Evaluation of efficacy of Shunti and Gokshura      in Amavata (Rheumatoid Arthritis) –          A Comparative Clinical Stu...
D.G.M.AYURVEDIC MEDICAL COLLEGE  POST GRADUATE STUDIES AND RESEARCH CENTRE                                   GADAG, 582 10...
J.S.V.V. SAMSTHE’S                     D.G.M.AYURVEDIC MEDICAL COLLEGE     POST GRADUATE STUDIES AND RESEARCH CENTRE      ...
Declaration by the candidate       I here by declare that this dissertation / thesis entitled “Evaluation ofefficacy of Sh...
© Copy right             Declaration by the candidate        I here by declare that the Rajiv Gandhi University of Health ...
ACKNOWLEDGMENT        I express my deep sense of gratitude to my respected guide Professor.Dr. G.V.Mulagund M.D (Ayu) Head...
I wish to convey my thanks to beloved Librarian Shri V.M. Mundinamani and Mr.S.B. Sureban for providing me essential refer...
ABBREVIATION       A.H.         Astanga Hrudaya       A.K.         Amara kosha       A.P.I.       Ayurvedic Pharmacopoeia ...
ABSTRACT          The disease Amavata is named after two major factors Ama and Vata whicheffects the sandhi’s. Madhavakara...
CONTENTS  Page No1. Introduction              1-22. Objectives                3-33. Review of literature      4-64       A...
LIST OF TABLES               Table 1 SHUNTI                                               Page No.Table 1.1 – Showing syno...
Table 4 OBSERVATIONS AND RESULTS                                                 Page No.Table 4.1 – Showing age distribut...
LIST OF GRAPHS.                                                            Page No.Graph 1- Showing Age distribution of 30...
LIST OF PHOTOGRAPHS1. Plant shunti2. Shunti kanda3. Plant Gokshura4. Gokshura phala5. Shunti Choorna6. Shunti kwatha7. Gok...
INTRODUCTION       Ayurveda is a science of life with two main objectives maintenance andpromotion of positive health and ...
These factors basically disturb the core controller of health. Majority of thedisease result from the abnormal status of A...
OBJECTIVES1. To evaluate the efficacy of the Shunti kwatha in Amavata2. To evaluate the efficacy of the Gokshura kwatha in...
A) DRUG REVIEW                  CLASSICAL REVIEW OF THE DRUG SHUNTIHISTORICAL ASPECT OF THE DRUG       Ardraka is delineat...
Table 1.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORS                        2    3         4         5   M.N6         7     ...
Table 1.2: GANA AND VARGA : ACCORDING TO DIFFERENT CLASSICS    Charaka Samhita              Deepaniya                     ...
GUNA KARMA       Table 1.3: GUNA (PROPERTIES) ACCORDING TO DIFFERENT AUTHORSGUNA              Cha12       Su13           A...
Table 1.5: PRAYOGA (USES) ACORDING TO DIFFERENT AUTHORSPrayoga    Su33 D.N34 M.N35 R.N36 K.N37 BP.N38 Mau.N39 B D A40 PVS4...
Table 1.6: USE OF SHUNTI IN DIFFERENT YOGASSL No           YOGA                    INDICATION                 REFERENCE  1...
SL No           YOGA                 INDICATION                  REFERENCE  22.   Shunti putapaka    Amatisara            ...
SL No          YOGA                     INDICATION                 REFERENCE  43. Mahaushadi kwatha         Moorcha and ma...
MODERN REVIEW OF THE DRUG SHUNTIBOTANICAL NAME: Zingiber officinale (Rosc)      Meaning of Zingiber officinale is -      Z...
TAXONOMICAL CLASSIFICATION OF SHUNTI46           Ø Kingdom          -       Plantae           Ø Division         -       E...
Calyx -       Sepals three in number united to form a tube               odd sepal anterior in position. Aestivation valua...
CHARACTERS OF ZINGIBER OFFICINALAEMORPHOLOGY (HABIT) 48Rhizome         -Stout tuberous with erect leafy stems 0.6-1.2 m hi...
walled parenchymatous cells containing numerous circular to oval starch grains withstriations and hilum at one end idiobla...
Aroma and flavour are the main characters of ginger. Aroma is due to fragrantprinciples of volatile oil while the flavour,...
They are washed in remove mould and clay attached to them. Rhizome is peeledon flat surface as well as between the fingers...
RESEARCH PROFILE1: Ginger syrup as an antiemetic in early pregnancy.2: Nausea and vomiting of pregnancy.3: Gastroprotectiv...
placebo. Gastric emptying was measured using the oral paracetamol absorptionmodel. Ingestion of ginger did not effect gast...
CLASSICAL REVIEW OF THE DRUG GOKSHURAHISTORICAL ASPECT OF THE DRUG       There is no convincing reference of the drug Goks...
13) Kantakatrika        –   The fruit of which has got three thorns.14) Kshura              –   Its thorns are as sharp as...
Table 2.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORSSynonyms           Cha58   Su59   A.S60   D.N61   M.N62   R.N63   K.N64 ...
Table 2.2: GANA AND VARGA ACCORDING TO DIFFERENT CLASSICS          Charaka samhita         Mutra virechaniya              ...
BHEDA (VARIETIES) 69        The Gokshura, which we are using in medicines, is of two types. They are,     1. Laghu or Kshu...
Table 2.4: KARMA (ACTION) ACCORDING TO DIFFERENT AUTHORSKarma            Cha80   D.N81   M.N82   R.N83   K. N84   BP.   M....
Table 2.5: PRAYOGA (USES) ACCORDING TO DIFFERENT AUTHORSPRAYOGA       D.N91   M.N92    R.N93       K.N94   BP.N95       Ma...
Table 2.7: USE OF GOKSHURA IN DIFFERENT YOGA’SSL          YOGAS                 INDICATION         REFERENCENo 1.   Amruta...
SL. NO            YOGAS                    INDICATION            REFERENCE   25. Trikantakadya grutha      Mutrakrucchra,A...
SL            YOGAS                        INDICATION      REFERENCENo 49. Gokshura Kwatha             Mootraghata        ...
MODERN REVIEW OF THE DRUG GOKSHURABOTANICAL NAME: TRIBULUS TERRESTRIS (Linn)Meaning of Tribulus terrestris109       Tribul...
TAXONOMICAL CLASSIFICATION OF GOKSHURA111  Ø Kingdom     –   Plantae  Ø Division    –   Spermatophyta  Ø Class       –   D...
FAMILY CHARACTERS – ZYGOPHYLLACEAE112Shrubs or herbs woody at the base, rarely trees. Branches often jointed at the nodes....
GENUS CHARACTERS - TRIBULUS113Branching prostrate herbs, often with silky hairs.Leaves         –       Stipulate, opposite...
MORPHOLOGY114A procumbent herb : Stems and branches pilose. Young parts silky villous.Leaves         –      Opposite, abru...
PHARMACOGNOSTICAL FEATURES OF TRIBULUS TERRESTRIS116MACROSCOPICFruit - Fruit is globose 0.5 inch in diameter and 1/3 inch ...
IDENTITY PURITY AND STRENGTH117   v Foreign matter                    –     not more than 2 percent   v Total ash         ...
RESEARCH PROFILE1:Furostanol saponins from Tribulus terrestris.              An HPLC-ELSD-ESI-MS method has been developed...
B) DISEASE REVIEWHISTORICAL ASPECTS OF AMAVATA        There is no convincing reference to this disease in vedic literature...
AMAVATA        The nomenclature of the diseases can be done in many ways. Somenomenclatures are based on the subjective an...
Definition of Ama :        The term in ordinary parlance means unripe, uncooked immature and undigestedparticles. In the c...
indicate either Jatharagni or Dhatwagni in respect of the genesis of Ama, dependingon the pathological process exhibited.A...
4. Manasika : Food consumption while afflicated with mental instability due to       Kama, Krodha, Lobha, Moha, Irshya, Sh...
•   Mala sangha (constipation)    •   Aruchi (Anorexia)    •   Klama (Anayasa shrama)    Most of the symptoms are produced...
Vata on account of its quality of subtleness is really the impeller of the other twohumors. When Vata is provoked, it agit...
Viruddha is Dhatu pratyanika that is Dhatu virodhaka (Antagonistic to Dhatus ).Leads to dhatukshaya due to inadequate nour...
Samprapti of Amavata. 138       In a state of pre-existing Mandagni if a person in exposed to etiological factorsthen Ama ...
SAMPRAPTI                   Viruddha Ahara + Viruddha Vihara                         Agnidushti in amashaya               ...
Efficacy of Shunti & Gokshura in AmavataTable 3.1: SAMPRAPTI GHATAKA :1   Dosha            Tridoshaja, mainly Vata (Vyana,...
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Evaluation of efficacy of Shunti and Gokshura in Amavata (Rheumatoid Arthritis) – A Comparative Clinical Study - Veena. S. Kor, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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  1. 1. Evaluation of efficacy of Shunti and Gokshura in Amavata (Rheumatoid Arthritis) – A Comparative Clinical Study By Veena. S. Kori Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Dravya Guna Under the Guidance of Dr. G.V. Mulagund M.D. (Ayu) and Co- Guidance of Dr. Kuber Sankh M.D. (Ayu) Department of Dravya GunaPost Graduate Studies & Research CentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2002-2005
  2. 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 This is to certify that the dissertation entitled “Evaluation of efficacy of Shunti andGokshura in Amavata (Rheumatoid Arthritis)-A Comparative Clinical Study” is a bonafideresearch work done by Veena. S. Kori in partial fulfillment of the requirement for the postgraduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv GandhiUniversity of Health Sciences, Bangalore, Karnataka.Dr. KUBER SANKH Dr. G.V. MULAGUND M.D. (Ayu) M.D. (Ayu)Co- Guide GuideLecturer in Dravya Guna Professor & HODDGMAMC, PGS&RC, GADAG Dept. of Dravya GunaDate: DGMAMC, PGS&RC, GADAGPlace: Gadag Date: Place: Gadag
  3. 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled “Evaluation of efficacy of Shunti andGokshura in Amavata (Rheumatoid Arthritis)-A Comparative Clinical Study” is abonafide research work done by Veena. S. Kori under the guidance of Dr. G. V.MULAGUND, M.D. (Ayu), Professor & HOD and Dr. KUBER SANKH, M.D. (Ayu), inpartial fulfillment of the requirement for the post graduation degree of “AyurvedaVachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi University of Health Sciences,Bangalore, Karnataka.. (Dr. G. V. Mulagund) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Dravya Guna DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
  4. 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “Evaluation ofefficacy of Shunti and Gokshura in Amavata (Rheumatoid Arthritis)-AComparative Clinical Study” is a bonafide and genuine research workcarried out by me under the guidance of Dr. G. V. Mulagund M.D.(Ayu)Professor and Dr. Kuber Sankh, M.D.(Ayu), Lecturer in Dravya Guna,DGMAMC, PGS&RC, Gadag.Date :Place : Gadag (VEENA. S. KORI)
  5. 5. © Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation/ thesis in print or electronic format for the academic / researchpurpose.Date :Place : Gadag (VEENA. S. KORI)© Rajiv Gandhi University of Health Sciences, Karnataka
  6. 6. ACKNOWLEDGMENT I express my deep sense of gratitude to my respected guide Professor.Dr. G.V.Mulagund M.D (Ayu) Head of department of Dravya Guna. D.G.M. Ayurvedic medical college andpostgraduate and research centre, Gadag. He has been very kind to guide me in thepreparation of Thesis and for whose extraordinary efforts, emendous encouragement andmost valuable thought provoking advise made me to complete this work. I am also grateful to my respected Co-guide Dr. Kuber Sankh M.D.(Ayu) lecturer inDravya Guna, PGARC, D.G.M. Ayurvedic medical college, Gadag, for patiently goingthrough the draft of thesis and correcting with precious remarks, which has been very useful. I am extremely thankful to our Principal Dr. G.B. Patil for providing all necessaryfacilities for this research work. I am very much grateful to Dr. G. S. Hiremath H. O. D. of Dravya Guna and Dr. S. B.Nidagundi. Lecturer in department of post graduation studies in Dravya Guna for theirvaluable suggestion in this work. I wish to convey thanks to my respected Lecturers Dr. V.Varadacharyalu, Dr.Purushottamacharyulu, Dr. M.C.Patil, Dr.K.S.R.Prasad, Dr. Shivaramudu, Dr. ShashidharDoddamani, Dr.R.V.Shetter, Dr.Girish Danappagoudar, Dr. Santosh Belavadi, Dr JagadeeshMitti, Dr. U.V. Purad, Dr. B.G. Swamy, Dr. K.S. Paraddi. Dr.S.D.Yerageri, Dr.S.V. Sankanurand other lectures of our College for their help and suggestions during my post graduationstudies. I thanks to Mr. T M Nandakumar for his help in statistical evaluation and Professor. BI Biradar for his help in Botanical aspect of study. I sincerely thank my beloved classmates Dr. S B Bani, Dr. K.S. Hiremath, Dr. AshokBingi, Dr.Shivakumar Sajjanar, Dr.SunitaG. Dr.S.A.Ronad, Dr.Anand Doddamani, Dr.Jagadeesh H, Dr.C B Inamdar, Dr. Gangur. Dr.V.S. Hiremath,Dr. B. L. Kalmath, Dr. MangalaPatil, Dr. Varsha Kulkarni, Dr. Shaila B, and all classmates of other post graduation branchesfor their constant co-operation and help.
  7. 7. I wish to convey my thanks to beloved Librarian Shri V.M. Mundinamani and Mr.S.B. Sureban for providing me essential references in the study. I am thankful to Mr. B.S.Tippanagoudar and Dr. S.A.Morab lab technician, who extended his co-operation ininvestigations. I am very much grateful to all lecturers, Physicians, house surgeons, hospital staff,and non teaching staff for their timely assistance in completion of this work. I am very much grateful to Principal, all the staff members, librarian ofR.G.E.S.A.M.C, Ron for their timely assistance in completion of this work. I wish to convey my thanks to beloved friends Dr. Deepa Hasbi, Dr. Jyothi, Dr.Akkamma, Dr. Uma and other U.G. friends for their co-operation. I am highly indebted to my beloved mother-in-law & father-in-law Smt. and Shri. B.S.Kotturshatti, my sisters in law Lalita, Akkamahadevi, Sumangala, Ratna, My brother in lawShivakumar, my parents Smt. and Shri. S.V. Kori, My sisters Rekha, Geeta, and Beena, mybrother Basavaraj Nadagaddi and family, Dr. Mallikarjuna and family, for their love andaffection throughout my carrir. I am ever thankful to my brothers in law Prof. S.B. Yapalparvi, Shri. Rudresh. Hallurand Raju Hubballi for their constant moral support encouragement and help throughout mycarrier. This list is incomplete without remembering my beloved husband Dr. I.B.Kotturashatti M.D (Ayu) who helped in all respects to complete this valuable dissertation workand at last its my pleasure to remember my ever loving daughter Srusti for her inspiration. Lastly I pay my deep homage and tribute to my former teacher late Dr.C.M.Sarangamath for his support to this valuable project. Date: Place: Veena. S. Kori
  8. 8. ABBREVIATION A.H. Astanga Hrudaya A.K. Amara kosha A.P.I. Ayurvedic Pharmacopoeia of India A.R. Abhidana Ratnamala A.S. Astanga sangraha B.P. BhavaprakashaB.R. Bhaishajya Ratnavali BDA Brahat Dravyagunadarsha BP.N. Bhavaprakasha Nighantu C.Chi Charaka Samhita Chikitsa Sthana C.D Chakradatta C.S. Charaka samhita D.N. Dhanwantari Nighantu DG.PV Dravyaguna Vijnana By Priyavrat Sharma DG.VMG Dravyaguna vijnana By V.M. Gogte DGHB Dravyaguna Hastamlaka by Banvarilal DGYt Dravyaguan vijnana By yadavji Trikamji I.M.M. Indian Materia Medika I.M.P. Indian Medicinal Plants K.N. Kaiyadeva Nighantu M.D. Madava Dravyaguna M.N. Madanapala Nighantu M.N Madhava Nidana Mau.N. Mahausadha Nighantu N.A. Nighantu Adarsha R.N. Raja Nighantu Sha.S.M Sharangadhara Samhita Madhyama Khanda Su Sushruta Samhita V.N Vanoushadhi nidarshika Y.R. Yoga Ratnakar
  9. 9. ABSTRACT The disease Amavata is named after two major factors Ama and Vata whicheffects the sandhi’s. Madhavakara for the first time mentioned this disease as a separateentity. Amavata can be correlated with Rheumatoid Arthritis on the basis of symptomsmentioned in the concerned literatures. Amavata is a chronic progressive systemicinflammatory disorder that primarily targets the joints of middle age adults. Herecomparative clinical trail has been carried out with the required parameters. Here shunti(Zingiber officinale) and Gokshura’s (Tribulus terristris) are utilized in the form ofkwatha to find out their comparative efficacy in the Amavata (Chakradatta 25/9).OBJECTIVES 1. To evaluate the efficacy of the Shunti kwatha in Amavata. 2. To evaluate the efficacy of the Gokshura kwatha in Amavata. 3. To assess the additive efficacy of Shunti Gokshura kwatha (Shuntyadi) in Amavata.METHOD: In this prospective comparative clinical study, 30 patients randomly selectedand Grouped as A, B and C receiving Shunti kwatha, Gokshura kwatha and ShuntiGokshura kwatha respectively for the duration of 30 days with dose of 40 ml in the earlymorning. Efficacy was assessed by the difference of before and after treatment from thesubjective and objective parameters.RESULTS : Individually all the 3 groups showed highly significant in subjective aswell as objective parameters. Comparatively group C shows more significant than thegroup A and group B.INTERPRETATION & CONCLUSION :This clinical study is quite obvious thatcombination of treatment as provided in Group C that is Shunti Gokshura kwatha has gotedge over the treatment provided in Group A (Shunti kwatha) and group B (Gokshurakwatha) improvement in all the respect is observed specially in subjective as well asobjective parameters. Shunti and Gokshura kwatha (Group C) is very effective inAmavata.KEY WORDS Amavata; Rheumatoid Arthritis; Shunti (Zingiber officinale); Gokshura (Tribulus terrestris); Methods; Clinical study; Results;
  10. 10. CONTENTS Page No1. Introduction 1-22. Objectives 3-33. Review of literature 4-64 A) Drug Review 4-38 B) Disease Review 39-644. Methodology 65-735. Results 74-1056. Discussion 106-1107. Conclusion 111-1128. Summary 113-1139. Bibliography 114-12110. Annexure 122-129
  11. 11. LIST OF TABLES Table 1 SHUNTI Page No.Table 1.1 – Showing synonyms according to different authors. 05Table 1.2 – Showing Gana and varga according to different classics 06Table 1.3 – Showing Guna according to different authors 07Table 1.4 – Showing Karma according to different authors 07Table 1.5 – Showing Prayoga according to different authors 08Table 1.6 – Showing use of shunti in different yoga’s. 09-11 Table 2 GOKSHURATable 2.1 – Showing synonyms according to different authors 23Table 2.2 – Showing Gana and varga according to different classics 24Table 2.3 – Showing Guna according to different authors 25Table 2.4 – Showing Karma according to different authors 26Table 2.5 – Showing Prayoga according to different authors 27Table 2.6 – Showing Prayojyanga according to different authors 27Table 2.7 – Showing use of Gokshura in different yoga’s. 28-30 Table 3 DISEASETable 3.1- Showing samprapti ghataka 49Table 3.2 – Showing comparison of lakshanas with different Ayurvedic treatises 52Table 3.3 – Involvement of srotas according to symptoms. 53
  12. 12. Table 4 OBSERVATIONS AND RESULTS Page No.Table 4.1 – Showing age distribution of 30 patients. 75Table 4.2 – Showing sex distribution of 30 patients. 76Table 4.3- Showing distribution of religion of 30 patients. 77Table 4.4- Showing Distribution of patients according to the occupation. 78Table 4.5- Showing distribution of patients according to the economical status. 79Table 4.6- Showing distribution of patients according to the diet habit. 80Table 4.7- Showing presenting symptoms of thirty patients. 81Table 4.8- Showing duration of the patients in the present study. 83Table 4.9- Showing the affected joints of thirty patients. 84Table 4.10- Showing Agnibala of thirty patients. 85Table 4.11- Showing nidra of thirty patients. 86Table 4.12-Showing prakruti of thirty patients. 87Table 4.13 Showing Grades of sandhi shoola before treatment in Group A ,B & C.88Table 4.14 Showing Grades of sandhi shoola after treatment in Group A, B & C. 88Table 4.15 Showing Grades of sandhi shotha before treatment in Group A, B & C.89Table 4.16 Showing Grades of sandhi shotha after treatment in Group A, B & C. 89Table 4.17 Showing Grades of jwara before treatment in Group A, B & C. 90Table 4.18 Showing Grades of jwara after treatment in Group A, B & C. 90Table 4.19 Showing Grades of stabdata before treatment in Group A, B & C. 91Table 4.20 Showing Grades of stabdata after treatment in Group A, B & C. 91Table 4.21 Showing comparative results of Group A, B & C with sandhishoola. 92Table 4.22 Showing comparative results of Group A, B &C with Sandhishotha. 93Table 4.23 Showing comparative results of Group A, B & C with Jwara.(fever) 94Table 4.24 Showing comparative results of Group A, B & C with Stabdata. 95Table 4.25 Showing statistical analysis of subjective and objective parameters in Group A. 96Table 4.26 Showing statistical analysis of subjective and objective parameters in Group B 97Table 4.27 Showing statistical analysis of subjective and objective parameters in Group C 97Table 4.28 Showing Anova table for sandhi shoola. 98Table 4.29 Showing Anova table for sandhi shotha. 98Table 4.30 Showing Anova table for jwara. 98Table 4.31 Showing Anova table for stabdata. 98Table 4.32 Showing Anova table for Hb% 99Table 4.33 Showing Anova table for ESR. 99Table 4.33 (a) Showing least significance difference among the groups 99Table 4.34 Showing Anova table for TC. 100Table 4.35 Showing comparative overall assessment of therapeutic response of Group A, B & C. 101
  13. 13. LIST OF GRAPHS. Page No.Graph 1- Showing Age distribution of 30 patients. 75Graph 2 – Showing Sex distribution of 30 patients. 76Graph 3 – Showing distribution of Religion of 30 patients. 77Graph 4- Showing distribution of Patients according to the occupation. 78Graph 5 - Showing distribution of Patients according to the economical status. 79Graph 6 - Showing distribution of Patients according to the diet habit. 80Graph 7 - Showing Presenting Symptoms of thirty patients. 82Graph 8- Showing duration of the patients in the present study. 83Graph 9 - Showing the affected joint of thirty patients. 84Graph 10 - Showing Agnibala of thirty patients. 85Graph 11- Showing Nidra of thirty patients. 86Graph 12– Showing Prakruti of thirty patients. 87Graph 13 -Showing comparative results of Group A, B & C with sandhishoola. 92Graph 14-Showing comparative results of Group A, B &C with Sandhishotha. 93Graph 15-Showing comparative results of Group A, B & C with Jwara.(fever) 94Graph 16-Showing comparative results of Group A, B & C with Stabdata. 95Graph 17 - Showing comparative overall assessment of therapeutic response of Group A,B & C. 101
  14. 14. LIST OF PHOTOGRAPHS1. Plant shunti2. Shunti kanda3. Plant Gokshura4. Gokshura phala5. Shunti Choorna6. Shunti kwatha7. Gokshura choorna8. Gokshura kwatha9. Shunti Gokshura kwatha MASTER CHARTS Page No.1. Showing the demographic data 1032. Showing assessment of Subjective parameters of Group A, B and C 1043. Showing assessment of Objective parameters of Group A, B and C 105
  15. 15. INTRODUCTION Ayurveda is a science of life with two main objectives maintenance andpromotion of positive health and cure of the diseases. Ayurveda is believed to beprevalent since 5000 years in India. In 1974 W.H.O. recognized Ayurveda the Indiantraditional medicine and requested to improve the service and availability of Ayurvedicdrugs in our country. This traditional medicine is much popular for curing the most of thediseases. Drug being one among the Chikitsa chatushpada and the armour of the physician.The drug occupies a pre-eminent position in the requisite for achieving the success oftreatment. The drug is given vital importance because of its efficacy, easy availability andmultiple formulation, which helps in achieving on effective treatment which also costeffective. Since the time immemorial herbs are being used as good as well as formedicinal purpose and also to making materials like chariot etc. Amavata is chronic progressive systemic inflammatory disorder that primarilytarget the joints of middle aged adults. Over all prevalence of RA in caucasion populationis about 1% with a female to male ratio of 3:1. Presently the non steroidal Antiinflammatory drugs (NSAIDs) are the mainstay inthis condition how ever they have serious adverse effects and have limitations for a longterm therapy. NSAIDs temporarily control pain and possibility of further damage to jointincreases where as the root cause remains un attended. In the fast moving world man is stepping forward after success in finding it notdifficult to achieve total health. This is because of in judicious life style like improperfood habits added to this mental factors like greed anger etc. 1
  16. 16. These factors basically disturb the core controller of health. Majority of thedisease result from the abnormal status of Agni. Amavata is one among such disease. It isa disease that physicians are compelled to combat in their practice very often. Present available treatment with contemporary science is able to give a temporaryrelief to the patients. Amavata often cripples the routine life of the patients. Ayurvedicapproach to this disease aims basically at stabilizing agni which is the root cause. Thereby trying to promote a long lasting relief. Among the various formulation indicated in the management of Amavata, Shunti(Zingiber officinale rosc) and Gokshura (Tribulus terrestris linn) appear to be costeffective easily available and there is no substantial adverse effect. Shunti posses katu rasa. Ushna veerya and Madhura vipaka. It allivates vata andKapha dosha. It mitigates shoola and shotha and it is agni deepaka and amapachaka. Gokshura is tridosha shamaka, rujahara, deepana and shothahara action can be aneffective remedy for Amavata. The present study aims at a comparative study on the efficacy of Shunti Gokshura(Shuntyadi kwatha C.D. 25/9) in Amavata. 2
  17. 17. OBJECTIVES1. To evaluate the efficacy of the Shunti kwatha in Amavata2. To evaluate the efficacy of the Gokshura kwatha in Amavata3. To assess the additive efficacy of Shuntyadi kwatha in Amavata. 3
  18. 18. A) DRUG REVIEW CLASSICAL REVIEW OF THE DRUG SHUNTIHISTORICAL ASPECT OF THE DRUG Ardraka is delineated in Agnivesha Grhyasutra Jaimini Brahmana quotes thename srngabera. Suntha or Shunti described in the Guhya sutras is considered as a type ofGrass but not ginger. Visvabhesaja term is used for water and rice in Rgveda (1/13/20and 1/137/3). The above mentionings confirm that Ardraka and shunti are relatively newnames not familiar in the ancient times. Mujumdar is of the openion that Adara describedin Rgveda may be Z. officinale1.SYNONYMS WITH MEANING • Mahaushada - It promotes the growth of human body. • Kaphari - That which over comes the disease of Kapha • Ushna - It is having ushna veerya • Vishwoushadha - It cures all the diseases • Vishwabheshaja - It almost cures every disease • Vishwa - It can be cultivated/available all over the world • Shunti - Shunti word is used in the sense of Equalizing or to combat. It may combat Ama dosha or kapha dosha. • Shringavera - It possesses several sringas (germinating buds) on Its surface. • Ardrakam - It will provide moisture to the tongue that is useful in the treatment of dryness of mouth. 4
  19. 19. Table 1.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORS 2 3 4 5 M.N6 7 8 9 Mau. 11Synonyms Cha Su A.S D.N R.N K.N BP.N A.R. N10Mahaushadha + - + + + + + + + +Vishwa - - - + + + - + + +Nagara + + + + + + + + + +Vishwabheshaja + - - + + + + + + +Vishwoushadha - - - + + + + - + -Shringavera + + + + + + - + + +Katubhadra - - - + + + + + + +Ardraka - - - + - + - - - +Katutkhatam - - - - + - + - + -Rahucchatra - - - - - - + - - -Katugranthi - - - - - + - - + -Katushanam - - - - - + - - + -Sauparna - - - - - + - - + -Kaphari - - - - - + - - + -Shushkadra - - - - - - - - + -Chandraka - - - - - - - - + -Chandrabheshaja - - - - - - - - + -Ushana - - - - - - - + + -Bheshaja - - - - - - - - + +Shunti - - - + + + + + + + 5
  20. 20. Table 1.2: GANA AND VARGA : ACCORDING TO DIFFERENT CLASSICS Charaka Samhita Deepaniya Truptighna Arshoghna Stanyashodana Trushna nigrahana Sheeta prashamana Shoola prashasmana Aharopayogi varga Susruta samhita Pippalyadi Trikatu Shaka varga Astanga Sangraha Deepaniya Truptighna Arshoghna Stanya shodana Trushna nigrahana Sheeta shamana Shoola shamana Pippalyadi Dhanwantari Nighantu Shatapushpadi varga Madanapala Nighantu Shuntyadi varga Raja Nighantu Pippalyadi varga Kaiyadeva Nighantu Oushadi varga Bhavaprakasha Nighantu Haritakyadi varga Mahaushada Nighantu Mahaushada varga Nighantu Aadarsha Aadrakadi varga Madava Dravyaguna Vividoushada varga Abidana Ratnamala Katuskanda 6
  21. 21. GUNA KARMA Table 1.3: GUNA (PROPERTIES) ACCORDING TO DIFFERENT AUTHORSGUNA Cha12 Su13 A.Hr14 D.N15 M.N16 R.N17 K.N18 BP.N19 Mau.N 20 M.D21 N.A22Rasa-Katu - + - + + + + + + + +Guna-Laghu - + + - + - + + + + -Snigdha + + + + + + + + + + -Veerya-Ushna + + + - + + + + + + +VipakaMadhura + + + - + - + + + + +Kapha Vataghna + + + - + + + + + + +Kaphaghna - - - + - - - - - - - Table 1.4: KARMA (ACTIONS) ACCORDING TO DIFFERENT AUTHORS 23 24 25 26 27 28 29 30 31 32 Karma Cha Su A.Hr D.N M.N K.N BP.N Mau.N M.D. BDA Vrushya + + + + + + + + + + Pachana - - - - + + + + - + Rochana + + + - + + + + + - Hridya + + + - - + - - + - Deepana + - + - - + - - + - Swarya - + - - + + + + - - Grahi - - + - - + + - - + Anulomana - - - - - - - - - + Arshoghna - - - - - - - - - - 7
  22. 22. Table 1.5: PRAYOGA (USES) ACORDING TO DIFFERENT AUTHORSPrayoga Su33 D.N34 M.N35 R.N36 K.N37 BP.N38 Mau.N39 B D A40 PVS41Shoola + - + + + + + + -Udara - + + + + + + - +Swasa - + + + + + + - +Kasa - - + - + + + - +Shlepada - + + + + + + - +Vibandha + - + - + + + - +Aruchi - + - - - - - - +Amavata - - + - - + - - +Vamana - - + - + + + - +Arsha - - + - + + + - -Aanaha + - + - + + + + -Hridroga - - + - + + + - -Shotha - - - - - + + - +Shopa - + + + + - - - -Pandu - + - - - - - - -Adhama - - - - - - - - -Hidma - - - + + - - - -Hikka - - - - - - - - +PRAYOJYA ANGA - Kanda ( Rhizome) 42 8
  23. 23. Table 1.6: USE OF SHUNTI IN DIFFERENT YOGASSL No YOGA INDICATION REFERENCE 1. Nagardi grutha Udara roga K&V gulma Cha. Chi 13/115 2. Vidangadi kshara Gulma and Pleeha roga Cha. Chi 13/80 3. Gandiradyarista Shotha, Bagandara, Arsha Cha. Chi 12/29-31 4. Pippalyadi lavana Hrudaya and shotha Cha. Chi. 13/158-161 5. Nilinyadhya choorna Udara roga and gulma Cha. Chi. 13/137 6. Kshara vatika Shotha and Jalodara Cha. Chi. 13/162-164 7. Pippalyadi grutha Arsha Cha. Chi. 14/104 8. Chavyadi grutha Pravahika Cha. Chi. 14/107-109 9. Nagaradhya grutha Arsha. Grahani Cha. Chi. 14/110-112 10. Trushandya grutha Mandagni Cha. Chi. 15/87 11. Nagaradhya choorna Pittaja grahani. Raktapitta Cha. Chi. 15/130-131 12. Bhallataka kshara Hrudroga, pandu, grahani Cha. Chi. 15/177-78 13. Navayasa choorna Pandu. Hrudroga Cha. Chi. 16/70-71 14. Mandoora vataka Pandu Cha. Chi. 16/73-77 15. Datryavaleha Kamala. Pittavikara Cha. Chi. 16/100-101 16. Sauvarchaladi choorna Hikka swasa Cha. Chi 17/109 17. Shuntyadi choorna Tamaka swasa Hikka Cha. Chi. 17/123-124 18. Vidangadi Choorna Vataja kasa Cha. Chi. 18/47 19. Chitrakadi leha Hrudroga, Swasa Cha. Chi. 18/53-56 20. Pushkaramooladi kalka Vataja Hrudroga Cha. Chi. 26/84 21. Nagaradi kwatha Raktapitta pittashoola Sha. S.M. Kha. 2/97 9
  24. 24. SL No YOGA INDICATION REFERENCE 22. Shunti putapaka Amatisara Sha. S.M. Kha. 1/42-43 23. Nagaradi kwatha Jwara, Atisara Sha. S.M. Kha. 2/62 24. Shuntyadi kalka Parinama shoola and Amavata Sha. S.M. Kha. 5/18 25. Shunti kalka Grahani Sha. S.M. Kha. 5/28 26. Panchakola choorna Deepana, Pachana, Anaha Sha. S.M. Kha. 5/13.14 27. Shuntyadi choorna Amatisara Sha. S.M. Kha. 6/46 28. Chitrakadi choorna Gulma, Grahani Sha. S.M. Kha. 6/110-113 29. Gudadi gutika Swasa, Kasa Sha. S.M. Kha. 7/16 30. Yoshadi vati Swasa, Kasa Sha. S.M. Kha. 7/22.23 31. Yogaraj guggulu Tridosha shamaka, Rasayana Sha. S.M. Kha. 7/53-69 32. Pippalyadi grutha Vishamajwara, Pleeharoga Sha. S.M. Kha. 9/19.20 33. Changeri grutha Grahani, Vatavikar Sha. S.M. Kha. 9/21-24 34. Mahaushadi kwatha Vishama jwara C.D. 1/210 35. Nagaradi kashaya Jwara, Atisara C.D. 2/4 36. Nagaradi kwatha Atisara, Shoola C.D. 2/30 37. Shunti grutha Shotha, Amadosha yukta grahani C.D. 4/41 38. Nagaradhya modaka All types of Arsha C.D. 5/27 39. Navayasa loham Pandu, Kusta, Hrudayavikara C.D. 8/10-11 40. Vishwadi leha Vatika kasa C.D. 11/6 41. Kantakari grutha Swarabheda, All types of Kasa C.D. 13/12 42. Chandana kalka Cchardhi C.D. 15/6 10
  25. 25. SL No YOGA INDICATION REFERENCE 43. Mahaushadi kwatha Moorcha and mada C.D. 17/6 44. Amrutadi choorna Amavata, Sandishotha C.D. 25/14 45. Patyadi choorna Shotha, Agnimandya, Amavata C.D. 25/44 46. Trikatukadi varti Anaha and shoola C.D. 29/8.9 47. Varunadi kwatha Vatajanya Ashmari C.D. 34/2.1 48. Shuntyadi kwatha Ashmari, Mutrakrucchra C.D. 34/5.7 49. Nagaradi kashaya Ashmari C.D. 34/28 50. Swadamstradi kashaya Ashmari C.D. 34/30 51. Ashta Dashanga Kwatha Jwara Y R Jwara chi 3rd Shloka 52. Navayasa Choorna Pandu, Hridroga Y R Pandu roga chikitsa - 1st Shloka 11
  26. 26. MODERN REVIEW OF THE DRUG SHUNTIBOTANICAL NAME: Zingiber officinale (Rosc) Meaning of Zingiber officinale is - Zingiber – altered form of the shrungber43 Officinale – sole in shops or used in medicine or in the arts.VERNACULAR NAME : 44 , 45 v Latin - Zingiber officinalae v English - Ginger v Bengal - Sonth v Maharastra - Sunt v Telagu - Sonti v Tamil - Shukku v Kannada - Vanashunti v Malayalam - Chukka v Konkani - Alem v Punjab - Sonth v Hindi - Ada, Adrak v French - Gingembre v Italian - Zenzero v Malaya - Alea v Tulu - Sunthi v Urdu - Adrak v Oriya - Adroko v German - Inqwer 12
  27. 27. TAXONOMICAL CLASSIFICATION OF SHUNTI46 Ø Kingdom - Plantae Ø Division - Embryophyta siphonogama Ø Class - Monocotyledons Ø Order - Scitaminea Ø Family - Zingiberaceae Ø Genus - Zingiber Ø Species - OfficinalisFAMILY CHARACTER – ZINGIBERACEAE. 47Habit - Herbaceous plantsRoot - Fibrous root systemStem - Usually an underground rhizome may be horizontal or tuberous. The rhizome periodically produces aerial shootsLeaf - Leaves may be radical or couline. Petiolate or subsessile. Arrangement of the leaves is distichous. Leaf base sheathing. Lamina is linear to elliptic or lanceolate. Venation unicostate parallel A ligule is present between the petiole and laminaInflorescence- Flowering clusters may be present on leafy aerial shoots or on leafless scapes as in zingiber. The inflorescence is varied. It is a spike head raceme or panicle.Flower - Pedicellate or sessile bracteate bracts are of ten coloured and arranged spirally or in two series flowers are complete trimerous, Zygomarphic, cyclic, heterochlamydeous, bisexual and epigynous. Flowers are large brightly coloured and aromatic in some 13
  28. 28. Calyx - Sepals three in number united to form a tube odd sepal anterior in position. Aestivation valuate.Corolla - Petals (inner whorl of perianth) three, gamo pentalous forming a corolline tube. Petals unequal in size. Posterior pental largest covering the margins of the remaining two. Aestivation valvate petals are brightly coloured and often delicateAndroecium -Basic number of stamens is six. Arranged in two whorls of three each. However all except one are sterile. The outer whorl is supposed to have three stamens of which the anterior one is always absent. The remaining two are represented by leafy staminodes. Among the three members of the inner whorl one is a fertile stamen it is epipetalous. The remaining two members are united to form a petaloid labellum. The labellum closely apresses the fertile stamen.Gynoecium - Ovary inferior tricarpellary, syncarpous trilocular with many ovules on axile placenta. Style is single and is more or less enclosed by the groove of the fertile stamen. Stigma simple capitate or three lobed. Epigynous nectar secreting glands are present.Seeds - Seeds have a meaty endosperm with a straight embryo. An aril is often Present 14
  29. 29. CHARACTERS OF ZINGIBER OFFICINALAEMORPHOLOGY (HABIT) 48Rhizome -Stout tuberous with erect leafy stems 0.6-1.2 m high.Leaves -Narrow, distichous, subsessile on the sheaths, linear-lanceolate, 1-2cm Wide, glabrousFlowers -Greenish with a small dark purple or purplish black lip in radical spikes 3.8 –7.5 cm long and 2.5 cm diameter on peduncles 15-30 cm long.Stamens -Dark purple as long as the lip, rather shorter than the corolla.DISTRIBUTION (HABITAT) 49 Ginger is cultivated in many parts of India. On a large scale in the worm, moistregions. Chiefly in Madras, Cochin and Travancore, and to a somewhat less extent inBengal and the Punjab.PHARMACOGNOSTICAL FEATURES OF SHUNTI50a) MacroscopicRhizome - Drug occurs as entire rhizome or in pieces, rhizome laterally compressedbearing flattish ovate, oblique branches on upper side, each having a depressed scar itsopex pieces 5-15 cm long, 1.5 – 6.5 cm wide (usually 3-4 cm) and 1-1.5 cm thick,fracture, short with projecting fibres, transeversely cut surface shows a wide central stelehaving numerous grayish cut ends of fibres and yellow secreting cells gingery tastepungent.b) MicroscopicRhizome – Shows a few layered, irregularly arranged, tangentiolly elongated, browncells of outer cork and 6-12 rows of thin walled, colourless, radially arranged cells ofinner cork; secondary cortex consisting of hexagonal to polygonal, isodiametric, thin 15
  30. 30. walled parenchymatous cells containing numerous circular to oval starch grains withstriations and hilum at one end idioblasts containing large yellowish to brownish globulesof oleoresin walls of oil cells suberised, numerous closed, conjoint, collateral, corticalfibro vascular bundles scattered throughout cortical zone, greater number occurring ininner cortical region, larger bundles consists of 2-7 vessels. Small cells of sieve tube,polygonal cells of parenchyma and group of fibres; vessels showing reticulate,scalariform and spiral thickening; fibres septate with a few oblique pores on their walls;endodermis single layered, free from starch; pericycle single layered enclosing centralstels; stele consisting of thin walled polygonal, isodiametric cells of parenchyma, filledwith abundant starch grains, oleo resin cells similar to those present in cortex;fibrovascular bundles of two types; those arranged along pericycle in a definite ring aresmaller in sized and devoid of fibres, vessels 2-5 in number, larger bundles foundscattered throughout stele, composed of xylem, phloem parenchyma and sheath ofsclerenchyma.Powder – Light yellow; shows thin walled parenchymatous cells, septate fibres withoblique, elongated pits on their walls, reticulate and spiral vessels, oleo resin cellsabundant single starch grains of varying shapes with eccentric hilum, measuring 5-25micro in diameter.PHYTOCHEMISTRY51 Ginger consists of volatile oil (1-4%) starch (40-60%) fat, 10% protein (10%)fibre (5%) inorganic material (6%) residual moisture (10%) an acrid resinous matter (5-8%) Ginger oil is constituted of monoterpene hydrocarbons, sesquiterpene hydrocarbons,oxygenated mono and sesquiterpenes and phenyl propanoids. Sesquiterpene hydrocarbon content of all types of ginger oil from differentcountries is found to be same and includes Alpha - zingiberene, Beta - bisaboleneAlpha--farnesene, Beta - sequiphellandrene and curcumene. 16
  31. 31. Aroma and flavour are the main characters of ginger. Aroma is due to fragrantprinciples of volatile oil while the flavour, pungency and pharmacological action isexerted by phenolic ketones of oleoresin. Various components of volatile oil likeisometric terpenic aldehydes like geranial and citral. Which cause the delicate andlemony aroma. Few sesquiterpeneoil hydrocarbons are believed to exert spicy notephenolic ketones of oleoresin include gingerols like shogaols is zingerone, paradols.Gingediols, hexa hydrocurcumin and also O - methyl ethers of these compounds.Identity Purity and Strength52 Ø Foreign matter - not more than 1 percent Ø Total ash - not more than 6 percent Ø Water- soluble ash - not less than 1.5 percent Ø Alcohol (90%) soluble extractive - not less than 3 percent Ø Water soluble extractive - not less than 10 percentCULTIVATION53 The plant of ginger is a perennial herb about 1 meter high with sympodialbranching rhizome. For cultivation the rhizome is cut into pieces and each piececontaining a bud is planted into trenches in well-drained and loamy soil in March andApril. The plant requires about 80” rainfall per year and if rainfall is inadequate watermay be supplied by irrigation. Collection is done in December or January when the plantswither after flowering period. Rhizome are carefully dugout, aerial stems, fibrous rootsand buds are removed. 17
  32. 32. They are washed in remove mould and clay attached to them. Rhizome is peeledon flat surface as well as between the fingers and thoroughly washed in running water.Drug is then dried completely by keeping in the sun on mats, which are covered overnights, and in rainy and cloudy seasons. If moisture is present, drug may become mouldy.After drying it loses about 70% of its weight. USES OF PLANT IN OTHER SYSTEMS AND COUNTRIESACTION AND USES IN SIDDHA54 Katu rasam, Ushna veeryam, Vata kapha haram, Katu vipaka Laghu, Snigdha,Pachanam, Ruchyam, Vrishyam, Swaryam, Vibhanda harum, in grahani, Agnimathyam,Amavatham, Cchardhi, Swasam, Soolam, arsas, anaham, hrithrogam, udara rogam.ACTION AND USES IN UNANI55 The rhizome has sharp taste, pungent, stomachic aphrodisiac, tonic, expectorant,carminative, removes pain due to cold. Strengthens memory. Removes obstruction in thevessels, used in nervous diseases, ginger is anthelmintic good in piles, rheumatism,headache. In Cambodia56 - The rhizome is given internally as an aromatic tonic externally itis applied to boils and enlarged glands. In China and Malaya57 - Ginger is largely used as a condiment and in domesticmedicine. It is prescribed as an adjunct to many tonic and stimulating remedies. The rootskin is used as a carminative and is said to be a remedy for opacity of the cornea. 18
  33. 33. RESEARCH PROFILE1: Ginger syrup as an antiemetic in early pregnancy.2: Nausea and vomiting of pregnancy.3: Gastroprotective activity of ginger zingiber officinale rosc., in albino rats. The cytoprotective and gastric anti-ulcer studies of ginger have been carriedout in albino rats. Cytodestruction was produced by 80% ethanol, 0.6M HC1, 0.2MNaOH and 25% NaCl. Whereas gastric ulcers were produced by ulcerogenic agentsincluding indomethacin, aspirin and reserpine, beside hypothermic restraintstress and by pylorus ligated Shay rat technique. The results of this studydemonstrate that the extract in the dose of 500 mg/kg orally exert highlysignificant cytoprotection against 80% ethanol, 0.6M HC1, 0.2M NaOH and 25% NaClinduced gastric lesions. The extract also prevented the occurrence of gastriculcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) and hypothermicrestraint stress. These observations suggest cytoprotective and anti-ulcerogeniceffect of the ginger.4: Prospective comparative study of the safety and effectiveness of ginger for thetreatment of nausea and vomiting in pregnancy.5: Zingiber officinale (ginger)--an antiemetic for day case surgery.6: Zingiber officinale does not affect gastric emptying rate. A randomised,placebo-controlled, crossover trial. The effect of the powdered rhizome of Zingiber officinale (ginger root) on thegastric emptying rate was investigated. In a double-blind crossover trial, 16healthy volunteers were randomly allocated to receive either 1 g of ginger or 19
  34. 34. placebo. Gastric emptying was measured using the oral paracetamol absorptionmodel. Ingestion of ginger did not effect gastric emptying. The antiemeticeffect of ginger is not associated with an effect on gastric emptying. Noadverse effects were noted.7: Ginger does not prevent postoperative nausea and vomiting after laparoscopicsurgery.IMPLICATIONS: The potential antiemetic effect of two different oral doses of theherbal remedy ginger (Zingiber officinale) to prevent postoperative nausea andvomiting in 180 patients undergoing gynecologic laparoscopy was investigated inthis randomized, double-blinded trial. Ginger failed to reduce the incidence ofpostoperative nausea and vomiting after these procedures.8: Effects of a ginger extract on knee pain in patients with osteoarthritis.9: Effect of a ginger extract on pregnancy-induced nausea: a randomised controlledtrial.References: WWW.PUBMED.COM. PMID: [PubMed - indexed for MEDLINE] 20
  35. 35. CLASSICAL REVIEW OF THE DRUG GOKSHURAHISTORICAL ASPECT OF THE DRUG There is no convincing reference of the drug Gokshura in vedic period.Information of this plant is available from the time of Samhita’s. Various therapeutic usesof this drug are seen in many classics. Gokshura has been mentioned is variousNighantu’s.SYNONYMS AND ITS MEANINGS 1) Bahu kantaka – Which has got many thorns. 2) Bhadra kantaka – That which has got useful thorns. 3) Bhakshata – The fruit which is having thorns is being eaten as a medicine. 4) Bhakshaka – The fruit which is having thorns is being eaten as a medicine. 5) Bhakshakanta – The fruit which is having thorns is being eaten as a medicine. 6) Chanadruma – Its kshupa resembles with chanaka (cicer alietinum) 7) Chanapatraka – The leaves resembles the leaves of Bengal gram plant. 8) Granthila – The root of which has got nodules 9) Gokshuraka – Its thorn will pinches the legs of cow like knife 10) Gokantaka – The thorns of Gokshura can enter legs of wandering cows. 11) Kanti – Its fruit having thorns. 12) Kantaka – Its fruit having thorns. 21
  36. 36. 13) Kantakatrika – The fruit of which has got three thorns.14) Kshura – Its thorns are as sharp as kshuraka knife.15) Ikshugandhika – The smell which comes out from this kshupa resembles with ikshu16) Sthala shrunghata – Its fruit resembles with shrungataka (trapa bespinosa) and it grows on the earth (stala).17) Swadamstra – Its thorns are as sharp as dogs teeth.18) Shadanga – a) It has got six parts like root, stem, leaf, flower, fruit, and seed. b) All the six parts of it are used for therapeutic purpose.19) Swadukantaka – The fruits are sweetish in nature20) Trika – That which allievaites all the three doshas.21) Trikantaka – The fruit of which has got three thorns.22) Palankasha – The fruit of which makes wounds and causes pain.23) Vyaladamstra – It causes pain which is like wild animal bite. It easily digests the meat24) Vanashringara – It is present with the horns (thorns) in the garden.25) Kanta Phala – Fruits are having Thorns 22
  37. 37. Table 2.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORSSynonyms Cha58 Su59 A.S60 D.N61 M.N62 R.N63 K.N64 BP. Mau. A.R.67 A.K.68 N65 N66Gokshura + - + + + + + + + + +Bhakshyaka - - - + - - + - - - -Swadu kantaka - - - + + + + + + - +Gokantaka - - - + + - - + + - +Bhakshakha - - - + + - - - - - -Kantakatrika - - - + - - - - - - -Swadamstra + + + + + + + + + + +Trikantaka - + - - + - + + + + -Kantaphala - - - - + - + - - + -Vyaladamstraka - - - - + + + - - + -Sthalashrunghata - - - - + + + - + + -Kshura - - - - + + + + - - -Kshuranga - - - - - + - - - - -Kantaka - - - - - + - - - - -Bhakshya kanta - - - - - + - - - - -Mahanga - - - - - + - - - - -Palankasha - - - - - + - + + - +Kshudrakshura - - - - - + - - - - -Vanashrunghataka - - - - - + - + - - +Ikshugandha - - - - - + - + + - +Trika - - - - + - + - - - -Kantaka kshura - - - - - - - - - + -Chanadruma - - - - - + - - - - -Bahukantaka - - - - - + - - - - -Shadanga - - - + + - + - - - - 23
  38. 38. Table 2.2: GANA AND VARGA ACCORDING TO DIFFERENT CLASSICS Charaka samhita Mutra virechaniya Shothahara Krimighna Anuvasanopaga Sushruta samhita Vidarigandadi Veeratarvadi Laghu panchamoola Kantaka panchamoola Ashtanga Sangraha Krimighna Mootravirechana Shothahara Vidaryadi Veerataradi Laghu panchamoola Dhanvantari Nighantu Guducchyadi varga Madanapala Nighantu Abhayadi varga Raja Nighantu Shatavhadi varga Kaiyadeva Nighantu Oushadi varga Bhavaprakasha Nighantu Guducchyadi varga Mahaushada Nighantu Bilwadi varga Madava Dravyaguna Vividoushadi varga Abidana ratnamala Swadu kanda Nighantu Adarsha Laghugokshuradi varga Amara kosha Vanoushadi varga 24
  39. 39. BHEDA (VARIETIES) 69 The Gokshura, which we are using in medicines, is of two types. They are, 1. Laghu or Kshudra Gokshura 2. Brihat Gokshura Charaka and Sushrutha have not mentioned about the varieties. Only Gokshura has been mentioned. The name Brihat Gokshura is found in Raja Nighantu. Raja Nighantu mentioned about Kshudra Gokshura and Gokshura (Brahat). And lastly he claims even both Gokshsura’s endowed with same properties but Brahat Gokshura is effective. GUNA KARMA Table 2.3: GUNA (PROPERTIES) ACCORDING TO DIFFERENT AUTHORS GUNA D.N70 M.N71 R.N72 K.N.73 BP.N74 Mau. N.A76 BDA77 DG. API79 N75 H78RASAMadhura - + + + + + + + + +GUNAGuru Guna - - - - - - - - + +Snigdha Guna - - - - - - - - + +VEERYASheeta - + + + + + + + + +VIPAKAMadhura - - - + + - + + + -DOSHAGHNATATridoshahara + - - + - - - + - -Vatahara - + - - + + - - - -Kaphavata hara - - - - - - + - - -Vatapittahara - - - - - - - + - - 25
  40. 40. Table 2.4: KARMA (ACTION) ACCORDING TO DIFFERENT AUTHORSKarma Cha80 D.N81 M.N82 R.N83 K. N84 BP. M. Mau. BDA88 IMM89 API90 N85 D86 N87Brimhana - + - + - - - + - - +Vrishya - + - - + - + + + + +Deepana - + - - + + - - - + -Pustikruta - - - - + + - + + + -Balakruta - - + + + + + + - + -Rasayana - - - + - - - - - -Mootrala - - - - - - - - + + -Anulomana - - - - - - - + - -Vajikara - - - - - - - - - - -Shothahara + - - - - - - - - - -Basti Shodhana - + - - + - + - - +Krimighna + - - - - - - - - - -Asmarihara - - - - - - - - - +Rujahara - - - - + - - - - - - 26
  41. 41. Table 2.5: PRAYOGA (USES) ACCORDING TO DIFFERENT AUTHORSPRAYOGA D.N91 M.N92 R.N93 K.N94 BP.N95 Mau.N96 BDA97 IMM98 YTA99 API100Shoola + - - - - - - - + +Hridroga + + - + + + + + - +Prameha + + + + + + + + + +Swasa - + - + + + - + + +Kasa - + - + + + - + + +Mutrakrichra + + + + + + + + + +Ashmari - - + - + + + + + +Arsha - - - - + + - + + +Shotha - - - - - - - - - -Vibanda - - - - - - - - - -Vataroga - - - - - - - - + - Table 2.6: PRAYOJYANGA ACCORDING TO DIFFERENT AUTHORS PRAYOJYA V.N101 B.D.A102 Y.T.A103 N.A104 P.V.S105 V.M.G106 D.G.H107 I.M.M108 ANGA Panchanga + + - + - + + + Phala + - + + + + + + Moola + - + + + + + + Beeja - + - - - - - - 27
  42. 42. Table 2.7: USE OF GOKSHURA IN DIFFERENT YOGA’SSL YOGAS INDICATION REFERENCENo 1. Amrutadya Taila Vatavyadhi Cha.chi 28/158-163 2. Swadamstra Taila All types of Vatajanya roga Cha.chi 28/146-147 3. Swadamstradi gritha Ashmari Cha chi 26/74 4. Gokshuradi yoga Ashmari patana Cha chi 26/62 5. Pashanabhedadi churna Ashmari bhedana and patana Cha chi 26/60-61 6. Shatavaryadi kwatha Pittaja Mutrakrucchra Cha chi 26-50 7. Dashamooladhya gritha Agnideepana, Pachana, Vataghna Cha chi 15/82 8. Agastya Haritaki All types of Kasa, Kshaya,Swasa Cha chi 18/58-62 9. Punarnavadi yoga Ashmari Cha chi 26/63 10. Gokshuradi kwatha Mutrakrucchra,Ushnavata Sha.S.M.Kha 2/107 11. Gokshuradi guggulu Mutrakracchra, Prameha Sha.S.M.kha7/84-87 12. Kamadeva gritha Raktapitta, Mutrakrcchra Sha.S.M.kha9/27-37 13. Dashamoolarista Grahani,Swasa,Kasa,Aruchi Sha.S.M.kha10/79-84 14. Dashamooladi kwatha Parshwa shoola, Shirashoola C.D. 10/10 15. Bhargiguda Swasa,Kasa C.D. 12/25-30 16. Kantakari gritha Swarabheda, All types of kasa C.D. 13/12 17. Bhrangarajadhya grithum Swarabheda, kasa C.D 13/14 18. Chavan prash Kasa, Swasa,Kshataksheena C.D.10/47-54 19. Amrutadi choornam Amavata C.D.25/14 20. Alambushadhya Choorna Amavata, Sandhi shotha C.D. 25/19-22 21. Yogaraja guggulu Amavata, Urustamba C.D. 25/25-30 22. Swadamstra gritha Hrudroga,Shoola, Mutrakrucchra C.D.31/27-30 23. Haritakyadi kwatha Daha, Mutrakrucchra C.D. 32/7 24. Trikantakadi kwatha Ashmari, Mutrakrucchra C.D.32/22 28
  43. 43. SL. NO YOGAS INDICATION REFERENCE 25. Trikantakadya grutha Mutrakrucchra,Ashmari C.D.32/28 26. Sukumarakumarakam Mutrakrucchra, Katishoola, C.D.32/28 grutha Yonishoola 27. Varunadi kwatha Vatajanya ashmari C.D. 34/1 28. Shuntyadi kwatha Ashmari, Mutrakrucchra C.D.34/5-7 29. Pashanabhedadhya gritha Vatajanya ashmari C.D.34/8-10 30. Nagaradi kashay Ashmari C.D.34/28 31. Swadamstradi kashay Ashmari C.D.34/30 32. Swadamstradi panakam Ashmari C.D.34/31 33. Trikantakabeeja choorna Ashmari C.D.34/34 34. Dashamoola kwatha Swasa,Sannipata jwara Y.R.Jwara chikitsa slk 10 35. Dashamooladya Sannipata jwara, Kasa Y.R.Jwara chikitsa Astadashanga kwatha slk 11 36. Shuntyadi Kwatha Amavata , Katishoola Y R Amavata Chikitsa slk 1 37. Ashta dashanga kwatha All types of Jwara Y R Sannipata Jwara Chikitsa slk 3 38. Dashamooladi Kwatha Hrudroga Y R Hrudroga Chikitsa slk 1 39. Gokshuradi Kwatha Mootrakrucchra Y R Mutrakrucchra Chikitsa slk 1 40. Trikantakadi Guggulu Mootrakrucchra, Mootraghata Y R Mutrakrucchra Chikitsa slk 12 41. Dashamoola Kwatha Parshwa Shoola , Jwara B.R. 15/13 42. Agastya Haritaki Rasayana, Vali, Phalita B.R. 15/173-178 43. Trayo Dashanga Guggulu Katigraha , Grudrasi B.R. 26/99-101 44. Mahamasha Taila Pakshaghata, Hanustamba B.R. 26/578-584 45. Maha Vishagarbha Taila Al types of Vatavikaras B.R. 27/140-147 46. Trikantakadi Guggulu Mootrakrucchra, Ashmari B.R. 34/22 47. Datryadi Kwatha Mootrakrucchra B.R. 34/23 48. Haritakyadi Kwatha Mootrakrucchra, Vibanda B.R. 34/27 29
  44. 44. SL YOGAS INDICATION REFERENCENo 49. Gokshura Kwatha Mootraghata B.R. 35/4 50. Dashamooli Kwatha Jwara B.P.M 1/413 51. Amrutadya Choorna Amavata B.P.M 26/62 52. Alambushadi Choorna Amavata, Vatarakta B.P.M 26/63-65 53. Gokshuradi choorna Gutika Prameha ,Shotha B.P.M 138/82-87 54. Gokshuradyavaleha Mootradaha, Malabanda B.P.M 38/105-107 55. Truna Panchamooladya Ashmari B.P.M 37/55-57 Grutha 30
  45. 45. MODERN REVIEW OF THE DRUG GOKSHURABOTANICAL NAME: TRIBULUS TERRESTRIS (Linn)Meaning of Tribulus terrestris109 Tribulus = having three sides Terrestris = of the groundVERNACULAR NAMES110 v Latin - Tribulus terrestris v Hindi - chotagokhru v English - Caltrops, small caltrops v Kannada - Neggila mullu v Gujarat - Betagokhru v Marathi - Ghokaru v Tamil - Neringi nerinjal v Telagu - Chirupalleru, palleru mullu v Malayalam - Neringil Nerinnil v Urdu - Gokharu v Arab - Khara khusk v Punjab - Kurkundai v Burma - charatte v Bengal - Gokhuri 31
  46. 46. TAXONOMICAL CLASSIFICATION OF GOKSHURA111 Ø Kingdom – Plantae Ø Division – Spermatophyta Ø Class – Dicotyledonae Ø Subsclass – Polypetalae Ø Series – Disciflorae Ø Order – Geraniales Ø Family – Zygophyllaceae Ø Genus – Tribulus Ø Species – Terrestris 32
  47. 47. FAMILY CHARACTERS – ZYGOPHYLLACEAE112Shrubs or herbs woody at the base, rarely trees. Branches often jointed at the nodes.Leaves – opposite or alternate, 2-foliolate or pinnate, rarely 3 – foliolate, not gland dotted.Stipules – paired, persistent, often spinescent.Flowers – rarely blue, hermaphrodite, actinomorphic or Zygomorphic.Sepals – 5, rarely 4, free or rarely connate at the base, imbricate, rarely valvate.Petals – 4-5, rarely absent, hypogynous, free, imbricate or conorted, rarely valvate.Disk – mostly present.Stamens – the same number as to triple the number of the petals, often unequal in length.Filaments – free, often with a scale inside.Anthers – 2 celled, opening lengthwise.Ovary – superior, sessile or rarely stipitate, usually 4-5 celled, cells rarely transversely locellate,Style – simple, short or stigmas sessileOvules – 2 or more in each cell, axile.Fruit – various but never baccate.Seeds – mostly with some endosperm, embryo as long as the seed, straight or slightly curved. 33
  48. 48. GENUS CHARACTERS - TRIBULUS113Branching prostrate herbs, often with silky hairs.Leaves – Stipulate, opposite (or sometimes alternate by suppression) usually one of the pair smaller than the other, abruptly pinnate.Flowers – Solitary pseudoaxillary, white or yellow.Sepals – 5, imbricate.Petals – 5,spreading, imbricate, fugacious, disk annular, 10-lobed.Stamens – 10 (rarely 5), inserted on the base of the disk, the longer opposite to the petals, the 5 shorter with a small gland outside.Filaments – Filiform, naked.Ovary – Sessile, hirsute, 5-12 lobed, 5-12 celled.Ovules – 1-5 in each cell, superposed.Style – Short, pyramidal or filiform.Stigmas – 5-12Fruit – 5 angled. of 5-12 winged or spinous or tuberculate indehiscent cocci.Seeds – Obliquely pendulous, testa membranous, embryo exalbuminous; cotyledons oval radicle short. 34
  49. 49. MORPHOLOGY114A procumbent herb : Stems and branches pilose. Young parts silky villous.Leaves – Opposite, abruptly pinnate, one of each pair usually smaller than the other, sometimes wanting.Stipules – Lanceolate, hairy.Leaflets – 3-6 pairs. 6-12 mm in long , oblong mucronate, sericeo villous with appressed hairs beneath and more or less so on the upper surface, base rounded obliquePetioles – Very short, pilose.Flowers – Axillary or leaf-opposed, solitaryPedicels – 1.2-2 cm long slender, hairySepals – 6 mm long lanceolate, acute, hairy.Petals – 1 cm long, oblong, obovate, claw short, hairy.Ovary – Bristly.Style – Short, Stout. Stigmatic lobes longer than the diameter of the style.Fruit – Globose, consisting of (usually) 5 hairy or nearly glabrous, often muriculate, woody cocci each with 2 pairs of hard sharp spines one pair longer than the other.Seeds – Several in each coccus with transverse partition between them.HABITAT115- This trailing plant is common in sandy soil throughout India and Ceylon.Plentiful in the united provinces and in Madras. 35
  50. 50. PHARMACOGNOSTICAL FEATURES OF TRIBULUS TERRESTRIS116MACROSCOPICFruit - Fruit is globose 0.5 inch in diameter and 1/3 inch in thickness. Fruit consists offive densely hairy. Woody. Often-muricate coccii. Each coccus bears two large sharp,pointed rigid spines directed towards the apex and two smaller. Shorter spines directeddownwards. Colour is yellowish brown. Seeds several in each coccus with transversepartition between them.MICROSCOPICFruit - The transvers section of the fruit exhibits five coccii, which are free in the upperpart but united below. In the transverse section five pairs of large spines are seendistinctly. In coccii epicarp consists of one layer of epidermis with unicellular lignifiedtrichomes. Mesocarp is parenchymatous and contains vascular bundles. Rosette crystals ofcalcium oxalate are in abundance in mesocarp. Endocarp is lignified and contains fiveseeds one in each coccus.PHYTOCHEMISTRY The fruits contain furastanol is glycoside which is identical with protodioscin and onacid hydrolysis it yields spirostanol diosgenin. Further fruits contain sapogeninsdiosgenin, rus cogenin and gitogenin of the steroid saponins. Fruits contain three flavoneglycosides. Two glycosides are kampferol 3- rhamnosides and third tribuloside iskampferol 6”, p-coumaroyal 3. D-glucoside. It contains traces of an alkaloid, fixed oiland potassiumnitrate. 36
  51. 51. IDENTITY PURITY AND STRENGTH117 v Foreign matter – not more than 2 percent v Total ash – not more than 15 percent v Acid-insoluble ash – not more than 2 percent v Alcohol soluble extractive – not less than 6 percent v Water-soluble extractive – not less than 10 percent. USES OF PLANT IN OTHER SYSTEMS AND COUNTRIESACTION AND USES IN SIDDHA118 Madhura rasam, seetha veeryam, mootralam, vrishyam, deepanam, balakaram,pushtikaram, in ashmari, prameham, arshas, mootrakrichram, swasakasam, hridrogam.ACTION AND USES IN UNANI119,120 Murakabul khuva, diuretic, aphrodisiac, increases, semen, removes stones causesnuzi in madda, in colic due to heat. The fruit is sour with bad taste, diuretic removes gravel from the urine and stonein the bladder. Cures strangury, gleet. The leaves are diuretic, tonic, enrich the blood,and increase the menstrual flow. Cure gonorrhoea and gleet, a decoction is useful as agargle for mouth troubles and painful gums reduce inflammation. The root is goodstomachic and appetizer, emmenagogue, diuretic, carminative, cures lumbago. In South of France and in the southern countries of Europe the roots and theleaves are considered tonic and aperient. In China the fruit is reputed tonic and astringent. It is used for coughs,spermatorrhoea, scabies, anemia.opthalmia; it is powerful haemostatic, much used in postpartum haemorrhage and in dysenteries; It is a Suto Rheumatism remedy in South Africa. 37
  52. 52. RESEARCH PROFILE1:Furostanol saponins from Tribulus terrestris. An HPLC-ELSD-ESI-MS method has been developed for the analysis of thesteroidal saponins in the aerial parts of Tribulus terrestris. Protodioscin, a new saponin(5,6-dihydroprotodioscin, neoprotodioscin) and their respective sulfates weredetected. The structure of the new compound was elucidated on the basis of NMRand ESI-MS spectral analysis.2:Preliminary studies on the diuretic effects of Hygrophila spinosa and Tribulusterrestris.3:Some aspects of chemical and pharmacological studies of Tribulus terrestris.Linn.4:Tribulus terrestris: preliminary study of its diuretic and contractile effectsand comparison with Zea mays.5: Effect of Tribulus terrestris on oxalate metabolism in rats.6:New steroidal glycosides from the fruits of Tribulus terrestris.7: Study of antihypertensive mechanism of Tribulus terrestris in 2K1C hypertensiverats: role of tissue ACE activity.8: Aphrodisiac properties of Tribulus Terrestris extract (Protodioscin) in normaland castrated rats.9: Tribulosin and beta-sitosterol-D-glucoside, the anthelmintic principles ofTribulus terrestris.10: Effect of saponin from Tribulus terrestris on hyperlipidemiaReferences: WWW.PUBMED.COM. PMID: [PubMed - indexed for MEDLINE] 38
  53. 53. B) DISEASE REVIEWHISTORICAL ASPECTS OF AMAVATA There is no convincing reference to this disease in vedic literatures scatterednominal mention is found in classical period elaborate description in the medieval periodand above all in depth study of the problem based on the revolutionary changes in theunderstanding of disease process brought about by the leap in to electronic era of twentyfirst century. The elaborate description of in this disease as a separate entity is not available inCharaka Samhita. However the term Amavata is included in some of the therapeuticindications of drug compounds “Kamsa haritaki” of swayathu chikitsa and “visaladiphanta” of pandu chikitsa. Further in the 28th chapter while illustrating the Avaranachikitsa, Amavata word is used to connote Avarana of vata by Ama and also as asymptom. Even though no reference of Amavata is found in susruta. The classification andelaborate description about the anatomy of the joints gives way for better understandingof the joint diseases in general. Similarly, Vaghbata also gives no details about this disease entity but whilementioning the indication of “vatsakadi yoga” and “vyoshadi yoga” is vata vyadhichikitsa has included Amavata also. Madhavakar who gave this disease entity a separate status and devoted a fullchapter. There after, Chakradatta added treatment aspects at length and mentioned theline of treatment and effective drug remedies. Like wise, Bhava prakasha, yoga Ratnakara, Bhaisajya Ratnavali and Vangasenaalso mentioned some drug compounds for the treatment of Amavata. 39
  54. 54. AMAVATA The nomenclature of the diseases can be done in many ways. Somenomenclatures are based on the subjective and objective symptoms. Others are based oninvolved dushya and its causative factors. The disease Amavata signifies the underlyingpathological condition in its nomenclature. It is formed by union of two words Ama andvata.Definition of Amavata 1. The word Amavata comprised with the words Ama and vata, which can be generally defined as “Amam cha vatam Amavatam”. In the same way another description generally can be made as “Amena Samhito vataha Amavatah” that is the vata dosha associated with Ama creating a disease known as Amavata. 2. Madhavakara defines as highly vitiated Ama and vata mixed together with other dosha’s enters the trika sandhi leading to the disease Amavata. 121AMA IN AMAVATA The production of Ama is a central phenomenon in Amavata. In Ayurveda, verymuch importance is given to the concept of Ama, as the disease itself is also known asAmaya that is caused by Ama. The presence or absence of Ama that is Samavastha orNiramavastha decides the line of treatment of the disease.Etymology of Ama : • Ama means the undigested or unprocessed matter. 122 • Ama means that is detrimental to groups of srotas. 123 40
  55. 55. Definition of Ama : The term in ordinary parlance means unripe, uncooked immature and undigestedparticles. In the context of Ayurveda this term refers to the events that follows andfactors, which arrives as the consequence of impaired functioning of Agni. It is necessaryto analyze different definitions of Ama given in different texts. Some of which are asfollows. 1) Due to the hypo functioning of Ushma the food that is not completely/properly digested, yields immature Rasa in Amashaya and due to retention it undergo fermentation and or putrefaction. This state of Rasa is spoken of as Ama. 124 2) The Adya ahara dhatu is known as Ama, which is undigested and formed due to hypo functioning of Agni, in Amashaya. 125 3) The matter that has not undergone Vipaka, leads to Durgandha (bad smell), which is large in quantity, which is picchila (sticky) and which leads to Gatra sadana is called as Ama. 126 4) The food residue that is not digested due to impairment of Agni is known as Ama and it is considered as the root caused of all the diseases. 127 Even though both Charaka and Susruta have described the diseases associated with Ama, Vagbhata was the earliest author to define Ama. Three words from the definition of Ama as given by Vagbhata require further explanations. 1. Ushma 2. Adya dhatu 3. Amashaya Ushma : There are different opinions about Ushma. According to Arunadutta ushma is Agni. Hemadri consider it as Rasagni. Only sreedasapanditha explained Ushma as Jatharagni. Here dalhana’s statement that Ama is also produced due to hypofunctioning of the Dhatwagni should also be considered. Therefore Ushma 41
  56. 56. indicate either Jatharagni or Dhatwagni in respect of the genesis of Ama, dependingon the pathological process exhibited.Adya Dhatu : The fuel of Agni in the development or genesis of Ama is stated asAdya dhatu. Arundatta consider it as Rasa Dhatu and Hemadri consider it as Rasawhich is not capable of executing its functions and also not capable of transforming into Rakta. Chandranandana and Sreedasapanditha consider it as Ahara Rasa. Theidentity of Adhya Dhatu depends on the Agni. i.e Agni not only feeble but also notcapable of conducting its normal functions. Therefore the Adhya Dhatu may be AharaRasa, Rasa Dhatu or any other Dhatu.Amashaya : The word Amashaya has two meanings. Hemadri define Amashaya as areceptacle of undigested or incompletely digested food. It is also the place whereAma is produced. Amashya is one of the two places of pithadhara Kala. The Samanavata secretes pachaka pitta from pithadhara kala for the purpose of digestion of fooddue to the stimulation.Etiology of Ama :Following can be considered as chief causative factors of Ama128, 129, 1301. Ahara : Abhojana (not taking meals), Atibhojana (taking meals in excess quantity), Ajirnabhojana (eating prior to digestion of previous meals) Vishamasana (taking sometimes in excess and sometimes in less quantity of food) Asatmya bhojana, viruddha bhojana, Dvishta - Asuchi bhojana, Guru, Ruksha, Sheeta, Sushka, Vishtambhi and Vidahi bhojana.2. Iatroghenic Causes : Erroneous administration of Virechana, Vamana sneha Karma.3. Vihara : Vegavidharana, Prajagarana, Dukkha Sayya. 42
  57. 57. 4. Manasika : Food consumption while afflicated with mental instability due to Kama, Krodha, Lobha, Moha, Irshya, Shoka, Manodvega, Bhaya etc. 5. Miscellaneous: Adverse Desha, Kala, Rutu (Vaishmya) and Vyadhikarsana (emaciation due to disease). Ama visha : 131 The Ama dosha formed by unwholesome food habits like Viruddhasana, Adhyasana,Ajimasana etc. are known as Ama visha. It is very difficult to treat due to its Asukriyaand opposite natures of treatment of Ama and visha.Physical properties of Ama132 In physical properties Ama closely aligned to kapha dosha. Drava, Guru, Snigdha,Picchila, Thantumat, Anekavarna, Durgandha, Avipakwa, and Asamyukta are thephysical properties of Ama. These may be applied to the Ama developed both in gastrointestinal tract and Dhatus. According to Charaka, Ama has visha sadrusa linga, but thereis no similarity in Guna. Still Ama act like poison. It may also be noticed that thephysiochemical properties of ama resemble those of prithvi and Ap bhutas. Ama has atendency for accumulation and blockage of micro channels that is srotorodha.Symptoms produced due to Ama133 • Srotorodha (Obstruction in Channels) • Balabramsa (Lowering of immunity or debility) • Gaurava (feeling of heaviness) • Anila mudhata (Hindrance to normal path of Vata) • Alasya (Unwillingness to perform of duties in spite of capability) • Apakti (indigestion) • Nisthivana (Accumulation of excessive saliva in mouth) 43
  58. 58. • Mala sangha (constipation) • Aruchi (Anorexia) • Klama (Anayasa shrama) Most of the symptoms are produced either by the hypo functioning of Agni or due tothe obstruction of the srotas by Ama. When Ama is in contact with Dosha and Dushyathey are called as Sama dosha and Sama dushya respectively.VATA IN AMAVATA Vata plays an important role in the Samprapti of Amavata so its brief description isnecessary.Etiology : The tem vata is derived from root “Va” and pratyaya (suffix) “Tan” “Va”signifies Gati and Gandhana Karma of Vayu.Guna : Ruksha, Sheeta, Laghu, Sukshma, Chala, Vishada, Dharuna and khara are theGunas of Vata. 134, 135Functions of normal Vata (Karma). Acharya Charaka has given elaborated explaination about functions of Vata,whichstates that vata is responsible for each and every function and movement for all the bodyparts. That is “vayu stantra yantra dharaha” (Cha. Su. 12)Importance of Vata: Pitta, Kapha, Dhatu and Mala’s are functionless, unless they are brought to the placeby Vata and carry out their functions. Thus Vata governs functions of the all the tissuesof the body. 136 A person whose Vata Dosha is not impended, which is at its own place, not vitiatednor reduced, that person lives for hundred years without aliment. 44
  59. 59. Vata on account of its quality of subtleness is really the impeller of the other twohumors. When Vata is provoked, it agitates the other two humors and causes occlusion ofthe body channels thereby producing disorders. it also leads to the diminution of the bodynutrient fluid and other body elements The vata plays a predominant part in samprapti of Amavata. By virtue of vitiatedVata deleterious effects of virulent Ama get manifested in the body.Nidana for Amavata : 137Madhavakara has mentioned the specific etiological factors for Amavata. 1. Viruddha Ahara (incompatible food) 2. Viruddha cheshta (Incompatible work) 3. Mandagni (Hypo functioning of agni) 4. Nischala (Lack of exercise) 5. Snigdha Ahara followed by immediate exercise1. Virudha Ahara (Incompatible food) Acharya charaka clearly mentions that wholesome diet is an essential factor forthe formations of body and any unwholesome diet is responsible for disease. Wholesomediet is required to meet the needs of body’s basal metabolism in the form of energy.Viruddha Ahara (Incompatible food) produces dosha utklesa instead of meeting the basicneeds. Utklishta dosha is abnormal functional states. It they are not eliminated from bodythe functions of Agni and Dhatus will be affected. Afflication of Agni may seriously affects their normal functions. When theprocesses of digestion and metabolism are affected, improperly metabolized intermediatebye products (Ama) are produced in body. The Ama in turn may causeDhatwagnimandya. 45
  60. 60. Viruddha is Dhatu pratyanika that is Dhatu virodhaka (Antagonistic to Dhatus ).Leads to dhatukshaya due to inadequate nourishment of dhatu.2. Viruddha Chesta : (Incompatible work) Viruddha chesta is not clerly mentioned in texts, still considering the main themeof Dosha utklesa due to viruddha, following may be considered as Viruddha chesta. 1. Sheetoshna vyathyasa (Altemate use of heat and cold) 2. Vegavidharana (Suppression of natural urges) 3. Diva swapna (Sleeping day time) 4. Ratri jagarana (Waking at night) 5. Sahasa etc (Over indulgence in heavy works)3. Mandagni (Hypo functioning of Agni) Mandagni is the root cause of all diseases. Mandagni i.e diminished digestion andmetabolism always affect pachana or digestion and metabolism. Which are the continousprocesses in the body. Ama is the immediate resultant of Mandagni.4. Nischala (Lack of exercise) Lack of exercise leads to Kapha dosha vrudhi, leading to Agnimandya.5. Snigdha Ahara followed by immediate exercise: Tridosha are not constant but kept on fluctuating according to age, day, night andafter ingestion of food. Chakrapani interprets that the three basic elements increaseduring Avastha paka and are producded during Nishta paka. Due to snigdha Ahara, Kapha Udeerana takes palce in large quantity during PrathamaAvastha paka. Exercise is held responsible for throwing the Dosha from Koshta toShakha. Immediate exercise after taking food leads to improper digestion and thusApakwa Ahara Rasa is formed. 46
  61. 61. Samprapti of Amavata. 138 In a state of pre-existing Mandagni if a person in exposed to etiological factorsthen Ama is formed in Amashya along with vitiation of Vata Dosha. This morbid Amacirculates in the body propelled by vitiated Vata with the predilection for sleshma sthana.Here, by the action of Vata dosha,Ama becomes more virulent and reaches Dhamani.Inthe Dhamani’s it blends with Vata, Pitta, Kapha and consequently attains various colours,becomes heavy and viscous. These qualities facilitates srotoabhishyanda andsrotoavarodha. These change in the srotas, endures sthanasamshraya, leading to the themanifestation of symptoms like Hritgourava, Hritdourbalya and Sandhishotha, Shula etc.If kapha and pitta are also involved with above symptoms, specific symptoms of theseDosha will also manifest. The disease takes its root in Annavaha srotas with the production of Ama thestrength of all the Agni in the body is declined with result of production of Ama.Rasavaha srotas are the nearest and opened. Hence, these are mainly afflicted. ThoughAma circulates in the whole body, the chief presentation of the disease is in the Kaphasthanas, due to similarity of Guna of Ama and Kapha. Trika is the main sthana of thecontroller Avalambaka Kapha. Also due to specific Nidana sevana and picchilatwa ofSleshmaka kapha in Sandhis it is the main site of Pathogenesis. Other parts of locomotorsystem like muscles, tendons, ligaments are also affected and Gatra graha or Gatrasthabdhata appears. 47
  62. 62. SAMPRAPTI Viruddha Ahara + Viruddha Vihara Agnidushti in amashaya Formation of Amarasa Sanchara through Dhamani all over the body by vatadosha Samadosha Accumalates in the sleshmasthana likeAmashaya, sandhi (Trika), Ura, Shira, Kanta gets contact with other dosha’s Enters into kostha, Trika sandhi Leads or causes Stabdhata of sandhi Sandhi ruja Sandhi shotha Apaka, Gourava, Alasya, Angamarda, Trishna, Aruchi, Jwara AMAVATA 48
  63. 63. Efficacy of Shunti & Gokshura in AmavataTable 3.1: SAMPRAPTI GHATAKA :1 Dosha Tridoshaja, mainly Vata (Vyana, Samana, Apana) and Kapha (Kledaka, Bodhaka, Shleshmaka)2 Dhatu Rasa, Mamsa, Asthi, Majja3 Upadhatu Snayu, Kandara4 Srotas Annavaha, Rasavaha, Asthivaha, Majjavaha5 Srotodusti Sanga, Vimargagamana6 Udhbhavasthana Amashaya-Production of Ama Pakvasaya - Mula sthana of Vata7 Adhisthana Whole body8 Vyaktasthana Sandhi (whole body)9 Avayava Sandhi10 Vyadhisvabhava Mainly chirakari11 Sanchara sthana Hridaya, Dhamani, Rasayani12 Roga marga Madhyama roga marga13 Agni Jatharagni mandya, Dhatwagni mandya 49

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