An Evaluation of the Efficacy of    Phalatrikadiyoga in Kamala             (Jaundice)                                     ...
This is to certify that GANGADHAR. S. HADIMANI has carried out present workentitled An Evaluation of the Efficacy of Phala...
Acknowledgement       I express my deep sense of gratitude to my guide Dr. Siva Rama PrasadKethamakka, M.D (Ayu) MA (Astro...
Patil, Matoshri Girijamma Melmalagi for providing M.D seat and also helping duringstudy.         I sincerely thanks to my ...
Ayurveda is a Science it deals with the study of knowledge of life. The aim of thisscience is to protect the Human being f...
Ratnavali. So the attempt is made in this thesis to evaluate the efficacy of Phalatrikadi yogain Kamala on scientific basi...
The disease, which is, characterised by the colour pigmentation such as greenish,yellowish and white etc, Kamala and Pandu...
3. Sangraha Kala:         This is the period of commentators and laghutrayees. In this period many of goodcompilation work...
varieties of jaundice. The present days more researches are done more and more about theliver disorders with their managem...
and environmental pollutants); internally produced chemicals, such as hormones,            that are no longer needed; nitr...
Nirukti:        The word Kamala developed and explained as “ kamam kantim harati haridra varnamlati iti Kamala’”. Here kam...
Yellowish discoloration of the skin, selera, mucous membranes, and excretions due tohyper biliruibinemia and deposition of...
1. Hemolytic jaundice               2. Hepato cellular jaundice               3.Chole static jaundice               4.Cong...
The Disease Kamala is Nidanarthakara Roga of Pandu.             The Nidana generallyspeaking word applied to the etiologic...
These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In suchcases all causative factors play their ro...
Tabel No: 2 Katu Rasa Atisevana113,114,115.Charaka                            Sushruta                               Vagbh...
Tabel No: 4 Lavana Rasa Atisevana119,120,121         Charaka                         Susruta                      Vagbhata...
The above mentioned etiological factors provoke Pitta, with their specific qualities.“Agnireva shareere Pittantargatha” Ag...
1. Excessive intake of rooksa guna ahara,                          2. Sheeta, guru, madura rasa ahara                     ...
Samprapti       Samprapti it means the description of pathology of disease. In detail of all the morbidprocess that take p...
take place127, consequently it turns the effect of Yakrit and Pleeha are the main organ’s ofRakta Dhatu. During the destru...
Shakhashrita Kamala Samprapti:         Acharya Charaka and Vagbhata described the shakhashrita Kamala. Can be ofeither rud...
Ati Rookhsa, sheeta, Guru, swadu, Vyayama, Bala nigraha                                        Vata and kapha Sanchaya    ...
manifest the sings and Symptoms of the forth coming disease. Such signs and symptomsare called premonitory symptoms.      ...
Table No 7     The summarization of laxanas according to various text’s. 135, 136, 137, 138, 139, 140.Sl. No_Lakshanas_   ...
The disease manifestation sites are specifically liver and spleen. Thus it needs toknow about the physiological conditions...
Yakrit is located at right upper part of the abdomen, which is described by Susrutaand Modern science also. It is consider...
d)    The porta hepatis,             e)    Along the lines of reflection of peritoneum. A number of peritoneal folds      ...
The foetal liver is an important center for blood formation large aggregations of bloodforming cells are present between h...
leaves the lobule at it’s base there it join with central vein of the neighboring lobules thusends in the large hepatic ve...
capillaries through the intercellular canaliculi. The primary bile capillaries start from betweenhepatic cells as blind tu...
Activating action:          The bile salts by virtue of the cholic acid radical acts as specific activator for differentli...
combine with plasma and globulin and circulate through the blood stream and enter theliver. In the diver cells bilirubin a...
II.    Manufactures of bile:       Bile is secreted continuously from the liver cells and stored in the gall       bladder...
VI.    Hormone metabolism:                      Reduce the circulating adrenal cortical and sex hormones by               ...
The term Pitta is derived from the root of “Tapa” it is having 3 meaning 42.                       1. Tapa santhape- produ...
Table no: 8             Acharya clearly explain qualities Pitta, varna, gandha, ruchi and sandrata. The summarization of P...
continuance and completion of the digestion in the small intestine. The pancreas becauseof its participation in both the d...
Some of the abnormal conditions are Aruchi, Avipaka, Ajeerna, Abnormal bodytemperature, abnormal colour of the body courag...
The Pachakapitta is produced from the Pittadharakala by the stimulation ofSamanavata, based on the concept of Adharadheya ...
pigments cholesterol and lecithin, these organic materials make up over 60% of the totalbiliary solids. Only bile salts ar...
of the fact that, though bright red in colour if undisturbed. The blood separates into twoparts the lower contains the cel...
According to Ayurvedic view, rasadhatu is stated to contribute to the formation ofRakta with the help of Ranjakapitta, whi...
been shown to be a cobalt complex, this is obviously the erythrocyte naturation factor inpure or nearly pure form.        ...
b) Malarupa Pitta: waste product produced in the dhatwagni paka by the action of           raktagni on Rakta dhatu, it is ...
Rakta panchabhoutikatwa : Table No 9         Mahabhuta                           Gunadarma1      Prutvi mahabhoota        ...
It would be seen the Pitta to which the physical characteristics and qualities ofunder discussion are attributed might ref...
conalienlai. re-absorption of it from the intestine in the form of colorless           compounds the stereto bilonogen, wh...
That is ‘Vijatiya’, fit for being converted and utilised by the body as organism.Specific carbohydrates, fats and proteins...
important, post-digestive functions and metabolic event’s which modern advances haveshowed on physiology and biochemistry ...
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An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice), Gangadhar. S. Hadimani, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  1. 1. An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice) By Gangadhar. S. HadimaniAs partial fulfillment of post graduation degree M.D.(Ayurveda Vachaspati) Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka Guide Dr. K. Siva Rama Prasad M.A. (Jyotish) M.D. (Ayu) (Osm) Assistant Professor / Reader in Kayachikitsa Department of Kayachikitsa Post Graduate Studies and research D.G. Melmalagi Ayurvedic Medical College Gadag - 582 103 Post graduation and research center Kayachikitsa 2000-2003
  2. 2. This is to certify that GANGADHAR. S. HADIMANI has carried out present workentitled An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice)under close guidance and supervision. He did this clinical study very sincerely andmethodically. His study, which is presented as a dissertation for the award of M.D.(Ayurveda Vachaspathi) Kayachikitsa from Rajiv Gandhi University of Health Sciences,Bangalore is satisfactory. This study bears ample evidences of original thoughts and expressions and thisdissertation is not an ersatz and has not been formed previously for the award of anyDegree /Diploma or titles in the field of research in Ayurveda. This dissertation is recommending to be submitted before the adjudicators forassessment, approval and awarding the M.D. (Ayurveda Vachaspathi) Kayachikitsa. Date: Guide Place: Dr. Siva Rama Prasad Kethamakka M.D. (Ayu) (Osm) M.A (Jyotish) Assistant Professor / Reader in Kayachikitsa Department of Kayachikitsa Post graduate Studies and research, D.G. Melmalagi Ayurvedic Medical College Gadag - 582 103
  3. 3. Acknowledgement I express my deep sense of gratitude to my guide Dr. Siva Rama PrasadKethamakka, M.D (Ayu) MA (Astro) Reader / Assistant Professor, Department ofKayachikitsa, Post Graduate studies and Research, D.G.M Ayurvedic Medical Collage,Gadag for his much valued guidance, constant support and encouragement throughoutthe study. I acknowledgement my sincere gratitude to Dr. V. Varadacharyulu H.O.DDepartment of Kayachikitsa, Post Graduate studies and Research, D.G.M.A.M.C Gadagfor his experts comments critical analysis and affectionate encouragement throughoutthe study. I am very extremely thankful to Dr. G. B. Patil Principal D.G.M Ayurvedic MedicalCollege and Post Graduate studies and Research, Gadag for his support to postGraduation study and providing all necessary facilities for this research works. It gives me pleasure to express my gratitude Dr. S. H. Doddamani,Dr. R. V. Shetter, Dr. A. K. Panda lecture’s of post graduation research studies inKayachikitsa, D.G.M.A.C Gadag for his valuable suggestions and moral support throughthe study. I extend my immense gratitude to Dr. M. C. Patil professor P. G. Rasashastra &Dr. Kuber Shank, Lecturer in Dravyaguna, Post Graduation studies and research centerD.G.M Ayurvedic Medical College Gadag. I sincerely remember to my all under graduate professors, Assistant Professorsand lecturers of D.G.M Ayurvedic Medical College, Gadag for there help andsuggestions during my post graduate studies. The grace of God and blessings of Shree Jagadguru Abhinava ShivanandaSwamiji, it is pleasure to express my thankful to the management committee. ShriS.B.Sanshi Chairman and members Shri M. S. Mulkipatil, Shri B. S. Patil, Shri. B. C.
  4. 4. Patil, Matoshri Girijamma Melmalagi for providing M.D seat and also helping duringstudy. I sincerely thanks to my beloved colleagues Dr. Srinivasreddy CM, Dr. YasminPA, Dr. B.G. Swamy. I am also thankful to all my postgraduate collegues Dr.B.M.Mulkipatil, Dr. Anil Baccha, Dr. V.N. Kulkarni, Dr. Seetaramaprasad, Dr. G.S.Hiremath, Dr. Suresh.R.D, Dr. C.V.Rajashekhar, Dr. Shankaragouda, Dr.Hanumanthagouda, Dr. Shayju, Dr. U. V. Purad for their constant co-operation and helpin the PG study. My sincere thanks to Shri V.M.Mundinamani, beloved librarian and Mr. S. B.Sureban for supplying me essential reference in the study. I am thankful to Mr.Basavaraj, S. Tippanagoudar, and Lab Technician, Dr. Rajashekhar Pawadashettarpathologist in Gadag who extended his co-operation on investigations. I thanks to Mr. P. M. Nandakumar for his help in the statistical evaluate. I thank toMr. Anjaneyappa. B,, Mr. Shivakumar.G, Dr. Chandahussain, Dr. Girish. N. D,, Dr.Anand. K. P, Dr. S. S. Patil, Dr. B. K. Hiremath and Dr. P.S.Chavadi support to thecompletion of this work. I express my deep affectionate love to my father Shri. Sadashivappa. G.Hadimani, Smt. Shantavva, Brother’s, Sisters and my all-family member and relatives fortheir love and affection rendered throughout my career. With deep sense to gratitude I thank all the subjects who participated in thisstudy. Gangadhar. S. Hadimani
  5. 5. Ayurveda is a Science it deals with the study of knowledge of life. The aim of thisscience is to protect the Human being from various diseases, which acquire by not followingthe swasthavritha, The prevention of the disease and curative aspect of disease knowledgeExplanation available in the ancient period. Ayurveda is the Upaveda of Atharvaveda. InVedas there is a vivid description of a Vyadhi, which has characterized by yellowishpigmentation of sclera, tongue, nails, urine and skin etc and with suitable treatment alsoexplained. Ayurvedic healthcare system has perfected efficient methods and herbal preparationsto keep the physical, mental and emotional health of a person in its prime throughout life. It iscontrary to current practice of seeking treatment when disease strikes, or waiting to getmedical help till the symptoms manifest. It is a mind, body Medicare system evolved to helphuman beings and get maximum benefit out of their lives in a perfectly natural healthy way. Ayurveda instills in you a view of life that is holistic and congenial to enjoy thepleasures of life in a sustainable way. This can be achieved without disturbing the rhythm ofyour life. Ayurveda favors administration of natural health care products (of plant, animal,mineral origin) and their preparations. Generally Ayurvedic Medicare products cause no toxicor side effects, and hence are totally safe. These are time-tested preparations, which havebeen used by many generations. There is no question of tolerance, resistance or addictionwith Ayurvedic health care products. Day today practice receives number of patients suffering from Kamala (Jaundice)and its complications as the negligence of Kamala management. I inspired to take up the Kamala and its management as the dissertation topic as thisailment is prevalent in this province. Even though there are innumerable recipes in Ayurvedicliterature apart from the contemporary management, I have selected the Phalatrikadiyoga, asit seems as classical, authentic, economical and easily available mentioned in Bhishajya 1 Introduction
  6. 6. Ratnavali. So the attempt is made in this thesis to evaluate the efficacy of Phalatrikadi yogain Kamala on scientific basis. The Phalatrikadi yoga, contents are, Triphala, Katuki, Nimba, Guduchi, Vasa,Bhrugaraja, Bhumyamalaki and Chirayata are some of the very frequently these drugs usedin Kamala. In contemporary medical system jaundice is the word analogous with Kamala. The present study comprise of two parts, the first part is mainly concerned with thereview of the literature regarding Kamala and various aspects of the diseases such ashistory, nirukti, paribhasha, Nidana panchaka and Chikitsa etc reviewed and discussed. Thesecond part consists of details of clinical trial of the efficacy of Phalatrikadi yoga in Kamala. Itcomprises of the materials and the methods used for the study and the observations andresults, of the study with detailed discussion over them.Historical aspect: Before preceding the subject, it will be very much worth to have a brief historical reviewof the individual diseases, understand the subject in better manner. Here historical reviewhas been classified under four heading they are as follows: 1. Vedic period 2. Samhita period 3. Sangraha period 4. Adhunika period1.Vedic Period: Vedas are the oldest testimonials of information regarding to the particular diseaseand use of medicinal plants. Atharvaveda is most important Veda among other four Veda. Itis an authentic source of Ayurveda. We found some of the scattered information in mantrasas such diseases of Hridaya, kloma, mastiska, pleeha and Yakrit. It is significantly noticedabout Yakrit vikara’s and explanation of “Yakrit” as well as the disease engendered inconnection with it with elaborated management 1. 2 Introduction
  7. 7. The disease, which is, characterised by the colour pigmentation such as greenish,yellowish and white etc, Kamala and Pandu appear to have been studied. The term “Harita”and Halima vilohitawa is referring to Kamala disease. The Atharvaveda mentions turmericand yellow birds in which Kamala is charmed to enter, leaving the human by receiving themantras. Right therapy also explained in Atharvaveda, the rays of the raising sun in themorning care the disorders. It may be implicated here it is adopted to cure the diseases likeHridroga, Harima etc, the colour change is predominantly found. In Garuda purana and Agni purana there are references of Kamala. Garuda Purana isat the consideration of that the Kamala as Harima is one of the Nidanarthakara Roga ofPandu. Red coloured cow milk is very beneficial to disease of Harima 2. Anjana Chikitsa alsoexplained the management of Kamala 3.2.Samhita Period: This is the scientific age of Indian system of Medicine. In this period CharakaSamhita, Susruta Samhita and Astanga Hridaya are the great literatures. Major literatures ofAyurveda explain the disease Kamala and it’s management. In Charaka Samhita Kamala ismentioned as Nidanarthakara Roga of Pandu. The later author Vagbhata explained aboutSwatantra Kamala apart from the Paratantra Kamala, which was explained by the Charakaand Susruta. Kashyapa Samhita author Vrudda Jeevaka also mentioned as the Pitta is thecausative Dosha and the disease is prominent with yellowish discoloration of conjunctiva andskin. However the predominant Dosha in both Swatantra and Paratantra Kamala is thePitta Dosha. It is significantly noticed that as edification advanced the conditionalmanagement of the disease and draws the attention to words its management by prominentprophylactic measures by seasonal regimens and adaptations of sequential seasonalPanchakarma eliminative measures. 3 Introduction
  8. 8. 3. Sangraha Kala: This is the period of commentators and laghutrayees. In this period many of goodcompilation works are done, laghutrayees are Madhava Nidana, Bhava Prakasha andSharanghadar Samhita, The latter authors like Yogaratnakara, Vangasena explained Nidana,Lakshana and Chikitsa of Kamala. Charaka Samhita commentator, Chakrapani in his commentary on Chikitsa 16thchapter discussed the two-word ruddha marga or rudda patha. He elaborated the patho-physiological aspect of swetha varchata under the heading kosta shakhashrita Kamala,where in Shakashrita Kamala is established. Dalhana, Susruta Samhita commentator, in his ideology on Kamala enrolled the termPanaki as a variety of Kamala. This term has not been used by any other ancient Acharyas.Dalhana used synonyms like Kamala, Apanakya, Kumbhavya, Lagharaka, Laghavaka, Alasa, 4and Alasakya according to its severity and stages . Arunadutta and Hemadri thecommentators of Vagbhata have also commented on the description of shakhashrita Kamalaexplained in the Nidana sthana of Astanga Hridaya. Madhavakara included and explainedKamala and its patho-physiology in the chapter Pandu, considering it as the late stage ofPandu.4. Adhunika kala: The period of after 18th century is called as adhunika kala, many authors such as Dr.Rama Rakshaka patak, Dr. Ranajit Roy Desai, Dr. Vidhyadhara Shukla etc have compiledmaterials from classical texts. In contemporary medicine called it as jaundice, is one of theliver disorders in modern medical area. Comprehensive studies in this field are made andthey have discovered and established new diseases relating to the liver. The modern and Ayurvedic concept of Kamala is similar. It is characterised by theyellowish pigmentation in the conductive, skin and urine etc. both systems explained incurative method in details certain causative factors, which are responsible for producing the 4 Introduction
  9. 9. varieties of jaundice. The present days more researches are done more and more about theliver disorders with their management. The liver is the largest glandular organ in the body, and has more functions than anyother human organ. A persons entire blood supply passes through the liver several times aday, and at any given time there is about a pint of blood there.The Liver has a pivotal role in human metabolism. • The liver produces and secretes bile (to be stored in the gallbladder until needed) that is used to break down and digest fatty acids. • It also produces prothrombin and fibrinogen, both blood-clotting factors, and heparin, a mucopolysaccharide sulfuric acid ester that helps keep blood from clotting within the circulatory system. • The liver converts sugar into glycogen, which it stores until the muscles need energy and it is secreted into the blood stream as glucose. • The liver synthesises proteins and cholesterol and converts carbohydrates and proteins into fats, which are stored for later use. • It also produces blood protein and hundreds of enzymes needed for digestion and other bodily functions. • The liver also produces urea, while breaking down proteins, which it synthesises from carbon dioxide and ammonia. The kidneys eventually excrete it. • The liver also stores critical trace elements such as iron and copper, as well as vitamins A, D, and B12. • The liver is also responsible for detoxifying the body of poisonous substances by transforming and removing toxins and wastes. There are five main sources of body toxins and wastes that the liver deals with: toxins from food (traces of pesticides, preservatives)and alcohol; toxins from outside (drugs, adulterants, 5 Introduction
  10. 10. and environmental pollutants); internally produced chemicals, such as hormones, that are no longer needed; nitrogen-containing waste left over from protein re- use; and energy production. • These toxins and wastes are converted into less harmful substances by the liver and then eliminated from the body. Because of the significant role the liver plays in maintaining our health, we must do allwe can to keep it functioning properly. The liver is a large chemical factory; the heat produced by the chemical changestaking place in it contributes greatly to the general warming of the body. The liver secretesbile, which comprises salts and pigments, and aids the digestion of fats. It stores thesubstance necessary for the proper functioning of the bone marrow, which manufactures redblood corpuscles. It also manufactures the fibrinogen of the blood, stores iron and copper, anddetoxicates the noxious products, which are made in the intestines and absorbed into theblood. It stores carbohydrates in the form of glycogen. The liver is one of the largest organs in the body and one of the five major organs,which are vital to life. A malfunctioning of the liver may not become apparent immediately,unless, of course, the blood flow through it is impeded or the bile ducts are obstructed. Nordoes it recover quickly once it suffers from a disorder. (Indiangyan.com, Diseases of THELIVER &THE CARDIO-VASCULAR SYSTEM)Kamala (Jaundice) Jaundice or Kamala is a condition in which there is discoloration of the skin becauseof deposition of bile pigment in its deeper layers.KAMALA VYUTPATTI The term Kamala is derived by the root ‘kamu’ which means kanti by suffixing Nhin’’pratyaya is substituted by kalaha thus the term Kamala is kumu + Nhin (kalaha) 5 6 Introduction
  11. 11. Nirukti: The word Kamala developed and explained as “ kamam kantim harati haridra varnamlati iti Kamala’”. Here kamam means desire and kanti is the luster, both are diminished incase of Kamala. Haridra is yellowish discoloration, lati means Runaddati or to get yellowishdiscoloration, In other words Kamala is a disease in which an individual looses interest in allaspects and gets the yellowish discoloration 6. Klama glano dhatunam nispanna Kamala shabda shareerendriya glanayati ’’Dhaturupa manjari” 7Paribhasha: The term Kamala translated by Sir Monier Williams to give certain meaningslibidinous, luster, dry and sterile soil, desert, a form of Jaundice, excessive secretion of bile orobstruction of bile etc. “ Atha kamalati kama shabda Ayam sadharana shabda vesheshati Swalpe baktadabhilasha pravartate tam latoti kamala” The Kamala would be point out to a disease conditions in which hunger and appetitefor food are diminished, simple meaning of Kamala is a disease where there is little or nodesire for food according to Harana Chandra 8. In sabdha sthoma maha nidhi defined as “kamam Kanthim lunathi iti Kamala”which means and indicate the diseased condition in which the changes of colour arevisualized. And the term kanthi means to be luster or natural colour of the skin. Haridra andHarita colours are manifested in the normal skin colour bringing kanthi or luster of the skin into abnormal state i.e. yellowish discoloration. 7 Introduction
  12. 12. Yellowish discoloration of the skin, selera, mucous membranes, and excretions due tohyper biliruibinemia and deposition of bile pigment’s 9 are seen in Kamala i.e. jaundice.PARYAYA In classics the different terminology are used for the Kamala. In Atharvaveda Kamala was known as Harima, Harita, vilohitatwa and Haridraka.Dalhana while commenting on Susruta reviewed the different stages of Pandu Roga anddeclared that Kamala with terminology such as panaki, apanaki, kumbha Kamala,lagharaka, Alasa, Alasakya etc. These nomenclature gives expression as different stages 10of Pandu Roga and therefore all these words even though looks like synonyms of Kamalathey are different stages of Kamala. Astanga Hridaya 11 used the word lothara as synonymsof Kamala. Chakrapani has used the term “Bahu Pitta Kamala as the synonyms ofkostashkhastrita Kamala and alpa Pitta Kamala as the synonyms of “shakhashrita Kamala 12.BHEDA 13,14 Charaka has classified the disease Kamala in two types. They are as follows: 1. Kostha shakhashrita Kamala 2. Shakhasharita Kamala Kamala is considered as a paratantra vyadhi and by some others as swatantraVyadhi. Susruta has stated the Kamala is a later stage of Pandu Roga and kumbha Kamala,lagharaka, Alasa and Haleemaka are it’s different stages. Thus Kamala can be classified according to the dispersal of Pitta in the body as - 1) Bahu Pitta Kamala or kostha shakhashrita Kamala 2) Alpa Pitta Kamala or shakhashrita Kamala.Classification of jaundice 15 The classification of jaundice in modern medical science is based on the basis of patho-physiology and etiology. 8 Introduction
  13. 13. 1. Hemolytic jaundice 2. Hepato cellular jaundice 3.Chole static jaundice 4.Congenital non-hemolytic hyper bilirubinaemia. i. Hemolytic jaundice- Increased bilirubin load from the liver cells. ii. Hepato cellular and cholestatic jaundice liver disease and large duct obstruction. Congenital non- hemolytic hyper bilirubinaemia defects in conjugation 16This dissertation is divided into six chapters, Viz. 1. Introduction 2. Literary Review 3. Drug Review 4. Material and Methods 5. Observations and Results 6. Discussion and Conclusion This dissertation is appended with References, Bibliography, Master Charts andCase Sheet at the end. 9 Introduction
  14. 14. The Disease Kamala is Nidanarthakara Roga of Pandu. The Nidana generallyspeaking word applied to the etiological factors for the concerned diseases the word Nidanarefers specially to the cause that brings about disease. The causation of disease considered in many ways: Nidana has been defined as “sethi karthavyathakar and rgathapadaka hetu”which means that all such another factors which by deranging dynamic state of doshic un-equilibrium. All the disease factors to causes the Dosha imbalance and produce disease“Rogasthu Dosha vaishamyam (Vagbhata) The etiological factors of Kamala broadly explain in the classics. In fundamental theindulgence of habits which vitiate Pitta in a person who is already suffering from PanduRoga. Susruta and Vagbhata also at the same opinion about etiology for the Kamala106,107. Chakrapani has expressed affirmation with the above view point he has made areference to an unknown author who makes a distinction kosta shakhasritha Kamala, whichrepresents only an aggravated condition of Pandu Roga and shakhasrita Kamala accordingto him some times is an independent disease entity 108. The below mentioned are the conditions of kosta shakhashrita Kamala andshakhashrita Kamala can occur in different situations. They are - a) during Pandu Roga b) during any other disease of Pitta c) without any other perceptible diseases 10 Literary review
  15. 15. These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In suchcases all causative factors play their role in vitiating Pitta. This condensation of Pitta offunctional and sensible hyper activity may result in to Kamala from the following Pittavitiating ahara, vihara etc109. Table No:1 Pitta Prakophaka Karan110,111,112. Charaka Susruta VagbhataAharaAti amla rasa sevana Ati katu sevana Ati katu sevana “ Lavana “ “ Amla “ Amla ““ Katu “ “ Lavana “ Ushna ““ Ushna “ “ Ushna “ Teekshna ““ Teekshna “ “ Vidagdha “ Lavana ““ Kara “ “ Tilatiala “ Vidahianna ““ Ajeernabhojana “ “ Peenyaka ““ Vishana ahas “ “ Vidahi ““ Deergya kala “ Kulatta “ shita “ “ Athasi ““ Madya “ “ Harika shakha “ “ Godha matsya “ “ Javika Mamsa “ “ Dadhi,Takra,Kurchika Masthu, sowveeraka,suravikara, Amlapala,KatwaVihara Krodha Shoka Krodhaa) Manasika krodha Bhayab) Shareerika Ayasa Shrama, atapa, Agni Atimaithunam Santapa, UshnavasaAcharya Upavasa SharatrutuUpavasa Dhoomapana Ushnakala MadyanhaKala Meghante Ratrayardha Madhyante Vidaaha Ardharathri Samayeshu Jeetyanne 11 Literary review
  16. 16. Tabel No: 2 Katu Rasa Atisevana113,114,115.Charaka Sushruta VagbhataPumsaptva hrasa Bhrama Trushna balakshayaMoha Mada MurchaGlani Gala, talu and ostasotha AkunchanaAvasada Daha santapa deha Kampha kati and prustaDatu shithilla balanasha Vyapad etc.Murcha KamphanaBhrama Pricking painDaha, tapa Hasta pada parsha &Balabrasa UdarashodaTrushnaShrira kampaPricking pain and Rogautpatti Tabel No: 3 Amla Rasa Atisevana116,117,118.Charaka Sushruta VagbhataDanta harsha, Trushna, Dantaharsa, Nayana Shaithilya, Timira,Romanchana, Kapha samilana, Roma, Bhrama, Kandu, PanduVilayana, Pitta uruddi, Samavegana, Kapha vispra,a Shopha visphata,Mamsa vidahati, Ksheena, vilayana, Sharira saithilya, Trushna, JwaraKshata, Dourbalya, Rakta Kshata, Abhihata dagda,dusti, Kshataathihata, dasta Bhagna, rugna,Dagda, Bhagna, Mutrila shoon, prachyatava, motritaPrisarpita, chinna bhima, visarpita, chinna,Knatha, Urho, Hridayam bhinnavidhota, paridahati,paridhaha kantam, urhi, hridayam etc. 12 Literary review
  17. 17. Tabel No: 4 Lavana Rasa Atisevana119,120,121 Charaka Susruta VagbhataPitta KopayatiRakta Vardana Gatra Kondhu AsrapavanaPipasa Utapatti Kotha KhaliryaMurcha Utapatti Shopha Palitya(Kaphala roga)Tapa Vruddi Vaivanya ValeemTwacha vidar Punsatva upaghata TrishnaManisa Pesivikrutti Upatapa KushtaVisha Vruddi Mukha, Akshipaka VishaKusta roga Rakta Pitta VisarpaSotha, danta patan Vatashanita Balakshaya etc.Ramsatva Shaktiprasa Amlika etc.Indriya Shakti prasaPalita, KhalityaRaktaPitta , AmlapattaVisarpa, vataraktaVicharachika, Indralupta Tabel No: 5 Rakta Prakopaka Hetu122,123.Charaka SushrutaAti Teekshna Pitta Prakopaka aharAti Ushna Ati drava aharaMadyasevan Ati Snigda aharaAti Lavan Ati Guru aharaAti Skhara Diva SvapnaAti Amlarasa KrodhaAti Katurasa Amala and Atapa sevanaAti Kulatha ShramaAti Udada AbhighataAti Tila taila AjeernaPidalu Virudda bhojanaMoolika Adhyasana etc.Jalaja ManasaAnupmamsaDahi, KanjjiSura, SoaveeraDurgandita aharaDiva SvapnaDoopa and AtapasevanVamana Vegadharana 13 Literary review
  18. 18. The above mentioned etiological factors provoke Pitta, with their specific qualities.“Agnireva shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluidhaving Ushna and teekshna properties enough and sufficient to digest the food. With the above-mentioned Nidana person with vitiated Pitta and Agni is unbalancingthe functions of liver where mala roopa Pitta is discharged. When hypo functioning of Pitta(Agni) consequently in turns produce Ama or Amavisha. This Ama corresponds with Raktaand may produce Kamala. Pitta has its seat in Rakta has the Ashrayashrayee bhava because are of samequalities i.e. “Samavaguna”. Some of the above said aetiological factors may adversely acton Rakta Dhatu with its similar qualities, which can also vitiate of Pitta. These factors probably disturb Rakta Dhatwagni and when vitiated the prasadamshaof Rakta Dhatu is not nourished properly. The by-product of Rakta i.e. Pitta is produced inexcess consequently producing bahu Pitta, with results in to “kostashakhashrita Kamala” According to modern concept, certain bacterial, protozoan infection such aspneumonia, syphilis, septicemia, typhoid, relapsing fever, damage liver cells. With this livercells become inefficient thus favoring the retention of bile pigment and bile salt in the blood.Some chemical poisons such as arsenic, phospherous, Arosono-benz derivativesnitrobenzyme lead etc also capable to damage the liver cells. Toxemia of this nature sometimes occurring in pregnancy and certain chronic heart disease with congestion may bebecause of liver disease and ensuring the jaundice.Shakhashrita Kamala nidana124 The careful appraisal of distinct clinical features of shakhashrita Kamala would be ofruddapatha resulted from Kapha occupying the Pitta vaha srotas. The development of thiscondition implicated as a result of sroto vimarga gamana. Charaka narrating aetiologicalfactors of shakhashrita Kamala as under- 14 Literary review
  19. 19. 1. Excessive intake of rooksa guna ahara, 2. Sheeta, guru, madura rasa ahara 3. Ati Vyayam and 4. Vega dharana These Nidana narrated in the Charaka Samhita is represented as below, Vimargagamana Srotorodha Srotovaigamya Kamala a disease of elevated bile in the blood is visualized in so many roots. Out ofthem some are due to mechanical obstruction and others are of infectious in origin.Rudhapatha is of obstructive variety develops because of Pitta vaha Sroto vaigunyadevelops from different aetiology is classified and considered as under.Mechanical obstruction The excessive intake of ushna, teekshna, katu,madhura and vidhahi ahara provokethe Pitta . Thus the Pitta is altered in its quality and quantity. The sara and drava gunas ofPitta diminished and fluid become thickened even hard. This may perhaps be correlated tothe inflammatory condition of the mucosa of bile canaliculae in infective hepatitis. The obstruction of Pitta marga possible by the intestinal warms and other parasitesthere is no reference to obstruction from the krimis. Srotorodha it is a certain pathologicalconditions. Created in the stricture of bile duct. It may happen by external pressure or anygrowth either inside of out side the passage. According Charaka causative factors to augment Kapha exchanging in the role toblock the passage. These Doshas when provoked by such causative factors. Vatapreparedly its rooksha guna it dries the Kapha, thus making soft and hard to block the Pittavaha marga resulting on vimarga gamana of Pitta. This results in to the shakhashritaKamala. 15 Literary review
  20. 20. Samprapti Samprapti it means the description of pathology of disease. In detail of all the morbidprocess that take place in different stages of the disease .It is the periods of Nidana sevanato the period of Vyadhi janana and continues along with signs and symptoms. “Tasmada vyadhi janaka dosha vyapar visheshayuktam Vyadhi janmeha samprapti “125 The disease manifests by Dosha dushya sammurchana when the all evadingDoshas in their provoked state, come into contact with an organ or Srotas that is sufferedVaigunya, This manifestation of disease preceded the other evaluative stages. Theabnormal increased state of Pitta this is outcome of disturbance in paka of Rakta.Elsewhere a reference was made to Rakta when it was noted, that a constituent of wholeRasa and homologue of Pitta. The ingested food particle digested by Pachakapitta produce ahara-rasa this ahara-rasa, digested by rasagni after it devised sarabhaga and kittabhaga. arabhaga of Rasacirculate all over the body by the help of Vyanavata .The ahara Rasa gets colour ofdigested by raktagni, Rasa colour will be change and Rakta Dhatu utapatti takes place toYakrit and Pleeha “rasad raktam prajayate” In the case of mitya ahara and vihara it vitiatethe Dosha and dushyas Ama rasa obtained if the Rasa carrying Ama visha, along with theprovoked Pitta Dosha get vitiated the moola of Raktavaha Srotas Yakrit and Pleeha, itproduces Rakta pradusaja Vyadhi on combination with Rakta in which Kamala is one out ofsuch disease. Pitta vriddhi at the level of Rakta paka independently causes Pandu. ThePitta becomes prominent its ushna and teekshna qualities, thus vitiated Pitta circulate allover the body when it comes in the contact with the Srotas that has already sufferedvaigunya gets into the circulatory system and mixed with blood this turn with the cause ofKamala125,126. Because of Pitta ushna and teekshna guna’s of Pitta more of Rakta will be 16 Literary review
  21. 21. take place127, consequently it turns the effect of Yakrit and Pleeha are the main organ’s ofRakta Dhatu. During the destruction of the Rakta there may from mala of Rakta i.e. Pittaabnormally in its quantity. This is spread in the all over the body and having lodged in spacebetween twacha and mamsha, it produces characteristic features like peeta netrata, peetatwacha and peeta mootrata etc.Samprapti of kostashakhashrita Kamala Intake of Pitta vardhaka ahara, viharas and pandurogi Pitta Sanchaya in kosta Panchakagni vikruti by increased of teekshna and ushna gunas Amarasa utapatti Vitiate the Kapha and Vata Dosha Circulate all over the body through Rasa Rakta complex Saman gunas Rakta and Pitta aggravated Vitiated Pitta Rakta not digest by mamsagni.Vidagdata takes place in mamsa dhatu vitiated Pitta Rakta and mamsa it leads to yellowish discolouration of neetra. Twach. Nakha. Reduction of jeevana kriya of Rakta it leads sharira, dourbalya and indriya dourbalya. Increased mala rupi Pitta in kosta it gives yellowish and redness of feaces and urine. Kamala Roga 17 Literary review
  22. 22. Shakhashrita Kamala Samprapti: Acharya Charaka and Vagbhata described the shakhashrita Kamala. Can be ofeither ruddhapatha or vimargagamana128,129. The sleshma occupying biliary passage prevents the Pitta from entering the kostaand hence cause Ruddha Pitta, the other hand when Vayu due to it’s conjunction withSleshma(Kapha Sammurchitha) dries up the biliary passage. There occurs theVimargagamana of Pitta. This is regulation of Jaundice. If the sara and dravagunatas ofPitta are diminished, the fluid becomes thickened and even hard. A note has to be made inconnection of the responsible factor or predominant factor of asmari. Where the asmari termused according to Susruta, that the adhistana dosha, or all types of asmaris as Sleshma. Itis associated with Pitta Dosha is becomes hard and get increased size it blocks the margaand adversly affecting. However the Tridosha are involved in the process. This processdevelopment of asmaris takes place it refer to the one of the factors of Pitta margavarodhai.e. gallstone. In shakhashrita Kamala Vata and Kapha are predominant. And not only Pitta isprevented from passing into the gut but also regurgitated this is vimarga of Pitta. It is takenback to Rasa Rakta this Pitta not being eliminated in sufficient qualities is found deposited inthe skin conjunctiva, nails and tongue the colour of the feaces is swetha or tilapistanibham.Samprapti GhatakaDosha : Pachakapitta and Ranjakapitta Vyanavata and Kostastha KaphaDushya : Rakta, mamsa, twaka,Agni : Jatharagni and dhatwagni,Srotas : Raktavaha srotas,Srotodusti prakar : Sanga and vimargagamana.Udbhava sthan : Amashaya.Vyakta sthan : Netra, twaka, Mootra, pureesha, Nakha,etcAdisthana : Yakrit,Marga : Bhahya and Abhyantara. 18 Literary review
  23. 23. Ati Rookhsa, sheeta, Guru, swadu, Vyayama, Bala nigraha Vata and kapha Sanchaya Agnimandya Ama Utapatti—it not proper digested by rasagni Chalaguna of vata and pichala guna of Khapa increased in Kosta, Vitiated vata vitiates the kapha Vitiated vata and kapha circulated through the Pitta vaha srotas, Avarodha of Pitta vaha srotas by the vitiated kapha Raktagni and Ranjaka Pitta not nourishing the forth coming dhatu. ‘Absence of ranjaka Pitta in kosta due to the avarodha of Pitta vaha Srotas by Kapha- Samurchana. Vitiated Pitta due to the avarodha of Kapha circulates on the shakha rather than coming to the kosta by vitiated Vata. Peeta netra, nakha, Mootra, Anana and sweta pureesha passed. Shakhashrita KamalaPOORVA ROOPA Poorva roopa are the prodromal symptoms which occur before completemanifestation of the disease poorva roopa appears in the stage of chaturtha Kriyakala whichis said as sthana samshraya.130 The vitiated Doshas at the stage of sthana samashraya will 19 Literary review
  24. 24. manifest the sings and Symptoms of the forth coming disease. Such signs and symptomsare called premonitory symptoms. The poorva roopa of Kamala may be fall under the latter category. Since they arenot distinctly pronounced to indicate the same or it at all they may be present in obscureform Kamala premonitory symptoms not visible.Roopa131,132. The roopa stage actual symptoms commences from vyaktavastha this is the fifthstage of disease. The clear manifestation of the prodromal itself is called as roopa. Most of all Ayurvedic classics given explanation about disease Kamala is a resultantof untreated or Chronic Pandu Roga. Later authors give more information about Kamala.They believe that the Kamala is resultant of untreated Pandu, and further they told that theKamala might manifest in normal person also by the excessive in take of Pitta vardhakaahara and vihara. Table No 6 Roopa of Kosta shakhashrita and shakhashrita Kamala133,134. Kosta shakhashrita Shakhashrita__ Haridra Netra Haridra Netra Haridra twacha Haridra twacha Haridra mukha Haridra mootrata Haridra Nakha Swetha varchastwam Bhekha varnata Atopa Rakta peeta mootra Vistambha Rakta peeta mala Hrudgraha Daha Parswharti Avipaka Hikka Dourbalya Swasa Sheetalata Aruchi Aruchi Jwara Angasada Dourbalya 20 Literary review
  25. 25. Table No 7 The summarization of laxanas according to various text’s. 135, 136, 137, 138, 139, 140.Sl. No_Lakshanas_ Ch Su AHR MN BP YR1 Haridra netra_ + + + + + +2 Haridra twacha + + + + + +3 Haridra mukha + + + + + +4 Haridra nakha + + + + + +5 Haridra mutra +6 Rakta peeta mutra + - + + +7 Rakta peeta mala + - + + +8 Daha + + + + +9 Avipaka + + + + + +10 Dourbalya + + - + + +11 sheetalata +12 Aruchi + + - + + +13 Krusha - + - - - +14 Tandra - + - - - -15 Balakshaya - + - - - -16 Trushna - - + - - -17 Indriyadourbalya + - + + + +18 Bhekavarana + - + + + +19 Panduvarnata - + - - - - 21 Literary review
  26. 26. The disease manifestation sites are specifically liver and spleen. Thus it needs toknow about the physiological conditions and possible pathology in accordance withcontemporary medicine.Shareeram Kamala according Ayurveda is a disease of Rakta Dhatu, it is explain under contextof Rakta ruddi laxana and Charaka explain under the Rakta pradusaja Vyadhi, Kamalarelated organ is a Yakrit, it is a moola of Rakta vaha Srotas all Acharyas has same opineregarding Srotas 17. In Kamala the Dosha vitiated is Pitta. The prime symptoms of Kamala is yellowishdiscoloration of Netra, twacha, mootra etc because of vitiated Pitta Dosha, Ranjakapitta ismainly contributory of above-mentioned symptoms. In classic also mentioned Yakrit is aseat of Ranjakapitta 18,19. The diagnostic symptoms of shakashrita Kamala is tilapistanibha varchas, which isdue to the absence of Pitta in kosta. The samprapti of shakashrita Kamala is clearlymentioned in classics, that Kapha obstructs Pitta. So Pitta will not reaches the kostaresulting tila pistanibham. From above explanation we conclude the Yakrit and Pitta Doshainvolved in disease of Kamala20.Niukti of Yakrit The word Yakrit grammatically made up of ‘yaj dhatu, shakerutin pratya in which itmean dakshinabhaga mamsa khanda. YAJ + SHAKERUTTIN = YAKRITSynonyms of Yakrit Karanda, Kalakam, Kalakhanja, Kalakhanda, Kaleam21 In modern the synonym ofliver is Hepar22. The liver develops from hallow endodermal bud from the foregut during the3rd week of gestation, from the matruja bhava it is developed. The utapatti of Yakritis from shonita23 Yakrin is a composition of liver = Medas24 22 Literary review
  27. 27. Yakrit is located at right upper part of the abdomen, which is described by Susrutaand Modern science also. It is consider one of the kostanga it is a largest gland in the body,it is situated in the upper and right part of the abdominal cavity, it occupying almost wholeright hypochondrium, greater part of epigastrium and extending to the left hypochondrium25. 1. It is exocrine and excreting bile, which goes to the second part of the duodenumvia the biliary passage. 2. Endocrine by secreting glucose going to blood 26 In the male it commonly weight from 1.4 to 1.8 kg. In female from 1.2 to 1.4 kg withhowever, a range of 1.0 to 2.5 kg. It is relatively much larger in the fetus than in the adult. Itis somewhat wedge-shaped, reddish in colour27.It has five surfaces they are: 1) Anterior surface 2) Posterior surface 3) Superior surface 4) Inferior surface 5) Right surfacePeritoneal relations: Most of the liver covered by the peritoneum. The areas not covered by peritoneum areas follows. a) A triangular ‘bare area on the posterior surface of the right lobe, limited by the upper and lower layers of the coronary ligament and the right triangular ligament. b) The groove for the inferior venacava on the posterior surface of the right lobe of the liver, between the caudate lobe and the bare area. c) The fossa for the gall bladder, which lies on the inferior surface of to right lobe of the quadrate lobe. 23 Literary review
  28. 28. d) The porta hepatis, e) Along the lines of reflection of peritoneum. A number of peritoneal folds are attached to the liver, although these folds are called ligaments each of them is made up only of two layers of the peritoneum, these are as follows. The falciform ligament is connected with the antero superior surface of the liver to theanterior abdominal wall and to the under surface of the diaphragm. The left triangularligament connecting the superior surface of the left lobe of the liver to the diaphragm. Theright triangular ligament connects the lateral part of the posterior surface of the right lobe ofthe liver to the diaphragm. The coronary ligament having superior and inferior layers, whichenclose the bare area of the liver and the lesser omentum27.Embryology: The liver develops from an endodermal bud that arises from the ventral aspect of thegut, at the point of junction between foregut and midgut, this bud grows into the ventralmesogastrium and passes through into the septum transversum. It enlarges and soonshows a division into a larger cranial part called the pars hepatica and a smaller caudalportion called the pars cystic. The pars hepatica divides into right and left parts each ofwhich forms one lobe of the liver. As the right and left divisions of the pars hepatica enlarge and extend into theseptum transeversum. The cells arising from them are broken up into interlacting columnscalled hepatic trabeculae. In this process, the umbilical and vitelline veins that lie in theseptum transeversum are broken up to forms the sinusoids of the liver. Sinusoids are alsoformed form the mesechyme of septum transeversum. The endodermal cells of the hepatic bud give rise to the parenchyma of the liver andto bile capillaries. The mesoderm of the septum transversum forms the capsule and fibroustissue basis of the liver. 24 Literary review
  29. 29. The foetal liver is an important center for blood formation large aggregations of bloodforming cells are present between hepatic cells and blood vessels. Bile formation begins when the fetus is about three months old. The bile isresponsible for the black colour of the first stools (meconium) passed by the new born28.HISTILOGY OF LIVER30 The liver is both a secretary and excretory glands, it is solid organ consisting ofseveral lobes. Each lobe is made up of numerous lobules, under the microscope, eachlobule is found to composed of row of polygonal cells radiating from the center. Like thespokes of wheel the periphery of the lobule being delineated by the presence of portaltriads. The control vein occupies the center. The portal duct and hepatic vein emerge out ofthe liver through a connective tissue sheath (Glisson’s capsule). After entering they branchrepeatedly there is frequent hepatic artery and portal vein in the interlobular region, recentstudies the liver cells are arranged in the form of plates having a thickness of single cellsdiameter which provide, which provide a honey comb or sponge like structure. Through outthis structure, the cell plates are tunneled by a communicating system of cavities or lacunae.The lacunae of endothelica cells and phagocytic cells of the RE system are called Kupffercells. Electron microscope reveals that kupffer cells may contain phagocytosed substanceand they are elongated structures haveing an irregular outline created nucleus, fewmitochondria and varying separating the sincesaidal wal from the liver cells plates is knownas ‘Disses space. The flow through the sinusoids is guarded by inlet and outlet sptrincters and theintermittent flow of is mostly due to presence of these sphincters. In the lover lobule thesinusoids are drained in the central vein. The interlobular branches of the hepatic arteryalso end in the sinusoids directly. The central vein while passing through the long axis ofthe lobule, constantly receives sinusoids from all and ultimately leaves the lobule, constantly 25 Literary review
  30. 30. leaves the lobule at it’s base there it join with central vein of the neighboring lobules thusends in the large hepatic vein. Bile is formed and discharged through fine intercellular canaculi into the bilecapillaries, hepatic cells are polygonal in shape and on the average 25 inches in size. 85 %of hepatic cells being parenchymal type has a clear cells membrane and often binucleated,and mitosis is rare normally. The cytoplane contains stored glycogen and fat, alsobasophilic materials, mitochondria, galgi apparatus granular and agranular material,mitochendsa endoplasmic reticula and lysosomes are present. Two or more liver cellsseparate the excretory system of the liver starts with bile canaliculi, which are lined by singlemembrane and the membrane. The membrane is protruded into canaliculus in the form ofmicrovilli which increases the area for interchanges partial removal of liver in man andanimals results rapid regulation by cell replication. Some hormonal regulations may bepresent in the mechanism of rapid regeneration. Mitochodria contain mostly cytochrome oxidase, suclinoxidase and phospholipids inlarge amounts. They can oxides numerous substance substrates including fatty acids andintermediates of TCA cycle. Mitochondria transport energy releasing in the form of ATP. The rough surface endoplasmic reticula contain granules, ribosome’s with RNA andare the seat of protein synthesis. These granules are responsible for basophilia. Thesmooth surface endo plasmic reticula are the sites of detoxification of drug conjugation ofbilirubi, synthesis of steroid hormones and enzymes. The liver cell lysosomes, adjacent to bile canaliculi, are the sites of deposition offerrition, lipofuseion, bile pigment and copper and contain many hydralytic enzymes,pericanalicular dense bodies and pinocyltic vacuoles are also seen.FORMATION OF BILE AND BILIRUBIN Bile is both a product of secretion as well as excretion of the liver minute droplets ofbile collect inside the tiny vacuoles of the liver cells and are discharged into the bile 26 Literary review
  31. 31. capillaries through the intercellular canaliculi. The primary bile capillaries start from betweenhepatic cells as blind tuloules. They join together repeatedly and form bigger channels andultimately come out of the liver as the right and left hepatic ducts. The two ducts unite andform into the duodenum through the ampulla of Vater, through the same ampulla also thepancreatic duct commences the cystic duct. Formation of bile by the liver is an activeprocess but entry of bile into duodenum is intermittent and takes place only after meal31. Bile secreted continuously from the liver cells and stored in the gall bladder. Bilecontains water, nuclein, pigments neutral fat, fatty acids, ophospholipids, cholesteral and inorganic ions, cholesterol is synthesized in the liver from active acetate, cholesterol is alsoexcreted from the liver. Bile acids chalic have been considered to be the derivations withglycine and tausrine. From the compounds glycocholic acid and tourocholic acidrespectively bile salts are the Na- salts of taurocholic acid and glycocholie acid. Bile saltshouse got important functions on absorption of fats and also for the emulsification of fatswith concurrent production of a great surface area to enable lipase and other enzymes to actmore efficiently. Bile pigments are the biliwerdion and bilirubin, these are the excretory products ofhemoglobin of broken down RBC and are formed in the RE system in the various parts ofthe body. Bone marrow liver and spleen have been considered to be the site or formation ofthe bile pigments32. Bile is essential for life. Although if does not contain any enzyme. Yetit as a very important digestive juice.Digestion: The complete digestion of fats and to some extent of protein and carbohydrates isdone in liver.Reducing surface tension: So that fats are converted into exclusion. 27 Literary review
  32. 32. Activating action: The bile salts by virtue of the cholic acid radical acts as specific activator for differentlipase.Solvent action: It serves as a good medium of the interacting fats and fat splitting enzymes.Absorption: Bile helps to in the absorption of various substances due to presence of bile salts likefats iron calcium and lipid soluble vitamin A.D E and K and provitamion carotene.Excretion: Certain substances are excreted through bile for instance as some metals like (a) copper, zinc, mercury (b) Toxins, bacteria (c) Bile pigments (d) Cholesterol and lecithin are probably chiefly excretory products33. The majority of bilirubin is delivered from the destruction of Red blood cellsHemoglobin is the iron containing pigment of the red blood cells. The red colour of the R &C and the blood is due to the presence of the hemoglobin. In normal condition life span ofRed cells are only few months they destroyed by the phagocytosis. The hemoglobin ofthese cells broken down into haemosiderin and haemotoidin. Normally it is also present in certain amount in phagocytes of spleen, liver and bonemarrow and the quantity increased during rapid destruction of RBC on diseased state agreen rise to a yellow brown pigment bilirubin. Haematidins a break down product ofhemoglobin during destruction of RBC and identical to bilirubin34. It is derived from turn overof the hepatic proteins and from premature distinction of newly formed erythrocytes into thebone narrow whatever the source of hepogenase oxidized heam to biliverdin. Biliverdina isfirst formed and which by reduction forms beliverdina. Beliverbin and biliverdina probably 28 Literary review
  33. 33. combine with plasma and globulin and circulate through the blood stream and enter theliver. In the diver cells bilirubin and biliverdin are separated from globulin and conjugate withuridine diphosphate glucuronate to produce monobilirubin and bilirubin glucoronide, theuridine diphosphate is set free. These compounds enter the duodenum through the bileduct and then to the intestine. In the large intestine by bacterial action they are changedinto stercobilinogen. Some of urobilinogen is reabsorbed and excreted in the urine asurobilinogen. The rest is excreted in the faeces as stercobilinogen and stercobilin, whichare responsible for the brown colour of the stool35.FUNCTIONS OF LIVER 36 Liver is an essential organ of the body. Its functions are numerous which are brieflysummarized below. I. In connection with blood and circulation i) Formation of RBC in foetal life ii) Destruction of RBC in adult life iii) Store house of the blood and regulates the blood volume iv) Relation with blood clotting a) Manufacturing prothrombin and fibrinogen and thus essential for clotting. b) Most cells from heparin and prevent intra vascular clotting v) It transfers blood from portal to systemic circulation vi) Manufactures all plasma proteins vii) Stores the iron, haematinic factor also known as Vit-B12 and copper and thus helps in the formation of red cells and hemoglobin. 29 Literary review
  34. 34. II. Manufactures of bile: Bile is secreted continuously from the liver cells and stored in the gall bladder.III. Relation with carbohydrate metabolism i) Converts honglucose monosacharides into glucose ii) Converts lactiacid, pyruvic acid and glyceral into glucose and also glycogen. iii) Store carbohydrate in the form of glycogen and when the blood sugar tends to below it mobilizes glycogen iv) Takes an important part in blood sugar regulations v) It is the seat of neogulcogenesis vi) Manufactures fats from carbohydrates.VI. Relation with fat metabolism i) It stores fats liver contains about 3% of fat ii) It helps in the oxidation of fat, releasing energy in the form of ATP. iii) Site of synthesis of cholesterol from acetate iv) Synthesis of phospholipids v) Synthesises of fats from corbohydrates and proteins vi) It is the seat of ketone body formation vii) Unused free fatty acid released from fat depot is converted to triglycerides and other lipids to meet energy requirement.V. Relation with protein metabolism: Main seat of urea and uric acid formation, synthesis of some aminoacid takes place plasma protein manufactured Coagulation factors, inaddition to fibrinogen and prothrombin, are manufactured here. 30 Literary review
  35. 35. VI. Hormone metabolism: Reduce the circulating adrenal cortical and sex hormones by digression and conjugation. VII Relation with vitamins: i) Manufactures prothrombin with the help of vitamin K ii) It forms vitamin A from carotene and stores vitamin A and D iii) Chronic liver disease is always associated with folic acid deficiency. It is known that the liver converts folate to its active form tetrahydrofolate. iv) It is the principal storage organ for Vitamin B12 and in condition of hepato cellular disease. VIII Excretory functions Certain heavy metals are temporarily fixed by the liver cells, which are then excretedin the bile various toxins, bacteria and drugs are excreted through bile. Cholesterol and bilepigments are excreted in the bile.Concept of Pitta in KAMALA: Kamala is a one of the Pitta predominant disease. It was pointed in Pitta vruddhilakshana, it is the responsible colouring factor of peeta in the sense that abnormal colourssuch as peeta, Haredra manifestation, they become he characteristic feature of the Kamala 37,38,39.disease, it is recognized due to Pitta vruddhi While discussing about nanatmajavyadhi, Acharyas consider the Kamala as one of the Pittaja nanatmaja vyadhi40. The production of colour as well as its appreciation brought by Teja mahabhoota, itschief functioning of paka or transform action. Tejas is the one of the quality of Pitta. Briefreview of physiological functions and quality of this teja mahabhoota vis-a-vis Pitta. It isnecessary to secure an intimate knowledge of prakruta gnana before to the study ofvikrutha41. 31 Literary review
  36. 36. The term Pitta is derived from the root of “Tapa” it is having 3 meaning 42. 1. Tapa santhape- production of heat. 2. Tapadahe – Burning of food particles. 3. Tapacishwarya (sid kammadi) – gaining of powers. These are represents the functions of Pitta in the body. “Tapa” means to generatethe heat, it refers the burning the ingested (food) materials.Synonyms of Agni: Agni, Anala, ushma, Teja etc, These are synonym of Pitta. Importance of Agni and it’s functions in the body are clearly mentioned in CharakaChikitsa sthana Grahini chapter, the commentator of Chakrapani on Agni clearly explain thatthe Agni which present in our body is in the form of Pitta. Agni is under stood as Antaragni that the Agni which is internal to the body.Antaragni, does not indicates only it is already stated that the Agni which does the functionof paka, dahana etc Charaka has clearly stated that the Agni are Pitta it is digest the foodparticle and controls the other Agni. The questionnaire Pitta and Agni are identical or different has been raised andanswered by Susruta himself, that Pitta is identical to Agni in view of the fact that suchactions as dahana pachana and similar actions performed by fire hence Pitta is known asAntaragni 43. According to bruhatraye composition of Pitta is dominated by Agni bhoota the qualityof Pitta are sneha teekshna, ushna, laghu, visra, saram and drava 44,45,46. Drava and saram which are the quality are predominance of Apa-bhoota, sneha is apruthvi mahabhoota, ushna and Teekshna are Teja mahabhoota, laghu is the vayamahabhoota, visra is the Akasha mahahoota vagbhat clearly mentioned Pitta ispanchabhouthika and drava consistancy.Qualities of Pitta: 32 Literary review
  37. 37. Table no: 8 Acharya clearly explain qualities Pitta, varna, gandha, ruchi and sandrata. The summarization of Pitta guna dharma according to various text’s 47,48,49,50,51,52. Varna Sandrata Rasa Gandha Guna’sCharaka Sukla Drava Amla Visra Ushna, Katu teeksna, sneha.Sushruta Neela, peeta Drava Amla Puti Ushna, teeksna KatuVagbhata Drava, sneha Amla Vaigandha Ushna, Katu teeksna, laghu, sara.Kashyapa Sukla, Aruna Snehayukta Amla Visra Ushna, Katu teeksna, laghu.Bhavaprakasha Sukla, Neela Drava Amla Ushna, sara. KatuSharanghadar Peeta neela Drava Amla Ushna,Laghu,S nigdata Seat of Pitta The Pitta occupies the entire systems of the body. Its location particularly between Hridaya and Nabhi in general other seats of Pitta presumed sweda, laskiha, rudira, amasaya, druk, twacha. Among all Nabhi is found to be the particular and specific seat of Pitta 53. Charaka and Vagbhata described Amashaya not only as the seat of Kapha it is also seat of Pitta. Susruta stated clearly that Amashaya is a seat of kapha54. All that is eaten food will be digested and absorbed in stomach 55. Amashaya: According to Chakrapani Ado-Amashaya is the seat of Pitta 56. Nabhi: This does not indicates any organ but some authorities consider that Nabhi represents the “Agnyashaya” which may refer to pancreas which takes a major part in the 33 Literary review
  38. 38. continuance and completion of the digestion in the small intestine. The pancreas becauseof its participation in both the digestive and metabolic process may be truly calledAgnyashaya in the locality of Nabhi.Pavamasaya Madhyaga This is actually the seat of Pachakapitta one of the five sub divisions of Pitta and also ofPitta dharakala or grahani57. Pakvamashaya madhyaga- Dalhana widely explains Yakritpleeha, Hridaya, druka twacha these are all organs’ seats for Pitta.Lasika 58: It is a part of udaka (Apyadravya) which is capable of coagulation. According toHemadri lasika is the Rasamala it is located in twak59. Sweda,(sweat) Chakshu andsparspanendriya (Both sense organs). Chandranandana’s commentary is that Nabhi isconsidered as a special seat of Pitta because of its association with Samanavata.The word Amashaya indicates two meanings 1. It is the seat of immature or unripe or incompletely or partially digested food even though the ingested food digestion takes from Amashaya. 2. It is the site where in the Ama is generated. The word “Pakwashaya” denotes the place of completed digestion. Since the Pitta islocated in Amashaya and Pakwashaya, the Rasa of Pitta in Amashaya is Amla and inPakwashaya katu Rasa. The anatomical organs located in the umbilical region are the smallintestines, where the digestion is completed. It has to be born in mind that any pain causedin the small intestine is usually referred and felt in the umbilical region60.Functions of Pitta The general functions of Pitta can be summarized as below, and abnormal functionof Pitta we assess by Pitta vruddi lakshana and Kshaya lakshana bases. 34 Literary review
  39. 39. Some of the abnormal conditions are Aruchi, Avipaka, Ajeerna, Abnormal bodytemperature, abnormal colour of the body courage, fear, anger, confusion, impairment ofvision etc such are the abnormal function of Pitta.I. Biological functions Ruchi ,trishna, pakti, vshala crelish food thirst (digestion and metabolism) (productionof norma body temparature) shut (appetite and hunger) darshana (visual perception) ragkrit(imparting colour of the rasadhatu converting in to Rakta dhatu and also normal colour tothe skin) prabha (lustre) deha mardhvam (softness of the body) ojakrit (production of ojas)I. Psychological II. Medhakrit, buddhi and dhi (aids, intellectual functions, understanding) III. Prasada (happiness) IV. Shauryam (courage and valor) V. Krodham (anger) VI. Moham (infatuation) 61,62,63,64 In brief above mentioned biological and psychological functions of Pitta. It isclassified into five main categories on the basis of functions and its seat.Pachakapitta: Pachana is avikruta Pitta karma this is one of the five varieties of Pitta and animportant one. The life span, complex in vitality good health, enthusiasm, and plumpnessglow vital essences luster heat and the life breaths are derived from the dehagni65. When this Agni is extinguished, the man dies when a man is endowed with itadequately, he lives long in good Health, when it is deranged he falls sick therefore thefunction of the Agni is said to be the main stay of life66. All other Pitta is originated from Agni,therefore the increase and decrease of Pitta causes the waxing and waning of the otherPitta 67. 35 Literary review
  40. 40. The Pachakapitta is produced from the Pittadharakala by the stimulation ofSamanavata, based on the concept of Adharadheya bhana, the integrity of Grahanidepends on the proper function of Agni68. There fore any impairment of Pachakapittainvolves the integrity of the Grahani and vice versa. Pittadharakala, the source of Pachakapitta is stated to be located in both Amashayaand Pakwashaya there fore the Pachakapitta secreted in these two places possesses twodifferent tastes. 1. secreted into Amashaya, it has the Amlarasa that is vidagdha state 2. Secreted in to Pakwashaya it has the katurasa the natural taste of Pitta. This difference in the Rasa of Pachakapitta secreted into Amashaya andPakwashaya is indicated the amlavastha and katu avastha in the process of the digestion offood. The secretion of Pachakapitta from the Pitta dharakala is controlled by twomechanisms. 1. Neural through the stimulation by the samanvata 2. Humaral There is abundent production of clear Pitta in the Amlavastha or pachamanavasta of the digestion the partly digested food stimulates a copious secretion of the digestive juices. For a successful completion of the digestion of food, the pachaka Pitta requires thesupport of other factors in adition to the action of samanavata 69,70,71.Malarupa Pitta: Even through not produced by the kalas of the kostha, but being excreted in to thekostha to help the digestive processes, this is discussed here mala rupi Pitta is the productof dhatu parinama from the kittapaka of raktagni on Rakta Dhatu and released from theRakta sthana yakrit72. Since the dhatuparinama / dhatuposhan is a continuos process. The mala rupa Pittaor bile is produced in liver continuously. The chief biliary components are bile salts and bile 36 Literary review
  41. 41. pigments cholesterol and lecithin, these organic materials make up over 60% of the totalbiliary solids. Only bile salts are use full in digestion. These salts aid in digestion andabsorption of fat largely because of their property of lowering the surface tension and theability to form chemical compound with fatty acids, thus increasing their solubility bile saltsstimulate peristalsis and there fore have a mild laxative action. Bile acts as the own stimulant, bile salts are the strongest chologogues. Themalarupi Pitta is also known as malaranjaka Pitta since it imparts colour to the faeces. The Ancient authorities have not made any mention of the colour, taste, smell andden0sity of Pachakapitta. The only physical quality of these substances, to which there isreference, is its dravatva of liquidity. Concept of Pachakapitta pointed to some internalsecretion secreted by the Agnidharakala, in the Grahani (corresponding to the mucosalglands of duodenum) some of them exercise a regional influence and others systemic,particularly metabolic. A suggestion was, then made to the secretogogue influence of food,which had attained amlabhava (acidification) resulting in the secretion and discharge of theachapita. [Corresponding to combined hepatic bile and pancreatic juice] Such tests have yielded fairly accurate information as regards their physical qualitiesand chemical composition. These are significant in the present context. The secretion,relevant to the present discussion is bile, which is a yellowish, reddish brown or green fluidaccording to the relative preponderance of its two chief pigments. It has a characteristicmusk like odor, a bittersweet taste and alkaline reaction 73. The physical characteristics and qualities of the Pitta described in ancient Ayurvedaclassics striking resemblance to hepatic bile (better still the combined bile and pancreaticjuicy. The payments of bile the bilirubin and biliverdin are essential constituents of thehaemoglobin complex. From this point of view, it may be stated that, Rakta is the seat ofPitta the bile pigments is also the waste products or mala of the blood. Rakta and Pitta haveidentical colour. The truth of this statement will become evident by taking in to consideration 37 Literary review
  42. 42. of the fact that, though bright red in colour if undisturbed. The blood separates into twoparts the lower contains the cells and is opaque and red. While the upper is a clear paleyellow liquid the plasma. Under the microscope, an enormous numbers of pale yellows diskthe red blood corpuscles floating in a clear colorless fluid can be seen. It is the setting downof these red cells, which brings about the separation of the blood into two parts, althoughyellow when seen individually, they appear red in bulk. The colour of the hepatic bile is golden yellow this is largely due to its pigments,when set free into the blood. The bilirubin contributes to the normal colour of the plasma,both blood and bile have nearly the same characteristics fleshy smell. In addition to the twofactors are initially correlated to the liver and spleen. Pitta may refer to the hepatic bile orpossibly, to the combined bile and pancreatic juice. This conclusion is further supported by authoritative references made to conditionscaused by abnormal states of functioning of Pitta for example according to Vagbhata anincrease of Pitta cases yellowness of urine, feaces, eyes and skin, increased appetite, thirstburning sensatioin in the body and insomnia. These signs and symptoms, especially, theyellowish urine, feaces, skin and eyes are known today, to be due to circulation in excess ofthe bile pigments bilirubin a condition described in bilirubinaemia. The Chakrapani in his commentary reference to shakhaashrita Kamala says that, thenon-excretion of the Pitta, which imparts to feces its characteristic colour mala ranjaka in toRakta, is responsible for the swetha varchas or whiteness, among others of the pureesha(faeces). In this condition this allusion would lend additional support to the thesis that Pitta towhich the physical characteristics and qualities.RANJAKA PITTA: Susruta coated Yakrit and pleeha are main seat of Ranjakapitta, in function he hasstated, that it74 confers colour to Rasa i.e., Rasa ragakrit. Vagbhata has on the other handidentified its location in Amashaya and ascribed to it the same function as Susruta has done. 38 Literary review
  43. 43. According to Ayurvedic view, rasadhatu is stated to contribute to the formation ofRakta with the help of Ranjakapitta, which is claimed to impart to Rasa, its colour75. Intreatment aspect Susruta coated goat liver with raw drug, together with the Pitta containedin it, in the treatment of loss of blood in Rakta Pitta. The fact that between them, thestomach and liver contributes an identical factor the Ranjakapitta essential for formation ofthat element which makes the blood appear red, visualized by Susruta and Vagbhata roundabout the 4th century BC and 5th Century A.D respectively. Modern workers haveexperimentally confirmed it in the late twenties of the present century, during 1926 Minotand Murphy showed that the liver was the most effective ingredient in the diet for thetreatment of pernicious anemia patients. Susruta has given Rakta a special place of importance in the physiological andpathological process. Two points 76 may also recognize the importance of Rakta. i. Its function of jeevankriya Hemadri on Astanga Hridaya sutra 11/3 transporting and supplying a visista vayu known as prana through the Rakta (haemoglobin) ii. Even a minor deficit in the above stated function can initiate the pathological processes. In view of the important function of Rakta, a separate Pitta necessarily required forthe production of it. In the formation of raktadhatu, Ranjakapitta assists the raktagni whichsynthesis the cellular structure from rasadhatu. The factor in the liver, which is essential for the maturation of erythrocytes has, sincebeen demonstrated to be associated with the non protein fraction of the liver substance,which is known as the antianaemic or haematenic principle. Smith reported that isolation ofan amorphous red principle from proteolised liver, which was effective in pernicious anemiain very small doses around half a milligram. This material now referred to as B12 has since 39 Literary review
  44. 44. been shown to be a cobalt complex, this is obviously the erythrocyte naturation factor inpure or nearly pure form. In text’s we see the seat of Rakta and Ranjakapitta are Yakrit and ‘Pleeha’ both.Pleeha is a storage house of the erythrocytes and its functions and blood supplies throughits sinuses (spleenic sinuses) The chemical factor essential for the maturation of erythrocytes has been as alreadynoted as the liver principle viz. B12, a red cobalt linked enzyme corresponding toRanjakapitta.BHRAJAKA PITTA: The importance of the skin in the maintenance of the body temperature and colour ofits recognized in Ayurveda and a separate subdivision of Pitta is a located for this function.Charaka describing under the heading of general function of Pitta, the product of normal andabnormal temperature and color of the skin is due to the Pitta 85 Susruta and Vagbhata directly mentioned Ranjakapitta its seat and functions. It’sseat is twak, production of normal and abnormal temperature of body, normal and abnormal 86,87,88colour, luster etc this is by the paka of substance used for Abhyanga , parisheka lepaetc. Pitta classified under different groups not only under the five headings they are maturityquality functions etc89.1. Based on the state of Maturity: As immature state in Amashaya with Amlarasa, mature state in pakvasaya withkaturasa.2. Based on its qualities: Which is drava and snigdha conducting the normal physiological functions in thebody, Nirdrava and ruksha which is the cause of jwara and other disease.3. Based on its Paka stage: a) The prakrita Pitta present in the body with the normal functions. 40 Literary review
  45. 45. b) Malarupa Pitta: waste product produced in the dhatwagni paka by the action of raktagni on Rakta dhatu, it is excreted into Pakvasaya supporting the digestion in that region. This malarupa Pitta is an excretion from Yakrit seat of Rakta dhatu and imparts colour to pureesha and therefore it is also known as malaranjaka Pitta.3. Based on the metabolic process: There is another important classification of the Pitta in the body based on theirfunction particularly metabolic processes4. The Anabolic process: This group consists of 13 types of Pitta, which are concerned with the digestion ofthe food, absorption of nutrients and assimilation in the Dhatu the fundamental tissue of thebody. a) Pachakapitta also known as Jatharagni, Kayagni etc. b) Bhutagnis – these are four in number, which acts on their own corresponding bhoutic components of the ingested food. c) Dhatwagnis: there are seven in number, which incorporate the respective nutrients into the respective dhatus for their nourishment or replenishment. d) The Catabolic processes: these are the Amasas of kayagni mentioned only by Vagbhata. These moieties are distributed in all the dhatus since these are the amsasa of kayagni their function is similar to that of kayagni i.e. effecting sanghatabheda the kayagni is located.PITTA Vs RAKTA Apart from three Doshas Susruta explain Rakta as 4th dosha90. Susruta as he is oneof the expert surgeon, he has given more importance to Rakta Dhatu. Pitta is mala of raktadhatu91 Vata, Pitta, Kapha and Rakta these are essential factors for sharira Utpatti, sthiti andNasa92. 41 Literary review
  46. 46. Rakta panchabhoutikatwa : Table No 9 Mahabhuta Gunadarma1 Prutvi mahabhoota Amagandha2 Jala “ Dravatva3 Teja “ Varna4 Vayu “ Spandana5 Akasha “ Laghuta Above-mentioned gunadarma is evidencing of the Rakta panchabhoutikata. The causative factors for all the diseases are Tridosha mainly they are Vata Pitta andKapha. They are susceptible to imbalance and vitiation along with structural and functionalimpairment Dhatu. Rakta Dhatu is the group of organs concerned with the production and maintenanceof Rakta Dhatu. Charaka enumerated Yakrit and pleeha as the root or moola of Rakta vahasrotas. In addition Acharyas recognized Yakrit and Pleeha as Rakta sthana. Yakrit is closely related with Rakta Dhatu and Pitta Dosha. It is the origin ofraktavaha srotas and seat of Ranjakapitta. After absorption Rasa is conveyed to Yakrit andPleeha, there it is acted upon Ranjakapitta and it is converted into Rakta dhatu93 Charaka has described Sonitaja Roga i.e. disease caused by Rakta there Kamalahas not been included94.charaka sutra sthana and further 28th chapter sutra sthana. Charakahas described the disease caused by the Doshas when they are situated in morbid stateeven Dhatus. Kamala has been included in the disease caused due to the situation ofmorbid Doshas in Rakta dhatu95. It is clear from the above observations that Kamala is not aRaktaja Roga but when morbid Pitta Dosha involves the Rakta then Kamala may beproduced. Rakta is particularly involved in the Samprapti of kosthashrita Kamala96. 42 Literary review
  47. 47. It would be seen the Pitta to which the physical characteristics and qualities ofunder discussion are attributed might refer to liver bile and not others. This view find supportfrom the description of Pitta as the kitta of Rakta “ asrujapittam” and also reference madeby Charaka, Pitta and Rakta possess nearly identical smell and colour. in addition, thelocation of these two factors of Yakrit and Pleeha. The Asruja Pitta m finds direct correlation from modern physiological views itregards blood. Bile relationships, which can be summarized, are as follows. 1. The pigments of bile, bilirubin and biliverdin are the essential Constituents of Haemoglobin complex of the erythrocytes from this point of view. It may be stated that Rakta is the seat of Pitta. This bile Pigments are also of the waste products or the mala’s of Rakta. 2. Rakta and Pitta are stated to have identical colour. The truth of this Statement will become the evident by taking into consideration the fact that, though bright red in colour. If left undisturbed, the blood separates into two parts. The lower part is opaque and red. While the upper part is yellow liquid plasma, under the microscope on enormous number of pale yellow discs, the RBC pleasant in a colorless fluid can be seen. Although yellow when seen individually. The erythrocytes appear to be red in colour the colour of the hepatic bile is golden yellowish which is largely due to its pigments bilirubin constituent to the normal colour of the plasma. Both bile and blood have nearly the same characteristic fleshy smell. In addition both blood and bile are intimately connected with the liver and exists. 3. The coloration of Pitta and Rakta may represents the assumption of the normal relationship that exists between the blood and some of the important constituents of bile. This can be seen from the fact that the formation of bile consists in the removal of bilirubin from blood its conversion in the liver its exertion in the bile 43 Literary review
  48. 48. conalienlai. re-absorption of it from the intestine in the form of colorless compounds the stereto bilonogen, which later is utilised by liver cells for the production of fresh haemoglobin. The spleen has disposal of red blood corpuscles can be seen from the fact, that the macrophages present in it convert the fragmented dust of degenerated red cells into bilirubin, which is transported to the liver where it is utilised for purposes mentioned above.Bhutagni A review of Pitta may refer to Agni. Agni classified Jataragni, Bhutagni anddhatwagnis. All the Ayurvedic classics have described them-Charaka has describedbhutagni under the process of normal digestive events. In his view, the digestion of food byJatharagni leads to the break down sanghatabheda of the former in to five distinct physico-chemical groups. The Agni mostly present in substances belonging to each group is thenstated to digest the substance of that group, leading to a radical change in their qualities-vilakshanaguna. Thus food substance are rendered fit for being assimilated into and built upas part of the corresponding bhutas class of substances present in the Dhatus. Thisprocess of assimilation is stated to be mediated as it was by the seven dhatwagnis, presentin each species of dhatus97. According Susruta “This animated organism is composed of five Mahabhuta’s andthe food of living organic being necessarily partakes the character of its corporealcomponents”. The food, which consists of the five mahabhutas, is digested, in its turn bythe five bhutagnis and each of its principles proceeds to argument it’s own analogue in thehuman organism98. The modern physiology and bio-chemistry that the main purpose of digestion of foodin the elementary Canal is to render it’s different basic components viz starches, fats,proteins, which are entirely foreign to the body. 44 Literary review
  49. 49. That is ‘Vijatiya’, fit for being converted and utilised by the body as organism.Specific carbohydrates, fats and proteins that is ‘Sajatiya’ thus the vegetable starch orcellulose is first broken down in to its elemental form. The glucose towards the end ofintestinal digestion, before the same is rebuilt in the body as organism. In the same way, fats derived from various plants and animal sources viz. oils, Gheeetc. are first broken down into their elemental forms viz. fatty acids and glycerol. Before theyare re-synthesized as organism specific lipids, like wise, animal and vegetable proteinderived from external source are also broken down in first into their elemental form viz., theaminoacids. Before to they are rebuilt in the body as the organism specific proteins viz.,albumin, fibrinogen most of the globulin and non-essential amino acids. The above part,some of the aminoacids are also utilised for functional use viz., the Synthesis of enzymesand some of the hormones. The bhutagni paka takes place in the Amashaya, actually speaking, the availabledescriptions of this paka resemble, in some respects, the events that take place in the Yakritand Jatharagnipaka in the adho-Amashaya. The Yakrit it self is functionally andanatomically related to anthakoshta. The inclusion of it as one among the koshtangas, issignificant. Apart from the fact the Yakrit is located in the kostha interpreted as Mahanimnaor great cavity, in the Madhyasharira or the trunk99. Which in turns it also considered to bea Kostha, the fact remains, as shown by modern researches on embryology, that it arises asa diverticulam below the stomach from the region of the intestine which is destined tobecome the duodenum. The endodermal diverticulam grows into a thick walled vesicle from which the livertubules and hepatic duct arise. The endodermal duct grows to splanchnic desaderm, whichprovides the connective tissue of the liver and its capsule. The view advanced in the foregoing that, reactions comparable to bhutagnipaka takeplace in the Yakrit and not in the Amashaya, derives additional support from some of the 45 Literary review
  50. 50. important, post-digestive functions and metabolic event’s which modern advances haveshowed on physiology and biochemistry to takes place in Yakrit. Liver is imediatelyconcerned with carbohydrates, lipid and protein metabolism. Is so far as the Carbohydratemetabolism is concerned it converts the Glucose to Glycogen. Segments of Carbon skeletonportion of total aminoacids metabolized in the body are converted into substances which, inturn, may be employed for glucose and Glycogen Synthesis. Gluco-neogenesis, fatty acidare synthesized de novo in this organs, and released to circulation for being deposited in theadipose tissues, there also, fatty acids of the diet are transformed into a mixture moreclosely resembling that of the species. These functions of the liver are important, in thecontext of bhutagnipaka. The liver synthesizes cholesterol and esters. In the cause of it’ssteroid metabolism-the liver elaborates cholic acid and couples it with glycine and taunine tomake the bile acids. It activates in the metabolism of individual aminoacids, liver alsofabricates a number of plasma proteins including albumin, fibrenogen , prothrombin and amajor protein of globulins. Finally there is the secretary role of the liver concerned with the formation of bile. Inthis role, the liver prepares the bile salt’s separates bilirubin from proteins with which it isassociated in the plasma, re synthesizes cholesterol and pours these, with other bile-components, into the biliary capillaries and hence via the connecting duct of the gall bladder.This has also proved to the route for excretion of serum phosphatase. Vilakshana gunas canapply only to a complete change over the qualities of ahara dravyas ingested, which do not,takes place in the adho Amashaya. Bhutagnipaka is required to process and convert them suitably as pre-homologues ofsubstances, which compose of the seven Dhatus.Haemoglobin Haemoglobin is the iron containing pigment of the red blood corpuscles. The redcoloured of RBC and the blood as well is due to the presence of the haemoglobin. In 46 Literary review

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