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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,......

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. 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. 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. 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. 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. © 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. • 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. 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. 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. 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. 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. 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
  • 64. Efficacy of Shunti & Gokshura in AmavataRUPA OF AMAVATA : Madhavakara has described the Rupa of Amavata as Samanya and pravrudhalakshana.Samanya Rupa : 139 1. Angamarda (Aching all over the body) 2. Aruchi (Loss of taste) 3. Trishna (Thirst) 4. Alasya (lack of enthusiasm) 5. Gourava (Heaviness) 6. Jwara (Fever) 7. Apaka (Indigestion) 8. Angasunata (Swelling of body parts) 50
  • 65. Efficacy of Shunti & Gokshura in AmavataPRAVRIDHA RUPA : 140 1. Sandhi Ruja and Sandhi shotha of Hasta-Pada-Sira-Gulpha-Trika-Janu and Uru (Pain and Inflammatory swelling in the joints) 2. Vruschika damsavata peeda (Pain like scorpion sting) 3. Agni Daurbalya (Weakness of Agni) 4. Praseka (Salivation) 5. Aruchi (Loss of taste) 6. Gourava (Heaviness) 7. Utsahahani 8. Vairasya (anorexia) 9. Daha (Burning sensation) 10. Bahu mutrata (Profuse urination) 11. Kukshi kathinyata 12. kukshi shoola (Pain in Abdomen) 13. Nidra Viparyaya (Loss of sleep) 14. Thrit (Thirst) 15. Chardi (Vomiting) 16. Bhrama (Giddiness) 17. Murcha (Fainting) 18. Hrit graha (Pain in the Heart) 19. Vit Vibandha (Constipation) 20. Jadhyata 21. Antra Kujana (Intestinal gurgling) 22. Anaha (Distention) 51
  • 66. Efficacy of Shunti & Gokshura in AmavataTable 3.2: Comparison of Lakshanas with different Ayurvedic treatises: Sl No. Lakshana M.N. 141 B.P. 142 Y.R. 143 1. Agni dourbalya + + + 2. Alasya + + + 3. Anaha + + + 4. Angamarda + + + 5. Angasoonata + + + 6. Antra kujana + + + 7. Apaka + + + 8. Aruchi + + + 9. Bahu mutrata + + + 10. Bhrama + + + 11. Chardi + + + 12. Daha + + + 13. Gourava + + + 14. Hrit graha + + + 15. Jadhyata + + + 16. Jwara + + + 17. Kukshi Kathinyata + + + 18. Murcha + + + 19. Nidra viparyaya + + + 20. Prasekam + + + 21. Sandhi Gourava + - - 22. Sandhi Ruja + + + 23. Sandhi shotha + + + 24. Trishna + + + 25. Utsaha Hani + + + 26. Vairasyam + + + 27. Vit vibandha + + + 28. Vruschika damsavat peeda + - - 52
  • 67. Efficacy of Shunti & Gokshura in AmavataTable 3.3: Involvement of Srotas according to the symptoms Sl Srotas SymptomsNo.1 Annavaha Aruchi, Apaka, Agni Daurbalya, Chardi, Vishuchi, Praseka2 Udakavaha Trishna3 Rasavaha Angamarda, Aruchi, Gaurava, Jwara, Agni daurbalya, praseka, Utsahahani, Vairasya, Hritgraha, Angasunata4 Medovaha Alasya, Trishna,5 Majjavaha Sandhi Shoola, Sandhi shotha, Bhrama, Murcha, Jadya,6 Purishavaha Kukshi Kathinyata, Vit vibandha, Antra Kujana, Anaha7 Mutravaha Bahumutrata8 Manovaha Utsahahani, Nidra viparyaya CLASSIFICATION OF AMAVATA144According to Dosha ; Seven types of Amavata mentioned in Madhava Nidana. 1. Vata pradhana : This variety is associated with predominance of shoola; which is innovating feature of vitiated vata. In Amavata, Shoola is present due to Chala and Sheeta Guna of Vata. 2. Pitta pradhana : Daha and Raga of the joint are manifested in this type of Amavata. Due to Ushna and Tikshna Guna of vitiated pitta, Daha occurs in the joint. The increased circulation may be responsible for appearance of Raga. 3. Kapha Pradhana : Staimitya, Gourava and Kandu are the manifestation of this variety. Staimitya is the feeling of a wet cloth around the joint. It occurs due to increased Picchila, Sthira and sheeta Guna of vitiated kapha. Kandu is pathogenic 53
  • 68. Efficacy of Shunti & Gokshura in Amavata feature of vitiated Kapha.Due to similarity of guna of vitiated Kapha and Ama and sroto Abhishyanda, itching sensation is felt at the joint. 4. Vata Pitta pradhana : Associated symptoms of Vata and Pitta arte produced. 5. Vata Kapha Pradhana : symptoms of both Vata and Kapha are produced. 6. Pitta kapha pradhana : This variety is found with mixed symptoms of pitta and kapha. 7. Sannipatika : Symptoms of all the three Doshas are found in this variety. On the basis of the severity of the disease Amavata can be classified SamanyaAmavata and pravridha Amavata stage. In samanya stage symptoms are more or lessgeneral and less severe and in Pravridha stage symptoms are prominent and associatedwith Upadravas. UPADRAVA OF AMAVATA145 Madhava Nidana mentioned Upadrava as Jadya, Antra Kujana, Anaha, Trit,Chardi, Bahumutrata, Shoola Samkocha, and Khanjata etc. SADHYASADHYATA146 ü If it is affected by a single dosha (Eka doshaja) Sadhya. ü If it is affected by with two dosha’s (Dwi doshaja) Yapya. ü It is difficult to manage (Asadhya) the disease where in all three dosha’s (Sannipatika) and all the parts of the body is affected with the swelling. 54
  • 69. Efficacy of Shunti & Gokshura in AmavataSAMANYA CHIKITSA : 147 Chakradatta was the first to describe the principles and management of Amavatafollowing these guidelines the later authors advocated further effective remedies. Ama and Vata, the chief pathogenic factors of Amavata are contradictory innature. Only sheeta guna is common in both. The line of treatment and principlesproposed appear firstly to digest the virulent Ama and promote the function of Agni andthen Vata Samaka and Balya Chikitsa are prescribed.(1) Langhana : The drug of procedure that generates a sense of lightness (Laghavakara ) in thebody is known as Langhana. 148 Charaka has mentioned ten types of Langhana viz, fourtypes of Suddhi, Pipasa,Atapa, Pachana, Upavasa and Vyayama. Where as Vagbhata hasrecasted langhana in to broad headings of Shodhana and Shamana which are furtherdivided in to five and seven types respectively. In the treatment of Amavata, Upavasafrom Langhana is preferred in the initial stage that is a kind of Samana chikitsa.(2) Swedana : The procedure which alleviates Stambha, Gaurava, Shoola and Sheeta and which 149is Sweda kara is Swedana. It is having Ushna, Tikshna, Sara, Snigdha, Ruksha,Sukshma, Drava, Sthira and guru properties. The swedana brings about pachana, clearsand dilates the channels. Ruksha sweda that is given by means of sand is considered bestfor Amavatav, taking of hot water (Ushna jala pana) is also a kind of internal Swedana,Pachana, Jwaraghna, Srotoshodhana, Balya, Ruchi kara and swedana. 55
  • 70. Efficacy of Shunti & Gokshura in Amavata(3) Tikta Katu Rasa : Tikta and Katu Rasa have the dominance of Vayu Akasha Mahabhuta and VayuTejas respectively. They bring about dipana, Pachana, Rochana and Laghuta in the body.Katu Rasa is Baddha, Chedaka and Margavivaraka and Kapha samaka. Tikta Rasa isVishaghna and Lekhana. Both are kleda and meda Nasaka e.g. Chitraka, Guduchi, Shuntietc. these drugs are Agnivardhaka and Antagonist to Ama and Kapha.(4) Virechana: After langhana and Pachanadi chikitsa, when Dosha are processed and loosened(Nirama) Virechana should be administerd to eliminate them out of the body. Because theDosha may again vitiate after langhana and pachana treatment but once Shodhanaeliminates them, the disease does not recur, as there remains no root cause to induce thedisease. Virechana is indicated in Amavata because of following reasons. Ø Production of Ama is result of involvement of Pitta Sthana and Kledaka Kapha both. Kledaka Kapha after leaving its normal site settles at Pitta Sthana, thus hampering the digestive activity of Pachaka Pitta. Virechana helps in this condition by two ways. Ø It removes the Kledaka kapha from the Pitta sthana. Ø It is the most suited therapy for the sthanika dosha pitta. Ø Symptoms of Amavata like Anaha, Vibandha, Antra kujana and Katishoola are indicative of Pratiloma Gati of Vayu, which is made Anulomana by Virechana.(5) Snehapana : The process that brings snehana, Vishyandana Mruduta and kleda in the body is 150called snehana. Sneha should be used according to the condition (Sama or nirama 56
  • 71. Efficacy of Shunti & Gokshura in Amavatavastha) and Bala of the patient. It is specially indicated in the chronic conditions due tofollowing reasons. Ø To prevent the provocation of Vata produced by Ama hara Chikitsa. Ø As a best Balya regimen for the patient who has got reduction of Bala. Ø Sneha is Agni Dipana. Ø Sneha is Vata hara and Vatanulomana. Ø In Asthimajjagata Vata, Snehapana is also indicated so, it may be beneficial in Nirama stage of Amavata.(6) Basti : Basti is the best treatment of vitiated Vata. As the disease attains chronicityRukshata increases in the body leading to vitiation of Vata. Niruha Basti in addition actsas a sothana measure. It is also locally effective for the symptoms like Anaha, Vibandhaetc. Anuvasana Basti is Vata hara and Rukshata hara. Due to intermittent remissions thedisease Amavata is neglected most of the time by patients. Thus, it attains chronicity andbecomes deep rooted (Gambhira). Basti due to its Veerya acts the whole body to alleviatethe disease. Chakrapani has recommended saindhavadi Taila for Anuvasana and KsharaBasti as Niruha Basti. It acts on the subtle leaves to remove Dosha from the body clearingthe channels and normalizing the body function. PATHYAPATHYA151, 152Pathya : § Annavarga - Yava, Kulattha, Raktasali, Syamaka, Kodru § Saka - Vastuka, Sigru, Karvavellaka, Patola § Dugdha Vikara - Ardraka/Lasuna siddha takra § Mamsa - Jangala Mamsa § Paniya - Tapta Nira 57
  • 72. Efficacy of Shunti & Gokshura in Amavata Bhallataka, Gokshura, Vruddha Daru, Ardraka, Gomutra and Katu, Tikta andDipana Dravya are beneficial for Amavata.Apathya : 153 Dadhi, Mastu, Guda, Kshira, Masha, Viruddha bhojana, Asatmya bhojana,Vishamasane, Anupa Mamsa, Abhisyandi, Guru, Picchila Dravya.Vihara - Vegavarodha, Jagarana. 58
  • 73. Efficacy of Shunti & Gokshura in Amavata RHEUMATIOID ARTHRITIS The understanding of Ayurveda cannot be superimposed with the understandingof modern medicine. But there is a trend to co-relate Ayurveda with modern medicine.Moreover in recent years people are deviated towards the evidence based Medicine forthe rational use of our indigenous medical knowledge’s. Amavata can be co-related with Rheumatoid diseases according to westernmedicine. This term Rhuma refers to ‘ A substance that flows’ and probably was derivedfrom kapha (phlegm) and ancient primary humours. The American committee for thecontrol of Rheumatism is established in USA for the guidance of these diseases. Thereare ten major rheumatic diseases can be included in the group of Rheumatoid disease.Most important diseases is systemic connective tissue disease among them. This diseasehamper the purposeful motion of a individuals which is depending on the effectiveinteraction between joint and neuromuscular units attached with it. The importantcomponents take part in musculoskeletal systems are muscles, tendons, ligaments,cartilages and bones.Definition of Rheumatoid Arthritis 154Rheumatoid arthritis is a chronic, systemic, inflammatory disorder of unknown etiologythat is characterised by its pattern of diarthoiridial joint involvement. Its primary site ofpathology is the synovium of the joints. The synovial tissues become inflamed andprolifeate, forming pannus, which invades bone, cartilage and ligament and leads todamage and deformities.Epidemiology- The prevalence of Rheumatoid Arthritis is approximately 0.8 percent ofthe population (range 0.3 to 2.1 %); women are affected approximately three times moreoften than men) the prevalence increases with age and sex differences diminish in theolder age group. Rheumatoid Arthritis is seen throughout the world and affects all races.However, the incidence and severity seem to be less in rural sub-saharan Africa and in 59
  • 74. Efficacy of Shunti & Gokshura in AmavataCaribbean blacks. The onset is most frequent during the fourth and fifth decades of life80 percent of all patients developing the disease between the ages of 35 and 50. Theincidence of Rheumatoid Arthritis is more than six times as great in 60 to 64 year oldwomen compared to 18 to 29 year old women. 155Etiology-The cause of Rheumatoid Arthritis remains unknown. It has been suggestedthat Rheumatoid Arthritis might be a manifestation of the response to an infectious agentin a genetically susceptible host. 156Pathology - The earliest change is swelling and congestion of the synoviol membraneand the underlying connective tissues, which become infiltrated with lymphocytes(especially CD4 T cells), Plasma cells and macrophages. Effusion of synovial fluid intothe joint space takes place during active phases of the disease. Hypertrophy of thesynovial membrane occurs, with the formation of lymphoid follicles resembling animmunologically active lymph node. Inflammatory granulation tissue (pannus) spreadsover and under the articular cartilage, which is progressively eroded and destroyed Latter,fibrous or bony ankylosis may occur. Muscles adjacent to inflamed joints atrophy andthere may be focal infiltration with lymphocytes. 157Pathogenesis – Immunologic reactions play a major role in the pathogenesis ofrheumatoidc arthritis. The inflammatory reaction in the joints is similar to that in delayedhypersensitivity reactions. It seems likely that the lymphokines and monokines formed bythe lymphocytes and macrophages in the inflamed joints initiate the inflammation and area major cause of the fibrosis and damage to cartilage. Interleukin 1 is believed to be ofparticular importance. Chemotactic factors attract the neutrophils in to the synovial fluid.The phagocytosis of immune complexes by the neutrophils in the joint fluid and thesynovial cells releases lysosomal enzymes and further damages the articular cartilagesand synovium. Activation of compliment adds to the injury. Collagenases formed in thepannus erode the underlying cartilage. Prostaglandins help cause inflammation and 60
  • 75. Efficacy of Shunti & Gokshura in Amavataosteoporosis. Circulating immune complexes formed with the rheumatoid factors areresponsible for the vasculitis and rheumatoid nodules. 158, 159PATHOGENESIS OF RHEUMATOID ARTHRITIS Localization of antigens in joints Antigen by microphages Activation of helper T cells Release of intraleukin –2 Cytokenes like IL-4, IL-6, IFN are released by Cd4 cells Cytokenes increases the expression molecules like ICMA-1, LFA-1, MAC-1 It helps in localization of inflammatory cells Cytokines stimulates, activates and proliferation of B cells produces antibody producing plasma cells. These cells produce antibodies against Fc fragment of lgG (RA) RA factor forms immuno complex with lgG Production of CA3, C5a C3b and C5, 6,7,8,9 Ca3 and C5a as anapphylotoxins Release of histamines C5,6,7,8,9 is capable of damage cells by drilling pores n their membrane. Inflitration of neutrophillsRelease of oxygen free radicals, inflammatory metabolites, archidomic acid pathwaylike prostaglndins leutrines metalo-proteins like collagenase. Damage of articular cartilage demineralization of underlying bond erosion of the joint margins laxicity of the joint capsule leading to deformity. 61
  • 76. Efficacy of Shunti & Gokshura in AmavataCLINICAL FEATURES160 In the majority of patients the onset is insidious, with joint pain, stiffness andsymmetrical swelling of a number of peripheral joints. Initially pain may be experiencedonly on movement of joints, but rest pain and prolonged early morning stiffness arecharacteristic features. In the typical case the small joints of fingers and toes are the first to be affected,swelling of the proximal, but not the distal, interpharangeal joints gives the fingers aspindled appearance, and swelling of the metatarsopharangeal joints results in broadeningof the forefoot. Fever, weight loss profound fatigue, anorexia and malaise without jointsymptoms occur less often. As the disease advances there is a tendency for it to spread to involve wrists,elbows, shoulders, knees, ankles, subtarsal and midtarsal joints. The advancement ofpathogenesis leads to muscle atrophy, tendon sheath and joint destruction results inlimitation of joint motion, joint instability with anterior subluxation of Metatarsophalangeal joints in common with ulnar deviation of the fingers in addition to thislymphadenopathy, osteoporosis muscle weakness and wasting, tenosynovitis, bursitis,popliteal cysts, sometimes subcutaneous nodules are formed. Apart from thisscleromalacia, keratoconjantivitis, scleritis is found to occur a symptomatic pericordities,pleural effusion may occur infrequently.COMPLICATIONS161 Septic arthritis may complicate Rheumatoid Arthritis staphylococcus aureus iscommonly implicated secondary to invasion from an ulcerated nodule. Amyloidosis is acomplication of prolonged active disease. 62
  • 77. Efficacy of Shunti & Gokshura in AmavataCRITERIA FOR THE DIAGNOSIS OF RHEUMATOID ARTHRITIS1621988 REVISED ACR CRITERIA Ø Morning stiffness Ø Arthritis of 3 or more of 14 possible joint areas Ø Arthritis of hand joints Ø Symmetrical arthritis Ø Rheumatoid nodules Ø Serum rheumatoid factor Ø Radiographic changes For the diagnosis of RA four of the seven criteria are required MANAGEMENT163 The etiology of Rheumatoid arthritis is unknown, and so treatment is empirically directed towards • Relief of symptoms • Suppression of active and progressive disease • Conservation and restoration of function in affected joints. These are achieved by combining: v Treatment of the patient – drugs, rest, physiotherapy surgery v Modification of the Environment- aids, appliances, housing, occupation, statutory social benefits 63
  • 78. Efficacy of Shunti & Gokshura in AmavataGeneral treatment in the active phase164 Physical rest, anti-inflammatory drug therapy and maintenance exercises are thecorner stones of treatment for exacerbations of Rheumatoid arthritis. The rest formphysical and emotional stress provided by 1-2 week’s in hospital is usually sufficient toinduce marked remission. Symptoms without recourse to strict bed rest. In few patients aperiod of complete bed rest may be required to induce a remission. Rest splints can beused to support a particular painful joint to correct flexion deformities.Surgical Treatment165 Surgical decompression and synovectomy are needed when corticosteroids andphysical measures have failed to relieve movements of limbs. 64
  • 79. Efficacy of Shunti & Gokshura in Amavata METHODOLOGYMATERIALSSource of DataLiterary Source- Literary aspect of study is collected from classical Ayurvedic texts, Modern texts,and from Internet.Drug – Shunti Kanda [Rhizome]- Zingiber officinalae. Rosc Gokshura phala [Fruit] – Tribulus terrestris. Linn are taken for the clinical trail.Collection of Raw Materials – Good quality Shunti was purchased from the local market of Gadag. Botanically identified Gokshura was collected in surrounding area of Gadag.Method of Preparation- The method of preparation of Kwatha given in Sharangadhara Samhita wasadopted.Shunti Kwatha- 1. 20 gms of Shunti coarse powder taken in clean stainless steel vessel. 2. Add 160 ml of water to the container containing coarse powder. 3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼ of its quantity 4. Then it was filtered 5. Luke warm quatha was given for consumption 65
  • 80. Efficacy of Shunti & Gokshura in AmavataGokshura Kwatha- 1. 20 gms of Gokshura coarse powder taken in clean stainless steel vessel. 2. Add 160 ml of water to the container containing coarse powder. 3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼ of its quantity 4. Then it was filtered 5. Luke warm quatha was given for consumptionShunti Gokshura Kwatha- 1. 20 gms [Shunti + Gokshura] of coarse powder taken in clean stainless steel vessel. 2. Add 160 ml of water to the container containing coarse powder. 3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼ of its quantity. 4. Then it was filtered. 5. Luke warm quatha was given for consumptionPlace of preparation of Medicine- The preparation of Medicine was done in Post Graduation Research StudiesDepartment of Dravyaguna. D.G.M.Ayurvedic Medical College. Gadag.Form of the Medicine The Medicine was administered in the form of Kwatha. 66
  • 81. Efficacy of Shunti & Gokshura in Amavata Result of Analysis of physical constants of the drug samples1) Zingiber officinale rhizome a. Foreign matter 0.42% b. Total Ash 8.34% c. Acid insoluble Ash 1.01% d. Alcohol soluble extractive 7.02% e. Water soluble extractive 44.0%2) Zingiber officinale powder (rhizome) a. Foreign matter 0.32% b. Total Ash 8.01% c. Acid insoluble 0.99% d. Water soluble extractive 5.2% e. Alcohol soluble extractive 8.88%3) Zingiber officinale decoction a. Description Yellowish brown thick liquid b. Specific gravity 1.0965 c. Total solids 19.08%w/w d. Total ash 2.01% e. Acid insoluble ash Zingiber 0.08% f. Ph 5.64) Tribulus terristris fruits a. Foreign matter 0.75% b. Total Ash 10.8% c. Acid insoluble ash 0.82% d. Alcohol soluble extractive 7.12% e. Water soluble extractive 9.68% 67
  • 82. Efficacy of Shunti & Gokshura in Amavata5) Tribulus terristris fruit powder a. Foreign matter 0.5% b. Total Ash 10.88% c. Acid insoluble ash 0.78% d. Water soluble extractive 15.78% e. Alcohol soluble extractive 14.08%6) Tribulus terristris decoction a. Description Green coloured thick liquid b. Specific gravity 1.052 c. Total solids 15.835% d. Ph 6.2 e. Total Ash 2.2% f. Acid insoluble ash 0.3% 68
  • 83. Efficacy of Shunti & Gokshura in AmavataMETHODSSelection of Sample- Patients suffering from Amavata were selected from OPD, Department ofDravyaguna. Post Graduation studies and Research centre, D.G.Melmalgi AyurvedicMedical College and Hospital by present inclusion and exclusion criteria.Criteria for selection of Patient- v Patients diagnosed as Amavata as per the classics. v Irrespective of sex [Both male & female patients were considered] v Patients in between the age group of 15-65 years.Exclusion Criteria- Ø Patients below 15 and above 65 years of the age group Ø Patients with complications and deformity. Ø Patients with loss of joint function and granthi Ø Pregnant women and lactating mother Ø The patients having Rheumatic heart disease, Rheumatic fever Ø Any other Systemic disorder other than Amavata.Inclusion Criteria- • All other conditions other than that of exclusion criteria are included. • Any doshanubandha • Without any discrimination of Chronicity. 69
  • 84. Efficacy of Shunti & Gokshura in AmavataLab Investigations The laboratory investigations were done to diagnose the disease, to exclude thepatient and to know the prognosis of the patient. Blood- Haemoglobin (Hb %) percentage Total count of W.B.C. [T.C] Differential leukocyte count [DLC] Erythrocyte sedimentation Rate [E.S.R] Serological- R.A. test C-Reactive protein [CRP] Radiology- X-ray Exclusion – Random Blood sugar Urine Examination.Criteria of Diagnosis • Symptoms mentioned in Ayurvedic texts • ACR criteria [1988 revised ACR criteria] • X-ray( If necessary) • RA test and C-Reactive protein is not considered as diagnostic criteria both sero- positive and sero-negative cases were included in this study.Study design Prospective comparative clinical studySample size A minimum of 30 patients equally distributed in 3 groups. 70
  • 85. Efficacy of Shunti & Gokshura in AmavataGroups § Group A – Shunti kwatha § Group B – Gokshura kwatha § Group C – Shunti Gokshura [Shuntyadi] Kwatha.Posology 1. Shunti – 40 ml of kwatha early morning 2. Gokshura – 40 ml of kwatha early morning 3. Shunti Gokshura – 40 ml of kwatha early morningStudy duration Duration of the study was 30 days. The patients were instructed to report every 10 days. 1st Assessment – Before treatment 2nd Assessment – 10th day after treatment 3rd Assessment – 20th day after treatment 4th Assessment – 30th day after treatment [After treatment] These assessment ware made for the progressive signs after the medication. Butthe 1st & 4th [last] assessment were taken for the assessment of results.Assessments of Results- Results of the treatment were assessed on difference between the Before and Aftertreatment. Data of the subjective and objective parameters by using paired ‘t’ test. TheAnova considered here for the readings of after treatment by using completelyrandomised design. 71
  • 86. Efficacy of Shunti & Gokshura in AmavataSubjective parameters As designated in classical texts 1. Sandhi shoola [pain] 2. Sandhi shotha [swelling] 3. Jwara [Fever] 4. Stabdata [Morning stiffness]Objective Parameters Haemoglobin Percentage [Hb %] Total count of W.B.C (TC) Differential leukocyte count [DLC] Erythrocyte Sedimentation Rate [E S R] R.A. testGrades of Subjective Parameters 1. Sandhi Shoola (Pain) -O- No pain 1 – Pain but not difficulty in moving 2- Slightly difficulty in moving 3 – Much difficulty in moving 2. Sandhi Shotha (Swelling)-O – No swelling 1- Slightly obvious 2- Covers well the bony prominence 3 – Much elevated so that joints seems grossly deformed 3. Jwara [Fever] O- 98.60F 1- 98.70F –99.70F 2- -99.80F –100.80F 3-100.90F and above 72
  • 87. Efficacy of Shunti & Gokshura in Amavata 4. Stabdata [Morning Stiffness]-O-No stiffness 1-Stiffness within 1 hr 2- Stiffness 1-2 hrs 3- Stiffness for 2 + + hrs 5. Over all Assessment of Results. As the objective parameters are not suggesting any crucial role in the assessment ofresults in this study, so here assessment of results is made only with subjectiveparameters The over all assessment of Results in the present study were grouped into thefollowing categories 1. Complete remission – Complete subsidence of all the subjective symptoms irrespective of any degree before the initiation of treatment. 2. Major Improvement – Complete subsidence of 2 or 3 subjective symptoms irrespective of any degree before initiation of treatment. 3. Minor Improvement – Reduction of 2 or less than 2 degrees of subjective symptoms or subsidence of only one symptom. 4. Not Responded – No reduction of degrees of subjective symptoms. 73
  • 88. Efficacy of Shunti & Gokshura in Amavata OBSERVATION AND RESULTS The present comparative clinical study was ment for evaluation of efficacy ofshunti and Gokshura in Amavata [Rheumatoid Arthritis]. Total 30 patients were takenrandomly for the above mentioned study. All the patients were taken for the abovementioned study assessed before and after treatment. Both subjective and objectivechanges were recorded according to the proforma of case sheet The data was collected as follows Section “A” - Demographic data. Section “B” - Data related to disease Amavata Section “C” - Data related to response to the treatment 74
  • 89. Efficacy of Shunti & Gokshura in Amavata SECTION “A” DEMOGRAPHIC DATA1) Age incidence Present study of Evaluation of efficacy of Shunti and Gokshura in Amavata[Rheumatoid Arthritis] – A comparative clinical study has the following age incidences. It suggests that much of the patients fall under the age group in between 36-45.i.e., 11 (36.67%), 8 (26.67%) patients fall under the age group in between 26-35.7 (23.33%) patients fall under the age group in between 46-55. Very few patients i.e., 4(13.33%) fall under the age group in between 56-65. Table 4.1: Age distribution of 30 Patients Sl No Age group No of Patients Percentage 1. 15-25 00 00.00% 2. 26-35 08 26.67% 3. 36-45 11 36.67% 4. 46-55 07 23.33% 5. 56-65 04 13.33% Total 6. 30 100% 12 11 10 8 8 7 6 No of Patients 4 4 2 0 0 15-25 26-35 36-45 46-55 56-65 Graph number 1 Age distribution of 30 patients 75
  • 90. Efficacy of Shunti & Gokshura in Amavata2) Sex incidence Evaluation of efficacy of Shunti and Gokshura in Amavata [Rheumatoid Arthritis]A comparative clinical study has the following data in sex incidence. From the available data we can draw a conclusion that the incidence of Amavatais more in female’s i.e., 18 (60%). Where as males are of only 12 (40%). The ratioreveals in the study is as 2:3 for male and female respectively. Table 4.2 Sex distribution of 30 patients Sl No Sex No of Patients Percentage 1. Male 12 40% 2. Female 18 60% 3. Total 30 100% Male 40% Male Female Female 60% Graph number 2 Sex Distribution of 30 patients 76
  • 91. Efficacy of Shunti & Gokshura in Amavata 3) Incidence of Religion:- An attempt was made to understand the religious influence in this disease; Hindu,Muslim and Christians were included in this study. There was no any descrimination ofreligion in this study. In this study maximum patients 28 (93.33%) were Hindu’s and only 2 (6.67%)patients were muslim. There were no any patients other than these communities werereported. Table 4.3: Distribution of religion of 30 patients Percentage Sl No Category No of Patients 1. Hindu 28 93.33% 2. Muslim 02 06.67% 3 Christian . 00 00.00% 4. Others 00 00.00% 5. Total 30 100% 30 25 20 15 10 5 0 Hindu Muslim Christian Others No of Patients 28 2 0 0 Graph number 3 Distribution of religion of 30 patients 77
  • 92. Efficacy of Shunti & Gokshura in Amavata4) Occupation incidence Study suggests that the patients out of Housewives occupational group were moreprone to get the Amavata. Out of 30 cases studied 16 (53.33%) patients were inHousewives category. 9 (30%) were Labor group of occupational category. 3 (10%)patients were in active group of occupational category and only 2 (6.67%) patients werein sedentary group of occupational category. Table 4.4: Distribution of Patients According to the occupation Sl No Categories No of Patients Percentage 1. Labor 09 30.00% 2. Sedentary 02 06.67% 3. Active 03 10.00% 4. Housewife 16 53.33% 5. Total 30 100% Labor 30% Housewife 53% Sedentary 7% Active 10% Graph number 4 Distribution of patients according to the Occupation 78
  • 93. Efficacy of Shunti & Gokshura in Amavata5) Economical Status Data collected in the study shows that more values of percentage i.e., 63.33% (19)patients fall under middle class economical status category. 30.%(9) patients fall under poor class economical status category.And only 6.67% (2) patients fall under Higher class economical status category. Table 4.5 : Distribution of Patients according to the Economical status Sl No Economical Status No of Patients Percentage 1. Poor 09 30.0% 2. Middle class 19 63.33% 3. Higher class 02 6.67% 4. Aristocrat 00 0.00% 5. Total 30 100% Aristocrat Higher class Middle class Poor 0 5 10 15 20 No of Patients Graph number 5 Distribution of Patients according to the Economical status 79
  • 94. Efficacy of Shunti & Gokshura in Amavata6) Diet [Food Habits] Distribution of Patients according to the Diet habit. The food habit distribution in the locality of research has more percentage ofvegetarians in comparison with mixed diet dependents. The ratio of percentage between vegetarian and mixed diet is 20:10 i.e.,66.67%: 33.33% respectively. Table 4.6 : Distribution of Patients according to the Diet habit. Sl No Category No of Patients Percentage 1. Vegetarian 20 66.67% 2. Mixed diet 10 33.33% 3. Total 30 100% Mixed diet 33% Vegetarian Mixed diet Vegetarian 67% Graph number 6 Distribution of Patients according to the Diet [Food Habits] 80
  • 95. Efficacy of Shunti & Gokshura in Amavata SECTION ‘B’ DATA RELATED TO DISEASE 7) Complaints presented by treated thirty patients:- In this study all of the 30 (100%) patients were complained about Sandhi shoola.(Joint Pain), Sandhi shotha (swelling), jwara (fever), Stabdata (stiffness), most of thepatients 28 (93.33%) were presented the complaint Gowrava (heaviness), Angamarda(malaise), 26 (86.66%) patients complained Alasya. 25 (83.33%) patients complaintsApaka (indigestion), 23 (76.66%) patients complained Aruchi (indigestion), only 10(33.33%) patients complained Trushna (Thirst), Vruschik damshavat pida (Scorpion bitelike pain) was found in 15 (50%) of the patients. Table 4.7 : Presenting Symptoms of thirty patients Sl No Complaints No of Patients Percentage 1. Sandhi Shool 30 100% 2. Sandhi Shotha 30 100% 3. Jwara 30 100% 4. Stabdata 30 100% 5. Gowrava 28 93.33% 6. Angamarda 28 93.33% 7. Aruchi 23 76.66% 8. Apaka 25 83.33% 9. Trushna 10 33.33% 10. Alasya 26 86.66% 11. Vruschik damshavat peeda 15 50.00% 81
  • 96. Efficacy of Shunti & Gokshura in Amavata Vruschik damshavat peeda 5% Sandhi Shool 12% Alasya 9%Trushna Sandhi Shotha 4% 11%Apaka 9% Jwara 11% Aruchi 8% Stabdata Angamarda 11% 10% Gowrava 10% Graph number 7 Presenting Symptoms of thirty patients 82
  • 97. Efficacy of Shunti & Gokshura in Amavata8) Duration The duration which patients had their illness ranged from 1 month to more than 2years. Maximum patients 11 (36.66%) were suffered in this disease in between 7-12months duration followed by 9 (30%) patients were suffered in between 13-18 monthsduration, 4 (13.33%)patients were suffered in this disease more than 2 yrs duration. 3(10%) patients were suffered in between 1-6 months of duration and 3 (10%) patientswere suffered in between 19-24 months of duration.Table 4.8 : Duration of the Patients in the present Study Sl No Duration No of Patients Percentage 1. 1-6 Months 03 10.00% 2. 7-12 Months 11 36.66% 3. 13-18 Months 09 30.00% 4. 19-24 Months 03 10.00% 5. More than 2 yrs 04 13.33% 6. Total 30 100% 12 11 10 9 8 6 4 4 3 3 2 0 1-6 Months 7-12 13-18 19-24 More than 2 Months Months Months yrsGraph number 8 Duration of the Patients in the present Study 83
  • 98. Efficacy of Shunti & Gokshura in Amavata9) Data of Affected joints Amavata can affect any joint but in this study maximum patients 10 (33.33%)affected joints were Ankle and Knee. 8 (26.66%) patients affected joints were all thejoints irrespective of small and big joints. 5 (16.66%) patients affected joints were shoulder, elbow and wrist. 4(13.33%)patients affected joints were shoulder and elbow. 3 (10%) patients affected joints werewrist and interphalangeal. Table 4.9 : Showing the affected joints of thirty patients Sl No Affected joints No of Patients Percentage 1. Ankle and knee joints 10 33.33% 2. Shoulder, elbow and Wrist joint 05 16.66% 3. Wrist and interpharengeal joints 03 10.00% 4. Shoulder and elbow 04 13.33% 5. Affected all joints 08 26.66% 6. Total 30 100% 10 5 0 1. 2. 3. 4. 5. No of Patients 10 5 3 4 8 Graph number 9 Affected joints of thirty patients 84
  • 99. Efficacy of Shunti & Gokshura in Amavata10) Agnibala- Agnibala of thirty patients This present study a systemic correlation between Agni and Ama was made out. Maximum patients 22 (73.33%) had mandagni and 8 (26.66%) patients hadVishamagni.There were no any Patients reported about teekshnagni and samagni. Table 4.10 : Agnibala of thirty patients Sl No Agni No of Patients Percentage 1. Manda 22 73.33 % 2. Teekshna 00 0.00% 3. Sama 00 0.00% 4. Vishama 08 26.66% 5. Total 30 100 25 22 20 Manda 15 Teekshna Sama 10 8 Vishama 5 0 0 0 Graph number 10 Agnibala of thirty patients 85
  • 100. Efficacy of Shunti & Gokshura in Amavata11) Nidra - Nidra of thirty patients This present study mode of Nidra in the patients was made out. Maximum 21 (70%) patients have reported with Nidra Vaishamya and only 9 (30%) patients have reported with Alpa nidra. Table 4.11 : Nidra of thirty patients Sl No Nidra No of Patients Percentage 1. Sukha 00 0.00% 2. Alpa 09 30.00% 3. Ati 00 0.00% 4. Vaishamya 21 70.00% 5. Total 30 100% 30 20 10 0 Sukha Alpa Ati Vaishamya 1. 2. 3. 4. No of Patients 0 9 0 21 Graph number 11 Nidra of thirty patients 86
  • 101. Efficacy of Shunti & Gokshura in Amavata12) Prakruti - Prakruti of thirty patients In Ayurveda prakruti is the fundamental entity in disease process. In this studymaximum patient 12 (40%) screened as Vata kapha prakruti followed by 7 (23.33%) Vataprakruti 6 (20%) Kapha prakruti patients and Vata pitta prakruti patients were 5 (16.66%). Table 4.12 : Prakruti of thirty patients Sl No Prakruti No of Patients Percentage 1. Vata 07 23.33% 2. Pitta 00 00.00% 3. Kapha 06 20.00% 4. Vata Pitta 05 16.66% 5. Vata kapha 12 40.00% 6. Kapha pitta 00 00.00% 7. Vata Pitta Kapha 00 00.00% 8. Total 30 100% 12 10 8 6 4 2 Graph number 12 0 Prakruti of thirty patients Vata Vata Kapha Vata Vata Pitta Kapha Pitta Pitta kapha pitta Kapha No of Patients 7 0 6 5 12 0 0 Graph number 12 Prakruti of thirty patients 87
  • 102. Efficacy of Shunti & Gokshura in Amavata Section C - Data Related To Response To The TreatmentTable 4.13 Showing Grades of Sandhi shoola Before Treatment in Group A, B & C No of Patients Group Grades 3 % 2 % 1 % 0 % 10 A 6 60% 4 40% - - - - 10 B 4 40% 6 60% - - - - 10 C 7 70 % 3 30% - - - - 3=Much difficulty in moving, 2 = slightly difficulty in moving, 1=Pain but not difficulty in moving, O= No pain. Table 4.14 Showing Grades of Sandhishoola After Treatment in Group A, B & C No of Patients Group Grades 0 % 1 % 2 % 3 % 10 A 5 50% 4 40% 1 10% - - 10 B 1 10% 6 60% 3 30% - - 10 C 6 60% 3 30% 1 10% - - O= No pain, 1=Pain but not difficulty in moving, 2 = slightly difficulty in moving, 3= much difficulty in moving. 88
  • 103. Efficacy of Shunti & Gokshura in AmavataTable 4.15 Showing Grades of Sandhishotha Before Treatment in Group A, B & C No of Patients Group Grades 3 % 2 % 1 % 0 % 10 A 2 20% 7 70% 1 10% - - 10 B 6 60% 4 40% - - - - 10 C 4 40% 6 60% - - - -3=Much elevated so that joints seems grossly deformed. 2=Covers well the BonyProminence, 1=Slightly obvious, O= No Swelling. Table 4.16 Showing Grades of Sandhishotha After Treatment in Group A, B & C No of Patients Group Grades 0 % 1 % 2 % 3 % 10 A 6 60% 3 30% 1 10% - - 10 B 7 70% 3 30% - - - - 10 C 7 70% 2 20% 1 10% - - O= No Swelling, 1=Slightly obvious, 2=Covers well the Bony Prominence, 3=Much elevated so that joints seems grossly deformed. 89
  • 104. Efficacy of Shunti & Gokshura in AmavataTable 4.17 Showing Grades of Jwara Before Treatment in Group A, B & C No of Group Grades Patients 3 % 2 % 1 % 0 % 10 A - - 5 50% 5 50% - - 10 B - - 3 30% 7 70% - - 10 C - - 2 20% 8 80% - - 3=100.90F and above, 2=99.80F –100.80F, 1= 98.7 0F –99.70F, O= 98.60F,.Table 4.18 Showing Grades of Jwara After Treatment in Group A, B & C No of Patients Group Grades 0 % 1 % 2 % 3 % 10 A 9 90% 1 10% - - - - 10 B 8 80% 2 20% - - - - 10 C 9 9% 1 10% - - - - O= 98.60F, 1= 98.7 0F –99.70F, 2=99.80F –100.80F,3=100.90F and above. 90
  • 105. Efficacy of Shunti & Gokshura in AmavataTable 4.19 Showing Grades of Stabdata Before Treatment in Group A, B & C No of Patients Group Grades 3 % 2 % 1 % 0 % 10 A 1 10% 6 60% 3 30% - - 10 B 1 10% 5 50% 4 40% - - 10 C 2 20% 6 60% 2 20% - - 3= Stiffness for 2 + +hrs, 2= Stiffness 1-2 hrs, 1=Stiffness within 1 hr, O=No stiffness,Table 4.20 Showing Grades of Stabdata After Treatment in Group A, B & C No of Patients Group Grades 0 % 1 % 2 % 3 % 10 A 6 60% 4 40% - - - - 10 B 4 40% 5 50% 1 10% - - 10 C 8 80% 2 20% - - - - O=No stiffness, 1=Stiffness within 1 hr, 2= Stiffness 1-2 hrs, 3= Stiffness for 2 + +hrs 91
  • 106. Efficacy of Shunti & Gokshura in AmavataTable 4.21 COMPARATIVE RESULTS OF GROUP A, B & C WITH SANDHISHOOLA (PAIN) Group Before treatement Percentage After Treatment Percentage Total No. of patients No. of Patients Relived A 10 100% 5 50% B 10 100% 1 10% C 10 100% 6 60%Graph no 13. SHOWING COMPARATIVE RESULTS OF GROUP A, B & CWITH SANDHI SHOOLA (PAIN) 10 8 6 4 2 0 A B C Before treatement Total No. 10 10 10 of patients After Treatment No. of 5 1 6 Patients Relived In the present study all the patients (30) from all the groups have presented thesubjective symptom sandhishoola with varying degrees. After the treatment the studyreveals that effect of all the three groups have consistent convinced results over snadhishoola. In Group A 5(50%) patients completely relived with sandhishoola. In the sameway Group B only 1 (10%) patient completely relived and In Group C 6 (60%) patientscompletely relived with sandhishoola. 92
  • 107. Efficacy of Shunti & Gokshura in AmavataTable 4.22 COMPARATIVE RESULTS OF GROUP A, B & C WITH SANDHISHOTHA (SWELLING) Group Before Treatment Percentage After Treatment Percentage No. of Patients No. of Patients Relived A 10 100% 6 60% B 10 100% 7 70% C 10 100% 7 70%Graph no 14 SHOWING COMPARATIVE RESULTS OF GROUP A, B & CWITH SANDHI SHOTHA (SWELLING) 10 8 6 4 2 0 A B C Before Treatment 10 10 10 No. of Patients After Treatment No. 6 7 7 of Patients Relived All the patients from all the groups have presented the subjective symptom sandhishotha before the treatment with varying degrees. After the treatment in Group A 6 (60%) patients have shown complete relief fromsandhi shotha. In the same way Group B 7 (70%) and in Group C 7 (70%) patientsrelived completely from sandhi shotha. 93
  • 108. Efficacy of Shunti & Gokshura in AmavataTable 4.23 COMPARATIVE RESULTS OF GROUP A, B & C WITH JWARA(FEVER) Group Before Treatment Percentage After Treatment Percentage No. of Patients No. of Patients relieved A 10 100% 9 90% B 10 100% 8 80% C 10 100% 9 90%Graph no 15 SHOWING COMPARATIVE RESULTS OF GROUP A, B & CWITH JWARA 10 5 0 A B C Before Treatment 10 10 10 No. of Patients After Treatment 9 8 9 No. of Patients relieved All the patients from all the groups have presented the subjective symptom jwarabefore the treatment with varying degrees (1.2), after treatment most of the patientsrelived with jwara that is In Group A 9 (90%) patients, Group B 8(80%) patients andGroup C 9(90%) patients. 94
  • 109. Efficacy of Shunti & Gokshura in AmavataTable 4.24 COMPARATIVE RESULTS OF GROUP A, B & C WITH STABDATA(MORNING STIFFNESS) Group Before treatment Percentage After treatment Percentage No. of Patients No. of Patients Relieved A 10 100% 6 60% B 10 100% 4 40% C 10 100% 8 80%Graph no 16 SHOWING COMPARATIVE RESULTS OF GROUP A, B & CWITH STABDATA (MORNING STIFFNESS) 10 8 6 4 2 0 A B C Before treatment No. of 10 10 10 Patients After treatment No. of 6 4 8 Patients All the patients from all the groups have presented the subjective symptomstabdata before treatment with varying degrees. After treatment in Group A 6(60%) patients. In Group B 4(40%) patients and InGroup C 8(80%) patients have completely relived from stabdata. 95
  • 110. Efficacy of Shunti & Gokshura in AmavataRESULTS 30 patients were studied in three groups with 10 paitents in each. Group Apatients were treated with shunti kwatha, Group B patients were treated with Gokshruakwatha and Group C patients were treated with Shunti Gokshura kwatha. The results obtained in the three groups were assessed on the basis of sandhishoola, sandhi shotha, jwara, stabdata, Hb%, ESR and Total count.Table 4.25 Statistical Analysis of subjective and objective parameters in Group A Parameter Mean S.D S.E ‘t’Value P Value Remarks Sandhi Shoola 2.00 0.942 0.298 6.711 <0.001 H.S Sandhi Shotha 1.6 0.843 1.266 6.015 <0.001 H.S Jwara 1.4 0.516 0.163 8.58 <0.001 H.S Stabdata 1.4 0.516 0.163 8.58 <0.001 H.S Hb% 0.72 0.418 0.132 5.45 <0.001 H.S ESR 16.2 7.22 2.28 7.105 <0.001 H.S TC 318.3 352.92 111.60 2.852 <0.05 H.SSubjective and Objective parameters in Group A statistical analysis showed highlysignificant 96
  • 111. Efficacy of Shunti & Gokshura in AmavataTable 4.26 Statistical Analysis of subjective and objective parameters in Group B Parameter Mean S.D S.E ‘t’ Value P Value Remarks Sandhi Shoola 1.2 0.421 0.133 9.02 <0.001 H.S Sandhi Shotha 2.3 0.483 0.152 15.13 <0.001 H.S Jwara 1.1 0.316 0.1 11.0 <0.001 H.S Stabdata 1.0 0.666 0.210 4.76 <0.01 H.S Hb% 0.58 0.541 0.171 3.39 <0.01 H.S ESR 11.5 6.346 2.00 5.75 <0.001 H.S TC 419.0 552.88 174.83 2.39 <0.05 H.SSubjective and Objective parameters in Group B statistical analysis showed highlysignificantTable 4.27 Statistical Analysis of subjective and objective parameters in Group C Parameter Mean S.D S.E ‘t’ Value P Value Remarks Sandhi Shoola 2.0 0.471 0.149 13.42 <0.001 H.S Sandhi Shotha 2.0 0.666 0.21 9.52 <0.001 H.S Jwara 1.1 0.316 0.1 11.0 <0.001 H.S Stabdata 1.8 0.632 0.2 9.0 <0.001 H.S Hb% 0.728 0.499 0.157 4.636 <0.01 H.S ESR 15.9 4.818 1.52 10.46 <0.001 H.S TC 404.0 231.76 73.29 5.512 <0.001 H.SSubjective and Objective parameters in Group C statistical analysis showed highlysignificant 97
  • 112. Efficacy of Shunti & Gokshura in AmavataTable 4.28 Anova table for Sandhi shoola Source of D.f Sum of Mean sum F.value F.Table P.value Remarks variation square of squares valueGroup 2 2.866 1.433 3.09 3.35 >10.05 N.S Error 27 12.5 0.463 Total 29 15.366Table 4.29 Anova table for Sandhi shotha Source of D.f Sum of Mean sum F.value F.Table P.value Remarks variation square of squares valueGroup 2 0.2 0.1 0.245 3.35 >10.05 N.S Error 27 11.0 0.407 Total 29 11.2Table 4.30 Anova table for Jwara Source of D.f Sum of Mean sum F.value F.Table P.value Remarks variation square of squares valueGroup 2 0.066 0.033 0.264 3.35 >10.05 N.S Error 27 3.4 0.125 Total 27 3.466Table 4.31 Anova table for Stabdata Source of D.f Sum of Mean sum F.value F.Table P.value Remarks variation square of squares valueGroup 2 1.27 0.635 2.123 3.35 >10.05 N.S Error 27 8.097 0.299 Total 29 9.367 98
  • 113. Efficacy of Shunti & Gokshura in AmavataTable 4.32 ANOVA table for the Hb% Source of D.f Sum of Mean sum F.Value F. table P.value Remarks variation square of squares valueGroups 2 2.984 1.492 Error 27 112.724 4.174 0.357 3.35 p>0.05 N.S Total 29 115.708Table 4.33 ANOVA table for the ESR Soruce of D.f Sum of Mean sum F.value F.Table P.value Remarks variation squares squares valueGroup 2 1482.00 741.0 7.188 3.35 <0.05 H.S Error 27 2783.2 103.081 Total 29 4265.2Table 4.33 (a) Least significance difference among the groups. Groups Mean Difference Difference C 26.5 * - - B 23.2* 3.3 + - A 21.2 5.3+ 2.00+ * Significant + Not Significant Least significance difference value = L.S.D. t 0.05 √ 2s2 E/K √ = 2.05√2x103.08/10 Here the L.S.D Value is 9.3. 99
  • 114. Efficacy of Shunti & Gokshura in Amavata Table 4.34 Anova table for the TCSource of D.f Sum of Mean sum F F.table P.value Remarksvariation square of squares value valueGroup 2 63677.27 31838.63 0.02 3.35 >10.05 N.S Error 27 32252890.1 1194551.48 Total 29 32316567.37 RESULTS v Here we are comparing mean effect of 3 groups is same or not due to treatment. For that we use completely randomized design. v All the parameters except ESR shows non significant, i.e., the mean effect of ESR in the three groups shows highly significant. From the table 4.33(a) by using least significant difference value is the parameter, the group c is more significant than the other(Group A & B). v If we compare the 3 groups individually the group c shows much response than the group A & B. [By using paired ‘t’ test as p is <0.001 & ‘t’ values]. v The parameter Hb% in-group A shows highly significant. v The mean net effect of parameter TC is more in group C. v Where as the net mean effect in ESR is more in group A. v The parameter Sandi shotha & Jwara shows highly significant in group B than A & C [By comparing t values]. v Where as the parameter Sandi shoola highly significant in group C than A & B. 100
  • 115. Efficacy of Shunti & Gokshura in AmavataTable no 4.35 Comparative overall Assessment of therapeutic Response of Group A, B&C The overall effect of the therapies were assessed as complete remission, Major improvement, Minor improvement and not responded. Types of Group Percentage Group Percentage Group Percentage Response A B C Complete 02 20% 01 10% 03 30% remission Major 07 70% 06 60% 06 60% improvement Minor 01 10% 03 30% 01 10% improvementNot responded 0 0 0 0 0 0 Discontinued 0 0 0 0 0 0Graph no 17 Showing Comparative overall Assessment of therapeutic Response ofGroup A, B & C 7 6 5 4 3 2 1 0 No.of Patients No.of Patients No.of Patients in Group A in Group B in Group C Complete remission 2 1 3 Major improvement 7 6 6 Minor improvement 1 3 1 s 101
  • 116. Efficacy of Shunti & Gokshura in Amavata The overall effect of the therapies were as mentioned in this Graph no. 17,3 (30%) patients have got complete remission in Group C compared to 2 (20%) patientsand 1 (10%) patients in Group A and Group B respectively Major improvement was shown maximum 7 (70%) patients in Group A comparedwith Group B & Group C with 6 (60%) patients in both the Groups. Minor improvement was shown in 3(30%) patients in Group B as compared withGroup A & Group C with only 1(10%) patient in each Group. There were no patients, which falls under not responded category of assessment,so it speaks that all the patients of all the three Groups were responded well. 102
  • 117. Efficacy of Shunti & Gokshura in Amavata Master Chart 1Demographic Data of “Evaluation of Efficacy of Shunti and Gokshura inAmavata (Rheumatoid Arthritis) - A Comparative clinical studyS.No. OPD Age Sex Religion Occupation Economical Food status M F H M C O L S A Hw P M H A V M1 4041 32 - + + - - - - - - + - + - - + -2 134 40 + - + - - - + - - - - + - - + -3 1245 30 - + + - - - - - - + - + - - + -4 1747 58 - + + - - - - - - + + - - - - +5 1893 45 + - + - - - + - - - + - - - - +6 1908 45 - + + - - - - - - + - + - - + -7 1481 48 - + + - - - - - - + - + - - + -8 1906 42 + - + - - - + - - - - + - - + -9 2367 50 - + + - - - - - - + - + - - + -10 2584 65 + - + - - - - + - - - + - - + -11 86 39 - + + - - - - - - + - - + - + -12 489 40 - + + - - - + - - - + - - - + -13 473 60 + - + - - - + - - - + - - - + -14 791 56 + - + - - - - - + - - + - - - +15 1368 48 - + + - - - - - - + - + - - + -16 3625 28 + - - + - - - - + - + - - - - +17 3801 28 + - + - - - - - + - + - - - - +18 3802 50 + - + - - - + - - - + - - - - +19 4172 30 + - - + - - + - - - - + - - - +20 2627 36 - + + - - - - - - + - + - - + -21 4570 40 - + + - - - - - - + - + - - - +22 1408 44 + - + - - - + - - - - + - - - +23 1538 47 - + + - - - - - - + - - + - - +24 1039 45 - + + - - - - - - + - + - - + -25 1628 39 - + + - - - - - - + - + - - + -26 1698 48 - + + - - - - - - + - + - - + -27 1792 32 - + + - - - - - - + - + - - + -28 1175 30 - + + - - - + - - - + - - - + -29 2010 27 + - + - - - - + - - + - - - + -30 3179 48 - + + - - - - - - + - + - - + -M=Male, F=Female, H=Hindu, M=Muslim,C=Christian,O=Others,L=Labour,S=Sedentry,A=Active,Hw=Housewife,P=Poor,M=Middle,H=High,A=Aristocrat, V=Vegetarian, M=Mixed diet Group A- No. 1 to 10, Group B No.- 11 to20, Group C No.- 21 to 30 103
  • 118. Efficacy of Shunti & Gokshura in Amavata Master Chart 2ASSESSMENT OF SUBJECTIVE PARAMETERS OF GROUP A, B AND C No. O.P.D Sandishoola Sandishotha Jwara Stabdata BT AT BT AT BT AT BT AT 1 4041 3 0 2 0 2 0 2 0 2 134 3 1 2 0 1 0 2 0 3 1245 3 0 2 1 1 0 1 0 4 1747 2 1 2 1 1 0 1 0 5 1893 2 0 1 0 1 0 2 1 6 1908 3 0 3 0 2 0 2 0 7 1481 3 0 3 1 2 0 1 0 8 1906 2 1 2 0 2 0 2 1 9 2367 2 1 2 0 1 0 2 1 10 2584 3 2 2 2 2 1 3 1 11 86 2 0 3 0 1 0 2 0 12 489 2 1 3 0 2 0 1 0 13 473 3 2 3 1 1 0 1 1 14 791 2 1 2 0 2 1 2 0 15 1368 3 2 3 1 1 0 2 1 16 3625 2 1 2 0 1 0 2 1 17 3801 2 1 3 0 1 0 1 0 18 3802 2 1 2 0 1 0 1 1 19 4174 3 1 3 1 2 1 3 2 20 2627 3 2 2 0 1 0 2 1 21 4570 3 1 2 0 1 0 1 0 22 1408 2 0 2 0 1 0 3 1 23 1538 3 0 3 1 2 0 2 0 24 1039 3 1 2 0 1 0 2 0 25 1628 3 0 3 0 1 0 2 0 26 1698 3 0 2 0 1 0 3 0 27 1792 3 1 3 0 1 0 2 0 28 1175 2 0 2 0 1 0 1 0 29 2010 3 2 3 2 2 1 2 1 30 3179 2 0 2 1 1 0 2 0 Group A- No. 1 to 10, Group B No.- 11 to 20, Group C No.- 21 to 30 BT- Before treatment, AT- After treatment 104
  • 119. Efficacy of Shunti & Gokshura in Amavata Master Chart 3 ASSESSMENT OF OBJECTIVE PARAMETERS OF GROUP A , B AND CNo. OPD.No Hb% Gmldl ESR mmof 1st hr TC cell /cumm RA CRP BT AT BT AT BT AT BT AT BT AT 1 4041 7.1 6.0 52 26 7850 8050 +ve +ve weakly+ve weakly +ve 2 134 12.2 13.0 33 21 5350 5410 - ve - ve - ve - ve 3 1245 7.4 9.0 28 18 4000 5000 - ve - ve - ve - ve 4 1747 13.2 14.0 25 14 9350 9350 - ve - ve - ve - ve 5 1893 14.0 14.0 48 20 5800 6200 - ve - ve - ve - ve 6 1908 9.4 10.0 40 20 5800 6000 - ve - ve - ve - ve 7 1481 9.5 10.0 38 18 4500 5000 - ve - ve - ve - ve 8 1906 10.0 10.5 40 22 5800 5000 - ve - ve - ve - ve 9 2367 11.8 12.5 31 22 4975 4998 - ve - ve + ve + ve10 2584 10.4 11.0 38 30 6350 6350 - ve - ve - ve - ve11 86 11.0 12.5 40 28 8400 6450 - ve - ve weakly weakly + ve + ve12 489 7.9 9.0 32 18 6800 6500 - ve - ve - ve - ve13 473 10.0 10.0 28 20 5100 5000 - ve - ve - ve - ve14 791 13.8 14.0 06 06 6100 5600 - ve - ve - ve - ve15 1368 9.0 9.5 36 26 6895 6710 - ve - ve - ve - ve16 3625 9.5 10.0 38 25 6700 6400 - ve - ve - ve - ve17 3801 9.0 10.0 45 23 5300 4900 - ve - ve - ve - ve18 3802 8.5 9.5 48 28 5000 5175 - ve - ve - ve - ve19 4174 11.0 11.0 36 28 6630 6500 - ve - ve -ve - ve20 2627 9.5 9.5 42 30 7150 7000 + ve + ve + ve + ve21 4570 9.5 11.0 38 19 6850 6400 - ve - ve - ve - ve22 1408 10.0 10.0 28 10 6700 6200 - ve - ve - ve - ve23 1538 13.33 14.0 30 18 6900 7200 - ve - ve - ve - ve24 1039 10.59 11.3 49 25 6400 5900 + ve + ve - ve - ve25 1628 9.0 10.0 40 28 6200 6150 - ve - ve - ve - ve26 1698 10 10.6 40 20 5500 5000 - ve - ve - ve - ve27 1792 9.4 9.5 44 28 5500 4650 + ve + ve weakly weakly +ve +ve28 1175 9.4 10.0 22 14 5300 5800 - ve - ve - ve - ve29 2010 5.4 6.0 98 80 7900 7600 + ve + ve weakly weakly +ve +ve30 3179 8.5 10.0 35 23 5890 5800 - ve - ve - ve - ve BT – Before treatment AT- After treatment Hb% - Hemoglobin percentage. ESR – Erythrocyte Sedimentation Rate. TC – Total Count of WBC RA - Rheumatoid Arthritis test, CRP- C-Reactive Protein , Group A- No.1 to 10, Group B- No. 11 to 20, Group C- No. 21 to 30 105
  • 120. Efficacy of Shunti & Gokshura in Amavata DISCUSSION Drug being one among the chikitsa chatushpada and the armour of thephysician. The drug occupies a pre-eminent position in the requisite for achievingthe success of treatment. In this study “Evaluation of efficacy of Shunti and Gokshura in Amavata(Rheumatoid Arthritis] – A comparative clinical study” the treatment of Amavata withShuntyadi (Shunti, Gokshura) kwatha was selected from chakradatta. The drug Shunti is being dealt directly as Amavatahara by Bhavamishra andMadanapala.And also it is being mentioned as Shoolahara, Agnideepaka, Shothahara,and Amapachaka by different authors. Even it is being popular with Vishwabheshaja, asone of the synonym i.e medicine for all ailments. As it is endowed with laghu guna it actas srotoshodhaka. As it is endowed with katu rasa it supports the line of treatment ofAmavata i.e. “Tikta deepanani katu ni cha”. The drug Gokshura is delt in Shothahara gana of Charaka i.e which alleviatesShotha which is one of the main symptoms of Amavata. Gokshura is also mentioned asRujahara by Kaiyadeva where Ruja is one of the main symptom of Amavata. Also it actsas Deepana, Rasayana, Vathahara, which is one of the essential treatment for Amavata.Hence it supports in treating the deisease Amavata. The disease Amavata is named after two major pathogenic factors Ama and Vata,which mainly affects the sandhi’s. Madhavakara for the first time reffered this disease asa separatge entity. Subsequently Chakradatta and Vangasena gave a good deal ofdescription regarding this disease and its treatment. 106
  • 121. Efficacy of Shunti & Gokshura in Amavata The disease Amavata manifests due to unwholesome diet and regimen, andhypofunction (mandagni) of agni is also an important factor for the initiation of diseaseprocess. The samprapti of this disease is originated from annavaha srotas and madhayamaroga marga with special predilation of sleshma sthana. Amavata is affected theshleshmasthana and migrated to other stanas like sandhi, Asthi, Majja etc Rasa, Asthi andMajja are primarily involve dushyas, after that mamsa and snayu are also affected. The Ayurvedic line of treatment profounded by ancient sages are largely dependsupon the stages of the disease. The treatment Shodana, Shamana, Deepana andAmapachana employed at the outset to check formation of Ama (and to start sampraptivighatana). The modern medical science cannot be exactly identical with the understanding ofAyurveda. Amavata can be co related with the disease Rheumatoid Arthritis in modernprevalence. The disease Rheumatoid Arthritis is identical with the signs and symptoms ofAmavata. The study of 30 cases of Amavata was treated with shunti and Gokshura in postgraduation and research centre (Dravya Guna) of Shri D.G.M. Ayurvedic MedicalCollege, Gadag. The disease was diagnosed as Amavata based on the signs and symptomsdescribed in our classics with concentrating more on subjective as well as objectiveparameters. In the present study of 30 patients, most of the patients fall under middle agegroup (26-55 yr). Out of which 36.67% (11 pateints) were between the age of 36-45 yrs. 107
  • 122. Efficacy of Shunti & Gokshura in AmavataWhich suggests the main causative factor for Amavata is Adhika chesta in this age grouppeoples. In this study female patients were dominated (60%) which is identical withinternational data. The study records that the patients out of housewife’s occupational group aremore prone to get Amavata with 16 (53.33%) patients. The majority of the patients in this study where mandagni 22 (72.33%) whichsuggested the production of Ama due to mandagni which is also co-relating with ancienttexts. According to the prakruti of the patients maximum patients 12 (40%) screened asvatakapha prakruti. Which is suitable with samprapti as Amavata is mainly due to vataand kapha disease. Majority of the signs and symptoms explained in our classics regarding Amavatawere observed in this study. But assessment is made only with subjective parameters i.esandhi shoola. Sandhi shotha, Jwara and stabdata which is mentioned in materials andmethods. All the thirty patients presented with subjective symptom sandhi shoola withvarying degrees before the treatment ( Table no 4.13). After the treatment Group C hasshown a marked result compared with other Groups i.e. 6 (60%) patients completelyrelived with sandhi shoola. Group A 5 (50%) patients and in Group B only 1 (10%)patients relived completely (Table 4.21). Even statistically it is proved that sandhi shoolais highly significant in Group C than A & B (Table No. 4.27). 108
  • 123. Efficacy of Shunti & Gokshura in Amavata The subjective parameter sandhi shotha is best responded in Group B & C with 7(70%) patients completely relived in both the groups (Table 4.22). As the Gokshura issaid to be shothahara which both the Groups contain. The subjective parameter Jwara presented with minimum degree before thetreatment in all the Groups (Table 4.17). Which responded well in both the Group A & Cwith 9 (90%) patients (Table 4.23). In which the main Shunti consists which is said asAgnideepaka. Amapachaka. The relief of stabdata is highly impressive of patients 8 (80%) of Group C Table4.24. Which have received both Shunti and Gokshura. The objective parameter Haemoglobin (Hb%) percentage shows highly significantin all the Groups (P<0.001) (Table no 4.25, 4.26, 4.27). The objective parameter Erythrocyte Sedimentation Rate (ESR) shows highlysignificant in all the 3 Groups where as the net mean effect in ESR is more in Group A.(Table 4.25, 4.26, 4.27). The objective parameter total leukocyte count (TC) is increased in some of thepatients with in the normal limits and in most of the patients the total leukocyte count isobserved as decreased in with in the normal limits. As mentioned in the materials and methods the RA test investigation andC-Reactive protein were under taken and the patients were selected irrespective of seropositive and sero negative. There is no change observed in serological examinationbefore and after the treatment. Radiological investigation was also undertaken in doubtful condition to excludethe patient from the study. 109
  • 124. Efficacy of Shunti & Gokshura in Amavata The overall effect of the therapies were assessed as complete remission, majorimprovement, minor improvement and not responded. (Table 4.35). From this clinical study it is quite obvious that combination of treatment asprovided in Group C that is Shunti Gokshura kwatha has got edge over the treatmentprovided in Group A (Shunti kwatha) and Group B (Gokshura kwatha) improvement inall the respect is observed specifically in subjective as well as objective parameters. As the result is found Group C showed 30% of patients as complete remission, ascompared with Group A (20%) and Group B (10%) respectively. And even majorimprovement is also not less (60%) in Group C as compared with Group A (70%) andGroup B (60%) respectively. In 10% of patients are observed as minor improvement ascompared with Group A (10%) and Group B (30%) respectively (Table 4.35).Overall response to the Shunti and Gokshura kwatha (Group C) was exceptionally best. 110
  • 125. Efficacy of Shunti & Gokshura in Amavata CONCLUSION1. Amavata can be correlated with Rheumatoid Arthritis of contemporary science with the vision of similarity in both pathophysiology as well as clinical manifestation.2. Shuntyadi (Shunti, Gokshura) kwatha has been recommended in Amavata by chakradatta.3. Shunti and Gokshura is an economical effective drug in Amavata without any substantial adverse effect.4. Three preparations of kwatha selected here for the study are found to be effective in Amavata. This has been proved here clinically with individual three Groups.5. Shunti kwatha (Group A) showed well response in Amavata with the objective parameters haemoglobin percentage and Erythrocyte sedimentation rate highly significant and among the subjective parameters sandhi shoola showed marked improvement.6. Gokshura kwatha (Group B) showed well response in Amavata with subjective parameter Sandhi shotha and Jwara shows highly significant.7. Anova test with sandhi shoola, sandhi shotha, jwara, stabdata, haemoglobin percentage, total count showed that difference in improvement noted with these parameters among the three different groups were statistically non significant.8. Comparing three groups individually Group C (Shunti Gokshura kwatha) showed much response than Group A (Shunti kwatha) and Group B (Gokshura kwatha) by using paired “t” test as P value is < 0.001 and ‘t’ values. 111
  • 126. Efficacy of Shunti & Gokshura in Amavata FUTURE PROSPECTIVE Though this work maximum efforts put to fulfill the subject and achieve the aimsand objective of the present project work. There is still a wide scope to a greater distanceof studies as follows. Ø Similar study carried with larger sample. Ø Similar study carried with more duration of treatment. Ø As the disease has wide range of symptoms one can assess the role of Shunti and the role of Gokshura in each of the symptoms. Ø The active components of Shunti and Gokshura can be detected with the help of Chromatography. 112
  • 127. Efficacy of Shunti & Gokshura in Amavata SUMMARY This study was formulated to evaluate the efficacy of Shunti and Gokshura inAmavata (Rheumatoid Arthritis) - A comparative clinical study.Ø The aims and objectives of the present study has been discussed.Ø The drugs Shunti and Gokshura were reviewed discussed and elaborated explained from the Ayurvedic and Modern literatures.Ø The definition, history, etiology, samprapti, laxana and treatment of Amavata according to the classics and also the definition, epidemology, etiology, Pathogenesis, clinical features and treatment of Rheumatoid Arthritis were reviewed in the study.Ø The study was conducted on 30 patients with Equally distributed in 3 Groups A, B & C. In Group A- Shunti kwatha was administered. In Group B Gokshura kwatha was administered. In Group C Shunti Gokshura kwatha was administered early morning for 30 days.Ø In this study incidence of age, sex, occupation. religion, economical status and diet incidents were highlighted in the observation.Ø Almost all the symptoms of Amavata reported in this study and showed response with all the groups.Ø Comparing 3 Groups individually Group C (Shunti Gokshura kwatha) showed much response than Group A (Shunti kwatha) and Group B (Gokshura kwatha) By using paired ‘t’ test as P value is <0.001 and ‘t’ values. BIBLIOGRAPHIC REFERENCES 113
  • 128. Efficacy of Shunti & Gokshura in AmavataSHUNTI 1. J.L.N. Shastry, Dravyaguna vijnana Vol- II. Ist ed. Varanasi: Chaukhamba Orientalia ; 2004. Pg 519. 2. Agnivesha, Charaka Samhita sutra sthana chapter 4 Sloka 6,11,12,18. Kashinatha shastri editor. 10th ed. Varanasi: Chowkhamba Bharati Academy; 1982. Pg 75,80,81,84. 3. Susruta, Susruta samhita sutra sthana chapter 38 Sloka 28,58. Kaviraj Ambikadatta shastri editor. 8th ed. Varanasi: Chowkhamba Sanskrit sansthan; Pg. 143,145. 4. Vagbhatacharya, Astanga sanghraha sutra sthana chapter 15 Sloka 11,12. Vaidya Shree Govardana Sharma chhanganee editor. 7th ed. Varanasi: Chowkhamba Sanskrit samstana; 1991. Pg 256. 5. Dhanvantari, Dhanvantari Nighantu shatapushpadi varga 2 sloka 82. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 85. 6. Madanapala, Madanapala Nighantu shuntyadi varga 2 sloka 2. Ramprasad patiyala editor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 65. 7. Pandit Narahari, Raj Nighantu pippalyadi varga sloka 24,25. Indradeo Tripathi editor. 2nd ed. Varanasi: Krishnadas Academy; 1998. Pg 138. 8. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 1150. P.V. Sharma editor. 1st ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 213. 9. Bhavamisra, Bhavaprakasha Nighantu Haritakyadi varga sloka 44. G.S. Pandey editor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 12,13. 10. Pandit Aryadasa kumar singh, Mahaushadha Nighantu mahaushadha varga 1 sloka 18,19. Shri Indradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 5. 11. Abhidana Ratnamala (Sadrasa Nighantu). Katu dravya skanda (Panchama skanda) sloka 9. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba orientalia; 1977. Pg 31. 12. Agnivesha, Charaka samhita sutra sthana chapter 27 Aharopayogi varga sloka 296. Kashinatha shastri editor. 10th ed. Varanasi: Chowkhamba Bharati Academy; 1982. Pg 560. 13. Susruta, Susruta sutra sthana chapter 46. Shaka varga sloka 226. Kaviraj Ambikadatta shastri editor. 8th ed. Varanasi; Chowkamba Sanskrit sanstana; Pg 203. 14. Vaghbata, Astanga Hrudaya sutrasthana chapter 6 sloka 161. Shrit Lalchandra Vaidya editor. 1st ed. Delhi: motilal Banarasidas Publishers; 1990. Pg 59. 15. Dhanvantari, Dhanvantari Nighantu shatapushpadi varga 2 sloka 83. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 85. 16. Madanapala, Madanapala Nighantu shuntyadi varga 2 sloka 3. Ramprasad patiyala editor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 65. 17. Pandit Narahari, Raj Nighantu pippalyadi varga sloka 26. Indradeo Tripathi editor. 2nd ed. Varanasi: Krishnadas Academy; 1998. Pg 138,139. 18. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 1151. P.V. Sharma editor. 1st ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 213. 19. Bhavamisra, Bhavaprakasha Nighantu Haritakyadi varga sloka 45. G.S. Pandey editor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 12,13. 20. Pandit Aryadasa kumar singh, Mahaushadha Nighantu mahaushadha varga 1 sloka 20. Shri Indradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 6. 21. Madhava, Madhava dravyagunah vividoushadi varga 1 sloka 49. P.V. Sharma editor. 1st ed. Varanasi; Chowkhamba vidyabhawan ; 1973. Pg 4. 22. Bapalal G. Vaidya, Nighantu Adarsha Uttarardha Adrakadi varga 110. 1st ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 569. 23. Agnivesha, Charaka samhita sutra sthana chapter 27 Aharopayogi varga sloka 296. Kashinatha shastri editor. 10th ed. Varanasi: Chowkhamba Bharati Academy; 1982. Pg 560. 114
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  • 130. Efficacy of Shunti & Gokshura in Amavata50. The Ayurvedic Pharmacopiea of India Vol-I. 1st ed. New Delhi: Published by Government of India. Ministry of Health and Family welfare. Department of Health. 1989. Pg 103-104.51. Dr. C.K. Kokate. Prof. Purohit. S.B. Gokhale, Pharmacognosy. 12th ed. Pune: Nirali prakashana; 1999. Pg 426.52. The Ayurvedic Pharmacopiea of India Vol-I. 1st ed. New Delhi: Published by Government of India. Ministry of Health and Family welfare. Department of Health. 1989. Pg 103-104.53. Dr. C.S. Shah and Dr. J.S. Qadry, A Text book of Pharmacognosy. 11th ed. Ahemedabad: B.S. Shah Prakashan; 1995-96. Pg 287.54. K.M. Nadakaranis, Indian Materia Medica Vol-I . A.K. Nadakarni ed. 3rd ed. Bombay: Popular Prakashan; 1982. Pg 1309-1310.55. K.R. Kirtikar B.D. Basu, Indian Medicinal Plants Vol-IV. 2nd ed. Dehra Dun: International Book Distributors; 1999. Pg 2436.56. Ibid.57. Ibid. GOKSHURA58. Agnivesha, Charaka Samhita sutra sthana chapter 4 Sloka 35,38. Kashinatha shastri editor. 10th ed. Varanasi: Chowkhamba Bharati Academy; 1982. Pg 89,91.59. Susruta, Susruta samhita sutra sthana chapter 38 Sloka 4,67. Kaviraj Ambikadatta shastri editor. 8th ed. Varanasi: Chowkhamba Sanskrit sansthan; Pg. 141,146.60. Vagbhatacharya, Astanga sanghraha sutra sthana chapter 15 Sloka 11,12. Vaidya Shree Govardana Sharma chhanganee editor. 7th ed. Varanasi: Chowkhamba Sanskrit samstana; 1991. Pg 256.61. Dhanvantari, Dhanvantari Nighantu Guducchadi varga 1 sloka 102. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 34.62. Madanapala, Madanapala Nighantu Abhayadi varga 2 sloka 58. Ramprasad patiyala editor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 11.63. Pandit Narahari, Raj Nighantu Shatavhadi varga sloka 40-42. Indradeo Tripathi editor. 2nd ed. Varanasi: Krishnadas Academy; 1998. Pg 69.64. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 68,69. P.V. Sharma editor. 1st ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 16.65. Bhavamisra, Bhavaprakasha Nighantu Guducchadi varga sloka 44-45. G.S. Pandey editor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 292.66. Pandit Aryadasa kumar singh, Mahaushadha Nighantu Bilvadi varga 3 sloka 19. Shri Indradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 109.67. Abhidana Ratnamala (Sadrasa Nighantu). Swadu skanda (Prathama skanda) sloka 38. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba orientalia; 1977. Pg68. Amarasimha’s, Amarakosha Vol-II. Vanoushadi varga 4 Sloka 99. Vishwnatha Ja editor. 2nd ed. Delhi; Motilal Banarasi Das; 1979. Pg 65.69. Pandit Narahari, Raj Nighantu Shatavhadi varga sloka 40-43. Indradeo Tripathi editor. 2nd ed. Varanasi: Krishnadas Academy; 1998. Pg 69.70. Dhanvantari, Dhanvantari Nighantu Guducchadi varga 1 sloka 103. P.V. Sharma editor. 1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 34.71. Madanapala, Madanapala Nighantu Abhayadi varga 2 sloka 59. Ramprasad patiyala editor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 11.72. Pandit Narahari, Raj Nighantu Shatavhadi varga sloka 43. Indradeo Tripathi editor. 2nd ed. Varanasi: Krishnadas Academy; 1998. Pg 69.73. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 69-70. P.V. Sharma editor. 1st ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 16. 116
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  • 133. Efficacy of Shunti & Gokshura in Amavata DISEASE REVIEW121.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by Sri Vijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part–I Chapter 25 sloka 1-5, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi: Chaukhamba Sanskrit sansthana; 2000. Pg 460-61.122.Raja Radha kantadeva, Shabda kalpa drooma. Part –I. 3rd ed. Varanasi: Chowkhamba sanskirt series; 1967. Pg 180.123.Sri Taranatha Battacharya, sabdastoma Mahanidi. 3rd ed. Varanasi: Chowkhamba Sanskrit series; 1967. pg 67.124.Vagbhata, Astanga Hradayam with sarvanga sundara commentary by Arunadatta and the vidyotini Hindi commentary by Artideva Gupta. Sutrasthanam Chapter 13 sloka 25. Priyavrat Sharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978. Pg 175.125.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by Sri Vijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part –I Chapter 25 sloka 1-5, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi: Chaukhamba Sanskrit sansthana; 2000. Pg 460-61.126.Ibid127.Ibid128.Agnivesha, Charaka samhita purva Bhaga Vimana Sthana chapter 2 sloka 11. Ayurvedacharya Shri Jayadeva Vidyalankara editor. 9th ed. 1986. Pg 320.129.Agnivesha, Charaka samhita uttarardha chikitsa stana chapter 15 sloka 42. Sri satya narayana sastri editor. 18th ed. Varanasi: Chaukhambha Bharati Academy; 1992. Pg 460.130.Vagbhata, Astanga Hrudayamm with sarvanga sundari commentary Sutrasthana Chapter 8 sloka 31-32. Shri.Lalchandra Vaidya editor.Delhi: Motilal Banarasidas publishers; 1st ed. 1990. Pg 75.131.Vagbhata, Astanga sangraha with sarvanga sundari commentary part I. Sutra stana chapter 11 sloka 19. Pandit lalchandra shastri Vaidya editor. 2nd ed. Nagapur: Shri Baidhyanatha Ayurveda Bhavana limited; 1981. Pg 471.132.Vagbhata, Astanga hrdaya with sarvangasundara commentary by Arundatta and the vidyotini hindi commentary by Atrideva Sutrasthanam. Chapter 13 sloka 17. Priyavarat Sharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978 Pg 175.133.Vagbhata, Astanga hrdaya with sarvangasundara commentary by Arundatta and the vidyotini hindi commentary by Atrideva Sutrasthanam. Chapter 13 sloka 23,24 priyavarat Sharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978 Pg 175.134.Vrudda Vagbhata , Astanga sangraha Arthaprakashika vyakya by Shri.Govardan Sharma Cchangani sutrastana Chapter 1. Shrit Yadavaji Trikamji Acharya editor. 11th ed. Varanasi: Choukhamba Sanskrit sansthana; 1996 Pg 9.135.Agnivesha, Charaka samhita purva Bhagah sutra stana chapter 12 sloka 3. Ayurvedacharya Shri Jatyadeva vidya lankara editor. 9th ed. Delhi: Motilal Banarasidas; 1986. Pg 93.136.Pandita Sharangadhara, Sharangadhara samhita Purva khanda Chapter 5 sloka 43. Dr. Brahmanand Tripathi editor. 1st ed. Varansi: Chaukhambha Surbharati prakasha; 1990. Pg 60.137.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by Sri Vijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part –I Chapter 25 sloka 1-5, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi: Chaukhamba Sanskrit sansthana; 2000. Pg 460-61.138.Ibid. 119
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  • 136. 13. CHIEF COMPLAINTS Sl. No. Complaints Duration Present Absent 01. Sandhi Shoola 02. Sandhi Shotha 03. Stabdata 04. Angamarda 05. Vrischika Damshavata Peeda 06. GouravaASSOCIATED SYMPTOMS Sl. No. Complaints Duration Present Absent 01. Jwara 02. Aruchi 03. Apaka 04. Trushna 05. Alasya14. HISTORY OF PRESENT ILLNESS :Mode of onset :Insidious Acute Systemic Oligo articularPoly articular Mono articular Symmetrical AsymmetricalSequence of joints involved -----------------------------------------------------------------------Aggravating factors --------------------------------------------------------------------------------Relieving factors ------------------------------------------------------------------------------------
  • 137. Nature of disease Progressive Regressive Constant IntermittentRoutine activities affected Mild Moderate Severe Not affected15. FAMILY HISTORY :16. TREATMENT HISTORY : Treatment Yes / No Duration Dosage Antibiotic / Pain killer Steroid External application17. PERSONAL HISTORY :a) Ahara : Vegetarian Mixed Viruddha Snighdhab) Jatharagni :Manda Teekshan Vishama Samac) Purisha pravritti :Vit Vibandha Drava Vit Prakrita Frequencyd) Mutra pravritti :Frequency Day Night Mootra Daha
  • 138. e) Nidra :Sukha Alpa Ati Vaishamyaf) Vyasana :Smoking Alcohol Tobacco No Habit18. GENERAL EXAMINATION :Pulse B. P Temp Resp. RateHeart Rate Height Weight19. ATURA BALA PAREEKSHA :A) Prakruti : V P K VP VK PK VPKB) Sara :Twaka Rakta Mamsa Meda Asthi Majja Shukra SatwaC) Samhanana : Pravara Madhyama AvaraD) Satmya : Pravara Madhyama AvaraE ) Satwa : Pravara Madhyama AvaraF) Vyayama Shakti : Pravara Madhyama Avara
  • 139. G) Vaya : Balya Youvana VruddhaH) Desha : Jangala Anupa Sadharana20. SPECIAL EXAMINATION OF JOINTS :I . Pain a) Mode of onset : Sudden Gradual b) Site : Localised Referred to other joints c) Character :Aching Throbbing Pricking d) Movement Aggravates Pain : Yes No e) Relation to weather :Worst in------------------ weather Aggravates in Full Moon No MoonII . Morning Stiffness :Present Absent 0 1 2 3III . Inspection : a) Any deformity : Present Absent b) Soft tissue swelling :
  • 140. c) Skin over joint :Redness Itching Glossiness Oedema d) Muscle wasting :Present Absent Above the Below the effected joint affected joint e) Rheumatoid nodes : Present AbsentIV . Palpation : a) Local temperature : Present Absent b) Maximum tenderness :Bone Ligaments Tendon sheath Other21. LAB INVESTIGATION : SL. NO. Name of the taste Values A. Blood 01. ESR mm for 1st hour. 02. Hb Mg % 03. Total count Per cms 04. Differential count of N E B M LB. Serological Test01. R . A . Test Positive Negative02. C. R. P. Positive Negative
  • 141. C. Urine test01. Albumin Present Absent02. Sugar Present Absent22. TREATMENT PROTOCOL :Dosage :23. ASSESMENT OF RESULT :SubjectiveSl. No. Complaints Before treatment After treatment 01. Sandhi Shoola 02. Sandhi Shotha 03. Jwara 04. StabdataObjectiveSl. No. Investigation Before treatment After treatment 01. Hb% 02. E S R mm of 1st hr 03. T L C ( WBC) 04. DLC 05. R A test24. INVESTIGATORS NOTE : Signature of ScholarSignature of Co-guide Signature Of Guide
  • 142. Grades of Subjective Parameters1. Sandhi Shoola (Pain) -O- No pain 1 – Pain but not difficulty in moving 2- Slightly difficulty in moving 3 – Much difficulty in moving2. Sandhi Shotha (Swelling)-O – No swelling 1- Slightly obvious 2- Covers well the bony prominence 3 – Much elevated so that joints seems grossly deformed3. Jwara [Fever] O- 98.60F 1- 98.70F –99.70F 2- -99.80F –100.80F 3-100.90F and above4. Stabdata [Morning Stiffness]-O-No stiffness 1-Stiffness within 1 hr 2- Stiffness 1-2 hrs 3- Stiffness for 2 + + hrs