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Preparation and Analytical Study of Bola Parpapti and Its Clinical Efficacy in Raktapradara” - Dr. Shakuntala. B. Saswihalli, Department of rasashastra, Post graduate studies and research center, Shri …

Preparation and Analytical Study of Bola Parpapti and Its Clinical Efficacy in Raktapradara” - Dr. Shakuntala. B. Saswihalli, Department of rasashastra, Post graduate studies and research center, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag

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  • 1. “Preparation and Analytical Study of Bola Parpapti and Its Clinical Efficacy in Raktapradara” By Shakuntala. B. Saswihalli. Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M.D. (RASASHASTRA) In Rasashastra Under the guidance of Dr. Dilipkumar B., M.D. (Ayu) Post graduate department of Rasashastra, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag – 582103. 2006.
  • 2. Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis en-t i t l e d “ P r e p a r a t i o n a n d t h e A n a l y t i c a l St u d y o f B o l aP a r p a t i a n d i t s C l i n i c a l E f f i c a c y i n R a k t a p r a d a r a ” is abonafide and genuine research work carried out by me un-der the guidance of Dr. Dilipkumar B. M.D. (Ayu) , Asst. Profes-sor, Post-graduate department of Rasashastra.Date:Place: Gadag. Shakuntala. B. Saswihalli
  • 3. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled“Preparation and the Analytical Study of Bola Parpati and itsClinical Efficacy in Raktapradara ” is a bonafide research workdone by Shakuntala. B. Saswihalli in partial fulfill-m e n t o f t h e r e q u i r e m e n t f o r t h e d e g r e e o f Ay u r v e d aVachaspathi. M.D. (Rasashastra).Date:Place: Gadag Dr. Dilipkumar, M.D. (Ayu). Asst. Professor Post graduate department of Rasashastra.
  • 4. ENDORSEMENT BY THE H.O.D AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled“Preparation and the Analytical Study of Bola Parpati andits Clinical Efficacy in Raktapradara ” is a bonafide researchw o r k d o n e b y Shakuntala. B . S a s w i h a l l i u n d e r t h eguidance of Dr.Dilipkumar, M . D . ( Ay u ) , Asst. Professor, Post-graduate department of Rasashastra. Dr. M.C. Patil, M.D. (Ayu) Dr. G. B. Patil. Professor & H.O.D, Principal.Post graduate department of Rasashastra.Date : Date :Place : Gadag. Place : Gadag.
  • 5. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University ofHealth Sciences, Karnataka shall have the rights to preserve,use and disseminate this dissertation / thesis in print or elec-tronic format for academic / research purpose.Date: Shakuntala. B. SaswihalliPlace: Gadag© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 6. I ACKNOWLEDGEMENT I bow to the “SUPREME SOUL” who graced Adi Madhya and Antya throughOM vibration to human kind. I bow to OMKARA which makes us to realize the“SUPREME SOUL” I bow to God who graces his blessings in the form of love andaffection through Gurus, Father Mother, Elders Youngers etc. I express my deep sense of gratitude to respected Dr. M.C Patil M.D. (Ayu) Professor,Head of the Department, Department of post Graduate studies and Research Rasashastra,D.G.M.A.M.C Gadag. He has been very kind to guide me in research and for whoseextraordinary efforts, tremendous encouragement and most valuable advice made me tocomplete this work. I express my obligation to my guide Dr DilipKumar B. M.D.(Ayu) Asst Prof in theDepartment of Rasashastra, P. G. A. R. C., D. G. M. A. M. C., Gadag for tremendousencouragement and thought provoking advice to complete this thesis. I express my deep sense of gratitude to Dr. Girish N. DanappagoudarM.D.(Ayu) andDr. Jagadish Mitti M.D.(Ayu) Lecturer Department of Rasashastra P.G.A.R.C D.G.M.A.M.CGadag for his constant encouragement and support throughout my P. G. studies. With profound sense of gratitude I express my sincere thanks to Dr G. B. PatilPrincipal D.G.M.A.M.C Gadag for encouragement and facilities provided during mypostgraduate studies. I am very much thankful to Dr Shashidhar H Doddamani M.D.(Ayu) , Dept ofPanchakarma for this valuable suggestions and support through out this study It is with deep sense of gratitude and regard that I acknowledge to my husbandDr. Prabhakar S. Biradar who was the root cause of my entry into this Post-graduationI remain ever great-full to him.
  • 7. II I wish to add my warmest thanks to my P.G. Teaching faculty Dr. K. Siva RamaPrasad, Dr. R.V Shettar, Dr. Kuber Sankh, Dr. Mulkipatil, Dr. Santosh N. Belavadi,Dr. Nidagundi and for their valuable suggestions and timely help which made me tocomplete this dissertation work successfully I am very much thankful to Dr. R. V. Gachinamath, Dr. V. M. Sajjan and Dr. B.G. Swami and all the U. G. staff for encouragement and moral support during the study. I am thankful to Sri B.S Tippangouda, Laboratory technician who extended hisco-operation in investigations. I extend my gratefulness and sincere heartfelt gratitude to my colleagues Dr.Santoji Dr. Koteshware, Dr. Pattanshetti, Dr. Jaggal, Dr. V.S. Hiremath, Dr. Ganti Dr.Pradeep, Dr. Sobagin, Dr. Suvarna, Dr. Anita, Dr. Anand, Dr. Sharanu, Dr. Teggi andDr. M.S. Hiremath, Dr. Jayashree, Dr. Suma K., Dr. Rudrakshi, Dr. Kattimani and otherscholars of Kayachikitsa Panchakarma and Dravyaguna Department for their timelysupport during the study. With due respect I convey my heartiest thanks to Dr Poornima Pyati for Dr.Jadar their moral support and suggestions through out this study I am very much thankful to college librarian Shri V. M. Mundinmani and otherLibrary staff for their timely help and co-operation during the study. I am very much thankful to my parents, brothers, Father-in-law and mother-in-lawand brother-in-law who inspired me for higher studies through rendering their valuablesuggestions and encouragement throughout the study. I wish to thank R.M.O. Dr. S. D. Yeargeri and L. M. O. Dr. Jayashree Physiciansand other hospital staff for their co-operation and all the patients who agreed to under gothe treatment with trial drug. I wish to thank all the persons who have helped me directly and indirectly withapologies for my inability to identify them individually.Date :-Place :- Gadag. (Dr. Shakuntala B. Saswihalli.)
  • 8. III ABBREVIATION1) A.H. - Ashtanga Hridaya2) A.P - Ayurveda Prakash3) A.S. - Ashtanga Sangraha4) A.T. - After Treatment5) B.R.R.S - Brihat Rasa Raja Sundara6) B.P. - Bhavaprakash Nighantu7) B.T. - Before Treatment8) Ch.S - Charaka Samhita9) D.N. - Dhanvantri Nighantu10) K.N. - Kaideva Nighantu11) M.N. - Madhava Nidhana12) R.A - Rasamritam13) R.C - Rasendra Chintamani14) R.CL - Rasendra chudamani15) R.J.Ni - Rasa Jala Nidhi16) R.N. - Raja Nighatu17) R.K. - Rasa Kamadhenu18) R.P.S - Rasa Prakash Sudhakara19) R.R.S - Rasaratna Samachchaya20) R.S.S. - Rasendra Sara Sangraha21) R.T - Rasa Tarangini22) S.S. - Sushruta Samhita23) - - Not mentioned24) + - Mentioned.
  • 9. IV ABSTARCT The gynaecological health of a woman depends to a large extent on the normallyor other wise on her menstrual cycle. Though the causes of menorrhagia are various yetDUB is one of the common complaints. The therapeutic options in addition to medicaltreatment is use are varied and confusing. The lack of effective reversible treatment (longterm) have been a problem. Our treaties have described a variety of treatment options inthe management of Raktapradara. The importance of Bola Parpati has been emphasizedin all Raktasrava rogas. It is the need of the hour evaluate the efficacy of this formulationObjectives : The present study was planned with the following aims and objectives • Preparation of Bola parpati. (Yogaramakara) • Analytical study of Bola parpati. • To study the clinical efficacy of Bola parpati in the selected cases of Rakta pradara.Methods : Pharmaceutical study • Hingula shodhana was done. (Rasatarangini) • Gandhaka shodhana was done. (Rasamrita) • Hingulakrista parada was done. (Ayurveda Prakash) • Kajjali was prepared. (Rasatarangini) • Bola was added to Kajjali and mardana done • According to classical references Bola parpati was prepared.
  • 10. VAnalytical Study Bola parpati was analyses by Physico-chemical parameters, which includeAuthentication of Bola, determination of Volatile oil Percentage, Organoleptic characterslike colour, odour etc and pH value, fineness of particles, flow rate, disintegration test,essay for elements. Clinical Study : Patients of Raktapradara with confirmed diagnosis were receivedBola parpati for 45 days. Improvements results were recorded every 15th daysobservations were recorded before and after treatments and statistically analyzed.Results : 1. Bola parpati prepared by following the classical method is proved to be genuine one. 2. Bola parpati is proved that it reduces the symptoms of Rakta pradara, which is confirmed by the value of the subjective and objective parameter. All the 10 patients were treated in a single group and observations were recorded and statistically analyzed.Interpretation And Conclusion 1. By Observing values of subjective and objective parameters and statistical analysis of Bola parpati can be proved as one of the best formulation for Rakta pradara. 2. The values are almost under normal limits according to confirmation tests of Physico-chemical analysis of Bola parpati.Key Words :- Rakta pradara, Dysfunctional Uterine bleeding, Bola parpati, Hingula,Hingulakrista Parada, Gandhaka, Kajjali, Bola shodhana, Parpati paka, Physico-chemicalAnalysis, Subjective and Objective parameters, Ultra-sonography.
  • 11. VI CONTENTS Page No.1. Introduction 1-32. Objectives 4-43. Literary review 5- a) Parpati Kalpana b) Drug Review c) Disease review4. Methodology a) Pharmaceutical Study b) Analytical Study c) Clinical Study5. Observation and results6. Discussion7. Conclusion8. Summary9. Bibliography10. Annexure
  • 12. VII LIST OF TABLESTable Showing the Page No. No. 01. Ingredients of different parpati kalpanas 9 02. Therapeutic uses of different parpati kalpanas 10 03. Synonyms of Hingula according to different authors 12 04. Varga of Hingula according to different authors 14 05. Bheda of Hingula 15 06. Rasa of Hingula according to various texts 16 07. Doshaghnata of Hingula according to various texts 17 08. Synonyms of Parada 20 09. Varieties of Parada depending on colour 22 10. Varieties of Parada depending upon the place of origin 22 11. Ores of Parada along with chemical composition 23 12. Synonyms of Gandhaka 27 13. Gandhaka shodhana according to different authors 31 14. Therapeutic uses of Gandhaka according to different authors 32 15. Synonyms of Bola 42 16. Therapeutic uses of Bola according to different authors 43 17. Description of menstrual pattern 61 18. Features of normal Rajasrava 64 19. Description of pelvic pathology 73 20. Systemic causes of DUB 73 21. Classification of DUB 74 22. Ovulatory DUB with the altered cycle length 75 23. Role of eiscosinoids 77 24. Vishesha lakshana of Raktapradara 82 25. Medical hormonal and non-harmonal treatment 87 26. Pittaja Yonivyapat 89 27. Differential diagnosis of DUB 90 28. Result of Hingula shodhana 93 29. Quantity of Hingula before and shodhana 93 30. Results of Hingula shodhana 94 31. Result of extraction of Parada 96 32. Result of Gandhaka shodhana 98 33. Distribution of patients by Age 113 34. Distribution of socio Economic status 114
  • 13. VIII35. Distribution of patients by Domicile 11536. Distribution of the patients by Educational state 11537. Distribution of the patients by Dietary habits 11638. Distribution of the patients by Predominance of Rasa 11739. Distribution of the patients by Occupation. 11740. Distribution of the patients by Mental stress 11841. Distribution of patients by Body build 11942. Distribution of patients by Prakriti 11943. Distribution of patients by Aharashkati 12044. Distribution of patients by Abhyasa (Addiction) 12145. Distribution of patients by Vyayama shakti 12146. Distribution of patients by Vyavaya shakti 12247. Distribution of patients by Bowel habit 12348. Distribution of patients by Past history 12449. Distribution of patients by Marital status 12450. Distribution of patients by Parity 12551. Distribution of patients by History of abortion 12652. Distribution of patients by Use of contraception 12653. Distribution of patients by Chronicity 12754. Distribution of patients by Menstrual bleeding 12855. Distribution of patients by Abdominal pain 12956. Distribution of patients by Pradhana vedana 13057. Distribution of the patients by Anubandhi vedana 13158. Distribution of the patients by Hb% 13159. Distribution of patients by Bleeding time 13260. Distribution of patients by Clotting time 13261. Distribution of patients by Platelet count 13262. Distribution of patients by degree of menstrual bleeding before and 133 after the treatment63. Distribution of patients by degree of blood loss before and after the 134 treatment64. Distribution of patients by degree of consistency before and after 134 the treatment65. Distribution of patients by degree of abdominal pain before and 135 after the treatment66. Distribution of patients by degree of anubadhi vedana before and 136 after the treatment67. Distribution of patients by Hb% before and after the treatment 136
  • 14. IX 68. Distribution of patients by bleeding time before and after the 137 treatment 69. Distribution of patients by clotting time before and after the 137 treatment 70. Distribution of patients by platelet count before and after the 138 treatment 71. Statistical analysis of parameter before and after treatment 139 72. Overall result of the treatment 140 73. Depreciating overall assessment of the response to “bola parpati” 141 based on assessment criteria 74. Master chart showing demographic data 142 75. Master chart showing the subjective parameters 143 76. Master chart showing the objective parameters 144 LIST OF GRAPHSGraph No. Showing the Page No. 01. Distribution of patients by Age 113 02. Distribution of socio Economic status 114 03. Distribution of patients by Domicile 115 04. Distribution of the patients by Educational state 116 05. Distribution of the patients by Dietary habits 116 06. Distribution of the patients by Predominance of Rasa 117 07. Distribution of the patients by Occupation 118 08. Distribution of the patients by Mental stress 118 09. Distribution of patients by Body built 1119 10. Distribution of patients by Prakriti 120 11. Distribution of patients by Aharashkati 120 12. Distribution of patients by Abhyasa (Addiction) 121 13. Distribution of patients by Vyayama shakti 122 14. Distribution of patients by Vyavaya shakti 123 15. Distribution of patients by Bowel habit 123 16. Distribution of patients by Past history 124 17. Distribution of patients by Marital status 125 18. Distribution of patients by Parity 125 19. Distribution of patients by History of abortion 126 20. Distribution of patients by Use of contraception 127 21. Distribution of patients by Chronicity 128 22. Distribution of patients by pattern of Menstrual bleeding 128 23. Distribution of patients by Abdominal pain 129 24. Overall response 140
  • 15. X LIST OF FLOW CHARTSFlow chart Showing the Page No. No. 01. Showing the formation of Raja 63 02. Showing Artava nirmana 64 03. Schematic representation of menstrual abnormalities 70 04. Involvement of pschycological factors in menstrual 71 irregularities 05. Involvement of Raktavaha srotas in Raktapradara 71 06. Raktapradara Samprapti 72 07. Pathogenesis in DUB 76 08. Post-menopausal uterine bleeding 76 09. Normal physiology of menstruation 78 10. Pathogenesis of Menorrhagia 78 11. Pathogenesis of Menorrhagia 79 12. Pathogenesis in endometrium 79 13. Pathogenesis in Menorrhagia 80 14. Normal physiological consequences of Menstruation 80 LIST OF PHOTOGRAPHS Photograph No. Showing the 01. Ingredients and Preparation of Bola Parpati
  • 16. The preparation and analytical study of Bola parpati was carried out as per theplans designed and presented in the synopsis presented. Bola used in this studied wascollected after a through market search and research. Bola parpati was taken from thereference Yogaratnakar and was prepared as per the Rasashastra siddhanta. Rasavaidya padhathi is a unique system of treating the Vyadhi as it adopts a novelapproach to the management of Vyadhis. Unlike the Kayachikitsaka who generallyfollows Charaka and other Brihatrayies, which advocate the Dashavidha pareeksha andDashavidha pareeksha bhavas clinical study of a Rasayaga needs to be executed by astudent of Rasashastra as Rasavaidya vruthi is their right and duty Rasoushadhis play an important role in the medicine. As it has been stated inmany Rasashastra treaties that, mercury kills the diseases and death. When it is itself inthe state of Murchitavastha. Hence Rasoushadhis have been termed as Daivabhaishajya.Churna, Sneha, Kashaya has been called Manusha bhaishajya and Shastra; Ksharas areplaced as an Asura bhaishjya. Therefore it is rightly stated by Rasa siddhas that. “Uttamo Rasavaidhyastu Madhyamo Mulikadhibihi | Adhamaha Shastra dahabhyamithan Vaidhyam Tridha Mathoh ||” The Rasouhadhis are administered in a smaller dose not reduced acceptability andgiving quicker relief. They have longer durability and enhanced properties of main drug.Indian philosophers say that Kastoushadhis are used in curable disease but Rasushadhisare used in curable as well as incurable diseases also. That is why Rasoushadhis areconsidered as most potent among the Bhaishajya. 1 Introduction
  • 17. Among the Rasoushadhis Parpati Kalpana is one of the Therapeutic modes ofpresentation of Rasashastra. Parpati is the pota bandha of parada and is one of the bestexamples of sagandha murchana. Parpati was first introduced by Chakrapanidutta (11thCentury AD) for Grahini Chikitsa through his famous book “Chakradutta.” Later on ShriVatsanka elaborated the Parpati nirman and used Parpati extensively. Parpati is considered as Papad like preparation having very similar physicalcharacteristics i.e., it produces a specific sound on breaking, flat flakes, fresh on bothsides. In most of the Rasa granthas like Yogaratnakar, Rasachandamshu, Bharatbhaishajya ratnakar etc., the yoga “BOLA PARPATI” is explained as acting on Raktapradara Rakta pitta, Raktarsh, and Raktatisara rogas. In all the stated diseases Bolaparpati stops the bleeding immediately. The treaties like Ayurveda Prakash, RasendraSambhav, Bhav Prakash, Kaiyadev Nighantu etc., have explained that Rakta bola exhibitsthe Raktasthambana property chiefly. As Bola parpati contains parada and gandhakaalong with Rakta bola, it falls under the herbo-mineral category. The literature regarding Rakta pradara is reviewed in order to fulfill the objectiveof the study. 10 diagnosed cases of Raktapradara were incidentally selected and anobservation study was made. All the 10 patients were treated with Bola parpati for 45days. Before and after the treatment observation were done at the completion of thestudy. Observational data was scrutinized and results were obtained by statisticallyanalyzing the data given to subjective and objective findings before and after thetreatment. 2 Introduction
  • 18. It also includes Bola parpati pareeksha according to classical treatises andphysical and chemical characteristics according to mode of pharmaceutical chemistry.After discussing the result and presenting the data. We have finally come to certainconclusions. Statistical analysis revealed a highly significant response in the reduction ofsymptomatology and bleeding. DUB is the most frequent gynaecological problem. It may present as irregularbleeding or excessive cyclical bleeding. Normal menstrual cycle has been defined as amean interval of 28 days (+7days) with duration of 4 days (±2-3days) & the averageamount of blood loss is 30 ml per cycle with upper limit of normal at 60-80 ml.Therefore bleeding occurring at an interval of less than 21 days, for more than 7 days &more than 80 ml is considered abnormal. Here the aim of the study is clinical evaluation of Bola parpati in Rakta pradarawith special reference to Dysfunctional uterine bleeding disease related to reproductivesystem. Previous work Published in relation to the subject Standardization toxicity and clinical trial of Bola parpati in certain disease By DrShanthabai. K., Govt. Ayurvedic College, Kerala University, Tiriruvanthapuram. 3 Introduction
  • 19. The Present study was planned with the following aims and objectives.Preparation of Bola parpati.Analytical study of Bola parpati.To study the clinical efficacy of “Bola parpati” in the selected cases of Raktaparadra. 4 Objectives
  • 20. PARPATI KALPANA “Parpati” has many meanings; one of the common understandings is the8thParada Bandha.1 It also refers to one of the Sapta kanchuka doshas2 and one amongthe Chaturvidha parada kalpanas. Parpati kalpana has some special interest, as almostParpati kalpanas are Kajjaliyukta preparations, which helps in binding other drugs presentin various Parpati. As an exception some Parpati kalpanas are Kajjali rahita preparationse.g. Shweta parpati. Now coming to salient features of Parpati, we have a classical conclusion aboutthe shape and nature of final product i.e. product must be flake like after cooling3 and canalso be powdered Agni is the most important factor to be considered before starting treatment withspecial care. Since medicine will also make Ama due to Mandagni. Anatragni iscausative factor, which supply for mahasrotas. Due to the inhibition of Agni the ingestedfood is not properly digested. Acharya refers the etiological factor of Amadosha are dieticand psychological mistakes such as errors in mode of feeding, emotional disturbancesetc., important of parpati yogas are in this context. They are Rasa parpati, Swarnaparpati, Panchamrita parpati, Vijaya parpati etc are narrated in Grahani roga Prakarana4They rehabilitate the deranged agni. Most of the Parpati are related to Grahani roga,though they have some other marked achievements. Parpati is a drug of choice in Grahani and chronic Atisara. It is said that Parpatistrengthens the musculature of intestine, improves the retaining characters of the intestinethus useful in Grahani and Atisara5. Some exceptions are in it, they are Shweta parpatiand Bola parpati etc., Shweta parpati is indicated for Mootrakricchra, Mootraghata,Ashmari, Chardi, Amlapitta6, and Bola parpati is in Raktapradara7, Raktapitta7,Raktatisara, Raktayaarsha. 5 Parpati Kalpana
  • 21. Now coming to the preparation the drugs mentioned, as ingredients must bepurified accordingly, special purification mentioned deserve special interest. Ratio ofingredients and other factors for preparation such as equipments and optimum conditionsmust be stratified in full extent.For Preparation of parpati three stages are mentioned. Samanya and Vishesha sodhana of ingredients Preparation of Kajjali. Preparation of parpati. In general Shodhita parada and Gandhka are first triturated to make Kajjali, in theprescribed proportions. Genuiness of kajjali depends on Nischandratwa, Masrinatwa andKajjalabha, which are the essential conditions. Then fine powder of other drugs aremixed with it and triturated well In third step a small portion of above is taken in an iron pan, which is previouslycoated with Ghee and heated on Mandagni. After uniform melting quickly transfer thecontents to a clean Kadali patra placed on Gomaya bed. Then cover it with anotherKadali patra and keep some more Gomaya. Press gently & allow to cool8. After perfectcooling, collect the parpati, which is flaking, like which is black or dark brown in colour,it should be thick and as thin as possible. Then it is dried and powdered9 and stored inairtight glass container. The Process of preparing parpati involves melting of Kajjali along with otherdrugs some times and cooling it suddenly, to bring it to solid state. It is claimed that byusing Kadali patra in Gomaya is the process makes it more potent. It is said that theKashaya property of Kadali patra, which is transferred to parpati, which is useful in 6 Parpati Kalpana
  • 22. Grahani, similarly the Pitta available in Gomaya is absorbed in to parpati through Kadalipatra in the presene of heat. This would help in enhancing the Pitta component ofJatharagni. However the Patra may also help in the process sudden cooling where as theGomaya bed acts as cushion. Ghee lubricates and parpati would not stick to the patra10.PAKA LAKSHANA OF PARPATI There are various stages during the preparation of parpati. But the therapeuticallyimportant stages are divided mainly in to three. They are Mridu, Madhya and Khara,where as the formers two are therapeutically valuable and the latter are unfit and waste11.A brief description of these stages is given below.Mridupaka Lakshana12 : The Salient characters are it is in waxy state a soft and can be bends if bent,smooth & have shiny appearance.Madhyapaka Lakshana12 : In Madhyapaka hardness is some what increased and have impression of leafvenation in it. Breaking is with ‘Crackling’ noise and surface is not shining.Kharapaka lakshana12 : Instead of parpati, it will become red colour choorna. The entire product isuseless. The Madhyapaka is the best parpati with blackish luster and smooth surface isconsidered to be proper. 7 Parpati Kalpana
  • 23. Special precautions : ⇒ Ingredients must be free from moisture & should be genuine samples. ⇒ They should be shuddha. ⇒ The earthen pot or steel pan used should be dried. ⇒ Keep the product in moisture free containers as far as possible. ⇒ Keep the powder in air tight bottle only otherwise it will show deliquescent nature ⇒ Constant stirring is necessary till the ingredients are totally liquefied. ⇒ The final product should be powdered in a totally dried mortar. ⇒ When Nischandratva & Masrina, Kajjalabha appear stop trituration. ⇒ All the contents are stirred well during melting. ⇒ Melting should be done without smoke and charring. ⇒ The moment kajjali uniformly melts; suddenly pour it on to a kadali paltra. ⇒ Fresh Gomaya should be used. ⇒ Collect parpati only after Swangasheeta. ⇒ Keep this powdered sample away from light. ⇒ Look for Samyak ganda varna. ⇒ Kharapaka parpati should be discarded.Pathya Pathyam : About Pathyapathyam a unique opinion exists among Acharyas, that is old shali,wheat, barley, juice of sweat fruits, milks, buttermilk etc are Pathyas specified.13Sour things, pickles, seasame oil, blackgrams, mustard, hot things, cold food, cold wind,long journey suppression of mental business, sexual matters should be avoided.14 8 Parpati Kalpana
  • 24. Table No. 01. Showing ingredients of different Parpati Kalpanas. Ingredients Parpati Kalpanas Rasa Gagana Loha Swarna Pancha Vijaya Tamra Shweta Bola Sheetala Malla Pranada Parpati Parpati Parpati Parpati mrita Parpati Parpati Parpati Parpati Parpati Paarpati Parpati ParpatiParada + + + + + + + - + - - +Gandaka + + + + + + + - + - - -Swarna - - - + - + - - - - - -Tamra - - - - + - + - - - - -Loham - - + - + - - - - - - +Rajata - - - - - + - - - - - -Vaikranta - - - - - + - - - - - -Mukta - - - - - + - - - - - -Suryakshara - - - - - - - + - + - -Sphatika - - - - - - - + - - - -Navasadara - - - - - - - + - - - -Abhraka - + - - + - - - - - - +Bola - - - - - - - - + - -Vatsanabha - - - - - + - - - - +Gandhakamla - - - - - - - - - + - -Safed Rala - - - - - - - - - - + -Somala - - - - - - - - - - + -Naga - - - - - - - - - - - +Vanga - - - - - - - - - - - +Mareecha - - - - - - - - - - - +
  • 25. Table No. 02. Showing therapeutic uses of different Parpati Kalpanas. Ingredients Parpati Kalpanas Rasa Gagana Loha Swarna Panchamrita Vijaya Tamra Shwetha Bola Sheetala Parpati Parpati Parpati Parpati Parpati Parpati Parpati Parpati Parpati ParpatiAgnimandya + + + + + - + - - -Grahani + + + - + + + - - -Atisara + + + + + + + - + -Jwara + - + - + + + - - -Pandu + + + + - + + - - -Rajayakshma + + - + + + + - - -Pleehavriddhi + - + + - + + - - -Shoola + - + + - + + - - +Kasa + + - + - - + - - -Shwasa - + - + - - + - - -Kamala + - + - - + - - - -Kusta - - + - - - + - - -Arshas + - - - + + - - + -Jalodara + - - - - + - - - -Amlpitta + - - - - + - + - +Chardi - - - - - + - + - -Prameha - - - + - + - - - -Mootrakrichra - - - - - - - + - +Ashmari - - - - - - - + - -Shweta Pradara - -- - - - - - + - -Rakta Pradara - - - - - - - - + -Rakta pitta - - - - + - - - + -Sutika roga - - + - - - - - - -Amavata - - + - - - - - - -Bhasmaka - - + - - - - - - -Krimi - - - - - - + - - -Valiphalita - - - - + + - - - -Netra roga - - - - + - - -
  • 26. HINGULAIntroduction Rasahastra is a science, which deals with the Rasadravyas. Here, Rasa meansParada, which is ones of the major ingredients of majority of Rasayogas hence, the name,Rasashastra. Parada that is collected from market it has to under go the Samskaras.Ashtasamskaras are tedious & time-consuming procedure. Usage of improperly purifiedParada cause serious ill effect. So to avoid the toxicity & tedious process ofAshtasamskara is an alternative method as per Rasa classics should be adopted which isless time consuming and free from toxic effects. This can be achieved by Hingaulotha parada this is said to be free from all typesof impurities and equal to Astasamskarita parada. The name Hingulotha parada suggeststhat Parada is extracted from Hingula. So we should give prime importance to goodquality of Hingula. Thus Hingula, which is obtained from market, should be screened forclassical Grahya & Agrahya laxanas. 11 Hingula
  • 27. SynonymsTable No 03. Showing the synonyms of Hingula according to different authors.Sl.No Synonyms R.T R. Sa.Sn A.P R.A D.N R.A K.N 1. Hingulam - - - - - - - 2 Hingul + - - - - - - 3 Hingula + + + + - + - 4 Ingula + - - - - - - 5 Hingulaka - - - - - - + 6 Mleccha + - + - - - + 7 Rakta + - + - - - + 8 Gairika + - - - - - + 9 Suranga + - + - - - + 10 Chitranga + - - - - - + 11 Churna + - - + - - Parada 12 Rasodbhava + - - - + - - 13 Rasasthana + - - - + - - 14 Ranjana + - - - - - - 15 Kupishirshaka + - - - - - - 16 Raktakaya + - - + - - - 17 Hamsapada + - - - - + + 18 Darada + + + - - - - 19 Barbara - - - - - - - 20 Shuka tunda - - - - - - 21 Jati - - - - - + 22 Rasagandhasa - - - - - - - mbhuka 23 Daitya - - - - - - - raktaka 24 Maraka - - - - - - - 25 Maniroga - - - - - - + 26 Rasagarbha - + + - + - - 27 Charmanu - - - - - - - Ranjana 28 Atirakta - - - - - - - 29 Parvata - - - - - - + 30 Saikta - - - - - - + 12 Hingula
  • 28. Vernacular names English name – Cinnabar. Scientific name – Red sulphides of Mercury Sanskrit – Hingula Darada. Hindi – Hingula, Singraph. Bengal – Higula. Marathi – Hingula. Gujarathi – Hingualo. Assam – Janjapher. Pharsi – Sangarph. Kannada – Ingulika.Historical BackgroundVedic Period No references about Hingula are available in any of the Vedas.Samhita kala No reference available in Charaka, Sushruta, Astanga sangraha & AshtangaHridaya. The author of Kautilya Arthashastra Chanakya has mentioned Hingula in this textfor the first time. He mentioned it for testing various metals. He was using this fortesting the suvarna the uses of Hingula as a medicine was not described by him16. In Samhita kala, there were no references for Hingula but we get reference ofParada. It is assumed that in olden days, it was imported from other countries. 13 Hingula
  • 29. According to history of oldest text of Rasashastra Rasendra Mangala. We get thereference of Hingula. Here he used the word Darada for Hingula.17 Rasahridayatantrakara mention, it is one of the Rasadravya.18 Author of Rasarnava considered,19 as itis one of the Maharasa dravya. While describing synonyms by Rasendrasara sangraha,mentioned it as Rasagandhaka sambhoota for Hingula. From this word it shows that theywere aware of chemical composition of Hingula.20 The usage of Hingula as a medicinestarted between sixth & eight century.Inclusion of Hingula Different authors of various Rasa Granthas have included Hingula under thevarious titles. The Classification of all Rasa dravyas done generally according to their usage andimportance in the procedure related with Parada. The important Rasa texts have includedHingula under following classes.Table No. 04. Showing the hingula included under following classes as in different texts. Dravya Rasa Maharasa Uparasa Sodharasrasa Hingula Rasahridaya Rasarnava22 Anandakanda23 Rasajala nidhi27 Tantra21 Rasendrasara Rasendra Sangraha24 chudamani28 Brihatrasaraj Rasaprakash Sundara25 Sudhakara29 Ayurveda Rasaratna prakash26 Samuchaya30 14 Hingula
  • 30. Hingula Bheda No description about Varieties of Hingula is available in Rasendra Mangala &Rasa Hridayatantra. But we get reference of Hingula bheda in other texts.Table No. 05. Showing the bheda of Hingula.Sl No. Name of Text Charmara Shukatunda Hamaspada Anya 1 Ananda Kanda31 + + + - 2 Radendra - + + - 32 Chudamani 3 Ayurveda Prakash33 + + + - 4 Rasaratna - + + - 34 Samuchaya 5 RasaPrakash - + + - 35 Sudhakara 6 Rasatarangini36 - - - Kritima Khanija 7 Rasamrita37 - - + MlechhaAshuddha Hingula dosha If ashuddha Hingula is consumed it causes –Moha, Prameha, Chittavibhrama,Andhyata, Klama, Kshaunya and this directs to use always Shodhita HingulaShodhana of Hingula Various shodhana methods are explained in different classics, according toavailability, cost efficacy and medicinal formulations.1) Hingula should be given Bhavan of Mahisha dugdha subject to mardana with amla rasa dravyas392) Keep Hingula in kushmanda khanda, do potalli & give swedana in Lakucha swarasa poorita dolayantra40 15 Hingula
  • 31. 3) Subject 7 bhavanas of adraka swarasa and Lakucha swarasa414) Subject 7 bhavanas of adraka swarasa.425) Subject 7 bhavana of Nimbu swarasa 43Satrvapatana Shodhita Hingula is smeared in the upper part of Adhahpatane yantra, water isfilled in lower vessel. This apparatus is placed in the earth. Give heat to the upper vessel.We get Parada samana satura in lower vessel.Hingula Properties Rasa:-Various opinions are available regarding the Rasa of HingulaTable No. 06. Showing the Rasa of Hingula according to various text.Sl. No. Author Madhur Tikta Kashaya Katu 1. Dhanwantari Nighantu + + - - 2 Raja Nighnatu + + - - 3 Ayurveda prakash - + + +Guna Most of the texts considered Hingula as Ushna guna. yukta dravya.Veerya & Vipaka No Rasashashtriya text had mentioned veerya & vipaka of Hingula, through theDhanwantari nighantu being the text of Dravya guna vignana has mentioned Hingula ishaving the Ushna veerya & Katu vipaka.Doshakarma Even though almost all the authors enormously agree the tridoshaghna karma ofthe Hingula, by some of the texts mention either Kaphaghna or Kapha pittaghna action ofHingula as well. 16 Hingula
  • 32. Table No. 07. Showing the Dosaghnata of Hingula to various texts.Sl. No. Author Kaphaghna Kaphapittahna Tridoshaghna 1 Rasatarangini + - - 2 Ayurveda prakash - + - 3 Rasendra Chudamani - - + 4 Rasamrita - - + Rasaratnasamucchaya has quoted hingula as Sarva doshahara, Deepana,Atirasayana, Sarvarogahara, Vrishya. It is useful in Dhatujarana. Parada extracted fromHingula is equal to the properly of Shadguna gandhaka jarita parada.44. Rasaprakasha sudhakara quoted that the Hingula has the property of Deepanasarva doshaghna, Atirasayana, Sarvarogahara. It is helpful in dravana karma. Paradaextracted from Hingula is said to be equal to the property of Shadguna gadhaka jaritaparada.45 Ayurveda Prakashakara has quoted the property of Hingula as Tikta, Kasaya rasaKapha pittahara. It cures Netra roga, Hrillasa, Kushta, Kamala Pleeha amavata andKrutrima visha. It also subsides Navajwara and Sannipatajajwara 46 Rasendra chudamanikara quoted the property of Hingula as Sarvadoshaghna,Deepana, Atirasayana, Sarva roghahara, Vrishya. It is helpful in Jarana samskara 47 Rasamrita quoted the property of Hingula that it pacifies all the Tridoshas It hasDeepana and powerful Rasayana effect. It can destroy all disease and may be used for theMarana of gold and iron etc metals Rasataranginikara quoted that it has a property of Netra rogahara, Kaphaprakopanashaka, Pitta prakopajanya roganashaka. It alternates Pleeha, Kushta, GaravishaKamala. It is Pachaka agni vardhaka and Anna pachaka and it cures Prameha, Amavataand Jwara.49 It increases Shareera kanti, bala vriddhi. 17 Hingula
  • 33. Dhanvantari Nighantukara quoted that; it has Katu vipaka, Ushna veerya. Italleviates Dwandwaja and Tridoshajajwara visha, Kushta, Visarpa, and Twak vikara,Madhura tikta rasa, Kapha vata shamaka. Rajanighantukara quoted that it is having Madhura tikta rasa and Ushna veerya. Itsubsides Vata and kapha roga, Dwandwaja and Tridoshaja jwara 51. Kaiyadeva Nighantukara quotes that Hingula is Laghu, Tikla and Katu rasa, Katuvipaka and Ushana veerya It subsides Netra peeda, Kushta, Visarpa, pitta & kapha.52Cinnabar53 Chemical composition-sulphur of mercury (Hgs) It contains 13.8% of sulphur and 86.2% of mercury. Form- Trigonal or rhombohydral usually massive granules Intense red in colour sometimes brownish red in colour. Streak –Red. Transparency-Opaque or translucent. Hardness-2-2.5. Specific gravity-8.09. Lusture –Admentive. Variety-Hepatic liver brown colour. Occurrence – Generally occurs due to the volcanic activity also available near hot springs. Important places of occurrences are Spain Italia, Western states of USA Mexico.Extraction of Parada from Hingula54 In ancient days the only source of mercury was Hingula. Since, olden days it isaccepted that Hingulotha parada is pure and devoid of Sapta kanchuki doshas andbelieved to posses with the property of Jeerna gandha guna (Jeerna gandha samogunaha).In Rasa ratnakara also it is advised to use Hingulotha parada for all purposes withoutdoing Astasamskaras. 18 Hingula
  • 34. The methodology of extracting Parada from Hingula is explained in Rasarnava(12th century) Ananda Kanda (12th century) Rasa Ratnakara (12th century) Rasa prakashsudhakara (13-14th century) Ayurveda prakash (17th century AD), etc. Prior to extraction of Parada from Hingula it should be subjected for ShodhanaHingulakrista parada procedure According to Ayurvedic texts Hg mercury may be obtained from hingula byfollowing methods 1. Urdwa patana yantra process 55 (Ayurveda prakasha 2/83-85) 2. Adah patana yantra process 56 (Rasaratna Samucchaya /154) 3. Tiryaka patina yantra process 57 (Rasamrita) 4. Nada yantra process 58 (siddinandan mishra)Damaruyantra Process In this process Hingula is triturated with Nimbu swarasa and made into small flatround pieces which after being dried are kept in earthen pot covering with another pot ofthe same size and sealed at the joint with cloth and clay in such a way so as to make it airtight. Then heat the lower vessel with a strong heat and cool the upper vessel with wetcloth so as to condense mercury fumes in the upper vessel. In the end allow the apparatusto cool by itself and open it to collect Parada from the upper vessel of the apparatus. IfHingula is remaining repeat the process and collect the remaining portion of mercuryfrom Hingula.Superiority of Hingulotha parada Parada extracted from Hingula is considered to be the best because it is free fromvarious types of doshas. Hence, the same does not need any other further Samskara forthe removal and could be used even without subjecting it to Astasamskaras and isclaimed to be capable of performing all the actions attributed to it. More over accordingto “Rasaprakasha Sudhakara” Parada extracted from Hingula may posses all thoseproperties, which are seen in Shadgunabalijarit parada thus it is considered superior toordinary Parada. 19 Hingula
  • 35. PARADA Parada Considered the most powerful Rasa has been accepted to have originatedby Lord Shiva. It has a spectrum of application in the field the philosophy of revolvesaround parada.SynonymsTable No. 08. Showing the synonyms of parada.Sl. Swarropa Synonym01. Swaroopat maka Galadroupya nibham, Mahavanhi, Mahateja, Suvarna.02. Darmika/Devatmaka Trinetra, Trilochana, Deva, Dehaja, Prabhu, Rudraja, Lokesh, Vijendra, Budha, Rajaswala, Shantu, Shiva, Shivaveerya, Skandha, Harateja, Harabeeja, Shivahaya, Shivabeeja.03. Gatyatmaka Kechara, Chapala, Chala, Dhurtaka.04. Dehava datmaka Amrita, Jaiva, Dhehada, Paramamrita, Parata, Parada, Mrityunashana, Rasayana, Rasayansresta.05. Dhatuvadatmaka Divyarasa, Maharasa, Rasa, Rasendra, Rasesha, Rasottama, Rasadhatu, Rasaraja, Rasanatha, Siddadhatu, Soota, Sootaka, Sootaratha, Mishraka06. Visista Guna Ananta, Amara, Kalikantaka, Sukshma, Soubagya.07. Darshanika Jeeva, Jaiva, Divya, Achintya. AdyatmikaVernacular Name English name – Mercury. Latin name – Hydrargium. Sanskrit – Parada. Hindi – Para. 20 Parada
  • 36. Bengal – Para. Gujarathi – Para. Assami – Jivaka, Inul Hayata. Parsi – Simaba, Jivah. Telugu – Padarasamu Kannada – PadavasaHistorical Review In Indian Alchemy parade is considered as one of the most important drug duringto its ability to amalgamate most metals. Indian history says that Parada is being used as amedicine since 8000 years References of Parada as available in Charaka Samhita – For Internal use Sushrut Samhita – For external use Ashatanga Hridaya – For internal usesOccurance59 In Rasaratna samucchaya it is mentioned that in ancient times mercury was foundmainly in Darada desha and also in Himalayas in small amount. But now a days it isobtained mainly from the mines of Spain, America, Italy, Australia, British, Borneo,China, Russia, Japan and Africa as cinnabar or metacinnabar.It occurs in two forms 01. Native 02. Ore form 21 Parada
  • 37. Varities The varieties of Parada described in various texts are based on the followingfactors – 1. Depending on the colour 2. Depending on the place of origin01. Depending on the colour As a soon as Parada is taken out of Kupas it has been classified into four varietieson the basis of its colour and lusture.Table No. 09. Showing the varieties of Parada depending on the colour.60 Sl.No Types Colour Varna Karma 1. Sweta White Bramhana Swetakarma 2. Rakta Red Kshatriya Therapeutics 3. Peeta Yellow Vaishya Used in alchemy or to prepare gold 4. Krishna Black Shudra Used in maintaining healthDepending on the place of originTable No. 10. Showing the varieties of parada depending upon the place of origin.61Sl.No Variety Colour Impurities Uses 1. Rasa Rakta Which is free from all types Rasayana of impurities 2. Rasendra Peeta Free from Impurities Rasayana 3. Suta Isatpeeta With impurities Deharogahara 4. Parada Sweta With Impurities Sarvarogahara 5. Mishraka Mayura chandrika With Impurities Sarvasiddidayaka varna 22 Parada
  • 38. Ores of Mercury Generally mercury is found in the form of ores, the most important ores arecinnabar and meta cinnabar which are in sulphide forms and the other important ores are.Table No. 11. Showing the ores of Parada along with chemical composition.62 Sl.No. Ores Chemical Composition 1. Cinnabar Hgs 2. Meta Cinnabar Hgs 3. Calomel Hg2 Cl2 4. Living stonite 2Sb2H3 Hgs 5. Mon tryodite Hgo 6. Falh ore 7. Barsenite 8. Gwadal Kwajrite 9. Steel ore of mercury 10. Liver ore of mercury 11. Carolline 12 Brick oreEffect of Ashuddha Parada sevana63 It is said in the texts that impure mercury if used internally may produce variousdiseases in the body viz. Vidaha, Krimi, Kusta, Agnimandya, Aruchi, Vamana, Jadya andeven death. Thus instead of doing therapeutic effects it may cause serious ill effects andhence purified mercury should be used for general medication.Shodhana of parada64 All the Rasa Granthas have stated that the advocation of parada is for Loha siddhiand to attain these Siddhi parada is subjected to Ashtadasha Samskaras. To use Parada asa medicine two types of Shodhana have been explained. 23 Parada
  • 39. Shodhana is of two types 1. Samanya Shodhana – For vyadhinashana guna 2. Vishesha Shodhana – For rasayana gunaSamanya Shodhana Pre-Preparation process : Before starting any Rasakarma one should think ofShubha naxatra, Shubha dina and worshiping Lord Shankara and Bhairava then theprocedure are to be carried out. Because the studies shown those particular days, time andworshipping will impart the efficacy in medicine. So these should be followed by everyAyurvedic Pharmacologist. Different procedures are explained by various texts for general purification ofParada those are as follows 01. Parada sudha raja (lime powder) should be taken in equal quantity andMardana should be done for 3 days - Parada should be filtered through two folded cloth Add equal quantity of Nistusha lasuna and half of lasuna quantity, Saindhava lavana and mardana should be done up to kalka should become Krishan varna.66 02. Grithakumari, chitraka rakta sarsapa brihati triphala kwath and parada should betriturated for 3 days. The Parada obtained by this method will be devoid of Sapta malas.67 03. Parada should be triturated with Nagavalli swarasa, Ardraka swarasa andKsharatraya for 3 days and washed with water. This Parada will be shining like Muktaand devoid of Sapta dosa.68 04. Parada should be triturated with Lasuna and Saindhava lavana in Taptakhalvayantra for 7 days.69 24 Parada
  • 40. Pharamacological and Therapeutic properties of Shodhita Parada70 Rasa – Shadrasa Guna – Snigda, sara Veerya – Ushna Vipaka – Madhura Karma – Yogavahi, Rasayana, Ativrishya, Balya, Vajikara, Drustibalaprada, Vayasthapakara, Bhukti, Muktiprada, Pustikara, Deepana, Ayushkara, Kamagni, Sandhuksana, Khecharigatiprada, Dehasiddikar, Loha siddhikara, Ropana, Krimighna, Shodhana purushastha chatustayaprada. Dosha Prabhava – Tridoshagna Vyadhi Prabhava – Krimi, Kusta, Akshiroga, Vataroga, Valiphalita, Kshaya, Tridosaja roga sarvaroga, Tapatraya, Janya roga, Papajayoga.Mercury Modern ConceptsPhysical Properties71 Symbol – Hg. Atomic No – 80 Atomic Weight – 200.61. Atomic Volume – 14.8 Atomic Radius – 1.57. Specific Gravity – 13.6. Melting point – -38.87C. Boiling point – 35.6990C. Mercury72 is a liquid metal silvery white in colour at ordinary temperatures and ofhigh density It is divisible into spherical globules, mobile without any odour or taste,slowly volatilizing at ordinary temperatures, insoluble in H20, HCl and cold H2SO4 Itsolidifies by cooling with liquid CO2 and ether and the solid melts at -38.87c. It boils at357oC nearly. The vapors density determination shows that its molecule is monatomic inthe vaporous state. Mercury combines with Sulphur and oxygen when heated. Chlorineattacks mercury at ordinary temperatures. 25 Parada
  • 41. Chemical properties7101. Action of HNO3 on Hg Cold and dilute niric acid dissolves mercury first with production of mercurousnitrate Hg2 (No2)2 that subsequently changes over to mercurous nitrate. 6Hg + 8HNO3 3Hg (No2)2 + 4 H2o + 2NO3 . Hot & strong nitric acid dissolves mercury and produces mercuric nitrate. 3Hg+8HNO3 3Hg (No2)2 + 2NO + 4H2O.02. Action of H2SO4 on Hg : Cold and dilute H2SO4 has no action on mercury but hot andstrong euphoric acid dissolves mercury producing mercuric sulphate evolving SO2. Hg+2H2SO4 HgSO4 + SO2 +2H2O.03. Action of HCL on Hg : Mercury does not react with HCl under ordinary conditions inthe absence of air.04. Action of O2 on Hg : Mercury does not react with oxygen or air at normaltemperature but when heated above 3500C it is slowly combine with O2 forming mercuricoxide 2Hg +O2 2HgO2Therapeutic Uses73 The specific actions of mercury are considered else where in connection with theseveral therapeutic uses of the mercury compounds. The inorganic mercuric salts as wellas certain organic compounds of mercury are employed chiefly as antiseptic andpreservatives also certain mercury compounds are effective parasiticides and fungicideswhen locally applied certain complex organic mercurial compounds are employed asdiuretics Mercurous chloride is an catharatic.Mercurial diuretics74 It is contraindicated in renal inefficiency or acute nephritis absolutely the mainuse of mercurial diuretics is in edema of cardiac origin Good results are some timesobtained in chronic stage of glomerulonephritis and ascitis due to hepatic cirrhosis andportal obstruction. 26 Parada
  • 42. GANDHAKA Gandhaka is said to be the second most important drug in Rasashastra afterparada. Its origin is said to be from the Godess Parvati. The noticeable use of Gandhakawherever Parada is used may act as antidote. It is considered as an essential agent for thevarious process of Parada samskaras such as Murchana, Jarana bandhana etc. It is alsoused for marana of various metals. Before using Parada for the medicinal purpose theJarana samskara of the Parada should be perform. The importance of Jarana samskara istold in Ayurveda prakash 1/117-120 shloks. If Jarana samaskara of parada is done withgandhak potenciation parada would be up to 100 times. If we use the Gandhaka is sixtimes as that of Parada. Kajjali is prepared from the combination becomes Sarvarogahar.Table No. 12. Showing the synonyms of Gandhaka.Sl.No. Synonyms A.P75. R.A.76 RS.S77 R.T.78 A.R79 1. Gandhaka + + + + + 2. Gandhapashana + - + + + 3. Gandhi - - - + - 4. Rasagandhaka - - - + + 5. Sugandha - - + + + 6. Pootigandha - - - + + 7. Pamari - - + + + 8. Kitanashana - - - + + 9. Bali + + - + + 10. Balivasa. + + - + + 11. Kushtari - - - + - 12. Sharabhoomija - - - + - 13. Shulbhari - - + + + 14. Navaneeta - - + + + 15. Daityendra - - - + + 16. Gandhamadana - - - + - 17. Krilaghna - - - + - 18. Kruragandha - - - + + 19. Lelitaka + + - - + 20. Atiganda - - - + + 21. Amlasara - - - - - 22. Gandhika + - - + - 23 Savagandhika + - + + + 24. Gandhasm - + - - - 27 Gandhaka
  • 43. Vernacular Names ⇒ Sankrit – Gandhaka ⇒ Scientific Name – Sulphur ⇒ English – Brim stone (Sort fire) ⇒ Hindi – Gandhaka ⇒ Kannada – Gandhaka ⇒ Marathi – Gandhaka ⇒ Gujarathi – Gandhaka ⇒ Bengali – Gandhaka ⇒ Assam – Kiburit ⇒ Pharasi – GogirdOres of Sulphur (Gandhaka Khanija)Sulphides ⇒ Iron Pyrite – FeS2 ⇒ Copper pyrite – CuFeS2 ⇒ Galena – Pbs ⇒ Zinc Blend – Zns ⇒ Cinnabar – Hgs (Hingula) ⇒ Stibnite – Sb2S3 ⇒ Real Gar – AS2S2 (manashila) ⇒ Orpiment – AS2S3 (Haratala) ⇒ Hydrogen sulphide – H2S 28 Gandhaka
  • 44. Sulphates ⇒ Gypsum – CaSO4. 2H2O ⇒ Heavyspar – BaSo4 ⇒ Salestone – Sr So4 ⇒ Kalerite – MgSo4 H20 (Epsum salt) ⇒ Ferrous Sulphate – Feso4 5H2p ⇒ Copper sulphate – CuSo4 5H2O ⇒ Glanibets salt – Na26So4, 10H2O Sulphur can be extracted from the above said minerals apart from the minerals itis also available from some of the vegetables and food materials like Garlic Beetroot,Radish, Onion Cabbage Milk and Meat.Occurance81Gandhaka is available in two forms 1. Native form (Muktavastha)-free form 2. Compound form (Samyuktavastha or Khanijaroopa) ores A part from this carbolic substances such as Onion Garlic, Eggs and crudepetroleum also contains sulphur Free Gandhaka is available from cisily (Shitadipa) Japan, Iran, Europa,Kohisulthan Hills in Beluchides, Spain, Newzealand etc Khanija variety (Compound form) Gandhaka is available all over the worldspecially in Japan, Burma, America, Chili and Philippiness. 29 Gandhaka
  • 45. Varieties82 According to various texts following four varieties of Gandhaka are mentioned. 1. Sukhacanchunibha - Rakta - Dhatu Vadartha 2. Peeta (amalasara) - Shukapicha - Rasarasayana 3. Sukla (White) - Katikakara - Lohamarana 4. Krishna (black) - Durlabha - Jaramrityanasaka According to Rasarnava83 1. Shukachanchunibha - Shresta 2. Shukhapichanibha - Madyama 3. Shwetha - Adhama 4. Peeta - Amlasara After going through all these varieties Shri. Gulraj Sharma has considered thatGandhaka is one its colour changes depend upon giving the temperature. At 250o C it getsblack colour and hard, under 500o C it gets Red colour, in 350o C it gets soft and yellowcolour called as Balivasa.Physical Properties84 The sulphur, which is clear yellow in colour just, like Haridra transparent ortranslucent and as smooth glistening as butter is known as Amalasar gandhaka and isrecommended for medicinal usesChemical constituent Practically pure Sulphur may contain traces of selenium, Tellurium, Arsenic,Bitumen and clay 30 Gandhaka
  • 46. Guna Karma85 ⇒ Rasa – Katu, Madhura, Tikta. ⇒ Guna – Laghu, Snigda. ⇒ Veerya – Ushna. ⇒ Vipaka – Katu. ⇒ Dosagnata – Kapha, Vatahara. ⇒ Dose – 1-8 Ratti. ⇒ Vehicle – Milk, Water, Honey. ⇒ Action – Deepana, Pachana, Vrishya, Rasayana and Yogawahi. ⇒ Indication – Kusta, Krimi and Vata-kaphaja roga.Gandhaka Shodhana Various types of shodhana procedures with different shodhana dravyas wereexplained This process of shodhana imparts some qualities to the drug minimizes thetoxic effects and potencifies the drugs. Following table shows the drugs according todifferent authors.Table No. 13. Showing the Gandhaka shodhana according to different authors. Sl.No Shodhana A.P86 R.S.S 87. R.CH188 RRS 89 RT 90 dravya 1. Gritha and + + + + + Dugdha 2. Bringarajaswarasa - - + + + 3. Kanji + + + + + 4. Sarshapataila - - - + + 5. Tilataila - - - + + 6. Dugdha - - - + - 7. Sudha Jula - - - + + 31 Gandhaka
  • 47. Table No. 14. Showing the therapeutic uses of Gandhaka according to different authors. Sl.No Therapeut A.P91 R.S.S 92. R.CH 93 R.T 94. RRS 95 ic uses 1 Kandu + + + + + 2 Kusta + + + + + 3 Visarpa + + + + + 4 Dadru + + + + + 5 Amadosha + + + + + 6 Krimi + + + + + 7 Pleeharoga + + + + + 8 Netraroga + + + + + 9 Twak + + + + + vikara 10 Kshaya + + + + + rogaSULPHUROccurrence 96 Sulphur occurs in the free state in nature. It’s met with in large amounts involcanic regions in Sicily Japan and especially in USA large deposits of sulphur areobtainable, particularly it is met with as underground deposits in huge quantity in USAand about ¾ of the world supply come from these. Besides are metallic sulphides andsulphates sulphur is found in nature in large amounts chief among these is 1. Iron Pyrites (FeS2) 2. Copper Pyrites (Cu2S) 3. Galena (Pbs) 4. Zinc Blend (Zns) 5. Cinnabar (Hgs) 6. Real gar (AS2S3) 7. Orpiment (AS2S3) 32 Gandhaka
  • 48. Important ores of Sulphates 96 Gypsum (CaSo4 2H20) Kieserite (MgSo4 H20) Barites or heavy spar (NaSo4) Beside the above modes of occurrences sulphur is found in the animal and plantkingdom, onion, garlic, mustard oil, hair, eggs etc also contain sulphur in nature are twotypes. a. Sulfatric types b. Gypsum typePhysical properties Symbol – S. Appearance – Crystals. Form – Orthorhombic. Colour – Yellow. Shape – Bipyramidal. Atomic Weight – 32.064. Atomic No. – 16. Valency – +2. Specific gravity – 1.92 - 2.1. Melting point – 112.8oC. Configuration – 2,8,6. Hardness – 1.5 to 2.5. Boiling point – 444oC. Action on heat – Non-conductor of heat Sulphur occurs in nature as a lemon coloured powder as spiral or globular massesand in crystal form. Its colour varies from yellow or yellowish brown greenish gray etc. Itis insoluble in water and alcohol but soluble in carbon disulphideChemical properties96 1. It burns in oxygen or air with a blue flame giving sulphur dioxide mixed with a small amount of sulphur trioxide S+O2 SO2 2SO2+O2 2SO3 33 Gandhaka
  • 49. 2. It combines directly with carbon phosphorous arsenic and many of the metals at high temperature giving the corresponding sulfides C + 2S CS2 2AS2 + 3S AS2 S3 Cu +S CuS 3. It is also combines with hydrogen and chlorine when the gases are let through boiling sulphur H2 + S H2S 2S + Cl2 S2Cl2 4. Sulphur doesn’t react with water in the cold state, But reacts with steam when the later is made to pass through boiling sulphur 3S+2H2o 2H2S + So2Pharmacology of sulphur Sulphur is present in all cells in associated with protein in the sulphur containing amino acids cysteinr and methionine It is ingested in the form of protein mainly and is eliminated in the urine in three forms described as inorganic organic and etheral sulfates totaling about 0.5 to 10 gm a day. The formation of inorganic sulphate occurs mainly in the liver. It plays an important role in detoxification of Phenolic compounds and steroidal harmones. For these conjugation reaction, the inorganic sulfate is activated by ATP to form adenosine phosphosulfate or “Active sulphate”. 34 Gandhaka
  • 50. Sulphur forms sulphydryl group (-SH) which act as active centers of the enzymes and play an important role in tissue respiration Sulphur also forms disulphide linkage (S-S) in the protein molecules which are responsible for maintenance of high level structure of protein Sulphur also plays an important role in production of hormones e.g. Insulin heparin corticosteriod hormones. In Rasamruta, it is stated that for the preparation of parpati kalpana gandhakashodhana should be done in Bhringaraj swarasa. Hence for the present study gandhakashodhana is carried out using Bhringaraj swarasa as mentioned in the Rasamruta. 35 Gandhaka
  • 51. KAJJALI KALPASIntroduction98 Kajjali is black sulphide of mercury. It is prepared of classically treated andShodhita parada ganadhaka. It is a sagandha Niragni pota bandha of parada. It is aKhalwi rasayana. As the Shodhita parada and Gandhaka are constantly triturated under pressure atatmospheric temperature initially the silvery white mercury and greenish yellow sulphurgradually turn into black. Tiny mercuric goblets peals completely disappear at the end.As the Parada gandhaka amalgam resemble “Kajjali” (naturally occurring Zinc oxideZinc Sulphide) antimony sulphide etc. The name Kajjali is coined rarely apart from blackcoloured amalgams of mercury is also called Kajjali. It is invariable to note that constant and consistent pressurized triturating ofmercury and Sulphur has its definite role to play in pharmacodynamic properties ofKajjali. Triturating time and saturation of mercuric pearls with Sulphur molecules isdirectly proportional to the pharmacological effect of Kajjali and its further complexcompounds classical and traditional concepts at every stage must be followed otherwiseresults may vary. The Sagandhayukta parada yogas holds top most place i.e. Sagandha niragniPrathama murchana of parada. Parada when undergoes the process only then it will beable to cure the disease. The first Murchana of Parada is Kajjali where Sagandha niragnimurchana of parada, which may be used as a basic compound for preparation ofcompound drug and some, time it may be used single. Kajjali is one of the independent medicines.99 36 Kajjali Kalpana
  • 52. It also aggravates the action of its co-ingredient when administered with anotherdrug. It is the main ingredient of the Chaturvida rasayana. They are 1. Parpati Kalpana 2. Kupipakwar rasayana 3. Khalvi rasayana 4. Pottali rasayana Sometimes Kajjali is also used for the inciration of the metals. Their by thepharmacological action of the bhasma will become enhances. The method of preparation of Kajjali is same, but the colour of the Kajjali maydiffer after certain processes. In Kharaleya rasayana colour changes depending on colour of mixing ingredients. In parpati kalpana usually it has same colour. In Kupipakwa it is sindhooravarna. When the Kajjali is heated up to 500oc thecolour of the molten sulphur is red and that the same time mercury converts into oxidewith the help of red coloured Sulphur so its colour turns red. 37 Kajjali Kalpana
  • 53. NIMDU SWARASA100 ⇒ Latin name – Citrus medica. ⇒ Family – Rutaceae. ⇒ English Name – Lemon peel. ⇒ Sanskrit name – Nimbuka. ⇒ Rasa – Amla katu. ⇒ Guna – Laghu, Tikshna. ⇒ Veerya – Ushna. ⇒ Vipaka – Amla ⇒ Dosha Karma – Vata-kaphahara, Dipana-pachana, Chaksusya. ⇒ Indication – Agnimandya, Gulma, Shoola, Amlpaitta, Visuchi, Vata roga.Chemical composition Lemon peel contains volatile oil from 2 to 40%. The other continents of the peelsare hesperidin, pectin calcium oxlate and bitter substance (About 90%) Citral (About 4%)and other aromatic compounds like guanyl acetate and terpineol. The lemon oil has poleyellow colour.Action It is a carminative and stimulant and oil is used as perfuming and flavoring agent.It is also used for extraction of pectin and volatile oil. 38 Nimbuka
  • 54. BHIRINGARAJ101 ⇒ Latin name – Eclipta alba Hassk. ⇒ Family – Asteraceae (Compositeae). ⇒ English – Wedelia Calendulacealess. ⇒ Hindi – Bhangra, Bhangraiya. ⇒ Sanskrit – Bhringaraj.Useful part The whole plant “Bhringaraj.” Is useful & its leaves, roots, stems & Seeds arealso useful separately. ⇒ Rasa – Katu, Tikta. ⇒ Guna – Rukshan, Laghu. ⇒ Verrya – Ushna. ⇒ Vipaka – Katu ⇒ Dasakaranra – Kapha vata shamaka, kesya Rasayana, balya, caksusyas Dantya ⇒ Indication – Pandu, Kamala, Svara, Kasa Netraroga, Hrdroga, Krind, Kustha, Sotha, Sirah shootaChemical composition Plant contains resin in high quantity and an alkaloid ecliptine. Leaves containleucine, isoleucine valine, phenybalmine and methionine, glycine, glutamine, glutamicacid cystone, and Methionine and they are richer in protein than any other greenvegetable.ActionAnemic, Insomnia, Asthma, Hypertension, Bronchitis, Bronchilal Asthama Alopecia,Liver toxicity. 39 Bhringaraj
  • 55. GHRITA102 It is obtained from class Mammalia of the Animal Kingdom (Jangama) Ghees contains vitamin. A.D.E and K. Vitamins A and E are anti oxidant and arehelpful is preventing oxidative injury to the body. Vitamin A keeps epithetial tissue ofbody intact, ghees resists spoilage by Microorganisms or chemical reaction. Its digestibility or rate of absorption is 96%, which is the highest of all oils andfats. Digestion, absorption and delivery to a target organ system are crucial in obtainingthe maximum benefit from any formulation. This is with ghee, they are easily digestedand absorbed lipophilic action of ghee facilitates transportation to a target organ and finaldelivery inside the cell because cell membrane also contains lipid. This lipophilic natureof ghee facilitates the entry of the formulation into the cell and its delivery to themitochondria, microsomes and nuclear membrane. ⇒ Rasa – Madhura, Tikta, ⇒ Guna – Snigdha ⇒ Veerya – Sheeta ⇒ Vipaka – Madhura ⇒ Dosha Karma – Pitta and vata Shamak Rasa, dhatu, shukra dhatu & ojas vardhaka Mrudukaram, swara and varna Prasadanam. Ghrita when treated or impregnated with other drugs has a specific property ofaccepting the attributes of those drugs without loosing its own characters. 40 Ghrita
  • 56. BOLA Botanical name – Commiphora Myrrha (Nees) Engl. English Name – Balsemanudendron Myrrha T Nees. Family – Burseraceae. Classical Names – Bola. Sanskrit names – Bola, Jatirasa , Prana,Goparasa, Gandharasa, Pinda.Regional names Hindi – Bol Hirabol. Bengali – Gandhbol. Marathi – Hirabol. Gujarathi – Hirabol. Tamil – Vellaippapolam. Telagu – Valintrapolam. Arabic – Murre. Persia – Bol. English – Myrrh. 41 Bola
  • 57. Table No. 15. Showing the synonyms of Bola.Sl Synonyms A.P. B.R.R.S. B.R.N. K.N. R.N. D.N.1 Bola + + + + + +2 Gandarasa + + + - - +3 Pranamindra + + - - - -4 Goparasa + + + - - +5 Pranamindra - - + - - -6 Jatirasa - - - + - -7 Poram - - - + - -8 Nirloham - - - + - +9 Barvaram - - - + + +10 Rasam - - - + - +11 Rasagandham - - - + + -12 Gandramam - - - + - -13 Gomatham - - - + - -14 Nalikam - - - + - -15 Balam - - - + - -16 Pindom - - - + + +17 Sthokam - - - + - -18 Kalakutam - - - + - -19 Sthomakam - - - + - -20 Vasagandhakam - - - + - -21 Raktapanam - - - - + -22 Surasam - - - - + -23 Pindakam - - - - + -24 Visham - - - - + +25 Saurabham - - - - + -26 Rakthagandhakam - - - - + -27 Mahagandha - - - - + -28 Vishwagandha - - - - - -29 Vidhu - - - - - + 42 Bola
  • 58. Table No. 16. Showing the therapeutic uses of Bola According to different Authors.Sl. Therapeutic uses A.P. B.R.R.S. B.P. K.N. R.N. D.N.1 Rakthaharam + + + - - +2 Jwara + + + + - -3 Apasmara + + + + - -4 Kustha + + + + - -5 Garbhashaya Shodhaka + + + + - -6 Chakshsya + + - - - -7 Vrushya - - - + - -8 Arsha - - - + - -9 Bagna - - - + - -10 Pradara - - - - + +11 Puja - - - - + + Though we get to see the explanation regarding Paryaya, Bheda and Gunas ofbola in the Rasagranthas like. Ayurvedic prakash and Brihat Rasarajasundara explanationregarding the Bola parpati is not available.Types of Bola109 Rakta Shyama Manushyaja. Of these three, Rakta bola chiefly exhibits the rakthahara property. Hence, is a majoringredient in Bola Parpati.References of Bola in classics Charaka Samhita Chikistasthana – 28/150 as Rasa. Ashtanga Hridaya Shareerasthana – 2/50 as Jatirasa. Ashtang Hridaya Chikitsasthana – 21/27, 3/135 as Jatirasa. Ashtanga Hridya Sutrasthana – 15/43 as Jatirasa. 43 Bola
  • 59. Pharmacodynamics110 ⇒ Rasa – Tikta, Katu, Kashaya ⇒ Guna – Ruksha,laghu ⇒ Veerya – Ushna ⇒ Vipaka – Katu ⇒ Dosakarma – Tridosahara In Kriyatmak Aushadhi Parichay vijnan book no page 257.111 In the chapterNiryasa Pareeksha under the heading “Heerabol Ki Pareeksha” it is stated as follows This is a Guggulu jateeya vriksha, belongs to Guggulvadi varga and is a resin ofBasamodendran Myrrh plant. Small rounded pieces of gum resin colour yellowish red,and possess uneven surfaces. On touch this is rough and hard most often the thin layer ofbark sticks to the resin. Particles of resin are opaque, translucent and resin posses apeculiar smell when put into water, resin dissolves completely in hot water Resin partlydissolves in oil and ghee, but the gum settles down to the bottom.Ghulansheelata 1. Jala – Dissolves in water and when triturated with water gives yellowish brown emulsion. 2. Tail and Ghruta – When given low and gradual heat the resin dissolves in oil and ghee and the colour turns to red. 3. Jwala – When heated on fire gives out red flames. 4. Gandha – Resin posses mild aroma when heated the aroma is very strong i.e. Ugra Gandha. 5. Sparsh – It is uneven rough and hard touch. 44 Bola
  • 60. 6. Shabda – It does not give out any shabda during heating. 7. Rasa – Tikta adhika, ishat kashaya and madhura. 8. Varga – Taijasvarga.COMMIPHORA MYRRH Latin Name – Commiphora Myrrha/ Commiphora molmol Pharmacopeial Name – Myrrha Other Names – Common myrrh, gum, myrrh, hirabol, myrrh, Bol, hirabol, myrrh, gummi myrrh.Description of the Plant112 A small tree, which is the source of Herabol myrrh. The gum resin exudates fromwounds in the stem is pale yellow at first and later solidifies to brown black The shrub or small size tree of myrrha resembles of commiphora (Guggulu). Thetrunk of plant exudates oleoresin, which is known as Bola. Such exudation is obtainedfrom two or three varieties of trees under this group. This Oleoresin contains numerous round crystals that forms the consolidation ofresinous substances It is reddish yellow or alike, fragile, odourous and bitter in taste. The bushes yielding the resin do not grow more than 9 feet in height, but they areof sturdy build with knotted branches, and branch lets that stand out at right angles,ending in a sharp spine. The trifoliate leaves are scanty small and very unequal oval andentire It was first recognized about 1822 at Ghizan on the Red sea coast a district so bareand dry that it is called “Tehama” meaning “hell” Botanically there is still uncertainty about the origin and identity of the variousspecies 45 Bola
  • 61. There are ducts in the bark and the tissue between them breaks down forminglarge cavities which with the remaining ducts becomes filled with a granular secretionwhich is freely discharged when the barks is wounded or from natural fissures. It flows asa pale yellow liquid but hardens to a reddish brown mass, being that of a walnut. Thesurface is rough and powdered and the pieces are brittle with a granular fracture semitransparent oily and often show whitish marks. The odour and taste are aromatic on thelatter also acrid and bitter. It is inflammable but burns feebly. Several species are recognized in commerce It is usually imported in chestsweighing 1 or 2 cuts and wherever produced comes chiefly from the east Indies. Adulterations are not easily detected in the powder so that it is better purchased inmass when small stones, Senegal gum, chestnuts pieces or of a brownish resin called“False Myrrh” may be sorted out with little difficulty.Other Species113 Bissa Bol or perfumed bdellium of the Arabs, has an odour like mushroomsThough it is sent from Arabian ports to India and china it was formerly known as eastIndian Myrrh. It is of a dark colour and may be a product of commophora erythraca varglabrescents of B. Kalaf, A. Kafal, B. Playfairil or Hemprichia eryhtraea, B. Kera ofAbyssinia has been found to yield Myrrh Mecca balsam a product of B or Copobalsamum, is said to be the Myrrh of the Bible, the Hebrew word mar having beenconfused with the modern Arabic morr or Myrrh in translation. 46 Bola
  • 62. Bdellium, recognized as inferior Myrrh and often mixed with or substituted for itis a product of several species of Commiphora according to American writers orBalsamodendron according to English ones. Four kinds are collected in Somalilandmaking sub division of African Bdellium are as follows – 1. Perfumed Bdellium or Habaghadi 2. African Bdellium 3. Opaque Bdellium These African bdelliums said by some writers to be products of Balsamodendron(Heudelotia) Africanum, are in irregular, hard, round tears, about an inch in diameter.Pale yellow to red brown translucent the fracture waxy taste and odour slight. The product of ceradia furcata is also called African Bdellium The commercial Guggul or Indian Bdellium is said by some writers to be aproduct of commiphora roxburghiana by others of B. Mukul and by others again of B.roxbhurghii or Amyris Bdellium. It is more moist, the Mrryh is found in irregular darkreddish brown masses with a waxy fracture softens with the heat of the hand adheres tothe teeth when chewed and smells slightly of Myrrh.Distribution114 Indigenous to North –East Africa especially Somalia Island. Collected in SaudiArabia, Abyssinia, Iran, Thailand and sold in Indian Bazzars. It is native of northeastern America and it also occurs in Arab Persia Abyssyniaand Siam The resinous product of Macca is considered best which is called “Murmacci.” 47 Bola
  • 63. Collection Almost all members of the Burseraceac possess in the phloem oleoresin canals,which are formed schizogenously and may afterwards unite with one another to formschizolysigenous cavities. This occurs in the species commiphora. Much of the secretionis obtained by spontaneous exudation from the cracks and fissures which commonly formin the bark, and some is obtained from incisions made by the Somalis This yellowishwhite viscous fluid soon hardens in the great heat to reddish brown masses which arecollected by the Somalis. As bdelliums and gums are collected at the same time thesefrequently find their way into the drug and have subsequently to be picked out.Characters Myrrh occurs in somewhat irregular tears or masses weighing up to about 250gThe surface is reddish brown or reddish yellow in colour and powdery The drug featuresand powders readily, the freshly exposed surfaces being of a rich brown colour and oilyWhitish marks are sometimes seen and thin splinters are translucent. Myrrh forms a yellowish emulsion when triturated with water when extractedwith alcohol (90o) as in the preparation of Trincture of Myrrh a whitish mass of gum andimpurities remains. The BP alcohol insoluble matter should not exceed 70% lump Myrrhusually yields not more than 5% of ash but the commercial powdered drug frequentlyyields more It may be distinguished from perfumed bdellium and similar products byallowing an ethereal extract of the drug to evaporate to dryness and passing the vapor ofbromine over the resinous film produced A violet colour is given by genuine Myrrh butnot by bdellium TLC and visualization with ultraviolet light at 365 nm is used by the BPas an identification test and also to establish the absence of “C”, Mukul, an inferiorbdellium product. 48 Bola
  • 64. Composition It contains a volatile oil known as Myrrhol, resin, bitter, extract, calciumphosphate, carbonate and other substances. Volatile oil, resin (Myrrhin) gum ash, salt, sulphates, benzoates, malates andacetates of potassa. It is partially soluble in water alcohol and ether It may be tested by acharacteristics violet reaction if nitric acid diluted with an equal volume of water isbrought into contact with the residue resulting from the boiling of 0.1 gram of coarselypowdered Myrrh with 2.cc of 90% alcohol evaporated in a porcelain dish so as to leave athin film. The oil is thick pale yellow and contains Myrrholic acid and heerabolene asesquiterpenne.Chemistry and Pharmacology Myrrh contains approximately 30-60% water soluble gum 20 to 40% alcoholsoluble resins consisting of commiphoric acids Commiphorinic acid andheerabomyrrhols: approximately 8% volatile oil (Bradley, 1992: Leung and Foster, 1996:Newall etal 1996) The volatile oil fraction contains myrcene and a comphorene ;steroidsincluding Z -guggul sterol and I, Ii, III, guggulsterol (Huang1999: Kappor 1990). The water-soluble gum or mucilage fraction is composed mainly of acidicpolysaccharide with galactose 4-0 methyl glucoronic acid and arabinose in ratio of 8:7:2with approximately 18-20% proteins (Bradley 1992: Jones and Numm, 1955: whichtl andBisset 1994) Characteristic constituents are mainly terpenoids, includingfuranosesquiterphenoids with eudesmane germacrane, elemane or guaine structures(Broadly 1992: whichtl and Bisset 1994) Its characteristic odour is due to thefuranosesquiterpenses (Bruneton 1995) which may also be the characteristic componentsof pharamaceutical myrrh (Wichtl and Bisset, 1994). 49 Bola
  • 65. Constituents115 Myrrh contains 7-17% of volatile oil 25-40% of resin 57-61% of gum and some3-4% of impurities. The volatile oil contains contterpenes, Sesquiterpenses, esters cuminic aldehydeand eugenol. The sesquiterpene fraction contains furs-nosesqui. The volatile oil contains terpenes including furanogermacranes furanoguaianesand furanoeudesmanes. Furaneudesma 1, 3 diene and curzarene have morphine likeproperties and act on the CNS opioid receptors furanodi ene 6 one and methoxyfuranoguaia -9-one-8-one show antibacterial and antifungal activity against standardstrains of pathogenic species CP Dolara et. Al., Nature, 1996, 379, 29: Planta medico2000,66,356). The oil which is distilled outside the countries of origin readily resinifiesand the gives a violet colour with bromine. The chemistry of the resins is complex and not fully elucidated The larger ethersoluble portion contains alpha beta gama commiphoric acids the esters of another resinacid and two phenolic resins The smaller ether insoluble fraction contains alpha betaheerabomyrrholic acids The crude alcohol insoluble matter (gum) contains about 18% ofprotein and 64% of carbohydrates containing galactose arabinose and glucuronic acidThis gum is associated with an oxidase enzymes.Tests 1. When triturated with water it yields a yellowish brown emulsion 2. Etheral solution of myrrh becomes reddish when treated with bromine vapour and purplish when moistened with nitric acid The above tests are negative in case of Bdellium. 50 Bola
  • 66. Properties and Uses116 The gum is bitter, acrid and astringent, acrid after the process of digestionthermogenic digestive, carminative, expectorant, intellect promoting aphrodisiac,anthelmintic, depurative, anti-inflammatory, diuretic, sudorific, deodorant, ophthalmicantiseptic, stimulant and tonic and is useful in vitiated conditions of Vata-pitta and Kaphastomatitis, dyspepsia, helminthiasis, amenorrhoea dysmenorrhoea and other menstrualdisorders, bronchitis, asthama, phthisis, ophthalmia, spongy gum pharynyodynia,rheumatoid arthritis, sciatica, wounds and ulcers, inflammations, strangury and skindiseases. The Herabol Myrrh is also used in perfumery, mouthwashes, and dentifrices andin religious ceremonies as incense. This is reported to be used by ancients for embalming. Myrrh is used in incense and perfumes like many other resins it has localstimulant and antiseptic properties. It is chiefly employed in medicine in the form of amouthwash. For research on the positive gastric antiulcer and cytoprotective effect ofmyrrh on treated rats. The genuine myrrh of commerce also known as heerabol myrrh is obtained fromcommiphora myrrha (Necs) Engl. and some other species such as C. abyssinica Engl. andC. schimperi Engl. C. molmol Engl. Ex. Tschirch also yields a myrrh and is consideredby some to be C. myrrha var, Molmol Engl. Heerabol myrrh is often confused withBissabol myrrh or sweet myrrh an exudates from C. erythraea (Ehrh) Engl. These speciesare native to ethiopia the Somali Republic and Arabia and are not found in India but theMyrrh (gum resin is imported into idia, but the Myrrh is very often adulterated withOleogum resin from C. wightii. The Myrrh is used in perfumery as incense and for 51 Bola
  • 67. embalming It is used as tonic, stimulant, astringent, stomachic and antispectic and isoften a constituent of mouthwashes and dentifrices. The tincture of Myrrh is useful inmenstrual disorders and chlorosis. “Aloes Compound” containing myrrh as one of theingredients promotes conception in primary and secondary sterility. The Oleogum resinshowed cytotoxic and anthumous activity in ehrlich ascites carcinoma cell beasing miceIn china the gum is used as an ingredient to prepare oiniments for inflammation inhibitionand tissue growth promotion (Hill, 173: Chopra etal, 1958, 670: Uphof, 146:Dutt Indianoil soap J, 1961, 26,233:Agrawal Med surg 1985, 25 (4), 11:chem. Abstract,1994,121,169981, 18104, Information from the Deputy director Botanical survey of Indiasouthern circle Coimbatore and Prof. Sivaraja, University of Calicut, Kerala. The word Myrrh is derived from a Hebrew and Arabic word “Mur” meaning“bitter” The genus name commiphora is from the Greek “Kommi”, meaning “Gum” and“Phoras” meaning “Carrier”. Myrrh is emotionally strengthening and empowering Itcontains antiseptic, antibacterial, antiviral anti-fungal and anti inflammatory compoundsIt has traditionally been used for aging skin The primary chemical constituents of Myrrhinclude the gum resin and essential oil (Limonene eugenol, furanosesquiterpenes pinen)Myrrh is an effective antimicrobial agent that has been shown to work in twocomplementary ways. Primarily it stimulates the production of white blood corpuscles(with their anti-pathogenic actions) and secondary it has a direct antimicrobial effect. Myrrh Gum is also known by the names Mo Yao in china Bola Myrrh Tree andBalasmodendron Myrrh It has been used since at least 600 B.C as a wound herb andblood stimulate in china 52 Bola
  • 68. Myrrh has been used in Middle Eastern medicine for treatment of infectedwounds and bronchial complaints for thousands of years. (Bown 1995) It was also usedas an embalming agent by the ancient Egyptians Today crude myrrh is dispensedthroughout eastern Africa and Saudi Arabia as an anti inflammatory and anti-rheumatismdrug. (IWU. 1990) Myrrh has a long history of therapeutic use in the Indian Ayurvedic system ofmedicine, (Bown 1995) where it is used to treat mouth ulcers, Gingivitis and pharyngitisas well as respiratory catarrh. (Karnick 1994) Externally it is used as an astringent topical application to ulcers and as a garglefor spongy gum. (Nadkarni 1976) Myrrh tincture is also used to treat many disordersassociated with the female productive cycle, particularly dysmenorrhea and amenorrheaand to help relieve some of the un comfortable symptoms of menopause. (Fravley andLad 1986: Nadkarni 1976) These uses have not been corroborated by clinical studies. Itsuse was later introduced into both the Chinese and Tibetan systems of medicinesometimes during the seventh century C.E. (Bown 1995: Clifford 1984 Leung and Foster1996) Somelian Myrrh (C. Myrrh) is used to treat impact injury, incised wounds, sinewand bone pain menstrual block and hemorrhoids among other conditions. In Germany Myrrh gum resin and myrrh tincture are both official in the Germanpharmacopoeia appeared in the commission E monographs. In the United States Myrrhwas formerly official in the United States pharmacopoeia and National Formulary. As asalve Myrrh is used to treat hemorrhoids wounds and bedsores. 53 Bola
  • 69. The British Herbal compendium indicates the use of Myrrh tincture as a gargle totreat pharyngitis and tonsillitis as a mouthwash for gingivitis and ulcers and externalapplication to treat sinusitis and minor skin inflammations (Bradley 1992). In France itstopical use is approved for the treatment of small wounds for nasal congestion from thecommon cold and for local application as an anodyne to treat affections of the buccalcavity and /or the oropharynx. (Bradley 1992: Bruncton 1995) Myrrh may also help prevent heart disease Preliminary Indian studies suggest thatit reduces cholesterol. The herb may also help prevent the internal blood clots that triggerheart attack. Myrrh can stimulate the uterus. Myrrh also stimulates mucus secretions andfacilitates drainage. The common Myrrh also includes the species commiphora abyssinicaand commiphora molmol which are used interchangeably with commiphora myrrha. A stimulant to the nervous system, with tonic properties. This agent has alwaysbeen highly esteemed as a stimulant although its influence is more of a local than ageneral character. Myrrh is excellent in the sore mouth and extreme ulceration of mercurialptyalism. Myrrh is direct in its action. It quickly increases the power of the digestivefunction, stimulating the peptic glands to extreme action. It increase the appetite andpromotes the absorption and assimilation of nutrition. Stimulates the secretion from the mucous membranes in deficient or excessiveaction it restores the normal conditions. It is an old popular remedy in amenorrhea givenin combination with aloes and iron especially in chlorotic and anemia patients. 54 Bola
  • 70. It has been used from remote ages as an ingredient in incense perfumes etc in theholy oil of the jews and the Kyphi of the Egyptians for embalming and fumigations. Little appears to be definitely known about the collection of Myrrh It seemsprobably that the best drug comes from Somaliland, is brought at the fairs of Berbera bythe Banians of India shipped to Bombay and there sorted the best coming to Europe andthe worst being sent to china The true myrrh is known in the markets as karam formerlycalled Turkey Myrrh and the Opaque bdellium as meena harma. The gum makes good mucilage and the insoluble residue from the tincture can beused in this way. Myrrh improves digestion diarrhea and immunity It treats coughs gum disease,wounds, candid over active thyroid and scanty menstruation. Cosmetic /Skin Use – Myrrh is an expensive treatment for chapped cracked oraged skin eczema bruises infection various veins and ring worm. Emotional Attribute – Myrrh has been used since antiquity to inspire prayer andmeditation and to fortify and revitalize the spirit. Researches at Rutgers University have found two compounds in Myrrh that arestrong painkillers another compound that helps lower cholesterol and mostly recently apotent anti cancer agent that shows great potential for treating breast and prostate cancer, The scientist report their findings in the Journal of Natural products They wrotethat a compound in Myrrh effectively killed all human breast tumor cells in a lab culturedish even though the cells are resistant to other anti cancer drugs. It’s a very excitingdiscovery said Mohamed Rafi117 an assistant professor of Food science at Rutgers and Coauthor of the study Rim Optismistic this compound can be developed into a anticancerdrug: that could have fever toxic side effects than other cancer drugs although it has yetto be tested in animals or humans. 55 Bola
  • 71. Rafi and his research team tested a concentrate of Myrrh extract as part of a largersearch for anti-cancer compounds in plants. They isolated Myrrhis active components andfound a previously unknown compound sesquiterpenoids part of a growing class that hasbeen found to be toxic against various lines of cancer cells although none has beenbrought to market as a drug. Rafi says that the reason these compounds are worth pursuing is that since theycome from food they’re less likely to be toxic to healthy cell and should make for feverside effects if they are used for chemotheraphy. 56 Bola
  • 72. MADHU118 Madhu is one of the jangama dravya. We get reference in all samhitas, Madhu isused as medicine and anuparna.Veracular name ⇒ Sanskrit – Madhu, Makshika. ⇒ English – Honey ⇒ Kannada – Jenutuppa.Sources Beehives or honeycomb, where it is departed by the honey- bee occurs in thenectars of flowers where up in the comb. The finest honey is the virgin honey, whichdrained itself from the comb and that which is; finally procured from the hive.Characters It is viscid, saccharine, substance semi translucent liquid of a light yellowishbrown colour of an aromatic odour and of a sweet acrid taste, after a time it becomeopaque and crystalline.Constituents Dextose, levulose, wax, volatile oils, protein, mucliage, colouring matter, formicacid some of the substance counted are pollen dust ethereal oil various phosphate limeiron.Properties ⇒ Rasa – Madhura. ⇒ Anurasa – Kashaya ⇒ Guna – Ruksha, Laghu. ⇒ Verya – Sheeta ⇒ Doshaghnata – Tridoshaghnahara. ⇒ Karma – Agnideepana, Lekhana, Bala Vardhaka, Vruna ropka, Hridya, Netrya. It subsides Vamana, Visha, Shwasa, Kasa, Shosha, Raktapitta, Krimi, Trishna, Murcha and is Grahi.Action It is demulcent, and laxative, more than one year old is astringent, demulcent,pectoral emollient and laxative. It also possesses nutrient properties. 57 Madhu
  • 73. HISTORICAL REVIEW The study of the history gives the comprehensive knowledge about the diseaseand the contribution of our ancestors towards the development. For convenience, the history of Ayurveda can be studied under different periods. 1. Aadi Kala (Ancient period) 2. Madhyama Kala (Medieval period) 3. Adhunika kala (Modern period)01. Aadi Kala (Ancient period) The ancient period can again be subdivided into vedakala and samhitakala. Vedic Samhitas : The Vedas are the first written record of Indian literaturecontain innumerable references in relation to stree roga. Reference of continuousbleeding from rajo vaha siras of woman (Pradara) is available. A direct reference of atirajpravartana is available in Kausika Sutra, where inarma kapalika or suska panka mrittika/fine mud has been suggested as internal remedy.Samhita period Charaka Samhita : Almost all gynaecological disorders characterised withdysmenorrhea, oligomenorrhea etc. are described under vimsati yoni vyapad. Veryelaborate description of meno-metrorrhagia under the heading of Raktapradara isavailable. 58 Historical Review
  • 74. Sushruta Samhita : Almost contemporary or just behind the Charaka Samhita –his contributions in the field of prasooti specially in the knowledge of anatomy ofreproductive system, physiology of menstruation and obstructed labour are note worthy. The artava, which is agneya, is formed after a month from ahara rasa. Artava isaccumulated in vascular apparatus of the uterus for the whole month to be dischargedduring menstruation. Though the description of Raktapradara is very short, he has included evennormal scanty bleeding coming in short intermenstrual period under it.Artava vriddhi with their nidana, lakshana and chikitsa have been described. Kasyapa Samhita : He has explained the use of satapuspa and satavarikalpamfor menstrual disorders. Harita Samhita : Rajas vitiated by vata etc. doshas produces clinical features notonly related to menstrual blood but other systems also.02. Madhyama Kala (Medieval period) Astanga Sangraha : Detailed classification and clinical features of Raktapradaraof Charaka Samhita, artva vaha srotas, marmas of genital tract, artava kshaya and artavavrddhi are given. Rtu kala may be of even 16 days, non achievement of conception after rtu kaladue to closure of yoni – thus preventing the entry of shukra. Astanga Hridaya : Entire subject of Astanga Sangraha is described insummarized way. 59 Historical Review
  • 75. Madhava Nidana : Description of clinical features and complications etc. ofAsrigdara or Pradara almost as in Sushruta. Vriddha Madhava : He has explained treatment of Pradara, yoni vyapad andsutika roga. Chikitsa Kilaka : Pradara is said to be due to evil deeds (karmaja) and is suchnot cured with medicines. Yet certain recipes are prescribed for the treatment of Pradara.03. Adhunika Kala The term menstruation is derived from Latin, “Menstruns” meaning monthly.Dysfunctional uterine bleeding may present as irregular bleeding or excessive cyclicalbleeding which may which may upper limit the normal at 60-80ml for more than 7 days.Therefore bleeding occuring at an interval of less than 21 days. 60 Historical Review
  • 76. Nirukti – Derivation Pradiryate iti pradaraha vistharitho bavathi asrik diryate yasmunniti asrigdaram || (Ch. Chi.30.) Asrk = Rakta / Raja. Dara = Continuous or excessive flow. Atiprasangena anruthva rutva va thadheva asrigdaram | (A.S.Utt 38) Excessive or prolonged flow of blood occurring in menstrual or inter menstrualperiod is asrigdara. Asrig diryate chyavate yasminnityasrigdaram || (M. Ni. 61/2)Dysfunctional Uterine Bleeding (DUB) DUB is best defined as abnormal bleeding from the uterus in the absence oforganic disease of the genital tract. (Schofield M. J., Bernett A., Redman S., et. al., Obs.& Gynae., 1991, 98 : 1129) DUB is not one condition with one etiology, but is a group of disorderscharacterized by dysfunction of the uterus, ovary, pituitary, hypothalamus or other partsof the reproductive system, which results in abnormal or excessive uterine bleeding. Inclinical practice, the precise nature of dysfunction is often not determined and thediagnosis is usually made by exclusion of organic disease of the genital tract.Table No. 17. Description of menstrual pattern. Term Interval Duration Amount Menorrhagia Regular Prolonged Excessive Metrorrhagia Irregular Prolonged Normal Meno metrorrhagia Irregular Prolonged Excessive Hypermenorrhea Regular Normal Excessive Hypomenorrhea Regular Normal or less Less Infrequent & / or Oligomenorrhea Variable Scanty Irregular Metropathia Prolonged Prolonged Excessive haemorrhagica Epimenorrhea Frequent Normal Normal 61 Disease Review
  • 77. Nidana And Its Understanding Through Normal PhysiologyNormal physiology Menstruation a specific event to characterize womanhood, encompassing about32-38 years of her active life is a physiologic process. Yet at times it troubles the woman.To understand the etiopathogenisis of this phenomenon as well as to plan the treatment, itis imperative to look into the physiology of menstruation; specifically rhythmic variationof doshas during phases of menstrual cycle.(1) Rtukala: It is the most fertile period of first 12-16 days of menstrual cycle (MC). Inexceptional cases, it may be a whole month or even with out menstruation 119. During thisperiod, two most important events take place with in the reproductive system i.e.,accumulation of raja in vascular apparatus of uterus (proliferative changes) andovulation. The raja or menstrual blood is derived from Rasa dhatu, Rakta dhatu. Raja isalso considered to be the upadhatu of rakta. These opinions in spite of appearing as different are actually similar. Thedifference is only in the description of the stage of the cycle. The proliferative phase isdominated by kapha. The rasa dhatu reaches the uterus during the phase of formation oravirbhava of raja. Prithvi and jala tatwa of kapha nourished by rasa dhatu (a sowmyasubstance) causes proliferation of endometrium. Gradually due to influence of kala ortime, the change of character of rasa takes place. It becomes agneya and assumes thecharacter of rakta during the preparation for discharge i.e., tirobhava 120. Specific delicate balance between the decreasing sowmya tatwa (kapha) andincreasing agneya tatwa (pitta) triggers ovulation. 62 Disease Review
  • 78. (2) Rtu vyateeta kala (Post ovulation phase) 121, 121(a) This phase is predominated by pitta. During this phase, the raja or artava is fullyestablished. Body has preponderance of agneyatwa, resulting in slight increase in basalbody temperature. Just as at the end of the day, the kamala pushpa closes, similarly after rtu kala,the yoni of the nari becomes sankuchita. This agneyatwa desiccates jaliyamsha of kapha, the thick vicid mucous whichplugs the cervix and thus entry of shukra, a sowmya substance is prevented.(3) Raja srava kala (Phase of menstruation) This phase is dominated by vayu (apana vayu), which discharges the menstrualblood.122Rtu charka & its sharira kriya vivechana The specific life span of the female should be dealt with on the basis of herreproductive capacity.Flow chart No. 01. Showing formation of Raja Aahara Pachaka pitta Samana vayu Avalambaka kapha Aahara rasa Rasadhatwagni Artava (Cha. Chi., 15/17, Rasa dhatu Su. Su., 14/6) Reaches garbhashaya Tryaham pravartamanam Artava or raja pravartate 63 Disease Review
  • 79. Artava a upadhatu of rasa is sowmya in nature during avirbhava, assumes agneyanature by kalavashesha and during tirobhava.123Raja srava kala & antarkalavadhi • Normal flow – 3-5 days.124 • Prabhoota srava – 3 days. • Madhyama pravrutya – 5 days. • Alpa pravrutya – 16 days is considered normal The blood collected for the whole month by both the dhamanees (artavavimochini) assuming.Flow chart No. 02. Showing the Artava nirmana. Iishat krsna varna & vigandha Brought down by vayu to Yoni Sukshmakesha pratikasha – Garbhashaya tarpayanti ArtavaArtava parimana Samanya matra – 4 anjali 126Table No. 18. Showing features of normal rajasrava. Duration Associated No. Author Colour Amount Staining (days) symptoms Naeva No daha atibahu No arti 1. Charaka 5 Gunja phala - na eva ati No alpam pichilatwam Sushruta Laksharasa Yatvasa na 2. - 4 anjali - Vagbhata-I Shasaruk viranjayet 3. Vagbhata-II 3 - - - - 4. Harita 7 - - - - 5. Bhela 7 - - - - Bhava 6. 16 - Prakasha 64 Disease Review
  • 80. PHYSIOLOGY OF NORMAL MENSTRUATIONThe female hormonal system consists of three hierarchies of hormones. They are: 1. A hypothalamic releasing hormone Gonadotropin-releasing hormone (GnRH) also called lutenizing-hormone releasing hormone (LHRH) 2. The anterior pituitary sex hormones, follicle stimulating hormone (FSH) and lutenizing hormone (LH), both of which are released in response to the releasing hormone GnRH from the hypothalamus. 3. The ovarian hormones, estrogen and progesterone, which are secreted by the ovaries in response to the FSH and LH 127.The normal menstrual cycle can be divided into two segments: Ovarian cycle and uterine cycle based on the organ under examination. Theovarian cycle can be further divided into follicular and luteal phases, whereas the uterinecycle is divided into corresponding proliferative and secretory phases. Although two ovarian hormones directly control the activity of the endometrium,the ovary itself is activated by the pituitary gland, the secretion of which is under thenervous control of the hypothalamus. The hypothalamus starts a pulsatile secretion of GnRH, resulting in activation ofhypothalamus-pituitary ovarian uterine axis and in establishment of menstrual cycles. Pulsatile GnRH initiates secretion of FSH and LH. FSH release stimulates thegrowth of a few primordial follicles into graffian follicles. Multiple follicles startgrowing, but ultimately only one mature dominant graffian follicle ovulates whereas theothers become atretic. Graffian follicles under the influence of FSH together with only aminimal amount of LH secrete 17 β-oestradiol. 65 Disease Review
  • 81. It has three functions - • Produces proliferative changes in the endometrium. • Inhibits the further secretion of FSH by the anterior pituitary. • It stimulates the LH secretion.127 The maximum peak of oestrogen is seen about 48 hours before ovulation whereas the LH peak occurs about 24 to 36 hours before ovulation.LH has two functions • Stimulates a graffain follicle to secrete 17 β-oestradiol. • It causes the follicle to rupture at ovulation and to form a corpus luteum.Corpus luteum secretes progesterone, which is responsible for, • Secretary changes in endometrium, and • Inhibition of further LH secretion. Both oestrogen and progesterone remain elevated through the life span of corpusluteum and in the absence of pregnancy their levels start declining which brings aboutmenstruation. A fall in the level of these hormones also sets in off a fresh positive feedback mechanism and triggers the hypothalamus to secrete gonadotropin.Follicular Phase The hormonal feed back promotes the orderly development of a single dominantfollicle, which should be mature at midcycle and prepared for ovulation. The averagelength ranges from 10 to 14 days, and variability in this length is responsible for mostvariations in total cycle length.Luteal Phase The time from ovulation to the onset of menses, with an average length of 14days. 66 Disease Review
  • 82. MECHANISM OF NORMAL MENSTRUATIONThe blood supply of the uterus The arcuate and radial arteries (branches of the uterine artery) supply themyometrium and the basal endometrium. On approaching the surface epithelium, theradial arteries develop a corkscrew appearance and are known as spiral arterioles. Theyare present only in species, which menstruate and are end arterioles, each supplying inarea of 4 to 7 mm. They are sensitive to changes in gonadal steroid levels and thecapillaries are lost with the glands and stroma at menstruation. There is an irregularnetwork of venous vessels with the veins frequently intersecting forming venous lakes.128Histology Along with the histological changes that occur in the endometrial glands andstroma in a menstrual cycle, the spiral arterioles also undergo cyclic change. Followingthe cessation of menstruation, they are simple in form extending just into theendometrium. The secretory phase is characterized by the growth of arterioles. In the late secretory phase coiling occurs due to proliferation and extension of thearterioles as well as the resorption of the stromal oedema. With the fall in steroidconcentrations menstrual shedding of the endometrium occurs. Dramatic changes occurs in the spiral arterioles at menstruation. These changeswere described by Markee (1948) after experiments involving the transplantation ofendometrium into the anterior chamber of the eye of the rhesus monkey. This work is thecorner stone of the current day concepts of the menstrual process. On observing thebleeding process, Markee suggested that the arteriole coiling caused constriction of thevessel lumen with vascular stasis and leukocytic infiltration. About 24 hourspremenstrually intense vasoconstrictions led to ischemia which was then followed byvasodilatation with haemorrhages from both arterial and venous vessels. 75% of the losswas arteriolar, 15% venous and 10% diapedesis of erythrocytes.128 67 Disease Review
  • 83. Control of Menstrual Blood loss The endometrial surface area is large (10 to 45 mm) indicating that hemostasisduring menstruation is usually very efficient. Possible factors in the blood loss are: 1) Platelet plug formation 2) Vasoconstriction 3) Endometrial repairPlatelet Plug (Hemostasis) Formation If menstrual blood was to clot as peripheral blood then man would be at a graveevolutionary disadvantage as menarche would result in extensive formation of intra-uterine adhesions and infertility. One of the fascinating aspects of menstruation is that menstrual blood does notclot and the endometrium has a high fibrinolytic activity. Menstrual blood contains platelets, which fail to aggregate in response to pro-aggregatory agents such as ADP and collagen. • Contains no fibrinogen and • Contains reduced amounts of coagulation factors compared to peripheral blood • It does contain fibrin and fibrin degradation products confirming the potent fibrinolytic activity within the uterus.Vasoconstriction At the onset of menstruation, damaged blood vessels are seated by intravascularthrombi of platelets and fibrin. However, as menstruation progresses, the functionalendometrium is shed, thus these hemostatic thrombi are lost. By 20 hours after the start ofthe menstruation, blood loss is controlled by intense vasoconstriction of the spiralarteries. 68 Disease Review
  • 84. The role of prostaglandins in menstruation is well established. Prostaglandinssynthesized from arachidonic acid are present both in endometrium and menstrual fluid inhigh concentrations. Their synthesis is endometrium influenced by steroid hormones and highest levelsare found during menses. This is particularly true for prostaglandin F2α is a potentvasoconstrictor whereas others prostaglandin E2 and prostacyclin (PGI2) leads tovasodilatation. Inhibitors of the prostaglandin synthesis decrease menstrual blood loss andmyometrial contractility. Exogenous prostaglandins affect uterine contractility and caninduce menstrual type bleeding. Other vasoconstrictors which have attracted recent interest are Endothelin andplatelet activating factor (PAF). Lysosomal enzymes liberated at the time of menstruation as lysosomalphospholipase A2 increases the availability of the prostaglandin precursor, arachidonicacid. The endometrial tissue in DUB has higher concentrations of PGE2 and PGF2α.Endometrial Repair Menstruation is finally curtailed by endometrial repair. This process is stimulatedphysiologically by increasing levels of oestrogen released into the circulation by thedeveloping ovarian follicle. The oestrogen induced endometrial proliferation is mediatedby epidermal growth factor (EGF). It seems likely that endometrial EGF contributes torepair of both glandular and stromal tissue. 69 Disease Review
  • 85. Angiogenesis is an important part of endometrial repair, as the developing tissuesneed adequate blood supply. Vascular endothelial growth factor (VGEF) is a highlypotent endothelial mitogen produced by the endometrium. Its production is stimulatedboth by oestrogen and by hypoxia. These data suggest a role VGEF in endometrial repairat the start of the menstrual cycle. Understanding the mechanism of the control of menstrual blood loss is steadilyincreasing. Further information about these mechanisms and their abnormalities duringmenstruation will enable effective medical treatments to be developed and reduce theneed for surgical treatment.NIDANA As understood, according to normal physiology, raja which is considered aupadhatu of rasa dhatu or rakta can get vitiated due to abnormalities of the relatedsrotas.Flow chart No. 03. Showing schematic representation of Menstrual abnormalities.1) Rasavaha srotas129 Guru Sheeta Ahara Vitiates rasa Atisnigdha Atimatra Atichintana Vitiates manas Vitiates vata (prana vayu) Inturn vitiates apana vayu Menstrual abnormalities 70 Disease Review
  • 86. As told in modern parlance, Schroder (1954) says that DUB has onset at times oflowered physical psychological resistance, which permits the assumption of endocrinedisorders between suprarenal and thyroid. Emotional influence could be significantlyassociated with this disease. Limbic system (emotional brain) is closely related tohypothalamus.Flow chart No. 04. Showing the involvement of Psychological factors in Menstrualirregularities. Stress Affects hypothalamus Disturbs the H-P-O axis Hormonal imbalance Menstrual irregularitiesFlow chart No. 05. Showing the involvement in Raktavaha srotas in Raktapradara.Rakta vaha srotas129 Vidahi anna pana Snigdha Annapana Vitiates rakta & pitta Ushna If other factors are also favourable Can result in asrigdara 71 Disease Review
  • 87. Flow No. 06. Showing the schematic representation of Raktapradara samprapti. SAMPRAPTI 130 Nidana Factors vitiating vata Factors vitiating pitta - rakta (chinta, shoka, yana, bhara, atimaituna) Increase in drava pitta Increase in volume of rakta Reaches Garbhashaya gata rajovaha sira Formation of increased raja Ashu vivardhayati, rasa Nidana is pitta prakopakara bhavat vimanatah Increases the amount of rakta Apana vayu expels the increased raja Increases the amount of raja Asrigdara Nidana – vitiates vata Brings the increased rakta to garbhashaya gata sira Abnormal Uterine Bleeding & Its Etiopathogenesis Menorrhagia is a symptom of some under lying pathology – organic or functional 131 • Organic :- Pelvic Systemic Endocrinal Blood dyscrasias Emotional upset • Functional : Due to disturbance of H-P-O endometrial axis 72 Disease Review
  • 88. Table No. 19. Showing Pelvic pathology.Pelvic pathology : Due to : Congestion, increased surface area, hyperplasia of endometrium. • Fibroid uterus • Adenomyosis • Pelvic endometriosis • IUCD in-utero • Chronic tubo-ovarian mass • Tubercular endometriosis (Early cases) • Retroverted uterus (Due to congestion) • Granulosa cell tumor of the ovaryTable No. 20. Showing the systemic causes of DUB. • Liver dysfunction – failure to conjugate – there by inactivates the oestrogen. • Congenital cardiac failure. • Severe hypertension.Endocrinal • Hypothyroidism • HyperthyroidismBlood dyscrasias • Idiopathic thrombocytopenic purpura • Leukemia • Von Willebrands diseaseCommon causes of menorrhagia : • DUB • Fibroid • Adenomyosis • Chronic tubo-ovarian mass 73 Disease Review
  • 89. Classification of DUB132Table No. 21. Showing the classification of DUB132Classification of DUB Primary DUB – Due to primary dysfunction in the uterus, ovary, pituitary,hypothalamus, higher centers. Secondary DUB – IUCD or administration of sex hormones, Organicdisease outside the reproductive system. DUB can occur during the life span of a woman at any time from menarche;occasionally even after menopause. The etiological factors, investigatory procedures andtreatment modalities vary widely in the 3 major groups, namely 1. Pubertal less than 20 years 5 – 15% 2. Child bearing 20 to 40 years 40 – 55% 3. Perimenopausal age more than 40 years 40 – 55% Pubertal – irregular menstrual cycle, long cycles, cause – immaturity of H-P-Oaxis, menstrual cycle, anovulatory, organic disease - rare and usually resolvesspontaneously. Child bearing – regular menstrual cycles, regular ovulation, benign organicdisease - Common, Malignancy rare. Curettage should be done to exclude complicationsof pregnancy and other diseases. Perimenopausal age – irregular cycles, (due to decreased number of ovarianfollicles & their increased resistance to gonadotrophin stimulation), longer cycles,increase in corpus luteum insufficiency/anovulatory cycles, eventually cessation ofmenstruation. Post menopausally DUB associated with atrophic endometrium. Premenopausally DUB is common but organic disease (fibroma, malignancy) may occur.Therefore curettage and hysteroscopy should be done without delay. 74 Disease Review
  • 90. Ovulatory DUB Primary DUB Anovulatory DUB 133Ovulatory DUB These women with menorrhagia and normal cycles show no abnormality of theH-P-O axis (Haynes, 1980). The under lying pathology is thought to be with pancrinecontrol of endometrial spiral arteries. There is altered ratio of different prostaglandinsproduced locally. There is an increase in PGE2 and high ratio of PGE2 : PGF2α – resultingin vasodilatation – abnormal bleeding. There is increased fibrinolysis and increasedplasminogen activator (TPA) in primary menorrhagia. Vasoactive substances like leukotrines, cytokines & endothelins are implicated. Ovulatory DUB with altered cycle length It occurs due to endocrine imbalance. Short or long follicular phase results inpolymennorrheaTable No. 22. Showing Ovulatory DUB with altered cycle length.132 Endocrine abnormality & Type Typical bleeding pattern Endocrine histology Short cycle – short proliferative phase, Polymenorrhea , menorrhagia Normal normal endometrium ovulatory Long cycle – long proliferative phase, Oligomenorrhea, menorrhagia normal endometrium Insufficiency – short luteal phase, Premenstrual spotting, menorrhagia Corpus irregular or deficient secretory luteum endometriumabnormality Persistent (Halban’s disease) irregular Prolonged menstruation endometrial shedding Insufficient follicles – short cycle, Polymenorrhea inadequate proliferative or atropic endometriumAnovulatory Persistent follicles/PCOD – prolonged Oligomenorrhea, metropathia cycle, proliferative or hyperplastic hemorrhagica endometrium 75 Disease Review
  • 91. Pathology of EndometriumFlow chart No. 07. Showing the pathogenesis in DUB. Abnormalities of luteal phase (in ovulatory menorrhagia) Deficient progesterone Underdevelopment/Irregular ripening of endometrium Resistant corpus luteum Irregular sheddingEndometrial hyperplasia Most commonly observed abnormality in DUB Varies from slight exaggeration of proliferative phase to marked overgrowth – approaching adenocarcinoma.It is classified into 4 phases/types Simple hyperplasia – most common, has least malignant potential (Fig. 11 & 12) Complex hyperplasia Simple hyperplasia with atypia Complex hyperplasia with atypia (Fig. No. 14)Atrophy of the endometriumFlow chart No. 08. Showing the representation of post-menopausal uterine bleeding. It is associated with the development of large dilated venules situated superficially under a thin endometrium Rupture of venules Post menopausal uterine bleeding 76 Disease Review
  • 92. Table No. 23. Showing Role of EicosinoidsRole of Eicosinoids134 Cell ischemia/death Physiological Phospholipase A2 LYSOSOME Phospholipase A2 oestrogen Phospholipase A2 (inactive) progesterone (active) Phospholipids Arachidonic Acid Prostaglandin MICROSOME synthetase Prostaglandin Endoperoxide Thromboxane PGF PGE PGD ProstacyclinPGF2α – Vasoconstrictor & weakly platelet aggregatory.PGE2 – Vasodilator & weakly platelet anti-aggregatory.PGD2 – Platelet aggregation inhibitor.PGI2 – Potent vasodilator & inhibitor of platelet aggregation.TxA2 – Potent vasoconstrictor & platelet aggregator.[Prostanoids are not stored in the tissues but are synthesized & released as required.PGI2 – mainly formed in endothelial & vascular tissue.TxA2 – formed in platelets.] All prostanoids are rapidly metabolized & inactivated, are believed to act at theirsite of synthesis. 77 Disease Review
  • 93. Normal menstruation134 In proliferative phase – the endometrium synthesizes equal amounts of PGF2α &PGE2 . During luteal phase, PGF2α synthesis increases, the ratio being F2α : E2 = 2 : 1.Flow chart No. 09. Showing the normal physiology of Menstruation. PGF2α - synthesized in the endometrium Produces vasoconstriction of spiral arterioles Increased production of endoperxidase Deviated into the myometrium Produces PGI surge Diffuses back into the endometrium Vasodilatation Menstruation In Anovulatory DUB, amounts of PGF2α & PGE2 found in persisting proliferativeendometrium are same.Flow chart No. 10. Showing the pathogenesis of Menorrhagia. Absence of progesterone No increase in synthesis of PGF2α Decrease in PGF2α : PGE2 + increase in PGE2 Atrophic endometrium (deficient) Menorrhagia (also accounts for absence of uterine contraction & painless bleeding) 78 Disease Review
  • 94. In ovulatory DUB, the order of prostaglandin is changed from PGF2α / PGE2 /PGD2 to PGE2 / PGD2 & PGF2α.Corpus luteum insufficiencyFlow chart No. 11. Showing the pathogenesis of Menorrhagia. Inadequate development of corpus luteum Insufficient secretory changes Decrease in PGF2α : PGE2 ratio MenorrhagiaPersistent Corpus Luteum:Flow chart No. 12. Showing pathogenesis in Endometrium. Continued secretion of oestrogen & progesterone + absence of the normally sharp fall in oestrogen & progesterone secretion which precedes menstruation Inadequate release of phospholipids A2 Inadequate release of prostaglandins Irregular shedding of endometriumAnovulatory DUB: • Insufficient follicular development • Persistent ovarian follicle 79 Disease Review
  • 95. Flow chart No. 13. Showing pathogenesis in Menorrhagia. Insufficient follicular development Inadequate production of oestrogen & progesterone Inadequate proliferation of endometrium without any secretory changes Atrophic endometrium (deficient) Associated with large dialated sub endothelial vennules MenorrhagiaFlow chart No. 14. Showing normal physiological consequences of menstruation. Persistent ovarian follicle Adequate production of oestrogen, but no ovulation, corpus liteum fails to develop No progesterone reaction Continuous unopposed oestrogen secretion Continued proliferation of endometrium Benign hyperplasia / adenomatous hyperplasia When endometrium outgrows, its blood supply or there is decrease in oestrogen secretion Menstruation 80 Disease Review
  • 96. Intermittent vaginal bleeding is usually associated with low circulating oestrogenlevels resulting in break through bleeding due to prolonged anovulation leading topersistent desquamation.ROOPASamanya Roopa: Rajaha pradiryate yasmath pradarasthena sa smrutaha ||135 Asrigdaram bhaveth sarve sa angamardam sa vedhanam ||136 Atiprasangena – excess menstruation (Atimatra + Dirgakalanubandhi)138 Pravruttam anrutavapi – alpa dirgakalanubandhi (menses even in intermenstrualperiod, scanty & associated for a long duration.)137 Anyad rakta lakshanam139 – features different from normal menstruation i.e.,doshanubandhi Associated symptoms:137 angamarda, samvedana, achirena ghoran arti inadhovanmkshana desha, shroni, prushta, kukshi & garbhashayaBheda:140 o Vataja, o Pittaja, o Kaphaja, o Sannipataja 81 Disease Review
  • 97. Vishesha Lakshanas141Table No. 24. Showing vishesha lakshanas.Sl. Symptoms Vataja Pittaja Kaphaja Sannipataja Amount of Nitanta 1. Alpam Bahalam ---- flow raktam Kimshukodaka, Nila, peeta, Sarpimajja 2. Colour Pandu krshna, aruna krshna vasopama Visra, matsya 3. Smell Loha gandhi Vasa gandhi Durgandha gandha Guru, Phenila, tanu, 4. Consistency Snigdha picchilam, Picchilam ruksha ghanam Tantumat Nature Askandi 5. Askand Madhu Vranadwara Bahuvega (Clotting) vasad Pittarti Mandarujaka 6. Pain Saruja/niruja Madhu ---- ram Kati vamkshanam, Daha, raga, Chardi, Trisna, daha, Associated hritparswa, trishna, arochaka, 7. jwara, ksheena symptoms prishta, sroni- moha, jwara, hrillasa, rakta, durbala shoola brama swasa, kasa Temperature 8. Sheeta Atiushnam Sheetalam ---- of discharge 9. Rasa Kashaya Katu Lavana ---- Sashabda, Anrutavapi10. Others Anrutavapi ---- Anrutavapi Dvidoshaja lakshanas of asrigdara is not seen to be mentioned in any of theclassics. However, to understand this dvidoshaja lakshana, the lakshanas mentioned invidhishonitiyam adhyayam of Sushruta Sutra and from siravyadha adhyaya of AstangaSamgraha can be applied to understand the lakshana of each dosha. 82 Disease Review
  • 98. Upadrava:136 Dourbalya Weakness Bhrama Giddiness Moorcha Fainting Tama Darkness Trishna Thirst Daha Burning sensation Pralapa Delirium Pandu Anemia Tandra Drowsiness Vata roga Different vataja rogas Shopha57 SwellingSadhyasadhyata142All the classics consider tridoshaja asrigdara as asadhya • Saswat sravanti • Trishna • Daha Are the asadhya lakshanas • Jwara • Ksheena rakta • DurbalaHarita under the description of arista lakshana of artava says, when associated with….Jwararta FeverApoorne divase pushpa mapmuyat Rajasrava even before completion of rtu charkaSarena Continuous bleeding …..then that stree – na jeevet 83 Disease Review
  • 99. CHIKITSAThe general line of treatment of any disease is followed on the basic lines as Nidana parivarjana Samshodana Samshamana Rasayana chikitsa. Nidana plays the prime role in the initiation of pathogenic process, whichproceeds towards the development of the disease. Hence, nidana parivarjana shouldfollow the first line of treatment. Charaka explains the treatment to be like for Raktayoni i.e., rakta sthapana oushadha after giving due consideration to the association of doshas. 143 Treatment prescribed for vataladi yonivyapat should be used in respective asrigdara. It should be treated on the lines of rakta atisara, shonita pitta & raktarshas.144 Treatment on the lines of adhoga rakta pitta is to be applied. 145 Use of uttaravasti is beneficial.146 Diseases treated with Shodana chikitsa have negligible chance of recurrencebecause vitiated Doshas are totally expelled from the body. Those treated with Shamanachikitsa are vulnerable for recurrence because subtle amount of vitiated Doshas left overin the body after shamana chikitsa can get aggravated with the slightest opportunity. 84 Chikitsa
  • 100. Vamana : As mentioned earlier Asrigdara should be treated on the lines ofAdhoga raktapitta. Vamana may help to normalize the Gati of Vayu (Apana). Thus,helping to cure it. However there is no direct reference of either its indication orcontraindication. Virechana : Virechana has been indicated wherein Charaka has suggested the useof mahatiktaka ghrita for virechana in pittaja type of asrigdara. The predominant doshabeing pitta, virechana serves as the best shodhana therapy. Vasti : It is a well-known fact that none of the yoni rogas is caused without thevitiation of vata dosha. Hence, the pacification and regulation of the vitiated vatabecomes necessary. Classics have mentioned the use of both niruha and anuvasana vastiin asrigdara to pacify vata (specially apana vayu). Another type of vasti explained is the uttara vasti. Acharyas have recommendedthe efficacy and importance of uttara vasti in the treatment of atrava vyapat. The presentstudy has been conducted to evaluate the usefulness of uttara vasti in the management ofasrigdara. The topic of uttara vasti has been presented latter. Nasya : In the brihatrayi, no mention of nasya with reference to asrigdara hasbeen made. However, Kashyapa quotes that nasya should not be given during raja sravakala. 85 Chikitsa
  • 101. Thus, to sum up the aims of treatment of Asrigdara should be – To cease the excessive bleeding, thus preventing the progress of Dhatukshaya and their complications. To pacify the vitiated Doshas and maintain their equilibrium. To correct or regularize the Rtuchakra. To maintain the general health of the body, which is governed by Rasadhatu, which if deteriorated can influence the Artava.Management (Modern Review)147 Exclusion of organic disease of the genital tract, if necessary by repeatedinvestigations. Diagnosis of underlying dysfunction, if possible Assessment of the nature & severity of DUB & the age, parity & wishes of the patient with regard to contraception, future pregnancies & surgery. The management of DUB can be studied under 3 headings 148 Reassurance Medical Surgical Reassurance : Many women can be satisfied just from the knowledge that theirmenstrual loss is not abnormal compared to others. Other women will be satisfied withthe knowledge that there is no underlying cause of their menorrhagia. Non-anemicwomen with primary menorrhagia should understand that treatments offered aresymptomatic control. 86 Chikitsa
  • 102. Medical (Hormonal or/and Non hormonal) :Table No. 25. Showing the medical line of treatment. (Hormonal and Non hormonal)149 Success rate (i.e. %Drug Mode of action Side effects Advantages reduction of M.B.L)NSAID Decrease(Eg. prostaglandin level by Headache, GIT Taken only during 20 – 30 %Mefenamic inhibiting cyclo disturbances mensesacid) oxygeneseAntifibrinol GITytic drugs Prevent activation of disturbances, Taken only during(Eg. 50 % plasminogen intracranial mensesTranexamic thrombosisacid) Maturation of the Weight gain, endometrium, healing nausea, Appropriate RxProgesteron of superficial breaks, bloating, 15 % only fore increased structural oedema, anovulatory DUB stability & cessation of headache, bleeding depression Atrophy of the endometrium because Weight gain, the chronic oestrogen abdominal & progesterone discomfort,Combined exposure suppresses 53 % break through ContraceptionOCP pituitary bleeding, gonadotrophin & cardiovascular inhibits endogenous risk steriodogenesis Difficulty during insertion, Beneficial effectLevenorgest Local release of initial irregular in dysmenorrheal,erol IU progesterone – 82 – 96 % bleeding, endometrialDevice endometrial atropy prolonged hyperplasia, PMS, amenorrhea, contraception progesteronic side effect. Has carry over Inhibits binding of sex effect till 4 steroid to androgen & AndrogenicDanzol 60 % months of progesterone receptor side effects cessation of – endometrial atrophy therapy Has carry over Post Inhibits FSH & LH – effect till 2GnRH menopausal amenorehoea with in 4 85 – 90 % months ofanalogous side effects, –6 weeks cessation of costly therapy 87 Chikitsa
  • 103. Surgical149 : The range of treatment options have multiplied in recent yearsespecially in the field of minimally invasive surgery. • Dilatation & Curettage • Endometrial Ablation – Electro surgery, laser • HysterectomyDifferential Diagnosis Excessive or prolonged or any type of abnormal uterine bleeding can be seen as asymptom in different other diseases also. To diagnose the condition of asrigdara, it needsto be differentially diagnosed from the other condition. The various diseases considered under differential diagnosis are – (1) Asruja yonivyapat. (2) Lohitakshara yonivyapat. (3) Pittaja yonivyapat. (4) Astartva dushti. (5) Pittavruta apanavayu. (6) Raktarshas. (7) Raktatisara. (8) Adhogata Rakta Pitta. Asruja Yoni Vyapat150 : Asruja is a condition wherein due to Raktapittakaranidana, the Yonisthita rakta gets vitiated by Pitta, resulting in Atipravartam of Rakta evenwith Garbhae Api Labdhe (with conception). 88 Chikitsa
  • 104. Chakrapani commenting on this says – Excessive bleeding leads to abortion,therefore the woman remains without Praja (Apraja). Due to excessive bleeding pervaginum it is referred to as Raktayoni. Lohitakshara Yoni Vyapat151 : This condition is characterized by continuous orexcessive bleeding or oozing or trickling or blood associated with other features of Pitta –Osha, Chosha, Jwara, Daha, etc. the word Kshara refers to oozing or trickling. This kind of bleeding pattern is seen in small cervical polyp or erosions whichpresents with intermittent scanty bleeding. Due to association of chronic inflammationwith erosion, symptoms like burning sensation etc., are present. Therefore this condition can be considered irregular bleeding associated witherosion or polyp. It can be ruled out by clinical examination, PAP smear and by D&C.Pittaja Yoni Vyapat143 :Table No. 26. Showing Pittaja Yonivyapat143 Pittaja Lakshana Pittaja Yoni Vyapat Asrigdara Stanika Paka + - Sarvadaihika Ushnata + - Atyadika Ushna & Kunapa Gandhi Yoni + - Srava Rakta Srava + ++ Anrutavapi Bhutartava - + Raga Trushna Moha - + Bhrama Astartva Dushti152 : Among the Ashtartava dushti, Kunapagandhi arthava dushticaused due to rakta presents with excessive menstrual flow associated with other featurespittavedana and Kunapagandhi (smell of dead body). This asadhya vyadhi – can be seenin conditions of carcinomas with necrosis of tissue. 89 Chikitsa
  • 105. Pittavruta Apana Vayu153 : Rajascha ativartanam is the feature associated withother lakshanas – Haridra mutra varcha, Tapa guda medrayaha. The concept of Aavaranais considered as a pathological process towards the development of the vyadhi, but notthe vyadhi itself. Raktarshas & Raktatisara154-155 : These can be differentiated as the margathrough which it presents. Adhoga Rakta pitta145 : This can be differentiated from Asrigdara as Adhogaraktapitta presents with bleeding through other Adhogata margas like Gudamarga,Mutramarga apart from Yonimarga.Table No. 27. Showing Differential Diagnosis of DUB. Differential Diagnosis of DUB: Hormonal: Anovulation Polycystic ovarian syndrome Thyroid dysfunction Hormonal contraception Depot medroxyprogesterone acetate Oral contraceptive Levonorgestrel implants Pregnancy: Threatened or spontaneous abortion Ectopic pregnancy Incomplete elective abortion Postabortal endometritis Local pathology: STD Foreign body (e.g., tampon, intrauterine device) Polyp (Cervix & uterus) Trauma Dysplasia or malignancy Bleeding Diathesis: Platelet disorder Thrombocytopenia Platelet dysfunction Coagulopathy Inherited clotting factor deficiencies Vitamin K deficiency Anti coagulant therapy Consumptiom coagulopathy 90 Chikitsa
  • 106. METHEDOLOGYThe Materials and methods of the present study consist of following headings. 1. Pharmaceutical study 2. Analytical study 3. Clinical studyPharmaceutical study Bola parpati is one of the parpati kalpana explained in various classical works.The formula adopted here is according to Yogaratnakara. This preparation is mainlyindicated for Rakta Pradara. Raktapitta, Raktatisara etc., A Detailed and clear description of steps taken to prepare these trial drugs Bolaparpati is being explained under this heading.Study design This section includes three major steps Step 1 – Identification and selection of raw drugs. Step 2 – Purification and processing of raw drugs. Step 3 – Preparation of Bolaparpati.MethodStep 1 : Identification and selection of raw drugs. Proper Identification and selection of raw drugs are need of the hour for theAyurvedic formulations; because without these things we cant assure the quality of ourmedicaments. So this selection of study deals with the same.Ingredients 1. Parada – 100 gms 2. Gandhaka – 100 gms 3. Bola – 200 gms. 91 Pharmaceutical Study
  • 107. Special request indent was made to the local herbomineral drugs shop dealer toget the particular quality of raw drugs and those were screened for the classical Grahyaand Agrahya lakshanas then those were certified by the concerned departments. 1. Parada : Parada was extracted from Hingula. So the quality assessment ofHingula was as per classics. Selected Hingula had the colour of Japakusuma. It easilybroken while triturating it was having white lines on it and heavy in weight. (Ref. RasaTarangini 9/3, Ayurveda Prakasha 2/71, Rasa Ratna Samucchaya 3/139) 2. Gandhaka : Which was clear, yellow in colour just like Haridra and as smoothglistening as butter, Amalasara variety was selected for the study. (Ref. AyurvedaPrakasha2/20) 3. Bola : Bola was identified and authenticated.Step 2 : Purification and processing raw drugs. Ayurveda has enlisted certain drugs, which will cause adverse effects and lesstherapeutic effect if administered in impure (unpurified) state. So proper purification isnecessary to combat the probable adverse effects. This section deals with the purificationand processing raw drugs.Practical No. 01.Title – Hingula Shodhana.Date of commencement – 10/6/05.Date of completion – 17/6/05.References – RasataranginiMaterial required – Khalva Yantra, Juice Extractor.Ingredients & quantity – Hingula 200 gms Nimbu swarasa Q.S. 92 Pharmaceutical Study
  • 108. Table No. 28. Results of Hingula Shodhana.Ingredients in Bhavanadravya in Mardana in Hours Results RemarksQuantity QuantityHingula 200gm Nimbuswarasa 100ml 6 ½ hrs 204 Gain 4 6 hrs 207 3 6 ½ hrs 210 3 6 hrs 214 4 6 ½ hrs 218 4 6 hrs 222 4 7 hrs 225 3Table No. 29. Showing the quantity of Hingula before Shodhana and after Shodhana.Dravya Quantity of Hingula before shodhana (in Quantity of Hingula After gms) ShodhanaHingula 200 gms 225 gmsMethod Hingula was taken in a Khalva yantra and powdered nicely 100 ml of Nimbuswarasa was added and Maradana was done for 6 hrs.Observations ⇔ While Powdering of Hingula white shining line were seen. ⇔ After half an hour of Mardana white shining line of Hingula disappeared. ⇔ After 45 minutes the colour turned to red.Precautions ⇔ Initially Mardana should be done slowly to avoid the spillage of material. ⇔ After it attains semisolid consistency the Mardana should be done firmly and continuously. 93 Pharmaceutical Study
  • 109. Results Before Shodhana – 200 gms. After Shodhana – 225 gms.Note : The above procedure was adopted for another 200 gms of Hingula sample.Practical No. 02.Results Before Shodhana – 200 gms. After Shodhana – 226 gms.Table No. 30. Showing the results of Hingula shodhana.Sl. Ingredients & quantity Time of Results Remarks Mardana1. Hingula 200 gms 6Hrs for 225 gms Gain 25 gms Nimbu Swarasa 700 ml 7days2. Hingula 200 gms 6 Hrs for 7 226 gms Gain 26 gms Nimbu swarasa 700 ml daysPractical No. 03.Title – Extraction of Parada.Date of Commencement – 30/6/05.Date of Completion – 04/7/05.Reference – Ayurveda Praksha.Equipment – Urdhawa Patana Yantra Khalva, Yantra, gas storeIngredients & quantity – Hingula 225 gms and Nimbu swarasa 25 ml. 94 Pharmaceutical Study
  • 110. ProcedureStage 1 : Preparation of Chakrikas. Shuddha Hingula was taken in a Khalva yantra and Nimbu swarasa was added,Mardana was done till proper consistency observed then chakrikas were prepared anddried in the shade for two days. Average measurement of Chakrikas. Thickness – 3.5 mm. Circumference – 3-31/2 cm.Stage 2 : Preparation of Urdhava Patana Yantra.Materials required – Two earthen pots of equal size, Cloth 4 x 60 cms. Multani clay.Method The mouth surface of two parts was rubbed on a smooth stone with sand to makethe facing surface of mouth even. Dried Chakrikas of Shuddha hingula were kept in the pot and it was covered withthe another pot fixed. The gap left at the union of two months of pot was closed with multani smearedthread. Sandhibandhana was done with cotton cloth strip smeared with multani clay andallowed it for a day.Stage 3 : Extraction of Parada. Next day Urdwa patana yantra was kept on gas stove and heat was givencontinuously for 8 hours. While heating cold water was maintained on the upper pot andalso a cotton pad was placed at the uncovered part of the upper pot. After Swangasheeta of Urdaava patana Yantra carefully it was opened thematerial was filtered through a clean cloth and parada was collected in a clean glass jar. 95 Pharmaceutical Study
  • 111. Observations After one hour of Agni sulphur smell was noticed After opening of the Urdhawa partana yantra globules of mercury was seen adhered to the upper part of the pot. Some globules of mercury were also seen in the lower pot along with cooked material. Mercury collected was shining like a mid day sun.Precautions The upper part should be maintained with cold water & cold cotton pod at the uncovered part of pot continuously. The water should not wet the Sandhi bandhita area Heat should be given uniformly i.e. 550o c heat was maintained. Note : The same extraction procedure was followed for another sample was thedetails obtained.Results Weight of Chakrikas – 227 gms. Weight of Parada – 157 gms.Practical No. 04. Weight of Chakrikas – 220 gms. Weight of Parada – 152 gms.Table No. 34. Results of Extraction of Parada.Sl. Before Extraction Weight of After Extraction Weight of material Chakrikas Weight of Parada residual01. 1. 227 gms 157 gms 70 gms02. 2. 220 gms 152 gm 74 gms 96 Pharmaceutical Study
  • 112. Practical No. 05.Title – Gandhaka Shodhana.Date of Commencement – 11/7/05.Date of Completion – 11/7/05.Reference – Rasamrita.Equipments – Khalva yantra, Iron pan, Earthen pot, Thread-40 cms, Cloth 30 x 30 cms.Ingredients & quantity – ⇒ Gandhaka – 250 gm. ⇒ Go ghrit – 250 gms. ⇒ Bhringraj swarasa – 200 ml.Procedure Gandhaka was made into fine powder. Gandhaka powder was fried in a pan using go ghrita. Orange coloured liquified Gandhaka was powdered into a earthen pot containing the Bringaraj swarasa the neck of which was tied by 4 fold cloth. Gandhaka in cake from is obtained and washed with hot water. It was powdered and dried. Repeated this for 7 times.Observations Every times fresh Brhringaraj swarasa about ¼ liter was taken To remove the ghrita coated on the gandhaka cake brushing was needed. Every time Gandhaka was washed with hot water till the smell and stickiness of ghrita was removed totally. 97 Pharmaceutical Study
  • 113. Precautions To avoid spillage wide mouthed pot should be used. Cloth should be firm. The thread should be tied firmly. Washing of shuddha Gandhaka should be done with hot water for three times.ResultTable No 32. Showing the result of Gandhaka Shodhana.Before Shodhana After Shodhana RemakrsGandhaka 244 gms Loss 6 gmsPractical No. 06.Title – Preparation of Kajjali.Date of commencement – 15/07/05.Date of completion – 27/07/05.Reference – Yogaratnakara.Equipments – Kalva yantra.Ingredients and quantity – Hingulotha parada - 200 gms. Shuddha Gandhaka - 200 gms.Procedure Equal quantity of Hingulotha parada and shuddha Gandhaka was taken in a Khalwa Yantra and triturated. Trituration was carried out till the mixture becomes completely black, smooth fine powder. Trituration was carried out for 8 days initially. As small shiny particles were observed in the mixture trituration was continued for another 4 days. 98 Pharmaceutical Study
  • 114. Observation During trituration colour changes was observed after 2 ½ hrs Mixture become completely black at 6 hrs of trituration Spilling of Kajjali during trituration was observed because of chanchalata of parada. Though precaution was taken the loss on spilling could not be prevented After day 7 when the trituration was carried out the Kajjali used to stick to the Kalwa and on the Kajjali Removing the scales it was shiny 380 gms of kajjali was obtainedPrecautions Purified Gandhaka and parada should be taken for kajjali preparation Initially Maradana should be done slowly to avoid the spillage. The Mardana should be continued till the specific tests prove the standards of kajjali.Results ⇒ Weight of Parada – 200 gms. ⇒ Weight of Gandhaka – 200 gms. ⇒ Weight of Kajjli – 380 gms. ⇒ Loss – 20 gms.Practical No. O7.Title – Bola Parpati Nirmana.Date of Commencement – 28/9/05.Date of Completion – 29/9/05.Reference – Yogaratnakara.Equipments – Kalva yantra, Palika yantra, Gas stove, Kadlipatra, Gomaya.Ingredients & quantity – Kajjali – 200 gms. Bolachoorna – 200 gms 99 Pharmaceutical Study
  • 115. Procedure Equal parts of Kajjali & Bola choorna were taken together in a khalva & triturated for 6 hrs The Mixture of Bola choorna and Kajjali was then put into a Ghrita lipta palika yantra and heated. The liquified mixture was poured on the Ghrita lipta kadalipatra kept on Gomaya platform was immediately covered with another Ghritalipta kadalipatra & pressed. The Bola parpati was obtained.Observations If the Khalva is moist the bola choorna on trituration sticks to khalva. The Bola choorna was filtered through chalni and then taken for trituration. After 6 hrs of trituration bola choorna mixed well with kajjali. During heating aroma of bola was observed. After disappearance of fumes the mixture becomes liquid & was poured on Kadali patra. On liquification heat recorded was 1300C. The Parpati was thick because of the Bola choorna. 395 gms of Parapti was obtained.Precautions If the Ghrita is more the paka becomes dagdha and parpati become brittle. The parpati should pass through confirmative test like the parpati must have venation marks of Kadalipatra on breaking crackling shabda should be heard. 100 Pharmaceutical Study
  • 116. ANALYTICAL STUDYIntroduction Analysis is an attempt to find an explanation of certain phenomenon. Manbecause of his curiosity tried to analyze various phenomenon happening around him anddeveloped various sciences. Though Ayurveda is having its unique analytical approachtowards drugs, but in present era there is necessity of analysis of drug based on modernmethodology. So, it is a need to evaluate drugs by various parameters which includes – 01. Physical analysis 02. Chemical analysisPhysical evaluationOrganoleptic characteristics 01. Colour – Black. 02. Smell – Faint odour. 03. Touch – Coarse.AUTHENTICATION OF BOLA When trituration with water, it form yellowish-brown emulsion. When about o.1 gm of sand are triturated with solvent ether, filtered and allowed to evaporate, the thin film formed gives reddish colour on contact with bromine vapour and purplish when moistened with nitric acidResult : Bola passes the test. 101 Analytical Study
  • 117. DETERMINATION OF VOLATILE OIL CONTENT The determination of volatile oil in a drug is made by distilling the drug withwater collecting the distillate in a graduated tube in which the aqueous portion of thedistillate is automatically separated and returned to the distilling flask and measuring thevolume of oil.Procedure Place accurately weighed sample around 50 grams of coarsely communicateddrug in a round bottom flask and fill it with 300 ml of water. Add glass beads to themixture to prevent bumping during boiling of the contents. Boil the contents of the flaskslowly until distillation is complete (around 4 hours).Result : The volatile oil of Bola is 7.47%Determination of pH The pH value of the sample was determined by a digital pH meter. One percentsolution was prepared, as the sample was dry and solid in the form of pills. The pills werepowdered. One gram of the sample was weighed accurately and dissolved in 100ml ofwater and pH was noted in the digital pH meter.Result : pH value is 5.19Loss on drying Digest pure quartz sand that passes through No. 40 but 60 sieves withhydrochloric acid wash acid free, dry and ignite preserve in a stopped bottle. Place 25-30gms prepared sand and short glass rod in a nickel or stainless steeldish about 55 ml diameter and 40 mm deep fitted with cover. Dry thoroughly cover dishcool in desiccators. 102 Analytical Study
  • 118. Pipette out of quantity of drug to yield about 1gm of dry matter mix with a few mlof water and transfer quantitatively to the dish containing prepared sand with aid ofwater. Mix the sample thoroughly with the sand. Dry at a temperature not more than 110°C under pressure not more than 50 mm ofHg. Making trail washing at 2 hours interval. Towards end of drying period untilsuccessive weighing do not differ by more than 2 mg. Calculate the total solid from theloss of weight on drying.Result : Loss on drying is 3.68%.Determination of total ashProcedure Take about 2gms accurate weighed, ground drug in a previously traced silica dish,previously ignited and weighed. Scatter the ground dry in a fine even layer on the bottomof the dish. Incinerate by gradually increasing the heat not exceeding dull red heat(4500C) until free from carbon. Cool and weigh. Calculate the percentage of ash withreference to the air-dried drug.Result : Total ash is 5.1%.Acid in soluble ash The ash obtained was taken with dilute HCl filtered through Whatman no 42 filterpaper. The residue was washed with hot water till it was free from chloride; the residuewas taken in a cruisible, dried and ignited at low temperature. The percentage of acidinsoluble ash with reference to the moisture free drug was calculatedResult : 0.03%. 103 Analytical Study
  • 119. IDENTIFICATION OF ALKALOIDS Silica gel 60 F254 Merck pre-coated plates. Mobile phase – Chloroform – Methanol (90:10). Location reagent – Dragendroff’s reagent.Procedure Weight about 2gms of the sample into a separating flask. Add about 20ml water.Basify with dilute ammonia and extract with two quantities 25 ml of chloroform. Filterthrough anhydrous sodium sulphate. Evaporate the chloroform layer to the residueobtained. Add about 1 ml of methanol. Shake well to dissolve and spot about 10μsolutionon the TLC plate. Elute the plate with mobile phase to 3/4th of the plate. Dry the plate at1050C and spray the plate with dragendroff’s reagent. If alkaloids are present brownishred spots were obtained in the sample solution.Result : Alkaloids absent.THE FINENESS OF PARTICLE TEST It can be possible to use the ordinary microscope for particle size measuring in therange of 0.2 micro meters to about 100 micro meters. According to microscope methodthe fine powder was sprinkled on the slide covered with covering slip & placed on amechanical stage. In initially standardization of mino meter was carried out by coincidingthe lines of both oculo minometer style minometer & standarised by using the formula – SM / OM x 10 = m. In the next step, the style minometer was removed & the mounted slide wasplaced on a mechanical stage & focused. The particles are measured alops an orbitarilychosen fixed lines covered by the particles using the oculominometers. The size of theparticle was calculated using the standard value.Result : 8.722 micrometers. 104 Analytical Study
  • 120. FLOW PROPERTY Bola Parpati is in powder form, so to maintain the actual dose and for betterdispensing, it is filled in a hard gelatin capsules. Prior to doing the capsulation, BoleParpati is subjected to flow property test i.e., “Angle of repose” by which we can analyzeeither the powder having very good flow property, good property or a bad flow property.ANGLE OF REPOSE It is maximum angle that can be obtained between the free standing surface of apowder heap and the horizontal plane i.e., tanθ = 2h / d, where d is the diameter of thecircle and h is the height of the powder heap. This test involves the hollow cylinder; half is filled with Bola Parpati with oneend sealed by transparent plate. The cylinder is rotated about its horizontal axis until thepowder surface cascades. The curved wall is lined with sand paper to prevent prefentialslip at this surface. If the value is between 200 to 400 indicates reasonable flow potentialResult : 29.98±14.35.FLOW RATES A sample indication of the ease with which a material can be induced to flow isgiven by application of a compressibility index “I”. I = (1-V/Vo) × 100. Where V is the volume occupied by sample of the powder after being subjected toa standardized tapping procedure. Vo is volume before tapping procedure. In this procedure one measuring cylinder is taken and filled with Bole Parpati.The level of the Bole Parpati should be noted. Then at a height of 2cms continuous tentapping should be done, after that the level of the Bole Parpati in the cylinder is onceagain noted and the value ‘I’ is calculated with respect to the Vo and V value. If the value‘I’ is below 15% usually having good flow rates. 105 Analytical Study
  • 121. DISINTEGRATION TEST FOR CAPSULES The disintegration test determines whether the capsules disintegrates within theuniversal accepted time when placed in a liquid medium. The apparatus used fordisintegration test contains a horizontal strip with clamp at one end is screwed to a shaft.The basket having 6 tubes of 75 to 80 mm long, 21 to 25 mm internal diameter & withwall thickness of about 2 mm. The lower end with disc of stainless steel wire gauze of 10sieve is fixed to the clamp. One-liter glass beaker filled with 1% of HCL is kept under thebasket. The HCL in the beaker is maintained to a constant 370C temperature + 20 c bymeans of thermostat fitted on the front panel. The shaft with the basket moves vertically up & down through a distance of 5 cm.At the highest position of the basket the wire gauze remains at 2.5 cm below the uppersurface of the 1% HCL & at the lower position it remains 2.5 cm up from the bottom ofthe basket. The upward & downward movement of the shaft & basket is adjusted at a rate30 times / minutes. Disintegration is considered to be achieved when no residue remainson the disc. It is observed that Bolaparpati capsules completely disintegrated within <15min.SOLUBILITY TEST About one gram of the sample was weighed and dissolved in 10ml of the solvents.When the sample did not dissolve, an excess of solvent by 10 ml quantity up to 100mlwas added and noted that the sample was sparingly soluble in water and 1M Hydrochloricacid (1 gm of sample in 100 ml of water and 1 M Hydrochloric acid) and slightly solublein chloroform and alcohol (1 gram of sample in 600 ml to 1000 ml of chloroform andalcohol. 106 Analytical Study
  • 122. SOLUBILITY TESTS RESULTS Water Insoluble. Chloroform Slightly soluble. Alcohol Slightly soluble.CHEMICAL EVALUATIONDETERMINATION OF MERCURYProcedure Dissolve about 0.3gms of the sample in 5 ml of aquaregia and add 100 ml ofwater. Add 40ml of 0.05N EDTA, 5 ml of Ammonia buffer solution and 0.5ml ofsolochrome black indicator. Titrate the solution with 0.05 M Zinc sulphate until the bluecolour changes to purple (do not overshoot the end point), add 3gms of Potassium iodide,swirl to dissolve. Allow to stand for two minutes. Then, continue the titration with zincsulphate solution to the same end point as before. Each ml Zinc sulphate solutionrequired after addition of potassium iodide = 0.0103 Hg.DETERMINATION OF SULPHUREschka Mixture Mix two parts by weight calcined magnesia with one part of anhydrous sodiumcarbonate.Procedure Cover the bottom of a 50 ml crucible with 0.5 gm of Eschka’s mixture. Weighaccurately the appropriate quantity of the sample material and mix it immediately with2gms of Eschka’s mixture and put evenly on the previously weighed Eschka’s mixture.Level the contents by tapping gently on a bench. Cover this uniformly with 0.5gm ofEschka mixture. Place crucible in the muffle furnace. Raise the temperature from roomtemperature to 8000C +250C in about one hour and then heat for further 90 minutes. 107 Analytical Study
  • 123. Transfer the ignited mixture as completely as possible from the crucible to abeaker containing 25 to 30 ml of water. Wash out the crucible thoroughly with about50 ml of hot distilled water and add the washings to the contents of the beaker. Add carefully sufficient quantity of concentrated hydrochloric acid to dissolve thesolid matter, warming the content of the beaker to effect solution. Boil for 5 minutes toexpel carbon dioxide. Add drop wise from a pipette; warm 5% Barium chlorine solution.Stir the solution constantly during the addition. Allow the precipitate to settle for aminute or two. Then test the supernatant liquid for complete precipitation by adding a few dropsof Barium chloride solution. If a precipitate is formed, add slowly a further 3 ml of thereagent allow the precipitate to settle as before and test again, repeat this operation untilan excess of Barium Chloride is present. When an excess of the precipitating agent hasbeen added, keep the covered solution hot, but not boiling for an hour (steam bath) inorder to allow time for complete precipitation. The precipitation should settle and a clearsupernatant liquid should be obtained. Test the latter with a few drops of barium chloridesolution for complete precipitation. If no precipitate obtained, the Barium sulphate isready for filtration. Filter the solution through an ash less filter paper (Whatman No. 42). Wash theprecipitate with small portion of hot water. Dry the paper and place it in a silica orporcelain crucible, previously ignited to redness and cooled in desiccators and weighed.Gradually increase the heat until the paper chars and volatile matter is expelled. Do notallow the paper to burst into flame as mechanical loss may thus ensue. When charring iscomplete, raise the temperature of the crucible to dull redness and burn off carbon withfree excess of air. When the precipitate is white ignite the crucible at red heat for 10-15minutes. Allow the crucible to cool in air, transfer it to desiccators and when cold, weighthe crucible and contents. Repeat until constant weight is attained. A blank is necessary. Calculate the percentage of sulphur converting Bariumsulphate x 0.1374. 108 Analytical Study
  • 124. CLINICAL STUDY Bola parpati is one of the Ayurvedic formulas, and claimed to be very good for itsefficacy on Rakta pradara patients. But in what type of patient, in which avastha of thepatient and to what extent this drug is effective is not confirmed. Hence the clinicalevaluation of Bola parpati to understand the action on Rakta pradara in general and itsefficacy in individual symptoms is studied. The Material and methods of the present study consist of following headings Selection of patients Duration and way of administration of drug Parameters of AssessmentSelection of Patients 14 Patients of Raktapradara were selected out of 17 patients after screening withinclusion and exclusion from O.P.D. and of 14. 4 patients were drop out during the traildue to various reasons. The remaining 10 patients were completed the treatment andfollow up.a) Inclusion Criteria 1. Patients with classical signs and symptoms of Rakta pradara will be considered for selection. 2. Patients will be selected from the out patients department irrespective of their castes, race and socioeconomic states. 3. Patients between the age of 20 years to 50 years. 109 Clinical Study
  • 125. b) Exclusion Criteria To exclude fibroid polyp or congenital malformations of uterus. To exclude unsuspected pelvic pathology such as endometriosis PID & ovarian tumour if associated with pelvic pain. Polyp and submucous fibroid, Retroverted uterus due to congestion, Tubercular endometrites, Adenomyosis chronic tubo-ovarian mass. Patients of Raka pradara less than 20 years and more than 50 years.c) Grouping This study was conducted `10 diagnosed patients of Rakta pradara forobservational study in a single group.d) Administration of drug The Bola parpati was prepared in Department of Rasashastra and Bhaishajyakalpana, D.G.M.A.M.C., Gadag by using Hingulotha Parada, Gandhaka, Bola andfollowed classical method, was used for this clinical study.e) Route and way of Administration Bola parpati was given through oral route – Anuparna – Madhu.f) Duration of the treatment The total duration was 45 days and assessment was made before and aftertreatment. 110 Clinical Study
  • 126. g) Parameters of the study Clinical subjective improvement will be criteria for evaluation Duration of menstrual flow. Internal between 2 menstrual cycles. Amount of Menstrual blood loss. Consistency of Bleeding. Staining. Odour. Intensity of pain during menstruation.Grading and Scoring :A. Duration of Menstrual Flow 0 – 1-5 days. 1 – 6-9 days. 2 – 10-14 days. 3 – 15-19 days. 4 – > 20 days.B. Interval between 2 menstrual cycles Normal :- 28- 32 days Frequent :- Menstrual bleeding occurring at 21 days cycle or less. Inter-menstrual:- Menstrual bleeding occurring at 15-16 days cycle or in between 2 menstrual cycles Delayed :- Menstrual bleeding occurring > 35 days.C. Amount of Menstrual blood loss 0 – 1-3 Pads/day 1 – 4-6 Pads/day 2 – 7-9 Pads/day 3 – 10-12 Pads/day 4 – >12 Pads/dayD. Consistency of Bleeding 0 – Watery 1 – Watery +Clots 2 – Clots (mild) 3 – Clots (Moderate) 4 – Clots (Severe) 111 Clinical Study
  • 127. E. Staining 0 - Absent 1 - PresentF. Odour 0 – Absent 1 – PresentG. Intensity of pain during Menstruation ⇒ Absent ⇒ Mild (Patient able to tolerate, subsides with rest) ⇒ Moderate ⇒ SevereOverall assessment of the results Finally overall assessment of result was made with the help of above mentionedsubjective parameters. Grouping of results were made as follows – Well Responded. Moderate Responded. Responded. Not RespondedA. Well Responded Regularization of Menstruation Reduction in duration Reduction in amount of bleeding Reduction in clots Reduction in associated symptomsB. Moderate Responded Normalization of all Characteristics of menstruation, except any oneCharacteristics of menstruation duration, amount, interval or clots.C. Responded Normalisation of any 2 Characteristics of menstruation duration, amount, intervalor clots.D. Not Responded No response to treatment, along with persistence of most of the associatedsymptoms 112 Clinical Study
  • 128. OBSERVATION AND RESULTS In this present study 17 patients were reported as Raktapradara. Out of this 3patients were excluded on the bases of exclusive criteria fibroid, retroverted uterus & agebasis. Total 14 patients were recorded in this study. As they are fulfilled inclusive criteriaout of 14, 4 patients were dropped out during the trail due to various reasons, theremaining 10 patients were completed the treatment and follow up. The observation datas were recorded in well designed perform a before and aftertreatment. Total observations data divided into 3 sections for better understanding Demographic data Data related to disease. Data related to response to the treatmentDEMOGRAPHIC DATADistribution of Patients by ageTable No. 33. Showing the distribution of patients by age. Age Group No of Pt.’s % 20 –29 4 40 30-39 3 30 40-50 3 30 Among 10 Patients, 4 patients (i.e.40%) were belonged to the aged 20-29 years, 3patients (i.e.30%) were between the age of 30-39 years, 3 patients (i.e.30%) were inbetween 40-50 years of age. 113 Clinical Study
  • 129. Graph No. 01. Showing the distribution of Pt.’s by age groups. Distribution of Pt.s by Age groups 5 4 4 No. of Pt.s 3 3 3 2 1 0 20 –29 30-39 40-50 No of Patients Age GroupsDistribution of Patients by economical statusTable No. 34. Showing the distribution of socio economic status. S-E Status No of Pt.’s % Lower Class 3 30 Middle class 2 20 Upper class 5 50 Among 10 patients, 5 patients (i.e.50%) were belongs to upper class, 3 patients(i.e.30%) belongs to lower class and 2 patients (i.e.20%) were lies in middle class socio-economical status.Graph No. 02. Showing the distribution of Pt.’s by Socio-economic status. Distribution of Pt.s by Socio-economic status 6 5 5 No. of Pt.s 4 3 3 2 2 1 0 Lower Class Middle class Upper class No Of Patients Socio-economical Status 114 Clinical Study
  • 130. Distribution of Patients by domicileTable No. 35. Showing the distribution of patients by domicile. Domicile No of Pt.’s % Urban 5 50 Rural 5 50 There was equal distribution of patients was found in urban and rural domicile.Graph No. 03. Showing the distribution of Pt.’s by domicile status. Distribution of Pt.s by Domicile status Rural Urban 50% 50% Urban RuralDistribution of Patients by educational statusTable No. 36. Showing the distribution of the patients by educational status. Edu. States No. of Pt.’s % Primary 5 50 High School 1 10 Pre degree 1 10 Degree 2 20 In the present study, 5 patients (i.e.50%) had studied till primary, 2 patients (20%)were educated till degree and 1 patient each (i.e.10%) had studied till high school and predegree. 115 Clinical Study
  • 131. Graph No. 04. Showing the distribution of Pt.’s by educational status. Distribution of Pt.s by Educational Status 6 5 5 4 No. of 3 2 Pt.s 2 1 1 1 0 Pri. HS Pr. Dg. Dg. No Of Patients Educaitonal statusDistribution of Patients by dietary habitsTable No. 37. Showing the distribution of the patients by dietary habits. Diet No of Pt.’s % Vegetarian 9 90 Mixed 1 10 9 patients (i.e.90%) were habituated to vegetarian foods and 1 patient (i.e.10%)were habituated to mixed type of dietary habits.Graph No. 05. Showing the distribution of Pt.’s by food habits. Distribution of Pt.s by Food habits 1 9 Vegetarain Non Vegetaria 116 Clinical Study
  • 132. Distribution of Patients by predominance of rasaTable No. 38. Showing the distribution of the patients by predominance of Rasa. Rasa No of Pt.’s % Madhura 2 20 Amla 1 10 Lavana 8 80 Katu 8 80 Tikta 7 70 Kasaya 0 0 In the present study, 8 patients each (i.e.80%) were habituated to excess intake ofLavana and Katu rasa, 7 patients (i.e.70%) accustomed to Tikta rasa, 2 patients (i.e.20%)were taking excessive of Madhura rasa and 1 patient (i.e.10%) was accustomed toAmalarasa.Graph No. 06. Showing the distribution of Pt.’s by Rasa predominance. Distribution of Pt.s by Rasa predominance 10 8 8 8 7 No. of Pt.s 6 4 2 2 1 0 0 M A L Kt Tk Ks No of Patients Rasa PredominanceDistribution of Patients by occupationTable No. 39. Showing the distribution of the patients by occupation. Occupation No of Pt.’s % House wife 4 40 Working 1 10 Labour 3 30 Student 2 20 117 Clinical Study
  • 133. Among the 4 patients (i.e.40%) of patients were housewives, 3 patients (i.e. 30%)were labors, 2 patients (i.e.20%) were students and only 1 patient (i.e.10%) was working.Graph No. 07. Showing the distribution of Pt.’s by Occupation. Distribution of Pt.s by occupaton 5 No. of Pt.s 4 4 3 3 2 2 1 1 0 House hold Working Labour Student No of Patients OccupationDistribution of Patients by mental stressTable No. 40. Showing the distribution of the patients by mental stress. Mental stress No of Pt.’s % Present 3 30 Absent 7 70 In the present study, 7 patients (i.e.70%) were not mental stress and 3 patients(i.e.30%) were having mental stress.Graph No. 08. Showing the distribution of Pt.’s by mental stress. Distribution of Pt.s by Mental stress 3 7 Present Absent 118 Clinical Study
  • 134. Distribution of Patients by body built (Physic)Table no. 41 Showing the distribution of patients by body build. Build No of Pt.’s % Lean 6 60 Moderate 2 20 Obese 2 20 In the present study, 6 patients (i.e.60%) were lean, 2 patients each (i.e.20%) weremoderate & obese.Graph No. 09. Showing the distribution of Pt.’s by body built. Distribution of Pt.s by Body built 8 6 No. of Pt.s 6 4 2 2 2 0 Lean Moderate Obese No of Patient Body BuiltDistribution of Patients by prakritiTable No. 42. Showing the distribution of patients by prakriti. Prakit No of Pt.’s % Vata Pittaj 4 40 Pitta Kaphaj 6 60 Vata Kaphaj 0 0 In the Present study 6 patient (i.e.60%) were Pitta-kaphaj prakriti and 4 patients(i.e.40%) were of Vata-pittaj Prakriti. 119 Clinical Study
  • 135. Graph No. 10. Showing the distribution of Pt.’s by Prakriti. Distribution of Pt.s by Prakriti 7 6 6 No. of Pt.s 5 4 4 3 2 1 0 0 Vata Pittala Pitta Kaphala Vata Kaphala Vata Pittala Pitta Kaphala Vata Kaphala PrakritiDistribution of Patients by AharashaktiTable No. 43. Showing the distribution of patients by Aharashkati. Jarana shakti No of Pt.’s % Heena 2 20 Madhyama 6 60 Pravara 2 20 Among 10 patients, 6 patients (i.e.60%) were having Madhyama jaranashakti and2 patients (i.e.20%) each were having Heena and Pravara jranashakti.Graph No. 11. Showing the distribution of Pt.’s by Aharashakti. DIstribution of Pt.s by Aharashakti 7 6 6 No. of Pt.s 5 4 3 2 2 2 1 0 Hina Madhyama Pravara No of Patient Status of Aharashakti 120 Clinical Study
  • 136. Distribution of Patients by Abhyasa (Vyasana)Table No. 44. Showing the distribution of patients by Abhyasa (Addiction) Addiction No of Pt.’s % Tea 5 50 Coffee 2 20 Tabacco - 0 Pan 3 30 Snuff - 0 Alchol - 0 In the present study it was observed that 5 patients (i.e.50%) of patients wasaddicted to intake of tea, 3 patients (i.e.30%) were addicted to Pan chewing and only 2patients (i.e.20%) were habituated to coffee.Graph No. 12. Showing the distribution of Pt.’s by Abhyasa (addiction). Distribution of Pt.s by Addiction 6 5 5 4 3 No. of Pt.s 3 2 2 1 0 0 0 0 Tea Coffee Tabacco Pan Snuff Alchol No of Patient AddictionDistribution of Patients by Vyayama shaktiTable No. 45. Showing the distribution of patients by Vyayama shakti. Vyayama shakti No of Pt.’s % Heena 2 20 Madhyama 3 30 Ati 5 50 121 Clinical Study
  • 137. In the Present study out of 10 patients, 5 patients (i.e.50%) were having Ativyavaya shakti, and 3 patients (i.e.30%) were having Madhyama vyama shakti and 2patients (i.e.20%) were having heena shakti.Graph No. 13. Showing the distribution of Pt.’s by Vyayama shakti. Distribution of Pt.s by Vyayamashakti 6 5 5 No. of Pt.s 4 3 3 2 2 1 0 Hina Madhyama Ati No of Patients Vyayama shaktiDistribution of Patients by Vyavaya shaktiTable No. 46. Showing the distribution of patients by Vyavaya shakti. Vyavaya No of Pt.’s % Daily 0 0 >2 day 0 0 >2<4 days 1 10 <7 days 2 20 Rare 3 30 None 0 0 Incidence according to vyavaya showed that 30% of patients were havingintercourse at rare occasions, 20% had for <7 days, 10% had for >2<4 days. 122 Clinical Study
  • 138. Graph No. 14. Showing the distribution of Pt.’s by vyavaya shakti. Distribution of Pt.s by Vyavayashakti 3.5 3 3 2.5 2 No. of pt.s 2 1.5 1 1 0.5 0 0 0 0 Daily >2 day >2<4 <7 days Rare None days No of Patients VyavayaDistribution of Patients by bowel habitsTable No. 47. Showing the distribution of patients by bowel habit. Bowel habit No of Pt.’s % Regular 7 70 Constipation 3 30 In the present study it was observed 7 patients (i.e.70%) had regular bowel habitsand 3 patients (i.e.30%) were having constipation.Graph No. 15. Showing the distribution of Pt.’s by bowel habits. Distribution of Pt.s by Bowel Habits 3 7 Regular Constipation 123 Clinical Study
  • 139. Distribution of Patients by past historyTable No. 48. Showing the distribution of patients by past history. Past History No of Pt.’s % Present 2 20 Absent 8 80 In present study among 10 patents, 8 patients (i.e.80%) had no relevant pasthistory but 2 patients (i.e.20%) had relevant of past history.Graph No. 16. Showing the distribution of Pt.’s by previous history. Distribution of Pt.s Previous Histroy 2 8 Present AbsentDistribution of Patients by marital statusTable No. 49. Showing the distribution of patients by marital status. Martial Status No of Pt.’s % Married 8 80 Un married 2 20 In the present study among 10 patients 8 patients (i.e.80%) were married and 2patients (i.e.20%) were unmarried. 124 Clinical Study
  • 140. Graph No. 17. Showing the distribution of Pt.’s by Marital status. Distribution of Pt.s by Marital Status 2 8 Married Un marriedDATA RELATED TO DISEASETable No. 50. Showing the distribution of patients by parity. Parity No of Pt.’s % 1 1 10 2 2 20 3 2 20 >3 2 20 None 3 30 In the present clinical study it was observed that, 3 patients (i.e.30%) patientswere of nullipara, 2 patients each (i.e.20%) were having para 2, 3 and >3. Only 1 patient(i.e.10%) was having para 1.Graph No. 18. Showing the distribution of Pt.’s by Parity. Distribution of Pt.s by Parity 3.5 3 2.5 No. of Pt.s 2 1.5 1 0.5 0 One Two Three >Three None No of Patients Parity 125 Clinical Study
  • 141. Distribution of Patients by history of abortionTable No. 51. Showing the distribution of patients by history of abortion. Abortion No of Pt.’s % None 9 90 One 1 10 Two 0 - >Two 0 - In the present study, 9 patients (i.e.90%) were not having the history of abortionwhere as only 1 patient (i.e.10%) was having history of abortion once.Graph No. 19. Showing the distribution of Pt.’s by history of abortion. Distribution of Pt.s by Abortion 10 9 8 6 No. of Pt.s 4 2 1 0 0 0 None One Two >two No of patients AbortionDistribution of Patients by use of contraceptionTable No. 52. Showing the distribution of patients by use of contraception. Contraception No of Pt.’s % Ligation 5 50 IUCD 1 10 Pills 1 10 None 3 30 126 Clinical Study
  • 142. Incidence of use of contraception showed that 5 patients (i.e.50%) has undergoneligation, 3 patients (i.e.30%) had no history uses of contraception and 1 patient each(i.e.10%) were using IUCD and pills for contraception.Graph No. 20. Showing the distribution of Pt.’s by use of contraceptives. Distribution of Pt.s by use of Contraceptives 6 5 5 No. of Pt.s 4 3 3 2 1 1 1 0 Ligation 10CD Pills None No of patients ContraceptivesDistribution of patients by chronicityTable No. 53. Showing the distribution of patients by chronicity. Duration of illness No of Pt.’s % 3-6 months 4 40 7-12 months 3 30 >1<5 yrs 2 20 >5<10 yrs 1 10 >10 yrs 0 0 Incidence of the patients according to duration of illness shows that, 4 patients(i.e.40%) were suffering from symptoms since 3-6 months, 3 patients (i.e.30%) of thepatients had the history of the illness since 7-12 months, 2 patients (i.e.20%) were havingthe history of >1<5 yrs and only 1 patient (i.e.10%) had the history of illness since >5<10yrs and no patient was reported with the chronicity of more the 10 years. 127 Clinical Study
  • 143. Graph No. 21. Showing the distribution of Pt.’s by duration of illness. Distribution of Pt.s by Duration of illness 5 4 4 3 3 No. of Pt.s 2 2 1 1 0 0 3-6 months 7-12 >1<5 yrs >5<10 yrs >10 yrs months No of patients Duration of illnessDistribution of Patients by menstrual bleedingTable No. 54. Showing the distribution of patients by menstrual bleeding. Pattern of Bleeding No of Pt.’s % Excessive 6 60 Prolonged 2 20 Inter menstrual 1 10 Frequent 1 10 Among 10 patents, 6 patients (i.e.60%) were having excessive bleeding, 2 patients(i.e.20%) were having prolonged bleeding phase and 1 patient each had the history offrequent and inter-menstrual bleeding.Graph No. 22. Showing the distribution of Pt.’s by pattern of bleeding. Distribution of pt.s by Pattern of Bleeding 8 6 6 No. of Pt.s 4 2 2 1 1 0 Excessive Prolonged Inter menstrual Frequent No of Patients Pattern of Bleeding 128 Clinical Study
  • 144. Distribution of Patients by abdominal painTable No. 55. Showing the distribution of patients by abdominal pain. Abdominal Pain No of Pt.’s % Absent 2 20 Mild 3 30 Moderate 5 50 Severe 0 0 Among 10 patients, 5 patients (i.e.50%) reported with moderate abdominal pain, 3patients (i.e.30%) were having mild abdominal pain and 2 patients (i.e.20%) had the nohistory of abdominal pain before, in between and after menstruation.Graph No. 23. Showing the distribution of patients by abdominal pain. Distribution of Pt.s by Abdominal Pain 6 5 5 No. of Pt.s 4 3 3 2 2 1 0 0 Absent Mild Moderate Severe No of patient Nature of Abdominal Pain 129 Clinical Study
  • 145. Distribution of Patients by Pradhana vedanaTable No. 56. Showing the distribution of patients by Pradhana vedana. Sl. Pradhana vedana Grading No. of Pt.’s % 01. Duration of bleeding 3-5 4 40 6-10 5 50 11-15 1 10 16-20 0 0 02. Interval of bleeding <20 4 40 >21<30 5 50 >31<40 1 10 >41 0 0 03. Clots Absents 0 0 Mild 3 30 Moderate 6 60 Severe 1 10 04. Colour of bleeding Bright Red 0 0 Dark Red 8 80 Pale Red 1 10 Brown 0 10 05. Amount of bleeding Mild 1 10 Moderate 7 70 Severe 2 20 Mild 1 10 06. Staining Present 4 40 Absent 6 60 07. Odour Present 1 10 Absent 9 90 130 Clinical Study
  • 146. Distribution of Patients by Associated complaintsTable No. 57. Showing the distribution of the patients by associated symptoms. Associated complaints No of Pt.’s % Body ache 3 30 Weakness 7 70 Burning sensation 3 30 Low backache 6 60 Headache 4 40 Giddiness 3 30 Depression 3 30 Lack of concentration 2 20 Rise in temperature 1 10 Pain in calf muscles 3 30 Breast tenderness 0 0 Vomiting 0 0 Loose stools 0 0 Excessive sweating 1 10 Hot flushes 1 10Distribution of Patients by Hb%Table No. 58. Showing the distribution of the patients by Hb%. Hb% in gms No of Pt.’s % 6.0-8.0 0 00 8.1-10.0 3 30 10.1-12.0 7 70 12.1-13.0 0 00 Among 10 patients, 7 patients (i.e.70%) showed Incidence according to Hb%showed 70 of patients had Hb% between 10.1-12 gm% and 3 patients (i.e.30%) had Hb%between 8.1-10gm% and no patient reported with the Hb% between 6-8gm% and 12.1-13gm%. 131 Clinical Study
  • 147. Distribution of patients by bleeding timeTable No. 59. Showing the distribution of patients by bleeding time. Bleeding time No of Pt.’s % in minutes 1-2 00 00 2-3 00 00 3-4 10 100 4-5 00 00 All 10 patients (i.e.100%) were having the bleeding time 3-4 minutes.Distribution of Patients by Clotting timeTable No. 60. Showing the distribution of patients by clotting time. Clotting time No. of Pt.’s % in minutes 2.0-3.0 00 00 3.1-4.0 00 00 4.1-5.0 07 70 5.1-8.0 03 30 Among 10 patients, 7 patients (i.e.70%) were having clotting time 4.1 to 5.0minutes, 3 patients (i.e.30%) were having clotting time between 5.1 to 8.0 minutes and nopatient was reported with the history of clotting time between 2.0-3.0 minutes and 3.1-4.0minutes.Distribution of Patients by platelet countTable No. 61. Showing the distribution of patients by platelet count. Platelet count No. of Pt.’s % 10,000 cumm-1 lakh 00 00 1.1 lakh-2 lakh 00 00 2.1 Lakh-3 lakh 09 90 3.1 lakh-4 lakh 01 10 132 Clinical Study
  • 148. Incidence of platelet count showed that, 9 patients (i.e.90%) had platelet countbetween 2.1 lakh to 3 lakh cumm and 1 patient (i.e.10%) had platelet count between 3.1lakh to 4 lakh cum of blood. No patient reported with the history of 10,000 to 2 lakhsplatelet count.DATA RELATED TO RESPONSE TO THE TREATMENT Clinical and laboratory investigation of all patients were assessed before and afterthe treatment. The clinical conditions were assessed by the symptomatology viz. Durationon menstrual bleeding, amount of blood loss, consistency of menstrual blood, abdominalpain, pradhana and anubandhi vedana before and after the treatment. Laboratoryinvestigations like Hb%, C.T., B.T. and platelet count were taken as objectiveparameters.OVERALL ASSESSEMENT OF PARAMETERSDuration on menstrual bleedingTable No. 62. Showing the distribution of patients by degree of menstrual bleedingbefore and after the treatment. Sl Degree of bleeding BT % AT % 1 Normal 00 00 09 90 2 Mild 4 40 01 10 3 Moderate 5 50 00 00 4 Sever 1 10 00 00 Before the treatment it was observed that, 4 patients (i.e.40%) had menstrualbleeding for 3-5 days with the interval <20 days and 5patients (i.e.50%) had menstrualbleeding for 6-10 days interval >21<30 days and 1 patient (i.e.10%) had menstrualbleeding for 11-15 days with interval >31<40 days before the treatment. 133 Clinical Study
  • 149. After the treatment the menstrual bleeding of 9 patients (i.e.90%) was limited to3-5 days and the cycle was of 30-32 days and 1 patient (i.e.10%) was having mildbleeding for 7 days with interval of 32 days the improvement was statistically highlysignificant with the p<0.001.Amount of blood lossTable No. 63. Showing the distribution of patients by degree of blood loss before andafter the treatment. Sl. Degree of blood loss BT % AT % 1 Normal 00 00 10 100 2 Mild 1 10 00 00 3 Moderate 7 70 00 00 4 Severe 2 20 00 00 Before the treatment it was observed that, 2 patients (i.e.20%) has severe bloodloss (i.e. they use 10 pads per day), 7 patients (i.e.70%) has moderate blood loss (i.e. theyuse 7-9 pads/day) and 1 patient (i.e.10%) had mild blood loss (i.e. uses 4-6 pads /day)before the treatment. After treatment it was observed that all patients were reported with normal bloodloss and duration of bleeding and the improvement is statistically highly significant withthe p value <0.001.Consistency of menstrual bloodTable No. 64. Showing the distribution of patients by degree of consistency before andafter the treatment. Sl Degree of Consistency B.T % A.T. % 1 Normal 00 00 09 90 2 Mild 3 30 01 10 3 Moderate 6 60 00 00 4 Severe 1 10 00 00 134 Clinical Study
  • 150. Before treatment it was observed that, 1 patient (i.e.10%) had severe clots 6patients (i.e.60%) had moderate clot and 3 patients (i.e.30%) had mild clot with wateryconsistency. After treatment it was observed that, 9 patients (i.e.90%) were completely cured.(i.e. the blood was having watery consistency no clots were found) 1 patient (i.e.10%)was still had mild clot with watery consistency. The improvement is statistically highlysignificant with the p value <0.001.Abdominal PainTable No. 65. Showing the distribution of patients by degree of abdominal pain beforeand after the treatment. Sl Degree of abdominal pain B.T. % A.T. % 1 Normal 2 20 10 100 2 Mild 3 30 0 0 3 Moderate 5 50 0 0 4 Severe 0 0 0 0 Before treatment it was observed that, 5 patients (i.e.50%) had moderateabdominal pain, 3 patients (i.e.30%) had mild pain and 2 patients (i.e.20%) were nothaving the abdominal pain before the treatment. After treatment all patients were completely relieved by the symptom and theimprovement is statistically highly significant with p value <0.001. 135 Clinical Study
  • 151. Anubandhi vedanaTable No. 66. Showing the distribution of patients by degree of anubadhi vedana beforeand after the treatment. Sl Degree of Anubandhi B.T. % A.T. % vedana 1 Normal 00 00 9 90 2 Mild 06 60 1 10 3 Moderate 03 30 00 00 4 Severe 01 10 00 00 It was observed that 6 patients (i.e.60%) had mild degree of anubandhi vedana(i.e. not more than 3 symptoms), 3 patients (i.e.30%) had moderate degree of anubadhivedana (i.e. 5-8 symptoms) only 1 patient (i.e.10%) had severe degree of anubandhivedana (i.e. 12 symptoms) After the treatment 9 patients (i.e.90%) were completely cured (i.e. all thesymptoms resumes to normal) and 1 patient (i.e.10%) was still having weakness,bodyache. The improvement is statistically highly significant with the p value <0.001.Haemoglobin PercentageTable No. 67. Showing the distribution of patients by Hb% before and after thetreatment. Sl Hb% in gms B.T. % A.T. % 1 6.0-8.0 00 00 0 00 2 8.1-10.0 3 30 0 00 3 10.1-12.0 7 70 7 70 4 12.1-13.0 00 00 3 30 136 Clinical Study
  • 152. Before treatment it was observed that, 7 patients (i.e.70%) had Hb% between10.1-12 gm% and 3 patients (i.e.30%) had Hb% within 8.1-10 gm%. After treatment 7 patients (i.e.70%) were in the Hb% between 10.1-12.0 gm% and3 patients (i.e.30%) were between the Hb% between 12.1-13.0 gm%. The improvement isstatistically highly significant with p value <0.001.Bleeding TimeTable No. 68. Showing the distribution of patients by bleeding time before and after thetreatment. Sl Bleeding Time B.T. % A.T. % in minutes 1 1-2 00 00 00 00 2 2-3 00 00 10 100 3 3-4 10 100 00 00 4 4-5 00 00 00 00 Before treatment it was observed that 10 patients (i.e.100%) had bleeding timebetween 3 min 4 min and after treatment there was no change observed. The improvement is statistically highly significant with the p value <0.001.Clotting timeTable No. 69. Showing the distribution of patients by clotting time before and after thetreatment. Sl Clotting time B.T. % A.T. % in minutes 1 2.1-3.0 00 00 00 00 2 3.1-4.0 00 00 9 90 3 4.1-5.0 7 70 1 10 4 5.1-8.0 3 30 00 00 137 Clinical Study
  • 153. Before treatment it was observed that 7 patients (i.e.70%) had clotting timebetween 4-5 min and 3 patients (i.e.30%) had clotting time between 5-8 min beforetreatments. After treatment 9 patient (i.e.90%) had clotting time between 3-4 min and 1patient (i.e.10%) had clotting time between 4-5 min. The improvement is statistically highly significant p value is <0.001.Platelet countTable No. 70. Showing the distribution of patients by platelet count before and after thetreatment. Sl Platelet count B.T. % A.T. % 1 10.000cumm -1 lakh 00 00 00 00 2 1.1 lakhs - 2 lakhs 00 00 00 00 3 2.1 lakhs - 3 lakhs 09 90 04 40 4 3.1 lakhs - 4 lakhs 01 10 06 60 Before treatment it was observed that, 9 patients (i.e.90%) had platelet countbetween 2.1 lakhs/cumm to 3 lakhs/cumm and 1 patient (i.e.10%) had the platelet countin between 3.1 lakhs/cumm to 4 lakhs/cumm platelets. After treatment 6 patients (i.e.60%) were having the platelet count between 3.1lakhs/cumm to 4 lakhs/cumm and 4 patients (i.e.40%) were having platelet count between2.1 lakhs/cumm to 3.0 lakhs/cumm. The improvement is statistically highly significant p value is <0.001. 138 Clinical Study
  • 154. STATISTICAL ANALYSISTable No. 71. Showing the statistical analysis of parameter before and after treatment.Sl Parameters Mean SD SE t-value p-value Remarks1 Duration of menstrual 1.6 0.516 0.163 9.815 <0.001 H.S. bleeding2 Amount of blood loss 2.1 0.567 0.179 11.73 <0.001 H.S3 Consistency of 1.8 0.632 0.2 9.00 <0.001 H.S menstrual blood4 Abdominal Pain 1.3 0.823 0.26 5.00 <0.001 H.S5 Anubandhi vedana 1.4 0.699 0.221 6.33 <0.001 H.S6. Hb% 1.267 0.441 0.139 9.115 <0.001 H.S7 Bleeding time 1.025 0.17 0.053 19.33 <0.001 H.S8 Clotting time 1.285 0.59 0.186 6.908 <0.001 H.S9 Platelet count 0.42 0.154 0.048 8.75 <0.001 H.SSTATISTICAL CONCLUSION All the parameter shown highly significant results except in abdominal pain. (pvalue is <0.05) The subjective parameter orderly amount of blood loss, duration andconsistency of menstrual bleeding shown more significance than abdominal pain (bycomparing t-values). The parameter amount of blood loss shown more net mean effect before and afterthe treatment. The parameter abdominal pain shown less mean effect with more variationand the parameter duration of menstrual bleeding shown less-variations. (By comparingmean S.D.) Among the objective parameters orderly bleeding time, Hb%, platelet countshown more significance than clotting time. (By comparing t values) The mean net effect and variation of parameter clotting time is more before andeffect treatment. But the parameter platelet count shows less mean net effect with lessvariation. (By comparing mean and S.D) 139 Clinical Study
  • 155. Follow up After the treatment (45 days) an effort was made to know the long standing effectof the formula. Therefore 15 days follow up was made to resume the attack i.e.recurrence of the symptoms. It was noticed that recurrence was absent during follow up.Overall ResultsTable No. 72. Showing the overall result of the treatment. Result No of Pt.’s % Well responded 07 70 Moderately 03 30 responded Mild responded 00 00 Not responded 00 00 It was observed that maximum number of 7 patients (i.e.70%) had wellresponded, 3 patients (i.e.30%) shown moderate response to the treatment.Graph No. 24. Overall results assessment of the therapy. Overall assessment of results 8 7 7 6 No. of Pt.s 5 4 3 3 2 1 0 0 0 WR Mod R Mi R NR No of Pt.’s Overall Result 140 Clinical Study
  • 156. Table No. 73. Showing the depreciating overall assessment of the response to “bolaparpati” based on assessment criteria.Sl OPD Reduction in symptoms in % and Hb% platelet Count C.T B.T Resu No. Exam. lt S-1% S-2% S-3% S-4% S-5% Hb Plate let CT BT gm% count Min Min lakhs/cum sec sec m1 3560 100 100 100 100 100 11.2 2.4 lakhs 3.25 2.15 W.R2 3562 90 100 100 100 100 10.2 2.6 Lakhs 3.20 2.10 M.R3 3563 100 100 100 100 100 11.6 3.0 Lakhs 3.25 2.50 W.R4 3564 100 100 100 100 100 12.0 3.4 Lakhs 3.15 2.45 W.R5 3565 100 100 100 100 100 12.4 3.2 Lakhs 3.25 2.30 W.R6 3566 100 100 100 100 100 12.4 3.6 Lakhs 3.15 2.35 W.R7 3567 100 100 100 100 90% 12.2 3.2 Lakhs 4.15 2.20 M.R8 3568 100 100 90 100 100 11.2 2.8 Lakhs 3.50 2.10 M.R9 3569 100 100 100 100 100 11.8 3.2 Lakhs 3.45 2.30 W.R10 3570 100 100 100 100 100 11.2 3.5 Lakhs 3.10 2.25 W.R S-1 =Duration of Bleeding S-2= Amount of blood loss S-3= Consistency S-4=pain S-5= Associated symptoms W.R. – Well Responded, M.R. – Moderately Responded. R – Responded. 141 Clinical Study
  • 157. Table No. 74. Master charts showing the demographic datas. Sl. OPD Age MS Religion SES ResultNo. No. 20-29 30-39 40-50 MA UM H M C O P L.M U.M Ri W.R M.R R N.R 1 3560 - - + + - + - - - - - + - - + - - 2 3562 - + - + - + - - - + - - - + - - - 3 3568 - + - + - + - - - + - - - + - - - 4 3564 - - + + - + - - - - - + - + - - - 5 3565 + - - + + + - - - - - + - + - - - 6 3566 + - - - + + - - - - - + - + - - - 7 3567 - - + + - + - - - - + - - - + - - 8 3568 - + - + - + - - - - - + - - - + - 9 3569 + - - + - + - - - + - - - + - - - 10 3570 - - + + - - + - - - + - - + - - -M=Male F=Female MS=Martial status MA=Married UM=Unmarried H=Hindu MU=MuslimC=Christian O=Others P=poor SES=Socio economical status P=poor LM=Lower MiddleUM=Upper Middle RI=Rich WR=Well Responded MR=Moderately RespondedR=Responded NR=Not responded.
  • 158. Table No. 75. Master showing the subjective parameters. Sl. OPD DOB ABL Consistency PAIN A.C No. No. BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF 1 3560 2 0 0 3 0 0 2 0 0 1 0 0 2 0 0 2 3562 3 1 1 3 0 0 2 0 0 2 0 0 3 0 0 3 3563 2 0 0 2 0 0 2 0 0 2 0 0 1 0 0 4 3564 1 0 0 2 0 0 1 0 0 1 0 0 2 0 0 5 3565 1 0 0 2 0 0 1 0 0 2 0 0 1 0 0 6 3566 2 0 0 2 0 0 2 0 0 2 0 0 1 0 0 7 3567 2 0 0 2 0 0 2 0 0 0 0 0 2 1 1 8 3568 1 0 0 2 0 0 3 1 1 0 0 0 1 0 0 9 3569 2 0 0 2 0 0 2 0 0 1 0 0 1 0 0 10 3570 1 0 0 1 0 0 1 0 0 2 0 0 1 0 0DOB=Duration of bleeding ABL=Amount of blood loss AC=Associated complaints BT=Before treatmentAT=After treatment AF=After follow up
  • 159. Table No. 76. Master chart showing the objective parameters. Sl. OPD Hb gm% Bleeding Time Minutes. Clotting Time Platelet Count No No. Seconds Minutes. Seconds Lakhs/cumm B.T A.T B.T A.T BT AT BT AT 1 3560 9.11 11.2 3.15 2.15 4.40 3.25 2.2 2.4 2 3562 9.82 10.8 3.10 2.10 4.30 3.20 2.2 2.6 3 3563 10.6 11.6 3.30 2.50 4.35 3.25 2.4 3.0 4 3564 11.2 12.0 3.30 2.45 5.20 3.15 2.9 3.4 5 3565 11.4 12.4 3.45 2.30 5.15 3.25 2.8 3.2 6 3566 10.4 12.4 3.25 2.35 5.30 3.15 3.0 3.6 7 3567 11.0 12.2 3.10 2.20 4.50 4.15 3.0 3.2 8 3568 9.8 11.2 3.20 2.10 4.15 3.50 2.2 2.8 9 3569 10.6 11.8 3.55 2.30 4.50 3.45 2.8 3.2 10 3570 10.2 11.2 3.55 2.55 4.45 3.10 3.2 3.5 BT=Before Treatment AT=After treatment
  • 160. DISCUSSION This Chapter deals with the analysis of Probable cause of the observationsfindings and the results of the study. It is classified under the following heading 1) Review of literature 2) Pharmaceutical Study 3) Analytical Study 4) Clinical StudyREVIEW OF LITERATURE Bola Parpati has been explained in treatment of Raktapitta as well as Pradara. Itsmain ingredient is bola and is in thin flakes, it is named bolaparpati. The Bola parpati ischoice of medicine for Rakta stambana. Different Acharyas, have mentioned indicationsof Bola parpati in different bleeding disorder.Hingulotha Parada Hingulotha parada is eqivalent to Ashtasamskarita parada and Samagunabalijareetaparada. Because of its Yogavahi and Rasayana property it exhibits immuno-modulator property and acts as a catalyst. Hence, potencify the herbal preparation incombination with it.Gandhaka It is Bhringaraj swarasa shodhita Gandhaka. Apart form detoxification it alsopotecify the Gandhaka. Gandhaka is known to increase bile secretion, the Bhringarajbeing Hepato-protective drug, might help in regulating this flow.Kajjali Different Proportions of Parada and Gandhaka were used to prepare the medicinedepending upon the action of drug required. In this samaguna gandhaka was usedbecause Samaguna kajjali is sarvaroganashaka. 145 Discussion
  • 161. Bola Genuine and authenticated Rakta bola was selected for the study. Myrrh gum isbitter, acrid and astringent, acrid after the process of digestion, thermogenic, digestive,carminative, expectorant, intellect promoting, aphrodisiac antihelmintic, antiinflammatory, diuretic sudorific, deodorant, opthalmic, antiseptic, stimulant and tonic isuseful in vitiated conditions of Vata, Pitta, Kapha, stomatits, dyspepsia helminthiasis,amenorrhoea, dymenorrhea, and other menstrual disorders, bronchitis, asthama, pthies,spongy gum, pharyngodymia sciatica, wounds, ulcers, and skin diseases.Rakta Pradara Rakta pradara is a disease manifesting as excessive bleeding per vaginum.Mankind has known this disease since age of Vedas and Puranas. As understood,according to normal physiology, Raja which is considered as Upadhatu of Rasadhathu orRakta can get vitiated due to abnormalities of the related Doshas also Pradara is havingsynonyms like, Asrigdara, Pradara, Atyadhika, Rakatanasya, Atyartava. Charaka explainsRakta pradara as a separate disease with its management in Yonivyapad chikitsa.Sushruta explains it as a separate disease entity in Shukra shonita adhyaya and in Pittasamyukta apana and also in Rakta pradoshaja vyadhi. Astanga Sangraha explainsRaktayoni and says Pradara and Asidara as its synonyms Astanga Hridaya describesRaktayoni, but nothing is mentioned about Pradara, Asrigdara, excessive bleeding,weakness, low back pain, giddiness, etc are seen in this disease. Rakta pradara mentionedin Ayurveda treaties is merely correlated signs and symptoms of Dysfunctional uterinebleeding. 146 Discussion
  • 162. PHARMACEUTICAL STUDY To prepare the yoga trail drugs were selected strictly according to classicalreferences raw drugs were purified and processed. They are discussed below one by one.Hingulotha Parada It is the auto-reduction process. The captions of the least electropositive metalsmay be the reduced without the use of any additional reducing agents. This is also calledas air reduction. In the manufacture of mercury, the Sulphur ore (Cinnabar) is heated in acurrent of air, when following reaction occurs – 2HgS + 3O2 2HgO2+2SO2 2HgO 2Hg+O2 2HgO+HgS 3Hg+SO2 For 200 gms of HgS 157 gms of mercury was obtained. Approximately, 69%yield was obtained. The Hingula sample contains Hg mercury 85.47% and Sulphur14.49%. The difference in mercury percentage was which could be due to mishandling inthe form of Dhoomagati and Jalagati.Gandhaka Shodhana Gandhaka melted at the temperature range of 1200C. Later, this use for dalana inBhringaraj swarasa.Preparation of Kajjali Kajjali was prepared by adding equal quantity of Gandhaka to Parada. It took 12days to turn the whole mixture to black colour (Kajjala sadrisha varna). This time takenwas may be mainly depending upon the speed of mortaring, quantity of material takenamount of pressure given during Mardana. The black colour of the material may bebecause of the formation of black sulphide of mercury. (Hgs) 147 Discussion
  • 163. Preparation of Bola Parpati Equal quantity of Kajjali and Bola choorna are added and Mardana is done for 6hrs and taken into a Ghrita lipta palika yantra and heated on liquification heat recordedwas 103 c. the liquified mixture was poured on the ghrita lipta kadali patra kept ongomaya plat form and was immediately covered with another Ghrita lipta kadalitatra andpressed. Then bola parpati was obtained which consists the venation marks ofKadalipatra and on breaking produces the “Crackling Shubdha”, which are considered asa confirmative test for parpati. In most of the Parpati kalpanas it is claimed that by using Kadalipatra andGomaya in the process, makes it more potent .It is said that Kashaya property ofKadalipatra, which is transferred to parapti, would be useful in Grahani similarly the Pittaavailable in Gomaya is absorbed into parpati through Kadalipatra in presence of heat.This would help in enhancing the Pitta component of Jatharagni. So that these all Parpatisare indicated in Grahiniroga and Agnimandya. However, the bola parpati indicated inRaktapradara. While preparing this the Kadalipatra may help in the process of suddencooling were as the Gomaya bed acts as cushion.ANALYTICAL STUDY To know the market components Physico-chemical properties to identify thecomposition products, the analysis of the drug according to Modern parameters isnecessary. In this section of the study we have tried to give the inference for the analysis.Assay for mercury and Sulphur in Hingula The percentage of Mercury and Sulphur was assayed in the Hingula, whichrevealed that mercury was present in 85.47% and Sulphur was present in 14.49%. 148 Discussion
  • 164. Authentication of bola For the preparation of yoga a proper identification of drug is necessary so bola issubjected for identification test. The Etheral solution of myrrh became reddish whentreated with bromine vapour and purplish when moistened with Nitric acid this determinethe drug is genuine one.Volatile oil percentage The determination of volatile oil in a drug is made by distilling the drug withwater collecting the distillate in a graduated tube in which the aqueous portion of thedistillate in agraduated tube in which the aqueous portion of the distillate is automaticallyseparated and returned to the distilling flask and measuring the volume of oil or theMyrrh contain. 7.47% of Volatile oil.Organoleptic test Organoleptic properties of the drug suggest that these are all as mentionedspecification of Ayurvedic classics. So the drug prepared is genuine.Total ash The herbomineral drugs were converted into ash form resulting into weight loss.Here value of weight loss noted in 5.1%.Acid insoluble ash It has very least acid insoluble ash value i.e. 0.03% which indicates siliceousmatters is very small quantity. It shows drug is genuine one.Solubility test It is slightly soluble in alcohol and slightly soluble in chloroform. By this it isunderstood that Bola Parpati may be absorb slowly in GIT. 149 Discussion
  • 165. Assay for Mercury and Sulphur in Bola parpati The percentage of Mercury and Sulphur was assayed in the Bola parapati, whichrevealed that Mercury was present in 25.58% and Sulphur was present in 24.4%.Fines of particles test To know the size of the particles of Bola parpati, it was subjected to fines ofparticles test. This test was done in microscope observations it is evident that the particlesize of Bolaparpati is 8.722 micrometer. So this indicates particles are very fine in nature,which can be able to enter into the smaller capillaries and rate of absorption of drug isdirectly proportional to the particle size of the drug. As the Bola Parpati particle size isvery fine. So, the absorption is also quick.Flow rate The dose of Bola Parpati is only 250 mg t.i.d. So it is difficult to dispense thismuch small quantity drug. To over come this problem, Bola Parpati is capsulated anddispensed Before doing the capsulation it is tested either drug is fit for capsulation are notis accessed by the simple physical test i.e. flow property of the drug by “Angle ofresponse and flow rate” by compressibility index. Bola Parpati has a good flow propertybecause the angle of response Tan φ = Flow rate I has the so Bola Parpati has good flowrate so it can be filled in hard gelatin capsule.PH value The PH of the Bola parpati is 5.19. It is acidic in nature.Loss on drying It shows the end product contains 3.68% of moisture. 150 Discussion
  • 166. Alkaloids test The formation contains Hinguloth parada, Gandhaka and Bola. As Alkaloids areabsent in all the dravyas we fine absence of Alkaloid.Disintegration test The Bolaparpati is filled in a capsule so to evaluate the disintegration time of thecapsule was checked by the apparatus called disintegrate. By the observation it is evidentthat capsule are disintegrate within 15 min minutes. So Bola parpati is expected distributequickly all over the body as it has a very fine particles and disintegration time is also verysmall.CLINICAL STUDY The different features observed in the patients were recorded in case sheets andthese observations were analyzed and tabulated after the completion of clinical study.These observation findings are discussed below.Age In the present study, the patients belonged to the age group of 20-29 years were40.00% between 30-39 years were 30% and 30% were between 40-50 Years of age. DUBcan occur at any age group but its incidence is comparatively more during puberty andPre-menopausal age. However it can occur during reproductive age also. Asrigdara is aVata-pittaja disorders, its higher incidence is during the reproductive age group i.e., andwhen Pitta is more dominant can be analyzed.Religion Incidence in this showed that majorities were Hindus. Because Hindus representthe predominance of Hindu population in and around Gadag. 151 Discussion
  • 167. Socio Economical It was found that the majority of the patients were from upper class. Usually theupper class people visit the hospital for treatment this may be reason for finding morepeople from this group.Occupation Occupation has an important role to play in the manifestation of various diseases.Most of the times it is the root cause of all the unwholesome regimes consumed by aperson. In the present study, maximum were housewife 40% Household work, Day sleep,etc., may contribute to vitiation of Doshas sexual and Psyhco-social problems caninfluence the hormonal functions leading to manifestation of disease.Diet Alike other diseases diet has an important role to play in the Nidana ofRaktapradara. 80% of the Patients were habituated to consume excess amount of Katu,Amla, and Lavanarasa and spicy food items like, Rasam, Sambar, Pickles excessconsumption of chilies, fresh curry, beef etc consumption of fermented food items likeDosa, Idily etc, contribute to the etiology leading to vitiation of Vata-pitta and Rakatamainly, thereby substantiating the classical theory of its pathogenesis.Ahasa shakti and Abhyasa Incidence according to Ahara shakti showed that in the present study 60% ofpatient had Madhyma jarana shakti, 20% had Pravara shakti and 20% had Hina jaranashakti. Incidence of Abhyasa showed that 50% of patients were addicted to tea, 30% topan chewing and 20% to coffee. This further contributes to the Nidana and pathogenesisof Asrigdhara. 152 Discussion
  • 168. Prakruti Incidence according to Prakuti showed majority of patients i.e. 60% to be of Pittakaphala prakuti and 40% of Vata-pittala Prakuti this observation does not support thetheory of tendency of Vata-pitta prakuti in Rakta pradara. This small number of samplestaken for the study is inadequate ether to justify or to discard this principle.Pattern of menstrual bleeding Incidence according to pattern of menstrual bleeding showed 60% of patientswere suffering from excessive bleeding, 20% had prolonged menstruation 10% had inter-menstrual and frequent bleeding. Therefore, it can be seen that exclusive and prolongedmenstruation was common manifestation of Rakta pradara than frequent and inter-menstrual bleeding. Thus, it can be concluded that Asrigdara is a disease characterized byexcessive and prolonged, frequent, inter-menstrual and irregular or cyclical bleeding.DISCUSSION ON CLINICAL RESPONSE TO TREATMENT In this clinical study an attempt has been made to assure the clinical response ofBola parpati according to the guidelines laid down by Brihatrayees, Yogaratnakara andcontemporary science, in the selection of the patients and final analysis of the results. Clinical study was based on selection of cases by undergoing Ultrasonographyand the Pt with Normal USG study of pelvis, Bulky Uterus, slight Retro-verted uteruswere selected with symptoms of duration of menstrual bleeding, amount of menstrualblood loss, consistency of menstrual blood, abdominal pain, anubandhi vedana like bodyache weakness, burning sensation low backache giddiness depression were also present. Treatment duration was fixed for 45 day i.e. 2 Ratti t.i.d. with Madhu as Anupanaand follow up for 15 days. 153 Discussion
  • 169. DISCUSSIONS ON RESULTS It has been observed that the patients were relieved of symptoms of Rakta pradarawithin 1 month after the commencement of the treatment. Haemoglobin percentage,bleeding time, clothing time, platelet count examinations were taken before and after thetreatment. During the course of the treatment assessment of reduction of symptoms duringregular check up of patients was seen. It is observed that 50% reduction was found induration of menstrual bleeding, amount of blood loss, consistency of menstrual blood wasnoticed in majority of cases during the next menses. The complete reduction of amount ofblood loss and abdominal pain has been noticed after 45 day of treatment in almost allcases and 90% of patients were relived from duration of menstrual bleeding andconsistency of menstrual blood. The anubandhi vedana reduced in maximum no of patients after treatment. It was mentioned that vasoconstriction play a key role in all cases of Raktapradara, here an attempt has been made to understand the effect of Bola parpati on Bloodexaminations. All the patients had Hb% CT, BT and platelet count examination beforetreatment and it was also found all the patient have the normal value of platelet count CTand BT but the Hb% was less. It was also found that even in the presence of a normalplatelet count an individual might bleed if the function of the platelet is reduced. Aftertreatment it was seen, that there was slight increase in Hb% near about 1gm/dl slightreduction in CT and BT and mild increase near about 4 Lakhs cumm of platelets. So itclearly implies that the drug has mild action over Haemoglobin and platelet count. 154 Discussion
  • 170. Follow Up After the treatment (45 days) an effort was made to know the long-standing effectof the therapy. Therefore 15 days follow up was made to resume the reattack i.e.recurrences of symptoms. It was noticed that within this 15 days the patients had anotherperiod of menses where in there was no excessive bleeding and the duration was also notprolonged i.e. the bleeding was for 5-6 day and they used 1-3 pads/day except 1 Patientduration of bleeding was for 7 days, After completion of follow up i.e. 15th day nosymptoms were seen.PROBABLE MODE OF ACTION OF BOLA PARPATI In order to probe into the mode of action of Yogas, it is necessary to analyse theaction of each ingredient of the formulations. The individual property and the action ofeach of the constituents are collectively responsible for the action of Yogas. Bola parpati has Parada, Gandhaka and Bola as ingrdients. Parada having Shadrasa, Singdha, Sara guna, Uhsna Veerya and Madhura Vipaka acts Tridoshagna, Gandhaka having katu Madhura and Tiktarasa, Snigdha laghu guna,. Ushna veerya katu vipaka acts as Kapaha Vata hara Bola as main ingredient having Tikta, Katu Kashaya-rasa, Rooksha, guna, Ushna Veerya vipaka also acts Trdisoahara. Due to Tikta rasa, Kashyarasa laghu guna and rooksha guna mitigates pitta, by virture of its madhurarasa, Ushna guna, it mitigates vata and ushna guna it mitigates kapha. 155 Discussion
  • 171. Thus parada, gandhaka, in Pota Bhanda are known to exert grahi action. Theyalso have the Yogavahi guna. They enhance the activity of the dravyas added toit.Bola is known rakta stambaka, its activity in pota banda, will be enhanced. Inshort the activity can be attributed to synergistic activity of potabanda and bola.Bola parpati is rakta stambana. Its vasoconstriction leading to stoppage ofhaemorrhage. It is tonic, stimulant, stomachi and antiseptic. Thus by theseproperty it checks the bleeding it regulate the menstruation cycle it stops theinfection, increases the tone of muscles, acts as anti inflammatory and thus reliefthe pain. In the present study Bola Parpati is given with Madhu as Anupana whichis a demulucent and sweetning agent it is readily assimilated and accepted by thestomach hence acts as yogavahi, it is good nutrient to patients and also actsantiseptic. 156 Discussion
  • 172. CONCLUSION Parpati is the Pota bandha of Parada and is one of the important Kalpana in Chaturvidha rasayana. The Bola Parpati holds the precious place in Parapti kalpana, because as it is indicated in many bleeding disorders. During Pharmaceutical procedure i.e. Shodhana of Hingula with Nimbu swarasa for bhavana and Gandhaka shodhana in Bringaraj kawtha certainly have a role in detoxifying & potencfying the drugs. By the Physcio-chemical study it is evident that the prepared Bola parapti is genuine one and for convenience it can be dispersible in capsule from. As the Bola Parpati has Rakta stambana Properties with Anupana & reduction in the subjective & Symptoms of Rakta pradara patients it is proved that Bola Parpati is a good remedy for all, Raktasrava rogas, which are Statistically highly significant with p value is <0.001. 157 Conclusion
  • 173. LIMITATIONS 1) The Sample size was small to generalize the result. 2) Drug being a compound form, it was difficult to draw its direct mode of action. 3) Analysis of Hingula and Final product was done.REEOMMEDNATION FOR THE FURTHER STUDY 1) Management of Rakata pradara can be tried on large sample with few more objective criteria. 2) Bola Parpati & other yogas recommended in Rakta pradara can be studied comparatively. 3) Analytical estimation can be done at various stages of the preparation of Bola parpati. 158 Conclusion
  • 174. SUMMARY The present dissertation work entitled i.e. “Preparation And Analytical Study ofBola Parpati and its clinical Efficacy on Rakta Pradara” in this study an attempt wasmade to prepare genunie Bola parpati by following classical procedures. Physico-Chemical Analysis confirmed its genunity and its clinical efficacy was observed byclinical study. The Study includes the following chapters, i.e. Introduction, Objectives, Reviewof Literature, and Methodoloy, which contain Pharamceutical study, Analytical study,and Clinical study. Next Chapter observation and results of clinical study, Discussion,Summary and Conclusion.1) Introduction : General introduction, need of the study brief introduction of RataPradara and necessity for the assessment of this research work was discussed briefly.2) Objective : The present study was mentioned in the objective chapter.3) Review Of Literature : Is dealt in two main headings a) Drug review – The drug review commence with the description regarding parpati kalpana and deals about concept of Bola parpati ingredients both in Ayurveda and modern view i.e. about Vividha bhashanam, Paryaya nama, Parpati sathana, Grahya–Agrahya lakshanas, Bedha, Pharmacoligcal properties and pharmaceutical process according to different authorities Shodhana and indications matra, anupana of Hingula Parada Gandhaka & Bola. In modern View - the properties, Pharmacology, uses of cinnabar, Mercury, Sulphur & commiphor myrrh was explained. 159 Summary
  • 175. b) Disease review – Next Part of the same chapter deals about disease review commence with histrocial and general description of Rakta pradara - Nirukti, Paribhasha, Paryaya, Nidhana, Samprati, Roopa Upashaya, Anupashaya, Upadrava, Sadhyasadhya and Chikitsa explained in the context of Ayurvedic literature. The modern literatures review commences with dysfunctional uterine bleeding to definition etiology, pathogenesis clinical features, differential diagnosis, complications and management.4) Methodology : It deals about pharmaceutical, analytical & clinical Study. a) Pharmaceutical study – It deals with Shodhana of Hingula, Extraction of Parada, Gandhaka Shodhana, Kajjali Preparation, Preparation of Bola Parpati is explained. b) Analytical study - It deals about Authetication of Bola, Determination volatile oil percentage of Bola, Percentage of Mercury, Percentage of sulphur & Chemical analysis of Bola parpati carried out in Bangalore test house. Bangalore & KLE’s J.T. College of Pharmacy, Gadag. c) Clinical Study – Repeatedly specials camps were conducted in postgraduate department of Rasahastra D. G. M. A. M. C. and Hospital Gadag. The patients of Rakta pradara after the complete diagnosed were selected and the clinical study was done administering Bola parpati 250 mg t.i.d. with Madhu as Anupana for 45 days and the patients were accessed for the same. 160 Summary
  • 176. 5) Results : Patients were observed on the basics of various angles ie demographic andvarious disease relevant points, the patients were assessed according to the subjective &objective criteria and results are given with the help of statistical value P& S.D etc.6) Discussion : In drug Pharmaceutical discussion rationalities behind shodhana and parpatikalpana was discussed appropriately. In the clinical, discussion about the Rakta Pradarapatients & clinical response to the treatment. A Probable mechanism of action wasdiscussed.7) Conclusion : The essence of the research work has been reported. 161 Summary
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  • 187. xiSPECIAL CASE SHEET FOR “RAKTHA PRADARA” DEPARTMENT OF POST GRADUATE STUDIES IN RASASHASTRAGUIDE:-Dr DilipKumar B M.D (Ayu) P.G.Scholar :S.B.SaswihalliPART A : EXAMINATION01 Name of the patient: Sl. No.02. Fathers/Husband Name : O.P.D. No.03 Age: I.P.D No. Bed No.04 Religion Hindu Muslim Christian Others05 Occupation : Sedentary Active Labour06 Economical Status Poor Middleclass Higher Class07 Marital Status Married Unmarried08 Address ____________________ Date of Initiation ____________________ Date of Completion _____________________ Tel No Pin:- ____________________09 ResultWell Moderately Responded Not Responded DiscontinuedResponded RespondedCONSENT I ________________________________________ is fully aware of the fact thatam a part of clinical trail. The investigation has explained me in detail about the outcomes of the trail in the language I understand I voluntarily submit my self to the trailand give my consent to be one of trial cases. Signature of the Patient.
  • 188. xiiPRASHNA PAREEKSHAPRADHANA VEDANAArtava Sambandhi:-A) Duration of illness : Months/Yearsb) LMP :c) Onset : Gradual/Suddend) Duration of Blood loss : dayse)Interval of Blood loss : daysf)Amount of Blood Loss : 1) No of Pads/ Cloths per day 2)Staining 3) Clotsg) Character : 1) Colour:Brick Red, Dark Red Brown Pale Red 2) Consistency : Clots/ Watery 3) Staining : + - 4) Odour : + -2. Vedana Sambandhi:a) Pain Present /Absent 1) Premenstrual : 2) During menses : 3) Post Menstrual : 4) Continuous :b) Intensity : Mild/Moderate/Severe :c) Aggravating Factors :d) Relieving Factors3. Anya Yoni Srava Sambandhi :a) Vaginal Discharge : Present/Absentb) Amount : Mild/Moderate/Severec) Character : 1) Colour : 2) Consistency: 3) Odour : 4) Others :d) Relation with menses : Before/during/After.B. ANUBANHA VEDANAi) Body ache :ii)Weakness :iii)Burning Sensation :iv) Low Backache :v) Head ache :vi) Giddiness :vii) Depression :viii)Lack of Concentration :ix) Rise of temperature :
  • 189. xiiix) Pain in calf muscles :xi)Breast tenderness :xii)Vomiting :xiii) Loose stools :xiv) Excessive Sweating :xv) Hot flushes :C. RAJO VRITTANTAi) Menarche :ii) Previous Menstrual History :iii)Other Relevant Factors :D. OBSTETRIC HISTORYi) Married Status : Married (Unmarried/Widow)ii) Married life : Yearsiii) Gravida/Parity :iv) Mode of delivery /deliveries :v) Last delivery :vi) Puerperal History :vii) Abortions : No At Months Cause :E. CONTRACEPTIVE HISTORYi) Safe Method :ii)Contraceptive Pills :iii) IUCD :iv) Ligation :v) Any other :III POORVA VYADHI VRITTANTA:IV KOUTUMBHIKA VRITTANTAIV Vayaktika Vrittanta:-1 Ahara Vegetarian Dominent Mixed Pakshi rasa in food Mamsa Beaf meat2 Vihara Vyayama Vyavaya Mrityadi Dritta Karma Mala Prishtayana Mootra Nighrahana3 Vyasana Tobacco Tea Gutaka Coffee Alcohol No Smoking Others habit4 Nidra Sukha Vishama Anidra Diwaswapa5 Jataragni Bala Manda Vishama Teekshna Sama6. Koshta Mridu Madhyama Krura7 Mala Times/day Regular Irregular Constipation8. Mootra Times/day Day Night9. Rajaha Regular Irregular Menopause10 Occupational History11 Type of Employment12. Work involving any physical strain/ vegadharana/yes/no
  • 190. xivROGI PAREEKSHASamanya PareekshaShareeroshma F F TwakNadi /Min NetraHrit Spandana /Min JihwaShwasa gati /Min GhranaShareera Bhara /Kg Urdhwa ShakhaAyama /Cms Ddhaha ShakaRakta Chapa Mm of Nakha HgVISHESHA ANGA PRATYANGA PAREEKSHASystematic Examination : Special Examination of Reproductive system 1 Vulva 2 Vagina 3 Cervix : Size Normal Abnormal Conditions Healthy Unhealthy OS Nulliparous Parous Colour Normal Congested 4 Uterus Size Normal Abnormal Position A.V R.V Mobility Mobile Fixed Consistency Soft Firm Hard 5 Fornices Palpable Normal TenderPRAKRITYADI PAREEKSHA(Dashavidha Pareeksha)Prakrititaha Shareera ManasikaSarataha Pravara Madhyama AvaraSamhananataha Susamhata Madhyasamhata AsamhattaSatwa taha Pravana Madhyanva AraraSatmyataha Ekarasa Sarvarasa NyameshraVyayamashakti Pravana Madhyama AvaraAharashakti Pravara Madhyama AvaraPramanataha Sama Heena AdhikaVayataha Balya Yuva VriddhaDeshsa Sadharana Anupa JangalaINVESTIGATIONS i) Hb% ii) B.T% iii) C.T% iv) Plate let count v) Urine Routine vi) Ultrasonography vii) Other Investigations:
  • 191. xvPART B : INTEPRETATIONSamprapti Ghatakas ⇒ Dosha ⇒ Dushya ⇒ Srotas ⇒ Srotodushti ⇒ Agni ⇒ Ama ⇒ Udhavasthana ⇒ Sancharastana ⇒ Adhistana ⇒ Vyaktastana ⇒ RogamargaUpashaya AnupashayaVyadhiPrakaraUpadravaAvastha Sadhya Sadhyata :PART C : OBSERVATION AND ASSESSMENTChikitsa Vrittanta 1. Bola Parpati 2. Posology- 250 mg tid (2 Ratti) 3. Anupana - Madhu 4. Duration of treatment - 45 days 5. Follow up 15 daysLab InvestigationRESPONSE ASSESSMENT15 Days Assessment chartSubjective BT After Treatment Follow upParameters 15th Day 30th day 45th day 7th day 14th day1. Durationof bleeding2. Amountof bloodloss3.Consistency4.Pain5.AssociatedsymptomsObjective ParametersBlood Examination Before Treatment After TreatmentHb%B.TC.TPlatelet CountInvestigators note :Signature of the Guide Signature of Scholar.