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Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study - Dr. Kalavati. D. Petlur, Department of Dravya Guna, Post Graduate Studies & Research ...

Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study - Dr. Kalavati. D. Petlur, Department of Dravya Guna, Post Graduate Studies & Research Centre, D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE,GADAG

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    • Evaluation of Efficacy of Plaksha Twak Churna in the Management of Shweta Pradara A Comparative Clinical Study By Dr. Kalavati. D. Petlur Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Dravya Guna Under the Guidance of Dr. Kuber Sankh M.D. (Ayu) and Co-guidance of Dr. Shashikant Nidagundi M.D. (Ayu) Department of Dravya Guna Post Graduate Studies & Research Centre D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
    • D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG - 582 103 This is to certify that the dissertation entitled “Evaluation of Efficacy of PlakshaTwak Churna in the Management of Shweta Pradara A Comparative Clinical Study” is abonafide research work done by Dr. Kalavati. D. Petlur in partial fulfillment of therequirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)”Under Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.Dr. Shashikanth Nidagundi Dr. Kuber Sankh M.D. (Ayu) M.D. (Ayu)Co- Guide GuideLecturer in Dravya Guna Asst.ProfessorDGMAMC, PGS&RC, GADAG Dept. of Dravya Guna DGMAMC, PGS&RC, GADAGDate: Date:Place: Gadag Place: Gadag
    • J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTRE GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled “Evaluation of Efficacy of PlakshaTwak Churna in the Management of Shweta Pradara A Comparative ClinicalStudy” is a bonafide research work done by Dr. Kalavati. D. Petlur under the guidanceof Dr. Kuber Sankh , M.D. (Ayu), Asst. Professor and Dr. Shashikanth Nidagundi,M.D. (Ayu), in partial fulfillment of the requirement for the post graduation degree of“Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi University ofHealth Sciences, Bangalore, Karnataka.. (Dr. G. V. Mulagund) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Dravya Guna DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place: Gadag
    • Declaration by the candidate I here by declare that this dissertation / thesis entitled “Evaluationof Efficacy of Plaksha Twak Churna in the Management of ShwetaPradara A Comparative Clinical Study” is a bonafide and genuineresearch work carried out by me under the guidance of Dr. Kuber SankhM.D.(Ayu) Professor and Dr. Shashikanth Nidagundi M.D.(Ayu),Lecturer in Dravya Guna, DGMAMC, PGS&RC, Gadag.Date :Place : Gadag (DR. KALAVATI. D. PETLUR)
    • © Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminatethis dissertation/ thesis in print or electronic format for the academic /research purpose.Date :Place : Gadag (DR. KALAVATI. D. PETLUR)© Rajiv Gandhi University of Health Sciences, Karnataka
    • ACKNOWLEDGEMENT This is a moment of great pleasure and Contentment for me as writingAcknowledgment is the last phase in completion of this research work. At the onset my devotional pranamas to Shri Sainath, Shiradi Math and HolinessSri. Jagadguru Abhinava Shivanada Swamiji, Shivananda math, Gadag. I take this glorious opportunity to acknowledge with deep sense of gratitude to Dr.G.V. Mulagund, professor, Head of the Dept, Department of post graduate studiesresearch (Dravyaguna) D.G.M.A.M.C,Gadag for his valuable guidance and closesupervision during the entire phase of the study. I take this opportunity to acknowledge with the deep sense and gratitude to myguide Dr. Kuber Sankh. Asst. Professor, Department of post graduate studies andResearch (Dravyaguna) D.G.M.A.M.C,.Gadag for their valuable guidance and closesupervision during the entire phase of the study. My profound gratitude to my co- guide Dr. Shashikanth Nidagundi, lecturer,Department of Post graduate studies and Research (Dravyaguna) D.G.M.A.M.C, Gadagfor their good and valuable guidance through out this dissertation work. With profound sense A gratitude I express my sincere thanks to Dr. G.B. Patil,beloved Principal , D.G.M.A.M.C. Gadag, I thank Sri. S.B. Saunshi, Chairman and all thecommittee members for their constant encouragement, facilities provided and moralsupport during my post graduate study. I wish to add my warmest thanks to my PG teaching faculty, Dr. K.S. Paraddi, Dr.G.S. Hiremath, Dr. M.C. Patil, Dr. K. Shivaram Prasad, Dr. Shashidhar Doddamani, Dr.Santosh Belavadi, Dr. Jagadish Mitti, Dr. Raghavendra Shettar, Dr. GirishDanappagoudar, Dr. Veena Kori, Dr. Ashok Patil for their valuable suggestions andtimely help made me to complete this dissertation work successfully, I thank Dr. G.B. Mulugund, Prof and H.O.D, Department of P.G studies inDravyaguna GAMC, Bangalore. For their constructive suggestions and encouragement inpreparing this dissertation. I sincerely thank P.M. Nandakumar statistician, Sri. V.M. Mundinamani,Librarian, Sri. Lakkundi, Photographer, Sadguru Computers for their timely help duringmy study. I
    • I express my sincere thanks to Dr. Chandrakant. S. Hiremath, Principal ShriRaghavendra Ayurvedic Medical College, Malladahalli for their kind support. I extend my greatfulness to my colleague Dr. G.S. Kulkarni who helped meduring my dissertation work. I extend my gratefulness and sincere heart felt gratitude tomy colleagues Dr.Kavita Mittalkod, Dr. R.A. Malwad, Dr. Jaya Malgoudar, Smt. P.K.Belavadi and other office staff for their timely support and encouragement got during thecourse. I am very thankful to my friends Dr. Mukta, Dr. Savita, Dr. Jaya, Dr.Sarvamangala, Dr. Veena, for their help and co-operation during the study. I wish to thank Principals of Rajeev Gandhi D.Ed. College, Anglo Urdu D.Ed.College of Gadag R.M.O and all the physicians and other staff of the hospital and all mypatients and their assistants for their co-operation during my clinical study. And I expressmy deepest gratitude to my beloved Parents Devendrappa, Smt. Laxamavva and mybeloved Husband Rachappa and my lovely daughter Sunanda, my brother Mr & Mrs.Mahantesh, Udayavani, and family members, my aunty Shanta who have inspired me tocontinue my PG study with their constant moral support. I wish to thank G.B. Mamdapur, Chairman and all the committee members ofS.VP.R.A.M.C. Badami for their economical support.Place: GadagDate: (K. D. Petlur) II
    • ABBREVIATIONA.H. Astanga HridayaA.P.I. Ayurvedic Pharmacopoeia of IndiaA.S. Astanga sangrahaB.P. BhavaprakashaB.R. Bhaishajya RatnavaliBP.N. Bhavaprakasha NighantuC.Chi Charaka Samhita Chikitsa SthanaC.S. Charaka samhitaD.N. Dhanwantari NighantuPVS Dravyaguna Vijnana By Priyavrat SharmaVMG Dravyaguna vijnana By V.M. GogteD.G Dravyaguan vijnana.I.M.M. Indian Materia MedicaI.M.P. Indian Medicinal PlantsK.N. Kaiyadeva NighantuM.D. Madhava DravyagunaM.N. Madanapala NighantuN.A. Nighantu AdarshaR.N. Raja NighantuR.R.S Rasa Ratna SamucchayaR.S.S Rasendra Sara SangrahaS.S Sushruta SamhitaS.N Shaligrama NighantuSha.Sam Sharangadhara SamhitaY.R. Yoga Ratnakar III
    • ABSTRACT Shweta pradara is one of the commonest problems of women. Women suffer fromleucorrhoea at least once in a while during their lifetime. Recurrence also is a commonphenomenon and it occurs mainly due to infections by bacteri, fungi and protozoa.Usually it occurs in unhygienic conditions, but can also occur after some surgicalprocedures and at the time of delivery. This condition is described in ayurvedic classicsby the term shwetapradara as a symptom in various vaginal related diseases (yonivyapat).Though there are different modes of treatment for yonivyapat, the significant one is localtherapy. Hence this study was conducted to find out some suitable drug for this procedureand Plaksh (Ficus lcaor) was selected. Here study is aimed to evaluate the effect ofPlaksha twak churna in Shweta pradara.OBJECTIVES 1. Pharmacognoistical evaluation of Plaksha, Preliminary phyto chemical study, Macroscopical evaluation, Standardization and validation. 2. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta pradara. 3. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the management of Shweta pradara. 4. To evaluate the comparative effect of Plaksha twak churna orally and kashaya as trans vaginal douche in the management of Shweta pradara.METHOD In this prospective comparative clinical study, 30 patients randomly selected andGrouped as A and B receiving Plaksha twak churna with Madhu and Plaksha twak churna IV
    • kashaya as trans vaginal douche respectively for the study duration of 21 days from theday of initiation of medication with dose of 4 gms with honey BD. The patients are askedfor the reporting every 7th, 14th and 21st days efficacy was assessed by the difference ofbefore and after the treatment from the subjective and objective parameters.RESULTS Individually all the 2 groups showed highly significant in subjective as well asobjective parameters comparatively group A shows more significant then the group B.INTERPRETATION & CONCLUSION The statistical analysis is done by using student’s paired t-test, by assuming thatthe drug is not responsible for changes in the readings before and after treatment. Fromthe analysis all parameters shows highly significant (as p<0.05). The parametersExcessive Vaginal Discharge, Vaginal ph, Vaginal Smear and Extensive prurtis showsmore highly significant than the other parameters ( as p<0.001). and the parametersPersistent vulval moistness and General weakness shows less highly significant (asp>0.001). The percentage of improvement in the parameters is Excessive Vaginal Dischargewith 96.66667, Persistent vulval moistness with 91.42857 %, Extensive pruritis with91.11111%, General weakness with 93.47826%, Pain in lumbar region with 87.5%,Vaginal ph with 26.89394 % and Vaginal Smear with 100% from the study.KEY WORDS Plaksha (Ficus lacor), Madhu (Honey) Leucorrhoea; Methods; Clinical study; Results; V
    • CONTENTS Page No.1. Introduction 1-22. Objectives 3-33. Review of literature 4-60 a) Drug Review 4-32 b) Disease Review 33-60 4. Methodology 61-74 5. Results 75-105 6. Discussion 106-118 7. Conclusion 119-120 8. Summary 121-121 9.Bibliography 122-13110.Annexure VI
    • LIST OF TABLES DRUG REVIEW TABLE 1 PLAKSHA Page No.Table 1.1 – Showing Gana and Varga according to different 7 classicsTable 1.2 – Showing Prayaya according to different authors. 8-10Table 1.3 – Showing Guna according to different authors 20Table 1.4 – Showing Karma according to different authors 21Table 1.5 – Showing Prayojya anga according to different authors 22Table 1.6 – Showing Prayoga according to different authors. 23Table 1.7 – Showing the Matra according to different authors. 24Table 1.8 – Showing the use of Plaksha in different yogas. 25Table 1.9 – Showing Pharmacological action of Madhu 30 TABLE. 2. DISEASE REVIEW Page No.Table 2.1 – Showing the Swaroopa of Shuddha Artava 40Table 2.2 – Showing the Nidana of Shweta pradara. 40Table 2.3 – Showing the Yoni rogas in which Shwetasrava is 42 considered as a symptomTable 2.4 – Showing the Sthanika lakshanas of Shweta pradara 43Table 2.5 – Showing the Pathyapathya in Shweta pradara. 46Table 2.6 – Showing the Incidence of cause of Leucorrhoea 55 TABLE. 3. OBSERVATIONS AND RESULTS Page No. Table 3 a) Showing the Physical constants & found values of Bark 74 powder of Plaksha. Table 3 b) Showing the Thin layer Chromatography analysis of 74 Aqueous extract. Table 3 c) Showing the Phytochemical components and found 75 values of bark powder of Plaksha. Table 3.1 Showing the incidence of Menstrual history 77 Table 3.2 Showing the incidence of Age 78
    • Table 3.3 Showing the incidence of Socio-economic status 79Table 3.4 Showing the classification of Patients based on their 80 PrakrutiTable 3.5 Showing the incidence of Dietic pattern 80Table 3.6 Showing the incidence of Nidhana 81Table 3.7 Showing the result by religion in Shweta pradara with 82 Plaksh twak churna.Table 3.8 Showing the result by occupation in Shweta pradara 83 with Plaksh twak churna.Table 3.9 Showing the Economic status in Shweta pradara with 83 Plaksh twak churna.Table 4.0 Showing the result by Diet in Shweta pradara with 84 Plaksh twak churna.Table 4.1 Showing the percentage by presenting complaints. 84Table 4.2 Showing the percentage of distribution of patients by 84 Associated complaints.Table 4.3 Showing the percentage of Ahara Nidana observed in 84 the studyTable 4.4 Showing the percentage of Vihara Nidana observed in 84 the studyTable 4.5 Showing the percentage of Manasika Nidana observed 85 in the studyTable 4.6 Showing the Chronisity of Leucorrhoea observed in the 85 studyTable 4.7 Results of Plaksha twak churna in Swetapradara 85Table 4.8 Showing the grades of Excessive vaginal discharge 85 Before treatment in Group A & B.Table 4.9 Showing the grades of Excessive vaginal discharge 86 After treatment in Group A & B.Table 5.0 Showing grades of Persistent vulval moistness Before 86 treatment in Group A & B.Table 5.1 Showing grades of Persistent vulval moistness After 86 treatment in Group A & B
    • Table 5.2 Showing grades of Extensive pruritis before treatment 87 in Group A & BTable 5.3 Showing grades of Extensive purities after treatment in 87 Group A & BTable 5.4 Showing grades of General weakness before treatment 87 in Group A & BTable 5.5 Showing grades of General weakness after treatment in 87 group A & B.Table 5.6 Showing grades of pain in lumbar region before 88 treatment in Group A&BTable 5.7 Showing grades of pain in lumbar region after 88 treatment in Group A&BTable 5.8 Showing the grades of Draging sensation before 89 treatment in Group A & B.Table 5.9 Showing grades of Draging sensation after treatment in 89 Group A & B.Table 6.0 Showing the distribution of Patient by Degree of 89 vaginal pH before and after treatmentTable 6.1 Showing the distribution of Patient by Degree of 89 vaginal smear before and after treatmentTable 6.2 Showing the Statistical Analysis of both the groups, 90 Before and after treatment and Percentage of improvement with respect to excessive vaginal discharge.Table 6.3 Showing the Statistical Analysis of both the groups, 91 Before and after treatment and Percentage of improvement with respect to Vulval moistrness.Table 6.4 Showing the Statistical Analysis of both the groups, 91 Before and after treatment and Percentage of improvement with respect to Extensive Pruritis.Table 6.5 Showing the Statistical Analysis of both the groups, 92 Before and after treatment and Percentage of improvement with respect to General weakness.
    • Table 6.6 Showing the Statistical Analysis of both the groups, 93 Before and after treatment and Percentage of improvement with respect to Pain in Lumbar region.Table 6.7 Showing the Statistical Analysis of both the groups, 93 Before and after treatment and Percentage of improvement with respect to Vaginal pH.Table 6.8 Showing the Statistical Analysis of both the groups, 94 Before and after treatment and Percentage of improvement with respect to Vaginal Smear.Table 6.9 Analysis table by using student t- test 95Graph No. LIST OF GRAPHS Page No. 1 Showing the incidence of Menstrual history 77 2. Showing the incidence of Age 78 3. Showing the incidence of Socio-economic status 79 4. Showing the classification of Patients based on their 80 Prakruti. 5. Showing the incidence of Dietic pattern 80 6. Showing the incidence of Nidhana 82 7. Showing the incidence of Religion 82 8. Showing the distribution of patient by occupation 83
    • LIST OF PHOTOGRAPHS Plate No 1 Plant Plaksha (Ficus lacor) Fig. 1 Plaksha twak (Ficus lacor) Fig. 2 Plaksha twak churna (fine) Fig. 3 Madhu Fig. 4 Plaksha twak churna (course) Fig. 5 Plaksha twak kashaya Fig. 6 Vaginal douche Plate No 2 T.S. of Bark stem Fig.10 Microscopic view of Powder (Plaksha) Plate No 3 TLC of Plaksha twak churna Fig. 11 Dragendroff Fig. 12 UV LIST OF MASTER CHARTS Page NoMaster Chart 1 Assessment of subjective parameters in Group –A 96 98Master Chart 2 Assessment of objective parameters in Group –A 99Master Chart 3 Assessment of subjective parameters in Group –B 100Master Chart 4 Assessment of objective parameters in Group –B
    • Introduction INTRODUCTION In present era abnormal vaginal discharge is quite frequent complaint of womenin gynaecologic clinic1. Shweta pradara troubles more than 75% of women during theirlife. Most of the women are working, due to change in life style, food, habit, work load,faces lots of stress and strain. Women are subject to large number of complaints andconnected with genital organs. Gender differences play a role in manifestation of diseaseand health out comes. The disease Shweta pradara based on theoretical and clinical symptoms can becompared to Leucorrhoea. The pathogens like Trichomonas vaginalis 94.5%), Ngenorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea2.Gynaecological complaints includes leucorrhoea, disfunction uterine bleeding, pelvicinflammatory disease etc, among them leucorrhoea is more prevalent. The externalgenitalia with long tubular content is susceptible to the infectious conditions from pubertytill menopause, either because of unhygienic conditions or coital and evenphysiologically. Wide variety of reasons are encountered in its causation, commonly fungal,parasitic, bacterial and sexually transmitted diseases. Most secretions are regarding lifecycle physiological and warrant no medical interventions. But it is significant if it isblood stained, profuse, foul smelling or changes in its colour. If not treated infection maycontinue for months even years and may spread to other areas of genital tract3. Though there is an established line of treatment for leucorrhoea in the allopathicsystem of medicine, most of the drugs fail to cure the disease completely and recurrence 1Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Introductionis common. Many ayurvedic formulations have been evaluated clinically, and Plaksha isone of the new drug taken up for the trial in this study. Ayurveda is the safest curative system. There are many drugs described inayurvedic literature for Shweta pradara among them plaksha4 (Ficus lacor) is one of themost potent drug for Shweta pradara. On the basis of authentic classical references theeasy availability of a drug and cost effectiveness developed interest in selecting this drugfor Shweta pradara. An effective remedy for shweta pradara is Plaksha twak. (Ficus lacor) comesunder the kashaya skandha and is one among panchavalkala. Due to its kashaya rasa itacts as rakta stambhaka and grahi. Due to its sheeta veerya and laghu ruksha qualities actsas vranashodhana and vrana ropana5-9, so these actions are extremely beneficial in curingshweta pradara. A warm vaginal douche of plaksha twak churna kashaya is beneficial togeneral cleansing and elimination of purulent discharge. Plaksha twak churna have manymeans to kill fungus, bacteria, parasite as its acts as krimighna. In present study is aimed to evaluate the efficacy of Plaksha twak churna in themanagement of Shweta pradara with the view to find out therapeutically efficacious,safer, cost effective and easily available drug. 2Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ObjectivesOBJECTIVES 1. Pharmacognoistical evaluation of Plaksha. a. Macroscopical evaluation b. Microscopical evaluation c. Standardization and Validation. 2. Preliminary phyto chemical analysis of Plaksha. 3. TLC of Plaksha. 4. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta pradara. 5. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the management of Shweta pradara. 6. To evaluate the comparative effect of Plaksha twak churna orally and kashaya as trans vaginal douche in the management of Shweta pradara. 3Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review DRUG REVIEWHistorical aspect of the Drug Plaksa is one of the ficus species and is member of group vanaspatya chatustayaalong with aswattha, udumbara, nyagrodha. The plant is mentioned in vedic samhitas.Brahmanas and kalpa sutras10. Plaksha is used in the Indian system of medicine since antiquity and it has beenmentioned in Yajurveda, Charaka samhita, sushruta samhita, Astanga hridayam, Bhav-Prakasha and in various Nighantus like Dhanwantari Madanapala and texts of Ayurvedaand Yunani, Panini, the great grammarian of Sanskrit refers the principal tree of NorthIndia including Plaksha in his Astadhyas of Panini “(Agarwal, 1952)11. Madanapal described described the drug Plaksha as visarpajit i.e it cureserysepalas. Plaksha is extensiovely used ion the treatment of ulcers along with the fouringredients in the groups panchavalkala. The four drugs are the root barks of ficusglomerata, Ficus religiosa, Ficus bengalensis and Azardirachta indica. The healing takesplace properly when oils and ointments containing Plaksha are used. It’s fruits have been described in charaka samhita (su 27, 164) and shushrutasamhita (su. 46,165) along with other ficus fruits. It is also mentioned in visnu (1,22,9) and Bhagawata (5,20,2) puranas andraghuvamsha (8,93).Charaka: described it as mutra sangrahaniya while susruta and vagbhata have mentionedit under Nyagrodhadi gana. It is considered as one of the ksiri vrksas or pancha valkalasby Bhavamisra. 4Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewShatapathabrahmanha: gives reference pertaining to plaksha. One among vanaspatisand beneficial in the Yajna (Homage) Plaksha, Kashmarya, Ashvattha, Udumbara,Pitudaru, bilwa are shrestha, vetasa is Nikrastha.Etareya brahmanha: We come across the reference about these vanaspatis. Pranou vaivanaspati (E.Br. 2/4,20) 5/23, 7/32) Chatusta vanaspatis are Plaksha, Nyagrodha,Udumbara, Asvattha. (E.Br. 6/16)Kalpasutra: Gives the reference about the usage explained like Plakshodumbara.Panini: Mentioning of the vanaspatyadi gana (6/2/140) Plakshodumbara.Vattikakar: Description regarding vanaspatis (1/4/12)Bhattoji: Give the reference with an examples as “Plakshanyagrodhou”Taittiriya samhita: The references as Plakshanyayagrodhakhadirpalasha (6/3/20/2)Usage of “Praksha” word. One among Kshirivruksha In the unmada roga havan byplaksha is told. Fruits of this tree are edible. In the yajna usage of plakshakha explained.Darila: We come across the reference of Plakshodumbar “Pipariti” is supreme.In Yajurveda: Reference as Plaksha is one among vanaspatis.Patanjala: Reference as that “Plakshodumbara”Sushruta Samhita: Reference regarding Kshirivruksha such as plaksha, Nygrodha,Udumbara, Ashwattha these four vanspatis included in the “Vishnu sahasranam” even petnames of God Vishnu. Specific references are available regarding ‘plaksha’ cÉiÉÑhÉÉï ¤ÉÏUÏuÉפÉÉhÉÉqÉç (xÉÑ. 1/4) ¤ÉÏUÏuÉפÉMüwÉÉrÉ (zÉÑ.ÍcÉ. 16/13; 46/433) iÉcÉÈ ÌmɹuÉ ¤ÉÏËUhÉÉqÉç (xÉÑ.ÍcÉ. 20/34) Told ÌuÉSìÍkÉ ÍcÉÌMüixÉÉ WåûiÉÑ (ÍcÉ.16, /13) 5Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review ¤ÉÏUÏuÉÑ¤É MüwÉÉrÉ Told. In the context of “Nyagrodhaadi gana” explaination regarding plaksha, kapitana,Nyagrodha, Udumbara, Ashwatha. Shushruta clearly mentioned Panchakashayaprayojana in detail12. uÉÉiÉeÉ MühÉïzÉÔsÉ – MühÉïmÉë¤ÉÉsÉlÉ and MühÉïmÉÔUhÉ by mÉlcÉMüwÉÉrÉ YuÉÉjÉ, cÉÑhÉï. (xÉÑ.E. 11/42) SÒaÉÉïÎlSiÉ ÌmÉÎcNûiÉ rÉÉåÌlÉ – mÉlcÉMüwÉÉrÉ cÉÔhÉï – mÉÔUhÉ, mÉlcÉMüwÉÉrÉ YuÉjÉ – kÉÉuÉlÉ (xÉÑ.E. 36/25)Charaka Samhita: In Charaka samhita specification of Panchavalkala (Ch. 22/14),Panchakshirivruksha (Chi. 11/44) Nyygrodhadhaischturbi (Si. 10/37) toldmÉlcÉuÉsMüsÉ, mÉlcÉMüwÉÉrÉ – irÉaÉëÉåkÉ, AμÉijÉ, ESÒqoÉU, msɤÉ, uÉåiÉxÉ explained. (Ch. 15/41)Astanga Hradaya: In the context of chikitsa Shofanirvanartha, nygrodhadipanchavalkala explained. (Ch. 15/41)Vagbhat: Vagbhat attributed the same opinion as that of charaka, Shofa nirvapana hetu(chi. 15/16) Nayagrodhadi four drugs with vetasa valkala told chandanadi ghrita (chi10/42)Brahatrayi: Especially the manifold actions of the drugs mentioned are highlighted bythe synonyms, Kshiri vruksha kashaya, valkala, specifically Nyagrodha, Udumbara,Ashvattha, Plaksha known as Panchavalkala and panchakshiri. Different opinionsregarding these five drugs.Chakrapani: Reference regarding “Panchavalkala kashaya” In this context vetasa told.In the chapter on “dviruniya” Shofanirpanha hetu (Chi. 25/46) these 4 drugs vetasavalkala ghruta mishrita pralepa told. Visarpa chikitsa hetu (Chi. 12/84) 4 drugs with 6Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Reviewvetasa, pallava, valkala kalka gruta mishrita- pralepa In panchaksheeravruksha prasangawith 4 drugs + kapitana told.Dalhana: In this (Vi.Chi) references regarding Nyagrodha, Udumbar, ashvatta, plakshagardabhanda told. Anupana vivechana (Su. 46/433) and vranashodhana hetu prayukta‘kashayanam’ hetu (chi. 20/16) (Chi. 2/66) ‘Kshiri’ i.e kshudraroga chikitsa. Dalhana toldtwachaha pishtava kshireenam and vatadi pancha kshirini vruksha twacha told.Utpatti13: msɤÉÉå qÉåkÉålÉ – iÉæ 7/4/12/1 iÉxrÉ (SæuÉæUÉsÉprÉqÉÉlÉxrÉ mÉzÉÉåÈ) AuÉÉQÒû qÉåkÉÈ mÉmÉÉiÉ | xÉ LuÉ uÉlÉxmÉÌiÉUeÉÉrÉiÉ | iÉÇ SåuÉÉÈ mÉëÉmÉzrÉlÉç | iÉxqÉÉiÉçç mÉëZrÉÈ| mÉëZÄrÉÉå Wû uÉæ lÉÉqÉæiÉSè, rÉiÉç msÉ¤É CÌiÉ’- zÉ0 3/8/12)Table No-1.1 Ganas and vargas according to different classicsCharaka samhita Mutra sangrahniya kasaya skandhaSushruta samhita Nyagrodhadi Phala vargaAstanga hridaya NyagrodhadiBhavaprakasha Nighantu (Kshirivriksha) vatadi varga panchavalkalaNighantu Adarsha Vatadi vargaKaiyadev Nighantu Oushadhi vargaRaj Nighantu Amradi vargaDhanvantari Nighantu Amaradi vargaMadanapala Nighantu Vatadi vargaShaligram Nighantu Vatadi varga 7Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review Abhidana Ratnamal Kashaya dravya skandha Madhav dravya guna Vividoushadi varga Amara kosha Vanoushadi varga Table No-1.2 Paryayas according to different authorsSynonyms CS14 SS15 AH16 BN17 KN18 RN19 MN20 NA21 Ab AK23 SN24 SKD25 R22Plaksha + + + + + + + + + + + +Jathi + + + + + +Parkari + +Parkati + + + + + +Pippari +Shrungika +Vathi + + + +Pugamunda +Gardabhanda + + + + + +Kamandalu + + + +Plava + + +Gandhamunda +Charudaru +Suparshva + + + + + +Charudarshana + + +Mundika + 8 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewAshwath patra + +Kapitana + +Ksiri + + + + +Shrangi + +Varohashakhi + +Kapitaka +Drada praroha + + +Plavaka + +Plavanga + +Mahabala + +Hrsva plaksha + +Sushita +Shitaviryaka +Pundra + +Mahavaroha + +Hrsva parna + +Pimpari + +Bhidura + +Mangalacchaya +Charuvrksha +Garbha +bhandaka 9 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewPippari + +Yupa +Pippalapadapa + +Kapotana +Pitana +Ashwatthi +Karpari +Plavaksha +Shungi +Avarohashakha +Ploksha +Sukshma +Sushouta +Shoutavarnyak +Bhitura + Paryayas and its meanings26 1) msÉ¤É - mÉë¤ÉUÌiÉ CÌiÉ msɤÉÈ | Spreading much more 2) msɤÉÌiÉ: AkÉÉå aÉcNûÌiÉ msÉ¤É = mÉëÌiÉ AkÉÉå aÉcNûÌiÉ qÉÔsÉÉæ CÌiÉ | By its Jatha rupa root facing towards down. 3) eÉPûÏ : eÉOûÉ xÉÉÎliÉ AxrÉ CÌiÉ eÉOûÏ | (N.A) 10 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review Here Jata found 4) eÉOûÌiÉ – xÉÇbÉÉiÉÏ pÉuÉiÉÏÌiÉ | ‘eÉOû xÉÇbÉÉiÉå’ (N.A) It founds as Jata all at one 5) mÉMïüOûÏ : mÉMïüOûÉZrÉÇ TüsÉqÉxrÉ mÉMïüOûÏ | rÉSè uÉÉcÉxmÉÉÌiÉ: = TüsÉÇ iuÉålÉxrÉmÉMïüOûqÉç | mÉ×crÉiÉå xÉqrÉMçü xÉÇoÉkrÉiÉå uÉëhÉÉÌSwÉÑ CÌiÉ | (N.A) Best remedy in Ulcers 6) ÌmÉmmÉsÉmÉÉSmÉ: A synonym told by ¤ÉÏUxuÉÉqÉÏ 7) Suparshwa – Few branches and many adventitious roots growing down word 8) Kamadalu – Probably indicates the habitat near fresh water or it may also refer to shape of fruit. MODERN REVIEW OF THE DRUG PLAKSHABotanical Name27: Ficus lacor Ficus = From an original Arabic word meaning fig Lacor = or thespasia populuca = divine.VERNACULAR NAMES28Latin Name : Ficus lacorSanskrit : Ashvatthi, charudarshani, Dradapraroha, Gardabhanda, Jati, KamandalrohataruHindi : Kahimal, Kaim, Pakar, Pakri, KhabarMarathi : Bassari, Lendwa, PakariGujarati : Pepri 11Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewTelgu : Badijuwi, Jati, JuvviKannada : Basarigida, Juvvi, Hasuri, Karibasari, Kadubasari, Jeevibasari, BasaBengal : Pakar, PakurEnglish : Wave leaved fig treeTamil : Jovi, Kallal, Kurugatti, KuruguMalayalam : Bakri, Chakkila, Chela, Itti, JathiBengal : Pakar, PakurBombay : Bassari, kaim, pakri, pipliKolami : BaswesaKonkani : KillahKurku : Pepere, pepreLambadi : KatipipriNepal : Safed kabraNorth-west provinces: PakurPunjab : Batbar, Jangli pipliSindhalese : Kalha, KiripellaTulu : Basari goliThana : KelUrdu : PakhariUriya : Pakodo, RushorchonaCan : Juvi, kari 12Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewCLASSIFICATION OF PLAKSHA Plaksha has been mentioned in various Ganas due to its manifold actions bydifferent authors. They have been listed below.Botanical Classification29Kingdom – PlantaeDivision – MagnoliophytaClass – MagnoliopsidaSub class – RosidaeOrder – RosalesFamily – MoraceaeGenus – FicusSpecies – FicusDiagnostic features of Family Moraceae Plant usually trees and shrubs with stipulate leaves; latex present, Inflorescencecymes of small male and female flowers, perianth usually 4 gamo-or polyphyllous,persistent, stamens 4 opposite to tepals; gynoecium bicarpellary, synacarpous, superior,unilocular, fruit nut or drupe.Distribution30 It is commonly called Mulberry family and consists of 53 genera and 1400species. It is distributed in warm temperate, tropical and substropical countries of theworld. In India the family represented by about 104 species belonging to 15 genera. 13Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewVegetative characters:Habit – Mostly trees (Morus, Ficus), shrubs or climbers rarely herbs (Dorstenia), mostlywith lates.Root – Tap root, branched, produce adventitious aerial roots (Ficus sp)Stem – Aerial, erect or climbing, cylindrical solid, branched, woody, gum may be exudedfrom the surface.Leaf – Alternate usually simple, cauline, ramal, in some, stipulate stipules large andleafy, caduceus, entire or deeply lobed, or serrate, glabrous or glaucous, reticulate-unicostate or multicostate.Floral CharactersInflorescence – catkin (Morus) or hypathodium (Ficus) or globose heads(Plecospermum).Flower – Small, inconspicuous, bacteate, or ebracteate, incomplete usually unisexual,monoecious (Ficus, Morus) or dioecious, actinomorphic, hypogynous, clclic. In Ficusfive types of Flowers viz.1. Male with pistillode, 2. Female flower, 3. Male without pistillode, 4. Female with shortstyle, 5. Sterile flowers.2. Perianth – 2 to 6, two in Ficus carica, four in Morus, six in other Ficus spp. Free orunited, inferiou, usually green, persistent, valvate or imbricate in bud; sometimes absent.Male flowersPerianth – As above.Androecium – 1 to 6 in various specied of Ficus, 4 in Morus, bent or straight opposite toperianth leaves, introrse, bithecous, basifixed or dorsifixed. 14Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewGynoecium – Represented by pistillode.Female FlowerPerianth – As aboveAndroecium – AbsentGynoecium – Bicarpellary, syncarpous, superior, unilocular, ovule solitary or two, erector pendulous, style simple or bifid, stigma 1 or 2, linear of filiform.Fruit – Sorosis (Morus), syconus (Ficus) etaerio of achenes or drupes (Maclura), berry(Cudrania).Seed – Endosperimic or non-endospermic.Pollination – Entomophilous or anemophilousFicus exhibits extraordinary way of pollination. The insects enter the hypanthodiumthrough apical opening to lay eggs in the ovaries of sterile flowers (or gall flowers). Theinsects cannot lay eggs in the ovaries of fertile female flowers as they are covered byhairs. The bodies of insects get dusted with pollen from the male flowers, then they enteranother hypanthodium and so come in contact with the papillose long styles of the fertilefemale flowers, in this way cross pollination is ensured.Flower formulae:Male flower –  0 P2-6 or (4) A1-6 or 3-8 G0 or pistillode.Female flower –  0 P2-6 or (4) or zero A0 G(2).Botanical DescriptionFicus lacor - A large spreading deciduous fast growing tree, all parts glabrous; barkgrey, smooth, scaly. 15Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewLeaves – membranous, 9-12.5 by 5-6.3cm. ovate or ovate-oblong, shortly and ratherabruptly acuminate, with entire, subundulate margins.Base – Usually rounded, slightly cordate, or sometimes narrowed or acute, 3-nerved;lateral main nerves 5-7 not very prominent.Petioles – 3.8 – 5.7 cm. long, some times indistinctly jointed with the blade;Stipules – about 13mm long, broadly ovate, acute, pubescent.Receptacles – axillary in pairs, sessile, globose, 6mm diam, whitish, flushed with red anddotted, when ripe; basal bracts, ovate- round, minute.Male flowers - few, bracte sessile near the mouth of the receptacles.Stamen1; another broadly ovate; Filament short. Sepals 4 or 5, Gall and fertile flowers;perianth as in the Male. Style of fertile female flowers long, of the gall folwers short;stigma elongate.Distribution: Plains and lower hills of India, Ceylon- Malaya.Pharmacognosy of Plaksha (Stem Bark)31 a) Macroscopic – Bark rough, occurring in flat to curved, quilled pieces, measuring 0.4-0.7 cm in thickness; external surface ash or whitish-grey; numerous transversely arranged lenticels; ranging from 0.1 cm – 1.3 cm in length, lip- shaped and exfoliating; internal surface rough, fibrous, longitudinally striated, reddish-brown; fracture, fibrous. b) Microscopic – Shows 5-8 layered cork consisting of thin-walled, rectangular cells, a few external layers exfoliating; secondary cortex very wide consisting of compactly arranged, rectangular, thick-walled, pitted cells, patches of circular to elongated, lignified, elliptical stone cells with radiating canals, a few with 16Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review concentric striations; a few prismatic crystals of calcium oxalate and reddish- brown contents found scattered throughout the secondary cortex; secondary phloem very wide consisting of mostly stratified layers of collapsed cells forming ceratenchyma, groups of fibres, phloem parenchyma, laticiferous cells, traversed by 2-5 seriate phloem rays; phloem fibres lingnified with wide lumen and pointed tips; thin-walled, rectangular, a few phloem parenchyma containing prismatic crystals of calcium oxalate. c) Powder – Reddish-brown; shows thick-walled parenchyma with simple pits; stone cells in groups and singles, prismatic crystals of calcium oxalate, elongated phloem fibres with wide lumen and pointed tips.Identity, Purity and StrengthForeign matter - Not more than 1 percentTotal ash - Not more than 10 percentAcid-insoluble ash - Not more than 1.5 percentAlcohol-soluble extractive- Not more than 5 percentWater-soluble extractive - Not more than 6 percentPharmacognosy of Plaksa (Fruit)32 a) Macroscopic: Fruit is a syconus, 0.5 to 1.0 in dia, attached with pedicel; sub- globose, wrinkled, glabrous, having three basal bracts; grayish- borown to yellowish-brown; taste, astringent. b) Microscopic: Fruits shows single layered, thin-walled epidermis followed by a narrow zone of 2 to 5 layers, of round, oval, rectangular, lignified stone cells with wide lumen; rest of mesocarp very wide consisting of oval to polygonal, 17Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review collenchymatous cells containing brownish contents; a few vascular traces found scattered in this zone; inner zone consisting of stone cells similar in shape and size to these found scattered in outer zone; male and female flower attached to inner of mesocarp. c) Powder – Dark grayish-brown; shows fragments of epidermal cells; single, or groups of lignified stone cells; collenchymatous cells; a few debris of male and female flowers present.Identity Purity and StrengthForeign matter - Not more than 2 percentTotal ash - Not more than 9 percentAcid-insoluble ash - Not more than 1 percentAlcohol-soluble extractive - Not more than 5 percentWater-soluble extractive - Not more than 15 percentTLC TLC of alcoholic extract on Silica Gel ‘G’ using n-Butanol: Acetic Acid: Water(4:1:5) shows in visible light three spots at Rf. 0.27, 0.63 (both grey) and 0.97 (yellowishgreen). Under UV (366 nm) six fluorescent zones are visible at Rf. 0.53, 0.63, 0.84, 0.91,(all blue) and 0.97 (pink). On exposure to Iodine vapour twelve spots appear at Rf. 0.12,0.16, 0.22, 0.27, 0.50, 0.63, 0.73, 0.84, 0.91, 0.94 and 0.97 (all yellow). On spraying withNinhydrin reagent a single spot appears at Rf. 0.97 (brick red).Constituents – Amino Acids 18Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewVARIETIES OF PLAKSHA:According to Bhavaprakasha Nighantu331. Jangala2. GramyaAccording to P.V. Sharma34Three varieties – 1) Var, infectoria 2) Var, lambertiana 3) Var, weightiana 4) Ficus lacor,Other species35 - 1) Ficus arnottiana 2) Ficus rumphii, Blume 3) Ficus talboti. G 4) Ficus retusa, Ficus microcrapa syn, Firetusa acuct 5) Ficus tsiela Roxb 6) Ficus tsjakela Burm f.Table No. 1.3 GUNAS (PROPERTIES) ACCORDING TO DIFFERENTAUTHORS.Properties BN36 DN37 MN38 RN39 KN40 NA41 SN42 P.V. Sharma43RasaKashaya + + + + + + +Katu - + + - + + -GunaSheeta + + + + + + + -Guru - - - - - - - +Ruksha - - - - - - - +VeeryaSheeta + + + + + + +Vipaka 19Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewKatu + + + + + + +DoshaghnataKaphahara + - + - + + - +Pittahara + + + + + + + +Phytochemistry: Stem bark44 – contains methyl ricinolate, caffeic acid, bergenin,lanosteral and B- sita sterol, sterols, sugar, Tannin, Alkaloid and saponin.(Carbohydrates, glycosides, Proteins, amino acids)Leaves – contain the flavonoids, scrbifolin -6-0- (arabinopyranosy 1- (1-2) – B-Dglucopyranoside) [(C27 H30O15, mp 340-420) and scutellarein 6-0B-glucoside.Fruit – Amino AcidsTannins45 – They have been known as astringents substances, having capacity tocombine with tissue proteins and precipitate them. They are used as antiseptics, in thetreatment of diarrhea, to check small haemorrhages. Tannin detoxifies the fungal infections, acts as tonic. They are agents whichcontract muscular fibers and control the abnormal secretions of mucous membranes.Tannins are soluable in water.Table No. 1.4 KARMAS ACCORDING TO DIFFERENT AUTHORSKarmas CS46 SS47 AH48 BP49 DN50 RN51 KN52 NA53 DG. 54 M P.V.56 HMK N55 SharmaVrana ropaka + + + + + + +Yonigata roga + + + + + + +Rakta vikara + + + + + + +Grahi + + +Shotahara + + + + +Vrana + + +prakshalana 20Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewMedahara +Visarpa + +Murcha + +Bhrma + +Pralapa + +Shamaka +Sthambhana + + +Mutrasangrah + + +aniyaSangrahaka + +Vistambakara +kaKaphapitta + + + + +NashakaDahaPrashananaRaktashodhanaStanya +Shonita +stapanaVarnya +Garbhashaya +shothaharaMukha +rogahara 21Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewTable No. 1.5 PRAYOJYA ANGAParts used P.V.57 RN58 BN59 NA60 Indian D.G.V Sharma material61 M.G62Bark + + + + + +Leaves - - - + + -Fruit - + - - - -Table No. 1.6 PRAYOGA ACCORDING TO DIFFERENT AUTHORSPrayoga CS63 SS64 AH65 B K R M D N D.G D.G. D.G74 P N67 N68 N69 N70 A71 P.V.S72 J.L. V.M.G 73 N 66 NShotha + + - + + + +Vrana + + + + + + +Rakta vikara + + + + +Visarpa + + + + +Raktapitta + + + + + +Raktapradara + + +Shwetapradara + +Prameha + +Atisara blood + + + +Pravahika + +Yonisrava + +Yoniroga + + +Daha + + + + + +Astanya +Stomatitis +Jvara + +Vidradi 22Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewPrayoga75: All parts are acrid, pungent, cooling; useful in diseases of the blood and thevagina, ulcers, burning sensations, biliousness, “kapha” inflammations, leprosy,hallucinations, loss of consciousness. The fruit is sour; the seeds are useful in bronchitis, biliousness, scabies, boils,inflammation. The bark of this, along with the barks of other four species of ficus and of meliaazadirachta, pass by the name of panchavalkala. They are used in combination. Adecoction is much employed as a gargle in salivation, as a wash for ulcers, and as aninjection in leucorrhoea. Nighantu describes this tree as cooling, pungent astringent and curative of Raktadosha, moorcha srama and pralapa. Bark enters the composition of Panchavalkala decoction of the bark is used asgargle in salivation; as a wash for ulcers and also as an injection in leucorrhoea. This alsocures yonidosha charaka prescribes a varti or suppository made with the pulversised barkto be inserted into the vagina in case of yoni-srava. As a vegetable, the leaves can beeaten as they are, by those who suffers from Raktapitta.Table No. 1.7 Matra (Posology) D.G. D.G. D.G. Indian Charak80 P.V.S76 HMK77 V.M. Gogte78 material79Powder - 3-5 gm -Decoction 50-100 ml 40-50 ml 50-100 ml 23Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewTherapeutic uses81Charaka – Erysipelas – cold paste of the tender leaves and bark mixed with profuse gheeshould be applied (cs.ci. 21.85)Charaka – Meno metrorrhagia – Lump of powdered bark of plaksha mixed with honeyshould be kept in lubricated vagina. (cs.chi. 30,119)Charaka – Inflammation – paste of bark of above drugs mixed with ghee form anexcellent anti-inflammatory agent (cs.ci. 25, 46)Sushrut – Diarrhoea with blood – Barks of plash sallaki and tinisa are pounded withmilk, mixed with honey and then taken (ss.u. 40.119)Bhavaprakasha – Intrinsic haemorrhage tender leaves of Plaksha vetasa etc andtanduliya etc are wholesome as vegetable (B.P. Ci. 9,18)Uses in othersystem of medicine In Chinese medicine bark diaphoreticTable No.1.8. USE OF PLAKSHA IN DIFFERENT YOGASS.L.No Yoga Indication Reference1 Changeri ghrita Raktarsha Bhel,sa 16/39/4012 Vranashodhana kashaya Vrana Bhel, sa 27/10/467-4683 Nyagrodhadhya ghrita Pradara, shweta, rakta, Bhai. R 93/2036-2037 Krishna, shrava, yonishrava4 Vatadi lepa Shotha C.S.Chi. 25/46/7055 Nyagrodhadi lepa Vrana C.S. Chi 25/63/7076 Panchavalkala churna Vrana C.S. Chi. 25/67/7057 Vrana shodhaka kashaya Vrana prakshalana C.S. Chi. 25/84/710 24Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review8 Nyagrodhadi ropanha kwatha Vrana ropanartha C.S.Chi 25/87/7209 Nyagrodhadi kashaya Vrana C.S. Chi. 30/84/85110 Nygrodhadi pralepa Vrana C.S.Chi. 30/46/811 Panchavalkalamr lepa Abhighataja Y.R.U 6/163/164 mutrakricchra, vataja mutrakrucchra12 Shatadhouta ghrita Raktaja vrana shotha Y.R. Chi 6/163/164 lepartha13 Nyagrodhadi kwatha Vrana shotha Y.R. Chi. 8/17614 Panchavalkaladi yoga Puya vrana Y.R. 10/17615 Gouradhya ghrita Vrana, sahaja, purana Y.R Chi. 1-4/183 nadi, vishama vrana16 Baladi taila Sadhya vrana ropana S.S. Chi 2/53/1917 Decoction of plaksha bark Stomatitis, Ulcer I.M.M. P 55118 Inj of Plakshatwak kashaya Leucorrhoea yonidosha I.M.M. P55119 Varti of pulversed plaksha Yoni srava I.M.M 551 bark20 Vaginal suppository of Menorrhagia A.Ph. logy P.659 plaksha bark powder leucorrhoea21 Vaginal douche of plaksha Menorrhagia A.Phology P 659 kashaya leucorrhoea22 Plaksha twak churna Yonisrava C. S. Chi 36/11623 Plaksha twak kwatha Vranaropanartha C. S. Chi. 13/85 25Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review24 Nyagrodhadi lepa Shotha Vr. Ma IInd vol 44/7 P- 57325 Preprn of ile & aintment Ulcers A.D. plant sources P- 37726 Usirasava Ulcers A.D. plant sources P- 37727 Gandhatailam Ulcers A.D. plant sources P- 37728 Nalpamaradi tailm Ulcers A.D. plant sources P- 37729 Dinesavalyadi Kulambu Ulcers A.D. plant sources P- 37730 Parantyadi taila Ulcers A.D. plant sources P- 37731 Valiya marma gulika Ulcers A.D. plant sources P- 377Research Profile821) Plaksha as anti inflammatory- Ficus lacor was studied experimentally for anti-inflammatory activity in caraginin induced paw edema. This showed a good result.However, in the classics it used or external application alone. Only two formulationshave reference for this drug to be one of the ingredients keeping this in mind anotherstudy was carried out though topical application of Plaksha kashaya in ear edema in rats 26Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Reviewinduced by croton seed oil. This method of application of this was 5 minutes parisheka(pouring in thin a stream of kashaya) in 1 hour and repetition of the same in every hourfor four hours. This was sufficient to produce significant anti-inflammatory effect. Thisstudy proved the drug to be having highly significant effect both as internal and topicalapplication.2) The caloric values and ash content in the leaves at different growth stages of five Ficusspecies (Ficus religiosa, F elastica, F. lacor, F. Microcarpa cv Golden-leaves, Fmicrocarpa) were studied. The results showed that the ash content increased with thegrowth of the leaves, the relatively high ash contents of old leaves were not the lowest,which indicates that the leaves have a mechanism to maintain the balance of nutritiouselements. The young leaves have relatively higher gross caloric value than mature andold leaves, gross caloric value in the leaves at different development stages vary withspecies. The gross caloric values in the leaves at different development stages havedistinct liner correlation with ash contents. The ash-free caloric values in the leaves at thedifferent development stages also vary with species.3) Tanin stimulates the uterus. In prolonged and frequent uterine bleeding is suggested inall cases of uterine bleeding. It is reported to have stimulant effects on the endometriumand ovarian tissue, and useful in menorrhagia.4) Reported as even infected with trichomanas vaginalis were also cured. Cervicalerosion cases showed healing of erosions. 27Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review ANUPANAMadhu83,84 UeÉlÉÏcÉÔhÉïqÉkÉÑMüqÉç kÉȨ́ÉTüsÉUxÉlÉiÉÑ cÉiÉÑmÉëMüÉU mÉëSUqÉç lÉzÉrÉåiÉ lÉ xÉÇzÉrÉÈ | Harudra powder, madhu (honey), amalaki, swarasa are supposed to be bestvehicles or anupanas for pradara roga.The role of Mahdu: MüwÉÉrÉlÉÑUxÉÇ Ã¤É zÉÏiÉsÉÇ qÉkÉÑU qÉkÉÑ | SÏmÉlÉÇ sÉåZÉlÉÇ oÉsrÉ uÉëzÉÉåkÉlÉUÉåmÉhÉqÉç | xÉÇkÉÉlÉÇ sÉbÉÑ cɤÉÑwrÉ xuÉjÉïqÉç ¾û±Ç ̧ÉSÉåwÉlÉÑiÉç || Madhu is astringent in anurasa, unctuous cooling, sweet, digestive stimulant,lekhana and strength promoting. It cleans and heals ulcers and helps in joining offractured bones, It is light promoter of eye sight and good voice, cardiac tonic andalleviant of all the doshas.Synonyms: Madhu Makshika, Madhvika, Kshaudra, Saragh, Makshikavanta,Varativanta, Bringa vanta, Pushpa, Rasobhava.Vernacular Name:Kannada : Jenu tuppaEnglish : HoneyHindi : ShahadMarathi : MadhuTamil : TeniBangali : Madhu 28Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewGujarathi : MadhuPharmacological Properties:Rasa : Madhura, KashayaGuna : Guru, RukshaVeerya : SheetaVipaka : MadhuraPrabhava : YogavahiDoshagnata : TridoshaPhysical Properties: Honey is thick, Semitranslucent liquid of yellowish brown clour of aromaticodour. After some times it becomes opaque and crystalline.Chemical Composition : The sugars in honey, fructose, glucose and maltose followed by lowerconcentration of sucrose and maltose. The average composition of honey is as follows.Moisture - 17.1% Calcium - 5mgProtein - 0.2% Phosphorous - 16mgMinerals - 0.2% Iron - 0.9mgCarbohydrates - 74% Vitamin C - 4mgNava Madhu: Navamadhu i.e freshly collected madhu is nourishing. It does not alleviate kaphain excess. 29Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug ReviewPurana Madhu: Bhava mishra says, purana means after one year (Samvastra) Madhu becomespurana i.e old. Purana Madhu in general, cures meda and sthaulya. It is grahi, Ruksha andexceedingly depleting one.Table No.1.9. SHOWING PHARMACOLOGICAL ACTION OF MADHUS.L.No Pharmacological Ch.s Sus. V. B.P R.N D.N P.N action1. Balya - + - - + + +2 Chedana + - + - - - -3 Chakshyashya - + + + - + +4 Deepana - - - + - + +5 Hridya - - - + - + -6 Lekhana - - - + - + +7 Medo hara - + - - + - +8 Ropona - + + + - + +9 Sandhana - + + - + + -10 Swarya - - - + + + -11 Srotashodhaka - + - + - - -12 Sangrahi - + - + - + -13 Varnya - + - + - - -14 Vajeekar - - - + - - -15 Medhya - - - + - - - 30Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review MODERN PHARMACOGNOSY OF HONEY85Synonyms – Madhu, honey, purified, melBiological surce – Honey is a sugar secretion deposited in honey comb by the bees, Apismellifera, Apis dorsata, belonging to family Apidae, order Hymenoptera.Geographical source – Honey is produced in Africa, Australia, New zeland, Californiaand India.Preparation for market – Honey is extracted from the comb by centrifugation. It must befree from foreign bodies Honey is liable to fermentation, unless it is suitable processed.Honey is heated to 800C before it sent to the market cooled rapidly. Filtered throughflannel.Description – Colour – Pale yellow to yellowish brown Odour – Characteristic, pleasant Taste – Sweet and faintly acid.Standards – Weight per ml – 1.35 to 1.35g Specific rotation - +300 to - 100 Total ash – 0.1 to 0.8% It is syrupy thick liquid, translucent when fresh onkeeping it becomes opadue and glanular due to the crystallization of glucose.Chemical constituents – Gulcose 35% ( 3%) Fructose 45% ( 5%) Sucrose 25% Uther constituent maltose, gum, traces of succinic acid, acetic acid, dextrin,formic acid, enzymes, vitamins Adulteration – Artificial invert sugar, an adulterant ofhoney contains furfural – detected by fiechel’s test gives instant red colour withresorcinol in hydrocholoric acid.Uses – 1) Used as demulcent and sweeting agent 2) Good nutrient to patients. 31Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Drug Review 3) It is antiseptic and applied to wounds.Exploration – 1) India is only exploited 10% of its honey potential. 2) India is producing 11000 tones of honey per annum 3) Per capital consumption of honey in India only 8.0gms while in Germany is 1800gms. 32Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review DISEASE REVIEWHistorical Review This Indian system of medicine has got a vast history based on veda, upaveda,purana etc which are dealt as under. Veda kala (2500 BC – 100 BC) Samhita kala (1000BC – 100AD) Sangraha kala (800AD – 1600AD) Adhunika kala (1600AD –onward) Atharva veda is regarded to be the authentic source of Ayurveda, given fewreferences pertaining to pradara but no reference available regarding shvetapradara. Inveda there is a mentioning of krimis, which cause the injury to uterus through vagina.The word “Asrava” has been mentioned which mean to flow, to flow, to move, in vedathere is a mentioning of Krimis, which (A.V. 44.3) cause the injury to uterus throughvagina.SAMHITA PERIOD Samhita period is said to be the scientific era of medicine in India.  CHARAKA SAMHITA (400BC-500BC): Indetail description of yoni vyapat is described in chikitsasthana 30th chapter. In the context of chikitsa he mentioned about pandure-asragdare (C.Ci. 30/119)86  SUSHRUTA SAMHITA (800BC-700BC): He explained the yoni rogas in chapter yonivyapatpratishedhadhyaya. No specific reference are available regarding shevetapradara (SU.U. 38 chapter)87  ASTANGA SANGRAHA (400AD): He explained the yonirogas in chapter guhyarogavignaniyadhyaya specific reference of shwetapradara is mentioned but 33Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review in chikitsa he mentioned about “site shukle asrakdhare” is shwetapradara (A.S.U. 39/123)88  ASTANGA HURDAYA (500AD): He explained yonirogas in Guhyaroga vignaniya adhyaya. No specific reference of shwetapradara available, but he mentioned pandu srava for yoni in kaphaja yoni Lakshana. (A.H.U. 33/44)89  MADHAVA NIDANA (800AD): He mentioned the Pandu srava in kaphaja asragdara lakshana, no specific reference is available regarding shweta pradara. (M.N. II 61/3)90  CHAKRAPANI (1100AD); Chakrapani clearly mentioned the Lakshana and chikitsa of shwetapradara. He mentioned pandusrava from yoni is shwetapradara and in chikitsa kashaya dravyas are used. (Chakrapani coments on C.Ci. 30/119)91  SHARANGADHARA SAMHITA (1300AD): Specific reference are not available but he mentioned the yoni rogas and shwetapradara chikitsa. (Sr.S.P.K. 7/177 and M.K. 2/110&114)92  BHAVAPRAKASHA (500AD): There is a detail explanation of pradara under streerogaadhikara and pandu srava is mentioned in kaphaja pradara and chikitsa of shweta pradara along with all types of pradara is also explained. (B.P.M.K.streerogadhikara)93  YOGARATNAKARA (1600 AD): Detail explaination of pradar, in that pandu srava is mentoned in kaphaja pradara. In chikitsa also he indicated shweta pradara chikitsa while explaining all types of pradara chikitsa. (Y.R.Streerogadhikara)94 34Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review  BHAISHAJYARATNAVALI (1600 AD): The author explained the shweta pradara chikitsa in detail. (B.R.Pradararoga chikitsa prakarana)95.  NIRUKTHI AND PRATHIBHASHA: The term “SHWETA PRADARA” is formed by union of two words, shweta and pradara. They can be derived in following way.  Shwitt+Acch The word shweta is formed by ‘shwit’ dhatu.  Shwetate iti / Rupyaml Shweta is the varna resembles to Roupya  Shwetate its / shwita shouklo + pachadach/shukla Shweta is varna which resembles shukla varna and also kshira, Dadhi, Roupya are different substances which resembles the shweta varna. (S.K.D)96  Shweta-white (San-eng dictionary)PRADARA  Pra + Dru Vidarane + Rudaram (S.K.D)97 This term pradara is formed by “pradhatu and indicates vidarana.  Vidarana (Samskrit-kan-dictionary) The term vidara means srava  Tannamaka srouraktadisravaroge | Rajaha pradeeryate yasmat Pradarastena sa smratana. | Pradara is a roga in which raktadi srava is occur and depending upon the srava the name comes along with pradara. Narou Rugbhedah iti medinou || It is a rogabeda of nari (women) 35Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review Asya Namantaram asragadara || Tattu phalitayonya Raktadidhatu ksharanam || The raktadi dhatu ksharana from yoni is pradara (S.K.D)98 Pradara: Rending, Tearing, A kind of disease of women | (San-eng dictionary) Rajah pradeeryate yasmat pradarastena sa smrutah || (C.Chi. 30/209)99 Due to Pradirana (excessive excretion of raja, it is named as pradara.SHWETA PRADARA: The word shwetapradara is not mentioned as an independent disease in greatyonirogas, specially kaphaja yoni rogas as “yonigata shweta picchila srava”.………….. MüTüÉåÅÍpÉwrÉÇÌSÍpÉuÉ×kkÉÈ………….. xÉÑMÑüjÉïiÉç ÌmÉΊsÉ zÉÏiÉsÉÉ MühQÒûaÉëxiÉÅsmÉuÉåSlÉÉqÉç………….. mÉÉÇQÒûuÉhÉï iÉjÉÉ mÉÉhQÒûÌmÉÎcNûsÉÉiÉïuÉuÉÉÌWûlÉÏqÉç || (cÉ.ÍcÉ. 30/13)100 Commenting on this chakrapani quotes that mÉëSU ÌuÉÍzɹ AjÉÉåï pÉuÉÌiÉ mÉÉÇhQÒûUå mÉëSUÍqÉÌiÉ μÉåiÉmÉëSU | cÉ.ÍcÉ. 30/223101 Here pradara referes to both asrugdhara and kaphajasrava. But chakrapani in his commentary has used the term shwetapradara for pandura ashrugdhara. In the same chapter at 116 shloka charaka quotes UÉåÌWûiÉMüÉiqÉÔsÉMüsMÇü mÉÉÇhQÒûUåÅxÉ×akÉUå ÌmÉoÉåiÉç || (cÉ.ÍcÉ. 30/116)102 Where pandura ashrugdhara refers to shweta pradara Sharangadhara, bhavaprakasha,Yogaratnakara have used the word shwetapradara for white vaginal discharge. 36Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review Like this shwetapradara is described as cordinal symptom in so many yonirogas.Some times this symptom is so severe that it over shadows the symptom of actual diseaseand woman come for the treatment of only this shwetapradara. Probably due to thisreasons charaka, vagbhata etc have not mentioned shweta pradara as disease but haveprescribed only symptomatic treatment. Hence a consolidated aspect of other yonirogasshould be taken into consideration to study the Nidana roopa, samprapti etc. Among the yonirogas slesmala yonivyapat sannipataja yonivyapat, vipluta yoniyapadaticharana yonivyapad and acharana yonivyapad represents shwetapradara with theirspecific features. Other reasons to consider the shwetapradara under yonirogas is, CjjÉæiÉæsÉï¤hÉæÈ mÉëÉå£üÉ ÌuÉÇzÉÉÌiÉjÉæÌlÉeÉÉaÉSÉÈ iÉzÉÑ¢ükÉÉUcÉirÉÉåÍpÉSÉæwÉærÉÉåÌlÉÃmÉSìuÉiÉÉ | aÉÑsqÉ AÉzÉï mÉëSUÉSÉïYcÉ uÉÉiÉÉkÉæYcÉÉÌiÉmÉÏQûlÉqÉç || 103 While explaining the upadrvas of yonirogas pradara is one among them. Another reason is in the same chapter at the end of the yonivyapath rogas, UÉåÌWûiÉMüÉiqÉÔsÉYsÉMÇü mÉÉhQÒûUåÅxÉ×akÉUå ÌmÉoÉåiÉç || 104 Shwetapradara is related to arthavaha srothas, susrutha quotes that, AÉiÉïuÉhWåû ²å iÉrÉÉåqÉÔïsÉÇ aÉpÉÉïzÉrÉ AÉiÉïuÉuÉÉÌWûlrÉ Arthava vahini is two in number having roots in garbhashaya and arthavavahasrothas. Injury to these srotas leads to vandhyathva,maithuna asahishnutha andarthavanasha. This reveals anatomical stucters and physiological importance ofarthavaha srotas. The main root of arthavavahaa srotas is garbhashaya which refers to 37Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Reviewuterine cavity, and atrthavavahini refers to to yoni,fallopian tubes and ovarian gland.Hence detail knowledge about these structures is necessary to know the diseaseshwetapradara.YONIDerivation: The word yoni is derived from the Sanskrit root YU (Amarakosh) YU means joinor unite, which is suffixed with NI to form the word yoni. Thus the literal meaning of theword yoni is a place of contact or union.Synonyms of Yoni Bhagam, Varangam, Upasthah, samara mandiram, madanalayah, rati kuharum,rati graham, rati, mandiram, janma vartanum, adharam, prakritih, apatham, samara kupah,ratyanga, pushpa pathah. Utpatti sthana, pushpin, samsarmargaka, samsar, marga, guhyam, adhah. The dictionary meaning of yoni is wombs, uterus, vulva, the female organs ofgeneration any place of birth or origin, generating cause, spring. Vagbhata while describing the specific muscles of woman used the word yoni todenotes the entire reproductive system. Maharshi sushruta and vagbhat while giving thereasons for conception occurring only during rtu kala have used the word yoni to donoteuterus and cervical canal. ûrÉÉåÌlÉxiÉÑ zÉUuÉlÉÉprÉÉM×üÌiÉUrÉÉxiÉÉuÉiÉÉï | iÉxrÉ iÉ×iÉÏrÉ AÉuÉiÉåï ÌmɨÉmÉYuÉzÉÉrÉÉ UÉåÌWûiÉqÉixrÉqÉÑZÉMüÉUÉ aÉpÉÉïzÉÉrÉrÉÉ iÉxrÉ zÉÑ¢üÉiÉïuÉmÉëuÉåzÉÏlrÉÉx§ÉÏx§É mÉåzÉrÉ || A.xÉÇ.AÉ 5/116105 38Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review The shape of yoni resembles shankha nabhi is hallow portion of conch shell andhas three avruthas. The garbhashaya is attached to third avrutha. In yoni, there are threnadis- samirana, chandramasi and gowri. At clitoris is mainly samirana shukra falling onit becomes fertile. The woman having mainly chandramasi is easily satisfied with clitorisand delivers female children sexual satisfaction to women possessing gowri nadi inupasthagrabha (deepen part of vaginal cannel is attached with difficulty and she deliversusually male children. The word yoni in ayurveda classics refers to whole reproductivesystem of woman starting from the valva to the ovaries as well as supporting strugtures.2. Garbhashaya: Garbhashaya as the word is combination of two words. Garbha+Ashaya, Garbha resides in this ashaya so it is called as Garbhashayawomen possess one extra ashaya known as Garbhashaya. Which is situated in the thirdavarta of the yoni, in between pittasaya and pakwashaya, behind the bladder.x§ÉÏhÉÉÇ aÉpÉïzÉrÉÉåŹÍqÉÌiÉ ÌmɨÉmÉMüuÉÉzÉrÉÉåqÉïkcÉå aÉpÉïzÉrrÉÉ rÉ§É aÉpÉÉïÎxiɹÌiÉ || xÉÑ.zÉÉ. 5/32106rÉjÉÉ UÉåÌWûiÉqÉxirÉ qÉÑZÉÇ pÉuÉÌiÉ ÃmÉiÉÈ || xÉÑ.zÉÉ. 5/44107 In shape it resembles the mouth of rohita fish. Acharya kashayapa has described it is in between the vipula kundala of srotas(multiple coils of intestine) covered with jarayu (peritoneum) It resembles to the mouthof the rohita a fish Acharya Dalhana explains that the resembalance to the mouth ofRohita fish is to denote the internal structures of the uterus. Acharya Bhava mishraexplains identically to that of sushruta. 39Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review3. Artava:Derivation: Artavam is derived from the root word Rutu.“Rutuhu asya prapthah”Who has got rutu i.e period, suffixed with Ann. Artava is formed, means stree beeja orpushpa.Defination: The rakta gets collected inside the Garbhashaya and flows out for three daysevery month, this is known as artava. Artava, which is agneya, has characterstics of rakta, forms garbha and is essentialfor life. The dominant mahabhoota is tejas. Its pramana is 4 anjalis. The period of about12 days from the commencement of menstruation which is most suitable period forconception is termed as rutukala. Artava is slightly black. Is also called as Rajah, which is produced from theRasadhatu itself.Table No-2.1. Swaroopa of Shudha Artava108Swaroopa Cha.Sam Su. Sam As. S As. Hri Bha. PraGunja phala varna + - - - -Padma lakta + - - - -Indra gopa + - - - -Shasa asrak - + + + +Laksha rasa - + + + -Nishpicchila + - - - +Na daha + - - - +Na arthi + - - - +Dautam cha - + + + -Virajyayate + - - - -Na ati bahu + - - - -Na ati alpa + - - - - 40Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewVRIDHI, KSHAYA, LAKSHAN OF ARTAVA: 1) Vridhi: Anga marda (Body ache) Artava ati pravriti (increased flow of artava) Daurgandhya (Bad smell) 2) Kshaya: Yathochita kala adarshana (Tringular menstruation) Alpata (Scanty flow) yonivedana (Pain in the vagina)Table No-2.2. Showing the Nidana of Shweta pradaraNidana Cha.S Su. S As. S As. Hri Bha. Pra MN Yog.rMithyachara + + + + + + +a) Mithyaharab) Mithy viharaArtava Dusthi + + + + + + +Beeja Dosha + + + + + + +Daiva + + + + + + +Pravridha - + + + - - -linga purushaatisevanaRuksha - + + + - - -Durbala BalaApadravya - - + + - - -PrayogaManasika - - + + - - -Garavisha - - + + - - -Specific shvetapradara nidana is not mentioned in classical literature. General pradaranidana is mentioned as follows. Lavana, Amla, Katurasa, Vidahi, Guru, Snigda Mamsa of gramya, Oudaka, Medya Krashara, Payasa, Dadhi, shukta, mastu, sura Virudhahara, adhayashana, madhyapana Garbhapata, Atimithuna, Yana, Ajirna, Adwa 41Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review Bharavahana, Abhigata, Divashayana Among the above nidana the aharajanya nidana will vitiates rakta, it’s amount willincreased and reach shleshmadhara kala of artavavaha srotas, vitiates stanika kapha andvata, result in shvetapradara. The viharajanya causes are vitiates vata and increases amount of rakta and resultin shvetapradara Apadravya will vitiates sthanika vata & kapha result in shveta pradara.Some other causative factors of shvetapradara are as follows:Yoni adhavana Ativyavaya AbhigataUnhygenic condition Chills Guru aharaRaktalpata Oily substances Ati katu rasa sevanaDurbalata Ati ushna ahara ShalyaKrimi Malabaddhata Ati nidraGarbhapata Nagnayoni ChintaAti prasava Malnutrition Krodha Constant cold water bath specially during rutukala constant working in water orwearing wet under garments, unsatisfied married life, contraceptives.Table No. 2.3. The yoni rogas in which the shweta srava is considered as a symptomS.No Name of Yoni vyapata Predominarncy of dosha1. Shleshmala yoni vyapata Kaphaja2. Tridoshaja yoni vyapata Tridoshaja3. Acharana Yoni vyapata Vataja (Cha) Kaphaja (Su)4. Atichurna Yoni vyapata Vataja (Cha) Kaphaja (Su)5. Upapluta Yoni vyapata Vata, kapha (cha)6. Vipluta Yoni vyapata Vataja (Su)Purva Roopa In Ayurvedic classics it is observed that purva roopa is explained as samanya i.ewhich predicts the on coming disease but also specifies the doshic sub type of particularon coming disease. 42Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review In case of shweta pradara and yoni vyapata there is no reference regarding thepoorva roopa but according to the vagbhata quotation the avyakta or alpa lakshanaas areconsidered under poorva roopa.Roopa Yonitach shweta srava Samanya lakshanas are mentioned in charaka, Yogaratnakara as follows: 1) xÉ MÑürÉÉïiÉç ÌmÉÎcNûsÉÉ zÉÏiÉÉ MühQÕûaÉëxiÉÉsmÉ uÉåSlÉqÉç | cÉ.ÍcÉ. 30 2) zÉsÉåwqÉsÉÉ ÌmÉÎcNûsÉÉÇ rÉÉåÌlÉÈ MühQÒûaÉëxÉÉiÉÅÌiÉzÉÏiÉsÉÉ ---------------- zsÉåwqÉÉ _________ pÉuÉåiÉç || rÉÉå.U.E. 14109-110 excessive srava (shweta) Angamarda Vedana The lakshanas are divided into slanika sarvadaihika lakshanaTable No. 2.4. Stanika lakshana:Lakshana C.Chi C.D A.S.U A.N.U B.P.U V.R.U M.N.IPandu or shveta srava + + + +Srava is like amarasa + + +(Apakwarasa)Srava is like sapicchila + + +Srava is like pulakatoya + + +(rice or flesh washedwater)Picchila + + + +Guru + + - -Snigda + + - -Shitalata + + + +Alpavedana + + - -Kandu + + + + 43Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewSAMPRAPTI Acharya charaka mentioned pradara samprapti as follows: The lakshana of kaphaja pradara resembles to shvetapradara. So its samprapti canbe formed like this: Due to excessive intake of gurvadi ahara and kaphavardhaka vihara (kleda, drava,shita picchila guna), produce srotodusti in artavaha srotas, vitiates stanik kapha and vataresults in shwetapradara. Due to shweta srava it is named as pandure asragdare andshweta pradara. All yoni rogas are caused by vata vikruti (C.Ci 30/115)111 The vata vikriti nidanasare not observed in aharajanya nidana, here vata vitiates due srotodusti, prarada is one ofsymptom of apanavrata pitta (su.ni. 1/37)112 and disorder of rakta (C.Su. 28/11-12)113 Ahitakara ViharaSaravadaihika (kapha) Sthanika Vata vikruti (apanavata)Agnimandya AmaSamarasadhatu Artavaha srotus dushti Sthana samshraya of dustha dosha in gabhashaya and yoni Shwetasrava 44Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewSamprapti ghataka:Dosha : Kapha (Vatanubandhi)Doshya : Rasa and RaktaAgni : Jatharagni mandajanya amaSrotas : Artavaha srotasSrotodusti prakara: Sanga and atipravrutti are more suggestive, sanga occur due to ama formation in artavaha srotas. Vitiates the vata and sthanika kapha produce atipravrutti.Adhisthana : Gabhashaya, YoniSanchara stana : Artavaha srotasVyakta stana : YoniAma : Jatharagni, Vikruti will produce ama. This cause sama rasa and saamaraktaVyadhi swabhava: It takes prolong duration from nidana sevana to lakshana vyaktavasta. After vyaktavasta also the woman hegitate or neglects to consult the physician. So it again prolongs the duration. Hence it is chirakariSarvadaihika lakshana:Dourbalya Supra pubic painPulling sensation in jangha Heavyness in janghaAlasya AruchiAjirna MalabaddataShirashoola Shirobrama 45Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewKatishoola Pschycological disturbance – sampraptiVYAVACHHEDAKA NIDANA The vyava chhedaka nidana are as follows:  Upapluta  Sannipataja yoni vyapatUpashaya and AnupashayaUpashaya:Specific upashaya is not mentioned in texts  Rukshopachara and Ushnopa chara  Japa kusuma  Tandulodak  Coconut water  Yoni prakashalana by kashaya rasa dravya like panchakshiri quatha or kankshi jala.Anupashaya  Nidana  Constant cold water bath and wearing wet clothes.SADHYASADHYATA : YAPY  The woman with continuous discharge, suffering from trushna, daha, durbala is asadhya for chikitsa.  Hrutbhara, vedana, hrutipidana, cause swasakrusta, murchana later leads to raktapradara  Treated in time is susadhya otherwise dusadhya. 46Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewUPADRAVA  Dourbalya, Brama, Murcha, Tama, Trushna, Daha, Pralapa, Pandutwa, Tandra vata vikara  Shopha is produced by pradara.Table No. 2.5. PATHYA APATHYAS.L.No Pathya Apathya1. Diet with milk and mamsarasa Excessive katu rasa, shveta shali2. Diet made with yavana usage of Mamsa, Fish, Egg Abhyarista, sidhu, tail, pippalichurna, pathya and lohabhasma along with madhu3. Samashana Fried substance, excessive hot substance3. Vegetable fruits Guru ahara, Madhyapana4. Nutricious food Onion, garlic, potato5. Good hygiene Excessive srama, cold water bath and wearing wet clothes chinta, krodha6. Maintain dinacharya7. Satvika vicharaChikitsa sutra: zÉsÉåwÉçqÉeÉÉxÉÑ cÉ Ã¤ÉÉåwhÉÉÇ MüqÉï MÑürÉÉïSÉÌuÉ cÉsɤÉhÉÈ|| cÉ.ÍcÉ. 30/42114 According to ayurvedic principles the first line of treatment is “Nidana parivarjana” since it is kaphaja vyadhi, chikitsa should be done byrooksha, ushna karmas this includes samshamana and samshodhana.Samshamana: Systemic medication, local medication like pich, varti, kalka dharana withkaphanashaka dravyas. 47Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewSamshodhana: Uttaravasti, Yoni prakshalana with kwath prepared out ofkashayarasatmaka dravyas.Abhyantara: 1. Rohitaka moola kalka should be taken with water. cha.chi. 30/116115 2. Juice of amalaki mixed with honey or sugar. A.S. 3. Paste of lohdra mixed with decoction of stem bark of nyagrodha should be taken. Cha.Chi. 30/116116 4. Prepare the paste of amalaki beejakalka with water and add honey sugar give for oral administration. Y.R.U 155P 5. Drinking of root of chakramarda pasted with rice water in morning hours cures shwetapradara. Y.R.U. 156P 6. Use of nagakeshara with butter milk followed by diet on only cooked rice and butter milk cures shwetapradara. Y.R.U. 156P 7. Badarabeeja choorna with honey and jaggery cures shwetapradara with in 3 days. Cha.Chi. 30/118117 8. Use of darvyadi decoction cures shweta pradara. Sh.S.M.K. 2/113-116.118 9. Use of kashaya prepared with nyagrodha group of dravya is beneficial due to its astringent properly.Rasoushadhis:  Pradarantaka loham I & II  Pradarantaka rasha  Pradarari rasah (III)  Trivanga bhasma 48Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review All these rasoushadhis contain vanga along with parada and gandhaka.BHAHYA PRAYOGA: (STANIKA) 1. In case of excessive vaginal discharge a kshauma (flexon cloth) –vastra dipped with decoction of stem-bark of only nyagrodha lodhra with vata should be placed in vagina. (cha.chi. 30/173)119 2. Vaginal irrigation with kashaya of twak of lodra and vata should be done. Cha.Chi. 30/72120 3. After snehana of vaginal canal kalka prepared with twak of plaksha mixed honey should be placed. I.E. 39/73 4. Varti made with powder of lodhra priyangu and madhuka mixed with honey or else of with kashaya drugs should be placed in snigdha yoni. Sh.S.M.K. 2/112)121 5. After snehana vaginal canal dhupana with sarala, guggulu and yava mixed with plenty of grita or else katu matsyaka with oil should be done. Sh.S.M.K. 2/112122 6. Watery discharge per vaginum is cured by insufficient fine powders of khadira, pathya, Jatiphala, nimba and puga triturated with soup of mudga and dried or else powdered kahdhira, pathya, jatiphala puga and flowers of mudga. Sh.S.M.K. 116. B.P. Ch. 70/47123,124Anupana125: UeÉlÉÏcÉÔhÉïqÉkÉÑMüqÉç kÉȨ́ÉTüsÉUxÉlÉiÉÑ cÉiÉÑmÉëMüU mÉëSUqÉç iÉzÉcÉåiÉ lÉ xÉÇzÉÉrÉÈ | Haridara powder, madhu, amalaki swarasa are supposed to be best vehicles oranupanas for pradararoga. 49Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewThe role of madhu: MüwÉÉrÉlÉÑUxÉÇ Ã¤ÉÇ zÉÏiÉsÉÇ qÉkÉÑU qÉkÉÑ | SÏmÉlÉÇ sÉåZÉlÉÇ oÉsrÉÇ uÉëhÉzÉÉåkÉlÉUÉåmÉhÉqÉç xÉÇbÉÉlÉÇ sÉbÉÑ cɤÉÑwrÉ xuÉrÉïqÉç QûkrÉÇ Ì§ÉSÉåwÉlÉÑiÉç || Madhu is astringent in anurasa, unctuous, cooling sweet, a digestive stimulant,lekhana and strength promoting. It cleans and heals ulcers and helps in joining offractured bones. It is light promotes of eye sight and good voice, cardiac tonic andalleviant of all the three doshas. 50Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review MODERN CONCEPT “LEUCORRHOEA”126,127,128Syn: Vaginal white discharge The term leucorrhoea is strictly defined as an excessive vaginal discharge morethan normal. The term leucorrhoea should be restricted to those patients in whom thenormal vaginal secretion is increased in amount. In such patients there will be no excessof leucocytes present when the discharge is examined under the microscope, and thedischarge is macroscopically and microscopically non-purlent. Purulent discharge is dueto specific infections such as gonorrhoea, trichomoniasis and moniliasis, to ulceratedgrowths of the cervix and vagina. The symptom of excessive is a subjective one withindividual variation. To decide it to normal and not an infetive one requires clinical andlaboratory investigations. The term leucorehoea should fulfil the following criteria. Theexcess secrtion is evident from persistent vulval moistness or staining of undergarments(brownish yellow on drying) or need to wear a vulval pad. It is non-purulent, non-offensive and non-irritant never causes prurities.VAGINA The Vagina of a healthy audult female is consist of white coagulated materialwhich contain squamous cells, Doderlein bacilli and coagulated secretion. Doerleinbacilli are large gram positive organisms which are sugar fermenting. This ability toconvert glycogen in to latic acid is responsible for the high acidity of the normal healthyaudult vagina. The vaginal contents are mostly derived from the squamous cells ofvagina. In healthy women the cervical secretion is small in amount and there is littlesecretion from the endometrium of the body of uterus even during secretory phase of 51Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Reviewmenstrual cycle. If the escape of endometrial serection is largely blocked by the plug ofmucous in the endocervix. The pathological conditions as erosions and ectropion of thecervix are fromed, the mucus secrection is increased, so that patients may complain of amucous discharge at vaginal orifice. The superficial cornified cells of the vaginal mucosa produce glycogen underestrogen stimulation and are continuosly desquamated. As a result of breaking down ofthe cells, glycogen is liberated and is ultimately converted into lactic acid. In the new born before the appearance of Doderlein’s bacilli, glycogen is brokendown in to lactic acid and there is some evidence that the process is brought about byenzyme action. After the appearance of Doderlin’s bacilli the production of lactic acid isaugmented by the action of the bacilli on simple sugars. The amount of normal vaginal seretions varies with age in health and disease.Pregnancy increase it, and just before the menstruation. In healthy it is dependent on the vascular state of the genitalia and this itself islargely oestrogen dependent. Congestive conditions of the genitalia and the adjacentpelvic organs increase vaginal transudation apart from increased secretion that suchconditions themselves contribute to the vaginal contents. The normal moistness of the vagina is sufficient to lubricate the vagina and labiaminora without staining the under clothes. Except at certain times when the secretion isincreased. These times are at ovulation, the immediate premenstrual phase, duringpregnancy and under the stimulus of sexual excitation. A moderate increase in vaginal secretion is one in which the under clothes are wetand require changing 52Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewVaginal acidity: The vaginal acidity is due to lactic acid, which may be present as much as 0.6%.The PH value is 5.7% in the newborn and reaches 6-7 in children, and falls to 4 atpuberty. During pregnancy the PH value is usually 4. After menopause the PH rises to 7.the normal PH for healthy women during the child bearing period of life is about 4.5. The deorlen’s bacillius is almost the only organism which will grow at a PH of 4-4.5. as the acidiy of vagina falls and the PH rises, non-resident pathogens are able tothrive.Natural defence mechanism of the vagina against infection: The skin of the vagina is a tough stratified squamous epithelium devoid of glands.It presents a smooth unbroken surface to the attack of pathogenic organisms. The PH islow and high acidity mitigates against bacterial growth. The thickeness of the squamousthe epithelium and the hostile PH depend upon oestrogen and therefore it is only inextreme with before puberty. During the era of sexual activity and maxium oestrogenproduction there are certain times at which the PH is raised.  During menstruation when the cervical and endometrial discharge which is alkaline, tends to neutralize the vaginal acidity.  After abortion or labour when the alkaline lochia has a similar effect.  An excess cervical discharge has the same effect.  Apart from these excess cervical discharge has the same effect.  Apart from these exceptions, the vagina is naturally self sterilizing. 53Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewFlora of the female genital tract: In healthy women the fallopian tubes, the cavity of the uterus and the upper thirdof the cervical canal are free of micro-organisms as does the vagina. In healthy vagina theDoderlei’s bacillus is the only organism found in upper two thirds of the vagina, but inthe neighborhood of the vulva both saprophytic and paracitic organisms can usually bedemastrated. Doderlein’s bacilli have been found in the vagina of the new born with in ninehours after delivary, although the usualtime for them to appear is fifteen hours. Thevagina of the new born is probably inoculated during parturition. During the puerperium the acidity of vagina is reduced and foreign organisms andother pathogens can grow. During the climacteric and after menopause the number ofDoderein’s bacilli is reduced and sometimes this organism cannot be demonstrated in thevagina. The important of doderlein’s bacillis is that its presence is associated with theproduction of lactic acid contained in the vagina and these acidy inhibits the growth oforganisms. In the multiparous woman when the vaginal orifies is patulous as a result oflacerations during child birth, foreign organisms may be found in the lower part ofvagina, which by producing low grade vaginitis give rise to discharge.AETIOLOGYPhysiological: The physiological basis involved in normal vaginal secretion is dependent on theendogenous oestrogen level. With the rising oestrogen level, there is abundant secretoryactivity of the endocervical glands and superficial vaginal epithelium becomes rich in 54Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Reviewglycogen. The glycogen loaded epithelium sheds. The glycogen being converted in tolactic acid by Doderlein bacilli. As a result the vaginal PH becomes acidic. The mucoidsecretion from cervical glands is normally small in amount. The carbohydrate radicle ofthe glycoprotein mucin is split off and fermented in to lactic acid. If however the mucusis secreted in excess, it pours out at the vulva. Normal secretion from vulva, vagina, cervix show an increase in conditions whenthe oestrogen level becomes high. Such conditions are. 1) New born: Some newborn gets leucorrhoea for a week due to maternal oestrogen. 2) During puberty: Increased levels of endogenous oestrogen lead to marked over growth of the endocervical epithelium which may encroach on to the ectocervix producing congenital erosion leads to increased secretion. 3) During Menstrual cycle:  Around ovulation – Peak rise of oestrogen leads to increase in secretory activity of cervical glands.  Premenstrual pelvic congestion and increased mucous secretion from the hypertrophoid endometrial glands. 4) Pregancy: There is hyperoestrinism with increased vascularity. This leads to increased vaginal transudate and cervical gland secretion. 55Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review 5) During sexual excitement: When there is abundant secretion from bartholin’s glands. It is of tempaorary duration and needs no treatment.Non-Pathogenic leucorrhoea: It is classified in to two: 1) Cervical leucorrhoea 2) Vaginal leucorrhoea1) Cervical Leucorrhoea: Non-infective cervical lesion may produce excessive secretion which pours out atvulva. Such lesions are cervical erosion, chronic cervicitis mucous polyp and ectropion,which is caused when the cervix has been badly lacerated during child birth so that thecervix is partly everted to expose the cervical glands.2) Vaginal Leucorrhoea: This form of leucorrhoea is seen when the discharge originates in the vagina itselfasa transudation through the vaginal walls. It is now established that almost all the lacticacid of the healthy vagina is formed from the glycogen contain in the keratinized cells ofvagina and the vaginal protion of the cervix. The cells are constantly being desquamated,when that glycogen is liberated to be fermented by Doderlein’ bacilli, a process whichresult in the production of lactic acid. This process is under the control of oestrogen, thelevel of which determines the PH of the vaginal transudation. Local congestive states of the pelvic organs such as pregnancy aquiredreroversion, prolapsed congested ovaries, chronic pelvic inflammatory diseases and 56Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Reviewchronic constipation with a sedentary occupation, pills ill health is also one of theimportant cause of an excessive discharge.Pathological: This can be divided in to two 1. General health causes (One third) 2. Genital causes (Two third) The important causes are ill health, Aneamia, colitis, vaginitis cervical erosion.Table No. 2.6. Incidence of cause of Leucorrhoea a) Ill health and malnutrition 25.4%General Health factor b) Dysfunctional 7.0% c) Psychological 0.6% Vulval growth and ulcer 1% Vaginitis 19% Cervical erosion -20%Pelvic factors Chronic cervicitis -7% Uterine tumour (Polyptibroid) 1% Genital prolapse 10% Contraceptives 2% Pregnancy 3%Clinical features:  Excessive white discharge per vagina  Non irritant, non offensive, non purulent  No prurities 57Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease ReviewDIGNOSIS:1. HISTORY:i. Age of the patient Marriageii. Present illness: Character of leucorrhoea Its duration Timing with menstruation Vulval irritation or any other symptoms Use of contraceptivesiii. Menstrual History and obstetrical historyiv. Pastmedical and drug history H/o tuberculosis, anaemia, dysentery, diabetes, antibiotic taken.2. General health Examination: to detect ill health, anaemia etc.,3. Gynacological examination:P/v and P/s examination to detect the condition of valva, urethra, Bartholin glands,vagina, cervix, uterus, foreign body and any growth.Local ExaminationA) Vulval inspection reveals -The discharge looks white or creamy in colour. - There is no evidence of Pruritis.B) Bimanual including a speculum examination reveals - The nature and amount of the discharge. - The condition of the vaginal wall and cervix. 58Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review - It reveals either a negative pathology. - Associated pelvic lesion mentioned earlier causing vaginal Leucorrhoea.C) To exclude the infective nature,the discharge is subjected to microscopic examination for detection of pus cells.  If pus calls are not found,then irrespective of any organism present,it can be concluded that the discharge is true leucorrhoea and not due to infection.  If pus cells are found,and unless an obvious cause such as cancer or a foreign body is revealed,the nature of organisms present must then be determined by the study of fresh preparations,stained smears and cultures.4. Investigation: To exclude infective nature, the discharge is subjected to microscopicexamination for detection of pus cells. If pus cells are not detected, it is considered as acase of true leucovrhoea. If pus cells are detected further investigation are to be carriedout to identify the organism from the discharge.  Wet mount preparation of vaginal discharge for T.vaginalis and moniliasis.  Vaginal and cervical discharges should be examined by staining and culture for the causative factor.  Cytological study from vagina and cervical scraping.Treatment:  This should be conducted according to the determined cause.  Local hygiene should be maintained. 59Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Disease Review  Improvement of general health  Cervical factors may require surgical treatment  Pelvic lesion producing vaginal leucorrhoea require appropriate therapy Pill users have to stop it.  Ill health leucorrhoea is treated by deworming,boiled water.  Correction of anemia.s  Pond bathing is prohibited.  Consolation to patient is done.  Vaginal irrigations – Betadine is the best antiseptic douche.  Introduction of pessaries like— 1) Estrogen to promote Keratinization. 2) Antibiotics. 3) Cortisone or Bacteriostatic drugs. 4) Fungicidal drugs.  Bactericidal cream like triple sulpha cream,betadine.  Phisiological leucorrhoea does not need any treatment. It subsides by itself and the patient is to be repeatedly assured and convinced by making to understand that it is purely physiological. 60Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology METHODOLOGYMATERIALS  Source of Data  Literary source  T.L.C. Literary aspect of study is collected from Ayurvedic texts, modern texts, andupdated with recent medical journals and from internet search.Drug Plaksha (Ficus lacor) twak Madhu (Honey) – As (anupana)Collection of Raw MaterialsSource of data: 1. Identification: Botanically identified plaksha twak is selected for the study. 2. Collection: The good quality plaksha twak is collected from the market of Udupi. 3. Physical properties of plaksha twak: The bark is rough in appearance, occurring in flat to curved, pieces, external surface ash or whitish grey in colour.Method of preparationSource of the drug Botanically identified freshly collected bark of plaksha (Ficus lacor) wereprocured, cut into small pieces and dried. These dried pieces were powdered withpulvaliser. 59 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • MethodologyProcess of preparation of plaksha twak churna. (Course and fine) 1. The dried pieces weighting 5 kg were made into course powder. 2. The course powder was allowed to dry completely by keeping in drying chambers. 3. Further among 5 kg course powder 2 kg course powder was made into fine powder with the help of pulvaliser and sieved through 120 size mesh. 4. 3 kg of course powder and 2 kg of fine powder was collected and preserved in separate airtight containers.Place of preparation of medicine The preparation of medicine was done in post Graduation Research studiesDepartment of Rasashastra D.G.M. Ayurvedic medical college Gadag.Form of the medicineThe medicine was administered in the form of 1. Churna – orally 2. Kashaya – As vaginal douche. 60 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology METHODSMaterial The preparation of plaksha twak churna (fine) (sample A) and plaksha twakchurna (coarse) (sample B) are taken for study.MethodsObjectives: 1. Pharmacognoistical evaluation of Plaksha. a. Macroscopical evaluation b. Microscopical evaluation c. Standardization and Validation. 2. Preliminary phyto chemical analysis of Plaksha. 3. TLC of Plaksha. 4. To Evaluate the efficacy of Plaksha twak churna in the management of Shewta pradara. 5. To evaluate the Plaksha twak kashaya as a trans vaginal douche in the management of Shweta pradara. 6. To evaluate the comparative effect of Plaksha twak churna orally and kashaya as trans vaginal douche in the management of Shweta pradara.Criteria for selection of patients a. Patients are diagnosed as shweta pradara as per the classics. b. Respective of sex (only female patients are considered) c. Patients in between the age group of 20-50 years.2. Study Design It is comparative clinical study of both churna and kashaya in shwetapradara. 61 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology3. Source of Data 30 patients are selected from free check up health campus and also fromO.P.D department of Dravyaguna. Post Graduation studies and Research centre,D.G.M.A.M.C and Hospital by present inclusion and exclusion criterial.4. Sampling method The patients are made into two groups Group A consists 15 patients andGroup B consists of 15 patients.5. Inclusion criteria 1. All patients are between age group 20-50 years with complaint of a. Shweta srava from Yoni b. Shitalata c. Kandu d. Katishula e. Dourbalya f. Dragging sensation in abdomin. 2. The patients of shwetapradara are selected irrespective of their occupation, socio-economical status, food habits etc. 3. Shweta pradara associated with trichomonas vaginals and candida albicans.6. Exclusion criteria a. Pregnancy and lactation 62 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology b. Pelvic inflammatory disease c. Abnormal papsmear d. Abnormal uterine bleeding e. Gynaecological causes like ovarian cyst, prolapse fibro myoma polyps f. Systemic diseases including severe anemia and HIV g. Uses of hormones or intra uterine devices. h. Classical veneral diseases like gonorrhoea and syphilis.7. Diagnostic criteria a. Patients having shweta srava from yoni with or without associated symptoms are taken for study. b. Vaginal pH is below 5.7 to 6.0 c. Microscopic study of vaginal smear shows clue cells is selected for study8. Intervention Group A – Patients administered Plaksha twak churna 4 gm B.D with madhu for 21 days before meals. Group B – Patients administered Plaksha twak churna kashaya 50 ml as vaginal douche in the morning before meals for 21 days. 9. Laboratory investigations Investigations were done to diagnoses the disease, to exclude the patients and to know the prognosis of the patients. Haematological - a) Hb% (Haemoglobin%) b) E.S.R. (Erythrocyte sedimentation rate) c) T.C (Total count) d) D.C. (Differential count) 63 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology Vaginal smear Vaginal pH10. Assessment of clinical trial a. The assessment of clinical trial is done by observing the severity of symptomatology as well as Lab investigation. b. The clinical assessment are done before treatment and after treatment, observed after 1st week, after 2nd week, after 3rd week of treatment. c. The Lab investigation is done before and after treatment and the difference in values assessed and analyzed.Grades for the subjective Parameters 1. Excessive vaginal discharge 0 – Normal 1 – Persistent moistness of vulva 2 – Need to change the under garments frequently 3 – Severe moistness 2. Persistent vulval moistness 0 – Normal 1 – Mild moistness 2 – Moderate moistness 3 – Severe moistness 3. Extensive pruritis 0 – Normal 64 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology 1 – Occasionally pruritis 2 – Pruritis through out the day 3 – Increase particular time of day / Night4. General weakness 0 – Normal 1 – Patient is able to involve in Physical activity 2 – Patient is slow to involve in Physical activity 3 – Patient feels exhausted to involve in physical activity5. Pain in lumbar region 0 – Normal 1 – Particular time concerned with menstrual cycle 2 – Pain particular time of day relieves after rest 3 – Severe continuous pain more relief even after rest.6. Dragging sensation in abdomen 0 – Normal 1 – Mild 2 – Moderate 3 – Severe before menstruation 65Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology1. Pharmacognostic study of Plaksha The Plaksha twak was taken for pharmacognostic study both in wet as well asdry form. Its macroscopical and microscopical structures were studied in detail. Latercharacteristics of the powder were also studied.Materials for T.S. of Stem bark1291) Napkin 2) Watch glass 3) Test tubes4) Painting brush 5) Bunsen burner 6) A sharp razor blade7) Micro slides 8) Cover slips 9) A beaker full of water10) A dropper 11) filter paper /blotting paper 12) Stains13) Drug sample 14) Forceps 15) Test tube holder16) Test tube stand 17) Needle 18) Camel hair brushesMethodology for T.S. of Stem bark (Micro preparation) To study the anatomy of stem, a hand section is taken with the razor bladesections are stained with saffren in and made semipermanent and observed under 10X and 45 X magnification in light microscope. Photographs are taken throughbinocular lens.Methodology for the Microscopic powder The powder drug was taken in the watch glass and few ml of chloralhydrate isadded and warmed, then removed chloral hydrate, then equal amount of Phloroglucinol and HCL acid was added then wait for few minutes and mounted on the slaidthen one drop of glycerin is added, placed a cover slip and observed under microscop.Photographs are taken through binocular lens.2. IDENTIFICATION BY T.L.CDrug: Extraction of sample (Aq & Alc) which is treated with 1:10ml solute; solventlike ethyl alcohol with dilution method. 66 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • MethodologyEquipment: Silica gel, TLC kit, hot air oven, standard glass, wattaman glass plate,beakers, sprayer.Chemicals: Dragendroff’s reagent, Silica gel, ethyl alcohol.Method: T.L.C. of the ethyl alcohol extract of the sample & Aqueous extract of thesample was carried out as follows. The silica gel powder mixed with water and made thin paste, then with thehelp of glass slide, the silica gel was spread on glass plates uniformly, After sometimes the air dried plate were kept in a hot oven at110-120 degree centigrade heaywas given continuously then the prepared sample is kept on a side of the plate thenimmersed in solvents upto 30 minutes then Dragendroff’s solution is sprayed on theplates. A parameter called the Rf value is always used in TLC this is determined asfollows.Rf = Distance traveled by the solute __________________________ Distance traveled by the solventAq extract = 12.6 Alc extract = 12.5 _____ = 0.96 _____ = 0.86 13 14.53. Preliminary Phytochemical analysis of Plaksh twak churna Preliminary Phytochemical analysis of Plaksh twak churna was carried out atDr. Sandesh Kamat, Chief Executive, Bio Genics Research & training Institute inBiotechnology, Unkal, Hubli.4. Analysis of Plaksha twak churna for physical constants 67 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology Bark powder of Plaksha was analysed for physical constants at Dr. SandeshKamat, Chief Executive, Bio Genics Research & training Institute in Biotechnology,Unkal, Hubli.I. Determination of moisture contentMaterial : Petriplates, physical balance, dessicator oven.Method : 2 gms of the sample was taken in the previously weighed petriplates.Petriplates were kept in the oven maintained at 1100c for drying. After 3 hourspetriplates were taken out and weight was noted down. This procedure was repeatedfor 4-5 times until the constant weight is reached.%Moisture = difference in weights X 100/ weights of the sampleII. Determination of ash contentMaterials: Silica crusible, physical balance, dessicator, Bunsen burner.Method : Weight of the empty crucible was noted down. 2 gms of the sample wastaken in the previously weighed crucible and was heated on a Bunsen burner until itturned into ash. It was then cooled in a dessicator and weighed.%Ash = difference in weights X 100/ weight of the sampleIII. Determination of water insoluble ashMaterials : Silica crucible, hot H2O, ash less filter paper (whatmann No.42),dessicator.Method : The ash obtained from the above test was dissolved in H2O and filtered. Thewater insoluble as collected on the filter paper was heated again on the Bunsen burneruntil it turned into ash. The crucible was cooled in the dessicator and weighed.%Water insoluble ash = difference in weights X 100 / weight of the sampleIV. Determination of acid insoluble ashMaterials : Silica crucible, 25% Hcl, ashless filter paper (whatmann no.42) dessicator. 68 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • MethodologyMethod : The water insoluble ash obtained is dissolved in 15ml of 25% HCL and thenfiltered. The acid insoluble ash collected on the filter paper was heated again. Thecrucible was cooled in the dessicator and weighed.%Acid insoluble ash = difference in weights X 100 / weight of the sampleV. Determination of water soluble extractiveMaterials : Volumetric flask, distilled water, Chloroform, filter paper, evaporatingdishwater bath, ovan. Dessicator, physical balance.Method : 5 gms of the powder was taken in the volumetric flask. Few drops ofchloroform were added to avoid the fungal attack. Subsequently 100 ml of distilledwater was added. It was kept for 24 hours, shaking frequently during the first sixhours. The solution was filtered the next day and 25 ml of this filtrate was evaporatedin a previously weighed evaporating dish on a water bath. Later it was dried in theoven at 1100c to remove the traces of water. Weights were noted.%Water soluble extractive = difference in weights X 100 / weight of the sampleVI. Determination of alcohol soluble extractiveMaterials : 5 gms of the powder was taken in the volumetric flask. 100 ml of alcoholwas added to it, flask was kept for 24 hours, shaking frequently during the first sixhours. The solution was filtered the next day and 25 ml of this filtrate was evaporatedin a previously weighed evaporating dish on a water bath. Later it was dried in theoven at 1100c to remove the traces of alcohol. Constant weights were noted down.% Alcohol soluble extractive = difference in weights X 100 / weight of the sample.Preliminary Phytochemical investigations of extracts130 Qualitative chemical tests were conducted for alcoholic and aqueous extracts of Plaksh (Ficus lacor) to identify the various phyto constituents. The various tests and reagent used are given below and observation are recorded. 69 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • MethodologyMaterial:Drug: Aqueous & Alcoholic Extractive sample of Plaksh (Ficus lacor)Equipments: Test tube, holder, stand, spirit lamp, pipette, glass rods, beakere 50 mlto 250 ml, conical flask, water bath. I. Test for alkaloids a) Mayer’s test: The different reagents used are Mayer’s reagent (Potassium mercuric iodide solution) giving cream coloured precipitate 1.Test solution with Mayer’s reagent b) Test solution plus concentrated HNO3 plus 3% KOH in ethamol c) Dragendorff’s reagent (Potassium bismuth iodide solution) giving reddish brown precipitate 1.Test solution with Dragendorff’s reagent d) Wagner’s reagent (Iodine, potassium iodide solution) Yielding reddish brown precipitate 1.Test solution with Wagner’s reagent II. Test for Carbohydrates a) Molish reagent : Ag or alcoholic solution of sub’s plus 10% alcoholic solution of A Napthol Shake plus concentrated H2SO4 along the side of the tube b) Benedict’s test : 5 ml of Benedict’s reagent plus 3 ml of sugar solution boil for 2 minutes then allow to cool c) Fehling’s test :2 ml of fehling’s solution A + 2 ml of fehling solution B + 2 ml of sugar solution then boil. 70 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology d) Barfoed’s test :2 ml of test solution plus 2ml of barfoed’s reagent, boil on water bath. e) Seliwanoff’s test :3 ml of Seliwanoff’s reagent plus 1 ml of sugar solution, boil for 2 minutes.III. Test for Glycosides a) Keller-kiliani test for digitoxose : The test consists of boiling about 1 gm finally powdered digitalis with 10 ml 70% alcohol for 2-3 minutes. The extract is filtered. To the filtrate is added, 5 ml water and 0.5 ml strong solution of lead acetate. Shake well and separate the filtrate. The clear filtrate is treated with equal volume of chloroform and evaporated to yield the extractive. The extractive is dissolved in glacial acetic acid and after cooling, two drops ferric chloride solution is added to it. These contents are transferred to a test tube containing 2 ml concentrated sulphuric acid. A reddish brown layer acquiring bluish-green colour after standing is observed due to the presence of giditoxose. b) Baljet test : To a section of digitalis, sodium picrate solution is added. It shows yellow to orange colour. 1. Foreign organic matter - Not more than 2% 2. Loss on drying - Not more than 5% W/W, by drying to constant weight at 1050 C. 3. Acid – insoluble - Not more than 5% c) Bornatrager’s test : Anthraquinone derivatives are generally detected by Bornatrager’s test. In this test, the drug is powdered and further extracted with ether or any water immiscible organic solvent. The filtered ethereal extract is made 71 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Methodology alkaline ether with caustic soda or ammonia, by which the aqueous layer shows, after shaking, pink, red or violet colour. Bornatrager’s test is negative in case of anthrenols (Reduced forms). Anthrones are detected with their fluorescence test.IV. Test for Amino Acid a) Ninhydrin test : 2 ml of Original solution plus 5 ml of Ninihydrin solution boil for 2 minutes then allow to cool. V. Test for Steroids a) Salkowaski’s test : 2 ml of test solution in chloroform plus slowly add 2 ml of concentrated H2 SO4 wait for 3 minutes. b) L.B, : Libermann-Burchrdt’s test : 2 ml of test solution in chloroform plus 10 drops of acetic anhydride plus 2 drops of concentrated H2 SO4.VI. Test for Proteins a) Biuret test : 2 ml of Original solution plus 2 ml of 10% NaOH solution plus 2-3 drops of 1 % CUSO4 solution mix.VII. Test for Tannins Test solution plus Ferric chloride (Fecl3) gives bluish black or brownish – green colour 72 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results OBSERVATION AND RESULTS The observation and result of the present study are presented as under-  Pharmacognoistical and Preliminary Phyto chemical data pertaining to the values of study, macroscopic evaluation, standardization and validation of prepared drug.  Thin layer chromatography analysis of Aqueous extract.  Observations of the clinical study for the evaluation of effect of the drug have been recorded.Observation pertaining to the pharmacognostic study of Plaksh twak a) Macroscopic – Bark rough, occurring in flat to curved, quilled pieces, measuring 0.4-0.7 cm in thickness; external surface ash or whitish-grey; numerous transversely arranged lenticels; ranging from 0.1 cm – 1.3 cm in length, lip-shaped and exfoliating; internal surface rough, fibrous, longitudinally striated, reddish-brown; fracture, fibrous. b) Microscopic – Shows 5-8 layered cork consisting of thin-walled, rectangular cells, a few external layers exfoliating; secondary cortex very wide consisting of compactly arranged, rectangular, thick-walled, pitted cells, patches of circular to elongated, lignified, elliptical stone cells with radiating canals, a few with concentric striations; a few prismatic crystals of calcium oxalate and reddish-brown contents found scattered throughout the secondary cortex; secondary phloem very wide consisting of mostly stratified layers of collapsed cells forming ceratenchyma, groups of fibres, phloem parenchyma, laticiferous cells, traversed by 2-5 seriate phloem rays; phloem fibres lingnified with wide lumen and pointed tips; thin-walled, rectangular, a few phloem parenchyma containing prismatic crystals of calcium oxalate. 73 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsPowder – Reddish-brown; shows thick-walled parenchyma with simple pits; stonecells in groups and singles, prismatic crystals of calcium oxalate, elongated phloemfibres with wide lumen and pointed tips.Phytochemical study The following observations were made in Plaksha with regard to-  Physical constants  Physico-chemical study Table No. 3.a. Showing the Physical constants and found values of bark powder of Plaksha Sl no Method adopted Plaksha (Ficus lacor) 1 Foreighn matter Not more than 1% 2 Total Ash Not more than10% 3 Acid insoluble Ash Not more than 1.5% 4 Water soluble extractive Not more than 6% 5 Alcohol soluble extractive Not more than 5% Table No. 3.b. Showing the Thin layer Chromatography analysis of Aqueous extractS.L.no Phyto TLC Detector Rf Spot colour Result constituents Plate values system1 Alkaloid Silicagel Ultra violet 0.75 Fluorescent Present G Green 0.61 Fluorescent Present Green2. Alkoloid Silicagel Drangendroff’s 0.75 Orange Present G reagent 0.61 Orange Present 74 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results Table No. 3.c. Showing the Phytochemical components and found values of bark powder of Plaksha. Test and reagents Observation InferenceTest for Carbohydrates (aqeous) The purple violet ring at the Presence of junction of two layers carbohydratesMolis Test: To the 2 ml of sample,aqueous 2 drops of alpha-naptholand mixed carefully rundown theconcentrated H2SO4 along thewalls of the tubes carefullyTest for Glycosides(aqeous)To 1ml of test solution add 3 ml of Green coloured complex Presence of glycosideanthrone reagent and mix well formedTest for Polysaccharides(alcoholic)To 1 ml of test solution, 2 drops ofiodine solution was added Absencey of Blue coloured solution PolysaccharidesTest for Proteins (aqeous) observedTest for free amino acids(aqueous)To 1 ml of test sample add 5 drops Presence of freeof ninhydrin and boil for 2 min amino acidsBradford’s test (aqeous) Purple coloured solution observedTo 0.5 ml of test sample add 2 mlof Bradford’s reagent Presence of proteinsTest for alkaloids (aqeous)To 1ml of test sample add 3ml of Observe the blue colourDrangendroff reagent, mix well,boil for 5 min. Presence of alkaloidsMayer’s test (aqeous) Dark brown orange colourTo the 1 ml of test sample add 1ml of mayer’s reagent, mixcarefully Alkaloids presentTest for SteriodsLiberman burchard test White pale Yellow observedTo 2ml of sample (chloroform at the bottom of test tubeextract) add 10 drops of aceticacid and 2 drops of conc. H2SO4, Steroids presentmix. Initially red colour appearsSalkwoski test followed by blue and finally2 ml of sample (chloroform green colour development 75 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Resultsextract) in a dry tube and add 2 ml Steroids presentof Conc. H2SO4, mix vigorously. Steroid and H2SO4 layersTest for Flavonoids(aqueous) separated and sample layerTo 1ml of test sample, iodine formws cherry red colour andsolution was added drop wise acid layer forms green colour Presence ofTest for Lipid(chloroform) FlavonoidsTo 2ml of test sample, iodine Yellow colour formationsolution was added drop wise Lipids are presentTest for Oils(chloroform)The 1 drop of sample was placed Original iodine colouron a filter paper and allowed to disappearsdry. Lipids are presentTest for saponinsFew drops of sample heated with Clear greasy spot observedalcoholic KOH and boiled for1min and cooled. Acidified with 1ml of conc. HCl. A portion of it Saponins are absentwas treated with 10 ml of waterand 5% NaOH, added drop wiseTest for Tannins (aqueous) Clear soap was observed while shaking Tannins are presentTest solution plus Ferric chloride(Fecl3) Bluish black or brownish – green colour Clinical observations The present clinical study was meant for evaluation of Plaksha Twak Churnain the Management of Shweta Pradara. Total 30 patients were taken randomly for theabove-mentioned study. All the patients under study were observed clinically duringthe course of treatment and follow up. The patients were selected as per the studydesign and evaluated through various subjective and objective parameters. The demographic data pertained to age, Menstrual history, socio-economicstatus, dietic pattern, habits and etiological factors have been tabulated andpercentages are represented through diagrams. 76 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results The data pertaining to objective parameters like vaginal smear and Vaginal pHhave been recorded before and after treatment. The data pertaining to subjective response of the patients are shown inpercentage through tables and finally compared between two groups. Table 3.1 Showing the Incidence of Menstrual History Menstrual Group Percentage Group Percentage Total Percentage History A B Excessive 13 86.66% 10 66.66% 23 76.66% Irregular 5 33.33% 2 13.33% 7 23.33% Graph No 1 Showing the Incidence of Menstrual History. 80% 60% 40% 20% 0% Excessive Irregular Percentage 77% 23% 77 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsIncidence of Age : Incidence of age between 20-30 years, 30-40 years and 40-50 years was 80%(12 patients) 20% (3 patients) respectively in group A. where as in group B theincidence of age between 20-30 years, 30-40 years and 40-50 years was 66.66% (10patients), 33.33% (5 patients) and 0% in both groups of (40-50) In total the incidenceof age between 20-30 Years , 30-40 Years, 40-50 Years was 73.33% (22 patients)26.66% (8 patients) and 0% (40-50) age respectively.Table 3.2 Showing the incidence of Age Age Group A Percentage Group B Percentage Total Percentage 20-30 Yrs 12 80% 10 66.66% 22 73.33% 30-40 Yrs 03 20% 05 33.33% 08 26.66% 40-50 Yrs 0 0% 0 0% 0 0% Total 15 100% 15 100% 30 100%Graph No 2 Showing the incidence of Age 80% 60% 40% 20% 0% 20-30 30-40 40-50 Percentage 73% 27% 0% 78 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsIncidence of socio economic status : Incidence of the socio economic status is 80% (12 patients) 20% (3 patients)and 0% (patients) belongs to Poor, Middle, Higher middle, Higher class respectivelyin group A. where as in group B 13.33% (2 patients) 4.66% (7 patients), 40.6% (6patients) 0% (patients) belongs to Poor, Middle, Higher middle, Higher class Socioeconomic status respectively. Table 3.3 Showing the incidence of Socio-economic status Income Group Percentage Group Percentage Total Percentage A BPoor 12 80 % 02 13.33 % 14 46.66 %Middle 03 20 % 07 46.66 % 10 33.33%Higher 0 0% 06 40.66 % 06 20.10 %middleHighers 0 0% 0 0% 0 0% Total 15 100 % 15 100 % 30 100 % Graph No 3 Showing the incidence of Socio-economic status 50.00% 46.66% 40.00% 33.33% 30.00% 20.10% 20.00% 10.00% 0% 0.00% Poor Middle Higher middl Higher 79 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable No. 3.4. Showing the classification of Patients based on their Prakruti Prakruti Group A Group B Total Percentage Vata Kapha 03 06 09 30% Kapha vata 09 06 15 50% Kapha pitta 03 03 06 20%Graph No. 4. Showing the classification of Patients based on their Prakruti 50.00% 50.00% 40.00% 30.00% 30.00% 20.00% 20.00% 10.00% 0.00% Vata kapha Kapha vata Kapha pittaIncidence of dietic pattern In the group A 60% (9 females) belongs to Mixed and 40% (5 females) belongto vegetarian. Where as in group B 40% (6 females) belongs to mixed and 60% (9females) belongs to vegetarian. In total the clinical study comprises 50% (15 females)belongs to mixed and 50% (15 females) belongs to vegetarian food patterns. Table 3.5 Showing the incidence of dietic pattern Diet Group A Percentage Group B Percentage Total PercentageMixed 09 60% 6 40% 15 50%Vegetarian 06 40% 09 60% 15 50% Total 15 100% 15 100% 30 100% 80 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results Graph No 5 Showing the incidence of dietic pattern Mixed Vegetarian Mixed 50% 50% VegetarianIncidence of etiological factors In the group A 13.33% (2 females), 20.00% (3 females), 60.00% (9 females)86.66% (13 females) 13.33% (2 females) 73.33% (11 females) were affected withAbhishyandi ahara, Viruddha ahara, Lavana amla, katu, rasa, yoni, yoni aprakshalana,atimaithuna, chinta, nidanas respectively. Where as in group B 20.00% (3 females)13.33% (2 females) 40.00% (6 females) 66.66% (10 females), 06.66% (1 females),73.33% (11 females) nidana’s respectively. In total 16.66% (5 females), 16.66% (5 females), 50.00% (15 females),76.66%, (23 females), 10.00% (3 females) affected with nidanas respectively.Table 3.6. Showing the incidence of Nidana Aetiological Group Percentage Group Percentage Total Percentage Factors A B Abhishyandi 2 13.33% 3 20.00% 5 16.66% aharaVirudha ahara 3 20.00% 2 13.33% 5 16.66% Lavana amla 9 60.00% 6 40.00% 15 50.00% katu rasa pradhara Yoni 13 86.66% 10 66.66% 23 76.66%aprakshalanaAti maithuna 2 13.33% 1 06.66% 03 10.00% Chinta 11 73.33% 11 73.33% 22 73.33% 81 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsGraph No 6. Showing the incidence of Nidana 16.66% 16.66% 73.33% A B S Ahara Virudahara 50% L A K ahara Yoni aprakshalana Ati m aithuna 10.00% Chinta 76.66%Table No. 3.7. Result by religious in shweta pradara with plaksh twak churna. Religion Good Moderate Poor No Total Percentage response Response Response ResponseHindu 14 0 0 0 14 46.66%Muslim 9 0 0 0 9 30.00%Christian 0 3 0 0 3 10.00%Others 0 4 0 0 4 13.33%Total 23 7 0 0 30 100%Percentage 76.66% 23.33% 0% 0% 100% - In the present study, 14 patients (46.66%) are Hindus, 9 patients (30%) areMuslims, 3 patients (10%) are Christain, 4 patients (13.33%) are others.Graph No. 7. Showing the incidence of Religion 13.33% 10.00% HINDU 46.66% MUSLIM CHRISTIAN OTHERS 30.00% 82 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable No. 3.8. Results by occupation in Swetapradara with Plaksha twak churna.Occupation Good Moderate Poor No Total Percentage response Response Response ResponseSendentory 8 0 0 0 8 26.66%Active 0 10 0 0 10 33.33%Labour 0 12 0 0 12 40%Total 8 10 12 0 30 100%Percentage 26.66% 33.33% 40.00% 0% 100% - In the present study 8 patients (26.66%) are of Sedentary type, 10 patients(33.33%) active, 12 patients (40%) Labour.Graph No. 8. Showing the distribution of Pt.’s by Occupation. 27% 40% Sedentary Active Labour 33%Table No.3.9. Results by Economic status in Swetapradara with Plaksha twakchurna.Economic Good Moderate Poor No Total Percentage status response Response Response ResponsePoor 16 0 0 0 16 53.33%Middle 0 7 0 0 7 23.33%Higher 0 0 7 0 7 23.33%middleHigher 0 0 0 0 0 0%Total 16 7 7 0 30 100%Percentage 53.33% 23.33% 23.33% 0 100 - 83 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable No. 4.0. Results by Diet in Swetapradara with Plaksha twak churna. Diet Good Moderate Poor No Total Percentage response Response Response ResponseVegetarian 12 0 0 0 12 40.0%Mixed diet 0 18 0 0 18 63.0%Total 12 18 0 0 30 100%Percentage 40.0% 63.0% 0% 0% 100% -Table No. 4.1. Distribution of Patients by presenting complaints. Presenting Patients Percentage ComplaintsYoni srava 15 50.00%Kandu 6 20.00%Katishula 9 30.00%Table No. 4.2 Distribution of Patients by Associated complaints. Associated Patients Percentage ComplaintsKatishula 3 10.00%Jwara 5 16.66%Angamarda 6 20.00%Udarashoola 5 16.66%Dourbalya 5 16.66%Yonidaha 6 20.00%Table No. 4.3. Ahara Nidana observed in the study Ahara Nidana Patients PercentageAbhishyandi Ahara 5 16.66%Lavana amla katu 15 50.00%Viruddha ahara 9 30.00%Adhyashara 1 3.33%Table No. 4.4. Vihara Nidana observed in the study Vihara Nidana Patients PercentageDiwa swapna 5 16.66%Ayana 2 6.66%Yonia prakshalana 19 63.33%Atimaithuna 4 13.33% 84 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable No. 4.5. Manasika Nidana observed in the study Manasika Nidana Patients PercentageChinta 25 83.33%Krodha 2 6.66%Anya Vegavarodha 3 10.00%Table No. 4.6. Chronisity of Leucorrhoea observed in the cases Chronisity of Patients Percentage Swetapradara10-20 days 6 20.00%20-30 days 6 20.00%. 1 months 12 40.00%> 2 months 6 20.00%Table No. 4.7. Results of Plaksha twak churna in Swetapradara. Result No of Patients PercentageWell respond 25 83.33%Moderately 5 16.66%Responded 0 0%Not Responded 0 0%Total 30 100% Section C - Data Related To Response To The Treatment Response to treatment w.r.t Excessive Vaginal dischargeTable 4.8 Showing Grades of Vaginal discharge Before Treatment in Group A &B No of Group Grades Patients 3 % 2 % 1 % 0 % 15 A 4 26.66% 10 66.66% 1 7% 0 - 15 B 1 6% 10 67% 4 26.66% 0 - 85 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable 4.9 Showing Grades of Excessive vaginal discharge After Treatment inGroup A & B No of Patients Group Grades 0 % 1 % 2 % 3 % 15 A 13 87% 2 13.33% - - - - 15 B 15 100% - - - - - -Gr-O No Discharge, Gr-1 Persistent moistness of Vulva, Gr-2 Need to change theundergarments frequently, Gr-3 Need to use an extra cloth or padTable 5.0 Showing Grades of Persistent vulval moistness Before Treatment inGroup A & B No of Patients Group Grades 3 % 2 % 1 % 0 % 15 A 1 7% 7 46.6% 7 47% - - 15 B - - 3 20% 5 33% 7 47%Table 5.1 Showing Grades of Persistent vulval moistness After Treatment inGroup A & B No of Patients Group Grades 0 % 1 % 2 % 3 % 15 A 12 80% 3 20% - - - - 15 B 15 100% - - - - - - Gr-O No Moistness, Gr-1 Mild moistness, Gr-2 Moderate moistness , Gr-3 Severe moistness 86 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable 5.2 Showing Grades of Extensive pruritis Before Treatment inGroup A & B No of Group Grades Patients 3 % 2 % 1 % 0 % 15 A 1 7% 8 53.3% 6 40% - - 15 B 3 20% 3 20% 6 40% 3 20%Table 5.3 Showing Grades of Extensive pruritis After Treatment inGroup A & B No of Group Grades Patients 0 % 1 % 2 % 3 % 15 A 13 87% 2 13.3% - - - - 15 B 13 87% 2 13.3% - - - -Gr-O No Pruritis, Gr-1 Occasionally pruritis, Gr-2 Pruritis through out the day, Gr-3 Increases particular time of day/nightTable5. 4 Showing Grades of General weakness After Treatment inGroup A & B No of Group Grades Patients 3 % 2 % 1 % 0 % 15 A 7 46.6% 6 40% 2 13.3% - - 15 B - - 5 33% 1 7% 9 60%Table 5.5 Showing Grades of General weakness After Treatment inGroup A & B No of Patients Group Grades 0 % 1 % 2 % 3 % 15 A 12 80% 3 20% - - - - 15 B 15 100% - - - - - - 87 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsGr-O No Weakness, Gr-1 Patient is able to involve in routine activityGr-2 Patient is slow to involve in routine activityGr-3 Patient feels exhausted to involve in routine activityTable 5.6 Showing Grades of Pain in lumbar region Before Treatment inGroup A & B No of Group Grades Patients 3 % 2 % 1 % 0 % 15 A 5 33% 8 53.3% 2 13.3% - - 15 B - - 3 20% 1 7% 11 73%Table 5.7 Showing Grades of Pain in lumbar region After Treatment inGroup A & B No of Group Grades Patients 0 % 1 % 2 % 3 % 15 A 11 73% 4 26.6% - - - - 15 B 14 93.3% 1 7% - - - -Gr-O No Pain, Gr-1 Mild , Gr-2 Moderate, Gr-3 SevereTable 5.8 Showing Grades of Dragging sensation in abdomen Before Treatment inGroup A & B No of Group Grades Patients 3 % 2 % 1 % 0 % 15 A - - 5 33% 10 66.66% - - 15 B - - - - 2 13.3% 13 87% 88 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • ResultsTable 5.9 Showing Grades of Dragging sensation in abdomen After Treatment inGroup A & B No of Group Grades Patients 0 % 1 % 2 % 3 % 15 A 14 93.3% 1 7% - - - - 15 B 15 100% 0 - - - - -Gr-O Normal, Gr-1 Mild , Gr-2 Moderate, Gr-3 SevereObjective ParametersTable No.6.0. Showing the distribution of the patients by degree of Vaginal pHbefore and after treatment.SL.No Degree of Vaginal pH BT % AT % 1 3-4 0 0% 7 23.33% 2 4-5 6 20.00% 20 66.6% 3 5-6 11 36.66% 3 10.33% 4 6-7 10 33.33% 0 0% 5 7-8 3 10.00% 0 0Vaginal SmearTable No.6.1. Showing the distribution of the patients by degree of VaginalSmear before and after treatment.SL.No Degree of Vaginal BT % AT % Smear 1 Grade – 0 0 0% 30 100% 2 Grade – 1 19 63.33% 0 0 3 Grade – 2 11 36.6% 0 0% 89 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results OVERALL ASSESSMENT OF STATISTICAL DATA Table No.6.2. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to excessive vaginal discharge.Parameter Treatmen Duration Mean±SD Mean±SE DF T- P- Rema t Group Value Value rks BT 2.2 0.560 - - - - -Excessive A AT 0.133 0.351 2.06 0.118 14 17.457 <0.001 HSVaginal B BT 1.8 0.56 - - - -discharge AT 0.0 0.0 1.8 0.144 12.5 <0.001 HS In order to assess the Excessive Vaginal discharge patients of each group were examined according to the clinical findings and the results were analyses from the statistical analysis. The parameter Excessive Vaginal discharge in group A Mean ±SD before was 2.2 ±0.56 and after the treatment it is reduced to 0.133 ±0.351, with Mean difference 2.06 and standard of mean 0.118 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 1.8 ±0.56 and after the treatment it is reduced to 0.0 ±0.0 with Mean difference 1.8 and standard of mean 0.144 and test shows more highly significant in group B as P<0.001. The parameter Excessive Vaginal discharge is having more effect in group A than group B ( By Comparing t-values). 90 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results Table No.6.3. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vulval moistrness.Parameter Treatmet Duration Mean±SD Mean±SE DF T- P- Rem Group Value Value arksPersistent BT 1.6 0.632 - - - - - Vulval A AT 0.2 0.414 1.466 0.133 14 11.02 <0.00 HSmoistness 1 B BT 0.733 0.798 - - - - - AT 0.0 0.0 0.733 0.206 3.55 <0.01 HS The parameter Persistent Vulval moistrness in group A Mean ±SD before was 1.6 ±0.632 and after the treatment it is reduced to 0.2 ±0.414, with Mean difference 1.466 and standard of mean 0.133 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 0.733 ±0.798 and after the treatment it is reduced to 0.0 ±0.0 with Mean difference 0.73 and standard of mean 0.206 and test shows more highly significant in group B as P<0.01. The parameter Persistent Vulval moistrness is having more effect in group A than group B ( By Comparing t-values). Table No.6.4. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Extensive Pruritis. Para- Treatment Duration Mean±SD Mean±SE DF T- P- Remar meter Group Value Value -ks Exten BT 1.666 0.617 - - - - - sive A AT 0.133 0.09 1.5 0.133 14 11.52 <0.001 HS Prurit 33 is B BT 1.33 0.975 - - - - - AT 0.133 0.351 1.2 0.243 4.93 <0.001 HS 91 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results The parameter Extensive Pruritis in group A Mean ±SD before was 1.666 ±0.617 and after the treatment it is reduced to 0.133 ±0.09, with Mean difference 1.533 and standard of mean 0.133 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 1.33 ±0.975 and after the treatment it is reduced to 0.133 ±0.351 with Mean difference 1.2 and standard of mean 0.243 and test shows more highly significant in group B as P<0.001. The parameter Extensive Pruritis is having more effect in group A than group B ( By Comparing t-values). Table No.6.5. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to General weakness.Parameter Treatment Duration Mean±SD Mean±SE DF T- P- Rem Group Value Value arksGeneral BT 2.33 0.723 - - - - -weakness A AT 0.2 0.414 2.2 0.174 14 12.64 <0.001 HS B BT 0.733 0.961 - - - - - AT 0.0 0.0 0.733 0.248 2.955 <0.05 HS The parameter General weakness in group A Mean ±SD before was 2.33 ±0.723 and after the treatment it is reduced to 0.2 ±0.414, with Mean difference 2.2 and standard of mean 0.174 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 0.733 ±0.961 and after the treatment it is reduced to 0.0 ±0.0 with Mean difference 0.733 and standard of mean 0.248 and test shows more highly significant in group B as P<0.05. 92 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results The parameter General weakness is having more effect in group A than group B ( By Comparing t-values). Table No.6.6. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Pain in Lumbar region. Parameter Treatment Duration Mean±SD Mean±SE DF T- P- Rem Group Value Value arks Pain in BT 2.2 0.676 - - - - - Lumbar A AT 0.266 0.457 1.93 0.181 14 10.66 <0.001 HS region B BT 0.466 0.833 - - - - - AT 0.066 0.258 0.4 0.19 2.10 >0.05 NS The parameter Pain Lumba region in group A Mean ±SD before was 2.2 ±0.676 and after the treatment it is reduced to 0.266 ±0.457, with Mean difference 1.93 and standard of mean 0.181 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 0.466 ±0.833 and after the treatment it is reduced to 0.066 ±0.258 with Mean difference 0.4 and standard of mean 0.19 and test shows non significant in group B as P>0.05. The parameter Pain in Lumba region is having more effect in group A than group B ( By Comparing t-values). Table No.6.7. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vaginal pH.Parameter Treatment Duration Mean±SD Mean±SE DF T- P- Re Group Value Value mar ksVagnial BT 6.1 1.22 - - - - - pH A AT 4.54 0.65 1.533 0.34 14 4.508 <0.001 HS B BT 6.22 1.116 - - - - AT 4.46 0.714 2.12 0.177 11.977 <0.001 HS 93 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results The parameter Persistent Vaginal Ph in group A Mean ±SD before was 6.1 ±1.22 and after the treatment it is reduced to 4.54 ±0.65, with Mean difference 1.533 and standard of mean 0.34 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 6.22 ±1.116 and after the treatment it is reduced to 4.46 ±0.714 with Mean difference 2.12 and standard of mean 0.177 and test shows more highly significant in group B as P<0.001. The parameter vaginal Ph is having more effect in group B than group A ( By Comparing t-values). Table No.6.8. Showing the Statistical Analysis of both the groups, Before and after treatment and Percentage of improvement with respect to Vaginal Smear.Parameter Treatment Duration Mean±SD Mean±SE DF T- P- Rema Group Value Value rksVaginal BT 1.266 0.457 - - - - - Smear A AT 0.0 0.0 1.266 0.118 14 10.72 <0.001 HS B BT 1.466 0.516 - - - - - AT 0.0 0.0 1.466 0.133 11.022 <0.001 HS The parameter Vaginal smear in group A Mean ±SD before was 1.26 ±0.457 and after the treatment it is reduced to 0.0 ±0.0, with Mean difference 1.266 and standard of mean 0.118 and test shows more highly significant in group A as P<0.001. In group B Mean ±SD before was 1.466 ±0.516 and after the treatment it is reduced to 0.0 ±0.0 with Mean difference 1.466 and standard of mean 0.133 and test shows more highly significant in group B as P<0.001. The parameter Vaginal Smear is having more effect in group B than group A ( By Comparing t-values). Overall the drug is having more effective in vaginal smear and Vaginal Ph in group B and it is more highly significant in all other parameter in group A. 94 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Results Table No. 6.9.Analysis table by using student t-test. Parameter Mean SD SE t-value p-value RemarksExcessive 1.933333 0.52083 0.095091 20.33148 <0.001 HSVaginalDischargePersistent vulval 1.1 0.758856 0.138548 7.93948 <0.01 HSmoistnessExtensive 0.76489 0.13965 0.13965 9.786377 <0.001 HSpruritisGeneral 1.466667 1.105888 0.201908 7.26405 <0.01 HSweaknessPain lumbar 1.166667 1.053183 0.192285 6.067382 <0.01 HSregionVaginal ph 1.983333 0.769722 0.140532 14.11304 <0.001 HSVaginal Smear 1.366667 0.490133 0.089486 15.27241 <0.001 HS % of imp 96.66667 91.42857 91.11111 93.47826 87.5 26.89394 100 Conclusion: The statistical analysis is done by using student’s paired t-test, by assuming that the drug is not responsible for changes in the readings before and after treatment. From the analysis all parameters shows highly significant (as p<0.05). The parameters Excessive Vaginal Discharge, Vaginal ph, Vaginal Smear and Extensive pruritis shows more highly significant than the other parameters ( as p<0.001). and the parameters Persistent vulval moistness and General weakness shows less highly significant (as p>0.001). The percentage of improvement in the parameters is Excessive Vaginal Discharge with 96.66667, Persistent vulval moistness with 91.42857 %, Extensive pruritis with 91.11111%, General weakness with 93.47826%, Pain lumba region with 87.5%, Vaginal ph with 26.89394 % and Vaginal Smear with 100% from the study. 95 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Master chart 1 ASSMENT OF SUBJECTIVE PARAMETERS OF GROUP ASL OPD Excessive Persistent Extensive General Pain in DragingNo . No Vaginal Vulval Pruritis weakness Lumba sensation inGr discharge moistness region abdominA BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif1 9 2 0 2 3 1 2 2 0 2 3 1 2 2 0 2 2 1 12 10 3 0 3 2 0 2 2 0 2 2 0 2 3 0 3 1 0 13 34 2 0 2 2 0 2 1 0 1 3 0 3 3 1 2 1 0 14 18 2 0 2 1 0 1 1 0 1 3 0 3 2 0 2 1 0 15 35 3 1 2 2 1 1 1 0 1 3 0 3 3 0 3 1 0 16 56 3 1 2 2 0 2 2 0 2 2 1 1 2 0 2 2 0 27 55 1 0 1 2 0 2 2 1 1 3 1 2 2 0 2 1 0 18 37 2 0 2 1 0 1 1 0 1 1 0 1 2 1 1 1 0 19 3 2 0 2 1 0 1 1 0 1 2 0 2 1 0 1 1 0 110 5 2 0 2 1 0 1 3 1 2 2 0 2 1 0 1 2 0 211 61 2 0 2 2 1 2 2 0 2 2 0 2 2 1 1 1 0 112 1 2 0 2 1 0 1 2 0 2 3 0 3 2 0 2 2 0 213 25 2 0 2 1 0 1 2 0 2 2 0 2 3 1 2 1 0 114 29 2 0 2 1 0 1 2 0 2 1 0 2 2 0 2 2 0 215 37 3 0 3 2 0 2 1 0 1 3 0 3 3 0 3 1 0 1 BT= Before Treatment AT= After Treatment Dif = Difference 96Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Master ChartExcessive vaginal dischargeGr-O No Discharge, Gr-1 Persistent moistness of Vulva, Gr-2 Need to change theundergarments frequently , Gr-3 Need to use an extra cloth or padPersistent vulval moistnessGr-O No Moistness, Gr-1 Mild moistness, Gr-2 Moderate moistness , Gr-3 SeveremoistnessExtensive pruritisGr-O No Pruritis, Gr-1 Occasionally pruritis, Gr-2 Pruritis through out the day ,Gr-3 Increases particular time of day/nightGeneral weaknessGr-O No Weakness, Gr-1 Patient is able to involve in routine activity , Gr-2 Patient isslow to involve in routine activity, Gr-3 Patient feels exhausted to involve in routineactivityPain in lumbar regionGr-O No Pain, Gr-1 Mild , Gr-2 Moderate, Gr-3 SevereDragging sensation in abdomenGr-O Normal, Gr-1 Mild , Gr-2 Moderate, Gr-3 Severe 97 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Master Chart Master Chart 2 ASSMENT OF OBJECTIVE PARAMETERS OF GROUP A S.L. OPD Vagnial pH Vaginal Smear No BT AT Dif BT AT Dif Gr. A 1 9 6.5 4.5 2 1 0 1 2 10 7.0 4.5 2.5 2 0 2 3 34 6.0 4.2 1.8 2 0 2 4 18 4.2 4.5 -0.3 2 0 2 5 35 8 5.0 3 1 0 1 6 56 4.1 6.0 -1.9 1 0 1 7 55 8.0 5.0 3 2 0 2 8 37 5.9 4.5 1.4 1 0 1 9 3 7.0 5.5 2.5 1 0 1 10 5 6.0 4.0 2.0 1 0 1 11 61 6.0 3.5 2.5 1 0 1 12 1 4.5 3.5 1 1 0 1 13 25 6.5 4.5 1 1 0 1 14 29 6.8 4.5 2.3 1 0 1 15 37 5.0 4.5 0.5 1 0 1 BT= Before Treatment AT= After Treatment 98Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Master Chart Master Chart 3 ASSESSMENT OF SUBJECTIVE PARAMETERS OF GROUP BSl OPD Excessive Persistent Extensive General Pain in DragingNo No Vaginal Vulval Pruritis weakness Lumba sensation inGr discharge moistness region abdominB BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif BT AT Dif1 63 2 0 2 2 0 2 2 0 2 0 0 0 0 0 0 0 0 02 61 2 0 2 2 0 2 3 0 3 2 0 2 0 0 0 0 0 03 60 1 0 1 2 0 2 3 0 3 0 0 0 0 0 0 0 0 04 67 1 0 1 1 0 1 0 0 0 2 0 2 0 0 0 0 0 05 94 3 0 3 1 0 1 1 0 1 0 0 0 0 0 0 0 0 06 83 2 0 2 1 0 1 2 0 2 1 0 1 0 0 0 0 0 07 69 2 0 2 1 0 1 2 1 1 0 0 0 0 0 0 0 0 08 85 2 0 2 0 0 0 1 0 1 0 0 0 0 0 1 0 0 09 74 1 0 1 0 0 0 0 0 0 2 0 2 1 0 2 0 0 010 87 2 0 2 0 0 0 1 0 1 2 0 2 2 0 0 0 0 011 75 2 0 2 0 0 0 1 0 1 0 0 0 0 0 0 0 0 012 76 2 0 2 0 0 0 1 0 1 0 0 0 0 1 1 1 0 113 77 2 0 2 0 0 0 1 0 1 0 0 0 2 0 0 0 0 014 78 1 0 1 0 0 0 0 0 0 2 0 2 2 0 2 1 0 115 79 2 0 2 1 0 1 2 1 1 0 0 0 0 0 0 0 0 0 BT= Before Treatment AT= After Treatment Dif = Difference 99Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Master Chart Master Chart 4 ASSESSMENT OF OBJECTIVE PARAMETERS OF GROUP B Sl. Vagnial pH Vaginal Smear No OPD BT AT Dif BT AT Dif Gr. B 1 63 5.8 4.2 1.6 1 0 1 2 61 6.0 3.5 2.5 2 0 2 3 60 7.0 4.5 2.5 1 0 1 4 67 5.8 3.5 2.3 2 0 2 5 94 6.0 3.5 2.5 1 0 1 6 83 6.5 4.5 2 2 0 2 7 69 7.0 4.5 2.5 1 0 1 8 85 6.0 4.2 1.8 2 0 2 9 74 4.2 4.5 -0.3 2 0 2 10 87 8 5.0 3 2 0 2 11 75 4.1 6.0 -1.9 1 0 1 12 76 8.0 5.0 3 2 0 2 13 77 5.9 4.5 1.4 1 0 1 14 78 7.0 5.5 2.5 1 0 1 15 79 6.0 4.0 2.0 1 0 1 100Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion DISCUSSION In This study the Evaluation of efficacy of plaksha twak churna in themanagement of Shweta pradara, A Clinical study is done. 1) Shweta pradara is a very common and irritating condition in women, Around 30- 40% of the patients attending the Gynecological OPD in routine practice are suffering from this disease. 2) The disease Shweta pradara based on theoretical and clinical symptoms can be compared to Leucorrhoea. 3) The pathogens like Trichomonas vaginalis (4.5%) N gonorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea. 4) Charaka described plaksha under the Kashayakanda while shushruta and Vagbhata have mentioned it under Nyagrodhadi gana. It is considered as one of the ksirivraksas or pancha valkalas by Bhavamisra. Much beneficial in Yonigata vikaras. 5) Tha plaksha twak, (Ficus lacor) is used in this study. It is having properties like Kashaya rasa it acts as rakta stambhaka & grahi. Due to its sheeta veerya and laghu, ruksha qualities acts as Vranashodhana and vrana ropana. So these actions are extremely beneficial in curing Shweta pradara. A warm vaginal douche of plaksha twak churna kashaya is beneficial to general cleansing and elimination of purulent discharge. Plaksha twak churna have many means to kill fungus, bacteria, parasite as it acts as krimighna. In shwetapradara there is mere predominance of kapha dosha, here the rasadi dhatu get decreased due to vata 101 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion dosa. So in order to cure the vitiated kapha, plaksha twak churna is implemented in this clinical study as it is kaphagna.Importance of madhu as anupana in this study: Madhu as it is katu, tikta kashaya rasa pradhana and ushna virya ruksha gunayukta so it does dosha bhedan and effect in kapha vitiated diseases and as shweta pradarais one among kaphaja vyapat.Dose – group A 4 gms of plaksha twak churna with madhu per day in divided dose wasadvised. And madhu enhances the properties of plaksha twak churna.Aushadhi sevana kala – Medicine should be taken before meals reason behind this isthe main cause for yoni vyapat especially apana vata vitiation plays an important role.For the purpose of vata anulomana, agni deepana.Group B- the patients of group B were treated with Plaksha twak churna kashaya everyday fresh kashaya was prepared as the saveeryata kalavadhi of kashaya is 24 hours.Dose – 50gms powder to prepare kashaya. Sterilized vaginal douche was placedapproximately till it reaches to cervix carefully. Sterilization was maintained to avoidinfection. Douche was removed to avoid infection. After 5 to 10 minutes.Pharmacognostic study In order to standardize the identification of Plaksha, a detail pharmacognosticstudy including microscopic and macroscopic characters of the twak and its powder wascarried out. The features observed are furnished in the related chapter and compared withpharmacognostic study of Ficus lacor done at Ayurvedic Pharmacopia of India. Both thestudy seemed similar thus proving the genuinity of the drug collected. 102 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • DiscussionAnalytical study The result of analytical study of Plaksha twak done at Bio Genics research &training institute in Biotechonology, Unkal, Hubli was matched with analytical studyreports of previous research works and was found to be similar. The result of physicalconstant in Plaksha twak churna also matched with the reports of previous works andhave been found to be similar.Plan of Study: In this study total 30 patients were taken for clinical trial in which two groups A& B of each 15 patients were selected for study at D.G.M.A.M.C.P.G.R&S Gadag. The disease shwetapradara is diagnosed on the basis of subjective parameters i.esigns and symptoms as mentioned in our classics and objective parameters. In present study overall 30 patients fall under age group of 20-50 years. Out ofwhich 73.33% (22 patients) between age between 30-40 years. The incidence is foundmore in between age of 20-30 years due to in present study the minimal age criteria forthe study is 20 because the age for marriage for women is 18 and above and trans vaginaldouche can be advised only to married women. Maximum is 50 years because the menopause stage starts at the age of 40 there ishormonal changes. So the age is limited. The incidence of Socio-economic status majorly concerned to shwetapradara. Itwas found that 46.66% in poor state. 33.33% middle class families and where less as20.10% in higher middle class families. Due to poor state malnutrition, unhygieniccondition. Mostly poor woman’s more prone to shweta pradara. 103 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion The incidence of disease was found up to 50% Kapha vataja, and 30% vata kapha,20% kapha pitta in the present study it can be preassumed that kapha vataja prakratiperson get affected more by shweta pradara compared to other prakrati person. Becauseshweta pradara is due to vitiation of kapha and vata dosha. The incidence of yoni aprakshalana 76.66% indicates the negligence towardshealth and hygine more prone to words infection. It is a major cause for shweta pradara. In the present study out of 30 patients 23 (76.67%) patients were having theexcessive menstruation, and 7 (23.33%) patients were having complaint of irregularmenstrual cycle. Which is also cause for artavadusti is also major cause for shwetapradara. It was evident from the present study the 40% of the patients were labour. Moreprone towards the disease due to the unhygienic living standards. In the present study out of 30 patients 10 (33.33%) were having the history ofabortions. It is also one of the cause for shweta pradara. It may be due to vitiated vatadosha. Subjective parameters like excessive vaginal discharge shows highly significantin both groups due to control of kapha. Extensive purities was another major parameterfound more in both groups. It was also markedly reduced and shows highly significant. Itmay be due to the kandugnata action of drug. And sthambaka action of the drug.Associated with madhu act as kapha vata shamaka grahi guna present in madhu acts asamapachaka & sthambak. The lekhana guna helps to destroy the sanga and act assrotomukh vishodhaka with its yoga vahi guna. 104 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • DiscussionDuration For all the two groups duration was fixed upto 21 days. As it is comparative studybased on duration of vaginal douche, the duration of plaksha twak churna along withmadhu was fixed up to 21 days.Data collection Data from each group was collected before treatment after treatment and at theend of the follow up. The data was collected properly and documented and statisticallyanalyzed. To see the effect of plaksha twak churna along with madhu & plaksha twakkashaya as trans vaginal douche.Statistical analysis The data collected was statistically analyzed under the guidance of statician. Thedata was computed for mean, standard deviation standard error, t value and p value. Pvalue was obtained by using students paired ‘t’ test. Significance of the results was basedon the p value. The statistical values from each group were compared and analyzed to seethe significance of the treatment. Other objective parameters are found to be improved after the treatment in bothgroups. 1) Chemical compound tannic acid present in the drug helps to normalize pH value of vagina. 2) The normal vaginal pH is acidic that is 4.5 alteration in this vaginal pH value leads to growth of organism which cause white vaginal discharge. 105 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion Vaginal secretion consist of tissue fluid, epithelial debris. Electrolytes, proteins and lactic acid, so excessive vaginal discharge causes imbalance of all essential component, individual feel general weakness, body ache, back ache. 3) The Objective parameter vaginal smear shows highly significant 100% result by the study. Here the probable mode of action of the drug due to as it is krimighnna have many means to kill fungus, bacteria, parasite. As it is of antiseptic destroy invading organisms like (Trichomonas vaginalis) (Candida albicans) shofagna – action helpful in the inflammatory conditions of the patients and improvement shown in the results with highly significant. Astringent nature of kashaya rasa are locally protein precipitants. They reduce the permeability of cell membranes. These are used therapeutically reduce inflammation of mucous membranes promote healing. 4) The laboratory investigations show Hb% more significantly improved observed findings that 0.1gm – 0.2gm of haemoglobin increases in every individual. The selected plaksha has the rasayanik sangatan like carbohydrates, amino acids, polysaccharides, proteins, calcium oxalate, and tannic acid. Madhu has rasayanaika sangathan phosphorus, barbohydrate and iron vitc, tannic acid, both together helpful to fulfil deficiency in above criteria.Probable mode of action of Trailed drugsProbable mode of action of Plaksha twak churna with madhu. 1) Charaka described Plaksha under mootra sangrahaniya which indicates its action on mootravaha srotovikara i.e a drug of choice for some uro-genital diseases and 106 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion also been used in sukra vaha sroto vikaras. Shweta pradara is seen in anemia and in artavaha srotovikaras The artavaha srotos of female is homologus in function with shukra vaha srotas of males. Hence the drugs acting on Sukravaha srotas may act as similarly on artavaha srotas. Again Plaksha twak comes under kashaya sknda, nyagrodhadi gana and one among panchavalklas so it is considered as much beneficial in yonigata vikaras. 2) Plaksha twak churna, kapha vata shamaka, agini deepaka, ama pachaka, sthambaka, sroto mukha vishodhaka, vrana shodhana, vrana roopana, grahi, shotahara, yoni doshahara. 3) Kashaya rasa act as lekhana and stambhaka due to rooksha guna, sheeta veerya and laghu paka aggravates vata subsides kapha have absorbing effects (kledhahara). Hence it checks the ati pravruti of shweta srava as it is sheeta veerya it helps to check the flow of discharge. Improves the tissues increases the bala acts as dourbalya nashaka. 4) Katu vipaka act as Jatharagni deepaka, ama pachaka, plaksha twak churna with madhu as it has been sroto mukha vishodhana due to chedana and lekhana properties. It destroys the sangha of rasavaha srotas caused due to ama kapha. Kashaya rasa makes dhatus free from impurities. 5) Presence of rich in alkaloids shows Haemostatic action. Which is beneficial in shwetapradara including disfunction of uterine bleeding. 107Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • DiscussionProbable mode of action of Plaksha twak kashaya as vaginal douche. Grahi, kaphagna, vrana ropaka, vedana sthapaka, shothahara, yoni dosha nasha,kashaya rasa act as kapha shamaka. The grahi guna present in Plaksha twak act as sthanikdhatwagni janya ama pachaka, and sthambaka which helps to check the yoni gata srava.Due to vedana sthapaka property helps to cure yonigata vedana, sothahara propertyrelives yonigata sotha. By all these properties it acts as yonidosha nashaka which indicates that in alltypes of yoni vyapat, it can be advisable.NIDANA Avoiding the nidana itself is a first line of treatment so it seems very essential tounderstand the nidana of the every vyadhi1) Mithya achara Mithya achara includes both mithya ahara and viharaa) Mithya ahara Ahara which are kapha vardak, are main etiological factors for shweta pradaradue to excess intake of guru, snigda, picchila, drava, sheeta, madhura, rasayukta aharawhich are predominant in prathivi and apa maha bhuta, due to their chirapaki guna. Theyproduce agni mandya, then produces ama further does the rasa vaha sroto dushti nad artwvaha srotas dushti, leads to the shweta pradar. Abhishendi ahara dravya produces the kleda in the dosha, dhatu, mala and srotas.Due to this picchila and guru guna present in the abhishendi dravya act as srotoavarodhak and simultaneously it increases the kapha doshas leads to shweta pradara. 108 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion In the present study most of the patients were having the history of intake ofkapha vardaka and abhishendi ahara such as curds, milk, jaggery and chapatti etc.b) Mithyavihara It includes the vyavaya karma with the purush who has the pravradha linga,ativayaya karma, who follows unhygienic procedure, that is yoni adhavana, repeatedgrabha pata and D&C and adhik vyayam. These all are included in mithya viahara whichproduces the sthanika uttejana in the yoni as well as external genitalia which ultimatelyresult in the vitiation of sthanika dosha particularly vata and kapha. And also the vegadharana like mala, mutra leads to vitiation of apana vata, sthana samshraya of apana vatatakes place in artaw vaha srotas cause shweta pradar. In present study most of the patients were having the history of ativyayamakarma, yoni adhavana, (unhygienic procedure) repeated abortions with Dilation andCuratage, vega dharana like malavega etc.c) Apadravya prayoga: Copper T,d) Manasika Manasika dosha and shareerika doshas are interlinked, due to the mental anxietyand depression as well as desiring for sex etc will cause the vitiation of raja and tamadosha which ultimately vitiate the vata and kapha dosha thus produces the shwetapradara. In present study most of the patients were having the history of manasika isanxiety depression etc. 109 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion2) Artava dusti Here artava vruddhi, artava kshaya are considered and all hormonal imbalancecan be included. In the present study patients were having the history of artava kshaya and vruddhi.3) Beeja dosha Abnormalities of shukra and stree beeja various chromosomal or geneticabnormalities can be considered i.e kulaja vrattanta.4) Daiva Unknown or idiopathic factor come under this category, cause may be supernatural power or poorva janma kruta karma.ROOPA The complete vyakta lakshanas are considered as roopa. In this vyadhi pratyatma lakshana is yoni gata shweta srava. And in the present study all most all the patients were having the complaint ofyonigata, kandu, vedana, kati, shoola, sarvang marda, daurbalyata, so these can beconsidered as anubandi vedana.1) Yoni gata Shweta srava Excessive yonitah shweta srava is the main complaint, swaroopa of srava differsfrom jaliya, dadhi vata.2) Yoni gata kandu It is the main clinical symptom of shweta pradar. Due to excessive srava which iskaphaia causes the kandu and also it may be due to unhygienic procedure. 110 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Discussion3) Yonigata vedana This may be due to the effects of vata vitiation. Especially apana vata dushti. Asthe functions of artaw vaha srotas are under the control of apanavata hence aggravatedapana vata may cause the yoni gata vedana.4) Kati shoola Kati shoola may be due to the vitiation of apana vata, particularly pain is at thesacrum vitiated vata cause pain as vata and asthi dhatu are related with ashraya ashrayibhava.5) Sarvanga marda Sarvang marda is also due to the vitiation of the vata dosha.6) Daurbalyata Prakrat shleshma is considered as bala, in shweta pradara there is excessivedischarge of sama kapha which leads to bala kshaya according to modern the vaginaldischarge consist of electrolyte, proteins, epithelial cells which are essential elements,when there is excessive discharge that leads to weakness.7) Adho udara shoola It indicates the shoth condition of the yoni because of the sthana samshraya ofdosha and dushya at trayavart yoni.8) Vibanda Aggravated vata dosha particularly apanavata dosh causes the vibanda 111 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • DiscussionUPASHAYA Acharya charaka in nidana explains all the chikitsa as upashaya and it also calledas pathya in different contexts. Hence all the therapies that relieve shweta pradar can betaken of upashaya.ANUPASHAYA All nidana explained for shweta pradar and apathya can be considered asanupashaya.CHIKITSA OF SHWETA PRADARA 1) Shamana – abhyantar 2) Sthanika 1) Shamana – By going through all the chikitsa dravya explained shamanaushadhi we come to know that all dravyas contain kapha shamak, agni Deepak, grahi, vrana prashamana, shothahar, krimigna, kandugna, amapachak, sroto mukha, vishodaka, and vatanulomak properties, these all help in the samprapti vighatana. 2) Sthanika – Yoni dhawana, pichu dharana, kalka lepana, varti prayoga and dhoopana etc sthanika chikitsa are advised. Dravyas used for sthanika chikitsa are similar to with abhyantar chikitsa As in shweta pradara vyadhi, kapha dosha is sthanantara gata dosha. Kapha accumulates in vata Pradesh especially apana vata Pradesh, hence one should give chikitsa for kapha dosha without harming the vata dosha. In this clinical study both shamana as plaksha twak churna with madhu and plaksha twak kashaya as transvaginal dush as a sthanika chikitsa was done. 112 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • DiscussionPathya ApathyaPathya: All the pathya ahara explained in classics having Ushna, ruksha, laghu guna act asagni Deepak, amapachaka, kapha vata shyamaka and vatanulomak. In the present study Jawar roti, kulath, mudga, patola, lashuna, vrantaka, andushnodaka were advised these all help to stimulate agni and mitigate kapha vata dosha. Invihara to avoid unhygienic procedure, remove copper T and abstinence from intercourseup to treatment period.Apathya: All Nidanas of Shweta pradara are considered as apathya. In the present study curd, Jaggery abhishyandi ahara, oral contraceptive pill wereadvised. 113 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Conclusion CONCLUSION After a prompt theory and clinical study on evaluation of efficacy of Plaksha twakchurna in the management of Shwetapradara, A clinical study, following conclusion aredrawn. 1) Shweta pradara correlates with modern disease Leucorrhoea on the basis of symptomatology. 2) Apart from the one of the symptom in yoni vyapat sweta pradara is considered as a swatantra vyadhi as differentiated in the aspect of srava, varna and chikitsa. 3) Along with kapha vardaka aharajanya nidana, viharajanya nidanas like ativyavaya repeated garbhapata and Dilate and Curatage, use of apadravya and yoni adhawana etc are also major cause for shweta pradara. 4) Plaksha is identified as Ficus lacor and anupana madhu as honey. Have the effect shwetapradara. 5) With the dose of 4gms/BD with madhu for 21 days to the first group and the 50ml of the plaksha twak churna kashaya administered before the meals for 21 days, do not cause any untoward effect in patients between the age group 20-50 yrs. 6) The percentage and result evaluated on the basis of subjective and objective parameters for group A and B cumulatively and graphically. 7) Plaksha contains nutrients like protein carbohydrates, calcium oxalate, amino acids and tannin which have specific action over shwetapradara and also anaemia. 8) Clinical study revealed that both groups are effective in the management of swetapradara. 114 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Conclusion 9) Plaksha and madhu are economical effective drug in shwetapradara without any side effects. 10) In the patients who complains of yonigata shweta srava with pain in lumbar region, General weakness, yonigata kandu and less Hb% alone plaksha twak churna with madhu is effective. 11) In the patients who complains of yonigata srava along with yonigata kandu, bahya shotha alone plaksha twak kashaya as vaginal douch is effective. 12) In the result there is zero (0%) patients who does not respond, 25 (83.33%) patients shown good response and moderately response in the schedule are 5 (16.66%)Limitations of the Study  The sample size is very small to generalize the result.Future Prospective To achieve the aims and objectives of study the maximum work is to be done topresent this clinical study. Even though there is wider scope to study further.  In larger samples the study reveals the good sort of results.  Role of plaksha twak churna on female hormones like oestrogen, progesterone etc.  Role of plaksha twak kashaya in maintanance of vagnial pH. 115 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
    • Summary SUMMARY This study is performed to understand efficacy of plaksha twak churna in themanagement of shweta pradara.  The aims and objectives of present study have been discussed.  The drugs plaksha and anupana madhu are reviewed, discussed elaborately and explained from Ayurvedic and modern pharmacognosy and journals.  The definition history, etiology, samprapti, laxana and treatment of shwetapradara according to all classics were reviewed in study.  The study was conducted on 30 patients which made into 2 equal groups each 15 patients in group A Plaksha twak churna 4gms BD Madhu. In group B plaksha twak churna kashaya as Vaginal douche was administered in the dosage of 50ml early in the morning, Before meals for 21 days duration to each group.  In this study incidence of socio economic status, sex, religion, constitution dietics were highlighted in the observation.  Good response to symptoms of shweta pradara found in both groups.  Overall the drug is having more effective in vaginal smear and Vaginal Ph in group B and it is highly significant in all other parameter in group A. 116 Evaluation of Efficacy of Plaksha Twak (Ficus lacor) in the Management of Shweta Pradara- A Clinical study.
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    • References28. msɤÉÉå eÉÌOû mÉMïüUÏ cÉ mÉMïüOûÏ cÉ mÉMïüOûÏ cÉ Îx§ÉrÉÉqÉÌmÉ || 11|| msÉ¤É MüwÉÉrÉÈ ÍzÉÍzÉUÉå uÉëëhÉÉrÉÉåÌlÉaÉSÉmÉWûÈ | SÉWûÌmɨÉMüTüxÉë klÉÈ zÉÉåjÉWûÉ U£üÌmɨɾÒûiÉç || 12 || (pÉÉ.mÉë.ÌlÉ) (uÉOûÉÌSuÉaÉï)29. ÌmÉmmÉËU: ´É×ÇÌaÉMüÉ uÉÉOûÏ aÉSïpÉÉhQûÈ MüqÉhQûsÉÑÈ ||435|| msɤÉ: msÉuÉÉå aÉlkÉqÉÑhQûÉå qÉÑÎhQûMüÉåÅxuÉijÉmɧÉMüÈ || mÉÔaÉqÉÔhQû¶ÉÉÂSÉÂ È xÉÑmÉÉμÉï¶ÉçÃSzÉïlÉÈ ||436|| ÌmÉmmÉËUxiÉÑuÉUÈ zÉÏiÉÉå uÉëhÉrÉÉåÌlÉÌuÉxÉmÉïlÉÑiÉç | SÉWûÌmɨÉMüÄTüMüxÉëklÉÉå qÉåSÈ ÌmɨÉÉxÉëzÉÉåÄTüÎeÉiÉç || 437|| (Mæü.Så.ÌlÉ) AÉæwÉÍkÉ uÉaÉï)30. msɤÉ: MümÉÏiÉlÉÈ ¤ÉÏUÏ xÉÑmÉÉμÉæÅjÉ MüqÉhQûsÉÑÈ | ´ÉÑ…ûÏ uÉUÉåWûzÉÉUuÉÏ cÉ aÉSïpÉhQûÈ MümÉÏiÉMüÈ | SØûQûmÉëUÉåWûÈ msÉuÉMüÈ msÉuÉQè¶É qÉWûÉoÉsÉÈ || 123|| msɤɶÉåzÉcÉæuÉÉmÉUÉå ¾ûxuÉÈ xÉÑzÉÏiÉÈ zÉÏiÉuÉÏrÉïMüÈ | mÉÑhQíûÉåû qÉWûÉÅuÉUÉåWû¶É ¾ûxuÉmÉhÉïxiÉÑ ÌmÉqmÉËUÈ | ÍpÉSÒUÉå qÉ…ûsÉcsÉÉrÉÉå ¥ÉçårÉÉå ²ÉÌuÉzkÉÉÍqÉkÉÈ ||124|| msɤÉÈ MüOÒûMüwÉÉrɶÉç ÍzÉzÉÏUÉå U£üSÉåwÉÎeÉiÉç | qÉÔcNïûpÉëqÉmÉësÉÉmÉlkÉÉå WûxuÉsmɤÉÉå ÌuÉzÉÉåwÉiÉÈ || 125|| (UÉeÉ.ÌlÉ) (AÉqÉëÌSuÉaÉï)31. msɤÉ: MümÉÏiÉlÉÈ ´ÉÑ…ûÏ xÉÑmÉÉμÉæ¶ÉÉÂSzÉïlÉÈ | msÉuÉMüÉå aÉSïpÉhQû¶É MüqÉhQûsÉÑC uÉïOûsmÉuÉÈ || 74|| qÉÔNïû´ÉqÉmÉësÉÉmÉÉ¶É WûUåiÉç msɤÉÉå ÌuÉzÉåwÉiÉÈ || 75|| (kÉ.ÌlÉ) (AÉqÉëÌSuÉaÉï)32. msÉuɶÉçÃuÉפÉÈ xÉÑmÉÉμÉÉå aÉpÉïpÉÉhQûMüÈ | uÉOûÏ MüqÉhQûsÉÑrÉÑïmÉÈ ÌmÉmmÉËU¶ÉÉÂSzÉïlÉÈ | msɤÉÈ zÉÏiÉÉå uÉëhÉzsÉåwqÉÉÌmɨÉzÉÉåjÉÌuÉxÉmÉïÎeÉiÉç ||7|| (qÉSlÉmÉsÉ. ÌlÉ) (uÉOûÉÌSuÉaÉï)
    • 34. msɤÉÉåeÉOûÏmÉMïüUÏcÉMümÉïUÏcÉÃSïzlÉÏ | ´ÉÑ…ûÏuÉUÉåWûzÉÉUÌuÉcɽμÉijÉÏÌmÉÇmÉUÏuÉOûÏ || msɤÉÈ MüOÒûÈ MüwÉrɶÉzÉÏzÉÏUÉåU£üSÉåwÉÎeÉiÉç | qÉÔNïûpÉëqÉmÉësÉÉmÉblÉÉå¾èxuÉmÉiÉÉåÌuÉzÉåwÉiÉÈ | (zÉÍsÉaÉëqÉ ÌlÉ) (uÉiÉÉÌSuÉaÉï) AlÉÑmÉÉlÉ 84. qÉkÉÑ xuÉÉSÒ ÌWûqÉ Ã¤É MüwÉÉrÉlÉÑUxÉ sÉbÉÑ | SÏmÉlÉÇ aÉëÉÌWû cɤÉÑwrÉÇ xuÉjÉïÇ uÉhrÉïÇ ÌuÉsÉåmÉlÉqÉç || 205 || xÉÉæMÑüqÉÉrÉïMüUÇ uÉ×wrÉÇ ¾Òû±Ç xÉëÉåuÉÉåÌuÉzÉÉåkÉlÉqÉç | xÉÔ¤ÉqÉÇ qÉåkÉÉMüUÇ NåûÌS uÉëlÉzÉÉåkÉlÉUÉåmÉhÉqÉç || ÌuÉUÉSÇ UÉåcÉlÉÇ ¾ûÉÌS mÉëxÉÉSeÉlÉlÉÇ eÉrÉåiÉç | qÉåSÈ ÌmɨÉMüTüμÉÉxÉ ÌWûkqÉqÉåWûuÉÍqɤÉrÉÉlÉ || SÉåwɧÉrÉÉÌiÉxÉÉUxÉëiÉ×wÉhÉÉ SÉWûÌuÉwÉM×üÍqÉlÉç | MÑü¹ÉzÉÉåïU£üÌmɨÉblÉÇ rÉÉåaÉuÉÉÌWû cÉ uÉÉiÉsÉqÉç || uÉÉiÉsÉÇ uÉÉiÉMüÉåmÉåÅÌmÉ uÉwÉïwÉÑ qÉkÉÑ zÉxrÉiÉå | (Mæü.ÌlÉ. AÉæwÉÍkÉ uÉaÉï)
    • DEPARTMENT OF POST GRADUATE STUDIES IN DRAVYAGUNA D.G.M.A.M.C.GADAG SPECIAL CASE SHEET FOR “MANAGEMENT OF SHWETA PRADARA WITH PLAKSHA TWAK”Guide: Dr. Kuber Sankh, M.D (Ayu), Schoar: Dr. Kalavati. D. PetlurAsst. Prof., P.G. Dept of Dravyaguna.1) Name of the Patient Sl.No2)Father’s / Husband’s name3) Sex Male Female OPD No4) Age Years IPD No5) Religion Hindu Muslim Christian Other6) Occupation Sedentary Active Labour7) Marital status Married Unmarried Widow8) Economical status Poor Middle Higher middle Higher class9) Address Contact No: Pin10) Selection Included Excluded11) Schedule Initiation Completion Date Date12) Result Well responded Moderately responded Responded Not responded Discontinued13) INFORMED CONSENT I Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed to my satisfaction,by the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am alsoaware of my right to opt out of the treatment schedule, at any time during the course of the treatment.EzÀÄ £Á£ÀÄ ²æ/²æªÀÄw ___________________________________________________ £À£À߸ÀéEZÉѬÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞwAiÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtðªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ AiÀiÁªÁUÁzÀgÀÄ aQvÉì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÉÛ£É. gÉÆVAiÀÄ gÀÄdÄ/Patients Signature “Management of Shweta Pradara with Plaksha Twak” 1
    • 14) Chief Complaints (Pradhana vedana) : Complaints - Lakshana Duration 1 Excessive vaginal discharge (White, Red tinged, Creamy) 2 Persistent vulval moistness 3 Extensive pruritis 4 General weakness 5 Pain in lumbar region 6 Dragging sensation in abdomen 7 Anya Laxanas15) Associated Complaints (Anubandha vedana) : Associated Complaints - Lakshana Duration 1 Katishoola (Back Pain) 2 Jwara (Fever) 3 Anga marda (Malaise) 4 Udara shoola (Abdominal pain) 5 Dourbalya (Weakness) 6 Yoni daha (Burning sensation)16) Occupational History (if any) :17) Personal History (Vaiktiyaka vrutanta) :Food habits Vegetarian Mixed dietTaste preferred Sweet Sour Salty Pungent Bitter AstringentAgni Sama Vishma Manda TeekshnaKosta Mrudu Mandhyama KruraNidra Day Night Sound DistrubedAddictions Tobacco Alcohol DrugsBowel habits Normal Loose ConstipatedMenstrual History Regular Irregular Amenorrhea MenopauseFamily history – Specify if any has the same diseaseTreatment history Other system medications(if any)Obstetric history(if any)GynaecologicalHistory (if any)History of pastillness (if any) “Management of Shweta Pradara with Plaksha Twak” 2
    • 18) Examination of Patientsa) Vitals: 1. Temp F 2. Pulse rate /min 3. Resp. Rate /min 4. B.P Mm of hg 5. Height M 6. Weight Kgsb) Systemic: System FindingsG.I.TRespiratory systemCardio vascular systemCentral nervous systemGenito urinary systemc) Ayurvedic methods of Examination:Prakruti V P K VP VK PK VPKSara Pravara Avara MadhyamaSamhanana Susamhita Asamhita Madhyma samhitaPramana Height in Cms Weight in KgsSatmya Ekarasa Sarvarasa Ruksha SnehaSatwa Pravara Avara MadhyamaAhara Shakti Abhyavaharana JaranaVyayam Shakti Pravara Avara MadhyamaVaya Balya Yauvana Vardhakya Nadi Dosha Mutra Pravrutti GatiAstasthana Varna Purnata Gandha Spandana Kathinya Jihwa Ardra Sushka Mala Sama Nirama Lepa Nirlepa Shabda Sparsha Sheeta Ushna Drik Akruti “Management of Shweta Pradara with Plaksha Twak” 3
    • d. Local Examination (Yoni Pareeksha) : ( SzÉïlÉiÉÈ LuÉqÉç xmÉzÉïiÉÈ)1. External genital organ - vulval (Bahya yoni) a. Prakrata e. Vaivarnya b. Vaikruta f. Shotha c. Vruna g. Utseda d. Pidaka h. Anya2. Yoni Mukha a. Samvruta d. Srava b. Ragata e. Anya c. Vivruta3. Yoni Patha a. Ragatha b. Shotha c. Anya4. Grabhashaya Greeva (By speculum examination) a. Tanu e. Vruna b. Bahula f. Arsha c. Mrudu g. Mamsankurani d. Kathina h. Anya5. Srava a. Pramana - Bahula, Natibahula, Alpa b. Gandha - Visra, Pooti, Knupa, Anya c. Varna - Sweta, Pandu, Raktabha Rakta shyava varna Anya6. Guna - Picchita, Drava, Ghana, Tanu, Phenila, Pooya, Grathita “Management of Shweta Pradara with Plaksha Twak” 4
    • 19) Nidana:Ahara Vihara Anya Nidanarthakara VyadhiAbhishyandi Ahara Diwaswapna Vegavarodha AjeernaLavana amla katu Avyayama Manasika karana AgnimandyaViruddha ahara Yoni Upapluta AprakshanaAdhyashana Atimiathuna Acharana Aticharana Atyananda20) Samprapti Ghatakas a. Dosha e. Dooshya b. Agni f. Ama c. Srotas d. Dusti Prakara21) Investigations (Prayoga shala pareeksha krama)1) Erythrocyte Sedimentation Rate2) Hb%3) Differential count - Lymphocytes Neutrophils Eosinophils Basophils Monocytes4) Total count5) Vaginal smear test6) Vaginal Ph “Management of Shweta Pradara with Plaksha Twak” 5
    • 22) Treatment Schedule (Plaksha twak kashaya – 50 ml as vaginal douch for 21 days) Day Date Investigator’s NoteDay 1Day 7Day 14Follow upDay 2123) AssessmentA) Disease Assessment1) Subjective Parameters Before After Difference BA1 Excessive vaginal discharge (White, Red tinged, Creamy)2 Persistent vulval moistness3 Extensive pruritis4 General weakness5 Pain in lumbar region6 Dragging sensation in abdomen7 Anya Laxanas1 Vaginal PH2 Vaginal Smear “Management of Shweta Pradara with Plaksha Twak” 6
    • Grades of assessment1) Excessive vaginal discharge 5) Pain in lumbar regionGr-O No Discharge Gr-O No PainGr-1 Persistent moistness of Vulva Gr-1 MildGr-2 Need to change the undergarments frequently Gr-2 ModerateGr-3 Need to use an extra cloth or pad Gr-3 Severe2) Persistent vulval moistness 6) Dragging sensation in abdomenGr-O No Moistness Gr-O NormalGr-1 Mild moistness Gr-1 MildGr-2 Moderate moistness Gr-2 ModerateGr-3 Severe moistness Gr-3 Severe3) Extensive pruritis 7) Vaginal SmearGr-O No Pruritis Gr-O Negative (No abnormal findings)Gr-1 Occasionally pruritis Gr-1 Inflammatory smearGr-2 Pruritis through out the day Gr-2 Inflammatory smear with organisimGr-3 Increases particular time of day/night4) General weaknessGr-O No WeaknessGr-1 Patient is able to involve in routine activityGr-2 Patient is slow to involve in routine activityGr-3 Patient feels exhausted to involve in routine activityInvestigators Note Signature of Guide: Signature of Scholar: (Dr. Kuber Sankh,) M.D (Ayu), (Dr. Kalavati D. Petlur) “Management of Shweta Pradara with Plaksha Twak” 7