of death),
Atichinta, Dikha (Excessive worry), Indriya vyatha (Disorders of sense organs), Durmana (Bad
mental state), Duschaya (Bad discolouration) and even Marana (Death).[9]
Discussion:
Immunity is a parallel concept to vyadhikshamatva in contemporary sciences. But
immunity concerns about only communicable diseases or allergic reaction. Concept of
vyadhikshamatva includes both communicable and non-communicable or life style disorders.
Ayurveda offers healthy life style along with lot many procedures and medicines to develop
vyadhikshamatva, bala or Oja.
There are certain concepts which vyadhikshamatva depends upon such as Ahara; Good, potent
food give proper nourishment to dhatus, Agni; if the digestive power is low, it causes
formation of Aam; which further leads to disease hence good quality of agni offers goo
vyadhikshamatva. Aharavidhi; the protocol of consuming food is also given by ayurveda,
following this protocol avoids formation of Aam and maintain proper digestion. Following
Daily and seasonal routine (Dinacharya and Ritucharya), Seasonal detoxification (Ritu
shodhan-Panchakarma), Nitya rasayana, Rasayana Therapy these are some of the concept
which can improve vyadhikshamatva very effectively.
References:
1) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurved-dipika ki Ayushi Hindi – commentary Part I
Sutrasthan 28/07 Pg. No. 472.

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2) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurvedipika ki Ayushi Hindi – commentary Part I
Sutrasthan 26/81 Pg. No. 397.
3) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurvedipika ki Ayushi Hindi – commentary Part I
Sutrasthan 11/36 Pg. No. 172.
4) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurvedipika ki Ayushi Hindi – commentary Part I
Sharirsthan 06/13 Pg. No. 831.
5) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurvedipika ki Ayushi Hindi – commentary Part I
Sutrasthan 28/07 Pg. No. 472.
6) Kushwaha Harish Chandra Singh Chaukhamba Orientalia Varanasi, Edition 2011, Charak
Samhita Shri Chakrapani Virachita Ayurvedipika ki Ayushi Hindi – commentary Part I
Sutrasthan 26/104 Pg. No. 403.
7) Sharma PVChaukhamba Vishwabharati, Varanasi, Edition 2004, Sushrut samhita, Volume
I, sutrasthana 15/21, Page No. 166
8) Shrikanthamurthy KR , Chaukhamba krishnadas academy Varanasi, Edition 2007,
Vagbhata’s Ashtang Hridaya,Part I, Sutrasthana, 11/34, Page No. 162
9) Sharma PV, Chaukhamba Vishwabharati, Varanasi, Edition 2004, Sushrut samhita,
Volume I, sutrasthana 15/21, Page No. 167.

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36.
MANAGEMENT OF LUMBAR RADICULOPATHY THROUGH
PANCHAKARMA & SHAMANA CHIKITSA -A CASE REPORT
1
Shweta Parwe, 2Milind Nisargandha, 3Anita Wanjari, 4Sheetal Asutkar
1
Department of Panchakarma, 2Associate professor, Saveetha Medical College, and Hospital,
Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
3
Department of R.S.B.KK. 4Department of Shalya. Mahatma Gandhi Ayurved College
Hospital & Research Centre, Salod (H), Wardha, Datta Meghe Institute of Higher Education &
Research (D.M.I.H.E.R.) (D.U.), Wardha, Maharashtra, India.

Abstract
Background: The most productive population on earth is greatly impacted by lumbar
radiculopathy. It has properties similar Gridhrasi, which is referenced in ancient Ayurvedic
texts. It can be identified by pain that travels from the lower back down one or both legs. One of
the most frequent issues examined by a spine surgeon is lumbar radiculopathy. It is thought to
afflict between 3 and 5 percent of the population and affects both men and women. The main
risk factor is ageing, which is made worse by the spinal column's degenerative process. Men
frequently experience symptoms in their 40s, whereas women typically experience them in
their 50s and 60s. Aim and Objectives: The purpose of this study was to evaluate the efficacy
of Ayurvedic therapy for Lumbar Radiculopathy, including Shodhana and Shamana Chikitsa.
Material and Methods: A single case study of a 42-year-old man who had Lumbar
Radiculopathy in L4-L5 was examined. He reported right leg tingling and numbness as well as
lumbar pain that had migrated to the right leg. He received panchakarma therapy, which
includes Siravedhana, Kati Vasti, Patrapinda Sweda, and Sarwanga Snehan and Swedana. A
total of 14 days were added to the course of treatment. Observation & Results: The patient's
symptoms were assessed after 14 days. The successful outcome resulted in a significant
improvement in the patient's overall quality of life. Conclusion: The regime mentioned above
significantly relieves the management of lumbar Radiculopathy.
Keywords: Gridhrasi, Lumbar Radiculopathy, Panchakarma, Shamana, chikitsa,
Vedanasthapana, Shothahara, Bruhana.
INTRODUCTION
Radicular pain frequently results from the irritation or compression of a spinal nerve. Sciatica
is the common name for the pain that travels down the back of the leg to the calf or foot. This
sort of pain is frequently deep and constant and can typically be triggered by particular
behaviors or situations, such as sitting or walking [1]. At some point in their lives, 3% to 5% of

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people are thought to develop lumbar Radiculopathy, a highly prevalent condition [2].
Men are more likely than women to experience symptoms in their 40s, while women are more
frequently afflicted between 50 and 60[3]. The leading cause of lumbar Radiculopathy is
degenerative spondyloarthropathies.
Without contrast, M.R.I. of the lumbar spine is the best imaging technique for assessing
Radiculopathy because it can detect nerve root compression. (see Figure 2). When a tumor,
infection, or previous surgery has occurred, contrast-enhanced M.R.I. may be beneficial or
necessary [4].
The main course of treatment includes NSAID, physiotherapy, and steroids, all of which have
serious adverse effects on the hepatic and renal systems. However, the apparent negative
effects of these procedures prevent their prolonged use [5]. As symptoms increase over time,
lumbar canal stenosis may develop, necessitating surgical treatment such as hemifacetectomy,
microdiscectomy, laminectomy, nucleoplasty, or disc excision, among other procedures [6].
As a result, many researchers are seeking for alternative preventative and curative approaches
in Ayurveda, i.e., holistic science.
In Ayurveda, the world's most productive population is harmed by lumbar Radiculopathy, a
severe health issue. It has closets resembling Gridhrasi, mentioned in Ayurvedic classics. It is
characterized by pain that radiates along the sciatic nerve, which travels from the lower back
down one or both legs. Gridhrasi comes under Nanatamja Vata Vyadhi. Several ancient
scriptures mention Katigraha and Gridhrasi; according to the ancient Acharyas,
Panchakarma, particularly Vasti (Niruha & Anuvasana), which Charaka regarded as excellent
treatment, can be pretty effective in managing Katigata Vata. This technique, given in
Pakvashaya, can effectively manage vitiated Vata as it develops in the lumbar region [7]. The
current case study demonstrates how effective it is to manage Lumbar Radiculopathy
employing a collaborative therapy method based on Shodhana & Shaman Chikitsa.
PATIENT INFORMATION:
It is a single Case study having Demographic details mentioned in Table No.1
CLINICAL PRESENTATION OF THE PATIENT:
The chief & associated complaints of patients are mentioned in Table No. 2
PROGRESSION OF DISEASE:
The patient was well before 4-5 months but had a history of falls, and the above symptoms
developed. He adopted allopathic treatment for the same and got temporary relief. Therefore,

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he approached the outpatient department of Panchkarma, Mahatma Gandhi Ayurveda College,

Hospital & Research Center Salod (H) Wardha, Maharashtra, for further treatment.
HISTORY OF THE PATIENT:
The detailed account of the patient is given as follows:
 Family history: No significant family history was found.

 Past History: History of fall five months back. No other surgical history related to the
Disease was obtained.

 Personal history:
 Ahar: Vegetarian, Daily intake of oily, sweet, and fermented food
 Vihara: Jagrana (Night awakening), Atishrama (excessive exertion)
 Nidra: Interrupted sleep at night due to aggravation of the pain
 Vyasana: Nil
 Vyayam: No
CLINICAL EXAMINATION
 Ayurvedic examination

Ayurvedic examination of the patient is narrated in table no. 3

 SAMPRAPTI GHATAKA

Dosha - Vata and Kapha

 Dushya - Majjadhatu, Asthidhatu, Mamsadhatu

 Strotas- Majjavaha, Asthivaha, Mamsavaha

 Udbhavsthan- Pakvashaya

 Adhishthan- Sandhi, Asthi

 Vyaktisthan - Katisthana

 Modern Examination

 Inspection:

 No kyphosis or scoliosis, but there was flattening lordosis as well

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 No additional anomalies, such as spina bifida or scars that may indicate spinal surgery

 The functional overlay was present, i.e., there was discomfort when the patient was
requested to sit up on the couch and flex their knees or recline on the couch.
 Auscultation: No abnormality seen
 Percussion: No abnormality observed
 Palpation:
 Leaning forward caused mild sensitivity between the lumbar vertebrae, the
lumbosacral junction, and the lumbar muscles.
 There was no sacroiliac joint tenderness.
 There was axial loading since the back pain worsened when pressure was applied to
the head.
The Local examinations (i.e., Disease specific examination) is given in Table 4.
INVESTIGATIONS: (Clinical findings of M.R.I. lumbosacral spine dated 25-10-2022(Image
no.1)
L4-L5 DISC LEVEL: There are episodes of diffuse disc bulge indenting over the anterior
thecal sac at this level with narrowing of bilateral lateral recess and severe narrowing of
right-sided neural foramina and obliteration of left-sided neural foramina causing compression
of bilateral traversing and exiting nerve roots. There are episodes of canal stenosis at this level
IMPRESSION: MRI LS Spine reveals LUMBAR RADICULOPATHY at L4-L5 the disc level
DIAGNOSIS: Lumbar Radiculopathy
THERAPEUTIC INTERVENTIONS:
The line of treatment (Panchakarma & Shamana Chikitsa) is given in tables 5 & 6, separately.
THERAPEUTIC OUTCOME:
Observations: On the basis of tables 7 and 8 this indicate the symptoms that were observed and
how they improved. After 14 days of Ayurvedic treatment, the patient reported total remission
from all indications and symptoms of lumbar Radiculopathy, including pain in the lumbar area
radiating to the right leg, tingling, and numbness in the right leg.
DISCUSSION: A very serious issue is lumbar radiculopathy. It has clinical characteristics
include discomfort that spreads to both legs, tingling, and numbness in both legs. It resembles
Gridhrasi the most among the classical Ayurvedic remedies. The Samprapti, or Ayurvedic
idea of pathogenesis, is as follows: The degeneration of Asthi, Mamsa, and Majja Dhatu is

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what leads to the symptoms of gridhrasi, which are brought on by vitiated Vata and reduced
Shleshak Kapha. The intended therapy strategy for this patient's likely mode of action is as
follows:
Mode of action of Panchakarma Chikitsa
Abhyanga strengthens muscles by acting directly on them. Mamsavaha Srotas's root is
comprised of Snayu (ligaments), Tvacha (skin), and Raktavahini (blood vessels). Abhyanga is
performed over Tvacha and Snayu in this instance and involves Raktavahini. Therefore,
Mamsavaha Srotas receives a direct benefit in this case. Additionally, Abhyanga nourishes
deeper Dhatus. Here, we may state that Abhyanga strengthens muscles, which results in stable
joint joints[8].
Through transdermal absorption into the Ushna Veerya and Snigha Guna, Dashmool oil in Kati
Vasti affects the surrounding musculature. As a result, it serves as a school for Prashamana,
Pushtikara, Shramahara, and Bala Vardhaka. In the impacted area, it results in Snigdhata and
Mardawata. Additionally, it stimulates local blood flow, which aids in the drainage of
inflamed exudates[9].
Patra Pinda Sweda reduced Stambha when applied to the damaged parts part of
body—Sandhichestakara, Srotosuddhikara, Agnideepaka, and Kapha-Vatanirodhana. It
reduced pain, relaxed muscles, activated the local metabolic process, increased regional blood
flow, and so promoted Sneha absorption through the skin. Swedana may have a hypoalgesic
effect after consumption by deflecting stimuli. [10]
An essential Sneha Kalpana (oil formulation) called Ksheerabala Taila is made from
Go-Ksheera (cow milk), Bala (Sida cordifolia), and Tila Taila and is referenced in Ayurvedic
writings (sesame oil). All the nutrients needed for bone, nerve, muscle, and other bodily tissue
growth and sustenance are in cow's milk. One of the three most used raw medications in
Ayurveda, Bala is a precious drug. It is frequently mentioned in Ayurveda and used extensively
in treating neurological and cardiovascular conditions. It is also said to have hepatoprotective,
anti-inflammatory, and analgesic properties. All Dhatus are nourished and strengthened by
Tila Taila, which regulates Dhatukshaya and calms Vata. Go-Ksheera, Bala, and Tila Taila's
presence enable Ksheerabala Taila to appease all eighty [11].
Sahachara Taila, or "Sarvavatavikarajit," was utilized for Basti [12]. Ayurvedic herbal oil
called Sahachar Tail Basti is used to cure diseases caused by Vata imbalance, including tight
muscles and joints. Because of its weight and luscious Guna, Vata Dosha is balanced. It

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improves healthy muscle function by nourishing the muscle fibers. Tendons and ligaments are
relaxed and soothed by their phytochemical makeup.[13].
Pitta, Rakta, and Kaphaja Vyadhies or situations where Pitta and Kapha are in Anubandha to
Vata Dosha are where Siravedhan is most often recommended. In such cases of Vata Prakopa
caused by Kapha and Pitta Avarana, Siravedhan can assist in removing the Avarana of Pitta
and Kapha Dosha, allowing for Anuloma Gati of vitiated Vata which in turn indirectly treats
the Vatika symptoms as well as symptoms brought on by Kapha Dosha [14] because the blood
that has gathered is released through Siravedhan, creating a space that is free for limb
movement [15]. Numerous potential mechanisms, including an improvement in local blood
supply, a boost in local metabolism, and the production of new, active R.B.C.s, are thought to
occur in the body due to bloodletting, according to contemporary theory. Resuming the healing
process is made possible by directly stimulating immune-related T-lymphocytes in the bone
marrow and releasing hormones and other chemical messengers, such as sympathetic nerve
function [16].
Simhanada Guggulu possesses Ama and Kapha's antagonistic qualities, which are the leading
causes of this sickness. They boost digestive power due to their Agnivriddhikara property,
which also aids in the digestion of Amarasa, lowers excessive Kapha production, and relieves
Srotas blockage. It also soothes vitiated Vata because of Ushna Virya. When Katu Rasa and
Kaphahara Karma of Ruksha, Laghu Guna, and Ushna Virya Amadosha Pachana occur, Katu
Rasa aids in the Agni Deepana Pachana Karma of Ushna Virya. The Lekhana Karma of Laghu
Guna and Tikta Rasa eliminates the attached Dosha from the Dushita Srotas. Simhanada
Guggulu's Ushna qualities prevent the Ama from remaining at the site of pathogenesis and
producing Srotorodha. This lowers Srotorodha[17].
Ashwagandha is an anabolic herb that gives you strength, a Bruhaniya herb that feeds your
muscles and bones, and a Rasayana herb (immunomodulator)[18].
According to ancient texts, tablet Shallaki performs as Aampachak, Kaphapitta Shamak,
Vedanahara, and Shotha Shamaka [19].

CONCLUSION:
Based on the fundamentals of Ayurveda, this case study demonstrated that Lumbar
Radiculopathy could be successfully handled with Shodhana and Shamana Chikitsa. No, this
treatment plan is what caused the unintended adverse effect. Future clinical trials should be

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planned in a broad population using the same protocol.

ACKNOWLEDGEMENT:
I am very grateful to the Patient, PGs, editor and all research cell team, Mahatma Gandhi
Ayurveda College Hospital and Research Center Salod (H), Wardha, for giving me this
opportunity and encouragement

FINANCIAL SUPPORT AND SPONSORSHIP: Nil

CONFLICTS OF INTEREST: There is no conflict of interest

REFERENCES:
1. https://www.spine-health.com/conditions/lower-back-pain/lumbar-radiculopathy

2. Parchake A, Parwe S, Nisargandha M. Management of gridhrasi (Sciatica) through

panchakarma and shamana chikitsa: A case study. Asian J Biomed Pharmaceut Sci.
2022; 12 (92).;138.

3. Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurologic clinics. 2007 May
1;25(2):387-405.

4. Berry JA, Elia C, Saini HS, Miulli DE. A review of lumbar Radiculopathy, diagnosis,
and treatment. Cureus. 2019 Oct 17;11(10).

5. Ukhalkar VP. EFFECT OF MASHADI TAILAM ANUVASAN BASTI IN

MANAGEMENT OF KATIVATA WITH SPECIAL REFERENCE TO LUMBAR
SPONDYLOSIS. International Journal of Research in Ayurveda & Pharmacy. 2013
May 1;4(3).

6. Amarprakash D, Anaya P. Management Of 'Katigat Vata'wsr To Lumbar

Spondylolisthesis. Ayushdhara. 2017;4(4):1224-9.

7. Sharma PV, editor. Sutrasthana; Maharog Adhyaya. Charaka Samhita of Agnivesha.

8th ed. Chapter 20, Verse 11. Varanasi, India: Chaukhamba Orientalia; 2007. p. 139.

8. Shah MR, Mehta CS, Shukla VD, Dave AR, Bhatt NN. A clinical study of Matra Vasti
and an ayurvedic indigenous compound drug in managing Sandhigatavata

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(Osteoarthritis). AYU (An international quarterly journal of research in Ayurveda).

2010 Apr 1;31(2):210.

9. Parwe S, Jadhav S, Nisargandha M. Comparative Clinical Trial on Aragwadha Erand

and Trivrutta Eranda Nitya Virechana in Gridhrasi (Lumbago Sciatica Syndrome): A
Study Protocol. Journal of Pharmaceutical Research International. 2021 Jul
29;33(39A):68-74.

10. Joshi A, Mehta CS, Dave AR, Shukla VD. Clinical effect of Nirgundi Patra pinda
sweda and Ashwagandhadi Guggulu Yoga in managing Sandhigata Vata
(Osteoarthritis). Ayu. 2011 Apr;32(2):207.

11. Verma J, Mangal G. New Perspectives of Ksheerabala Taila (oil): A Critical Review.
International Journal of Ayurveda and Traditional Medicine. 2019 Dec 31;1(1):24-30.

12. Kumari CR, Singh BK. EFFECT OF PATHADI KWATHA AND SAHCHARA
TAILA MATRA BASTI IN POLYCYSTIC OVARIAN DISEASE-A CASE
REPORT.

13. Pednekar SB, Tiwari VJ, Chavan A. EFFECT OF BASTI KARMA IN GRIDHRASI-A
CASE STUDY. International Journal of Ayurveda and Pharma Research. 2020 Apr
2:25-30.

14. Kumar JV, Dudhamal TS, Gupta SK, Mahanta V. A comparative clinical study of
Siravedha and Agnikarma in management of Gridhrasi (sciatica). Ayu. 2014
Jul;35(3):270.

15. Poonam M, Sudesh G, Kirandeep K. Clinical Evaluation of Siravedha in the

Management of Gridhasi with Special Reference to Sciatica. International Journal of
Ayurveda and Pharma Research. 2015;3(10):21-5.

16. Uniyal N, Kumar V, Verma S, Sharma PK. SCIATICA-A CONCEPTUAL STUDY.

17. Pandey SA, Joshi NP, Pandya DM. Clinical efficacy of Shiva Guggulu and Simhanada
Guggulu in Amavata (rheumatoid arthritis). Ayu. 2012 Apr;33(2):247.

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18. Narayan G, Sharma MK. MANAGEMENT OF CERVICAL SPONDYLOSIS

REDICULOPATHY IN AYURVEDA CASE REPORT.

19. Verma A, Dhenge S. A Case Study on Ghatiyantra and Shaman Yoga Chikitsa in
Management of Gridhrasi (Sciatica Neuritis).

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Image no.1: clinical findings of M.R.I. lumbosacral spine

Table No.1: Demographic details of the patient
S.N Demographic details of patient Information
1 Name of patient A.B.C
2 Age 42yrs
3 Sex Male
4 Residence Wardha
5 Occupation Cleark
6 D.O.A 27-01-23
7 D.O.D 10-01-23

Table No.2: Complaints of the patient

S.N Nature of Complaint Duration
A Chief Complaints:
1 Pain in the lumbar region radiating to the right leg

2 Tingling sensation on Right leg Since 4-5months

3 Numbness in Right leg
B Associated complaints:
1 Difficulty while walking & forward bending Since four months
2 Disturbed sleep due to pain

Table No.3 Ashtavidh Parikshana

S.N Head Observation
1 Nadi 74/min, Niyamit
2 Mala Asamyak (Once Per day, Unsatisfactory, Irregular, hard and sticky
stool)
3 Mutra Samyak(5-6 times /day , satisfactory)
4 Jivha Saam
5 Drika Spashta

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6 Shabda Spashta
7 Sparsha Anushnasheeta
8 Akruti Madhyam

Table No.4: Local examination specific to Disease

S.N Type of Examination Rt. Leg Lf. Leg
1 S.L.R.T. 30° 45°
2 Sciatic notch tenderness +++ Absent

Table No.5: Types of Panchakarma Chikitsa

S. Type Panchakarma Drug Dos Time of Dura
N Chikitsa e administ tion
ration
1 Sarwanga Snehana Karpooradi oil Q.S Morning 14
days
2 Kativasti Dashmool oil 100 Morning 14
ml days
3 Patrapinda Sweda Nirgundi(100 -
Morning 14
g),Eranda(100g),Chincha(100g), days
Dhatura(25g),Shigru(25g),Arka(
25g),Grated
coconut(150g),Lemon(4) , Cotton
cloth(45cm 45cm),Tags(20
4 Matravasti Sahachar oil (50ml) +Ksheerbala 100 Morning 14
oil (50ml) ml (after days
lunch )
5 Siravedhana - - - One
day

Table No.6: Shamana Chikitsa

S.N Medicine Dose Frequency Time of Anupana Duration
administration
1 Simhanad 2tab T.D.S. After food Lukewarm 14 days
Guggulu water
2 Tab.Ashwagandha 2tab B.D. After food Lukewarm 14 days
water
3 Aamvartari Ras 2tab B.D. After food Lukewarm 14 days
water
4 Cap.Neuron plus 1tab B.D. After food Lukewarm 14 days
water
5 Tab.Shallaki XT 1tab B.D. After food Lukewarm 14 days
water

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6 Tab.Dardnash 1tab B.D. After food Lukewarm 13 days

water

Table No.7: Therapeutic outcome

S.N Assessment of Gradation Before Rx After Rx (14
subjective days)
parameters
1 Pain in the 4 0
lumbar region (
Katishula)
No pain 0
Bearable pain 1
relieved without
medication
Moderate pain 2
relieved by
medication
Severe pain 3
with disturbed
routine work
and relieved by
strong
analgesics
The patient can 4
not tolerate
2 Numbness in 3 0
right leg (
Suptata)
No numbness 0
Occasionally 1
once a day for a
few minutes
Daily once a day 2
for a few
minutes
Daily two or 3
more times
/30-60 minutes
Daily more than 4
1 hour and
many times a
day
3 Tingling - Present Absent
sensation on
right leg
4 Difficulty while - Present Absent
walking &

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bending
5 Disturbed sleep - Present Absent
due to pain

Table No.8: Assessment of objective variables

S.N Assessment Before After
of objective treatment treatment
variables
Right Leg Left Leg Right Leg Left Leg
1 S.L.R.T. 30° 45° 90° 90°
2 Sciatic notch +++ Absent Absent Absent
tenderness

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 Editors Information

Dr.Bhushan Deoreoraoji Mhaiskar

Dr Arun Uttam Wankhede B.A.M.S. M.D. Ayurved
rved (Ayurved Samhita),
B.A.M.S. M.D. Ayurved Ph.D. (Scholar), Fellowship
hip in Panchkarma (Scholar),
(Rognidan & Vikritivigyan), Ph.D.(Schola
holar), Associate
te Professor,
P
Fellowship in Panchkarma, (Scholar),
lar), PG Guide, PhD
hD Co-Supervisor,
C
Professor & Head of The Departmentent Department of Samhamhita and Siddhant,
Mahatma Gandhi Ayurved College Hospital and d Research
Re Centre, Mahatma Gandhi Ayurved College
llege Hospital and Research Centre,
Salod (H),Wardha, Maharashtra Salod (H),Wardha
rdha, Maharashtra
PG Guide, PhD Guide & Co-Supervisovisor 8 years of Teachi
aching experience
More than 15 yrs of Teaching Experien
rience (BAMS AND Post ost graduate level)
Research Articles & Chapters: 27 Researchch Paper:10
P Research Articles: 12, Chapt
apters: 05 Research Paper: 3
Book Publication: Rogi Rog Pariksha, (ISBN-978-93
93-5268-008-5), Copyrig
yrights:3
A book publish on Pathya –Pathya in Life style
tyle disorders, A book on Textbook ok of
o Nyayaratnamala
E-Proceeding book on KARMA, ISBN: 978-93-5407 5407-565-0. Team Leader in AYUSH Fundednded Project scheme under PHI
A book on Textbook of Epidemiology (Aupsar
psargik Roga)

Dr Sushama R Khirodkar

Qualification: B.A.M.S. M.D. Ayurved

(Swasthvritta ), Ph.D.(Scholar), Associate
(Sw
Professor Department of Swasthvritta
Mahatmama Gandhi
G Ayurved College Hospital and Research
Centre, Salod (H),Wardha
Experience: PhD Co-Supervisor,
Mo than 9 yrs of Teaching Experience
More
Research
arch Articles & Chapters: 23 Research Paper:10
Book Publication:
tion: Rogi Rog Pariksha, (ISBN-978-93-5268-008 5),
A bookk on Pathya –Pathya in Life style disorders,
A bookk on Textbook of Epidemiology (Aupsargik Roga)
 College-07152 304532, 304545 I Dean Chamber 07152-304567
Email-mgayurvedcollege.com I Web:www.dmiher.edu.in

Published by
The Registrar
Datta Meghe Institute of Higher Education and Research (DU)
Sawangi (Meghe), Wardha.