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Preparation and Analytical study of Sri Sidhadaradamrita Rasa and its clinical efficacy in Amavata - Dr. Pradeep Agnihotri, Department of rasashastra, Post graduate studies and research center, Shri ...

Preparation and Analytical study of Sri Sidhadaradamrita Rasa and its clinical efficacy in Amavata - Dr. Pradeep Agnihotri, Department of rasashastra, Post graduate studies and research center, Shri D. G. Melmalagi Ayurvedic Medical College, Gadag

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    Siddadarada amavata rs010_gdg Siddadarada amavata rs010_gdg Document Transcript

    • PREPARATION AND ANALYTICAL STUDY OFSRI SIDDHADARADAMRUTA RASA AND ITS CLINICAL EFFICACY IN AMAVATA By Pradeep Agnihotri Dissertation Submitted to the Rajeev Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of AYURVEDA VACHASPATHI M. D. In RASASHASTRA Under the guidance of Dr. M. C. Patil M.D. (Ayu) Under the co-guidance of Dr. G. N. Danappagoudar M.D. (Ayu) DEPARTMENT OF RASASHASTRA, POST GRADUATE STUDIES AND RESEARCH CENTER, SHRI D. G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG – 582103. 2003-2006
    • Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. DECLARATION BY THE CANDIDATE I here by declare that this dissertation / thesis entitled“Preparation and Analytical study of Sri Siddhadaradamruta Rasa and itsClinical Efficacy in Amavata” is a bonafide and genuine research workcarried out by me under the guidance of Dr. M. C. Patil, M.D. (Rasashastra),Professor and H.O.D, Post-graduate department of Rasashastra and underthe co-guidance of Dr. G. N. Danappagoudar M.D. (Rasashastra), Lecturer,Post-graduate department of Rasashastra.Date:Place: Pradeep Agnihotri.
    • SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA. CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “Preparation andAnalytical study of Sri Siddhadaradamruta Rasa and its Clinical Efficacy inAmavata” is a bonafide research work done by Pradeep Agnihotri in partialfulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.(Rasashastra). Dr. M. C. Patil, M.D. (Rasashastra) Professor & H. O. D.Date: Department of Rasashastra,Place: Gadag. Post Graduate Studies and Research Center, D.G.Melmalgi Ayurvedic Medical College, Gadag.
    • SHRI D.G. MELMALGI AYURVEDIC MEDICAL COLLEGE, GADAG. POST GRADUATE DEPARTMENT OF RASASHASTRA. CERTIFICATE BY THE CO-GUIDE This is to certify that the dissertation entitled “Preparation andAnalytical study of Sri Siddhadaradamruta Rasa and its Clinical Efficacy inAmavata” is a bonafide research work done by Pradeep Agnihotri in partialfulfillment of the requirement for the degree of Ayurveda Vachaspathi. M.D.(Rasashastra). Dr. G. N. Danappagoudar M.D. (Rasashastra) LecturerDate: Department of Rasashastra,Place: Gadag. Post Graduate Studies and Research Center, D.G.Melmalgi Ayurvedic Medical College, Gadag.
    • ENDORSEMENT BY THE H.O.D. AND PRINCIPAL OF THE INSTITUTION This is to certify that the dissertation entitled “Preparation andAnalytical study of Sri Siddhadaradamruta Rasa and its Clinical Efficacy inAmavata” is a bonafide research work done by Pradeep Agnihotri under theguidance of Dr. M. C. Patil, M.D. (Rasashastra), Professor and H.O.D, Postgraduatedepartment of Rasashastra and under the co-guidance of Dr. G. N.Danappagoudar M. D. (Rasashatra) Lecturer, Postgraduate department ofRasashastra. Dr. M.C. Patil, M.D. (Rasashastra) Dr. G. B. Patil. Professor & H.O.D Principal Department of Rasashastra, D G M A M C, Gadag.P G S & R C, D.G.M A M C, Gadag.Date: Date:Place: Gadag. Place: Gadag.
    • COPYRIGHT Declaration by the candidate I here by declare that the Rajiv Gandhi University of HealthSciences, Karnataka shall have the rights to preserve, use and disseminate thisdissertation / thesis in print or electronic format for academic / research purpose.Date:Place: Gadag. Pradeep Agnihotri. © Rajiv Gandhi University of Health Sciences, Karnataka
    • ABBREVIATION1) A. H. – Ashtanga Hridaya.2) A. P. – Ayurveda Prakash.3) A. S. S. – Ayurveda Sara Sangraha.4) A. T. – After treatment.5) B. P. – Bhavaprakasha.6) B. R. – Bhaishajya Ratnavali.7) B. R. R. Su. – Bruhat Rasaraja Sundar.8) B. T. – Before treatment.9) C. D. – Chakradatta.10) C.S. – Charaka Samhita.11) D. G. – Dravyaguna Vignana.12) D. N. – Dhanwantari Nighantu.13) FRLHT – Foundation for Revitalisation of Local Health Traditions14) K. N. – Kaiyadeva Nighantu.15) Ra. – Rasamruta.16) R. A. – Rheumatoid arthritis.17) R. C. – Rasendra Chudamani.18) R. J. N. – Rasajala nidhi.19) R. K. – Rasa Kamadhenu.20) R. N. – Raja Nighantu.21) R. Pr. Su. – Rasa Prakasha Sundar.22) R. R. S. – Rasa Ratna Samucchaya.23) R. S. S. – Rasendra Sara Sangraha.24) R. T. – Rasatarangini.25) S. S. – Sushruta samhita.26) SSDR – Sri Siddhadaradamruta Rasa27) Y. R. – Yoga Ratnakara. III
    • ABSTRACT The Rasa dravyas are basically classified on the basis of Agni samskaras theyhave undergone that’s how Kharaleeya, Parpati, Kupipakwa, and Pottali rasayanas camein to existence with varying grade of therapeutic efficacy.. There are certain otherpreparations which cannot be grouped under these categories the agni samskara given tothem also varies. These preparations are few and do have the equivalent therapeuticefficacy as above. Sri Siddhadaradamruta Rasa , a preparation involving ShodhitaHingula which when subjected to Dahana and Pachana samskara with specified drugslike Vata ksheera, Palandu swarasa, Bhallataka, Lavanga and Grutha is claimed toincrease the therapeutic efficacy which is advocated in Amavata as one of its indicationalong with Purana Guda as anupana. After thorough preparation as per classics the drugwas analytically studied to ascertain the effect of samskaras on it. There was presence ofmedia substrates in to the sample like Fat. Its Organoleptic character variations such aschange in colour from Red to Dark Brown was noticed along with changes in Hg% andS% before and after the preparation (Hg% from 86.6 to 62% and S% from 12.83 to 12.28respectively). The ESCA reported the presence of HgO and HgS in the ratio of 60:40. Itwas noted that there was a presence of selenium in lesser proportion which was not inelemental form. This was therapeutically tested over 15 cases of Amavata in a singleblind prospective clinical trial. The result in the trials statistically showed highlysignificant in the cardinal symptoms like sandhi shotha, Sandhishoola, Gouravata,Jadyata, jwara (Sthanika Ushmata) Nidraviparyaya ( p-value <0.001). Thus it wasinferred that the Samskaras has a definite role in increasing the therapeutic efficacy of thedrug. It was found promising in navottha Amavata.Key Words: Samskara; Dahana; Pachana; Sri Siddhadaradamruta Rasa; Amavata; Organoleptic Characters; ESCA; Clinical efficacy. IV
    • ACKNOWLEDGEMENT I salute to Lord Venkateshwara and HisHoliness Shri Abhinav Shivanand swamijito have bestowed their blessings through out my carrier. I express my heartfelt obligations to my honorable guide Dr. M C Patil MD (Ayu)Professor and HOD, PG Dept of Rasashastra, DGMAMC, Gadag, for his criticalsuggestions, guidance, and encouragement at every stage in the accomplishment of thiswork. I am greatful and obliged to my co-guide Dr G N Danappagoudar MD (Ayu)Lecturer, PG Dept of Rasashastra, DGMAMC, Gadag, under whose guidance andinspiration I have been able to complete this work. I am happy to convey my deep sense of gratitude to Dr G B Patil Principal, PGS& RC, DGMAMC, Gadag, for his encouragement and providing facilities during thisresearch work worthwhile. I offer my sincere thanks to Dr RKGacchinmath, Professor and HOD, UG Dept ofRasashastra, DGMAMC, Gadag, for his constant support and valuable directions. Humble thanks to Dr DilipkumarB, Asst Professor, PG Dept of Rasashastra,DGMAMC, Gadag, for his valuable suggestions and critical views. My sincere gratitudes to Dr J G Mitti, Lecturer, PG Dept of Rasashastra,DGMAMC, Gadag, for his valuable information in bringing out this work. I express my earnest gratitude to Dr GS Hiremath, Dr Varadacharyulu, DrBSPatil,Dr Avvanni, Dr Prushottamacharyulu, Dr Mulugund, Dr KSR Prasad, Dr SH Doddamani,Dr Shettar, Dr Belawadi, Dr Paraddi, Dr Sankh, Dr Nidagundi, Dr Mulkipatil, DrShankargouda, Dr Samudri, and Dr Yasmin for their great co-operation. I ackwoledge my sincere thanks to Nandakumar for his statistical work,DrDVijaykumar, DrRevati, ShriChandur, ShriSuresh, ShriDNPatil, ShriPolicepatil fortheir kind co-operation and help in analytical study. I extend my gratitude to Shri VMMundinmani and Sureban and SSRAMCollgefor providing the required books during the study. I render my sincere thanks to Tungabhadra Grameena Bank for monitory support. I am greatful Dr KY Krishnaji, Dr BB Joshi, Dr Gudagnatti, Dr RS Hiremath, DrMAHullur, Dr SKBannigol, Dr AS Prashant, and Dr Jadar for their heartfelt co-operationand advise. With pleasure I extend my sincere gratitude to Dr SDYarageri RMO, Dr UVPurad,DrAMAdi,Principal,AMC,Ron, DrKotturshetti, DrBGSwamy, DrVMSajjan, I
    • SmtPKBelwadi, Smt Sarangmath, Tippanagoudar, Kallangoudar, Biradar, SmtEkbote,MMJoshi, Shri Shankar Belwadi for their co-operation and help during the study. I am always at rememberance of Mr and Mrs Lalitprasad and Mr and Mrs DrBabuVijayanathan whose encouragement is the result of my present work. This work remains incomplete without mentioning my brother Mr Bhaskar andsister in law Mrs Geeta Bhat whose love and affection has brought me up to this altitude,I am greatful to them. I am ever thankful to my intimate friends Dr BYGanti, DrShaila, DrMouli,DrUday, DrRatna who stood with me all the way at my turmoil. I thank my kiths and kins especially Mrs and Mr Malteash, Mrs and Mr Gururaj,Shashi for their in time support valuable help during my work. I extend my regard to mysisters Anju, Roopa, Deepa for their affection. I owe my immense thanks to Mrs and Mr Dr BDBhat, CDPatil, RDPatil,ASeenam Bhat for their love and affection shown through out my life. I have no words to explain my feelings towards my all time friends Mrs and MrCBRaj, Mrs and Mr Jagdish, Mr Chandru, Dr Basavaraj, Mr Ghouse and Dr SatishPaiwho are spirit behind my enthusiasm. I am ever thankful to them. My in depth regards to Dr Koteshwar, DrChetan, DrDPJoshi, DrSantoji,DrVSHiremath, DrPattanshetti, DrVeenaK, DrSReddy, DrYadalli, Dr PDDeshpande,Dr GSKulkarni, DrVMKullolli, DrAIAkki, DrTeggi, DrSubin, DrFebin, DrSatish,DrMaheshAbhang, Dr SAPatil, DrAnita, DrSantosh Kulkarni, DrBani and DrVarsha fortheir friendly affection. I am also thankful to my junior friends DrAnandH, DrAnita, DrSuvarna,DrSharanu, DrJayashri, DrSuma, DrRudraxi, DrKattimani, DrJagdishH, DrVijaySH,DrHakkandi, DrAshwin, DrGavi, DrAnandHD, DrAshwini, DrJiglur, DrSarvi, DrAshok,DrSulochana, DrManjunath, DrAmnish, DrShibaprasad, DrGavimath, DrPrasanna,DrBudi, DrMadhushri, DrPayappagouda, DrShivaleela, DrKumbar and DrArunkumarBiradar for their support and affection. I acknowledge my patients for their kind co-operation and whole-hearted consentto participate in this clinical trial. I express my thanks all those who have helped medirectly and indirectly with apologies for my inability to identify them individually. Finally I dedicate my whole effort to my beloved parents Mr A.Shankar Bhat andMrs Uma.S Bhat who are the driving force behind all my fruitful endeavors. Date: Place: Dr Pradeep Agnihotri. II
    • CONTENTS Page No.’s01. Introduction 1-302. Objectives 403. Review of Literature 5-5304. Methodology 54-7705. Results 78-10106. Discussion 102-11407. Conclusion 115-11708. Summary 118-11909. Bibliography 120-13010. Annexure i. Shlokas of Sri Siddhadaradamruta Rasa ii. Case sheet Proforma IV
    • Graph Contents Page No No 01. Showing Distribution by age Group 78 02 Showing the distribution of patients by Sex. 79 03 Showing Patients distribution by Religion 80 04 Showing the distribution of patients by Socio-economic status. 81 05 Showing the distribution of patients by Occupation 82 06 Showing the distribution of patients by Prakriti. 85 07 Showing the distribution of patients by desha 88 08 Showing the distribution of patients by chief complaint 89 09 Showing the distribution of patients by associated complaints 90 10 Showing the distribution of patients by Nidana. 91 11 Showing the response of the therapy in Sandhishoola. 92 12 Showing the response of the therapy in Sandhishotha. 93 13 Showing the response of the therapy in Jwara 94 14 Showing the response of the therapy in Gouravata. 95 15 Showing the response of the therapy in Nidraviparyaya 96 16 Showing the response of the therapy in Jadyata. 97 17 Showing the overall result assessed on the basis of subjective & 98 objective parameters V
    • Sl.No Content Page No01 Shows list of synonyms of Hingula according to different 07 authors.02 Shows inclusion of Hingula under different classes. (As per 09 different texts)03 Showing the bhedas of Hingula. 1004 Sowing the rasa of Hingula according to various texts 1305 Showing the doshaghnata of Hingula according to various 14 texts06 Synonyms according to different authors 1707 List of Synonyms of vata 2308 Synonyms of Palandu according to different authors 2609 Synonyms of Lavanga according to different author 2910 Showing synonyms of Guda. 3211 Synonyms of Grutam. 3412 Showing the samanya laxanas of Amavata 4013 Showing the different treatment modalities adopted in 44 Amavata according to various authors.14 Showing the pattern of onset of Rheumatoid arthritis. 4915 Results of Hingula Shodhana 5716 Showing the quantity of Hingula before shodhana and after 57 shodhana17 Showing weight of Bhallataka before and after shodhana. 5918 Showing weight of Hingula before and after threading. 6019 Showing details of Pachana Samskara. 6120 Showing details of Ghruta Pachana. 6321 Showing the gradation which is adopted in statistical 75 evaluation of clinical symptoms.22 Showing the gradation which is adopted in statistical 76 evaluation of walking time.23 Showing Distribution by age Group 7824 Showing the distribution of patients by Sex 7925 Showing Patients distribution by religion 8026 Showing the distribution of patients by Socio-economic 81 status27 Showing the distribution of patients by Occupation. 8228 Showing the distribution of patients by marital status 83 VI
    • Sl.No Content Page No29 Showing the distribution of patients by food habits 8330 Showing the distribution of patients by addiction. 8431 Showing the Distribution of patients by predominant Rasa in 84 diet.32 Showing the distribution of patients by Prakriti. 8533 Showing the distribution of patients by Sara. 8634 Showing the distribution of patients by Samhanana 8635 Showing the distribution of patients by Satwa. 8736 Showing the distribution of patients by Vyayama shakti. 8737 Showing the distribution of patients by desha. 8838 Showing the distribution of patients by chief complaint. 8939 Showing the distribution of patients by associated complaints 9040 Showing the distribution of patients by Nidana. 9141 Showing the response of the therapy in sandhishoola. 9242 Showing the response of the therapy in sandhishotha. 9343 Showing the response of the therapy in Jwara (Sthanika 94 Ushmata)44 Showing the response of the therapy in gouravata. 9545 Showing the response of the therapy Nidraviparyaya 9646 Showing the response of the therapy in Jadyata 9947 Showing the overall result assessed on the basis of subjective 98 & objective parameters.48 Showing statistical analysis before and after treatment. 99 VII
    • 1 Ayurveda, the upaveda of Atharvaveda is the first systematically dealt medicalsystem ever known to the man kind with a vital panorama to preserve health, alleviatediseases and even prevent them .The distinctive principles of approach to an ailmentand its thorough management has been a boon to the existing medical world. Ayurveda defines swastha as one whose physical, spiritual, social andenvironmental aspects are in harmony. With the advent of Rasashastra, this has a parallel thought as that of Ayurvedawas clubbed to fortify the results in a short duration. It pledged the dehasiddhi usingdifferent minerals, metals, pearls etc after subjecting them to various samskaras. Thesamskaras help in Gunaantardhana of a dravya which is being subjected. This couldbe understood as the one by which it enhance the property of the dravya used. SriSiddhadaradamruta Rasa, a unique mode of preparation which does not fall underchaturvidha rasayanas, involves chiefly the pachana samskara of Shodhita Hingulawith Vatakseera, Palanduswarasa, and Dahana with Shuddha Bhallataka, and lastlypachana with Gogrutha. Such pachita Hingula for long hours develops properties tocure Amavata. Different Acharyas have explained the management of Amavatainvolving the Hingula, Bhallataka separately. The Rasataranginikara came up withunique preparation for the management of Amavata which involves these drugstogether and also with a simpler procedure of preparing the drug. The efficacy ofHingula has been highlighted by Brahatrasaraja sundara, Rasataranginikara inAmavata, Pliha and Garavisha. Similarly the Bhallataka is made use for managementof Amavata by Yogaratnakara in Amavata chikitsa. Amavata being a crippling disease claiming maximum loss of human workingpower ranging from simple Artharalgia to severe complication like deformities,systemic disturbances and may cause temporary or permanent disabilities. Introduction
    • 2 Amavata is a condition in which improperly metabolized intermediate byproduct known as Ama, becomes the core cause of the disease and get deposited byprakupita vata at different Shleshmasthanas. Rheumatoid arthritis (RA) is an autoimmune musculoskeletal disorderexplained in modern medicine closely resembles with the clinical entity of Amavata.It occurs in all races and ethnic groups. Females are more affected (3:1) as comparedto males. There are several preparations listed in Ayurvedic classics for Amavata likeguggulu preparation and gold preparation. They are costly and even give varyingdegree of relief. Ayurveda believes that every individual differs form each other andrequire a specific yoga in a disease. Sri Siddhadaradamruta Rasa is considered as an ideal preparation byRasataranginikara and found promising for Amavata.The whole study has been arranged in to following chapters –01. Introduction This part introduces the subjects by laying emphasis on its importance in thepresent time. Plan of study is also dealt.02. Review of Literature It is based on the description of Ayurveda texts and also modern,pharmacotherapeutic properties of the Hingula, Bhallataka, Vata, Palandu, Lavanga,and Grutha. Description of Amavata and Rheumatoid arthritis is dealt. Introduction
    • 303. Methodology a. Pharmaceutical study This chapter includes the selection of raw materials, shodhana of Hingula, andcollection of Vata dugdha, Shodhana of Bhallataka and executing the preparation ofSri Siddhadaradamruta Rasa. b. Analytical study This chapter includes the Organoleptic and chemical analysis of ShuddhaHingula and Sri Siddhadaradamruta Rasa which assess the changes in it. c. Clinical study This includes single group prospective clinical study and explains aboutefficacy of Sri Siddhadaradamruta Rasa in Amavata.01. Results In this part the results obtained are systematically presented, which includedemographic data, data related to disease and data related to response to treatment.02. Discussion In this chapter observation, findings and results of various studies have beenfound out with possible explanation for its effects.03. Conclusion The essence of the whole study is mentioned in this chapter.04. Summary It contains the information of the overall work in a nut shell. Introduction
    • 4 Aims and Objectives:1. Preparation of Sri Siddhadaradamruta Rasa.2. Analytical study of Sri Siddhadaradamruta Rasa.3. To study the clinical efficacy of Sri Siddhadaradamruta Rasa in the selected cases of Amavata. Objectives
    • 5 Sri Siddhadaradamruta Rasa All the Rasa classics have mentioned the use of Hingula along with combinationof one or the other herbal drugs. Sole use of Hingula is not advised, but Hingula aftersubjecting to different Samskara is made suitable for its sole administration along withsuitable anupana. Such preparations are few and Sri Siddhadaradamruta Rasa is oneamong them. The other preparations involve more or less same drugs for samskara aswell as procedure involved.Different methods of samskara to Hingula to enrich its Rasayana properties: 1 Rasaratnakara–va-Sidda Prayoga sangraha under the heading of HingulaRasayana has enumerated different procedures that are adopted for Hingula to make it fitfor internal administration and to enrich its Rasayana properties. 1. 5 Tola cake of Hingula is embedded in Indrayana Phala and is encrusted with mud. When dried it is burnt. When it is red hot it is brought out this is repeated for 21 times. This is called Hingula Rasayana. 2. 40 Tola of Lavanga is grounded to paste with Palandu swarasa and is converted in to a glass shape. This glass is placed in an Iron pan and kept over the fire. Place 20 Tola Hingula cake in to the glass and exactly above the pan place the vessel filled with 5 lit (approx) of onion juice. The juice is made to drop over the Hingula drop by drop. The agni is maintained in such a way that the juice should evaporate as soon as it falls on the Hingula. Later it is powdered and stored. 3. Asuddha Hingula 20 Tola, Bhallataka 80 Tola, Gogrutha, Erenda Taila and Madhu 60 Tola each. Hingula is made into cakes and Bhallatka are broken in to yava kuta choorna. Half of the Bhallataka choorna is spread in a pan over which Hingula is placed and is covered with rest of the Bhallataka. Upon this Grutha Drug review
    • 6Taila, and Madhu is put and is placed over fire for 4hrs over samanya agni. When halfis burnt in this way, then the rest is burnt by burning the content directly in the pan.After Swanga sheeta the cake of Hingula is removed and used.4. Rasatarangini kara in 9th taranga has explained similar formulation: 2 Shodhita Hingula is prepared in to cake and tied with cotton thread. This issubjected to pachana in Vatadugda and Palandu swarasa till whole of the liquidevaporates. Then Pachita Hingula is placed over lavanga choorna in a pan and overwhich Shuddha Bhallataka is placed in a conical manner and gaps are filled withLavanga choorna and subjected to Dahana till all Bhallataka is turned in to ashes.That Hingula is collected and again subjected to Pachana with grutha which is tentimes more than Hingula in quantity. Later threads are removed, Hingula is powderedand administered. Thus prepared, is best indicated in Amavata, Pleeha vrudhi, Pakshaghata andKlaibya. This method is taken for the study.5. The reference of Sri Siddhadaradamruta Rasa is also quoted by Sri harisharananda vidya in Bhasma vignana3 where he calls it as Hingula bhasma. Even he has taken the reference from Rasatarangini.6. In Ayurvedasara Sangraha same method of preparation and indication is explained. 4 Drug review
    • 7HingulaIntroduction – Hingula is compound of Parada and Gandhaka, which occurs as a mineral in themines, associated with other minerals and also made artificially. This is a chief source ofmercury since ancient times to this date. In ancient times mercury was obtained from itthrough patana process. Many varieties of this mineral have been described in ancienttexts. Out of these Hamsapada variety is considered best as it consists less impurities.Synonyms –Table No. 01. Shows list of synonyms of Hingula according to different authors. Sl. Synonym RT R. Sa. Sn. AP RA DN RA KN 01. Hingulam - - - - + - - 02. Hingul + - - - - - - 03. Hingula + + + + - + - 04. Ingula + - - - - - - 05. Hingulaka - - - - - - + 06. Mleccha + - + + + + + 07. Rakta + - + - - - + 08. Gairika + - - - - - + 09. Suranga + - + - - - - 10. Chitranga + - - - - - + 11. Churna parada + - - - + - - 12. Rasodbhava + - - - + - - 13. Rasasthana + - - - + - - 14. Ranjana + - - - - - - 15. Kapishirshaka + - - - - - - 16. Raktakaya + - - + - - - 17. Hamsapada + - - - - + + 18. Darada + + + - - - - 19. Barbara - - - - - - - 20. Shuka tunda - - - - - - - 21. Jati - - - - - - + 22. Rasagandha sambhuta - - - - - - - 23. Daitya raktaka - - - - - - - 24. Maraka - - - - + - - 25. Maniraga - - - - - - + 26. Rasagarbha - + + - + - - 27. Charmanu ranjana - - - - - - - 28. Ati rakta - - - - - - + 29. Parvata - - - - - - + 30. Saikta - - - - - - + Drug review
    • 8Vernacular name –English name – Cinnabar.Scientific name – Red sulphide of mercury.Sanskrit – Hingula, darada.Hindi – Hingula, Singraph. Assam – Janjapher.Bengal – Hingula. Pārsi – Sangarph.Marathi – Hingula. Telagu – Ingulakam.Gujarathi – Higualo. Kannada – Ingulika.Historical BackgroundVedic period: No references about Hingula are available in any of the Vedas.Samhita kala: No reference about Hingula is available in Brahatrayees and Samgrahas. The author of Kautilya Arthashastra, Chanakya has mentioned Hingula in his textfor the first time. He mentioned it for testing various metals. He was using this for testingthe suvarna. The uses of Hingula as a medicine was not described by him.5 In Samhita kala, there were no references of Hingula. But, we get references ofparada. It is assumed that in olden days, it was imported from other countries. Drug review
    • 9 According to history of oldest text of rasashastra, Rasendra Mangala, we get thereferences of Hingula. Here, he used the word Darada for Hingula6. Rasa Hridayatantrakara mentions, it is one of the rasadravya.7 Author of rasarnava considered, as it isone of the maharasa dravya.8 while describing synonyms, Rasendra sara samgraha,mentioned it as Rasa Gandhaka Sambhoota.9 The usage of Hingula as a medicine startedbetween sixth and eighth century.Inclusion of Hingula Different authors of various Rasa Granths have included Hingula under thevarious titles. The classification of all Rasa dravyas done generally, according to their usage andimportance in the procedure related with parada. The important Rasa texts have includedHingula under following classes –Table No. 02. Shows inclusion of Hingula under different classes. (As per different texts)Dravya Rasa Maharasa Uparasa Sadharana rasaHingula Rasahridaya Rasarnava11 Anandkanda,12 R.S.S,13 R.J.N. 16 tantra10 B.R.R.Su.14, A.P15 R.C. 17 R.Pra. Su 18 R.R.S.19 Drug review
    • 10Hingula Bheda No description about varieties of Hingula is available in Resendra Mangala andRasa Hridayatantra. But we get reference of Hingula bheda in other texts.Table No. 03. Showing the bhedas of Hingula.Sl. Name of the text Charmara Shukatunda Hamsapada Anya01. Anand kanda20 + + + -02. Rasendrachudamani21 - + + -03. Ayurevda prakasha22 + + + -04. Rasaratnasamuchhaya23 - + + -05. Rasaprakasha + + + - sudhakara2406. Rasatarangini25 - - - Kritrima khanija07. Rasamrita26 - - + Mlechha Drug review
    • 11Charmara Hingula Shuka varna i.e. Greenish colour.Shukatunda Hingula Sapeeta varna i.e. Yellowish colour.Hamsapada Hingula (Grahya Hingula) 27 It has Pravala samana and having sweta rekhas on the surface of Hingula. It isconsidered to be best for therapeutic purpose. Among these three are having the quality of uttarottara gunavan.Asuddha Hingula dosha28 If ashuddha Hingula is consumed, causes – Moha, Prameha, Chittavibhrama,Andhyata, Klama, Kshainya and this directs to use always Shodhita Hingula.Tasya chikitsa29: It is treated similar to the ashuddha parada bhakshanajanya doaha. Theperson should be administered Shuddha Gandhaka for 2 months.Shodhana of Hingula: Various shodhana methods are explained in different classics, according toavailability, cost efficacy and medicinal formulations. 01. Do mardana with amla rasa dravyas and give 7 bhavanas of mahisha dugdha30. Drug review
    • 12 02. Keep Hingula in kushmanda khanda, do pottali, and give swedana in Lakucha swarasa poorita Dola yantra. 31 03. Give 7 bhavanas of adraka swarasa or lakucha swarasa. 32 04. Give 7 bhavanas of adraka swarasa. 33 05. Give 7 bhavanas of nimbu swarasa. 34Satwapatana35 Shodhita Hingula is smeared in the upper part of adhapatana yantra, water is filledin lower vessel. This apparatus is placed in the earth. Give heat to the upper vessel. Weget parada samana satwa in lower vessel.Marana36 Generally marana is not advised for Hingula. Shodhita Hingula can be used forthe preparation of yogas. However elaborate process of marana has been described in Ayurveda prakasha. Hingula is wrapped in the cloth and kept inside nila kanda, which is then coveredwith the mud paste around. When dried, it is subjected to puta, and baked in 10 vanopalasuch 100 putas are given similarly it is kept inside vanavarataka and given 100 putas thenin mandara phala and given hundred putas then in indravaruni phala and subjected to 100putas and lastly in amlavetasa phala and given 100 putas. At the end Hingula attainsintense red colour. Drug review
    • 13Hingula PropertiesRasa – Various opinions are available regarding the Rasa of Hingula.Table No. 04. Sowing the Rasa of Hingula according to various texts Sl. Author Madhura Tikta Kashaya Katu 01. Rasarnava + + - - 02. Dhanwantari + + - - nighantu 03. Raja nighantu + + - - 04. Bhava prakasha - + + + 05. Ayurveda prakasha - + + + 06. Rasendra purana - + + +Guna – Most of the texts considered Hingula as ushna gunayukta dravya.Veerya and Viapaka – No rasa shashtriya text has mentioned veerya and vipaka of Hingula, though theDhanwantari nighantu being the text of dravya guna vignana has mentioned Hingula ishaving the ushna veerya and katu vipaka.Doshakarma – Even though almost all the authors enormously agree the tridoshaghna karma ofthe Hingula, still some of the texts mention either kaphaghna or kapha pittaghna action ofHingula as well. Drug review
    • 14Table No. 05. Showing the doshaghnata of Hingula according to various texts – Sl. Author Kaphaghna Kapha-pittaghna Tridoshaghna 01. Rasatarangini + - - 02. Bhava prakasha - + - 03. Ayurveda prakasha - + - 04. Rasendra chudamani - - + Rasendrasara 05. - - + sangraha 06. Rasendra purana - - + 07. Rasamrita - - + Rasaratnasamuchhyakara has quoted Hingula as sarva doshahara, deepana,atirasayana, sarvarogahara, vrishya. It is useful in dhatujarana, Parada extracted formHingula is equal to the property of Gandhaka jarita parada. 37 Rasaprakashasudhakara quoted that the Hingula has the property of deepana,sarvadoshaghna, atirasayana, sarvarogahara. It is helpful in dravana karma. Paradaextracted form Hingula is said to be equal to the property of shadguna Gadhaka jaritaparada. 38 Ayurveda prakashakara has quoted the property of Hingula as tikta, kashaya rasa,kapha-pittahara. It subsides netra roga, hrillasa, kushta, kamala, pleeha, amavata andkrutrima visha. It also cures navajwara and santapajwara. 39 Rasendrachudamanikara quoted the property of Hingula as sarvadoshaghna,deepana, atirasayana, sarva rogahara, vrishya. It is helpful in jarana samskrara. 40 Drug review
    • 15 Rasamrita quoted the properties of Hingula that it pacifies all the tridoshas. It hasdeepana and powerful rasayana effect. It can destroy all diseases and may be used for themarana of gold and iron, metals. 41 Mercury extracted form the Hingula is considered to be equal in properties to themercury in which gandhaka jarana has been carried out. Rasataranginikara quoted that, it has a property of netrarogahara, kaphanashaka,pittajaroga nashaka. It subsides pleeha, kushta, gara visha, kamala. It is pachaka agnivardhaka and ama pachaka. It is pramehgna. It enhances shareera kaanti, and bala. Itcures prakupita amavata and jwara. 42 Dhanwantari nighantukara quoted that, it has katu vipaka, ushna veerya. It subsidevisha, kushta, visarpa and twak vikara. It is madhura tikta in rasa, and is kapha vatashamaka. It cures tridoshaja and dwandwaja jwara. 43 Rajanighantukara quoted that it is having madhura tikta rasa and ushna veerya. Itsubside vata and kapha roga, dwandwaja and tridoshaja jwara. 44 Kaiyadeva nighantukara 45 quotes that, Hingula is laghu, tikta and katu rasa, katuvipaka and ushna veerya. It subsides netra peeda, kushta, visarpa, visha, pitta and kapha .Vishishta Yoga Hinguleshwara rasa, Mrityunjaya rasa, Ananda bhairava rasa, Siddha daradamritarasa, Darada vati. Drug review
    • 16Cinnabar 46 Chemical composition – Sulphide of mercury (HgS). It contains 13.8% of Sulpher and 86.2% of Mercury Form – Trigonal or rhombohydral usually. Massive, granules. Intense red in colour, sometimes brownish red in colour. Streak – Red. Transparency – Opaque or translucent. Hardness – 2-2.5. Specific gravity – 8.09. Luster – Admentine. Variety – Hepatic with liver brown colour. Occurrence – Generally occurs due to the volcano activity. Also available near hot springs. Important places of occurrence are Spain, Italia, Western states of USA, Mexico.Cinnabar classification-• Dana class - Contains sulfides including Selenides and Telluride.• Strunz class - Contains sulfides and Sulpho salts. Drug review
    • 17 BHALLATAKA- Semicarpus Anacardium Family: Anacardiaceae.Introduction: Earliest references about Bhallataka are found in the Panini sutras. LaterCharaka emphasized the Rasayana property of Bhallataka and described ten types ofpreparations with it. He considered Bhallataka as the best drug to cure the diseaserelated to kapha 47. Susruta mentioned it as the drug of choice in the management ofarshas along with kutaja. Vagbhata has quoted Bhallataka as the best drug of choicein the management of suska arsas. Bhallataka asthi shall be considered for dipaniyapurpose 48Yogaratnakara has explained yogas of Bhallataka in Amavata chikitsa. 49Vernacular Names:Hindi -Bhilava Telugu - Nall jidi chettu.English - Marking Nut. Kannada - KeruBengali -Bhela. Gujarati & Marathi - Bilama. Table No. 06: Synonyms according to different authors: Sl.No DRUG D.Ni K.Ni B.Ni R.T. R.Ni 01 Bhallataka + + + + + 02 Agnika + - - + + 03 Dahana + - - - + 04 Tapana + - - + + 05 Aruskara + + - + + 06 Virataru + + - - - 07 Agnimukha + + - - - 08 Dhanu + + - - - 09 Balli - + - - - 10 Anala - + - - + 11 Vrunakrut - + - - - 12 Spotahetu - + - - - 13 Krumighna - - - + + 14 Vatari - - - + + 15 Tailabeeja + 16 Prutak Beeja + 17 Dhanur Beeja + Drug review
    • 18Botanical Description: 50,51,52 A moderate sized, deciduous tree, exudating a dark juice .young branches,inflorescence, petioles and under side of leaves pubescent.a) Leaves- Oblong, obovate, rounded at apex, cartilaginous at margin, verycoriaceous.b) Flowers- Fasciculate, arranged in erect, compound, terminal panicles, greenishyellow colored.c) Fruits- Drupes, obliquely oval or oblong, smooth, shining, purplish-black whenripe, cup orange red flowering round the year, mostly during May-June, fruits ripenfrom November to February.d) Habitat- This tree is found growing on the sub Himalayan and tropical part ofIndia as for east as Assam.e) Chemical constituents: The fruits of Bhallataka yielded Bhilawanol which was shown to be a mixture of cis and trans isomers of ursuhenol Bhilawanol was found to be a mixture of 1,2- dihydroxy-3-(pentadecenyl-8)-benzene and 1,2- dihydroxy-3-(pentadecadienyl- 8,11)-benzene studies on methylated Bhilawanol showed that it contained more than seven components; two major components were identified as dimethyl ethers of 1-pentadeca-8-enyl-2,3-dihydroxybenzene (I) and 1-pentadeca-7,10-dienyl-1,3- dihydroxybenzene (II); defatted nuts yielded three biflavones A, B and C; latter two compounds were characterised as 3,8-binaringenin and 3,8-biliquiritigenin, re-examination of bhilawanol showed it to be comprised of two components, Drug review
    • 191,2-dihydroxy-3-pentadecenylbenzene (32-32%) and its corresponding diene analogue (68-70%); a new biflavan, tetrahydrorobustaflavone and tetrahydroamentoflavone were isolated from nuts; leaves yielded only amentoflavone• Confirmation of structure of Semecarpus biflavanone B by chemical studies was carried out; a new biflavonoid, jeediflavanone was isolated from nut shells and characterised; galluflavanone was isolated from nut shells and its structure determined; isolation and structure elucidation of semecarpuflavanone from nut shells was reported.• Isolation of a biflavonoid, jeediflavanone from nutshells, a biflavonoid, galluflavanone from nutshells, a third biflavanoid, semecarpuflavanone from nutshells and a new dimeric flavonoid nallaflavanone were reported and the structure of nallaflavanone was determined and confirmed; isolation of another new biflavonoid semecarpetin from nutshells and its characterisation were reported.• A new biflavanone, anacarduflavanone was isolated from nut shells and its structure established• The acetate of a novel phenolic glycoside,1-O- β-D-glucopyranosyl-(1→6)- β-D- glucopyranosyloxy-3-hydroxy-5-methylbenzene, anacardoside was isolated from the fruits of Semecarpus anacardium, and its diastereomers were first synthesized using Koenigs-Knorr method from D-glucose through six steps with total yields 33% and 16% respectively. Drug review
    • 20• Chemical constituents of the shell liquid have not been exhaustively investigated. The major constituent (~ 46% of the weight of extract) is bhilawanol, C21H32O2, which distils over at 225-26°/3 mm. when the shell liquid is subjected to vacuum distillation; it is an o-dihydroxy compound with a catechol nucleus and an unsaturated C15-side chain; it has since been shown to be a mixture of cis and trans- isomers of urushenol [3-(pentadecenyl-8)-catechol]. A small quantity (c. 0.1 %) of a monohydroxy phenol, semicarpol, C17H28O (distilling at 185°- 90°/2.5 mm.) is also present. The dark tarry residue left after distillation contains high boiling phenols and hydrocarbons. Thermal degradation of the shell liquid at 400° gives catechol and a mixture of phenols and hydrocarbons.Grahya Bhallataka53: The pakwa Bhallataka which sinks in the water has to be collected for shodhana procedures.Bhallataka Shodhana:1. Bhallatakas are to be tied into a pottali along with Ishtika choorna and subjected toslight gharshana. This is done till the external skin is peeled off and oil is properly setfree in to the isthika choorna. Later it is washed with hot water and brought to use. 542. Bhallataka is cut in to pieces and is subjected to swedana with narikela jala fortwo hours. This purifies Bhallataka. 553. Bhallataka is tied in a pottali and is subjected to swedana for 12 hrs in the mixtureof buffalo dung and water in the ratio 1:4. Later swedana in godugdha and gomutra Drug review
    • 21for 4hrs each is done. Then it is washed in hot water and again swedana is done innarikela jala for 12 hrs, and brought to use.564. Bhallataka to be subjected to swedana in gomutra for 4 praharas and washed withhot water and brought to use. 57Antidote: Application of coconut oil externally Internally Coconut oil with tila and haritaki.Part used: • Fruit, Seed, Seed kernel, Gum and oil.Dosage: Choorna - 1 to 3 Gunja. Taila - 1 to 2 Drops. Avaleha - ¼ to ½ Tola . Ksheera paka - 1 to 2Tola. Guna karma: Rasa – Katu, Tikta, Kashaya. Guna – Tikshna, Laghu, Snigdha. Veerya – Ushna. Vipaka – Madhura. Dosha karma: Kaphavatahara, Rasayana, Shukrala, Medhya, Bhedana. Drug review
    • 22 Bhava prakashakara has included the drug under the Hariyakyadi varga.Bhallataka is best indicated in Kusta, Arsha, Grahini, Gulma, Jwara, Agnimandya, Krimiand Vruna. 58 Dhanwantari Nighantu includes Bhallataka under Chandanadi varga. It isgood in Krumi vikaras, Gulma, Arsha, Grahani, and Kusta59. Kaiyadeva nighantukara explains that the pakwa phala of Bhallataka isVistambi, Bhrumana, Shukrala, Raktapitta nashaka. Its Asti is Pachaka, Chedi ,Bhedi,Medhya, Agnikara. Bhallataka is indicated in Kustha, Arsha, Gulma, Shopha, and Jwara.The majja of Bhallataka is vrushya.60 Rasataranginikara has similar views as of other Acharyas. He mentionedBhallataka is Rasayana and Balakara.61 Rajanighantukara explained that the majja is exceptionally Daha shamakaand does agni vardhana and pitta shamaka.62 The fruits are acrid, hot and anti-helminthic; it is considered beneficial inascites, tumours, warts, acute rheumatism, asthma, neuralgia, epilepsy and psoriasis.They are thermogenic, emollient, digestive, anti-arthritic, depurative, anti-inflammatory,uterine stimulant, alterant, expectorant, liver tonic, febrifuge and rejuvenating. They areused in sciatica, neuritis, dyspepsia, flatulence, constipation, colic, hemorrhoids,splenopathy and hepatopathy. They are also useful in cough, asthma, beriberi, leprosy,leukoderma, diabetes, dismenorrhoea, amenorrhoea, ulcers and general debility.63 Plant -Showed anti-inflammatory activity in rats. Nut - Milk extract was active inrats Vs Carragenin, It suppressed primary inflammation of adjuvant arthritis in rats andhad no effect on secondary lesion. Significant effect was seen as anti-arthritic. The milkextract of S. anacardium produces regression of hepatocarcinoma by stimulating hostimmune system and normalizing tumor markers including alpha-fetoprotein levels. Drug review
    • 23 Vata – Ficus Bengalensis Family: MoraceaeIntroduction: It is one among panchavalkalas. It is a big tree with adventious roots to support itsbranches. It spreads up to miles. It is commonly found all over India.Vernacular Name: Hindi: Vada Kannada: Ala Gujarati: Vadalo Punjabi: Bera, Baragad Tamil: Alum Table No. 07: List of Synonyms Sl.No Drug R.Ni D.Ni K.Ni B.Ni 01 Vata + + + + 02 Jatala + - - - 03 Vyagroda + - - - 04 Rohini + - - - 05 Rohini + - - - 06 Vitapi + - - - 07 Raktaphala + - - - 08 Skandaruha + - - - 09 Mandali + - - - 10 Mahachaya + - - - 11 Shrungi + + + + 12 Yakshavasa + - + - 13 Yakshataru + - - - 14 Neela + - - - 15 Ksheeri + - - - 16 Shiparocha + - - - 17 Bahupada + + + + 18 Vanaspati + + + - 19 Padarohini + - + - 20 Nyagroda - + + + 21 Skandaja - + + + 22 Vishravanaja - + - + 23 Danto - - + - 24 Dhruvaha - - - + Drug review
    • 24Botanical Description: 64 Banyan trees are huge and out spreading. Trunk is whitish grey in color.Leaves – are big, oval in shape, 12 to 14 cms long, thick, turgid and dark green having 3 to 5 veins. Fruits- These are Red and round in shape. Flowers bloom in spring and Fruiting occurs in Monsoon. Tree survives many years. Habitat – Found all over India.Chemical Constituents65, 66: Bark and young buds contain about 10% of Tannin, waxand caoutchoue. Fruits contain oil, albuminoids, carbohydrates, fiber and ash 5% to 6 %.The bark contains Leucoanthocyanin, Tiglic acid, β-sitsterol-a-D-glucoside.Part Used: Panchanga.Dose: Decoction ─ 50 to 100 ml. Powder ─ 3 to 5 gms. Latex ─ 5 to 10 drops.Guna Karma:Rasa – Kashaya Virya : Sita Guna : Guru, Ruksha Vipaka : KatuKarma- Kapha- pittahara, Mutra sangrahaniya, Varnya. Stambana. Charaka has classified Vata under Mutrasangrahaniya while Sushruta andVagbhata have classified under Nyagrodadi gana. Drug review
    • 25 Kaiyadeva Nighantukara has dealt it in oushadi varga. He claims that drug curesVisarpa and improves the shareera varna67. Dhanwantari nighatukara explains the same and includes Raktapitta nashanaproperty.68 Bhavaprakashakara and RajNighantu explain similar properties along withYonidoshahara property.69 The latex of Vata is applied on Wounds, Cracked soles, Synovitis, Arthritis,Lymphadenitis. Internally it is used to treat Diarrhea, Amoebic dysentery and bacillarydysentery.70 Palandu - Allium Cepa Family: LiliacaeIntroduction: It is an annual herb with bulb and white flowers. It is cultivated all overIndia palandu is quoted in the Bruhattrayee texts. Chakrapani considered Grunjanaka asLohita Palandu.Vernacular Names: Hindi: Pyaz Telugu: Ullipaya English: Onion Marathi: Kanda Drug review
    • 26Table No. 08: Synonyms according to different authors: Sl.No Drug Bp.Ni K.Ni R,Ni D,Ni 01 Palandu + + + + 02 Mukhadushika + + - + 03 Sukanda - + - + 04 Yavanesta + - + + 05 Durgandha + - - - 06 Raj palandu - - + - 07 Nrupahwaya - - + - 08 Raj priya - - + - 09 Mahakanda - - + - 10 Dheerga patra - - + - 11 Rochaka - - + - 12 Nrupesta - - + - 13 Nrupakanda - - + - 14 Nrupapriya - - + - 15 Raktakanda - - + - 16 Rajesta - - + -Botanical Description: 71 The shrub grows to a height of 60 to 90 cms. Leaves- Thick, round, and green with Green Coloured flower stalk at the top. It bears white flowers in clusters. These produce triangular seeds. Flowering and fruiting occurs after winter. Drug review
    • 27Verities: 1. Red ─ Rakta palandu- Small in size. 2. White ─ Swetaksheeri palandu- Large in Size. Habitat: All over India. Onions growing in Maharastra are large.Chemical Constituents: 72, 73 Onions have a unique combination of three families of compounds that arebelieved to have salutary effects on human health — fructans, flavonoids andorganosulfur compounds. A great deal of research has focused on one flavonoid,quercetin, which is found at particularly high levels in onions. Onion contain many sulfurcontaining active principles mainly in the form of cysteine derivatives, viz. S-alkylcysteine sulfoxides which decompose into a variety of thiosulfinates and polysulfides bythe action of an enzyme allinase on extractionPart used: Bulb and seedsDose: Juice ─ 10 to 30 ml. Seed Powder ─ 1 to 3 gms.Guna and Karma: Rasa: Madhura, Katu. Veerya:Ushna Vipaka: Madhura Guna: Guru, Snigda, Tikshna. Dosha karma- Vatahara, Vrushya, Rasayana Drug review
    • 28 Bhavaprakakara has included this under Haritakyadi varga. Palandu is excellentremedy for Agnimandya as it is Agnivardhaka. It is also Vrushya, Uttejaka and bestVatahara next to lashuna.74 Kaiyadeva Nighantukara has also considered this as next to lashuna but a littlemilder to it.75 In Rajanighantu, apart from the above mentioned properties he adds that Redpalandu is Kshareeya, teekshna and is best deepaka.76 In Dhanwantari Nighantu it has been included in Karaveeradi varga. He explainsproperties same as other Acharyas.77 Research studies have shown organosulfur compounds to:78 – Reduce symptoms associated with diabetes mellitus. – Inhibit platelet aggregation (involved in thrombosis). – Prevent inflammatory processes associated with asthma. Many of these studies used non-human subjects. The organosulfur compounds arebelieved to possess anti-inflammatory, anti-allergic, anti-microbial, and anti-thromboticactivity by inhibition of cyclooxygenase and lipoxygenase enzymes. Most likely thecompounds work through sulfur-sulfur or sulfur-oxygen linkages. Quercetin’s anti-inflammatory effect on prostaglandins, eukotrienes, histamine release and subsequentantiasthmatic activity has been investigated. Drug review
    • 29 Lavanga: Syzygium aromaticum Family: Myrtaceae.Introduction: It is a less utilized herb during the Brahattrayee period. At later timesespecially in yoga granthas we come across the utility of Lavanga in therapeutics.Traditionally cloves have been used to treat flatulence, nausea, vomiting.Vernacular Names: Hindi: Laung Telugu: Lavangaumu. English:clove Tamil: Kirambu Kannada: Lavanga Table No. 09: Synonyms according to different author Sl.No Drug K.NI D.NI R.Ni B.p.Ni 01 Lavanga + + + - 02 Devakusuma + + + - 03 Shrungaram + - - - 04 Shikaram + + + - 05 Lavam + + + - 06 Sripuspam + + + - 07 Varijam + - - - 08 Sravyam + - - - 09 Devyam + + + - 10 Chandanapuspakam + + - - 11 Brungaram - + + - 12 Varisambhavam - + + - 13 Lavanga kalika - - + - 14 Ruchiram - - + - 15 Teekshnapushpam - - + - 16 Greevana kusumam - - + - Drug review
    • 30 79Botanical Description: Tree full of green leaves, 10-13 mts height. Bark of trunkyellowish white and tender. Branches appear from the bottom and are tender and directeddownwards. Flowers brown externally, four triangular petals. Fruits are fleshy, 3 cmslong, seeds-single in each fruit. Flowering season is summer and fruiting in pre-monsoonflowering starts after nine years of plantation.Habitat: Originally from Malaya-Saillbius island. At present cultivated in southern India.Chemical Costituents:80 A heavy volatile oil 16% to 20%., A Camphor Resin 6%, Caryophyllin occurs insilky stellate needles. Oil distilled from cloves contains:-1) Eugenol 85% to 92% chemically resembling phenol.2) Acetyleugenol3) Caryophyllene, a sesquiterpene, furfural and Methyl-amyl-ketone.Parts used : Floral bud, Clove oil. Dose: Powder ─ 1to 2 gms. Oil ─ 1 to 2 drops.Gunakarma: Rasa: Tikta, katu, Guna: Laghu, Snigdha Virya: Sita Veepaka: Katu. Karma: Kaphapitta hara, Ruchya, Deepaneeya, Pachana, Netryam. Drug review
    • 31 Rajnighantukara explained Lavanga to possess vata, pitta and kaphaharaproperties. Hence, best in shiro rogas.81 Kaiyadeva nigantu kara has included it in the Ousadivarga and attributes itto posses the Hridya, Netrya and Pachaka. This cures Shoola, Anaha, Tridosha, Kasa,Swasa, Visha, and Peenasa.82 Dhanwantari nighantu kara highlights its Vajikarana properties with allother properties as explained by other acharyas.83 Eugenol, the primary component of clove’s volatile oils, functions as an anti-inflammatory substance. Clove also contains a variety of flavonoids, includingkaempferol and rhamnetin, which also contribute to clove’s anti-inflammatory (andantioxidant) properties.84 Nutrient Amount Manganese 1.32 mg Omega 3 fatty acids 0.20 g Dietary fiber 1.52 g Vitamin C 3.56 mg Magnesium 11.60 mg Calcium 28.40 mg Drug review
    • 32Guda Vernacular Names: Hindi: Guda English: Tracle, Jaggery Kannada: Bella Synonyms; Table No.10.showing synonyms. Sl.No Drug R.Ni 01 Guda + 02 Ikshurasa + 03 Madhura + 04 Rasapakaja + 05 Sishupriya + 06 Sitadi +Utpatti: Well-cooked sugarcane juice when solidifies and become hard like stone is known as guda. Drug review
    • 33Guna Karma: Rasa: Madhura Guna- Laghu Doshagnata- Tridoshashamaka. Purana guda is said to be best because of its action over all dhatu vahasamsthana. It is Agni vardhaka, Ruchya, there by it gets digested easily and nourishesbody and kindles the Jatharagni. It is Vrishya and also claimed as Sadhya Sukrala, Hencein association with Sukravardhaka dravya Ikshu vikaras esp Purana guda is prescribed.Itsrole on Rakta and Raktavaha srotas, Nidravaha srotas is remarkable. It enriches theproduction and shows the qualitative and quantitative increase of Rasa and Rakta dhatu.It is also hridya as its action conferred on Rasa and rakta reflects as such RasaRaktacomplex is flown in the Hrudaya and Dasha dhamani. It is said as Mala, Mootra vikarashodhaka and acts on Prameha as it is Mootrala. Very especially it cures a condition ofRakta kshaya and Anidra. It is Shramaharam also.85 Sushruta quotes that Guda is Kshara yukta and Madhura and not Atiseeta. And isSnigdha and it is Mutra and Rakta shodaka, and it does not mitigate excessive aggravatedPitta, but it is best Vata shamaka and Medovrruddikaraka and Krimi and Kapha karakaand increases the Bala of the body and Vrushya.86 Guda is said to posses Pittanashaka, Madhura, Vatanashaka, Raktaprasadakaqualities and a year old guda (Purana guda) posses more qualities and it is Pathy karaka. Drug review
    • 34GruthaEnglish: Clarified Butter. Hindi-Ghee Telagu- Nayee Kannada- TuppaSynonym: Table no 11. Synonyms of Grutam. Sl.No Synonyms K.N R.N 01 Ghrutam + + 02 Aajyam + + 03 Havi + + 04 Sarpi + + 05 Pavitra + + 06 Navaneetaja + + 07 Amrutam + + 08 Abhigara + + 09 Jeevaneeya + - 10 Homya - + 11 Ayu - + 12 Taijasa - + Ghruta is Agnideepaka, Balya, and Ayushya dayaka. It makes shareera Sthira. Itis Madhura in Vipaka Sheeta in Veerya and Vatapitta shamaka, Vishahara.87 Cow’s ghee has sufficient oxygen and is considered the best for the diseasesrelating to the area of the head. Kerotine is ten times more in cow’s ghee than in that ofbuffalo’s. When instilled in the nostrils the oxygen of cow’s ghee cures the diseasescreated as a result of imbalance of Vata, Pitta, Kapha. In the problems of obesity which isrampant these days, amount of ghee consumed in one month will directly &proportionately reduce obesity while in the undernourished people it will proportionatelyincrease the weight. In short cow’s milk & ghee are the best nourishment and thefundamental regulators of a healthy body.88 Drug review
    • 35ArdrakaLatin name – Zingeber officinale.Synonyms – Adraka, gulma, moola, mulaja, kandala, vara, shringavera, mahija,saikateshta, anupaja, apekshika, adravya, rahu chhatra shishuka, shagra, aardra shakha,sachaka.Vernacular names – Sanskrit – Ardraka. English – Green ginger. Hindi – Adraka. Malyali – Alia. Telagu – Allam. Tamila – Inji. Bengali – Duk. Marathi – Shunti. Kannada –ShuntiCharacters – The plant with the dingy yellow flowers on a leafless flowers stalk andlong lanceolate leaves on a separate stem.Rhizomes – 2 to 4 inch long.Tubers – Branched, knotty and some what compressed on one side lobed and clavatelybranched without a wrinkled corcky epidermis. Buff coloured and striate on sectionfracture meanly and fibrous showing many scattered resin cells and fibro-vascularbundles.Odour – Agreeable, aromatic, penetrating.Taste – Acrid and pungent. Drug review
    • 36Chemical Constituents – A volatile oil 2%, fat acquired liquid oleo resin, gingerol, orgingerin insulase, resin, starch 20%, ash 4%. The volatile oil contains camphene andphelladrene. Gingerol, an active principle extracted form ginger is a viscid, inodourouspungent liquid.Habit – Through out India, West-Indies, Africa, cultivated in Jamica, Sierraleone.Part used – Rhizomes.Adraka – Rasa – Katu. Guna – Laghu. Veerya – Sheeta. Vipaka – Madhura. Dosha – Kaphahara. Karmaghnata – Hridya, deepana, ruchikaraka. It subsides kaphajnya vikara and kantha roga.Gomutra Gomutra is used as a medicine since olden days. We get the reference about it inbrihatrayees. Charaka considered, it as one of the ashta mutra varga dravya.Synonyms – Gomutra, Gojala, Goambu, Gomashanda, Godrava. Drug review
    • 37Vernacular names – ⇒ Sanskrit – Gomutra. ⇒ Hindi – Gomutra. ⇒ English – Cow’s urine. ⇒ Kannada – Gomutra.Properties – Rasa – Katu. Guna – Teekshna, Ushna, Kshara. Dosha – Kapha-vata shamaka, pitta janaka. Karmaghnata – Agni deepaka, medhya, shoolahara, gulma, anaha. It is used in virechana karma and asthapana basti. Charakacharya quotes that Gomutra has madhura rasa, dosha nashaka and krimiand kanduhara. By abhyantarapana it subside doshajanya udara roga.Nadakarni in his material medica explains Gomutra contains ammonia in a concentratedform and is much used in both internal and external purpose. Gomutra is a laxative,diuretic, and used in preparation of various medicines. Eg. Poonarnava mandura. It is alsorecommended by Chakradatta as an anupana for eranda taila given as virechana. It is used as externally in the purification and roasting of various metals andpreparation of oils, decoctions. Drug review
    • 38Disease reviewHistorical review: The Vedas are the earliest documented sources of knowledge. Of these Vedas asan offshoot Ayurveda developed. The disease Amavata does not find its references in anyof the Vedas. In the samhita period though brahatrayees did not explain about the diseaseseparately but there are few passing remarks about Amavata in charaka. He has dealt indetail about the production of Ama and its treatment. Amavata finds a mention in the listof therapeutic indication of Kamsaharetaki in Shwayathu chikitsa and Vishaladi phanta inPandu chikitsa. It was Madhavacharya who in Madhavanidhana, included Amavata as anindependent disease entity and dealt in detail about its nidana vinishchya. Laterchakradatta an outstanding work pertaining to the treatment of disease contributes the lineof management and many remedies for the disease. Works of Bhavaprakasha,Yogaratnakara, and Bhaishajyaratnavali have only corroborated the descriptions withadditional principles of treatment.ETYMOLOGY OF AMAVATA:Amam cha vatam cha Amavatam: The word Amavata comprises of two meaningful terms‘Ama’ and ‘Vata’ which forms the pathogenic basis of the disease.Ama: In the context of Udararoga89 it has been highlighted that Hypofunction of agni isthe cause of all diseases. Therefore it is not alone tridoshas which takes part but thedeficient function of Agni which plays important role in efficient nourishment of bodycan cause disease. Ama is of dual origin – 01. Formed by apakwa anna rasa90. 02. Dhatwagni durbalata91. Disease review
    • 39Apakwa anna rasa – Due to the impaired agni in the amashaya there is malformation ofahara rasa and this incomplete ahara rasa is defined as ama.Dhatwagnimandyajanya ama – At the level of dhatus due to hampering of dhatwagni.Concept of Ama Biologically Ama corresponds to the undigested protein, carbohydrate, fat,bacterial content. When they gain accesses in to the general circulation they act asantigens. Antigen92 Are usually proteins, with in the body they stimulates antibody production. They are of two types 1) Exogenous antigen – Infectious agent’s drugs and chemical. 2) Endogenous antigen – Involves blood components. Production of Ama can also be expressed in two ways- Ama which is a resultant of hypo function of agni(exogenous sources). Vagbhata explains that vitiated doshas may combine together to form Ama within the body (endogenous sources). Thus the ama from either of the above source become unwholesome to the bodyand part of it gets access into the circulation and ends up in causing disease Amavatawhich resembles RA.Nidanapanchaka 93, 94 Various classical texts have explained the same nidana for the Amavata. 01. Viruddha ahara 02. Viruddha cheshta 03. Mandagni 04. Nischeshta (Sedentary habits). 05. Who does the exercise after snigdha ahara bhojana. Disease review
    • 40 o Viruddha ahara – Those substances, which are accumulated in the body and increase the dosha with in the body, are known as viruddha ahara. They remain antagonistic to the dhatus. o Viruddha cheshta – It comprises of wide variety of causative factors like Divaswapna, sedentary habits, exercise after bhojana, excessive indulgence in sex, suppression of natural urges. EtcPoorva Roopa There is no description regarding poorva roopa in any of the Ayurvedic classics.LaxanasSamanya laxanas95.96 – Table No. 12. Showing the samanya laxanas of Amavata. Sl. Laxana Madhavakara Yogartnakara 01. Angamardha + + 02. Aruchi + + 03. Trishna + + 04. Hrullasa + + 05. Gourava + + 06. Jwara + + 07. Apaka + + 08. Shunata anga + + 09. Aalasya + + 10. Kati,Prusta,Janu Sandi akuncana and + +` sashabadata 11 Nidraviparyaya + + Disease review
    • 41Sampraptia) Primarily ama (undigested or improperly digested Ahararasa) is produced in the digestive tract.b) Secondly this ama circulates in the body through Dhamani ie along with the blood.c) While circulating the materials do not completely undergo further metabolic changes.d) This improperly metabolized ‘Ama’ mixes with the doshas ie, vata, pitta & Kapha which further vitiates Ama.e) This vitiated ‘Ama’ by its selective discrimination produces blocking (Abhishyanda) of the shrotasas.f) Blocked channels get inflamed and further transformation of the nutrient materials do not take place resulting into inflammation and permanent or chronic damage of shleshmasthana. Viruddha ahara + Vihara Agni dushti in Amashaya Formation of Amarasa Sanchara all over the body by prakupita vata dosha. Samadosha accumulates in the shleshmasthana like Amashaya, shandhi. Amarasa gets vidagdata and circulates in to shrotasas. Formation of kleda in different srotas of the body due to the picchila guna. Leads to durbalata and Gouravata Disease review
    • 42 Vata and ama vitiates at a time Enters into trika, koshta, sandhis. Where ever vikruta doshas travels produces angamarda, aruchi, apaka, gourava, jwara, shotha, ruja. AMAVATAPravriddha Amavata Laskhana 97. Ruja, Shotha in hasta-pada-shira-gulpha-trik-janu-and uru sandhi. Wherever dosha travel it causes pain which resembles the string of scorpion. On keen observation we can categories the laxanas as below 1. Lakshana specific to involvement of sandhi. 2. Lakshana specific to involvement of Ama 3. Lakshanas produced as a consequence of the disease process.1. Lakshana specific to involvement of sandhi: ∗ Shoola and Shotha in hasta-pada-shira-gulpha-trik-janu-and uru sandhi. ∗ Shunata Anganam (Swelling in Sandhi) ∗ Gatrastabdhata. ∗ Jadyata. ∗ Sandhi Vikunchana ∗ Sankocha Disease review
    • 432. Lakshanas specific to the involvement of Ama: ∗ Chardi Shrotodusti lakshana of Annavaha shrotas. ∗ Arochaka ∗ Aruchi ∗ Anaha Rasavahasroto dusti lakshana. ∗ Angamardha ∗ Alasya3. Lakshanas produced as a consequence of the disease – process: The others like ∗ Bhrama ∗ Moorcha ∗ NidraviparyayaUpadrava98 Agnimandya, praseka, aruchi, gaurava, utsahaheena, vairasya, daha, bahumutra, kukshi shoola, nidra viparyaya, trishna, chardi, moorcha, hrit graha, vit vibandhatwa, jadya, antra kujana.Doshanubandha Amavata Laskahana99 Pittanubandha -daha and raga, Vatanubandha -shoola, Kaphanubandha - stimita, granthila and kandu.Sadyaasadyata100 o Eka doshaja Amavata sadhya, o Dwidoshaja Amavata yapya, o Sarva shareera shothayukta sannipata Amavata is kricchra sadhya. Disease review
    • 44Amavata Chikitsa101,102,103Table No. 13. Showing the different treatment modalities adopted in Amavata according to various authors. Sl. Chiktsopakrama YR CD BR 01. Langhana + + + 02. Ruksha swedana + + + 03. Deepana by tikta and katu dravyas + + + 04. Snehapana + + + 05. Virechana - + + 06. Basti - + + 07 Shamanoushadi + + +Pathya104 – Patola,Ardraka, Punarnava, Karavellaka, Yava, Raktashali, Kulattha, Kodrava, Shigru, Ushnajala, Lasuna sanskruta takra, Jangalamamsarasa.Apathya – Dadhi, Matsya, Dugdha, Mashapisti, Virrudhabhojana, Asatmyapadartha, Vegaavarodha, Ratrijagarana, Vishamabojana, Gurupadartha, Abishyandi padhartha. Disease review
    • 45 RHEUMATOID ARTHRITIS105Definition: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that mayaffect many tissues and organs – skin, blood vessels, heart, lungs and muscles butprincipally attacks the joints, producing a nonsuppurative proliferative synovitis thatoften progresses to destruction of the articular cartilage and ankylosis of the joints.1 Rheumatoid arthritis is a chronic multi system disease of unknown cause.Although there are a variety of systemic manifestations the characteristic feature of RA ispersistent inflammatory synovitis, usually involving pheripheral joints in a systemicdistribution. The potential of the synovial inflammation to cause cartilage destruction,bone erosion and subsequent changes in joint integrity is Hallmark of the disease106. Rheumatoid arthritis (RA) is an immmuno-inflammatory disease that affectsjoints and entire articular tissues107.PATHOLOGY108 The earliest change in swelling and congestion of the synovial membrane and theunderlying connective tissues, which becomes infiltrate with lymphocyte, plasma cellsand micro phases. Diffusion of synovial fluid into the joint space takes place duringactive phase of disease. Hypertrophy of the synovial membrane occurs with the formationof lymphoid follicles resembling an immunologically active lymph node. Inflammatorygranulation tissues (pannus) is formed spreading over and under the articular cartilage,which is progressively eroded and destroyed later fibrosis adhesions may be formedbetween the layers of pannus across the joint space and fibrosis or bony ankylosis mayoccur. Muscles adjacent to inflamed joints atrophy and there may be focal infiltrationwith lymphocytes. Disease review
    • 46ETIOLOGY109. The case of RA remain unknown it has been suggested that RA may be themanifestation to the response to an infectious agent in genetically susceptible host. Anumber of possible causative agent have been suggested, micoplasma Epstein – Bar virus(EBV), cytomegalo virus, parvo-virus, and rubella virus, but convincing evidence thatthese are other infectious agents cause RA has not emerged. Alternatively themicroorganisms or response to the microorganisms might induce an immune response tocomponents of the joints by altering its integrity and revealing antigenic peptide. Recentwork has focused on the possible role on the super antigens produced by the number ofmicroorganisms including staphylococci, streptococci and M–arthritis. Super antigens areproteins with the capacity to bind to HLA-DR molecule and particular VB segment of theheterodinimic T cell receptor and stimulate particular T cell expressing the VB geneproducts of all the potential environmental triggers. The only clearly associated with thedevelopment of RA is cigarette smoking.Gastro-intestinal Aetiology of RA: The co-existence of arthritis and diseases of gastro-intestinal tract has aroused increasing interest in recent years.The hypothesis of malabsorption of aminoacids in the aetiology of rheumatoid arthritis iscapable to explain the deficiency of protein, histine, arginine, glutamine and thyrosineetc. Disease review
    • 47ENTEROPATHY AS PRIMARY CAUSE OF RHEUMATOID ARTHRITIS:Genetics Environment Enteropathy Malabsorption Impeded Biosynthesis of proteins in system. Fibrinoid changes Excessive dissolution of collagen tissue Collagen diseases e.g.: Rheumatoid arthritis.PATHOGENESIS110. Localization of antigens in joints Antigen by microphages Activation of helper T cells Release of intraleukin – 2 Cytokenes like IL-4, IL-6, IFN are released by Cd4 cells Disease review
    • 48 Cytokenes increases the expression molecules like ICMA-1, LFA –1, MAC-1 It helps in localization of inflammatory cells Cytokines stimulates, activates and proliferation of B cells produce antibody producing plasma cells. These cells produce antibodies against Fc fragment of IgG (RA) RA factor forms immuno complex with IgG Production of Ca3, C5a, C3b and C5,6,7,8,9Ca3 and C5a as anapphylotoxins Release of histamines C5,6,7,8,9 is capable of damage cells by drilling pores in their membrane. Inflitration of neutrophillsRelease of oxygen free radicals, inflammatory metabolites, arachidnic acid pathway like prostaglandins leutrines metalo-proteins like collagenase. Damage of articular cartilage demineralization of underlying bone erosion of the joint margins laxicity of the joint capsule leading to deformity. Disease review
    • 49 111Articular Features The onset is usually insidious but may be acute or systemic, symmetrical jointinvolvement is common in middle aged women. Asymmetrical presentation is commonas a disease progresses. Acute onset with asymmetrical polyarthritis is more often seen inelderly patients. In the pelidromic onset type abrupt self limiting exaggeration of joint swellingerethrima and warmth over the joint occur and resolve completely within hours to fewdays. Only reoccur after period of time. The characteristic pattern of joint involvement in descending order is frequentlyin metacarpals (MCP), wrists, proximal, intraphalangeal (PIP), metatorso-phalangeal(MTP) joints, knee, ankles, hips and elbows. The affected joints are painful to start withthen become swollen, warm, and tender with restriction of movement.Pattern of Onset Table No. 14. Showing the pattern of onset of Rheumatoid arthritis. Sl. A B 01. Insidious, > 70%, Oligoarticualr 45 to 50 , Acute 10-15%) Polyarticualr 30-35% Sytemic - <10%, Monoarticular 20-25 %. palidromic least <5 Common. >5patient. Disease review
    • 50Extra Articular Manifestation of RA Systemic Cardiac Respiratory Low grade fever Pericarditis Plural effusion Fatigue Myocarditis Fiborsing alveolitis Loss of weight Aortitis Nodules Loss of appetite Conduction disturbances Bronchitis Musculo-skeletal Hematological Neurological Muscle wasting Anemia Entropment syndrome Bursitis Thrombocytosis Cervical compression Tenosynovitis Esinophilia Mononeuritis multiplex Skin Felty’s syndrome Others Subcuatneous nodules Spleenomegaly Systemic vasculitis Vasculitis Eye Amylodosis Ulcers Sicca syndrome Gangrene Episcleritis Pyoderme gangrenosum Scleritis Nail fold infarcts ScleromalaciaDeformities112Hand – Hands include button hole associated with flexion at the PIP joints and hyperextension of the distal intraphalangeal joints. Swan neck deformity associated with flexion of the digital interphalangeal andhyperextension of PIP joint. Z deformity of thumb and ulnar deviation of the finger. Disease review
    • 51Feet – Feet involvement of MTP joints causes plantar subluxation of the metatarsalheads. Resulting in cock-up toes. The deformity seen in the feet include Hallex valgeus orvarus, and Hammer toes, Axial joint involvement is restricted to the cervical spine, where it takes the formof either atlanto axial subluxataions or subaxil subluxation.Laboratory Investigations113, 114 Laboratory investigations may help either to establish a clinical diagnosis or toassess the prognosis and the possible cause of the disease. ESR – Is elevated in RA and comes down as the disease remitts. Hb% – May shows a normocytic normochromic anemia. C- reactive protein – High levels of CRP at the onset of disease correlates withpoor prognosis. Serological – The most important immunological investigation is detection ofrheumatoid factor. Other auto antibodies seen include antinuclear (ANA), Anti collagen,Anti keratin, Antiperinuclear (ANA) and anti-rheumatoid arthritis antibodies. Synovial fluid analysis – Synovial fluid analysis confirms the presence ofinflammatory arthritis, although none of the findings are specific. The fluid is usually turbid, with reduced viscosity, increased protein content andslightly decreased or normal glucose concentration. White blood cell – WBC count is usually normal, but mild leukocytosis may bepresent. Radiographic evaluation – Plain radiograph of the joint in the early stages showssoft tissues swelling around the affected joint and later jextra articular osteoporosis;erosions are seen as the disease progresses. In later stages there is destruction of thecartilage, resulting in joint space narrowing, cyst formation subluxation of the joints anddeformities. Disease review
    • 52Treatment / Management115 Because the etiology of rheumatoid arthritis is unknown, treatment is empiricallydirected towards – ♣ Relief of symptoms. ♣ Suppression of active progressive disease. ♣ Conservation and restoration of function in affected joints. To a greater or lesser extent these are achieved by combining:- ♣ Treatment of the patient – Drugs, rest, physiotherapy, surgery. ♣ Modification of the environment – Aids, appliances, housing, occupation, statutory benefits.General Treatment Physical rest, anti-inflammatory therapy and maintenance exercises are importanttreatment for rheumatoid arthritis. The rest from physical and emotional stress providedfor 2-3 weeks in hospital is usually sufficient to induce a marked remission of symptoms.Rest splints can be used to support a particular painful joint to correct flexion deformities.Medications Medications for rheumatoid arthritis include some for pain relief, others to reduceinflammation. Some medications are disease modifying anti rheumatic drugs (DMARD)which to try to show the course of the disease. Intra-articular cortico-steroidal injections are given to bring symptomatic relief.Non-steroidal anti-inflammatory drugs therapy is beneficial chloroquine phosphate orhydroxy chloroquinine sulphate are used as the initial adjacent to basic therapy. Auranofin an oral gold compound, pencillamine, and parental gold are also usedand immuno modulators are also used in the treatment. Disease review
    • 53Surgical Treatment Surgical decompression and synovectomy are needed when NSAID’s, localinsatous of corticosteroids and simple physical measurement failed to reduce movementof limbs.Prognosis116. The course and prognosis in RA is very variable. 25% will have a completeremission of symptoms and remain fit for all normal activities. 40% will have onlymoderate improvement of function despite exacerbation and remission of disease. 25%will be more severely disabled. 10% will be severely crippled.A poor prognosis may be associated with – 01. High titer of RA factor. 02. Insidious on set of disease. 03. More than a year of active disease without remission. 04. Early development of nodules and erosion. 05. Extra articular manifestations. 06. Sever functional impairment. Mortality is gradually increased in RA patients with functional impairment. The 5 years survival for severely disabled RA patient is reduced by 50%, the prognosis in such patients is similar to that of patients with 3 vessels coronary artery disease. Disease review
    • 54 MethodologyMethodology can be studied under three headings, 1) Pharmaceutical study. 2) Analytical study. 3) Clinical study.PHARMACEUTICAL STUDY The study involves proper identification, collection, processing of raw drugsand preparation of Sri Siddhadaradamruta. The rationale of this branch is to make available the effective, safe, andsuitable medicine. It is evident that samskara given to the drug will change the qualityof the drug and also acts in a different manner when mixed with other drugs. Timingsof medication and anupana also direct the medicine to act in a different ways.Study designThis section includes major steps,Step 01: Identification and Collection of raw drugs.Step 02: Purification and Processing of raw drugs.Step 03: Preparation of Sri Siddhadaradamruta.Date of Commencement:Date of Completion:Ref: Rasatarangini-Navama Taranga.Method: Pharmaceutical study
    • 55Step 01: Identification and Collection of raw drugs.Date of Commencement: 26.11.04Date of Completion: 26.11.04 An important part in the preparation of medicament lies in the properidentification and procurement of the raw materials. Only this determines the qualityof drugs. So this section of the study deals with the same. Sri Siddhadaradamrutacontains;Key ingredient: HingulaSamskarartha Prayojya Ghatakas:Vataksheera, Palanduswarasa, Bhallataka, Lavanga and Ghruta. Special request was made to the herbo mineral drug shop dealer to get theparticular quality drugs and those were screened for classical grahya lakshanas andthose were certified by the concerned departments.Step 02.Purification and processing of raw drugs Shodhana procedures are mentioned for certain drugs with the intention toenhance their therapeutic value and to make them sajateeya from vijateeya dravyas. Itis also done to make the drug free from its toxic properties. Hence this has to be donewith utmost care as improper purification may prove drug fatal. Pharmaceutical study
    • 56Practical No; 1 Title: Hingula Shodhana. Date of commencement : 02.12.04 Date of completion : 09.12.04 Reference: Rasa Ratna Samuchaya 3/152,153. Materials required: Khalwa yantra. Drugs used: a) Hingula-500gms. b) Ardraka swarasa-Q.SProcedure: * Hingula was taken in khalva yantra and powdered nicely. * 130 ml of fresh ardraka swarasa was added and mardana was done for 8Hrs till it became dry. * The Hingula was subjected for continual and cautious mardana till powder completely absorbs the swarasa and this completes one bhavana. * Similar such bhavana was repeated for another six times. * In the 7th bhavana when Hingula was thick paste it was converted in to a cake of approximately equal weights. Pharmaceutical study
    • 57 Table No. 15. Results of Hingula Shodhana Ingredients Bhavana dravya in Mardana in Results Remarks In quantity quantity hours Ardraka swasa 130 ml 8 hours 505 gms Gain – 5 gms. Hingula Ardrakaswarasa 130 ml 8 hours 512gms Gain – 500 gms. 7gms. Ardrakaswarasa 130 ml 8 ½ hours 518gms Gain – 6gms. Ardrakaswarasa 130 ml 8½ hours 525gms Gain – 7gms. Ardrakaswarasa 130 ml 9 hours 530gms Gain – 5gms. Ardrakaswarasa 130 ml 9 hours 538gms Gain – 8gms. Ardrakaswarasa 130 ml 10 hours 545gms Gain – 7gms.Table No. 16.Showing the quantity of Hingula before shodhana and after shodhana.Draya Quantity of Hingula before Quantity of Hingula after shodhana shodhana (in gms) (in gms).Hingula 500 545Observation: o Hingula can be made in to fine powder without much effort. o A fine powdered Hingula appears bright red with a free flow character. o Shodhita Hingula is deep red in appearance and its flow is reduced.Precaution: o When Hingula attained semisolid consistency the mardhana was carried out continuously. Pharmaceutical study
    • 58Practical no: 02 Title : Bhallataka Shodhana Date of commencement : 10.12.04 Date of completion : 10.12.04 Reference: Rasatantra sara- Dravya Shodhana prakarana. Drugs used: a) Grahya Bhallataka- 800gms b) Gomutra-7 lit.Procedure: * The Bhallataka which sinks in water were identified and tied in to the cloth and pottali was prepared. * A mud pot of 3 lit capacity was taken in which this pottali was hanged such that it moved freely in the pot. Distance of 4 angula from below to the Pottali height was maintained. * Gomutra was filled up to 3/4th of the pot. * It was placed on mandagni over gas stove for 12 hrs. * Gomutra was added in between whenever the level of gomutra was reduced. * After 12 hrs the Pottali was removed and the Bhallatakas were washed with hot water.Observations: * Gomutra turned black tiny oil miscicles seen in it. * After shodhana when Bhallataka was washed with hot water, it gained dull appearance. Pharmaceutical study
    • 59Precaution: * When Gomutra starts boiling the froth is produce. This overflows from the pot. Hence during that period, for few minutes the agni has to be lowered. * Whenever the level of Gomutra is reduced, fresh Gomutra was added to bring it up to the level of ¾ of the pot. Table No. 17. Showing weight of Bhallataka before and after shodhana.Dravya Weight of Bhallataka Weight of Bhallataka before Shodhana after ShodhanaBhallataka 800 gms 750 gmsPractical No 3: Name : Preparation Hingula cake: Date of commencement : 08.01.05 Date of completion : 08.01.05 Reference: Rasatarangini Navama TarangaMaterials Required: 1. Shodhita Hingula cake 2. Cotton threadProcedure: * Shodhita Hingula cakes were taken and weighed. * Each Hingula cake was tied with cotton thread separately such that the whole of the Hingula was densely covered with cotton thread, in a way not to expose it outside. * Later they were weighed again. Pharmaceutical study
    • 60 Table No. 18. Showing weight of Hingula before and after threading.Drug Before Threading After Threading 100gm 105gmShuddha Hingula cakes 110gm 115gm 110gm 115gm 110gm 115gm 115gm 120gmObservation: The threads are to be fastened very closely and carefully such that no gapsare to be formed.Precaution: Care is taken that whole of the Hingula is covered with threads so thatHingula is not revealed at the outset.Practical No 4:Name : Pachana Samskara- IDate of commencement: 27.01.05Date of completion : 27.01.05Reference: Rasatarangini Navama TarangaMaterials Required: 1. Vata ksheera – 250 ml 2. Palandu swarasa – 2 litre 3. Hingula cakes – all 5. Pharmaceutical study
    • 61Procedure: * A moderate sized deep fry pan was taken in which all the five Hingula cakes tied with cotton thread were placed. * Both Vataksheera and Palandu swarasa were poured in to pan. * Pan was placed over mruduvagni, till all the liquid in the pan evaporated. * When the pan was dry all the cakes were collected. Table No. 19. Showing details of Pachana Samskara.Drug Pachanadravya Quantity Temperature/ Total wt. Total wt. Total no of before after hoursShuddha Vata ksheera 250 ml 80˚C for 5 570gms 650gmsHingula cake Palandu swarasa 2litres hoursObservation:* A sweet smell emerged through out the procedure.* At the end of the pachana, the fibers with rubbery consistency remained at the bottom.Precaution: The Mrudu agni has to be maintained through out the procedure. Pharmaceutical study
    • 62Practical No 5:Name : DhahanasamskaraDate of commencement: 29.01.05Date of completion : 29.01.05Reference: Rasatarangini Navama TarangaMaterials Required: 1. Pachita Hingula 2. Shuddha Bhallataka 3. Lavangachoorna 4. Funnel.Procedure: * Two tola of lavanga yavakuta choorna is spread at the bottom of a pan. * Over this place pachita Hingula. * Make the heap of shudha bhallataka over Hingula cake in the form of cone. * Fill the gaps with lavanga choorna such that it forms a tight pack. * Over this inverted funnel is placed such that the funnel wall covers completely the cone of Bhallataka. * Now surround the funnel with charcoal and set fire to it. * When whole of Bhalataka is burnt the Hingula cake is taken and cleaned and taken for next procedure.Observation: * When Bhallataka burns inside fumes come out from the opening of the funnel. * When all Bhallataka is burnt the fumes stop coming from the funnel. This can be considered as the end point of this procedure. Pharmaceutical study
    • 63Precaution: * While burning Bhallataka it is better not to sit within its vicinity as it causes boils over the exposed skin in sensitive person. * Apply coconut oil over hand and face to avoid its reactions.Practical No 6:Name : Pachana Samskara- IIDate of commencement: 02.02.05Date of completion : 07.02.05Reference: Rasatarangini Navama TarangaMaterials Required: 1. Hingula cake -135gms. 2. Grutha -1350 ml (ten times that of Hingula)Procedure: * Taka a deep frying pan and place the Hingula cake at the center. * On mandagni pour little by little grutha on Hingula khanda and make it to evaporate. * This is repeated till all the grutha is evaporated. Temperature during the procedure was 260oc- 280oc. * When all the grutha evaporates the cake is collected and the threads are untied and made it in to powder and administered.Observation: * At the end of the procedure the grutha turned black. * The residual grutha turned to thick, rubbery consistency material which further did not evaporate. Table No. 20. Showing details of Ghruta Pachana. Drug Wt before Pachana Wt after Pachana Dahita Hingula 135gms 130gms Pharmaceutical study
    • 64 ANALYTICAL STUDY The Rasoushadhies mentioned in Ayurvedic Pharmacopoeia should be analyzedfor physical and chemical properties to confirm the genuinity and safety beforeadministration in human beings. Hence it becomes obligatory to adopt modern analyticalmethodology for better understanding & interpretation of physico-chemical changesoccurred during the process. In the present study sample is collected at the completion of the preparation &subjected to modern analytical methods1. Loss on drying 1100: One grams of Sri Siddhadaradamruta accurately weighed, heated on electric ovenup to1100 c & again weighed. The difference in weighed was calculated & the result isattached.Result: 0.21%2. Acid insoluble ash: The ash obtained was taken with dilute HCl filtered through Whatmann no. 42filter paper. The residue was washed with hot water till it was free from chloride. Theresidue was taken in a crucible, dried & ignited at a low temperature. The percentage ofacid insoluble ash was calculated with reference to the moisture free drug.Result: 0.42%3. The fineness of particle test: It can be possible to use the ordinary microscope for particle size measuring in the range of 0.2 micro meters to about 100 micro meters. According to microscope method the fine powder was sprinkled on the slide covered with covering slip & Analytical study
    • 65 placed on a mechanical stage. Initially standardization of micrometer was carried out by coinciding with the lines of both Oculo-micrometer and stage micrometer & standardized by using the formula; SM -------- X 10 = m OM In the next step, the stage micrometer was removed & the mounted slide wasplaced on a mechanical stage & focused. The particles are measured along the arbitrarilychosen fixed lines covered by the particles using the Oculo- micrometer. The size of theparticle was calculated using the standard value.Result: Sample AMD in µm Mean Surface Volume Diameter µm Shodhita Hingula 6.534 9.222 Sri Siddhadaradamruta Rasa 4.788 8.1984. Flow property: Sri Siddhadaradamruta is very fine powder so to maintain the actual dose and forbetter dispensing, it was subjected to flow property test i.e., “Angle of repose” by whichwe can analyze goodness of flow property. Angle of repose: - It is the maximum angle that can be obtained between the freestanding surface of a powder heap & the horizontal plane i.e., tan θ = 2h / D Where D is the diameter of the circle & ‘h’ is the height of the powder heap. This test involves the hollow cylinder half is filled by Sri Siddhadaradamruta withone end sealed by transparent plate. The cylinder is rotated about its horizontal axis untilthe powder surface cascades. The curved wall is lined with sand paper to prevent Analytical study
    • 66preferential slip at this surface. If the value comes between 200– 400 indicates reasonableflow potential.Shodhita Hingula: 32.86±2.75 Sri Siddhadaradamruta Rasa: 37.46±7.865. Flow rates: A simple indication of the ease with which a material can be induced to flow isgiven by application of a compressibility index “I” I= 1– V x 100 V0 Where ‘V’ is the volume occupied by sample of the powder after being subjected to a standardized tapping procedure. V0 = volume before tapping procedure In this procedure one measuring cylinder is taken and is filled with SriSiddhadaradamruta. The level of the Sri Siddhadaradamruta Rasa is noted. Then at aheight of 2 cm continuous 10 tapping should be done, after that the level of the SriSiddhadaradamruta Rasa in the cylinder is once again noted & the value ‘I ’ is calculatedwith respect to the Vo & V value. If the value ‘I’ is below 15% usually having good flowrates.Shodhita Hingula-12% Sri Siddhadaradamruta Rasa -15%7. Determination of pH – The pH value of the sample was determined by a digital pH meter. One percentsolution was prepared, as the sample was dry and solid in the form of capsules. Thepowder was separated and one gram of the sample was weighed accurately and dissolvedin 100ml of water and pH was noted in the digital pH meter.Result:pH (1% solution)- 6.66 Analytical study
    • 678. Determination of total ash:Procedure – Take about 2gms accurate weighed, ground drug in a previously tracedsilica dish, previously ignited and weighed. Scatter the ground dry in a fine even layer onthe bottom of the dish. Incinerate by gradually increasing the heat not exceeding dull redheat (4500C) until free from carbon. Cool and weigh. Calculate the percentage of ash withreference to the air-dried drug.Total ash- 29.1%9. Determination of sulphur:Eschka Mixture – Mix two parts by weight calcined magnesia with one part ofanhydrous sodium carbonate.Procedure – Cover the bottom of a 50 ml crucible with 0.5 gm of Eschka’s mixture. Weighaccurately the appropriate quantity of the sample material and mix it immediately with2gms of Eschka’s mixture and put evenly on the previously weighed Eschka’s mixture.Level the contents by tapping gently on a bench. Cover this uniformly with 0.5gm ofEschka mixture. Place crucible in the muffle furnace. Raise the temperature from roomtemperature to 8000C + 250C in about one hour and then heat for further 90 minutes. Transfer the ignited mixture as completely as possible from the crucible to abeaker containing 25 to 30 ml of water. Wash out the crucible thoroughly with about50 ml of hot distilled water and add the washings to the contents of the beaker. Add carefully sufficient quantity of concentrated hydrochloric acid to dissolve thesolid matter, warming the content of the beaker to effect solution. Boil for 5 minutes toexpel carbon dioxide. Add drop wise from a pipette; warm 5% Barium chlorine solution.Stir the solution constantly during the addition. Allow the precipitate to settle for aminute or two. Analytical study
    • 68 Then test the supernatant liquid for complete precipitation by adding a few dropsof Barium chloride solution. If a precipitate is formed, add slowly a further 3 ml of thereagent allow the precipitate to settle as before and test again, repeat this operation untilan excess of Barium Chloride is present. When an excess of the precipitating agent hasbeen added, keep the covered solution hot, but not boiling for an hour (steam bath) inorder to allow time for complete precipitation. The precipitation should settle and a clearsupernatant liquid should be obtained. Test the latter with a few drops of barium chloridesolution for complete precipitation. If no precipitate obtained, the Barium sulphate isready for filtration. Filter the solution through an ash less filter paper (Whatmann No. 42). Wash theprecipitate with small portion of hot water. Dry the paper and place it in a silica orporcelain crucible, previously ignited to redness and cooled in desiccators and weighed.Gradually increase the heat until the paper chars and volatile matter is expelled. Do notallow the paper to burst into flame as mechanical loss may thus ensue. When charring iscomplete, raise the temperature of the crucible to dull redness and burn off carbon withfree excess of air. When the precipitate is white ignite the crucible at red heat for 10-15minutes. Allow the crucible to cool in air, transfer it to desiccators and when cold, weighthe crucible and contents. Repeat until constant weight is attained. A blank is necessary. Calculate the percentage of sulphur converting Bariumsulphate X 0.1374. Sulphur: Shuddha Hingula- 12.83% and Sri Siddhadaradamruta – 12.28%.10. Determination of mercuryProcedure –Dissolve about 0.3gms of the sample in 5ml of Aquaregia and add 100 ml of water. Add40ml of 0.05N EDTA, 5ml of Ammonia buffer solution and 0.5ml of solo chrome black Analytical study
    • 69indicator. Titrate the solution with 0.05 M Zinc sulphate until the blue colour changes topurple (do not overshoot the end point), add 3gms of Potassium iodide, swirl to dissolve.Allow to stand for two minutes. Then, continue the titration with zinc sulphate solution tothe same end point as before. Each ml Zinc sulphate solution required after addition ofpotassium iodide = 0.0103 Hg.Mercury: Shuddha Hingula- 86.10% and Siddhadaradamruta Rasa -64.28%.11. Solubility: About one gram of the sample was weighed and dissolved in 10ml of the solvents.When the sample did not dissolve, an excess of solvent by 10 ml quantity up to 100mlwas added and noted that the sample was sparingly soluble in water and 1M Hydrochloricacid (1 gm of sample in 100 ml of water and 1 M Hydrochloric acid) and slightly solublein chloroform and alcohol (1 gram of sample in 600 ml to 1000 ml of chloroform andalcohol.Solubility tests ResultsWater Slightly soluble.Chloroform Slightly soluble.Alcohol Soluble.12. Electron Spectroscopy for Chemical Analysis (ESCA) ESCA of Sri Siddhadaradamruta Rasa (final product) was carried out at IndianInstitute of Chemical Technology (IICT), Hyderabad for both Qualitative andQuantitative analysis. Among the methods of surface analysis based on ultra high vaccum techniques,which have been developed dramatically during the past years, only ESCA – whichstands for ‘Electron Spectroscopy for Chemical Analysis’ or XPS X-ray photo electronspectroscopy, besides Auger electron Spectroscopy (AES) and Secondary Ion Mass Analytical study
    • 70Spectrometry (SIMS) became well established in the field of Materials surface analysis.ESCA involves the determination of the energy distribution of electrons emitted from X–ray irradiated compounds. In principle all the electrons of a compound, from the atomiccores of the Valence levels, can be studied, however, the technique is used principally forthe study of core electrons.Physical Principle of ESCA ESCA has its origin in the investigations of the photoelectric effect in which X –rays were used as the existing photon source. In addition to the valence electron, whichprovide the bonding for the systems. Each atom present in the surface (except H2 and He)posses core electrons not directly involved in the bonding (Anti-bonding electrons). Theso-called binding energy Eb of each core electron (conceptually, but not strictlyequivalent of I.E. of the electron) is characteristic of the individual atom to which it isbound. In the basic ESCA experiment the samples source (Depth of analysis between 1.5and 6 nm). The resultant photoelectrons (emitted particles) have a Kinetic energy (Ek) inthe range of 20 to 2000 ev which is related to X-ray energy (hγ) and binding energy (Eb)Ek = hγ – eb - ψ Where ‘h’ is plancks constant, γ is frequency of the exciting radiation, ψ is the work function of spectrometer (the energy required brining an electron from the Fermi level of the spectrometer to its zero level). If the photoelectrons have sufficient Kinetic energy that they are able to escapefrom the surface by overcoming the work function, photoemission occurs. Since theenergy levels are quantised the photoelectrons have a Kinetic energy distributionconsisting of series of discrete bands, which essentially reflect the shell from electronicstructure of the atoms in the sample. In this way ESCA is the experimental determinationof Kinetic energy distribution by analysis of the photoelectrons produced by exposure toX – rays. Analytical study
    • 71Experimental conditions ESCA recorded on a KRATOS AXIS 165 with a dual anode (Mg and Al)apparatus using the Mg K ∝ anode. The pressure in the spectrometer is about 10-9 torr.Spectrum was deconvoluted using the sun solaris based vision 2 curve resolver. Thelocation and the full width at half maximum (fwhm) for a species was first determinedusing the spectrum of a pure sample. The location and fwhm of the products, which werenot obtained as pure species, were adjusted until the best fit was obtained as pure species,were adjusted until the best fit was obtained symmetrical Gaussian shapes were used inall cases. Binding energies for identical samples were in general reproducible to with in +1 ev. Routinely used X – ray sources are Mg K ∝ (1253.6 ev) and Al K ∝ (1486.3 ev)as incident particles, which normally cover of an area of many mm2. Alk ∝ radiation canbe mono chromate and this leads to some focusing may be to spot diameter of about10µm as lateral resolution. The ESCA Spectrum is usually a plot of intensity of thephotoelectrons versus binding energy (Eb).ESCA – General aspects ESCA yields information on the elemental analysis and their composition, theoxidation state of the elements and in favourable cases on the dispersion of one phaseover another. ESCA can be used to give reasonable quantitative accuracy (up to + 10%)provided that good calibration standards are used. The detection limit is about 10– 3. A major advantage of the technique is that photo electron energy is dependent onthe precise chemical configuration of the surface atoms and pronounced chemical shiftsare produced in the position of peak in the ESCA, is amenable to virtually all vaccumcompatible samples since the incident rays do not normally cause surface damage due tothe beam. Therefore the techniques can be used even with very delicate material. Usingsample charging is minimal. The collection of spectra is normally fast (typically less than5 min) and the reproducibility of results is high. ESCA shows a narrow range ofsensitivity and the range of sensitivity across the element range is about a factor by 10. Analytical study
    • 72 Results: In the sample Mercury is present in Oxide and Sulphide forms. Noelemental mercury is present. Majority of mercury is in the form of oxide and less in theSulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide20.79%. The sample has mercury oxide and sulphide in the ratio of 60:40. The peak at59.3 is due to Selenium oxide and if it is due to elemental selenium it will be at 54.8,because it is too low in concentration it can not be marked.13. Estimation of FAT content: Weigh about 2 g of previously dried sample. Take in a thimble made of coarsefilter paper and knotted with thread. Extract with 25ml anhydrous alcohol, free ether orpetroleum ether in a soxhlet extraction apparatus. Extraction period may vary from 4hours at condensation rate of 5-6 drops/sec to 16 hours at 2-3 drops per sec. evaporatesolvent and dry the extract to a constant weight at 1100C. Calculate the fat contentpercentage.Result: 7%. Analytical study
    • 73 CLINICAL STUDY Rasoushadhies are basically divided in to four types viz- Khalviya,Parpati, Kupipakwa, and Pottali. In all these preparation one major difference we note isthe pattern of agni (to attain Agnisthayitwa), based on which the Rasayana property ofthese kalpas are enhanced. This also reflects on the dose to be administered, as it is notedthat the dose of Pottali kalpa is very minute. Sri Siddhadaradamruta Rasa not mentionedin these four basic kalpas and is subjected for different samskaras with agni. To evaluateits liability in therapeutics it was put to test in Amavata. Efficacy can be determined byfinding out the difference between the baseline data and assessment data. The materials and methods of the present study consist of following headings. I. Selection of patients. II. Research Design. III. Duration and Method of administration of drug. IV. Parameters of Assessment. V. Criteria for Assessment of Results1. SELECTION OF PATIENTS: The patients were diagnosed based on the presentation of history, signs,symptoms, and detailed clinical examination. 15 patients were selected after criticaladaptation of inclusion and exclusion criteria. a) Source of data: 15 patients of Amavata with confirmed diagnosis were taken from OPD and IPD of DGM Ayurvedic Medical College Hospital, Gadag. The Samples were selected by simple sampling technique. b) Inclusion criteria: a) Patients of Amavata having the history of less then 5years. b) Patients of Amavata between the age group of 20 to 50 years of either sex. c) Classical signs and symptoms will be considered for selection of patients. Clinical study
    • 74 c) Exclusion Criteria: a) Patients of Amavata having the history of more than 5 years b) Patients of Amavata having the systemic diseases. c) Patients of Amavata below 20 years and above 50 years of age. d) Pregnant women and lactating mothers. d) Intervention: a) The patients are assessed before and after the treatment as per assessment criteria. b) The nature of the study is explained to the patients in detail and pre treatment consent is taken. c) The patients have full right to withdraw from the study at any time. d) The data is maintained confidently. e) 15 patients of Amavata of either sex are taken in simple randomized selection of sampling techniques.II RESEARCH DESIGN: The study was conducted on total 15 patients who could continue the treatmentfor full duration and came for follow up till to the last; the patient was selected from theOPD, DGM Ayurvedic Medical College & Hospital for prospective clinical trial.III DURATION AND METHOD OF ADMINISTRATION OF DRUG: Study duration - 30 days. Follow up - 15 days. Method of Administration: Sri Siddhadaradamruta was administered orally Dosage – ½ Ratti (62.5 mg) two times a day. Anupana – Purana Guda. Clinical study
    • 75IV PARAMETERS FOR ASSESSMENT: Subjective parameters: Signs and Symptoms explained in the Ayurvedic textsTable No. 21. Showing the gradation which is adopted in statistical evaluation of clinicalsymptoms. Sl.No Symptoms Severity Grade 01 Sandhi Shoola No complaints 0 Patients tells about it After inquire 1 Patients frequently complaints 2 Excruciating condition 3 02 Shotha No complaints 0 Slight Obvious 1 Covers well the boney prominence 2 Much elevated 3 03 Jwara (sthanika ushmata) Normal 0 During severity of pain 1 During severity of pain with swelling 2 `Continuous pain with pain. 3 04 Gouravata No Gouravata 0 During morning up to 1hrs. 1 Continuous in the morning less than 24Hrs 2 Throughout day 3 05 Nidraviparyaya No discomfort 0 Discomfort during night 1 Discomfort during night and affects day. 2 Day sleep and night awakes. 3 06 Jadya No stiffness 0 Stiffness for 5 min-1hour 1 Stiffness for 1-2 hours 2 More than 2 hours. 3 Clinical study
    • 76 Objective Parameters: Hb%, TC, DC, ESR, Walking time, Grip strength, Table No 22. Showing the gradation which is adopted in statistical evaluation of walking time. Sl No To cover 21 Meters Grading 01 Up to 20 Seconds 0 02 21 to 30 Seconds 1 03 31 to 40 Seconds 2 04 41 to 50 seconds 3 Grip strength: - Patient’s grip strength is assessed before and after treatment according to the readings in the grip strength meter in terms of pound.Assessment of Result: Subjective and objective parameters before and after treatment data comparison is assessed for result.V CRITERIA FOR ASSESSMENT OF RESULTSThe results are classified into four groups as listed below –A. Complete remission 1. Sandhi Shoola (pain) 2. Sandhi Shotha (swelling) 3. Gouravata 4. Jwara (Sthanika ushmata) 5. Nidraviparyaya 6. Jadya 7. No elevation of ESR. 8. Complete subsidence of above subjective parameters. Clinical study
    • 77B. Major improvement 1. Complete subsidence >2 or <6 below mentioned subjective parameters i.e. I. Sandhi Shoola (Pain) II. Sandhi Shotha (Swelling) III. Gouravata IV. Jwara (Sthanika ushmata) V. Nidraviparyaya VI. Jadya 2. ESR may be elevated.C. Minor improvement 1. Complete subsidence of any one below mentioned subjective parameters i.e. I. Sandhi Shoola (Pain) II. Sandhi Shotha (Swelling) III. Gouravata IV. Jwara (Sthanika ushmata) V. Nidraviparyaya VI. Jadya 2. Elevation of ESR.D. No improvement 1. No change or exaggerations of signs and symptoms 2. Elevation of ESR.The persons who don’t come under above three criteria’s will come in these criteria. Clinical study
    • ANALYSIS REPORT OF Dr Pradeep Agnihotri3. DVK PA SReport: Mercury is present in oxide and sulphide forms. No elemental Mercury is present. Majorly mercury is in the form of oxideand less in the sulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. The sample has mercury oxide andsulphide in the ratio of 60:40.
    • DVK PA SR_Report: Mercury is present in oxide and sulphide forms. No elemental Mercury is present. Majorly mercury is in the formof oxide and less in the sulphide form as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. The sample has mercuryoxide and sulphide in the ratio of 60:40.
    • 78 DEMOGRAPHIC DATADistribution of patients by age; Table No. 23. Showing Distribution by age Group Sl Age group No. of pts Percentage 01 21-30 05 33.33 02 31-40 04 26.66 03 41-50 06 40 It was observed that, the maximum number of patients 06(40%) were in the agegroup of 41-50; 05 (33.33%) from the age group of 20-30 years. Graph.1: Showing Distribution by age Group DISTRIBUTION BY AGE GROUP 33% 40% 21-30 31-40 41-50 27% Results
    • 79Distribution of patients by sex; Table No. 24. Showing the distribution of patients by Sex Sl Sex No of Pts Percentage 01 Male 04 26.66 02 Female 11 73.33 Graph 2: Showing the distribution of patients by Sex. DISTRIBUTION BY SEX INCIDENCE 80 73.33 60 40 26.66 20 11 4 0 Male Female No of Pts Percentage It was observed that, out of 15 patient’s maximum number of patients i.e.11(73.33%) were females and males were 4 (26.66%). Results
    • 80Distribution of patients by Religion; Table No. 25. Showing Patients distribution by Religion Sl. Religion No. of Pts. Percentage 01. Hindu 13 86.66 02. Muslim 2 13.33 03. Christian - - 04. Others - - It was observed that, the majority of patients were from Hindu, 13 (86.66%) and Muslim 2, (13.33%). Graph No 3; Showing Patients distribution by Religion Distribution by Religion 100 80 60 40 20 0 Hindu Muslim Christian Others No. of Pts. Percentage Results
    • 81Distribution of patients by Socio-economic status; Table No. 26 Showing the distribution of patients by Socio-economic status. Sl. Socio-economic No. of Pts. Percentage 01. Poor 7 46.66 02. Middle 8 53.33 03. Upper class 0 0 It was observed that, the maximum number of patients i.e. 8 (53.33%) belong tomiddle socioeconomic class, poor 7 (46.66%). Graph No 4 Showing the distribution of patients by Socio-economic status. Socio-economic status. 60 40 No. of Pts. Percentage 20 0 Upper Poor Middle class No. of Pts. 7 8 0 Percentage 46.66 53.33 0 Results
    • 82Distribution of patients by Occupation; Table No. 27 Showing the distribution of patients by Occupation. No. of Sl. Occupation Percentage Pts. 01. Labour 4 26.66 02. Sedentary 0 0 03. Active 3 20 04. House wife 8 53.33 It was observed that, the majority of the patients were from the housewife8(53.33%), labor 4 (26.66%), and active 3 (20%). Graph No 5 Showing the distribution of patients by Occupation Distribution by Occupation H.W 53.33 8 Actv 20 3 Sed 0 0 Lbr 26.66 4 0 10 20 30 40 50 60 No. of Pts. Percentage Results
    • 83Distribution of patients by marital status; Table No. 28 Showing the distribution of patients by marital status; Sl. Marital status No. of Pts. Percentage 01. Married 12 80 02. Unmarried 3 20 It was observed that, the maximum number of patients were married 12 (80%)and unmarried 3 (20%).Distribution of patients by food habits;Table No. 29 Showing the distribution of patients by food habits. Sl. Food habits No. of Pts. Percentage 01. Vegetarian 13 86.66 02. Mixed 2 13.33 It was observed that, the maximum number of patients 13 (86.66%) werevegetarian and only 2 (13.33%) mixed food habits. Results
    • 84Distribution of patients by addiction; Table No. 30 Showing the distribution of patients by addiction. Sl. Addiction No. of Pts. Percentage 01. Smoking 1 6.66 02. Alcohol 0 00 03. Tobacco 3 20 04. No habits 11 73.33 It was observed that, the out of 15 patients 11 (73.33%) had no habits, smokingaddiction 1(6.66%), and tobacco addiction 3 (20%).Distribution of patients by predominant Rasa in diet; Table No. 31 Showing the Distribution of patients by predominant Rasa in diet. Sl. Rasa pradhanyata in No. of Percentage ahara Pts. 01. Madhura 08 53.33 02. Amla 3 20 03. Lavana - - 04. Tikta - - 05. Katu 4 26.66 06. Kashaya - - It was observed that, the maximum number of patients 8 (53.33%) had madhurapredominance in diet, katu predominance 4(26.66%). Results
    • 85Distribution of patients by Prakriti; Table No. 32 Showing the distribution of patients by Prakriti. Sl. Prakriti No. of Pts. Percentage 01. Vata-pitta 05 33.33 02. Vata-kapha 7 46.66 03. Pitta-kapha 3 20.00 It was observed that, the majority of patients were vata-kapha 7 (46.66%) andvata-pitta 5 (33.33%) and pitta-kapha prakriti 3 (20%). Graph No 6 Showing the distribution of patients by Pra Distribution By Prakruti 50 46.66 40 33.33 30 No. of Pts. 20 20 Percentage 10 5 7 3 0 Vata-pitta Vata-kapha Pitta-kapha Results
    • 86Distribution of patients by Sara; Table No.33 Showing the distribution of patients by Sara. Sl. Sara No. of Percentage Pts. 01. Pravara 2 13.33 02. Madhyama 11 73.33 03. Avara 2 13.33 It was observed that, the maximum number of patients were madhyama sara11(73.33%), pravara were 2 (13.33%) and avara 2(13.33%).Distribution of patients by Samhanana ; Table No. 34 Showing the distribution of patients by Samhanana. No. of Sl. Samhanana Percentage Pts. 01. Pravara 2 13.33 02. Madhyama 11 73.33 03. Avara 2 13.33 It was observed that, the maximum patients were madhyama samhana 11(73.33%), pravara 2(13.33%) and avara 2 (13.33%). Results
    • 87Distribution of patients by Satwa Table No. 35 Showing the distribution of patients by Satwa. No. of Sl. Satwa Percentage Pts. 01. Pravara 4 26.66 02. Madhyama 9 60 03. Avara 2 13.33 It was observed that, the maximum patients were madhyama satwa 9 (60%),pravara 4(26.66%) and avara 2 (13.33%).Distribution of patients by Vyayama Shakti; Table No. 36 Showing the distribution of patients by Vyayama shakti. Vyayama No. of Sl. Percentage shakti Pts. 01. Pravara 3 20 02. Madhyama 9 60 03. Avara 3 20 It was observed that, the majority of the patient were madhyama vyayama shakti 9(60%), avara 3(20%), pravara 3 (20%). Results
    • 88Distribution of patients by Desha Table No. 37 Showing the distribution of patients by desha. Sl. Desha No. of Pts. Percentage 01. Jangala 5 33.33 02. Anupa 0 0 03. Sadharana 10 66.66 It was observed that, the maximum number of patients was from sadharana desha10 (66.66%) and jangala 5 (33.33%). Graph 7 Showing the distribution of patients by desha Destribution Showing Desha 70 66.66 60 50 40 33.33 30 20 10 10 5 0 0 0 Jangala Anupa Sadharana No. of Pts. Percentage Results
    • 89Distribution of patients by chief complaint; Table No. 38 Showing the distribution of patients by chief complaint. Sl. Chief complaints No. of Pts. Percentage 01. Sandhi shoola 15 100 02. Sandhi shotha 15 100 03. Jadyata 15 100 04. Gaurava 15 100 05. Vrischika damshavat peeda 03 20 06. Jwara(sthanika ushmata) 15 100 It was observed that, the almost all patients were with Sandhi shoola, Sandhishotha, jadya, jwara, gouravata in 15(100%), Vrischik damshavat peeda 3 (20%) Graph 8 Showing the distribution of patients by chief complaint CHIEF COMPLAINTS. 15 15 3 15 15 15 Sa shl Sa sho Jad GaV Vd P Jwr sthSa Shl – Sandhishoola; SaSho – Sandhishotha; Jad – Jadya; GaV – Gauravata;Vd P – Vrischikadamshavata peeda; Sth Jwr – Jwara(sthanika ushmata). Results
    • 90Distribution of patients by associated complaints; Table No. 39 Showing the distribution of patients by associated complaints. Sl. Associated complaints No. of Pts. Percentage 01. Anga marda 9 60 02. Aruchi 11 73 03. Nidraviparyaya 15 100 04. Trishna 1 6.6 05. Apaka 2 13.33 06. Daha 3 20 07. Alasya 6 40 08. Vid baddhata 8 53.33 It was observed that, the maximum patients of Nidraviparyaya i.e. 15 (100%),Aruchi 11(73%), Anga marda 9 (60%),Malabaddhata 8 (53.33%), Alasya 6 (40%), Daha3 (20%), Apaka 2 (13.33%),Trishna 1(6.6%). Graph 9: Showing the distribution of patients by associated complaints Distribution By Associated Complaints 16 14 12 10 No of PtS 8 6 4 2 0 AM Ar NV Tr Ap Dh Als Vit Associated Complaints Vib AM – Angamarda; Ar – Aruchi; NV – Nidra viparyaya; Tr – Trishna; Ap –Apaka; Dh – Daha; Als – Alasya; Vid Vib – Vid vibandha. Results
    • 91Distribution of patients by Nidana; Table No. 40 Showing the distribution of patients by Nidana. Sl. Nidana No. of Pts. Percentage 01. Viruddha ahara 3 20 02. Viruddha chestha 2 13.33 03. Mandagni 8 53.33 04. Sasnigdha ahara, bhojanottara vyayama 4 26.66 It was observed that, the maximum nidana of patient were having 8 (53.33%)mandagni, snigdha ahara bhojanottara vyayama 4 (26.33%), virudha ahara 3 (20%). Graph 10: Showing the distribution of patients by nidana. Nidana 3, 18% 2, 12% 8, 46% 4, 24% V ah V ch Man Ssn, bjn, vymV Ah- Viruddha Ahara, V Ch- Viruddha Chesta, Man- Mandagni, SSn,aha, bjn Vym-Sasnigda Ahara, Bhojanottara Vyayama. Results
    • 92Data related to response to the treatment;Sandhi shoola (Pain) Table No. 41 Showing the response of the therapy in sandhishoola. Sl. Grading B.T. % A.T. % No. of Pt.’s No. of Pt.’s 01. 0 0 0 6 40 02. 1 2 13.33 5 33.33 03. 2 9 60 4 26.66 04. 3 4 26.66 0 0 Among the 15 patients, 9(60%) patients had the grade 2 pain and 4 (26.66%)patients had the grade 3 pain before the treatment. Patients with grade1 pain were2(13.33%). After the treatment 4 (26.66%) patients had 0 grade pain and7 (46.66%)patients had the 1 grade pain & 4 (26.66%) patients had the 2 grade pain. No patient hadgrade 3 pain. Statistically it is highly significant, where p value is <0.001. Graph 11: Of Sandhishoola. Showing Sandhishoola 10 9 8 No. PtS 6 6 5 4 4 4 2 2 0 0 0 Gardings 0 1 2 3 B.T. No. of Pt.’s A.T. No. of Pt.’s 1– 0 grade of sandhishoola; 2 – 1 grade of sandhishoola; 3 – 2 grade ofsandhishoola; 4 – 3 grade of sandhishoola. Results
    • 93Sandhi shotha (Swelling);Table No. 42 Showing the response of the therapy in sandhishotha. Sl. Grading BT AT No. of pt. % No. of Pt. % 01. 0 0 0 7 46.66 02. 1 7 46.66 5 33.33 03. 2 5 33.33 3 20 04. 3 3 20 0 0 Among the15 patients 5 (33%) patients had grade 2 shotha , 7(46.66%)patientshad grade 1 shotha and 3(20%) patients had grade 3 shotha before treatment. After thetreatment 7 (46.66%) patients had grade 0 shotha and 5 (33.33%) patients had grade 1shotha, 3 (20%) patients had grade 2 shotha. Statistically it is highly significant, where pvalue is <0.001. Graph 12: Showing the response of the therapy sandhishotha. Response of the Therapy Before and After in Sandhi Shotha 8 7 7 6 5 5 4 3 3 3 2 0 0 1 2 3 4 GRADINGS No. of pt. No. of Pt. 1 – 0 grade of sandhishotha; 2– 1 grade of sandhishotha; 3 – 2 grade ofsandhishotha; 4 – 3 grade of sandhishotha. Results
    • 94Jwara (Sthanika Ushmata)Table No. 43 Showing the response of the therapy in Jwara (Sthanika Ushmata) Sl. Grading BT AT No. of pt. % No. of Pt. % 01. 0 0 0 8 53.33 02. 1 7 46.66 4 26.33 03. 2 5 33.33 3 20 04. 3 3 20 0 0 Among 15 patients7 (46.33) patients were observed with grade 1, 5(33.33)patients with grade 2 and 3(20%) patients were in grade 3 jwara before treatment. Aftertreatment 8 (53.33%) patients had 0 grade fever, 4(26.33%) patients were in grade1,3(20%) patients were in grade 2. Graph 13: Showing the response of the therapy in Jwara Jwara(Sthanika Ushmata) 8 8 7 7 6 5 No of Pts 5 4 4 3 3 3 2 1 0 0 0 1 2 3 4 BT AT Grading 1 – 0 grade of Jwara (Sthanika Ushmata) 2– 1 grade of Jwara; 3 – 2 grade of Jwara; 4 – 3 grade of Jwara. Results
    • 95 Gouravata: Table No. 44 Showing the response of the therapy in gouravata. Sl. Grading BT AT No. of pt. % No. of Pt. % 01. 0 0 0 12 80 02. 1 10 66.66 1 6.66 03. 2 2 13.33 2 13.33 04. 3 3 20 0 0 Among 15 patients10 (66.66%) patients were observed with grade 1, 2(13.33%)patients with grade 2 and 3(20%) patients were in grade 3(20%) gouravata beforetreatment. After treatment 12(80%) patients had 0 grade gouravata, 1(6.66%) patientswere in grade1, 2(13.33%) patients were in grade 2. Graph 14: Showing the response of the therapy in gouravata. Gouravata 14 12 12 10 10 No. of Pts 8 6 4 3 2 2 2 1 0 0 0 1 BT AT 2 3 4 Grading 1 – 0 grade of Gouravata. 2– 1 grade of Gouravata; 3 – 2 grade of Gouravata; 4 – 3 grade of Gouravata. Results
    • 96 Nidraviparyaya: Table No. 45 Showing the response of the therapy Nidraviparyaya; Sl. Grading BT AT No. of pt. % No. of Pt. % 01. 0 0 0 6 40 02. 1 6 40 6 40 03. 2 6 40 3 20 04. 3 3 20 0 0 Graph 15: Showing the response of the therapy in Nidraviparyaya Nidraviparyaya 6 5 No of Pts 4 3 2 1 0 Grading 0 1 2 3 BT No. of pt. AT No. of Pt. Among 15 patients 6 (40%) patients were observed with grade 1, 6(40%) patientswith grade 2, and 3 (20%) patients were in grade 3(20%) of Nidraviparyaya beforetreatment. After treatment 6(40%) patients had 0 grade Nidraviparyaya , 6(40%) patientswere in grade1, 3(20%) patients were in grade 2. Results
    • 97Jadyata:Table no 46: Showing the response of the therapy in Jadyata Grade B.T No.of Pt’s % A.T No.of Pt’s % 0 0 04 26.66 1 0 0 6 40 2 11 73.33 3 20 3 4 26.66 2 13.33 Graph 16: Showing the response of the therapy before and after in Jadyata. SHOWING JADYATA 12 11 10 NO of PtS 8 6 6 4 4 4 3 2 2 0 0 0 0 1 2 3 GRADING B.T No.of Pt’s A.T No.of Pt’s Among 15 patients 5(33.33%) patients were observed with grade 1, 7(46.66%)patients with grade 2, and 3 (20%) patients were in grade 3 of Jadyata before treatment.After treatment 5(33.33%) patients were observed with grade 0 of Jadyata, 6(40%)patients were in grade1, 2(13.33%) patients were in grade 2, 2(13.33%) patients remainedin grade 3. Results
    • 98OVERALL RESULTTable No. 47 Showing the overall result assessed on the basis of subjective and objectiveparameters. Sl. Overall result No. of Pts. Percentage 01. Complete remission 4 26.66 02. Major improvement 4 26.66 03. Minor improvement 4 26.66 04. No improvement 3 20 Among the 15 cases of Amavata shows the following results which was assessedon the basis of subjective and objective parameters – 4 patients (i.e. 26.66%) had shown complete remission. 4 patients (i.e. 26.66%) had shown major improvement. 4 patients (i.e.26.66%) had shown minor improvement. 3 patients (i.e. .20%) reported in no improvement group. Graph 17: Showing the overall result assessed on the basis of subjective andobjective parameters. Overall Result 3 4 4 4 CR Mj imp Mi imp No imp Results
    • 99 Table No. 48 showing statistical analysis before and after treatment.Sl.No Parameter Mean S.D S.E t-value p-value Remarks 01 Sandhi shoola 1.266 0.242 0.062 20.41 <0.001 H.S 02 Sandhi Shotha 1.00 0.00 0.00 - - - 03 Gouravata 1.2 0.414 0.106 11.32 <0.001 H.S 04 Jwara 1.066 0.258 0.066 16.15 <0.001 H.S 05 Nidraviparyaya 1.00 0.00 0.00 - - - 06 Jadyata 1.066 0..7030 0.1815 5.8732 <0.001 H.S 07 Hb% 0.96 0.54 0.139 6.906 <0.001 H.S 08 TC 303.33 224.77 58.03 5022 <0.001 H.S 09 DC(L) 6.133 1.06 0.273 22.46 <0.001 H.S 10 ESR 9.4 6029 1.626 5.78 <0.001 H.S 11 Walking time 1.00 0.00 0.00 - - - 12 Grip Right hand 3.752 2.603 0.672 5.58 <.0001 H.S Strength Left hand 3.433 2.135 0.551 6.23 <0.001 . Overall all the parameters show highly significant before and after the treatment. The subjective parameters orderly Jwara, jadya, gouravata and Sandhi shoola shows more highly significant. But the parameters Sandhi shota and Nidraviparyaya shows the same mean effect before and after treatment (by comparing p-value, t-value) The parameter gouravata shows high net mean effect with high variation, where as Nidraviparyaya and Sandhishota show same mean net effect with zero variation. (by comparing mean and S.D). Among the objective parameters DC (L) and Hb% show more highly significant than other (P<0.05). The mean net effect of TC is more with more variations. The mean net effect of Hb% is low with low variance. The parameter walking time shows zero variations before and after treatment. The mean net Grip strength right hand is more with more variance even though left hand grip strength show more highly significant then Right hand Grip strength. This is due to the sampling errors and variations among the patients (samples)[by comparing mean, S.D.] The parameter ESR also shows more highly significant than TC and also the mean ESR reading lies with in normal range for both sexes. Results
    • Master Chart of SUBJECTIVE PARAMETERSSl.no OPD Sandhi Sandhi Jwara(Sthanika Gouravata Nidraviparyaya Jadyata Response No Shoola Shotha Usmata) BT AT BT AT BT AT BT AT BT AT BT AT 01 5430 3 2 2 1 2 1 1 0 2 1 3 2 Min Imp 02 0573 2 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem 03 1684 2 0 1 0 1 0 1 0 2 0 2 1 Maj .Imp 04 2859 1 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem 05 3000 2 1 2 1 2 1 2 0 2 1 2 1 Min Imp 06 3123 3 2 3 2 3 2 3 2 3 2 3 3 Not Resp 07 3346 2 1 2 1 2 1 1 0 2 1 2 2 Min Imp 08 3373 3 2 3 2 3 2 3 2 3 2 3 3 Not Resp 09 3415 2 1 2 1 2 1 1 0 2 1 2 1 Min Imp 10 3416 2 0 1 0 1 0 1 0 1 0 2 0 Maj Imp 11 3638 1 0 1 0 1 0 1 0 1 0 2 0 Comp.Rem 12 3934 2 1 1 0 1 0 1 0 1 0 2 1 Maj Imp 13 4181 2 0 1 0 1 0 1 0 1 0 2 0 Comp Rem 14 5010 2 1 2 1 2 0 2 0 2 1 2 1 Min Imp 15 5021 3 2 3 2 3 2 3 2 3 2 3 2 Not RespMin Imp- Minor Improvement, Not Resp-Not Responded, Maj.Imp- Major Improvement, Comp Rem- Complete Remission, BT- Before Treatment, AT- After treatment. 100
    • Master chart of OBJECTIVE PARAMETERSSl.no OPD Hb% TC DC(BT) DC(AT) ESR Walking Grip Strength Response No Time RIGHT LEFT BT AT BT AT N L E N L E BT AT BT AT BT AT BT AT 01 5430 11 12 6500 5900 55 38 07 62 32 06 35 30 3 2 13 15.2 13 20 Min Imp 02 0573 10 12 7200 7000 61 35 04 65 30 05 18 10 3 2 20 23.99 13 18.5 CompRem 03 1684 10.2 11 6200 6000 57 37 06 63 30 07 14 12 1 0 38 42 31.2 32.28 Maj Imp 04 2859 10 11 6000 5900 50 42 08 58 36 06 24 15 1 0 28 31.2 22.66 28 CompRem 05 3000 7 7 6900 6000 58 37 05 65 30 05 45 28 2 1 13 15.2 13. 14.1 Min.Imp 06 3123 9 9.5 7000 6600 56 39 05 65 30 05 85 80 3 2 13 13 11.8 11.8 Not Resp 07 3346 8.4 9 6850 6700 53 40 07 61 34 05 40 32 2 1 13 18.5 13 18.5 Min Imp 08 3373 8 8.5 8000 7500 51 41 08 57 36 07 72 68 3 2 20 23.99 13 18.5 Not Resp 09 3415 10 11 7200 7000 48 45 07 58 38 04 60 45 1 0 22.6 25.2 20 22.5 Min Imp 10 3416 12 13 6400 6000 35 61 04 38 56 06 36 28 1 0 28 3102 22.6 25.2 Maj Imp 11 3638 9.2 10 5050 5000 56 41 03 60 35 05 21 14 1 0 38 50 38 42 CompRem 12 3934 10 12 4950 4800 56 40 04 61 32 07 18 12 2 1 38 42 32.8 38 Maj Imp 13 4181 9.6 10.5 5450 5150 64 32 04 65 28 07 20 15 1 0 38 42 38 40 CompRem 14 5010 8 905 5800 5600 54 39 07 64 32 04 55 30 2 1 28 31.2 25.2 28 Min Imp 15 5021 7 7.5 5800 5600 49 42 09 55 36 09 62 45 3 2 13 15.2 13 14.28 Not Resp Min Imp- Minor Improvement, Not Resp-Not Responded, Maj.Imp- Major Improvement, Comp Rem- Complete Remission, TC-total count, DC- differential count, N-neutrophils, L-Lymphocytes, E-Eosinophil, BT-before Treatment, AT-After Treatment, Hb%- in gms/dl. 101
    • 102 DISCUSSION The present topic deals with the interpretation of the materials, which areexplained in previous chapters. Discussion is the solution for most of the things explainedin previous chapters.Hingula: It is a chief ore of Mercury and combination of Mercury and Sulphur. In samhitakala there were no references of Hingula, but we get the reference of parada. The reasonbehind this is, in olden days it was assumed to be imported from other countries. According to Rasendra Mangala Hingula has been called as Darada, because maybe it was available in Darada desha. Rasendra sara samgraha explained Hingula asRasagandhaka Sambhoota. It proves that they were very much aware about chemicalcomposition of individual mineral. There is a bit of controversy on varieties of Hingula and there is no referenceregarding Hingula varieties in Rasendra Mangala and Rasa Hrudaya Tantra. Rasaratnasamucchaya, Rasendra Chudamani classified Hingula as Hamsapada and Shukatunda.Ayurevda prakasha and Ananda Kanda classified Hingula in three varieties – Charmara,Shukatunda and Hamsapada. Rasatarangini classified it as Khanija and Kritrima. Becauseit is available in natural form and also can be prepared artificially with the help ofmercury and sulphur. Hamsapada Hingula has been accepted for this study, because of its lessimpurities and ideal one for therapeutic one according to Rasagranthas. Hingula can be administered after proper purification. Shodhana is adopted toreduce its toxicity and also to deal for therapeutic purpose. If impure Hingula isadministered, leads to many complications. Hingula satwa is parada. Rasaprakasha sudhakara quotes that the parada,extractedfrom Hingula is having equal property of Shad guna gandhaka jarita parada. Discussion
    • 103 Rasaratna samucchyakara and Rasamritakara, explains that the Hingulotthaparada is equal to the property of Gandhaka jarita parada. Generally, marana is not advised for Hingula. Shodhita Hingula can be used forthe preparation of yogas. Rasamrita explains that, it is used for the marana of Swarna and Loha, because ofits chemical constituent Parada. Hingula is sarva doshahara, deepana, atirasayana, vrishya, these are explained byRasaratna samucchayakara because it contains Parada.Bhallataka: It is classified under upavisha. Charaka has explained it as a best kapha and Vatahara drug. He has advocated use of Bhallataka in 10 different forms like ghruta, ksheera,etc. Rasataranginikara has explained its synonym as Vatari, this explains its activerole against vata. Bhallataka is the best drug for kapha and vataja rogas. It should besubjected to shodhana before it is used. As ama is kaphaja bhava the Bhallataka is used inresolving the ama and pacifying the vata in Amavata. Its efficacy in Amavata may be due to its anti inflammatory, Neuroprotective,immunomodulator, anti rheumatism action.Vata: Charaka has included it under Mutrasangrahaniya varga where as Sushruta andVagbhata included it under Nyagrodadi gana. Vata has a property of Kaphahara more than Pittahara. The Latex is Anti-inflammatory.Palandu: All Brahttrayee texts have quoted Palandu. The properties are Vatahara, Vrushya,and Rasayana. It is an organosulphur compound. The sulphur is essential in theproduction of Glucosamine sulphate along with other Proteins. This helps in the Discussion
    • 104regeneration of joint tissues and cartilages. It is also proved to be anti inflammatory inaction. The Flavanoids are known to deactivate molecules that are injurious to health.Lavanga: It is said to possess kapha pittahara property and is best Ruchya, Deepanapachana.Kaiyadeva nighatukara has explained its property as Shoolaghna, Vishaghna. Thealkaloid Eugenol along with other Alkaloids is proved to be Anti inflammatory.Guda: An Ikshu Vikara obtained by concentrating the juice of Ikshu. It is a rich source ofIron and Puranaguda is best Vatanashaka, Raktaprasadaka. It is a sucrose sugar.Ghruta: It is a Vatapitta shamaka, Balya, Agnidipaka, and is Vishahara. This pacifies theteekshanata of Bhallataka. This is ascertained by its presence in prepared sample.Sri Siddhadaradamruta Rasa A unique preparation for Amavata explained by Rasataranginikara and other Rasaclassics under Hingula Rasayana. The uniqueness of this yoga is potenciating ShuddhaHingula by Pachana and Dahana samskaras with the drugs which have Amahara and Vatahara properties. The dose of the drug is also being low i.e. ½ gunja pramana which can beincreased according to the dosha and bala prabhlyata of a patient. The drug isadministered along with Puranaguda in cases of Amavata. In Bhasma vignana it isexplained as Hingula bhasma prepared by Samputa paka.PHARMACEUTICAL STUDY The Rasa dravyas being Vijateeya they are subjected to Shodhana samskarawhich make them Sajateeya, that is to say that, they are converted in to homogenenous tothe body systems. The Shodhana samskaras has diversified meanings which not only aim Discussion
    • 105at making dravya sajateeya but also act in many different ways like increasing theconcentration of active principle, reducing toxicity, enhancing the property of drug.Hingula Shodana: Shodhana was carried for Hingula with 7 bhavanas of ardraka swarasa. One of theadvantages of bhavana is to reduce size of the particles. It will be easy for absorption inGIT. After bhavana weight of the Hingula was increased i.e. from 500 gms to 545 gms.Ardraka swarasa contains fibrous matter and starch in abundant which may be the causeof increase in weight.Bhallataka Shodhana: The pericarp of the Bhallataka contains corrosive juice. To minimize its ill effectsits Shodhana with Gomutra is mentioned. During this the juice escaped in GomutraColouring it black and as a tiny droplets. Gomutra contains certain amount of Ammonia in it. This Ammonia is a goodsolvent. It brings out the excess of oils from the pericarp to out side.Vataksheera Collection: The collection of Vataksheera was done in Hemantha ruthu i.e. in the month ofOct- Dec. The period was the sprouting of off shoots. This is what is called as “Pallava”.When this off shoot was broken it yields latex. This latex was collected and stored infridge. The yield was more in the early house of the day i.e. between 5:30 to 7 am.Palandu Swarasa: The moderate sized Palandu a red verity was selected for the extraction ofSwarasa. 1 kg of Palandu yielded ½ liter of Swarasa. The Swarasa was pink to look withcharacteristic odour.Cotton Thread: As cotton is known to tolerate heat for longer hours hence this was made use toact as a barrier between Hingula and the media used for samskara. Discussion
    • 106Samputapaka The author of Bhasma Vignanam explains that the dravyas which are susceptibleto high temperature like Hingula and somala are usually subjected to this method of paka.The temperature they obtain by this method is usually between 2500C to 3000C. This iscarried out by jacketing dravya with mamsa pisti, dough, Bhallataka, and frying in tailaor grutha. By this method the structural changes is anticipated.Dahana Procedure: In the classics use of funnel for dahana procedure is not mentioned. Dahana ifdone directly, the Hg from cinnabar escapes out and there will be great amount of weightloss in Hingula cake. To minimize the loss by this way the alternate method was plannedi.e. bhalltaka heap was covered with a inverted funnel as a barrier and the sides was filledwith charcoals and ignited. This was most appropriate arrangement as after dahana theBhallataka and lavanga choorna was charred and the Hingula also retained its weight.Probably this is what it was meant by saying “tatha Prajwalayet vanhi RasatantraVisharadaihe”Ghruta Pachana: The vaporization point of ghruta is very high. At the temperature of 2600C-2800CIt starts evaporating. It means to say that Hingula should be in contact with ghruta at thetemperature till all the ghruta evaporates i.e.10 times the weight of the Hingula. It takes120 hrs/ 5 days to finish the process. At the end of the procedure thick fiber like structurewere remained with un-evaporated mass. This would be due to the formation of thepolymer which remained rubbery consistency. After all the samskaras there was a weight loss of 5 gms in each cake. The losscould be due to the evaporation of Hg from Hingula. This was inferred from the first cakewas prepared according to the classical verses when 80 gms was lost (before 115gmsafter 35 gms). Hence the Dahana procedure was modified using in direct heat. Discussion
    • 107ANALYTICAL STUDIESOrganoleptic Characters: The colour of Sri Siddhadaradamruta Rasa is dark brown with Faint smell andFine Touch. The colour of Hingula, as noted, changed with the change in temperature andnature of preparation. The faint smell is seen same in all prepared samples with Hingula.Flow property: As the drug is in powder form it is tested for its flow property. This analysismakes us to know weather any adjuncts are essential for proper flow of drug duringCapsule or Tablet preparation. Flow property was identified by “Angle of Repose(Tanθ)” and Flow rate by “Compressibility index (I)”. Sri Siddhadaradamruta Rasa has agood Flow property with Tanθ=37.46±7.86 and Flow rate I=15%.hence it can be said thatit does not need any adjuncts in capsule preparation.Particle size: Smaller the particles better the absorption. To know the size of particles the drugwas viewed under microscope and was calculated according to the procedure. This wasdone for the sample of Shodhita Hingula and to the prepared drug. The mean Arithmeticmean was calculated. The mean of both samples are as under-Arithmetic mean of Shodhita Hingula: 6.53 microns.Arithmetic mean of Sri Siddhadaradamruta Rasa: 4.788 microns. The results clearly indicate that the particle size is less for Sri SiddhadaradamrutaRasa than for Shodhita Hingula even though both are with in the permissible range.Total fat content: Sri Siddhadaradamruta Rasa contains 7% of Fat in it. This ascertains that therewas an exchange of pachana material through the cotton thread barrier to the Hingula. Discussion
    • 108Test for Alkaloids: As per the analytical tests there was no Alkaloids detected. The procedureemployed in detection of Alkaloid also plays an important role in interpreting about thepharmaco kinetics and dynamics of a drug. Here the Alkaloid detection was done usingchemical procedures. Instead if TLC procedure was adopted there would be certainamount of Alkaloid separation would have been expected, unfortunately the solvent forcinnabar was not identified.Assay for Hg% and S%. Hg% and S% was analysed in Shodhita Hingula and Sri Siddhadaradamruta Rasato ascertain the changes after the procedure or in other words the effect of Dahana andPachana Samskaras on the Shodhita Hingula was studied. Sample Hg% S% Shodhita Hingula 86.10% 12.83% Sri Siddhadaradamruta Rasa 64.28% 12.28%Loss on drying at 1100 C. Sri Siddhadaradamruta Rasa was subjected to the test “Loss on drying 1100c”.It was evident that weight loss is very minimum i.e. 0.12% which indicates the preparation is completely free from the moisture.Solubility: It is learnt that it is soluble in Alcohol and slightly soluble in water and Chloroform. That is to say that, 10-30 parts of Alcohol and 30 to 100 parts of Chloroform and water is essential to dissolve 1gm of the sample. Discussion
    • 109ESCA Studies: In the sample Mercury is present in Oxide and Sulphide forms. No elementalmercury is present. Majority of mercury is in the form of oxide and less in the Sulphideform as the sulphide indicated is 5.51% where as Hg in 24.69% and oxide 20.79%. Thesample has mercury oxide and sulphide in the ratio of 60:40. The grutha contain o2 inabundant quantity and drug is also in oxide form. Perhaps this o2 might have acted inconverting the sulphide in to oxide form. This needs further studies for throughunderstanding. The peak at 59.3 is due to Selenium oxide and if it is due to elementalselenium it will be at 54.8, because it is too low in concentration it can not be marked.This result is in parlance with the views of acharya Hari Sharananda author of Bhasmavignanam. He has included this drug in Bhasma prakarana and says the Samputapakaadopted will convert Hingula in to Bhasma form. The drug Sri Siddhadaradamruta Rasa,satisfies the Bhasma gunas like Rekha purnata, nirasa, but fails to pass varitaratwa. In theindications of Sri Siddhadaradamruta Rasa one is in Klaibya, as it contains SELENIUMin smaller doses even this could prove efficacious in such cases. In a recent news articlepublished in Times of India (27th Feb. 2006) “Jayesh Bellare, Professor, IIT-Bombay,said, Bhasmas seem to be a natural recipe to make protein coated nano-particles”.Transforming the inorganic material in to its finest state along with both bringing andpreserving therapeutic property is the sole aim of Ayurvedic pharmaceutics like Bhavana,Puta, Kupipakwa Rasa, Pottali Rasa. This is the method of bio-transformation wherein it is a process of pharmaceuticsbut not merely a chemical reaction taking place. There occurs a series of chemicalreactions which are useful but not harmful to the body. It is a complex process; analysisof an isolated preparation cannot concretely give the whole idea. Whatever we aredescribing is a tip of an iceberg but it does not describe complete iceberg. In the sameway, the study is to be further carried out so as to know what the possible, probablereactions may be taking place. Discussion
    • 110CLINICAL STUDIES It is clear in classics that the efficacy of Rasa is enhanced when it is madeagnisthayi hence Parpati, Kupipakwa, Pottali kalpas are put in ascending superioritytherapeutically. In the present context Hingula, again ore of Rasa is subjected to agnisamskara like Dahana, Pachana which is believed to enhance its therapeutic efficacy forthis reason it was subjected to Clinical trail in the cases of Amavata. It was a prospective clinical trial over 15 patients, randomly selected in a singlegroup. The results obtained were statistically analysed and mean percentage, SD, SE, andt values were calculated by using t test. The patients were of either sex, age groupbetween 20-50 years. The age group assumed as the sex of the patient is concerned, so itrefines the classics. There are more patients 6 (40%) in 41-50 years. Females dominated11 (73.33%) in the study. The study records larger no of Hindus 13 (86.66%) compared to other religions.As the sample size is too small, it cannot be concluded that Hindus are more susceptiblefor the disease Amavata. Other reason may be that, it is the reflection of geographicalpredominance of particular section of the society i.e., Hindus are dominant in Gadag. In the study as maximum patients were housewives (53.33%), which simplycorrelate with the maximum percentage of female patients. Otherwise occupation as suchwas not significant. Majority of the patients belonged to middle (53.33%) socio-economic group. 86.66% of the patients were vegetarians and 13.33% were having mixed foodhabit. This only reflects the predominant diet of the religion. However majority of the cases under the study had tendency towards kaphajaahara (Madhura- 53.33% and Amla- 20%). Maximum no of patients were having vata- kapha prakruti (46.66%) followed byvatapitta (33.33%). Discussion
    • 111 Majority of the patients (73.33%) had no bad habits and 20% were addicted totobacco chewing. Majority of the patients having madhyama sara (73.33%), madhyama satva (60%)and madhyama samhanana (73.33%) suggesting as in any other disease greatersusceptibility among those who were not in the pink of health. Sandhi shoola, Sandhishotha, Sthanika ooshmata (jwara), Gouravata, Nidraviparyaya, jadya were presented by all the patients. The presence of Gouravata in allpatients reflects the involvement of Ama.8 (53.33%) patients had mandagni as nidana atthe same time 8 (53.33%) patients had vid bhaddata as associated complaints. Cent percent patients were free from extra articular manifestation in eye,respiratory system, cardiac system, and nervous system. Out of extra articularmanifestation, majority of the patients were affected with systemic complaints such asloss of appetite. This suggests the early stage of the disease and their prognosis was good.Clinical response of the treatment: In this study an effort has been made according to the guide lines laid down byour classical texts in the selection of patients. All the cardinal symptoms were scoredaccording to the severity grade. The clinical response of the therapy was assessed on thebasis of change in the severity score after the treatment. The cardinal symptoms likeSandhishoola, Sandhishotha, Sthanikaooshmata (jwara), Gouravata, Nidraviparyaya,jadyata were taken into consideration of the functional activity of the patients, laboratoryinvestigations were also assessed before and after treatment.Effect on Sandhishoola: 40 % of patients were completely relieved in shoola. The reduction of severity ofpain grade reported statistically significant where p value is less than 0.001.Effect on Gouravata: 80 % of the patients were completely relieved in Gouravata. Statistically it provedhighly significant with p value < 0.001. Discussion
    • 112Effect on Jwara (Sthanika Ushmata): In Amavata samprapti it clearly explains that the produced Ama under theinfluence of vata is taken into the sleshmasthanas hence the Sthanika Ushmata is taken into consideration. In pravrudda avastha of Ama sarvanga Jwara is appreciated. As in the group of patients the pyrexia was not significantly noted, for whichSthanika Ushmata of the involved joint was considered. 53.33% of patients werecompletely relieved in Jwara. Statistically it was reported highly significant with p value< 0.001.Effect on Sandhishotha and Nidra Viparyaya: 46% of patients with Sandhishotha were relieved completely whereas 40% of thepatients were relieved completely with Nidraviparyaya. The mean net effect for both theparameters is same with zero variation.Effect on Jadyata: 4 (26.66%) patients were relived from Jadyata and 2(13.33%) patient did notrespond to the treatment. This data implies that the effect of drug on Jadyata is good inthe initial stages. Statistically it showed highly significant with p value <0.001.Effect on Walking Time: 40% patients showed improvement in the walking time. The variation within thegroup was zero. Hence same net mean effect before and after the treatment was observed.Effect on Grip strength: Certain degree of improvement was recorded among the patients. The statisticalanalysis shows highly significant as p value is < 0.001. The mean net Grip strength ofright hand is more with more variance even though left hand grip strength shows morehighly significant than right hand grip strength. This is due to sampling error andvariations among the patients. Discussion
    • 113Effect on ESR: There was a notable change in the ESR reading, before and after the treatment.The statistical analysis showed highly significant as p value is < 0.001. This reduction isof much importance which explains the relief in disease process.Effect on Hb%: Improvement in the Hb% is a good sign in such patients. In the study there wasmarginal increase in Hb% in patients. Statistically it shows highly significant with pvalue < 0.001.Effect on DC: The lymphocyte also showed highly significant.Total Effect: In 15 patients 4 cases showed complete remission, 4 patients demonstrated majorimprovement and 4 patients illustrated minor improvement and 3 cases showed noimprovement.Discussion on Dose In the classics it is mentioned that the dose of the drug is ½ gunja matra and canbe varied according to the bala of the patient and disease. In the study it is noticed that inchronic patients the dose was not sufficient. In such condition the dose was increased to 1gunja two times a day. The maximum dose tried in the trial is 1 gunja three times a day.Probable mode of Action: Ama and Vata are the root cause of Amavata. Ama circulates all over the bodycauses sroto-avarodha and gets lodged in sandhis and contributes to the formation of thedisease Amavata. The gunas of Ama and Vata are both contradictory in nature, except thesheeta guna which in common to both. Discussion
    • 114 Sri Siddhadaradamruta Rasa is prepared with Shodhita Hingula by subjecting intosamskara with drugs like Vataksheera, palandu swarasa, bhallatka, lavanga and ghruta.Among them, Bhallataka, Lavanga and Palandu have Katu Rasa in common and exceptLavanga both are ushna in veerya. The other drugs are Vata and kaphahara in nature.They do the deepana, pachana of Ama and relieve sroto-avarodha and pacify Vata, thencebreaking the Ama and same Vata complex. Hingula has the property of tikta, katu, kashaya and ushna veerya, katu vipaka,tridoshahara, deepana and amapachaka. It subside Amavata and jwara. It is Rasayana andbalavardhaka, by these properties Hingula pacify jwara and does amapachana, and help inresolving the samprapti. Vataksheera and palandu swarasa are best vatahara drugs. Bhallataka is bestknown for kaphahara property. It is best deepaka and pachaka. It liquefies the Ama andthereby resolves Amavata. It is also known as an immuno-modulator drug, hence it’s used in Amavata andimmune related disorders are much beneficial. It is proved for its anti-inflammatoryactivity. Ghruta helps in reducing the teekshnata due to the use of Bhallataka. Palandu, Hingula are sulphur containing compounds which increase the bilesecretion from liver. This intern helps in correction of digestion and Metabolism withinthe body and there by may help in the formation of certain essential proteins, histine,arginine, and glutamine. Besides sulphur is bacteriostatic, Antiseptic in nature It is found in ESCA analysis that SSDR contain selenium in oxide form in traces,because of its action over many of the enzymatic systems under immune system, it maybe responsible for Rasayana activity justifying its phalasruti. In the present study Puranaguda was selected for Anupana which has a propertyof vata shamaka, Agnivardhaka, Ruchya. It is also Raktaprsadaka therefore it improvesthe quality of Rasa and Rakta. It is also Ksharayukta and NaatiSheeta hence the quality ofRasa is improved by it as Anupana in the cases of Amavata. Discussion
    • 115 Conclusion1. The inferences of the pharmaceutical study are as under - The Hingula shodhana was done using Ardraka swarasa Bhavana which again aims increasing its Amapachana property. The Bhallataka was made Shuddha by subjecting it to swedana in Gomutra which is again beneficial in Amavata. The temp recorded are as – Pachana with Vata Ksheera and Palandu Swarasa- 800C Pachana with Grutha-2600 C- 2800C for 5days. For dahana procedure using inverted funnel was most convincing as in this procedure the loss of Hg can be cut down to greater extent.2. Inferences of analytical studies are summed up as- Samskarohi gunaantardhana ucchate is what was tried to establish by Analytical gadgets like Organoleptic characters, Hg%, S%, Pachana and dhahana samskaras adopted in the preparation has definite role in potencefying the Shodhita Hingula. The media has certain interaction with the enveloped Hingula cake which was evident with the presence of 7% fat in the prepared sample and slight acidic ph (6.66) of prepared sample. The size of the particle of Sri Siddhadaradamruta Rasa is significantly less than Shodhita Hingula which means that the samskara had role in making it fine and obviously make it better absorption. Colour of Shodhita Hingula is changed from Red to Dark Brown. The taste and smell remained unchanged. Loss on drying is 0.12% which determines that the moisture is in negligible percentage. Conclusion
    • 116 As a result of Dahana samskara there was certain amount of loss in both Hg% and S%. Alkaloids were not identified by the methods adopted. Superior methods should be taken for help. The ESCA report suggests that the Selenium presence is increased markedly after the samskaras. There is no direct reference for the use of Shodhita Hingula internally, but by this dahana and pachana samskaras it was made possible for sole administration.During the clinical study the inferred observation are as- As the word suggests, in Amavata, the pivoting entities in disease process are Ama and Vitiated Vata. Pathogenesis of Amavata is initiated by Ama, occupying various Shleshma sthanas, mainly joints On the basis of observations preponderance of Vata and Kapha dosha was found to play an important role along with Tridosha dushti in the disease. Majority of patients were middle aged (40%) females (73.33%), Hindus (86.66%), Housewives (53.33%), of Middle economic status (53.33%), Married (80%), Vegetarian (86.66%) and having Tobacco addiction (20%) All the patients of this study were having Dwandaja prakriti with maximum of Kapha-Vata prakriti (46.66%), madhyama Sara (73.33%), Madhyama Samhanana (73.33%), Madhyama Satva (60%), sadharana desha (66.66%). From the findings of the clinical study it can be concluded that Sri Siddhadaradamruta Rasa is better effective in Navottha Amavata. Conclusion
    • 117 The statistical data showed highly significant (p<0.001) in all individual subjective and objective parameters, affirms that there was significant efficacy of the drug noted in the clinical study justifies it. The over all result is 4 (26.66%) patients showed complete remission, 4 (26.66 %) patients showed major improvement, 4 (26.66 %) patients showed minor improvement, 3 (20%) patients showed no improvement, Limitations1. The duration of the study was precise.2. As the sample was small and it was a prospective clinical trial.3. Minimum instrumental and investigatory facilities. Scope for further study.1) The samskaras might influence on the structural change or has the chance of converting the drug in to its isomer. This has to be appreciated by sophisticated instrumental analysis like x-ray diffraction.2) Further the drug has to be tried over the other indications to establish its efficacy.3) The drug has to be tried in chronic Amavata condition with higher dosage.4) Various shodhana procedures has to be carried out on Hingula and then subjected to Pachana and Dahana samskaras with same media and analytical and clinical study may be compared.5) The exact solvent for Hingula has to be identified and tested for the separation of Alkaloids.6) The study of nano particles in relevance to this Hingula bhasma is proposed. Conclusion
    • 118 SUMMARY The present dissertation work entitled “Preparation and analytical study ofSri Siddhadaradamruta Rasa and its clinical efficacy in Amavata” contains topicsintroduction, methodology which embraces pharmaceutics, analytical study, clinicalstudy, observations, results, discussion and conclusion. “Samskaro hi naama Gunantardhanam Ucchyate” is best explained by takinginto account of the Rasa Rasayana kalpas. The agni samskara given to parada to make itagnisthayi improves its efficacy to manifold. Sri Siddhadaradamruta Rasa is one suchpreparation, wherein Hingula, the ore of parada, is subjected to dahana and pachanasamskaras with different media which makes its properties enhanced to greater extent.The media used in the study are like Vata ksheera, Palandu swarasa, Shodhita Bhallataka,lavanga, ghruta in toto have amapachana, kaphahara, vatashamaka, Rasayana properties. Amavata is a crippling disease which presents with simple arthralgia to severecomplications. It is a disease entity wherein improperly metabolized intermediate byproduct, Ama, under influence of vata takes shelter in the sleshma sthanas. The treatmentmodality aims at breaking the Ama and vata complex- samprapti and resolve Ama. The impact of samskara on the drug is analysed by the changes in the organolepticcharacters and analytical methods focusing mainly on Hg % and S % before and after thesamskara, presence of alkaloid and media substrates in the prepared sample. It was notedthat there was significant change in the organoleptic characters, flow rate, fineness ofparticle. There was presence of media used for pachana in the prepared sample likeghruta which may imply the exchange of materials through the barrier i.e., a cotton threadenvelope. The chemical tests for the presence of alkaloid using picric acid and vagnorsreagent did not establish the presence of alkaloid. To know the status of mercury andsulphur in the compound further ESCA was done, which reported that Hg was both in theform of sulphide and oxide in 40:60 ratio respectively. It could be approximated that the Summary
    • 119drug after samskara has turned in to a Bhasma form bearing in mind for the opinion of SriHarisharananda sharma. With this analytical background it was assumed to have definite changes intherapeutical activity. Hence it was put to test in the selected cases of Amavata whichdiagnosed as per classical signs and symptoms. It was a prospective clinical trial over 15 patients, randomly selected in singlegroup. The results obtained were statistically analysed and mean percentage, SD, SE, andt value were calculated by using student t test. The cardinal symptoms like sandhishoola, sandhishotha, jwara (SthanikaUshmata), gouravata, nidraviparyaya, jadya were present in almost all the cases. Theparameters which reflects the Ama condition was considered for assessment. Theobjective parameter ESR was assessed which is a marker of disease process along withother parameter like walking time and Grip strength. There was a marked response after treatment in the parameter sandhishoola(40%), sandhishotha (46.66%), jwara (Sthanika Ushmata) (53.33%), gouravata, (80%)nidranasha (40%).jadyata (26.66%) The ESR also showed highly significant statistically.The changes in the ESR readings were present but not drastic changes. The parameterswalking time and grip strength were also statistically highly significant. The overallresponse in the treatment was that 4 patients had shown complete remission, 4 patientshad shown major improvement. 4 patients had shown minor improvement, and 3 patientshad no improvement. Summary
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    • 12774. Bhavamishra, Bhavaprakasha nighantu, edited by Bheemashankara shastri, 6th edition, Varanasi : Choukhamba Samskruta Samsthana, 1984, chapter Haritakyadi varga, shloka 226, p.134.75. P.V. Sharma, Kaiyadeva Nighantu, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter Oushadhi varga, shloka 1222-1224, pg-226.76. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Amradi varga, shloka 57-61,p. 19977. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, Amradi varga, Sholka 66-67,p.133.78. Journal: Onion-Phyto chemical and health properties provided by the national onion association. www.liv.ac.uk. Date: 20/11/0579. Vaidya V.M.Gogte, Ayurvedic Pharmacology and Therapeutic uses of Medicinal Plants.1st Edition 2000, pg-475.80. www.essentialoils.co.ze/glossary date: 20/11/0581. Pandita Narahari, Rajanighantu, edited by Indradeva Tripathi, 2nd edition, Varanasi : Krishnadasa Academy, 1998, chapter Amradi varga, shloka 81-84,p. 41282. P.V. Sharma, Kaiyadeva Nighantu, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter Oushadhi varga, shloka 1333-1334, pg-247.83. P.V. Sharma, Dhanwantari Nighantu, editor Guruprasada Sharma, 1st edition, Varanasi : Choukhamba Orientalia, 1982, Sholka 39-40,p.98.84. www.essentialoils.co.ze/glossary date: 20/11/05 Bibiliography
    • 12885. Bhavamishra, Bhavaprakasha nighantu, edited by Bheemashankara shastri, 6th edition, Varanasi : Choukhamba Samskruta Samsthana, 1984,Poorva khanda, chapter Ikshuvarga, shloka 26, p.895.86. Sushruta, Sushruta samhita, editor Ambikadatta Shastri, 13th edition, Varanasi : Choukhamba Saskrit Samsthana, 2002, Sutrasthana, chapter 45, shloka 160, p. 183.87. P.V. Sharma, Kaiyadeva Nighantu, 1st edition, Varanasi : Choukhamba Orientalia, 1989, chapter Oushadhi varga, shloka 135-136.88. Net source: Journal: East Meets West Times Globe staff. Authour: Dr. G. R.Gokani. sarina@chifamily.com89. Agnivesha, Charakasamhita, Chikitsasthana, editor Kashinatha Shastri 12th edition, Varanasi : Choukhamba Bharateeya Academy, 1984, chapter 13th, shloka 9, p. 382.90. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition, Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 25, p. 99.91. Vagbhatacharya, Ashtanga Hridaya, editor Yadunandana Upadhyaya, 11th edition, Varanasi : Choukhamba Orientalia, 1993, chapter 13, shloka 26, p. 99.92. Ayurmedline, Dr. S. Prabhakara, Jan. to June 2001, Dr. Seetaram Banglore, Pravin Madikonda, Prof. R.H. Singh, New dimensions of concepts of Ama, p. 33-36.93. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 1-5, p. 460.94. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-5, p.564.95. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 6, p. 462. Bibiliography
    • 12996. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-2, p.564-565.97. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 7, p. 462-463.98. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 8-10, p. 463.99. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 11, p. 463.100. Acharya Madhava, Madhava nidana, Vijayarakshita, Sudarshana Shastri, 25th edition, Varanasi : Choukhamba Sanskrit Bhavama, 1995, shloka 12, p. 464.101. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1, p. 568.102. Chakrapani Datta, Chakradatta Jagadishwara Pasada Tripathi, 4th edition, Varanasi : Choukhamba Sanskrit Series, 1976, chapter 25th, shloka 1, page 225.103. Shri. Govindadas, Bhaishajya Ratnavali edited by Ambikadatta Shastri, 11th Edition, Varanasi : Choukhamba Sanskrit Samsthana; 1996, Chapter 29th Amavata chikitsa, shloka 1, p. 431.104. Yogaratnakara, Laxmipati Shastri, 6th edition, Varanasi : Choukhamba Sanskrit Samsthana, 1997, Poorvardha, Amavata nidana, shloka 1-4, p. 573.105. Vinayakumar, Basic Pathology, 5th edition, Philadelfia, W. B. Sundar’s company, 1992, chapter 6th, p. 145.106. Harisson’s, Principles of Internal Medicines, Vol – II, 15th edition, Braunwald, Fauci Casper, Jemsons, 2003, Boston : Mc Graw Hill, chapter 12th, p. 1928. Bibiliography
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    • CASE SHEET PROFORMA DEPARTMENT OF RASASHASTRA DGM AYURVEDIC MEDICAL COLLEGE, GADAG Topic: PREPARATION AND ANALYTICAL STUDY OF SRISIDDHADARDAMRUTA RASA AND ITS CLINICAL EFFICACY IN AMAVATA. Guide: Dr.M.C.Patil Dr. Pradeep.Agnihotri M.D(Ayu) P.G.Scholar Co-Guide: Dr.G.N. Danappagoudar M.D (Ayu) 01. Name: Sl.No:02. Father’s/Husband’s Name: O.P.D.No.03.Age : Years D.O.I. :04. Sex: D.O.C.: M F05. Marital Status: Married Unmarried06. Religion : Hindu Muslim Christian Others07. Occupation: Labour Sedentary Active Housewife08.Ecconomical Status: Poor class Middle class Upper class09. Address: Telephone :10. Result : Complete Major Minor No remission improvements improvements improvement11.Consent : I ------------------------- Son| Daughter| Wife of---------------- Exercise my free will in the said study, I have been informed to my satisfaction by the attending the purpose of the clinical evaluation and nature of drug treatment. I was also aware of my right to quit at any time during the schedule. Patient’s Signature 1
    • 11. Chief complaints: Sl.No. Complaints P/A Duration 01. Sandi shoola 02. Sandhi shotha 03. Jadya 04. Jwara 05. Vrischika Danshavata Peeda 12. Associated complaints: Sl.No. Complaints P/A Duration 01. Angamarda 02. Aruchi 03. Gourava 04. Nidra viparyaya 05. Bahumootrata 06. Trushna 07. Apaka 08. Daha 09. Alayasya 10. Vid vibandhata 2
    • 13. History of present illness:Mode of onset Insidious Acute ChronicSequence of joint involved:Monoarticular Polyarticular Asymmetrical symmetrical OligoarticularAggravating factors:Relieving factors:Nature of disease: Progressive Regressive Constant IntermittentRoutine activities affected: Mild Moderate Severe Not affected14. Family history:15. Previous treatment history:Steroid dependent:NSAID’s:Others: 3
    • 16. Personal history:Ahara : Taste Sweet Sour Salt Vegetarian Mixed Predominance Pungent Bitter Astringent Jatharagni: Manda Teekshna Vishama SamaNidra : Sukha Alpa Ati VaishyamyaVyasana : Smoking Alcohol Tobacco No habitArtava pravriti: Days Samya Alpa Adhika Rajo nivritti17. General examination: Pulse B.P. Temp. Resp.rate Height Weight Heart rate18. Atura bala pareeksha: Prakriti V P K VP KP VK VPK Sara: Pravara Madhyama AvaraSamhana: Pravara Madhyama Avara Satmya: Pravara Madhyama Avara 4
    • Pravara Madhyama AvaraSatwa: Vyayama shakti: Pravara Madhyama Avara Vaya: Balya Youvana Vruddha Desha: Jangala Anupa SadharanaAshtasthana pareeksha: • Nadi: Shabda: • Mootra: Sparsha : • Mala: Drika: • Jihwa: Akruti:19. Systemic examination: a) Cardiovascular system: b) Respiratory system: c) Digestive system d) Nervous system: 5
    • 20. Special examination of the joints: A] Pain: i) Mode of onset: Sudden Gradual ii) Site: Localized Referred to other joints P/A If P iii) Trauma: iv) Character: Aching Throbbing Pricking v) Moment Yes No aggravates pain: vi) Relation to Worst in weather weather: B] Morning stiffness: Present Absent 0 1 2 3C] Inspection: i) Any other deformity: P/A If P ii) Soft tissue swelling: Present Absent iii) Skin over the joint: Redness Itching Glossiness Oedmaiv) Muscle wasting: P/A If P Above the Below the affected joint affected jointv) Rheumatoid nodes: P/A If P 6
    • D] Palpation: i) Local temperature: Present Absentii) Maximum tenderness: Bone Ligament Tendon Others sheet iii) a. Flexion deformity b. Extension deformity21. Nidana pareeksha: ` I. Nidana : Viruddha Bhojana Virudha chesta Vyayama after Snigdha Bhojana MandagniII. Upashaya / Anupashaya : 22. Lab investigations: Sl.No Name of the test Value A Blood 01. Hb% mg % 02. ESR mm for I hour 03. Total count % 04. Differential count N E B M Lb. Radiological examination: 7
    • 23 . Intervention: Trail medicine drug: Sri Siddhadaradamruta rasa. Dose : Started on: Anupana : Completed on :24. Assessment of results: Subjective parameters Sl. No. Complaints 0 day 15 days 30 days 45 days 01. Sandhi shoola 02. Sandhi shotha 03. Jadya 04. Jwara 05 Gouravata 06 NidraviparyayaObjective parameter: S.No Parameters 0 day 30 days 01. Hb % 02. TC 03. DC N E B M L N E B M L 04. ESR Sl.No Parameter 0 day 15 day 30 day 45 day 05 Walking time 06 Grip strength Rt- Lt- Rt- Lt- Rt- Lt- Rt- Lt-Investigator note:Signature of Scholar Signature of Guide Signature of Co-Guide 8
    • Score sheet 01. Sandhishoola. 0=No complaints 1=Patient tells about after inquiry 2=Patient frequently complaints 3=Excruciating condition 02. Sandhi shotha 0=No complaints 1=Slight obvious 2=Covers well the boney prominence 3=Much elevated 03. Jwara(Sthanika Ushmata) 0 = Normal 1= During severity of Pain 2 = During severity of pain with swelling. 3 = Continue shula with pain04. Jadya 0 = No stiffness. 1 = Stiffness for 5 minutes to 1 hour. 2 = Stiffness for1-2 hours. 3 = Stiffness for more than 2 hours. 05. Nidraviparyaya: 0= No discomfort. 1= discomfort during night. 2= discomfort during night and affects day. 3= day sleep and Night awakes. 06 Gouravata: 0= No gouravata 1= during morning up to 1Hr 2= continues in the morning<24 Hrs. 3=throughout the day. Walking time: (To cover 21 meters) 0= Up to 20 seconds. 1= 21 – 30 ” 2= 31 – 40 ” 3= 41 – 50 ” 4= 51 – 60 ” 5= 60 ” 9
    • Annexure I• Slokas of - • • • •• ••• • ••• •• • • •• • • •• •• ••• •• • •• • •• • • •• •• • •• • • • •• •• •• • • • •••• •• •• ••• •• • •••• • ••• • • • •••• • •• • • • • • • • • •• • • • •• • ••• •• • • • •• •• •• • • • • • • • • •• •• • •• •• •• • • • • • • • • ••• • • •• •• • • • ••• •• •• ••• • •• • • • • ••• •• • • •• ••• •• ••• • ••• •• • •• • •• • •• •• • • •• • • • • • • • • • • ••• •• ••• • • • •• • ••• • ••• • •• •• • • •• •• •• •• •• •• •• • • •• • • • ••• •• • • • • • ••• •• •• •• •• ••• • •• • • • • • • • • • • • •• • •• ••• •• • • • •• •• •• • • •• • • • •• •• • • • •• • • • •• •• • •• •• • •• • •• • ••• •• • •• • ••• ••• • •• •• • • • • • •• • • •• • •• •• • • • • •• •• • •• • •• • • • • • •• • • • • ••• •• ••• •• • •• • • • • • • • • • • •• •• •• • • •• • •• •• • •• •• •• • • • ••• •• • •• •• •• • • • •• • • • •• • •• • • • •• • • •• •• ••• • • •• •• • •• •• •• • • •• • • •• •• •• •• •• • •• ••• • • •• •••• •• •• • • •• • • •• • •• ••• •• • • •• • • • • • •• • • • ••• • • •• • •• •• • • • • • •• •• • •• ••• • •• •• • • • • • ••• • • •• • • • • ••• • • •• • • •• • •• •• • •• • •• • ••• •• • •• • ••• ••• • • • • • • • ••• •• • •• • • ••• ••• • • • •• •• • •• •• •• • •• • • ••• • • ••• • •• • ••• • •• • •• ••• • • ••• •• • • •• •• • • • •• •• •• •• •• •• ••• • • •• • • •• • ••• ••• • •• •• • • • • • ••• •• •• • •• •• • • • • • •• •• •• • • •• ••• •• • •• •• •• • • • ••• •• • ••• • • • •• •••• • •• •• • • •• •• • • •• ••• • •••••• • •• •• • • •• • •• ••• •• • ••• •• •• •• • • •• • • • • ••• • • •••• • • •• •••• • • • ••• •• • • • •• • •• • •• • • • • • • •• • • • • ••• •• • • • • •• • ••••••• • •• • ••• • • •• • ••• •• • •• • ••• • • • •• • • • • • •• • • • •• • ••• ••• ••• •• •• • ••• • •• • • •• ••• ••• • •• •• • •• • • • • • • • • • • • • •• • •• ••• •• • • • •• • • • • •• • ••• • • • • ••• •• • • • • •• • •• ••• •• • • • •• ••• ••• •••••••••••• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• • • ••• •• •• ••• •• • •• • ••• •• ••• ••• •••• • • •• • •• •• • ••• • • • • • • •• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •• • •• ••• •• • • • •• • • • • •• • •