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Hinguleshwararas amavata rs002-gdg

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Preparation Physico – chemical analysis of Hinguleshwar rasa and its clinical efficacy in Amavata with special reference to Rhemuloid arthritis - Dr.Koteshwara. P, Department of rasashastra, Post …

Preparation Physico – chemical analysis of Hinguleshwar rasa and its clinical efficacy in Amavata with special reference to Rhemuloid arthritis - Dr.Koteshwara. P, Department of rasashastra, Post graduate studies and research center, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag


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  • 1. Preparation, Physico-chemical Analysis of HinguleshwaraRasaand its Clinical Efficacy on Amavatawith sepcial reference to Rheumatoid Arthritis. By P. Koteswara. Dissertation Submitted to the Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M. D. In RASASHASTRA Under the guidance of Dr. M. C. Patil, M.D. (Ayu) Under the co-guidence of Dr. G. N. Danappagoudar M.D. (Ayu) DEPARTMENT OF RASASHASTRA, POST GRADUATE STUDIES AND RESEARCH CENTER, SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103. 2005.
  • 2. Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “Preparation, Physico-chemical Analysis of Hinguleshwara Rasa and its Clinical Efficacy on Amavata with Special Reference to Rheumatoid Arthritis.” is a bonafide and genuine research work carried out by me under the guidance of Dr. M. C. Patil, M.D. (Rasashastra) , Professor and H.O.D, Post-graduate depart- ment of Rasashastra and under the co-guidence of Dr. G. N. Danappagoudar , Lecturer, Post-graduate department of of Rasashastra. M.D. (Rasashastra) Date : Place : P. Koteswara.
  • 3. SHRI. D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST -GRADUATE DEPARTMENT OF RASASHASTRA. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Preparation, Physico-chemical Analysis of Hinguleshwara Rasa and its Clinical Efficacy on Amavata with Special Reference to Rheumatoid Arthritis.” is a bonafide research work done by P. Koteswara. in partial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D. (Rasashastra). Date : Place : Gadag. Dr. M. C. Patil, M.D. (Rasashastra). Professor & H.O.D Department of Rasashastra. Post Graduate studies and research center, Shri. D.G.Melmalgi Ayurvedic Medical college, Gadag.
  • 4. ENDORSEMENT BY THE H.O.D. AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Preparation, Physico-chemical Analysis of Hinguleshwara Rasa and its Clinical Efficacy on Amavata with Special Reference to Rheumatoid Arthritis.” is a bonafide research work done by P. Koteswara. under the guidance of Dr. M. C. Patil, M.D. (Rasashastra), Professor and H.O.D, Postgraduate depart- ment of Rasashastra and under the co-guidence of Dr. G. N. Danappagoudar M. D. (Rasashatra) Lecturer, Postgraduate department of Rasashastra. Dr. M.C. Patil, M.D. (Rasashastra) Dr. G. B. Patil. Professor & H.O.D Principal Department of Rasashastra. Shri. D.G.Melmalgi Ayurvedic Medical college, Post Graduate studies and research center,Shri. D.G.Melmalgi Ayurvedic Medical college, Gadag. Gadag. Date : Date : Place : Gadag. Place : Gadag.
  • 5. SHRI. D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST-GRADUATE DEPARTMENT OF RASASHASTRA. CERTIFICATE BY THE CO- GUIDE This is to certify that the dissertation entitled “Preparation, Physico-chemical Analysis of Hinguleshwara Rasa and its Clinical Efficacy on Amavata with Special Reference to Rheumatoid Arthritis.” is a bonafide research work done by P. Koteswara. in partial fulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D. (Rasashastra). Date : Dr. G. N. Danappagoudar, M.D. (Ayu). Lecturer Place :Gadag. Department of Rasashastra. Post Graduate studies and research center, Shri. D.G.Melmalgi Ayurvedic Medical college, Gadag.
  • 6. COPYRIGHT Declaration by the candidate I hereby declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and dissemi-nate this dissertation / thesis in print or electronic format for academic /research purpose.Date : P. Koteswara.Place :Gadag.© Rajiv Gandhi University of Health Sciences, Karnataka.
  • 7. I ACKNOWLEDGEMENT This work carries some memories to express and record about some distinguishedpersonalities I had been inspired during the course of the study. I express my obligation to my honorable guide Dr. M. C. Patil M.D. (Ayu) Prof andHead of the Department of Rasashastra, Post-graduate and research center, D. G. M.Ayurvedic Medical College, Gadag for his critical suggestions and guidance,encouragement at every stage for the completion of thesis. I am extremely grateful and obliged to my co-guide Dr. Girish DanappagoudarM. D. (Ayu) Lecturer, Department of Rasashastra, Post-graduate and research center, D.G.M.Ayurvedic Medical College, Gadag, under whose guidance and inspiration I have beenable to complete this research work. I express my obligation to beloved principal Dr. G. B. Patil., Post-graduate andresearch center D.G.M. Ayurvedic Medical College , Gadag for his encouragement aswell as providing facilities for this research work. I express my deep sense of gratitude to Dr. Dilipkumar M. D. (Ayu), Asst prof.Department of Rasashastra, Post-graduate and research center, D.G.M. AyurvedicMedical College , Gadag for his valuable suggestions and critical views. I am extremely greatful and obliged to Dr. Jagadish Mitti M. D. (Ayu), Lecturer,Department of Rasashastra, Post-graduate and research center D.G.M. AyurvedicMedical College, Gadag for his inspiration and his advise to complete this research work.I express my sincere gratitude to Dr. S. H. Doddamani, Dr. G. S. Hiremath, Dr. R. Y.Shetter, Dr. K.S.R. Prasad, Dr. Kuber Sankh, Dr. Shashidhar Nidagundi,Dr.Mulkipatil, Dr. Santosh Belwadi, Dr. K. S. Paraddi and Dr. U. V. Purad & Dr. Y. D.Yarageri R.M.O. for their whole heartfelt co-operation and advise.
  • 8. II I am greatful to Shri Chandur and Inamdar, Lecturer, K.L.E. Society’s Pharamcycollege, Gadag for his whole hearted co-operation and advise in the study. I am thankful to Shri. V. M. Mundinmani, Librarian, and Shri. S. D. Sureban,Library Assistant for their kind support in my study. I render my sincere thanks to StateBank of India, Bellary, Nandakumar for their help in statistical analysis of the study. I wish to express thanks to my colleagues Dr. Santoji, Dr. Shrinivas Raddy,Dr. Harish, Dr. Murthy, Dr.Raghu, Dr. Mrutyunjay, Dr. Tyagraj, Dr. Jaggal, Dr. Kalmath,Dr. Jayaraj, Dr. Santosh Yadahalli, Dr. Ravi Pattanshetty, Dr. V. S. Hiremath, Dr. Anita,Dr. Suvarna, Dr. Sharanu, Dr. Pradeep Agnihotri, Dr.Basavaraj. Ganti,Dr.M.V.Sobagin.,Dr. Saswihalli, Dr. M.S. Hiremath, Dr. Anand, Dr. Teggi, Dr. Joshi, Dr. Chetana, Dr. Varsha, Dr.Venkareddy, Dr. Chandramouli, Dr. Kashinatha, other scholars and other scholars of myinstitute. I acknowledge to my relatives, friends for their inspiration and moral support tocomplete this work successfully. I acknowledge my patients for their whole hearted consent to participate in thisclassical trial. Lastly I express my thanks to all the persons who have helped me directlyand indirectly with apologies for my inability to identify them individually.Place :Date : Dr. Koteswara
  • 9. IIIABSTRACTBack ground – Ama and vata are the root cause of Amavata. Amavata characterized by sandhishoola, sandhi shotha, gaurava, jadya, jwara, etc Cause of Amavata. viz viruddha ahara,cheshta, vihara and mandagni, etc. lead to vata prakopa later this mixes with ama,causing srotodushti, lodged into shleshmasthana resulting in Amavata. In modern science there are number of drugs for Amavata or Rheumatoidarthritis. But,. They may cause many complications and also Ayurveda has manyformulations like herbal, mineral, herbo-mineral preparations which are claiming to bevery effective in Amavata. Some are difficult to prepare and costly and some are easy toprepare and economical. Rasataranginikara has considered Hinguleshwara rasa as anideal formulation for Amavata.So, it is expected to pacify amavata and reduces shotha.jadya, sandhi shoola, jwara, angamarda. Hence, the present study undertaken.Objectives – 01. Preparation of Hinguleshwara rasa. 02. Physico-chemcial analysis of Hinguleshwara rasa. 03. Clinical efficacy of Hinguleshwara rasa on Amavata w.r.s.to Rheumatoid arthritis.Methods – Pharmaceutical study – 01. Shodhana of Hingula 02. Shodhana of Vatsanabha 03. Preparation of Hinguleshwara rasa
  • 10. IVAnalytical study – Hinguleshwara rasa subjected to physico-chemcal analysis, assay for mercury andsulphur and, Loss on drying , disintegration, uniformity of weight and organolepticcharacters.Clinical study – 30 patients of Amavata (Rheumatoid Arthritis) with confirmed diagnosis takenfrom the OPD section of PG R.C. DGM Medical College, hospital, Gadag.Results – 01. Hinguleshwar rasa prepared by following the classical method is proved to be genuine one. 02. Hinguleshwara rasa is proved that it is reduces the symptoms of Amavata which is confirmed by the value of the subjective and objective parameters. All the 30 patients were treated in a single group and observations were recorded and statistically analyzed. Interpretation and Conclusion – 01. By observing values of subjective and objective parameters and statistical analysis of Hinguleshwara rasa can be proved as one of the best formulation for Amavata. 02. The values are almost under normal limits according to confirmative tests of physico-Chemical analysis of Hinguleshwara rasa.Key words – Joints, Amavata, Rheumatoid arthritis, Hingula, Vatsanabha, Pippali, Shodhana,Vati, Physico-chemical analysis, Madhu.
  • 11. V ABBREVIATION1) A. H. – Ashtanga Hridaya.2) A. P. – Ayurveda Prakash.3) A. S. S. – Ayurveda Sara Sangraha.4) A. T. – After treatment.5) B. P. – Bhavaprakasha.6) B. R. – Bhaishajya Ratnavali.7) B. R. R. Su. – Bruhat Rasaraja Sundar.8) B. T. – Before treatment.9) C. D. – Chakradatta.10) C.S. – Charaka Samhita.11) D. G. – Dravyaguna Vignana.12) D. N. – Dhanwantari Nighantu.13) K. N. – Kaiyadeva Nighantu.14) Ra. – Rasamruta.15) R. A. – Rheumatoid arthritis.16) R. C. – Rasendra Chudamani.17) R. J. N. – Rasajala nidhi.18) R. K. – Rasa Kamadhenu.19) R. N. – Raja Nighantu.20) R. Pr. Su. – Rasa Prakasha Sundar.21) R. R. S. – Rasa Ratna Samucchaya.22) R. S. S. – Rasendra Sara Sangraha.23) R. T. – Rasatarangini.24) S. S. – Sushruta samhita.25) Y. R. – Yoga Ratnakara.
  • 12. VI CONTENTS Page No.’s01. Introduction 1-402. Objectives 503. Review of Literature 6-5704. Methodology 58-7805. Results 79-10106. Discussion 102-11307. Conclusion 11408. Summary 115-11609. Bibliography 117-13110. Annexure
  • 13. VII LIST OF TABLES Page No.01. Table No. 01. Showing the synonyms of Hingula. 702. Table No. 02. Showing the Hingula included under different classes. 1003. Table No. 03. Showing the bheda of hingula. 1104. Table No. 04. Showing the rasa. 1305. Table No. 05. Showing the doshaghnata of hingula. 1306. Table No. 06. Showing the synonyms of vatsanabha. 1607. Table No. 07. Showing the synonyms of pippali. 2508. Table No. 08. Showing the samanya lakshana of amavata. 4009. Table No. 09. Showing the different treatment modalities adopted in treatment of Amavata. 4110. Table No. 10. Showing the pattern of onset of Rheumatoid arthritis. 5111. Table No. 11. Showing the results of Hingula shodhana. 6012. Table No. 12. Showing the quantity of hingula before and after shodhana. 6013. Table No. 13. Showing the quantity of vatsanabha before and after shodhana.6214. Table No. 14. Showing the pippali before and after churnikarana. 6315. Table No. 15. Showing the vatsanabha before and after churnikarana. 6416. Table No. 16. Showing the ingredients of Hinguleshwara rasa with their proportions and quantity. 6417. Table No. 17. Showing the gradation which is adopted in statistical evaluation of clinical symptoms. 7518. Table No. 18. Showing the gradation which is adopted in statistical evaluation of walking time. 7619. Table No. 19. Showing the distribution of patients by age group. 7920. Table No. 20. Showing the distribution of patients by sex incidence. 8021. Table No. 21. Showing the distribution of patients by religion. 8122. Table No. 22. Showing the distribution of patients by socio-economic status.8123. Table No. 23. Showing the distribution of patients by occupation. 81
  • 14. VIII24. Table No. 24. Showing the distribution of patients by marital status. 8225. Table No. 25. Showing the distribution of patients by food habits. 8226. Table No. 26. Showing the distribution of patients by addiction. 8227. Table No. 27. Showing the distribution of patients by predominance of rasa.8328. Table No. 28. Showing the distribution of patients by prakriti. 8329. Table No. 29. Showing the distribution of patients by sara. 8430. Table No. 30. Showing the distribution of patients by samhana. 8431. Table No. 31. Showing the distribution of patients by satwa. 8432. Table No. 32. Showing the distribution of patients by vyayama shakti. 8533. Table No. 33. Showing the distribution of patients by desha. 8534. Table No. 34. Showing the distribution of patients by chief complaints. 8635. Table No. 35. Showing the distribution of patients by associated complaints.8736. Table No. 36. Showing the distribution of patients by nidana. 8837. Table No. 37. Showing the response of the therapy before and after in sandhishoola. 8938. Table No. 38. Showing the response of the therapy before and after in sandhishotha. 9039. Table No. 39. Showing the response of the therapy before and after in jadya.9140. Table No. 40. Showing the response of the therapy before and after in jwara.9241. Table No. 41. Showing the overall result assessed on the basis of objective parameters. 9342. Table No. 42. Showing the statistical analysis before and after treatment. 9443. Table No. 43. Showing the master chart of subjective parameters. 9644. Table No. 44. Showing the master chart of objective parameters. 9845. Table No. 44. Showing the master chart of objective parameters. 100
  • 15. IX LIST OF GRAPH & FIGURES Page No.01. Graph No. 01. Showing the distribution of patients by age group incidence. 7902. Graph No. 02. Showing the distribution of patients by sex incidence. 8003. Graph No. 03. Showing the distribution of patients by chief complaints. 8604. Graph No. 04. Showing the distribution of patients by associated complaints. 8705. Graph No. 05. Showing the distribution of patients by nidana. 8806. Graph No. 06. Showing the response of the therapy before and after in sandhishoola. 8907. Graph No. 07. Showing the response of the therapy before and after in sandhishotha. 9008. Graph No. 08. Showing the response of the therapy before and after in jadya. 9109. Graph No. 09. Showing the response of the therapy before and after in Jwara. 9210. Graph No. 10. Showing the overall result on the basis of subjective and objective parameters. 9311. Photograph No. 01. Ingredients and pharmaceutics of Hinguleshwara rasa.
  • 16. Ayurveda is one of the system of medicine in the world. Among so manysystems of medicine it has its own identities. Because, it deals with health as well asdisease. The aims of Ayurveda are preserving and promoting health as well as preventingand curing diseases. Ayurveda defines swastha as one whose physical, spiritual, social andenvironmental aspects are in a good harmony. Ayurveda has taken maximum care to consider even routine events of the dailylife in view of their vital role in promoting health and preventing disease. Almost everysource of life and matter surrounding human being has been in use for treating thedisease. Rasashastra a branch of Ayurveda deals with metals, minerals, etc. Rasaoushadhisare mainly grouped into four varieties – 01. Kharaliya rasayana 02. Pottali rasayana 03. Parpati rasayana 04. Kupipakwa rasayana Method of preparation of Rasaushadhies are different from each other. Kharaliyarasayana occupies major proportion in the Rasa rasayanas. In that four rasayanasKupipakwa and pottali rasayanas are limited. But kharaliya rasayas are numerous. Kharaleeya rasayanas are prepared by mercurial compounds like Kajjali, Hingula,etc. Mardana is done in Kalva yantra with dhatu, bhasmas, vishas, upavishas, sadharanarasa. Bhavana is given with dugdha, jala, swarasa. It can be used as churna or vati. Here 1 Introduction
  • 17. no agni samskara is given and yogas which are prepared in khalwa yantra are called askharaleeya rasayana. The most of the Kharaleeya rasayanas are herbomineral combinations. Thesemedicaments are having both herbal and mineral drugs. Because the herbal constituentswill nullify the untoward effects of the minerals and increases the potency of the mineralsforming the herbomineral complex. Hinguleshwara rasa, which comes under Kharaleeya rasayana, which is thetypical combination of drugs to combat the crippling disease,Amavata. Hinguleshwararasa contains shodhita Hingula, shodhita vatsanabha and pippali. Amavata is a condition in which improperly metabolized intermediate by productknown as ama, becomes the core cause of the disease and get deposited by prakupita vataat different joints. Rheumatoid arthritis (RA) is an autoimmune musculoskeletal disorder explainedin modern medicine closely resemble with the clinical entity of Amavata. It occurs in all races and ethnic groups. Females are more affected 3:1 ascompared to males. There are several preparations listed in Ayurvedic classics for Amavata likeguggulu preparation and gold preparation they are costly and when we look at the list weare confused. Why there is a necessity of several preparations on one disease. Ayurvedabelieves that every individual differs form each other and require a specific yoga in adisease. 2 Introduction
  • 18. Hingluleshwara rasa is considered as an ideal preparation by Rasatarangini andfound recommended for Amavata. The combination of shodhita hingula, shodhitavatsanabha and pippali are capable to over come a disease amavata.The whole study has been arranged in to following chapters – 01. Introduction Introducing the subjects by putting emphasis on its importance and necessity inthe present time and plan of study. 02. Review of Literature It is based on the description of Ayurveda texts and also modern,pharmacotherapeutic properties of the Hingula, Vatsanabha, and pippali. Description ofAmavata and Rheumatoid arthritis. 03. Methodology a. Pharmaceutical study This chapter includes the selection of raw materials, shodhana of hingula,shodhana of vatsanabha,and preparation of Hinguleshwara rasa. b. Analytical study This chapter includes physicochemical analysis of Hinguleshwara rasa. c. Clinical study This includes single group prospective clinical study and explains about efficacyof Higuleshwara rasa over Amavata. 3 Introduction
  • 19. 04. Results In this part the results obtained are systematically presented, which aredemographic data, data related to disease and data related to response to treatment. 05. Discussion In this chapter observations, findings and results of various studies have beenfound out with possible explanation for its effects. 06. Conclusion The essence of the whole study is mentioned in this chapter. 07. Summary It contains about the brief note, which are explained earlier.Previous works published in relation to the subject : Pandey – K – Vataja Jwara Par Hinguleshwara Rasa ka prayogika Evaumsamalochanatmaka adhyayana – 1985 Rajapur University, Government AyurvedicCollege, Pandit Ravishankar University Raipur Dept. of Kayachikitsa. 4 Introduction
  • 20. 01. Preparation of Hinguleshwara Rasa02. Physico-chemical analysis of Hinguleshwara Rasa.03. To study the clinical efficacy of Higuleshwara Rasa in the selected cases of Amavata (Rheumatoid Arthritis). 5 Objectives
  • 21. DRUG REVIEWHinguleshwar Rasa Rasashastra is a branch of Ayurveda deals with the drugs and efficaciousformulations, rasa-rasayanas celebrates prime class under khalvi rasayana under whichHinguleshwar Rasa included. Hinguleshwara Rasa is a unique combination of drug documented to treatAmavata. We get 4-5 references of Hinguleshwara Rasa in different texts of Rasashastra.Different Methods Of Preparation In Various TextsI. Shri. Govindadasa Author of Bhaishajya Kalpana – He explains as – Take equal quantity of Pippali churna, shodhita Hingula,shodhita Vatsanabha – do mardana in khalwa yantra. Prescribe half ratti with madhu. Itsubsides vataja jwara.1II. Dattaramsundara the author of Brihatrajasundara – He explains as – Take equal quantity of pippali churna, shodhita visha, shodhitaHingula – do mardana in khalwa. Give in two-ratti pramana with madhu. It subsidesvataja jwara.2III. According to Rasakamadhenu – Take equal quantity of pippali, hingula and visha do mardana in khalwa. Give it in2 gunja pramana with madhu. It subsides vataja jwara. 3IV. Indradeva Tripathi author of Rasendrasara Sangraha – He explains that – Take equal quantity of Pippali, shoditha Hingula, shodithaVatsanabha and do mardana in khalwa yantra. Give it in 2 gunja pramana with madhu. Itsubsides vataja jwara. 4 6 Drug Review
  • 22. V. The author of Rasataranginikara – He explains – Take 2 tola of shuddha isha, 2 tola of shuddha Hingula and 2 tola ofPippali churna – do vati in yava pramana. It subsides Amavata and vataj jwara, which isselected for study.5 And also highlights the amayika prayoga of Higuleshwar Rasa as it subsidesteevra jwara, angamarda, sandhishoolayukta amavata, along with all types of teevra shirovedana. Apart from that it is useful in nava jwara, jeerna jwara, savirama jwara.6HingulaIntroduction – Hingula is compound of parada and gandhaka, which occurs as a mineral in themines, associated with other minerals and also made artificially. This is a chief source ofmercury since ancient times to this date. In ancient times mercury was obtained from itthrough patana process. Many varieties of this mineral have been described in ancienttexts. Out of these Hamsapada variety is considered best as it consists less impurities.Synonyms –Table No. 01. Showing the synonyms of Hingula according to different authors.Sl. Synonym RT R. Sa. Sn. AP RA DN RA KN01. Hingulam - - - - + - -02. Hingul + - - - - - -03. Hingula + + + + - + -04. Ingula + - - - - - -05. Hingulaka - - - - - - +06. Mleccha + - + + + + + 7 Drug Review
  • 23. 07. Rakta + - + - - - +08. Gairika + - - - - - +09. Suranga + - + - - - -10. Chitranga + - - - - - +11. Churna parada + - - - + - -12. Rasodbhava + - - - + - -13. Rasasthana + - - - + - -14. Ranjana + - - - - - -15. Kapishirshaka + - - - - - -16. Raktakaya + - - + - - -17. Hamsapada + - - - - + +18. Darada + + + - - - -19. Barbara - - - - - - -20. Shuka tunda - - - - - - -21. Jati - - - - - - +22. Rasagandha sambhuta - - - - - - -23. Daitya raktaka - - - - - - -24. Maraka - - - - + - -25. Maniraga - - - - - - +26. Rasagarbha - + + - + - -27. Charmanu ranjana - - - - - - -28. Ati rakta - - - - - - +29. Parvata - - - - - - +30. Saikta - - - - - - + 8 Drug Review
  • 24. Vernacular name –English name – Cinnabar.Scientific name – Red sulphide of mercury. Sanskrita – Hingula, darada. Hindi – Hingula, Singraph. Bengal – Higula. Marathi – Hingula. Gujarathi – Higualo. Assam – Janjapher. Pharsi – Sangarph. Telagu – Ingulakam. Kannada – Ingulika. Historical BackgroundVedic period – No references about Hingula is available in any of the Vedas.Samhita kala – No reference available in Charaka, Sushruta, Ashtanga Samgraha and AshtangaHridaya. The author of Kautilya Arthashastra, Chanakya has mentioned hingula in his textfor the first time. He mentioned it for testing various metals. He was using this for testingthe suvarna. The uses of Hingula as a medicine was not described by him.7 In Samhita kala, there were no references for Hingula. But, we get references ofparada. It is assumed that in olden days, it was imported from other countries. 9 Drug Review
  • 25. According to history of oldest text of rasashastra, Rasendra Mangala, we get thereferences of Hingula. Here, he used the word Darada for Hingula8. Rasa Hridayatantrakara mentions, it is one of the rasadravya.9 Author of rasarnava considered, as it isone of the maharasa dravya.10 While, describing synonyms by Rasendra sara samgraha,mentioned it as Rasa Gandhaka Sambhoota for Hingula.11 The usage of Hingula as amedicine started between sixth and eighth century.Inclusion of Hingula Different authors of various Rasa Granths have included Hingula under thevarious titles. The classification of all rasa dravyas done generally, according to their usage andimportance in the procedure related with parada. The important rasa texts have includedHingula under following classes –Table No. 02. Showing the Hingula included under following classes as in different texts.Dravya Rasa Maharasa Uparasa Sadharana rasaHingula Rasahridaya Rasarnava Anandkanda, R.S.S, R.J.N. tantra B.R.R.Su., A.P. R.C. R.Pra. Su. R.R.S.Hingula Bheda No description about varieties of Hingula is available in Resendra Mangala andRasa Hridayatantra. But we get reference of Hingula bheda in other texts. 10 Drug Review
  • 26. Table No. 03. Showing the bhedas of Hingula.Sl. Name of the text Charmara Shukatunda Hamsapada Anya01. Anand kanda + + + -02. Rasendrachudamani - + + -03. Ayurevda prakasha + + + -04. Rasaratna samuchhaya - + + -05. Rasaprakasha + + + - sudhakara06. Rasatarangini - - - Kritima khanija07. Rasamrita - - + MlechhaCharmara Hingula Shuka varna i.e. greenish colour.Shukatunda Hingula Sapeeta varna i.e. yellowish colour.Hamsapada Hingula (Grahya Hingula) It has Pravala samana and having sweta rekhas on the surface of Hingula. It isconsidered to be best for therapeutic purpose. Among these three are having the quality of uttarottara gunavan.Asuddha Hingula dosha If ashuddha Hingula is consumed, causes – Moha, Prameha, Chittavibhrama,Andhyata, Klama, Kshaunya and this directs to use always shodhita Hingula. 11 Drug Review
  • 27. Shodhana of Hingula Various shodhana methods are explained in different classics, according toavailability, cost efficacy and medicinal formulations. 01. Do mardana with amla rasa dravyas and give 7 bhavanas of mahisha dugdha. 02. Keep hingula in kushmanda khanda, do pottali, and give swedana in Lakucha swarasa poorita Dola yantra. 03. Give 7 bhavanas of adraka swarasa or lakucha swarasa. 04. Give 7 bhavanas of adraka swarasa. 05. Give 7 bhavanas of nimbu swarasa.Satwapatana Shodhita Hingula is smeared in the upper part of adhapatana yantra, water is filledin lower vessel. This apparatus is placed in the earth. Give heat to the upper vessel. Weget parada samana satwa in lower vessel.Marana Generally marana is not advised for Hingula. Shodita Hingula can be used for thepreparation of yogas. However elaborate process of marana has been described in Ayurveda prakasha. Hingula is wrapped in the cloth and kept inside nila kanda, which is then coveredwith the mud paste around. When dried, it is subjected to puta, and baked in 10 vanopalasuch 100 putas are given similarly it is kept inside vanavarataka and given 100 putas thenin mandara phala and given hundred putas then in indravaruni phala and subjected to 100putas and lastly in amlavetasa phala and given 100 putas. At the end Hingula attainsintense red colour. 12 Drug Review
  • 28. Hingula PropertiesRasa – Various opinions are available regarding the rasa of Hingula.Table No. 04. Sowing the rasa of Hingula according to various texts –Sl. Author Madhura Tikta Kashaya Katu01. Rasarnava + + - -02. Dhanwantari nighantu + + - -03. Raja nighantu + + - -04. Bhava prakasha - + + +05. Ayurveda prakasha - + + +06. Rasandra purana - + + +Guna – Most of the texts considered Hingula as ushna gunayukta dravya.Veerya and Viapaka – No rasa shashtriya text has mentioned veerya and vipaka of Hingula, though theDhanwantari nighantu being the text of dravya guna vignana has mentioned Hingula ishaving the ushna veerya and katu vipaka.Doshakarma – Even though almost all the authors enormously agree the tridoshaghna karma ofthe Hingula, but some of the texts mention either kaphaghna or kapha pittaghna action ofHingula as well. 13 Drug Review
  • 29. Table No. 05. Showing the doshaghnata of Hingula according to various texts –Sl. Author Kaphaghna Kapha-pittaghna Tridoshaghna01. Rasatarangini + - -02. Bhava prakasha - + -03. Ayurveda prakasha - + -04. Rasendra chudamani - - +05. Rasendrasara sangraha - - +06. Rasendra purana - - +07. Rasamrita - - + Rasaratnasamuchhyakara has quoted hingula as sarva doshahara, deepana,atirasayana, sarvarogahara, vrishya. It is useful in dhatujarana, Parada extracted formHingula is equal to the property of Gandhaka jarita parada. Rasaprakashasudhakara quoted that the Hingula has the property of deepana,sarvadoshaghna, atirasayana, sarvarogahara. It is helpful in dravana karma. Paradaextracted form Hingula is said to be equal to the property of shadguna Gadhaka jaritaparada. Ayurveda prakashakara has quoted the property of Hingula tikta, kashaya rasa,kapha-pittahara. It subsides netra roga, hrillasa, kushta, kamala, pleeha, amavata andkrutrima visha. It also subsides navajwara and santapajwara. Rasendrachudamanikara quoted the property of Hingula as sarvadoshaghna,deepana, atirasayana, sarva rogahara, vrishya. It is helpful in jarana samskrara. 14 Drug Review
  • 30. Rasamrita quoted the properties of Hingula that its pacifies all the tridoshas. It hasdeepana and powerful rasayana effect. It can destroy all diseases and may be used for themarana of gold and iron, etc metals. Mercury extracted form the Hingula is considered to be equal in properties to themercury in which gandhaka jarana has been carried out. Rasataranginikara quoted that, it has a property of netrarogahara, kaphaprakopanashaka, pitta prakopajanya roga nashaka. It subsides pleeha kushta, gara visha, kamala.It is pachaka agni vardhaka and ama pachaka. It subsides prameha. It increases shareerakanti, bala vriddhi. It subsides amavata prakopa and jwara. Dhanwantari nighantukara quoted that, it has katu vipaka, ushna veerya. Itsubsides visha, kushta, visarpa and twak vikara, madhura tikta rasa, kapha vata shamaka,and it subsides tridoshaja and dwandwaja jwara. Rajanighantukara quoted that it is having madhura tikta rasa and ushna veerya. Itsubsides vata and kapha roga, dwandwaja and tridoshaja jwara. Kaiyadeva nighantukara quotes that, Hingula is laghu, tikta and katu rasa, katuvipaka and ushna veerya. It subsides netra peeda, kushta, visarpa, visha, pitta and kapha.Vishishta Yoga Hinguleshwara rasa, Mrityunjaya rasa, Ananda bhairava rasa, Siddha daradamritarasa, Darada vati. 15 Drug Review
  • 31. Cinnabar Chemical composition – Sulphide of mercury (HgS). It contains 13.8% of Sulpher and 86.2% of Mercury Form – Trigonal or rhombohydral usually. Massive, granules. Intense red in colour, sometimes brownish red in colour. Streak – Red. Transparency – Opaque or translucent. Hardness – 2-2.5. Specific gravity – 8.09. Luster – Admentine. Variety – Hepatic with liver brown colour. Occurrence – Generally occurs due to the volcano activity. Also available near hot springs. Important places of occurrence are Spain, Italia, Western states of USA, Maxico.VatsanabhaBotanical name – Aconitum ferox wall.Family – Ranunculaceae.Introduction – Vatsanabha is known to the Ayurvedic pharmacopeia since long ago. Weget reference in Charaka samhita and Sushruta samhita. Charaka samhita classified understhavara visha and Sushruta classified under Kandavisha and also explain its effects. Explanation of vatsanabha is found in all most classical texts and Nighantus. Theutility of vatsanabha definitely increased after the development of Rasashastra.Rasataranginikara classified it under visha. 16 Drug Review
  • 32. The term aconite refers to the genus aconitum of which there are several species.The name may be originated form the Greek aconoits (meaning without struggle orwithout dust) or from the Greek city acona where naturolist in the third century onceidentified plant. Other sources suggest that the name comes from the hill of aconites. Aconites is Greek word meaning arrows coated with the poison and used forhunting the animals. Hence, the aconite.Synonyms –Table No. 06. Showing the synonyms of Vatsanabha.Sl. Names D.N. R.N. R.T.01. Vatsanabha + + +02. Amruta + + +03. Visha + + +04. Ugra + + -05. Maha oushadha + + -06. Garalam + + -07. Marana + + -08. Naga + + -09. Stokakam + + -10. Pranaharaka + + -11. Sthavaradyam + + -12. Kshweda - - + 17 Drug Review
  • 33. Vernacular Names – 01. Sanskrit – Visha, Vatsanabha. 02. Hindi – Bisha, Mithazahar. 03. English – Indian aconite. 04. Bengali – Katbish or Mitha visha. 05. Telagu – Vasanubhi. 06. Kannada – Vatsanabhi. 07. Gujarathi – Vachanag. 08. Marathi – Vacha nag. 09. Assam – Visha. 10. Bihari – Dakara. 11. Malyalama – vatsanabhi. 12. Punjabi – Mohari. 13. Arab – Bish. 14. Parsi – Bishmag.Classical Categorization Charaka Samhita – Stavara visha. Sushruta Samhita – Kanda visha. Dhanwanatari nighantu – Misraka varga. Raja nighantu – Misraka varga. Bhavaprakasha nighantu – Dhatvadi varga. Rasataragini – Visha. 18 Drug Review
  • 34. Modern Toxicological Categorization Cardiac poison.Different verities of Vatsanabha (BHEDA) –According to Yogaratnakara – 01. Brhmana 02. Kshatriya 03. Vaishya 04. ShudraAccording to Rasatarangini – 01. Krishna 02. Kapisha 03. Pandu Kapisha is better than Krishna. Pandu is better than kapisha. Pandu is consideredbest for therapeutic uses.According to Ayurveda Prakasha – 01. Shukla 02. KrishnaIdentification – Vatsanabha plant resembles like sinduvarna. These palnts always 5-6 in a group.Around these plants no other plants grow. Its flowers are blue in colour. It is kshupa. Itsheight in 2 hasta pramana. This plant grows Gadaval, Kashmir, Nepal. 19 Drug Review
  • 35. Botinical description – It is a perennial herb. Root – Paired, daughter, tuber ovoid oblong to ellipsoid, 2.5-4 cm long, about 1-1.5 cm thick, with fill form root fibers, dark brown externally, yellowish on fracture, another tuber much shrunk and wrinkled with more numerous root fibers. Stem – Erect, with or without a slender, hypogynous base, simple, 40-90 cm high, covered with short spreading yellow hairs in the upper part and glabrous below. Leaves – Scattered, distant, glabrous, petioles, slender up to 25 cm, blade or bicedar – cordate to remiform in out line with rather wide sinus. Planately 5- lobeal. Inflorescence – Peduncle straight, bearing flowers on both sides, flowers pale, blue, brown in a dense, terminal raceme, 10-25 cm long, helmet, volatile with short shared beak, resembling a pea flower. Fruit – Carpels 5, tomentose, follicles oblong, 15-20 mm long and 4-5 mm, broad, seeds obovoid to obpyramidal, 2.6-3 mm long, winged along with the raphe. Distribution – Grows solid in the alpine Himalayas. Kashmir at an attitude of 3,600 m, alpine Himalayas of Nepal. Chemical Constituents – Roots contains tanic alkaloids, pseudo aconitine along with bikha aconitine, chasmaconitine, chahnaconitine, indaconitine (Loydia 1972, 35, 55) Veratroyl pseudoaconitine are diacetyl psedioaconitine (manske and Rodrgo) 1979). Two new alkaloids 2-(11+) quinolinome and 3,4 dihydro – 6 – hydroxy – 2 –(11+) – quinolone (Nat. prod. Lett.) 1993, 227, chem., abortr. 1994, 121, 175, 172b). 20 Drug Review
  • 36. A new diterpenoid alkaloid – 14 – 0 – acetyl senbasimet, vakognavime, chasmaconitine, crassican line A, flconericine, senbusine B, isotalatizocline and aconine arereported (phyto chem.. 1994, 36, 1527). Four lipoalkalaoids viz, liposcude aconitine, lipoyunaconuitine, lipoindaconitineand lipobikhaconitine and four aconine viz. veraatropylpseudaconine, auisolyona comine,benzoylida aconine and veratroylbikkaconine are also reported. (J. Nat. Prod. 1994, 57,105.). Grahya Vatsanabha – Sthoola, snigdha, guru, naveena, after fruiting free from keetaadi are the grahya laxanas.Need of Vatsanabha shodhana – Ashodhita vatsanabha causes daha, moha, hirtagata rodha. To avoid these doshasor vikaras it should under go shodhana process.Vatsanabha shodhana – 1st method – Take vatsanabha cut in small pieces. It is kept in mud pot. Fill withgomutra and place under sunlight. Every morning replace the old Gomutra with the newone. Do this process for 3 days. After that take out vatsanabha form Gomutra, removeouter layer, dry under sunlight. 2nd Method – Vatsanabha cut in to chana pramana. Made pottali. Do swedana indolayantra with Go dugdha for 6 hours. 3rd Method – Vatsanabha cut in to small pieces, made pottali. Do swedana in dolayantrawith ajadugdha for 3 hours. 21 Drug Review
  • 37. 4th Method – Pieces of vatsanabha tide in vastra put in dolayantra. Give swedana withjala and ksheera for one prahara.Gunakarma – Rasa – Madhura. Guna – Ushana. Veerya – Ushna. Vipaka – Madhura. Dosha karmarma – Vata-kapha shamaka. Dhanwantari nighantu classified under Mishrakadivarga. Madhura rasa, ushnaguna, vatakaphahara, it subsides kanthashoola, sannipataghna, pitta samshodhini. Rajanighantu classified under pippalyadi varga. Atimadhura, ushna,vatakaphahara. It subsides kantaruja, sannipataghna, pitta santapa karaka. According to Rasatarangini vatsanabha katu, tikta, kashaya rasa, ushna guna andyogavahi. It is rasayana, tridoshahara particularly vata-kaphahara. It increases agni. Itsubsides sheeta and brumhana and bala vardhaka. It subsides agnimandya rogas, pleeharoga, vatarakta, shwasa, kasa, grahani, gulma, pandu, jwara and amavata. It relievestimira, naktandhyata, netrabhishyanda, netrashotha, karna shoola, gudaroga and kativedana. Application of bhahya lepa subsides the aku, vrushika, sarpavisha. Diaphoretic, diuretic, antiperiodic, anodyne and antidiabetic, antiphlogistic,antipyretics in small doses. In large doses it is virulent poison, narcotic and powerfulsedative. It reduces the frequency and tension of the pulse and paralysis the respiratorycenter. 22 Drug Review
  • 38. Part used – Dried tuberous root.Dose – 1/10th ratti to 1/8th ratti (R.T). (24/64-66).Visha prayoga Nishedha – Balaka, atyantavridhha, garbhavati, rugna, atikshinashareera, rajayakshmalaxanayukta avasta, krodhi, atibhranti, durbalavastha in less quantity and short durationwith precautions.Toxic effects and antidotes – Sushruta clearly documented the toxic effects of vatsanabha viz. Grivastambhaand peeta vit, mutra, netra.Antidotes – Accidental poisoning or over dosage with aconite may produce the toxicsymptoms. Different antidotes have been mentioned for the management. Gogrutha isconsidered as one of the best antidotes for visha. Tankana (Borax) is considered to be the main antidote. It may be administratedalong with Ghee. Arjuna bark is mixed with Honey and Ghee may be another alternativeantidote.Aconite Poisoning and its management in toxicology – The symptoms of poisoning occur immediately or within a few minutes afterconsumption of root. First burning sensation is experienced from the mouth to stomachfollowed by tingling and numbness in the mouth, tongue and pharynx. This is followedby salivation, Nausea, Vomiting and diarrhoea. Later dryness of mouth and polydypsia isdeveloped and the patient will be unable to swallow. 23 Drug Review
  • 39. Other symptoms include headache, giddiness, pallor, profuse sweating, subnormaltemperature weakness of limbs and inability to stand or walk. Twitching of muscles. pain,and cramps and convulsions may occur. The pupils contract and dilate alternately but remain dilated at the later stage.Dimness of vision and diplopia may be caused. The pulse becomes slow, feeble andirregular. Blood pressure will be low and the patient complains of breathlessness. Themental conduction remains normal but there may be hallucination. Death finally occurs either due to paralysis of heart or respiratory centers or evenboth.Fatal Dose – 1-2 grams of root. OR 4– 6 mg of aconitine.Fatal Period – 3 –6 hours.Treatment – 1. Gastric lavage with warm water and weak solution of potassium permanganate or with a solution of iodine in potassium iodide or with tannic acid or strong coffee or strong tea to precipitate the alkaloids. 2. Powdered charcoal to diminish solubility. 3. Atropine 0.5 – 1mg is useful. 4. Strychnine, artificial respiration, application of heat etc., may also be useful. 5. Symptomatic treatment.Vishishta yogas – 01. Ramabanarasa 02. Hinguleshwara rasa 03. Tribhuvanakirti rasa 04. Kaphaketu rasa 24 Drug Review
  • 40. PippaliBotanical name – Piper longum linn.Family – Piperacae.Introduction In Atharvana veda pippali is mentioned as rasayana. Kshipta bheshaj, atividdhaabheshaji and vati krita bheshaji. Pippali is drug which is widely used in Ayurvedicformulations. Charaka and Sushruta have extensively quoted pippali among dashemanigroup and ganas respectively. Charaka quoted pippali in dashemani like deepaneeya, kanthya, asthapanopaga,shirovirechanopaga, hikkanigrahana, kasahara, sheetaprashamana and shoolaprashamana. Charaka describes vardhamana pippali rasayana where pippali in ten numbers isgiven on first day to tenth day in increasing dosage and tapered to the original dose of tenpippali on the 19th day. Sushruta quoted in their ganas like pippalyadi and amalakyadi gana. Astangasangrahakara also quoted pippali in pippalyadi gana and nyagrodhadigana.Vernacular names – 01. Hindi – Pipala. 02. English – Piper. 03. Telagu – Pippali. 04. Tamil – Tippali. 05. Bengali – Pipali. 25 Drug Review
  • 41. 06. Marathi – Hippali. 07. Malyalam – Tippali. 08. Punjabi – Moghaum. 09. Gujarati – Pipali. 10. Kannada – Hippali. 11. Parsi – Pipli. 12. Burma – Peikchin. 13. Arb – Darfifil. 14. Sanskrit – Pippali. 15. Barma – Peikchin.Synonyms –Table No. 07. Showing the synonyms of Pippali according to various authors – Sl.No Name D.N B.N R.N K.N M.N 01. Upakulya + + - - - 02. Shyama + - + + - 03. Ushna + + - + - 04. Pippali + + + - + 05. Magadhi + + + + + 06. Krishna + + + _ _ 07. Tikshna + - - - - 08. Tandula + - - - - 09. Kakura - + - 10. Shoundi + + + + + 26 Drug Review
  • 42. 11. Kana + + + + + 12. Katubeeja - - + - - 13. Korangi - - + - - 14. Tiktatandula - - + - - 15. Kola + + + - - 16. Chapala + + + + + 17. Vaidehi + + + + - 18. Danta Phala - - + - - 19. Magdodudbhava - - + - - 20. Vishvopakulya - - - - + 21. Tikshana tandula - + - + +Bheda It is of 4 types – Pippali Gajapippali Simhali Vana pippaliBotanical Description – An aromatic slender, climber.01. Stem – Cripping, jointed, attached to other plants while climbing.02. Leaves – 5-9 cm X 3-5 cm., subacute, entire, glabrous, cordate at the case.03. Flower – In pendular spikes, straight. A. Male – Larger and slender. B. Female – 1.3 – 2.5 cm X 4.5 cm in diameter. 27 Drug Review
  • 43. 04. Fruit – Yellowish orange ovoid, sunk in flesh spikes fruits in rainy season and fruit in autumn.05. Distribution – Found in the hotter parts of India, form central Himalaya toAssam and Mikir hills. Also found in forests of western ghats form Konkan to Kerala.06. Chemical constitution – Essential oil, mono and sesquitrpenes, caryophyllene,piprine, piper longumine, piper longuminine, piper nonaline, piper undecalindine,pipercide, sesamin, β-sitosterol, four aristolactan, five 4,5 – dioxoporphinos.Properties – Rasa – Katu. Guna – Laghu, snigdha, teekshna. (Ardha guru) Veerya – Anushna sheeta veerya. Vipaka – Madhura. Karma – Vata-shleshmahara. Useful parts – Fruit, root. Dhanwantari nighantu, includes under shatapushpadi varga. Pippali have theproperties of katu rasa, madhura vipaka, sheeta veerya, snigdha guna, tridoshahara. It israsayana and subsides jwara, trishna, udara roga, krimi, amadosha. Raja nighantukara includes under pippalyadi varga. Pippali have the properties ofsnigdha ushna guna, katu tikta rasa. It is vrishya, deepana and subsides jwara, kasa,shwasa, kaphahara. Bhavaprakasha nighantukara includes pippali under haritakyadi varga. Pippalihave the deepana, vrishya, madhura vipaka and rasayani. Anushna sheeta veerya, katurasa, snigdha laghu, vata shleshmahara. It subsides shwasa, kasa, udara, jwara, kushta,meha, gulma, arsha, pleeha, shoola, amavata. Ardra pippali is kaphaprada, snigdhasheetala, madhura and guru. 28 Drug Review
  • 44. Madanapala nighantukara has included pippali under shunthyadi varga. Pippalihas properties of deepana, vrushya, madhura paka, rasayani, atyushna, katu rasa, snigdha,laghu, kaphahara, pitta rechani. It subsides swasa, udara, jwara. Kaiyadeva nighantukara includes pippali under oushadhi varga. Ardra pippalihave the property of sheeta, guru, madhura, snighdha, ushna, kaphaprada. Shushkapippali is laghu madhura paka, snigdha ushna, katu rasa, kapha vatahara. ruchya, sara,vrishya, rasayani, deepani, pachani. It subsides kapha, gulma, arsha, meha, pleeha, jwara,udara. Infusion is stimulant, carminative and alternative tonic more powerful than blackpiper, also aphrodisiac, diuretic, vermifuge and emmengogue. Externally rubefacient. Piper longumin or piperine shows immuno-modulatory and antitumour activity.Piperine also shows cytotoxic towards DLA and EAC cells at concentration of 250 microgm/ml. Administration of piper longum or piperine increased the total WBC count. Bonemarrow cellularity and alpha esterase positive cells were also increased by theadministration of piper longum extract or piperine. Pipper longum or piperine shows to posses bioavilability enhancing activity withvarious structurally and therapeutically diverse drugs. It may be hypothesized that,piperine bioavailability enhancing property may be attributed to increased absorption,which may be duet to alteration in membrane lipid dynamics and change in conformationof enzymes in the intestine. Piper longum acts as antioxidant and is predominant in catalytic activity. Itcontains vitamin E and A. The antioxidant components of piper species constitute a veryefficient system in scavenging a wide variety of reactive oxygen species.Dosage – Choorna – 0.5-1 gm. 29 Drug Review
  • 45. Vishishta Yoga – Pippali ghrita Pippalyasava Vyoshadi vati Pippalyadi leha Yakritapippali yoga Vardhamana pippali.ArdrakaLatin name – Zingeber officinale.Synonyms – Adraka, gulma, moola, mulaja, kandala, vara, shringavera, mahija,saikateshta, anupaja, apekshika, adravya, rahu chhatra shishuka, shagra, aardra shakha,sachaka.Vernacular names – 01. Sanskrita – Ardraka. 02. English – Green ginger. 03. Hindi – Adraka. 04. Malyali – Alia. 05. Telagu – Allam. 06. Tamila – Inji. 07. Bengali – Duk. 08. Marathi – Shunti. 09. Kannada –ShuntiCharacters – The plant with the dingy yellow flowers on a leafless flowers stalk and longlanceolate leaves on a separate stem.Rhizomes – 2 to 4 inch long. 30 Drug Review
  • 46. Tubers – Branched, knotty and some what compressed on one side lobed and clavatelybranched without a wrinkled corcky epidermis. Buff coloured and striate on sectionfracture meanly and fibrous showing many scattered resin cells and fibro-vascularbundles.Odour – Agreeable, aromatic, penetrating.Taste – Acrid and pungent.Chemical Constituents – A volatile 2%, fat a cured liquid oleo resin, gingerol, or gingerininsulase, resin, starch 20%, ash 4%. The volatile oil contains camphene and phelladrene.Gingerol, an active principle extracted form ginger is a viscid, inodourous pungent liquid.Habit – Through out India, West-Indies, Africa, cultivated in Jamica, Sierraleone.Part used – Rhizomes.Adraka – Guna – Laghu Rasa – Katu. Guna – Laghu. Veerya – Sheeta. Vipaka – Madhura. Dosha – Kaphahara. Karmaghnata – Hridya, deepana, ruchikaraka. It subsides kaphajnya vikara and kantha roga.Gomutra Gomutra is used as a medicine since olden days. We get the reference about it inbrihatrayees. Charaka considered, it as one of the ashta mutra varga dravya.Synonyms – Gomutra, Gojala, Goambu, Gomashanda, Godrava. 31 Drug Review
  • 47. Vernacular names – ⇒ Sanskrit – Gomutra. ⇒ Hindi – Gomutra. ⇒ English – Cow’s urine. ⇒ Kannada – Gomutra. Properties – Rasa – Katu. Guna – Teekshna, Ushna, Kshara. Dosha – Kapha-vata shamaka, pitta janaka. Karmaghnata – Agni deepaka, medhya, shoolahara, gulma, anaha. It is used in virechana karma and asthapana basti. Charakacharya quotes that Gomutra has madhura rasa, dosha nashaka and krimiand kanduhara. By abhyantarapana it subsides doshajanya udara roga.Nadakarni in his material medica explains Gomutra contains ammonia in a concentratedform and is much used in both internal and external purpose. Gomutra is a laxative,diuretic, and used in preparation of various medicines. Eg. Poonarnava mandura. It is alsorecommended by Chakradatta as a anupana for eranda taila given as virechana. It is used as externally in the purification and roasting of various metals andpreparation of oils, decoctions, etc. 32 Drug Review
  • 48. Madhu Madhu is one of the jangama dravya. We get reference in all samhitas. Madhu isused as a medicine and anupana.Vernacular names – ⇒ Sanskrita – Madhu, Makshika. ⇒ English – Honey. ⇒ Kannada – Jenutuppa.Source – Bee hives or honey comb, where it is departed by the honey-bee. It occurs in thenectars of flowers where from it is sucked by the bees and then stored up in the comb.The finest honey is the virgin Honey which drains itself from the comb, and that which isfinally procured from the hive.Characters – It is viscid, saccharine, substance, semitranslucent liquid of a light yellowishbrown colour, of an aromatic odour and of a sweet acrid taste. After a time it becomesopaque and crystalline.Constituents – Dextrose, levulose, wax, volatile oils, proteins, mucilage, colouring matter, formicacid. Some of the substances counted are pollen dust, ethereal oil, various phosphate,lime, iron.Action – It is demulcent, and laxative, more than one year old is astringent, demulcent,pectoral, emollient and laxative. It also possess nutrient properties. 33 Drug Review
  • 49. Properties – Rasa – Madhura, Anurasa – Kashaya. Guna – Ruksha, Laghu. Veerya – Sheeta. Doshaghnata – Tridoshaghnahara.Karma – Agni deepana, Lekhana, Bala vardhaka, vruna ropaka, Hridya, Netrya. It subsidesVamana, Visha, Shwasa, Kasa, Shosha, Atisara, Raktapitta, Krimi, Trishna, Moorchhaand is grahi. 34 Drug Review
  • 50. DISEASE REVIEW Amavata is a disease entity explained by recent authors of Ayurveda. In this Amaand Vata plays the crucial role in the manifestation of disease. In recent years the instance of Amavata is rising. This may be because of faultydietary habits and sedentary life style. The acute painful state of Amavata is unbearable and if disease progresses and itbecomes chronic then it leaves the patient crippled, in his day today life in the form ofreduction in his working capacity. Disease review contains two headings – 01. Historical review 02. Disease reviewHISTORICAL REVIEW The Vedas, the prime documented source of knowledge in India, including that ofmedicine, gives no reference regarding the disease Amavata. Among Brihatrayees, Charaka samhita gives good description about the etiology,clinical manifestation and clinical manifestation and treatment of ama. But there is nodirect reference regarding Amavata as a disease. Even in Sushruta and Vagbhata we don’tget references about the diseases. Nidana vinishchya which subsequently became familiar with the name Madhavanidana, wherein author Madhavacharya turns a new leaf in the history of joint diseases. Acomplete chapter has been devoted to elucidate the disease entity in length. LaterChakradatta, an outstanding work pertaining to the treatment of disease contributes theline of treatment and many remedies for the disease. 34 Disease Review
  • 51. Likewise Bhavaprakasha, Yogaratnakara, Bhaishajya ratnavali and Vangasenaalso mentioned some drug components for the treatment of Amavata.Ama It is a well-known fact accepted by all Ayurvedic physicians that the cause ofdisease is vitiated state of vata, pitta and kapha. In the vitiated state they are known asdisease. The exogenous disease are also accompanied by the any of these doshas. While discussing the Udara roga another cause of the disease is mentioned ashypofunction of agni is the cause of all diseases106. Therefore, it is to be understood that not only the vitiation of vata, pitta and kaphacausing the disease but also deficient function of agni, which plays important role inefficient nourishment of body, can cause a disease. A deficient function of agni, producesama, which comprises a group of toxic substances and not capable of nourishing the bodybut vitiates the doshas and cause disease. Hence, one of the synonyms of the disease isAmaya. Ama is of dual origin – 01. Formed by apakwa anna rasa107. 02. Dhatwagni durbalata108.Apakwa anna rasa – Due to the impaired agni in the amashaya there is malformation ofahara rasa and this incomplete ahara rasa is defined as ama.Dhatwagnimandyajanya ama – At the level of dhatus due to hampering of dhatwagni. Excessively vitiated dosha may combine together to form Ama within the body . 35 Disease Review
  • 52. Sama Dosha109,110 – Ama combines with vatadi doshas or Raktadi dushyas are called sama. Diseasesmanifested by Ama and dosha are called as Samaroga.Sama vata – The sama vata will produce the lakshanas like vibandha, agnimandya, tandra,antra kujana, vedana, shopha, toda, peeda.Sama pitta – The sama pitta produces the lakshanas like durgandhayukta, harita or ishadKrishna amla, sthira, guru, amlodgara, daha in kantha and Hridaya.Sama kapha – The sama kapha will produce the lakshanas Aswachha, tantuman, Sandra, stickyin kantha, durgandhayukta, it reduces the appetite and the udgara.Concept of Ama Biologically ama is true mixture of undigested protein, carbohydrate, fat, bacterialcontent, some of its protein content must find access into the general circulation to betermed as antigen.Antigen111 Is defined as substance usually protein in nature which when introduced into thetissues stimulates antibody production. Two types of antigens can cause immune complexes mediated tissue injury. Exogenous antigen – Infectious agents (bacteria, virus, fungi, parasite), drugs and chemical. 36 Disease Review
  • 53. Endogenous antigen – Such as blood components (antigens in cell tissues) autoantibodies, free radicals. We have appraised, Ama as a morbid factor resultant of hypo functioning of agni.Incompatible foods also stated as one of the prime factor responsible for the formation ofama. (Exogenous source). Vagbhata was the first to mention the internal formation of ama without havingthe involvement and agni and ahara. According to him, exclusively vitiated doshas maycombine together to form ama within the body. (Endogenous production of ama). Thus the ama form either of the above source become unwholesome to the bodyand part of it gets access into the circulation and ends up in causing disease Amavatawhich resembles RA. By considering all the above viewpoint, one can deduce following observationregarding the role of ama in Rheumatoid arthritis. 01. Ama as an antigen possess the potency to induce immunological reactions in a susceptible individual. 02. Ama is supposed to act as an exogenous antigen by virtue of its protein and bacterial content. 03. Ama can also be generated within the body by virtue of exclusively vitiated doshas (autoimmune antibody production free radical mediated tissue injury). 37 Disease Review
  • 54. Nidanadi112,113. Various classical texts has explained the same nidana for the Amavata. 01. Viruddha ahara (incompatible foods) 02. Viruddha cheshta 03. Mandagni 04. Nischeshta (those have given up physical exercise). 05. Who does the exercise after snigdha ahara bhojana. Viruddha ahara – Those substances, which cause the increase of doshas in the body, do not expels out of the body are known as viruddha ahara. They remain antagonistic to the dhatus. Viruddha cheshta – It includes a wide variety of causative factors like sedentary habit exercise immediately after the intake of snigdha ahara, day sleep, keeping awake at night, excessive exercise, excessive sex indulgence, horse riding, suppression of natural urges. etcSamprapti By viruddha ahara, vihara, mandagni, nischeshta or those who does vyayama aftersnigdha ahara by this ama rasa is formed. This ama rasa mixed with prakupita vayulodges into shleshmasthana i.e. Amashaya, Sandhi, Sira, etc. Adhika vikruta, apakwaamarasa, it gets prerita by vayu and gets entry into dhamanis. In dhamanis ama mixeswith vatadi tridoshas which gets vitiated. This ama having pichhila guna with differentcolours form kleda in different srotas of the body. From this patient feels durbalata andgourava. Vata and ama vitiates at a time and enters in to koshta, trika pradesha andsandhis leading to shareera stabdhata. It is called Amavata. 38 Disease Review
  • 55. Viruddha ahara + Vihara Agni dushti in Amashaya Formation of Amarasa Sanchara all over the body by prakupita vata dosha. Samadosha accumulates in the shleshmasthana like Amashaya, shandhi. Sanchara through dhamani all over the body by prakupita vata dosha. Formation of kleda in different srotas of the body due to the picchila guna. Leads to durbalata and Gourava Vata and ama vitiates at a time Enters into trika, koshta, sandhis.Where ever vikruta doshas travels produces angamarda, aruchi, apaka, gourava, jwara, sthotha, ruja. AMAVATA 39 Disease Review
  • 56. Poorva Roopa There is no description regarding poorva roopa in any of the Ayurvedic classics.LaxanasSamanya laxanas114,115. –Table No. 08. Showing the samanya laxanas of Amavata. Sl. Laxana Madhavakara Yogartnakara 01. Angamardha + + 02. Aruchi + + 03. Trishna + + 04. Hrullasa + + 05. Gourava + + 06. Jwara + + 07. Apaka + + 08. Shunata anga + + 09. Aalasya + + 10. Kati,Prusta,Janu Sandi akuncana and + + sashabadataPravriddha Amavata Laskhana 116. Madhavakara explains about the pravriddha Amavata laskahanas as follows – Ruja, shotha in hasta-pada-shira-gulpha-trik-janu-and uru sandhia, whereverdosha travel it causes pain which resembles the string of scorpion. 40 Disease Review
  • 57. Upadrava117 Agnimandya, praseka, aruchi, gaurava, utsahaheena, vairasya, daha, bahumutra,kukshi shoola, nidra viparyaya, trishna, chardi, moorcha, hrit graha, vit vibandhatwa,jadya, antra kujana.Doshanubandha Amavata Laskahana118 If it is Pittanubandha causes daha and raga, Vatanubandha causes shoola,Kaphanubandha causes stimita, granthila and kandu.Sahdyasahdyata119 Eka doshaja Amavata sadhya, dwidoshaj Amavata yapya, sarva shareerashothayukta sannipata Amavata kricchra sadhya.Amavata Chikitsa120,121,122.Table No. 09. Showing the different treatment modalities adopted in Amavata accordingto various authors.Sl. Chiktsopakrama YR CD BR01. Langhana + + +02. Ruksha swedana + + +03. Deepana by tikta and katu dravyas + + +04. Snehapana + + +05. Virechana - + +06. Basti - + +07 Shamanaoushadi + + + 41 Disease Review
  • 58. Pathya and apathya in amavata123 Pathya – Patola,Ardraka,Punarnava,Karavellaka,Yava,Raktashali,Kulattha,Kodrava,Shigru,Ushnajala,Lasuna sanskruta takra,Jangalamamsarasa. Apathya – Dadhi,Matsya,Guda,Dugdha,Mashapisti,Virrudhabhojana,Asatmyapadartha,Vegaavarodha,Ratrijagarana,Vishamabojana,Gurupadartha,Abishyandi padhartha.Sandhi Locomotion is made possible by the presence of joints in the body. Affliction ofsandhi is the central event in the Samprapti of Amavata. Though sandhi connotes thejunction of any two or more anatomical structure still it mainly refers to the asthisandhi inthe present context. The junction of sandhi is sustained by shleshaka kapha and snayu.The former imparts lubrication to the joints and later brings about stability. On the basis of mobility the joints are classified are124 – 01. Sthira (Fixed) 02. Chala (Mobile) Chala sandhi is chiefly involved in Amavata. On the basis of approximate shapeof the joint it is classified as follows125 – 01. Kora sandhi – eg. finger, knee, ankle. 02. Ulukhala sandhi – eg. hip. 03. samudga sandhi – eg. shoulder, symphysis. 04. Pratara sandhi – eg. prishta sandhi. 05. Tunna sevani – eg. skull, pelvis. 42 Disease Review
  • 59. 06. Vayusatunda – eg. tempero-mandibular joint. 07. Mandala – eg. eye, trachea. 08. Shringataka – eg. shringataka. In modern joints are classified on the range of motion permitted. Furthersubdivided on the basis of anatomical structure of the joint126. 01. Immovable joint – (Synarthrosis) A synarthrosis may be fibrous or cartilaginous, depending on the nature of the connection or the two bones may fuse. Eg. between the teeth and jaw. 02. Slightly movable – (Amphiarthrosis) An amphiarthrosis may be fibrous or cartilaginous, depending upon the nature of the connection between the opposing bones. Eg. between tibia and fibula. 03. A freely movable joint – (Diathrosis) It is also called as synovial joint. Eg. elbow, ankle.Synovial Joints (Diarthorsis) – Diathrosis or synovial joints permits wide range of motion. A synovial joint issurrounded by a fibrous articular capsule and synovial membrane lines the articularcavity. These joints are typically found at the ends of long bones, such as those of theupper and lower limb.Articular Cartilage – Bony surfaces at the synovial joints can not contact one another, because thearticular surface covered by special articular cartilage. However articular cartilage haveno perichondrium. 43 Disease Review
  • 60. The surface of articular cartilages is slick and smooth. This feature alone canreduce friction during movement at the joint. However, even pressure is applied across ajoint the smooth articular cartilage do not actually touch one another because they areseparated by a thin film of synovial fluid in the joint cavity. Proper synovial function can continue only if the articular cartilage retain theirnormal structure. If the articular cartilage damage the matrix may begin to break down.The exposed surface then change from slick, smooth, gliding surface to rough felt workof collagen fiber.Synovial fluid – Synovial fluid resembles interstitial fluid but contents high concentration ofproteoglycons secreted by fibroblast of the synovial membrane. It is thick, viscoussolution with the consistency of the heavy molosis. It does lubrication, nutrient shock absorption.Accessory structures – Meniscus is a pad of fibrocartilage situated between opposing bones withinsynovial joints.Menisci – Articular disc may subdivided a synovial cavity channel, the flow of synovialfluid or allow for variation in the shape of articular surface.Fat pads – Are localized mass of adipose tissue covered by a layer of synovial membrane.They are commonly superficial to the joint capsule. Fat pads protect the articular cartilageand acts as packing material for the joint. 44 Disease Review
  • 61. Ligaments – Accessory ligament – Are localized in the capsule. These ligaments reinforce andstrengthens the capsule and they may also limit the rotation to the joint. Extra capsular ligament – Interconnect the articulating bones and pass out side ofthe capsule. These ligaments provide additional support to the wall of the joint. Intra capsular ligament – Found inside the capsule. Help prevent extrememovement that might other wise damage the joint.Tendon – It is not a part of the articulation itself. Tendon passing across or around joint maylimit the range of motion and provide the mechanical support.Bursae – Are small fluid filled packet in connective tissue. They contain synovial fluid andlined by synovial membrane. Their function is to reduce friction and acts as a shockabsorber.Structural Classification Of Synovial Joints On the basis of the shape of the articulating surfaces, each type of joint permits adifferent type and range of motion. 01. Gliding joint – The relatively flat, articular surfaces, slide across one another, but the amount of movement is very slight. These are found at the end of the clavicus between the carpal bones. 02. Pivot joints – These are also monoaxial but they present only rotation. A pivot joint between the atlas and axis allows you to rotate either side. Another head of radius the proximal shaft of the ulna permits the supination and pronation of the palm. 45 Disease Review
  • 62. 03. Ellipsoidal joints – These are called condyloid joint. An oval articular face nestles within a depression in the opposing surface. With such an arrangement angular motion occurs in two planes along or across the length of the oval. Uniform of angle movement including circumduction is permitted but rotation cannot occur. These joints connects the radius with the proximal carpal bones and phalanges of fingers. 04. Saddle joint – These type of joints have articular faces that resembles saddles. Each face is concave on one axis and convex on the other. The opposing faces nest together. This arrangement permits angular motion including the circumduction, but prevent the rotation. Thumb is best example of saddle joint. 05. Ball and socket joint – In these the round head of a bone rest within a cup shaped depression in another. All combinations of angular and rotational movements including circumduction and rotation can be performed at ball and socket joints.RHEUMATOID ARTHRITIS127. Rheumatoid Arthritis (RA) is a systemic, chronic, inflammatory disease thataffects principally the joints and sometimes many other organs and tissues throughout thebody as well. More specially, the disease is characterized by a non supportive proliferatesynovitis, which in time leads to the destruction of articular cartilage and progressivedisabling arthritis. Rheumatoid arthritis is a chronic multi system disease of unknown cause.Although there are a variety of system manifestation the characteristic feature of RA ispersistent inflammatory synovitis, usually involving pheripheral joints in a systemicdistribution. The potential of the synovial inflammation to cause cartilage destruction,bone erosion and subsequent changes in joint integrity is Hallmark of the disease128. 46 Disease Review
  • 63. Rheumatoid arthritis (RA) is an immmuno-inflammatory disease that affectsjoints and entire articular tissues129.Epidemiology And Genetics130,131. The prevalence of RA in appropriately 0.8% of the population. Women areaffected approximately three times more than men. The prevalence increases with ageand sex differences diminish in the older age and sex. Differences diminish in the olderever, the incidence and severity seen to be less in rural, sub-Saharan Africa and in carbonblocks. The onset is most frequent during the fourth and fifth decade of life, with 80% ofall patients developing the disease between the age of 35-50. the incidence of RA is morethan six times as great in 60 to 64 years old women conferred to 18-20 years old women.Genetics Family studies indicate a genetic predisposition. For example, severe RA isformed at approximately four times the expected rate in first degree relatives ofindividuals with disease associated with the presence of the autoantibody only 15 to 20%of monozygotic twins are concordant for RA. However, implying that factors other thangenetics play an important etiopathogenic role. The higher risk for concorduace of RA innoted in twins who have two HLA-DRB1 alleles known to be associated with RA. Theclass II major histocompatability complex allele HLA-DR4 related alleles are known tobe major genetic risk factors for RA.` HLA-DR4 is the major susceptibility hapato type in most ethnic group but DR1 ismore important in Indians and Israeli and DW15 in Japanese; alleles of Dw10, DW13and DW14 have also been implicated. Whatever the initiating contimulus, RAcharacteristically by persistent cellular activity automatically and the presence of immune 47 Disease Review
  • 64. complexes at sites of articular lesions. The development of amyloidosis in some patientspreviews further clinical evidence for chronic immune stimulation while the strikingremission of activity that can follow lymphocytophoresis or cytotoxic drug therapy attestto the importance of lymphocytes and cellular immunity. The rheumatoid arthritis is bothan extra-vascular immune complex disease and a disorder of cell-mediated immunity inwhich the events depicted lead to chronic inflammation of granuloma formation and jointdestruction.PATHOLOGY132. The earliest change in swelling and congestion of the synovial membrane and theunderlying connective tissues, which becomes infiltrate with lymphocyte, plasma cellsand micro phases. Diffusion of synovial fluid into the joint space takes place duringactive phase of disease. Hypertrophy of the synovial membrane occurs with the formationof lymphoid follicles resembling an immunologically active lymph node. Inflammatorygranulation tissues (pannus) is formed spreading over and under the articular cartilage,which is progressively eroded and destroyed later fibrosis adhesions may be formedbetween the layers of pannus across the joint space and fibrosis or bony ankylosis mayoccur. Muscles adjacent to inflamed joints atropy and there may be focal infiltration withlymphocytes.ETIOLOGY133. The case of RA remain unknown it has been suggested that RA may be themanifestation to the response to an infectious agent in genetically susceptible host. Anumber of possible causative agent have been suggested, micoplasma Epstein – Bar virus(EBV), cytomegalo virus, parvo-virus, and rubella virus, but convincing evidence that 48 Disease Review
  • 65. these are other infectious agents cause RA has not emerged. Alternatively themicroorganisms or response to the microorganisms might induce an immune response tocomponents of the joints by altering its integraty and revealing antigenic peptide. Recentwork has focused on the possible role on the super antigens produced by the number ofmicroorganisms including staphylococci, streptococci and M–arthridis. Super antigensare proteins with the capacity to bind to HLA-DR molecule and particular VB segment ofthe heterodinimic T cell receptor and stimulate particular T cell expressing the VB geneproducts of all the potential environmental triggers. The only clearly associated with thedevelopment of RA is cigarette smoking.PATHOGENESIS134. Localization of antigens in joints Antigen by microphages Activation of helper T cells Release of intraleukin – 2 Cytokenes like IL-4, IL-6, IFN are released by Cd4 cells Cytokenes increases the expression molecules like ICMA-1, LFA –1, MAC-1 It helps in localization of inflammatory cells Cytokines stimulates, activates and proliferation of 49 Disease Review
  • 66. B cells produces antibody producing plasma cells. These cells produce antibodies against Fc fragment of IgG (RA) RA factor forms immuno complex with IgG Production of Ca3, C5a, C3b and C5,6,7,8,9 Ca3 and C5a as anapphylotoxins Release of histamines C5,6,7,8,9 is capable of damage cells by drilling pores in their membrane. Inflitration of neutrophillsRelease of oxygen free radicals, inflammatory metabolites, arachidnic acid pathway like prostaglandins leutrines metalo-proteins like collagenase. Damage of articular cartilage demineralization of underlying bone erosion of the joint margins laxicity of the joint capsule leading to deformity.Articular Features135. The onset is usually insidious but may be acute or systemic, symmetrical jointinvolvement is common in middle aged women. Asymmetrical presentation as a diseaseprogresses. Acute onset with asymmetrical polyarthritis is more often seen in elderlypatients. 50 Disease Review
  • 67. In the pelidromic onset type abrupt self limiting exaggeration of joint swellingerethrima and warmth over the joint occur and resolve completely within hours to fewdays. Only reoccur after period of time. The characteristic pattern of joint involvement in descending order of frequentlyin metacarpals (MCP), wrists, proximal, intraphalangeal (PIP), metatorso-phalangeal(MTP) joints, knee, ankles, hips and elbows. The affected joints are painful to start withthen become swollen, warm, and tender with restriction of movement.Pattern Of OnsetTable No.10. Showing the pattern of onset of Rheumatoid arthritis. Sl. A B 01. Insidious, > 70%, Oligoarticualr 45 to 50 , Acute 10-15%) Polyarticualr 30-35% Sytemic - <10%, Monoarticular 20-25 %. palidromic least <5 Common. >5 patient. 51 Disease Review
  • 68. Extra Articular Manifestation Of RASystemic – Low grade fever Loss of appetite Loss of weight FatigueMusculo-skeletal – Muscle wasting Bursitis TenosynovitisSkin – Subcuatneous nodules Vasculitis Ulcers Gangrene Pyoderme gangrenosum Nail fold infarctsEye – Sicca syndrome Episcleritis Scleritis ScleromalaciaRespiratory – Plural effusion Fiborsing alveolitis Nodules Bronchitis 52 Disease Review
  • 69. Cardiac – Pericarditis Myocarditis Aortitis Conduction disturbancesHematological – Anemia Thrombocytosis Esinophilia Felty’s syndrome SpleenomegalyNeurological – Entropment syndrome Cervical compression Peripheral neuritis Mononeuritis multiplexOthers – Systemic vasculitis AmylodosisRevised Acr Criteria For Classification Of Rhumatoid Arthritis136.Criteria for diagnosis of Rheumatoid arthritis 01. Morning stiffness – for more than 1 hour, for more than 6 weeks. 02. Arthritis of three or more or 14 possible joint areas should have swellings of soft tissues or fluid for more than 6 weeks. Joint areas or right or left PIP MCP, elbow, knee, ankle and MTP joints. 03. Arthritis of hand joints – the wrist MCP or PIP joints for more than 6 weeks. 53 Disease Review
  • 70. 04. Symmetrical arthritis – Bilateral involvement of any one of PIP, MCP or MTP joint areas and or other joint lasting for more than 6 weeks. 05. Rheumatoid nodules – At bony prominences or exterior surfaces or extra articular regions as observed by physician. 06. Serum rheumatoid factor – As deducted by any one of the methods positive in 5% or less of control subjects. 07. Erosions and are jextra articular porosis of involved joints in the anterior-posterior film of hands and wrist. At least 4 of these criteria must be satisfied for classification purpose.Deformities137Hand – Hands include button hole associated with flexion at the PIP joints andhyperextension of the distal intraphalangeal joints. Swan neck deformity associated with flexion of the digital interphalangeal andhyperextension of PIP joint. Z deformity of thumb and ulnar deviation of the finger.Feet – Feet involvement of MTP joints cause plantar subluxation of the metatarsal heads.Resulting in cock-up tose. The deformity seen in the feet include Hallex valgeus or varus,and Hammer toes, Axial joint involvement is restricted to the cervical spine, where it takes the formof either atlanto axial subluxataions or subaxil subluxation. 54 Disease Review
  • 71. Laboratory Investigations138,139. Laboratory investigations may help either to establish a clinical diagnosis or toassess the prognosis and the possible cause of the disease. ESR – It is elevated in RA and comes down as the disease remitts. Hb% – May shows a normocytic normochromic anemia. C- reactive protein – High levels of CRP at the onset of disease correlates withpoor prognosis. Serological – The most important immunological investigation is detection ofrheumatoid factor. Other autoantibodies seen include antinuclear (ANA), Anti collagen,Anti keratin, Antiperinuclear (ANA) and anti-rheumatoid arthritis antibodies. Synovial fluid analysis – Synovial fluid analysis confirms the presence ofinflammatory arthritis, although none of the findings are specific. The fluid is usually turbid, with reduced viscosity, increased protein content andslightly decreased or normal glucose concentration. White blood cell – WBC count is usually normal, but mild leukocytosis may bepresent. Radiographic evaluation – Plain radiograph of the joint in the early stages showssoft tissues swelling around the affected joint and later jextra articular osteoporosis,erosions are seen as the disease progresses. In later stages there is destruction of thecartilage, resulting in joint space narrowing, cyst formation subluxation of the joints anddeformities. 55 Disease Review
  • 72. Treatment / Management140. Because the etiology of rheumatoid arthritis Is unknown, treatment is empiricallydirected towards – ♣ Relief of symptoms. ♣ Suppression of active progressive disease. ♣ Conservation and restoration of function in affected joints. To a greater or lesser extent these are achieved by combining:- ♣ Treatment of the patient – Drugs, rest, physiotherapy, surgery. ♣ Modification of the environment – Aids, appliances, housing, occupation, statutory benefits.General Treatment Physical rest, anti-inflammatory therapy and maintenance exercises are importanttreatment for rheumatoid arthritis. The rest from physical and emotional stress providedfor 2-3 weeks in hospital is usually sufficient to induce a marked remission of symptoms .Rest splints can be used to support a particular painful joint to correct flexion deformities.Medications Medications for rheumatoid arthritis, include some for pain relief, others to reduceinflammation. Some medications are disease modifying anti rheumatic drugs (DMARD)which to try to show the course of the disease. Intra-articular cortico-steroidal injections are given to bring symptomatic relief.Non-steroidal anti-inflammatory drugs therapy is beneficial chloroquine phosphate orhydroxy chloroquinine sulphate are used as the initial adjacent to basic therapy. 56 Disease Review
  • 73. Auranofin an oral gold compound, pencillamine, and parental gold are also usedand immuno modulators are also used in the treatment.Surgical Treatment Surgical decompression and synovectomy are needed when NSAD’s, localinsatous of corticosteroids and simple physical measurement failed to reduce movementof limbs.Prognosis141. The course and prognosis in RA is very variable. 25% will have a completeremission of symptoms and remain fit for all normal activities. 40% will have onlymoderate improvement of function despite excerbration and remission of disease. 25%will be more severely disabled. 10% will be severely cruppled.A poor prognosis may be associated with – 01. High titer of RA factor. 02. Insidious on set of disease. 03. More than a year of active disease without remission. 04. Early development of nodules and erosion. 05. Extra articular manifestations. 06. Sever functional impairment. Mortality is gradually increased in RA patients with functional impairment. The 5years survival for severely disabled RA patient is reduced by 50%, the prognosis in suchpatients is similar to that of patients with 3 vessels coronary artery disease. 57 Disease Review
  • 74. Methodology can be studied under three headings 1. Pharmaceutical study. 2. Analytical study 3. Clinical studyPHARMACEUTICAL STUDYIntroduction – This section deals with identification , selection and, processing of raw drugs andpreparation of Hinguleshwara rasa. The very purpose of this branch of medicine is to provide suitable, safe andeffective medicine. Ayurveda believes that, “Samskara” given to the drug will change thequality of drug and also drug acts in different manner when mixed with other drugs.Timings of medication and anupana also directs the medicine to act in a different ways.Study design – This section includes major steps –Step 01. : Identification and Collection of raw drugs.Step 02. : Purification and processing of raw drugs.Step 03. : Preparation of Hinguleshwara rasa.Date of commencement : 01:06:04Date of completion : 21:06:04Reference : Rasatarangini – Chaturvimshati taranga.MethodStep 01. : Identification and collection of raw drugs.Date of commencement : 01:06:04Date of completion : 01:06:04 58 Pharmaceutics
  • 75. Proper identification, selection and collection of raw drugs are necessary forAyurvedic formulation, because without these things we cannot assure the quality of ourmedicaments. So this section of the study deals with the same. Higuleshwara rasacontains the following ingredients –Ingredients – Hingula Vatsanabha Pippali Special request was made to the local herbo-mineral drug shop dealer to get theparticular quality drugs and those were screened for classical grahya lakshanas and thosewere certified by the concerned departments.Step 02. : Purification and processing of raw drugs. Ayurveda has enlisted certain drugs, which will cause adverse effects or notherapeutic effects if used in the impure state or may lead to complication. So properpurification is necessary to combat the probable adverse effects. This section deals withthe purification and processing of raw drugs.Practical No. 01. :Title : Hingula shodhana.Date of commencement : 02:06:04Date of Completion : 09:06:04Reference : Rasaratna samuchaya 3/152,153.Materials required : Khalwa yantra. 59 Pharmaceutics
  • 76. Drugs used : a) Hingula – 200 gms. b) Adraka swarasa – Q.S.Table No. 11. Results of Hingula ShodhanaIngredients Bhavana dravya in Mardana in hours Results RemarksIn quantity quantity Ardraka swasa 100 ml 6 ½ hours 205 gms Gain – 5 gms. Ardraka swasa 100 ml 6 hours 212 gms Gain – 7 gms.Hingula Ardraka swasa 100 ml 6 ½ hours 218 gms Gain – 6 gms.200 gms. Ardraka swasa 100 ml 5 ½ hours 224 gms Gain – 6 gms. Ardraka swasa 100 ml 6 ½ hours 229 gms Gain – 5 gms. Ardraka swasa 100 ml 6 hours 235 gms Gain – 6 gms. Ardraka swasa 100 ml 7 hours 242 gms Gain – 7 gms.Table No. 12. Showing the quantity of Hingula before shodhana and after shodhana.Draya Quantity of Hingula before Quantity of Hingula after shodhana shodhana (in gms) ( in gms).Hingula 200 gms. 242 gms.Method : Hingula was taken in a khalva yantra and powdered nicely, 100 ml of adrakaswarasa was added and mardana was done for 6 hours.Observation : ⇒ While powdering Hingula, white shiny lines were seen. ⇒ After half an hour of mardana, shiny particles disappeared. ⇒ After 25-35 minutes the colour turned to red 60 Pharmaceutics
  • 77. Precautions : Initially mardana was done slowly to avoid the spillage of material. When it attained semisolid consistency the mardana was carried out continuously.Practical No. 02.Title : Vatsanabha shodhana.Date of commencement : 10:06:04Date of Completion : 12:06:04Reference : Rasa Tarangini 24/19-22.Materials required : Vessel.Drugs used : Vatsanabha – 400 gms. Gomutra – Q.S.Method : Vatsanabha cut into small pieces. Then it is soaked in vessel containing Gomutrafor three days and placed under sunrays. Everyday fresh Gomutra was replaced with theold one. Remove outer layer and dried under sunrays.Observation : ⇒ After soaking in gomutra it becomes soft. ⇒ Colour of Gomutra was changed. ⇒ After drying Vatsanabha changed its colour from white to black. 61 Pharmaceutics
  • 78. Test for vatsanabha shodhana : ⇒ It becomes soft so that a pin can be easily pierced. ⇒ This does not produce the tingling sensation or numbness of tongue.Precaution : Gomootra was changed everyday. Gomootra was added so much so that vatsanabha is immersed completely.Table No. 13. Showing the quantity of Vatsanabha before shodhana and after shodhana.Draya Quantity of Vatsanabha before Quantity of Vatsanabha after shodhana (in gms) shodhana (in gms)Vatsanabha 400 gms. 300 gms.Practical No. 03.Title : Preperation of Pippali churna.Date of commencement : 14:06:04Date of Completion : 14:06:04Reference : Rasa Tarangini.Materials required : Ulukhala yantra, Vastra.Drugs used : Pippali – 250 gms.Method : Pippali is taken, powdered in ulukhala yantra and filtered through cloth andsukshma churna was collected. 62 Pharmaceutics
  • 79. Table No. 14. Showing the quantity of Pippali before and after churnikaranaDraya Before After Loss ObservationPippali 250 gms. 200 gms. 50 gms Colour – Dark greenish. Smell – Aromatic. Touch – Fine. Taste – Pungent.Practical No. 04.Title : Vatsanabha churna.Date of commencement : 15:06:04Date of Completion : 16:06:04Reference : Rasa Tarangini.Materials required : Ulukhala yantra, Vastra.Drugs used : Shodhita vatsanabha – 300 gms.Method : Shodhita vatsanabha is taken, powdered in ulukhala yantra and filtered throughcloth sukshma churna was collected.Table No. 15. Showing the quantity of Vatsanabha before and after churnikarana.Draya Before After Loss ObservationVatsanabha 300 gms. 250 gms. 50 gms Colour – Grey. Smell – Gomutra gandha. Touch – Fine. Taste – Tikta. 63 Pharmaceutics
  • 80. Step 03. : Preparation of Hinguleshwara rasa.Practical No. 05.Title : Hinguleshwara rasa.Date of commencement : 21:06:04.Date of Completion : 21:06:04.Reference : Rasa Tarangini 24/78-79.Materials required : Khalwa yantra.Table No.16. Ingredients of Hinguleshwara rasa with their proportions and quantity.Sl. Ingredients Quantity01. Shodita Hingula 200 gms.02. Shodita Vatsanabha 200 gms.03. Pippali 200 gms.Method : The homogenous mixture of shodita Hingula, shodita Vatsanabha churna and Pippali churna was prepared by mardana. Required quantity of water is added and mardana was done. The vati of 62.5 mg or ½ Ratti was prepared by smearing hands with goghruta. The vati were kept for drying in shade.Observations : The whole mixture turned to red colour. At one stage the mixture becomes a single bolus not sticking to the surface of khalva yantra . At this stage small amount of mixture was taken in between hands smeared with ghruta and tried to roll in to vatis and this was achieved. 64 Pharmaceutics
  • 81. Precautions : Purified ingredients were used. Care was taken that mixture do not spilled out of khalva. Mardana was done well. Vati was prepared while the mixture is soft. The mixture was not allowed to dry. Uniformity of weight was maintained while preparing vati. 65 Pharmaceutics
  • 82. ANALYTICAL STUDYIntroduction – Analysis is an attempt to find an explanation of certain phenomenon. Manbecause of his curiosity tried to analyze various phenomenon happening around him anddeveloped various sciences. Though Ayurveda is having its unique analytical approachtowards drugs, but in present era there is necessity of analysis of drug based on modernmethodology. So, it is a need to evaluate drugs by various parameters which includes – 01. Physical analysis 02. Chemical analysisPhysical evaluation (Organoleptic characteristics) – 01. Colour – Reddish brown. 02. Smell – Faint odour. 03. Touch – Smooth.01. Hardness test – The finished vati has to be hard, as it may not disintegrate in the required periodof time and if the vati is too soft, it may not withstand during packing and transporting.Therefore, it is necessary to check hardness of tablets. The hardness of tablets or vati can be roughly determined by holding them inbetween the fingers of the hand and throwing it lightly on the floor. If it does not break itindicates the proper hardness.Method – (Monsanto Hardness test) It is a soft portable hardness tester, which was manufactured and introduced byMonsanto chemical company. It consists of a spring, which can be compressed bymoving the screw knob forward. 66 Analytical study
  • 83. The tablet which to be tested is held between a fixed and a moving jaw andreading of the indicator is adjusted to zero. The force is applied to the edge of the vatiand gradually increased by moving the screw knob forward until the vati breaks. Readingis noted from the scale, which indicates the pressure required in Kg or in pounds to breakthe tablet. Hardness of 4 Kg considered suitable for handling of vati. Hardness in Kg. = 3.5+0.502. Uniform weight of tablets – The average weight is determined by weighing 20 tablets. The tablets are alsoweighed singly. The deviation from the average weight in each case is calculated andexpressed as a percentage. Not more than two of the tablets deviate form the averageweight by a greater percentage. No tablet deviate by more than that percentage. If 20 tablets are not available 10 may be used for the determination, not more thanone deviate from the average weight by a greater percentage. Weight variation = 4.28%.03. Friability – Friability test is performed to evaluate the ability of the tablet to withstandabrasion in packing, handling and transporting. The instrument used for the same isknown as “Friability test apparatus”Method – It consists of a plastic chamber, which is divided into two parts and revolves at aspeed of 25 rpm. A number of tablets are weighed and placed in the tumbling chamber,which is rotated for four minutes of 100 revolutions. During each revolution the tabletsfall from a distance of 6 inches to undergo shock. After 100 revolutions the tablets areagain weighed and loss in weight indicates the friability. The acceptable limit of weightloss should be not more than 0.8%. Friability – 0.15% 67 Analytical study
  • 84. 04. Determination of disintegration timeProcedure – One pill was introduced into each tube of the disintegration apparatus. Disc wasadded to each tube. The assembly was suspended in a beaker containing water at 370Cand the apparatus was operated. The time was noted down with the help of stopwatch.The time taken for all the tablets to disintegrate completely is disintegration time. Disintegration time : 16 minutes05. Determination of pH – The pH value of the sample was determined by a digital pH meter. One percentsolution was prepared, as the sample was dry and solid in the form of pills. The pills werepowdered. One gram of the sample was weighed accurately and dissolved in 100ml ofwater and pH was noted in the digital pH meter.pH value : 6.5806. Loss on drying – Digest pure quartz sand that passes through No. 40 but 60 sieves withhydrochloric acid wash acid free, dry and ignite preserve in a stopped bottle. Place 25-30gms prepared sand and short glass rod in a nickel or stainless steeldish about 55 ml diameter and 40 mm deep fitted with cover. Dry thoroughly cover dishcool in desiccators. Pipette out of quantity of drug to yield about 1gm of dry matter mix with a few mlof water and transfer quantitatively to the dish containing prepared sand with aid ofwater. Mix the sample thoroughly with the sand. Dry at a temperature not more than 110°C under pressure not more than 50 mm ofHg. Making trail washing at 2 hours interval. Towards end of drying period untilsuccessive weighing do not differ by more than 2 mg. Calculate the total solid from theloss of weight on drying.Loss on drying: 5.84% 68 Analytical study
  • 85. 07. Determination of total ashProcedure – Take about 2gms accurate weighed, ground drug in a previously traced silica dish,previously ignited and weighed. Scatter the ground dry in a fine even layer on the bottomof the dish. Incinerate by gradually increasing the heat not exceeding dull red heat(4500C) until free from carbon. Cool and weigh. Calculate the percentage of ash withreference to the air-dried drug.Total ash : 7.10%8. Identification of alkaloids Silica gel 60 F254 Merck pre-coated plates. Mobile phase - Chloroform : Methanol (90:10). Location reagent - Dragendroff’s reagent.Procedure – Weigh about 2gms of the sample into a separating flask. Add about 20ml water.Basify with dilute ammonia and extract with two quantities 25 ml of chloroform. Filterthrough anhydrous sodium sulphate. Evaporate the chloroform layer to the residueobtained. Add about 1 ml of methanol. Shake well to dissolve and spot about 10μsolutionon the TLC plate. Elute the plate with mobile phase to 3/4th of the plate. Dry the plate at1050C and spray the plate with dragendroff’s reagent. If alkaloids are present brownishred spots were obtained in the sample solution. Result : Alkaloids present 69 Analytical study
  • 86. 10. Determination of sulphurEschka Mixture – Mix two parts by weight calcined magnesia with one part of anhydrous sodiumcarbonate.Procedure – Cover the bottom of a 50 ml crucible with 0.5 gm of Eschka’s mixture. Weighaccurately the appropriate quantity of the sample material and mix it immediately with2gms of Eschka’s mixture and put evenly on the previously weighed Eschka’s mixture.Level the contents by tapping gently on a bench. Cover this uniformly with 0.5gm ofEschka mixture. Place crucible in the muffle furnace. Raise the temperature from roomtemperature to 8000C +250C in about one hour and then heat for further 90 minutes. Transfer the ignited mixture as completely as possible from the crucible to abeaker containing 25 to 30 ml of water. Wash out the crucible thoroughly with about50 ml of hot distilled water and add the washings to the contents of the beaker. Add carefully sufficient quantity of concentrated hydrochloric acid to dissolve thesolid matter, warming the content of the beaker to effect solution. Boil for 5 minutes toexpel carbon dioxide. Add drop wise from a pipette; warm 5% Barium chlorine solution.Stir the solution constantly during the addition. Allow the precipitate to settle for aminute or two. Then test the supernatant liquid for complete precipitation by adding a few dropsof Barium chloride solution. If a precipitate is formed, add slowly a further 3 ml of thereagent allow the precipitate to settle as before and test again, repeat this operation untilan excess of Barium Chloride is present. When an excess of the precipitating agent has 70 Analytical study
  • 87. been added, keep the covered solution hot, but not boiling for an hour (steam bath) inorder to allow time for complete precipitation. The precipitation should settle and a clearsupernatant liquid should be obtained. Test the latter with a few drops of barium chloridesolution for complete precipitation. If no precipitate obtained, the Barium sulphate isready for filtration. Filter the solution through an ash less filter paper (Whatman No. 42). Wash theprecipitate with small portion of hot water. Dry the paper and place it in a silica orporcelain crucible, previously ignited to redness and cooled in a desiccators and weighed.Gradually increase the heat until the paper chars and volatile matter is expelled. Do notallow the paper to burst into flame as mechanical loss may thus ensue. When charring iscomplete, raise the temperature of the crucible to dull redness and burn off carbon withfree excess of air. When the precipitate is white ignite the crucible at red heat for 10-15minutes. Allow the crucible to cool in air, transfer it to a desiccators and when cold,weigh the crucible and contents. Repeat until constant weight is attained. A blank is necessary. Calculate the percentage of sulphur converting Bariumsulphate X 0.1374.Sulphur : 6.44%11. Determination of mercuryProcedure – Dissolve about 0.3gms of the sample in 5ml of aquaregia and add 100 ml ofwater. Add 40ml of 0.05N EDTA, 5ml of Ammonia buffer solution and 0.5ml ofsolochrome black indicator. Titrate the solution with 0.05 M Zinc sulphate until the bluecolour changes to purple (do not overshoot the end point), add 3gms of Potassium iodide,swirl to dissolve. Allow to stand for two minutes. Then, continue the titration with zincsulphate solution to the same end point as before. Each ml Zinc sulphate solutionrequired after addition of potassium iodide = 0.0103 Hg. Mercury : 21.73%. 71 Analytical study
  • 88. 12. Solubility About one gram of the sample was weighed and dissolved in 10ml of the solvents.When the sample did not dissolve, an excess of solvent by 10 ml quantity up to 100mlwas added and noted that the sample was sparingly soluble in water and 1M Hydrochloricacid (1 gm of sample in 100 ml of water and 1 M Hydrochloric acid) and slightly solublein chloroform and alcohol (1 gram of sample in 600 ml to 1000 ml of chloroform andalcohol.SOLUBILITY TESTS RESULTSWater Sparingly soluble.Chloroform Slightly soluble.Hydrochloric acid Sparingly soluble.Alcohol Slightly soluble. 72 Analytical study
  • 89. CLINICAL STUDY The present clinical study was meant for clinical efficacy of Hinguleshwara rasain amavata (with special reference to Rheumatoid Arthritis). Total 34 patients werediagnosed as Amavata out of that 30 patients were included, 4 patients were excluded.All the patients were assessed before and after treatment. Both subjective and objectiveparameters recorded according to the proforma of case sheet. The Clinical study consists of following headings – I. Selection of patients. II. Research Design. III. Duration and Method of administration of drug. IV. Parameters of Assessment. V. Criteria for Assessment of ResultsI. SELECTION OF PATIENTS : The patients were diagnosed based on the presentation of history, signs,symptoms, and detailed clinical examination. 30 patients were selected after criticaladaptation of inclusion and exclusion criteria. a) Source of data : 30 patients of Amavata (Rheumatoid Arthritis) with confirmed diagnosis weretaken from OPD and IPD of DGM Ayurvedic Medical College Hospital, Gadag. The Samples were selected by simple sampling technique. b) Inclusion criteria : Patients of Amavata with the history of less than 5 years. Patients of Amavata between the age of 20 to 50 of either sex. Patients complaining with classical signs and symptoms of Amavata (RA) as mentioned in ayurvedic and modern texts. 73 Clinical study
  • 90. c) Exclusion criteria : A patient of Amavata having the history of more than 5 years. Patients of age group less than 20 years and more than 50 years. Patients of Amavata having the systemic diseases like diabetes mellitus, Asthma, Hypertension, Rheumatoid Heart disease and Heart diseases etc. Pregnant women and lactating mothers: d) Intervention : The patient are assessed before and after treatment as per assessment criteria. The nature of the study is explained to the patients in detail and pre treatment consent is taken. The patients have full right to withdraw from the study at any time. The data is maintained confidently. 30 patients of Amavata of either sex are taken in simple randomized selection of sampling techniques.II RESEARCH DESIGN : The study was conducted on total 30 patients who could continue the treatmentfor full duration and come for follow up till to the last, the patient was selected from theOPD, DGM Ayurvedic Medical College & Hospital for prospective clinical trial.III DURATION AND METHOD OF ADMINISTRATION OF DRUG : Study duration - 30 days. Follow up - 15 days. Method of Administration : Hinguleshwara rasa was administered orally Dosage – ½ Ratti (62.5 mg )BID Anupana – Madhu. 74 Clinical study
  • 91. IV PARAMETERS FOR ASSESSMENT : Subjective parameters : Signs and Symptoms explained in the Ayurvedic texts and modern texts.Table No. 17. Showing the gradation which is adopted in statistical evaluation of clinical symptoms. Sl. Symptoms Severity Grade 1. Sandhi Shula No Complaints 0 (Pain ) Patients explains after 1 enquiry Patients frequently 2 complains Excruciating condition. 3 2. SandhiShotha No complaints 0 (Swelling) Slightly obvious 1 Covers well the bony 2 prominence Much elevated 3 3. Jadya No stiffness 0 (Stiffness) Stiffness for 5 min-1hour 1 Stiffness for 1-2 hours 2 More than 2 hours. 3 4. Jwara Normal 98.4 F 0 Fever Mild 99-101 F 1 Moderate 102-104 F 2 Severe - 104 F 3 75 Clinical study
  • 92. Objective Parameters: Hb%, TC, DC, ESR, CRP, Walking time, Grip strength, Foot pressure.Table No. 18. Showing the gradation, which is adopted, in statistical evaluation of Walking time. S.No. To cover 21 Meters Grading 1. Up to 20 Seconds 0 2. 21 to 30 Seconds 1 3. 31 to 40 Seconds 2 4. 41 to 50 Seconds 3 5. 51 to 60 Seconds 4Grip strength : - Patient’s grip strength is assessed before and after treatment according tothe readings in the grip strength meter in terms of pound.Foot pressure : - Patient’s foot pressure is assessed before and after treatment byweighing machine in terms of kg’s. Assessment of Result : Subjective and objective parameters be0fore and after treatment data comparisonis assessed for result. 76 Clinical study
  • 93. V CRITERIA FOR ASSESSMENT OF RESULTSThe results are classified into four groups as listed below – A. Complete remission 1. Sandhi Shoola (pain) 2. Sandhi Shotha (swelling) 3. Jadya (stiffness) 4. Jwara (fever) 5. No elevation of ESR. 6. Complete subsidence of above subjective parameters. B. Major improvement 1. Complete subsidence of 2 or 3 below mentioned subjective parameters i.e. i. Sandhi Shoola (Pain) ii. Sandhi Shotha (Swelling) iii. Jadya (Stiffness) iv. Jwara (Fever) 2. ESR may be elevated. 77 Clinical study
  • 94. C. Minor improvement 1. Complete subsidence of any one below mentioned subjective parameters i.e. i. Sandhi Shoola (Pain) ii. Sandhi Shotha (Swelling) iii. Jadya (Stiffness) iv. Jwara (Fever) 2. Elevation of ESR. D. No improvement 1. No change or exaggerations of signs and symptoms 2. Elevation of ESR.The persons who don’t come under above three criterias will come in this criteria. 78 Clinical study
  • 95. DEMOGRAPHIC DATADistribution of patients by Age –Table No. 19. Showing the distribution of patients by age groups.Sl. Age group No. of Pts. Percentage01. 15-25 3 10.0002. 25-35 11 36.6603. 36-45 7 23.3304. 46-55 9 30.00 It was observed that, the maximum number of patients 11 (36.66%) were in theage group of 26-35; 9 (30%) from the age group of 46-55 years.Graph No. 01. Showing the distribution of patients by age group incidence. D is trib u tio n o f P t.s b y A g e g ro p u s 1 5 -2 5 10% 4 6 -5 5 30% 1 5 -2 5 2 5 -3 5 3 6 -4 5 4 6 -5 5 2 5 -3 5 37% 3 6 -4 5 23% 79 Results
  • 96. Distribution of patients by Sex –Table No. 20. Showing the distribution of patients by Sex –Sl. Sex No. of Pts. Percentage01. Male 13 43.3302. Female 17 56.66 It was observed that, out of 30 patients maximum number of patients i.e. 17(56%) were females and males were 13 (43%).Graph No. 02. Graph showing the sex incidence of the patients. Distribution of pt.s by sex incidence 20 17 15 13 No. of Pt.s 10 5 0 No. of Pts. Male Sex Female 80 Results
  • 97. Distribution of patients by Religion –Table No. 21. Showing the distribution of patients by Religion.Sl. Religion No. of Pts. Percentage01. Hindu 24 8002. Muslim 6 2003. Christian - -04. Others - - It was observed that, the majority of patients were from Hindu, 24 (80%) andMuslim 6, (20%).Distribution of patients by Socio-economic status –Table No. 22. Showing the distribution of patients by Socio-economic status.Sl. Socio-economic No. of Pts. Percentage01. Poor 12 4002. Middle 16 53.3303. Upper class 2 6.66 It was observed that, the maximum number of patients i.e. 16 (53.33%) belong tomiddle socioeconomic class, poor 12 (40%), upper class 2 (6.66%).Distribution of patients by Occupation –Table No. 23. Showing the distribution of patients by Occupation.Sl. Occupation No. of Pts. Percentage01. Labour 9 3002. Sedantary 5 16.6603. Active 1 3.3304. House wife 15 50.00 It was observed that, the majority of the patients were from the housewife 15(50%), labour 9 (30%), sedentary 5 (16.66%) and active 1 (3.33%). 81 Results
  • 98. Distribution of patients by marital status –Table No. 24. Showing the distribution of patients by marital status –Sl. Marital status No. of Pts. Percentage01. Married 24 8002. Unmarried 6 20 It was observed that, the maximum number of patients were married 24 (80%0and unmarried 6 (20%).Distribution of patients by food habits –Table No. 25. Showing the distribution of patients by food habits.Sl. Food habits No. of Pts. Percentage01. Vegetarian 19 63.3302. Mixed 11 36.33 It was observed that, the maximum number of patients 19 (63.33%) werevegeterian and only 11 (36%) mixed food habits.Distribution of patients by addiction –Table No. 26. Showing the distribution of patients by addiction.Sl. Addiction No. of Pts. Percentage01. Smoking 4 13.3302. Alcohol 2 6.6603. Tobacco 3 10.0004. No habits 21 70.00 It was observed that, the out of 30 patients 21 (70%) had no habits, smokingaddiction 4 (13.33%), tobacco addiction 3 (10%). 82 Results
  • 99. Distribution of patients by predominant rasa in diet –Table No. 27. Showing the Distribution of patients by predominant rasa in diet.Sl. Rasa pradhanyata in ahara No. of Pts. Percentage01. Madhura 15 5002. Amla 5 16.6603. Lavana - -04. Tikta - -05. Katu 10 33.3306. Kashaya - - It was observed that, the maximum number of patients 15 (50%) had madhurapredominance in diet, katu predominance 10 (33.33%).Distribution of patients by Prakriti –Table No. 28. Showing the distribution of patients by Prakriti.Sl. Prakriti No. of Pts. Percentage01. Vata-pitta 10 33.3302. Vata-kapha 11 36.6603. Pitta-kapha 9 30.00 It was observed that, the majority of patients were vata-kapha 11 (36.66%) andvata-kapha 10 (33.33%) and pitta-kapha prakriti 9 (30%). 83 Results
  • 100. Distribution of patients by Sara –Table No. 29. Showing the distribution of patients by Sara.Sl. Sara No. of Pts. Percentage01. Pravara 7 23.3302. Madhyama 20 66.6603. Avara 3 10.00 It was observed that, the maximum number of patients were madhyama sara 20(66.66%), pravara were 7 (23.33%) and avara 3(10%).Distribution of patients by Samhanana –Table No. 30. Showing the distribution of patients by Samhanana.Sl. Samhanana No. of Pts. Percentage01. Pravara 8 26.6602. Madhyama 18 6003. Avara 4 13.33 It was observed that, the maximum patients were madhyama samhana 18 (60%),pravara 8 (26.66%) and avara 4 (13.33%).Distribution of patients by satwa –Table No. 31. Showing the distribution of patients by Satwa.Sl. Satwa No. of Pts. Percentage01. Pravara 8 26.6602. Madhyama 17 56.6603. Avara 5 16.66 It was observed that, the maximum patients were madhyama satwa 17 (56.66%),pravara 8(26.66%) and avara 5 (16.66%). 84 Results
  • 101. Distribution of patients by Vyayama shakti –Table No. 32. Showing the distribution of patients by Vyayama shakti.Sl. Vyayama shakti No. of Pts. Percentage01. Pravara 4 13.3302. Madhyama 20 66.3303. Avara 6 20.00 It was observed that, the majority of the patient were madhyama vyayama shakti20 (66.33), avara 6 (20%), pravara 4 (13.33%).Distribution of patients by Desha –Table No. 33. Showing the distribution of patients by desha.Sl. Desha No. of Pts. Percentage01. Jangala 1 3.3302. Anupa 2 6.6603. Sadharana 27 90 It was observed that, the maximum number of patients was from sadharana desha27 (90%) and anupa 2 (6.66%), and jangala 1 (3.33%). 85 Results
  • 102. Distribution of patients by chief complaint –Table No. 34. Showing the distribution of patients by chief complaint.Sl. Chief complaints No. of Pts. Percentage01. Sandhi shoola 30 10002. Sandhi shotha 30 10003. Jadyata 30 10004. Gaurava 12 4005. Vrischika damshavat peeda 14 46.6606. Jwara 30 100 It was observed that, the almost all patients were with Sandhi shoola, Sandhishotha, jadya, jwara in 20 (66.66%), gourava 12 (40%), Vrischik damshavat peeda 14(46.66%)Graph No. 03. Showing the distribution of patients by chief complaints. D is t r ib u t io n o f P t . s b y c h ie f c o m p la in t 35 30 30 30 30 30 25 No. of Pt.s 20 15 14 12 10 5 0 SShl S S th Jd G V Vd pd Jr N o . o f P ts . C o m p la in tsSShl – Sandhishoola; SSth – Sandhishotha; Jd – Jadya; GV – Gauravata;Vdpd – Vrischikadamshavata peeda; Jr – Jwara. 86 Results
  • 103. Distribution of patients by associated complaints –Table No. 35. Showing the distribution of patients by associated complaints.Sl. Associated complaints No. of Pts. Percentage01. Anga marda 22 73.3702. Aruchi 17 56.6603. Nidra viparyaya 22 73.3304. Trishna 3 10.0005. Apaka 4 13.3306. Daha 4 13.3307. Alasya 16 53.3307. Vid baddhata 11 36.66 It was observed that, the maximum patients of angamarda i.e. 22 (73.33%),nidraviparyaya 22 (56.66%), aruchi 17 (56.66%), trishna 3 (10%), apaka 4 (13.33%),daha 4 (13.33%), alasya 16 (53.33%), malabaddhata 11 (36.66%).Graph No. 04. Showing the distribution of patients by associated complaints. D is t r ib u t io n o f P t .s A s s o c ia t e d c o m p la in t s 25 22 22 20 17 16 15 N o . o f 11 P t.s 10 5 4 4 3 0 A M A r N V T r A p D h A ls V id V b N o . o f P ts . A s s o c ia te d c o m p la in tsAM – Angamarda; Ar – Aruchi; NV – Nidra viparyaya; Tr – Trishna; Ap – Apaka; Dh –Daha; Als – Alasya; Vid Vib – Vid vibandha. 87 Results
  • 104. Distribution of patients by Nidana –Table No. 36. Showing the distribution of patients by Nidana.Sl. Nidana No. of Pts. Percentage01. Viruddha ahara 7 23.3302. Viruddha chestha 4 13.3303. Mandagni 15 5004. Sasnigdha ahara, bhojanottara vyayama 4 13.33 It was observed that, the maximum nidana of patient were having 15 (50%)mandagni, snigdha ahara bhojanottara vyayama 4 (13.33%), virudha ahara 7 (23.363%).Graph No. 05. Showing the distribution of patients by nidana. Distribution of Pt.s by Nidana 13% 23% 13% 51% Vr Ahr Vr Ch Md SSn. Ahr. Bjn. VymVr Ahr- Viruddha Ahara, Vr Ch- Viruddha Chesta, Md- Mandagni, S Sn Bjn Vym-Sasnigda Ahara, Bhojanottara Vyayama. 88 Results
  • 105. Data related to response to the treatmentSandhi shoola (Pain)Table No. 37. Showing the response of the therapy before and after in sandhishoola.Sl. Grading B.T. % A.T. % No. of Pt.’s No. of Pt.’s01. 0 0 0 18 6002. 1 0 0 6 2003. 2 24 80 6 2004. 3 6 20 0 0 Among the 30 patients, 24 (80%) patients had the grade 2 pain and 6 (20%)patients had the grade 3 pain before the treatment. No patients belong to 0 and 1 gradepain. After the treatment 18 (60%) patients had 0 grade pain and 6 (20%) patients had the1 grade pain & 6 (20%) patients had the 2 grade pain. No patient had grade 3 pain.Statistically it is highly significant, where p value is <0.001.Graph No. 06. Showing the response of the therapy before and after in sandhishoola. The treatment response before & after in Sandhishoola 30 24 25 NO. of Pt.s 20 18 15 10 6 6 6 5 0 0 0 0 A B C D BT AT GradingsA – 0 grade of sandhishoola; B – 1 grade of sandhishoola; C – 2 grade of sandhishoola; D– 3 grade of sandhishoola. 89 Results
  • 106. Sandhi shotha (Swelling)Table No. 38. Showing the response of the therapy before and after in sandhishotha.Sl. Grading BT AT No. of pt. % No. of Pt. %01. 0 0 0 15 5002. 1 0 0 9 3003. 2 24 80 6 2004. 3 6 20 0 0 Among the 30 patients 24 (80%) patients had grade 2 shotha and 6(20%) patientshad grade 3 shotha before treatment. After the treatment 15 (50%) patients had grade 0shotha and 9 (30%) parents had grade 1 shotha, 6 (20%) patients had grade 2 shotha.Statistically it is highly significant, where p value is <0.001.Graph No. 07. Showing the response of the therapy before and after in sandhishotha. Showing the response of the therapy before & after in Sandhishotha 30 24 25 No. of Pt.s 20 15 15 9 10 6 6 5 0 0 0 0 A B C D BT AT GradingsA – 0 grade of sandhishotha; B – 1 grade of sandhishotha; C – 2 grade of sandhishotha;D – 3 grade of sandhishotha. 90 Results
  • 107. Jadya (Stiffness)Table No. 39. Showing the response of the therapy before and after in jadya.Sl. Grading BT AT No. of pt. % No. of Pt. %01. 0 0 0 16 53.3302. 1 0 0 8 26.6603. 2 24 80 5 16.6604. 3 6 20 0 0 Among the 30 patients observed that 24 (80%) were grade 2 jadya and 6 (20%)patient were with grade 3 jadya before treatment. After the treatment 16 (53.33%)patients were with 0 grade jadya, 8 (26.66%) were with grade 1 jadya and 5 (16.66%)patients were having grade 2 jadya. Statistically it is highly significant, where p value is<0.001.Graph No. 08. Showing the response of the therapy before and after in jadya. The response of the therapy before & after in Jadya 30 24 25 No. of Pt.s 20 16 15 10 8 5 6 5 0 0 0 0 A B C D BT AT GradingsA – 0 grade of jadya; B – 1 grade of jadya; C – 2 grade of jadya; D – 3 grade of jadya. 91 Results
  • 108. Jwara (Fever)Table No. 40. Showing the response of the therapy before and after in Jwara.Sl. Grading BT AT No. of pt. % No. of Pt. %01. 0 0 0 30 10002. 1 30 100 0 003. 2 0 0 0 004. 3 0 0 0 0 Among 30 (100%) patients were observed with grade 1 jwara before treatment.After treatment 30 (100%) patients had 0 grade fever.Graph No. 09. Showing the response of the therapy before and after in Jwara. Response of the therpy before & after in Jwara 30 30 30 25 No. of Pt.s 20 15 10 5 0 0 0 0 0 0 0 A B C D Gradings BT ATA – 0 grade of Jwara; B – 1 grade of Jwara; C – 2 grade of Jwara; D – 3 grade of Jwara. 92 Results
  • 109. OVERALL RESULTTable No. 41. Showing the overall result assessed on the basis of subjective 7 objectiveparameters.Sl. Overall result No. of Pts. Percentage01. Complete remission 7 23.3302. Major improvement 17 56.6603. Minor improvement 6 2004. No improvement 0 0 Among the 30 cases of Amavata shows the following results which was assessedon the basis of subjective and objective parameters – 7 patients (i.e. 23.33%) had shown complete remission. 17 patients (i.e. 56.66%) had shown major improvement. 6 patients (i.e.20%) had shown minor improvement. No patients reported in no imoprovement group.Graph No. 10. Showing the overall assessment of results. Overall result NI MiI CR 0% 20% 23% MjI CR MjI MiI NI 57% 93 Results
  • 110. Table No. 42. Statistical analysis before and after treatmentSl. Parameter Mean S.D. S.E. t-value p-value Remarks01. Sandhi shoola 1.6 0.498 0.090 17.77 <0.001 H.S.02. Sandhi shotha 1.5 0.5085 0.0928 16.160 < 0.001 H.S.03. Jadya 1.53 0.3936 0.071 21.549 <0.001 H.S.04. Jwara 1.0 - - - <0.001 H.S.05. Hb% 1.0 0.615 0.112 8.912 < 0.001 H.S.06. TC 533.33 449.776 82.11 6.49 < 0.001 H.S.07. ESR 20.43 6.946 1.268 16.11 < 0.0014 H.S.08. Walking time 1.46 0.7172 0.1309 11.15 < 0.001 H.S.09. Grip strength Rt. Hand 5.579 2.87 0.524 10.648 < 0.001 H.S. Lt. Hand 4.194 1.929 0.352 11.914 < 0.001 H.S.10. Foot pressure Rt. Leg 1.33 0.546 0.099 13.43 < 0.001 H.S. Lt. leg 1.3 0.595 0.108 12.037 < 0.001 H.S.1. DCL 3.066 2.132 0.381 7.88 < 0.001 H.S. All the parameters shows highly significance within the group to assume thatHinguleshwara rasa is not responsible for changes in the reading of before and afterexperiment on the patient. The parameter jadya shows highly significant which is havingleast variation and also having uniform effect over the patient. (By comparing t-value andt-value variance and co-efficient of variation. 94 Results
  • 111. The parameter sandhishoola is also shows more significant (as p is 0.001). Themean effect of parameter TC is more also shows more variation. The ESR rise showshighly significant. The Hb% (by comparing t-value). The mean effect of right hand gripstrength is more than left hand grip strength and also right hand grip strength variation ismore. This may be due to the more number of patients are working in right hand. Themean effect of right and left foot pressure is same and also variation is same, The parameter jwara does not have any variation and mean net effect is one withvariance zero. After the treatment in the parameter CRP the 38 % of the patients has significantimprovement. (Out of 8 patients 3 got Improvement), The lymphocyte count also shows highly significant. There is a improvement inpolymorphs, eosinophil readings after the treatment. 95 Results
  • 112. Table No. 43. Showing subjective parameters Sl. OPD Sandhishoola Sandhi sthotha Jadyata Jwara Response No. No. BT AT BT AT BT AT BT AT 01. 1109 2 0 2 0 2 0 1 0 CR 02. 1189 3 2 3 2 3 2 1 0 MI 03. 1175 2 0 2 0 2 0 1 0 CR 04. 1138 2 0 2 0 2 0 1 0 CR 05. 1368 2 0 2 1 2 1 1 0 MJ 06. 1413 2 0 2 1 2 1 1 0 MJ 07. 1467 3 2 3 2 3 2 1 0 MI 08. 1481 2 1 2 0 2 0 1 0 MJ 09. 1499 2 0 2 0 2 0 1 0 CR 10. 1579 3 2 3 2 3 2 1 0 MI 11. 1619 2 0 2 0 2 0 1 0 CR 12. 1835 2 1 2 0 2 0 1 0 MJ 13. 1906 2 0 2 0 2 1 1 0 MJ 14. 2171 2 0 2 1 2 1 1 0 MJ 15. 2367 3 2 3 2 2 1 1 0 MIBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 113. Table No. 43. Ctd . . . Sl. OPD Sandhishoola Sandhi sthotha Jadyata Jwara Response No. No. BT AT BT AT BT AT BT AT 16. 2619 2 0 2 0 2 0 1 0 CR 17. 2661 2 1 2 0 2 0 1 0 MJ 18. 3018 3 2 3 2 3 2 1 0 MI 19. 3018 2 1 2 0 2 0 1 0 MJ 20. 3179 2 0 2 1 2 1 1 0 MJ 21. 3180 2 0 2 0 2 0 1 0 MJ 22. 3343 2 0 2 1 2 0 1 0 MJ 23. 3564 2 1 2 0 2 1 1 0 MJ 24. 3599 3 2 3 2 3 2 1 0 MI 25. 3610 2 0 2 0 2 0 1 0 CR 26. 3611 2 1 2 0 2 0 1 0 MJ 27. 3809 2 0 2 1 2 0 1 0 MJ 28. 3865 2 0 2 1 2 1 1 0 MJ 29. 3866 2 0 2 1 2 1 1 0 MJ 30. 3867 2 0 2 1 2 0 1 0 MJBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 114. Table No. 45. Showing the objective parameters Sl. OPD Walking time Grip strength Foot pressure Response No. No. Right Left Right Left BT AT BT AT BT AT BT AT BT AT 01. 1109 2 0 28 38 20 28 9 11 11 12 CR 02. 1189 3 2 20 23.99 13 18.5 9 10 8 10 MI 03. 1175 2 0 28 31.2 22.66 28 11 12 9 10 CR 04. 1138 2 0 38 46 38 42 10 3 14 17 CR 05. 1368 2 1 13 15.2 13 20 10 12 12 14 MJ 06. 1413 2 1 31.2 38 28 31.2 13 14 11 12 MJ 07. 1467 3 2 38 42 31.2 32.28 15 17 14 15 MI 08. 1481 2 0 20 28 22.6 28 10 11 8 9 MJ 09. 1499 2 0 38 50 38 40 15 16 14 15 CR 10. 1579 3 2 13 18.5 13 18.5 9 10 11 12 MI 11. 1619 2 0 38 50 38 42 19 22 20 55 CR 12. 1835 2 0 22.6 28 20 23.9 9 10 8 10 MJ 13. 1906 2 1 28 31.2 28 30.6 14 16 13 14 MJ 14. 2171 2 1 23.9 28 20 22.6 13 14 11 12 MJ 15. 2367 3 2 13 15.2 13 14.1 12 13 11 12 MIBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 115. Table No. 45. Ctd . . . Sl. OPD Walking time Grip strength Foot pressure Response No. No. Right Left Right Left BT AT BT AT BT AT BT AT BT AT 16. 2619 2 0 13 18.5 13 15.2 15 16 13 14 CR 17. 2661 2 0 28 31.2 25.2 31.2 13 14 11 12 MJ 18. 3018 3 2 25.2 28 25.2 28 9 10 8 9 MI 19. 3018 2 0 20 28 18.5 20 10 11 9 10 MJ 20. 3179 2 1 28 36.3 28 34.4 11 12 10 11 MJ 21. 3180 2 1 36 42 28 32.8 15 16 14 15 MJ 22. 3343 2 1 40 44 32.8 38 14 16 12 13 MJ 23. 3564 2 1 20 28 22.6 25.2 9 10 8 11 MJ 24. 3599 3 2 22.6 25.2 20 22.6 10 11 9 10 MI 25. 3610 2 0 28 38 20 28 12 14 10 12 CR 26. 3611 2 0 28 31.2 22.6 25.2 11 12 9 10 MJ 27. 3809 2 1 38 42 32.8 38 13 14 12 13 MJ 28. 3865 2 0 28 31.2 25.2 28 10 11 9 10 MJ 29. 3866 2 1 38 42 31.2 36 12 13 11 12 MJ 30. 3867 2 1 38 44 28 34.4 14 15 13 14 MJBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 116. Table No. 44. Master chart showing objective parameters –Sl. OPD Hb% TC DC (BT) DC (AT) ESR CRP RA Res. No. B A B A P L E M B P L E M B B A B A B A01. 1109 11 12 7000 6900 68 32 2 1 0 60 30 1 1 0 35 8 -ve -ve -ve -ve CR02. 1189 10.5 11 9200 8300 65 36 3 1 0 50 39 2 1 0 75 43 -ve -ve +ve +ve MI03. 1175 12 13.5 6000 5000 55 30 2 1 0 50 26 1 1 0 24 10 -ve -ve -ve -ve CR04. 1138 9 11 7500 6000 62 35 4 1 0 52 31 1 1 1 32 9 -ve -ve -ve -ve CR05. 1368 8 9.5 7000 6600 68 33 3 2 0 60 30 1 1 0 40 24 -ve -ve -ve -ve MJ06. 1413 8.5 10 7500 7000 65 30 2 1 1 58 27 1 1 0 55 30 -ve -ve -ve -ve MJ07. 1467 5 5 8000 7800 77 36 5 1 1 65 26 3 1 0 85 80 +ve +ve +ve +ve MI08. 1481 9.5 11 6200 5600 58 35 2 1 1 56 29 1 1 0 45 28 -ve -ve -ve -ve MJ09. 1499 9 10 6500 5900 60 30 4 1 1 52 27 2 1 0 36 10 +ve -ve -ve -ve CR10. 1579 8 8 8000 7500 65 32 5 1 1 60 35 4 1 0 72 45 -ve -ve +ve +ve MI11. 1619 10 12 7200 7000 68 30 3 1 1 59 25 2 1 0 30 10 +ve -ve -ve -ve CR12. 1835 8 8 10000 9000 59 38 2 1 0 58 40 1 1 0 60 45 +ve +ve -ve -ve MJ13. 1906 10 11 6400 6000 56 28 2 1 0 54 28 2 1 0 48 38 -ve -ve -ve -ve MJ14. 2171 11 11.5 6000 5900 54 30 4 1 1 52 23 2 1 0 55 36 -ve -ve -ve -ve MJ15. 2367 7 7.5 11000 9000 73 19 4 4 0 68 20 5 1 0 50 40 +ve +ve +ve +ve MIBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 117. Table No. 44. Ctd . . .Sl. OPD Hb% TC DC (BT) DC (AT) ESR CRP RA Res. No. B A B A P L E M B P L E M B B A B A B A16. 2619 10 12 7000 6800 60 28 3 1 0 57 26 1 1 0 35 13 +ve -ve -ve -ve CR17. 2661 11 12 6300 6000 62 28 2 1 0 58 27 1 1 0 48 28 -ve -ve -ve -ve MJ18. 3018 7 8 7500 6500 70 15 3 1 0 60 20 5 1 0 70 43 +ve +ve -ve -ve MI19. 3018 10 11 7000 6800 59 26 4 1 0 58 24 2 1 0 35 20 -ve -ve -ve -ve MJ20. 3179 9 11 6700 6500 64 28 5 1 1 62 25 1 1 0 70 45 -ve -ve -ve -ve MJ21. 3180 10 10.5 6600 6000 68 30 5 2 1 66 26 1 1 0 46 24 -ve -ve -ve -ve MJ22. 3343 9.5 11 7500 6800 66 28 2 1 1 60 27 1 1 0 62 45 -ve -ve -ve -ve MJ23. 3564 7 7.5 6900 6000 68 30 2 1 1 50 26 2 1 0 45 27 -ve -ve -ve -ve MJ24. 3599 7 7 8000 7000 70 28 5 1 1 60 34 4 0 0 50 40 +ve +ve +ve +ve MI25. 3610 10 11 5800 5600 60 30 2 1 1 58 22 2 1 0 38 14 -ve -ve -ve -ve CR26. 3611 8 9 6500 6300 69 32 3 1 0 57 31 1 1 0 43 25 -ve -ve -ve -ve MJ27. 3809 10 10 6600 5900 62 30 2 1 1 54 29 2 1 0 46 27 -ve -ve -ve -ve MJ28. 3865 7.5 9 3800 7900 65 34 4 1 0 50 28 1 1 0 57 31 -ve -ve -ve -ve MJ29. 3866 12 13 5600 5500 68 29 3 1 0 58 27 1 1 0 62 38 -ve -ve -ve -ve MJ30. 3867 11 11.5 6400 6000 70 28 2 1 0 56 28 1 0 0 53 25 -ve -ve -ve -ve MJBT – Before treatment, AT – After treatment, CR – Complete remission, MJ – Major improvement, MI – Minor improvement.
  • 118. The present topic deals with the interpretation of the materials, which areexplained in previous chapters. Discussion is the solution for most of the things explained in previous chapters.Hingula – It is a chief ore of Mercury and combination of Mercury and Sulphur. In samhitakala there were no references of Hingula, but we get the reference of parada. The reasonbehind this is, in olden days it was assumed to be imported from other countries. According to Rasendra Mangala Hingula has been called as Darada, because maybe it was available in Darada desha. Rasendra sara samgraha explained Hingula asRasagandhaka Sambhoota. It proves that they were very much aware about chemicalcomposition of individual mineral. There is a bit of controversy on varieties of Hingula and there is no referenceregarding Hingula varieties in Rasendra Mangala and Rasa Hrudaya Tantra . Rasaratnasamucchaya, Rasendra Chudamani classified Hingula as Hamsapada and Shukatunda.Ayurevda prakasha and Ananda Kanda classified Hingula in three varieties – Charmara,Shukatunda and Hamsapada. Rasatarangini classified it as Khanija and Kritrima. Becauseit is available in natural form and also can be prepared artificially with the help ofmercury and sulphur. Hamsapada Hingula has been accepted for this study, because of its lessimpurities and ideal one for therapeutic one according to Rasa granthas. Hingula can be administered after proper purification. Shodhana is adopted toreduce its toxitcity and also to deal for therapeutic purpose. If impure Hingula isadministered, leads to many complications. 102 Discussion
  • 119. Hingula satwa is parada. Rasaprakasha sudhakara quotes that the parada,extractedfrom Hingula is having equal property of Shad guna gandhaka jarita parada. Rasaratna samucchyakara and Rasamritakara, explains that the Hingulotthaparada is equal to the property of Gandhaka jarita parada. Generally, marana is not advised for Hingula. Shodhita Hingula can be used forthe preparation of yogas. Rasamrita explains that, it is used for the marana of Swarna and Loha, because ofits chemical constituent Parada. Hingula is sarva doshahara, deepana, atirasayana, vrishya, these are explained byRasaratna samucchayakara because it contains Parada.Vatsanabha – Vatsanabha is known to Ayurvedic pharmacopoeia since long ago. Charakaclassifies it under sthavara visha, Sushruta classified it under kanda visha. Sthavaravishas are used mainly in therapeutics. Among sthavara visha kanda and moola vishas arevery commonly used as they are claimed to be as more potent and effective. Amrita synonym of Vatsanabha, quoted by Rasatarangini and DhanwantariNighantu, as it may be that visha dravyas may be acting quick in the body, would provehighly beneficial to body, if it is administered after purification, with proper dose andprecautions. Some acharyas explained marana, pranahara, for vatsanabha. Because it is vishadravya. In Greek also it is used as poison. Aconite is a Greek word. It means an arrow.The arrows were coated with this poison were used for hunting animals. 103 Discussion
  • 120. In samhita kala the use of Vatsanabha for therapeutic purpose was limited becauseof less development of shodhana procedures. Shodhana is necessary for Vatsanabha before using therapeutically. Ashodhitavisha when used may prove highly injurious to body. It may lead to severalcomplications. Purification is done to reduce its toxicity. While explaining grahya vatsanabha it is sthoola, snigdha, guru, naveena. Afterfruiting free from kita etc, as explained by Taranginikara and also pandu variety isconsidered best. It may be that it is less toxic to other varieties and gives more therapeuticeffects. Vatsanabha indicated in Vatarakta, Shwasa, kasa, does the prashamana of Jwaraand Amavata. It may be due to the property of diaphoretic, antipyretic, anti inflammatoryin small doses. It is narcotic when administered in large doses.Pippali – Pippali is used as a drug in Charaka, Sushruta and Vagbhata samhitas, usuallyused dravya in many Ayurvedic formulations. Magadhi synonym quoted by Dhanwantari nighantu and Bhavaprakash nighantu,it shows the place of availability. Pippali has the property of Rasayana, Jwarahara, Kasashwasahara, Shoola,Amavata. It is stimulant, carminative, and also immuno-modulator. 104 Discussion
  • 121. Hinguleshwara rasa – It is an unique combination of antirheumatic drug found in Rasatarangini and alsoexplained in Rasa classics. All rasa classics explained about preparation of yoga bytaking shodhita Vatsanabha, shodhita Hingula and Pippali churna in equal quantity. Dosevaries according to different acharyas. Rasataranginikara has advised one yava pramanaor ardhagunja pramana. Only the Rasataranginikara has advised to do the preparation in the vati form andindicates for Amavata. Rest of the acharyas advised for vataj jwara.Pharmaceutical study – Most of the times metals and minerals are found in the compound form i.e. mixedwith other ingredients. Some of them may be unwanted and toxic in nature includingeffective ingredients. Shodhana not only intended to remove impurities or toxic materials but alsomakes the metal or mineral suitable for further procedure. It may enhance its property orit reduces its particle size.Hingula shodhana – Shodhana was carried for Hingula with 7 bhavanas of ardraka swarasa. One of theadvantage of bhavana is to reduce into smaller or finer particles. It will be easy forabsorption in GIT. After bhavana weight of the Hingula was increased i.e. from 200gm (beforeshodhana) to 242gm (after shodhana). Because, ardraka swarsa contains fibrous matterand starch. It may cause increase in weight of Hingula. 105 Discussion
  • 122. Vatsanabha shodhana – After the shodhana procedure vatsanabha lost its weight i.e before shodana 400gmto after shodana 300gm. It is due to removal of layers and drying. It is believed that by shodhana process the toxicity was decreased due to treatmentwith cow’s urine and exposure to the sunlight. This brought about a partial change oftoxins Aconitine and Pseudoaconitine into far less poisonous substance Benzyleaconitine, and Vertaroyla aconite.Preparation of Hinguleshwara rasa – Before the preparation , the weight of ingredient were 600 gms. After thepreparation they weiged 580 gms. It was found that there was a loss of 20 gms after thepreparation. The loss may be due to procedures like mardana.Discussion on analytical study –Uniformity of weight For the present study vatis were prepared manualy. 20 vatis taken randomly andweighed.The average weight was calculated.The weight variation fall with in normallimits.Hardness test Hinguleshwara rasa was subjected to hardness test, values were observed as3.5±0.5kg.Disintegration test It was observed that the vatis disintegrated in 16min.As bhavana was done withArdraka swarasa, which contain Starch, this may act as binding agent and disintegrateslowly. 106 Discussion
  • 123. Friability test The weight of the tablets weighed before and after 100 revolutions showed weightloss of 0.15% which shows that it can withstand abrasion in packing, handling andtransporting.pH The pH of the vati is 6.58. It is acidic in nature.Loss on drying It shows the end product contain 5.84% of moisture.Alkaloids The formulation contains Hingula,Vatsanabha,Pippali bhavita with Ardrakaswarasa. Alkaloids of all the dravyas were restored even in the end product, which wasconfirmed by TLC procedure.Total ash The herbal drugs were converted in to ash form resulting in to weight loss. Herevalue of weight loss noted is 7.10%.Solubility test It is sparingly soluble in hydrochloric acid and slightly soluble in alcohol. By thisit is understood that Hinguleshwara rasa may be absorb slowly in GIT.Assay for Mercury and Sulphur The percentage of Mercury and Sulphur was assayed in the vati which revealedthat Mercury was present in 21.73% and Sulphur was present in 6.44%. 107 Discussion
  • 124. Discussion on Clinicals It was a prospective clinical trial over 30 patients, randomly selected in singlegroup. The results obtained were statistically analyzed and mean percentage SD, SE, andt-value were calculated by using t-test. The patients were of either sex age group between 20-50 years. The age groupassumed as the sex of the patient is concerned to it refines the classics. There are morepatients 11 (36.66%) in 26-35 years. Females were dominant 17 (56.66%). Due to thesmaller size of the sample the ratio 3:1 female to male was not achieved. The study records the large number of Hindus 24 (80%) compare to otherreligions. However, it is fallacious to conclude that Hindus are more susceptible forAmavata on this basis. Since, this data is only reflection of geographical predominance ofparticular section i.e. Hindus are dominant in Gadag. Occupation was not significant because the majority of housewives (50%) maysimply correlate with the maximum percentage of female patients in their study. Middlesocioeconomic status patients (53.33 %) are dominating in the study. 63.33% of the patients were vegetarians and only 36.33% were having mixedfood habit. This only reflects the predominant diet of the religion. However majority of the cases under the study had tendency towards kaphajaAhara (Madhura 50%, Amla 16.66%). Maximum number of patients were having vata kapha prakruti (36.66%) followedby vatapitta (33.33%). Majority of the Patients (70%) had no bad habits and 13.33 % were addicted tosmoking. 108 Discussion
  • 125. Majority of the patients having madhyama sara (66.66%) madhyama satwa (56%)and madhyam samhanana (60%) suggesting as in any other disease greater susceptibilityamong those who were not in the pink of their health. Sandhi shoola, sandhi shotha, jadya, were presented by all the patients. Majorityof the patients were having vrischika damshavat vedana. This data reflects the processand substantiate the classics. Maximum number of patients were with mandagni as nidana (46%) with suggeststhe predominance of Ama in Amavata. This is also supports the classics. R.A positive test (16.66%) shows that the typical nature of Rheumatoid arthritisand bad prognosis in these cases. C.R.P. was positive in 8 cases (26.66%) which shows the acuteness of the disease. Cent percent patients were free from extra articular manifestation in eye,respiratory system, cardiac system and nervous system. Out of extra articularmanifestation majority of patients were affected with systemic complaints such as loss ofappetite. This suggests the early stage of disease and hence their prognosis was good.Clinical response of the treatment In this study an effort has been made according to the guideline laid down by ourclassical texts and American Criteria of Rheumatology (ACR) in the selection of thepatients. All the cardinal symptoms were scored according to the severity grade. Theclinical response of the therapy was assessed on the basis of change in the severity scoreafter the treatment. The cardinal symptoms like sandhishoola, sandhishota, jadya, andjwara were taken in to consideration of the functional capacity of the patients laboratoryinvestigations were also assessed before and after treatment. 109 Discussion
  • 126. Effect On Sandishoola 60% of patients were complete relived in shoola the reduction of severity of paingrade reported statistically significant where p value is < 0.001.Effect On Sandhishota 50% of patients were completely releaved in shotha, the reduction of severity ofshotha grade was reported. Statistically highly significant where p value is < 0.001.Effect On Jadya 53% of the patients were completely relieved in jadya the reduction of severity ofshotha grade were reported statistically highly significant where p value is <0.001.Effect On Jwara 100% of patients were completely relived from jwara wherein before treatment allcases had mild fever.Effect on walking time The maximum patients showed improvement in their walking time. The statisticalanalysis shows highly significant as P value is < 0.001.Effect on grip strength The maximum improvement in the handgrip strength was recorded among thepatients. The statistical analysis shows highly significant as p value is <0.001. The meaneffect of right hand grip strength more than left handgrip strength and also right hand gripstrength variation is more. This may be due to more number of patients working in righthand.Effect on Foot Pressure The maximum patients showed improvement in their foot pressure. The statisticalanalysis shows highly significant as p is < 0.001. The mean effect of right and left footpressure is same and also variation is same. 110 Discussion
  • 127. Effect on ESR The mean value of ESR of the patients are markedly changed before and aftertreatment. The ESR values reduced after treatment. The findings are statisticallysignificant where p value is < 0.001. This reduction is highly impressed due too the reliefof disease process.Effect on Hb % The percentage of haemoglobin is also important in this type of patients. Patientsshowed increase of mean Hb%. The finding are statistically significant where p value<0.001.Effect on TLC The leucocytes count can give the idea about disease process. The reduction inleucocytes count before and after treatment shows highly significant at p value is <0.001.It shows reduction of infection.Effect on CRP After the treatment in the CRP parameter 38% patients had significantimprovement (out of 8 patients 3 got improved).Effect on RA After the treatment there is no change in rheumatoid factor (RA).Effect on DC The lymphocyte count also shows highly significant. They are in improvement inpolymorphs, oesinophil reading after the treatment.Total Effect In 30 patients 7 cases noted complete remission 17 patients noted majorimprovement and 6 patients noted minor improvement. 111 Discussion
  • 128. PROBABLE MODE OF ACTION OF THE DRUG Ama and vata are the root cause of Amavata. Ama circulates all over the bodycauses srotovarodha and gets lodged in sandhis and contributes a disease amavata. The ingredient of Hinguleshwara rasa are shodhita Hingula, shodhita Vatsanabhaand Pippali. Among these, two dravyas are having properties of katurasa, katu vipaka andushna veerya. Pippali is having katu rasa, anushna sheeta veerya and madhura vipaka. Allthese are having kapha-vatahara. They does the deepana-pachana and relievessrotovarodha and pacifies vata. Hence, breaking of ama and vata complex. Hingula has the property of tikta, katu, kashaya rasa, ushna veerya, katu vipaka,tridoshahara, deepana, amapachana. It subsides amavata, and jwara. It is rasayana andbala vardhaka. By these properties Hingula subsides jwara, amapachana. It helps inbreaking of Samprapti. Pippali has the property of katu rasa, madhura vipaka, asnushnasheeta veerya,vatakapha shamaka. It subsides jwara, shoola, and amavata. It is deepana, rasayana.These properties of pippali pacifies vata dosha, ama pachana, relieves pain, jwara,amavata lakshanas. Pippali contains active principle piperine. It shows bioavailability enhancingproperty with various structurally and therapeutically diverse drugs. Piperine increasesabsorption, which is due to alteration in membrane lipid dynamics and change inconfirmation of enzymes in the intestines. Pippali acts as immunomodulator. Amavata is one of the auto-immune disease.Pippali has the immunomodulatory effect on immune system. 112 Discussion
  • 129. Vatsanabha has the property of tikta, katu rasa, ushna veerya, kapha vatahara,yogavahi, grahi guna. It increases agni and acts as a rasayana. It cures pandu, swasa andamavata. Vatsanabha contains active principles like aconitine and pseudoaconitine which isgood anti-inflammatory, analgesic and antipyretic. By these properties Vatsanabha doesthe ama pachana and it relieves pain, inflammation and fever. By the above drugs ama and vata will be alleviated, srotodushti will be removedand the drugs which act over the pathology and relieves the symptoms by correcting thepathogenesis along with pathyapathya measures. 113 Discussion
  • 130. CONCLUSION 01. Hinguleshwara rasa has definite activity in reducing the cardinal symptoms of Amavata i.e. Sandhi shoola, sandhi shotha, jadya, jwara. 02. Values of ESR, T.C., Walking time, showed significant reduction after the administration of Hinguleshwara Rasa. 03. Hb%, Grip strength, foot pressure were improved after administering Hinguleshwara Rasa. 04. By observing the results of statistical analysis, it can be concluded that Hinguleshwara rasa is best herbo-mineral formulation for Amavata. 05. All the analytical values of Hinguleshwara rasa found almost in normal limits as per physico-chemical analysis reports.Scope for study – The same study can be taken comparing with other formulations, which areindicated for Amavata. As this study was undertaken with small sample, it can be tried on large sampleand in longer duration. 114 Conclusion
  • 131. The present dissertation work entitled preparation and physicochemical analysisof Hinguleshwara rasa and its clinical efficacy in Amavata with special reference toRheumatoid arthritis. This topic contains, interpretation, observations, review ofliterature, pharmaceutics, analytical study, clinical study, and results, discussion andsummary and conclusion.Introduction The introduction covers need of the study description of khalvi rasayana,Hinguleshwara rasa, Amavata, Rheumatoid arthritis, the purpose of the study in presentscenario were discussed briefly.Review of Literature This aspect of literary review dealt with drug and disease review, composition ofthe trial drugs and their properties. Hingula shodhana and morphology, distribution,pharmacological properties, chemical constitution of vatsanabha and pippali are dealt.The disease review commence with general description of ama, brief description ofsandhi, amavata chikitsa, pathyapathya. The modern review of literature commences withdefinition of rheumatoid arthritis, etiology, pathogenesis, clinical features, diagnosis,investigations, prognosis, complications and management.Pharmaceutical study This deals with selection of raw materials, shodhana of Hingula, shodhana ofVatsanabha, churnikarana of Vatsanabha and Pippali, preparation of Hinguleshwara rasa.Analytical study This deals with organoleptic characteristics, weight and uniformity, PH, assay,disintegration and solubility. 115 Summary
  • 132. Clinical study This part deals with materials and methods. It contains research approach,research design, selection criteria, diagnosis criteria, treatment schedule and criteria forclinical assessment. In this part results obtained are systematically presented, which are demographicdata, data related to disease-Amavata and data related to response to the treatment.Result The results are statistically analyzed, explained and presented in the form oftables.Discussion This part deals with logical interpretation of results. An attempt was made todiscuss pharmaceutical studies, analytical studies, clinical studies and probable mode ofaction of Hingula, Vatsanabha, Pippali and Hinguleshwar rasa. 116 Summary
  • 133. Drug review 1. Shri. Govindadas, Bhaishajya Ratnavali edited by Ambikadatta Shastri, 11th Edition, Varanasi : Choukhamba Sanskrit Samsthana; 1996, Chapter 5th shloka 483, p. 82. 2. Dattaramasundar, Brihatrasaraj Sundar, 3rd edition, Varanasi : Choukhamba Orientalia, 2000, Uttarakhanda Jwarachikitsa, p. 253. 3. Vaidya Chudamani, Rasakamadhenu edited by Acharya Shri. Gularaja Sharma Mishra, 2nd edition, Varanasi : Choukhamba Orientalia, 1999. chapter Poorvardha Jwarachikitsa adhikara, shloka 101, p. 28. 4. Indradeva Tripathi, Rasendrasara Sangraha, edited by Siddhinandana Mishra, 3rd Edition, Varanasi : Choukhamba Orientalia, 2003, Jwarachikitsa, shloka 2, page 107. 5. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 78-79, p. 662. 6. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 80-82, p. 663. 7. Siddhinandana Mishra, Ayurvediya Rasashastra, 5th Edition, Varanasi : Choukhamba Orientalia, 1994, Sadharana Rasavarga, p. 485. 8. Nagarjuna, Rasendra Mangala, edited by Kaviraj H.S. Sharma, 1st edtion, Varanasi : Choukhamba Orientalia, 2003, 1st chapter, shloka 43, p. 18. 9. Srimad Govinda Bhagvatapadacharya, Rasahridayatantra, edited by Rameshwara Dayalu Someeyajilu, 1st edition, Varanasi : Krishnadasa Academy, 1998, shloka no. 4. p. 76. 117 Bibliographic References
  • 134. 10. Indradeva Tripathi, Rasaavarana Nama Rasaratnam, 4thedition, Varanasi : Choukhamba Sanskrit Series, 2001, Jwarachikitsa, shloka 2, page 86.11. Indradeva Tripathi, Rasendrasara Sangraha, edited by Siddhinandana Mishra, 1st edition, Varanasi : Choukhamba Orientalia, 2003, Jwarachikitsa, shloka 235, page 60.12. Srimad Govinda Bhagvatapadacharya, Rasahridayatantra, edited by Rameshwara Dayalu Someeyajilu, 1st edition, Varanasi : Krishnadasa Academy, 1998, shloka no. 4. p. 76.13. Indradeva Tripathi, Rasaavarana Nama Rasaratnam, 4th edition, Varanasi : Choukhamba Sanskrit Series, 2001, Saptamapatala, shloka 2, page 86.14. Radhakrishna Shastri, Ananda Kanda, Tanjore : S. Gopanalan TMSSM Library, 1952, Kriyakarma nama dwitiya vishruti, prathama ullasa, shloka 4, p. 522.15. Indradeva Tripathi, Rasendrasara Sangraha, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter 1st, shloka 118-119, p.30.16. Dattaram Choube, Brihatrasaraj Sundar, 2nd edition, Varanasi : Choukhamba Orientalia, 2000, p.164.17. Acharya Madhava, Ayurveda Prakasha, editor Gularaja Sharma Mishra, Varanasi : Choukhamba Bharateeya Academy, 1999, chapter 2nd, shloka 1, p. 252.18. Shri. Buddhadeva Mookerjee, Rasajala nidhi, edited by Siddhinanadana Mishra, 2nd edition, Varanasi : Shri. Gokulamangala Mudranalaya, 1984, p.2.19. Acharya Somadeva, Rasendra Chudamani, editor Siddhinanadana Mishra, 2nd edition, Varanasi : Choukhamba Orientalia, 1999, chapter 11th, shloka 60-61, p. 190. 118 Bibliographic References
  • 135. 20. Acharya Yashodhara, Rasaprakasha Sudhakara, editor Siddhinanadana Mishra, 3rd edition, Varanasi : Choukhamba Orientalia, 2004, chapter 6th, p. 127.21. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 126-127, p. 80.22. Radhakrishna Shastri, Ananda Kanda, Tanjore : S. Gopanalan TMSSM Library, 1952, Kriyakarma nama dwitiya vishruti, prathama ullasa, shloka 181-182, p. 542.23. Acharya Somadeva, Rasendra Chudamani, editor Siddhinanadana Mishra, 3nd edition, Varanasi : Choukhamba Orientalia, 1999, chapter 11th, shloka 106, p. 194.24. Acharya Madhava, Ayurveda Prakasha, editor Gularaja Sharma Mishra, Varanasi : Choukhamba Bharateeya Academy, 1999, chapter 2, shloka 69-71, p. 272-273.25. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 147, p. 83.26. Acharya Yashodhara, Rasaprakasha Sudhakara, editor Siddhinanadana Mishra, 3rd edition, Varanasi : Choukhamba Orientalia, 2004, chapter 6th, shloka 85, p. 130.27. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 9th Taranga, shloka 4, p.199.28. Yadavaji Trikamaji Acharya, Rasamrita, editor Damodara Joshi, 1st edition, Varanasi : Choukhamba Sanskrit Bhavana, 1988, chapter 1st, p. 26. 119 Bibliographic References
  • 136. 29. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 149, p. 83.30. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 9th Taranga, shloka 11, p.200.31. Indradeva Tripathi, Rasaavarana Nama Rasaratnam, 4thedition, Varanasi : Choukhamba Sanskrit Series, 2001, Saptampatala, shloka 236, page 60.32. Acharya Yashodhara, Rasaprakasha Sudhakara, editor Siddhinanadana Mishra, 3rd edition, Varanasi : Choukhamba Orientalia, 2004, chapter 6th, shloka 86, p. 130.33. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 152-153, p. 83.34. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 9th Taranga, shloka 12, p.201.35. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 9th Taranga, shloka 16-17, p.202.36. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 154, p. 84.37. Acharya Madhava, Ayurveda Prakasha, editor Gularaja Sharma Mishra, Varanasi : Choukhamba Bharateeya Academy, 1999, chapter 2, shloka 76, p. 275. 120 Bibliographic References
  • 137. 38. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 3rd, shloka 151-152, p. 83.39. Acharya Yashodhara, Rasaprakasha Sudhakara, editor Siddhinanadana Mishra, 3rd edition, 2004, Varanasi : Choukhamba Orientalia, chapter 6th, shloka 87-88, p. 130.40. Acharya Madhava, Ayurveda Prakasha, editor Gularaja Sharma Mishra, Varanasi : Choukhamba Bharateeya Academy, 1999, chapter 2, shloka 72, p. 274. %%%%41. Acharya Somadeva, Rasendra Chudamani, editor Siddhinanadana Mishra, 3nd edition, Varanasi : Choukhamba Orientalia, 1999, chapter 11th, shloka 107-108, p. 195.42. Yadavaji Trikamaji Acharya, Rasamrita, editor Damodara Joshi, 1st edition, Varanasi : Choukhamba Sanskrit Bhavana, 1988, chapter 1st, shloka 52-53, p. 27.43. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 9th Taranga, shloka 18-19, p.202.44. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, chapter Suvarnadi varga, shloka 37-39, p. 185.45. Narahari Pandita, Rajanighantu editor Indradeva Tripathi, 2nd edition, Varanasi, Krishnadasa Academy, Suvarnadi varga,, shloka 58, p. 439.46. P.V. Sharma, Kaiyadeva Nighantu, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter Dhatuvarga, shloka 92, p. 238. 121 Bibliographic References
  • 138. 47. Shri Gopala Krishna, Rasendra Sarasangraha, editor Ashok D. Satputte, 1st edition, Varanasi : Krishnadasa Academy, 2003, chapter 1, p. 147.48. Agnivesha, Charaka samhita, editor Kashinatha Shastri and Gorakhanatha Chaturvedi, 12th edition, Varanasi : Choukhamba Bharatee Academy, 1996, chikitsasthana, chapter 23rd chapter, shloka 11-12, p. 625.49. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 11th edition, Varanasi : Choukhamba Saskrit Samsthana, 1997, Kalpasthana, chapter 2, shloka 5, p. 17.50. Yogaratnakara, Yogaratnakara, edited by Laxmipati Shastri, 5th edition, Varanasi, Choukhamba Sanskrit Samsthana, 1993, Poorvardha, shloka 2, p. 165.51. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 15, p.650.52. Acharya Madhava, Ayurveda Prakasha, editor Gularaja Sharma Mishra, Varanasi : Choukhamba Bharateeya Academy, 1999, chapter 6, shloka 17, p. 487.53. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 10-11, p.649.54. JLN Shastri, Dravyaguna Vignana, 1st edition, Varanasi : Choukhamba Orientalia, 2004, p. 45255. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 17, p.651.56. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 18, p.651.57. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 19-22, p.652. 122 Bibliographic References
  • 139. 58. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 23-24, p.652.59. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 25, p.652.60. Yogaratnakara, Yogaratnakara, edited by Laxmipati Shastri, 5th edition, Varanasi, Choukhamba Sanskrit Samsthana, 1993, Poorvardha, p. 166.61. P.V.Sharma, Dravyaguna Vignana Vol-II, 1st edition, Varanasi : Choukhamba Bharateeya Academy, 1981,2nd chapter, p. 107.62. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, chapter Mishrakadi varga, shloka 11- 12, p. 280.63. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, shloka 8, p. 179-180.64. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 26-31, p.653.65. K.M. Nadakarani, Indian Materia Medica, Vol - I, editor A. K. Nadakarni, 3rd edition, Bombay : Popular Prakashana Private Limited, 1982, p. 23.66. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 64-66, p.660.67. Sadananda Sharma, Rasatarangini, edited by Kashinatha Shastri, 11th edition, Varanasi : Motilala Banarasi Das, 1979, 24th Taranga, shloka 61-63, p.659.68. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 11th edotion, Varanasi : Choukhamba Saskrit Samsthana, 1997, Kalpasthana, chapter 2, shloka 12, p. 20. 123 Bibliographic References
  • 140. 69. Bapalala Bahisha, Nighantu Adarsha, Poorvardha, 1st edition, Varanasi : Choukhamba Vidyabhavana, 1981, Vatsanabha varga, p. 4.70. Vagbhatacharya, Rasaratna Samucchaya, editor Ambikadatta Shastri, 9th edition, Varanasi : Choukhamba Ambarabharati Prakashana, 1998, chapter 29th, shloka 145, p. 602.71. Krishnan Vij., Textbook of Forensic Medicine and Toxicology, 2nd edition, Delhi B. Chirchill’s Livingstone Private Limited, 2002, 12th chapter, p. 940-942.72. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 6, p. 60.73. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 9, p. 61.74. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 25, p. 64.75. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 29, p. 64.76. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 30, p. 65. 124 Bibliographic References
  • 141. 77. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 36, p. 66.78. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 42, p. 67.79. Agnivesha, Charaka samhita, editor Gangasahya Pandyeya, 2nd edition, Varanasi : Choukhamba Sanskrit Samsthana, 1983, Sutrasthana, chapter 4th chapter, shloka 45, p. 68.80. Agnivesha, Charakasamhita, Chikitsasthana, editor Kashinatha Shastri 22nd edition, Varanasi : Choukhamba, Bharateeya Academy, 1996, chapter 3rd, shloka 36-40, p. 40.81. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 11th edition, Varanasi : Choukhamba Saskrit Samsthana, 1997, Sutrasthana, chapter 39, shloka 22, p. 143.82. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 11th edotion, Varanasi : Choukhamba Saskrit Samsthana, 1997, Sutrasthana, chapter 39, shloka 60, p. 145.83. Vagbhatacharya, Ashtangasangraha, Sutrasthana, editor Ravidatta Tripathi, 2nd edition, Varanasi : Choukhamba Sanskrit Series, 1992, chapter 16th, shloka 40, p. 324.84. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, Pippalyadi varga, shloka 1, p. 135-136.85. P.V.Sharma, Dravyaguna Vignana Vol-II, 1st edition, Varanasi : Choukhamba Bharateeya Academy, 1981, chapter 4th, p. 275. 125 Bibliographic References
  • 142. 86. K.M. Nadakarani, Indian Materia Medica Vol - I, editor A. K. Nadakarni, 3rd edition, Bombay : Popular Prakashana Private Limited, 1982, p. 965.87. JLN Shastri, Dravyaguna Vignana Vol - II, 1st edition, Varanasi : Choukhamba Orientalia, 2004, p. 452.88. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, chapter 2nd, shloka 73-74, p. 83.89. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Pippalyadi varga, shloka 11-13, p. 135-136.90. Bhavamishra, Bhavaprakasha nighantu, edited by G.S. Pandye, 7th edition, Varanasi : Choukhamba Bharateeya Academy, 1984, chapter Haritakyadi varga, shloka 55-58, p. 15.91. Nrupanandana Pala, Madanapala nighantu, Mumbai : Kemaraja Shri. Krishnadasa Prakashana, 1988, chapter Shyunthyadi varga,, shloka 12, p. 66.92. P.V. Sharma, Kaiyadeva Nighantu, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter Oushadhi varga, shloka 1165-1169, p. 215.93. K.M. Nadakarani, Indian Materia Medica Vol - I, editor A. K. Nadakarni, 3rd edition, Bombay : Popular Prakashana Private Limited, 1982, p.965.94. Net source Pub. Med. 15013199, By Sunila ES, Kuttan G. at Amala canere Research Center, Amaalanagara, Thrissur.95. Net source Pub. Med. 12046863, Khajuria A, Thusu N, Zutshia, at M Anitoba Institute of cell Biology, Winnipeg, Canada.96. Net source Pub. Med. 152555605 By Karthikeyan J Rani p. at Dept. of Biochemistry, PSG college of Arts & science, Coimbatore – 04.97. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Pippalyadi varga, shloka 27-28, p. 139. 126 Bibliographic References
  • 143. 98. Restomajee, Indian Materia Medica, 2nd edition, Delhi : Nearest Publishing House, 1985, p. 600. 99. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Pippalyadi varga, shloka 29, p. 139.100. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Ksheeradi varga, shloka 8, p. 505.101. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 13th edition, Varanasi : Choukhamba Saskrit Samsthana, 2002, Kalpasthana, chapter 43, shloka 217-221, p. 186.102. Agnivesha, Charakasamhita, Chikitsasthana, editor Kashinatha Shastri 16th edition, Varanasi : Choukhamba Orientalia, 1989, chapter 1st, shloka 96-106, p. 44- 45.103. K.M. Nadakarani, Indian Materia Medica Vol - I, editor A. K. Nadakarni, 3rd edition, Bombay : Popular Prakashana Private Limited, 1982, p. 232-233.104. K.M. Nadakarani, Indian Materia Medica Vol - II, editor A. K. Nadakarni,3rd edition, Bombay : Popular Prakashana Private Limited, 1976, p. 191.105. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, chapter Suvarnadi varga, p. 217.106. Agnivesha, Charakasamhita, Chikitsasthana, editor Kashinatha Shastri 12th edition, Varanasi : Choukhamba Bharateeya Academy, 1984, chapter 13th, shloka 9, p. 382. 127 Bibliographic References
  • 144. 107. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition, Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 25, p. 99.108. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition, Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 26, p. 99.109. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition, Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 23-24, p. 98.110. Bhavamishra, Bhavaprakasha nighantu, edited by Bramhashankara Mishra, part – II, 5th edition, Varanasi : Choukhamba Sanskrit Samsthana 1980, chapter Jwarachikitsa, p. 17.111. Ayurmedline, Dr. S. Prabhakara, Jan. to June 2001, Dr. Seetaram Banglore, Pravin Madikonda, Prof. R.H. Singh, New dimensions of concepts of Ama, p. 33- 36.112. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 1-5, p. 460.113. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-5, p.564.114. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 6, p. 462.115. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-2, p.564-565.116. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 7, p. 462-463. 128 Bibliographic References
  • 145. 117. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 8-10, p. 463.118. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 11, p. 463.119. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 12, p. 464.120. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1, p. 568.121. Chakrapani Datta, Chakradatta Jagadishwara Pasada Tripathi, 4th edition, Varanasi : Choukhamba Sanskrit Series, 1976, chapter 25th, shloka 1, page 225.122. Shri. Govindadas, Bhaishajya Ratnavali edited by Ambikadatta Shastri, 11th Edition, Varanasi : Choukhamba Sanskrit Samsthana; 1996, Chapter 29th Amavata chikitsa, shloka 1, p. 431.123. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-4, p. 573.124. Sushruta, Sushruta samhita, Shareerasthana, editor Ambikadatta Shastri, 11th edition, Varanasi : Choukhamba Saskrit Samsthana, 1997, Kalpasthana, chapter 5th, shloka 16, p. 45.125. Sushruta, Sushruta samhita, Shareerasthana, editor Ambikadatta Shastri, 11th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Kalpasthana, chapter 5th, shloka 31-32, p. 45. 129 Bibliographic References
  • 146. 126. Fedric H. Martin, Fundamentals of Anatomy and Physiology, editor William C. Ober, W. Garison, Kathelin Geltch, 4th edition, New Jersey, 1998, chapter 9, p. 253- 265.127. Vinayakumar, Basic Pathology, 5th edition, Philadelfia, W. B. Sundar’s company, 1992, chapter 6th, p. 145.128. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald, Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1928.129. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p.1028.130. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald, Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1928.131. Davidson’s, Principles and Practice of Internal Medicine, CRW, Ederverts, Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 888.132. Davidson’s, Principles and Practice of Internal Medicine, CRW, Ederverts, Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 889.133. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald, Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1929.134. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p. 1029. 130 Bibliographic References
  • 147. 135. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p. 1029-1030.136. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p.1031.137. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p.1030.138. G.S. Sannai, A.P.I. Textbook of Medicine, editor Philip Arahim, F.D. Daster, V.R. Joshi, R.D. Lele, 6th edition, Mumbai : Association of Physicians of India, 1999, Section 17th, p.1032.139. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald, Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1933.140. Davidson’s, Principles and Practice of Internal Medicine, CRW, Ederverts, Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 896- 902.141. Davidson’s, Principles and Practice of Internal Medicine, CRW, Ederverts, Bouchers, 7th edition, Edinburgh, Churchill Livingstone, 1995, chapter 15th, p. 903.142. Pharmacopoeial Standers for Ayurvedic Formulations, Central Council for Research in Ayurveda and Sidda (Ministry of Health and Family Welfare) Government of India, New Delhi, 1987. 131 Bibliographic References

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