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Garbhini chardi-psr
Garbhini chardi-psr
Garbhini chardi-psr
Garbhini chardi-psr
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A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi, Sujatha, B S, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi, Sujatha, B S, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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  • 1. Abbreviations    List of Abbreviations (Ayurvedic) According to Reference Books 1. A. H. Astanga Hridaya 2. A. S. Astanga Samgraha 3. A. K. Amara Kosha 4. S. S. Sushruta Samhita 5. B. P. Bhavaprakasha 6. H. S. Harita Samhita 7. C. S. Charaka Samhita 8. C. D. Chakra Dutta 9. Ckr. Chakrapani 10. Dl. Dalhana 11. K. S. Kashyapa Samhita 12. K. N. Kaiyyadeva Nighantu 13. M. Ni. Madhava Nidana 14. S. K. D. Shabda Kalpa Druma 15. Y. R. Yogaratnakara 16. Sh. S. Sharangdhara Samhita 17. Vag. Vagbhatta 18. Chi. Chikitsa Sthana 19. Ind. Indriya Sthana“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”    
  • 2. Abbreviations    20. Ka. Kalpa Sthana 21. Ni. Nidana Sthana 22. Su. Sutra Sthana 23. Ut. Uttara Sthana 24. Sha. Shareera Sthana 25 Hb Hemoglobin 26 CTZ Chemo receptor trigger zone 27 & and 28 UTI Urinary tract infection 29 syn Syndrome 30 Int Intestinal 31 HCG Human chorionic Gonadotrophine 32 OCP’S Oral contraceptive pills 33 UOS Upper oesophageal sphincter 34 LOS Lower oesophageal sphincter 35 ATP Adenosine triphosphophate 36. AMP Adenosine monophosphate 37. CNS Central nervous system 38. GIT Gastro intestinal tract 39. LFT Liver function test 40 SGOT Serum glutamic oxaloacetic transaminase“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”    
  • 3. Abbreviations    41. SGPT Serum glutamic pyruvic transaminase 42. ECG Electro cardiograph 43. USG Ultra sonography 44. HT3 Hydroxy triptane 45. U.S United states 46. hrs hours 47 kg Kilograms 48. % Percentage 49 RBC Red blood corpuscles 50. WBC White blood corpuscles 51 HLA Human Lymphocyte antigen “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”    
  • 4.    ABSTRACTTitle - “A Clinical Study on effect of Dadimaavaleha in the management of GarbhiniChardi”. Garbhini chardi or Morning sickness is a worldwide problem in the pregnantwomen. About 50-80% of pregnant women suffer from this. The common symptoms arenausea, vomiting & occasional sickness on rising in the morning. It may however occurat other times of the day. Altered hormonal & immunological states are responsible forinitiation of the manifestations which is probably aggravated by the neurogenic factors.Whatever may be the cause of initiation unless it is not quickly rectified features ofdehydration & carbohydrate starvation occurs leading to a vicious cycle of vomiting.Under these circumstances practitioners are in need of alternative, safe, economic &nontoxic medicine to treat the morning sickness. Dadima Avaleha is one such drug whichcan be used in morning sickness safely.Objectives: 1. To do conceptual study of Garbhini chardi. 2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.Study design: This research work is a single blind clinical study with pre test and post testdesign.30 Patients fulfilling above criteria were assigned in to two groups. Group A – Dadimaavaleha for 21 days. Dose-24gms with divided dose of 8gms T.I.D. withlukewarm waterGroup B – Placebo for 21 days. 24gms with divided dose of 8gms T.I.D. with lukewarm waterResult: Dadimaavaleha was effective in treating Chardi Vega, Hrullasa, Anannabhilasha& Quantity of Vomitus.Key words: Garbhini, Dourhrda avamana, Aapanna satwa, Shamana chikitsa, Agnimandya,Hrullasa, Chardi, Dadima Avaleha.
  • 5. ACKNOWLEDGENMENT MY GRATITUDE: With a bowed Head to the Almighty, With folded Hands to Revered Teachers And a warm Heart to My Parents, Husband & Friends. With profound gratitude, I am greatly indebted to myrevered teacher and guide, Dr. Mamatha. K.V, M.D (Ayu) Prof., Dept.of Prasooti tantra & stree roga, S.D.M.C.A., Udupi, who has not onlyguided me to complete my research work, but has always been asource of inspiration and encouragement in all stages of my tenureof Post Graduate education. Her great patience and fortitude hashelped me immensely in completing my work successfully. I am ever grateful to my Co-guide Dr. SuchethaKumari, M. D. (Ayu), Asst. Prof., Department of Prasooti Tantra andStree Roga, S.D.M.C.A., Udupi, for her encouragement, help, valuablesuggestions and critically reviewing this study. My eternal gratitude to Dr. V. N. K. Usha, M. D. (Ayu),Prof. & Head of Department of Prasooti Tantra and Stree Roga,S.D.M.C.A., Udupi, for her continuous inspiration and valuablesuggestions.   
  • 6. I express my heartfelt thanks to Dr. Ramadevi, Dr.VidyaBallal for their support and help in the clinical study of this work. I offer my sincere thanks to Dr.U.N.Prasad, PrincipalS.D.M.C.A., Udupi,, Dr.K.R.Ramachandra, Vice Principal, S.D.M.C.A.,Udupi,. I offer my sincere thanks to Dean of P.G Faculty Dr.Srikant.Ufor their encouragement and guidance. I thank Dr. Y. N. Shetty, Medical Superintendent, Dr.Krishnabai & Dr.Veena Mayya and all the staff of S. D. M. Hospital, Udupi. My eternal gratitude to Dr. Murali Krishna manager,Dr.Mohan and all other staff of S. D. M. A. Pharmacy, Udupi. I thank Sri Harish Bhat, Librarian, S. D. M. C. A., and hisstaff for providing necessary books in time. I heartily convey my thanks to my Uncle N.S. Hiremath, myGrandmother, Mother, my inlaws, Husband, Brother & sisters whoinspired me to do my post graduation. Lastly I thank all my friends Dr.Shilpa, Dr. Vijayalakshmi,Dr.Shubha, Dr.Kavya, Dr. Sukanya, Dr. Prakash, Dr. Vinod & all myseniors & juniors without whome this work would not be complete. Date- Dr.Sujatha.B.S     
  • 7. Contents   CONTENTS                                                                                              PAGE.NO  1 Certificates         2 Acknowledgment   3 Contents   4 List of Abbreviations   5 List of Tables   6 List of Diagrams   7 List of Graphs   8 INTRODUCTION 1‐2  9 OJECTIVE OF STUDY 3  10 CONCEPTUAL STUDY 4‐50  Historical Review Review of Garbhini chardi Drug Review   11 CLINICAL STUDY 51‐86  Materials & methods Observations Results 12 DISCUSSION 87‐97  13 SUMMARY & CONCLUSION 98‐101  14 BIBILOGRAPHY 102‐106  15 CASEPROFORMA   “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”    
  • 8. List of Tables  List of Tables in different chapters Table No.1 Nidanas of chardi Table No.2 Vishista Nidanas of chardi Table No.3 Purvarupa of chardi Table No.4 Roopa of Vataja chardi Table No.5 Roopa of Pittaja chardi Table No.6 Roopa of Kaphaja chardi Table No.7 Roopa of Sannipataja chardi Table No.8 Asadya lakshanas Table No.9 Showing rasa, guna, veerya,vipaka & karma of the drug Table No.10 Showing botanical description of drugs Table No.11 Distribution of patients based on age Table No.12 Distribution of patients based on Religion Table No.13 Distribution of patients based on Occupation Table No.14 Distribution of patients based on Education Table No.15 Distribution of patients based on Habitat Table No.16 Distribution of patients based on Gravida Table No.17 Distribution of patients based on Nausea Table No.18 Distribution of patients based on Vomiting Table No.19 Distribution of patients based on Frequency of vomiting Table No.20 Distribution of patients based on Quantity of vomitus Table No.21 Distribution of patients based on content of vomitus Table No.22 Distribution of patients based on Ananabhilasha Table No.23 Distribution of patients based on Alasya“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 9. List of Tables  Table No.24 Distribution of patients based on Angamarda Table No.25 Distribution of patients based on Anidra Table No.26 Distribution of patients based on Agnimandya Table No.27 Distribution of patients based on Brama Table No.28 Distribution of patients based on Daurbalya Table No.29 Distribution of patients based on Talu Shosha Table No.30 Distribution of patients based on Jihwa Shosha Table No.31 Distribution of patients based on Tandra Table No.32 Distribution of patients based on Shira Shoola Table No.33 Distribution of patients based on Family history Table No.34 Distribution of patients based on Diet Table No.35 Distribution of patients based on Appetite Table No.36 Distribution of patients based on Sleep Table No.37 Distribution of patients based on Mala Pravruti Table No.38 Distribution of patients based on Prakruti Table No.39 Distribution of patients based on Vikruti Table No.40 Distribution of patients based on Saara Table No.41 Distribution of patients based on Samhanana Table No.42 Distribution of patients based on Pramana Table No.43 Distribution of patients based on Satwa Table No.44 Distribution of patients based on Satmya Table No.45 Distribution of patients based on Ahara Shakti Table No.46 Distribution of patients based on Vyayama Shakti Table No.47 Effect of chardi vega in group A“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 10. List of Tables  Table No.48 Effect of chardi vega in group B Table No.49 Comparison of Chardi vega within the groups Table No.50 Effect of Hb% in group A Table No.51 Effect of Hb% in group B Table No.52 Comparison of Hb% within the groups Table No.53 Effect of weight in group A Table No.54 Effect of weight in group B Table No.55 Comparison of weight within the groups Table No.56 Effect of Ananabhilasha in group A Table No.57 Effect of Ananabhilasha in group B Table No.58 Comparison of Ananabhilasha within the groups Table No.59 Effect of Nausea in group A Table No.60 Effect of Nausea in group B Table No.61 Comparison of Nausea within the groups Table No.62 Effect of Quantity of vomitus in group A Table No.63 Effect of Quantity of vomitus in group B Table No.64 Comparison of Quantity of vomitus within the groups“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 11. List of Tables  List of Diagrams Graph No.1 Incidence according to age Graph No.2 Incidence according to Religion Graph No.3 Incidence according to Occupation Graph No.4 Incidence according to Education Graph No.5 Incidence according to Habitat Graph No.6 Incidence according to Gravida Graph No.7 Incidence according to Vomiting Graph No.8 Incidence according to Frequency of vomiting Graph No.9 Incidence according to Quantity of vomiting Graph No.10 Incidence according to Content of vomitus Graph No.11 Incidence according to Ananabhilasha Graph No.12 Incidence according to Alasya Graph No.13 Incidence according to Angamarda Graph No.14 Incidence according to Anidra Graph No.15 Incidence according to Agnimandya Graph No.16 Incidence according to Brama Graph No.17 Incidence according to Daurbalya Graph No.18 Incidence according to Talu Shosha Graph No.19 Incidence according to Jihwa Shosha Graph No.20 Incidence according to Tandra Graph No.21 Incidence according to Shirashoola Graph No.22 Incidence according to Habitat Graph No.23 Incidence according to Family history Graph No.24 Incidence according to Diet“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 12. List of Tables  Graph No.25 Incidence according to Appetite Graph No.26 Incidence according to Sleep Graph No.27 Incidence according to Mala Pravruti Graph No.28 Incidence according to Prakruti Graph No.29 Incidence according to Vikruti Graph No.30 Incidence according to Saara Graph No.31 Incidence according to Samhanana Graph No.32 Incidence according to Pramana Graph No.33 Incidence according to Satwa Graph No.34 Incidence according to Satmya Graph No.35 Incidence according to Ahara Shakti Graph No.36 Incidence according to Vyayama Shakti Graph No.37 Effect of chardi vega in both the groups Graph No.38 Comparison of chardi vega within the groups Graph No.39 Effect of Hb% in both the groups Graph No.40 Comparison of Hb% within the groups Graph No.41 Effect of weight in both the groups Graph No.42 Comparison of weight within the groups Graph No.43 Effect of Ananabhilasha in both the groups Graph No.44 Comparison of Ananabhilasha within the groups Graph No.45 Effect on Nausea in both the groups Graph No.46 Comparison of Nausea within the groups Graph No.47 Effect on quantity of vomitus in both the groups Graph No.48 Comparison of Quantity of vomitus within the groups“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 13. List of Tables  List of Flow Charts Chart No.1 Flow chart showing types of chardi Chart No2 Flow chart showing Samprapti of chardi Chart No.3 Flow chart showing Upadrava of Chardi Chart No.4 Flow chart showing Physiology of vomiting Chart No.5 Flow chart showing Act of vomiting Chart No.6 Flow chart showing Causes of vomiting Chart No.7 Flow chart showing Cycle of vomiting Chart No.8 Flow chart showing Management of Vomiting List of Pictures SI.NO NAMES 1. Physiology of vomiting 2. Dadima 3. Shunti 4. Pippali 5. Maricha 6. Manjista 7. Pata 8. Nimba 9. Lavanga 10 Ativisha 11. Vamshalochana“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 14. List of Tables  12 Danyaka 13 Jeeraka 14 Haritaki 15 Ajamoda 16 Jatiphala 17 Madhu 18 Sharkara 19 Preparation of Dadima Avaleha 20 Formation of Leha“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”      
  • 15. Introduction  INTRODUCTION Pregnancy is a unique, exciting & joyous time in a women’s life, as it highlightsthe women’s amazing creative & nurturing power. The growing fetus depends entirely onits mother’s body for all its needs. So pregnant women must take measures to remainhealthy & well nourished to have a healthy child which is a motive of every humanbeing.1 Many demands are made during pregnancy as a consequent upon the rapidlygrowing fetus. To meet these requirements the maternal internal system has to undergocertain changes to create conditions favorable to the fetus.2 As a result certainphysiological changes take place among which Garbhini Chardi or emesis gravidarum isone. However this natural phenomenon turns into nightmare when she suffers from hyperemesis which may affect the growing fetus as well as health of the mother.3 Garbhini Chardi is mentioned as vyakta garbha laxana along with other laxanaslike Artava adarshana, asyasamsravana, arochaka, gurugatrata, stanamandala krushnataetc.4,5. All these laxanas are seen due to the presence of Garbha. When Chardi is seen as alaxana there is no much harm on growing fetus & mother, because of which it isconsidered as Physiological. But when it is seen in excess it becomes pathological whereearly intervention is needed to prevent this as it causes severe dehydration, tiredness,weight loss etc which may affect the growing fetus. So one should take care to treat theseconditions in initial stage & prevent complications as aim of every obstetrician is to givehealthy child to a healthy mother. In classics Acharyas have mentioned that pregnantwomen should be taken care like a pot filled with oil is carried with more caution asslight oscillation may cause spilling of oil from it.6 Similarly hyper emesis in certainwomen produces severe adverse affect on fetus & the mother where decision is taken toterminate pregnancy to save life of the mother. While explaining regarding chikitsa in Garbhini Acharyas have mentioned thatshe should be given things which are easily palatable, Hrudya & the one which is likedby her.6 Lehya which is one among the four types of food items is having goodpalatability because of sweetening agents present in this & is liked by Garbhini. Themetabolism & absorption of medicine in this form starts from the mouth itself because ofpresence of glucose, Fructose etc.7 Vomiting in pregnancy is seen mainly due to“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 1  
  • 16. Introduction carbohydrate starvation. As Honey & sugar is seen more in Lehya preparation along withmedicines it helps in supplementing carbohydrates. So acceptance of Avalehya inGarbhini is more compared to other form of medicines. In today’s world Avalehya isgaining rapid importance since it is easily consumable, rich in taste & is also having highdietic value.7Dadima is easily available in the market, liked by everyone especially by pregnantwomen as it is Hrudya, ruchi vardaka, ahara pachaka, Rakta vardaka. So this was selectedfor the study.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 2  
  • 17. Objectives of the study   OBJECTIVES OF THE STUDY1. To do conceptual study of Garbhini chardi.2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page3   
  • 18. Historical Review HISTORICAL REVIEW xÉÉåÅrÉÇ AérÉÑuÉåïS zÉÉxuÉiÉÉå ÌlÉÌSïxrÉiÉåAlÉÉÌSiuÉÉiÉç | xuÉpÉÉuÉ xÉÇÍxɬè sɤÉiuÉÉiÉç pÉÉuÉ xuÉpÉÉuÉÌlÉirÉiuÉÉiÉç |8 Ayurveda, the science of life which has no begining, deals with the thingswhich are inherent in nature & is eternal. This holistic science is known sinceprevedic, Vedic Period & practiced till today in preventing & curing the upcomingdiseases.Pre Vedic Period: - 2700-500 BCReferences regarding Garbhini or Garbhini chardi are not found.Vedic Period: - 2500 BC Among the 4 Vedas Ayurveda is considered as upaveda of Atharva Veda.References regarding Garbhini, Sutika are found, which shows that they hadknowledge regarding all these, but much of the explanation is not found. Garbhastapaka Aushadi’s & its use is explained.In Upanishads & Puranas:-13Padma Purana: - Explanations regarding development of garbha the food & regimenWhich must be followed by Garbhini is told.Vishnu Purana: - Chardi is explained as one of the somatic disorder but referenceRegarding Garbhini chardi is not found.Agni Purana: - It contains materials pertaining to all branches of Indian tradition &Culture including medicine. Description regarding development of garbha is found.Garuda Purana: - Description regarding development of the fetus & formation of bodyis explained.In Ramayana & Mahabharata:-Reference regarding Garbhini & Garbha is found. But references about Garbhinichardi is not found.Samhita Period: - (1000BC- 500AD)“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 4 
  • 19. Historical ReviewCharaka Samhita:–Acharya Charka has mentioned chardi as one among vyakta garbha laxana in shareraSthana & included it under Dwistarthaja i.e. Dauhrudaja type. A separate chapter onChardi is available in chikitsa sthana where nidana, Purvarupa, roopa, samprapti &Chikitsa for chardi is mentioned.4Sushruta samhita:-Acharya Susrutha opines chardi as one of the Vyakta garbha laxana. He considersAapanna Satwa as nidana for chardi. Dalhana commenting mentions apanna satwameans Garbhini. 5Astanga sangraha / Astanga Hridaya :-Both Vagbhatas mentioned chardi as vyakta garbha laxana & there explanation issimilar to that of Susrutha.9Sangraha Kala: - (500AD- 1700AD)Madava nidana:-A separate chapter is available which explains chardi & its management. Whileexplaining about nidanas of chardi Garbhini is explained as one among the cause forchardi.10Bhava prakasha:-He has also mentioned chardi as one of the vyakta garbha laxana. His opinion is sameas that of Susrutha.11Yogaratnakara:-Explanation regarding chardi & its management is found, but references for GarbhiniChardi is not available.12Kashyapa Samhita:-Much of the explanations about Garbhini & diseases seen in garbhavastha isexplained by Kashyapa. He explains Garbhini chardi, its types & managementaccordingly in Khilasthana. 14Haritha Samhita:-“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 5 
  • 20. Historical ReviewChardi is explained as one among the astagarbha Upadrava by Harita. Nidana, laxana& Chikitsa of these Upadrava are mentioned in same chapter.15Vangasena:-His explanation is same as that of Susrutha.16Previous work done -17 1. Dr.A.A.Shitre - .A study on effect of Mayura picchamasi in garbhinichardi, Ayurveda mahavedyalaya pune, Pune University in 1991. 2. Dr.Sonagara -.A clinical study on Garbavasttajanya chardi, G.A.U Jamnagar in 1993. 3. Dr.S.S Mohite -Garbhinichardi – Haritaki anupana madhu, Ayurveda mahavidyalaya pune, Pune University in 1994. 4. Dr. Hemavati S.K -The control study of Mathulunga Avaleha in management of garbhinichardi, SDMCA Udupi, RGUHS Karnataka in 2005“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 6 
  • 21. Disease Review  GARBHINI CHARDI During pregnancy many demands are made by the growing fetus, to meet theserequirements maternal system has to undergo certain changes.2 As a consequence there ismanifestation of certain conditions among which Garbhini chardi is one such conditionseen in early trimester. It is mentioned as one of the vyakta garbha laxana in classics.There is no separate chapter regarding Garbhini chardi, it can be considered under chardiwhich is elaborately explained in our classics, as Acharya Kashyapa has mentioned that euÉUɱÉlÉÉÇ ÌuÉMüÉUÉhÉÉÇ rÉ§É rɧÉåWû sɤÉhÉqÉç | A³ÉÉSÉlÉÉÇ mÉëuɤrÉÉÍqÉ iÉe¥ÉårÉ aÉÍpÉïhÉÏwuÉÌmÉ || (MüÉ. xÉÇ. ÎZÉ. 10) There is no difference in physical & psychological disorder of a pregnant womanfrom any other individual i.e. the child of 2 yrs till old man as the doshas & dusyas of thebody are same. She also exhibits similar symptology for all the diseases. Soeitiopathogenesis of Chardi in Garbhini is same as that seen in other individuals but onlythe principle of treatment differs as she is considered as sukumari. 18VYUTPATTI:-19The word “chardi” is a stree linga pada.It is derived from two words i.e. ‘chad’ dhathu & ‘inn’ pratyaya.The word ‘Chardh’ is again formed by two words‘Chad’- Means to fill. ‘Ardh’- Means discomfort.The one which fills the mouth & comes out causing discomfort to the body is calledchardi.      NûSïrÉÌiÉ Nû±ïiÉå CÌiÉ uÉÉ | NûSï uÉqÉlÉå (zÉ.Mü.SìÓqÉ) NIRUKTI:-“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 7  
  • 22. Disease Review          AÉqÉÉzÉrÉÉiÉç qÉÑZÉqÉÉaÉåïhÉ SÉåzÉÉhÉÉÇ oÉÌWûaÉïqÉlÉqÉç | 20(cÉ.ÍcÉ.) Vitiated doshas present in amashaya come out through the mukha marga called as chardi.           NûÉSrÉÌiÉ qÉÑZÉqÉç, ASïrÉÌiÉ cÉÉ…¡ûÉlÉÏÌiÉ cNûÌSïÈ | NûÉSrɳÉÉlÉlÉÇ uÉaÉæUSïrɧɅ¡ûpÉleÉlÉæÈ | (qÉSÒMüÉåwÉ) 21 ÌlÉÂcrÉiÉå cNûÌSïËUÌiÉ SÉåwÉÉå uÉY§ÉÇ mÉëkÉÉÌuÉiÉÈ |(xÉÑ.E.49/6) 22The vitiated doshas rush up to the mouth after covering whole of it & comes out withgreat force causing body ache called as chardi.PARYAYA:-23 Vantaou, Vamana, Vamatu, Vamihi, Chardika, Utkasika, Chardanam, Udgaraha.NIDANA:- Avoidance of the etiological factors of the disease comprises the prime line oftreatment in Ayurveda. The various causative factors mentioned by different Acharyas can besummarized under three major headings - i) Aharataha ii) Viharataha iii) Nidanarthakara rogajanyai) Aharataha: - Ahara plays a vital role not only in maintaining the health but is equallyresponsible for the causation of the disease if taken in improper way. Various etiologicalfactors related to food are: Excessive intake of Atidrava, Atisnigda, Ahrudya, Atilavana, Akala, Atimatra,Asatmya, ahara (Sushruta, Ashtanga Hridaya, Madhava Nidana, Bhavaprakash“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 8  
  • 23. Disease Review Vangasena, Yogaratnakara).All these factors leads to Agnimandya which further leads toahara dusti which in turn causes Vikruti of vatadi tridosha leading to Chardi.22ii) Viharataha: -Shrama, Kshaya, Manogata Karana: Krodha, chinta, bhaya, shoka Krodha produces Vatapitta prakopa. Chinta, Shoka and krodha produceVataprakopa. Krodha, Bhaya and shoka produce Pitta prakopa. All these factors & dustaAhara rasa in Garbhini causes chardi.iii) Nidanarthakara Roga: -              Aapannasatwa (Garbhini acc to Dalhana), Krumi. Acharya Susrutha while explaining Nidana of chardi has mentionedAapannasatwa as one of the cause, Dalhana on commenting has told that Aapannasatwameans “Garbhini”. Which means presence of Garbha is one of the cause for chardi. Healso mentions Dauhruda avamana as one of the causative factor.Acharya Yogaratnakara, Sarangadara, Vangasena etc followed Sushruta. Madhukosa has explained that along with “Aapannasatwa” Vata Vaigunya due topresence of garbha is a cause for chardi. Acharya Harita has explained Chardi as one of the Upadrava of garbha, where thecause for chardi is the presence of garbha. From all the above explanations we find three main causative factors for Garbhinichardi i.e.1. Aapannasatwa (Garbhini)2. Dauhruda avamana3. Vatavaigunya due to presence of garbha.Aapannasatwa: - Presence of garbha itself is one of the causes for chardi.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 9  
  • 24. Disease Review Dauhruda avamana: - During pregnancy women develops desire for certain foods &articles. If her desires are not fulfilled then that may lead to vata vruddi which vitiatemanasika & other doshas leading to chardi.Vata Vaigunya: - During pregnancy the poshana of the garbha takes place through therasas of the mother because of which dhathu shitilata may be seen which may lead to vataVaigunya. This vitiated vata along with other doshas may expel out through the mukhamarga in the form of chardi. NIDANA Table No.1 Nidanas of Chardi   Sl. Laxana Su.S A.S A.H MA.N Y.R VanNo. 1. Atidrava, + - - - + + 2. Atisnigda, + + + - + + 3. Atilavana rasa sevana + + + - + + 4. Akala + - - - + + 5. Atimatra, + - - - + + 6. Asatmya, + - - - + + 7. Ajeerna. + + + + + + 8. Ama. + + + - + _ 9. Shrama, + + + + + _ 10. Kshaya + + + + + - 11. Ahrudya - + + - - + 12. Chinta, + + + - + - 13. Bhaya, + + + - + + 14. Shoka - + + + + + 15. Aapannasatwa + + + + + + 16. Krumi + + + + + + 17. Atidruta - - - + - +“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 10  
  • 25. Disease Review Vishista Nidana according to Charakacharya –Table No.2 Vishista Nidanas of chardi 24Vataja Chardi Vyayama, Tikshna aushada, Shoka, Bhaya, Roga, Upavasa, Atikrusha.Pittaja Chardi Ajeerna, Vdahi ahara bhojana, Atyadika ushna Ahara sevana.Kaphaja Chardi Snigdha, Atiguru, Vidahi ahara sevana, Diwaswapna.Sannipataja Chardi Sarva rasa ahara sevana, Amapradosha, Rutuvipareeta ahara sevana.Dwistarthaja Chardi Dwista, Vipareeta, Apavitra, Maleena, Aprasanna ahara sevana.PURVAROOPA:-24mÉëxÉåMüÉå ¾ÒûSrÉÉåiYsÉåzÉÉå pÉ£üxrÉÉlÉÍpÉlÉlSlÉqÉç mÉÔuÉïÂmÉÇqÉiÉÇ NûÌSï | (xÉÑ.E.49/8)Table No.3 Purvarupa of chardi   Laxana Ca Su M.Ni A.S A.H Vanga Y.R1. Hrudayautklesha + + + + + + +2. Kaphapraseka + + + + + + +3. Annadwesha + + + + + + +4. Udgararodha - - + + + + +BHEDA:- 24Acharya Charaka, Susrutha, Madhava nidana, Vagbhata, Y.R, Vangasena haveconsidered Dauhrudaja Chardi among Agantuja type & mentioned that they must beidentified by the lakshanas of all the doshas & treated accordingly.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 11  
  • 26. Disease Review 1. Flow chart of types of chardi. Chardi Vataja Pittaja Kaphaja Sannipataja Agantuja 1. Krimija 2. Dauhrdaja 3. Amaja 4. Bibatsaja 5. Asatmyaja Dauhrudaja Vataja Pittaja Kaphaja SannipatajaAcharya Sharangadara has mentioned 7types of Chardi & included Garbhadana as one ofthe type. Chardi25Vataja Pittaja Kaphaja Sannipataja Krumija Garbhadana Grunya“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 12  
  • 27. Disease Review ROOPA:-Table No.4 Roopa of Vataja Chardi  VATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.RHrutparshvapeda + + + + + + +Mukhashosha + _ + _ _ + +Kasa + _ + + + + +Swarabheda + _ + + + + +Shabdaprabalaudgara + + + + + + +Alpamatra + + + + + + +Pheneela + + + + + + +Krushna Varna + _ _ + + + +Kashayarasa + + + + + + +Srantha - + + + + + +Shosha - _ _ + + _ +Table No.5 Roopa of Pittaja chardi  PITTAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.RMurcha + + + + + + +Pipasa + _ + + + _ +Mukhashosha + _ + + + _ +Santapa + + + + + + +Bramha + _ + + + + +Peeta, Harita, varna + + + + + + +Ushnayukta + + + + + + +Tikta rasa + + _ + + _ +Daha + + + + + + +Ksharodaka - _ _ _ _ + _“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 13  
  • 28. Disease Review Table No.6 Roopa of Kaphaja chardi KAPHAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.RTandra + _ + _ _ + +Madhurata + + + + + + +Kaphapraseka + _ + _ _ + +Santosha + _ _ _ + + +Nidra + _ + _ _ + +Aruchi + + + + + + +Gourava + + + + + + +Lomaharsha + + + + + + +Alparuja + _ + _ _ + +Swetavarna _ + _ _ _ _ +Snigda _ _ _ + + + _Adikamatra _ + _ _ _ _ _Hrullasa _ _ _ + + _ _Tandra _ _ _ + + _ _“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 14  
  • 29. Disease Review Table No.7 Roopa of Sannipataja chardiSANNIPATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.RShula + _ + _ _ + +Avipaka + _ + + + + +Aruchi + _ + _ _ + +Daha + _ _ _ + + +Trushna + _ + _ _ + +Swasha + _ + + + + +Murcha + _ + + + _ +Sarva Varna yukta + _ + + + + +Moha _ _ _ _ _ _ +SAMPRAPTI:- Samprapti involves dosha dushya sammurcchana and the subsequentmanifestation of the disease. Hence an indepth scrutiny into the different angles becomesnecessary by which the clarity of the disease process is established. This alone enables usto efficiently manage or cure the disease as samprapti vighatana is Chikitsa.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 15  
  • 30. Disease Review 2. Flow chart showing samprapti of chardi26 Garbhini stree due to Garbha utpeedana & Atidravadi nidana sevana Vatadi shareerika dosha prakopa Manasika dosha prakopa Dauhruda avamana Udanavruta apana, Vyana Vata vruddi Kapha Pitta prerana Amashaya stitha aahara dusti (Agnimandya) Vimargagamana of vrudda dosha Mukha achadana, poorana ChardiDuring pregnancy due to garbha peedana or due to Dauhruda avamana there is Vataprakopa which further vitiates Kapha, Pitta & ahara rasa. Due to dosha utklesha they areforcibly expelled through the mouth with the help of Vata resulting in Chardi.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 16  
  • 31. Disease Review Samprapti ghatakaDosha – Udana, apanna, vyana, Kapha & Pitta.Dushya - Rasa (Ahara rasa)Srotas – Annavaha & RasavahaAgni – Jatharagni, RasadhatwagniAma - Jatharagni, Rasadhatwagnijanya AmaAdhistana – AmashayaVyakta sthana- MukhaSrothodusti – Sanga, VimargagamanaVyadi avastha – AmaSanchara sthana – RasavahiniRogamarga – AbyantaraSadyasadyatha – SadyaNidana panchakaChaya – Aharaja, viharaja & Manasika nidana sevana leads to Chaya of vatadi dosha.Prakopa – Further exposure to same kind of nidana & Dauhruda avamana leads tovitiation of vatadi three dosha.Prasara – Aggravated vatadi dosha & ahara rasa move towards Amashaya.Sthanasmsraya – These vitiated dosha come out from Amashaya through mukha margaVyakta – In the form of Chardi.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 17  
  • 32. Disease Review ASADYA LAXANAS:-Table No.8 Laxanas of Upadrava SI laxanas C.S S.S Y.R Van NO 1. Vit,Sweda,Mutra,Ambuvaha + - + + srota avarodha 2. Vinmutra ganda varna + - + + chardi 3. Shonita & pooya yukta + + + + 4. Swasa, Kasa etc - + + + Acharya Charaka, Susrutha, Y.R, Vangasena have explained that there isobstruction to Sweda, Mutra & Ambuvaha Srotas. Due to this obstruction they move inupward direction because of which the chardi which comes out contains the Varna andgandha of mutra, sweda etc. When Chardi is seen in excess times then it may beassociated with Shonita or pooya which may lead to kasa, swasa, hrudrogadi etc laxanas.These above features are seen in condition called hyper emesis where there is presence ofexcess vomiting which may be sometimes mixed with blood & due to severe dehydrationthere is presence of Ketone bodies in urine & smell of acetone may be seen through thebreath. Person becomes weak & emaciated if they are left untreated then they enter intothe stage of coma which may eventually lead to death. In ancient times people used to neglect these conditions or used to approachvaidyas in later condition which were not treatable & patient used to die. So Acharyashave mentioned them as Asadya laxanas. But in present era due to public awareness &regular antenatal care they are diagnosed earlier & with good advancement of medicines& rehydration therapy these conditions can be controlled, but certain side effects on fetusas well as on mother is seen.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 18  
  • 33. Disease Review UPADRAVA:-241. Kasa2. Swasa3. Jwara4. Hikka5. Trushna6. Vaichintya7. Hridroga8. Tamaka swasa3. Flow chart showing samprapti of Upadrava.These conditions are seen as a complication due to excess vomiting. Excess chardi Vata prakopa Urdwagamana of vata Along with Chardi Trusna, Kasa, swasa Hridroga Vaichintya Death“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 19  
  • 34. Disease Review CHIKITSA:- xÉÔ¤qÉÉÇ ÍcÉÌMüixÉÉÇ uɤrÉÉÍqÉ aÉÍpÉïhÉÏlÉÉÇ ÌuÉpÉÉaÉzÉÈ | iÉjÉÉ aÉpÉï¶É lÉÉUÏ cÉ uÉkÉïiÉå U¤rÉiÉåÅÌmÉ cÉ | 27(MüÉ.ÎZÉ.10/3) Even though Acharya Kashyapa has mentioned that the diseases occurring inpregnant women is same as that of non pregnant women, the principles of treatmentdiffers from that of general chardi. There they have mentioned langana & shodhana asline of treatment, which cannot be given to the pregnant women. Hence gentle treatmentshould be given which helps to cure the disease & also maintains the growth of fetus.Pregnant women should be treated just like a pot which is filled with oil because theslightest movement will cause spilling of oil from the pot. Similarly slight excitementmay cause problem to the fetus.            AlÉÑMÔüsÉÉåmÉcÉÉUåhÉç rÉÉÌiÉ Ì²¹ÉjÉïeÉÉ zÉqÉqÉç |(A.xÉÇ.ÍcÉ.8/13)28Dwistarthaja chardi should be treated by providing agreeable foods & drinks which helpsto cure the condition & also maintains pregnancy. SÉæ¾ÒûÌSÇ MüÉÌXû¤ÉiÉæÈ TüsÉæÈ | (xÉÑ.E.49/25)29 If desires of dourhda is not fulfilled there may be dhathu Kshaya as she will notconsume food properly which leads to Vata vruddhi leading to chardi. So the line oftreatment should be stambana & bramhana which helps to control vomiting & providenutrition for the fetus. So the preparations made up of a drug which specifies vatadidoshas, laghu, Hrudya, Agnideepaka, Dhathu vardaka should be used. Preparations in theform of Leha, Churna, and Syrups etc which are pleasant & easily palatable to Garbhiniare beneficial. Among all Acharyas, Kashyapa is one who has mentioned management ofdoshaja chardi in antarvatnichikitsadyaya but has not specified its use as only in Garbhinichardi. 30“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 20  
  • 35. Disease Review Vataja chardi:- ‐ Leha prepared with Matulunga rasa, laja, kola, dadima rasa, sharkara, anjana & madhu. ‐ A salt free soup prepared with juice of Matulunga, meat of goat or buffalo with dadima rasa & appetizing articles.Pittaja chardi:- ‐ Caturjata Kalka is added with tandulodaka along with laja, sugar, madhu, & sugandha pushpa. ‐ Laja peya along with sugar & honey.Kaphaja chardi:- ‐ Phanta prepared with tender leaves of Amra & jamboo along with honey. ‐ Soup prepared with Mudga, medicated with seeds of dadima mixed with salt & butter.Sannipataja chardi:- ‐ Here according to predominance of doshas combined treatment should be given.Krimija chardi:- ‐ Kwatha prepared with mula of punarnava & bhadradaru along with honey should be used.Harita has mentioned use of bilva fruit along with curd or sugar. Vatsaka, pippali, shunti& amalaki fruit can also be used.Acharya Susrutha, Y.R, Vangasena have explained use of saindava lavana & ghruta inVataja chardi. ‐ Three types of lavana mixed with Ksheerodaka. ‐ Yusha prepared with mudga, Amalaki, Saindava along with panchamula kashaya.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 21  
  • 36. Disease Review Pittaja chardi:- ‐ Yavagu prepared with Laja, Yava, Mudga, along with honey should be used. ‐ Yusha prepared with Sugandhita, Madhura or Tikta dravya should be used. ‐ In case of Pittaja chardi associated with daha & Trushna draksha rasa along with honey should be used. ‐ Haritaka churna along with madhu should be given, Because of which doshas move out through down ward movement & chardi is controlled.Kaphaja chardi:- ‐ Vidanga, Triphala, Trikatu churna along with madhu should be used for licking. ‐ Aragvadha khashaya, chardi nirahana gana dravya khashaya should be taken along with honey.Sannipataja chardi:- ‐ Guduchi phanta should be mixed with honey & should be taken internally. ‐ Masura sathhu is done mardana with honey & taken along with dadima rasa. ‐ Mayura piccha basma along with honey cures Upadrava yukta chardi.Acharya Yogaratnakara has mentioned – ‐ Dhanyaka Kalka along with tandulodaka & sugar. ‐ Bilva majja mixed with liquid prepared from laja. ‐ Decoction of shunti & bilva mixed with flour of parched barley is beneficial in both vomiting & diarrhea.Preparations used in chardi chikitsa:- 31Kwatha :- Parpatadi Kwatha (p) Guduchyadi Kwatha (p) Mudga Kwatha (p)“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 22  
  • 37. Disease Review Hima :- Marichadi Hima Guduchi HimaPhanta :- Amradi phantaChurna :- Vidangadi churna (k) Eladi churna (sa)Vati :- Sootashekar Chardi ripuAvaleha :- Chandanavaleha (p) Makshikadi Avaleha Laja saktavavaleha Koladi Avaleha (sa)Sharkara :- Dadima sharkaraYusha :- Lajjadi yusha (p)Panaka :- Chandana panaka (p) Dhatriphaladi panaka (sa)Dhupa :- Jeerakadi dhupa (sa)Pisti :- Pravala pisti Mukta pistiArka :- Pudina ArkaGhruta :- Jeevaneeya ghruta Padmakadi ghruta Patoladi ghruta (kp)Bhasma :- Mayura puccha bhasma Swarnamakshika bhasmaRasa :- Jirakadi rasa“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 23  
  • 38. Disease Review  Vamanamruta rasa (sa) Vantitihd rasa, Chardyantaka rasaPathya Apathya -Ahara Pathya ApthyaVegetables Nimba DhanyakaFruits Dadima Bimbi Phala Badara Amra Jambeera Amalaki Draksha NareekelaSpices Shunti (min. qty.) Shunti (large dose) MareechaCereals Yava Indrayava Shali shastikaFoods Manoonukula Prakruti Viruddha Satmya aharaDrinks Coconut water Excess liquid & Mamsa rasa Dushita jalaChikitsa Shamana Shodhana Dairya, Sneha Chinta, Bhaya Counseling Shoka.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 24  
  • 39. Disease Review Vihara Pathya Apathya All Manoanukula karya ExcesVyayama, Exertion Like Praying, Meditation Bibhatsya vastu darshana Yoga, Walking. Leading to fear & sudden emotions Listening to good music, Good words. Riding vehicle, Hitakara rasa gandha sevana Lifting heavy weights.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 25  
  • 40. Disease Review  VOMITING Vomiting is considered as one of the symptom of many diseases especially ofgastro intestinal tract rather than a separate disease entity. It is present as a cardinalsymptom in many diseases which helps in diagnosis. Nausea & Vomiting are seentogether in many diseases/conditions among which pregnancy is one such conditionwhere with history of amenorrhea & presence of nausea & vomiting it was diagnosed thatwomen is pregnant . It is present in most mammals except rodents, a species that lacksthe vomiting centre. The word Nausea is derived from the Greek word “naus” meaning “ship” & theLatin word “nauta” meaning sailor & thus originally carried the idea of sickness from seatravel. 32Definition:- It can be defined as the process by which the contents of the upper gut areexpelled to the exterior through the mouth. It helps in removing unwanted & irritatingmaterials out of the body. 33 It is also defined as a forcible expulsion of the contents of upper G.I. tract throughthe mouth. The strongest stimuli include unpleasant sights & dizziness or irritation &distension of the stomach.Causes of Vomiting:- 34 ‐ Indulgence of foods which are very fatty, unpleasant, very watery & salty. ‐ Taking meals at odd times, in excess quantity. ‐ Infection by worms. ‐ Pregnancy ‐ Sight of terrific, fearsome, ugly & unpleasant things. ‐ Ingestion of toxins i.e. food poisoning.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 26  
  • 41. Disease Review  ‐ Gastritis, peptic ulcer with or without pyloric stenosis, dyspepsia, intestinal obstruction etc. ‐ Raised intra cranial tension, meningial irritation, motion sickness, encephalitis, labrynthitis, and migraine. ‐ Acute hepatitis. ‐ Psychogenic vomiting. ‐ Drugs which produce gastritis, over dose of digitalis etc. Physiology of vomiting 354. Flow chart showing Physiology of vomiting.                                                         CORTEX SMELL, PAIN, SIGHT STIMULI CTZ VOMITING CENTRE CEREBELLUM GIT INNER EARG.I.IRRITATION, VEGAL STIMULATIONINFECTION, DRUGSRADIATION. MOTION SICKNESS“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 27  
  • 42. Disease Review                                                 Different connections of the vomiting centre  Vomiting which is accompanied by complex movements is being controlled bythe vomiting centre. There are multiple pathways that stimulate vomiting, i.e. afferent &efferent pathway which are carried by both vagus & sympathetic nerves. Among theseafferent impulses play major role in stimulating vomiting. The major relay station in thispathway is the CTZ (chemo receptor trigger zone) which is situated in the lateral borderof area postrema of the medulla oblongata & is unprotected by the blood brain barrier &other is the solitary tract nucleus. CTZ being a purely sensory relay station is capable ofinitiating vomiting even in absence of vomiting centre. Disturbed equilibrium leads togeneration of impulses from vestibular apparatus which reach the vomiting centrethrough cerebellum. Various unpleasant sensory stimuli such as bad odor, ghastly sight,pain & fear stimulates vomiting acting through the higher centre.Nausea & vomiting due to olfaction pathway:- 36 Major portion of the nasal cavity is covered by the olfactory mucosa; the receptorcells for the smell sensation are present in this mucosa, when the odorant substancecomes in contact with olfactory surface that covers cilia & then diffuses into the mucosa“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 28  
  • 43. Disease Review by binding with the receptor that protrudes through the ciliary membrane. This activatesadenyl cyclase that is attached to the insight of the ciliary membrane. Which internconverts intracellular ATP into c-AMP. This causes sodium ions to pour into the receptorof cell cytoplasm, thus exciting the olfactory neuron system & transmitting actionpotential into the CNS by way of an olfactory nerve.ACT OF VOMITINGThe vomiting act encompasses three types of outputs initiated by CTZ. ‐ Increased salivation to protect the enamel from the gastric acid. ‐ Retro peristalsis movement which starts from the middle of the small intestine & moves upward sweeping all the contents into the stomach through the relaxed pyloric stinosis. ‐ A lowering of intra thoracic pressure, coupled with an increased in abdominal pressure making abdominal muscles to contract & propels stomach contents into esophagus as the esophageal sphincter relaxes causing vomiting which is followed by retching . 5. Flow chart showing act of vomiting:- 37 Taking a deep breath. Raising the hyoid bone & larynx to pull the UOS open Closing of the glottis-prevents aspiration in the trachea. Soft palate lifted to close the posterior nares Subsequently strong downward contraction of diaphragm. Simultaneous contraction of abdominal wall muscles. Squeeze stomach to build up high intra gastric pressure“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 29  
  • 44. Disease Review  Finally LES relaxes allowing expulsion of gastric contents upwards.  MORNING SICKNESSDefinition: -38 Morning sickness is the nausea & vomiting scene in women during pregnancy inearly trimester. All though it is more common in the morning it can last for all the day insome women. 38Prevalence of Nausea & vomiting in pregnancy:- It is one of the common conditions & affects 70 - 85 % pregnant women. Around30-50 % of pregnant women have episode of vomiting while 30-90 % of womenexperience nausea alone.Etiology:- 38 The exact cause remains unknown but various theories have been proposed whichleads to nausea & vomiting during pregnancy.HORMONAL THEORY :-38Progesterone: - It is the pregnancy dominating hormone which helps in maintainpregnancy by producing softening effect on the muscular system thus preventing uterinecontraction. This softening effect is also seen on muscles of stomach of intestines whichleads to slow emptying of stomach giving rise to excess gastric secretion which maycause vomiting.HCG (Human chorionic Gonadotrophine) :- During pregnancy level of HCGdramatically rises, peaks & diminishes from week 5-15 of pregnancy. At the same timewe find morning sickness in most of the women raises, peaks & diminishes. It may bebecause of high level of HCG in the blood stream activates the vomiting centre in thebrain which causes vomiting.Estrogen ;- It is known to produce nausea & vomiting as seen in women on OCP’S.Vomiting is more common when oestradiol levels are increased & vice versa is also true.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 30  
  • 45. Disease Review Psychogenic theory: - Psychiatric illness, Conversion of somatization disorder ordepression during pregnancy directly stimulate higher centers & leads to nausea &vomiting. Vestibular & olfaction: - Hyperactivity of olfaction & disturbed equilibrium investibular apparatus may lead to nausea & vomiting during pregnancy.Infection: - Presence of Helicobacter pylori in the stomach may cause nausea &vomiting during pregnancy.Adrenal insufficiency: - In normal pregnancy certain morphological changes are seen inthe adrenal gland. There is decrease in the size of adrenal compared to that of the nonpregnant. Metabolic clearance is lowered during pregnancy because of which the serumlevel of sodium, chloride, bicarbonate & glucose are below normal level, but serumpotassium level is elevated. This may result in weakness, anorexia, nausea & vomiting.Immunological basis: - Maternal recognition of pregnancy is brought by the way ofsignals generated by the trophoblast that act upon the maternal ovary. The immunologicalacceptance of semiallogenic tissue of the concepts is modulated by the regulation of HLAi.e. Human Lymphocyte antigen expressed by trophoblast. This may sometime triggervomiting during pregnancy.Toxins: - How far this theory is true is not yet known. It is said that vomiting seen inearly trimester helps to protect the developing fetus by encouraging the mother to avoiddangerous or toxic food intake. It is a kind of defense mechanism seen due to thepresence of fetus to protect itself.Other causes;-39 ‐ Family history of emesis or hyper emesis. ‐ Most common in unplanned pregnancies. ‐ In women with high dietary intake of saturated fat before pregnancy. ‐ Most common in women with history of motion sickness or migraine. ‐ Women with increased placental mass as in case of multiple pregnancies & hydatidiform.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 31  
  • 46. Disease Review  ‐ Decreased levels of calcium & glycogen in mother leads to morning sickness. ‐ Smoking & Alcohol.Causes of vomiting in pregnancy –406. Flow chart showing causes of Vomiting. Morning Sickness Early pregnancy Late pregnancyRelated to pregnancy Associated with pregnancySimple vomiting Hyper emesis Medical Surgical Gynecological 1. Intestinal infection 1.Appendicitis 1.Twisted ovarian syn 2. UTI 2.Peptic ulcer 2.Fibrod Degeneration 3. Hepatitis 3.Int.Obstruction 4. Diabetic Ketoacidosis 4.Cholecystitis 5. Uremia“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 32  
  • 47. Disease Review  The different causes of vomiting such as appendicitis, Gastroenteritis,Cholecystitis, Pancreatitis, intestinal obstruction & pylonephritis should be considered. Inselected patients with additional clinical features appropriate investigations to exclude anunderlying cause may be indicated. Once a diagnosis of hyper emesis has been reachedthen associated conditions of multiple pregnancies & hydatidiform mole should be soughtby clinical examination & an ultrasound scan of the uterus. When these conditions havebeen excluded, it is possible to feel confident that one is dealing with specific idiopathichyper emesis of an otherwise normal singleton pregnancy. Whatever may be the cause of initiation of vomiting unless it is not quicklyrectified features of dehydration & carbohydrate starvation supervene & a vicious cycleof vomiting appears.7. Flow chart showing Cycle of vomiting- 40 Vomiting Carbohydrate starvation Ketoacidosis VomitingSymptoms:- 39In case of simple vomiting- ‐ Nausea, Vomiting & occasional sickness on rising in the morning. ‐ The Vomitus is small, clear or bile stained, Sometimes associated with food. ‐ Persistent vomiting shortly after eating or drinking even water is seen. ‐ Nutrition does not suffer.In case of severe vomiting – ‐ Vomiting is increased in amount & frequency.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 33  
  • 48. Disease Review  ‐ Vomitus may be coffee brown or mixed with blood. ‐ Weight loss may be seen. ‐ Oliguria. ‐ Epigastric pain. ‐ Constipation may occur. ‐ Person is unable to do any activities. ‐ Giddiness & tiredness is present.   Signs – 39If emesis is not treated earlier then features of severe vomiting such as dehydration & Ketoacidosis is seen which may lead to ‐ Dry coated tongue. ‐ Sunken eyes. ‐ Skin becomes lusterless & in elastic. ‐ Anxious look. ‐ Acetone smell in breath. ‐ Increased pulse rate 120 or more/minute. ‐ Tachycardia. ‐ Hypotension. ‐ Features of peripheral neuritis may be seen. ‐ Appearance of Jaundice as a late feature.Consequences – ‐ Due to severe vomiting patient may develop frustration which may lead to depression. ‐ A feel of being neglected may develop. ‐ There may be adverse effect on family relationships. ‐ She might take decisions of not to have another child. ‐ Effect on physical, Social & Psychological state of the pregnant women on fetus & on her family. ‐ Fear of severe morbidity & mortality may be seen.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 34  
  • 49. Disease Review Metabolic, Biochemical & Circulatory Changes due to severe vomiting – 40Metabolic changes: - Due to excess vomiting patient develops fear for intake of foodthinking that it further aggravates vomiting. Because of inadequate food intake there isdepletion in glycogen level, for the energy supply fat reserve is called upon. There is incomplete oxidation of fat due to low carbohydrate because of which there isaccumulation of ketone bodies in the blood. The acetone is ultimately excreted throughthe kidney & breath. There is also increase in tissue protein metabolism resulting inexcessive excretion of non protein nitrogen in urine.Biochemical changes: - Due to excess vomiting there is loss of water & salts from thebody which results in fall of plasma sodium, potassium & chloride. Hepatic dysfunctionresults in acidosis & ketosis with rise in blood urea, uric acid, hypoglycemia,hypoprotienamia, hypovitaminosis & rarely hyperbilirubinaemia.Circulatory changes: - There will be increase in hemo concentration which will furtherlead to rise in Hemoglobin levels, RBC, WBC & haematocrit values.Complications due to severe vomiting:- 40 ‐ Neurological complication like wernick’s encephalopathy, peripheral neuritis, Korsakoff’s psychosis may be seen. ‐ Esophageal tear or rupture. ‐ Stress ulcer may develop in the stomach. ‐ Spleenic avulsion. 39 ‐ Jaundice. ‐ Renal failure. ‐ Psychological morbidity in the form of depression or somatization may be seen. ‐ Death from nausea & vomiting of pregnancy is rare but may occur due to the complications of hyper emesis.Effect on Fetus:-39Mild to moderate vomiting has no much effect on fetus.In severe vomiting there is higher incidence of low birth weight in about 30% of womenwho lose weight in pregnancy.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 35  
  • 50. Disease Review Investigation:-In simple vomiting – Blood group – Hb % – Urine routine – USG if necessaryIn severe vomiting ‐ Hb % / Haematocrit values ‐ Serum electro light values ‐ LFT (SGOT, SGPT, Bilirubin) ‐ Urine analysis its quantity, color, specific gravity, ketone bodies, bile pigments, chlorides. ‐ Opthalmoscopic examination ‐ ECG ‐ USGManagement:-39In simple vomiting ‐ Assurance. ‐ Taking water, dry toast or biscuit before getting up from the bed. ‐ Eating several meals during a day instead of three big once because empty stomach can cause nausea & vomiting. ‐ Fatty food must be avoided as they can worsen the condition. ‐ Food rich in carbohydrate must be taken. ‐ Drinking plenty of fluids is necessary as they help in replacing lost fluids & neutralize stomach secretions. ‐ Foods with smell which bother must be avoided. ‐ Drinking ginger tea or ginger ale is beneficial. ‐ Eating crackers every morning 20 min. before getting out of bed. ‐ Wearing one or two acupressure wrist bands to prevent motion sickness.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 36  
  • 51. Disease Review  ‐ Avoiding stress. ‐ Wearing loss fitting clothes. ‐ Extra sleeping. ‐ Doing activities which are pleasing to the mind. ‐ Drugs like multivitamin supplementation, pyridoxine 25mg 8th hourly, doxalamine10mg + pyridoxine 10mg for three to four times a day can be taken.Hyperemisis:- 40 ‐ The principle of management is to correct fluids, electrolyte & other metabolic disturbances effectively. ‐ Hospitalization, Laboratory investigations. ‐ To prevent or detect at the earliest about the complication that may arise & treat them. PHARMACOLOGICAL PRINCIPLES OF MANAGEMENT OF NAUSEA &VOMITING35 The antiemetic agents are classified as: 1) Anticholinergics 2) Antihistaminics 3) Antidopaminergics 4) Anti 5 HT3 5) Miscellaneous.AnticholinergicsBlock afferent impulses to vomiting center by anticholinergic actionMild sedative action also contributes to antiemetic effect E.g. ScopolamineAntihistaminicAction on vomiting centre & mild sedative effect“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 37  
  • 52. Disease Review  E.g. Cyclizine: Available as Cyclizine hydrochloride (Marzine)Dose: - 50mg (oral)Action: - H1 receptor antihistaminic agent - Action prolonged - Mainly used for motion sickness Meclizine: Available as Meclizine hydrochloride.Dose: - 25 – 50 mg oralAction: - Action longer than Chlorcyclizine mainly used for motion sickness.Promethazine hydrochloride (Phenargan):Dose: - 12.5 – 25 mgAction: - Longer duration of action - Produces marked sedationPromethazine chlorotheophyllinate (Avomine):Dose: - 25-75 mgAction: - Used mainly in motion sickness. Superiority over Promethazine is doubtful.AntidopaminergicAct on CTZ by selectively depressing CTZ. E.g. Chlorpromazine Available as:Chlorpromazine hydrochloride (Largactil)Tab - 10, 25, 50, 100 mgSyp - 25 mg (adults) per mlDaily dose: Varies according to condition of patient.Range 25 mg to 1000mg.And related drugs- Metoclopramide Domperidone“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 38  
  • 53. Disease Review Anti 5 HT3Block the 5 HT3 receptors & thus prevent vomiting. Ex - Ondansetron and Granisetron.MiscellaneousButerophenones - Droperidol & Haloperidol have significant antiemetic effect byantagonism of dopamine receptors.8.Flow chart showing Management of Emesis & Hyper emesis. 38 Gestational Emesis  Reassurance, rest, Dietary ManipulationPersisting Emesis Stable weight, Minimal ketosisWeight loss, Ketosis Normal fetal growth*Electrolyte hydration Routine prenatal care*Dietary Manipulation*Laboratory evaluationHospitalization,Electrolyte replacement,Psychological & Pharmacological support.Termination of pregnancy, if necessary in case of complications.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 39  
  • 54. Disease Review Final Impact 38 Recent studies on effect of nausea & vomiting on pregnancy has shown following reports. ‐ About 35% of women with nausea & vomiting in pregnancy are unable to work. The average loss of work time is said to be 62hrs. ‐ A study on quality of life variables found that pregnant women with mild to moderate nausea vomiting are unable to care for young children or perform house hold tasks & daily activities. ‐ The mother risk programme at the hospital for sick children in U.S. has reported that nausea & vomiting is often cited as a reason for pregnancy termination by therapeutic abortion, on the other hand some studies have associated nausea & vomiting with good pregnancy out come. ‐ Moderate nausea & vomiting have been found to lower the risk of miscarriage .This protective effect is absent in mothers not suffering from nausea & vomiting during pregnancy which indicates lower levels of estrogen.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 40  
  • 55. Drug Review                                                                                                                                                                             DRUG REVIEW  The use of plants as medicine can be seen in almost all the ancientcivilizations of India, Egypt etc. In India from Vedic period plants have beenconsidered as principle remedy for the mitigation and cure of diseases.Various plant remedies have been evaluated in Ayurveda for the managementof diseases. The Indian sages discovered drugs, invented combinations,studied potential toxic effects and prescribed therapeutic uses long ago. Thiswas based on the observations of the effect of drug on human beings andanimals. Large numbers of drugs used in a similar manner have been foundfrom Vedic period itself. As research is the scientific and diligent study, this herbal preparationof Dadimaavaleha is taken for clinical experimentations in order to establishfacts and analyze their significance in Garbhini chardi.Ingredients of Dadimaavaleha: 4 11. Dadima – 1Kg 11.Nimba patra- 50gms2. Nagara – 50gms 12.Manjistha- 50gms3. Pippali - 50gms 13.Kuta shalmali- 50gms4. Pippali mula – 50gms 14.Pata- 50gms5. Danyaka- 50gms 15.Lavanga- 50gms6. Ajamoda- 50gms 16.Ativisha- 50gms7. Jatiphala -50gms 17.Jeeraka- 50gms8. Jatipatra – 50gms 18.Haritaki- 50gms9. Maricha- 50gms 19.Madhu- 50gms10. Vamshalochana- 50gms 20.Grutha- 50gmsWater – 4litSugar – 1 kgMadhu- 1kgGhrutha – 1kg“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 41  
  • 56. Drug Review                                                                                                                                                                              42,43,44   Table No: 9 Showing rasa, guna, veerya,vipaka & karma of the drugs Sl. Dravya Rasa Guna Veerya Vipaka DoshagnataNo Madhura, amla, Madhura/A1. Dadima Laghu, snigdha Ushna Tridoshahara Kashaya mla Kapha vata2. Shunti Katu Laghu, Snigdha Ushna Madhura shamaka Laghu, Theekshna, Kapha vata3. Pippali Katu Sheetha Madhura Snigdha shamaka Laghu, Ruksha, Kapha vata4. Pippalimoola Katu Ushna Katu Theekshna shamaka Madhura,5. Danyaka Laghu, Snigdha Sheetha Madhura Pitta shamaka Kashaya Kapha vata6. Ajamoda Tikta, Katu Laghu Ushna Katu shamaka Kapha vata7. Jatiphala Tikta, Katu Theekshna, Ushna Ushna Katu shamaka Kapha vata8. Jatipatra Tikta, Katu Theekshna, Ushna Ushna Katu shamaka Kapha vata9. Jeeraka Tikta, Katu Laghu, Ruksha Ushna Katu shamaka Kapha10  Maricha Katu Laghu, Theekshna Ushna Katu shamaka vamshalochan Madhura, Kapha pitta11 Laghu, Ruksha Sheetha Madhura a Kashaya shamaka Kapha pitta12 Nimba patra Tikta, Kashaya Laghu, Ruksha Sheetha Katu shamaka Madhura, Kapha13 Manjista Guru Ushna Katu Kashaya shamaka Pitta vata14 Kuta shalmali Kashaya Snigdha Sheetha Katu shamaka15 Pata Tikta kashaya Laghu, Ruksha Sheetha Katu Tridoshahara Kapha pitta16 Lavanga Tikta,Katu Laghu, Theekshna Sheetha Katu nashaka Kapha pitta17 Ativisha Katu,Tikta Laghu, Ushna Katu shamaka Pancharasa(lav ana varjitha),18 Haritaki Laghu, Ruksha Ushna Madhura Tridoshahara Kashaya pradhana Kapha vata19 Grutha Lavana, Katu Ruksha, Theekshna Ushna - shamaka Madhura, Lagu,Ruksha, Kapha pitta20 Madhu Sheetha - Kashaya sheetala, shamaka Sheetala,snigda21 Sharkara Madhura Sheetha - Pitta shamaka Guru22 Guda Madhura Guru,snigdha Sheetha - Pitta shamaka “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 42  
  • 57. Drug Review                                                                                                                                                                              Table No: 10 Showing botanical description of drugs Botanical Family Karma Chemical CompositionSI.No Dravya Name Fruits contain -Tannins, Pu Hrdhya, Punnica icalin, Punicalagin. 1. Dadima Punicaceae Tridoshahara, granatum Seeds contain - Shukrala. estrone,vpunicic acid. Shigarol,Gingerol,Protein 2.3%, fat 0.9%, Carbohydrate Zingiber Zingiberac Shothahara, rakta 12.3%, Minerals 1.2%, 2. Shunti officinale eae shodhana Calcium 20%, Phosphorous 60%, Iron 2.6mg/100g, Iodine and fluorine trace Piperine 0.15%, Piplartine Piper Rakta vardhaka, 3. Pippali Piperaceae 0.16%, Piperlogumine and longum rakta shodhana piperlonguminine Deepana, Piperine 0.15%, Piplartine Pippalimo Piper Pachana, Vata 4. Piperaceae 0.16%, Piperlogumine and ola longum anulomana, piperlonguminine Krimihara, Protein 14.1%, fat 21.8%, Coriandru Deepana, Carbohydrate24.6%, Umbellifer 5. Danyaka m Hrdhya, Minerals1.2%, Calcium1.5%, ae sativum Balya,Vrsya Iron28.8mg/100g, Phosphorous0.39%. Protein 18.1%, fat 16.1%, Carbohydrate21.6%, Trachysp Rakta prasadana, Minerals1.2%, Umbellifer 6. Ajamoda ermum Shothahara, Calcium0.63%, ae ammi Varnya Iron18.6mg/100g, Raboflavin0.28, Nicotinic acid. Deepana,Rochan Myristica Myristicac Myristic acid, Cyanadin, 7. Jatiphala a, fragrans eae Lignans, Neolignans, Safrole. Vrsya, Svarya Myristica Deepana,Rochan Myristicac Pectin, Glyceroid, Myristic 8. Jatipatra malabaric a, eae acid. um Vrsya, Svarya Cuminum Umbellifer Rakta shodhana, Cuminin, diacyl glycerol, 9. Jeeraka cyminum ae agni deepaka, isoimpinellin,P- “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 43  
  • 58. Drug Review                                                                                                                                                                              cymene,isoimperatorin. Protein 11.5%, fat 6.8%, Deepana, Calcium 4.6%, mineral Pachana, sroto Piper matter 4.4%, Phosphorous,10. Maricha Piperaceae shodhana, nigrum Iron 3.2mg, Vitamin A, krimihara, Nicotinic acid 1.4 mg/100g, raktothklesha oxalic acid 0.4-3.4% Bambusa vamshaloc Methylanthraquinones,11. arundinac Poaceae Balya hana Fucosterol eae Azardirectin, azadirone, Nimba Azardirac Deepana, nimbin, nimbandiol,12. Meliaceae patra hta indica Krumihara nimbolide. Rubifolic acid,rubiatrol, Rubia Varnya,shothahar13. Manjista Rubiaacea rubicoumaric acid, cardifolia a rubimallin,alizarin, purpurin. Eriodendr Kuta on Bombocac Shothahara, Galli acid, tannic acids,D-14. shalmali anfractuo eae 44akta shodhana galactopyranose. sum Oroxylu Baicalein, Bignonace Rakta vardhaka,15. Pata m tetulin,aloeemodin, b- ae 44akta shodhana indicum sitosterol. B-caryophyllene, Furfural, Syzygium Deepana, valeraldehyde,16. Lavanga aromaticu Myrtaceae Pachana, Vata methylbenzoate, Methyl m anulomana, alcohol. Aconitum Atidine, heterophyllisine, Ranuncula Visha hara,17. Ativisha hetrophyl letisinone,B-sitosterol, ceae deepana, Pachana lum carotene. Terminali Combretac Hrdya, Rasayana Fruits contains Tannic acid,18. Haritaki a chebula eae Anulomana chebulinic acid, gallic acid. Fructose 45%, glucose 35%19 Madhu Traces of minerals. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 44  
  • 59. Drug Review                                                                                                                                                                            RESEARCH WORKS DONE:-Dadima:- 45 Pomegranate contains isopelletierine, Methylisopelletierine, Pelletierine,Pseudopelletierine and tannins. Its known effects are to shrink tissues, prevent secretionof fluids and destroy intestinal worms. It is speculated to treat stasis ulcers.Dried fruit peel alcoholic extract & decoction administered in rats had intestinal antisecretory activityShunti:-46 Ginger was found to be superior to dimenhydrinate in preventing motion sicknessand the Gingerols and shogaols were identified as the main antiemetic principles. Studiessuggest that the action of ginger modulated vestibular impulses to the autonomic centersof the central nervous system. In a study of 30 pregnant women, in a double-blind randomized cross-over trial,it was observed that powdered root ginger was superior to placebo in reducing thesymptoms of hyper emesis gravidarum (morning sickness). Ginger, rhizome of Zingiber officinale, has been used for antiemetic effect.Several Components of ginger such as gingerol, shogaol and galanolactone have beenshown to have Anti-5HT activity in iso- lated guinea pig ileum. Galanolactone is acompetitive antagonist predominantly at ileal 5-HT3 receptors. The pungent principles, including gingerop and zingerone, demonstrated in vitroeffects in Scavenging the superoxide and hydroxyl radicals and inhibiting lipidperoxidation. Humoral immunity was enhanced, as shown by humoral antibody titer, andcell-mediated response was also stimulated in leukocyte migration inhibition tests.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 45  
  • 60. Drug Review                                                                                                                                                                             Rhizome of Zingiber containing shogaols 5-biphenyl, 6-phenylpropanoids,gingerols (50 mg/kg b. wt.) Showed improved anti-emetic activity in frogs. Oral doses of shogaol accelerated intestinal transit in rats. Also an extract ofginger, and Isolated shogaol and gingerols enhanced gastrointestinal motility in miceafter oral doses. Pharmacological study of Myrestica fragrans crude suspension increasedintestinal tone while (PE) petroleum ether had no such effect on guinea pig ileum.Jatiphala:-47 A preliminary study conducted on the effect of alcoholic extract of pippalirasayana on serum Proteins in rabbits showed a significant increase in body weight.Pippali, Dhanyaka:-48 The effect of spices on the secretion and composition of saliva in humansobserved that red Pepper, ginger, capsicum, black pepper, coriander and mustardenhanced the secretion of saliva and activity of salivary amylase. Further the salivastimulating capacity was greatest for red Pepper and mustard among these spices.Harikati:-49 Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents ofstomach earlier. So it can be used as adjuvant with other drugs that interfere with gastricmotility as Antihistaminics like drugs.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 46  
  • 61. Drug Review                                                                                                                                                                             DADIMA SHUNTI PIPPALI                          MARICHA“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 47  
  • 62. Drug Review                                                                                                                                                                             MANJISTA PATA NIMBA LAVANGA ATIVISHA VAMSHALOCHANA“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 48  
  • 63. Drug Review                                                                                                                                                                             DANYAKA JEERAKA HARITAKI AJAMODA JATIPHALA MADHU                       SHARKARA“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 49  
  • 64. Drug Review                                                                                                                                                                             Preparation of Dadima Avaleha“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”   Page 50  
  • 65. Materials & methods  MATERIALS AND METHODS  The present study ‘A clinical study on effect of Dadima Avaleha in themanagement of Garbhini Chardi’ was carried out on 30 patients attending the O.P.D. andI.P.D sections of Prasooti Tantra & Stree Roga Department, S.D.M. Ayurveda Hospital,Udupi.Aims and Objectives of the Study1. To do conceptual study of Garbhini chardi.2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.Source of data:About 30 patients in O.P.D & I.P.D of S.D.M Ayurveda Hospital, Kutpady, UdupiKarnataka diagnosed as Garbhini chardi were taken for study.Inclusion criteria:*Patients between 20-35 years of age.*Patients diagnosed as Garbhini chardi in first trimester of pregnancy.Exclusion criteria:*Patients in whom chardi seen in second & third trimester.*Patients with hyper emesis gravidarum.*Patients with twin pregnancy & vesicular mole.*Vomiting caused due to other systemic disorders like peptic ulcer, appendicitis etc.Assessment criteria: - Number of Vegas. - Quantity of Vomitus. - Aversion to smell - Improvement in weight - Improvement in Hb%. - Improvement in nausea“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”            Page  51 
  • 66. Materials & methods Final assessment: Cured – Complete cessation of nausea & vomiting. Improved – Reduction in quantity & quality of Vomitus. No change – No change in complaint. Aggravated – Symptoms became more severe than before.Investigations: Urine pregnancy test. Hb %. Urine routine. USG(if necessary)Intervention: Patients fulfilling above criteria were assigned to two groups. Group A – Dadimaavaleha for 21 days.  Dose‐24gms  with  divided  dose  of  8gms  T.I.D.  with lukewarm water Group B – Placebo for 21 days.  Follow up period: Patients will be asked to follow up for once in a week for 3 weeks. Materials taken for the study are:41Collection of drugs:  All the drugs were collected and prepared by S.D.M. Ayurveda Pharmacy, Udupi,Karnataka.Methods of preparation:Ingredients of Dadimaavaleha:1. Dadima – 1Kg 11.Nimba patra- 50gms2. Nagara – 50gms 12.Manjistha- 50gms3. Pippali - 50gms 13.Kuta shalmali- 50gms4. Pippali mula – 50gms 14.Pata- 50gms5. Danyaka- 50gms 15.Lavanga- 50gms6. Ajamoda- 50gms 16.Ativisha- 50gms“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”            Page  52 
  • 67. Materials & methods 7. Jatiphala -50gms 17.Jeeraka- 50gms8. Jatipatra – 50gms 18.Haritaki- 50gms9. Maricha- 50gms 19.Madhu- 50gms10. Vamshalochana- 50gms 20.Grutha- 50gmsWater – 4litSugar – 1 kgMadhu- 1kgGhrutha – 1kgOne Kg of Dadima is taken to which 4lit of water is added & kept on fire. Kashaya isprepared. To this Kashaya 1Kg of sugar is added. After formation of paka all theingredients are added in the powder form & mixed well. After swanga sheeta Honey &Grutha is added & mixed well.Group-BGuda Paka - One Kg of purana guda is taken to which quantity sufficient of water isadded & kept on fire until paka siddha laxana is seen.Research Design: It is a comparative clinical study with pre test and post test design. Patients wereregistered in a detailed proforma containing details of history, examination. Diagnosiswas done according to classical procedures and modern instruments were also employed.Registered patients were randomly placed under two groups.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”            Page  53 
  • 68. Observations and Results  OBSERVATIONS AND RESULTS Total of 30 patients were taken for the clinical study and were randomly allocatedinto group A and B 0f 15 patients each. 1) Generalized observations for overall patients :TABLE NO :11– DISTRIBUTION OF PATIENTS BASED ON AGEGRAPH NO: 1 Age No. of patients Total Percentage Group A % Group B % 20-23 03 20% 03 20% 06 20% years 24-27 06 40% 05 33.33% 11 36.66% years 28-31 06 40% 06 40% 12 40% years 32-35 00 00 01 6.66% 01 3.33% years 40 35 30 25 20‐23 20 24‐27 15 28‐31 10 32‐35 5 0 Gr‐A Gr‐B Total %   Among 30 patients selected for the study, 40% of patients were in the age groupbetween 28 to 31 years, 36.66% of patients were in the age group between 241to 27years, 20% of patients were in the age group between 20 to 23 years. 3.33% patients werepresent in the age group between 32 to 35 years.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   54 
  • 69. Observations and Results              TABLE NO: 12– DISTRIBUTION OF PATIENTS BASED ON RELIGION GRAPH No:2 RELIGION No. of patients Total Percentage Group A % Group B % Hindu 12 80% 12 80% 24 80% Muslim 03 20% 02 13.33% 05 16.66% Christian 00 00 01 6.66% 01 3.33% 80 70 60 50 HINDU 40 MUSLIM 30 20 CHRISTAIN 10 0 Gr‐A Gr‐B Total %Among the 30 patients selected for the study, 80% of patients were Hindus and 16.66%were Muslims & 3.33% were Christians.TABLE NO : 13– DISTRIBUTION OF PATIENTS BASED ON OCCUPATIONGRAPH No: 3 Occupation No. of patients Total Percentage Group A Group B House wife 15 15 30 100% Service 00 00 00 00% 100 80 60 H.W 40 SERVICE 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected, 100% patients were house wives“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   55 
  • 70. Observations and Results TABLE NO: 14– DISTRIBUTION OF PATIENTS BASED ON EDUCATIONGRAPH NO: 4 Education No. of patients Total Percentage Group A Group B Primary 10 06 16 53.33% Secondary 04 06 10 33.33% Graduation 01 03 04 13.33% 60 50 40 PRIMARY 30 SECONDARY 20 GRADUATION 10 0 Gr‐A Gr‐B Total %Among the 30 patients selected for the study, the maximum incidence of 53.33% hadprimary education,33.33% had secondary education & 13.33% were graduated.TABLE NO :15– DISTRIBUTION OF PATIENTS BASED ON HABITATGRAPH NO:5 Habitat No. of patients Total Percentage Group A Group B Rural 14 12 26 86.66% Urban 01 03 04 13.33% 100 80 60 RURAI 40 URBAN 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 86.66% werefrom rural area & 13.33% were from urban area.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   56 
  • 71. Observations and Results TABLE NO : 16– DISTRIBUTION OF PATIENTS BASED ON GRAVIDAGRAPH NO:6  Gravida No. of patients Total Percentage Group A Group B Primi 10 09 19 63.33% Multi 05 06 11 36.66% 70 60 50 40 PRIMI 30 MULTI 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 63.33% wereprimy gravida & 36.66 % were multi gravida.TABLE NO : 17– DISTRIBUTION OF PATIENTS BASED ON NAUSEAGRAPH NO:7  Nausea No. of patients Total Percentage Group A Group B Present 14 15 29 96.66% Absent 01 00 01 3.33%  100 80 60 PRESENT 40 ABSENT 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 96.66% hadnausea & in 3.33% nausea was absent.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   57 
  • 72. Observations and Results TABLE NO: 18– DISTRIBUTION OF PATIENTS BASED ON VOMITINGGRAPH NO:8  Vomiting No. of patients Total Percentage Group A Group B Present 15 14 29 96.66% Absent 00 01 01 3.33% 100 80 60 PRESENT 40 ABSENT 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 96.66% hadvomiting & in 3.33% vomiting was absent.TABLE NO: 1 9– DISTRIBUTION OF PATIENTS BASED ON FREQUENCY OFVOMITINGGRAPH NO:9  Freq.of No. of patients Total Percentage Vomiting Group A Group B 1-2 times 05 02 07 23.33% 2-5 times 08 10 18 60% >5 times 03 02 05 16.66% 60 50 40 1‐2times 30 2‐5times 20 >5times 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 60% had vomitingfor 2-5 times,23.33% of patients had 1-2 times & in 16.66%patients vomiting was formore than 5 times.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   58 
  • 73. Observations and Results   TABLE NO : 20– DISTRIBUTION OF PATIENTS BASED ON QUANTITY OFVOMITUSGRAPH NO:10 Quantity of No. of patients Total Percentage Vomitus Group A Group B < 50 ml 01 01 02 6.66% 50-100 ml 08 06 14 46.66% 100-150 ml 07 04 11 36.66% >150 ml 00 03 03 10% 50 40 <50ml 30 50‐100ml 20 100‐150ml 10 >150ml 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 46.66% hadquantity of 50-100ml, 36.66% of patients had 100-150ml, in 10% patients quantity wasmore than 150 ml & in 6.66% patients it was less than 50ml. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   59 
  • 74. Observations and Results TABLE NO 21 – DISTRIBUTION OF PATIENTS BASED ON CONTENT OFVOMITUSGRAPH NO:11  Content of No. of patients Total Percentage Vomitus Group A Group B Saliva, 02 01 03 10% Gastric Juice All 13 14 27 90% 100 80 60 SA &GJ 40 ALL 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 90% had vomituscontaining all i.e saliva, gastric juice & food.10% of patients had only saliva & gastricjuice in vomitus.  TABLE NO: 22– DISTRIBUTION OF PATIENTS BASED ONANNANABHILASHAGRAPH NO:12 Aversion No. of patients Total Percentage Group A Group B Present 14 10 24 80% Absent 01 05 06 20% 80 60 40 PRESENT ABSENT 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 80% hadAversion to smell & food & in 20% of patients it was absent.         “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   60 
  • 75. Observations and Results  TABLE NO : 23– DISTRIBUTION OF PATIENTS BASED ON ALASYA GRAPH NO:13 Alasya No. of patients Total Percentage Group A Group B Present 09 10 19 63.33% Absent 06 05 11 36.66% 70 60 50 40 PRESENT 30 ABSENT 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 63.33% hadAlasya as a symptom & in 36.66% of patients it was absent. TABLE NO : 24– DISTRIBUTION OF PATIENTS BASED ON ANGAMARDAGRAPH NO:14 Angamarda No. of patients Total Percentage Group A Group B Present 02 03 05 16.66% Absent 13 12 25 83.33% 90 80 70 60 50 PRESENT 40 ABSENT 30 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, the maximum patients of 83.33% had noAngamard as a symptom & in 16.66% of patients it was present.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   61 
  • 76. Observations and Results TABLE NO: 25– DISTRIBUTION OF PATIENTS BASED ON ANIDRAGRAPH NO:15 Anidra No. of patients Total Percentage Group A Group B Present 02 01 03 10% Absent 13 14 27 90% 90 80 70 60 50 PRESENT 40 ABSENT 30 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 90% Anidra as asymptom was absent & in 10% of patients it was present.  TABLE NO: 26– DISTRIBUTION OF PATIENTS BASED ON AGNIMANDYA GRAPH NO:16 Agnimandya No. of patients Total Percentage Group A Group B Present 14 09 23 76.66% Absent 01 06 07 23.33% 80 60 40 PRESENT ABSENT 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 76.66% hadAgnimandya as a symptom was & in 23.33% of patients it was absent.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   62 
  • 77. Observations and Results  TABLE NO : 27– DISTRIBUTION OF PATIENTS BASED ON BRAMA GRAPH NO:17 Brama No. of patients Total Percentage Group A Group B Present 10 09 19 63.33% Absent 05 06 11 36.66% 70 60 50 40 PRESENT 30 ABSENT 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 63.33% had Bramaas a symptom & in 36.66% of patients it was absent. TABLE NO: 28 – DISTRIBUTION OF PATIENTS BASED ON DAURBALYAGRAPH NO:18 Daurbalya No. of patients Total Percentage Group A Group B Present 13 14 27 90% Absent 02 01 03 10% 90 80 70 60 50 PRESENT 40 ABSENT 30 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 90% Daurbalyawas present as a symptom & in 10% of patients it was absent.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   63 
  • 78. Observations and Results TABLE NO: 29– DISTRIBUTION OF PATIENTS BASED ON TALU SHOSHAGRAPH NO:19 Talu Shosha No. of patients Total Percentage Group A Group B Present 04 02 06 20% Absent 11 13 24 80% 80 70 60 50 40 PRESENT 30 ABSENT 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 80% Talushosha asa symptom was absent & in 20% of patients it was present. TABLE NO: 30 – DISTRIBUTION OF PATIENTS BASED ON JIHWA SHOSHA GRAPH NO:20 Jihwa Shosha No. of patients Total Percentage Group A Group B Present 04 01 05 16.66% Absent 11 14 25 83.33% 90 80 70 60 50 PRESENT 40 ABSENT 30 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 83.33%Talushosha as a symptom was absent & in 16.66% of patients it was present.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   64 
  • 79. Observations and Results TABLE NO: 31 – DISTRIBUTION OF PATIENTS BASED ON TANDRAGRAPH NO:21 Tandra No. of patients Total Percentage Group A Group B Present 04 01 05 16.66% Absent 11 14 25 83.33% 100 80 60 PRESENT 40 ABSENT 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 83.33% Tandra asa symptom was absent & in 16.66% of patients it was present.  TABLE NO: 32– DISTRIBUTION OF PATIENTS BASED ON SHIRA SHOOLA GRAPH NO:22 Shira Shoola No. of patients Total Percentage Group A Group B Present 05 04 09 30% Absent 10 11 21 70% 70 60 50 40 PRESENT 30 ABSENT 20 10 0 Gr‐A Gr‐B Total %   Among the 30 patients selected for the study, in maximum patients of 70% Shirashoolaas a symptom was absent & in 30% of patients it was present. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   65 
  • 80. Observations and Results TABLE NO: 33 – DISTRIBUTION OF PATIENTS BASED ON FAMILYHISTORYGRAPH NO:23 Family No. of patients Total Percentage History Group A Group B Present 08 08 16 53.33% Absent 07 07 14 46.66% 60 50 40 30 PRESENT ABSENT 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, in maximum patients of 53.33% had familyhistory of vomiting in pregnancy & in46.66% patients it was absent. TABLE NO: 34– DISTRIBUTION OF PATIENTS BASED ON DIETGRAPH NO:24 Diet No. of patients Total Percentage Group A Group B Veg 00 01 01 3.33% Mixed 15 14 29 96.66% 100 80 60 VEG MIXED 40 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum patients of 96.66% are havingmixed diet & 3.33% are having vegetarian diet.  “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   66 
  • 81. Observations and Results TABLE NO: 35– DISTRIBUTION OF PATIENTS BASED ON APETITEGRAPH NO:25 Apetite No. of patients Total Percentage Group A Group B Good 04 04 08 26.66% Moderate 06 06 12 40% Reduced 05 05 10 33.33% 40 35 30 25 GOOD 20 MODERATE 15 REDUCED 10 5 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum patients of 40% are havingModerate apetite, 33.33% of patients had Reduced apetite & in 26.66% patients apetitewas fond Good.  TABLE NO: 36– DISTRIBUTION OF PATIENTS BASED ON SLEEPGRAPH NO:26 Sleep No. of patients Total Percentage Group A Group B Sound 14 13 27 90% Disturbed 01 02 03 10%  100 80 60 SOUND 40 DISTURBED 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum patients of 90% had sound sleep,10% of patients had disturbed sleep. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   67 
  • 82. Observations and Results TABLE NO: 37 – DISTRIBUTION OF PATIENTS BASED ON MALAPRAVRUTI GRAPH NO: 27 Mala No. of patients Total Percentage Pravruti Group A Group B Regular 09 14 23 76.66% Irregular 06 01 07 23.33% 80 70 60 50 40 REGULAR 30 IRREGULAR 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum patients of 76.66% had regularMala pravrutti, 23.33% of patients had irregular Mala pravrutti. TABLE NO: 38 – DISTRIBUTION OF PATIENTS BASED ON PRAKRUTIGRAPH NO: 28 Prakruti No. of patients Total Percentage Group A Group B Vata Pitta 04 02 06 20% Pitta Kapha 06 04 10 33.33% Kapha Vata 05 09 14 46.66% 50 40 30 VATA PITTA PITTA KAPHA 20 KAPHA VATA 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum patients of 46.66% were ofKapha Pitta Prakruti, 33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   68 
  • 83. Observations and Results TABLE NO: 39– DISTRIBUTION OF PATIENTS BASED ON VIKRUTIGRAPH NO : 29  Vikruti No. of patients Total Percentage Group A Group B Vata Pitta 02 04 06 20% Pitta Kapha 04 03 07 23.33% Kapha Vata 08 08 16 53.33% Tridoshaja 01 00 01 3.33% 60 50 40 VATA PITTA 30 PITTA KAPHA KAPHA VATA 20 TRIDOSHAJA 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study,in maximum patients of 53.33% Kapha vatavikruti was seen, in 23.33% Pitta Kapha vikruti was seen, in 20% of patients pitta vatavikruti was present & in 3.33% Tridoshaja vikruti was present.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   69 
  • 84. Observations and Results TABLE NO: 40 – DISTRIBUTION OF PATIENTS BASED ON SAARAGRAPH NO: 30  Saara No. of patients Total Percentage Group A Group B Rasa 01 02 03 10% Mamsa 03 05 08 26.66% Asthi 04 03 07 23.33% Rasa+Mamsa 04 02 06 20% Rakta+Mamsa 01 01 02 6.66% Mamsa+Asthi 01 01 02 6.66% Rakta+Asthi 01 01 02 6.66%   30 25 RASA 20 MAMSA ASTHI 15 RASA+MAMSA 10 RAKTA+MAMSA 5 MAMSA+ASTHI RAKTA+ASTHI 0 Gr‐A Gr‐B Total %  Among 30 patients taken for study maximum of 26.66% of patients were of mamsasaara,23.33% were of asthi saara,20% were of rasa & mamsa saara,10% were of Rasasaara, 6.66% of patients were of Rakta Mamsa, Rasa mamsa, Mamsa asthi respectively.     “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   70 
  • 85. Observations and Results TABLE NO: 41– DISTRIBUTION OF PATIENTS BASED ON SAMAHANANAGRAPH NO:31 Samhanana No. of patients Total Percentage Group A Group B Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00% 100 80 60 PRAVARA MADYAMA 40 AVARA 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum of 100% of patients were ofMadhyama Samhanana. TABLE NO: 42– DISTRIBUTION OF PATIENTS BASED ON PRAMANAGRAPH NO: 32  Pramana No. of patients Total Percentage Group A Group B Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00% 100 80 60 PRAVARA 40 MADYAMA AVARA 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum of 100% of patients were ofMadyama Pramana. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   71 
  • 86. Observations and Results TABLE NO: 43– DISTRIBUTION OF PATIENTS BASED ON SATWAGRAPH NO : 33  Satwa No. of patients Total Percentage Group A Group B Pravara 00 00 00 00% Madhyama 14 15 29 96.66% Avara 01 00 01 3.33% 100 80 60 PRAVARA 40 MADYAMA AVARA 20 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum of 96.66% of patients were ofMadhyama Satwa, 3.33% of patients were of Avara satwa.TABLE NO: 44– DISTRIBUTION OF PATIENTS BASED ON SATMYA GRAPH NO: 34 Satmya No. of patients Total Percentage Group A Group B Madhura 05 05 10 33.33% Amla 02 03 05 16.66% M+A 01 01 02 6.66% Katu 02 03 05 16.66% Katu+Amla 03 00 03 10% Sarva 02 03 05 16.66% 35 30 MADHURA 25 AMLA 20 MADURA+AMLA 15 KATU 10 KATU+AMLA 5 SARVA 0 Gr‐A Gr‐B Total %   “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   72 
  • 87. Observations and Results Among the 30 patients selected for the study, maximum of 33.33% had satmyata forMadhura rasa, 16.66% of patients had satmyata for Amla rasa, Katu rasa, Sarva rasarespectively,10% of patients had satmyata for Katu Amla rasa,6.66% 0f patients hadsatmyata for Madhura & Amla rasa.  TABLE NO: 45– DISTRIBUTION OF PATIENTS BASED ON AHARA SHAKTIGRAPH NO : 35  Ahara Shakti No. of patients Total Percentage Group A Group B Pravara 02 00 02 6.66% Madhyama 09 11 20 66.66% Avara 04 04 08 26.66% 70 60 50 40 PRAVARA 30 MADYAMA 20 AVARA 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum of 66.66% had Madhyamaaahara Shakti, 26.66% 0f patients had Avara ahara Shakti, and 6.66% had Pravara aharaShakti. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   73 
  • 88. Observations and Results TABLE NO: 46 – DISTRIBUTION OF PATIENTS BASED ON VYAYAMASHAKTIGRAPH NO : 36 Vyayama No. of patients Total Percentage Shakti Group A Group B Pravara 01 00 01 3.33% Madhyama 12 12 24 80% Avara 02 03 05 16.66% 80 70 60 50 PRAVARA 40 MADYAMA 30 AVARA 20 10 0 Gr‐A Gr‐B Total %  Among the 30 patients selected for the study, maximum of 80% had MadhyamaVyayama Shakti, 16.66% 0f patients had Avara Vyayama Shakti, and 3.33% of patientshad Pravara Vyayama Shakti.     “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   74 
  • 89. Result RESULTSTABLE NO: 471.EFFECT OF CHARDI VEGA IN GROUP A: Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 1.600 AT1 1.533 0.0667 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.0909 11.000 <0.001 14TABLE NO :48EFFCET OF CHARDI VEGA IN GROUP B: Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 2.267 AT1 1.867 0.400 0.743 0.192 2.449 0.0028 14 2.267 AT2 1.533 0.733 0.640 0.165 4.036 0.001 14 2.267 AT3 1.200 1.267 0.414 0.107 6.959 <0.001 14 2.267 AT4 0.933 1.333 0.704 0.182 6.325 <0.001 14GRAPH NO: 37 2.5 2 1.5 GR-A GR-B 1 0.5 0 BT AT1 AT2 AT3 AT4“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   75
  • 90. ResultGroup A: The mean score of the symptom of which was 1.600 before treatment reducedTo 1.533 after treatment, reduced to 0.733 in first follow up, further reduced to 0.333 insecond follow up and further reduced to 0.133 in final follow up . When these valueswere analyzed statistically, the difference was significant at the level of p = < 0.001.Group B: The mean score of the symptom of which was 2.267 before treatment reducedTo 1.867 after treatment, reduced to 1.533 in first follow up, further reduced to 1.200 insecond follow up and further reduced to 0.933 in final follow up . When these valueswere analyzed statistically, the difference was significant at the level of p = < 0.001.TABLE NO :49COMPARISION OF CHARDI VEGA WITHIN THE GROUPS: Groups Mean d ‘t’ test S.D S.E M t P df Group A 0.133 -0.200 0.352 0.0909 - 0.285 28 Group B 0.333 0.617 0.159 1.090GRAPH NO :38 2.5 2 1.5 GR-A GR-B 1 0.5 0 BT ATThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.061).“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   76
  • 91. ResultTABLE NO : 502) EFFECT OF Hb %IN GROUP A: Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 11.297 BT 11.297 0.013 0.366 0.0945 =0.941 14 11.297 AT 11.283 0.681 0.176 0.0752 =0.941 14TABLE NO :51EFFECT OF Hb %IN GROUP B: Mean Mean of AT D Paired ‘t’ test of BT S.D S.E T P df 11.717 BT 11.717 0.800 0.990 0.256 4.413 =0.021 14 11.717 AT 10.917 0.800 0.910 0.235 4.413 =0.021 14GRAPH NO:39 11.8 11.6 11.4 11.2 GR-A 11 GR-B 10.8 10.6 10.4 BT AT“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   77
  • 92. ResultGroup A: The mean score of the symptom of which was 11.297 before treatmentreduced To 11.283 after treatment,The change that occurred with the treatment is not great enough to exclude the possibilitythat the difference is due to chance (P = 0.237)Group B: The mean score of the symptom of which was 11.717 before treatmentreduced To 10.917 after treatment,The change that occurred with the treatment is not great enough to exclude the possibilitythat the difference is due to chance (P = 0.021)TABLE NO : 52EFFCTS OF HB% IN BOTH GROUPS: Groups Mean d ‘t’ test S.D S.E M t P df Group A 11.283 0.367 0.681 0.176 1.250 0.222 28 Group B 10.917 0.910 0.235GRAPH NO:40 11.8 11.6 11.4 11.2 GR-A 11 GR-B 10.8 10.6 10.4 BT ATThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.336).“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   78
  • 93. ResultTABLE NO :533. EFFECT OF Wt IN GROUP A: Mean Mean of AT d Paired ‘t’ test of BT S.D S.E T P df 52.867 AT1 53.000 -0.133 9.000 2.324 -1.468 0.164 14 52.867 AT2 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT3 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT4 52.933 -0.066 9.114 2.353 -0.564 0.582 14TABLE NO : 54EFFECT OF Wt IN GROUP B: Mean Paired ‘t’ test Mean of AT d of BT S.D S.E T P df - 51.733 AT 51.800 -0.066 8.274 2.136 =0.670 9 0.435 51.733 AT1 51.733 0.00 8.250 2.130 0.000 =1.000 9 51.733 AT2 51.733 0.00 8.250 2.130 0.00 =1.000 9 51.733 AT3 51.733 0.00 8.250 2.130 0.00 =1.000 9GRAPH NO : 41 53.2 53 52.8 52.6 52.4 52.2 GR-A 52 GR-B 51.8 51.6 51.4 51.2 51 BT AT1 AT2 AT3 AT4 Group A:“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   79
  • 94. ResultThe mean score of the symptom of which was 52.867 before treatment increased to To53.000 after treatment, & was decreased to 52.933 which was maintained same in all thefollow ups. When these values were analyzed statistically, the difference was notsignificant at the level of p = 0.582The change that occurred with the treatment is not great enough to exclude the possibilitythat the difference is due to chance (P = 0.582)Group B:The mean score of the symptom of which was 51.733 before treatmentincreased To 51.800 after treatment, which was again reduced to 51.733 & remainedsame in all the follow ups. When these values were analyzed statistically, the differencewas not significant at the level of p = 1.000The change that occurred with the treatment is not great enough to exclude the possibilitythat the difference is due to chance (P = 1.000)TABLE NO : 55COMPARISION OF Wt WITHIN THE GROUPS: Groups Mean D ‘t’ test S.D S.E M t P df Group A 52.933 1.200 9.114 2.353 0.378 0.708 28 Group B 51.733 8.250 2.130GRAPH NO: 42 53.2 53 52.8 52.6 52.4 52.2 GR-A 52 GR-B 51.8 51.6 51.4 51.2 51 BT AT“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   80
  • 95. ResultThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.708).TABLE NO : 564. EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP A Mean Paired ‘t’ test Mean of ATe d of BT S.D S.E t P Df 1.867 AT1 1.667 0.200 0.915 0.236 1.871 =0.082 14 1.867 AT2 1.067 0.800 1.082 0.799 4.583 <0.001 14 1.867 AT3 0.867 1.000 0.640 0.165 4.583 <0.001 14 1.867 AT4 0.400 1.467 0.507 0.131 5.735 <0.001 14TABLE NO : 57EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP B Mean Paired ‘t’ test Mean of AT d of BT S.D S.E t P Df 1.733 AT1 1.533 0.200 1.125 0.291 1.871 =0.082 14 1.733 AT2 1.267 0.467 0.884 0.228 2.824 =0.014 14 1.733 AT3 0.933 0.800 0.799 0.206 3.292 =0.005 14 1.733 AT4 0.467 1.267 0.467 0.516 4.750 <0.001 14GRAPH NO: 43 2 1.8 1.6 1.4 1.2 GR-A 1 GR-B 0.8 0.6 0.4 0.2 0 BT AT1 AT2 AT3 AT4“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   81
  • 96. ResultGroup A: The mean score of the symptom of which was 1.867 before treatment reducedTo 1.667 after treatment, which was again reduced to 1.067 after first follow up & againreduced to 0.867 after second follow up & finally reduced to 0.400 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)Group B The mean score of the symptom of which was 1.733 before treatment reducedTo 1.533 after treatment, which was again reduced to 1.267 after first follow up & againreduced to 0.933 after second follow up & finally reduced to 0.467 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)TABLE NO : 58COMPARISION OF EFFECT OF ANNANABHILASHA WITHIN THE GROUPS: Groups Mean d ‘t’ test S.D S.E M T P df Group A 0.400 0.00 0.507 0.131 -0.0667 =0.724 28 Group B 0.467 0.516 0.133GRAPH NO : 44 2 1.5 GR-A 1 GR-B 0.5 0 BT AT“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   82
  • 97. ResultThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 1.000).TABLE NO : 595. EFFECT OF TREATMENT ON NAUSEA IN GR-A Mean Paired ‘t’ test Mean of AT d of BT S.D S.E T P Df 1.600 AT1 1.533 0.067 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.090 11.000 <0.001 14TABLE NO : 60EFFECT OF TREATMENT ON NAUSEA IN GR-B Mean Paired ‘t’ test Mean of AT d of BT S.D S.E T P Df 2.000 AT1 1.600 0.400 0.737 0.190 4.583 <0.001 14 2.000 AT2 1.133 0.867 0.640 0.165 6.959 <0.001 14 2.000 AT3 0.600 1.400 0.632 0.163 12.220 <0.001 14 2.000 AT4 0.333 1.667 0.617 0.159 11.297 <0.001 14GRAPH NO : 45 2.5 2 1.5 GR-A GR-B 1 0.5 0 BT AT1 AT2 AT3 AT4“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   83
  • 98. ResultGroup A The mean score of the symptom of which was 1.600 before treatment reducedTo 1.533 after treatment, which was again reduced to 0.733 after first follow up & againreduced to 0.333 after second follow up & finally reduced to 0.133 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)Group B The mean score of the symptom of which was 2.000 before treatment reducedTo 1.600 after treatment, which was again reduced to 1.133 after first follow up & againreduced to 0.600 after second follow up & finally reduced to 0.333 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)TABLE NO: 61COMPARISION OF EFFECT OF NAUSEA WITHIN THE GROUPS:Groups Mean D ‘t’ test S.D S.E M t P DfGroup A 0.133 -0.200 0.352 0.090 - =0.285 28Group B 0.333 0.617 0.159 1.090GRAPH NO : 46 2.5 2 1.5 GR-A 1 GR-B 0.5 0 BT AT“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   84
  • 99. ResultThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.566).TABLE No : 626.EFFECT ON QUANTITY OF VOMITUS IN GROUP A : Mean Paired ‘t’ test Mean of AT d of BT S.D S.E T P df 2.400 AT1 1.933 0.467 0.632 0.163 3.500 =0.004 14 2.400 AT2 1.867 0.533 0.640 0.165 4.000 =0.001 14 2.400 AT3 1.400 1.000 0.507 0.131 7.246 <0.001 14 2.400 AT4 1.200 1.200 0.676 0.175 6.874 <0.001 14TABLE NO : 63EFFECT ON QUANTITY OF VOMITUS IN GROUP A : Mean Paired ‘t’ test Mean of AT d of BT S.D S.E T P df 2.533 AT1 2.133 0.400 0.640 0.165 3.055 =0.009 14 2.533 AT2 1.933 0.600 0.594 0.153 4.583 <0.001 14 2.533 AT3 1.667 0.867 0.617 0.159 4.516 <0.001 14 2.533 AT4 1.533 1.000 0.743 0.192 7.246 <0.001 14Graph no : 47 3 2.5 2 GR-A 1.5 GR-B 1 0.5 0 BT AT1 AT2 AT3 AT4Group A The mean score of the symptom of which was 2.400 before treatment reducedTo 1.933 after treatment, which was again reduced to 1.867 after first follow up & again“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   85
  • 100. Resultreduced to 1.400 after second follow up & finally reduced to 1.200 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)Group B The mean score of the symptom of which was 2.533 before treatment reducedTo 2.133 after treatment, which was again reduced to 1.933 after first follow up & againreduced to 1.667 after second follow up & finally reduced to 1.533 at last follow up.When these values were analyzed statistically, the difference was significant at the levelof (P = <0.001)The change that occurred with the treatment is greater than would be expected by chance;there is a statistically significant change (P = <0.001)TABLE NO :64COMPARISION OF EFFECT OF QUANTITY WITHIN THE GROUPS: Groups Mean D ‘t’ test S.D S.E M t P df Group A 1.200 -0.133 0.676 0.175 - =0.209 28 Group B 1.533 0.743 0.192 1.285Graph no : 48 2.5 2 1.5 GR-A 1 GR-B 0.5 0 BT ATThe difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.209)“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page   86
  • 101.                                                                                                  Discusssion  DISCUSSION Pregnancy & childbirth have been given an extraordinary status as an expressionof both the human & the sacred simultaneously. All her needs must be fulfilled as onelife participates in the creation of another & care must be taken to bring this new life intothe world. Many physiological changes are taking place in women from puberty tillMenopause. Changes taking place during pregnancy is a unique process & experience inwomen’s life as it created for the new budding life. As a consequence to these changescertain conditions manifest among which Garbhini chardi or emesis gravidarum is one. Inolden days women with history of amenorrhea & vomiting were diagnosed as beingpregnant. This clearly explains that vomiting was present in most of the pregnant women.In present era people have become more optimistic towards their child. So, even withsimple vomiting people rush to their obstetrician with the view that it should not produceany harm to the fetus. In some women it so happens that with the fear of vomiting theydo not consume any food which further leads to carbohydrate starvation & vicious cycleof vomiting begins which may affect both child & mother. Thus it is necessary to treatemesis gravidarum & prevent women from suffering through hyper emesis. Garbhini Chardi is explained as one of the “Vyakta garbha laxana”. Explanationsor description for “Garbhini chardi” as a separate disease is not available. It is a coinedterm used for chardi seen during pregnancy. While explaining Chardi Vyadi Acharyashave mentioned Garbhini chardi as one among the type of Agantuja chardi. AcharyaKashyapa while explaining Garbhini Vyadhis has told that Nidana, laxana & samprapti issame in Garbhini & other people as dosha & dhathu remains the same but only principleof treatment differs as vigorous treatment like Shodhana & langana cannot be given inGarbhini. Thus Shamana line of treatment is adopted in the present study. In the present study, a detailed description of Garbhini Chardi is done with all itsnidana, lakshanas samprapti, samprapti ghatakas, Chikitsa etc. The effect of drug asevidenced in the clinical trials were recorded along with detailed case history. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 87  
  • 102.                                                                                                  Discusssion Discussion on Garbhini ChardiNidana –Aapanna satwa, Dauhruda avamana & Vata Vaigunya due to Garbha utpeedanaare mentioned as a cause for Chardi. This clearly explains that presence of garbha is acause for Garbhini chardi. In the early trimester garbha is said to be in amavastha as it isin the stage of formation due to which many changes are taking place in the internalsystem. On the other hand women start consuming excessive food so as to keep herhealthy & nourish the fetus. Due to these physiological changes & sudden change in thedietary habits leads to indigestion which may cause vomiting. If she is suffering fromagnimandya before conception then this may further aggravate the existing condition. InGarbhini avastha women develops desire for certain food or article if these desires are notfulfilled then this may lead to shoka, krodha or chinta which may cause Vata Vikruti &lead to chardi. Incidence from the study have proven that Primies are more likely tosuffer from vomiting as it is a new experience where she has a sort of fear & happiness inher which may lead to manasika dosha prakopa this psychologic responses can interactand exacerbate the physiology of nausea and vomiting during pregnancy. If chardi is seenin excess then she may stop consuming taking food with a view that it may control it. Bydoing so it further vitiates Vata & vicious cycle of vomiting is seen. During pregnancythere is increased sensitivity for smell perception thus certain odors cause sensation ofnausea or vomiting.Samprapti: - Due to Atidravadi nidana sevana & Dauhruda avamana shareerika &manasika dosha Vikruti takes place which leads to Vata vruddi, which further causesAgnimandya & formation of ama which leads to ahara dusti & further vitiates otherdoshas. Due to dosha utklesha it is expelled out from the body in the form of chardi. It isexplained in classics that Samprapti vighatana is chikitsa. Thus all measures should betaken to control vomiting.Chikitsa: - While mentioning chikitsa for Garbhini Vyadhis Acharyas have mentionedthat she should be treated with soft, sweet, cold, pleasing & gentle drugs, dietics & “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 88  
  • 103.                                                                                                  Discusssion behavior. Vigorous treatment like shodhana & langana cannot be given to Garbhini, thusShamana method of treatment is adopted.In Garbhini stree due to the nourishment of fetus, there is dhatu Kshaya which leads toVata vruddi. So bruhmana dravyas has to be taken by her. The plan of treatment shouldbe such that it should nourish the garbha as well as control Chardi.So the line of treatment is to treat all these conditions. - To fulfill the needs of Dauhruda: A³ÉÍqÉ¹Ç ½ÑmÉÌWûiÉÍqɹæaÉïlkÉÉÌSÍpÉÈ mÉ×jÉMçü | SåWåû mÉëÏhÉÉÌiÉ aÉlkÉÉSÏlÉç bÉëÉhÉÉÌSlÉÏÌSìrÉÉÍhÉ cÉ | (cÉ.ÍcÉ.15/10)All dravyas are made up of pancha mahabhuta similarly is the garbha. When personconsume the food which is Hitakara, priya, endowed with Roopa, Rasa, Gandha, Sparshathen that ahara does the poshana of the dhatus & indriyas. Similarly the food that isconsumed by the Garbhini nourishes the garbha. Thus all the desires of dourhrda must befulfilled. - Aapanna satwa & dourhrda must be treated with priya vachana, ahara & Vihara which provides her with physical & mental support. - To cure Agnimandya, ama conditions one should use the drugs which are deepana, pachana, Hrudya, Trushna nigrahana & dahashamaka properties which helps to treat ama as well as maintain pregnancy. Upadrava –Due to excess vomiting there is obstruction to Sweda, Mutra & Ambuvaha Srotas .Due tothis obstruction there is Vata vruddi which carries them in upward direction because ofwhich the chardi which comes out contains the Varna & gandha of mutra, sweda etc. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 89  
  • 104.                                                                                                  Discusssion When there is increased frequency of Chardi then it may be associated with Shonitawhich may lead to kasa, Hrudrogadi laxanas. Hence these conditions are not treatable.From this above explanation it can be said that Chardi mentioned as vyakta garbha laxanacan be taken as emesis gravidarum & that mentioned by Harita as Upadrava can be takenas Complications of hyper emesis.  Discussion on drug review: -While explaining regarding chikitsa in Garbhini Acharyas has mentioned that she shouldbe treated with the things which are easily palatable, Hrudya & the one which is liked byher. Lehya which is one among the four types of food items is having good palatabilitybecause of sweetening agents present in this & is liked by Garbhini. Even though thereare many formulations available for treating Garbhini Chardi Dadima Avaleha is selectedbecause it has the properties of Agnideepaka, Amapachaka, Vatanulomaka, Hrudya,Balya, and Dhatu vardaka, Krimihara etc which does the samprapti vighatana of Chardi& helps in curing it.Probable mode of action:Dadima Avaleha contains Dadima, Madhu & Sharkara in more quantity which is havingAmla, madhura rasa, sheeta veerya , madhura vipaka & kapha pitta shamaka property. Its prakshepaka dravyas are shunti, Maricha, Pippali, Pippali mula,etc.. All these drugscontain shad rasas among which Tikta & Katu rasa are Pradhana, they pocess laghu ,ruksha guna, Ushna veerya & Kapha Vata shamaka property.With the presence of honey & sugar in the drug it becomes palatable & absorption of thedrug in the form of lehya starts from the mouth as the taste receptors are stimulated whichhelps in excessive secretion of saliva & mix with it. It is readily assimilated & acceptedby the stomach hence absorption of the nutrients take place. As vomiting is caused due tocarbohydrate starvation presence of fructose, glucose in the drug helps to supplement itthus preventing vomiting. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 90  
  • 105.                                                                                                  Discusssion  - A study conducted on Dried fruit peel alcoholic extract & decoction administered in rats had intestinal anti secretory activity thus Dadima acts by preventing excessive secretions from the intestines there by preventing regurgitation of the food which is caused due to mucosal irritation because of these secretions. - Rhizome of zingiber containing shogaols,gingerols showed improved anti emetic activity in frog. It is best in vomiting caused due to motion sickness & in emesis gravidarum. It action is by modulating vestibular impulses to the autonomic centers of the central nervous system & also by increasing the intestinal motility by preventing stasis of food in the stomach for longer time. - Pharmacological study of Myrestica fragrans in suspension form showed increased intestinal tone on guinea pig ileum. - The effect of spices on the secretion and composition of saliva in humans observed that red Pepper, ginger, black pepper, coriander and mustard enhanced the secretion of salivaand activity of salivary amylase. These drugs do agnideepana & increases perception for taste. - Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents of stomach earlier. So it can be used as adjuvant with other drugs that interfere with gastric motility as Antihistaminics like drugs. It acts like vatonulomaka & helps in controlling Vata there by controlling chardi. Action of Madhura rasa on chardi – Drugs like Dadima, Danyaka, Manjista, Madhura &sharkara contains Madhura rasa .This rasa acts as Brumhana & tarpana which does pittashamaka & helps in nourishing the dhathus there by doing poshana of the garbha. Action of Tikta rasa on chardi – Drugs like Ajamoda, Jati phala, Jeeraka, Maricha,Nimba, Pata, Lavanga contains Tikta rasa .Even though Tikta rasa is swadarahita itincreases perception of taste by activating the taste receptors. It acts as Agni deepaka,Ahara pachaka, Daha shamaka, Trushna nigrahana, Krumi hara & maintains texture ofTwak & Mamsa. In Garbhini Chardi patient’s complaints of Aruchi, Agnimandya, Daha, “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 91  
  • 106.                                                                                                  Discusssion Trushna & dryness of mouth. Tikta rasa by its action helps in curing all these laxanas &helps in controlling vomiting.While explaining chikitsa for chardi all the Acharyas have mentioned use of Kashaya &yusha prepared out of Tikta rasa dravyas like Guduchi, Nimba, Danyaka etc probablybecause of chardi hara property of this rasa.Action of Katu rasa on Chardi – Drugs like shunti, Pippali, Maricha, Ativisha containsKatu rasa. It acts as Mukha shodaka, Agnideepaka, dathuposhaka, indriya prasadaka,srotovisrutikaraka & kapha shamaka. By mukha shodaka property it cures Aruchi byincreasing the perception of taste. By Agnideepana property it cures ama & does aharapachana which helps in formation of rasadi dhatus by which proper poshana to the garbhais maintained.Some of the drugs like shunti, Danyaka, Maricha, Ajamoda, Honey contain calcium, iron,Carbohydrate , vitamins like B,C etc these are very much essential during pregnancy asthere is increased demand of these during pregnancy. This will also help for the properdevelopment of the fetus & she will not suffer from vomiting, anemia etc conditionsduring pregnancyThus dadima Avaleha with its property of Bruhmana, Ruchivardhaka, Agnideepaka,Amapachaka, Dhatu poshaka maintains Vata in normal proportion there by controllingchardi & nourishing garbha.Mode of action of guda paka:It is having Madhura rasa, Madhura vipaka, guru guna & sheeta veerya, It is havingspecial qualities like ruchikara, raktakara, rasayana, vrushya which is not only palatablebut also helps in dhatu vruddi. It acts like Brumhana & does dhatu poshana which helpsin nourishing the fetus. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 92  
  • 107.                                                                                                  Discusssion Discussion on methodology, observations and resultsIt is a single blind clinical study with a pre test and post test design. Here 30 patientsbetween the age group of 20-35years were randomly selected from the OPD and IPD ofSDM hospital of Ayurveda, Udupi. The test group comprising of 15 patients, dadimaAvaleha was given and for another group of 15 patient’s placebo was given & the resultsare compared.General Description of the patients: 45 patients were registered for the study out of whom, 14 dropped out in duecourse, 2 patients underwent MTP as it was diagnosed as blighted ovum, 1 patient hadmiscarriage, 1patient had twin pregnancy which was diagnosed later & was excludedfrom the study.Incidence studies of all the registered patients are as follows1) Age incidence: Patients within the age group of 20-35yrs were selected for the study asit is the active reproductive phase. Among which 40% of patients were in the age groupbetween 28 to 31 years.2) Religion: In this study 80% of patients were Hindus and Study records larger numberof Hindus, when compared to other religions. Data reflects more on the geographicalpredominance of a particular sector, Hindus being dominant in & around Udupi.3) Socio economic status & Occupational Incidence: Maximum no of patients was of lowsocio economic status & 100% patients were house wives.4) Educational Status: In the study 53.33% of patients had primary education, i.e. theyhave completed their education till high school. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 93  
  • 108.                                                                                                  Discusssion 5) Habitat Incidence: In the study maximum patients of 86.66% were from rural area thanurban area as our hospital is located in rural area.6) Parity: In the study 63.33% were primy gravida & 36.66 % were multi gravida.Maximum patients were primigravida as incidence of vomiting in pregnancy is more inprimies than in multies. Even this study proves the same.7) Dietary Incidence: In the study 96.66% are having mixed diet. This will explain theprevalent food pattern in this region. The food which they consume contains more of fat& excessive intake of fatty substances is one of the causes for vomiting in pregnancy.8) Family History: In the present study maximum patients of 53.33% had family historyof vomiting in pregnancy & in 46.66% patients it was absent. Persons with family historyof vomiting are more likely to suffer from vomiting in there pregnancy.9) Sleep pattern: Maximum patients of 90% had sound sleep, 10% of patients haddisturbed sleep.10) Incidence on Agni: Maximum patients of 76.66% had Agnimandya as a symptom &in 23.33% of patients it was absent. It leads to improper formation of ahara rasa becauseof which nourishment to the fetus is reduced which may further lead to abortion or IUGRlike conditions. So it is important to treat this in initial stage before embarking onpregnancy.11) Incidence of Prakruti: Maximum patients of 46.66% were of Kapha Pitta Prakruti,33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti.12) Incidence of Vikruti: In the study maximum patients of 53.33% had Kapha VataVikrutiAs Vitiated Pitta & Kapha causes Agnimandya, this will lead to formation of ama. Thisama causes ahara dusti leading to Chardi. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 94  
  • 109.                                                                                                  Discusssion 13) Incidence on Saara: In the study maximum of 26.66% of patients were of mamsasaara.14) Incidence on Satwa: Maximum of 96.66% of patients was of Madhyama Satwa,3.33% of patients were of Avara satwa. This shows that satwa also play role in personssuffering from vomiting.15) Incidence on Samhanana: Maximum of 100% of patients was of MadhyamaSamhanana.17) Incidence on aharashakti: Maximum no of patients had Madhyama & Avara aharaShakti. This may be because of Agnimandya where digestion capacity is reduced.18) Incidence on vyayamashakti: Most of the patients had Madhyama Vyayama Shakti.19) Incidence on symptoms: Maximum of patients had symptoms like Aruchi in 40%,Hrullasa in 96.66%, Alasya in 63.33%, dourbalyata in 90%, Brama in 63.33%; these arelaxanas of Ama which are caused due to Agnimandya which may lead to Vikruti of Vatawhich may further lead to problems like pregnancy loss, IUGR, Eclampsia & obstructedlabor in later stages. So anulomana of Vata is given prime importance throughoutpregnancy.Effect of therapy-Effect of treatment was assessed both clinically as well as based on laboratoryparameters. Clinical features and hemoglobin percentage were assessed before, aftertreatment and on follow up. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 95  
  • 110.                                                                                                  Discusssion Effect of treatment on individual signs and symptomsChardi Vega-The mean score of the symptom which was 1.600 before treatment was reduced to0.133after treatment. The change was found to be statistically significant. As dadimaAvaleha processes Agnideepaka & Vatanulomaka properties gradual reduction in chardiVega was seen. As Urdvagaman of Vata causes chardi its anulomana cures it.Hemoglobin percentage –The mean score of Hemoglobin before treatment was 11.283 which was increased to11.297 after treatment. The change was found to be statistically significant. As DadimaAvaleha contains dadima in excess quantity & it has a property of Raktavardhakabecause of which improvement in Hb% is seen. Weight –The mean score of the symptom of which was 52.057 before treatment reduced To 52.00after treatment, & was maintained same in all the follow ups. As the duration of treatment& sample size was small the effect could not be seen. Hence the result is inconclusive.Ananabhilasha - The mean score of the symptom of which was 1.667 before treatment reduced to 0.467 atlast follow up. The change was found to be statistically significant .Dadima Avaleha hasthe property of Amapachaka, Agni deepaka & Vatanulomaka property it was foundeffective.Nausea –The mean score of the symptom of which was 2.000 before treatment reduced to 0.467 at lastfollow up. The change was found to be statistically significant. It is Hrudya,ruchivardhaka, Madhura rasayukta & liked by Garbhini. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 96  
  • 111.                                                                                                  Discusssion Quantity of vomitus –The mean score of the symptom of which was 2.400 before treatment reduced to 1.200 at lastfollow up. The change was found to be statistically significant. As dadima Avalehaprocesses Agnideepaka & Vatanulomaka properties gradual reduction in quantity ofchardi was seen. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi    Page 97  
  • 112. Conclusion CONCLUSIONConclusion is the total extort that is obtained from the work done to complete the study.Whatever was explained earlier are the particular facts and reasons that are supported bythe obtained evidences / data as well as textual references. The conclusions are madefrom observations seen in the present study. - Even though Garbhini chardi is mentioned as a vyakta garbha laxana, it can be seen as a separate disease were its nidana, laxana & samprapti are same as that of samanya chardi. - The principle line of treatment is to treat Garbhini with priya vachana, ahara & Vihara along with Shamana chikitsa. - Among all the shad rasas Amla & Tikta rasa dravyas have better action in controlling chardi. - Garbhini chardi mentioned as vyakta garbha laxana can be correlated to emesis gravidarum & that mentioned as Upadrava can be correlated to complications of hyper emesis. - In emesis gravidarum along with medication, dietary manipulation, bed rest, & assurance help in controlling it. - Dadima Avaleha which is palatable, nutritious & having good dietic value was effective in reducing Chardi Vega, Hrullasa, Ananabhilasha, Agnimandya, Aruchi & Malavarodha. With the current study following results were obtained & it can be concluded as:- - In controlling chardi Vega trail group was found more effective than control group proving retention of food for more time. - Dadima Avaleha having Rakta vardaka property showed slight raise in Hb% where as in control group it was found reduced. - Both the Trial & control group did not show any effect in weight gain instead it was effective in maintaining it. This shows that the drug has no adverse effect concern to weight.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 100  
  • 113. Conclusion - Trail group was better in controlling Ananabhilasha compared to control group. Hence dadima Avaleha proved to be more effective. - The effect of both dadima Avaleha & control group proved significant in controlling Nausea. - Dadima Avaleha was better in reducing quantity of vomitus compared to the control group. Hence it proved to be more effective. By the clinical trial on 30 patients with 15 patients each in Group A- Dadima Avaleha &Group B –Guda paka, the results in group A was more effective in reducing Chardi Vega,Anannabhilasha, Nausea & quantity of vomitus. Group B was better in improving nausea.Both the groups were effective in maintaining the weight. “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 101  
  • 114. Summary  SUMMARYThe present dissertation study entitled as “A CLINICAL STUDY ON EFFECT OFDADIMA AVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI” isplanned with the following aim and objectives1. A conceptual study of Garbhini chardi.2. To evaluate the efficacy of Dadima Avaleha.The whole study was elaborated in 5 parts. o Review of literature. o Clinical study o Discussion o Conclusion o SummaryReview of literatureIt contains of 2sections, first section comprises of historical review of garbha, Garbhini &all the drugs that are included in this study.The second section contains –Garbhini Chardi with its nidana, samprapti, chikitsa withthe drug review of the concerned drugs.It also includes the modern view of emesis & hyper emesis Clinical study: 30 patients diagnosed as Garbhini chardi were randomly selected anddivided in to 2 groups each. Criteria of inclusion, exclusion and assessment withparameters are given. The data recorded from the observations and results obtained at theend of therapy are represented in tabular and graphical form. The results of statisticalanalysis by applying paired‘t’ test and unpaired‘t’ test are mentioned.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 98  
  • 115. Summary Discussion: In this part, discussion is made on the concept of disease from referencescollected and compiled from Ayurvedic and modern texts. Discussion on the data ofobservations obtained from patients along with the effect of therapy is done.A probable mode of action of dadima Avaleha on the basis of its rasapanchaka, activechemical constituents is drawn on the basis of discussion on the whole study:Conclusion: • Significant results were seen in the criteria like Chardi Vega, Hrullasa, Ananabhilasha & Quantity of Vomitus. • This study would be considered more genuine when a large sample will be taken for the study.  “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 99  
  • 116. Table Showing Demographic Data CASE NO. A S RELIGION SES OCCUPAT DIET GE E ION X M H M C L M U A S L V M 52056 38 + + - - - - + + - - + - 148250 29 + + - - - + - - - + - + 158739 35 + + - - + - - - - + - + K. Vasu 40 + + - - + - - - - + - + Abdul Aziz 32 + - + - + - - - - + - + Gopal 29 + + - - - + - - - + - + Jaya 37 + + - - + - - - - + - + Imtiazkhan 27 + - + - + - - + - - - + Devdas 35 + + + - + - - - - + - + Puthran Joseph 40 + - - + + - - - - + - + Javed 23 + - + - + - - + - - - + Chiranjeevi 31 + + - - - + - + - - - + Shekhar 35 + + - - + - - - - + - + Praveen 40 + + - - - + - + - - - + Kumar 
  • 117. CASE PROFORMA “A CLINICAL STUDY ON EFFECT OF DADIMAAVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI”GUIDE: Dr. Mamatha K.V., M. D. CO-GUIDE: Dr.Sucheta ,M.S(Ayu)AATURA VIVARA:-NAME: SERIAL NO:AGE: O.P.D .NO:RELIGION: I.P.D.NO:EDUCATION: D.O.A. :OCCUPATION: D.O.D. :SOCIO ECONOMIC STATUS:PLACE:ADDRESS:DIAGNOSIS:RESULT:PRADANA VEDANA: - CHARDI HRULLASA ARUCHIVEDANA SAMUCCHAYA- EARLY MORNING AFTERNOON NIGHTFREQUENCYQUANTITYVOMITUS
  • 118. ANUBANDA VEDANA:-ALASYA –ANGAMARDA -ANIDRA -AGNIMANDYA -BRAMHA-BALAKSHAYA –DOURBALYA -TALUSHOSHA-JIHWASHOSHA-TANDRA –SHIRASHOOLA -VEDANA VRUTTANTA:-ONSET:-DURATION;-PRECIPITATING FACTOR:-AGGRAVATING FACTOR;- Food SMELLRELIVING FACTORS:- Food Season Clothing Other measuresTREATMENT RECEIVED:-RESPONSE TO PREVIOUS TREATMENT:-
  • 119. POORVA VYADI VRUTTANTA:-GENARAL – HPT/ DM/ ASTHAMA/ TBSPECIFIC – INFERTILITY/ABORTIONSURGICAL INTERVENTION –KOUTUMBIKA VRUTTANTA:- TB DM HTN ASTHAM AIDS SYPHILLISFATHERMOTHERHUSBANDSIBLINGSVAIYAKTIKA VRITTANTA:-AHARA – V/MDIETIC HABITS –SAMA/VISHAMAHABITS – TEA/ COFFE/ TOBACCO/ SMOKINGRASA SAMBANDI – M/A/L/K/T/KAPPETITE – A/M/PNIDRA – S/DMALA PRAVRUTTI – R/IRRAJO VRUTTANTA :-PRATHAMA RAJO PRAVRUTTI KALA –RAJO PRAVRUTTI –SRAVA KALA-ASSOCIATED WITH PAIN-ANTIMA RAJO PRAVRUTTI DINANKA-PRASAVA VRUTTANTA :-VAIVAHIKA KALA-L.M.P.-E.D.D-GRAVIDA PARA ABORTION LIVE DEAD M.O.DEL PER.PERIOD BREAST.FCONTRASEPTIVE HISTROY:-
  • 120. SAFE METHOD –CONTRASEPTIVE PILLS-IUCD-GENERAL EXAMINATION:-BUILT –NOURISHMENT –HEIGHT –WEIGHT –PULSE –ICTERUS –TEMPRATURE –RESPIRATORY RATE –B.P-H.R – i. General Examinations ii. Systemic CVS RS CNS examination GIT CVS Others iii. Dashavidha Prakruti Vyayama shakti pariksha Saara Aahara shakti Abhyavaharana Jarana Samhanana Vaya Pramana Desha Satwa Vikriti Saatmya SAMPRAPTIGHATAKA:- Nidaana Dosha Dooshya- dhatu mala Strotas Srotodusti prakaaraInvestigations:- Udbhava staana Sanchara staanaUrine Vyakta staana Adhistaanapregnancy test - RogamargaBlood Hb% - Vyadhi prakaara Sadhya/ krachrasadhya/ asaadhya Sampraapti
  • 121. Urine Routine -USG -2. Assessment Criteria Scorings QUANTITY Nausea only 0 CHARDI Nil 0 OF <50ml 1 VEGA Mild - 1 VOMITUS <2times 50-100ml 2 Moderate- 2 2-5times >100ml 3 Severe 3 >5times IMPROVEMENT Nil 0 NAUSEA Nil 0 IN WEIGHT Mild -1/2 kg 1 Mild- 1 Moderate ½- 2 Moderate 2 1kg More- 1kg 3 Severe 3 IMPROVEMENT Nil 0 AVERSION Nil 0 IN Hb% Mild - 1 TO SMELL Mild-nausea 1 0.25gm Moderate ½- 2 Moderate – 2 1gm vomiting 1- 2times More-> 1gm 3 Severe – 3 vomiting >2times3. Complications4 Results Completely cured Partially cured Not reduced condition is same Aggravated Association of complications if any
  • 122. 5. ConclusionsDate: Signature:Observation Table Symptoms BT AT1 AT2 AT3 AT4NauseaChardi vegaContent of vomitusImprovement inhb%Improvement inweightAversion to smellGiddinessTirednessQuantity ofvomitusAppetiteSignature of guide: Signature of student :
  • 123. Bibilography  BIBILOGRAPHY1. Guide to a healthy pregnancy by Dr.Kamini Rao 2006 addition Pg no1. 2. Clinical obstetrics By Mudaliar & Manon’ s 10th edition Pg no 37.3. Ancient science of life a research journal on Ayurveda volume 28 Published by AVReducational foundation of Ayurveda. Pg no 20.4. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya JadavajiTrikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia, Varanasi. Shareerastana Ch4/16 Pg no642.5. Sushruta, Sushruta samhita with the Nibandhasangraha Commentary of SriDalhanacharya, Edited by Vaidya Jadavji Trikamji Acharya, Ninth edition:2007,Chaukhambha Orientalia, Varanasi. Shareera stana Ch3/14-15.6. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya JadavajiTrikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia, Varanasi. Shareerastana Ch 8/22 Pg no9307.Bhaisajya Kalpana vijnnanam By rama Chandra reddy Chaukhambha orientalia Firstedition 1998 Pg no 209,210.8. Agnivesha, Charaka samhita with Chakrapani commentary, Edited by Vaidya JadavajiTrikamji Acharya, Reprinted edition 2007, Chaukhambha orientalia, Varanasi. Sutrasthana.,Agnivesha.9. Vagbhatacharya, Ashtangahridayam with Sarvangasundara commentary of Arunadattaand Ayurvedarasayana of Hemadri collated by late Dr.Anna Moreshwara Kunte andRamachandra Shastri Navare Edited by Bhishagacharya Harishastri Paradakara Vaidya,Reprint 9th edition 2005, Chaukhambha Orientalia, Varanasi10.Madhavakara; Madhava Nidana, with Madhukosha commentary by Vijayarakshita &SrikanthaDatta, ’Vimala’ Madhukara Hindi commentary by Dr Brahmananda Tripathi, ChaukambaSurabharati Prakashana, Varanasi.“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”  Page 102  
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