International Ayurvedic Medical Journal April 2016

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!"#$%&%'()* %,'( #(!&"-(%. /'012 "3 /40114% 5%/(/% %,1

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Dr. Nisha Kumari.P. R *Dr. Dinesh Nayak J **,

Dr. Sathyanarayana B. ***

* *Asst Prof, Dept. of RSBK, SDM College of Ayurveda Hassan

** Professor and Head, Dept. of PG studies in Rasashastra, Muniyal institute of Ayurveda

medical Sciences, Manipal

*** Principal and Head, Dept. of PG studies in Bhaishajya Kalpana,Muniyal institute of

ayurveda medical sciences, Manipal

(,'&"10!'(",

The antimicrobial activities of any

therapeutic agent are understood by the

degree of growth inhibition of

microorganisms it produces as well as its

bactericidal property. Usually different

microbial species or even strains have

different degrees of susceptibility to

therapeutic agents. The susceptibility ofmicroorganisms can change with time, even

during therapy with a specific drug. Thus, it

is essential for the physician to know the

sensitivity of the pathogen before treatment.

In present the study, the antibiotic,

antibacterial and antifungal effect of ferrous

sulphate (Kasisa) is evaluated. Shodhana of

Kasisa was performed according to Rasa

Tarangini 21/230 (Bhavana). Marana of

Kasisa was done as per the method explained

in Rasatarangini 21/259.

Antimicrobial study

Research Article International Ayurvedic Medical Journal ISSN:2320 5091

ABSTRACT

In Rasa shastra, minerals are categorized as Maharasa, Uparasa and Sadharana rasa based

on different criteria. Kasisa, one among the uparasa1 is being therapeutically used since

centuries. Kasisa Bhasma has Ushna virya, Kashaya amla rasa properties. It act as netrya,vishaghna,Kapha Vata nashaka, Vranaghna, Svitraghna, Kshayaghna, Kesharanjaka. It is also

Kandughna, Pandughna, Krimighna, Rakta sanjanana, Raja pravartaka, Balya, Jwaraghna,

Pleehanashana2 So an attempt was made to comparatively analyze the antimicrobial properties of

shuddha Kasisa and Kasisa Bhasma by in Vitro study. Qualitatively prepared shuddha kasisa

and kasisa bhasma was evaluated against staphylococcus aureus, Pseudomonas aeruginosa,

Escherichia coli, Candida albicans and compared with standard drugs like ampicillin,

gentamycin and amoptericin. In the present study, sensitivity testing was done by disc diffusion

technique pattern.

Key words: Shuddha kasisa(SK), Kasisa bhasma(KB), Ampicillin, Gentamycin, Amoptericin.

How to cite this URL: Dr. Nisha Kumari.P. R. Comparative Anti Microbial Study of Shuddha Kasisa And Kasisa Bhasma.

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Nisha Kumari.P. R Et; Al: Comparative Anti Microbial Study Of Shuddha Kasisa And Kasisa Bhasma

!"#www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016

The antimicrobial activity of a drug is

generally expressed as its inhibitory action

on the growth of the bacterium in nutrient

broth or nutrient agar.

For the purpose of this study, the following

conditions are required.

1.

The substance or test drug must be incontact with the test organisms.

2. Conditions must be favorable for the

growth of microorganisms in the

absence of antimicrobial substances.

3. There must be a means of estimating the

amount of growth and thereby

percentage of inhibition of growth.

4. The activity of test drug should be

observed and determined by the growth

response of microorganisms.

Procedure

Bacterial strain used

• Gram negative Strain - Escherichia

coli(NCIM 2574) and Pseudomonas

aeruginosa (NCIM 2036)

• Gram positive Strain - Staphylococcus

aureus (NCIM 2079)

• Fungal Strain – Candida albicans

•

Media used- Mueller Hinton agar,

Mueller Hinton broth, Sabouraud

dextrose broth

and Sabouraud dextrose agar.

Standard drug disc – Gentamycin (10

µg/disc) for Gram negative, Ampicillin (10

µg/disc) for Gram positive, Amphotericin B

(20 µg/disc) for fungi

PROCEDURE

Preparation of Inocula3

For preparation of inoculum, growth from

the agar slant was scrapped by adding 3 ml

of sterile saline solution. This saline cell

suspension was then spread evenly on large

sterile Petri plates containing solidified

Muller Hinton agar (for bacteria) and

Sabouraud dextrose agar (for fungi) using a

sterile glass spreader. These plates were

incubated in bacteriological incubator at

370C for 24 hours and at 28

0C for 48 hours

for bacteria and fungi respectively. After

profuse growth of the organism in the

Petridish, it was scrapped using sterile

spatula and adding small portion of sterile saline. This suspension was transferred to a

sterile 100ml conical flask. The final volume

of the suspension was made upto 50ml with

sterile saline.

Standardization of Inocula

For the determination of MIC, the inoculum

density was adjusted to contain 5 x 106

CFU/ml which has turbidity equal to 0.5

McFarland standard. For this, 0.5 McFarland

standard was prepared by adding 0.05ml of

0.048M BaCl2 (1.17% w/v BaCl2.2H2O) to

9.95ml of 0.18M H2SO4 (1% w/v) with

constant stirring. The standard was

transferred to a glass screw capped bottle.

Absorbance of the McFarland standard was

checked at 625nm (absorbance at 625nm

should range between 0.08- 0.13).

Preparation of drug Dilution

Each drug was suspended in sterile waterwith the help of 1% tween 80 at the

concentration of 1mg/ ml. Sterile water with

1% tween 80 was also prepared to use a

blank for the drug.

Disk Diffusion Assay

Disk diffusion assay of drug was performed

in 40 mm Petri plates to observe growth

inhibition of test organism in term of zone of

diameter (mm). Mueller Hintonagar (3 in

No.) and Sabouraud dextrose agar (1 in No.)

medium was prepared and sterilized. Molten

agar media were poured into sterile Petri

plates (4 in No.) and left for Solidification.

Each plate was neatly labeled with all the

details. Each plate was divided into four

parts which were labeled as ST, SK, KB and


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!"%www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016

BL. Standard cultures (100 µl of each) of test

organism were transferred to the respective

solidified agar aseptically. Transferred

cultures were uniformly distributed all over

the surface of agar medium using L

spreader. Respected standard was kept in the

center of the respective part of the plate.

Three sterile discs were transferred into the

remaining parts of the plate. Each sterile

disc was loaded with the 20 µl of respective

drug or blank. First, Petri plates were kept in

fridge for 30 min. for drug diffusion and

then transferred into the respective

incubator. Zone of inhibition were measured

using antibiotic zone reader after 24 h for

bacteria and 48 h for fungi. Table No 1 Report of antimicrobial assay of Shuddha Kasisa

Name of tested organism Zone Diameter (mm) of Growth Inhibition

Test drug Blank Standard drug

E.coli 12 9 21

P. aeruginosa 10 8 32

S. aureus - - 24

C. albicans - - 8

Table No 2 Report of antimicrobial assay of Kasisa Bhasma

Name of tested organism Zone Diameter (mm) of Growth Inhibition Test drug Blank Standard drug

E.coli 10 9 21

P.aeruginosa 8 8 32

S.aureus - - 24

C.albicans - - 8

Results

Shuddha Kasisa was found to be

partially active against the used species of

Gram negative bacteria at the tested

concentration, while it was found to be

inactive against the Gram positive and the

fungal strain.

DISCUSSION

Comparative evaluation of Shuddha Kasisa

and Kasisa Bhasma for antimicrobial

potential wasthe main aim of the study.

Based on the claim of Krimighna property

of Kasisa Bhasma and external use ofShuddha Kasisa for wound healing, the

antimicrobial study was planned. Disc

diffusion method was followed. As a

standard protocol Gram Negative Strain -

Escherichia coli (NCIM 2574) and

Pseudomonas aeruginosa (NCIM 2036),

Gram positive Strain – Staphylococcus

aureus (NCIM2079) and Fungal Strain –

Candida albicans were selected. Standard

drugs used were Gentamycin (10 µg/disc)

for Gram negative, Ampicillin (10 µg/disc)

for Gram positive and Amphotericin B (20

µg/disc) for fungi. The products were found

to be partially active against the used species

of Gram negative at tested concentration

while found to be inactive against the Gram

positive and the fungal strain. Shuddha

Kasisa was found to be slightly better in

antimicrobial activity as the zone ofinhibition was slightly higher than that of

Kasisa Bhasma (for E coli 12mm against 10

mm of Kasisa Bhasma), which may be due

to better solubility and highly acidic pH of

Shuddha Kasisa. However, the zone of

inhibition was far low when compared to the


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!"&www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016

standard drugs. However, using the media in

which the products are more

soluble may be useful. Multiple strains of

microorganisms may have to be tried. Mode

of action

of Kasisa Bhasma and Shuddha Kasisa may

be different than that of antimicrobial

agents. Evaluation of antioxidant profile and

wound healing activity may be more useful.

!",!.0/(",

The products were found to be partially

active against the used Gram negative at

tested concentration while found to be

inactive against Gram positive and fungal

strain. Shuddha Kasisa was found to be

slightly better in activity as the zone of

inhibition was slightly higher. than that of

Kasisa Bhasma (for E coli 12mm against 10

mm of Kasisa Bhsma) which may be

because of the better solubility and highly

acidic pH of Shuddha Kasisa.

Figures:

Figure1: Escherichia coli Figure2: Pseudomonas aeruginosa

Figure3: Staphylococcus aureus Figure 4: Candida albicans


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!"'www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016

&*3*&%,!*

1. Shri Vagbhata, Rasarathna

samuchchaya, with Hindi

Commentary of Ras Prabha,

Translate by Indra Dev Tripathi,

Chaukhamba Sanskrit Sansthan,

Varanasi, edition 2009, 3rd Chapter,

page no.26. Pp418.

2. Shri Sadananda Sharma, Rasa

Tarangini by Pandith Kashinath

Shastri, Motilal Banarasidas, New

Delhi, edition 2000, 21th

Chapter,page no.564,Pp772.

3. Clinical and Laboratory Standards

Institute. Performance Standards forAntimicrobial Susceptibility Testing;

Twenty-First Informational

Supplement. CLSI document

M100S21 (ISBN 1-56238-742-1).

Clinical and Laboratory Standards

Institute, 940 West Valley Road,

Suite 1400, Wayne,

Pennsylvania19087 USA, 2011.

!"&&*/$",1(,6 %0'4"&Dr. Nisha Kumari.P. R

Asst Prof, Dept. of RSBK, SDM College of

Ayurveda Hassan, Karnataka, India

Source of support: Nil

Conflict of interest: None Declared


6/198

!"#$ &'()* +"", -". /0(&",#.1 $0+2.30("4'4 /#$'2,$4

Nishigandha Dandekar1, Nalin Shah

2

1. MD (Ayu.) Scholar, Department of Rasashastra and Bhaishajya kalpana2. Lecturer, Department of Rasashastra and Bhaishajya kalpana, Y.M.T. Ayurvedi-

c Medical College.

INTRODUCTION:

Pulmonary Tuberculosis remains a major

public health problem in developing coun-

tries. It causes due to infection with My-

cobacterium tuberculosis. It causes 2 mil-

lion deaths per year in all over the world.

Majority of the cases are likely to occur in

the world’s poorest nations, who struggle

to cover the cost associated with manage-ment and control programme. Thus many

patients remain untreated or receive in-

complete treatment which results in multi

drug resistant tuberculosis (MDR TB). TB

statistics published by WHO in 2015 in-

cludes India amongst the 14 TB, MDR TB

and TB/HIV high burden countries1. Cur-

rent estimates suggest that around one

third of world’s population has latent tu-

berculosis. Recently, TB hospital, Shivdi

declared that clinical study on goat milk

will be carried out on tuberculosis patients

as they found remarkable improvement in

some patients who received goat milk

along with AKT2

. Pulmonary tuberculosisis correlated with Rajayakshma mentioned

in Ayurvedic texts. It is a contagious dis-

ease which is transmitted from an infected

person to susceptible person in airborne

particles that are released when infected

person sneezes, cough, laugh, shout etc.

According to Ayurveda, Rajayakshma is

included in aupasargik roga3. So the in-

fection can also be considered the etiology

of Rajayakshma and this is the San-

Review Article International Ayurvedic Medical Journal ISSN:2320 5091

ABSTRACT

TB statistics published by WHO in 2015 includes India amongst the 14 TB, MDR TB and

TB/HIV high burden countries. Pulmonary tuberculosis is correlated with Rajayakshma

mentioned in Ayurvedic texts. Currently, TB hospital, Shivdi declared that clinical study on

goat milk will be carried out on tuberculosis patients as they found remarkable improvement

in some patients who received goat milk along with AKT. Aja kshira (Goat milk) is im-

portant Ayurvedic drug in chikitsa of Rajayakshma vyadhi. Thus review of goat milk ac-

cording to ayurvedic and modern literature was done. It has efficacy against kshaya, kasa,

shwasa, atisara etc. It has deepana, laghu, balya, grahi properties. According to modern re-

search, it has anti-fungal, anti-microbial properties which affect lungs. It also has immuno-

logical role in gastrointestinal infections. Also goat milk has higher content of medium chain

fatty acids which are easy for digestion and used as medicine for malabsorption syndrome

and steatorrhoea.

KEYWORDS: Goat milk, pulmonary tuberculosis, Rajayakshma, Chhagaseva.

How to cite this URL: Nishigandha Dandekar. Goat

Milk: Boon for Pulmonary Tuberculosis Patients.

International Ayurvedic medical Journal {online}2016 {cited 2016 April} Available from:



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Nishigandha Dandekar & Nalin Shah: Goat Milk: Boon For Pulmonary Tuberculosis Patients

nikrishta cause of the Rajayakshma. Mod-

ern science describes that Mycobacterium

tuberculosis does not produce the disease

in all the persons, but produces primary

tuberculosis.

So they described some

provocating factors like cigarette smoking,

alcoholism, immune-suppressive agent and

some diseases like leukemia, lymphoma

etc. which may be responsible for the dis-

ease. Similarly, there are two type of ni-

dana in pathogenesis of Rajayakshma:

a) Sannikrishta nidana which is the

upasarga and this may be the infection of

Mycobacterium tuberculosis.

b) Viprakrishta nidana is 4 typed sahas-

janya, sandharanajanya, kshayajanya andvishamashanajanya. These may act like

provocating factors responsible for the dis-

ease. Also, Trirupa, Shadrupa and Eka-

dashrupa lakshana of Rajayakshma have

been correlated to signs and symptoms of

pulmonary tuberculosis4. Chikitsa for Ra-

jayakshma rogi according to Ayurveda is

Chhagaseva5. Meaning of word Chhaga &

Aja is Goat. Sushruta samhita, Chakra-

datta, Vangasena, Yogratnakara have ad-

vocated the use of various products ob-

tained from goat. The patients suffering

from Kshaya i.e. synonym of Rajayakshma

should stay in the company of goats in the

same room, drinks goats milk, use ghrita

prepared from goat's milk in the ahara.

The room in which the patient and goats

leave should be painted, and tiled withgoat's faces and urine. In current study, lit-

erature review on goat milk is done.

REVIEW OF GOAT MILK

Ayurveda texts:

SrN. Text Rasa Virya Vipaka Dosha

ghnata

Uses Roga

Ghnata

1. Ca. Sa. Kashay

madhur

Shita - - Grahi, Laghu Kshaya,

Kasa, Atisar, Rak-

tapitta,

Jwara,

2. Su. Sa. - - - - Properties similar

to cow milk.

Dipaniya, Laghu,

Sangrahi

Shosha,

Kasa

Shwasa,

Raktapitta

3. A. Hr. - - - - Laghu Shosha,

Shwasa

Jwara,

Atisar, Rak-

tapitta

4 Bha.

Pra.

Ni.

Kashay

Madhur

Shita Katu Grahi, Laghu Kshaya

atisar

Kasa,

Jwara,

Raktapitta

5 Yo. Ra. - - - Tridosha Properties similar

to cow milk,Vishesh dipana,

Kshaya,

Arsha, Jwara


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Grahi, Laghu Atisara,

Raktadosh

Bhrama,

6 Kai.

Ni.

Madhur

Kashay

Shita - Kapha Properties similar

to cow milk,

Dipana, Laghu

Sangrahi,

Snigdha,

Mrudu, Balya

Shukrala,

Kshaya,

Kasa Arsha,

Jwara

Shwasa,

Atisara,

Trushna,

Vatarakt

Raktapitt

7 Dha.

Ni.

Kashay

Madhur

Shita - - Grahitara, Laghu Kshaya,

Kasa

Jwara,

Atisar, Rak-

tapitta.

8 Ni. Ra. Kashay

Madhur

Shita - - Grahi, Laghu Kshaya,

Kasa

Jwara,

Atisar, Rak-

tapitta

9 Ra. Ni - - - - More potent than

cow milk, Diet for

weak person.

Sarva

Vyadhi hara

Table No. 1: Properties of goat milk according to Ayurvedic literature.Modern research papers:

Sr. N Drug Journal/Article Proved activity/ Findings

1. Goat milk Ancient Science of Life 1993

January; 12 (3-4) :335-337 Pub-

med ID: 22556611

87.06 per cent inhibition in the spore ger-

mination of fungi Absidia corymib-

ifera.(third-most-common cause of in-

vasive fungal infection in immuno-

compromised patients.)

2. Goat milk lac-

toperoxidase

Indian journal of experimental

biology 1998 Aug;36 (8):808-10. PMID: 9838883

Anti bacterial property

3. Goat milk lac-

toperoxidase

Life

Sciences.2000;66(25):2433-

9.PMID -10894086

antifungal and antibacterial property

4. Goat

Milk-Serum

Amyloid A-3

Protein

International Conference on

Antimicrobial Research

(ICAR2010) Valladolid

(Spain), 3-5 November 2010

1) Antimicrobial activity

S. Aureus

Enteropathogenic E. coli.

2) Gastrointestinal

protection and

immunological role5. Goat milk Asian journal of animal sci- Anti bacterial property:


9/198


lacto

peroxidase

ences ! January 2011

DOI:10.3923/ajas.2011.56.63

" Vibrio cholerae,

" Salmonella typhi,

" klebsiella pneumoniae,

" Shigella dysenteriae.

6. Goat milk Indian J. Dairy Sci. 65(4),

2012

" Size of fat globules - less than 5

microns is 83% thus easy diges-

tion.

" Higher values of Caprylic acid,

capric acid, Medium chain

triglyceride than cow milk

which are used in treatment for

Malabsorption syndrome, and

Steatorrhea.

7. Goat milk Journal of Dairy Research.

2001; (Barrionuevo et al

2002; Alferez et al, 2003;

Campos et al, 2003; Lopez-

Aliaga et al, 2003).

In vivo study - Animals with symp-

toms of malabsorption show more

efficient absorption of calcium,

phosphorus, iron, copper, zinc, mag-

nesium and selenium from goat milk

compared to cow milk

Table No. 2: Properties of goat milk according to Modern research work.

.240($4 #,5 5'43044'",*

" According to review of Ayurvedic litera-

ture, goat milk is beneficial in Kshaya,

Shosha which are synonyms of

Rajayakshma.

" Main symptom of rajayakshma is cough,

breathlessness, and fever.

Goat milk has efficacy on Kasa, shwasa

and jwara. According to research work,

goat milk causes inhibition in the spore

germination of fungi Absidia corymibifera

which affects lungs. Also, goat milk has

anti bacterial and anti fungal properties. Ithas anti microbial activity against S.

Aurius which causes diseases like

pneumonia, UTI, sinusitis, infective

endocarditis, osteomyelitis etc. which

induce fever.

" According to Charaka samhita6, Purisha

rakshan is very important in case of

rajayakshma rogi. Goat milk has efficacy

on atisara. According to modern research,it has anti bacterial properties against E.

coli, Vibrio cholerae, Salmonella typhi,

klebsiella pneumoniae, Shigella

dysenteriae which cause diarrhea and

dysentery. It shows immunological role in

gastrointestinal protection." In Rajayakshma rogi, samprapti

7 (patho-

physiology) starts with agnimandya

(diminished digestive activity) and

rasavaha strotas avarodha which causes

kshaya of further dhatu. Goat milk has

deepana, grahi, laghu, balya, shukrala

properties which can cause samprapti

bhanga. It has 83% fat globules which are

less than 5 microns’ size. Thus it is easy

for digestion. Also, it has higher values of

Caprylic acid,capric acid, Medium chain

triglyceride which are used in treatment

for Malabsorption syndrome, and

Steatorrhea. Animal study shows that

absorption of micro nutrients is more

efficient from goat milk in comparison

with cow milk.

" It has properties similar to cow milk

which is best amongst all milks according

to Ayuveda.


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CONCLUSION:

• Pulmonary tuberculosis is correlated with

Rajayakshma.

• Ayurvedic literature review cocludes that

goat milk can break pathophysiology of

Rajayakshma.

• Modern research papers support the proper-

ties of goat milk mentioned in ayurvedic

texts.

• Thus, goat milk can be an effective medi-

cine in Pulmonary tuberculosis patients.

.-2.2,324*

1. Global tuberculosis report 2015.

2. Pg No. 9, Date- 17/2/2016, MaharashtraTimes.

3. Sushrut samhita, Nidan sthan 5/34,

Acharya Priyavat Sharma, reprint – 2004,

Prakashan– Chaukhamba surbharati

prakashan.

4. Anish Kumar, Comparative study of rajay-

akshma and pulmonary tuberculosis,

Indian journal of re-search (2014)8,9-13

5. Chakradatta Rajayakshma chikitsa shloka

92, Dr.Indradev. Tripathi, 4th edi – 2002,

Chaukhamba Sanskrit Sanstha.

6. Charak samhita (vol-2), Chikitsa

sthan 8/41,42, Acharya vidyadhar

shukla, reprint – 2004, Prakashan –

Chaukhambha Sanskrit Pratishthan.

7. Charak samhita (vol-2), Chikitsa

sthan 8/39,40, Acharya vidyadhar

shukla, reprint – 2004, Prakashan –

Chaukhambha Sanskrit Pratishthan

3"..24/",5',! #0$6".

Dr. Dandekar Nishigandha Sadanand

(MD scholar) Rasashastra and Bhaishajya

kalpana 5-B, R.B.I. colony, Old Dombivliroad, Vijaynagar, Dombivli (west). Pin –

421202

Email ID – [email protected]




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!"#$%#&'()*#%+&, '. /#$!#*# #*( +/, 0/+1+/) +* %#*#234

%3*/ '. %)'!+# 1Bende Yogita 2Sarika Choure 3Suraj Rathod 4Auti Swapnil S

1Asso. Professor, Dept of Panchkarma, Shri Ayurveda Mahavidyalaya, Nagpur.

2Assistant Professor, Dept. of Shalakya BM Ayurveda Mahavidyalaya, Nagpur.

3MD schlor. (Kayachikitsa) Govt. Ayurveda College and Hospital, Nagpur.

4Asst. Professor Dr. D.Y. Patil college of Ayurved and research centre, Pimpri, Pune.

+*/$'(0&/+'*5

Eyes hold special status among all the

senses. Eyes are the most precious gift of

the God to the living beings. Good vision

is crucial for social and intellectual devel-

opment of a person. Recent data suggests

that a large number of people are blind in

different parts of the world due to high

refractive errors especially myopia. Vari-

ous surveys in India have found the myo-

pia prevalence ranging from 6.9% to

19.7%.1,2 Due to the significance of myo-

pia as a global public health concern, it

was chosen as a priority for Vision 2020,

World Health Organization's global initia-

tive for the elimination of avoidable blind-

ness by year 2020.3 Ayurvedic ocular ther-

apies also known as Kriyakalpa are well

known now a day in management of Myo-

pia which is considered as Timira in Ayur-

veda. Among them also Tarpana is used

frequently and classical references also

justify the clinical utility of Tarpana in

management of Myopia. Thus an attempt

has been made to elaborate the clinical

utility in management of myopia & to

evaluate its pharmacodynamics in light of

available scientific knowledge and under-


ABSTRACT

Nearsightedness, or myopia, is the most common refractive error of the eye, and it has be-

come more prevalent in recent years. Nearsightedness can be corrected with glasses, contact

lenses or refractive surgery. All these treatments are not much patient friendly and also not

the actual solution to the pathology occurring in eye. Tarpana is one of the popular ocular

therapies that is performed in Ayurveda and which is known to have a definite answer to the

problem of Myopia. Thus it becomes necessary to explore the mode of action of Tarpana and

give exact pharmacodynamics picture of the therapy so that its utility can be explained in sci-

entific way. With this view an attempt was made to discover the scientific facts which can

ascertain the Ayurvedic concepts. After a critical review of various researches, scientific texts

and Ayurvedic classics it is concluded that Tarpana acts on the principle of Bahya Snehana. It

can successfully cross the defensive barriers present in eye for absorption and nourishes the

ocular and periocular structures, strengthens the sphincters & brings about changes in dioptric

power and visual acuity.Key words: Tarpana, Myopia, nearsightedness, Snehana.

How to cite this URL: Bende Yogita. Pharmacodynamics Of Tarpana And Its Utility In Management Of Myopia

.International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:



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1Bende Yogita et;all: PHARMACODYNAMICS OF TARPANA AND ITS UTILITY IN MANAGEMENT OF MYOPIA

standing of the ocular therapies.

Ayurvedic concept of Tarpana:

The literary meaning of the Tarpana is to

give nourishment to the eye through

Ghruta, Ghruta Manda, medicated Ghruta,

Vasa, Majja, (bone marrow), milk etc.

Acharya Charaka in Sutrasthana Snehadh-

yaya explained that “Snehoanilam Hanti”

which means that Snehana is the supreme

treatment for Vata Dosha.4 He mentioned

Akshi - Tarpana as one of the 24

Snehapravicharana in Sutrasthana 13th

chapter.5 Ghruta is used primarily for Tar-

pana. Ghruta is effective in subsiding Pit-

taja and Vataja disorders, it improves

Dhatus and is overall booster for improv-ing Ojas.6

The Ghruta has the quality of

trespassing into minutest channels of the

body. Hence when applied in the eye, it

enters into deeper layer of Dhatus and

cleanses every minutest part of them.

Moreover, Ghruta due to its San-

sakaranuvartana quality easily imbibes the

properties of other drugs processed with it

without leaving its own properties.

7

Ghrutais also Sheeta Veerya, hence the eye being

the site of Alochaka Pitta can be effec-

tively managed by constantly using Ghee

for Akshi Tarpana. Ghruta also contains

properties like Balya, Brimhana and Ra-

sayana, so it gives strength to the overall

tissues of the eyeball as well as to the

nervous tissues.

To provide nourishment the prerequisite is

the absorption of drug through the ocular

surface. But the eyes are supplied with va-

riety of defence mechanisms for protection

that offers the barrier in drug absorption.

Challenges in ocular drug delivery &

Tarpana: Tarpana can also be considered

as a route of ocular drug delivery through

topical administration. For most of the

topically applied drugs, the site of action is

usually different layers of the cornea,conjunctiva, sclera, and the other tissues of

the anterior segment such as the iris and

ciliary body (anterior uvea). Upon admin-

istration, precorneal factors and anatomical

barriers negatively affect the bioavailabil-

ity of topical formulations.

Pre-corneal factors include:8

•

solution drainage,

• blinking,

• tear film,

• tear turn over, and

• induced lacrimation

Tear film, whose composition and amount

are determinants of a healthy ocular sur-

face, offers the first resistance due to its

high turnover rate. Mucin present in the

tear film plays a protective role by forming

a hydrophilic layer that moves over the

glycocalyx of the ocular surface and clears

debris and pathogens.9 Human tear volume

is estimated to be 7 µl, and the cul-de-sac

can transiently contain around 30 µl of the

administered ocular drug. However, tear

film displays a rapid restoration time of 2–

3 min, and most of the topically adminis-

tered solutions are washed away within just 15–30 s after instillation. Considering

all the precorneal factors, contact time

with the absorptive membranes is lower,

which is considered to be the primary rea-

son for less than 5% of the applied dose

reaching the intraocular tissues.10

In case

of Tarpana the volume of drug retained

over ocular surface is much higher in

comparison to the eye drops thus mucin

itself may get diluted by the Ghruta or any

other Tarpana drug removing the hydro-

philic layer barrier and provides more drug

available for absorption. In addition, vari-

ous layers of the cornea, conjunctiva, and

sclera play an important role in drug per-

meation. The cornea, the anterior most

layer of the eye, is a mechanical barrier

which limits the entry of exogenous sub-

stances into the eye and protects the ocular

tissues. It can be mainly divided into the


13/198


epithelium, stroma, and endothelium. Each

layer offers a different polarity and a po-

tential rate-limiting structure for drug per-

meation. The corneal epithelium is lipoidal

in nature which contains 90% of the total

cells in the cornea and poses a significant

resistance for permeation of topically ad-

ministered hydrophilic drugs. Furthermore,

superficial corneal epithelial cells are

joined to one another by desmosomes and

are surrounded by ribbon-like tight junc-

tional complexes (zonula occludens)11,12.

Presence of these tight junctional com-

plexes retards paracellular drug permeation

from the tear film into intercellular spaces

of the epithelium as well as inner layers ofthe cornea. Tarpana is mostly done with

lipophilic drugs in the form of Ghruta,

Vasa etc. thus it can be well absorbed

through lipoidal membrane and also it can

nourish this membrane so that its function

gets improved. Moreover, Tarpana is done

in lukewarm form that may dilate the tight

junctional complexes thus allowing para-

cellular drug permeation. The stroma,which comprises 90% of the corneal

thickness, is made up of an extracellular

matrix and consists of a lamellar

arrangement of collagen fibrils. The highly

hydrated structure of the stroma poses a

significant barrier to permeation of lipo-

philic drug molecules. Endothelium is the

innermost monolayer of hexagonal-shaped

cells. Even though endothelium is a sepa-

rating barrier between the stroma and

aqueous humor, it helps maintain the

aqueous humor and corneal transparency

due to its selective carrier-mediated

transport and secretory function.13 Fur-

thermore, the corneal endothelial junctions

are leaky and facilitate the passage of mac-

romolecules between the aqueous humor

and stroma.14

Thus, corneal layers, partic-

ularly the epithelium and stroma, are con-sidered as major barriers for ocular drug

delivery. It is vital to understand that the

permeant should have an amphipathic na-

ture in order to permeate through these

layers. Certain drugs used for Tarpana like

Siddha Kshira are of this nature. Com-

pared to cornea, conjunctival drug absorp-

tion is considered to be nonproductive due

to the presence of conjunctival blood ca-

pillaries and lymphatics, which can cause

significant drug loss into the systemic cir-

culation thereby lowering ocular bioavail-

ability. Conjunctival epithelial tight junc-

tions can further retard passive movement

of hydrophilic molecules.15 However, in

Tarpana the drug used is significantly in

high dose that can give enough bioavaila- bility even after the loss in systemic cir-

culation or in other words it can act both

locally and systemically. The sclera, which

is continuous with the cornea originates

from the limbus and extends posteriorly

throughout the remainder of the globe. The

sclera mainly consists of collagen fibers

and proteoglycans embedded in an extra-

cellular matrix. Permeability through thesclera is considered to be comparable to

that of the corneal stroma. Recent reports

indicate that the permeability of drug mol-

ecules across the sclera is inversely pro-

portional to the molecular radius.16 Tar-

pana when did with Siddha Ghruta, it

contains more small chain fatty acids hav-

ing small molecular radius than the long

chain fatty acids. Thus, they may get read-

ily absorbed.

Pressure effect and refractive index:

Tarpana exerts extraocular pressure to the

lens thus increasing its axial length.

Though this pressure effect is transient but

due to the oleation and hydration provided

by Tarpana may improve the accommoda-

tion which can retain this pressure effect

for longer duration.

More contact time: Ghruta preparationsused in Akshi-Tarpana are in the form of


14/198


suspension containing different particles of

the drugs and the particles do not leave the

eye as quick as solution. Tissue contact

time and bio availability is more hence

therapeutic concentration can be achieved

by Akshi – Tarpana.

Accommodation and visual acuity: Ac-

commodation is the ability of the eye to

change the refractive power of the lens to

automatically focus on objects at various

distances. It is a complex constellation of

sensory, neuromuscular and biophysical

phenomena by which the overall refracting

power of the eye changes rapidly to image

objects at different viewing distances

clearly on to the retina.17 Tarpana may act

over accommodation capacity of eye by

providing nutrition not only to the cornea

but also to the sphincter muscles and

nerves innervating it.

Fig 1: changes in lens shape by accommodation for distant and close vision

Nutritional supplement from Tarpana

drugs: Ghruta is used widely for Tarpana

which contains mainly omega-3 & 6 fatty

acids, Vit A, E & K & antioxidants.18 Milk

is also used for Tarpana which contain va-

riety of Vitamins, minerals, amino acids

etc.19

Review of researches to understand the

clinical utility:20,21,22,23,24

.

Tarpana is used in Shalakya – a branch of

Ashtang Ayurveda to treat mainly Myopia.

Variety of Tarpana formulations have been

tried in various researches. Its clinical

utility can be understood by reviewing

these researches.

The dioptric power of the spherical lens

was reduced by 9 to 20 % in most of the

researches. Durastha Avyakta Darshana or

indistinct distant vision,

Netrasrava, Netradaha , Netrayasa ,

and Shirobhitapa were reduced statistically

significantly (P


15/198


After reviewing various researches and

available scientific data regarding Tarpana

it can be concluded that, Tarpana is a supe-

rior therapy than merely using eye drops.

Tarpana acts on the principle of Bahya

Snehana. It can successfully cross the de-

fensive barriers present in eye for absorp-

tion and nourishes the ocular and periocu-

lar structures & also strengthens the

sphincters. On virtue of drug utilised for

Tarpana it also provides nutrition directly

to the target organ. Changes in dioptric

power and visual acuity are evident hence

can be used for successful management of

myopia.

REFERENCES:

1. Jain IS, Jain S, Mohan K. The epidemiol-

ogy of high myopia-changing trends. In-

dian J Ophthalmol 1983;31:723-8

2. Mohan M, Pakrasi S, Zutshi R. Myopia in

India. ActaOphthalmolSuppl 1988;185:19-

23.

3. McCarty CA, Taylor HR. Myopia and vi-

sion 2020. Am J Ophthalmol

2000;129:525-74. Agnivesha, Charakasamhita. Varanasi,

India: Chaukhamba Sanskrit Series; 2004.

Charaka Siddhisthana. 1/7, P 678

5. Agnivesha, Charakasamhita. Varanasi,

India: Chaukhamba Sanskrit Series; 2004.

Charaka Sutrasthana. 13/25, P 83

6. Agnivesha, Charak Samhita, Rashtrita

Sanskrita Sansthan, New delhi, reprint

2006; sutrasthana13 / 14

7.

Agnivesha, Charakasamhita. Varanasi,India: Chaukhamba Sanskrit Series; 2004.

Charaka Sutrasthana. 13/13, P 82

8. Ananthula HK, Vaishya RD, Barot M,

Mitra AK. Duane's Ophthalmology. In:

Tasman W, Jaeger EA, editors. Bioavaila-

bility. Philadelphia: Lippincott Williams &

Wilkins; 2009

9. Gipson IK, Argueso P. Role of mucins in

the function of the corneal and conjuncti-

val epithelia. Int Rev Cytol. 2003;231:1–

49. doi: 10.1016/S0074-7696(03)31001-0.

10. Ahmed I. The noncorneal route in ocular

drug delivery. In: Mitra AK, editor. Oph-

thalmic drug delivery systems. New York:

Marcel Dekker; 2003. pp. 335–63

11. Klyce SD, Crosson CE. Transport pro-

cesses across the rabbit corneal epithe-

lium: a review. Curr EyeRes.1985;4(4):323–31. doi:

10.3109/02713688509025145

12. McLaughlin BJ, Caldwell RB, Sasaki Y,

Wood TO. Freeze-fracture quantitative

comparison of rabbit corneal epithelial and

endothelial membranes. Curr Eye Res.

1985;4(9):951–61. doi:

10.3109/02713689509000002

13. Barar J, Javadzadeh AR, Omidi Y. Ocular

novel drug delivery: impacts of membranes and barriers. Expert Opin Drug

Deliv. 2008;5(5):567–81. doi:

10.1517/17425247.5.5.567.

14. Sunkara GKU. Membrane transport pro-

cesses in the eye. In: Mitra AK, editor.

Ophthalmic drug delivery systems. New

York: Marcel Dekker, Inc; 2003. pp. 13–

58

15. Saha P, Kim KJ, Lee VH. A primary cul-

ture model of rabbit conjunctival epithelial

cells exhibiting tight barrier properties.

Curr Eye Res. 1996;15(12):1163–9. doi:

10.3109/02713689608995151.

16. Geroski DH, Edelhauser HF. Transscleral

drug delivery for posterior segment dis-

ease. Adv Drug Deliv Rev.

2001;52(1):37–48. doi: 10.1016/S0169-

409X(01)00193-4.

17. Kaufman PL. Accommodation and

Presbyopia: Neuromuscular and Biophysi-

cal Aspects, in Hart WM, editors: Adler's

Physiology of the eye: 9th Ed. St Louis:

CV Mosby; 1994. p. 391-411.

18. https://en.wikipedia.org/wiki/Ghee#cite_n

ote-16 retrieved on 21 feb 2016

19. https://en.wikipedia.org/wiki/Milk re-

trieved on 21 feb 2016

20. Durgesh Prasad Gupta1, Manjusha Ra-

jagopala2, Kartar Singh Dhiman A clini-

cal study on Akshitarpana and combina-

tion of Akshitarpana with Nasya therapy


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in Timira with special reference to myopi-

aAYU, 2010;31:473-7.

21. Poonam, R. Manjusha, D. B. Vaghela, and

V. J. Shukla A clinical study on the role of

Akshi Tarpana with Jeevantyadi Ghrita in

Timira (Myopia) Ayu. 2011 Oct-Dec;

32(4): 540–54522. Poonam, R. Manjusha, D. B. Vaghela, and

V. J. Shukla A clinical study on the role of

Akshi Tarpana with Jeevantyadi Ghrita in

Timira (Myopia) Ayu. 2011 Oct-Dec;

32(4): 540–545

23. Manesh Kumar, a comparative study on

the efficacy of Tarpana and Triphaladi

drug compound in the management of

Timira w.s.r. to myopia, MD Thesis, IPGT

& RA, Jamnagar, 2003

24. Vinayaka Ashu, A clinical study on the

efficacy of Tarpana and Shatavaryadi

churna in the management of Timira w.s.r.

to Myopia. MD Thesis, IPGT & RA, Jam-

nagar, 2004

&67789:6; #?@A67

Dr. Yogita Bende

Asso. Professor, Dept of Panchkarma,

Shri Ayurveda Mahavidyalaya, Nagpur,

Maharshtra, India

Email: [email protected]




17/198

! #$%&%#!$ '()*+ (, -.!$)!(- (/- (/-0!1-)(%# -22-#( ,2

.!(!0!3(!&(!3 0!'! !&* $-3/!&! 4!'(%

%& .!(!0!3(! 1

Pundpal Amitkumar B.2Patil Kuldeep V.

1Assocciate Professor, Shalya Tantra Dept., Late Kedari Redekar Ayurved

Mahavidyalaya,Gadhinglaj, Dist.Kolhapur, Maharashtra, 4165022Assocciate Professor, Shri Kalidas Ayurved Mahavidyalaya,Badami,

Dist.Bagalkot,Karnatak,

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Vatarakta comes under the domain of

Vatavyadi 1 (Nervous disorders) and

mostly affecting the extremities 2. The

umbrella of vatarakta in parlance with

conventional medicine includes manyconditions related to extremities and to

mention a few are connective tissue disor-

ders as well as peripheral vascular disor-

ders. In the literature it is emphasized that

the etiological factors leads to the pre-

dominant morbidity of vata dosa and rakta

dhatu (Blood tissue) and hence the name

vatarakta. To be more specific, the ob-

struction of raktamarga or raktavaha sro-

tas (Circulatory system) is the leading pa-

thology 3.

Two distinct modes of etiopathogenesis ofvatarakta are elaborated in the literature.

The specific etiological factors of vatadosa and rakta dhatu separately leading to

the morbidity of the same with the

involvement of raktamarga (Circulatory

system) is about the first clinical variety of

vatarakta 4. The etiopathogenesis of

second clinical variety is different from

this. In the second clinical type instead of

etiological factors of vata and rakta, it is


ABSTRACT

There is a definite need to study vatarakta (Gout) as peripheral arterial disease and its man-

agement with both sodhana (Purification) and samana (reducing) treatment, with the dueconsideration of its severity, chronicity as well as possible complications. This study is

planned to evaluate the therapeutic effect of Vataraktantakarasa and Lekhana basti (Scraping

agent or ayurvedic drugs used for enema) in patients suffering from Vatarakta. Design: Single

blind clinical study with a pre-test and post-test design. Source of the data: 20 patients of

vatarakta who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital, Kuthpady,

Udupi, Karnataka. Intervention: Patients were subjected to 16 days course of lekhana bastialong with oral medication with vataraktantaka rasa in a dose of 250mg tid for 30 days Ob-

servations: Out of 20 patients of Vatarakta studied in this work. All the patients had the

Dvandvaja praktiti (Two types of Prakrutis like Vatapittaj,Vatakaphaj etc.). Results: Statisti-

cally significant improvement was observed in all the criteria of assessment that included

regards to pain, burning sensation, malaise and disturbance of sleep, tenderness, walkingability, peripheral pulses and lipid profile. Conclusion: The combination of lekhana basti and

vataraktantaka rasa is an ideal regimen in patients suffering from raktamargavarana janya

vataraktaa (Obstruction for blood causes Vatarakta)

Key Words: Vatarakta, margavarana, raktavahasrotas, ILD, PVD

How to cite this URL: Pundpal Amitkumar B. A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak

Rasa And Lekhana Basti In Vatarakta .International Ayurvedic medical Journal {online} 2016 {cited 2016 April}Available from: http://www.iamj.in/posts/images/upload/595_601.pdf


18/198

Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta

the etiology of kapha(Mucus) and

medas(Fat) that initiates the illness. The

etiological factors of kapha and medas

obviously lead to the morbidity of thesame. This abnormally increased kapha

and medas in turn gets accumulated in the

rakta marga causing the provocation of

vata as well as rakta 5 (Blood). Dietary

habits and life style modalities plays a

major role in the causation of vata rakta.

Also the morbidity of kapha and medas

can cause different other serious diseases

in different systems. Prameha (Diabetes),

Sonitadust(Impure blood disorder) ,hrdroga(Cardiac problem) and vatavyadhi

etc all are found to be due to incriminatory

affect of kapha and medas in respectivesystems6. Hence forth the concept of mar-

gavarana (Obstructed path) in different

parts of the body is emphasized in Caraka

samhita. The pathology of margavarana

leads to the establishment of clinical signs

and symptoms in vatarakta. Further to

add, sodhana, samana, bahiparimarjana and rasayana cikitsa all are aimed at the

rectification of margavarna in this dis-

ease7. The whole concept of margavarana

can be best explained by the pathology ofatherosclerosis and peripheral vascular

disease in modern parlance. Peripheral

vascular diseases include arterial, venous

as well as lymphatic disease, and the ill-

ness has a long lingering course. Inad-

aquate treatment or failure of treatmentmay lead to fatal complications. Further to

add, obstructive arterial diseases are

named after the anatomical structure af-

fected as coronary artery disease, cerebro-

vascular disorders and Ischemic limb dis-eases etc.

OBJECTIVES OF STUDY:

1.

To carry out literary study on vatarakta as

well as the role of kapha

and medas in its causation of vatarakta 2.

To evaluate the therapeutic effect of

Vataraktantakarasa and Lekhana basti in

Vatarakta.

MATERIALS AND METHODS:

Source of the data: The patients who at-

tended the O.P.D. and I.P.D. of S.D.M.

Ayurveda Hospital, Kuthpady, Udupi,

Karnataka, during the period of November

2005 to August 2006, having the signs and

symptoms of Vatarakta were screened.

Inclusion criteria- 20 patients taken in this clinical trial .

- The patients of Vatarakta clinically di-agnosed and confirmed by investigations.

- The patients between ages of 16 to 70

years were included in study.

- Patients were randomly selected irre-

spective of sex, occupation, caste, etc.

Exclusion criteria: The patients suffering

from Vatarakta showing the presence of

followingcriteria were excluded from the study.

- The patients with severe toxicity

-

Progressive gangrenous changes invicinity are excluded from study.

- Diseases of immunological basis and

syphilis are excluded.

Investigations

Following are the list of investigations car-

ried out in 20 patients of Vatarakta taken

for this study. Hb %,TC, DC, ESR, RBS,Liver function test, Blood urea, serum cre-

atinin, Lipid Profile, Arterial Doppler Ul-

tra sound, Arteriography.

Design: It is a single blind clinical studywith a pre-test and post-test design. In this

study 20 patients diagnosed as Vatarakta

of either sex were subjected to clinical

study.

Intervention: The selected patients were

administered with1)

Lekhana Basti as kaala basti course

of 16 days, in which Niruha Basti is

administered in a dose of 480 ml for 6

days by using the enema can. In this

basti course 10 sittings of Anuvasanabasti was also administered with

Shatapaka madhukataila in a dose of

120ml. Anuvasana basti was given by

using Plastic syringe.

2) In conjunction with basti treatment the patient was also treated orally with

Vataraktantaka Rasa in the Dose of

250 mg tid. This oral medication was

continued for 30 days with the

anupana of warm water.

Duration of study: 30 days


19/198


Assessment criteria: The state of the dis-

ease Vatarakta changes after the interven-

tion. Improvement or otherwise was de-

termined by adopting the standard methodsof scoring for subjective, objective and

special investigation criteria. The Mar-

gavarana was assessed both before and

after the intervention to note any change

by using the arterial Doppler study. Lipid

profile was also studied before and after

the treatment.

Assessment of overall effect : As per the

reduction in the total scores of the assess-

ment parameters, the overall effect is cal-culated as follow-

Complete remission - total score is 0 after

the treatment Marked improvement – re-duction in the mean symptom score by

75to 99% from the initial score.

Moderate remission - reduction in the

mean symptom score by 50 to 74%

Average remission - reduction in the mean

symptom score by 25 to 49%Unchanged - reduction in the mean symp-

tom score by < 24 % from the initial score.Effect of Treatment in Vatrakta-

Effect on Pain: Patients treated with Vata-

raktantakarasa and Lekhana basti had

marked remission of the symptom pain.

1.8 was the mean initial score of pain in 20

patients of Vatarakta which came down to

1.0 after the treatment. The improvement

to the tune of 44.44% is found to be statis-tically highly significant (P!0.001) as

shown in the Table No.1.

Table No.1: Effect of treatment on Pain

Mean Score Difference

in means

% Paired ‘t’ test

BT AT S.D S.E.M. t value P value

1.800 1.000 0.800 44.4 0.410 0.0918 t= 8.718 P=


20/198


patients of Vatarakta. This initial meanscore came down to 0.0500 after the

treatment. The improvement to the tune of

92.30 % was highly significant (P!0.001)

as revealed by the paired‘t’ test. Details ofthe same are given in the Table No.4

Table No.4: Effect of treatment on disturb-

ance of Sleep


in means



0.650 0.0500 0.600 92.30 0.503 0.112 t = 5.339 P = !0.001

EFFECT ON TENDERNESS:

Tenderness is another symptom of Vata-

rakta. The initial mean score of the pa-

tients in tenderness was 0.100 which was

reduced to 0.00 after the treatment. The

improvement to the tune of 100% was rec-

orded, is statistically significant. Details of

the same are represented in the Table No.5.

Table No.5 comparison of effect on Ten-

derness


in means



0.1000 0.000 0.1000 100 0.308 0.0688 t = 1.453 P = 0.163

EFFECT ON EDEMA: Before the treat-

ment the mean score of symptom of

Edema was 0.350. After the treatment with

Vataraktantak rasa and Lekhana Basti this

was reduced to 0.0500 giving 85.71% ef-

fect. The change that occurred with thetreatment is greater than would be ex-

pected by chance; there is a statistically

significant change (P = 0.010) as assessed

by the paired‘t’ test.

The details of the same are given in the

Table No.6.

Table No.6 Effect of treatment on Edema


in means



0.350 0.0500 0.300 85.71 0.470 0.105 t = 2.854 P = 0.010

EFFECT ON LOCAL COLOUR

CHANGES: Patients treated with Vata-raktantak rasa and Lekhana Basti had no

difference in Local color changes. 0.200was the mean initial score in 20 patients of

Vatarakta which remained as 0.200 after

the treatment.Table No.7 Effect of treatment on Local

colour changes


in means



0.200 0.200 0.000 0 - - - -

EFFECT ON WALKING ABILITY:

47.22% of improvement was observed in

the score of walking ability. 1.8 was theinitial mean score recorded in the 20 pa-

tients of Vatarakta This was brought

down to 0.950 after the administration of

Vatarakta and Lekhana Basti This

improvement after the treatment is foundto be highly significant (P!0.001) as per


21/198


the paired ‘t’ test. The details of the differ-

ent statistical values are shown in the Ta-

ble No.8.

Table No.8: Effect of treatment on walking

ability


in means



1.800 0.950 0.850 47.22 0.366 0.0819 t = 10.376 P = !0.001

EFFECT ON PERIPHERAL PULSES: 1.5

was the mean initial score of Peripheral

pulses before the treatment in patients of

Vatarakta This initial mean score came

down to 1.05 after the treatment. The improvement to the tune of 30 % was signifi-

cant (P=


22/198


BT AT in means S.D S.E.M. t value P value

39.850 44.500 4.650 4.705 1.052 t = -4.420 P =


23/198


Results showed that there is definite re-duction in the bad cholesterol and increase

in the good cholesterol following the

treatment. These changes establish the ef-

ficacy of lekhana basti and vataraktantaka

rasa in preventing the progression of margavarana as well as the illness vatarakta. The marginal improvement in the circula-

tion following medication with lekhanabasti and vaataraktantaka rasa confirms

the effect of medicine on reducing themargavarana. Reduction in pain burning

sensation etc proves the reduction in the

morbidity of vata dosa following the

medication. The combination of shodhana treatment in the form of lekhana basti and

shamana treatment in the form of vata-raktantaka rasa is an ideal regimen in pa-

tient’s sufferirng from raktamargavarana janya vataraktaa.

0-2-0--'

1. Chakrapani,on Agnivesa: Charaka

Samhita ,Varanasi, Chaukambha

Sanskrita sansthana, 5th

edi-

tion,2001, Chikitsa sthana, chapter

29, Slok 1, 738 PP, Page no. 628

2.

Sushruta’s, Sushruta Samhita,Varanasi, Chaukambha orientalia,

7th

edition, 2002, Ni-danasthana, chapter 1, slok 1-48,

824 PP, Page no. 264

3. Agnivesa: Charaka Samhita

,Varanasi, Chaukambha Sanskrit

sansthana, 5th

edition,2001,

Chikitsa sthana, chapter 29, Slok 1

- 100, 738 PP, Page no. 627-634

4.

Agnivesa:Charaka sam-hita,,Varanasi, Chaukambha San-

skrit sansthana, 5th

edition,2001,Chikitsa sthana, chapter 29, Slok

10- 738 PP, Page no. 627

5. Agnivesa: Charaka Sam-

hita,Varanasi, Chaukambha San-

skrit sansthana, 5th

edition, 2001,

Chikitsa sthana, chapter 29, Slok

156, 738 PP, Page no. 634

6. Sushruta’s, Sushruta Samhita,

Varanasi, Chaukambha orientalia,7

th edition, 2002, Sutrasthana,

chapter 15, slok 32, 824 PP, Pageno. 73

#,00-'1,&*%&6 !)(/,0

Dr. Pundpal Amitkumar B.

Assocciate Professor, ShalyaTantra Dept.,

Late Kedari Redekar Ayurved

Mahavidyalaya,Gadhinglaj,

Dist.Kolhapur, Maharashtra,

416502Mob. no.- 09420779594

Mail Id-

[email protected]




24/198

!"#$%&'() +"()%+ (#, (-'&.",(

Dr. Amrutha.B.L1 Dr. Elgeena Varghese

2 Dr. Pratibha Kulkarni

3

1,2.PG Scholars, 3. HOD & Asso Professor Department of Kriyashareera SDM College of Ayur-veda & Hospital Hassan

/#%&0,'1%/0#Ayurveda is the science which deals with

maintenance of health and cure of disease. It

stands on the frame work of Tridoshas,

Saptha Dhathus and Trimalas. Ayurveda

examine the menstrual cycle as a window into

the human body. Artava is considered as the

Upadhathu of the first and foremost dhathu ie

the Rasa dhathu. Rajapravrithi is a normal

physiological process in women as sleep,

bowel activity etc. As the nature and patternof all the physiological and psychological

processes are dependent on the inherent

constitution of doshas ie the Prakruthi, the

pattern and nature of Rajapravrithi should

also show some relation to the Prakruthi ofthe individual. So by understanding the nature

of menstrual pattern in women the menstrual

health can be maintained by administering

according diet and regiments.

Aims and Objectives: An attempt has

been done to analyze the characteristics of

Rajapravrithi according to the Prakruthi or

Doshic constitution of a women.

Artava and Prakruthi: Artava is defined

as the periodical expulsion of blood through

the vagina of an adult female1. It is one of the

most important physiological process which

enables the formation of Garbha. So the

regular and uninterrupted occurrence of

!"#$"% '()$*+" ,-)"(-.)$/-.+ '01(#"2$* 3"2$*.+ 4/1(-.+ ,5567898: ;:


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Dr. Amrutha.B.L et;all : Menstrual Health And Ayurveda

!"#www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016

Artava is necessary for a healthy progeny.

Artava is considered as the Upadhatu of Rasa 2. It is produced cyclically and being directed

by Vata and is expelled through the vagina3.

As far as modern science is considered,

menstruation is the process where there is

flow of blood from the uterus through thevagina occurring primarily in humans,

determined by a complex interaction of

hormones4. Prakruthi is the innate constitution

of an individual based on the predominance of

Dosha determined at the time of conception which

cannot be changed till death5. Qualities of Dosha

are expressed on body due to its predominance

and it is called Deha Prakruthi. It is the

enumeration or consideration of body features

internal as well as external. Depending on the Dosha that is predominant in the Sukra and

Shonita at the time of union, the food and

activities of the pregnant women, uterus and

season Prakruthi is determined6. Human body is

made up of Doshas and all physiological

functions are depending on Doshas. Prakruthi of

each individual is determined from the time of

consumption itself. So each individual is specific

in his/her own constitution of Prakruthi . If every

physiological function depend on Doshas, then

there will be a relation between the characteristics

of all physiological functions with individual

Prakruthi and so with menstruation also.

Ayurvedic understanding of the cycle of

Doshas during the whole lifespan is important

particularly in the case of menstrual health in

women. During the earlier stages of life ie.

from the life in vitro through young adulthood

it is the Kapha Dosha which predominates.

Pitta increases dramatically during

adolescence and tends to dominate the body

processes until early thirties. Later stages the

Vata Dosha dominates mainly during sixties

and seventies. So the period of time where

Pitta is dominant is more prone to get

disorders such as high blood pressure, non-

congestive heart disease, hyperthyroidism etc.

It is also a high risk of time for many female

disorders.

Present generation females are facing

many problems related to their menstrua-

tion like painful menstruation, irregular

cycles, irregularity in bleeding patterns etcin their adolescent age without any specific

pathology in their reproductive system. As

long as the Doshas function in their

normal state and are not affected or

overshadowed by another Dosha, the

menstrual cycle happens optimally. In a

specific Prakruthi person there will be

predominance of that particular Dosha

which may interfere with the normal or

optimal functions of the other Doshas. So

according to the Prakruthi there are

chances that there will be variations in the

characteristics of Rajapravruthi. For

example, pain is a feature where Vata is

responsible, so in Vata Prakruthi indi-

viduals there is an increased chance for

painful menstruation, Pitta Prakruthi in-

dividuals may get subjected more to mood

variations, Kapha Prakruthi individualsmay have more clots in their menstrual

blood etc. During the period of menopause

also, different symptoms can be seen in

women with different intensities, that may

be due to the variations in bodily

constitution. Mostly premenopausal

symptoms are due to increased Pitta which

will get exhibited as hot flushes, rashes

over skin, intolerance to heat etc.

DISCUSSION

Vatika menstrual flow

As Vata dominates the uterus, its Sheeta

and Khara qualities causes the blood ves-

sels to constrict. Ruksha guna depletes the


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bodily tissues and finally causes early

cessation of menstrual flow. Due to de-

crease in plasma and blood tissues, de-

creased nourishment to the endometrial

lining of uterus the overall flow and men-

strual discharge will be less. Where ever

there is a blockage for the free flow ofVata, there will be pain. So most of the

Vata dominating cycles will be painful.

Paittika menstrual flow

Pitta is hot and sharp. So it brings more

fluidity to the blood so that it flows easily.

Pitta resides in blood and in excess I may

cause heavy bleeding. As it causes

tendency for swelling, it leads to tender,

swollen breasts, acne etc that women experience during their premenstrual period.

Kaphaja menstrual flow: Kapha is

dull, heavy and sticky. Stronger the influence

of Kapha Dosha, the more likely to get a

prominent growth of the endometrial tissue.

As more blood vessels grow to supply this

growth, the Kapha cycle is more likely to

experience a heavier flow than Vata cycle.

General Menstrual Care: Menstrual

cycle is an effective monthly cleanse. Soit is essential to support the process of

cleansing. All cleansing actions are giving

importance to rejuvenation, rest and

kindling of Agni.

Guidelines for healthy menstrual

cycle

1. Consume simple, freshly prepared and

hot food items. Try adding spices such

as Ginger, Cardamom, Cumin,

Coriander and Cinnamon

2. Cleansing involves the downward

movement of wastes out of the body. So

the direction of flow should not be

interrupted by any upward movements

like excessive talking, thinking, sexual

intercourse and even Pranayama and

Yoga. All these activities need energy

and our body needs to use all its reserve

energy towards cleansing

3. Suppression of urges like urination,

defecation and sneezing should be

avoided. All these will cause the upwardflow of Vata which will disturb the free

flow of cleansing action.

4. Meditation will bring peace of mind

which again assists the action of Vata

5. Hydrate the body with warm teas such as

ginger tea, lemon tea with honey, cumin,

coriander and fennel teas.

6.

Maintaining the balance of Doshas even

at the time without menstruation is also

important. The better way to maintain

Doshas in equilibrium is to do yearly

cleanse. Seasonal cleansing is highly

effective way to balance and rejuvenate

all bodily tissues so that they function

optimally.

7. Practicing Pranayama for balancing the

mind as it helps to equalize the right and

left sides of the brain and Yoga as per

constitution will keep your body strongand energetic.

Herbal care for healthy men-

struation

Herbs can be used in accordance to the

Doshas involved. In a Vatik cycle mainly

Dasamoola can do its work of pacifying

Vata dosha. Ginger is another drug which

helps in a Vatik flow with discomfort.

Herbs can really help in Pitta flow

mainly. Asoka tones the uterus and thus

eases a heavy flow. Satavari, Amalaki,

Gudoochi, Kumari, Brahmi etc are useful

drugs in a Paittik flow as they are very

famous for their Pitta pacifying action.

Spices such as cinnamon, cardamom,


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black pepper etc are useful in case of a

Kaphaja cycle due to their Agni

stimulating action. Castor oil pack due to

its warm and penetrating quality can break

up the stagnation latent in the pelvis.

Paying an eye on the characteristics of

menstruation will bring into light the Dosha which is predominant in that cycle.

That may also be depending on the

Prakruthi of the individual. Application of

theories related to Doshas and practical

application of drugs mentioned for

particular Doshas will help to cure the

discomforts or ailments during menstru-

ation.

CONCLUSION

Being the natural cleansing process of the

body menstruation needs anassistance from

the individual. The unobstructed flow of

menstrual blood will be possible only by the

optimal assistance of the Tridoshas. Any

disturbance in the equilibrium of Doshas will

create problems in menstrual cycle. In a

particular Prakruthi there is a physiological

increase in the level of that particular dosha,which may show its effect on the character-

istics of menstruation. Such effects due to the

Prakruthi of the individual may cause some

ailments which can be considered

physiological. So understanding the Doshic

play and adequate application of medication,

control of diet and regiments is needed to re-

store the optimal action of menstrual cycle

which is very crucial to maintain the health of

a women.

REFERENCES

1. Paradakara HSS. Ashtanga Hrudaya with

Sarvangasundara commentary of

Arunadatta and Ayurvedarasayana

commentary of Hemadri.Reprint ed .

Varanasi (India): Chaukambha

publications; 2011. p.363

2. Acharya JT. Charaka Samhita with

Ayurveda Dipika commentary of

Chakrapani Datta. Reprint ed. Varanasi(India): Chaukambha Orien-

talia;2009.p.514

3. Paradakara HSS. Ashtanga Hrudaya with

Sarvangasundara commentary of

Arunadatta and Ayurvedarasayana

commentary of Hemadri.Reprint ed .

Varanasi (India): Chaukambha publi-

cations; 2011. p.361

4. Usha VNK.A Text Book OF Obstetrics

Prasuthi Tantra,Vol 1,Reprint ed , Va-

ranasi,Chaukambha Sanskrit

Prathishthan;2013.p.71

5. Acharya JT. Susrutha Samhita with Ni-

bandhasangraha commentary of Dalhana.

Reprint ed. Varanasi (India):

Chaukambha Sanskrit Sansthan; 2009. p.

360.

6. Acharya JT. Charaka Samhita with

Ayurveda Dipika commentary ofChakrapani Datta. Reprint ed. Varanasi

(India): Chaukambha Orien-

talia;2009.p.516

10&&"$20#,/#3 ('%+0&

Dr. Amrutha.B.L

Department of Kriyashareera SDMCollege of Ayurveda & Hospital Hassan

Karnataka, India




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! #$%&%#!$ '()*+ ,& -+./0$%.%*/1%! 2%(-

1/*,-!0 3)33)$) !&* $/4-!&%+! 1!-!4!'-!+!1DR . SANDEEP SINGH 2Dr. S. G. Chavan

3DR . M. A. HULLUR

1M.D.Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India2M.D.(Ayu),Prof. and Guide, Department of Kayachikitsa,Ayurveda Mahavidyalaya, Hubli, Karnataka,

India3M.D.(Ayu), Ph.D. (Ayu),Prof. and Principal,Department of Kayachikitsa,Ayurveda

Mahavidyalaya,Hubli, Karnataka, India

%&(0,*)#(%,&5

Ayurveda, the ancient science of life is being

increasingly accepted by the world at large for

its relevance and adoptability to the modern

science. As we moved into rapid moderniza-

tion, the lifestyle of an individual has become

sedentary along with lack of exercise and there

is increased popularity of fast foods leading to

impairment of metabolism in an individual

making him prone to series of disorders called

as lifestyle disorders. Everybody constituents

have specific proportions and specific functions

in the body. They will perform their functions

only in their optimal levels. The normal level is

maintained by controlling the metabolism. The

metabolism is normally regulated by a well-de-

veloped controlling system functioning in the

healthy body. Healthy state is maintained by

keeping the equilibrium of various constituents

of the body. Any abnormalities in the control-

ling system will lead to abnormalities in this

equilibrium and thus leads to various diseases.


ABSTRACT

Hyperlipidemia means abnormally high levels of lipids in the blood. These lipids or fats include cho-

lesterol and triglycerides. It results from abnormalities in lipid metabolism or plasma lipid transport or a

disorder in the synthesis and degradation of plasma lipoproteins. Sedentary life style and increased popularity of fast foods are the most contributory factors. More than half of the Coronary Heart Dis-

eases (CHD) are attributable to abnormalities in the levels and metabolism of plasma lipids and lipo-

proteins. . In India, persons suffering from CHD have increased in last 20 years. It is estimated that

there are almost 224 million people with high cholesterol in India. According to WHO, raised serum

cholesterol levels is one of the top ten causes of death throughout the world. There are many effective

medicines and therapies described in different classics of Ayurveda for treating the hyperlipidemic

activity. A clinical study comprising of 25 patients of either sex attending OPD clinic of AMVH Hubli

presenting with Hyperlipidemia confirmed by Lipid Profile were treated with Medhohar Guggulu and

Lekhaniya Mahakashaya. The results shown were highly significant.

KEY WORDS: Hyperlipidemia, MedhoharaGuggulu, LekhaniyaMahakashaya

How to cite this URL: Dr. Sandeep Singh, A Clinical Study on Hyperlipidemia with Medohar Guggulu and Lekhaniya

Mahakashaya. International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:



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D R . S ANDEEP S INGH E T ;A LL : A C LINICAL S TUDY O N H YPERLIPIDEMIAW ITH M EDOHAR G UGGULU A ND L EKHANIYA M AHAKASHAY A

!"#www.iamj.in IAMJ: Volume 4; Issue 05; april;- 2016

Hyperlipidemia is one such disorder where

there is an abnormally elevated level of any

one, or all lipids and lipoproteins in the blood.

It is most common form of "dislipidemia". Li-

pids consist of fats, waxes, sterols, mono-

glycerides, phospholipids, and fat-soluble vita-

mins and minerals. Since lipids are hydrophobic

i.e. insoluble in water, these are (e.g. choles-

terol) transported in the blood plasma within

protein particles (lipoproteins). It is of utmost

significance because it leads to atherosclerosis

of vessels (arterial walls) leading to vascular

accidents like Cerebro vascular or Coronary

Artery Diseases.More than half of the Coronary

Heart Diseases (CHD) are attributable to

abnormalities in the levels and metabolism of plasma lipids and lipoproteins. However, ele-

vated lipoprotein levels in most patients with

CHD reflect the adverse impact of sedentary

lifestyle, excess body weight, and diets high in

total and saturated fat superimposed on a ge-

netic background that confers susceptibility to

increased circulating lipids. In India, persons

suffering from CHD have increased in last 20

years. In South India CHD incidence is 7% in

rural areas and 13% in urban areas.Accordingto WHO, raised serum cholesterol levels is one

of the top ten causes of death throughout the

world.Several modern drugs are available for

the management of Hyperlipidemia where most

of them are potentially toxic, costly and are

contraindicated in hepatic or renal impairment,

gall bladder disease and pregnancy. Atorvas-

tatin is one such a drug of choice which is

highly used and recommended in hyper-

lipidemia. It has shown very good results but

also responsible for many side effects like myo-

sitis, joint pain, stomach upset, liver damage

and many more. Here, Ayurveda can intervene

by modifying the risk factors aiming at the pre-

vention.It can be included under santarpana-

janyavyadhi as “Medoroga”. It is a condition

caused by derangement of agni, leads to ama-

rasa, there is medodhatvagnimandya leading

to improper formation of medodhatu in excess

and if not arrested further results in sthoulya

and other santarpanjanya vyadhi’s1.Lack of

physical exercise and indulging in

Kaphavardhaka ahara leads to Medovriddhi and

hence causes “Medo roga”2. The morbid

accumulation of kapha and meda tends to get

adhered to the vessel wall causing its thicken-ing, tortuosity, stiffness as well as narrowing.

This change in the vessel wall is referred as

Dhamani pratichaya3 (throm-

bosis/atherosclerosis). Thus considering above

facts, this study is intended in treating the Hy-

perlipidemia with Medhohar Guggulu and Lek-

haniya Mahakashaya.

AIMS AND OBJECTIVES:

1. To study Hyperlipidemia according to

Ayurveda and Modern science. 2. To study efficacy of Medhohar Guggulu

and Lekhaniya Mahakashaya in Hyper-

lipidemia

MATERIALS AND METHODS:

1. Trikatu Churna4

2. MedhoharGuggulu5

3. Lekhaniya Mahakashaya6

STUDY DESIGN:A minimum of 25 Subjects di-

agnosed as Hyperlipidemia were selected after

fulfillment of inclusion criteria.

Procedure Drug used Matra No.of Days

Ama Pachana Trikatu Choorna

5 gms BD with warm water

before food

3 days (or till

niramalakshana seen)

Lekhaniya

Mahakashaya

30 ml

before food 60 days


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Samanoushadhi Medhohar

Guggulu

250 mg (2 BD) with luke-

warm water after food 60 days

Duration- 2 months - weekly visit

Follow up- 1 month - Fortnightly visit

INCLUSION CRITERIA:

•

Aged between 20-60 yrs.

• Had clinical features of Medoroga.

• Both obese and non-obese patients were se-

lected for the study.

• Both the sex (male and female) were se-

lected for the study.

• Subjects having all or at least any one of

the lipid profile above normal range

were selected for the study.

EXCLUSION CRITERIA:1. Subjects had history of serious cardiac

disorders like Myocardial infarction,

Cardiac failure, etc.

2. Subjects had any major illness,

Hypertension or if the patient was al-

ready taking some therapy or recently

adjusted therapy.

3. Subjects had history of Thyroid disorder,

Renal disorder, Cholelithiasis and PCOS.

4.

Subjects with systemic disorders which

interfere with the course of treatment.

5. Hyperlipidemia due to Consumption of

drugs such as glucocorticoids.

6. Pregnant women and lactating mothers.

WITHDRAWAL CRITERIA:

1. If the patients having clinical feature would

aggravated into serious condition.

2. If the patient is irregular in the decided

course of treatment.

Intervention

• Amapachana with Trikatu Churna 5gm BID

30 minutes before food with Ushnodaka as

Anupana till niramalakshana seen.

• Subjects were subjected for

ShamanaChikitsa with Lekhaniya

Mahakashaya (30ml BID) with water

before food for 60 days.

• Medhohara Guggulu (250 mg BID) with

lukewarm water after food for 60 days.

• Pathya Aahara and Pathya Vihara was ad-

vised to all the Subjects.

ASSESSMENT CRITERIA:Subjective parameter

• Ashaktahsarvakarmasu (Difficulty in

routine acitivities)

• Kshudrashwasa (Dyspnoea)

• Utsahahani (Lethargic)

• Angagaurava (Heaviness in body parts)

• Daurbalya (Weakness/Decreased physical

activity)

• Swedhadikya (Increased Perspiration)

• Trishna (Increased Thirst)

• Nidradikya (Increased Sleep)

• AlpaMethunah (Decreased sexual desire)

Objective parameter

• Lipid profile before and after treatment.

Gradation of Clinical feature

1-ASHAKTAH SARVAKARMASU: (Diffi-

culty in routine acitivities)

Not seen - 0

Lack of interest in doing activity with feeling of lethargic. - 1

Lack of interest in doing activity with fatigability. - 2

Absolutely no interest in doing activity and easy fatigability. - 3

2- KSHUDRA SHWASA: (Dyspnoea)

Dyspnoea after heavy work (movement) but relieved soon and up to tol-erance

- 0


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Dyspnoea after little work but relieved later and up to tolerance - 1

Dyspnoea after little work but relieved later and beyond tolerance - 2

Dyspnoea in resting condition - 3

3- UTSAHA HANI: (Lethargic)

No lethargy (Doing work satisfactorily with proper vigor in time) - 0

Doing work at his own with lethargy and late initiation - 1

Not starting any work on his own responsibility and doing little work veryslowly

- 2

Does not take any initiation and not want to work even after pressure - 3

4-ANGA GAURAVA: (Heaviness in body parts)

Not felt - 0

Feeling heaviness in the body - 1

Heaviness not pertaining to do more work - 2

Totally sedentary due to heaviness of body - 3

5- DAURBALYA: (Weakness/Decreased physical activity):

Can do routine exercise - 0

Can do moderate exercise without difficulty - 1Can do mild exercise with very difficulty - 2

Can not do even mild exercise - 3

6- SWEDADIKYA: (Increased Perspiration)

Sweating after heavy work and fast movement or in hot season - 0

Profuse sweating after moderate work and movement - 1

Profuse sweating after little work and movement - 2

Sweating even at rest or in cold season - 3

7- TRISHANA: (Increased Thirst)

Normal thirst - 0

Thirsty but relieved after drinking 1-2 liter of water - 1

Thirsty but not relieved after drinking 1-2 liter of water - 2

Repeated thirst and not relieved at all - 3

8- NIDRADIKYA:( Increased Sleep)�

Documents

International Ayurvedic Medical Journal April 2016