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!"#$%&%'()* %,'( #(!&"-(%. /'012 "3 /40114% 5%/(/% %,1
5%/(/% -4%/#%
Dr. Nisha Kumari.P. R *Dr. Dinesh Nayak J **,
Dr. Sathyanarayana B. ***
* *Asst Prof, Dept. of RSBK, SDM College of Ayurveda Hassan
** Professor and Head, Dept. of PG studies in Rasashastra, Muniyal institute of Ayurveda
medical Sciences, Manipal
*** Principal and Head, Dept. of PG studies in Bhaishajya Kalpana,Muniyal institute of
ayurveda medical sciences, Manipal
(,'&"10!'(",
The antimicrobial activities of any
therapeutic agent are understood by the
degree of growth inhibition of
microorganisms it produces as well as its
bactericidal property. Usually different
microbial species or even strains have
different degrees of susceptibility to
therapeutic agents. The susceptibility ofmicroorganisms can change with time, even
during therapy with a specific drug. Thus, it
is essential for the physician to know the
sensitivity of the pathogen before treatment.
In present the study, the antibiotic,
antibacterial and antifungal effect of ferrous
sulphate (Kasisa) is evaluated. Shodhana of
Kasisa was performed according to Rasa
Tarangini 21/230 (Bhavana). Marana of
Kasisa was done as per the method explained
in Rasatarangini 21/259.
Antimicrobial study
Research Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
In Rasa shastra, minerals are categorized as Maharasa, Uparasa and Sadharana rasa based
on different criteria. Kasisa, one among the uparasa1 is being therapeutically used since
centuries. Kasisa Bhasma has Ushna virya, Kashaya amla rasa properties. It act as netrya,vishaghna,Kapha Vata nashaka, Vranaghna, Svitraghna, Kshayaghna, Kesharanjaka. It is also
Kandughna, Pandughna, Krimighna, Rakta sanjanana, Raja pravartaka, Balya, Jwaraghna,
Pleehanashana2 So an attempt was made to comparatively analyze the antimicrobial properties of
shuddha Kasisa and Kasisa Bhasma by in Vitro study. Qualitatively prepared shuddha kasisa
and kasisa bhasma was evaluated against staphylococcus aureus, Pseudomonas aeruginosa,
Escherichia coli, Candida albicans and compared with standard drugs like ampicillin,
gentamycin and amoptericin. In the present study, sensitivity testing was done by disc diffusion
technique pattern.
Key words: Shuddha kasisa(SK), Kasisa bhasma(KB), Ampicillin, Gentamycin, Amoptericin.
How to cite this URL: Dr. Nisha Kumari.P. R. Comparative Anti Microbial Study of Shuddha Kasisa And Kasisa Bhasma.
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Nisha Kumari.P. R Et; Al: Comparative Anti Microbial Study Of Shuddha Kasisa And Kasisa Bhasma
!"#www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
The antimicrobial activity of a drug is
generally expressed as its inhibitory action
on the growth of the bacterium in nutrient
broth or nutrient agar.
For the purpose of this study, the following
conditions are required.
1.
The substance or test drug must be incontact with the test organisms.
2. Conditions must be favorable for the
growth of microorganisms in the
absence of antimicrobial substances.
3. There must be a means of estimating the
amount of growth and thereby
percentage of inhibition of growth.
4. The activity of test drug should be
observed and determined by the growth
response of microorganisms.
Procedure
Bacterial strain used
• Gram negative Strain - Escherichia
coli(NCIM 2574) and Pseudomonas
aeruginosa (NCIM 2036)
• Gram positive Strain - Staphylococcus
aureus (NCIM 2079)
• Fungal Strain – Candida albicans
•
Media used- Mueller Hinton agar,
Mueller Hinton broth, Sabouraud
dextrose broth
and Sabouraud dextrose agar.
Standard drug disc – Gentamycin (10
µg/disc) for Gram negative, Ampicillin (10
µg/disc) for Gram positive, Amphotericin B
(20 µg/disc) for fungi
PROCEDURE
Preparation of Inocula3
For preparation of inoculum, growth from
the agar slant was scrapped by adding 3 ml
of sterile saline solution. This saline cell
suspension was then spread evenly on large
sterile Petri plates containing solidified
Muller Hinton agar (for bacteria) and
Sabouraud dextrose agar (for fungi) using a
sterile glass spreader. These plates were
incubated in bacteriological incubator at
370C for 24 hours and at 28
0C for 48 hours
for bacteria and fungi respectively. After
profuse growth of the organism in the
Petridish, it was scrapped using sterile
spatula and adding small portion of sterile saline. This suspension was transferred to a
sterile 100ml conical flask. The final volume
of the suspension was made upto 50ml with
sterile saline.
Standardization of Inocula
For the determination of MIC, the inoculum
density was adjusted to contain 5 x 106
CFU/ml which has turbidity equal to 0.5
McFarland standard. For this, 0.5 McFarland
standard was prepared by adding 0.05ml of
0.048M BaCl2 (1.17% w/v BaCl2.2H2O) to
9.95ml of 0.18M H2SO4 (1% w/v) with
constant stirring. The standard was
transferred to a glass screw capped bottle.
Absorbance of the McFarland standard was
checked at 625nm (absorbance at 625nm
should range between 0.08- 0.13).
Preparation of drug Dilution
Each drug was suspended in sterile waterwith the help of 1% tween 80 at the
concentration of 1mg/ ml. Sterile water with
1% tween 80 was also prepared to use a
blank for the drug.
Disk Diffusion Assay
Disk diffusion assay of drug was performed
in 40 mm Petri plates to observe growth
inhibition of test organism in term of zone of
diameter (mm). Mueller Hintonagar (3 in
No.) and Sabouraud dextrose agar (1 in No.)
medium was prepared and sterilized. Molten
agar media were poured into sterile Petri
plates (4 in No.) and left for Solidification.
Each plate was neatly labeled with all the
details. Each plate was divided into four
parts which were labeled as ST, SK, KB and
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Nisha Kumari.P. R Et; Al: Comparative Anti Microbial Study Of Shuddha Kasisa And Kasisa Bhasma
!"%www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
BL. Standard cultures (100 µl of each) of test
organism were transferred to the respective
solidified agar aseptically. Transferred
cultures were uniformly distributed all over
the surface of agar medium using L
spreader. Respected standard was kept in the
center of the respective part of the plate.
Three sterile discs were transferred into the
remaining parts of the plate. Each sterile
disc was loaded with the 20 µl of respective
drug or blank. First, Petri plates were kept in
fridge for 30 min. for drug diffusion and
then transferred into the respective
incubator. Zone of inhibition were measured
using antibiotic zone reader after 24 h for
bacteria and 48 h for fungi. Table No 1 Report of antimicrobial assay of Shuddha Kasisa
Name of tested organism Zone Diameter (mm) of Growth Inhibition
Test drug Blank Standard drug
E.coli 12 9 21
P. aeruginosa 10 8 32
S. aureus - - 24
C. albicans - - 8
Table No 2 Report of antimicrobial assay of Kasisa Bhasma
Name of tested organism Zone Diameter (mm) of Growth Inhibition Test drug Blank Standard drug
E.coli 10 9 21
P.aeruginosa 8 8 32
S.aureus - - 24
C.albicans - - 8
Results
Shuddha Kasisa was found to be
partially active against the used species of
Gram negative bacteria at the tested
concentration, while it was found to be
inactive against the Gram positive and the
fungal strain.
DISCUSSION
Comparative evaluation of Shuddha Kasisa
and Kasisa Bhasma for antimicrobial
potential wasthe main aim of the study.
Based on the claim of Krimighna property
of Kasisa Bhasma and external use ofShuddha Kasisa for wound healing, the
antimicrobial study was planned. Disc
diffusion method was followed. As a
standard protocol Gram Negative Strain -
Escherichia coli (NCIM 2574) and
Pseudomonas aeruginosa (NCIM 2036),
Gram positive Strain – Staphylococcus
aureus (NCIM2079) and Fungal Strain –
Candida albicans were selected. Standard
drugs used were Gentamycin (10 µg/disc)
for Gram negative, Ampicillin (10 µg/disc)
for Gram positive and Amphotericin B (20
µg/disc) for fungi. The products were found
to be partially active against the used species
of Gram negative at tested concentration
while found to be inactive against the Gram
positive and the fungal strain. Shuddha
Kasisa was found to be slightly better in
antimicrobial activity as the zone ofinhibition was slightly higher than that of
Kasisa Bhasma (for E coli 12mm against 10
mm of Kasisa Bhasma), which may be due
to better solubility and highly acidic pH of
Shuddha Kasisa. However, the zone of
inhibition was far low when compared to the
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Nisha Kumari.P. R Et; Al: Comparative Anti Microbial Study Of Shuddha Kasisa And Kasisa Bhasma
!"&www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
standard drugs. However, using the media in
which the products are more
soluble may be useful. Multiple strains of
microorganisms may have to be tried. Mode
of action
of Kasisa Bhasma and Shuddha Kasisa may
be different than that of antimicrobial
agents. Evaluation of antioxidant profile and
wound healing activity may be more useful.
!",!.0/(",
The products were found to be partially
active against the used Gram negative at
tested concentration while found to be
inactive against Gram positive and fungal
strain. Shuddha Kasisa was found to be
slightly better in activity as the zone of
inhibition was slightly higher. than that of
Kasisa Bhasma (for E coli 12mm against 10
mm of Kasisa Bhsma) which may be
because of the better solubility and highly
acidic pH of Shuddha Kasisa.
Figures:
Figure1: Escherichia coli Figure2: Pseudomonas aeruginosa
Figure3: Staphylococcus aureus Figure 4: Candida albicans
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Nisha Kumari.P. R Et; Al: Comparative Anti Microbial Study Of Shuddha Kasisa And Kasisa Bhasma
!"'www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
&*3*&%,!*
1. Shri Vagbhata, Rasarathna
samuchchaya, with Hindi
Commentary of Ras Prabha,
Translate by Indra Dev Tripathi,
Chaukhamba Sanskrit Sansthan,
Varanasi, edition 2009, 3rd Chapter,
page no.26. Pp418.
2. Shri Sadananda Sharma, Rasa
Tarangini by Pandith Kashinath
Shastri, Motilal Banarasidas, New
Delhi, edition 2000, 21th
Chapter,page no.564,Pp772.
3. Clinical and Laboratory Standards
Institute. Performance Standards forAntimicrobial Susceptibility Testing;
Twenty-First Informational
Supplement. CLSI document
M100S21 (ISBN 1-56238-742-1).
Clinical and Laboratory Standards
Institute, 940 West Valley Road,
Suite 1400, Wayne,
Pennsylvania19087 USA, 2011.
!"&&*/$",1(,6 %0'4"&Dr. Nisha Kumari.P. R
Asst Prof, Dept. of RSBK, SDM College of
Ayurveda Hassan, Karnataka, India
Source of support: Nil
Conflict of interest: None Declared
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!"#$ &'()* +"", -". /0(&",#.1 $0+2.30("4'4 /#$'2,$4
Nishigandha Dandekar1, Nalin Shah
2
1. MD (Ayu.) Scholar, Department of Rasashastra and Bhaishajya kalpana2. Lecturer, Department of Rasashastra and Bhaishajya kalpana, Y.M.T. Ayurvedi-
c Medical College.
INTRODUCTION:
Pulmonary Tuberculosis remains a major
public health problem in developing coun-
tries. It causes due to infection with My-
cobacterium tuberculosis. It causes 2 mil-
lion deaths per year in all over the world.
Majority of the cases are likely to occur in
the world’s poorest nations, who struggle
to cover the cost associated with manage-ment and control programme. Thus many
patients remain untreated or receive in-
complete treatment which results in multi
drug resistant tuberculosis (MDR TB). TB
statistics published by WHO in 2015 in-
cludes India amongst the 14 TB, MDR TB
and TB/HIV high burden countries1. Cur-
rent estimates suggest that around one
third of world’s population has latent tu-
berculosis. Recently, TB hospital, Shivdi
declared that clinical study on goat milk
will be carried out on tuberculosis patients
as they found remarkable improvement in
some patients who received goat milk
along with AKT2
. Pulmonary tuberculosisis correlated with Rajayakshma mentioned
in Ayurvedic texts. It is a contagious dis-
ease which is transmitted from an infected
person to susceptible person in airborne
particles that are released when infected
person sneezes, cough, laugh, shout etc.
According to Ayurveda, Rajayakshma is
included in aupasargik roga3. So the in-
fection can also be considered the etiology
of Rajayakshma and this is the San-
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
TB statistics published by WHO in 2015 includes India amongst the 14 TB, MDR TB and
TB/HIV high burden countries. Pulmonary tuberculosis is correlated with Rajayakshma
mentioned in Ayurvedic texts. Currently, TB hospital, Shivdi declared that clinical study on
goat milk will be carried out on tuberculosis patients as they found remarkable improvement
in some patients who received goat milk along with AKT. Aja kshira (Goat milk) is im-
portant Ayurvedic drug in chikitsa of Rajayakshma vyadhi. Thus review of goat milk ac-
cording to ayurvedic and modern literature was done. It has efficacy against kshaya, kasa,
shwasa, atisara etc. It has deepana, laghu, balya, grahi properties. According to modern re-
search, it has anti-fungal, anti-microbial properties which affect lungs. It also has immuno-
logical role in gastrointestinal infections. Also goat milk has higher content of medium chain
fatty acids which are easy for digestion and used as medicine for malabsorption syndrome
and steatorrhoea.
KEYWORDS: Goat milk, pulmonary tuberculosis, Rajayakshma, Chhagaseva.
How to cite this URL: Nishigandha Dandekar. Goat
Milk: Boon for Pulmonary Tuberculosis Patients.
International Ayurvedic medical Journal {online}2016 {cited 2016 April} Available from:
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Nishigandha Dandekar & Nalin Shah: Goat Milk: Boon For Pulmonary Tuberculosis Patients
nikrishta cause of the Rajayakshma. Mod-
ern science describes that Mycobacterium
tuberculosis does not produce the disease
in all the persons, but produces primary
tuberculosis.
So they described some
provocating factors like cigarette smoking,
alcoholism, immune-suppressive agent and
some diseases like leukemia, lymphoma
etc. which may be responsible for the dis-
ease. Similarly, there are two type of ni-
dana in pathogenesis of Rajayakshma:
a) Sannikrishta nidana which is the
upasarga and this may be the infection of
Mycobacterium tuberculosis.
b) Viprakrishta nidana is 4 typed sahas-
janya, sandharanajanya, kshayajanya andvishamashanajanya. These may act like
provocating factors responsible for the dis-
ease. Also, Trirupa, Shadrupa and Eka-
dashrupa lakshana of Rajayakshma have
been correlated to signs and symptoms of
pulmonary tuberculosis4. Chikitsa for Ra-
jayakshma rogi according to Ayurveda is
Chhagaseva5. Meaning of word Chhaga &
Aja is Goat. Sushruta samhita, Chakra-
datta, Vangasena, Yogratnakara have ad-
vocated the use of various products ob-
tained from goat. The patients suffering
from Kshaya i.e. synonym of Rajayakshma
should stay in the company of goats in the
same room, drinks goats milk, use ghrita
prepared from goat's milk in the ahara.
The room in which the patient and goats
leave should be painted, and tiled withgoat's faces and urine. In current study, lit-
erature review on goat milk is done.
REVIEW OF GOAT MILK
Ayurveda texts:
SrN. Text Rasa Virya Vipaka Dosha
ghnata
Uses Roga
Ghnata
1. Ca. Sa. Kashay
madhur
Shita - - Grahi, Laghu Kshaya,
Kasa, Atisar, Rak-
tapitta,
Jwara,
2. Su. Sa. - - - - Properties similar
to cow milk.
Dipaniya, Laghu,
Sangrahi
Shosha,
Kasa
Shwasa,
Raktapitta
3. A. Hr. - - - - Laghu Shosha,
Shwasa
Jwara,
Atisar, Rak-
tapitta
4 Bha.
Pra.
Ni.
Kashay
Madhur
Shita Katu Grahi, Laghu Kshaya
atisar
Kasa,
Jwara,
Raktapitta
5 Yo. Ra. - - - Tridosha Properties similar
to cow milk,Vishesh dipana,
Kshaya,
Arsha, Jwara
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Nishigandha Dandekar & Nalin Shah: Goat Milk: Boon For Pulmonary Tuberculosis Patients
Grahi, Laghu Atisara,
Raktadosh
Bhrama,
6 Kai.
Ni.
Madhur
Kashay
Shita - Kapha Properties similar
to cow milk,
Dipana, Laghu
Sangrahi,
Snigdha,
Mrudu, Balya
Shukrala,
Kshaya,
Kasa Arsha,
Jwara
Shwasa,
Atisara,
Trushna,
Vatarakt
Raktapitt
7 Dha.
Ni.
Kashay
Madhur
Shita - - Grahitara, Laghu Kshaya,
Kasa
Jwara,
Atisar, Rak-
tapitta.
8 Ni. Ra. Kashay
Madhur
Shita - - Grahi, Laghu Kshaya,
Kasa
Jwara,
Atisar, Rak-
tapitta
9 Ra. Ni - - - - More potent than
cow milk, Diet for
weak person.
Sarva
Vyadhi hara
Table No. 1: Properties of goat milk according to Ayurvedic literature.Modern research papers:
Sr. N Drug Journal/Article Proved activity/ Findings
1. Goat milk Ancient Science of Life 1993
January; 12 (3-4) :335-337 Pub-
med ID: 22556611
87.06 per cent inhibition in the spore ger-
mination of fungi Absidia corymib-
ifera.(third-most-common cause of in-
vasive fungal infection in immuno-
compromised patients.)
2. Goat milk lac-
toperoxidase
Indian journal of experimental
biology 1998 Aug;36 (8):808-10. PMID: 9838883
Anti bacterial property
3. Goat milk lac-
toperoxidase
Life
Sciences.2000;66(25):2433-
9.PMID -10894086
antifungal and antibacterial property
4. Goat
Milk-Serum
Amyloid A-3
Protein
International Conference on
Antimicrobial Research
(ICAR2010) Valladolid
(Spain), 3-5 November 2010
1) Antimicrobial activity
S. Aureus
Enteropathogenic E. coli.
2) Gastrointestinal
protection and
immunological role5. Goat milk Asian journal of animal sci- Anti bacterial property:
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Nishigandha Dandekar & Nalin Shah: Goat Milk: Boon For Pulmonary Tuberculosis Patients
lacto
peroxidase
ences ! January 2011
DOI:10.3923/ajas.2011.56.63
" Vibrio cholerae,
" Salmonella typhi,
" klebsiella pneumoniae,
" Shigella dysenteriae.
6. Goat milk Indian J. Dairy Sci. 65(4),
2012
" Size of fat globules - less than 5
microns is 83% thus easy diges-
tion.
" Higher values of Caprylic acid,
capric acid, Medium chain
triglyceride than cow milk
which are used in treatment for
Malabsorption syndrome, and
Steatorrhea.
7. Goat milk Journal of Dairy Research.
2001; (Barrionuevo et al
2002; Alferez et al, 2003;
Campos et al, 2003; Lopez-
Aliaga et al, 2003).
In vivo study - Animals with symp-
toms of malabsorption show more
efficient absorption of calcium,
phosphorus, iron, copper, zinc, mag-
nesium and selenium from goat milk
compared to cow milk
Table No. 2: Properties of goat milk according to Modern research work.
.240($4 #,5 5'43044'",*
" According to review of Ayurvedic litera-
ture, goat milk is beneficial in Kshaya,
Shosha which are synonyms of
Rajayakshma.
" Main symptom of rajayakshma is cough,
breathlessness, and fever.
Goat milk has efficacy on Kasa, shwasa
and jwara. According to research work,
goat milk causes inhibition in the spore
germination of fungi Absidia corymibifera
which affects lungs. Also, goat milk has
anti bacterial and anti fungal properties. Ithas anti microbial activity against S.
Aurius which causes diseases like
pneumonia, UTI, sinusitis, infective
endocarditis, osteomyelitis etc. which
induce fever.
" According to Charaka samhita6, Purisha
rakshan is very important in case of
rajayakshma rogi. Goat milk has efficacy
on atisara. According to modern research,it has anti bacterial properties against E.
coli, Vibrio cholerae, Salmonella typhi,
klebsiella pneumoniae, Shigella
dysenteriae which cause diarrhea and
dysentery. It shows immunological role in
gastrointestinal protection." In Rajayakshma rogi, samprapti
7 (patho-
physiology) starts with agnimandya
(diminished digestive activity) and
rasavaha strotas avarodha which causes
kshaya of further dhatu. Goat milk has
deepana, grahi, laghu, balya, shukrala
properties which can cause samprapti
bhanga. It has 83% fat globules which are
less than 5 microns’ size. Thus it is easy
for digestion. Also, it has higher values of
Caprylic acid,capric acid, Medium chain
triglyceride which are used in treatment
for Malabsorption syndrome, and
Steatorrhea. Animal study shows that
absorption of micro nutrients is more
efficient from goat milk in comparison
with cow milk.
" It has properties similar to cow milk
which is best amongst all milks according
to Ayuveda.
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Nishigandha Dandekar & Nalin Shah: Goat Milk: Boon For Pulmonary Tuberculosis Patients
CONCLUSION:
• Pulmonary tuberculosis is correlated with
Rajayakshma.
• Ayurvedic literature review cocludes that
goat milk can break pathophysiology of
Rajayakshma.
• Modern research papers support the proper-
ties of goat milk mentioned in ayurvedic
texts.
• Thus, goat milk can be an effective medi-
cine in Pulmonary tuberculosis patients.
.-2.2,324*
1. Global tuberculosis report 2015.
2. Pg No. 9, Date- 17/2/2016, MaharashtraTimes.
3. Sushrut samhita, Nidan sthan 5/34,
Acharya Priyavat Sharma, reprint – 2004,
Prakashan– Chaukhamba surbharati
prakashan.
4. Anish Kumar, Comparative study of rajay-
akshma and pulmonary tuberculosis,
Indian journal of re-search (2014)8,9-13
5. Chakradatta Rajayakshma chikitsa shloka
92, Dr.Indradev. Tripathi, 4th edi – 2002,
Chaukhamba Sanskrit Sanstha.
6. Charak samhita (vol-2), Chikitsa
sthan 8/41,42, Acharya vidyadhar
shukla, reprint – 2004, Prakashan –
Chaukhambha Sanskrit Pratishthan.
7. Charak samhita (vol-2), Chikitsa
sthan 8/39,40, Acharya vidyadhar
shukla, reprint – 2004, Prakashan –
Chaukhambha Sanskrit Pratishthan
3"..24/",5',! #0$6".
Dr. Dandekar Nishigandha Sadanand
(MD scholar) Rasashastra and Bhaishajya
kalpana 5-B, R.B.I. colony, Old Dombivliroad, Vijaynagar, Dombivli (west). Pin –
421202
Email ID – [email protected]
Source of support: Nil
Conflict of interest: None Declared
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!"#$%#&'()*#%+&, '. /#$!#*# #*( +/, 0/+1+/) +* %#*#234
%3*/ '. %)'!+# 1Bende Yogita 2Sarika Choure 3Suraj Rathod 4Auti Swapnil S
1Asso. Professor, Dept of Panchkarma, Shri Ayurveda Mahavidyalaya, Nagpur.
2Assistant Professor, Dept. of Shalakya BM Ayurveda Mahavidyalaya, Nagpur.
3MD schlor. (Kayachikitsa) Govt. Ayurveda College and Hospital, Nagpur.
4Asst. Professor Dr. D.Y. Patil college of Ayurved and research centre, Pimpri, Pune.
+*/$'(0&/+'*5
Eyes hold special status among all the
senses. Eyes are the most precious gift of
the God to the living beings. Good vision
is crucial for social and intellectual devel-
opment of a person. Recent data suggests
that a large number of people are blind in
different parts of the world due to high
refractive errors especially myopia. Vari-
ous surveys in India have found the myo-
pia prevalence ranging from 6.9% to
19.7%.1,2 Due to the significance of myo-
pia as a global public health concern, it
was chosen as a priority for Vision 2020,
World Health Organization's global initia-
tive for the elimination of avoidable blind-
ness by year 2020.3 Ayurvedic ocular ther-
apies also known as Kriyakalpa are well
known now a day in management of Myo-
pia which is considered as Timira in Ayur-
veda. Among them also Tarpana is used
frequently and classical references also
justify the clinical utility of Tarpana in
management of Myopia. Thus an attempt
has been made to elaborate the clinical
utility in management of myopia & to
evaluate its pharmacodynamics in light of
available scientific knowledge and under-
Research Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
Nearsightedness, or myopia, is the most common refractive error of the eye, and it has be-
come more prevalent in recent years. Nearsightedness can be corrected with glasses, contact
lenses or refractive surgery. All these treatments are not much patient friendly and also not
the actual solution to the pathology occurring in eye. Tarpana is one of the popular ocular
therapies that is performed in Ayurveda and which is known to have a definite answer to the
problem of Myopia. Thus it becomes necessary to explore the mode of action of Tarpana and
give exact pharmacodynamics picture of the therapy so that its utility can be explained in sci-
entific way. With this view an attempt was made to discover the scientific facts which can
ascertain the Ayurvedic concepts. After a critical review of various researches, scientific texts
and Ayurvedic classics it is concluded that Tarpana acts on the principle of Bahya Snehana. It
can successfully cross the defensive barriers present in eye for absorption and nourishes the
ocular and periocular structures, strengthens the sphincters & brings about changes in dioptric
power and visual acuity.Key words: Tarpana, Myopia, nearsightedness, Snehana.
How to cite this URL: Bende Yogita. Pharmacodynamics Of Tarpana And Its Utility In Management Of Myopia
.International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:
http://www.iamj.in/posts/images/upload/589_594.pdf
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1Bende Yogita et;all: PHARMACODYNAMICS OF TARPANA AND ITS UTILITY IN MANAGEMENT OF MYOPIA
standing of the ocular therapies.
Ayurvedic concept of Tarpana:
The literary meaning of the Tarpana is to
give nourishment to the eye through
Ghruta, Ghruta Manda, medicated Ghruta,
Vasa, Majja, (bone marrow), milk etc.
Acharya Charaka in Sutrasthana Snehadh-
yaya explained that “Snehoanilam Hanti”
which means that Snehana is the supreme
treatment for Vata Dosha.4 He mentioned
Akshi - Tarpana as one of the 24
Snehapravicharana in Sutrasthana 13th
chapter.5 Ghruta is used primarily for Tar-
pana. Ghruta is effective in subsiding Pit-
taja and Vataja disorders, it improves
Dhatus and is overall booster for improv-ing Ojas.6
The Ghruta has the quality of
trespassing into minutest channels of the
body. Hence when applied in the eye, it
enters into deeper layer of Dhatus and
cleanses every minutest part of them.
Moreover, Ghruta due to its San-
sakaranuvartana quality easily imbibes the
properties of other drugs processed with it
without leaving its own properties.
7
Ghrutais also Sheeta Veerya, hence the eye being
the site of Alochaka Pitta can be effec-
tively managed by constantly using Ghee
for Akshi Tarpana. Ghruta also contains
properties like Balya, Brimhana and Ra-
sayana, so it gives strength to the overall
tissues of the eyeball as well as to the
nervous tissues.
To provide nourishment the prerequisite is
the absorption of drug through the ocular
surface. But the eyes are supplied with va-
riety of defence mechanisms for protection
that offers the barrier in drug absorption.
Challenges in ocular drug delivery &
Tarpana: Tarpana can also be considered
as a route of ocular drug delivery through
topical administration. For most of the
topically applied drugs, the site of action is
usually different layers of the cornea,conjunctiva, sclera, and the other tissues of
the anterior segment such as the iris and
ciliary body (anterior uvea). Upon admin-
istration, precorneal factors and anatomical
barriers negatively affect the bioavailabil-
ity of topical formulations.
Pre-corneal factors include:8
•
solution drainage,
• blinking,
• tear film,
• tear turn over, and
• induced lacrimation
Tear film, whose composition and amount
are determinants of a healthy ocular sur-
face, offers the first resistance due to its
high turnover rate. Mucin present in the
tear film plays a protective role by forming
a hydrophilic layer that moves over the
glycocalyx of the ocular surface and clears
debris and pathogens.9 Human tear volume
is estimated to be 7 µl, and the cul-de-sac
can transiently contain around 30 µl of the
administered ocular drug. However, tear
film displays a rapid restoration time of 2–
3 min, and most of the topically adminis-
tered solutions are washed away within just 15–30 s after instillation. Considering
all the precorneal factors, contact time
with the absorptive membranes is lower,
which is considered to be the primary rea-
son for less than 5% of the applied dose
reaching the intraocular tissues.10
In case
of Tarpana the volume of drug retained
over ocular surface is much higher in
comparison to the eye drops thus mucin
itself may get diluted by the Ghruta or any
other Tarpana drug removing the hydro-
philic layer barrier and provides more drug
available for absorption. In addition, vari-
ous layers of the cornea, conjunctiva, and
sclera play an important role in drug per-
meation. The cornea, the anterior most
layer of the eye, is a mechanical barrier
which limits the entry of exogenous sub-
stances into the eye and protects the ocular
tissues. It can be mainly divided into the
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epithelium, stroma, and endothelium. Each
layer offers a different polarity and a po-
tential rate-limiting structure for drug per-
meation. The corneal epithelium is lipoidal
in nature which contains 90% of the total
cells in the cornea and poses a significant
resistance for permeation of topically ad-
ministered hydrophilic drugs. Furthermore,
superficial corneal epithelial cells are
joined to one another by desmosomes and
are surrounded by ribbon-like tight junc-
tional complexes (zonula occludens)11,12.
Presence of these tight junctional com-
plexes retards paracellular drug permeation
from the tear film into intercellular spaces
of the epithelium as well as inner layers ofthe cornea. Tarpana is mostly done with
lipophilic drugs in the form of Ghruta,
Vasa etc. thus it can be well absorbed
through lipoidal membrane and also it can
nourish this membrane so that its function
gets improved. Moreover, Tarpana is done
in lukewarm form that may dilate the tight
junctional complexes thus allowing para-
cellular drug permeation. The stroma,which comprises 90% of the corneal
thickness, is made up of an extracellular
matrix and consists of a lamellar
arrangement of collagen fibrils. The highly
hydrated structure of the stroma poses a
significant barrier to permeation of lipo-
philic drug molecules. Endothelium is the
innermost monolayer of hexagonal-shaped
cells. Even though endothelium is a sepa-
rating barrier between the stroma and
aqueous humor, it helps maintain the
aqueous humor and corneal transparency
due to its selective carrier-mediated
transport and secretory function.13 Fur-
thermore, the corneal endothelial junctions
are leaky and facilitate the passage of mac-
romolecules between the aqueous humor
and stroma.14
Thus, corneal layers, partic-
ularly the epithelium and stroma, are con-sidered as major barriers for ocular drug
delivery. It is vital to understand that the
permeant should have an amphipathic na-
ture in order to permeate through these
layers. Certain drugs used for Tarpana like
Siddha Kshira are of this nature. Com-
pared to cornea, conjunctival drug absorp-
tion is considered to be nonproductive due
to the presence of conjunctival blood ca-
pillaries and lymphatics, which can cause
significant drug loss into the systemic cir-
culation thereby lowering ocular bioavail-
ability. Conjunctival epithelial tight junc-
tions can further retard passive movement
of hydrophilic molecules.15 However, in
Tarpana the drug used is significantly in
high dose that can give enough bioavaila- bility even after the loss in systemic cir-
culation or in other words it can act both
locally and systemically. The sclera, which
is continuous with the cornea originates
from the limbus and extends posteriorly
throughout the remainder of the globe. The
sclera mainly consists of collagen fibers
and proteoglycans embedded in an extra-
cellular matrix. Permeability through thesclera is considered to be comparable to
that of the corneal stroma. Recent reports
indicate that the permeability of drug mol-
ecules across the sclera is inversely pro-
portional to the molecular radius.16 Tar-
pana when did with Siddha Ghruta, it
contains more small chain fatty acids hav-
ing small molecular radius than the long
chain fatty acids. Thus, they may get read-
ily absorbed.
Pressure effect and refractive index:
Tarpana exerts extraocular pressure to the
lens thus increasing its axial length.
Though this pressure effect is transient but
due to the oleation and hydration provided
by Tarpana may improve the accommoda-
tion which can retain this pressure effect
for longer duration.
More contact time: Ghruta preparationsused in Akshi-Tarpana are in the form of
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1Bende Yogita et;all: PHARMACODYNAMICS OF TARPANA AND ITS UTILITY IN MANAGEMENT OF MYOPIA
suspension containing different particles of
the drugs and the particles do not leave the
eye as quick as solution. Tissue contact
time and bio availability is more hence
therapeutic concentration can be achieved
by Akshi – Tarpana.
Accommodation and visual acuity: Ac-
commodation is the ability of the eye to
change the refractive power of the lens to
automatically focus on objects at various
distances. It is a complex constellation of
sensory, neuromuscular and biophysical
phenomena by which the overall refracting
power of the eye changes rapidly to image
objects at different viewing distances
clearly on to the retina.17 Tarpana may act
over accommodation capacity of eye by
providing nutrition not only to the cornea
but also to the sphincter muscles and
nerves innervating it.
Fig 1: changes in lens shape by accommodation for distant and close vision
Nutritional supplement from Tarpana
drugs: Ghruta is used widely for Tarpana
which contains mainly omega-3 & 6 fatty
acids, Vit A, E & K & antioxidants.18 Milk
is also used for Tarpana which contain va-
riety of Vitamins, minerals, amino acids
etc.19
Review of researches to understand the
clinical utility:20,21,22,23,24
.
Tarpana is used in Shalakya – a branch of
Ashtang Ayurveda to treat mainly Myopia.
Variety of Tarpana formulations have been
tried in various researches. Its clinical
utility can be understood by reviewing
these researches.
The dioptric power of the spherical lens
was reduced by 9 to 20 % in most of the
researches. Durastha Avyakta Darshana or
indistinct distant vision,
Netrasrava, Netradaha , Netrayasa ,
and Shirobhitapa were reduced statistically
significantly (P
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1Bende Yogita et;all: PHARMACODYNAMICS OF TARPANA AND ITS UTILITY IN MANAGEMENT OF MYOPIA
After reviewing various researches and
available scientific data regarding Tarpana
it can be concluded that, Tarpana is a supe-
rior therapy than merely using eye drops.
Tarpana acts on the principle of Bahya
Snehana. It can successfully cross the de-
fensive barriers present in eye for absorp-
tion and nourishes the ocular and periocu-
lar structures & also strengthens the
sphincters. On virtue of drug utilised for
Tarpana it also provides nutrition directly
to the target organ. Changes in dioptric
power and visual acuity are evident hence
can be used for successful management of
myopia.
REFERENCES:
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9. Gipson IK, Argueso P. Role of mucins in
the function of the corneal and conjuncti-
val epithelia. Int Rev Cytol. 2003;231:1–
49. doi: 10.1016/S0074-7696(03)31001-0.
10. Ahmed I. The noncorneal route in ocular
drug delivery. In: Mitra AK, editor. Oph-
thalmic drug delivery systems. New York:
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11. Klyce SD, Crosson CE. Transport pro-
cesses across the rabbit corneal epithe-
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10.3109/02713688509025145
12. McLaughlin BJ, Caldwell RB, Sasaki Y,
Wood TO. Freeze-fracture quantitative
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10.3109/02713689509000002
13. Barar J, Javadzadeh AR, Omidi Y. Ocular
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Deliv. 2008;5(5):567–81. doi:
10.1517/17425247.5.5.567.
14. Sunkara GKU. Membrane transport pro-
cesses in the eye. In: Mitra AK, editor.
Ophthalmic drug delivery systems. New
York: Marcel Dekker, Inc; 2003. pp. 13–
58
15. Saha P, Kim KJ, Lee VH. A primary cul-
ture model of rabbit conjunctival epithelial
cells exhibiting tight barrier properties.
Curr Eye Res. 1996;15(12):1163–9. doi:
10.3109/02713689608995151.
16. Geroski DH, Edelhauser HF. Transscleral
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2001;52(1):37–48. doi: 10.1016/S0169-
409X(01)00193-4.
17. Kaufman PL. Accommodation and
Presbyopia: Neuromuscular and Biophysi-
cal Aspects, in Hart WM, editors: Adler's
Physiology of the eye: 9th Ed. St Louis:
CV Mosby; 1994. p. 391-411.
18. https://en.wikipedia.org/wiki/Ghee#cite_n
ote-16 retrieved on 21 feb 2016
19. https://en.wikipedia.org/wiki/Milk re-
trieved on 21 feb 2016
20. Durgesh Prasad Gupta1, Manjusha Ra-
jagopala2, Kartar Singh Dhiman A clini-
cal study on Akshitarpana and combina-
tion of Akshitarpana with Nasya therapy
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in Timira with special reference to myopi-
aAYU, 2010;31:473-7.
21. Poonam, R. Manjusha, D. B. Vaghela, and
V. J. Shukla A clinical study on the role of
Akshi Tarpana with Jeevantyadi Ghrita in
Timira (Myopia) Ayu. 2011 Oct-Dec;
32(4): 540–54522. Poonam, R. Manjusha, D. B. Vaghela, and
V. J. Shukla A clinical study on the role of
Akshi Tarpana with Jeevantyadi Ghrita in
Timira (Myopia) Ayu. 2011 Oct-Dec;
32(4): 540–545
23. Manesh Kumar, a comparative study on
the efficacy of Tarpana and Triphaladi
drug compound in the management of
Timira w.s.r. to myopia, MD Thesis, IPGT
& RA, Jamnagar, 2003
24. Vinayaka Ashu, A clinical study on the
efficacy of Tarpana and Shatavaryadi
churna in the management of Timira w.s.r.
to Myopia. MD Thesis, IPGT & RA, Jam-
nagar, 2004
&67789:6; #?@A67
Dr. Yogita Bende
Asso. Professor, Dept of Panchkarma,
Shri Ayurveda Mahavidyalaya, Nagpur,
Maharshtra, India
Email: [email protected]
Source of support: Nil
Conflict of interest: None Declared
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Pundpal Amitkumar B.2Patil Kuldeep V.
1Assocciate Professor, Shalya Tantra Dept., Late Kedari Redekar Ayurved
Mahavidyalaya,Gadhinglaj, Dist.Kolhapur, Maharashtra, 4165022Assocciate Professor, Shri Kalidas Ayurved Mahavidyalaya,Badami,
Dist.Bagalkot,Karnatak,
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Vatarakta comes under the domain of
Vatavyadi 1 (Nervous disorders) and
mostly affecting the extremities 2. The
umbrella of vatarakta in parlance with
conventional medicine includes manyconditions related to extremities and to
mention a few are connective tissue disor-
ders as well as peripheral vascular disor-
ders. In the literature it is emphasized that
the etiological factors leads to the pre-
dominant morbidity of vata dosa and rakta
dhatu (Blood tissue) and hence the name
vatarakta. To be more specific, the ob-
struction of raktamarga or raktavaha sro-
tas (Circulatory system) is the leading pa-
thology 3.
Two distinct modes of etiopathogenesis ofvatarakta are elaborated in the literature.
The specific etiological factors of vatadosa and rakta dhatu separately leading to
the morbidity of the same with the
involvement of raktamarga (Circulatory
system) is about the first clinical variety of
vatarakta 4. The etiopathogenesis of
second clinical variety is different from
this. In the second clinical type instead of
etiological factors of vata and rakta, it is
Research Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
There is a definite need to study vatarakta (Gout) as peripheral arterial disease and its man-
agement with both sodhana (Purification) and samana (reducing) treatment, with the dueconsideration of its severity, chronicity as well as possible complications. This study is
planned to evaluate the therapeutic effect of Vataraktantakarasa and Lekhana basti (Scraping
agent or ayurvedic drugs used for enema) in patients suffering from Vatarakta. Design: Single
blind clinical study with a pre-test and post-test design. Source of the data: 20 patients of
vatarakta who attended the O.P.D. and I.P.D. of S.D.M. Ayurveda Hospital, Kuthpady,
Udupi, Karnataka. Intervention: Patients were subjected to 16 days course of lekhana bastialong with oral medication with vataraktantaka rasa in a dose of 250mg tid for 30 days Ob-
servations: Out of 20 patients of Vatarakta studied in this work. All the patients had the
Dvandvaja praktiti (Two types of Prakrutis like Vatapittaj,Vatakaphaj etc.). Results: Statisti-
cally significant improvement was observed in all the criteria of assessment that included
regards to pain, burning sensation, malaise and disturbance of sleep, tenderness, walkingability, peripheral pulses and lipid profile. Conclusion: The combination of lekhana basti and
vataraktantaka rasa is an ideal regimen in patients suffering from raktamargavarana janya
vataraktaa (Obstruction for blood causes Vatarakta)
Key Words: Vatarakta, margavarana, raktavahasrotas, ILD, PVD
How to cite this URL: Pundpal Amitkumar B. A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak
Rasa And Lekhana Basti In Vatarakta .International Ayurvedic medical Journal {online} 2016 {cited 2016 April}Available from: http://www.iamj.in/posts/images/upload/595_601.pdf
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
the etiology of kapha(Mucus) and
medas(Fat) that initiates the illness. The
etiological factors of kapha and medas
obviously lead to the morbidity of thesame. This abnormally increased kapha
and medas in turn gets accumulated in the
rakta marga causing the provocation of
vata as well as rakta 5 (Blood). Dietary
habits and life style modalities plays a
major role in the causation of vata rakta.
Also the morbidity of kapha and medas
can cause different other serious diseases
in different systems. Prameha (Diabetes),
Sonitadust(Impure blood disorder) ,hrdroga(Cardiac problem) and vatavyadhi
etc all are found to be due to incriminatory
affect of kapha and medas in respectivesystems6. Hence forth the concept of mar-
gavarana (Obstructed path) in different
parts of the body is emphasized in Caraka
samhita. The pathology of margavarana
leads to the establishment of clinical signs
and symptoms in vatarakta. Further to
add, sodhana, samana, bahiparimarjana and rasayana cikitsa all are aimed at the
rectification of margavarna in this dis-
ease7. The whole concept of margavarana
can be best explained by the pathology ofatherosclerosis and peripheral vascular
disease in modern parlance. Peripheral
vascular diseases include arterial, venous
as well as lymphatic disease, and the ill-
ness has a long lingering course. Inad-
aquate treatment or failure of treatmentmay lead to fatal complications. Further to
add, obstructive arterial diseases are
named after the anatomical structure af-
fected as coronary artery disease, cerebro-
vascular disorders and Ischemic limb dis-eases etc.
OBJECTIVES OF STUDY:
1.
To carry out literary study on vatarakta as
well as the role of kapha
and medas in its causation of vatarakta 2.
To evaluate the therapeutic effect of
Vataraktantakarasa and Lekhana basti in
Vatarakta.
MATERIALS AND METHODS:
Source of the data: The patients who at-
tended the O.P.D. and I.P.D. of S.D.M.
Ayurveda Hospital, Kuthpady, Udupi,
Karnataka, during the period of November
2005 to August 2006, having the signs and
symptoms of Vatarakta were screened.
Inclusion criteria- 20 patients taken in this clinical trial .
- The patients of Vatarakta clinically di-agnosed and confirmed by investigations.
- The patients between ages of 16 to 70
years were included in study.
- Patients were randomly selected irre-
spective of sex, occupation, caste, etc.
Exclusion criteria: The patients suffering
from Vatarakta showing the presence of
followingcriteria were excluded from the study.
- The patients with severe toxicity
-
Progressive gangrenous changes invicinity are excluded from study.
- Diseases of immunological basis and
syphilis are excluded.
Investigations
Following are the list of investigations car-
ried out in 20 patients of Vatarakta taken
for this study. Hb %,TC, DC, ESR, RBS,Liver function test, Blood urea, serum cre-
atinin, Lipid Profile, Arterial Doppler Ul-
tra sound, Arteriography.
Design: It is a single blind clinical studywith a pre-test and post-test design. In this
study 20 patients diagnosed as Vatarakta
of either sex were subjected to clinical
study.
Intervention: The selected patients were
administered with1)
Lekhana Basti as kaala basti course
of 16 days, in which Niruha Basti is
administered in a dose of 480 ml for 6
days by using the enema can. In this
basti course 10 sittings of Anuvasanabasti was also administered with
Shatapaka madhukataila in a dose of
120ml. Anuvasana basti was given by
using Plastic syringe.
2) In conjunction with basti treatment the patient was also treated orally with
Vataraktantaka Rasa in the Dose of
250 mg tid. This oral medication was
continued for 30 days with the
anupana of warm water.
Duration of study: 30 days
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
Assessment criteria: The state of the dis-
ease Vatarakta changes after the interven-
tion. Improvement or otherwise was de-
termined by adopting the standard methodsof scoring for subjective, objective and
special investigation criteria. The Mar-
gavarana was assessed both before and
after the intervention to note any change
by using the arterial Doppler study. Lipid
profile was also studied before and after
the treatment.
Assessment of overall effect : As per the
reduction in the total scores of the assess-
ment parameters, the overall effect is cal-culated as follow-
Complete remission - total score is 0 after
the treatment Marked improvement – re-duction in the mean symptom score by
75to 99% from the initial score.
Moderate remission - reduction in the
mean symptom score by 50 to 74%
Average remission - reduction in the mean
symptom score by 25 to 49%Unchanged - reduction in the mean symp-
tom score by < 24 % from the initial score.Effect of Treatment in Vatrakta-
Effect on Pain: Patients treated with Vata-
raktantakarasa and Lekhana basti had
marked remission of the symptom pain.
1.8 was the mean initial score of pain in 20
patients of Vatarakta which came down to
1.0 after the treatment. The improvement
to the tune of 44.44% is found to be statis-tically highly significant (P!0.001) as
shown in the Table No.1.
Table No.1: Effect of treatment on Pain
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
1.800 1.000 0.800 44.4 0.410 0.0918 t= 8.718 P=
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
patients of Vatarakta. This initial meanscore came down to 0.0500 after the
treatment. The improvement to the tune of
92.30 % was highly significant (P!0.001)
as revealed by the paired‘t’ test. Details ofthe same are given in the Table No.4
Table No.4: Effect of treatment on disturb-
ance of Sleep
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
0.650 0.0500 0.600 92.30 0.503 0.112 t = 5.339 P = !0.001
EFFECT ON TENDERNESS:
Tenderness is another symptom of Vata-
rakta. The initial mean score of the pa-
tients in tenderness was 0.100 which was
reduced to 0.00 after the treatment. The
improvement to the tune of 100% was rec-
orded, is statistically significant. Details of
the same are represented in the Table No.5.
Table No.5 comparison of effect on Ten-
derness
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
0.1000 0.000 0.1000 100 0.308 0.0688 t = 1.453 P = 0.163
EFFECT ON EDEMA: Before the treat-
ment the mean score of symptom of
Edema was 0.350. After the treatment with
Vataraktantak rasa and Lekhana Basti this
was reduced to 0.0500 giving 85.71% ef-
fect. The change that occurred with thetreatment is greater than would be ex-
pected by chance; there is a statistically
significant change (P = 0.010) as assessed
by the paired‘t’ test.
The details of the same are given in the
Table No.6.
Table No.6 Effect of treatment on Edema
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
0.350 0.0500 0.300 85.71 0.470 0.105 t = 2.854 P = 0.010
EFFECT ON LOCAL COLOUR
CHANGES: Patients treated with Vata-raktantak rasa and Lekhana Basti had no
difference in Local color changes. 0.200was the mean initial score in 20 patients of
Vatarakta which remained as 0.200 after
the treatment.Table No.7 Effect of treatment on Local
colour changes
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
0.200 0.200 0.000 0 - - - -
EFFECT ON WALKING ABILITY:
47.22% of improvement was observed in
the score of walking ability. 1.8 was theinitial mean score recorded in the 20 pa-
tients of Vatarakta This was brought
down to 0.950 after the administration of
Vatarakta and Lekhana Basti This
improvement after the treatment is foundto be highly significant (P!0.001) as per
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
the paired ‘t’ test. The details of the differ-
ent statistical values are shown in the Ta-
ble No.8.
Table No.8: Effect of treatment on walking
ability
Mean Score Difference
in means
% Paired ‘t’ test
BT AT S.D S.E.M. t value P value
1.800 0.950 0.850 47.22 0.366 0.0819 t = 10.376 P = !0.001
EFFECT ON PERIPHERAL PULSES: 1.5
was the mean initial score of Peripheral
pulses before the treatment in patients of
Vatarakta This initial mean score came
down to 1.05 after the treatment. The im- provement to the tune of 30 % was signifi-
cant (P=
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
BT AT in means S.D S.E.M. t value P value
39.850 44.500 4.650 4.705 1.052 t = -4.420 P =
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa AndLekhana Bastiin Vatarakta
Results showed that there is definite re-duction in the bad cholesterol and increase
in the good cholesterol following the
treatment. These changes establish the ef-
ficacy of lekhana basti and vataraktantaka
rasa in preventing the progression of mar- gavarana as well as the illness vatarakta. The marginal improvement in the circula-
tion following medication with lekhanabasti and vaataraktantaka rasa confirms
the effect of medicine on reducing themargavarana. Reduction in pain burning
sensation etc proves the reduction in the
morbidity of vata dosa following the
medication. The combination of shodhana treatment in the form of lekhana basti and
shamana treatment in the form of vata-raktantaka rasa is an ideal regimen in pa-
tient’s sufferirng from raktamargavarana janya vataraktaa.
0-2-0--'
1. Chakrapani,on Agnivesa: Charaka
Samhita ,Varanasi, Chaukambha
Sanskrita sansthana, 5th
edi-
tion,2001, Chikitsa sthana, chapter
29, Slok 1, 738 PP, Page no. 628
2.
Sushruta’s, Sushruta Samhita,Varanasi, Chaukambha orientalia,
7th
edition, 2002, Ni-danasthana, chapter 1, slok 1-48,
824 PP, Page no. 264
3. Agnivesa: Charaka Samhita
,Varanasi, Chaukambha Sanskrit
sansthana, 5th
edition,2001,
Chikitsa sthana, chapter 29, Slok 1
- 100, 738 PP, Page no. 627-634
4.
Agnivesa:Charaka sam-hita,,Varanasi, Chaukambha San-
skrit sansthana, 5th
edition,2001,Chikitsa sthana, chapter 29, Slok
10- 738 PP, Page no. 627
5. Agnivesa: Charaka Sam-
hita,Varanasi, Chaukambha San-
skrit sansthana, 5th
edition, 2001,
Chikitsa sthana, chapter 29, Slok
156, 738 PP, Page no. 634
6. Sushruta’s, Sushruta Samhita,
Varanasi, Chaukambha orientalia,7
th edition, 2002, Sutrasthana,
chapter 15, slok 32, 824 PP, Pageno. 73
#,00-'1,&*%&6 !)(/,0
Dr. Pundpal Amitkumar B.
Assocciate Professor, ShalyaTantra Dept.,
Late Kedari Redekar Ayurved
Mahavidyalaya,Gadhinglaj,
Dist.Kolhapur, Maharashtra,
416502Mob. no.- 09420779594
Mail Id-
Source of support: Nil
Conflict of interest: None Declared
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!"#$%&'() +"()%+ (#, (-'&.",(
Dr. Amrutha.B.L1 Dr. Elgeena Varghese
2 Dr. Pratibha Kulkarni
3
1,2.PG Scholars, 3. HOD & Asso Professor Department of Kriyashareera SDM College of Ayur-veda & Hospital Hassan
/#%&0,'1%/0#Ayurveda is the science which deals with
maintenance of health and cure of disease. It
stands on the frame work of Tridoshas,
Saptha Dhathus and Trimalas. Ayurveda
examine the menstrual cycle as a window into
the human body. Artava is considered as the
Upadhathu of the first and foremost dhathu ie
the Rasa dhathu. Rajapravrithi is a normal
physiological process in women as sleep,
bowel activity etc. As the nature and patternof all the physiological and psychological
processes are dependent on the inherent
constitution of doshas ie the Prakruthi, the
pattern and nature of Rajapravrithi should
also show some relation to the Prakruthi ofthe individual. So by understanding the nature
of menstrual pattern in women the menstrual
health can be maintained by administering
according diet and regiments.
Aims and Objectives: An attempt has
been done to analyze the characteristics of
Rajapravrithi according to the Prakruthi or
Doshic constitution of a women.
Artava and Prakruthi: Artava is defined
as the periodical expulsion of blood through
the vagina of an adult female1. It is one of the
most important physiological process which
enables the formation of Garbha. So the
regular and uninterrupted occurrence of
!"#$"% '()$*+" ,-)"(-.)$/-.+ '01(#"2$* 3"2$*.+ 4/1(-.+ ,5567898: ;:
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Dr. Amrutha.B.L et;all : Menstrual Health And Ayurveda
!"#www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
Artava is necessary for a healthy progeny.
Artava is considered as the Upadhatu of Rasa 2. It is produced cyclically and being directed
by Vata and is expelled through the vagina3.
As far as modern science is considered,
menstruation is the process where there is
flow of blood from the uterus through thevagina occurring primarily in humans,
determined by a complex interaction of
hormones4. Prakruthi is the innate constitution
of an individual based on the predominance of
Dosha determined at the time of conception which
cannot be changed till death5. Qualities of Dosha
are expressed on body due to its predominance
and it is called Deha Prakruthi. It is the
enumeration or consideration of body features
internal as well as external. Depending on the Dosha that is predominant in the Sukra and
Shonita at the time of union, the food and
activities of the pregnant women, uterus and
season Prakruthi is determined6. Human body is
made up of Doshas and all physiological
functions are depending on Doshas. Prakruthi of
each individual is determined from the time of
consumption itself. So each individual is specific
in his/her own constitution of Prakruthi . If every
physiological function depend on Doshas, then
there will be a relation between the characteristics
of all physiological functions with individual
Prakruthi and so with menstruation also.
Ayurvedic understanding of the cycle of
Doshas during the whole lifespan is important
particularly in the case of menstrual health in
women. During the earlier stages of life ie.
from the life in vitro through young adulthood
it is the Kapha Dosha which predominates.
Pitta increases dramatically during
adolescence and tends to dominate the body
processes until early thirties. Later stages the
Vata Dosha dominates mainly during sixties
and seventies. So the period of time where
Pitta is dominant is more prone to get
disorders such as high blood pressure, non-
congestive heart disease, hyperthyroidism etc.
It is also a high risk of time for many female
disorders.
Present generation females are facing
many problems related to their menstrua-
tion like painful menstruation, irregular
cycles, irregularity in bleeding patterns etcin their adolescent age without any specific
pathology in their reproductive system. As
long as the Doshas function in their
normal state and are not affected or
overshadowed by another Dosha, the
menstrual cycle happens optimally. In a
specific Prakruthi person there will be
predominance of that particular Dosha
which may interfere with the normal or
optimal functions of the other Doshas. So
according to the Prakruthi there are
chances that there will be variations in the
characteristics of Rajapravruthi. For
example, pain is a feature where Vata is
responsible, so in Vata Prakruthi indi-
viduals there is an increased chance for
painful menstruation, Pitta Prakruthi in-
dividuals may get subjected more to mood
variations, Kapha Prakruthi individualsmay have more clots in their menstrual
blood etc. During the period of menopause
also, different symptoms can be seen in
women with different intensities, that may
be due to the variations in bodily
constitution. Mostly premenopausal
symptoms are due to increased Pitta which
will get exhibited as hot flushes, rashes
over skin, intolerance to heat etc.
DISCUSSION
Vatika menstrual flow
As Vata dominates the uterus, its Sheeta
and Khara qualities causes the blood ves-
sels to constrict. Ruksha guna depletes the
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!"%www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
bodily tissues and finally causes early
cessation of menstrual flow. Due to de-
crease in plasma and blood tissues, de-
creased nourishment to the endometrial
lining of uterus the overall flow and men-
strual discharge will be less. Where ever
there is a blockage for the free flow ofVata, there will be pain. So most of the
Vata dominating cycles will be painful.
Paittika menstrual flow
Pitta is hot and sharp. So it brings more
fluidity to the blood so that it flows easily.
Pitta resides in blood and in excess I may
cause heavy bleeding. As it causes
tendency for swelling, it leads to tender,
swollen breasts, acne etc that women ex- perience during their premenstrual period.
Kaphaja menstrual flow: Kapha is
dull, heavy and sticky. Stronger the influence
of Kapha Dosha, the more likely to get a
prominent growth of the endometrial tissue.
As more blood vessels grow to supply this
growth, the Kapha cycle is more likely to
experience a heavier flow than Vata cycle.
General Menstrual Care: Menstrual
cycle is an effective monthly cleanse. Soit is essential to support the process of
cleansing. All cleansing actions are giving
importance to rejuvenation, rest and
kindling of Agni.
Guidelines for healthy menstrual
cycle
1. Consume simple, freshly prepared and
hot food items. Try adding spices such
as Ginger, Cardamom, Cumin,
Coriander and Cinnamon
2. Cleansing involves the downward
movement of wastes out of the body. So
the direction of flow should not be
interrupted by any upward movements
like excessive talking, thinking, sexual
intercourse and even Pranayama and
Yoga. All these activities need energy
and our body needs to use all its reserve
energy towards cleansing
3. Suppression of urges like urination,
defecation and sneezing should be
avoided. All these will cause the upwardflow of Vata which will disturb the free
flow of cleansing action.
4. Meditation will bring peace of mind
which again assists the action of Vata
5. Hydrate the body with warm teas such as
ginger tea, lemon tea with honey, cumin,
coriander and fennel teas.
6.
Maintaining the balance of Doshas even
at the time without menstruation is also
important. The better way to maintain
Doshas in equilibrium is to do yearly
cleanse. Seasonal cleansing is highly
effective way to balance and rejuvenate
all bodily tissues so that they function
optimally.
7. Practicing Pranayama for balancing the
mind as it helps to equalize the right and
left sides of the brain and Yoga as per
constitution will keep your body strongand energetic.
Herbal care for healthy men-
struation
Herbs can be used in accordance to the
Doshas involved. In a Vatik cycle mainly
Dasamoola can do its work of pacifying
Vata dosha. Ginger is another drug which
helps in a Vatik flow with discomfort.
Herbs can really help in Pitta flow
mainly. Asoka tones the uterus and thus
eases a heavy flow. Satavari, Amalaki,
Gudoochi, Kumari, Brahmi etc are useful
drugs in a Paittik flow as they are very
famous for their Pitta pacifying action.
Spices such as cinnamon, cardamom,
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!"&www.iamj.in IAMJ: Volume 4; Issue 04; March- 2016
black pepper etc are useful in case of a
Kaphaja cycle due to their Agni
stimulating action. Castor oil pack due to
its warm and penetrating quality can break
up the stagnation latent in the pelvis.
Paying an eye on the characteristics of
menstruation will bring into light the Dosha which is predominant in that cycle.
That may also be depending on the
Prakruthi of the individual. Application of
theories related to Doshas and practical
application of drugs mentioned for
particular Doshas will help to cure the
discomforts or ailments during menstru-
ation.
CONCLUSION
Being the natural cleansing process of the
body menstruation needs anassistance from
the individual. The unobstructed flow of
menstrual blood will be possible only by the
optimal assistance of the Tridoshas. Any
disturbance in the equilibrium of Doshas will
create problems in menstrual cycle. In a
particular Prakruthi there is a physiological
increase in the level of that particular dosha,which may show its effect on the character-
istics of menstruation. Such effects due to the
Prakruthi of the individual may cause some
ailments which can be considered
physiological. So understanding the Doshic
play and adequate application of medication,
control of diet and regiments is needed to re-
store the optimal action of menstrual cycle
which is very crucial to maintain the health of
a women.
REFERENCES
1. Paradakara HSS. Ashtanga Hrudaya with
Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana
commentary of Hemadri.Reprint ed .
Varanasi (India): Chaukambha
publications; 2011. p.363
2. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi(India): Chaukambha Orien-
talia;2009.p.514
3. Paradakara HSS. Ashtanga Hrudaya with
Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana
commentary of Hemadri.Reprint ed .
Varanasi (India): Chaukambha publi-
cations; 2011. p.361
4. Usha VNK.A Text Book OF Obstetrics
Prasuthi Tantra,Vol 1,Reprint ed , Va-
ranasi,Chaukambha Sanskrit
Prathishthan;2013.p.71
5. Acharya JT. Susrutha Samhita with Ni-
bandhasangraha commentary of Dalhana.
Reprint ed. Varanasi (India):
Chaukambha Sanskrit Sansthan; 2009. p.
360.
6. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary ofChakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orien-
talia;2009.p.516
10&&"$20#,/#3 ('%+0&
Dr. Amrutha.B.L
Department of Kriyashareera SDMCollege of Ayurveda & Hospital Hassan
Karnataka, India
Source of support: Nil
Conflict of interest: None Declared
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! #$%&%#!$ '()*+ ,& -+./0$%.%*/1%! 2%(-
1/*,-!0 3)33)$) !&* $/4-!&%+! 1!-!4!'-!+!1DR . SANDEEP SINGH 2Dr. S. G. Chavan
3DR . M. A. HULLUR
1M.D.Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India2M.D.(Ayu),Prof. and Guide, Department of Kayachikitsa,Ayurveda Mahavidyalaya, Hubli, Karnataka,
India3M.D.(Ayu), Ph.D. (Ayu),Prof. and Principal,Department of Kayachikitsa,Ayurveda
Mahavidyalaya,Hubli, Karnataka, India
%&(0,*)#(%,&5
Ayurveda, the ancient science of life is being
increasingly accepted by the world at large for
its relevance and adoptability to the modern
science. As we moved into rapid moderniza-
tion, the lifestyle of an individual has become
sedentary along with lack of exercise and there
is increased popularity of fast foods leading to
impairment of metabolism in an individual
making him prone to series of disorders called
as lifestyle disorders. Everybody constituents
have specific proportions and specific functions
in the body. They will perform their functions
only in their optimal levels. The normal level is
maintained by controlling the metabolism. The
metabolism is normally regulated by a well-de-
veloped controlling system functioning in the
healthy body. Healthy state is maintained by
keeping the equilibrium of various constituents
of the body. Any abnormalities in the control-
ling system will lead to abnormalities in this
equilibrium and thus leads to various diseases.
Research Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
Hyperlipidemia means abnormally high levels of lipids in the blood. These lipids or fats include cho-
lesterol and triglycerides. It results from abnormalities in lipid metabolism or plasma lipid transport or a
disorder in the synthesis and degradation of plasma lipoproteins. Sedentary life style and increased popularity of fast foods are the most contributory factors. More than half of the Coronary Heart Dis-
eases (CHD) are attributable to abnormalities in the levels and metabolism of plasma lipids and lipo-
proteins. . In India, persons suffering from CHD have increased in last 20 years. It is estimated that
there are almost 224 million people with high cholesterol in India. According to WHO, raised serum
cholesterol levels is one of the top ten causes of death throughout the world. There are many effective
medicines and therapies described in different classics of Ayurveda for treating the hyperlipidemic
activity. A clinical study comprising of 25 patients of either sex attending OPD clinic of AMVH Hubli
presenting with Hyperlipidemia confirmed by Lipid Profile were treated with Medhohar Guggulu and
Lekhaniya Mahakashaya. The results shown were highly significant.
KEY WORDS: Hyperlipidemia, MedhoharaGuggulu, LekhaniyaMahakashaya
How to cite this URL: Dr. Sandeep Singh, A Clinical Study on Hyperlipidemia with Medohar Guggulu and Lekhaniya
Mahakashaya. International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:
http://www.iamj.in/posts/images/upload/606_612.pdf
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D R . S ANDEEP S INGH E T ;A LL : A C LINICAL S TUDY O N H YPERLIPIDEMIAW ITH M EDOHAR G UGGULU A ND L EKHANIYA M AHAKASHAY A
!"#www.iamj.in IAMJ: Volume 4; Issue 05; april;- 2016
Hyperlipidemia is one such disorder where
there is an abnormally elevated level of any
one, or all lipids and lipoproteins in the blood.
It is most common form of "dislipidemia". Li-
pids consist of fats, waxes, sterols, mono-
glycerides, phospholipids, and fat-soluble vita-
mins and minerals. Since lipids are hydrophobic
i.e. insoluble in water, these are (e.g. choles-
terol) transported in the blood plasma within
protein particles (lipoproteins). It is of utmost
significance because it leads to atherosclerosis
of vessels (arterial walls) leading to vascular
accidents like Cerebro vascular or Coronary
Artery Diseases.More than half of the Coronary
Heart Diseases (CHD) are attributable to
abnormalities in the levels and metabolism of plasma lipids and lipoproteins. However, ele-
vated lipoprotein levels in most patients with
CHD reflect the adverse impact of sedentary
lifestyle, excess body weight, and diets high in
total and saturated fat superimposed on a ge-
netic background that confers susceptibility to
increased circulating lipids. In India, persons
suffering from CHD have increased in last 20
years. In South India CHD incidence is 7% in
rural areas and 13% in urban areas.Accordingto WHO, raised serum cholesterol levels is one
of the top ten causes of death throughout the
world.Several modern drugs are available for
the management of Hyperlipidemia where most
of them are potentially toxic, costly and are
contraindicated in hepatic or renal impairment,
gall bladder disease and pregnancy. Atorvas-
tatin is one such a drug of choice which is
highly used and recommended in hyper-
lipidemia. It has shown very good results but
also responsible for many side effects like myo-
sitis, joint pain, stomach upset, liver damage
and many more. Here, Ayurveda can intervene
by modifying the risk factors aiming at the pre-
vention.It can be included under santarpana-
janyavyadhi as “Medoroga”. It is a condition
caused by derangement of agni, leads to ama-
rasa, there is medodhatvagnimandya leading
to improper formation of medodhatu in excess
and if not arrested further results in sthoulya
and other santarpanjanya vyadhi’s1.Lack of
physical exercise and indulging in
Kaphavardhaka ahara leads to Medovriddhi and
hence causes “Medo roga”2. The morbid
accumulation of kapha and meda tends to get
adhered to the vessel wall causing its thicken-ing, tortuosity, stiffness as well as narrowing.
This change in the vessel wall is referred as
Dhamani pratichaya3 (throm-
bosis/atherosclerosis). Thus considering above
facts, this study is intended in treating the Hy-
perlipidemia with Medhohar Guggulu and Lek-
haniya Mahakashaya.
AIMS AND OBJECTIVES:
1. To study Hyperlipidemia according to
Ayurveda and Modern science. 2. To study efficacy of Medhohar Guggulu
and Lekhaniya Mahakashaya in Hyper-
lipidemia
MATERIALS AND METHODS:
1. Trikatu Churna4
2. MedhoharGuggulu5
3. Lekhaniya Mahakashaya6
STUDY DESIGN:A minimum of 25 Subjects di-
agnosed as Hyperlipidemia were selected after
fulfillment of inclusion criteria.
Procedure Drug used Matra No.of Days
Ama Pachana Trikatu Choorna
5 gms BD with warm water
before food
3 days (or till
niramalakshana seen)
Lekhaniya
Mahakashaya
30 ml
before food 60 days
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D R . S ANDEEP S INGH E T ;A LL : A C LINICAL S TUDY O N H YPERLIPIDEMIAW ITH M EDOHAR G UGGULU A ND L EKHANIYA M AHAKASHAY A
!"%www.iamj.in IAMJ: Volume 4; Issue 05; april;- 2016
Samanoushadhi Medhohar
Guggulu
250 mg (2 BD) with luke-
warm water after food 60 days
Duration- 2 months - weekly visit
Follow up- 1 month - Fortnightly visit
INCLUSION CRITERIA:
•
Aged between 20-60 yrs.
• Had clinical features of Medoroga.
• Both obese and non-obese patients were se-
lected for the study.
• Both the sex (male and female) were se-
lected for the study.
• Subjects having all or at least any one of
the lipid profile above normal range
were selected for the study.
EXCLUSION CRITERIA:1. Subjects had history of serious cardiac
disorders like Myocardial infarction,
Cardiac failure, etc.
2. Subjects had any major illness,
Hypertension or if the patient was al-
ready taking some therapy or recently
adjusted therapy.
3. Subjects had history of Thyroid disorder,
Renal disorder, Cholelithiasis and PCOS.
4.
Subjects with systemic disorders which
interfere with the course of treatment.
5. Hyperlipidemia due to Consumption of
drugs such as glucocorticoids.
6. Pregnant women and lactating mothers.
WITHDRAWAL CRITERIA:
1. If the patients having clinical feature would
aggravated into serious condition.
2. If the patient is irregular in the decided
course of treatment.
Intervention
• Amapachana with Trikatu Churna 5gm BID
30 minutes before food with Ushnodaka as
Anupana till niramalakshana seen.
• Subjects were subjected for
ShamanaChikitsa with Lekhaniya
Mahakashaya (30ml BID) with water
before food for 60 days.
• Medhohara Guggulu (250 mg BID) with
lukewarm water after food for 60 days.
• Pathya Aahara and Pathya Vihara was ad-
vised to all the Subjects.
ASSESSMENT CRITERIA:Subjective parameter
• Ashaktahsarvakarmasu (Difficulty in
routine acitivities)
• Kshudrashwasa (Dyspnoea)
• Utsahahani (Lethargic)
• Angagaurava (Heaviness in body parts)
• Daurbalya (Weakness/Decreased physical
activity)
• Swedhadikya (Increased Perspiration)
• Trishna (Increased Thirst)
• Nidradikya (Increased Sleep)
• AlpaMethunah (Decreased sexual desire)
Objective parameter
• Lipid profile before and after treatment.
Gradation of Clinical feature
1-ASHAKTAH SARVAKARMASU: (Diffi-
culty in routine acitivities)
Not seen - 0
Lack of interest in doing activity with feeling of lethargic. - 1
Lack of interest in doing activity with fatigability. - 2
Absolutely no interest in doing activity and easy fatigability. - 3
2- KSHUDRA SHWASA: (Dyspnoea)
Dyspnoea after heavy work (movement) but relieved soon and up to tol-erance
- 0
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!"&www.iamj.in IAMJ: Volume 4; Issue 05; april;- 2016
Dyspnoea after little work but relieved later and up to tolerance - 1
Dyspnoea after little work but relieved later and beyond tolerance - 2
Dyspnoea in resting condition - 3
3- UTSAHA HANI: (Lethargic)
No lethargy (Doing work satisfactorily with proper vigor in time) - 0
Doing work at his own with lethargy and late initiation - 1
Not starting any work on his own responsibility and doing little work veryslowly
- 2
Does not take any initiation and not want to work even after pressure - 3
4-ANGA GAURAVA: (Heaviness in body parts)
Not felt - 0
Feeling heaviness in the body - 1
Heaviness not pertaining to do more work - 2
Totally sedentary due to heaviness of body - 3
5- DAURBALYA: (Weakness/Decreased physical activity):
Can do routine exercise - 0
Can do moderate exercise without difficulty - 1Can do mild exercise with very difficulty - 2
Can not do even mild exercise - 3
6- SWEDADIKYA: (Increased Perspiration)
Sweating after heavy work and fast movement or in hot season - 0
Profuse sweating after moderate work and movement - 1
Profuse sweating after little work and movement - 2
Sweating even at rest or in cold season - 3
7- TRISHANA: (Increased Thirst)
Normal thirst - 0
Thirsty but relieved after drinking 1-2 liter of water - 1
Thirsty but not relieved after drinking 1-2 liter of water - 2
Repeated thirst and not relieved at all - 3
8- NIDRADIKYA:( Increased Sleep)�