Siddadarada amavata rs010_gdg

PREPARATION AND ANALYTICAL STUDY OF SRI SIDDHADARADAMRUTA RASA AND ITS CLINICAL

EFFICACY IN AMAVATA

By

Pradeep Agnihotri

Dissertation Submitted to the Rajeev Gandhi University of Health Sciences,

Karnataka, Bangalore.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATHI M. D.

In

RASASHASTRA

Under the guidance of

Dr. M. C. Patil M.D. (Ayu)

Under the co-guidance of

Dr. G. N. Danappagoudar

M.D. (Ayu)

DEPARTMENT OF RASASHASTRA, POST GRADUATE STUDIES AND RESEARCH CENTER,

SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103.

2003-2006

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I here by declare that this dissertation / thesis entitled

“Preparation and Analytical study of Sri Siddhadaradamruta Rasa and its

Clinical Efficacy in Amavata” is a bonafide and genuine research work

carried out by me under the guidance of Dr. M. C. Patil, M.D. (Rasashastra),

Professor and H.O.D, Post-graduate department of Rasashastra and under

the co-guidance of Dr. G. N. Danappagoudar M.D. (Rasashastra), Lecturer,

Post-graduate department of Rasashastra.

Date: Place: Pradeep Agnihotri.

SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA.

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “Preparation and

Analytical study of Sri Siddhadaradamruta Rasa and its Clinical Efficacy in

Amavata” is a bonafide research work done by Pradeep Agnihotri in partial

fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Rasashastra).

Dr. M. C. Patil, M.D. (Rasashastra)

Professor & H. O. D. Date: Department of Rasashastra, Place: Gadag. Post Graduate Studies and Research Center, D.G.Melmalgi Ayurvedic Medical College, Gadag.

SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA.

CERTIFICATE BY THE CO-GUIDE



Amavata” is a bonafide research work done by Pradeep Agnihotri in partial

fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.

(Rasashastra).

Dr. G. N. Danappagoudar M.D. (Rasashastra)

Lecturer Date: Department of Rasashastra, Place: Gadag. Post Graduate Studies and Research Center, D.G.Melmalgi Ayurvedic Medical College, Gadag.

ENDORSEMENT BY THE H.O.D. AND PRINCIPAL OF

THE INSTITUTION



Amavata” is a bonafide research work done by Pradeep Agnihotri under the

guidance of Dr. M. C. Patil, M.D. (Rasashastra), Professor and H.O.D, Postgraduate

department of Rasashastra and under the co-guidance of Dr. G. N.

Danappagoudar M. D. (Rasashatra) Lecturer, Postgraduate department of

Rasashastra.

Dr. M.C. Patil, M.D. (Rasashastra) Dr. G. B. Patil.

Professor & H.O.D Principal

Department of Rasashastra, D G M A M C, Gadag.

P G S & R C, D.G.M A M C, Gadag.

Date: Date:

Place: Gadag. Place: Gadag.

COPYRIGHT

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health

Sciences, Karnataka shall have the rights to preserve, use and disseminate this

dissertation / thesis in print or electronic format for academic / research purpose.

Date:

Place: Gadag. Pradeep Agnihotri.

© Rajiv Gandhi University of Health Sciences, Karnataka

ABBREVIATION

1) A. H. – Ashtanga Hridaya.

2) A. P. – Ayurveda Prakash.

3) A. S. S. – Ayurveda Sara Sangraha.

4) A. T. – After treatment.

5) B. P. – Bhavaprakasha.

6) B. R. – Bhaishajya Ratnavali.

7) B. R. R. Su. – Bruhat Rasaraja Sundar.

8) B. T. – Before treatment.

9) C. D. – Chakradatta.

10) C.S. – Charaka Samhita.

11) D. G. – Dravyaguna Vignana.

12) D. N. – Dhanwantari Nighantu.

13) FRLHT – Foundation for Revitalisation of Local Health Traditions 14) K. N. – Kaiyadeva Nighantu.

15) Ra. – Rasamruta.

16) R. A. – Rheumatoid arthritis.

17) R. C. – Rasendra Chudamani.

18) R. J. N. – Rasajala nidhi.

19) R. K. – Rasa Kamadhenu.

20) R. N. – Raja Nighantu.

21) R. Pr. Su. – Rasa Prakasha Sundar.

22) R. R. S. – Rasa Ratna Samucchaya.

23) R. S. S. – Rasendra Sara Sangraha.

24) R. T. – Rasatarangini.

25) S. S. – Sushruta samhita.

26) SSDR – Sri Siddhadaradamruta Rasa

27) Y. R. – Yoga Ratnakara.

III

ABSTRACT

The Rasa dravyas are basically classified on the basis of Agni samskaras they

have undergone that’s how Kharaleeya, Parpati, Kupipakwa, and Pottali rasayanas came

in to existence with varying grade of therapeutic efficacy.. There are certain other

preparations which cannot be grouped under these categories the agni samskara given to

them also varies. These preparations are few and do have the equivalent therapeutic

efficacy as above. Sri Siddhadaradamruta Rasa , a preparation involving Shodhita

Hingula which when subjected to Dahana and Pachana samskara with specified drugs

like Vata ksheera, Palandu swarasa, Bhallataka, Lavanga and Grutha is claimed to

increase the therapeutic efficacy which is advocated in Amavata as one of its indication

along with Purana Guda as anupana. After thorough preparation as per classics the drug

was analytically studied to ascertain the effect of samskaras on it. There was presence of

media substrates in to the sample like Fat. Its Organoleptic character variations such as

change in colour from Red to Dark Brown was noticed along with changes in Hg% and

S% before and after the preparation (Hg% from 86.6 to 62% and S% from 12.83 to 12.28

respectively). The ESCA reported the presence of HgO and HgS in the ratio of 60:40. It

was noted that there was a presence of selenium in lesser proportion which was not in

elemental form. This was therapeutically tested over 15 cases of Amavata in a single

blind prospective clinical trial. The result in the trials statistically showed highly

significant in the cardinal symptoms like sandhi shotha, Sandhishoola, Gouravata,

Jadyata, jwara (Sthanika Ushmata) Nidraviparyaya ( p-value <0.001). Thus it was

inferred that the Samskaras has a definite role in increasing the therapeutic efficacy of the

drug. It was found promising in navottha Amavata.

Key Words: Samskara; Dahana; Pachana; Sri Siddhadaradamruta Rasa; Amavata; Organoleptic Characters; ESCA; Clinical efficacy.

IV

ACKNOWLEDGEMENT

I salute to Lord Venkateshwara and HisHoliness Shri Abhinav Shivanand swamiji to have bestowed their blessings through out my carrier.

I express my heartfelt obligations to my honorable guide Dr. M C Patil MD (Ayu) Professor and HOD, PG Dept of Rasashastra, DGMAMC, Gadag, for his critical suggestions, guidance, and encouragement at every stage in the accomplishment of this work.

I am greatful and obliged to my co-guide Dr G N Danappagoudar MD (Ayu) Lecturer, PG Dept of Rasashastra, DGMAMC, Gadag, under whose guidance and inspiration I have been able to complete this work.

I am happy to convey my deep sense of gratitude to Dr G B Patil Principal, PGS & RC, DGMAMC, Gadag, for his encouragement and providing facilities during this research work worthwhile.

I offer my sincere thanks to Dr RKGacchinmath, Professor and HOD, UG Dept of Rasashastra, DGMAMC, Gadag, for his constant support and valuable directions.

Humble thanks to Dr DilipkumarB, Asst Professor, PG Dept of Rasashastra, DGMAMC, Gadag, for his valuable suggestions and critical views.

My sincere gratitudes to Dr J G Mitti, Lecturer, PG Dept of Rasashastra, DGMAMC, Gadag, for his valuable information in bringing out this work.

I express my earnest gratitude to Dr GS Hiremath, Dr Varadacharyulu, DrBSPatil, Dr Avvanni, Dr Prushottamacharyulu, Dr Mulugund, Dr KSR Prasad, Dr SH Doddamani, Dr Shettar, Dr Belawadi, Dr Paraddi, Dr Sankh, Dr Nidagundi, Dr Mulkipatil, Dr Shankargouda, Dr Samudri, and Dr Yasmin for their great co-operation.

I ackwoledge my sincere thanks to Nandakumar for his statistical work, DrDVijaykumar, DrRevati, ShriChandur, ShriSuresh, ShriDNPatil, ShriPolicepatil for their kind co-operation and help in analytical study.

I extend my gratitude to Shri VMMundinmani and Sureban and SSRAMCollge for providing the required books during the study.

I render my sincere thanks to Tungabhadra Grameena Bank for monitory support. I am greatful Dr KY Krishnaji, Dr BB Joshi, Dr Gudagnatti, Dr RS Hiremath, Dr

MAHullur, Dr SKBannigol, Dr AS Prashant, and Dr Jadar for their heartfelt co-operation and advise.

With pleasure I extend my sincere gratitude to Dr SDYarageri RMO, Dr UVPurad, DrAMAdi,Principal,AMC,Ron, DrKotturshetti, DrBGSwamy, DrVMSajjan,

I

SmtPKBelwadi, Smt Sarangmath, Tippanagoudar, Kallangoudar, Biradar, SmtEkbote, MMJoshi, Shri Shankar Belwadi for their co-operation and help during the study.

I am always at rememberance of Mr and Mrs Lalitprasad and Mr and Mrs DrBabu Vijayanathan whose encouragement is the result of my present work.

This work remains incomplete without mentioning my brother Mr Bhaskar and sister in law Mrs Geeta Bhat whose love and affection has brought me up to this altitude, I am greatful to them.

I am ever thankful to my intimate friends Dr BYGanti, DrShaila, DrMouli, DrUday, DrRatna who stood with me all the way at my turmoil.

I thank my kiths and kins especially Mrs and Mr Malteash, Mrs and Mr Gururaj, Shashi for their in time support valuable help during my work. I extend my regard to my sisters Anju, Roopa, Deepa for their affection.

I owe my immense thanks to Mrs and Mr Dr BDBhat, CDPatil, RDPatil, ASeenam Bhat for their love and affection shown through out my life.

I have no words to explain my feelings towards my all time friends Mrs and Mr CBRaj, Mrs and Mr Jagdish, Mr Chandru, Dr Basavaraj, Mr Ghouse and Dr SatishPai who are spirit behind my enthusiasm. I am ever thankful to them.

My in depth regards to Dr Koteshwar, DrChetan, DrDPJoshi, DrSantoji, DrVSHiremath, DrPattanshetti, DrVeenaK, DrSReddy, DrYadalli, Dr PDDeshpande, Dr GSKulkarni, DrVMKullolli, DrAIAkki, DrTeggi, DrSubin, DrFebin, DrSatish, DrMaheshAbhang, Dr SAPatil, DrAnita, DrSantosh Kulkarni, DrBani and DrVarsha for their friendly affection.

I am also thankful to my junior friends DrAnandH, DrAnita, DrSuvarna, DrSharanu, DrJayashri, DrSuma, DrRudraxi, DrKattimani, DrJagdishH, DrVijaySH, DrHakkandi, DrAshwin, DrGavi, DrAnandHD, DrAshwini, DrJiglur, DrSarvi, DrAshok, DrSulochana, DrManjunath, DrAmnish, DrShibaprasad, DrGavimath, DrPrasanna, DrBudi, DrMadhushri, DrPayappagouda, DrShivaleela, DrKumbar and Dr ArunkumarBiradar for their support and affection.

I acknowledge my patients for their kind co-operation and whole-hearted consent to participate in this clinical trial. I express my thanks all those who have helped me directly and indirectly with apologies for my inability to identify them individually.

Finally I dedicate my whole effort to my beloved parents Mr A.Shankar Bhat and Mrs Uma.S Bhat who are the driving force behind all my fruitful endeavors.

Date: Place: Dr Pradeep Agnihotri.

II

CONTENTS

Page No.’s

01. Introduction 1-3

02. Objectives 4

03. Review of Literature 5-53

04. Methodology 54-77

05. Results 78-101

06. Discussion 102-114

07. Conclusion 115-117

08. Summary 118-119

09. Bibliography 120-130

10. Annexure

i. Shlokas of Sri Siddhadaradamruta Rasa

ii. Case sheet Proforma

IV

Graph No

Contents Page No

01. Showing Distribution by age Group 78

02 Showing the distribution of patients by Sex. 79

03 Showing Patients distribution by Religion 80

04 Showing the distribution of patients by Socio-economic status. 81

05 Showing the distribution of patients by Occupation 82

06 Showing the distribution of patients by Prakriti. 85

07 Showing the distribution of patients by desha 88

08 Showing the distribution of patients by chief complaint 89

09 Showing the distribution of patients by associated complaints 90

10 Showing the distribution of patients by Nidana. 91

11 Showing the response of the therapy in Sandhishoola. 92

12 Showing the response of the therapy in Sandhishotha. 93

13 Showing the response of the therapy in Jwara 94

14 Showing the response of the therapy in Gouravata. 95

15 Showing the response of the therapy in Nidraviparyaya 96

16 Showing the response of the therapy in Jadyata. 97

17 Showing the overall result assessed on the basis of subjective & objective parameters

98

V

Sl.No Content Page No

01 Shows list of synonyms of Hingula according to different authors.

07

02 Shows inclusion of Hingula under different classes. (As per different texts)

09

03 Showing the bhedas of Hingula. 10 04 Sowing the rasa of Hingula according to various texts 13 05 Showing the doshaghnata of Hingula according to various

texts 14

06 Synonyms according to different authors 17 07 List of Synonyms of vata 23 08 Synonyms of Palandu according to different authors 26 09 Synonyms of Lavanga according to different author 29 10 Showing synonyms of Guda. 32 11 Synonyms of Grutam. 34 12 Showing the samanya laxanas of Amavata 40 13 Showing the different treatment modalities adopted in

Amavata according to various authors. 44

14 Showing the pattern of onset of Rheumatoid arthritis. 49 15 Results of Hingula Shodhana 57 16 Showing the quantity of Hingula before shodhana and after

shodhana 57

17 Showing weight of Bhallataka before and after shodhana. 59 18 Showing weight of Hingula before and after threading. 60 19 Showing details of Pachana Samskara. 61 20 Showing details of Ghruta Pachana. 63 21 Showing the gradation which is adopted in statistical

evaluation of clinical symptoms. 75

22 Showing the gradation which is adopted in statistical evaluation of walking time.

76

23 Showing Distribution by age Group 78 24 Showing the distribution of patients by Sex 79 25 Showing Patients distribution by religion 80 26 Showing the distribution of patients by Socio-economic

status 81

27 Showing the distribution of patients by Occupation. 82 28 Showing the distribution of patients by marital status 83

VI

Sl.No Content Page

No 29 Showing the distribution of patients by food habits 83 30 Showing the distribution of patients by addiction. 84 31 Showing the Distribution of patients by predominant Rasa in

diet. 84

32 Showing the distribution of patients by Prakriti. 85 33 Showing the distribution of patients by Sara. 86 34 Showing the distribution of patients by Samhanana 86 35 Showing the distribution of patients by Satwa. 87 36 Showing the distribution of patients by Vyayama shakti. 87 37 Showing the distribution of patients by desha. 88 38 Showing the distribution of patients by chief complaint. 89 39 Showing the distribution of patients by associated complaints 90 40 Showing the distribution of patients by Nidana. 91 41 Showing the response of the therapy in sandhishoola. 92 42 Showing the response of the therapy in sandhishotha. 93 43 Showing the response of the therapy in Jwara (Sthanika

Ushmata) 94

44 Showing the response of the therapy in gouravata. 95 45 Showing the response of the therapy Nidraviparyaya 96 46 Showing the response of the therapy in Jadyata 99 47 Showing the overall result assessed on the basis of subjective

& objective parameters. 98

48 Showing statistical analysis before and after treatment. 99

VII

1

Ayurveda, the upaveda of Atharvaveda is the first systematically dealt medical

system ever known to the man kind with a vital panorama to preserve health, alleviate

diseases and even prevent them .The distinctive principles of approach to an ailment

and its thorough management has been a boon to the existing medical world.

Ayurveda defines swastha as one whose physical, spiritual, social and

environmental aspects are in harmony.

With the advent of Rasashastra, this has a parallel thought as that of Ayurveda

was clubbed to fortify the results in a short duration. It pledged the dehasiddhi using

different minerals, metals, pearls etc after subjecting them to various samskaras. The

samskaras help in Gunaantardhana of a dravya which is being subjected. This could

be understood as the one by which it enhance the property of the dravya used. Sri

Siddhadaradamruta Rasa, a unique mode of preparation which does not fall under

chaturvidha rasayanas, involves chiefly the pachana samskara of Shodhita Hingula

with Vatakseera, Palanduswarasa, and Dahana with Shuddha Bhallataka, and lastly

pachana with Gogrutha. Such pachita Hingula for long hours develops properties to

cure Amavata. Different Acharyas have explained the management of Amavata

involving the Hingula, Bhallataka separately. The Rasataranginikara came up with

unique preparation for the management of Amavata which involves these drugs

together and also with a simpler procedure of preparing the drug. The efficacy of

Hingula has been highlighted by Brahatrasaraja sundara, Rasataranginikara in

Amavata, Pliha and Garavisha. Similarly the Bhallataka is made use for management

of Amavata by Yogaratnakara in Amavata chikitsa.

Amavata being a crippling disease claiming maximum loss of human working

power ranging from simple Artharalgia to severe complication like deformities,

systemic disturbances and may cause temporary or permanent disabilities.

Introduction

2

Amavata is a condition in which improperly metabolized intermediate by

product known as Ama, becomes the core cause of the disease and get deposited by

prakupita vata at different Shleshmasthanas.

Rheumatoid arthritis (RA) is an autoimmune musculoskeletal disorder

explained in modern medicine closely resembles with the clinical entity of Amavata.

It occurs in all races and ethnic groups. Females are more affected (3:1) as compared

to males.

There are several preparations listed in Ayurvedic classics for Amavata like

guggulu preparation and gold preparation. They are costly and even give varying

degree of relief. Ayurveda believes that every individual differs form each other and

require a specific yoga in a disease.

Sri Siddhadaradamruta Rasa is considered as an ideal preparation by

Rasataranginikara and found promising for Amavata.

The whole study has been arranged in to following chapters –

01. Introduction

This part introduces the subjects by laying emphasis on its importance in the

present time. Plan of study is also dealt.

02. Review of Literature

It is based on the description of Ayurveda texts and also modern,

pharmacotherapeutic properties of the Hingula, Bhallataka, Vata, Palandu, Lavanga,

and Grutha. Description of Amavata and Rheumatoid arthritis is dealt.

Introduction

3

03. Methodology

a. Pharmaceutical study

This chapter includes the selection of raw materials, shodhana of Hingula, and

collection of Vata dugdha, Shodhana of Bhallataka and executing the preparation of

Sri Siddhadaradamruta Rasa.

b. Analytical study

This chapter includes the Organoleptic and chemical analysis of Shuddha

Hingula and Sri Siddhadaradamruta Rasa which assess the changes in it.

c. Clinical study

This includes single group prospective clinical study and explains about

efficacy of Sri Siddhadaradamruta Rasa in Amavata.

01. Results

In this part the results obtained are systematically presented, which include

demographic data, data related to disease and data related to response to treatment.

02. Discussion

In this chapter observation, findings and results of various studies have been

found out with possible explanation for its effects.

03. Conclusion

The essence of the whole study is mentioned in this chapter.

04. Summary

It contains the information of the overall work in a nut shell.

Introduction

4

Aims and Objectives:

1. Preparation of Sri Siddhadaradamruta Rasa.

2. Analytical study of Sri Siddhadaradamruta Rasa.

3. To study the clinical efficacy of Sri Siddhadaradamruta Rasa in the selected cases

of Amavata.

Objectives

5

Sri Siddhadaradamruta Rasa

All the Rasa classics have mentioned the use of Hingula along with combination

of one or the other herbal drugs. Sole use of Hingula is not advised, but Hingula after

subjecting to different Samskara is made suitable for its sole administration along with

suitable anupana. Such preparations are few and Sri Siddhadaradamruta Rasa is one

among them. The other preparations involve more or less same drugs for samskara as

well as procedure involved.

Different methods of samskara to Hingula to enrich its Rasayana properties: 1

Rasaratnakara–va-Sidda Prayoga sangraha under the heading of Hingula

Rasayana has enumerated different procedures that are adopted for Hingula to make it fit

for internal administration and to enrich its Rasayana properties.

1. 5 Tola cake of Hingula is embedded in Indrayana Phala and is encrusted with

mud. When dried it is burnt. When it is red hot it is brought out this is repeated for

21 times. This is called Hingula Rasayana.

2. 40 Tola of Lavanga is grounded to paste with Palandu swarasa and is converted in

to a glass shape. This glass is placed in an Iron pan and kept over the fire. Place

20 Tola Hingula cake in to the glass and exactly above the pan place the vessel

filled with 5 lit (approx) of onion juice. The juice is made to drop over the

Hingula drop by drop. The agni is maintained in such a way that the juice should

evaporate as soon as it falls on the Hingula. Later it is powdered and stored.

3. Asuddha Hingula 20 Tola, Bhallataka 80 Tola, Gogrutha, Erenda Taila and

Madhu 60 Tola each. Hingula is made into cakes and Bhallatka are broken in to

yava kuta choorna. Half of the Bhallataka choorna is spread in a pan over which

Hingula is placed and is covered with rest of the Bhallataka. Upon this Grutha

Drug review

6

Taila, and Madhu is put and is placed over fire for 4hrs over samanya agni. When half

is burnt in this way, then the rest is burnt by burning the content directly in the pan.

After Swanga sheeta the cake of Hingula is removed and used.

4. Rasatarangini kara in 9th taranga has explained similar formulation: 2

Shodhita Hingula is prepared in to cake and tied with cotton thread. This is

subjected to pachana in Vatadugda and Palandu swarasa till whole of the liquid

evaporates. Then Pachita Hingula is placed over lavanga choorna in a pan and over

which Shuddha Bhallataka is placed in a conical manner and gaps are filled with

Lavanga choorna and subjected to Dahana till all Bhallataka is turned in to ashes.

That Hingula is collected and again subjected to Pachana with grutha which is ten

times more than Hingula in quantity. Later threads are removed, Hingula is powdered

and administered.

Thus prepared, is best indicated in Amavata, Pleeha vrudhi, Pakshaghata and

Klaibya. This method is taken for the study.

5. The reference of Sri Siddhadaradamruta Rasa is also quoted by

Sri harisharananda vidya in Bhasma vignana3 where he calls it as Hingula

bhasma. Even he has taken the reference from Rasatarangini.

6. In Ayurvedasara Sangraha same method of preparation and indication is

explained. 4

Drug review

7

Hingula

Introduction –

Hingula is compound of Parada and Gandhaka, which occurs as a mineral in the

mines, associated with other minerals and also made artificially. This is a chief source of

mercury since ancient times to this date. In ancient times mercury was obtained from it

through patana process. Many varieties of this mineral have been described in ancient

texts. Out of these Hamsapada variety is considered best as it consists less impurities.

Synonyms –

Table No. 01. Shows list of synonyms of Hingula according to different authors.

Sl. Synonym RT R. Sa. Sn. AP RA DN RA KN01. Hingulam - - - - + - - 02. Hingul + - - - - - - 03. Hingula + + + + - + - 04. Ingula + - - - - - - 05. Hingulaka - - - - - - + 06. Mleccha + - + + + + + 07. Rakta + - + - - - + 08. Gairika + - - - - - + 09. Suranga + - + - - - - 10. Chitranga + - - - - - + 11. Churna parada + - - - + - - 12. Rasodbhava + - - - + - - 13. Rasasthana + - - - + - - 14. Ranjana + - - - - - - 15. Kapishirshaka + - - - - - - 16. Raktakaya + - - + - - - 17. Hamsapada + - - - - + + 18. Darada + + + - - - - 19. Barbara - - - - - - - 20. Shuka tunda - - - - - - - 21. Jati - - - - - - + 22. Rasagandha sambhuta - - - - - - - 23. Daitya raktaka - - - - - - - 24. Maraka - - - - + - - 25. Maniraga - - - - - - + 26. Rasagarbha - + + - + - - 27. Charmanu ranjana - - - - - - - 28. Ati rakta - - - - - - + 29. Parvata - - - - - - + 30. Saikta - - - - - - +

Drug review

8

Vernacular name –

English name – Cinnabar.

Scientific name – Red sulphide of mercury.

Sanskrit – Hingula, darada.

Hindi – Hingula, Singraph.

Bengal – Hingula.

Marathi – Hingula.

Gujarathi – Higualo.

Assam – Janjapher.

Pārsi – Sangarph.

Telagu – Ingulakam.

Kannada – Ingulika.

Historical Background

Vedic period:

No references about Hingula are available in any of the Vedas.

Samhita kala:

No reference about Hingula is available in Brahatrayees and Samgrahas.

The author of Kautilya Arthashastra, Chanakya has mentioned Hingula in his text

for the first time. He mentioned it for testing various metals. He was using this for testing

the suvarna. The uses of Hingula as a medicine was not described by him.5

In Samhita kala, there were no references of Hingula. But, we get references of

parada. It is assumed that in olden days, it was imported from other countries.

Drug review

9

According to history of oldest text of rasashastra, Rasendra Mangala, we get the

references of Hingula. Here, he used the word Darada for Hingula6. Rasa Hridaya

tantrakara mentions, it is one of the rasadravya.7 Author of rasarnava considered, as it is

one of the maharasa dravya.8 while describing synonyms, Rasendra sara samgraha,

mentioned it as Rasa Gandhaka Sambhoota.9 The usage of Hingula as a medicine started

between sixth and eighth century.

Inclusion of Hingula

Different authors of various Rasa Granths have included Hingula under the

various titles.

The classification of all Rasa dravyas done generally, according to their usage and

importance in the procedure related with parada. The important Rasa texts have included

Hingula under following classes –

Table No. 02. Shows inclusion of Hingula under different classes. (As per different texts)

Dravya Rasa Maharasa Uparasa Sadharana

rasa

Hingula Rasahridaya

tantra10

Rasarnava11 Anandkanda,12 R.S.S,13

B.R.R.Su.14, A.P15

R.J.N. 16

R.C. 17

R.Pra. Su 18

R.R.S.19

Drug review

10

Hingula Bheda

No description about varieties of Hingula is available in Resendra Mangala and

Rasa Hridayatantra. But we get reference of Hingula bheda in other texts.

Table No. 03. Showing the bhedas of Hingula.

Sl. Name of the text Charmara Shukatunda Hamsapada Anya

01. Anand kanda20 + + + -

02. Rasendrachudamani21 - + + -

03. Ayurevda prakasha22 + + + -

04. Rasaratnasamuchhaya23 - + + -

05. Rasaprakasha

sudhakara24

+ + + -

06. Rasatarangini25 - - - Kritrima

khanija

07. Rasamrita26 - - + Mlechha

Drug review

11

Charmara Hingula

Shuka varna i.e. Greenish colour.

Shukatunda Hingula

Sapeeta varna i.e. Yellowish colour.

Hamsapada Hingula (Grahya Hingula) 27

It has Pravala samana and having sweta rekhas on the surface of Hingula. It is

considered to be best for therapeutic purpose.

Among these three are having the quality of uttarottara gunavan.

Asuddha Hingula dosha28

If ashuddha Hingula is consumed, causes – Moha, Prameha, Chittavibhrama,

Andhyata, Klama, Kshainya and this directs to use always Shodhita Hingula.

Tasya chikitsa29: It is treated similar to the ashuddha parada bhakshanajanya doaha. The

person should be administered Shuddha Gandhaka for 2 months.

Shodhana of Hingula:

Various shodhana methods are explained in different classics, according to

availability, cost efficacy and medicinal formulations.

01. Do mardana with amla rasa dravyas and give 7 bhavanas of mahisha

dugdha30.

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12

02. Keep Hingula in kushmanda khanda, do pottali, and give swedana in

Lakucha swarasa poorita Dola yantra. 31

03. Give 7 bhavanas of adraka swarasa or lakucha swarasa. 32

04. Give 7 bhavanas of adraka swarasa. 33

05. Give 7 bhavanas of nimbu swarasa. 34

Satwapatana35

Shodhita Hingula is smeared in the upper part of adhapatana yantra, water is filled

in lower vessel. This apparatus is placed in the earth. Give heat to the upper vessel. We

get parada samana satwa in lower vessel.

Marana36

Generally marana is not advised for Hingula. Shodhita Hingula can be used for

the preparation of yogas.

However elaborate process of marana has been described in Ayurveda prakasha.

Hingula is wrapped in the cloth and kept inside nila kanda, which is then covered

with the mud paste around. When dried, it is subjected to puta, and baked in 10 vanopala

such 100 putas are given similarly it is kept inside vanavarataka and given 100 putas then

in mandara phala and given hundred putas then in indravaruni phala and subjected to 100

putas and lastly in amlavetasa phala and given 100 putas. At the end Hingula attains

intense red colour.

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Hingula Properties

Rasa – Various opinions are available regarding the Rasa of Hingula.

Table No. 04. Sowing the Rasa of Hingula according to various texts

Sl. Author Madhura Tikta Kashaya Katu

01. Rasarnava + + - -

02. Dhanwantari

nighantu

+ + - -

03. Raja nighantu + + - -

04. Bhava prakasha - + + +

05. Ayurveda prakasha - + + +

06. Rasendra purana - + + +

Guna –

Most of the texts considered Hingula as ushna gunayukta dravya.

Veerya and Viapaka –

No rasa shashtriya text has mentioned veerya and vipaka of Hingula, though the

Dhanwantari nighantu being the text of dravya guna vignana has mentioned Hingula is

having the ushna veerya and katu vipaka.

Doshakarma –

Even though almost all the authors enormously agree the tridoshaghna karma of

the Hingula, still some of the texts mention either kaphaghna or kapha pittaghna action of

Hingula as well.

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14

Table No. 05. Showing the doshaghnata of Hingula according to various texts –

Sl. Author Kaphaghna Kapha-pittaghna Tridoshaghna

01. Rasatarangini + - -

02. Bhava prakasha - + -

03. Ayurveda prakasha - + -

04. Rasendra chudamani - - +

05. Rasendrasara

sangraha - - +

06. Rasendra purana - - +

07. Rasamrita - - +

Rasaratnasamuchhyakara has quoted Hingula as sarva doshahara, deepana,

atirasayana, sarvarogahara, vrishya. It is useful in dhatujarana, Parada extracted form

Hingula is equal to the property of Gandhaka jarita parada. 37

Rasaprakashasudhakara quoted that the Hingula has the property of deepana,

sarvadoshaghna, atirasayana, sarvarogahara. It is helpful in dravana karma. Parada

extracted form Hingula is said to be equal to the property of shadguna Gadhaka jarita

parada. 38

Ayurveda prakashakara has quoted the property of Hingula as tikta, kashaya rasa,

kapha-pittahara. It subsides netra roga, hrillasa, kushta, kamala, pleeha, amavata and

krutrima visha. It also cures navajwara and santapajwara. 39

Rasendrachudamanikara quoted the property of Hingula as sarvadoshaghna,

deepana, atirasayana, sarva rogahara, vrishya. It is helpful in jarana samskrara. 40

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Rasamrita quoted the properties of Hingula that it pacifies all the tridoshas. It has

deepana and powerful rasayana effect. It can destroy all diseases and may be used for the

marana of gold and iron, metals. 41

Mercury extracted form the Hingula is considered to be equal in properties to the

mercury in which gandhaka jarana has been carried out.

Rasataranginikara quoted that, it has a property of netrarogahara, kaphanashaka,

pittajaroga nashaka. It subsides pleeha, kushta, gara visha, kamala. It is pachaka agni

vardhaka and ama pachaka. It is pramehgna. It enhances shareera kaanti, and bala. It

cures prakupita amavata and jwara. 42

Dhanwantari nighantukara quoted that, it has katu vipaka, ushna veerya. It subside

visha, kushta, visarpa and twak vikara. It is madhura tikta in rasa, and is kapha vata

shamaka. It cures tridoshaja and dwandwaja jwara. 43

Rajanighantukara quoted that it is having madhura tikta rasa and ushna veerya. It

subside vata and kapha roga, dwandwaja and tridoshaja jwara. 44

Kaiyadeva nighantukara 45 quotes that, Hingula is laghu, tikta and katu rasa, katu

vipaka and ushna veerya. It subsides netra peeda, kushta, visarpa, visha, pitta and kapha .

Vishishta Yoga

Hinguleshwara rasa, Mrityunjaya rasa, Ananda bhairava rasa, Siddha daradamrita

rasa, Darada vati.

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Cinnabar 46

Chemical composition – Sulphide of mercury (HgS). It contains 13.8% of

Sulpher and 86.2% of Mercury

Form – Trigonal or rhombohydral usually. Massive, granules. Intense red in

colour, sometimes brownish red in colour.

Streak – Red.

Transparency – Opaque or translucent.

Hardness – 2-2.5.

Specific gravity – 8.09.

Luster – Admentine.

Variety – Hepatic with liver brown colour.

Occurrence – Generally occurs due to the volcano activity. Also available near

hot springs. Important places of occurrence are Spain, Italia, Western states of

USA, Mexico.

Cinnabar classification-

• Dana class - Contains sulfides including Selenides and Telluride.

• Strunz class - Contains sulfides and Sulpho salts.

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17

BHALLATAKA- Semicarpus Anacardium Family: Anacardiaceae.

Introduction:

Earliest references about Bhallataka are found in the Panini sutras. Later

Charaka emphasized the Rasayana property of Bhallataka and described ten types of

preparations with it. He considered Bhallataka as the best drug to cure the disease

related to kapha 47. Susruta mentioned it as the drug of choice in the management of

arshas along with kutaja. Vagbhata has quoted Bhallataka as the best drug of choice

in the management of suska arsas. Bhallataka asthi shall be considered for dipaniya

purpose 48Yogaratnakara has explained yogas of Bhallataka in Amavata chikitsa. 49

Vernacular Names:

Hindi -Bhilava

English - Marking Nut.

Bengali -Bhela.

Telugu - Nall jidi chettu.

Kannada - Keru

Gujarati & Marathi - Bilama.

Table No. 06: Synonyms according to different authors:

Sl.No DRUG D.Ni K.Ni B.Ni R.T. R.Ni 01 Bhallataka + + + + + 02 Agnika + - - + + 03 Dahana + - - - + 04 Tapana + - - + + 05 Aruskara + + - + + 06 Virataru + + - - - 07 Agnimukha + + - - - 08 Dhanu + + - - - 09 Balli - + - - - 10 Anala - + - - + 11 Vrunakrut - + - - - 12 Spotahetu - + - - - 13 Krumighna - - - + + 14 Vatari - - - + + 15 Tailabeeja + 16 Prutak Beeja + 17 Dhanur Beeja +

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Botanical Description: 50,51,52

A moderate sized, deciduous tree, exudating a dark juice .young branches,

inflorescence, petioles and under side of leaves pubescent.

a) Leaves- Oblong, obovate, rounded at apex, cartilaginous at margin, very

coriaceous.

b) Flowers- Fasciculate, arranged in erect, compound, terminal panicles, greenish

yellow colored.

c) Fruits- Drupes, obliquely oval or oblong, smooth, shining, purplish-black when

ripe, cup orange red flowering round the year, mostly during May-June, fruits ripen

from November to February.

d) Habitat- This tree is found growing on the sub Himalayan and tropical part of

India as for east as Assam.

e) Chemical constituents:

The fruits of Bhallataka yielded Bhilawanol which was shown to be a mixture of

cis and trans isomers of ursuhenol Bhilawanol was found to be a mixture of 1,2-

dihydroxy-3-(pentadecenyl-8')-benzene and 1,2- dihydroxy-3-(pentadecadienyl-

8',11')-benzene studies on methylated Bhilawanol showed that it contained more

than seven components; two major components were identified as dimethyl ethers

of 1-pentadeca-8-enyl-2,3-dihydroxybenzene (I) and 1-pentadeca-7,10-dienyl-1,3-

dihydroxybenzene (II); defatted nuts yielded three biflavones A, B and C; latter

two compounds were characterised as 3',8-binaringenin and 3',8-biliquiritigenin,

re-examination of bhilawanol showed it to be comprised of two components,

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1,2-dihydroxy-3-pentadecenylbenzene (32-32%) and its corresponding diene

analogue (68-70%); a new biflavan, tetrahydrorobustaflavone and

tetrahydroamentoflavone were isolated from nuts; leaves yielded only

amentoflavone

• Confirmation of structure of Semecarpus biflavanone B by chemical studies was

carried out; a new biflavonoid, jeediflavanone was isolated from nut shells and

characterised; galluflavanone was isolated from nut shells and its structure

determined; isolation and structure elucidation of semecarpuflavanone from nut

shells was reported.

• Isolation of a biflavonoid, jeediflavanone from nutshells, a biflavonoid,

galluflavanone from nutshells, a third biflavanoid, semecarpuflavanone from

nutshells and a new dimeric flavonoid nallaflavanone were reported and the

structure of nallaflavanone was determined and confirmed; isolation of another

new biflavonoid semecarpetin from nutshells and its characterisation were

reported.

• A new biflavanone, anacarduflavanone was isolated from nut shells and its

structure established

• The acetate of a novel phenolic glycoside,1-O- β-D-glucopyranosyl-(1→6)- β-D-

glucopyranosyloxy-3-hydroxy-5-methylbenzene, anacardoside was isolated from

the fruits of Semecarpus anacardium, and its diastereomers were first synthesized

using Koenigs-Knorr method from D-glucose through six steps with total yields

33% and 16% respectively.

Drug review

20

• Chemical constituents of the shell liquid have not been exhaustively investigated.

The major constituent (~ 46% of the weight of extract) is bhilawanol, C21H32O2,

which distils over at 225-26°/3 mm. when the shell liquid is subjected to vacuum

distillation; it is an o-dihydroxy compound with a catechol nucleus and an

unsaturated C15-side chain; it has since been shown to be a mixture of cis and

trans- isomers of urushenol [3-(pentadecenyl-8')-catechol]. A small quantity (c.

0.1 %) of a monohydroxy phenol, semicarpol, C17H28O (distilling at 185°-

90°/2.5 mm.) is also present. The dark tarry residue left after distillation contains

high boiling phenols and hydrocarbons. Thermal degradation of the shell liquid at

400° gives catechol and a mixture of phenols and hydrocarbons.

Grahya Bhallataka53: The pakwa Bhallataka which sinks in the water has to be

collected for shodhana procedures.

Bhallataka Shodhana:

1. Bhallatakas are to be tied into a pottali along with Ishtika choorna and subjected to

slight gharshana. This is done till the external skin is peeled off and oil is properly set

free in to the isthika choorna. Later it is washed with hot water and brought to use. 54

2. Bhallataka is cut in to pieces and is subjected to swedana with narikela jala for

two hours. This purifies Bhallataka. 55

3. Bhallataka is tied in a pottali and is subjected to swedana for 12 hrs in the mixture

of buffalo dung and water in the ratio 1:4. Later swedana in godugdha and gomutra

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21

for 4hrs each is done. Then it is washed in hot water and again swedana is done in

narikela jala for 12 hrs, and brought to use.56

4. Bhallataka to be subjected to swedana in gomutra for 4 praharas and washed with

hot water and brought to use. 57

Antidote:

Application of coconut oil externally

Internally Coconut oil with tila and haritaki.

Part used:

• Fruit, Seed, Seed kernel, Gum and oil.

Dosage: Choorna - 1 to 3 Gunja.

Taila - 1 to 2 Drops.

Avaleha - ¼ to ½ Tola .

Ksheera paka - 1 to 2Tola.

Guna karma:

Rasa – Katu, Tikta, Kashaya. Guna – Tikshna, Laghu, Snigdha.

Veerya – Ushna. Vipaka – Madhura.

Dosha karma: Kaphavatahara, Rasayana, Shukrala, Medhya, Bhedana.

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Bhava prakashakara has included the drug under the Hariyakyadi varga.

Bhallataka is best indicated in Kusta, Arsha, Grahini, Gulma, Jwara, Agnimandya, Krimi

and Vruna. 58

Dhanwantari Nighantu includes Bhallataka under Chandanadi varga. It is

good in Krumi vikaras, Gulma, Arsha, Grahani, and Kusta59.

Kaiyadeva nighantukara explains that the pakwa phala of Bhallataka is

Vistambi, Bhrumana, Shukrala, Raktapitta nashaka. Its Asti is Pachaka, Chedi ,Bhedi,

Medhya, Agnikara. Bhallataka is indicated in Kustha, Arsha, Gulma, Shopha, and Jwara.

The majja of Bhallataka is vrushya.60

Rasataranginikara has similar views as of other Acharyas. He mentioned

Bhallataka is Rasayana and Balakara.61

Rajanighantukara explained that the majja is exceptionally Daha shamaka

and does agni vardhana and pitta shamaka.62

The fruits are acrid, hot and anti-helminthic; it is considered beneficial in

ascites, tumours, warts, acute rheumatism, asthma, neuralgia, epilepsy and psoriasis.

They are thermogenic, emollient, digestive, anti-arthritic, depurative, anti-inflammatory,

uterine stimulant, alterant, expectorant, liver tonic, febrifuge and rejuvenating. They are

used in sciatica, neuritis, dyspepsia, flatulence, constipation, colic, hemorrhoids,

splenopathy and hepatopathy. They are also useful in cough, asthma, beriberi, leprosy,

leukoderma, diabetes, dismenorrhoea, amenorrhoea, ulcers and general debility.63

Plant -Showed anti-inflammatory activity in rats. Nut - Milk extract was active in

rats Vs Carragenin, It suppressed primary inflammation of adjuvant arthritis in rats and

had no effect on secondary lesion. Significant effect was seen as anti-arthritic. The milk

extract of S. anacardium produces regression of hepatocarcinoma by stimulating host

immune system and normalizing tumor markers including alpha-fetoprotein levels.

Drug review

23

Vata – Ficus Bengalensis Family: Moraceae

Introduction:

It is one among panchavalkalas. It is a big tree with adventious roots to support its

branches. It spreads up to miles. It is commonly found all over India.

Vernacular Name:

Hindi: Vada Kannada: Ala

Gujarati: Vadalo Punjabi: Bera, Baragad Tamil: Alum

Table No. 07: List of Synonyms

Sl.No Drug R.Ni D.Ni K.Ni B.Ni 01 Vata + + + + 02 Jatala + - - - 03 Vyagroda + - - - 04 Rohini + - - - 05 Rohini + - - - 06 Vitapi + - - - 07 Raktaphala + - - - 08 Skandaruha + - - - 09 Mandali + - - - 10 Mahachaya + - - - 11 Shrungi + + + + 12 Yakshavasa + - + - 13 Yakshataru + - - - 14 Neela + - - - 15 Ksheeri + - - - 16 Shiparocha + - - - 17 Bahupada + + + + 18 Vanaspati + + + - 19 Padarohini + - + - 20 Nyagroda - + + + 21 Skandaja - + + + 22 Vishravanaja - + - + 23 Danto - - + - 24 Dhruvaha - - - +

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Botanical Description: 64

Banyan trees are huge and out spreading. Trunk is whitish grey in color.

Leaves – are big, oval in shape, 12 to 14 cms long, thick, turgid and dark green having 3

to 5 veins.

Fruits- These are Red and round in shape. Flowers bloom in spring and Fruiting occurs

in Monsoon. Tree survives many years.

Habitat – Found all over India.

Chemical Constituents65, 66: Bark and young buds contain about 10% of Tannin, wax

and caoutchoue. Fruits contain oil, albuminoids, carbohydrates, fiber and ash 5% to 6 %.

The bark contains Leucoanthocyanin, Tiglic acid, β-sitsterol-a-D-glucoside.

Part Used: Panchanga.

Dose: Decoction ─ 50 to 100 ml.

Powder ─ 3 to 5 gms.

Latex ─ 5 to 10 drops.

Guna Karma:

Rasa – Kashaya Virya : Sita Guna : Guru, Ruksha Vipaka : Katu

Karma- Kapha- pittahara, Mutra sangrahaniya, Varnya. Stambana.

Charaka has classified Vata under Mutrasangrahaniya while Sushruta and

Vagbhata have classified under Nyagrodadi gana.

Drug review

25

Kaiyadeva Nighantukara has dealt it in oushadi varga. He claims that drug cures

Visarpa and improves the shareera varna67.

Dhanwantari nighatukara explains the same and includes Raktapitta nashana

property.68

Bhavaprakashakara and RajNighantu explain similar properties along with

Yonidoshahara property.69

The latex of Vata is applied on Wounds, Cracked soles, Synovitis, Arthritis,

Lymphadenitis. Internally it is used to treat Diarrhea, Amoebic dysentery and bacillary

dysentery.70

Palandu - Allium Cepa Family: Liliacae

Introduction:

It is an annual herb with bulb and white flowers. It is cultivated all over

India palandu is quoted in the Bruhattrayee texts. Chakrapani considered Grunjanaka as

Lohita Palandu.

Vernacular Names:

Hindi: Pyaz Telugu: Ullipaya English: Onion Marathi: Kanda

Drug review

26

Table No. 08: Synonyms according to different authors:

Sl.No Drug Bp.Ni K.Ni R,Ni D,Ni

01 Palandu + + + +

02 Mukhadushika + + - +

03 Sukanda - + - +

04 Yavanesta + - + +

05 Durgandha + - - -

06 Raj palandu - - + -

07 Nrupahwaya - - + -

08 Raj priya - - + -

09 Mahakanda - - + -

10 Dheerga patra - - + -

11 Rochaka - - + -

12 Nrupesta - - + -

13 Nrupakanda - - + -

14 Nrupapriya - - + -

15 Raktakanda - - + -

16 Rajesta - - + -

Botanical Description: 71 The shrub grows to a height of 60 to 90 cms.

Leaves- Thick, round, and green with Green Coloured flower stalk at the top. It

bears white flowers in clusters. These produce triangular seeds.

Flowering and fruiting occurs after winter.

Drug review

27

Verities: 1. Red ─ Rakta palandu- Small in size.

2. White ─ Swetaksheeri palandu- Large in Size.

Habitat: All over India. Onions growing in Maharastra are large.

Chemical Constituents: 72, 73

Onions have a unique combination of three families of compounds that are

believed to have salutary effects on human health — fructans, flavonoids and

organosulfur compounds. A great deal of research has focused on one flavonoid,

quercetin, which is found at particularly high levels in onions. Onion contain many sulfur

containing active principles mainly in the form of cysteine derivatives, viz. S-alkyl

cysteine sulfoxides which decompose into a variety of thiosulfinates and polysulfides by

the action of an enzyme allinase on extraction

Part used: Bulb and seeds

Dose: Juice ─ 10 to 30 ml.

Seed Powder ─ 1 to 3 gms.

Guna and Karma:

Rasa: Madhura, Katu. Veerya:Ushna

Vipaka: Madhura Guna: Guru, Snigda, Tikshna.

Dosha karma- Vatahara, Vrushya, Rasayana

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28

Bhavaprakakara has included this under Haritakyadi varga. Palandu is excellent

remedy for Agnimandya as it is Agnivardhaka. It is also Vrushya, Uttejaka and best

Vatahara next to lashuna.74

Kaiyadeva Nighantukara has also considered this as next to lashuna but a little

milder to it.75

In Rajanighantu, apart from the above mentioned properties he adds that Red

palandu is Kshareeya, teekshna and is best deepaka.76

In Dhanwantari Nighantu it has been included in Karaveeradi varga. He explains

properties same as other Acharyas.77

Research studies have shown organosulfur compounds to:78

– Reduce symptoms associated with diabetes mellitus.

– Inhibit platelet aggregation (involved in thrombosis).

– Prevent inflammatory processes associated with asthma.

Many of these studies used non-human subjects. The organosulfur compounds are

believed to possess anti-inflammatory, anti-allergic, anti-microbial, and anti-thrombotic

activity by inhibition of cyclooxygenase and lipoxygenase enzymes. Most likely the

compounds work through sulfur-sulfur or sulfur-oxygen linkages. Quercetin’s anti-

inflammatory effect on prostaglandins, eukotrienes, histamine release and subsequent

antiasthmatic activity has been investigated.

Drug review

29

Lavanga: Syzygium aromaticum Family: Myrtaceae.

Introduction: It is a less utilized herb during the Brahattrayee period. At later times

especially in yoga granthas we come across the utility of Lavanga in therapeutics.

Traditionally cloves have been used to treat flatulence, nausea, vomiting.

Vernacular Names:

Hindi: Laung Telugu: Lavangaumu. English:clove Tamil: Kirambu

Kannada: Lavanga

Table No. 09: Synonyms according to different author

Sl.No Drug K.NI D.NI R.Ni B.p.Ni

01 Lavanga + + + -

02 Devakusuma + + + -

03 Shrungaram + - - -

04 Shikaram + + + -

05 Lavam + + + -

06 Sripuspam + + + -

07 Varijam + - - -

08 Sravyam + - - -

09 Devyam + + + -

10 Chandanapuspakam + + - -

11 Brungaram - + + -

12 Varisambhavam - + + -

13 Lavanga kalika - - + -

14 Ruchiram - - + -

15 Teekshnapushpam - - + -

16 Greevana kusumam - - + -

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Botanical Description: 79 Tree full of green leaves, 10-13 mts height. Bark of trunk

yellowish white and tender. Branches appear from the bottom and are tender and directed

downwards. Flowers brown externally, four triangular petals. Fruits are fleshy, 3 cms

long, seeds-single in each fruit. Flowering season is summer and fruiting in pre-monsoon

flowering starts after nine years of plantation.

Habitat: Originally from Malaya-Saillbius island. At present cultivated in southern India.

Chemical Costituents:80

A heavy volatile oil 16% to 20%., A Camphor Resin 6%, Caryophyllin occurs in

silky stellate needles. Oil distilled from cloves contains:-

1) Eugenol 85% to 92% chemically resembling phenol.

2) Acetyleugenol

3) Caryophyllene, a sesquiterpene, furfural and Methyl-amyl-ketone.

Parts used : Floral bud, Clove oil.

Dose: Powder ─ 1to 2 gms.

Oil ─ 1 to 2 drops.

Gunakarma:

Rasa: Tikta, katu, Guna: Laghu, Snigdha

Virya: Sita Veepaka: Katu.

Karma: Kaphapitta hara, Ruchya, Deepaneeya, Pachana, Netryam.

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Rajnighantukara explained Lavanga to possess vata, pitta and kaphahara

properties. Hence, best in shiro rogas.81

Kaiyadeva nigantu kara has included it in the Ousadivarga and attributes it

to posses the Hridya, Netrya and Pachaka. This cures Shoola, Anaha, Tridosha, Kasa,

Swasa, Visha, and Peenasa.82

Dhanwantari nighantu kara highlights its Vajikarana properties with all

other properties as explained by other acharyas.83

Eugenol, the primary component of clove’s volatile oils, functions as an anti-

inflammatory substance. Clove also contains a variety of flavonoids, including

kaempferol and rhamnetin, which also contribute to clove’s anti-inflammatory (and

antioxidant) properties.84

Nutrient Amount

Manganese 1.32 mg

Omega 3 fatty acids 0.20 g

Dietary fiber 1.52 g

Vitamin C 3.56 mg

Magnesium 11.60 mg

Calcium 28.40 mg

Drug review

32

Guda

Vernacular Names:

Hindi: Guda English: Tracle, Jaggery Kannada: Bella

Synonyms; Table No.10.showing synonyms.

Sl.No Drug R.Ni

01 Guda +

02 Ikshurasa +

03 Madhura +

04 Rasapakaja +

05 Sishupriya +

06 Sitadi +

Utpatti: Well-cooked sugarcane juice when solidifies and become hard like stone is

known as guda.

Drug review

33

Guna Karma:

Rasa: Madhura Guna- Laghu Doshagnata- Tridoshashamaka.

Purana guda is said to be best because of its action over all dhatu vaha

samsthana. It is Agni vardhaka, Ruchya, there by it gets digested easily and nourishes

body and kindles the Jatharagni. It is Vrishya and also claimed as Sadhya Sukrala, Hence

in association with Sukravardhaka dravya Ikshu vikaras esp Purana guda is prescribed.Its

role on Rakta and Raktavaha srotas, Nidravaha srotas is remarkable. It enriches the

production and shows the qualitative and quantitative increase of Rasa and Rakta dhatu.

It is also hridya as its action conferred on Rasa and rakta reflects as such RasaRakta

complex is flown in the Hrudaya and Dasha dhamani. It is said as Mala, Mootra vikara

shodhaka and acts on Prameha as it is Mootrala. Very especially it cures a condition of

Rakta kshaya and Anidra. It is Shramaharam also.85

Sushruta quotes that Guda is Kshara yukta and Madhura and not Atiseeta. And is

Snigdha and it is Mutra and Rakta shodaka, and it does not mitigate excessive aggravated

Pitta, but it is best Vata shamaka and Medovrruddikaraka and Krimi and Kapha karaka

and increases the Bala of the body and Vrushya.86

Guda is said to posses Pittanashaka, Madhura, Vatanashaka, Raktaprasadaka

qualities and a year old guda (Purana guda) posses more qualities and it is Pathy karaka.

Drug review

34

Grutha

English: Clarified Butter. Hindi-Ghee Telagu- Nayee Kannada- Tuppa

Synonym: Table no 11. Synonyms of Grutam.

Sl.No Synonyms K.N R.N

01 Ghrutam + +

02 Aajyam + +

03 Havi + +

04 Sarpi + +

05 Pavitra + +

06 Navaneetaja + +

07 Amrutam + +

08 Abhigara + +

09 Jeevaneeya + -

10 Homya - +

11 Ayu - +

12 Taijasa - +

Ghruta is Agnideepaka, Balya, and Ayushya dayaka. It makes shareera Sthira. It

is Madhura in Vipaka Sheeta in Veerya and Vatapitta shamaka, Vishahara.87

Cow’s ghee has sufficient oxygen and is considered the best for the diseases

relating to the area of the head. Kerotine is ten times more in cow’s ghee than in that of

buffalo’s. When instilled in the nostrils the oxygen of cow’s ghee cures the diseases

created as a result of imbalance of Vata, Pitta, Kapha. In the problems of obesity which is

rampant these days, amount of ghee consumed in one month will directly &

proportionately reduce obesity while in the undernourished people it will proportionately

increase the weight. In short cow’s milk & ghee are the best nourishment and the

fundamental regulators of a healthy body.88

Drug review

35

Ardraka

Latin name – Zingeber officinale.

Synonyms – Adraka, gulma, moola, mulaja, kandala, vara, shringavera, mahija,

saikateshta, anupaja, apekshika, adravya, rahu chhatra shishuka, shagra, aardra shakha,

sachaka.

Vernacular names –

Sanskrit – Ardraka.

English – Green ginger.

Hindi – Adraka.

Malyali – Alia.

Telagu – Allam.

Tamila – Inji.

Bengali – Duk.

Marathi – Shunti.

Kannada –Shunti

Characters – The plant with the dingy yellow flowers on a leafless flowers stalk and

long lanceolate leaves on a separate stem.

Rhizomes – 2 to 4 inch long.

Tubers – Branched, knotty and some what compressed on one side lobed and clavately

branched without a wrinkled corcky epidermis. Buff coloured and striate on section

fracture meanly and fibrous showing many scattered resin cells and fibro-vascular

bundles.

Odour – Agreeable, aromatic, penetrating.

Taste – Acrid and pungent.

Drug review

36

Chemical Constituents – A volatile oil 2%, fat acquired liquid oleo resin, gingerol, or

gingerin insulase, resin, starch 20%, ash 4%. The volatile oil contains camphene and

phelladrene. Gingerol, an active principle extracted form ginger is a viscid, inodourous

pungent liquid.

Habit – Through out India, West-Indies, Africa, cultivated in Jamica, Sierraleone.

Part used – Rhizomes.

Adraka –

Rasa – Katu.

Guna – Laghu.

Veerya – Sheeta.

Vipaka – Madhura.

Dosha – Kaphahara.

Karmaghnata – Hridya, deepana, ruchikaraka. It subsides kaphajnya

vikara and kantha roga.

Gomutra

Gomutra is used as a medicine since olden days. We get the reference about it in

brihatrayees. Charaka considered, it as one of the ashta mutra varga dravya.

Synonyms – Gomutra, Gojala, Goambu, Gomashanda, Godrava.

Drug review

37

Vernacular names –

⇒ Sanskrit – Gomutra.

⇒ Hindi – Gomutra.

⇒ English – Cow’s urine.

⇒ Kannada – Gomutra.

Properties –

Rasa – Katu.

Guna – Teekshna, Ushna, Kshara.

Dosha – Kapha-vata shamaka, pitta janaka.

Karmaghnata – Agni deepaka, medhya, shoolahara, gulma, anaha. It is

used in virechana karma and asthapana basti.

Charakacharya quotes that Gomutra has madhura rasa, dosha nashaka and krimi

and kanduhara. By abhyantarapana it subside doshajanya udara roga.

Nadakarni in his material medica explains Gomutra contains ammonia in a concentrated

form and is much used in both internal and external purpose. Gomutra is a laxative,

diuretic, and used in preparation of various medicines. Eg. Poonarnava mandura. It is also

recommended by Chakradatta as an anupana for eranda taila given as virechana.

It is used as externally in the purification and roasting of various metals and

preparation of oils, decoctions.

Drug review

38

Disease review

Historical review:

The Vedas are the earliest documented sources of knowledge. Of these Vedas as

an offshoot Ayurveda developed. The disease Amavata does not find its references in any

of the Vedas.

In the samhita period though brahatrayees did not explain about the disease

separately but there are few passing remarks about Amavata in charaka. He has dealt in

detail about the production of Ama and its treatment. Amavata finds a mention in the list

of therapeutic indication of Kamsaharetaki in Shwayathu chikitsa and Vishaladi phanta in

Pandu chikitsa.

It was Madhavacharya who in Madhavanidhana, included Amavata as an

independent disease entity and dealt in detail about its nidana vinishchya. Later

chakradatta an outstanding work pertaining to the treatment of disease contributes the line

of management and many remedies for the disease. Works of Bhavaprakasha,

Yogaratnakara, and Bhaishajyaratnavali have only corroborated the descriptions with

additional principles of treatment.

ETYMOLOGY OF AMAVATA:

Amam cha vatam cha Amavatam: The word Amavata comprises of two meaningful terms

‘Ama’ and ‘Vata’ which forms the pathogenic basis of the disease.

Ama:

In the context of Udararoga89 it has been highlighted that Hypofunction of agni is

the cause of all diseases. Therefore it is not alone tridoshas which takes part but the

deficient function of Agni which plays important role in efficient nourishment of body

can cause disease.

Ama is of dual origin –

01. Formed by apakwa anna rasa90.

02. Dhatwagni durbalata91.

DDiisseeaassee rreevviieeww

39

Apakwa anna rasa – Due to the impaired agni in the amashaya there is malformation of

ahara rasa and this incomplete ahara rasa is defined as ama.

Dhatwagnimandyajanya ama – At the level of dhatus due to hampering of dhatwagni.

Concept of Ama

Biologically Ama corresponds to the undigested protein, carbohydrate, fat,

bacterial content. When they gain accesses in to the general circulation they act as

antigens.

Antigen92

Are usually proteins, with in the body they stimulates antibody production.

They are of two types

1) Exogenous antigen – Infectious agent’s drugs and chemical.

2) Endogenous antigen – Involves blood components.

Production of Ama can also be expressed in two ways-

Ama which is a resultant of hypo function of agni(exogenous sources).

Vagbhata explains that vitiated doshas may combine together to form Ama

within the body (endogenous sources).

Thus the ama from either of the above source become unwholesome to the body

and part of it gets access into the circulation and ends up in causing disease Amavata

which resembles RA.

Nidanapanchaka 93, 94

Various classical texts have explained the same nidana for the Amavata.

01. Viruddha ahara

02. Viruddha cheshta

03. Mandagni

04. Nischeshta (Sedentary habits).

05. Who does the exercise after snigdha ahara bhojana.


40

o Viruddha ahara – Those substances, which are accumulated in the body and

increase the dosha with in the body, are known as viruddha ahara. They remain

antagonistic to the dhatus.

o Viruddha cheshta – It comprises of wide variety of causative factors like

Divaswapna, sedentary habits, exercise after bhojana, excessive indulgence in

sex, suppression of natural urges. Etc

Poorva Roopa

There is no description regarding poorva roopa in any of the Ayurvedic classics.

Laxanas

Samanya laxanas95.96 –

Table No. 12. Showing the samanya laxanas of Amavata.

Sl. Laxana Madhavakara Yogartnakara

01. Angamardha + +

02. Aruchi + +

03. Trishna + +

04. Hrullasa + +

05. Gourava + +

06. Jwara + +

07. Apaka + +

08. Shunata anga + +

09. Aalasya + +

10. Kati,Prusta,Janu Sandi akuncana and

sashabadata

+ +`

11 Nidraviparyaya + +


41

Samprapti

a) Primarily ama (undigested or improperly digested Ahararasa) is produced in the

digestive tract.

b) Secondly this ama circulates in the body through Dhamani ie along with the blood.

c) While circulating the materials do not completely undergo further metabolic changes.

d) This improperly metabolized ‘Ama’ mixes with the doshas ie, vata, pitta & Kapha

which further vitiates Ama.

e) This vitiated ‘Ama’ by its selective discrimination produces blocking (Abhishyanda)

of the shrotasas.

f) Blocked channels get inflamed and further transformation of the nutrient materials do

not take place resulting into inflammation and permanent or chronic damage of

shleshmasthana.

Viruddha ahara + Vihara

Agni dushti in Amashaya

Formation of Amarasa

Sanchara all over the body by prakupita vata dosha.

Samadosha accumulates in the shleshmasthana like Amashaya, shandhi.

Amarasa gets vidagdata and circulates in to shrotasas.

Formation of kleda in different srotas of the body due to the picchila guna.

Leads to durbalata and Gouravata


42

Vata and ama vitiates at a time

Enters into trika, koshta, sandhis.

Where ever vikruta doshas travels produces angamarda, aruchi, apaka, gourava,

jwara, shotha, ruja.

AMAVATA

Pravriddha Amavata Laskhana 97.

Ruja,

Shotha in hasta-pada-shira-gulpha-trik-janu-and uru sandhi.

Wherever dosha travel it causes pain which resembles the string of

scorpion.

On keen observation we can categories the laxanas as below

1. Lakshana specific to involvement of sandhi.

2. Lakshana specific to involvement of Ama

3. Lakshanas produced as a consequence of the disease process.

1. Lakshana specific to involvement of sandhi:

∗ Shoola and Shotha in hasta-pada-shira-gulpha-trik-janu-and uru sandhi.

∗ Shunata Anganam (Swelling in Sandhi)

∗ Gatrastabdhata.

∗ Jadyata.

∗ Sandhi Vikunchana

∗ Sankocha


43

2. Lakshanas specific to the involvement of Ama:

∗ Chardi

∗ Arochaka

∗ Aruchi

Shrotodusti lakshana of Annavaha shrotas.

∗ Anaha Rasavahasroto dusti lakshana.

∗ Angamardha

∗ Alasya

3. Lakshanas produced as a consequence of the disease – process:

The others like

∗ Bhrama

∗ Moorcha

∗ Nidraviparyaya

Upadrava98

Agnimandya, praseka, aruchi, gaurava, utsahaheena, vairasya, daha,

bahumutra, kukshi shoola, nidra viparyaya, trishna, chardi, moorcha, hrit graha,

vit vibandhatwa, jadya, antra kujana.

Doshanubandha Amavata Laskahana99

Pittanubandha -daha and raga,

Vatanubandha -shoola,

Kaphanubandha - stimita, granthila and kandu.

Sadyaasadyata100

o Eka doshaja Amavata sadhya,

o Dwidoshaja Amavata yapya,

o Sarva shareera shothayukta sannipata Amavata is kricchra sadhya.


44

Amavata Chikitsa101,102,103

Table No. 13. Showing the different treatment modalities adopted in Amavata according

to various authors.

Sl. Chiktsopakrama YR CD BR

01. Langhana + + +

02. Ruksha swedana + + +

03. Deepana by tikta and katu dravyas + + +

04. Snehapana + + +

05. Virechana - + +

06. Basti - + +

07 Shamanoushadi + + +

Pathya104 –

Patola,Ardraka, Punarnava, Karavellaka, Yava, Raktashali, Kulattha, Kodrava,

Shigru, Ushnajala, Lasuna sanskruta takra, Jangalamamsarasa.

Apathya –

Dadhi, Matsya, Dugdha, Mashapisti, Virrudhabhojana, Asatmyapadartha,

Vegaavarodha, Ratrijagarana, Vishamabojana, Gurupadartha, Abishyandi

padhartha.


45

RHEUMATOID ARTHRITIS105

Definition:

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that may

affect many tissues and organs – skin, blood vessels, heart, lungs and muscles but

principally attacks the joints, producing a nonsuppurative proliferative synovitis that

often progresses to destruction of the articular cartilage and ankylosis of the joints.1

Rheumatoid arthritis is a chronic multi system disease of unknown cause.

Although there are a variety of systemic manifestations the characteristic feature of RA is

persistent inflammatory synovitis, usually involving pheripheral joints in a systemic

distribution. The potential of the synovial inflammation to cause cartilage destruction,

bone erosion and subsequent changes in joint integrity is Hallmark of the disease106.

Rheumatoid arthritis (RA) is an immmuno-inflammatory disease that affects

joints and entire articular tissues107.

PATHOLOGY108

The earliest change in swelling and congestion of the synovial membrane and the

underlying connective tissues, which becomes infiltrate with lymphocyte, plasma cells

and micro phases. Diffusion of synovial fluid into the joint space takes place during

active phase of disease. Hypertrophy of the synovial membrane occurs with the formation

of lymphoid follicles resembling an immunologically active lymph node. Inflammatory

granulation tissues (pannus) is formed spreading over and under the articular cartilage,

which is progressively eroded and destroyed later fibrosis adhesions may be formed

between the layers of pannus across the joint space and fibrosis or bony ankylosis may

occur. Muscles adjacent to inflamed joints atrophy and there may be focal infiltration

with lymphocytes.


46

ETIOLOGY109.

The case of RA remain unknown it has been suggested that RA may be the

manifestation to the response to an infectious agent in genetically susceptible host. A

number of possible causative agent have been suggested, micoplasma Epstein – Bar virus

(EBV), cytomegalo virus, parvo-virus, and rubella virus, but convincing evidence that

these are other infectious agents cause RA has not emerged. Alternatively the

microorganisms or response to the microorganisms might induce an immune response to

components of the joints by altering its integrity and revealing antigenic peptide. Recent

work has focused on the possible role on the super antigens produced by the number of

microorganisms including staphylococci, streptococci and M–arthritis. Super antigens are

proteins with the capacity to bind to HLA-DR molecule and particular VB segment of the

heterodinimic T cell receptor and stimulate particular T cell expressing the VB gene

products of all the potential environmental triggers. The only clearly associated with the

development of RA is cigarette smoking.

Gastro-intestinal Aetiology of RA: The co-existence of arthritis and diseases of gastro-

intestinal tract has aroused increasing interest in recent years.

The hypothesis of malabsorption of aminoacids in the aetiology of rheumatoid arthritis is

capable to explain the deficiency of protein, histine, arginine, glutamine and thyrosine

etc.


47

ENTEROPATHY AS PRIMARY CAUSE OF RHEUMATOID ARTHRITIS:

Genetics Environment

Enteropathy

Malabsorption

Impeded Biosynthesis of proteins in system.

Fibrinoid changes Excessive dissolution of collagen tissue

Collagen diseases

e.g.: Rheumatoid arthritis.

PATHOGENESIS110.

Localization of antigens in joints

Antigen by microphages

Activation of helper T cells

Release of intraleukin – 2

Cytokenes like IL-4, IL-6, IFN are released by Cd4 cells


48

Cytokenes increases the expression molecules like ICMA-1, LFA –1, MAC-1

It helps in localization of inflammatory cells

Cytokines stimulates, activates and proliferation of

B cells produce antibody producing plasma cells.

These cells produce antibodies against Fc fragment of IgG (RA)

RA factor forms immuno complex with IgG

Production of Ca3, C5a, C3b and C5,6,7,8,9

Ca3 and C5a as anapphylotoxins Release of histamines C5,6,7,8,9 is capable of damage

cells by drilling pores in their membrane.

Inflitration of neutrophills

Release of oxygen free radicals, inflammatory metabolites, arachidnic acid pathway like

prostaglandins leutrines metalo-proteins like collagenase.

Damage of articular cartilage demineralization of underlying bone erosion of the joint

margins laxicity of the joint capsule leading to deformity.


49

Articular Features111

The onset is usually insidious but may be acute or systemic, symmetrical joint

involvement is common in middle aged women. Asymmetrical presentation is common

as a disease progresses. Acute onset with asymmetrical polyarthritis is more often seen in

elderly patients.

In the pelidromic onset type abrupt self limiting exaggeration of joint swelling

erethrima and warmth over the joint occur and resolve completely within hours to few

days. Only reoccur after period of time.

The characteristic pattern of joint involvement in descending order is frequently

in metacarpals (MCP), wrists, proximal, intraphalangeal (PIP), metatorso-phalangeal

(MTP) joints, knee, ankles, hips and elbows. The affected joints are painful to start with

then become swollen, warm, and tender with restriction of movement.

Pattern of Onset

Table No. 14. Showing the pattern of onset of Rheumatoid arthritis.

Sl. A B

01. Insidious, > 70%,

Acute 10-15%)

Sytemic - <10%,

palidromic least <5

Common. >5patient.

Oligoarticualr 45 to 50 ,

Polyarticualr 30-35%

Monoarticular 20-25 %.


50

Extra Articular Manifestation of RA

Systemic Cardiac Respiratory Low grade fever Pericarditis Plural effusion

Fatigue Myocarditis Fiborsing alveolitis

Loss of weight Aortitis Nodules

Loss of appetite Conduction disturbances Bronchitis

Musculo-skeletal Hematological Neurological

Muscle wasting Anemia Entropment syndrome

Bursitis Thrombocytosis Cervical compression

Tenosynovitis Esinophilia Mononeuritis multiplex

Skin Felty’s syndrome Others

Subcuatneous nodules Spleenomegaly Systemic vasculitis

Vasculitis Eye Amylodosis

Ulcers Sicca syndrome

Gangrene Episcleritis

Pyoderme gangrenosum Scleritis

Nail fold infarcts Scleromalacia

Deformities112

Hand –

Hands include button hole associated with flexion at the PIP joints and

hyperextension of the distal intraphalangeal joints.

Swan neck deformity associated with flexion of the digital interphalangeal and

hyperextension of PIP joint.

Z deformity of thumb and ulnar deviation of the finger.


51

Feet –

Feet involvement of MTP joints causes plantar subluxation of the metatarsal

heads. Resulting in cock-up toes. The deformity seen in the feet include Hallex valgeus or

varus, and Hammer toes,

Axial joint involvement is restricted to the cervical spine, where it takes the form

of either atlanto axial subluxataions or subaxil subluxation.

Laboratory Investigations113, 114

Laboratory investigations may help either to establish a clinical diagnosis or to

assess the prognosis and the possible cause of the disease.

ESR – Is elevated in RA and comes down as the disease remitts.

Hb% – May shows a normocytic normochromic anemia.

C- reactive protein – High levels of CRP at the onset of disease correlates with

poor prognosis.

Serological – The most important immunological investigation is detection of

rheumatoid factor. Other auto antibodies seen include antinuclear (ANA), Anti collagen,

Anti keratin, Antiperinuclear (ANA) and anti-rheumatoid arthritis antibodies.

Synovial fluid analysis – Synovial fluid analysis confirms the presence of

inflammatory arthritis, although none of the findings are specific.

The fluid is usually turbid, with reduced viscosity, increased protein content and

slightly decreased or normal glucose concentration.

White blood cell – WBC count is usually normal, but mild leukocytosis may be

present.

Radiographic evaluation – Plain radiograph of the joint in the early stages shows

soft tissues swelling around the affected joint and later jextra articular osteoporosis;

erosions are seen as the disease progresses. In later stages there is destruction of the

cartilage, resulting in joint space narrowing, cyst formation subluxation of the joints and

deformities.


52

Treatment / Management115

Because the etiology of rheumatoid arthritis is unknown, treatment is empirically

directed towards –

♣ Relief of symptoms.

♣ Suppression of active progressive disease.

♣ Conservation and restoration of function in affected joints.

To a greater or lesser extent these are achieved by combining:-

♣ Treatment of the patient – Drugs, rest, physiotherapy, surgery.

♣ Modification of the environment – Aids, appliances, housing,

occupation, statutory benefits.

General Treatment

Physical rest, anti-inflammatory therapy and maintenance exercises are important

treatment for rheumatoid arthritis. The rest from physical and emotional stress provided

for 2-3 weeks in hospital is usually sufficient to induce a marked remission of symptoms.

Rest splints can be used to support a particular painful joint to correct flexion deformities.

Medications

Medications for rheumatoid arthritis include some for pain relief, others to reduce

inflammation. Some medications are disease modifying anti rheumatic drugs (DMARD)

which to try to show the course of the disease.

Intra-articular cortico-steroidal injections are given to bring symptomatic relief.

Non-steroidal anti-inflammatory drugs therapy is beneficial chloroquine phosphate or

hydroxy chloroquinine sulphate are used as the initial adjacent to basic therapy.

Auranofin an oral gold compound, pencillamine, and parental gold are also used

and immuno modulators are also used in the treatment.


53

Surgical Treatment

Surgical decompression and synovectomy are needed when NSAID’s, local

insatous of corticosteroids and simple physical measurement failed to reduce movement

of limbs.

Prognosis116.

The course and prognosis in RA is very variable. 25% will have a complete

remission of symptoms and remain fit for all normal activities. 40% will have only

moderate improvement of function despite exacerbation and remission of disease. 25%

will be more severely disabled. 10% will be severely crippled.

A poor prognosis may be associated with –

01. High titer of RA factor.

02. Insidious on set of disease.

03. More than a year of active disease without remission.

04. Early development of nodules and erosion.

05. Extra articular manifestations.

06. Sever functional impairment.

Mortality is gradually increased in RA patients with functional impairment. The 5

years survival for severely disabled RA patient is reduced by 50%, the prognosis in

such patients is similar to that of patients with 3 vessels coronary artery disease.


54

Methodology

Methodology can be studied under three headings,

1) Pharmaceutical study.

2) Analytical study.

3) Clinical study.

PHARMACEUTICAL STUDY

The study involves proper identification, collection, processing of raw drugs

and preparation of Sri Siddhadaradamruta.

The rationale of this branch is to make available the effective, safe, and

suitable medicine. It is evident that samskara given to the drug will change the quality

of the drug and also acts in a different manner when mixed with other drugs. Timings

of medication and anupana also direct the medicine to act in a different ways.

Study design

This section includes major steps,

Step 01: Identification and Collection of raw drugs.

Step 02: Purification and Processing of raw drugs.

Step 03: Preparation of Sri Siddhadaradamruta.

Date of Commencement:

Date of Completion:

Ref: Rasatarangini-Navama Taranga.

Method:

Pharmaceutical study

55

Step 01: Identification and Collection of raw drugs.

Date of Commencement: 26.11.04

Date of Completion: 26.11.04

An important part in the preparation of medicament lies in the proper

identification and procurement of the raw materials. Only this determines the quality

of drugs. So this section of the study deals with the same. Sri Siddhadaradamruta

contains;

Key ingredient: Hingula

Samskarartha Prayojya Ghatakas:

Vataksheera, Palanduswarasa, Bhallataka, Lavanga and Ghruta.

Special request was made to the herbo mineral drug shop dealer to get the

particular quality drugs and those were screened for classical grahya lakshanas and

those were certified by the concerned departments.

Step 02.Purification and processing of raw drugs

Shodhana procedures are mentioned for certain drugs with the intention to

enhance their therapeutic value and to make them sajateeya from vijateeya dravyas. It

is also done to make the drug free from its toxic properties. Hence this has to be done

with utmost care as improper purification may prove drug fatal.


56

Practical No; 1

Title: Hingula Shodhana.

Date of commencement : 02.12.04

Date of completion : 09.12.04

Reference: Rasa Ratna Samuchaya 3/152,153.

Materials required: Khalwa yantra.

Drugs used:

a) Hingula-500gms.

b) Ardraka swarasa-Q.S

Procedure:

* Hingula was taken in khalva yantra and powdered nicely.

* 130 ml of fresh ardraka swarasa was added and mardana was done for

8Hrs till it became dry.

* The Hingula was subjected for continual and cautious mardana till powder

completely absorbs the swarasa and this completes one bhavana.

* Similar such bhavana was repeated for another six times.

* In the 7th bhavana when Hingula was thick paste it was converted in to a

cake of approximately equal weights.


57

Table No. 15. Results of Hingula Shodhana

Ingredients In quantity

Bhavana dravya in quantity

Mardana in hours

Results Remarks

Ardraka swasa 130 ml 8 hours 505 gms Gain – 5 gms.

Ardrakaswarasa 130 ml 8 hours 512gms Gain – 7gms.

Ardrakaswarasa 130 ml 8 ½ hours 518gms Gain – 6gms.

Ardrakaswarasa 130 ml 8½ hours 525gms Gain – 7gms.



Hingula 500 gms.


Table No. 16.Showing the quantity of Hingula before shodhana and after shodhana.

Draya Quantity of Hingula before

shodhana (in gms)

Quantity of Hingula after shodhana

(in gms).

Hingula 500 545

Observation:

o Hingula can be made in to fine powder without much effort.

o A fine powdered Hingula appears bright red with a free flow character.

o Shodhita Hingula is deep red in appearance and its flow is reduced.

Precaution:

o When Hingula attained semisolid consistency the mardhana was carried out

continuously.


58

Practical no: 02

Title : Bhallataka Shodhana



Reference: Rasatantra sara- Dravya Shodhana prakarana.

Drugs used: a) Grahya Bhallataka- 800gms

b) Gomutra-7 lit.

Procedure:

* The Bhallataka which sinks in water were identified and tied in to the

cloth and pottali was prepared.

* A mud pot of 3 lit capacity was taken in which this pottali was hanged

such that it moved freely in the pot. Distance of 4 angula from below to

the Pottali height was maintained.

* Gomutra was filled up to 3/4th of the pot.

* It was placed on mandagni over gas stove for 12 hrs.

* Gomutra was added in between whenever the level of gomutra was

reduced.

* After 12 hrs the Pottali was removed and the Bhallatakas were washed

with hot water.

Observations:

* Gomutra turned black tiny oil miscicles seen in it.

* After shodhana when Bhallataka was washed with hot water, it gained dull

appearance.


59

Precaution:

* When Gomutra starts boiling the froth is produce. This overflows from the

pot. Hence during that period, for few minutes the agni has to be lowered.

* Whenever the level of Gomutra is reduced, fresh Gomutra was added to

bring it up to the level of ¾ of the pot.

Table No. 17. Showing weight of Bhallataka before and after shodhana.

Dravya Weight of Bhallataka

before Shodhana

Weight of Bhallataka

after Shodhana

Bhallataka 800 gms 750 gms

Practical No 3:

Name : Preparation Hingula cake:



Reference: Rasatarangini Navama Taranga

Materials Required:

1. Shodhita Hingula cake

2. Cotton thread

Procedure:

* Shodhita Hingula cakes were taken and weighed.

* Each Hingula cake was tied with cotton thread separately such that the

whole of the Hingula was densely covered with cotton thread, in a way not

to expose it outside.

* Later they were weighed again.


60

Table No. 18. Showing weight of Hingula before and after threading.

Drug Before Threading After Threading

100gm 105gm

110gm 115gm

110gm 115gm

110gm 115gm

Shuddha Hingula cakes

115gm 120gm

Observation: The threads are to be fastened very closely and carefully such that no gaps

are to be formed.

Precaution: Care is taken that whole of the Hingula is covered with threads so that

Hingula is not revealed at the outset.

Practical No 4:

Name : Pachana Samskara- I

Date of commencement: 27.01.05



Materials Required:

1. Vata ksheera – 250 ml

2. Palandu swarasa – 2 litre

3. Hingula cakes – all 5.


61

Procedure:

* A moderate sized deep fry pan was taken in which all the five Hingula

cakes tied with cotton thread were placed.

* Both Vataksheera and Palandu swarasa were poured in to pan.

* Pan was placed over mruduvagni, till all the liquid in the pan evaporated.

* When the pan was dry all the cakes were collected.

Table No. 19. Showing details of Pachana Samskara.

Drug Pachanadravya Quantity Temperature/

Total no of

hours

Total wt.

before

Total wt.

after

Vata ksheera 250 ml Shuddha

Hingula cake Palandu swarasa 2litres

80˚C for 5

hours

570gms 650gms

Observation:

* A sweet smell emerged through out the procedure.

* At the end of the pachana, the fibers with rubbery consistency remained at

the bottom.

Precaution:

The Mrudu agni has to be maintained through out the procedure.


62

Practical No 5:

Name : Dhahanasamskara




Materials Required:

1. Pachita Hingula

2. Shuddha Bhallataka

3. Lavangachoorna

4. Funnel.

Procedure:

* Two tola of lavanga yavakuta choorna is spread at the bottom of a pan.

* Over this place pachita Hingula.

* Make the heap of shudha bhallataka over Hingula cake in the form of

cone.

* Fill the gaps with lavanga choorna such that it forms a tight pack.

* Over this inverted funnel is placed such that the funnel wall covers

completely the cone of Bhallataka.

* Now surround the funnel with charcoal and set fire to it.

* When whole of Bhalataka is burnt the Hingula cake is taken and cleaned

and taken for next procedure.

Observation:

* When Bhallataka burns inside fumes come out from the opening of the

funnel.

* When all Bhallataka is burnt the fumes stop coming from the funnel. This

can be considered as the end point of this procedure.


63

Precaution:

* While burning Bhallataka it is better not to sit within its vicinity as it

causes boils over the exposed skin in sensitive person.

* Apply coconut oil over hand and face to avoid its reactions.

Practical No 6:

Name : Pachana Samskara- II




Materials Required:

1. Hingula cake -135gms.

2. Grutha -1350 ml (ten times that of Hingula)

Procedure:

* Taka a deep frying pan and place the Hingula cake at the center.

* On mandagni pour little by little grutha on Hingula khanda and make it to

evaporate.

* This is repeated till all the grutha is evaporated. Temperature during the

procedure was 260oc- 280oc.

* When all the grutha evaporates the cake is collected and the threads are

untied and made it in to powder and administered.

Observation:

* At the end of the procedure the grutha turned black.

* The residual grutha turned to thick, rubbery consistency material which

further did not evaporate.

Table No. 20. Showing details of Ghruta Pachana.

Drug

Wt before Pachana Wt after Pachana

Dahita Hingula 135gms 130gms


64

ANALYTICAL STUDY

The Rasoushadhies mentioned in Ayurvedic Pharmacopoeia should be analyzed

for physical and chemical properties to confirm the genuinity and safety before

administration in human beings. Hence it becomes obligatory to adopt modern analytical

methodology for better understanding & interpretation of physico-chemical changes

occurred during the process.

In the present study sample is collected at the completion of the preparation &

subjected to modern analytical methods

1. Loss on drying 1100:

One grams of Sri Siddhadaradamruta accurately weighed, heated on electric oven

up to1100 c & again weighed. The difference in weighed was calculated & the result is

attached.

Result: 0.21%

2. Acid insoluble ash:

The ash obtained was taken with dilute HCl filtered through Whatmann no. 42

filter paper. The residue was washed with hot water till it was free from chloride. The

residue was taken in a crucible, dried & ignited at a low temperature. The percentage of

acid insoluble ash was calculated with reference to the moisture free drug.

Result: 0.42%

3. The fineness of particle test:

It can be possible to use the ordinary microscope for particle size measuring in the

range of 0.2 micro meters to about 100 micro meters. According to microscope

method the fine powder was sprinkled on the slide covered with covering slip &

Analytical study

65

placed on a mechanical stage. Initially standardization of micrometer was carried out

by coinciding with the lines of both Oculo-micrometer and stage micrometer &

standardized by using the formula;

SM

-------- X 10 = m

OM

In the next step, the stage micrometer was removed & the mounted slide was

placed on a mechanical stage & focused. The particles are measured along the arbitrarily

chosen fixed lines covered by the particles using the Oculo- micrometer. The size of the

particle was calculated using the standard value.

Result:

Sample AMD in µm Mean Surface Volume Diameter µm

Shodhita Hingula 6.534 9.222

Sri Siddhadaradamruta Rasa 4.788 8.198

4. Flow property:

Sri Siddhadaradamruta is very fine powder so to maintain the actual dose and for

better dispensing, it was subjected to flow property test i.e., “Angle of repose” by which

we can analyze goodness of flow property.

Angle of repose: - It is the maximum angle that can be obtained between the free

standing surface of a powder heap & the horizontal plane i.e., tan θ = 2h / D

Where D is the diameter of the circle & ‘h’ is the height of the powder heap.

This test involves the hollow cylinder half is filled by Sri Siddhadaradamruta with

one end sealed by transparent plate. The cylinder is rotated about its horizontal axis until

the powder surface cascades. The curved wall is lined with sand paper to prevent

Analytical study

66

preferential slip at this surface. If the value comes between 200– 400 indicates reasonable

flow potential.

Shodhita Hingula: 32.86±2.75 Sri Siddhadaradamruta Rasa: 37.46±7.86

5. Flow rates:

A simple indication of the ease with which a material can be induced to flow is

given by application of a compressibility index “I”

I = 1 – V x 100

V0

Where ‘V’ is the volume occupied by sample of the powder after being subjected to a

standardized tapping procedure.

V0 = volume before tapping procedure

In this procedure one measuring cylinder is taken and is filled with Sri

Siddhadaradamruta. The level of the Sri Siddhadaradamruta Rasa is noted. Then at a

height of 2 cm continuous 10 tapping should be done, after that the level of the Sri

Siddhadaradamruta Rasa in the cylinder is once again noted & the value ‘I ’ is calculated

with respect to the Vo & V value. If the value ‘I’ is below 15% usually having good flow

rates.

Shodhita Hingula-12% Sri Siddhadaradamruta Rasa -15%

7. Determination of pH –

The pH value of the sample was determined by a digital pH meter. One percent

solution was prepared, as the sample was dry and solid in the form of capsules. The

powder was separated and one gram of the sample was weighed accurately and dissolved

in 100ml of water and pH was noted in the digital pH meter.

Result:

pH (1% solution)- 6.66

Analytical study

67

8. Determination of total ash:

Procedure – Take about 2gms accurate weighed, ground drug in a previously traced

silica dish, previously ignited and weighed. Scatter the ground dry in a fine even layer on

the bottom of the dish. Incinerate by gradually increasing the heat not exceeding dull red

heat (4500C) until free from carbon. Cool and weigh. Calculate the percentage of ash with

reference to the air-dried drug.

Total ash- 29.1%

9. Determination of sulphur:

Eschka Mixture – Mix two parts by weight calcined magnesia with one part of

anhydrous sodium carbonate.

Procedure –

Cover the bottom of a 50 ml crucible with 0.5 gm of Eschka’s mixture. Weigh

accurately the appropriate quantity of the sample material and mix it immediately with

2gms of Eschka’s mixture and put evenly on the previously weighed Eschka’s mixture.

Level the contents by tapping gently on a bench. Cover this uniformly with 0.5gm of

Eschka mixture. Place crucible in the muffle furnace. Raise the temperature from room

temperature to 8000C + 250C in about one hour and then heat for further 90 minutes.

Transfer the ignited mixture as completely as possible from the crucible to a

beaker containing 25 to 30 ml of water. Wash out the crucible thoroughly with about

50 ml of hot distilled water and add the washings to the contents of the beaker.

Add carefully sufficient quantity of concentrated hydrochloric acid to dissolve the

solid matter, warming the content of the beaker to effect solution. Boil for 5 minutes to

expel carbon dioxide. Add drop wise from a pipette; warm 5% Barium chlorine solution.

Stir the solution constantly during the addition. Allow the precipitate to settle for a

minute or two.

Analytical study

68

Then test the supernatant liquid for complete precipitation by adding a few drops

of Barium chloride solution. If a precipitate is formed, add slowly a further 3 ml of the

reagent allow the precipitate to settle as before and test again, repeat this operation until

an excess of Barium Chloride is present. When an excess of the precipitating agent has

been added, keep the covered solution hot, but not boiling for an hour (steam bath) in

order to allow time for complete precipitation. The precipitation should settle and a clear

supernatant liquid should be obtained. Test the latter with a few drops of barium chloride

solution for complete precipitation. If no precipitate obtained, the Barium sulphate is

ready for filtration.

Filter the solution through an ash less filter paper (Whatmann No. 42). Wash the

precipitate with small portion of hot water. Dry the paper and place it in a silica or

porcelain crucible, previously ignited to redness and cooled in desiccators and weighed.

Gradually increase the heat until the paper chars and volatile matter is expelled. Do not

allow the paper to burst into flame as mechanical loss may thus ensue. When charring is

complete, raise the temperature of the crucible to dull redness and burn off carbon with

free excess of air. When the precipitate is white ignite the crucible at red heat for 10-15

minutes. Allow the crucible to cool in air, transfer it to desiccators and when cold, weigh

the crucible and contents. Repeat until constant weight is attained.

A blank is necessary. Calculate the percentage of sulphur converting Barium

sulphate X 0.1374.

Sulphur: Shuddha Hingula- 12.83% and Sri Siddhadaradamruta – 12.28%.

10. Determination of mercury

Procedure –

Dissolve about 0.3gms of the sample in 5ml of Aquaregia and add 100 ml of water. Add

40ml of 0.05N EDTA, 5ml of Ammonia buffer solution and 0.5ml of solo chrome black

Analytical study

69

indicator. Titrate the solution with 0.05 M Zinc sulphate until the blue colour changes to

purple (do not overshoot the end point), add 3gms of Potassium iodide, swirl to dissolve.

Allow to stand for two minutes. Then, continue the titration with zinc sulphate solution to

the same end point as before. Each ml Zinc sulphate solution required after addition of

potassium iodide = 0.0103 Hg.

Mercury: Shuddha Hingula- 86.10% and Siddhadaradamruta Rasa -64.28%.

11. Solubility:

About one gram of the sample was weighed and dissolved in 10ml of the solvents.

When the sample did not dissolve, an excess of solvent by 10 ml quantity up to 100ml

was added and noted that the sample was sparingly soluble in water and 1M Hydrochloric

acid (1 gm of sample in 100 ml of water and 1 M Hydrochloric acid) and slightly soluble

in chloroform and alcohol (1 gram of sample in 600 ml to 1000 ml of chloroform and

alcohol.

Solubility tests Results

Water Slightly soluble.

Chloroform Slightly soluble.

Alcohol Soluble.

12. Electron Spectroscopy for Chemical Analysis (ESCA)

ESCA of Sri Siddhadaradamruta Rasa (final product) was carried out at Indian

Institute of Chemical Technology (IICT), Hyderabad for both Qualitative and

Quantitative analysis.

Among the methods of surface analysis based on ultra high vaccum techniques,

which have been developed dramatically during the past years, only ESCA – which

stands for ‘Electron Spectroscopy for Chemical Analysis’ or XPS X-ray photo electron

spectroscopy, besides Auger electron Spectroscopy (AES) and Secondary Ion Mass

Analytical study

70

Spectrometry (SIMS) became well established in the field of Materials surface analysis.

ESCA involves the determination of the energy distribution of electrons emitted from X–

ray irradiated compounds. In principle all the electrons of a compound, from the atomic

cores of the Valence levels, can be studied, however, the technique is used principally for

the study of core electrons.

Physical Principle of ESCA

ESCA has its origin in the investigations of the photoelectric effect in which X –

rays were used as the existing photon source. In addition to the valence electron, which

provide the bonding for the systems. Each atom present in the surface (except H2 and He)

posses core electrons not directly involved in the bonding (Anti-bonding electrons). The

so-called binding energy Eb of each core electron (conceptually, but not strictly

equivalent of I.E. of the electron) is characteristic of the individual atom to which it is

bound. In the basic ESCA experiment the samples source (Depth of analysis between 1.5

and 6 nm). The resultant photoelectrons (emitted particles) have a Kinetic energy (Ek) in

the range of 20 to 2000 ev which is related to X-ray energy (hγ) and binding energy (Eb)

Ek = hγ – eb - ψ

Where ‘h’ is plancks constant, γ is frequency of the exciting radiation, ψ is the work

function of spectrometer (the energy required brining an electron from the Fermi level

of the spectrometer to its zero level).

If the photoelectrons have sufficient Kinetic energy that they are able to escape

from the surface by overcoming the work function, photoemission occurs. Since the

energy levels are quantised the photoelectrons have a Kinetic energy distribution

consisting of series of discrete bands, which essentially reflect the shell from electronic

structure of the atoms in the sample. In this way ESCA is the experimental determination

of Kinetic energy distribution by analysis of the photoelectrons produced by exposure to

X – rays.

Analytical study

71

Experimental conditions

ESCA recorded on a KRATOS AXIS 165 with a dual anode (Mg and Al)

apparatus using the Mg K ∝ anode. The pressure in the spectrometer is about 10-9 torr.

Spectrum was deconvoluted using the sun solaris based vision 2 curve resolver. The

location and the full width at half maximum (fwhm) for a species was first determined

using the spectrum of a pure sample. The location and fwhm of the products, which were

not obtained as pure species, were adjusted until the best fit was obtained as pure species,

were adjusted until the best fit was obtained symmetrical Gaussian shapes were used in

all cases. Binding energies for identical samples were in general reproducible to with in +

1 ev.

Routinely used X – ray sources are Mg K ∝ (1253.6 ev) and Al K ∝ (1486.3 ev)

as incident particles, which normally cover of an area of many mm2. Alk ∝ radiation can

be mono chromate and this leads to some focusing may be to spot diameter of about

10µm as lateral resolution. The ESCA Spectrum is usually a plot of intensity of the

photoelectrons versus binding energy (Eb).

ESCA – General aspects

ESCA yields information on the elemental analysis and their composition, the

oxidation state of the elements and in favourable cases on the dispersion of one phase

over another. ESCA can be used to give reasonable quantitative accuracy (up to + 10%)

provided that good calibration standards are used. The detection limit is about 10– 3.

A major advantage of the technique is that photo electron energy is dependent on

the precise chemical configuration of the surface atoms and pronounced chemical shifts

are produced in the position of peak in the ESCA, is amenable to virtually all vaccum

compatible samples since the incident rays do not normally cause surface damage due to

the beam. Therefore the techniques can be used even with very delicate material. Using

sample charging is minimal. The collection of spectra is normally fast (typically less than

5 min) and the reproducibility of results is high. ESCA shows a narrow range of

sensitivity and the range of sensitivity across the element range is about a factor by 10.

Analytical study

72

Results:

In the sample Mercury is present in Oxide and Sulphide forms. No

elemental mercury is present. Majority of mercury is in the form of oxide and less in the

Sulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide

20.79%. The sample has mercury oxide and sulphide in the ratio of 60:40. The peak at

59.3 is due to Selenium oxide and if it is due to elemental selenium it will be at 54.8,

because it is too low in concentration it can not be marked.

13. Estimation of FAT content:

Weigh about 2 g of previously dried sample. Take in a thimble made of coarse

filter paper and knotted with thread. Extract with 25ml anhydrous alcohol, free ether or

petroleum ether in a soxhlet extraction apparatus. Extraction period may vary from 4

hours at condensation rate of 5-6 drops/sec to 16 hours at 2-3 drops per sec. evaporate

solvent and dry the extract to a constant weight at 1100C. Calculate the fat content

percentage.

Result: 7%.

Analytical study

73

CLINICAL STUDY

Rasoushadhies are basically divided in to four types viz- Khalviya,

Parpati, Kupipakwa, and Pottali. In all these preparation one major difference we note is

the pattern of agni (to attain Agnisthayitwa), based on which the Rasayana property of

these kalpas are enhanced. This also reflects on the dose to be administered, as it is noted

that the dose of Pottali kalpa is very minute. Sri Siddhadaradamruta Rasa not mentioned

in these four basic kalpas and is subjected for different samskaras with agni. To evaluate

its liability in therapeutics it was put to test in Amavata. Efficacy can be determined by

finding out the difference between the baseline data and assessment data.

The materials and methods of the present study consist of following headings.

I. Selection of patients.

II. Research Design.

III. Duration and Method of administration of drug.

IV. Parameters of Assessment.

V. Criteria for Assessment of Results

1. SELECTION OF PATIENTS:

The patients were diagnosed based on the presentation of history, signs,

symptoms, and detailed clinical examination. 15 patients were selected after critical

adaptation of inclusion and exclusion criteria.

a) Source of data:

15 patients of Amavata with confirmed diagnosis were taken from OPD and IPD of

DGM Ayurvedic Medical College Hospital, Gadag.

The Samples were selected by simple sampling technique.

b) Inclusion criteria:

a) Patients of Amavata having the history of less then 5years.

b) Patients of Amavata between the age group of 20 to 50 years of either sex.

c) Classical signs and symptoms will be considered for selection of patients.

Clinical study

74

c) Exclusion Criteria:

a) Patients of Amavata having the history of more than 5 years

b) Patients of Amavata having the systemic diseases.

c) Patients of Amavata below 20 years and above 50 years of age.

d) Pregnant women and lactating mothers.

d) Intervention:

a) The patients are assessed before and after the treatment as per assessment

criteria.

b) The nature of the study is explained to the patients in detail and pre treatment

consent is taken.

c) The patients have full right to withdraw from the study at any time.

d) The data is maintained confidently.

e) 15 patients of Amavata of either sex are taken in simple randomized selection

of sampling techniques.

II RESEARCH DESIGN:

The study was conducted on total 15 patients who could continue the treatment

for full duration and came for follow up till to the last; the patient was selected from the

OPD, DGM Ayurvedic Medical College & Hospital for prospective clinical trial.

III DURATION AND METHOD OF ADMINISTRATION OF DRUG:

Study duration - 30 days.

Follow up - 15 days.

Method of Administration: Sri Siddhadaradamruta was administered orally

Dosage – ½ Ratti (62.5 mg) two times a day.

Anupana – Purana Guda.

Clinical study

75

IV PARAMETERS FOR ASSESSMENT:

Subjective parameters:

Signs and Symptoms explained in the Ayurvedic texts

Table No. 21. Showing the gradation which is adopted in statistical evaluation of clinical

symptoms.

Sl.No Symptoms Severity Grade01 Sandhi Shoola No complaints

Patients tells about it After inquire Patients frequently complaints Excruciating condition

0 1 2 3

02 Shotha No complaints Slight Obvious Covers well the boney prominence Much elevated

0 1 2 3

03 Jwara (sthanika ushmata) Normal During severity of pain During severity of pain with swelling `Continuous pain with pain.

0 1 2 3

04 Gouravata No Gouravata During morning up to 1hrs. Continuous in the morning less than 24Hrs Throughout day

0 1 2 3

05 Nidraviparyaya No discomfort Discomfort during night Discomfort during night and affects day. Day sleep and night awakes.

0 1 2 3

06 Jadya No stiffness Stiffness for 5 min-1hour Stiffness for 1-2 hours More than 2 hours.

0 1 2 3

Clinical study

76

Objective Parameters:

Hb%, TC, DC, ESR, Walking time, Grip strength,

Table No 22. Showing the gradation which is adopted in statistical evaluation

of walking time.

Sl No To cover 21 Meters Grading

01 02 03 04

Up to 20 Seconds 21 to 30 Seconds 31 to 40 Seconds 41 to 50 seconds

0 1 2 3

Grip strength: - Patient’s grip strength is assessed before and after treatment

according to the readings in the grip strength meter in terms of pound.

Assessment of Result:

Subjective and objective parameters before and after treatment data

comparison is assessed for result.

V CRITERIA FOR ASSESSMENT OF RESULTS

The results are classified into four groups as listed below –

A. Complete remission

1. Sandhi Shoola (pain)

2. Sandhi Shotha (swelling)

3. Gouravata

4. Jwara (Sthanika ushmata)

5. Nidraviparyaya

6. Jadya

7. No elevation of ESR.

8. Complete subsidence of above subjective parameters.

Clinical study

77

B. Major improvement

1. Complete subsidence >2 or <6 below mentioned subjective parameters i.e.

I. Sandhi Shoola (Pain)

II. Sandhi Shotha (Swelling)

III. Gouravata

IV. Jwara (Sthanika ushmata)

V. Nidraviparyaya

VI. Jadya

2. ESR may be elevated.

C. Minor improvement

1. Complete subsidence of any one below mentioned subjective parameters i.e.

I. Sandhi Shoola (Pain)

II. Sandhi Shotha (Swelling)

III. Gouravata

IV. Jwara (Sthanika ushmata)

V. Nidraviparyaya

VI. Jadya

2. Elevation of ESR.

D. No improvement

1. No change or exaggerations of signs and symptoms

2. Elevation of ESR.

The persons who don’t come under above three criteria’s will come in these criteria.

Clinical study

ANALYSIS REPORT OF Dr Pradeep Agnihotri

3. DVK PA SReport: Mercury is present in oxide and sulphide forms. No elemental Mercury is present. Majorly mercury is in the form of oxide and less in the sulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. The sample has mercury oxide and sulphide in the ratio of 60:40.

DVK PA SR_Report: Mercury is present in oxide and sulphide forms. No elemental Mercury is present. Majorly mercury is in the form of oxide and less in the sulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. The sample has mercury oxide and sulphide in the ratio of 60:40.

78

DEMOGRAPHIC DATA Distribution of patients by age; Table No. 23. Showing Distribution by age Group

Sl Age group No. of pts Percentage

01 21-30 05 33.33

02 31-40 04 26.66

03 41-50 06 40

It was observed that, the maximum number of patients 06(40%) were in the age

group of 41-50; 05 (33.33%) from the age group of 20-30 years.

Graph.1: Showing Distribution by age Group

DISTRIBUTION BY AGE GROUP

33%

27%

40%

21-30 31-40 41-50

Results

79

Distribution of patients by sex;

Table No. 24. Showing the distribution of patients by Sex

Sl Sex No of Pts Percentage

01 Male 04 26.66

02 Female 11 73.33 Graph 2: Showing the distribution of patients by Sex.

DISTRIBUTION BY SEX INCIDENCE

4 1126.66

73.33

0

20

40

60

80

Male FemaleNo of Pts Percentage

It was observed that, out of 15 patient’s maximum number of patients i.e.

11(73.33%) were females and males were 4 (26.66%).

Results

80

Distribution of patients by Religion;

Table No. 25. Showing Patients distribution by Religion

Sl. Religion No. of Pts. Percentage

01. Hindu 13 86.66

02. Muslim 2 13.33

03. Christian - -

04. Others - -

It was observed that, the majority of patients were from Hindu, 13

(86.66%) and Muslim 2, (13.33%).

Graph No 3; Showing Patients distribution by Religion

Distribution by Religion

0

2040

6080

100

Hindu Muslim Christian Others

No. of Pts. Percentage

Results

81

Distribution of patients by Socio-economic status;

Table No. 26 Showing the distribution of patients by Socio-economic status.

Sl. Socio-economic No. of Pts. Percentage

01. Poor 7 46.66

02. Middle 8 53.33

03. Upper class 0 0

It was observed that, the maximum number of patients i.e. 8 (53.33%) belong to

middle socioeconomic class, poor 7 (46.66%).

Graph No 4 Showing the distribution of patients by Socio-economic status.

Socio-economic status.

0

20

40

60

No. of Pts.Percentage

No. of Pts. 7 8 0Percentage 46.66 53.33 0

Poor Middle Upper class

Results

82

Distribution of patients by Occupation;

Table No. 27 Showing the distribution of patients by Occupation.

Sl. Occupation No. of Pts. Percentage

01. Labour 4 26.66

02. Sedentary 0 0

03. Active 3 20

04. House wife 8 53.33

It was observed that, the majority of the patients were from the housewife

8(53.33%), labor 4 (26.66%), and active 3 (20%).

Graph No 5 Showing the distribution of patients by Occupation

Distribution by Occupation

4

0

3

8

26.66

0

20

53.33

0 10 20 30 40 50 60

Lbr

Sed

Actv

H.W

No. of Pts. Percentage

Results

83

Distribution of patients by marital status;

Table No. 28 Showing the distribution of patients by marital status;

Sl. Marital status No. of Pts. Percentage

01. Married 12 80

02. Unmarried 3 20

It was observed that, the maximum number of patients were married 12 (80%)

and unmarried 3 (20%).

Distribution of patients by food habits;

Table No. 29 Showing the distribution of patients by food habits.

Sl. Food habits No. of Pts. Percentage

01. Vegetarian 13 86.66

02. Mixed 2 13.33

It was observed that, the maximum number of patients 13 (86.66%) were

vegetarian and only 2 (13.33%) mixed food habits.

Results

84

Distribution of patients by addiction;

Table No. 30 Showing the distribution of patients by addiction.

Sl. Addiction No. of Pts. Percentage

01. Smoking 1 6.66

02. Alcohol 0 00

03. Tobacco 3 20

04. No habits 11 73.33

It was observed that, the out of 15 patients 11 (73.33%) had no habits, smoking

addiction 1(6.66%), and tobacco addiction 3 (20%).

Distribution of patients by predominant Rasa in diet;

Table No. 31 Showing the Distribution of patients by predominant Rasa in diet.

Sl. Rasa pradhanyata in ahara

No. of Pts.

Percentage

01. Madhura 08 53.33

02. Amla 3 20

03. Lavana - -

04. Tikta - -

05. Katu 4 26.66

06. Kashaya - -

It was observed that, the maximum number of patients 8 (53.33%) had madhura

predominance in diet, katu predominance 4(26.66%).

Results

85

Distribution of patients by Prakriti;

Table No. 32 Showing the distribution of patients by Prakriti

.

Sl. Prakriti No. of Pts. Percentage

01. Vata-pitta 05 33.33

02. Vata-kapha 7 46.66

03. Pitta-kapha 3 20.00

It was observed that, the majority of patients were vata-kapha 7 (46.66%) and

vata-pitta 5 (33.33%) and pitta-kapha prakriti 3 (20%).

Graph No 6 Showing the distribution of patients by Pra

Distribution By Prakruti

5 73

33.33

46.66

20

0

10

20

30

40

50

Vata-pitta Vata-kapha Pitta-kapha

No. of Pts.Percentage

Results

86

Distribution of patients by Sara;

Table No.33 Showing the distribution of patients by Sara.

Sl. Sara No. of

Pts.

Percentage

01. Pravara 2 13.33

02. Madhyama 11 73.33

03. Avara 2 13.33

It was observed that, the maximum number of patients were madhyama sara

11(73.33%), pravara were 2 (13.33%) and avara 2(13.33%).

Distribution of patients by Samhanana ;

Table No. 34 Showing the distribution of patients by Samhanana.

Sl. SamhananaNo. of

Pts. Percentage

01. Pravara 2 13.33

02. Madhyama 11 73.33

03. Avara 2 13.33

It was observed that, the maximum patients were madhyama samhana 11

(73.33%), pravara 2(13.33%) and avara 2 (13.33%).

Results

87

Distribution of patients by Satwa

Table No. 35 Showing the distribution of patients by Satwa.

Sl. Satwa No. of

Pts. Percentage

01. Pravara 4 26.66

02. Madhyama 9 60

03. Avara 2 13.33

It was observed that, the maximum patients were madhyama satwa 9 (60%),

pravara 4(26.66%) and avara 2 (13.33%).

Distribution of patients by Vyayama Shakti;

Table No. 36 Showing the distribution of patients by Vyayama shakti.

Sl. Vyayama

shakti

No. of

Pts. Percentage

01. Pravara 3 20

02. Madhyama 9 60

03. Avara 3 20

It was observed that, the majority of the patient were madhyama vyayama shakti 9

(60%), avara 3(20%), pravara 3 (20%).

Results

88

Distribution of patients by Desha

Table No. 37 Showing the distribution of patients by desha.

Sl. Desha No. of Pts. Percentage

01. Jangala 5 33.33

02. Anupa 0 0

03. Sadharana 10 66.66

It was observed that, the maximum number of patients was from sadharana desha

10 (66.66%) and jangala 5 (33.33%).

Graph 7 Showing the distribution of patients by desha

Destribution Showing Desha

50

10

33.33

0

66.66

010203040506070

Jangala Anupa SadharanaNo. of Pts. Percentage

Results

89

Distribution of patients by chief complaint;

Table No. 38 Showing the distribution of patients by chief complaint.

Sl. Chief complaints No. of Pts. Percentage

01. Sandhi shoola 15 100

02. Sandhi shotha 15 100

03. Jadyata 15 100

04. Gaurava 15 100

05. Vrischika damshavat peeda 03 20

06. Jwara(sthanika ushmata) 15 100

It was observed that, the almost all patients were with Sandhi shoola, Sandhi

shotha, jadya, jwara, gouravata in 15(100%), Vrischik damshavat peeda 3 (20%)

Graph 8 Showing the distribution of patients by chief complaint

CHIEF COMPLAINTS.

15

15

15

15

3

15

Sa shl Sa sho Jad GaV Vd P Jwr sth

Sa Shl – Sandhishoola; SaSho – Sandhishotha; Jad – Jadya; GaV – Gauravata; Vd P – Vrischikadamshavata peeda; Sth Jwr – Jwara(sthanika ushmata).

Results

90

Distribution of patients by associated complaints;

Table No. 39 Showing the distribution of patients by associated

complaints.

Sl. Associated complaints No. of Pts. Percentage 01. Anga marda 9 60 02. Aruchi 11 73 03. Nidraviparyaya 15 100 04. Trishna 1 6.6 05. Apaka 2 13.33 06. Daha 3 20 07. Alasya 6 40 08. Vid baddhata 8 53.33

It was observed that, the maximum patients of Nidraviparyaya i.e. 15 (100%),

Aruchi 11(73%), Anga marda 9 (60%),Malabaddhata 8 (53.33%), Alasya 6 (40%), Daha

3 (20%), Apaka 2 (13.33%),Trishna 1(6.6%).

Graph 9: Showing the distribution of patients by associated complaints

Distribution By Associated Complaints

02468

10121416

AM Ar NV Tr Ap Dh Als VitVibAssociated Complaints

No

of P

t'S

AM – Angamarda; Ar – Aruchi; NV – Nidra viparyaya; Tr – Trishna; Ap –

Apaka; Dh – Daha; Als – Alasya; Vid Vib – Vid vibandha.

Results

91

Distribution of patients by Nidana; Table No. 40 Showing the distribution of patients by Nidana.

Sl. Nidana No. of Pts. Percentage

01. Viruddha ahara 3 20

02. Viruddha chestha 2 13.33

03. Mandagni 8 53.33

04. Sasnigdha ahara, bhojanottara vyayama 4 26.66

It was observed that, the maximum nidana of patient were having 8 (53.33%)

mandagni, snigdha ahara bhojanottara vyayama 4 (26.33%), virudha ahara 3 (20%).

Graph 10: Showing the distribution of patients by nidana.

Nidana

3, 18% 2, 12%

4, 24%8, 46%

V ah V ch Man Ssn, bjn, vym

V Ah- Viruddha Ahara, V Ch- Viruddha Chesta, Man- Mandagni, SSn,aha, bjn Vym-

Sasnigda Ahara, Bhojanottara Vyayama.

Results

92

Data related to response to the treatment;

Sandhi shoola (Pain)

Table No. 41 Showing the response of the therapy in sandhishoola.

B.T. A.T. Sl. GradingNo. of Pt.’s

% No. of Pt.’s

%

01. 0 0 0 6 40 02. 1 2 13.33 5 33.33 03. 2 9 60 4 26.66 04. 3 4 26.66 0 0

Among the 15 patients, 9(60%) patients had the grade 2 pain and 4 (26.66%)

patients had the grade 3 pain before the treatment. Patients with grade1 pain were

2(13.33%). After the treatment 4 (26.66%) patients had 0 grade pain and7 (46.66%)

patients had the 1 grade pain & 4 (26.66%) patients had the 2 grade pain. No patient had

grade 3 pain. Statistically it is highly significant, where p value is <0.001.

Graph 11: Of Sandhishoola.

0

6

2

5

9

4 4

002468

10

No.

Pt'S

0 1 2 3Gardings

Showing Sandhishoola

B.T. No. of Pt.’s A.T. No. of Pt.’s

1– 0 grade of sandhishoola; 2 – 1 grade of sandhishoola; 3 – 2 grade of

sandhishoola; 4 – 3 grade of sandhishoola.

Results

93

Sandhi shotha (Swelling);

Table No. 42 Showing the response of the therapy in sandhishotha.

BT AT Sl. GradingNo. of pt. % No. of Pt. %

01. 0 0 0 7 46.66 02. 1 7 46.66 5 33.33 03. 2 5 33.33 3 20 04. 3 3 20 0 0

Among the15 patients 5 (33%) patients had grade 2 shotha , 7(46.66%)patients

had grade 1 shotha and 3(20%) patients had grade 3 shotha before treatment. After the

treatment 7 (46.66%) patients had grade 0 shotha and 5 (33.33%) patients had grade 1

shotha, 3 (20%) patients had grade 2 shotha. Statistically it is highly significant, where p

value is <0.001.

Graph 12: Showing the response of the therapy sandhishotha.

0

7 75 5

3 3 3

02468

1 2 3 4GRADINGS

Response of the Therapy Before and After in Sandhi Shotha

No. of pt. No. of Pt.

1 – 0 grade of sandhishotha; 2– 1 grade of sandhishotha; 3 – 2 grade of sandhishotha; 4 – 3 grade of sandhishotha.

Results

94

Jwara (Sthanika Ushmata)

Table No. 43 Showing the response of the therapy in Jwara (Sthanika Ushmata)

BT AT Sl. Grading

No. of pt. % No. of Pt. %

01. 0 0 0 8 53.33

02. 1 7 46.66 4 26.33

03. 2 5 33.33 3 20

04. 3 3 20 0 0

Among 15 patients7 (46.33) patients were observed with grade 1, 5(33.33)

patients with grade 2 and 3(20%) patients were in grade 3 jwara before treatment. After

treatment 8 (53.33%) patients had 0 grade fever, 4(26.33%) patients were in grade1,

3(20%) patients were in grade 2.

Graph 13: Showing the response of the therapy in Jwara

0

87

45

3 3

0012345678

No o

f Pt's

1 2 3 4Grading

Jwara(Sthanika Ushmata)

BT AT

1 – 0 grade of Jwara (Sthanika Ushmata) 2– 1 grade of Jwara; 3 – 2 grade of Jwara;

4 – 3 grade of Jwara.

Results

95

Gouravata: Table No. 44 Showing the response of the therapy in gouravata.

BT AT Sl. Grading


01. 0 0 0 12 80

02. 1 10 66.66 1 6.66

03. 2 2 13.33 2 13.33

04. 3 3 20 0 0

Among 15 patients10 (66.66%) patients were observed with grade 1, 2(13.33%)

patients with grade 2 and 3(20%) patients were in grade 3(20%) gouravata before

treatment. After treatment 12(80%) patients had 0 grade gouravata, 1(6.66%) patients

were in grade1, 2(13.33%) patients were in grade 2.

Graph 14: Showing the response of the therapy in gouravata.

Gouravata

0

10

23

12

12

002468

101214

1 2 3 4Grading

No. o

f Pt's

BT AT

1 – 0 grade of Gouravata. 2– 1 grade of Gouravata; 3 – 2 grade of Gouravata; 4 – 3 grade of

Gouravata.

Results

96

Nidraviparyaya: Table No. 45 Showing the response of the therapy Nidraviparyaya;

BT AT Sl. Grading


01. 0 0 0 6 40

02. 1 6 40 6 40

03. 2 6 40 3 20

04. 3 3 20 0 0

Graph 15: Showing the response of the therapy in Nidraviparyaya

0123456

No

of P

t's

0 1 2 3Grading

Nidraviparyaya

BT No. of pt. AT No. of Pt.

Among 15 patients 6 (40%) patients were observed with grade 1, 6(40%) patients

with grade 2, and 3 (20%) patients were in grade 3(20%) of Nidraviparyaya before

treatment. After treatment 6(40%) patients had 0 grade Nidraviparyaya , 6(40%) patients

were in grade1, 3(20%) patients were in grade 2.

Results

97

Jadyata:

Table no 46: Showing the response of the therapy in Jadyata

Grade B.T No.of Pt’s % A.T No.of Pt’s %

0 0 04 26.66 1 0 0 6 40 2 11 73.33 3 20 3 4 26.66 2 13.33

Graph 16: Showing the response of the therapy before and after in Jadyata.

0

4

0

6

11

34

2

02468

1012

NO o

f Pt'S

0 1 2 3

GRADING

SHOWING JADYATA

B.T No.of Pt’s A.T No.of Pt’s

Among 15 patients 5(33.33%) patients were observed with grade 1, 7(46.66%)

patients with grade 2, and 3 (20%) patients were in grade 3 of Jadyata before treatment.

After treatment 5(33.33%) patients were observed with grade 0 of Jadyata, 6(40%)

patients were in grade1, 2(13.33%) patients were in grade 2, 2(13.33%) patients remained

in grade 3.

Results

98

OVERALL RESULT

Table No. 47 Showing the overall result assessed on the basis of subjective and objective

parameters.

Sl. Overall result No. of Pts. Percentage

01. Complete remission 4 26.66

02. Major improvement 4 26.66

03. Minor improvement 4 26.66

04. No improvement 3 20

Among the 15 cases of Amavata shows the following results which was assessed

on the basis of subjective and objective parameters –

4 patients (i.e. 26.66%) had shown complete remission.

4 patients (i.e. 26.66%) had shown major improvement.

4 patients (i.e.26.66%) had shown minor improvement.

3 patients (i.e. .20%) reported in no improvement group.

Graph 17: Showing the overall result assessed on the basis of subjective andobjective

parameters.

Overall Result

4

44

3

CR Mj imp Mi imp No imp

Results

99

Table No. 48 showing statistical analysis before and after treatment.

Sl.No Parameter Mean S.D S.E t-value p-value Remarks01 Sandhi shoola 1.266 0.242 0.062 20.41 <0.001 H.S 02 Sandhi Shotha 1.00 0.00 0.00 - - - 03 Gouravata 1.2 0.414 0.106 11.32 <0.001 H.S 04 Jwara 1.066 0.258 0.066 16.15 <0.001 H.S 05 Nidraviparyaya 1.00 0.00 0.00 - - - 06 Jadyata 1.066 0..7030 0.1815 5.8732 <0.001 H.S 07 Hb% 0.96 0.54 0.139 6.906 <0.001 H.S 08 TC 303.33 224.77 58.03 5022 <0.001 H.S 09 DC(L) 6.133 1.06 0.273 22.46 <0.001 H.S 10 ESR 9.4 6029 1.626 5.78 <0.001 H.S 11 Walking time 1.00 0.00 0.00 - - -

Right hand 3.752 2.603 0.672 5.58 <.0001 12 Grip Strength Left hand 3.433 2.135 0.551 6.23 <0.001

H.S

. Overall all the parameters show highly significant before and after the treatment.

The subjective parameters orderly Jwara, jadya, gouravata and Sandhi shoola shows

more highly significant. But the parameters Sandhi shota and Nidraviparyaya shows

the same mean effect before and after treatment (by comparing p-value, t-value)

The parameter gouravata shows high net mean effect with high variation, where

as Nidraviparyaya and Sandhishota show same mean net effect with zero variation.

(by comparing mean and S.D).

Among the objective parameters DC (L) and Hb% show more highly significant

than other (P<0.05). The mean net effect of TC is more with more variations. The

mean net effect of Hb% is low with low variance. The parameter walking time shows

zero variations before and after treatment. The mean net Grip strength right hand is

more with more variance even though left hand grip strength show more highly

significant then Right hand Grip strength. This is due to the sampling errors and

variations among the patients (samples)[by comparing mean, S.D.]

The parameter ESR also shows more highly significant than TC and also the

mean ESR reading lies with in normal range for both sexes.

Results

Master Chart of SUBJECTIVE PARAMETERS

Sandhi Shoola

Sandhi Shotha

Jwara(Sthanika Usmata)

Gouravata Nidraviparyaya JadyataSl.no OPD No

BT AT BT AT BT AT BT AT BT AT BT AT

Response

01 5430 3 2 2 1 2 1 1 0 2 1 3 2 Min Imp 02 0573 2 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem03 1684 2 0 1 0 1 0 1 0 2 0 2 1 Maj .Imp 04 2859 1 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem05 3000 2 1 2 1 2 1 2 0 2 1 2 1 Min Imp 06 3123 3 2 3 2 3 2 3 2 3 2 3 3 Not Resp 07 3346 2 1 2 1 2 1 1 0 2 1 2 2 Min Imp 08 3373 3 2 3 2 3 2 3 2 3 2 3 3 Not Resp 09 3415 2 1 2 1 2 1 1 0 2 1 2 1 Min Imp 10 3416 2 0 1 0 1 0 1 0 1 0 2 0 Maj Imp 11 3638 1 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem12 3934 2 1 1 0 1 0 1 0 1 0 2 1 Maj Imp 13 4181 2 0 1 0 1 0 1 0 1 0 2 0 Comp Rem14 5010 2 1 2 1 2 0 2 0 2 1 2 1 Min Imp 15 5021 3 2 3 2 3 2 3 2 3 2 3 2 Not Resp

Min Imp- Minor Improvement, Not Resp-Not Responded, Maj.Imp- Major Improvement,

Comp Rem- Complete Remission, BT- Before Treatment, AT- After treatment.

100

Master chart of OBJECTIVE PARAMETERS

Grip Strength Hb%

TC DC(BT) DC(AT) ESR WalkingTime RIGHT LEFT

Sl.no OPD No

BT AT BT AT N L E N L E BT AT BT AT BT AT BT AT

Response

01 5430 11 12 6500 5900 55 38 07 62 32 06 35 30 3 2 13 15.2 13 20 Min Imp 02 0573 10 12 7200 7000 61 35 04 65 30 05 18 10 3 2 20 23.99 13 18.5 CompRem 03 1684 10.2 11 6200 6000 57 37 06 63 30 07 14 12 1 0 38 42 31.2 32.28 Maj Imp 04 2859 10 11 6000 5900 50 42 08 58 36 06 24 15 1 0 28 31.2 22.66 28 CompRem 05 3000 7 7 6900 6000 58 37 05 65 30 05 45 28 2 1 13 15.2 13. 14.1 Min.Imp 06 3123 9 9.5 7000 6600 56 39 05 65 30 05 85 80 3 2 13 13 11.8 11.8 Not Resp 07 3346 8.4 9 6850 6700 53 40 07 61 34 05 40 32 2 1 13 18.5 13 18.5 Min Imp 08 3373 8 8.5 8000 7500 51 41 08 57 36 07 72 68 3 2 20 23.99 13 18.5 Not Resp 09 3415 10 11 7200 7000 48 45 07 58 38 04 60 45 1 0 22.6 25.2 20 22.5 Min Imp 10 3416 12 13 6400 6000 35 61 04 38 56 06 36 28 1 0 28 3102 22.6 25.2 Maj Imp 11 3638 9.2 10 5050 5000 56 41 03 60 35 05 21 14 1 0 38 50 38 42 CompRem 12 3934 10 12 4950 4800 56 40 04 61 32 07 18 12 2 1 38 42 32.8 38 Maj Imp 13 4181 9.6 10.5 5450 5150 64 32 04 65 28 07 20 15 1 0 38 42 38 40 CompRem 14 5010 8 905 5800 5600 54 39 07 64 32 04 55 30 2 1 28 31.2 25.2 28 Min Imp 15 5021 7 7.5 5800 5600 49 42 09 55 36 09 62 45 3 2 13 15.2 13 14.28 Not Resp

Min Imp- Minor Improvement, Not Resp-Not Responded, Maj.Imp- Major Improvement,

Comp Rem- Complete Remission, TC-total count, DC- differential count, N-neutrophils, L-Lymphocytes, E-Eosinophil, BT-before Treatment, AT-After Treatment, Hb%- in gms/dl.

101

102

DISCUSSION

The present topic deals with the interpretation of the materials, which are

explained in previous chapters. Discussion is the solution for most of the things explained

in previous chapters.

Hingula:

It is a chief ore of Mercury and combination of Mercury and Sulphur. In samhita

kala there were no references of Hingula, but we get the reference of parada. The reason

behind this is, in olden days it was assumed to be imported from other countries.

According to Rasendra Mangala Hingula has been called as Darada, because may

be it was available in Darada desha. Rasendra sara samgraha explained Hingula as

Rasagandhaka Sambhoota. It proves that they were very much aware about chemical

composition of individual mineral.

There is a bit of controversy on varieties of Hingula and there is no reference

regarding Hingula varieties in Rasendra Mangala and Rasa Hrudaya Tantra. Rasaratna

samucchaya, Rasendra Chudamani classified Hingula as Hamsapada and Shukatunda.

Ayurevda prakasha and Ananda Kanda classified Hingula in three varieties – Charmara,

Shukatunda and Hamsapada. Rasatarangini classified it as Khanija and Kritrima. Because

it is available in natural form and also can be prepared artificially with the help of

mercury and sulphur.

Hamsapada Hingula has been accepted for this study, because of its less

impurities and ideal one for therapeutic one according to Rasagranthas.

Hingula can be administered after proper purification. Shodhana is adopted to

reduce its toxicity and also to deal for therapeutic purpose. If impure Hingula is

administered, leads to many complications.

Hingula satwa is parada. Rasaprakasha sudhakara quotes that the parada,extracted

from Hingula is having equal property of Shad guna gandhaka jarita parada.

Discussion

103

Rasaratna samucchyakara and Rasamritakara, explains that the Hingulottha

parada is equal to the property of Gandhaka jarita parada.

Generally, marana is not advised for Hingula. Shodhita Hingula can be used for

the preparation of yogas.

Rasamrita explains that, it is used for the marana of Swarna and Loha, because of

its chemical constituent Parada.

Hingula is sarva doshahara, deepana, atirasayana, vrishya, these are explained by

Rasaratna samucchayakara because it contains Parada.

Bhallataka:

It is classified under upavisha. Charaka has explained it as a best kapha and Vata

hara drug. He has advocated use of Bhallataka in 10 different forms like ghruta, ksheera,

etc.

Rasataranginikara has explained its synonym as Vatari, this explains its active

role against vata. Bhallataka is the best drug for kapha and vataja rogas. It should be

subjected to shodhana before it is used. As ama is kaphaja bhava the Bhallataka is used in

resolving the ama and pacifying the vata in Amavata.

Its efficacy in Amavata may be due to its anti inflammatory, Neuroprotective,

immunomodulator, anti rheumatism action.

Vata:

Charaka has included it under Mutrasangrahaniya varga where as Sushruta and

Vagbhata included it under Nyagrodadi gana.

Vata has a property of Kaphahara more than Pittahara. The Latex is Anti-

inflammatory.

Palandu:

All Brahttrayee texts have quoted Palandu. The properties are Vatahara, Vrushya,

and Rasayana. It is an organosulphur compound. The sulphur is essential in the

production of Glucosamine sulphate along with other Proteins. This helps in the

Discussion

104

regeneration of joint tissues and cartilages. It is also proved to be anti inflammatory in

action. The Flavanoids are known to deactivate molecules that are injurious to health.

Lavanga:

It is said to possess kapha pittahara property and is best Ruchya, Deepanapachana.

Kaiyadeva nighatukara has explained its property as Shoolaghna, Vishaghna. The

alkaloid Eugenol along with other Alkaloids is proved to be Anti inflammatory.

Guda:

An Ikshu Vikara obtained by concentrating the juice of Ikshu. It is a rich source of

Iron and Puranaguda is best Vatanashaka, Raktaprasadaka. It is a sucrose sugar.

Ghruta:

It is a Vatapitta shamaka, Balya, Agnidipaka, and is Vishahara. This pacifies the

teekshanata of Bhallataka. This is ascertained by its presence in prepared sample.

Sri Siddhadaradamruta Rasa

A unique preparation for Amavata explained by Rasataranginikara and other Rasa

classics under Hingula Rasayana. The uniqueness of this yoga is potenciating Shuddha

Hingula by Pachana and Dahana samskaras with the drugs which have Amahara and Vata

hara properties. The dose of the drug is also being low i.e. ½ gunja pramana which can be

increased according to the dosha and bala prabhlyata of a patient. The drug is

administered along with Puranaguda in cases of Amavata. In Bhasma vignana it is

explained as Hingula bhasma prepared by Samputa paka.

PHARMACEUTICAL STUDY

The Rasa dravyas being Vijateeya they are subjected to Shodhana samskara

which make them Sajateeya, that is to say that, they are converted in to homogenenous to

the body systems. The Shodhana samskaras has diversified meanings which not only aim

Discussion

105

at making dravya sajateeya but also act in many different ways like increasing the

concentration of active principle, reducing toxicity, enhancing the property of drug.

Hingula Shodana:

Shodhana was carried for Hingula with 7 bhavanas of ardraka swarasa. One of the

advantages of bhavana is to reduce size of the particles. It will be easy for absorption in

GIT.

After bhavana weight of the Hingula was increased i.e. from 500 gms to 545 gms.

Ardraka swarasa contains fibrous matter and starch in abundant which may be the cause

of increase in weight.

Bhallataka Shodhana:

The pericarp of the Bhallataka contains corrosive juice. To minimize its ill effects

its Shodhana with Gomutra is mentioned. During this the juice escaped in Gomutra

Colouring it black and as a tiny droplets.

Gomutra contains certain amount of Ammonia in it. This Ammonia is a good

solvent. It brings out the excess of oils from the pericarp to out side.

Vataksheera Collection:

The collection of Vataksheera was done in Hemantha ruthu i.e. in the month of

Oct- Dec. The period was the sprouting of off shoots. This is what is called as “Pallava”.

When this off shoot was broken it yields latex. This latex was collected and stored in

fridge. The yield was more in the early house of the day i.e. between 5:30 to 7 am.

Palandu Swarasa:

The moderate sized Palandu a red verity was selected for the extraction of

Swarasa. 1 kg of Palandu yielded ½ liter of Swarasa. The Swarasa was pink to look with

characteristic odour.

Cotton Thread:

As cotton is known to tolerate heat for longer hours hence this was made use to

act as a barrier between Hingula and the media used for samskara.

Discussion

106

Samputapaka

The author of Bhasma Vignanam explains that the dravyas which are susceptible

to high temperature like Hingula and somala are usually subjected to this method of paka.

The temperature they obtain by this method is usually between 2500C to 3000C. This is

carried out by jacketing dravya with mamsa pisti, dough, Bhallataka, and frying in taila

or grutha. By this method the structural changes is anticipated.

Dahana Procedure:

In the classics use of funnel for dahana procedure is not mentioned. Dahana if

done directly, the Hg from cinnabar escapes out and there will be great amount of weight

loss in Hingula cake. To minimize the loss by this way the alternate method was planned

i.e. bhalltaka heap was covered with a inverted funnel as a barrier and the sides was filled

with charcoals and ignited. This was most appropriate arrangement as after dahana the

Bhallataka and lavanga choorna was charred and the Hingula also retained its weight.

Probably this is what it was meant by saying “tatha Prajwalayet vanhi Rasatantra

Visharadaihe”

Ghruta Pachana:

The vaporization point of ghruta is very high. At the temperature of 2600C-2800C

It starts evaporating. It means to say that Hingula should be in contact with ghruta at the

temperature till all the ghruta evaporates i.e.10 times the weight of the Hingula. It takes

120 hrs/ 5 days to finish the process. At the end of the procedure thick fiber like structure

were remained with un-evaporated mass. This would be due to the formation of the

polymer which remained rubbery consistency.

After all the samskaras there was a weight loss of 5 gms in each cake. The loss

could be due to the evaporation of Hg from Hingula. This was inferred from the first cake

was prepared according to the classical verses when 80 gms was lost (before 115gms

after 35 gms). Hence the Dahana procedure was modified using in direct heat.

Discussion

107

ANALYTICAL STUDIES

Organoleptic Characters:

The colour of Sri Siddhadaradamruta Rasa is dark brown with Faint smell and

Fine Touch. The colour of Hingula, as noted, changed with the change in temperature and

nature of preparation. The faint smell is seen same in all prepared samples with Hingula.

Flow property:

As the drug is in powder form it is tested for its flow property. This analysis

makes us to know weather any adjuncts are essential for proper flow of drug during

Capsule or Tablet preparation. Flow property was identified by “Angle of Repose

(Tanθ)” and Flow rate by “Compressibility index (I)”. Sri Siddhadaradamruta Rasa has a

good Flow property with Tanθ=37.46±7.86 and Flow rate I=15%.hence it can be said that

it does not need any adjuncts in capsule preparation.

Particle size:

Smaller the particles better the absorption. To know the size of particles the drug

was viewed under microscope and was calculated according to the procedure. This was

done for the sample of Shodhita Hingula and to the prepared drug. The mean Arithmetic

mean was calculated. The mean of both samples are as under-

Arithmetic mean of Shodhita Hingula: 6.53 microns.

Arithmetic mean of Sri Siddhadaradamruta Rasa: 4.788 microns.

The results clearly indicate that the particle size is less for Sri Siddhadaradamruta

Rasa than for Shodhita Hingula even though both are with in the permissible range.

Total fat content:

Sri Siddhadaradamruta Rasa contains 7% of Fat in it. This ascertains that there

was an exchange of pachana material through the cotton thread barrier to the Hingula.

Discussion

108

Test for Alkaloids:

As per the analytical tests there was no Alkaloids detected. The procedure

employed in detection of Alkaloid also plays an important role in interpreting about the

pharmaco kinetics and dynamics of a drug. Here the Alkaloid detection was done using

chemical procedures. Instead if TLC procedure was adopted there would be certain

amount of Alkaloid separation would have been expected, unfortunately the solvent for

cinnabar was not identified.

Assay for Hg% and S%.

Hg% and S% was analysed in Shodhita Hingula and Sri Siddhadaradamruta Rasa

to ascertain the changes after the procedure or in other words the effect of Dahana and

Pachana Samskaras on the Shodhita Hingula was studied.

Sample Hg% S%

Shodhita Hingula 86.10% 12.83%

Sri Siddhadaradamruta Rasa 64.28% 12.28%

Loss on drying at 1100 C.

Sri Siddhadaradamruta Rasa was subjected to the test “Loss on drying 1100c”.It

was evident that weight loss is very minimum i.e. 0.12% which indicates the

preparation is completely free from the moisture.

Solubility:

It is learnt that it is soluble in Alcohol and slightly soluble in water and

Chloroform. That is to say that, 10-30 parts of Alcohol and 30 to 100 parts of

Chloroform and water is essential to dissolve 1gm of the sample.

Discussion

109

ESCA Studies:

In the sample Mercury is present in Oxide and Sulphide forms. No elemental

mercury is present. Majority of mercury is in the form of oxide and less in the Sulphide

form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. The

sample has mercury oxide and sulphide in the ratio of 60:40. The grutha contain o2 in

abundant quantity and drug is also in oxide form. Perhaps this o2 might have acted in

converting the sulphide in to oxide form. This needs further studies for through

understanding. The peak at 59.3 is due to Selenium oxide and if it is due to elemental

selenium it will be at 54.8, because it is too low in concentration it can not be marked.

This result is in parlance with the views of acharya Hari Sharananda author of Bhasma

vignanam. He has included this drug in Bhasma prakarana and says the Samputapaka

adopted will convert Hingula in to Bhasma form. The drug Sri Siddhadaradamruta Rasa,

satisfies the Bhasma gunas like Rekha purnata, nirasa, but fails to pass varitaratwa. In the

indications of Sri Siddhadaradamruta Rasa one is in Klaibya, as it contains SELENIUM

in smaller doses even this could prove efficacious in such cases. In a recent news article

published in Times of India (27th Feb. 2006) “Jayesh Bellare, Professor, IIT-Bombay,

said, Bhasmas seem to be a natural recipe to make protein coated nano-particles”.

Transforming the inorganic material in to its finest state along with both bringing and

preserving therapeutic property is the sole aim of Ayurvedic pharmaceutics like Bhavana,

Puta, Kupipakwa Rasa, Pottali Rasa.

This is the method of bio-transformation wherein it is a process of pharmaceutics

but not merely a chemical reaction taking place. There occurs a series of chemical

reactions which are useful but not harmful to the body. It is a complex process; analysis

of an isolated preparation cannot concretely give the whole idea. Whatever we are

describing is a tip of an iceberg but it does not describe complete iceberg. In the same

way, the study is to be further carried out so as to know what the possible, probable

reactions may be taking place.

Discussion

110

CLINICAL STUDIES

It is clear in classics that the efficacy of Rasa is enhanced when it is made

agnisthayi hence Parpati, Kupipakwa, Pottali kalpas are put in ascending superiority

therapeutically. In the present context Hingula, again ore of Rasa is subjected to agni

samskara like Dahana, Pachana which is believed to enhance its therapeutic efficacy for

this reason it was subjected to Clinical trail in the cases of Amavata.

It was a prospective clinical trial over 15 patients, randomly selected in a single

group. The results obtained were statistically analysed and mean percentage, SD, SE, and

t values were calculated by using t test. The patients were of either sex, age group

between 20-50 years. The age group assumed as the sex of the patient is concerned, so it

refines the classics. There are more patients 6 (40%) in 41-50 years. Females dominated

11 (73.33%) in the study.

The study records larger no of Hindus 13 (86.66%) compared to other religions.

As the sample size is too small, it cannot be concluded that Hindus are more susceptible

for the disease Amavata. Other reason may be that, it is the reflection of geographical

predominance of particular section of the society i.e., Hindus are dominant in Gadag.

In the study as maximum patients were housewives (53.33%), which simply

correlate with the maximum percentage of female patients. Otherwise occupation as such

was not significant. Majority of the patients belonged to middle (53.33%) socio-

economic group.

86.66% of the patients were vegetarians and 13.33% were having mixed food

habit. This only reflects the predominant diet of the religion.

However majority of the cases under the study had tendency towards kaphaja

ahara (Madhura- 53.33% and Amla- 20%).

Maximum no of patients were having vata- kapha prakruti (46.66%) followed by

vatapitta (33.33%).

Discussion

111

Majority of the patients (73.33%) had no bad habits and 20% were addicted to

tobacco chewing.

Majority of the patients having madhyama sara (73.33%), madhyama satva (60%)

and madhyama samhanana (73.33%) suggesting as in any other disease greater

susceptibility among those who were not in the pink of health.

Sandhi shoola, Sandhishotha, Sthanika ooshmata (jwara), Gouravata, Nidra

viparyaya, jadya were presented by all the patients. The presence of Gouravata in all

patients reflects the involvement of Ama.8 (53.33%) patients had mandagni as nidana at

the same time 8 (53.33%) patients had vid bhaddata as associated complaints.

Cent percent patients were free from extra articular manifestation in eye,

respiratory system, cardiac system, and nervous system. Out of extra articular

manifestation, majority of the patients were affected with systemic complaints such as

loss of appetite. This suggests the early stage of the disease and their prognosis was good.

Clinical response of the treatment:

In this study an effort has been made according to the guide lines laid down by

our classical texts in the selection of patients. All the cardinal symptoms were scored

according to the severity grade. The clinical response of the therapy was assessed on the

basis of change in the severity score after the treatment. The cardinal symptoms like

Sandhishoola, Sandhishotha, Sthanikaooshmata (jwara), Gouravata, Nidraviparyaya,

jadyata were taken into consideration of the functional activity of the patients, laboratory

investigations were also assessed before and after treatment.

Effect on Sandhishoola:

40 % of patients were completely relieved in shoola. The reduction of severity of

pain grade reported statistically significant where p value is less than 0.001.

Effect on Gouravata:

80 % of the patients were completely relieved in Gouravata. Statistically it proved

highly significant with p value < 0.001.

Discussion

112

Effect on Jwara (Sthanika Ushmata):

In Amavata samprapti it clearly explains that the produced Ama under the

influence of vata is taken into the sleshmasthanas hence the Sthanika Ushmata is taken in

to consideration. In pravrudda avastha of Ama sarvanga Jwara is appreciated.

As in the group of patients the pyrexia was not significantly noted, for which

Sthanika Ushmata of the involved joint was considered. 53.33% of patients were

completely relieved in Jwara. Statistically it was reported highly significant with p value

< 0.001.

Effect on Sandhishotha and Nidra Viparyaya:

46% of patients with Sandhishotha were relieved completely whereas 40% of the

patients were relieved completely with Nidraviparyaya. The mean net effect for both the

parameters is same with zero variation.

Effect on Jadyata:

4 (26.66%) patients were relived from Jadyata and 2(13.33%) patient did not

respond to the treatment. This data implies that the effect of drug on Jadyata is good in

the initial stages. Statistically it showed highly significant with p value <0.001.

Effect on Walking Time:

40% patients showed improvement in the walking time. The variation within the

group was zero. Hence same net mean effect before and after the treatment was observed.

Effect on Grip strength:

Certain degree of improvement was recorded among the patients. The statistical

analysis shows highly significant as p value is < 0.001. The mean net Grip strength of

right hand is more with more variance even though left hand grip strength shows more

highly significant than right hand grip strength. This is due to sampling error and

variations among the patients.

Discussion

113

Effect on ESR:

There was a notable change in the ESR reading, before and after the treatment.

The statistical analysis showed highly significant as p value is < 0.001. This reduction is

of much importance which explains the relief in disease process.

Effect on Hb%:

Improvement in the Hb% is a good sign in such patients. In the study there was

marginal increase in Hb% in patients. Statistically it shows highly significant with p

value < 0.001.

Effect on DC:

The lymphocyte also showed highly significant.

Total Effect:

In 15 patients 4 cases showed complete remission, 4 patients demonstrated major

improvement and 4 patients illustrated minor improvement and 3 cases showed no

improvement.

Discussion on Dose

In the classics it is mentioned that the dose of the drug is ½ gunja matra and can

be varied according to the bala of the patient and disease. In the study it is noticed that in

chronic patients the dose was not sufficient. In such condition the dose was increased to 1

gunja two times a day. The maximum dose tried in the trial is 1 gunja three times a day.

Probable mode of Action:

Ama and Vata are the root cause of Amavata. Ama circulates all over the body

causes sroto-avarodha and gets lodged in sandhis and contributes to the formation of the

disease Amavata. The gunas of Ama and Vata are both contradictory in nature, except the

sheeta guna which in common to both.

Discussion

114

Sri Siddhadaradamruta Rasa is prepared with Shodhita Hingula by subjecting into

samskara with drugs like Vataksheera, palandu swarasa, bhallatka, lavanga and ghruta.

Among them, Bhallataka, Lavanga and Palandu have Katu Rasa in common and except

Lavanga both are ushna in veerya. The other drugs are Vata and kaphahara in nature.

They do the deepana, pachana of Ama and relieve sroto-avarodha and pacify Vata, thence

breaking the Ama and same Vata complex.

Hingula has the property of tikta, katu, kashaya and ushna veerya, katu vipaka,

tridoshahara, deepana and amapachaka. It subside Amavata and jwara. It is Rasayana and

balavardhaka, by these properties Hingula pacify jwara and does amapachana, and help in

resolving the samprapti.

Vataksheera and palandu swarasa are best vatahara drugs. Bhallataka is best

known for kaphahara property. It is best deepaka and pachaka. It liquefies the Ama and

thereby resolves Amavata.

It is also known as an immuno-modulator drug, hence it’s used in Amavata and

immune related disorders are much beneficial. It is proved for its anti-inflammatory

activity. Ghruta helps in reducing the teekshnata due to the use of Bhallataka.

Palandu, Hingula are sulphur containing compounds which increase the bile

secretion from liver. This intern helps in correction of digestion and Metabolism within

the body and there by may help in the formation of certain essential proteins, histine,

arginine, and glutamine. Besides sulphur is bacteriostatic, Antiseptic in nature

It is found in ESCA analysis that SSDR contain selenium in oxide form in traces,

because of its action over many of the enzymatic systems under immune system, it may

be responsible for Rasayana activity justifying its phalasruti.

In the present study Puranaguda was selected for Anupana which has a property

of vata shamaka, Agnivardhaka, Ruchya. It is also Raktaprsadaka therefore it improves

the quality of Rasa and Rakta. It is also Ksharayukta and NaatiSheeta hence the quality of

Rasa is improved by it as Anupana in the cases of Amavata.

Discussion

115

Conclusion

1. The inferences of the pharmaceutical study are as under -

The Hingula shodhana was done using Ardraka swarasa Bhavana which again

aims increasing its Amapachana property.

The Bhallataka was made Shuddha by subjecting it to swedana in Gomutra which

is again beneficial in Amavata.

The temp recorded are as –

Pachana with Vata Ksheera and Palandu Swarasa- 800C

Pachana with Grutha-2600 C- 2800C for 5days.

For dahana procedure using inverted funnel was most convincing as in this

procedure the loss of Hg can be cut down to greater extent.

2. Inferences of analytical studies are summed up as-

Samskarohi gunaantardhana ucchate is what was tried to establish by

Analytical gadgets like Organoleptic characters, Hg%, S%,

Pachana and dhahana samskaras adopted in the preparation has definite role in

potencefying the Shodhita Hingula.

The media has certain interaction with the enveloped Hingula cake which was

evident with the presence of 7% fat in the prepared sample and slight acidic ph

(6.66) of prepared sample.

The size of the particle of Sri Siddhadaradamruta Rasa is significantly less than

Shodhita Hingula which means that the samskara had role in making it fine and

obviously make it better absorption.

Colour of Shodhita Hingula is changed from Red to Dark Brown. The taste and

smell remained unchanged.

Loss on drying is 0.12% which determines that the moisture is in negligible

percentage.

Conclusion

116

As a result of Dahana samskara there was certain amount of loss in both Hg% and

S%.

Alkaloids were not identified by the methods adopted. Superior methods should

be taken for help.

The ESCA report suggests that the Selenium presence is increased markedly after

the samskaras.

There is no direct reference for the use of Shodhita Hingula internally, but by this

dahana and pachana samskaras it was made possible for sole administration.

During the clinical study the inferred observation are as-

As the word suggests, in Amavata, the pivoting entities in disease process are

Ama and Vitiated Vata.

Pathogenesis of Amavata is initiated by Ama, occupying various Shleshma

sthanas, mainly joints

On the basis of observations preponderance of Vata and Kapha dosha was found

to play an important role along with Tridosha dushti in the disease. Majority of

patients were middle aged (40%) females (73.33%), Hindus (86.66%),

Housewives (53.33%), of Middle economic status (53.33%), Married (80%),

Vegetarian (86.66%) and having Tobacco addiction (20%)

All the patients of this study were having Dwandaja prakriti with maximum of

Kapha-Vata prakriti (46.66%), madhyama Sara (73.33%), Madhyama Samhanana

(73.33%), Madhyama Satva (60%), sadharana desha (66.66%).

From the findings of the clinical study it can be concluded that Sri

Siddhadaradamruta Rasa is better effective in Navottha Amavata.

Conclusion

117

The statistical data showed highly significant (p<0.001) in all individual

subjective and objective parameters, affirms that there was significant efficacy of

the drug noted in the clinical study justifies it.

The over all result is 4 (26.66%) patients showed complete remission, 4 (26.66 %)

patients showed major improvement, 4 (26.66 %) patients showed minor

improvement, 3 (20%) patients showed no improvement,

Limitations

1. The duration of the study was precise.

2. As the sample was small and it was a prospective clinical trial.

3. Minimum instrumental and investigatory facilities.

Scope for further study.

1) The samskaras might influence on the structural change or has the chance of

converting the drug in to its isomer. This has to be appreciated by sophisticated

instrumental analysis like x-ray diffraction.

2) Further the drug has to be tried over the other indications to establish its efficacy.

3) The drug has to be tried in chronic Amavata condition with higher dosage.

4) Various shodhana procedures has to be carried out on Hingula and then subjected

to Pachana and Dahana samskaras with same media and analytical and clinical

study may be compared.

5) The exact solvent for Hingula has to be identified and tested for the separation of

Alkaloids.

6) The study of nano particles in relevance to this Hingula bhasma is proposed.

Conclusion

118

SUMMARY

The present dissertation work entitled “Preparation and analytical study of

Sri Siddhadaradamruta Rasa and its clinical efficacy in Amavata” contains topics

introduction, methodology which embraces pharmaceutics, analytical study, clinical

study, observations, results, discussion and conclusion.

“Samskaro hi naama Gunantardhanam Ucchyate” is best explained by taking

into account of the Rasa Rasayana kalpas. The agni samskara given to parada to make it

agnisthayi improves its efficacy to manifold. Sri Siddhadaradamruta Rasa is one such

preparation, wherein Hingula, the ore of parada, is subjected to dahana and pachana

samskaras with different media which makes its properties enhanced to greater extent.

The media used in the study are like Vata ksheera, Palandu swarasa, Shodhita Bhallataka,

lavanga, ghruta in toto have amapachana, kaphahara, vatashamaka, Rasayana properties.

Amavata is a crippling disease which presents with simple arthralgia to severe

complications. It is a disease entity wherein improperly metabolized intermediate by

product, Ama, under influence of vata takes shelter in the sleshma sthanas. The treatment

modality aims at breaking the Ama and vata complex- samprapti and resolve Ama.

The impact of samskara on the drug is analysed by the changes in the organoleptic

characters and analytical methods focusing mainly on Hg % and S % before and after the

samskara, presence of alkaloid and media substrates in the prepared sample. It was noted

that there was significant change in the organoleptic characters, flow rate, fineness of

particle. There was presence of media used for pachana in the prepared sample like

ghruta which may imply the exchange of materials through the barrier i.e., a cotton thread

envelope. The chemical tests for the presence of alkaloid using picric acid and vagnors

reagent did not establish the presence of alkaloid. To know the status of mercury and

sulphur in the compound further ESCA was done, which reported that Hg was both in the

form of sulphide and oxide in 40:60 ratio respectively. It could be approximated that the

Summary

119

drug after samskara has turned in to a Bhasma form bearing in mind for the opinion of Sri

Harisharananda sharma.

With this analytical background it was assumed to have definite changes in

therapeutical activity. Hence it was put to test in the selected cases of Amavata which

diagnosed as per classical signs and symptoms.

It was a prospective clinical trial over 15 patients, randomly selected in single

group. The results obtained were statistically analysed and mean percentage, SD, SE, and

t value were calculated by using student t test.

The cardinal symptoms like sandhishoola, sandhishotha, jwara (Sthanika

Ushmata), gouravata, nidraviparyaya, jadya were present in almost all the cases. The

parameters which reflects the Ama condition was considered for assessment. The

objective parameter ESR was assessed which is a marker of disease process along with

other parameter like walking time and Grip strength.

There was a marked response after treatment in the parameter sandhishoola

(40%), sandhishotha (46.66%), jwara (Sthanika Ushmata) (53.33%), gouravata, (80%)

nidranasha (40%).jadyata (26.66%) The ESR also showed highly significant statistically.

The changes in the ESR readings were present but not drastic changes. The parameters

walking time and grip strength were also statistically highly significant. The overall

response in the treatment was that 4 patients had shown complete remission, 4 patients

had shown major improvement. 4 patients had shown minor improvement, and 3 patients

had no improvement.

Summary

120

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edition, Varanasi : Choukhamba Samskruta Samsthana, 1984, chapter Haritakyadi

varga, shloka 232, p. 139.


Varanasi : Choukhamba Orientalia, 1982, chandanadi varga, p. 114.


1989, chapter Oushadhi varga, shloka 494-500, p. 90.



62. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi

: Krishnadasa Academy, 1998, chapter Amradi varga, shloka 66-69,p. 352

Bibiliography

126

63. Kirtikar .K.R.andB.D. Basu, Indian medicinal plants, Edited by E.Blatter, J.F.Caius

and K.S.Mhaskar. 2nd edition, 1999, vol-I p-667.

64. Vaidya V.M.Gogte, Ayurvedic Pharmacology and Therapeutic uses of Medicinal

Plants.1st Edition 2000, pg-714.

65. K.M. Nadakarani, Indian Materia Medica Vol - I, editor A. K. Nadakarni, 3rd

edition, Bombay : Popular Prakashana Private Limited, 1982, p.544.


Orientalia, p.941.


1989, chapter Oushadhi varga, shloka 423, pg-78.


Varanasi : Choukhamba Orientalia, 1982, Amradi varga, Sholka 69-70,p.161.



varga, shloka 1-2, p.513.

70. Kirtikar .K.R.andB.D. Basu, Indian medicinal plants, Edited by E.Blatter, J.F.Caius

and K.S.Mhaskar. 2nd edition, 1999, vol-III p-2313.



72. http.www.liv.ac.uk/onion/biosynthesis.htm date;20/11/05

73. Ibid., dept of Biochemistry,University of Kerala, India

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127



varga, shloka 226, p.134.


1989, chapter Oushadhi varga, shloka 1222-1224, pg-226.




Varanasi : Choukhamba Orientalia, 1982, Amradi varga, Sholka 66-67,p.133.

78. Journal: Onion-Phyto chemical and health properties provided by the national onion

association. www.liv.ac.uk. Date: 20/11/05



80. www.essentialoils.co.ze/glossary date: 20/11/05




1989, chapter Oushadhi varga, shloka 1333-1334, pg-247.


Varanasi : Choukhamba Orientalia, 1982, Sholka 39-40,p.98.

84. www.essentialoils.co.ze/glossary date: 20/11/05

Bibiliography

http://www.liv.ac.uk/

http://www.essentialoils.co.ze/glossary

http://www.essentialoils.co.ze/glossary

128


edition, Varanasi : Choukhamba Samskruta Samsthana, 1984,Poorva khanda,

chapter Ikshuvarga, shloka 26, p.895.

86. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 13th edition, Varanasi :

Choukhamba Saskrit Samsthana, 2002, Sutrasthana, chapter 45, shloka 160, p. 183.


1989, chapter Oushadhi varga, shloka 135-136.

88. Net source: Journal: East Meets West Times Globe staff. Authour: Dr. G.

R.Gokani. [email protected]

89. Agnivesha, Charakasamhita, Chikitsasthana, editor Kashinatha Shastri 12th edition,

Varanasi : Choukhamba Bharateeya Academy, 1984, chapter 13th, shloka 9, p. 382.

90. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition,

Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 25, p. 99.

91. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition,

Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 26, p. 99.

92. Ayurmedline, Dr. S. Prabhakara, Jan. to June 2001, Dr. Seetaram Banglore, Pravin

Madikonda, Prof. R.H. Singh, New dimensions of concepts of Ama, p. 33-36.

93. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th

edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 1-5, p. 460.

94. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit

Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-5, p.564.


edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 6, p. 462.

Bibiliography

129


Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-2, p.564-565.


edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 7, p. 462-463.


edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 8-10, p. 463.


edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 11, p. 463.

100. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri,

25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 12, p. 464.


Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1, p. 568.

102. Chakrapani Datta, Chakradatta Jagadishwara Pasada Tripathi, 4th edition,

Varanasi : Choukhamba Sanskrit Series, 1976, chapter 25th, shloka 1, page 225.

103. Shri. Govindadas, Bhaishajya Ratnavali edited by Ambikadatta Shastri, 11th

Edition, Varanasi : Choukhamba Sanskrit Samsthana; 1996, Chapter 29th Amavata

chikitsa, shloka 1, p. 431.

104. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba

Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-4, p. 573.

105. Vinayakumar, Basic Pathology, 5th edition, Philadelfia, W. B. Sundar’s company,

1992, chapter 6th, p. 145.

106. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald,

Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1928.

Bibiliography

130

107. A.P.I. Textbook of Medicine, editor Dr.Siddharth.N..Shah, 7th edition, Mumbai :

Association of Physicians of India, 2003, Section 17th, p.1160.

108. Davidson’s, Principles and Practice of Internal Medicine, CRW, Ederverts,

Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 889.



110. A.P.I. Textbook of Medicine, editor Dr.Siddharth.N..Shah, 7th edition, Mumbai :

Association of Physicians of India, 2003, Section 17th, p.1161.

111. Ibid.

112. Ibid Pg-1161-1162

113. I.Bid,Pg-1163.




Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 896-

902.


Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 903.

Bibiliography

CASE SHEET PROFORMA

DEPARTMENT OF RASASHASTRA DGM AYURVEDIC MEDICAL COLLEGE, GADAG

Topic: PREPARATION AND ANALYTICAL STUDY OF SRISIDDHADARDAMRUTA

RASA AND ITS CLINICAL EFFICACY IN AMAVATA.

Guide: Dr.M.C.Patil Dr. Pradeep.Agnihotri M.D(Ayu) P.G.Scholar

Co-Guide: Dr.G.N. Danappagoudar M.D (Ayu)

01. Name: Sl.No:

02. Father’s/Husband’s Name: O.P.D.No. 03.Age : D.O.I. : Years 04. Sex: D.O.C.: 05. Marital Status:

06. Religion : 07. Occupation: 08.Ecconomical Status: 09. Address:

Telephone :

Married Unmarried

Hindu Muslim Christian Others

Labour Sedentary Active Housewife

Poor class Middle class Upper class

M F

Complete remission

Major improvements

Minor improvements

No improvement

10. Result : 11.Consent : I ------------------------- Son| Daughter| Wife of---------------- Exercise my free will in

the said study, I have been informed to my satisfaction by the attending the purpose of the clinical evaluation and nature of drug treatment. I was also aware of my right to quit at any time during the schedule.

Patient’s Signature

1

11. Chief complaints:

Sl.No. Complaints P/A Duration

01. Sandi shoola

02. Sandhi shotha

03. Jadya

04. Jwara

05. Vrischika Danshavata Peeda

12. Associated complaints:

Sl.No. Complaints P/A Duration

01. Angamarda

02. Aruchi

03. Gourava

04. Nidra viparyaya

05. Bahumootrata

06. Trushna

07. Apaka

08. Daha

09. Alayasya

10. Vid vibandhata

2

13. History of present illness: Mode of onset Insidious Acute Chronic Sequence of joint involved:

Monoarticular Polyarticular Asymmetrical symmetrical Oligoarticular

Aggravating factors:

Relieving factors: Nature of disease: Progressive Regressive Constant Intermittent

Routine activities

Mild Moderate Severe Not affected

affected: 14. Family history: 15. Previous treatment history: Steroid dependent: NSAID’s: Others:

3

16. Personal history: Ahara : Jatharagni: Nidra : Vyasana : Artava pravriti: 17. General examination: 18. Atura bala pareeksha: Prakriti Sara: Samhana: Satmya:

Manda Teekshna Vishama Sama

Sukha Alpa Ati Vaishyamya

Smoking Alcohol Tobacco No habit

Days Samya Alpa Adhika Rajo nivritti

Pulse B.P. Temp. Resp.rate Height Weight Heart rate

V P K VP KP VK VPK

Pravara Madhyama Avara



Taste Sweet Sour Salt Vegetarian Mixed Predominance Pungent Bitter Astringent

4

Satwa:


Vyayama shakti:


Vaya: Balya Youvana Vruddha Desha: Jangala Anupa Sadharana Ashtasthana pareeksha:

• Nadi: Shabda: • Mootra: Sparsha :

• Mala: Drika: • Jihwa: Akruti:

19. Systemic examination:

a) Cardiovascular system:

b) Respiratory system:

c) Digestive system d) Nervous system:

5

20. Special examination of the joints:

A] Pain:

i) Mode of onset: Sudden Gradual

ii) Site: Localized Referred to other joints iii) Trauma: P/A If P

iv) Character: Aching Throbbing Pricking v) Moment aggravates pain: Yes No

vi) Relation to

weather: Worst in weather

B] Morning stiffness: Present Absent 0 1 2 3 C] Inspection:

P/A If P i) Any other deformity: ii) Soft tissue swelling: Present Absent iii) Skin over the joint: Redness Itching Glossiness Oedma iv) Muscle wasting: P/A If P Above the

affected joint Below the

affected joint

v) Rheumatoid nodes:

P/A If P

6

D] Palpation: i) Local temperature: Present Absent

ii) Maximum tenderness: Bone Ligament Tendon

sheet Others

iii) a. Flexion deformity b. Extension deformity 21. Nidana pareeksha:

` I. Nidana :

Viruddha Bhojana

Virudha chesta

Vyayama after Snigdha Bhojana

Mandagni

II. Upashaya / Anupashaya : 22. Lab investigations:

Sl.No Name of the test Value A Blood 01. Hb% mg % 02. ESR mm for I hour 03. Total count %

N E B M L 04. Differential count

b. Radiological examination:

7

23 . Intervention: Trail medicine drug: Sri Siddhadaradamruta rasa.

Dose : Started on:

Anupana : Completed on :

24. Assessment of results: Subjective parameters

Objective parameter:

Sl. No. Complaints 0 day 15 days 30 days 45 days 01. Sandhi shoola 02. Sandhi shotha 03. Jadya 04. Jwara 05 Gouravata 06 Nidraviparyaya

S.No Parameters 0 day 30 days

01. Hb % 02. TC

N E B M L N

E B M L 03. DC

04. ESR

Sl.No Parameter 0 day 15 day 30 day 45 day

05 Walking time

06 Grip strength Rt- Lt- Rt- Lt- Rt- Lt- Rt- Lt-

Investigator note: Signature of Scholar Signature of Guide Signature of Co-Guide

8

Score sheet 01. Sandhishoola. 0=No complaints 1=Patient tells about after inquiry 2=Patient frequently complaints 3=Excruciating condition 02. Sandhi shotha 0=No complaints 1=Slight obvious 2=Covers well the boney prominence 3=Much elevated

03. Jwara(Sthanika Ushmata) 0 = Normal 1= During severity of Pain 2 = During severity of pain with swelling. 3 = Continue shula with pain 04. Jadya 0 = No stiffness. 1 = Stiffness for 5 minutes to 1 hour. 2 = Stiffness for1-2 hours. 3 = Stiffness for more than 2 hours.

05. Nidraviparyaya: 0= No discomfort. 1= discomfort during night. 2= discomfort during night and affects day. 3= day sleep and Night awakes. 06 Gouravata: 0= No gouravata 1= during morning up to 1Hr 2= continues in the morning<24 Hrs. 3=throughout the day. Walking time: (To cover 21 meters) 0= Up to 20 seconds.

1= 21 – 30 ” 2= 31 – 40 ” 3= 41 – 50 ” 4= 51 – 60 ” 5= 60 ”

9

Annexure I •

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