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Role of BMI in the Prognosis and Symptomatic Treatment of

Shleepada (Chronic Filariasis) with Reference to a Study on
two Compound Guggulu Preparations

Article · January 2011

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 JR.A.S. Vol. XXXII, No. 1-2, Jan. -June. 2011 pp. 25-38

Role of BMI in the Prognosis and Symptomatic

Treatment of Shleepada (Chronic Filariasis)
with Reference to a Study on two Compound
Guggulu Preparations
Goli Penchala Prasad*and G K Swamy**

Abstract
India is the largest Filariasis endemic country in the world; it contributes
about 40% of total global burden of Filariasis and accounts for about 50% of the
people at risk of infection'. Based on Ayurvedic and modern literatures, obesity
plays an important role in the prognosis and management of Shleepada
(filariasis). To evaluate the therapeutic efficacy of two compound Guggulu
preparations namely Kanchanara guggulu and Gokshuradi guggulu as a
combination therapy in the management of Shlipada(Chronic filariasis) with
special reference to BMI(Body mass Index), 239 cases were studied during the
period of 2000-2007 at R.R.J. (Ay.), Vijayawada. Encouraging results were
observed on overall treatment and in relation to BMI in both subjective and
objective parameters. Out of 239 cases, 92(38.5%) got good response, 87got
(36.40%) fair response, 41 patients (17.15%) showed poor response and 19
cases (7.95%) showed no response. Based on numerical score 67.02% relief was
found on over all parameters. 92.96% of relief in lymphadinitis, 95.39% in
lymphangitis, 36.61% in lymphedema, 79.89% in pain, 91.05% in tenderness,
61.61% in heaviness, 98.37% infever and 96.69% relief in rigor were found. By
the statistical analysis (t-test) effect of treatment on each parameter was found
highly significant in all BMI groups. The effect of treatment, in high BMI group
(obese filarial patients) espesially in chronic symptoms like Lymphedema,
heaviness was less in comparison to Low BMI group.

Introduction
Shleepada which is akin to be Filariasis is a vector born parasitic
disease caused by three lymphatic dwelling, nematode parasites viz, Wuchereria

*Research Officer(Ay.) *'Assistant Director-in-charge Regional Research

Institute (Ay.), IGMS Complex, Labbipet, Vijayawada.-lO (A.P.)

25
Goli Penchala Prasad et al.

bancrofti, Brugia malayi and Brugia timori. Among them Wuchereria bancrofti is
most common in India (98%). According to the estimates made in 1995 globally,
there are nearly 1100 million people at the risk of Filariasis apart from 120
million cases of Filariasis. According to another study, in India the population
exposed to of infection was 25 million in 1953 and 420 million in 19951.3.

The disease Shleepada (Filariasis) is well described in Ayurvedic

classics. Sushruta mentioned it as a Tridoshaja Vyadhi with Kapha dosha
predominance. Vitiated doshas gradually descends from groins, thighs, knees
and calf regions to the foot and causes swelling in it. As the foot gradually
becomes harden like Shila (stone), this disease is called Shleepada (Shilavat
padamiti Shleepadam). This disease is of three types i.e. Vataja, Pittaja and
Kaphaja. Sushruta stresses the role of Kapha in these three varieties by quoting
huge and heavy swelling, the characteristic feature of filariasis (Shleepada) can
not manifest without Kapha predominance (Gurutvam ca mahatvam ca
yasmatnasti vina Kaphatv Among the three Prakritis (body constitutions)
Kaphaprakriti person will be obese or over weight. Kaphaja ahara and viharas
also increases body weight. Madhavakara stressed that Shleepada (Filariasis) in
Kaphaprakriti person and Shleepada produced by the Kaphaja ahara and Vihara
(obesity causing diet and activities) should be left untreated (or having bad
prognosis). He also stressed Shleepada patients with huge lymphedema
(swelling), Anthill like deformity should also be left untreated", All these
Ayurvedic literatures stress the role of obesity in the prognosis of Shleepada. As a
general rule in all types of Shleepada Kaphaja ahara and vihara are contra
indicated. Kaphahara (anti obese) diet and medicines are indicated as palliative
treatment procedures.
Modem recent researches also stress the role of obesity in the progression
of lymphedema. It is proved that obesity exacerbates lymphedema, particularly
in lower leg, as it makes the compression more difficult. The study clearly
suggested the role of weight reduction diet in Shleepada' . In another research it is
also mentioned, improper lymphatic drainage or return of lymph also causes
obesity as a vicious cycle. As per the report abnormal leakage oflymph fluid from
the ruptured lymphatic vessels - caused by the absence of the Prox 1 gene in
laboratory mice - was stimulating the accumulation of fat, particularly in regions
ofthe body rich in lymphatics (abdomen and thorax/chest). 10
In another reference it is quoted that "The knowledge that obesity is a
rising epidemic draws attention to its cofactor in lymphatic filariasis. There are

26
ROLE OF 8MIIN THE PROGNOSIS .

clinical facts that an obese person with lymphedema suffers from greater
immobility, rarely takes a deep breath, cannot elevate, and has a body posture that
aggravates lymph drainage. In obesity, the tissues are less responsive to massage
and to compression, there is considerable additional venous loading, and the
skin's barrier function is more easily breached".
It is also mentioned that causes of secondary lymhedema are acquired
blockage of the lymph nodes or by disruption of the local lymphatic channels
because of (1) recurrent attacks oflymphangitis (a key type ofthis is cellulitis),
(2) malignancy, (3) obesity, or (4) surgery Maintenance of ideal body weight
should be encouraged. Obesity is a contributing factor for the development of
lymphedema and may limit the effectiveness of treatment ': All these re rerences
suggest that obesity plays an important role in the progression; prognosis and
treatment of chronic lymphedema and other associated symptoms of Filariasis

Considering these facts two guggulu preparations namely Kanchanara

Guggulu and Goksliuradi Guggulu, having anti obesity and other desired
properties, were selected for the management of Shleepada. 239 patients were
selected for the present study from Regional Research Institute (Ayurveda),
Vijayawada to find the efficacy of treatment in various clinical findings and also
to find out the influence of body weight in the treatment.

Materials and Methods

Selection of drugs:
l.Kanchanara Guggulu-500 mg } thrice a day
. with water for
2. Gokshuradi Guggulu-500 mg q; k
Jour wee s

Selection of patients :( Inclusion and Exclusion criteria)

Based on Council's proforma 239 patients were selected for the trial of
Shleepada. Patients having cardinal signs and symptoms like lymphadenitis,
lymphangitis, lymphedema, deformity, chylurea, fever, rigors etc with (or) with
out positive blood test for microfilaraemia. Patients within the age limit of 5 to
70 years and chronicity of the disease more than one year were selected. Patients
having nodular deformity, wound ulcer, thorny deformity, anthill like deformity,
nutritional edema, edema due to liver, cardiac and arthritic disorder were
excluded from the study.

27
Goli Penchala Prasad et at.

Criteria for the assessment ofthe response after the therapy:

Specific scores were denoted against each and every parameter. All
parameters were recorded initially and during subsequent assessments i.e. every
week up to 4 weeks.
Gradation of Parameters with specific scores for the assessments of results
I. Lymphedenitis:
a). When one or more 1ymph gland( s) are excessi vel y enlarged 10
b).When lymph gland( s) enlarged mildly 5
c). Lymph glands are in normal size 0
II Lymphangitis:
a). Swelling of any lymphatic channel visible / palpable 10
b). Mild swelling of Lymphatic channels, mildly palpable but not visible 5
c). Normal 0
III. Swelling (lymphedema):
Much elevated that the part seems grossly deformed 30
Covers well the bony prominences / upper surface ofthe affected part 20
Slightly obvious or reveals more in comparison with normal side 10
No swelling 0
IV. Pain:
Moderate: Patient frequently complain of pain 8
Mild: Patient tells of pain after asking 4
Nil: No pain at all 0
V.Tenderness:
Grade-I. The patient winces and withdraws the affected part 15
Grade-II The patient winces 10
Grade-III. The patient says that the part is tender 5
Grade-IVNo tenderness at all 10
VI. Chyluria:
I). Presence of chyle in every sample of urine 15
ii). Presence of chyle frequently (More than 50% sample) 10

28
Goli Penchala Prasad et al.

Out of239 cases, 92(38.5%) got good response, 87got (36.40%) fair response,
41 patients (17.15%) showed poor response and 19 cases (7.95%) showed no
response (Table-Vl), In comparison of various BMI groups, in obese and overweight
patients poor and no responses percentages are more than low BMI groups (Table-Vll),
Based on numerical score 67.03% relief was found in over all parameters. 92.96%
of relief in lymphadinitis, 95.39% in lymphangitis, 36.61%in lymphoedema, 79.89%
in pain, 91.05% in tenderness, 61.61% in heaviness, 98.37% in fever and 96.69%
relief in rigor were found (Table-VIII). By the statistical analysis (t-test) effect of
treatment on each parameter was found highly significant(Table-IX). (P.<O.OO 1).This
highly significant effect was observed in all clinical findings in various BMI groups
(Table-X to'Iable-Xvlllj.But statistically inobese and overweightgroup patients'effect
in terms of mean difference (BT- AT) was less in chronic symptoms like
lymphedema (Table-XII) and heaviness (Table-XV) in comparison to normal and
underweight group patients.
Out of 239 Patients many patients visited OPD as follow up. Among these
patients 79 patients suffered from various degrees of periodical episodes along with
involvement of many clinical findings. Recurrence in clinical findings was
observed more in high BMI groups (Table-XIX).

Table-I
Demographic pattern of 239 Shleepada Patients
Patients Particulars
Male: Female 83(34.73%) : 156 (65.27%)
Mean age in years 42.98
Mean disease duration in years 9.64
Mean score on overall parameters (BT: AT) 58.07 : 19.20

Table-II
Showing the duration of illness
SL.No. Duration of illness in yrs. No. of Patients
1 1-5 Years 108 (45.2)
2 6-10 years 44(18.41%)
3 11 -15 Years 29(12.13%)
4 16 -20 Years 38 (15.9%)
5 21 -25 Years 10 (4.18%)
6 25 Years and above 10 (4.18%)
Total 239 (100%)

30
ROLE OF 8MIIN THE PROGNOSIS .

Table-III
Showing the distribution of Shariraka and Manasika Prakriti

SI.No. Sharira No. of Manasika No. of

Prakriti Patients Prakriti Patients
1. Vata 11(4.60%) Satva 4(1.67%)
2. Pitta 14(5.86%) Rajas 18(7.53%)
3. Kapha 16(6.69%) Tamas 16(6.69%)
4. Vatapitta 82(34.31%) Satva Rajas 46(19.25%)
5. Vatakapha 50(20.92%) Satva Tamas 60(25.11%)
6. Pittakapha 65 (27.2%) Rajo Tamas 95(39.75%)
7. Sannipata 1(0.42%) Sarna 0
Total 239(100%) Total 239(100%)

Table-IV
Showing the parts affected
Sl. No Affected Part No. of Patients
l. Right leg 102 (42.68%)
2. Left leg III (46.44%)
3. Both legs 21 (8.79%)
4. Right hand 1(0.42%)
5. Left hand 4(1.67%)
6. Both hands 0
Total 239 (10 0%)
Table-V
Classification of the Body Mass Index (8MI) .To find the role of
body weight or Obesity patients were divided to 4 BMI groups"

S.No. 8MI group 8MI Range (Kg/m')

1 Under weight <20
2 Normal 20 to<25
3 Over weight 25 to <30
4 Obese 30& above
Table-VI
Showing the results of the treatment
Drugs Results of the treatment
Good Fair Poor No Total
Resp. Resp. Resp. Resp.
Kanchanara Guggulu 92 87 41 19 239
Gokshuradi Guggulu (38.5%) (36.4%) (17.2%) (7.9%)

31
Goli Penchala Prasad et al.

Table-VII
Showing the results of the treatment in Various BMI groups
BMlRANGE Results of the treatment (Number of Patients)
(Kg/m')
Good Fair Poor No Total
Resp. Resp. Resp. Resp.
<20 18( 48.65% ) 11(29.73%) 6( 16.22%) 2(5.40%) 37
20 to<25 36(44.44%) 30(37.04%) 11(13.58%) 4( 4.94%) 81
25 to <30 19(29.69%) 26(40.62%) 12(18.75%) 7(10.94%) 64
30& above 19(33.33%) 20(35.09%) 12(21.05%) 6(10.53%) 57
Total 92 (38.5%) 87 (36.4%) 41 (17.2%) 19(7.9%) 239
Table-VIII
Showing the percentage of 1elief on various parameters:
S1. Parameters Total score Before Total score After Percentage of
No Treatment Treatment relief
1. Lymphadenitis 1350 95 92.96%
2. Lymphangitis 1410 65 95.39%
3. Lymphoedema 6060 3720 36.61%
4. Pain 1512 304 79.89%
5. Tenderness 2235 200 91.05%
6. Heaviness 448 172 61.61 %
7. Fever 615 10 98.37%
8. Rigor 242 8 96.69%
Total 13872 4574 67.027%
Overall effect of treatment in terms of score = BT-AT / BT X 100 = 67.027%
Table-IX
Showing the effect of treatment on various clinical Findings
Symptom Mean grade score S.D S.E t P N
B.T A.T BT-AT
Lymphadenitis 8.23 0.58 7.65 ± 2.793 0.218 35.092 <0.001 164
Lymphangitis 8.20 0.38 7.82 ±2.712 0.207 37.82 <0.001 172
Lymphedema 25.356 15.565 9.791 ±7.359 0.476 20.568 <0.001 239
Pain 7.132 1.434 5.698 ±2.366 0.162 35.073 <0.001 212
Tenderness 10.694 0.957 9.737 ± 4.224 0.292 33.328 <0.001 209
Heaviness 1.931 0.741 1.190 ±0.789 0.052 22.978 <0.001 232
Fever 5 0.081 4.919 ± 0.635 0.057 85.913 <0.001 123
Rigor 1.967 0.065 1.902 ± 0.564 0.051 37.399 <0.001 123
Overall 58.071 19.197 38.874 ±20.293 1.313 29.616 <0.001 239
Parameters

32
ROLE OF 8MIIN THE PROGNOSIS .

iii). Presence of chyle rarely 5

iv). Absence of chy Ie o
VII. Fever:
Present 5
Absent o
VIII. Rigor:
Present 2
Absent o
IX Heaviness:
Severe Heaviness 2
Mild/ Moderate Heaviness 1
Absent o
On the basis of the individual score of each finding before and after
treatment, the response of the treatment has been assessed. Over all effect of the
treatment in each individual patient has been assessed by the formula mentioned
below.
i.e. over all percentage of relief = (Total score of all findings before treatment
-Total score of all findings after treatment) x 100 / Total score of all findings
before treatment.

Classification ofthe Results:

i. Good Response: 75% or more relief in clinical symptomatology
ii. Fair Response: 50% to 75% relief in symptomatology.
iii. Poor Response: 25% to 50% reliefin symptomatology.
iv. No Response: Reliefbelow 25% in symptomatology

Observation and Results

Patients were selected in between the age of 5-70 years. Highest incidence of
patients was observed in between the age of 26-35 i.e 59 (24.7%). Among the 239
patients 156 (65.27%) were females and 83 (34.73%) were males (Table-I).The
patients having chronicity of more than one year only were selected for the present
study and majority patients 108 (45.19%) were having 1-5 year's duration of
illness (Table-II). In Shareera Prakriti majority of patients belong to Vatapitta
(82(34.31 %», Pittakapha 65 (27.2%) in nature (Table-III). Manasik Prakriti in
majority of patients is Raja lamas (95(39.75%) (Table-Ill). 102(42.68%) patients
were suffering from filariasis in right leg, III (46.44%) left legs Filariasis,
21(8.79%) both legs, 1(0.42%) Right hand and 4 (1.67%) patients with left hand
(Table-IV).

29
ROLE OF 8MIIN THE PROGNOSiS .

Table-X
Showing the effect of treatment on Lymphadenitis in various BMI groups.
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 7.8 0.2 7.6 ± 2.550 0.510 14.905 <0.001 25
20 to<25 8.19 0.60 7.59 ± 2.847 0.374 20.292 <0.001 58
25 to <30 8.22 0.89 7.33 ± 2.939 0.438 16.739 <0.001 45
30 & above 8.75 0.417 8.33 ± 2.673 0.445 18.708 <0.001 36
Total 164
Table-XI
Showing the effect of treatment on Lymphangitis in various BMI groups.
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m2)
B.T A.T BT-AT
<20 7.7 0.2 7.5 ± 2.559 0.546 13.748 <0.001 22
20 to<25 8.500 0.417 8.083 ± 2.753 0.352 22.936 <0.001 60
25 to <30 8.222 0.555 7.667 ± 2.739 0.408 18.779 <0.001 45
30& above 8.111 0.222 7.89 ± 2.715 0.405 19.488 <0.001 45
Total 172
Table-XII
Showing the effect of treatment on Lymphedema in various BMI groups.
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 22.432 12.432 10 ±7.817 1.285 7.781 <0.001 37
20 to<25 25.185 13.704 11.481 ± 6.912 0.768 14.950 <0.001 81
25 to <30 25.781 16.875 8.906 ± 7.153 0.887 10.038 <0.001 64
30& above 26.667 18.246 8.421 ± 7.744 1.026 8.210 <0.001 57
Total 239
Table-XIII
Showing the effect of treatment on Pain in various BMI groups.
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 7.1 0.4 6.7 ±1.878 0.343 19.539 <0.001 30
20to<25 7.253 1.627 5.626 ± 2.364 0.273 20.613 <0.001 75
25 to <30 6.962 1.555 5.407 ± 2.595 0.353 15.310 <0.001 54
30& above 7.13 1.88 5.25 ± 2.804 0.385 13.644 <0.001 53
Total 212

33
Go/i Penchala Prasad et al.

Table-XIV
Showing the effect of treatment on Tenderness in various BMl groups
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m2)
B.T A.T BT-AT

<20 10.517 0.517 10 ±4.009 0.744 13.433 <0.001 29

20to<25 10.608 0.878 9.730 ± 3.872 0.450 21.615 <0.001 74
25 to <30 10.943 1.226 9.717 ± 4.643 0.638 15.238 <0.001 53
30& above 10.849 1.038 9.811 ± 4.270 0.587 16.728 <0.001 53

Total 209
Table-XV
Showing the effect of treatment on Heaviness in various BMl groups
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 1.89 0.58 1.31 ± 0.822 0.137 9.532 <0.001 36
20 to<25 2.012 0.594 1.418 ± 0.914 0.103 13.781 <0.001 79
25 to <30 1.9 0.833 1.067 ± 0.778 0.100 10.617 <0.001 60
30& above 1.965 0.930 1.035 ± 0.823 0.109 9.496 <0.001 57
Total 232
Table-XVI
Showing the effect of treatment on Fever in various BMl groups
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 5 0 5 ±OOOO 0000 <0.001 18
20 to<25 5 0.111 4.889 ± 0.745 0.111 44.000 <0.001 45
25 to <30 5 0 5 ± 0000 0000 <0.001 33
30& above 5 0.185 4.815 ± 0.962 0.185 26.00 <0.001 27
Total 123
Table-XVII
Showing the effect of treatment on Rigor in various BMI groups
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m')
B.T A.T BT-AT
<20 2 0 2 ±OOO 000 <0.001 18
20 to<25 1.957 0.087 1.870 ± 0.653 0.096 19.103 <0.001 46
25 to <30 2 0 2 ±OOO 000 <0.001 32
30& above 1.926 0.148 1.778 ± 0.847 0.163 10.902 <0.001 27
Total 123

34
 ROLE OF 8MIIN THE PROGNOSiS .

Table-XVIII
Showing the effect of treatment on Heaviness in various BMI groups
BMIRANGE Mean grade score S.D S.E t P N
(Kg/m2)
B.T A.T BT-AT
<20 51.54 14.00 37.54 ± 20.125 3.309 11.346 <0.001 37
20 to<25 59.457 17.815 41.642 ± 19.292 2.144 19.427 <0.001 81
25 to <30 58.093 21.625 36.468 ± 21.838 2.730 13.359 <0.001 64
30& above 61.070 22.333 38.737 ± 20.619 2.731 14.184 <0.001 57
Total 239

Table-XIX
Showing the foUow-up incidences of recurrences in various BMI groups
S.No. BMIRANGE Number of Number of patients Percentagoof
(Kg/m") patients suffered from periodic recurrence patients
treated attacks with in 6 months in comparison to
duration in followups to treated (%)
OPD
1 <20 37 7 18.92
2 20 to<25 81 15 18.52
3 25 to <30 64 28 43.75
4 30& above 57 29 50.88
5 Total 239 79

Discussion
The drugs Kanchanara Guggulu and Gokshuradi Guggulu were selected
for the clinical trial on Shleepada (Manifested Filariasis). Though these two
prepara: 'ons were not directly indicated for the treatment ofShleepada they have
been used to reduce Swelling, Pain, Tenderness, Heaviness, Inflammation,
Nodular Deformity etc. Gokshura, Kanchanara & Guggulu are the three main
ingredients having major parts used in the above said preparations. 7 Among them
Gokshura (Tribulus telTestris) has been mentioned in Charaka Shothahara
dasaimani, as having Shothahara (reduces swelling) and Kapha Nissaraka
propertieis". Kanchanara (Bauhinia variegata) is having Shothara, Krimighna
(wormicidal), Kaphaghna, Medohara, Vranashothara, Granthihara
properties".
Guggulu (Commiphora mukuJ) is having Medohara (hypocholestremic,
hypolipidemic), Granthihara (reduces hard masses and tumours),
Pidakanashana, Krimighna, Shothahara, Vedanasthapana (stops pain), Vrana
Shothahara (reduces swelling due to wound) and Vranaropana (wound healing)

35
Go/i Penchala Prasad et al.

properties". Based on Modem pharmacological studies Kanchanara is having

antitumor, anti-inflammatory, anti-ulcer,antimicrobial and hypothermic properties".
Guggulu is having anthelmintic, anti-inflammatory, hypocholestremic,
hypolipidemic, hypolipidaemic and fibrinolitic properties'. Gokshura is having
muscle relaxant, diuretic, antimicrobial and analgesic properties'. All the above
actions of the drugs can be corroborated in getting of these significant results.

By the observations and results of the treatment and statistical analysis it is

clear that the overall effect of treatment on various clinical parameters is highly
significant in all BMI groups. Though overall percentage of relief of clinical
findings is 67.02%, it is very poor (36.61%)inchroniclymphoedema (Table-V)In high
BMI group it is further low (31.56%) (Table-IX). Statistically the treatment is
effective. But in follow-up studies at OPD levels it was observed that in obese and
heavy weight groups the recurrences are frequent. Complications like wounds,
ulcers, oozing or lymphorrhea, cellulitis or lymphangitis, fibrosis and elephantiasis
are more common in obese and heavy weight groups' patients. Probably in
Ayurvedic classics, this may be the main reason for the exclusion of Kapha
Prakriti (obese filarial) patients from the treatment. Though recurrences are
observed, the duration between periodic episodes was reduced. The important
result of the treatment is the state of well being in spite of acute periodic episodes.

By this study it can be concluded that Kaphahara (anti obesity), Sothahara

(anti-inflammatory), Medohara (hypolipidemic), Pidakanasana or Granthihara
(anti tumor) dravyas like Kanchanara Guggulu and Gokshuradi Guggulu should
be taken to attain significant results in all BMl groups. Further research can
provide more benefits to the suffering filarial populations.

Acknowledgement
The authors are very grateful to the Director, Central Council for Research
in Ayurveda and Siddha, New Delhi for providing opportunity to conduct this
clinical trial.

36
 ROLE OF 8MIIN THE PROGNOSiS .

References
1. Anonymous. ICMR Bulletin 2002 May-June; 32 (5-6).

2. Bhavamisra. Bhava Prakasha Nighantu Commentary by Chunekar KC.

Chaukhambha Bharati Academy; 2002.

3. Harrison. (Principles ofInternal medicines; Vol 1). 15thed. 2001.

4. Madhavakara. Madhavanidanam translated by Srikanta Murty KR. 4thed.

Chaukhambha Orientalia; Varanasi: 2001.

5. Sharma PC, Yelna MB, Dennis TJ. (Database on Medicinal plants used in
Ayurveda; Vol 2-3). Central Council for Research in Ayurveda and Siddha;
New Delhi: 2001.

6. Sharma PY. (Dravyaguna vignanam; part 2 -3). 2nd ed. Chaukhambha

Sanskrit series; 1969.

7. Sharangadara. Sarangadhar Sarnhita translated by Himasagara Chandhra

Murthy P. 1sted. Chaukhambha Sanskrit series; Varanasi: 2001.

8. Sushruta. Sushruta samhita commentary by Ambikadatta Shastri. 3rd ed.

Chaukhambha Sanskrit series; Varanasi: 1972.

9. Anonymous. Pathophysiology of Lymphedema. AOL Journal 2005

November.

10. Harvey NL, Srinivasan RS et a1. Lymphatic vascular defects ProxI haplo-
insufficiency cause adult- oset obesity. E pub 2005 Sep to Oct;
37(10):1072-81.

11. Ryan. Lymphatic Filariasis and the International Society of Lymphology.

2004 Sept; 37( 3).

12. Davidson. Principles and practice of Medicine. 17thed. ELBS publication;

1995.

13. Harris Susan R, Hugi Maria R et al. Clinical practice guidelines for the care
and treatment of breast cancer. JAMC 2001 January 23.

14. Lavekar as et a1. (Database on Medicinal plants used in Ayurveda; Vol 8).
Central Council for Research in Ayurveda and Siddha; New Delhi: 2007.

37
 Goli Penchala Prasad et al.

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(\ifrtfr~, \ifr~~)
mffi 1f ~c11q~ ~lfTl<Ol'ifcp ~ Xl6f ~ ~ ~ I crf 2000-2007 ~
3R'fl"ffi 239 ~c11q~ ~lfI'J<:j'i em- Cfji'il'1I"! ~-500 Pi. TIT. ~ <TIP- ~-
500 fit. TIT. ~ 1f ~ 6fR 28 ~ ~ ~ (4 ~) ~ .-m I ~ ~
~ ~$1I~Cfj ~ ~ ~c1l)lq~ cBI ~Fchf{il ~ Xi1~ 1f ~ ~ ~
~ cBI ~gC'c:lliol ~ ~ I Cfji'il'1I"! ~ ~ <TIP- ~ ~ ~~lg,,! ~
3RT ~c11q~g,,! wncr ~ Xi1~ Xi1~ ~ ~ 11R-f ~ ~ 1f ~Fchf{il ~
~ em gC"l'11~ Cfj3ltzr<:A fcnm 'RIT I

239 ~c11q~ ~1fI'J<:j'i # 92(38.5%) em- ~ "C'1T+f,87(36.40%)

~'lfTl<:j'j
~ em- ~ fI'J<:j'j em- 3T(>q" "C'1T+ff1iC'1l 3tR
"C'1T+f, 41 (17. 15% ) ~1
19(7.95%) ~1fI'J41 1f ~ C1T~ ~ LTmT Tf<n I ~lfTI<:j'j cj) c;{afUll em- ~ .-m
xi'LC<:!I~Cfj ~ ~ ~ x-Pft c;{afUll1f cgc;r f1iC'1l~ 67.02% 3lRT111WlT
Tf<n I fC;t%~'1I~R:xi # 92.96%, ~Lf)I;:JtR:fl # 95.39%, fC;t%~~1 1f
36.61%, ~ 1f 79.89%, t~ # 91.05%, ~fcl~xi (~) 1f 61.61%
~ (\JCR) 1f 98.37%, ~ # 96.69% C1T~ 1WlT Tf<n I xii'Lc<:!<f>l<Plol'1
(IR IR:t?1 CfjC"I31'11C"Iffl fl) cj) ~ ~ ~ c;{~ 1f ~ gfC1crol "C'1T+f1WlT Tf<n I
~ ~ 11R-f ~ cj) ~ 1f 3lc;{TT ~ cBI ~ <$1<P I01'1
fl i'Lc<:!
(IR IR:xi) CfjC"l3i'11 C"Ifflfl) ~ 31jffR '4T ~ ~ C1T~ LTmT Tf<n I ~ ~
~1t)~lfl~;gCffi ~ 1f, \ifrul c;{afUll1f ~Fchf{il em "C'1T+fCf)l1 ~ 11R-f ~
~ cBI ~ 1f Cf)l11WlT Tf<n I
(Approved on 04-08-2009)

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