RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU,

KARNATAKA

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SYNOPSIS BY

Dr PARVATHY GOPAN
FOR THE DEGREE OF AYURVEDA DHANWANTARI
DEPARTMENT OF POST GRADUATE STUDIES IN SHALYATANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL,
BENGALURU, KARNATAKA-560082

TITLE OF THE SYNOPSIS

A RANDOMISED CONTROLLED CLINICAL STUDY TO EVALUATE THE ROLE OF

NIRVAPANA UPAKRAMA WITH DURVA OINTMENT IN THE MANAGEMENT OF
PITTAJA DUSHTA VRANA WITH SPECIAL REFERENCE TO FISSURE-IN-ANO
GUIDED BY
Dr. PREM CHANDRA M.S (Ayu)
ASSOCIATE PROFESSOR
DEPARTMENT OF POST GRADUATE STUDIES SHALYA TANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL,
BENGALURU, KARNATAKA - 560082

2019-2020

1
FROM

Dr. PARVATHY GOPAN

PRELIMINARY MS(AYU) SCHOLAR
DEPARTMENT OF SHALYATANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL, BENGALURU,
KARNATAKA-560082

TO

THE REGISTRAR
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BENGALURU, KARNATAKA

THROUGH
THE PRINCIPAL
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL, BENGALURU,
KARNATAKA-560082

Sub: Submission of completed proforma for registration of subject for dissertation

Respected sir,

I request you to kindly register the below mentioned subject against my name for submission of
dissertation to Rajiv Gandhi University of Health Sciences, Bengaluru for partial fulfillment of M.S.(Ayu)
in Shalyatantra.

TITLE OF DISSERTATION: A RANDOMISED CONTROLLED CLINICAL STUDY TO EVALUATE

THE ROLE OF NIRVAPANA UPAKRAMA WITH DURVA OINTMENT IN THE MANAGEMENT OF
PITTAJA DUSHTA VRANA WITH SPECIAL REFERENCETO FISSURE-IN-ANO

Here with I am enclosing the complete proforma for registration of subject for dissertation.
Thanking you,
Yours faithfully
Place: Bengaluru (Dr Parvathy Gopan)
Date:

2
 ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.Name of the candidate & Address : Dr PARVATHY GOPAN

D/O Dr K GOPAKUMAR
SHREYAS
MARAYAMUTTOM
MARAYAMUTTOM P.O, PERUMKADAVAILA
NEYYATTINKARA, THIRUVANANTHAPURAM,
KERALA- 695124

2.Name of the institution : PRELIMINARY M.S(AYU) SCHOLAR

DEPARTMENT OF SALYATHANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND
RESEARCH HOSPITAL, BENGALURU,
KARNATAKA-560082

3.Course of study & subject : M.S(Ayu) IN SHALYATANTRA

4.Date of Admission to the course : 30-09-2019

5.Title of the Topic : A RANDOMISED CONTROLLED CLINICAL STUDY TO

EVALUATE THE ROLE OF NIRVAPANA UPAKRAMA WITH DURVA OINTMENT IN THE
MANAGEMENT OF PITTAJA DUSHTA VRANA WITH SPECIAL REFERENCETO FISSURE-IN-ANO

3
6. BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY:
In the present era about 30- 40% of the population are suffering from anorectal disorders.1 Among them
fissure-in-ano is one of the commonest having prevalence about 17.91%. 2The major predisposing factor being
change in lifestyle and food habits. Fissure-in-ano is an ulcer in the longitudinal axis of lower anal canal,
commonly occurs in midline posteriorly, but can also be occur in midline anteriorly. 95% of anal fissure in men
are posterior and 5% are anterior. 80% of anal fissures in females are posterior and 10% anterior. It is more
common in females.3

“Parikarthika”- which literally means “Karthanavat Shoola” has been explained as a stand-alone symptom in
Virechana Vyapat having Vata Pitta predominance along with other symptoms like Gudadaha and Anilasanga.
This has close similarity with “fissure-in-ano”. In this context Picchabasthi with Yasthimadhu, Krishna-Tila,
Honey and Ghee, Anuvasana Basti, Pichu, Parisheka, Lepa etc. are mentioned as management.4

Even though in the classics there is no detailed explanation of Parikarthika as an individual

disease entity, by analysing the signs and symptoms we can take it as one among 6 varieties of
Dushtavrana i.e. Pittaja Dustavrana. Susrutha5. Acharya mentioned Shashtirupakrama in the management of
Vrana in Susrutha Chikitsa first chapter starting from Apatharpana to Rakshavidhana vidhi. Each of this
Upakrama has an important role in management of various stages of Vrana. 6

Numerous studies are done in the management of fissure-in-ano as Shodhana and Ropana, here an attempt
to study the effect of Nirvapana upakrama in the management of same is taken. This upakrama is used for the
treatment of Vrana accompanied with Daha, Paka, Jwara and having Pitta Kopa and Raktena Abhibhuta. Here
Acharya mention to give Seetha Guna Dravyas macerated in Ksheera added with Ghee to be applied- as a
Lepa.7

Since fissure is having the similar symptoms this treatment can be adopted for the management of the same.
In the context of Shashti Upakrama Acharya Dalhana commented on Seethala Dravya as Durvadi, which includes
Durva, Nalamoola, Madhuka, Chandana etc. As Durva is mentioned first and having properties like Kashaya
Rasa, Seetha Virya, Kapha-Pittahara, Raktapitta Samaka and Daha Samana, it is taken here.8

4
 The current study “A randomised controlled clinical study to evaluate the role of Nirvapana Upakrama with
Durva ointment in the management of Pittaja Dushta Vrana with special reference to fissure-in-ano” would be
an attempt to re-introduce and validate Nirvapana Upakrama one among Shashti Upakrama in an ointment form,
which enables easy and better storage, preservation and mode of application.

6.2. REVIEW OF LITERATURE:

• The review of the literature includes screening of Ayurvedic classics, modern literatures, journals and
internet source to collect sufficient data for the study.

• The earliest reference about the details of Parikarthika is in Susrutha Samhitha(1500BC)

Chikitsasthana in Vamana Virechana Vyapat Chikitsa 34th chapter. In this chapter Acharya
mentioned it as a complication of Vamana Virechana Vyapat which is caused due to administration of
purificatory medicine to the individual who is having Mandhagni, Rooksha etc.4

• When it is caused due to Virechana called as Gudaparikarthika which is associated with Adhah
Parisravanam.9

• Acharya Kashyapa mentioned treatment for three types of Parikarthika in Garbhini based on Dosha
in Kashyapa Samhitha Khilasthana i.e. Vataja, Pittaja and kaphja.10

• Fissure-in-ano is mainly of two types-acute and chronic. Its symptoms include chronic constipation,
sharp agonising pain during defecation, passage of bright streaks of blood along with stool. If acute
fissure-in-ano is not treated properly, will gradually developed into a deep undermined ulcer. 3

• Acharya Charaka mentioned it as a Bastikarma Vyapath.11

• Definition, incidence, etiology, pathology, clinical features, examination and treatment of fisssure-
in- ano explained in modern texts will be reviewed in detail.

• Malahara the root from the word Malaham or Marham. It is mainly originated from Unani System
of medicine. The word Malahara is adapted from Yogaratnakara meaning “it removes Mala”

5
 (residue from Vrana, Twak Vikara etc.) which is used as external application, similar to ointments in
modern. The common base used for Malahara (ointments) is Siktha Taila (beewax and Taila). 12

• Topical diltiazem gel has properties like reducing pain, inducing healing and also has effect in
sphincter relaxation.13

DRUG REVIEW
14
Durva : -
a) Botanical name: - Cynodon dactylon (Linn.) Pers.
b) Family: - Poaceae
c) English: - Conch Grass
d) Part used: - Whole plant, root.
e) Properties

Rasa: - Kashaya, Madhura

Guna: - Laghu

Virya: - Seetha

Vipaka: - Madhura

Karma: - Kapha-Pittahara, Varnya, Prajasthapana

Indication: - Mutrakrichra, Twakroga, Raktapitta, Pradara, Trsna, Daha, Visarpa.

15
Ksheera : -
English name: - Milk
Synonyms: - Payas, Ksheera
Properties

Rasa: - Madhura

Guna: - Snigdha, Guru

6
 Virya: - Seetha

Vipaka: - Madhura

Karma: - Rakthapittahara
Vatapittagna

Indications: - Daha, Rakthapittahara,

Sramahara, Jeevanam etc.

16
Ghritam : -

English Name: - Ghee

Synonyms: - Sarpi, Havis
Properties

Rasa: - Madhura

Guna: - Soumya, Mridu

Virya: - Seetha

Vipaka: - Madhura

Karma: - Vatapitta prasamana, Agni deepana, Smruthi, Mathi, Medha, Kanthi

17
Madhuchishta : -

English name: - Bee wax

Synonyms: - Madhuchishta, Madhukosha, Siktaka, Madhulita, Madanaka.
Properties

Guna: - Snigdha, Mrudu

7
 Karma: - Vrana Ropana

Rogaghnata: - Bhagna, Kushta, Visarpa, Raktapitta,

Agnidagdha, Atisara.

Doshaghnata: - Vataghna

6.3 PREVIOUS WORKS DONE:

Uncontrolled single armed clinical study in the management of fissure-in-ano by Durvadi Kera Taila by
V Sreedevi, Amrita School of Ayurveda, Vallikavu, Clappana, Kollam, Kerala. The study was done on 30
diagnosed cases of acute fissure- in-ano. On the basis of assessment criteria and overall result of treatment
Durvadi Kerathaila showed better result in reducing burning sensation, pain and also reduction in the size of
Vrana.18

Nazira Banu. Efficacy of Ashtanga Matrabasthi in the management of Parikarthika W.S.R. to

fissure-in-ano (Bangalore): Govt.Ayurveda Medical College Mysore, R.G.U.H.S; 2011-2012.This study was
done on 40 diagnosed cases of Parikarthika. 20 patients were given Ashtanga Thaila Matra Basthi and 20 were
given Anal Dilatation. Both have proved effective in the management of Parikarthika, but comparatively
Ashtanga Matrabasthi is superior to anal dilatation.1

RESEARCH QUESTIONS AND HYPOTHESIS:

NULL HYPOTHESIS: -

H :- There is no difference in the efficacy in the group receiving Durva ointment in fissure -in-ano than the
0

group receiving diltiazem gel 2%

ALTERNATE HYPOTHESIS: -

H :- The efficacy of Durva ointment in fissure-in-ano is greater than the group receiving
1

diltiazem gel 2%.

H :- The efficacy of Durva ointment in fissure-in-ano is lesser than the group receiving
2

diltiazem gel 2%

8
6.4. AIM AND OBJECTIVES OF THE STUDY

AIM: -
To evaluate the role of Nirvapana Upakrama with Durva ointment in the management of
Pittaja Dushtavrana w.s.r to fissure-in-ano.

OBJECTIVES: -

• To evaluate the role of Nirvapana Upakrama with Durva ointment in the management of fissure-
in- ano
• To re-evaluate the role of diltiazem 2% gel in the management of fissure-in-Ano.
• To compare the role of Durva ointment and diltiazem 2% gel in the management of fissure- in-ano.

7. METHODOLOGY:

7.1. SOURCE OF DATA

(a)Literary Source: -
Literary data will be collected from classical Ayurvedic and modern texts, reputed
journals, internet with updated information, retrospective study on related works from
different universities etc.
(b)Sample source: Thirty subjects fulfilling inclusion criteria, irrespective of gender,
religion, caste, race or socio-economic status will be taken from OP and IP department of
Shalya Tantra, SSCASR&H, Bengaluru.
(c)Drug source: Raw materials shall be procured from certified suppliers. And Durva
19,20
ointment will be prepared by classical methods in the teaching pharmacy of
Rasasastra and Bhaishajya Kalpana department, SSCASR&H. Diltiazem gel will be
procured from GMP certified company.

9
7.2. METHOD OF COLLECTION OF DATA

STUDY DESIGN:

Study is a randomised open label controlled clinical trial in which thirty subjects are divided
into two groups of fifteen each.

GROUPING:
A number of thirty subjects suffering from Parikarthika fulfilling the inclusion criteria will be
selected by simple randomization technique. They are divided into two groups of fifteen
each. Each group will be given sitz bath followed by Triphala Choorna (dose 5-10g) at bed time
as constipation is the main factor for fissure-in-ano.

Group A (control group) Fifteen subjects of this group will be

treated with diltiazem gel daily twice for
two weeks.

Group B (trial group) Fifteen subjects of this group will be

treated with Durva ointment daily twice for
two weeks.

STUDY DURATION: -

Total duration of study: - Twenty-eight days.

th th th
Duration of treatment: - Fourteen days. (observations will be made on 0 ,7 , 14 day)
st th
Follow up period: - Fourteen days (21 and 28 day-to observe any recurrence)

SAMPLE TECHNIQUE:

Subjects will be randomized into two groups.

SAMPLE SIZE:

Thirty subjects

10
STATISTICAL ANALYSIS:
• The collected data will be presented in the form of Mean ± SD, SEM or Range whichever is
applicable.
• For parametric values paired t test within the group and unpaired t test within the group.
• For nonparametric values Wilcoxon signed rank test within the group and Mann Whitney U test
between the group
• p value ≤ 0.05 will be considered statistically significant.
• IBM SPSS Software version 20 will be used for the analysis. 21

(a)DIAGNOSTIC CRITERIA:

Subjects with classical symptoms of Parikarthika will be selected for study such as Guda Daha, Karthanavat
Peeda, Anilasanga and those having characteristics of Pittaja Dushta Vrana.

(b)INCLUSION CRITERIA:

• Clinically diagnosed cases of Parikarthika (Chronic Fissure-in-Ano will be taken for the study.)
• Patient irrespective of sex, religion, occupation and economic status.
• Patients between 21- 60 years of age irrespective of both sexes.
• Patients of Parikarthika with Diabetes and Hypertension which are under control, are also
included in study.

(c) EXCLUSION CRITERIA:

• Fissure-in-ano secondary to ulcerative colitis, tuberculosis, syphilis, crohn’s disease, other systemic
diseases pertaining to colon will be excluded from the study.
• Previously diagnosed cases of Ca – rectum, Ca – colon and fistula-in-ano.

d) ASSESSMENT CRITERIA:
Following subjective and objective parameters will be considered in the study.
1)Subjective parameters: -
• Gudagata Karthanavat Peeda (cutting and burning type of pain.)
• Itching
• Bleeding
• Constipation
• Burning sensation

11
Pain assessment VAS Scale

22
Itching
Grade 0 - Absent (no itching)
Grade 1 - Mild (Occasional itching)
Grade 2 - Moderate (Frequent itching)
Grade 3 - Severe (Continuous itching)

22
Burning sensation
Grade 0 - No burning sensation
Grade 1 - Mild burning sensation
Grade 2 - Moderate burning sensation
Grade 3 - Severe Burning sensation.
1
Bleeding
Grade 0 - No bleeding
Grade 1 - Bleeding per anum.
1
Constipation
Grade 0 - Easy evacuation / Normal consistency
Grade 1 - Hard stools passed once daily
Grade 2 - Hard stools passed once in 2-3 days
Grade 3 - Very hard stools passed once in 3-4 days

2)Objective parameters: -
1
(1) Length of ulcer
After gently parting the gluteal region, the fissure will be visualized and the length of
ulcer is measured with a cotton swab by keeping it over the ulcer. This is later measured in
millimetre.
1
(2) Sphincteric spasm (by per rectal digital examination.)
Grade 0 - Normal
Grade 1 - Spastic

12
(e)WITHDRAWAL CRITERIA
If general condition is worsening, treatment will be stopped and withdrawn from the study and will be treated
accordingly.

(f) MONITORING ADVERSE EVENTS

Any adverse events during the study will be monitored, and recorded in the specific format and reported to
pharmacovigilance cell of Sri Sri College of Ayurvedic Science and Research Centre.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVETIONS TO BE

CONDUCTED ON THE PATIENTS OR OTHER HUMANS OR ANIMALS?

• Yes, study will be conducted on human subjects who fulfils the inclusion criteria.
• A separate case proforma will be prepared with details of history, signs and symptoms of fissure-in-
ano as mentioned in classics and allied sciences.
• Lab investigations will be done according to necessity and the findings will be documented.
• Researcher will ensure that subjects of the study are in compliance with medicine/ treatment of this
study protocol.

INTERVENTION:

GROUP A GROUP B

PROCEDURE Diltiazem ointment should be Durva ointment should be

applied twice daily after sitz applied twice daily after sitz
bath. bath.
DOSE Quantity sufficient to cover Quantity sufficient to cover
the ulcer. the ulcer.
DURATION Two weeks Two weeks

FOLLOW UP st th st th
Fourteen days (21 and 28 Fourteen days (21 and 28
day-to observe any day-to observe any
recurrence) recurrence)

13
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

YES

8. LIST OF REFERENCES

1. Banu N. Efficacy of Ashtanga Matrabasthi in the management of Parikarthika w.s.r. to

Fissure-In- Ano [Dissertation]. Govt.Ayurveda Medical College Mysore, Karnataka: R.G.U.H.S, Bangalore,
Karnataka;2011-12.

2. Ranjit Chaudary, Chirag Shanthi Dausage. Prevalence of Anal Fissure in patients with Anorectal Disorders: A
single – centre experience. Journal of Clinical and Diagnostic Research, 2019 Feb; Vol-13(2): PCO5-PCO7.

th
3. Das.S. A Concise Textbook of Surgery, 10 edition. Kolkata: Dr. S. Das .13; 2018. P.1083-86.

4. Susruta, Susrutasamhita, edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram Acharya
‘Kavyatirtha’. Chikitsasthana.Ch.34,Ver.16. Reprint, 2015 edition,Varanasi:Choukhambha Sanskrit Sansthan,
Kashi Sanshrit series 316;2015.p.523-24.

5. Susruta, Susrutasamhita, edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram Acharya
‘Kavyatirtha’. Soothrasthana.Ch.22,Ver.7. Reprint,2015edition,Varanasi:Choukhambha Sanskrit Sansthan,
Kashi Sanshrit series 316;2015.p.108.

6. Susruta, Susrutasamhita, edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram Acharya
‘Kavyatirtha’. Chikitsasthana.Ch.1,Ver.8. Reprint, 2015 edition,Varanasi:Choukhambha Sanskrit Sansthan,
Kashi Sanshrit series 316;2015.p.397.

14
7. Susruta, Susrutasamhita, edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram Acharya
‘Kavyatirtha’. Chikitsasthana.Ch.1,Ver.49-50. Reprint, 2015 edition Varanasi:Choukhambha Sanskrit Sansthan,
Kashi Sanshrit series 316;2015.p.401.

8. Susruta, Susrutasamhitha,edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram Acharya
‘Kavyatirtha’. Soothrasthan.Ch.37,Ver.4. Reprint, 2015 edition,Varanasi:Choukhambha Sanskrit Sansthan,
Kashi Sanshrit series 316;2015.p.160.

9. Susruta, Susrutasamhitha of Susruta,edited by Vaidya Jadavaji Trikamji Aacharya and Narayan Ram
Acharya ‘Kavyatirtha’. Chikitsasthana.Ch.34,Ver.21. Reprint, 2015 edition,Varanasi:Choukhambha Sanskrit
Sansthan, Kashi Sanskrit series 316;2015.p.524.

10. Kashyapa, Kashyapasamhita of Kashyapa,edited by P.V.Tewari, Khilasthana.Ch.10,Ver.102-06. Reprint,

2018 edition,Varanasi:Chaukamba Visvabharathi,Haridas Ayurveda Series 2;2018.p.565.

11. Agnivesa, Charaka Samhitha of Acharya Charaka, Drdabala krit, edited by Vaidya Jadavji
Trikamji Acharya, Siddhi Sthana. Ch.7. Ver.54-56. 1st edition, Varanasi: Chaukamba
Sanskrit Sansthan;1990.p.712.

12. Hiremath SG. A Textbook of Bhaishajya Kalpana (Indian Pharmaceutics).

Reprint, 2011 edition, Banglore: IBH Prakashana;p.326.

13. Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal
fissure [Internet]. Br J Surg. 2001[cited 2020 Feb 24];88(4):553-56. doi:10. 1046/j.1365
-2168.2001.01736.x.Available from: https://www.ncbi.nlm.nih.gov/pubmed/11298624

15
14. Sharma PV. Dravyaguna-Vijnana, Vol 2. Reprint,2008 editon.Varanasi: Chowkhamba
Krishnadas Academy;2008.p.1036-37.

15. Susruta,Susrutasamhita of Susruta,edited by Vaidya Jadavaji Trikamji Aacharya and Narayan

Ram Acharya ‘Kavyatirtha’. Soothra Sthana.Ch.45,Ver.49. Reprint, 2015 edition,
Varanasi:ChoukhambhaSanskrit Sansthan, Kashi sanskrit series 316;2015.p.200.

16. Susrta,Susrutasamhita of Susruta,edited by Vaidya Jadavaji Trikamji Aacharya and Narayan

Ram Acharya ‘Kavyatirtha’. Soothra Sthana.Ch.45,Ver.96. Reprint, 2015edition,
Varanasi:Choukhambha Sanskrit Sansthan, Kashi sanskrit series 316;2015.p.204.

17. Manish Kumar Rangrej Divya, K Malathi, S Vikram. Role of Mahishi Navaneeta and
Madhuchishta as a base for healing fissures of the feet w.s.r to Malahara Kalpana.
J Ayurveda Integr Med Sci [Internet]. 2019 Nov [2020 Feb 25];4(5): 244- 48. Available
from:http://www.jaims.in/index.php/jaims/article/view/863

18. V Sreedevi, Uncontrolled single armed clinical study in the management of fissure-in-ano by
Durvadi Kera Taila [Dissertation]. Amrita School of Ayurveda, Kollam: Amrita Viswa
Vidyapeetham, Coimbatore;2013-14.

19. Sargandara, Sargandara Samhitha, edited by Pt. Parashuram Shastri Vidyasagar,

Madhyamkhanda.Ch.9, Ver.1-8. Reprint, 2013 edition, Varanasi: Choukhambha Surbharati
Prakashan;2013.p.212-13.

th
20. Shastri K, editor, (11 edition). Rasatarangini of Sadanadha Sharma,
dwithiya Taranga; Paribhasha vigyaniya: Chapter 2, Verse 34. Delhi: Mothilal
Banarasi Das, 2012;17.

21. Kothari C R. Research Methodology. 2nd ed. New Delhi: New Age International(P) Ltd., Publishers; 2004

16
22. Tichkule SV, Khandare KB, Shrivastav PP. Proficiency of Khanduchakka Ghrita in the
management of Parikarthika: A case report. J Indian Sys Medicine [serial online] 2019
[cited 2020 Feb 24]; 7:47-50. Available from:
http://www.joinsysmed.com/text.asp?2019/7/1/47/265514.

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF GUIDE :(In block letters)

11.1. GUIDE : Dr. PREM CHANDRA M.S (Ayu)

ASSOCIATE PROFESSOR
DEPARTMENT OF POST GRADUATE STUDIES SHALYATANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL,
BENGALURU, KARNATAKA - 560082

11.2 SIGNATURE :

11.3 CO-GUIDE :

11.4 SIGNATURE :

11.5 HEAD OF THE

DEPARTMENT : DR. P. RAMESH BHAT, M.S (AYU), PhD
PROFESSOR AND HOD
DEPARTMENT OF POST GRADUATE STUDIES SHALYATANTRA
SRI SRI COLLEGE OF AYURVEDIC SCIENCE AND RESEARCH HOSPITAL,
BENGALURU, KARNATAKA - 560082

11.6 SIGNATURE :
17
12.1 REMARKS OF :

PRINCIPLE

12.2 SIGNATURE :

18