Oligozoospermia kc001 udp


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A comprehensive clinical study of Anupana in the management of Shukradushti vis-à-vis Oligozoospermia, by Sandhya, DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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Oligozoospermia kc001 udp

  1. 1. A comprehensive clinical study of Anupana in the management of Shukradushti vis-à-vis Oligozoospermia, by Sandhya, S. D. M. COLLEGE OF AYURVEDA, UDUPI Introduction INTRODUCTIONMankind has been concerned about its health, protection from evils of diseasesand suffering since the dawn of civilization. Since then he believed that, naturealone could help in conquering these afflictions and he sought remedies in Naturei.e., in Plants, Minerals and Animals. Many of the drugs were added to their therapeutic armametrium only afterconsiderable trial and error and application of their clinical judgment. In the lightof the knowledge then available, they had good reasons for what they said anddid. The answers to this questions what they considered as good reasons is not asimple one, one must take into consideration their intellectual, ethical and culturalbackground. The greatest and noblest pleasure that man can have in world is to discovernew truth and the next is to shake off old prejudices. Here is an attempt to explore the treasure of knowledge of Ayurvedicscience wherein the concept of Anupana; drugs Masha, Sharkara and Usheera;Disease – Shukradushti vis-à-vis Oligozoospermia are considered. The concept of Anupana has been in Ayurvedic classics since archaictimes. However, its importance and practical utility does not appear to have beenfully recognized and applied, at any rate, during the last five or six hundred years,with the result that it is today a proposition of historical and academical value.Hence, the obvious requirement is to secure detailed information from theavailable literature, then procure a fair and critical understanding of theimplication of this term in the light of observable and verifiable facts available tous today and reconstruct the concept in view of later developments in the field ofmedicine. To do so, this concept is taken up for the study. Interest in medicinal plants has increased enormously over the last twodecades. The untapped wealth of the plant kingdom has become a target for thesearch by multinational drug companies and research institute for new drugs andcompounds. Prominent in this has been the investigations of Traditional remedies,largely of botanical origin on which a worldwide majority of population still relies 1
  2. 2. Introductionfor its source of medicine. Society has also become increasingly interested innatural products with the general public acquiring herbal preparations from theplethora of various retail outlets. With this background, being in the field ofAyurveda-Indian system of Medicine, which is predominantly dealing with theHerbs, it becomes primary duty to untap the treasure and mysteries of this richscience, re-establish its claims and to remove the old prejudices. To aid this, thedrugs Masha, Usheera and Sharkara were considered for the study. Masha, Usheera and Sharkara are some of the easily available drugs in themarket. Presently, considerable legislation has been introduced to control thesales, quality and efficacy of each Ayurvedic product. Standardisation and Qualitycontrol is a must in today’s GMP. To authenticate the identity of the above drugs,the drug samples were subjected to Preliminary Pharmacognostic andPhysicochemical tests and recorded herein. Details of each drug, its indication inparticular conditions, its method of processing to obtain the required form, itsspecific combination, dosage, time and mode of administration are not dealt inclarity and at one place. Drug study is complete only after a clinical study. Inpursuit of clarity of knowledge in above respects and to establish the efficacy ofthe drugs, the clinical study was undertaken. Infertility has been an issue of great concern since times immemorial and isconsidered as a public health problem given its medical, psychological, social anddemographic consequences. Infertility is estimated to affect 15% of all the co-habiting couples and data available over past 20 yrs reveal that in a stupendousportion of 1/3 of the cases, male factor is responsible (Obs. & Gynae., Jan, 2001,WHO report). The prevalent environmental, socioeconomic conditions, lifestyle, stresshave influenced the rise of male infertility. Among the various causes of maleinfertility, Oligozoospermia takes a substantial role. In the contemporarymedicine, although important advances have been made, treatment of infertilitycaused by primary testicular disease is unsatisfactory. The results of therapy ofhormonally normal men with Oligozoospermia by use of large doses ofandrogenic steroids an so on have been generally unsuccessful (TBM, Vol. I, 2
  3. 3. Introduction1982, W & S). Shukra and its relation with seminal aspect are discussed in thedisease review. Shukradushti means the vitiated Shukra – the male factorresponsible for conception i.e. Poor Semen Quality (PSQ). PSQ includes variouspathological conditions among which Oligozoospermia is taken up for the study. Abundant references of Shukrajanana property of Masha and Sharkara andShukrashodhana property of Usheera are found in Ayurvedic literature. Toevaluate these and to analyse the concept of Anupana, patients were allotted in 2groups after a thorough assessment. In one group, Masha with Anupana Sharkarawas administered while in the other group, Masha with Anupana Usheera phantawas administered. The effect of this combination of Pradhana dravya andAnupana are then evaluated. This Dissertation work is designed to comprise of five sections namelyLiterary review, Pharmacognostic study, Clinical study, Discussion, Summary andConclusion. Section I Literary review is divided into 3 chapters comprising ofConceptual study on Anupana, Drug study on Masha, Sharkara, Usheera andDisease review on Shukradushti – Oligozoospermia. Section II includes Pharmacognostic and Physicochemical studies on thesedrugs. Section III details regarding the Clinical study. Section IV discusses the complete Dissertation work under the titleDiscussion. Section V lastly gives a brief Summary of this work followed by theConclusions drawn from this study. 3
  4. 4. Conceptual study Anupana ANUPANAMContents • Vyutpatti • Nirukti • Paribhasha • Itihasa • Anupana Swaroopa • Anupana Bheda • Anupana Dravyas • Anupana Matra • Anupana Kala • Anupanavacharna vidhi • Anukte Anupana Yojana • Uktanupana Rasa Yoga Guna Kala Dravya Vayah Varga Dosha Kalpana Roga / Avastha Swasthya • Anupana ayogyah • Nishiddhanupana • Anupananantaram nishiddha karma • Anupana guna-karma • Anupana karmukata • Anupana pradhanyata. 1
  5. 5. Conceptual study Anupana ANUPANAM Bheshajavacharana vidhi in Ayurveda is a science by itself. Under this title,it constitutes a concept, Anupana which forms an integral part of Chikitsa. Information with regards to its description, importance and utility arefound to be scattered in the extant literature. Here is an attempt to pool up theavailable data for better comprehension and application.Vyutpatti1, 2Anupanam: Neuter gender Anu + Dhatu PaAnu • after, along, with • subordinate to, inferior to, near to • following methodically, orderly, accordingly Pana • a drink • observing, keeping, protection, defence Anupana • to drink after, drink at • to preserve, cherish, keep, wait for Adjuvant (L) • ad – juvo • juvans – to give, aid toNirukti1, 2 • Anugatam panam Anupanam3 • Anu saha paschat va piyate iti Anupanam4 2
  6. 6. Conceptual study Anupana • Oushadha bhakshanopari yatpitam tadAnupanam5 • Annat anupaschat piyate iti Anupanam6Paribhasha • Anupanamiti anu shabdam lakshanarthamahuh | Aharam lakshikrutyapanam ….. sukhapakartham ||7 • Tena bhavi bhojanam trushnam chanulakshikrutya piyata ityanupanam |8 • Yadyogena rasadinam vibhaktah paramanavah | Drutamangeshu sarpati sahapana taduchyate || Tattat rogaghna bhaishajyam bheshajasyanupiyate | Yaccha sahayakari syadanupanam taducyate ||25 • Oushadhangapeya vishesha taccha oushadhapananantaram vilambya prayojanam |9 Synonyms9 • Anupanam • Sahapanam • Rogaghna bhaishajyam Itihasa “The further back you look, further forward you see”. Winston Churchill Vedic Period: 2000BC -1000BC Vedas are the oldest known literature available today and have been a rich source of knowledge for varied sciences. References regarding Anupana are found in the commentary on Chandogyopanishad10a where it is considered to be a drink, to be had near at hand. In the context of describing various Dravya-Gunas, Anupana is dealt under Hitahita Anupanavidhi10b. 3
  7. 7. Conceptual study Anupana Samhita Period: 1000 B.C – 500 A.D. Charaka Samhita11: Charakacharya deals about Anupana in the context of Annapanavidhi in Sutrasthana. After Krutanna varga, in Aharayogi varga the description, qualities, mode of action, criteria for selection of specific Anupanas are vividly dealt. The action of Anupana is related in accordance with the Ahara upayogitva here .However while describing the selection of Anupanas based on disorders like Sthoulya, Tandra and Alpagni, specific Anupanas are prescribed too. Further, the author says if the prescribed Anupana is not available then based on the habitat, suitable Anupanas are to be considered. From the list of 84 Asavas and other Peyas like Jala are advised to be evaluated and then considered for administration. Sushruta Samhita12: Following the description of Manda-peyadi pathya kalpanas in Krutanna varga and various delicacies in Bhakshya varga, Anupana is distinguishedly dealt in a Varga. in Sutrasthana, Annapana vidhi adhyaya of this treatise. Under this varga, list of various Anupana dravyas, specific Anupana: for set of drugs belonging to a particular varga, specific to a drug, dosha and disorders are detailed. Benefits, properties, action of Anupana are also stated in this context.Ashtanga Hrudayam13: In Sutrasthana, Matrashiteeyadhyaya, describing Ahara vidhana, Bhojanavyavastha, Bhojya padarthas, Anupana Pramana and Samaya concept of Anupanais dealt. General and specific qualities of Anupana, indication w.r.t. dosha, roga,drug selected and constitution are described here. Anupana ayogya roga and rogiare also discussed here.Ashtanga Sangraham14: This treatise too discusses about Anupana in the context of Annapana vidhiadhyaya of Sutrasthana, subsequent to Ahara kalpana vidhi and Bhojanavidhi. 4
  8. 8. Conceptual study AnupanaFollowing Anupana, Bhojanottara kartavya, Ahara parinamakara bhava, Viruddhaaharadi topics are dealt. Anupana is discussed with regards to its properties andaction. Apart from this, methods of selection of Anupana based on Roga, Rogi,Dosha, kalpana, Rasa, Kala, Vayah and such factors are incorporated here.Kashyapa Samhita15: Unlike the earlier treatises, Kashyapa has not separately expounded aboutAnupana. However applications of Anupana are extensively found in this text. Forinstance, in Snehadhyaya of Sutrasthana specific Anupanas for snehas viz.,Ghrita, Taila, Vasa and Majja – Ushnodaka, Yusha and Manda are indicatedrespectively.Bhela Samhita16: Treading the common footsteps, Bhela too elaborates Anupana inassociation with Ahara and Ahara dravyas. Wholesome Anupanas for specificMamsa, Dhanyas, fruits, Ganas, Snehas and so on are mentioned. Guna karma ofAnupanas like Pachana, Rochana and Satmyatam prayacchana are stated in thiscontext.Sangraha Kala: 500 A.D. – 1700 A.D. Madhava dravya guna17, one of the earliest Nighantu in its 28th chapterdiscusses about Anupana under the heading Anupanavidhi. List of Anupanadravya like Toya, Asava, Yusha and so on are advocated in accordance with thesuitability. Mode of action of Anupana is depicted with the illustration of oilspreading swiftly when dropped on water surface. Here, the oil drop is comparedto the Pradhana oushadha while water simulates the role of Anupana. Furthervarious selection criterias for Anupanas based on drugs, formulations, diseasecondition and so on are dealt with besides the importance and uses of Anupanam. Chakrapanidatta18 in his work Dravya guna sangraha has dedicated acomplete Varga for Anupana emphasizing its importance in Ayurveda. He detailsregarding the Anupana dravyas, directions for selecting the Anupanas, 5
  9. 9. Conceptual study Anupanacontraindications for the usage of Anupana, Samanya Anupana Karma and basedon time of administration and the dosage of Anupana. Kaiyyadeva Nighantukara19 under Viharavarga inducts Anupana. Hisdescription appears to be taken from Sushruta’s treatise. Information of Anupana is found in Mishraka varga of Madanapalanighantu20 and is similar to the description of Kaiyyadeva. In Kalyanakaraka21, Anupana is contented in Anupanadhikara. Anupanafor various Rasas are given importance in this text rather than other criterias. Suchdrugs are advocated whose Rasa is liked by the patient apart from beingwholesome and beneficial. In the previous pariccheda, Anupana for various fooditems, time of administration and its benefits are told. For Rasayana purpose,Kwatha prepared from the ingredients of the Rasayana yoga is specially indicatedin this text Under Churna kalpana, Anupana and its dosage for Churnadi yogas is dealtby Sharangadhara in his Madhyama khanda22. More information regarding thiscontext is provided by the commentators Adhamalla and Kashirama. They writethe Nirukti, Paribhasha, dosage and state Jala as the foremost among Anupanasapart from clarifying the mode of action of Anupana with the oil-water illustration We find that Bhavamishra23 has not elaborated like other authors regardingAnupana. However, in the context of Bheshaja vidhanaprakarana,Sharangadhara’s opinion of dosage and mode of action are found to be followedby this author. Raja Nighantukara24 Narahari Pandit is the only person who has mentionedabout 2 types of Anupana viz. Kramana and Pachana Anupana. Apart from this,not much details regarding Anupana are available.Adhunika kala: 1700 A.D onwards In Yogaratnakara, the last topic discussed by the author afterRasayanadhikara is Anupanam. He has given importance to the Anupanas specificto particular diseases like Kirata, Musta, Parpata in Jwara and so on. Interestingly, 6
  10. 10. Conceptual study Anupanawe find many dravyas apart from the commonly prescribed Anupanas like:Svarna, in Gara; Guggulu in Vatavyadhi and so on. All other authors till nowmentioned have advocated Anupana to be administered through oral routes onlybut author of Yogaratnakara has prescribed diversified routes of administration ofAnupana. . To mention a few, Virechana as Anupana in Udara, Nidra in Ajirna,Aruchi, Toshana in Bhaya, Nasya in Urdhvajatruroga, Sheeta vidhi in Murccha,Raktamokshana in Vidradhi and so on. Further, the author says Anupanainfluences on the prime drugs’ strength and effectivity. Bhaishajya Ratnavali, Vangasena, Gada nigraha and other worksincorporate descriptions of various Yogas to be administered with particularAnupanas to derive the desired effects in specific indications. Incidentally, diversified applications of Anupanas are found in theRasashastreeya literature among all other Ayurvedic texts. Rasashastra a non-conventional branch of Ayurveda evolved into a branch by itself, and rose to itszenith in development more recently. In the course of evolution, the scientistsinvolved, tried to squeeze the basic concepts available in our science and adoptthem to the fullest extent in the development of this science. Probably, during thisprocess, Anupana could be one such concept worked upon for which we find itsextensive references in these texts. For instance, usage of Rasasindoora withvarious Anupana like Chitraka, Sharkara in Kapharoga, Pittaroga and so on isfound in Ayurveda Prakasha25. Rasa Taranginikara25 has vividly described themode of action of Anupana as that which disintegrates the Paramanus of the Yogathus aids in carrying it swiftly in the body. He adds, Rogaghna Bhaishajya assynonym to Anupana. In Rasa jala nidhi26, Gandhaka and its diversified utility dueto usage of various Anupanas and many such formulations are mentioned. Few books are dedicated to the concept of Anupana alone and constitute acompilation of numerous Rasaoushadhas in majority and few Kashtoushadhas inminority and their specific Anupanas. However critical analysis of Anupana is notelaborated in these texts. To mention a few: Anupanamanjari by Vishrama;Anupanatarangini by Raghunath Prasad; Anupana Kalpataru by Jagannath Prasad 7
  11. 11. Conceptual study AnupanaShukla; Anupanavidhi by Shyam Sundara Acharya Vaidya and Anupana darpanaby Jnarasara Sharma. In modern lexicons like Monier Williams and Stedmans Medicaldictionary, Anupana is a fluid vehicle taken with or after medicine or eating.Monier Williams described it as • that which aids or assists the action of main ingredient • a synergist, an adminiculum • a vehicle to enhance antigenicity -Immunology • in adjuvant therapy- use of another form of treatment in addition to primary surgical therapy as in Oncology27.• Modern Pharmacological texts:• Based on the information in lexicons, the term Adjuvant can beincorporated under the concept of Anupana. While doing so, concept of Adjuvantalong with other relavant concepts will be dealt in parlance with Anupana fromhere on. In modern pharmacology, Adjuvant again is also a drug According toW.H.O. definition:• A Drug is any substance or product that is used to modify or explorephysiological systems or pathological states for the benefit of the recipient. In thecontext of medicine, it means a chemical used in prevention, diagnosis ortreatment of diseases. It is to be noted that benefits are in terms of physical,mental and economical value28. An ideal prescription contains inscription as its main part. This constitutesof (a) Basis - the primary drug which is responsible for the main action of theprescription. (b) Adjuvant- this is a drug which facilitates or promotes the actionof the primary drug. (c) Corrective - this is added to modify or eliminate theundesired effects of the basis. (d) Vehicle- this is a carrier, commonly a solventwhich facilitates the administration of preparation into human body. 8
  12. 12. Conceptual study AnupanaHowever, under the name Adjuvant, Corrective and Vehicle too are inducted. Inmodern prescription, firstly Basis is written, followed by Adjuvants but are notmentioned.Further, extensive details of the concept of Adjuvant are not dealt as a distincttopic in modern literature. However Drug interactions and Biopharmaceutics arethe sectors of modern pharmacology which speak of drug or formulationcombinations and their effect - harmful or beneficial on therapeutic activity. Thesetopics can be inducted under the concept of Anupanam.Previous works done:Concept of Anupana in Ayurveda by Dr.Sharma K K, Dept of Basicprinciples,B.H.U. Varanasi 1987Anupana Swaroopam: Before proceeding with the details of Anupana, it is essential to resolve theSwaroopa of Anupana as to its (i) usage in Ahara vidhi only or in Bheshaja vidhialso and (ii) the nature of Anupana - liquids only or others too could beconsidered under this heading. The contexts under which Anupana is dealt invarious Ayurvedic texts are enlisted below: • Cha. Sa. Su. 27 Annapanavidhi - Aharayogivarga • Su. Sa. Su. 46 Annapanavidhi - Anupanavarga. • Ash. Hr. Su. 8 Matrashitiyadhyaya - Bhojanavidhi • Ash. Sa. Su. 10 Annapana Vidhi – Bhojanavidhi • Bhe. Sa. Su. 27 Annapanavidhi • Dr. Gu. Sa. 14 Anupanavarga • Kal. Ka. 5 par – Anupanadhikara • Kai. Ni. Vihara varga – Anupana • Yo. Ra. - Anupana • Bh. Pr. Mishraka varga - Bheshajavidhana prakarana From this, it is evident that authors of older times have dealt with this topicin relation to Ahara vidhi and Ahara dravya while the later authors have tried to 9
  13. 13. Conceptual study Anupanahighlight its therapeutic value for which, they devoted separate sectors for itsdiscussion. Sushruta while describing the planning of selecting an Anupana, saysthat a Hita dravya of suitable Matra in particular Kala should be administered onlyafter considering the disease in which it would be administered 29 Rasa Taranganikara’s synonym Rogaghna bhaishajyam25 and indication toadminister Anupana following Bheshaja makes it very clear that Anupana is to beadministered with Oushadha. Adhamalla5 lucidly defines that Anupana is thatwhich is administered following Oushadha as “ Oushadha Bhakshanopari ”.Bhavaprakasha has deliberately dealt about Anupana in Bheshajavidhanaprakarana. Similarly, Yogaratnakara says Oushadhas are given to patient alongwith Anupana based on the diseased state. Apart from this, we find plenty ofreferences of specific Anupanas to be used along with particular Yogas to obtainthe required effect in a particular disorder/disease. By this, we can see that Anupana is that which is given with both Aharadravyas - regularly and Oushadha dravyas - specifically.Nature of Anupana: The term Anupana1,2 is in itself suggestive of a substance which isadministered for drinking. Sushruta describing the qualities of the ShreshtaAnupana – water, says, by virtue of its Toyatmakatva29 and presence of Sarvarasa,it is the most favourable Anupana. The list of dravyas meant for utilization asAnupana constitutes only Drava Pradhana dravyas in Sushrutha samhita. However, we find many references of solids being prescribed as Anupanain all these texts. For instance, • Guda as Anupana to Guduchi in Vibandha – Bha. Pra. Vol I • Sita as Anupana to Guduchi in Pittaroga – Bha. Pra. vol I • Chitraka churna as Anupana to Rasa sindura in Kapharoga – Ay Pr. 1 /404This reveals that Anupana includes substances other than liquid forms also. 10
  14. 14. Conceptual study AnupanaAnupana Bheda:24 Except for Raja Nighantukara, no other author speaks of Anupana Bheda.Accordingly the two types of Anupana are: i) Kramana Anupana is that which is administered in delay following the Basis. ii) Pachana Anupana is given in the night, without delaying but immediately. No lucid information regarding type of adjuvant is available in most of themodern literature. From the available information, adjuvant can be understoodunder three classes28: 1. Adjuvant - which facilitates and promotes the action of Basis 2. Corrective - which modifies or eliminates the undesired effect of the Basis 3. Vechicle - a carrier, commonly a solvent which facilitates the administration of preparation into human body.Anupana Dravyas11 - 26: We find numerous substances belonging to diverse drug groups which areindicated in accordance with the requirement. Enlisting them are : • Sheeta jala, Ushna jala, Madhu, Ghrita, Taila • Asava of various drugs like Durva, Chitraka, Pippali, Nyagrodha, Kapittha, Shireesha phala • Ksheera, Mastu, Takra, Udashwit, Mahisha payah, Mamsarasa, Yusha, Manda • Dhanyamla, Madhya, Madhvasava, Souveera, Kanji, Chukra, Sura, Ikshurasa • Sharkarodaka, Triphalodaka, Ardrakodaka, Madhudaka • Lavana, Sita, Guda, Shunti churna, Hingu grhitanvitam, Pippali churna, Shilajatu, Rasonaka kalka, Bhallataka, Nisha churna, Parpata kwatha, Hema, Laja, Guggulu, Mashavataka. 11
  15. 15. Conceptual study Anupana Majority of the authors11, 12 prescribe Meghambu collected in a cleancontainer as the superiormost Anupana and that this could be used in allconditions. However, pioneers of Rasashastra advocate Madhu in the absence ofrequired Anupana and with all the Basis25, 26Anupana Matra: It is a well know fact that even poison acts as a life saving drug providedits dosage is judiciously fixed. Information regarding the dosage of Anupana isfound to be varying from author to author. Based on the doshas involved and formof basis dosage of Anupana too varies as recorded below: • According to Sharangadhara, Anupana matra is 3, 2 and 1 pala for Vataja, Pittaja and Kaphaja rogas respectively22. • According to Madhava, Chakrapanidutta, Bhavamishra and Kashirama vaidya, the dosages are 3, 2 and 1 pala respectively in Pittaja, Vataja and Kaphaja disorders17, 18, 22, 23. • According to Sharangadhara22, 2 and 1 pala dravas are advised to be used with the Churna when consumed in the form of linctus or drink respectively.Anupana Kala: Opinions of various authors with regard to the administration of Anupanaare accounted below: • The term Anupana1,2 suggests that it should be administered after the consumption of the primary drug • Sahapana a synonym of Anupana indicates its usage along with the prime drug • Raja Nighantukara24 advocates Kramana Anupana to be delayed in administration while Pachana Anupana is advised not to be delayed and is indicated in the night • In the context of Aharavidhi, three Kalas are indicated for Anupana and their effects are also described i.e., before food for Karshanartham, inbetween food 12
  16. 16. Conceptual study Anupana for Sthapanartham and after food for Brumhanartham. This Vidhi probably holds good only for Jala in Aharavidhi19, 30.Anupanavacharana Vidhi26: In Rasa jala nidhi, mode of administration of both Bheshaja and Anupanaare portrayed in the context of Anupana in Rasoushadhas. Here, both Bheshajaand the Anupana are directed to be triturated with Madhu in a Khalva yantra andthen to be consumed following recitation of Aghoramantram or offering prayersto the esteemed diety.Anukte – Anupana Yojana: Charakarcharya31 clarifies stating that it is not possible to describe all theAnupana dravyas in toto. Sometimes those Anupanas advocated in a particularDesha need not be beneficial in another or may not be available. In such acondition, he advices one should critically evaluate the drug and only those whichare beneficial32, not possessing fallacies by nature, but possess qualities useful inrelation to the Ahara or Bheshaja should be selected. Charaka and other authors like Vagbhata, Chakrapani, Gangadhara,Sushruta opine that the Anupana dravya should possess opposite qualities in termsof Rasa, Guna to that of the Ahara or Bheshaja but should not be Viruddha to it toobtain the desired effect33. Sushruta emphasizes that one should judiciously evaluate the considerationof Anupana in terms of the disease involved; Kala - Roga kala, Rogi kala, Nityakala and Matra34. Further, he indicates that the selected drug should be wholesometo the patient or person administered34a However, water is to be consumed as the adminiculam saysSharangadhara22 when no specified Anupana is mentioned. Vagbhata indirectlyhints that Anupana dravya should be Satmyakara and possess Jeevanadi guna init34b. Rasa jala nidhikara26 gives the liberty to change to another Anupana in dueconsideration to Desha, Kala and requirement34b. Rasanusara selection of 13
  17. 17. Conceptual study AnupanaAnupana should be such that it should be Parasparaviruddha, Ruchikrut,Satmyam, Hitam, Sukhakaram says Sushruta35.Uktanupanah: Abundant illustrations of Anupana are found in the text. For a betterunderstanding of this concept, here is an attempt to classify these illustrationsunder various factors which influence the effect of Anupana viz. Rasa, Guna,Dravya, Dravya varga, Kalpana, Yoga, Kala, Vaya, Dosha, Roga-avastha andSwasthya.Anupana in Swasthya: Sushrutha, Chakrapanidutta specify that amidst food, Chitram-varioustypes of Paniya and other dravyas which do not alter the doshic homoeostasis areto be consumed by the healthy persons37. Gangadhara commenting on Charaka’s similar view defines Chitram asChitraka udaka and indicates its consumption by normal persons37.Table a: Based on RasaRasa Anupanam ReferencesMadhura Katu rasa Kal. Ka. 5 Pa/39-42Amla Lavana rasa Kal. Ka. 5 Pa/39-42 Madhura rasa Su. Su. 46/419-Da.Katu Tikta rasa Kal. Ka. 5 pa/39-42 Durvanalavetrasava Su. Su. 46/432Kashaya Madhura rasa Kal. Ka.5 Pa/39-42Tikta Amla rasa Kal. Ka. 5 Pa/39-42Lavana Amla rasa Kal. Ka. 5 Pa/39-42Sarva rasa Ksheera Kal. Ka. 5 Pa/39-42 14
  18. 18. Conceptual study AnupanaTable b: Based on Guna Guna Anupanam ReferencesUshnata Pittaja vikara Ash. Sa. Su. 10/43-44 Sheeta jala Raktajavikara Su. Su. 46/435 Dal. VidahaSheetata - Vataja vikara Ushna jala Su. Su. 46/435 Dal. Kaphaja vikaraTable c: Based on Ahara and Oushadha dravya – Samanya Anupana Ahara/Oushadha Anupanam References dravyaShali, Shastikashali Ksheera As. Sa. Su. 10/43-44Mudgadi Dhanya Mamsa rasa Su. Su. 46/423-433Odana Takra Kal. Ka. 4 Pa./18Vaidala supa Souvira Kal. Ka. 4 Pa. /18Dhanyadi Phala Khandasava Bhe. Sa. 27/31 Dadhi, ChukraShaka Mudgadi vikaras Dhanyamla, Mastu, Takra As. Hr. Su. 8/48Yava, Godhuma,Pishtamayanna, Su. Su. 46/423-433Bisagranthi, Dadhi, Sheeta jala As. Sa. Su. 10/43-44Madhu, Madhyavikaras, As. Hr. Su. 8/47SnehaMamsa-Varahamamsa Koshna jala Kal. Ka 4 Pa / 18Aja mamsa,HayamamsaTaila Madhya, Ash. Hr. Su. 8/ 47-48, Sheetakashaya,Udaka, Su. Su. 46/423-433 15
  19. 19. Conceptual study Anupana Khadirodaka, YushamlakanjiVasa majja sneha Manda Kas. Sa. 22/11Varuni Kakubha Bhe. Sa. 27/36Ashwagandha kashaya Varuni, Manda Bhe. Sa. 27/37Table d-Based on Ahara and Oushadha dravya – Rogabhedena AnupanamDravya Roga / Vikara Anupanam ReferencesGuduchi Vata vikaram Ghritam Bha. Pra. Ma. Kha. Va Ra. Pitta vikaram Sita kapha vikaram Madhu Vibandham Guda Vataraktam Erandatailam AmavatamGuda Sleshmavikaram Ardrakam Bha. Pra. Ik. Va. 28 Pittavikaram Haritaki Vata vikaram ShuntyahasamamGandhaka Twagdosham Mochaphalam Ras. Jal. Ni. 266-267 Balakshayam Chitrakam Kshaya Kasa Bhallataka Kashaya Agnimandya Triphala kashaya Bala-virya kshaya, Dugdha Arti NetrarogamBased on DravyaVargas 16
  20. 20. Conceptual study AnupanaDravya Varga Anupanam ReferenceVaidalanam Dhanyamlam Su Su 46 / 433Shasyajatanam BhadramlamJangala Dhanvajanam PippalyasavamVishkiranam KolabadarasavamPratudanam Ksheerivrukshasavam Su su 46/433 Sura Draksha- kashmarya Bhe sa 27/35 kharjrasaramGuheshayanam Kharjura – narikelasavam Bilwa, kapitha Bhe sam 27/35 pindakasavamPrasaha Ashwagandhasavam Su Su 461/433 Amlaphalasavam Ash Hr Su 10/ 43-44Parnamruganam Krushnagandhasavam Su Su 46 / 433Bileshayanam Phalasavam Su Su 46/433 Of kapitha shireesha Bhe Sa 27/35Ekashephanam Triphalasavam Su Su 46/433Aneka shephanam Khadirasavam Su Su 46/433Kulecharanam Shrungtaka – kas Su Su 46/433Kosharasipadi Erukasavam Su Su 46/433Plaranam IkshurasasavanNadeya matsyanam MrunalasavamSamudranam Matulung asavamAnelaphalanam Padmotpala kandasaramKashayanam DodimavetrasavamTalaphaladinam Shwadamstravasu kasavamKushmandadinam Darvikarirasavam 17
  21. 21. Conceptual study Anupana Chucchu prabritinane Lodhrasavam Kusumbha shakha Triphalasavam Jeevantyacinam Manadukaparnyadinam Mahapanchamulasavam Talamastakanam Anelaphalasavam Saindhavadinam Sura Aranalam Gramyehu Madhrasavam Ash Hr Su 10/43-44 Vanyeshu Tekshnaphalasavam Oudakeshu Ikshu kash Padmake Mahamrugeshu Shrungataka - Kasereeka Mrudvika madirasavam Kshoulka/ Sheetadaks/ Udcelshwith yuktam Based on Kalpanas Kalpana Anupanam Reference Avalehya Madhu ksheera sita Sha sa ma khr 41 Ghrita Sneham Ushnodakam Kal ka 4 paBased on yogas table g Yoga Rogaghnata Anupannam Reference Rasa Vataroga Madhu-pippali Ayu.pr.1/404 sindhura Kapharuja Trikatu-chitrata chura Pittaroga Ela-Sitendu Vrana Triphala guggulu Pushtyarthan Chaturjatha,Triphaa 18
  22. 22. Conceptual study AnupanaKauhora Netraroga Vasa Sha.sa.ma7/8Gugyulu 0-87 Gulnea Varuna Varana kushta Khadira kwatha Ajeernam Anrla-teeksha dravyaKankayaneGutika Gullma Ghruta,ksherra Anela Madhya Ushnodaka Sha. ma. 7/53-55 Vataja Gulnea Madhya Pittaja Gulma Goksheera Kaphaja Gulma Gonumtra Tridoshaja Dashanula Gulma Rakta gulma Oushtra dugdhaYogaraj Vatarikaran Rasnadikwatha Sha Su MaGuggula 7/66- 69 Pittarikaran Kankolyadi kwatha Kapha vikaran Aragwadhadi kwath Pranuhar Darvikwatha Pandu Gonutra Medornuddi Madhu Kushta Ninebashruta Vatarakta Shotha Shula Pippali kwatha Mushaka visha Patala quatha Netrathi Triphala kwatha Sarvaudara Punarnavadi kwathaBased on Kala 19
  23. 23. Conceptual study Anupana Kala Anupanam Reference Ushna kale Yusha – with Taila Su Su 46/422-433 Sheeta kale Amala kanji with Taila Sharad Greeshna Sheeta jala Ash San. Su 10/43 Hemanta -44Based on vaya Vaya – Avastha Anupanam ReferenceKsheerapa Ksheerasalpi – Dhatryaha Su Sha aloneKsheerannada Ksheerararpi – matrgaha and DhatryahaAnnada Kashayadini-with aroidance of DhatryahaBased on Dasha Dosha Anupanam ReferenceVata Singdha,UshnaDrava Amla As Sa Su 10/43 Kanjika, manuarasa Cha Su 27/321 GangPitta Sheeta Madhura Shakarodakam SitaKapha Ruksha Ushna Dravam Triphalodakam with MadhuSannipate Skenoudra Ardra kadakamAnupana based on Roga / Arstha Roga/vikara Anupana Roga Anupanam /Vikara 20
  24. 24. Conceptual study Anupana Jwara Musta Parpata Raktapitta Vala, Ikshurasa kirata Grahani Takram Kruni Vidanga Prameha Nishamalaka, Ashmari Pashanabhed Triphala Arshal Bhallataka, chitrka Amarata Mutrayukeranda taila Swaraguda Samadhu Pushkara Pleharoga Pippali Sheeta Tambula dala Kasa Kantakari maricha Vataryadhi Ajya rasonaka Apasmear Vacha Brahmi Guggulu Kshaya Shitajith, Marsa Udara Virechaka drevya Puranajwara Madhu– Maricha Vataeakta Guduchi Sheela Ghritanvita hingu Ardita Masharataks Visha Kostinajala, Hema Medaroga Madhudeka Sthoulya Madhudaka Prallara Lodhra Krusha Shrama Sura Aruchi Matulunga Pandu Loha kitta Vrana Guggulu Chardi Laja Amlapitta Draksha Atisara Kutaja Mutrakrucha Shatavari kushmandea Netraroga Triphalodaka sakshoudra Unmada Punarnaghrita Kushta Khadisa sara Nidrakshaya Mahisha ghrita Parshwarhula Pushkara mula Shwitra Bakuchi Gulma ShigrutwachaShwasa – samadhu trikatu, sashunti BrahmadandiVishagni Shastra – Arkaselu, Shireesha kapitha phalasavam Sheetodaka hateAlpagni – Madhya if Madhya satnya 21
  25. 25. Conceptual study AnupanaAnupanam Avastha :Ksheera Atapa Upvasa Langhana, Adhwa, Bhashya, Vyayam, klanta Vyavaya stri Balye, VardhakyaDhnyamala Anidra Tandra Bhaya klameDhadhi mastuAnupana Ayogyaha Most of the times the knowledge of patients in whom particular drugs arecontraindicated becomes more important than in whom it is indicated. Ayurvedicscholars38 like Charaka, Vagbhatta, Chakrapani have propounded that peoplesuffering from : Urdhwanga Vata, Hikka, Shwasa, Kasa, Urah kshata, PrasekaSwaropahata, Medhra – Akshi – Galaroga, Praklinnadeha and those who areengaged in Geeta, Bhashya, Adhyayana should refrain from Anupana followingconsumption. Charaka reasons, for this contraindication as: in these persons Anupanastagnates in Kanta and Uras because of which Aharaja sneha is withheld resultingin re-causation of the Doshas. Chakrapani and Shivadas Sen elaborate this reasoning as follows: UdakadiAnupana combines with Ahara and results in Aharasneha i.e., Aharasara jananaby virtue of its Snigdhatva. However, in patients suffering from Shwasadiroga dueto the predominantly vitiated Vata the procession of Anupana lower down, ishindered due to the absence of Dravamsha appropriate Pachana does not takeplace. Consequently Sara or Snehajanana does not occur resulting in only vitiatingthe Vatadi Doshas again. Vagbhata39a adds to this stating that thus vitiated VatadiDoshas result in disorders like Agnisada, Chardi, Syandana - sleshma sravana andso on. Indukara39b, commentator of Ashtanga Sangraha quotes that according tosome, Anupana here refers to only jala while Ksheeradi in Kasadi roga can be 22
  26. 26. Conceptual study Anupanapermitted. Further he clarifies according to his school of thought inUrdwajatrugatadi rogas in general all Anupanas are prohibited. But Ksheeradi inKasadiroga are considered as exceptions. Shivadas Sen40 opines that Alpa pana could be allowed since “No” meansIshat i.e. Alpam.Nishidhanupanas Sometimes, certain combination of drugs are likely to produce certainuntoward or toxic effects in the body. In this context, Sushruta41 advisesprohibition of usage of Ushnajala along with Bhallataka and Tuvaraka Sneha.While, Kashyapa inhibits the utility of Ushnodaka along with Paya, Dadhi andMadhu and in disorders of Pitta, Raktasrava,Garbhachyavana and Garbhadaha42. It is more likely that this topic could be understood better under the topic ofVirudhatwa i.e., incompatibility According to Charaka drugs are harmful if theyare incompatible from the point of view of Desha, Kala, Matra, Veerya, Samyoga,Gunadi - 11 factors43. In modern parlance, Drug - Drug interactions; Drug - Food interactions,Drug formulations interactions could be considered here.Anupananntaram Nishiddha Karma38 We come across references which advises the following activities to beavoided immediately after the consumption of Anupana viz., Adhayayana,Bhashana, Gayana, Adhwagamana. Dalhana supporting author scholars reasons out stating that by such ofthese activities doshas get vitiated and result in Chardyadi Vikaras, similar to theconsequences of Anupana administered in Ayogyaha.Anupana Guna Karma47: 23
  27. 27. Conceptual study Anupana Dealing with the rationality of drugs combination Charka states that two ormore durgs together exhibit some special properties which can never be producedby the individual components46. Accordingly utility of Anupana by virtue of itscombination produces diversified actions and these are enlisted in the table ‘l’. On screening this list of Anupana Karma following implications could bederived. Charaka, Vagbhata have described the effect of Anupana underAnnapanavidhi and in relation to Ahara/Anna. While Sushruta25, Sharangadhara5and Rasataranginikara29,47 speak of the role of Anupana on influencing theBeshaja and its therapeutic effect. On the whole, the effect of Anupana can beunderstood at four levels.(i) Effect on Ahara: Bhuktam Avasadhayati, Sanghatam Bhinatti, Kledayti,Mardavatamapadayati, Sukham parinamati, Ashu vyavayi tamapnuyati, Doshala –atimatra - Guru Bhuktam Prajeeryati. Deha Paryaptini abhivardhayati, Satmyatamprayacchati(ii) Effect on Oushadha: Bhaishajyam Kshanena angeshu prasarpati, Oushadha gunakaram,Rasadeenam paramanavaha vibhajayati, Rasadeenam drutam agenshu sarpati,Bheshajam paribrumhayet, Yogavahi-yuktaha karyavardhanamcha.Rasataranginikara47g quotes Charaka’s Anupana Guna karma and commentssimilar to the effect of Anupana on Anna, its influence on other dravyas too canbe considered: Based on this, probably all those effects of Anupana over Aharacould be emulated in the context of Oushadha dravyas too to some extent.(iii) Effect on Roga/Vikara 24
  28. 28. Conceptual study Anupana Dosha Shamanam, Dosha – Sanghata bhedanam, Pipasam harati, ShramaKlamahram, Rogahna Bhaishajyam sahayakari, Rogahari shakti – gunavati cha.(iv) Effect on the Rogi/Swastha Tarpayati Preenayati Urjayati, Brumhayati, Ayu-jeeva balam karoti,Drudhangatam karoti, Sukham-swasthyam dadati, Rochayati, DeepanamVrushyam, Varngam.Anupana Guna Karma47 Table ‘l’ Guna – Karma ReferenceTarpayati- Chakshuradi prasadam Janayati a b, d, iPreenayati – Manah prasadanam Janayati a, b, d,Urjayati - Utsaham Janayati, Bala Jeevanayoho a, b, d,Brumhayati a, b, iDeha - paryaptim Abhivardhayati – Aloluptamvjanayati a,b,Adhobhagam nayatiBhuktam Avasadhayati – Shathilatam janayati - Adhobhagam nayati a, b, dAnna sanghatam – Kathingam a, b - Bhinnatti a, b - Kledayati a, b - Marda vatam apadayati sharira komalatam - Sukham parinamati a, b, i - Ashu vyarayitamapnuyati – Akhita deha a, b, i vyapkatvam Janayati a, bAyu - Balaya Hitam, Jeevayati, Balavantamkaroti b, i - Drudangatam karoti cSatmyatam prayacchati e 25
  29. 29. Conceptual study AnupanaBhashajyam kshanena Angeshu prasurpati fOushadha gunakaram gSukham dadati - swasthyotpadakem iRochayati iPipasam harati iDoshala - Guru – Atimatra bhuktam sukham jeeryati h, iVrushyam iDosha - Sanghata Bhedanam iShrama Klamaharam iDeepanam iDosha Shamanam iVarnyam iRasadeenam paramanavaha vibhajayati gRasadeenam drutamangeshu sarpati gRogaghna bhaishajyam - Sahayakari gBheshajam paribrumhayet gRogahara shakti, Gunavati bhavet gYogavahi - Yuktaha karyavardhanam cha jAlpa dosham - Adosham jeevati cFurther we can distinguish these Karmas based on the duration of the effect asfollows:(i) Immediate effect: Generally medicines as compared to Ahara are meant to obtain immediateaction. Hence all the Karma listed against effect on Oushadha and those againsteffect on Roga/Vikara could be considered here. The purpose of intake of Anupana with Ahara dravya is to procure easierand Sukha Parinamana. These effects though not found as early as in case ofOushadha yukta but still could be put under this categoryDistant effect: 26
  30. 30. Conceptual study Anupana Tarpana, Brumhanadi effects listed under effect on Swasthya areapparently achieved after a prolonged duration. However in some cases of Rogasthe benefits may not be immediate as in case of Vrushaya Karma. Hence, effecton Swastha and on few cases of Rogi could be accounted here.Balavaranakarama – refers to long terms effect of Ahara but may refer to its effectin abala and twakrogi too.##############################################Dosha Sanghata bhedanam – aids in samprapti righatana in rogi or the dasha Sanghata in the drug like the undesired harmful effectsproperties, constituents of the drug are removed or destroyed. Eg : Vatsnabha isalways administered with Tankana, Tamra with Ardraka swarasaurjayati – utsaha as well as may indicate vyadhikshamatwa too Sukham Jarayati-aids in beneficial and faster metabolism of medicines vyaptimapnuyat – aids inthe spread of the pradhana oushada.This might refer to its capacity to narigate the pradhana oushadha to reach thedesired site of action maybe to particular Dhatu eg yogaraj guggulu with madhu inmedorga I or to a specific Arayava - eg: yogaraja Guggulu with Triphalodakain Netraroga, Guduchi kwatha in VatasakaApart from this it indicates that by the properties of Anupana Basis is carried toeven the remote corners of the body passing across the other wise barriers.###############################################################Anupana Karmukata: Deriving the mode of action of a drug is a complex matter for a given drug.We know that a single drug has been consisting of various fractions on analysisand its action might be due to each one of them or in sum toto. In a compound, itbecomes even more necessary to enquire the effect produced by the compound asa whole is due to the some total effect of all composing ingredients or in units. 27
  31. 31. Conceptual study Anupana Also Charaka 48 says the effect exerted by the whole compound need not besame as that of individual drugs. We can see such an evidence especially in theRasoushadhas wherein their range of effect i.e., widened and improved withAnupama. Looking into the Ayurvedic literature except for Sharangadara andRasataranginikara vivid description of mode of action of Anupama is notavailable 47 f, g. Sarangadara illustrates “as oil in contact of water readily radiates all overthe surface of water, similarly drug followed by Anupana soon pervades all overthe body”. Rasataranginikara being a recent author, seems to be influenced by Modernscience and tries to imbibe its fundamentals. According to him Anupana aids indisintegrating the complex basis into its components and then carrying swiftly inthe body. Anupana augmenting the effect of the primary drug thus helps inproducing a therapeutic effect. The Karmas described in relation to Ahara are said to be applied for otherdravyas too like Bhuktam avasadhayate, Kathinyam bhinnati, Kledayati,Mardavatam apadayati, Akhila deham ashu vyapakatvam janayati and Sukhamparinamati which could be considered for Oushadha dravyas too as said nyTaranginikara.Modern references aiding in understanding the mode of action ofAnupanaAnupana in the form of solution44b: For absorption from gastro intestinal tract (GIT) the drug must be insolution. When not in solution the rate of absorption slows down due to timerequired for disintegration and release from the dosage form and time needed fordissolution in to GIT fluid. Once drug is in solution, absorption is a function ofGIT membrane and follows the process of simple diffusion across lipidmembranes with water filled pores. GIT membrane is permeable to lipid solubleforms, unionized and weak acids. 28
  32. 32. Conceptual study AnupanaAnupana and various solvents and suspensions Drugs in aqueous forms are absorbed faster and more completely than solidforms like tablets or suspensions. Microcrystalline suspensions are better absorbedthan their coarser counterparts. Drugs with high lipid - water partition co-efficient, lipid solubility, lowdegree of ionization have greater absorption in GIT and from the basic criteria forentry in to the Blood Brain Barrier44c.Anupana and absorption in GIT Drugs which accelerate gastric emptying time aid the drug to reach largeabsorptive surface of small intestine sooner and increases the drug absorption.Basic drugs are best absorbed from alkaline environment of small intestine44c.Anupana and Renal clearance Resultant metabolites are almost always more polar and water soluble, thisfacilitates rapid rate of renal clearance as renal tubular reabsorption decreases44d.Anupana vis-à-vis Controlled Release Drug Delivery Systems: Some drugs when combined with certain other chemicals agents, formchemical complexes which are slowly soluble in body fluids depending upon thepH of the environment. This slow dissolution rate provides a constant release ofthe drug for sustained action. This type of drug designing provides: • Prolonged duration of action – used in treating chronic ailments • Sustained drug action – of those having rapid rate of absorption and excretion • Reduced frequency of administration - for drugs required in small doses • Stable plasma concentration maintenance : to have reduced potential for adverse effects and to aid in uniform absorption from GIT44fAnupana vis-à-vis Drug interactions “Biopharmaceutics” is the study of the influence of formulations on thetherapeutic activity. When two substances are administered simultaneously onemay alter the response of the other which may be a beneficial - desired effect or a 29
  33. 33. Conceptual study Anupanaharmful undesired effect. This interaction between the two substances could beunderstood under Drug-Drug interaction, Drug-Food interaction in vivo andpharmaceutical interaction in vitro wherein chemical principals are involved.There are basically two mechanisms responsible for drug interaction : (1) Pharmacodynamic interaction (2) Pharmacokinetic interaction(1) Pharmacodynamic Interaction: This involves modification of pharmacological respone without altering theconcentration of the drug in the tissue fluid i.e. when two drugs with similarpharmacological effects are administered with each other, they may alter thesensitivity of the effect or organ resulting in a synergistic: addition or potentiationeffect or in a antagonistic effect: physiological or functional antagonism. Thedrugs may act on some or different receptors or processes to produce the response(2) Pharmacokinetic interaction: Here there is a change in the concentration of the drug at the target site andcould be due to alteration in drug absorption, distribution, metabolism andexcretion. These interaction may result in synergism antagonism.(a) Interaction at the site of the absorption In the gut, drugs may interfere with each others absorption by (i) chemicalinteraction. (ii) Effecting gut motility. (iii) Changing gut flora.(b) Interaction during distribution:This includes (i) Competition for plasma protein binding site (ii) Displacement from tissue binding sites(c) Interaction during metabolism Altered response at this stage is because of i) Enzyme induction ii) Enzyme inhibition(d) Interaction during excretion : This results due to (i) Interference with active transport. (ii) Diureticactivity44g. 30
  34. 34. Conceptual study Anupana As Charaka says one should always equip oneself with excellent appliancesfor the advancement of science49. In the light of modern pharmacology the modeof action of drug complex thus detailed here could be adopted in betterunderstanding the effect of Anupana complex.Anupana Pradhanyata Commending the efficiency of Anupana Vagbhata says whether the dravyais Alpadoshayukta or Nirdosha, Anupana brings about Sukhaparinamana47c.Kayyadeva47h adds to it stating that eventhough Laghu, Satmyhara is consumed inan appropriate time, Atyambupana, Vishamasana, Sandharana and SwapnaViparyaya result in Apaka. In such a state utilization of Anupana results inSukhajeerana. Furthermore, utilization of Anupana is emphasized by the Ayurvedicscholars50, without which consequences like Ajeerna bhada are said to be resulted. This reveals to us the need of Anupana in both daily life as well as indiseased conditions. 31
  35. 35. SharkaraContents • Nirukti • Historical review • Synonyms • Vernacular names • Classification • Manufacture • Bheda • Rasapanchaka • Chemical composition • Karma - Samanya - Doshakarma • Rogaghnata • Pharmacological studies • References
  36. 36. Sharkara: References1. Ash. Sa. Su. 6/472. Sha. Ka. Dru. Vol V pp 31 – 323. Harivamsha, Paramarthasara Kavya, Varahamihira’s Bruhat samhita – Monnier Williams pp 10584. Varahamihira’s Bruhat samhita, Harshacharita, Dhootanarthaka, Sahitya darpana, Pancharatra, Kavya, Bha. Pra., Amarakosha, Monnier Williams pp 12145. Naishada charita, Sahitya darpana, Amarakosha, Harivamsha, Monnier Williams pp 335, 3366. Cha. Su. 27/(10) – 240 Chakra7. Su. Su 45/162 Dal8. Su. Su 45/165 Dal9. Ash. Hru. Su 5/49 – 5110. Ash. Sa. Su 6/45, 46 Hem.11. Panini 4/2/45 Monnier Williams pp 335 - 33612. Dha. Ni. Shalyadi varga 101 – 10213. Ma Pa Ni Ikshu varga 11 – 15, 2214. Kai. Ni. Oushadha varga 151 – 15315. a) Dha. Ni. Shalyadi varga 101, 102 b) Kai. Ni. Oshadha varga 151 – 161 c) Sal. Ni. Iksh varga pp 812 – 814 d) Dra. Gu. Sa. Ikshu varga 1 – 12 e) Ra. Ni. 14/10316. Bha. Pra. 23/21 – 30, 38; Kai. Ni. Oshadha varga 152 – 156 Cha. Su. 27/(10) – 240; Su. Su. 45/162, 16517. The Wealth of India Vol 9 pp 153, 156, 157
  37. 37. Clinical study Material and methods CLINICAL STUDY “The man of Science has learned to believe in justification not by faith, butby verification” -Huxley. Ayurveda is a rich science but its mysteries are yet to be untapped. Theinformation available regarding each drug, its indication in particular condition,the required method of processing to administer in a particular form, itsappropriate adjuvant and so on are not dealt in clarity. It is well known that thedrug study is complete only after the clinical study. In the pursuit of knowledge, this clinical study was taken up to evaluate theeffect of drugs, Masha, Usheera and Sharkara in Shukradushti vis-à-visOligozoospermia. Anupana has so far been a topic of historical and academical value. Here isa step towards systematic study of Anupana in relevance to its practicalimplications. Chikitsa for Shukradushti is based on Doshahara chikitsa, Dhatuchikitsa and Rakta pittahara chikitsa according to Charaka, Sushruta advocatesUpachaya nimittha chikitsa, Janana nimitta chikitsa and in Dushta retas prasadanachikitsa in the context of Vajikarana prakarana. Based on the previous worksdone, Oligozoospermia falls under Vatapittaja shukradushti. Hence Vatahara andPittahara chikitsa are more relevant here. Masha is frequently referred to as an important Vatahara dravya,Shukrasrutikara, Shukavruddhikara, Shukravahaka, Bijakaraka, Viryakara,Shukrajanaka – Pravartaka – Rechaka, Vrushya dravya. Qualities of Masha havebeen equated to that of Atmagupta – a well known Shukrala dravya. In addition tothis, we find plenty of Vrushya prayoga containing Masha as a prime ingredient.Out of about 50 Vrushya yogas in Charaka samhita, 17 contain Masha. Around 23yogas are available in Bh. Bai rathnakar*. (Table No 1) 89
  38. 38. Clinical study Material and methods Sushruta emphasizes that selection of Anupana should be based on thedisorders aimed apart from other factors, based on which Sharkara and Usheeraare selected and their role in Shukradushti are elaborated hence forth. Sharkara in this study refers to Khanda Sharkara. Its use as a substitute toSharkara is found in Sharangadhara samhita and is said to have similar qualities inKayyadeva nighantu. Quality of khandasari sugar is comparable with ordinarygrade vacuum pan sugar-Hadi 1956. Its Vatahara-vatapittahara, Shukrakarini,Vrushya, Raktapittahara qualities are evident in our classics. 21 out of 50 Vrushyayogas mentioned in Charaka include Sharkara as its ingredient. More than 34Vrushya yogas are found in Bha. Bhai Ratn. (Table 2) Usheera has been vividly described to possess Pittahara, Raktapittahara,Shukra shodhana. Description of Usheera yogas in classics is very limited. Bha.Bai Rat presents with 2 such Vrushya yogas ( Table 3). In this backdrop, to evaluate these claims, Masha - as Pradhana dravya;Usheera and Sharkara as Anupana dravyas were selected in the management ofShukradushti.Objectives of this study: i) To evaluate the effect of Masha churna with Anupana - Sharkara in Shukradushti vis-à-vis Oligozoospermia. ii) To evaluate the effect of Masha churna with Anupana - Usheera phanta in Shukradushti vis-a-vis Oligozoospermia.Materials and Methods:Source of data:1. Male patients attending the OPD section of Infertility clinic at S.D.M. Ayurveda Hospital diagnosed with Shukradushti vis-a-vis Oligozoospermia were selected irrespective of their race, caste and social status. 90
  39. 39. Clinical study Material and methods2. Trial drugs Masha, Usheera, Sharkara khanda were collected from the locality of Udupi District, pharmacognostically identified and then inducted into the study.Method of collection of data: Male patients who complained of either Primary or Secondary Infertilitywere examined clinically, involving elicitation of a detailed history regarding thedisease, psychological, sexual, familial and treatment status into a speciallyprepared proforma based on Ayurveda and Reproductive biology.Investigations: Patients then were subjected to Semen analysis and relevant Labinvestigations before, during and after treatment. The WHO criteria (1992) forSemenogram was followed to diagnose Normozoospermia. (Table 3)Inclusion and Exclusion criteria:• All patients diagnosed with Shukradushti & Oligozoospermia in the reproductive age group.• Patients with semen having abnormal qualitative and quantitative picture were also considered, excluding Azoospermia, Necrospermia, Teratospermia and Polyspermia.• Patients with Tuberculosis and STD’s were excluded.Study design: This is a single blind clinical study carried out in 21 patients, who wererandomly placed under 2 groups, Masha Sharkara group (SM) and UsheeraSharkara group (UM). They received medication for one month and followed upfor another two months.Assessment criteria: Qualitative and quantitative improvement in the semen based on WHOsemenogram (1992) 91
  40. 40. Clinical study Material and methods• Colour Grayish white• Liquefaction time 20-30minutes• Volume >2 million/ml• Viscosity (ratio) <9• pH 7.2-8.0• Sperm concentration ≥20 mill/ml• Sperm motility >25% Rapid linear progressive motility >50% Slow linear progressive motility• Viability ≥75% live• Morphology ≥30% normal• WBC <1x10 mill/ml Finally, the observations and results were evaluated statistically for eachgroup.Medications intervened: Masha directly brought from the fields along with the seed coat were finelypowdered and packed in 5g packets. Usheera was made into a Yavakuta churnafor the preparation of Phanta kalpana and packed in 25g packets. Khanda sharkarawas also finely powdered and advised to take in 5g dosage. Packing was done atS.D.M. Pharmacy, Udupi.• SM group patients received 5g Masha churna + 5g Sharkara churna as Anupana b.i.d. for 1 month.• UM group patients were given 5g Masha churna+100ml Usheera phanta as Anupana b.i.d. for 1 month. Patients were educated regarding the method of phanta preparation. 92
  41. 41. Sharkara - Tables Table ‘a’ Khanda sharkara Paryaya Dh. Kai. Sal. Ra. Ma.pa. Synonyms Ni. Ni. Ni. Ni. NiSharkara + - - + -Minandi + - - + -Matsyandika + - - + -Sita + - - + -Ahichatra + - - + -Sikata + - - + -Shubhra + - - - -Sitopala + - - - -Khanda sita - + - - +Khanda sharkara - + +- - -Pinda sharkara - + - - -Rasodbhava - - + - +Shukla - - + - -Supishta - - + - -Pandura - - + - -Guda khanda - - + - -Shweta + - + + -Gudobhava - - - + -Vishapaladganda - - - - +Shigruka - - - - +Krittika - - - - +Amala - - - - +
  42. 42. Table ‘b’ Ikshu vikaras Bha. Kai. Ra. Ra. Ash. Cha. Su. Ma. Dr. Gu. Pr. Ni. Ni. Va. Ni. Hr. Sa. Sa. Pa. Ni. Sa. Matsyandi + + - + + + + + + Guda + + + + - + + + + Khanda + + - + + + + + + Sharkara + + + - - + + - + Sitopala + - - - - - - + + Phanita - + - + + - + + + Lasika - - - + + - - - - Sita - - - + + - - - Dhouta - - - - + + + - + Guda Adhouta - - - - + - - - - Guda Ikshu rasa + + + + + + + + + Kshudra - - - - - + - - - Guda Table ‘c’ Classification of Sharkara Text Varga/ Gana/other groups Dha. Ni. Shatapushpadi varga Kai. Ni. Oshadhi varga Raj. Ni. Paniya varga Bha. Pr. Iskhu varga Ni. Ad. Trunadi varga Cha. Sa. Daha prashamana gana, Shonita sthapana gana, Jwarahara gana, Ikshu varga, Hitatama Su. Sa. Ikshu varga, Kaphavardaka Ash. Hr. Dravyavarga Table ‘d’ Sharkaras other than Ikshu Sharkara Ma. Dr. Bha. Kai. Dha. Ra. Ash. Su. Cha. Pa. Gu. Pr. Ni. Ni. Ni. Hr. Sa. Sa. Ni. Sa.Pushapsita + - - - - - - + -MadhuSharkara/Khanda + + + + + + + + +Yavasa Sharkara - + + - + + + + +Tavaraja Sharkara - + - + - - - - +Yavanala Sharkara - - - + - - - - -Tavaraja Khanda - - - + - - - - -
  43. 43. Table ‘e’ Khanda-Rasapanchaka Rasa Guna Veerya Vipaka Madhura Tuvara Snigdha Sara Guru Laghu Shita MadhuraDha. Ni + - - - - - + -Kai. Ni + + + + + + +Sal. Ni + - + + - + + -Bha. pra. + - + - - + - -Ra. Ni + - - - - - + -Ma. Pa. Ni. - - - - + - + -Cha. Sa - + - - - - - -Dra. Gu. Sa. - - + - - - - - Table ‘f’ Khanda sharkara - Samanya Karma Dh. Kai. Sal. Bh Cha Ma. Pa Dra. Gu. Ni. Ni. Ni. Pr. Sa. Ni Sa.Sarvadahanashaka + + - - - - -Balya - + + + - + +Vrushya - + + + + - +Mukhapriyam - - + - - - -Chakshushyam - - + + - - +Dhatu vivardhini - - + - - - -Indriya truptikara - - + - - - -Santarpani - - + - - - -Hridya - - + - - - +Brumhanam - - - + - - +Pushtida - + - - - + -Ruchyam - - - - - + -Sukhaprada - - - - - - +
  44. 44. Table ‘g’ Khanda sharkara - Doshaghnata Vata Pitta Kapha Kai. Ni. - - Sal. Ni. - - + Ni. Ra. - - + Bha. Pr. - - Ra. Ni. - Ma. Pa Ni. - - Dra. Gu. Sa. - - Table ‘h’ Khanda Sharkara Rogaghnata Dha. Ni. Kai. Ni. Sal. Ni. Bha. Pr. Ra. Ni.Rakta Pitta + + + - -Chardi + + + + -Murcha + + + - -Trishna + + + - -Kshaya - + + - -Kasa - + - - -Visha - + - - -Shwasa - + + - -Mada - + + - -Moha - + + - -Jwara - + + - -Kshata ksheena - + + - -Shosha - - + - -Ksheenretas - - + - -Asyasosha - - + - +Daha + - + - -Klama - - + - -Dourbalaya - - + - +Shrama - - - - +Raktadosha - - - - +Bhranti - - - - +Krimi - - - - +
  45. 45. Shukra dushti – References1. Bramhana upa. 3.5.1:4.4.222. Rigveda 10.85.373. Atharvaveda Shounaka 6.72.3:101.24. Atharvaveda Shounaka 4-8 Khanda:Rigveda 1.112, 116, 117:5.74, 75, 68, 71:10.395. Manusmruthi 3.456. Kas. Su. 7.1.36-487. Su. Sha. 2.38. Kas. Su. 27/55-569. Ash. Sa. Sha. 1/1310. Har. Sa. 3/5011. Chikitsa Sara Samgraha, pp 991:Yo. Ra. Ut.-Vajikarana Adhyaya12. Ma. Ni. Parichheda, pp 476-47813. M. S. Baghel14. Sha. Kal. Br. Vol V, pp 114-11615. Monnier Williams, pp 108016. Cha. Sha. 2/417. Cha. Chi. 30/145, 2/4/5018. Su. Sha. 3/2119. Cha. Chi. 15/1520. Cha. Chi. 2/4/4621. Dha. Ni. Suvarnadivarga, 34322. Cha. Vi. 5/823. Su. Sha. 9/7, 4/20-21, Sha. Pu. 5/4224. Cha. Sha. 7/15:Padmapurana 2/66/62-6525. Cha. Vi. 8/10926. Cha. Su. 19/3,427. Su. Sha. 2/3,428. Ash. Sa. Sha. 1/1329. Ash. Hr. Sha. 1/1030. Kas. Sa. 27/55,5631. Ma. Ni. Pariccheda, pp 477
  46. 46. 32. Sha. Sa. Pu. 7/172, 12333. Cha. Chi. 30/135-13834. Cha. Chi. 30/14035. Rao Niranjan, ’97:Prasad ’9736. Cha. Chi. 30/13837. Su. Sha. 2/438. Cha. Chi. 30/15339. Cha. Chi. 30/126-12740. Su. Sha. 2/6 Da41. Ash. Sa. Sha. 1/24, 1/1442. Cha. Chi. 30/146-14843. Su. Su. 1/7,8 Da44. Cha. Chi. 30/149, 15045. Cha. Chi. 30/15246. Dalal-Obs. & Gynae. Today, Vol VI, No. 1, Jan. 2001; Chandra & Bansal, Obs. & Gynae. Today, Vol VI, No. 1, Jan. 200147. Medical Management of Male Infertility-Suresh Kumar, Obs. & Gynae. Today, May ’9848. Richard Petty, Wellman Clinic, UK49. Horizon, BBC, Oct. 31, ’9350. James Crissman- New Scientist, W. E., July 200251. University of South Carolina Medical School, USA52. Dr. Luc, INSERM, French research Institute53. Scientist of Australia and Singapore54. Larry & Michel-Infertility in Male.
  47. 47. SHUKRADUSHTIContents• Brief history of Vajikarana and Shukradushti• Shukra Vyutpatti Paryaya Swaroopa Bhoutika Sanghatana Utpatti Sthana Abhivyakti Pramana Karma Saratha• Shukradushti Bheda Nidana Roopa Samprapti Sadhyasadhyata Upadrava Chikitsa Pathya• Oligozoospermia
  48. 48. Conceptual study Usheera Usheera - References 1. Sha. Kal. Dr. Vol. I, pp 275 2. Monnier.Williams, pp 219-220 3. Rig.Veda 1.91.3., Atharva Veda Shaunakeya, 8.3. 4. History of Indian Medicine 5. Kou. Su. 18.10.13; 25 30, 26, 26, 31.13 6. Indian Medicine in Classical Age pp141, 242, 228; Kashi Ka 2.4.20; Prashasta Bhashya, Abi. Shakuntala 3 7. Sri Bhagavata11.27.30;10.86.41 8. www. himalaya healthcare.com/Vetivera 9. Cha. Su. 4/10-(5),(14),17 ; 4/12-(20); 4/14(28); 4/14-(28); 4/17-(41), 44 10. Cha. Su. 25/40 ; 5/21-24 11. Cha. Chi. 23/78-93 12. Su. Su. 38/24,39;39/8 13. Su. Ka. 6/19 14. Ash. Hr. Su 3/53 15. Ash. Hr.Su. 10/28, 13/6 15/11 16. Ash. Hr. Su. 22/20 17. Ash. Hr. Ut. 5/31,33,35 18. Cha. Chi. 19/53 Chakra. 19. Ma. Pa. Ni. Karpooradivarga 38-39, Bha. Pr. Karaveeradivarga 86-88, Dha. Ni. Chandanadivarga pp. 93; Kai. Ni. Oushadivarga 1368 – 1370; Ra. Ni. Chandanadivarga pp. 427; Sal. Ni. pp. 50 - 51 20. Bha. Bhai. Ra. 21. Indian Materia Medica Vol II pp. 109. 110 ; Indian Medicinal Plants Vol.IV pp. 2672-2673 22(a) The Wealth of India Vol X pp 451 (b) www. himalaya healthcare.com/vetiver (c) http:// www.vetiver.com (d) dr p @ essential oils. org. 22. Glossary of vegetabe drugs in Brihtrayi pp 15, 66, 70,214, 218, 342-346 350, 364, 374, 444.
  49. 49. Conceptual study Usheera USHEERA Contents • Vyutpatti • Nirukti • Synonyms • Vernacular names • Drugs other than Usheera – known by its synonyms • History • Previous works done • Classification • Habit • Varieties • Distribution • Rasapanchaka • Chemical composition • Karma -Dosha karma -Samanya karma • Rogaghnata • Uses • References
  50. 50. USHEERA TABLES Table ‘a’ Usheera Paryaya Kai. Ma. Ma. Sal. Bha. Dha. Ra. Am. Ni. Pa. Ni. Vi. Ni. Ni. Pr. Ni. Ni. Ko.Usheera + + + + + + + -Veerana + - - + + - - -Sevya + + + + + - - +Abhaya + + + + - + + +Samagandhika + - - + + + + -Bahumula + - - - - - - -Veerataru + - - + - + + -Veera + + + - - + + -Ranapriya + - - + - + + -Sheetamula + - - - - - - -Amrunala + - - + + + + +Mrunalaka + - - - - - - -Nalada - - - + + - - +Avadaha - - - + - - - +Jalashaya - - - + - - - +Lamajjaka - - - + - - - +Laghubhaya - - - + - - - +Ishtakapatha - - - + - - - +Avadhatha - - - + - - - -Avadaheshtakapatra - - - + - - - -Indraguptha - - - + - - - -Jalavasa - - - + - - - -Haripriya - - - + - - - -Shishira - - - + - - - -Vithanamulaka - - - + - - - -Dahaharana - - - + - - - -Jalamoda - - - + - - - -Gandhadya - - - + - - - -Sugandhimulaka - - + - - - -Sugandhika - - - + - - - -Kambhu - - - + - - - -Katagana - - - + - - - -Veerabhadra - - - + - - - -Bahumulaka - - - + - - - -Venimulaka - - - - - - - -Shubra - - - - - - - -Valaka - - - - - - - -Grahabhuhvaya - - - - - - + -
  51. 51. Table ‘b’ Usheera Rasapanchaka Rasa Guna Veerya Madhura Tikta Laghu Ruksha Hima Snigdha SheetaKai. Ni. + + + + + - +Ma. Pa.Ni. - - - - + - +Ma. Vi. Ni. - - - - + - +Sal. Ni. + + + - + - +Bha. Pr. + + + - - - +Dha. Ni. - + - - - + +Ra. Va. Ni. - - - - - - -Ra. Ni. - + - - - - +Cha. Sa. - - - - - - -Su. Sa. - - - - - - - Table ‘c’ Usheera Dosha karma Vata Pitta Kapha Ma. Pa.Ni. - + + Ma. Vi. Ni. - + + Sal. Ni. - + + Bha. Pr. - + + Dha. Ni. + + - Ra. Va. Ni. - + - Ra. Ni. - + - Cha. Sa. - + -
  52. 52. Table ‘d’ Usheera Samanya karma Klamahara Stambhana Shramahar Dourgandh Swedahara Dahaghna Pachana. yahara a Kai. Ni. + + + - - - - Ma. + + + - - - - Pa.Ni. Ma. Vi. + + + - + - - Ni. Sal. Ni. + + + + + + + Bha. Pr. + + + - - - - Dha. Ni. - - + - + + + Ra. Va. - - + - + + - Ni. Ra. Ni. - - + + - - - Cha. Sa. - - + - - + - Ash. Hr. + - + - + + + Su. Sa. - + + - + + - Table ‘e’ Usheera Rogaghnata Mada Jvara Trushna Raktaroga Visha Krucchrata Kushta Chardi Vrana Visarpa Arti Prameha Raktapitta Atisara KshataKai. Ni. + + + + + + + + + - - - - - -Ma. Pa. Ni. - - + + + + - - + + - - - - -Ma. Vi. Ni. - - + + + + - - + + - - - - -Sal. Ni. + + + + + + - + + + + - - - -Bha. Pr. + + + + + + - + + + - - - - -Dha. Ni. - + + + - - - - - - - + - - -Ra. Ni. - + - - - - - - - - + - - - -Ash. Hr. + + + + + - - - + + - + + + +Su. Sa. + + + + + + + + + + - + + + -
  53. 53. Pharmacognostic study: References1. Cha. Vi. 8/462. Cha. Vi. 8/873. Cha. Vi. 8/134. A P I pg 190-195; IP Appendix; Pharmacognosy Kokate et. al.
  54. 54. Conceptual study Usheera USHEERAVyutpatti1 • Masculine – Usheerah • Neuter- Usheeram • Vash kantou + Vashaha kith • Iti Anadi Sutrena Iran • SamprasaranamNirukti2 • fragrant root of the plant Andropogon muricatus • a specific grass • name of a mountainHistory Vetiver has long been an important plant because of its fragrance and itsrole in indigenous medicine. Looking back at its history, we can find itsreferences in the below mentioned literature:Vedic Period: Brahmana, Samhita, Upanishad, Kalpasutra, Purana(2000 – 1000 B.C.) Rigveda and Atharvaveda enumerate Usheera in the name of Virana orVirina among the grasses3. Sayana has mentioned the use of Virana and also as atuft of grass4. In Koushika sutra5, its several benefits are explained. Shatapathabrahmana, Grihya sutra and Katyayana sutra have described Virana as a bunch ofgrass2. Utilization of Usheera in the making of mats and bags from the root fibresof Virana was known from the time of Kashika and Prashastapada6. It wasextensively used as a coolant says Markandeya Purana7,9. Yajnavalkya smritienlists Usheera among the Gandha/Sarvagandha dravyas6. 40
  55. 55. Conceptual study UsheeraSamhita period 1000 B.C – 500 A.D Shrimad Bhagavatham quotes Usheera as one of the Sugandha dravya7 andas being employed as a coolant. It is said that Lord Buddha meditated on themattress made of Usheera when he got enlightenment8.Charaka Samhita: Acharya Charaka enrolls Usheera among the Shukra shodhaka,Chardinigrahaka, Dahaprashamaka, Angamardaprashamaka, Varnya, Kandughna,Stanyajanaka and Trushnanigrahaka Dashemani in Sutrasthana9. It is accounted asthe foremost Pralepaka dravya in Daha, Tvakdosha and Svedana10 and as one ofthe Mrudu dhumapana dravyas10. Aphrodisiac preparations like Amrutadi taila, Vidangadi taila and theiradministration techniques are dealt in Chikitsa sthana apart from fifty and abovepreparations beneficial in various disorders. Usheera forms one of the primeingredients in the Mahasugandhinama Agada yoga which is expounded to be avital emergency remedy in cases of Sarvavisha, Jwaradi rogas related by LordShankara to Kubera11.Sushruta Samhita : Usheera finds its place among Sushruta’s Sarivadigana, Pittasamshamakadravya, Eladi gana and Surasadi gana12. Sushruta directs that it is a Truna and itsSugandhimula is its officinale part12. Forty five and above preparations of Usheerais described in various indications. Chitrakadi yoga and Mustadiyapana basti areillustrated as Vrushya yogas containing Usheera in them. The benefits of Usheerain Mahasugandhinama agada yoga are described by Sushruta in Kalpasthana13.Ashtanga Hrudaya: Customisation of Usheera in various forms for both internal and externalpurpose is advocated in Sharad rutu14. Usheera is under the Sarivadigana tiktaskandha and Pittahara dravya in Sutrasthana15. Describing specific lepas to beemployed in different Rutus, Usheera lepa has been advocated in Vasanta rutu16. 41