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Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

COMPARATIVE ANTI MICROBIAL STUDY OF SHUDDHA KASISA AND


KASISA BHASMA
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
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.
INTRODUCTION
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 of
microorganisms 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

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

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 in
contact 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 usedMueller Hinton agar,
Mueller Hinton broth, Sabouraud
dextrose broth
and Sabouraud dextrose agar.
Standard drug disc Gentamycin (10
g/disc) for Gram negative, Ampicillin (10
g/disc) for Gram positive, Amphotericin B
(20 g/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

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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 water
with 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

IAMJ: Volume 4; Issue 04; March- 2016

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

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

remaining parts of the plate. Each sterile


organism were transferred to the respective
disc was loaded with the 20 l of respective
solidified agar aseptically. Transferred
drug or blank. First, Petri plates were kept in
cultures were uniformly distributed all over
fridge for 30 min. for drug diffusion and
the surface of agar medium using L
then transferred into the respective
spreader. Respected standard was kept in the
incubator. Zone of inhibition were measured
center of the respective part of the plate.
using antibiotic zone reader after 24 h for
Three sterile discs were transferred into the
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 of
Shuddha 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),

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Gram positive Strain Staphylococcus


aureus (NCIM2079) and Fungal Strain
Candida albicans were selected. Standard
drugs used were Gentamycin (10 g/disc)
for Gram negative, Ampicillin (10 g/disc)
for Gram positive and Amphotericin B (20
g/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 of
inhibition 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

IAMJ: Volume 4; Issue 04; March- 2016

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

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.
CONCLUSION

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

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Figure 4: Candida albicans

IAMJ: Volume 4; Issue 04; March- 2016

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

REFERANCE
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 for
Antimicrobial 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.

CORRESPONDING AUTHOR
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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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

GOAT MILK: BOON FOR PULMONARY TUBERCULOSIS PATIENTS


Nishigandha Dandekar1, Nalin Shah2
1
. MD (Ayu.) Scholar, Department of Rasashastra and Bhaishajya kalpana
2
. Lecturer, Department of Rasashastra and Bhaishajya kalpana, Y.M.T. Ayurvedic Medical College.
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 important Ayurvedic drug in chikitsa of Rajayakshma vyadhi. Thus review of goat milk according 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 research, it has anti-fungal, anti-microbial properties which affect lungs. It also has immunological 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.
INTRODUCTION:
Pulmonary Tuberculosis remains a major
public health problem in developing countries. It causes due to infection with Mycobacterium tuberculosis. It causes 2 million deaths per year in all over the world.
Majority of the cases are likely to occur in
the worlds poorest nations, who struggle
to cover the cost associated with management and control programme. Thus many
patients remain untreated or receive incomplete treatment which results in multi
drug resistant tuberculosis (MDR TB). TB
statistics published by WHO in 2015 includes India amongst the 14 TB, MDR TB
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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and TB/HIV high burden countries1. Current estimates suggest that around one
third of worlds population has latent tuberculosis. 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 tuberculosis
is correlated with Rajayakshma mentioned
in Ayurvedic texts. It is a contagious disease 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 infection can also be considered the etiology
of Rajayakshma and this is the San-

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

nikrishta cause of the Rajayakshma. Modern 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 disease. Similarly, there are two type of nidana 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 sahasjanya, sandharanajanya, kshayajanya and
vishamashanajanya. These may act like
provocating factors responsible for the dis-

ease. Also, Trirupa, Shadrupa and Ekadashrupa lakshana of Rajayakshma have


been correlated to signs and symptoms of
pulmonary tuberculosis4. Chikitsa for Rajayakshma rogi according to Ayurveda is
Chhagaseva5. Meaning of word Chhaga &
Aja is Goat. Sushruta samhita, Chakradatta, Vangasena, Yogratnakara have advocated the use of various products obtained 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 with
goat's faces and urine. In current study, literature review on goat milk is done.

REVIEW OF GOAT MILK


Ayurveda texts:
SrN. Text
1.

Ca. Sa. Kashay


madhur

Shita

Dosha
ghnata
-

2.

Su. Sa.

3.

A. Hr.

Bha.
Pra.
Ni.

Kashay Shita
Madhur

Yo. Ra. -

585

Rasa

www.iamj.in

Virya

Vipaka

Katu

Uses

Properties similar
to cow milk.
Dipaniya, Laghu,
Sangrahi
Laghu

Grahi, Laghu

Grahi, Laghu

Tridosha Properties similar


to cow milk,
Vishesh dipana,

IAMJ: Volume 4; Issue 04; March- 2016

Roga
Ghnata
Kshaya,
Kasa,
Atisar, Raktapitta,
Jwara,
Shosha,
Kasa
Shwasa,
Raktapitta
Shosha,
Shwasa
Jwara,
Atisar, Raktapitta
Kshaya
atisar
Kasa,
Jwara,
Raktapitta
Kshaya,
Arsha,
Jwara

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

Grahi, Laghu

Atisara,
Raktadosh
Bhrama,
6
Kai.
Madhur Shita
Kapha
Properties similar Kshaya,
Ni.
Kashay
to cow milk,
Kasa Arsha,
Dipana, Laghu
Jwara
Sangrahi,
Shwasa,
Snigdha,
Atisara,
Mrudu, Balya
Trushna,
Shukrala,
Vatarakt
Raktapitt
7
Dha.
Kashay Shita
Grahitara, Laghu Kshaya,
Ni.
Madhur
Kasa
Jwara,
Atisar, Raktapitta.
8
Ni. Ra. Kashay Shita
Grahi, Laghu
Kshaya,
Madhur
Kasa
Jwara,
Atisar, Raktapitta
9
Ra. Ni More potent than Sarva
cow milk, Diet for Vyadhi hara
weak person.
Table No. 1: Properties of goat milk according to Ayurvedic literature.
Modern research papers:
Sr. N
1.

Drug
Goat milk

2.

Goat milk lac- Indian journal of experimental


toperoxidase
biology 1998 Aug;36 (8):80810. PMID: 9838883
Goat milk lac- Life
toperoxidase
Sciences.2000;66(25):24339.PMID -10894086

3.

Journal/Article
Ancient Science of Life 1993
January; 12 (3-4) :335-337 Pubmed ID: 22556611

4.

Goat
Milk-Serum
Amyloid A-3
Protein

5.

Goat

586

Proved activity/ Findings


87.06 per cent inhibition in the spore germination of fungi Absidia corymibifera.(third-most-common cause of invasive fungal infection in immunocompromised patients.)
Anti bacterial property

antifungal and antibacterial property

International Conference on 1) Antimicrobial activity


Antimicrobial
Research
S. Aureus
(ICAR2010)
Valladolid
Enteropathogenic E. coli.
(Spain), 3-5 November 2010 2) Gastrointestinal
protection and
immunological role
milk Asian journal of animal sci- Anti bacterial property:

www.iamj.in

IAMJ: Volume 4; Issue 04; March- 2016

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

ences January 2011


Vibrio cholerae,
DOI:10.3923/ajas.2011.56.63 Salmonella typhi,
klebsiella pneumoniae,
Shigella dysenteriae.
6.
Goat milk
Indian J. Dairy Sci. 65(4), Size of fat globules - less than 5
2012
microns is 83% thus easy digestion.
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. In vivo study - Animals with symp2001; (Barrionuevo et al toms of malabsorption show more
2002; Alferez et al, 2003; efficient absorption of calcium,
Campos et al, 2003; Lopez- phosphorus, iron, copper, zinc, magAliaga et al, 2003).
nesium and selenium from goat milk
compared to cow milk
Table No. 2: Properties of goat milk according to Modern research work.
coli, Vibrio cholerae, Salmonella typhi,

klebsiella
pneumoniae,
Shigella
RESULTS AND DISCUSSION:
dysenteriae which cause diarrhea and
According to review of Ayurvedic literadysentery. It shows immunological role in
ture, goat milk is beneficial in Kshaya,
gastrointestinal protection.
Shosha which are synonyms of In Rajayakshma rogi, samprapti7 (pathoRajayakshma.
physiology) starts with agnimandya
Main symptom of rajayakshma is cough,
(diminished digestive activity) and
breathlessness, and fever.
rasavaha strotas avarodha which causes
Goat milk has efficacy on Kasa, shwasa
kshaya of further dhatu. Goat milk has
and jwara. According to research work,
deepana, grahi, laghu, balya, shukrala
goat milk causes inhibition in the spore
properties which can cause samprapti
germination of fungi Absidia corymibifera
bhanga. It has 83% fat globules which are
which affects lungs. Also, goat milk has
less than 5 microns size. Thus it is easy
anti bacterial and anti fungal properties. It
for digestion. Also, it has higher values of
has anti microbial activity against S.
Caprylic acid,capric acid, Medium chain
Aurius which causes diseases like
triglyceride which are used in treatment
pneumonia, UTI, sinusitis, infective
for Malabsorption syndrome, and
endocarditis, osteomyelitis etc. which
Steatorrhea. Animal study shows that
induce fever.
absorption of micro nutrients is more
According to Charaka samhita6, Purisha
efficient from goat milk in comparison
rakshan is very important in case of
with cow milk.
rajayakshma rogi. Goat milk has efficacy
It has properties similar to cow milk
on atisara. According to modern research,
which is best amongst all milks according
it has anti bacterial properties against E.
to Ayuveda.
lacto
peroxidase

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IAMJ: Volume 4; Issue 04; March- 2016

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

CONCLUSION:

5. Chakradatta Rajayakshma chikitsa shloka


92, Dr.Indradev. Tripathi, 4th edi 2002,
Pulmonary tuberculosis is correlated with
Chaukhamba Sanskrit Sanstha.
Rajayakshma.
6. Charak samhita (vol-2), Chikitsa
Ayurvedic literature review cocludes that
sthan 8/41,42, Acharya vidyadhar
goat milk can break pathophysiology of
shukla, reprint 2004, Prakashan
Rajayakshma.
Chaukhambha Sanskrit Pratishthan.
Modern research papers support the proper7. Charak samhita (vol-2), Chikitsa
ties of goat milk mentioned in ayurvedic
sthan 8/39,40, Acharya vidyadhar
texts.
shukla, reprint 2004, Prakashan
Thus, goat milk can be an effective mediChaukhambha Sanskrit Pratishthan
cine in Pulmonary tuberculosis patients.
CORRESPONDING AUTHOR
Dr. Dandekar Nishigandha Sadanand
RFERENCES:
(MD scholar) Rasashastra and Bhaishajya
1. Global tuberculosis report 2015.
kalpana 5-B, R.B.I. colony, Old Dombivli
2. Pg No. 9, Date- 17/2/2016, Maharashtra
road, Vijaynagar, Dombivli (west). Pin
Times.
421202
3. Sushrut samhita, Nidan sthan 5/34,
Email ID nishid10@gmail.com
Acharya Priyavat Sharma, reprint 2004,
Prakashan Chaukhamba surbharati
prakashan.
4. Anish Kumar, Comparative study of rajayakshma and pulmonary tuberculosis,
Indian journal of re-search (2014)8,9-13

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Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

PHARMACODYNAMICS OF TARPANA AND ITS UTILITY IN MANAGEMENT OF MYOPIA


1

Bende Yogita 2Sarika Choure 3Suraj Rathod 4Auti Swapnil S


1
Asso. 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.
ABSTRACT
Nearsightedness, or myopia, is the most common refractive error of the eye, and it has become 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 scientific 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.
INTRODUCTION:
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 development 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. Various surveys in India have found the myopia prevalence ranging from 6.9% to
19.7%.1,2 Due to the significance of myopia as a global public health concern, it
was chosen as a priority for Vision 2020,

World Health Organization's global initiative for the elimination of avoidable blindness by year 2020.3 Ayurvedic ocular therapies also known as Kriyakalpa are well
known now a day in management of Myopia which is considered as Timira in Ayurveda. 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-

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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 Snehadhyaya 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 Tarpana. Ghruta is effective in subsiding Pittaja and Vataja disorders, it improves
Dhatus and is overall booster for improving 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 Sansakaranuvartana quality easily imbibes the
properties of other drugs processed with it
without leaving its own properties.7 Ghruta
is also Sheeta Veerya, hence the eye being
the site of Alochaka Pitta can be effectively managed by constantly using Ghee
for Akshi Tarpana. Ghruta also contains
properties like Balya, Brimhana and Rasayana, 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 variety 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

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the anterior segment such as the iris and


ciliary body (anterior uvea). Upon administration, precorneal factors and anatomical
barriers negatively affect the bioavailability 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 surface, 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 l, and the cul-de-sac
can transiently contain around 30 l of the
administered ocular drug. However, tear
film displays a rapid restoration time of 2
3 min, and most of the topically administered solutions are washed away within
just 1530 s after instillation. Considering
all the precorneal factors, contact time
with the absorptive membranes is lower,
which is considered to be the primary reason 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 hydrophilic layer barrier and provides more drug
available for absorption. In addition, various layers of the cornea, conjunctiva, and
sclera play an important role in drug permeation. The cornea, the anterior most
layer of the eye, is a mechanical barrier
which limits the entry of exogenous substances into the eye and protects the ocular
tissues. It can be mainly divided into the

IAMJ: Volume 4; Issue 04; March- 2016

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

epithelium, stroma, and endothelium. Each


layer offers a different polarity and a potential rate-limiting structure for drug permeation. 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 administered hydrophilic drugs. Furthermore,
superficial corneal epithelial cells are
joined to one another by desmosomes and
are surrounded by ribbon-like tight junctional complexes (zonula occludens)11,12.
Presence of these tight junctional complexes retards paracellular drug permeation
from the tear film into intercellular spaces
of the epithelium as well as inner layers of
the 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 paracellular 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 lipophilic drug molecules. Endothelium is the
innermost monolayer of hexagonal-shaped
cells. Even though endothelium is a separating 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 Furthermore, the corneal endothelial junctions
are leaky and facilitate the passage of macromolecules between the aqueous humor
and stroma.14 Thus, corneal layers, particularly the epithelium and stroma, are considered as major barriers for ocular drug

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delivery. It is vital to understand that the


permeant should have an amphipathic nature in order to permeate through these
layers. Certain drugs used for Tarpana like
Siddha Kshira are of this nature. Compared to cornea, conjunctival drug absorption is considered to be nonproductive due
to the presence of conjunctival blood capillaries and lymphatics, which can cause
significant drug loss into the systemic circulation thereby lowering ocular bioavailability. Conjunctival epithelial tight junctions can further retard passive movement
of hydrophilic molecules.15 However, in
Tarpana the drug used is significantly in
high dose that can give enough bioavailability even after the loss in systemic circulation 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 extracellular matrix. Permeability through the
sclera is considered to be comparable to
that of the corneal stroma. Recent reports
indicate that the permeability of drug molecules across the sclera is inversely proportional to the molecular radius.16 Tarpana when did with Siddha Ghruta, it
contains more small chain fatty acids having small molecular radius than the long
chain fatty acids. Thus, they may get readily 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 accommodation which can retain this pressure effect
for longer duration.
More contact time: Ghruta preparations
used 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: Accommodation 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
The dioptric power of the spherical lens
drugs: Ghruta is used widely for Tarpana
was reduced by 9 to 20 % in most of the
which contains mainly omega-3 & 6 fatty
researches. Durastha Avyakta Darshana or
18
acids, Vit A, E & K & antioxidants. Milk
indistinct
distant
vision,
is also used for Tarpana which contain vaNetrasrava, Netradaha , Netrayasa ,
riety of Vitamins, minerals, amino acids
and Shirobhitapa were reduced statistically
19
etc.
significantly (P<0.001). clinical refraction,
Review of researches to understand the
for spherical lens, average improvement of
20,21,22,23,24
clinical utility:
.
14-26 % can be achieved through TarTarpana is used in Shalakya a branch of
pana. In old myopes also about 20% imAshtang Ayurveda to treat mainly Myopia.
provements can be seen with Tarpana.
Variety of Tarpana formulations have been
Jeevantyadi Ghruta, Triphala Ghruta, Gotried in various researches. Its clinical
Ghruta, Ghrutamanda, Patoladi Ghruta
utility can be understood by reviewing
have been used in various researches.
these researches.
CONCLUSION:

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IAMJ: Volume 4; Issue 04; March- 2016

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 superior therapy than merely using eye drops.
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 & also strengthens the
sphincters. On virtue of drug utilised for
Tarpana it also provides nutrition directly
to the target organ. Changes in dioptric
power and visual acuity are evident hence
can be used for successful management of
myopia.
REFERENCES:
1. Jain IS, Jain S, Mohan K. The epidemiology of high myopia-changing trends. Indian J Ophthalmol 1983;31:723-8
2. Mohan M, Pakrasi S, Zutshi R. Myopia in
India. ActaOphthalmolSuppl 1988;185:1923.
3. McCarty CA, Taylor HR. Myopia and vision
2020.
Am
J
Ophthalmol
2000;129:525-7
4. Agnivesha, Charakasamhita. Varanasi,
India: Chaukhamba Sanskrit Series; 2004.
Charaka Siddhisthana. 1/7, P 678
5. Agnivesha, Charakasamhita. Varanasi,
India: Chaukhamba Sanskrit Series; 2004.
Charaka Sutrasthana. 13/25, P 83
6. Agnivesha, Charak Samhita, Rashtrita
Sanskrita Sansthan, New delhi, reprint
2006; sutrasthana13 / 14
7. Agnivesha, Charakasamhita. Varanasi,
India: Chaukhamba Sanskrit Series; 2004.
Charaka Sutrasthana. 13/13, P 82
8. Ananthula HK, Vaishya RD, Barot M,
Mitra AK. Duane's Ophthalmology. In:
Tasman W, Jaeger EA, editors. Bioavailability. Philadelphia: Lippincott Williams &
Wilkins; 2009
9. Gipson IK, Argueso P. Role of mucins in
the function of the corneal and conjunctival epithelia. Int Rev Cytol. 2003;231:1
49. doi: 10.1016/S0074-7696(03)31001-0.

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10. Ahmed I. The noncorneal route in ocular


drug delivery. In: Mitra AK, editor. Ophthalmic drug delivery systems. New York:
Marcel Dekker; 2003. pp. 33563
11. Klyce SD, Crosson CE. Transport processes across the rabbit corneal epithelium:
a
review.
Curr
Eye
Res.1985;4(4):32331.
doi:
10.3109/02713688509025145
12. McLaughlin BJ, Caldwell RB, Sasaki Y,
Wood TO. Freeze-fracture quantitative
comparison of rabbit corneal epithelial and
endothelial membranes. Curr Eye Res.
1985;4(9):95161.
doi:
10.3109/02713689509000002
13. Barar J, Javadzadeh AR, Omidi Y. Ocular
novel drug delivery: impacts of membranes and barriers. Expert Opin Drug
Deliv.
2008;5(5):56781.
doi:
10.1517/17425247.5.5.567.
14. Sunkara GKU. Membrane transport processes 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 culture model of rabbit conjunctival epithelial
cells exhibiting tight barrier properties.
Curr Eye Res. 1996;15(12):11639. doi:
10.3109/02713689608995151.
16. Geroski DH, Edelhauser HF. Transscleral
drug delivery for posterior segment disease.
Adv
Drug
Deliv
Rev.
2001;52(1):3748. doi: 10.1016/S0169409X(01)00193-4.
17. Kaufman PL. Accommodation and
Presbyopia: Neuromuscular and Biophysical 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
retrieved on 21 feb 2016
20. Durgesh Prasad Gupta1, Manjusha Rajagopala2, Kartar Singh Dhiman A clinical study on Akshitarpana and combination of Akshitarpana with Nasya therapy

IAMJ: Volume 4; Issue 04; March- 2016

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

in Timira with special reference to myopiaAYU, 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): 540545
22. 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): 540545
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

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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, Jamnagar, 2004

Corresponding Author
Dr. Yogita Bende
Asso. Professor, Dept of Panchkarma,
Shri Ayurveda Mahavidyalaya, Nagpur,
Maharshtra, India
Email: yogitabende@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

A CLINICAL STUDY TO EVALUATE THE THERAPEUTIC EFFECT OF


VATARAKTANTAK RASA AND LEKHANA BASTI
IN VATARAKTA
1

Pundpal Amitkumar B. 2Patil Kuldeep V.

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


Mahavidyalaya,Gadhinglaj, Dist.Kolhapur, Maharashtra, 416502
2
Assocciate Professor, Shri Kalidas Ayurved Mahavidyalaya,Badami,
Dist.Bagalkot,Karnatak,

ABSTRACT
There is a definite need to study vatarakta (Gout) as peripheral arterial disease and its management with both sodhana (Purification) and samana (reducing) treatment, with the due
consideration 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 basti
along with oral medication with vataraktantaka rasa in a dose of 250mg tid for 30 days Observations: 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: Statistically significant improvement was observed in all the criteria of assessment that included
regards to pain, burning sensation, malaise and disturbance of sleep, tenderness, walking
ability, 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
INTRODUCTION
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 many
conditions related to extremities and to
mention a few are connective tissue disorders as well as peripheral vascular disorders. In the literature it is emphasized that
the etiological factors leads to the predominant 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 srotas (Circulatory system) is the leading pathology 3.


Two distinct modes of etiopathogenesis of
vatarakta are elaborated in the literature.
The specific etiological factors of vata
dosa 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

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Rasa And Lekhana Basti In Vatarakta .International Ayurvedic medical Journal {online} 2016 {cited 2016 April}
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Pundpal Amitkumar B & Patil Kuldeep V.A Clinical Study To Evaluate The Therapeutic Effect Of Vataraktantak Rasa And
Lekhana 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 the
same. 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 respective
systems6. Hence forth the concept of margavarana (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 disease7. The whole concept of margavarana
can be best explained by the pathology of
atherosclerosis and peripheral vascular
disease in modern parlance. Peripheral
vascular diseases include arterial, venous
as well as lymphatic disease, and the illness has a long lingering course. Inadaquate treatment or failure of treatment
may lead to fatal complications. Further to
add, obstructive arterial diseases are
named after the anatomical structure affected as coronary artery disease, cerebrovascular disorders and Ischemic limb diseases 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 attended the O.P.D. and I.P.D. of S.D.M.
Ayurveda Hospital, Kuthpady, Udupi,

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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 diagnosed and confirmed by investigations.
- The patients between ages of 16 to 70
years were included in study.
- Patients were randomly selected irrespective of sex, occupation, caste, etc.
Exclusion criteria: The patients suffering
from Vatarakta showing the presence of
following
criteria were excluded from the study.
- The patients with severe toxicity
- Progressive gangrenous changes in
vicinity are excluded from study.
- Diseases of immunological basis and
syphilis are excluded.
Investigations
Following are the list of investigations carried out in 20 patients of Vatarakta taken
for this study. Hb %,TC, DC, ESR, RBS,
Liver function test, Blood urea, serum creatinin, Lipid Profile, Arterial Doppler Ultra sound, Arteriography.
Design: It is a single blind clinical study
with 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 with
1) 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 Anuvasana
basti 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 And
Lekhana Bastiin Vatarakta

Assessment criteria: The state of the disease Vatarakta changes after the intervention. Improvement or otherwise was determined by adopting the standard methods
of scoring for subjective, objective and
special investigation criteria. The Margavarana 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 assessment parameters, the overall effect is calculated as followComplete remission - total score is 0 after
the treatment Marked improvement reduction in the mean symptom score by
75to 99% from the initial score.
Mean Score
Difference
%
in
means
BT
AT
1.800
1.000
0.800
44.4

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 symptom score by < 24 % from the initial score.
Effect of Treatment in VatraktaEffect on Pain: Patients treated with Vataraktantakarasa 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 statistically highly significant (P0.001) as
shown in the Table No.1.
Table No.1: Effect of treatment on Pain

S.D
0.410

Paired t test
S.E.M.
t value
0.0918 t= 8.718

P value
P=<0.001

FFECT ON BURNING SENSATION:


Burning sensation one of the cardinal
symptoms of Vatarakta relieved by
57.14% as the initial score of Burning sensation which was 0.700 reduced to 0.300
after the treatment with VataraktanMean Score
Difference
%
in
means
BT
AT
0.700
0.300
0.400
57.14

takarasa and Lekhana basti. This improvement when analyzed by the pairedt
test found to the significant (P=0.008) as
shown in the Table No. 2
Table No.2: Effect of treatment on Burning sensation
Paired t test
S.D
S.E.M.
t value
P value
0.598
0.134
t = 2.990
P= 0.008

EFFECT ON MALAISE: 78.57% of improvement was observed in the symptom


Malaise. 0.700 was the initial mean score
of Malaise recorded in the 20 patients of
Vatarakta . This was brought down to
0.150 after the administration of Vataraktantaka rasa and Lekhana Basti. This imMean Score
Difference in
%
means
BT
AT

provement after the treatment is found to


be highly significant (P0.001) as per the
pairedt test. The details of the different
statistical values are shown in the Table
No.3
Table No.3: Effect of treatment on Malaise
Paired t test

0.700
EFFECT
SLEEP:

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0.150
ON

0.550

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www.iamj.in

78.57
OF

S.D

S.E.M.

t value

P value

0.510

0.114

t = 4.819

P= 0.001

0.650 was the mean initial score of disturbance of Sleep before the treatment in

IAMJ: Volume 4; Issue 04; March- 2016

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

patients of Vatarakta. This initial mean


score came down to 0.0500 after the
treatment. The improvement to the tune of
92.30 % was highly significant (P0.001)
Mean Score
Difference
%
in means
BT
AT
0.650

0.0500

0.600

92.30

EFFECT ON TENDERNESS:
Tenderness is another symptom of Vatarakta. The initial mean score of the patients in tenderness was 0.100 which was
reduced to 0.00 after the treatment. The
improvement to the tune of 100% was recMean Score
Difference
%
in means
BT
AT
0.1000

0.000

0.1000

100

EFFECT ON EDEMA: Before the treatment 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% effect. The change that occurred with the
treatment is greater than would be exMean Score
BT
AT
0.350
0.0500

Difference
in means

0.300

85.71

EFFECT
ON
LOCAL
COLOUR
CHANGES: Patients treated with Vataraktantak rasa and Lekhana Basti had no
difference in Local color changes. 0.200
was the mean initial score in 20 patients of
Mean Score
Difference
%
in means
BT
AT
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 the
initial mean score recorded in the 20 paimprovement after the treatment is found
to be highly significant (P0.001) as per

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as revealed by the pairedt test. Details of


the same are given in the Table No.4
Table No.4: Effect of treatment on disturbance of Sleep
Paired t test
S.D

S.E.M.

t value

P value

0.503

0.112

t = 5.339

P = 0.001

orded, is statistically significant. Details of


the same are represented in the Table
No.5.
Table No.5 comparison of effect on Tenderness

S.D
0.308

Paired t test
S.E.M.
t value
0.0688 t = 1.453

P value
P = 0.163

pected by chance; there is a statistically


significant change (P = 0.010) as assessed
by the pairedt test.
The details of the same are given in the
Table No.6.
Table No.6 Effect of treatment on Edema

S.D
0.470

Paired t test
S.E.M.
t value
0.105
t = 2.854

P value
P = 0.010

Vatarakta which remained as 0.200 after


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

S.D
-

Paired t test
S.E.M. t value
-

P value
-

tients of Vatarakta
This was brought
down to 0.950 after the administration of
Vatarakta and Lekhana Basti
This

IAMJ: Volume 4; Issue 04; March- 2016

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

the paired t test. The details of the different statistical values are shown in the Table No.8.
Mean Score
Difference
%
in means
BT
AT
1.800

0.950

0.850

47.22

EFFECT ON PERIPHERAL PULSES: 1.5


was the mean initial score of Peripheral
pulses before the treatment in patients of
Vatarakta This initial mean score came
down to 1.05 after the treatment. The improvement to the tune of 30 % was signifiMean Score
Difference
%
in
means
BT
AT
1.500

1.050

0.450

30

Table No.8: Effect of treatment on walking


ability
Paired t test
S.D

S.E.M.

t value

P value

0.366

0.0819

t = 10.376

P = 0.001

cant (P=<0.010) as revealed by the


pairedt test.
Details of the same are given in the Table
No.9
Table No.9: comparison of effect on Peripheral pulses
Paired t test
S.D

S.E.M.

t value

P value

0.510

0.114

t = 3.943

P = <0.001

EFFECT ON TOTAL CHOLESTEROL:


Before the treatment the mean total Cholesterols was 274.950 after the treatment
with Vataraktantak rasa and Lekhana
Basti this was reduced to 224.00. This improvement after the treatment was found to
Mean Score
Difference
in means
BT
AT
S.D
274.950
224.00
50.950
21.36

be
statistically
highly
significant
(P<0.001) as assessed by the pairedt test.
The details of the same is given in the Table No. 10
Table No.10: Effect of treatment on total
Cholesterols
Paired t test
S.E.M.
t value
P value
4.776
t = 10.667
P = <0.001

EFFECT ON TRIGLYCERIDE: Before


the treatment the mean Triglyceride was
247.100 After the treatment with Vataraktantak rasa and Lekhana Basti is was
reduced to 196.40. This improvement after
the treatment was found to be statistically
Mean Score
Difference
in means
BT
AT
S.D
247.100
196.400
50.700
36.319

highly significant (P<0.001) as assessed by


the pairedt test. The details of the same is
given in the Table No. 11
Table No.11: Effect of treatment on Triglyceride

EFFECT ON HDL CHOLESTEROL:


Before the treatment the mean HDL Cholesterol was 39.850 after the treatment
with Vataraktantak rasa and Lekhana
Basti this was increased to 44.500. This
increase after the treatment was found to
Mean Score
Difference

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S.E.M.
8.121

Paired t test
t value
t = 6.243

P value
P = <0.001

be
statistically
highly
significant
(P<0.001) as assessed by the pairedt test.
The details of the same is given in the Table No. 12
Table No.12 Effect of treatment on HDLCholesterol
Paired t test

IAMJ: Volume 4; Issue 04; March- 2016

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

BT
39.850

AT
44.500

in means
4.650

S.D
4.705

S.E.M.
1.052

t value
t = -4.420

P value
P = <0.001

EFFECT ON LDL CHOLESTEROL:


Before the treatment the mean LDL Cholesterols was 169.200 After the treatment
with Vataraktantak rasa and Lekhana
Basti this was reduced to 134.650 This
increase after the treatment was found to
Mean Score
Difference
BT
AT
S.D
169.200
134.650
34.550
30.346

be
statistically
highly
significant
(P<0.001) as assessed by the paired t
test. The details of the same are given in
the Table No. 13
Table No.13: Effect of treatment on LDL
Cholesterols
Paired t test
S.E.M.
t value
P value
6.786
t = 5.092
P = <0.001

EFFECT ON VLDL CHOLESTEROL:


Before the treatment the mean VLDL
Cholesterols was 43.550 After the treatment with Vataraktantak rasa and Lekhana Basti this was reduced to 33.450 This
decrease in values after the treatment was
Mean Score
Difference
in means
BT
AT
S.D
43.550
33.450
10.100 9.414

found to be statistically highly significant


(P<0.001) as assessed by the paired t
test. The details of the same are given in
the Table No. 14
Table No.14: Effect of treatment on VLDL
Cholesterols
Paired t test

EFFECT ON LDL: HDL:


Before the treatment the mean LDL: HDL
was 4.245 after the treatment with Vataraktantak rasa and Lekhana Basti this was
reduced to 3.150. This improvement after
the treatment was found to be statistically
Mean Score
Difference in
means
BT
AT
S.D
4.245
3.150
1.095
0.624
DISCUSSION:
After the completion of the 1 month course
of treatment in Vatarakta the overall assessment of the patients were made as discussed in the assessment criteria. The
analysis revealed that no patient had complete relief from the signs and symptoms
of vatarakta Moderate remission of the
signs and symptoms was seen in 90% of
the patients treated with Vataraktantaka
rasa and Lekhana basti . No patient
showed marked improvement. One patient

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S.E.M.
2.105

t value
t = 4.798

P value
P = <0.001

highly significant (P<0.001) as assessed by


the pairedt test. The details of the same
are given in the Table No. 15
Table No.15: Effect of treatment on LDL:
HDL

S.E.M.
0.139

Paired t test
t value
t = 7.852

P value
P = <0.001

after treatment showed 40 % remission of


the symptoms which comes under average
remission category. Another one patient
after treatment showed 20 % remission
from the signs and symptoms of vatarakta
which considered as unchanged category.
All the 20 patients taken for the study had
some or the other form of improvement in
the symptoms of Vatarakta.

CONCLUSION

IAMJ: Volume 4; Issue 04; March- 2016

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

Results showed that there is definite reduction in the bad cholesterol and increase
in the good cholesterol following the
treatment. These changes establish the efficacy of lekhana basti and vataraktantaka
rasa in preventing the progression of margavarana as well as the illness vatarakta.
The marginal improvement in the circulation following medication with lekhana
basti and vaataraktantaka rasa confirms
the effect of medicine on reducing the
margavarana. 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 vataraktantaka rasa is an ideal regimen in patients sufferirng from raktamargavarana
janya vataraktaa.

REFERENCES
1. Chakrapani,on Agnivesa: Charaka
Samhita ,Varanasi, Chaukambha
Sanskrita sansthana, 5th edition,2001, Chikitsa sthana, chapter
29, Slok 1, 738 PP, Page no. 628
2. Sushrutas, Sushruta Samhita,
Varanasi, Chaukambha orientalia,
7th edition, 2002,
Nidanasthana, 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
samhita,,Varanasi, Chaukambha Sanskrit sansthana, 5th edition,2001,
Chikitsa sthana, chapter 29, Slok
10- 738 PP, Page no. 627
5. Agnivesa:
Charaka
Samhita,Varanasi, Chaukambha Sanskrit sansthana, 5th edition, 2001,
Chikitsa sthana, chapter 29, Slok
156, 738 PP, Page no. 634
6. Sushrutas, Sushruta Samhita,
Varanasi, Chaukambha orientalia,
7th edition, 2002,
Sutrasthana,

601

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chapter 15, slok 32, 824 PP, Page


no. 73
CORRESPONDING AUTHOR

Dr. Pundpal Amitkumar B.


Assocciate Professor, Shalya
Tantra Dept.,
Late Kedari Redekar Ayurved
Mahavidyalaya,Gadhinglaj,
Dist.Kolhapur, Maharashtra,
416502
Mob. no.- 09420779594
Mail Idprajkaktapundpal@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Review Article International Ayurvedic Medical Journal ISSN:2320 5091

MENSTRUAL HEALTH AND AYURVEDA


1,2.

Dr. Amrutha.B.L 1 Dr. Elgeena Varghese 2 Dr. Pratibha Kulkarni 3


PG Scholars, 3. HOD & Asso Professor Department of Kriyashareera SDM College of Ayurveda & Hospital Hassan

ABSTRACT
Artava in females is considered equivalent to Sukra in males. There lies the importance of maintaining menstrual health for a healthy progeny. Menstruation can be considered as an additional
opportunity of the body for cleansing or removal of toxins. It is believed that some amount of
Ojas is also lost during menstruation. When the menstrual cycle itself is considered, the menstrual phase is dominated by Pitta Dosha, later the influence of Kapha persists a few days before
ovulation. During the time of ovulation the Vata Dosha becomes powerful enough to propel the
ovum out of the follicle. In the absence of fertilization Vata gives way for Pitta during the premenstrual days and during menstruation. Most of the discomforts during menstruation are because of the imbalance of Doshas. So within the inherent constitutional frame work of Doshas
timely and purposeful administration of Aushadha, Aahara and Vihara will restore the doshic
balance. Thus menstrual health can be maintained from the onset till the period of menopause.
Various drugs like Amalaki, Satavari, Nagakesar, Asoka etc have proved very effective in case
of menstrual abnormalities.
Key words: - Artava, menstruation, Doshas, drugs
INTRODUCTION
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 pattern
of 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 of


the 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

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

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 vagina 3.
As far as modern science is considered,
menstruation is the process where there is
flow of blood from the uterus through the
vagina occurring primarily in humans,
determined by a complex interaction of
hormones 4. 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 death 5. 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 determined 6. 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-

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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 menstruation like painful menstruation, irregular
cycles, irregularity in bleeding patterns etc
in 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 individuals there is an increased chance for
painful menstruation, Pitta Prakruthi individuals may get subjected more to mood
variations, Kapha Prakruthi individuals
may 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 vessels to constrict. Ruksha guna depletes the

IAMJ: Volume 4; Issue 04; March- 2016

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

bodily tissues and finally causes early


cessation of menstrual flow. Due to decrease in plasma and blood tissues, decreased nourishment to the endometrial
lining of uterus the overall flow and menstrual discharge will be less. Where ever
there is a blockage for the free flow of
Vata, there will be pain. So most of the
Vata dominating cycles will be painful.

3.

Paittika menstrual flow

4.

Pitta is hot and sharp. So it brings more


fluidity to the blood so that it flows easily.
Pitta resides in blood and in excess I may
cause heavy bleeding. As it causes
tendency for swelling, it leads to tender,
swollen breasts, acne etc that women experience during their premenstrual period.

5.

6.

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. So
it 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

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7.

intercourse and even Pranayama and


Yoga. All these activities need energy
and our body needs to use all its reserve
energy towards cleansing
Suppression of urges like urination,
defecation and sneezing should be
avoided. All these will cause the upward
flow of Vata which will disturb the free
flow of cleansing action.
Meditation will bring peace of mind
which again assists the action of Vata
Hydrate the body with warm teas such as
ginger tea, lemon tea with honey, cumin,
coriander and fennel teas.
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.
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 strong
and energetic.

Herbal care for healthy menstruation


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,

IAMJ: Volume 4; Issue 04; March- 2016

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

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 menstruation.

2.

3.

4.
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 characteristics 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 restore the optimal action of menstrual cycle
which is very crucial to maintain the health of
a women.

5.

6.

Arunadatta and
Ayurvedarasayana
commentary of Hemadri.Reprint ed .
Varanasi
(India):
Chaukambha
publications; 2011. p.363
Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia;2009.p.514
Paradakara HSS. Ashtanga Hrudaya with
Sarvangasundara commentary of
Arunadatta and Ayurvedarasayana
commentary of Hemadri.Reprint ed .
Varanasi (India): Chaukambha publications; 2011. p.361
Usha VNK.A Text Book OF Obstetrics
Prasuthi Tantra,Vol 1,Reprint ed , Varanasi,Chaukambha Sanskrit
Prathishthan;2013.p.71
Acharya JT. Susrutha Samhita with Nibandhasangraha commentary of Dalhana.
Reprint ed. Varanasi (India):
Chaukambha Sanskrit Sansthan; 2009. p.
360.
Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia;2009.p.516
CORRESPONDING AUTHOR
Dr. Amrutha.B.L
Department of Kriyashareera SDM
College of Ayurveda & Hospital Hassan
Karnataka, India

Source of support: Nil


Conflict of interest: None Declared

REFERENCES
1. Paradakara HSS. Ashtanga Hrudaya with
Sarvangasundara
commentary
of

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IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

A CLINICAL STUDY ON HYPERLIPIDEMIA WITH


MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA
1

DR. SANDEEP SINGH 2Dr. S. G. Chavan 3DR. M. A. HULLUR


M.D.Scholar, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli, Karnataka, India
2
M.D.(Ayu),Prof. and Guide, Department of Kayachikitsa,Ayurveda Mahavidyalaya, Hubli, Karnataka,
India
3
M.D.(Ayu), Ph.D. (Ayu),Prof. and Principal,Department of Kayachikitsa,Ayurveda
Mahavidyalaya,Hubli, Karnataka, India
1

ABSTRACT
Hyperlipidemia means abnormally high levels of lipids in the blood. These lipids or fats include cholesterol 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 Diseases (CHD) are attributable to abnormalities in the levels and metabolism of plasma lipids and lipoproteins. . 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
INTRODUCTION:
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 modernization, 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-developed 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 controlling system will lead to abnormalities in this
equilibrium and thus leads to various diseases.

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DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

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". Lipids consist of fats, waxes, sterols, monoglycerides, phospholipids, and fat-soluble vitamins and minerals. Since lipids are hydrophobic
i.e. insoluble in water, these are (e.g. cholesterol) 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, elevated 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 genetic 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.According
to 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. Atorvastatin is one such a drug of choice which is
highly used and recommended in hyperlipidemia. It has shown very good results but
Procedure
Ama Pachana

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also responsible for many side effects like myositis, joint pain, stomach upset, liver damage
and many more. Here, Ayurveda can intervene
by modifying the risk factors aiming at the prevention.It can be included under santarpanajanyavyadhi as Medoroga. It is a condition
caused by derangement of agni, leads to amarasa, there is medodhatvagnimandya leading
to improper formation of medodhatu in excess
and if not arrested further results in sthoulya
and other santarpanjanya vyadhis1.Lack of
physical
exercise
and
indulging
in
Kaphavardhaka ahara leads to Medovriddhi and
hence causes Medo roga2. The morbid
accumulation of kapha and meda tends to get
adhered to the vessel wall causing its thickening, tortuosity, stiffness as well as narrowing.
This change in the vessel wall is referred as
Dhamani
pratichaya3
(thrombosis/atherosclerosis). Thus considering above
facts, this study is intended in treating the Hyperlipidemia with Medhohar Guggulu and Lekhaniya 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 Hyperlipidemia
MATERIALS AND METHODS:
1.
Trikatu Churna4
2.
MedhoharGuggulu5
3.
Lekhaniya Mahakashaya6
STUDY DESIGN:A minimum of 25 Subjects diagnosed as Hyperlipidemia were selected after
fulfillment of inclusion criteria.

Drug used

Matra

No.of Days

Trikatu Choorna
Lekhaniya
Mahakashaya

5 gms BD with warm water


before food
30 ml
before food

3 days (or till


niramalakshana seen)

IAMJ: Volume 4; Issue 05; april;- 2016

60 days

DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

Samanoushadhi

Medhohar
Guggulu

250 mg (2 BD) with lukewarm water after food

60 days

Duration- 2 months - weekly visit


Intervention
Follow up- 1 month - Fortnightly visit
Amapachana with Trikatu Churna 5gm BID
INCLUSION CRITERIA:
30 minutes before food with Ushnodaka as
Aged between 20-60 yrs.
Anupana till niramalakshana seen.
Had clinical features of Medoroga.
Subjects
were
subjected
for
ShamanaChikitsa
with
Lekhaniya
Both obese and non-obese patients were seMahakashaya (30ml BID) with water
lected for the study.
before food for 60 days.
Both the sex (male and female) were se Medhohara Guggulu (250 mg BID) with
lected for the study.
lukewarm water after food for 60 days.
Subjects having all or at least any one of
Pathya Aahara and Pathya Vihara was adthe lipid profile above normal range
vised to all the Subjects.
were selected for the study.
ASSESSMENT CRITERIA:
EXCLUSION CRITERIA:
Subjective parameter
1. Subjects had history of serious cardiac
disorders like Myocardial infarction,
Ashaktahsarvakarmasu (Difficulty in
Cardiac failure, etc.
routine acitivities)
2. Subjects had any major illness,
Kshudrashwasa (Dyspnoea)
Hypertension or if the patient was al Utsahahani (Lethargic)
ready taking some therapy or recently
Angagaurava (Heaviness in body parts)
adjusted therapy.
Daurbalya (Weakness/Decreased physical
3. Subjects had history of Thyroid disorder,
activity)
Renal disorder, Cholelithiasis and PCOS.
Swedhadikya (Increased Perspiration)
4. Subjects with systemic disorders which
Trishna (Increased Thirst)
interfere with the course of treatment.
Nidradikya (Increased Sleep)
5. Hyperlipidemia due to Consumption of
AlpaMethunah (Decreased sexual desire)
drugs such as glucocorticoids.
Objective parameter
6. Pregnant women and lactating mothers.
Lipid profile before and after treatment.
WITHDRAWAL CRITERIA:
Gradation of Clinical feature
1. If the patients having clinical feature would
1-ASHAKTAH SARVAKARMASU: (Diffiaggravated into serious condition.
culty in routine acitivities)
2. If the patient is irregular in the decided
course of treatment.
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- 0
erance

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IAMJ: Volume 4; Issue 05; april;- 2016

DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

Dyspnoea after little work but relieved later and up to tolerance


Dyspnoea after little work but relieved later and beyond tolerance
Dyspnoea in resting condition
3- UTSAHA HANI: (Lethargic)
No lethargy (Doing work satisfactorily with proper vigor in time)
Doing work at his own with lethargy and late initiation
Not starting any work on his own responsibility and doing little work very slowly
Does not take any initiation and not want to work even after pressure
4-ANGA GAURAVA: (Heaviness in body parts)
Not felt
Feeling heaviness in the body
Heaviness not pertaining to do more work
Totally sedentary due to heaviness of body
5- DAURBALYA: (Weakness/Decreased physical activity):
Can do routine exercise
Can do moderate exercise without difficulty
Can do mild exercise with very difficulty
Can not do even mild exercise
6- SWEDADIKYA: (Increased Perspiration)
Sweating after heavy work and fast movement or in hot season
Profuse sweating after moderate work and movement
Profuse sweating after little work and movement
Sweating even at rest or in cold season
7- TRISHANA: (Increased Thirst)
Normal thirst
Thirsty but relieved after drinking 1-2 liter of water
Thirsty but not relieved after drinking 1-2 liter of water
Repeated thirst and not relieved at all
8- NIDRADIKYA:( Increased Sleep)
Normal sleep 6-7 hrs. per day
Sleeping of up to 8 hours/day with angagaurava
Sleepy and drowsy even after sleeping for 10 hours/day
Not satisfied even after sleeping for > 12 hours/day
10-ALPA METHUNAH: (Decreased sexual desire)
Not seen
Lack of interest but performing sexual activity once in a week
Lack of interest but performing sexual activity only once in a month
Totally loss of interest in sexual act.
OBSERVATION AND RESULTS:

1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3

PARAMETERS

BT

AT

SD

SE

AshaktahSarvakarmasu

0.56

0.00

0.56

100%

0.71

0.14

3.934

<0.0006

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IAMJ: Volume 4; Issue 05; april;- 2016

REMAR
K
HS

DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

Kshudraswasa
Utsahahani
Angagaurava
Daurbalya
Swedhadikya
Trishna
Nidradikya
AlpaMethunah
Total Cholesterol
Triglycerides
HDL
LDL

0.48
0.96
1.08
0.44
0.64
0.80
0.32
0.16
211.6
174.6
37.17
123.9

0.00
0.00
0.00
0.00
0.16
0.20
0.00
0.00
142.59
111.71
40.97
88.16

0.48
0.96
1.08
0.44
0.48
0.60
0.32
0.16
69.03
62.86
-3.796
35.80

Of the 25 patients registered, All are completed


the treatment schedule and all 25 patients are
considered for statistical analysis. Patients who
enrolled for the study were above 20 year of
age.
Ashaktahasarvakarmashu :
The
mean
Ashaktaha Sarvakarmashu before treatment
was 0.56 which was reduced to 0.00 after the
treatment. The total effect of therapy provided
statistically Highly Significant (p<0.0006) result with t value of 3.934.
Kshudraswasa: The mean Kshudra Swasa before treatment was 0.48 which was reduced to
0.00 after the treatment. The total effect of
therapy provided statistically Highly Significant (p<0.0001) result with t value of 4.096.
Utsahahani: The mean Utsaha Hani before
treatment was 0.96 which was reduced to 0.00
after the treatment. The total effect of therapy
provided statistically Highly Significant
(p<0.0001) result with t value of 13.66.
Angagaurava: The mean Anga Gaurava before
treatment was 1.08 which was reduced to 0.00
after the treatment. The total effect of therapy
provided statistically Highly Significant
(p<0.0001) result with t value of 13.50.
Daurbalya: The mean Daurbalya before treatment was 0.44 which was reduced to 0.00 after
the treatment. The total effect of therapy provided
statistically
Highly
Significant
(p<0.0009) result with t value of 3.772.

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100%
100%
100%
100%
75%
93%
100%
100%
32.61%
36.00%
10.21%
28.87%

0.58
0.35
0.40
0.58
0.65
0.57
0.62
0.37
48.80
59.11
1.67
29.02

0.117
0.07
0.08
0.116
0.130
0.115
0.125
0.074
9.761
11.82
0.334
5.805

4.096
13.66
13.50
3.772
3.674
5.196
2.551
2.138
7.073
5.317
11.35
6.169

<0.0001
<0.0001
<0.0001
<0.0009
<0.001
<0.0001
<0.0175
<0.0429
<0.0001
<0.0001
<0.0001
<0.0001

HS
HS
HS
HS
VS
HS
VS
S
HS
HS
HS
HS

Swedhadikya: The mean Swedadikya before


treatment was 0.64 which was reduced to 0.16
after the treatment. The total effect of therapy
provided
statistically
Very
Significant
(p<0.001) result with t value of 3.674.
Trishna:The mean Trishana before treatment
was 0.80 which was reduced to 0.20 after the
treatment. The total effect of therapy provided
statistically Highly Significant (p<0.0001) result with t value of 5.196.
Nidradikya: The mean Nidradikya before
treatment was 0.32 which was reduced to 0.00
after the treatment. The total effect of therapy
provided statistically Significant (p<0.01) result with t value of 2.551.
AlpaMaithunah: The mean Alpa Maithunaha
before treatment was 0.16 which was reduced
to 0.00 after the treatment. The total effect of
therapy provided statistically Significant
(p<0.04) result with t value of 2.138.
Total Cholesterol: The mean Total Cholesterol
before treatment was 211.62 which was reduced
to 142.59 after the treatment. The total effect of
therapy provided statistically Highly Significant
(p<0.0001) result with t value of 7.073.
Triglycerides: The mean Triglyceride before
treatment was 174.57 which was reduced to
111.71 after the treatment. The total effect of
therapy provided statistically Highly Significant (p<0.0001) result with t value of 5.317.

IAMJ: Volume 4; Issue 05; april;- 2016

DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

HDL: The mean HDL before treatment was


37.17 which was increased to 40.97 after the
treatment. The total effect of therapy provided
statistically Highly Significant (p<0.0001) result with t value of 11.35.
LDL: The mean LDL before treatment was
123.98 which was reduced to 88.16 after the
treatment. The total effect of therapy provided
statistically Highly Significant (p<0.0001) result with t value of 5.805.

DISCUSSION:
In the present Study Medohara Guggulu is
taken for Clinical trial. It mainly contains drugs
like Sunthi, Pippali, Marich, Chitraka, Haritaki,
Vibhitaki, Amalaki, Musta, Vaividanga and
Shuddha Guggulu having highest concentration
of Guggulu in the combination. Almost all the
drugs are having Katu rasa, laghu ruksha guna,
Ushnaveerya, Katuvipaka and KaphaVata
Shamaka properties which may be helpful in
disintegrating the Samprapati of Medoroga. It
is also having properties of Deepana (enlighten
the Agni), Paachana (enhances digestive
power), Kleda-Meda Shoshaka (scrap out excessive Meda and Kapha), Srotovishodhaka
(open the micro channels) and potent in Lekhana property. So, by all these properties it also
helps in scrapping of excessive Meda and
Kapha and helps in breakage of pathogenesis of
Disease. Guggulsterone, the bioactive constituent of Guggulu, a key transcriptional regulator
for the maintenance of cholesterol and bile acid
homeostasis in body system. It removes excess
cholesterol from body by converting in to bile
acid through enterohepatic circulation and this
is major pathway to remove excessive cholesterol from the body. On assessing the ingredients of Lekhaniya Mahakashaya (Musta,
Kustha, Haridra, Daruharidra, Vaca, Ativisa,
Katurohini, Chitraka, Chirbilva, Haimavati), it

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is found that the drugs like Chitraka contains sitosterol which act as Hypolipidemic. Saponins are also found in drugs like Vacha,
Haimvatietc which is well known for lowering
lipids. The combination showed highly significant results on subjective parameters like
Ashaktaha Sarvakarmashu, Kshudraswasa,
Atinidra, Atisweda etc. which is due to excess
of Meda and Kapha. The combination act by
its properties like Lekhana, Karshana, usna, tikshana, Medohara Kaphahara etc. and gives relief in the symptoms. The result is highly significant on Objective parameters also. This is
because of internationally accepted effect of
Guggulipids, -sitosterol and saponins on lipid
levels.
CONCLUSION
Hyperlipidemia is a very prevalent disease
in todays world which is causing physical,
mental and social impact on the suffering
individual.
Hyperlipidemia is common in people leading sedentary and are used to Madhura and
Snigdhaahara.
All the subjects showed marked reduction
in serum Total Cholesterol, Triglycerides,
LDL and HDL ratio and also showed significant increase in HDL levels.
Medohara Guggulu and Lekhaniya Mahakashaya plays good role in the management
of Hyperlipidemia.
No adverse effects were found during and
after the study.
It can be said with full confidence that the
combination used can be safely administered in patients with Hyperlipidemia.
REFERENCES:
1. Kaviraj Ambikadutta Shastri, SusrutaSam-

hita, Ayurveda Tatva Sandipika, hindi


commentary,
Chaukhamba
Sanskrit
Sansthan, Varanasi; reprinted 2011, pg 107

IAMJ: Volume 4; Issue 05; april;- 2016

DR. SANDEEP SINGH ET;ALL: A CLINICAL STUDY ON HYPERLIPIDEMIA WITH MEDOHAR GUGGULU AND LEKHANIYA MAHAKASHAYA

2. Dr. Nirmal Saxena, Vangasenas Chikitsa

3.

4.

5.

6.

Sara Sangraha, 1st edition, Chaukambha


Sanskrit Series Office, Varanasi, 2004, pg
805
VaidyaHarishchandraKuswaha, ShriChakkarpani commentary on CharakSamhita,
Ayurvedipika ki
Ayushi vistrit hindi
vyakhya, Chaukhamba Orientalia, Varanasi;
reprinted 2011, sutrasthana 20/19
Ayurvedacharya Kaviraj Shri Ambikaduttshastri, Bhaisajya Ratnavali, Vidyotini hindi
vyakhaya, Chawkhamba Parkashan, Varanasi; reprinted 2010, pg 50
Shri Krishan Gopal, Ras Tantra Saar va
Sidhprayogsangrah, Krishangopal Ayurveda
Bhavan, Rajasthan; part-2, 13th edition,2011, pg 190
Vaidya Harishchandra Kuswaha, Shri Chakkarpani commentary on Charak Samhita,
Ayurvedipika ki Ayushi vistrit hindi
vyakhya, Chaukhamba Orientalia, Varanasi;
reprinted 2011, pg 60

CORRESPONDING AUTHOR
DR. SANDEEP SINGH
M.D.Scholar, Department of Kayachikitsa,
Ayurveda Mahavidyalaya, Hubli, Karnataka,
India
Email: sunnysingh0011@gmail.com

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 05; april;- 2016


Case Report

International Ayurvedic Medical Journal ISSN:2320 5091

A CASE STUDY OF SPASTIC CEREBRAL PALSY WHICH RESPONDED TO


PANCHAKARMA TREATMENT
1

Dr Preetham pai, 2Dr R.H Gujarathi 3Dr J A Nandgaonkar


1
Associate Professor,Dept of kaumarabhritya;
2
Associate Professor,Dept of kaumarabhritya;,
3
Prof and HOD Dept. of kaumarabhritya, Bharti vidyapeeth Deemed university college of
Ayurved, Dhankawadi, pune-43


INTRODUCTION: Congenital spinal
anomalies are a rare occurrence and the only
treatment available is surgical intervention.
In conditions of fused vertebrae surgery
does not promise complete recovery and it is
also associated with severe complications.
Case presentation: A boy of 1 year of age
had complaints of not able to sit without
support , and not able to stand with/without
support. Examination of motor system revealed spasticity in all the four limbs with
increased severity in the lower limbs. Deep
tendon reflexes were brisk in the lower
limbs. Muscle power- grade II. Sensory examination: no sensation for touch and pain.
Keywords: spastic cerebral palsy, panchakarma treatment, delayed developmental
milestones
Investigation:
MRI of brain: normal
MRI of spine: -short segment of lumbar
cord extending from lower border of L1 vertebral body to L3 vertebra is absent / severely hypoplastic. Atropy of thew lower
Bulky thickened terminal cord that is low
lying and tethered.

Segmentation abnormalities in lower lumbar


vertebrae, fused lower lumbar vertebras.
Considering the complaints and on examination the vata and kapha dosha was vitiated
Management and outcome: : First udwarthana was done with kolakulathadi
choorna 3 days, dhanyamla dhara for 7
days, and then for treating vata dosha -dhara with dhanwanthara thaila for 7 days.
After 18 days of treatment the spasticity reduced and the patient was able to sit with
support, crawl and stand with support and
could feel deep touch sensations
Discussion: In this case the patient was unable to sit , stand and walk . There was no
history of trauma/ high fever/ convulsions.
These rules out traumatic causes and infective causes. Hence a MRI of the brain
showed normal study. MRI of the spine
showed congenital anamolies of the spine
and spinal nerves. On the basis of the symptoms and investigations we can diagnose this
case as janmajat vata vyadhi. Hence the
treatment would involve bahya and abhyanthara snehana (oleation therapies),swedana,

How to cite this URL: Dr Preetham Pai, A Case Study of Spastic Cerebral Palsy Which Responded to Panchakarma
Treatment. International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:
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A Case Study Of Spastic Cerebral Palsy Which Responded To Panchakarma Treatment.

sodhana, brihmana procedures2,3.


CASE STUDY:
Introduction: Congenital anamolies of the
spine causing biplegia are rare. In these conditions surgery is the only option available
to the patient. Surgical procedures generally
cause complications and
dont promise
complete cure to the patient. Such interventional procedures are expensive. this is a
case study of a boy aged 1 year who came
with complaints of not able to sit, stand and
walk. Spasticity was seen in the lower limbs.
. The symptoms were similar to vata vyadhi
with avarana of kapha. Hence the first line
of management was kaphahara chikitsa and
then vata doshahara chikitsa. MRI of the
spine showed short segment of lumbar cord
extending from lower border of L1 vertebral
body to L3 vertebra is absent / severely hypo plastic. Atrophy of the lower spinal
nerves. Fusion of the lower lumbar vertebrae
from L1-L3.
Case presentation:
A boy of 1 year came to the pediatric opd
with following complaints of not able to sit,
stand, crawl and walk, loss of pain sensation
in the lower limbs. The other milestones
such as social smile, head holding and turning over was achieved at appropriate age.
The patient didnt have any history of fall or
trauma or high grade fever, convulsions. .
The antenatal, birth h/o and post natal h/o
were normal.
central nervous system examination showed
normal higher mental functions such as
speech intellect, and orientation. The sensory motor and functions of the upper limbs
were normal. Motor Examination of the
lower limb showed decreased muscle power,
muscle tone and bulk . Reflexes were exaggerated- grade III in the lower limbs.. Both

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the superficial and deep sensations were lost


in the lower limbs.
Investigations:
MRI of brain: normal
MRI of spine: -short segment of lumbar
cord extending from lower border of L1 vertebral body to L3 vertebra is absent / severe
lyhypoplastic. Atrophy of the lower lumbar
cord. Bulky thickened terminal cord that is
low lying and tethered. Segmentation abnormalities in lower lumbar vertebrae, fused
lower lumbar vertebras. The MRI showed
congenital anomaly i.e. fusion of the lower
lumbar vertebra and atrophy of the lumbar
cord.
In such conditions the only treatment option
available is surgical and does not provide
complete relief to the patient and Surgery is
associated with complications. The disease
was diagnosed as janmajat kaphavrita vata
vyadhi.
Management and outcome:
The line of management in Vata vyadhi external treatments such as oleation therapy(
snehana)sudation therapy( nadi sweda)and
Internal administration of sneha(oil,ghee
etc) and vatahara medicines1 In this particular case initially kaphahara chikitsa was
followed since there is avarana of kapha
dosha. So Udwarthana with kolakulathadi
choorna for 3 days was done followed by
dhanyamla(kanji) dhara for 7 days.Next line
of management was aimed to subside vata
dosha. hence pizhichil with dhanwanthara
thaila was done for 7 days followed by shastikapinda sweda for 7 days. Oral medicines
such as kalyanaka ghrita tsp twice daily
and rajanyadi choorna 1/4tsp twice daily
were given for 30 days.
The followings findings were noted in the
lower limb before treatment and after 30
days of treatment

IAMJ: Volume 4; Issue 04; March- 2016

A Case Study Of Spastic Cerebral Palsy Which Responded To Panchakarma Treatment.

Sign
Muscle tone
Muscle power
Head holding
Sitting
Standing
crawl

Before tt
Grade III
GradeII
Present
Absent
Not achieved
Not achieved

DISCUSSION:
In this case study the patient was not able to
sit , stand, crawl and walk . The patient had
no history of trauma/ high fever/ convulsions. Hence this rules out traumatic causes
and infective causes. MRI of the brain and
spine was done. MRI showed normal brain
study . MRI of the spine showed congenital
anamolies of the spine and spinal nerves.
Considering the above said symptoms and
investigations we can diagnose this case as
janmajat kaphavrita vata vyadhi. So the
treatment would involve kaphahara chikitsa
to alleviate kapha. For vitiated vata doshabahya and abhyanthara snehana (oleation
therapies),swedana, sodhana, brihmana procedures2,3 have to be followed.
For the bahya snehana - abyanga, pizhichil was used. For swedana procedure nadi
sweda is best in children. In this patient
since there is association of kapha with vata
. so the first line of management was towards subsiding kapha. Hence udwarthana
with kolakulathadi choorna was advised for
three days. Udwarthana is a ruksha, ushna
and tiksna procedure and it subsides kapha
dosha. kolakulathadi choorna is usna and
tikhna.hence it is also kaphahara in nature4,5. After udwarthana procedure dhanyamla dhara was advised. It is also usna
and tikshna guna
and hence subsides
kapha.so once kapha dosha has subsided the
next treatment was aimed to treat vitiated

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After 15 days of tt
GradeII
GradeIII
Present
Sits with support
Stands with support
achieved

vata. pizhichil was done with Dhanwantahra


thaila. pizhichil procedure has usna and
snighdha gunas and so is vata hara5,6 .it
was done for a period of 7 days. This was
followed by sastikapinda sweda for 7 days.
For abyanthara sneha kalyanaka ghrita
tsp twice daily was given for a period of
30days. Rajanyadi choorna 1/4tsp twice daily was given orally for 30 days. After 24
days of treatment significant improvement
was seen in the muscle tone and muscle
power . The child also showed improvent in
the motor mile stones. The child was able to
sit and stand with support. After treatment
there was improvement in the touch and
pain sensation . The child was able to feel
pain and touch sensations. The treatment
procedures and the oral medications improved the child s motor and sensory functions. The treatment has to be followed once
in three months till the child achieves all the
mile stones.
CONCLUSION:
1. Congenital anamolies of the spine with
delayed developmental milestones can
be co related with janmajat kaphavrita
vatavyadhi
2. Udwarthana and dhanyamla dhara help
in subsiding the prakupita kapha
3. Bahya and abhyantara snehana help in
subsiding vata and hence helps in im-

IAMJ: Volume 4; Issue 04; March- 2016

A Case Study Of Spastic Cerebral Palsy Which Responded To Panchakarma Treatment.

proving the sensorory and motor functions.


4. Abyanthara snehana using kalyanaka
ghrita helps in nourishing the mastishkagata majja and also in subsiding vata.
5. The treatment should be done once in
every 3months to get complete relief
Acknowledgement: The authors render
their heartfelt thanks to Chancellor Dr Patangrao kadam , Vice chancellor Prof Dr
Shivaji rao kadam Bharti vidyapeeth
deemed university and for their continuous
support
We are indebted to the help and support
provided by Dr Abhijith Patil ,Principal,
Bharti vidyapeeth Deemed university college of Ayurved; Dr Asmita Wele ,Dean,
Bharti vidyapeeth Deemed university college of Ayurved; Dr Shubangi khatkar medical director, Bharti vidyapeeth Medical
Foundations Ayurved Hospital;

6. kasture,Pancakarma
vijnana
(Chaukambha surbharati prakashan9 oriental publishers and distributers Varanasi)

CORRESPONDING AUTHOR:
Dr Preetham pai
Email id: pai_preetham@yahoo.co.in
Address: hills and dales, m2- 301, near
bishops high school, Uundri -411060

Source of support: Nil


Conflict of interest: None Declared

REFERENCES
1. Acharya Charaka. Charaka Samhita,chikitsa
sthan
28/75,76.
(Chaukambha surbharati prakashan9 oriental publishers and distributer Varanasi)
2. Achraya vaghbhat. Astangha hriday,chikitsasthan 21/81. (Chaukambha
surbharati prakashan9 oriental publishers
and distributers Varanasi)
3. Acharya vaghbhat .Astanga hriday
chikitsasthan
21/17
(Chaukambha
surbharati prakashan9 oriental publishers
and distributers Varanasi)
4. Mukundilal Dwivedi ,Text book of pancakarma
5. Nachiket vachasundar,vyavaharik pancakarma

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

ROLE OF SUVARNAPRASHANA IN AYURVEDA


Dr. Shubhangi Kapil Thakur
Assistant Professor, Kaumarabhritya Department, Sumatibhai Shah Ayurved Mahavidyalaya,
Hadap-sar, Pune-28
Email: shubhangikthakur@gmail.com
ABSTRACT
One of the sixteen Samskaras (rituals) which were described in ancient scriptures is Suvarnaprashana. Suvarnaprashana means to administer Suvarna (gold) in liquid form with
the help of honey, ghee (clarified butter) and some herbal medicines. Suvarnaprashana has
been extensively described in main reference book i.e Brihitrayee Granthas. Kashyapa is the
main pioneer of Kaumarbhritya (paediatrics) who described Suvarnaprashana vidhi in detail
with its benefits. Suvarnaprashana has been traditionally practiced across India as a recipe
for child growth and memory enhancement and also to promote longetivity.Suvarnaprashana
is such Rasayana mentioned in Ayurveda to promote immunity and memory of children.
Keywords- Suvarnaprashana, Kaumarbhritya, Samskaras.
INTRODUCTION
Suvarnaprashana is one of the sixteen
Samskaras (rituals) which were described in
ancient scriptures. The modern days have
left human beings amidst a lot of stress, the
altered food habits, a great deal of
distractibil-ity, addiction, varied agricultural
practices which in turn affect the strength of
individuals both physically and mentally,
this makes the humanity to fall prey of
diseases. In the ever demanding competitive
age of today there is always need to excel.
This in turn requires best of health and
intelligence. Ayurveda has explained such
health promoting agents under the heading
of Rasayana. Suvarnaprashana is such
Rasayana mentioned in Ayurveda to
promote immunity and memory of children.
Ayurveda is known for its own specialties.
Today the whole world is affected with

different diseases. Modern medicines fail to


treat the patients satisfactorily in spite of
many researches & latest technologies
because of their hazardous side effects.
Ayurveda the science of life ,provides many
other alternative ways to tackle with such
disorders successfully. Not only treating unhealthy individuals, Ayurveda mainly helps
to maintain the healthy state of mind & body.
Ayurveda explains suvarnaprashan while
modern medicines explains about vaccines.
Vaccines produce immunity against specific
diseases where as suvarnprashan produces
non-specific immunity along with many
beneficial effects.
Kashyapa is the pioneer of Kaumarbhritya
who described Suvarnaprashana vidhi in
detail with its benefits.
Aim: To study Suvarnaprashana Sanskar in
detail
OBJECTIVIES:

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Dr. Shubhangi Kapil Thakur: Role Of Suvarnaprashana In Ayurveda

1. Study the literature of Kashyapa Samhita regarding Suvarnaprashana


2. Study the relevant literature of
Suvarnaprashana from other texts.
MATERIALS AND METHODSAdministration of Suvarna Kalpa
Keeping face towards east, pure gold
should be rubbed on a washed stoned with
little quantity of water then churned with
honey and ghrita, this should be given to the
child for consumption. Feeding of gold
increases intellect, digestive and metabolic
power, strength, gives long life; is auspicious, virtuous, aphrodisiac, increases
complexion and eliminates the evil effects
of Grahas. By feeding the gold for one
month child becomes extremely intelligent
and is not attacked by the disease, and by
using for six months increases his hearing
and retaining capabilities. Kasayap sahmita
mentions that suvarna should be rubbed on
stone facing towards east , it could be because east direction belongs to lord Indra
,it is considered to be auspicious & holy for
all diseases. Suvarnaprashana
medication includes Suvarna, medicated
ghrita, and Madhu.(1,2)
Gold is considered as very precious in
Ayurveda and it would possess properties
like madhura, rejuvenate, immunity
booster, improves complexion and growth
of the body , accelerate growth of the brain
and improves memory , also increase
digestion power of the body. Gold possesses lot of antioxidant properties and it is
very beneficial for babies who were
delivered with difficulty during the process
of delivery, oxidative stress to the baby and
this can be relieved with the antioxidant
properties of Suvarna Bhasma in the
Suvarnaprashana.(3)
Madhu and ghrita has a natural tendency to
accept and imbibe various conditions, its
properties and actions become more evident
when combined with other dravyas.(4,5)
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Ghee alleviates Pitta and Vata, is beneficial for rasa, semen and Ojas, cooling,
softening and improves voice and complexion.(5)
Suvarnaprashana can be given everyday
morning or on the day of Pushya Nakshtra.
Pushya Nakshtra has great importance in
Ayurvedic medical science. It is considered
to be very effective in terms of action,
probably the body on this day is in a better
position to absorb the drugs for its optimum
benefits and the drugs used are more potent
than the usual. (4). Sushruta has advised its
use after emesis of liquor amni, but before
massage and bath. While Vagbhatas have
indicated it after massage and bath before
emesis in Jatkarma Samsakar to ensure
sucking and swallowing reflexes. (5)
The basic concept of this gold licking is
entirely different as it is used only once in
Jatkarma Samskar performed after birth.
BENEFITS OF SUVARNAPRASHANA:
Following are the benefits of Suvarnaprashan mentioned by Kashyapa
Grasping power, sharpness, analysis
power, recall memory becomes very
strong
Improves digestion power
Auspicious
Virtuous
Aphrodisiac
Increases complexion
Eliminates the evil effects of grahas
Tones up skin colour
Growth of mind and body becomes
faster than usual
DISCUSSION
In children up to 2 years brain development is continued and which is accelerated
by Suvarnaprashana samsakar As per
literature review and practical application
of the concept Suvarnaprashana improves
digestive, metabolic and immune system. It
also benefits preterm and I.U.G.R babies.
618

Dr. Shubhangi Kapil Thakur: Role Of Suvarnaprashana In Ayurveda

Many unpublished studies in hospital at


Ayurvedic colleges indicate that Suvarnaprashana Samsakar improves the
recurrent attacks of common cold, fever
also in asthamatic patient, as asthamatic
attacks relapse is reduced. In malnourished
children Suvarnaprashana Sanskar may
affects the recurrent attacks of infections
and which may helpful to improves digestive and metabolic power this may result in
weight gain of these babies. In delayed
milestones babies it is found that due to Suvarnaprashana Samsakar milestones have
started to develop efficiently in terms of
motor, social and adaptive milestone
properly.
In Kashyap Samhita while describing
the benefits of Suvarna Lehan, Aacharya
Kashyap opines that after feeding gold for
one month the child is not attacked by the
disease, and also eliminates evil effect of
grahas; this implicates that ingestion of
Swarna modulates the immune system so
that the morbidity is reduced.
CONCLUSION:
Suvarnaprashana is described in various
Ayurvedic texts but mostly elaborated by
Kashyapa
in
Lehanadhyaya.
Suvarnaprashana can be helpful for physical growth and development in terms of
weight, height and memory. It may be
helpful in preventive aspect of decreasing
illness i.e. Suvarnaprashana has immune
modulator and immune stimulant effect in
children.
REFERENCES
1. Kashyapa Samhita / Vriddhajivakiya
Tantra edited by prof. P. V Tiwari,
reprint Chaukhamba Bharti Academy
Varanasi 2008.
2. Kashyapa Samhita / Vriddhajivakiya
Tantra by Pandit hemraj Sharma, reprint
2012 Chaukhamba Sanskrit Sansthan
Varanasi.
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IAMJ: Volume 4; Issue 04; March- 2016

3. Rastarangini
by
Pandit
Kashinathsastrina, motilal banarasidas
Varanasi reprint 2009 4.sushruttSamhita
by Kaviraj Ambikadatta Shashtri, ,
Chaukhamba
Sanskrit
Sansthan
Varanasi reprint 2005.
4. charak Samhita of Agnivesha by
Kashinath
Shastri,
Chaukhamba
Sanskrit Sansthan Varanasi reprint 2007,
Vol-I, vol-II
5. Ashtang Hriday Samhita Induvirchitya
Sashilekha Chaukhamba Krishnadas
academy Varanasi reprint 2007.
6. Ashtang Sangraha Induvirchitya Sashilekha, Sanskrit series Vranasi reprint
2008.
CORRESPONDING AUTHOR
Dr Shubhangi Kapil Thakur
Assistant
Professor,
Kaumarabhritya
Department, Sumatibhai Shah Ayurved
Mahavidyalaya, Hadap-sar, Pune-28
Email: shubhangikthakur@gmail.com

619

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

A CONCEPTUAL STUDY ON GRAHANI DOSHA WITH ITS AYURVEDIC MANAGEMENT


Anita B. Desai*1
Dhananjay V. Patel2
1.
P.G. Scholar, Upgraded P.G. Dept. of Kayachikitsa, Govt. Akhandanad Ayurved College,
Ahmedabad, Gujarat, India.
2.
M.D., Ph.D, Assi. Prof., Dept. of Kayachikitsa, Govt. Akhandanad Ayurved College,
Ahmedabad, Gujarat, India.
ABSTRACT
In Ayurveda, Grahani Dosha is one among the Mahagadas. In modern science, Grahani Dosha
included into digestive disorders. Its prevalence about 69% in current time because of faulty
dietary habits, sedentary lifestyle, stress and side effects of modern drugs. This cause leads too
many digestive diseases. The organ Grahani is the seat of Jatharagni (digestive fire) both are
interrelated. Its supported and nourished by the strength of Agni. Normally, it receives the ingested food, which is retained by restraining the downward movement (Grahanati). After digestion it releases the food through sides of lumen to next Ashaya i.e. Pakvashaya. In abnormal
conditions due to weakness of Agni, it gets vitiated and releases food in indigested form. When
Agni is not proper the food will not be digested properly and this undigested food gets fermentation and acts like poison in the body. Its called Ama. Ama Utpatti leads to Grahani Dosha. Agnimandhya is important factor in the Samprapti of the disease Grahani Dosha. So it should be
mainly treated for Agnivardhana by Drugs with Deepana (which enhances digestive power) and
Pachana (digestive) qualities.
KEY WORDS: Agni, Deepana, Grahani, Grahani Dosha, Pachana
INTRODUCTION:
In Ayurveda, Ayu (life) is defined as
conjunction of body, soul, mind and senses.
Each has been given due importance in the
maintenance of health and in prevention and
cure of disease. A balanced diet and regular
exercise are the keys to good digestive
health. But in current era, faulty dietary habits, sedentary lifestyle and stress are main

causative factors for diseases. People eat a


lot of junk and highly processed food with
preservatives which contributes significantly
to maldigestion and irritable bowel. All
these disturb in the function of digestion and
absorption, leads to many digestive disorders. These disorders related to digestion
and its absorption is broadly covered under
the heading of Grahani Dosha mentioned

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Anita B. Desai & Dhananjay V. Patel: A Conceptual Study On Grahani Dosha With Its Ayurvedic Management

in the Ayurvedic classics, which is the one of


the main disorder of the gastrointestinal
tract.
PREVALENCE:
The survey assessed the prevalence of 20
functional gastrointestinal syndromes based
on fulfillment of multinational diagnostic
criteria. 69% reported having at least one of
20 functional gastrointestinal syndromes in
the research. The symptoms were attributed
to four major anatomic regions; esophageal
(42%), gastro duodenal (26%), bowel
(44%), and anorectic (26%) with
considerable overlap. Females reported
greater frequencies of functional dysphagia,
irritable bowel syndrome, functional
constipation, functional abdominal pain,
functional biliary pain; males reported
greater frequencies of aerophagia and functional bloating. The rate of work, school absenteeism and physician visits is increased
for those having a functional gastrointestinal
disorder.1
Etymology of Grahani: The word Grahani
is derived from Dhatu Graha which
means, to catch, to hold or to get. (Shabdakalpdrum). Grahani is the specialized part
of the Mahasrotas (Gastrointestinal System).
Mandagni in Grahani Dosha: Rogasarvepimandagnou2 - As the malfunction of Agni
i.e. Mandagni is the root cause of the
gastrointestinal tract. The disease Grahani
Dosha is also mainly caused by Agni Dushti.
The organ Grahani and Agni have AshrayaAshrita type of relationship.3 The prime site
of Agni and the site of occurrence of the disease Grahani Dosha is organ Grahani.4 This
ensues with symptomatology like Atishrusta
and Vibaddha Mala Pravritti, Jwar, Udgara,
Arochaka etc.5

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Nidana of Grahani Dosha: The impairment


of Grahani will impair the functional aspects of Agni and vice versa. Therefore all
the etiological factors of Agni Dushti may
cause Grahani Dosha and finally results in
Grahani Roga.

Aharaj- Abhojana(excessive fasting), Atibhojana(excessive food intake), Vishama Bhojana(improper


food),
Asatmya
Bhojana(unwholesome food ) etc.
Vyapada of Vamana, Virechana,
Snehana
(Adverse
effect
of
therapeutic measures)
Vega Vidharana (Suppression of
natural urges)
Viruddha or incompatibility of,
Desha, Kala and Rutu
Shoka(Grief),
Krodha(Anger),
6
Bhaya(Fear)

Probable Etiopathology of Grahani


Dosha: 7
Etiological Factors
Agni Dushti
Apachana
Ama Utpatti
Shuktapaka
Annavisha or Amavisha
Grahani Dosha
Grahani Roga
Purvarupa: Aalasya(inaction), Balakshaya,
Trishna(excessive
thirst),
Anna

IAMJ: Volume 4; Issue 04; March- 2016

Anita B. Desai & Dhananjay V. Patel: A Conceptual Study On Grahani Dosha With Its Ayurvedic Management

Vidaha(burning
sensation),
Chirapaka(delayed digestion), Kayagaurava8
Rupa: Ati Srushta Mala Pravritti, Vibbadha
Mala Pravritti (occasional hard and soft
stool),
Arochaka(testlessness),
Vairashya(alteredtasteintongue),
Praseka(nausea), Tamaka, ShunaPadkara, Asthiparvaruka,
Chhardana(vomiting),
Jwara(fever), Lohanugandhi Udgara.5
Chikitsa: Agnimandhya is important factor
in the Samprapti of the disease Grahani
Dosha. So it should be mainly treated for
Agnivardhana by Deepana(carminative
property) and Pachana(digestive property)
drugs. All the treatment modalities of Ajirna
and Atisara should be implemented in the
management of Grahani Ashrita Dosha.9
Procedure: If the Ama moves downwards
and remains adhered to the Pakvashaya,
then patient should be given purgation with
drugs having Agni Deepana property.10
If Dosha are spreaded all over the body then
the Shodhana is contraindicated and the
principle management should be Langhana,
Pachana. Various Deepana Pachana drugs
described in various classics should be
administered along with follow of Laghu
and Supachya Ahara.10
Importance of Takra in Grahani Dosha:
All Ayurvedic classics have showed
importance of Takra as the main diet in Grahani Dosha. Acharya Charaka has also suggested the use Takrarishta in the routine
treatment of Grahani.11
As the Takra is Laghu in Guna, possesses
Deepana properties and attains Madhura
Paka, it does not provoke and increase Pitta;
because of Kashaya Rasa, Ushna Veerya,
Vikasi and Ruksha Gunas it is useful in
Kapha; as freshly churned Takra is Madhur,
slightly Amla, it will not produce Daha in
the Kostha and it is also Vatahara.12

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Medicine used in Grahani Dosha: Medicines having Deepana and Pachana properties like Chitrakadi Vati, Marichadi Churna,
Takrarishta,
Bhunimbadi
Churna,
13
Madhukasava, Kshara Ghrita. can be used
for Grahani Dosha. Bhaisajya Ratnavali has
also mentioned some yoga for Grahani
Dosha Pancha Pallava, Pancha Lavana,
Rasanjanadi Churna.14
Pathya-Apathya:
Pathya
Ahara:
Takra(buttermilk),Masur,Tuvara,Mudaga,Ti
la Tail,Makshika, Dadima
Pathya Vihara: Nidra,Chhardan,Langhana
Apathya
Ahara:
Guru
Anna,Draksha,Gomutra,Dugdha,Gud,Gomu
tra,Viruddha Bhojana,
Apathya
Vihara:
Aatap,Ratri
Jagarana(nightawakening),Snana,Vega
Dharana,Nasta
Karma,
An15
jana,Sveda,Dhumpana,Shrama.
CONCLUSION:
The disorders related to digestion of food
and its absorption is becoming more
common than the past due to our faulty food
habits, which are covered under Grahani
Dosha. They are treated more pronounced
way with considering Ayurvedic concept of
Agni and administrating Deepana and Pachana drugs.
REFERENCES:
1. Douglas A, Digestive Diseases and Sciences
September
1993, Volume
38, Issue 9, pp 1569-1580 U. S. Householder
survey
of
functional
gastrointestinal disorders, Available
from
http://link.springer.com/article/10.1007

IAMJ: Volume 4; Issue 04; March- 2016

Anita B. Desai & Dhananjay V. Patel: A Conceptual Study On Grahani Dosha With Its Ayurvedic Management

2. Vagbhatta, Astanga Hridaya, Nidana


Sthana,Udara Nidana Adhyaya 12/1, edited by Y
Upadhyaya, Chaukhambha Prakashan,
Varanasi. 2012; 358.
1. Agnivesha,
Charaka,
Dridhabala,
Charaka Samhita, Chikitsa Sthana, Grahani Dosha Chikitsa Adhyaya 15/56, edited by K. Shastri and G. Chaturvedi,
Chaukhambha Bharati Academy, Varanasi, 2013; 462
2. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/56,57; 462
3. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/53,54; 461
4. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/42,43; 460
5. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/44; 460
6. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/55; 462
7. Vagbhatta, Astanga Hridaya, Chikitsa
Sthana, Grahani Dosha Chikitsa
Adhyaya 10/1, edited by Y. Upadhyaya,
Chaukhambha Prakashan, Varanasi.
2012; 492
8. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsas Adhyaya 15/75; 464
9. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/120,121;
470
10. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15/117-119;
469
11. Ibidem Charaka Samhita(3), Grahani
Dosha Chikitsa Adhyaya 15
12. Bhaisajya Ratnavali Grahani Roga
Chikitsa Adhyaya 8 edited by Kaviraj
Ambikadatta Shastri, Chaukhambha Prakashana ,Varansi,2011.

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13. Ibidem Bhaisajya Ratnavali(14), Grahani


Roga Chikitsa Adhyaya 8/617-625;
292,293.
CORRESPONDING AUTHOR:
Dr. Anita B. Desai
Email: desaianita0@gmail.com
Mobile: 9727038921

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

EVALUATION OF THE EFFECT OF BIOPURIFICATION ON PSORIASIS

Yashpalsinh A. Jadeja1 Dhananjay V.Patel2


P.G.Scholar, Upgraded P.G. Dept. of Kayachikitsa, Govt. Akhandanad Ayurved College Ahmedabad, India.
2
M.D., Ph.D., Assistant Professor, Upgraded P.G. Dept. of Kayachikitsa, Govt. Akhandanad
Ayurved College Ahmedabad, India.

ABSTRACT
Psoriasis is a big issue on health. Its prevalence is around 11% worldwide. According to Ayurveda the main reason of psoriasis and its recurrence is faulty dietary habits and faulty life style.
Due to these reasons Dhosha accumulates in the body and comes in contact with Dushya ( Twak,
Rakta, Mamsa, Ambu) and manifested as Kushtha. Ubhay Marga Shodhana by Vamana and Virachana (biopurification) is very important to expel the Dosha and purify the body. It also effective to break down Dosh-Dushya Sammurchhana of Kushtha. After break down of sammurchhana, Dosha can be treated easily. Hence, biopurification will not only provide fast and best
relief in psoriatic symptoms but also reduces the chances of its recurrence. Thus, biopurification
is essential part of management of Psoriasis.
KEYWARDS: Biopurification, Ekakushtha, Kushtha, Psoriasis.
INTRODUCTION:
Skin is the envelope of internal structure
which protects us from various external invasions. Now a days skin disease are very
common. Though skin diseases are common
at any age of the individual, they are particularly frequent in the elderly. The patients
always experience physical, emotional and
socioeconomic embarrassment in the society. Psoriasis is a common skin condition that
changes the life cycle of skin cells. Psoriasis
causes cells to build up rapidly on the surface of
the skin. The extra skin cells form thick, silvery
scales and itchy, dry, red patches that are sometimes painful. Psoriasis is a persistent and long-

lasting
(chronic)
disease.
Psoriasis is
an autoimmune disease. The underlying mechanism involves the immune system reacting
to skin cells1. Psoriasis is also thought to be
a genetic disease which is triggered by some
environmental factors. Sometimes patients family member afraid to spreading of psoriasis in
other member but it is not contagious disease2.
In allopathic science, psoriasis is treated with
long term use of steroid and only symptomatic,
whereas in Ayurveda, there is wide range of
treatment from purification (Shodhana) therapy
to pacifying (Shamana).

AIM & OBJECTIVE: To evaluate the efficacy of biopurification in the management


of psoriasis.

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Yashpalsinh A.Jadeja & Dhananjay V.Patel: Evaluation Of The Effect Of Biopurification On

Prevalence of Psoriasis: There is a growing


number of population-based studies providing worldwide prevalence estimates of psoriasis. Prevalence of psoriasis varies in different parts of the world. Prevalence in different populations varies from 0% to 11.8%.
In the USA, the prevalence of psoriasis was
estimated to be around 4.6%. Prevalence
studies from India are mostly hospital-based.
It was found that the incidence of psoriasis
among total skin patients ranged between
0.44 and 2.2%, with overall incidence of
1.02%. The ratio of male to female (2.46:1)
was very high which could not be clearly
accounted for. Highest incidence was noted
in the age group of 20-39 years3.
Etymology
of
Psoriasis:
The
word psoriasis is from Greek meaning "itching condition" or "being itchy". It consist of
two wards psora means "itch" and -iasis,
means "action, condition"4.

Ayurvedic View on Psoriasis: All the skin


diseases in Ayurveda have been discussed
under the broad heading of Kushtha,
which are further divided in Mahakushtha &
KshudrakushthA5. Ekakushtha is considered
one of the Kshudrakushtha in Ayurvedic
texts6. Ayurvedic classics have considered
each type of Kushtha to be a Tridoshaja
manifestation7. Their Doshik identity can be
established on the basis of dominance of
Dosha in the Samprapti. The Ekakushtha is
Vata-Kaphaja phenomenon8. In present
study psoriasis has been correlated with
Ekakushtha.

a"#& "u ./"02 |


(Ch.Chi.7/21)9 The symptoms of Ekakushtha
are Aswedanam (absence of sweating)
Mahavastu (extensive lesions invading
whole body), Matsyashakalopam (scaling
resembling scales of fish).

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Causes of Kushtha: Specific etiology for


Ekakushtha has been not described in any
Ayurvedic texts. So it can be understood by
general etiology of Kushtha. All causes of
Kushtha can be considered under two main
cause as:
Aharaja Hetu faulty diet and dietetic
pattern: The most common Hetu ( cause ) of
Kushtha mentioned in all the Samhitas is
Aharaj Hetu. Mithya Ahara, Virodhi Anna
constitutes the major cause of Kushtha. Viruddha Aahara (Dietetic incompatibilities) is
described in detail as the cause of Kushtha 10.

Viharaja Hetu faulty lifestyle: Proper


follow up of Dincharya, Rutucharya,
Aachar Rasayana, Aahara Vidhi Vidhana
and Panchkarma is important for maintenance of health. Viharaj Hetu results in immediate aggravation and vitiation of
Tridosha10.
Saptako Dravya Sangraha: As per Ayurvedic classics, the seven important factors (
Saptako Dravya Samgraha) are related to
Kushtha. Three Dosha ( Vata,Pitta,Kapha )
and four Dushya (Twak, Rakta, Mamsa,
Ambu) are involved under the pathology of
skin disease11.
According to Sushruta Samhita, due
to Nidana Sevan vitiated Pitta and Kapha
Dosha with help of vitiated Vayu Dosha
they comes in contact with Dushya and they
causes Mandala at affected part12.
LINE OF TREATMENT: In Ayuevedic
texts the line of treatment of Kushtha is
mentioned as Shodhana and Shamana therapy. According to Dosha Pradhanyata
Acharya Charaka mentioned Sarpi Pana in
Vata Dosha, Vamana Karma in Kapha
Dosha, Virechana and Raktamoxana in Pitta
Dosha Pradhanya13.
Mode of Action of Vamana Karma: Vamana Karma can be performed after its Pur-

IAMJ: Volume 4; Issue 04; March- 2016

Yashpalsinh A.Jadeja & Dhananjay V.Patel: Evaluation Of The Effect Of Biopurification On

vakarma.
By
Purvakarma(Snehana,
Swedana) Dosha becomes Shithila and
ready to remove outside from body. Because
of its Prabhava, Vamana removes vitiated Kapha from whole body through upper
part of elementary canal14. Vamana Karma
is very effective in skin disorders. According to Dosha Pradhana Lakshana of Kushtha as Matsyashakalopamam (Scaling, elevation and plaque formation) and Kandu (
Itching ) is due to Kapha Dosha. As per
Ayurvedic texts, Kapha is one of the main
vitiated Dosha in Ekakushth8. So Vamana is
the best for excreting vitiated Kapha from
body in Ekakustha. As per literature and
practical view it is noted that itching and
scaling can be reduced by Vamana Karma.
Considering the importance of Vamana in
relieving the psoriatic symptoms, Acharya
Sushruta has suggested to perform it every
15 days15.
Mode of Action of Virechana Karma:
Virechana removes
vitiated Pitta
Dosha from whole body through lower part
of elementary canal16. Pitta Dosha is reside
in Rakta Dhatu. Therefore the purificative
measures of Pitta Dosha, also improve the
Rakta Dhatu. In Charaka Samhita it is mentioned that Kushtha is due to Rakta Dushti17.
In this way, Virechana is effective procedure for the management of Ekakustha.
The line of treatment of Raktaja Roga :
This way Virechana can apply for Rakta
Shuddhi( Blood purification) purpose in
Kushtha. Ekakushtha is mainly VataKaphaja dominant Vyadhi but Pitta Dosha
is also involved in the pathophysiology of
the disease. Thus Virechana will remove
vitiated Pitta and at the same time purifies
vitiated Rakta. So Acharya Sushruta has
suggested to perform Virechana every one
month19.

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DISCUSSION:
Shodhana is foremost part of the
management of the Kushtha disease. So that
Acharya has advised to perform all the Panchakarma purificative procedure again and
again.19 Among all the five type of Panchakarma, Vamana and Virechana are major
purifying Karma, which excrete the elevated
Kapha20 and Pitta Dosha20 as well do Anulomana of Vayu too21. Hence in this review
article emphasis given to Ubhay Shodhana
(bio purification) i.e. Vamana and
Virechana.
Why Bio purification: Acharya Charaka
mentioned Kushtha as Dirgharoganam22
that means it is long lasting disease and
practically recurrences of psoriasis is also
observed.
23
If the Dosha are pacified with Langhana
or Pachana therapy, there may be chances
of recurrences of that disease. But if they are
removed with Samshodhana, there is not
possibility of its recurrences. Similarly, if
biopurification (Vamana and Virechana) is
performed prior to Shamana therapy recurrence chance can be reduced considerably.
Moreover, if the Shamana treatment is given
after the proper Shodhan, it provides better
effect. So that the Ayurvedic classics emphasize on purification with the example to colour the cloth. If the cloth is coloured without
its washing, it is not properly coloured while
if it is done with its proper washing, it coloured appropriately. Similarly, medicine
given after the Urdhvaga and Adhoga Shuddhi or Ubhaya Marga Shuddhi, will provide
desirable effect24.
CONCLUSION:
Therefore, the conclusion can be drawn that
the bio purification (Vamana and
Virechana) should be performed prior to

IAMJ: Volume 4; Issue 04; March- 2016

Yashpalsinh A.Jadeja & Dhananjay V.Patel: Evaluation Of The Effect Of Biopurification On

Shamana therapy in the management of Psoriasis, for reduction of its recurrence and to
obtain the optimal effect of Shamana therapy.
REFERENCE:
1. "Questions and Answers about Psoriasis". National Institute of Arthritis and
Musculoskeletal and Skin Diseases. October 2013. Retrieved 1 July 2015.
Available
from
:
https://en.wikipedia.org/wiki/Psoriasis.
2. Boehncke, WH; Schn, MP (26 May
2015). "Psoriasis.". Lancet (London,
England) 386:
983
94. doi:10.1016/S0140-6736(14)619097. PMID 26025581. Available from:
https://en.wikipedia.org/wiki/Psoriasis.
3. S Dogra, S Yadav, Indian Journal Of
Dermatology,Veneriology and Leprology, 2010, Volume 76, Issue 6 : 595-601
Available
from:
http://www.ijdvl.com/default.asp
4. Ritchlin, Christopher; Fitzgerald, Oliver
(2007). Psoriatic and Reactive Arthritis:
A Companion to Rheumatology (1st ed.).
Maryland Heights, Miss.: Mosby.
p. 4. ISBN 978-0-323-03622-1. Available
from
:
https://en.wikipedia.org/wiki/Psoriasis.
5. Kaviraja Ambika Datta Shastri edited
with Ayurveda Tatva Sandipika commentary, Sushruta Samhita, Nidana
Sthana, Kustha Nidana Adhyaya, 5/5
Varanasi: Chaukhambha Prakashan, Reprint 2011;320
6. Ibidem Sushruta Samhita(5), Kustha Nidana Adhyaya,5/5;320
7. Kashinath Shastri and Gorakhanath Chaturvedi edited with Vidyotini hindi
commentary, Charaka Samhita of Agnivesh Revised by Charaka and Dhra-

www.iamj.in

dhabala, Chikitsa sthan, Kustha Chikitsa


Adhyay,7/31 Varanasi: Chaukhambha
Prakashan, 2013;253
8. Ibidem Charaka Samhita(7), Kustha
Chikitsa Adhyay,7/29;253
9. Ibidem Charaka Samhita(7), Kustha
Chikitsa Adhyay,7/21;252
10. Ibidem Charaka Samhita(7), Kustha
Chikitsa Adhyay,7/4-8;248
11. Ibidem Charaka Samhita(7), Kustha
Chikitsa Adhyay,7/9;248
12. Ibidem Sushruta Samhita(5), Kustha Nidana Adhyaya,5/3;311
13. Ibidem Charaka Samhita(7), Kustha
Chikitsa Adhyay,7/39;255
14. Ibidem Charaka Samhita(7), Kalpa
Sthana,
Madanaphala
Kalpa
Adhyaya,1/4;890
15. Ibidem Sushruta Samhita(5), Chikitsa
Sthana,
Kushtha
Chikitsa
Adhyaya,9/43;67
16. Ibidem Charaka Samhita(7), Kalpa
Sthana,
Madanaphala
Kalpa
Adhyaya,1/4;890
17. Acharya Vidyadhar Shukla and Ravi
Datta Tripathi edited with Vaidyamanorama hindi commentary, Charaka Samhita of Agnivesh elaborated by Charak
and redacted by Dradhabala, Sutrasthan,
Vidhishonitiya Adhyaya,24/15, Varanasi: Chaukhambha Prakashan, Reprint
2010;323
18. Ibidem Charaka Samhita(17), Sutrasthana, Vidhishonitiya Adhyaya,
24/18;323
19. Ibidem Sushruta Samhita(5), Chikitsa
Sthana,
Kushtha
Chikitsa
Adhyaya,9/43;67
20. Ibidem Charaka Samhita(17), Sutrasthana,
Yajjapurushiya
Adhyaya,25/40;337

IAMJ: Volume 4; Issue 04; March- 2016

Yashpalsinh A.Jadeja & Dhananjay V.Patel: Evaluation Of The Effect Of Biopurification On

21. Ibidem Charaka Samhita(17), Sutrasthana,


Chikitsaprabhrutiya
Adhyaya,16/6;250
22. Ibidem Charaka Samhita(17), Sutrasthana,
Yajjapurushiya
Adhyaya,25/40;338
23. Ibidem Charaka Samhita(17), Sutrasthana,
Chikitsaprabhrutiya
Adhyaya,16/20;242
24. Pandit
Shivasharma
edited
with
Bhashatikasahitacommentary, Charaka
Samhita,
Siddhisthan,6/10,
Part-2,
Mumbai: Ganga Vishnu Shri Krishnadas
Prakashana,1988;1854
CORRESPONDING AUTHOR:
Dr. Yashpalsinh A. Jadeja
P. G. Scholar, Upgraded P.G. Dept. of
Kayachikitsa, Govt. Akhandanad Ayurved
College Ahmedabad, India.
Email: yashpaljdj@gmail.com
Mobile: 9638881208

Source of support: Nil


Conflict of interest: None Declared

www.iamj.in

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

STUDY THE EFFICACY OF KARPASASTHYADI TAILA MATRA BASTI IN


SANDHIGATA VATA (OSTEO ARTHRITIS) WITH SPECIAL REFERENCE
TO JANU SANDHI (KNEE JOINT)
Gaikwad Pranesh 1* Chudhari Kalpesh2 Girde Samir3 Pachkawade Ganesh4
1
Lecturer, Dept. of Panchakarma, Dr. D. Y. Patil College of Ayurved & Research Centre
2
Lecturer, Dept. of Panchakarma, Smt.K.G. Mittal Punarvasu Ayurved Mahavidyalaya.
3
Lecturer, Dept. of Panchakarma, Shri Ayurved Mahavidyalaya Nagpur.
4
M.D. Panchakarma, Tilak Ayurtved Mahavidyalaya Pune

ABSTRACT
In Ayurveda the disease Sandhigata Vata resembles with OA. Modern medicines like Nonsteroidal anti inflammatory drugs (NSAIDS) are mainly prescribed for its treatment. These
medicines provide symptomatic relief, but the underlying pathology remains unchecked. In
Ayurveda, application of Bahya Snehan (External oleation), Swedana (fomentation), Abhyantara Tikta Snehapana (medicated ghee), Basti (medicated enema) treatment are prescribed in the management of Sandhigata Vata. Basti is prime treatment for various vata disorders which includes Sandhigat vata. Karpasasthyadi Taila mentioned in Charak
chikitsasthan for management of various Vata related disorders.1 Aim: To evaluate the efficacy of Karpasasthyadi Taila Matra Basti2 in Sandhigata vata. Materials & Method: In the
present study, 30 patients of Sandhigata Vata were given Karpasasthyadi Taila Matra Basti .
Subjective assessment by classical symptoms Sandhi Shoola, Sandhi Shotha, Vatapurna Druti
Sparsha, Graha (Restricted movement), Oxford pain chart, WOMAC (Western Ontario and
McMaster Universities Osteoarthritis Index) index of O.A. for knee by Visual analog scale,
Walking time for 10 meters were graded according to their severity. Result: Significant
(P<0.05) result were found in all cardinal symptoms of Sandhi Shoola, Sandhi Shotha , Vatapurna Druti Sparsha, Graha (Restricted movement). Conclusion: Karpasasthyadi Taila Matra
Basti was significant in the subjective symptoms of Sandhigata Vata.
KEYWORDS: Sandhigat vata, Osteoarthritis, Karpasasthyadi Taila, Matra Basti.
INTRODUCTION
In todays present scenario it has become
really important for every one to maintain
a physical and mental balance. With so
much of pollution in environment, food
adulteration, untimely working hours and
unhealthy life style it has become
mandatory for everyone to look after our
health. Leading an improper lifestyle or
consuming stale foods/ cold foods/ processed foods/ fermented foods and either

doing over exercises or not doing any exercises at all results in vitiation of doshas
mainly vata dosha.3 The vital force, vata is
concerned with all sort of movements
ranging from joint and muscle movements
to the movements at the cellular level.
When this vata is well harmonized functions in a balanced manner, it results in
healthy joints. When there is an imbalance
or disharmony, it results in various kinds
of ailments. Ayurveda describes old age as

How to cite this URL: Gaikwad Pranesh, Study the Efficacy of Karpasasthyadi Taila Matra Basti in Sandhigata Vata (Osteo
Arthritis) With Special Reference To Janu Sandhi (Knee Joint). Ayurvedic medical Journal {online} 2016 {cited 2016 April}
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Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis) With
Special Reference To Janu Sandhi (Knee Joint)

vata age, which is why a majority of patients suffering from Sandhigata Vata fall
in this age group. Sandhigata Vata vyadhi
commonly involves major joints namely
hip, knee, shoulder etc. Out of these Janu
sandhi is commonly involved since it is
weight bearing joint. Janusandhigata Vata
presents with symptoms of shool(pain),
shoth(edema), chankramana kashtata
(pain during movement) etc. According to
modern science, the disease is managed by
NSAIDS, analgesic drugs corticosteroids
etc. Potent analgesic and anti-inflammatory drugs run the risk of producing side
effects like gastric erosion, hepatic and
nephro toxicity etc. Even surgery statistically reveals to have considerable failure
rate in knee replacement. Its a limitation
in contemporary science to provide a comprehensive effective management. So research works in Ayurveda has evident
scope in this condition. In Charaka Samhita for Ashti pradoshaja vikaras, Panchakarma treatment is described.4 Among
these Pancharma, Basti chikitsa is regarded as the prime treatment modality. It
is considered as the best treatment for vata
dosha.5 It is explained that Matra basti can
be given to almost everybody, in all the
seasons and it can be given with maximum
ease and has no complications thereafter.6
In ayurvedic samhitas different siddhataila
has described to treat Sandhigata vata.
Karpasasthyadi taila (Charak samhitaVatavyadhi chikitsa adhyaya) is one of
them. Due to increased prevalence of this
disorder it has become a major problem
and burden for society, as it directly reduces the working potency resulting in
dependency. All the above factors inspired
me to study the effect of Karpasasthyadi

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taila matra basti in Sandhigata Vata with


special reference to Janu Sandhi.
AIM & OBJECTIVES: - Study the efficacy of Karpasasthyadi taila matra basti in
sandhigata vata with special reference to
janu sandhi.
MATERIAL AND METHODS:The objective of the dissertation is to study
the efficacy of Karpasasthyadi taila matra
basti in sandhigata vata with special
reference to janu sandhi.
Clinical study Patients having janusandhigat vata were selected for the research work. Total 30 Patients were selected. Clinical trials were conducted on
them. Clinical Data obtained from the trial
was analyzed with pair t -test method &
the results are presented.
SELECTION OF PATIENTS: - All patients of Janu Sandhigat Vata who will be
attending OPD of tarachand hospital,
Pune, will be selected irrespective of sex,
religion, economical status, education, occupation etc
INCLUSION CRITERIA:
1) Patients having textual symptoms of
Sandhigata vatawith special reference to
janu sandhi will be taken as a subject to
study.7
Sandhi Shoola(Joint pain)
Sandhi Shotha(Joint effusion)
Vatapurna Druti Sparsha
Graha (Restricted movement)
2) Sex: Male & Female
3) Age: 40 to 70Years.
4) Patient who will give written consent.
EXCLUSION CRITERIA:

Patients with other joints deformities


or diseases which are not relatedto
Janu Sandhigata vata, such as
Amavata, Vatarakta.

IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis) With
Special Reference To Janu Sandhi (Knee Joint)

Fracture of Knee joint, and needs


surgical care will be excluded.
Auto immune diseases Ankylosing
Spondylitis
Neoplasm
Permanent joint damage.
Known cases of Cardiac disease,
Pulmonary TB, Pregnancy, DM,
Paralysis, HIV, Neurological disorder
etc.
Having severe crippling deformity.
Age <40 yrs. &>70 yrs.
WITHDRAWAL CRITERIA:
a) Occurrence of Serious adverse events.
b) The investigator feels that the protocol
has been violated or Patient has
become incorporative.
c) Further continuation of the study is
likely to be detrimental to health of the
patients.
d) Patients absent for continuous 2
follow-ups will be considered as
dropped out from this project.
e) The patients are not willing to continue
the trial.
Method of administration
1. Form:Matra Basti.
2. Dose: 60ml.
3. Kala:Just after lunch once a day.
4. Duration of therapy: For 9 days
5. Follow up: 9 day, 15th& 21th days.
Procedure: - Purvakarma- Sthanik
snehan (Local oleation) and Swedana
(Medicated fomentation) Position- left
lateral Pradhankarma- Basti-dana Pashchatakarma- Tadana karma and Uttana
position.
PREPARATION
OF
KARPASASTHYADI TAILA:
Karpasasthyadi taila prepared as per described in Ayurvedic samhita, by Following methods.

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The essential components


1) Kwath Dravyasa) KarpasasthiGossypium
herbaceum Linn.
b) Kulattha- Dolichos biflorus Linn.
2) Sneha:- Tila taila- Sesamum indicum
Linn.
Karpasasthyadi Taila was prepared in following two steps
First decoction was prepared by adding
water to kwath dravya as per Sharangadhar
Samhita.8
Then to the decoction sneha dravya was
added, boiled and stirred well. When all
the Drava dravya have evaporated and
samyaka sneha siddhi lakshan9 observed,
madhyama snehapaka was done.
Method of preparation of Matra Basti
Karpasasthyadi taila 1.5 Pal
Prakshepa- Shatavha- 4 Mashak
Saindhav - 4 Mashak
To the taila prakshapa was added in given
amount and matra basti was prepared.10
Methods of assessment of symptoms :
Assessment of Shotha: Shotha can be
measured. So it is an objective parameter.
In this study shotha of janusandhi was
measured at3 levels in cm.
Level A At the upper level of joint,
Level B - At the centre of joint,
Level C At the lower level of joint
All measurements were taken. Mean
calculated& Effect of a trial is calculated
in terms of difference between the Shotha
before treatment and after treatment.
Assessment of Graha It is a subjective
parameter which can sometimes be
objective.Because when a patient can
move his leg up to a certain limit and then
suddenly further movement of the joint is
not possible because of the stiffness then it
is easy to decide the grade of the stiffness.

IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis) With
Special Reference To Janu Sandhi (Knee Joint)

The angle of the joint up to which the joint


moves can be measured for assessment in
such condition. But when a patient feels
stiffness in all positions of the joint and
can move it anyhow but with difficulty
then how can angle be measured?

Moreover in the case of amavata Graha


markedly varies with time to time and also
in the nature. So to avoid the fallacies and
to make it an objective criterion following
gradation was adopted-

Grade
Condition
No Stiffness
0
Mild Stiffness
1
Moderate Stiffness
2
Severe Difficulty due to Stiffness
3
Severe Stiffness more than 10 min
4
Patients were grouped accordingly before
Assessment of Crepitus/Vatapurna
& after treatment. Proper calculations were
Druti Sparsha It is done with following
done as per that of pain chart and assessgradation ment of efficacy was done.
Grade
Condition
0
No Crepitus
1
Palpable Crepitus
2
Palpable Audible Crepitus
3
Always Audible
Patients were grouped accordingly before
cates complete relief while 100 indicate
& after treatment. Proper calculations were
severe pain other symptoms, patient ware
done as per that of pain chart and assessasked to grade their severity of pain and
ment of efficacy was done.
allied complaints. Marking was defined
Visual analogue scale- There is 100 mm
accordingly in number.
long scale for assessment of overall relief.
VAS
There is 0marking on left hand side and
0
50
100
100 marking on right hand side.0 indiVISUAL ANALOG SCALE: Observation
Visit 1
Visit 2
Visit 3
Visit 4
VAS Score
Calculation ware done according to folWhere, Ibt - is intensity of Symptom belowing formula
fore treatment, & Iat is intensity of SympPercentage of relief (Ibt - Iat) / Ibt X
tom after treatment.
100
Assessment of Shoola (Pain) :
Sandhihoola
None
Mild
Moderate
Severe

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Grade
0
1
2
3
IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis) With
Special Reference To Janu Sandhi (Knee Joint)

Symptoms
Shool
Shotha
Vatapurnadrytisparsha
Graha
VAS
OXFORD PAIN
Walking Time
Overall assessment
Score

BT
1.98
30.77
1.2
1.48
79
2.63
16.17
133.23

AT
0.67
30.63
0.5
0.43
38.3
1.0
13.23
84.76

OBSERVATION:
SYMPTOM WISE ASSESMENT BEFORE AND AFTER TRETMENT:

Symptom Wise
B
T

GRADIATION

Percentage pain/Symptoms relief= (IPo


IPL) / IPo X 100
Where, IPo - is intensity of Symptoms before treatment & IPL - is intensity of
Symptoms after treatment.

RELIEF IN PERCENTAGE

Shoola
Shotha
Vatpurnadrutisparsha
Graha
VAS
OXFORD PAIN GRADE
WALKING TIME
Over All Assessment Score

% of Relief
66.16%
0.45%
58.33%
70.94%
51.52%
61.98%
18.18%

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Sh

36.38%

DISCUSSION: - The objective of the dissertation was to study the efficacy of


Karpasasthyadi Taila Matra Basti in
sandhigatvata. In this clinical study 30 patients were registered. Clinical trials were
carried methodically & proper record of
the observations was maintained. All the
observations were observed thoroughly.
The data is discussed as follows.
1. Age: - The eligibility criteria of age
group for this study were between 40
to 70 years. Majority of the patients
belonged to the age group of 40-50

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% of Relief

% OF Relief

Symptoms

years (53.33%), followed by 51-60


years (33.33%) and 61-70 years
(13.34%).
2. Sex: - Among the 30 patients of Janu
Sandhigata Vata, majority of them
were females (60.00%) and remaining
were males(40.00%). Even the universal data says the prevalence of osteoarthritis is more in elderly women.
3. Diet: - Among the 30 patients of Janu
Sandhigata Vata, majority was having
a mixed kind (60.00%) of dietary hab-

IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis)
With Special Reference To Janu Sandhi (Knee Joint)

its and rest were Vegetarians


(40.00%).
4. Occupation: - The occupation of the
patients indicate that 16(53.33%) of
the
patients
were
housewives,
14(46.67%) patients were doing some
job mostly sedentary in nature. Majority of the housewives are busy in some
activity or the other. Their work
profile includes all most all activities
releted to house keeping. They may
have to work in some odd postures.
This
excessive
activity
&
Vishamcheshta
may
lead
to
Dhatukshya
resulting
in
to
Vataprakopa there by manifesting
Sandhigatvata . In patient having sedentary jobs due to lack of activity,
there by putting on weight again lead
to Dhatukshya & then Sandhigatvata.
5. Prakruti:- All the patients in this
study were having Dwandwaja
prakruti. Maximum number of patients
i.e. 14 (46.67%) were having vata
kaphaja while 13(43.33%) having vata
pittaja prakruti, & 3(10.00%) were
having pitta kaphaja prakruti. Thus it
can be concluded that vata dominant
patients suffer more from sandhigata
vata & prognosis may be poor in them
as prakruti & dosha involvement is
same. In patients having kapha pittaj
prakruti prognosis may be good as
prakruti & dosha involved are not
same.
6. Menstrual History: In this study majority of the female patients
i.e.14(46.67%) were having history of
menopause or irregular menstruation.
Menopause history or irregular menstrual history plays important role in
manifestation of Sandhigata vata due

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to such history Apana gets pratiloma


direction which in turns vitiates other
type of vayu.
7. Malpravartan (Bowel Habit): 22 patients (73.33%) were having irregular
Malpravartan, while 8 (26.67%) patients had regular Malpravartan. Irregular Malpravartan, constipation is considerable as factor, as it obstructs the
prakrita gati of apana vayu & creates
the habit of vegodirana, which vitiates
vayu, agni as well as purishadhara
kala.
8. According to symptoms:
9. Shoola : According to statistics, Mean
of reduction in Shoola was 1.31
&
Percentage of relief was 66.16%.
10. Shotha : According to statistics, Mean
of reduction in Shotha was 0.14 and
Percentage of relief was 0.45%.
11. Vatpurna Druti Sparsha : According
to statistics, Mean of reduction in Atopa was 0.7 and Percentage of relief
was 58.33%.
12. Graha : According to statistics, Mean
of reduction in Graha was 1.05 and
Percentage of relief was 70.94%.
13. VAS : According to statistics, Mean of
reduction in VAS was 41 and Percentage of reduction in VAS was
51.90%.
14. OXP: According to statistics, Mean
of reduction in OXP was 1.63 Percentage of reduction in OXP was
61.98%.
15. Walking Time: According to
statistics, Mean of reduction in
walking time was 2.94 and
Percentage of reduction in walking
time was 18.18%.
CONCLUSION

IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis)
With Special Reference To Janu Sandhi (Knee Joint)

1. Janu Sandhigata Vata has been


considered as a major problem in
the society since long and the
chance of occurence is expected to
be increasing through the coming
years because of present life style.
2. Majority of the drugs in
Karpasasthyadi Taila are having
Ushna Veerya, Vatahara and VataKapha shamaka properties. So by
their virtue, they help in breaking
the samprapti of Janu Sandhigata
Vata.
3. Janu Sandhigata Vata afflicts predominantly in females.
4. In
Janu
Sandhigata
vata
karpasasthyadi Taila Matra Basti
was found statistically highly significant.
5. Karpasasthyadi Taila Matra Basti
has provided better relief in Sandhi
Graha (reduced up to 70.94%) followed in Sandhi shoola (reduced
up to 66.16%) and Vatapurna Druti
Sparsha(reduced up to 58.33%) but
only slight relief was observed in
Sandhishotha.
6. Overall assessment score shows
36.60% relief in all symptoms of
janusandhigata
vata
by
Karpasasthyadi taila Matra Basti.
7. Karpasasthyadi taila Matra Basti is
found to be good pachana and
vatashaman.
8. No any adverse effect was found
during or after treatment.

2.

3.

4.

5.

6.

7.

8.

REFERENCES
1. Cha. chi. 28/136, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika

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9.

commentary, Varanasi, Chaukhamba


Surabharati Prakashan.
Cha. Sidhi. 4/53, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Cha. chi. 28/13-15, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Cha.Sutra. 28/27, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Asht. Hru. Sutra. 19/1, Pandita Hari
Sadashiv Shastri, 2010, The Ashtang
Hruday of Shrimadvagbhatta, with
Sarvangsundari and Ayurvedarasayana
commentary, Varanasi; Chaukhamba
Surabharati Prakashan.
Cha. Sidhi. 4/52-53, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Cha. chi. 28/36, Dr. Bramhanand
Tripathi, 2006, The Charakasamhita of
Agnivresha, with Charak- Chandrika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Sharangadhara Samhita 9/2-3, Dr.
Bramhanand
Tripathi,
2007,
Sharangadhara samhita of Pandita
Sharangadharacharya, with Dipika
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
Sharangadhara Samhita 12/13, Dr.
Bramhanand Tripathi, 2007, Sharangadhara samhita of Pandita Sha-

IAMJ: Volume 4; Issue 04; March- 2016

Gaikwad Pranesh Et;All: Study The Efficacy Of Karpasasthyadi Taila Matra Basti In Sandhigata Vata (Osteo Arthritis)
With Special Reference To Janu Sandhi (Knee Joint)

rangadharacharya, with Dipika commentary, Varanasi, Chaukhamba Surabharati Prakashan.


10. Bhavaprakasha samhita Poorvakhand
5/103, Shri Brahmasankara Misra,
2010, Bhavaprakasha samhita of Pandita Sri Bhava Misra, with Vidyotini
commentary, Varanasi, Chaukhamba
Surabharati Prakashan.
CORRESPONDING AUTHOR
Dr. Gaikwad Pranesh
Lecturer, Dept. of Panchakarma,
Dr. D. Y. Patil College of Ayurved &
Research Centre, Pimpri,
Pune. 411 018
Email- vd.pranesh@gmail.com
Mobile No.- 8149861142

Source of support: Nil


Conflict of interest: None Declared

!"!

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

PREVENTION AND MANAGEMENT OF OSTEOPOROSIS

Devangi lashkari 1* Rajesh Gupta 2 Alankruta Dave 3


1
PG Scholar Department of Shalaya Tantra, Dr.Saravepalli Radhakrishanan Raj. Ayurved
University Jodhpur, Rajasthan.
2
HOD, Department of Shalaya Tantra,Dr.Saravepalli Radhakrishanan Raj. Ayurved University
Jodhpur, Rajasthan.
3
HOD,Department Kayachikitsa I.P.G.T. & R.A., Gujarat Ayurved University,Jamnagar.
ABSTRACT
Living in the 21st century has its advantages but with fast and stressful life style comes disadvantages also .One disadvantage is having unhealthy diet and faulty life style .Around the world
osteoporosis ,obesity and cardiovascular diseases are affecting the health status. Among the diseases osteoporosis is a growing public health problem world wide. It is often known as The Silent Thief. WHO (World health organization) is found that the fractures from osteoporosis are
more common then heart attack, stroke and breast cancer combined. Due to its prevalnce world
wide, osteoporosis is considered as a serious public health concern. Currently it is estimated that
over 200 Million people worldwide suffer from this disease. Modern drugs for the treatment of
osteoporosis include calcium supplements and other medicines has its own side effects. Ayurveda recommends healthy life style through Aahara, Vihara, Aaushadh, different kinds of karmas
to prevent all kind of diseases .By following Ayurveda rules, one can prevent himself from
osteoporosis (Asthi- majja kshaya).
Keywords- Life style disorders, osteoporosis( Asthi- majja kshaya) prevention and management.
INTRODUCTION
Osteoporosis has emerged as new challenge
for Medical science. Osteoporosis term describes a group of bone disorders in which
the absolute bone mass is less than normal
Osteoporosis is defined as a progressive
systemic skeletal disease characterized by
low bone mass and micro architectural
deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture.1Osteoporosis is often
known as the silent thief because bone
loss occurs without symptoms and is usually
diagnosed when fracture occurs in situations
where healthy people would not normally

have a fracture. At Some point Early detection and preventive treatment before fractures occur is the vital key to treating
osteoporosis.2 It is defined by the World
Health Organization (WHO) criteria as a
BMD T-score of 2.5 standard deviations
(SD) or more below the average for young,
healthy, premenopausal women [equating to
a T-score of less than or equal to -2.5 (a normal T-score is greater than -1)].. Early
detection and therapy is the basis for trying
to prevent these complications.
Incidence:-osteoporosis has reached epidemic proportions in the 21st century, Currently it is estimated that over 200 million

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Devangi Lashkari Et; All: Prevention And Management Of Osteoporosis

people worldwide suffer from this disease.3


Urbanization and modernization has been
associated with osteoporosis. In North
,Osteoporosis is most prevalent in urban
populations. Women are more suffering than
men.
Etiological factors:Modern life:-(Sedentary habits with little
exercise)
Faulty diet:-people are taking more junk and
fatty foods .Due to these diet habits,person
cant get Vit.D3, Calcium and other minerals
which is helpful for bone health.
Alcohol Consumption
Emotional distress
Hereditary
Over activity
Female gender
Increasing age
Menopause
Weight:-Thin body build or excessive
weight
Nutrition and pregnancy:-One theory is that
when children are under nourished in the
womb of their mother, When become adults,
if mother is osteoporotic the baby would be
also osteoporotic. 8
Classifications of osteoporosis
Signs and symptoms
Bone pain
Continuous bone pain
Fractures
Extreme fatigue
Joint pain
Peridontal disease
Hair loss
Forward bending of spine
Weakness
Brittle and soft bones
Difficulty in Walking
Diagnosis:
Osteoporosis is a silent disease, until a fracture is sustained.
Acute pain in middle to low thoracic region
or high lumber regions.

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Primary
(1) Post menopausal: type I (it occurs within
15 to 20 years after the onset of menopause.4)
(2) Age related: type II (A long history of
calcium deficiency is largely responsible for
this condition, which is called senile
osteoporosis because it occurs in patients
over the age of 70.)5,6
Secondary
Endocrine Thyrotoxicosis, Pituitary
insufficiency, Athletic amenorrhoea
Drugs Corticosteroids, Long term heparin
use, Anticonvulsant drugs
Inherited-Osteogenesis
imperfect,
Homocystinuria
Nutritional -Anorexia nervosa, Alcoholism,
Malabsorption syndrome
Immobility-General (lack of weight bearing
exercises), Local (e.g., hemiplegia, fracture )
Other (rare)- Chronic hepatic disease, Pregnancy.7
Signs and symptoms of Osteoporosis:- Being a osteopenic may not cause many
noticeable problems. However, Once you
are Osteoporotic you may develop symptoms that mentioned below:Lakshana
Asthi toda
Asthi bheda
Anga bhanga
Srama
Sandhishoola
Danta bhanga
Kesha patina
Vinamana
Bala kshaya
Asthi saushirya
SandhiSaithilya

The onset of pain is sudden and patient indicates exact moment of its beginning and
specific site i.e. vertebral level where the
pain originated.

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Devangi Lashkari Et; All: Prevention And Management Of Osteoporosis

Pain in above mentioned regions while at


rest or during routine daily activity is the
earliest symptom of osteoporosis.
Spinal movement is severely restricted. Pain
intensifies with movements sitting or
standing and is relieved considerably with
bed rest in fully recumbent position.
Even coughing, sneezing and straining
exacerbate pain.
Incremental loss in height and mild thoracic
kyphosis may be evident.
Clinical findings:
In early stages,patients exhibit marked
discomfort on sitting and standing.
Spinal movements considerably reduced,
with more restriction in flexion than in
extension.
Thoracic kyphosis may be present as a result
of previous anterior compression fractures.
Involvement of lumbar spine is noted by
progressive loss in lumber lord sis.
Axial height may be decreased.
Spine and paravertebral muscles are tender
on palpation and percussion over the level of
fracture.
Most patients are totally pain free during the
intervals between compression fractures,
whereas some may complain of chronic,
dull, aching postural pain in mild thoracic
and upper lumber region.
Loss of height may be upto 2 to 4 cm with
each episode of segmental vertebral collapse
and progressive kyphosis.
There is no significant loss of height when
the lower ribs come to rest on iliac crest due
to collapsed spine. Yet loss of bone mass
continues.
This result in decrease in size of thoracic
and abdominal cavities, which are
responsible for clinically disturbing side effects exercise tolerance is reduced.
Abdominal distention, protrusion is a common manifestation secondary to severe lumbar vertebral collapse.
Radiographic findings:
(T-Score)

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Axial sites have a greater proportion of


trabecular to cortical bone than appendicular
sites. Therefore vertebral deformities may be
the first evidence of osteoporosis.
Thoracolumbar spine x rays may reveal important and relatively early evidences of
osteoporosis.
At an early stage, spinal radiographs show
loss of transverse trabeculae, with prominence of the vertical weight bearing trabeculae. Later as trabecular architecture is lost,
principal x-ray appearances include wedge,
crush and biconcave deformities.
The most frequently fractured vertebrae are
those subject to the greatest mechanical
stresses, namely T8, T12 and L1.
Bone densitometry:
The following methods are widely available
for Bone Mineral assessment.
1. SPA single photon absorptiometry.
2. DPA Dual photon absorptiometry
3. DXA Dual x-ray absorptiometry
4. QCT Quantitative computerized
tomography
5. QUS Quantitative ultrasound
Amongst the above Dual energy X- ray absorptiometry represents the best available
measure of bone density and is the most
reliable predictor of fracture risk. BMD values are expressed as absolute values in g /
cm2 (i.e. as an areal density corrected for
height or width of bone but not depth) or as
SDs related to the young adult (T scores) or
age matched (Z scores) reference range.
T scores between -1 and -2.5 represents
osteopenia, clinical significance of which is
not completely understood.
T score below -2.5 represents osteoporosis
and a high risk of fracture.
T score below -2.5 plus one or more fragility
fractures is indicative of established
osteoporosis.
Bone densitometry measures bone density,
not bone turnover or bone stability.
Bone Mineral Density (T-Score): WHO
Criteria for assessing osteoporosis
Condition

IAMJ: Volume 4; Issue 04; March- 2016

Devangi Lashkari Et; All: Prevention And Management Of Osteoporosis

greater than -1
between -1 to -2.5
less than or equal to -2.5

Normal
Osteopenia
Osteoporosis

Complications
of
Osteoporosis:
Osteoporosis increase the risk of many
physical, mental and social conditions.
Fracture is main risk factor of osteoporosis
.Osteoporosis complications include both
morbidity and mortality. Bone fractures,
particularly in the spine or hip, are the most
serious complication of osteoporosis.
Kyphosis is a serious Complication.
significant amount of pain
decrease in quality of life
Complications of fractures.9
Vertebral- Back pain, Height loss, Kyphosis
(commonly known as Dowagers hump
Multiple thoracic- Restrictive lung disease
Lumbar fractures- Constipation, Abdominal
pain,
Distention.
Reduced
appetite,
Premature satiety.
Management of osteoporosis: Dietary/lifestyle modification,
Generally used Biophosphonates,
Oral drugs like Calcium and Vitamin D supplements. The drugs improve Bone density
and redusing bone turn over.
Drawbacks of modern therapy for
osteoporosis:- As with any therapy, the
benefits of efforts directed towards Bone
density control must be weighed against the
risk of treatment, side effects of intensive
treatment(calcium gluconate) include- an
allergic reaction while taking calcium gluconate: hives; difficulty breathing; swelling
of your face, lips, tongue, or throat. Less
serious side effects of calcium gluconate
may include: nausea or vomiting;decreased
appetite,upset
stomach,constipation;dry
mouth or increased thirst; or increased urination.rapid intravenous injections of Calcium
gluconate may cause hypercalcaemia,which
can result in vasodilation,cardiac arrhythmias,decreased blood pressure and brady
cardia,Extra rasation of calciu gluconate can
lead to cellulitis. Side effects of Vitamin D
is weakness,fatigue,sleepiness,headache,loss

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of appetite,dry mouth,metallic taste,nausea


and vomiting.
Osteoporosis in Ayurveda:Osteoporosis is taken in relation to Asthikshaya.In our classical text book there is the
disease Asthi-kshaya is not find as a seprate
disease.In our classical text books described
asthi-kshaya mentioned under Dhatu kshaya
.Acharya Charak described eighteen types of
kshaya in adhyaya no. seventeen kiyanta
shirashiya sutrasthana.So,we can take as an
indipendant disease.The sign and symptoms
of this disease are described all the texts of
ayurveda and we can find its specific etiology also.
The disease and its pathology understood by
ashraya-ashrayi bhava-A very important and
impressive theory given by Astang hridaya.
The theory is that there is vata doshas specific sthan is Asthi dhatu. And Vata is increase Asthi dhatu is decrease and this is
vice-versa. The relationship between Asthi
and Vayu is called Asrayasrayi Sambandha.This relationship helps in knowing
hetu and chikitsa of a vyadhi as nourishment
of Asraya and Asrayi is similar. The ahara,
vihara or aushadha that increase or decrease
the dosha will increase or decrease the
corresponding asraya (dhatu and mala). The
above mentioned rule is not applicable to asthi dhatu and vata dosha.10
Brimhana chikitsa; use of Snigdha, madhura
etc. dravyas is indicated for increasing asthi
dhatu (asthi vriddhi). This decreases vata
dosha. In the same way to increase vata
dosha, ruksha, katu etc. dravyas are indicated which causes kshaya of asthi. Hence
the rule of asrayasrayi is opposite for asthi
and vata.Hence for treatment of diseases related to asthi dhatu, this unique relationship
should be taken into consideration. Drugs
acting both on Asthi dhatu and vata dosha
provide better treatment of diseases related
to asthi dhatu.11

IAMJ: Volume 4; Issue 04; March- 2016

Devangi Lashkari Et; All: Prevention And Management Of Osteoporosis

Nidana (Causative factors)of Osteoporosis:All the causative factors described in


Ayurvedic classics can be classified in to
four groups:1. Ahartmaka Nidana(Dietary)
2. Viharatmaka Nidana(Regimens)
3. Manas Nidana(Psychological)
4. Anya Nidana(Others)
Ahartmaka Nidana(Dietary):- Aptarpana(lack of nourishing),Alpashana(Lack of
eating),excessive
consumption
of
laghu,Katu(spicy
food),Sheeta(cold
diet),Ruksha(food without oil/ghee), Ahartmaka nidana Laghvanna(To eat light
foods.langhana(starvation).
Viharatmaka
Nidana:Ativyayama
(excessiveexcersise), ativyavaya(excessive
intercourse), Atiprajagrana(Asomnia), Vishamadupchara(faulty treatment), Dosha
Ashruka Stravanadi(excessive bleeding),
Plavana (sweeming), Ati Adhva gamana(Excessive walking), Divasvapana(Day
sleep),Vega Vidharana (control natural
urges).
Manshika
Nidana:Chinta(tension),
Shoka(Sadness),
Krodha(enger),
Bhaya(fear),
Others: Chirkalaj roga (long time unhealthy),Aghata(trauma).12
Samprapti:- Consumption of nidana sevana
are reason for vata prakopa and as per
ashraya ashrayi bhava vata dosha increase
asthi dhatu decrease .So, resulting in Asthikhaya.
Impact of Asthi-kshaya:- Disproportinately
increased vat dosha and decrease asthi dhatu
are accountable for several serious consequences reported in Charaka ,Sushruta and
vagbhata like- Asthi toda, Asthi bheda, Anga
bhanga, Danta bhanga ,Srama, Kesha
patina, Vinamana, Bala kshaya, Asthi saushirya, Sandhishoola SandhiSaithilya.13
Ayurveda management of osteoporosis:
In Ayurveda,management of any disorders is
devided into three parts;1. Nidana parivarjana
2. Shodhana

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3. Shamana
Nidana parivarjana:- It is the first line of
treatment of any disease and it is most important line of treatment for Asthi kshaya
also.It says that the root of Samprapti process,Nidana must be avoided for best
management of the disease.In osteoporosis
the
factors
i.e.Ahartamaka,Viharatmaka,manas and others which are responsible for the causation
of the diseases should be avoided.14
Sodhana therapy:- Meaning of Sodhana is
Apakarshana of dosha.therapies in which the
aggravated doshas or the excretonny product
of digestion are elimated after mobilizing
them from their respective sites,by urdhava
or adhva marga from the body is known as
sodhana therapy.It is also termed as Apkarshana.Panchkarma is including in Sodhana therapy.Tikta basti is indicated in
Osteoporosis.15
Shamanatherapy:-Among said upkrama
(six types of therapies-snehana, swedana,
rukshana,
langhana,
stambhana,brihana.)Snehana and swedanacan be administered for shaman purpose in
asthi-khaya.charaka samhita best grantha
for treatment .has given treatment in following
words.
Administration
of
guru,Brinhan,Snehana,swedana
articles
which posses additional vata nasaka properties is considered as an ideal for shaman
therapy.16
Different medicaments for Asthi-khaya:
Single drugs like Asthi shrinkhala
ghrita,Satavari,Ashwagandha churna, guggulu,
Mukta
pisti,Praval
pisti,pravalpisti,Sankhabhama.
Compound drugs: Yograj guggulu,Rasayana
churna,Triphala guggulu,aaabha guggulu,
laxadi guggulu
REFRENCES
1. John P. Bilezikian, Endocrinology and Metabolism clinics of North America, Osteoporosis,
Elsevier India Private Limited, New Delhi, 2004,
preface.

IAMJ: Volume 4; Issue 04; March- 2016

Devangi Lashkari Et; All: Prevention And Management Of Osteoporosis

2.
3.
4.
5.

6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Osteoporosis for Dummies by Carolyn Reister


O
Conner
MD
Sharon
perkin,RN,copyright@2005 Willy publishing Inc.
http://www.indianjmedsci.org/text.asp?2006/60/
5/183/25679
Riggs BL, Melton LJ III. The prevention and
treatment of osteoporosis. NEJM; 327 620-627,
1992.
Melton LJ III, Riggs BL. Clinical Spectrum. In :
Riggs BL, Melton LJ III. Eds.Osteoporosis :
etiology, diagnosis and management. New York
: Raven Press; 155-79, 1998
6.Atiken M. Osteoporosis in Clinical Practise,
Bristol, UK : John Wright; 1984.
Riggs BL, Melton LJ. Evidence of two distinct
syndromes of osteoporosis .N Engl J
Med.1983;314:1676-1685)
Anatomy and physiology in health and illness,
Ross and Wilson, Tenth Edition.
National Osteoporosis Foundation. Clinicians
Guide to Prevention and Treatment of
Osteoporosis. Accessed 21 February 2011.
Astanghridaya sutrasthana adhyaya eleven.
CharakaSamhita sutrasthana adhyaya twenty
two.
Charaka Samhita Chikitsasthana twenty eight.
Charaka Samhita sutrasthana seventeen.
Sushruta samhita uttartantra adhyaya one.
Charaka samhita sutrasthana Adhyaya twentyeight.
Acharya vidhyadhara shukla and prof Ravidutta
tripathi editor-Charak samhita of Agnivesha,elaborated by charak and dalhana with
vaidhyamanorama
hindi
commentary,reprint.Delhi.Chaukhamba
Sanskrit
pratisthan;2000

CORRESPONDING AUTHOR
Dr. Devangi Lashkari
PG Scholar Department of Shalya Tantra,Dr.Sarvapalli
Radhakrishanan
Raj.
Ayurved University Nagaur highway Road,
Kadwad, Jodhpur Rajasthan -342037,
India.
Mo-09426130238.
Email-devangi.lashkari07@gmail.com.

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

EFFECT OF YOGASAN IN THE INFERTILITY


Sutar Asmita Maheshkumar 1, Jadhav Sujata Popatrao 2
1.

Associate Professor, Dept. of Samhita & Siddhant, Yashwant Ayurvedic College, Post Graguate Training & Research Center, Kodoli, Dist. Kolhapur 416114, Maharashtra, India
2
Assistant Professor, Dept. of Kayachikitsa, Yashwant Ayurvedic College, Post Graguate Training & Research Center, Kodoli, Dist. Kolhapur 416114, Maharashtra,India.

ABSTRACT
Infertility is the most common gynecological problem which many couples in 21st century are facing. According to mayo clinic USA about 20% of cases of infertility are due to the problems in the
men. About 40 to 50% of the cases of the infertility are due to problems in both men & women.
Increasing rate of infertility has become challenging for gynecologists. As the allopathic treatment
developed upon hormone supplementation, surgical procedure & artificial reproductive technique,
its the turn of ayurved & yog to give solution & active conception by natural method to give
healthy offspring. Yoga is one among oldest system of health care in the world which uniquely
perceived an intimate relationship between lifestyle of an individual to its health & disease. In
Yogsutra, Achary Patanjali explained various asanas. These asanas are very helpful in controlling
the mind as well as other element of the body. By the regular practicing the asanas the reproductive organs get strengthen & the neuro-mascular co-ordination improve. Also hormonal imbalance
gets corrected. Review study concluded that modern life style stress is mainly responsible for abnormal condition like infertility and yogasanas a part of yoga therapy place significant effect in
treating infertility.
Keywords: infertility, yogasanas, reproductive organ, mind, yogshastra, stress.
INTRODUCTION
Reproduction is one of the most important
biological functions for all life forms. For
most couples having children is a somewhat
primal need & inability to reproduce can be
divesting individuals and couples. There are
certain myths about infertility. One of them
is that infertility is not a problem in countries with high fertility rates. Paradoxically
countries with higher fertility rate also have

high prevalence of infertility. Another myth


is the common belief that infertility is a
womens problem. However, research evidence indicates that the best result for infertility treatment are obtained when both partners are investigated together. Another myth
is the belief that infertility neither preventable nor treatable. Infertility is a major
reproductive health concern. It affects an
estimated 50 to 80 millions couples globally.

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

Generally world wide it is estimated that one


in seven couples have problems concaving
with incidence similar in most countries independent of the level of countries development roughly half of fertility problems with
the men & half due to women. However
about one in five cases of infertility have no
clear diagnosed cause. Male factor infertility
accounts for 25% of infertile couple, while
25% remain unexplained 50% are female
cause with 25% being due to anovulation &
25% tubal problems. Infertility is the most
common gynecological problem which
many couples in 21st century is facing. The
increasing rate of infertility has become
challenging for the gynecologists. As the
allopathic treatment develop upon hormone
supplementation, surgical procedure & artificial reproductive technique its the turn of
Ayurved & yoga to give solution and
achieve the conception by natural method to
give healthy offspring. In todays era yogashstra gives us a helping hand, With the
help of certain asanas, bandha, mudras
nerves are stimulated results in activated
nerve work co-ordination. It improves physiological cleaning process blood congestion
is removed by various positive pressure, local circulation in region where the sex organs & sex glands are situated improves.
Hence the reproductive system function
well.
Aims & objectives:
1. To study the concept of infertility according to ayurved & modern science.
2. To evaluate the role of yogasanas in infertility.
Material & method:
Only textual material has been used for this
study, from which various references have
been collected. Ayurvedic text & available

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commentaries on it, modern text & related


websites have also been searched.
Concept of female infertility in ayurved :
In ayurvedic classics majority of the gynecological disorders have been described under
the heading of yonivyapad. All the classics
have given the number of yonivyapad as
twenty.However, there exists much differences of opinion regarding causative
doshas.In Sushrut samhita(Su.U.38/10,11)
vandhytva has been included in twenty
yonivyapad. Achary Charak (Ch.Sha.4/30)&
Vagbhat(Ash.Sanh.Sha.2/48) has referred
vandhytva seen due to abnormality of beej.
Achary Harit (Ha. Trutiyasthan 48) has
classified vandhyatva in detail & six types
of vandhyatva has mentioned. Madhavnidan
& Yogratnakar have followed Achary
Sushrut. In Rasratnasamuchhaya, nine types
of vandhya have been described (R.R.S / A/
32) In Vandhya kalpdruma eight types of
vandhya have been described. (Stri. Chiki.
46-50)
Vandhya is a woman who lost her artav
(menstruation). Some of the recent writers
interpreting artav as ovum consider
vandhya as unovulatory menstrual cycle.
Ovum is a microscopic structure, its presence during those days was imagined due to
its role in conception. Here, instead of infertility a clinical feature of anovulatory cycle,
amenorrhea has been described. Though distraction of artav denotes that artav was present, which finished afterwards, thus it
should be considered as secondary amenorrhea. The word nirartav. (without menstruation) used in Bhavaprakash hints
towords primary amenorrhea. Acharya
Charak & Vagbhat, while describing
beejmans dushti chromosomal, genetic abnormalities have mentioned that if part of
beej responsible for the development of

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

uterus defective then born child would be


vandhya. Achary Chakrapani has included
abnormalities of the part of beej responsible
for the development of artav & garbhashay
both. If description of Achary Charak &
Sushrut are considered together, then
vandhya yonivyapad would appear to be
identical to primary amenorrhea due to congenital absence or marked abnormalities of
uterus & ovaries.
Concept of male infertility in Ayurveda:
In Ancient times, probably because there
was no microscope, sperm and seminal fluid
were not known as separate entities both
were known as shukra dhatu. The shukra
dhatu is the last of hierarchical tissue and
therefore its quality is influenced by the
quality of prior tissues. further any abnormality in the shukra dhatu leads to either
infertility or congenital anomalies in the
child. Ancient physician have described
characteristic features of fertile shukra dhatu
thus, the semen should be produced in large
quantities ,should be thick and viscous in
consistency, sweet in taste with sweet honey
like odor and white in colour. Achary Charka, has described four main causes of infertility namely1. Bijopaghat Anatomical or quantitative
abnormalities in sperm
2.Shukra-Sankshay Deficiency in seminal
fluid
3.Dhwajopaghat Defect in penile function
(either in erection or ejaculation)
4.Jara senility or old age.
In Similar fashion Achary Sushrut has also
described different types of abnormalities in
semen including
1.Kshin Congenitally less in quantity
2.Alpa Decreased quantity due to any disease
3.Dusht Acquired pathology in quality

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4.Vishushk Decreased quantity due to age


Interestingly,Achary Sushrut has also emphasized the importance of the psychological component in fertility and penile function.
Concept of infertility in modern science:
Infertility is generally defined as failure to
conceive, after twelve months or more of
normal sexual practice without contraception. Approximately 85% of couples conceive within twelve months ,93% of couples
within twenty-four months 8% remain infertile by the end of twenty-four months. Causes are identified in 90% patients pregnancy
results in 40% of those.
Types of infertility
1. Primary infertility: It denotes those patients who have never conceived. Prevalence of primary infertility is 3% in India.
2. Secondary infertility: It indicates previous pregnancy but failure to conceive
subsequently. Prevalence of secondary
infertility in 8% in India.
Etiology according to Ayurveda: Acharya
Charak has clearly described the nidan of
vandhyatva which are almost similar to
causes of infertility according to modern
science.
According to ayurved disorders of factors of
conception related to (i) Rutukal e.g
kaphapradhnya (ii) Kshetra e.g. vyapanna
yoni (iii) Ambu e.g garbhsravi (iv) Beeja e.g.
artav dushti.
A.Yonipradosha (abnormalities of reproductive organs): All twenty yonivyapad if
not treated properly causes infertility. (Su.
Sha. 2/3)
Without vata the yoni never gets spoilt,
vandhyatva has also been described in
eighty types of vatavyadhi (ca . ica . 28) so
vata as the prime.

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B. Mansik Abhitap (Psychoiogical abnormalities): Normal psychology of the couple


as very important for achievement of pregnancy. Fear of doing sex, marital disharmony and infrequent coitus affect the fertility. ( ca.Saa.2 /5)
C. Shukra dushti (Abnormalities of
shukra): Quntitative & qualitative abnormalities of sperms along with seminal fluid
causes infertility. (sau. Saa. 2/5) Causes of
male infertility are akaal yonigaman,
nirghat (suppression of urge coitus),
atimaithun (over indulegence), asatmyanam
cha sevan (eating improper food) & other
causes like fear, sorrow, stress.(ca . iva
.5/19)Also cases of shukrakshay has described by Achary Charak i.e. jara, chinta
etc (ca . ica . 2/4,42,43)
D. Asruk dosha (Abnormalities of asruk):
The word artav refers to ovum, menstrual blood
and ovarian hormones.Abnormalities of ovum
and ovarian hormones produce infertility (sau.
Saa. 2 4/)

E. Abnormalities of diet: For maintenance


of normal health the balanced diet is essential. Dietetic abnormalities influence nourishment of the body or cause loss of dhaus
which influences normal secretion of hormones resulting into failure to achieve pregnancy. Samyaj and rasaj bhawas included
under sadbhawas and ambu or nutrient, one
of the four factors of conception come under
this heading. Abnormal diet is one of the
important cause of vitiation of doshas,
which if vitiated, influence fertilization by
producing gynecologic disorders, diseases of
vat, chronic illness and udavarta etc. The
fertilized egg is nourished by the exudates of
epithelial lining of fallopian tubes and endometrium, these exudates are derived from
the ras dhatu formed from maternal diet; for

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implantation of zygote, the endometrium is


prepared by the hormones, which are also
formed with the help of maternal diet, if fertilized egg is not nourished properly, then
either fails to develop or after getting implanted in endometrium may get discharged
with menstrual blood and the woman will
never know that she ever conceived and
consider herself as infertile. In short dietetic
abnormalities cause infertility in three ways
i.e. (i) by producing loss of dhtus, thus influencing hormones (ii) by vitiating doshas
which cause various gynecologic diseases,
thus infertility(iii) by hampering nourishment of fertilized egg or implantation of zygote.
F. Abnormalities of mode of life: Abnormal mode of life and suppression of natural
urges aggravate doshas, which influence impregnation by producing various gynecologic abnormalities. Coitus with the woman
in her hump-back or lateral posture, discharge of semen over samirana nadi or outside the vaginal canal, all come under defective practice, in all these conditions probably
semen is not properly deposited inside the
vaginal canal, thus sperms fail to enter uterus causing infertility. In short, abnormalities
of mode of life also produce infertility in
two ways i.e. (1) by vitiating doshas, thus
causing gynecologic disorders (2) by preventing proper entry of sperms due to faulty
deposition of seminal ejaculation.
G.Akal yog (coitus in improper time)
Word kal (time or period) refers to period of
age and rutukal both. In young or old ladies
due to premenarche and menopausal stage
respectively and before or after rutukal due
to absence or destruction of ovum respectively conception does not take place.
H. Loss of bal or strength

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

Bal refers to physical strength and capacity


to become pregnant. Physical strength depends upon dhatus, which has already been
discussed under diet. Here probably bal refers to capacity to achieve conception. Few
women fail to become pregnant during their
active reproductive life or much before the
normal age of menopause, others do not
conceive with no apparent cause, probably
only due to loss in the capacity to achieve
pregnancy, thus loss of bal or strength refers
to infertility due to unknown cause or premature aging
I. Abnormalities of atma & satva
This heading includes infertility due to
influence of misdeeds done by the couple
in.their previous life as well as abnormalities ofatma descending in this pregnancy.
Misdeeds of previous life refer to idiopathic
causes. Atma descending in the fertilized
egg is encircled by satva, both these i.e.atma
and satva are included under habhawas of
embryo, conception is the result of union of
shukr, shonit and atma, naturally its
abnormality
may
cause
infertility
Affliction by jtahrini refers to idiopathic
cause of infertility. On the basis of clinical
features, the puspaghni jtahrini (having
infertility as cardinal symptom) seems to be
infertility due to inadequate level of hormones. (Ka.Revatikalpa/33)
K. Curses of god or fate
This also refers to idiopathic causes of infertility.
L. Life style and environmental factors
causing infertility
Age, stress, poor diet, obesity or underweight, smoking, drugs, alcohol, medication, environmental toxins, genetic conditions, other health problems such as STD &
immunological. Since many women delay

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child bearing on account of education & carrier. Fertility rates have been shown to decline with increasing age of spouse with duration of marriage, presumably secondary to
decrease in sexual activity. Exposure to excessive heat at work places increasing risk
of oligospermia & also affect the quality of
sperm. Occupational exposures also have
demonstrated increased risk of idiopathic
infertility. Exposure to radiation which may
be occupational, accidental, iatrogenic or
therapeutic can contribute to infertility. Exposure to pesticides can link with poor
sperm function in men. Unhygienic obstetrical practices & inappropriate gynecological
practices leading to postpartum infections,
unsafe abortion etc. may also cause infertility. Any psychiatric illness can cause hypothalamic dysfunction & un ovulatory infertility. Infertility as a major reproductive
health concern . In many cultures the consequences of infertility can be devasting specially for women.
Etiology according to modern science:
A. Causes of female infertility
- Ovulatory dysfunction e.g. un- ovulation
- Tubal factors e.g. obstruction of tubal lumen
- Peritoneal factors e.g. endometriosis
- Uterine factors e.g. inadequate secretory
endometrium
- Cervical factors e.g. chronic cervicitis
- Vaginal factors e.g. frequency & timing of
coitus
B. Causes of male infertility
-Defective spermatogenesis
-Obstruction of the efferent duct system
-Failure to deposit sperm high in the vagina
-Defect in the sperm & seminal fluid
Essential Factors for fertility: Ayurvedic
view

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

Achary Charak has mentioned both male &


female after observing the advocated dietic
regimen & ejaculated unvitiated shukra
passing through healthy yoni reaches
healthy grabhashay & gets mixed with disease free shonit, then conception as definite.
(ca. Saa. 8/17) According to Achary Sushrut
four essential factors for the conception are
similar as the germination of seed
(sau.Saa.3/6)
(a) Rutu (ovulation period) fertile period
(b) Kshetra Reproductive organs in
healthy state
(c) Ambu Proper nourishment, adequate
hormonal level & proper nutrition to genital
organs.
(d) Beej adequate ovum & spermatozoa
Essential Factors for fertility:Modern Science view
For an unassisted conception, both partners
should be fecund.
Female partners requirement
a. Functioning reproductive anatomy &
physiology
b. Adequate nutritional, chemical & health
status to maintain nutrition & oxygenation
of placenta & fetus
c. Adequate sexual desire to permit coitus &
its frequency.
Male partners requirement
a. Normal spermatogenesis & ductal system
b. Ability to transmit spermatozoa in the female vagina.
c. Ability to achieve a normal ejaculation.
Importance of yog:
Health & fitness are essential for all persons.
Yog is one among oldest system of heath
care in the world which uniquely perceived
an intimate relationship between lifestyle of
an individual to its health & disease. The
concept of medicine & its approaches in recent years also has changed the medical pro-

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fessional & is facing with the rapid growth


of newer disorders whose routs lies in the
society & modern way of life itself. An
overview of current trends in western medicine too now shows increasing tendency of
emphasis on the life style management in
prevention & treatment of many modern
diseases Yog deliberates the concept of
achar,vichar,ahar,vihar as primary modes
of care of human health.
A.Achar (Behavioral regimen)
In yog, achar includes yam & niyam. Yam is
control of the body, speech & mind. It is
classified into five subtypes;Ahinsa, Satya,
Astey,Brahmacharay,Aparigrah.Niyam
is
following the rules of good conduct. It is
classified
into
5
subtypes,Shouchya(cleanliness),Santosh(Conten
tment),Tap (Penance,)Swadhyay (study of
religious scriptures),Ishwarpranidhan (Remember God).
B. Vichar (Thoughts)
In yog yaaogastu ica%tvaRi%t inaraoQa :
yaaogasaU~ 1 /2
Dharna is concentration of chitta on some
object. Dhyan is perfect contemplation. It involves concentration upon a point of focus
with the intention of knowing the truth about
it.
C. Aahar ( Dietary principles)
Satvik & vegetarian ahar mentioned in
yog.which has a vital role in promoting ones
total health.(Hathyog pradipika 1/62)
D.Vihar (Healthy life style)
In vihar yogcontents asanas,pranayam
,shudhikriy such as dhauti ,basti ,neti ,tratak
,nauli ,kapalbhati.Asanas (posture);yog has
percribed various types of postures.These
postures are very helpful in controlling the
mind as well as other element of the body.
In Hathyog an eight fold path viz yam
,niyam ,asan ,pranayam,pratyahar ,dharana

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

,dhyan ,samadhi. Yam ,niyam ,asan and pranayam are clubbed together as bahirang yog
and are practiced for mental and physical
health..Dharana ,dhyan,samadhi are considered parts of antarang yog .Pratyahar is
considered by some as a bridge between bahirang and antarng yog.
Role of asanas in infertility:
In the Yogsutras,Patanjali defines asan as to
be seated in a position that is firm but relaxed. Patanjali mentions the ability to sit
for extended periods as one of the eight
limbs of his system known as ashtang yog
Asanas are also performed as physical exercise where they are sometimes reffered to as
yog posture or yogpositions. Some asanas
are regularly performed by many practitioners just for health purpose.Asanas do promote good health although in different ways
compared to physical exercises placing the
physical body in positions that cultivate also
awareness, relaxation & concentration
Common practices:In the Yogsutras the only rule Patanjali
suggests for practising asan is that it be
steady & comfortable. The body is head
poised with the practitioner experiencing no
discomfort. When the control of the body is
mastered, practitioners are believed to free
themselves from the duality of heat or cold,
hunger or satiety, joy or grief which is the
first step towards the unattachment that relieves suffering. Listed below are the traditional rules for performing asanas.
1. The stomach should be empty.
2. Force or pressure should not be used.
3. Lower the head and other parts of the
body slowly, in particular, raised heels
should be lowered slowly.
4. The breathing should be controlled. The
benefits of asanas increased if the spe-

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5.
6.

1.

2.

3.

4.

5.

cific pranayam to the yog type is performed.


f the body as stressed perform corpse
pose or child pose.
Such asanas as sukhasan or shavasan
help to reduce headaches.
The asanas which are useful for infertility are as follows.
Vajrasan (Thunderbolt pose):Vajrasan
improves the blood circulation in the
lower part of abdominal region and
maintains the health of the genital area.
Paschimottanasan (Forward bend pose):
Unnecessary blood accumulation in the
lower abdomen is eliminated. It eliminates the disorders arising from excessive indulgence in sex and thereby improves the health of the sex glands.
Padmasanasth yog mudra(Lotus pose):
The sex life of men and women become
healthy and fulfilling. Seminal weakness and nocturnal emission in youths
and problem of excessive menstruation
in young women is eliminated by practicing over a period of time. It is one of
the most important meditative asan posture.Blood is made to flow more towords
pelvic region.
Viparitkarani mudra (Legs up the wall
pose): This mudra specially benefits
women ,the tendency and possibility of
displacement of the uterus is considerably reduced. For healthy gestation and
smooth delivery, it is used. Keeps the
muscles of abdomen and sex organs optimally elastic.
Halasan (Plough Pose): The functioning
of thyroid & parathyroid glands is improved because of the pressure exerted
on these throat glands. Due to this endocrinal harmony is maintained & improved, resulting in conception.

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

6. Suptavajrasan

(Reclined Thunderbolt
pose): It activates & tones up large
group of nerves which arises in the lower lumbar region which supplies the buttok & back of the thigh.
7. Bhadrasan (Gracious or blessed position): It is useful in genito- urinary deformities.It indicated in impotency. It is
a purely meditative posture.
8. Siddhasan (Expert sitting position): It is
purely meditative posture.Pelvic region
gets larger blood supply.
9. Kukutasan (Cock Pose): It strengthens
the pelvic organs.
10. Sarvangasan (Shoulder stand pose):It
corrects the improper function of thyroid.Due to chin lock thyroid & parathyroid glands are well nourished & there
will be an increase in blood flow through
the body. It is indicated in mental distress.
11. Naukasan (Boat pose):It facilitates suitable stretching compressing & relaxation
to the uterus and toned it. More or less, it
strengthens the all the system of body
like hormonal system.
12. Shalabhasan (Locust pose):It strengthens the abdominal organ & low back region. Thus increases the blood supply to
the reproductive organs.
13. Dhanurasan (Bow pose):It strengthens
the groins & abdominal organs. It cures
menstrual disorders. It helps in stimulating the reproductive organs.
14. Shirshasan (Head stand pose):It stimulates & regulates the body system. It relaxes mind & releases anxiety.
15. Sinhasan (Lion pose): It stimulates the
thyroid gland & also abdominal organs.
16. Trikonasan (Triangle pose): It is used for
stress management. It strengthens the
muscles of thighs, hips & back.

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17. Ushtrasan (Camel pose):It stimulates the


thyroid gland and also abdominal organs.
18. Chakrasan (Wheel pose):It strengthens
the back & abdominal muscle. It tones
the organs in the abdomen including the
reproductive organs.
19. Hastapadasan (Standing forward bend
pose):
It is helpful to receive the
menstrual problems.
20. Janushirshasan (Head knee pose): It
calms the nervous system. The gentle
abdominal squeeze in this stretch, aids
increasing blood flow to the abdominal
organs.
DISCUSSION:
Infertility is described in the ayurved in a
very wide sense including the nidans and
chikitsa Regarding treatments so many treatments have been given in ayurvedic texts
but which type of infertility or on which factor like rutu, kshetra ,ambu,beej it will act it
is not mentioned clearly Yet treatment has
been given according to the cause i.e. yoni
vyapadas
,shukradushti
artav
dosha etc. So it is very important to find out
the cause. which is responsible for infertility
.
Treatment of infertility without stress relief
may not show any result. One of the key
remedies for infertility is yog. Yogasanas
encourage blood flow to pelvic area increasing the chances of conception. Yogic
asanas & meditation relax the body & regulate sexual functions. The endocrine is
soothed, anxiety is chucked out & calm sets
in. Yogasanas like butterfly pose, childs
pose, lotus pose & supported bridge pose are
advised for reproductive health. Thus the
maximum poses of yogasanas increases the
blood flow to the pelvic region & also relax

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

the body, mind.So the chances of conception


are better with more relaxed body & mind.
For example in the supported head stand position that is mother of all poses , stimulation of head causes hypo-thalamus to release
more harmones. In the supported shoulder
stand position triggers thyroid gland when
the sternum presses the thyroid region
,relaxing pelvis increases the blood flow to
the uterus. Uterus & ovary circulation increases in bridge pose. Also stimulation of
hormone production in uterus in cobra position. Yogic sleep (Shavasan) is important in
attaining the equilibrium in body & mind is
optimistic health.
CONCLUSION
The incidence of infertility is increasing in
the present era. A majority of infertile couples do conceive irrespective of weather or
not they were treated for infertility. For example 38% of infertile couples concieve before treatment began, another 27% conceived before completion of treatment.
Ayurvedic & yogic management can be the
better alternative. Usually yog seems to be
associated more with the practice of asanas
& pranayam without considering that there
are two limbs of yog & work together with
the others. Yogasan has effect on the whole
personality. By doing yogasanas one get
better functioning of all the systems of the
psychosomatic structure. It brings integrity
in these functions & develops the wholeness. By doing yogasanas nerves are stimulated & the activated nerves work in co- ordination. This strengthens the conscious
mind & improves the balancing of the parasympathetic & sympathetic nervous system
resulting in the harmony amongst the various endocrinal glands. On account of pressure manipulation, the blood circulation in

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the region where the sex organs & sex


glands are situated improves, hence the reproductive system functions well. Hence we
can conclude that yogasanas can be very effective in infertile couples. Modern science
had given many treatment for infertility, but
it may cause side effect & costly, where as
ayurved & yog has mentioned many treatment like basti, various drug combination,
yogasanas with minimum side effects & are
cost effective .So can be used as first line of
treatment. Review study concluded that
modern lifestyle and stress are mainly responsible for abnormal condition like infertility. Review suggested that yogasanas a
part of yoga therapy plays significant role in
treating the infertility. It acts on body as
well as mind as it relives stress main causative factor for infertility Review summaries
that yogasanas has the major role in treating
the infertility along with ayurvedic management.
REFERENCES:
1. Text Book of Gynaecology, Datta D.C,
New Central Book Agency Pvt Ltd Calcutta, edition 6th , 2004.
2. Jeffcoats Principles of Gynecology,
Pratap kumar and Narendra Malhotra
,Jaypee Brothers Medical Publishers ,
7th edition 2008.
3. Berek & Novaks Gynecology, Jonathan
S Berek Williyams & Willkins Publication, 12th edition 1996.
4. Clinical Gynecologic Endocrinology
and Infertility,Leon Speroff , Jaypee
brothers ,2005.
5. Ayurved Prasuti Tatra evum Striroga
part I and II,Prof. Premvati Tiwari,
Chaukhambha Orientalia Varanasi, 2nd
edition, 2000.

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Sutar Asmita Maheshkumar & Jadhav Sujata Popatrao: Effect Of Yogasan In The Infertility

6.

Ayurvedic Concepts in Gyneocology,


Nirmala Joshi, Chaukambha Sanskrit
Pratishthan, Delhi , edition 2006.
7. Charak Samhita with Savimarsh Vidyotini commentary, Pt . Kashinath Sastri,
Pt.
Gorakhnath
Chaturvedi
,
th
Chaukambha Bharati Academy , 9 edition, 2001.
8. Sushrut
Samhita
with
Ayurtatvasandeepika commentary ,Kaviraj Abmhikadutta Shastri, Chaukambha Sanskrit Sansthan, 17th edition, 2003.
9. Ashtang Hridayam ,Prof . K.R. Srikanta Murthi , Krishnadas Academy 1st
edition 1991.
10. Hareet Samhita ,Vd Ramavalamba
Shastri,Prachy Prakashan, 1st edition
1985.
11. Kashyap Samhita with Vidyotini commentary
,Vd.Shri.Satyapala
,Chaukambha Sanskrit Sansthan Varanasi, 8th edition 2002.
12. Yogika
Kriya
Arogyparichaya,Padmashree Sadashiv Nimbalkar
,Pustak Prakashan Samiti Yogvidyaniketan Mumbai , 3rd edition 2003.
13. Structure & function of human body &
effect of yogic practices on it ,
Shrikrushna Yogic Health Centre, 1st
edition 1988.
14. Pranayama & Effective mean to Mental
Health, Padmashree Sadashiv Nimbalkar,Pustak Prakashan Samiti Yogvidyaniketan, 3rd edition 2009.
15. Yoga for Health Care & Peace , Padmashree Sadashiv Nimbalkar ,Pustak
Prakashan Samiti Yogvidyaniketan
Mumbai , 7rd edition 2007.
16. .Hatyogpradipika Pandit Hariprasad
Tripathi, Chaukambha Krishnadas Acadaemy , Varanasi,1st edition 2006.

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17. New Horizons of Yoga & Tantra,


Dr.Ramandas Mahatyagi, Chaukambha
Orientalia Varanasi,1st edition 1998.
18. Yog & Ayurveda ,Prof.Satyendra Prasad
Mishra,
Chaukhambha
Sanskrit
rd
Sansthan Varanasi,3 edition 2004.
19. Dr.Reddys Comprehensive Guide to
Swasthvritta,Dr P.Sudhakar Reddy ,
Chaukambha
Sanskrit
Pratishthan
,reprint 2006.
20. Mahilansathi Yogasane , V.G. Devkule,
Utkarsh Prakashan Pune, 10th edition
1992.
21. Yogka Vaidyanik Rahasya evam Yogic
Chikitsa, Shri.Ramndas
Mahatyagi
,Chaukambha Orientalia Varanasi, 2nd
edition 1999.
22. Yog evam Pranayam Chikitsarahasya ,
Dr. Anup Lata, Chaukambha Orientalia,
Varanasi , 1st edition 2007.
23. Monthly Journal of
Yoga & Total
Health, edited & published by Dr.
Jaydeva Yogendra, Mumbai.
24. Patanjali Yogsutras ,Swami Prabhavanand, published by Sri Ramkrishna
Math.
25. ..Asana Pranayam Mudra Bandha, Saraswati Swami Satyanand, Yog Publication Trust Munger, Bihar, 2008
CORRESPONDING AUTHOR:
Vd Sujata Popatrao Jadhav
B-13. Priyadarshani Hsg.Soc,
Unchagaon, Kolhapur.416005
Tel:09404956429 .
Email.: vdsujatajadhav@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

OBSERVATIONAL STUDY OF BODY FAT PERCENTAGE WITH THE


HELP OF BODY FAT MONITOR IN MEDAVRUDDHI SYMPTOMS
QUOTED IN BRIHATRAYI
Dr. Pathak Akshay.
Assistant Prof. Department of Kriya Sharir, Shiv Shakti Ayurvedic Medical College and Hospital
ABSTRACT
Obesity is one among the major diseases of modern era, increasing in prevalence. The World
Health Report of W.H.O. listed obesity under the 10 top selected risks to the health. Sthaulya
[OBESITY] is well recognized from the Samhita period and is included under eight undesirable Conditions [Astha Nindita], Shleshma Nanatmaja, Samtarpana Nimitaja, Atinindita,
Bahu Dosha Janita Vikara. In spite of advanced technology & researches, the modern medicine is failing to give the best due to its multifactorial nature. So patients are continuously
looking with a hope towards Ayurveda to overcome this challenge. For this purpose 50 patients were registered. The patients were assessed on different parameters. All clinical signs
and symptoms were assessed on the basis of scoring given to them. Duration of clinical trial
was of three months.
KEY WORDS: Sthaulya, Obesity
INTRODUCTION
The Nature has taught the man how to be
healthy before the science has discovered
the laws of health. Obesity is one among
the major diseases of modern era. World
Health Organization recognizes obesity as
the greatest health threat of the twenty-first
century. Obesity is widely regarded as a
pandemic with potentially disastrous consequences for human health. Obesity is a
blessing of the modern age of machines
and materialism. It occurs as a result of
lack of physical activity with increased
intake of food. The industrialization, stress
during the work, dietary habits, lack of exercise & various varieties among the daily
diet e.g. fast food, freezed fruits, increased
amount of soft drinks and beverages,
canned foods results into the clinical entity
which we can call as obesity.

Many theories have been put forward with


many new hypotheses describing the exact
aetiopathogenesis of obesity. In various
studies, it has been found that android or
abdominal obesity has more association
with an atherogenic lipid profile, diabetes
mellitus and hypertension. In Ayurvedic
texts too, central obesity has been targeted
from its cardinal sign "chala- sphikaudara-stanam (Pendulous movements of
buttocks, abdomen and Breast)". Its various clinical features such as kshudra
shwasa (Breathlessness on Exertion),
kranthana (Snoring), sarva- kriya asamartha (Inability to work), alapa prana
avum maithun Shakti (Low vitality & Impotence),
javoparodha
(Lassitude),
daurbalya. (Weakness), atinidra (Excessive sleep), kshudra - pipasa atiyoga (Excessive Appetite & Thirst) etc. The Fram-

How to cite this URL: Dr. Pathak Akshay, Observational Study Of Body Fat Percentage With The Help Of Body Fat
Monitor In Medavruddhi Symptoms Quoted In Brihatrayi. International Ayurvedic medical Journal {online} 2016
{cited 2016 April} Available from: http://www.iamj.in/posts/images/upload/653_657.pdf

Dr. Pathak Akshay: "Observational Study Of Body Fat Percentage With The Help Of Body Fat Monitor In Medavruddhi
Symptoms Quoted In Brihatrayi"

ingham Heart study revealed that there has


been marked increase in cardiovascular
diseases associated with obesity including
HT, Dyslipidemia, CVA, PVD,CAD,MI
and Sudden death. The Ayurvedic texts of
later age have identified obesity and its
complications and have mentioned this
disease separately as not just increased
adiposity or atisthaulya but as 'Medoroga'
or disorders arising due to vitiation of medadhatu.
AIMS & OBJECTIVES
1. To observe relation between symptoms of medavruddhi & body fat
percentage.
2. To develop a modern parameter to
diagnose symptoms of medavruddhi.
PLAN OF STUDY
1. Informed consents have been taken.
2. Assessment of medavruddhi & sthaulya
in study subjects is done as per CRF &
gradations of anguli pramana are done &
validated.
3. Body fat percentage, BMI, WHR, Abdominal fold have been measured.
4. Sorting of subjects between medavruddhi and sthaulya have been done according
to the observations.
MATERIALS & METHODS
MATERIALS
1. Literature search
A] A review of Ayurvedic literature have
been taken regarding the symptoms of
4. Gradation chart for Anguli pramana:
Std
0
Udar
Vistaar
12
<12
Aayam
10
<10
Parshva
Aayam
12
<12
Vistaar
10
<10
Uru
Aayam
12
<12

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medavruddhi & sthaulya quoted in Brihatrayi. A review of Modern literature


have been taken related to body fat percentage & BMI.
2. Sample size- 50 subjects will be selected randomly.
Methods
1. Type of study- Observational study
2. Medium of dissertation English supplemented with Sanskrit
3. Criteria for selection of patients
A. Inclusion criteria1. Age- 18 to 25 year
2. Sex- Both male and female
3. Community-Indian
4. Socio-economy class-Higher middle
class
5. According to diet-Mixed (veg& nonveg)
6. Showing symptoms of medavruddhi &
sthaulya
B. Exclusion criteria1.
2.
3.
4.

Below 18 & above 25 years


Pregnant ladies
Chronic ill patients
People having prameha purvarupa,
sthaulya upadrava, shleshma vikara, rakta
vikara, mamsa vikara. Though these diseases are included in medavruddhi symptoms quoted in Ashtang sangraha, to avoid
ativyapti, the above said diseases are excluded
from
the
study.

>14
>12

>16
>14

>18
>16

>14
>12

>16
>14

>18
>16

>14

>16

>18

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Pathak Akshay: "Observational Study Of Body Fat Percentage With The Help Of Body Fat Monitor In Medavruddhi
Symptoms Quoted In Brihatrayi"

Parinah
30
Sphik
Utseda
12
Manya
Utseda
4
Parinah
22
OBSERVATIONS AND RESULTS

<30

>32

>34

>36

<12

>14

>16

>18

<4
<22

>6
>24

>8
>26

>10
>28

Table No: 1 Vistar-12 Grade Vs

Body Fat Grade (udar)

Vistar 12

Body Fat
0 Grade

Obese

0 Grade

100.00%

40

86.96%

44

88.00%

1 Grade

0.00%

6.52%

6.00%

2 Grade

0.00%

2.17%

2.00%

3 Grade

0.00%

4.35%

4.00%

Total

100.00%

46

100.00%

50

100.00%

Table no: 2 Aayam-10 Grade


Body Fat
0 Grade
1 Grade
2 Grade
3 Grade
Total

0 Grade
3
75.00%
1
25.00%
0
0.00%
0
0.00%
4
100.00%

Table no: 3

0 Grade
Total

Vs

Aayam-12 Grade
Body Fat
0 Grade
4
4

Vs

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5
6
7
32
50

0.593

p
value

.898

Total
10.00%
12.00%
14.00%
64.00%
100.00%

Chi. Value
df
pvalue

22.373
3
.000

Body Fat Grade (parshav)


Obese
46 100.00%
46 100.00%

100.00%
100.00%

Table no: 4 Vistar-10 Grade Vs


Body Fat
0 Grade
0 Grade
4
100.00%
1 Grade
0
0.00%
2 Grade
0
0.00%
3 Grade
0
0.00%

Chi.
Value
df

Body Fat Grade (udar)


Obese
4.35%
10.87%
15.22%
69.57%
100.00%

2
5
7
32
46

Table no: 5 Aayam-12 Grade


Body Fat

Total

Total
50
50

100.00%
100.00%

Body Fat Grade (parshav)


Obese
39
5
1
1

Vs

84.78%
10.87%
2.17%
2.17%

Total
43
5
1
1

86.00%
10.00%
2.00%
2.00%

Body Fat Grade (uru)

IAMJ: Volume 4; Issue 04; March- 2016

Chi. Value
df

0.708
3

Dr. Pathak Akshay: "Observational Study Of Body Fat Percentage With The Help Of Body Fat Monitor In Medavruddhi
Symptoms Quoted In Brihatrayi"

0 Grade
1 Grade
2 Grade

0 Grade
0
0.00%
1
25.00%
3
75.00%

Obese
3
6.52%
8
17.39%
15
32.61%

Total
3
9
18

6.00%
18.00%
36.00%

3 Grade
Total

0
4

20
46

20
50

40.00%
100.00%

0.00%
100.00%

Table no: 6 Vistar-30 Grade Vs

43.48%
100.00%

Chi.
Value
Df
p value

3.955
3
.266

Body Fat Grade (uru)

0 Grade

Body Fat
0 Grade
4 100.00%

Obese
41 89.13%

Total
45 90.00%

Chi. Value

0.483

1 Grade

0.00%

10.87%

10.00%

df

Total

100.00%

46

100.00%

50

100.00%

p value

.487

Table no: 7 Utsedha-12 Grade


Body Fat

Vs

Body Fat Grade (sphik)

0 Grade

Obese

Total

0 Grade

75.00%

20

43.48%

23

46.00%

1 Grade

25.00%

13

28.26%

14

28.00%

2 Grade

0.00%

13.04%

12.00%

Chi. Value

1.939

3 Grade

0.00%

15.22%

14.00%

df

Total

100.00%

46

100.00%

50

100.00%

p value

.585

CONCLUSION
1. Body fat monitor can be used as a
parameter to access symptoms of
medavruddhi.
2. Medavruddhi has been accessed by
anguli pramana & gradations are
done accordingly. These gradations
are related with given standard scale
of body fat percentage by using body
fat monitor. In this way relation between medavruddhi & body fat percentage has been established.

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3. By review of literature & observational data it has been concluded that


symptoms of medavruddhi &
sthaulya are definitely not same.
4. Demarcation
line
between
medavruddhi & sthaulya is in males
& in females has been determined.
For males it is 20-35% & for females
it is 25-45%.
5. Derived range of body fat percentage
in males & in females definitely
achieve sound health which prevents
sthaulya in stage of medavruddhi by
scheduling proper regimen.

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Pathak Akshay: "Observational Study Of Body Fat Percentage With The Help Of Body Fat Monitor In Medavruddhi
Symptoms Quoted In Brihatrayi"

REFRENCES:
1. Ashtanga Hridaya Vidyotani Hindi
Commentary.
2. Ashtanga Samgraha - Hindi Commentary
3. Charaka Samhita - Hindi Commentary by Bramhanand Tripathi.
4. Charaka Samhita - Eng. Translation
5. Sushruta Samhita - Hindi Comm. By
Ambikadatta Shastri
6. API Textbook of Medicine, 2003.
7. Introduction to Clinical Nutrition,
1998:Author-Vishwanath.M.Sardeai.
8. Harrisons Textbook of Int. Med,
15th edition.
9. International
standards
for
Anthropometric assessment (2001),
published by the International society for the assessment of kinanthropometry.(ISAK),
www.topendsport.com.
CORRESPONDING AUTHOR
Dr. Pathak Akshay.
Assistant Prof. Department of Kriya Sharir, Shiv Shakti Ayurvedic
Medical College and Hospital
Email:
akshaypathak745@gmail.com
Phone no: 9501700200

657

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

ROLE OF NUTRITIOUS DIET IN PREGNANCY IN AYURVEDIC PERSPECTIVE


*Dr. Vinaya V Yaji
**Dr.Vijay B Neglur
*1st year PG scholar , Department of PG studies of Swasthavritta, Sri Dharmasthala
Manjunatheswaram college of Ayurveda, Kuthpady- Udupi
** Associated professor, Department of Swasthavritta, Sri Dharmasthala Manjunatheswaram
college of Ayurveda, Kuthpady- Udupi

ABSTRACT
According to WHO survey announcement 99% of all maternal deaths occur in developing
country like India. Maternal mortality rate in India=239/1 lakh live births (2015) whereas, 12
/1lakh live births in developed countries. Maternal morbidity rate in India is behind the target
of 103 deaths/1 lakh live births to be achieved by 2016 .Thus prime importance should be
given to maintain or improve the health status of the woman to optimum till delivery. Judicious advice regarding diet, drugs and hygiene is essential factor.
Ayurveda the life science in which there is description about diet and nutrition of mother and
child care under the heading of Masanumasika garbhini paricharya garbhini swasthya
rakshanartha,emphasing garbhinaahara,vihara,manasikasthithi, aushadha and shuchitva is
the main aim and it is clearly mentioned in our all ancient text books of Ayurveda. In the
present paper an attempt made to explain the dietary regimen and relevance of garbini
paricharya in present day.
Key words: Nutritious diet in according to Ayurveda

INTRODUCTION
Antenatal care is the care of woman during pregnancy. The primary aim of antenatal care is to achieve at the end of pregnancy a healthy mother and healthy baby.
Ideally this care should be begin soon after
the conception and continue throughout the
pregnancy. In some countries, notification
of pregnancy is required to bring the
mother in prevention care cycle as early as
possible. In Ayurveda our ancient acharyas
like Charaka, Susruta, Vagbhata, and
kashyapa they clearly emphasised about

diet and nutrition of mother and child care


under the heading of masanumasika
garbhini paricharya.Balanced and adequate diet is therefore of utmost importance during pregnancy and lactation to
meet the increased needs of the mother,
and to prevent nutritional stress.
Garbhini paricharya is the unique and relevant regimen for pregnant ladies.
Antenatal care:
Main objectives of antenatal care are;
To promote, protect and maintain the
health of the mother during pregnancy.

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Dr. Vinaya V Yaji & Dr.Vijay B Neglur : Role Of Nutritious Diet In Pregnancy In Ayurvedic Perspec-Tive

To detect high risk cases and give them


To teach the mother elements of child
special attention.
care, nutrition, personal hygiene and environmental sanitation.
To reduce maternal and infant mortality
rate and morbidity.
DAILY DIETARY ALLOANCES FOR A PREGNANCY
Table no 1
In pregnancy second
Sources
half
Energy(k cal)
2600 k cal
Protein, fat, carbohydrate
Protein(gm)
60gm
Meat, fish, polutary, dairy product
Iron(mg)
40mg
Meat, egg, grain
Calcium(mg)
1000mg
Dairy products
Zinc(mg)
15mg
Meat, egg, sea food
Vitamin A(IU)
8000IU
Vegetables, liver, fruits
Vitamin D(IU)
400 IU
Dairy products
Iodine(ug)
175ug
Iodised salt, sea food
Thiamine(mg)
1.5mg
Grains ,cerals
Riboflavin
1.6mg
Meat liver ,grains
Nicotinic acid(mg)
17mg
Meat, nut, cerals
Ascorbic acid(mg)
70mg
Citrus fruits, tomato
Folic acid (ug)
400ug
Leafy vegetables, liver
Vitamin B12
2.2ug
Animal proteins(5)
Antenatal care in Ayurveda
studies have indicated that weight gain of
Garbha definition; Garbha is the union of
poor Indian women averaged 6.5kg during
shukra (sperm), shonitha(ovum) jeeva
pregnancy.
(life) atma (soul) in womb of mother. To
Role of masanumasika aahara krama
protect garbha, adopting garbhini palabha(month wise dietary regimen for
richarya by pregnant women is much esPregnant women and its effect) with refersential because a pregnancy in total duraence to garbhini chinha(signs and symp(4)
tion consumes about 60000kcal over and
toms of pregnant women) which is exabove normal metabolic requirements. On
plained in charaka sharira sthana and
an average, normal healthy woman gains
susruta sharira sthan 10th chapter respec12kg of weight during pregnancy, several
tively.
Dietary regimen:
During 1st Month(1,2,10 )
Charaka samhita
Ksheera
Susruta samhita
Madhura sheeta drava ahara
Astanga sangraha
Aushadha sidda ksheera
Harita samhita
Madhuyasti, madhuka pushpa with
Navaneeta, madhu, madhura ksheera

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IAMJ: Volume 4; Issue 04; March- 2016

Dr. Vinaya V Yaji & Dr.Vijay B Neglur : Role Of Nutritious Diet In Pregnancy In Ayurvedic Perspec-Tive

Ksheera(milk)

Qualities=madhura rasa
paka,oojoskara,jeevaniya,dhatuvardhaka
Madhu(honey)
Kashaya madhura rasa,relieves trashna

Indication-shrama
bhrama,kshut,durbala
Indication-trshna,chardi,kasa

Sarpi(clarified
butter extracted
from milk)

Indication-praja,vatapitta
roga,vishapaha

Madhura,balya.jeevan, rasayana

(2)
TABLE NO2
During 2nd month (2,6,7, 10)
Cha. Samhita
Susruta samhita
Astan. Samgraha
Haritah
During 3rd month(2,6,7, 9,10)
Char. Samhita
Su. Samhita
A.Sam
Harita
Kashyapa
Bhoja
During 4th month(2,6,7,10)
Char. Samh.
Su.sam
Ast. Sma
Harita

Ksheera with madhura rasa


Same as 1st month
Same as charaka
Madhura sidda ksheera with kakoli
Ksheera with madhu ghrita
Same as 1st month
Ksheera with madhu ghrita
Krushara
Ksheera with madhura aushdha
Ksheera
Ksheera with navneeta
Shastika shali anna with dadhi, navneeta, jangalamamsa rasa
Ksheera with 1 tola of navaneeta
Medicated odana

During 5th month(2,6,7,10)


Charak. Sam.
Ghrita prepared with navaneeta extracted ksheera
Su. Sam
Cooked shastika odana with ksheera, ghrita, jangala mamsa rasa, ghrita
Ast. Sam
Same as charaka
Harita
Payasa
th
(2,6,7,10)
During 6 month
Char. Samhita
Ghrita prepared from maddhura aushdha
Su.samhita
Ghrita or yavagu gokshura
Ast. Sam.
Same as charaka
Harita
Madhura dadhi
th
(2,6,7,10)
During 7 month
Cha. Samhita
Same as 6th month
Su. Samhita
Ghrita prepared with prathakparnyadi gana
Ast. Samgraha
Same as charaka
Harita
Ghritakhanda
th
(2,6,7,10 )
During 8 month
Charaka. Samhita
Ksheera yavagu mixed with ghrita

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IAMJ: Volume 4; Issue 04; March- 2016

Dr. Vinaya V Yaji & Dr.Vijay B Neglur : Role Of Nutritious Diet In Pregnancy In Ayurvedic Perspec-Tive

Su. Samhita
Ast. Sam

Harita

Asthapana basti with badara kwatha mixed with bala, atibala,


shatapushpa
Ksheera yavagu mixed with ghrita
Asthapana basti with badari kwatha
Anuvasana basti with taila with medicated madhura aushadha
Ksheera yavagu

During 9th month(2,6,7, 10 )


Char. Samhita
Anuvasana basti with taila prepared with madhura aushadha
Su.sam
Snehayukta yavagu, jangala mamsa rasa upto the period of delivery
A.
Sam
Same as charaka
Harita
Different varieties of cerals
DISSCUSSION:
During 1st trimester of pregnancy most
women experience nausea and vomiting,
thus can not take proper diet. Use of cold
and sweet liquid diet and milk will prevent
dehydration and supply required nourishment, besides the drugs of Madura group
being anabolic will help in maintenance of
proper health of mother and foetus. Fourth
month onwards muscular tissues of foetus
grows sufficiently requiring more protein
which is supplied by use of meat-soup. By
the end of second trimester most women
suffer from oedema of feet and other complications of water accumulation. Use of
gokshura a good diuretic in 6th month will
prevent retention of water as well as its
complications. The drugs of vidarigandhadi group are diuretic, anabolic, relieves emaciation and supress pitta , kapha,
their regular use in 7th month might help in
maintaining health of mother and foetus.
Most women experience constipation in
late pregnancy due to pressure of gravid
uterus over the bowels and effect of progesterone. Use of enema in 8th month will
relieve this constipation, besides this may
also affect the autonomous nervous system
governing myometrium and help in regulating their function during labour. Milk
and drugs of madhura group have been

##'

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advice for entire period .Milk is a whole


diet. The drugs of madhura group are anabolic ,thus use of this will help in maintenance of proper health of mother and
growth and development of foetus.(4,5)
CONCLUSION;
Generally the diet in pregnancy should be
with womans choice as regard the quantity and the type. Women with normal BMI
should eat adequately so as to gain the optimum weight (11kg). Overweight women
with BMI between 26-29 should limit
weight gain to 7 kg and obese women
(BMI>29) should gain less weight. Excessive weight gain increases antepartum and
intrapartum complications including foetal
macrosomnia.
The pregnancy diet should be light, nutritious, easily digestible and rich proteins,
minerals and Vitamins. In terms of figures,
the daily requirement during pregnancy is
given in table2.(3,4,5) It is not an absolute
recommendation but simply a guide. The
diet should consist in addition to the, principal food at least half litre,1 litre of
milk(1litre milk contains 1 gm of calcium),plenty of green vegetables and fruits.
The amount of salt should be of sufficient
amount to make the foodtasty.Atleast half
of the total proteins should be first class

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Vinaya V Yaji & Dr.Vijay B Neglur : Role Of Nutritious Diet In Pregnancy In Ayurvedic Perspec-Tive

containing all amino acids and majority of


the fatal should be animal type which contains vitamin A and D. Survey in different
parts of India indicate that about 50 to 60%
of women belonging to low socio-economic groups are anaemic so dietic advice
should be given with due consideration to
the socioeconomic condition,food habits
and taste of the individual. Woman with
normal BMI should eat as to maintain the
schedule weight gain in pregnancy. The
instruction about diet should be reasonable
and realistic to individual women .
REFERENCES;
1. Ayurveda deepika-by chkrapanidatta,edited by Vaidya jadavji trikamji
acharya Page no-320-329
2. Astanga hrudaya and Astanga
samgraha-by T sreekumar Page no-6879
3. Ayurvediya prasuti tantra and stree
roga-by Prof Premavati tivari page
no-201-238
4. Park text book of preventive and social medicine(21st edition)-by K. Park
page no-484
5. Textbook of obstetrics-By D.C Dutta
Page no-102-103
6. Susruta samhita with nibhandha sangraha commentary of Sri Dalhanaacharya-by Vaidya Jadavaji tirkamji
acharya Page no-387-389
7. Acharya JT Editor, Charaka samhita of
agnivesha with
Ayurveda-Dipika
commentary by Chakrapanidatta, Reprinted ed. Varanasi : Chaukambha
Orientalia:2009. p. 526
8. Sri Indradev Tripati Editor, Acharya
Sodhala-Gada nigraha kayachikitsa
khandatmako
no,7/63
Varnasi:Chaukamba Sanskrit Sansthana:
Eddition 2006 Pp180 Pg 1167.

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9. Kashyapa samhita- Edi and translated


by Prof. P. V. Tewari, Chaukambha
vishwabarati prakshana 1996
10. Harita samhita: Hindi comm.by Ravidas Shastri ; Gangavishnu, Ganaptikrishnaji Press, Bombay,

CORRESPONDING AUTHOR
Dr. Vinaya V
1st year PG scholar , Department of
PG studies of Swasthavritta,
Sri Dharmasthala Manjunatheswaram
college of Ayurveda,
Kuthpady- Udupi

E-mail: yajivinaya24@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Case Report

International Ayurvedic Medical Journal ISSN:2320 5091

AYURVEDA: A HOPE FOR HSP- HEREDITARY SPASTIC PARAPARESIS


Dr Chitte Om Virbhadra* Dr. Aswathy Prakash** Dr Swati S. Deshpande ***
*PGScholar, Dep Of PG studies in Panchakarma, Srikalabyraveshwara swamy Ayurvedic
Medical College Hospital and Research centre, Bangalore
** PGScholar, Dep Of PG studies in Kayachikitsa, Srikalabyraveshwara swamy Ayurvedic
Medical College Hospital and Research centre, Bangalore
*** Professor & HOD, Dep Of PG studies in Panchakarma, Srikalabyraveshwara swamy
Ayurvedic Medical College Hospital and Research centre, Bangalore
ABSTRACT
Hereditary Spastic Paraparesis is a group of hereditary ataxic disorders; Symptoms usually
begin in the third or fourth decade, presenting as progressive spastic weakness beginning in
the distal lower extremities. The two genes, spastin and alastin has been identified as the defective gene in causing HSP. In hereditary ataxias, an autosomal recessive inheritance is
characterised by several affected members in one generation with healthy parents. Presence
of consanguinity in parents strongly favours such inheritance. Typically these disorders manifest in childhood, adolescence or early adulthood. However a negative family history does
not always rule out a hereditary disorder This article explains how this disorder begins, how it
is managed in Ayurveda by taking the help of the PANCHAKARMA procedures such as
Basti, Abhyanga etc.
Keywords: Hereditary Spastic Paraparesis, Abhyanga, Basti, Nasya

INTRODUCTION
Hereditary spastic paraparesis (HSP) is not
a single disease entity; it is a group of
clinically
and
genetically
diverse
disorders. Symptoms usually begin in the
thirties or fourties, presenting as
progressive spastic weakness beginning in
the distal lower extremitiesi. However,
there are variants with onset so early that
the differential diagnosis includes cerebral
palsy. Strumpell (German Neurologist)
first described hereditary forms of spastic
paraplegia in 1883, with Lorrain later
providing more extensive detail. HSP is

also called familial spastic paraparesis and


Strmpell-Lorrain syndrome. Syndromes
are classified as uncomplicated, or pure,
when only spinal involvement occurs, and
they are classified as complicated when
they are associated with neurologic
abnormalities, such as ataxia, mental
retardation, dementia, extrapyramidal
dysfunctions,
visual
or
hearing
dysfunctions, adrenal insufficiency, and
ichthyosis. In its pure form , HSP is
usually transmitted as an autosomal trait;
most adult-onset cases are dominantly
inherited. HSP has typically long term

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survival presumably because respiratory


function is spared. Late in the illness, there
may be urinary urgency and incontinence
and sometimes fecal incontinence, sexual
function tends to be preserved. In pure
forms of HSP, the spastic leg weakness is
often accompanied by posterior Colum
(vibration & position) abnormalities and
disturbance of bowel and bladder function.
Some family members will have spasticity
without clinical symptoms. In hereditary
ataxias, an autosomal recessive inheritance
is characterised by several affected
members in one generation with healthy
parents. Presence of consanguinity in
parents strongly favours such inheritance.
Typically these disorders manifest in
childhood, adolescence or early adulthood.
However a negative family history does
not always rule out a hereditary disorderii.
Defects at numerous loci underlie both
dominantly and recessively inherited forms
of HSP. More than 30 HSP genes have
now been identified. The gene most
commonly implicated in dominantly
inherited HSP is spastin. The most
common childhood onset dominant form
arises from mutations in the atlastin geneiii.

Aims and objectives


1. To study about Hereditary spastic
paraparesis,
its
pathological
manifestations, symptoms in detail.
2. To assess the effect of Panchakarma
therapies in Hereditary spastic
paraparesis.

CASE REPORT
Preliminary Data of Patient: A 17-yearold female patient Hindu by religion
belonging to middle socio-eonomic status
without any premorbid status such as
Diabetes mellitus & Hypertension
approached to OPD (No- 14588) IP No
(2510/15) of SKAMCH & RC, department of

Panchakarma to DR. SWATI S. DESPANDE,


HOD & Panchakarma consultant at KAMCH
& RC- with complaints of Gait disturbance
from the age of 5 years and Nystagmus since
childhood. She is the second child( FTND) of
her
parents
was
born
through
2consanguineous marriage. Her mothers
pregnancy was uneventful and her mother had
taken folic acid & calcium supplements
prescribed by the consultant gynecologist then.
She was apparently normal till the age of 1
years. She was having recurrent episodes of
fever (once in 15 days) for which they took
allopathic medications and got relief. Her
milestones were slightly delayed. She started
talking and walking at the age of 1 years.
She was given vaccinations as per schedule.
When she was 5years old, her parents
gradually noticed that she was falling
frequently while walking and her legs were
going sideways. She reduced playing with
friends outdoors as she lost her confidence in
walking and running. Her mingling with
friends remained normal. With the support of
her friend she was able to walk confidently. At
the age of 6 years she was taken to Orthopedic
surgeon and he advised MRI scan with referral
to Neurologist at NIMHANS. At NIMHANS,
she was advised physiotherapy. They couldnt
continue physiotherapy as there was no
physiotherapist near to their home. At the age
of 13 years she was taken to St. Johns and got
admitted there for 4 days. At St. Johns some
investigations were done and they advised
some medications along with physiotherapy.
As she didnt show any improvement even
after few months, she was taken to Martha
hospital( No improvement). Since then her
parents took her to many other physicians and
got no significant results. So they stopped
going to doctors for the past 4-5 years. She
presents with difficulty in walking with
balance. Her bowel and bladder habits are
regular and under control. There was tongue
tie and she started talking after the surgery at 1
year of age. One elder sister aged 20 years is
healthy. No family members is said to have
similar complaints.

General Examination: On the day of

examination found to be moderately built


and nourished, afebrile, normotensive,
coated tongue, Ht- 146.5 cms, Wt- 50kg,
BMI-23.29, other parameters such as
pallor, cyanosis, icterus, clubbing,
lymphadenopathy, edema was normal.
Systemic Examination
CVS: On auscultation; S1 S2 heard, No
murmurs
RS :
Inspection
Shape
of
chest
bilaterally
symmetrical
Respiratory rate 16/min
Palpation
Trachea - centrally placed
Auscultation
Normal Vesicular Breath Sounds
heard
PA
Inspection :
No distension
Umbilicus centrally placed
No scars
No visible peristalsis
Palpation:
Soft, Tenderness in right illiac &
hypogastric region, No organomegaly
CENTRAL NERVOUS SYSTEM
Facial
a)Forehead frowning
b)Eyebrow raising
c)Eye closure
d)Teeth showing
e)Blowing of cheek
f)Naso labial fold
Vestibulo-cochlear
-Rinnes test-AC>BC
-Webers test-no lateralisation of sound
Glossopharyngesl and Vagus
Position of uvula- centrally placed
Taste sensation- intact
Spinal accessory
Shrugging
shoulderpossible
against
resistance
2)Muscle bulk

Higher Mental Functions


Consciousness Fully conscious
Orientation to - time, place & personintact
Memory - immediate, recent & remoteintact
Intelligence - Intact
Hallucination & Delusion - Absent
Speech disturbance - absent
Handedness - Right

Cranial Nerve Examination


Olfactory- Smell sensation-intact
Optic - a) Visual acuity- intact
b) Colour vision-intact
c) Visual field- intact
d) Light reflex- intact
e) Accomodation-impaired
Occulomotor,Troclear & Abducent Nerve
-Eyeball movement-Possible in all directions
in right eye. Left eye- nystagmus
-Pupil-position, shape, size & symmetry- NAD
-Ptosis-Absent
Trigeminal
Sensory-Touch, pain and pressure sensation
intact
-corneal reflex-present
Motor-clenching of teeth -possible
-lateral movement of jaw- possible
Reflex-corneal-present
- jaw jerk- couldnt elicit

normal
normal
possible
no deviation of angle of mouth
normal
equal on both sides
Neck movement -possible against resistance
Hypoglossal
Protrusion of tongue -possible
Tongue movements -possible
Motor System
1)Involuntary movements Absent

Muscle bulk
Upper arm
Fore arm
Thigh
Calf

Left
30cms
20.5cms
50cms
27cms

3)Muscle tone
Right hand
Left hand
Right leg
Left leg

Normal
Normal
-Spasticity present
Spasticity present

4)Muscle strength
a) Elbow
-Flexion
-Extension
b) Wrist
-Flexion
-Extension
c) Finger abduction
d) Opposition of thumb
e) Test of grip
Lower limb
Hip
-adduction
-abduction
-flexion
-extension
Knee -flexion
-extension
Ankle -dorsiflexion
-plantarflexion
5)Coordination
UL
LL
6)Involuntary movement- Absent
7)Gait- Waddling gait
Tandem walking - positive
Romberg sign
- negative
Govers sign
- negative
8)Reflexes
Superficial
a) Corneal
b) Abdominal

Deep
a) Biceps jerk
b) Triceps jerk
c)Knee jerk
d)Ankle jerk
e) Clonus - patella
- ankle

Right
31.5cms
21cms
50cms
28cms

Rt.
5/5
4/5
5/5
5/5
5/5
5/5
5/5
Rt.
4/5
4/5
5/5
3/5
5/5
5/5
5/5
5/5

Lt.
5/5
4/5
5/5
5/5
5/5
5/5
5/5
Lt.
4/5
4/5
5/5
3/5
5/5
4/5
5/5
5/5

Finger nose test


Knee heel test

Intact
Intact

Rt

Lt

++
++
+++
++
absent
absent

++
++
+++
++
absent
absent

Co ordination present

f) Jaw jerk couldnt elicit


Plantar response- Babinski sign - +ve
Measurements
LOWER LIMB
Right- 84 cms
Left-81 cms
UPPER LIMB
Right-68.5cms
Left-66.5 cms
Sensory system
1)Superficial:
Touch
present
Temperature
present
Pain
present
3. Deep:
Crude touch
present
Vibration
present
Joint sense
present
Position sense
present
Pressure sense
present
3) Cortical
g. Impaired tandem walking - Ataxia
a. Tactile localisation- present
h. Waddling gait - muscle weakness
b. Tactile discrimination- present
i. Muscle bulk is same on both sides c. Stereognosis-present
excludes MD
d. Graphesthesia-present
j. Govers sign - -ve
e. Brisk Knee reflex- suggestive of upper
k. Limb length difference-suggestive of
motor neuron lesion
neurological conditions
f. Babinski sign - +ve
Dashavidha pariksha
Prakruti
- Kapha pitha
Vikruti
- Pravara
Hetu
- Beeja dosha (atlastin gene)
Dosha
- Vata, Pitha, kapha
Dushya
- Majja, Snayu, Sira ,
Prakruti
- Kapha pitha
Desha
- Saadharana
Kaala
- 12 yrs
Bala
- Rogi- madhyama
Roga
- Pravara
Sara
- Madhyama
Samhanana
- Madhyama
Pramana
- height-146.5cms,weight-50kgs
Satmya
- Madhyama (Madhura amla rasa)
Satva
- Madhyama
Ahara sakthi
- Abvyaharana sakthi-madhyama Jarana sakthi madhyama
Vyayama sakthi
- Madhyama
Vaya
- Bala
Samprapthi ghataka
Dosha
- Tridosha with vata pradhanatha
Dooshya
- Rasa, Mamsa, Snayu
Agni
- Jataragni
Srothas
- Rasavah, mamsavaha,majjavaha, asthivaha
Srotho dushti prakara
Sanga
Udbava sthana
- Beeja doshaja

Vyaktha sthana
- Shaka
Adhishtana
- Masthishka
Marga
- Madhyama
Sadhyasadhyatha
- Yapya
Samprapthi: Beeja dosha, Due to beeja dosha Vata prakopa , Affecting majjavaha srotas, sira and
snayu Resulting in weakness of both legs and gait disturbance
Differential
Diagnosis

VYAYACHEDAKA NIDANA

Available Reports of investigations


MRI Spine - Normal
MRI Brain - Normal
Nerve conduction study - Normal

Diagnosis: The Dx of HSP is total history


and clinical based Dx can be confirmed
with the study of DNA & Gene.
Intervention

Abhyanga with maha masha taila+


Mahanarayana taila followed by Nadi
sweda for 14 days
Mustadi Raja Yapana Basti for 8 days
Shastika shali pinda sweda for 14 days
Nasya with ksheerbala taila 101 (8
drops in each nostrils) for 7 days
Balarishta 3tp tid A/F
Dhanvantaram gutika 1-1-1
Cardorium plus 2tp tid A/F
T. BVC with gold 1-0-0 with honey
Post Panchakarma Treatment Status of
the patient
The patient was hospitalised for one month
and given Panchakarma treatment. There
was significant change in the strength of
lower limbs. She gained more confidence
in walking with balance and the speed of
walking improved.
The patient was discharged with some oral
medication and physiotherapy was advised
by SKAMCH & RC physiotherapy unit in
charge. The patient comes for follow up
walking herself and under supervision of
consultant with oral medications.
DISCUSSION
In most cases of HSP, the primary problem
may be disturbance of the ends of the long
axons, with little or no loss of myelin and
no abnormal myelin. The Abhyanga,
Nadisweda and Shashtika Shali Pinda
Sweda helps to reduce the spasticity and
improves the balance of the patients while
walking. Mustadi Raja Yapana Basti
further helps in reducing the symptoms
and gives a sustained relief to the patien.
CONCLUSION
Hereditary Spastic Paraparesis can be well
treated in the lines of Vatavyadhi Chikitsa.
The known complications of HSP are:
Gastrocnemius-soleus contracture, Cold
feet, Fatigue, Back and knee pain and
Stress and depression. Hence the treatment
should be planned according to the

condition of patient aiming at improving


the quality of life of patient. Panchakarma
Chikitsa is definitely a ray of hope for
patients suffering from HSP.

REFERENCES

1.
2.
3.

Harrison Principles of Internal Medicine,


th
19 Edition, Pgno:2636
th
API Text book of medicine,6 Edition, Pg
no:1356
iii
.Harrison Principles of Internal
th
Medicine, 19 Edition, Pgno:2636

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

CONCEPT OF PACHAKA PITTA A SHAREERA KRIYATMAKA


(PHYSIOLOGICAL) UNDERSTANDING
1

Kamath Nagaraj
Assistant. Professor, Department of Shareera Kriya, Karnataka Ayurveda Medical College,
Manglore 575006; Karnataka, India

ABSTRACT
Dosha, Dathu, Mala together form the basis of the body. The balance of these entities represents the healthy state and imbalance will cause various diseases. In normalcy, Dosha will be
performing their own functions and individual Dosha will be having their own specific site.
There are five types of Pitta namely Pachaka, Ranjaka, Sadhaka, Alochaka, Brajaka. The Visesha
Sthana of Pachaka Pitta is said to between Pakwashaya and Amashaya near Jatharagni. The main
function of Pachaka Pitta is said to be digestion of the ingested food. The functions of Pachaka
Pitta can be related to the functions of digestive enzymes, Gastro-intestinal hormones and local
hormones .
Keywords: Pachaka, Pitta, Shareera, Kriya, Enzymes, Hormones.
INTRODUCTION
The individual is an epitome of the universe.
All the material & spiritual phenomenon of
the universe are present in the individual.
Similarly all those resent in the individual
are also contained in the universe.
Originating in cosmic consciousness, this
wisdom was intuitively received in the
hearts of the ancient scholars. They perceived that consciousness was energy manifested into the five basic principles or elements. Man is microcosm of the nature and
so the five basic elements present in all matter also exists within each individual. Thus
out of the womb of the five elements, all
matter is born. The five basic elements exist
in all matter. Water provides the classic

example: - the solids of iced water are manifestation of the Prithvi Mahabhuta (earth
principle). Latent heat in the ice (Agni)
liquefies it, manifesting into Jala Mahabhuta (water principle). And then eventually
it turns into steam expressing the Vayu
Mahabhuta (air principle) the steam disappears into Akasha or space.[2]Bhuta is that
which is not born out of something, but out
of which something is born. It is the material
cause of substances in the world. When we
say Bhuta we mean that subtle level of existence, where as Mahabhuta refers to gross
level of existence.[3]Panchikarana is the process through which invisible Bhutas combine with each other and form the visible
Mahabhutas in such a way that all Bhutas

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Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

are present together in each Drisya Bhuta in


varying degrees of predominance. Thus in
the physical world everything is a combination of Pancha Mahabhutas & we cannot
see them independently. [4]

the mouth to the anus through the thoracic


and abdominopelvic cavities. Organs of the
gastrointestinal tract include the mouth,
most of the pharynx, esophagus, stomach,
small intestine, and large intestine. [10]

Dosha, Dathu, Mala together form the basis


of the body.[5] The balance of these entities
represents the healthy state and imbalance
will cause various diseases.[6] In normalcy,
Dosha will be performing their own functions and individual Dosha will be having
their own specific site. By mentioning the
various Sthana of the each Dosha the different function performed by individual Dosha
in different sites has been emphasised. The
sub-types of Dosha, its location and function
have also been mentioned. [7] Regarding the
Sthana of various Dosha authors have
different opinion. Later authors have added
some more Sthana of Dosha. For example,
ears among the location of Vata; umbilicus,
eyes and skin among the location of Pitta;
Kloma, nose, tongue among the location of
Kapha.[8]

Overall, the digestive system performs six


basic processes:Ingestion: This process involves taking foods and liquids into the
mouth (eating). Secretion: Each day, cells
within the walls of the GI tract and accessory digestive organs secrete a total of about
7 liters of water, acid, buffers, and enzymes
into the lumen (interior space) of the tract.
Mixing and propulsion: Alternating contractions and relaxations of smooth muscle in
the walls of the GI tract mix food and secretions and propel them toward the anus. This
capability of the GI tract to mix and move
material along its length is called motility.
Digestion: Mechanical and chemical processes break down ingested food into small
molecules. In mechanical digestion the teeth
cut and grind food before it is swallowed,
and then smooth muscles of the stomach and
small intestine churn the food. As a result,
food molecules become dissolved and thoroughly mixed with digestive enzymes. In
chemical digestion the large carbohydrate,
lipid, protein, and nucleic acid molecules in
food are split into smaller molecules by hydrolysis. Absorption: The entrance of ingested and secreted fluids, ions, and the
products of digestion into the epithelial cells
lining the lumen of the GI tract is called absorption. The absorbed substances pass into
blood or lymph and circulate to cells
throughout the body. Defecation: Wastes,
indigestible substances, bacteria, cells
sloughed from the lining of the GI tract, and
digested materials that were not absorbed in
their journey through the digestive tract

There are five types of Pitta namely Pachaka, Ranjaka, Sadhaka, Alochaka, Brajaka. The Visesha Sthana of Pachaka Pitta
is said to between Pakwashaya and
Amashaya near Jatharagni. The main function of Pachaka Pitta is said to be digestion
of the ingested food.[9]
Brief Physio- anatomical understanding of
the Gastro-intestinal tract with reference to
chemical and physical digestion is necessary
to understand physiology of Pachaka Pitta.
Two groups of organs compose the digestive
system the gastrointestinal (GI) tract and the
accessory
digestive
organs.
The
gastrointestinal (GI) tract, or alimentary canal, is a continuous tube that extends from

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IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

leave the body through the anus in a process


called defecation. The eliminated material is
termed feces. [11]
Two enzymes, salivary amylase and lingual
lipase, contribute to chemical digestion in
the mouth. Salivary amylase, which is secreted by the salivary glands, initiates the
breakdown of starch. Dietary carbohydrates
are either monosaccharide and disaccharide
sugars or complex polysaccharides such as
starches. Most of the carbohydrates we eat
are starches, but only monosaccharides can
be absorbed into the bloodstream. Thus, ingested disaccharides and starches must be
broken down into monosaccharides. The
function of salivary amylase is to begin
starch digestion by breaking down starch
into smaller molecules such as the disaccharide maltose, the trisaccharide maltotriose,
and short-chain glucose polymers called _dextrins. Even though food is usually swallowed too quickly for all the starches to be
broken down in the mouth, salivary amylase
in the swallowed food continues to act on
the starches for about another hour, at which
time stomach acids inactivate it. Saliva also
contains lingual lipase, which is secreted by
lingual glands in the tongue. This enzyme
becomes activated in the acidic environment
of the stomach and thus starts to work after
food is swallowed. It breaks down dietary
triglycerides into fatty acids and diglycerides. A diglyceride consists of a glycerol
molecule that is attached to two fatty acids.
[12]

The strongly acidic fluid of the stomach kills


many microbes in food. HCl partially denatures (unfolds) proteins in food and stimulates the secretion of hormones that promote
the flow of bile and pancreatic juice. Enzymatic digestion of proteins also begins in the
stomach. The only proteolytic (protein-

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digesting) enzyme in the stomach is pepsin,


which is secreted by chief cells. Pepsin severs certain peptide bonds between amino
acids, breaking down a protein chain of
many amino acids into smaller peptide fragments. Pepsin is most effective in the very
acidic environment of the stomach (pH 2); it
becomes inactive at a higher pH.
First, pepsin is secreted in an inactive form
called pepsinogen; in this form, it cannot
digest the proteins in the chief cells that produce Pepsinogen is not converted into active pepsin until it comes in contact with
hydrochloric acid secreted by parietal cells
or active pepsin molecules. Second, the
stomach epithelial cells are protected from
gastric juices by a 13 mm thick layer of
alkaline mucus secreted by surface mucous
cells and mucous neck cells.
Another enzyme of the stomach is gastric
lipase, which splits the short-chain triglycerides in fat molecules (such as those found in
milk) into fatty acids and monoglycerides. A
monoglyceride consists of a glycerol molecule that is attached to one fatty acid molecule. This enzyme, which has a limited role
in the adult stomach, operates best at a pH of
56. More important than either lingual lipase or gastric lipase is pancreatic lipase, an
enzyme secreted by the pancreas into the
small intestine. Only a small amount of
nutrients are absorbed in the stomach because its epithelial cells are impermeable to
most materials. However, mucous cells of
the stomach absorb some water, ions, and
short-chain fatty acids, as well as certain
drugs (especially aspirin) and alcohol.
Within 2 to 4 hours after eating a meal, the
stomach has emptied its contents into the
duodenum. Foods rich in carbohydrate
spend the least time in the stomach; highprotein foods remain somewhat longer, and

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Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

emptying is slowest after a fat-laden meal


containing large amounts of triglycerides
In the mouth, salivary amylase converts
starch (a polysaccharide) to maltose (a
disaccharide), maltotriose (a trisaccharide)
and dextrins (short-chain, branched fragments of starch with 510 glucose units). In
the stomach, pepsin converts proteins to
peptides (small fragments of proteins), and
lingual and gastric lipases convert some triglycerides into fatty acids, diglycerides, and
monoglycerides. Thus, chyme entering the
small intestine contains partially digested
carbohydrates, proteins, and lipids. The
completion of the digestion of carbohydrates, proteins, and lipids is a collective
effort of pancreatic juice, bile, and intestinal
juice in the small intestine.
The final stage of digestion occurs in the
colon through the activity of bacteria that
inhabit the lumen. Mucus is secreted by the
glands of the large intestine, but no enzymes
are secreted. Chyme is prepared for elimination by the action of bacteria, which ferment
any remaining carbohydrates and release
hydrogen, carbon dioxide, and methane
gases. These gases contribute to flatus (gas)
in the colon, termed flatulence when it is
excessive.
Bacteria also convert any remaining proteins
to amino acids and break down the amino
acids into simpler substances: indole, skatole, hydrogen sulfide, and fatty acids. Some
of the indole and skatole is eliminated in the
feces and contributes to their odor; the rest is
absorbed and transported to the liver, where
these compounds are converted to less toxic
compounds and excreted in the urine. Bacteria also decompose bilirubin to simpler pigments, including stercobilin, which gives
feces their brown color. Bacterial products
that are absorbed in the colon include sev-

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eral vitamins needed for normal metabolism,


among them some B vitamins and vitamin
K. Role of local hormones plays an important role in mechanical chemical digestion. Gastrin: Stimulates gastric glands to
secrete gastric juice with more pepsin and
hydrochloric acid; Accelerates gastric motility; Promotes growth of gastric mucosa;
Stimulates secretion of pancreatic juice,
which is rich in enzymes; Stimulates islets
of Langerhans in pancreas to release pancreatic hormones. Secretin: Inhibits secretion of
gastric juice; Inhibits motility of stomach;
Causes constriction of pyloric sphincter; Increases the potency of action of cholecystokinin on pancreatic secretion. Cholecystokinin: Accelerates the activity of secretin to
produce alkaline pancreatic juice, with large
amount of bicarbonate ions; Increases the
secretion of enterokinase; Inhibits the gastric
motility; Increases the motility of intestine;
Augments contraction of pyloric sphincter;
Plays an important role in satiety by
suppressing hunger; Induces drug tolerance
to opioids. Gastric inhibitory peptide (GIP):
Stimulates the beta cells in the islets of
Langerhans in pancreas to release insulin. It
causes insulin secretion, whenever chime
with glucose enters the small intestine.
Hence it is called glucose-dependent
insulinotropic hormone; Inhibits the secretion of gastric juice; Inhibits gastric motility.
Somatostatin:Inhibits the secretion of
growth hormone (GH) and thyroid-stimulating hormone (TSH) from anterior pituitary;
Inhibits gastric secretion and motility; Inhibits secretion of pancreatic juice; Inhibits
secretion of GI hormones such as: Gastrin,
Cholecystokinin (CCK), Vasoactive intestinal polypeptide (VIP), Gastric inhibitory
peptide (GIP).[13]

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Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

AIMS & OBJECTIVES: To critically


analyze the Pachaka Pitta
MATERIALS & METHODS: The Bruhat
Trayi were scrutinised regarding the
references for the Guna and Karma of the
Pachaka Pitta. Later, physiologico-anatomical aspects of the Gastro-intestinal tract
with reference to chemical and physical
digestion were studied from modern
physiology books. Later, supportive correlation was done between Ayurvedic and modern views to build valid and reliable
hypothesis regarding Pachaka Pitta in relation to the various anatomical and
physiological aspects of the central nervous
system.
DISCUSSION
Dosha, Dathu, Mala together form the basis
of the body. The balance of these entities
represents the healthy state and imbalance
will cause various diseases. In normalcy,
Dosha will be performing their own functions and individual Dosha will be having
their own specific site. There are five types
of Pitta namely Pachaka, Ranjaka, Sadhaka,
Alochaka, Brajaka. The Visesha Sthana of
Pachaka Pitta is said to between
Pakwashaya and Amashaya near Jatharagni.
The main function of Pachaka Pitta is said
to be digestion of the ingested food.
Digestion: Mechanical and chemical processes break down ingested food into small
molecules. In mechanical digestion the teeth
cut and grind food before it is swallowed,
and then smooth muscles of the stomach and
small intestine churn the food. As a result,
food molecules become dissolved and thoroughly mixed with digestive enzymes. In
chemical digestion the large carbohydrate,

674

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lipid, protein, and nucleic acid molecules in


food are split into smaller molecules by hydrolysis. In the mouth, salivary amylase
converts starch (a polysaccharide) to
maltose (a disaccharide), maltotriose (a
trisaccharide) and dextrins (short-chain,
branched fragments of starch with 510
glucose units). In the stomach, pepsin
converts proteins to peptides (small
fragments of proteins), and lingual and
gastric lipases convert some triglycerides
into fatty acids, diglycerides, and
monoglycerides. Thus, chyme entering the
small intestine contains partially digested
carbohydrates, proteins, and lipids. The
completion of the digestion of carbohydrates, proteins, and lipids is a collective
effort of pancreatic juice, bile, and intestinal
juice in the small intestine. Role of local
hormones plays an important role in
mechanical chemical digestion. For example
Gastrin: Stimulates gastric glands to secrete
gastric juice with more pepsin and
hydrochloric acid; Accelerates gastric motility; Promotes growth of gastric mucosa;
Stimulates secretion of pancreatic juice,
which is rich in enzymes; Stimulates islets
of Langerhans in pancreas to release pancreatic hormones. Secretin: Inhibits secretion of
gastric juice; Inhibits motility of stomach;
Causes constriction of pyloric sphincter; Increases the potency of action of cholecystokinin on pancreatic secretion.

CONCLUSION
There are five types of Pitta namely Pachaka, Ranjaka, Sadhaka, Alochaka, Brajaka. The Visesha Sthana of Pachaka Pitta
is said to between Pakwashaya and
Amashaya near Jatharagni. The main func-

IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

tion of Pachaka Pitta is said to be digestion


of the ingested food
Digestion: Mechanical and chemical processes break down ingested food into small
molecules. In mechanical digestion the teeth
cut and grind food before it is swallowed,
and then smooth muscles of the stomach and
small intestine churn the food. As a result,
food molecules become dissolved and thoroughly mixed with digestive enzymes. In
chemical digestion the large carbohydrate,
lipid, protein, and nucleic acid molecules in
food are split into smaller molecules by hydrolysis.
The functions of Pachaka Pitta can be related to the functions of digestive enzymes,
Gastro-intestinal hormones and local hormones .
LIST OF REFERENCES
1. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia; 2007.
p. 325.
2. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia; 2007.
p. 326.
3. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia; 2007.
p. 325.
4. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi
(India): Chaukambha Orientalia; 2007.
p. 326.
5. Acharya JT, editor, Reprint ed. Susrutha
Samhita
with
Nibandhasangraha

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commentary of Dalhana, sootrasthana;


Dosha datu mala ksaya vridhi
vignaniyam adhyayam: chapter 15, verse
3. Varanasi (India): Chaukambha
Orientalia,2010;67.
6. Acharya JT, editor, Reprint ed. Charaka
Samhita
with
Ayurveda
Dipika
commentary
of
Chakrapani
Datta,sootrasthana; kuddaka chatuspadam adyayam:chapter 9, verse 4. Varanasi (India): Chaukambha Prakashan,2007;62.
7. Paradakara HSS, editor, 9th ed. Ashtanga
Hrudaya
with
Sarvangasundara
commentary of Arunadatta and Ayurvedarasayana
commentary
of
Hemadri.sootrasthana;
dosadivignaniyam adhyayam:chapter 11,verse 4-18.
Varanasi
(India):
Chaukambha
Orientalia; 2005;192.
8. Paradakara HSS, editor, 9th ed. Ashtanga
Hrudaya
with
Sarvangasundara
commentary of Arunadatta and Ayurvedarasayana
commentary
of
Hemadri.sootrasthana;
dosadivignaniyam adhyayam:chapter 11,verse 1-3.
Varanasi
(India):
Chaukambha
Orientalia; 2005;192.
9. Paradakara HSS, editor, 9th ed. Ashtanga
Hrudaya
with
Sarvangasundara
commentary of Arunadatta and Ayurvedarasayana
commentary
of
Hemadri.sootrasthana;
dosabediya
vignaniyam adhyayam:chapter 12,verse
7-8. Varanasi (India): Chaukambha
Orientalia; 2005;192.
10. Toratora GJ, Derickson B. Principles of
anatomy and physiology.11th edi. United
States of America: John wiley &
sons.Inc;2007,925.
11. Toratora GJ, Derickson B. Principles of
anatomy and physiology.11th edi. United

IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Concept Of Pachaka Pitta A Shareera Kriyatmaka (PhysiologiCal) Understanding

States of America: John wiley &


sons.Inc;2007,926.
12. Toratora GJ, Derickson B. Principles of
anatomy and physiology.11th edi. United
States of America: John wiley &
sons.Inc;2007,927.
13. Toratora GJ, Derickson B. Principles of
anatomy and physiology.11th edi. United
States of America: John wiley &
sons.Inc;2007,928.

CORRESPONDING AUTHOR:
Dr. Kamath Nagaraj
Assistant. Professor, Department of
Shareera Kriya, Karnataka Ayurveda
Medical College, Manglore 575006;
Karnataka, India
Email: nagaraj.kamath1989@gmail.com

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; april;- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

CRITICAL ANALYSIS OF VYANA VATA IN TERMS OF SHAREERA KRIYA


Kamath Nagaraj
1

Assistant. Professor, Department of Shareera Kriya, Karnataka Ayurveda Medical College,


Manglore 575006; Karnataka, India

ABSTRACT
Dosha, Dathu, Mala together form the basis of the body. The balance of these entities represents the healthy state and imbalance will cause various diseases. In normalcy, Dosha will be
performing their own functions and individual Dosha will be having their own specific site.
There are five types of Vata namely Prana, Udana, Vyana, Samana, Apana. The Visesha Sthana
of Vyana Vata is said as Hrudhaya and also said to moves throughout the shareera. The functions
of Vyana Vata is said to be forcefull ejection of Rasa from Hrudhaya and make it circulate
throughout the body and is also responsible for various movements like flexion, extension, opening and closure of eyelids. The active site of Vyana Vata is Hrudhaya. It makes the circulation of
blood possible by controlling the heart. Vyana makes blood to get forcefully ejected out of the
heart and makes it circulate throughout the body. The sympathetic and parasympathetic control
of heart should be included under Vyana Vata. The functions of Somatic nervous system can also
be ascribed to Vyana Vata since it is responsible for various movements like flexion, extension,
opening and closure of eyelids. The functions of Vyana Vata can be related to the functions of
autonomic and somatic Nervous system.
Keywords: Vyana, Vata, Shareera, Kriya, Automic, Somatic, Nervous system
INTRODUCTION

The individual is an epitome of the universe.


All the material & spiritual phenomenon of
the universe are present in the individual.
Similarly all those resent in the individual
are also contained in the universe. [1]
Originating in cosmic consciousness, this
wisdom was intuitively received in the
hearts of the ancient scholars. They perceived that consciousness was energy manifested into the five basic principles or elements. Man is microcosm of the nature and
so the five basic elements present in all matter also exists within each individual. Thus

out of the womb of the five elements, all


matter is born. The five basic elements exist
in all matter. Water provides the classic
example: - the solids of iced water are manifestation of the Prithvi Mahabhuta (earth
principle). Latent heat in the ice (Agni)
liquefies it, manifesting into Jala Mahabhuta (water principle). And then eventually
it turns into steam expressing the Vayu
Mahabhuta (air principle) the steam disappears into Akasha or space.[2]Bhuta is that
which is not born out of something, but out
of which something is born. It is the material
cause of substances in the world. When we

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Kamath Nagaraj : Critical Analysis Of Vyana Vata In Terms Of Shareera Kriya

say Bhuta we mean that subtle level of existence, where as Mahabhuta refers to gross
level of existence.[3]Panchikarana is the process through which invisible Bhutas combine with each other and form the visible
Mahabhutas in such a way that all Bhutas
are present together in each Drisya Bhuta in
varying degrees of predominance. Thus in
the physical world everything is a combination of Pancha Mahabhutas & we cannot
see them independently. [4]
Dosha, Dathu, Mala together form the basis
of the body.[5] The balance of these entities
represents the healthy state and imbalance
will cause various diseases.[6] In normalcy,
Dosha will be performing their own functions and individual Dosha will be having
their own specific site. By mentioning the
various Sthana of the each Dosha the different function performed by individual Dosha
in different sites has been emphasised. The
sub-types of Dosha, its location and function
have also been mentioned. [7]
Regarding the Sthana of various Dosha authors have different opinion. Later authors
have added some more Sthana of Dosha.
For example, ears among the location of
Vata; umbilicus, eyes and skin among the
location of Pitta; Kloma, nose, tongue
among the location of Kapha.[8]
There are five types of Vata namely Prana,
Udana, Vyana, Samana, Apana. The
Visesha Sthana of Vyana Vata is said as
Hrudhaya and also said to moves throughout
the shareera. The functions of Vyana Vata is
said to be forcefull ejection of Rasa from
Hrudhaya and make it circulate throughout
the body and is also responsible for various
movements like flexion, extension, opening
and closure of eyelids.[9]
Brief Physio- anatomical understanding of
the Autonomic and somatic nervous system

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is necessary to understand physiology of


VyanaVata.
The peripheral nervous system (PNS) includes all nervous tissue outside the CNS.
Components of the PNS include cranial
nerves and their branches, spinal nerves and
their branches, ganglia, and sensory receptors. The PNS may be subdivided further
into a somatic nervous system (SNS) , an
autonomic nervous system (ANS) and an
enteric nervous system (ENS).
The SNS consists of sensory neurons that
convey information from somatic receptors
in the head, body wall, and limbs and from
receptors for the special senses of vision,
hearing, taste, and smell to the CNS and motor neurons that conduct impulses from the
CNS to skeletal muscles only. Because these
motor responses can be consciously controlled, the action of this part of the PNS is
voluntary. The ANS consists of sensory neurons that convey information from autonomic sensory receptors, located primarily
in visceral organs such as the stomach and
lungs, to the CNS and motor neurons that
conduct nerve impulses from the CNS to
smooth muscle, cardiac muscle, and glands.
Because its motor responses are not normally under conscious control, the action of
the ANS is involuntary. The motor part of
the ANS consists of two branches, the
sympathetic division and the parasympathetic division. With a few exceptions, effectors receive nerves from both divisions, and
usually the two divisions have opposing actions. For example, sympathetic neurons
increase heart rate, and parasympathetic
neurons slow it down. In general, the
sympathetic division helps support exercise
or emergency actions, so-called fight-orflight responses, and the parasympathetic
division takes care of rest-and-digest
activities.[10]
Heart rate is maintained within normal range
constantly. It is subjected for variation during normal physiological conditions such as
exercise, emotion, etc. However, under
physiological conditions, the altered heart

IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Critical Analysis Of Vyana Vata In Terms Of Shareera Kriya

rate is quickly brought back to normal. It is


because of the perfectly tuned regulatory
mechanism in the body. Heart rate is regulated by the nervous mechanism, which consists of three components: Vasomotor center, Motor (efferent) nerve fibers to the
heart, Sensory (afferent) nerve fibers from
the heart. Vasomotor center is formed by
three areas: Vasoconstrictor area, Vasodilator area, Sensory area. Vasoconstrictor area
increases the heart rate by sending accelerator impulses to heart, through sympathetic
nerves. It also causes constriction of blood
vessels. Stimulation of this center in animals
increases the heart rate and its removal or
destruction decreases the heart rate
Vasodilator area decreases the heart rate by
sending inhibitory impulses to heart through
vagus nerve. It also causes dilatation of
blood vessels. Stimulation of this area in
animals with weak electric stimulus decreases the heart rate and stimulation with a
strong stimulus stops the heartbeat. When
this area is removed or destroyed, heart rate
increases. Sensory area receives sensory impulse via glossopharyngeal nerve and vagus
nerve from periphery, particularly, from the
baroreceptors. In turn, this area controls the
vasoconstrictor and vasodilator areas.
Heart receives efferent nerves from both the
divisions of autonomic nervous system.
Parasympathetic fibers arise from the medulla oblongata and pass through vagus
nerve. Sympathetic fibers arise from upper
thoracic (T1 to T4) segments of spinal cord.
Vagus nerve is cardioinhibitory in function
and carries inhibitory impulses from
vasodilator area to the heart. Stimulation of
sympathetic nerves increases the rate and
force of contraction of heart. The effect depends upon the strength of stimulus.[11]
Movements of the body depend upon different groups of skeletal muscles. Various
types of movements or motor activities
brought about by these muscles are: Execution of smooth, precise and accurate voluntary movements; Coordination of movements responsible for skilled activities;

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Coordination of movements responsible for


the maintenance of posture and equilibrium.
Voluntary actions and postural movements
are carried out by not only the simple
contraction and relaxation of skeletal muscles but also the adjustments of tone in these
muscles. The execution, planning, coordination and adjustments of movements of the
body are under the influence of different
parts of nervous system, which are together
called motor system. Sensory system of the
body also plays a vital role in the control of
movements. Spinal reflexes are responsible
for most of the movements concerned with
voluntary actions and posture. Stimulation
of receptor activates the motor neuron in
spinal cord, leading to the contraction of
muscle innervated by spinal motor neuron.
Apart from these reflexes, signals for voluntary motor activities are also sent from
different areas of the brain, particularly the
cerebral cortex to spinal motor neurons.
Coordination and control of movements
initiated by cerebral cortex depends upon
two factors: Feedback signals from proprioceptors in muscle and other sensory receptors; Interaction of other parts of brain such
as brainstem, cerebellum and basal ganglia.
Neuronal circuits between these parts of
nervous system, which are responsible for
the motor activities are called the motor
pathways. cerebellum and basal ganglia.
Thus, the motor system includes spinal cord
and its nerves, cranial nerves, brainstem,
cerebral cortex. [12]
Depending upon the location or termination,
motor pathways are divided into two categories, namely the lateral system or pathway
and the medial system or pathway. Lateral
motor system is phylogenetically new and
medial motor system is old. Functions of
lateral motor system: Lateral corticospinal
tract activates the muscles of distal portions
of limbs and regulates the skilled voluntary
movements Rubrospinal tract facilitates the
tone in the muscles, particularly the flexor
muscles. Corticobulbar fibers of lateral system are concerned with the movements of

IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Critical Analysis Of Vyana Vata In Terms Of Shareera Kriya

expression in lower part of face and movements of tongue.


Functions of medial motor system: Anterior
corticospinal tract is responsible for the
maintenance of posture and equilibrium. Fibers of corticobulbar tract belonging to medial motor system, innervating muscles of
upper part of trunk are involved in the
maintenance of posture and equilibrium. Fibers innervating muscles of jaw and face are
involved in the movements of chewing and
movements of eyebrow. Vestibulospinal
tract is concerned with the adjustment of
position of head and body during angular
and linear acceleration. Pontine fibers of
reticulospinal tract facilitate the tone of
extensor muscles and regulate the postural
reflexes. However, medullary fibers of this
tract inhibit the tone of the muscles involved
in postural movements. Tectospinal tract is
responsible for the movement of head in response to visual and auditory stimuli.[13]

AIMS & OBJECTIVES


To critically analyze the Vyana Vata
MATERIALS & METHODS
The Bruhat Trayi were scrutinised regarding
the references for the Guna and Karma of
the Vyana Vata. Later, physiologicoanatomical aspects of the autonomic and somatic nervous system were studied from
modern physiology books. Later, supportive
correlation was done between Ayurvedic and
modern views to build valid and reliable hypothesis regarding Vyana Vata in relation to
the various anatomical and physiological
aspects of the Autonomic and somatic nervous system.

DISCUSSION
Dosha, Dathu, Mala together form the basis
of the body. The balance of these entities
represents the healthy state and imbalance
will cause various diseases. In normalcy,
Dosha will be performing their own func-

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tions and individual Dosha will be having


their own specific site.
There are five types of Vata namely Prana,
Udana, Vyana, Samana, Apana. The
Visesha Sthana of Vyana Vata is said as
Hrudhaya and also said to moves throughout
the Shareera. The functions of Vyana Vata
is said to be forceful ejection of Rasa from
Hrudhaya and make it circulate throughout
the body and is also responsible for various
movements like flexion, extension, opening
and closure of eyelids.
Heart receives efferent nerves from both the
divisions of autonomic nervous system.
Parasympathetic fibers arise from the medulla oblongata and pass through vagus
nerve. Sympathetic fibers arise from upper
thoracic (T1 to T4) segments of spinal cord.
Vagus nerve is cardioinhibitory in function
and carries inhibitory impulses from
vasodilator area to the heart. Stimulation of
sympathetic nerves increases the rate and
force of contraction of heart. The effect depends upon the strength of stimulus. This
Autonomic control of heart rate by in turn
regulating the force of ejection of blood
from the heart and also controlling the
circulation of blood to different parts of the
body can be related to forceful ejection of
Rasa from Hrudhaya and make it circulate
throughout the body which is the function of
Vyana Vata
Movements of the body depend upon different groups of skeletal muscles. Various
types of movements or motor activities
brought about by these muscles are: Execution of smooth, precise and accurate voluntary movements; Coordination of movements responsible for skilled activities;
Coordination of movements responsible for
the maintenance of posture and equilibrium.
Voluntary actions and postural movements
are carried out by not only the simple
contraction and relaxation of skeletal muscles but also the adjustments of tone in these
muscles. The execution, planning, coordination and adjustments of movements of the

IAMJ: Volume 4; Issue 04; april;- 2016

Kamath Nagaraj : Critical Analysis Of Vyana Vata In Terms Of Shareera Kriya

body are under the influence of different


parts of nervous system, which are together
called motor system. Sensory system of the
body also plays a vital role in the control of
movements. Spinal reflexes are responsible
for most of the movements concerned with
voluntary actions and posture. Stimulation
of receptor activates the motor neuron in
spinal cord, leading to the contraction of
muscle innervated by spinal motor neuron.
Apart from these reflexes, signals for voluntary motor activities are also sent from
different areas of the brain, particularly the
cerebral cortex to spinal motor neurons. This
function of somatic nervous system can be
related to various movements like flexion,
extension, opening and closure of eyelids,
which is the function of Vyana Vata.
CONCLUSION
There are five types of Vata namely Prana,
Udana, Vyana, Samana, Apana. The
Visesha Sthana of Vyana Vata is said as
Hrudhaya and also said to moves throughout
the Shareera. The functions of Vyana Vata
is said to be forceful ejection of Rasa from
Hrudhaya and make it circulate throughout
the body and is also responsible for various
movements like flexion, extension, opening
and closure of eyelids.
The active site of Vyana Vata is Hrudhaya.
It makes the circulation of blood possible by
controlling the heart. Vyana makes blood to
get forcefully ejected out of the heart and
makes it circulate throughout the body. The
sympathetic and parasympathetic control of
heart should be included under Vyana Vata.
The functions of Somatic nervous system
can also be ascribed to Vyana Vata since it
is responsible for various movements like
flexion, extension, opening and closure of
eyelids.
The functions of Vyana Vata can be related
to the functions of autonomic and somatic
Nervous system.

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REFERENCES
1.Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia;
2007. p. 325.
2. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia;
2007. p. 326.
3. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia;
2007. p. 325.
4. Acharya JT. Charaka Samhita with
Ayurveda Dipika commentary of
Chakrapani Datta. Reprint ed. Varanasi (India): Chaukambha Orientalia;
2007. p. 326.
5. Acharya JT, editor, Reprint ed.
Susrutha Samhita with Nibandhasangraha commentary of Dalhana,
sootrasthana; Dosha datu mala ksaya
vridhi vignaniyam adhyayam: chapter 15, verse 3. Varanasi (India):
Chaukambha Orientalia,2010;67.
6.Acharya JT, editor, Reprint ed.
Charaka Samhita with Ayurveda
Dipika commentary of Chakrapani
Datta,sootrasthana; kuddaka chatuspadam adyayam:chapter 9, verse 4.
Varanasi (India): Chaukambha Prakashan,2007;62.
7.Paradakara HSS, editor, 9th ed. Ashtanga Hrudaya with Sarvangasundara
commentary of Arunadatta and
Ayurvedarasayana commentary of
Hemadri.sootrasthana;
dosadivignaniyam adhyayam:chapter

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Kamath Nagaraj : Critical Analysis Of Vyana Vata In Terms Of Shareera Kriya

11,verse 4-18. Varanasi (India):


Chaukambha Orientalia; 2005;192.
8.Paradakara HSS, editor, 9th ed. Ashtanga Hrudaya with Sarvangasundara
commentary of Arunadatta and
Ayurvedarasayana commentary of
Hemadri.sootrasthana;
dosadivignaniyam adhyayam:chapter
11,verse 1-3. Varanasi (India):
Chaukambha Orientalia; 2005;192.
9. Paradakara HSS, editor, 9th ed. Ashtanga Hrudaya with Sarvangasundara
commentary of Arunadatta and
Ayurvedarasayana commentary of
Hemadri.sootrasthana; dosabediya
vignaniyam
adhyayam:chapter
12,verse 7-8. Varanasi (India):
Chaukambha Orientalia; 2005;192.
10. Toratora GJ, Derickson B. Principles
of anatomy and physiology.11th edi.
United States of America: John
wiley & sons.Inc;2007,425.
11. Sembulingam K, Essentials of medical physiology.6th edi. New Delhi:
Jaypee publications;2012,588-9.
12. Sembulingam K, Essentials of medical physiology.6th edi. New Delhi:
Jaypee publications;2012,832.
13. Sembulingam K, Essentials of medical physiology.6th edi. New Delhi:
Jaypee publications;2012,835-6.









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CORRESPONDING AUTHOR:
Kamath Nagaraj 1
1
Assistant. Professor, Department of
Shareera Kriya, Karnataka Ayurveda
Medical College, Manglore 575006; Karnataka, India
Email id:
nagaraj.kamath1989@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; april;- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

IMPORTANCE OF AGNI IN RESTORATION OF YUKTIKRUTA BALA


Deshpande Anil Chandrakant
Assistant Professor,Sumatibhai Shah Ayurved Mahavidyalaya, Hadapsar,Pune 28
ABSTRACT
Fatigue is a subjective feeling of tiredness which is distinct from weakness, and has a gradual
onset. Fatigue can have physical or mental causes. Physical fatigue is the transient inability of
muscle to maintain optimal physical performance. Fatigue is considered a symptom, rather than a
sign because it is a subjective feeling reported by the patient, rather than an objective one that
can be observed by others. So to relieve fatigue Agni is very crucial as Agni is mula of bala.
Acharya Charak in vimanasthan states dashavidh pariksha to examine bala of patient for diagnosis and treatment. Purpose of examination is to obtain knowledge relating bala of an individual.
So Bala which we can build by efforts i.e. Yuktikruta bala plays an important role in maintenance of health which is gained by chesta (physical exercise), ahara (wholesome diet) and yoga
(rasayan prayog) after action of Agni.The jatharagni plays an important role in generation and
restoration of yuktikruta bala from ahara. The restoration of yuktikruta bala depends on the normal functioning of agni i.e. dahana and pachana of ahara.
Key words : Yuktikruta bala, Rasayana, jatharagni)
INTRODUCTION
Any living body respires, metabolizes and uses a lot of energy gained from eaten food. [1] As dictated in Loka purusha
nyay, everything that exists in universe is
represented by some entity in living body
and it functions in same way. Fire is represented by Agni in living body. Agni in body
digests, helps in absorption of digested material, transforms digested food into body
entities. Agni is mula of bala.So Agni
rakshana is very important. Dehagni is the
hetu of ayu, varna, bala, swasthya, utsaha,
upachaya, prabha, oja, teja, Agni and
Pana..[2] Agni Vikruti leads to Rogavastha.

Life depends on Agni and in its absence life


ends.[3] Annapachana is the prime function
of jatharagni.

MATERIAL AND METHODS All classical texts available in the library of Ayurved
College, Hadapsar had been reviewed. Database available after net surfing was also
reviewed. Acharya Charak in vimanasthan
states dashavidh pariksha to examine bala
of patient for diagnosis and treatment. Purpose of examination is to obtain knowledge
relating bala of individual.
Types of Bala
1) Sahaja bala

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Deshpande Anil Chandrakant: Importance Of Agni In Restoration Of Yuktikruta Bala

2) Kalaja bala
3) Yuktikruta bala
1. Sahaja bala- This type of bala is stated
to be prakruta (genetic natural inborn)
and it exists right from birth4. It is inherent in every individual to lesser to greater degree. It is said to increase with genuine growth of the dhatus and does not
depend on any other cause. Some individuals are observed as physically strong
from their birth whereas some are observed as physically weak from very
birth.
2. Kalaja bala - This type of bala is influenced by seasonal traits and the age of
person.
3.Yuktikruta bala- The three factors, which
are capable of affecting the yuktikruta bala,
are ahara, cheshta and yoga.[4] (rasayan
prayog).Yuktikruta bala refers to resorting to
appropriate nutrition such as meat, milk and
ghee etc. Physical exercise is depletory, impletory and restorative and rasayana therapies in keeping the seasonal needs. In
doshasamyavastha, annapachana by agni
leads to arogya-pushti,ayu,bala,vruddhi.
The individual can achieve yuktikruta bala
from ahara only after conversion of complex food particle into absorbable ones in
respective strotas after action of jatharagni.
Agni is the ultimate and unavoidable entity
which is responsible for bioconversion of
ahara into ahara rasa. Ahara Rasa nourishes dhatus by various nyayas. The bodily
movement which produce firmness and
strength is known as vyayama. One gets
lightness, capacity to work, firmness, tolerance of difficulties, diminution of impurity
and stimulation of Agni.[5] Agni vrudhi is
ultimate benefit of vyayama if practiced in
moderation. Acharya Sushruta included
vyayama in anagnisweda (sudation without

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the use of fire ) as one of the effective measure when agrevated vata is associated with
kapha and medas..[6] According to
Chakrapani the strength begins to develop
by regular diet, rest and exercises.The jatharagni plays an important role in generation,
restoration of
yuktikruta bala from
ahara.The restoration of yuktikruta bala depends on the normal functioning of Agni i.e.
dahana and pachana of Ahara.
The rasayana Therapy aims specially at the promotion of strength and Vitality. It is stated to contribute to the integrity of the Sapta dhatus and thus increase the
longevity. It preserves the youth, maintains
optimum strength of the body and senses.
Agni is medium for rasayana to act on various dhatus to maintain integrity and perform
various activity. The normalcy of Agni enables dravyarupa rasayana to produce supreme sharir bhavas to generate yuktikruta
bala. Ahara and vyayama stabilizes the
body.
DISCUSSION
Yuktikruta bala is dependent on chesta,
ahara and rasayan prayoga.
Chesta which is predominantly depends on
mamsa ,medas and asthi dhatu. If
dhatvagni is not in normal state then
absence of lassitude, Stability, feeling of
lightness, ability to withstand exertion,
reduction of corpulence is not possible
which are the benefits of vyayama.
The term rasayana has a specific meaning.
Drug, Diet and Regimens which promotes
longevity, preventing ultimately ageing
and disease are called rasayana. The effects of rasayana therapy are longevity
(good long life),memory, intelligence,
good health, youthfulness, bright complexion depends upon the normal func-

IAMJ: Volume 4; Issue 04; March- 2016

Deshpande Anil Chandrakant: Importance Of Agni In Restoration Of Yuktikruta Bala

tioning of all types of Agni. The Normalcy


of all types of Agni produces the supreme
saptadhatus to withstand the body by
dharana and poshana karma of dhatus.
CONCLUSION
Yuktikruta bala depends on chesta, ahara
and rasayan prayoga. But for the bioconversion of ahara into further
poshakabhaga, Agni- the almighty God
is unavoidable and very crucial entity.
Cheshta and Rasayana prayoga enhances
the Yuktikruta bala. So one should eat in
proper quantity and follow the protocol
of dieting to promote Yuktikruta bala .
REFERENCES
1. Naighantuk kand.
2. Agnivesh, charak, Dhridbala, Charak
samhita sutra sthan 15/2, kashinath
pandey & Gorakhanath Chaturvedi,
Charak samhita Vidyotini Vyakhya,
Chaukhambha
Bharti
Akadami,Varanasi, Edition 2005.
3. Charak samhita sutra sthan 15/2,
kashinath pandey & Gorakhanath
Chaturvedi, Charak samhita Vidyotini
Vyakhya, Chaukhambha Bharti Akadami,Varanasi, Edition 2005.

!"%

www.iamj.in

4. Charak samhita sutra sthan 11/36,


kashinath pandey & Gorakhanath
Chaturvedi, Charak samhita Vidyotini
Vyakhya, Chaukhambha Bharti Akadami,Varanasi, Edition 2005.
5. Sushruta samhita chikitsa sthan
24/39-40, Srikantha Murthy, Chaukhamba Orien-talia, Varanasi, Edition
2008.
6. Sushruta samhita chikitsa sthan
32/15, Srikantha Murthy, Chaukhamba Orien-talia, Varanasi, Edition
2008.
CORRESPONDING AUTHOR
Dr. Deshpande Anil Chandrakant
Assistant Professor,Sumatibhai Shah
Ayurved Mahavidyalaya, Hadapsar,Pune
28
Mail Id : deshpandeanil04@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

IMPORTANCE OF VAYASTHAPANA-MAHAKASHAYA DRUGS WSR TO ITS


POTENTIAL USES IN GERIATRIC CARE
Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.
1.

P.G. Scholar, Dept. of P.G. Studies in DravyaGuna, National Institute of Ayurveda, Jaipur,
Rajasthan
2
Assistant professor,in P.G. Dept. of DravyaGuna. National Institute of Ayurveda, Jaipur,
Rajasthan,

ABSTRACT
Ageing is an inevitable change for not only human kind but all living creatures. In Ayurveda jara
chikitsa (geriatrics) is mentioned as one of 8 branches (Sushuruta samhita) and jara is said to be
swabhavika vyadhi. Ayurveda has given unique importance to geriatric care . In Ayurveda the
concept of anti-ageing is embodied in Rasayana. Rasayana therapy helps to prevents ageing and
its ill effects. It provides longevity, immunity against diseases and improves mental and intellectual competence. Various single and combination of drugs like Vayasthapana mahakashaya having Rasayana properties have been mentioned in ancient treaties which helps in overall nourishment of different dhatu. Rasayana drugs possess strong anti-oxidant activities. This activity is
responsible for combating the effect of ageing, stress, diabetes and auto immune diseases.
Aacharya charaka has given unique importance to Vayasthapana Mahakashaya for maintaining
vitality and managing ageing and its allied ill effects.
The purpose of this paper is to put forward and reestablish the role of vayasthapana mahakashaya
drugs in alleviating age related disorders and its uses in Geriatric health and care potential.
Key words: Ageing, Ayurveda, Rasayana, Vayasthapana Mahakashaya.
INTRODUCTION
Ageing is defined as gradual biological impairment of normal functions, probably as a
result of changes made into the cells and
structural components. These changes would
consequently have a direct impact on functional ability of organs and biological symptoms. Ayurveda counters the aging and its
allied ill-effects with three pronged approach. First it recommends the countering
of aging and its adverse effects by use of
Vayasthapak drugs (age stabilizers) and the

second approach is to rejuvenate the aged


body by Jeevneeya drugs (vitalisers) and
third approach is Jarachikitsa i.e. Rasayana
Chikitsa (Rejuvenating process and formulations) which is a very well developed branch
among eight branches of the management of
Geriatrics disorders. Rasayana also elaborated in Rig-Veda and Atharva-Veda like Soma
etc. Rasayana basically boosts the Oja (vital
force of life - the immune system) and helps
the person to maintain good healthi.
Life extension science, also known as anti-

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

aging medicine, experimental gerontology,


and bio-medical gerontology is the study of
slowing down or reversing the processes of
aging to extend both the maximum and average lifespan. Experimental studies done on
various Rasayana drugs prove that they have
immune stimulant, antioxidant, and antistress etc properties.ii
Global health scenario in geriatrics
The twenty-first century is witnessing a
gradual decline in fertility; and with increase
in life expectancy, the society will need to
grapple with issues of longevity. The leading causes of mortality among aged people
comprise respiratory problems, heart diseases, cancer and stroke. Significant causes of
morbidity among this group is chronic inflammatory and degenerative conditions
such as Arthritis, Diabetes Osteoporosis,
Alzheimers disease, Depression, Psychiatric disorders, Parkinsons disease and age
related urinary problems.iii
MATERIAL AND METHOD:iv
Theories of ageing
a) Free radical theory
b) Telomerase Theory
c) Hayflick Limit Theory
d)Cross-linking Theory

Age
Associated
changes:v

Physiological

Sensory System - Change in vision and


hearing etc.
Nervous System - Decrease in neurons and
slow neurotransmitter, changes in sleep cycles.
Musculoskeletal System -Sarcopenia, gradual loss of bone mass, and joints becomes
less lubricated.
Gastrointestinal Systems - Decreased tone
of intestine and stomach result in slow peri-

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staltic movement and diminished enzymes,


gastric juices, nutrients result in malabsorption .
Cardiovascular System - the heart less
able to pump efficiently,Left ventricular and
atrial hypertrophy, Sclerosis of atrial and
mitral valves.
Respiratory System- Decreased volume
and expansion of lungs may lead to decreased function.
Renal and Genitourinary Systems- Decreases in kidney mass, blood flow, GFR,
Decreased drug clearance, Reduced bladder
elasticity, muscle tone, capacity
Immune System -Immune response dysfunction with increased susceptibility to infection, reduced efficacy of vaccination,
chronic inflammatory state.
According to Ayurveda:
Ageing is known as Jara and defined as that which has become old by the
act of wearing out jiryatiitijara. It is synonyms as vardhakya meaning increasing
age. Ayurveda divides human life into
childhood (up to the age 16years), middle
age[ from16 to 60 years (Charak) or 70
years (Sushruta)and exhibits progressively
the traitsof growth (vivardhamana, 16-20
years of age),youth ( youvana, 20-30 years),
maturity ( sampooranta, 30-40 years), deterioration ( hani, 40 years on wards) which
gradually sets in up to 60 years[, old age,
where in after 60-70 years the body elements, sense organs, strength and so forth
begin to decay.vi
Aacharya Sushruta has classified the diseases and mentions SvabhavaBalaPravritta diseases, which include Kshudha (hunger), Pipasa (thrist), Nindra (sleep), Jara
(Ageing) and Mrityu (death).vii

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

Sushruta divided SvabhavaBalaPravritta


Vyadhi into Kalaja Jara (Timely Ageing)
and Akalaja Jara-(Premature Ageing).
Acharya Sarangadhara beautifully quoted
thatchanges of ageing are always degenerative in natureviii
i%
i,./1 (..,. 356 6/20)
The childhood, growth, luster/beauty, intellect, luster of skin, Vision, sexual ability,
physical ability, thinking ability and locomotion starts to loss from the body with
each passing decade. Likewise, many herbs
have been described to be used as per the
age as followsAge ( 0-10 )Balya (childhood),
Vacha
(Acorus calamus) Kasmari (Gmelina arborea)
Age (11-20) Vruddhi (growth), Bala (Sida
cordifoila) Aswagandha (Withania- somnifera)

Management for Geriatric care:


1. Keep the lifestyle as close as possible to the ideal prescribed by
Ayurveda.
2. Utilization of Rasayana regularly.
In Ayurveda the concept of antiageing is embodied in Rasayana.
Rasayana therapy helps to prevents ageing and its ill effects. It
provides longevity, immunity
against diseases and improves
mental and intellectual competence.Various single and combination of drugs like Vayasthapana
Mahakashaya and jeevneeya dravya (vitalisers)having Rasayana
properties.

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3. Avoid the provocative causes


of Kshaya (degeneration)
and Vata, for example, excessive
physical and mental work, vigorous exercise, tolerance of unsuppressible urges, intolerance of
suppressible urges, and so on.
4. Panchakarma & Yoga are proven to
be efficacious in many chronic
health Problems of elderly people.ix

Rasayana:
8,;<=>,?, (cha.su. 1/5)
Charaka has briefly defined Rasayana
as the measure by which one gets Rasa, Rakta, and etc Dhatu in its best
condition. Sushruta has defined Rasayana as the therapy, which establishes the age (Vayasthapana), increases the life span (Ayuskar), intelligence (Medha) and strength (Bala)
as well as it enables the person to rid
of the diseases.
Mechanism of Action of Rasayana
therapy
The word Rasayana is a combination of
two separate words Rasa and ayana. The
word Rasa in this context means the first
liquid tissue which nourishes all the tissues in the body and Ayana is its circulation. This means that if rasa dhatu is
produced in optimum quality and quantity, then naturally all the tissues in the
body will be nourished properly.x
Rasayana acts through various ways It
improves micro-circulation and been reported that the Rasayanas are rejuvenators, nutritional supplements and possess strong antioxidant activities. They
also exert antagonistic action on oxidative stressors, giving rise to the for-

IAMJ: Volume 4; Issue 04; March- 2016

Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

mation of different free radicals. They


are used mainly to combat the effects of
ageing, atherosclerosis, cancer, diabetes,
rheumatoid arthritis, autoimmune disease and Parkinsons disease. The Rasayana herbs seem to operate through
immunostimulant, immunoadjuvant, and
immunosuppressant activities or by affecting the effector arm of the immune
response. Mechanisms of immunomodulation activity occur mainly via phagocytosis stimulation, macro-phages activation, immunostimulatory effect on peritoneal macro-phages, lymphoid cells
stimulation, cellular immune function
enhancement and nonspecific cellular
immune system effect, antigen-specific
immunoglobulin production increase, increased nonspecific immunity mediators
and natural killer cell numbers, reducing
chemotherapy-induced leukopenia, and
increasing circulating total white cell
counts.xi
Types of Rasayana:
a) Kutipraveshika (Indoor method),in
this form of Rasayana therapy, the
person is made to stay in a specially
designed chamber for a certain period and is given Rasayana preparations (Non-ambulatory method/ In door therapy). Before taking this
form of rejuvenation therapy, the
person has to undergo Panchakarma
therapy.

b) Vatatapika Open air, this method is


outdoor method.
c) Kamya Rasayans- (use oriented) also
divided in three parts
1. Medhya Rasayan: Promote intelligence
exm-. Brahmi, Mandukaparni, Jyotishmati, Jivanti etc.
2. Prana Rasayan: Promoteage-stabilization,longevity,vitalityexm-.Amalaki,
Haritaki, Guduchi, Shatavari
3. Srikamya Rasayan: Promote complexion
exm. Guduchi, Amalaki, Triphala,
Ashvagandha etc
Rasayanas based on drug, diet and
life style:
1. Aushdha Rasayana - Drug Based Rasayana.
2. Ahara Rasayana - Dietary Rasayana.
3. Achara Rasayana - Lifestyle Rasayana.
(d) Naimittika Rasayans- help to fight a specific disease..exm Prameha- Haridra, Shilajatu, Amalaki etc. Amavata- Bhallataka,
Lashuna, Pippali etc.xii
ntial uses ofPote Vayasthapana
Dravya
Dalhana has explained the word
Vayasthpana by giving its two meanings of Vayasthapana: (1) it enables the
person to live a full life span of 100 years.
(2) It makes the man to live young for a
long period thus prevents the Jara.xiii
Aacharya Charak mentioned Vayasthapana Mahakashaya dravyas in sutra sthana
and said the drugs which prevents ageing
process is known as Vayasthapana.

i (Ch.su.4/50)
Sanskrit
Name

695

Latin Name

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Rasa

Guna

Virya

IAMJ: Volume 4; Issue 04; March- 2016

Vipaka

Dosha Action

Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care
Amrita

Tinospoara
cordifolia
(Willd)
Miers
exHook.f.&
Thoms
Terminalia
chebula Retz

Tikta,
Kashaya

Guru,
Snigdha

Usha
na

Madhura

Tridosha shamaka

(Pancharas)
Kashaya

Laghu
Ruksh

Usha
na

Madhura

Tridoshashamakas

Embelica
officinalis
Gaertn.

(Pancharas)Amla

Guru, Ruksh

Shita

Madhura

Yukta
(Rasana)

Pluchea
lanceolata
C.B.Clarke

Tikta

Guru

Usha
na

Katu

Vatashamaka

Shweta
Jiwanti

Clitoria ternatea Linn.


Leptadenia
reticulataW.& A.
Asparagus
recemosus
Willd
Centella
asiatica
(Linn.)
Desmodium
gangeticum
DC.
Boerhavia
diffusa Linn.

Katu,
Tikta
Madhur
a

LaghuRuksh

Shita

Katu

Tridoshashamaka

LaghuSnigdha

Shita

Madhura

Vata-Pitta shamaka

Madhur
a, Tikta

Guru,
Snigdha

Shita

Madhura

Vata-Pitta shamaka

Tikta,
Kashaya

Laghu

Shita

Madhura

Kapha-Pitta
shamaka

Madhur
a, Tikta

Laghu

Usha
na

Madhura

Tridoshashamaka

Madhur
a, Tikta

Laghu
Ruksh

Usha
na

Madhura

Tridoshashamakaxiv

Abhaya
Dhatri

Atirasa
Mandookparni
Sthira

Punar
nava

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p(Vatashamaka)
Tridosha
ShamakaSp.(Pittashamaka)

v Amrita- 1. Presence of the two gunas, of


guru and snigdha are nutritive in action,
being similar in quality to rasa dhatu.
The heating Virya not only stimulates
correct digestive fire treating mandaagni
and vishamaagni but coupled with its
tikta rasa it does not aggravate pitta
whilst digesting ama toxins and the
post-digestive action of madhura indicate that the action of the herb is more
anabolic than catabolic in nature and
from an energetic perspective it counters
the catabolic nature of ageing.

696

2. According morden Research :- Tinospora


cordifolia
Willd.Possesses
immunomodulatory function.xv It has adaptogen, Antipyretic, Anti inflammatory properties. The antioxidant activity of root extract is reported in alloxan diabetic rats
(Prince P.S.M. et al; 1999).
v Abhaya 1.- It is recorded as being more
vata pacifying and used in extensively in
disorders of vata. This may be due to the
heating virya and madhura vipaka, both
of which counter vata. It is called Pathya
that means removing any obstructive
material and clarifying the path (srotasa).

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

It is revered for its rejuvenative action


hence it is recommended for long term
intake being combined with various
agents during the different seasonal
changes to promote and fortify its rejuvenative properties. It also known as
'Digestive Rasayana' by eliminating the
waste products from the tissues/organs,
perticularly G.I.tract.xvi
2. Terminalia chebula Retz. Possess, Antioxidant, antidiabetic, gentle purgative
etc.xvii
Dhatri-1. Amalaki is a rejuvenative to
the pitta dosha, via its cooling quality
and virya, and due to its madhura vipaka. It is also balancing to vata and kapha
Its vata pacifying action due amla rasa
and madhura vipaka is expressed in the
anabolic action as it supports the building and strengthening of tissues countering degeneration associated with ageing.
decrease the catabolic process and thus
postpones ageing. Therefore, they are
known as 'Vayasthapak Rasayana'
(Adaptogenic tonic).
2. Embelica officinals Gaertn. Possess
Antiinflammatory, antioxidant properties.xviii.astringent. (Anti inflamattory
effect of emblica officinale in rodent
models
of
acute
and
chronic
inflamation,IJRPBS,vol.3jun2012.)
Yukta-1. Rasna has vata pacifying action can be seen in the Guru guna and
the heating virya. Vata is dissociative in
nature and this is also a causative factor
of jara. Charak said Rasnavataharanama in Agrayaprakarana. So it is best
drug, palliative for vata.
2 Pluchea lanceolata C.B.Clarke possesses Immunomodulator properties.(

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DP.Bhagwat et al.;Immunosuppresive
properties of pluchea lanceolata leaves;
2010,IJP)
v Shweta-.According to modern research
Clitoria turnatea Linn. has antibacterial
properties.xix
v Jivanti- 1. Having the main feature of
having snigdha quality, madhura rasa,
shita virya and madhura vipaka, indicates that this herb is building and
strengthen in its actions supporting the
kapha dosha in maintaining stability of
the tissues. The nutritive effect supports
the formation of rasa dhatu and ojas
maintaining health and immunity,
providing strength and energy and nourishes the remaining dhatus.
2. Leptadenia reticulata W.& A possesses Anti-fungal and antiseptic properties.xx
v Atirasa-1. Shatavari madhura, tikta rasa
and shita virya is pacifying to pitta and
vata is pacified by the madhura rasa,
guru and snigdha qualities and madhura
vipaka. It is a nourishing herb to rasa
dhatu observed in its galactagogue action as breast milk is an upadhatu of rasa
hence exhibits the quality of rasa in its
production. It is a building and nourishing herb countering the wasting of tissues.
2.Asparagus racemosus Willd: Antioxident, hepatoprotective, antiulcer, antidepressant, hypoglycemic properties.xxi
(M.Gautam,S.Mishra
et
al.2009,Immunomodulatory activity on
systemic
TH1/TH2
immunity
implication
for
immunoadjuvants
potential.J Elsevier.)

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

Mandookpasrni- 1. Mandukaparni
also known as Bramhi promotes circulation to the peripheral tissues as well as
the brain therefore known as 'Medhya
Rasayana' (Brain Tonic).Its action as a
Vayasthapana relates directly to the actions on the mind as it promotes memory
recall, concentration and reduces stress.
Its actions is circulation and blood vessel
health can also be associated with antiaging properties.
2. Centella asciatica Linn.Oxidative
stress, adaptogen, detoxifier nurvine tonic properties.xxii
Sthira-1.The energetic profile of the
herb suggests that it is a building
strengthening herb that nourishes the
kapha aspect of the doshas whilst its
heating virya guards against the excess
formation of kledakakapha in the stomach. The herb is a nervine and cardiotonic effective in treating heart conditions
caused by mental stress such as heart
palpitation.
2. Desmodium gangeticumDC. nervine and
cardiotonic effective in treating heart conditions caused by mental stress.
Punarnava- 1.Punarnavaslaghu, ruksha
qualities with ushana virya counters the
qualities of ama toxins. It is an effective
rejuvenative of the urinary system which
promotes the functions of the kidney and
improves the regenerating capacity of the
nephrons (a functional unit of the kidneys).
2. Boerhhavia diffusa Linn used as immunomodulator, adaptogen, anti-stress, anti
inflammatory.xxiii
All of these dravyas having capability to
stable the process ageing and protect body
from ageing disorders before time. If a per-

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son takes these herbal drugs regularly, become youth for longer time, so these dravyas
are known as Rasayana. Others may call it
as one which provides more than 100 years
of healthy life. (Dalhana Su. Su.1). in present day Jara is coming in early age in
people. This is a result of Dhatukshaya. The
Vayasthapana drugs are used in prevent these early age symptoms. acharyacharaka considered Amlaki as the best vayasthapana
dravya.
DISCUSSION & CONCLUSION
Hence this present review on the
Vayasthapana mahakashaya dravya and its
potential uses WSR to Geriatric care provide information that all of these dravyas
having capability to stable the process ageing before time and protect body and protect
geriatic disorders in old age. In Ayurveda
these drugs are grouped as Vayasthapana
Drugs. The various types of Rasayana therapy are useful for specific as well as general
use of it. Both dravyabhuta and adravyabhuta form of rasayanas are important for promote general well being and in specific conditions relating to geriatrics. If a person
takes these herbal drugs regularly, become
youth for longer time, so these dravyas are
known as Rasayana. Others may call it as
one which provides more than 100 years of
healthy life. (Dalhana Su. Su.1). Acharya
charaka considered Amlaki as the best
vayasthapana dravya. Modern research also
covered a lot of pharmacological screening
of most of these rasayana and vayasthapana
herbs. The possible mechanisms by which
action of Rasayana can be interpreted with
modern aspects are as follows Immunomodulatory action - Prevents recurrent in-

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care

fection, expelling the damaged cells .Adaptogenic action - Maintains the balance between mind and body. Anti aging actionEncourages the growth of new cells.

shurutaSamhita,
PurvardhaSutra
sthan
ch.24,Verse 8, page 130,reprint year 2011;
Chaukhambha Sanskrit Sansthan,Varanasi.
ix

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Ritu Rajoriya Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In Geriatric Care


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425-435
xxii

H nur hidayah,T.i rasyidaH Journal of


medical and bio-engineering vol.4 no.4 august 2015
xxiii
Krishna murti, Mayank A.panchal International journal of pharmaceutical science
review and research vol.5, issue2, nov.dec.2010.

CORRESPONDING AUTHOR:
Dr. Ritu Rajoriya, P.G. Scholar,
Dept. of P.G. Studies in DravyaGuna,
National Institute of Ayurveda,
Amer road Joravar Singh gate,
Jaipur, Rajasthan, India, 302002

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

CONCEPTUAL STUDY OF PRANAVAHA STROTAS WITH REFERENCE TO


MODERN ANATOMY
Dr. Budruk Pramod Appasaheb
M.D. Sharir Rachana, L.L.B.(spl), Principal- Hon.Shri. Annasaheb Dange Ayurved
Medical College, Ashta. Tal- Walwa, Dist- Sangli.
strotas, but for clarification and underABSTRACT
Sharir Rachana is basic subject of medical science. Hence concepts of Sharir should be cleared.
Ayurveda gives various ideas of sharir, which should be explained on the modern basis. Strotas
is one of Ayurvedic terminology & basic thing of Ayurveda, but it should be cleared to
ayurvedic students. Charak had explained strotas as medicinal view while sushrut had explained
strotas according to surgical aspect. Pranavaha strotas is first & important strotas, which carry
pran all over body. By studying this strotas mulasthana, vidha laxanas & vahana, also by
studying concern reference regarding prahvaha strotas, respiration, etc. idea of this strotas is
explained, how it is related to respiratory system & internal & external respiration is elaborated
in this article. It will be helpful to ayurvedic students to clear ideas regarding strotas as well as
pranvaha strotas.How Pranavaha strotas related to heart,lungs and other structures like
pulmonary artery and pulmonary vein is elaborated in this article.
KEY WORDS: pranavaha strotas, prana, respiration, strotas, lungs, oxygen
INTRODUCTION
Sharir Rachana and Sharir Kriya are two
sides of coin. These two departments are
now different made by ccim but should
work hand to hand. Ayurveda never given
separate Sharir Rachana or Anatomy and
Physiology or Sharir Kriya. Anatomy is
well mentioned with physiology, pathology,
surgery or medicine.We must to know basic
things or anatomical concepts.Now in globalization world these concepts should be
clear on the modern basis.Strotas is one of
the major anatomical concept of Ayurveda.
It is said that stroto aium purusha that
means human body is made up of so many

standing various functions of strotas are


mentioned by Sushrut and Charak. Charak

gives 14 numbers of strotas while Sushrut


gives 11 numbers of strotas.First and most
important strotas given by both acharyas is
pranavaha strotas. It is very important
hence we must know details of this strotas
in relation with modern science. The concept of strotas is not detail mentioned by
ancient scholars hence I am elaborating this
concept of pranavaha strotas.
Charak first clears concept of strotas as ,
Yavant purushe murtimanto, Bhavavish-

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Dr. Budruk Pramod Appasaheb: Conceptual Study Of Pranavaha Strotas With Reference To Modern Anatomy

eshanto avasmin strotasam prakar vishesh


|1
Charak says that number of matters or
bhava present in the body, same number of
strotas present in the body, hence he says
that infinite number of strorasas present in
the body. These strotasas has individual
work according to separate bhavas, that is
which matter stored or conducted through it.
There are mainly 16 murtimant bhav present
in the body and these are prana, anna or
food, udak or water, rasadisapatdhatu, and
trimala and tridosha. Indivisual each bhav
suggest its own strotas. All these strotas
come together to form body. Charaka has
given example of cloth. If we seprate all fibers of the cloth then we cant say it as a
cloth but when all fibers are collectively arranged then it is said to be cloth, same way
separate strotas is not constitute body but all
strotasas collectively indicates body.
Strotavansi khalu parinam, Prapadhemananam dahtunam vahini, bhavatyayanarthena |2
This gives clear idea about strotas.Strotas
either create matter or transfer matter form
one place to another places
Tatre pranvaha strotasan, Hrudya mulam
mahastrotasam |3 Charak told that pranavah strotas has main mulasthan is hridaya
and secondary is mahastrotas. Chrak and
Sushrut both give first priority to pranavaha
strotas. sushrut gives clear idea regarding
prana, agnisomvayu satvarajatama, panchendriya bhutatmethi prana |4 He says that
agni, soma, vayu satwa,raja and tama and
also panchdnyanendriya are pranas because
due to these vital factors signs of aliveness is
seen. one more important definition is
pranaha vahantiti prana means: The
chaitnya or jivana giving matter is pran.The
vahan or transfer or conduction of this

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prana through all structures of the body is


called as pranvaha strotas.The factor which
gives life to body is called as prana. Oxygen is very important factor for life process
which is inhaled by respiration. And the
strotas which carry this prana is called as
pranvaha strotas and the system which supplies oxygen is called as respiratory system.
Nadya panthano margaha sharir chidrani |5
Charak has given various synonyms of
strotas that are sira,dhamani rasayani,
rasavahini, nadi, path, sharirchidrani, niket
but he mentioned important thing is nadi or
tube like structure, path or marg means special way for special matter,sharirchidrani
means vacuoles of body. These structures
are specially called as strotas.
MATERIALS AND METHODOLOGY
Respiratory system or mamilian airway is
formed by nose, nasal cavity, pharynx, larynx, trachea, bronchus, bronchioles and finally alveolar sac. This sack is surrounded
by capillaries and vessels.|6
As air inhaled through the upper airway filtered in the nose heated to body temperature
and fully saturated with water vapors, partial
recovery of this heat and moisture occurs on
expiration. Then air goes to glottis and glottis to trachea, major bronchus, secondary;
tertiary bronchioles and alveoli |7 The acinus is gas exchange unit of the lung and
comprises branching respiratory bronchioles
and clusters of alveoli here filtered moistures heated air makes close contact with
pulmonary capillaries and oxygen up take
and carbon dioxide excretion occurs the alveoli lined with flattened epithelial cells. |8
The gas exchange of oxygen and carbon dioxide are purely passive no ATP is consumed they depend on behavior of gases described in daltens law and henry law | 9

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Budruk Pramod Appasaheb: Conceptual Study Of Pranavaha Strotas With Reference To Modern Anatomy

Transport of gases between lungs and body


tissue is function of blood, when oxygen
enters the blood certain physical and chemical changes occurs that aids in gas transport
and exchange. |10
Oxygen does not dissolve easily in the water
therefore very little oxygen only 1.5 % is
carried in the dissolved state in water blood
plasma and remained oxygen 98.5% is
transported as chemical combination with
hemoglobin inside RBC. Each 100 ml oxygenated blood contains about 20 ml of oxygen and 0.3ml dissolved. |11 The change of
respiratory gases between lungs and blood
takes place by diffusion across alveolar and
capillary walls. Collectively the layer
through which the respiratory gases diffuse
are known as alveolar capillary membrane.
|12
The heart act as two separate pumps operating side by side . The right heart generate
circulation to lungs and left heart feeds rest
of body. The right atrium drains deoxygenated blood from superior and inferior vena
cava and discharges blood in to left atrium
and in to left ventricle through bicuspid
valve. 13
Tatra pranvahanam hrudayam mullam mahastrotasam pradustanam khavisheshmedh
Vishehsh bhavati charak |14
When this strotas is not working properly
then special signs and symptoms or seen
more expiration rate, vising sounds at the
time of resperation, painful breathing and
tightening of chest also seen. Sushrut commentrator Dhalan says that
Tatra vidhasaya kroshanavinaman mohan
bramhan vepenani maranam vaa bhavati |15
When this strotas hampers then following
symptoms are seen croshan means to cry,
winamana means bending forward, bramhana means vertigo, mohana means uncon-

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sciousness, vepenani means tremors of the


body and lastly death occurs.
DISCUSSION
As we seen that pranvaha strotas is first
strotas of the body. Srotas concept is based
on following four main qualities.
1. To produce specific bhava or matter that
means utpatti of bhav.
2. to transfer or to carry these bhava from
one place to another place means vahana
of these bhavas.
3. To secreat these specific bhava means
stravanath strothansi.
Specific root or marg of these bhava. Some
strotas has all four qualities but some has one
quality out of four the structure used for
above functions. These structures are like
ducts, tubules, blood vessels, capillaries,
organs and ashaya. Strotas is decided according to transfer of matter through it and it
is related to its mulsthana. charak and
sushriut gives there mulsthana according to
their function or storage of bhava or relay
center of bhava. Second mula is considered as
conducting system of these bhava. In case of
pranvaha strotas air entered from external
nares to pharynx, larynx, trachea and right
and left bronchus and then bronchioles and
finally to alveoli. This is the path of oxygen.
In this way external atmospheric oxygen is
reaches to lungs. In alveoli gas exchange
process of oxygen and carbon dioxide takes
place. This is purely passive process, hence
no ATP is consumed. Transport of gases
between lungs and body tissue is physical and
chemical process. The exchange of
respiratory gases takes place by diffusion
method across alveoli and capillary walls.
Oxygen does not dissolve easily in the water
therefore very little oxygen only 1.5 % is

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Budruk Pramod Appasaheb: Conceptual Study Of Pranavaha Strotas With Reference To Modern Anatomy

carried in the dissolved state in water blood


plasma. and remained oxygen 98.5% is
transported as chemical combination with
hemoglobin is transported in chemical
combination with hemoglobin inside RBC.
Each 100 ml oxygenated blood contains about
20 ml of oxygen and 0.3ml dissolved.
Hemoglobin consists of protein portion
called globins and an iron pigment called
heme. Each hemoglobin molecule has four
heme group can combined with one molecule of oxygen. Oxygen and hemoglobin
combine in an easily reversible reaction to
form oxyhemoglobin since 98.5%of oxygen
is bound to hemoglobin and trapped inside
RBC only 1.5 can diffuse out tissue capillaries into tissue cells.
When we think sharir rachana & sharir
kriya regarding pranavaha strotas. Ancient
scholar never given separate sharir rachana
& sharir kriya. Anatomy is well mentioned
in the ayurved. We must know basic concepts of the ayurveda. Now in globalization
world this concept of pranavaha strotas
must be proved on the modern basis. Strotoaium purusha Means body is made by so
many strotas . But for understanding these
strotas properly charak & sushrut mentioned special strotas, charaka has given 14
number of strotas while sushrut given11
number of strotas.
Pranavaha strotas starts from nose and supply oxygen to haemoglobin through alveoli.
This is clear path of pranavaha strotas, but
next to it gases exchange occurs with the
help of blood. This blood is firstly transferred to heart by pulmonary veins and
poured to left atrium. From left atrium
poured to left ventricles and all over body
through aorta, arterioles and capillaries.
Thus oxygen is supplied to every cell.

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Same time carbon dioxide is absorbed by


RBC. In each 100 ml of deoxygenated
blood7% of carbon dioxide is dissolved in
plasma 23% combines with hemoglobin as
carbonation and 70% is converted into bicarbonate ions. This carbon dioxide along
with hemoglobin travels through veins, vena
cava to right atrium of the heart. Then it is
poured into right ventricle. This deoxygenated blood then transferred to lungs by pulmonary arteries. Exchange of carbon dioxide
and oxygen occurs in alveoli by alveolar-capillary membrane,
Mainly carbon dioxide and oxygen exchange occurs in lungs and heart. Hence
Chrak As well As Susarut both mentioned
heart as a mulasthana, and path from nose to
alveoli, alveoli to left ventricle, then to all
body tissue and cells, body tissue to veins
and right ventricle of the heart includes in
the pranavahana dhamani. This gives clear
idea about pranavaha strotas.
CONCLUSION
Pranavaha strotas is impotant & main
strotas of the body. It consists from nose to
alveoli via external nares, nasal chambers,
pharynx, larynx, trachea, bronchus & bronchioles, which carry oxygen or carbon dioxide to lungs. From lungs these gases are
transported to heart by pulmonary veins.
From heart oxygen is supplied to all body
cells. Then gases exchange occurs in tissue
cell level. In this process heart plays very
important role so heart is mentioned as
mulsthana of the pranavaha strotas. The
gases path and exchange occurs nose to alveoli, alveoli to heart by pulmonary veins,
heart to all cells of body by arteries, all body
cells to again heart with the help of veins.
This total path includes in pranavahini
dhamanya.

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Budruk Pramod Appasaheb: Conceptual Study Of Pranavaha Strotas With Reference To Modern Anatomy

.There is very less amount of gases transported through plasma hence ancient scholars not clearly mentioned regarding vahana
of prana through artery and veins This includes respiration as well as pulmonary and
systemic circulation hence Charak might be
called as mahastrotasam, Thus Charak and
Susharut both described nicely and clearly
about pranavaha strotas.
REFERENCES
1. CharakSamhita-VdKashinathaPandya-Chaukhambha-BharatiAcademy-Gokul Bhavan, Gopal
Mandir Lane Varanasi 221001 reprint 2001 charak sutrasthana 5\3
page no.709
2. CharakSamhita-VdKashinathaPandya-Chaukhambha-BharatiAcademy-Gokul
Bhavan, Gopal Mandir Lane Varanasi 221001 reprint 2001 charak
sutrasthana 5\3-page no.709
3. Charak Samhita-Vd. Kashinatha
Pandya-Chaukhambha-BharatiAcademy-Gokul Bhavan, GopalMandir Lane Varanasi 221001 reprint 2001 charak sutrasthana 5\7
page no.710
4. Sushrut samhita sharirsthanam.Dr B.G. Ghanekar- Meharchand
Laghamchand Publication, New
Delhi -110002.Reprint -2006 Chapter 4\2 Page- 104 Charak SamhitaVd. Kashinatha PandyaChaukhambha-Bharati-Academy
5. Gokul Bhavan, GopalMandir Lane
Varanasi 221001 reprint 2001
charak vimansthana 5\9 page no
712.

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6. Greys anatomy f or studentsbyRichard L Drake, Wayne Vogl,


Adam W.M. Mitchell Elsevier
Churchil Philadelphia Edinburgh
London 2005 international edition
ISBN-0808923064 page no.-1249
7. Devidsons Principles and Practise of
Medicines. -By Nicholas Boom,
Nicki R. Colledge, and Brian
R.Walkar-Churchill
Livngestone
Elsevier-B.L. Catloguing Publication-20th edition print 2006. ISSN 9780443100574Page -650
8. Davidsons Principles and Practise of
Medicines. -By Nicholas Boom,
Nicki R.Colledge, and Brian
R.Walkar-Churchill
Livngestone
Elsevier-B.L. Catloguing Publication-20th edition print 2006. ISSN 9780443100574Page -650
9. Tortora Principles of Anatomy and
Physiology-By Gerard J. Tortora and
Sandra Reynold Grabowski-Harper
Collins College Publishers-Eighth
Edition-1996-ISBN-0-673-99355-8
Page-729
10. Tortora Principles of Anatomy and
Physiology-By Gerard J. Tortora and
Sandra Reynold Grabowski-Harper
Collins College Publishers-Eighth
Edition-1996-ISBN-0-673-99355-8
Page-722
11. Tortora Principles of Anatomy and
Physiology-By Gerard J. Tortora and
Sandra Reynold Grabowski-Harper
Collins College Publishers-Eighth
Edition-1996-ISBN-0-673-99355-8
Page-732
12. Tortora Principles of Anatomy and
Physiology-By Gerard J. Tortora and
Sandra Reynold Grabowski-Harper
Collins College Publishers-Eighth

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Budruk Pramod Appasaheb: Conceptual Study Of Pranavaha Strotas With Reference To Modern Anatomy

Edition-1996-ISBN-0-673-99355-8
Page-722
13. Devidsons Principles and Practise of
Medicines. -By Nicholas Boom,
Nicki R. Colledge, and Brian
R.Walkar-Churchill
Livngestone
Elsevier-B.L. Catloguing Publication-20th edition print 2006. ISSN 9780443100574-page-522
14. CharakSamhita-VdKashinathaPandya-Chaukhambha
Bharati
Academy-Gokul
Bhavan,Gopal
Mandir Lane Varanasi 221001 reprint 2001 charak sutrasthana5\7
page no. 710
15. SusrutaSamhita of Susruta with Nibandhasangraha Commentary of
Shree
Dalhanacharya-by
Vd.YadavajiTrikamjiAcharya-Chaukhamba Sanskrit SansthanVaranashiGolghar 221001-Reprint 2009susrutasamhita sharer 9\12 Dalhana
tika-12 Page-386
CORRESPONDING AUTHOR
Dr. Budruk Pramod Appasaheb
M.D. Sharir Rachana, L.L.B.(spl)
Principal- Hon. Shri. Annasaheb
Dange Ayurved
Medical College, Ashta. Tal- Walwa,
Dist- Sangli.
E-mail: pramodbudruk@rediffmail.com
Mob No. - 9423284876

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

A CLINICAL TRIAL FOR EFFICACY OF ASHWAGANDHA EXTRACT IN


STRESS RELATED DISORDERS AND GENERAL INDEX OF QUALITY OF
LIFE
Dr.Shilpi* Prof.Y.K.Sharma**
*B.A.M.S. Delhi University, M.D.Kayachikitsa. R.G.G.P.G.Ayu.College,Paprola
**M.D. Ph.D.,Kayachikitsa, Principal cum Dean, R.G.G.P.G.Ayu.College,Paprol
ABSTRACT
The response of human body & mind is within brain and nervous system. During it becomes
intensely active leading to altered metabolic state. Hormones such as adrenaline are released
into circulation along with glucose from liver. Persistent stress can lead to various health
problems being associated with sustained disturbance of autonomic nervous system and poor
stress adaptation. In Ayurveda one of the answer for these stress related ailments is Rasayana chikitsa which means Rejuvenation therapy.Ashwagandha is one of the most
powerful medicinal plant and has been used for more than 3000 years.Ayurveda pharmacopeia considers it Rasayana and it has been found to be excellent adaptogenic natural product.It promotes sleep and normalise nervous drive, thereby restores vitality, strength, energy
and reduces feeling of tiredness and fatigue. The Present study conducted at R.G.G.A.P.G.H.,
Paprola, H.P. is based on clinical trial of ashwagandha extract(1000 mg/day) in form of a
capsule each containing 500 mg of drug. Total 30 patients were enrolled for present study.
The analysis of pre and post trial objective and subjective criteria establish anti stress potential of the drug.
Keywords: Ashwagandha, Rasayana, Stress disorders, Anxiety, Depression, Adaptogens
INTRODUCTION
In Modern Era there are various challenges
to health like stress leading to anxiety, depression, insomnia and related disorders.
The body & mind react to any stress factor
wherein brain and nervous system became
intensely active during stress and may lead
to altered metabolism. Hormones such as
adrenaline are released into system along
with glucose from Liver. Persistent stress
can lead to altered autonomic nervous
drive which is root cause of stress related
ailments.1Stress induced reduced immunity is also a common challenge. Reduction
of natural ability of immune system to attack intruding microorganisms, and toxins

causes increase susceptibility to infection


and serious illness. It is therefore important to strengthen the immune system
in patients under stress.2In Ayurveda one
of the answer for these problems is Rasayana chikitsa. Rasayana chikitsa
means Rejuvenation therapy .It is concerned with measures that relate to physical, social and spiritual harmony. Rasayana is an active step toward achieving
this.3Rasayana means the physical,mental
and spiritual assistance to the human body
which brings the body out of condition of
natural or man made loss. Rasayan
chikitsa basically boosts the immune system. It helps a person to maintain good

How to cite this URL: Dr. Shilpi, A Clinical Trial For Efficacy of Ashwagandha Extract In Stress Related Disorders And
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Dr.Shilpi & Prof.Y.K.Sharma: A Clinical Trial For Efficacy Of Ashwagandha Extract In Stress Related Disorders And
General Index Of Quality Of Life

health or to establish impaired or lost


physical or mental health. It provides a
long disease free life to the person who
undergoes this therapy. It is supposed to
nourish blood , lymph, flesh, adipose tissue and semen and thus prevent degenerative changes and illness,giving freedom
from chronic degenerative disorders like
arthritis and senile diseases. Rasayana
helps to improve metabolic processes
which results in best possible biotransformation and provide the best quality of
body tissues, metabolism and delays diseases of old age.4Ashwagandha literally
means To impart the strength of horse is
also known as Indian Gigseng or Indian
Winter cherry. It is extensively used in
Ayurveda as Rasayana. It is used as general tonic, adaptogen thereby helping body
adapt to stress. Ashwagandha has been
shown to possess antioxidant activity as
well as ability to support a healthy immune
system.5 It is one of the most powerful
medicinal plant and has been used for
more than 3000 years.It promotes sleep
and normalizes the nervous drives therby
restores vitality, strength, energy and reduce feeling of tiredness and fatigue. It is
used as Rasayana meaning that it acts as
an overall tonic for greater vitality
&longevity.Ashwagandha nourishes the
crucial mind body connection and pshyconeuro immune response. It helps coordinate the mind and senses as well,which is
essential for good quality sleep. It balances
the mind. This is essential for happiness in
face
of
mental
or
emotional
6
stress. Ashwagandha is also having tissue
building properties. It is also considered an
anti-aging herb due to its Rejuvenation and
longevity enhancer properties. It also act
as Anti-inflammatory and pain reducing
agent in Arthritis.It also enhances virility
and have aphrodisiac properties. It is also
well known for its powerful immune enhancing benefits.it is an effective brain
tonic.7 So Ashwagandha thus being Immunomodulatory,
Anti-stress,
Adaptogenic, Anti-oxidants, Anti-inflammatory,
Anti-arthritic, Cytoprotective, Cardioprotective, Sedative, Anti bacterial etc.This

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can be used for multiple therapeutic benefits in human body. Numerous studies
suggest Aswagandha can directly or indirectly prevent & treat a number of disease.
Present study was conducted to explore
evidence based therapeutic potential of
Ashwagandha extract in Management of
Stress related Disorders.
Aims & Objectives of Present Study
1. To evaluate the efficacy of Ashwagandha extract in management of Stress
related Disorders especially mood disorders.
2. To evaluate the safety of Drug
Material and Method: The study was
conducted in compliance with good clinical practice (GCP) guidelines and other
applicable regulations.
Study Subjects- A total of 20 subjects
were assessed with regard to eligibility for
inclusion in study in hospital wing of
Kayachikitsa,R.G.G.P.G.A.H.,
Paprola,
H.P.
Trial patients of either sex were selected
between age group of 20-60 years. Routine
blood examination was carried out in order
to rule out any other pathology and monitor normal values of blood during trial period. Trial Subjects were detailed about
nature of trial and informed consent was
obtained.
Inclusion criteria1. All the patients suffering from generalized weakness.
2. All the patients in age group of 20-60
years.
3. The patients having three or more features included in clinical study like
weight loss , numbness of hand and
feet, Wasting, Easy fatigability, Stage
1 Hypertension as per JNC-7 parameters, disturbed sleep, Stress related
features like Anxiety, Depression etc.
4.Patients able to provide informed consent.
Exclusion criteria1. Patient not willing for trial.
2. Patient below age 20 and above age
60.
3. Patient with advanced chronic diseases.

IAMJ: Volume 4; Issue 04; March- 2016

Dr.Shilpi & Prof.Y.K.Sharma: A Clinical Trial For Efficacy Of Ashwagandha Extract In Stress Related Disorders And
General Index Of Quality Of Life

4. Alcohol and drug abuse.


5. Patient with acute disorders.
Period of clinical study:
Start date: December 2014
Completion date- March 2015
GROUPThe study was done in single trial group. It
was open trial with voluntary participation
of subjects.
Statistical method usedt-test (IBM
SPSS STATISTICS 20)
Study, Visits and AssessmentThe subjects visited the hospital at
screening and enrollment and after 30 days
of trial period.
Routine investigations were done at the
time of enrollment and necessary investigations done at the time of completion of
trial.
The efficacy of Ashwagandha as Rasayana was evaluated by special proforma
for assessment & evaluation which include
grading for General feeling of wellbeing,
Fatigue, Weight gain, Sleep, Digestion,
Grip Power, Foot Thrust, QOL Questionnaire, VAS etc. improvement categorized
as GOOD, MODERATE & MILD.
RESULTS & OBSERVATIONS20 Patients were registered and all turned
for follow up after 30 days.
As per assessment criteria out of 20 patients, 3 patients showed good improvement, 13 shows moderate Improvement
and 4 showed mild/no improvement. Statistical analysis shows all variables kept in
Assessment and Evaluation criteria have
significant
positive
improvement
(p<0.001).
Ashwagandha has shown to exert a greater
improvement in all QOL subdomains.
(Dimensions of Quality of Life in SF-36)
Marked improvement found in fatigue.
The patients of all ages and both the sex
groups reported improvement in their
complaints.
No side/adverse effect found in any patient.
Symptom wise details1.General feeling of wellbeing
Mean Score before treatment was 2.100
which fell to 0.7500 giving improvement

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of 64% which was highly significant with t


value of 12.33 and P<0.001
2.FatigueMean Score before treatment was 1.700
which fell to 0.400 giving improvement of
76.47% which was highly significant with
t value of 10.17 and P<0.001
3.Appetite
Mean Score before treatment was 2.100
which fell to 0.8500 giving improvement
of 64% which was highly significant with t
value of 8.753 and P<0.001
4.Weight gainMean Score before treatment was 3.000
which fell to 1.6500 giving improvement
of 45% which was highly significant with t
value of 10.283 and P<0.001
5.Ability to workMean Score before treatment was 1.900
which fell to 0.600 giving improvement of
68.42% which was highly significant with
t value of 10.177 and P<0.001
6.Digestion
Mean Score before treatment was 1.300
which fell to 0.6500 giving improvement
of 50% which was highly significant with t
value of 5.940 and P<0.001
7.SleepMean Score before treatment was 0.9500
which fell to 0.200 giving a improvement
of 78.94% which was highly significant
with t value of 7.550 and P<0.001
8.The QOL questionnaire( Dimensions
of Quality of Life in SF-36) was used to
evaluate a given subjects quality of life. It
comprised 8 items which measures the
broad domains ;physical & psychological
health. The Procedure entails each question being read out to the subject, along
with response option. Ashwagandha has
shown to improve all domains of the QOL
questionnaire.
9.VAS (Visual analogue scale ) . Patients
were asked to explain their sense of wellbeing in percentage. Improvement was
found in all patients.
10.Grip powerIt was checked with the help of cuff of
mercury sphygmomanometer. Mean Score
before treatment was 109.5 which increases to 127.65 giving a improvement of

IAMJ: Volume 4; Issue 04; March- 2016

Dr.Shilpi & Prof.Y.K.Sharma: A Clinical Trial For Efficacy Of Ashwagandha Extract In Stress Related Disorders And
General Index Of Quality Of Life

14.93 % which was highly significant with


t value of 6.0422 and P<0.001.
11.Foot thrustMeasured with the help of weighing machine. Score before treatment was 35.5
which increases to 38.8 giving a improvement of 9.19% which was highly significant with t value of 9.864 and P<0.001.
12.Blood InvestigationsAll routine investigations were done before trial to exclude pathology and only
required investigations done after trial.

Hb- Mean Score before treatment


was 11.01 which increases to 11.97 giving
a improvement of 2.5% with t value of 0.766 and P= 0.456

FBS- Mean Score before treatment


was 86.33 which increases to 97.91 giving
a improvement of 1.3% with t value of 0.906 and P= 0.384,not significant
The data of study shows significant improvement(p<0.001) Except Hb and FBS.
The present study was limited by small
sample size. Further study with a larger
sample validate the finding of this study.

Table no 1
S.NO SYMPTOM

%DIFF S.D.

S.E.

64.00

0.4893

0.1094

12.337

<0.001

76.47
59.52
45.00
68.42
50.00
78.94
2.5
1.3
14.93
9.19

0.5712
0.6386
0.5870
0.5710
0.4890
0.9934
1.4829
44.29
12.11
1.481

0.5712
0.1428
0.1312
0.1277
0.1094
0.5420
0.382
12.78
2.7091
0.331

10.177
8.753
10.283
10.177
5.940
7.550
-0.766
-0.906
6.0422
9.864

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.456
0.384
<0.001
<0.001

2
3
4
5
6
7
8
9.
10.
11.

MEAN
BT
AT
General feeling 2.100 0.750
of wellbeing
fatigue
1.700 0.400
Appetite
2.100 0.850
Weight gain
3.000 1.650
Ability to work 1.900 0.600
Digestion
1.300 0.650
Sleep
0.950 0.200
Haemoglobin
11.01 11.97
FBS
86.33 97.91
Grip power
109.5 127.65
Foot thrust
35.5 38.8

DISCUSSION
Stress is reaction to a stimulus that disturbs
our physical or mental equilibrium.6Inappropriately handled stress can
be devastating. It lowers our resistance and
make us more vulnerable to illness and
disease1. Hypertension, Diabetes mellitus,
Coronary Artery Disease, Tuberculosis are
common health problems. Reduced Immunity is a common challenge. Reduction
in immunity fail to check natural intruding
microorganism, and toxin causing increased susceptibility to infection and serious illness. It is therefore important to
strengthen the immune system. Similarly
aging is important part of all human society reflecting cultural and society conventions. It is a progressive change related to
passage of time.7 Ayurveda is concerned
with measures to protect Ayu(age)
which includes healthy living along with

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therapeutic measures that relates to physical ,mental ,social and spiritual harmony.
Ayurveda sees a strong connection between the mind and body. The objective of
Ayurveda is to accomplish the physical,mental,social &spiritual well being by
way of adopting preventive approaches as
well as to treat the disease with holistic
approach.8
Ashwagandha is also having Immunomodulatory activity. It also enchances virility and has aphrodisiac properties. It is
also well known for its powerful Immune
enchancing benefits.Ashwagandha is also
used in certain ailments like digestive disorders,general
debility,
rheumatism
,Tuberculosis, Diabetes mellitus, Insomnia
in certain stressful situation ,cough etc. It
is also an effective brain tonic9.
Study from university of Leipzig in Germany has shown that it inhibits Acetyl-

IAMJ: Volume 4; Issue 04; March- 2016

Dr.Shilpi & Prof.Y.K.Sharma: A Clinical Trial For Efficacy Of Ashwagandha Extract In Stress Related Disorders And
General Index Of Quality Of Life

cholinesterase(AchE) an enzyme responsible for breaking down of Acetylcholine.


Ashwagandha is used to treat mental deficit in geriatric patients, including amnesia10
. Antioxidant reseachers from B.H.U.in
Varanasi have discovered that some of
chemicals with in this compounds for their
effects on rat brain andfound on increase
in level of 3 natural anti-oxidants
ie.superoxide dismutase,catalase and glutathione peroxidase. These findings are
consistent with therapeutic use of Somnifera as an Ayurvedic Rasayana.
A study done in Department of pharmacology (2000).Univ.of Texas health sciences indicated that extract of Ashwagandha has GABA like activity. This may account for this herbs anti-anxiety effect.
Study by Pathania Sanjeev et.al 2005 , at
R.G.G.P.G.A.H.34 patients were registered and given Ashwagandha churna
5gm bd with milk in chronic ailments like
Tuberculosis, Diabetes Mellitus, Reumatoid Arthritis . Results were highly significant.11
Similar study by Hemraj et.al.2007, at
R.G.G.P.G.A.H.,38 patients were registered out of which 32 patients completed
trial.This includes 16 patients of Pulmonary Tuberculosis and 16 Patients of Diabetes mellitus who completed trial. Each
group was given Ashwagandha churna
5gm BD with milk. There were highly significant results in general feeling of well
being,fatigue, ability of work ,sleep, cough
,fever expectoration,tingling sensation and
ESR.12
Another study which was done in Dept.of
Zoology Kurukshetra India and Univ.of
Texas Health Sciences indicated that extract of Ashwagandha on copper induced
lipid peroxidation (a cause of ageing process) and has antioxidant enzymes in aging
.It was concluded that Ashwagandha might
have role in delaying aging and copper
induced physiological and pathogical condition .
Ashwagandha improves bodys ability to
maintain physical effort and helps body to
adopt to various types of stresses.It acts to

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calm the mind & promote sound and restful sleep.It works as adoptogen ,promoting
bodys ability to maintain homoeostasis
and resist stress.Ashwagandha also has
sedative effect,which calm the fuelled
anxiety that accompanies stressful life
style.Ashwagandha has often been used to
meet primary anxiety states.13.
No side/adverse effect found in any patient.
CONCLUSION
Findings of this study suggest that Ashwagandha is effective as rasayana as it improves quality of life. Aahwagandha is
also having antistress property, antioxidant
action, antianxiety action. It acts as immunomodulator and is useful in chronic
fatigue syndrome. It helps in delaying aging. It is cognition enhancer and memory
improving. It possesses hemopoietic effect, adaptogenic action, nutritive fuction
and neuroprotective action.
No side/adverse effect found in any patient
which shows drug is safe for use.
REFERENCES
1. Stoudemire A: Epidemiology of
anxiety in medical patients
2. google.com /health problems
3. google.com/rasayanachikitsa
4. Bhattacharya S.K.2000
5. Davis
L,Kuttan
G
s.Immumnomodulatory activity of
Ashwagandha
6. www.pshycologytoday.com/basics/st
ress
7. googlee.com/healthproblems
8. google.com/rasayanachikitsa
9. Ahmad M,Saleem S et.al Neuroprotective Effects of Ashwagandha
Mar.Chem.Pharma Bull Tokyo 2005.
10. Research of University of Leipzig,
Germany
11. Sanjeev sharma ; Z: To evaluate the
efficacy of Ashwagandha as Rasayana in chronic ailments like Tuberculosis,Diabetes
Mellitus,Reumatoid Arthritis.Thesis2005
P.G.Dept. of Kayachikitsa.

IAMJ: Volume 4; Issue 04; March- 2016

Dr.Shilpi & Prof.Y.K.Sharma: A Clinical Trial For Efficacy Of Ashwagandha Extract In Stress Related Disorders And
General Index Of Quality Of Life

12. Hemraj et al.2007august


13. Study of antistress effects of Ashwagandha by Archana R.Singh Deptt.of
physiology Institute of Basic Medical
Sciences Taramani India.
Dr. Shilpi
B.A.M.S. Delhi University, M.D.
Kayachikitsa.R.G.G.P.G.Ayu.College,
Paprola
Email: singhshilpi731@gmail.com

712

Source of support: Nil


Conflict of interest: None Declared

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IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

EFFECT OF CHINCHADI LEHA IN PANDU - AN OBSERVATIONAL STUDY


Dewmol M. J. **Byresh A.**
* PG Scholar ** Professor, Dept.,of PG Studies in Kayachikitsa, SKAMCH&RC, Vijayanagar,
Bangalore.
ABSTRACT
Pandu is a Rasa Pradoshaja Vikara in which Pandutwa is the main feature1. Samanya roopa of
Pandu include Raktalpata, Alpa Medaska, Nissara, Shithilendriya and Vaivarya2. Pandu is considered as anaemia. In modern prevalence around 30% of the total world population is anaemic
and half of these, some 600 million people have iron deficiency3.
The present study was undertaken to evaluate the effect of Chinchadi Leha in Pandu Roga. 20
diagnosed case of Pandu in age group between 21-60 years were selected for the study. Chinchadi leha was given for 30 days at the dose of 6 gm once daily. Detailed research proforma was
prepared to record the observation which were graded as per their severity. The results obtained
after the clinical study were analysed statistically. Overall assessment of the therapy was done
based on the significance of the statistical test values in subjective and objective parameters. The
study revealed that Chinchadi Leha was effective in relieving the clinical features of Pandu.
Keyword: Pandu, Anaemia, Chinchadi leha, Takra.
INTRODUCTION
Pandu, is a Varnopalakshitha Vyadhi in
which Pandutwa is the Prathyatma Lakshana. This disease characterized by Alaparaktata (Panduta) of body, Alpamedaska
(Balahani), Nissara (Ojokshaya), Shitilindrya (Arohanayasa), which strikingly resembles with Anaemia of modern science.
Pandu occurs due to improper functioning
of Rasa leading to malnourishment of body
and deterioration of other Dhatus like Rakta,
Mamsa, Meda etc. Basically Pandu Roga is
Pitta Pradha Tridoshaja Vyadhi but according to Dosha predominance it is of
Vataja, Piitaja, Kaphaja & Sannipathaja.
Mrudbhakshana is a visista vyadhi karana,
forms another variety of Pandu Roga.

Chinchadi Leha explained in sahasrayoga is


said to be Pandu Nashaka. This study was
conducted to evaluate the effect of Chinchadi Leha in patients suffering from
Pandu.
Aims & Objectives of the study:
To evaluate the effect of Chinchadi Leha in
Pandu Roga.
Materials and Methods
20 patients fulfilling the inclusion criteria
were selected irrespective of sex, occupation, religion, economic status from OPD &
IPD of Sri Kalabyraveshwara swamy Ayurvedic Medical College, Hospital & Research
Centre, Vijayanagar, Bangalore. Informed
Consent (IC) was obtained from all patients
enrolled for the study.

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Dewmol M. J. & Byresh A.: Effect Of Chinchadi Leha In Pandu - An Observational Study

Diagnostic criteria:
Pandu associated with any other
Patient suffering with lakshanas of
systemic disorder interfering with the
pandu roga.
treatment.
Haemoglobin per-cent 7 to 12g/dl.
Pregnant and lactating women.
Criteria for assessment:
Inclusion criteria:
The assessment was done on the basis of
Patients presenting with Lakshanas of
changes in subjective and objective paramPandu Roga.
eters (see Table No. 1) before and after
Haemoglobin 7 to 12gm %.
treatment. The obtained results were ana Patient of either sex aged between 18-60
lyzed statistically.
years
Exclusion criteria:
Table No.1 Subjective & objective parameters
Sl. No.
SUBJECTIVE PARAMETERS
1
Panduta
2
Dourbalya
3
Shirashoola
4
Bhrama
5
Arohana ayasa
6
Pindikodwestana
7
Gatrashoola
OBJECTIVE PARAMETER
8
Heamoglobin percentage
Intervention:
The selected patients were administered
Chinchadi Leha in the dose of 6 gms after
breakfast with Takra as Anupana for a period of 30 days.
Drug review
Chinchadi Leha consists of Purana Chincha
5 Pala, Purana Guda 10 Pala, Loha
Bhasma and Mandoora Bhasma 2 Pala each
respectively, Bilwa, Vidanga, Triphala,
Triooushana,
Trijata,
Yasti,
Rasna,
Jathiphala and Jathidala, Chavya, Sweta
Jeeraka and Krishna Jeeraka each drug
pala respectively. It is indicated in Pandu,
Kamala, Trishna, Swasa Vigandya, Ajeerna,
Jwara, Vatanulomana.
Observation

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Among 20 patients, 50% belonged to age


group of 31-40 years, 40% were house
wives, 65% had Katu Rasa Pradhana
Ahara, 50% indulged in Viruddhashana and
65% had Vishamashana. 70% indulged in
Vegadharana among which 50% patient had
Mootra Vegadharana. 55% and 60% indulged in Divaswapna and Ratri Jagarana
respectively. 90% had addiction to coffee/tea.
In the study it was observed that 20 (100%)
patients were having Alpa Rakta, Twak
Panduta, Shweta Akshi, Dourbalya, Brama,
Pindikodweshtana, Arohana Ayasa, Gatra
Shola, Kopanatva, Shirashoola & Ojakshya,
18 (90%) patients were having Hrid Drava,
Hata Prabha, shirna loma, 17 (85%) Shweta
Nakha, 15 (75%) patients were having Hat-

IAMJ: Volume 4; Issue 04; March- 2016

Dewmol M. J. & Byresh A.: Effect Of Chinchadi Leha In Pandu - An Observational Study

anala and Annadwesha, Anidra, 14 (70%)


patients were having Dhatu Shithilatha,
sadana and Tandra, 13 (65%) were having
Kati, Uru, Pada Shoola, chanchalatva respectively 12 (60%) patients were having
Shrama, Aruchi, 11 (55%) patients were
having Shweta Vaktra and Karna Kshweda,
10 (50%) were having Shishiradweshi, 9
Table No. 2 Effect of therapy.
PARAMETERS
MEAN
SD (BT(BT-AT) AT)
Panduta
1.15
0.489
Dourbalya
1.3
0.470
Shirashoola
1.35
0.47697
Pindikodwestana
1.25
0.433
Bhrama
1.1
0.435
Arohana Ayasa
1.2
0.509
Gatrashoola
1.6
0.663
Haemoglobin
per- 1.3
0.695
centage
HS Highly Significant
DISCUSSION
During the 30day study, it was observed that
symptoms like Gatra Shola and Dourbalya
got reduced within 2 weeks. The next
symptom to respond was Pindikodwestana,
Shirashoola within three weeks. The remaining symptoms reduced gradually by the
end of treatment. A maximum of 2.7 % increase in heamoglobin was observed in the
study.
Chinchadi Leha is Tridoshashamaka, Agnivardhaka, Ruchya, Pandu Nashana. Drugs
like Yasti, Hareetaki, Amalaki, Pippali,
Vidanga along with iron preparation is having Rasayana property. Drugs like Maricha,
Shunti, Jathi, Purana Chincha, Jeeraka,
Bilwa, Pippali, Chavika, Vidanga are having
Deepana property improves Agni there by
helping in Abyavaharana Sakti and Jarana

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(45%)
were having Alpa Medaska,
Gourava, Vibanda, 8 (40%) Admana, Suptata, 6 (30%) were having Akshikoota Shopha, Shteevana, 4 (20%) were having
Shithila Indriya, Jwara, Alpa Vak, 3 (15%)
were having Atyartava and 2 (10%) were
having Anartava.

SE(BTAT)
0.109
0.105
0.1067
0.096
0.097
0.114
0.148
0.155

T
VALUE
10.504
12.359
12.651
12.903
11.280
10.519
10.782
8.352

PVALUE
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001

REMARK
HS
HS
HS
HS
HS
HS
HS
HS

Sakti. Purana Chincha is Madhura Rasa and


high potent in antioxidant activity and a
good supplier of aminoacids-serine, betaalaine, proline for better metabolic activity
and also having Shola Hara property. Drugs
used like Tejopatra, Chincha, Chavika,
Rasna, Ela, Jathiphala, Bilwa, Maricha,
Pippali, Jeeraka, Shunti are Kaphavatahara.
and Hareethaki, Amalaki, Yasti are
Tridoshashamaka. Chincha is having Shola
Prashamana property. Most of the drugs are
having Raktavardhana property. Loha
Bhasma and Mandoora Bhasma are good
source of iron.
Takra is Tridoshashamaka, Agnideepana,
Pachana and Vatahara. Takra is also having
pandughna & srotoshodaka property. It
helps in proper absorption of Aahara as well
as Oushadha and help in formation of Rasadi Dhatu. Buttermilk is rich in Vitamin C

IAMJ: Volume 4; Issue 04; March- 2016

Dewmol M. J. & Byresh A.: Effect Of Chinchadi Leha In Pandu - An Observational Study

and Calcium. Vitamin C increases the absorption of non-haem iron by two to three
times. There is a dose-related effect; the
more Vitamin C in a meal, the greater the
iron absorption. Chincha is also a good supplement of vitamin C along with Takra will
potentiate the effect of absorbtion of iron
and helps in Pandu Nashana.
CONCLUSION
1. Chinchadi Leha in the dose of 6 gms once
daily for a period of 30 days proved effective in relieving all symptoms of Pandu.
2. The overall effect of treatment has shown
statistically highly significant i.e., p value
<0.001 in all subjective and objective parameters.
3. The palatability and single dose was acceptable by patients which enhanced amenability by patients to the drug regimen.

Press,
Kollam, 9th edition - 1967,
pp: 652, pg: 387.

CORRESPONDING AUTHOR
Dr. Dewmol M. J
PG Scholar Dept.,of PG Studies in
Kayachikitsa, SKAMCH&RC, Vijayanagar,
Bangalore. dewpinto@gmail.com

Source of support: Nil


Conflict of interest: None Declared

REFERENCE
1. Agnivesa, Charaka Samhita, Ayurveda
Dipika commentary of Chakrapanidatta,
edited by Vaidya Jadavaji Trikamji
Acharya, Chaukhambha Prakashan,
Varanasi, reprint - 2011, Sutra Sthana,
28thchapter, verse: 10, pp: 738, pg: 179.
2. Agnivesa, Charaka Samhita, Ayurveda
Dipika commentary of Chakrapanidatta,
edited by Vaidya Jadavaji Trikamji
Acharya,
Chaukhamba
Prakashan
,Varanasi, reprint 2011, chikitsa
Sthana, 16thchapter, verse: 6, pp: 738,
pg: 526.
3. Colledge Nicki.R, Walker Brian.r,
Ralston Stuart.H, Davidsons Principles
and Practice of Medicine,Churchill
LivingStone- Elsevier, 21st edition2010, 24th chapter, pp: 1360, pg: 1017.
4. Velaayudhakuruppu
Kollurveettil
Vaidya, Sahasrayoga, Sri Rama vilasam

#$&

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IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

EFFECT OF YOGA THERAPY ON COGNITIVE AND AFFECTIVE DOMAINS


AMONG SCHOOL GOING CHILDREN: A RANDOMIZED CONTROLLED
TRIAL
Meena Thakur*1, MC Shobhana2 , Pankaj Kumar3
1
PG Scholar, 2 Professor and Head, Department of Swasthavritta, VPSV Ayurveda College
Kottakkal, Kerala, 3PG Scholar, Department of Kayachikitsa, NIA, Jaipur

ABSTRACT
During the transition of children into adults, many of them get afflicted with behavioural
disorders which signals the alterations in affective domain along with disruption of
cognitive domain. Yoga is evolving as effective therapy for behavioural modifications which
can be used for improving cognitive and affective potentials of the children. Objectives: To
study the effect of Yoga therapy on cognitive and affective domains among school going
children. Methods: Sixty school going children aged 13 to 15 years were selected from local
schools and randomized into yoga group and wait list control group. Study group practised
the given yoga module one hour daily in morning for two months while control group did
not receive any intervention during this period. Cognitive domain was assessed on five tests
taken from NIMHANS neuropsychological battery for children manual and Affective
domain was assessed by Positive and Negative Affect Scale for Children (PANASC).Results: Attention, visual memory, comprehension and auditory verbal learning showed
significant improvement at p<0.001. At PANAS-C, Positive affect and Positivity ratio
improved at p<0.001 and p<0.01 respectively. Discussion: Significant difference between
two groups on cognitive and affective test indicates the improved awareness and perceptive
abilities in cognitive domain along with enhanced mental attitude in overcoming usual
stressors and increase in positive attitude of affective domain. Conclusion: Yoga therapy is
effective in improving cognitive capacities and affective abilities among school going
children.
Keywords: School going Children, behaviour, Yoga, Cognitive, Affective
INTRODUCTION
Transformation is a dynamic process which
brings marked changes in the nature of an
object. In case of humans, the most marked
change is transformation of children into
adults. Abrupt changes occur at physical,
physiological, psychological, psychosocial
and cognitive domains. Because of rapid

ongoing changes, children are not able to


handle many situations which make them
vulnerable
to
psychological
and
behavioural disorders. It is reported that
about 15% of adolescents have depressed
mood and by the age of 18, 5% suffers
clinical depression1. Most of the
epidemiological surveys on school going

How to cite this URL: Dr Meena Thakur, Effect Of Yoga Therapy On Cognitive And Affective Domains Among
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Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

children and adolescents have reported a


(20-33%) variation in the prevalence of
psychological problems with individual
studies illustrating between 10-40%2. Daily
newspapers report many of the abnormal
tendencies of adolescents such as
committing suicide, drug abusing, stealing,
rape, murder etc. which exhibit their mental
instability. This hampers their potentials to
achieve the academic goals and is the most
essential need to be dealt. Yoga can provide
students a means to handle stress3. Yoga
influences the emotional state4 and
improves adjustment among stressed and
disadvantaged youth by improving selfregulatory capacities5. Emotional stability
empowers the abilities of mind and result in
productive outcome. A study shows that
school children practicing yoga for 10 days
improved spatial memory scores6, strategic
planning7 and the ability to concentrate8 .
In various studies cognitive and affective
aspects have been studied in different
perspectives among different population.
So a broad view of benefits of yoga has
been evolved. Through this study we intend
to see whether yoga can improve both
cognitive
and
affective
domains
simultaneously among the most vulnerable
and needy population of school going
children.
Methods
Selection of participants: The inclusion
criteria were (i) those who were interested
to practice yoga (ii) those who were willing
to give written consent signed up by their
parents. Exclusion criteria were (i) having
Assessment Criteria: Cognitive tests were
taken from NIMHANS Neuropsychological battery for children manual (Kar et al.,
2004)9. Attention was assessed by color
cancellation test, color trail test part A &
B, language by expressive speech test,
short term memory by visuo spatial

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any systemic illness (ii) any physical


disability or congenital deformity (iii)
having any treatment for psychiatric illness.
Two schools from kottakkal panchayat
were selected by lottery method from which
initially 157 students were registered as per
the interest, with 103 satisfying the
eligibility criteria and among them 60 were
selected and allocated into two equal
groups by random number table method
(Figure 1).
Study group: Before starting intervention,
pre assessment was taken on 0 day. Then
study group practised yoga module 5 days
at school and 2 days at home per week in
the first month (0 30 day); all days at
home in second month (31 60 days) and
daily assessment charts were given to their
parents to ensure the adherence of practising yoga module. On 61st day, post assessment was taken again.
Control group: Other group was kept as
wait list control during the study period.
After completion of the study, interested
and willing participants of control group
were also given yoga intervention in order
to fulfil their right for receiving intervention.
Drop outs: The criteria of drop outs were
discontinuation of practice of yoga module
for more than 15 days in the period of total
60 days.
The study was approved by institutional
ethics committee of Vaidyaratnam P.S
Varier Ayurveda College Kottakkal as
Proceedings No: IEC/CI/22/13 dated 2204-2013.
memory span task, comprehension by token
test and learning by reys auditory verbal
learning test. Affective domain was
assessed by Positive and Negative Affect
Scale for Children (PANAS-C) by Laurent
& colleagues, 199910

IAMJ: Volume 4; Issue 04; March- 2016

Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

Figure 1 Trail profile for the RCT

Enrolment

Assessed for eligibility (n=157)

Excluded (n=54)
Parents not willing to give
written consent

n=103

Randomization &
Allocation

Allocated to study group


(n=30)

Analysed (n=30)

Allocated to control group


(n=30)

Analysis

Analysed (n=30)

(After Intervention)
Compared

Intervention
Table No 1. Selected Yoga Package
Skama vyyma
(10 minutes)
san (20 minutes)
1. Ardhakaticakra san
2. Ardhacakrasan
3. Vrikhasan
4. Dhanursan
5. Suryanamaskra

Pryma (10 minutes)


1. Kplbhati
2. N huddhi
3. Ujjay
4. Bhrmari

Meditation (Transcendental - 10 minutes)


Relaxation (avsan -10 minutes)
Data analysis: Data was checked, analysed
within the groups. Unpaired t test was
and presented with the help of tables and
used to check the difference between the
graphs. Levenes test was used to check the
groups after intervention. Statistical
comparability of two groups. Paired t test
analysis was done by using Microsoft office
was used to assess effect of intervention
2007 Excel.
RESULTS
Table No 2. Baseline characteristics of the subjects

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Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

Groups

Yoga

Wait list control

Age in years
Age range
Gender ratio (B:G)
Socio economic status
Average height
Average weight
Average BMI (Kg/m2)
Average SBP
Average DBP
Sleep disturbance
Irregular bowels

13.66 0.66
13 15
17:13
Lower middle
148.6 7.04
42.6 9.26
19.14 3.05
109 5.03
73.73 6.90
1
1

13.86 0.77
13 -15
15:15
Lower middle
147.5 9.10
41.43 6.64
19.01 2.45
111.93 4.65
74.73 5.90
0
0

B = boys; G = girls; SBP = Systolic blood pressure; DBP = Diastolic blood pressure
Table No. 3 Effect of therapy on Cognitive domain
Tests
Pre
Post
Paired t Unpaired t
Mean (SD)
Mean (SD)
CCT(time taken in sec)
S 89.03 (12.61) 68.1 (12.59)
8.72*** 4.31***
C 86.2 (13.7)
95.4 (10.8)
-8.03***
CTTA (time taken in sec)
S 170.73(66.02) 130.56.61)
6.01**
-8.16***
C 154.33(43.03) 190.76(57.75) -5.46***
CTTB (time taken in sec)
S 251.93(90.35) 185.66(70.51) 8.38*** -8.84***
C 216.36(70.05) 247.94(65.96) -4.06***
VSWMS
S 3.9 (0.84)
4.6 (0.71)
-6.18*** 4.11***
C 4.03 (0.66)
3.5 (0.82)
3.56**
Token test(TT)
S 29.33 (3.58)
33.5 (2.58)
13.75*** 8.74***
C 30.3 (2.29)
29.46 (1.79)
0.86
RAVLT(total scores)
S 85.8 (16.76)
99.16 (15.87) -8.22*** 7.25***
C 77.9 (17.01)
73.93 (15.78 2.17*
Table No. 4 Effect of therapy on Affective domain
PANAS-C
Pre
Post
Paired t Unpaired
t
Mean (SD)
Mean (SD)
Positive affect
S 46.06 (5.28)
50.26 (5.22)
-3.81***
4.93***
50.83 (5.35)
47.7 (6.1)
3.14**
C
Positivity ratio
S 1.28 (0.19)
1.59 (0.33)
-5.49***
3.18**
1.58 (0.37)
1.61 (0.41)
-0.43
C
Abbreviations: S = Study group, C =
Control group, CCT Color cancellation
test, CTTA Color trail test A, CTTB

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Color trail test B, EST Expressive speech


test, VSWMS Visuo spatial working
memory span task, TT Token test,

IAMJ: Volume 4; Issue 04; March- 2016

Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

RAVLT Reys auditory verbal learning


test, PANAS-C = Positive and negative
affect scale for children
Few components of the cognitive and affective domain did not showed significant
difference between two groups. CTTA &
CTTB (commissions) on color trail test,
object naming and category naming on expressive speech test and negative affect on
PANAS-C did not showed significant improvement in study group. Rest all other
parameters of the two domains showed
significant improvement in study group at
varied levels of significance.
DISCUSSION
Discussion on main outcome measures:
The scores on Color cancellation test
(CCT) for number of commissions, omissions and time taken showed a significant
improvement in study group as compared to
control group which suggests that study
group had increased their potentials of
sustaining/maintaining attention.
On Color trail test A & B (CTTA &
CTTB), scores for number of omissions
and time taken for task completion had
shown significant improvement in the study
group. These results were similar to the
study by Galigi Sripad et al. 200611, who
found that vedic chanting group had
significantly reduced the total errors and
time taken on cancellation task as compared
to non chanting group after yoga practice.
Intensive meditation training has also been
claimed
to
improved
perceptual
discrimination and sustained attention 12,
which was one of the component of yoga
module. Both the sustained and focused
attention had shown significant improvement which is suggestive of increased
threshold levels of perception and awareness. This could be explained on the basis
of load theory of attention that explains

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two mechanisms. First is Perceptual selection mechanism according to which


when there is high perceptual load then
perceptual capacity only receives the relevant stimuli and perception of irrelevant
stimuli or distracters is reduced. Second is
cognitive control mechanism which says
that when perceptual load is low at other
times, then all relevant and irrelevant
stimuli are perceived but as long as cognitive control mechanisms are available the
current priorities are maintained and this
reduces interference from perceived distracters. Both these mechanisms explain the
same situations that an individual has to
overcome during yoga practice.
On Expressive speech test (EST) Out of
six subcomponents, four had shown significant improvement in mean case difference after intervention. The positive change
indicates increased levels of confidence and
self esteem which might have helped
students for fluent expression of their
language and ability to express them. A
study by Radhakrishna et al. 2010 13 shows
that after 20 months of yoga practice there
was significant improvement on receptive
language
skills,
imitation
skills,
communication and language on children
with autism spectrum disorders. This suggests yoga improve the expression of language by building confidence or by some
unknown mechanisms. The scores of study
group on the three tests Visuo spatial
working memory span task (VSWMS),
Token test (TT), Reys auditory verbal
learning test (RAVLT) were improved at
same level of significance (p<0.001). Significant increased scores of these test
among study group suggests high alertness,
awareness, ability to concentrate and
improved short term memory, learning/grasping ability and improved ability to
comprehend. These results also substantiate

IAMJ: Volume 4; Issue 04; March- 2016

Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

some findings of previous research works.


A study by Manjunath NK14 shows that
yoga practice improves delayed recall of
spatial information. Left nostril breathing
has also been shown to improve verbal
spatial scores in a study by Meesha Joshi
and Shirley Telles15. Although there are no
direct studies on yoga evidencing its effect
on comprehension but it is very important
aspect to be analysed. Working memory has
been directly related to comprehension16 so
any intervention that affects working
memory will also affect comprehension
which has been reflected in this study also.
Another study shows that daily yoga
sessions for a period of one month
improved immediate and delayed recall on
RAVLT scores17 which has been substantiated in this study also. On the PANAS-C,
Positive affect and positivity ratio has been
improved significantly. These results were
similar to a study conducted by Narasimhan
L et al. 18 where affective well being have
shown beneficial role on positive emotions
and in cognitive processing and the harmful
role on negative emotions on coping stress
and health status. Also, a study by Dubey
SN.2011, found improvement in some
psychological variables among adolescents
after yoga practice 19.
CONCLUSION
The present study shows a significant effect
of yoga therapy on cognitive and affective
domains of school going children.
REFERENCES
1. Birmaher B, Ryan ND, Williamson DE.
Childhood and adolescent depression:
review of past 10 years. Child adolescent
psychiatry 1996;35:1427-39.
2. Jellinek MS, Murphy JM, Robinson J,
Feins A, Lamb S, Fenton T. Pediatric
symptom checklist: Screening school

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age children for psychosocial dysfunction.J Pediatr 1988;112: 201-9.


3. Janowiak, John J. Theoretical foundations of yoga meditation: a contribution
to self actualization and stress management.ERIC 1993;1-22. ED364786.
4. Berger DL, Silver EJ, Stein RE: Effects
of yoga on inner-city childrens wellbeing: a pilot study. Altern Ther Health
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5. Mendelson T, Greenberg MT, Dariotis
JK, Gould LF, Rhoades BL, Leaf PJ:
Feasibility and preliminary outcomes of
a school-based mindfulness intervention
for urban youth. J Abnorm Child Psychol 2010;38:985994.
6. Naveen KV, Nagarathna R, Nagendra
HR, Telles S: Yoga breathing through a
particular nostril increases spatial
memory scores without lateralized effects. Psychol Rep 1997; 81:555561
7. Manjunath NK, Telles S: Improved performance in the tower of London test
following yoga. Indian J Physiol Pharmacol 2001;45:351354
8. Telles S, Hanumanthaiah B, Nagarathna
R, Nagendra HR: Improvement in static
motor performance following yogic
training of school children. Percept Mot
Skills 1993; 76:12641266.
9. Kar, Bhoomika R. NIMHANS Neuropsychological Battery for Children:
Manual. Bangalore, India: National Institute of Mental Health and Neurosciences, 2004.
10.Laurent Jeff, Catanzaro, Salvatore J,
Joiner Jr, Thomas E, Rudolph, Karen D,
Potter, Kirsten I, Lambert Sharon, Osborne Lori, Gathright, Tamara. A
measure for positive and negative affect
for children: Scale development and
preliminary validation. Psychological
assessment. 1999; 11(3): 326-338.

IAMJ: Volume 4; Issue 04; March- 2016

Meena Thakur Et; All: Effect Of Yoga Therapy On Cognitive And Affective Domains Among School Going Children: A
Randomized Controlled Trial

11.Ghaligi Sripad, Nagendra HR, Bhatt


Ramachandra. Effect of vedic chanting
on memory and sustained attention. Indian journal of traditional knowledge
2006; 5(2): 177-180.
12.MacLean KA, Ferrer E, Aichele SR,
Bridwell DA, Zanseco AP, et al. Intensive meditation improves perceptual
discrimination and sustained attention.
Psychological Science 2010; 21(6): 829839.
13.Radhakrishna S, Nagarathna R, Nagendra HR. Integrated approach to yoga
therapy and autism spectrum disorders.
Journal of Ayurveda and Integrative
Medicine 2010; 1(2): 120-124.
14.NK Manjunath, Telles S. Spatial and
verbal memory test scores following
yoga and fine arts camps for school
children. Indian J Physiol Pharmacol
2004; 48(3): 353356.
15.Joshi M, Telles S. Immediate effects of
right and left nostril breathing on verbal
spatial scores. Indian J Physiol Pharmacol 2008; 52(2): 197200.
16.Sandra VL, Martin B, Walter JP, Susanne MJ. Working memory training
improves reading process in typically
developing children. Child Neuropsychology 2012; 18(1): 62-78.
17.Hariprasad VR, Koparde V, Sivakumar
PT, et al. Randomized clinical trial of
yoga-based intervention in residents
from elderly homes: Effects on cognitive
function.Indian Journal of Psychiatry
2013; 55(3): S357-S363.
18.Narasimhan L, Nagarathna R, Nagendra
H. Effect of integrated yogic practices on
positive and negative emotions in
healthy adults. International Journal of
Yoga 2011; 4(1): 13-19.
19.Dubey SN. Impact of Yogic Practices on
some Psychological Variables among

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adolescents.
Indian
Journal
of
Community Psychology 2011; 7(1): 1-7.
CORRESPONDING AUTHOR
Dr. Meena Thakur
VPSV Ayurveda College Kottakkal,
Kerala,
Email- dr.meenuthakur@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal

ISSN:2320 5091

A COMPARATIVE STUDY ON EFFICACY OF GOMUTRA HARITIKI


AND VRIKSHAMLA(EXTRACT) IN THE MANAGEMENT OF STHAULYA.
W.S.R. TO OVERWEIGHT
1
Pankaj Kumar* , Meena Thakur2, Jai Prakash Singh3, Ajay Kumar Sahu4

1.

2.

P.G. Scholar, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur


P.G. Scholar, Department of Swasthavritta, VPSV Ayurveda College Kottakkal, Kerala
3.
Lecturer, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur
4.
Lecturer, P.G Department of Kayachikitsa, National Institute of Ayurveda, Jaipur

ABSTRACT
Sthaulya is abnormal and excess accumulation of Meda Dhatu. In contemporary medical
science it is compared with obesity and it is defined as excess body and visceral fat that poses
health risk. As we see the Samprapti of Sthaulya, due to Meda-Dhatwagni Mandya there is
excessive accumulation of Meda that leads to obstruction of Medovaha Strotasa. Due to this,
there is Vimargagamana of Vata Dosha. The Vimargaga Vayu in Koshta ultimately increases
the Jatharagni leading to an increase in appetite. This cycle goes on and on. This study was
taken by looking at the present statistics of the incidence and prevalence of Obesity. In
present study 30 patients were randomly selected and divided into two groups of 15 patients
each. Gomutra Haritiki and Vrikshamla(extract) were given to Group I and Group II
respectively for 60 days. After the completion of trial comparative efficacy and safety profile
of both the formulations were assessed on different subjective and objective parameters.
Result and Discussion revealed that both Gomutra Haritiki and Vrikshamla(extract) were
quite effective in relieving both subjective and objective parameters after the course of 60
days.
Keywords: Sthaulya, Meda Dhatu, Obesity, Gomutra Haritiki, Vrikshamla

INTRODUCTION
Previously, the stigma of infectious
diseases was the most common concern of
the health sector, especially in the
developing nation like India.
But
gradually with advancements in the
medical health sciences, such infectious
diseases are now more or less well under
human control. More recently, there had
been a major shift in the thrust area of
medical concern from the infectious to
non-infectious
diseases
or
noncommunicable diseases1. Very rightly,
such
non-infectious
diseases
are,
otherwise, known as the lifestyle
diseases as their causation has been very

well studied and associated with the


change in the lifestyle including the diet
and activities2. Obesity is one among such
lifestyle diseases, which has been
identified to be posing a major threat in the
community in the recent years. Obesity is
a leading preventable cause of death
worldwide, with an increasing prevalence
in adults and children, and authorities view
it as one of the most serious public health
hazard of 21st century. Its like a sword
hanging over ones head tied in a weak
thread which can strike at any time and
create numerous difficulties and boundless
miseries. Excess weight brings in
increased mortality and morbidity. Among

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(Extract) In The Management Of Sthaulya. W.S.R. To Overweight. International Ayurvedic medical Journal {online}
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Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

Vrikshamla(Extract) In The

Indian population 75% of women and


purusha4. It is one among the
3
58% of male are obese . Obesity is a state
santarpanotta vikara5.
in which there is generalized accumulation
Many new researches and new efforts are
of excess fat in the body leading to
being carried out in the path of solution for
increased body weight in excess of 20% of
Sthaulya. An attempt has been made in the
desired weight for age and height. Obesity
present study to compare the efficacy and
is no longer a problem in developed nasafety profile of Gomutra Haritiki6 and
tions. Obesity is stigmatized in many of
Vrikshamla in the management of
the modern world (particularly in Western
Sthaulya.
world) though it was widely perceived as a
AIMS AND OBJECTIVE
symbol of wealth and fertility at other
1. To evaluate the efficacy of Gomutra
times in history and is in some parts of the
Haritiki and Vrikshamla(extract) in
world. People are getting fatter everywhere
Sthaulya(obesity) w.s.r. Overweight
in almost all the parts of the world. There
2. To compare clinical efficacy of Gomutra
are various reasons for more and more
Haritiki with Vrikshamla(Extract).
people getting fatter by each day.
MATERIALS & METHODS:
Obesity is the cause of various diseases
1. Selection of Cases: The study was
particularly heart disease, diabetes,
conducted on 30 clinically diagnosed
breathing difficulties during sleep, certain
patients of Sthaulya(Obesity) w.s.r.
type of cancer and osteoarthritis.
Overweight. The selection of patients was
Acharya Charaka has quoted Sthaulya
made from OPD/IPD of Arogyashala,
under the eight varieties of impediments
National Institute of Ayurveda, Jaipur
which are designated as Astha ninditha
(Raj.).
2. Eligibility Criteria:
Inclusion Criteria:
Exclusion Criteria:
Diagnosed and confirmed cases of Patients suffering from diseases like nephrotic
Sthaulya on the basis of clinical exami- syndrome, hypothyroidism, jaundice, hepatitis,
nation.
chronic infections and other serious diseases.
Age group 20-60 years of either sex.
Age below 20 years and above 60 years.
BMI in between 25 to 29.9.
BMI below 25 or over 29.9
Patients willing to sign the consent Obesity due to secondary reason such as drug
form.
induced or hormonal imbalance.
3. Selection of Drugs: In the pathology of
Group A - 15 patients were administered
Sthaulya, Kapha is main Dosha and Meda
Gomutra Haritiki in dose of 5gm twice in
is main Dushya, while Agnimandya takes
a day before meal with Madhu for 60days.
place at Medodhatvagni level. So, that type
Group B - 15 patients were administered
of drug therapy should be selected which
Vrikshamla (extract) 3 cap (500mg) twice
have Kapha and Medohara property and
a day before meal with lukewarm water for
have efficacy to correct the function of
60days.
Medodhatvagnimandya.
So
many
5. Routine Examination and Assesspreparations have been mentioned in our
ment: texts for the treatment of Medodhatu
The full details of history and physical
Vridhi. But keeping in mind easy
examination of patients will be recorded as
availability, compatibility, cost and
per
the
proforma.
Clinical
and
preparation of drugs Gomutra Haritiki and
physiological assessment were done on 0th
Vrikshamla were preffered over others for
day, 15th day, 30th day, 45th day & 60th day.
present study.
6. Pathyapathya:- Patients were advised to
4. Administration of Drug: 30 clinically
follow Pathyapathya as mentioned in
diagnosed patients were randomly divided
Ayurvedic classics during the trial period.
into 2 Groups of 15 each as below:

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IAMJ: Volume 4; Issue 04; March- 2016

Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

Vrikshamla(Extract) In The

1. PARAMETERS OF EVALUATION:
1) Subjective parameters: For subjective
The effect of trial drug will be assessed in
parameters following symptoms will be
terms of Subjective, Anthropometry and
assessed:Laboratory parameters.
Kshudha aadhikya (excessive hunger)
A. Subjective parameters: - All the -Pipasa aadhikya (excessive thirst)
patients were registered for clinical trial -Kshudra swasa (Breathlessness on
and were looked for any changes in their
exertion )
clinical manifestations. Symptom rating Sweda aadhikya (excessive sweating)
scale was used for assessment of -Atinidra (excessive sleep)
subjective parameters like Atiksudha, -Dourbalya (weakness)
Atipipasa, Daurgandhya, Swedadhikya, -Gaurava (Heaviness of body)
Daurbalya,
Nidradhikya, -Alasya (letharginess)
Krichchavyavayta,
Gaurava, -Angasada (sluggishness of body )
Kshudraswasa and Angasada before and
-Kricchavyavayata(difficulty in sexual
after the treatment. Clinical trial was
intercourse)
conducted by making a special research
proforma.
All the above symptomatic assessment will be done by using Symptom Rating Scale as
following:
Symptoms:
Score:
0
Absent
1
Mild (Irregular)
2
Mild (Regular)
3
Moderate
4
Severe

ASSESSMENT OF SUBJECTIVE PARAMETERS

Assessment of Kshudha aadhikya (Excessive hunger)


0 becomes hungry after about 6hrs
1 becomes hungry after about 4-5 hrs
2 becomes hungry after about 3hrs
3 becomes hungry after about 2-3hrs
4 becomes hungry after about 2hrs
Assessment of Pipasa aadhikya (Excessive thirst)
0
Drinks about 8-10 glass of water daily
1
Drinks about 10-15 glass of water daily
2Drinks about 15-20 glass of water daily
3Drinks about 20-25 glass of water daily
4
unable to have a sound sleep for his thirst
Assessment of Kshudra shwasa (Breathlessness)
0
No shortness of breath
1

Mild dyspnoea after physical exertion relieved on rest

2
Moderate dyspnoea after physical exertion
3
Dyspnoea even after daily routine
4
Breathless even at rest
Assessment of Swedaadhikya (Exceesive sweating )
0
Normal perspiration
1
Mild perspiration after doing exertion

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Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

01234
01234-

01234-

B.

Increased perspiration after doing little exertion

Profuse perspiration after doing little exertion

Vrikshamla(Extract) In The

4
Perspiration without exertion
Assessment of Atinidra(Excessive sleep)
0
6-8 hrs/day sleep
1
8-10hrs/day sleep
2
10-12 hrs/day sleep
3
12-14 hrs/day sleep
4
- >14 hrs/day sleep
Assessment of Daurbalya (General debility)
0
Feeling of well being
1
Tired after doing strenuous physical activity
2
- Tired after doing moderate physical activity but can do daily activity
3
Perform daily activity with difficulty
4
Extremely tired to carry out daily routine activity
Assessment of Gaurava (Heavyness of the body)
0
No feeling of heaviness.
1
Occasional feeling of heaviness.
2
- Continuous feeling of heaviness, but patient does usual work.
3
Continuous feeling of heaviness which hampers usual work.
4
Unable to do any work due to heaviness.
Following measurements were done;
Assessment of Alasya (Letharginess)
Weight, BMI and Waist Hip Ratio.
Normally active.
Hesitate to start work but once started C. Laboratory Parameters: Following
complete it.
investigations were done to assess the
Start work but does not complete it.
changes of different regimes: Doesnt have desire, works under Routine Blood Investigation
compulsion.
-Hemoglobin%
Doesnt start work.
-Total Leukocyte Count
Assessment of Angasada (Sluggishness -Differential Leukocyte Count
of the body)
-Erythrocyte Sedimentation Rate
Absent
Renal Function Test
Occasional Angasada
Liver Function Test
Continuous Angasada but not interfere any Lipid profile
activity
Total cholesterol
Continuous Angasada and sometimes Sr.Triglyserides
interfere daily activity
Sr.LDL
Continuous Angasada which hamper daily

Sr.HDL
activity and confined patient to complete
Sr.VLDL
rest.
D. Results:- Results were presented
Assessment of Krichchavyavayata (loss
into three steps:of libido)
a) Effect of Therapy on Subjective
Absent
Parameters.
mild loss of libido
b) Effect of Therapy on Objective
moderate loss of libido
Parameters.
severe loss of libido
c) Effect of Therapy on Laboratory
complete loss of libido
Parameters.
Anthropometry Parameters: -

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Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

E. Statistical Analysis:-

Vrikshamla(Extract) In The

b) Paired t test within group comparison


c) Unpaired t test between group
comparisons

a) Unpaired t test baseline data


comparison
SUBJECTIVE PARAMETERS
Table1. Showing the pattern of clinical recovery in 15 patients of Sthaulya (Obesity)
treated with Gomutra Haritki i.e. Group I (pairedt test)
Signs & symp- Mean
Mean
differ- Relief
t
p
toms
enceSD
in %
stat
value
BT SD
AT SD
Kshudhaadhikya
1.8 0.77
1.2 0.67
0.6 0.73
33.33
3.15 <0.01
Pipasa
2.13 0.63
1.53 0.63 0.6 0.63
28.16
3.67 <0.01
Daurbalya
0.93 0.79
0.6 0.73
0.33 0.48
35.48
2.64 <0.05
Swedaadhikya
1.26 0.74
0.86 0.51 0.4 0.63
31.74
2.44 <0.05
Atinidra
1 0.75
0.73 0.7
0.26 0.45
26
2.25 <0.05
Kshudraswasa
0.86 0.63
0.6 0.63
0.26 0.45
30.23
2.25 <0.05
Angasada
1.06 0.7
0.66 0.72 0.4 0.63
37.73
2.44 <0.05
Krichhavyavaya
0.26 0.45
0.13 0.35 0.13 0.35
50
1.46 >0.05
Gaurav
1.13 0.63
0.8 0.67
0.8 0.67
29.2
2.64 <0.05
Aalsyata
1.2 0.67
0.86 0.74 0.86 0.74
27.5
2.64 <0.05
Table2. Showing the pattern of clinical recovery in 15 patients of Sthaulya (Obesity)
treated with Vrikshamla i.e. Group 2 (paired test)
Signs & symp- Mean
Mean differ- Relief
t
p
toms
ence
SD
in
%
stat
value
BT SD
AT SD
Kshudhaadhikya
1.8 0.77
1.13 0.74 0.66 0.61
36.6
4.18 <0.01
Pipasa
2.26 0.59
1.4 0.63
0.86 0.35
38.05
4.53 <0.001
Daurbalya
0.93 0.79
0.46 0.51 0.46 0.51
49.4
3.5
<0.01
Swedaadhikya
1.33 0.81
0.86 0.74 0.46 0.51
34.5
3.5
<0.01
Atinidra
1 0.75
0.66 0.61 0.33 0.48
33
2.64 <0.05
Kshudraswasa
0.86 0.74
0.46 0.51 0.4 0.5
46.51
3.05 <0.01
Angasada
1.06 0.7
0.6 0.5
0.46 0.51
43.39
3.5
<0.01
Krichhavyavaya
0.26 0.45
0.13 0.35 0.13 0.35
50
1.56 >0.05
Gaurav
1.13 0.6
0.6 0.5
0.53 0.51
46.9
4
<0.01
Aalsyata
1.4 0.73
0.8 0.67
0.6 0.5
42.8
4.58 <0.001
Table3. Inter group comparison of subjective parameters (unpairedt test)
Subjective parameters
Mean difference
t stat
p value
Group 1
Group 2
Kshudhaadhikya
0.6
0.66
0.26
>0.05
Pipasa
0.6
0.86
1.42
>0.05
Daurbalya
0.33
0.46
0.72
>0.05
Swedaadhikya
0.4
0.46
0.31
>0.05
Atinidra
0.26
0.33
0.38
>0.05
Kshudraswasa
0.26
0.4
0.75
>0.05
Angasada
0.4
0.33
0.32
>0.05
Krichhavyavaya
0.13
0.13
0
>0.05
Gaurav
0.33
0.53
1.09
>0.05
Aalsyata
0.33
0.6
1.46
>0.05
2. OBJECTIVE PARAMETERS

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IAMJ: Volume 4; Issue 04; March- 2016

Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

Vrikshamla(Extract) In The

Table4. Showing the pattern of objective parameters in 15 patients of Sthaulya (Obesity)


treated with Gomutra Haritki in Group I (pairedt test)
Signs & symptoms Mean
Mean differ- Relie t
p
enceSD
f in stat
value
BT SD
AT SD
%
Haemoglobin
12.7 1.45
12.72 1.48
0.240.38
1.88 4.36 <0.001
ESR
26.4 14.8
25.26 13.49 1.137.87
4.28 0.31 >0.05
Total Cholesterol
193.0617.69 182.218.75 10.912.06
5.66 3.4
<0.01
Serum
158.2625.19 149.529.16 8.869.27
5.59 3.5
<0.01
Triglycerides
Serum HDL
50.61 5.89
50.745.81
0.131.55
0.25 1.58 >0.05
Serum LDL
96.88 23.76 89.7421.94 7.137.85
7.35 3.27 <0.01
Serum VLDL
33.94 9.6
30.488.51
3.355.52
9.87 2.09 >0.05
RF B.Urea
32.2 4.44
29.264.18
2.930.03
9.09 3.1
<0.01
T
Sr.Creatinin 0.85 0.1
0.760.14
0.080.13
9.41 11.8 <0.001
e
LF SGOT
29.6 7.06
27.934.26
1.664.25
5.6
1.06 >0.05
T
SGPT
30.06 8.77 28.738.41
1.333.55
4.42 0.9
>0.05
Al.Phos.
173.8650.56 161.1341.06 16.0624.92 9.23 2.49 <0.05
Table 5 Showing the pattern of objective parameters in 15 patients of Sthaulya
(Obesity)) treated with Vrikshamla in Group 2 (paired test)
Signs & symptoms
Mean
Mean
Relief t
p
diff.SD
in %
stat
value
BT SD
AT SD
Haemoglobin
12.761.67
12.791.76
0.240.4
1.88
4.27
<0.001
ESR
23.9315.51
20.1312.17
3.85.6
15.87 2.27
<0.05
Total Cholesterol
188.0630.94 174.4627.03 13.611.17 7.23
4.53
<0.001
Serum Triglycerides 158.4637.62 149.2634.02 9.25.65
5.8
5.95
<0.001
Serum HDL
53.136.88
50.866.9
2.533.6
4.76
1.8
>0.05
Serum LDL
94.1321.41
85.4622.43
8.667.03
9.2
4.94
<0.001
Serum VLDL
30.664.49
29.332.94
1.462.99
4.7
1.05
>0.05
RFT B.Urea
32.135.65
29.25.23
2.932.98
9.11
3.15
<0.01
Sr.Creatinine 0.830.13
0.780.094
0.0530.1
6.38
16.31 <0.001
LFT SGOT
29.266.02
284.92
1.533.48
5.22
0.64
>0.05
SGPT
27.86.1
274.92
1.461.92
5.25
0.5
>0.05
Al.Phosphate 165.9337.97 159.7334.67 6.210.64
3.73
2.07
>0.05
Table6. Inter group comparison of objective parameters (unpaired test)
Objective parameters
Haemoglobin
ESR
Total cholesterol
Serum triglycerides
Serum HDL
Serum LDL
Serum VLDL
Serum urea

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Mean difference
Group 1
Group 2
0.246
0.24
1.13
3.8
10.93
13.6
8.86
9.2
0.13
2.53
7.13
8.66
3.53
1.46
2.93
2.93
IAMJ: Volume 4; Issue 04; March- 2016

t stat

p value

0.045
1.06
0.628
0.11
2.36
0.56
1.16
0

>0.05
>0.05
>0.05
>0.05
>0.05
>0.05
>0.05
>0.05

Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

Vrikshamla(Extract) In The

Serum creatinine
0.086
0.053
0.75
>0.05
SGOT
1.66
1.53
0.093
>0.05
SGPT
1.33
1.46
0.12
>0.05
Alkaline phosphatase
16.06
6.2
1.409
>0.05
3.
ANTHROPOMETRIC PARAMETERSTable No.7.Showing the pattern of
physiological changes in 30 patients of Sthaulya(Obesity) among both Groups
Param- Groups
Mean
Mean dif- Relief t stat p
eters
ference
value
BT SD
AT SD
Body
Weight
BMI

Gp 1
72.68.77
70.568.31
2.031.74
2.79
3.39
<0.01
Gp 2
70 7.53
68.067.26
1.931.03
2.75
5.37
<0.001
Gp 1
27.80.9
27.041.18
0.750.66
2.69
1.49
>0.05
Gp 2
26.930.97
26.181.04
0.740.37
2.74
2.59
<0.05
WHR
Gp 1
0.990.03
0.950.05
0.0430.045 4.343 39.04
<0.001
Gp 2
1.0020.027 0.950.03
0.0420.02 4.19
68.01
<0.001
Table8. Inter group comparison of anthropometric parameters (unpairedt test)
Parameters
Mean difference
t stat
p value
Body
Group 1
2.03 1.74
0.19
>0.05
Weight
Group 2
1.93 1.03
BMI
Group 1
0.757 0.66
0.06
>0.05
Group 2
0.745 0.37
WHR
Group 1
0.043 0.045
0.04
>0.05
Group 2
0.042 0.02

DISCUSSION:
A. Probable Mode of Action of
Drugs: In Ayurveda, the action of drugs
is determined on pharmacodynamic factors
as Rasa, Guna, Veerya and Vipaka along
with certain specific properties called
Prabhava (Karma), which cannot be
explained on these principles inherited by
the drugs. These drugs in combination act
as antagonist to the main morbid factors
i.e. Dosha and Dushya to cause Samprapti
Vighatana to all of the symptoms of the
disease.

Gomutra Haritiki:
In Gomutra Haritiki the only constituents
are Gomutra and Haritiki. Gomutra has
Tikshana, Ushana and Laghu Guna, while
Haritiki has laghu and Ruksha Guna. Both
the constituents have predominance of
Vayu and Agni Mahabhuta. So by means
of such properties both drugs have a
negative impact on Kaphavridhi and
Medovridhi. Also Gomutra Haritiki have
Deepana, pachana properties which
stimulate Jathargani along with Dhatvagni

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as well as it digest Ama, clears Srotorodha.


Hence Amasanchya and Srotorodha are
the fundamental cause of Sthaulya, So
having such property of clearing
Amasanchaya and Srotorodha in Gomutra
Haritiki will lead to breakdown of
pathology
of
Sthaulya(Samprapti
vighatana).
Vrikshamla(Extract): The extract (water
based) of Vrikshamla fruits has Amla, Katu
and Madhura Rasa. It also has Laghu and
Ushna Guna with predominance of Vayu and
Agni Mahabhuta. The Deepana, Pachana and
Kapha-Medohara properties of Vrikshamla
are also mentioned in Ayurvedic literature.
Due to its Laghu and Ushana Guna it digest
the Amasanchaya and clears the Srotorodha.
It contains mainly Amla Rasa which has the
property of Agnideepana also predominance
of Vayu and Agni Mahabhuta makes it Laghu
Dravya having inherent tendency of
Agnisamdhukshana(Ch.Su.-5/6). So on the
basis of these factors it is quite acceptable
that Vrikshamla digest the Amasanchaya,
clears the Srotorodha and improves the status

IAMJ: Volume 4; Issue 04; March- 2016

Pankaj Kumar Et;All: A Comparative Study On Efficacy Of Gomutra Haritiki And


Management Of Sthaulya. W.S.R. To Overweight

of Jatharagni and Dhatvagni. Moreover


modern science has also shown interest in
Vrikshamla. Many studies have shown that
intake of HCA present in Kokam reduces
appetite, inhibits lipogenesis and reduces
body weight.
CONCLUSION
In the present research work on the basis
of facts, observations and result the whole
study can be concluded in following steps:
Gomutra Haritiki and Vrikshamla both
showed significant improvement in all the
subjective
parameters
except
Krichchvyavayta.
Gomutra Haritiki and Vrikshamla both
showed significant improvement in all the
anthropometric parameters like
Body
Weight, BMI and Waist Hip Ratio.
Gomutra Haritiki and Vrikshamla both
showed significant in all the considered
biochemical investigative parameters
except Sr. HDL.
No side effect were noticed in any of the
group which proves safety of Gomutra
Haritiki and Vrikshamla for internal use.

CORRESPONDING AUTHOR
Dr. Pankaj Kumar

P.G. Scholar, Dept. of P.G. Studies in


DravyaGuna, National Institute of
Ayurveda, Jaipur,Rajasthan
Email- chikitsitam@gmail.com

Source of support: Nil


Conflict of interest: None Declared

REFERENCES:
1. Saker Lance, et al. Globalizations and
infectious diseases: A review of the
linkages Special topics No.3.TDR,
Special Programme for Research and
Training in Tropical Diseases.WHO. 2004
2. K. Park.
Preventive and Social
Medicine. M/s Banarasidas Bhanot
Publishers, Jabalpur India. Edition
21st.2011; chap 6; pg 335.
3. http://en.wikipedia.org/wiki/anemia
4. Shashtri RD, Edi. Charak Samhita,
Chaukhamba Sanskrit orientalia.2008.
Sutra Sthan, Chap. 21/3
5. Shashtri RD, Edi. Charak Samhita,
Chaukhamba Sanskrit orientalia.2008.
Sutra Sthan, Chap. 23/6
6. Tripathi B, Edi. Astang Hridaya,
Chaukhamba Sanskrit orientalia.2011 Chi.
Sthan, Chap 8/55

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Vrikshamla(Extract) In The

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

AN AYURVEDIC ANALYSIS OF TWINNING PHENOMENON


EXPLORATION OF SOME UNRAVELLED AREAS OF HUMAN
REPRODUCTION
Meena Thakur*1, Dinesh KS2 , Pankaj Kumar3
1
PG Scholar, 2Assistant Professor, Department of Kaumarbhritya, VPSV Ayurveda College
Kottakkal, Kerala, 3PG Scholar, Department of Kayachikitsa, NIA, Jaipur
ABSTRACT
Twinning is a phenomenon which fascinates both medicos and non medicos. Twins are
miraculous creatures of nature and share unique relationship among them. But at the same
time multiple pregnancies are considered as high risk pregnancies associated with maternal
complications, perinatal morbidity and mortality. Twining is associated with wide range of
impacts on family, society and national economy. It burdens the economic productivity since
more frequently it is associated with congenital anomalies impairing the life of an individual.
Previous literature has found associations between twinning and its allied pathologies but
none of them has related the pathology behind twinning and several other congenital
anomalies. In ayurveda this phenomenon is regarded as highly pathological. To explore the
details about the phenomenon a pilot survey was conducted in a village of kerala (India)
having twinning frequency four times the national average. Survey reports are showing
substantiation of vata humour which is mainly of obstructive type. Maximum vitiation is
found for the two subtypes of vata governing the lower pelvic area which is 30% and 23.3%
respectively. By odds ratio, this is significant in twin mothers by 2.327 and 4.261.Odds for
all three humours is significant with Vata-1.714, Pitta-1.125, Kapha-1.536. Other parameters
are also substantiating previous studies. Analysis through ayurveda shows that twinning is
pathological and is maximum pertaining to the food and lifestyle pattern of twin mothers.
Key words: Twinning, Congenital Anomalies, Pathology, Ayurveda, Kodinji, Prakriti,
Doshas
INTRODUCTION
Twinning among humans is many
times considered as the boon resulting
from super fecundity of mothers. At the
same time multifetal gestations are coined
as high risk pregnancies because of
complications it produces in both mother
and fetus like prematurity, low birth

weight, pre-eclampsia, anaemia, PPH,


IUGR, congenital anomalies, neonatal
morbidity and high neonatal & infant
mortality. Multiple pregnancies are result
of complex interaction between a wide
range of genetic and environmental factors
including race/ethinicity1, geographical
distribution and climatic conditions2,

How to cite this URL: Dr. Meena Thakur, An Ayurvedic Analysis of Twinning Phenomenon Exploration of
Some Unrivalled Areas Of Human Reproduction. International Ayurvedic medical Journal {online} 2016 {cited
2016 April} Available from: http://www.iamj.in/posts/images/upload/731_738.pdf

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

maternal age3, parity4, food5, lifestyle6,


maternal height and weight7, smoking8,
alcohol9, use of contraceptives10, socio
economic
status11
and
other
12
epidemiological factors etc. The increase
in the trends of incidences has raised the
curiosity to explore the phenomenon as
high twinning rates points to the existence
of a great public health challenge with
increasing burden on family, society and
national economy. Maternal morbidity is
reported to be 7 fold greater in multiple
pregnancies than in singeltons13 and
perinatal mortality rates are reported to be
4 fold higher in twins (33.1/1000), six fold
in triplets (56.2/1000) than singletons
(7.4/1000) with cerebral palsy (CP) rates at
one year of age, 4 fold higher in children
of multiple births (5.9/1000) than
singletons (1.4/1000)13, 14. Till now
researchers have found various allied
morbidities associated with twining,
congenital anomalies being the prime one
but none of them has related the pathology
behind twinning and pathology behind
several other associated conditions. In the
current situation, an ayurvedic analysis to
such a phenomenon may be helpful to
explore the pathology of complex
unexplained interactions of factors
resulting to mysterious phenomenon. The
literature of ayurveda contains facts about
almost all spheres of life including some
epistemological understanding regarding
twinning and its allied pathologies. In this
regard, we conducted a prime pilot study at
a place reporting abnormally high
frequency of twinning. Kodinji, a small
village in Kerala (India) has more than 230
pairs of twins with no more than 2000
households (14,600 inhabitants) with
twinning rate of 5% 15. Such a high
frequency twinning (four fold as compared
to national average of 0.8%) is extremely

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striking although India has one of the


lowest twinning rates in the world which is
less than 9/100016. Till now no study has
been undertaken to explore this
phenomenon.
Aims and objectives
1. Elucidate the causation behind
twinning mechanism in terms of
ayurvedic etiopathogenesis so as to
frame
a
hypothesis
regarding
upcoming untoward health events
related to twinning.
2. Constitutional analysis for any
significant imbalance of body humours
particularly among the mothers of
twins as per ayurvedic principles of
body constitution(Prakriti).
Materials and methods: A survey was
conducted among kodinji population and
general population at the sites other than
kodinji. Survey was done using
questionnaire method and to find out the
strength of association between outcome
(twinning) and exposure (risk factors) odds
ratio was calculated. There were four
groups in the study each comprising of n
=10 (total nt =40). Group A (K+) and B
(K-) were exposed cases and non cases
while group C (O+) and D (O-) were non
exposed cases and non cases. Stratified
random sampling was done to select the
appropriate sample. As the village had 7
wards so two cases one with twin and
other with non twin were selected
randomly from each ward. The other three
cases of twins were special cases from the
families having triplets or where most of
siblings in 2nd generation (father, fathers
brothers & sisters) had parallel twins. In
general population twins and non twins
were selected from different panchayats.
Information was obtained on general
socio-demographic
habits,
personal
characteristics and personal habits,

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

gynaecological and obstetric history, food


Observations : Firstly we compared the
& lifestyle. The data were entered into an
all 4 groups together on a particular
ayurvedic questionnaire after informed
variable for any difference between kodinji
consent was obtained from the mothers.
group as compared to general population
Then mothers of both cases and controls in
group. If there is any positive association
both populations were interviewed as per
then kodinji women ( K+ & K-) were
the questionnaire. All data were entered
compared to find out whether kodinji twin
into Microsoft excel version 2007.
mothers (K+) differ significantly from
Association of risk factors under study was
kodinji non twin mothers (K-) for the same
to be assessed by applying chi-square test
variable. And lastly we compared only
but since sample size was small so chitwin mothers of both groups, kodinji twin
square was not accurate instead Fischers
mothers and twin mothers in general
exact test was done. To assess the
population (K+ & O+) for any significant
association between risk factors and
difference in the variable which might
outcome odds ratio (OR) and 95%
have been contributed by that particular
confidence interval of OR was calculated.
geographical area if any.
Fig. 1 Status of morbid doshas among kodinji people
35
%AGE OF DOSHAS AMONG
ALL FOUR v

30
25
20

%AGE OF DOSHAS AMONG


ALL FOUR p

15
10

%AGE OF DOSHAS AMONG


ALL FOUR k

5
0
K+

K-

O+

O-

Table 1: Association of morbid doshas with twinning (Odds ratio at 95% C.I)
Group
K+ & K-

Vata dosha
1.714 (0.8 3.2)

Pitta dosha
1.125 (0.4 2.9)

Kapha dosha
1.536 (0.7 3.2)

Fig2. Status of body constitution/prakriti among kodinji people


45%
40%
35%
30%
25%
20%
15%
10%
5%
0%

vata
pitta
kapha
K+

K-

O+

O-

AVERAGE % AGE PRAKRITI ASSESSMENT

Table2: Association of body constitution/prakriti with twinning (Odds ratio at 95% C.I)

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IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

Group
K+ & K-

Vata dosha
1.50 (0.2 8.8)

Pitta dosha
1.50 (0.2 0.8)

Kapha dosha
0.6667 (0.11 3.92)

Fig 3. Status of food in terms of Predominance of doshas among kodinji population


120
100
80
60

Vata aggravating

40

Pitta aggravating

20

Kapha aggravating

0
K+

K-

O+

O-

% age doshic predominant DIET

Table3: Food status in terms of doshas and its association with twinning (Odds ratio at
95% C.I)
Group 2
K+ & K-

0.642 (0.1 2.3)

DISCUSSION
High frequency twinning suggests
the vitiation of body humours in excessive
amount in a large number of people sharing
something in common on the basis of
seasonal, traditional (food and lifestyle),
geographical and cultural backgrounds,
indicating the disturbance and widespread
effects on human reproductive system. It is
a pathology pointing towards the deviation
of normal processes of the body due to
change in composition of body humours
which has resulted in disequilibrium of body
elements at subtle level. The complex
interaction between etiological factors in
terms of number of factors, the manner of
interaction and depth or bonding of
interaction at different levels governs this
pathology, which may not be the reason for
twining only but for the other associated
adverse outcomes of pregnancy also.
According to ayurveda twinning itself is
highly pathological. This is lined up as
chronic pathology which results as vitiation
of body humours sufficient enough to direct

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1.063 (0.4 2.3)

1.063 (0.4 2.3)

the ongoing pathogenesis resulting into


congenital abnormalities which may be
clinically conspicuous or not at the time of
birth. Ayurveda explains the theory of three
humours or Tridosha theory similar to the
one suggested by Hippocrates in his concept
of health and disease that matter is made up
of 4 elements- Earth, Air, Fire and Water
which were represented in body by 4
humours - Phlegm, Yellow bile, Blood and
Black bile 17. Similar body humours in
ayurveda
are
responsible
for
the
maintainence of healthy and diseased state
namely: Vata (which is related to locomotor
system, nervous system & all other
movement related principles of body), Pitta
(related to all type of metabolism which is
involved in transformation of molecules and
in conversion of various forms of energy),
Kapha (related to the dense part of body
composition which can be directly seen). Of
which physiology and pathology of
reproductive issues like twinning and
congenital anomalies is chiefly governed by
vitiation of vata humour21. Abnormalities of

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

seminal fluid or gametes, as well as vitiated


vata located in it are also believed to
produce congenital anomalies19.
These physiological principles called
humours governs the physiology of both
healthy and diseased condition in the body.
Vata humour is stated to be responsible for
twinning, ocular, spiral anomalies, still
births, dwarfism and other dysmorphic
congenital anomalies20 of which twinning
observation has substantiated this statement
among kodinji population. If this principle is
true, then we need to keep a constant
vigilance in such areas regarding congenital
issues as multiple births have been
associated with increased birth defects than
in singletons21.
In ayurveda, the status of these body
humours is chiefly dependent on two factors
internal & external. Among them former
factor is the body constitution/prakriti
(which is an inborn quality of an individual
and quality of this constitution is
exclusively attributed by the status of body
humours of both parents at the time of
conception and by maternal humours during
the course of pregnancy) and the later
factors are external agents like food &
environment
which
have
inevitable
influence in altering the natural state of
humours after birth. In our study, we
analysed the inherent constitution of those
population & the food items consumed
regularly which might have otherwise
contributed for the vitiation of humours. A
broad concept of prakriti in ayurveda is that
it is formed at the time of conception with
respect to predominance of one, two or all
three body humours/doshas22. Accordingly
such permutations and combinations (vatapitta, pitta-kapha, kapha-vata, or sama
prakriti ) can be seen in individuals. This
constitution is also influenced by further six
factors out of which two factors food &

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disorders were analysed for the current


status of imbalanced humours.
Generally, a vata body type is more
prone to get afflicted with nervous disorders
and disturbances in secretions regulatory
principles, pitta body type is prone to get
afflicted with increased metabolic disorders
and kapha body type to get obesogenic
disorders. In this study we found a contrast
of more vata disorders in kapha body
constitution which is a paradox. Ayurveda
has a beautiful answer for this situation.
This vata aggravation is generally caused in
2 ways- either independent vata aggravation
(IVA, where there is actual increase in its
quantity), or dependent aggravation23
(DVA, where aggravation is due to the
reduced space for accommodation of normal
amount of vata, which is secondary to the
increased quantity of other two humours).
As per this study, there is a DVA of vata
humour in kapha & pitta body type & this
can be substantiated by the nature of their
food i-e kapha and pitta affluent food items
(100% consumption of both pitta and kapha
predominant food items by kodinji twin and
non twin mothers).
So here, either IVA/DVA is
contributing to produce MZ twins while
aggravated pitta might have contributed for
DZ twining. These vata and pitta
pathologies are either inherent by
constitution/prakriti or might have been
acquired through food and daily activities of
living. Keeping this in mind, the status of
morbid doshas shows that the mothers of
twins at kodinji (K+) are suffering from
predominantly vata dosha in comparison to
other doshas. DVA might have happened on
the basis of kapha and pitta aggravation.
Another striking observation is the higher
percentage of vitiation of all doshas among
twins mothers than non twins mother at
kodinji. Odds analysis reveals that each

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

dosha vitiation has a positive association


with twinning but higher odds are seen with
vata dosha followed by kapha and lastly by
pitta.
Among
kodinji
people,
predominance of vata in their constitution is
noteworthy but that is not seen highest
among the mothers of twins. So the Prakriti
is not the soul factor but one among several
factors determining twinning morbidity.
Prakriti has a specific gene pool to produce
vata morbidity especially when vata
aggravating factors are present. That is why
twins are more in mothers who are having
twins in their 1st or 2nd degree relatives.
But how much diet might have
contributed and influenced the status of
morbid doshas to produce twinning can be
understood by the gravity of type of food
intake shown in the diet graph mentioned
above. The morbid status of vata dosha
might have produced by dependent way
because kodinji people are consuming diet
more of kapha and pitta type. So a
dependent vata dosha is seen in maximum
number of individuals.
In terms of modern parameters diet
like coffee, alcohol, smoking etc. has been
evidencing for increased risk of multiple
pregnancy.
In
biological
terms,
explainations like lowering of oestrogen
concentration,
increasing
pituitary
gonadotrophins and ovarian stimulations
etc. has been attributed to such type of
diets24 But in ayurveda coffee, alcohol and
smoking all are said to increase vata and
pitta dosha. Such food consumption directly
vitiates either vata or pitta dosha in the
body. If consumed in excess then this status
might be sufficient enough to trigger the
mechanisms underlying both MZ and DZ
pregnancies.
In general increased vata is
suggested to produce MZ twins as it

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enhances the splitting of zygote and


increased pitta is suggested to produce DZ
twins by increasing the basal metabolism
rate thus contributing to change in
concentrations
of
hormones.
This
association has also been pointed by Martin
Nicholas G. et al.1991, who found elevated
levels of serum inhibin throughout the cycle
in mothers of DZ twins. Also elevated were
the early follicular FSH levels, LH levels
throughout the follicular phase and early to
midfollicular estradiol in DZ mothers,
indicative of greater follicular activity25.
Our findings has also shown a
positive association of twinning with
increased BMI levels among Kodinji twin
mothers compared to the non twin mothers
and this association has been established by
large number of studies7. Increase in body
weight is a direct indicator of vitiated vata
and kapha dosha as per ayurveda26. So
almost all three doshas are vitiated
significantly in kodinji twin mothers of
which excess vata with kapha might be
responsible for MZ twinning and excess
pitta along with kapha might be producing
DZ twinning. But in what proportion, these
humours might have been vitiated and how
they are interacting is a real challenge to
ayurveda community. Since ayurveda along
with clinical, also is a philosophical science
describing the various meanings and styles
of life in different aspects, so the
interpretation of health and disease is based
on deductive reasoning as morbidity of body
tissues (Dhatus) in ayurveda depends on
quality of doshas contributed through their
lifestyles.
Nowadays there are sufficient
evidences suggesting that epigenetic
mechanisms may mediate the effect of
nutrition and may be causal for the
development
of
chronic
diseases27.
Numerous dietary factors including

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

micronutrients and non nutrient components


can modify epigenetic marks which are
responsible for altering gene expression not
only during the cellular differentiation in
embryonic and foetal development but also
through lifecourse28. Thus when certain
foods items which are vitiating body
humours are consumed regularly for long
time on traditional basis can have big hand
in altering epigenetic mechanisms which are
further inherited into their upcoming
generations and thus share a common gene
pool. This might be a reason for sudden
increase in twinning rate at kodinji village
after 1985 that made kodinji notified for
twins.

CONCLUSION
According to ayurveda twinning is
highly pathological and high frequency
twinning is a great concern of public health
problem as it is associated with many comorbid conditions along with congenital
anomalies theoretically. In kodinji, village
of pronounced twinning in Kerala, food and
phenotypical characterization called Prakriti
and interaction between the two might have
played a significant role in aggravating the
web of causation known for twinning so as
to produce abnormally high frequency
twins.
Acknowledgement
I am sincerely thankful to Najma mol K,
Jasna Kazhungil and Krishna Sreedharanour undergraduate students, for their help in
conducting the survey.

REFERENCES
1. Conley, D., & Strully, K. W., Birth
weight, infant mortality, and race: Twin
comparisons and genetic/ environmental
inputs, Social Science & Medicine;
Elsevier, (2012),[Article in press]

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2. I. Nakamura, Y. Amau, K. Nonaka, T.


Miura.Alternate changes in birth
seasonality of Twins during 1971-1984
in Japan. Acta Genet Med Gemellol.
1987;36:373-380.
3. Hoekstra, C., Zhao, Z. Z., Lambalk, C.
B., Willemsen, G., Martin, N. G.,
Boomsma, D. I. & Montgomery, G. W.
Dizygotic twinning. Hum. Reprod.
Update. 2008; 14: 3747.
4. Bulmer MG. The Biology of Twinning
in Man. Oxford, UK: Oxford Clarendon
PressOxford, UK, 1970.
5. Nylander, P.P.S. Causes of high
twinning frequencies in Nigeria. In
Nance, W.E Allen, G. and Parisi, P(eds).
Twin Research. Part B: Biology and
Epidemiology. Alan R. Liss. New York.
1978. pp. 35-43.
6. Nylander, P.P.S. The factors that
influence twinning rates. Acta Genet.
Med. Gemellol. 1981;30:189-202.
7. Reddy Uma M, Branum Amy,
Klebanoff. Relationship of Body Mass
Index and Height to Twinning.
Obstetrics
&
Gynecology.2005;
105(3):593-597
8. Olsen J, Bonnelykke B, Nielsen J.
Tobacco smoking and twinning. Acta
Med Scand 1988;224:491494.
9. Waldron M, Heath AC, Buchloz KK,
Madden P AF, Martin NG. Alcohol
dependence and reproductive onset:
Findings in Two Australian Twin
Cohorts. Alcoholism.2008; 32(11):18651874.
10. Kotb MM, El-Ghannam MA. Oral
contraceptives and twinning: A case
control study. The Journal of Egyptian
Public Health Association.1993; 68(34):265-275.
11. MacGillivray I, Campbell DM.The
physical characteristics and adaptations

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Ritu Rajoriya1, Dr. Sumit Nathani2.Importance Of Vayasthapana-Mahakashaya Drugs Wsr To Its Potential Uses In
Geriatric Care

of women with twin pregnancies. Prog


Clin Biol Res 1978;24: 8186.
12. Bortolus Renata et al.The epidemiology
of multiple births. human reproduction
update 1999.5(2);179-187.
13. Wimalasundera RC, Trew G, Fisk
NM.Reducing the incidence of twins
and triplets. Best Pract Res Clin Obstet
Gynaecol 2003;17:30929.
14. Scher AI, Petterson B, Blair E,
Ellenberg JH, Grether JK, Haan E, et al.
The risk of mortality or cerebral palsy in
twins: a collaborative population
basedstudy.
Pediatric
Research
2002;52:67181.
15. 15.Khan Sahab P, Skandhan KP.
Kodinji village puzzles medical science.
J. Obstet. Gynaecol. Res. 2011;
37(4):375-376.
16. Smits J, Monden C. Twinning across the
developing world. PLoS One.2011;
6(9):e25239.
17. Kark, S.L. epidemiology and community
medicine, Appleton century crofts. 1974.
18. Donga R Krupa et al. Role of nasya &
matra basti with narayan taila on
anovulatory factor. AYU. 2013.34(1);
81-85.
19. Dhiman Kamini et al. Shad Garbhakara
Bhavas vis--vis congenital & genetic
disorders. AYU. 2010.31(2);175-184.
20. Murthy KR. Ashtanga Hridya. Edi. 9.
Chowkhamba Krishnadas academy,
Varanasi. 2013; Vol.1. p- 368. Ref. 48.
ISBN 978-81-218-0018-8
21. Myrianthopoulos
NC.
Congenital
Malformations in twins: epidemiologic
survey. Birth Defects Original Article
Series.1975;11(8):1-39.
22. Purvya MC, Meena M.S. A review on
role of prakriti in ageing.AYU.2011;
32(1):20-24.

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23. Sharma RK, Dash B. Caraka Samhita.


Chowkhamba Sanskrit series office.
Varanasi.2012.vol 5.p-36 (ref. 59)
ISBN: 978-81-7080-024-2
24. Parazinni F, Chatenoud L, Benzi G et al.
Coffee, smoking alcohol & multiple
pregnancy.Hum Reprod.1996;11:23062309
25. Martin NG, Shanley S, Butt K, Osborne
J, OBrien G. Excessive follicular
recruitment and growth in mothers of
spontaneous dizygotic twins. Acta Genet
Med Gemellol (Roma) 1991; 40:291
301.
26. Balkampady SV. Dyspnoes on exertion
in patients of heart failure as a
consequence
of
obesity:
An
observational
study.
AYU.2013;
34(2):160-166.
27. Wu G, Bazer FW, Cudd TA, Meninjer
CJ, Spencer TE. Maternal nutrition and
fetal
development.
J.Nutr.2004;134(9):2169-2172.
28. Meaney MJ, Szyf M, Seckl JR.
Epigenetic mechanisms of perinatal
programming
of
hypothalamicpiyuatary-adrenal function and health.
Trends in Molecular Medicine.2007;
13(7):269-277.
CORRESPONDING AUTHOR
Dr. Meena Thakur
PG Scholar
Department of Kaumarbhritya, VPSV
Ayurveda College Kottakkal, Kerala
Email- dr.meenuthakur@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

STUDY OF APPLIED ASPECTS OF KAKSHADHARA MARMA W.S.R. TO


KALARY PAYYATU
*Dr. Premanand Bhalerao **Dr. Sunil kumar
(Ph.D. scholar) Department of Sharir Rachana, N.I.A. Jaipur
2
M.D.(Ayu) PhD. Associate professor, Department of Sharir Rachana,N.I.A. Jaipur
1

ABSTRACT
In Ayurveda, Marma was first documented by Acharya Charak. The detailed description of
Marma Sharir is available in Samhitas. Acharya Sushruta stated every aspect of Marma like
definition, signs and symptoms of Marma injury. The total numbers of Marma as described
in Samhitas are 107 in number. Twelve Pranas, the vital energy of the body, are the contents
of the Marma sthana. As Marma are vital points of the body they should be protected from
any injury. Acharya Sushruta believes that Marma Sharir covers the half knowledge of
surgery. Any injury to these points may results into death and physician expert in Marma
therapy, patient will cause some deformity. Acharya Sushruta explains the Marmaviddha
Lakshanas in detail. In similar way like Marma, there are other ancient indian sciences also
in which the vital points of human body are described. Among them kalary payyatu is the
oldest technique. It is a combat science which is introduced to the world by lord parshurama
and inspired by Marma sharir of Ayurveda. The main aim of the study is to understands the
kakshadhara marma ,its applied aspect and to find out any similarity with vital point
explained in kalary payattu.
Key words: - marma, kakshadhara marma, kalary payyatu
INTRODUCTION
Marma is one of the most widely
described at the same time one of the most
debated topics in the Bruhatrayees. The
word marma appeared in Vedic period. In
dictionaries the word Marman means
mortal sport, vulnerable point, weak or
sensitive part of body, joint or articulation,
core of anything, vital structure. Marma in
Ayurvedic classics is illustrated as the vital
point in human body, the injury of which
leads to termination of life. In olden times
a vaidya had to deal with more exigencies

during the time of war and it might have


been the reason why marma was given
utmost importance in our Samhitas.
Descriptions of 107 marmas given by all
Acharyas being classified into five
varieties on the basis of structure involved,
five on the basis of effect of injury, five on
the basis of location on the body.
Kakshadhara marma is one such vital
region in human anatomy which falls
under the above classification on the basis
of structure involved. It is explained as one
among the snayu marma. Totally there are

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Premanand Bhalerao & Sunil Kumar : Study Of Applied Aspects Of Kakshadhara Marma W.S.R. To Kalary Payyatu

27 number of snayu marma.Kashadhara


and Vitap both are considered under Sira
marma by Acharya Vagbhata so he stated that
Snayu marma are 23 in number.

Kakshadhara marma is situated at the


shoulder joint (brachial plexus).
Hence this study is aimed to analyses the
anatomical structure of kakshadhara
marma and its viddha lakshana. Present
work is been taken up with an idea of
updating early concept of a better
understanding of kakshadhara Marma in
accordance with the advance anatomical
description in view of modern and applied
anatomy and also to explore viddha
lakshana of kakshadhara Marma in
relation to pakshaghata.. Name of the
kalary points are based on their traumatic
effect. The knowledge of pathophysiology
of injury to marma is must be understood
by every Ayurvedic physician.
So a humble effort is made for a better
understanding of this kakshadhara marma
in accordance with advance anatomical
description and to find out any similarity
with points explained in kalary payyatu.
MATERIALS AND METHODS
1. The Ayurvedic literature related to
kakshadhara marma was studied from
various sources like Brihat - trayee ,
Laghu Trayee etc.
2. The modern literature related to
shoulder joint will be studied.
3. Comparative study of kakshadhara
marma with kalary payyatu, was done.
4. Materials from electronic media and
journals related to the subject were
reviewed.
NEED OF STUDY
Name
Kakshadhar
Number

02

Site

(at axilla)

Type(acc. to Rachana)

Snayu

Type(acc.to aghataj parinaam)

Vaikalyakar

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1. To analyse and explain the concept of


kakshadhara marma scientifically
given in Ayurvedic classics.
2. To find out any relation in between
applied aspect of kakshadhara Marma
and vital points explained in kalary
payyatu.
3. The study related to the subject will be
beneficial for self-defence and health.
REVIEW, KAKSHADHARA MARMA
Etymology
i')+i-ii3. 6'. .
i

There are two kakshadhara marma.


Kakshdhara is devoid of sira, sandhi and
asthi
The word Kaksha means related with the
armpit.The word Kakshadhara means the
part of the body where the upper arm is
connected with the trunk,ie the shoulder
joint. Kaksha means bahu moolam.
Kaksha means bahu moolam which are
two in number. Kakshadhara marma is
situated between the region of arm and the
breast. Injury to Kakshadhara marma will
lead to pakshaghatha. Pakshaghata means
Pakshavadha that is the paralysis of one
side.
As per the description, kakshadhara
marma sthana is lies in between the
kaksha and vaksha but as the name
indicates it is more related to kaksha. It is
situated in the region of the body where
the upper arm is connected with the
trunk.Any injury to this particular
marmasthana will lead to pakshaghatha,
that is the paralysis.
Table no.01 showing kakshadhara marma.

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Premanand Bhalerao & Sunil Kumar : Study Of Applied Aspects Of Kakshadhara Marma W.S.R. To Kalary Payyatu

Type(acc.to parimaan)
Structures involved
Sign if injured

01 angula
1. Subscapulari, Pectoralis minor, Brachial plexus
2. Axillary artery, Axillary vein, Axillary lymph node
Paralysis of arm.

fig.no.01- showing the brachial plexus


within circle (contains axillary A.& N.),the
site of kakshadhara marma.
DESCRIPTION OF KALARY POINT
ASSOCIATED
WITH
KAKSHADHARA MARMA: Phanam ("):- Location: - Center of
the axilla.
Number-02
Symptom if injured: - a) Paralysis of hands
b) Swelling in hands c) Clawing of finger
d) Stiffness or rigidity over the area
between neck and upper part of nipples
(pectoral region)
BRACHIAL PLEXUS: The brachial plexus is a network of nerves
that originate in the neck region and
branch off to form most of the other nerves
that control movement and sensation in the
upper limbs, including the shoulder, arm,
forearm, and hand. The radial, median, and
ulnar nerves originate in the brachial
plexus.
Symptoms of a brachial plexus injury:Pain
Loss of sensation
Muscle weakness

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Paralysis of some or all of the muscles of


the shoulder and upper limb
DISCUSSION
Study of kakshadhara marma has been
carried out by collecting reference from
different Ayurvedic literature and correlate
it with modern anatomy text books and
compare with marma explained in kalary
payyatu.
The kakshadhara marma lies in the kaksha
region, the detail discussion of these points
are as follows:
LOCATION
As per the available reference from the
Samhita,the exact location of kakshadhara
marma is mentioned as between kaksha
and vaksha,that will be more related to
kaksha. The kaksha region refers to root of
the arm,ie the joint which connects the arm
to the shoulder known as kaksha sandhi.Vaksha is the region above the
hrudaya and below the kanta.It may be
considered as the subclavicular region and
the region above breast. The word dhara
means bearing or holding.Since it is named
as kakshadhara,it is assumed that it holds
the kaksha region with the help of muscles
and ligaments. So the location of the
marma is in between the chest and kaksha
sandhi but nearer to the kaksha sandhi as
the name indicates. Specifically, the
kakshadhara marmasthana is to be considered just below the clavicle nearer to
the kaksha sandhi. The muscles, ligaments,
blood vessels and nerves in the subclavicular & brachial plexus region are related to
the kakshadhara marma sthana.
MAMSA

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Premanand Bhalerao & Sunil Kumar : Study Of Applied Aspects Of Kakshadhara Marma W.S.R. To Kalary Payyatu

Acharya susrutha has described10 peshis


in kaksha region. The subclavicular &
shoulder region has been dissected and
observed the muscles and other structures.
The following muscles were studied &
identified;
Pectoralis major & minor, Deltoid, Coracobrachialis, Bicepsbrachi, Subscapularis,
Trapezius, Supraspinatus, Infraspinatus,
Teres major & minor, triceps brachi.
These 10 muscles may be correlated with
the concept of Acharya Sushrutha.
SIRA
As such there is no direct reference regarding siras present in kakshadhara
marma region, but in the context of marma
shareera Acharya Susrutha explains that
siras are present in marmas. They nourish
the ligaments, bones,muscles, and joints.
The following blood vessels are observed
in the marmasthana;
Superior thorasic artery, thoraco acromial
artery, lateral thorasic artery, circumflex
scapular arter,thoracodorsal artery,anterior
circumflex humeral artery,posterior circumflex
humeral
artery,axillary
vein,brachial vein,cephalic vein,subclavian
vein,suprascapular artery,superficial cervical artery,the descending branch of occipital artery,circumflex scapular artery and
dorsal scapular artery. These blood vessels
may be compared with the siras present in
marmasthana.
NERVES
The following nerves were observed in the
subclavicular & shoulder region related
with the marmasthana.
1. Posterior supraclavicular nerves from
the third and fourth cervical nerves
2. Cutaneous branches from the axillary
nerve
3. The cords of the brachial plexus
4. The axillary nerve
5. The musculocutaneous nerve
6. The medial & lateral pectoral nerve.

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7. The median nerve


According to kashyapa mastulunga is the
mulasthana of snayus.According to
Dalhana snayus are the rope like
structures.Considering these opinions
these nerves may be compared with
snayus.
SNAYU.
According to the modern explanation the
following ligaments are found during the
dissection of the subclavicular & shoulder
region in relation to the marmasthana.
Glenohumeral ligaments.These are again
divided into superior glenohumeral,middle
glenohumeral and inferior glenohumeral
ligaments.
Coracoacromial ligament.
Capsular ligament.
Acromioclavicular ligament.
Transverse humeral ligament.
The fascia that has been observed
are the deep fascia covering the deltoid
muscle,the subscapular fascia,the clavipectoral fascia and the supraspinatus fascia. The clavipectoral fascia is a strong
fascia situated under cover of the
clavicular portion of the pectoralis major.It
occupies the interval between the pectoralis minor and subclavius, and protects
the axillary vessels and nerves.
Since snayus does the anga bandhana,
these ligaments may be compared with
snayu in the marmasthana.
ASTHI & SANDHI
Acharya susrutha opines that one asthi is
present in the bahu and two in the amsa
phalaka. The articulation between one
bahu asthi and two amsaphalaka asthi results in kaksha sandhi.It is a type of ulukhala sandhi.A per the modern reference
the articular parts of the humerus,scapula,and clavicle are observed as
the bony parts and the joint formed is the
glenohumeral joint which is the ball and
socket variety of the synovial joint.These

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Premanand Bhalerao & Sunil Kumar : Study Of Applied Aspects Of Kakshadhara Marma W.S.R. To Kalary Payyatu

bony parts may be compared as asthi in the


marmasthana and the glenohumeral joint
may be compared as sandhi in the marmasthana.
DISCUSSION ON PRAMANA
All marmas have been explained in terms
of definite pramana in samhithas.It helps
in the determination of location of the
marma.The pramana of kakshadhara
marma has been explained as one
angula.It is the area occupied by the
marma in terms of own fingers
breadth(svanguli).While explaining about
the pramana of kakshadhara marma it is
mentioned just as one angula pramana
without much explanation about its upper
limit and lower limit of the site and also
regarding the length,breadth and depth of
the marma.So here the one angula pramana
is
considered
equally
as
length,breadth or as diameter present in the
kaksha region.This helps to assess the
structures present in and around the
marma.
DISCUSSION ON MARMA VIDHA
LAKSHANA
As
per
rachananusara
the
kakshadharamarma is a snayumarma according to Sushrutha and sira marma according to Vagbhata. According to the
vidhalakshana it is a vaikalykara
marma.The snayu marma vidha lakshanas are ayaama,akshepaka,sthambha,
excessive ruja in snayus,yanasthana
ashakthi and vaikalyatha in anga. In the
case of kakshadhara marmavidha the
symptom explained is pakshaghatha. It is
a snayu marma and snayusobserved in
relation to the marma are the glenohumeral
ligaments,coraco
acromial
ligaments,coracoclavicular ligaments, the
transverse humeral ligament & the clavipectoral fascia. Injury to these ligaments
will lead to the disability of the joint.The
clavipectoral fascia is a very important

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structure that protect the axillary vessels


and nerves.The structures piercing the fascia are thoraco acromial artery,cephalic
vein and the lateral pectoral nerve.An injury to the clavipectoral fascia will damage
these structures.An injury to the fascia can
damage the axillary artery,axillary vein
and axillary nerve.These all will lead to the
disability of the arm.Acharya vagbhata
highlighted the importance of siras in this
region. The blood vessels related to
kakshadhara marma are axillary artery,superior
thorasic
artery,thoraco
acromial artery,l ateral thorasic artery,circumflex
scapular
artery,thoracodorsal artery, anterior circumflex humeral artery, posterior circumflex
humeral artery, axillary vein,brachial
vein,cephalic
vein,subclavian
vein,suprascapular artery,superficial cervical artery,the descending branch of occipital artery, and dorsal scapular artery.An
injury to these vessels will result in severe
blood loss and lack of blood supply to the
muscles of the arm and shoulder region.This will lead to the disability of the
arm. The disability of arm in all these
occasions refers to pakshaghatha in
Ayurveda.
Discussion on kakshadhara marma with
phanam (of kalary payyatu) :The total number number of kalary marma are
67 and discribed by 37 names whereas in
ayurvedokt marma are 107 and discribed by 43
names.
After profound study of both marma shastras,
it is found that phanam marma is having common location and up to some extent common
traumatic effect.
Phanam and kakshadhar :Similarities in their location i.e. axilla
Traumatic effect
;= ;
Phanam:Paralysis of hands; Swelling in
hands; Claw finger; Stiffness or rigidity over

IAMJ: Volume 4; Issue 04; March- 2016

Premanand Bhalerao & Sunil Kumar : Study Of Applied Aspects Of Kakshadhara Marma W.S.R. To Kalary Payyatu

the
area between neck and upper part of
nipples (pectoral region)
It is very clear that these two marmas having
similar traumatic effect.
This traumatic effect occurs due to Brachial
plexus injury.

CONCLUSION:
From the above discussion it is concluded
that, phanam marma of kalary payyatu is
having same location as well as same
traumatic effects like kakshdhara marma.
The structures lies at the kakshadhara
marma region is brachial plexus only.

744

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REFERENCES
1. Sushruta samhita- sharir sthan
6/11(bhaskar
govind
ghaneka
tikapunarmudrita samskaran 2012

2. Asthang hruday sharir sthana 4/4243 (vidyodini tika ,shri yadunandan


upadhyaya punarmudrit
sanskaran 2007)
3. Marma darpanam by acha ya
yuduvansham

IAMJ: Volume 4; Issue 04; March- 2016

Research Article

International Ayurvedic Medical Journal ISSN:2320 5091

ANTHROPOMETRICAL STUDY OF TIBIA WITH SPECIAL REFERANCE TO


OSTEOARTHRITIS
Dr. Premanand Bhalerao (Ph.D. scholar), Department of Sharir Rachana, N.I.A. Jaipur
Dr. Sunil kumar, M.D.(ayu) PhD. Associate professor, Department of Sharir Rachana,
N.I.A. Jaipur
ABSTRACT
Anthropometry is systemic, quantitative representation of human body. It deals with the
physical dimensions, proportions and variations in measurements. Anthropometry is a latin
word. Anthropos means human and metry means measurement. Anthropometry was first
used in 19th and early 20th century in criminalistics to identify criminals. Now it has wide
application in the field of medicine, space programming and archaeology etc. In our ancient
science, there are numerous references of human measurements and they are explained in
terms of anguli praman, Anjali praman, yava praman. The morphological characters such as
height, bredth etc. are given in swa anguli praman, (breadth of ones own finger). In our ancient classics, the tibia is termed as antarjanghaasthi and it is eighteen anguli, measured
bredth of the individuals finger. The praman shaarir is explained in the context of investigatory methods ie. In dashavidha pareeksha and those who are coming under heena pramana is
more susceptible to pathology. Osteoarthritis is the most common pathology in present era
and upper end of tibia is the main victim. Tibia is the main weight bearing bone in the body
so the study is aimed to observe the patients of osteoarthritis and to find out the variations of
tibial length anthropometrically.
Key words : Anthropometry, Tibia, Praman Sharir, Osteoarthritis.

INTRODUCTION
In ayurveda the sharir is given prime importance as one among those factors which
contributes to ayu of an individual, the other
factors being indriya, satwa, atma. This complete knowledge about sharira at all times is
very much essential for a physician in order to
provide a healthy life for mankind. The
essentiality of praman is depicted in the fundamentals of ayurveda as , the mana/ praman of
hitayu, ahitayu, sukhayu, and dukhayu is the
one which constitutes ayurveda.1 Ayurvedic

literature pertaining to sharir rachana furnish


detailed description on measurements of body
and its elements. In our classics praman sharir
is the term given to this subdivision which
depicts the importance of measurements or
anthropometry.Praman,the other way defines
the concept of measurements of various
biological entities. It bears an ample importance in medical applied science. Before
starting with the chikitsa which is consider as
karya in the field of medicine, the wise physician should perform the pareeksha of karyadesha
i.e.ATUR
SHARIR.2
ACHARYA

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Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

CHARAK explained dashveedha pareeksha


vidhi. Praman pareeksha is one of them.3 The
basic goal behind pareeksha is to get
knowledge regarding the bala of rogi where
ACHARYA SUSHRUTA considered it as the
main tool to get the information regarding ayu
along with that of Bala3. The sharir praman is
only tool for determining the ayu of an
individual. The ayurvedic classical literature
are documented along with many hypothetical
concepts. The concept of praman is also one
among them which should be evaluated
scientifically to bring out the hidden logical
knowledge of ayurveda.Pramaan of purusha
gives the detailed information regarding each
body parts in terms of its external features.
This can be helpful in the understanding the
anatomical knowledge required for the practice of Aurveda. The modern ANTROPOMETRY also has a similar kind of intentions in
the field of medical science. Anthropometry is
systemic, quantitative representation of human
body. It deals with the physical dimensions,
proportions and variations in measurements.
Anthropometry is a latin word. Anthropos
means human and metry means measurement4.
Anthropometry was first used in 19th and
early 20th century in criminalistics to identify
criminals. Now it has wide application in the
field of medicine, space programming and archaeology. In our ancient science, there are
numerous references of human measurements
and they are explained in terms of anguli
praman, Anjali praman, yava praman. The
morphological characters such as height,
bredth etc.are given in swa anguli
praman(breadth of ones own finger). In our
ancient classics, the tibia is termed as
antarjanghaasthi and it is eighteen anguli,
measured by bredth of the individuals finger5.
The pramaan shaarir is explained in the context of investigatory methods, ie. In dasavidha
pareeksha and those who are coming under
heena pramaana is more susceptible to pathology. Sandhigatavata is described under
Vatavyadhi in all the Samhita and Sangraha
Grantha. In Vriddhavastha, all Dhatus undergo Kshya, Thus leading to Vataprakopa
and making individual prone to many diseases.

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Among them Sandhigatavata stands top in the


list. Osteoarthritis is the most common articular disorder begins asymptomatically in the
2nd and 3rd decades and is extremely common
by age 70. Almost all persons by age 40 have
some pathologic change in weight bearing
joint. 25% females and 16% males have
symptomatic OA.6 The disease Osteoarthritis
may be regarded as a reward of longevity. It
seems man has paid price for standing on hind
limbs in form of osteoarthritis of weight bearing joints of the body.6 Arthritis is second only
to heart disease as a cause of work disability. It
limits everyday activities such as walking,
dressing, bathing etc., thus making individual
handicapped. No treatment is available which
can prevent or reverses or blocks the disease
process. In Allopathic science, mainly analgesics, anti inflammatory drugs or surgery are
the options for the treatment of Osteoarthritis.
These dont give satisfactory relief and also
causes great adverse effect. Researchers are
looking for drugs that would prevent, slo down
or reverse joint damage. Drugs that slowdown
or halt disease progression are critically
needed. For the search of cure of the disease
Sandhigatavata, many researches has been
carried out. Still till date we dont have
treatment which can actually cure or provide
good relief in Sandhigatavata. Prevention is
better than cure, The present study is a humble
effort in search of prevention of the disease
Sandhigatavata. Osteoarthritis is the most
common pathology in present era and upper
end of tibia is the main victim.7 Tibia is the
main weight bearing bone in the body8, so the
study is aimed to observe the patients of
osteoarthritis and to find out the variations of
tibial length anthropometrically.

Objectives:1. Compile the description of pramaan


shaarir and antarjanghaashi in brihat
trayees, mainly Sushruth Samhitha
2. Survey study to determine the
measurement of tibia in osteoarthritic
patients and to correlate it with pramaan shaarir of Ayurveda.

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

3.

To analyse the anguli pramaana of


selected patients.
MATERIALS AND METHODS :1. The ayurvedic literature of related subject will be studied from brihat trayee,
mainly Sushruth Samhitha.
2. The modern literature related to
anthropometry will be studied.
3. A survey study will be conducted in
fifty osteoarthritic patients for the
collection of anthropometrical data of
length of tibia.
4. The anguli pramaan of patients will be
assessed by taking the bredth of four
fingers except thumb, at different sites,
i.e. proximal and distal interphalangeal
region. The obtained data will be analysed and compared with the textual
references.
5. The measurement of tibia will be taken
by appropriate, authentic instruments.
6. Internet materials, journals , periodicals and previous research papers related to this subject will be reviewed
Criteria for patient selection :1. Inclusion :
a. Age between 35 to 70 years.
b. Male patients belonging to Rajasthan
2. Exclusion:
a. Patients with other systemic disease

1.

2.

4.

5.

NEED OF STUDY:To scientifically analyse and explain the


concept of pramaan shaarir given in our
classics
Eventhough there are previous studies
related with anthropometry, no studies related with anthropometry of tibia has been
done yet.
Osteoarthritis, being one of the most
common disease, a study related to the
subject will be beneficial for better
prognosis of the disease.
To substantiate that the inclusion of
pramaan sharir in dasavidha pareeksha is
both scientific and authentic.
OBSERVATION:- The different features
observed in individual patient were recorded in a case sheet after the proper history taking, examining the patients who
were selected for the clinical observational
study based on diagnostic, inclusion and
exclusion criteria. After completion of the
study the observations were analyzed,
tabulated and presented in the form of tables as follows -

S.No.
1.

Sharirik Prakriti
Vataj

No. of Patients
00

Percentage
00.00%

2.

Pittaj

00

00.00%

3.
Kaphaj
00
00.00%
4.
Vata-Pittaja
19
37.25%
5.
Vata-Kaphaja
16
31.37%
6.
Pitta-Kaphaja
16
31.37%
7.
Tridoshaja
00
00.00%
Table no. 1: Showing the incidence of Age in 51 registered cases of Osteoarthritis.
S.No.

Age Group (In Years)

No. of Patients

Percentage

1.
2.
3.

35- 45 Years
45-55 Years
55-70 Years

12
19
20

23.53%
37.25%
39.22%

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IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

Table no. 1 show that maximum patients are of under 55 to 70 years group i.e. 39.22%, after
that 37.25% patients are under 45-55 years group ,minimum no. of patients are under 3545years i.e.23.53%.
Table no. 2: Showing the incidence of Religion in 51 registered cases of osteoarthritis.
S.No.

Religion

No. of Patients

Percentage

1.
Hindu
45
88.24%
2.
Muslim
04
07.84%
3.
Sikh
01
01.96%
4.
Sindhi
01
01.96%
Table no.2 shows that out of 51 registered
Table no.3 and fig.no.3 shows that maxicases maximum i.e.88.24% are of hindu
mum no. of patients,19, are from vata pitta
community ,after that 7.84 %were musprakriti i.e.37.25%, then vata-kapha and
lims, sindhi and Sikhs both 1.96%.
pitta-kapha both having 16 patients
Table no. 3: Showing the incidence of
i.e.31.37%, however we have zero patients
Sharirika
Prakriti
in
51
of pure vata, pitta, kapha and tridoshaja
registered
cases
of
prakriti.
Osteoarthritis.
Table no. 4: Showing the incidence of Chronicity (in years) in 51
registered cases of Osteoarthritis.
S.No.
Chronicity (In years)
No. of Patients
Percentage
1.
1 Year
08
15.69%
2.
2 Year
17
33.33%
3.
3 Year
17
33.33%
4.
4 Year
08
15.69%
5.
5 Year
01
01.96%
Table no.4 shows that maximum patients
years of chronicity i.e.15.69% and only a
having 2 and 3 years of chronicity i.e.17
single patient with 5 years of chronicity
(33.33%),then 08 patients having 1and 4
i.e.1.96%.
Table no. 5: Showing
the
incidence
of
Occupation
in
51
registered cases of Osteoarthritis.
S.No.
Occupation
No. of Patients
Percentage
1.
Govt Service
10
19.61%
2.
Retired
03
05.88%
3.
Pvt. Job
17
33.33
4.
Labour Work
14
27.45%
5.
Farmer
07
13.73%
Table no. 5 shows maximum no. of patients,17i.e.33.33% are privet servants,
then 14 patients were labours i.e.
27.45%,10 patients19.61% are from

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government
service.07patients
are
farmer(13.73%),03 are retired patients
05.88%.

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

Table no. 6: Showing the incidence of Anguli pramana of Right Jangha in 51registered
cases of Osteoarthritis.
S.No.
Anguli Pramana
No. of Patients
Percentage
1.
17 - 18.5
11
21.57%
2.
18.5 - 19
10
19.61%
3.
19 - 19.5
14
27.45%
4.
19.5 - 20
09
17.65%
5.
20 - 20.5
04
07.84%
6.
20.5 - 21
01
01.96%
7.
21 - 21.5
02
03.92%
Table no. 7: Showing the incidence of Anguli pramana of Left Jangha in 51 registered
cases of Osteoarthritis.
S.No.
Anguli Pramana
No. of Patients
Percentage
1.
17 - 18.5
10
19.61%
2.
18.5 - 19
09
17.65%
3.
19 - 19.5
14
27.45%
4.
19.5 - 20
09
17.65%
5.
20 - 20.5
05
09.80%
6.
20.5 - 21
02
03.92%
7.
21 - 21.5
02
03.92%
Table no. 8: Showing the incidence of Actual Anguli pramana of Right & Left Jangha
in 51 registered cases of Osteoarthritis.
Patient Sr. No.
RIGHT
LEFT
1
18.88
19.14
2
19.32
19.47
3
21.15
21.15
4
19.80
19.53
5
18.29
18.39
6
19.29
19.19
7
18.65
18.19
8
18.65
18.19
9
18.45
18.35
10
17.14
17.03
11
20.38
20.06
12
20.46
20.41
13
18.71
18.71
14
19.18
19.14
15
19.21
19.17
16
19.58
19.34
17
19.30
19.10
18
18.06
18.43
19
19.00
19.15

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IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51

18.90
19.33
19.32
18.80
19.36
18.58
21.45
19.16
18.29
19.82
19.86
18.28
20.71
18.43
18.60
19.33
19.74
18.36
19.24
19.45
19.84
18.34
19.67
19.67
18.08
19.36
18.58
20.40
19.16
20.48
19.82
18.28

18.79
19.55
19.06
18.12
19.41
19.15
21.00
19.86
18.48
20.11
19.13
18.52
20.34
18.72
18.30
18.88
19.54
18.57
18.84
19.50
19.58
18.90
19.56
19.60
18.20
19.41
19.15
20.50
19.80
20.96
20.00
18.52

DISCUSSION
On PRAMANA : In ayurveda ,pramanas
are considered as the methods for gaining
knowledge. Anguli pramana is used to
quantitatively express the dimensions of the
human body part. Acharya charak considered
as it as one among the dashvidh parikshabhavas. In the era of sushrutacharya and charakacharya ,swa-anguli pramana is used for
estimating the anga-pratyang and other body
constituents.the person should be examined by

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measuring angapratyang by using swa-angula


praman as unit measurement.It helps in determining the ayu and bala of person.The person
having appropriate pramanas of angapratyangasis considered to atten the deergayu.
Basically there are 2 type of pramanas explained in ayurveda.Those are anguli pramaan
and anjali pramaan.The anjali praman is used
for measuring other body constituents including fluids. But anguli praman which is based

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

on swa-anguli praman is used for measuring


the dimensions (ayam,vistara,parinaha etc.)of
different anga-pratyangas of the body.

On JANGHA : The jangha is that


anatomical part which is present below the
janu and above the gulpha.In some context
,this word is being replaced by uru and
anga.The measurement of jangha are mentioned in both charak and sushrut samhitas.In charak samhita,in the context of
dashvidh atura pareeksha in vimana sthan
8th chapter, it is said as,ASHTA DASH ANGUL DEERGA,and SHODASHAANGULA
PARIKSHEPA in the pramaan of jangha.In the sushrut-samhita,35thchapterof,sutrasthana,named
AATUROPKRAMANIYA ADHYAYA, the
sharir pramaan enlisted in which the pramaan of jangha is said as, CHATURADASHANGULA PARINAH and
ASHTADASHANGULA DEERGA.No anatomical land marks are being mentioned,
neither by author nor by the commentators,so the modern anthropometric procedures and technique were personalized accordingly.
Anatomically jangha is considered as the
LEG (or the lower leg), based on the
definations available in ayurvedic literatures. The normalized anthropometric data
documented in the book introduction to
On the observation:Group A
Mean
S.D.
Rt. jangha
19.21
0.84
Lt. jangha
19.22
0.81
The study was conducted on 50 osteoarthritic patients in the age group 35 to 70
years and all patients were belongs to rajasthan In the collected data the following
the observations.
So from this study it is derived that mean
length of jangha of osteoarthritic patients
were 19 angula approximetly.The length of
jangha of healthy person, given in our clas-

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biomechanics,university of rhode island


,department of bio medical engineering ,
suggests that the average lenth of lower leg
is 50cms.,but while calculating these
measurements they have included both
knee and ankle joint.In this survey study
this has been modified by selecting
particular anatomical point,the measurement are documented.
On Anthropometry:Anthropometry is a systemized body of
techniques for measuring and taking the
observations on man, his skeleton, the
limb and trunk etc. by most reliable means
and scientific methods. It concentrates on
the observations and measurement of the
physical variation both within and between
human populations seeking to understand
the origins and mechanisms of survival of
the variations. In view of the fact that no
two individuals are ever alike in all their
measurable characters and that the later
tend to undergo change in varying degree,
hence person living under different conditions and members of different ethnic
groups frequently present interesting
differences in body form and proportions.
The anthropometry forms a mean of giving
quantitative expression to the variations
exhibited by such traits.

S.E.
t
p
0.12
10.35
< 0.001
0.11
10.69
< 0.001
sics is 18 angula.with afrosaid data,it may
be say that there is a variation in length of
jangha of healthy individual and diseased
person (here it is osteoarthritis).
CONCLUSION AND RESULT
1. Individualistic approach of pramaan shareera helps to plan the
treatment and decide the prognosis

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Premanand Bhalerao & Dr. Sunil Kumar: Anthropometrical Study Of Tibia With Special Referance To Osteoarthritis

2.

3.

4.

5.

6.

depending on the result of dashvidh


pareeksha.Applicability of pramaan shareera in the assessment of
disease prognosis and mortality is
true from centuries.
The description of specific
anatomical landmarks for jangha
are not explained by samhitas.With
the available references in ayurvedic and contemporary science the
TIBIA and FIBULA was togetherly considered as jangha in this
study and landmarks are from tibial
tuberosity up to inferior medial
malleolus.
The study entitles anthropometrical study of tibia with special
reference to osteoarthritis gave
positive results in proving the relation of length of jangha and
osteoarthritis.
Observation of the present study
revealed that mean length of jangha of osteoarthritic patients were
19 angula approximetly.The length
of jangha of healthy person, given
in our classics is 18 angula. With
aforesaid data,it may be said that
there is a variation in length of jangha of healthy individual and diseased person (here it is osteoarthritis).
The observations from this study
also gives strong positive thought
about, the length of jangha of
healthy person(18 angula), which
is given in our classics,is significant.
We can also,may be,said that
individual with more than 18 angula length of tibia are prone to the
disease osteoarthritis.

1. Astanga Hridaya: Vagbhata with


Ayurveda Rasayana and Sarvanga
Sundara. Comm. Chaukhambha
Surabharati Prakashan, Varanasi
(1997) page no.19
2. Astanga Hridaya: Vagbhata with
English translation by Dr. Srikantamurthy, Bangalore (1991)
3. Charak Samhita With Ayurveda
Dipika
Commentary
Of
Chakrapani Datta,Ed. Yadavji
Trikarma Ji Acharya, Chaukhambha Surbharti Prakashan,
Varanasi. Edition 7th, 2002
4. Indera p singh and m.k.bhasin
Anthropometry. Delhi:-Kamala raj
Enterprises 1989.
5. Sushruta Samhita Comentary Of
Dalhana, Ed. Acharya Y.T. Chaukhambha Surbharti Prakashan,
Varanasi, Reprint 2008
6. Bray GA. "Medical Consequences
Of Obesity". J. Clin. Endocrinol.
Metab.2004; 89 (6): 25832589.
7. WHO Consultation On Obesity
2000.Obesity: Preventing And
Managing The Global Epidemic:
Report Of A WHO Consultation.
(WHO Technical Series Report 894
).
8. Sharma AK., Gautam VK.
Diagnostic Methods in Ayurveda.
Chaukhambha Visvabharati, Varanasi, India, 2008

Source of support: Nil


Conflict of interest: None Declared

REFERENCES

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IAMJ: Volume 4; Issue 04; March- 2016

Review Article

International Ayurvedic Medical Journal ISSN: 2320 5091

PATHS OF YOGA FOR DIFFERENT SAADHAKA


Dr. Nagraj G Bhat1 Dr. Vijay B Negalur2Dr.Shubhasri3 Dr. Yagyik4
1,2,3,4
P G Department of Swasthavritta SDMCA Udupi, Karnataka, India

ABSTRACT

Stress management is essential tool to maintain healthy life in the present era.
Bad Lifestyle modification may be leading to many diseases. Yoga plays a major
role to maintain health. From Yoga we can have control over Chittavruttis like
Pramana, Viparyaya, Vikalpa,Nidra and Smruti. Yoga makes a bridge between
body and mind. Main aim of Yoga is to get Moksha. classical text Shiva samhita
explains different paths of yoga for different individual depending on their caliber.
Every individual cant practice every types of Yoga, specific path of yoga should
be followed for best result. There are four types of yoga, they are Mantra yoga,
Hatayoga, Layayoga, Smratiyoga. These are explained for Mrudu, Madhyama,
Adhimatraka, and Adhimatratama people respectively. For this reason it is
essential to understand the Concept of Saadhakas. Yoga is such a beautiful science
which gives the inner peace and heals the body in spiritual way in order to attain
the Moksha.
Key words: Yoga, Saadhaka, Moksha, Health
INTRODUCTION
Yoga is the unique science which
makes bridge between body and mind.
From Yoga one can have control over
Chittavruttis1. Main aim of the yoga is
to get salvation. Attainment of
salvation is not so easy, one has to
follow specific paths of yoga according to his nature, lifestyle and caliber.
In yoga different texts like Patanjali

yogasutra,
Gheranda
samhita,
Hatayogapradeepika
and
Shiva
samhita explains about attaining
Moksha by different Yogic techniques.
Among those, Shiva samhita clearly
explains regarding the different
aspirants or Sadhakas and their specific paths of Yoga.
There are four types of yoga, they are
Mantra yoga,Hata yoga,Laya yoga,

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Dr. Nagraj G Bhat Et;Al: Paths Of Yoga For Different Saadhaka

and Smrati yoga. These are explained


for Mrudu,Madhyama,Adhimatraka,
and
Adhimatratama
people
respectively.
Types of of Saadhakas and their
specific paths of Yoga.
Mrudu Saadhaka:
Person who are lazy, oblivious, sick,
finding faults in teacher, excessive
desire, involving in sinful acts,
depending on wife for all works,
fickle, timid, not independent, weak,
cruel, having bad characters, these all
are consider as Mrudu saadhakas.
Mantra yoga will be fit for this group
of people. With great efforts, such
person will get succeed in 12 years.2
Madhyama Saadhaka: Person who are
good in mind, merciful, desire to do
good thing, sweet in speech, normal
minded with his normal work. These
all are considered under Madhyama
saadhakas.
This group of people will be fit for
Laya yoga.3
Adhimatraka: Person who are steady
in mind, knowing to practice Laya
yoga, Independent, full of energy,
Magnanimous, full of sympathy,
forgiving, worshipping the teachers,
engaged always with yoga.
This group of people will be fit for
Practicing the Hata yoga and its
branches. They obtain success in yoga
within 6 years. 4

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IAMJ: Volume 4; Issue 04; March- 2016

Adhimatratama: Person who has


largest amount of energy, always
involving in good works, heroic, who
know the shastra, perceiving free from
effect of blind emotions, not easily
confused, who are in the prime of their
youth, moderate in their diet, who has
good rules over senses, fearless, clean,
skillful, charitable, forgiving, good
natured, religious, who keep their endeavor secret, sweet speech, peaceful
faith in scriptures, worshippers of guru
and god, who free from grievous work,
who acquired with the duties of
adhimatra. These all are consider as
adhimatra tama.
This group of people are fit for every
kind of Yoga, they obtain success in
3years. 5
DISCUSSION
Yoga is such a beautiful science which
gives the inner peace and heals the
body very easily. To practice the yoga
proper guidelines are required. Shiva
samhita explains very systematically
that, which paths of yoga is suitable for
which kind of persons.
Mrudu saadhakas may consider as
bad people who involving always in
bad activities and dont have control
over mind. For such people Mantra
yoga will be suitable. In mantra yoga
they
have
to
chant
mantra
continuously to attain Psychological
and spiritual mind power. by chanting
mantra satvika guna will increases and
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Dr. Nagraj G Bhat Et;Al: Paths Of Yoga For Different Saadhaka

rajo tamoguna will decreases. so that


person who having bad mind may
convert in to good by Positive inner
vibration.
Madhyama
saadhakas
may
consider as moderate minded
people, who involving in both good
and bad things equally. Laya yoga
is suitable for this group. Laya yoga
is also known as Kundalini yoga. It
focuses on awakening kundalini
energy by Meditation, Pranayama,
Mantra and Asanas. These yogic
techniques arouse the Kundalini
shakti
by
Ida,Pingala
and
Sushumna
nadis
at
6
Chakras.Kundalini Yoga can be
understood as a tri-fold approach of
Bhakti Yoga for devotion, Shakti
yoga for Power, And Rajayoga for
mental power and control.
Adhimatraka
Saadhakas
are
Superior than Madhyama sadhaka.
these people involve in good things,
and their intention will be good.
Hata yoga and its branches are
suitable to practice for this group.
In Hatayoga Asanas, pranayama,
Pratyahara, Dharana, Dhyana and
Samadhi are included. If one is
master over body then he can
control over Manas.
Adhimatratama Saadhakas are
most superior one. This group of
people are best in all aspects. They
have control over mind and senses.
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IAMJ: Volume 4; Issue 04; March- 2016

These people can practice all types


of Yoga, especially Smrati yoga.
CONCLUSION

Proper practice of Yoga may give


tremendous result in every aspects. But
every individual cant practice all
types of Yoga, specific path of yoga
should be followed for best result. For
this reason it is essential to understand
the Concept of Saadhakas. According
to that one has to choose their path of
Yoga. It can be combined in the
treatment of Ayurveda. Caliber and
capacity of the individual varies from
person to person, depending upon the
desire and capacity one can select the
path of yoga and attain the ultimate
aim of yoga that is Moksha-Salvation.
If Ayurveda and yoga going together
means success will be definite.
REFFERENCE:

1. Vachaspati mishra,shrinarayana
mishra.PatanjalaYogadarshana,
Bharateeya vidyaprakashana,
Varanasi 1960,Pp9
2. Raibahadur srisachandra vasu. The
Siva Samhita,Sri satguru
publications,new
delhi
nd
1984,2 edition,Pp54.
3. Raibahadur srisachandra vasu. The
Siva Samhita,Sri satguru
publications,new
delhi
nd
1984,2 edition,Pp54.
4. Raibahadur srisachandra vasu. The
Siva Samhita,Sri satguru

756

Dr. Nagraj G Bhat Et;Al: Paths Of Yoga For Different Saadhaka

publications,new
delhi
nd
1984,2 edition,Pp55.
5. Raibahadur srisachandra vasu. The
Siva Samhita,Sri satguru

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IAMJ: Volume 4; Issue 04; March- 2016

publications,new
delhi
nd
1984,2 edition,Pp55.

757

Research Article

International Ayurvedic Medical Journal

ISSN:2320 5091

ROLE OF SHILAJIT IN THE MANAGEMENT OF MADHUMEHA w.s.r. to


DIABETES MELLITUS
1
Trivedi Atal Bihari , Mahajan Nitin2, Mahajan Nikhil3, Gupta Poonam4.
1
Prof, HOD, PG Dept, of Kayachikitsa, 2Asst. Prof, 3Lecturer,4 P.G.Scholar,
JIAR, Jammu, India
ABSTRACT
Ayurveda, the science of life if followed and practiced appropriately keeps an individual hale and healthy. The Madhumeha is equated with the Diabetes Mellitus due to similarity
in etiology, pathology, symptoms and prognosis but different in the treatment. In the present
study we planned to get effective and safe treatment for Madhumeha with the help of clinical principles of Ayurveda. In the present study, 30 patients having Madhumeha were selected
from O.P.D. & I.P.D. of Jammu Institute of Ayurveda & Research College and Hospital,
Jammu. These patients were subjected to the following therapeutic regimen namely Shilajit.
Then assessment of therapy on signs and symptoms was done by adopting suitable scoring
methods and repeating laboratory investigations and critically analyzed. The results thus obtained finally were subjected for statistical analysis for the therapy. The end results thus obtained were interpreted and graded as complete remission, marked improvement, moderate
improvement and mild improvement and presented in details.
Keywords: Madhumeha, Shilajit, Ayurveda.

INTRODUCTION
Awareness about 'Health' and
approach of community towards
Ayurveda, in quest of 'Healthy Life'
is increasing. Its holistic approach,
its natural and mostly safe methods,
its potential for taking care of global
health needs, are getting recognized
globally. It has placed a new challenge in front of Ayurvedic society.
The challenge of medical practice
today is to identify individuals who
are at risk of developing disease,
determine the severity of disease
and
distinguish the
responders

from the non- responders (individualized -medicine).


Madhumeha, which is known
to world as Diabetes, is a global
health problem and receiving much
attention now-a-days. Sanskrit Literature from the times of 'Vedas' constitutes the description of Madhumeha. Ancient Ayurveda physicians like
Charaka, Sushruta, and Vagbhata
were well versed with many of the
nuances of this disease. Ayurvedic
classics contain ample literature
about Madhumeha and its treatment.
Madhumeha is a metabolic disorder

How to cite this URL: Dr. Trivedi Atal Bihari, Role of Shilajit in tyhe Management of Madhumeha W.S.R. To Diabetes
Mellitus. International Ayurvedic medical Journal {online} 2016 {cited 2016 April} Available from:
http://www.iamj.in/posts/images/upload/754_761.pdf

and is diagnosed mainly with the


Trivedi Atal Bihari Et;Al: Role Of Shilajit In The Management Of Madhumeha W.S.R. To Diabetes Mellitus

help of signs and symptoms related


to 'Mutra ' (Urine). Injudicious intake of food, sedentary life style,
stress, genetic predisposition is some
of the important etiological factors
of Madhumeha1.
Epidemiological figures indicative of prevalence of disease worldwide are growing day by day and major share of India is quite alarming.
According to data presented by
WHO, more than 220 million people
worldwide suffer from Diabetes.
Although prevalence of both Type-l
& Type-2 Diabetes is increasing
worldwide, the prevalence of Type2
Diabetes is spreading more rapidly in
developing countries because of increasing obesity, reduced activity levels & western style diet2. In 2010,
45.2 million people in India were
diabetic. By the end of 20l6, this
number will increase to 50.6 million.
This is likely to be 71.4 million in
2030 which will be 115th of the total
Diabetic population at that time. India has long passed the stage of epidemic& the number has given the
country the dubious distinction of
DIABETES CAPITAL OF THE
WORLD.
Global access of Diabetes is 1.
increasing. Various Oral hypoglycemic agents, Insulin formulations, life
style modification plans consisting
dietary management and exercise, 2.
are some of the important efforts towards the management of Diabetes.
Inspite of these, world is seeking for
a safer and effective remedy. Increased side effects, lack of effective
treatment for complications, high cost 3.
of new drugs and resistance to the
drugs are some reasons for renewed
public interest in Ayurvedic medi

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cines. So, now it's a duty of an Ayurvedist to try to understand the disease
and complications according to
Ayurveda and to establish our time
tested drugs as a prime therapy.
Taking into account the hazardous
nature of Diabetes and to establish
efficacy of Ayurvedic compounds,
present study entitled-"Role of
Shilajit in the Management of
Madhumeha
w.s.r.to
Diabetes
Mellitus" was undertaken. In Ayurveda it is said that there is not any
curable disease that can't be cured
with Shilajit. Shilajit has Rasayana
properties, in Madhumeha body acquires shaithilya & Shilajit is able to
improve quality of body tissues.
That is why Shilajit was selected for
this study3.
MATERIALS AND METHOD
Selection of patients: For the present
study, 30 patients with classical signs
and symptoms of Madhumeha and
patients who had blood glucose level
more than normal limits were selected
from OPD and I.P.D of Jammu Institute of Ayurveda and Research, Hospital.
Criteria for Diagnosis/ inclusion:
Patients were diagnosed on the basis
of classical signs and symptoms of
disease Madhumeha as per Ayurvedic
texts.
After diagnosis diabetes specific
biochemical investigations were carried out. Patients with F.B.S. level
more than 126mgldl and P.P.B.S.
level more than 200mg/dl were selected for study.
A detail proforma was filled consisting Signs and Symptoms, Complete
history of disease, Family history,
Dashavidha pariksha and Ashtavidha

IAMJ: Volume 4; Issue 04; March- 2016


Trivedi Atal Bihari Et;Al: Role Of Shilajit In The Management Of Madhumeha W.S.R. To Diabetes Mellitus

pariksha was filled for every patient


in favour to support the diagnosis of
disease.
4. In addition to this, following
laboratory investigations were
carried out Urine-Routine and
Microcsopic. Blood - Hb%,
TLC, DLC, ESR.
Exclusion Criteria:
1. Patients with Type 1 DM.
2. Patients with Type 2 DM who
were insulin dependent.
3. Patients above age of 65 yrs.
4. Patients with severe diabetic
complications like cardiovascular
diseases, n e p h r o p a t h y , and
retinopathy.
5. Diabetes due to endocrinopathies
e.g. Phaeochromocytoma, Acromegaly, Cushing's
syndrome,
Hyperthyroidism etc.
1.
Pregnancy i.e. gestational Diabetes mellitus.
1) Prabhuta Mutrata5 [Polyuria]:
Grade

Frequency

0
1

2
3
2)
Grade
0
1

3-5

3
3)
Grade

6-9

10-12
>12
6
Avilmutrata Turbidity
Clear urine.
slight turbidity
T urbidity clearly presents but news print can be read.
News print cannot be read (more turbid).
Trishnadhikya 7 {Polydipsia}:
Frequency

0
1
2
3

Therapeutic regimen: Patients were


randomly selected. All patients were
given Shilajit. In those patients who
were taking some oral hypoglycemic
agents, their blood sugar at that time
was considered as a basal level and
the patients were advised to take hypoglycemic drug in the same dose. Effect of study drug was observed in relation to the basal records of symptoms
and sugar levels.
Diet and Exercise: Patients were advised to take diet which is in dicated for
Madhumeha. Patients were encouraged for r e g u l a r , suitable exercise
and advised to avoid Apathya viharas4.
Criteria for Assessment: Effect of
the treatment was assessed by assessing- Signs and symptoms before
and after treatment. FBS, PPBS levels
before and after treatment.

Normal
Mild increased but tolerated
Moderate increased but tolerated
Severely increased but can't Tolerated

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IAMJ: Volume 4; Issue 04; March- 2016


Trivedi Atal Bihari Et;Al: Role Of Shilajit In The Management Of Madhumeha W.S.R. To Diabetes Mellitus

4)
Kshudhadhikya 8{Polyphagia} :
Grade
Frequency
0
Normal
1
Mild increased but tolerated
2
Moderate increased but tolerated
3
Severely increased but can 't tolerated
5) Kara-pada-tala-daha9(Burning sensation in hand & feet) :
Grade
Daha
0
No Daha
1
Occasionally noticed
2
Very often and regular activity not hampered
3
Whole day and regular activity hampered
10
6)
Daurbalya General debility):
Grade
Daurbalya
0
Can do routine work I exercise
1
Can do moderate exercise with hesitancy
2
Can do mild exercise only, with difficulty
3
Can 't do mild exercise either

BIOCHEMICAL PARAMETERS:
1.
Blood Sugar Level: Blood sugar level [BSL]-FBS:.125mgldl and PPBS200mgldl- were c o n s i d e r e d as base line. Improvement in blood sugar level of
each patient was calculated by below mentioned formulaImprovement in FBS (%) = Total BT- Total AT X 100 Total BT -125
Improvement in PPBS (%) = Total BT- Total AT X 100
Total BT-200
Results obtained from individual patient were categorized according to following
gradation pattern-
Grad Assessment
Criteria
No Improvement
Improvement
e0
No
Improvement in BSL < 25% or no change in
0
BSL
1
Mild Improvement
Improvement in BSL25%
(up to 50%)
2
Moderate Improvement
Improvement in BSL50% (up to 75%)
3
Marked Improvement
Improvement in BSL75%
4
Control
Blood sugar level within normal
RESULTS AND DISCUSSION

EFFICACY OF TREATMENT

Signs and Symptoms of Madhumeha.


Table 1: Effect on Prabhut Mutrata.

Mean Score
%Relief
S.D.()
S.E() t
p
B.T.
A.T.
N=26
2.42
0.5
79.33
1.05
0.19
9.7 <0.001
The table1 shows that mean initial score for Prabhuta mutrata was
2.42, which reduced to 0.5, showing 79.33% improvement. Statistical
analysis shows that the improvement was highly significant at P < 0.001.

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IAMJ: Volume 4; Issue 04; March- 2016


Table 2: Effect on Avila Mutrata

Mean Score

%Relief
S.D. () S.E. () t
p
B.T.
A.T.
N=4
0.21
0.21
0
0
0
Effect of therapy on Avila mutrata shows no improvement with unchanged mean (0.21).
Table 3: Effect on Kshudhadhikya
S.D.
S.E.
Mean Score





p
%Relief
t
B.T.
A.T.
()
()
N=20

1.71

0.67

60.23

0.88

0.16

6.22

<0.001

The mean score for Kshudhadhikya was 1.71 in the beginning, which reduced
to 0.67at the end of treatment, showing 60.23% improvement. Statistical
analysis shows that the improvement was highly significant givingt value
6.22.

Table4: EffectonTrishnadhikya:

N=26

Mean Score

S.D.

S.E

B.T.

A.T

%Relief

()

()

2.17

1.07

50.69

0.83

0.15

7.04

<0.001

Effect on Trishnadhikya reveals that B.T. mean score was 2.17 which reduced to 1.07
with 50.69% relief, giving 't' value of 7.04 which is highly significant at P <0.001.
Table 5: Effect on Kara-pada-tala-daha:
S.D.
S.E.

Mean Score





p
t
()
B.T.
A.T %Relief ()
N=14

0.71

0.54

33.7

0.47

0.08

1.98 >0.05

Effect on Kara-pada-tala-daha by this therapy was 33. 7%. The initial mean score was
0.71 which decreased to 0.54 after treatment giving 't' value of 1.98 which is insignificant at P>0.05.
Table 6: Effect on Daurbalya:

N=27

Mean Score
B.T.
A.T

2.1

69.5

0.64

%Relief

S.D.

S.E.

()
0.57

()
0.10

13.14

<0.001

Mean scores for Daurbalya before and after treatment were 2.1 and 0.64 respectively. It showed 69.5% relief with't' value 13.14 which is highly significant at P <
0.001.

Blood sugar levels:

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IAMJ: Volume 4; Issue 04; March- 2016

Table 7: Effect on F.B.S.


Mean Score %Relief

N=28

20.67

54.15

S.D.

S.E

()
9.6

()
1.8

11.2

<0.001

Mean score of improvement in F.B.S. calculated by formula, was 20.67 which shows
54.15% relief giving 't' value of 11.2 which is highly significant (P<O.001).
Table 8: Effect on P.P.B.S.

Mean
Score

% Relief

S.D.

S.E.

N=28

14.92

37.2

8.5

1.6

9.28

<0.001

Mean score of improvement in P.P.B.S., calculated by formula, was 14.92 which shows
37.2% relief giving 't' value of 9.28 which is highly significant (P<0.001).
OVERALL EFFECT OF THERAPY:
Table 9: Improvement In Signs and Symptoms

RESULTS
Patients
%
Controlled
1
3.57
Marked Improvement
3
10.7
Moderate Improvement
13
46.4
Improvement
11
39.28
Unchanged
0
0.00
1 patient (3.57%) assessed as controlled and 3 patients (10.7%) as Markedly Improved.
Moderate improvement was seen in 13 patients (46.4%) whereas Mild improvement was
observed in 11 patients (39.28%). All patients responded to treatment to some extent
and no patient assessed as unchanged.
Table 10: Improvement In Blood Sugar Level

RESULTS
Controlled
Marked Improvement
Moderate Improvement
Improvement
Unchanged

F. B.S.
Patients
7
6
8
1
5

%
25
21.4
28.6
3.6
17.85

P.P.B.S.
Patients
3
3
7
8
7

%
10.7
10.7
25.0
28.5
25.0

CONCLUSION
Secrets of healthy life are minutely
described
in
Ayurveda.
Dinacharya, Ritucharya, Annapanavidhi are some of these secrets11.

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Though it is true that modernization of


life style is responsible for the increasing prevalence of Madhumeha in
community, Madhumeha is known to
Acharyas since long and they were the

IAMJ: Volume 4; Issue 04; March- 2016

1.
2.
3.

1.

masters as far as the diagnosis and


treatment of Madhumeha
is concerned. Diabetes mellitus, a metabolic
disease described by Allopathic medical science, can be simulated with
Madhumeha.
Data presented by WHO is
quite indicative of increasing prevalence of DM (Madhumeha) in the
community. This is an effort to find
out an effective remedy for Madhumeha (DM), present study entitled.
Role of Shilajit in the Management of Madhumeha w.s.r. to Diabetes Mellitus was undertaken. Study
was persuaded in the direction of following Aims and ObjectivesTo study etiopathogenesis and symptomatology of Madhumeha and Diabetes mellitus simultaneously.
To assess the efficacy of Shilajit on
signs and symptoms of Madhumeha
[DM].
To assess the role o f Shilajiti on
diabetes specific biochemical

REFERENCES
Aruna Datta -Sarvangasundari
commentary on Asthanga Hridaya, Editor,
A.M. Kunte, Chaukhamba, 1982.

2. www.who.int
3. Ayurvediya Vyadhivijnana by Vd.
Jadavji Trikamji Acharya SriBaidyanath Ayurveda Bhavan Ltd., 3rd Edition, 1983.

760

www.iamj.in

4. Bhava Prakash Edited By Brahmashandar Mishra and Rupalalji Vasihya by


Chaukhambha Sanskrit Sansthana, Varanasi, 1990.
5. Bhavaprakash Nighantu- Edited by
K.C.Chunekara and Pandey G.S., 6 Edition, Chauhhambha Bharti Academy,
Varanasi-1982.
6. Charaka Samhita with Commentary of
Chakrapani, Editor Yadavaji Trikamaji
Acharya,
Chaukhambha
Sanskrit
Sansthana, 1994.
7. Charaka Samhita Edited by Dr.Ram
Karan Sharma & Vd.Bhagwan Dash.
Chaukhamba Sanskrit Series Office, 1st
Edition, 2001.
8. Chakradatta by Shri Chakrapanidatta, by
Shri Indudeva Tripathi, Chaukhambha
Sanskrita
Sansthana, First Edition,
1991.
9. Chikitsa-pradeepa by Vd. B.V.Gokhale.
Vaidyamitra Prakashana, Pune.
10. C.Dwarakanatha 'An introduction to
Kaya Chikitsa', Chaukhambha Orientalia, Varanasi, 2nd Edition,
11. Harita Samtita Edition by Ravidutta
Shastri, Kshemaraja Shrikrishnadas,
Bombay, 1927.
12. Kashyapa Samhita with Hindi Comm. By
Satyapala
Bhishagacharya,
Chaukhambha, Varanasi, 1988.
13. Madhava Nidana by Madhavakar with
Madhu Kosha and Vidyoting Commentary, Edited by S, Shastri and
Y.Upadnaya, Chaukhambha Sanskrit
Sansthana,

IAMJ: Volume 4; Issue 04; March- 2016


Research Article

International Ayurvedic Medical Journal

ISSN:2320 5091

A CLINICAL STUDY OF AN AYURVEDIC FORMULATION FOR THE


MANAGEMENT OF OBESITY
Chandan Singh1, Rashmi Sharma
1
HOD & Associate Professor, P.G. Dept. of Dravyaguna, 2Assistant Professor, Dept. of Prasuti &Stri Rog; Dr. S. R. Rajas than Ayurveda University
Jodhpur, Rajasthan, India
ABSTRACT
The incidence of obesity is increasing at alarming rates worldwide and India is no
exception. Obesity has now become an important health problem in developing countries
particularly in India, which is currently experiencing a rapid epidemiological transition.
Obesity has reached epidemic proportions in India in the 21st century, affecting 5% of the
country's population. In India 12.1% of males and 16% of females are obese. Obesity is
gaining more and more attention at globally. In Ayurveda literature many medicines were
indicated and one of the medicine is referred by the Sushrut Samhita (Sutra Sthan 15/38)
which contains Tri-phala, Guggulu, Rasanjan, Loha-bhasma, Shilajit, Madhu and Gomutra
and advised to mix in equal ratio to prepare the vati ( pill) ,for the treatment of obesity..
The 60 obesity patients between 14-50 yrs were selected and the prepared pill was administered for 90 days. The result shows that 53.33% improved and 46.67% moderately improved.
Key words: Obesity; Vati, Ayurveda, Sushruta Samhita
INTRODUCTION
Obesity is a global problem and
more prevalent in developing countries.
Overweight and obesity is the fifth leading risk for global health. At least, 2.8
million adults die each year as a result of
being overweight or obese. The International Obesity Task Force (IOTF-2005)
stated that more than 300 million people
worldwide classified as clinically obese;
having a BMI >30.1 Obesity and overweight occurs due to imbalance between
calories consumed and calories utilized.
Globally, there have been two reasons for
overweight and obesity:
1) An increased intake of energy-dense
foods that is high in fat, salt and sugars

but low in vitamins, minerals and other


micronutrients.
2) A decrease in physical activity due to
the increasingly sedentary nature of many
forms of work, changing modes of transportation, and increasing urbanization.2
Changes in dietary and physical activity
patterns are often results from sedentary
lifestyle, not sleeping enough, endocrine
disruptors, such as some foods that interfere with lipid metabolism, medications
that make patients put on weight.3
Morbid obesity has reached epidemic
proportions in India in the 21st century;
affecting 5% of the countrys population
and 12.1% males and 16.0% females are

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Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

obese or overweight. A large number of


and categorized this problem under Sanmedical conditions have been associated
tarpanajanita Vyadhi in Charak Samhita.5
with obesity. Obesity is a state in which
Sushrut Samhita also refers the Obesity
there is generalized accumulation of ex(sthaulya / medoroga) treatment in the
cess fat in the body leading to a body
sutra sthan under the heading Rasaweight of more than 20% of the required
nimittamev Stholyam Karshyam Cha.
weight. A recent National Institute of
In the chapter 15 and verse 32. 6
Health Conesus Conference defined obeMATERIAL AND METHODS This
sity as Body Mass Index greater than 27
study was conducted in the Department of
kg/m. Now a days obesity is defined at or
Dravyaguna, Dr. S. R. Rajasthan Ayurved
4
greater than 25 Kg/m BMI.
University, Jodhpur. For the present study
Obesity (sthaulya / medoroga) is defined
60 patients were selected from O.P.D. of
among the Ashta Nindatiya Purusha
its associated hospital.
(eight despised or undesirable physiques)
S
criteria
assessment Criteria
Scoring
N
1.

Chalasphika
(pendulous
buttock)

Chalaudarastana (pendulous abdomen)

Javoparodha /
alasya (laziness)

Krchchhrvyavayata (loss
of libido)

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Absence of chalatva
Little visible movement after fast movement.
Little visible movement even after moderate movement.
Movement after mild movement.
Movement even after changing posture
Absence of chalatva
Absence of chalatva
Little visible movement after fast movement.
Little visible movement even after moderate movement.
Movement after mild movement.
Movement even after changing posture
Absence of Alasya
Doing work satisfactory with initiation late in time
Doing work unsatisfactory with lot of mental pressure
& late in time
Not starting any work in his own responsibility, doing
little work very slow
Does not have any initiation & not wants to work even
after pressure
Unimpaired libido and sexual performance
Decrease in libido but can perform sexual act
Decrease in libido but can perform sexual act with difIAMJ: Volume 4; Issue 04; April - 2016

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Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

Nindradhikya
(excessive
sleep)

Daurgandhya
(bad smell)

Swedadhikya
(excessive
sweating)

Kshudadhikya
(excessive
hunger)

Trishadhikya
(excessive
thirst)

10

Shaithilya (fatigue)

11

Guruta / Anga
gaurava (heaviness)

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ficulty
Loss of libido and cant perform sexual act
Normal sleep 6-7 hrs/ day
Sleep up to 8hrs / day with Anga Gaurava
Sleep up to 8hrs / day with Anga Gaurava & Jrimbha
Sleep up to 10hrs / day with tandra
Sleep up to 10hrs / day with Tandra & Klama
Absence of bad smell
Occasionally bad smell limited to close areas difficult
to suppress with deodorants
Persistent bad smell felt from long distance is not suppressed by deodorant
Persistent bad smell felt from long distance even intolerable to the patient himself
Sweating after heavy work
Sweating after little work
Profuse sweating after heavy work
Profuse sweating after minimum work
Sweating even in resting condition
Person not at all taking food
Person taking food in less quantity once a day
Person taking food in less quantity twice in a day
Person taking food in moderate quantity twice in a day
Person taking food in excessive quantity twice or thrice
in a day
Normal thirst
Up to 1 lit. excess intake of water
1 to 2 lit. excess intake of water
2 to 3 lit. excess intake of water
More than 3 lit. intake of water
No fatigue
Little fatigue in doing hard work
Moderate fatigue in doing routine work
Excessive fatigue in doing routine work
Excessive fatigue even in doing little work
No heaviness in the body
Feels heaviness in the body but it does not hamper routine work
Feels heaviness in the body which hamper daily routine work
IAMJ: Volume 4; Issue 04; April - 2016

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Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

Feels heaviness in the body which hamper movement


3
of the body
Feels heaviness with flabbiness in all over body which 4
cause distress to the person
12
Kshudra Svasa Dyspnoea after heavy work (movement) but relieved
0
(dyspnoea)
soon and up to tolerance
Dyspnoea after moderate work but relived later and up 1
to tolerance
Dyspnoea after little work but relieved later and up to
2
tolerance
Dyspnoea after little work but relieved later and be3
yond tolerance
Dyspnoea in resting condition
4
13
Snigdha Gatra Normal snigdhata
0
(oiliness)
Oily luster of body in summer season
1
Oily luster of body in dry season
2
Excessive oily luster of body in dry season which can
3
be removed with difficulty
Persistence and profuse stickiness all over body
4
14
Vyayama AsaCan do routine exercise
0
hatva (intolerCan do moderate exercise without difficulty
1
ance)
Can do only mild exercise
2
Can do only mild exercise with very difficulty
3
Can do even mild exercise
4
Drug material For the study the drug,
accordance to Vati kalpana preparation
Sushrut Samhita referred in the sutra
methodology the pills were made.
sthan under the chapter 15 and verse 32
Selection of patients The patients of obesity were selected according to the followwas selected from the Ayurvedic literaing criteria.
ture which contains Tri-phala (TermiA. Inclusion criteria:
nalia chebula,Terminalia belerica, Embel1. The patients of age group 14-50yrs
ica officinalis), Guggulu(Commiphora
were selected.
wightii), Rasanjan(Berberis aristata), Lo2. The patients having clinical signs and
ha-bhasma, Shilajit(Ashphaltum punjabisymptoms of obesity according to
Ayurveda and modern science.
num), Madhu (honey) and Gomutra (cow
3.
Patients whose B.M.I. >25 but <45
urine).
were considered for the study.
The ingredients of this preparation were
B. Exclusion criteria:
procured from open market with authenti1. Patients below the age of 14 years and
cation and identification. It has been
above 50 years.
transferred the University college of
2. Patients with Hypothyroidism.
Ayurveda pharmacy under job card num3. Patients with long term Steroid
treatment.
ber 184/18-01-08. All these drugs were
taken in same quantity of 1.2 kg each. In

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IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

4. Patients having CHD, IHD and highly


obese and evidence of Renal, Hepatic
involvement.
5. Patients with Diabetes mellitus.
6. Patients having history of hereditary.
7. The patients having B.M.I.>45were
also excluded.
C. Assessment criteria: Assessment includes both objective and subjective criteria
(I) Objective criteria:
The assessment criteria were B.M.I., girth
measurement of Chest Abdomen - Hip Mid thigh - Mid arm & Biochemical test
i.e. S. cholesterol and S. triglycerides. In
case of all circumference measurements,
the mean values were taken before and
after treatment. The body wt. was also
taken before and after treatment.
(II) Subjective criteria:
Most of the symptoms and signs of obesity (sthaulya), described in Ayurveda, are
subjective in nature and to give results
objectively and for statistical analysis,
multidimensional scoring system was
adopted. This score was obtained before
and after treatment through statistical
analysis and percentage relief was taken
to assess the efficacy of medicine. The
scores were given 0-4 according to severity of signs andsymptoms. (Table 1) Scoring was adopted from the previous study
Rajput et al. 7
Dose schedule The human dose of VATI
is : one-two pills.

Symptoms

Chalasphika (pendulous
buttock)
Javoparodha / alasya
(laziness)
Krchchhrvyavayata
(loss of libido)
Nindradhikya (excessive
sleep)
Daurgandhya (bad

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Diet and exercise Patients were advised


to
Dos- to take normal diet with increased
amount of vegetable salad such as cucumber, cabbage etc and do some exercise like walking, running.
Donts avoid fatty diet i.e. fried spicy
food, cold drinks, ice creams, chocolate
and day sleeping is strictly avoided.
Total effect of the therapy Total effect
of the therapy was assessed in terms of
cured, markedly improved, moderately
improved, moderately improved, improved and unchanged with the following
accounts.
1. Cured 100% relief in signs and symptoms.
2. Markedly improved more than 75%
reduction in the score of assessment rating
scale.
3. Moderately improved 50% to 75%
reduction in the score of assessment rating
scale.
4. Improved 25% to 50% reduction in
the score of assessment rating scale.
5. Unchanged Less than 25% reduction
in the score of assessment rating scale.
Statistical test Unpaired t test was used
to analyze the results.
Table 1: Subjective Criteria for Assessment
Observation:
Table: - 2 Observation of Sushrut Samhita referenced preparation as a pill
GroupA
Dif.

% of
Change

SD

SE

20

Mean
BT AT
2.40 1.45

0.95

39.58

0.22

0.05

19.00

<0.001

20

1.50

0.55

0.95

63.33

0.39

0.09

10.78

<0.001

20

1.25

0.60

0.65

52.00

0.59

0.13

4.95

<0.001

20

2.35

1.05

1.30

55.32

0.66

0.15

8.85

<0.001

20

1.60

0.50

1.10

68.75

0.72

0.16

6.85

<0.001

IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

smell)
Swedadhikya (excessive
sweating)
Kshudadhikya (excessive hunger)
Trishadhikya (excessive
thirst)
Shaithilya (fatigue)

20

2.35

0.95

1.40

59.57

0.60

0.13

10.47

<0.001

20

2.70

1.10

1.60

59.26

0.75

0.17

9.49

<0.001

20

2.45

1.15

1.30

53.06

0.47

0.11

12.37

<0.001

20

1.70

0.65

1.05

61.76

0.39

0.09

11.92

<0.001

Guruta / Anga gaurava


(heaviness)
Sukumarata (Softness)

20

1.75

0.35

1.40

80.00

0.82

0.18

7.63

<0.001

20

1.80

0.90

0.90

50.00

0.55

0.12

7.28

<0.001

Ayathopachaya (Irregular Metabolism)


Udar vriddhee (Abdomen increase)
Vyayam Asahatv (Intolerance to Physical Exercise)
Krinthan (Spasm)

20

1.05

0.60

0.45

42.86

0.60

0.14

3.33

<0.001

20

2.55

1.05

1.50

58.82

0.51

0.11

13.08

<0.001

20

1.55

0.65

0.90

58.06

0.55

0.12

7.28

<0.001

20

1.05

0.55

0.50

47.62

0.51

0.11

4.36

<0.001

Kshudra Svasa (dysp20 2.15 0.95 1.20


55.81
0.52 0.12 10.26 <0.001
noea)
Table: - 3 Observation of Sushrut Samhita referenced preparation as a pill Group B
Symptoms

Dif.

% of
Change

SD

SE

20

Mean
BT AT
2.35 1.95

Chalasphika (pendulous
buttock)
Javoparodha / alasya (laziness)
Krchchhrvyavayata (loss
of libido)
Nindradhikya (excessive
sleep)
Daurgandhya (bad smell)

0.40

17.02

0.50

0.11

3.56

<0.05

20

1.90

1.60

0.30

15.79

0.47

0.11

2.85

<0.05

20

1.30

0.95

0.35

26.92

0.49

0.11

3.20

<0.05

20

2.50

2.05

0.45

18.00

0.51

0.11

3.94

<0.05

20

1.80

1.40

0.40

22.22

0.50

0.11

3.56

<0.05

Swedadhikya (excessive
sweating)
Kshudadhikya (excessive
hunger)
Trishadhikya (excessive
thirst)
Shaithilya (fatigue)

20

1.90

1.55

0.35

18.42

0.49

0.11

3.20

<0.05

20

2.00

1.55

0.45

22.50

0.51

0.11

3.94

<0.05

20

2.70

2.35

0.35

12.96

0.49

0.11

3.20

<0.05

20

2.20

1.65

0.55

25.00

0.60

0.14

4.07

<0.05

Guruta / Anga gaurava


(heaviness)
Sukumarata (Softness)

20

1.95

1.55

0.40

20.51

0.50

0.11

3.56

<0.05

20

2.10

1.65

0.45

21.43

0.51

0.11

3.94

<0.05

Ayathopachaya (Irregu-

20

1.50

1.15

0.35

23.33

0.49

0.11

3.20

<0.05

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IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

lar Metabolism)
Udar vriddhee (Abdomen
increase)
Vyayam Asahatv (Intolerance to Physical Exercise)
Krinthan (Spasm)

20

2.30

1.90

0.40

17.39

0.50

0.11

3.56

<0.05

20

2.50

2.05

0.45

18.00

0.51

0.11

3.94

<0.05

20

1.60

1.20

0.40

25.00

0.60

0.13

2.99

<0.05

Kshudra Svasa (dyspnoea)

20

1.95

1.45

0.50

25.64

0.51

0.11

4.36

<0.001

Table: - 4 Observation of Sushrut Samhita referenced preparation as a pill Group C


Symptoms

Dif.

% of
Change

SD

SE

20

Mean
BT AT
1.95 1.80

Chalasphika (pendulous
buttock)
Javoparodha / alasya (laziness)
Krchchhrvyavayata (loss
of libido)
Nindradhikya (excessive
sleep)
Daurgandhya (bad smell)

0.15

7.69

0.37

0.08

1.83

>0.10

20

1.90

1.70

0.20

10.53

0.41

0.09

2.18

>0.10

20

1.00

0.90

0.10

10.00

0.45

0.10

1.00

>0.10

20

2.35

2.20

0.15

6.38

0.37

0.08

1.83

>0.10

20

1.60

1.25

0.35

21.88

0.49

0.11

3.20

<0.05

Swedadhikya (excessive
sweating)
Kshudadhikya (excessive
hunger)
Trishadhikya (excessive
thirst)
Shaithilya (fatigue)

20

2.25

1.95

0.30

13.33

0.47

0.11

2.85

<0.05

20

2.15

1.95

0.20

9.30

0.41

0.09

2.18

>0.10

20

2.45

2.10

0.35

14.29

0.49

0.11

3.20

<0.05

20

2.20

1.90

0.30

13.64

0.47

0.11

2.85

>0.10

Guruta / Anga gaurava


(heaviness)
Sukumarata (Softness)

20

1.65

1.30

0.35

21.21

0.49

0.11

3.20

<0.05

20

1.70

1.55

0.15

8.82

0.37

0.08

1.83

>0.10

Ayathopachaya (Irregular
Metabolism)
Udar vriddhee (Abdomen
increase)
Vyayam Asahatv (Intolerance to Physical Exercise)
Krinthan (Spasm)

20

1.40

1.15

0.25

17.86

0.44

0.10

2.52

>0.10

20

2.30

2.00

0.30

13.04

0.57

0.13

2.35

>0.10

20

1.70

1.50

0.20

11.76

0.41

0.09

2.18

>0.10

20

1.25

1.10

0.15

12.00

0.37

0.08

1.83

>0.10

Kshudra Svasa (dyspnoea)

20

2.15

1.80

0.35

16.28

0.49

0.11

3.20

<0.05

Table :- 5 Observation of Sushrut Samhita referenced preparation as a pill on the basis of


BMI changes Group A
BMI ObservaN
Mean
Dif.
% of
SD
SE
t
p

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IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

tion on
Body Weight
BMI
Neck
Arm
Back
Abdomen

20
20
20
20
20

BT
76.95
31.56
36.08
32.35
104.60

AT
72.53
29.50
34.08
29.85
101.25

20

100.50

95.10

4.43
2.05
2.00
2.50
3.35

Change
5.75
6.51
5.54
7.73
3.20

1.73
0.96
0.74
0.99
1.88

0.39
0.21
0.17
0.22
0.42

11.46
9.61
12.03
11.33
7.98

<0.001
<0.001
<0.001
<0.001
<0.001

5.40

5.37

2.95

0.66

8.19

<0.001

Hips
20 109.20 104.35 4.85
4.44
2.82 0.63 7.68 <0.001
Thai
20 60.30
57.80 2.50
4.15
0.79 0.18 14.07 <0.001
Table: - 6 Observation of Sushrut Samhita referenced preparation as a pill on the basis of
BMI changes Group B
Symptoms
N
Mean
Dif. % of Change
SD
SE
t
p
BT
AT
Body Weight 20 77.60
74.20 3.40
4.38
5.36 1.20 2.83 <0.05
BMI
20 31.25
28.86 2.39
7.63
3.27 0.73 3.27 <0.05
Neck
20 34.50
33.88 0.63
1.81
0.72 0.16 3.86 <0.05
Arm
20 31.20
29.58 1.63
5.21
2.18 0.49 3.34 <0.05
Back
20 102.63 101.75 0.88
0.85
1.05 0.23 3.73 <0.05
Abdomen
20 97.75
95.65 2.10
2.15
1.73 0.39 5.43 <0.05
Hips
20 108.95 105.48 3.48
3.19
4.21 0.94 3.69 <0.05
Thai

20

56.95

54.13

2.83

4.96

2.99

0.67

4.23

<0.05

Table :- 7 Observation of Sushrut Samhita referenced preparation as a pill on the basis of


BMI changes Group C
Symptoms

Dif.

% of Change

SD

SE

20
20
20
20

Mean
BT
AT
76.85
76.15
30.92
30.59
35.08
34.93
31.60
30.58

Body Weight
BMI
Neck
Arm

0.70
0.33
0.15
1.03

0.91
1.07
0.43
3.24

1.44
0.61
0.40
2.65

0.32
0.14
0.09
0.59

2.18
2.41
1.67
1.73

>0.10
<0.05
>0.10
>0.10

Back

20

102.28

100.25

2.03

1.98

3.85

0.86

2.35

<0.05

Abdomen

20

95.55

94.75

0.80

0.84

2.86

0.64

1.25

>0.10

Hips

20

107.50

105.00

2.50

2.33

5.75

1.29

1.94

>0.10

Thai

20

59.48

57.78

1.70

2.86

3.99

0.89

1.90

>0.10

Table: - 7 Observation of Sushrut Samhita referenced preparation as a pill on the basis of


Biochemical changes Group A
Symptoms
N
Mean
Dif.
% of
SD
SE
t
p
Change
BT
AT
Hbgm%
20 12.63
13.03
0.40
3.17
0.45 0.10 3.99 <0.05
Triglesride
20 168.37 163.90 4.47
2.65
27.25 6.09 0.73 >0.01
TLC

764

20

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161.93

149.95

11.97

7.39

IAMJ: Volume 4; Issue 04; April - 2016

15.45

3.45

3.47

<0.05

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

HDL

20

53.53

60.46

6.92

12.93

5.29

1.18

5.85

<0.001

LDL

20

98.54

86.54

12.00

12.18

7.84

1.75

6.84

<0.001

VLDL

20

28.21

26.81

1.40

4.96

2.40

0.54

2.61

<0.05

Table: - 8 Observation of Sushrut Samhita referenced preparation as a pill on the basis of


Biochemical changes Group B
Symptoms
N
Mean
Dif.
% of
SD
SE
t
p
Change
BT
AT
Hbgm%
Triglesride

20
20

12.85
170.63

13.18
164.43

0.33
6.20

2.53
3.63

0.40
17.52

0.09
3.92

3.61
1.58

<0.05
>0.10

TLC
HDL

20
20

160.89
54.53

149.74
59.28

11.15
4.74

6.93
8.69

12.94
5.72

2.89
1.28

3.85
3.71

<0.05
<0.05

LDL

20

92.47

87.80

4.66

5.04

9.40

2.10

2.22

<0.05

VLDL

20

28.12

26.69

1.44

5.10

2.66

0.59

2.41

<0.05

Table: - 9 Observation of Sushrut Samhita referenced preparation as a pill on the basis of


Biochemical changes Group C
Symptoms

N
20
20

Mean
BT
AT
12.64
12.73
169.09 166.35

Hbgm%
Triglesride
TLC

20

159.42

HDL

20

52.20

Dif.

SD

SE

0.09
2.75

% of
Change
0.71
1.62

0.24
4.15

0.05
0.93

1.66
2.96

>0.10
<0.05

157.90

1.52

0.95

6.18

1.38

1.10

>0.10

53.25

1.05

2.01

1.51

0.34

3.11

<0.05

LDL
20
93.54
90.63 2.91
3.11
3.47 0.77 3.75
<0.05
VLDL
20
27.99
26.42 1.58
5.63
2.85 0.64 2.47
<0.05
RESULTS: Totally 60 patients were
significant (P<0.001). The effect of trialed
treated with study drug and completed the
drug was 53.33% of patients improved
full course of three month of treatment
and 46.67% of moderately improved.
duration. The data related to the im
provement in the signs and symptoms

were individually summarized in the TaDISCUSSION
ble 1,2,3,4. The analysis of objective
In the present study, the antimeasurements of BMI is shown in Table obesity (Medohara) effect of group of a
5,6,7. and biochemical test are shown in
drugs which is reffered in Sushrut SamTable 8-10.
hita the - Tri-phala (Terminalia chebuResults of therapy were assessed mainly
la,Terminalia belerica, Embelica officion the basis of adopted score. Statistically
nalis)), Guggulu(Commiphora wightii),
highly significant improvement can be
Rasanjan(Berberis
aristata),
Lohanoticed in excessive sleep (62.27%),
bhasma, Shilajit(Ashphaltum punjabiheaviness in body (61.25%), fatigue
num), Madhu (honey) and Gomutra (cow
(60.80%) and excessive hunger (58.06%).
urine) was studied.
Reduction in weight is statistically highly

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IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

Obesity is considered to be a disorder of


energy balance, occurring when energy
expenditure is no longer in equilibrium
with daily energy intake, so as to ensure
body weight homeostasis. Although the
etiology of obesity is complex, dietary
factors, particularly the consumption of an
atherogenic diet, is considered a risk factor for its development.8 It is well known
that obesity is associate with increased
adipose tissues accumulation in the body.
In Ayurveda the role of Agni (digestive
fire) is quite relevant to life and responsible factor for maintenance of health, digestion and metabolism from gross to
subtle level. Diminished function of Agni
is responsible for formation of Ama, i.e.
an unwanted metabolic waste product at
respective level. Ama has tendency to
block the micro-channels (srotorodha),
i.e. Medovaha srotasa, and increases Ama
Meda resulting to obesity.9
The action of Ayurvedic drugs is proportionate to the Panchabhautika composition
which in turn is responsible for Rasa
(taste), Guna (properties), Virya (potency), Vipaka (post digestive) and Prabhava
(specific action) of the respective drugs.
Vachadi Churna consists of six drugs.
Properties of this formulation in combined form is bitter and pungent in Rasa,
Ushna Virya (hot potency), Katu Vipaka,
Laghu (light), Tikshana (penetrating nature) and Ruksha Guna (dryness) and
Medohara properties10 and exhibit the
Kapha-Vata shamaka, Lekhaniya (scraping), Amapachana, Dhatushoshana properties which decrease the excessive
Kapha, improves the digestion and clears
the obstruction in fat deposition and reduces the excessive fat.11
The efficacy of most herbal remedies is
attributed to the combination of various
active principles. Here it may be due to

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the presence of phytochemicals Ascorbic


acid, Limonene, Pectine, Zinc, Shogaol.
A study shows that pectin delays gastric
emptying and induces satiety in obese patients and it may be useful adjuvant in the
treatment of obesity 12 and an animal
study shows that Pectin inhibits lipids accumulation in the adipocytes.13




REFERENCES
1. Paul P, Thomas D, Giles, George AB,
Yuline H, Judith, et al. Obesity and
cardiovascular disease: Pathophysiology, evalutaion and effect of weight
loss. American Heart Association
2006; 113: 898-918.
2. Anonymous. Obesity Preventing and
Managing the Global Epidemic, Report of a WHO Consultation (WHO
Technical Report Series 894). World
Health Organization; 2000.
3. Worldwide Obesity Trends Globesity.
[Retrieved
from:http://www.annecollins.com/obesity/c
auses-of-obesity.htm on: 02/10/2012]
4. Buchake Aanand, et al. An assessment
of the activities of Ruksha Guna w.s.r.
to Sthaulya. (PG Dissertation). Jamnagar: I.P.G.T.&R.A.; 2002.
5. Caraka. Carak Samhita. Shastri KN,
Chaturvedi GN, editor. 13th ed. Varanasi: Chaukhamba Sanskrit series;
1986.p.407.
6. Sushrut. Sushrut Samhita, Nibandha
Sangraha Commentary by Dullhan,
editor Priyavrat Sharma, Chokhamba
Orientalia, Varanasi, 2009, p 73
7. Rajput AS, et al. A pharmaceuticopharmaco-clinical study on Guggulu
w.s.r. to Medohar effect. (PG dissertation). Jamnagar: I.P.G.T.&R.A.;2003.
8. Dhyani SC. Dravya Guna Siddhanta,
1st ed. Varanasi: Krishna Das Academy; 1986. p. 54.

IAMJ: Volume 4; Issue 04; April - 2016

Chandan Singh & Rashmi Sharma: A Clinical Study Of An Ayurvedic Formulation For The Management Of Obesity

9. Charaka. Charak Samhita. Shastri KN,


Chaturvedi GN, editors. 1st ed. Varanasi: Chaukhambha Bharati Academy; 1998.p.411.
10. Vagbhata. Astanga Hridayam. Tripathi
B, editor. 1st ed. Delhi: Chaukhamba
Sanskrit Pratishthan; 2007. p.201.
11. Sharma P.V. Dravyaguna Vigyana,
Vol.I. 1st ed. Varanasi: Chaukhambha
Bharati Academy; 1998.p.184-185.
12. Williams CM, Hajnal F, Di Lorenzo
C, Valenzuela JE. Pectin delays gastric emptying and increases satiety in
obese subjects. Gastroenterology
1988; 95(5): 1211-5.
13. Kwon JY, Park KY, Cheigh HS, Song
YO, et al. The beneficial effects of
pectin on obesity in vitro and in vivo.
Journal of the Korean Society of Food
Science and
Nutrition 2005; 34(1): 13-20.

767

www.iamj.in

CORRESPONDING AUTHOR
Dr. Chandan Singh
HOD & Associate Professor
Dr. S. R. Rajas than Ayurveda University
Jodhpur, Rajasthan, India
Email: chandan_singh4@yahoo.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; April - 2016

Review Article

International Ayurvedic Medical Journal ISSN:2320 5091

LIFESTYLE MANAGEMENT BY SADVRITTACHARANA


1

Aphale Vaibhavi M., 2Gokhale Vivek


1,2
P G Department of Dravyaguna, B.V.D.U.C.O.A. PUNE.
ABSTRACT
With rapid economic development and increasing westernisation of lifestyle in past few decades, prevalence of Lifestyle Disorders such as Hypertension, DM, Arthritis, Obesity associated with Cardiovascular disorders, PCOD, Cancer etc. have risen alarmingly in recent years
due to Stress, Sedentary lifestyle etc. Ayurveda is a life science which describes ways to prevent Lifestyle disorders in the form of proper dietary management, lifestyle advices etc. In
cases where already diseases have taken place various medicinal treatments & Panchakarma
are advised in Ayurveda.
Ayurveda has explained importance of Sadvrittacharana by following Dinacharya & Rutucharya which helps in prevention of any kind of diseases which may take place in future.
Main reason behind any disease is Mithya, Hina or Atiyoga of Kaala, Artha & Karma. Also
not following basic rules of Dinacharya, Rutucharya, Vega dharana leads to vishama avastha
of Doshas which ultimately results in Roga/Disease. In Brihattrayi, each stage of Dinacharya
(Daily regime), their uses etc. Rutucharya i.e rules to be followed according to Rutu (Seasonal regime), Dos & Donts for each Season has been specifically mentioned; also Panchakarma & Rasayana chikitsa for specific disease has been explained.
This paper deals in length about following Dinacharya, Rutucharya, Aachar Rasayana as explained in Ayurveda, in day to day life for prevention of Lifestyle diseases.
Keywords Lifestyle diseases, Ayurveda, Sadvrittacharana.

INTRODUCTION
LIFESTYLE DISEASES Diet & Lifestyle are the major factors to
influence susceptibility of many diseases.
PCOD, DM, Carcinoma, Arthritis, Renal failure, Atherosclerosis, Hypertension etc. are the diseases which has
emerged as Lifestyle diseases due to westernization, extreme stress & ignorance of
Health.
Causes of Lifestyle diseases- A sedentary
lifestyle combined with an increase in the

consumption of fatty food and alcohol is to


blame

Lifestyle diseases are a result of an inappropriate relationship of people with their


environment.
Onset of these lifestyle diseases is insidious, delayed development, and they are
difficult to cure.
Aim of Ayurveda:
Aim of Ayurveda: It is of 2 types Preventive & Curative aspect.
Prevention of
Lifestyle diseasesAyurveda insists on preventing diseases,
either physical or mental - first.

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Dr. Vaibhavi M. Aphale & Dr. Vivek Gokhalelifestyle Management By Sadvrittacharana

Accordingly in Charaka samhita the first


Adhyaya or chapter in Chikitsasthana is
written about Rasayana to prevent
diseases. Even in Sutrasthana the concepts
of Swasthvrutta are discussed within first
10 Adhyaya or chapters. It indicates the
importance of prevention of diseases over
their treatment.
Cause of any Disease according to Ayurveda Asatmendriyartha Samyoga
Pradnyaparadha
Parinama i.e Kaala
These
3
are
the
vikalpa,
Heena/Mithya/Atiyoga of above Hetu results
in Vyadhi utpatti.
Asatmendriyartha
SamyogaHeena/Mithya/Atiyoga of any Indriya &
Indriyartha, leads to diseases related to
that respective Indriya such as Atiyoga of
Rasanendriya due to Atibhojana may lead
to Vyadhis such as Ajeerna, Chardi,
Atisara etc.
Pradnyaparadha: Vegavarodha, Ati-sahasa sevana, Mithyoga of Panchakarma,
Ati-maithuna, Sadvritta tyaga such Hetu
sevana leads to Raja-Tamo guna vriddhi
resulting in various diseases.
Parinama
(Kaala)Heena/Mithya/Atiyoga of Lakshana of
Kaala i.e Shadrutu leads to various diseases.
Out of above 3 Hetu,
Parinama(Kaala) is a Nishpratikriya Hetu
i.e it is not in our hands but remaining 2
Hetu (Asatmendriyartha Samyoga &
Pradnyaparadha),
can be avoided by
Sadvrittacharana, so diseases could be
avoided. Preventive aspect includes, rules
mentioned in
Trayopastambha. Rules related to Aahar,
Nidra & Brahmacharya.
Aahar includes Aahar vidhi, Matrayukta
Aahar sevana, knowledge of Hitakara &
Ahitakara Dravya, Virruddha Anna etc.
Rasa related to Aahar & Aushadhi Dravya
are responsible for Swasthya. So proper
use of Shadrasa is insisted by considering
Prakriti, Satmyasatmya, Viruddha etc.
Such as, Vata Prakriti has affinity for

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Madhura, Amla & Lavana Rasa; Pitta Prakriti has affinity for Madhura, Tikta &
Kashaya Rasa; Kapha Prakriti for Katu,
Tikta & Kashaya Rasa.
In Charaka Samhita Sutrasthana, Hitakara
& Ahitakara Dravya are specifically mentioned. Following this advice will lead to
maintainance of Health. Also Agrya Sangraha is mentioned by Acharya in which
Uttama/Agrya Karma of specific Dravyas
have been mentioned.
Dietic Incompatibility i.e concept of Viruddha should also be considered as these
days it is the main cause for various diseases.
Rules related to Nidra, Maithuna are explained in Ratricharya & Sadvritta.

SADVRITTACHARANA
cludes,

it in-

Dinacharya (Daily Regime)


Rutucharya (Seasonal Regime)
Sadvritta i.e Aachar Rasayan
Dinacharya & Rutucharya are described
for maintainance of Physical Health while
Sadvritta is described for maintainance of
sound mental health .
Main Aim for adapting these conducts is
to maintain Dosha in Samyavastha. With
the help of samyak Rasa sevana this equilibrium can be maintained.
Dinacharya- Scientific evidences are
available emphasising importance of
Dinacharya in ones life. Following are
various Vidhi which should be included in
Daily regime.
Dantadhavana-It is adviced to clean
teeth & oral cavity early morning by herbs
which are Kashaya-Tikta-Katu rasatmaka.
As these rasa are Kaphahara & Keldaghna
they help in pacifying Kapha Dosha. So, in
day to life it can be related as toothpaste
which are Madhura rasatmaka should be
avoided. As it will negate the main purpose of Dantadhavana.
Anjana Use of Sauveeranjana & Rasanjana is adviced to maintain health of Eyes.

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Vaibhavi M. Aphale & Dr. Vivek Gokhalelifestyle Management By Sadvrittacharana

Dhoomapana, Gandusha - Doomapana


is also indicated in Kaphavata Avastha by
Katu-Tikta-Kashaya Rasa dravya mainly.
Abhyanga Daily Abhyanga is adviced
as it is Jara-Shrama-Vatahara, Pushtikara,
Tvachya, Sharir Dardhyakrita.
Vyayama - Vyayama should be done as
Ardhashakti.
Udvartana - Udvartana is the application
or rubbing of dry Choorna or powder on
the skin externally.Udvartana is for Medoghna-Twakprasadana action by KatuTikta-Kashaya Rasa dravya like Musta
etc. as these are Kaphahara in nature.
Snana Snana relieves stiffness, causes
Vata Shamana.
Many Panchakarma procedures are included in Dinacharya such as Nasya,
Dhoomapana, Anjana etc. Inclusion of
these karma in daily regime specifies their
importance in Prevention of diseases.
Rutucharya
In Ayurveda,
the
knowledge
of Rutucharya is a first hand guide to the
concept which describes the modes and
stages of the development of diseases,
with regard to the state of different DoshasVata, Pitta, and Kapha in accordance with the changes in Rutu. A
good understanding of it, is very much essential for early diagnosis and prognosis of
any disease & for adopting preventive and
curative measures.
It is to be known that disharmony in
the DoshasVata, Pitta,
and Kapha results in Roga (disease). And
aim of Ayurveda is to maintain this harmony. With changes in diet and lifestyle,
there are changes in the state of Tridosha,
resulting in disharmony, causing lifestyle
diseases. Rutu
acts
as Vyanjaka or Nimittakarana in the aggravation and manifestation of disease.
Shadrutu as explained in our Samhitas are
observed in Indian Sub-continent only. So
Dosha avastha such as Sanchaya, Prakopa,
Prasara according to Rutu as stated in
Ayurveda & treatment according to it
should be followed. In other continents,

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seasons are different so accordingly by


minute observations related to Dosha
dushti, their lakshana, avastha should be
taken into account.

Rutucharya also shows many important principles of correlation of


Rasa-Dosha. Each Rutu shows the
dominance of a specific Rasa.
Shishira-Vasant-Greeshma belongs to
Aadanakala as the Bala or energy level
is diminishing day by day. On the
contrary,
Varsha-Sharada-Hemant
belongs to Visargakala as the Bala is
getting aggravated gradually. So the
dominance of Rasa is present as follows-

Shishira Tikta
Vasanta - Kashaya
Grishma Katu
Varsha - Amla
Sharad - Lavana
Hemanta Madhura
So, consuming specific Rasa & avoiding
Aahar with specific Rasa according to
Rutu should be followed. If not, it may result in Dosha dushti. Such as in Sharad
Rutu, Lavana Rasa dominance can be seen
due to Aatapa, resulting in Pitta prakopa
hence to pacify Pitta, Madhura-TiktaKashaya rasa are adviced as chikitsa.
Similarly, in Vasanta Rutu Kapha prakopa
takes place hence Kaphaghna rasa such as
Tikta-Katu-Kashaya are adviced in diet.
Sheeta, Snigdha, Guru & Madhura rasatmaka aahar is adviced to be avoided as it
can furthur cause Kaphaja Vyadhi.
With global warming and variation in the
advent of season, it can surely be a query,
of the importance of Rutucharya in the
present scenario. It is to be understood that
the background on which Rutucharya is
based,
that
is, Dosha and Panchamahabhuta theory.
Although today Rutu do not follow uniformity, the level of Dosha dushti
and Panchamahabhuta lakshana can be
analyzed accordingly, to decide the regi-

IAMJ: Volume 4; Issue 04; March- 2016

Dr. Vaibhavi M. Aphale & Dr. Vivek Gokhalelifestyle Management By Sadvrittacharana

men, this knowledge of Ayurveda will be


the pathfinder.
Sadvritta: Sadvritta means physical & mental
decorum which should be followed by everyone on daily basis. In Charak Samhita Sutrasthan detailed description of Sadvritta has
been stated. In which
Behavioural Dos & Donts
Eating etiquettes
Social rules
Rules for Study, Havana Karma
Guidelines for Chastity etc.
In Indriyopakramaniya adhyaya Acharya
Charak has explained the importance of
Sadvritta as by following these rules one
will lead a healthy life without suffering
from any diseases also For Moksha prapti
Sadvritta should be followed.
It can be interpreted as by following these
rules a man can achieve all his goals with
sound mind & body.
Aachar Rasayana is behavioural conduct
i.e Sadvritta following it acts as Rasayana
on our body & mind.
In Charak Samhita Chikitsasthana Rasayanadhyaya, Aachar Rasayana has been
explained which is nothing but the mental
hygeine to be followed by definite methods to lead an ideal ethical way of living.
Such physical & behavioural conduct
definitely leads to a life with Rasayna effect. Achara Rasayana may act as a
Rasayana by 3 paths
Improves the personality
Improves social relations
Improves physical health

CONCLUSION
The behavioural conducts are the effective
preventive principles for psychological
disorders especially at primary prevention
levels. These can be propagated through
interventions like individual education,
Mass education etc.
Ayurveda views each individual with a
unique mind-body constitution. So, with
appropriate use of Ayurvedic preventive
measures such as Dinacharya, Rutucharya,
Aahar Vidhi & respective therapeutic

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measures for diseases such as Shamana


chikitsa or Shodhana i.e. Panchakarma
chikitsa, Lifestyle Diseases may be prevented.

1.

2.

3.

4.

5.

REFERENCES
Ashtanga Hridaya, Commentary by
Arundatta
Sarvangasundar
&
Hemadri Ayurved Rasayan(Edition
6th,Reprint 2010), Chaukhamba Publications, Varanasi.
SarthaVagbhat & its Marathi translation by Ganesh Krishna Garde (Reprint
2002), Rajesh Prakashan, Pune.
Charak Samhita of Agnivesha by
Dr.Brahmananda Tripathi (Edition 5th,
1997), Chaukhamba Publications, Varanasi.
DravyaGunaVigyana Vol-1 & 2, by
Acharya Priyavrat Sharma (Edition
2012), Chaukhamba Publications, Varanasi.
DravyaGunaVigyana, by Dr. A. P.
Deshpande Vol 1 & 2 (Edition 2006),
Anmol Publications, Pune.

CORRESPONDING AUTHOR
Dr. Vaibhavi M. Aphale

P G Department of Dravyaguna,
B.V.D.U.C.O.A. PUNE.
9860595793,
Email: vaibhaviaphale@gmail.com

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016

Case Report

International Ayurvedic Medical Journal ISSN:2320 5091

A RARE DELAYED COMPLICATION OF APPENDICECTOMY: A CASE REPORT OF STUMP APPENDICITIS

Bharadkar Mangesh Kachruji1


Kale Rashmi Anil2
1,2
P. G Department of Shalya Tantra, Sumatibhai Shah Ayurved Mahavidyalaya, Hadapsar Pune
28
ABSTRACT
Appendicitis is most common acute abdominally surgical emergency. And treatment for the Appendicectomy as the common procedure performed. Residual appendix left at the time of appendicectomy may prone to a rare development of stump appendicitis. As the sign and symptoms
relate to appendicitis but its is often neglected the possibility of appendicitis which can lead to
perforation. So early attempt must be made for its diagnosis.
Key words: Stump appendicitis , Appendicectomy
INTRODUCTION:
Stump appendicitis means the inflammation
of the residual appendix which is a rare
complication of appendicectomy1. Very few
cases of stump appendicitis are reported till
date2. Post operative complication of appendicitis includes bleeding wound rarely stump
appendicitis3. Most of the clinicians and
medical are not aware of the fact that post
appendicectomy appendicitis can be taken as
an differential diagnosis for right lower abdominal pain and which causes subsequent
failure of diagnosis and treatment which
ultimately fall off increase morbidity4. The
time interval for onset of symptoms can
range from two weeks to two years post appendicectomy5. Stump appendicitis was first
reported by Rose in 1945; It is defined by
him as the interval re-inflammation of any
residual appendiceal tissue after appendicectomy6. The purpose of this article is to

raise awareness about stump appendicitis


and discuss its management.
Case Report:
A female patient of age 55years visited to
hospital with complaints of, pain in right
lower abdomen since 3days. The pain was
initially localized around the umbilicus and
gradually shifted to right lower quadrant.
Vomiting and nausea associated by pain.
History fever noted once during the course
since pain started. The patient is known case
of bronchial asthma for which she is taking
regular treatment. She was having the history of appendicitis for which she has undergone appendicectomy before 3 to 4 years.
When patient visited hospital she was afebrile, blood pressure was 110/70 mm of hg
and pulse rate was of 80/min with respiration 22/min and bilateral air entry was normal. Patient has achieved her menopause
before 7 years.

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Yashpalsinh A.Jadeja Et;All: A Rare Delayed Complication Of Appendicectomy: A Case Re-Port Of Stump Appendicitis

Physical examination of abdomen


reveals healed (Mac burneys Incision)
surgical scar, severe tenderness was noted at
Mac. Burneys point with guarding. In USG
examination it was shown to have ill defined
3.6cm size long and around 1.8cm size wide
hypo echoic collection with inflammation of
the adjacent fat planes in right iliac fossa,
infero-lateral to the caecum. Which could
represent? Inflammatory secondary collection to divertculitis ? Involvement of appendicular stump. To confirm the diagnosis patient was advised C.T abdomen which revealed tubular blind ended structure in
retro-caecal region showing thickened enhancing wall with mild surrounding collection ,fat stranding and lymphadenopathy as
mentioned , could suggest stump appendicitis /diverticulitis with associated adjacent
infective collection abscess. Lab investigation revealed Hb-11.6gm%, WBC-8100
cu/mm, other lab investigation was normal
patient underwent 2D-Echo which showed
LVEF 60% for cardiac fitness. Patient underwent appendicectomy the finding were
stump appendicitis with adhesions to caecum and pus collection at antero-lateral aspect of caecum. The stump was separated
from the adhesion and stump appendicectomy was performed and the remnant part of
the stump was buried and closure was done.
Patient got well post-operatively with no
further complaints of abdominal pain.
DISCUSSION:
Stump appendicitis is rare and most oftenly
delayed complication of stump appendicitis.
Uptill now 36 cases are available in the
medical literature world wide2 7. It is not
usually consider while evaluating a patient
with right lower quadrant pain because pre-

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vious appendicectomy and long list of differential diagnosis for appendicitis 5 8. It is


usually diagnosed late pre-operatively when
the stump get perforated or abscess formation occurs. The suggested causes can be
enlisted as insufficient inversion of the
stump left after appendicectomy 8 9. Laproscopic appendicectomy has potential to result in incomplete removal of appendix owing to mis-identification of appendico-caecal junction during appendicectomy 5 10.
There is no relation of simple ligation and
inversion of the stump with stump appendicitis. So when laproscopic surgery has been
performed chances of appendicitis increases
and it must be kept in mind while evaluating
the patient with right lower quadrant pain 5
10 11
. The time interval from initial appendectomy to stump appendicitis varies and it
ranges from 2months to 5 years 1 2. So it
must be kept in mind while handling a case
of appendicitis. If the appendiceal stump
less than 3mm in width accurately from the
base of appendix can minimize appendicular
stump formation 1 2. The stump length varies
from 0.5mm to 6.5cm in clinical practice.
Pre-operative evaluation and diagnosis of
patient with stump appendicitis. It is difficult to diagnose it with USG only one case
reported up till date with stump appendicitis
diagnosed by USG 9. So need comes for
more advanced technology in our literature.
In our case it was identified under C.T scan
with further possibility of stump appendicitis with a high indexed suspicion can help in
early diagnosis and decreasing the mortality.
CONCLUSION:
Correct diagnosis and evaluation of patient
with right lower quadrant pain is important
with help C.T scan to reduce the further

IAMJ: Volume 4; Issue 04; March- 2016

Yashpalsinh A.Jadeja Et;All: A Rare Delayed Complication Of Appendicectomy: A Case Re-Port Of Stump Appendicitis

morbidity. The stump should be less than


3mm in width. It is necessary to search for
the remanant appendicular stump and if it is
causing some difficulties another senior surgeon opinion must be taken.

REFERENCES:
1. Gupta R, Gernsheimer J, Gelden J,
Narran, Haydock T, Abdominal pain
secondary to stump appendicitis in a
child, J emerg med 2000; 18:431433.
2. Shin LK, Halpern D, Weston SR,
Meiner EM, Katz DS, Prospective
CT diagnosis of stump appendicitis,
AJR AMJ Roentgenal 2005; 184
562-564.
3. Truty MJ, Stulak JM, Utter PA, Solberg JJ, Deghim AC. Appendicitis
appendicectomy Arch surg 2008:
143 (4):413-415.
4. Walsh DC, Roediger WE, Stump appendicitis a potential problem after
laprosopic appendicectomy surg.
Laprosc endosc 1997:7 (4): 357-358.
5. Watkins BP, Kothari SN, Lander
casper J stump appendicitis : case report and review, surg. Laprosc Endosc Percutan Tech 2004:2013:16771.
6. Hala Kanona, Ahmad AL Samazaee,
Colin Nice, Vish Bhattacharya stump
appendicitis A Review International
Journal of surgery 2012.07-007.
7. Aschkenas MT, Rybicki FJ. Acute
appendicitis of appendiceal stump, J
Emerg med 2005; 28:41-43 (pub
med).
8. Roche, Nagle G , Gallagher C, Kilgallen C, Cadwell M, Stump appen-

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dicitis a rare but important entity ,


surgeon 2005:3:53:53.
9. Baldi serotto M, Cavarzola LT, etal.
Acute edematous stump appendicitis
diagnosed preoperatively on sonography. ASR 2000; 125:503-504.
10. Liang MK, LOHG, MORKSJL.
Stump appendicitis; a comprehensive
review of literature, AM Surg 2006;
7-2(2): 162-166.
11. Deverexux DA, Mc Dermott JP,
Caushaj PF. Recurrent appendicitis
following laproscopic appendicectomy. Dis colon Rectum 1994:
37(7):719:720.
12. Mangi AA, Berger DL. Stump
appendicitis,
AM
Surg.
2000:66:739:741.
CORRESPONDING AUTHOR
Dr. Bharadkar Mangesh Kachruji
Email: manns.mb@gmail.com
Mob 9420368667
Sumatibhai Shah AyurvedMahavidyalaya,
Hadapsar. Pune 28

Source of support: Nil


Conflict of interest: None Declared

IAMJ: Volume 4; Issue 04; March- 2016