life cycle of leeches

vk;qosZn esa fNis gS] lqUnj o LoLFk Ropk ds jkt

The management of baldness is a multidiscipilanary effort that spans the medical ,pharmaceutical,food supplement ,exercise and fashion industries.

1.finesteride and minixidol are usually first line therapy for its treatment.other opestions include tropical or systemic spironolactone or fhutamide ,at through they have a high incidence of feminiging side effects and better threated in female androgenic hair loss.

A number of other medication used commonly off label are dutasteride and ketokanazole and in female androgenic alopecia spironolactone and flutamide .

Combination of finesteride ,minoxidol and ketokanazole are more effective than individual use ,suigesting synergistne effects of the medication

2 More advanced cases may be resistant or unresponsiveness to medical therapy,however and reqire hair transplantation.
3-PRP (PLATELET REACH PLASMA THERAPY

Hair care

1.Always use clean and cold water to wash your head avoid using warm water .

2.Regular application of oil on the scalp

3.use conditioners

4eat protein rich food ie. Soya milk ,egg etc

5. Comb hair only after hair get dried after wath

6.Remove stress from your life .

7.Yogasana to be done on regular basis

A)Shirsasan

b)Shavashan

c)Bhramari pranayama

d)Anuloma viloma pranayama.

Some house hold remedies

1.one pinch saffron powder

2 Table spoon yasthimadhuka churna +2 table spoon milk make it like paste and apply on scalp and keep for 1 Hour and rinse .

2.Gokshur churna +amalki churna +guduchi satva same quantity mix and take 1tsf bi a day with milk

3.Drink milk atleast 2 times a day

4.if there is dandruff on hair ,then apply lemon juice in night on the scalp then reinse in the morning

5.eats lot of frouts like gwava .orenge .ect

AURVEDIC LINE OF TREATMENT

1.pachana and dipan

2.snehan and swedan

3.panchakarma (virechana)

4.nasya(yastimadhu tail) and vasti.

5.basti(panch tikta kshir)

6.dhumpan

7.shirodhara

8.Rasayana chikitasa

Ayurvedic yogas’

1.sanjeevani vati

2.Aarogya vardhini vati

3.sutshekhar rasa

4.kapardika bhasma

5.shankha bhasma

6.krumi kuthar rasa

7.mahamanjisthadi kashaya

8.Asthi posak vati

9.Ashwa gandha arista

10.brahami vati

11.gunja tail

12.karanj tail

14.neeli bhrungraj tail

15.rasayana churna

16.guduchi ghan vati

17.chyawan prash

18.langali tail

19.swarna bhama

20.maltyadi tail

21.amrutadi guggul

22.panchatikta gruth

23.trifala gruta

24.avipattikar churna

25.Shatavari kalp

26.Abha guggul

DAIGNOSTIC TESTS

1.Trichogram,tricoscopy,biopsy

2.Microscopic examination of plucked follicle

3.Biopsy of the scalp

4.Androgenic lab analysis of DHEA (dehydroepiandrosterone sulphate and testosterone)

5.TSH

6.Serum iron

7.Total iron binding capacity

8.Trans ferrin saturation

9.CBC

Anatomical View of Medicinal leeches & Related Facts

Phylum              :  Annelida

Class                 :  Hirudinea

Genus                :  Hirudiniaria

            Leeches are segmented worms that belong to the phylum  Annelida and comprise the subclass Hirudinea. Like other oligochaetes, such as earthworms, leeches share a clitellum and are hermaphrodites.      

           Nevertheless, they differ from other oligochaetes in significant ways. For example, leeches do not have bristles and the external segmentation of their bodies does not correspond with the internal

 segmentation of their organs. Their bodies are much more solid as the spaces in their coelom are dense with connective tissues. They also have two suckers, one at each end.

The majority of leeches live in freshwater environments, while some species can be found in terrestrial and marine environments, as well.          Most leeches are hematophagous, as they are predominantly blood suckers that feed on blood from vertebrate and invertebrate animals. Almost 700 species of leeches are currently recognized, of which some 100 are marine, 90 terrestrial and the remainder freshwater

         Leeches, such as the Hirudo medicinalis, have been historically used in medicine to remove blood from patients. The practice of leeching can be traced to ancient India and Greece, and continued well into the 18th and 19th centuries in both Europe and North America. In modern times, the practice of leeching is much rarer and has been replaced by other contemporary uses of leeches, such as the reattachment of body parts and reconstructive and plastic surgeries and, in Germany, treating osteoarthritis.

Some facts about Leeches

a)   700 Known leech species

b)   Only 5 are used for medicinal purpose

c)   It has 32 brains

d)   Leeches die after one or to bouts of reproduction

e)   3 sets of jaw

f)    Each jaw has around 100 teeth

g)   4 to 10 hour bleeding +nt after leech application

h)   Leeches can live up to one year without food so you don't need to feed them

i)     Life span of leech  - 10yr

Modern & Ayurvedic Concept of Khalitya (Alopecia)

It is said is the mirror of our personality and it should be maintained from the what hairstyle we keep.

In today’s developing world there is lots changes in the eating habits and the lifestyle . Due to which its ill effects are seen on the body and out of which hair is affected the most. And hair fall has erupted as a major problem.

The most who are affected with this problem is the young population not only men but also womens. And people are spending lots of money to get rid of this problem but all in vain. In our ancient ayurvedic granthas it is said that hair and nail are the malas of the asthi dhatu ie they develop from the asthi dhatu.

Acharya shusruta had said in his shushruta samhita that the drusthi and the lomkupaa never grow throughout lifetime but hairs and nail do. Acharya charaka have also mentioned in his text that hairs are the mala of asthi dahtu. Acharya sharanagdhara have mentioned that kesha, loma, are the updhatu of majja dhatu.

Causes of Hair Fall:

Ayurveda

1) Virudh aahara vihara
2) Pitta vardhaka aahara vihara
3) Hina, mithya, and aatiyoga of aahara, nidra and bhramachaya.
4) Consuming polluted water
5) Living in polluted environment
6) Non application of oil on the scalp
7) Consumption of dushi visha

Modern

1) Fungal infection (tinia capitis)
2) Ulcerative colitis
3) Vit b12, iron, zinc, biotin and also vit e deficiency
4) Overdosage of vit a
5) Lack of vit b6 and folic acid in food
6) Rheumatoid arthritis
7) Thyroid dysfunction
8) Vitiligo
9) Radiotherapy and chemotherapy
10) Systemic lupus erthrematus
11) Pshycological stress
12) Nutrition
13) Seborhhic dermatitis
14) Hormonal imbalance
15) Folliculitis
16) Secondary syphilis and usage of drugs like warfarin and heparin
17) Usage of contraceptive pills antihypertensive drugs and anti diabetic drugs.
18) Anemia
19) Long term usage of steroids
20) Over usage of shampoo containing Selenium.

Way to Grow:

Hair grow in three different cycles

1) Anagen
2) Catagen
3) Telogen

About 90% of the the hair of the head is in the anagen or the growing phase, which last for anywhere from 2 to 8 years. The catagen or the transition phase typically last for 2 to 3 weeks during which the follicles shrink. During the telogen cycle which last for around 2 to 4 months the hair rests.

Hairs grow about 6 inches a year for most people. In a normal individual hair falling of 100 to 250 hair sper day is a normal thing but more then 150 per day hair e fall would indicate there is a problem.

Ayurvedic Concept:

Acharya Sushruta have mentioned about hairfall in sushruta samhita nidan sthan there are three stages

1) Khalitya (alopecia totalis)
2) Palitya (whitening of hairs)
3) Indralupta (hairfall in patches ie alopecia areata)

“Romakupanugam pittam vaaten saha murchitam |
Prachyavayati romani tata: shleshma sahshonitam||
Runadhi romkupanstu taato anyesham sambhav|
Tad indraluptam khalitya rujyeti ch vibhajyate||”. Su. Ni. 11

The meaning of the above phrase is that when the vaata dosha get vitiated along with pitta dosha it goes into the romkupam ie the hair follicles and which results in hairfall. The next pathology that occurs is that the rakta dosha along with the kapha dosha goes in the romkupas whish cause the romkupas to close which ultimately results in non growth of hair from that respective follicle. this disease is known as indralupta, khalitya, or rujya.

Strotasa that get involved in the following pathology.-

1) Swedawaha strotasa
2) Asthivaha strotasa
3) Majjavaha strotasa
4) Rasavaha strotasa
5) Purishvaha strotasa

Modern concept:

Alopecia is a condition in which there is a loss of hair from head and body. Alopecia can refer to general hair loss or male pattern baldness. in a normal individual there are 1 to 1.5 lakh of hairs. Mainly there are two types of alopecia

1) Scarring
2) Non scarring

1) Scarring: The type of baldness the hairfall in which the hairs fall with the follicle and is known as scarring alopecia. In this type of baldness there is no chance of hairs growing back after falling.
2)  Non scarring: The type of baldness in which only the hairs falls and not the follicles so there is a chance that the hairs grow again. The main cause of non scarring baldness is Telogen effluvium.

In women the ovarian and adrenal gland dysfunction causes the hairs to fall.

Diagnostic Tests

1. Trichogram, tricoscopy, biopsy
2. Microscopic examination of plucked follicle
3. Biopsy of the scalp
4. Androgenic lab analysis of DHEA (dehydroepiandrosterone sulphate and testosterone)
5. TSH
6. Serum iron
7. Total iron binding capacity
8. Trans ferrin saturation
9. CBC

Ayurvedic Line of Treatment

1. pachana and deepan
2. snehan and swedan
3. panchakarma (virechana)
4. nasya (yastimadhu tail).
5. basti (panch tikta kshir)
6. dhumpan
7. shirodhara
8. Rasayana chikitasa

Ayurvedic yogas

1. sanjeevani vati
2. Aarogya vardhini vati
3. sutshekhar rasa
4. kapardika bhasma
5. shankha bhasma
6. krumi kuthar rasa
7. mahamanjisthadi kashaya
8. Asthi posak vati
9. Ashwa gandha arista
10. brahami vati
11. gunja tail
12. karanj tail
14. neeli bhrungraj tail
15. rasayana churna
16. guduchi ghan vati
17. chyawan prash
18. langali tail
19. swarna bhama
20. maltyadi tail
21. amrutadi guggul
22. panchatikta gruth
23. trifala gruta
24. avipattikar churna
25. Shatavari kalp
26. Abha guggul

Modern Line of Treatment

The management of baldness is a multidiscipilanary effort that spans the medical , pharmaceutical, food supplement ,exercise and fashion industries.

1. finesteride and minixidol are usually first line therapy for its treatment. Other options include tropical or systemic spironolactone or flutamide , at through they have a high incidence of feminizing side effects and better threated in female androgenic hair loss.
A number of other medication used commonly off label are dutasteride and ketokanazole and in female androgenic alopecia spironolactone and flutamide. Combination of finesteride, minoxidol and ketokanazole are more effective than individual use, suggesting synergistne effects of the medication.

2 More advanced cases may be resistant or unresponsiveness to medical therapy, however and require hair transplantation.

Hair care

1) Always use clean and cold water to wash your head avoid using warm water.
2) Regular application of oil on the scalp
3) use conditioners
4) eat protein rich food ie. Soya milk ,egg etc
5) Comb hair only after hair get dried after wath
6) Remove stress from your life .
7) Yogasana to be done on regular basis
A) Shirsasan
b) Shavashan
c) Bhramari pranayama
d) Anuloma viloma pranayama.

Some house hold remedies

1) one pinch saffron powder, two Table spoon yasthimadhuka churna +2 table spoon milk make it like paste and apply on scalp and keep for 1 Hour and rinse .
2) Gokshur churna +amalki churna +guduchi satva same quantity mix and take 1tsf bi a day with milk
3) Drink milk atleast 2 times a day
4) if there is dandruff on hair ,then apply lemon juice in night on the scalp then reinse in the morning

5) eats lot of frouts like gwava, orange .etcthat face 

Comparative Study of Yashtimadhusiddha Ghrita (Glycyrrhiza glabra Medicated Ghee) and Silver Sulphadiazine Local Application in Agnidagdha Vrana Management”

ABSTRACT- In all over the world, out of all accidental death 2.10% males and 3.40% females died due to burns.  It is a major socio-economical problem related to dowry deaths, so it is necessary to study this problem with depth so taken as a study topic.

Burn is commonly met casualty in surgical wards of hospital.It occurs due to accidential spillage of hot water, oil, curry etc .Depending upon thickness of skin involved, burns are classified as 1 ^st  ,2^nd ,  3^rd  and 4^th degrees. In 1^st degree burn the skin looks red and is painful ,no blisters are seen. In 2^nd degree burn the skin is mootled, red, painful with blisters. It is further divided into superficial burn which heals by causing pigmentation and deep burn which heals by causing pigmentation and scarring. 3^rd burn is characterised by charched, insensitive,painfull skin whereas 4^th degree burn is characterised by involvement of muscles, bones,etc. Aarcharya Sushruta has mentioned plushtam dagdha characterised by discolouration and severe burning,dur dagdham  by blisters, redness, pain, etc.Hence it resembles 1^st and 2^nd burns described by modern context.Aarcharya Sushruta has mentioned the use of Yashtimadhu, Rodhra,Manjistha,Chandan siddha grita as uttam vranaropak in burn.Yashtimadhu has Dahashamak,Vedanasthapak ,Vrana-ropak properties.

 Hence I have decided to study the Dahashamak, Vrana-ropak properties of Yashtimadhu Ghrit  on burn as compared with silver sulphadiazine and to evaluate the efficacy of Yashtimadhusiddha Ghrit.

Hence there is a need to find such a therapy which gives better relief without any side or toxic effect and also natural, cost effective and easily available .hence the study was selected.

Key words - Dagdha, Yastimadhu Grita, Burn, Daha.

       

INTRODUCTION :

 Ayurveda is an applied science and time-tested health system with vast scope of trials to prove certain principles as well as therapeutic effects of the medicines, which is the need of the hour to make theAyurveda more acceptable globally.

 Ayurved Science is being practised in eight cults of “Ashtang Ayurved”. Shalya Tantra offers quicker and faster solution for diseases than other branches. Father of surgery Sushrutacharya has explained in Sushrut Samhita- Agnikarma Vidhi and Dagdha Vrana¹.  Sushruta has also explained Shit Dagdha (Frostbite) & ushana dagdha (sunburn) included in Dagdha vrana². In Ayurved burn may be grouped under four distinct heads via. 1. Plushtam 2. Dur-dagdham 3. Samyag-dagdham 4. Ati- dagdham^{3 .}

1.  Plushtam:- A burn characterized by discoloring of its seat and extreme burning and marked by absence of any vesicle or blistes⁴ is called plusta.

2. Dur Dagdha:- A burn which is characterized by eruption of large vesicle or blister and assumes a red colour and is characterized by excessive burning and of drawing pain and which suppurates and takes a long time to heal  called the Dur-dagdha (bad burn or scald).

3. Samyag Dagdham:-  A burn which is not deep (superficial) and assumes the colour of ripe tala fruit, and does not present a raised or elevated aspect and develops the preceding symptoms is called Samyag Dagdham.

4. Ati Dagdham:- A burn in which the flesh hangs down and where the veins and nerves, bones are destroyed a companied with fever burning thirst fainting and such like disturbances which leads to permanent disfigurations is called as Ati Dagdha^.

    In 1^st degree burn the skin looks red and is painful ,no blisters are seen. In 2^nd degree burn the skin is mootled, red, painful with blisters⁴.

Whereas the1st & 2^nd degree burn descried in modern science can be correlated with plushta and durdaghdha angnidagdha because it also produces the same sign and symptom.

AIM AND OBJECTIVES:

1-   To evaluate the efficacy of Yashtimadhu siddha Ghrit in burn    management for local application.

2-   To find out possibilities in combine therapy in burn patient.

DRUG REVIEW:            

  Name : Yashtimadhu

 Guna : guru, Snigdha

 Rasa : Madhur

 Vipaka  : Madhur

 Veerya : Sheet

 Modern Aspect

 English Name :Liquorice 

 Latin name         :  Glycyrrhiza glabra

 Family                : Leguminosae

 Habitat               :  Northern India

 Plant: 1. tree up to 6 feet in ht.

Other Properties: Pittashamak,vatshamak,Kaphanisarak,vedna sthapak   .

 Properties- Dahashamak,  Vranya,Shonitasthapan^3,

MATERIALAND METHODS :

The present clinical study is an open randomized comparative study. The aim of the clinical study is to assess the efficacy of prepared Yashtimadhu siddha Ghrit in burn management for local application.

Material:      1) Yashtimadhu siddha Ghrit.

                   2) Silver sulphadiazine ointment

                  3) Distilled water,Dressing material

Method:

Yashtimadhusiddha  grita was poured in a steel sterile container  containing sterile gauze piece.The container was closed with lid properly and was given for auto-claving.The auto-claved gauze pieces were used for dressing in pts of 1^st and 2^nd degree  burns after cleaning with distilled water. The Blisters if present were drained prior to the application of ghrita and ointment.

Duration: 15-30 days

Follow-up: Daily, the dressing was changed after 24 hrs.Gradations  were noted on  0,7^th,14^th,^, 21^st days.

 Before starting treatment routine investigation were done as necessary.

 Antibiotic and Analgesics were given as required.

 The patients were treated and observed, comparative study was  done in   two groups.

 1. Group 'A'(Experimental Group of 15 pts) -      patients were treated with local application of      yashtimadhu ghrit.

 2. Group 'B'(Comparative Group of 15 pts) - patients were treated with local application of silver Sulphadiazine Ointment.

 Criteria for selection of patient

(A)Inclusive Criteria-      

                                     1. Patient having 1^st and 2^nd   degree burn.

                                        2. Superficial burn (Twacha, Maunsa dagdha) .                                                                            

                                        3. Irrespective of sex and occupations.

                                        4. Age group 6yr to 65yr.

 (B) Exclusive Criteria-

 1. Patient having 3^rd and 4^th degree burn

 2. Deep burn (Sira, Snayu, Asthi, Sandhi dagdha).

  3. Diabetic, Lepromatus, HIV, HBSAG positive    patients.

  4. above 65 ages and below 6yr.age

                

Place of Work: -   SOPD    of   R A Podar Medical College worli,Mumbai  .

CRITERIA FOR ASSISMENT  :

 Subjective criteria

    I.        VEDANA(pain) by VAS scale :

a)   No pain                                  0

b)   Mild pain                                1

    c)  Moderate pain                        2

    d)  Severe pain                           3

  II.        DAHA (Burning ) :

a)   No burning                         0

b)   Mild burning                       1

c)   Moderate burning               2

d)   Severe burnig                    3

Objective criteria:

III.        Parinam(Size):

1.   Original wound                 0

2.   Healed by 25% - 50%       1

3.   Healed by 50% - 75%       2

4.   Healed by 75% - 100%     3

a)    

IV.        Vranawarna (Colour of wound) :

a)   Normal  reddish colour        0

b)   Pinkish red                         1

c)   whiten yellow colour Starting of slough formation 2             

d)   yellow slough formation   

   V.        Strava (Secretion) :

a)   No Strava                        0

b)   Alpa strava                      1

c)   Madhyam strava               2

d)   Ati strava                         3

RESULT-

1.   As per Ayurvedic text,Dagdha vrana is a common word, which is used for medicosurgical condition which is produced due to vitiated Pitta and Rakta. In such condition, Yatimadhu grita is one of the best treatments⁴.

2.   All obtained data were analyzed statistically with help of INSTAT GRAPHPAD software.

3.   By applying yastimadhu grita highly significant result were obtained in Daha with significant improvement.

4.   Highly significant results were obtained burning, regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation .

DISCUSSION: 

     30 patients were randomly selected in two groups as Yashtimadhu Ghrit    and Silver Sulfadiazine Ointment as a local application therapy. In silver sulfadiazine all patient shows good result in  wound healing process ,discharge, slough,  etc in a short duration but burning , regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation cannot be achieved in the silversulfadiazine group  whereas they were achieved in Yashtimadhusiddha Ghrit group .The  Yashitimadhusiddha Ghrit has shown less efficacy  in control of discharge, slough thus a slower healing was observed. So finally from the above observation we can conclude that Yashtimadhu Ghrit will be useful with the silversulfadyzine in the modern era.

CONCLUSION:

       This study showed the significant result of Yastimadhu grita application in dagdha vrana 1^st and 2^nd digree .

Symptoms like pain, burning and regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation reduced a lot.

ACKNOWLEDGEMENT –

I am very much thankful to Dr. K.R. Reddy, Associate Professor, Shalyatantra dept. of R.A.PODAR Medical (AYU.) College Worli for encourage and guidance to me. I am also thankful to Dr.Amrita mishra Dr Vivek,Dr Pallavi, Dr Leena  MD Scholar for moral support and valuable guidance in this project work.

ROLE OF VAITARANBASTI AND BRIHATVATA CHINTAMANI RASA IN THE MANAGEMENT OF AMAVATA W.S.R. RHEUMATOID ARTHRITIS.

ROLE OF VAITARANBASTI AND BRIHATVATA CHINTAMANI RASA IN THE MANAGEMENT OF AMAVATA W.S.R. RHEUMATOID ARTHRITIS.

Dr .Shiv Prasad Dwivedi

Assistant professor J.S. Ayurved college Nadiad, Gujarat

Emai.shiv1245@rediffmail.com

Mob-09867007893, 9479497749

Abstract

Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints of hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when our immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body such as the skin, eyes, lungs and blood vessels.

Although rheumatoid arthritis can occur at any age, it usually begins after age 40. The disorder is much more common in women.

While in Ayurveda Amavata is the most crippling of the joint disease. It occurs throughout world in the all climate and all ethical groups. Ama associated with aggravated vat play dominant role. The clinical features of Amavata such as pain, swelling, stiffness, fever, general debility are most identical mentioned in classical texts. In classics treatment mentioned in Amavata is Dipan, Pachan, Shodhan, Shaman, Asthapanbasti, Vaitaranbasti. Among them VaitaranBasti is very effective in Bahudosh and Leendoshavastha. It used in new and old Amavata as well because it brings Doshas from Shakha to Kostha and remove it from Gudmarg(anus) and gives relief.

Presently available modern medication for Rheumatoid arthritis and medication for pain (NSAID) is causing many side and toxic effect and requires long term medication which suppresses immunity and produces other diseases.

Hence there is a need to find such a therapy which gives better relief without any side or toxic effect and also natural, cost effective and easily available .hence the ayurvedic treatment required for this autoimmune diseases study was selected.

Key words –Amavata, VaitaranaBasti , BrihatvataChintamai rasa

Introduction

Amavata is first mentioned as separate disease by Madhavnidan¹, where it is stated that Mandagni plays key role in the manifestation of the disease. Acharya Madhav described most characteristics features of the disease, severe pain similar to a scorpion bite. Asthi and sandhi are chief sites of presentation of cardinal symptoms, such as sandhi shool(pain),sandhi grah (stiffness), sandhi sotha(swelling of joint) etc. this symptoms are resembles the cardinal symptoms of Rheumatoid arthritis i.e. pain, swelling, stiffness, fever, general debility etc. Amavatchikitsa described by chakradatta is Dipan,tiktakatu rasa, ksharBasti, VaitaranBasti, SaindhavadiAnuvasan and much yoga. While in modern science Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that primarily affects joints. It may result in deformed and painful joints, which can lead to loss of function. The disease may also have signs and symptoms in organs other than joints.

The cause of RA is not completely understood. The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. It also affects the underlying bone (focal erosions) and cartilage (thinning and destruction)^. 

Sign and  symptoms of Amavata.

Cardinal symptoms of Amavata² are-

1. (Vriscikdamshavatavedana)Morning pain severe in nature
2. (SanchariVedana)shifting pain
3. (Stambha) stiffness of joints
4. (Jwara )Increase temperature
5. (Karmahani) loss of movements
6. (Sandhi Vikruti) joint deformity.
7. (Kshudhamandya) Loss of appetite

Aim and objective.

1-To evaluate the efficacy of vaitarna Basti and BrihatvataChintamani Rasa in the management ofAmavata (Rheumatoid arthritis)

 2- To evaluate theefficacy of Vaitarna Basti in  the management of  Amavata.

 3-To compare the effect of Vaitaran Basti and BrihatvataChintamani rasa with Vaitaran Basti .

Drug review

VaitranaBasti4

Vaitranbasti was described by Chakrapanidatt ³and Vangsen⁴, as very safe and effective in-

Indication

Shool

Anaha

Amavata

Content and dose of Vaitranvasti⁵

Chincha (tamarindusindica)                         50gm

Guda(jiggery)                                            20gm

Saindhava                                                 5gm

Gomutra                                                    50ml

Til tail                                                        20ml

Madanphalchurna as prakshep 5gm

Content of Brihatvatachintamani rasa⁶ -

§  Swarnbhashma –   2 tola

§  Rajatbhashma -     2 tola

§  Abhrakbhashma –  2 tola

§  Motibhashma -       3 tola

§  Pravalbhashma -    3 tola

§  Lauhabhashma -    5 tola

§  Rasa sindoor -         7 tola

§  Ghritkumariswarshkibhawana -

Material and methods:

The present clinical study is an open randomized comparative study. The aim of the clinical studyis to evaluate the combined effect of vaitaranabasti and oral use of BrihatVatachintamani rasa in the patients suffering from Rheumatoid Arthritis.

Material:      1)Brihatvatachintamani rasa.

                   2) VaitaranaBasti

3) Rubbercatheter

                   4) Glycerine syringe ect.

Method

 Study was carried out over a period of 1yr in M.A. Podar Ayurved hospital, Worli Mumbai. Total 30 selected and diagnosed Patients of both the sexes between the ages 15 to 65 year with condition of Rheumatoid arthritis (Amavata) were selected on the basis of selection criteria. And divided in two group.1)Group- A and Group- B with 15 patients in each group.

In  Group-AVaitranBasti and in Group-B Vaitaran Basti along with oral administration of Brihatvatachintamani rasa 125 mg. BD was given after meal.

At the time of baseline assessment, a profile of haemogram, biochemical investigations R.A test, ASO TITER, and serum uric acid was obtained.

Duration of treatment in one cycle-10 to 15 days

Follow-up: weekly for three week,

Before starting treatment routine investigation were done as necessary.

The patients were treated and observed; comparative study was done in two groups.

Prepration of Basti Dravya-

50gm of Chincha and 20 gm of Guda will be mixed in 100ml water on previous night. Mixture will be crushed thoroughly. The mixture will be heated up to boiling on next morning.after that 40ml of til tail, 5gm of saindhava,50ml of Gomutra and 5 to 7gm of MadanphalChurna as prakshep will be added. This mixture will be used as Basti Dravya.

Time of administration- After lunch.

Mode of action of vaitaranBasti in Amavta

Chakradatta and Vangsen has mentioned VaitaranBasti is useful in the Amavata⁷. It brings DoshasShakha to kostha by utkleshan or lekhan action and it eliminated by Gudmarg.

Srotomukhvishodhanat -Gomutra cleans the channels.

Vridhdhi -Amlika increase the doshas.

Abhishyandanat – Saindhavlavan increases the abhishyandi quality.

Paka –Gudam used for doshapaka.

Vayoschnigrahat – Oil controls over the vayu.

Table no.1

S.No.	Aharavarga	Pathya	Apathya
1	Annavarga	Yava, kulattha, Raktashali, kodrava.	Navanna , amlapadartha
2	Shakavarga	Vastuka, Shigru ,karela , Patola.	Maasha
3	Dugdha varga	Ardraka or Bhallatakaksheerpaka, Takra.	Dugdha , dadhi, Grita
4	Mamsavarga	Jangalmansa	Anupamansa
5	Drava	Ushnajala , Gomutra , Sunthiphanta	Sheeta jala
6	Aushadhavarga	Katutiktdrvya ,shunthi, Gokshur, Bhallataka, varuna , Lasuna , Eranda.	Madhurdravya , Amladravya

Criteria for selection of patient-

A)    Inclusion criteria:-

1)     Sex – both male and female

2)     Age group -15 to 65 years

3)     Patients having signand symptoms of amavata as in Madhavnidan

4)     Patients full fill the American criteria of rheumatoid arthritis.

5)     Patient fit for Basti.

B)    Exclusion criteria:-

1)     Patients presenting with complication like Endocarditis, major joints deformities.

2)     Above 65yr age and below 15yr.

3)     Patient having HIV, HbsAg and other STD.

4)     Pregnancy and lactation

5)     Patient not fit for Basti.

Criteria of assessment

Tenderness

No tenderness                                                                                                    0

Subjective experiences of tenderness                                                        1

Wincing of face on pressure and withdrawal of affected part           2

Resists to tough.                                                                                              3

Joint pain:

Gradation of pain by visual analogue scale

0                                     Nil

1                                     Mild pain.

2                                     Moderate pain.

3                                     Severe pain.

Swelling over joint:

0                                  Nil

1                                  Mild tenderness, causing patient to wince on digital pressure.

2                                  Moderate tenderness, causing patient to wince on digital pressure.

3                                  Severe tenderness, patient does not allow totouch.

Morning stiffness:

0                Absence 

1                25% restriction of movement

2                25 to 50% restriction of movement

3                More than 50% restriction of movement

Discussion

1.      As per Ayurveda Basti is mainly indicated in Vata predominant diseases. The two type of abnormalities of Vatanamely; Avaran and Dhatukshayjanya can be treated by Basti karma. Direct application of this type of treatment to colon helps not only in regulating and co-ordinating and Vatadosha in its site,but also controls the other doshas involved in the pathogenesis of the disease (S.S.Chi.35/6). Basti is used in Sakhagat, Tiyarkgamidosha, kosthagatrogas. Among them vaitaranBastis is lekhan or utkleshanBasti used in those diseases in which dosha reached at deeper dhatu ex Amavata, urustambh.

Vaitaranbasti

Vaitaran is the name of a river,which a person is supported to cross during death in his astral realm. This Basti is so powerful in a sense that it can bring back life of a person who is about to cross the Vaitaran river.

While Brihatvatachintamani

Conclusion-
1. Amavata is disease of Madhyamrogmarg with chirkariswabhav. Ama and vata being contra indicatory in nature make it difficult to plan the line of treatment, in chronic stage doshas become lindoshaand reaches to the sakha. Here VaitaranBasti is utkleshkarBasti which increase the doshas so it comes out from the shakha to kostha and expel out from the body from GudmarG , hence basti is best treatment for vatarogas so Vaitaran Basti play key role in Amavat  lindoshavastha.

2.      In Group - A significant result were obtained inJoint painwith   60.08% improvement. In morning stiffness 59.29% in swelling65.38% (which was highly significant),in tenderness 61.5% result were obtained.

3.      In Group-B highly significant results were obtained in swelling, pain stiffness, and tenderness. All parameters show highly significant result of VaitranBasti along with BrihatvataChintamani rasa.

4.      It was observed that relief in sign and symptom of Amavata was found in the both group correlatively Group-B (Brihatvatachintamani rasa with VaitaranBasti) group showed better result.

5.      Amavata is chronic disease and so many individuals are affected every year from it, keeping this point in to consideration it was found that VaitranBasti and BrihatvataChintamanirasa may be a Good Ayurvedic formulation for Amavata with some other supporting treatment.

After study it is observed that the drug is highly effective in both groups the percentage relief was more in group -B. than in Group

Table no.-2                         Group-B

Parameters	Mean BT	Mean AT	Mean deff	%mean	S.D.	S.E.	t	p
Pain	2.3	0.9	1.4	60.8	0.69	0.221	6.1	<0.01
Swelling	2.6	0.9	1.7	65.38	0.82	0.26	7.005	<0.001
Stiffness	2.6	1	1.6	61.5	0.519	0.16	6	<0.01
Tenderness	2.4	1.1	1.3	59.2	0.580	0.15	5.9	<0.01

Table no.3                     Group -B

Parameters	Mean BT	Mean AT	Mean deff.	Mean %	S.D.	S.E.	t	p
Pain	2.6	.8	1.8	74.23	0.72	0.18	12	<0.001
Swelling	2.4	1	1.4	79.02	0.50	0.13	18	<0.001
Stiffness	2.5	0.9	1.6	78.21	0.50	0.13	12	<0.001
Tenderness	2.3	1.2	1.1	71.03	0.74	0.19	12	<0.001

REFERENCES

1)     Madhavakara , Madhavnidan with commentary of Vijayarakshita and shrikanthadatta, amavatanidanam ,published by Choukhambaprakashan Varanasi 2005. P508

2)     Madhavakara , Madhavnidan with commentary of Vijayarakshita and Shrikanthadatta, amavatanidanam ,published by choukhambaprakashan Varanasi 2005. P511

3)     Chakrapanidatta, chakradatta , Niruha Basti, published by Choukhambaprakashan Varanasi 2005.p555

4)     Vangsen, Chikitsha Saarsangraha, Basti, published by Praghya Prakashan varanasi2001,p805

5)     Chakrapanidatta ,chakradatta , niruha basti, published by choukhambaprakashan Varanasi 2005.p555

6)     Ayurved Saarsamgrah rashrashyana prakarana,published by Shree vadyanatha Ayurved Bhawan limited Allahabad, p346

7)     Harrison Harisons ,principles of internal medicines edited by Eugene Brauwold ,Anthony Sfanci ,Stephen l Hauser ,Dennis L Kasper, Dan L.longo,Jlarry,Jameson and MC Grawhill, medical publishing division vol-i12th international edition 2002.p455

8)     Chakrapanidatta ,Chakradatta , Amavatachikitsa , published by choukhambaprakashan Varanasi 2005.p555.

9)     Chakrapanidatta ,chakradatta , Amavatachikitsa ,published by Choukhambaprakashan Varanasi 2005.p555

10) J.Maheshwari, essential orthopaedics, 4^th edition ,Chap 21 ,new Delhi, Jaypee brothers publication, P 157.