Gabhashaya mukha shotha psr

5,684 views

Published on

Clinical evaluation of efficacy of Avachoornana with certain indigenous drugs(Kaseesa, Tuttha, Gairika, Lodhra) in Gabhashaya Mukha Shotha W.S.R to Primitive cervical cell pathology, Padmasaritha, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
5,684
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
39
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Gabhashaya mukha shotha psr

  1. 1. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA DECLARATIONI hereby declare that this dissertation entitled “clinical evaluation ofefficacy of Avachoornana with certain indigenous drugs(Kaseesa,Tuttha, Gairika, Lodhra) in Gabhashaya Mukha Shotha W.S.R toPrimitive cervical cell pathology ” is a bonafide research work carriedout by me under the guidance of Dr.VNK Usha. M.D. (Ayu),Professor&HOD, Department of Prasooti tantra & Stri-roga and co-guidance of Dr. Sucheta, Assistant Professor, Department of Prasootitantra & Stri-roga.Date: Signature of the candidatePlace: Udupi Dr. Padmasaritha
  2. 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA CERTIFICATEThis is to certify that the dissertation entitled “clinical evaluation ofefficacy of Avachoornana with certain indigenous drugs(Kaseesa,Tuttha, Gairika, Lodhra) in Gabhashaya Mukha Shotha W.S.R toPrimitive cervical cell pathology” is a bonafide research work done byPadmasaritha in partial fulfilment of the requirement for the degree ofMaster of surgery (M.S)Date: Signature of the GuidePlace: Udupi Dr. VNK Usha. M.D. (Ayu) Professor&HOD Dept.Of Prasooti tantra & Stri-roga
  3. 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ENDORSEMENTThis is to certify that the dissertation entitled “A clinical study on theeffect of Upanaha Sveda in Pakshaghatha” is a bonafide research workcarried out by me under the guidance of Dr. VNK Usha. M.D. (Ayu),Professor&HOD, Department of Prasooti tantra & Stri-roga and co-guidance of Dr. Sucheta, M.D. (Ayu), Assistant Professor, Departmentof Prasooti tantra & Stri-roga.Signature of the H.O.D Signature of the PrincipalDr. VNK Uska. M.D. (Ayu) Dr. U.N. Prasad M.D. (Ayu)Date: Date:Place: Udupi Place: Udupi
  4. 4. COPYRIGHT I hereby declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate thisdissertation in print or Electronic format for academic / research purpose.Date: Dr. PadmasarithaPlace: Udupi© Rajiv Gandhi University of Health Sciences, Karnataka
  5. 5. ACKNOWLEDGEMENT In the beginning of the treatise, I bow to the almighty;At this happiest juncture of successful completion of this research work, I prostrate to the feet of“My Mother”, whose blessings and pain brought me up to this position. I am greatly indebted to my revered teacher and guide Dr. VNK Usha, Professor andHOD, Department of Prasooti tantra & Stri-roga, SDM College of Ayurveda and Hospital. It ismy fortune to have her as my guide whose excellent guidance, assistance and support in everystep during my course of study gave me a way to success for the dissertation and in futureprofession also. I express my sincere gratitude to my Co-Guide Dr. Sucheta kumari, Asst. Professor,Department of Prasooti tantra & Stri-roga, for her timely guidance in carrying out this project. It’s my great pleasure to express my deep gratitude to Prof. Muralidhara Sharma,Department of Shalya tantra, my preceptor and role model whose erudite expositions andbenevolent ideas had given me a propitious direction in all stages of my life and I am everthankful for his support and guidance.I express my heartfelt thanks to Dr. Mamatha K.V, Professor, for her immense inspiration,valuable training and constructive ideas, throughout my study period. I am thankful to my teachers, Dr.Ramadevi.G, Dr. Veena Mayya, Dr.Vidya Ballal,Dr.Krishna Bai, for their support thought out these 3years. It will not be out of the way to express my whole hearted thanks to my most lovablepersons on earth my Sister Dr.Abhilasha & Brother Prathap for their encouragement in allaspects of my life.
  6. 6. I thank my batchmates, Dr.Prathima, Dr.Rekha, Dr. Rachana, Dr. Sunitha,Dr.Deerashree, for their presence & support throughout the my work. I would like to put on record the affection with which my friends Dr.Ravikanth,Dr.Chaitra, Dr.Yashaswini, Dr.Radhika, Dr.Prakash, Dr.Seetharam for their support. I thank all my patients for their co-operation, which was crucial for the successfulcompletion of this work. I acknowledge my sincere thanks to all those who helped me during this study. Dr.Padmasaritha
  7. 7.   Abstract  ABSTRACTReproductive age of women is crucial involving complications of labour, infections duringpurperium, hormonal imbalance, etc predisposing to different kinds of pathology, where Cervicalpathology being common, disturbes the lifestyle of women and her family.Primitive cervical cell pathology, which includes the main clinical conditions – Cervicalhypertrophy, Cervical hyperplasia, Chronic cervicitis, Cervical erosion, which can be consideredas Garbhashaya Mukha Shotha, has been given importance in the present study, as these pre-clinical conditions carry the risk of carcinogenesis.Under the guidelines and treatment modalities of Sushruta, from the time tested Ayurvedicformulations, Avochoornana of shodhana dravyas, mentioned for ‘Shotha-Samutthana’ has beenplanned to cut the root cause of the disease.The Drugs Kaseesa, Tuttha, Gairika, Lodhra, having Shothahara, Granthihara, Ropana, Lekhanaand Krimighna properties are selected for the present study.Materials and Methods:20 patients diagnosed as ‘Garbhashaya – mukha shotha’(Cervical Hypertrophy, CervicalHyperplasia, Chronic Cervicitis and Cervical Erosion ) were taken for study from OPD andIPD sections of SDM Ayurveda Hospital , Kuthpady , Udupi.The diagnosed patients of Garbhashaya Mukha Shotha were subjected to Tutthadi Avachoornanakarma.Duration of treatment: 7 daysFollow Up period : Follow up after 15 days of completion of the treatment.Results: Statistically significant results were seen in Subjective parameters of Vaginaldischarge(86%), Dysmenorrhoea(84%), Backache(82%), Burning micturition. In Objectiveparameters, satisfactory results were seen on Nabothian cysts(60%) and Pap-smearchanges(71%), where as significant results were obtained on Area of Erosion(80%), CervicalHypertrophy(67%) and Irregularity of Os(90%).Key words: Garbhashaya mukha shotha, Cervical hypertrophy, Cervical hyperplasia, Cervicalerosion, Chronic cervicitis, Tutthadi-Avachoornana.“Clinical evaluation of efficacy of Avachoornana with certain indigenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” 
  8. 8.            Dedicated to    MY BELOVED MOTHER Surekha surya  
  9. 9. CONTENTSAcknowledgementAbstractList of TablesList of GraphsList of Abbreviations Page NoPART - I: Introduction 1PART - II: Objectives of the Study 2PART – III: Conceptual StudyChapter I Historical Review 3Chapter II Garbhashaya- mukha shareer 5 Shotha 8 Ekadeshothita Shotha 18Chapter III Anatomy of Cervix 25 Cervical Hypertrophy 30 Cervical Hyperplasia 30 Chronic Cervicitis 31 Cervical erosion 31Chapter IV Drug Review 32PART -V: CLINICAL STUDY Materials and Methods 41 Observations 46 Results 67PART –V1: DISCUSSION 76PART –V11: SUMMARY AND CONCLUSION 84 BIBLIOGRAPHY 88 APPENDIX-CASE SHEET
  10. 10. Abbreviations ABBREVIATIONS 1. A.H. - Astang hridaya 2. A.S. - Astang Samgraha 3. A.T - After Treatment 4. B.T - Before Treatment 5. C. S - Charak Samhita 6. M.N - Madhava Nidana 7. S.S. - Sushrut Samhita 8. S.K.D – Shabda Kalpa druma“Clinical evaluation of efficacy of Avachoornana with certain indigenous drugs (Kaseesa, Tuttha,Gairika, Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology”
  11. 11.   Introduction   INTRODUCTIONThe active reproductive years of female are quite interesting to observe, as it includes differentphysiological changes. The peak levels of estrogen which are inevitable for feminine orientation,sometimes lead to certain pathological problems, the Cervical Pathology being one of that.Injuries during parturition, infections result in inflammation of cervix and conditions likepregnancy, lactation, unopposed estrogen action, inevitable estrogen therapy lead to histologicalchanges with increase in cell size, multiplication of cells, destruction of epithelial tissue andlastly atypical cell formation.These changes clinically give rise to many pathological conditions. Among them, CervicalHypertrophy, Cervical Hyperplasia, Chronic Cervicitis, Cervical Erosion, which can beconsidered as Garbhashaya Mukha Shotha, should be treated promptly, if not may lead tomalignancy. The Primitive Cervical cell pathology has the advantage, that it has a prognosismuch better than the rest of Stage-1 tumours and also it is not possible to define the pre-clinicalpathological conditions by the point of histology. Hence in suspected cases, the improvedCytologic screening like Pap-Smear has been adopted to diagnose the abnormal smears,interpreting High Grade Cervical Intra-epithelial Neoplasia, to rule out from the study. Eventhough modern science has effective treatment methods like Cryotherapy, Laser resection,Electro-cautery etc are not out of side effects like secondary bleeding, cervical stenosis, etc. Asthe primitive cervical cell pathology provides ample time for correction, a proper therapeuticmeasure to combat the pathology, has been planned with Avachoornana, one of Shashti-Upakramas mentioned by Acharya Sushruta with the drugs Kaseesa, Tuttha, Gairika, Lodhra,which are having Ropana, Lekhana, Shodhana, Shothahara and Granthihara properties. Thesedrugs had been the choice of selection as kshara dravyas are indicated for shodhana tobreakdown the further invasion of pathologic process.“Clinical evaluation of efficacy of Avachoornana with certain indigenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 1 
  12. 12.   Objectives OBJECTIVE OF THE STUDY Conceptual Study Of Garbhashaya – Mukha Shotha (Cervical Hypertrophy, Cervical Hyperplasia, Chronic Cervicitis & Cervical Erosion). Clinical study to evaluate the efficacy of Avachoornana with Kaseesa, Tuttha, Gairika, Lodhra in Garbhashaya-Mukha Shotha (Cervical Hypertrophy, Cervical Hyperplasia, Chronic Cervicitis & Cervical Erosion).“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 2
  13. 13. LIST OF TABLES Tb List Of Tables PgNo. No.01 Types of Shotha according to nidana 1202 Samanya Nidana of Nija-Shotha 1303 Agantuja Nidana Of Shotha 1404 Pathya-Apathya in Shotha Chikitsa 1705 Measurements of Uterus 2506 Observations 4607 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 46 Age:08 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 47 Religion:09 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 47 Marital Status:10 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According to 48 Education11 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According to 48 Habitat12 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 49 Socio-Eco Status13 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 49 Socio-Economic Status:14 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 50 Dietary Habit:15 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 50 Prakriti:16 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 51 Sara:17 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 51 Samhanan:18 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 52 Satva:19 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 52 Satmya:20 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 53 Agni:21 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 53 Ahara Shakthi:22 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 54 Vyayama Shakthi:
  14. 14. 23 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 54 Desha:24 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 55 Bowel & Bladder25 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 55 Vaya:26 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 56 Duration of Illness:27 Distribution Of 20 Patients According To Onset: 5628 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 58 Pradhana Nidana Present:29 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 58 History Of Menstrual Cycle Interval:30 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 59 History of Duration of Menstrual Flow:31 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 59 History of Clots Present:32 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 60 History of Menstrual Blood Loss:33 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 60 History of Abortion:34 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 67 History of Contraceptive Methods:35 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 61 History of Parity:36 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 61 History of Delivery Type:37 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 62 History of Vaginal Discharge:38 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 62 History of Dysmenorrhoea:39 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 63 History of Bckache:40 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 63 History of Dyspareunia:41 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 64 Area Of Erosion:42 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 64 Nabothian Cysts:43 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 65 Cervical Hypertrophy:44 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 65 Irregularity Of Os:
  15. 15. 45 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According To 66 Pap-Smear Reports46 Distribution Of 20 Patients Of Garbhashaya Mukha Shotha According 66 Burning Micturition:47 Effect Of Avachoornana on Vaginal Discharge 6748 Effect Of Avachoornana on Dysmenorrhoea 6849 Effect Of Avachoornana on Backache 6950 Effect Of Avachoornana on Area Of Erosion 7051 Effect Of Avachoornana on Nabothian Cysts 7152 Effect Of Avachoornana on Cervical Enlargement 7253 Effect Of Avachoornana on Irregularity Of Os 7354 Effect Of Avachoornana on Pap-Smear Changes 74
  16. 16. Chapter 2 Conceptual study  CONCEPTUAL STUDY RACHANA SHAREERA OF GARBHASHAYA MUKHAGARBHASHAYA:The words – Garbha and Ashaya forms GarbhashayaAshaya denotes “Avasthana visesha”28.Purusha shareera is comprised of sapta ashayas, where stri possess Garbhashaya as one extraashaya29.Sushruta denoted “Shukra shonitam Garbhashayastham”30, which means the place wherefertilized ovum gets implanted after shukra-shonita samyoga.Garbhashaya Sthana:In between ‘vipula kundala’ or Pitta-Pakwashaya Madhya, behind the vasti, Garbhashaya issituated, which clearly states that uterus is a pelvic organ, located in between the rectum andbladder in pelvic cavity 31,32,33.The term ‘Jarayuna parivitam’34 has been explained as the covering of uterus by Kashyapa,which is denoting the peritoneum.Garbhashaya Akriti:‘Rohita matsya akriti’ denotes the pyriform shape of the uterus.Alpamukham and Mahasushira mentioned by Dalhanacharya can be considered as cervix andcavity of body of the organ 35,36.GARBHASHAYA:Shabda kalpa dhruma states - vasasthanna of garbha as Garbhashaya.“Yatra garbha thishtati”, the place where garbha resides is termed as Garbhashaya by Dalhana.Kriya-vignana of Garbhashaya:“Sukshma kesha pratikasha beeja raktavaha sira garbhashayam tarpayati maasadbeejayakalpate”37- has been explained by Vishwamitra, which describes the functional aspect ofendometrium, where rich supply of blood to it, in every month is meant to nourish the awaitingfertilized ovum. Where this is explained in the contemporary science, as secretory phase underthe influence of oestrogen and progesterone hormones.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 5
  17. 17. Chapter 2 Conceptual study “masena upachitam raktam dhamanibhyam rutau punah”- describes the blood collection in theuterus for whole month, through endometrial capillaries.‘ishatakrishnam vigandham cha vayuryonimukhanudeta’ – the word ‘yonimukha’ here isreffering to vagina, through which the blackish red menstrual blood escapes, under the influenceof vata38,39,40. GARBHASHAYA-MUKHAYoni:Derivation of the term yoni is from – “Yu Mishrane”, meaning ‘UNION’, which can be taken asvagina in this context, reffering to organ of copulation.Yoni refers to female reproductive tract-In ayurvedic classiscs, yoni is a general term ascribed to all the female genital organs, in thecontext of gynaecological disorders.- ‘Vimshatiryoni vyapadani’41,42- ‘Yoni dosha’43Yoni reffering to Garbhashaya-Mukha-- Antarmukhi yonivyapat : Charaka described the word ‘vakrayatyananam’, meaning crookingof the mouth of the yoni, which refers to Garbhashaya-Mukha ( cervix ) 44- Suchimukhi yonivyapat : ‘Anudwaram kuryat’ is the feature, meaning excessive narrowing ofthe orifice, which refers to Garbhashaya-Mukha45,46.Garbhashaya- mukha :Karnini yonivyapat – Indu commentary says, “Yonau garbhashya dwaramukhe”47, reffering toGarbhashaya-Mukha and due to formation of karnika, there is obstruction to menstrual flow(‘rajomarga nirodhini), semen cannot enter the uterine cavity ( ‘shukrasya apratigrahat’),resulting in female infertility.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 6
  18. 18. Chapter 2 Conceptual study Garbhashaya-Mukha paryaya : Apara mukha48Artava vaha sroto mukha49Garbha – chidra50Yoni – mukha51Kriya-shareera of Garbhashaya-Mukha :Garbhashaya-Mukha, is the gateway to the upper uterine cavity, having wide range of functionslike, endometrial shedding, protection against infections, facilitation of sperm entry, helping inthe process of reproduction.The cervical changes has been explained at different phases of menstrual cycle :Niyatam diwase atite sankuchatyambujam yatha |Rutau vyatite naryastu yonih samvriyate tatha ||52,53After sunset, as the lotus gets closes, in the same way the yoni of a woman gets contricted, aftercompletion of rutukala and hence does not allow the entry of shukra.The hormones oestrogen & progesterone maintains the physical, chemical & cellularenvironment of the cervix.Oestrogen decreases the protein, but increases the content of water and electrolytes. Hence in theproliferative phase, the mucus is copious, thin & clear, with higher viscosity and stretchingcapacity of upto 10cm (Spinnbarkeit phenomenon) 54, facilitating the sperm entry.Progesterone increases the protein, but decreases water and electrolyte content. Hence the mucuswill be tenacious, thick & scanty, with lesser viscosity & stretching ability, leading to fracturewhen put under tension ( tack property)55. Progesterone dominant mucus, restricts sperm entry.Hence these hormones give clinical guidelines for clinical practice in the detection of ovulation.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 7
  19. 19. Chapter 2 Conceptual study  SHOTHA 1. Utpatti – Shotha - Shwayati iti shotha56 From the word “Shu Gatau” by adding suffix “Thana” shotha is derived. Sh.ka.dru - Shu Gatau + Bahulakata Thana Nirukti: • Utseda is the Pratyatma lakshana of shotha “Utsedham lingam shwayathu karoti”57 • Utsedham samhatam Shopham tamahu nichayadatah58,59 • According to Vagbhatta utsedha means samhat i.e. stable and ‘ Samhatam ’refers to ‘Nischalatva’ Shopha includes different kinds of diseases, like granthi, alaji, arbuda, etc which are having utseda as cardinal feature. Shopha are the swellings caused by the localized doshas, residing in between twak & mamsa, which will have various manifestations like pruthu or grathita, sama or vishama60. Paryayas: “Shotha roga vishesha . Tat paryayah shopha shwayathu ityamarah shothakah .” Vyutpatti of shopha & shwayathu Shopha – ‘ Shu Gatau’ Dhatu + ‘Pha’ pratyaya Shwayathu - ‘Tu O Shvi Gati vriddhoh’ The word Gati means to move ( S.k.d. ) 61“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 8
  20. 20. Chapter 2 Conceptual study Dosha-sambandha of Shotha:In ‘Shotha chikitsa adhayaya’, Kashyapa described that, Vata is responsible for shotha , as Pitta& Kapha are causative factors for daha & shaitya 62.SHOTHA PRAKARA: Utseda is the samanya lakshana of shotha, where ever its manifestation may be. Hence it has been classified depending on different entities, as follows:63- Cause- Dosha involved- Part involved- Shape1. Karana bhedena:64,65 i. Nija Shotha ii. Aganthu Shotha2. Avayava bhedena:66 i. Sarvangaja ii. Ekangaja3. Anga-bhedena:67 i. Sarvangaja - Sarva shareera gata shotha ii. Ardhangaja - Ardha shareera gata shotha iii. Ekangaja - Shotha in particular anga“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 9
  21. 21. Chapter 2 Conceptual study 4. Dosha vikruti bhedena:68 i) Vatika ii) Paittika iii) Slaismika5. Akaara bhedena:69 (i) Pruthu (ii) Unnatha (iii) Grathita6. Dosha bhedena - Ekangaja shotha and Sarvangaja Shotha are again classified 5 types of Sarvangaja Shotha70 (i) Vata (ii) Pitta (iii) Kapha (iv) Sannipataja (v) Visha7. 6 types of Ekangaja Shotha71 (i) Vata (ii) Pitta (iii) Kapha (iv) Shonita (v) Sannipataja (vi) Aganthu“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 10
  22. 22. Chapter 2 Conceptual study 8. Nine types of Shotha72 (i) Vataja (ii) Pittaja (iii) Kaphaja (iv) Vata Pitta (v) Vata Kapha (vi) Pitta Kapha (vii) Vata Pitta Kaphaja (viii) Abhighataja (ix) Vishaja“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 11
  23. 23. Chapter 2 Conceptual study  GENERAL CONCEPTS OF SHOTHANidana :Charaka has enumerated many karanas for manifestation of Nija as well as Agantuja Shotha. - “Shuddhyamayabhakthakrushabalanam ksharamlatikshnoshnagurupaseva | Dadhyamamrut shaaka virodhidushtagaropasrushtaanna nishevanam cha ||”73Agantuja shotha manifests due to aghata on bahya twacha, - “Bahyastwacho dushayitaabhighata: kashtashmashastragnivishayasadhyai: |”74Identification of nidana and nidana-parivarjana has been given prime importance in ayurvedicclassiscs on the basis of chikitsa, as Charaka stated in “Shwayathuchikitsadhyaya”- - “Nidanadoshaviparyayakramairupacharet baladoshakaalavit” 75Different kinds of Shotha nidanas explained by Acharyas : TABLE NO - 1 Nidanas C.S S.S A.H M.N B.P K.S H.S Nija Shotha + + + + + + + Agantuja + + - - - + + Abhighataja - - + + - - - Vishajanya - + + + - - - Raktaja - + - - + - -“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 12
  24. 24. Chapter 2 Conceptual study Various shotha nidanas according to different Acharyas :TABLE NO - 2Shotha Samanya Nidana:76,77,78,79 Nidanas CS SS AH MNMithyayoga of vamanadi karma + + + +Apathya prayoga after Panchakarma + + + +Ati Krusha with alasaka, jwara, shwasa, atisara,bhagandara + + + +Kushta, kandu peedita + + - +Udgara, mala, mutra, apana vayu vega dharana + + + +Amla , Lavana atisevana + + + +Pishtanna atisevana + + - +Phala, shaaka atisevana + + + +Dadhi , Madhya, mandaka atisevana + + + +Shooka, Shami dhanya atisevana + + + +Ati sevana of aanupa and audaka mamsa + + + +Garbha sampeedana + + - -Garbha prapatana + + - -Prajatanaam mithyopachara + + - +Ati upavaasa + + + +Ratri jagarana - - + -Mrudbhakshana + + + +Ati maithuna - + + -Ati chankramana - + + -Ati yaana - + + -“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 13
  25. 25. Chapter 2 Conceptual study TABLE NO - 3Agantuja nidana: 80,81,82 Nidanas CS SS AS AH MNChedana + + + + +Bhedana + + + + +Kshanana + + + + +Bhanjana + + + + +Utpeshana + + - - +Prahara + + + + +Bhandana + + - - +Veshtana + + - - +Vyadhana + + + + +Peedana + + - - +Bhallataka pushpa, phala, rasa samsparsha + + + + +Shooka, krimi shookahita + + + + +Visha patra, lata, gulma samsparsha + + + + +Savisha prani damshtra + + + + +Garbha sampeedana + + - - -Ama garbha prapatana + + - - -“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 14
  26. 26. Chapter 2 Conceptual study Poorva rupa of shotha:83,84Anga-gauravamDhawathuSira-ayamaUshmaSAMANYA LAKSHANAS: 85,86Anga-vivarnataAnavasthitatwaGauravamSira-tanutwam 87 , 88, 89,90Vataja shotha: -vaata varna vedanaLakshanas – Krishna/Aruna varna, Todavata, chhedanavat, bhedanavat, pidanvat,pippilikasarpanavat, Shigra unnatatwa, Shigra shamanatwa, sarshapa kalkavaliptachimichimayate, etcPittaja shotha: 91,92,93,94-pitta varna-vedanaLakshanas – Krishna/pita/nila/pingala varna, Bhrama, jwara, sweda, trishna,mada, akshiraga. Ushyate, dhuyate, ushmayate, sparshaasahatwa Utsedha, Ushma, etcKaphaja shotha:95,96,97,98-kapha varna-vedanaLakshanas – Pandu varna, Kruchroothanaprashamobhavati, guru, shtira, shlakshna, atyana,shitala,nipidito na cha unnamed, ratribali, ghana, Kandu.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 15
  27. 27. Chapter 2 Conceptual study Dwandwaja - Mixed lakshanas of the dosha involved 99Sannipataja – Tridoshaja lakshanas are seen 100 101,102Abhighataja ShothaThis type of Shotha is characterized by following features Visarpavana, bhrushoshma,Lohitabhasa, Pitta lakshana 103 , 104Vishaja ShothaThis type of Shotha is characterized by following features Mrudu, Chala, Adhogamanshil, Dahaand Ruja.UPADRAVAS OF SHOTHA: 105AruchiAtisarachardhiDaurbalyaJwaraSwasaTrishnaCHIKITSA: 106Chikitsa-sutra includes 3 basic principles:AntahparimarjanaBahirparimarjanaShastra-pranidhana“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 16
  28. 28. Chapter 2 Conceptual study SAMANYA CHIKITSA: 107 “Nidanadoshaviparyayakramairupacharetm baladoshakaalavit”APATHYA: 108,109,110TABLE NO – 4Ahara Navadhanya,shushkshaka, krushara,dadhi,madhya, guda,amla-guru-vidahi dravyas,gramya-mamsa, lavana, pishtanna.Vihara Maithuna,diwaswapnaPATHYA: 111Gomutra Jangala mamsa rasaMahishi mutraTakraUshtra mutraYavannaYusha          “Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 17
  29. 29. Chapter 2 Conceptual study  EKADESHOTHITA SHOTHABrihatrayi has explained about shotha in general and Ekadeshothita-shotha112 briefely atdifferent context.Sushruta described ‘shareera ekedeshothite’, reffering to localized swellings, seated in betweentwak & mamsa.Vagbhata says ‘pratyangeshu tadaashraya113’, meaning shotha manifested at different organshould be named accordingly.charaka too explained Ekadeshothita shotha in ‘Ashtodareeya adhyaya’, reffering to regionalswellings, on which Chakrapani comments that – “Sampratyutseda samanyat pradeshikanshotha”114 which refers to general manifestation of shotha at different tissues or organs.Charaka in the context of Ekadeshothita shotha says-“ Rogasch utsedha samanyad adhimamsa arbudadayah |Vishishta naamrupabhyam nirdeshyah shotha samgrahe ||”115Even though Arbuda, Adhimamsadi are having their own nidana, samprapti, etc, the pratyatmalakshana is utseda, hence these must be considered under shotha.Hence the heading Ekadeshothita shotha involves Arbuda, Adhimamsa too.Shothastu Anekasankhyaha:“Shophastu gaatraavayavaashrita ye te sthanadushyakrutinaamabhedat |Anekasankhya: katiciccha teshaam nidarshanartham gadato nibodha ||” 116shareera is comprised of numerous anga-pratyangas and hence diseases are innumerable117depending upon the Sthana, Samsthana, Samuthana etc & also on the lakshanas of vitiated doshalike ruja, varna etc. To mention every disease in one text is quite lengthy, hence only broadclassifications are described in our classics and one has to use yukti in understanding and namingthe disease entity.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 18
  30. 30. Chapter 2 Conceptual study Hence, in the same way shotha can afflict any tissue or organ, as charaka has clearly classifiedaccording to aakriti, dushya, naama & sthana bhedena. Certain shothas were described bycharaka with their lakshanas & chikitsa sutras like- ‐ Gala ganda ‐ Upakusha ‐ Talu vidradhi ‐ Shaaluka And Granthi, Arbuda has also been explained in the same context.GRANTHI SHOTHA: 118Charaka has mentioned - Granthi shotha can manifest in any part or organ in the body,depending upon the dosha-vitiation, along with utseda as pratyatma lakshana.Garbhashaya mukha shotha :“Angaekadeseshwaniladibhi: syat swarupadhari sphurana: sirabhi: |Granthirmahanmamsabhavastvanartirmedhobhava: snigdhatamaschalashcha ||”Granthi shotha can manifest anywhere in the body, by the vitiation of siras and mamsa.Even though there is no direct reference, all the explinations above clearly says shotha pertainingto Garbhashaya-Mukha can be considered under the category of Pradeshika shotha & hencegeneral shotha nidana, samprapti, lakshanas & chikitsa are applicable to Garbhashaya-Mukhashotha also.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 19
  31. 31. Chapter 2 Conceptual study  GARBHSHAYA - MUKHA SHOTHAThe refernce for shotha of female genital tract is available in kashyapa samhita, in the chapternamed “Dushprajata chikitsa adhyaya” 119, where he explained ‘YONI-SHOTHA’ as one of thesootika rogas.‘Karnikaakara Granthi’ formation has been explained by charaka in ‘Karnini yonivyapat’120.Where as Granthi can also manifest as shotha.Hence, under the guidelines of samanya shotha nidana, samprapthi, lakshanas & chikitsa, shothamanifesting in Garbhashaya-mukha can be taken as Garbhashaya-mukha shotha.Nidana:A. Depending on the aetiopathology, it is of 2 types: 1. Nija – due to dosha-dushya vaishamya 2. Agantuja – abhigaatadi bahya karanasEven though agantuja shotha is having different aetiology, after 7 days of affliction, it shows thefeatures of nija shotha itself. As charaka said, “ Aganturanveti nijam vikaram”121Nidanas for general shotha are applicable to Garbhashaya-mukha shotha too.B. Gabhashaya-mukha shotha nidanas can also be categorized into 2 types:1. Samanya:2. Visesha:Samanya nidana:Mithya ahara-viharaChikitsa upadravaNidanarthakara rogaDhatu-kshaya“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 20
  32. 32. Chapter 2 Conceptual study Mithya ahara:Prakruti virudha ahara, irregular food habits, ati katwamlalavana rasa sevana, abhishyandhiahara, virudha bhojana, adhyashana, amatrashana, vishamashana, etc leading to dosha utklesha,dislodging at different parts of the body manifests shotha.Present day colouring, sweetening, flavouring, additives & preservatives are harmful to thebiological system in the body leading to pathology.Addctions like tobacco chewing, smoking, fast foods with rich fat & low nutritive value.Mithya vihara:Ati vayu-atapa sevanaAti vyayama & vyavayaDiwasvapna, ratri jagaranaAltered Dina & Rutu charya in present era, with excess work, stress, multiple partners.Chikitsa upadrava: ‐ Iatrogenic causes like, instrumentation during D&C, MTP, Forceps & Vacuum delivery leads to tears & lacerations of the genital tract, inviting pathogens if left untreated. ‐ Sootika will be deprived of agni & bala due to ati raka-nisruti & dhatu-shaithilyata, if proper care & nourishment is not given, leads to various diseases. ‐ Contraceptive methods like, Cu-T, Vaginal creams, Diaphragms irritates the local mucosal tissue & alters the normal vaginal flora manifesting infections. ‐ Other systemic disorders if not treated properly, lowers immunity, resulting in predisposition of various diseases.Nidanarthakara roga:Shotha may manifest as secondary to other disorders due to established dosha-dathu vaishamya& altered defence mechanism.Dhatu-kshaya :Sootikavastha and external trauma(abhighata), leads to excessive blood loss leading to vaatavruddhi, which is the prime factor for causation of shotha.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 21
  33. 33. Chapter 2 Conceptual study  Visesha nidana: ‐ Garbha sampeedana ‐ Ama-garbha prapatana ‐ Vishama prasuti ‐ Dushprajata ‐ Prajatanam mityopachara Garbha sampeedana: It refers to faults in passenger. Garbha means fetus; Sampeedana - sam means constant/continuous; Peeadana – pressure of fetus on Garbhashaya-mukha. Nidanas for Garbha sampeedana might be taken as: ‐ Oversized fetus/Macrosomia : Vivrudha garbha ‐ Malpresentations : Asamyak agata, Which are considered as nidanas for Mudagarbha122. Ama-garbha prapatana:123 One of the main reason behind Ama-Garbha prapatana is hormonal imbalance/estrogen excess. Incomplete abortion : Excess blood loss – Anemia – Infections Incomplete abortion : Instrumentation / Surgical intervention – Lacerations over cervix – Infections. Vishama-prasuti : Abnormal / difficulty / prolonged labour may over strain the cervix with constant pressure on the organ,which will lead to cervical oedema, injury & predispose to infections.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 22
  34. 34. Chapter 2 Conceptual study Dushprajata:Refers to Difficult labour.“Garbha nishkramana kriya” – is the function of normal Apana vayu.“Viguna apana vata” causes inco-ordinate uterine contractions & cervical dystociaMithyopachara in Sootikavastha:Achiraprajatanam- just delivered woman, if indulges in Mithyopachara124.If sootika paricharya is not followed – agni vaishamya & dhatu shithilata – dhatu kshaya & vatavrudhi – shothaMithyahara sevana – dosha prakopa – shothaPoor hygiene, unrepaired cervical tears & lacerations – infections.Samprapti of Gabhashaya-mukha shotha: 1. Nidana sevana Dosha-prakopaka ahara-vihara Dosha vikruti Dhatwagni dushti Khavaigunyata in the Garbhashaya-Mukha Garbhashaya-Mukha Shotha Yoni-srava, Yoni-kandu, Kashtartava, Kati-shoola, etc“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 23
  35. 35. Chapter 2 Conceptual study 2. Abhighata (Instrumentation on cervix), Cervical tears                                                                                                      Rakta-nisruti Vaata-vruddhi Dosha-vikruti ShothaSamprapti ghatakas: 1. Dosha – Vata pradhana tridosha 2. Dushya – Rasa, Rakta, Mamsa 3. Srotas – Rasavaha, Artavavaha 4. Vyadhi vyaktasthana – Garbhashaya-mukhaChikitsa:After explanation of broad classification and treatment modalities of shotha, Charaka clearlymentioned that every shotha lakshanas depends on the involved doshas and hence treatmentshould be directed towards the vitiated dosha, with the utility of chedana, bhedana, lepana,dahana adi kriyas in unexplained shothas.                                        “Parikshaya shothaprakaran anila adilinge | Shanti nayedoshaharae yathaswam alepana chedana bhed dahae ||”125According to Vagbhata, in any disease, where Mamsa vruddhi is present, Shastra, Kshara, Agnikarmas should be employed. Mamsa vridhibhawan rogan shastra kshara agni karmabhi | 126“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 24
  36. 36. Chapter 1  Historical review   HISTORICAL REVIEWVedic period:Vedas are said to be the primitive scripts of Indian literature. To denote the female genitalorgans, different words has been mentioned like upastha, bhasad, bhamsas, yoni, etc., speciallyreffering to vulva, vagina and uterus.It is mentioned that rakshasa’s or krimi’s if enters garbhasaya cause infertility and yoni-dushtiand hence has to be eradicated.1In Rigveda:Pralepa with ushna veerya dravyas like shigru and parna patra is mentioned as one of thetreatment modality in shotha.2In Atharvaveda:Shothahara drugs like- varuna, pushkaramula, plaksha, latex of ashwatha are explained undershotha chikitsa.3Brahmanas:The external and internal female reproductive organs are reffered as yoni and upastha. Thelocation of yoni is shareera Madhya and below udara, attached to mamsa.4Samhita kala:Charaka samhita:In sutrasthana trishothiyadhyaya, charaka mentioned garbha sampeedana and amagarbhaprapatana as the nidana’s of shotha. Depending upon the site affected, pradeshika shotha’s alsohas been enumerated. In chikitsasthana, mithya achara and vishama prasuti are described as thecausative factors of nija shotha, where Shastradi abhighata will lead to agantuja shotha.Alepanadi chikitsa krama’s also are mentioned for anukta shotha’s.5,6,7,8Sushruta samhita:In shareerashana, sushruta described sthana and rachana-shareera of garbhashaya, representing“Rohitamatsya akriti”9,10 as simili, along with which tri-avarta’s are compared to “shankhanabhiakriti”. In sutrasthana, Amapakwaishaniyam adhyaya explains about “Ekadeshothita shotha”11,12.Similar treatment modalities has been mentioned for shotha and granthi13.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 3
  37. 37. Chapter 1  Historical review  Ashtanga hridaya / Ashtanga sangraha:Both the texts has given explaination about garbhashaya14,15. Uttara tantra of Ashtanga sangrahadescribed the word garbhashaya dwara16. Both the Vagbhata’s has given similar descriptions ofshotha, its nidana, purvaroopa, roopa etc, along with the explination of sthanika shotha17,18.Kashyapa samhita:Garbhashaya sthana is explained in shareera sthana19. Shotha adhyaya20 describes aboutsamprapti lakshanas etc. In “Dushprajata chikitsa adhyaya” kashyapa explained “Yoni shopha”as one of the sootika roga21.Sangraha kala:Madhava nidana:Vishama prasuti and aamagarbha patana are included as the causative factors of shotha22.Madhava explained nidana, samprapti, lakshanas of shotha in a separate chapter.Bhava Prakasha:Shothadhikara adhyaya also explained vishamaprasuti as one of the shotha nidana23.Bhela Samhita:Shwayathu chikitsa adhyaya explaines about shotha in detail24.Yoga Ratnakara:An indivisual chapter on shotha is available with all its nidana, samprapti and chikitsa, where hetoo has described vishamaprasuta as tha causative factor. Prishniparnyadi drugs mentioned fortha treatment of shotha25.Harita Smhita:Short description of shotha is available26.Vangasena:Detailed explination regarding shotha nidana, samprapti, chikitsa are mentioned, includingvishamaprasuti as one of the nidana of shotha27.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 4
  38. 38. Chapter 4 Drug review  DRUG REVIEWKASEESA :138,139 Ferrous sulphate – FeSO4H2OGroup –Uparasa groupUtpatti : ‐ Sahaja : Naturally available as a decomposition product of Iron sulphide ‐ Krutrima : Artificially prepared by the action of SO4 on iron.Occurrence :It occurs in crystalline and massive forms, which is greenish and obtained by the name‘Hirakasa’.Localities:Germany, Boveria, Swedan, Spain, and USA.Prakara :Rasarnava : -1.Shukla 2.Krishna 3.PeetaRasajala nidhi: - 1.Baluka kaseesa (swetha) 2.Pushpa kaseesa (peeta) 3.Kritrima kaseesa (harita) 4.Dhatu kaseesa (shyama)“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 32 
  39. 39. Chapter 4 Drug review Rasendra chudamani & Rsa ratna samuchaya: According to form 1. Baluka kaseesa 2. Pushpa kaseesaAyurveda prakasha: - 1. Dhatu kaseesa (pamshu kaseesa) 2.Pushpa kaseesa (kinchitpeeta)Gunakarma :Rasa : Tikta, amla, kashaya, kshareeyaGuna : Snigdha, ushna, guru, nirmala, dhumabhaVeerya : UshnaKarma : Ropana, amasamsoshana, vishapaha, vranaghna, ragakara, jantughna, etcDosha prabhava : Sleshma nashana, vatakaphahara.Method of shodhana: ‐ Dolayantra shodhana : Bhringaraja swarasa, Kanji, Rajakoshataki rasa, etc ‐ Bhavana : Nimbu rasa, Kanji, KsheeraMarana : Laghuputa 2-3 times.TUTTHA140,141: Copper sulphate (Sasyaka)Group – Maharasa varga, Upadhatu“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 33 
  40. 40. Chapter 4 Drug review Mythological origin:Sasyaka is a solidified vomited material of Garuda pakshi. The vomitus was on Marakatamountain, after drinking amrita first and then halahala poison. Hence it is a mixture of bothAmrita & Visha, possessing the properties of both.According to ‘Ayurveda prakasha’ – Tuttha is an upadhatu of tamra and hence have theproperties of tamra & sasyaka both. Sasyaka is the mineral form of copper sulphate, where astuttha is now artificially prepared copper sulphate.Paryaya nama: ‐ Amrutasanga ‐ Shikhi-griva ‐ Tamra grabha ‐ Vitunnaka ‐ Shikhi tuthaka ‐ Sasyaka ‐ Mayura tuthakaPrakara :As per Source : - 1. Swabhavaja (sasyaka) 2. Kritrima (tuttha)As per Colour : -1. Rakta (sreshta) 2.Kalika / Blackish (adhama)Gunakarma :Rasa : Katu, kashaya, madhura, ksharaGuna : Laghu, rukshaDoshakarma : Kaphapitta hara, tridosha shamanaKarma : Lekhana, bhedana, krimighna, twak doshaharaMethod of shodhana : ‐ 1. Swedana in dolayantra for 2 yama ‐ 2. Bhavana with raktavarga dravya rasa or qwatha ‐ 3. Tapana and nimajjana“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 34 
  41. 41. Chapter 4 Drug review Marana : Kukkuta putaModern description:Tuttha is the hydrous sulphate of copper combined with water. Its mineral is copper ore knownas ‘chalcenthite’Hardness – 2.5Specific gravity – 2.1 to 2.3Appearance : Lustre vitrious to dullColour : Deep blue, sky blue, greenish blueStreak : White to light blue, translucentTaste : Disagreeable, metallicComposition :CuSO4 5H2O : - Cu : 31.6% - SO4 : 32.1% -H2O : 36.1%Readily soluble in water, yielding blue solution.GAIRIKA142,143: Red ochre-Hematite [ Fe2O3]Group – Uparasa group“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 35 
  42. 42. Chapter 4 Drug review Nirukti: Due to its golden red colour, it is called as ‘Swarna gairika’Paryaya nama: ‐ Rakta dhatu ‐ Girija ‐ Girimrut ‐ Rakta pashanaPrakara: ‐ Swarna gairika ‐ Pashana gairika ‐ Samanya gairikaGunakarma :Rasa : Mdhura, tiktha, kashayaGuna: ‐ Snigdha ‐ Katina ‐ Ruksha ‐ HimamVeerya : SheetaVipaka : MadhuraKarma : Vranaropana, Dahahara, Kandughna, Alakshmihara, Vishapaha, etcDosha prabhava : Pitta shaman, Kaphapaha, VatajitPhysical properties :Swarna gairika is raktatara, where as pashana gairika will be in tamra varna and hard in touch.Method of shodhana : ‐ Bhavana with Godugdha ‐ Bharjana in Gritha.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 36 
  43. 43. Chapter 4 Drug review Modern description:The mineral of Iron sulphate is ‘Malatite’, belonging to monoclinic and prismatic class. Crystalform is rarely available, where earthy, fibrous or capillary crusts or efflorescences are commonlyobtained.Its crystals have perfect basal or distinct prismatic cleavages.Hardness – 2Specific gravity – 1.8 to 1.9Various green shades can be seen, which on exposure looks yellowish, luster vitrious to dull,transparent to translucent.Contains – FeO : 25.9% SO3 : 29.8% H2O : 45.3%Manganes, Magnessium, Copper, ZincIt is decomposition productof Iron sulphide mineral, especially Pyrite, Marcasite, Chalcopyriteand Pyrrhotite.LODHRA144:Botanical name – Symplocos racemosaFamily – Symplocaceae“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 37 
  44. 44. Chapter 4 Drug review Synonyms: ‐ Akshibhaishajya ‐ Rodhra ‐ Sthoolavalkala ‐ Tirita ‐ Tilva ‐ GalavaGunakarma: Rasa – Kashaya Guna – Laghu, Ruksha Veerya – sheeta Vipaka – Katu Dosha karma – Kapha pitta haraActions and uses: ‐ Astingent ‐ Refrigerant ‐ Anti-inflammatory ‐ Depurative ‐ Febrifuge ‐ Haemostatic ‐ Alterant ‐ Ophthalmic ‐ ExpectorantIt is useful in eye diseases, spongy and bleeding gums, asthma, bronchitis, skin diseases,menorrhagia, leucorrhoea, haemorrhages, gonorrhea, etcPhysical constants: ‐ Total ash : Not more than 12% ‐ Acid-insoluble ash : Not more than 1% ‐ Alcohol-soluble extractive : Not less than 9% ‐ Water-soluble extractive : Not less than 15%“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 38 
  45. 45. Chapter 4 Drug review Chemical constituents: ‐ Monomethyl pelargonidin glucosides ‐ Loturine ‐ Colloturine ‐ Loturudine ‐ Reducing sugars ‐ Oxalic acid ‐ Phytosterol ‐ 3-monoglucofuranoside of 7-O-methyl leucopelargonidin ‐ Pelargonodin-3-O-glucoside ‐ Betulinic ‐ Acetyloleanolic ‐ Olealonic ‐ Ellagic acidsPharmacological activities: ‐ Antimicrobial ‐ Antidiarrhoeal ‐ Spasmogenic ‐ Heart depressant ‐ Blood pressure depressantFormulations and preparations: ‐ Rodhrasava ‐ Pushyanuga churna ‐ Brihat gangadhara churna ‐ Kutajashtaka churna ‐ Asthisandhanaka lepa ‐ Laghugangadhara churna ‐ Nagarjunanjana ‐ Vajrakapata rasa ‐ Lodhradi qwatha“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 39 
  46. 46. Chapter 4 Drug review  AVACHOORNANA 145Avachoornitam – tri, ava+choorna+karmani i.e dusting of the powder. Choornikruta dravyam | Gudaa karaa iti bhashaatatparyayaha | [ s.k.d ]Sushruta has explained “AVACHOORNANA” as one of the ‘Shashti upakramas’. ‐ Medojushtanagambheeran durgandhamscha choornashodhanai : |146Which states that – in medayukta, utthana, durgandhita vranas shodhana dravya Avachoornana isadvised.Avachoornana dravyas are also explained :Triphala dhatakipushpa rodhra sarjarasan samaan |Krutwa sukshmani choornani vranam tairavachoornayet ||147In utsanna mamsa associated with katinyata, kandu and existing since long time, shodhana withKshara karma is advised. ‐ Utsannamamsan katinaan kanduyuktam chirotthitan | Tathaiva khalu du:sadhyan shodhayet kshara karmana ||148Sushruta in sutrasthana – “Mishrakadhyaya”, included kaseesa as “shodhana choorna”.1. Kaseesa saindhava kinve….|Shodhanangeshu chanyeshu choornam kurveeta shodhanam || 149In other context, lodhra & kaseesa are explained under “Ropana choorna”.2. Kangukaa triphalaa rodhram kaseesam shravanaahwayaa | Dhavaashwakarnayostwak cha ropanam choorna mishyate || 150Sushruta in chikitsasthana 19th chapter151, included the drugs - Kaseesa, Tuttha, Gairika &Lodhra, for their Granthihara properties.- Kaseesa tutthe tato atra deye choornikrute…| “Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika, Lodhra) inGarbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 40 
  47. 47. Chapter 5  Clinical study   CLINICAL STUDYGarbhashaya Mukha Shotha considered under Ekadeshotthita shotha, can manifest in differentforms, with various clinical features along with Utseda. Acharya Sushruta has mentionedAvachoornana for shodhana of affected dhatu, where he included Kshara dravyas forRopanartha, Lekhanartha, ksharana & Kshanana of vitiated dhatu.Objectives of the study:1) To accomplish a comprehensive literary study to understand Garbhashaya- Mukha Shotha (Cervical hypertrophy, Cervical hyperplasia, Chronic cervicitis and Cervical erosion).2) To evaluate the efficacy of Avachoornana on Garbhashaya- Mukha Shotha (Cervical hypertrophy, Cervical hyperplasia, Chronic cervicitis and Cervical erosion).MATERIALS & METHODSSource of the data:Minimum 20 patients diagnosed as ‘Garbhashaya – mukha shotha’(Cervical hypertrophy,Cervical hyperplasia, Chronic cervicitis & Cervical erosion ) will be taken for the studyfrom OPD and IPD sections of SDM Ayurveda Hospital , Kuthpady , Udupi .STUDY DESIGN:It is a single blind clinical study with a pre-test and post-test design where in a minimum of 20patients suffering from Garbhashaya Mukha Shotha were selected. Selected 20 patients will besubjected to Avachoornana with Kaseesa, Tuttha, Gairika, Lodhra.A special format was prepared considering all the points pertaining to the history in our classicsand allied sciences. Patient were analyzed and selected accordingly. The parameters of signs andsymptoms were scored on the basis of standard method of statistical analysis.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 41   
  48. 48. Chapter 5  Clinical study  Inclusion criteria: Age – 18 to 40 yrs. Married women Clinically diagonosed cases of Chronic Cervicites & Cervical Erosion. Patients diagnosed with PAP SMEAR test as Cervical Hypertrophy &Cervical HyperplasiaExclusion criteria: Unmarried & pregnant women. Cervical polyps. Carcinoma of cervix. Other systemic disorders like diabetes mellitus, HTN etcAssessment criteria:Subjective parametersVaginal discharge: Purulent Discharge 3 Mucopurulent discharge 2 Slight discharge 1 No discharge 0Dysmenorrhoea : Severe 3(Not able to do routine work, forced to take rest) Moderate 2(Pain during work) Mild 1“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 42   
  49. 49. Chapter 5  Clinical study  (Pain able to tolerate, routine work will not affect) Absent 0Backache: Severe Pain 3(Interfering daily routine, relief on medication not satisfactory) Moderate pain 2(Continuous, interfering daily routine, relief on taking medicine) Mild pain 1(Pain occasional , or only feeling of discomfort) No pain 0Objective parameters:Cervical featuresArea of Erosion 76% - 100% 3 51% - 75% 2 26%-50% 1 00%-25% 0Nabothian cysts : Multiple/congested 4 Multiple/non –congested 3 Single/congested 2 Single/non-congested 1 No cysts 0Cervical enlargement : Cervical Width > 3.5cm 3“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 43   
  50. 50. Chapter 5  Clinical study   Cervical width > 3 cm 2 Cervical width > 2.5cm 1 Cervical width – 2.5 cm 0Irregularity : All Round The Cervix 3 On either side of cervix 2 On one side of cervix 1 Regular 0Changes in papsmear reports : Presence of atypical cells 3 Changes in cellular patterns 2 With Infections/Inflammation 2 Changes in cellular pattern 1 Normal cells 0Vaginal discharge : Purulent discharge 3 Mucopurulent discharge 2 Slight discharge 1 No discharge 0INVESTIGATIONS: Blood- Hb,TC, DC, ESR, RBS Urine – Albumin“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 44   
  51. 51. Chapter 5  Clinical study   Sugar Microscopic PAP SMEAR USG when indicated. Interventions: Drug : Avachoornana with Kaseesa, Tuttha, Gairika, Lodhra, once in the Morning. Mode of administration of drug: local Dusting of the drugs in choorna form. Dose : 3-5gm Duration of treatment: 7 days Follow Up period: Follow up after 15 days of completion of the treatment.Method of Avachoornana:Patients are advised to come early in the morning after finishing their menstrual period.Procedure: - Advised to empty the bladder - Then taken in Lithotomy position - Under aseptic measures, Vulva is cleansed with sterile cotton & antiseptic solution. - Using Cusco’s speculum, Cervix was visualized, cervical discharges were cleaned with cotton. - With the help of sterile Wooden spatula, about 3-5gm of choorna was dusted over the affected area of the cervix. - Speculum was removed.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 45   
  52. 52. A total number of 20 patients of Primitive cervical pathology fulfilling the inclusion criteria wereincluded for the study.Observations and results of the study are analysed below. Observations were made before andafter the treatment. - Number of patients taken for the study : 20 - Number of patients completed the study : 20 - Number of drop outs : 0TABLE NO – 7 & CHART NO - 1 Distribution of Garbhashaya Mukha Shotha patients according to Age: Age in years No of patients % 20 – 30 08 40% 30 - 40 12 60%
  53. 53. Distribution of Garbhashaya Mukha Shotha patients according to Religion : Religion No of patients % Hindu 18 90% Muslim 1 5% Christian 1 5% others 0 0TABLE NO – 9 & CHART NO - 3Distribution of Garbhashaya Mukha Shotha patients according to marital status : Married life in No of patients % yrs Married 20 100% Unmarried 0 0
  54. 54. Distribution of Garbhashaya Mukha Shotha patients according to Education :Education No of patients %Uneducated 2 10%Primary 6 30%schoolHigh school 8 40%Graduates 4 20%TABLE NO – 11 & CHART NO - 5Distribution of Garbhashaya Mukha Shotha patients according to Habitat : Desha No of patients % Urban 4 20% Rural 16 80%
  55. 55. Distribution of Garbhashaya Mukha Shotha patients according to Socio-economic status : Socio-economic No of patients % status Poor 4 20% Lower middle 10 50% Upper middle 6 30% Rich 0 0TABLE NO – 13 & CHART NO - 7Distribution of Garbhashaya Mukha Shotha patients according to Diet : Diet No of patients % Vegetareans 2 10% Mixed 18 90%
  56. 56. Distribution of Garbhashaya Mukha Shotha patients according to Prakriti : Prakriti No of patients % Vata-pitta 6 30 Vata-kapha 12 60 Pitta-kapha 2 10TABLE NO – 15 & CHART NO - 9Distribution of Garbhashaya Mukha Shotha patients according to Saara : Saara No of patients % Pravara 2 10 Madhyama 16 80 Avara 2 10
  57. 57. Distribution of Garbhashaya Mukha Shotha patients according to Samhanana : Samhanana No of patients % Pravara 2 10 Madhyama 14 70 Avara 4 20TABLE NO – 17 & CHART NO - 11Distribution of Garbhashaya Mukha Shotha patients according to Satwa :Satwa No of patients %Pravara 0 0Madhyama 16 80Avara 4 20
  58. 58. Distribution of Garbhashaya Mukha Shotha patients according to Satmya : Satmya No of patients % Madhura 8 40 Amla 0 0 Lavana 2 10 Katu 10 50 Tikta 0 0 Kashaya 0 0TABLE NO – 19 & CHART NO - 13Distribution of Garbhashaya Mukha Shotha patients according to Agni : Agni No of patients % Samagni 4 20 Mandagni 10 50 Tikshnagni 2 10 Vishamagni 4 20
  59. 59. Distribution of Garbhashaya Mukha Shotha patients according to Ahara shakti : Abhyavarana No of patients % Jarana shakti No of patients % shakti Pravara 2 10 Pravara 2 10 Madhyama 12 60 Madhyama 12 60 Avara 6 30 Avara 6 30TABLE NO – 21 & CHART NO - 15Distribution of Garbhashaya Mukha Shotha patients according to Vyayama shakti : Vyayama shakti No of patients % Pravara 4 20 Madhyama 12 60 Avara 4 20TABLE NO – 22 & CHART NO - 16
  60. 60. Desha No of patients % Anupa 20 100 Jangala 0 0 Sadharana 0 0TABLE NO – 23 & CHART NO - 17Distribution of Garbhashaya Mukha Shotha patients according to Bowel & Bladder habits:Bowel No of patients % Bladder No of patients %Regular 8 40 Regular 10 50Irregular 12 60 Burning micturition 10 50 70 60 50 40 Reg 30 20 Irreg 10 0 No.of Pts %TABLE NO – 24 & CHART NO - 18
  61. 61. Vaya No of patients % Madhyama 20 100 Vruddha 0 0TABLE NO – 25 & CHART NO - 19Distribution of Garbhashaya Mukha Shotha patients according to Duration of illness : Duration of No of patients % illness Weeks 3 15 Months 11 55 Years 6 30TABLE NO – 26 & CHART NO - 20
  62. 62. Onset No of patients % Sudden 6 30% insidious 14 70%TABLE NO – 27 & CHART NO – 21, 22 & 23Distribution of Garbhashaya Mukha Shotha patients according to pradhana Nidanapresent in the patient :Aharaja No of patients %Vishamashana 7 35Adhyashana 6 30Anashana 4 20Viharaja No of patients %Diwaswapna 8 40Ati-vyayama 0 0Ati-vyavaya 6 30Anya No of patients %Ama 16 80Durbala / Krusha 4 20 40 30
  63. 63. TABLE NO – 28 & CHART NO - 24Distribution of Garbhashaya Mukha Shotha patients according to History of menstrualcycle interval : Interval of cycle No of patients % 26-28(a) 4 20% 28-30(b) 12 60% 30-32(c) 3 15% 32-34(d) 1 5%
  64. 64. TABLE NO – 29 & CHART NO - 25Distribution of Garbhashaya Mukha Shotha patients according to the History of durationof menstrual flow : Duration of menstrual No of patients % flow 2-3(a) 6 30% 3-4(b) 8 40% 4-5(c) 2 10% 5-7(d) 4 20%TABLE NO – 30 & CHART NO - 26Distribution of Garbhashaya Mukha Shotha patients according to the History of clotspresent : Clots No of patients % Present 5 25% Absent 15 75%
  65. 65. TABLE NO – 31 & CHART NO - 27Distribution of Garbhashaya Mukha Shotha patients according to the History of amount ofmenstrual blood loss: Amount of Men. bl. loss No of patients % Mild (a) 4 20% Moderate(b) 12 60% Severe (c) 4 20%TABLE NO – 32 & CHART NO - 27Distribution of Garbhashaya Mukha Shotha patients according to the History of Abortion: Abortion No of patients % Present 4 20% Absent 16 80%
  66. 66. TABLE NO – 33 & CHART NO - 28Distribution of Garbhashaya Mukha Shotha patients according to Contraceptive History : Contraceptive No of patients % method Barrier method 9 45% Oral pills 4 20% Cu-T 2 10% Tubectomy 5 25%TABLE NO – 34 & CHART NO - 29Distribution of Garbhashaya Mukha Shotha patients according to History of Parity : Parity No of patients % P1 8 40% P2 8 40% P3 4 20%
  67. 67. TABLE NO – 35 & CHART NO - 30Distribution of Garbhashaya Mukha Shotha patients according to History of the Deliverytype : Type of delivery No of patients % FTND 18 90% Ass.Vag.Delivery 0 0% LSCS 2 10%SUBJECTIVE PARAMETERS:TABLE NO – 36 & CHART NO - 31Distribution of Garbhashaya Mukha Shotha patients according to vaginal discharge: Vaginal No.of Pt’s % discharge Mild 3 15 Moderate 16 80
  68. 68. TABLE NO – 37 & CHART NO - 32Distribution of Garbhashaya Mukha Shotha patients according to Dysmenorrhoea: Dysmenorrhoea No.of Pt’s % Mild 8 40 Moderate 4 20 Severe 1 5 Absent 7 35TABLE NO – 38 & CHART NO - 33Distribution of Garbhashaya Mukha Shotha patients according to Backache: Backache No.of Pt’s % Mild 8 40 Moderate 6 30 Severe 1 5 Absent 5 25
  69. 69. TABLE NO – 39 & CHART NO - 34Distribution of Garbhashaya Mukha Shotha patients according to Dyspareunia: Dyspareunia No.of Pt’s % P 4 20 A 16 80OBJCTIVE PPARAMETERS:TABLE NO – 40 & CHART NO - 35Distribution of Garbhashaya Mukha Shotha patients according to Area of Erosion: Area of Erosion No.of Pt’s % 76%-100%(A) 8 40 51%-75%(B) 10 50 26%-50%(C) 2 10
  70. 70. TABLE NO – 41 & CHART NO - 36Distribution of Garbhashaya Mukha Shotha patients according to Nabothian Cysts: Nabothian cysts No.of Pt’s % Present 8 40 Absent 12 60TABLE NO – 42 & CHART NO - 37Distribution of Garbhashaya Mukha Shotha patients according to Cervical Hypertrophy: Cx No.of Pt’s hypertrophy >3.5cm 3 15 >3cm 6 30 >2.5cm 9 45 =2.5cm 2 10
  71. 71. TABLE NO – 43 & CHART NO - 38Distribution of Garbhashaya Mukha Shotha patients according to Irregularity of Cx Os: Irregularity No.of Pt’s % All around Cx(A) 9 45 On either side(B) 6 30 On one side(C) 5 25TABLE NO – 44 & CHART NO - 39Distribution of Garbhashaya Mukha Shotha patients according to the changes in Pap-smear reports: Changes in Pap-smear reports No.of Pt’s % Presence of Atypical cells(A) 0 0 Changes in cellular pattern with 6 30 infection(B) Changes in cellular pattern(C) 2 10
  72. 72. TABLE NO – 45 & CHART NO - 40Distribution of Garbhashaya Mukha Shotha patients according to the associated C/OBurning micturition : Burning micturition No of patients % Absent 2 10% Mild 8 40% Moderate 9 45% Severe 1 5%  
  73. 73. Chapter  Results  EFFECT OF AVACHOORNANA ON PRIMITIVE CERVICAL PATHOLOGY - The analysis was done statistically using Sigma plot 11.0 - Paired t-test was used for comparing the results TABLE NO - 46 Effect on Vaginal discharge : No of Mean Diff in % patients mean Paired t-test BT AT S.D S.E T P Df 20 1.900 0.250 1.650 86.84 0.489 0.109 15.079 <0.001 19 CHART NO - 41 Statistical analysis revealed that, the mean value of Cervical discharge which was 1.900 before treatment has reduced to the value 0.250 after treatment and remained same after follow-up , which is statistically significant (P=<0.001) TABLE NO - 47“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 67
  74. 74. Chapter  Results  Effect on Dysmennorhoea : No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P Df 20 0.950 0.150 0.800 84.21 0.696 0.156 5.141 <0.001 19CHART NO - 42 Statistical analysis revealed that, the mean value of Dysmenorrhoea which was 0.950 before treatment has reduced to the value 0.150 after treatment, has further reduced to 0.005, which is statistically significant (P=<0.001)TABLE NO - 48Effect on Backache :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 68
  75. 75. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P Df 20 1.150 0.200 0.950 82.60 0.686 0.153 6.190 <0.001 19CHART NO - 43Statistical analysis revealed that, the mean value of Backache which was 1.150 before treatmenthas reduced to the value 0.200 after treatment and after follow-up it has further reduced to 0.150,which is statistically significant (P=<0.001)Objective parameters :Cervical features :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 69
  76. 76. Chapter  Results 1.Area of erosion :TABLE NO - 49 No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P Df 20 2.300 0.450 1.850 80.43 0.587 0.131 14.091 <0.001 19CHART NO - 44Statistical analysis revealed that, the mean value of Area of Erosion which was 2.300 beforetreatment has reduced to the value 0.450 after treatment and after follow-up further reduced to0.200, which is statistically significant (P=<0.001)2.Nabothian cysts :TABLE NO - 50“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 70
  77. 77. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P Df 20 0.750 0.300 0.450 60 0.686 0.153 2.932 0.009 19CHART NO - 45Statistical analysis revealed that, the mean value of Nabothian cysts which was 0.750 beforetreatment has reduced to the value 0.300 after treatment and after follow-up has still reduced to0.150, which is statistically significant (P=0.009)TABLE NO - 513.Cervical enlargement :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 71
  78. 78. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P df 20 1.400 0.450 0.950 67.85 0.605 0.135 7.025 <0.001 19 CHART NO - 46  Statistical analysis revealed that, the mean value of Cervical Hypertrophy which was 1.400before treatment has reduced to the value 0.450 after treatment has further reduced to 0.300,which is statistically significant (P=<0.001)TABLE NO - 524. Irregularity :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 72
  79. 79. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E t P df 20 2.200 0.200 2.000 90 0.858 0.192 10.420 <0.001 19 CHART NO - 47  Statistical analysis revealed that, the mean value of Irregularity which was 2.200 beforetreatment has reduced to the value 0.200 after treatment has remained same, which isstatistically significant (P=<0.001)TABLE NO - 535. Changes in Pap smear reports :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 73
  80. 80. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E T P df 08 1.750 0.500 1.250 71.42 0.463 0.164 7.638 <0.001 7 CHART NO - 48  Statistical analysis revealed that, the mean value of Pap-Smear changes which was 1.750 beforetreatment has reduced to the value 0.500 after treatment, which is statistically significant(P=<0.001)TABLE NO - 546. Vaginal discharge :“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 74
  81. 81. Chapter  Results  No of patients Mean Diff in mean % Paired t-test BT AT S.D S.E T P df 20 0.950 0.350 0.600 63.15 0.598 0.134 4.485 <0.001 19 CHART NO - 49  Statistical analysis revealed that, the mean value of Vaginal discharge which was 0.950 beforetreatment has reduced to the value 0.350 after treatment has further reduced to 0.150, which isstatistically significant (P=<0.001)    “Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 75
  82. 82. Chapter 6  Discussion   DISCUSSIONGarbhashaya Mukha is the access for yoni, as Indu has mentioned – “Yonau garbhashaya dwara”This term has been explained in the context of ‘Karnini yonivyapat’, while eloberating thedescription of ‘Karnika’ formation at Garbhashaya mukha dwara.The terms ‘Vakrati aananam’ & ‘Anudwaram kuryat’ in Antarmukhi & Suchimukhi yonivyapatsignifies Garbhashaya Mukha.‘Shotha’ is manifested by the local amalgamation of doshas with twak & mamsa, presenting‘Utsedha’ as the pratyatma lakshana.Tri-shothiya adhyaya of Charaka, has forwarded the description of” Avayava-pradhanashotha”(Oragan specific),on which Chakrapani, comments and hints about Pradeshika shotha,which includes both neoplastic & non-neoplastic tissue proliferations.Sushruta described - “Shopha samutthana granthividhradyalaji prabhrutaya:”, which states thatall the granthi, vidhradhi, alaji, arbuda, adi conditions are having Utsedha as common feature,eventhough they are having different akruti, lakshanas and dhatu involvement, representing bothbenign and malignant neoplastic conditions.Charaka states that Shotha are innumerable and hence depending upon the factors involved, theyshould be named and treated - ‘sthanadushyakrutinaamabhedat’ and he made classifications inthe view of ‘ruja varna samutthana samsthanaam’.Sushruta’s description of ‘Ekadeshotthita Shotha’, Chakrapani eloberation of ‘PradeshikaShotha’ refers to regional swellings.Vagbhata’s description of ‘Pratyangeshu tadashraya’ refers to Shotha pertaining to particularorgan.The present study on Primitive cervical cell pathology, involving the conditions – CervicalHypertrophy, Cervical Hyperplasia, Cervical Erosion, Chronic Cervicitis are based on‘Ekadeshotthita shotha’, which involves both the neoplastic and non-neoplastic cellproliferations.The cervical canal is the lower part of the uterus, with S-C junction as histological hallmark,which is present in between columnar epithelium of endocervix and squamous epithelium of theectocervix.Depending on age, hormones, parity, it varies in its location in regard to theanatomical external os.“Clinical evaluation of efficacy of Avachoornana with certain indegenous drugs (Kaseesa, Tuttha, Gairika,Lodhra) in Garbhashaya mukha shotha w.s.r to Primitive cervical cell pathology” Page 76 

×