Toddler’s developmental milestones at 2 years

 

     Research shows that 80% of a child's brain development occurs within the first 1,000 days of life – making those three years important for lifelong health, learning, and success.

   By the age of 2, your toddler is talking, walking, climbing, jumping, running and bustling with energy. Your child now has a growing vocabulary and acquires new words on a regular basis. They can sort shapes and colours and may even show an interest in potty training. As your little one grows more independent, they may show signs of defiance as they begin to push boundaries and explore the world around them.

 

Social and emotional milestones at 2 years

Some of the ways you’ll see your little one learning to connect with the people around them at 2 years:

• ·        Likes to copy adults and other children
• ·        Gets excited when they're with other children
• ·        Is more independent, even more defiant

Tips for parents

Find opportunities to engage in play and conversations with your toddler. Playtime could be as simple as rolling a ball back and forth, handing you their toys or helping you with safe activities like folding clothes with your supervision. These types of activities can help develop pro-social behaviours by fostering a sense of belonging and collaboration with others.

 

Language and communication milestones at 2 years

How your toddler is expressing their needs:

·        Says short sentences with two to four words

·        Points to things when they are named

·        Knows familiar body parts

·        Recognizes familiar people

·        Repeats words they have overheard and follows simple instructions

Tips for parents

·        When taking them for a walk, tell them the names of things you see.

Brain development milestones at 2 years

How your child’s brain is growing:

·         Starts to sort shapes and colours

·         Can find things hidden under multiple layers

·         Completes sentences in familiar books

·         Plays simple make-believe games

·         Builds towers with four or more blocks

·         Can follow two-step instructions

·         May start to develop a dominant hand

Tips for parents

·         Encourage them to go looking around the room for objects you hide and give them hints.

·         When taking them for a walk, tell them the names of things you see.

 

Movement and physical development milestones at 2 years

How they’ll move through their environment:

·         Can run, kick a ball and throw a ball overhead

·         Climbs up and down from furniture without assistance

·         Makes or copies straight lines and circles.

Tips for parents

·         Create little fine-motor skills challenges for your toddler, like asking them to turn the page of a book.

Food and nutrition milestones at 2 years

What mealtimes look like at 2 years:

·         Chews with full jaw movements

·         Uses utensils with some spills

Tips for parents

·         Be calm and accepting. Give your child positive attention when they do eat, but don’t make it a problem when they don’t eat. Just take the food away, cover it and offer it to them again a bit later. 

Child’s Development: 2 Years (24 Months)

Communication and Language Skills

• say at least 2 words together, like “more milk”

• point to things in a picture book when asked (“Where is the dog?”)

• point to at least 2 body parts when asked (“Where is your nose?”)

• use more gestures, like blowing a kiss or nodding yes

Movement and Physical Development

• run

• kick a ball

• walk (not climb) up a few stairs with or without help

• eat with a spoon

Social and Emotional Development

• notice when others are hurt or upset, like pausing or looking sad

• look at your face to see how to react in a new situation

Cognitive Skills (Thinking and Learning)

• hold something in one hand while using the other, like holding a container and taking the lid off

• try to use switches, knobs, or buttons on a toy

• play with more than 1 toy at a time, like putting toy food on a toy plate

When Should I Call the Doctor?

You know your toddler best. So share your concerns — even little ones — with your child's doctor.

If your toddler is not meeting one or more milestones or you notice that your child had skills but has lost them, tell the doctor.

To help prevent heart disease, you can:

 

Heart disease is the leading cause of death for both men and women in the United States. Take steps today to lower your risk of heart disease.

To help prevent heart disease, you can:

Eat healthy

Get active

Stay at a healthy weight

Quit smoking and stay away from secondhand smoke

Control your cholesterol and blood pressure

Drink alcohol only in moderation

Manage stress

Am I at risk for heart disease?

Anyone can get heart disease, but you’re at higher risk if you:

 

Have high cholesterol, high blood pressure, or diabetes

Smoke

Are overweight or have obesity 

Don't get enough physical activity

Don't eat a healthy diet 

Your age and family history also affect your risk for heart disease. Your risk is higher if: 

 

You’re a woman over age 55

You’re a man over age 45

Your father or brother had heart disease before age 55

Your mother or sister had heart disease before age 65

But the good news is there's a lot you can do to prevent heart disease.

 

What Is Heart Disease?

When people talk about heart disease, they’re usually talking about coronary heart disease (CHD). It’s also sometimes called coronary artery disease (CAD). This is the most common type of heart disease.

 

When someone has CHD, the coronary arteries (tubes) that take blood to the heart are narrow or blocked. This happens when cholesterol and fatty material, called plaque, build up inside the arteries.

 

Several things can lead to plaque building up inside your arteries, including:

 

Too much cholesterol in the blood

High blood pressure

Smoking

Too much sugar in the blood because of diabetes

When plaque blocks an artery, it’s hard for blood to flow to the heart. A blocked artery can cause chest pain or a heart attack. Learn more about CHD

 

 Heart-healthy diet changes

Manage excess body fat

Research in the Journal of the American College of Cardiology has linked excess belly fat to higher blood pressure and unhealthy blood lipid levels. If you’re carrying extra fat around your middle, it may be time to make lifestyle adjustments. Eating fewer calories and watching your portion sizes more can make a big difference.

 

Include fiber into your diet

According to the Mayo Clinic, a diet rich in soluble fiber can help lower your level of low-density lipoprotein, or “bad cholesterol.” Sources of soluble fiber include beans, oats, barley, apples, pears, and avocados.

 

Make time for breakfast

The first meal of the day is an important one. Eating a nutritious breakfast every day can help you maintain a healthy diet and weight. To build a heart-healthy meal, reach for:

 

whole grains, such as oatmeal, whole-grain cereals, or whole-wheat toast

lean protein sources, such as turkey bacon or a small serving of nuts or peanut butter

fruits and vegetables

Eat fish

Eating a diet rich in omega-3 fatty acids can also help ward off heart disease. Many fish, such as salmon, tuna, sardines, and herring, are rich sources of omega-3 fatty acids.

 

Try to eat fish at least twice a week, suggests the AHATrusted Source. If you’re concerned about mercury or other contaminants in fish, you may be happy to learn that its heart-healthy benefits tend to outweigh the risks for most people.

 

Eat nuts

Almonds, walnuts, pecans, and other tree nuts deliver a powerful punch of heart-healthy fats, protein, and fiber. Including them in your diet can help lower your risk of cardiovascular disease.

 

Remember to keep the serving size small, suggests the AHATrusted Source. While nuts are full of healthy stuff, they’re also high in calories.

 

Limit your salt intake

If the entire U.S. population reduced its average salt intake to half a teaspoon a day, it would significantly cut the number of people who develop coronary heart disease every year, report researchers in the New England Journal of Medicine.

 

The authors suggest that salt is one of the leading drivers of rising healthcare costs in the United States. Processed and restaurant-prepared foods tend to be especially high in salt.

 

So think twice before filling up on your favorite fast-food fix. Consider using a salt substitute, such as Dash, if you have high blood pressure or heart failure.

 

Reduce your saturated fat intake

Slicing your saturated fat intake to no more than 7 percent of your daily calories can cut your risk of heart disease, advises the USDA. If you don’t normally read nutrition labels, consider starting today. Take stock of what you’re eating and avoid foods that are high in saturated fat.

 

Instead, you can switch your unhealthy fat intake with healthy fats, such as avocados, olive oil, and eggs.

 

Drink tea

No magic is needed to brew a cup of green or black tea. According to the AHATrusted Source, drinking one to three cups of tea per day may help lower your risk of heart problems. For example, it’s linked to lower rates of angina and heart attacks.

 

Eat dark chocolate

Dark chocolate not only tastes delicious, it also contains heart-healthy flavonoids. These compounds help reduce inflammation and lower your risk of heart disease, suggest scientists in the journal Nutrients.

 

Eaten in moderation, dark chocolate — not oversweetened milk chocolate — can actually be good for you. The next time you want to indulge your sweet tooth, sink it into a square or two of dark chocolate. No guilt required.

 

Incorporating exercise into your routine

Move your body throughout the day

No matter how much you weigh, sitting for long periods of time could shorten your lifespan, warn researchers in the Archives of Internal MedicineTrusted Source and the American Heart AssociationTrusted Source.

 

Couch potato and desk jockey lifestyles seem to have an unhealthy effect on blood fats and blood sugar. If you work at a desk, remember to take regular breaks to move around. Go for a stroll on your lunch break, and enjoy regular exercise in your leisure time.

 

Practice yoga

Yoga can help you improve your balance, flexibility, and strength. It can help you relax and relieve stress. As if that’s not enough, yoga also has potential to improve heart health.

 

According to research published in the Journal of Evidence-Based Complementary & Alternative MedicineTrusted Source, yoga has the potential to reduce one’s risk of cardiovascular disease.

 

Try strength training

Aerobic fitness is key to keeping your heart healthy, but it’s not the only type of exercise you should do. It’s also important to include regular strength training sessions in your schedule.

 

The more muscle mass you build, the more calories you burn. That can help you maintain a heart-healthy weight and fitness level.

 

Try interval training

Start and stop, then start and stop again. During interval training, you alternate bursts of intense physical activity with bouts of lighter activity. The Mayo Clinic reports that doing so can boost the number of calories you burn while working out.

 

Try dancing

Whether you prefer a rumba beat or two-step tune, dancing makes for a great heart-healthy workout. Like other forms of aerobic exercise, it raises your heart rate and gets your lungs pumping. It also burns up to 200 calories or more per hour, reports the Mayo Clinic.

 

Engage in sexual activity

That’s right, having sex can be good for your heart. Sexual activity may add more than just pleasure to your life. It may also help lower your blood pressure and risk of heart disease.

 

Research published in the American Journal of CardiologyTrusted Source shows that a lower frequency of sexual activity is associated with higher rates of cardiovascular disease.

 

Go for a walk

The next time you feel overwhelmed, exasperated, or angry, take a stroll. Even a five-minute walk can help clear your head and lower your stress levels, which is good for your health. Taking a half-hour walk every day is even better for your physical and mental health.

 

Take the stairs

Exercise is essential for good heart health, so why not sneak it in at every opportunity? Take the stairs instead of the elevator. Park on the far side of the parking lot. Walk to a colleague’s desk to talk, instead of emailing them.

 

Play with your dog or kids at the park, instead of just watching them. Every little bit adds up to better fitness.

 

Use housework as exercise

Vacuuming or mopping the floors may not be as invigorating as a Body Slam or Zumba class. But these activities and other household chores do get you moving.

 

They can give your heart a little workout while burning calories, too. Put your favorite music on and add some pep to your step while you complete your weekly chores.

 

Be a kid

Fitness doesn’t have to be boring. Let your inner child take the lead by enjoying an evening of roller skating, bowling, or laser tag. You can have fun while burning calories and giving your heart a workout.

 

 

 

 

 

 

 

 

 

 

 

 

 क्या कभी सोंचा आपने कि आधुनिक विज्ञान ने कैंसर का इलाज क्यों नहीं ढूंढा ??

आप हैरान होंगे कि आधुनिक विज्ञान ड्रग और टेस्ट माफिया के दुष्चक्र में फंसकर इसके सहज और सरल भारतीय इलाज को सामने ही नहीं आने देना चाहता।

ऋषि कपूर की मृत्यु हो गई और  इरफ़ान ख़ान की भी,और अभी हाल ही में बिहार के बड़े ही जुझारू नेता सुशील कुमार मोदी भी चले गए!

पहले के दोनों अभिनेताओं में एक बात कॉमन थी, दोनों को कैन्सर था। दोनों ही विदेश गए। ऋषि कपूर अमेरिका गए, इरफ़ान लंदन गए। फिर भी बच नहीं पाए। मनोहर पर्रिकर जी,सुषमा जी की भी ये ही कहानी थी। 

बड़ी ही गंदी बीमारी है ये कैंसर जो  परिवार, घर-बार सबको तबाही के कगार पर पहुंचा देती है।

डबल्यूएचओ कहता है कि इस बीमारी से विश्वभर में 96 लाख लोग मरते हैं एक साल में ! करीब 8 लाख लोग हर महीने मारे जाते हैं। 27 हज़ार रोज़ ये दुनिया छोड़ देते हैं।

भारत में  14-15 लाख लोग इस बीमारी के शिकार होते हैं हर साल। 1.16 लाख हर महीने यानी 3,900 लोग हर रोज।

कुल मिला के भारत का योगदान 8-9 प्रतिशत का है। 

कैंसर का इलाज आज एक बहुत बड़ी मार्केट बन चुका है। वैसे अब लोग ठीक भी होने लगे हैं पर पैसा बहुत लग जाता है।

जापान के “योशिनोरी ओसुमी” को मेडिसिन के क्षेत्र में नोबेल पुरस्कार दिया गया था। उनकी थेरेपी ऑटोफैगी (autophagy) के लिए जो कैन्सर के लिए बहुत उपयोगी है।

 वैसे तो ऑटोफैगी बहुत पुरानी थेरेपी है। मगर इन्होंने सिद्ध किया तो नोबेल इनको मिल गया।

ऑटोफैगी का मतलब होता है :- ऑटो मतलब ख़ुद को, फ़ैगी मतलब खाना। ख़ुद को खाना या ख़ुद को खा जाना।

इस ऑटोफैगी में ज़्यादा कुछ नहीं करना, केवल उपवास रखना है जो हमारी सदियों पुरानी परंपरा रही है।

 योशिनोरी ओसुमी ने 72 घंटे का उपवास बताया था। मतलब 3 दिन। केवल पानी पीना है,खाना कुछ नहीं। 

तो योशिनोरी ओसुमी की ऑटोफैगी थेरेपी बहुत सी बीमारी के आने से पहले का इलाज है। 

मगर दवाई का मार्केट भी बहुत बड़ा है ,इसलिए इसके बारे में कम ही बात होती है। फिर विवाद जोड़ा गया कि ये तो भारत में हज़ारों साल से होता आया है एकादशी का व्रत ये ही तो है।

शरीर विज्ञान कहता है कि कैन्सर के सेल सबके शरीर में होते हैं लेकिन अधिकांश लोगों में ये कैंसर सेल सुषुप्तावस्था में रहते हैं।लेकिन  जब ये किसी कारणवश बिगड़ जाते हैं या फिर छेड़कर (बायोप्सी,मैमोग्राफी,सी टी ,पेटस्कैन, MRI, Dopler जैसे टेस्ट के जरिए ) बिगाड़ दिए जाते हैं तो ये ही कैंसर जैसी बीमारी का रूप ले लेते हैं। 

ऑटोफैगी के उपवास से हमारी स्वस्थ कोशिकाएं इन बीमार कैंसर कोशिकाओं को खा जाती हैं जिससे इनके फैलने के चांस कम होते हैं। बस इतना सा है ऑटोफैगी, इतनी सी बात के लिए नोबेल मिल गया।

भारत में रविवार की छुट्टी जैसा कुछ नहीं था। यहाँ के स्त्री-पुरुष स्वस्थ रहते थे । हफ़्ते के सातों दिन काम करते थे। मगर महीने की छः छुट्टियाँ मिलती थी। 

3 पूर्णमासी को, तीन अमावस्या को। पूर्णमासी से एक दिन पहले एक पूर्णमासी को एक उस से अगले दिन। ऐसे ही अमावस्या को भी। 

ये तीन दिन छुट्टी मिलती थी जिसमें आप उपवास करो। शरीर का विषहरण (detoxification) करो और स्वस्थ रहो। पृथ्वी में ज्वार भाटा भी इन ही दिनों में आता है। कहा गया है “यत् ब्रह्माण्डे तत् पिण्डे” अर्थात जो ब्रह्माण्ड में है वो ही शरीर में है। अब पृथ्वी के जल में ज्वार भाटा आता है तो शरीर के जल में भी आता है। इसलिए इन तीन दिन उपवास करने की बात कही गयी है। तीन दिन मतलब 72 घंटे, ऑटोफैगी।

चलिए छोड़िए। आप भी 24, 36 और 72 घंटे का उपवास करें केवल साल में एक दो बार भी फिर अमेरिका लंदन क्या पड़ोस के डॉक्टर के पास जाने की भी ज़रूरत नहीं पड़ेगी।

हमारे यहां नवरात्र पर्व यूं ही नहीं बने ,उनके पीछे एक बड़ा ही सूक्ष्म शरीरविज्ञानी कारण छिपा है,और यही हमारे स्वस्थ रहने का मूल मंत्र भी।

ध्यान रहे अगर 72 घंटे का नहीं कर सकते तो 15 घंटे से शुरुआत करें केवल पानी लें,मौसमी फल भी। लेकिन अन्न नहीं क्योंकि इससे बीमार कोशिकाओं को फिर से पोषण और पनपने का मौका मिल जाता है।

मूल मंत्र यही है कि आप अपनी और अपने देश के प्राचीन विज्ञान की शक्ति को पहचानिए और भारी भरकम लैब परीक्षणों के खर्चीले जंजाल से बचकर अपनी काया को आजीवन निरोगी और शक्तिमान बनाकर रखिए।

इसके लिए खर्च भी कुछ खास नहीं है,ताजा मटके का जल, मौसम की ताजी सस्ती हरी और कुछ पत्तेदार सब्जी और फलों का सलाद को अपने दैनिक आहार में नियमित रूप से जोड़कर रखें हल्का व्यायाम व योग करें,सुबह की धूप अवश्य लें, रोज आधे घंटे घास या कच्ची मिट्टी पर चलें ,हफ्ते में दो तीन दिन मालिश करें लेकिन रोज नियमित स्नान करें।

आप प्रसन्न रहकर प्रभु , प्रकृति , परिवार , घर और कार्यस्थल और अपने सहयोगियों और मित्रों का रोज सुबह उठने पर और रात में सोने से पहले धन्यवाद तो करें ही ,उन लोगों का भी धन्यवाद करें जो आपसे ईर्ष्या और शत्रुतापूर्ण व्यवहार करते हैं क्योंकि ऐसे लोग आपको और भी बेहतर और विनम्र बनाते हैं यानी स्वस्थ बनाते हैं और इसका कुल खर्च उस कैंसर के इलाज की तुलना में हजार गुना कम है,जिससे घर परिवार, जमीन- जायदाद ,आपकी खुशियों का संसार सबकुछ देखते-देखते उजड़ जाता है।

अपने इसलिए घर का बना ताजा खाना ,अच्छा आहार विहार ,दिनचर्या और 6-8 घंटे की नींद आपको दुनिया में धनवान बनाती है क्योंकि पहला सुख है निरोगी काया यानी स्वास्थ्य के सर्वोत्तम धन  से सम्पन्न बनाती है।और जब स्वस्थ तन और मन हो तो माया,यश-वैभव सभी कुछ प्राप्त हो सकता है। 

ध्यान रहे कि इस भूलोक में हम केवल यात्री हैं जहां हम थोड़ी देर विश्राम करने के लिए रुके हैं,यह यात्रा बहुत लम्बी है, ये भूलोक केवल एक धर्मशाला है मंज़िल नहीं!

What is the right age for your child to start brushing?

 

For children 0–18 months of age – use only water, no toothpaste. from 18 months until the child turns six years old – use a small pea-sized amount of low fluoride children's toothpaste

Tips for healthy mouth

• Start brushing as soon as first tooth erupts in the mouth of a child. The first tooth erupts at an average age of 6-7 months.
• Before the eruption of teeth; use a wet soft cloth/gauze to clean and massage gums of the baby. This will reduce the chances of any bacterial growth in the mouth.
• Massaging gums with wet gauze moistened with cold water will relieve pain during teething.
• For the first few years of life, children may not need any toothpaste. Run a tooth brush under warm water to soften the bristles and gently brush your child’s teeth.
  – Flossing is necessary to clean adjacent surfaces of teeth; where the brush can not reach.

1- Brush and floss your child’s teeth:

Age 0-3 years:

• Soft tooth brush is recommended. Chose a small size tooth brush for a smaller mouth.
• Tooth paste is generally not recommended as the child is not able to spit properly.
• Moisten the tooth brush bristles by running under warm water and brush your child’s teeth.
• Parents should Floss their child’s teeth.
• Brush twice a day and floss at least once daily.
• Visit the dentist regularly; they can review your performance and make appropriate suggestions.
• Dentist can catch dental issues at an early stage and recommend required treatment before the problem gets worse.

2- Help Children with brushing and flossing:

Age 3-6 years:

If your child is not able to write his/her name clearly; they are not ready to brush and floss independently.

1. For 3-6 years of age; parents should assist the child for brushing and flossing.
2. For 3-6 years of age; tooth paste of the size of green pea should be used.
3. Your dentist and their team can help to teach how to brush and floss.
4. Your dentist can also assess and inform about your performance brushing child’s teeth and make or suggest any changes needed.

3- Supervise children over 6 years of age:

Age over 6 years:

Children over 6 years of age should be supervised for brushing and flossing.

1. Children over 6 years will need regular supervision. Make sure parents check their teeth after brushing to make sure all areas in the mouth have been cleaned.
2. Parents must observe them while flossing and help as needed.
   C) Children after 6 years, become more independent with eating food. So, they must be provided with healthy snack options.

4- Brushing at least twice daily and make it fun activity.

1. Make brushing a fun activity.
2. Parents should brush along with their children. Children enjoy doing activities with their parents.
3. Make brushing a fun activity. Play a song that your child likes.
4. Encourage him/her to brush through the whole song. It will make the whole activity fun and at the same time help that the child gets enough time to brush all teeth and all surfaces of teeth.

 

“UPSHAYATMAK STUDY OF PATHYADI CHURNA IN AMAVATA (R.A.) WITH SPECIAL REFRENCE TO ANTI CYCLIC CITRULLINATED PEPTIDE (ANTI-CCP) ANTI BODY LEVEL".

 

ABSTRACT

       Amavata is a disease of vitiated vata associated with Ama and it persists with multiple systemic involvements mostly affecting the bony joints. The disease starts with minor symptoms, but may develop and extend to all over the body wherever Ama is going to get lodged along with vitiated vayu. As the disease progresses additional symptoms with complications like kanja, pangulya etc may be seen. Rheumatoid arthritis presents with more similar features of Amavata. It exhibits either as oligo or poly arthritis with symmetrical involvement alongwith inflammation, stiffness, tenderness etc. It is also a troublesome long persisting disorder having articular as well as extra articular signs and symptoms, yielding socioeconomically problems and unable to have self care even. As per the data available 5% of the total population of the world is said to be affected with crippling disorder. It is estimated that females are affected three times that of the males usually manifests from 20-60 years of life. It is an autoimmune disease in which the immune system of the body attacks its own tissues i.e. h ere own cartilage and joint linings characterized by persistent inflammation of peripheral joints with associated systemic features. Rheumatoid arthritis is a chronic and disabling condition that causes joint destruction and functional decline unless early treatment occurs. The prevention of disability in RA may be further enhanced with detection in the preclinical stage. Furthermore, accurately identifying individuals at risk for the development of RA during the preclinical phase of the illness is important, since this would allow for the primary prevention of this disease. At present, little is known about markers for preclinical RA. such as rheumatoid factor (RF) and the anticyclic citrullinated peptide (anti-CCP) have been shown to predate the clinical diagnosis of Rheumatoid arthritis, Another potential marker for increased risk of RA may be C-reactive protein (CRP), since CRP is a sensitive marker of systemic inflammation and is elevated in patients with RA.

 

Pathyadi Churna:   Pathyadi Churn described in Chakradutta under Amavata Rogadhikar. The primary herbal ingredients of Pathyadi Churna are  Pathya (Terminalia Chebula), (Shunthi) Zingiber officinale, Yawani (Ajwayan) Trachyspermum ammi in equal quantity.

 

          Reference: Chakrapanidatta. Amavata Adhikara (chapter 25)

          Anupana of the Pathyadi churna – Ushnaodak

          Dose- 5 gm BD with lukewarm water

          Uses:-Amavata, Sotha , Mandagni

          Keywords: Pathyadi Churna, Amavat, Ama, Rheumatoid Arthritis.

 

 

 

 

 

OUTLINE OF THE PROPOSED RESEARCH WORK

ABSTRACT OF SYNOPSIS -

I.                   Title of the Research Work:

“UPSHAYATMAK STUDY OF PATHYADI CHURNA IN AMAVATA (R.A.) WITH SPECIAL REFRENCE TO ANTI CYCLIC CITRULLINATED PEPTIDE (ANTI-CCP) ANTI BODY LEVEL"

 

II.                Importance/ Rationale of Proposed Investigation:

Amavata (Rheumatoid arthritis) is an auto-immune disease¹ with an aggravation of Vata dosha and accumulation of Ama² in different body parts, including joints with significant inflammatory changes and symmetrical polyarthritis. Ama, the metabolic byproducts that do not undergo oxidation, get lodged in body tissues and joints, which leads to symptoms such as pain, stiffness and swelling. Therefore, Amavata initially starts as a metabolic disorder with symptoms of indigestion and loss of appetite, which later encroaches on all the tissues, especially bones, muscles, joints, and multiple organs. The non-metabolized Ama goes into circulation and causes blockage of all the microchannels that provide nutrition to body parts; various tissues, especially connective tissues, get damaged; thus, disease manifestation occurs. The persistent inflammatory changes, mainly confined to the joints, significantly damage the joints' cartilage and bone.

Overview of Disease- Rheumatoid Arthritis (Amavata)

Rheumatoid arthritis is an auto-immune disorder triggered by some infection and genetic pre-deposition. Joint involvement in rheumatoid arthritis is usually symmetrical with pain, swelling, tenderness, and restricted movement of joints. Modern science treats the disease by using DMARDs, steroids, and NSAIDs. Amavata is confined to Madhyam-Rogamarg³, affecting Asthi and Sandhi as chief sites, and has clinical similarities with rheumatoid arthritis(R.A). The symptoms include sandhi shool, sandhi shoth, and sandhi graha. As per Ayurveda's philosophical concept, the aetiology of the disease is heavy food intake or intake of food that is difficult to digest, indulgence in excessive sexual intercourse, and getting nourished by tubers and leafy vegetables. These conditions generate metabolic disturbance, resulting in the formation of Ama; further, vata gets vitiated due to the same reasons, leading to disturbance of moortha Kapha and pitta humors. This dosha disturbance affects the basic body tissues, especially the Shleshma Sthana in Sandhi pradesha, causes inflammatory changes in the presence of vitiated pitta dosha, and gradually disease manifestation occurs⁴.

 

III.             Scope of Proposed Investigation:

Rationale behind the selection of Pathaydi Churna:-

     The topic of Upshayatmak Study of Pathyadi Churna in Amavata (R.A.) with Special Reference to ANTI-CCP⁵ has been selected to validate the efficacy of Pathyadi Churna in Amavaat patients and evaluate the effect of PATHYADI CHURNA⁵ on ANTI-CCP Level as very little work has been done on Pathyadi Churna. In the present scenario, viruddhahara has become very common due to irregular diet & dietary habits and negligence due to busy lifestyle. The cascading effects of these improper food combinations and habits ruin our health & vitality.

A recently published research work on a clinical study on the combined effectiveness of Pathyadi Churna and Kshara Basti in Amavata (Rheumatoid Arthritis) wherein the biochemical analysis in respect of C-Reactive Protein Level has not been performed; hence, the proposed study to validate the effect of Pathyadi churna on the inflammatory marker Anti CCP Level is relevant.

 

Rationale behind the selection of disease Amavata:–

Rheumatoid Arthritis (Amavata) is an autoimmune inflammatory disease in society & is an abnormal pathological condition of joints. Now a day’s prevalence of the disease has increased due to irregular dietary habits, faulty diets, hectic lifestyles etc. All these factors are contributing to the occurrence of this disease. Acharya Madhavkar has mentioned Amavata in the list of krichasadhya diseases and available modern medication/ treatment of amavata/ R.A having many adverse effects and long-term complications. Therefore, Upshayatmak Study of Pathyadi Churna in Amavata (R.A.) with special refrence to Anti-CCP, level, it has been undertaken to evaluate the efficacy of Pathyadi churn in Amvata for study.

 

IV.             Location:

a)      Organization/Department where the work is to be done – The study will be conducted under Mandsaur Institute of Ayurvedic Education & Research , Mandsaur, M.P.

b)      Geographical Area of Investigation, if any- The study will be conducted at Shubhdeep Ayurved Medical College & Hospital and P.G. Dept. of Rog Nidan Avum Vikriti Vigyan, Indore 452020 (M.P). 

 

V.                Objective of the proposed study:

·         To study etiopathogenesis and prevalence of Amavata.

·         To study the Upashayatmak efficacy of Pathyadi Churna in Amavaat.

·         To evaluate the effect of PATHYADI CHURNA on ANTI-CCP Level.

 

VI.             Review of Work done on the Subject:

                                i.            P. Madhavikutty (2015) Comparative Clinical Study on Musta, aswagandha and Pancakarma Therapy in Amavata (Rheumatoid Arthritis)

 

                              ii.            Praveen Kuma (2018) The Management of Amavata (Rheumatoid Arthritis) with Vatari Guggulu and Brihat Simhanada Guggulu

 

                            iii.            Sandip D Bansode (2020) A Comparative Study of Haritaki Prayoga and Trivrutadi Churna in the Management of Amavata Rheumatoid Arthritis

 

                            iv.            Bera pabitra kumar  (2018) Clinical Study to evaluate the Therapeutic Effect of Balaguducyadi Basti and Baluka Swedan in the Case of Amavata (Rheumatoid Arthritis).

 

                              v.            Sudhanshu K. Meher (2015) Clinical Evaluation of Vyoshadi Guggulu and Panchasama Churna in the Management of Rheumatoid Arthritis: An Open-Label, Single-Arm, Prospective Study.

 

                            vi.            RR Kulkarni  (2016)  Efficacy of an Ayurvedic Formulation In Rheumatoid Arthritis: A Double-Blind, Placebo-Controlled, Cross-Over Study

 

                          vii.            Archana Negi (2019) A Clinical Study to Evaluate the Efficacy of Hingwadi Churna and Rasnadashmula Kwatha in Amavata with Special Reference to Rheumatoid Arthritis.

 

                        viii.            Divya Gupta  A Comparative Study to Evaluate the Rujahara (Analgesic) Effect of Virechana Karma and Vaitarana Basti in Amavata (Rheumatoid Arthritis).    

 

                            ix.            Saroj Kumar Debnath A Clinical Study on the Management of Amavata (Rheumatoid Arthritis) with Simhanada Guggulu and Alambushadi Churna Tablet.

 

                              x.            SK Tiwari Clinical Evaluation of Alambushadi Compound and its Vasti in the Management of Amavata (Rheumatoid Arthritis).

 

                            xi.            Rachana Tiwari, (2020) Upashayatamak Study of Kansa Haritiki in Amavata (R.A) W.S.R to  CRP( C- REACTIVE PROTEIN) Level.

 

VII.          Research gaps identified in the proposed field of investigation:

Key words	Pubmed	Ayush Portal	Dhara	Doaj	Google Scholar
Amavata	67	94	60	34	210
Ama	78	168	50	45	360
Pathyadichurna in Amavata	55	15	40	10	34
Pathyadi Churna in amavata w.s.r. to Anti CCP level	0	0	0	0	0

 

1.      There are few survey study done which shows the effect of other classical drugs in Amavata. But this study is specific.

 

2.      No such work has been conducted on “UPSHAYATMAK STUDY OF PATHYADI CHURNA IN AMAVATA (R.A.) WITH SPECIAL REFRENCE TO ANTI CYCLIC   CITRULLINATED PEPTIDE (ANTI-CCP) ANTI BODY LEVEL”.

 

VIII.       Research Methodology:

Reseaech Question:- Is Pathyadi Churna is effective in Amavata (R.A) with Special refrence to Anti Cyclic Citrullinated peptide (Ant- CCP) level.

Hypothesis to be tested: 

Null Hypothesis:

Pathyadi Churna is not effective in Amavata (R.A) with Special refrence to Anti Cyclic Citrullinated peptide (Ant- CCP) level.

 

Alternate hypothesis:

Pathyadi Churna is highely  effective in Amavata (R.A) with Special refrence to Anti Cyclic Citrullinated peptide (Ant- CCP) level.

Source of information:

a)      Organization/ Depatrtment where the work is to be done: – The study will be conducted under Mandsaur Institute of Ayurvedic Education & Research , Mandsaur, M.P.

b)       Geographical Area of Investigation, if any- The study will be conducted at Shubhdeep Ayurved Medical College & Hospital and P.G. Dept. of Rog Nidan Avum Vikriti Vigyan, Indore- 452020 (M.P). 

 

Literary source:

All the Classical Samhitas, Ayurvedic and Modern books, Magazines, Articles, Publications, Internet, Website will be reviewed and documented for the intended study.

All aspects regarding the subject will be collected from Modern and Ayurvedic texts and other relevant publications about Amavaat and Rheumatoid Athritis.

Sample source:

Patients attending the OPD and IPD of Shubhdeep Ayurveda medical college and hospital Indore.

M.P. and other referral Hospital will be made and patients fulfilling the criteria of diagnosis of Amavata (R.A) as per the Proforma will be selected for the study.

Drug Source:

The drugs will be collected from the local area for the therapy.

Pathyadi Churna will be prepared in the pharmacy of the College.

 

·         Tools and Techniques of Research:

 

METHODOLOGY (MATERIAL AND METHOD):-

 

Criteria of Diagnosis:

 

The diagnosis will be done on the basis of signs and symptoms as per ayurvedic texts as well as modern text. The criteria of diagnosis A.R.A.(1987) will also be followed for additional information for comparision of signs and symptoms.

 

American Criteria is mentioned as follows:-

 

1)    Morning stiffness lasting for at least 1hr. and for>6 weeks.

2)    Arthritis of 3 or more of 14 possible joints area.

3)    Arthritis of hand joints, wrist metacarpophalangeal, interphalsngeal, metatarsophalangeal, joints > 6 weeks.

4)    Symmetrical arthritis.

5)    Rheumatoid nodules-subcutaneous nodules over bony prominence.

6)    Serum rheumatoid factor.

7)    Radiological changes.

 

All routine investigations will be carried out to exclude other pathology.

 

A.    INCLUSION CRITERIA:

 

1.    Patient with presence of classical sign and symptoms along with modern parameter of Amavaat (RA).

2.    Age group between 20-60 yrs.

3.    Patients giving informed consent for the trial.

 

B.     EXCLUSION CRITERIA:

 

1.      Patients who left the treatment in between

2.      Patients who are steroid dependent for relief of symptom

3.      Patients representing with complication like SLE, Endocarditisetc

4.      Patients with contractures of joints of severe deformities will not be included.

 

C.    Discontinuation Criteria:

 

1.      Patients who developed hypersensitivity for any constituent of the selected formulation.

2.      Patients who discontinued the treatment themselves due to any reason.

 

D.    Laboratory investigations:-

 

•        ANTI CCP Test

•        ESR Test

•        RA Factor Test

 

E.     Plan of Study :

 

Study design:     Randomized control study.

 

Sample Size:- In this study minimum 60 patient from the O.P.D. and I.P.D of Shubhdeep Ayurved Medical College and PG Institute complaining with Amavata (Rheumatoid Arthritis).

 

Diagnostic criteria:-Diagnosis based on incliusion and Exclusion Criteria

 

PROCEDURE PLANNED:-

 

 

A.    Conceptual Study:

 

1.     Case Study: Amavata Patient according Ayurvedic and modern texts.

2.     Interventional Study: Upshayatmak role of  Pathyadi Churna on Amavata.

 

B.     Drug Study:

 

1.     Collection of The Drug: Pathyadi Churna

 

The drug will be prepared in the Pharmacy of Shubhdeep Ayurved Medical College on the basis of Chakradutta Amavata Rogadhikr  (12/44).

 

C.    Upashayatmak Study:  Internal medicine will be applied/used for 30 days.

 

•        Effect of the medicine will be observed on 30 days.

•        If any complications arise after starting the treatment, i.e. within 30 days, patient will        be referred to the Pharmacovigilance department.

•        Selection of subjects: 60 patients will be selected randomly from OPD, IPD, and   camps of ShubhdeepAyurvedic medical College & Hospital, Indore (M.P.)

•        Patients will be selected as per inclusion criteria.

 

Upashayatmak Group:

•        Sample size: 60

•        Drug : Prepared Pathyadi Churna

•        Form of Drug: Churna

•        Dose of internal administration : 5 gm BD

•        Medium: luke warm water.

•        Duration: 30 days

•        Type of study: Simple clinical (Upshyatmak) trial

•        Data collection: On 1st, 30th Days

•        Data collection by: Ph. D Research scholar

•        Adverse Drug Reaction:

 

•        If any ADR will be seen patient will be dropped out from the study and immediately local or central pharmacovigilance cell will be informed and urgently precautionary medicines will be administered.

 

D.    DATA COLECTION & METHOD:-

 

Assessment:

Subjective criteria:-

1            Sandhishoola (Pain in joints)

2            Sandhishotha (Swelling in joints)

3            Sparshasahyata (Tenderness in joints)

4            Sandhigraha (Stiffness in joints)

5            Angamarda

6            Aruchi

7            Trishna

8            Aalasya

9            Gaurava

10        Apaka,

11        Vairasyata,

12        Agnimandya

13        Daha,

14        Bahumutrata

15        Vidvibandha

16        Jadya

17        Nidraviparyaya

E.     Objective Criteria :-

1            Anti CCP Test

2            ESR Test

3            RA Factor Test

Grading –

                         Sandhishoola (Pain in joints):-       

-          No Pain                                                                                                     0

-          Mild pain of low intensity causing no disturbance in routine work         1

-          Moderate pain but bearable                                                                      2

-          Moderate pain hampers the daily routine work                                        3

-          Severe pain causing definite interruption in routine work                       4

Sandhishotha (Swelling in joints):-         

-          No Swelling                                                                                              0

-          Mild Swelling                                                                                           1

-          Moderate swelling                                                                                    2

-          Huge Swelling                                                                                          3

-          Very huge swelling                                                                                   4

 

Sparshasahyata (Tenderness in joints):-

-          No Tenderness                                                                                          0

-          Subjective experience of tenderness                                                        1

-          Wincing of face on pressure                                                                     2

-          Wincing of face on pressure and withdrawal of affected part                3

-          Resists to touch                                                                                        4

       Sandhigraha (Stiffness in joints):-

-          No restriction of movement                                                                     0         

-          Restriction u to 0 to 20 %                                                                        1

-          Restriction up to 20 to 40 %                                                                    2

-          Restriction up to 40 to 60%                                                                     3

-          Above 60 %                                                                                              4

Angamarda  :-                     

-          No Angamard                                                                                          0

-          Occasional Angamarda but Patients is able  to do usual work                1

-          Continuous Angamarda but Patients is able to do usual work                2

-          Continuous Angamarda which hampers routine work                             3

-          Patient is unable to do any work                                                              4

Aruchi :-

-          Normal desire for food                                                                             0

-          Eating timely without much desire                                                          1

-          Desire for food, little late than normal time                                             2

-          Desire for food only after long intervals                                                  3

-          No desire at all                                                                                         4

Trishna:-                              

-          Normal feeling of thirst                                                                            0

-          Frequent feeling of thirst but quench with normal amount of liquid       1

-          Satisfactory quench after increases intake of fluids but no awakening

       during night                                                                                              2

-          Satisfactory quench after increases intake of fluids with regular

       awakening during right                                                                            3

-          No quench after heavy intake of liquid                                                   4

Aalasya:-

-          No Aalasya                                                                                               0         

-          Starts work in time with efforts                                                               1

-          Unable to start work in time but completes the work                              2

-          Delay in start of work and unable to complete it                                     3

-          Never able to start the work and always likes rest                                   4

Gaurava:-                             

-          No feeling of  heaviness                                                                           0         

-          Occasional heaviness in body but  can do usual work                             1

-          Continous heaviness in body but can do usual work                               2

-          Continuous heaviness which hampers usual work                                   3

-          Unable to do any work due to heaviness                                                 4

Apaka:-

-          No apaka at all ( Normal digestion)                                                         0         

-          Occasional indigestion once or twice a week in one meal                       1

-          Occasional indigestion 3 to 5 time / week in one meal                            2

-          Indigestion 3 to 5 times / week in both  meals                                         3

-          Indigestion after every meal                                                                    4

Agnimandya:-

-          No Agnimandya                                                                                       0         

-          Occasional Agnimandya 1 to 2 times/ week                                            1

-          Agnimandya 3 to 4 times/ week                                                              2

-          Agnimandya 4 to 6 times / week                                                             3

-          Continous Agnimandya                                                                           4

Vairasyata :-

-          Normal taste of mouth                                                                             0

-          Occasional sensation of unpleasant taste                                                 1

-          Continuous sensation of unpleasant taste but vanishes                            2

-          Continuous mild sensation of unpleasant taste which persist

after eating                                                                                               3

-          Severe unpleasant taste throughout the day                                             4

 

Daha:-

-          No burning sensation                                                                                0

-          Occasional retro sterna burning                                                                1

-          Occasional retro sterna, plam and sole burning                                        2

-          Intermittent burning sensation throughout body                                     3

-          Continuous burning sensation throughout body                                      4

Bahumutrata:-                     

-          Absent                                                                                                      0

-          Urine > 2 times/ Night                                                                              1

-          Urine > 3 times/ Night                                                                              2

-          Urine > 5 times/ Night                                                                             3

-          Urine > 7 times/ Night                                                                              4

Vidvibandha :-                     

-          Absent                                                                                                      0

-          Motion once a day but not a regular interval                                           1

-          Alternate day                                                                                            2

-          Interval for more than one day                                                                3

-          Interval for more than two day                                                                4

Nidraviparyaya:-

-          Normal Sleep                                                                                            0

-          Disturb sleep during night with short naps during day                            1

-          1 to 2 hrs reduction in night sleep with gross increase in day sleep         2

-          3 to 5 hrs reduction in night sleep with gross increase in day sleep         3

-          Wakes during night & sleep during day                                                   4

Jadya:-

-          No morning stiffness                                                                                0

-          Morning stiffness >  1/2 hrs but < 1 hrs                                                   1

-          Morning stiffness >  1 hrs but < 6 hrs                                                      2

-          Morning stiffness >  6hrs but < 12 hrs                                                     3

-          Stiffness all the day through                                                                    4

FINAL ASSESSMENT OF RESULT:- The subjective and objective parameters of base line data to post medication will be compared for assessment of the results. All the result will be analyzed statistically for ‘p’ value using paired - t test.

 

IX.             Expected Outcome of Research:-

It may be a boon to provide such a cost- effective and safe medicine to the society as many people suffer from this troublesome disease which can end up in a series of complications and disturbed life, stress and uneasiness. Once the stablishment of effectiveness of  pathyadi churna inAmavata, the more effective prepration can be obtained.

 

X.                Tentative Chapterization:-

·                     Introduction

·                     Objectives

·                     Review of Literature

·                     Methodology

·                     Results

·                     Discussion

·                     Conclusion

·                     Summary

·                     Bibliography

·                     Annexures

 

PLAN OF WORK

 

 

 

 

 

I.        BIBLIOGRAPHY:

 

1.      Shukla Vidyadhar Acharya Charaka Samhita, reprinted edition 2006; Chaukhamba Sanskrit pratishthan ch.chi.28/37 : 694

2.      Ashtanga Hridaya of Vagbhatt, commentary by Atridev Gupt Nidana Sthana 8/30 Chaukhamba Prakashan.

3.      Shukla Vidyadhar Acharya Charaka Samhita, reprinted edition 2006; Chaukhamba Sanskrit pratishthan ch.chi.28/37 : 694

4.      https://www.who.int/news-room/fact-sheets/detail/osteoarthritis      Date:    18/12/2024 Time: 13:30

5.      ShastriKashinath. Charaka Samhita. Sutra Sthana. Ch-20. Sl-11. Varanasi. Chaukamba Sanskrit Samsthan. 2009. (vol 1). p269.

6.      Tripathi Brahmanand Charaka Samhita, edition reprinted 2004; Chaukhamba Surbhararati prakashan ch.su.22/4 : 412

7.      Chakradutta of Sri Chakrapanidatta, editon reprint 2010; Chaukhamba Surbhararati prakashan 210-214/22 p149

8.      Acharya G. Shrinivas Panchkarma Illusrated, edition reprinted 2009-2013 Chaukhamba Sanskrit pratishthan,:261

9.      Tripathi Brahmanand Astang Hridayam, Edition reprinted 2007; Chaukhamba Sanskrit pratishthan As.H. Chi. 21/67-69:812

 

Name and Signature of Candidate Name and Signature of Co Supervisor Name & Signature of Supervisor

 

Reference:-

 

1.     Madhavakara, Madhavanidhanam, with Madhukosh commentary, Vijayaraksita and Srikantadatta, Editor Vaidya Jadavji Trikamji Acharya, Chaukambhaorientalia Varanasi, 6^th Edition 2001, P No 186.

 

2.     Long, Fauci, Kasper, Hauserjamesonlascalzo “Harrisions Principal of Internal Medicine 18” Edition, E-Book, 2012, The Mcgraw-Hill Companies INC. Chapter no 321

 

3.     http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/769548

 

4.     Charak Samhita of Agnivesh, Prof. Ravidatttripathi, Chaukhambha Sanskrit Pratishtan Delhi, Second volume ,P. No. 15

 

5.     Charak Samhita of Agnivesh, Prof. Ravidatttripathi, Chaukhambha Sanskrit Pratishtan Delhi, Second volume, P.No. 27.