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1st Edition, 2017

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First Edition, October 2017

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Ayurvedic Standard
Treatment Guidelines
A document prepared by
Ministry of AYUSH
Government of India

Executive Editor
Vaidya Manoj Nesari
Adviser (Ay)
Ministry of AYUSH
AYUSH BHAWAN
B Block, GPO Complex, INA
New Delhi-110023, India

Collaborative Institutes
Institute for Postgraduate Teaching &
Research in Ayurveda, Jamnagar
and
National Institute of Ayurveda, Jaipur
Executive Editor
Vaidya Manoj Nesari,
Adviser (Ay)
Ministry of AYUSH
Govt. of India, New Delhi

Editors
Professor M. S. Baghel
Former Director, Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar
Professor Anup Thakar
Director, Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar
Dr. S. K. Khandel
Former Head, Dept. of Roga Nidan, National Institute of Ayurveda, Jaipur
Dr. Pawan Godatwar
Professor, Dept. of Roga Nidan, National Institute of Ayurveda, Jaipur
Dr. Prakash Mangalasseri
Associate Professor, Dept. of Kayachikitsa, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala

Coordinator
Dr. Mandip Goyal
Associate Professor, Dept. of Kayachikitsa,
Institute for Post Graduate Teaching & Research in Ayurveda, Jamnagar

Peer Reviewers: 4. Professor Abhimanyu Kumar, Director,


1. Professor Gurdip Singh, Former All India Institute of Ayuveda, New
Director, Institute for Post Graduate Delhi
Teaching & Research in Ayurveda, 5. Professor H. M. Chandola, Former
Jamnagar Director/ Principal, Ch. Brahm Prakash
2. Professor R. 
H. Singh, Professor Ayurved Charak Sansthan, Najafgarh,
Emeritus, Faculty of Ayurveda Banaras New Delhi
Hindu University, Varanasi 6. Dr. S. N. Gupta, Head, Dept. of
3. Professor R. B. Dwivedi, Former Director Kayachikitsa, J. S. Ayurveda College,
& Head, Dept. of Basic Principles, Nadiad – Gujarat
Institute for Post Graduate Teaching 7. Professor Tanuja Nesari, Head, Dept.
& Research in Ayurveda, Jamnagar of Dravyaguna, All India Institute of
Ayurveda, New Delhi


8. Professor Meeta Kotecha, Head, Dept. 19. Dr. Srinivas Acharya, Professor &
of Dravyaguna, National Institute of Head – Dept. of Kayachikitsa, Sri
Ayuveda, Jaipur Dharmasthala Manjunatheshwara
College of Ayurveda, P. O. Kuthpady,
9. Professor Mahesh Chandra Sharma,
Udupi, Karnataka
Former Director, National Institute of
Ayuveda, Jaipur 20. Vd. Tapan Vaidya, Associate Professor
Dept. of Kayachikitsa, J.S. Ayurveda
10. Dr. Haridra Dave, Head, Dept. of
College, Nadiad – Gujarat
Shalakya Tantra, J. S. Ayurveda College,
Nadiad - Gujarat 21. Professor Manda Ghorpade, Professor,
Head, Dept. of Stree Roga Prasutitantra,
11. Dr. B. M. Singh, Dept. of Kaumarbhritya, Sumatibhai Shalu Ayurved
Faculty of Ayurveda, Banaras Hindu Mahavidyalaya Hadapsar, Pune,
University, Varanasi Maharashtra
12. Dr. Ved Prakash Vyas, Dept. of Bal 22. Dr. Jayant Deopujari, Consultant,
Roga, Govt. Dhanwantri Ayurved Shrinidhi Ayurveda Panchakarma
College, Ujjain Chikitsalaya, Nagpur, Maharashtra
13. Dr. Eswar Sarma, Principal, VPSV 23. Dr. Manoj A. K., Professor, Dept. of
Ayurveda College, Edarikkode, Panchakarma, VPSV Ayurveda College,
Kottakal, Kerala Edarikkode, Kottakal, Kerala.
14. Dr. P. Rammanohar, Research Director, 24. Professor Umesh Shukla, Principal,
Amrita Center for Advanced Research Pt. Khushilal Sharma Government
in Ayurveda, Amritapuri, Kerala Ayurveda College, Bhopal

15. Professor A. K. Tripathi, Vice Chancellor, 25. Dr. B. L. Mehra, Head, Dept. of
Ayurved and Unani Services, Dehradun, Kayachikitsa, R.G. Govt. Ayurvedic
Uttarakhand College, Paprola, Kangra (H.P.)

16. Dr. M. M. Padhi, Deputy Director, 26. Dr. Rakesh Sharma, Reader, Dept of Bala
Central Council for Research in Roga PG Section, R.G. Govt. Ayurvedic
Ayurvedic Sciences, New Delhi College, Paprola, Kangra (H.P.)
27. Dr. Sasikumar, Chief Physician, Nechiyil
17. Dr. D. K. Dwivedi, Medical
Ayurveda Vaidyasala and Nursing
Superintendent, S. R. M. Government
Home, Karalmana, Palakkad, Kerala
Ayurveda College and Hospital,
Bareilly, Uttar Pradesh 28. Professor Y. K. Sharma, Principal cum
Dean & Head, Dept. of Kayachikitsa,
18. Dr. Kishor Sinh Chudasama, Former
Rajiv Gandhi Govt Ayurvedic College,
Principal, Sheth J. P. Govt. College,
Paprola, Distt. – Kangra, Himachal
Bhavnagar, Gujarat
Pradesh

vi AYURVEDIC STANDARD TREATMENT GUIDELINES




29. Dr V. N. K. Usha, Professor, Dept. of 38. Dr. Neru Nathani, Assistant Prof., Dept.
Stree Roga and Prasutitantra, SDM of Swasthavritta and Yoga, Faculty of
college of Ayurveda, P.O. Kuthpady, Ayurveda, Institute of Medical Sciences,
Udupi, Karnataka Banaras Hindu University, Varanasi
30. Dr A. R. V. Murthy, Dean & Medical 39. Dr. Dinesh K S, Assistant Prof., Dept.
Superintendent, Atreya Ayurvedic of Kaumar Bhritya, VPSV Ayurveda
Medical College, Hospital & Research College, Edarikkode, Kottakal, Kerala
Center, Doddaballapura, Bangalore
40. Dr. A. R. Trivedi, Former, Head, Dept. of
31. Dr. Vijay Chaudhary, Reader, Dept.
Kaumarbhritya, Shri Gulab Kunverba
of Kayachikitsa, Rajiv Gandhi Govt
Ayurved Mahavidyalaya, Jamnagar,
Ayurvedic College, Paprola, Distt. –
Gujarat
Kangra, Himanchal Pradash
41. Dr. Girish K.J., Reader, Dept. of
32. Dr. Mukund Sabnis, Consultant,
Jeevan Rekha Ayurved Chikitsalaya Kayachikitsa, SDM College of
and Research Center, Aurangabad, Ayurveda, BM Road, Thanniruhalla,
Maharashtra Hassan, Karnataka

33. Dr. Bharti, Assistant Director-In-Charge, 42. Dr. Govind Reddy, Research officer
Central Ayurveda Research Institute (Ayu), In-charge, R.R.A. Podar, Central
for Cardiovascular Diseases, Central Ayurveda Research institute for Cancer,
Council for Research in Ayurvedic Mumbai.
Sciences, New Delhi
43. Dr. Manohar Gundeti, Research officer
34. Dr. Renu Singh, Research Officer (Ayu) R.R.A. Podar, Central Ayurveda
(Ayu), Central Council for Research in Research institute for cancer, Mumbai
Ayurvedic Sciences, New Delhi
44. Dr. Bhavana Prasher, Ayurved Scientist,
35. Professor Ena Sharma, Head, Dept. of
Institute of Genomics & Integrative
PTSR, Rajiv Gandhi Govt. Ayurveda
Biology, New Delhi
College, Paprola, Distt. – Kangra,
Himachal Pradesh 45. Dr. Rakhi Mehra, Former Assistant
36. Dr. Prashantha A. S., Professor, Dept. of Director-In-charge, Central Ayurveda
Kayachikitsa, Ayurved Mahavidyalaya Research Institute for Cardiovascular
and Hospital, Hubli, Karnataka Diseases, Central Council for Research
in Ayurvedic Sciences, New Delhi
37. Professor Bishnu Prasad Sharma,
Head, Dept. of Kayachikitsa, Govern-
ment Ayurvedic college and Hospital,
Guwahati

vii AYURVEDIC STANDARD TREATMENT GUIDELINES




Subject experts and Contributors –


1. Professor P. K. Prajapati, Dean & Head, 11. Professor B. J. Patgiri, Head, Dept. of
Dept. of Rasa Shastra & Bhaishajya Rasashastra & Bhaishajya Kalpana,
Kalpana, All India Institute of Ayurveda, Institute for Post Graduate Teaching &
New Delhi Research in Ayurveda, Jamnagar
2. Professor Kalpana Patel, Head, Dept. 12. Dr. A. S. Baghel, Incharge Head,
of Kaumarabhritya, Institute for Post Associate Prof., Dept. of Basic Principles,
Graduate Teaching & Research in Institute for Post Graduate Teaching &
Ayurveda, Jamnagar, Gujarat Research in Ayurveda, Jamnagar

3. Professor Dhiman K., Director General, 13. Dr. Hitesh Vyas, Associate Prof., Dept.
Central Council for Research in of Basic Principles, Institute for Post
Ayurvedic Sciences, New Delhi Graduate Teaching & Research in
Ayurveda, Jamnagar, Gujarat
4. Professor Sanjay Gupta, Head, Dept. of
14. Dr. Galib, Associate Prof., Dept. of
Shalya, All India Institute of Ayurveda,
Rasashastra & Bhaishjya Kalpana, All
New Delhi
India Institute of Ayurveda, New Delhi
5. Professor L. P. Dei, Incharge Director,
15. Dr. T. S. Dudhamal, Incharge Head,
& Head, Dept. of Stree Roga and
Associate Prof., Dept. of Shalya, Institute
Prasutitantra, Institute for Post Graduate
for Post Graduate Teaching & Research
Teaching & Research in Ayurveda,
in Ayurveda, Jamnagar
Jamnagar, Gujarat
16. Dr. D. B. Vaghela, Incharge Head,
6. Professor Manjusha Rajgopala, Head,
Associate Prof., Dept. of Shalakya,
Dept. of Shalakya, All India Institute of
Institute for Post Graduate Teaching &
Ayurveda, New Delhi
Research in Ayurveda, Jamnagar
7. Professor K. S. Nisteshwar, Ex Head,
17. Dr. Rajgopala S, Associate Prof., Dept.
Dept. of Dravyaguna, Institute for
of Kaumarabhitya, All India Institute of
Post Graduate Teaching & Research in
Ayurveda, New Delhi
Ayurveda, Jamnagar, Gujarat
18. Dr. Shilpa Donga, Associate Prof., Dept.
8. Professor S. H. Acharya, Dept. of
of Stree Roga and Prasutitanta, Institute
Pachakarma, Institute for Post Graduate
for Post Graduate Teaching & Research
Teaching & Research in Ayurveda,
in Ayurveda, Jamnagar, Gujarat
Jamnagar, Gujarat
19. Dr A R Dave, Incharge Head, Associate
9. Professor M. K. Vyas, Head, Dept. of
Prof., Dept. of Kayachikitsa, Institute for
Basic Principles, All India Institute of
Post Graduate Teaching & Research in
Ayurveda, New Delhi
Ayurveda, Jamnagar, Gujarat
10. Professor R. N. Acharya, Head, Dept. of
20. Dr. Darshana Pandya, Assistant Prof.,
Dravyaguna, Institute for Post Graduate
Dept. of Roga Nidan, Institute for Post
Teaching & Research in Ayurveda,
Graduate Teaching & Research in
Jamnagar, Gujarat
Ayurveda, Jamnagar, Gujarat

viii AYURVEDIC STANDARD TREATMENT GUIDELINES


21. Dr. B. R. Patel, Assistant Prof., Dept. of 31. Dr. Rajshree Undakat, Reader & Head,
Dravyaguna, Institute for Post Graduate Dept. of Shalakya, Shri Gulab Kunverba
Teaching & Research in Ayurveda, Ayurved Mahavidyalaya, Jamnagar,
Jamnagar, Gujarat Gujarat
22. Dr. Rajkala Ramteke, Research Officer 32. Dr. Varsha Solanki, Reader & Head,
(Ayu), Central Ayurveda Research Dept. of Dravyaguna, Shri Gulab
Institute for Cardiovascular Diseases, Kunverba Ayurved Mahavidyalaya,
Central Council for Research in Ayuveda Jamnagar, Gujarat
Sciences, New Delhi 33. Dr. Harshit Shah, Head, Dept. of Shalya
23. Dr. Prashant Bedarkar, Assistant Prof, Tantra, Akhandanand Ayurveda
Dept. of Rasashastra & Bhaishjya College, Opp. Victoria Garden Bhadra,
Kalpana, Institute for Post Graduate Ahmedabad, Gujarat
Teaching & Research in Ayurveda, 34. Dr. Kamini Dhiman, Associate Prof.,
Jamnagar, Gujarat Dept. of Stree roga and Prasutitanta, All
24. Dr V. K. Kori, Associate Prof., Dept. India Institute of Ayurveda, New Delhi
of Kaumarabhritya, Institute for Post 35. Dr. Gurucharan Bhuyan, Research officer
Graduate Teaching & Research in (Ay), Central Council for Research in
Ayurveda, Jamnagar, Gujarat Ayurvedic Sciences, Hq. New Delhi
25. Dr. Vyasdeo Mahanta, Associate Prof., 36. Dr. Ashu Vinayak, Reader, Dept. of
Dept. of Shalya, All India Institute of Shalakya Tantra, Shri Krishna Govt.
Ayurveda, New Delhi, Gujarat Ayurvedic College & Hospital, Umri
26. Dr. Shubhangi Kamble Assistant Prof., Road, Near DC Residence, Sec-8,
Dept. of Basic Principles, Institute for Kurukshetra-136118, Haryana
Post Graduate Teaching & Research in 37. Dr. Shantla Priyadarshini, Reader,
Ayurveda, Jamnagar, Gujarat Dept. of Shalakya, Sri Jai Chamrajendra
27. Dr. Nilesh Bhatt, Assistant Prof., Dept. of Wadeyar Govt. Ayurveda Medical
Kayachikitsa, Institute for Post Graduate College, Mysore, Karnataka
Teaching & Research in Ayurveda, 38. Dr P. K. Shanthakumari, Retd. Prof.,
Jamnagar, Gujarat Matha Ayurveda Eye Hospital,
28. Dr. Arpan Bhatt, Head, Dept. of Jayprakash Lane, Pokudappanakunnu,
Swasthvritta, Shri Gulab Kunverba Thiruvanathpuram, Kerala
Ayurved Mahavidyalaya, Jamnagar,
39. Dr. Shivanand Gavimath, Assistant
Gujarat
Prof., Dept. of Shalakya, J. S. S. Ayurved
29. Dr. Neha Tank, Reader, Dept. of
Hospital, Mysore, Karnataka
Panchakarma, Shri Gulab Kunverba
Ayurved Mahavidyalaya, Jamnagar,
Gujarat
30. Dr. Pashmina Joshi, Reader & Head,
Dept. of Shalya, Shri Gulab Kunverba
Ayurved Mahavidyalaya, Jamnagar,
Gujarat

ix AYURVEDIC STANDARD TREATMENT GUIDELINES


FOREWORD

In last twenty years or so Ayurveda sector has witnessed an upsurge globally. The personalized
medicine approach of Ayurveda and the huge diversity in Ayurvedic formulations have always
been glorified by supporters of Ayurveda including practitioners and scientists. At the same
time the same strengths have been used by others as impediments for its wider implementation
at public health. The National Health Policy 2017 of India has strongly recommended for
integrating Ayurveda in main health care delivery. The health policy has focussed on attaining
Sustainable Development Goals 3 (SDG 3) identified by United Nations (UN). The Ministry
of AYUSH, Government of India in an effort to streamline the implementation of Ayurveda
services, has developed Ayurvedic Essential Drug List (EDL). The issue of quality of Ayurvedic
drugs is also being addressed by developing Ayurvedic Pharmacopoeia of India. Development
of Ayurvedic Standard Treatment Guidelines is the next step in standardising the Ayurveda
services and their mainstreaming in Public Health.
The work of developing this document has been going on for over two years. It has gone
through wider consultation involving experts of different Ayurvedic subjects across the country.
Ayurveda practices in different parts of country have lot of diversity owing to availability of
local natural resources as well as local Vaidya traditions. The major challenge faced was to
arrive at consensus on Ayurvedic formulations to be prescribed for different disease conditions
with respect to available Clinical Infrastructure i.e. PHC/CHC/ DH. There were also issues
in identifying nearest correlation between Ayurvedic understandings of various disease
conditions with their allopathy counterpart. The scientists and experts having understanding
of both systems would understand easily the difficulties underlying.
The guidelines are neither prescriptive nor restrictive but are more facilitative in nature. The
guidelines doesn’t restrict Ayurveda practitioners for using various formulations as per their
wisdom, knowledge of Ayurveda and experience. This is a maiden effort to extract the wider
scope of Ayurveda practices and accommodate them in to a relatively restrictive format. For
this purpose 38 most common disease conditions commonly found in general practice have
been shortlisted. The format has been developed considering the available infrastructure and
resources at Primary Health Center (PHC) where only OPD facility is available, Community
Health Center (CHC) having 20 beds and District Hospital (DH) which has 50 beds and
good diagnostic labs. While developing this document, efforts have been made to explain
the case and treatment on Ayurvedic principles and thereby to retain the soul of Ayurveda.


At the same time conventional terminology has been used so that the document should be
easy to understand for every stakeholder. The introduction and case definition explained
at the beginning of every disease condition narrates the clinical condition making it easy to
understand to all stake holders. The references in support of treatment recommended have
been listed in scientific manner at the end of every chapter. Thus, an effort has been made to
make these guidelines more scientific and practical for implementation. The document will be
useful not only to young Ayurveda graduates but also could be useful to supporting staff and
non-Ayurveda practitioners so as to reach to the last person in the society to realize the dream
and intention of “Health for All” of the Government. The document, first of its kind would also
be useful to policy makers in future policy making, to regulators for promoting good Ayurveda
services as well as to Insurance sector to provide wider coverage to Ayurveda treatment and
services. The document would also be useful in Government’s drive for promoting Ayurveda
based Medical and Wellness Tourism.
The document has undergone nearly six reviews to eliminate any kind of discrepancy. However,
Ministry would welcome suggestions or further improvements, which in consultation with
experts and after authentication could be accommodated in next edition.

Date : 17th October, 2017, Dhanwantari Jayanti Vaidya Manoj Nesari


Place : New Delhi Executive Editor
Adviser (Ay), Ministry of AYUSH
Govt. of India

xii AYURVEDIC STANDARD TREATMENT GUIDELINES


GUIDELINES xii
PREFACE TO THE FIRST EDITION

Ayurveda is the most ancient system of medicine of Indian origin and is equally relevant in
modern times. It is the knowledge base of life which, in addition to description of clinical profile
of diseases, various etiological factors – primary or secondary, the etio-pathogenesis, different
stages of disease progression, stage wise medical intervention, the prognosis and all such other
clinical details; has also described in detail the dietary substances, various physical and mental
activities, role of various epigenetic factors, methods for promotion of health, Community and
social medicine etc. Ayurveda has also emphasised on social and spiritual wellbeing. The beauty
of Ayurveda lies in the flexibility it has provided to clinicians in application part i.e. choice of
medicinal plants, drug formulations, dosage forms etc. which may vary depending upon the
availability of raw material according to geo-climatic conditions without compromising with
the fundamental principles.
India is bestowed with rich bio-diversity. The Himalayan ranges, North east India, Western
Ghats from Gujarat and extending up to southern tip of India in Kerala are bio-diversity
hotspots. Around 6000 plant varieties are found in India, out of which 600 are commonly
used. But that doesn’t mean that other are not used at all. Certain varieties are used in
certain pockets depending upon the traditions. Some medicinal plants entered in to main
stream Ayurvedic practice through folklore practices are also within the ambit of Ayurvedic
principles. According to Ayurveda principles every substance available on earth has some or
the other medicinal property. At the same time, Ayurveda has also described the mechanism
of adopting various natural resources in to main stream practice. Many Vaidya traditions have
some unique specialties of practices those have traversed through generations in their family.
Most of them have come from their long standing observations, understanding and experience.
Often, a medicinal plant or part thereof has many medicinal uses; out of those some could be
popular where as some may not. Apparently, one may find strange the unpopular use, but
may find their mention in ancient classical text. For e.g. plant parts like leaf, bark, stem, roots
are commonly used in Ayurvedic medicines. However, flowers are not frequently used. This is
because, they are season specific and perishable and also difficult to store.
In India, Ayurveda education and clinical practices are regulated under Indian Medicine
Central Council Act, 1970 whereas; Ayurveda drugs are regulated under Drugs & Cosmetics
Act, 1940 and Rules 1945. Enrolment of Ayurveda Clinical practitioners in State Register is


regulated under State (Provincial) Ayurveda Practitioners Acts of relevant States. Uniformity
of curricula and syllabi of graduation level degree course and Post Graduate degree courses in
various specialties has been maintained throughout the country. However, there is also wide
diversity observed in the prescriptions of Vaidyas in different parts of the country, which is
within the broad frame work of Ayurveda practices recognized under different legislative
provisions in force.
As per the market trends, currently Ayurveda practices are gradually shifting on pharma based
products readily available in market. Nevertheless, few Vaidyas continue to prepare classical
medicines on their own and also have their own formulations. This is very much legal as per
the provisions under Drugs and Cosmetics Act, 1940.
Ayurveda practices are not only the prescriptions of medicines but also include various
procedures. They include Panchakarma procedures, Marma Therapy, Viddha Karma, Agni Karma,
Upakalpana, dietary preparations etc.
With the onset of National Health Mission (NHM) in the year 2005, Ayurveda received major
boost towards mainstreaming in public health through which, Ayurveda services are being
made available at Primary Health Centres as well as at District Hospitals. In the year 2014, the
then Department of AYUSH under Ministry of Health and family Welfare was elevated to a
separate Ministry making clear that Ayurveda is one of the thrust area identified by Government
towards major reforms in the developing New India. This started a new era for major upsurge
for Ayurveda nationwide. These efforts are further augmented by the Ministry of AYUSH
with the implementation of National AYUSH Mission (NAM). Presently, Ayurveda services
are available in nearly 40% of PHCs throughout the country. At the same time, there is also rise
of Ayurveda infrastructure in private sector. The Ministry of AYUSH has also encouraged for
development of tertiary care through Ayurveda. Development All India Institute of Ayurveda
at New Delhi is a major milestone in this regard. Ministry of AYUSH, Government of India
has also encouraged private sector to develop tertiary care services through Ayurveda. As a
result, few Ayurveda specialty hospitals have come up in private sector in recent past. There is
increasing trend in well reputed allopathy corporate hospitals to start Ayurveda wing.
With this background, it was felt necessary to develop an authentic document which could
provide some basic guidelines about Ayurvedic practices. The present document would be
useful not only to Ayurveda practitioners but also to regulators, policy makers as well as to
International community in supporting Ayurveda practices.

Vaidya Manoj Nesari Vaidya Rajesh Kotecha


Adviser (Ay) Secretary
Ministry of AYUSH , Govt. of India Ministry of AYUSH, Govt. of India

xvi AYURVEDIC STANDARD TREATMENT GUIDELINES


ACKNOWLEDGEMENT

Developing the Ayurvedic Standard Treatment Guidelines was a stiff task considering
the diversity in the choice of medicines and the regional variation and also considering that all
of them are scientific and are based on Ayurvedic principles. Therefore, the task was primarily
assigned to “Institute of Post Graduate Teaching and Research in Ayurveda”, (IPGT&RA)
Jamnagar and “National Institute of Ayurveda”, (NIA) Jaipur. Both these are top-notch
premier institutes of Ayurveda having international repute. I am highly indebted to Directors
and faculty of these institutes for whole heartedly supporting in this endeavour. This being the
maiden document, took long time for completion. The initial phase was more crucial wherein
the template and skeletal content were to be framed. It involved lot of energy. This could be
achieved because of dynamic leadership of Prof. M.S. Baghel, the then Director of IPGT&RA,
Jamnagar and strongly supported by Vaidya Rajesh Kotecha, the then Vice Chancellor of
Gujarat Ayurveda University and presently Secretary to Government of India, Ministry of
AYUSH. I am also thankful to Prof. Sanjeev Sharma, the present Director of NIA Jaipur, for
his support in the last and final phase of completing this document. The coordination of the
project was skilfully handled by Dr. Mandip Goyal, Associate Prof. of Kayachikitsa, IPGT & RA
Jamnagar. Dr. Prakash Mangalasseri, Associate Prof. Kayachikitsa, Ayurveda College Kottakal
had always been resourceful and supportive for getting the job completed.
Senior faculty from nearly 32 Ayurveda Institutes including All India Institute of
Ayurveda, New Delhi; Faculty of Ayurveda, Banaras Hindu University; Ayurveda College,
Kottakal; Ch. Brahm Prakash Ayurved Charak Sansthan New Delhi; Rajiv Gandhi Government
Post-Graduate Ayurvedic College, Paprola; SDM Ayurveda College, Hassan & Udupi; Central
Council for Research in Ayurvedic Sciences etc. were involved in developing this document.
Their names and specialty has been listed under list of contributors. The responsibility of
designing, proof checking etc. and getting the printed this document was assigned to Rashtriya
Ayurveda Vidyapeeth, New Delhi. Mr. N. Ramakrishnan, A.O. RAV and Dr. Varun Gupta
efficiently handled this responsibility to complete the task in time bound manner.
Most importantly I am grateful to Sh. Shripad Naik, Hon’ble Minister of State,
Independent Charge for Ministry of AYUSH, Government of India for his vision, guidance
and continuous support.

Vaidya Manoj Nesari


Adviser (Ay)
ABBREVIATIONS

2D Echo 2 dimensional Echo


ABC Airway, breathing, circulation
AFB Acid-Fast Bacilli
ALT Alanine transaminase
ANA Anti-Nuclear Antibody
ASO Antistreptolysis ‘O’ titer
AST Aspartate Aminotransferase
Ay/Ayu Ayurveda
AYUSH Collective name for Ayurveda, Yoga, Unani, Siddha & Homeopathy
BMD Bone Mineral Density
BMI Body mass index
BP Blood Pressure
BPH Benign Prostrate Hyper-trophy
BSL Blood sugar level
BT Bleeding time
Ca Calcium
CBC Complete blood count
CHC Community Health Center
COPD Chronic Obstructive Pulmonary Disease
CRP C-reactive protein
CT Scan computed tomography scan
CVA Cerebro - Vascular Accident
DLC Differential leucocyte counts
DM Diabetes Mellitus
DMARD Disease modifying anti rheumatic drugs
Ed. or ed. Edition
ABBREVIATIONS

ECG Electro cardio gram


EEG Electro Encphalogram
ESR Erythrocyte sedimentation rate
FT3 Free Triiodothyronine 
FT4 Free Thyroxine
GFR Glomerular Filtration Rate
GI or GIT Gastro Intestinal Tract
gm% Gram percent
Govt. Government
GTT Glucose Tolerance Test
H1N1 Swine flu - subtype of the Influenza A virus
H5N1 Bird Flu - subtype of the Influenza A virus
Hb Haemoglobin
HbA1c Glycated Haemoglobin
HBsAg Australia antigen - surface antigen of the Hepatitis B virus
HDL High-density lipoprotein
HIV  Human immune-deficiency virus
IC Intra cranial
ICA Islet cell Autoantibody
IgG Immunoglobulin G antibody
IgM Immunoglobulin M antibody
IHD Ischemic heart disease
ILD Interstitial Lung Disease
IOP Intraocular pressure 
ISM&H Indian systems of Medicine and Homoeopathy
IVP Intravenous Pyelogram
IVU Intravenous Urogram
K Potassium
KSS Kshar Sutra Suturing

xix AYURVEDIC STANDARD TREATMENT GUIDELINES


ABBREVIATIONS

KUB Collective name for Kidney, Ureter and Bladder


LDL Low-density lipoprotein
LFT Liver Function Test
LPD Lymphoproliferative Disease
MRI scan Magnetic resonance imaging 
Na Sodium
NS1 Antigen-Based ELISA Test for Dengue
OCT Optical coherence tomography
OPD Out Patient Department
PA view Postero-Anterior view
PACG Primary Angle-Closure Glaucoma
PCOD polycystic Ovarian Disease
PCOS Polycystic Ovary Syndrome
PCR Polymerase chain reaction
PHC Primary Health Centre
PNS Paranasal sinuses
POAG Primary open angle glaucoma
P/R Per rectal
PPBS Post prandial blood sugar
PSA Prostate-specific antigen
PUI Platelet Uptake Index
Q.S. Quantity sufficient
RA Rheumatoid arthritis
RFT Renal Function test
RIND Reversible ischemic neurological deficit
S. or Sr. Serum
SLR test Straight leg raised test
T3 Triiodothyronine 
T4 Thyroxine

xx AYURVEDIC STANDARD TREATMENT GUIDELINES


ABBREVIATIONS

Tab Tablet
TB Tuberculosis
TIA Transient Ischaemic Attack
TLC Total Leucocyte Counts
TRUS Trans Rectal Ultra Sonography
TSH Thyroid-Stimulating Hormone
tsp teaspoon
U/Lit Unit per Litre
USG Ultra Sonography
UTI Urinary Tract Infection
VDRL test Venereal Disease Research Laboratory test 
Vol. Volume

xxi AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

1. Abhyanga An Ayurvedic oil massage practice. This helps loosen and


facilitate the removal of accumulated Ama (toxins) and the
Doshas (Vata, Pitta and Kapha) from the body.
2. Aadharniya vega Non-suppression of natural urges It means the natural urges
which should not be suppressed by force as a habit.
3. Aschyotana Type of eye treatment in which drops of herbal liquids are
put into the eyes.
4. Agantuka External factor
5. Ajirna/ Ajeerna Indigestion, weak digestion
6. Amla Sour taste
7. Anna-vaha srotas The channels transporting grains or food, the digestive
system, alimentary canal.
8. Anupana Vehicle for medicine
9. Anuvasana (Basti) Enema given with an oily substance
10. Apana One of the five types of Vata, which goes downward and is
responsible for expulsion of faces, flatus, urine, menstrual
blood etc.
11. Asatmya Unwholesome, bad, improper.
12. Agni Agni is the form of fire and heat that is the basis of the
digestive system and the process of release of energy. The
term includes the body heat, body temperature, sight, the
digestive fire; its function is transformation, absorption,
elimination and discrimination is Agni.
13. Ahara Food articles used by human
14. Ahara Rasa It is the nutrient substance developed after digestion process
taken in the digestive tract where enzymes or the bile juice
acted upon food articles
15. Ama Toxins or Ama is produced in the body by the raw, undigested
food products that become fetid.
16. Artava Menstrual blood
GLOSSARY

17. Artavavaha Srotas The channel that carries menstrual fluid and ovum; consists
of female reproductive system i.e. fallopian tubes, ovaries,
uterus and vaginal canal
18. Bala Strength
19. Balya An energizer that gives strength to the body
20. Bhasma Substance obtained by calcination
21. Basti It refers to the enema therapy under Panchakarma. Basti is
the most effective treatment of Vata disorder. In Ayurveda
Basti involves the introduction of herbal solution and oil
preparations in the rectum. 
22. Chakhyushya Substances that are good for eyes
23. Churna Powder
24. Chikitsa Treatment, a therapy to retain balance of Doshas, practice or
science of medicine.
25. Dhatu Basic structural and nutritional body factor that supports or
nourishes the seven body tissues. These seven tissues of our
body includes the rasa, Rakta, Mamsa, Meda, Asthi, Majja and
Shukra.
26. Deepaniya Natural substances that kindle the gastric fire and augment
the appetite
27. Dinacharya Daily routine to be followed in day to day practice
28. Dushti Unhappiness, imbalanced, improper functioning
29. Ghrita (Ghee) Clarified butter made by heating unsalted butter from cow
especially
30. Hina yoga Insufficient, deficient
31. Jala Water
32. Jalauka Leech
33. Jathara Stomach, belly or abdomen
34. Jatharagni Fire located in stomach, digestive fire, gastric juices,
digestive enzymes
35. Kala Time, period, season
36. Kalka Paste of herbs to be used for medicinal purposes

xxiii AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

37. Kapha It is one of the three Doshas i.e. the water humour, the
intracellular fluid and the extra cellular fluid that plays
significant role in the nutrition and existence of body cells
and tissues
38. Kashaya Astringent taste or flavour; sometimes use for decoction of
herbs
39. Katu Pungent taste or flavour
40. Kaumarabhrtya The branch of Ayurveda that deals with child health
(Paediatrics)
41. Kayachikitsa Internal Medicine, treatment of body diseases,
42. Kshara Alkali preparations of herbs
43. Kriyakalpa Medical procedures used in eye treatment
44. Laghu Light, small, minute
45. Langhana Depletion therapy, slimming therapy makes body thin and
light 
46. Lavana Salty taste of flavour
47. Lekhaniya Substances that have scraping actions on body tissues
48. Madhu Honey
49. Majja Bone marrow
50. Mala Waste products that are to be excreted out of the body. It
primarily includes urine, faeces and sweat
51. Mana Mind
52. Manovaha Srotas The channel that carries thought, feelings and emotions;
refers to the entire mind
53. Meda It is the fat tissue supported by Mamsa Dhatu
54. Madhura Sweet taste of flavour, pleasant, charming, delightful
55. Mamsa Muscles and related systems in body
56. Mamsavaha Srotas Channels transporting to the muscles and related tissues
57. Medhya That which enhances wisdom, mental power and intelligence
58. Medovaha Srotas Channels transporting to fat and related tissues
59. Mithyaayoga Wrong use, wrong employment

xxiv AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

60. Mootra /Mutra Urine


61. Mutravaha Srotas Channels transporting to the urinary system
62. Nadi Pulse, any tubular organ such as vein or artery
63. Nadi Vrana Wounds with sinuses
64. Nasya Herbal medication through nasal
65. Netra Eye
66. Netragata Related to eye
67. Nidaana Causes, refers to the etiology or cause of the disease
68. Nidaana Parivarjana Removal or avoiding of causative factors related to the
disease
69. Nidra Sleep
70. Nija Innate, one’s own, internal
71. Niruha (Basti) An enema of herbal decoctions
72. Ojas Vigour, strength and vitality that is the essence of all tissues
(Dhatus)
73. Pachaniya Substances that help in proper digestion
74. Panchakarma According to Ayurveda this refers to the five cleansing
therapies i.e. Vaman, Virechana, Basti, Nasya and
Raktamokshana.
75. Pitta It is one of the three Doshas i.e. the bile humour, entire
hormones, enzymes, coenzymes and agencies responsible
for the physiochemical processes of the body

xxv AYURVEDIC STANDARD TREATMENT GUIDELINES


LIST OF TABLES

SL NO. TABLES PAGE NO.

1 Table 1.1: Types of Kasa with their characteristics 5


2 Table 1.2: Common medicines at level 1 for Kasa 7
3 Table 1.3: Medicines at level 1 for Vataja Kasa 7
4 Table 1.4: Medicines at level 1 for Pittaja Kasa 8
5 Table 1.5: Medicines at level 1 for Kaphaja Kasa 8
6 Table 1.6: Common medicines at level 2 for all type of Kasa 9
7 Table 1.7: Medicines at level 2 for different type of Kasa 9
8 Table 2.1: Medicines at level 1 for Kaphadhika Tamaka Swasa 15
9 Table 2.2: Medicines at level 1 for Vatadhika Tamaka Swasa 16
10 Table 2.3: Medicines at level 2 for Kaphadhika Tamaka Swasa 18
11 Table 2.4: Medicines at level 3 for Kaphadhika Tamaka Swasa 19
12 Table 2.5: Medicines at level 3 for Vatadhika Tamaka Swasa 20
13 Table 3.1: Medicines at level 1 for Amlapitta 28
14 Table 3.2: Medicines at level 2 for Amlapitta 29
15 Table 4.1: Medicines at level 1 for Jalodara 34
16 Table 4.2: Medicines at level 2 for Jalodara 35
17 Table 5.1: Medicines at level 1 for Amavata 42
18 Table 5.2: Medicines at level 2 for Amavata 43
19 Table 5.3: Medicines at level 3 for Amavata 45
20 Table 6.1: Medicines at level 1 for Jwara 48
21 Table 6.2: Management of Jwara as per the Doshik predominance 48
at level 1.
22 Table 6.3: Clinical features as per Doshik predominance 49
23 Table 6.4: Clinical features at the level of Dhatus. 50
24 Table 6.5: Management of Jwara at level 2 as per Dhatugata Avastha 50
LIST OF TABLES

25 Table 6.6: Medicines at level 2 for Jwara 51


26 Table 6.7: Comparative features for various type of Jwara 52
27 Table 6.8: Medicines for Dengue fever 53
28 Table 6.9: Medicines for Influenza 54
29 Table 6.10: Medicines for Malaria 54
30 Table 7.1: Medicines at level 1 for Pandu 59
31 Table 7.2: Medicines at level 2 for Pandu 60
32 Table 8.1: Medicines at level 1 for Ekakushta 65
33 Table 8.2: Medicines at level 2 for Ekakushta 67
34 Table 9.1: Medicines at level 1 for Kamala 70
35 Table 9.2: Medicines at level 2 for Kamala 71
36 Table 10.1: Medicines at level 1 for Hypothyroidism 76
37 Table 10.2: Medicines at level 2 for Hypothyroidism 78
38 Table 10.3: Medicines at level 3 for Hypothyroidism 77
39 Table 11.1: Medicines at level 1 for Madhumeha 80
40 Table 11.2: Medicines at level 2 for Madhumeha 83
41 Table 12.1: Medicines at level 1 for Sthaulya 87
42 Table 12.2: Medicines at level 2 for Sthaulya 89
43 Table 13.1: Types of Arsha with their characteristics 93
44 Table 13.2: Medicines at level 1 for Arsha 94
45 Table 13.3: Medicines at level 2 for Arsha 96
46 Table 14.1: Types of Atisara with their characteristics 99
47 Table 14.2: Medicines at level 1 for Atisara 100
48 Table 14.3: Medicines at level 2 for Atisara 101
49 Table 14.4: Medicines at level 3 for Atisara 102
50 Table 15.1: Types of Bhagandara with their characteristics 104
51 Table 15.2: Another classification of Bhagandara based on 105
Dosha Samsarga
52 Table 15.3: Medicines at level 1 for Bhagandara 106
53 Table 15.4: Medicines at level 2 for Bhagandara 107

AYURVEDIC STANDARD TREATMENT GUIDELINES xxvii


LIST OF TABLES

54 Table 16.1: Medicines at level 1 for Krimi 112


55 Table 16.2: Medicines at level 2 for Krimi 113
56 Table 17.1: Medicines at level 1 for Parikartika 115
57 Table 17.2: Medicines at level 2 for Parikartika 117
58 Table 18.1: Medicines at level 1 for Anidra 123
59 Table 18.2: Medicines at level 2 for Anidra 125
60 Table 19.1: Medicines at level 1 for Apasmara 127
61 Table 19.2: Medicines at level 2 for Apasmara 128
62 Table 19.3: Medicines at level 3 for Apasmara 130
63 Table 20.1: Medicines at level 1 for Vishaada 132
64 Table 20.2: Medicines at level 2 for Vishaada 133
65 Table 21.1: Medicines at level 1 for Ashmari 138
66 Table 21.2: Medicines at level 2 for Ashmari 140
67 Table 22.1: Medicines at level 1 for Mutraghata 144
68 Table 22.2: Medicines at level 2 for Mutraghata 146

69 Table 23.1: Differential diagnosis of Mutrashtila with their 148


clinical features

70 Table 23.2: Medicines at level 1 for Mutrashtila 149

71 Table 23.3: Medicines at level 2 for Mutrashtila 151

72 Table 24.1: Types of Asrigdara with their characteristics 157

73 Table 24.2: Differential diagnosis of Asrigdara 157

74 Table 24.3: Medicines at level 1 for Asrigdara 158

75 Table 24.4: Medicines at level 2 for Asrigdara 159

76 Table 24.5: Medicines at level 3 for Asrigdara 160

77 Table 25.1: Medicines at level 1 for Kashtaartava 163

78 Table 25.2: Medicines at level 2 for Kashtaartava 164

79 Table 25.3: Basti Dravyas at level 2 for Kashtaartava 166

80 Table 25.4: Medicines at level 3 for Kashtaartava with heavy bleeding 167

81 Table 25.5: Medicines at level 3 for Kashtaartava with scanty bleeding 167

xxviii AYURVEDIC STANDARD TREATMENT GUIDELINES


LIST OF TABLES

82 Table 26.1: Medicines at level 1 for Shweta Pradara 170


83 Table 26.2: Medicines used for Yoni Prakshalana in Shweta Pradara 171
84 Table 26.3: Medicines used for Yoni Vartia in Shweta Pradara 171
85 Table 26.4: Medicines used for Yoni Pichu in Shweta Pradara 172
86 Table 26.5: Medicines used for Yoni Dhupan in Shweta Pradara 172
87 Table 26.6: Medicines at level 2 for Shweta Pradara 172
88 Table 27.1: Medicines at level 1 for Avabahuka 177
89 Table 27.2: Medicines at level 2 for Avabahuka 179
90 Table 27.3: Panchakarma Procedures at level 3 for Avabahuka 180
91 Table 28.1: Medicines at level 1 for Katigraha 183
92 Table 28.2: Medicines at level 2 for Katigraha 185
93 Table 28.3: Medicines at level 3 for Katigraha 186
94 Table 28.4: Panchakarma procedures at level 4 for Katigraha 187
95 Table 29.1: Medicines at level 1 for Gridhrasi 190
96 Table 29.2: Medicines at level 2 for Gridhrasi 192
97 Table 29.3: Panchakarma Procedures at level 3 for Gridhrasi 193
98 Table 30.1: Differential diagnosis of Pakshaghat with various 198
presentations of the diseases
99 Table 30.2: Medicines at level 1 for Pakshaghat 201
100 Table 30.3: Medicines at level 2 for Pakshaghat 205
101 Table 30.4: Panchakarma procedures at level 3 for Pakshaghat 210
102 Table 31.1: Medicines at level 1 for Sandhivata 215
103 Table 31.2: Medicines at level 2 for Sandhivata 217
104 Table 32.1: Medicines at level 1 for Vatarakta 220
105 Table 32.2: Medicines at level 2 for Vatarakta 222
106 Table 32.3: Rasayanas can be used at level 3 for Vatarakta 223
107 Table 33.1: Differentiating features of common types of conjunctivitis 228
108 Table 33.2: Medicines at level 1 for Abhishyanda 228
109 Table 33.3: Medicines at level 2 for Abhishyanda 231
110 Table 33.4: Shodhana Chikitsa and other Kriyakalpas at level 3 232
for Abhishyanda

AYURVEDIC STANDARD TREATMENT GUIDELINES xxix


LIST OF TABLES

111 Table 34.1: Medicines at level 2 for Adhimantha 239


112 Table 34.2: Uses of Nasyas in various type of Adhimantha 242
113 Table 34.3: Uses of Tarpana in various type of Adhimantha 242
114 Table 34.4: Uses of Ashchyotana & Parisheka in various type of Adhimantha 243
115 Table 34.5: Uses of Anjana in various type of Adhimantha 243
116 Table 34.6: Uses of Siramokshana in various type of Adhimantha 243
117 Table 34.7: Uses of Dhumapana in various type of Adhimantha 243
118 Table 35.1: Medicines at level 1 for Dantaveshtaka 251
119 Table 35.2: Medicines at level 2 for Dantaveshtaka 252
120 Table 35.3: Kriya Kalpa / Panchakarma at level 3 for Dantaveshtaka 253
121 Table 36.1: Medicines at level 1 for Mukhapaka 256
122 Table 36.2: Medicines at level 2 for Mukhapaka 257
123 Table 36.3: Medicines at level 3 for Mukhapaka 258
124 Table 37.1: Medicines at level 1 for Pratishyaya 263
125 Table 37.2: Medicines at level 2 for Pratishyaya 264
126 Table 38.1: Clinical features of different types of Shiroroga 270
127 Table 38.2: Medicines at level 1 for Shiroroga 271
128 Table 38.3: Medicines at level 2 for Shiroroga 272
129 Table 38.4: Medicines at level 3 for Shiroroga 273

xxx AYURVEDIC STANDARD TREATMENT GUIDELINES


INDEX
1 Foreword x
2 Message from Minister xii
3 Preface xiv
4 Acknowledgement xvi
5 Abbreviation xviii
6 Glossary xxii
7 List of Tables xxvi

NO. CHAPTERS PAGES

INTRODUCTION 1

PRANAVAHA SROTAS ROGA


1 Kasa 5
2 Tamaka Swasa 14

ANNAVAHA SROTAS ROGA


3 Amlapitta 27

UDAKAVAHA SROTAS ROGA


4 Jalodara 33

RASAVAHA SROTAS ROGA


5 Amavata 41
6 Jwara 47
7 Pandu 58

RAKTAVAHA SROTAS ROGA


8 Ekakushtha 65
9 Kamala 69

MEDOVAHA SROTAS ROGA


10 Hypothyroidism 75
11 Madhumeha 79
12 Sthoulya 86

PURISHAVAHA SROTAS ROGA


13 Arsha 93
14 Atisara 99
INDEX

15 Bhagandara 104
16 Krimi 109
17 Parikartika 113

MANOVAHA SROTAS ROGA


18 Anidra 121
19 Apasmara 125
20 Vishada 129

MUTRAVAHA SROTAS ROGA


21 Ashmari 137
22 Mutraghata 142
23 Mutrasthila 148

ARTAVAVAHA SROTAS ROGA


24 Asrigdara 157
25 Kashtaarthava 162
26 Shwetapradara 169

VATA VYADHI
27 Avabahuka 177
28 Katigraha 182
29 Gridhrasi 189
30 Pakshaghata 196
31 Sandhigata Vata 215
32 Vatarakta 220

NETRAGATA ROGA
33 Abhishyanda 227
34 Adhimantha 237

URDHWA JATRUGATA ROGA


35 Dantavestaka 251
36 Mukhapaka 255
37 Pratishyaya 261
38 Shiroroga 270

APPENDIX -
Atura Pariksha Patrak 277

xxxii AYURVEDIC STANDARD TREATMENT GUIDELINES


Copies may be obtained from:

Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH)
Government of India
AYUSH BHAWAN
B Block, GPO Complex,
INA, New Delhi-110023, India
Telefax: 011-24651964
Website: www.ayush.gov.in

First Edition, 2017

© Copyright 2017, ministry of ayush, government of india. Any part of this document may be
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Ayurvedic Standard
Treatment Guidelines
A document prepared by
Ministry of AYUSH
Government of India

Executive Editor
Vaidya Manoj Nesari
Adviser (Ay)
Ministry of AYUSH
AYUSH BHAWAN
B Block, GPO Complex,
INA, New Delhi-110023, India

Collaborative Institutes
Institute for Postgraduate Teaching &
Research in Ayurveda, Jamnagar
and
National Institute of Ayurveda, Jaipur
Executive Editor
Vaidya Manoj Nesari,
Adviser (Ay)
Ministry of AYUSH, Govt of India, New Delhi

Editors
Professor M. S. Baghel
Former Director, IPGT&RA, Jamnagar
Professor Anup Thakar
Director, IPGT&RA, Jamnagar
Dr. S. K. Khandel
Former Head, Dept. of Roga Nidan, NIA, Jaipur
Dr. Pawan Godatwar
Professor, Dept. of Roga Nidan, NIA, Jaipur
Dr. Prakash Mangalasseri
Associate Professor, Dept. of Kayachikitsa, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala

Coordinator
Dr. Mandip Goyal
Associate Professor, Dept. of Kayachikitsa, IPGT&RA, Jamnagar

Peer Reviewers:
1. Professor Gurdip Singh, Former 6. Dr. S. N. Gupta, Head, Dept. of
Director, IPGT&RA, Jamnagar Kayachikitsa, J. S. Ayurveda College,
2. Professor R. H. Singh, Professor Nadiad –Gujarat
Emeritus, Faculty of Ayurveda BHU, 7. Professor Tanuja Nesari, Head, Dept. of
Varanasi Dravyaguna, AIIA, New Delhi
3. Professor R. B. Dwivedi, Former Director
8. Professor Meeta Kotecha, Head, Dept. of
& Head, Dept. of Basic Principles,
Dravyaguna, NIA, Jaipur
IPGT&RA, Jamnagar
9. Professor Mahesh Chandra Sharma,
4. Professor Abhimanyu Kumar, Director,
Former Director, NIA, Jaipur
AIIA, New Delhi
5. Professor H. M. Chandola, Former 10. Dr. Haridra Dave, Head, Dept. of
Director/ Principal, CBPACS, Najafgarh, Shalakya Tantra, J. S. Ayurveda College,
New Delhi Nadiad -Gujarat


11. Dr. B. M. Singh, Dept. of Kaumarbhritya, 22. Dr. Jayant Deopujari, Consultant,
Faculty of Ayurveda, BHU, Varanasi Shrinidhi Ayurveda Panchakarma
Chikitsalaya, Nagpur, Maharashtra
12. Dr. Ved Prakash Vyas, Dept. of Bal
Roga, Govt. Dhanwantri Ayurved 23. Dr. Manoj A. K., Professor, Dept. of
College, Ujjain Panchakarma, VPSV Ayurveda College,
Edarikkode, Kottakal, Kerala.
13. Dr. Eswar Sarma, Principal, VPSV
Ayurveda College, Edarikkode, 24. Professor Umesh Shukla, Principal,
Kottakal, Kerala Pt. Khushilal Sharma Government
Ayurveda College, Bhopal
14. Dr. P. Rammanohar, Research Director,
25. Dr. B. L. Mehra, HOD Kayachikitsa,
Amrita Center for Advanced Research
R.G. Govt. Ayurvedic College, Paprola,
in Ayurveda, Amritapuri, Kerala
Kangra (H.P.)
15. Professor A. K. Tripathi, Director,
26. Dr. Rakesh Sharma, Reader, Dept
Ayurved and Unani Services, Dehradun,
of Balaroga PG Section, R.G. Govt.
Uttarakhand
Ayurvedic College, Paprola, Kangra
16. Dr. M. M. Padhi, Deputy Director, (H.P.)
CCRAS, New Delhi
27. Dr. Sasikumar, Nechiyil Ayurveda
17. Dr. D. K. Dwivedi, S. R. M. Government Vaidyasala and Nursing Home,
Ayurveda College and Hospital, Bareilly Karalmana, Palakkad, Kerala
Dept. of Surgery Uttar Pradesh 28. Professor Y. K. Sharma, Principal cum
18. Dr. Kishor Sinh Chudasama, Former Dean & HOD – Kayachikitsa, Rajiv
Principal, Sheth J. P. Govt. College, Gandhi Govt Ayurvedic College,
Bhavnagar, Gujarat Paprola, Distt. – Kangra, Himachal
Pradesh
19. Dr. Srinivas Acharya, Professor &
Head – Dept. of Kayachikitsa, Sri 29. Dr VNK Usha, Dept. of Dtree roga and
Dharmasthala Manjunatheshwara Prasuti tantra, SDM college of Ayurveda,
College of Ayurveda, P. O. Kuthpady, P.O. Kuthpady, Udupi, Karnataka
Udupi, Karnataka 30. Dr A R V Murthy, Dean & Medical
20. Vd. Tapan Vaidya, Associate Professor Superintendent, Atreya Ayurvedic
Dept. of Kayachikitsa, J.S. Ayurveda Medical College, Hospital & Research
College, Nadiad – Gujarat Center, Doddaballapura, Bangalore
21. Professor Manda Ghorpade, Professor, 31. Dr. Vijay Chaudhary, Reader –
H.O.D. Streeroga Prasutitantra Kayachikitsa, Rajiv Gandhi Govt
Dept, Sumatibhai Shalu Ayurved Ayurvedic College, Paprola, Distt. –
Mahavidyalaya Hadapsar, Pune, Kangra, Himanchal Pradash
Maharashtra

vi AYURVEDIC STANDARD TREATMENT GUIDELINES




32. Dr. Mukund Sabnis, Consultant, 39. Dr. Dinesh K S, Asst. Professor, Dept.
Jeevan Rekha Ayurved Chikitsalaya of Kaumar Bhritya, VPSV Ayurveda
and Research Center, Aurangabad, College, Edarikkode, Kottakal, Kerala
Maharashtra
40. Dr. A. R. Trivedi, Former, HOD,
33. Dr. Bharti, Assistant Director-In-Charge, Kaumarbhritya, Shri Gulab Kunverba
Central Ayurveda Research Institute for Ayurved Mahavidyalaya, Jamnagar,
Cardiovascular Diseases, CCRAS, New
Gujarat
Delhi
41. Dr. Girish K.J., Reader, Dept. of
34. Dr. Renu Singh, Research Officer (Ayu),
Kayachikitsa, SDM College of
CCRAS, New Delhi
Ayurveda, BM Road, Thanniruhalla,
35. Professor Ena Sharma, Head, Dept. of
Hassan, Karnataka
PTSR, Rajiv Gandhi Govt. Ayurveda
College, Paprola, Distt. – Kangra, 42. Dr. Govind Reddy, Research officer
Himachal Pradesh (Ayu), In-charge, R.R.A. Podar, Central
Ayurveda Research institute for Cancer,
36. Dr. Prashantha A. S., Professor, Ayurved
Mahavidyalaya and Hospital, Hubli, Mumbai.
Karnataka 43. Dr. Manohar Gundeti, Research officer
37. Professor Vishnuprasad Sharma, (Ayu) R.R.A. Podar, Central Ayurveda
Department of Kayachikitsa, Govern- Research institute for cancer, Mumbai
ment Ayurvedic college and Hospital, 44. Dr. Bhavana Prasher, Ayurved Scientist,
Guwahati
IGIB, New Delhi
38. Dr. Neru Nathani, Assistant Professor,
45. Dr. Rakhi Mehra, Former Assistant
Department of Swasthavritta and Yoga,
Director-In-charge, Central Ayurveda
Faculty of Ayurveda, Institute of Medical
Research Institute for Cardiovascular
Sciences, Banaras Hindu University,
Varanasi Diseases, CCRAS, New Delhi

Subject experts and Contributors –


1. Professor P. K. Prajapati, Dean, All India 4. Professor Sanjay Gupta, Dept. of
Institute of Ayurveda, New Delhi Shalya, All India Institute of Ayurveda,
New Delhi
2. Professor Kalpana Patel, Prof & HOD,
Kaumarabhritya, IPGT&RA, Jamnagar, 5. Professor L. P. Dei, In-charge Director,
Gujarat HOD, Stree Roga and Prasutitantra,
IPGT&RA, Jamnagar, Gujarat
3. Professor Dhiman K., Director General,
CCRAS, New Delhi 6. Professor Manjusha Rajgopala, HOD,
Shalakya, All India Institute of
Ayurveda, New Delhi

vii AYURVEDIC STANDARD TREATMENT GUIDELINES




7. Professor K. S. Nisteshwar, ex HOD, 20. Dr. Darshana Pandya, Assistant


Dravyaguna, IPGT&RA, Jamnagar, Professor, Roga Nidan, IPGT&RA,
Gujarat Jamnagar, Gujarat
8. Professor S. H. Acharya, Pachakarma 21. Dr. B. R. Patel, Assistant Professor,
Dept, IPGT&RA, Jamnagar, Gujarat Dravyaguna, IPGT&RA, Jamnagar,
9. Professor M. K. Vyas, HOD, Basic Gujarat
Principles, All India Institute of 22. Dr. Rajkala Ramteke, Research Officer
Ayurveda, New Delhi (Ayu), Central Ayurveda Research
Institute for Cardiovascular Diseases,
10. Professor R. N. Acharya, HOD,
CCRAS, New Delhi
Dravyaguna, IPGT&RA, Jamnagar,
Gujarat 23. Dr. Prashant Bedarkar, Assistant Prof,
Rasashastra & Bhaishjya Kalpana,
11. Professor B. J. Patgiri, HOD, Rasashastra
IPGT&RA, Jamnagar, Gujarat
& Bhaishjya Kalpana, IPGT&RA,
24. Dr V. K. Kori, Associate Professor,
Jamnagar
Kaumarabhritya, IPGT&RA, Jamnagar,
12. Dr. A. S. Baghel, In-charge HOD,
Gujarat
Associate Professor, Dept. of Basic
25. Dr. Vyasdeo Mahanta, Associate
Principles, IPGT&RA, Jamnagar
Professor, Dept. of Shalya, All India
13. Dr. Hitesh Vyas, Associate Prof, Basic Institute of Ayurveda, New Delhi,
Principles, IPGT&RA, Jamnagar, Gujarat Gujarat
14. Dr. Galib, Associate Professor, 26. Dr. Shubhangi Kamble Assistant
Rasashastra & Bhaishjya Kalpana, All Professor, Dept. of Basic Principles,
India Institute of Ayurveda, New Delhi IPGT&RA, Jamnagar, Gujarat
15. Dr. T. S. Dudhamal, In-charge HOD, 27. Dr. Nilesh Bhatt, Assistant Professor,
Associate Professor, Dept. of Shalya, Dept. of Kayachikitsa, IPGT&RA,
IPGT&RA, Jamnagar Jamnagar, Gujarat
16. Dr. D. B. Vaghela, In-charge HOD, 28. Dr. Arpan Bhatt, HOD, Dept. of
Associate Professor, Dept. of Shalakya, Swasthvritta, Shri Gulab Kunverba
IPGT&RA, Jamnagar Ayurved Mahavidyalaya, Jamnagar,
17. Dr. Rajgopala S, Associate Professor, Gujarat
Kaumarabhitya, All India Institute of 29. Dr. Neha Tank, Reader, Dept. of
Ayurveda, New Delhi Panchakarma, Shri Gulab Kunverba
Ayurved Mahavidyalaya, Jamnagar,
18. Dr. Shilpa Donga, Associate Professor,
Gujarat
Stree Roga and Prasutitanta, IPGT&RA,
Jamnagar, Gujarat 30. Dr. Pashmina Joshi, HOD, Reader, Dept.
of Shalya, Shri Gulab Kunverba Ayurved
19. Dr A R Dave, In-charge HOD, Associate
Mahavidyalaya, Jamnagar, Gujarat
Professor, Kayachikitsa, IPGT&RA,
Jamnagar, Gujarat

viii AYURVEDIC STANDARD TREATMENT GUIDELINES


31. Dr. Rajshree Undakat, HOD, Reader, 36. Dr. Ashu Vinayak, Reader, Dept. of
Dept. of Shalakya, Shri Gulab Kunverba Shalakya Tantra, Shri Krishna Govt.
Ayurved Mahavidyalaya, Jamnagar, Ayurvedic College & Hospital, Umri
Gujarat Road, Near DC Residence, Sec-8,
32. Dr. Varsha Solanki, HOD, Reader, Dept. Kurukshetra-136118, Haryana
of Dravyaguna, Shri Gulab Kunverba 37. Dr. Shantla Priyadarshini, Reader,
Ayurved Mahavidyalaya, Jamnagar, Dept. of Shalakya, Sri Jai Chamrajendra
Gujarat Wadeyar Govt. Ayurveda Medical
33. Dr. Harshit Shah, Dept. of Shalya Tantra, College, Mysore, Karnataka
Akhandanand Ayurveda College, Opp. 38. Dr P. K. Shanthakumari, Retd. Professor,
Victoria Garden Bhadra, Ahmedabad, Matha Ayurveda Eye Hospital,
Gujarat Jayprakash Lane, Pokudappanakunnu,
34. Dr. Kamini Dhiman, Associate Professor, Thiruvanathpuram, Kerala
Dept. of Stree roga and Prasutitanta, 39. Dr. Shivanad Gavimath, Dept. of
AIIA, New Delhi Shalakya, J. S. S. Ayurved Hospital,
35. Dr. Gurucharan Bhuyan, Research Mysore, Karnataka
officer (Ay), CCRAS Hq. New Delhi

ix AYURVEDIC STANDARD TREATMENT GUIDELINES


FOREWORD

In last twenty years or so Ayurveda sector has witnessed gradual upsurge globally.
The personalized medicine approach of Ayurveda and the huge diversity in Ayurvedic
formulations have always been glorified by supporters of Ayurveda including practitioners
and scientists. At the same time the same strengths have been used by others as impediments
for its wider implementation at public health. The National Health Policy 2017 of India has
strongly recommended for integrating Ayurveda in main health care delivery. The health
policy has focussed on attaining sustainable development goals 3 (SDG 3) identified by United
Nations (UN). The Ministry of AYUSH, Government of India in an effort to streamline the
implementation of Ayurveda services, has developed Ayurvedic Essential Drug List (EDL).
The issue of quality of Ayurvedic drugs is also being addressed by developing Ayurvedic
Pharmacopoeia of India. Development of Ayurvedic Standard Treatment Guidelines is the
next step in standardising the Ayurveda services and their mainstreaming in Public Health.
The work of developing this document has been going on for over two years. It has gone
through wider consultation involving experts of different Ayurvedic subjects across the country.
Ayurveda practices in different part of country have lot of diversity owing to availability of
local natural resources as well as local Vaidya traditions. The major challenge faced was to
arrive at consensus on Ayurvedic formulations to be prescribed for different disease conditions
with respect to available Clinical Infrastructure i.e. PHC/CHC/ DH. There were also issues
in identifying nearest correlation between Ayurvedic understandings of various disease
conditions with their allopathy counterpart. The scientists and experts having understanding
of both systems would understand easily the difficulties underlying.
The guidelines are neither prescriptive nor restrictive but are more facilitative in nature. The
guidelines doesn’t restrict Ayurveda practitioners for using various formulations as per their
wisdom, knowledge of Ayurveda and experience. This is a maiden effort to extract the wider
scope of Ayurveda practices and accommodate them in to a relatively restrictive format. For
this purpose 40 most common disease conditions commonly found in general practice have
been shortlisted. The format have been developed considering the available infrastructure and
resources at primary health center (PHC) where only OPD facility is available, Community
health Center (CHC) having 20 beds and District Hospital (DH) which has 50 beds and good
diagnostic labs. While developing this document efforts have been made to explain the case
and treatment on Ayurvedic principles and thereby to retain the soul of Ayurveda. At the same


time conventional terminology has been used so that the document should be easy understand
for every stakeholder. The introduction and case definition explained at the beginning of every
disease condition narrates the clinical condition making it easy to understand to all stake
holders. The references in support of treatment recommended have been listed in scientific
manner at the end of every chapter. Thus, an effort has been made to make these guidelines
more scientific and practical for implementation. The document will be useful not only to
young Ayurveda graduates but also could be useful to supporting staff and non-Ayurveda
practitioners so as to reach to the last person in the society to realize the dream and intention
of ‘Health for All” of the Government. The document, first of its kind would also be useful to
policy makers in future policy making, to regulators for promoting good Ayurveda services as
well as to Insurance sector to provide wider coverage to Ayurveda treatment and services. The
document would also be useful in Government’s drive for promoting Ayurveda based Medical
and Wellness Tourism.
The document has undergone nearly six reviews to eliminate any kind of discrepancy. However,
Ministry would welcome suggestions or further improvements, which in consultation with
experts and after authentication could be accommodated in next edition.

Vaidya Manoj Nesari


Adviser (Ayurveda), Ministry of AYUSH and
Executive Editor.

AYURVEDIC STANDARD TREATMENT GUIDELINES xi


PREFACE TO THE FIRST EDITION

Ayurveda is the most ancient system of medicine of Indian origin and is equally relevant in
modern times. It is the knowledge base of life which, in addition to description of clinical profile
of diseases, various etiological factors – primary or secondary, the etio-pathogenesis, different
stages of disease progression, stage wise medical intervention, the prognosis and all such other
clinical details; has also described in detail the dietary substances, various physical and mental
activities, role of various epigenetic factors, methods for promotion of health, Community and
social medicine etc. Ayurveda has also emphasised on social and spiritual wellbeing. The beauty
of Ayurveda lies in the flexibility it has provided to clinicians in application part i.e. choice of
medicinal plants, drug formulations, dosage forms etc. which may vary depending upon the
availability of raw material according to geo-climatic conditions without compromising with
the fundamental principles.
India is bestowed with rich bio-diversity. The Himalayan ranges, North east India, Western
Ghats from Gujarat and extending up to southern tip of India in Kerala are bio-diversity
hotspots. Around 6000 plant varieties are found in India, out of which 600 are commonly
used. But that doesn’t mean that other are not used at all. Certain varieties are used in
certain pockets depending upon the traditions. Some medicinal plants entered in to main
stream Ayurvedic practice through folklore practices are also within the ambit of Ayurvedic
principles. According to Ayurveda principles every substance available on earth has some or
the other medicinal property. At the same time, Ayurveda has also described the mechanism
of adopting various natural resources in to main stream practice. Many Vaidya traditions have
some unique specialties of practices those have traversed through generations in their family.
Most of them have come from their long standing observations, understanding and experience.
Often, a medicinal plant or part thereof has many medicinal uses; out of those some could be
popular where as some may not. Apparently, one may find strange the unpopular use, but
may find their mention in ancient classical text. For e.g. plant parts like leaf, bark, stem, roots
are commonly used in Ayurvedic medicines. However, flowers are not frequently used. This is
because, they are season specific and perishable and also difficult to store.
In India, Ayurveda education and clinical practices are regulated under Indian Medicine
Central Council Act, 1970 whereas; Ayurveda drugs are regulated under Drugs & Cosmetics


Act, 1940 and Rules 1945. Enrolment of Ayurveda Clinical practitioners in State Register is
regulated under State (Provincial) Ayurveda Practitioners Acts of relevant States. Uniformity
of curricula and syllabi of graduation level degree course and Post Graduate degree courses in
various specialties has been maintained throughout the country. However, there is also wide
diversity observed in the prescriptions of Vaidyas in different parts of the country, which is
within the broad frame work of Ayurveda practices recognized under different legislative
provisions in force.
As per the market trends, currently Ayurveda practices are gradually shifting on pharma based
products readily available in market. Nevertheless, few Vaidyas continue to prepare classical
medicines on their own and also have their own formulations. This is very much legal as per
the provisions under Drugs and Cosmetics Act, 1940.
Ayurveda practices are not only the prescriptions of medicines but also include various
procedures. They include Panchakarma procedures, Marma Therapy, Viddha Karma, Agni Karma,
Upakalpana, dietary preparations etc.
With the onset of National Health Mission (NHM) in the year 2005, Ayurveda received major
boost towards mainstreaming in public health through which, Ayurveda services are being
made available at Primary Health Centres as well as at District Hospitals. In the year 2014, the
then Department of AYUSH under Ministry of Health and family Welfare was elevated to a
separate Ministry making clear that Ayurveda is one of the thrust area identified by Government
towards major reforms in the developing New India. This started a new era for major upsurge
for Ayurveda nationwide. These efforts are further augmented by the Ministry of AYUSH
with the implementation of National AYUSH Mission (NAM). Presently, Ayurveda services
are available in nearly 40% of PHCs throughout the country. At the same time, there is also rise
of Ayurveda infrastructure in private sector. The Ministry of AYUSH has also encouraged for
development of tertiary care through Ayurveda. Development All India Institute of Ayurveda
at New Delhi is a major milestone in this regard. Ministry of AYUSH, Government of India
has also encouraged private sector to develop tertiary care services through Ayurveda. As a
result, few Ayurveda specialty hospitals have come up in private sector in recent past. There is
increasing trend in well reputed allopathy corporate hospitals to start Ayurveda wing.
With this background, it was felt necessary to develop an authentic document which could
provide some basic guidelines about Ayurvedic practices. The present document would be
useful not only to Ayurveda practitioners but also to regulators, policy makers as well as to
International community in supporting Ayurveda practices.

Vaidya Manoj Nesari Vaidya Rajesh Kotecha

AYURVEDIC STANDARD TREATMENT GUIDELINES xv


ACKNOWLEDGEMENT

Developing the Ayurvedic Standard Treatment Guidelines was a stiff task considering
the diversity in the choice of medicines and the regional variation and also considering that
all of them are scientific and are based on Ayurvedic principles. Therefore, the task was
primarily assigned to “Institute of Post Graduate Teaching and Research in Ayurveda”,
(IPGT&RA) Jamnagar and “National Institute of Ayurveda”, (NIA) Jaipur. Both these are top-
notch premier institutes of Ayurveda having international repute. I am highly indebted to
Directors and faculty of these institutes for whole heartedly supporting in this endeavour.
This being the maiden document, took long time for completion. The initial phase was more
crucial wherein the template and skeletal content were to be framed. It involved lot of energy.
This could have been possible because of dynamic leadership of Prof. M.S. Baghel, the then
Director of IPGT&RA, Jamnagar and strongly supported by Vaidya Rajesh Kotecha, the then
Vice Chancellor of Gujarat Ayurveda University and presently Secretary to Government of
India, Ministry of AYUSH. I am also thankful to Prof. Sanjeev Sharma, the current Director
of NIA Jaipur, for his support in the last and final phase of completing this document. The
coordination of the project was skilfully handled by Dr. Mandip Goyal, Associate Prof. of
Kayachikitsa, IPGT & RA Jamnagar. Dr. Prakash Mangalasseri, Associate Prof. Kayachikitsa,
Ayurveda College Kottakal had always been resourceful and supportive for getting the job
completed.
Senior faculty from nearly 32 Ayurveda Institutes including Faculty of Ayurveda,
Banaras Hindu University; Ayurveda College, Kottakal; Ch. Brahm Prakash Ayurved Charak
Sansthan New Delhi; Tilak Ayurveda College; Pune; R. R. A.Podar,Central Ayurveda Research
Institute for Cancer, Mumbai; SDM Ayurveda College, Hassan; SDM Ayurveda College
Udupi; Ayurveda College Belgaum etc. were involved in developing this document. Their
names and specialty has been listed under list of contributors. The responsibility of designing,
proof checking etc. and getting the printed this document was assigned to Rashtriya Ayurveda
Vidyapeeth, New Delhi. Mr. N. Ramakrishnan, A.O. RAV and Dr. Varun Gupta efficiently
handled this responsibility to complete the task in time bound manner.
Most importantly I am grateful to Sh. Shripad Naik, Hon’ble Minister of State,
Independent Charge for Ministry of AYUSH, Government of India for his vision, guidance
and continuous support.

Vaidya Manoj Nesari


Adviser (Ay)
ABBREVIATIONS

2D Echo 2 dimensional Echo


ABC Airway, breathing, circulation
AFB Acid-Fast Bacilli
ALT Alanine transaminase
ANA Anti-Nuclear Antibody
ASO Antistreptolysis ‘O’ titer
AST Aspartate Aminotransferase
Ay/Ayu Ayurveda
AYUSH Collective name for Ayurveda, Yoga, Unani, Siddha & Homeopathy
BMD Bone Mineral Density
BMI Body mass index
BP Blood Pressure
BPH Benign Prostrate Hyper-trophy
BSL Blood sugar level
BT Bleeding time
Ca Calcium
CBC Complete blood count
CHC Community Health Center
COPD Chronic Obstructive Pulmonary Disease
CRP C-reactive protein
CT Scan computed tomography scan
CVA Cerebro - Vascular Accident
DLC Differential leucocyte counts
DM Diabetes Mellitus
DMARD Disease modifying anti rheumatic drugs
Ed. or ed. Edition
ABBREVIATIONS

ECG Electro cardio gram


EEG Electro Encphalogram
ESR Erythrocyte sedimentation rate
FT3 Free Triiodothyronine 
FT4 Free Thyroxine
GFR Glomerular Filtration Rate
GI or GIT Gastro Intestinal Tract
gm% Gram percent
Govt. Government
GTT Glucose Tolerance Test
H1N1 Swine flu - subtype of the Influenza A virus
H5N1 Bird Flu - subtype of the Influenza A virus
Hb Haemoglobin
HbA1c Glycated Haemoglobin
HBsAg Australia antigen - surface antigen of the Hepatitis B virus
HDL High-density lipoprotein
HIV  Human immune-deficiency virus
IC Intra cranial
ICA Islet cell Autoantibody
IgG Immunoglobulin G antibody
IgM Immunoglobulin M antibody
IHD Ischemic heart disease
ILD Interstitial Lung Disease
IOP Intraocular pressure 
ISM&H Indian systems of Medicine and Homoeopathy
IVP Intravenous Pyelogram
IVU Intravenous Urogram
K Potassium
KSS Kshar Sutra Suturing

xix AYURVEDIC STANDARD TREATMENT GUIDELINES


ABBREVIATIONS

KUB Collective name for Kidney, Ureter and Bladder


LDL Low-density lipoprotein
LFT Liver Function Test
LPD Lymphoproliferative Disease
MRI scan Magnetic resonance imaging 
Na Sodium
NS1 Antigen-Based ELISA Test for Dengue
OCT Optical coherence tomography
OPD Out Patient Department
PA view Postero-Anterior view
PACG Primary Angle-Closure Glaucoma
PCOD polycystic Ovarian Disease
PCOS Polycystic Ovary Syndrome
PCR Polymerase chain reaction
PHC Primary Health Centre
PNS Paranasal sinuses
POAG Primary open angle glaucoma
P/R Per rectal
PPBS Post prandial blood sugar
PSA Prostate-specific antigen
PUI Platelet Uptake Index
Q.S. Quantity sufficient
RA Rheumatoid arthritis
RFT Renal Function test
RIND Reversible ischemic neurological deficit
S. or Sr. Serum
SLR test Straight leg raised test
T3 Triiodothyronine 
T4 Thyroxine

xx AYURVEDIC STANDARD TREATMENT GUIDELINES


ABBREVIATIONS

Tab Tablet
TB Tuberculosis
TIA Transient Ischaemic Attack
TLC Total Leucocyte Counts
TRUS Trans Rectal Ultra Sonography
TSH Thyroid-Stimulating Hormone
tsp teaspoon
U/Lit Unit per Litre
USG Ultra Sonography
UTI Urinary Tract Infection
VDRL test Venereal Disease Research Laboratory test 
Vol. Volume

xxi AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

1. Abhyanga An Ayurvedic oil massage practice. This helps loosen and


facilitate the removal of accumulated Ama (toxins) and the
Doshas (Vata, Pitta and Kapha) from the body.
2. Aadharniya vega Non-suppression of natural urges It means the natural urges
which should not be suppressed by force as a habit.
3. Aschyotana Type of eye treatment in which drops of herbal liquids are
put into the eyes.
4. Agantuka External factor
5. Ajirna/ Ajeerna Indigestion, weak digestion
6. Amla Sour taste
7. Anna-vaha srotas The channels transporting grains or food, the digestive
system, alimentary canal.
8. Anupana Vehicle for medicine
9. Anuvasana (Basti) Enema given with an oily substance
10. Apana One of the five types of Vata, which goes downward and is
responsible for expulsion of faces, flatus, urine, menstrual
blood etc.
11. Asatmya Unwholesome, bad, improper.
12. Agni Agni is the form of fire and heat that is the basis of the
digestive system and the process of release of energy. The
term includes the body heat, body temperature, sight, the
digestive fire; its function is transformation, absorption,
elimination and discrimination is Agni.
13. Ahara Food articles used by human
14. Ahara Rasa It is the nutrient substance developed after digestion process
taken in the digestive tract where enzymes or the bile juice
acted upon food articles
15. Ama Toxins or Ama is produced in the body by the raw, undigested
food products that become fetid.
16. Artava Menstrual blood
GLOSSARY

17. Artavavaha Srotas The channel that carries menstrual fluid and ovum; consists
of female reproductive system i.e. fallopian tubes, ovaries,
uterus and vaginal canal
18. Bala Strength
19. Balya An energizer that gives strength to the body
20. Bhasma Substance obtained by calcination
21. Basti It refers to the enema therapy under Panchakarma. Basti is
the most effective treatment of Vata disorder. In Ayurveda
Basti involves the introduction of herbal solution and oil
preparations in the rectum. 
22. Chakhyushya Substances that are good for eyes
23. Churna Powder
24. Chikitsa Treatment, a therapy to retain balance of Doshas, practice or
science of medicine.
25. Dhatu Basic structural and nutritional body factor that supports or
nourishes the seven body tissues. These seven tissues of our
body includes the rasa, Rakta, Mamsa, Meda, Asthi, Majja and
Shukra.
26. Deepaniya Natural substances that kindle the gastric fire and augment
the appetite
27. Dinacharya Daily routine to be followed in day to day practice
28. Dushti Unhappiness, imbalanced, improper functioning
29. Ghrita (Ghee) Clarified butter made by heating unsalted butter from cow
especially
30. Hina yoga Insufficient, deficient
31. Jala Water
32. Jalauka Leech
33. Jathara Stomach, belly or abdomen
34. Jatharagni Fire located in stomach, digestive fire, gastric juices,
digestive enzymes
35. Kala Time, period, season
36. Kalka Paste of herbs to be used for medicinal purposes

xxiii AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

37. Kapha It is one of the three Doshas i.e. the water humour, the
intracellular fluid and the extra cellular fluid that plays
significant role in the nutrition and existence of body cells
and tissues
38. Kashaya Astringent taste or flavour; sometimes use for decoction of
herbs
39. Katu Pungent taste or flavour
40. Kaumarabhrtya The branch of Ayurveda that deals with child health
(Paediatrics)
41. Kayachikitsa Internal Medicine, treatment of body diseases,
42. Kshara Alkali preparations of herbs
43. Kriyakalpa Medical procedures used in eye treatment
44. Laghu Light, small, minute
45. Langhana Depletion therapy, slimming therapy makes body thin and
light 
46. Lavana Salty taste of flavour
47. Lekhaniya Substances that have scraping actions on body tissues
48. Madhu Honey
49. Majja Bone marrow
50. Mala Waste products that are to be excreted out of the body. It
primarily includes urine, faeces and sweat
51. Mana Mind
52. Manovaha Srotas The channel that carries thought, feelings and emotions;
refers to the entire mind
53. Meda It is the fat tissue supported by Mamsa Dhatu
54. Madhura Sweet taste of flavour, pleasant, charming, delightful
55. Mamsa Muscles and related systems in body
56. Mamsavaha Srotas Channels transporting to the muscles and related tissues
57. Medhya That which enhances wisdom, mental power and intelligence
58. Medovaha Srotas Channels transporting to fat and related tissues
59. Mithyaayoga Wrong use, wrong employment

xxiv AYURVEDIC STANDARD TREATMENT GUIDELINES


GLOSSARY

60. Mootra /Mutra Urine


61. Mutravaha Srotas Channels transporting to the urinary system
62. Nadi Pulse, any tubular organ such as vein or artery
63. Nadi Vrana Wounds with sinuses
64. Nasya Herbal medication through nasal
65. Netra Eye
66. Netragata Related to eye
67. Nidaana Causes, refers to the etiology or cause of the disease
68. Nidaana Parivarjana Removal or avoiding of causative factors related to the
disease
69. Nidra Sleep
70. Nija Innate, one’s own, internal
71. Niruha (Basti) An enema of herbal decoctions
72. Ojas Vigour, strength and vitality that is the essence of all tissues
(Dhatus)
73. Pachaniya Substances that help in proper digestion
74. Panchakarma According to Ayurveda this refers to the five cleansing
therapies i.e. Vaman, Virechana, Basti, Nasya and
Raktamokshana.
75. Pitta It is one of the three Doshas i.e. the bile humour, entire
hormones, enzymes, coenzymes and agencies responsible
for the physiochemical processes of the body

xxv AYURVEDIC STANDARD TREATMENT GUIDELINES


LIST OF TABLES

SL NO. TABLES PAGE NO.

1 Table 1.1: Types of Kasa with their characteristics 5


2 Table 1.2: Common medicines at level 1 for Kasa 7
3 Table 1.3: Medicines at level 1 for Vataja Kasa 7
4 Table 1.4: Medicines at level 1 for Pittaja Kasa 8
5 Table 1.5: Medicines at level 1 for Kaphaja Kasa 8
6 Table 1.6: Common medicines at level 2 for all type of Kasa 9
7 Table 1.7: Medicines at level 2 for different type of Kasa 9
8 Table 2.1: Medicines at level 1 for Kaphadhika Tamaka Swasa 15
9 Table 2.2: Medicines at level 1 for Vatadhika Tamaka Swasa 16
10 Table 2.3: Medicines at level 2 for Kaphadhika Tamaka Swasa 18
11 Table 2.4: Medicines at level 3 for Kaphadhika Tamaka Swasa 19
12 Table 2.5: Medicines at level 3 for Vatadhika Tamaka Swasa 20
13 Table 3.1: Medicines at level 1 for Amlapitta 28
14 Table 3.2: Medicines at level 2 for Amlapitta 29
15 Table 4.1: Medicines at level 1 for Jalodara 34
16 Table 4.2: Medicines at level 2 for Jalodara 35
17 Table 5.1: Medicines at level 1 for Amavata 42
18 Table 5.2: Medicines at level 2 for Amavata 43
19 Table 5.3: Medicines at level 3 for Amavata 45
20 Table 6.1: Medicines at level 1 for Jwara 48
21 Table 6.2: Management of Jwara as per the Doshik predominance 48
at level 1.
22 Table 6.3: Clinical features as per Doshik predominance 49
23 Table 6.4: Clinical features at the level of Dhatus. 50
24 Table 6.5: Management of Jwara at level 2 as per Dhatugata Avastha 50
LIST OF TABLES

25 Table 6.6: Medicines at level 2 for Jwara 51


26 Table 6.7: Comparative features for various type of Jwara 52
27 Table 6.8: Medicines for Dengue fever 53
28 Table 6.9: Medicines for Influenza 54
29 Table 6.10: Medicines for Malaria 54
30 Table 7.1: Medicines at level 1 for Pandu 59
31 Table 7.2: Medicines at level 2 for Pandu 60
32 Table 8.1: Medicines at level 1 for Ekakushta 65
33 Table 8.2: Medicines at level 2 for Ekakushta 67
34 Table 9.1: Medicines at level 1 for Kamala 70
35 Table 9.2: Medicines at level 2 for Kamala 71
36 Table 10.1: Medicines at level 1 for Hypothyroidism 76
37 Table 10.2: Medicines at level 2 for Hypothyroidism 78
38 Table 10.3: Medicines at level 3 for Hypothyroidism 77
39 Table 11.1: Medicines at level 1 for Madhumeha 80
40 Table 11.2: Medicines at level 2 for Madhumeha 83
41 Table 12.1: Medicines at level 1 for Sthaulya 87
42 Table 12.2: Medicines at level 2 for Sthaulya 89
43 Table 13.1: Types of Arsha with their characteristics 93
44 Table 13.2: Medicines at level 1 for Arsha 94
45 Table 13.3: Medicines at level 2 for Arsha 96
46 Table 14.1: Types of Atisara with their characteristics 99
47 Table 14.2: Medicines at level 1 for Atisara 100
48 Table 14.3: Medicines at level 2 for Atisara 101
49 Table 14.4: Medicines at level 3 for Atisara 102
50 Table 15.1: Types of Bhagandara with their characteristics 104
51 Table 15.2: Another classification of Bhagandara based on 105
Dosha Samsarga
52 Table 15.3: Medicines at level 1 for Bhagandara 106
53 Table 15.4: Medicines at level 2 for Bhagandara 107

AYURVEDIC STANDARD TREATMENT GUIDELINES xxvii


LIST OF TABLES

54 Table 16.1: Medicines at level 1 for Krimi 112


55 Table 16.2: Medicines at level 2 for Krimi 113
56 Table 17.1: Medicines at level 1 for Parikartika 115
57 Table 17.2: Medicines at level 2 for Parikartika 117
58 Table 18.1: Medicines at level 1 for Anidra 123
59 Table 18.2: Medicines at level 2 for Anidra 125
60 Table 19.1: Medicines at level 1 for Apasmara 127
61 Table 19.2: Medicines at level 2 for Apasmara 128
62 Table 19.3: Medicines at level 3 for Apasmara 130
63 Table 20.1: Medicines at level 1 for Vishaada 132
64 Table 20.2: Medicines at level 2 for Vishaada 133
65 Table 21.1: Medicines at level 1 for Ashmari 138
66 Table 21.2: Medicines at level 2 for Ashmari 140
67 Table 22.1: Medicines at level 1 for Mutraghata 144
68 Table 22.2: Medicines at level 2 for Mutraghata 146

69 Table 23.1: Differential diagnosis of Mutrashtila with their 148


clinical features

70 Table 23.2: Medicines at level 1 for Mutrashtila 149

71 Table 23.3: Medicines at level 2 for Mutrashtila 151

72 Table 24.1: Types of Asrigdara with their characteristics 157

73 Table 24.2: Differential diagnosis of Asrigdara 157

74 Table 24.3: Medicines at level 1 for Asrigdara 158

75 Table 24.4: Medicines at level 2 for Asrigdara 159

76 Table 24.5: Medicines at level 3 for Asrigdara 160

77 Table 25.1: Medicines at level 1 for Kashtaartava 163

78 Table 25.2: Medicines at level 2 for Kashtaartava 164

79 Table 25.3: Basti Dravyas at level 2 for Kashtaartava 166

80 Table 25.4: Medicines at level 3 for Kashtaartava with heavy bleeding 167

81 Table 25.5: Medicines at level 3 for Kashtaartava with scanty bleeding 167

xxviii AYURVEDIC STANDARD TREATMENT GUIDELINES


LIST OF TABLES

82 Table 26.1: Medicines at level 1 for Shweta Pradara 170


83 Table 26.2: Medicines used for Yoni Prakshalana in Shweta Pradara 171
84 Table 26.3: Medicines used for Yoni Vartia in Shweta Pradara 171
85 Table 26.4: Medicines used for Yoni Pichu in Shweta Pradara 172
86 Table 26.5: Medicines used for Yoni Dhupan in Shweta Pradara 172
87 Table 26.6: Medicines at level 2 for Shweta Pradara 172
88 Table 27.1: Medicines at level 1 for Avabahuka 177
89 Table 27.2: Medicines at level 2 for Avabahuka 179
90 Table 27.3: Panchakarma Procedures at level 3 for Avabahuka 180
91 Table 28.1: Medicines at level 1 for Katigraha 183
92 Table 28.2: Medicines at level 2 for Katigraha 185
93 Table 28.3: Medicines at level 3 for Katigraha 186
94 Table 28.4: Panchakarma procedures at level 4 for Katigraha 187
95 Table 29.1: Medicines at level 1 for Gridhrasi 190
96 Table 29.2: Medicines at level 2 for Gridhrasi 192
97 Table 29.3: Panchakarma Procedures at level 3 for Gridhrasi 193
98 Table 30.1: Differential diagnosis of Pakshaghat with various 198
presentations of the diseases
99 Table 30.2: Medicines at level 1 for Pakshaghat 201
100 Table 30.3: Medicines at level 2 for Pakshaghat 205
101 Table 30.4: Panchakarma procedures at level 3 for Pakshaghat 210
102 Table 31.1: Medicines at level 1 for Sandhivata 215
103 Table 31.2: Medicines at level 2 for Sandhivata 217
104 Table 32.1: Medicines at level 1 for Vatarakta 220
105 Table 32.2: Medicines at level 2 for Vatarakta 222
106 Table 32.3: Rasayanas can be used at level 3 for Vatarakta 223
107 Table 33.1: Differentiating features of common types of conjunctivitis 228
108 Table 33.2: Medicines at level 1 for Abhishyanda 228
109 Table 33.3: Medicines at level 2 for Abhishyanda 231
110 Table 33.4: Shodhana Chikitsa and other Kriyakalpas at level 3 232
for Abhishyanda

AYURVEDIC STANDARD TREATMENT GUIDELINES xxix


LIST OF TABLES

111 Table 34.1: Medicines at level 2 for Adhimantha 239


112 Table 34.2: Uses of Nasyas in various type of Adhimantha 242
113 Table 34.3: Uses of Tarpana in various type of Adhimantha 242
114 Table 34.4: Uses of Ashchyotana & Parisheka in various type of Adhimantha 243
115 Table 34.5: Uses of Anjana in various type of Adhimantha 243
116 Table 34.6: Uses of Siramokshana in various type of Adhimantha 243
117 Table 34.7: Uses of Dhumapana in various type of Adhimantha 243
118 Table 35.1: Medicines at level 1 for Dantaveshtaka 251
119 Table 35.2: Medicines at level 2 for Dantaveshtaka 252
120 Table 35.3: Kriya Kalpa / Panchakarma at level 3 for Dantaveshtaka 253
121 Table 36.1: Medicines at level 1 for Mukhapaka 256
122 Table 36.2: Medicines at level 2 for Mukhapaka 257
123 Table 36.3: Medicines at level 3 for Mukhapaka 258
124 Table 37.1: Medicines at level 1 for Pratishyaya 263
125 Table 37.2: Medicines at level 2 for Pratishyaya 264
126 Table 38.1: Clinical features of different types of Shiroroga 270
127 Table 38.2: Medicines at level 1 for Shiroroga 271
128 Table 38.3: Medicines at level 2 for Shiroroga 272
129 Table 38.4: Medicines at level 3 for Shiroroga 273

xxx AYURVEDIC STANDARD TREATMENT GUIDELINES


INDEX
1 Foreword x
2 Message from Minister xii
3 Preface xiv
4 Acknowledgement xvi
5 Abbreviation xviii
6 Glossary xxii
7 List of Tables xxvi

NO. CHAPTERS PAGES

INTRODUCTION 1

PRANAVAHA SROTAS ROGA


1 Kasa 5
2 Tamaka Swasa 14

ANNAVAHA SROTAS ROGA


3 Amlapitta 27

UDAKAVAHA SROTAS ROGA


4 Jalodara 33

RASAVAHA SROTAS ROGA


5 Amavata 41
6 Jwara 47
7 Pandu 58

RAKTAVAHA SROTAS ROGA


8 Ekakushtha 65
9 Kamala 69

MEDOVAHA SROTAS ROGA


10 Hypothyroidism 75
11 Madhumeha 79
12 Sthoulya 86

PURISHAVAHA SROTAS ROGA


13 Arsha 93
14 Atisara 99
INDEX

15 Bhagandara 104
16 Krimi 109
17 Parikartika 113

MANOVAHA SROTAS ROGA


18 Anidra 121
19 Apasmara 125
20 Vishada 129

MOOTRAVAHA SROTAS ROGA


21 Ashmari 137
22 Mutraghata 142
23 Mutrasthila 148

ARTAVAVAHA SROTAS ROGA


24 Asrigdara 157
25 Kashtaarthava 162
26 Shwetapradara 169

VATA VYADHI
27 Avabahuka 177
28 Katigraha 182
29 Gridhrasi 189
30 Pakshaghata 196
31 Sandhigata Vata 215
32 Vatarakta 220

NETRAGATA ROGA
33 Abhishyanda 227
34 Adhimantha 237

URDHWA JATRUGATA ROGA


35 Dantavestaka 251
36 Mukhapaka 255
37 Pratishyaya 261
38 Shiroroga 270

APPENDIX -
Atura Pariksha Patrak 277

xxxii AYURVEDIC STANDARD TREATMENT GUIDELINES


INTRODUCTION

The classical texts of Ayurveda i.e. ‘Samhita’ were structured thousands of year ago. The Samhita
have a set pattern in which first part is narrative of entire text followed by principles, Ayurvedic
biology, Diagnosis, treatment, therapies etc. This is probably the most relevant pattern to learn
Ayurveda in depth. However, in recent times, practitioners need ready reckoners. This trend
might have started since last 3-4 centuries. The texts like Bhaishajya Ratnavali have described
disease wise formulation. In the present era, medicines are mostly prepared by Ayurveda
Pharma-companies. The diagnosis is largely laboratory based. Often allopathic method of
diagnosis is used in clinical practice followed by Ayurvedic formulations as treatment.

The Insurance coverage is getting more and more importance because of rising trend of lab
investigations, which has also become a part of evidence to support the claim submitted by
the beneficiary. As a matter of fact, typical Ayurvedic terminology is also being replaced by
contemporary words. Though it might have facilitated non Ayurveda people to understand
the prescription, it has also led to loss of specific knowledge behind the terminology.

In the above mentioned circumstances, disease conditions most frequently observed in general
practice have been chosen for preparing this document.The diseases have been categorized on
the basis of Ayurvedic method of classification i.e. according the main Srotas involved. It was
decided to stick to Ayurvedic nomenclature and put nearest allopathy term in bracket for easy
understanding of end user. Often, both the terms cannot be equated. Therefore, to clarify the
meaning, case definition is given in each chapter. This is followed by presentation of disease,
cardinal symptoms etc. to give weightage to clinical diagnosis. At the same time essential lab
investigations have been mentioned wherever felt necessary. Types subtypes based on Dosha
have been described. Efforts are made to describe the treatment according to Doshik type of
disease. It is not merely a compilation of references from classical text, but lot of brain storming
have undergone while preparing the document. The treatment described is evidence based as
well as experience based. Various formulations mentioned are indicative and not exclusive.
Number of drugs has been listed for each of the disease condition. The treating physician shall
have liberty to use any one or more medicines and formulations of his/her choice.

It is expected that an Ayurveda Vaidya working at Primary Health Center may have limited
resources. Therefore referral criteria have been mentioned. It must be kept in mind, especially
by fresher that successful doctors are those who know when to refer the patient.
Diet has major role to play in management of diseases. Therefore, emphasis has been given
on specific medicinal properties of dietary substances mentioned in classical texts or have
been scientifically established, while elaborating specific diet. Dietary substances known to
aggravate disease condition have been specifically contraindicated. Entire part related to diet
is purely based on Ayurvedic concept and non Ayurvedic reader might feel it contradictory at
times to conventional understanding of diet.

Every aspect of this document have been thoroughly discussed by experts of that particular
subject, e.g. Diet was discussed by experts of Swasthavritta, single plants were discussed by
experts of Dravyaguna and so on.

At the end of the document, classical Ayurvedic case record form based on Dashavidha Pariksha
pattern of Ayurveda integrated with some relevant conventional method of case recording has
been given for convenience for those working in hospital set-up.

Efforts have been made to develop the document as per the international standards and could
be useful not only in India but also to international community. It is expected that this effort
would introduce uniform pattern of clinical record keeping that would facilitate data exchange
and collate the data from different centers for academic purpose.

2 AYURVEDIC STANDARD TREATMENT GUIDELINES


Pranavaha Srotas Roga
KASA (COUGH)

Brief Introduction of the disease: Kasa has Case definition:- Prana Vayu obstructed in
been described as an independent disorder the respiratory tract due to various reasons,
as well as a symptom of many diseases attains upward direction and comes out
like Tamaka Swasa (Bronchial Asthma), with force making specific sound is called as
Rajayakshma etc. Kasa (Cough) is the disease Kasa.
or symptom of respiratory tract occurring
due to obstruction of Vata Dosha and its Various Presentation of Kasa
reverse movement. When occurring as an
• Common clinical features: Kasa
independent disease, it has mainly 5 different
Pravriti - Shushka or Sakapha.
presentations as described in classical texts.
(coughing – either dry or produc-
The characteristic sound and pain of cough
tive)
produced will be different according to causes
of Dosha vitiation & nature of obstruction to Kasa depending upon its presentation is of
the forceful movement of the Vata Dosha. five types-

Table 1.1: Types of Kasa with their characteristics

Features Vataja Pittaja Kaphaja Kshathaja Kshayaja


Nature of Dry cough with Continuous Oral cavity Dry cough in
cough resonant or cough coated with initial stage.
___
hollow sound thick saliva/
phlegm
Character Scanty, dry Yellow Excess, slimy Dry Foul
of Sputum and difficult and thick expectoration smelling,
expectoration expectoration stained with greenish
blood. haemoptysis
with pus.
Pain Pain in Hrut- Burning Painless Excessive
parshva-urah-shira sensation in coughing. pain in throat,
___
chest. pricking pain
in chest
Voice Hoarseness of Change in voice Change in
voice ­­­___ voice with ___
rhonchi
Associated Dryness of chest, Bitterness of sweetness pain in
features throat, mouth mouth, Burning and stickiness flanks,
sensation in in mouth, Sinusitis,
throat, chest etc Sinusitis, ___ feeling
KASA (COUGH)

Feeling of hollowness
fullness in chest,
of chest &
heaviness of
body
Systemic Anorexia, Fever, Thirst, Diminished Fever, Fever,
features Giddiness, Anorexia, Pandu appetite, Arthralgia, sudden
Weakness, Giddiness, Anorexia Dyspnoea, desire for
Unconsciousness Unconsciousness Thirst hot & cold,
glossy &
clear skin,
consumes
excessive
food; but
weak and
emaciated,
unformed/
hard stool.

Differential Diagnosis: Examination:

• Tamaka Swasa • Throat congestion - In almost all


types and more specifically in
• Rajayakshma
Pittaja and Vataja Kasa.
• Kshataksheena
• Muco-purulent (greenish) sputum
• Kapha Pittaja Jwara with foul smell – Kshayaja Kasa.
• Vata Kaphaja Jwara • Raised body temperature, raised
• COPD pulse or feverish feeling - Pittaja,
Kshataja, Kshayaja Kasa.
• Bronchitis
• Emaciated and debilitated general
• Bronchiectasis.
condition along with fever, muco-
purulent sputum, - Kshayaja Kasa.
LEVEL 1: AT SOLO AYURVEDA
• On auscultation of chest,
PHYSICIAN’S CLINIC/PHC
o Congestion, crepitation due
Clinical Diagnosis: Kasa Pravriti (coughing), to mucus/fluid trapped air –
Aruchi (anorexia), Jwaranubhuti (feverish), Kaphaja Kasa
Kaphasthivana (expectoration) and other o Wheezing in Vataja or Pittaja
specific Doshaja symptoms as mentioned Kasa.
above.

6 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASA (COUGH)

Investigation: No specific investigation is • Parisheka – Snigdha Parisheka, pref-


required to be performed in this level. erably Ushna Jala Siddha with Erand
Patra2, Tila Taila.3
Line of treatment:
• Dhoomapana - Snaihika
In Vataja Kasa-

• Snehapana - Ghrita with diet of Peya, In Kaphaja Kasa-


Mudagyusha or milk • Dhoomapaana - with Vairechanika
• Snigdha Swedana - Apply Sneha on Dhooma using Maricha4, Pippali5,
chest area (Abhyanga), and then Ela6, Surasamanjari7 in conditions of
hot fomentation with warm hot Shirahshoola, Nasasrava, Urogaurav.
water bag or hot Erand Patra1 (for 20 (heaviness in chest due to
minutes). congestion)

Table 1.2: Common medicines at level 1 for Kasa

Drugs Dosage form Dose Time of Anupana


administration
Vasa Svarasa8 Swarasa 20 ml two to three times Honey
Bibhitaki Kwatha 9
Decoction 20 - 40 ml Twice a day Luke warm
water
Bibhitaki Choorna10 + Powder 2 gm + 1 gm Twice a day Luke warm
PippaliChoorna11 water
Yastimadhu Churna12 + Powder 1 gm + 2 gm Twice a day Honey
Sitopaladi Churna13

Vataja Kasa- The treatment should be started prepared with Vataghna drugs, Abhyanga,
with Snehana with ghee, Peya/Yusha/Kshira Parisheka, Snigdha Sveda.

Table 1.3: Medicines at level 1 for Vataja Kasa

Drugs Dosage form Dose Time of administration Anupana


Kantakaari Ghrita14 Ghee 10 ml Empty stomach in early Warm water
morning and evening
Pippalyadi Ghrita15 Ghee 10 ml Empty stomach in early Warm water
morning and evening
Rasna Ghrita16 Ghee 10 ml Empty stomach in early Warm water
morning and evening
Talishadi Choorna17 Powder 3 gm Twice a day Ghee and honey
Dashmoola Kwatha18 Decoction 10 ml Twice a day Sharkara and Ghrita
Agastya Haritaki19 Avaleha 6-12 gm Warm water/milk

AYURVEDIC STANDARD TREATMENT GUIDELINES 7


KASA (COUGH)

Table 1.4: Medicines at level 1 for Pittaja Kasa

Drugs Dosage form Dose Time of Anupana


administration
Vasa Churna20 Powder 3 gm Twice a day Madhu or
Sharkara
Trinapanchmula + Pippali21 Medicated milk Twice a day Madhu or
+ Drakshakashaya22 Siddha Sharkara
Kshira
Gojihvadi Kwatha23 Decoction 10 ml Twice a day Water
Drakshadi Leha24 Avaleha 6-12 gm Twice a day Warm water/
milk
Kantakaryadi Kwatha25 Decoction 12 – 24 ml Twice a day Water

Table 1.5: Medicines at level 1 for Kaphaja Kasa

Drugs Dosage form Dose Time of Anupana


administration
Trikatu + Vasa Powder Lehana 3gm+ 2 gm Twice a day Madhu

Sitopaladi26 + Bharangi27 Powder Lehana 3gm + 1 gm Twice a day Madhu

Pippali28 roasted with Tila Powder Twice a day Sharkara


Taila29

Devadaaru30 + Haritaki31 Powder Lehana 1 gm each Twice a day Madhu


+ Musta32 + Pippali33 +
Shunthi Churna34

Referral criteria: LEVEL 2: CHC’S OR SMALL


HOSPITALS WITH BASIC
• If patient not responding to above
FACILITIES
therapy.
If patient is not responding to level-1
• In the cases where complications treatment, following investigations should
arise. be carried out.
• Hemogram with ESR
• If further investigations are
• Sputum
needed.
• X-Ray Chest PA View
• In case of Kshataja (blood stained Treatment: Treatment given in level -1 may
sputum) and Kshayaja Kaasa be continued. Following medicines may be
added.

8 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASA (COUGH)

Table 1.6: Common medicines at level 2 for all type of Kasa

Drugs Dosage form Dose Time of Anupana


administration
Chandramrut Vati 1 Tab Twice a day Ajadugdha in Vata,
Rasa35 Gojihvadi Kwatha36 in Kapha,
Draksharishta37 in Pitta
Bhagottara Gutika38 Two tabs 2 Tab Thrice a day Luke warm water
Lavangadi Vati39 Vati as 6 pills/day Six time a day -
lozenges
Khadiradi Vati40 Vati as 6 pills/day Six time a day -
lozenges
Samasharkara Powder 2-4 gm Twice a day Honey
Churna41

Table 1.7: Medicines at level 2 for different type of Kasa

Drug Dosage Dose Time of Duration Anupana


Administration
Vataja Kasa
Chandrmrut Rasa42 Powder 125 mg - Thrice daily 1-2 weeks Sitopaladi Churna
250 mg & honey
Kantakari Avaleha43 Granules 10gm Twice daily 1-2 weeks
Sameerapannaga Rasa Powder 60 mg Twice daily 1-2 weeks Sitopaladi Churna
& honey
Pittaja Kasa
Shati Churna Powder 2-3 gm 4-5 times a day 1 week With Honey
Draksharishta44 Arishta- 10-20 ml Twice daily 2 weeks With equal
Liquid quantity of
water
Vasavaleha45 Granules 10 gm Twice daily 2-3 weeks
Bharangyadi Avaleha46 Granules 10 gm Twice daily 2-3 weeks
Kaphaj Kasa
Shrungyadi Churna Powder 2-3 gm 4-5 times a day 1 week With Honey
Vyaghriharitaki Granules 10 gm Twice daily 2-3 weeks
Avaleha47
Agastya Haritaki Granules 10 gm Twice daily 2-3 weeks
Avaleha48

AYURVEDIC STANDARD TREATMENT GUIDELINES 9


KASA (COUGH)

Kantakari Avaleha49 Granules 10 gm Twice daily 2-3 weeks


Kaphaketu Rasa50 Powder 125-250 Twice daily 1-2 weeks Talisadi Churna
mg with honey
Abhraka Bhasma51 Powder 125-250 Twice daily 1-2 weeks Sitopaladi with
mg honey
Mrigashringa Bhasma52 Powder 125-250 Twice daily 1-2 weeks Sitopaladi with
mg honey

Kshataja Kasa
Eladi Gutika53 Tab 2 tab Thrice daily 2-3 weeks –
Kushmand Avaleha54 Avaleha 10g Twice daily 2-3 weeks Warm milk
Kshayaj Kasa
Draksharishta55 Arisht- 10-20 ml Twice daily 2-3 weeks with same
Liquid quantity of
water
Shwasakuthara Rasa Tablet 125-250 3-4 times a 2-3 weeks with honey
mg day
Malla Sindura Powder 30 mg Twice daily 1 week With Vyaghri
Haritaki / honey
Shringarabhra Rasa Powder 125-250 Twice daily 2-3 weeks Sitopaladi with
mg honey
Shwaskaschintamani Powder 125-250 Twice daily 2-3 weeks Sitopaladi with
Rasa56 mg honey

Referral criteria:
LEVEL 3: AYURVEDA
• If patients not responding to above HOSPITALS AT INSTITUTIONAL
therapy. LEVEL OR DISTRICT HOSPITAL/
INTEGRATED AYURVEDIC
• Koch’s lesion or pleural effusion HOSPITALS
found in chest x-ray.
If patient is not responding to level-2 treat-
• In the cases where complications
ment, following radiological investigations
arise.
should be carried out.
• If further investigations are
• CT scan- for further confirmation of
needed.
diagnosis.
• Sputum Culture.
• 2D Echo

10 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASA (COUGH)

Treatment: Treatment given in level -2 may In Paitika Kasa with Ghana Kapha – Tikta
be continued. Dravya Samyukta Trivrit Virechana.

Panchakarma: Panchakarma may be carried • Shirovirechana: Kaphaja Kasa -


out in following conditions of Kasa. Apamarga57, Tulsi58, Shigru Patra
Swarasa59, Katphala60
• Vamana: In Kaphaja or
Bahukaphapittaja Kasa, only in • Niruha Basti: In Vataj Kasa
patients with good strength. associated with Purisha and
Adhovayu Vibandha
• Virechana: In Paitika Kasa with Tanu
Kapha - Madhura Dravya Samyukta • Anuvasana Basti: Snehanartha in
Trivrit Virechana Vataja Kasa.

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of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 2 (4:7) Welfare, Govt. of India, Part 1 (20:16)
24 Sri Govinda Dasa, Bhaishajya Ratnavali 36 Anonymous, The Ayurvedic Formulary
Kasachikitsa 15/6, In: Ambikadutta Shastri, of India, Ministry of Health and Family
Chaukhamba Prakashan Varanasi, 2009 Welfare, Govt. of India, Part 2 (4:7)

12 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASA (COUGH)

37 Anonymous, The Ayurvedic Formulary 50 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (1:20) Welfare, Govt. of India, Part 1 (20:8)
38 Sri Govinda Dasa, Bhaishajya Ratnavali 51 Anonymous, The Ayurvedic Formulary
Kasachikitsa 15/127-129, In: Ambikadutta of India, Ministry of Health and Family
Shastri, Chaukhamba Prakashan Varanasi, Welfare, Govt. of India, Part 1 (18:1)
2009
52 Anonymous, The Ayurvedic Formulary
39 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family
of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (18:19)
Welfare, Govt. of India, Part 1 (12:26)
53 Anonymous, The Ayurvedic Formulary
40 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family
of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (12:3)
Welfare, Govt. of India, Part 1 (12:26)
41 Sri Govinda Dasa, Bhaishajya Ratnavali 54 Anonymous, The Ayurvedic Formulary
Kasachikitsa 15/33-34, In: Ambikadutta of India, Ministry of Health and Family
Shastri, Chaukhamba Prakashan Varanasi, Welfare, Govt. of India, Part 1 (3:7)

42 Anonymous, The Ayurvedic Formulary 55 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (20:16) Welfare, Govt. of India, Part 1 (1:20)
43 Anonymous, The Ayurvedic Formulary 56 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (3:4) Welfare, Govt. of India, Part 2 (16:58)
44 Anonymous, The Ayurvedic Formulary 57 Anonymous, The Ayurvedic Pharmaco-
of India, Ministry of Health and Family poeia of India, Ministry of Health and
Welfare, Govt. of India, Part 1 (1:20) Family Welfare, Govt. of India, Part 1
45 Anonymous, The Ayurvedic Formulary Vol. 3 (7)
of India, Ministry of Health and Family
58 Anonymous, The Ayurvedic Pharmaco-
Welfare, Govt. of India, Part 1 (3:2))
poeia of India, Ministry of Health and
46 Sri Govinda Dasa, Bhaishajya Ratnavali
Family Welfare, Govt. of India, Part 1
Kasachikitsa 15/5, In: Ambikadutta Shastri,
Vol. 3 (72)
Chaukhamba Prakashan Varanasi, 2009
59 Anonymous, The Ayurvedic Pharmaco-
47 Anonymous, The Ayurvedic Formulary
poeia of India, Ministry of Health and
of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part 1 Vol. 4
Welfare, Govt. of India, Part 2 (3:6)
(51,52,53)
48 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family 60 Anonymous, The Ayurvedic Pharmaco-
Welfare, Govt. of India, Part 1 (3:1) poeia of India, Ministry of Health and
Family Welfare, Govt. of India, Part 1
49 Anonymous, The Ayurvedic Formulary
Vol. 3 (42).
of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (3:4)

AYURVEDIC STANDARD TREATMENT GUIDELINES 13


TAMAKA SWASA (BRONCHIAL ASTHMA)

INTRODUCTION g. Kasa
h. Urahkshata
Tamaka Swasa is one among the five types of
Swasa (dyspnoea) mentioned in Ayurveda.
It can be compared to bronchial asthma in
Line of management
modern medical science. Tamaka Swasa as a Type 1 – Kaphadhika – Shodhana / Kapha
diagnostic terminology encompasses various Nissaraka / Dhuma followed with Shamana
stages of asthma including atopic (allergic) treatment, Kutipraveshika Rasayana.7
asthma to chronic obstructive pulmonary
disorders. The Tamaka Swasa of recent onset Type 2 – Vatadhika – Tarpana / Shamana and
is curable; however it becomes incurable after Bhrimhana, Vatatapika Rasayana.8
attaining the chronicity.1 So early diagnosis
and therapeutic intervention is important.
LEVEL 1: AT SOLO AYURVEDIC
Case definition:
PHYSICIAN’S CLINIC/ PHC

Episodic manifestation of breathlessness Clinical Diagnosis: On the basis of history


triggered due to dust, cloudy atmosphere, and clinical presentation. Subtypes to
exposure to direct wind, cold water,2 often be analyzed considering the tolerance of
associated with cough, wheezing is called as patient, periodicity and chronicity of the
Tamaka Swasa. complaints.

Variants Patient Examination: Detailed examination


of Pranavaha Srotasa to identify the severity
a. Type 1 – Kaphadhika of breathing difficulty.
b. Type 2 – Vatadhika
Investigations: Hemogram, ESR
Differential Diagnosis:
Treatment:
a. Kshudra Swasa 3

Type 1 Kaphadhika variant: Treatment of


b. Chhinna4 / Mahan5 / Urdhwa Swasa6
Vegavastha (At the time of acute exacerbations):
c. Hridroga Local Abhyanga with Lavana Taila (Taila
d. Rajayakshma added with powdered salt and heated ) or
any Vatahara Taila like Brihatsaindhavadi Taila
e. Pandu Roga
applied over the chest and back followed
f. Vataja Grahani with Swedana (local steam fomentation).9
TAMAKA SWASA (BRONCHIAL ASTHMA)

Table 2.1: Medicines at level 1 for Kaphadhika Tamaka Swasa

Drugs Dosage Dose Time of Duration Anupana


Form administration
Shunthi Siddha Jala Paniya Q.S. Frequently 15 days to 30 Nil
days
Dashamool-arishta Arishta 15-30 ml 4-5 times a day 15 days to -
one month
Chandrashura Beeja Kwatha 15-30 ml 4-5 times a day 15 days to Nil
Kwatha one month
Swasakuthara Rasa10 Powder 125 mg Before food/ Twice 15 days to Honey
or thrice daily one month
Talishadi Churna11 Powder 2-3 gm As linctus frequently 15 days to Honey
one month
Sitopaladi Churna12 Powder 2-3 gm For chewing/ 15 days to Honey
frequently one month
Shatyadi Churna13 Powder 2-3 gm Before meals/Twice 15 days to Honey
or thrice daily one month
Dasamoola Kwatha14 Decoction 60 ml empty stomach/ 15 days to 1 tsp
Twice daily one month Honey
Bharangyadi Kwatha15 Decoction 60 ml empty stomach/ 15 days to 1 tsp
Twice daily one month Honey
Gojihvadi Kwatha16 Decoction 60 ml empty stomach/ 15 days to 1 tsp
Twice daily one month Honey
Vasavaleha17 Avaleha/ 3-5 gm As linctus/ 15 days to -
linctus frequently one month
Dashamoola Avaleha/ 3-5 gm As linctus/ 15 days to -
Rasayana18 linctus frequently one month
Agasthya Avaleha/ 3-5 gm As linctus/ 15 days to -
Rasayana19 linctus frequently one month

AYURVEDIC STANDARD TREATMENT GUIDELINES 15


TAMAKA SWASA (BRONCHIAL ASTHMA)

Type 2 Vatadhika variant: In addition to the line of treatment mentioned at Level 1-

Table 2.2: Medicines at level 1 for Vatadhika Tamaka Swasa

Drugs Dosage Dose Time of administration Duration Anupana


Form

Vidaryadi Decoction 60 ml empty stomach/twice 15 days to 1 tsp


Kashaya20 daily one month Honey

Vayu Vati 125 mg Before meals/Twice or 15 days to Honey


Gutika21 thrice daily one month

Dhanwantara Vati 125 mg Before meals/Twice or 15 days to Honey


Gutika22 thrice daily one month

Nayopayam Decoction 60 ml empty stomach/twice 15 days to Honey


Kwatha23 daily one month

Kantakari Ghee 3-5 gm After food/Twice or 15 days to Warm water


Ghrita24 thrice daily one month

Vidaryadi Ghee 3-5 gm After food/Twice or 15 days to Warm water


Ghrita25 thrice daily one month

Somasava Asava 15-30 ml 4-5 times a day 15 days to Equal amount


one month of water

Mahanarayana Taila 5 ml 4-5 times a day 15 days to Balajirakadi


Taila one month Kwatha

Pathya-apathya (diet and life style): (Kulatha), goat milk, green leafy
vegetables like Patola, Shigru, brin-
All such food items alleviating Kapha and
jal, garlic, cardamom, cinnamon,
Vata, Ushna in property should be taken.
pepper, ginger, honey, crab soup,
And all such food items increasing Vata are
Krita and Akrita Mamsa Rasa. Luke
contraindicated. Care should be taken to
warm water for drinking26
improve the strength of the patient without
aggravating Kapha. • Regimen (Vihara): Fomentation,
hot water bath, moderate sun bath,
Do’s (Pathya)– warm clothes etc. and staying in
• Food (Ahara): All dietary articles fresh and ventilated places. Doing
should be easily digestible and light exercises and maintaining
served warm. Unpolished rice, daily routine.
wheat, green gram, horse gram

16 AYURVEDIC STANDARD TREATMENT GUIDELINES


TAMAKA SWASA (BRONCHIAL ASTHMA)

Don’ts (Apathya)– LEVEL 2: CHC’S OR SMALL


HOSPITALS WITH BASIC
• Food (Ahara): All cold and heavy FACILITIES
food should be avoided. Oily
and fried items, bakery items, Clinical Diagnosis:- Same as level 1 for a
fast foods, chocolates, wafers etc. fresh case reporting directly.
should be strictly avoided. All Investigation: same as level 1, in addition
dairy products27 especially curd,
• Sputum for AFB and Mantoux Test
paneer and ice creams should be
(Both to rule out Pulmonary TB in
strictly avoided. Intake of sesame,
suspected cases)
black gram, jaggery should be
limited.28 • X- Ray of chest – PA view to rule out
structural abnormalities to bilateral
• Vihara: Exposure to cold, dust, lungs, allied parts and heart.
smokes and direct wind should be
• Pulmonary function tests- To assess
strictly avoided.29 Hard exercises
the lung capacities.
and peak sun exposure are not
advisable. Avoid air coolers and • ECG
air conditioners. Avoid cold water
Treatment:
bath and application of oil on head
especially on symptoms of cold. Type 1 Kaphadhika Variant: Treatment
Do not suppress natural urges of Vegavastha (At the time of acute
especially coughing, sneezing and exacerbations): The patients with Vegavastha
bowel and bladder responses. and Utklishta Dosha should be given Abhyanga
Avoid day sleeping.30 with Lavana Taila and Swedana followed by
Ullekhna (Vamana) with warm saline water.
Referral criteria: Refer to level 2 Repeated Ushma Sweda with steam made from
1. Cases not responding to above line of water and Tulasi leaves may be given. After
management. Kapha Shodhana patient may be subjected
to moderate laxatives (Mridu Virechana)
2. All cases of severe persistent Asthma. using Trivrita Lehya 15-20 gm without any
Purvakarma.31
3. Patient with co-morbidity of fever,
patient may be suffering from cyano- In addition to the Shamana management
sis, patient may have signs of hyper- mentioned in Level 1, few of the following
capnia and in acute phase of febrile drugs may be added as per the requirement
illness. and status of the patient.

AYURVEDIC STANDARD TREATMENT GUIDELINES 17


TAMAKA SWASA (BRONCHIAL ASTHMA)

Table 2.3: Medicines at level 2 for Kaphadhika Tamaka Swasa

Drugs Dosage Dose Time of Duration Anupana


form administration
Dashamoola Katutrayadi Decoction 60 ml Empty stomach/ 15 days to 1 tsp
Kashaya32 Twice daily one month honey
Swasakuthara Rasa33 Churna / 125-250 After meal/twice 2-3 weeks Honey/
Vati mg / 1-2 daily Luke
Vati warm
water
Svasakasa Chimtamani Churna / 125-250 After meal/twice 2-3 weeks Honey/
Rasa 34 Vati mgs/ 1-2 daily luke warm
Vati water
Kanakasava35 Asava 10-20 ml After meal/ twice 2-3 weeks Equal
daily quantity
of water
Pipplayasava36 Asava 10-20 ml After meal / twice 2-3 weeks Equal
daily quantity
of water
Vyaghriharitaki Avaleha 5-10 gm Before meal twice 2-3 weeks -
Avaleha37 daily
Shirisharishta38 Arishta 10-20 ml After meal/ twice 2-3 weeks Equal
quantity
of water
Suvarnamalini Vasanta39 Churna/ 125-250 After meal/twice 2-3 weeks Honey/
Vati mg / 1-2 daily Luke
Vati warm
water
Swasakuthara mishrana Powder 1-2 gm 3-4 times a day During Honey
– Swasakuthara Rasa40 during attack attack
1 part, Sutasekhara
Rasa41 1 part and
Karpooradi Churna42
4 part
Laxmivilasa Rasa43 Powder 250 mg After food thrice 2-3 weeks Honey
a day
Mrityunjaya Rasa44 Powder 250 mg After food thrice 2-3 weeks Honey,
a day Ardraka
Swarasa,
Narilkela
Sitayukta

18 AYURVEDIC STANDARD TREATMENT GUIDELINES


TAMAKA SWASA (BRONCHIAL ASTHMA)

Type 2 Vatadhika variant: Snigdha Mridu Investigation:-


Virechana with Eranda Taila 15-20 ml and
• TMT to rule out Cardiac pathology
milk (50-75 ml) may be given. Dhanwantarm
and to ensure fitness for Shodhana
Gutika45 in frequent doses with Jeeraka water
therapy.
may be given in increased distress.
Pathya-Apathya (diet and life style): Same • 2D Echocardiography
as Level 1 Treatment: In addition to the management
Referral Criteria: Refer to Level 3 of Level 1 and Level 2, if needed Panchakarma
procedures can be performed.
1. Cases not responding to above therapy.
2. Moderate to Severe cases of Tamaka Type 1 Kaphadhika variant: Purvakarma
Swasa with complications. as Pachana, Deepana (Rookshana if required),
3. Severe cases associated with tuberculosis, Snehapana and Swedana may be done before
cardiac diseases etc. Shodhana
4. Chronic cases of Tamaka Swasa which 1. Pachana & Deepana
require classical Shodhana therapy
2. Rookshana if required - Butter milk
with Hingvashtaka Churna to be given
LEVEL 3: AYURVEDA
frequently for 2-3 days.
HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT HOSPITAL / 3. Snehapana & Swedana
INTEGRATED AYURVEDIC 4. Vamana followed with Dhoomapana
HOSPITALS
5. Virechana
Clinical Diagnosis: Same as level 1 for a
6. Rasayana
fresh case reporting directly

Table 2.4: Medicines at level 3 for Kaphadhika Tamaka Swasa

Drugs Dosage Dose Time of Duration Anupana


form administration
Vardhamana Kshirapaka Starting with Early morning 1 course Nil
Pippali Prayoga 3 Pippali empty stomach (22 days)
increasing upto
33 Pippali
Agasthya Avaleha 15 gm Early morning One Warm
Rasayana46 empty stomach month water

Chyavana Prasha Avaleha 15 gm Early morning One Warm


Avaleha47 empty stomach month milk

AYURVEDIC STANDARD TREATMENT GUIDELINES 19


TAMAKA SWASA (BRONCHIAL ASTHMA)

Type 2 Vatadhika variant: Same line of over the chest and mild massage. Debilitated
management in Level 2 during Vegavastha. patients may be planned for Sarvanga
Patient can also be supported with application Abhyanga with Dhanwantaram Taila49 and
of 20-30 drops of Ksheerabala (101) Avrita48 Shashtika Pinda Sweda as IPD.

Table 2.5: Medicines at level 3 for Vatadhika Tamaka Swasa

Drugs Dosage Dose Time of Duration Anupana


form administration
Malla Naga Mishrana (Malla Powder 250 to 3-4 times as One With honey
Sindoora 1 part50, Naga Guti 500 mg frequent dose month
1 part51, Abhraka Bhasma1
part52, Shringha Bhasma 4
part53
Prabhakra Vati54 Vati 750 mg Twice daily One Arjunarishta
month

REFERENCES

1 Charaka, Charaka Samhita, Chikitsa Sthana 6 Charaka, Charaka Samhita, Chikitsa Sthana
17/62, In: Yadavji Trikamji Acharya, 17/49-51, In: Yadavji Trikamji Acharya,
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Sansthan; 2009. p. 515 p. 373

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TAMAKA SWASA (BRONCHIAL ASTHMA)

11 Anonymous, The Ayurvedic Formulary 21 Vajrajivana, Sahastrayogam Gutika


of India, Ministry of Health and Family Prakarna, 3 edition, Delhi: Chaukhamba
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Welfare, Govt. of India, Part I (7:13), 2000, Sanskrit Prathisthan; 2001, p. 255
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of India, Ministry of Health and Family Welfare, Govt. of India, Part I (12:14), 2000,
Welfare, Govt. of India, Part I (7:34), 2000, p. 518
p. 348
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13 Charaka, Charaka Samhita, Chikitsa Sthana of India, Ministry of Health and Family
17/123-124, In: Yadavji Trikamji Acharya, Welfare, Govt. of India, Part I (4:14), 2000,
Reprint, Varanasi: Chaukhamba Sanskrit p. 180
Sansthan; 2009. p. 526
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Welfare, Govt. of India, Part I (4:25), 2000, p. 297
p. 192
26 Sri Govindacharya, Bhaishajya Ratnavali,
16 Anonymous, The Ayurvedic Formulary Hikka-Swasa Chikitsa Adhyaya 16/137-
of India, Ministry of Health and Family 139, p. 509
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Diagonostic modalities; Indian Journal of
18 Anonymous, The Ayurvedic Formulary
Allergy, Asthma and Immunology; July-
of India, Ministry of Health and Family
Dec 2013, Vol. 27, Issue 2
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p. 135 29 Raj Kumar, Nirupam Sharan, Manoj
Kumar, Indu Bisht, S. N. Gaur, Pattern of
19 Anonymous, The Ayurvedic Formulary
skin sensitivity to various aeroallergens in
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Welfare, Govt. of India, Part I (3:1), 2000,
rhinitis in India; Indian Journal of Allergy,
p. 111
Asthma and Immunology Jul-Dec 2012,
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50/3-5, In: Ambikadutta Shastri, Reprint,
p. 199

AYURVEDIC STANDARD TREATMENT GUIDELINES 21


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Varanasi: Chaukhamba Sanskrit Sansthan; 40 Anonymous, The Ayurvedic Formulary


2008, p. 365 of India, Ministry of Health and Family
31 Charaka, Charaka Samhita, Chikitsa Sthana Welfare, Govt. of India, Part I (20:49), 2000,
17/89, In: Yadavji Trikamji Acharya, p. 730
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Sansthan; 2009. p. 521 of India, Ministry of Health and Family
32 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (20:52), 2000,
of India, Ministry of Health and Family p. 735
Welfare, Govt. of India, Part I (4:9), 2000, 42 Anonymous, The Ayurvedic Formulary
p.107 of India, Ministry of Health and Family
33 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (7:6), 2000,
of India, Ministry of Health and Family p. 313
Welfare, Govt. of India, Part I (20:49), 2000, 43 Anonymous, The Ayurvedic Formulary
p. 730 of India, Ministry of Health and Family
34 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (20:39), 2000.
of India, Ministry of Health and Family 44 Pandit Duttaram Chaubhay, Bruhat Rasa
Welfare, Govt. of India, Part II (16:58), 2000, Raj Sundar p. 244, Varanasi: Chaukhambha
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45 Anonymous, The Ayurvedic Formulary
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Welfare, Govt. of India, Part I (1:9), 2000,
Welfare, Govt. of India, Part I (12:14), 2000,
p. 53
p. 518
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46 Anonymous, The Ayurvedic Formulary
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Welfare, Govt. of India, Part I (1:22), 2000,
Welfare, Govt. of India, Part I (3:1), 2000,
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Prakshan Varanasi, 2008 of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (8:11), 2000,
39 Siddha Bhaishajya Manimala of Mahakavi
p. 378
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Second edition. 1999. Jvaraadhikar 60-62 p. 394

22 AYURVEDIC STANDARD TREATMENT GUIDELINES


TAMAKA SWASA (BRONCHIAL ASTHMA)

50 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (18:1), 2000,
of India, Ministry of Health and Family p. 591
Welfare, Govt. of India, Part I (15:3), 2000,
53 Anonymous, The Ayurvedic Formulary
p. 567
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52 Anonymous, The Ayurvedic Formulary
Chaukhamba Prakashan Varanasi, 2009
of India, Ministry of Health and Family

AYURVEDIC STANDARD TREATMENT GUIDELINES 23


Annavaha Srotas Roga
AMLAPITTA

• Pittaja Gulma
INTRODUCTION
• Pittashmari
Amlapitta is a disease of Annavaha Srotas with
• Annadravashoola
main characteristics like Urodaha, Avipaka,
Tikta Amla Udgara etc. The chronic conditions • Parinamashoola
may cause Kotha, Kandu, Mandala, etc. The • Udara Poorvarupa
condition may be co-related with Acid Peptic
Disorders. Line of Treatment

Case Definition: • Nidana Parivarjana should be the


first line of treatment.
Patients presenting with Tikta Amla Udgara
(Bitter and sour belching), Hrit Kantha Daha • Shodhana Chikitsa – Vamana and
(Burning sensation in throat and chest), Virechana
Aruchi (Tastelessness), Hrillasa (Nausea), • Shamana Chikitsa - Langhana,
Uthklesha (Nausea), Avipaka (Indigestion) etc. Pachana, Deepana
can be diagnosed as a case of Amlapitta.
• Treatment according to Doshik
Types: involvement

Amlapitta is of three types according to


Anubandha Dosha as Vataja, Vatakaphaja and LEVEL 1: AT SOLO
Kaphaja. According to clinical presentation AYURVEDIC PHYSICIAN’S
Amlapitta is of two types Urdhwaga and CLINIC/PHC
Adhoga. Urdhwaga is characterised with upper
GIT symptoms and Adhoga is characterised Clinical Diagnosis: On the basis of history
with lower GIT symptoms. and clinical presentation

Differential Diagnosis Investigations: nothing specific


Treatment: any of the following drugs:
• Chhardi
AMLAPITTA

Table 3.1: Medicines at level 1 for Amlapitta

Drugs Dosage Dose Time of Duration Anupana


form administration
Shunthi Churna Churna 2-3 gm Before meal / 1-2 weeks Warm water
twice a day
Amalaki Churna Churna 2-3 gm Before meal / 1-2 weeks Warm water
twice a day
Yashtimadhu Churna Churna 2-3 gm Before meal / 1-2 weeks Warm water
twice a day
Hingwashtaka Churna Churna 2-3 gm Before meal / 1-2 weeks Warm water
twice a day
Shivakshara Pachana Churna 2-3 gm Before meal / 1-2 weeks Warm water
Churna twice a day
Avipattikara Churna1 Churna 4-6 gm Before meal / 1-2 weeks Warm water
twice a day / Madhu
Kamadudha Rasa Vati 1-2 tab Before meal / 1-2 weeks Warm water
(125-250 mg) thrice a day

Pathya-Apathya (Diet and life style Referral criteria:


education):
• Patients not getting relief
Do’s:
• Chronic cases
• Ahara – Yava, Godhuma, Seasoned
Shali, Mudga Yusha, Laaja Saktu,
Karavellaka, Patola, Kushmanda, LEVEL 2: CHC’S OR SMALL
Dadima, Amalaki, Kapittha, Godugdha, HOSPITALS WITH BASIC
Mamsarasa, Sharkara, Madhu, FACILITIES
Narikelodaka
• Vihara – Follow dinacharya, Yogasana Clinical diagnosis: Same as level 1 for a fresh
case reporting directly.
Don’t s:
• Ahara: Heavy food, Vidahi, Viruddha Investigations:
Ahara, Kulatha, Udada, Navanna,
• Stool for occult blood
Tila, fermented foods like bread,
excessive intake of curd, spicy food, • LFT
bakery food, untimely food habit, • USG abdomen / pelvis
deep fried food, alcohol intake and
Treatment: Virechana and Rasaushadhis along
smoking.
with Shamana Aushadhi mentioned in Level 1
• Vihara – Suppression of urges,
can be given:
worry, anger, stress, day sleep.

28 AYURVEDIC STANDARD TREATMENT GUIDELINES


AMLAPITTA

Table 3.2: Medicines at level 2 for Amlapitta

Drugs Dosage Dose Time of Duration Anupana


form administration
Pravala Vati 1 to 2 tab After meal / 1-2 weeks Warm water
panchamrita Rasa2 (125-250 mg) thrice a day
Sutashekhara Vati 1 to 2 tab Before meal / 1-2 weeks Warm water
Rasa3 (125-250 mg) thrice a day
Shankha Bhasma4 Churna 125-500 mg / Before meal 1-2 weeks Warm water
day / Takra
Narikela Lavana Churna 1 gm Before meal 1-2 weeks Warm water
/ Takra.
Pravala Bhasma5 Churna 250 mg - 500 Before meal 1-2 weeks Warm water
mg / day

Kapardika Bhasma Churna 125-500 mg / Before meal 1-2 weeks Warm water
day / Takra
Patoladi Kwatha Kwatha 10-15 ml Empty stomach 1-2 weeks -
Kalyanaka Kshara Churna 2-3 gms Before meals 1-2 weeks Warm water

Virechana Karma – Abhyantara Snehapana Investigations: In addition to those men-


with Dadimadi Ghrita, Vidaryadi Ghrita, tioned in Level 2.
plain Gau Ghrita followed with Virechana by • Endoscopy
Trivritta Lehya, Panchasakara Churna, Eranda
Bhrishta Haritaki etc. Treatment:
Referral criteria: Shodhana:
• Patients not responding to treat-
• Vamana - Madanaphala, Vacha,
ments mentioned in level 2
Patola, Nimba Kalka, Yashtimadhu
Phanta, Saindhava Lavana Jala.
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL • Virechana
LEVEL OR DISTRICT Pathya-Apathya (Diet and life style
HOSPITAL/ INTEGRATED education): Same as mentioned in
AYURVEDIC HOSPITALS level 1.

Clinical diagnosis: Same as level 1 & level 2


for a fresh case reporting directly.

AYURVEDIC STANDARD TREATMENT GUIDELINES 29


AMLAPITTA

REFERENCES

1. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (20/52),


of India, Ministry of Health and Family 2000.
Welfare, Govt. of India, Part I (7/2), 2000. 4. Anonymous, The Ayurvedic Formulary
2. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part I (18/18), 2000.
Welfare, Govt. of India, Part II (16/37), 5. Anonymous, The Ayurvedic Formulary
2000. of India, Ministry of Health and Family
3. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (18/8),
of India, Ministry of Health and Family 2000.

30 AYURVEDIC STANDARD TREATMENT GUIDELINES


Udakavaha Srotas Roga
JALODARA (ASCITES)

INTRODUCTION • Hepatocellular adenoma

Eight different types of Udara Roga are • Hepato-renal syndrome


mentioned in Ayurvedic classics, such • Protein-Losing enteropathy
as Vatika, Paittika, Kaphaja, Sannipaatika,
Pleehodara, Baddhodara, Kshatodara and
Jalodara. If untreated, all types of Udara will LEVEL 1: AT SOLO AYURVEDA
culminate into Jalodara. Jalodara is considered PHYSICIAN’S CLINIC / PHC
as one among the ‘Ashta Mahagada’. The
Clinical Diagnosis: On the basis of history
main pathogenesis involved in Udara is
and clinical presentation, patient can be
Agnimandya, Doshopachaya & Srotorodha.
diagnosed provisionally as case of Jalodara.
Therefore, the treatment involves Deepana,
Distended abdomen, excessive thirst, anal
Pachana & Nitya Virechana.
wetness, presence of averted umbilicus,
shifting dullness, fluid thrill, engorged
Case Definition:
vessels over abdomen etc. may confirm the
Distention of abdomen due to accumulation diagnosis.
of fluid in peritoneal cavity associated with Investigations: Though much can be
loss of appetite, heaviness of abdomen, diagnosed based on the clinical signs and
general debility and edema. symptoms, laboratory investigations may
help the clinician to confirm the diagnosis
Differential Diagnosis: and rule out other conditions.
• Gulma • Blood for Hb, TLC (leucocytosis),
• Yakrutodara DLC (Neutrophilia)

• Pleehodara • Urine Routine and microscopic

• Kamala Treatment: In the initial stage when the


patient is having mild features of Jalodara,
• Cirrhosis
along with diet restriction, two or more of
• Hepatitis following drugs may be given:
JALODARA (ASCITES)

Table 4.1: Medicines at level 1 for Jalodara

Drugs Dosage Dose Time of Duration Anupana


form administration
Bhumyamalaki Churna 3-6 gm After meal / 2-3 weeks Honey /
thrice a day water
Katukarohini1 Churna 3-6 gm After meal / 2-3 weeks Honey /
thrice a day water
Kumari Swarasa 10-20 ml After meal / 2-3 weeks With water
thrice a day
Punarnavadi Churna2 Churna 3-6 gm After meal / 2-3 weeks Honey /
thrice a day water
Haritaki3 Churna 3-6 gm After meal / 2-3 weeks Luke warm
thrice a day water
Indrayana4 Churna 3-6 gm / After meal / 2-3 weeks Honey /
10-20 ml thrice a day water
Punarnavashtaka Kwatha 12-24 ml before meal / 2-3 weeks
-
Kwatha5 twice a day
Dashamoola Kwatha6 Kwatha 12-24 ml before meal / 2-3 weeks
-
twice a day
Phalatrikadi Kwatha7 Kwatha 12-24 ml before meal / 2-3 weeks
-
twice a day
Pathyadi Kwatha8 Kwatha 12-24 ml before meal / 2-3 weeks
-
twice a day
Gomutra Haritaki Churna 3–6 gm After meal / 2-3 weeks Luke warm
Churna9 twice a day water

In addition to these, patients may be advised e.g. Yavagu, Yusha, Tilanala Kshara
to maintain input-output chart for fluid or Palasha Kshara, Vartaka Kshara,
regulation, and record of abdominal girth. Swarjika Kshara etc. semi liquids are
advised. Yava along with Vastuka
Pathya - Apathya (Diet and life style): (Bathua leaves), Karela (Karavellaka)
are advised.
Do’s -
• Vihara: Timely meals, relaxation
• Ahara: Only milk diet is advised. techniques
Goat / camel / cow / buffalo
milk, buttermilk, Peya – Jangala Don’ts -
Mamsa Rasa, Khichadi prepared
with seasoned rice and Moong Daal, • Ahara: Salt and water intake should
Shigru, fresh vegetables soup. Diet be restricted, heavy food, green
with Deepana (digestive) property peas, black eyed beans, lentils,
and Laghu (light to digest) property yellow gram, raw vegetables and

34 AYURVEDIC STANDARD TREATMENT GUIDELINES


JALODARA (ASCITES)

salads, refined foods such as white Investigations: Same as Level 1, In addition;


flour (Maida- bread, pizza, biscuits), the following tests can be done:
sprouts, etc. are contraindicated. • Liver Function Tests: Elevated
• Vihara: Physical and mental stress, amino transferase - ALT/AST
excessive exercise, suppression of > 45U/lit, disturbed albumin:
natural urges, day sleep, blood- globulin ratio; raised alkaline
letting, phosphates; higher values of
prothrombin time
Referral Criteria: Refer to level 2
• Lipid profile - Increased values of
1. Patients not responding to above S. Cholesterol, S. Triglyceride
mentioned management
• Renal function tests
2. Imbalance in fluid input-output ratio
• Sr. electrolytes (Na, K, Ca)
3. Signs of jaundice, cardiac failure or renal
failure • ECG for cardiac function
4. Signs of hepatic encephalopathy monitoring.
• USG
LEVEL 2: CHC’S OR SMALL Treatment: In addition to the management
HOSPITALS WITH BASIC mentioned in Level 1, few of the following
FACILITIES drugs may be added as per the requirement
Clinical Diagnosis: The diagnosis is made and status of the patient. Rasaushadhi
on the basis of criteria mentioned in level-1 (Herbo-mineral drugs) can be used at
for fresh cases. The case referred from level-1 this level. Patient may be kept under
or fresh case must be evaluated thoroughly observation while prescribing these kinds of
for any complication. medicines.

Table 4.2: Medicines at level 2 for Jalodara

Drug Dosage Dosage Time of Duration Anupana


form administration

Narayana Churna10 Churna 3-5 gm Before meal / 2-3 Takra


twice a day weeks

Kumaryasava11 Asava 20-40 ml Before meal / 2-3 Equal quantity of


twice a day weeks water

Abhaya Vati12 Vati 1-2 Vati After meal / 2-3 Lukewarm water
thrice a day weeks

Shilajatu Churna13 Churna 1-2 gm After meal / 3 months Cow urine


thrice a day

AYURVEDIC STANDARD TREATMENT GUIDELINES 35


JALODARA (ASCITES)

Chitraka Ghrita14 Ghrita 3-5 gm before meal / 2-3 Luke warm


twice a day weeks water

Jalodaradi Rasa15 Vati 1-2 Vati After meal / 2-3 Water


thrice a day weeks

Arogyavardhini Churna / 250–500 mg After meal / 2-3 Water


Rasa16 Vati (1-2 Vati) thrice a day weeks

Icchabhedi Rasa17 Vati 1 Vati Early morning 2 times a Water


empty stomach week

In addition to these, patients may be advised Investigation:


to maintain input-output chart for fluid
• USG Abdomen
regulation and record of abdominal girth.
• Abdominal paracentesis and
Pathya - Apathya (Diet and life style): analysis of ascitic fluid
Same as level 1
• CT Scan

Referral Criteria: Treatment: In addition to the management of


Level 1 and Level -2, if needed Panchakarma
1. Cases not responding to above therapy. procedures indicated for Jalodara can be
2. Patients with increased level of performed.
bilirubin
3. Severe persistent vomiting or diarrhea Shodhana Chikitsa
1. Nitya Mridu Virechana
LEVEL 3: AYURVEDA
2. Virechana Karma
HOSPITALS AT INSTITUTIONAL
LEVEL OR 3. Abdominal tapping may be done as
DISTRICT HOSPITAL / per requirement.
INTEGRATED AYURVEDIC 4. Rasayana - Vardhamana Pippali
HOSPITALS Shilajatu Rasayana

Clinical Diagnosis: Same as level 1 for a Pathya - Apathya (Diet and life style): Same
fresh case reporting directly as level 1

36 AYURVEDIC STANDARD TREATMENT GUIDELINES


JALODARA (ASCITES)

REFERENCES

1. Govind Das Sen, Bhaishajya Ratnavali, 10. Anonymous, The Ayurvedic Formulary
Jwara Rogadhikar, Adhyaya 5/172 edited by of India, Ministry of Health and Family
Brahma Shankara Mishra. 11th ed. Varanasi: Welfare, Govt. of India, PART-I (7:19).
Chaukhambha Sanskrit Sansthan; 1993. 11. Anonymous, The Ayurvedic Formulary
2. Govind Das Sen, Bhaishajya Ratnavali, of India, Ministry of Health and Family
Udara Rogadhikar, Adhyaya 40/36 edited Welfare, Govt. of India, PART-I ( 1:12).
by Brahma Shankara Mishra. 11th ed. 12. Govind Das Sen, Bhaishajya Ratnavali,
Varanasi: Chaukhambha Sanskrit Sansthan; Udara Rogadhikar, Adhyaya 40/87-90
1993. edited by Brahma Shankara Mishra. 11th ed.
3. Govind Das Sen, Bhaishajya Ratnavali, Varanasi: Chaukhambha Sanskrit Sansthan;
Chardi Rogadhikar, Adhyaya 19/9 edited 1993.
by Brahma Shankara Mishra. 11th ed. 13. Govind Das Sen, Bhaishajya Ratnavali,
Varanasi: Chaukhambha Sanskrit Sansthan; Udara Rogadhikar, Adhyaya 40/60 edited
1993. by Brahma Shankara Mishra. 11th ed.
4. Govind Das Sen, Bhaishajya Ratnavali, Varanasi: Chaukhambha Sanskrit Sansthan;
Ashmari Rogadhikar, Adhyaya 36/22 1993.
edited by Brahma Shankara Mishra. 11th 14. Govind Das Sen, Bhaishajya Ratnavali,
ed. Varanasi: Chaukhambha Sanskrit Udara Rogadhikar, Adhyaya 40/139 edited
Sansthan; 1993. by Brahma Shankara Mishra. 11th ed.
5. Anonymous, The Ayurvedic Formulary Varanasi: Chaukhambha Sanskrit Sansthan;
of India, Ministry of Health and Family 1993.
Welfare, Govt. of India, PART-I (4:22) 15. Anonymous, The Ayurvedic Formulary
6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part-II ( 16:19)
Welfare, Govt. of India, PART-I (4:16). 16. Anonymous, The Ayurvedic Formulary
7. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, PART-I ( 20:4)
Welfare, Govt. of India, PART-II (4:15). 17. Govind Das Sen, Bhaishajya Ratnavali,
8. Anonymous, The Ayurvedic Formulary Udara Rogadhikar, Adhyaya 40/65-66,
of India, Ministry of Health and Family edited by Brahma Shankara Mishra. 11th
Welfare, Govt. of India, PART-I (7:8). ed. Varanasi: Chaukhambha Sanskrit
9. Anonymous, The Ayurvedic Formulary Sansthan; 1993.
of India, Ministry of Health and Family
Welfare, Govt. of India, PART-I (7:8).

AYURVEDIC STANDARD TREATMENT GUIDELINES 37


Rasavaha Srotas Roga
AMAVATA (RHEUMATOID ARTHRITIS)

Line of Treatment
INTRODUCTION:
• Nidana Parivarjana should be the
Amavata is a condition described in Ayurveda
first line of treatment.
involving multiple joints, including sacroiliac
joints with severe pain swelling and stiffness. • Shodhana Chikitsa – Virechana, Basti,
General symptoms like fever, loss of appetite Raktamokshana
etc may also be associated. The disease • Shamana Chikitsa - Langhana,
conditions like Rheumatoid Arthritis, many Swedana, Rukshana, Pachana, Deepana
other forms of connective tissue disorders
like Polymyositis, Polyarthritis in elderly • External applications - Lepa,
like Polymayalgia Rheumatica and common Upanaha
infective Arthritis in children like Rhueumatic • Rasayana Chikitsa for Rasa
Fever, Chikungunya Arthritis, Myofascial
Pain Syndromes may be considered under • Treatment according to Doshik
the umbrella of Amavata. involvement

• General line of treatment prescribed


Case Definition: for Ama and Vata
Polyarthritis associated with stiffness and
associated symptoms of Ama like Angamarda LEVEL 1: AT SOLO AYURVEDA
(generalized body pain), Aruchi (anorexia), PHYSICIAN’S CLINIC/ PHC
Trushna (increased thirst), Alasya (lassitude),
Gaurava (heaviness of the body), Jwara
Clinical Diagnosis: On the basis of history
(fever), Apaka (delayed digestive capacity)
and clinical presentation
and Shunata Anganam (joint specific or
generalized swelling), constipation and
Investigations:
polyuria. Rarely the disease can manifest as
monoarthritis also. • ESR
• Complete Blood Count
Differential Diagnosis:
Treatment: In the initial stage, Rookshana,
• Sandhigat Jwara Pachana and Deepana should be attempted
• Ama Jwara with some of the following drugs.
AMAVATA (RHEUMATOID ARTHRITIS)

Table 5.1: Medicines at level 1 for Amavata

Drug Dosage Dose Time of Duration Anupana


Form administration
Shunthi Churna 1-2 gm Before meal / 2-3 weeks 3-5 Eranda Taila
twice daily with warm water
Trikatu Churna 1-2 gm Before meal / 2-3 weeks Luke warm water
twice daily
Musta Churna 3-5 gm Before meal / 2-3 weeks Luke warm water
twice daily
Shadanga Paneeya Phanta QS Whole day – to 3-5 days
quench the thirst
Gomutra Haritaki1 Vati 1-2 Vati After meal / 2-3 weeks Luke warm water
thrice daily
Ajmodadi Churna2 Churna 2-3 gm Before meal / 2-3 weeks Luke warm water
twice daily
Amrutadi Kwatha 12-24 ml Empty stomach / 2-3 weeks Sugar – 3 gm
Kashaya3 6 am & 6 pm
Dashamoola Kwatha 12-24 ml Empty stomach / 2-3 weeks -
Kwatha4 6 am & 6 pm
Sanjivani Vati5 Vati 1-2 Vati After meal / 2-3 weeks Luke warm water
thrice daily
Amapachana Vati Vati 1-2 Vati After meal / 2-3 weeks Luke warm water
thrice daily
Eranda Taila Oil 15-30 ml* Once at bed time 2-3 weeks Luke warm water /
or empty stomach warm milk
early morning

*Dose can be individualized according to instructed to stick on to light and non-fatty


bowel response diet in two Annakala, preferably at morning
and evening. The amount of food should be
The patient may also be instructed to do
less than moderate and eat while hungry.
mild poultice fomentation with heated sand
Consumption of large amount of water while
(Baluka Sweda) on the affected joints self.
eating also is not good. Patient should avoid
stress in general.
Pathya - Apathya (Diet and life style
education): Do’s (Pathya)
Since formation of Ama is the key factor in • Ahara: Light diet, Panchakola
the pathogenesis of Amavata all food articles Yavagu, Ushna Jala, Vegetables like
and activities leading to reduction of Agni Methi, Shigru, Vastuka, Karvellaka,
and formation of Ama should be avoided. Ardraka and pulses like horse gram
The patients should be always specifically (Kulattha). Crab soup, Rasona.

42 AYURVEDIC STANDARD TREATMENT GUIDELINES


AMAVATA (RHEUMATOID ARTHRITIS)

• Vihara: Hot water bath, sun bath, Referral Criteria:


timely eating, following daily &
• Patients not responding to above
seasonal regimen properly
management
Don’ts (Apathya) • Chronic patients with complications
like joint deformities, muscle
• Ahara: Food articles which are
wasting, anaemia
heavy to digest like fried items,
sweets, all dairy products except
buttermilk, Dadhi, Matsya, Guda, LEVEL 2: CHC’S OR SMALL
Ksheera, Upodika, Masha, Pishta HOSPITALS WITH BASIC
preparations made of green peas, FACILITIES
raw vegetables and salads, pota-
Clinical diagnosis: Same as level 1 for a fresh
toes, sour food like tomato, lemon,
case reporting directly
tamarind etc.
Investigations: Same as level 1, in addition
• Vihara: Divaswapna (Day sleeping),
• CRP and RF
Ratri Jagarana (night awakening),
Ajirnashana (eating without the • Radiographic evaluation – X rays of
feel of appetite), overeating, the more affected joints to evaluate
Vishamashana (eating at odd the level of evolving joint deformity.
timings), physical exertion just after Treatment: In addition to the management
eating, exposure to cold, sedentary mentioned in Level 1, few of the following
life style etc are to be avoided. drugs may be added

Table 5.2: Medicines at level 2 for Amavata

Drugs Dosage Dose Time of Duration Anupana


Form administration
Rasnapanchaka Kwatha 12-24 ml Empty stomach / 2-3 Shunti Churna
Kwatha 6 am & 6 pm weeks 2-3 gm
Rasanasaptaka Kwatha 12-24 ml Empty stomach / 2-3 -
Kwatha6 6 am & 6 pm weeks
Agnitundi Vati7 Vati 1-2 tab After meal / 2-3 Water
thrice daily weeks
Simhanada Guggulu8 Vati 1-2 Vati After meal / 2-3 Water
twice daily weeks
Saubhagyasunthi Churna 5-10 gm After meal / 2-3 Water
Paka twice daily weeks
Amavatari Rasa9 Vati 1-2 Vati After meal / 2-3 Water
(Avoid milk and thrice daily weeks
green gram)

AYURVEDIC STANDARD TREATMENT GUIDELINES 43


AMAVATA (RHEUMATOID ARTHRITIS)

Inpatient Panchakarma treatment: Investigation:


Swedana with Dhanyamla Dhara for 7 days, • ANA (Anti-nuclear Antibody)
Rooksha Pinda Sweda, Nadi Sweda, Agni Lepa profile to identify the specific auto
(external application of drugs having Ushna immune disorder when ANA
Virya like Tulasi, Maricha, Agnimantha, screening is found to be positive.
Nirgundi etc). Lepa with Dashanga Lepa or
Lepa Gutika, Grihadhoomadi, Jatamayadi, • Echocardiography to rule out
Kottamchukkadi etc. cardiac involvement in ASO
(Antistreptolysin O Titers) positive
Abhyanga (external oil application) in
patients
Nirama Avastha: Visha Garbha Taila, Pancha
Guna Taila, Kottamchukadi Taila, Brihat • Liver Function Test to rule out
Saindhavadi Taila, Karpooradi Taila. disease related or drug related
Pathya - Apathya (Diet and life style hepatic impairment (do at least
education): Same as level 1 ALT) especially to patients of RA
or other connective tissue disorder
Referral criteria: who were under long term DMARD
(Disease-Modifying Anti-rheumatic
• Patient not responding to above
Drugs) or other medications.
mentioned management
• Patients showing signs of severe • Renal Function Test (at least
complications S. Creatinine) to rule out renal
impairment.
• Patients of severe chronicity who
require complete Panchakarma ther- • Chest X ray or CT chest to rule out
apy and Rasayana Chikitsa for better Interstitial Lung Disease (ILD).
recovery
• Synovial Fluid Analysis in
unresponsive mono-arthritis to rule
LEVEL 3: AYURVEDA
out infective arthritis like TB or
HOSPITALS AT INSTITUTIONAL
gonococcus.
LEVEL OR DISTRICT
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS Treatment: In addition to the management
of Level 1 and Level -2, Panchakarma
Clinical Diagnosis: Same as level 1 for a procedures indicated for Amavata can be
fresh case reporting directly performed.

44 AYURVEDIC STANDARD TREATMENT GUIDELINES


AMAVATA (RHEUMATOID ARTHRITIS)

Table 5.3: Medicines at level 3 for Amavata

Drugs Dosage Dose Time of Duration Anupana


Form administration
Vishatinduka Vati Vati 1-2 Vati After meal / 2-3 weeks Water
thrice daily
Vatavidhwamsa Rasa10 Churna 125-250 mg After meal / 2-3 weeks honey/
thrice daily water
Sameerpannaga Rasa Churna 60-125 mg After meal / 2-3 weeks honey/
thrice daily water
Malla Sindura Churna 60-125 mg After meal / 2-3 weeks honey/
thrice daily water
Amrita Bhallataka Granules 5-10 gm After meal / 2-3 weeks Water
Avaleha11 twice daily

Guggulu Tiktakam Kwatha 12-24 ml Morning & 2-3 weeks


Kashaya evening empty -
stomach

Panchakarma Procedures: b. Basti – Vaitarana Basti, Kshara Basti,


Ardha Matrika Niruha12
Shodhana Chikitsa
Rasayana:
a. Virechana Karma - Abhyantara Snehana
with Shatpala Ghrita, Indukanta Ghrita, • Pippali Vardhamana Rasayana13
Shunthi Ghrita or gaughrita added with • Bhallataka Rasayana
Kshara and Saindhava Lavana followed
• Guduchi Rasayana
with Virechana by Trivritta Avaleha
30-100 gm, Abhayadi Modaka 2-5 tablets Pathya - Apathya (Diet and life style
etc. education): Same as level 1

REFERENCES

1. Vagbhatta, Ashtanga Hrudaya Commentary, Chaukhambha Orientalia


Vidyotini commentary, Chaukhambha Publication, Reprint 2011, Madhyama
Prakashana, Varanasi, Uttara sthana Khanda, 6/115-119, p.no.187.
Mukharogapratishedha Adhyaya 22/102 p. 3. Nishteshwara, Parishishta Prakarana,
no. 724. Sahasrayogam, Chowkhamba Sanskrit
2. Sharangdhara, Sharangdhara Samhita, Series, Varanasi, Third edition 2011,
Shailja Srivastava, Jivanprada Hindi p.362.

AYURVEDIC STANDARD TREATMENT GUIDELINES 45


AMAVATA (RHEUMATOID ARTHRITIS)

4. Sharangdhara, Sharangdhara Samhita, 9. Govind Das Sen, Bhaishajya Ratnavali


Shailja Srivastava, Jivanprada Hindi Siddhiprada Commentary, Chaukhambha
Commentary, Chaukhambha Orientalia Surbharti Prakashan, Varanasi, Amavata
Publication, Reprint 2011, Madhyama Rogadhikar 29/69-70, p.601.
Khanda, 2/30-33, p.no.140.
10. Yogaratnakara, Vaidya Lakshmi Pati
5. Sharangdhara, Sharangdhara Samhita, Shastri, Vidyotini Hindi Commentary,
Shailja Srivastava, Jivanprada Hindi Chaukhambha Prakashan, Reprint 2013
Commentary, Chaukhambha Orientalia Vatavyadhi Chikitsa, 1-3, p.no. 546.
Publication, Reprint 2011, Madhyama
11. Vagbhatta, Ashtanga Hrudaya Vidyotini
Khanda, 2/18-21, p.no.197.
Commentary, Chaukhambha Prakashana,
6. Sharangdhara, Sharangdhara Samhita,
Varanasi, Uttara Sthana Rasayana Vidhi
Shailja Srivastava, Jivanprada Hindi
Adhyaya 39/75-78, p. no.818.
Commentary, Chaukhambha Orientalia
Publication, Reprint 2011, Madhyama 12. Chakrapani, Chakradatta, Indradev
Khanda, 2/88-89, p.no.149. Tripathi, Vaidya prabha Hindi Commentary,
Chaukhambha Sanskrit Bhawan, Varanasi,
7. Govind Das Sen, Bhaishajya Ratnavali
Reprint 2014, Chakradatta Niruhadhikara
Siddhiprada Commentary, Chaukhambha
73/23-26, p.no. 455.
Surbharti Prakashan, Varanasi, Agnimandya
Rogadhikara 10/93-94 p. 344. 13. Vagbhatta, Ashtanga Hrudaya Vidyotini
8. Govind Das Sen, Bhaishajya Ratnavali Commentary, Chaukhambha Prakashana,
Siddhiprada Commentary, Chaukhambha Varanasi, Uttara Sthana Rasayanavidhi
Surbharti Prakashan, Varanasi, Amavata Adhyaya 39/98-100, p. no.820.
Rogadhikar 29/173-184, p. 610.

46 AYURVEDIC STANDARD TREATMENT GUIDELINES


JWARA (FEVER)

• Sama / Nirama Avastha of Jwara


INTRODUCTION
• Taruna / Jirna Jwara
Jwara is a disease of Rasavaha Srotasa hav-
ing its origin from Amashaya, resulting due • Eka / Dwi / Tridoshaja Jwara
to Agnimandya and presented with Santapa • Dhatugata Jwara
(raised body temperature), Swedaavrodha
anhidrosis and Angamarda body ache as • Sharira / Manasa
its cardinal features.All most all the infec- • Agantuja / Nija Jwara
tious diseases (viral/bacterial) presenting
• Punaravartaka Jwara
with raised body temperature as predom-
inant feature have been categorized under Jwara due to specific conditions like Romantika,
Jwara. Masurika, Pratishyaya, Kasa, Mutrakrucchra,
On the basis of predominance of Dosha and Rajyakshma etc. should be diagnosed and
Dhatugata Avastha, Jwara has been classified treated accordingly.
into various types and while deciding
the line of treatment, all these types are LEVEL 1: AT SOLO AYURVEDA
to be considered. For deciding the line of PHYSICIAN CLINIC
treatment, differential diagnosis among
the Doshic varieties, Sama – Nirama Avastha, Clinical Diagnosis: Patient should be
Nava- Jirna Avastha or Dhatugata Avastha or diagnosed on the basis of history of illness,
other presentations like Punaravartaka Jwara degree of fever, onset, associated symptoms,
are considered. chronicity, complications etc. The body
temperature above the normal range of
Case Definition: 36.5–37.5  °C (97.7–99.5  °F) or temperature
in the  rectum is at or over 37.5–38.3 °C
Patients presenting with raised body temper- (99.5–100.9 °F) or temperature in the mouth
ature associated with anhidrosis, associated (oral) is at or over 37.7  °C (99.9  °F) or
with body ache, anorexia, headache, fatigue, temperature under the arm (axillary) is at or
weakness and lethargy. over 37.2 °C (99.0 °F) shall also be taken into
account.
Differential Diagnosis:

Differential diagnosis is essential for diag- Investigations:


nosing the type of Jwara and its stage. For the • CBC
purpose of deciding line of management, the
following stages should be diagnosed. • Peripheral blood smear
JWARA (FEVER)

Line of Treatment: Shadanga Paniya with few of the


medicines mentioned below can
• In Sama or Nava Avastha of Jwara,
be given considering the type of
patients shall be kept on fasting or
Jwara and its cause. In the Nirama or
light diet.
Jirna Jwara following medicines can
• After perspiration and some relief
be given as per requirement along
in body-ache, headache, light
with diet restrictions.
liquid diet or medicated water like

Table 6.1: Medicines at level 1 for Jwara

Drugs Dosage Dose Time of Duration Anupana


form administration
Nagaradi Kwatha1 Kwatha 10-30 ml Before meal 1 week -
Guduchyadi Kwatha 10-30 ml Before meal 1 week -
Kwatha2
Parpataka Kwatha3 Kwatha 10-30 ml Before meal 1 week -
Godanti Bhasma4 Churna 125-250 mg Before meal / 1 week Warm water
thrice a day
Samshamani Vati5 Vati 2 Vati Before meal / 1 week Warm water
(500 mg) thrice a day
Mahasudarshana Phanta 50 ml Before meal / 1 week Warm water
Churna6 thrice a day
Jwaramurari Rasa Vati 125-250 mg Before meal / 1-2 weeks Water / Madhu
thrice a day

Table 6.2: Management of Jwara as per the Doshik predominance at level 1

Vataja Pittaja Kaphaja Vata - Pittaja Pitta - Vata -


Shleshmaja Shleshmaja
Guduchyadi Patoladi Chaturbhadra Chandanadi Kantakaryadi Dashamula
Kwatha Kwatha Avaleha Kwatha Kwatha Kwatha
Drakshadi Duralabhadi Nimbadi Guduchyadhi Pippalyadi
Nagaradi Kwatha
Kwatha Kwatha Kwatha Kwatha Kwatha
Rasnadi Vasadi Abhayadi Bharangadi Panchakola
Patoladi Kwatha
Kwatha Kwatha Kwatha Kwatha Kwatha
Vishwadi Parpatakadi Vasa Kantakari Ushiradi Panchatiktaka Darvyadi
Kwatha Kwatha Kwatha Kwatha Kwatha Kwatha

*Ruksha Sweda in Vatashleshmaja Jwara

48 AYURVEDIC STANDARD TREATMENT GUIDELINES


JWARA (FEVER)

Pathya - Apathya (Diet and life style): ed water or food, sprouts, cold food
and beverages, junk foods, fried
Do’s - food, bakery items.
• Ahara: Shadanga Paniya (medicated • Vihara: Physical and mental exer-
water prepared by Musta, Parpataka, tion like physical exercises, expo-
Ushira, Chandana, Nagara, Udichya), sure to cold, breeze, suppression of
Tarpana prepared of the Laja Saktu natural urges, taking bath with cold
(Churna of perched paddy) mixed water etc.
with honey, sugar and juices of Referral Criteria: Patient not responding to
fruits, Mudga Yusha. Yavagu (gruel), above management, patient presenting with
odana (boiled rice) and Laja (popped signs of high grade fever, delirium, severe
or perched paddy), Peya prepared vomiting, posing danger of dehydration or
with Laja / Yava added with Nagar, any such other complications like bleeding,
Pippalimula, Amalaki, Mrudvika, anuria etc. shall be directly referred to
vegetables like Patola, Karavellaka, Level 3 or higher centers for emergency
Karkotaka. management.
• Vihara: complete bed rest, staying in
well ventilated room with hygienic
LEVEL 2: CHC’S OR SMALL
conditions
HOSPITALS WITH BASIC
Don’ts – FACILITIES

• Ahara: Heavy food, curd, green Clinical Diagnosis: The case referred from
peas, black eyed beans, lentils, Level 1 or newly diagnosed case must be
yellow gram, black gram, raw vege- evaluated thoroughly. At this level, line of
tables and salads, refined foods such treatment to be planned considering Doshika
as white flour (Maida), contaminat- involvement and cause of the Jwara.

Table 6.3: Clinical features as per Doshik predominance

Vata Vepathu Vishama Vega Kanth-oshtha Nindranasha Shirahshoola


(shivering) (irregular Shosha (insomnia) (headache)
intensity) (dryness of
throat & lip)
Pitta Tikshna Atisara Nidraalpta Vami Mukhapaka
Vega (high (diarrhoea) (diminished (Vommiting) (sore in mouth)
intensity) sleep)
Kapha Gaurav Sheeta Utklesha Romaharsha Atinidra
(heaviness) (cold) (nausea) (horripilation) (exessive sleep)

AYURVEDIC STANDARD TREATMENT GUIDELINES 49


JWARA (FEVER)

Vata-Pitta Trishna (thirst) Murchha Bhrama Daha (Burning Swapna-Nasha


(fainting) (giddiness) sensation) (insomnia)

Pitta-Kapha Tiktaasayata Tandra Kasa Aruchi Muhurdaha-


(bittermouth) (drowsiness) (coughing) (anorexia) muhurshitata
(burning
sensation
alternate with
chill)

Vata-Kapha Staimitya (cold Parvabheda Gaurava Nidra Pratishyaya


sweat) (jointpain) (heaviness) (sleepiness) (sneezing)

Sannipatika Nidranasha Bhrama Suptangata Aruchi Stambha


(Insomnia) (giddiness) (numbness) (anorexia) (Immobility)

Agantuja Glani Karshya Gaurava Chetana-prabhav A


(malaise) (emaciation (heaviness) (emotions
persistent)

Table 6.4: Clinical features at the level of Dhatus.

Sl No Dhatu Clinical features


1 Rasa Guruta, Dainya, Udvega, Sadana, Chhardi, Arochaka, Angamarda, Jrimbha, Tapa
2 Rakta Ushna, Pidaka, Trishna, Sarakta Sthivana, Daha, Raga, Bhrama, Mada, Pralapa
3 Mamsa Antardaha, Trishna, Moha, Glani, Srista Vitkata, Daurgandhya, Gatra Vikshepa,
4 Meda Tivra Sweda, Tivra Pipasa, Pralapa, Abhikshna Vamana, Svagandhasya Asahatvam,
Glani, Arochaka,
5 Asthi Virechana, Vamana, Asthibheda, Prakujanam, Gatra Vikshepa, Shvasa,
6 Majja Hikka, Maha Shvasa, Kasa, Atitama Darshana, Marmachheda, Bahishaityam,
Antardaha
7 Shukra Shukra Moksha and Mrityu

Table 6.5: Management of Jwara at level 2 as per Dhatugata Avastha7

Sl No Dhatu Management
Kalpas Panchakarma
1 Rasa Rasa Pachaka, (Kalinga, Patola Patra, Kutaki) Vamana, Upavasa
2 Rakta Rakta Pachaka (Patola, Sariva, Musta, Patha, Kutki) Seka, Pradeha,
Samshaman
3 Mamsa Nimba, Patol, Triphala, Draksha, Musta, Kutaja Vireka, Upavasa

50 AYURVEDIC STANDARD TREATMENT GUIDELINES


JWARA (FEVER)

4 Meda 1. Kiratatikta, Guduchi, Chandana, Shunthi. Vireka, Upavasa


2. Mahaushadhadi Kwath (Shunthi, Guduchi, Musta,
Chandana, Ushira, Dhanyaka)8
5 Asthi 1. Guduchi, Amalaka, Musta, Niruha and Anuvasana
2. Vasadi Kwath (Vasa, Dhatri, Pathya, Nagara)9 Basti
3. Pathyadi Kwath (Haritaki, Shaliparni, Shunthi,
Devdaru, Amalaki, Vasa)10
6 Majja — Niruha and Anuvasana
Basti
7 Shukra — —

Investigation: Same as Level 1 Treatment: In addition to the management


1. Widal test mentioned in Level 1, following drugs may
2. Urine – culture and sensitivity be added as per the requirement and status
of the patient.
3. Sputum
4. Mantoux test
5. X-ray Chest PA view

Table 6.6: Medicines at level 2 for Jwara

Drugs Dosage Dose Time of Duration Anupana


form administration
Pathyadi Kwatha Kwatha 10-30 ml Before meals once Upto 8 -
(in Sama Jwara of daily days
more than 8 days)
Sanjivini Vati11 Vati 1-2 tab Before meal / 1-2 weeks Warm water
thrice daily
Amrutottaram Kwatha 20-40 ml Before meal / 1-2 weeks -
Kwatha12 thrice daily
Amritarishta13 Arishta 10-20 ml Before meal / 1-2 weeks Equal quantity of
thrice daily water
Tribhuvanakirti Vati 125-250 mg Before meal / 1-2 weeks Water / Madhu
Rasa Vati14 thrice daily
Ananda Bhairava Vati 125-250 mg Before meal / 1-2 weeks Water / Madhu
Rasa15 thrice daily
Jayamangala Rasa16 Vati 125-250 mg Before meal / 1-2 weeks Water / Madhu
thrice daily
Note: Sanjivani Vati is specifically indicated in Amavastha of Jwara, Jayamangala Rasa in Sannipatika Jwara.
Tribhuvanakirti Rasa is specifically indicated in Shlaishmika Jwara and Ananda Bhairavarasa in Jwara with
Atisara.

AYURVEDIC STANDARD TREATMENT GUIDELINES 51


JWARA (FEVER)

Pathya - Apathya (Diet and life style): Same LEVEL 3: AYURVEDA


as Level 1. HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT HOSPITAL/
Referral Criteria: Patients not respond- INTEGRATED AYURVEDIC
ing to Level 1 and 2 shall be referred to HOSPITALS
Level 3.
Clinical diagnosis: At this level, confirma-
tion of various advanced or acute fevers can
be done and accordingly wherever needed,
the following medicines can be started as per
the type of fever.

Table 6.7: Comparative features for various type of Jwara

Fever type Dengue Malaria Influenza


(Sannipataj Jwara) (Vishama Jwara) (Vata-Shlesmika Jwara)
Symptoms Sudden-onset fever, Fever with rigor, High fever with chills or
headache, muscle & fatigue vomiting and sometimes with rigor, runny
joint pains, and rashes headache. nose, sore throat, muscle
In severe cases it can pain, headache, coughing,
cause seizures, coma watery eyes with irritation
or death. and feeling of tiredness.
Occasionally there may be
nausea and vomiting.
Differential Malaria, leptospirosis, Dengue, typhoid Rhinitis, initial stage of
diagnosis viral hemorrhagic fever, influenza, dengue fever, typhoid fever
fever, typhoid fever, measles,
meningococcal
disease, measles,
influenza, Swine flu,
Congo fever
Clinical The diagnosis of Cyclic occurrence Symptoms including fever
diagnosis dengue is typically of sudden coldness with chill (Sheet Purvaka
made clinically, followed by shivering, Jwara), running nose (Nasa
findings of fever fever and sweating. Srava), sore throat, headache
plus any two of the (Shirahshoola), muscle pain
symptoms from (Angamarda), coughing
nausea & vomiting, (Kasa), no desire to have
rash, generalized food (Aruchi), watery eyes
pains. (Nayanaplava), and lethargy
Signs: positive (Klama)
tourniquet test, (>10
patches / inch2)

52 AYURVEDIC STANDARD TREATMENT GUIDELINES


JWARA (FEVER)

Investigations 1. Virus isolation 1. Peripheral smear To precise the type of flu like
in cultures by PCR for malarial parasite swine flu (H1N1) or bird flu
(Polymerase Chain 2. Rapid slide method (H5N1) below mentioned
Reaction) - Day 1st to (Antigen based investigations are carried out:
5th diagnosis) to confirm 1. Polymerase chain reaction
2. Viral antigen malaria and its type. (PCR)
detection (such as for 3. Urine -Routine, 2. Viral culture from nasal,
NS1) – Day 1st to 7th Microscope, Bile pharyngeal, or throat
3. Serological tests: salt & Pigment – to aspirates.
IgM &, IgG (2nd ) – rule out presence of 3. Serology
Day 4th onwards black water fever and
IgG (1st) – Day 7th on presence of jaundice
wards
LFT, RFT and EEG
may be done to assess
the status of organs.
Treatment On the line of On the line of On the line of Vatashlaismika
Vata-Pittaja Jwara Sannipatika Jwara Jwara
considering
Dhatugatavasta

Table 6.8: Medicines for Dengue fever

Drugs Dosage Dose Time of Duration Anupana Remarks


form administration
Kalingadi Kwatha 20-40 ml Before meals / 5-7 days ---
Kashaya17 twice a day
Patoladi Kwath18 Kwatha 10-20 ml Before meals / 1 week Honey
twice a day
Truna Kwatha 40 ml 2 to 3 time 5-7 days --- Acidosis
Panchamoola condition
Kashaya19
Praval Pisthi Churna 250mg Twice a day 5 days Gokshura Acidosis
kashaya condition
AkikaPishti20 Churna 250-500 Twice a day 5 days Madhu / If bleeding
mg Gaudugdha present
Bhoonimbadi Kwatha 12–24 ml Twice a day 5 days Madhu Elevated
Kwatha21 PT, OT
level,
bleeding
condition

AYURVEDIC STANDARD TREATMENT GUIDELINES 53


JWARA (FEVER)

Table 6.9: Medicines for Influenza

Drugs Dosage Dose Time of Duration Anupana


form administration
Sudarshana Churna22 Churna 2-4 gm 2 to 3 time 3 days Warm water
Tribhuvankirti Rasa23 Vati 125-250 Twice a day 3 days Madhu, fresh
mg Ardraka Swarasa,
Tulsi Patra Swarasa
Naradiya Laxmi Vati 250 mg 2 to 3 time 3 to 4 Tambula Swarasa
Vilasa Rasa24 days
Jwaraghni Gutika25 Vati 1-2 tab Twice 3 to 5 Guduchi Swarasa
(250mg) days
Talisadya Churna26 Churna 3 gm Three time 1 week Madhu
Chandramrit Rasa27 Churna 250 mg 2 to 3 time 1 week Madhu, Ardraka
Swarasa, juice of
Vasa leaves

Shrungyadi Churna28 Churna 250 mg. to Three time 1 week Madhu


1 gm
Karpuradi Churna29 Churna 1 to 2 gm. Twice 3 to 5 Madhu
days
Jwarahara Kashaya30 Kwatha 40 ml Twice 10 days ----
Barihat Kasturi Churna 125 mg 1 to 2 time a day 2 to 3 Ardraka Swarasa,
Bhairava Rasa31 Madhu
Mrutyunjaya Rasa32 Churna 125 mg 2 time a day 3 to 5 Fresh ginger juice,
days Madhu
Laxminarayana Rasa33 Churna 250 mg Twice a day 3 to 5 Madhu, Tambula
days Swarasa

Table 6.10: Medicines for Malaria

Drugs Dosage Dose Time of Duration Anupana


form administration
Tulasi Swarasa34 Swarasa 5-10 ml Twice or thrice 3 to 5 days Trikart Churna +
a day Madhu
Sudarshana Vati 1-3 Vati Twice or thrice 3 to 5 days Luke warm water
Ghanavati (250-500 mg) a day
Kshudradi Kwatha 20-40 ml Twice a day 3 to 5 days Water
Kwatha35 and more
if needed

54 AYURVEDIC STANDARD TREATMENT GUIDELINES


JWARA (FEVER)

Bhunimbadi Kwatha 20-40 ml Twice a day 15 days Water


Kwatha36
Ayush 6437 Vati 4 Tab Twice a day 5 to 7 days Water
(500 mg)
Kirata Tiktakadi Kwatha 20-40 ml Twice a day 15 days Water
Kwath38*
Vishama Churna 125 mg Twice a day 15 days Madhu
Jwarantak
Lauha39**
Sarva Jwarahara Churna 125 mg Twice a day 5 to 7 days Madhu
Lauha40
Jayamangal Rasa41 Churna 125 mg Twice a day 7 days Madhu/Guduchi
Swarasa
Brihat Kasturi Churna 125 mg Twice a day 3 – 5 days Madhu, Ardrak
Bhairava Rasa42*** Swarasa
Vardhaman Pippali 0.5-5gm Once in 21 days
Pippali processed (daily dose morning
Prayoga43** in milk changes)

* In case of repeated fever


** In case of Spleenomegaly, Pandu
*** In case of respiratory involvement, hypotension

Pathya-Apathya (Diet and Life Style): Same as Level 144

REFERENCES

1 Sri Govinda Dasa, Bhaishajya Ratnavali 5 Anonymous, The Ayurvedic Formulary


Jwaradhikara 5/70, In: Ambikadutta Shastri, of India, Ministry of Health and Family
Chaukhamba Prakashan Varanasi, 2009 Welfare, Govt. of India, Part II (10/13),
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Jwaradhikara 5/66, In: Ambikadutta Shastri, 6 Anonymous, The Ayurvedic Formulary
Chaukhamba Prakashan Varanasi, 2009 of India, Ministry of Health and Family
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of India, Ministry of Health and Family 2000
Welfare, Govt. of India, part I, vol IV (39) 7 Charaka, Charaka Samhita, ChkitsaSthana
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of India, Ministry of Health and Family Reprint, Varanasi: Chaukamba Sanskrit
Welfare, Govt. of India, Part I (18/4), 2000 Sansthan; 2007.

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JWARA (FEVER)

8 Sri Govinda Dasa, Bhaishajya Ratnavali 18 Astanga Hridaya Sutra 15/15: Comm.
Jwaradhikara, 5/372, In: Ambikadutta By Sarvangasundara by Arunadatta and
Shastri, Chaukhamba Prakashan Varanasi, Ayurveda Rasayana of Hemadri annotated
2009 by Dr, Anna Moreswar Kunte and Krishna
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Jwaradhikara, 5/374, In: Ambikadutta Sadashiva Sastri Paradakara, Chaukhambha
Shastri, Chaukhamba Prakashan Varanasi, Surabharati Prakashan, Varanasi.
2009 19 Anonymous, The Ayurvedic Formulary
10 Sri Govinda Dasa, Bhaishajya Ratnavali of India, Ministry of Health and Family
Jwaradhikara, 5/376, In: Ambikadutta Welfare, Govt. of India, Part II (4/8), 2000
Shastri, Chaukhamba Prakashan Varanasi, 20 Anonymous, The Ayurvedic Formulary
2009 of India, Ministry of Health and Family
11 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part II (13/1), 2000
of India, Ministry of Health and Family 21 Sri Govinda Dasa, Bhaishajya Ratnavali
Welfare, Govt. of India, Part I (12/35), Jwaradhikara, In: Ambikadutta Shastri,
2000 Chaukhamba Prakashan Varanasi, 2009
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of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (4/1), 2000 Welfare, Govt. of India, Part I (7/35), 2000
13 Anonymous, The Ayurvedic Formulary 23 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (1/2), 2000 Welfare, Govt. of India, Part I (20/20), 2000
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of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (20/20), 2000 Welfare, Govt. of India, Part I (20/39),
15 Anonymous, The Ayurvedic Formulary 2000
of India, Ministry of Health and Family
25 Anonymous, The Ayurvedic Formulary
Welfare, Govt. of India, Part I (20/3), 2000
of India, Ministry of Health and Family
16 Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (10/15),
of India, Ministry of Health and Family 2000
Welfare, Govt. of India, Part II (16/61),
2000 26 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family
17 Astanga Hridaya Chikitsa 1/48-50: Comm.
Welfare, Govt. of India, Part I (7/13),
By Sarvangasundara by Arunadatta and
2000
Ayurveda Rasayana of Hemadri annotated
by Dr, Anna Moreswar Kunte and Krishna 27 Anonymous, The Ayurvedic Formulary
Ramachandra Sastriavre, edited by Pt. Hari of India, Ministry of Health and Family
Sadashiva Sastri Paradakara, Chaukhambha Welfare, Govt. of India, Part I (20/16),
Surabharati Prakashan, Varanasi. 2000

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JWARA (FEVER)

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of India, Ministry of Health and Family Surbharati Prakashan, Varanasi 2006.
Welfare, Govt. of India, Part I (7/31), 36 Sharangadhara, Sharangadhara Samhita
2000 Madhyama Khand 2/20; Pt. Parashuram
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of India, Ministry of Health and Family Surbharati Prakashan, Varanasi
Welfare, Govt. of India, Part I (7/6), 2000 37 CCRAS patented
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Ayurveda Deepika commentary by Sthana 3/343, In: Yadavji Trikamji
Chakrapanidatta Chi.3/200-6, Ed. By Acharya, Reprint, Varanasi: Chaukamba
Vaidya Yadavaji Trikamaji Acharya, Sanskrit Sansthan; 2009.
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Varanasi, Reprint 2011 of India, Ministry of Health and Family
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AYURVEDIC STANDARD TREATMENT GUIDELINES 57


PANDU (ANEMIA)

2. Kamala
INTRODUCTION AND
CASE DEFINITION: 3. Jwara – Vishama Jwara

4. Rajayakshma
Pandu is a disease classification involving
mainly the Rasa Dhatu with Panduta (pallor) 5. Grahani Roga
as the presenting cardinal symptom. Other
6. Udara Roga
associated symptoms are fatigue, malaise,
fever, weight loss, night sweats, palpitation, 7. Shotha – Kaphaja
dyspnoea on mild exertion. Various disease 8. Arsha
conditions affecting formation of hemoglobin
falls under the umbrella of Pandu Roga. 9. Asrigdara

10. Shosha
Clinical signs and symptoms of Pandu
11. Raktapitta
(Anemia):
12. Other nutritional deficiencies - folic acid,
Pandu is a disease of Pittaja dominance with
Vit B12, Vit. C, protein, copper etc.
following presenting signs and symptoms
1. Depleted functions of Dhatus in which
Pitta is vitiated LEVEL 1: AT SOLO AYURVEDA
2. Kshaya of Varna, Bala, Sneha and other
PHYSICIAN CLINIC/PHC
properties of Oja
Clinical Diagnosis: On the basis of history
3. Raktalpata and clinical presentation, patient can be
4. Alpa Meda diagnosed provisionally as case of Pandu
5. Debility of relevant Karmendriya and Investigations: Though much can be
Jnanendriya diagnosed based on the clinical signs and
6. Discoloration symptoms, laboratory investigations help
the clinician to confirm the diagnosis and
Classification of Pandu Roga: rule out other conditions

5 types: Vataja, Pittaja, Kaphaja, Sannipataja, • Hemogram and peripheral blood


Mridbhakshanaja smear
• Urine – routine and microscopic
Differential diagnosis of Pandu: examination
1. Krimi Roga • Stool – occult blood
PANDU (ANEMIA)

Treatment:
Table 7.1: Medicines at level 1 for Pandu

Drugs Dosage Dose Time of Duration Anupana


form administration
Amalaki Churna Churna 3 gm Every morning 2-3 months Madhu/ warm
water
Pippali Churna Churna 1 gm Twice daily 2-3 months Madhu/ water
Chausastha Churna 500 mg – 1gm Twice daily 2-3 months Madhu/ water
Prahari Pippali
Guda Haritaki Churna 3 gm Every morning 2-3 months Honey/ warm
water
Chitrakadi Vati Vati 500 mg After meals 1 month Warm water /
butter milk
Drakshadi Kwatha 20-40 ml Before meal/ 2-3 weeks -
Kashaya1 twice daily
Punarnavadi Kwatha 20-40 ml Before meal/twice 2-3 weeks -
Kashaya2 daily
Phalatrikadi Kwatha 20-40 ml Before meal/twice 2-3 weeks -
Kwatha daily
Drakshavaleha3 Avaleha 5-10 gm Before meal/ 2-3 weeks -
twice daily
Punarnava Churna 250-500 mg After meal / thrice 2-3 weeks Madhu/ Takra
Mandoora4 daily
Dadimadya Ghrita Ghee 5-10 ml Before meal/ 2-3 weeks Warm milk
twice daily

Whenever needed symptomatic treatment • Vihara: Following of daily and


of associated conditions can also been done seasonal regimen
e.g. if patients complains of loss of appetite, Don’ts–
Chitrakadi Vati 1-2 tablet after meal twice or
• Ahara: Avoid excessive use of
thrice daily can also be added.
Kshara, Amla, Lavana, Katu, Kashaya,
Atiushna, Tikshna, Rukshanna,
Pathya-Apathya (Diet and life style):
Viruddha Asatmya Bhojana, Masha,
Tila, Mridbhakshana and Dusta Jala
Do’s–
• Vihara: Atinidra, Ativyayama,
• Ahara: Purana Shali, Yava, Laja, Atiayasa, psychological stress,
Amraphala, Draksha, Dadima, Divaswapna, Ratri Jagarana and
Matulunga, Kadaliphala, Kharjura. Vegavarodha

AYURVEDIC STANDARD TREATMENT GUIDELINES 59


PANDU (ANEMIA)

Referral criteria: Patient not responding to Investigation: Same as level 1. In addition


above mentioned management and showing
• Test for sickling anaemia
advanced signs and symptoms of Pandu.
• Cytometric classification of Anemia
LEVEL 2: CHC’S OR SMALL ought to be done.
HOSPITALS WITH BASIC
FACILITIES Treatment: In addition to the management
mentioned in Level 1, few of the following
Clinical Diagnosis: Same as Level 1 for a drugs may be added as per the requirement
fresh case reporting directly. and status of the patient.

Table 7.2: Medicines at level 2 for Pandu

Drugs Dosage Dosage Time of Duration Anupana


form administration

Dhatri Lauha5 Churna 250-500 mg After meal/thrice 2-3 weeks Buttermilk


daily

Gomutra Haritaki6 Churna/ 2-3 gm/1-2 Before meal/twice 2-3 weeks Luke warm
Vati tabs daily water

Navayasa Lauha7 Vati / 250-500 mg After meal/ thrice 2-3 weeks Madhu
Churna daily

Vidangadi Lauha8 Churna 250-500 mg After / thrice 2-3 weeks Luke warm
daily meal water

Swarnamakshika Bhasma 125-250 mg Every morning 2-3 weeks Madhu


Bhasma

Kasisa Bhasma Bhasma 125-250 mg Every morning 2-3 weeks Madhu

Lohasava9 Asava 10-20 ml After meal/twice 2-3 weeks Equal quantity


daily of water

Draksharishta10 Arishta 10-20 ml After meal/twice 2-3 weeks Equal quantity


daily of water

Punarnavasava11 Asava 10-20 ml After meal/twice 2-3 weeks Equal quantity


daily of water

Shilajitvadi Loha12 Vati 125-250 mg Twice daily 2-3 months Brahma


Rasayana
Avaleha13

60 AYURVEDIC STANDARD TREATMENT GUIDELINES


PANDU (ANEMIA)

As per the status of the patient, Mrudu Investigation: Same as level 1 and 2. In
Virechana/Koshtha Shuddhi with Avipattikara addition
Churna 5-10 gm with Phalatrikadi Kashaya may • Bone marrow cytology
be done for the first few days of the treatment.
Pathya-Apathya (Diet and life style): Same Treatment: In addition to the management
as Level 1 of Level 1 and Level 2, if needed Panchakarma
procedures indicated for Pandu can be
Referral criteria: performed.

1. Cases not responding to above therapy.


•  Shodhana Chikitsa:
2. Pandu cases with complications
3. Severe Pandu cases Virechana: with Aragwadha Phala Majja/
Avipattikara Churna/ Sushka Draksha Kwatha

LEVEL 3: AYURVEDA
•  Rasayana Chikitsa:
HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT • Vardhamana Pippali Rasayana
HOSPITAL/ INTEGRATED • Swarna Malini Vasant Rasa
AYURVEDIC HOSPITALS
Pathya-Apathya (Diet and life style): Same
Clinical Diagnosis: Same as Level 1for a as level 1
fresh case reporting directly

REFERENCES

1 Vagbhatta, Ashtanga Hridaya, Atridev 4 Agnivesha, Charaka, Dridhabala, Charaka


Gupt, Vidyotini Hindi commentary, Samhita, Edited by Vaidya Yadavji Trikamji
Chaukhambha Prakashana, Edition Reprint Acharya, Reprint Edition, Chaukhambha
2008, Varanasi, Chikitsa Sthana Jwara Surbharati Publication, 2011 Chikitsa
Chikitsa 1/55,p. no. 395 Sthana Pandu Chikitsa Adhyaya 16/93-96,
p.no. 530
2 Govind Das Sen, Bhaishajya Ratnavali,
Siddhinandan Mishra, Siddhiprada 5 Govind Das Sen, Bhaishajya Ratnavali,
commentary, Chaukhambha Surbharti Siddhinandan Mishra, Siddhiprada
Prakashan, Varanasi, Udara Rogadhikar commentary, Chaukhambha Surbharati
40/31-32, p. 733 Prakashan, Varanasi, Pandu Rogadhikar
12/30, p.378
3 Vagbhatta, Ashtanga Hridaya, Atridev
6 Vagbhatta, Ashtanga Hridaya, Atridev
Gupt, Vidyotini Hindi commentary,
Gupt, Vidyotini Hindi commentary,
Chaukhambha Prakashana, Edition Reprint
Chaukhambha Prakashana, Edition Reprint
2008, Varanasi, Chikitsa Sthana, Pandu
2008, Varanasi, Chikitsa Sthana Pandu
Chikitsa 16/29-31, p. no. 541
Chikitsa 16/29-31

AYURVEDIC STANDARD TREATMENT GUIDELINES 61


PANDU (ANEMIA)

7 Govind Das Sen, Bhaishajya Ratnavali, 10 Sharangdharacharya, Sharangadhara


Siddhinandan Mishra, Siddhiprada Samhita, Madhyama Khanda 10, Tra.
commentary, Chaukhambha Surbharati Himsagar Chandra Murty, Varanasi,
Prakashan, Varanasi, Pandu Rogadhikar Chaukhambha Surabharati Series, 2007
12/28, p.378 11 Govind Das Sen, Bhaishajya Ratnavali,
8 Govind Das Sen, Bhaishajya Ratnavali, Siddhinandan Mishra, Siddhiprada
Siddhinandan Mishra, Siddhiprada commentary, Chaukhambha Surbharti
commentary, Chaukhambha Surbharati Prakashan, Varanasi, Shotha Rogadhikar
Prakashan, Varanasi, Pandu Rogadhikar 42/111-115, p.786
12/31, p.378 12 Govind Das Sen, Bhaishajya Ratnavali,
9 Sharangdharacharya, Sharangadhara Siddhinandan Mishra, Siddhiprada
Samhita, Madhyama Khanda 10, Tra. commentary, Chaukhambha Surbharti
Himsagar Chandra Murty, Varanasi, Prakashan, Varanasi, Rajayakshma
Chaukhambha Surabharati Series, 2007 Rogadhikar 14/86,

62 AYURVEDIC STANDARD TREATMENT GUIDELINES


Raktavaha Srotas Roga
EKAKUSHTHA (PSORIASIS)

Line of Treatment
INTRODUCTION
• Nidana Parivarjana should be the
Ekakushtha is one among eleven Kshudra
first line of treatment.
Kushta with the dominance of Vata and Kapha,
which is characterized by silvery plaques like • Shodhana Chikitsa – Vamana,
fish scales may be associated with itching Virechana, Rakta Mokshana,
and with tendency to spread all over the • Shamana Chikitsa – Pachana,
body. It can be correlated with psoriasis like Raktashodhana, external applications
diseases. Along with faulty dietary habits, (Lepa, Taila and Dhara Chikitsa)
psychogenic stress also plays important role
• Rasayana Chikitsa for Rasa – Rakta
in the pathogenesis of Ekakushtha.
Prasadana.
• Treatment according to Doshik
Case Definition:
involvement
A patient presenting with dry scaling
• General line of treatment prescribed
erythematous / maculopapulous patches,
for Kushtha
covered with adherent silvery white scales
which may or may not be associated with
itching. LEVEL 1: AT SOLO AYURVEDIC
PHYSICIAN CLINIC / PHC
Differential Diagnosis
Investigations: Nothing specific.
1. Sidhma: White colored shiny patches
Treatment: In the initial stage when the
associated with or without itching along
patient is having mild features of Ekakushta,
with exfoliation in the form of dust.
along with diet restriction, two or more of
2. Dadru: Circular patches with elevated following drugs may be given as per Doshic
periphery associated with severe itching predominance:

Table 8.1: Medicines at level 1 for Ekakushta

Drugs Dosage Dose Time of Duration Anupana


form administration
Sariva1 Churna 3-6 gm After meal / 2-3 weeks Madhu / Luke
thrice a day warm water
Haridra2 Churna 3-6 gm After meal / 2-3 weeks Madhu / Luke
thrice a day warm water
EKAKUSHTHA (PSORIASIS)

Khadira3 Churna 3-6 gm After meal / 2-3 weeks Madhu / Luke


thrice a day warm water
Guduchi4 Churna 3-6 gm After meal / 2-3 weeks Madhu / Luke
thrice a day warm water
Manjishtha5 Churna 3-6 gm After meal / 2-3 weeks Madhu / Luke
thrice a day warm water
Manjisthadi Kwatha6 Kwatha 20-40 ml After meal / 2-3 weeks -
twice a day
Mahatiktaka Kwatha Kwatha 20-40 ml Before meal / 2-3 weeks -
twice daily
Panchatiktakam Ghrita Ghrita 15 ml Before meal 2-3 weeks Luke warm
water
Kaishora Guggulu7 Vati 1-2 Vati Before meal / 2-3 weeks Luke warm
twice daily water

Whenever needed, symptomatic treatment • Vihara: Maintain hygiene, follow


of associated conditions can also been done Dinacharya and Ritucharya properly
e.g. if patients complains of constipation,
Avipattikara Churna or Swadishta Virechana Don’t -
Churna in empty stomach early morning
with luke warm water can be given. • Ahara: Viruddha Ahara, Adhyashana
(eating prior to the digestion of
External applications: previous meals), excessive sour
and salty food, exercise after heavy
Kshalana: Tankan Jala / Triphala Kwatha / meal, Masha (black gram), radish,
Panchavalkala Kwatha refined flour products, fermented
Lepa: Jeevantyadi Yamaka Lepa, Vajraka Taila, food, curd, fish, jaggery.
Mahamarichadi Taila, Gandhaka Malahara,
• Vihara: Mental stress / anxiety,
Karanja Taila, Jatyadi Taila, Adityapaka Taila
suppression of urges especially of
vomiting, day-sleeping, excessive
Pathya - Apathya (Diet and life style
exposure to sun, unhygienic condi-
education):
tions
Do’s -
• Ahara: Laghu Anna (light food), Referral Criteria:
Tikta Shaka (bitter leafy vegetables),
• Patients not responding to above
Purana Dhanya (seasoned grain),
mentioned management.
Yava (barley), Godhuma (wheat),
Mudga (green gram), Patola, • Need further investigations

66 AYURVEDIC STANDARD TREATMENT GUIDELINES


EKAKUSHTHA (PSORIASIS)

Treatment: In addition to the management


LEVEL 2: CHC’S OR SMALL mentioned in Level 1, few of the following
HOSPITALS WITH BASIC drugs may be added as per the requirement
FACILITIES and status of the patient. Rasaushadhi (herbo-
Clinical diagnosis: Same as level 1 for a fresh mineral drugs) can be used at this level.
case reporting directly. Patient may be kept under observation while
prescribing these kinds of medicines:
Investigation: Nothing specific

Table 8.2: Medicines at level 2 for Ekakushta

Compound Dosage Dosage Time of Duration Anupana


formulation form administration
Sarivadyasava8 Asava 10-20 ml After meal / 2-3 weeks Equal quantity
thrice daily of water
Mahamanjisthadi Kwatha 20-40 ml Before meal / 2-3 weeks
-
Kwatha9 twice daily
Gandhaka Rasayana Vati 1-2 Vati After meal / 2-3 weeks Luke warm
(125-250 mg) thrice daily water / Madhu
Khadirarishta10 Arishta 10-20 ml After meal / 2-3 weeks Equal quantity
thrice daily of water
Aragwadharishta Arishta 10-20 ml After meal / 2-3 weeks Equal quantity
thrice daily of water
Arogyavardhini Vati 1-2 Vati After meal / 2-3 weeks Madhu / water
Vati11 (500 mg) thrice daily
Manibhadra Gudam Lehya 15-30 gm Every morning For 1 month Luke warm
water

Local application: Same as Level 1


LEVEL 3: AYURVEDA
Pathya - Apathya (Diet and life style educa- HOSPITALS AT INSTITUTIONAL
tion): Same as Level 1 LEVEL OR DISTRICT
HOSPITAL / INTEGRATED
Referral Criteria: AYURVEDIC HOSPITALS
• Patients not responding to above
Clinical Diagnosis: Same as level 1 for a
mentioned management and having
fresh case reporting directly
extensive lesions all over body and
unexposed parts Investigation: Skin biopsy if required.

• Spreading lesions with increased Treatment: In addition to the management of


itching or burning sensation Level 1 and Level -2, if needed Panchakarma

AYURVEDIC STANDARD TREATMENT GUIDELINES 67


EKAKUSHTHA (PSORIASIS)

procedures indicated for Ekakushtha can be Rasayana - Amalaki, Guduchi, Bhringaraja,


performed. Ghrita Bhrishta Haridra, Brahmi,
Mandukaparni, Triphala, Khadira, Vidanga,
Shodhana Chikitsa: Tuvaraka, Bhallataka, Bakuchi
• Vamana
Pathya - Apathya (Diet and life style
• Virechana education): Same as Level 1.
• Raktamokshana: Siravedha,
Jalookavacharana

REFERENCES

1. Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part I (4:24),


poeia of India, Ministry of Health and 2000.
Family Welfare, Govt. of India, part I, Vol. 7. Anonymous, The Ayurvedic Formulary
IV (24). of India, Ministry of Health and Family
2. Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part I (5:2), 2000.
poeia of India, Ministry of Health and 8. Anonymous, The Ayurvedic Formulary
Family Welfare, Govt. of India, part I, Vol. of India, Ministry of Health and Family
III (30). Welfare, Govt. of India, Part I (1:37), 2000.
3. Anonymous, The Ayurvedic Pharmaco- 9. Sharangadhara, Sharangadhar Samhita
poeia of India, Ministry of Health and with commentary of Adhamal’s Dipika
Family Welfare, Govt. of India, part I, and Kashiram’s Gudharth Dipika, edited
Vol. I (46). by Pandit Parshuram Shastry, 5th edition,
4. Anonymous, The Ayurvedic Pharmaco- Madhyam Khanda, Varanasi, Chuakhambha
poeia of India, Ministry of Health and Orientalia 2002; 2/137-142.
Family Welfare, Govt. of India, part I, 10. Anonymous, The Ayurvedic Formulary
Vol. I (27). of India, Ministry of Health and Family
5. Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part I (1:14), 2000.
poeia of India, Ministry of Health and 11. Anonymous, The Ayurvedic Formulary
Family Welfare, Govt. of India, part I, of India, Ministry of Health and Family
Vol. III (52). Welfare, Govt. of India, Part I (20:4),
6. Anonymous, The Ayurvedic Formulary 2000.
of India, Ministry of Health and Family

68 AYURVEDIC STANDARD TREATMENT GUIDELINES


KAMALA (JAUNDICE)

• Shodhana Chikitsa – Virechana


INTRODUCTION
• Shamana Chikitsa: Pachana, Deepana,
Kamala is a disease of Pitta Dosha involving Snehana, Pittashamaka
Yakrit characterized by yellow discoloration
of skin, sclera, urine, stools, other body • External applications - Nil
parts and mucous membranes. This can be • Rasayana Chikitsa - Nil
correlated with jaundice.
• Treatment according to Doshik
involvement
Case definition:
• General line of treatment prescribed
Kamala (Jaundice) is the yellow discoloration
for Pitta Vyadhi
of skin and mucous membranes associated
with complaints like anorexia, malaise,
indigestion and with or without palpable LEVEL 1: AT SOLO AYURVEDIC
enlargement of liver. PHYSICIAN CLINIC/PHC

Types: Clinical Diagnosis: On the basis of history


and clinical presentation
• Kosthashrita
• Shakhashrita Investigations:
• Halimaka • Blood for Hb, TLC (leucocytosis),
• Kumbha Kamala DLC (neutrophilia)
• Serum bilirubin- Direct /Indirect
Differential Diagnosis
• Urine routine and microscopic
1. Pittaja Jwara examination
2. Pittaja Pandu
Treatment: In Koshtha-Shakhashrita Kamala,
3. Pittaja Udara
Pittahara Chikitsa and in Shakhashrita
Kamala, initially Kaphahara Chikitsa followed
Line of Treatment
by Pittahara Chikitsa is prescribed. Some
• Nidana Parivarjana should be the of the following medications can be
first line of treatment. advised.
KAMALA (JAUNDICE)

Table 9.1: Medicines at level 1 for Kamala

Drugs Dosage Dose Time of Duration Anupana


form administration
Kumari Swarasa Fresh Juice 10-20 ml After meal/ 2-3 weeks Honey/ water/
thrice daily Ikshurasa
Katuki Churna 3-6 gm After meal/ 2-3 weeks Honey/ water/
thrice daily Ikshurasa
Kalamegha Churna 3-6 gm After meal/ 2-3 weeks Honey/ water/
thrice daily Ikshurasa
Bhumyamalaki Churna / 3-6 gm/ After meal / 2-3 weeks Honey/ water/
Juice 10-20 ml thrice daily Ikshurasa
Phalatrikadi Decoction 20-40 ml Before meal/ 2-3 weeks -
Kwatha1 twice daily
Drakshadi Kwatha2 Decoction 20-40 ml Before meal/ 2-3 weeks -
twice daily
Vasaguduchyadi Decoction 20-40 ml Before meal/ 2-3 weeks -
Kwatha 3 twice daily
Arogyavardhini Vati/Churna 1-2 Vati/ After meal/ 2-3 weeks Honey/ water/
Vati4 500 mg thrice daily Ikshurasa

Pathya-apathya (diet and life style Referral criteria: Patient not responding to
education): above mentioned management and showing
signs of deep Jaundice; severe vomiting, pos-
Do’s –
ing danger of dehydration, signs of hepatic
• Ahara: Khichadi prepared from encephalopathy etc.
old rice (Purana Shali), green
gram, fruits like Draksha (dried
grapes), sugarcane juice, Shritashita LEVEL 2: CHC’S OR SMALL
Jala (boiled and cooled water), HOSPITALS WITH BASIC
vegeVatiles like Patola (Trichosanthes FACILITIES
dioica), gourd, Haridra, Ardrak.
• Vihara: Complete rest Clinical diagnosis: Same as level 1 for a fresh
case reporting directly.
Don’ts -
• Ahara: Heavy food, fried food Investigation: Same as level 1. In addition
articles, pungent food articles like
• HBsAg positive
chilli, alcohol
• Vihara: Excessive physical exercise, • LFT - Elevated amino transferase-
day sleep, ALT/AST > 45U/lit, disturbed

70 AYURVEDIC STANDARD TREATMENT GUIDELINES


KAMALA (JAUNDICE)

albumin: globulin ratio; raised Treatment: In addition to the management


alkaline phosphatase; higher values mentioned in Level 1, few of the following
of prothrombin time drugs may be added as per the requirement
and status of the patient. Rasaushadhi (herbo-
• Lipid profile- increased values of mineral drugs) or herbal drugs containing
S. Cholesterol, S. Triglyceride poisonous plants can be used at this level.
Patient may be kept under observation while
• USG Abdomen
prescribing these kinds of medicines.

Table 9.2: Medicines at level 2 for Kamala

Compound Dosage Dosage Time of Duration Anupana


Formulation form administration
Tiktakam Kwatha Decoction 40 ml Before meal/twice 2-3 weeks -
daily
Patolakaturohinyadi Decoction 40 ml Before meal/twice 2-3 weeks
Kwatha5 daily -
Mandoora Vataka6 Vati 1-2 Vati After meal/ thrice 2-3 weeks Buttermilk
daily
Punarnava Vati/ 1-2 Vati/ After meal/ thrice 2-3 weeks Buttermilk
Mandoora7 Churna 500 mg daily

Mridu Virechana: As per the status of the 4. Not able to take anything orally due to
patient, Mridu Virechana/Koshtha Shuddhi vomiting and nausea
with Avipattikara Churna 5-10 gm with
Drakhshadi Kashaya may be done for 3-5 days LEVEL 3: AYURVEDA
before treatment. HOSPITALS AT INSTITUTIONAL
Pathya-Apathya (Diet and life style
LEVEL OR DISTRICT
education): Same as level 1
HOSPITAL/ INTEGRATED
AYURVEDIC HOSPITALS
Referral criteria:
Clinical Diagnosis: Same as level 1 for a
1. Cases not responding to above fresh case reporting directly
mentioned therapy.
Investigation:
2. Patients having increased levels of
bilirubin with mental confusion and • Immuno assay for infective hepatitis
altered sensorium • Liver biopsy
3. Severe persistent vomiting • CT Scan

AYURVEDIC STANDARD TREATMENT GUIDELINES 71


KAMALA (JAUNDICE)

Treatment: In addition to the managements Both Vamana and Virechana can be


mentioned for Levels 1 and 2, Panchakarma done in Kapha Pitta presentation
procedures indicated for Kamala can be
• Vamana with Yashtimadhu Kwatha or
performed.
Iskhu Rasa + Madana Phala

Shodhana Chikitsa Rasayana Chikitsa


Indicated only in the patients who are Guduchi- 3 to 6 gm with warm water for one
having Uttama Bala and can tolerate Shodhana month
procedures
Amalaki – 1-3 gm with water for one month
Virechana Haridra - 3-6 gms with water for one month

Vata-Pitta presentation of Kamala - Avipattikara Nimba - 3-6 gms with water for one month
Churna, Manibhadra Leha, Aragwadha Phala Pathya-Apathya (Diet and life style
Majja, Draksha Kwatha education): Same as level 1

REFERENCES

1 Chakrapani, Chakradatta, Indradev 5 Vagbhata, Ashtanga Hridaya, Atridev


Tripathi, Vaidya Prabha hindi commentary, Gupt, Vidyotini hindi commentary,
Chaukhambha Sanskrit Bhawan, Varanasi, Chaukhambha Prakashana, Edition
Reprint 2014, Chakradatta Amlapitta Reprint 2008, Varanasi, Sutra Sthana 15/15,
Chikitsa 52/12, p.no. 296 p. no. 141
2 Vagbhata, Ashtanga Hridaya, Atridev Gupt, 6 Vagbhata, Ashtanga Hridaya, Atridev Gupt,
Vidyotini hindi commentary, Chaukhambha Vidyotini hindi commentary, Chaukhambha
Prakashana, Edition Reprint 2008, Varanasi, Prakashana, Edition Reprint 2008, Varanasi,
Chikitsa Sthana Jwara Chikitsa 1/55, p. no. Chikitsa Sthana Pandu Chikitsa 16/16-19,
395 p. no. 540
3 Vagbhata, Ashtanga Hridaya, Atridev Gupt, 7 Agnivesha, Charaka, Dridhabala, Charaka
Vidyotini hindi commentary, Chaukhambha Samhita, Edited by Vaidya Yadavji
Prakashana, Edition Reprint 2008, Varanasi, Trikamji, Reprint Edition, Chaukhambha
Chikitsa Sthana Pandu Chikitsa 16/13, Surbharti Publication, 2011 Chikitsa
p. no. 540 Sthana Pandu Chikitsa Adhyaya 16/93-96,
4 Rasa Ratna Samuchchaya Vipadika Chikitsa p.no.530
Adhikara.

72 AYURVEDIC STANDARD TREATMENT GUIDELINES


Medovaha Srotas Roga
HYPOTHYROIDISM

• Sthaulya: overweight, exertional


INTRODUCTION
dysponea.
Hypothyroidismis a clinical syndrome
Line of Treatment
which results from deficiency of thyroid
hormones.Iodine deficiency and autoim- • Nidana Parivarjana should be the
munity are the main causes of hypothyroid- first line of treatment.
ism out of which autoimmunity is common • Shodhana Chikitsa – Vamana,
in iodine replete areas.1 The features of Virechana, Lekhanabasti
Hypothyroidism closely resembles with
• Shamana Chikitsa - Pachana, Deepana,
Shotha. However, it can be correlated with
Udwartana, Swedana
Galaganda, when it is associated with swell-
ing over the neck. • External applications - Lepa
• Rasayana Chikitsa for Rasadhatu and
Case Definition:
Medodhatu
Patients presenting with history of weight • Treatment according to stages and
gain, puffy face, non-pitting edema over Doshik involvement
hands and feet, constipation, hair loss and
• General line of treatment prescribed
menstrual abnormality.
mainly for Kapha Dosha

Differential Diagnosis-
LEVEL 1: AT SOLO AYURVEDA
Hypothyroidism needs to be differentiated PHYSICIAN’S CLINIC/PHC
from Obesity, PCOS in women, thyroid
lymphoma, addison disease, goiter and Investigations: Though it can be clinically
thyroid carcinoma. However, following diagnosed based on the signs and symp-
clinical conditions similar to Shopha described toms, Laboratory investigations are essential
in Ayurveda need to be differentiated. to confirm the diagnosis and rule out other
• Kaphaja Pandu: Gaurava (heaviness conditions
in body), Tandra (sleepiness), • CBC
Panduta (pallor), Klama (fatigue),
• Serum T3, T4, TSH
Svasa (dyspnea on exertion), Aalasya
(lethargy), Aruchi (loss of appetite), Treatment: In the initial stage when the pa-
Svaragraha (hoarseness of voice), tient is suspected to have hypothyroidism-
Ushnakamita are the symptoms of some of the following advice may be given
Kaphaja Pandu.2 along with diet restrictions:
HYPOTHYROIDISM

Table 10.1: Medicines at level 1 for Hypothyroidism

Drugs Dosage Dose Time of Duration Anupana


form administration
Kanchnara Vati 2-3 Vati Before meal / 2-3 weeks Luke warm water
Guggulu3 twice a day
Chitrakadi Vati Vati 2-3 Vati Before meal / 2-3 weeks Luke warm water
twice a day
Trikatu Churna Churna 2-3 gm Before food 2-3 weeks Gomutra / Madhu /
Luke warm water
Vyoshadi Guggulu Vati 2-3 Vati Before meal / 2-3 weeks Luke warm water
twice a day
Varuna Shigru Kwatha 12-24 ml Before meal / 2-3 weeks -
Kwatha4 twice a day
Shuddha Guggulu5 Vati 1-2 Vati Before meal / 2-3 weeks Luke warm water
twice a day
Varanadi Kwatha Kwatha 10-15 ml Before meal / 2-3 weeks -
twice a day
Dashamoola Kwatha Kwatha 12-24 ml Before meal / 2-3 weeks -
twice a day

Pathya - Apathya (Diet and life style • Vihara: Sedentary life style, day
education): sleep, munching.

Do’s - Referral Criteria: Patients not responding to


• Ahara: Kaphahara Ahara like Yava above mentioned management
(barley), Bajra (millet), Jovar (pearl
millet), Ragi, vegetables like radish,
LEVEL 2: CHC’S OR
Sarshapa, drumsticks, Gandeera
SMALL HOSPITALS WITH
(coleus) and spices like Shunthi,
BASICFACILITIES
Jeeraka and Trikatu, buttermilk,
Ushna Jala (Luke warm water).
Clinical Diagnosis: Same as level 1 for a
• Vihara: Regular exercises, fresh case reporting directly.
Yogasanas, Pranayama like Surya
Bhedana, Kapalbhati etc. Investigation: Same as level 1: in addition

• FT3 and FT4


Don’ts –
• Ahara: Heavy food articles and fried • Thyroid antibodies
preparation, refined foods such Treatment: If patient does not respond to the
as white flour, black gram, peas, Shamana treatments, the following approach
potatoes, curd, milk, fermented and may be adopted.
bakery items,

76 AYURVEDIC STANDARD TREATMENT GUIDELINES


HYPOTHYROIDISM

Table 10.2: Medicines at level 2 for Hypothyroidism

Drugs Dosage Dose Time of Duration Anupana


form administration
Gomutra Haritaki Vati Vati 1-2 Vati Before meal / 2-3 weeks Luke warm
twice daily water
Amapachana Vati Vati 1-2 Vati Before meal / 2-3 weeks Luke warm
twice daily water
Arogyavardhini Rasa Vati 1-2 Vati Before meal / 2-3 weeks Luke warm
Vati6 twice daily water
Thrivrita Lehya Lehya 10-15 gm Early morning for 2 weeks
-
Nitya Virechana

Treatment: In addition to the management


LEVEL 3: AYURVEDA
mentioned in Level 1 & 2, few of the fol-
HOSPITALS AT INSTITUTIONAL
lowing treatment may be added as per the
LEVEL OR DISTRICT
requirement and status of the patient.
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS Shodhana -
Clinical Diagnosis: As mentioned in
• Vamana Karma
Level 1
• Virechana Karma
Investigation: As mentioned in Level
1 & 2. • Lekhana Basti

Table 10.3: Medicines at level 3 for Hypothyroidism

Drugs Dosage Dose Time of Duration Anupana


form administration
Phalatrikadi Kwatha7 Kwatha 10-15ml Before meal / 2-3 weeks
-
twice daily
Makandi, Kalamegh, Churna 3-5gm After meal / 2-3 weeks Luke warm
Aswagndha and Brahmi twice daily water

Rasayana - • Gudardraka Prayoga


• Shilajatu Rasayana8 Pathya - Apathya (Diet and life style
• Vardhamana Pippali9 education): Same as level - 1

• Bhallataka Rasayana10

AYURVEDIC STANDARD TREATMENT GUIDELINES 77


HYPOTHYROIDISM

REFERENCES

1. Harrison’s principles of Internal Medicine, 6. Anonymous, The Ayurvedic Formulary of


17th edition chap335 pg. no. 2229. India, Ministry of Health and Family Wel-
fare, Govt. of India, Part “A” Formulations.
2. Agnivesha, Charaka, Charaka Samhita
2000, Pg, no. 664.
edited by Vaidya Yadavaji Trikamji Acharya
7. Agnivesha, Charaka, Charaka Samhita:
Chaukhamba Surbharati Prakashana,
Prameha Chikitsasthana 6/40, edited
Varanasi 2011: Chikitsa Sthana 16/23,24
by Vaidya Yadavaji Trikamji Acharya
pg. no. 527.
Chaukhamba Surbharati Prakashana,
3. Anonymous, The Ayurvedic Formulary Varanasi 2011.
of India, Ministry of Health and Family 8. Agnivesha, Charaka, Charaka Samhita:
Welfare, Govt. of India, Part “A” Charaka Chikitsasthana 1-3/48-59, edited
Formulations. 2000, Pg. no. 206. by Vaidya Yadavaji Trikamji Acharya
4. Sri Govindacharya, Bhaisajya Ratnavali Chaukhamba Surbharati Prakashana,
with Vidyotini Hindi commentary by Sri Varanasi 2011.
Kaviraja Ambikadutta Shastri, edited by 9. Agnivesha, Charaka, Charaka Samhita:
Acharya Rajeshwaradutta Shastri, 36/4-6, Charaka Chikitsasthana 1-3/32-34, edited
18th edition, Chaukhambha Publications, by Vaidya Yadavaji Trikamji Acharya
Varanasi, 2007, Pg. no. 713. Chaukhamba Surbharati Prakashana,
Varanasi 2011.
5. Anonymous, The Ayurvedic Formulary
10. Agnivesha, Charaka, Charaka Samhita:
of India, Ministry of Health and Family
Charaka Chikitsasthana 1-3/13-17, edited
Welfare, Govt. Of India, Part “B” Formulary
by Vaidya Yadavaji Trikamji Acharya
of List of Single Drug of Plant Origin, 2000,
Chaukhamba Surbharati Prakashana,
Sr.no.353.
Varanasi 2011.

78 AYURVEDIC STANDARD TREATMENT GUIDELINES


MADHUMEHA (DIABETES MELLITUS)

General Diagnostic criteria


INTRODUCTION
1. Increased frequency of urine
rameha is one among the eight Maharoga
(disorders needing serious concern) and 2. Turbidity in urine
explained as most important among 3. Excessive thirst & hunger
Anushangi Roga (chronic disorders)
4. Lethargy
manifested as polyuria with turbidity in
urine occurs due to vitiation of Kapha Dosha 5. FBS >125 mg/dl and (or) PPBS >200
and Meda Dhatu. Madhumeha the commonest mg/dl1
clinical presentation of Prameha can be
Along with, any 2 or more of the following
compared to Diabetes Mellitus. All such
symptoms:
diet and life style factors which increase
Kapha, Meda and Kleda, contribute in the a. Like cool surroundings (Subjective)
pathogenesis of Madhumeha. Prameha can be b. Sweetness in mouth (Subjective)
classified into two as Sthula Pramehi or Apathya
c. Burning / Numbness in palms &
Nimittaja Pramehi with clinical features of
soles (Subjective)
obesity along with excessive frequency of
urination. In the second variety, Vata may be d. Ants noted in the toilet (Subjective)
dominantly involved, and such patients are
Sthula Pramehi: General Diagnostic criteria
lean and termed as Krisha Pramehi. Further
+ BMI > 25
Prameha can be further classified into Kapha
Prameha, Pitta Prameha and Vata Prameha Krisha Pramehi: General Diagnostic criteria
according Dosha involvement. Kapha Prameha + BMI < 18
is Sadhya (curable), Pitta Parmeha is Yapya
(manageable) and Vata Prameha is Asadhya Kapha Pramehi: General Diagnostic criteria +
(incurable). BMI > 25 with some of the following features
• Recent onset of Diabetes (< 2 years)
Case Definition: • Take excessive sweets and high
Excessive urination which may be associated calorie diet
with excessive thirst and hunger, lethargy, • Bulk eating habit
numbness or burning sensation in the
• Indigestion, predominant upper
extremities, calf muscle cramps or sudden
GIT symptoms and recurrent Upper
loss of weight with raised blood sugar levels
Respiratory Tract symptoms
(BSL).
MADHUMEHA (DIABETES MELLITUS)

Pitta Pramehi: General Diagnostic criteria +


LEVEL 1: AT SOLO AYURVEDA
BMI >18 and <25 with some of the following
PHYSICIAN CLINIC/PHC
features

• Medium onset of Diabetes (2-6 Clinical Diagnosis: On the basis of history


years) and clinical presentation patient can be
diagnosed provisionally as with subtypes
• Use of excessive spicy and salty diet
as Sthula / Krisha and Doshik variety Kapha/
• Moderate eating habit Pitta/ Vata. Patients diagnosed as Sthula /
• Acidity predominant, upper GIT Kapha / Pitta and having at least moderate
symptoms and recurrent Urinary physical strength and blood sugar level as
Tract Infections follows may be treated at this level.
• FBS >110 upto 180
Vata Pramehi: General Diagnostic criteria
• PPBS > 200 upto 280
+ BMI < 18 with some of the following
features Investigation:
• Chronic onset of Diabetes (> 6 years) • Blood-sugar level
• Use of dry low nutritional diet • Urine- sugar
• Less eating habit Treatment: In the initial stage when the
patient is having mild raised blood sugar
Differential Diagnosis: levels and not associated with major
• Sthoulya complications, along with diet restriction,
two or more of following drugs may be given
• Mutratisara
as in table 11.1:

Table 11.1: Medicines at level 1 for Madhumeha

Drugs Dosage form Dose Time of Dosha Anupana


administration Specification
Vijayasaradi Decoction 10-15 ml Before meal / Kapha / Pitta -
Kwatha twice a day
Phalatrikadi Decoction 10-15 ml Before meal / Kapha / Pitta -
Kwatha1 twice daily
Kathakakhadiradi Decoction 10-15 ml Before meal / Kapha -
Kashaya twice a day
Nisha Katakadi Decoction 10-15 ml Before meal / Pitta -
Kashaya twice a day
Nisha-Amalaki2 Powder 6 gm After meal / twice Irrespective of With water
a day Dosha
Mamajjaka Ghana Vati 2-3 Tab Before meal / - With water
Vati thrice a day

80 AYURVEDIC STANDARD TREATMENT GUIDELINES


MADHUMEHA (DIABETES MELLITUS)

Sapta Rgangyadi Vati 2-3 Tab Before meal / - With water


Vati3 thrice a day
Gokshuradi Vati 2-3 Before meal / Paittika with With water
Guggulu4 tablet thrice a day UTI
Triphala5 Powder / 3-6 gm / Before meal / With warm
Tab 2-3 Tab thrice a day water

Pathya - Apathya (Diet and life style education):

Do’s-
• Ahara: Use of Purana Dhanya are recommended. Bitter leafy
(grains harvested 1 year back), vegetables like fenugreek, Atasi
Bharjit Dhanya (roasted grains), (Flaxseed), Sarshapa (mustard) are
Yava (Barley), Mudga (Green recommended; roasted meat of dry
grams) and Kulattha (Horse grams), habitats animals
Adhaki, Masura (Lentils), Makushtha

Table 11.2: Chart Showing various diet Useful in Prameha

Type of Diet Name


Cereals Yava (Barley) (Hordeum vulgare), godh£ma (wheat), kodrava (grain variety –Paspolum
scrobiculatum) udd¡laka (according to dhanvantari Nighantu forest variety of k°drava),
Kangu (Seteria italica), Madhulika (Elusine coracana), Shyamaka (Echinochloea
frumentacea), Jurnahva (Sorghum vulgare), Vajranna (Pennisatum typhoides),
Purana shali (old rice),.
Pulses Adhaki (red gram-Cajamus cajan), kulattha (horse gram) and mudga (green gram),
Masura (Lentils), Makushtha (Moth Bean/Acpnite bean), Chanaka (Cicer arietinum)
should be taken with bitter and astringent leafy vegetables.
Vegetables Navapatola (young Tricosanthus dioica), young vegetables variety of banana,
tanduleyaka (Amaranthus spinosus), vastukam (bathuva), all bitter vegetables
(tiktasakam) like methika (Fenugreek leaves), Karavellaka (Bitter gourd), Bimbi
(Kovai), Shigru fruits and leaves (Drum stick), Vrintaka (Brinjal), Rakta vrintaka
(Tomato), Putiha (mint leaves), Suran (amorhophellus), Curry leaves, Mulaka
(radish), Kushmanda (Ash Gourd), Kritavedhana (Ridge gourd), Alabu
(Bottle gourd),
Fruits Jambu (Syzigium cumini), Kapitha (Feronia limonia), Amlaki (Phyllanthus embilica), Bilva
(Bael - Aegle marmelos), Dadima (Pomegranate - Punica granatum), Naranga (Orange
- Citrus aurantium), Parushaka (Falsa - Gravia asiatica), Udumbara (Cluster Fig – Ficus
racemosa) etc fruits.
Flesh Birds like Kapota (Pigeon), Titira (Grey Francolin)

AYURVEDIC STANDARD TREATMENT GUIDELINES 81


MADHUMEHA (DIABETES MELLITUS)

Oils Atasi (Linum usitatisimum), Sarshapa (mustard).


Condiments Haridra (Turmeric), Maricha (Pepper), Tvak (Cinnamon), Lashuna (Garlic), Shunthi
(Ginger), Methika (Fenugreek), Dhanyaka (Coriander), Jeeraka (Cumin seeds)

• Vihara: Ayurvedic texts suggest • Vihara: Day time sleep especially


Long walks, swimming, hard just after taking heavy meal,
labor like pulling carts, digging irregular pattern of sleep i.e. less
wells, serving animals etc. All this than 5 hours or more than 10 hours
involves muscular activity, which in a day or in improper way, no or
will help in maintaining muscle less or infrequent exercise.
tone and peripheral utilization of Referral Criteria: Patient not responding
glucose. Today, weight training to above mentioned management in terms
exercises can be done. Following of symptomatology and reduction in blood
norms should be followed before or sugar levels and developing signs of compli-
after exercise: cation of Diabetes may be referred to the next
• Exercise should be initiated at low level.
intensity and should be gradually
increased LEVEL 2: AYURVEDIC HOSPITAL
• It should not be done after eating WITH INDOOR FACILITIES:
heavy meals.
All patients referred from level 1 and those
• It should be done regularly at fixed
patients diagnosed as Krisha Parmehi / Vata /
timings.
Durbala / Pitta with Medo Dushti may be
• Before exercise, a person should treated at this level
have taken proper sleep, his diet
should have been digested properly. Clinical Diagnosis: Same as level 1for a fresh
case reporting directly.
Don’ts – Investigation: Same as level 1; in addition
• Ahara: Excessive use of sweets, 1. Hb A1C
fruit salad, Sugarcane, fruits like 2. Lipid profile
Mango, Watermelon, Chikoo,
Treatment: In addition to the management
Dates, Jack fruits, Custard apple,
mentioned in Level 1, few of the following
Banana, Grapes, Cashew nuts, and
drugs may be added as per the require-
other fruits with high glycemic
ment and status of the patient (Table 11.3).
index, use of cold drinks, intake
Rasaushadhi (Herbo-mineral drugs) or herb-
of oil, Hydrogenated Ghee, fried
al drugs of potential pharmaco-vigilance
food, over indulgence of meat
importance can be used at this level. Patient
especially of wet land animals, to
may be kept under observation while pre-
take food before complete digestion
of previous food, to take food scribing these kinds of medicines.
in improper time and in varied
quantity.

82 AYURVEDIC STANDARD TREATMENT GUIDELINES


MADHUMEHA (DIABETES MELLITUS)

Table 11.3: Medicines at level 2 for Prameha

Drugs Dosage Dose Time of Specific Anupana


form administration indications
Shiva Gutika6 Vati 1-2 tablet Before meal / Diabetic -
twice a day Impotence,
Neuropathy
Vanga Bhasma7 Powder 125-250 mg After meal / Water
twice a day
Trivanga Bhasma8 Powder 125-250 mg After meal / Water
twice a day
Vasanta Kusumakara Powder 125-250 mg After meal / Diabetic Water
Rasa9 twice a day peripheral
neuropathy
Arogyavardhini Vati10 Vati 1-2 tablet Before meal / With
thrice a day water
Chandraprabha Vati11 Vati 2-3 tablet Before meal / Diabetic With
thrice a day nephropathy water

Pathya-Apathya (Diet and life style of management for better recovery should
education): Same as level 1 be treated at this level. All patients of Krisha
Pramehi / Vata / Durbala should be treated
Referral Criteria: Patients’ blood sugar not
at this level. Patients having HbA1c above 9
well under control and having associated
should be treated at this level.
conditions like Macrovascular complications
like Ischemic heart disease, microvascular Clinical Diagnosis: Same as level 1 for a
complications like diabetic kidney disease, fresh case reporting directly
retinopathy, neuropathy etc may be referred
to the next level. Investigation:

1. Serum electrolytes
LEVEL 3: HOSPITALS WITH
INDOOR FACILITIES LIKE 2. Blood urea and serum creatinine
PANCHAKARMA, KSHARASUTRA 3. Urine for Micro albumin
ETC. AND HAVE
INTEGRATIVE FACILITIES 4. ECG

5. Fundus examination
All patients referred from level 2 should be
treated at this level. All patients come under Treatment: In addition to the management of
Sthula Pramehi / Balavan / Kapha / Pitta Level 1 and Level -2, if needed Panchakarma
Pramehi and willing to undergo Shodhana line procedures can be performed.

AYURVEDIC STANDARD TREATMENT GUIDELINES 83


MADHUMEHA (DIABETES MELLITUS)

• Udavartana with Yava Kolakulatha Patient with Apatarpana Janya presentation


Churna, Triphala powder or Yava (Vata predominance)
powder 1. Yapana Basti / Madhutailika Basti with
• Snehapana with Sarshapa Taila, Erandamoola Decoction, Shatapushpa
Dhanwantaram Ghrita, Kalyanakam paste, Honey and oil in equal quantity,
Ghrita Rock salt.
2. Anuvasana Basti with Dhanwantaram
• Vamana Karma with Madanaphala
Ghrita, Dhanwntaram Taila, Guggulu
Churna (5-10 gm), Pippali Churna
Tiktaka Ghrita
(1-2 gm), Vacha Churna (2-3
3. Shirodhara
gm), Rock salt (5-6 gm), Honey
(Q.S.), for Vamanopaga - Nimba 4. Sarvanga taila / Kseeradhara
Kashaya. Pathya - Apathya (Diet and life style
education): Same as level 1, along with
• Virechana with Brihat Triphala
modifications in diet and exercise should
Churna, Mishraka Sneha,
be made as per the strength and built of the
• Asthapana Basti prepared with concerned patient. Moderately nourishing
decoction of drugs from Surasadi article which do not aggravate Kapha and
Gana or Nyagrodhadi Gana. Meda can be advised.

REFERENCES

1. Anonymous, The Ayurvedic Formulary 5. Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part II (4/16), 2000. Welfare, Govt. of India, 2nd Revised English
ed. Part I (7/15), 2003, pg 110.
2. Anonymous, The Ayurvedic Pharmacopoeia
of India, Ministry of Health and Family 6. Anonymous, The Ayurvedic Formulary
Welfare, Govt. of India, Part I, Vol. I (30), of India, Ministry of Health and Family
2000. Welfare, Govt. of India, 2nd Revised English
ed. Part I (12/28), 2003, pg 193.
3. Singh KS, Chandola H, Kaur M, Ravishankar
B. Evaluation of Saptarangyadi Ghanavati in 7. Anonymous, The Ayurvedic Formulary
the management of  Apathyanimittaja of India, Ministry of Health and Family
Prameha  w.s.r. to type-2 diabetes mellitus. Welfare, Govt. of India, 2nd Revised English
AYU 2012; 33: 368-73 ed. Part I (18/15), 2003, pg 242.

4. Anonymous, The Ayurvedic Formulary 8. Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, 2nd Revised English Welfare, Govt. of India, 2nd Revised English
ed. Part I (5/3), 2003, pg 67. ed. Part I (18/06), 2003, pg 236.

84 AYURVEDIC STANDARD TREATMENT GUIDELINES


MADHUMEHA (DIABETES MELLITUS)

9. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, 2nd Revised English
of India, Ministry of Health and Family ed. Part I (20/4), 2003, pg 258.
Welfare, Govt. of India, 2nd Revised English 11. Anonymous, The Ayurvedic Formulary
ed. Part I (20/42), 2003, pg 273. of India, Ministry of Health and Family
10. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, 2nd Revised English
of India, Ministry of Health and Family ed. Part I (12/10), 2003, pg 185.

AYURVEDIC STANDARD TREATMENT GUIDELINES 85


STHOULYA (OBESITY)

Investigations: Nothing specific


INTRODUCTION

Sthaulya is excessive body weight due to Examination:


vitiated status of Kapha, Rasa and Meda.
• BMI which includes weight
Certain genetic characteristics may increase
measurements
an individual’s susceptibility to excess body
weight. Atisthaulya has been discussed under • Waist circumference values
Ashtanindita Purusha (eight undesirable • Anthropometry measurements
conditions).
Treatment: Obesity being life style disorder,
diet restriction, physical exercise with life
Case Definition
style modification is the most important part
Increased body mass i.e. BMI more than of management.
>25 (kg/m2) associated with pendulous
• If the patient presents with features
abdomen-buttocks-breasts, dyspnea on
of Ama and impaired digestion,
exertion, weakness, excessive perspiration
for the beginning few days Trikatu
and hunger, is termed as Sthaulya.
powder or a mixture of Haritaki,
Guduchi and Shunthi powder in the
Differential Diagnosis:
dose of 3-6 gm, before meal twice
• Metabolic syndrome, daily shall be given for 2-3 weeks
with lukewarm water.
• Hypothyroidism,
• Cushing syndrome • Similarly, patient complaining of
constipation and low appetite shall
• PCOD be treated first with laxatives like
Triphala powder or Haritaki powder
LEVEL 1: AT SOLO AYUVEDIC 5-6 gm twice daily empty stomach
PHYSICIAN’S CLINIC/PHC with lukewarm water.

Clinical Diagnosis: Clinical presentation • In addition, patient may be


i.e. overweight/obese, BMI more than 25 encouraged to drink medicated
(kg/m2), waist circumference value more warm water like Musta Siddha Jala,
than 80 cm in female and 102 cm in male, Triphala Siddha Jala instead of taking
patient can be diagnosed as case of Sthaulya. normal water.
STHOULYA (OBESITY)

Table 12.1: Medicines at level 1 for Sthaulya

Drugs Dosage Dose Time of Duration Anupana


form administration
Triphala Churna 3-6 gm Before meal/ 4-8 weeks Luke warm water
twice daily
Musta1 Churna 3-6 gm Before meal/ 4-8 weeks Luke warm water
thrice daily
Haritaki2 Churna 3-6 gm Before meal/ 4-8 weeks Luke warm water
thrice daily
Katuki3 Churna 3-6 gm Before meal/ 4-8 weeks Luke warm water
thrice daily
Vidanga Churna4 Churna 3-6 gm Before meal/ 4-8 weeks Luke warm water
thrice daily
Gomutra Haritaki5 Vati 3-6 gm Before meal/ 2-3 weeks Luke warm water
twice daily
Phalatrikadi Kwatha6 Kwatha 20-40 ml Before meal/ 2-3 weeks -
twice daily
Kanchanara Vati 0-5 -1gm Before meal/ 2-3 weeks Warm water
Guggulu7 twice daily
Triphala Guggulu8 Vati 0.5-1gm Before meal/ 2-3 weeks Warm water
twice daily
Medohara Guggulu Vati 0.5-1gm Before meal/ 2-3 weeks Warm water
twice daily
Vidangadi Lauha9 Vati 250-500 Before meal/ 2-3 weeks Warm water
mg twice daily
Abhayarishta10 Arishta 10-20 ml After meal/ 2-3 weeks Equal quantity of
thrice daily water
Arogyavardhini11 Vati 250-500 Before meal/ 2-3 weeks Warm water
mg twice daily

Note: selection of above drugs depends upon the status of obesity, e.g.
• Patients having overweight i.e. powder or Triphala Guggulu Vati or
BMI between 25 and 30 and have Gomutra Haritaki Vati along with
no other associated conditions like strict diet and life style modification.
hypothyroidism or positive family • Patients having BMI between 30 and
history of obesity, may be given 35, may be given above mentioned
drugs like Triphala powder, Haritaki drugs with Anupana of Phalatrikadi

AYURVEDIC STANDARD TREATMENT GUIDELINES 87


STHOULYA (OBESITY)

Kwatha or drugs like Kanchanara flour, peas, chick peas, potatoes,


Guggulu, Medohara Guggulu or curd, milk, fermented and bakery
Vidangadi Lauha may be added. items, day sleep,
Patients having Udavarta like • Vihra: excess sleep and sedentary
pathogenesis i.e. chronic history life style
of severe constipation and having Referral criteria: Patients not responding
Kapha dominant Prakriti may be to above mentioned management, BMI
better treated with Arogyvardhini, more than 35, having genetic or hormonal
Abhyarishta, Katuki powder or involvement or uncontrolled hypertension,
Gomutra Haritaki Vati. diabetes, hypothyroidism or IHD
• Patients having BMI more than 35
and having genetic predisposition LEVEL 2: CHC’S OR SMALL
may be given long term manage- HOSPITALS WITH BASIC
ment and if needed, may be re- FACILITIES
ferred to higher centers for better
management. Clinical diagnosis: Same as Level 1: For a
fresh case reporting directly.
Pathya-Apathya (Diet and life style):
Sthaulya due to hormonal imbalance should
Do’s – be treated depending upon the underlying
• Ahara: Chapatti prepared with Yava pathogenesis.
(barley), maize, millet like Jowara,
Investigation: Same as level 1: In addition
Ragi; regular use of Laja (puffed rice/
grains), Moonga Daal (green gram) • Thyroid function test
with or without husk or sprouted or
Treatment:
Tuvar Daal in food. Use of fruits like
papaya, orange, sweet lemon, co- • Patient suffering from Hypothy-
conut water, salads prepared with roidism may be given additional
cucumber, carrot, radish, spinach treatment like Kanchanara Guggulu,
etc. Vegetables soups prepared of Chincha Bhalltaka Vati, Varuna Shigru
Patola (Trichosanthes dioica), gourd Kwatha, Amrutadi Guggulu, Vardha-
etc. Luke warm water and seasoned mana Pippali Rasayana. In addition,
honey. external treatment in the form of
• Vihara: Waking up early morning, Udvartana with Triphala Churna,
regular exercises, brisk walking, barley powder or Bashpa Swedana
swimming, playing outdoor games, may also be done.
Yoga.
• Patients suffering from Diabetes
Don’ts– Mellitus may be given Phalatrikadi
• Ahara: Heavy fried food, black Kwatha, Guduchyadi Kwatha,
gram, refined foods such as white Shilajatu.

88 AYURVEDIC STANDARD TREATMENT GUIDELINES


STHOULYA (OBESITY)

Table 12.2: Medicines at level 2 for Sthaulya

Drugs Dosage Dose Time of Duration Anupana


form administration
Apamarga Churna 2-3 gm Before Meal/ 1 Months Warm water
Tandula twice daily
Lohaarishta12 Arishta 5-10 ml After meal/ 2-3 weeks Equal quantity of
thrice daily water
Shilajatu Churna 500 mg Before meal/ 2-3 weeks Madhu/ warm
thrice daily water
Triphaladi Taila13 Taila 10-20 ml Before meal/ 2-3 weeks Warm water
twice daily

In addition to it, Treatment: In addition to the management of


Level 1 and Level 2, Panchakarma procedures
Mridu Virechana: As per the status of the
as follows:
patient, Mridu Virechana/Koshtha Shuddhi
with Haritaki powder 5-10 gm with warm
water 3-5 days before treatment. Similarly Vamana:
patient may be kept on fasting for early few • Vamana Karma but for Snehana
days. should be either avoided or oil
Pathya-Apathya (Diet and life style): Same should be used instead of Ghrita1.
as level 1 Virechana:
Referral criteria: Cases not respond-
• Virechana Karma with Triphala
ing to above therapy and needs further
Kwatha 100 ml along with Eranda
management in the form of Panchakarma
(castor) oil 40 ml or any other
procedures.
suitable Virechana Kalpa
Tikshna Basti: Kshara Basti, Lekhana Basti
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL Rasayana:
LEVEL OR DISTRICT
1. Shilajatu Rasayana Kalpa
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS 2. Amalaki Rasayana Kalpa
3. Vardhamana Pippali Rasayana Kalpa
Clinical Diagnosis: Same as Level 1 for a 4. Vidangadi Rasayana Kalpa
fresh case reporting directly 5. Haritakyadi Rasayana Kalpa
Investigation: Hormonal assessment for Pathya-Apathya (Diet and life style): Same
endocrinal disorders as Level 1

AYURVEDIC STANDARD TREATMENT GUIDELINES 89


STHOULYA (OBESITY)

REFERENCES

1 Anonymous, The Ayurvedic Pharmaco- 7 Anonymous, The Ayurvedic Formulary


poeia of India, Ministry of Health and of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part I, Welfare, Govt. of India, Part I (5/1), 2000
vol. III (59) 8 Anonymous, The Ayurvedic Formulary
2 Anonymous, The Ayurvedic Pharmaco- of India, Ministry of Health and Family
poeia of India, Ministry of Health and Welfare, Govt. of India, Part I (5/5), 2000
Family Welfare, Govt. of India, Part I, 9 Anonymous, The Ayurvedic Formulary
vol. I (31) of India, Ministry of Health and Family
3 Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part I (21/10), 2000
poeia of India, Ministry of Health and 10 Anonymous, The Ayurvedic Formulary
Family Welfare, Govt. of India, Part I, of India, Ministry of Health and Family
vol. II (40) Welfare, Govt. of India, Part I (1/1), 2000
4 Anonymous, The Ayurvedic Pharmacopoe- 11 Anonymous, The Ayurvedic Formulary
ia of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I, vol. I (77),2000 Welfare, Govt. of India, Part I (20/4), 2000
5 Anonymous, The Ayurvedic Formulary 12 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (7/8), 2000 Welfare, Govt. of India, Part I (1/32), 2000
6 Anonymous, The Ayurvedic Formulary 13 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part II (4/16), 2000 Welfare, Govt. of India, Part I (8/21), 2000

90 AYURVEDIC STANDARD TREATMENT GUIDELINES


Purishavaha Srotas Roga
ARSHA (HAEMORRHOIDS / PILES)

treatments have been mentioned for Arsha i.e.


INTRODUCTION
Shastrakarma (surgical treatment), Agnikarma
Arsha is defined that the mass which is (cauterization), Ksharkarma (cauterization
formed in Guda by pathological involvement with alkali) and Shaman Chikitsa (medicines).
of Twak, Mamsa and Meda. Moreover it is also
Case Definition:
opined by Charaka that a projection which
is produced in Guda is called Arsha, while in Feeling of external mass in anal region
other places of body is known as Adhimansa. associated with or without bleeding and
pain. It usually occur at the level of Ano-
Arsha (Haemorrhoids) has been primarily
rectal ring and prolapsed through anus at 3,
classified into two types like Shushka and
7 and 11 o’clock positions.
Ardra, Sahaja (congenital) and Jatottara (origi-
nated later on due to its own causes). Consid-
Various Presentations:
ering Doshic dominance, it is again classified
into four varieties i.e. Vataja, Pittaja, Kaphaja According to the predominance of particular
& Shonitaja. Two or three Doshas together can Dosha, following presentations of the disease
produce mixed types of Arsha. Four kinds of may be found.

Table 13.1:  Types of Arsha with their characteristics

Features Vatika Paittika Kaphaja Raktaja


Morphology Wrinkled, Soft, flabby and Large sized, Shape like Vata,
of Pile mass hard, rough, delicate, red protuberant, smooth, Gunja seed,
dry, dusky red yellow black or rigid and benumbed, Vidruma
coloured pile blue coloured pile pale or white coloured
mass, Shape like mass, Shape like pile mass shape like
Karpasa Phala or Jalauka or Yava Karira, Panasa Ashti,
Kadamba Puspa Gaustana
Discharge Absent Foul smelling continuous and
thin yellowish red profound discharge
discharge of tawny, whitish or -
reddish and slimy
fluid
Bleeding - Present ­- Severe
Vega Retention of
flatus, urine and - - -
feces
ARSHA (HAEMORRHOIDS / PILES)

Colour of Blackish Yellowish or Whitish


Twak, Nakha, greenish
Mukha, Netra, -
Mala and
Mutra
On palpation - Tender Painless Hot

Associated Colicky, pricking Burning sensation, Thick & long standing Loss of strength
Features pain, twitching, itching, pricking swelling, excessive & valour, senses
tingling pain and tendency itching become weaker,
to suppuration Immunity
decreases

Differential Diagnosis:
LEVEL 1: AT SOLO AYURVEDA
• Rectal prolapse (Gudabhramsa) PHYSICIAN’S CLINIC/PHC
• Fissure-in-ano (Parikartika)
Clinical Diagnosis: On the basis of history
• Ulcerative colitis and Crohn’s
and clinical presentations, patient can be
disease
diagnosed provisionally as case of Arsha.
• Condyloma Acuminata
Investigations: At this level, no specific test
• Proctitis
is needed to be performed.
• Ano-rectal warts
Treatment: In the initial stage, when the
• Ano-rectal abscess patient is having mild features of Arsha,
• Rectal polyp along with diet restriction, two or more of
• Malignant tumours (Arbuda) following drugs may be given:

Table 13.2:  Medicines at level 1 for Arsha

Drugs Dosage Dose Time of administration Duration Anupana


form
Haritaki Churna1 Churna 2-4 gm Empty stomach / bed 2-3 weeks Luke warm
time or early morning water
Triphala Churna2 Churna 2-4 gm Empty stomach / bed 1-2 weeks Luke warm
time or early morning water
Draksha3 Dried 10-20 gm Empty stomach / bed 1-2 weeks Luke warm
fruit time or early morning water

94 AYURVEDIC STANDARD TREATMENT GUIDELINES


ARSHA (HAEMORRHOIDS / PILES)

Aragvadha4 Churna 2-4 gm Empty stomach / bed 1-2 weeks Luke warm
time or early morning water

Castor oil5 Oil 10-20 ml Empty stomach / bed 1-2 weeks Luke
time or early morning warm water

Avipattikara Churna 5-10 gm Empty stomach / bed 2-5 days Water


Churna6 time or early morning

Piplayadi Ghrita7 Ghrita 5 gm Twice daily before 1-2 weeks Luke warm
meals water

Takrarishta8 Arishta 10 -20 ml Twice daily after meals 1-2 weeks Equal quantity
of water

Abhayarishta9 Arishta 10 -20 ml Twice daily after meals 1-2 weeks Equal quantity
of water

Surana Vataka10 Vataka 500 mg Twice daily after meals 1-2 weeks Luke warm
water

Eranda Bhristha Churna 3-5 gm Empty stomach / bed 2-5 days Luke warm
Haritaki time or early morning water

Local Application: spinach and vegetables prepared


from green leafy vegetables, Surana,
• Parishek: Arka11, Eranda12, Bilvapatra
Patola, gourd, intake of sufficient
Kwatha13
quantity of warm water.
• Avagaha: Triphala Kvatha14,
• Vihara: Regular exercises like
Panchavalkala Kwatha
walking, jogging, outdoor games,
• Dhoopana: Arkamoola15 and following daily & seasonal regimen
Shamipatra16 properly.
• Abhyanga: Jatyadi Taila17, Murivenna
Don’ts -
Matra Basti: Jatyadi Taila Pippalyadi Taila
• Ahara: Heavy food articles and
Patha-Apathya (Diet and life style): preparation, green peas, black eyed
beans, yellow gram, raw vegetables
Do’s - and salads, refined foods such as
white flour, cabbage, cauliflower,
• Ahara: Green gram, fruits like
brinjal, peas, potato.
Draksha, orange juice, sweet lemon
juice, musk melon, salads prepared • Vihara: Jobs involving sedentary
from cabbage, cucumber, carrot, activities, continuous standing,

AYURVEDIC STANDARD TREATMENT GUIDELINES 95


ARSHA (HAEMORRHOIDS / PILES)

sitting for long durations on hard fresh case must be evaluated thoroughly for
seats, continuous cycling or bike any complication.
riding etc.
Examination:
Referral criteria: • Per rectal examination
1. Cases not responding to the therapy • Proctoscopic examination
2. All case of moderate to severe bleeding Investigations:
per rectum
• CBC
3. Cases with complications • Special investigations like ECG,
Chest X-Ray may also be required
for surgical fitness of patients who
LEVEL 2: CHC’S OR SMALL
requires operation.
HOSPITALS WITH BASIC
FACILITIES Treatment: Treatment given in level-1
may be continued. Following medicines
Clinical diagnosis: The diagnosis is made on may be added; patient may be kept under
the basis of criteria mentioned in level-1 for observation while prescribing these kinds of
fresh cases. The case referred from level-1 or medicines.

Table 13.3:  Medicines at level 2 for Arsha

Drugs Dosage Dose Time of Duration Anupana


form administration

Arogyvardhini Vati18 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach

Arshakuthara Rasa19 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach

Kankayana Vati20 Vati 1-2 Vati At bed time or early 1-2 weeks Luke warm
morning empty water
stomach

Phalatrikadi Kwatha21 Kwatha 20-40 ml Empty stomach / 1-2 weeks -


twice a day

Erandamula Kwatha22 Kwatha 20-40 ml Empty stomach / 1-2 weeks -


twice a day

96 AYURVEDIC STANDARD TREATMENT GUIDELINES


ARSHA (HAEMORRHOIDS / PILES)

Pathya - Apathya (Diet and life style Investigations: Same as level 2


education): Same as level 1 Treatment: At this level, in addition to
treatment options of level 1 and 2, the
Referral criteria:
following treatment options should also
• Patients with severe bleeding per be tried.
rectum.
• Patients having severe anaemia, Kshara Karma (potential
who needs blood transfusion. cauterization)
• Piles cases associated with other 1. Kshara Pratisarana
disorders like heart disease,
2. Kshara Sutra ligation
uncontrolled BP, DM, HIV positive,
HbsAg positive, VDRL positive, 3. Agni Karma (direct cauterization)
malignancy etc. 4. Shastra Karma (surgical management)
5. Classical Virechana Karma
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL Pathya - Apathya (Diet and life style
LEVEL OR DISTRICT education): Same as level 1
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS

Clinical Diagnosis: Same as level 1: For a


fresh case reporting directly

REFERENCES

1. Anonymous, The Ayurvedic Pharmacopoeia 5. Anonymous, The Ayurvedic Pharmacopoeia


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.1, pg. 31. Welfare, Govt. of India, Part 1 Vol 3, pg. 23.
2. Anonymous, The Ayurvedic Formulary 6. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.7, pg. 15. Welfare, Govt. of India, Part 1 Vol.7, pg. 2.
3. Anonymous, The Ayurvedic Pharmacopoeia 7. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol 3, pg. 21. Welfare, Govt. of India, Part 1 Vol.6, pg. 29.
4. Anonymous, The Ayurvedic Pharmacopoeia 8. Agnivesha, Charaka Samhita, Chakrapani
of India, Ministry of Health and Family commentary, Yadavji Trikamaji Acharya,
Welfare, Govt. of India, Part 1 Vol.1, pg. 5. editor, Varanasi: Chaukhambha Surbharti

AYURVEDIC STANDARD TREATMENT GUIDELINES 97


ARSHA (HAEMORRHOIDS / PILES)

Prakashana, Reprint 2011. Chikitsasthana, Family Welfare, Govt. of India, Part 1 Vol. 1,
Arsha Chikitsa Adhyaya (14/72-75), pg. pg. 6.
505. 16. Anonymous, The Ayurvedic Pharmaco-
9. Anonymous, The Ayurvedic Formulary poeia of India, Ministry of Health and
of India, Ministry of Health and Family Family Welfare, Govt. of India, Part 1 Vol. 6,
Welfare, Govt. of India, Part 1 Vol.1, pg. 1. pg. 62.
10. Anonymous, The Ayurvedic Formulary 17. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.12, pg. Welfare, Govt. of India, Part 1 Vol.8,
34). pg. 17.
11. Anonymous, The Ayurvedic Pharmaco- 18. Anonymous, The Ayurvedic Formulary
poeia of India, Ministry of Health and of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part 1 Vol. 1, Welfare, Govt. of India, Part 1 Vol.20, pg. 4.
pg. 6. 19. Anonymous, The Ayurvedic Formulary
12. Anonymous, The Ayurvedic Pharmaco- of India, Ministry of Health and Family
poeia of India, Ministry of Health and Welfare, Govt. of India, Part 2 Vol.16, pg. 2.
Family Welfare, Govt. of India, Part 1 Vol 3, 20. Anonymous, The Ayurvedic Formulary
pg. 23. of India, Ministry of Health and Family
13. Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part 1 Vol.12, pg. 5.
poeia of India, Ministry of Health and Fam- 21. Anonymous, The Ayurvedic Formulary
ily Welfare, Govt. of India, Part 1 Volume of India, Ministry of Health and Family
3 (15). Welfare, Govt. of India, Part 2 Vol.4,
14. Anonymous, The Ayurvedic Formulary pg. 16.
of India, Ministry of Health and Family 22. Anonymous, The Ayurvedic Pharmaco-
Welfare, Govt. of India, Part 1 Vol.7, pg. 15. poeia of India, Ministry of Health and
15. Anonymous, The Ayurvedic Pharmaco- Family Welfare, Govt. of India, Part 1 Vol. 3,
poeia of India, Ministry of Health and pg. 23.

98 AYURVEDIC STANDARD TREATMENT GUIDELINES


ATISARA (DIARROHEA)

cardiac, umbilical & anal region, and


INTRODUCTION
malaise.
Atisara is an acute gastrointestinal disorder
characterized with increased frequency of Types:
stools with loose motions.1 This could be cor- Considering the cause, there are main types
related with various diarrhoeal conditions. named as Vataja, Pittaja, Kaphaja, Sannipataja,
Amaja, Bhayaja / Shokaja. Depending upon the
Case definition: stage, classics have classified Atisara as Sama
Excessive passage of watery stools as- or Nirama.
sociated with discomfort in abdomen,

Table 14.1: Types of Atisara with their characteristics

Types Symptoms
Aamatisara Unformed stool with excessive mucus with foul odour, usually associated with
features of Ama like flatulence, heaviness in abdomen or body, loss of appetite,
lethargy.
Pakvatisara Stool which is contrasting to characteristics and symptoms of Amatisara.
Vataja Patient frequently passes small quantity of liquid stool with flatus or froth, with
discomfort or pain in abdomen, anus, thigh or sacral region, associated with
horripilation, increased respiration, dryness of mouth, weakness
Pittaja Patient passes stool with yellow, green, black tinge which may contain blood with
exceedingly foetid smell. Associated features may include increased thirst, burning
sensation, sweating, fainting, colic pain, inflammation and suppuration in anus
Kaphaja Patient passes stool as unctuous, white, slimy, foetid smell mixed with mucus, with
frequent colic pain, or tenesmus. Associated complains may include heaviness in
abdomen, anus, pelvis and groin, horripilation, nausea, lassitude and aversion to food.
Sannipataja Mixed symptoms of Tridoshaja (incurable)
Bhayaja The presentation of this variety is similar as Vataja Atisara. But in addition to it,
and Shokaja psychological factors can be traced in the induction of loose stool

Differential Diagnosis: 3. Vishoochika


1. Grahani 4. Krimiroga
2. Pravahika 5. Ajeerna
ATISARA (DIARROHEA)

Line of treatment • General line of treatment prescribed


for Purishavaha Srotas
• Nidana Parivarjana should be the
first line of treatment.
LEVEL 1: AT SOLO AYUVEDIC
• Shodhana Chikitsa – Nil PHYSICIAN’S CLINIC / PHC
• Shamana Chikitsa- Langhana, Pachana,
Clinical Diagnosis: On the basis of history
Deepana, Grahi, Stambhana
and clinical presentation.
• External applications - Nil Investigations: Routine stool examination
• Rasayana Chikitsa for Grahani Treatment: In the initial stage of Amatisara,
• Treatment according to Doshik it is not necessary to use Stambhana drugs.
involvement Pachana and Deepana should be advised.

Table 14.2: Medicines at level 1 for Atisara

Drugs Dosage Dose Time of Duration Anupana


form administration
Shunthi Churna Churna 2-3 gm 3-4 times 1-2 days Takra
Sanjivani Vati2 Vati 1-2 Vati Before food 2-3 Till symptom Plain water
times a day subsides
Bilwadi Gutika3 Vati 1-2 Vati Before food 2-3 Till symptom Plain water
times a day subsides
Ativisha Churna4 Churna 125-250 mg Before food 2-3 Till symptom Plain water
times a day subsides
Bilwamoola Churna5 Churna 1-2 gm Before food 2-3 Till symptom Plain water
times a day subsides
Musta Churna6 Churna 3-6 gm After meal / Till symptom Plain water
thrice a day subsides
Dadima Phala Twak Churna 3-6 gm After meal / Till symptom Plain water
Churna thrice a day subsides
Dadimashtaka Churna 3-6 gm After meal / Till symptom Water / fresh
Churna7 thrice a day subsides butter milk
Kutaja Churna8 Churna 3-6 gm After meal / Till symptom Water / fresh
thrice a day subsides butter milk
Balachaturbhadra Churna 3-6 gm After meal / Till symptom Honey / water
Churna9 thrice a day subsides
Kutajaghan Vati Vati 1-2 Vati After meal / Till symptom Plain water
thrice a day subsides
Kutajarishta10 Arista 10-20 ml After meal / Till symptom Equal amount
thrice a day subsides water

100 AYURVEDIC STANDARD TREATMENT GUIDELINES


ATISARA (DIARROHEA)

Pathya - Apathya (Diet and life style


education): LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Do’s - FACILITIES
• Ahara: Laja Manda, Peya, Vilepi,
Khichadi, Shritasheeta Jala, Takra Clinical diagnosis: Same as level 1 for a fresh
• Vihara: Rest case reporting directly.

Don’ts - Investigations:
• Ahara: Heavy Food, sweets and • Serum electrolytes
cold items, milk and milk products
• RFT
except buttermilk
• Vihara: Overeating, daytime sleep, Treatment: In addition to the management
night wakening, physical & mental mentioned in Level 1, few of the following
stress drugs may be added
Referral criteria:
1. Cases not responding to above therapy.

Table 14.3: Medicines at level 2 for Atisara

Drugs Dosage Dose Time of Duration Anupana


form administration

Bruhat Gangadhara11 Churna 500 mg-2 gm After meal / Till symptom Water / fresh
thrice daily subsides butter milk

Hingvastaka Churna12 Churna 2-3 gm After meal / Till symptom With water
thrice daily subsides

Mustakaranjadi Kwatha 12-24 ml 6 am & 6 pm in Till symptom -


Kashaya13 empty stomach subsides

Anandabhairava Rasa14 Churna 250-500 mg After meal / Till symptom Water


thrice daily subsides

Shankha Vati15 Vati 1-2 Vati After meal / Till symptom Water
thrice daily subsides

Kutaja Avaleha16 Granules 5-10 gm Before meal / Till symptom -


twice daily subsides

Karpoorasava17 Asava 5-10 drops Before meal / Till symptom


twice daily subsides

AYURVEDIC STANDARD TREATMENT GUIDELINES 101


ATISARA (DIARROHEA)

Pathya - Apathya (Diet and life style Investigation:


education): Same as Level 1
• Stool culture
Referral criteria: Cases not responding to
• Rapid rotavirus antigen test in
above therapy.
stool

LEVEL 3: AYURVEDA • Antigen tests for Giardia, Crypto-


HOSPITALS AT INSTITUTIONAL sporidium and E. histolytica
LEVEL OR DISTRICT • USG abdomen, colonoscopy
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS Treatment: In addition to the management
mentioned in Level 1 & 2, some of the
Clinical Diagnosis: As mentioned above following can be advised.

Table 14.4: Medicines at level 3 for Atisara

Drugs Dosage Dose Time of Duration Anupana


form administration
Panchamruta Churna 125-250 mg This Before meal / 10 days Madhu, Ghrita
Parpati Kalpa may be increased once a day Bhrushta
gradually upto Jeeraka Churna
750 mg.
Karpura Rasa Vati 1-2 Vati Thrice a day Till symptom Water
subsides
Picchha Basti: Emulsion 400 ml Once a day Till symptom -
Shalmali, Lodhra, subsides
Vatankura and
Yastimadhu Kalka
mixed with ghee,
milk, honey

Pathya - Apathya (Diet and life style


education): Same as Level 1 and 2.

REFERENCES

1. Acharya Sushruta, Sushruta Samhita with Uttartantra 40/6, edited By Vd. Jadavaji
Dalhana Commentary - Nibandhasangraha, Trikamji Acharya & Narayana Ram Acharya,
and Gayadas Acharya commentary - Chaukhamba Surbharti Prakashana,
Nyayachandrika Panjika on Nidanasthana, Varanasi, 2008.

102 AYURVEDIC STANDARD TREATMENT GUIDELINES


ATISARA (DIARROHEA)

2. Anonymous, The Ayurvedic Formulary Welfare, Govt. Of India, PART “A”


of India, Ministry of Health and Family FORMULATIONS. 2000, pg. 337.
Welfare, PART “A” FORMULATIONS,
10. Anonymous, The Ayurvedic Formulary
Govt. of India, 2000. pg. 549.
of India, Ministry of Health and Family
3. Anonymous, The Ayurvedic Formulary Welfare, Govt. Of India, PART “A”
of India, Ministry of Health and Family FORMULATIONS. 2000, pg. 36.
Welfare, PART “A” FORMULATIONS,
11. Anonymous, The Ayurvedic Formulary
Govt. of India, 2000. pg. 523.
of India, Ministry of Health and Family
4. Anonymous, The Ayurvedic Formulary Welfare, Govt. Of India, PART “A”
of India, Ministry of Health and Family FORMULATIONS. 2000, pg. 338.
Welfare, Govt. Of India, PART “B”
12. Anonymous, The Ayurvedic Formulary
FORMULARY OF SINGLE DRUGS, 2000,
of India, Ministry of Health and Family
pg. 139.
Welfare, Govt. Of India, PART “A”
5. Anonymous, The Ayurvedic Formulary FORMULATIONS. 2000, pg. 353.
of India, Ministry of Health and Family
13. Anonymous, The Ayurvedic Formulary
Welfare, Govt. Of India, PART “B”
of India, Ministry of Health and Family
FORMULARY OF SINGLE DRUGS, 2000,
Welfare, Govt. Of India, PART “A”
pg. 196.
FORMULATIONS. 2000, pg. 193.
6. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family 14. Anonymous, The Ayurvedic Formulary
Welfare, Govt. Of India, PART “B” of India, Ministry of Health and Family
FORMULARY OF SINGLE DRUGS, 2000, Welfare, Govt. Of India, PART “A”
pg. 678. FORMULATIONS. 2000, pg. 663.

7. Anonymous, The Ayurvedic Formulary 15. Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. Of India, PART “B” Welfare, Govt. Of India, PART “A”
FORMULARY OF SINGLE DRUGS, 2000, FORMULATIONS. 2000, pg. 545.
pg. 243. 16. Anonymous, The Ayurvedic Formulary
8. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. Of India, PART “A”
Welfare, Govt. Of India, PART “B” FORMULATIONS. 2000, pg. 118.
FORMULARY OF SINGLE DRUGS, 2000, 17. Anonymous, The Ayurvedic Formulary
pg. 576. of India, Ministry of Health and Family
9. Anonymous, The Ayurvedic Formulary Welfare, Govt. Of India, PART “A”
of India, Ministry of Health and Family FORMULATIONS. 2000, pg. 54.

AYURVEDIC STANDARD TREATMENT GUIDELINES 103


BHAGANDARA (FISTULA-IN-ANO)

Case Definition:
INTRODUCTION
Bhagandara is a Marmaasrita Vyadhi which One or more than one external opening
affects Bhaga, Guda & Basti, characterized present anywhere around the anus i.e. in
by the tract formation, tearing & multiple peri-anal area as an elevation of granulation
openings in the perineal region (Bhaga tissue with discharge of pus and associated
Pradesha) around anus & urethra, through with pain and itching.
which discharge of pus, urine, feces, semen,
flatus etc. may occurs. It is a disease of Various Presentations:
Madhyama Rogamarga which lists under
Due to predominance of particular Dosha,
Ashta Mahagada. It is a Krichrasadhya Vyadhi.
various kinds of presentations my found.
According to Dosha predominance, 8 types
Types described by Sushruta Acharya are as
of Bhagandara are described by different
follows:
Acharyas. It can be compared to Fistula-in-
ano in terms of Modern Science.

Table 15.1: Types of Bhagandara with their characteristics


Features Shataponaka Ushtragriva Parisravi Shambuk- Unmargi
avarta
Dosha Vatika Paittika Kaphaja Sannipatika Agantuja
predominance
Possible Multiple Horse shoe
Modern fistulas - - fistula -
Correlation
Structural Multiple Initially red Initially whitish, Initially a Ulceration
change small, tiny coloured thin long standing big boil converts into
openings boil followed boil developed Kotha and finally
by quick in hard, smooth developed as
suppuration. fistula Fistula
Discharge Profound, Foul smelling, Continuous Discharge
clean frothy hot discharge. sticky and of various
-
discharge whitish colours
discharge
Associated Cutting or Severe severe itching Pricking Krimi (micro
symptoms pricking type burning. pain, organism)
pain. burning
and itching
together.
BHAGANDARA (FISTULA-IN-ANO)

Three more types are mentioned by Vagbhata Acharya which comes under Dosha Samsargaja
variety.

Table 15.2: Another classification of Bhagandara based on Dosha Samsarga

Features Parikshepi Riju Arsho

Doshik Vata Pittaja Vata Kaphaja Kapha Pittaja


predominance

Structural change Circular fistula Straight fistula Tear in Swelling, later


around anus rectum developed as fistula

Discharge - - Continuous discharge

Associated Severe itching &


- -
Symptoms burning

Differential Diagnosis: Examination: Following examinations will


help in the confirmation of diagnosis.
• Arsha (Haemorrhoids)
• Gudabhramsha (Rectal prolapse) Hard stool mass with line of pus/
• Parikartika (Fissure-in-ano) blood on the direction of fistulous tract
opening
• Ano-rectal carcinoma
• Ano-rectal abscess 1. Palpation: One can feel indurated tract,
fresh discharge of pus on palpation and
• Diverticular Disease
mild tenderness.
• Herpes Simplex
2. Digital Examination (Per-rectal): It can
• Inflammatory Bowel Disease
reveal internal opening palpable as a
• Pilonidal Cyst and Sinus nodule, which can be in the straight line
• Proctitis to the external opening or at 6 o’clock in
lithotomy position and about middle of
LEVEL 1: AT SOLO AYURVEDA the anal canal.
PHYSICIAN’S CLINIC / PHC
Treatment: In the initial stage when the
Clinical Diagnosis: On the basis of history patient is having mild features of Bhagandara,
and clinical presentation, patient can be along with diet restriction, two or more of
diagnosed provisionally as case of Bhagandara. following drugs may be given.

AYURVEDIC STANDARD TREATMENT GUIDELINES 105


BHAGANDARA (FISTULA-IN-ANO)

Table 15.3: Medicines at level 1 for Bhagandara

Drugs Dosage Dose Time of Duration Anupana


form administration
Haritaki Churna1 Churna 2-4 gm Empty stomach / 2-3 weeks Luke warm
at bed time or early water
morning
Triphala Churna2 Churna 2-4 Empty stomach / 1-2 weeks Luke warm
gm at bed time or early water
morning
Draksha3 Dried fruit 10-20 gm Empty stomach / 1-2 weeks Luke warm
at bed time or early water
morning
Aragvadha4 Churna 2-4 gm Empty stomach / 1-2 weeks Luke warm
at bed time or early water
morning
Castor oil5 Oil 10-20 ml Empty stomach / 1-2 weeks Luke warm
at bed time or early water
morning
Avipattikara Churna 5-10 gm Empty stomach / 2-5 days Water
Churna6 at bed time or early
morning
Abhayarishta7 Arishta 10-20 ml After meals / 1-2 weeks Equal quantity
twice a day of water
Thriphala Guggulu8 Vati 500 mg After meals / 1-2 weeks Luke warm
(2 Vati) thrice a day water
Surana Vataka9 Vataka 500 mg After meals / 1-2 weeks Luke warm
twice a day water

Local or External Application: from cabbage, cucumber, carrot and


spinach, green leafy vegetables,
v Ushnodaka Avagaha (Hot sitz bath)
Surana, Patola, gourd, intake of
with 100 ml of Panchavalkala Kwatha
sufficient quantity of warm water.
or Triphala Kwatha10 twice a day
• Vihara: Regular exercises like
v Jatyadi Taila11, 5-10 ml P/R, twice a
walking, jogging, outdoor games,
day, after Ushnodaka Avagaha
following daily & seasonal regimen
properly.
Pathya-Apathya (Diet and life style):
Do’s - Don’ts –
• Ahara: Green gram, fruits like • Ahara: Heavy food articles and
Draksha, orange juice, sweet lemon preparations, green peas, black eyed
juice, musk melon, salads prepared beans, yellow gram, raw vegetables

106 AYURVEDIC STANDARD TREATMENT GUIDELINES


BHAGANDARA (FISTULA-IN-ANO)

and salads, refined foods such as LEVEL 2: CHC’S OR SMALL


white flour, cabbage, cauliflower, HOSPITALS WITH BASIC
brinjal, peas, potatoes FACILITIES
• Vihara: Jobs involving sedentary
Clinical Diagnosis: Same as level 1 for fresh
activities, continuous standing, or
cases reporting directly. A patient presenting
sitting for long durations on hard
in an advance stage of Fistula-in-ano would
seats, continuous bicycle, bike or
have Doshika Lakshanas of Bhagandara and
horse riding etc.
after examining the case thoroughly, the
selection of drugs may be done.
Referral Criteria:
Investigations:
• Cases not responding to above
therapy. 1) Digital Examination
• Development of complications 2) Proctoscopy
• Fistula-in-ano cases associated 3) Fistulogram
with one or more of the following 4) Trans-rectal Ultrasonography
conditions:
Treatment: In addition to the management
1. Pregnancy mentioned in Level 1, few of the following
2. Uncontrolled Tuberculosis drugs may be added as per the requirement
and status of the patient. Patient should be
3. Uncontrolled Hypertension kept under observation while prescribing
4. Uncontrolled Diabetes mellitus these kinds of medicines.

Table 15.4: Medicines at level 2 for Bhagandara

Drugs Dosage Dose Time of Duration Anupana


form administration
Guggulu Churna 2-4 gm Empty stomach / 2-3 weeks Madhu
Panchapala Ch. at bed time or early
morning
Yogaraja Churna* Churna 2-4 gm Empty stomach / 2-3 weeks Madhu
at bed time or early
morning
Arogyvardhini Vati 1-2 Vati Empty stomach / 1-2 weeks Luke
Vati12 at bed time or early warm water
morning
Arshakuthara Vati 1-2 Vati Empty stomach / 1-2 weeks Luke
Rasa13 at bed time or early warm water
morning

AYURVEDIC STANDARD TREATMENT GUIDELINES 107


BHAGANDARA (FISTULA-IN-ANO)

Drakshasava14 Asava 20-40 ml After meal / 1-2 weeks Equal quantity


twice a day of water
Kumaryasava15 Asava 20-40 ml After meal / 1-2 weeks Equal quantity
twice a day of water
Phalatrikadi Kwatha 20-40 ml Empty stomach / 1-2 weeks -
Kwatha16 twice a day
Erandamula Kwatha 20-40 ml Empty stomach / 1-2 weeks -
Kwatha twice a day
Trayodashanga Vati 2-3 Vati After meal / 2-3 weeks Luke warm
Guggulu17 thrice a day water
Shodashanaga Vati 2-3 Vati After meal / 2-3 weeks Luke warm
Guggulu thrice a day water
Kaishore Vati 2-3 Vati After meal / 2-3 weeks Luke warm
Guggulu18 thrice a day water
Saptavimshati Vati 2-3 Vati After meal / 2-3 weeks Luke warm
Guggulu19* thrice a day water

* Contraindicated in Pitta Rakta predominance

Pathya - Apathya (Diet and life style Investigations: Same as level 2


education): Same as Level -1 Treatment: At this level, the following
treatment options may be applied in addition
Referral Criteria: to treatment option available at level 1 and 2.
1. Cases not responding to above therapy In addition to the treatment prescribed in
2. Cases needing surgical intervention level-1 and 2, following procedures can be
(Shastra Karma / Ksharasutra Chikitsa) done

3. Associated with diseases like Osteomy- 1. Classical Vamana Karma


elitis, chronic or acute Ulcerative Colitis, 2. Classical Virechana Karma
Crohn’s disease etc.
Management for Pakwa Bhagandara
Pidika:
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL Shastra Karma: After proper Snehana and
LEVEL OR DISTRICT Swedana, Pakwa Pidika should be incised and
HOSPITAL / INTEGRATED drained from most prominent and dependent
AYURVEDIC HOSPITALS part. After that packing should be done with
sterilized dressing materials and bandage it
Clinical Diagnosis: Same as level 1 for a properly. From next day onwards, dressing
fresh case reporting directly should be changed daily with appropriate

108 AYURVEDIC STANDARD TREATMENT GUIDELINES


BHAGANDARA (FISTULA-IN-ANO)

Shodhana materials. After complete Shodhana • Ksharasutra Chikitsa: Ksharasutra


of Vrana, Ropana Karma should be done with can be prepared with Haridra20,
appropriate drugs. Snuhiksheera21, Arkaksheera22 etc.
Pathya - Apathya (Diet and life style
Management for established cases of education): Same as level 1
Bhagandara:
Note: Treatment of Parikartika can also be
• Shastra Karma applied in the management of Bhagandara.

REFERENCES

1. Anonymous, The Ayurvedic Pharmacopoeia 10. Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.1 (31). Welfare, Govt. of India, Part 1 (7:15).
2. Anonymous, The Ayurvedic Formulary 11. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (7:15). Welfare, Govt. of India, Part 1 (8:17).
3. Anonymous, The Ayurvedic Pharmacopoeia 12. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol 3 (21). Welfare, Govt. of India, Part 1 (20: 4).
4. Anonymous, The Ayurvedic Pharmacopoeia 13. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol.1 (5). Welfare, Govt. of India, Part 2 (16 : 2).
5. Anonymous, The Ayurvedic Pharmacopoeia 14. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol 3 (23). Welfare, Govt. of India, Part 2 (1 : 1).
6. Anonymous, The Ayurvedic Formulary 15. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (7:2). Welfare, Govt. of India, Part 1, (36).
7. Anonymous, The Ayurvedic Formulary 16. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (1:1). Welfare, Govt. of India, Part 2, (4 : 16).
8. Anonymous, The Ayurvedic Formulary 17. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (5:5). Welfare, Govt. of India, Part 1, (5 : 4).
9. Anonymous, The Ayurvedic Formulary 18. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (12:34). Welfare, Govt. of India, Part 1 (5: 2).

AYURVEDIC STANDARD TREATMENT GUIDELINES 109


BHAGANDARA (FISTULA-IN-ANO)

19. Anonymous, The Ayurvedic Formulary 21. Anonymous, The Ayurvedic Pharmacopoeia
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (5: 11). Welfare, Govt. of India, Part 1 Volume 1
20. Anonymous, The Ayurvedic Pharmacopoeia (63).
of India, Ministry of Health and Family 22. Anonymous, The Ayurvedic Pharmacopoeia
Welfare, Govt. of India, Part 1 Volume 1 of India, Ministry of Health and Family
(30). Welfare, Govt. of India, Part 1 Volume 1 (6).

110 AYURVEDIC STANDARD TREATMENT GUIDELINES


KRIMI (INTESTINAL WORM INFESTATION)

• Dermatological symptoms are


INTRODUCTION
seen due to larva penetration and
All small organisms ranging from insects migration as in the case of peri anal
to parasites and to micro-organisms can be dermatitis, vaginitis etc.
classified under the term Krimi. • Chronic cases of infestation suffer
Case definition: Acute infestation may from malnutrition and anemia.
present with epigastric pain, peri-umbilical • Children bear stigma of poor
pain, diarrhea etc. Chronic worm infestation growth and development.
is associated with Pandu Roga, Guda Kandu,
weakness and lassitude.
LEVEL 1: AT SOLO AYUVEDIC
PHYSICIAN CLINIC/PHC
Classification of Krimi:

• Drishta (visible) and Adrishta Clinical Diagnosis:


(invisible to naked eye)
• Clinical features of Krimi Roga:
• Sahaja (non-pathogenic) and Diarrhoea, halitosis, pallor,
Vaikarika (pathogenic) abdominal pain, anemia, headache
• Bahya (external) and Abhyantara • Cases of chronic infestations present
(internal) with the history of abdominal colics,
• Abhyantara (internal) intermittent diarrhoea, vomiting,
signs of malnutrition and poor
Krimi are further classified as: growth.
• Shleshmaja, Purishaja and Raktaja • Children with Enterobius infection
suffer from peri-anal pruritus and
Differential Diagnosis: sleep disturbance. Young adult
with recent onset of epilepsy needs
• Parasites lodging in various
to be investigated for cysticercosis.
organs have symptoms related to
these organs such as pneumonitis,
Investigations:
abdominal colic, hepatitis, pluritis
and epileptic seizures. Stools – routine and microscopic
KRIMI (INTESTINAL WORM INFESTATION)

Treatment: In the initial stage when the two or more of following drugs may be
patient is having mild features of Krimi, given

Table 16.1: Medicines at level 1 for Krimi


Drugs Dosage form Dose Time of Duration Anupana
administration
Vidangadi Churna1 Churna 500 mg -2 After meal thrice 28 days Luke warm
gm daily water
Palasha Beejadi Churna/ 250-500 mg After meal thrice 28 days Luke warm
Churna2 Vati / 1-2 tablet daily water
Kampillaka Churna3 Churna 250-500 mg After meal thrice 28 days Luke warm
daily water
Nimbadi Churna4 Churna 250-500 mg After meal thrice 28 days Luke warm
1-2 tablet daily water
Parasika Yavani Churna/ 250-500 mg After meal thrice 28 days Luke warm
Churna5 Vati / 1-2 tablet daily water
Krimimudagara Churna/ 250-500 mg After meal thrice 28 days Luke warm
Rasa6 Vati daily water
Krimikuthara Rasa7 Churna/ 250-500 mg After meal thrice 28 days Luke warm
Vati daily water
Vidanga Avaleha Avaleha 5-10 gm After meal thrice 28 days Luke warm
daily water
Krimighna Vati Vati 1-2 tablet After meal thrice 1 month Luke warm
daily water
Vidangarishta Arista liquid 10-30 ml Twice daily after One month Luke warm
meal water

Pathya-Apathya (Diet and life style): • Vihara: Suppression of natural


urges, Adhyashana.
Do’s–
• Ahara: Laghu and Ushna diet, red Referral criteria:
rice (unpolished), Kulattha, wheat,
barley, Patol, brinjal, garlic, Shigru, 1. Neurological complication such as
chili, black pepper, Methi seeds, hot seizures or radiological evidence of
water cysticercosis of brain.

Dont’s–
LEVEL 2: CHC’S OR SMALL
• Ahara: Fish, Tila, milk, sour food,
HOSPITALS WITH BASIC
green leafy vegetables, Amla Phala
FACILITIES
(citrus fruits) Dadhi, buffalo milk,
jaggery, sweets, Pishtanna (items Clinical Diagnosis: Same as Level 1 for a
prepared with white flour). fresh case reporting directly.

112 AYURVEDIC STANDARD TREATMENT GUIDELINES


KRIMI (INTESTINAL WORM INFESTATION)

Investigations: Nothing specific • Any of the following drugs


Treatment: Same as Level 1. In addition to it may be used – Mulaka, Sarshapa,
if needed following can be done: Lashuna, Karanja, Shigru, Apamarga,
Tulasi, Nirgundi, Mushakaparni,
• Apakarsana: with any of the Bhallataka
following suitable Karma – Vamana /
Virechana / Asthapana Basti / • External applications: Katu Taila
Shirovirechana [mustard oil] in anus region

Table 16.2: Medicines at level 2 for Krimi

Drugs Dosage Dose Time of Duration Anupana


form administration

Paribhadra (Erythrina Juice 10-30 ml Once in the morning One week Honey
indica) Patra Swarasa empty stomach

Pootikaranja Swarasa Juice 10-30 ml Once in the morning One week Honey
empty stomach

Haridra Khanda Granules 5-10 gm Twice daily after food 1 month Warm
water

Vidanga Churna Churna 500 mg For nasal Once a Nil


administration week
(Pradhamana Nasya)

Pathya-Apathya (Diet and life style): Same


LEVEL 3: AYURVEDA
as level 1
HOSPITALS AT INSTITUTIONAL
LEVEL OR DISTRICT
Referral criteria:
HOSPITAL/ INTEGRATED
• Evidence of complications like per- AYURVEDIC HOSPITALS
foration, migration or obstruction
due to nematodes. Clinical Diagnosis: Same as level 1 for a
• Neurological/ hepatic complica- fresh case reporting directly.
tions due to cestode infection caus-
ing liver abscess or cysticerosis. Investigations:

• Children below 2 years with • Same as level 2 for a fresh case


associated malnutrition. reporting directly.

AYURVEDIC STANDARD TREATMENT GUIDELINES 113


KRIMI (INTESTINAL WORM INFESTATION)

• Ultrasound abdomen (for localizing • Classical Virechana Karma


hydatid cysts and ascaris in
• Niruha Basti prepared with Krimihara
migrated sites.)
drugs.
Treatment:
Pathya-Apathya (Diet and life style): Same
• Same as Level 2 for uncomplicated as in Level 1
cases.

REFERENCES

1 Govind Das Sen, Bhaishajya Ratnavali, commentary, Chaukhamba Surbharti


Siddhinandan Mishra, Siddhiprada Prakashan, Edition 2011, Varanasi,
commentary, Chaukhamba Surbharti Vatarakta Rogadhikara 27/27-34,
Prakashan, Edition 2011, Varanasi, Krimi
5 Govind Das Sen, Bhaishajya Ratnavali,
Rogadhikara 11/17,
Siddhinandan Mishra, Siddhiprada
2 Govind Das Sen, Bhaishajya Ratnavali, commentary, Chaukhamba Surbharti
Siddhinandan Mishra, Siddhiprada Prakashan, Edition 2011, Varanasi, Krimi
commentary, Chaukhamba Surbharti Rogadhikara 11/15-16,
Prakashan, Edition 2011, Varanasi, Krimi
Rogadhikara 11/12, 6 Govind Das Sen, Bhaishajya Ratnavali,
Siddhinandan Mishra, Siddhiprada
3 Govind Das Sen, Bhaishajya Ratnavali,
commentary, Chaukhamba Surbharti
Siddhinandan Mishra, Siddhiprada
Prakashan, Edition 2011, Varanasi, Krimi
commentary, Chaukhamba Surbharti
Rogadhikara 11/42-43,
Prakashan, Edition 2011, Varanasi, Krimi
Rogadhikara 11/11, 7 Rasatantra Sara va Siddha Prayoga
Sangraha, Kharaliya Rasayana, 60
4 Govind Das Sen, Bhaishajya Ratnavali,
Siddhinandan Mishra, Siddhiprada

114 AYURVEDIC STANDARD TREATMENT GUIDELINES


PARIKARTIKA
(FISSURE-IN-ANO/ PAINFUL DEFECATION)

2) Intestinal Tuberculosis
INTRODUCTION
3) Carcinoma of large bowel
Parikarthika is not mentioned as a separate 4) Pruritis Ani of varied etiology
disease entity in any of the Brihattrayi or
Laghuthrayi. Acharya Charaka described it
LEVEL 1: AT SOLO AYURVEDA
as one among the Dasha Virechana Vyapat.
PHYSICIAN’S CLINIC/PHC
Athiyoga of Virechana, Atisara, constipation
etc. are the predisposing factors of Parikartika. Clinical Diagnosis: On the basis of history
In modern science, it is correlated with and clinical presentation, patient can
fissure-in–ano/painful defecation. be diagnosed provisionally as a case of
Case Definition: Parikartika.

Feeling of sharp cutting pain in anal orifice Investigations: At this level, no specific test
during and or after defecation associated is needed to be performed
with fresh bleeding usually in the form of a Treatment: Chikitsa should aim at Anulomana,
streak on passing of hard feces, with itching Ropana & Sulahara, deworming.
or burning in anal region.
In the initial stage when the patient is having
mild features of Parikartika such as hard stool
Differential Diagnosis:
mass with painful defecation, along with diet
1) Lower bowel inflammatory diseases like restriction, two or more of following drugs
ulcerative colitis may be given, in addition to local treatment.

Table 17.1: Medicines at level 1 for Parikartika

Drugs Dosage Dose Time of administration Duration Anupana


form
Haritaki1 Churna 2-4 gm At bed time or early 2-3 weeks Luke warm
morning empty stomach water
Triphala2 Churna 2-4 gm At bed time or early 1-2 weeks Luke warm
morning empty stomach water
Draksha3 Dried fruit 10-20 gm At bed time or early 1-2 weeks Luke warm
morning empty stomach water
Aragvadha 4 Churna 2-4 gm At bed time or early 1-2 weeks Luke warm
morning empty stomach water
PARIKARTIKA (FISSURE-IN-ANO/ PAINFUL DEFECATION)

Castor oil5 Oil 10-20 ml At bed time or early 1-2 weeks Luke warm
morning empty stomach water
Avipattikara Churna 5-10 gm At bed time or early 2-5 days Water
Churna6 morning empty stomach
Takrarishta Arishta 10-20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Abhayarishta7 Arishta 10-20 ml Twice daily after meals 1-2 weeks Equal quantity
of water
Surana Vatak 500 mg Twice daily after meals 1-2 weeks Luke warm
Vataka8 water

Local Application: Don’ts–


Ahara: Heavy food articles and preparations,
Parisheka: Arka,9 Eranda,10 Bilvapatra Kwatha11
green peas, black eyed beans, yellow gram,
Avagaha: Triphala Kwatha,12 Panchavalkala raw vegetables and salads, refined foods such
Kwatha as white flour, Cabbage, cauliflower, brinjal,
Dhoopana: Arkamoola13 and Shamipatra14 peas, potatoes, regular intake of chilled water

Abhyanga: Jatyadi Taila,15 Murivenna Vihara: Jobs involving sedentary activities,


Matra Basti: Jatyadi Taila,16 Pippalyadi Taila continuous standing, or sitting for long
durations on hard seats, suppression
Pathya-Apathya (Diet and life style of natural urges especially urination &
education): defecation etc.

Do’s– Referral criteria: Refer to level 2


• Ahara: Green gram, fruits like 1. Cases not responding to the therapy and
Draksha, orange juice, sweet lemon develop complications.
juice, musk melon, salads prepared
2. All case of moderate to severe bleeding
from cabbage, cucumber, carrot,
per rectum.
spinach and vegetables prepared
from green leafy vegetables, Surana,
Patola, intake of sufficient quantity LEVEL 2: CHC’S OR SMALL
of warm water. HOSPITALS WITH BASIC
FACILITIES
• Vihara: Regular exercises like
walking, jogging, outdoor games, Clinical Diagnosis: The diagnosis is made
following daily & seasonal regimen on the basis of criteria mentioned in level 1
properly. for fresh cases. The case referred from level

116 AYURVEDIC STANDARD TREATMENT GUIDELINES


PARIKARTIKA (FISSURE-IN-ANO/ PAINFUL DEFECATION)

1 or fresh case must be evaluated thoroughly Treatment: In addition to the management


for any complication. mentioned in Level 1, few of the following
drugs may be added as per the requirement
Investigations:
and status of the patient. Patient should be
• Per rectal examination kept under observation while prescribing
• Proctoscopic examination these kinds of medicines.

Table 17.2: Medicines at level 2 for Parikartika

Drugs Dosage Dose Time of administration Duration Anupana


form

Arogyvardhini Vati 1-2 Vati at bed time or early 1-2 weeks Luke warm
Vati 17 morning empty stomach water

Kankayana Vati18 Vati 1-2 Vati at bed time or early 1-2 weeks Luke warm
morning empty stomach water

Phalatrikadi Decoction 20-40 ml empty stomach/twice 1-2 weeks -


Kwatha19 daily

Erandamoola Decoction 20-40 ml empty stomach/twice 1-2 weeks -


Kwatha20 daily

Pathya-Apathya (Diet and life style


LEVEL 3: AYURVEDA
education): Same as level 1
HOSPITALS AT INSTITUTIONAL
Referral criteria: LEVEL OR DISTRICT
HOSPITAL/ INTEGRATED
• Patients with severe bleeding per AYURVEDIC HOSPITALS
rectum.
Clinical Diagnosis: Same as level 1 & 2 for
• Patients having severe anaemia,
fresh cases reporting directly.
who need blood transfusion,
• Haemorrhoids associated with Investigations: If facilities are available, do
heart disease, uncontrolled BP and the following investigation to confirm the
DM, HIV positive HbsAg positive, diagnosis as well as to rule out the other
VDRL positive, tuberculosis, malig- pathologies.
nancy etc. 1. Routine blood investigation

AYURVEDIC STANDARD TREATMENT GUIDELINES 117


PARIKARTIKA (FISSURE-IN-ANO/ PAINFUL DEFECATION)

2. Ultra sonography of whole abdomen. Treatment of Chronic Fissure-in-ano:


3. Proctoscopy Methods:
4. Colonoscopy
• Kshara Sutra Suturing (KSS) at
Treatment: At this level, the following fissure bed with trans-fixation and
treatment options may be made available ligation of sentinel tag (if present)
in addition to treatment option available at after Lord’s Anal Dilatation.
level 1 and 2. For un-responsive cases and
chronic cases of fissure, various types of • Anuvasana Basti: 3-5 ml of Anu
Basti, Ksharakarma and surgical treatment Taila21 (oil) is inserted high in to
may be opted. the anal canal with the help of a
catheter, twice daily.
1. Kshara Karma (potential cauterization)
2. Agni Karma (direct cauterization) • Sitz bath.
3. Shastra Karma (surgical management) Note: Treatment of Bhagandara can
4. Classical Virechana Karma also be applied in the management of
Pathya-Apathya (diet and life style Parikartika.
education): Same as level 1

REFERENCES

1 Anonymous, The Ayurvedic Pharmacopoeia 6 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 Vol. 1 (31) Welfare, Govt. of India, Part 1 (7:2)
2 Anonymous, The Ayurvedic Formulary 7 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (7:15) Welfare, Govt. of India, Part 1 (1:1)
3 Anonymous, The Ayurvedic Pharmaco-
8 Anonymous, The Ayurvedic Formulary
poeia of India, Ministry of Health and
of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part 1
Welfare, Govt. of India, Part 1 (12:34)
Vol. 3 (21)
9 Anonymous, The Ayurvedic Pharmaco-
4 Anonymous, The Ayurvedic Pharmaco-
poeia of India, Ministry of Health and
poeia of India, Ministry of Health and
Family Welfare, Govt. of India, Part 1
Family Welfare, Govt. of India, Part 1
Vol. 1 (6)
Vol. 1 (5)
5 Anonymous, The Ayurvedic Pharmaco- 10 Anonymous, The Ayurvedic Pharmaco-
poeia of India, Ministry of Health and poeia of India, Ministry of Health and
Family Welfare, Govt. of India, Part 1 Family Welfare, Govt. of India, Part 1
Vol. 3 (23) Vol. 3 (23)

118 AYURVEDIC STANDARD TREATMENT GUIDELINES


PARIKARTIKA (FISSURE-IN-ANO/ PAINFUL DEFECATION)

11 Anonymous, The Ayurvedic Pharmaco- 16 Anonymous, The Ayurvedic Formulary


poeia of India, Ministry of Health and of India, Ministry of Health and Family
Family Welfare, Govt. of India, Part 1 Welfare, Govt. of India, Part 1 (8:17)
Vol. 3 (15) 17 Anonymous, The Ayurvedic Formulary
12 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Ministry of Health and Family Welfare, Govt. of India, Part 1 (20: 4)
Welfare, Govt. of India, Part 1 (7:15) 18 Anonymous, The Ayurvedic Formulary
13 Anonymous, The Ayurvedic Pharmaco- of India, Ministry of Health and Family
poeia of India, Ministry of Health and Welfare, Govt. of India, Part 1 (12: 5)
Family Welfare, Govt. of India, Part 1 19 Anonymous, The Ayurvedic Formulary
Vol. 1 (6) of India, Ministry of Health and Family
14 Anonymous, The Ayurvedic Pharmaco- Welfare, Govt. of India, Part 2 (4: 16)
poeia of India, Ministry of Health and 20 Anonymous, The Ayurvedic Pharmacopoeia
Family Welfare, Govt. of India, Part 1 of India, Ministry of Health and Family
Vol. 6 (62). Welfare, Govt. of India, Part 1 Vol. 3 (23)
15 Anonymous, The Ayurvedic Formulary 21 Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part 1 (8:17), Welfare, Govt. of India, Part 1 (8:1)

AYURVEDIC STANDARD TREATMENT GUIDELINES 119


Manovaha Srotas Roga
ANIDRA (INSOMNIA)

Line of Treatment
INTRODUCTION
• Nidana Parivarjana should be the
Anidra is the sleep disorder caused by
first line of treatment.
aggravated Vata and Pitta. It is characterized
by difficulty in falling asleep at bedtime, • Shodhana Chikitsa – Virechana, Nasya
waking up at night and having difficulty
• Shamana Chikitsa - Snehana,
going back to sleep leading to daytime
Murdhataila, Shirolepa, Dhara
fatigue and loss of concentration.
• Medhya Rasayana
Case definition:
• Treatment according to Doshik
Patients complaining of insufficient sleep,
involvement
either due to delayed onset of sleep, or due
to frequent awakening at night or early
awakening and thus suffering from poor LEVEL 1: AT SOLO AYUVEDIC
concentration, headache, fatigue can be PHYSICIAN’S CLINIC / PHC
diagnosed as a case of insomnia.
Clinical diagnosis: On the basis of history
Differential Diagnosis: and clinical presentation
• Nidanarthkara Anidra due to any Investigations: Nothing Specific
disease conditions – Muscle fatigue,
Treatment: In the initial stage when the
restlessness, Diabetes, Asthma,
patient is having mild features of Anidra,
Arthritis etc.
two or more of following drugs may be
• Vataja Madatyaya given:
• Drug induced Insomnia

Table 18.1: Medicines at level 1 for Anidra

Drug Dosage Dosage Time of Duration Anupana


form administration
Sarpagandha Vati 1-2 Vati After meal/at 15 days to Water
Ghanavati1 (Each of 500 night one month
mg)
Jateephala Churna Churna 1-2 gm Bed time 15 days to Milk
one month
ANIDRA (INSOMNIA)

Ashwagandhadi Churna 3-6 gm Bed time 15 days to Milk


Churna2 one month

Sarpagandha Churna 250-500 mg After meal twice 15 days to Lukewarm


Churna daily one month water

Pippalimula Churna 1-3 gm After meal twice 15 days to Jaggery


churna3 daily one month

Tagara Churna 1-3 gm After meal twice 15 days to Water


daily one month

Saraswata Churna4 Churna 3-5 gm After meal twice 15 days to Ghrita


daily one month

Counselling must be done for insomnia due • Vihara: Day sleep, mental and
to stress or psychological reasons. Sarvanga physical excitement before bed,
Abhyanga in day time and Shiro Abhyanga, suppression of natural urges.
Padaabhyanga, and Karnapoorana before sleep
should be advised. Referral Criteria: Refer to level 2

Pathya - Apathya (Diet and life style Cases that are not responding to above
education): management

Do’s -
• Ahara: Mamsarasa, Shali, ghee, curd, LEVEL 2: CHCS OR SMALL
milk, wheat, sugarcane, sweets, HOSPITALS WITH BASIC
grapes, sugar, black gram, sesame, FACILITIES
Khaskhas
Clinical diagnosis: The diagnosis is
• Vihara: Comfortable room and bed, made on the basis of criteria mentioned in
regular bath, timely sleep, listening level-1
light music, Yoga and meditation
Investigations: Nothing specific
Dont’s -
Treatment: Treatment given in level-1 may
• Ahara: Excessive use of spicy food, be continued. Following medicines may be
stimulants like coffee, tea, tobacco added.
etc

124 AYURVEDIC STANDARD TREATMENT GUIDELINES


ANIDRA (INSOMNIA)

Table 18.2: Medicines at level 2 for Anidra

Formulation Dosage Dose Time Duration Anupana


form
Mamsyadi Kwatha5 Kwatha 20-40 ml Empty stomach / 15 – 30 days -
BD twice daily

Drakshadi Kwatha Kwatha 20-40 ml Empty stomach / 15 – 30 days


BD twice daily

Sarswatarishta Arishta 10-15 ml At bed time 15 – 30 days Luke warm


water

Nidrodaya Rasa6 Vati 1-2 tab (each After meal 15 – 30 days Milk
250 mg) twice a day

External management: Investigations: According to clinical


presentations
• Shiro Pichu: Chandanadi Taila,
Ksheerabala Taila Treatment: In addition to the treatment
• Shirolepa: Panchagandha Churna, prescribed at level-1 and 2, following
Amalaki Churna etc. with Takra procedures can be done.

• Pratimarsha Nasya: Gau Ghrita or 1. Shirodhara - Chandanadi Taila, Ksheerabala


Brahmi Ghrita Taila. It is usually done in Anxiety,
Insomnia
Pathya - Apathya (Diet and life style
education): Same as Level 1 2. Shirobasti - Chandanadi Taila, Ksheerabala
Referral Criteria: The cases those are not re- Taila. It is beneficial to do Shirobasti after
sponding to above mentioned management. proper purificatory procedures. But in
cases where Shodhana is not necessary it
can be done directly.
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL 3. Basti Karma: Tikta Ksheera Basti and
LEVEL OR DISTRICT Yapana Basti or Matra Basti
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS 4. Nasya: Gau ghrita or Brahmi Ghrita

Pathya - Apathya (Diet and life style


Clinical Diagnosis: Same as level 1 for a
education): Same as level 1
fresh case reporting directly.

AYURVEDIC STANDARD TREATMENT GUIDELINES 125


ANIDRA (INSOMNIA)

REFERENCES

1. Anonymous, The Ayurvedic Formulary 4. Anonymous, The Ayurvedic Formulary of


of India, Part 1, Ed. 2nd, Govt. of India, India, Part 2, Ed. 2nd, Govt. of India, Ministry
Ministry of Health and Family Welfare, of Health and Family Welfare, Department
Department of I.S.M. & H., New Delhi, of I.S.M. & H., New Delhi, 2003:97.
2003:181. 5. Yadavji Trikamji Acharya, Siddhayoga
2. Anonymous, The Ayurvedic Formulary of Sangraha, 8th edition, Sri Baidyanath
India, Part 1, Ed. 2nd, Govt. of India, Ministry Ayurved Bhavan Ltd. Nagpur, 1984,
of Health and Family Welfare, Department Pg. no. 86.
of I.S.M. & H., New Delhi, 2003:112. 6. Anonymous, The Ayurvedic Formulary of
3. Bhaishajya Ratnavali of Govind das; India, Part 1, Ed. 2nd, Govt. of India, Ministry
edited by Kaviraj Ambikadatt Shastri; of Health and Family Welfare, Department
Chaukhambha Surabharati, 2008, p. 418. of I.S.M. & H., New Delhi, 2003:256.

126 AYURVEDIC STANDARD TREATMENT GUIDELINES


APASMARA (EPILEPSY)

• Shodhana Chikitsa – Vamana,


INTRODUCTION
Virechana, Basti, Nasya,
Apasmara is convulsive disorder characterised Raktamokshana
by transient loss of memory. • Shamana Chikitsa – Dipana, Pachana,
Snehana, Swedana, Dhara, Brimhana
Case Definition:
• External applications – Shirolepa
Apasmara is diagnosed on the basis of and Pichu
episodes of transient loss of memory and • Medhya Rasayana
consciousness usually associated with
seizures, preceded with aura. • Treatment according to Doshik
involvement
Differential Diagnosis: • General line of treatment prescribed
Following conditions are to be ruled out as for Vata Vyadhi and Manasaroga
most of these present with convulsions.
• Akshepaka LEVEL 1: AT SOLO AYUVEDIC
PHYSICIAN’S CLINIC / PHC
• Sannipatajwara
• Darvikaradamsha Clinical Diagnosis: On the basis of history
and clinical presentation
Line of Treatment Investigations: Nothing Specific
• Nidaana Parivarjana should be the Treatment: Some of the following drugs may
first line of treatment. be advised

Table 19.1: Medicines at level 1 for Apasmara

Drug Dosage Dose Time of Duration Anupana


form administration
Mansyadi Kwatha 30-40 ml Empty stomach 15 days to -
Kwatha1 twice a day one month
Vacha Churna2 Churna 1-2 gm Empty stomach 15 days to With
twice a day one month Honey
Brahmi Ghrita3 Ghrita 10-20 gm Before meal twice 15 days to Warm
a day one month Water
APASMARA (EPILEPSY)

Kalyanaka Ghrita4 Ghrita 10-15 ml Empty stomach 15 days to Warm


twice a day one month Water
Shatavari Churna5 Churna 5 gm Empty stomach 15 days to Milk
twice a day one month
Lashuna Kalka6 Kalka 3 gm After meal twice 15 days to Tila Taila
a day one month
Saraswata Arishta 10-20 ml After meal twice 15 days to Equal
Arishta7 a day one month quantity
of Water

Pathya - Apathya (Diet and life style of natural urges, adventurous


education):- activities, deep water, standing on
edges at heights, fireplaces
Do’s -
Referral Criteria: Cases that are not
• Ahara: Wheat (Godhuma), Black responding to above management, Refer to
gram (Masha), Seasoned rice (Purana level 2
Shali), Green gram, milk and Ghee,
Kooshmanda
LEVEL 2: CHC’S OR SMALL
• Vihara: Yoga and meditation and HOSPITALS WITH BASIC
proper sleep FACILITIES
Don’ts -
Clinical diagnosis: The diagnosis is made on
• Ahara: Food which aggravate Vata the basis of criteria mentioned in level-1 for
like excessive use of Kalaya, potato, fresh cases.
chilli. Paryushita Ahara (stale food),
Viruddha Ahara (incompatible diet), Investigations: Nothing specific
Alcohol Treatment: Treatment given in level-1
• Vihara: Physical and mental stress, may be continued along with some of the
inadequate sleep, suppression following.

Table 19.2: Medicines at level 2 for Apasmara

Common Dosage form Dose Time Duration Anupana


medication
Saraswata Churna8 Churna 3-5 gm After meal / 15 days to Honey
twice a day one month
Smrutisagar Rasa9 Vati 1-2 Vati Empty stomach 15 days to Ghrita
(125-250 mg) twice a day one month

128 AYURVEDIC STANDARD TREATMENT GUIDELINES


APASMARA (EPILEPSY)

Jatamansya Arka10 Arka 10 ml After meals 15 days to Water


twice a day one month

Manasmitra Vati11 Vati 1-2 Vati Empty stomach 15 days to Warm water
(each 500 mg) twice a day one month

Mahakalyanaka Ghrita 10-20 ml Empty stomach 15 days to Warm water


Ghrita12 twice a day one month

Panchagavya Ghrita 10-20 ml Empty stomach 15 days to Warm water


Ghrita13 twice a day one month

4-8 ml Empty stomach 7 days Nasya Karma


once a day

Kooshmandaswrasa Ghrita 10-20 ml Empty stomach 15 days to Warm water


Ghrita twice a day one month

Panchagandha Churna 5 gm - Buttermilk /


Churna as Pichu, milk
Shirolepa

Pathya - Apathya (Diet and life style Treatment: In addition to the treatment
education): Same as Level 1 prescribed in level-1 and 2, following
procedures can be done.
Referral Criteria: The cases those are not
responding to above mentioned therapy 1. Vamana Karma

2. Virechana Karma
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL 3. Yapana Basti
LEVEL OR DISTRICT
4. Nasya
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS 5. Rasayana Therapy

Clinical Diagnosis: Same as level 1 for a a. Brahmi


fresh case reporting directly.
b. Aswagandha
Investigations: c. Vacha
1. EEG Pathya - Apathya (Diet and life style
2. CT / MRI Scan education): Same as level 1

AYURVEDIC STANDARD TREATMENT GUIDELINES 129


APASMARA (EPILEPSY)

Table 19.3: Medicines at level 3 for Apasmara

Formulation Dosage form Dose Time Duration Anupana


Brahma Rasayana14 Leha 10 gm Before meal; 15 days to one Milk
twice a day month
Survana Vasant Vati 1-2 Vati / After meals 15 days to one Water
Malati Rasa (each 125 mg) twice a day month

Suvarna Brahmi Vati Vati 100 mg Empty stomach 15 days to one Brahmi
twice a day month Swarasa

REFERENCES

1. Yadavji Trikamji Acharya, Siddhayoga of Health and Family Welfare, Department


Sangraha, 8th edition, Sri Baidyanath of I.S.M. & H., New Delhi, 2003, pg. 130.
Ayurved Bhavan Ltd. Nagpur, 1984, 9. Anonymous, The Ayurvedic Formulary of
pg. 86. India, Part 1, Ed. 2nd, Govt. of India, Ministry
2. Vaidya Ravidatta Shastri, Chakradatta, of Health and Family Welfare, Department
Choukambha Surabharati Prakashana, of I.S.M. & H., New Delhi, 2003, pg. 293.
Varanasi, 21/11, pg. 90. 10. Anonymous, The Ayurvedic Formulary of
3. Anonymous, The Ayurvedic Formulary of India, Part 1, Ed. 2nd, Govt. of India, Ministry
India, Part 1, Ed. 2nd, Govt. of India, Ministry of Health and Family Welfare, Department
of Health and Family Welfare, Department of I.S.M. & H., New Delhi, 2003, pg. 28.
of I.S.M. & H., New Delhi, 2003, pg. 94. 11. Anonymous, The Ayurvedic Formulary of
4. Anonymous, The Ayurvedic Formulary of India, Part 1, Ed. 2nd, Govt. of India, Ministry
India, Part 1, Ed. 2nd, Govt. of India, Ministry of Health and Family Welfare, Department
of Health and Family Welfare, Department of I.S.M. & H., New Delhi, 2003, pg. 68.
of I.S.M. & H., New Delhi, 2003, pg. 82. 12. Anonymous, The Ayurvedic Formulary of
5. Vaidya Ravidatta Shastri, Chakradatta, India, Part 1, Ed. 2nd, Govt. of India, Ministry
Chaukambha Surabharati Prakashana, of Health and Family Welfare, Department
Varanasi, 21/13, pg. 90. of I.S.M. & H., New Delhi, 2003, pg. 94.
6. Vaidya Ravidatta Shastri, Chakradatta, 13. Anonymous, The Ayurvedic Formulary of
Chaukambha Surabharati Prakashana, India, Part 1, Ed. 2nd, Govt. of India, Ministry
Varanasi, 21/13, pg. 90. of Health and Family Welfare, Department
7. Anonymous, The Ayurvedic Formulary of of I.S.M. & H., New Delhi, 2003, pg. 90.
India, Part 1, Ed. 2nd, Govt. of India, Ministry 14. Anonymous, The Ayurvedic Formulary of
of Health and Family Welfare, Department India, Part 1, Ed. 2nd, Govt. of India, Ministry
of I.S.M. & H., New Delhi, 2003, pg. 99. of Health and Family Welfare, Department
8. Anonymous, The Ayurvedic Formulary of of I.S.M. & H., New Delhi, 2003: Volume 1,
India, Part 1, Ed. 2nd, Govt. of India, Ministry pg. 43.

130 AYURVEDIC STANDARD TREATMENT GUIDELINES


VISHAADA (DEPRESSIVE DISORDERS)

Differential diagnosis:
INTRODUCTION
• Kaphaja Unmada
Vishaada is one of the Vatananatmaja Vikaras1
and is an important aggravating factor for • Anidra
most of diseases.2 It is a condition originating
from apprehension of failure leading to lack Line of management:
of initiation for any activity.3 The above Sattvavajaya Chikitsa - Ashwashana,
presentation is comparable with anxiety Harshana etc. along with imparting Jnana
with depression. (personal awareness), Vijnana (proved
sciences), Dhairya (assurance), Smriti
Case Definition
(experience sharing), Samadhi (helping to
The diagnosis will be made on the basis of divert the mind from causative factors and
sign and symptoms of Vishaada like; establishing self control)

A) Psychic Symptoms: Dukhita (distressed,


unhappy, grieved in mind), Avasada LEVEL 1: AT SOLO AYUVEDIC
(hopelessness, lassitude), Manahkheda PHYSICIAN’S CLINIC/PHC
(feeling of depression), Vishanna
(dejection, sorrow), Chittaglani (fatigue Clinical diagnosis: On the basis of history
of mind), Asiddhi Bhaya (fear and and clinical findings, patient can be diag-
anxiety or apprehension of failure), nosed as case of Vishaada.
Dainya (miserable state / depression)
Chittodvega (anxiety), Feeling of Investigations: It can be diagnosed based on
inadequacy, thought of death/suicide. the clinical signs and symptoms, systemic
examination may be done to review the
B) Somatic Symptoms: Sidanti Gatrani
status of the patient.
(fatigue), Mukha Shosha (Dryness of
mouth), Prasveda (excessive sweating), Treatment: In the initial stage along with
Bhramati Manas (wandering mind), Satvavajaya (counseling), patient should
Tvakparidaha (burning sensation of be given combination of two or more of
skin), Vepathu (tremor) Roma Harsha following drugs depending upon the status
(horripilation), Sransanam (inability to of depression.
hold).
VISHAADA (DEPRESSIVE DISORDERS)

Table 20.1: Medicines at level 1 for Vishada

Drugs Dosage Dose Time of Duration Anupana


form administration
Vacha4 Churna 1-2 gm Before meal/ 4-8 weeks Honey
twice daily
Brahmi 5 Churna 3-6 gm Before meal/ 4-8 weeks Ghee
thrice daily
Ashwagandha Churna 3-6 gm Before meal/ 4-8 weeks Ghee
thrice daily
Shankhapushpi Churna 3-6 gm Before meals / 4-8 weeks Ghee
thrice daily
Kushmanda Swarasa 50 ml Early morning 1 month
empty stomach
Jyothismati Taila Taila 2-4 drops Early morning 4-8 weeks Milk / Batasha
empty stomach
Mansyadi Kwatha6 Decoction 20-40 ml Before meal/ 2-3 weeks Water
twice daily
Saraswatarishta7 Arishta 10-20 ml After meal/ 2-3 weeks Equal quantity
thrice daily of water

Pathya-Apathya (Diet and life style): especially of hunger, bowel and


urine and emotions.
Do’s –
Referral criteria:
• Ahara: Fresh and Satvika food.
Godhuma, Mudga, Raktashali, • Patient not responding to above
Godugdha, Ghrita, Kushmanda, mentioned management
Parval, Vastuka, coconut, Draksha,
• Need further investigations
Kapittha.
• Vihara: Proper sleep, meditation,
LEVEL 2: CHC’S OR SMALL
techniques for self control, personal
HOSPITALS WITH BASIC
hygiene
FACILITIES
Dont’s– Clinical diagnosis: Same as Level 1: for a
• Ahara: Liquor, Viruddhashan, spicy fresh case reporting directly.
food, stale food, night awaking,
Investigation:
• Vihara: Excessive stress,
suppression of natural urge • Complete hemogram

132 AYURVEDIC STANDARD TREATMENT GUIDELINES


VISHAADA (DEPRESSIVE DISORDERS)

Treatment: Same as level 1: in addition the following drugs may be added

Table 20.2: Medicines at level 2 for Vishaada


Drugs Dosage Dose Time of Duration Anupana
form administration
Saraswatarishta8 Arishta 10-20 ml After meal/ 2-3 weeks Equal quantity
(With gold) thrice daily of water
Unmadagaja Vati 1-2 Vati After meal 2-3 weeks Ghee
Keshari Rasa9 (250-500 mg)
Kalyana Ghrita Ghrita 10-30 ml Early morning 1 month Warm milk
empty stomach
Panchagavya Ghrita Ghrita 10-30 ml Early morning 1 month Warm milk
empty stomach
Brahmi Ghrita Ghrita 10-30 ml Early morning 1 month Warm milk
empty stomach
Drakshadi Kashaya Decoction 60 ml Before food / 1 month
twice daily
Kushmanda Avaleha Avaleha 10-20 gm Early morning 1 month Warm milk
empty stomach

In addition to it, Investigation: nothing specific


Mridu Virechana: As per the status of the Treatment: In addition to the management
patient, Mridu Virechana / Koshtha Shuddhi of Level 1 and Level 2, if needed Panchakarma
with Avipatikara Churna10 5-10 gm with water procedures indicated can be performed.
3-5 days before treatment. Similarly patient
may be kept on fasting for early few days. Shodhana:
Pathya-Apathya (Diet and life style): Same Nasya: Tikshna with Hingu Ghrita,
as level 1 Panchagavya Ghrita11
Referral criteria: Cases not to be responded to
Vamana: Vamana Karma with Dhamargava
above therapy and needs further evaluation
after Snehapana with Panchagavya Ghrita.12
for management.
Virechana: Virechana Karma with Trivrita
LEVEL 3: AYURVEDA HOSPITALS Lehya 30 gm along with Avipatikara powder
AT INSTITUTIONAL LEVEL
OR DISTRICT HOSPITAL/ Yapana Basti
INTEGRATED AYURVEDIC
Rasayana:
HOSPITALS
1. Shilajatu Rasayana Kalpa
Clinical Diagnosis: Same as level 1 for a
fresh case reporting directly 2. Amalaki Rasayana Kalpa

AYURVEDIC STANDARD TREATMENT GUIDELINES 133


VISHAADA (DEPRESSIVE DISORDERS)

3. Brahmi Ghrita13 Pathya-apathya (diet and life style


4. Panchagavya Ghrita14 education): Same as level 1

REFERENCES

1 Acharya Jadavaji Trikamji, Charaka 8 Anonymous, The Ayurvedic Formulary of


Samhita, Chakrapanidatta, Reprint India, Part 1, Ed. 2nd, Govt. of India, Ministry
edi. Ayurveda Dipika commentary, of Health and Family Welfare, Department
Chaukhamba Prakashan: 2007. p.113 of I.S.M. & H., New Delhi, 2003:97
2 Sharma RK, Das B. Charaka Samhita, 9 Kaviraj Govindadas Sen, Bhaishajya
Chakrapanidatta. Reprint edi. Ayurveda Ratnavali, Siddhiprada hindi vyakhyasahita,
Dipika commentary, Varanasi: edited by Prof. Siddhinandan Mishra,
Chaukhambha Orientalia; 2009. p.416. chapt. 24/ 35-37, Reprint, Chaukhambha
3 Acharya YT. Sushruta Samhita, Surbharati Prakashan, Varanasi, 2011:504
Dalhanacharya. Reprint edi. Nibandha 10 Anonymous, The Ayurvedic Formulary
Samgraha commentary, Varanasi: of India, Ministry of Health and Family
Chaukhamba Krishnadas Academy; Welfare, Govt. of India, Part I (7:15), 2000
2004. p.6. 11 Anonymous, The Ayurvedic Formulary of
4 Anonymous, The Ayurvedic Pharmaco- India, Part 1, Ed. 2nd, Govt. of India, Ministry
poeia of India, Ministry of Health and of Health and Family Welfare, Department
Family Welfare, Govt. of India, Part 1 of I.S.M. & H., New Delhi, 2003:268
Vol. 2 (74) 12 Anonymous, The Ayurvedic Formulary of
5 Anonymous, The Ayurvedic Pharmaco- India, Part 1, Ed. 2nd, Govt. of India, Ministry
poeia of India, Ministry of Health and of Health and Family Welfare, Department
Family Welfare, Govt. of India, Part 1 of I.S.M. & H., New Delhi, 2003:268
Vol. 2 (11) 13 Anonymous, The Ayurvedic Formulary of
6 Yadavaji Trikamji Acharya, Siddhayoga India, Part 1, Ed. 2nd, Govt. of India, Ministry
Sangraha, 8th ed. Shri Baidyanatha Ayurveda of Health and Family Welfare, Department
Bhawan ltd. Nagapur, 1984:86 of I.S.M. & H., New Delhi, 2003:279
7 Anonymous, The Ayurvedic Formulary of 14 Anonymous, The Ayurvedic Formulary of
India, Part 1, Ed. 2nd, Govt. of India, Ministry India, Part 1, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:97 of I.S.M. & H., New Delhi, 2003:268

134 AYURVEDIC STANDARD TREATMENT GUIDELINES


Mootravaha Srotas Roga
ASHMARI (URINARY CALCULUS)

of ejaculation leads to accumulation of


INTRODUCTION
Shukra (semen) in the tract. Vayu gives
Formation of Ashma (stone) like substances rise to seminal concretion called Shukraja
within the urinary system is called Ashmari. It Ashmari. It obstructs the pathway of
can be considered as a Madhyama Rogamargaja urine thus causing dysuria, scrotal
Vyadhi as its Sthana is “Basti” – one among the swelling and lower abdominal pain. Its
Trimarma. The Asraya Sthana itself makes the special characteristic feature is that it
disease Krichrasaadhya. Its treatment consists can easily be dissolved by applying mild
of both Bheshaja & Shastra Karma. pressure by hands over it.

Differential diagnosis of Renal


Case Definition:
Calculus:
Pain during micturition, pain in the abdomen
1. Horse shoe kidney: Congenital anomaly
or loin region radiating towards supra pubic
and usually asymptomatic.
region, burning sensation, presence of blood
2. Polycystic kidney: Most common in
in urine occasionally, aggravation of pain
female with symptoms like loin pain,
during activities like running, swimming,
haematuria, hypertension, uremia.
jumping, riding, jerky movement etc.
suggests Ashmari (urinary calculus). 3. Hydronephrosis: Dull ache in loin with
backache, due to obstructive uropathy.
Various Presentations: According to the
4. Pyelonephritis (Acute/chronic): Asso-
predominance of particular Dosha, following
ciated with headache, lassitude, febrile,
presentations of the disease may be found.
nausea, vomiting and pain at renal
1. Vaataja Ashmari: Due to severe pain, angle.
patient cries out in agony, squeezes the
5. Renal Tuberculosis: Painless haematuria
umbilical region, rubs the penis and
in initial stages, common in 20-40 years
touches the perineum.
of age group.
2. Pittaja Ashmari: Burning sensation and 6. Tuberculous cystitis : Painful maturation
inflammatory changes in urinary tract.
7. Renal neoplasms
3. Shleshmaja Ashmari: Dysuria, cutting,
incising, pricking pain, heaviness and Differential diagnosis of ureteric
cold sensation over the area of bladder. calculus:
4. Shukraja Ashmari: Occurs in adult only. 1. Acute Appendicitis: Acute colicky pain
Any injury to urinary tract during sexual in right iliac fossa may be associated
act or by any other reason, suppression with anorexia, fever and vomiting.
ASHMARI (URINARY CALCULUS)

2. Acute salpingitis: Acute colicky pain in 5. Tumors of bladder: Benign Papillary


left or/and right iliac fossa. tumours and carcinoma of bladder

Differential diagnosis of urinary


bladder calculus: LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN’S CLINIC/PHC
1. Bladder exstrophy: It is congenital
anomaly. Clinical Diagnosis: On the basis of
2. Rupture of bladder: It is emergency history and clinical presentation patient
condition due to accidental rupture of can be diagnosed provisionally as case of
bladder. Ashmari.
3. Diverticulum of bladder: The victim is Investigations: On the basis of clinical
male above age of 50 years. It is due to examination and cardinal signs & symptoms,
bladder neck obstruction and the symp- provisional diagnosis can be made.
tom is haematuria and signs of cystitis.
Treatment: In the initial stage, when the
4. Cystitis: Middle and young females patient is having mild features of Ashmari
are main victim of this condition. (renal calculus), along with diet education,
The common symptom is increased two or more of following drugs may
frequency of maturation. be given:

Table 21.1:  Medicines at level 1 for Ashmari

Drugs Dosage Dose Time of Duration Anupana


form administration

Gokshura Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day

Punarnava Churna Churna 2-3 gm After meal / 2-3 weeks With water
thrice a day

Guduchi Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day

Parnabeeja Churna 3-6 gm After meal / 2-3 weeks With water


Churna thrice a day

Pashanbheda Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day

Rasayana Churna Churna 3-6 gm After meal / 2-3 weeks With water
thrice a day

Gokshuradi Guggulu1 Vati 1-2 Vati After meal / 2-3 weeks With water
thrice a day

138 AYURVEDIC STANDARD TREATMENT GUIDELINES


ASHMARI (URINARY CALCULUS)

Ashmarihara Kwatha2 Kwatha 12-24 ml After meal / 2-3 weeks -


thrice a day

Punaravashtaka Kwatha3 Kwatha 12-24 ml After meal / 2-3 weeks -


thrice a day

Varuna Shigru Kwatha Kwatha 12-24 ml After meal / 2-3 weeks -


thrice a day

Trinapanchamula Kwatha 12-24 ml After meal / 2-3 weeks -


Kwatha4 thrice a day

Chandraprabha Vati5 Vati 1-2 Tab After meal / twice or 2-3 weeks Warm water
thrice a day

For the complains like pain, Vedana Shamaka substances heavy to digest, excess
drugs like Triphala Guggulu, Sarjika Kshara or amount of milk products, Rhubarb,
Ajamodadi Churna etc. can be given. strawberries, plums, spinach,
asparagus, Kapittha Phala, Jambu
Pathya - Apathya (Diet and life style): Phala, dried dates, astringent foods
articles, brinjal, beans, lady finger,
Do’s -
capsicum, tomato, cucumber,
• Ahara (food articles): Intake of spinach, black grapes, kiwi,
excess fluid, dietary items having strawberries, chickoo, pear, refined
Vataanulomana and Mutrala wheat flour (Maida), papaya, garlic,
properties like Yava (barley), yogurt, cashew nut, dried food
Kulattha (Horse gram), Purana Shali items.
(old rice), Mudga (green gram),
• Vihara: Excessive exercise/ physical
puffed rice, Rajma, vegetables
work, over eating, healthy foods
like carrot, bitter guard, potatoes,
mixed with unhealthy, suppression
reddish, pumpkin, fruits like
of natural urges
banana, lemons, apricot, plums,
apple, almonds, coconut water,
lemon juice, Aloe vera juice, corn Referral criteria:
silk, pineapple juice, butter milk, 1. Cases not responding to above
spices like ginger etc. can be used. conservative therapy.
• Vihara: Sitz bath
2. Development of complications
Don’ts - 3. Haematuria
• Ahara (food articles): Cold food 4. Need for further investigations.
and drinks, fatty foods, food

AYURVEDIC STANDARD TREATMENT GUIDELINES 139


ASHMARI (URINARY CALCULUS)

Laboratory investigation:
LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC • Complete Haemogram,
FACILITIES • Serum uric acid,
• Serum calcium.
Clinical diagnosis: The diagnosis is made
• Renal function test.
on the basis of criteria mentioned in level-1
• Urine analysis, culture.
for fresh cases. The case referred from level-1
or fresh case must be evaluated according • X-Ray KUB (Kidney, Ureter,
to the Doshic involvement. The obstruction Bladder)
in the urinary system and stage of infection Treatment: The prime aim at this level is
should be ruled out. The clinical examination to confirm the diagnosis and assess the
should be done thoroughly for detecting prognosis.
complications. Mild to moderate symptoms: The line of
management is same as level-1 for fresh case.
Investigations: In this level-2 Laboratory and
Patient must be evaluated for conditions
radiological investigations should be done to
where surgical or any other special procedure
confirm the diagnosis.
is required.

Table 21.2: Medicines at level 2 for Ashmari

Drugs Dosage Dosage Time of Duration Anupana


form administration

Shuddha Shilajatu Churna 0.5-1.0 gm After meal / 2-3 weeks Milk


twice a day

Gokshuradi Kashaya6 Kwatha 12-24 ml After meal / 2-3 weeks -


thrice daily

Pashanabhedadi Churna 3-6 gm After meal / 2-3 weeks Water


Churna7 thrice daily

Usheeradi Churna8 Churna 3-6 gm After meal / 2-3 weeks Water


thrice daily

Chandraprabha Vati9 Vati 1-2 Vati After meal / 2-3 weeks Water
thrice daily

Palasha Kshaara Churna 250-500 mg After meal / 2-3 weeks Water


thrice daily

Varunadi Ghrita10 Ghrita 5-10 gm After meal / 2-3 weeks Luke warm water
thrice daily

140 AYURVEDIC STANDARD TREATMENT GUIDELINES


ASHMARI (URINARY CALCULUS)

Ushirasava11 Asava 10-20 ml After meal / 2-3 weeks Equal quantity of


twice a day water
Chandanasava12 Asava 10-20 ml After meal / 2-3 weeks Equal quantity of
twice a day water
Sarivadyasava13 Asava 10-20 ml After meal / 2-3 weeks Equal quantity of
twice a day water

Pathya - Apathya (Diet and life style 2. IVP / IVU


education): Same as level – 1 3. Cystography

Referral Criteria: 4. Cystoscopy

1. Cases not responding to above 5. Ureteroscopy


mentioned therapy 6. Percutaneous Nephroscopy
2. If the size of stone, pain and severity of
7. Renal Angiography
symptoms are increasing
8. CT Scan
3. Complications like hydronephrosis or
pylonephrosis are observed 9. MRI
4. Patients with some other uncontrolled
Treatment: In addition to the treatment
conditions like diabetes mellitus and
prescribed in level-1 and 2 following specific
hypertension etc.
treatment can be given.
5. The raised values of blood urea and
serum creatinine. Specific treatment as per the dominant
Dosha:
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL 1. In Vataja Ashmari, Ghrita prepared from
LEVEL OR DISTRICT Pashanabheda, Vasuka (Swetaarka), Vasira
HOSPITAL / INTEGRATED (Rakta Apamarga) Ashmantaka, Shatavari,
AYURVEDIC HOSPITALS Gokshura, Bŗihati, Kantakari, Brahmi,
Sahachar, Ushira, Kubjaka, Vrikshadini,
Clinical Diagnosis: Patient not responding Shyonaka, Varuņa, fruits of Shaka, barley,
to the conservative treatment mentioned in Kulattha, Kola and Kataka should be
level-1 and 2 should further be evaluated for given.
special investigation and treatment.
2. In Pittaja Ashmari, Ghrita prepared
Investigations: from Kusha, Kasha, Shara, Gundra, Itkata,
Morata, Pashanabheda, Shatavari, Vidari,
1. USG - KUB
Shalimula, Trikantaka, Bhalluka, Patola,

AYURVEDIC STANDARD TREATMENT GUIDELINES 141


ASHMARI (URINARY CALCULUS)

Patha, Pattura, Kuruntika, Punarnava and In addition to the treatment prescribed in


Shirisha should be given. level-1 and 2, following procedures can be
done
3. In Kaphaja Ashmari, Ghrita prepared
1. Virechana Karma
from Varunadi Gana, Guggulu, cardamom,
Harenu, Kushtha, drugs of Bhadradi gana, 2. Basti
Maricha, Chitraka and Devadaru should 3. Uttara Basti
be given. If patient is not responding to these treatment
modalities, he/she may be referred to modern
4. In Sharkara (urinary gravels), Pichuka,
surgical hospital for surgical removal or
Akol, Nirmali, Shaka, Nilkamal should be
lithotripsy treatment of calculus.
given with jaggary and water. Gokshur,
Musali, Ajavayan, Kadamb, Sunthi should Pathya - Apathya (Diet and life style
be given with warm water. education): Same as level - 1

REFERENCES

1. Anonymous, The Ayurvedic Formulary tion 2008, Ashmari Chikitsa, 50/36-37,


of India, Ministry of Health and Family pg. 213.
Welfare, Govt. of India, PART-I (5 : 3). 8. Bhaishjya Ratnavali, edited by Indradev
2. Anonymous, The Ayurvedic Formulary Tripathi and Dr. Daya Shankar Tripathi,
of India, Ministry of Health and Family Chaukhambha Prakashan, Varanasi, Edition
Welfare, Govt. of India, PART-II (4 : 3). 2013, Raktapittadhikar, 13/40-41, pg. 392.

3. Anonymous, The Ayurvedic Formulary 9. Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, PART-I ( 4:22). Welfare, Govt. of India, PART-I (12:10).
10. Yogaratnakara, Vidyotini Hindi Com-
4. Anonymous, The Ayurvedic Formulary
mentary by Vaidya Lakshmipati Shastri;
of India, Ministry of Health and Family
Chaukhambha Prakashan, Varanasi Edi-
Welfare, Govt. of India, PART - II (4:8).
tion 2008, Ashmarirogadhikara, 50/45-48,
5. Anonymous, The Ayurvedic Formulary pg.520-521.
of India, Ministry of Health and Family
11. Anonymous, The Ayurvedic Formulary
Welfare, Govt. of India, PART-I (12:10).
of India, Ministry of Health and Family
6. Yogaratnakara, Vidyotini Hindi Com- Welfare, Govt. of India, PART-I (1:8).
mentary by Vaidya Lakshmipati Shastri;
12. Anonymous, The Ayurvedic Formulary
Chaukhambha Prakashan Varanasi Edition
of India, Ministry of Health and Family
2008, Vata Rogadhikara, 26/71, pg. 524.
Welfare, Govt. of India, PART-I (1:15).
7. Yogaratnakara, Vidyotini Hindi Com-
13. Anonymous, The Ayurvedic Formulary
mentary by Vaidya Lakshmipati Shastri;
of India, Ministry of Health and Family
Chaukhambha Prakashan Varanasi Edi-
Welfare, Govt. of India, PART-I (1:37)

142 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUTRAGHATA (CHRONIC RENAL FAILURE)

either due to physiologic reasons


INTRODUCTION
or injury etc., but not due to
obstruction.
Mutraghata stand for low urine output
due to obstruction in the passage of urine.
The disorders of Mutravaha Srotasa, which
Case Definition:
have resemblance with the description of The main characteristic symptoms are
urological disorders on modern parlance, oliguria-anuria with edema (facial/
are well described in Ayurvedic literature. generalized); the condition may be associated
Mutraghata can be classified into three with nausea and/or vomiting, loss of appetite,
categories as projected below, then we may muscle cramps, vertigo/dizziness with or
be in a position to understand the varieties without headache, hiccough, breathlessness,
of Mutraghata more clearly and it would be weakness/malaise and anaemia.
more helpful to analyse a patient presenting
with related complaints. Differential diagnosis:
• Vatakundalika, Vatabasti and • Pre-renal: Poor cardiac function,
Mutrajathara can be grouped under Chronic liver insufficiency,
Neurogenic disturbances in the Narrowing of renal arteries
bladder functioning.
• Renal: Diabetic nephropathy,
• Vatastheela, Mutragranthi, Hypertensive Nephrosclerosis,
Mutrotsanga and Bastikundalika Chronic glomerular diseases,
can be grouped under organic Chronic Interstitial Nephritis,
disturbances, where the symptoms Polycystic Kidney Disease,
of retention of urine, increased Hereditary renal diseases
frequency of micturition, distension
of abdomen and mass felt per Post-renal: PUJ obstruction, Urinary calculus,
rectum etc. may be present due BPH, Obstructive uropathy.
to a growth either in the bladder,
urethra, prostate or other related
LEVEL 1: AT SOLO AYURVEDA
structures.
PHYSICIAN’S CLINIC/PHC
• Mutratita, Mutrakshaya, Ushnavata,
Mutraukasada, Vidavighata and Clinical Diagnosis: On the basis of history
Mutrashukra can be grouped under and clinical presentation as described above,
category “others”, where the a patient can be diagnosed provisionally as
disturbance in urinary function is case of chronic renal failure.
MUTRAGHATA (CHRONIC RENAL FAILURE)

Investigations:  c. Low Hemoglobin percentage than


normal
a. Raised Serum Creatinine level above
normal range Treatment: In the initial stage when the pa-
tient is having mild features of chronic renal
b. Raised Blood Urea level above normal failure, along with dietary corrections, two
range or more of the following drugs may be given:

Table 22.1: Medicines at level 1 for Mutraghata

Drugs Dosage Dose Time of Duration Anupana


form administration

Gokshura Churna1 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily

Punarnava Churna2 Powder 2-3 gm After meal/ 2-3 weeks with water
thrice daily

Guduchi Churna3 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily

Shatavari Churna4 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily

Rasayana Churna5 Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily

Bhumyamalaki Churna Powder 3-6 gm After meal/ 2-3 weeks with water
thrice daily

Gokushuradi Guggulu6 Vati 1-2 Vati After meal/ 2-3 weeks with water
thrice daily

Punaravashtaka Kwataha7 Decoction 12-24 ml After meal / 2-3 weeks -


thrice daily

Varunadi Kwatha8 Decoction 12-24 ml After meal / 2-3 weeks -


thrice daily

Shigru Kwatha9 Decoction 12-24 ml After meal / 2-3 weeks -


thrice daily

Shilajityadi Vati10 Vati 1-2 Vati After meal/ 2-3 weeks with water
thrice daily

Trinapanchamula Kwatha11 Decoction 20-40 ml After meal / 2-3 weeks -


thrice daily

144 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUTRAGHATA (CHRONIC RENAL FAILURE)

In addition to these, patients may be advised 2. Patients having persistent raised Blood
to maintain input-output chart for fluid Urea and serum creatinine levels with or
regulation. without oedema

Pathya-Apathya (Diet and life style


education): LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Do’s–
FACILITIES:
• Ahara: Food items prepared mainly
from rice or rice flour, Moong Daal, Here, patient may be directly referred to
fresh and easy to digest cooked level 3 care, as the role of level 2 and 3 care
vegetables with less/no salt, apple, are almost same
grapes, dates (except in diabetic
nephropathy) and papaya, and
LEVEL 3: AYURVEDA
perched rice are good. Rock salt
HOSPITALS AT INSTITUTIONAL
in limited amount is preferred.
LEVEL OR DISTRICT
Patients can take one or two
HOSPITAL/ INTEGRATED
Chapatti made of barley flour in a
AYURVEDIC HOSPITALS
day. Sesame oil and cow ghee are to
be used in small quantity but other
Clinical diagnosis: Same as level 1 for a fresh
cooking fats are to be avoided.
case reporting directly.
• Vihara: Timely meals, restricted
intake of water, proper following of Investigation: In addition to level 1
daily regimen investigation, the following are to be added:

Don’ts– • Blood for S. electrolytes: Altered


or normal serum electrolytes and
• Ahara: All other flour items (i.e. calcium
wheat, millet, corn), bakery items,
all oils except sesame, junk food, • Blood for S. Uric Acid: Serum
fermented items, salts, all the items uric acid may rise as a secondary
having sour taste, chilies, deep fried hyperuricemia.
items, milk products and vegetables • Blood Sugar: Blood sugar level
with slimy properties (brinjal, ladies should be checked for the patients
finger etc.), non-vegetarian foods of diabetic nephropathy, often there
• Vihara: Excessive physical and men- is reduction in blood sugar levels
tal stress, day sleep and night vigil. in diabetics as they develop renal
insufficiency.
Referral criteria: Refer to level 2
• Urine: Albuminuria is commonly
1. Patients not responding to above
seen in all cases
mentioned management

AYURVEDIC STANDARD TREATMENT GUIDELINES 145


MUTRAGHATA (CHRONIC RENAL FAILURE)

• Glomerular Filtration Rate (GFR): differentiation with raised cortical


less than 60 mL/min/1.73 m2 and echo-texture of the kidney. The
persistent (present for > 3 months) size of the kidneys mostly becomes
with or without any symptoms smaller.
and signs.
Treatment: In addition to the management
• Ultrasound investigation: Ul-
mentioned in Level 1, few of the following
trasonography (USG) of Kidney,
drugs may be added as per the requirement
Ureter and Bladder with signs of
and status of the patient:
altered or loss of cortico-medullary

Table 22.2: Medicines at level 2 for Mutraghata


Drug Dosage Dosage Time of Duration Anupana
form administration
Shuddha Shilajatu12 Powder 2-3 gm After meal/twice 2-3 weeks with milk
daily
Vastyamayantaka Ghrita13 Liquid 5 – 10 ml Twice a day on 2 – 3 weeks With warm
empty stomach milk

1. Shodhana: 1. Rasayana Churna (equal quantity


of Guduchi, Gok]sura and Amalaki
1. Nādīsvedana in both the loin region
Churna) 3 gm thrice a day with water.
once in the morning
2. Bhumyamalaki Churna 3 gm thrice a
2. Niruhabasti every day before lunch
day with water.
time. (Formation of Niruhabasti –
Madhu 30 ml + Saindhava Lavana 5 Special cautions:
g + Tila Taila 30 ml + Kalka Dravya
(Shatapushpa, Madanaphala, Pippali, • If the patient is already on mainte-
Vacha in equal quantity) in Chur]na nance dialysis, it is to be continued.
form 15 gm + Punarnavadi Kwatha14 The frequency of dialysis is to be re-
– 240 ml according to classical duced according to improvement in
method. Basti must be retained not the patient’s general condition and
less than 20 minutes. renal function.

3. Uttarabasti: Dashamoola Taila, • Patient not responding with above


particularly in cases of obstructive mentioned regimen are to be
uropathy. refereed to higher centers having
facility of dialysis.
2. Rasayana: List of Rasayana Drugs which
may be used for either for prevention or Pathya-Apathya (Diet and life style
management of the disease education): Same as level 1

146 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUTRAGHATA (CHRONIC RENAL FAILURE)

REFERENCES

1 Govind Das Sen, Bhaishajya Ratnavali, 8 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/20 Ashmari Rogadhikar, Adhyaya 36/18-20
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
2 Govind Das Sen, Bhaishajya Ratnavali, 9 Govind Das Sen, Bhaishajya Ratnavali,
Udara Rogadhikar, Adhyaya 40/36 edited Ashmari Rogadhikar, Adhyaya 36/7 edited
by Brahma Shankara Mishra. 11th ed. by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
3 Govind Das Sen, Bhaishajya Ratnavali, 10 Govind Das Sen, Bhaishajya Ratnavali,
Vatarakta Rogadhikara, Adhyaya 27/10 Mutraghata Rogadhikar, Adhyaya 35/15
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
4 Sharangadhara, Sharangadhara Samhita
11 Anonymous, The Ayurvedic Formulary
Madhyama Khanda 6/155; Pt. Parashuram
of India, Ministry of Health and Family
Shastri Vidyasagar. 1st ed, Chaukhambha
Welfare, Govt. of India, Part II (4:8)
Surbharati Prakashan, Varanasi.
12 Govind Das Sen, Bhaishajya Ratnavali,
5 Astanga Hridaya Rasayana: Comm. By
Mutraghata Rogadhikar, Adhyaya 35/15
Sarvangasundara by Arunadatta and
edited by Brahma Shankara Mishra. 11th ed.
Ayurveda Rasayana of Hemadri annotated
Varanasi: Chaukhambha Sanskrit Sansthan;
by Dr. Anna Moreswar Kunte and Krishna
1993.
Ramachandra Sastri Avre, edited by
Pt. HariSadashiva Sastri Paradakara, 13 Anonymous, The Ayurvedic Formulary
Chaukhambha Surabharati Prakashan, of India, Ministry of Health and Family
Varanasi. Welfare, Govt. of India, Part I (6 : 40)

6 Anonymous, The Ayurvedic Formulary 14 Govind Das Sen, Bhaishajya Ratnavali,


of India, Ministry of Health and Family Udara Rogadhikar, Adhyaya 40/43‑44
Welfare, Govt. of India, Part I (I 5 : 3) edited by Brahma Shankara Mishra. 11th ed.
7 Anonymous, The Ayurvedic Formulary Varanasi: Chaukhambha Sanskrit Sansthan;
of India, Ministry of Health and Family 1993.
Welfare, Govt. of India, Part I ( 4:22)

AYURVEDIC STANDARD TREATMENT GUIDELINES 147


MUTRASHTILA (BENIGN PROSTATIC
HYPERPLASIA)

is hard to firm in consistency associated


INTRODUCTION
with retention of urine, feces and flatus,
The disorders of Mutravaha Srotasa have poor urine flow which does not improve
resemblance with the description of rather worsen by straining, dribbling,
urological disorders on modern parlance. hesitancy, intermittent stream -stops and
The vitiated Vata gets lodged between starts, feeling of incomplete evacuation of
the bladder and rectum, produces stony urine and episodes of frequent retention of
hard swelling i.e. enlargement of prostatic urine, distension of the urinary bladder and
tissue. excruciating pain in the urinary bladder
suggest Mutrashthila (BPH).
Case Definition:
Differential Diagnosis: The differential
Single, movable and elevated cystic portion diagnosis of BPH with Carcinoma of
which resembles with prostate gland, which Prostate

Table 23.1: Differential diagnosis of Mutrashtila with their clinical features

Symptoms BPH Carcinoma of Prostate

Size Small to big Usually not very big

Consistency Firm and elastic Hard

Surface Smooth surface Irregular and nodular surface.


The gap between the enlarged The gap is obliterated by
prostate and the lateral pelvic invasion of the cancer
wall is clear

Sulcus Midline sulcus between two lateral Sulcus is usually obliterated


lobes is well defined.

Seminal Felt normal This may be invaded by the tumor


Vesicle and felt hard and irregular

Rectal mucosa The rectal mucosa moves The rectal mucosa is adherent
freely over the enlarged and cannot be moved over enlarged
prostate prostate
MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

Investigations: As it is level-1, facilities of


LEVEL 1: AT SOLO AYURVEDIC investigation may be lacking, so the diagnosis
PHYSICIAN’S CLINIC/PHC is purely on the basis of clinical examination
Clinical diagnosis: On the basis of history and symptoms, fairly good provisional
and clinical presentation patient can be diagnosis can be made.
diagnosed provisionally as case of BPH.
Treatment: In the initial stage when the
Thus, on the basis of clinical symptoms and patient is having mild features of BPH, along
per rectal finding of enlarged prostate gland with diet education, two or more of following
with soft, rubbery consistency, free mucosa drugs may be given:
and painless growth, further confirms the
diagnosed of BPH.

Table 23.2: Medicines at level 1 for Mutrashtila

Drugs Dosage form Dose Time of Duration Anupana


administration
Gokshura Churna1 Churna 3-6 gm After meal/ 2-3 weeks Water
thrice daily
Punarnava Churna2 Churna 2-3 gm After meal/ 2-3 weeks Water
thrice daily
Guduchi Churna3 Churna 3-6 gm After meal/ 2-3 weeks Water
thrice daily
Dhanyaka Hima4 Cold infusion - 10-20 ml After meal/ 2-3 weeks -
liquid thrice daily

Rasayana Churna5 Churna 3-6 gm After meal/ 2-3 weeks Water


thrice daily
Bhumyamalaki Churna 3-6 gm After meal/ 2-3 weeks Water
Churna thrice daily
Gokushuradi Vati 1-2 Vati After meal/thrice 2-3 weeks Water
Guggulu6 daily

Kanchanara Guggulu7 Vati 1-2 Vati After meal/thrice 2-3 weeks Water
daily
Punaravashtaka Decoction 20-40 ml After meal / 2-3 weeks -
Kwatha8 thrice daily
Varuna Kwatha9 Decoction 20-40 ml After meal / 2-3 weeks -
thrice daily

AYURVEDIC STANDARD TREATMENT GUIDELINES 149


MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

For the complaints like pain, Vedanashamaka • Vihara: Excessive exercise / physical
drugs like Triphala Guggulu, Sarjikakshara or work, over eating, suppression of
Ajamodadi Churna etc. can be given. natural urges.

Pathya-apathya (diet and life style Referral criteria: Refer to level 2


education): 1. Cases not responding to above conserv-
ative therapy.
Do’s– 2. Increased frequency of micturition and
• Ahara: Intake of excess fluid and dribbling which hamper the quality of
dietetic items having Vata Anulomana life.
and Mutrala properties like Purana 3. Severe burning micturition with
Shali (year old rice), Mudga (green unbearable pain.
gram), Yava (barley), Puffed rice, 4. The complications like acute retention
Kulattha (horse gram), Rajma and of urine.
vegetables like carrots, bitter guard,
5. Suspected case of carcinoma of prostate
potatoes, radish, pumpkin, fruits
gland
like banana, lemons, apricot, plums,
6. Patients who are in need of radiological
apple, almonds, coconut water,
investigations to rule out the enlargement
lemon juice, aloe vera juice, corn
of prostate or to differentiate from
silk, pineapple juice, butter milk
malignancy.
and spices like ginger can be used.

• Vihara: Timely meals, proper LEVEL 2: CHC’S OR SMALL


following of daily regimen HOSPITALS WITH BASIC
FACILITIES
Don’ts– Clinical diagnosis: The diagnosis is made
• Ahara: Healthy foods mixed same as mentioned in level-1 for fresh case
with unhealthy, Cold food and reporting directly. If a patient presents with
drinks, Fatty foods, Food sub- more severe symptoms, then the stage of
stances heavy to digest, Excess disease or malignancy should be find out as
sweet diet, Dried food items, mentioned in the table-1.
Kapittha Phala, Jambu Phala, dried Investigations: Laboratory and radiological
dates, Consumption of astringent investigations may be done to confirm
foods articles, brinjal, Beans, lady diagnosis.
finger, capsicum, tomato, cucum-
1. Ultrasonography (USG) of KUB
ber, spinach, black grapes, kiwi,
strawberries, chickoo, pear, refined 2. Blood Examination: Complete hemo-
wheat flour (Maida), papaya, garlic, gram, Blood urea, S. creatinine, PSA.
yoghurt, cashew nut etc. 3. Urine Examination.

150 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

Treatment: pound drug. If symptoms are getting aggra-


vated and patient is having acute retention
Mild to moderate symptoms: The treatment of urine then simple rubber catheterization
is similar as level-1 for fresh cases reporting should be done for temporary relief under
directly, like Pathya Apathya, single and com- aseptic precautions.

Table 23.3: Medicines at level 2 for Mutrashtila

Drug Dosage Dosage Time of Duration Anupana


form administration
Shuddha Shilajatu10 Churna 500 mg – after meal/twice 2-3 weeks Milk
1 gm daily
Gokshuradi Decoction 12-24 ml After meal / 2-3 weeks -
Kashaya11 thrice daily
Chandraprabha Vati 1-2 Vati After meal/ thrice 2-3 weeks Water
Vati12 daily

Palasha Kshara Churna 250-500 mg After meal/ thrice 2-3 weeks Water
daily
Varunadi Ghrita13 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Ushirasava14 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Chandanasava15 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Sarivadyasava16 Asava 10-20 ml after meal/twice 2-3 weeks Mixed with equal
daily quantity of water
Hingavadi Churna17 Churna 3-6 gm After meal/ thrice 2-3 weeks Water
daily
Mustaka Churna18 Churna 3-6 gm After meal/ thrice 2-3 weeks Water
daily
Gokshuradi Ghrita Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Pashanabhedadi Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
Ghrita19 daily
Sthiradi Ghrita20 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily
Changeri Ghrita21 Ghee 5-10 gm After meal/ thrice 2-3 weeks Luke warm water
daily

AYURVEDIC STANDARD TREATMENT GUIDELINES 151


MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

Manjishtadi Kwatha, Kamalanaala Kshara and Investigations:


Kadali Kanda Kshara may be given to patients
1. Biochemical investigations like Serum
of BPH.
acid phosphatase, Serum alkaline
Pathya-apathya (diet and life style educa- phosphatase and Serum testosterone
tion): Same as level-1
2. Trans Rectal Ultra Sonography (TRUS)
Referral criteria: 3. Cystoscopy

1. Cases not responding to above 4. Uroflowmetry


mentioned therapy. 5. Biopsy of prostate gland
2. If the size of prostate gland is on
6. CT-Scan
increasing
3. The cases of severe pain in supra-pubic Treatment: Same as level-1 and 2
region due to cystitis.
If the patient comes with acute retention of
4. Recurrent episodes of retention of urine.
urine and urethral catheterization fails then
5. Complications like hydronephrosis supra-pubic cystostomy should be carried
or pylonephrosis and signs of renal out immediately.
failure are observed due to obstructive
uropathy. Shodhana:
6. Incontinence of urine
Uttar Basti is mentioned in the classic for the
7. Recurrent urinary infection. management of all types of Mutraghata, but if
done without proper aseptic precautions, it
LEVEL 3: AYURVEDA may practically lead to infections via urethra.
HOSPITALS AT INSTITUTIONAL Matrabasti is much beneficial. The action of
LEVEL OR DISTRICT drug through urethral route or rectal route
HOSPITAL/ INTEGRATED is nearly similar, so rectal route is preferable.
AYURVEDIC HOSPITALS The Matrabasti is also beneficial in cases of
BPH to control the further progress of prostate
Clinical Diagnosis: Patients not responding gland without any aseptic precautions as
to the conservative treatment mentioned in needed in Uttarbasti.
level-1 and level-2 and having the clinical
conditions like recurrent episodes of urinary Kamalanaala Kshara, Kadali Kanda Kshara are
retention recurrent UTI, haematuria and also beneficial.
symptoms of renal failure should further
Pathya-Apathya (Diet and life style
be evaluated for special investigation and
education): Same as level-1
treatment.

152 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

REFERENCES

1 Govind Das Sen, Bhaishajya Ratnavali, 9 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/20 Ashmari Rogadhikar, Adhyaya 36/18-20
edited by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
2 Govind Das Sen, Bhaishajya Ratnavali, 10 Govind Das Sen, Bhaishajya Ratnavali,
Udara Rogadhikar, Adhyaya 40/36 edited Mootraghata Rogadhikar, Adhyaya 35/15
by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993. 1993.
3 Govind Das Sen, Bhaishajya Ratnavali, 11 Sharangadhara, Sharangadhara Samhita
Vatarakta Rogadhikar, Adhyaya 27/10 Madhyama Khand 2/109; Pt. Parashuram
edited by Brahma Shankara Mishra. 11th ed. Shastri Vidyasagar. 1st ed, Chaukhambha
Varanasi: Chaukhambha Sanskrit Sansthan; Surbharati Prakashan, Varanasi 2006
1993
12 Anonymous, The Ayurvedic Formulary
4 Sharangadhara, Sharangadhara Samhita of India, Ministry of Health and Family
Madhyama Khand 4/7; Pt. Parashuram Welfare, Govt. of India, Part I (12 : 10)
Shastri Vidyasagar. 1st ed, Chaukhambha
Surbharati Prakashan, Varanasi 2006 13 Govind Das Sen, Bhaishajya Ratnavali,
Ashmari Rogadhikar, Adhyaya 36/53
5 Astanga Hridaya Rasayana: Comm. By edited by Brahma Shankara Mishra. 11th ed.
Sarvangasundara by Arunadatta and Varanasi: Chaukhambha Sanskrit Sansthan;
Ayurveda Rasayana of Hemadri annotated 1993.
by Dr, Anna Moreswar Kunte and Krishna
Ramachandra Sastri Avre, edited by Pt. Hari 14 Anonymous, The Ayurvedic Formulary
Sadashiva Sastri Paradakara, Chaukhambha of India, Ministry of Health and Family
Surabharati Prakashan, Varanasi. Welfare, Govt. of India, Part I (1 :8)

6 Anonymous, The Ayurvedic Formulary 15 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I ( 5 : 3) Welfare, Govt. of India, Part I (1 : 15)

7 Anonymous, The Ayurvedic Formulary 16 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I ( 5 : 1) Welfare, Govt. of India, Part I (1 : 37)

8 Anonymous, The Ayurvedic Formulary 17 Anonymous, The Ayurvedic Formulary


of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I ( 4:22) Welfare, Govt. of India, Part I (7 : 38)

AYURVEDIC STANDARD TREATMENT GUIDELINES 153


MUTRASHTiLA (BENIGN PROSTATIC HYPERPLASIA)

18 Govind Das Sen, Bhaishajya Ratnavali, 20 Govind Das Sen, Bhaishajya Ratnavali,
Shoola Rogadhikara, Adhyaya 30/40 edited Udavartanaha Rogadhikar, Adhyaya 31/50
by Brahma Shankara Mishra. 11th ed. edited by Brahma Shankara Mishra. 11th ed.
Varanasi: Chaukhambha Sanskrit Sansthan; Varanasi: Chaukhambha Sanskrit Sansthan;
1993 1993.
19 Govind Das Sen, Bhaishajya Ratnavali, 21 Anonymous, The Ayurvedic Formulary
Ashmari Rogadhikar, Adhyaya 36/57-60 of India, Ministry of Health and Family
edited by Brahma Shankara Mishra. 11th ed. Welfare, Govt. of India, Part I (6:9)
Varanasi: Chaukhambha Sanskrit Sansthan;
1993.

154 AYURVEDIC STANDARD TREATMENT GUIDELINES


Artavavaha Srotas Roga
ASRUGDARA (MENO METRORRHGIA)

INTRODUCTION Kaphaja Slimy, pale, thick, with clots, mild


Asrugdara pain, associated with anorexia,
Asrugdara is a disease of excessive and nausea, feeling of heaviness and
prolonged blood loss per vagina during such other symptoms of Kapha.
menstrual and inter menstrual period Sannipataja Presence of the above features
without any palpable pathology. It is one of Asrugdara according to the predominance
the Rakta Pradosaja Vyadhi. Due to excessive of Dosha.
blood loss there may be moderate to severe
anemia associated with loss of appetite, Differential Diagnosis:
fatigue and such other symptoms which may
Asrugdara should be clinically differentiated
hamper the daily activities of women. Severe
from Pittaja Yonivyapad, Yonigranthi, Yoni
blood loss may lead to an emergency.
Arsha, Yoni Arbuda and systemic disorders of
coagulation defect.
Case Definition:

Cyclical bleeding at normal interval; the Table 24.2: Differential diagnosis of Asrigdara
bleeding is either excessive in amount (>80 Pittaja Yonivyapad Excessive bleeding only at
ml) or duration (>5 days) or both. Sometimes the time of menstruation,
there is short cycle (<21 days) with heavy cervical erosion etc

and prolonged menses or acyclic bleeding Asruja Yonivyapad Excessive Bleeding only at
the time of menstruation
from the uterus. All types of Asrugdara are
associated with infertility,
associated with body ache and pain.
feverishness and burning.

Types: Yoni Arsha PV examination / USG


reveals cervical /vaginal
Table 24.1: Types of Asrigdara with their polypoidal growth
characteristics Yoni Arbuda Bleeding on touch, USG /
PV examination reveals
Types Features
tumorous growth.
Vataja Menstrual fluid frothy, thin,
Yoni Granthi Menstrual bleeding in
Asrugdara blackish and may be associated
submucous fibroid.
with severe pain in sacral, groin,
flanks, low back and pelvis.
Line of Treatment
Pittaja Yellowish black in colour,
Asrugdara hot, fishy odor, profuse flow • Nidana Parivarjana should be the
associated with pain, burning first line of treatment.
sensation, thirst, feverish and • Shamana Chikitsa: Deepana,
giddiness.
Raktasamgrahana – Primarily Tikta
ASRUGDARA (MENO METRORRHGIA)

Rasa followed by Kashaya which is LEVEL 1: AT SOLO AYUVEDIC


followed by Madhura. PHYSICIAN’S CLINIC/PHC
• Rasayana Chikitsa for Rasa- Rakta-
Investigations:
Kshaya.
• Blood pressure and Pulse rate to
• Treatment according to Doshik
assess the general condition
involvement
• Urine pregnancy test - To detect
• Treatment prescribed for Raktatisara, pregnancy complications
Raktapitta, Raktarsha
Treatment: In the initial stage of the disease,
• Treatment prescribed for Adhoga drugs mentioned in the following table may
Raktapitta be given as per need.

Table 24.3: Medicines at level 1 for Asrigdara

Drugs Dosage Dose Time of Duration Anupana


form administration
Nagakesara, Lodhra, Churna 3-6 gm After meal / 2-3 month Water
Shunthi, Mocharasa twice a day
Amalaki Churna1 Churna 3-6 gm After meal / 2-3 month Water
twice a day
Lodhra Churna2 Churna 3-5 gm After meal / 2-3 month Tandulodaka
twice a day
Yastimadhu Churna3 Churna 2-4 gm After meal / 2-3 month Milk / water
twice a day
Shuddha Sphatika4 Churna 125-250 mg After meal / 2-3 weeks Water
twice a day
Ashoka Siddha Kshira 20 ml Empty stomach / 2-3 month -
Kshirapaka5 Paka morning & evening
Kamadudha Rasa6 Vati / 125-500 mg After meal / 2-3 month Sita / Ghrita
Churna twice a day
Ashokarishta7 Arishta 12-24 ml After meal / 2-3 month Equal amount
twice a day of water

Pathya - Apathya (Diet and life style bitter, sweet or astringent in taste,
education): milk, wheat, seasoned rice, green
gram, bitter guard, bottle gourd,
Do’s -
cucumber, beet root, pomegranate,
• Ahara: Shadangapaneeya, Tanduloda- grapes etc. Yusha, Yavagu mixed
ka, Laja / Lajamanda, food articles of with Ghrita, Madhura Aushadhi

158 AYURVEDIC STANDARD TREATMENT GUIDELINES


ASRUGDARA (MENO METRORRHGIA)

Siddha Ghrita and meat soup. Pa- • Chronic patients with complications
tient should have freshly prepared like moderate to severe Anaemia,
food only. Stale and re-heated food severe Dysmenorrhoea, irregular
should not be taken at all. bleeding per vagina.
• Vihara: Maintain local hygiene,
take rest. LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts - FACILITIES
• Ahara: Articles made with Maida,
sour curd, bakery items like bread, Clinical diagnosis: Same as level 1: for a
biscuits, fermented food, spicy fresh case reporting directly.
and salty food, fried food, pickles, However, at this level, persistence of
Kshara etc. symptoms along with moderate to severe
• Vihara: Avoid day sleeping, excess anaemia, mild to moderate fever due to pelvic
exposure to heat, sexual intercourse, infections etc. should also be considered.
night awaking, suppression of Investigation: Additional to the examina-
natural urges, strenuous physical tions described in Level 1 following investi-
exercise, excess of fasting, fear, grief gations also may be carried out.
and anger.
• CBC and PBS
Referral criteria: • BT, CT
• If the vitals are not stable.
• Ultrasonography
• If the blood loss is severe
Treatment: In addition to the management
• Patients not responding to level 1 mentioned in Level 1, the following drugs
management may also be tried out.

Table 24.4: Medicines at level 2 for Asrigdara

Drugs Dosage Dose Time of Duration Anupana


Form administration
Pushyanuga Churna 3-5 gm After meal / 2-3 months Madhu /
Churna8 thrice a day Tandulodaka
Bola Parpati9 Vati 125-250 mg Morning and 1 month Sharkara, Ghrita,
evening Madhu
Panchavalkala Kwatha 60 ml Morning 1-3 months Sharkara
Kwatha
Shatavari Ghrita Ghrita 15 ml Morning 1 month -

AYURVEDIC STANDARD TREATMENT GUIDELINES 159


ASRUGDARA (MENO METRORRHGIA)

Pathya - Apathya (Diet and life style bleeding per vagina with other systemic
education): Same as level 1. diseases like diabetes, obesity, hypertension,
severe anemia etc. should also be considered
Referral criteria: Investigation: All investigations mentioned
• Patients not responding to two to in Level 2. In addition to that the following
three cycles of treatment investigations also may be carried out.

• Severe Anemia • Endometrial biopsy to find out


malignancy
• Detection of any pelvic pathology
• Hormonal assay like S. TSH, S. T3,
T4
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL • Fasting blood sugar, Post prandial
LEVEL OR DISTRICT blood sugar
HOSPITAL / INTEGRATED • Saline infusion sonography to find
AYURVEDIC HOSPITALS out endometrial polyp

Clinical diagnosis: Same as level 1 for a Treatment: In addition to the management


fresh case reporting directly. Persistence of Level 1 and Level 2, following medicines
of symptoms, post-menopausal bleeding, could be prescribed:

Table 24.5: Medicines at level 3 for Asrigdara

Drugs Dosage Dose Time of Duration Anupana


Form administration

Shonitargala Vati / 2 Vati After meal / 2-3 month Water /


Rasa10 Churna (125-500 mg) twice a day Tandulodaka

Trunakanata Mani Pishti 250 mg Morning and 1-2 months Ghrita


Pishti Evening

Dhatri Lauha Vati 500 mg Morning and 2-3 months Guda Ghrita
evening

Tapyadi Lauha Vati 500 mg Morning and 2-3 months Guda Ghrita
evening

Bahushala Guda Avaleha 30 gm Before meals 1-2 months Water

Patients with other systemic diseases can be Pathya - Apathya (Diet and life style
referred to their respective departments. education): Same as level 1.

160 AYURVEDIC STANDARD TREATMENT GUIDELINES


ASRUGDARA (MENO METRORRHGIA)

REFERENCES

1. The Ayurvedic Pharmacopoeia Of India, of India, Ministry of Health and Family


Part 1, Volume 1, Ed 1st, Government of Welfare, Department of I.S.M. & H., New
India, Ministry of health and family welfare, Delhi, 2003, pg. 234.
Department of AYUSH, pg. 8. 7. Anonymous, The Ayurvedic Formulary
2. The Ayurvedic Pharmacopoeia Of India, of India, Part 1, Volume 1, Ed. 2nd, Govt.
Part 1, Volume 1, Ed 1st, Government of of India, Ministry of Health and Family
India, Ministry of health and family welfare, Welfare, Department of I.S.M. & H., New
Department of AYUSH, pg. 113. Delhi, 2003, pg. 8.
3. The Ayurvedic Pharmacopoeia Of India, 8. Anonymous, The Ayurvedic Formulary
Part 1, Volume 1, Ed 1st, Government of of India, Part 1, Volume 1, Ed. 2nd, Govt.
India, Ministry of health and family welfare, of India, Ministry of Health and Family
Department of AYUSH, pg. 169. Welfare, Department of I.S.M. & H., New
4. Shuddha Sphatika, Ayurved Prakasha, Delhi, 2003, pg. 113.
pg. 257-258. 9. Anonymous, The Ayurvedic Formulary
5. The Ayurvedic Pharmacopoeia Of India, of India, Part 1, Volume 1, Ed. 2nd, Govt.
Part 1, Volume 1, Ed 1st, Government of of India, Ministry of Health and Family
India, Ministry of health and family welfare, Welfare, Department of I.S.M. & H., New
Department of AYUSH, pg. 18. Delhi, 2003, pg. 217.

6. Anonymous, The Ayurvedic Formulary 10. Rasatantrasara, Siddhaprayoga Sangraha,


of India, Part 1, Volume 2, Ed. 2nd, Govt. Volume 2, pg. 531.

AYURVEDIC STANDARD TREATMENT GUIDELINES 161


KASHTARTAVA (DYSMENORRHOEA)

5) Paripluta Yoni Vyapad: continuous pain


INTRODUCTION
for the entire duration of menstrual
Menstruation associated with pain is a period associated with dysperunea.
common problem in females of reproductive 6) Vataja Rajo Vriddhi: Bheda (cutting
age. Kashtartava (Dysmenorrhoea) is a Pain) [vitiated Ruksha and Khara Guna]
cardinal symptom in Udavarta Yoni Vyapad. associated with increase in menstrual
It can be caused either by Margavarodha flow
(obstruction) or Ksheenata (depletion) of Raja.
7) Raja Ksheenata: Bheda (cutting Pain)
[vitiated Ruksha and Khara Guna]
Case Definition:
associated with decrease in menstrual
Chronic, cyclic pain or discomfort in the flow
pelvic region during menstrual period.
8) Generalized disease conditions like:
Pandu, Shosha, Rajayakshma
Differential diagnosis:

1) Vatala Yoni Vyapada: menstruation with Line of Treatment


Toda (pricking pain) [vitiated Ruksha Aggravated Vata due to either obstruction or
Guna], Stambha (stiffness) [vitiated Sheeta depletion is the main cause for the Kashtartava,
Guna] along with other Vataja Lakshanas. therefore, the treatment is directed either to
2) Suchimukhi Yoni Vyapad: Margavarodha remove the obstruction by medical / surgical
Janya Vata Prakopa causing severe measures or to replenish the Dhatus.
pain with structural abnormalities Following are the principles:
which may need dilation or invasive
• To reduce pain – pain relieving
procedures.
medications
3) Udavarta Yoni Vyapad: severe pain at
• To treat dryness and roughness –
the beginning of menstruation and
Oily preparations for external and
immediate relief of pain following
internal use Vatanulomana – mild
discharge of menstrual blood is the
laxatives and Basti
characteristic symptom
• To remove structural obstruction
4) Antarmukhi Yoni Vyapad: Margavarodha
by surgical intervention
Janya Vata Prakopa due to acute
anteversion or retroversion of Uterus • To remove functional obstruction –
causing severe pain and relieved by Fomentations, Shodhana (purifying
discharge of menstrual fluid. measures)
KASHTARTAVA (DYSMENORRHOEA)

• Dhatupurana – Nourishing, General in nature, confined to lower abdomen and


tonics and Dhatu Vriddhikara may radiate to back and medial aspect of
medication thighs gradually and sometimes associated
with nausea, diarrhoea or constipation,
dizziness, fatigue and headache.
LEVEL 1: AT SOLO AYUVEDIC
PHYSICIAN’S CLINIC/PHC Investigation: Hb gm% to rule out anemia

Clinical diagnosis: Painful menstruation; Treatment: During the initial phase of the
pain begins just few hours before disease, one or more drugs from the table can
menstruation. The pain is spasmodic or dull be selected as per the status of the patient.

Table 25.1: Medicines at level 1 for Kashtaartava

Drugs Dosage Dose Time of Duration Anupana


form administration
Eranda Taila Oil 10-25 ml Stat Stat Shunthi Kwatha
Eranda Bhrishta Powder 3-6 gm Before meal/ Eight days Luke warm
Haritaki1 (4 gm twice a day before the water
with Shunthi-1- scheduled start
2gm)* of menstruation
Hingvadi Powder 2-4 gm Before meal/ During Luke warm
Churna2** twice daily Menstruation water/
till pain subside buttermilk
Shankha Vati3 Tablet 1 tab 250- After meal/ During Luke warm
500 mg thrice daily Menstruation water/
till pain subside buttermilk/
honey
Hingvadi Tablet 250-500mg After meal/ twice During Luke warm
Gutika4 daily Menstruation water
till pain subside
Chaturbeeja5 Powder 2- 3 gm Morning and For 2-3 month Luke warm
Churna evening empty water /
stomach, if H/o buttermilk
gastritis take after
meal for 10 days
(starting from
7 days before
commencement
of menses till
3rd day of the
bleeding phase)

AYURVEDIC STANDARD TREATMENT GUIDELINES 163


KASHTARTAVA (DYSMENORRHOEA)

Dashamoola Decoction 30-40 ml Morning and 2-3 days


Kwatha with evening empty
Tila oil stomach
Milk Medicated 20 ml Morning and 2-3 days -
medicated milk evening empty
with stomach
Dashamoola6
Abhayarishta7 Arishta - 12-24 ml After meal/ twice 2-3 month With equal
liquid daily amount of
water
* For Anulomana of Apana Vayu
** For relieving of pain

Local treatment: Massage of the lower cardamom, ginger and mustard


abdomen with warm Tila Taila/ Sarshapa Taila seeds, meat soup, and chicken.
/ Narayana Taila for 10 to 15 minutes, followed • Vihara: Bath with warm water,
by application of hot fomentation (such Fomentation with hot water/
as a hot water bag). Advice to put vaginal decoction of Dashamoola or heating
tampon (Yonipichu) of Luke warm Tila Taila pad on lower abdomen and low
or Hingvadi Taila at least for 7 days at night back. Take sufficient physical and
before menstruation in married women. mental rest. Yogasana like Bhadrasana,
Bhujangasana and Shalabhasana and
Pathya-Apathya (Diet and life style Pranayama regularly.
education):
Don’ts
Do’s (Pathya) • Ahara: Food items causing abdomi-
• Ahara: Unctuous & warm, sweet, nal distention and constipation such
sour, salty substances, dairy as: Chick-peas, excess consumption
products like milk, buttermilk of legumes, raw vegetables, Maida
etc., rice & wheat., soup made and other food items heavy for di-
of ghee, rice and Mung Daal, gestion, cold food items, etc.
Sugarcane, Sugarcane products • Vihara: Cold water bath, Exposure
and honey. Oils- especially, to cold weather or air, Dry
sesame, peanut, mustard, fruits massage (Udavartana), Day sleep
like grapes, papaya etc. Vegetables (Divaswapna), Night awaking,
like radish, drumstick etc. Foods Excessive walking, Excessive
may be garnished with spices like exercises, and Suppression of
cumin, asafetida, black pepper, natural urges like Mutra, Purisha
cloves, coriander, mint, cinnamon, and Adhovata etc.

164 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASHTARTAVA (DYSMENORRHOEA)

Referral criteria: Patients not responding discomfort starting before a few days of
to level 1 management should be referred to menses etc. should be considered.
higher centre.
Investigation: Same as Level 1. In addition
to that, the following investigations may also
LEVEL 2: CHC’S OR SMALL be carried out.
HOSPITALS WITH BASIC
FACILITIES • Ultrasonography to detect pelvic
pathology
Clinical diagnosis: Same as level 1: For a
fresh case reporting directly. • CBC, ESR,

Patients having symptoms like dull lower Treatment: In addition to the drugs men-
abdominal pain situated in back and front tioned in Level 1, the following drugs may
without any radiation; lower abdominal also be given.

Table 25.2: Medicines at level 2 for Kashtaartava

Drugs Dosage Dose Time of Duration Anupana


Form administration

Devadarvyadi Decoction 30-40 ml Morning and 2-3 days -


Kwatha8 evening empty
stomach

Rajahpravartani Tablet 1-2 tablet After meal / twice From Luke warm
Vati9 of 250 mg daily 15thday of water / Tila
the cycle Kashaya /
till onset of Kulatta Kashaya
menses

Yogaraja Guggulu Vati 2-4 tab of After meal / twice 7days Luke warm
250 mg daily water /
Dashamula
Kwatha

Mahanarayana oil 10-20ml Stat Stat Warm water


Taila10

Basti (one of the Panchakarma procedures), Vata Dosha. Basti should be administered
in which medicated oils and decoction are during inter menstrual period.
administered as enema, is regarded as the Basti is given as per cited in classics with
best procedure to treat diseases caused by following Niruha and Anuvasana Basti

AYURVEDIC STANDARD TREATMENT GUIDELINES 165


KASHTARTAVA (DYSMENORRHOEA)

Table 25.3: Basti Dravyas at level 2 for Kashtaartava

Matra Basti Niruha Basti Kshira Basti

Dashamoola Taila11 Palashadi Niruha Basti12 Dashamoola Kshira13

Trivrita Taila14 – –

Tila Taila15 – –

Mahanarayana Taila16 – –

Pathya-apathya (Diet and life style Investigations: All investigations mentioned


education): Same as level 1 in Level 1 & Level 2. In addition to that the
following investigations also may be carried
Referral criteria: out.

• Patients not responding to two to • Urinalysis: To detect urinary tract


three cycles of treatment infection
• Stool test: To detect GI bleeding
• Detection of pelvic pathology
• Hysteroscopy and saline
• Associated complaints like fever,
Sonohysterography: To rule out
scanty menses or heavy periods
endometrial polyps and sub
• Other systemic diseases like mucosal leiomyomas
appendicitis, colitis, cystitis etc. • MRI (Magnetic Resonance Imaging):
Best for diagnosis of congenital
uterine anomalies. To diagnose
LEVEL 3: AYURVEDA
fibroids and to differentiate it from
HOSPITALS AT INSTITUTIONAL
ovarian mass or pregnancy
LEVEL OR DISTRICT
HOSPITAL/ INTEGRATED • Intravenous pyelogram: Intrave-
AYURVEDIC HOSPITALS nous pyelogram is indicated if uter-
ine malformation is confirmed as a
cause or contributing factor for the
Clinical diagnosis: Same as level 1: For a
dysmenorrhoea
fresh case reporting directly.
• Endometrial biopsy: To detect
Persistence of symptoms with associated endometritis
complaints like fever, scanty menses or
• Laparoscopy: To reach into the
heavy periods or other systematic diseases
definite diagnosis of endometriosis,
like appendicitis, colitis, cystitis etc. should
pelvic inflammatory disease, or
also be considered.
pelvic adhesions

166 AYURVEDIC STANDARD TREATMENT GUIDELINES


KASHTARTAVA (DYSMENORRHOEA)

Treatment: In addition to the management of In Kashtartava with heavy bleeding,


Level 1 and 2, following management should following medicines can be given as per
be done as per associated complaints. complaints.

Table 25.4: Medicines at level 3 for Kashtaartava with heavy bleeding

Drugs Dosage Dose Time of administration Duration Anupana


Form
Pradarari Lauha17 Tablet 2 tablets Morning and evening 2-3 month Milk or
(250 mg) after meal water
Patrangasva Asava 30-40 ml Morning and evening 2-3 month water
liquid after meal
Khadirarishtha Arishtha 30-40 ml Morning and evening 2-3 month water
liquid after meal
Pathadi Kwatha Decoction 30-40 ml Morning and evening 2-3 month water
after meal

In Kashtartava with Scanty bleeding, following medicines can be given as per complaints.

Table 25.5: Medicines at level 3 for Kashtaartava with scanty bleeding

Drugs Dosage Dose Time of administration Duration Anupana


Form
Kumaryasava Asava 30-40 ml Morning and evening 2-3 month Water
liquid after meal
Karpasamulasava Asava 30-40 ml Morning and evening 2-3 month Water
liquid after meal
Shatapushpa Kwatha Decoction 30-40 ml Morning and evening 2-3 month water
after meal

Pathya-apathya (Diet and life style education): Same as level 1

REFERENCES

1 The Ayurvedic Pharmacopoeia Of India, Welfare, Department of I.S.M. & H., New
Part 1, Volume 1, Ed 1st, Government of Delhi, 2003:118
India, Ministry of health and family welfare, 3 Anonymous, The Ayurvedic Formulary
Department of AYUSH:63 of India, Part 1, Volume 1, Ed. 2nd, Govt.
2 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Part 1, Volume 1, Ed. 2nd, Govt. Welfare, Department of I.S.M. & H., New
of India, Ministry of Health and Family Delhi, 2003:194

AYURVEDIC STANDARD TREATMENT GUIDELINES 167


KASHTARTAVA (DYSMENORRHOEA)

4 Kaviraj Shri Ambikadatta Shastri, 11 Anonymous, The Ayurvedic Formulary


Bhaishajya Ratnaavali, Chikitsasthana of India, Part 1, Volume 2, Ed. 2nd, Govt.
30/19, Chaukambha Sanskrit Sansthan, 446 of India, Ministry of Health and Family
5 The Ayurvedic Pharmacopoeia of India, Welfare, Department of I.S.M. & H., New
Part 1, Volume 1, Ed 1st, Government of Delhi, 2003:143
India, Ministry of health and family welfare, 12 Acharya Jadavaji Trikamji, Charaka
Department of AYUSH: 38, API Volume Samhita, Chakrapanidatta, Siddhisthana
2,114 3/44-45, Ayurveda Dipika commentary,
6 Anonymous, The Ayurvedic Formulary Chaukhamba Prakashan: 2008:696
of India, Part 1, Volume 1, Ed. 2nd, Govt. 13 Acharya Jadavaji Trikamji, Charaka
of India, Ministry of Health and Family Samhita, Chakrapanidatta, Chikitsasthana
Welfare, Department of I.S.M. & H., New 30/110-111, Ayurveda Dipika, commentary,
Delhi, 2003:55 Chaukhamba Prakashan:2008:639
7 Anonymous, The Ayurvedic Formulary
14 Acharya Jadavaji Trikamji, Charaka
of India, Part 1, Volume 1, Ed. 2nd, Govt.
Samhita, Chakrapanidatta, Chikitsasthana
of India, Ministry of Health and Family
30/110-111, Ayurveda Dipika, commentary,
Welfare, Department of I.S.M. & H., New
Chaukhamba Prakashan: 2008:639
Delhi, 2003:6
15 Bhavprakash of Sri Bhavmisra, Commentary
8 Anonymous, The Ayurvedic Formulary
by Shri Brahmasankara Mishra and Shri
of India, Part 1, Volume 1, Ed. 2nd, Govt.
Rupalalaji Vaishya, Taila varga, 2-7, 10th
of India, Ministry of Health and Family
edition, Chaukhambha Publications,
Welfare, Department of I.S.M. & H., New
Varansi, 2002.
Delhi, 2003: 74
16 Anonymous, The Ayurvedic Formulary
9 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt.
of India, Part 1, Volume 1, Ed. 2nd, Govt.
of India, Ministry of Health and Family
of India, Ministry of Health and Family
Welfare, Department of I.S.M. & H., New
Welfare, Department of I.S.M. & H., New
Delhi, 2003:149
Delhi, 2003:192
10 Anonymous, The Ayurvedic Formulary 17 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt. of India, Part 1, Volume 1, Ed. 2nd, Govt.
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Department of I.S.M. & H., New Welfare, Department of I.S.M. & H., New
Delhi, 2003:149 Delhi, 2003:285

168 AYURVEDIC STANDARD TREATMENT GUIDELINES


SHWETA SRAVA (LEUCORRHOEA)

cervix and cervical erosion or only


INTRODUCTION
cervix erosion
Leucorrhoea means an excessive amount of • Atyananda Yonivyapada (Achara-
white discharge from vagina due to inflam- na / Vipluta): White discharge with
mation or infections of lower genital tract, severe itching due to unhygienic
causing discomfort. This is a condition of condition
vitiated Kapha and Rasa Dhatu. The discharge
could be of thin watery, purulent, slimy, • Yoni Arsha: Foul smell reddish
sticky, frothy with foul smell and curdy white discharge, on examination
white depending upon vitiation of Dosha. reveals presence of Yoni Arsha
with bulky uterus with polypodial
Case Definition: growth
The excess secretion is evident from General disease conditions like anemia,
persistent vulval moistness or staining diabetes mellitus, etc.
of the undergarments or need to wear a
sanitary pad. Non–infective discharge is
LEVEL 1: AT SOLO AYUVEDIC
non-purulent, non-offensive, non-irritant
PHYSICIAN’S CLINIC/PHC
and never leads to pruritus vulva. Infective
discharge is purulent, offensive, and irritant Clinical diagnosis: Thin whitish watery,
associated with itching. odourless discharge from the vagina.
General condition of patient may reveal ill
Differential diagnosis:
health.
Disease conditions having Shweta Srava:
Investigation: proper clinical examination
• Kaphaja Yonivyapad: Yellowish
white thick mucoid discharge Treatment:
associated with severe itching • Eradication of the cause/local
• Upapulta Yonivyapad: Whitish hygiene etc.
mucoid vaginal discharge with
• Kaphaghana medicines
pricking pain in vagina
• Local applications in the form of
• Sannipatika Yonivyapad
Dhavana, Varti, Picchu, Dhupana
• Rakta Gulma: Foul smelling muco-
purulent discharge associated with • Kshara, Agni Karma
amenorrhoea and uterine growth In the initial stage of the disease, drugs
• Karnini Yonivyapada: White dis- mentioned in the following table may be
charge associated with oedematous given as per need.
SHWETA SRAVA (LEUCORRHOEA)

Table 26.1: Medicines at level 1 for Shweta Pradara


Drugs Dosage Dose Time of Duration Anupana
form administration
Sphatika Bhasma with Churna 500 mg Twice/thrice daily 1 week Water
Shuddha Gandhaka
Amalaki Churna1 Churna 3-6 g After meal/ twice 2-3 months Honey/sugar/
daily water
Lodhra Churna2 Churna 3-5 gm After meal/ thrice 2-3 months Tandulodaka
daily
Chopachini Churna3 Churna 2-3 gm After meal/ twice 2-3 months Water
daily
Darvyadi Kwatha4 Decoction 30-40 ml Empty stomach 2-3 months -
twice daily
Pradarari Lauha5 Tablet 1-2 Vati After meal/ twice 2-3 months -
daily
Chandraprabha Vati6 Tablet 2 Vati After meal/ twice 2-3 months Water/ milk
daily

Local treatment: Douche with Sphatika Jala / general disease condition such as to
Triphala Kwatha / Panchavalkala Kwatha / avoid sweets etc. in diabetics, stale
Nimba Patra Kwatha - twice a day for 5-7 days. food etc.
Pichu with Dhatkyadi Taila / Karanja Taila / • Vihara: Over eating, intercourse,
Neem Taila. day sleeping, mental stress, sup-
pression of natural urges, use of
Pathya-Apathya (diet and life style synthetic under garments
education):
Referral criteria:
Do’s (Pathya) • Patients not responding to level 1
• Ahara: Fresh vegetables, fruits, management
milk, Mudga / Mamsa Rasa Yusha • Chronic patients
and easily digestible food. Patient • Symptoms like purulent, offensive
should take freshly prepared food irritant blood stained discharge
only. with mild to severe pruritus vulva
• Vihara: Maintain local hygiene,
celibacy, LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts: FACILITIES
• Ahara: Dietary restrictions may Clinical diagnosis: Same as level 1: For a
be followed as per the prevailing fresh case reporting directly.

170 AYURVEDIC STANDARD TREATMENT GUIDELINES


SHWETA SRAVA (LEUCORRHOEA)

Examination: Per speculum and per vaginal • Pap smear - To detect pelvic
examination should be done to find out infection
vaginitis or cervical pathology. • VDRL, HIV - To detect sexually
Investigation: Following investigations may transmitting diseases
be carried out: • USG to rule out growth
• Heamogram Treatment: Drugs for external or local
• BSL use

Table 26.2: Medicines used for Yoni Prakshalana in Shweta Pradara

Drugs Dosage Dose Time of administration Duration


Form
Nyagrodhadi Kwatha7 Decoction 400 to Twice daily 8 to 10 days after
500 ml morning & evening menstruation
(48 gm)
Panchavalkala Kwatha8 Decoction 400 to Twice daily 8 to 10 days after
500 ml morning & evening menstruation
Nimba Patra Kwatha9 Decoction 500 ml Twice daily 8 to 10 days after
morning & evening menstruation
Triphala Kwatha with Decoction 400 to Twice daily 8 to 10 days after
Takra or cow’s urine, 500 ml morning & evening menstruation
Sphatika Churna
Guduchi, Triphala and Decoction 400 to Twice daily 8 to 10 days after
Danti Kwatha 500 ml morning & evening menstruation
Chandana Kwatha/ Decoction 400 to Twice daily 8 to 10 days after
Lodhra Kwatha 500 ml morning & evening menstruation
Pushyanuga Churna10 Churna 3-5 gm After meal/ thrice daily 2-3 months

Table 26.3: Medicines used as Yoni Varti in Shweta Pradara

Drugs Dosage Dose Time of administration Duration


Form
Varti of fine powder Varti 5 gm At night 8 to 10 days after
of Lodhra, Yashtimadhu menstruation
and Madhu
Varti of fine powder Varti 5 gm At night 8 to 10 days after
of Nimba, Triphala, menstruation
Sphatika and Madhu

The above mentioned suppositories can be prepared locally in any hospital

AYURVEDIC STANDARD TREATMENT GUIDELINES 171


SHWETA SRAVA (LEUCORRHOEA)

Table 26.4: Medicines used as Yoni Pichu in Shweta Pradara

Drugs Dosage Dose Time of Duration


Form administration
Dhatakyadi Taila Oil 5 ml Twice daily 8 to 10 days after
menstruation
Nyagrodha Kashaya Pichu Decoction 5 ml Twice daily 8 to 10 days after
menstruation
Karanja Taila Oil 5 ml Twice daily 8 to 10 days after
menstruation
Jatyadi Taila11 Oil 5 ml Twice daily 8 to 10 days after
menstruation

Table 26.5: Medicines used for Yoni Dhupan in Shweta Pradara

Drugs Dose Time of Duration


administration
Dhupana of Sarala, Guggulu and Yava with Ghruta 5 gm Twice daily 1-2 week

Haridra and Daruharidra 5 gm Twice daily 1-2 week

Oral Medications – All drugs mentioned in Level 1. In addition to that the following drugs
may also be tried.

Table 26.6: Medicines at level 2 for Shweta Pradara

Drugs Dosage Dose Time of Duration Anupana


Form administration
Triphala Guggulu Vati 2 - 3 Vati After meal/ twice 2-3 Water/milk/Ushira
daily months Kashaya
Kaishora Guggulu12 Vati 2 – 3 Vati After meal/ twice 2-3 Water/milk
daily months

Pathya-apathya (diet and life style • Presence of pre malignant or


education): Same as level 1 malignant changes in PAP
smear
Referral criteria:
• Blood stained vaginal discharge
• Patients not responding the above
treatment

172 AYURVEDIC STANDARD TREATMENT GUIDELINES


SHWETA SRAVA (LEUCORRHOEA)

• Colposcopy
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL • Punch biopsy or Cone biopsy
LEVEL OR DISTRICT (Cervix) or endometrial Biopsy to
HOSPITAL/ INTEGRATED rule out cervical malignancy.
AYURVEDIC HOSPITALS Treatment: In addition to the treatment
mentioned in levels 1 & 2, following therapies
Clinical diagnosis: Same as level 1: For a
can be performed in Level 3 with due care.
fresh case reporting directly
• Local Agni Karma (cauterization) in
Investigation: In addition to the investiga-
premalignant lesions of cervix
tions mentioned at Level 2, following inves-
tigations may also be carried out. • Kshara Karma
• Microscopic examination of vaginal In case of suspected malignancy, patient
discharge (wet vaginal smear test) must be referred for advanced management.
• Fungal and aerobic culture of Pathya-Apathya (Diet and life style
vaginal discharge education): Same as level 1

REFERENCES

1 Anonymous, The Ayurvedic Pharmaco- 5 Anonymous, The Ayurvedic Formulary of


poeia of India, Part 1, Vol. 1, Ed. 1st, Gov- India, Part 1, Vol. 1, Ed. 2nd, Govt. of India,
ernment of India, Ministry of Health and Ministry of Health and Family Welfare,
Family Welfare, Department of AYUSH:7 Department of I.S.M. & H., New Delhi,
2 Anonymous, The Ayurvedic Pharmaco- 2003:285
poeia of India, Part 1, Vol. 1, Ed. 1st, Gov- 6 Anonymous, The Ayurvedic Formulary of
ernment of India, Ministry of Health and India, Part 1, Vol. 1, Ed. 2nd, Govt. of India,
Family Welfare, Department of AYUSH:112 Ministry of Health and Family Welfare,
3 Anonymous, The Ayurvedic Formulary of Department of I.S.M. & H., New Delhi,
India, Part 1, Vol. 1, Ed. 2nd, Govt. of India, 2003:185
Ministry of Health and Family Welfare, 7 Anonymous, The Ayurvedic Formulary of
Department of I.S.M. & H., New Delhi, 2003 India, Part 1, Vol. 1, Ed. 2nd, Govt. of India,
4 Anonymous, The Ayurvedic Formulary of Ministry of Health and Family Welfare,
India, Part 1, Vol. 1, Ed. 2nd, Govt. of India, Department of I.S.M. & H., New Delhi,
Ministry of Health and Family Welfare, 2003:57
Department of I.S.M. & H., New Delhi, 8 Anonymous, Anonymous, The Ayurvedic
2003:73 Formulary of India, Part 1, Vol. 1, Ed. 2nd,

AYURVEDIC STANDARD TREATMENT GUIDELINES 173


SHWETA SRAVA (LEUCORRHOEA)

Govt. of India, Ministry of Health and Welfare, Department of I.S.M. & H., New
Family Welfare, Department of I.S.M. & H., Delhi, 2003:113
New Delhi, 2003 11 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt.
9 Anonymous, The Ayurvedic Pharmaco-
of India, Ministry of Health and Family
poeia of India, Part 1, Vol. 1, Ed. 1st, Gov-
Welfare, Department of I.S.M. & H., New
ernment of India, Ministry of Health and
Delhi, 2003:135
Family Welfare, Department of AYUSH:
131 12 Anonymous, The Ayurvedic Formulary
of India, Part 1, Volume 1, Ed. 2nd, Govt.
10 Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family
of India, Part 1, Volume 1, Ed. 2nd, Govt. Welfare, Department of I.S.M. & H., New
of India, Ministry of Health and Family Delhi, 2003:67

174 AYURVEDIC STANDARD TREATMENT GUIDELINES


Vata Vyadhi
AVABAHUKA (FROZEN SHOULDER)

Line of Management
INTRODUCTION
• Nidana Parivarjana should be the
Avabahuka is a Vatavyadhi caused by vitiation
first line of treatment.
of Vata at ‘Amsamoola’ (shoulder) leading to
restriction of shoulder movement. Amsashosha • Shodhana Chikitsa - Nasya
(wasting around the muscles of shoulder • Shamana Chikitsa - Pachana, Deepana,
joint) is a typical feature of Avabahuka in long Snehana, Swedana,
run. Patient experiences difficulty in lifting
• External applications - Lepa,
the shoulder with or without pain. Clinical
Upanaha
conditions like frozen shoulder, brachial
neuralgia etc. are similar with Avabahuka. • Rasayana Chikitsa for Mamsadhatu
• Treatment according to Doshik
Case definition:
involvement
Restricted shoulder movement and difficulty • General line of treatment prescribed
in lifting the arm associated with or without for Vatavyadhi
pain, begins gradually and worsen over time
leading to atrophy in shoulder muscles is
defined as Avabahuka. LEVEL 1: AT SOLO AYURVEDA
PHYSICIAN’S CLINIC/PHC
Differential Diagnosis:
Clinical diagnosis: On the basis of history
a. Manyasthambha and clinical presentation
b. Viswachi
Investigations: Nil
c. Amavata and such other diseases of
Shoulder joint – Treatment: See table 27.1

Table 27.1: Medicines at level 1 for Avabahuka

Drugs Dosage Dose Time of Duration Anupana


Form administration
Aswagandha Churna 3-5 gm Twice a day 2-4 weeks Luke warm
Churna water
Bala Churna Churna 3-5 gm Twice a day 2-4 weeks Luke warm
water
AVABAHUKA (FROZEN SHOULDER)

Rasna Churna Churna 3-5 gm Twice a day 2-4 weeks Luke warm
water

Chopchini Churna 2-5 gm Twice a day 2-4 weeks Sugar – 3 gm

Dashamoola Kwatha 10-15 ml Empty stomach / 6 2-4 weeks Luke warm


Kashaya am & 6 pm water

Yogaraja Vati 1-2 tab Twice day 2-4 weeks With warm
Guggulu1 water

Anutaila Taila 1 ml 4-5 times as 2 weeks -


Pratimarsha Nasya

Karpasasthydi Taila 1 ml 4-5 times as 2 weeks -


Taila Pratimarsha Nasya

3-5 ml 1-2 times for oral 2 weeks -


administration

Pathya - Apathya (Diet and life


style): LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Do’s - FACILITIES

• Ahara: Nourishing food, milk Clinical Diagnosis: Same as level 1 for a


porridge, Shali, Shashtik, Kulattha, fresh case reporting directly.
Udada (black gram), Shigru Investigation: Same as level 1, in addition
(drumstick), brinjal etc.
• Random blood sugar to rule out
• Vihara: Shoulder exercises Diabetes Mellitus.
• Rheumatoid factor (RA Factor) -
Dont’s - Qualitative (present / absent) and
quantitative (<15 IU/ml) to rule out
• Ahara: Kalaya (Lathyrus odoratus),
RA shoulder.
Sheetambu (cold water).
• X - ray of shoulder / cervical spine
• Vihara: Nothing specific
Treatment: In addition to the Shamana
Referral criteria: Cases not responding to management mentioned in Level 1, few of
above line of treatment. the following drugs may be added -

178 AYURVEDIC STANDARD TREATMENT GUIDELINES


AVABAHUKA (FROZEN SHOULDER)

Table 27.2: Medicines at level 2 for Avabahuka

Drug Dosage Dose Time of Administration Anupana


Form
Ksheerabala 101 Avarthi Taila 15 drops Twice a day for 2-4 weeks / -
before food
Guggulu Tiktakam Kwatha 12-24 ml Twice a day for 2-4 weeks / -
Kwatha empty stomach
Prasaranyadi Kashaya Kwatha 12-24 ml Twice a day for 2-4 weeks / Later milk
empty stomach porridge
Maharasnadi Kwatha2 Kwatha 12-24 ml Twice a day for 2-4 weeks / Shunthi Churna /
empty stomach Pippali Churna /
Yogaraja Guggulu /
Eranda Taila
Vidaryadi Kwatha3 Kwatha 12-24 ml Twice a day for 2-4 weeks / -
empty stomach
Dhanwantharam Kwatha Kwatha 12-24 ml Twice a day for 2-4 weeks / Dhanwantharam
empty stomach tablet
Guggulu Tiktaka Ghrita4 Ghee 15-30 ml Once or Twice a day for 2-4 Before food on
weeks appetite
Aswagandharishta5 Arishta 10-20 ml Twice a day for 2-4 weeks After food
Balarishta6 Arishta 10-20 ml Twice a day for 2-4 weeks After food
Nirgundi Taila Taila For External Application
Vishagarbha Taila7 Taila For External Application
Vatagajankusha Rasa8 Churna 60-125 mg Twice a day Madhu
Vatavidhwamsana Rasa9 Churna 60-125 mg Twice a day Madhu

Prasarini Taila10 Taila 10-15 Once or twice a With Prasaranyadi Kashaya


drops day / before meals
Karpasasthydi Tail11 / Taila Taila for head and external application. Kuzhambu for external
Kuzhampu, application only
Parinatha Keryadi Taila Taila External application

Local Abhyanga and Nadi Sweda, Snigdha Pathya - Apathya (Diet and life style): Same
Churna Pinda Sweda, Patrapinda Sweda, as level 1
Jambeera Pinda Sweda and Shashtika Pinda
Referral Criteria: Cases not responding to
Sweda etc can be according to the condition.
above therapy.

AYURVEDIC STANDARD TREATMENT GUIDELINES 179


AVABAHUKA (FROZEN SHOULDER)

LEVEL 3: AYURVEDA Investigation: Nothing specific


HOSPITALS AT INSTITUTIONAL
Treatment: In addition to the manage-
LEVEL OR DISTRICT
ment of Level 1 and Level -2, if needed
HOSPITAL / INTEGRATED
Panchakarma procedures can be performed.
AYURVEDIC HOSPITALS
Nasya may be done with classical
Clinical Diagnosis: Same as level 1 for a dosage.
fresh case reporting directly

Table 27.3: Panchakarma Procedures at level 3 for Avabahuka

No Karma Choice of drugs Indications Remarks


1 Udwartana Kolakulathadi Churna; Associated neck pain, Considering Vata
Yava, Kola, Kulatha; recurrent respiratory infections vitiation at Kapha
Triphala churna; Sthana
2 Swedana Tapa, Ushma, Upanaha In persistent pain without Pitta Upanaha
Various articles- symptoms
3 Churna Pinda Kolakulathadi Yoga, Early stages of Avabahuka, Contra indicated
Sweda Various Vata / Kaphahara Sama, Kapha Samsrishta in Anupasthambha
Churna Vata, Pittanubandha
4 Patra Pinda Various leaves of Vata Usually After Churna Pinda Pittanubandha
Sweda alleviating property Sweda, directly on Nirama stage contra indicated
5 Jambeera Citrus fruit, turmeric and Same as above + Localised Pittanubandha
Pinda Sweda Vata alleviating Churna oedema contraindicated
6 Shashtikashali Shashtika rice, Bala Kwatha Later stages of Avabahuka, Contraindicated
Pinda Sweda and milk disuse atrophy, wasting, in Kaphanubandha,
/ Shashtika weakness, Pittanubandha Saama
Lepana
7 Navana / Anutaila / Ksheera Bala In all Avabahuka Care for
Nasya (Avarthi), Dhanwantara contraindications
(Avarthi), Shadabindu Taila of Nasya
Mahamasha Taila12,
Mashabaladi Kashaya13
Katphala Churna
8 Moordha Various Taila explained In Later stages of Avabahuka, Contraindicated
Taila – (Shiro for application on head insomnia, stress Vata Pradhana in chronic /
abhyanga stage recurrent sinusitis
Shiro Pichu associated with
Shirodhara, head ache and
Shirobasti) Shiro Abhyanga
Anupashaya
9 Upanaha Upanaha Churna, Salwana Wasting and painful Contraindicated in
conditions Skin allergy
Pathya - Apathya (Diet and life style): Same as level 1

180 AYURVEDIC STANDARD TREATMENT GUIDELINES


AVABAHUKA (FROZEN SHOULDER)

REFERENCES

1. Govind Das Sen, Amavata Rogadhikara Commentary, Chaukhambha Surbharti


29/152-157, Bhaishajya Ratnavali Prakashan, Varanasi, pg. 415.
Siddhiprada Commentary, Chaukhambha
8. Rasendra Sara Sangraha Vatavyadhi
Surbharti Prakashan, Varanasi, pg. 607.
Chikitsa.
2. Sharangdhara, Sharangdhara Samhita,
9. Yogaratnakara, Vaidya Lakshmi Pati
Shailaja Srivastava, Jivanprada Hindi
Shastri, Vidyotini Hindi Commentary,
Commentary, Chaukhambha Orientalia
Chaukhambha Prakashan, Reprint
Publication, Reprint 2011, Madhyama
2013 Vatavyadhi Chikitsa Adhyaya 1-3,
Khanda, 2/90-96, pg. 149.
pg. 546.
3. Vagbhata, Ashtanga Hrudaya, Atridev
Gupt, Vidyotini Hindi Commentary, 10. Sharangdhara, Sharangdhara Samhita,
Chaukhambha Prakashana, Edition Reprint Shailaja Srivastava, Jivanprada Hindi
2008, Varanasi, Sutra Sthana 15/9-10, Commentary, Chaukhambha Orientalia
pg. 141. Publication, Reprint 2011, Madhyama
Khanda, 2/270-272, pg. 154.
4. Vagbhata, Ashtanga Hrudaya, Atridev
Gupt, Vidyotini Hindi Commentary, 11. K Nisteshwara, Sahasra Yogam with Eng-
Chaukhambha Prakashana, Edition Reprint lish Translation, Chowkhambha Sanskrit
2008, Varanasi, Chikitsa Sthana 21/58-61, Series, Varanasi, third edition 2011, Taila
pg. 572. Prakarana, pg. 118.

5. Govind Das Sen, Murchha Rogadhikara 12. Chakrapani, Chakradatta, Indradev


21/16-22, Bhaishajya Ratnavali Siddhiprada Tripathi, Vaidya Prabha Hindi Commentary,
Commentary, Chaukhambha Surbharti Chaukhambha Sanskrit Bhawan, Varanasi,
Prakashan, Varanasi, pg.492. Reprint 2014, Chakradatta Vatavyadhi
Chikitsa 22/192-200, pg. 148.
6. Govind Das Sen, Vata Vyadhi Rogadhikara
26/572-575, Bhaishajya Ratnavali 13. Chakrapani, Chakradatta, Indradev
Siddhiprada Commentary, Chaukhambha Tripathi, Vaidya Prabha Hindi Commentary,
Surbharti Prakashan, Varanasi, pg. 570. Chaukhambha Sanskrit Bhawan, Varanasi,
7. Govind Das Sen, Vatarakta Rogadhikara Reprint 2014, Chakradatta Vatavyadhi
26/595, Bhaishajya Ratnavali Siddhiprada Chikitsa 22/23-24, pg. 135

AYURVEDIC STANDARD TREATMENT GUIDELINES 181


KATIGRAHA (LUMBAGO)

Sweda as well as classical Basti procedures


INTRODUCTION
are performed. Katibasti and bandages as
Katigraha is common disorder explained in Snigdha Veshtana are very effective.
the context of Vatavyadhi. It is characterized
by vitiation of Vata at Kati Pradesha. It leads
LEVEL 1: AT SOLO AYURVEDA
to pain and stiffness in the low back region
PHYSICIAN’S CLINIC/ PHC
restricting all lumbar movements. The
disease explained is similar with Low Back Clinical Diagnosis: On the basis of history
Pain due to spinal causes. and clinical presentations

Case definition: Patient Examination – A detailed history


and examination of lumbar spine, hip joints
Katigraha is defined as an acute or chronic and Straight Leg Raise (SLR) test / Femoral
pain in the lumbo-sacral region with stiff- Stretch Test (FST).
ness. There are two clinical presentations as
Investigations: Nil
Upastambhi Vata and Anupastambhi Vata.
Treatment: In Level 1 also some minimal
Differential Diagnosis: Panchakarma procedures can be done in
OPD.
• Mutra/Purisha Vega Dharana
• Shweta Pradara • In Samavata conditions, Rooksha
Lepa like Nagaradi Lepa or Dashanga
• Yoni Vyapada
Lepa / Gandhabiroja Lepa  / Maidalakdi
• Amavata Lepa etc. can be applied over lumbo-
• Kapha-Pittaja Tritiyaka Jwara sacral region.

• Gridhrasi • Katipichu or Katibasti with Murivenna,


Dhanwataram Taila or Nirgundyadi
• PCOS/PCOD
Taila etc can be performed later.
• Ankylosing spondylitis • Mridu Samshodhana with Eranda
Taila mixed with Nirgundi Swarasa
Line of Management
can be given in patients with
Katigraha is managed according to clinical constipation.
presentation. In Samavata presentations, • Patient may be advised Matravasti
Rooksha Sweda, Pachana and Shodhana are with Dhanwantaram Taila in or
done initially. After establishing Nirama Sahacharadi Taila if found to be
stage, Local Snehana procedures, Snigdha Anupastambhi Vata
KATIGRAHA (LUMBAGO)

Table 28.1: Medicines at level 1 for Katigraha

Drugs Dosage Dose Time of Duration Anupana


Form administration

Aswagandha + Powder 3-5 gm Twice daily 1-2 weeks Luke warm


Pippalimoola Churna water

Rasna Churna Powder 3-5 gm Twice daily 1-2 weeks Luke warm
water

Shunthi Churna Powder 3-5 gm Twice daily 1-2 weeks Luke warm
water

Chopchini Powder .5-2 gm Twice daily 1-2 weeks Sugar – 3 gm

Rasnasaptakam Decoction 12-24 ml Empty stomach / 1-2 weeks Luke warm


Kashaya1 6 am & 6 pm water and
Nagara Churna

Saptasaram Kashaya2 Decoction 12-24 ml Empty stomach / 1-2 weeks Luke warm
6 am & 6 pm water

Erandamoola Kashaya Decoction 12-24 ml Empty stomach /6 1-2 weeks Luke warm
am & 6 pm water

Dashamoola Kashaya3 Decoction 12-24 ml Empty stomach /6 1-2 weeks Luke warm
am & 6 pm water

Eranda Bija Kshira Medicated 7 seeds/ Once in morning 1 week Nil


Paka milk day empty stomach

Yogaraja Guggulu4 Vati 1-2 Tab Twice daily 1-2 weeks With warm
water

Simhanada Guggulu5 Vati 1-2 Tab Twice daily 1-2 weeks With warm
water

Sahacharadi Taila6 Oil 10-15 Once or Twice 1-2 weeks With


(Madhyama Paka) drops daily Sahachardi
Kashaya

Eranda Taila, Oil 15-50 ml In early morning As per With hot water
Gandharwahastadi in empty stomach need or milk
Eranda Taila, or at bed time
Nimbamritadi Eranda
Taila
Murivenna/ Sahachardi Taila/ Kuzhampu, Karpasasthydi Taila / Kuzhampu, Dhanwntharam Taila /
Kuzhampu, Nirgundyadi Taila, Bala Taila etc For External application

AYURVEDIC STANDARD TREATMENT GUIDELINES 183


KATIGRAHA (LUMBAGO)

Pathya-apathya (diet and life style): Dont’s–


Since the disease may be caused and • Ahara: Use of food items like
aggravated by fall, acute sprains on bending Chanaka (Bengal gram), Kalaya
forward, lifting objects, hard works etc. (lathyrus), Kordusha (millets),
and absolute bed rest is essential initially Shyamaka, Rajmasha, Sheetambu (cold
to reduce the local inflammatory responses. water) should be avoided. Pungent
All situations leading to Apana Vata Prakopa /astringent food like red chilies,
should be avoided. excessive use of all spices, diet
Do’s– with low water content like wafers,
• Ahara: The patient should be pro- biscuits etc should be discouraged.
vided easily digesting, nutritional • Vihara: Chinta (excessive thinking),
and anti flatulent type of food. The Prajagarana (improper sleep at
food articles should be fiber rich to night), Vega Vidharana (suppression
prevent constipation. These include of natural urges), Shrama (excess
leafy vegetables, green salads, hard work) should be avoided. Hard
fruits, barley etc. Vata alleviating exercises are not good. It is better
food articles prepared with ghee or to avoid sponge like mattresses
any suitable oil, Udada (black gram), and easy chairs. Forward bending,
Shigru Shaka (drumstick), brinjal lifting articles etc are to be done
etc may be given. Patola, Rasona, very cautiously.
Dadima, Parushaka, Badara, Draksha,
may be advised by the patient. Shali, Referral criteria:
Shashtik, Kulattha, Wheat products
1. Cases not responding to above line of
etc. are suitable. Vegetable soups
Shamana management.
are recommended.
• Vihara: Regular exercise along with 2. Chronic cases of Katigraha with
Abhyanga, Mardana, Avgahana or recurrent sprains require well planned
Samvahana. Timely sleeping is very Panchakarma treatment.
important. It is always ideal to use 3. Acute cases of Katigraha with severe pain
hot water for drinking as well as which require strict bed rest and traction
bathing. Controlled physiotherapy massages etc.
to regain range of movement can be
advised in milder form. Comfortable
seats and bed should be used. Bowel LEVEL 2: CHC’S OR SMALL
and bladder responses should be HOSPITALS WITH BASIC
attended timely. Healthy postures FACILITIES
are to be adopted always. After the
symptoms are subsided, regular Clinical Diagnosis: Same as level 1 for a
Surynamaskara may be performed. fresh case reporting directly.

184 AYURVEDIC STANDARD TREATMENT GUIDELINES


KATIGRAHA (LUMBAGO)

Investigation: Same as level 1: in • MRI – Lumbosacral – For better


addition assessment soft tissue pathologies.

• USG abdomen & pelvis – to rule Treatment: In addition to the Shamana man-
out any visceral pathology and agement mentioned in Level 1, few of the
Gynecological issues related to following drugs may be added as per the
uterus and adnexa and PID leading requirement and status of the patient. Inten-
to low back pain. sive combination therapies of Rasaushadhi
and Kashthoushadhi (herbo-mineral drugs) or
• USG – KUB – To rule out renal calculi
herbal drugs containing potentially harm-
and obstructive lower urinary tract
ful ingredients can also be used cautiously
symptoms.
at this level. Patient may be kept under
• CT Scan– For better assessment of observation while prescribing these kinds of
bony canal medicines.

Table 28.2: Medicines at level 2 for Katigraha

Drug Dosage Dose Time of Duration Anupana


Form Administration

Sanjivani Vati Vati 125-250 mg Twice daily 1-2 weeks Warm water

Agnitundi Vati Vati 125-250 mg Twice daily 1-2 weeks Warm water

Soubhagya Shunthi Paka Avaleha 5 gm Twice daily 1-2 weeks Warm water

Gugguluthikthaka Ghrita7 Ghee 15-30 ml Once or twice 1-2 weeks Before food
daily on appetite

Abhayarishta8 Arishta 10-20 ml Twice daily 1-2 weeks After food

Balarishta9 Arishta 10-20 ml Twice daily 1-2 weeks After food

Dhanwantaram Taila10 Oil 10-15 drops Once or Twice 1-2 weeks –


(7-101 Avarthi) daily

Murivenna/ Sahachardi Oil For External Twice daily 1-2 weeks –


Taila/ Kuzhampu, application.
Karpasasthydi Taila / Kuzhambu
Kuzhampu, Prasarini applied
taila/ Vishagarbha Taila / externally only.
Dhanwntharam Taila / Suitable Taila
Kuzhampu, Nirgundyadi can be used for
Taila, Ksheera Bala Taila11 Anuvasana also.

Vatagajankusha Rasa Powder 60-125 mg Twice daily 1-2 weeks Madhu

Vatavidhwamsa Rasa12 Powder 60-125 mg Twice daily 1-2 weeks Madhu

AYURVEDIC STANDARD TREATMENT GUIDELINES 185


KATIGRAHA (LUMBAGO)

• The patient may be subjected to 2. Cases not responding to the above


local Abhyanga and Bashpa Sweda management and require parasurgical
or traction massage with Murivenna, procedures.
Sahacharadi Taila, Karpasasthydi Taila
3. Moderate to Severe cases of Katigraha
etc.
with complications like scoliosis, sciatica
• Snigdhachurna Pinda Sweda, etc.
Patrapotala Sweda, and Jambheera
Pinda Sweda and Shashtika Pinda
Sweda may be tried. LEVEL 3: AYURVEDA HOSPITALS
• Anuvasana Basti may be given with AT INSTITUTIONAL LEVEL
Dhanwantharm Taila, Sahacharadi OR DISTRICT HOSPITAL/
Taila etc and Madhutailika Basti or INTEGRATED AYURVEDIC
Erandamooladi Nirooha Basti may be HOSPITALS
done.
• The details of Shodhana treatment Clinical Diagnosis: Same as Level 1 for a
protocol is available in Level 3. fresh case reporting directly
It may be incorporated as per
Investigations: Nil
feasibility and availability
Pathya-Apathya (Diet and life style): Same Treatment: In addition to the management
as level 1 of Level 1 and Level 2, if needed Panchakarma
procedures can be performed. Full course
Referral Criteria: Basti Karma like Yogabasti, Kalabasti
1. Cases not responding to above therapy and Karmabasti can be done in selected
and require well planned Panchakarma cases.
therapy and Rasayana Chikitsa.

Table 28.3: Medicines at level 3 for Katigraha

Drug Dosage Dose Time of Duration Anupana


Form Administration

Amruta Bhallataka Avaleha 5 gm Twice daily 1-2 weeks Milk


Avaleha

Eranda Paka Avaleha 5 gm Twice daily 1-2 weeks Milk

Trayodashanga Guggulu Vati 2-4 gm Twice daily 1-2 weeks Warm


water

Ekangaveer Rasa Vati 125-250 mg Twice daily 1-2 weeks Warm


water

186 AYURVEDIC STANDARD TREATMENT GUIDELINES


KATIGRAHA (LUMBAGO)

Table 28.4: Panchakarma procedures at level 4 for Katigraha


Karma Choice of drugs Indications Remarks
Udwarthana Kolakulathadi Churna Saama Katigraha - associated More useful in
Yava, Kola, Kulatha; recurrent respiratory infections, stiffness
Triphala Churna; heaviness of back, spinal canal
stenosis, and LBA in obesity
Swedana Tapa, Ushma – various In persistent pain without Pitta Reduces associated
herbal powders, steam symptoms muscle spasm
generated with herbal immediately
leaves
Churna Pinda Kolakulathadi Yoga, Early stages of Katigraha Saama, Kevala Vata,
Sweda Various Vata/ Kapha Kaphsamsrishta Pittanubandha contra
Hara powders indicated
Patrapinda Various leaves of Vata Usually After Churnapinda Pittanubandha contra
Sweda alleviating property Sweda, directly on Nirama stage indicated
Jambeera Pinda Citrus fruit, turmeric Same as above + Localised Pittanubandha contra
Sweda and Vata alleviating oedema, Katigraha of traumatic indicated
powders origin
Shashtika Shashtika rice, Bala In Shuddha Vata Katigraha, Kaphanubandha, Sama,
Pinda Sweda / decoction and milk Wasting, Weakness, Sheeta Anupashaya
Shashtika Lepana Pittanubandha contra indicated
Kativasti Murivenna, In severe pain, when pain
Dhanwantaram Taila etc aggravates on manipulation.
Virechana Plain or processed Directly in all constipated Nirgundi Swarasa is
various Eranda Tail, cases. Also done after added in Eranda Taila
Trivrita Lehya, Abhayadi Shodhanaga Snehapana. for better results.
Modaka, Ichabhedi Rasa Always done as
etc Mridusamshodhana after various
Swedana procedures for 7 days
or so.
Anuvasana Basti Dhanwantara Taila, In all Katigraha in Vatapradhana Care for
Sahacharadi Taila etc. stage especially with habitual contraindications of
constipations. Nasya
Nirooha Basti Erandamooladi, – Vaitarana Basti is done
Madhutailika, Vaitarana in Ama stages.
Basti, Kshara Basti
etc and various yoga
explained in classics
Agnikarma Shalaka, Ghrita, Taila etc Non responding cases to any –
approaches., severe pain,
Kandaragata Shoola
Pathya-Apathya (Diet and life style): Same as Level 1

AYURVEDIC STANDARD TREATMENT GUIDELINES 187


KATIGRAHA (LUMBAGO)

REFERENCES

1 Sharangdhara, Sharangdhara Samhita, 7 Vagbhata, Ashtanga Hrudaya, Atridev


Shailja Srivastava, Jivanprada Hindi Gupt, Vidyotini Hindi commentary,
Commentary, Chaukhambha Orientalia Chaukhambha Prakashana, Edition Reprint
Publication, Reprint 2011, Madhyama 2008, Varanasi, Chikitsa sthana Vata Vyadhi
Khanda, 2/88-89, p.no. 149 Chikitsa 21/58-61, p. no. 572
2 Sahasrayoga, Hindi translation, CCRAS, 8 Govind Das Sen, Bhaishajya Ratnavali,
New Delhi, translated by Dr. D B Pandit Siddhinandan Mishra, Siddhiprada
Rao, edited by Dr. Vivekanand Pandey, commentary, Chaukhambha Surbharti
Reprint edition 2011, Kasaya Prakaranam, Prakashan, Edition 2011, Varanasi, Arsho
549, p.no.112 Rogadhikara 9/175-180 p. 323
3 Govind Das Sen, Bhaishajya Ratnavali,
9 Govind Das Sen, Bhaishajya Ratnavali,
Siddhinandan Mishra, Siddhiprada
Siddhinandan Mishra, Siddhiprada
commentary, Chaukhambha Surbharti
commentary, Chaukhambha Surbharti
Prakashan, Edition 2011, Varanasi, Kasa
Prakashan, Edition 2011, Varanasi,
Rogadhikara 15/13, p. 439
Vatavyadhi Rogadhikara 26/172-175, p. 570
4 Govind Das Sen, Bhaishajya Ratnavali,
10 Sahasrayoga, Hindi translation, CCRAS,
Siddhinandan Mishra, Siddhiprada
New Delhi, translated by Dr. D B Pandit
commentary, Chaukhambha Surbharti
Rao, edited by Dr. Vivekanand Pandey,
Prakashan, Edition 2011, Varanasi, Amavata
Reprint edition 2011, Taila Prakarana, 51,
Rogadhikara 29/152-157, p. 607
p.no. 260-261
5 Govind Das Sen, Bhaishajya Ratnavali,
Siddhinandan Mishra, Siddhiprada 11 Sahasrayoga, Hindi translation, CCRAS,
commentary, Chaukhambha Surbharti New Delhi, translated by Dr. D B Pandit
Prakashan, Edition 2011, Varanasi, Amavata Rao, edited by Dr. Vivekanand Pandey,
Rogadhikar 29/173-184, p. 610 Reprint edition 2011, Taila Prakaranam,
124, p.no. 292
6 Vagbhata, Ashtanga Hrudaya, Atridev
Gupt, Vidyotini Hindi commentary, 12 Yogaratnakara, Vaidya Lakshmipati
Chaukhambha Prakashana, Edition Reprint Shastri, Vidyotini Hindi commentary,
2008, Varanasi, Chikitsa sthana Vata Vyadhi Chaukhambha Prakashan, Reprint 2013
Chikitsa 21/67-69, p.no. 573 Vatavyadhi Chikitsa, 1-3. p.no. 546

188 AYURVEDIC STANDARD TREATMENT GUIDELINES


GRIDHRASI (SCIATICA)

Pangu, Marmabhighata at any of the Kukundara


INTRODUCTION
and Nitamba Marma.
Gridhrasi is a Vatavyadhi characterised by If the pain is localized to sacroiliac joint it
vitiation of Vata afflicting the Kandara / Snayu may be diagnosed as Katigraha a condition
of lower limbs. It is characterized by severe of ankylosing should be ruled out. Khanja
radiating pain starting from the low back and Pangu are characterized with weakness
to gluteal, posterior aspect of thigh, knee, of lower limbs due to loss of motor power.
calf and dorsum of the foot of either one Khanja affects any one limb and Pangu affects
or both sides of lower limbs. The condition both. These conditions may not have any
makes raising of the leg difficult. All types of pain associated. Kukundara Marmabhighata
lumbar radicuolpathy also can be interpreted is characterized by motor and sensory loss.
in terms of Gridhrasi. Nitamba Maramabhighata is characterised
with wasting of lower limbs.
Case Definition:

Gridhrasi is defined as Stambha (stiffness), Line of Treatment:


Ruk (pain), Toda (pricking pain) in a radiating
manner along with Spandana (tingling sensa- • Nidana Parivarjana should be the
tion) starting from Kati Pradesha (low back) first line of treatment.
to Prushtha (back), Janu (knee joints), Jangha • Shodhana Chikitsa – Virechana, Basti,
(calf muscles) and Pada (dorso lateral aspect Siravedha
of feet) of either one side of the lower limb or
may involve both lower limbs. This condition • Shamana Chikitsa- Pachana, Snehana,
makes raising of the affected leg difficult. Swedana including various types
Pindasweda, Agnikarma, Balya
Types:
• External applications - Abhyanga,
There are two clinical presentations as Kevala Lepa, Katibasti, Katipichu.
Vata and Kapha Vata. Association of Kapha
produces additional symptoms like Tandra • Rasayana Chikitsa for Asthi and
(drowsiness), Gaurava (heaviness) and Vata
Arochaka (loss of taste). • Treatment according to Doshik
involvement
Differential Diagnosis:
• General line of treatment prescribed
The condition should be differentiated from
for Vatavyadhi
Katigraha (Ankylosing spondylitis), Khanja,
GRIDHRASI (SCIATICA)

Dashanga Lepa etc can be applied in


LEVEL 1: AT SOLO AYURVEDA the low back region
PHYSICIAN’S CLINIC/PHC
• Katipichu or Katibasti with Murivenna,
Clinical Diagnosis: On the basis of history Dhanwataram Taila or Nirgundyadi
and clinical presentation Taila etc can be performed later.
Investigations: ESR (Males 0-15 mm/h, • Mridu Samshodhana with Eranda
Females – 0-20 mm/h) to rule out any Taila mixed with Nirgundi Swarasa
inflammation can be given in patients with
Treatment: In level 1 also some minimal constipation.
Panchakarma procedures can be done in
• Patient may be advised Matra
OPD.
Basti with Dhanwantaram Taila in
• In Kapha associated conditions, or Sahacharadi Taila if found to be
Rooksha Lepa like Nagaradi Lepa or Kevala Vatika.

Table 29.1: Medicines at level 1 for Gridhrasi

Drugs Dosage Dose Time of Duration Anupana


form administration
Aswagandha Churna 3-5 gm Twice a day 1-2 weeks Luke warm
water
Rasna Churna 3-5 gm Twice a day 1-2 weeks Luke warm
water
Shunthi Churna 3-5 gm Twice day 1-2 weeks Luke warm
water
Chopachini Churna 0.5-2 gm Twice a day 1-2 weeks Sugar – 3 gm
Eranda Beeja Ksheera Use 5 seeds for Once a day 1-2 weeks
-
Ksheerapaka Paka preparation
Paarijaat Patra Swarasa 15 ml Empty stomach / 1-2 weeks
-
Swarasa1 twice a day
Rasnasaptakam Kwatha 12 – 24 ml Empty stomach / 1-2 weeks Luke warm
Kashaya2 6 am & 6pm water and
Nagara Churna
Sahacharadi Kwatha 12 – 24 ml Empty stomach / 1-2 weeks Luke warm
Kashaya 6 am & 6 pm water
Maharasnadi Kwatha 12 – 24 ml Empty stomach / 1-2 weeks Luke warm
Kashaya3 6 am & 6 pm water
Yogaraja Guggulu4 Vati 1-2 tab Twice daily 1-2 weeks Warm water

190 AYURVEDIC STANDARD TREATMENT GUIDELINES


GRIDHRASI (SCIATICA)

Trayodashanga Vati 1-2 tab Twice daily 1-2 weeks Warm water
Guggulu4
Plain & various Taila 15-50 ml Empty stomach As per Hot water or
types of processed -early morning or need milk
Eranda Taila at bed time
Bala Taila, Mahanarayana Taila, Nirgundyadi Taila, Sahachardi Taila, Vishagarbha Taila, Prasaranyadi
Taila, Murivenna / Kuzhampu, Karpasasthydi Taila / Kuzhampu, Dhanwntaram Taila / Kuzhampu, etc. for
Abhyanga and Sweda

Pathya - Apathya (Diet and life style 2. Chronic cases of Gridhrasi with full-
education): fledged symptoms or associated
morbidities like foot drop, muscle
Do’s -
wasting etc which require well planned
• Ahara: Advice light Vatanuloman In - Patient Panchakarma treatment.
diet like Shigru Shaka (drumstick),
3. Acute cases of Gridhrasi with severe pain
brinjal, Methi, Jeerak, Hingu,
which require strict bed rest and traction
Saindhava, Yoosha, Mamsarasa etc.
massages etc.
may be given.
• Vihara: Correct postures while
sitting or lifting the weight, regular LEVEL 2: CHC’S OR SMALL
suitable Yogasana and Abhyanga, HOSPITALS WITH BASIC
hot water bath, fomentation, FACILITIES
comfortable seats and bed should
be used. Bowel and bladder urges Clinical Diagnosis: Same as level 1 for a
should be attended timely. fresh case reporting directly.
Dont’s -
Investigations: Same as level 1, in addition
• Ahara: Vata aggravating diet like
pulses, peas, wafers, biscuits etc, • X ray of the lumbo sacral spine
cold food and cold drinks, stale
Treatment: In addition to the Shamana
food, excessive use of chilly.
management mentioned in Level 1, some
• Vihara: Exposure to cold, heavy of the following drugs may be added
physical work, spongy mattresses as per the requirement and status of the
and easy chairs. patient. Intensive combination therapies
of Rasaushadhi and Kashthoushadhi (herbo-
Referral Criteria:
mineral drugs) can also be used.
1. Cases not responding to above line of
Shamana management.

AYURVEDIC STANDARD TREATMENT GUIDELINES 191


GRIDHRASI (SCIATICA)

Table 29.2: Medicines at level 2 for Gridhrasi

Drug Dosage Dose Time of Anupana


Form Administration
Dashamoola Kwatha Kwatha 12-24 ml Empty stomach / twice
-
daily
Guggulutiktakam Kashaya Kwatha 12-24 ml Empty stomach / twice
-
daily
Dhanwantaram Kwatha Kwatha 12-24 ml Empty stomach / twice Dhanwantaram
daily Vati
Guggulutiktaka Ghrita5 Ghrita 15-30 ml Before food on appetite
-
/ once-twice a day
Ashwagandharishta Arishta 10-20 ml After food /
-
twice daily
Balarishta6 Arishta 10-20 ml After food /
-
twice daily
Sahachardi Taila / Bala Taila Can be used for Basti.
Taila, Karpasasthyadi Taila,
Dhanwntaram Taila 7
Vatagajankusha Rasa8 Gutika 60-125 mg Twice daily Madhu

Vatavidhwamsa Rasa9 Gutika 60-125 mg Twice daily Madhu


Ekangaveera Rasa Gutika 60-125 mg Twice daily Madhu

Dhanwantharm Taila (101) Taila 10-15 drops Once or twice a day for Sahachardi
Avarti 1-2 weeks Kashaya

Sahacharadi Taila10 Taila 10-15 drops Once or twice a day for Sahachardi
(Madhyama Paka) 1-2 weeks Kashaya

• The patient may be subjected to • Basti may be given with


local Abhyanga and Bashpa Sweda or Dhanwantarm Taila, Sahacharadi
traction massage with Murivenna, Taila etc and Madhutailika Basti or
Sahacharadi Taila, Karpasasthydi Erandamooladi Nirooha Basti may be
Taila etc. done.

• Snigdha Churna Pinda Sweda, Pathya - Apathya (Diet and life style
Patrapinda Sweda, and Jambeera education): Same as level 1
Pinda Sweda and Shashtika Pinda Referral Criteria: Cases not responding to
Sweda may be tried. above therapy

192 AYURVEDIC STANDARD TREATMENT GUIDELINES


GRIDHRASI (SCIATICA)

to low back pain and pain in lower


LEVEL 3: AYURVEDA
limbs
HOSPITALS AT INSTITUTIONAL
• USG – KUB – To rule out renal calculi
LEVEL OR DISTRICT
and obstructive lower urinary tract
HOSPITAL / INTEGRATED
symptoms.
AYURVEDIC HOSPITALS
• CT Scan– For better assessment of
Clinical Diagnosis: Same as level 1for a fresh bony canal
case reporting directly • MRI Lumbosacral with whole spine
screening.
Investigations:
Treatment: In addition to the management of
• USG abdomen & pelvis– to rule Level 1 and Level -2, if needed Panchakarma
out any visceral pathology or procedures can be performed. Full course
gynecological issues related to Basti Karma like Yogabasti, Kalabasti and
uterus and adnexa and PID, leading Karmabasti can be done in selected cases.

Table 29.3: Panchakarma Procedures at level 3 for Gridhrasi

Karma Choice of drugs Indications Remarks


Udwartana Kolakulathadi Churna; Kapha Vata Ghridhrasi - More effective in
Yava, Kola, Kulattha; associated with heaviness in Sama conditions
Triphala Churna; affected limb, severe numbness,
spinal canal stenosis and
sciatica in obesity
Swedana Tapa, Ushma – Various In persistent pain without Pitta Reduces associated
herbal Churnas, steam symptoms muscle spasm
generated with herbal immediately
leaves
Churnapinda Kolakulathadi Yoga, Early stages of Gridhrasi Saama, Kevala Vata,
Sweda Various Vata / Kapha Kaphsamsrishta Pittanubandha contra
hara Churnas indicated
Patrapinda Various leaves of Vata Usually after Churnapinda Pittanubandha contra
Sweda alleviating property Sweda, directly on Nirama stage indicated
Jambeera Pinda Citrus fruit, turmeric Same as above + localised Pittanubandha contra
Sweda and Vata alleviating oedema indicated
Churnas
Shashtika Pinda Shashtika rice, Bala Later stages of Gridhrasi, disuse Kaphanubandha,
Sweda / Shashtika decoction and milk atrophy, wasting, weakness, Sama, Sheeta
Lepana Pittanubandha Anupashaya contra
indicated

AYURVEDIC STANDARD TREATMENT GUIDELINES 193


GRIDHRASI (SCIATICA)

Katibasti Murivenna Taila In severe pain, when pain


-
Dhanwantaharam etc aggravates on manipulation.
Virechana Plain or processed Directly in all constipated cases. Nirgundi Swarasa
various Eranda Tail, Also done after Shodhanaga is added in Eranda
Trivrita Lehya, Abhayadi Snehapana. Taila for better
Modaka, Ichabhedi Rasa Always done as Mridu results.
etc Samshodhana after various
Swedana procedures for 7 days.
Anuvasana Basti Dhanwantara Taila, In all Gridhrasi in Vata Pradhana Care for contra-
Sahacharadi Taila etc. stage. indications of Nasya
and oral Snehapana
Nirooha Basti Erandamooladi, Nirama stages of Gridhrasi, Vata Vaitarana Basti
Madhutailika, Vaitarana Pradhana stage. should be done
Basti, Kshara Basti even in Ama stages.
etc and various Yoga
explained in classics
Rakta Mokshana - Scalp set, intra-venous Non responding cases to
Siravedha canula, tray, tourniquet Snigdha Rooksa, Sheeta or Ushna
-
etc approaches, in acute and severe
pains
Agnikarma Shalaka, Ghrita, Taila etc Non responding cases to any
approaches., severe pain, -
Kandaragata Shoola

Pathya-Apathya (Diet and life style 2. Bhallataka


education): Same as level 1 3. Aswagandha
Rasayana: 4. Guduchi

1. Rasona Kalka 5. Bala

REFERENCES

1. Chakrapani, Chakradatta, Indradev 2. Sharangadhara, Sharangadhara Samhita,


Tripathi, Vaidya Prabha Hindi commentary, Shailja Srivastava, Jivanprada Hindi
Chaukhambha Sanskrit Bhawan, Varanasi, Commentary, Chaukhambha Orientalia
Reprint 2014, Chakradatta Vata Vyadhi Publication, Reprint 2011, Madhyama
Chikitsa 22/41, p.no. 136. Khanda, 2/88-89, p.no. 149.

194 AYURVEDIC STANDARD TREATMENT GUIDELINES


GRIDHRASI (SCIATICA)

3. Sharangadhara, Sharangadhara Samhita, 7. Govind Das Sen, Vata Vyadhi Rogadhikara


Shailja Srivastava, Jivanprada Hindi 26/267-276, Bhaishajya Ratnavali
Commentary, Chaukhambha Orientalia Siddhiprada Commentary, Chaukhambha
Publication, Reprint 2011, Madhyama Surbharti Prakashan, Varanasi, P. 542.
Khanda, 2/90-96, p.no. 149.
8. Govind Das Sen, Vata Vyadhi Rogadhikara
4. Govind Das Sen, Bhaishajya Ratnavali 26/114-118, Bhaishajya Ratnavali
Siddhiprada Commentary, Chaukhambha Siddhiprada Commentary, Chaukhambha
Surbharti Prakashan, Varanasi, Amavata Surbharti Prakashan, Varanasi, p. 528.
Rogadhikara 29/152-157, p. 607.
9. Yogaratnakara, Vaidya Lakshmipati
5. Vagbhatta, Chikitsasthana Vata Vyadhi
Shastri, Vidyotini Hindi Commentary,
Chikitsa 21/58-61, Ashtanga Hrudaya
Chaukhambha Prakashan, Reprint 2013
Vidyotini Commentary, Chaukhambha
Vatavyadhi Chikitsa, 1-3, p. 546.
Prakashana, Varanasi, p. 572.
6. Govind Das Sen, Vata Vyadhi Rogadhikara 10. Vagbhatta, Chikitsa Sthana Vata Vyadhi
26/572-575, Bhaishajya Ratnavali Chikitsa 21/67-69, Ashtanga Hrudaya
Siddhiprada Commentary, Chaukhambha Vidyotini Commentary, Chaukhambha
Surbharti Prakashan, Varanasi, p. 570. Prakashana, Varanasi, p. No. 573.

AYURVEDIC STANDARD TREATMENT GUIDELINES 195


PAKSHAGHATA
(HEMIPLEGIA / STROKE / CEREBRO
VASCULAR ACCIDENT)

dysfunctions etc can be successfully managed


INTRODUCTION
along with improvement of motor functions.
Pakshaghata (Pakshavadha / Ekanga Roga) is Ayurvedic classics recommend long term
an important disease enlisted in Vatavyadhi management in Pakshaghata like 3-4 months.
context in. It is characterized by motor or These include Snehana (internal & external),
sensory (or both) failure in any one side of the Swedana, Virechana, Basti, Nasya, Shirobasti
body. When it’s affected in all the four limbs etc. which are possible in secondary or
it is called as Sarvanga Vata. When the clinical tertiary care hospitals only. The primary
presentation is affected only one limb it is level care may be limited to prompt diagnosis
called Ekanga Vata. It may be associated with and timely reference to higher centers at
facial palsy (Ardita) and speech difficulties early stages. They can also do follow up
like aphasia (Vaksanga). Ayurveda identify & rehabilitating care after discharge from
the pathology of Pakshaghta in relation with secondary or territory care hospitals.
Cerebro Vascular Accident (CVA) and
hence importance is given to Masthishkya Case Definition
(therapeutic applications on scalp). There Pakshghata is defined as loss of motor functions
are some limitations in Ayurveda for or (and) sensations in any one side of the
management of acute stroke in comparison body caused by vitiated Vata affecting Sira
to approaches like thrombolysis etc in and Snayu located in the Moordha of contra
modern medicine. Still in rural areas many lateral side. [Since facial palsy (other than
Ayurvedic practitioners are successfully Bell’s palsy) is a common accompaniment
attending acute stroke cases also. In addition of paralysis; cases with Ardita are also
to this, Ayurveda definitely has a major role considered here for the purpose of better
to play in management of residual paralysis understanding while management.]
as well as rehabilitation of patient and to
prevent disease induced muscle atrophy and Differential Diagnosis
contractures. It also helps to improve muscle
strength in patients where loss of motor In Ayurveda the diagnosis of Pakshaghata
power is not complete. Many of the associated in terms of Cerebro Vascular Accident is
features of hemiplegia like facial deviation, made on the basis of various criteria like
speech and language deficits, bowel bladder stages of the disease, extent of involvement
PAKSHAGHATA

as well as Doshic predominance. Since all Localized swelling with symptoms


these are essential for classical Ayurvedic predominantly of Kapha – usually
management, the diagnosis of Cerebro initial few weeks (Kaphasamsrishta)
Vascular Accident is made with modern
• Thalamic Stroke (Pittasamsrishta)
analogue as follows.
• Degenerative brain lesion
A. Post Stroke Residual Manifestations especially in elderly secondary to
in Cerebro Vascular Disaeses multiple lacunar infarcts (Kshayaja
Pakshaghata)
I. Classification According to Extent of
Involvement • Monoplegia secondary to CVA
(Ekangavata)
• Hemiplegia / Stroke / Cerebro
Vascular Accident (Pakshaghata) • Quadriplegia – Brainstem Lesion
• Hemiplegia with Facial palsy (Sarvangaroga)
(Ardita)
B. Associated Morbidities in Stroke
Both the above diseases can be further
divided into three stages according to Speech & language deficits – Aphasia /
onset. Dysphasia / Dysarthria, secondary to CVA–
(Jihwasthambha /Vaksanga)
II. Classification according to Stages of
Disease
C. Pre stroke manifestations of CVA
• TIA or RIND (Ardita – Vega)
• Not related with substance abuse
• Hemi paresis / Lacunar infarcts (clouding of consciousness and
(Pakshasada) confusion state secondary to CVA)-
• Completed stroke (Pakshaghata) (Mada)
III. Classification according to Doshic pre- • Not related with substance abuse
dominance and prognosis (stupor stage related to CVA)-
Further Pakshaghata can be subdivided into 4 (Murccha)
major varieties as per prognosis explained in • Not related with substance abuse
Ayurveda classics. (coma related to brain injury
Late effects of CVA leading to Hemiplegia / secondary to CVA)- (Sanyasa)
Spastic paralysis / Disuse atrophy with
symptoms predominantly of Vata – usually D. Stroke due to traumatic brain
chronic in nature (Shuddha Vata) injury

• Early effects of CVA leading to Paralysis due to traumatic brain injury


Hemiplegia / Flaccid paralysis / (Shiromarmabhighataja Pakshaghata)

AYURVEDIC STANDARD TREATMENT GUIDELINES 197


PAKSHAGHATA

Diagnostic criteria and various presentation/phases of the disease are tabulated below:

Table 30.1: Differential diagnosis of Pakshaghat with various presentations of the diseases

Diagnostic Term Essential Criteria Confirmatory Ayurvedic Remarks


Criteria
Pakshaghata Hemiplegia with Motor loss (Akarmani) +/- Facial deviation is
symptoms of CVA sensory impairment (Vichetana) not mandatory for
(Either infarcts or on affected side diagnosis
haemorrhage)
Ardita Facial weakness on Facial deviation (Vaktrardha Facial deviation
any side + above Vakreekarana) + Above is mandatory for
symptoms symptoms diagnosis

Ekanga Vata CVA leading to Either one upper or lower limb Only one limb
monoplegia (Bahu or Sakthi) affected affected
Sarvanga Vata CVA leading to Sarvakayashrita Pakshaghata All the four limbs
quadriplegia affected

A. Classification According to Severity of Clinical Presentation


Ardita Vega TIA / RIND Vegavan Ardita Self limiting /
reversible. But
patient require
prophylactic care
for non recurrence
Pakshasada Hemi paresis Alpa Lakshanayukta Pakshaghata Pakshaghata
with minimal
symptoms
Pakshaghata Completed stroke Like Pakshaghata in row 1 & 2

B. Prognostic Classification
Shuddha Vata Late effects of CVA With symptoms predominantly Upashaya with
(Krichra Sadhyatama) - spastic paralysis / of Vata – Stabdha  /  Sankocha  / Snigdha / Ushna /
contractures / Sosha / Kaarshnya  / Ushnakamitwa / Brimhana line of
disuse atrophy - Kampa / Anaha / Shakritgraha / treatment
usually chronic in Shoola etc
nature
Kaphasamshrishta Early effects of CVA With symptoms predominantly Upashaya with
(Kriccha Sadhya) flaccid paralysis / of Kapha – Gourava/ Shopha/ Rooksha / Ushna /
localized swelling Sheeta/ Supta/ Shlathangata Langhana line of
– usually initial few treatment
weeks

198 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

Pittasamsrishta Thalamic stroke – With symptoms predominantly Upashaya with


(Kricchra Sadhya) Sensory stroke of Pitta –Krodha, Daha, Sweda, Sheeta / Sthambhana
Sparshasahishnuta etc line of treatment

Kshayaja Pakshaghata Degenerative brain Hemiplegia / paresis with Vatahara palliative


(Asadhya) lesion especially in features of generalized Sosha/ care may help
elderly secondary Smritikshaya / Nidranasha/ in minimizing
to multiple lacunar Ojakshaya problems
infarcts

C. Associated Morbidities in Stroke

Jihvasthambha / Sensory or Vaksanga / Vakgraha – difficulty May respond


Vaksanga motor Aphasia in speech to treatment of
/ Dysphasia / Jihvasthambha
Dysarthria
secondary to CVA

Mada Clouding of Pralapa / Cheshta / Krodha / Not exclusively


consciousness Alpavak / Dhyana / Asambadha due to any
and confusion / Vak substance abuse
delirium secondary
to CVA

Murcchha Stupor stage related Murcchha/ Tama Pravesha / visual Not exclusively
to CVA hallucinations due to any
substance abuse

Sanyasa Coma related Kashthibhuto Mritopama - total Not exclusively


to brain injury unresponsiveness due to any
secondary to CVA substance abuse

D. Stroke due to traumatic brain Injury

Shiro Paralysis secondary Shiromarmabhighata Lakshana


Marmabhighataja to traumatic brain
Pakshaghata injury

Line of management: Shrotra Tarpana, Akshi Tarpana, Ksheeradhooma


General line of management includes Snehana, etc are also incorporated. All these treatments
Swedana and Virechana. Further Aasthapana, can be done in secondary or tertiary
Anuvasana, Nasya, Upanaha, Maastishkya etc care hospitals. In primary care settings,
are also exclusive line of management of prophylactic care as well as rehabilitative
Pakshaghata. In Ardita associated conditions care can be offered.

AYURVEDIC STANDARD TREATMENT GUIDELINES 199


PAKSHAGHATA

Investigations: Patients of chronic residual


LEVEL 1: AT SOLO AYURVEDA paralysis and patients on prophylactic
PHYSICIAN’S CLINIC/PHC medications after TIA or RIND attending
Clinical Diagnosis: Two types of cases may the remotest Level 1 should be regularly
be presented monitored for control on blood pressure,
lipid profile and blood glucose levels. Acute
1. Acute stroke cases
stroke patients attending remotest Level 1
2. Residual paralysis cases. Clinics where immediate reference is not
Residual paralysis cases can be easily possible and treatment initiated should be
diagnosed on the basis of history and clinical closely monitored with regular checking of
presentation of the patient with respective BP and other vital signs.
stages described under differential diagnosis. Treatment: The treatment may be divided
In acute stroke cases clinical diagnosis is into three varieties of patients.
made on the basis of following symptoms 1. Acute stroke patients attending remotest
1. Acute or gradual onset of loss of sensory Level 1 where reference to higher centre
and / or motor functions on one side of is not possible.
the body 2. Patients with chronic residual palsy.
2. Changes in vision, gait or ability to speak 3. Patients with prophylactic treatment
or understand after a history of TIA or RIND
3. Experience of sudden severe headache. Treatment may be initiated to acute stroke
patients attending remotest Level 1 where
4. Altered consciousness
reference to higher centre is not possible
5. History of Hypertension, Dyslipideamia, only after proper informed consent. The
and smoking are risk factors probabilities and consequences of the
The patients with above features should be condition should be well informed to the
suspected for Pakshaghata due to CVA relatives of the patient.
Patient examination – Basic neurological • Patient may be given Pradhamana
examinations may be done immediately. Nasya with 2-3 pinches of Vacha
Blood pressure should be checked and noted. Churna and Rudraksha Churna
Airway, breathing and circulation (ABC) may at 30 minutes interval for 3 to 4
be checked and assured. The patient may instillations (Pradhamana Nasya
be immediately sent to higher centers with may be avoided in intra cranial
diagnostic imaging facilities and intensive hemorrhages suspected cases).
care units. • In suspected cases of intracranial
In remotest places, when reference is not hemorrhages possible measures
possible treatment may be initiated with from Urdhwga Raktapitta Chikitsa
proper informed written consent from may be adopted except purgation
relatives. as Pratiloma Shodhana. The patient

200 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

may be given Pichu over vertex with • Eventually measures should be


drugs having cooling properties like taken to transfer the patient to
Kachuradi Churna mixed in Eranda higher centers.
Taila. Kalka Nasya with Sthambhana Shamana medicines: Shamana medications
property like Vasa or Durva may be also should be planned according to the
attempted. clinical varieties described above.

Table 30.2: Medicines at level 1 for Pakshaghat

Drugs Dosage Dose Time of Duration Remarks /


administration Anupana
Acute stroke - Remotest Level 1 - reference to higher centre is not possible
Drakshadi Kwatha1 Decoction 12-24 ml Twice or thrice Few hours Preferably as
Phanta
Suvarnamuktadi Vati 1-2 Vati Twice or thrice Few hours With Drakshadi
Gutika Kwatha
Dhanwantaram Vati 2-4 Vati Twice or thrice Few hours Along with Jeera
Gutika water
Patients with chronic residual palsy
Aswagandha Churna 3-5 gm Twice daily 3-4 months Warm water/
Churna honey/ milk
Bala Churna Churna 3-5 gm Twice daily 3-4 months Warm water/
honey/ milk
Rasna (Alpinia Churna 3-5 gm Twice daily 3-4 months Warm water/
galangal) Churna honey/ milk
Brahmi Churna Churna 5-2 gm Twice daily 3-4 months Warm water/
honey/ milk
Shankhapushpi Churna 5-2 gm Twice daily 3-4 months Warm water/
Churna honey/ milk
Chopchini Churna 5-2 gm Twice daily 3-4 months Warm water/
honey/ milk
Guggulu Churna 5-2 gm Twice daily 3-4 months Warm water
Haritaki Churna 5-10 gm Bed time 3-4 months Hot water
Ashtavargam Decoction 12-24 ml Empty stomach / 3-4 months –
Kashaya2 6 am & 6 pm
Dhanadanayanadi Decoction 12-24 ml Empty stomach / 3-4 months –
Kashaya 6 am & 6 pm
Gandharvahastadi Decoction 12-24 ml Empty stomach / 3-4 months Saindhava and
Kashaya3 6 am & 6 pm Guda

AYURVEDIC STANDARD TREATMENT GUIDELINES 201


PAKSHAGHATA

Maharasnadi Decoction 12-24 ml Empty stomach / 3-4 months –


Kashaya4 6 am & 6 pm
Dashmula Kwatha5 Decoction 12-24 ml Empty stomach / 3-4 months –
6 am & 6 pm
Eranda Taila Oil 15-30 ml Once at bed During Luke warm
time or empty constipation water /
stomach early warm milk/
morning Shatapushpa
Siddha water
Yogaraja Guggulu6 Vati 1-2 Vati Twice daily 3-4 months With warm
water
All patients may be given external applications like Karpasasthyadi Taila, Dhanwantaram Taila,
Kottamchukkadi Taila, Bala Taila or Nirgundi Taila as per availability and advised self massage, slight
fomentation and suitable physical exercises.

Patients with prophylactic treatment after a history of TIA or RIND


(Treatment strategies of Hypertension and dyslipidaemia can also adopted)
Rasona Pinda Liquid 5-20 ml Once or twice 3-4 months As plane /
sesame oil
Guggulu Churna 5-2 gm Twice daily 3-4 months Warm Water
Rasonadi Kashaya Decoction 12-24 ml Empty stomach 3-4 months
/6 am & 6pm

Pathya-apathya (diet and life style and balanced food. Khichadi made
education): with rice and green gram added
Please also refer diet contributing to hyper- with pure little amount of clarified
tension and dyslipidaemia and diabetes. ghee, cream removed milk is good.
Non Constipating diet as fiber rich
Since the disease is caused by diet and
food like leafy vegetables, green
activities contributing to obesity, vitiation of
salads, fruits, barley etc should be
Vata Rakta, specific advices should be given
encouraged. Vata alleviating food
to avoid all these. The whole life style of
articles prepared with ghee or any
the patient should be changed especially in
suitable oil, Udada (black gram),
prophylactic cases of TIA or RIND to prevent
Shigru Shaka (drumstick), brinjal
recurrences.
etc may be given. Patola, Rasona,
Dadima, Parushaka, Badara, Draksha,
Do’s–
may be advised by the patient. Shali,
• Ahara: The patient should be Shashtik, Kulattha, wheat products
provided easily digesting, nutritional are suitable.

202 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

• Vihara: Regular exercise along with without letting proper digestion


Abhyanga, Mardana, Avagahana or (Adhyashana), incompatible foods
Samvahana should be regularly used. (Virudhashana). All diet leading
Timely sleeping, attending natural to habitual constipation and
urges and maintaining calmness indigestion should be restricted.
of mind are very important. It is • Vihara: Chinta (excessive thinking),
always ideal to use hot water for Prajagarana (improper sleep at
drinking as well as bathing. night), Vega Vidharana (suppression
of natural urges, Shrama (excess
Dont’s (Apathya) hard work) should be avoided.
• Ahara: Use of food items like Sedentary habits, day sleep, night
Chanaka (bengal gram), Kalaya awakening, habit of holding of
(lathyrus or pea), Kordusha (millets), urges, smoking & alcoholism
Shyamaka, Rajmasha, Shitambu substance abuse and exposure
(cold water) should be avoided. to hot and cold intermittently
Vata contributing diet as dry food, are to be avoided. Psychological
excessive usage of pulses like green factors contributing to worsening
peas, black beans, lentils, yellow of the condition like exposure to
gram etc. pungent / astringent food persistent grief and fear, recurrent
like red chilies, excessive use of all aggressiveness, over worrying,
spices, diet with low water content anxiety etc should be successfully
like wafers, biscuits etc should be managed through counseling.
discouraged. Diet contributing
Referral criteria:
to vitiation of blood as spicy and
salty food like pickle, papad, soya • All acute stroke patients should
sauces, chili sauces, immediate be immediately referred to
consumption of cold after hot diet higher centers after quick initial
etc. should be avoided. Repeated assessment.
and continuous usage of excess • Those patients with residual
oily deep fried foods, sugar / paralysis not responding to the
carbohydrate rich diet like cold above management and getting
drinks, sweets, dry fruits etc, milk worsening may require in - patient
products like butter, cheese, paneer, management for better recovery
meat products should be strictly and may be referred to level 2.
avoided. Awareness should be • Those patients on prophylactic
generated regarding unhealthy medication is not under control
dietary habits like skipping for risk factors like blood pressure
meals (Anashana), late eating and fasting lipid profile and those
habits (Pramitashana), over eating patients show recurrent TIA

AYURVEDIC STANDARD TREATMENT GUIDELINES 203


PAKSHAGHATA

should be referred to higher centers • In young stroke patients ANA


for detailed investigations and screening may be done to exclude
management. anti phospholipid antibodies.
• In all residual paralysis patient’s
LEVEL 2: CHC’S OR SMALL systematic and regular check up for
HOSPITALS WITH BASIC blood pressure, lipid profiles and
FACILITIES blood glucose may be done.
Treatment: As Pakshaghata is a disease which
Clinical Diagnosis: Same as level 1
requires long term in patient department
Patient examination: For acute stroke cases, follow up for better recovery, secondary and
quick neurological and cardiovascular tertiary care hospitals are more important.
assessment should be done and then
In addition to the management mentioned in
immediately send for imaging studies. For
Level 1, the following drugs may be added as
chronic residual palsy patients detailed
per the requirement and status of the patient.
neurological examination should be carried
Rasaushadhi (Herbo-mineral drugs) or herbal
out to assess the degree of disability.
drugs containing potent toxic contents can
also be used at this level. Patient may be kept
Investigations:
under observation while prescribing these
• For all suspected acute stroke cases kinds of medicines.
CT Brain is mandatory to exclude
All acute stroke patients after CT scan may
intracranial bleed.
be informed about all possible treatment
• Later follow up MRI Brain may be strategies and those who opt for intensive
done for detailed assessment. management including thrombolytic
• MR angiogram may be performed therapy etc under a modern physician may
in cases of TIA or RIND symptoms be sent for the same. Other patients willing
in carotid territory. for continuing Ayurveda management can
be treated with informed consent.
• X-ray cervical spine along with
In acute stroke patients Pradhamana Nasya,
lying and standing blood pressure
Kalka Nasya, Pichu Dharana etc may be
is helpful in TIA in vertebra-basilar
done as described in Level 1 by an experi-
territory.
enced Ayurvedic physician. Shirolepa with
• All patients should be serially Purana Dhatri, Musta and Panchagandha
monitored for fluctuations in blood Churna pasted in buttermilk or continuous
pressure. Shirodhara with Dhanwantaram Taila etc, are
• Routine tests like CBC, ESR, blood also performed. Brihatvata Chintamani Rasa
glucose, lipid profiles, urea and 1-2 Vatilets well triturated in ghee are given
protein, ECG and a chest X-ray are in empty stomach in alternate two hours in
to be performed. acute stroke which yield better outcome.

204 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

The general line of management in Ayurveda In patient Panchakarma treatment:


for completed stroke patients with residual
All possible Panchakrma treatments with
palsy are detailed below.
medicines and indications are detailed in
Line of Management Level 3. All feasible and available treatment
• Shamana – Amapachana, Deepana, strategies can be incorporated in level 2
Rookshana, Snehana, Vatahara, also. Here Shamana therapy is explained
Brimhana in detail.

• Shodhana - Langhana, Snehana, Shamana: (Internal and external medications)


Swedana, Virechana, Anuvasana Basti,
Note: As the treatment approaches overlap between sep-
Nirooha Basti, Nasya, Masthishkya
arate conditions (explained in the context of introduction

Specific Line of Management and differential diagnosis) in different stages and Doshic
permutations, the medicines / procedures enlisted here
• Pakshaghata - Snehana, Swedana,
are indicated generally. Specific indications are highlighted
Snehayuktavirechana + Mastishkya,
where ever necessary.
Upanaha
• Ardita    -     Navana, Moordhnitaila,
Karnapoorana, Akshi Tarpana

Table 30.3: Medicines at level 2 for Pakshaghat

Drug Dosage Dose Time of Anupana Specific indication


form Administration
Single Drugs
Aswagandha Churna Churna 3-5 gm Twice daily Warm Brimhana,
Water/ Anabolic,
Honey/ Adaptogenic,
Milk Neurogenerative
Bala (Sida cordifolia) Churna 3-5 gm Twice daily Warm Balya,
Churna Water/ Neurogenerative
Honey/
Milk
Rasna (Alpinia Churna 3-5 gm Twice daily Warm Vatahara,
galangal) Churna Water/ Vedanasthapana
Honey/
Milk
Kapikacchu (Mucuna Churna 3-5 gm Twice daily Warm Medhya, Brimhana,
pruriens) Churna Water/ Kampavatahara
Honey/
Milk

AYURVEDIC STANDARD TREATMENT GUIDELINES 205


PAKSHAGHATA

Shatavari (Asparagus Churna 3-5 gm Twice daily Warm Pitta samsrishtavata


racemosus) Churna Water/
Honey/
Milk
Devadaru (Cedrus Churna 3-5 gm Twice daily Warm –
deodara) Churna Water/
Honey/
Milk
Shunthi (Ginger) Churna 3-5 gm Twice daily Warm –
Churna Water/
Honey/
Milk
Rasona Pinda Churna 5-20 ml Once or twice Sesame oil –
Jatamansi (Nardostachys Churna 5-2 gm Twice daily Warm Medhya, Avasadaka
jatamamsi ) Churna Water/
Honey/
Milk
Brahmi (Bacopa Churna 5-2 gm Twice daily Warm Medhya
monnieri)  Water/
Churna Honey/
Milk
Shankhupushpi Churna 5-2 gm Twice daily Warm Medhya
(Mussaendra frondosa) Water/
Honey/
Milk
Chopchini (Smilax Churna 5-2 gm Twice daily Warm Shoolahara
china) Water/
Honey
Guggulu (Commiphora Churna 5-2 gm Twice daily Warm Medasvrita vata
mukul ) Water

Combinations / Preparations

A. Early Stages of Residual Stroke (Kaphanubandha)


Rasonadi Kwatha Decoction 12-24 Twice daily In empty Vata direction
ml stomach reversed,
(Urdhwavata)
Sahacharadi Kashaya Decoction 12-24 Twice daily Empty Paraplegia, When
ml stomach, lower limbs are
Taila 05 ml more affected

206 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

Shaddharanam Churna 5-10 Twice daily With Warm Saamavatahara


Churnam7 gm water

Yogaraja Guggulu8 Vati 1-2 Twice daily Warm water Vatahara


Vati /Kwatha

Sahacharadi Taila9 Oil l0-15 Once or Twice Before food –


ml daily on appetite,
with
Kashaya

Karpasasthyadi Taila10 Oil l0-15 Once or Twice Before food –


ml daily on appetite,
with
Kashaya

Plain or various Oil 10-30 Along Early Vatanulomana,


processed Eranda ml with above morning or Pakshaghata specific
(Ricinus communis ) decoctions, at bed time
Taila milk or as
plain

B. Early Stages of Residual Stroke (Pittanubandha)

Brahmidrakshadi Decoction 12-24 Twice In empty Pittanubandha Vata,


Kwatha ml daily stomach Sarvanga Daha, Mada,
Moorcha

Drakshadi Kwatha11 Decoction 12-24 Twice In empty Pittanubandha Vata,


ml daily stomach as Moorcha
Phanta or Hima

Mansyadi Kwatha Decoction 12-24 Twice In empty Manodosha, Stress, Mada


ml daily stomach

Suvarna muktadi Gutika Vati 1-2 Twice With Coconut Giddiness, BPPV
Vati daily water

Thiktaka/ Mahathiktaka Ghee 10- 30 Once – –


/ Kalyanakam Ghrita12 ml or
twice
daily

Brahmi(Bacopa Ghee 15-30 Twice Before food Nooropic


monnieri) Ghrita13 gm daily

Avipatikara Churna14 Churna 5-15 Twice Before food, Pittasaraka


gm daily with honey

AYURVEDIC STANDARD TREATMENT GUIDELINES 207


PAKSHAGHATA

C. Later Stages of Stroke on Chronicity and Vata Predominance


Gugguluthiktakam Decoction 12-24 Twice In empty stomach In Chronicity,
Kashaya ml daily Deeper Dhatu
involvement
Prasaranyadi Kashaya Decoction 12-24 Twice In empty stomach, Monoplegia,
ml daily then milk porridge Upper limb
specific
Shundibaladi Kwatha Decoction 12-24 Twice In empty stomach Supti, (Parasthesia)
ml daily
Maharasnadi Kwatha15 Decoction 12-24 Twice In empty stomach, Pakshaghata,
ml daily Shunthi Churna/ Brimhana
Pippali Churna/
Yogaraja Guggulu/
Eranda Taila
Vidaryadi Kwatha Decoction 12-24 Twice In empty stomach Shosha Pradhana
ml daily
Nayopayam Kwatha Decoction 12-24 Twice In empty stomach Prana Udana
ml daily Anulomana,
Dhanwantharam Decoction 12-24 Twice In empty stomach Shiromarmabhighata
Kwatha ml daily with Dhanwantharam
Vatilet
Rasna Dashamooladi Ghee 15-30 Once Before food on Brimhana,
Ghritam ml or appetite, Warm Shirakampa
Twice water
daily
Gugguluthikthaka Ghee 15-30 Once Before food on
Ghrita16 ml or appetite
Twice
daily
Aswagandharishta17 Liquid 30 ml Twice After food Nootropic,
daily Revitaliser
Balarishta18 Liquid 30 ml Twice After food Nootropic,
daily Revitaliser
Saraswatharishta19 Liquid 10-20 Twice After food Nootropic,
ml daily Memory booster,
Improve speech
Dhanwantharam Gutika Vati 1-2 Twice With Jeera water Vatanulomana
Vati daily

208 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

Ksheerabala1 / Oil 10-15 Once Before food on Nadi Balyam,


Dhanwantharam / drops or appetite, with Sukshma Sneham
Maharajaprasrini Taila Twice Kashaya
7-101 avarthi daily
Karpasasthydi Taila/ Oil l0-15 Once Before food on Vata and Vata
Sahacharadi Taila/ ml or appetite, warm Kapha Pradhana
Dhanwantahra Taila/ Twice water
Mahanarayana Taila daily
Karpasasthydi Oil For Head / External application Taila for head and
Taila / Kuzhampu, ext. application.
Dhanwantaram20 Taila/ Kuzhambu for ext.
Kuzhampu, Sahacharadi application only
taila / Kuzhampu,
Prabhanjanam Taila /
Kuzhambu
Ksheerabla Taila / Bala Oil For Head and External application
Taila21
Kottamchukkadi Taila Oil For External Application In Sheetavridhi –
Kapha Vata
Pinda Taila Oil For External Application In Ushnavriddhi –
Pitta Vata
Nirgundi Taila Oil For External Application
Vishamushti Taila Oil For External Application
Rasa Preparations Commonly Practiced in Pakshaghata
Brihatvatachintamani22 Churna 60-125 mg Once daily With ghee
Vatagajankusharasa Churna 60-125 mg Twice daily Combination
with
Kashtoushdhis
Vatavidhwamsarasa23 Churna 60-125 mg Twice daily Combination Acute conditions
with of Pakshaghata,
Kashtoushadhi Painful limbs

Pathya-apathya (diet and life style signs of severe complications,


education): Same as level 1 patients of severe chronicity who
require complete Panchakarma
Referral criteria: therapy and Rasayana Chikitsa
• Patients not responding to above for better recovery are to be
mentioned management and show referred.

AYURVEDIC STANDARD TREATMENT GUIDELINES 209


PAKSHAGHATA

Treatment: In addition to the management of


LEVEL 3: AYURVEDA HOSPITALS Level 1 and Level -2, complete Panchakarma
AT INSTITUTIONAL LEVEL procedures (Samanya and Vishesh Chikitsa of
OR DISTRICT HOSPITAL/ Pakshaghata) for chronic, complicated and
INTEGRATED AYURVEDIC non responding patients are detailed here
HOSPITALS under Shodhana therapy.

Clinical Diagnosis: Same as level 1 for a Shodhana: (This include the list of Karma in
fresh case reporting directly chronological order with complete details
of procedures along with choice of drugs,
Investigation: Same as level 2 indication and contra indications)

Table 30.4: Panchakarma procedures at level 3 for Pakshaghat

Karma Choice of drugs Indications Contraindications


Udwarthana Kolakulathadi Churna (Ca. Kaphasamsrishta, Absolute Vata
Su); Dyslipidaemia, Obesity, type, Skin Allergy,
Yava, Kola, Kulatha; Flaccid stage of Stroke, Wasting, In obstinate
Triphala churna; Early stage of stroke constipation &
Sleeplessness
Dhanyamla Dhara Dhanyamla Saama/ Kapha samsrishta –
stage in Pakshaghata,
Pittanubandha, Painful
limbs

Agnilepa Drugs having Ushna In acute stage of Pittaanubandha


Veerya like Maricha, Tulasi, Pakshaghata, for initial 7
Shunthi, etc days, to improve from
flaccidity
Abhyanga Various oils explained for Vata Pradhana, In Kapha vitiation,
external application Generalized body ache, Indigestion,
Wasting, contractures, Suspected Ama
Spastic
Swedana Tapa, Ushma, Upanaha and Pakshaghata with Vata Pitta predominant/
Drava Sweda – Various Kapha symptoms like associated stage
articles Parasthesia, pricking pain,
convulsions, oedema,
stiffness etc
Churnapinda Kolakulathadi Yoga, Various Early stages of Keavala Vata,
Sweda Vata/ Kapha-hara Churnas Pakshaghata, Sama, Pittanubandha
Kaphsamsrishta

210 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

Patra Pinda Various leaves of Vata Usually After Churna Pittanubandha


Sweda alleviating property Pinda Sweda, directly on
Nirama stage
Jambheera Pinda Citrus fruit, turmeric and Same as above + Localised Pittanubandha
Sweda Vata alleviating Churnas oedema
Shashtika Pinda Shashtika rice, Bala Later stages of Pakshaghata, Kaphanubandha,
Sweda / Shashtika decoction and milk Disuse atrophy, Wasting, Saama, Sheeta
Lepana Weakness, Pittanubandha Anupashaya
Virechana Snehapana (Indukantha Essentially in all types of Active Gastric /
Ghrita, Vidaryadi Ghrita, Pakshaghata. Peptic Ulcer, IHD,
Karpasasthyadi Taila, Snehapana only when Ulcerative colitis,
Sahacharadi Taila, Doshik predominance in Acute abdomen, if
Ksheerabala Taila etc) 3-7 Pakshaghata is kevala Vata patient physically
days and Nirupasthambha weak
Swedana (Bashpa Sweda)
3 days
Virechana (Snigdha Virecha,
Plain or processed castor
oil, Mishraka Sneha, Eranda
Taila with milk)
Samsarjana Karma (3-7 days)
Anulomana Eranda Taila, Eranda bhrishta Vatika type associated –
Hareetaki, Senna, Hridya with chronic Vibandha
Virechana etc
Anuvasana Pippalyadi Anuvasana Vatika type associated Agnimaandhya, Rakta
Taila, Dhanwantahram with chronic Vibandha, Arsha
Taila, Sahacharadi Taila, conventionally prior to
Karpasasthyadi Taila etc Nirooha
Nirooha Basti – Erandamooladi Basti, Essentially in all types Contraindications of
Yoga /Kala/ Karma Madhutailika, Siddha Basti, of Pakshaghata, Classical Nirooha
pattern Rajayapana Basti Shodhana for Vata
Ksheera Dhooma Balakwatha, Ksheera When associated with –
facial palsy
Navana / Nasya Anutaila/ Ksheerabala Vatika stage of Pakshaghata, Contraindications of
(Avarthi), Dhanwantahara Arditha, Mada, Moorcha Nasya
(Avarthi), Shandbindhu Taila
Pradhamana Nasika Choorna, Vacha, Kapha associated Suspected IC
Nasya Katphala Pakshagahta, Sanyasa, in hemorrhage
unresponsive patients/
brainstem lesions

AYURVEDIC STANDARD TREATMENT GUIDELINES 211


PAKSHAGHATA

Avapeedaka Nasya Surasa, Lashuna (Garlic) etc Kapha associated Suspected IC


as Swarasa Pakshagahta, brainstem hemorrhage
lesions
As Taila shirodhara Custom practice in almost Saama,
all typesof Pakshghata and Kaphapradhana,
Ardita Jwaranubandha
Moordhni Taila Various Taila explained for In Later stages of Chronic / Recurrent
– (Shiroabhyanga application on head Pakshaghata, as a finishing sinusitis associated
Shiropichu treatment in Pakshaghata, with head ache
Shirodhara, Insomnia, stress Vata and Shiroabhyanga
Shirovasti) Pradhana stage Anupashaya
Takradhara Medicated Takra with Paittika and Vata Paittika Do
Purana dhatri, Mustha and association in Pakshaghata,
Panchagandha Churna Mada, Moorcha as
prophylactic
Upanaha Upanaha Churna, Salwana Wasting and painful Skin allergy
conditions
Rasnadi Pichu Rasnadi Churna with Eranda Kaphaja type HTN –
Taila
Kacchuradi Pichu Kacchuradi Churna with Vatapaittika type –
Eranda Taila

Rasayana: List of Rasayana drugs which 5. Guduchi (Tinospora cordifolia) Swarasa


may be used for either for prevention or 6. Siddhmakaradwaja Vati
management of the disease
7. Chitraka (Plumbago indica) Churna
1. Lashuna (garlic) Churna
8. Bhallataka Rasayana Avaleha
2. Shankhupushpi (Mussaendra frondosa)
Churna 9. Shatavari (Crotalaria verrucosa) Rasa

3. Vacha (Acorus calamus) Churna 10. Brahmi (Bacopa monnieri ) Churna

4. Mandookaparni (Centella asiatica) Swarasa Pathya-Apathya (Diet and life style


(juice) education): Same as level 1

212 AYURVEDIC STANDARD TREATMENT GUIDELINES


PAKSHAGHATA

REFERENCES

1 Vagbhata, Ashtanga hrudaya, Atridev 9 Vagbhata, Ashtanga Hrudaya, Atridev


Gupt, Vidyotini Hindi commentary, Gupt, Vidyotini Hindi commentary,
Chaukhambha prakashana, Edition Reprint Chaukhambha prakashana, Edition Reprint
2008, Varanasi, Chikitsasthana Jwara 2008, Varanasi, chikitsa sthanaa vata vyadhi
Chikitsa 1/55, p. no. 394. chikitsa 21/67-69, p. no. 573
2 Sahasrayoga, CCRAS, New Delhi, translated 10 Sahasrayoga, CCRAS, New Delhi,
by Dr. D B Pandit rao, edited by vivekanand translated by Dr. D B Pandit rao, edited by
pandey, Reprint edition 2011, kasaya vivekanand pandey, Reprint edition 2011,
prakaranam, 105, p.no. 22 taila prakaranam, 22, p.no. 252
3 Sahasra Yoga, CCRAS, New Delhi, 11 Vagbhata, Ashtanga Hrudaya, Atridev
translated by Dr. D B Pandit rao, edited by Gupt, Vidyotini Hindi commentary,
vivekanand pandey, Reprint edition 2011, Chaukhambha prakashana, Edition Reprint
Kasaya Prakaranam, 105, p.no. 22 2008, Varanasi, chikitsa sthana jwara
4 Sahasrayoga, CCRAS, New Delhi, translated chikitsa 1/55, p. no. 394.
by Dr. D B Pandit rao, edited by vivekanand 12 Vagbhata, Ashtanga Hrudaya, Atridev
pandey, Reprint edition 2011, Kasaya Gupt, Vidyotini Hindi commentary,
Prakaranam, 398, p.no. 80 Chaukhambha Prakashana, Edition Reprint
5 Govind Das Sen, Bhaishajya Ratnavali, 2008, Varanasi, Uttara sthana 6/26-39,
Siddhi nandan mishra, Siddhiprada p. no. 644.
commentary, Chaukhambha Surbharti 13 Vagbhata, Ashtanga Hrudaya, Atridev
Prakashan, Edition 2011, Varanasi, Kasa Gupt, Vidyotini Hindi commentary,
Rogadhikara 15/13, p. 439 Chaukhambha prakashana, Edition Reprint
6 Govind Das Sen, Bhaishajya Ratnavali, 2008, Varanasi, uttara sthana 6/23-25,
Siddhi Nandan Mishra, Siddhiprada p. no. 643.
Commentary, Chaukhambha Surbharti 14 Govind Das Sen, Bhaishajya Ratnavali,
Prakashan, Edition 2011, Varanasi, Amavata Siddhi Nandan Mishra, Siddhiprada
Rogadhikara 29/152-157, p. 607 commentary, Chaukhambha Surbharti
7 Sushruta, Sushruta Samhita, Ambikadatta Prakashan, Edition 2011, Varanasi,
shastri, Ayurveda tatva dipika Hindi Amlapitta Rogadhikara 56/24-28, p. 903
commentary, Chaukhambha Sanskrit
15 Sharangdhara, Sharangdhara Samhita,
Sansthan, Reprimt edition 2005, Varanasi,
Shailja Srivastava, Jivanprada Hindi
Vatavyadhi Chikitsasthana 4/3, p. no. 25
Commentary, Chaukhambha orientalia
8 Govind Das Sen, Bhaishajya Ratnavali, publication, reprint 2011, Madhyama
Siddhi Nandan Mishra, Siddhiprada
khanda, 2/90-96, p.no. 149
commentary, Chaukhambha Surbharti
Prakashan, Edition 2011, Varanasi, Amavata 16 Vagbhata, Ashtanga Hrudaya, Atridev
Rogadhikara 29/152-157, p. 607 Gupt, Vidyotini Hindi commentary,

AYURVEDIC STANDARD TREATMENT GUIDELINES 213


PAKSHAGHATA

Chaukhambha Prakashana, Edition Prakashan, Edition 2011, Varanasi,


Reprint 2008, Varanasi, chikitsa sthana p. 1122.
21, p. no. 573. 20 Vaidya Yoga Ratnavali Taila Prakarana
17 Govind Das Sen, Murchha Rogadhikara 21 Vagbhata, Ashtanga Hrudaya, Atridev
21/16-22, Bhaishajya Ratnavali, Gupt, Vidyotini Hindi commentary,
Siddhi Nandan Mishra, Siddhiprada Chaukhambha Prakashana, Edition
commentary, Chaukhambha Surbharti Reprint 2008, Varanasi, Chikitsa Sthana
Prakashan, Edition 2011, Varanasi, 21, p. no. 573.
p. 492 22 Govind Das Sen, Vatavyadhi Rogadhi-
18 Govind Das Sen, Vatavyadhi Rogadhi- kara 26/141-144, Bhaishajya Ratnavali,
kara 26/572-575, Bhaishajya Ratnavali, Siddhi Nandan Mishra, Siddhiprada
Siddhi Nandan Mishra, Siddhiprada commentary, Chaukhambha Surbhar-
commentary, Chaukhambha Surbharti ti Prakashan, Edition 2011, Varanasi,
Prakashan, Edition 2011, Varanasi, p. 570 p. 530.
19 Govind Das Sen, Rasayana Adhikara 23 Yogaratnakara, Vaidya Lakshmipati
73/178-192, Bhaishajya Ratnavali, Shastri, Vidyotini Hindi commentary,
Siddhi Nandan Mishra, Siddhiprada Chaukhambha Prakashan, Reprint 2013
commentary, Chaukhambha Surbharti Vatavyadhi Chikitsa, 1-3, p.no. 546

214 AYURVEDIC STANDARD TREATMENT GUIDELINES


SANDHIGATA VATA (OSTEOARTHRITIS)

• Vatarakta
INTRODUCTION
• Katigraha
Sandhigata Vata is the type of pathogenesis
involved in various disease conditions affect- • Gridhrasi
ing the joints, e.g. osteoarthritis, rheumatoid • Ansashoola
arthritis, etc. and causing pain in affected
• Krostrukshirsha
joints.1
• Ankylosing spondylitis
Case Definition:

Painful condition of joints involving single LEVEL 1: AT SOLO AYURVEDIC


or multiple joints restricting the movements, PHYSICIAN’S CLINIC/PHC
with or without swelling and crepitus (Sandhi
Clinical diagnosis: On the basis of history
Sphutana).
and clinical presentation
Differential Diagnosis:- Investigations: Nothing Specific

• Amavata Treatment: See table 31.1

Table 31.1: Medicines at level 1 for Sandhivata

Drug Dosage form Dosage Time of Duration Anupana


administration

Ashwagandha Churna 3-5 gm Twice daily 2-3 months Milk


Churna

Shuddha Churna 250 mg Twice daily 2 weeks Water


Vishtinduka

Pippalimoola Churna 500 mg Twice daily 1 month Water


Churna

Sunthi-Haritaki Churna 3-5 gm Twice daily 1 month Water


Churna

Rasnadi Kwatha2 Decoction 30-40 ml Empty stomach 15 days to -


twice daily one month

Dashamula Kwatha Decoction 30-40 ml Empty stomach 15 days to -


twice daily one month
SANDHIGATA VATA (OSTEOARTHRITIS)

Rasna-Erandadi Decoction 30-40 ml Empty stomach 15 days to -


Kwatha3 twice daily one month
Yogaraja Guggulu4 Vati 1-2 Vati After food 15 days to Rasna-
(500 mg) Thrice a day one month saptaka
Kwatha /
warm
water
Simhanada Vati 1-2 Vati After meal thrice 15 days to Warm
Guggulu (500 mg) a day one Month water

Local: and ice cream, Continuously fasting


or taking limited food for a very
Abhyanga: On the affected joints with warm
long duration.
medicated oils like Bala Taila, Sahachara
Taila, Vishagarbha Taila, Nirgundi Taila, • Vihara: Inadequate sleep or fre-
Mahanarayana Taila, Brihat Saindhavadi Taila, quent changes in sleep pattern,
Dhanvantara Taila, Kottamchukadi Taila. suppression of natural urge espe-
Swedana: With hot water bag, Nadi Sveda, cially of hunger, bowel and urine
Baluka Pottali Sweda, Nirgundi Patra Pinda and emotions, Excessive physical
Sveda, Parisheka. strain like swimming, climbing,
walking, running, sports which
Pathya-apathya (diet and life style): involve straining of joints like in
badminton, football etc., all such
Do’s (Pathya) occupation which involves exces-
• Ahara: Purana Shali, green gram, sive movement of joints, resulting
milk, grape, Luke warm water, in joint injuries.
Paraval, drum stick, garlic. Referral Criteria: Refer to Level 2
• Vihara: Massage, warm water 1. Cases that are not responding to above
bath, posture correction, follow the management and develop complications
Dinacharya and Rutucharya. or severe painful condition.

Don’ts: 2. Need further investigations.

• Ahara: Dried vegetables, lentils,


LEVEL 2: CHC’S OR SMALL
sprouts, raw vegetables and HOSPITALS WITH BASIC
salads, refined foods such as white FACILITIES
flour, excessive use of leafy green
vegetables, mushrooms, peas, Clinical diagnosis: The diagnosis is made on
Excessive intake of pungent food, the basis of criteria mentioned in Level-1 for
cold drinks, beverages, chilled food fresh cases. The case referred from Level-1 or

216 AYURVEDIC STANDARD TREATMENT GUIDELINES


SANDHIGATA VATA (OSTEOARTHRITIS)

fresh case must be evaluated thoroughly for • RA Factor


any complication.
• S. alkaline phosphatase
Investigations:
• X-Ray of affected joint
• Haemogram
• CRP
• Serum uric acid
• Serum calcium Treatment: See table 31.2.

Table 31.2: Medicines at level 2 for Sandhivata

Drug Dosage Dose Time Duration Anupana


form
Maha Yogaraja Guggulu5 Vati 500 mg- Thrice a 15 days to Rasnadi Kwatha,
1 gm day one month Triphala Kwatha

Kaishora Guggulu6 Vati 500 mg- Thrice a 15 days to Dashamula Kwatha,


1 gm day one month Luke warm water

Vatavidhvamsa Rasa7 Vati 125-250 Twice 15 days to Warm water/


mg daily one month honey

Narsimha Churna 1.5 gm After meal 15days to Warm Water


Churna8 twice daily one month

Dashamool- arishta Arista 15-30 ml Twice One month Nil


daily

Ashwagandh- arista Arista 15-30 ml Twice One month Nil


daily

Amrita Bhallataka Avaleha 5-10 gm Once daily One month With milk

Local management: • Abhyanga / Sthanika Mridu


Snehana: Medicated oil such
• Upanaha with leaves of Eranda,
as Mahanarayana Taila,13 Masha
Nirgundi, Arka, Chincha etc. on
Taila, Kshirbala Taila, Ashwagandha
affected joints.
Balalakshadi Taila
• Lepa with Dashanga Lepa, Lepaguti, • Swedana (medicated fomentation):
Gandhabiroja Lepa etc.
1. Ekanga (local fomentation) or
• Janubasti / Greevabasti / Katibasti: Sarvanga Sweda (whole body
Mahanarayana Taila9, Masha Taila, fomentation) with decoction of
Prabhanjana Vimardana Taila,10 Nirgundi, Dashamula, Eranda,
Vishagarbha Taila,11 Bala Taila12 etc Balamula, etc

AYURVEDIC STANDARD TREATMENT GUIDELINES 217


SANDHIGATA VATA (OSTEOARTHRITIS)

2. Patra Pinda Sweda: local fomen- Investigations:


tation by Pottali made from
1. Investigations mentioned in level 2 may
leaves of Nirgundi, Eranda etc.
be repeated if necessary.
Pathya-apathya (diet and life style): Same
as Level 1 2. BMD
Referral Criteria: The cases those are not Treatment: In addition to the treatment
responding to above mentioned therapy prescribed in level-1 and 2, following
and suffering from advanced stages of procedures can be done.
disease like severe effusion, contractures,
1. Basti Karma: Tiktaksheera Basti, Yapana
osteoporosis or deformities or Patients with
Basti &Yoga Basti
some other uncontrolled conditions like
obesity, hypothyroidism, diabetes mellitus 2. Agni karma (cauterization): Agni Karma
and hypertension etc. on the affected joints

3. Virechana: obese patients may be given


LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL Virechana
LEVEL OR DISTRICT HOSPITAL/ 4. Siravedha
INTEGRATED AYURVEDIC
Pathya-Apathya (Diet and life style):- Same
HOSPITALS
as level 1
Clinical Diagnosis: Same as level 1 for a
fresh case reporting directly.

REFERENCES

1 Agnivesha, Charaka, Charaka Samhita, 4 Anonymous, The Ayurvedic Formulary of


Chikitsa Sthana 28/37, edited by Vaidya India, Part 1, Ed. 2nd, Govt. of India, Ministry
Yadavaji Trikamji Acharya Chaukhamba of Health and Family Welfare, Department
Surbharati Prakashana, Varanasi 2011. of I.S.M. & H., New Delhi, 2003:215
pg.no.618
5 Anonymous, The Ayurvedic Formulary of
2 Anonymous, The Ayurvedic Formulary of India, Part 1, Ed. 2nd, Govt. of India, Ministry
India, Part 1, Ed. 2nd, Govt. of India, Ministry of Health and Family Welfare, Department
of Health and Family Welfare, Department of I.S.M. & H., New Delhi, 2003:212
of I.S.M. & H., New Delhi, 2003:193
6 Sri Govinda Dasa, Bhaishajya Ratnavali,
3 Anonymous, The Ayurvedic Formulary of
Vatarakta Chikitsa Adhikar 27/98-108,
India, Part 1, Ed. 2nd, Govt. of India, Ministry
In: Ambikadutta Shastri, Chaukhamba
of Health and Family Welfare, Department
Prakashan, Varanasi, 2009
of I.S.M. & H., New Delhi, 2003:197

218 AYURVEDIC STANDARD TREATMENT GUIDELINES


SANDHIGATA VATA (OSTEOARTHRITIS)

7 Anonymous, The Ayurvedic Formulary of of Health and Family Welfare, Department


India, Part 1, Ed. 2nd, Govt. of India, Ministry of I.S.M. & H., New Delhi, 2003:406
of Health and Family Welfare, Department 11 Anonymous, The Ayurvedic Formulary of
of I.S.M. & H., New Delhi, 2003:722 India, Part 1, Ed. 2nd, Govt. of India, Ministry
8 Anonymous, The Ayurvedic Formulary of of Health and Family Welfare, Department
India, Part 1, Ed. 2nd, Govt. of India, Ministry of I.S.M. & H., New Delhi, 2003:444
of Health and Family Welfare, Department 12 Anonymous, The Ayurvedic Formulary of
of I.S.M. & H., New Delhi, 2003:326 India, Part 1, Ed. 2nd, Govt. of India, Ministry
9 Anonymous, The Ayurvedic Formulary of of Health and Family Welfare, Department
India, Part 1, Ed. 2nd, Govt. of India, Ministry of I.S.M. & H., New Delhi, 2003:413
of Health and Family Welfare, Department 13 Anonymous, The Ayurvedic Formulary of
of I.S.M. & H., New Delhi, 2003:436 India, Part 1, Ed. 2nd, Govt. of India, Ministry
10 Anonymous, The Ayurvedic Formulary of of Health and Family Welfare, Department
India, Part 1, Ed. 2nd, Govt. of India, Ministry of I.S.M. & H., New Delhi, 2003:436

AYURVEDIC STANDARD TREATMENT GUIDELINES 219


VATARAKTA (GOUT)

Line of Treatment
INTRODUCTION
Vatarakta is a disease of vitiated Vata External application, Abhyanga, Parisheka and
and Rakta. Most of the collagen vascular Upanaha are advised in Uttana Vatarakta and
disorders / connective tissue disorders come Virechana, Asthapan and Snehapan are given
under the broad umbrella of Vatarakta. in Gambhira Vatarakta.

Case Definition:
Often it is presented clinically in the form of LEVEL 1: AT SOLO AYUVEDIC
painful joints, parasthesia, eruption, swelling, PHYSICIAN’S CLINIC/PHC
redness etc. Vatarakta is of two types – Uttana
Clinical Diagnosis: On the basis of
when pathology is confined to Twak and
history and clinical presentation patient
Mamsa and Gambhira when deeper tissues
can be diagnosed provisionally as case of
and organs are involved in the pathogenesis.
Vatarakta.
Differential diagnosis: Investigations: Nothing specific
1. Amavata
Treatment: In the initial stage when the
2. Kushtha
patient is having mild features of Vatarakta,
3. Visarpa along with diet restriction, two or more of
4. Arbuda following drugs may be given:

Table 32.1: Medicines at level 1 for Vatarakta

Drugs Dosage Dose Time of Duration Anupana


form administration
Guduchi Swarasa / 10-20 ml / Before meal/ 2-3 weeks Warm water
Churna 3-5 gm thrice a day
Kokilaksham Decoction 20-40 ml Before meal/ 2-3 weeks Warm water
Kashayam twice daily
Rasna Erandadi Decoction 20-40 ml Before meal/ 2-3 weeks -
Kwatha1 twice daily
Laghu Decoction 20-40 ml Before meal/ 2-3 weeks -
Manjisthadi thrice a day
Kwatha
Kaishora Vati 1-2 Vati After meal/ 2-3 weeks Warm Water
Guggulu2 (500 mg) thrice a day
VATARAKTA (GOUT)

Punarnava Vati 1-2 Vati After meal/ 2-3 weeks Warm Water
Guggulu3 (500 mg) thrice a day
Simhanada Vati 1-2 Vati After meal/ 2-3 weeks Warm water
Guggulu4 (500 mg) thrice a day
Nimbadi Churna 1-3 gm After meal/ 2-3 weeks Guduchi
Churna5 thrice a day Kwatha,
Warm water
Triphala Decoction 20-40ml Before meal/ 2-3 weeks Madhu
Kwatha thrice a day
Amrutadi Decoction 20-40ml Before meal/ 2-3 weeks
Kwatha6 thrice a day
Pinda Taila7, Taila Q.S. Once daily 1 month External
application
Ksheerabala Taila Q.S. Once daily 1 month External
Taila8 application

Pathya-apathya (diet and life style): • Vihara: Suppression of natural


urge especially of hunger, bowel
Do’s (Pathya) and urine and emotions, day
sleep, excessive physical activity,
• Ahara: Green gram, barley, Syamaka
exposure to sun.
(Sava), Raktashali, wheat, goat milk,
cow milk. Tanduliya, Kushmanda, Referral criteria:
Draksha, Parval, Eranda Taila, butter,
• If patient is not responding to
bottle gourd, drumstick, Punarnava,
treatment.
Vastuka, bitter gourd, asafoetida,
black pepper, rock salt. Soup of • Need further investigations
Arhar, Moong, Chanak, Masur and
Makushtha. LEVEL 2: CHC’S OR SMALL
• Vihara: nothing specific
HOSPITALS WITH BASIC
FACILITIES
Don’ts (Apathya): Clinical diagnosis: Same as level 1 for a fresh
case reporting directly.
• Ahara: Black gram, horse gram,
Nishpava, Kalaya, Kshara, Anupa Investigation:
Mamsa, refined foods such as white • Complete hemogram
flour, peas, spinach, potatoes, butter
• CRP
milk, curd, tomato, fermented
foods, red meat, cold beverages, • S. Uric Acid, RA factor
liquor, cold water. • X-ray of affected joints

AYURVEDIC STANDARD TREATMENT GUIDELINES 221


VATARAKTA (GOUT)

Treatment: Treatment given in Level 1 may be continued.

Table 32.2: Medicines at level 2 for Vatarakta

Drugs Dosage Dose Time of Duration Anupana


form administration
Brhat manjistadi Kwatha9 Decoction 20-40 ml Before meal 2-3 weeks -
twice daily
Amrutadi Vati 1-2 Vati After meal/ 2-3 weeks Warm water
Guggulu (500 mg) twice daily
Panchtikta Ghee 12 gm Before meal/ 2-3 weeks Milk, warm
Guggulu Ghrita10 twice daily water
Sukumara Ghrita11 Ghee 12 gm Before meal/ 2-3 weeks Milk, warm
twice daily water
Madhu-yashtyadi Tailam12 6 to 10 Before meal/ 2-3 weeks Warm Water
Oil drops twice daily
Griha dhumadi13 Lepa Churna Q.S. Once daily 15 days External
application
Nagaradi Lepa Churna Q.S. Once daily 15 days External
application
Dashamoola Ksheera Kshira Paka Q.S. Once daily 15 days External
application
Sahacharadi Taila14/Pinda Taila Q.S. Once daily 15 days External
Taila15 / Dhanvantaram application
Taila16/ Ksheerabala Taila17
*Note: Brhat Manjistadi Kwatha, Panchatikta Guggulu Ghrita and Amruta Guggulu in Tridoshaja Vatarakta, Kokilaksham
Kashayam in Raktadhikya Vatarakta are advisable

Pathya-Apathya (Diet and life style): Same Investigation: ANA screening.


as level 1
Treatment:
Referral criteria: If patient is not responding
to treatment of Level 1 and 2 and develops a. Virechana Karma
complication. b. Rakta Mokshana – Jalaukavacharana (Leech
therapy) on painful and swollen joint.
LEVEL 3: AYURVEDA HOSPITALS c. Basti –
AT INSTITUTIONAL LEVEL 1. Matra Basti – Brihatsaindhavadi taila18-
OR DISTRICT HOSPITAL/ in painful condition, Amavastha,
INTEGRATED AYURVEDIC Madhuyastyadi Taila, Kshirabala Taila
HOSPITALS 2. Kshira Basti
Clinical Diagnosis: Same as level 1 for a 3. Yapana Basti - Guduchyadi Yapana,
fresh case reporting directly Madhutailika Basti

222 AYURVEDIC STANDARD TREATMENT GUIDELINES


VATARAKTA (GOUT)

Rasayana: See table 32.3

Table 32.3: Rasayanas can be used at level 3 for Vatarakta

Drugs Dosage Dose Time of Duration Anupana


form administration
Shilajatu Rasayana Churna 500 mg – 1 gm Early morning 2-3 months Guduchi
empty stomach Kwatha
Pippali Kshirapaka 3 Pippali in Early morning 22 days Milk
increasing dose empty stomach
upto 33 Pippali
and reverse

Pathya-Apathya (Diet and life style): Same as level 1

REFERENCES

1 Anonymous, The Ayurvedic Formulary of 7 Anonymous, The Ayurvedic Formulary of


India, Part 1, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:197 of I.S.M. & H., New Delhi, 2003:404
2 Anonymous, The Ayurvedic Formulary of 8 Anonymous, The Ayurvedic Formulary of
India, Part 1, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:207 of I.S.M. & H., New Delhi, 2003:378
3 Anonymous, The Ayurvedic Formulary of 9 Anonymous, The Ayurvedic Formulary of
India, Part 2, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003 of I.S.M. & H., New Delhi, 2003:189
4 Anonymous, The Ayurvedic Formulary of 10 Anonymous, The Ayurvedic Formulary of
India, Part I, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:223 of I.S.M. & H., New Delhi, 2003:270
5 Anonymous, The Ayurvedic Formulary of 11 Anonymous, The Ayurvedic Formulary of
India, Part I, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:321 of I.S.M. & H., New Delhi, 2003:301
6 Sri Govinda Dasa, Bhaishajya Ratnavali 12 Anonymous, The Ayurvedic Formulary of
Vataraktadhikara 27/26, In: Ambikadutta India, Part I, Ed. 2nd, Govt. of India, Ministry
Shastri, Chaukhamba Prakashan Varanasi, of Health and Family Welfare, Department
2009 of I.S.M. & H., New Delhi, 2003:434

AYURVEDIC STANDARD TREATMENT GUIDELINES 223


VATARAKTA (GOUT)

13 Anonymous, The Ayurvedic Formulary of 16 Anonymous, The Ayurvedic Formulary of


India, Part I, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:485 of I.S.M. & H., New Delhi, 2003:394
14 Anonymous, The Ayurvedic Formulary of 17 Anonymous, The Ayurvedic Formulary of
India, Part I, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:456 of I.S.M. & H., New Delhi, 2003:378
15 Anonymous, The Ayurvedic Formulary of 18 Anonymous, The Ayurvedic Formulary of
India, Part I, Ed. 2nd, Govt. of India, Ministry India, Part I, Ed. 2nd, Govt. of India, Ministry
of Health and Family Welfare, Department of Health and Family Welfare, Department
of I.S.M. & H., New Delhi, 2003:404 of I.S.M. & H., New Delhi, 2003:428

224 AYURVEDIC STANDARD TREATMENT GUIDELINES


Netragata Roga
ABHISHYANDA (CONJUNCTIVITIS)

coldness, Sravomuhuh – frequency of


INTRODUCTION
discharge is increased, Picchila – slimy
Abhishyanda is considered as the root cause discharge.
of almost all the eye diseases.1 Abhishyanda is 4. Raktaja Abhishyanda: Tamra Asruta -
one among the seventeen types of Sarvagata coppery tears, Lohita Netrata - blood red
Netra Rogas explained in the classics. It is discoloration of eye, Samanatat Atilohita
of four types viz. Vataja, Pittaja, Kaphaja Rajyah: Generalized congestion.
and Raktaja. The word Abhishyanda means
“Ativriddhi” and “Sravana”. Abhi - going
Case Definition:
towards / great / excessive, Syanda – tremor
/ to shaking. Other meanings of Abhishyanda Abhishyanda is defined as a disease in which
are oozing / flowing / trickling. Ayurvedic there is Sroto Syandana (secretions) in all
features of Abhishyanda as per classics are channels of head and neck. Inflammation
mentioned below: of the conjunctiva is classically defined as
conjunctival hyperaemia associated with
1. Vataja Abhishyanda: Nistodana - pricking
discharge which may be watery, mucoid,
sensation, Stambhana - stiffness,
mucopurulent, purulent.
Romaharsha - horripilation, Sangharsa
- foreign body sensation, Parushya -
roughness, Siro-abhitapa - headache, Differential Diagnosis:
Vishuskabhava - dryness, Shishiraasruta 1. Adhimantha: In Adhimantha, excessive
- cold or watery discharge. churning type of pain as if eye is being
2. Pittaja Abhishyanda: Daha - burning extracted from its socket.
sensation, Prapaka - severe
2. Sashopha Akshipaka: In Sashopha Akshipaka
Inflammation, Shishira Abinanda - relief
inflammation is more prominent feature
by cold measures, Dhumayana- feeling of
in comparison to Abhishyanda.
Smokiness, Baspasamuchhraya – sensation
of steam, Usnasruta – Warm lacrimation, 3. Sirotpata: If the eye is marked with
Pitakanetrata - yellowish discoloration of painless or painful coppery red vascular
the eye. streaks, which later on totally disappear
the disease is known as Sirotpata.
3. Kaphaja Abhishyanda: Usnaabhinanda
- relief by warm measures, Guruta – 4. Siraharsha: The advance stage of the
heaviness, Kandu – itching, Upadeha Sirotpata due to the neglecting leads
- stickiness due to increased exudates, to Siraharsha, in which there will be
Sitata- whiteness, Atisaityam - excessive difficulty in visual perception.
ABHISHYANDA (CONJUNCTIVITIS)

Table 33.1: Differentiating features of common types of conjunctivitis:

Signs Bacterial Viral Allergic Chlamydia


Congestion Marked Moderate Mild to Moderate
moderate
Chemosis ++ +/- ++ +/-
Subconjunctival +/- + - -
hemorrhage
Discharge Purulent or Watery Ropy / watery Mucopurulent
mucopurulent
Papillae +/- - ++ +/-
Follicles - + - ++
Pseudo membrane +/- +/- - -
Pannus - - - +
Pre-auricular lymph node + ++ - +/-

Differential Diagnosis of Conjunctivitis: Investigation: Though much can be


• Scleritis, diagnosed based on the clinical signs and
• Acute Iridocyclitis, symptoms, torch light examination of
• Acute Congestive Glaucoma, affected eye may be done.
• Trachoma, Treatment: In the initial stage when the
• Bacterial / Viral / Allergic / patient is having mild features of Abhishyanda,
Chlamydia Conjunctivitis. following drugs may be given. However, in
the initial five days, fasting in the form of
LEVEL 1: AT SOLO AYURVEDA light diet may be advised.
PHYSICIAN’S CLINIC / PHC
Clinical Diagnosis: Diagnosis can be done
on the basis of clinical presentation

Table 33.2: Medicines at level 1 for Abhishyanda

Drugs Dosage Dose Time of Anupana Duration


form administration
Aam Pachana Vati Vati 2 Vati After Meal / Hot 7 days
twice a day Water
Triphala Guggulu2 Vati 2 Vati After Meal / Hot 7 days
twice a day Water

228 AYURVEDIC STANDARD TREATMENT GUIDELINES


ABHISHYANDA (CONJUNCTIVITIS)

Vasakadi Kwatha3 Kwatha 20 ml Before meal / Water 7 days


twice a day
Brihat Vasakadi Kwatha4 Kwatha 20 ml Before meal / Water 7 days
twice a day
Patoladi Kwatha5 Kwatha 20 ml Before meal / Water 7 days
twice a day
Phalatrikadi Kwatha6 Kwatha 20 ml Before meal / Water 7 days
twice a day
Vasanimbadi Kwatha7 Kwatha 20 ml Before meal / Water 7 days
twice a day
Manjishthadi Kwatha8 Kwatha 20 ml Before meal / Water 7 days
twice a day
Drugs for local application:
Opthacare eye drops Liquid 1 drop Thrice a day - 7 days
Nayanamruta Liquid 1 drop Thrice day - 7 days
Netrabindu9
I tone eye drops Liquid 1 drop Twice day - 7 days
Netra Pariseka: Churna 2 gm + 1 gm + 1 Thrice day - 7days
Triphala Yavkuta, 10 gm + 1 gm + 500
Yashtimadhu, Vasa, mg respectively
Lodhra, Tankana

Diet education and preventive of Jeevanti (Leptadenia reticulata),


measures: Sunishannaka (Marsilea minuta),
Tanduleeya (Amaranthus aspera),
Do’s -
Vastuka (Chenopodium album),
• Ahara:11,12,13 Regular intake of Karkotaka (Momordica dioica),
Yava (Hordeum vulgare), Godhuma Karavellaka (Momordia charantia),
(Triticum sativum Linn), Lohita Shigru (Moringa oleifera), Agastya
Shali (Oryza sativa Linn), Mudga (Sesbania grandiflorum), Punarnava
(Phaseolus radiatus), Shatavari (Boerrhavia diffusa), brinjal, carrot,
(Asparagus racemosus), Patola spinach, cow ghee, cow milk, one
(Trichosanthes dioica), Kustumburu year old preserved Ghrita, meat of
(Coriander sativum), Surana (Phallus birds and wild animals, Amalaki
campanulatus), unripe banana (Embelica officinalis), Draksha (Vitis
(Musa spp.), cooked vegetables vinifera) dried and fresh both,

AYURVEDIC STANDARD TREATMENT GUIDELINES 229


ABHISHYANDA (CONJUNCTIVITIS)

Dadim (Punica granatum), Almond, lacrimation, hunger, thirst etc.;


Saindhava (rock salt), sugar candy looking at minute objects, excessive
(Sita), honey (Kshaudra) and weeping, excessive vomiting and
Amalaki Payasa, Shatavari Payasa suppression of vomiting, daytime
are beneficial for the eyes. sleep and awakening at night,
shift duties, working on computer
• Vihara: Withdrawing the mind
for continuous and longer
from objects of senses, Padabhyanga
duration and watching television
(Foot massage), Shiroabhyanga
for long time, sudden changes
(scalp massage with oil), Netra
of temperatures, exposure to
Prakshalana (eye wash), Mukhalepa
frequent change of hot and cold
(face pack with herbal medicines),
temperatures, exposure to dust
wearing head gear, always
and fumes, excessive sunlight
wearing shoes are also beneficial
exposure and smoking.
for the eyes.
Referral Criteria: Patient not responding
to the above treatment and needs further
Dont’s -
investigations to find out the cause.
• Ahara: Excessive and regular
intake of horse gram and black
gram pulses, Virudha Dhanya LEVEL 2: CHC’S OR SMALL
(sprouts), chillies and spices, sour HOSPITALS WITH BASIC
and fermented foods like pickles, FACILITIES
idali, dosa etc, heavy foods like
cheese, paneer, deep fried items Clinical Diagnosis: Same as level 1; for fresh
etc, Junk foods and fast foods, cases reporting directly.
Dadhi (curd), Matsya (fish), meat
Investigation: same as level 1 and in
of animals belonging to damp
addition
areas (Anoopa Mamsa), Phanita,
Pinyaka (oil cake) Aranala (sour 1. Vision test
gruel), excess water intake, excess
2. Slit lamp examination
alcohol intake, betel leaf chewing
(Tambula) 3. Fluorescein and Rose Bengal Staining

• Vihara: Life style factors like Treatment: In addition to the management


anger, grief, excessive coitus; mentioned in Level 1, few of the following
suppression of natural urges drugs may be added as per the requirement
like defecation, micturition, and status of the patient.

230 AYURVEDIC STANDARD TREATMENT GUIDELINES


ABHISHYANDA (CONJUNCTIVITIS)

Table 33.3: Medicines at level 2 for Abhishyanda

Drugs Dosage Dose Time of administration Duration Anupana


form
Sahacharadi Ghrita14 Ghrita 10 ml Before meal / once a 7 days Milk
day evening (Nishi Kala)
Tiktaka Ghrita15 Ghrita 10 ml Before meal / once a 7 days Milk
day evening (Nishi Kala)

Sutashekhara Rasa16 Churna 250 mg Twice a day 7 days Milk / warm


water

Kaphaketu Rasa17 Churna 125-250 Twice a day 7 Days Honey


mg

Vatavidhvamsana Churna 125-250 Twice a day 7 Days Honey


Rasa18 mg

Pathya - Apathya (Diet and life style): Same • Fluorescein and Rose Bengal
as level 1. Staining
Referral criteria: Refer to level 3
Treatment:
1. Cases not responding to above therapy.
• In addition to the management of
2. Patients with severe conjunctivitis,
Level 1 and Level -2,
infection spread on cornea and blurring
of vision. • Treatment can be done according to
predomince of Dosha.
3. Patient is indicated for Panchakarma
therapy. a. Chikitsa Sutra of Vataja
Abhishyanda19 – The patient
should be treated with old ghee
LEVEL 3: AYURVEDIC
(clarified butter). The part of
HOSPITALS AT INSTITUTIONAL
the forehead adjoining the eye
LEVEL OR DISTRICT
and not the eye itself should be
HOSPITAL / INTEGRATED
fomented and local venesection
AYURVEDIC HOSPITALS.
resorted to. Then after having
Clinical Diagnosis: Same as level-1 effected full purging with the
help of a Sneha-Basti (oleaginous
Investigation: enema), such measures as
Tarpana, Putapaka, fumigation,
• Culture and Sensitivity test Aschyotana (sprinklings), Nasya

AYURVEDIC STANDARD TREATMENT GUIDELINES 231


ABHISHYANDA (CONJUNCTIVITIS)

(snuffing), Sneha Parisheka fumigation, washes, Vidalaka,


(oily washings), Shirobasti or Kavala (gargles).
washing with any decoction
d. Chikitsa Sutra of Raktaja
prepared with the drugs of the
Abhishyanda22 – The patient
Vayu-subduing group.
should be first anointed
b. Chikitsa Sutra of Pitaja and lubricated with old and
Abhishyanda20– Bloodletting matured clarified butter,
and purgatives, eye-washes venesection should then be
and Vidalaka, Nasya (snuffing) resorted to. Vidalaka, washes,
and Anjana (collyrium). snuffs, inhalation of medicated
c. Chikitsa Sutra of Kaphaja smokes, eye drops, collyrium,
Abhishyanda21– In acute Tarpana (soothing measures),
stage it should be treated by Putapaka should be prescribed.
bloodletting by venesection
• If needed Panchakarma procedures
or other means, by the
indicated for Conjunctivitis can be
employment of fomentation,
performed.
Avapida Nasya, Anjana,

Table 33.4: Shodhana Chikitsa and other Kriyakalpas at level 3 for Abhishyanda

Shodhana Vataja Pittaja Kaphaja Abhishyanda Raktaja


Karma Abhishyanda Abhishyanda Abhishyanda
Nasya Oil processed Ghee processed Avapida Nasya with Ghritamanda
with Shalaparni, with Pittahara Trikatu, Katphala etc processed with
milk and drugs drugs Shali, Durva, Kapha breast milk
of Madhura Gana Daruharidra Shamaka drugs.25 and Madhuka,
are beneficial.23 Sariva, Kashmari and Nilotapala.26
sugarcane juice.24
Ashcyotana Goat’s milk Goat’s milk Decoction of Sunthi, Triphala, Lodhra,
processed with processed with Triphala, Nimba, Vasa, Yasti, Sharkara,
leaves, root and Lodhra, Yastimadhu Lodhra30 Musta with cold
bark of Eranda27 and ghee. 29 water31
Goat milk
processed
with Haridra,
Devadaru and
Saindhava28
Shigrupallav Rasa with Honey32
Triphala decoction33

232 AYURVEDIC STANDARD TREATMENT GUIDELINES


ABHISHYANDA (CONJUNCTIVITIS)

Parisheka Drugs used in Aschyotana can be used for Parisheka in respective Doshas.
Anjana Pashupata Yoga34 Pashupata Yoga35 Fruits of Shigru and Equal parts of
Karanja, Patala, Arjuna,
fruits and flowers of Sriparni,
Brihati36 Bilwa, Dhataki,
Manjishtha,
Amalaki pasted
with honey.37
Siramoksha Snehana, Swedana Snehana, Swedana Snehana, Swedana Bloodletting by
followed by followed by followed by Leech.41
bloodletting Siravyadhana39 Bloodletting by
with Shrunga38 Alabu or through
Siravyadha40
Dhoomapan Snaihika Dhoomapana with
Dhumapana with Trikatu, Haridra,
Agaru, Guggulu - Sarshapa, Nimba,
and Ghee etc42 Guggaluetc Kaphahara
Dravya43
Virechana Snehapana: plain Gau Ghrita, Mahatriphala Ghrita44 / Mahatiktaka Ghrita45 / Patola
Ghrita46
As per the status of the patient,
Virechana: Mridu Virechana / Koshtha Shuddhi with Avipattikara Churna47 5-10 gm with
Drakhshadi Kashaya48 (50-100 ml).
Tilwaka Ghrita (5-10 gm) with Tilwaka Kashaya (50-100 ml) may be done for early few
days of the treatment49

REFERENCES

1. Shri Dalhana Acharya, Sushruta, Sushruta Chaukhambha Vishvabharati, Varanasi,


Samhita with Nibandhasamgraha 2007.
commentary 1/11,12 edited by Vaidya 4. Vrindamadhava or Siddhayoga, 61/67,
Jadavji Trikamji Acharya, Chaukhamba edited and translated by Premvati Tiwari,
Surabharati Prakashan Varanasi, Chaukhambha Vishvabharati, Varanasi,
Uttaratantra, 2010. pg. 603. 2007.
2. Anonymous, The Ayurvedic Formulary 5. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (5:5), 2000. Welfare, Govt. of India, Part I (4:17), 2000.

3. Vrindamadhava or Siddhayoga, 61/65, 6. Anonymous, The Ayurvedic Formulary


edited and translated by Premvati Tiwari, of India, Ministry of Health and Family

AYURVEDIC STANDARD TREATMENT GUIDELINES 233


ABHISHYANDA (CONJUNCTIVITIS)

Welfare, Govt. of India, 2000, Part II (4:16), 17. Anonymous, The Ayurvedic Formulary
2000. of India, Ministry of Health and Family
7. Vrindamadhava or Siddhayoga, 61/71.72 Welfare, Govt. of India, Part I (20:8), 2000.
edited and translated by Premvati Tiwari, 18. Anonymous, The Ayurvedic Formulary
Chaukhambha Vishvabharati, Varanasi, of India, Ministry of Health and Family
2007. Welfare, Govt. of India, Part I (20:45), 2000.

8. Anonymous, The Ayurvedic Formulary 19. ShriDalhana Acharya, Sushruta, Sushruta


of India, Ministry of Health and Family Samhita with Nibandhasamgraha
Welfare, Govt. of India, Part I (4:24), 2000. commentary, Uttaratantra 9/3-4; edited
by Vaidya Jadavji Trikamji Acharya,
9. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan
of India, Ministry of Health and Family
Varanasi; 2008.
Welfare, Govt. of India, Part II (11:1), 2000.
20. Shri Dalhana Acharya, Sushruta, Sushruta
10. Anonymous, The Ayurvedic Formulary Samhita with Nibandhasamgraha
of India, Ministry of Health and Family commentary, Uttaratantra10/3; edited
Welfare, Govt. of India, Part II (4:9), 2000. by Vaidya Jadavji Trikamji Acharya
11. Yogaratnakara, Vidyotini Hindi Chaukhamba Surabharati Prakashan
Commentary by Vaidya Lakshmipati Varanasi; 2008.
Shastri; Netrarogadhikara; Chaukhambha 21. Shri Dalhana Acharya, Sushruta, Sushruta
Prakashan Vranasi Edition 2008. Samhita with Nibandhasamgraha
12. Sushruta. Sushruta Samhita Dalhana Comm. commentary, Uttaratantra 11/2-3; edited
- Nibandhasamgraha, Uttaratantra 17/50- by Vaidya Jadavji Trikamji Acharya,
51; Chaukhambha Orientalia Varanasi, Chaukhamba Surabharati Prakashan
2005, 8th Edition, 2010. Varanasi; 2008.
22. Shri Dalhana Acharya, Sushruta, Sushruta
13. Vrddha Vagbhata, Ashtanga Samgraha
Samhita with Nibandhasamgraha
- Sasilekha Comm. Indu, Uttartantra, 56;
commentary, Uttaratantra 12/2-3; edited
Chaukhambha Krishna Das Academy,
by Vaidya Jadavji Trikamji Acharya,
Varanasi, 2000.
Chaukhamba Surabharati Prakashan
14. Vrddha Vagbhata, Ashtanga Samgraha - Varanasi, 2008.
Sasilekha Comm. Indu; Uttartantra 19/17;
23. Shri Dalhana Acharya, Sushruta, Sushruta
Chaukhambha Krishna Das Academy,
Samhita with Nibandhasamgraha
Varanasi, 2000.
commentary, Uttaratantra 9/10-11 edited
15. Anonymous, The Ayurvedic Formulary by Vaidya Jadavji Trikamji Acharya,
of India, Ministry of Health and Family Chaukhamba Surabharati Prakashan
Welfare, Govt. of India, Part I (6:13), 2000. Varanasi; 2008.
16. Anonymous, The Ayurvedic Formulary 24. Shri Dalhana Acharya, Sushruta, Sushruta
of India, Ministry of Health and Family Samhita with Nibandhasamgraha
Welfare, Govt. of India, Part I (20:52), commentary Uttaratantra 10/5; edited
2000. by Vaidya Jadavji Trikamji Acharya,

234 AYURVEDIC STANDARD TREATMENT GUIDELINES


ABHISHYANDA (CONJUNCTIVITIS)

Chaukhamba Surabharati Prakashan Chaukhambha Krishna Das Academy,


Varanasi; 2008. Varanasi, 2000.

25. Shri Dalhana Acharya, Sushruta, Sushruta 33. Sharangdharacharya. Sharangdhara


Samhita with Nibandhasamgraha Samhita, Uttarakhanda 13/9, Tra. Himsagar
commentary, Uttaratantra 11/3-5, edited Chandra Murty, Chaukhamba Surabharati
by Vaidya Jadavji Trikamji Acharya, series. Varansi; 2007.
Chaukhamba Surabharati Prakashan 34. Vagabhata, Ashtanga Hridaya with
Varanasi; 2008. the commentaries Sarvangasundara of
Arundatta and Ayurveda Rasayana of
26. Vrddha Vagbhata, Ashtanga Samgraha -
Hemadri, Uttarasthana 16/25-27, edited
Sasilekha Comm. Indu; Uttartantra, 19/40;
by Pandit Hari Sadasiva Sastri Paradakara
Krishna Das Academy, Varanasi, 2000.
Bhisagacarya; Chaukhambha Orientalia,
27. Shri Dalhana Acharya, Sushruta, Sushruta Varanasi, Reprint -2011.
Samhita with Nibandhasamgraha
35. Vagbhata, Ashtanga Hridaya with the
commentary Uttaratantra, 9/13-14; edited
commentaries Sarvangasundara of
by Vaidya Jadavji Trikamji Acharya,
Arundatta and Ayurveda Rasayana of
Chaukhamba Surabharati Prakashan
Hemadri, : Uttarasthana16/25-27, edited
Varanasi, 2008.
by Pandit Hari Sadasiva Sastri Paradakara
28. Sharangdharacharya. Sharangdhara Bhisagacarya; Chaukhamba Orientalia,
Samhita, Uttarakhanda; 13/8, Tra. Himsagar Varanasi, Reprint – 2011.
Chandra Murty, Chaukhamba Surabharati 36. Shri Dalhana Acharya, Sushruta Samhita
series. Varanasi: 2007. with Nibandhasamgraha commentary,
29. Sharangdharacharya, Uttarakhanda; Uttaratantra11/6-9, edited by Vaidya Jadavji
13/8Tra. Himsagar Chandra Murty, Trikamji Acharya Chaukhamba Surabharati
Chaukhamba Surabharati series. Varanasi: Prakashan Varanasi, 2008.
2007. 37. Shri Dalhana Acharya, Sushruta, Sushruta
Samhita with Nibandhasamgraha
30. Vagbhata, Ashtanga Hridaya with the
commentary, Uttaratantra 12/11-12 edited
commentaries Sarvangasundara of
by Vaidya Jadavji Trikamji Acharya,
Arundatta and Ayurveda Rasayana of
Chaukhamba Surabharati Prakashan
Hemadri, : Uttaratantra 16/17, edited by
Varanasi, 2008.
Pandit Hari Sadasiva Sastri Paradakara
Bhisagacarya; Chaukhambha Orientalia, 38. Vagbhata, Ashtanga Hridaya with the
Varanasi, Reprint -2011. commentaries Sarvangasundara of
Arundatta and Ayurveda Rasayana of
31. Sharangdharacharya. Sharangdhara
Hemadri, Uttaratantra 19/10 edited by
Samhita, Uttarakhanda13/9, Tra. Himsagar
Pandit Hari Sadasiva Sastri Paradakara
Chandra Murty, Chaukhamba Surabharati
Bhisagacarya; Chaukhamba Orientalia,
series. Varansi; 2007.
Varanasi, Reprint -2011.
32. Vrddha Vagbhata, Ashtanga Samgraha - 39. Shri Dalhana Acharya, Sushruta, Sushruta
Sasilekha Comm. Indu; Uttartantra,16/9, Samhita with Nibandhasamgraha

AYURVEDIC STANDARD TREATMENT GUIDELINES 235


ABHISHYANDA (CONJUNCTIVITIS)

commentary, Uttaratantra 10/3 edited by Vaidya Jadavji Trikamji Acharya


by Vaidya Jadavji Trikamji Acharya year Chaukhamba Surabharati Prakashan
2008, Chaukhamba Surabharati Prakashan Varanasi, 2008.
Varanasi, 2008.
44. Anonymous, The Ayurvedic Formulary
40. Shri Dalhana Acharya, Sushruta, Sushruta of India, Ministry of Health and Family
Samhita with Nibandhasamgraha Welfare, Govt. of India, Part I (6:35), 2000.
commentary, Uttaratantra 19/30, edited
45. Anonymous, The Ayurvedic Formulary
by VaidyaJadavji Trikamji Acharya,
of India, Ministry of Health and Family
Chaukhamba Surabharati Prakashan
Welfare, Govt. of India, Part I (6:34), 2000.
Varanasi, 2008.
46. Anonymous, The Ayurvedic Formulary
41. Shri Dalhana Acharya, Sushruta, Sushruta
of India, Ministry of Health and Family
Samhita with Nibandhasamgraha
Welfare, Govt. of India, Part I (6:28), 2000.
commentary, Uttaratantra 12/8, edited
by Vaidya Jadavji Trikamji Acharya, 47. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan of India, Ministry of Health and Family
Varanasi, 2008. Welfare, Govt. of India, Part I (7:2), 2000.

42. Vrddha Vagbhata, Ashtanga Samgraha - 48. Anonymous, The Ayurvedic Formulary
Sasilekha commentary Indu, Uttartantra, of India, Ministry of Health and Family
19/11 Chaukhambha Krishna Das Academy, Welfare, Govt. of India, Part I (4:13), 2000.
Varanasi, 2000. 49. Vrddha Vagbhata, Ashtanga Samgraha -
43. Shri Dalhana Acharya, Sushruta, Sushruta Sasilekha Comm. Indu, Uttartantra, 19/10
Samhita with Nibandhasamgraha Chaukhambha Krishna Das Academy,
commentary, Uttaratantra 11/3-5 edited Varanasi, 2000.

236 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

muscular tissue), Avilam (blurring of


INTRODUCTION
vision), Kunchana Asphotana (feeling
Adhimantha1 is a disease characterized by of constriction & bursting), Adhmana
intense feeling in the eye, wherein eye seems (raised tension), Vepathu (twitching),
to be being extracted out and churned up Sirsoardham Vyathana (headache on one
along with the involvement of the half of side).
the head in association with specific features 2. Pittaja Adhimantha: Raktarajicitam
of the particular Dosha involved. On the (congestion), Sravi (discharges), Daha
basis of symptoms it can be correlated with (burning sensation), Yakrat Pindopmam
Glaucoma. (eye discoloration to brownish red),
Glaucoma is not a single disease process Ksharanaktamiva Kshatam (burning
but a group of disorders characterized by a sensation like salt applied on wound),
progressive optic neuropathy resulting in a Prapaka (severe inflammation), Sa-
characteristic appearance of the optic disc and swedana (perspiration), Pita Darsanam
a specific pattern of irreversible visual field (yellowish appearance of all objects),
defects that are associated frequently but not Murccha (unconscious), Sirodaha
invariably with raised intraocular pressure. (burning sensation in the head).
There are so many types of glaucoma out of 3. Kaphaja Adhimantha: Sopha (swelling),
which Primary open angle glaucoma (POAG) Srava (discharge), Kandu (itching), Sitata
and Primary angle closure glaucoma (PACG) (whiteness), Guruta (heaviness), Picchila
are most common type. On the basis of signs (slimy), Dushika (muddy discharge),
& symptoms, POAG can be correlated with Harshana (horripilation), Rupam Pashyati
Vataja & Kaphaja Adhimantha & PACG can be Dukhena (seeing is difficult or painful),
correlated with Raktaja & Pittaja Adhimantha. Pamshupurnam-iva-avilam (haziness of
cornea), Nasadhmana (blockage in the
Ayurvedic classification: nose), Shirodukha (headache).
1. Vataja Adhimantha: Utpatyataiva- 4. Raktaja Adhimantha: Bandhujiva
feeling like eye ball extraction, Mathyate Pratikasham (eye looks like Bandhujiva
Aranivat (feeling like eyeball is churned flower/bloody red eye), Tamra Ashruta
up by Arani – a churner for making (coppery tears), Sparshanaakshamam
buttermilk out of curd), Sangharsa (tenderness), Raktasrava (bleeding),
(Foreign body sensation), Todana & Nistoda (pricking type pain),
Nirbheda (pricking sensation or splitting Pashyatiagninibha disha (visualizes flames
pain), Mamsasamrabdha (swelling of in all directions).
ADHIMANTHA (GLAUCOMA)

Case Definition: of Glaucoma and should be referred for


management to hospital or center at level 2.
Excessive churning type of pain in which the
patient feels that his eye is being extracted
from its socket which can also lead to LEVEL 2: CHC’S OR SMALL
blindness in addition to pain.2 HOSPITALS WITH BASIC
FACILITIES
Differential diagnosis:
1. Abhishyanda – In Abhishyanda discharge Clinical Diagnosis: Same as level 1
is more in comparison to Adhimantha. Investigation: Though much can be
2. Sashopha Akshipaka – In Sashopha Akshipaka diagnosed based on the clinical signs and
inflammation is more prominent feature symptoms, Laboratory investigations help
in comparison to Adhimantha. the clinician to confirm the diagnosis and
3. Sirotpata - If the eye is marked with rule out other conditions:
painless or painful coppery red vascular • Complete Blood Count
streaks, which later on totally disappears,
• Torch light examination
the disease is known as Sirotpata.
• Vision test
4. Siraharsha - The advance stage of Sirotpata
due to the neglect leads to Siraharsha in • Slit lamp examination
which there will be difficulty in visual • Tonometry for IOP evaluation
perception. (normal 10-20 mm of Hg)
• Direct and indirect Ophthalmoscope
Differential diagnosis of Glaucoma:
examination
• Acute iridocyclitis • Confrontation / Automated
• Posterior uveitis Perimetry

• Congenital optic disc anomalies • Fundus Photography

• Acute conjunctivitis
Treatment:
• Ocular hypertension
POAG: (Vataja & Kaphaja Adhimantha)
• Physiological cupping of optic disc
• Mootrala (diuretics) drugs
• Secondary glaucoma for reducing IOP such as
Punarnavashtaka Kwatha, Gokshuradi
LEVEL 1: AT SOLO AYUVEDIC Guggulu, Chandraprabha Vati orally
PHYSICIAN’S CLINIC / PHC etc.
• Ashchyotana (mentioned below)
Clinical Diagnosis: On the basis of history
and clinical presentation patient can be • Chakshushya & Rasayana drugs
suspected provisionally as a fresh case (mentioned below)

238 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

• Oral administration of Sahacharadi • Ashchyotana with Goat’s milk used


Ghrita mentioned specially for as eye drops to relieve pain.6
Adhimantha3
• Other oral or local drugs can be used
PACG: (Pittaja & Raktaja Adhimantha) according to signs & symptoms of
• Mootrala (diuretics), Chakshushya & patient.
Rasayana drugs (mentioned below) In the initial stage when the patient is having
• Rakta Prasadaka drugs in Raktaja mild (two or more) features of Adhimantha
Adhimantha as Brihat Kushmanda following drugs may be given:
Avaleha4 &, Shatavari Paka5

Table 34.1: Medicines at level 2 for Adhimantha

Drugs Dosage Dose Time of Durations Anupana


form administration
Aampachana Vati Vati 2 Vati After meal / 7 days Hot Water
twice a day
Gokshuradi7 / Vati 2-3 Vati After meal / 15-20 days Hot Water
Triphala Guggulu8 twice a day
Pathyadi Kwatha9 Decoction 20 ml Before meal / 15-20 days Guda
twice a day
Vasakadi Kwatha10 Decoction 20 ml Before meal / 15-20 days Water
twice a day

Brihat Vasakadi Kwatha11 Decoction 20 ml Before meal / 15-20 days Water


twice a day
Patoladi Kwatha12 Decoction 20 ml Before meal / 15-20 days Water
twice a day
Phalatrikadi Kwatha13 Decoction 20 ml Before meal / 15-20 days Water
twice a day
Sahacharadi Ghrita14 Ghrita 10 ml Before meal / 15-20 days Milk
evening (Nishi Kala)
Tikataka Ghrita15 Ghrita 10 ml Before meal / 15-20 days Milk
evening (Nishi Kala)
Brihat Kushmanda Avaleha 5-10 gm After meal / 15-20 days Milk
Avaleha16 twice a day
Shatavari Paka17 Avaleha 5-10 gm After meal / 15-20 days Milk
twice a day
Punarnavashtaka Decoction 20 ml Before meal / 15-20 days Water
Kwatha18 twice a day

AYURVEDIC STANDARD TREATMENT GUIDELINES 239


ADHIMANTHA (GLAUCOMA)

Pathya-Apathya (Diet and life style (eye wash), Mukhalepa (face pack
education) with herbal medicines), wearing
head gear, always wearing shoes
Diet education and preventive measures: are also beneficial for the eyes.

Do’s -
Dont’s -
• Ahara:19,20,21 Regular intake of
Yava (Hordeum vulgare), Godhuma • Ahara: Excessive and regular intake
(Triticum aestivum Linn), Lohita of Horse gram and Black gram
Shali (Oryza sativa Linn), Mudga pulses, Virudhadhanya (sprouts),
(Phaseolus radiatus), Shatavari chillies and spices, sour and
(Asparagus racemosus), Patola fermented foods like pickles, idali,
(Trichosanthes dioica), Kustumburu dosa etc, heavy foods like cheese,
(Coriander sativum), Surana (Phallus paneer, deep fried items etc, Junk
campanulatus), unripe banana foods and fast foods, Dadhi (curd),
(Musa spp.), cooked vegetables Matsya (fish), meat of animals
of Jeevanti (Leptadenia reticulata), belonging to damp areas (Anoopa
Sunishannaka (Marsilea minuta), Mamsa), Phanita, Pinyaka (oil cake)
Tanduleeya (Amaranthus aspera), Aranala (sour gruel), excess water
Vastuka (Chenopodium album), intake, excess alcohol intake, betel
Karkotaka (Momordica dioica), leaf chewing (Tambula)
Karavellaka (Momordia charantia),
• Vihara: life style factors like
Shigru (Moringa oleifera), Agastya
anger, grief, excessive coitus;
(Sesbania grandiflorum), Punarnava
suppression of natural urges
(Boerrrhavia diffusa), brinjal, carrot,
like defecation, micturition,
spinach, cow ghee, cow milk, one
lacrimation, hunger, thirst etc.;
year old preserved Ghrita, meat of
looking at minute objects, excessive
birds and wild animals, Amalaki
weeping, excessive vomiting and
(Embelica officinalis), Draksha (Vitis
suppression of vomiting, daytime
vinifera) dried and fresh both,
sleep and awakening at night, shift
Dadim (Punica granatum), Almond,
duties, working on computer for
Saindhava (rock salt), Sita (sugar
continuous and longer duration and
candy), Kshaudra (honey) and
watching television for long time,
Amalaki Payasa, Shatavari Payasa are
sudden changes of temperatures,
beneficial for the eyes.
exposure to frequent change
• Vihara: Withdrawing the mind of hot and cold temperatures,
from objects of senses, Padabhyanga exposure to dust and fumes,
(Foot massage), Shiroabhyanga (scalp excessive sunlight exposure and
massage with oil), Netraprakshalana smoking.

240 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

Referral criteria: Refer to level 3 decoction prepared with the drugs


of the Vayu-subduing group.
1. Cases not responding to above therapy
as: Patients with persistent raised intra • Chikitsa Sutra of Pitaja
ocular pressure, field loss, optic atrophy Adhimantha 23
– Bloodletting
and sudden loss of vision, PACG etc. and purgatives, eye-washes and
Vidalaka, Nasya (snuffing) and
Anjana (collyrium).
LEVEL 3: AYURVEDA
HOSPITALS AT INSTITUTIONAL • Chikitsa Sutra of Kaphaja
LEVEL OR DISTRICT Adhimantha – In acute stage it
24

HOSPITAL / INTEGRATED should be treated by bloodletting


AYURVEDIC HOSPITALS by venesection or other means, by
the employment of fomentation,
Clinical Diagnosis: Same as level 1 Avapida Nasya, Anjana, fumigation,
washes, Vidalaka, Kavala (gargles).
Investigation:
• Chikitsa Sutra of Raktaja
• Gonioscopy Adhimantha – The patient should
25

• Automated perimetry be first anointed and lubricated with


old and matured clarified butter,
• OCT to evaluate optic disc, optic
venesection should then be resorted
cup.
to. Vidalaka, washes, Nasya (snuffs),
Treatment: In addition to the management inhalation of medicated smokes, eye
of Level-2, Treatment can be done according drops, collyrium, Tarpana (soothing
to predominance of Dosha. measures), Putapaka should be
prescribed.
• Chikitsa Sutra of Vataja
Adhimantha – The patient should
22 • if needed Panchakarma procedures
be treated with old ghee (clarified indicated for glaucoma can be
butter). The part of the forehead performed such as:
adjoining the eye and not the eye
itself should be fomented and local POAG: (Vataja & Kaphaja Adhimantha)
venesection resorted to. Then after • If not responding to above treatment
having affected full purging with then Agnikarma (cauterization) over
the help of a Sneha-Basti (oleaginous the eyebrows will be beneficial.26
enema), such measures as Tarpana,
• Siravyadha (bloodletting) mentioned
Putapaka, fumigation, Aschyotana
in all types of glaucoma.27
(sprinklings), Nasya (snuffing),
Sneha Parisheka (oily washings), • Tarpana indicated in primary open
Shiro-Basti or washing with any angle Glaucoma not in PACG.

AYURVEDIC STANDARD TREATMENT GUIDELINES 241


ADHIMANTHA (GLAUCOMA)

• Basti, Virechana etc. are also Shodhana Chikitsa


indicated.
1. Virechana:
PACG: (Pittaja & Raktaja Adhimantha) Snehapana: Plain Gau Ghrita, Mahatriphala
Ghrita28 / Mahatikataka Ghrita29 / Patola Ghrita30.
• All the treatment of POAG except
Virechana as per the status of the patient-
Tarpana.
Mridu / Krura Koshtha Virechana/ Koshtha
• Immediate IOP reducing treatment Shuddhi with Avipattikara Churna31 5-10 gm
as- Tikshna Virechana, Siravyadhana with Drakshadi Kashaya32.
etc.
Tilwaka Ghrita with Tilwaka Kashaya 5-10 gms
Other oral or local drugs can be used may be done/ given for early few days of the
according to signs & symptoms of patient. treatment.33

2. Nasya:
Table 34.2: Uses of Nasyas in various type of Adhimantha

Vataja Adhimantha: Snehana Nasya: Oil processed with Rasna, Dashmoola, Bala, milk and drugs of
Madhura Gana are beneficial.34

Pittaja Ksheersarpi (equal quantity of milk & ghee) Nasya in every 3-3 days
Adhimantha: Ghee processed with Pittahara drugs Shali, Durva, Daruharidra.35

Kaphaja Avapidana Nasya with Trikatu, Katphala etc. Kaphashamaka drugs.36


Adhimantha

Rakataja Ghritamanda processed with breast milk and Madhuka, Nilotapala.37


Adhimantha

3. Tarpana:
Table 34.3: Uses of Tarpana in various type of Adhimantha

Vataja Adhimantha Panchamula, Jivaniya and the flesh of Kukkuta should be cooked with milk
and this processed milk is used for Tarpana.38

Pittaja Adhimantha Shankha, Shukti, Madhu, Draksha, Yashti and Kataka should be cooked with
milk and this processed milk is used for Tarpana.39

Kaphaja Adhimantha The milk is cooked with goat’s liver, Agaru, Priyangu, Devadaru and it
should be churned to obtain butter and ghee should be obtained after
cooking it.40

242 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

4. Ashchyotana
Table 34.4: Uses of Ashchyotana & Parisheka in various type of Adhimantha

Vataja Pittaja Kaphaja Raktaja


Ashchyotana Goat’s milk Goat’s milk Decoction of Triphala, Lodhra,
processed with processed Sunthi, Triphala, Yashti, Sharkara,
leaves, root and with Lodhra, Nimbi, Vasa, Musta with cold
bark of Eranda.41 Yastimadhu and Lodhra44 water45
Goat milk ghee. 43
processed with
Haridra, Devadaru
and Saindhava42
Shigrupallav Rasa with Honey46
Triphala decoction47
Parisheka Same drugs used in Ashchyotana can be used in Parisheka in respective Doshas.

7. Anjana
Table 34.5: Uses of Anjana in various type of Adhimantha

Vataja Pittaja Kaphaja Raktaja


Anjana Pashupata Pashupata Yoga49 Fruits of Shigru Equal parts of Patala,
Yoga48 and Karanja Arjuna, Shriparni,
Fruits and flowers Dhataki, Amalaki, Bilwa,
of Brihati50 Manjishtha pasted with
honey.51

8. Siramokshana:
Table 34.6: Uses of Siramokshana in various type of Adhimantha

Vataja Adhimantha Siramokshana after sudation.52

Pittaja Adhimantha By Siravyadhana.53

Kaphaja Adhimantha After Dhoopana blood-letting (Siravyadha) should be done followed by


Virechana.54
Raktaja Adhimantha Leeches should be applied around the eye to induce blood-letting.55

9. Dhoomapana:
Table 34.7: Uses of Dhumapana in various type of Adhimantha

Dhoomapana Snaihika Dhoomapana with


Dhumapana with Trikatu, Haridra,
Agaru, Guggulu - Sarshapa, Nimba, -
and Ghrita etc.56 Guggulu etc.
Kaphahara Dravya.57

AYURVEDIC STANDARD TREATMENT GUIDELINES 243


ADHIMANTHA (GLAUCOMA)

REFERENCES

1. Sushruta. Sushruta Samhita Dalhana Comm. Chaukhambha Vishvabharati, Varanasi,


– Nibandha sangraha, Uttaratantra 6/12-13; 2007.
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6. Vrddha Vagbhata, Ashtanga Samgraha Welfare, Govt. of India, Part A (3/7), 2000.
- Sasilekha Comm. Indu; Uttartantra, 9/13- 17. Anonymous, The Ayurvedic Formulary
14, Chaukhambha Krishna Das Academy, of India, Ministry of Health and Family
Varanasi, 2000. Welfare, Govt. of India, Part A (3/27), 2000.
7. Anonymous, The Ayurvedic Formulary 18. Anonymous, The Ayurvedic Formulary
of India, Ministry of Health and Family of India, Ministry of Health and Family
Welfare, Govt. of India, Part I (5:3), 2000. Welfare, Govt. of India, Part A (4/21), 2000.
8. Anonymous, The Ayurvedic Formulary 19. Yogaratnakara, Vidyotini Hindi
of India, Ministry of Health and Family Commentary by Vaidya Lakshmipati
Welfare, Govt. of India, Part I (5:5), 2000. Shastri; Chaukhambha Prakashan Vranasi
9. Anonymous, The Ayurvedic Formulary Edition 2008.
of India, Ministry of Health and Family 20. Sushruta. Sushruta Samhita Dalhana Comm.
Welfare, Govt. of India, Part II (4:15), 2000. - Nibandhasangraha, Uttaratantra 17/50-
10. Vrinda Madhava or Siddhayoga, 61/65 51, Chowkhambha Orientalia Varanasi,
edited and translated by Premvati Tiwari, 2005.

244 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

21. Vrddha Vagbhata, Ashtanga Samgraha 28. Anonymous, The Ayurvedic Formulary
- Sasilekha Comm. Indu; Uttartantra, 56, of India, Ministry of Health and Family
Chaukhambha Krishna Das Academy, Welfare, Govt. of India, Part I (6:35), 2000.
Varanasi, 2000. 29. Anonymous, The Ayurvedic Formulary
22. Shri Dalhana Acharya Sushruta, Sushruta of India, Ministry of Health and Family
Samhita with Nibandhasamgraha Welfare, Govt. of India, Part I (6:34), 2000.
commentary, Uttaratantra 9/3-4, edited 30. Anonymous, The Ayurvedic Formulary
by Vaidya Jadavji Trikamji Acharya, of India, Ministry of Health and Family
Chaukhamba Surabharati Prakashan Welfare, Govt. of India, Part I (6:28),
Varanasi, 2008. 2000.
23. Shri Dalhana Acharya, Sushruta, Sushruta 31. Anonymous, The Ayurvedic Formulary
Samhita with Nibandhasamgraha of India, Ministry of Health and Family
commentary, Uttaratantra 10/3 edited Welfare, Govt. of India, Part I (7:2), 2000.
by Vaidya Jadavji Trikamji Acharya,
32. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan
of India, Ministry of Health and Family
Varanasi, 2008.
Welfare, Govt. of India, Part I (4:13),
24. Shri Dalhana Acharya, Sushruta, Sushruta 2000.
Samhita with Nibandhasamgraha 33. Vrddha Vagbhata, Ashtanga Samgraha -
commentary, Uttaratantra 11/2-3, edited Sasilekha Comm. Indu; Uttartantra, 19/10,
by Vaidya Jadavji Trikamji Acharya, Chaukhambha Krishna Das Academy,
Chaukhamba Surabharati Prakashan Varanasi, 2000.
Varanasi, 2008.
34. Shri Dalhana Acharya, Sushruta, Sushruta
25. Shri Dalhana Acharya, Sushruta, Sushruta Samhita with Nibandhasamgraha
Samhita with Nibandhasamgraha commentary, Uttaratantra 9/10-11, edited
commentary, Uttaratantra 12/2-3, edited by Vaidya Jadavji Trikamji Acharya,
by Vaidya Jadavji Trikamji Acharya, Chaukhamba Surabharati Prakashan
Chaukhamba Surabharati Prakashan Varanasi, 2008.
Varanasi, 2008.
35. Shri Dalhana Acharya, Sushruta, Sushruta
26. Vagabhata, Ashtanga Hridaya with Samhita with Nibandhasamgraha
the commentaries Sarvangasundara of commentary Uttaratantra 10/5, edited
Arundatta and Ayurveda Rasayana of by Vaidya Jadavji Trikamji Acharya,
Hemadri, Uttaratantra 16/21, edited by Chaukhamba Surabharati Prakashan
Pandit Hari Sadasiva Sastri Paradakara Varanasi, 2008.
Bhisagacarya; Chaukhambha Orientalia, 36. Shri Dalhana Acharya, Sushruta, Sushruta
Varanasi, Reprint 2011. Samhita with Nibandhasamgraha
27. Vrddha Vagbhata, Ashtanga Samgraha - commentary Uttaratantra 11/3-5, edited
Sasilekha Comm. Indu; Uttartantra, 19/22, by Vaidya Jadavji Trikamji Acharya,
Chaukhambha Krishna Das Academy, Chaukhamba Surabharati Prakashan
Varanasi, 2000. Varanasi, 2008.

AYURVEDIC STANDARD TREATMENT GUIDELINES 245


ADHIMANTHA (GLAUCOMA)

37. Vrddha Vagbhata, Ashtanga Samgraha - 45. Sharangdharacharya. Sharangdhara


Sasilekha Comm. Indu; Uttartantra, 19/40, Samhita, Tra. Himsagar Chandra Murty,
Chaukhambha Krishna Das Academy, Uttara khanda 13/9,Chaukhamba
Varanasi, 2000. Surabharati series. Varanasi; 2007.

38. Vrddha Vagbhata, Ashtanga Samgraha - 46. Vagbhata, Ashtanga Hridaya with
Sasilekha Comm. Indu; Uttartantra, 19/12, the commentaries Sarvangasundaraof
Chaukhambha Krishna Das Academy, Arundatta and Ayurveda Rasayana of
Varanasi, 2000. Hemadri: Uttaratantra, 16/9, edited by
Pandit HariSadasiva Sastri Paradakara
39. Shri Dalhana Acharya, Sushruta, Sushruta
Bhisagacarya; Chaukhamba Orientalia,
Samhita with Nibandhasamgraha
Varanasi, Reprint 2011.
commentary, Uttaratantra, 12/35-36;
edited by Vaidya Jadavji Trikamji Acharya, 47. Anonymous, The Ayurvedic Formulary
Chaukhamba Surabharati Prakashan of India, Ministry of Health and Family
Varanasi, 2008. Welfare, Govt. of India, Part II (4:9), 2000.

40. Vrddha Vagbhata, Ashtanga Samgraha - 48. Vagbhata, Ashtanga Hridaya with the
Sasilekha Comm. Indu; Uttartantra, 19/33, commentaries Sarvangasundara of
Chaukhambha Krishna Das Academy, Arundatta and Ayurveda Rasayana of
Varanasi, 2000. Hemadri, : Uttaratantra 16/25-27, edited
by Pandit Hari Sadasiva Sastri Paradakara
41. Shri Dalhana Acharya, Sushruta, Sushruta
Bhisagacarya; Chaukhambha Orientalia,
Samhita with Nibandhasamgraha
Varanasi, Reprint 2011.
commentary Uttaratantra 9/13-14, edited
by Vaidya Jadavji Trikamji Acharya, 49. Vagbhata, Ashtanga Hridaya with the
Chaukhamba Surabharati Prakashan commentaries Sarvangasundara of
Varanasi, 2008. Arundatta and Ayurveda Rasayana of
Hemadri, Uttaratantra 16/25-27, edited
42. Sharangdharacharya. Sharangdhara
by Pandit Hari Sadasiva Sastri Paradakara
Samhita Uttarakhanda 13/8, Tra. Himsagar
Bhisagacarya; Chaukhamba Orientalia,
Chandra Murty, Chaukhamba Surabharati
Varanasi, Reprint 2011.
series. Varanasi; 2007.
50. Shri Dalhana Acharya, Sushruta, Sushruta
43. Sharangdharacharya. Sharangdhara Samhita with Nibandhasamgraha
Samhita Uttarakhanda 13/8, Tra. Himsagar commentary, Uttaratantra 11/6-9, edited
Chandra Murty, Chaukhamba Surabharati by Vaidya Jadavji Trikamji Acharya,
series. Varanasi; 2007. Chaukhamba Surabharati Prakashan
44. Vagbhata, Ashtanga Hridaya with the Varanasi, 2008.
commentaries Sarvangasundara of 51. Shri Dalhana Acharya, Sushruta, Sushruta
Arundatta and Ayurveda Rasayana of Samhita with Nibandhasamgraha
Hemadri, Uttaratantra, 16/17 edited by commentary, Uttaratantra 12/11-12 edited
Pandit Hari Sadasiva Sastri Paradakara by Vaidya Jadavji Trikamji Acharya,
Bhisagacarya; Chaukhambha Orientalia, Chaukhamba Surabharati Prakashan
Varanasi, Reprint 2011. Varanasi, 2008.

246 AYURVEDIC STANDARD TREATMENT GUIDELINES


ADHIMANTHA (GLAUCOMA)

52. Vrddha Vagbhata, Ashtanga Samgraha - 55. Shri Dalhana Acharya, Sushruta, Sushruta
Sasilekha Comm. Indu, Uttartantra, 19/10, Samhita with Nibandhasamgraha
Chaukhambha Krishna Das Academy, commentary, Uttaratantra 12/8, edited
Varanasi, 2000. by Vaidya Jadavji Trikamji Acharya,
53. Shri Dalhana Acharya, Sushruta, Sushruta Chaukhamba Surabharati Prakashan
Samhita with Nibandhasamgraha Varanasi, 2008.
commentary, Uttaratantra 10/3 edited 56. Vrddha Vagbhata, Ashtanga Samgraha -
by Vaidya Jadavji Trikamji Acharya, Sasilekha Comm. Indu; Uttartantra, 19/11
Chaukhamba Surabharati Prakashan Chaukhambha Krishna Das Academy,
Varanasi, 2008. Varanasi, 2000.
54. Shri Dalhana Acharya, Sushruta, Sushruta 57. Shri Dalhana Acharya, Sushruta, Sushruta
Samhita with Nibandhasamgraha Samhita with Nibandhasamgraha
commentary, Uttaratantra 19/30; edited commentary Uttaratantra 11/3-5, edited
by Vaidya Jadavji Trikamji Acharya, by Vaidya Jadavji Trikamji Acharya,
Chaukhamba Surabharati Prakashan Chaukhamba Surabharati Prakashan
Varanasi, 2008. Varanasi, 2008.

AYURVEDIC STANDARD TREATMENT GUIDELINES 247


Urdhwa Jatrugata Roga
DANTAVESHTA (PERIODONTITIS)

are marked by severe swelling and


INTRODUCTION
pain.3
The Dantamulagata Rogas viz. diseases of
• Upakusha - In this disease the
the periodontium are considered under
gums become marked by a burning
the heading of Mukha Rogas. Dantaveshtaka
sensation and suppuration and the
means covering of the teeth. On the basis of
teeth become loose and shaky in
symptoms Dantaveshta can be correlated with
consequence and bleed on minimal
Periodontitis. Periodontitis is an inflamma-
touch.4
tory disease of the supporting tissues of the
tooth resulting in progressive destruction of
LEVEL 1: AT SOLO AYURVEDIC
periodontal ligaments & alveolar bone with
PHYSICIAN’S CLINIC/PHC
pocket formation, recession or both. There-
fore in severe case, teeth become mobile. Clinical Diagnosis: Ayurvedic differential
diagnosis can be done on the basis of signs
Case Definition: and symptoms mentioned above.
Dantaveshta is characterized by Raktasrava Investigation: Though much can be diagnosed
(bleeding from gum/s), Pooyasrava from based on the clinical signs and symptoms,
Dantamansa (pus discharge from gums) and investigations help the physician to confirm
Danta Chalatva (mobility of tooth/teeth).1 the diagnosis and rule out other conditions.

Differential Diagnosis Treatment:


• Shitada - The gums of the teeth Chikitsa Sutra: Kaya Virechana (purgation of
suddenly bleed and become the body), Shiro Virechana (purgation of the
putrified, black, slimy and emit a head), mouth gargles with liquids of pungent
fetid smell. They become soft and and bitter taste and therapies.5
gradually slough off. 2 In the initial stage when the patient is having
• Danta Pupputa - In this disease the above mentioned signs and symptoms
roots of two or three teeth at a time following drugs may be given:

Table 35.1: Medicines at level 1 for Dantaveshtaka

Drugs Dosage form Dose Time of administration / Retention time Duration


Panchvalkala Kwatha 6
Kwatha 40 ml Gentle gargling / thrice a day 5-7 days
Kshirivriksha Kashaya7 Kwatha 40 ml 10 min retention in mouth / twice a day 5-7 days
Dashanasanskara Churna 8
Churna 1 gm Pratisarana / thrice a day 5-7 days
Kalaka Churna9 Churna 1 gm Pratisarana / thrice a day 5-7 days
Pitaka Churna10
Churna 1 gm Pratisarana / thrice a day 5-7 days
DANTAVESHTA (PERIODONTITIS)

Pathya - Apathya (Diet and life style & other foods which is heavy too
education): i.e. milk, curd, dry & hard foods.
• Vihara: over brushing, sleeping in
Do’s -
prone posture, day sleep
• Ahara: Freshly cooked, easily
Referral Criteria: If patient is not responding
digestible diet such as barley, green
to above mentioned management within 5 or
gram, bitter guard, other bitter
7 days and if signs and symptoms observed
foods, ghee, luke warm water etc.
other than above mentioned signs and
should be taken.
symptoms should be referred to higher level.
• Vihara: Regular mouth washes with
normal water, luke warm water, LEVEL 2: CHC’S OR SMALL
camphor water, fomentation, betel HOSPITALS WITH BASIC
leaf chewing, Dhoomapana. FACILITIES

Don’ts - Clinical Diagnosis: Same as level 1 for fresh


case reporting directly.
• Ahara: Spicy and sour food11 e.g.
pickles, curd, butter milk, Masha Investigation: same as level 1: In addition
soup (soup of black beans), any detail history should be taken.
preparations of Ikshu Swarasa e.g. Treatment: In addition to the management
sugar, sugarcane juice, jaggery; mentioned in Level 1, few of the following
chocolates, sweets, confectionary drugs may be added as per the requirement
items, meat which is heavy to digest and status of the patient.

Table 35.2: Medicines at level 2 for Dantaveshtaka

Drugs Dosage form Dose Time of administration Duration

Irimedadi Taila12 Taila 10 to 20 ml Thrice a day for gum 10 days


as required massage

Khadiradi Gutika13 Vati 1 Vati Thrice a day for gum 10 days


massage

Triphala Guggulu14 Vati 2 Vati Thrice a day 10 days

Pathya - Apathya (Diet and life style days or signs and symptoms become more
education): Same as level 1 acute and required for Panchkarma therapy
should be refer to higher level
Referral criteria: If patient is not responding
to above mentioned management within 10

252 AYURVEDIC STANDARD TREATMENT GUIDELINES


DANTAVESHTA (PERIODONTITIS)

Treatment: Scaling should be done followed


LEVEL 3: AYURVEDA by treatment given below -
HOSPITALS AT INSTITUTIONAL
In addition to the management of Level 1
LEVEL OR DISTRICT
and Level 2, following special procedures
HOSPITAL / INTEGRATED
AYURVEDIC HOSPITALS indicated for different Dantmulagata Roga
(disease of gums) can be performed.
Clinical Diagnosis: Differential diagnosis
Shodhana Chikitsa: In all Dantmulagata
should be made as per signs and symptoms
Roga, Raktamokshana should be done first
mentioned above.
then following procedures should be
Investigation: Dental X-ray observed

Table 35.3: Kriya Kalpa / Panchakarma at level 3 for Dantaveshtaka

Kriya Kalpa / Drug Dose Duration


Panchakarma
Pratisarana Rodhradi Churna15 (Lodhra, Yashti, Laksha, Madhu) 2-3 gms 2 times in a day
for 7-21 days
Gandoosha Panchavalkal Kwath / Kshirivriksha Kashaya with 40-60 ml 7-21 days
honey, Ghrita and Sharkara16
Marsha Nasya Kakolyadi Ghrita/ Yashtimadhu Ghrita17 8-8 drops in 7 days
each nostrils

Pathya - Apathya (Diet and life style education): Same as level 1

REFERENCES

1. Sushruta, Sushruta Samhita, Nidana Sthana 4. Sushruta, Sushruta Samhita, Chikitsa Sthana
16/8, In: Ambikadutta Shastri, Reprint, 16/23-24, In: Ambikadutta Shastri, Reprint,
Varanasi: Chaukamba Sanskrit Sansthan; Varanasi: Chaukamba Sanskrit Sansthan;
2008, p. 296. 2008, p. 296.
2. Sushruta, Sushruta Samhita, Chikitsa Sthana 5. Yoga Ratnakara. Samasta Dantaveshta
16/15-16, In: Ambikadutta Shastri, Reprint, Chikitsa 1-3, In: Vidyotani Hindi
Varanasi: Chaukamba Sanskrit Sansthan; Commentary, Reprint, Varanasi:
2008, p. 295. Chaukamba Prakashana, 2013, p. 218.
3. Sushruta, Sushruta Samhita, Chikitsa Sthana 6. Sushruta, Sushruta Samhita, Chikitsa Sthana
16/17, In: Ambikadutta Shastri, Reprint, 22/17, In: Ambikadutta Shastri, Reprint,
Varanasi: Chaukamba Sanskrit Sansthan; Varanasi: Chaukamba Sanskrit Sansthan;
2008, p. 296. 2008, p. 68.

AYURVEDIC STANDARD TREATMENT GUIDELINES 253


DANTAVESHTA (PERIODONTITIS)

7. Sushruta, Sushruta Samhita, Chikitsa Sthana Welfare, Govt. of India, Part I (8:2), 2000,
22/17, In: Ambikadutta Shastri, Reprint, p.366.
Varanasi: Chaukamba Sanskrit Sansthan; 13. Anonymous, The Ayurvedic Formulary
2008, p. 68. of India, Ministry of Health and Family
8. Anonymous, The Ayurvedic Formulary Welfare, Govt. of India, Part I (12:6), 2000,
of India, Ministry of Health and Family p.505.
Welfare, Govt. of India, Part II (7:6), 2000, 14. Anonymous, The Ayurvedic Formulary
p. 83. of India, Ministry of Health and Family
9. Charaka, Charaka Samhita, Chikitsa Sthana Welfare, Govt. of India, Part I (5:5), 2000,
26/195, In: Yadavji Trikamji Acharya, p. 212.
Reprint, Varanasi: Chaukamba Sanskrit 15. Sushruta, Sushruta Samhita, Chikitsa Sthana
Sansthan; 2009. p. 752. 22/17, In: Ambikadutta Shastri, Reprint,
10. Charaka, Charaka Samhita, Chikitsa Sthana Varanasi: Chaukamba Sanskrit Sansthan;
26/197, In: Yadavji Trikamji Acharya, 2008, p. 68.
Reprint, Varanasi: Chaukamba Sanskrit 16. Sushruta, Sushruta Samhita, Chikitsa Sthana
Sansthan; 2009. p. 753. 22/16, In: Ambikadutta Shastri, Reprint,
11. Sushruta, Sushruta Samhita, Chikitsa Sthana Varanasi: Chaukamba Sanskrit Sansthan;
22/42, In: Ambikadutta Shastri, Reprint, 2008, p. 68.
Varanasi: Chaukamba Sanskrit Sansthan; 17. Sushruta, Sushruta Samhita, Chikitsa Sthana
2008, p. 100. 22/15, In: Ambikaduttashastri, Reprint,
12. Anonymous, The Ayurvedic Formulary Varanasi: Chaukamba Sanskrit Sansthan;
of India, Ministry of Health and Family 2008, p. 68.

254 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUKHAPAKA (STOMATITIS)

cavity. Though whole mucosa of cavity is not


INTRODUCTION
involved at a same time, it may cover any
part of oral mucosa.
The Sarvasara Rogas viz. diseases affecting
the whole Mukha are considered under the Differential Diagnosis:
heading of Mukharogas.1 These are important
Differential diagnosis can be done on the
among all the diseases upon which the entire
basis of signs and symptoms of above three
oral as well as general health and hygiene
mentioned varieties of Mukhapaka.
revolves. As per Ayurveda depending upon
the predominance of the Dosha, Mukhapaka
are of three types. Vataja Mukhapaka LEVEL 1: AT SOLO AYURVEDA
presents with Sphota (small follicles) with PHYSICIAN CLINIC/PHC
Toda (pricking pain), Pittaja Mukhapaka
presents with Sphota (small follicles) with Clinical Diagnosis: Diagnosis can be done
Daha (burning sensation), while Kaphaja on the basis of clinical presentation
Mukhapaka is characterized by Sphota (small Investigation: Torch light examination:
follicles) which are Savarna (same colour), Sphota or Vrana may be observed
associated with Kandu (itching) and Alparuja
(mild pain)2 Treatment:

Case Definition: Chikitsa Sutra: Initially in Mukhapaka,


Gandhusha (gargling the mouth with the
Mukhapaka is diagnosed on the basis of decoction) of Triphala, Patha, Mridwika and
presence of Vrana or Shotha (ulcer or tender buds of Jati added with honey should
inflammation or follicle) in Mukha (oral be done or Triphala may be chewed and
cavity) which includes Ostha (lips), Dantamula spit out.3
(gums), Danta (teeth), Jihwa (tongue), Talu
(palate), Gala (pharynx) and Galadisakala In addition to it when the patient is having
(complete oral cavity). Therefore Mukhapaka mild features of Mukhpaka following drugs
is the disease where inflammatory process may be given for local application or gurgling
occurs & that involves mucosa of whole oral or orally as per the status of the disease:
MUKHAPAKA (STOMATITIS)

Table 36.1: Medicines at level 1 for Mukhapaka

Drugs Form Dose Time of Anupana Duration


administration
Drugs for external application
Shudha Gairika Churna and Churna 1 gm of each Thrice a day for Honey and 5-7 days
Yashtimadhu Churna4 Churna local application Ghrita
Pratisarana with Tankana / Churna 1 gm of each Thrice a day for Honey 5-7 days
Saindhava Lavana5 Churna local application
Pratisarana with Churna 1 gm of each Thrice a day for Honey 5-7 days
Darvighana & Gairika6 Churna local application
Ksaudra (honey)7 Liquid 1 tsp. Thrice a day for Mixed with 5-7 days
gargle water
Jatipatra8 Paste 5 gm Thrice a day for - 5-7 days
local application
Drugs for internal usage:
Swadishta Virechan Churna9 Churna 4 gm at night Once at night Hot water 5-7 days

Samshamani Vati10 Vati 2 tab Twice a day Normal 5-7 days


water

Pathya-Apathya (Diet and life style Ikshuwika Rasa i.e. sugar, sugar-
education): cane juice, jaggery; food articles
which is heavy to digest like meat,
Do’s – cheese, Paneer, milk and dry & hard
• Ahara: Freshly cooked, easily foods.12
digestible diet such as barley, green • Vihara: Over brushing, sleeping in
gram, bitter guard, other bitter prone posture, day sleep13
foods, ghee, lukewarm water etc.
Referral Criteria: If patient is not responding
should be taken.
to above mentioned management within
• Vihara: Regular mouth washes with 5 or 7 days, he should be refer to higher
normal water or lukewarm water or level.
camphor water, betel leaf chewing,
Dhumapana.11
LEVEL 2: CHC’S OR SMALL
HOSPITALS WITH BASIC
Don’ts (Apathya):
FACILITIES
• Ahara: Spicy and sour food, curd,
Clinical Diagnosis: Same as level 1
butter milk, Masha soup (soup of
black beans), any preparations of Investigation: Same as level 1

256 AYURVEDIC STANDARD TREATMENT GUIDELINES


MUKHAPAKA (STOMATITIS)

Treatment: In addition to the management (Herbo-mineral drugs) can be used at


mentioned in Level 1, few of the following this level. Patient may be kept under
drugs may be added as per the requirement observation while prescribing these kinds of
and status of the patient. Rasaushadhi medicines.

Table 36.2: Medicines at level 2 for Mukhapaka

Drugs Dosage Form Dose Time of Anupana Duration


administration
Drugs for gargling or local application:
Triphala Kwatha14 Decoction 100 ml Gargle with it 3- 4 Honey 5 days
times in a day
Triphala Kwatha mixed Decoction 20 ml Gargle with it 3- 4 - 5 days
with Darvi, Guduchi times in a day
Mrudwika & Jatipatra15

Panchavalkala Kwatha16 Decoction 20 ml Gurgle with it - 5 days


3- 4 times in a day
Panchapallava Kwatha17 Decoction 20 ml Gurgle with it - 5 days
3- 4 times in a day
Panchatikta Kwatha18 Decoction 20 ml Gargle with it 3- 4 - 5 days
times in a day
Khadiradi Gutika19 Vati, Churna 1 Vati Thrice a day for Mixed 5 days
gum massage with
(local application) honey
Pratisarana with Churna 1 gm Thrice a day for Honey 5 days
Darvighana & Gairika20 of each local application
Churna
Drugs for internal administration:
Laghu Vasantamalati Vati 2 Vati Twice a day Normal 5 days
Rasa21 water

Pathya-Apathya (Diet and life style


LEVEL 3: AYURVEDA
education): Same as level 1
HOSPITALS AT INSTITUTIONAL
Referral criteria: If patient is not responding LEVEL OR DISTRICT HOSPITAL/
to above mentioned management within 10 INTEGRATED AYURVEDIC
days or signs and symptoms become more HOSPITALS
acute or spre