“A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENTOF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA”                            ...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                     KARNATAKA, BANGALORE.                    DECLARATION BY TH...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                      KARNATAKA, BANGALORE.                             Dr. B. ...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                    KARNATAKA, BANGALORE.                     DECLARATION BY TH...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,                     KARNATAKA, BANGALORE.                              Dr. B. ...
COPYRIGHT                  DECLARATION BY THE CANDIDATE        I here by declare that the Rajiv Gandhi University of Healt...
i                              ACKNOWLEDGEMENT        This is an unforgettable moment of contentment on the successfulfulf...
ii          The credit and my thanks for the guidance regarding drugs go to Dr.P.V.Savanur M.D (Ayu).          I take this...
iii        I am thankful to Mr. Amrut for his meticulous typing and Computer workduring dissertation and Mrs. Ganga. S. Ta...
iv                ABBREVIATIONS1.    C.S.                      Charaka Samhita.2.    Su.S.                     Sushruta Sa...
v                                     ABSTRACTBackground and Objectives:       Krimiroga is one of the most common disease...
viMethods:       Present work was undertaken to study the efficacy of Palashbeejadi Choornain the management of Gandoopada...
vii                                 CONTENTSSl. No.                            CONTENTS    PAGE NO.  1.      Acknowledgeme...
viii                                LIST OF TABLESTable no.           Contents                                            ...
ix                              LIST OF GRAPHSGraph          Contents                                                     ...
1                       INTRODUCTION                                  INTRODUCTION        Helminthic infestations contribu...
2                        INTRODUCTION       With the above said perspectives the present study is undertaken, so as to hav...
3                      OBJECTIVES                     OBJECTIVES OF THE STUDY:1) To study the Krimi roga in detail.2) To a...
4              REVIEW OF LITERATURE                        HISTORICAL REVIEW       Knowledge of history is essential for t...
5               REVIEW OF LITERATURE   Sun stands foremost among the destroyers of krimis.1   Agni, Indra and Megha also h...
6               REVIEW OF LITERATUREPURANA KALA:       In this period, Krimi word is widely used and the descriptions are ...
7              REVIEW OF LITERATURE       In Kashyapa Samhita only treatment part of krimi is available in chikitsasthana,...
8              REVIEW OF LITERATURE    Madhava Nidana (800 A.D.) by Madhavakara had arranged krimi description    systemat...
9              REVIEW OF LITERATUREIn 1960 effect of palasha beeja was studied on Gandupada Krimi by Dr. GirijaDayal.Studi...
10              REVIEW OF LITERATURE                                      NIRUKTHINIRUKTHI:“Krinati hinasti iti krimih” (A...
11              REVIEW OF LITERATURE“Krimi Kitetyadi Krimeyah Kostha Purishadi Baspa Sambhawah” (Dalhana)      In commenta...
12           REVIEW OF LITERATURE       Another important classification is according to the media in which they growand s...
13               REVIEW OF LITERATURE                               TABLE NO. 2            Nomenclature of Krimis accordin...
14              REVIEW OF LITERATURENOMENCLATURE OF ABHYANTRA KRIMIS:1. Shleshmaja krimis:       The Shleshmaja variety of...
15              REVIEW OF LITERATURE       Slight variations in the nomenclature of these internal Shleshmaja Krimis arefo...
16              REVIEW OF LITERATUREDwimukha indicate at their morphology, while Kipya and Churu show their feedinghabits....
17               REVIEW OF LITERATURE   CLASSIFICATION OF HUMAN HELMINTHS (WORMS) 32, 33        The Helminths of importanc...
18            REVIEW OF LITERATURE                                       HelminthsNemathelminthes                         ...
19               REVIEW OF LITERATURE                     STHANA/HABITAT OF KRIMIS          TABLE NO. 3- Classification of...
20              REVIEW OF LITERATUREStructure of Gandupada Krimi:        As per Ayurveda structure of Gandupada Krimi is e...
21                  REVIEW OF LITERATUREresistance to most chemicals. The chitinous layer is highly cross linked and provi...
22            REVIEW OF LITERATURE           ASCARIS LUMBRICOIDES (EGGS AT DIFFERENT STAGES)                          VARN...
23               REVIEW OF LITERATUREColour of Gandoopada krimi:The colour mentioned for identification of Gandupada Krimi...
24                REVIEW OF LITERATUREvitiated dosha depending upon pureesha, kapha and rakta are responsible for onset of...
25             REVIEW OF LITERATURE      TABLE NO.8- Showing Vishishta Nidana of Abhyantara Krimi: (51-55)                ...
26                REVIEW OF LITERATUREof faeces gives favourable, environment for the growth of krimis as they areoriginat...
27                  REVIEW OF LITERATUREsleshmaja, raktaja, pureeshaja and bhaya krimi. Acharya Charaka has used world“Pra...
28                REVIEW OF LITERATURE     10.   Jathargarjanam          -          +           -         -     11.   Mand...
29                REVIEW OF LITERATURE         CLINICAL MANIFESTATION IN ASCARIASIS 67,68,69        Most patients are asym...
30               REVIEW OF LITERATURE     presentations include lacrimal drainage obstruction, acute interstitial nephriti...
31              REVIEW OF LITERATURE9.     Svabhava       (a) Chirkari (Chronic).           LIFE CYCLE OF ASCARIS LUMBRICO...
32              REVIEW OF LITERATUREthe intestinal mucous membrane and feed on blood and tissue fluids. The femaleparasite...
33              REVIEW OF LITERATUREPathology of infection: The majority of infections (~85%) appear to beasymptomatic, in...
34              REVIEW OF LITERATURE(2)Pathology associated with Adult parasites in the Intestine:       The most common s...
35              REVIEW OF LITERATURELABORATORY DIAGNOSIS75: This may be described under two headings-Direct evidences and ...
36              REVIEW OF LITERATURE                           KRIMI ROGA CHIKITSA       Chikitsa of Krimiroga in all most...
37              REVIEW OF LITERATUREBeshaja Chikitsa: (Different Yogas) 77Swarasa : Palashabeeja , Paribhadra patra , Kara...
38               REVIEW OF LITERATURE       Treatment of vegetables and other garden crops with water containing iodine   ...
39             REVIEW OF LITERATURE                                 DRUG REVIEW                                   PALASHA ...
40            REVIEW OF LITERATURE                                      NIMBA82,83Family: Meliaceae (meli –Honey) bead tre...
41               REVIEW OF LITERATURESeed: Thermogenic, Purgative, Anthelmintic, Uterine stimulant.Dose: Bark powder 1 to ...
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A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA” Dr. SANDEEP CHAUHAN, SEPTEMBER 2007. DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA, B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.

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  1. 1. “A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENTOF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA” BY Dr. SANDEEP CHAUHAN DISSERTATION SUBMITTED TO THE RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. IN THE PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF MEDICINE (Ayurveda) IN KAYA CHIKITSA UNDER THE GUIDANCE OF GUIDE CO-GUIDEDr. B.S. TAMAGONDA M.D. (AYU) Dr. ANAND PATIL M.D. (Medicine)Prof. & H.O.D (Kayachikitsa), Lect. - Dept of Medicine,Dr.B.N.M.E.Trust’s Shri Mallikarjuna AL-AMEEN Medical College ,Swamiji Post Graduate And Research Bijapur-586101.Centre, Bijapur-586101. DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA, B.N.M.E.T’S SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR. SEPTEMBER 2007.
  2. 2. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CANDIDATEI, hereby declare that this dissertation entitled “A COMPARATIVE CLINICALSTUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITHPALASHBEEJADI CHOORNA” is a bonafide and genuine research work carriedout by me under the guidance of Dr. TAMAGONDA B.S. M.D. (AYU) Professor andH.O.D, Dept. of Kaya chikitsa, Shri Mallikarjuna Swamiji Post Graduate and ResearchCentre, Bijapur.Date:Place: Bijapur. Dr. SANDEEP CHAUHAN
  3. 3. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA CERTIFICATE BY THE GUIDEThis is to certify that the dissertation entitled “A COMPARATIVE CLINICALSTUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITHPALASHBEEJADI CHOORNA” is a bonafide research work carried out byDr. SANDEEP CHAUHAN in the partial fulfillment of the requirement for the degreeof M.D. (Ayurveda). SignatureDate: Dr. B.S. TAMAGONDA M.D. (AYU)Place: Bijapur. Professor and H.O.D. of Kaya Chikitsa, Shri Mallikarjuna Swamiji Post Graduate And Research Centre, Bijapur.
  4. 4. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION BY THE CO-GUIDEI, hereby declare that this dissertation entitled “A COMPARATIVE CLINICALSTUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITHPALASHBEEJADI CHOORNA” is a bonafide and genuine research work carriedout by Dr. SANDEEP CHAUHAN in the partial fulfillment of the requirement for thedegree of M.D. (Ayurveda). Signature :Date: Dr. ANAND PATIL M.D.(MEDICINE)Place: Bijapur. Lect.- Dept of Medicine, AL-AMEEN Medical College, Bijapur-586101.
  5. 5. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. Dr. B. N. M. E. T’s SHRI MALLIKARJUNA SWAMIJI POST GRADUATE AND RESEARCH CENTRE, BIJAPUR.DEPARTMENT OF POST GRADUATE STUDIES IN KAYA CHIKITSA ENDORSEMENT BY THE H.O.D. AND PRINCIPAL/HEAD OF THE INSTITUTIONThis is to certify that the dissertation entitled “A COMPARATIVECLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMIWITH PALASHBEEJADI CHOORNA”is a bonafide research work done byDr. SANDEEP CHAUHAN under the guidance of Dr. B.S.TAMAGONDAM.D (Ayu) Prof. and H.O.D, Dept.of Kaya chikitsa, Shri Mallikarjuna SwamijiPost Graduate and Research Centre, Bijapur.Seal and Signature of H.O.D Seal and Signature of PrincipalDr. B.S.TAMAGONDA M.D (Ayu) Dr. R.N.GENNUR M.D (Ayu)Date: Date:Place: Bijapur. Place: Bijapur.
  6. 6. COPYRIGHT DECLARATION BY THE CANDIDATE I here by declare that the Rajiv Gandhi University of Health Sciences,Karnataka shall have the rights to preserve, use and disseminate this dissertation inprint or electronic format for academic/research purpose.Date:Place: Bijapur. Dr. SANDEEP CHAUHAN© Rajiv Gandhi University of Health Sciences, Karnataka.
  7. 7. i ACKNOWLEDGEMENT This is an unforgettable moment of contentment on the successfulfulfillment of an ambition fostered for long. I offer my salutations to my lovingparents Dr. M. P. Singh and Mrs. Lakshmi Singh for suffering great agony tobring me up to this position. I am highly obliged for their blessing, support andsacrifice which have always been the constant sources of inspiration in my life I express my gratitude to the Chairman, Dr. K. B. Nagur M.D. (Ayu),management committee of Dr.B.N.M.E.T’s Shri.Mallikarjuna Swamiji Post Graduateand Research Centre and its Principal Dr. R. N. Gennur M.D. (Ayu) for giving me anopportunity to pursue my post graduation at this institution. Its been indeed a rare privilege to work under eminent professor Dr. B. S.Tamagonda M.D. (AYU) Prof. and Head, Department of post-graduate studies in kayachikitsa. I humbly and whole heartedly seize this opportunity to express my deep senseof gratitude and indebtedness to him for his heartily support, co-operation and valuableguidance. It is my privilege to convey my humble respect and deep sense of gratitude tomy Co-guide Dr. Anand Patil M.D.(med.) for his support, help and active guidanceduring my all work. I offer my respectful thanks to Dr. S. P. Managooli M.D. (Ayu) whose supportand guidelines encouraged me in every step in this dissertation work. I express my profound gratitude to Dr. B. G. Patil M.D (Ayu), Dr. Anita NaikM.D (Ayu), Dr. P. B. Savalagi M.D (Ayu), who gave me search light at every stage of mythesis work and are kind enough to extend their virtuous supervision and guidance inthe completion of this work.
  8. 8. ii The credit and my thanks for the guidance regarding drugs go to Dr.P.V.Savanur M.D (Ayu). I take this opportunity to thank the post graduate teaching staff of thisinstitution Dr. J. C. Huddar MD (Ayu), Dr. C. S. Hiremath MD (Ayu) and Dr.Girish Bagali MD(Ayu). I am thankful to Sri A. I. Tapashetti M.Sc (Stat) for his timely guidance andsuggestions in the statistical analysis of datas. I thank Sri R. G. Dolli for the official work and also non teaching staff of Dr.B.N.M.E. Trusts Ayurvedic medical College and Post graduate research centre, Bijapurfor their timely help. I would like to mention special thanks to Library staff of Dr. B.N.M.E. TrustsAyurvedic medical College and Post graduate research centre, Bijapur. I always remember the support, encouragement and wishes of my classmatesDr. Ankur Singhal, Dr. Amit Chowdhary, Dr. P. Rugvedi, Dr. Totad. M. S, Dr. G.K. Ankad, Dr. P. R.Vastrad, Dr. I. P.Ugar, Dr.Yalgund, Dr. Keshav. M.S, Dr.B.B.Ugare, Dr. S. Sajjan, Dr.Archana, Dr.M.Patil, Dr.Vidyalakshmi,Dr.S.B.Nargund, Dr.U.C.Bergi, Dr.Menasgi, Dr. A.Junjunwad, Dr. S.Sarwad andDr. Dhullapa. Special thanks to seniors Dr. Rajeshwari, Dr. Ranjit patil. Dr. J. P. Sagare,Dr. Kulkarni, who have helped me in one or the other way during my post graduationtenure. Cordially I thank my juniors Dr. Sunil Nair, Dr. Jitender Khot, Dr. ShakilSutar, Dr.Vasanta.B, Dr. Sudhir Koli, Dr.Gaurav Sharma, Dr. Manish Jain, Dr.Mahesh Khot, Dr. Santosh Kodag and Dr. Priyanka. S. I express my immense thanks to all my post graduate colleagues. Who havehelped me in every step of this course.
  9. 9. iii I am thankful to Mr. Amrut for his meticulous typing and Computer workduring dissertation and Mrs. Ganga. S. Tamagond, Lab technician for her cooperationduring clinical trail. Last but most important indebted gratitude to my brother Mr. Sunil Chauhan,sister in law Mrs. Renu Chauhan, my beloved wife Mrs. Jyoti Chauhan and to mymost loving nephew Sarthak Chauhan for their love, being supportive and inspiring inbuilding up my career. Finally, I would like to express my joy and gratitude to everyone who hashelped me directly or indirectly to complete my dissertation work.Date:Place: BIJAPUR DR. SANDEEP CHAUHAN
  10. 10. iv ABBREVIATIONS1. C.S. Charaka Samhita.2. Su.S. Sushruta Samhita.3. A.H. Astanga Hridaya.4. M.N. Madhav Nidana.5. Hr.S Hareeta Samhita.6. Y.R. Yoga Ratnakar.7. B.P. Bhava Prakash8. Sh.S Sharangadhar Samhita.9. Chi. Chikitsa.10. A.T. After Treatment.11. B.T. Before Treatment.12. A.F.U. After Follow Up.13. H.S. Highly Significant.14. S. Significant.15. N.S. Non Significant.16. Sl. No. Serial Number.
  11. 11. v ABSTRACTBackground and Objectives: Krimiroga is one of the most common diseases. In Ayurvedic classics most ofthe Acharayas gave extensive explanations regarding the krimi Roga. Gandoopadakrimi is one of the pureeshaja krimi mentioned in classics. Ascaris lumbricoides hasthe close resemblance to the Gandoopada krimi. Ascariasis is one of the mostcommon Helminthic infestations. It has a world wide distribution, but the highestprevalence occurs in tropical & subtropical regions and areas with inadequatesanitation. Poverty, ignorance, lack of hygiene maintenance, bad sanitation and use ofuncooked food or improper washing of food materials etc., are the important factorsfor spreading Helminthic infection in developing countries like India. Acharya Charaka has described three folded treatment of Krimiroga viz.Apakarshana, Prakritivighata and Nidanparivarjana. Apakarshana is done byshamshodhan procedures viz. Virechana, vamana, shirovirechana and asthapana.Shamshodhan is considered as a basic treatment of Krimiroga, but a major draw backattributed to these Shodhana therapies are that they involve laborious procedures,which are time consuming and prove to be costly for the patients. But to make thetreatment simple, effective and convenient to the patients, which can be practiced atOPD levels, shamana chikitsa has been selected. In Ayurveda many Krimighna (Anthelmintic) drugs are mentioned.Commonly single drug therapy is in practice and no particular duration is mentionedfor treatment. Expecting good efficacy on Ascaris lumbricoides, PalashabeejadiChoorna - an ideal and unique preparation mentioned in Bhaishajya Ratnavali, isselected to assess the results in the present study.
  12. 12. viMethods: Present work was undertaken to study the efficacy of Palashbeejadi Choornain the management of Gandoopada krimi in three days against previously provenmodern drug Mebendazole as standard drug. For the present study 30 diagnosedPatients of Gandoopada krimi (Ascariasis) were randomly selected from Dr. B.N.M.ETrust’s Shri Mallikarjuna Swamiji Post Graduate and Research Centre, Bijapur.Patients thus selected were randomly allocated to two groups- Group A and B (15patients to each group). Group A and B patients were treated with Palashbeejadichoorna and Tab.Mebex (mebendazole) respectively for a period of 3 days and a posttreatment follow up was made after 7 days. The patients were assessed for the severityof the symptoms subjectively and objectively before and after treatment and at the endof the follow up. The data thus collected from each group were statistically analyzedand compared.Conclusions: After the total course of the interventions the datas obtained towards theresults indicate that Palashbeejadi choorna had only significant effect on Gandoopadakrimi when compared with highly significant effect of Tab.Mebex (Mebendazole). It was an attempt made to clinically evaluate the efficacy of Palashbeejadichoorna in Gandoopada krimi and to compare its efficacy with Tab.Mebex(Mebendazole). The outcome of the present work is humbly present in front of therenowned scholars for their inspiration and constructive criticism for the betterment ofthe work.KEYWORDS Palashbeejadi choorna. Gandoopada Krimi.
  13. 13. vii CONTENTSSl. No. CONTENTS PAGE NO. 1. Acknowledgement i-iii 2. Abbreviations iv 3. Abstract v-vi 4. List of Tables viii 5. List of Graphs ix 6. Introduction 01-02 7. Objectives 03 8. Review of Literature 04-44 Drug Review 39-44 9. Materials and Methods 45-50 10. Observations and Results 51-85 11. Discussion 86-108 12. Conclusion 109 13. Recommendation for further study 110 14. Summary 111-112 15. Bibliography 113-119 16. Annexure a. Photographs b. Classical references I-III c. Clinical Proforma IV-VIII
  14. 14. viii LIST OF TABLESTable no. Contents Page no. 1. Classification of krimis. 12 2. Nomenclature of krimis. 13 3. Sthana/Habitat of krimis. 19 4. Classification acc.to structure of krimis. 19 5. Characteristics of Ascaris eggs. 21 6. Classification acc.to colour of krimis. 22 7. Samanaya nidanas of Abhyantara krimis. 24 8. Vishishta nidanas of Abhyantara krimis. 25 9. Symptomatology of Bahya Krimi. 27 10. Samanya Roopa of Abhyantara krimis. 27 11. Vishishta lakshnas of Abhyantara krimis. 28 12. Distribution of patients according to Age. 51 13. Distribution of patients according to Sex. 52 14. Distribution of patients according to Religion. 53 15. Distribution of patients according to Occupation. 54 16. Distribution of patients according to Marital Status. 55 17. Distribution of patients according to Socio Economical Class. 56 18. Distribution of patients according to Geographical area. 57 19. Distribution of patients according to Previous history. 58 20. Distribution of patients according to Family history. 59 21. Distribution of patients according to Literacy. 60 22. Distribution of patients according to Food Habits. 61 23. Distribution of patients according to Hygienic Environment. 62 24. Distribution of patients according to Type of toilet used. 63 25. Distribution of patients according to habit of not washing hands 64 26. Distribution of patients according to Type of water used. 65 27. Distribution of patients according to Prakruti. 66 28. Distribution of patients according to Saara. 67 29. Distribution of patients according to Kostha. 68 30. Distribution of patients according to Agni Bala. 69 31. Distribution of patients based on Guda kandu before treatment. 70 32. Distribution of patients based on Passing of worms before 71 treatment. 33. Distribution of patients based on Shoola before treatment. 72 34. Distribution of patients based on Atopa before treatment. 73 35. Distribution of patients based on Shakrita bheda before 74 treatment. 36. Distribution of patients based on Paktinasha before treatment. 75 37. Distribution of patients based on Stool examination before 76 treatment. 38. Distribution of patients according to response of therapies for 78 individual group after treatment. 39. Distribution of patients according to response of therapies for 80 individual group after post treatment follow up. 40. The Statistical results of group A. 81 41. The Statistical results of group B. 82
  15. 15. ix LIST OF GRAPHSGraph Contents Page no. no. 1. Distribution of patients according to Age. 51 2. Distribution of patients according to Sex. 52 3. Distribution of patients according to Religion. 53 4. Distribution of patients according to Occupation. 54 5. Distribution of patients according to Marital Status. 55 6. Distribution of patients according to Socio Economical Class. 56 7. Distribution of patients according to Geographical area. 57 8. Distribution of patients according to Previous history. 58 9. Distribution of patients according to Family history. 59 10. Distribution of patients according to Literacy. 60 11. Distribution of patients according to Food Habits. 61 12. Distribution of patients according to Hygienic Environment. 62 13. Distribution of patients according to Type of toilet used. 63 14. Distribution of patients according to habit of not washing hands 64 15. Distribution of patients according to Type of water used. 65 16. Distribution of patients according to Prakruti. 66 17. Distribution of patients according to Saara. 67 18. Distribution of patients according to Kostha. 68 19. Distribution of patients according to Agni Bala. 69 20. Distribution of patients based on Guda kandu before treatment. 70 21. Distribution of patients based on Passing of worms before treatment. 71 22. Distribution of patients based on Shoola before treatment. 72 23. Distribution of patients based on Atopa before treatment. 73 24. Distribution of patients based on Shakrita bheda before treatment. 74 25. Distribution of patients based on Paktinasha before treatment. 75 26. Distribution of patients based on Stool examination before 76 treatment. 27. Response of Guda kandu at the end of treatment. 83 28. Response of Guda kandu at the end of Follow up. 83 29. Response of passing of worms in stool at the end of treatment. 83 30. Response of passing of worms in stool at the end of Follow up. 83 31. Response of Shoola at the end of treatment. 84 32. Response of Shoola at the end of Follow up. 84 33. Response of Atopa at the end of treatment. 84 34. Response of Atopa at the end of Follow up. 84 35. Response of Shakrit bheda at the end of treatment. 84 36. Response of Shakrit bheda at the end of Follow up. 84 37. Response of Paktinasha at the end of treatment. 85 38. Response of Paktinasha at the end of Follow up. 85 39. Response of Ova (stool examination) at the end of treatment. 85 40. Response of Ova (stool examination) at the end of Follow up. 85
  16. 16. 1 INTRODUCTION INTRODUCTION Helminthic infestations contribute significantly to global burden of diseases inhuman, especially in tropical and subtropical regions. Most helminths are potentiallypathogenic to human beings, if these are present in sufficient number and arecausative factors for many diseases. Man is the definitive host for most of helminthsof the Nematode group. Among the helminths of the Nematode group Ascarislumbricoides is the most commonly found helminth in humans, infecting at least onein four of the world’s population. The non-availability of clean drinking water, inadequate sanitation and poor orabsent personal and community hygiene are the most important predisposing factors. Modern Science has the best of cost effective and highly efficient drugs likeMebendazole, Albendazole etc. to combat helminthic infestations. Although thesemedicines are highly effective and given only for short duration but these are havingsome adverse effects like diarrhoea, nausea, abdominal pain etc. In Ayurvedic classics most of the Acharayas give extensive explanationsregarding the krimi Roga. Gandoopada krimi is one of the purishaja krimi mentionedin classics. Ascaris lumbricoides has the close resemblance to the Gandoopada krimi. Although Ayurveda promises many effective therapies for krimi roga, a majordraw back attributed to these cures are that they involve laborious procedures(Shodhana Therapies), which are time consuming and prove to be costly for thepatients. But to make the treatment simple, effective and convenient to the patients,which can be practiced at OPD levels, shamana chikitsa has been selected. As thereare number of herbal, herbomineral and mineral yogas explained in Ayurvedicclassics for the management of krimi, so there is a need to evaluate the more effectiveyoga. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  17. 17. 2 INTRODUCTION With the above said perspectives the present study is undertaken, so as to havea better Anthelmintic drug which must be competent to the modern drugs, costeffective, highly efficient in short duration of treatment and having least adverseeffects. As, among the herbal, herbomineral and mineral, the herbal drugs may havethe least adverse effects, so a herbal yoga of Palashbeejadi choorna as krimighnamentioned in Bhaishajya Ratnavali is chosen for the study. Hence with the presentstudy an effort is being made to know the efficacy of this yoga in Gandoopada krimiand to compare its efficacy with Mebendazole. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  18. 18. 3 OBJECTIVES OBJECTIVES OF THE STUDY:1) To study the Krimi roga in detail.2) To assess the efficacy of Palashbeejadi choorna in Gandoopada Krimi with special reference to Ascaris lumbricoides.3) To compare the efficacy of Palashbeejadi choorna with the Mebendazole. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  19. 19. 4 REVIEW OF LITERATURE HISTORICAL REVIEW Knowledge of history is essential for the development of any field of science.In medicine the fight against disease through centuries is its history. For treating apatient the knowledge of medical history is not essential, but for the future planningof public health projects it is important. It is the compass that guides us towards abetter-planned future. Disease is as old as life itself and the phenomenon of parasitismis also very old. The logical study of history can be done under 4 divisions withrespect to time period. In the similar manner the subject matter of Krimi can also bestudied under 4 periodical classifications.1. Veda Kala (Vedic period).2. Purana Kala (Period of purana).3. Samhita Kala & Sangraha Kala.4. Adhunika Kala (Modern period).VEDA KALA: The Vedas are oldest authentic source of knowledge and science.Ayurveda thescience of life has its roots in Vedas. In Vedas terms like rakshasa, pishacha,gandharva, asura and apsara etc., are mentioned by Vedic scholars. Few considerthem as synonyms for krimis (Pt. Damodar Satvalekar and Pt. Ramgopal Shastri).While other scholars opine that they do not indicate Krimis. Even inShabdakalapadruma and Amarakosha such meaning is not available for Krimis. But inlater period i.e., Samhita period these terms were used with the meaning of Krimi.In Rugveda: Rugveda, the oldest grantha gives some idea about different Krimis. Somemantras and drugs are mentioned for Krimi management. Few such references ofKrimi (Similar terms) are as follows; A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  20. 20. 5 REVIEW OF LITERATURE Sun stands foremost among the destroyers of krimis.1 Agni, Indra and Megha also have the property of destroying Krimis. 2In Yajur Veda: We find a reference for movements of Krimi. It is said that Krimis arenumerous in number, are found free in atmosphere and cause different kinds ofdiseases.In Atharva Veda: Different types of Krimi, their etiological factors, structure, infestation andtreatment etc., were mentioned. Explanation about jeevanu, udara krimi, raktaja krimi,keeta, patanga etc are found. Agni, Indra, Surya, Apa, Marutha are mentioned to destroysuch krimis. Mantras, mani and certain drugs were mentioned in their therapeutic context.We find two different words Krumi and Krimi in Atharva Veda. The word Krumi standsfor insects and flies. While the word Krimi was ment to describe worms and germs,which creep, multiply and invade the body. It is mentioned that Krimis remain in thebody as a host once it enters such human body. Another reference says sun, maruta, seesa,shankhamani, prishniparni, shatavar, apamarga etc can kill the krimi.3 Some krimis live intrees, mountains, and water and in living beings also. They affect children and foetus ofthe pregnant generally.4 Another reference similar to parasite is quoted which describesKrimis to live in intestine (Avantyam), in head (Sheershanyam) and in lungs(Paasthyam). A Krimi with 3 heads / mouths (Thrisheersham) and colourless was 5mentioned. Some authors comment it for Round worms/ Threadworms. AlaganduKrimi, mentioned is similar to Round worm and vacha is indicated in its treatment. 6 Atri,Agasthya, Kanva and Jamadagni had mentioned certain procedures to destroy, remove orprevent Krimis i.e.dhoopana etc. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  21. 21. 6 REVIEW OF LITERATUREPURANA KALA: In this period, Krimi word is widely used and the descriptions are below- In Mahabharata for maintaining hygiene in living places, dumping of human manure out side the city is told. Manu advocates that faeces and urine should not be allowed to pollute water because such a contamination upsets the public health. Garuda Purana mentions, food stuffs causing Krimi along with signs and symptoms produced in the body. Vidanga choorna with gomutra is described for its management. It is further told that the faeces of pandurogi contain krimis. In arochaka nidana also the word krimi is mentioned.SAMHITA KALA: This period can be considered as golden era in the development of ancientmedical science. Samhitakaras gave maximum descriptive contributions. Acharyaslike Charaka, Sushruta, Vagbhata, gave a systematic description of Krimirogaincluding their classification, causitive factors, structure, signs and symptoms,treatment and preventive measures. In Charaka Samhita viman sthana the classification, morphology, symptoms, 7movement and treatment (Saptha ganas) of Krimiroga, in sutra sthana generaldescription of krimis8 and krimihara drugs are mentioned. 9 In nidana sthana terms likerakshasa, pishacha, gandharva, yaksha, deva, pitru, bhoota etc. are mentioned10. In Sushruta Samhita uttara tantra complete chapter is devoted to krimi withdescription, symptoms and treatment.11In sutra sthana krimihara drugs arementioned.12 A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  22. 22. 7 REVIEW OF LITERATURE In Kashyapa Samhita only treatment part of krimi is available in chikitsasthana, siddi sthana and kalpa sthana. He had mentioned krimiashaya.13 In Bhela Samhita many different varieties of krimis are described. Evenkrimis which reside on earth are told. A reference of shiraja, dantaja, shleshmaja,pureeshaja and netraja krimis can be found. 14 Hareeta Samhita also explains Krimiroga in detail. 15 In Hasthyayurveda by Balakapya, he has mentioned a separate chapter forKrimi. He mentions that, if krimi in elephant is neglected, it may cause even death ofthe elephant and many recipes are also mentioned. Even in other contemporary Samhitas description of krimi is available i.e.-Kautiliya Arthashastra by Chanakya - Udara krimi is told. Vishuddhimagga by aBuddhist mentioned anatomical forms with scientific explanation for krimis.Experiment of various drugs in human beings for the treatment of intestinalobstruction caused by krimi is mentioned. One such example is, once Ashoka -Mouryan emperor suffered with fecal odour in mouth due to krimi, hence he decidedto quit the crown. Then human experiment with pippali, maricha, palandu etc., wasdone. Palandu was proved effective to remove obstruction by krimis.SANGRAHA KALA: In this period similar explanations were seen with much elaboration. Astanga Sangraha gives description16 and treatment of krimi. 17 Varaha mihira mentioned Krimihara property of kapikacchu. Amarakosha by Amarasimha advised kampillaka, palandu and palasha for krimi chikitsa. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  23. 23. 8 REVIEW OF LITERATURE Madhava Nidana (800 A.D.) by Madhavakara had arranged krimi description systematically. Saptadasha paricchada by Kalyanakarka (Jain author) tells about krimi lakshana and treatment. Chakrapanidatta (1100 A.D.) in his work chakradatta mentioned different preparations like palasha beeja prayoga, vidanga gritha, surasadi qwatha for krimi chikitsa. Gadanigraha (1200 A.D.), Vangasena (1300 A.D.), Basavarajeeyam (1400A.D.), Bhavamishra (1500 A.D.), Yogaratnakara (1600 A.D.), Bhaishajya Ratnavali,all these books have mentioned almost similar views with regard to Krimiroga andit’s chikitsa. Sharangadhara Samhita by Sharangadhara adds new krimis i.e., Snayuka andVranaja Krimi.ADHUNIKA KALA: During this period the contributions to krimi vignana from Ayurveda includesthe following. Dr. Ghanekar has compiled Ayurveda and modern medicine in his book Roganu Vignana. Where we find explanation of microscopic parasites in a systematic way. Dr. P.V. Sharma and Dr. Nadakarni have worked on scientific analysis of Krimighna drugs. Kirthikar and Basu have pioneered in identification of medicinal plants which is a great contribution to Ayurvedic medicine. In 1959 C. I. R. I. S.M published a bulletin on Krimis by Dr. B. B. Tiwari. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  24. 24. 9 REVIEW OF LITERATUREIn 1960 effect of palasha beeja was studied on Gandupada Krimi by Dr. GirijaDayal.Studies on palasha ghanavati, katuki, vidanga, kalajeera, krimi mudgarasa,kampillaka etc., were tried on krimiroga by different people.Krimihara property of Bhallataka (Semicarpus anacardium-in vitro) was reportedby sharma and chaturvedi.In 1964 – Dr. Sharma worked on Oleum balantis in Gandupada Krimi.1965 Dr. Yamanath Acharya published Vidanga Vignana (Article on Helminthsand Anthelmintics in ancient literature).1966 Dr. Omprakash Sharma worked on Shodhana Karma in Krimikosta.1968 Dr. Kishanlal Agnihotri worked on finding the effect of “Eranda Karkati inKrimiroga”. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  25. 25. 10 REVIEW OF LITERATURE NIRUKTHINIRUKTHI:“Krinati hinasti iti krimih” (Amarkosha). Means ghatak (dangerous) in nature.“Kramati Kramu Pada Vikshepe.” (Halayudh kosha). The term “Krimi” is derived from the word Kramu, which means to step, toroam, or to walk. It has come out from “Kramu Padvikshepe”, means which movewith the legs are termed as Krimis. “Kravye medhyati kramaterva syath sarana karmana kramaterva.”(Yaskacharya Niruktam). Means those organism which grow on raw flesh and perform somemovements can be designated as Krimi.“Kramau Kshudra-jantou, Rogabhede Krimi Shabde.” (Amarkosha) At the same time Amarkosha says Krimi word is derived from “Kram + en”and this word stands for Kshudra-jantu and in differentiation of Rogas.“Lumpayanti Kida Krimayah Paritah.” (Vachaspatyam 3rd part). It means those which are capable to break or injure the surroundings can besaid as Krimi or Kidah. According to Paniniya Vyakaran both the words (Krami & Krimi) bears thesimilar meaning. Karambelker V.W. has differentiated the word Krimi and Krami.The wordKrimi is used for worms and germs which creep or jump while the word Krami is toindicate the insects which can fly. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  26. 26. 11 REVIEW OF LITERATURE“Krimi Kitetyadi Krimeyah Kostha Purishadi Baspa Sambhawah” (Dalhana) In commentary of Dalhana on Sushruta, Krimi is described for the living beingwhich born from the vapour of faecal material in intestinal tract or such environmentelsewhere.SANKHYA – NAMA (NOMENCLATURE OR CLASSIFICATION) The Krimi had been classified in different categories since Vedic period. InVeda itself pathogenic and non-pathogenic Krimis were mentioned. In Ayurvedamainly the Vaikarika (pathogenic) Krimis are described. That two types of relationshipbetween host and parasites exist was clearly known to our Acharyas. This can be seenfrom the classification of Krimis in two broad groups in Charaka Samhita- 1. SAHAJA KRIMI. 2. VAIKARIKA KRIMI.1. SAHAJA KRIMI: It constitutes that group of Krimis which normally reside in thehuman body right from the birth until death. It appears that by Sahaja Krimis referredto those organisms, which constitute normal bacterial flora in the buccal cavity andalimentary tract, as well as in the vaginal canal in females. In Charaka their presenceis described not to be harmful to humans.2. VAIKARIKA KRIMI: It consists of those Krimis which are harmful to humanbody. According to Charaka, this Vaikarika group includes two subgroups of Krimisclassified according to their site of invasion in human body, namely Bahya andAbhyantara, which literally means external and internal respectively. Those Krimis, which reside in external surfaces of our body, are termed asBahya Krimis while those Krimis which reside inside our body are termed asAbhyantara Krimis. Charaka and Vagbhata both have mentioned two types of BahyaKrimis while Sushruta has not mentioned Bahya Krimis. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  27. 27. 12 REVIEW OF LITERATURE Another important classification is according to the media in which they growand survive, according to which, Charaka and Vagbhata have shown Krimis are offour kinds viz. those born of Pureesha (faeces), born of Kapha, born of Rakta (blood)and born of Bahya mala are Bahya Krimis, while internal Krimis are those which areborn of Rakta (blood), Shleshma (Kapha) and Pureesha (Faeces). Most of Acharyasagree on total number of Krimis to be 20, but number of different types of Krimisdiffer which is shown in the table no.1. TABLE NO. 1 Classification of Krimis according to different scholars:Sl. Name Bahya Abhyantara krimi TotalNo. krimi Total Kaphaja Purishja Raktaja 1 Charaka18 2 18 7 5 6 20 2 Harita19 7 6 - - - 13 3 Bhela20 - - - - - 20 4 Sushruta21 - 20 6 7 7 20 5 Vagbhatta22 2 18 7 5 6 20 6 Madhavakara23 2 18 7 5 6 20 7 Sharangadhara24 2+1 18+1 7 5 6 22 8 Bhavamishra25 2 18 7 5 6 20 A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  28. 28. 13 REVIEW OF LITERATURE TABLE NO. 2 Nomenclature of Krimis according to different Scholars:Sl.No. Charaka26 Vagbhatta27 Sushruta28 Hareeta29BAHYA BAHYA 1 Yuka Yuka - Krishna 2 Pipllika Leeksha - ShwetaABHYANTAR Charma Yukika(1)SLESHMAJA KRIMI 1 Antrada Antrada Mahapushpa Binduki 2 Hridayada Hridayada Praloona Matkuna 3 Udarada Udarvestha Chipita Charmbha 4 Churu Churu Pipilika Vartula 5 Mahaguda Mahakuha Daruna 6 Saugandhika Sugandha ABHYANTARA 7 Darbhakusuma Darbhakusuma Darbhapushpa Prithumunda(2)PUREESHAJA KRIMI Dhanyankurnibha 1 Kakeruka Kakeruka Ajawa Suchimukha 2 Makeruka Makeruka Vijawa Kinchuka sanibha 3 Sausurada Sausurada Kipya Anavaha 4 Saushulaka Saluna Chipya Sukshmaha 5 Leliha Leliha Gandupada 6 Churu 7 Dwimukhaha(3)RAKTAJA KRIMI 1 Keshada Keshada Keshada 2 Lomada Lomavidhavamsa Romada 3 Lomadwipa Lomadwipa Nakhada 4 Saurasa Saurasa Dantada 5 Udumbara Udumbara Kikkisha 6 Jantumatra Matraha Kushtaja ParisarpajaBAHYA KRIMIS: 30 Acharya Charaka has described the Bahya Krimi i.e. Yuka and Pippilika, 31where as Vagbhatta mentioned Yuka and Leeksha . Hareeta has described KrishnaYuka (Live on scalp and black in color), Shweta Liksha (live in cloths and white incolor), Charmayukika (Flat in shape and live on Netracharma), Binduki (round inshape), Matkuna (creates external complication), Charmbha (Sticking on skin andresembles the dry skin), Vartula (Producing from urine). Sushruta has not mentionedbahya krimis. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  29. 29. 14 REVIEW OF LITERATURENOMENCLATURE OF ABHYANTRA KRIMIS:1. Shleshmaja krimis: The Shleshmaja variety of Krimis in the opinion of Charaka and Vagbhataconsists of seven Krimis, whereas according to Sushruta they are six in number. Thereappears uniformity of thoughts of Charaka and Vagbhata regarding the nomenclatureof Shleshmaja Krimi and this is evident from the name attributed to these sevenvarieties of Shleshmaja Krimis by them. Sushruta not only differs about their number(6), but accepting one Darbha Kusuma and has mentioned his own different names forthese Krimi. As mentioned earlier, Madhavakara, Sharangadhara, Bhavamishra andothers have followed the number, nomenclature and description of these internalShleshmaja Krimis as mentioned by Charaka and followed by Vagbhata. As concerned about the nomenclature it is apparent that the terms Antrada(Destroyer of intestines), Udarada (destroyer of stomach) and Hridayada (Destroyerof heart) denote their destructive effect on the organs Antra (Intestine), Udara(Abdomen) and the Hridaya (Heart) respectively and Churu (steals formed ahara rasa)denote its effect on the body due to consumption of nutrients from the diet. Where asthe term Mahaguda (resides in mahasrotas) and Saugandhika (resides in nasa andshira) denotes their dwelling place and Darbhakusuma (like the flower of Erogostriscynusuroides) is related with their morphology. The nomenclature of these Kaphaja Krimis according to Sushruta is differentfrom that of the Charaka and Vagbhata. He has mentioned these names asMahapushpa (Like the flower of Bauhinia varigata), Chipita (Flattened or flat),Pipilika (like red ant), Praloona (cut off in chips), Daruna (like Gomayakeeta andproducing shiroroga) and Darbhakusuma (like flower of Eragrostris cynasuroides).All these five terms denote the morphology. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  30. 30. 15 REVIEW OF LITERATURE Slight variations in the nomenclature of these internal Shleshmaja Krimis arefound. Charaka has mentioned term Hridayachara which in the opinion of Vagbhataand others is Udaraveshta, while Mahaguda of Charaka has been mentioned byVagbhata and others as Mahakuha. A trivial difference of these terms likes that ofSaugandhika of Charaka and Sugandha of Vagbhata and others, denote no significantdifference in the meaning of these respective terms.II-Pureeshaja krimis: While naming the Pureeshaja Krimi, Vagbhata has followed both number andterms given by Charaka. Sushruta has given not only seven numbers instead of five ofCharaka but has given different names to these Pureeshaja Krimi. The Churu varietyof Shleshmaja Krimi of Charaka and Vagbhata has been mentioned by Sushruta asPureeshaja Krimi. The five names mentioned by Charaka and Vagbhata includeKakeruka (highly motile in nature), Makeruka (like shape of Mudrika), Sausurada(shelters on madya etc., fermented materials), Sashulaka / Saluna (with pain) andLeliha (continuously licks and consumes the Dhatus). The terms for these Pureeshaja Krimis, mentioned by Sushruta include Ajawa(Having slow movement), Vijawa (having rapid or fast movement), Chipya(Chipatakara - flat), Kipya (grows by consuming Sharira dathus), Churu(steals/consumes formed Rasadidhatus), Gandupada (like Earth worm) andDwimukhah (having two mouths). The term Makeruka signifies its morphology, theSashulka denotes pain, Sausurada and Leliha show their feeding habits.Where asKakeruka shows its motile nature. The terms employed by Sushruta like Ajawa and Vijawa indicate that these arenon-motile and fast moving respectively. The term Chipya, Gandupada and A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  31. 31. 16 REVIEW OF LITERATUREDwimukha indicate at their morphology, while Kipya and Churu show their feedinghabits. The description of Pureeshaja krimis given by Hareeta provides us with a quitedifferent nomenclature for all the Purishaja krimis. These are six in all, and the termsdenote their morphology as Prithumunda (those with big head), Dhanyankura nibha(looking like germinating grains), Kinchukasannibhah (earth worm like), Suchimukha(like needle head), Sukshma (very small to be seen) and Anavah (minute).III-Raktaja Krimi: The third variety of internal Krimis is known as the Raktaja Krimi. As usual,Vagbhata has followed Charaka both in regard to their number and nomenclature.Sushruta as usual has mentioned his own names for these Raktaja Krimis and at someplace has more or less followed Charaka while doing so. The term Keshada (destroyer of hair), Lomada (destroyer of body hair),Saurasa (eats the tarunasthi) indicates their destructive effect on the hairs. TheLomadwipa denote that these inhabitant the hair follicle, where as the Udumbarameans having colour like the fruit of Ficus religiosa. The Jantumatara (produced fromthe flies) of Charaka mentioned as Matara by Vagbhata signifies their maternalpattern. As stated above, the terms for Raktaja Krimis mentioned by Sushruta are theKeshada (destroyer of hair), Lomada (destroyer of body hair) and Kikkisa (perniciousto skin) Nakhada and Dantada indicate that these destroy Nakha and Dantarespectively. The term Kushthaja (causing skin diseases) indicate that these arecausative factors of the Kushtha (several types of skin diseases) and the termParisarpaja (performing crippling movement) denote its motile nature. Hareetahowever has not mentioned the Raktaja variety of Abhyantara Krimis. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  32. 32. 17 REVIEW OF LITERATURE CLASSIFICATION OF HUMAN HELMINTHS (WORMS) 32, 33 The Helminths of importance to human being are divided in two main groupsshowing the following pecularities. HelminthsNemathelminthes Platyhelminthes(Nematodes)A) Intestinal Nematodes Trematodes Cestodes(Round worms) (Flukes) (Tape worms)- Ascaris lumbricoides - Schistosoma - Tenia saginata- Strongyloides stercoralis - Clonorchis sinensis - Tenia solium- Ancylostoma duodenale - Opisthorchis - Diphyllobothrium latum- Nectar americanus - Fasciola hepatica - Hymenole pisnana- Trichuris trichiura - Paragonimus westermani -Echinococcus granulosus- Enterobius vermicularis - Fasciolopsis buski - E. MultilocularisB) Non tissue Nematodes - Heterophyes- Brugia malay- B. timori or wuchereria bancrofti- Onchocerca volvulus- Loa – loaC) Tissue dwelling Nematodes- Toxocaracanis- Trichinella spiralis- Drancunculus medinensis A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  33. 33. 18 REVIEW OF LITERATURE HelminthsNemathelminthes Platyhelminthes(General Characteristics) (General Characteristics)- Elongated - Flattened- Cylindrical - Leaf like or Tape like- Unsegmented bodies - Segmented- Sexes separate (Diecious) - Mostly hermaphrodite- Alimentary canal complete (Monoecious)- Body cavity present - Alimentary canal incomplete or entirely lacking - Body cavity absentClassification of Ascaris lumbricoides:Kingdom - AnimaliaSubkingdom - MetazoaPhylum - NemathelminthesOrder - Rhabditida.Class - NematodaFamily - AscarididaeGenus - AscarisSpecies - Lumbricoides A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  34. 34. 19 REVIEW OF LITERATURE STHANA/HABITAT OF KRIMIS TABLE NO. 3- Classification of Krimis according to habitat: Habitat Charaka34 Sushruta35 Vagbhata36 (1)Bahya Krimi Kesha + - + Shmashru, Loma + - - Ambar - - + (2)Pureeshaja Krimis Pakwashaya Guda (Adho visarpana) + + + Amashayonmukha + - + Malashaya Hareeta (3)Kaphaja Krimis Amashaya + + + Kapha Koshta Hareeta (4)Raktaja Krimis Raktavahini dhamniyan + + + (Sira)Habitat of Ascaris lumbricoides: According to modern parasitology the organisms like Ascaris lumbricoides(Round worm) shelters in small intestine. AKRUTHI (STRUCTURE) – MORPHOLOGY TABLE NO.4 – Classification according to Structure of Different Krimis: Morphology Charaka37 Sushruta38 Vagbhata39 (1)Bahya Krimi Anu + - - Tilakriti, Bahupada + - + Sukshama - - + (2)Pureeshaja Krimis Sookshma + + - Vrittha + - + Deerga, Urnamshusankasha + - - Sthoola + - + Prithavapuccha (Flat tail) - + - Tanu - - + (3)Kaphaja Krimis Prithu + + + Vrutt + - - Gandupada, Anu, Braghna + - + Deerghastantva + - + (Deergha) Romasha, Romamurdhan, Spuchha - + - Rudhadhanyaankurakara, Tanva - + + (4)Raktaja Krimis Anu , Vrutt, Apada, Adrushya + - + Snigdha, Pruthu - + - A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  35. 35. 20 REVIEW OF LITERATUREStructure of Gandupada Krimi: As per Ayurveda structure of Gandupada Krimi is elongated and like the earthworm.40Features of mature adult worms (Ascaris):41Male – Measures 15-30 cm in length and 2-4 mm in thickness. Its posterior end iscurved and forms a hook and carries 2 copulatory spicules.Female- It is larger, 20-40cm in length and 3-6 mm thick. Its posterior extremity isstraight and conical. Vulva is situated mid-ventrally, near the junction of anterior andmiddle third of the body. A distinct groove is often seen surrounding the worm at thelevel of vulval opening. This is called vulval waist or genital girdle and believed tofacilitate mating. Vulva leads to single vagina, which branches in to a pair of genitaltubules that lie convoluted through much of the posterior 2/3rd of the body. Thegenital tubules of gravid worm contain enormous eggs (27 million at a time), singleworm lays 200,000 eggs/day and eggs are passed in feces. They are both characterized by having a smooth, finely straighted cuticle, anda mouth, which is characteristic of all the Ascarids, having three lips each equippedwith small papillae. Internally they follow the generalized body plan of allNematodes, and have a cylindrical oesophagus opening into a flattened ribbon likeintestine.Features of Ascaris eggs: Ascaris eggs are one of the most resistant micro organisms known. Their eggshells are upto 4 micrometer thick and have four layers; the ascaroside, chitinous,vitelline and uterine. The ascaroside layer is composed of ascaroside lipids (in adouble layer membrane) and this layer is believed to give the eggs their high A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  36. 36. 21 REVIEW OF LITERATUREresistance to most chemicals. The chitinous layer is highly cross linked and providesstructural rigidity. The roles of the vitelline and uterine layers are not well defined,although the uterine layer is known to contain proteins. The eggs liberated by both type of female (1) fertilized female and (2)unfertilized female are characteristically different. TABLE NO. 5 - Characteristics of Ascaris eggs:Characteristics Fertilised egg Unfertilised eggShape Round oval. Narrower, longer and more elliptical.Size 60 to 75 μm length, 80 μm length, 40 to 50 μm breadth. 55 μm breadth.Colour Bile stained - golden brown Bile stained brown. colour.Shell Thick smooth translucent Thin – with irregular coating of with an outer albumin coat. albumin.Contains Very large conspicuous Small atrophied ovum. unsegmented ovum.Miscellaneous Float in salt solution. Not float. Both fertilized and unfertilized eggs may be found in a sample of stool but if aspecimen shows only the unfertilized eggs, it signifies that the host is harbouring thefemale ascaris or mating between males and females has not occurred.Semi decorticated Fertilized Egg: Some eggs are without outer mamillated coat and are called as decorticatedeggs. In the middle of the egg is a large unsegmented ovum containing a mass ofcoarse lecithin granules.It nearly fills egg except for a clear cresentric area at eitherpole. It is single shelled, thick, round and a colourless granular central mass. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  37. 37. 22 REVIEW OF LITERATURE ASCARIS LUMBRICOIDES (EGGS AT DIFFERENT STAGES) VARNA (COLOUR) TABLE NO.6 – Classification according to Colour of Different Krimis: Colour Charaka42 Sushruta43 Vagbhata44(1)Bahya KrimiKrishna, Shukla + - -Tilvarna - - +(2)Pureeshaja krimiShweta, Rakta - + -Shyava, Peeta + - +Sita, Asita - - +Neela, Harita + - -(3)Kaphaja KrimiShweta + + (Shukla) +Raktabha + - -Shyavmandala - + -Tambra - - +(4)Raktaja krimiTamra + - +Rakta, Krishna - + - A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  38. 38. 23 REVIEW OF LITERATUREColour of Gandoopada krimi:The colour mentioned for identification of Gandupada Krimi in Ayurveda isRaktavarna (red). 45Colour of Ascaris lumbricoides: In freshly passed stool the worms are pinkish white in colour. In microscopic view the fertilized eggs are colourless but external shell looks brown and contents are pale yellow in colour. Unfertilized eggs have brown coloured external shell. Semi-decorticated fertilized eggs are colourless. KRIMI NIDANA (Etiological factors) The causative factor responsible for the production of a disease is considered asNidana. Acharya Charaka classified the disease in to two distinct groups designated asnija and agantuja. As far as Ayurveda is concerned in a normal course, a disease isproduced after vitiation of doshas, vata, pitta and kapha. But in case of agantuja vyadhi,the causative factor may be some external agents. Manifestation of disease occursprimarily followed by vitiation of doshas. Here krimiroga, a disease caused by invasion ofkrimis comes under the group agantuja, as it is produced due to injury or harm caused bykrimis followed by an imbalance in the equilibrium of doshas. Similar to each and every disease, the etiology of krimiroga is of two types -Viprakrusta nidana and Sannikrusta nidana. Sannikrusta conclude all factors that aredirectly and closely related to the manifestation of the disease while viprakrusta includesfactors that are indirectly and distantly responsible for the causation of the disease, whichmay also act as cause of sannikrusta nidana of all disease. A continuous use ofunwholesome diet or regimens may act as their viprakrusta nidana. In Krimiroga the A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  39. 39. 24 REVIEW OF LITERATUREvitiated dosha depending upon pureesha, kapha and rakta are responsible for onset ofdisease. Therefore the sannikrusta nidana of Krimiroga include vitiated kapha, rakta andpureesha. While viprakrusta nidana comprise the unwholesome diet and deeds describedas ‘Ajirnadi’ by Sushruta, Vijayarakshita and Srikanta datta’s “Ajirnadi KrimiSambhava” should also be apprehended in this manner. The etiological factors of Krimiroga described as viprakrusta can be divided intotwo namely samanya nidana and vishesha nidana. Samanya nidnanas includes thosevague factors which are responsible for the entrance and growth of krimis in human host.On the other hand, vishesha nidana constitutes all the specific factors that certainly causethe infestation of any of the Krimis designated as bahya, pureeshaja, sleshmaja or raktaja. TABLE NO. 7- Showing Samanya Nidana of Abhyantara Krimi: (46-50) Sl.No Samanya Nidana Su.S. Hr.S. M.N, Sh.S., B.P. PHYSICAL FACTORS 1. Avyayam + - + 2. Diwaswapna + + + DIET ARTICLES 3. Godhuma - + - 4. Masha, Vidala, Prithuka, Bisa + - - 5. Pishtanna,Guda + + + 6. Anupamamsa, Ikshu, Shaluka + - - 7. Kasheruka, Patrashaka, Dadhi + - - 8. Kshira + + - 9. Sura, Sukta, Palala, Pishita + - - TASTE & QUALITY OF DIET 11. Madhura - + + 12. Amla + - + 13. Ruksha - + - 14. Guru,Shitala + - - 15. Pichhila + + - 16. Drava + + + DIET HABITS 17. Asatmya, Malin,Adhyashana + - - 18. Virudha + - + 19. Ajeerna + + + A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  40. 40. 25 REVIEW OF LITERATURE TABLE NO.8- Showing Vishishta Nidana of Abhyantara Krimi: (51-55) Nidana C.S Su.S A.H. B.P. M.N. 1. Sleshmaja Krimi Kshira, Guda + + + + + Tilataila + + - + - Mamsa - + + + + Masha - + + + - Matsya, Anupmamsa + - - - + Pistanna, Paramanna, Kusumbha + - - - - Snehajeerna Putiklinna Sankirna + - - - - Viruddha, Asatmya + - - - - Dadhi - + + + + Shukta - - - + + Saktu, Aodan, Madhuranna - - + - - 2.Purishaja Krimi Masha, Pishtanna + - + + Vidala + - - - Parnashaka + + + + Guda, Amla, Lavana - - + + Dhanya-Bahumalkara,Ulaka - + - - 3.Raktaja Krimi Virudha Bhojan, Ajeerna, Shaka - + - + +1. Acharya Charaka has mentioned that nidana of pureeshaja krimi are same asnidana of shleshmaja krimi.2. Acharya Charaka and Vagabhatta has mentioned that nidana of raktaja krimi aresame as kustha nidana. Acharya Charaka mentioned only vishesha nidana while Sushruta, Hareeta andMadhava first explained samanya nidana and than vishesha nidana of krimis classifiedin different groups. Acharya Charaka mentioned marujavarjana means uncleanlinessas the nidana of bahya krimi. Observation of above table shows that nidanas like meat, patrashaka etc. helpin the ingestion of ova and cyst in to human body. Nidanas like diwasvapana,ajirnashana, asatmya, virudha bhojana etc. create agni mandya and a favourableatmosphere in the kostha for the growth of krimi and diet like green vegetables(Patrashaka), pishtanna, godhuma etc. create major bulk of faeces. This accumulation A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  41. 41. 26 REVIEW OF LITERATUREof faeces gives favourable, environment for the growth of krimis as they areoriginating from the vapours of faecal matter according to Dalhana.Modern view on etiological factors: The food substances like leafy vegetables, beef,pork, commonly consumed raw/improper boiling contaminated by human faeces or fliesare responsible for endemicity of helminthiasis. Also walking with bare foot, biting of nails,open field defecation and usage of common toilets, soil, contaminated water, dust andcloths are identified as transmitting agents of ova and cyst of the helminths.Mode of infection of Ascaris lumbricoides: Infection is effected by swallowing ripeAscaris eggs (embryonated eggs) with raw vegetables cultivated on soil fertilized byinfected human excreta. Water supplies may be contaminated and infection may occur bydrinking such water. Where soil pollution is common, the eggs may directly be conveyedto the mouth by the dirty fingers. Infection may also occur by inhalation of desiccatedeggs in the dust reaching the pharynx and swallowed. The eggs, instead of beingswallowed, may hatch in moist mucous surface of the upper air passage and the larvaemay directly penetrate into the blood stream. Fresh faeces do not contain infective eggs. POORVAROOPA There is no description of poorvaroopa for Krimi in Brihatrayis or laghutrayis. ROOPA Signs and symptoms of disease which can help in diagnosis are considered asRoopa of disease. Acharya Sushruta, Madhava, Bhavamishra and Vangasena described generalsymptomatology of Krimiroga first and then the specific symptoms. In HareetaSamhita and in Yogaratanakara, only general symptomatology is available whileAcharya Charaka and Vagabhatta described only specific symptomatology of A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  42. 42. 27 REVIEW OF LITERATUREsleshmaja, raktaja, pureeshaja and bhaya krimi. Acharya Charaka has used world“Prabhava” for the rupa of krimiroga. The clinical feature of the krimis always varies with the nature of the krimisand part of organ affected by them. Even then the presenting sign and symptoms ofkrimi roga can be grouped in to two categories – clinical feature of bahya Krimis andclinical features of abhyantara Krimi. In case of krimi roga caused by abhyantarakrimi possible signs and symptoms had been put forward by various Acharyas arejwara, vivarnata etc. If the individual is having these symptoms suspected as a Krimiroga. Clinical features of sleshmaja krimi clearly resemble the signs and symptoms ofannavaha srotodushti, while in case of pureeshaja krimi it is related with pureeshvahasrotodushti. Clinical features of raktaja krimiroga may mimic that of the disease kushta. TABLE NO. 9 - Symptomatology of Bahya Krimi: 56 57 BahyaKrimi Charaka Bhava Mishra l.No. Kandu + + 1 Kotha + + 2 Pidaka + + 3 Ganda - + 4 TABLE NO. 10 - Showing Samanya Roopa of Abhyantara Krimi: Sl.No. Symptom Su. 58 Hareeta59 M.N. 60 B.P. 61 1. Jwara + + + + 2. Vivarnata + + + + 3. Shoola + + + + 4. Hridroga + + + + 5. Bhrama + + + + 6. Bhaktadwesha + + + + 7. Atisara + - + + 8. Sadana + - + + 9. Vami - + - + A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  43. 43. 28 REVIEW OF LITERATURE 10. Jathargarjanam - + - - 11. Mandagni - + - - 12. Pipasa - + - - 13. Pitanetra - + - - TABLE NO. 11- Lakshanas of Abhyantara krimis by different authors: Lakshanas of Different krimis Ch. 62 Su 63 A.H. 64 M.N. 65 (1)Pureeshaja KrimiPureeshabheda + + + +Karshya, Parushya, Lomaharsha + - + +Gudamukha Paritudana, Kandu + - - -Guda Pravarthana + - + +Pureeshagandhi udgara, Nishwasha + - - +Shoola, Agnimandya. - + + +Pandu, Vistamba - + + +Balakshaya, Praseka - + - -Aruchi, Hridroga - + - -Gudakandu + - + +Atopa - + - -Sadana - - + - (2)Kaphaja krimiVamana + + + -Pratishaya + + + +Hrullasa, Avipaka, Arochaka + - + +Murcha, Jwara, Anaha + - + +Karshaya, Kshavthu + - + +Parushaya , Asya sansravana + - - -Jrumbha, Anga mardha + - - -Shiroroga, Hridroga - + - -Peenasa - - + + (3)Raktaja krimiKushta - + + +Visarpa, Pidika - + - -Kesha,Shamshru, Nakh, Loma, Pakshama, + - - -DhwansaVranagataharsha, Kandu,Toda, Sansrapana + - - -Twak, Sira, Snayu, Mamsa, Tarunasthi + - - -bhakshanGandoopada krimi Lakshanas 66 Gudakandu Passing of worms through anus Shoola Atopa Shakrita bheda Paktinasha A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  44. 44. 29 REVIEW OF LITERATURE CLINICAL MANIFESTATION IN ASCARIASIS 67,68,69 Most patients are asymptomatic. When symptoms occur, they are divided in twocategories: early (larval migration) and late (mechanical effects). In the early phase (4 – 16 days after egg ingestion), respiratory symptoms result from the migration of larvae through the lungs. Classically these symptoms occur in the setting of eosinophilic pneumonia (Loffler syndrome). - Fever - Nonproductive cough - Dyspnoea - Wheezing In the late phase (6 – 8 week after egg ingestion), gastrointestinal symptoms occur. - Passage of worms (from mouth, nares and anus). - Diffuse or epigastric abdominal pain. - Nausea, vomiting.Physical: General: - Fever - Jaundice (in biliary obstruction) - Cachexia (due to malnutrition) - Mental retardation Pulmonary: - Wheezing - Rales - Diminished breath sounds Abdominal: - Abdominal tenderness, which may be diffuse (in obstructive infections), or localized to the right lower (appendicitis) or right upper quadrant (hepatobiliary infections). - Peritoneal signs in cases of bowel perforation. Migrating larvae may transmit other organisms, causing bacterial pneumonia. Rare cases of airway obstruction have also been reported. Other much less common A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  45. 45. 30 REVIEW OF LITERATURE presentations include lacrimal drainage obstruction, acute interstitial nephritis and encephalopathy. UPASHAYA AND ANUPSHAYA No specific description has been given in ayurvedic classics about upashayaand anupashaya of Krimi roga. KRIMI ROGA SAMPRAPTHI Samprapthi of krimiroga is not clear in any classics.Sushruta70 has described that kapha dosha is responsible for krimiroga.Charaka71 has mentioned that vitiation of kapha dosha creates suitable medium forgrowth and development of pureeshaja krimi.Madhava nidana72 comments that ajirna is one cause for krimiroga.SAMPRAPTI GHATAKA1. Dosha - Tridosha2. Dushya (a) Ahara Rasa in Kaphaja and Purishaja Krimi (b) Rakta in Raktaja Krimi3. Srotasa (a) Mahasrotasa (b) Pureeshvaha Srotasa (c) Raktavaha Srotasa4. Adhisthana (a) Amashaya (b) Pakwashaya (c) Raktavaha Dhamani5. Agni (a) Jatharagni Mandya (Ama)6. Sanchara - Sarvatara7. Vyakti (a) Krimi Lakshana (sign & symptoms) (b) Krimi Darshana (in microscopic examination ova or cyst present)8. Bheda (a) Kaphaja (b) Pureeshaja (c) Raktaja A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  46. 46. 31 REVIEW OF LITERATURE9. Svabhava (a) Chirkari (Chronic). LIFE CYCLE OF ASCARIS LUMBRICOIDES 73,74 These parasites have a direct lifecycle, with no intermediate hosts. The adultparasite lives in the lumen of the small intestine of man, usually only feeding on thesemi-digested contents of the gut, although there is some evidence that they can bite A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  47. 47. 32 REVIEW OF LITERATUREthe intestinal mucous membrane and feed on blood and tissue fluids. The femaleparasite is highly prolific, laying an estimated 2 million eggs daily. In the intestinethese only contain a unembryonated mass of cells, differentiation occurring outsidethe host. This requires a temperature less than 300C, moisture and oxygen, before thedevelopment of the young L1 larvae after approximately 14 days. Eggs containing theL2 larvae take another week to develop, before they are infective to man and mayremain viable in the soil for many years if conditions are optimal. Infection occurs oningestion of raw food, such as fruit or vegetables, that are contaminated with theseinfective eggs. The eggs then hatch in the small intestine to release the L2rhabditiform larvae (measuring approximately 250 by 15um in size). These do notsimply grow into the adult forms in the intestine, but must then undergo a migrationthrough the body of their host. These L2 larvae penetrate the intestinal wall, enteringthe portal blood stream and then migrate to the liver, then heart, then after between 1to 7 days, the lungs. Here they moult twice on the way to form the L4 larvae,(measuring approximately 1.5mm long), then burrow out of the blood vessels,entering the bronchioles. From here they migrate up through the air passages of thelungs, to the trachea. They then enter the throat and are swallowed, finally ending upin the small intestine where they mature and mate, to complete their lifecycle. Theybecome sexually mature in about 6-12 weeks and the gravid females start laying eggs,to repeat the cycle. The adult worm has a life span of 6-24 months.They can’treproduce in the intestine. Thus a heavy infection is only occurred by getting manyinfective eggs. Upon excretion, ascaris eggs must undergo development for about onemonth in a moist, aerobic environment. The infective stage is an embryonated eggcontaining a stage three larva. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  48. 48. 33 REVIEW OF LITERATUREPathology of infection: The majority of infections (~85%) appear to beasymptomatic, in that there is no gross pathology seen. However the presence of theseparasites appears to be associated with the same general failure to thrive in their hostsseen in many of these intestinal nematodes. In terms of more easily identified pathology, this may be divided into 3 areas;(1) Pathology associated with the ingestion and migration of Larvae: Severe symptoms of Ascaris infection may be associated with the migratinglarvae, particularly in the lungs. If large numbers of these larvae are migratingthrough the lungs simultaneously this may give rise to severe haemorrhagicpneumonia. More commonly, as is the case with most infections, the haemorrhagesare smaller in scale, but still may lead to breathing difficulties, pneumonia and/orfever. A complication here is that many of the parasites proteins are highly allergenic.Because of this the presence of the migrating larvae in the lungs is often associatedwith allergic hypersensitivity reactions such as asthmatic attacks, pulmonaryinfiltration, urticaria and oedema of the lips. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  49. 49. 34 REVIEW OF LITERATURE(2)Pathology associated with Adult parasites in the Intestine: The most common symptoms of infection are due to the adult parasite, andconsist of rather generalized digestive disorders, such as a vague abdominaldiscomfort, nausea, colic. These symptoms are dependent to some extent of theparasite burden of the host, which in severe cases may consist of many hundreds oreven thousands of parasites, although these are extreme cases. In the case of theseheavy infections the presence of many of these large parasites may contribute tomalnutrition in the host, especially if the hosts (often children) are undernourishedanyway. A more serious and potentially fatal condition may arise in these more heavyinfections, where the mass of worms may block the intestine and need to be surgicallyremoved. This may also occur sometimes on treatment for other intestinal nematodessuch as hookworms, where the curative drug dose for these parasites irritates theascarids.(3)Pathology due to “Wandering” adults outside of the intestine: Adult parasites often leave the small intestine to enter other organs,(sometimes in response to anthelmintic drugs used to treat other intestinal nematodeinfections), where they may cause various types of pathology, sometimes with severeconsequences e.g. Adult Ascaris worms may migrate to the bile duct, which may thenbecome blocked causing jaundice and a general interference in fat metabolism. Adultparasites may also migrate to the appendix, or through the intestinal wall, bothconditions which may cause a fatal peritonitis as they may well carry intestinalbacteria to these sites. They may, alarmingly, sometimes migrate forward through theintestinal tract, to be either vomited up or emerging through the nose. More seriously,if they enter the trachea they may cause suffocation. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  50. 50. 35 REVIEW OF LITERATURELABORATORY DIAGNOSIS75: This may be described under two headings-Direct evidences and indirect evidences.DIRECT EVIDENCES:1. Finding of adult worms: (a) In the stool or vomit: The adult worm may pass outspontaneously in the stool or per anum between stools, or be vomited or escapethrough nares. Administration of specific anthelmintic may lead to expulsion of wormand its detection.(b) X-ray diagnosis: The presence of Ascaris lumbricoides has beendemonstrated by radiography with barium emulsion, which being ingested by theworm within four to six hours, casts an opaque shadow (string like shadow).(c) Obstructing Ascaris lesions cause cylindrical filling defects on contrast CT scans.(d) Cholangiopancreatography by endoscopy (ERCP) or Magnetic resonance imaging(MRCP) or Magnetic resonance Cholangiopancreatography) may detect adult wormsin the bile or pancreatic duct. (e) Ultrasonography may detect worms in gall bladder.2. Finding of eggs:(a) In the stool: As the ascaris eggs are passed in the stool inenormous numbers, it should be easy to detect the infected persons by a directmicroscopical examination of a saline emulsion of the stool. Concentration by thefloatation method may be employed for the detection of the eggs in the stool. It is tobe noted that unfertilized eggs don’t flow in salt solution. If the patient harbours asolitary male ascaris, eggs are not found in the stool. (b) In the bile: Microscopicalexamination of the bile obtained by duodenal intubation may reveal Ascaris eggs.INDIRECT EVIDENCES:Early infection (Larval migration): 1. Complete blood count (CBC) may show eosinophilia. 2. Sputum analysis may reveal larvae or Charcot- Leyden crystals. 3. Chest radiography may reveal patchy infiltrates of eosinophilic pneumonia. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  51. 51. 36 REVIEW OF LITERATURE KRIMI ROGA CHIKITSA Chikitsa of Krimiroga in all most all Samhitas is much emphasized and advisedsystematically. In vedas the reference of agni is found for the treatment of krimis. Even thedaiva vyapashraya chikitsa i.e. mantra, japa, puja etc., are included and the naturalsubstances like maruta, jala, megha are praised to destroy worms. Even we get theusage of palandu, pippali etc. and drugs for the treatment of krimis. In Atharva Vedasun rays are considered to kill the krimis. After considering different classics for the treatment, following treatmentprinciple of Charaka can be adopted i.e, Krimi chikitsa is followed in 3 aspects. 76 1. Apakarshana 2.Prakriti Vighata 3.Nidana ParivarjanaThe individual explanation of these can be listed as follows:Apakarshana: It is told in two ways:(1) Hasta / Yantra Apakarshana – To remove the visible krimis by yantra or by hands(manual expulsion).(2) Bheshaja Apakarshana is done in 4 ways –Shirovirechana,Vamana,Virechana andAsthapana bastiPrakriti Vighata: In this procedure the factors responsible for destruction of krimiprakriti (i.e. Samprapthi Vighatana) are followed viz. katu, tikta, kashaya, kshara andusana quality dravyas are used and also all dravyas which possess opposite qualitiesof krimi and pureesha are extensively used.Nidana Parivarjana: It is followed after prakriti vighata. The factors told as nidana(etiologies) and dravya similar to the qualities of nidana should be discarded oravoided from the usage. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  52. 52. 37 REVIEW OF LITERATUREBeshaja Chikitsa: (Different Yogas) 77Swarasa : Palashabeeja , Paribhadra patra , Karanjatwak , Sireesa , Apamarga.Choorna: Palashabeeja, Vidanga, Kampillaka, Yavani, Ativisa, Maricha, Vachadi,Nimba, Boonimba Choorna. Kwatha : Triphala, Vidanga, Dadimatwak, Surasadi,Khadiradi, Kharjurapatra, Mustadi, Bhunimbadikwath. Kalka: Nimba kalka,Vidanga,pippali kalka etc. Avaleha : Pippalyadi, Paribhadra avaleha. Asava and Arista:Vidangarista, Khadirarista. Taila : Surasadi taila, Vidangadi taila, Bhallataka taila,Dhatura taila, Katu taila. Ghrita : Vidanga ghrita, Triphala ghrita. Yoga: Vidangaditakra yoga, Surasadigana yoga, vidanga bhallataka yoga, Katukavidanga yoga etc.Gutika : Krumighatini gutika, Lakshadivati. Khanda : Haridrakhanda. Rasa : Krimi-mudgara rasa, Krimikutara rasa, Vidangadi loha, Krimikalanala rasa.Peya: Vidangadipeya. Manda: Vidangadi manda. 78TREATMENT OF ROUNDWORM (ASCARIS LUMBRICOIDES)Several drugs are available, these include –(1) Albendazole – 400mg/day in > 2 Years.(2) Mebendazole – 100 mg b.i.d. for 3 consecutive days.(3) Pyrantel pamoate – 11 mg /kg/dose – per oral x single dose not to exceed 1gm.(4) Piperazine citrate – 75mg /kg/day – per oral x 2 days not to exceed 3.5gm/dose.(5) Ivermectin – 150 to 200 mcg/kg for one dose.Prophylaxis: The measures should consists of – Proper disposal of human faeces. Treatment of parasitized individuals. Recommend good personal hygiene and food handling techniques. Wash hands with soap and water before handling food. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  53. 53. 38 REVIEW OF LITERATURE Treatment of vegetables and other garden crops with water containing iodine 200 ppm for 15 minutes kills the eggs and larvae of ascaris and other helminths. Avoiding soil consumption. Education of children in schools on sanitary laws and hygiene. Agricultural workers should wear personal protection (i.e. boots and gloves etc.) when working in soil contaminated with animal and human faeces. When traveling to countries where sanitation and hygiene are poor avoid water or food that may be contaminated. PATHYAPATHYA OF KRIMIROGA79PATHYA AHARA (Wholesome diet): Taste of diet articles should be predominantly of kasaya, katu and tikta rasa.Patola, Rasona, Amalaki, Ajwan, Paribhadra, Sarsapa, fruit of Brihati, Vidanga,Tambula, Haridra ,Karavellaka, Nimbapatra, Raktashali dhanya, Kulattha, Honey,Urine of Cow & Camel, meat of Rats, Tila and mustard oil, Kulattha & Yava Kshara.PATHYA VIHARA (Wholesome regimen): Intake of essential asthapana basti, sirovirechana & dhumapana, obey of dailyand seasonal regimen, avoidance of mental worries, to follow the principles ofswasthavritta.APATHYA AHARA (Unwholesome diet): Diet articles of madhura and amla rasa, parnashaka, masha, guda, eight typesof milk, curd, ghee, ajirna, virudha, asatmyabhojana and adhyashana.APATHYA VIHARA (Unwholesome regimen): Day sleep, with holding of natural urges like nausea, vomiting etc. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  54. 54. 39 REVIEW OF LITERATURE DRUG REVIEW PALASHA 80,81Family: Leguminoceae (legumin – Pulse).Sub-Family: Papilionaceae.Latin Name: Butea monosperma (Butea – named after John Earl of Bute.Mono –one, sperma – seed. Earlier name was Butea frondosa, frondosa = leafy).Synonyms: Palasha, Kimsuka, Raktapuspaka, Bramhavriksha, Triparna.Kula: Shimbi kula. Gana: Lodradi, Ambastadi, Nyogrodadi (su).Eng – Bustard teak, Hin – Dhak, Tesu, Kan – Muttaga, Pun – Palash, Dhak, Tesu,Sansk – Kimsuka, Raktapushpaka.Morphology: A medium sized deciduous tree with some what crooked trunk 12-16 min height with irregular branches, commonly found throughout the greater part of thecountry up to about 915 m. Leaves – 3 foliate, 10-15 cm long, 3 flowers – brightorange red, large in rigid recemes, legume – 12.20 cm long, 2 cm broad and containsround, reddish black seeds.Rasa: Katu, Tikta, Kashaya. Guna: Laghu, Snighda. Veerya: Ushna. Vipaka: Katu.Chem. compostion: Contains kinotannic acid and Gallic acid 50%, Alkali 2%, Seedshas palsonin – acts on Round worm, has 18% fixed oil, which is called as kino oil.Parts used: Seed, Bark, Flower, Leaf, and Gum.In the present study – Seed (Beeja) is used.Action of Bija: Vatakaphashamaka, Krimighana, Lekhana, Vishghana andKusthaghana.Dose: For worms ½ to 1 gram. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  55. 55. 40 REVIEW OF LITERATURE NIMBA82,83Family: Meliaceae (meli –Honey) bead tree (Latin), plant of melia.Latin Name: Azadirachta indica- Azadarachta (Persian Name – Best great tree),Indica (from India).Kula: Nimba Kula. Gana: Kandughna (Ch), Aragvadhadi, Guduchyadi (Su).Synonyms: Nimba, Pichumarda (pichu–leprosy, which cures Leprosy), Hinguniryas,Subhadra, Krimighna, Tiktaka, Arishta.Eng- Margosa tree, Hin – Nimba, Kan – Kahibevu, Oilevevu, Pun – Nimba, bakan,Sansk – Arishta, Pichumarda.Morphology: Tree of 12-15 mtrs height. A moderate to fairly large sized tree havinggrayish to dark gray tubercled bark with stout trunk and spreading branches, occurringthroughout the country up to an elevation of 900 mtrs. Leaves: Compound, alternaterachis 15-25 cms long, 0.1 cm thick, leaflets with oblique base, opposite, exstipulate,lanceolate, serrate 7-8.5 cm long and 1-1.7 cm white, slightly yellowish green, order:indistinct, taste: bitter. Flowers: Cream or yellow white in axillary panicles staminaltubes. Fruits: one seeded with woody endocorp, greenish yellow when ripe. Seeds -ellipsoid, cotyledons thick, fleshy and oily.Rasa: Tikta, Kashaya, Guna: Laghu, Veerya: Sheeta, Vipaka: KatuChemical Compostion: Nimbin – 0.04%, Nimbinin = 0.001%, Nimbidin – 0.4%,Nimbesterol – 0.03%, Volatile oil – 0.02%.Seed and Seed oil: Contains sulphur, alkali, resin, glycosoide.Parts used: Seed, Bark, Leaves, Flowers, Oil. In present study – Bark is used.Action: Kaphapittashamaka, Antimicrobial, Anthelminthic, Hypoglycemic,Antileprotic, Analgesic etc. A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA
  56. 56. 41 REVIEW OF LITERATURESeed: Thermogenic, Purgative, Anthelmintic, Uterine stimulant.Dose: Bark powder 1 to 2 gram. 84,85 BHUNIMBAFamily: Gentianaceae.Latin Name: Swertia ChirataKula: Bhoonimba kula.Gana: Aragvadadhi (Su), Haritakyadi varga (B.P.)Eng – Chireta, Hin – Chirayata, Kan – Nalabevu, Chirayat, Pun – Chiretta, Chiraita,Sansk – Kirata, Kirataka, Bhunimba, kiratatiktaka.Morphology: A small, erect, annual, herbacious plant, 0.6 – 1.25 m high, found intemperature Himalayas at an altitude between 1200 – 5000 m from Kashmir toBhutan and Khasia hills in Meghalaya; drug collected when flowering (July –October) and dried.Rasa: Tikta, Guna: Laghu, Ruksha, Veerya: Sheeta, Vipaka: Katu.Chemical composition: Ophelic acid, yellow glycoside(Chiratin), resin, gum, potash,carbonate, phosphate, lime and magnesium. It does not contain tannin.Parts used: Roots and whole plant.Action: Kaphapittahara,Vishama jwaraghana, Deepana, Saraka, Dahaprashamana,Raktashodhana, Stanyashodhana, Krimighana, Tikta paushtika.Dose: Powder 2 to 6 gram. VIDANGA 86,87Family: MyrsinaceaeLatin Name: Embelia ribes (Embelia – amlika – Sinhali word i.e. Sour, Ribes –rubarb’s – Arabic Name) A COMPARATIVE CLINICAL STUDY IN THE MANAGEMENT OF GANDOOPADA KRIMI WITH PALASHBEEJADI CHOORNA

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