Suthika paricharya psr
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A Comparative Clinical Study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya, Kavya, G M, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. ...

A Comparative Clinical Study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya, Kavya, G M, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPI

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Suthika paricharya psr Document Transcript

  • 1.                             
  • 2. ACKNOWLEDGEMENT At this peak of completion of my thesis work, I Undertake the honorable task ofexpressing my heart felt gratitude to all those who are part of my great task. Whowere really there for me in my blues and blooms of higher studies, and with whoseback support my present tense has been possible. I whole heartedly thank Dr.D.Veerendra Heggadeji, President of this institutionfor giving me an opportunity to study in this esteemed Institution. In this regard Iamthankful to Prof. U.N.Prasad Principal of SDMCA udupi. My deep sense of gratitude and heartful salutation to my respected teacher andguide Dr.Ramadevi G, for her comprehensive guidence & valuable suggestions. Herkind words and motherly concern through out my course kept my spirit going. I express my sincere gratitude to my HOD, Dr. Usha V.N.K, Her upgoing energy,deep and vast knowledge along with affection and care always helped me, encouragedme, to pursue right path in my academics. I am gratefully thankful to her. It is indeed a pleasing privilege for me to express my profound gratefulness andindebtedness to my professor Dr.Mamatha. My never ending gratitude to mydepartmental honorary Assistant Professors Dr.Sucheta and Dr. Vidya Ballal, forproviding me with precious training and constructive ideas, throughout my studyperiod. I am extremely energized by their presence. My sincere gratitude to the Dean Dr. Shreekanth U and associate Dean Dr.Govinda raju for their invaluable support, encouragement and guidance. I amgrateful to Dr. Veena Mayya, Dr. Krishna Bai, Dr.Subhramnya Bhat, Dr.Jonahfor giving me opportunity for gaining practical knowledge, their timely help andcarrier guidelines.. The thesis work has been carried out in SDM AyurvedicHospital, Kuthpady. Iam grateful to Dr.Y.N.Shetty, Medical Superintendent of theHospital.
  • 3. Finally Heartfelt regards to my fellow PG’s, seniors and junior colleagues, I amfortunate enough to have such a nice colleagues, So much deeply felt love to all myfriends, specially to Dr.Sujatha, Dr.Shilpa, Dr.Sukanya, Dr.Shubha andDr.Vijayalakshmi. I am privileged to have such a wounderful friends inDr.Harshita, Dr.Prathibha, Dr.Sindhu, Dr.Sumana, Dr. Geetha andDr.Vaishali. All of your company made this journey ease. DR.G.M.KAVYA
  • 4. Abstract  ABSTRACT Title: “A Comparative Clinical Study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya. Woman is treasured by the richness of continuing the human race. In Hindu culture,the puerperium was traditionally considered a period of relative impurity or ashoucha dueto the process of child birth. And a period of confinement of ten days. The elegant phaseof pregnancy & delivery brings adaptational changes in biophysiological & psychologicalparameters in puerperium, which may adversly affect her health if not properly takencare of. Since giving birth is stressful with an emotional touch of becoming new mother,even there is dramatic change in doshas, dhatus which result in declination of her health.The added responsibilities of nurturing the new baby along with recuperation of her ownhealth, makes suthika an aspirant for special attention. Ayurveda has ideally given prime importance to suthika and explained suthikaparicharya which helps in reverting her to the prepregnant state. In this perioddashamoola, jeeraka and panchakola are given importance. The Dashamoolajeerakakashaya and Panchakola kashaya being enriched with qualities like deepana, pachana,tridoshahara specially vatanulomana, vedana sthapana, vrana shodhana, grabhashayashodhana, garbhashaya sankochaka, sthanya janana, dhatuposhana, sandhaneya, grahi,jeevaneya, balya, medhya, hrudhya, rasayana etc. The same are the desired effects forthe study.Objectives: To study the concept of Suthika. To assess the effect of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika. To compare the efficacy of both the Kashayas in Suthika Paricharya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya
  • 5. Abstract Study design: This research work is a single blind comparative clinical study with pre test andpost test design. 20 Postnatal women were selected and randomly categorized into 2equal groups, Group A were given Dashamoolajeeraka Kashaya and Group B were givenPanchakola Kashaya. 90ml of kashaya is given thrice a day to each group for a period ofone month from delivery.Results: The kashaya given in both the groups showed good result with significant andsatisfying improvement in most of the parameters of assessment. The Group A with dashamoolajeeraka kashaya showed significant results in Tenparameters out-off eleven, it is ahead in the parameters like regularizing the bowel andmicturation habits, normalizing lochial discharge, doing proper healing of episiotomywound, reducing abdominal pain and backache. Group B with Panchakola kashaya also showed significant results in Ten parameters.It is ahead in the following parameters like increasing the appetite of the suthika, doingproper involution of the uterus, increasing and establishing adequate lactation,whencompared to Group A. Both the groups showed equally good result in increasing strength of the Suthika.At the same time both the groups have failed in reducing the abdominal wall thickness.In total there is a positive result for the kashaya of each of the groups and can be advisedin the suthika paricharya with confidence.Key Words - Suthika, Puerperium, Dashamoolajeeraka Kashaya, Panchakola Kashaya,Uterine Involution, lochial discharge and Lactation. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya
  • 6. LIST OF CONTENTSSl. No. Contents Page No. 1 Introduction 1-2 2 Objectives 3 3 Review of Literature 4-30 4 Drug review 31-35 5 Methodology 38-44 6 Photo’s 36,37,45 7 Observations 46-75 8 Result 76-113 9 Discussion 114-140 10 Conclusion 141 11 Summary 142-143 12 Bibliography 144-156 13 Annexure 157-161
  • 7. LIST OF TABLESTable No. Description Page No. 1 Previous Work Done 7 2 Samanya Suthika Paricharya 11 3 Hematological values in Puerperium 23 4 Composition of colostrums & Breast milk 27 5 Dashamoola and Jeeraka Drugs 32 6 Panchakola drugs 35 7 Incidence by age 46 8 Incidence by Religion 47 9 Incidence of Socioeconomic status 48 10 Incidence of Education 49 11 Incidence by Occupation 50 12 Incidence by Diet 51 13 Incidence by Habits 52 14 Incidence by Habitat 53 15 Incidence by Parity 54 16 Incidence of Prakruti 55 17 Incidence of Sara 56 18 Incidence of Samhanana 57 19 Incidence of Satmya 58 20 Incidence of Satwa 59 21 Incidence by Ahara Shakti 60 22 Incidence of Vayama Shakti 61
  • 8. 23 Incidence by Pramana 6224 Incidence related to Appetite 6325 Incidence by Bowel Habits 6426 Incidence related to Micturation 6527 Incidence according to intensity of Abdominal pain 6628 Incidence of Strength 6729 Incidence of Lactation 6830 Incidence of Backache 6931 Incidence related Abdominal Wall Thickness 7032 Incidence as per Height of Uterus 7133 Incidence of amount of Lochial discharge 7234 Incidence of Colour of Lochial discharge 7335 Incidence of Odour of Lochial discharge 7436 Incidence by Episiotomy Healing 7537 Effect of Involution in Group A 7638 Effect of Involution in Group B 7739 Interval of Involution in both Groups 7840 Effect on amount of Lochial discharge in Group A 7941 Effect on amount of Lochial discharge in Group B 8042 Effect on amount of Lochia in both Groups 8143 Effect on olour of Lochia in Group A 8244 Effect on colour of Lochia in Group B 8345 Effect on colour of Lochia in both Groups 8446 Effect on odour of Lochia in Group A 8547 Effect on odour of Lochia in Group B 8648 Effect on odour of Lochia in both Groups 87
  • 9. 49 Effect on Episiotomy healing in Group A 8850 Effect on Episiotomy healing in Group B 8951 Effect on Episiotomy healing in both Groups 9052 Effect on Abdominal pain in Group A 9153 Effect on Abdominal pain in Group B 9254 Effect on Abdominal pain in both Groups 9355 Effect on Appetite in Group A 9456 Effect on Appetite in Group B 9557 Effect on Appetite in both Groups 9658 Effect on Bowel clearance in Group A 9759 Effect on Bowel clearance in Group B 9860 Effect on Bowel clearance in both Groups 9961 Effect on Micturation in Group A 10062 Effect on Micturation in Group B 10163 Effect on Micturation in both Groups 10264 Effect on Lactation in Group A 10365 Effect on Lactation in Group B 10466 Effect on Lactation in both Groups 10567 Effect on Back ache in Group A 10668 Effect on Back ache in Group B 10769 Effect on Back ache in both Groups 10870 Effect on Abdominal wall thickness in Group A 10971 Effect on Abdominal wall thickness in Group B 11072 Effect on Strength in Group A 11173 Effect on Strength in Group B 11274 Effect on Strength in both Groups 113
  • 10. LIST OF GRAPHSGraph No. Description Page No. 1 Incidence by Age 46 2 Incidence by Religion 47 3 Incidence of Socioeconomic Status 48 4 Incidence of Education 49 5 Incidence by Occupation 50 6 Incidence by Diet 51 7 Incidence by Habits 52 8 Incidence by Habitat 53 9 Incidence by Parity 54 10 Incidence of Prakruti 55 11 Incidence of Sara 56 12 Incidence of Samhanana 57 13 Incidence of Satmya 58 14 Incidence of Satwa 59 15 Incidence by Ahara Shakti 60 16 Incidence of Vyayama Shakti 61 17 Incidence by Pramana 62 18 Incidence related to Appetite 63 19 Incidence by Bowel Habits 64 20 Incidence related to Micturation 65 21 Incidence According to intensity of Abdominal pain 66 22 Incidence of Strength 67 23 Incidence of Lactation 68 24 Incidence of Backache 69
  • 11. 25 Incidence related Abdominal wall thickness 7026 Incidence as per height of Uterus 7127 Incidence of amount of Lochial discharge 7228 Incidence of colour of Lochial discharge 7329 Incidence of odour of Lochial discharge 7430 Incidence by Episiotomy healing 7531 Effect of Involution in Group A 7632 Effect of Involution in Group B 7733 Effect of Involution in both Groups 7834 Effect on amount of Lochial discharge in Group A 7935 Effect on amount of Lochial discharge in Group B 8036 Effect on amount of Lochia in both Groups 8137 Effect on colour of Lochia in Group A 8238 Effect on colour of Lochia in Group B 8339 Effect on colour of Lochia in both Groups 8440 Effect on odour of Lochia in Group A 8541 Effect on odour of Lochia in Group B 8642 Effect on odour of Lochia in both Groups 8743 Effect on Episiotomy healing in Group A 8844 Effect on Episiotomy healing in Group B 8945 Effect on Episiotomy healing in both Groups 9046 Effect on Abdominal pain in Group A 9147 Effect on Abdominal pain in Group B 9248 Effect on Abdominal pain in both Groups 9349 Effect on Appetite in Group A 9450 Effect on Appetite in Group B 95
  • 12. 51 Effect on Appetite in both Groups 9652 Effect on Bowel clearance in Group A 9753 Effect on Bowel clearance in Group B 9854 Effect on Bowel clearance in both Groups 9955 Effect on Micturation in Group A 10056 Effect on Micturation in Group B 10157 Effect on Micturation in both Groups 10258 Effect on Lactation in Group A 10359 Effect on Lactation in Group B 10460 Effect on Lactation in both Groups 10561 Effect on Back ache in Group A 10662 Effect on Back ache in Group B 10763 Effect on Back ache in both Groups 10864 Effect on Abdominal wall thickness in Group A 10965 Effect on Abdominal wall thickness in Group B 11066 Effect on Strength in Group A 11167 Effect on Strength in Group B 11268 Effect on Strength in both Groups 113
  • 13. ABBREVIATIONS1. C.S. Charaka Samhitha2. SU.S Sushruta Samhitha3. A.S. Astanga Sangraha4. A.H. Astanga Hrudaya5. Bp.N Bhavaprakasha Nighantu6. Sh.S Sharangadara Samhita7. Y.N. Yoga Ratnakara8. Vai. S .S. Vaidyaka Shabda Sindhu.9. S.S. Shabda Samgraha10. BT Before Treatment11. AF After Treatment12. & And13. % Percentage14. IPD In Patient Department15. T.i.d Thrice in a day16. Kg Kilogram17. Cms Centimeters18. L.M.P Last Menstrual Period.19. E.D.D Expected Date of Delivery.20. RMLE Right mediolateral Episiotomy21. LMLE Left mediolateral Episiotomy22. PPH Post partum hemorrhage23. PRL Prolactin
  • 14. Introduction  INTRODUCTION New mothers may heave a sigh of relief after the nine months of pregnancy and astressful delivery, there are many changes which have happened to pregnant lady duringher antenatal period and even more are happening in post delivery period. The body demand relaxation and rejuvenation to the normal stature. In fact it isthe womanly wisdom and right to bring back the body Beautiful. Delivering a baby istiring to say the least. The mothers body is weary and needs to recuperate. This wear andtear is further added by the swings of hormone levels which are maximum in the firstweek post delivery. The baby may be keeping her awake all the time. Her breasts feelsore, stitches are hurting…… Many things add up to make her feel down. To monitor and over come all these, a woman needs special care after delivery.The exhausted mother not only requires complete bed rest, but monitoring her generalhealth should also be done. A complete care of Puerperium especially for the first sixweeks post delivery is mandatory. Ayurveda an ancient science gives importance to Swasthya rakshana and VikaraPrashamana by explaining various procedures like Dinacharya, Rutucharya, Sadvrutta formaintaining the physical and mental health and preventing the disease. Acharyas werestill ahead in this field of science pertaining to Prasoothi Tantra. They have also givenguidelines for the management of Prasootha stree. Acharya Kashyapa narrating stage ofPrasava says, it is like that her one foot is situated in this Loka and other in Yama Loka.The lady after such a difficult process of Prasava must be advised certain mode of life ora Paricharya. This Suthika Paricharya has been explained by almost all Acharyas. Peyadikramaprocessed with different medications given to Suthika will does Agni deepana, digests A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 1  
  • 15. Introduction the sashesha dosha in garbhasaya, yusha given to her will does Dhatuposhana, theAbhyanga, Parisheka etc Vatahara Upachara will relieve her conditions like exhaustion,strain, tiredness, back ache etc. These also have their effect on mental wellbeing & helpsin recapitulating the healthy status. The regime or the Paricharya for a stipulated periodis so necessary that it directs the Suthika towards a complete Punarnaveekarana of herbody, so that she will be a Swastha Stree and ready to bear all the day to dayresponsibilities of her family. And even her body becomes fit for future pregnancy. In this period Dashamoola, Jeeraka and Panchakola are given importance fortheir actions like Garbhashaya Shodhaka, Deepana, Pachana, Vatanulomana, ShoolaPrashamana & Sthanya Janana. Considering above factors this study is being selectedwith a hope to provide better results through the time tested Ayurvedic formulations likeDashamoolajeeraka Kashaya & Panchakola Kashaya in Suthika Paricharya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 2  
  • 16. Objectives  OBJECTIVES OF STUDY A detailed review of the Literature for the description of soothika, soothika kala, Suthika samanya and vishista Paricharya, pathya and apathya with modren description of puerperium. A Conceptual study on Dashamoolajeeraka kashaya and Panchakola Kashaya. To evaluate and Compare the efficacy of Dashamoolajeeraka Kashaya & Panchakola kashaya in Suthika. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 3  
  • 17. Review of Literature     HISTORICAL REVIEW “The function of the historian is neither to love the past nor to emancipatehimself from the past, but to master and understand it as the key to the understanding ofthe present.” -E.H. Carr The History of history goes back to eternity. Itihasa jointly with purana isregarded as the fifth veda. It is manifested simultaneously from all the four mouths of thecreator and as such is concerned with all the knowledge revealed before hand andcontained in Scriptures.Prevedic Period There is no Scriptual evidence in Pre-vedic period.Vedic Period Entire vedic literature is full of ideas and facts relating to prasoothi tantra and streeroga which guided the development of the subjects in post vedic era.Rigveda1 There is mention about a drug called “ Tejana” which means vamsha. The quathaof which is used to reduce the Lochial discharge.Atharva Veda1, 2 Various rakshasas and Krimi which can be considered as the infective organismare described, which attack the puerperial women. These were given various names according to their size and shape. Daruna,amiva etc are the krimis which causes asending or desending infection in Yoni, sroni andGavini. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  4 
  • 18. Review of Literature    These can be destroyed by Sun rays. Drugs like Baja ie, sweta sarshapa andPinga ie, Peeta sarshapa are krumi nashaka and are said to be useful in the treatment ofPrasoothi rogas. Also the use of Dashavriksha ie, Dashamoola in the treatment ofprasoothi rogas is being mentioned and it is considered to cure the vata prakopa and thebody ache present during the suthika period. Prushna parni is considered as drug ofchoice for rakshasas trouble the women during puerperium. Here some drugs were mentioned, which will increase the quantity of sthanya.Drug Pippali also called as vatikruth bheshaji, atividha bheshaji and kshipta bheshaji isconsidered as beneficial. Along with the pashana bheda lepa of pippali is done overBreast which will increase the secretion of Breast milk. Kamala or padma kanda is alsomentioned as dugdha vardhaka and raktha vikara nashaka. Kalpasuthra11 A reference mentions the use of paste made of the roots of kaktani,machakakatani, koshataki, bruhati and kalaklitaka which is to be applied in thesuthikagara for raksoghna purpose. It may be considered as a measure of Disinfectant.To avoid vulnerability of any infection in this period.Vishnupurana11 Here there is an explanation about a type of vata which causes the delivery of thefetus and it is termed as prajaptya vata or suthimarutha. Suthika gruha is also described.Harsha Charita12 There is a reference of pravichalita hingavaha in suthika, which was commonlyfound in the vindhya region. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  5 
  • 19. Review of Literature   Samhita Kala First and foremost complete documentation regarding suthika was seen in samhitakala. Description regarding soothika paribhasha, kaala, paricharya is available in all theGrantha’s of Bruhatrayee1,2,3,111,112,113,114,115 and laghutrayee6,8,116,117,118,121.. Elaborate explanation of suthika paricharya according to desha and jaati is foundin kashyapa samhita4,101,102. A list of suthika vyadhis are also explained with 103,104.treatment In Bhela Samhita105, Baishajya rathnavali7,119, Harita samhita106 also a briefexplalnation about suthika paricharya with chikitsa of suthika roga is available. Description regarding Dashmoola kwatha specially in suthika is available inKashyapa Samhita4, Sharangadhara Samhita6, Yogarathnakara5,120, BhaishajyaRathnavali7 and also in Bhava Prakasha8. Usage and indication of Jeeraka in Suthika ismentioned in Bhavaprakasha8 and Bruhath Nighantu Rathnakara9. Reference regardingindication of Panchakola in Suthika is available in Bruhatrayee1,2,3.History of puerperium13 In olden days the power of women was considered in the form of Goddess andlady was considered as Bearer or nurturer. In the middle ages however the child was given paramount importance. Thus inthreatening condition the life of the child was favoured, which led to high rate ofmaternal mortality. The only disease condition explained in detail was the puerperial fever which wasmuch talked about during the end of 18th century. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  6 
  • 20. Review of Literature    During the world war 1914-18 women were seen as “Saviour of the Race”.Moulding future generation on whom the society’s hope rested, which led to improvedmaternal care during pregnancy, birth and even post natal period. Puerperial care and after pains were mentioned in all the recent obstetric textbooks.Review of some previous works : Since 1975 many of researches have been dealt in Ayurvedic field. Few ofresearch works done in different institutions on soothika are as follows.Table No – 1 Shows the list of previous workSl.No Title of the research work Name of the Scholar & Year University.1. Study on role of Amritastaka kwatha Dr. Thakar. Neela. N 1991 & Dashamoolakwatha in soothika GAU, Jamnagar paricharya.2. Soothikawasthet Dashamoola Dr.Kutaskar.C.S. Tilak 1993 Kwatha Upayoga Ayurveda Mahavidyalaya. Poona3. Management of Soothika – An Dr.Mamta.B.S. BHU. 1998 Ayurvedic approach.4. Management of soothika with Dr. Sunita. Sumana 2004 Panchakola churna BHU.5. Efficacy of Panchokola Ghrita in Dr. Sachin. Choudhary SNK 2005 Soothika Paricharya Jabshetty Ayurvedic Medical College. Bidar    A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  7 
  • 21. Review of Literature    SUTHIKA PARICHARYA Birth which is a natural process represents the utmost important event thatmakes a lady responsible for producing offsprings. The physiological transition frompregnancy to motherhood heralds an enormous change in each women physically andmentally. This fabulous phase of pregnancy and delivery is strenuous and tedious to thelady. Inspite of that post delivery period itself needs adjustment of lady not only to theinfant needs but also to her own physiological and psychological variations. The suthika avastha is described in ayurveda with a particular mode of life for astipulated period. mÉëÉmiÉå mÉëxÉuÉ MüÉsÉå cÉ pÉrÉqÉÑimÉÉkrÉiÉå rÉiÉÈ | AÎxqɳÉåMüÈ ÎxjÉiÉÈ mÉÉSÉå pÉuÉSlrÉÉå rÉqɤÉrÉå: || MüÉ. xÉÇ.ÎZÉ. 11/2 LuÉÇ ÌWû aÉpÉïuÉ×̬ ¤ÉÌmÉiÉ ÍvÉÍjÉsÉ xÉuÉï vÉUÏU kÉÉiÉÑmÉëuÉÉWûhÉ uÉåSlÉÉ YsÉåS U£ü ÌlÉxÉ×iÉ ÌuÉvÉåwÉ vÉÔlrÉ vÉUÏUÉccÉ mÉÑlÉlÉïuÉÏpÉuÉÌiÉ|| (A. xÉÇ. vÉÉ. 3/39)  The life of Pregnant women will be at risk during delivery or it is one of the mostcrucial time in her life15. The sarva shareera dhatu of mother will be in shetila avasthabecause of growth and development of fetus in her. This is further added by pravahanavedana and kleda raktha srava during delivery16. Hence the women is with shunya shareera because of prasava vedana and she isprone for certain diseases. The suthika paricharya itself helps in punar navikarana of herbody.    A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  8 
  • 22. Review of Literature    Nirukthi17,18 xÉÔÌiÉMüÉ-  x§ÉÏ xÉÔ + £ü: + OûÉmÉç | - lÉuÉmÉëxÉÔiÉÉ (vÉoS MüsmÉSÙqÉç) mÉËUcÉrÉÉï – x§ÉÏ mÉËU + cÉUç + mÉËUcÉrrÉÉïmÉËUxÉrrÉåïÌiÉ | - xÉåuÉÉ (vÉoS MüsmÉSÙqÉç) x§ÉÏ xÉkrÉ: mÉëxÉÔiÉÉrÉÉqÉç x§ÉÏrÉÉqÉ||  ( uÉæ. vÉ. ÍxÉ.)   A women who has been just / recently delivered.  Paribhasha xÉÔiÉÉrÉɶÉÉÌmÉ iÉ§É xrÉÉSmÉUÉ cÉå³É ÌlÉaÉïiÉÉ | mÉëxÉÔiÉÉÌmÉ lÉ xÉÔiÉÉ x§ÉÏ pÉuÉirÉåuÉÇ aÉiÉå xÉÌiÉ || (MüÉ.xÉÇ. ÎZÉsÉ. 11/6)                         The word soothika is coined to a women, who has just given birth to a baby andafter apara patana. The process of labour is said to be completed only after theexpulsion of placenta19. qÉÑ£ü aÉpÉÉï AmÉUÉÇ rÉÉåÌlÉ…… (AÉ.¾è.vÉÉ.1) Vagbhata also has explained suthika paricharya only to be started after theexpulsion of garbha and apara20. Hence after the delivery of child till the placenta is not expelled the lady cannot becalled as soothika. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  9 
  • 23. Review of Literature   Soothika Kala All acharyas, except charaka have given a definite duration for period of suthika.                 AlÉålÉ ÌuÉÍkÉlÉÉ AkrÉkÉï qÉÉxÉqÉÑmÉxÉÇxM×üiÉÉÌuÉqÉÑ£üÉWûÉUÉcÉÉUÉ  ÌuÉaÉiÉ xÉÔÌiÉMüÉÍpÉkÉÉlÉÉ xrÉÉiÉç mÉÑlÉUÉiÉïuÉSvÉïlÉÉÌSirÉåMåü|| (xÉÑ.xÉÇ. vÉÉ. 10/16) LuÉÇ cÉ qÉÉxÉÉSè AkrÉkÉÉïlqÉÑ£üÉWûÉUÉÌSrÉl§ÉhÉÉ| aÉiÉxÉÔiÉÉ AÍpÉkÉÉlÉÉ xrÉÉimÉÑlÉUÉiÉïuÉ SvÉïlÉÉiÉç|| (A.¾è. vÉÉ.1/100, 101) Accoding to sushruta21 and vagbhata22 time period of soothika is said to be oneand half month or until the reappearance of her menstrual cycle. Four months period of soothika kala is explained for soothika after the extractionof mudha garbha(obstructed labour)23.                wÉQèÍpÉqÉÉïxÉæ: mÉëxÉÔiÉÉrÉÉ kÉÉiÉuÉÉå ÃÍkÉUÉSrÉ: |(MüÉ.xÉÇ. ÎZÉ.11)  Acharya kashyapa24, Bhavaprakasha25 and yogarathnakara26 have explainedone month period of specific dietic management and Still kashyapa specially confirmsthat soothika kala is for 6 months. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  10 
  • 24. Review of Literature   SAMANYA SUTHIKA PARICHARYA –Table no – 2 - Suthika Samanya Paricharya according to different Acharyas Charaka27 Sushruta28 Vagbhata29,30 Kashyapa31Vihara 1.Parisheka 1.Abhyanga 1.Abhyanga 1.Rakshoghna dravya, (ubhayata (sarvadaihika, (Yoni and 2. kukshi, parshva kala) Bala Taila) Sarvadaihika prusta Abhyanga, 2.Abhyanga 2.Parisheka Taila mardana - Samvahana 3.Udara (Vatahara Bala Taila) in nubja shayana, vestana Aushadha - 2. Parisheka with 3.Udara vestana, Badradarvadi ushnaJala 4. Bala taila purita kashaya etc) (Ubhayata kala) ushna 3. Sthanika charmavana asana, Udara abhyanga 5.Yoni Swedana 4. Udaravestana, (priyanguka, 5. Acchadana krushara), 6. Udvartana, 6.Suthika Snana, 7. Avagaha (Ushna Jala) (Jeevaniya,madh 7.Vishranta, ura,Bruhmaneya 8.Dhupana varga aushadi (kusta, guggulu, agaru, siddha) ghrutha)Ahara 1.Sneha 1.Ushna 1.Sneha pana 1.Manda pana3-7 days pana gudodaka (Pippalyadi 2.Hita Bhojana (Pippalyadi (pippalyadi Dravya with 3-5 days. Dravyas ) gana dravyas) saindhava) 3. Sneha pana 2.Yavagu 3-4 days. or 4. Sneha yavagu pana Pana 2.Sneha or 2.Ushna (Pippali, nagara etc (Pippalyadi Ksheera gudodaka/ dravya lavana rahita) Gana Yavagu Vatahara Kwatha 5-7 days. Dravyas) (Vidari with Harsva ganasadhita Panchamoola. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  11 
  • 25. Review of Literature    dravya) 3.Yavagu or 3-7days. Ksheera yavagu Pana. (pippalyadi or Vidari gana dravya) 4. Peya (purvoktha dravya)7-11days Swastha 1.Jangala 1.Yusha pana Yavagu Pana (Lavana, vritha Mamsa rasa ( yava, kola sneha aushadha palana 2.Yava,kola, Kulathadi yuktha) Kulathayusha, dravya) 3.Shali 2.Laghu Bhojana. annapana12 days 1.Jangala 1. Kulatha Yusha, Mamsarasa 2. Jangala Mamsa 2.Jeevaneeya, rasa Madura 3. Gritha bharjita Bruhmaneeya, shaka (Kushmanda, balya,Vatahara Mulaka, Earvaruka) dravya sadhita 4. Snehana,Swedana, annapana. Ushna jala sevana 1month.           Almost the same explanation is given by Harita, Yoga rathnakara andBhavaprakasha. The regimen explained to suthika by different acharyas can besummarised as follows.VIHARA – Soon after muktha garbha apara, the suthika stree should be given with yoni tailaabhangya and yoni mardana should be done, which is followed by yoni swedana usingpriyangu, krushara etc. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  12 
  • 26. Review of Literature    The lady is made to lie down in nubja position, abhyanga, samvahana is done overudara, prusta and kati pradesha, using sarpi or taila or yamaka sneha. This udara peedanahelps in removing the pravartita garbha dosha. Sthanika abhyanga is followed by udara vestana using a big clean cloth. Tieing itaround kukshi parshva helps udara or garbhashaya to be in its swasthana. It also preventsthe accumulation of vayu in Udara, Hence avoiding vayu vikruthi. Sarvadaihika abhyanga to suthika stree is advised using bala taila, followed byparesheka using vatahara aushadha kwatha or ushna jala, twice a day. The suthika is alsoadvised with avagaha, acchadana etc procedures. All these procedures done are mainly to suppress or controle the vitiated vata ie,for vatanulomana. Ushna bala taila purita charmavana asana / leather bag is prepared and suthika ismade to sit over that asana. This will help in yoni prasadana. Ushnambu snana isadvised to suthika followed by dhupana using Kusta, Guggulu, Agaru, Gritha etc. All these therapies are followed by adequate vishrama which helps in klamanirharana. AAHARA – The Suthika should be given with one of the chaturvidha sneha (Sarpi, taila, vasa,majja) in Uttama matra considering her agnibala and Sneha satmya. The sneha should bemixed with Pippali, Pippali mula, Chavya, Chitraka, Nagara, Hasti Pippali, Yavani,Upakunjika etc Churna. Ksheera yavagu or Sneha yavagu processed with vidaryadi ganadravyas is given after the digestion of Sneha. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  13 
  • 27. Review of Literature    If Sneha is contra-indicated for suthika in anupa desha then she should be givenwith vatahara Aushadha Kwatha or Laghu Panchamula Kwatha. To remove sasheshadosha in suthika, Ushna gudodaka with panchakola churna is beneficial. The lady needs vatanulomana and agnideepana soon after her child birth. Assoon as suthika feels hunger, here the immediate regime starts with snehapana withdeepana pachana drugs followed by yavagu pana after the digestion of sneha. The manda or yavagu pana processed with sneha, ksheera and Vidaryadi ganadravyas acts as agni deepana, vatanulomana, sweda janana, brings mrudutwa to srotas. After one week suthika should be given with yusha prepared of yava, kola,kulatha etc dravyas. Laghu annapana ie, shali odana with sufficient quantity of sneha,amla, lavana is given. This paricharya will inturn does agni deepana, acts as rochana,sweda janana, gives a feeling of contentment. It is shrama hara, glani hara and doesdhatu poshana ie it nourishes her body. After 12 days suthika is advised with brumhana dravya. She can be given withmamsa rasa with yava, kola, kulatha etc dravyas. Gritha bharjita shakas like kushmanda,earvaruka, mulaka are given. Gritha or taila or kwatha which is prepared with jeevaneya,brumhaneya, madhura, vatahara, hrudhya dravya or annapana advised is very muchneeded in this period. This hrudya laghu annapana given to suthika mainly after agnideepana andamapachana does tarpana and bruhmana karma, acts as dhatu vardhaka. The sasheshadosha nirharana from garbhasaya will help in garbha koshta shuddhi which is broughtabout by ushna gudodaka processed with different drugs. The dhatu poshana or paricharya to make dhatu paripurnata will in turn nourishesthe upadhatu which is needed for sthanya uthpathi, sthanya vruddhi and even for rudhirasanchaya in yoni for punar artava darshana. In total all these regimen will mitigate vata, increase agni, does bala vardhana anda total punarnaveekarana of Suthika. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  14 
  • 28. Review of Literature    32VISHISTA SUTHIKA PARICHARYA This particular regimen is explained by Kashyapa, based on the particular type ofdesha, in which suthika is residing.Anupa Desha - In this desha the suthika should use manda which is processed by agnibalavardhaka drugs. Nivata shayana, svedana and use of only ushna dravya is beneficial. All sneha dravyas and abhishyandi ahara should be avoided.Jangala Desha - Here Sneha upachara is advised to suthika stree specially. The suthika in thisdesha should be given with grutha, taila etc. Sneha pana or yavagupana for at least 3 or 5days is beneficial , Then followed by using snigdha anna samsarjana karma. Ushnodakaparisheka is also advised.Sadharana Desha - For the suthika from this kind of land, usage of neither too sneha nor too rukshadravyas is said to be beneficial. One should advise for sadharana vidhi.Videsha Jati – The suthika stree of mlecha jaati should use raktha, mamsarasa niryuha,kandamula and phala in their paricharya. Kashyapa also has given use of taila and gritha in case of delivery of male andfemale child respectively33. Followed by yavagu pana processed with deepaneya dravyaafter the digestion of sneha. This is for 5 to 7 days then mandadi upakrama should befollowed.GENERAL INDICATIONS AND CONTRA INDICATIONS - A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  15 
  • 29. Review of Literature                            mÉëxÉÔiÉÉ ÌWûiÉqÉÉWûÉUÇ ÌuÉWûÉUÇ cÉ xÉqÉÉcÉUåiÉç | urÉÉrÉÉqÉÇ qÉæjÉÑlÉÇ ¢üÉåkÉÇ vÉÏiÉxÉåuÉÉÇ ÌuÉuÉeÉïrÉåiÉç|| xÉuÉïiÉÈ mÉËUvÉÑ¬É xrÉÉSè ÎxlÉakÉ mÉjrÉÉ AsmÉpÉÉåeÉlÉÉ| xuÉåSÉprÉXûmÉUÉ ÌlÉirÉÇ pÉuÉålqÉÉxÉqÉiÉÎlSìiÉÉ ||(pÉÉ.mÉë.mÉÔuÉïç. 4)                          The prasutha stree should use hitakara ahara and vihara, avoid vyayama, vyavaya,sheeta maruta sevana and krodha. When she becomes parishudha, continue with snigdha,pathya alpa bhojana, abhyanga and sweda every day34. The Panchakarma procedures like Asthapana Basti, Nasya, Virechana, Siravyadhana, teekshna Sweda are also contraindicated in suthika.IMPORTANCE OF DOING SUTHIKA PARICHARYA35                        ÍqÉjrÉÉcÉÉUÉiÉç xÉÔÌiÉMüÉrÉÉ rÉÉå urÉÉÍkÉÂmÉeÉÉrÉiÉå |  xÉ M×ücNíûxÉÉkrÉÉå AxÉÉkrÉÉå uÉÉ pÉuÉåSèAirÉmÉiÉmÉïhÉÉiÉç || (xÉÑ. xÉÇ. vÉÉ 10/19) For proper naveekarana of suthika, the paricharya explained by our acharyas ismust to follow. Other wise improper regime in the form of excessive nourishing or moreof apatarpana procedures will make suthika easily suceptable for diseases. Kashyapa hasdescribed nearly Thirtyfive types36 and Sixtyfour types37 of suthika rogas. Twentyfivediseases are common38 at both the places, most of these are difficult to treat or incurable.Suthika if she does ratri nirgamana, divaswapna, having earsha, bhaya, shoka etc, A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  16 
  • 30. Review of Literature    36manasika abhitapa, ajeerna, adhyashana etc is prone to get all sort of vikara . So Suthikaparicharya is a part and parcel of every prasava.                   PUERPERIUM"Motherhood is neither a duty nor a privilege, but simply the way that humanitycan satisfy the desire for physical immortality and triumph over the fear of death." - - Rebecca West39 The Puerperium is the period of maternity care. Is also a time of psychologicaladjustment, This tuning back period in fact has received relatively less attention thanpregnancy and delivery. It is a time of great importance for both the mother and herbaby. The mother’s joy at the arrival of the new baby may be tempered by anxiety abouther child’s welfare and her ability to cope. From latin language “Puerperium“ word got originated or derived, which meansto bring forth (pario) a child (puer)40. It is the period of adjustment after child birth whenanatomical and physiological changes of conception are reversed to an almostprepregnancy level41. The pelvic organs returns to the non-gravid state, the metabolicchanges of pregnancy are reversed and lactation is established. This postpartum periodlasts from delivery of the placenta until 6 weeks after delivery. Ofcourse all maternal A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  17 
  • 31. Review of Literature   adaptations during pregnancy do not necessarily subside completely by 6 weekspostpartum42. For the purpose of proper management this period can be divided into an43,44 – 1. Immediate Puerperium 2. Early Puerperium 3. Remote PuerperiumImmediate Puerperium - It includes the first 24 hours after delivery, the stage of acutepost partum period.Early Puerperium - It is the period of first week after delivery.Remote Puerperium - It starts from second week to six weeks post-delivery. Following delivery, when the endocrine influences of the placenta are removed,the physiological changes of pregnancy are reversed and the body tissues, especiallypelvic organs, return to their previous state.POSTPARTUM CHANGES45,46,47 ,48 Changes in Uterus Involution of The Uterus The principal changes of puerperium is uterine involution. Immediately afterdelivery uterus weighs 1000gms and comes up to the level of umbilicus (about 24 weekspregnancy size). Within 10 days of delivery the uterine fundus will disappear below thesymphysis pubis. It is aided by oxytocin release and shrinks to around 50 – 60 gms inweight51. The puerperial uterus on section appears ischemic when compared with thereddish purple hyperemic pregnant organ. The process of involution is affected by A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  18 
  • 32. Review of Literature    52autolysis , where the protein of the uterine musculature is broken down into simplercomponents, which are then absorbed and excreted in the urine53. During the first week of post partum involution is up to the level of pubicsymphysis. There is approximately 34% decrease in uterine size (1.25cm per day). Bysecond week uterus usually returns to the pelvis. In the second and third week there is48% decrease in uterine size and the rest of the 18% reduction in size occurs after thethird week. The involution changes are due to a reduction in the length and overall sizeof muscles49,50. After delivery, the endometrial surface of the uterus is thick and rough especiallyover the placental site. The decidua is cast off as a result of ischaemia and is lost as thelochial flow which usually clears completely within 4 weeks of delivery. There are nodecidual cells seen at 6 weeks postpartum. New endometrium will grow from the basalareas of the deciduas53. The markedly thinned out, flabby, collapsed lower uterinesegment contracts and retracts but not as forcefully as the body of the uterus. Over thecourse of a few weeks, it is converted into uterine isthmus.Lochia54,55,56 It is the discharge, which escapes from the genital tract during the first 3 to 4 weeksof puerperium. It consists of sloughed decidua.Lochia Rubra: This occurs for 1 to 4 days. It is red in colour and consists of blood,fetal membranes, deciduas, vernix caseosa, epithelial cells, bacteria and meconium.Lochia Serosa: It is yellowish initially, then brownish in colour and lasts for next 5 to 9days. It consists of fewer RBCs more leucocytes, wound exudates, mucous from thecervix and micro organisms (anerobic streptococci and staphylococci), the presence ofbacteria is not pathogenic unless associated with clinical signs. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  19 
  • 33. Review of Literature   Lochia Alba: This is white in colour and lasts for 10 to 15 days after lochia serosa hasdisappeared. It consists of plenty of dicidual cells, leucocytes, mucus, crystals, granularepithelial cells and micro organisms. The lochia has fishy odour and is alkaline, tending to become acidic towards theend. During the first 5 to 6 days the amount secreted is 250 ml, It is excessive indeliveries following multiple gestation, hydramnios and big babies. It is scanty inpreterm deliveries. Changes in The Cervix 57,58 – After delivery, the cervical epithelium becomes very flaccid and thinner in thefirst 4 days, the outer cervical margin, which corresponds to the external os, is usuallylacerated, especially laterally. The cervical opening contracts slowly, and for a few daysimmediately after labour it readily admits two fingers. By the end of the first week it hasnarrowed, hence the cervix thickens and the canal reforms. At the completion of involution, however, the external os does not resume itsprepregnant appearance completely. It remains wider, with bilateral depressions at thesite of lacerations and remains as permanent changes that characterize the parous cervix.The cervical epithelium undergoes considerable remodeling; this complete re-epithelisation takes 6- 12 weeks. Vagina59- The over distended vagina, slowly returns to its prepartum shape around 3rd week.The reverting process is completed within 4-8 weeks. The tone of the vagina neverreturns back to virginal state. The increased venous congestion makes the mucosadelicate in this period. Even the vaginal rugasities reappear partially, introitus remainspermanently larger than virginal state. The lacerated, fibrosed healing hymen representsin the form of carunculae myrtiformes.Fallopian Tubes and Ovarian Functions60- A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  20 
  • 34. Review of Literature    After delivery the low level of estrogen and progesterone will effect the increasednumber of tall nonciliated cells in the fallopian tubes. Their nuclei will extrude out,thickness of the cellular layer decreases, inflammatory changes are also seen. Elevated prolactin levels are the basis of anovulation in lactating mothers. As theovarian activity is suppressed, the resumption of menstruation may be delayed for manymonths. Other wise in non-lactating mother, ovulation can occur as early as 70-75 dayspostpartum with the resumption of menstrual period after 7 – 9 weeks. Pelvic Changes61,62,63 For easy passage of the fetus, Even pelvic cavity increases in its width, thewideneing of the symphysis pubis and sacro-iliac joints are well observed. Afterdelivery the voluntary muscles of the pelvis and other pelvic supports slowly regain theirtone. Involution of muscles takes up-to 6-7 weeks, hence exercises should be postponedtill these stretched muscles come to their original state. Systemic Changes -Cardio Vascular System64,65,66 - Just after parturition, plasma volume decreases due to bleeding. Hematocrit valuesincreases by 5% and cardiac out put increases by 50%. Pulse rate is increased on the 1stday. On the 3rd day post delivery there is a shift from extracellular fluid into the vascularcompartment causing 900 to 1,200ml increase in intravascular volume. There is alsoslight increase in blood pressure in the first 5 days of puerperium. Ventricularhypertrophy of pregnancy resolves in about one year. Within 8 weeks after delivery the red cells volume returns to normal. The rapidloss of blood during delivery stimulates reticulocytosis (which is maximum at the 4thpostpartum day) and a moderate increase in the erythropoitin level during the first weekafter delivery. There is hyper activity of bone marrow during puerperium, prolactin also A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  21 
  • 35. Review of Literature   stimulates bone marrow. Due to stress of labour there is marked leucocytosis, consistingespecially of granulocytes. Respiratory SystemS67 – The oxygen consumption is increased during pregnancy and even in 7– 14 daysafter delivery. The delivery of child has decreased the uterine size hence the diaphragmcomes down. The volume of lungs will increase which reduces the respiratory alkylosisand metabolic acidosis. The hypoapnea will also reduce. Decreasing level ofProgesterone is also responsible for the increased PCO2 in first week postpartum. Theoxygen saturation is increased to 95% during day one after delivery.Urinary System64,68,69,70 During labour, the sustained trauma to the nerve plexus will make the bladderinsensitive to raised intravesicular pressure. The changes which occur in urinary tractduring pregnancy disappear in a similar manner as the involutional changes. Thebladder mucosa become oedematus, enlarged with increased capacity of urine. The overdistended bladder with incomplete emptying leads to significant amount of residual urine.Within 2 – 3 weeks the hydroureter and caliceal dilation of pregnancy is much lessevident. Diuresis occurs to get rid of excess of extracellular fluid accumulated duringpregnancy. Even there is mild proteinuria in immediate postpartum period which isnormal. And Pregnancy induced glycosuria disappears. Increased Glomerular FiltrationRate comes to normal by 8 weeks of puerperium and there is 25% increase in renalplasma flow. Metabolic Changes71 Fatty acids (Total and non esterified) return to the prepregnancy level on thesecond post partum day. Plasma Triglyceride levels slowly fall to normal by 6-7 weeks. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  22 
  • 36. Review of Literature   Lactation does not affect the fatty acid levels. Blood sugar level falls below thepregnancy level on the 2nd and 3rd day after delivery due to an elevated renal threshold.Free plasma amino acids increase post-partum on 2nd or 3rd day. Hemodynamic Re-adjustment72,73 Delivery leads to obliteration or low resistence of uteroplacental circulation andresult in 10-15% reduction in the size of the maternal vascular bed. Loss of placentalendocrine function also removes a stimulus to vaso dilatation. This reduction of bloodvolume and venous tone which becomes normal with a significant decrease in deep veinsize and increase in uterine vascular resistance. There is increase in venous blood flowvelocity in lower limbs. A declining in blood volume with a rise in hematocrit is usually seen with in 3-5days after delivery. Hemoconcentration occurs if the loss of red cells is less than thereduction in vascular capacity. Hemodilution takes place in woman who loses 20% ormore of their circulatory blood volume at delivery.Table no – 3 Shows Hematological Values in Puerperium Total Blood Decreases immediately Post Partum due to volume blood loss at delivery Plasma volume Decreases immediately Post Partum due to blood loss at delivery Increases 3 days Post Partum due to shift of extra cellular fluid into vessels RBCs RBC production returns to normal levels RBC count returns to normal by 8 weeks PP Hb & Hct Immediate decrease in Hb immediately PP due to blood loss at delivery Hb levels stabilize by 2-3 days HCT remains relatively stable immediately after delivery Hct returns to non-pregnant levels 4-6 weeks A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  23 
  • 37. Review of Literature    WBCs Decrease to 6- 10,000 after high of 25-30,000 during intrapartum and immediate postpartum Returns to normal 4-7 days Platelets Increases at 3-4 days Gradually returns to non-pregnant levels ESR Gradually returns to non-pregnant levels after antepartum increase Serum Fe Increases as Hgb is catabolized Gradually returns to non-pregnant levels Coagulation Increase in fibrolytic activity in first few hours factors Slow decrease to non-pregnant levels by 1-4 weeks Slow decrease in coagulation factors by 1-4 weeksCoagulation Mechanism74,75 A sudden reduction in the platelet count is seen immediately after the placenta hasseparated, but a secondary raise can occur later with an increase in their adhesiveness. During the 1st day after delivery the plasma fibrinogen concentration startsdecreasing and the lowest level is reached. After that a secondary increase in its leveloccurs which is maintained till the second week after parturition, after which a downword trend again starts for the next 7 to 10 days. These changes make the delivered women susceptible to thrombosis during thepuerperium. How ever a sharp return of normal fibrinolytic activity after delivery doesprevent this complication. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  24 
  • 38. Review of Literature    The clotting factors increased during pregnancy are used to provide a reserve tocompensate for their rapid utilization during delivery and also to achieve haemostasisafter delivery. A large deposition of fibrin occurs in the placental bed after the deliveryof the placenta. Thus there is a continous release of fibrin breakdown products from theplacental site.Weight Loss76,77,78 Approximately 10–13 kg weight is gained during pregnancy. There is animmediate loss of about 5–6 kg due to delivery of the infant, placenta, amniotic fluid andblood loss. At the end of 6 weeks most the mothers have lost the excess of 4-5 kgsweight due to excretion of fluids and electrolytes. At least 2 liters of fluid is lost withinthe first week and 1.5 liters in next 5 weeks after delivery. Factors that influence increased puerperial weight loss includes weight gain duringpregnancy, prime parity, early return to work. Of course breast feeding or maternal agewon’t affect weight loss.Hormonal Changes79 Placental hormone levels decline very fast following delivery.Human Placental Lactogen (HPL) - This has a half life of 20 min. No HPL can be seenin the maternal blood on the 1st day after delivery.Human Chorionic Gonadotrophin (hCG) - This has a half life of 9 hrs. 48 to 96 hrsafter delivery the levels are below 1000 mu/ml and 7th day post partum they are less than100 mu/ml. It virtually disappears by the 11 – 16th day after delivery.Plasma 17 B Estradiol - The level falls to 10% of pregnancy value within 3 hours of the3rd stage of labour. By one week after delivery its lower level is achieved. Follicularphase level (>50 pg/ml) is reached earliest by 19 to 21 days after parturition in non-lactating women and by 60 – 80 days in lactating women. In latter, during the period of A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  25 
  • 39. Review of Literature   lactational amenorrhoea the estrogen levels are less than 10pg/ml. Breast engorgementthat occurs 3-4 day after delivery is due to low estrogen levels (because high estrogenlevels suppress lactation)Progesterone - This has very short half life (in minutes) hence by 3rd post partum day,the levels are far less than 1ng/ml (luteal phase level).Prolactin (PRL)- During pregnancy prolactin level rises up to 200ng/ml or more. Thelevels rises in breast feeding mothers. With each suckling episode the level of prolactinraises up to 100ng/ml. Therefore the frequency of breast feeding has an important role inmaintaining the prolactin level.Serum FSH and LH -These levels during first 10 – 12 days after delivery are very low,irrespective of the status of lactation. After 12 days their levels increase, by the 3rd weektheir concentration is same as in follicular phase. Low level of FSH and LH in earlypuerperium is due to a reduced GnRH during pregnancy and the early post partumperiod. There is also reduction in the secretion of GnRH, Growth Hormone, Insulin,Thyroid Hormones and even the secretion of ACTH. There is relative normal or highlevel of these hormones during pregnancy, which reduces soon after parturition. Againall these levels are stabilized by 6-8 weeks of postpartum period. Lactation80,81 The major physiological event of the puerperium is the establishment ofLactation. The humoral and neural mechanisms involved in lactation are complex.Progesterone, estrogen, cortisol, placental lactogen as well as prolactin appear to act inconcert to stimulate the milk secreting apparatus82,83. Mainly prolactin helps in milk production and oxytocin helps in ejection of milk.Release of prolactin acts upon the glandular cells of the breast to stimulate milk secretionand the second induces the release of oxytocin which acts upon the myoepithelial cells ofthe breast to induce the milk ejection reflex. This milk ejection reflex is mediated by the A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  26 
  • 40. Review of Literature    85release of oxytocin from the posterior pituitary gland . It is readily inhibited by theemotional stress, maternal anxiety etc which frequently leads to a failure of lactation84. Both estrogen and progesterone are necessary for mammary development inpregnancy but prolactin, growth hormone and adrenal steroids may also be involved.During pregnancy only minimal amounts of milk is formed in the breast despite highlevels of the Placental lactogenic hormones and even prolactin. This is because theactions of these lactogenic hormones are inhibited by the secretion of high levels ofoestrogen and progesterone from the placenta and it is not until after delivery that copiousmilk production is inhibited85. The composition of breast milk varies according to the age of the baby and fromthe beginning to end of the feed. Colostrum is the breast secretion of the mother in thefirst few days after delivery. It is a deep yellow coloured thick serous secretion havinghigh specific gravity and alkaline reaction. contains high protein, vitamin A, sodium andchloride. More of antibodies (IgA, IgG, IgM), white blood cells and other anti infectiveproteins in cholestrum provides immunological defence to the new born. This colostrumalso has a mild purgative effect, which helps to clear the baby’s gut of meconium. Thisclears bilirubin from the gut and thus helps to prevent jaundice86. The milk secreted later is having more fat and lactose but less protein. The longchain poly unsaturated fatty acids present are important for neurodevelopmentalconsequences for the baby. ie, it helps in myelination of central nervous system.Facilitates absorption of calcium. The amino acids like taurine and cystein which areimportant neurotransmitters. Breast feeding protects the infant against infection ie,prevents gastrointestinal illness (diarrhea), respiratory tract infections etc. The protective factors like IgA, Macrophages, lymphocytes, Complements andinterferon etc. present are very much important in this aspect87.Table no – 4 shows Composition of colostrum and Breast milk88 Protein Fat Carbohydrates Water Colostrum 8.6% 2.3% 3.2% 86% A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  27 
  • 41. Review of Literature    Breast milk 1.2% 3.2% 7.5% 87%                                                                                    The proteins present are lactalbumin, lacto globulins, lactoferrin and casein. Among carbohydrates mainly lactose along with glucose and galactose. Mainly triglycerides (olein, palmitin, stearin) in fats. Vitamins like B,C,D with abundance of Vitamin A and exception of Vitamin K. There is no doubt that breast milk is the ideal nutrition for the New born baby.Highly nourishing, easily digestible and immunizing contents in mothers milknecessitates the exclusive breast feeding during first 6 months of neonatal life. A healthymother will produce about 500 – 800ml of breast milk a day to feed her infant with about500kcal/day. In well established lactation, it is possible to sustain a baby on breast milkalone for 4-6 months. This requires about 600 k cal / day for the mother which must bemade up from the mothers diet or from her body store. For this purpose a store of about 5kg of fat during pregnancy is essential to make up any nutritional deficit during lactation. Breast feeding accelerates the process of uterine involution in mother89, reducingthe chances of post partum hemorrhage, Improves post partum weight loss90, Inexclusively breast fed mothers it provides 98% protection against pregnancy for first 6months. It also lowers the risk of breast cancer and ovarian cancer91. Lactation or breastfeeding or nursing the child - What ever the terminology it strengthens the psychologicalbonding between mother and the baby.Care of Puerperium 92,93,94,95 A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  28 
  • 42. Review of Literature    The care of a pregnant woman does not end with the delivery of the child and theconclusion of the 3rd stage of labour. Even pregnancy should be considered as a natural,physiological event, Management and care of the delivered lady is a must. So the main objectives of puerperial management are - To monitor the physiological changes of puerperium. To diagnose and treat any postnatal complications. To establish infant feeding. To give the mother emotional support. To advise about contraception and other measures, will contribute in continuing her health. Immediately following delivery, lady may be given a drink or something to eat ifshe is hungry. Close monitoring of general health (BP, Pulse, Temperature, vaginalbleeding, P/A size of the uterus etc) of the lady and adequate bed rest is must. Roomingin, ie, keeping the infant with the mother, is very important, it builds up the parent-infantbonding. New mother is made ease by proper care of vulva, episiotomy wound, breast andnipple care. Proper feeding methods, care of bowel and bladder are advised. The lady ismoved out of bed with in 48hrs of post partum. By early ambulation, she feels strongerand better, Bladder complications leading to catheterization and even complaints ofconstipation are less frequent. Adequate fluid intake, liberalization of nourishing andfiber rich diet is necessary to prevent constipation. Bladder is to be emptied by thepatient as frequently as possible. Proper aseptic care, perineal wound dressing, observing the involution of uterusand lochial discharge is a part and parcel of the puerperial management. For all thesenecessary care and advice a minimum of 3-5 days of Hospital stay is needed. Correctionof anaemia in puerperial women is done by supplementation of iron therapy ie, ferrous A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  29 
  • 43. Review of Literature   sulphate 200mg daily and also with a supplementation of calcium 1500mgdaily, for 4-6weeks96. ‘After pains’ in puerperium may need the help of analgesics97.Post Natal Exercises98,99,100 – Post natal postures and exercises must be taught for better puerperialrehabilitation. Softness of elastic ligaments and collagenous connective tissue persists for4-5 months after delivery. The abdominal muscles are stretched and elongated duringpregnancy. Hence entire abdominal wall is weakened. If the back is not properly held (incorrect postures during lifting weight) it isvulnerable to injuries. The pelvic floor is also weakened during pregnancy duecontinuous support of the gravid uterus, stretching and trauma during delivery. Theperineum is stretched and sometimes may have tears or episiotomy. Hemorrhoids maycause severe pain; legs may be painful or swollen. The management starts with breathing exercises and free hand movements of thebody parts. Deep breathing is helpful for relaxation and improving circulation.Movement of the foot, ankle and leg also improve circulation. Proper Postures, lactatingmethods are important in prevention of future back ache etc. Correct postures itself willtone up the back muscles. Pelvic floor exercises are must and to be started as early as possible. Repeatedcontraction and relaxation of the pelvic floor muscles will help in regaining the tone andelasticity. Abdominal muscle exercises are essential to regain the size of over stretchedmuscles. And to prevent divarication of recti. For this lady should lie in dorsal position,with knee flexed, abdominal muscles are contracted and relaxed alternatively. Again sheshould lie on her face, then head and shoulders are slowly moved up and down. Theprocedure is to be repeated 3-4 times a day. These Exercises should be continued for atleast 3 months. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  30 
  • 44. Review of Literature   The main advantages of these exercises are – It minimise the risk of puerperial venous thrombosis by promoting arterial circulation and preventing venous stasis. It prevents back ache. It prevents genital prolapse and stress incontinence of urine. A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  31 
  • 45. Drug Review   DRUG REVIEW Dravya, one of the chikitsa chatushpada109, Usage of it in particular disease dependson yukti of vaidya, as there is no drug which cannot be used as medicine. xÉuÉï UÉåaÉ ÌuÉvÉåwÉ¥ÉÈ xÉuÉï MüÉrÉï ÌuÉvÉåwÉÌuÉiÉç| xÉuÉï pÉåwÉeÉ iÉiuÉ¥ÉÉå UÉ¥ÉÉÈ mÉëÉhÉmÉÌiÉpÉïuÉåiÉç || cÉ.ÌuÉ. 6/19 With the art and skill of formulations, a poisonous drug could be transmuted into a safeand effective drug. A simple drug could be converted into a most potent one14. Dashamoola, jeeraka and panchakola even though are considered as simple drugs, Butare very beneficial during suthika Avastha.DASHAMOOLAJEERAKA KASHAYA In classics a reference regarding Dashamoola kwatha specially in Suthika isavailable4,5,6,7,8. A clear reference regarding indication of Jeeraka in Suthika is alsoavailable8,9,108.Ingradients- Bilva, Agnimantha, Shyonaka, Patala, Gambhari, Bruhati, Kantakari, Shalaparni, Prushnaparni, Gokshura, Jeeraka and Jala. Above mentioned drugs has to be made in coarse powder form separately. Taken inequal quantity. Added with 4 parts of water. Boiled, reduced to ¼ th part and filtered107. Dosage – 2 pala (96 ml) Rasa- Swadu, Katu, Tikta, Kashaya. Guna- Laghu. Veerya- Ushna. Vipaka- Katu. Doshaghnata- Tridosha Shamaka. Rogaghnata – Vata Shleshma Jwara, Sannipata Jwara, Soothika Dosha Shamaka. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  31 
  • 46. Drug Review    Table Number: 5 shows drugs of Dashamoola & Jeeraka Drugs Latin name Rasa Guna Veerya Vipaka Karma Chemical and family composition BILVA Aegle Kashay Laghu Ushna Katu Kapha Marmelosin, marmelos a Ruksha Vata marmelide, tannic (Rutaceae Tikta Shamaka Grahi acid, family) Agnikruth skimmicianine, Pachaka marmelin, Shotha hara, skimmin, vedana sthapana mermesin,.AGNIMANTA Premna Tikta Ruksha Ushna Katu Kapha ceryl alcohol, mucronata Katu Laghu Vata clerodin, (Verbenacea Kashay Shamaka clerosterol and e family) a Shothahar, clerodendrin- A. Madhu Pandu ra Nashak, Agnikruth, Vibhandha nashakaSHYONAKA Oroxylum Madhu Laghu Ushna Katu Kapha Baicalein, chrysin, indicum ra Ruksha Vata 6- methylether of (Bignoniace Tikta Shamaka Vedana baicalein ae family) Kashay shtapana, a Shotha Hara, Aruchi nashaka, Grahi, Basti roga HaraPATALA Stereosperm Tikta Laghu Ushna Katu Kapha Albuminous, um Kashay Ruksha Vata Sacchrine and suaveolelns a Shamaka Vedana Mucilaginous (Bignoniace sthapaka, matter & Wax ae Family) Shothahar, Vrana ropana.GAMBHARI Gmelina Tikta Guru Ushna Katu Tridosha Root contains arborea Kashay Shamaka Deepana, Gmelofuran- a (Verbenacea a Pachana, furanosesquiterpe e Family) Madhu Medhya, noid, gmelinol, ra Shothhara, sesquiterpene, and Ama, shulahara, cerylalcohol Jwarahara, Vishahara A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya   32 
  • 47. Drug Review   BRUHATI Solanum Tikta Laghu Ushna Katu Kapha Vata Solanine, indicum Katu Ruksha Shamaka Kushta, Solanidine, (Solanaceae Tikshna shwasa, Jwara, Solasonine & Family) Shula-Kasa- Wax Agnimandya nashakaKANTAKARI Solanum Tikta Laghu Ushna Katu Kapha Vata Root contains surattense Katu Ruksha Shamaka , Vedana scopolin, (Solanaceae Tikshna sthapaka, Shotha scopoletin, esculin Family) hara, Krimighna, and esculetin. Kasahara, HikkanashakSHALAPARNI Desmodium Madhu Guru Ushna Madhu Tridosha Plant constitutes gangeticum ra Snigdha ra Shamaka Vedana N- (Leguminos Tikta Sthapaka, dimethyltryptamin ae Family) Vranaropaka, e, 5- methoxy-N, Shothahara, hypaphorine, Chardi-shwasa- horderine, caudine AtisaranashakaPRUSHNA Uraria picta Madhu Laghu Ushna Madhu Tridosha Amino acids &PARNI (Leguminos ra Snigdha ra Shamaka Vatahara, fatty acids ae Family) Tikta Deepana, Anulomana,,Balya, Shothahara, Sandha niya,Angamarda prashamana.GOKSHURA Tribulus Madhu Guru Sheeta Madhu Vata Pitta Roots contain terrestris ra Snigdha ra Shamaka Balya, neotigogenin, (zygophylla Mutrala, Vrishya, aminoacids ceae Ashmarihara, Family) BastirogaharaJEERAKA Cuminum Katu Laghu Ushna Katu Kapha vata Cumaldehyde, cyminum Ruksha shamaka Proteins, (Umbellifer pittavardhaka, carbohydrates, ae Family) Agnimandya phosphorus, Ajirna Sootikaroga hara Garbhasya vikara Stanya vikara shamaka A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya   33 
  • 48. Drug Review  PANCHA KOLA KASHAYA In classics reference regarding indication of Panchakola in Suthika is available1,2,3.Ingradients – Pippali, Pippali Mula, Chavya, Chitraka, Nagara and Jala. Preparation Method – Above mentioned drugs has to be made in coarse powder form separately and taken inequal quantity. 4 parts of water should be added, boiled and reduced to ¼ th part. It is filteredand used110. Dosage – 2 pala (96 ml) Rasa – Katu. Guna- Teekshna. Veerya – Ushna. Vipata – Katu. Karma – Ruchya, Deepaniya, Pachana. Rogaghnata – Anaha, Pleha, Gulma, Shula, Sleshmodara. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  34 
  • 49. Drug Review    Table no – 6 shows Drugs of Panchakola Drugs Latin name Rasa Guna Veerya Vipaka Karma Chemical and family compositionPIPPALI Piper Katu Snidgha Anushna Madhura Tridosha Piperine, longum Teekshna sheeta Shamaka Piplartine, (Piperaceae Laghu Deepana, Sesamin, family) Ruksha pachana, Piplasterol VatakaphaharaPIPPALI Piper Katu Laghu Sheeta Madhura Kapha vata Piperine,MULA longum Madhura Snidgha Shamaka Piplartine, (Piperaceae Teekshna Rochana, Piperleguminine, family) deepana, Setroids vatanulomana, &’Glycosides shoolapra shamanaCHAVYA Piper Katu Laghu Ushna Katu Kapha vata Proteins, Piperine retrofractu Ruksha shamaka Fixed oil, m Teekshna deepana, Volatile oil, (Piperaceae vatanulomana, Starch, Piplartine family) shoola prashamanaCHITRAKA Plumbago Katu Laghu Ushna Katu Kapha vata Plumbagin, zeylanica Ruksha shamaka Elliptinone, (Plumbagi Teeksha Deepana, 3- naceae pachana, Chloroplumbagin family) Grahi,Krimigh Zeylinone, na, Naphthelenone, Shotahara, Plumbagic acid. Gardhashaya sankocakaNAGARA Zingiber Katu Laghu Ushna Madhura Kapha vata Protein, officinale Shnigdha shamaka Carbohydrate, (Zingibera Tripthigna, Vit-A, B & C ceae rochana, Gingerin, Family) deepana, Zingiberol, pachana, Gingerol, vatanulomana, Shogaol,Zingeron shothahar e A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya   35 
  • 50. Photo’s   A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  36 
  • 51. Photo’s   PANCHAKOLA  A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  37 
  • 52. Methodology  METHODOLOGY Present study entitled as “A COMPARATIVE CLINICAL STUDY OFDASHAMOOLAJEERAKA KASHAYA AND PANCHAKOLA KASHAYA INSUTHIKA PARICHARYA.” was carried out on 20 patients from IPD sections ofPrasooti tantra and stree roga. Department, SDM Ayurveda Hospital Udupi.Research approach: It is a clinical as well as a conceptual study. Where in a single blind comparativeclinical study design is adopted with Pre-test & Post-test evaluations. On the conceptualbasis the objective was to develop an Ayurvedic understanding for Suthika Paricharyaand comparision of effect of two different kashaya preparation in suthika paricharya.Aims & Objectives of the Study A detailed review of the Literature for the description of suthika, suthika kala, Suthika samanya and vishista Paricharya, pathya and apathya with modren description of puerperium. A Conceptual study on Dashamoolajeeraka kashaya and Panchakola Kashaya in Suthika. To compare the efficacy of Dashamoolajeeraka Kashaya & Panchakola kashaya in Suthika. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  38 
  • 53. Methodology Source of Data A Minimum of 20 suthika will be selected for study from IPD of S.D.M. Ayurvedic hospital Udupi.Methods of Collection of Data It is a single blind comparative clinical study with pretest and post test design,where in 20 patients will be selected. The selected patients will be randomly dividedinto 2 equal groups. A special proforma will be prepared considering all the points pertaining to thehistory taking, physical examination, laboratory investigations as mentioned in ourclassics and allied sciences. The parameters of signs and symptoms will be scored on the basis of standardmethod of statistical analysis.Inclusion Criteria Patients within the age group of 18 to 35yrs. Both Primi para and Multipara are taken. Patients with full term normal vaginal delivery, assisted deliveries like forceps and ventous extraction.Exclusion Criteria Patients with Systemic disorders like Diabetes Mellitus, Hypertension, Tuberculosis etc. Patients with complications like PPH, IUD, Retention of placenta, Subinvolution, Sepsis etc. Patients with Gynaecological Complications like Huge Fibroid or Ovarian Cyst. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  39 
  • 54. Methodology  Patients with Malnutrition and severe anaemia. Patients with LSCS.Intervention A Minimum of 20 Suthika were taken for Study.Drug & Dose: For Group A Patients- 90 ml of Dashamoolajeeraka kashaya will be given, thrice a day. For Group B Patients - 90 ml of Panchakola kashaya will be given, thrice a day. For a period of one month from the day 1 after delivery.Follow up : Patients will be asked to follow up Once in a month for 2 months.Hypothesis: Null Hypothesis: H0: Dashamoolajeeraka kashaya and panchakola kashaya donot have any role in Suthika paricharya. Alternate Hypothesis: H1: Dashamoolajeeraka Kashaya is better thanPanchakola Kashaya in Suthika Paricharya. Alternate Hypothesis : H2: Panchakola Kashaya is better thanDashamoolajeeraka Kashaya in Suthika Paricharya. Alternate Hypothesis : H3: Both Dashamoolajeeraka Kashaya and PanchakolaKashaya were equally effective in Suthika Paricharya.Plan for data analysis: Statistical analysis of the study was carried out by obtaining the frequency,percentage, mean, standard deviation and standard error for different parameters. Thedata’s of the same are presented as tables and graphs in the results section. The statisticalsignificance of the difference between the means of various study parameters werederived using paired & unpaired “t” test. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  40 
  • 55. Methodology Assessment Criteria Subjective Parameter- Appetite Bowel Habits Micturation Abdominal Pain Lactation Backache Strength. Objective Parameter- Lochial Discharge Abdominal wall thickness Involution of Uterus Episiotomy wound Healing. Investigations Blood – Hb% Urine Routine – Albumin, Sugar, Microscopic. -If necessary.Criteria for Assessment: The patients were assessed on the basis of subjective and objective parametersbefore and after the treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  41 
  • 56. Methodology Subjective parameters Graded as:Appetite:No Appetite – 0Mild Appetite – 1Moderate Appetite – 2Good Appetite – 3Bowel Habits:Not Passed – 0Passed – 1Micturation:Not Passed – 0Once a day – 12-3 Times a day – 24-5 Times a day - 3Abdominal Pain:No Pain – 0Mild Pain – 1Moderate Pain – 2Severe Pain – 3Lactation:Inadequate – 0Adequate – 1Excess - 2 A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  42 
  • 57. Methodology Lochial Discharge:Amount of Bleeding:0 - ½ pad soaked /day – 01-2 Pads soaked/day – 13 Pads soaked a day – 24 Pads soaked a day – 35 Pads soaked a day – 4Colour:Bright Red – 1Reddish brown - 2Yellowish or pale white – 3Any other – 4Smell:No Smell - 0Nomal Fishy Smell – 1Foul Smell – 2Back ache:No Back ache – 0Mild – 1Moderate – 2Severe – 3 A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  43 
  • 58. Methodology Episiotomy Wound Healing:0 – Healthy : No Tenderness, No Redness, No Swelling.1 – Mild: Tenderness +, Redness +, Swelling+.2 – Moderate : Tenderness ++, Redness ++, Swelling ++.3 – Severe: Tenderness+++, Redness+++, Swelling, Gapping+, Secretions+, Wound Dehiscence+Strength:Reduced (Bed ridden) – 0Moderate (Able to move around) - 1Good (Able to do all activity) – 2 A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  44 
  • 59. Photo’s   DASHAMOOLAJEERAKA CHURNA & KASHAYA   PANCHAKOLA CHURNA & KASHAYA A Comparative clinicall study of Dashamoola Jeeraka kashaya and Panchakolakashaya in Suthika Paricharya  43 
  • 60. Observations  OBSERVATIONSAGE: Table no.7 - Incidence according to age Age Group-A Group-B Total % 20-25yrs 4 4 8 40 25-30yrs 4 3 7 35 30-35yrs 2 3 5 25 Total 10 10 20 100Graph no 1 - Incidence according to age 40 35 30 25 20-25 20 25-30 15 30-35 10 5 0 Gr-A Gr-B Total % Among the 20 Patients included in this study, 40% of the patients were in the agegroup of 20-25 yrs, 35% of the Patients were in the age group of 25-30 yrs, 25% of thePatients were in the age group of 30-35 yrs. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  46 
  • 61. Observations SOCIO ECONOMIC STATUS: Table no.9 – Incidence by Socioeconomic status. Socio Group-A Group-B Total % Economic Status LM C 3 2 5 25 MC 3 5 8 40 UC 4 3 7 35 Total 10 10 20 100Graph no. 3– Incidence by Socioeconomic status. 40 35 30 25 LC 20 MC 15 HC 10 5 0 Gr-A Gr-B Total % The study group consists of 20 Patients, 25% of Lower middle class patients, 40% ofMiddle class patients and 35% of Upper class patients. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  48 
  • 62. Observations EDUCATION:Table no. 10: Incidence by Education Education Group-A Group-B Total % Primary 4 1 5 25 SSLC 1 4 5 25 PUC 5 4 9 45 Graduate 0 1 1 5 Total 10 10 20 100Graph no.4: Incidence by Education 45 40 35 30 Primary 25 SSLC 20 PUC 15 Graduate 10 5 0 Gr-A Gr-B Total % Based on educational status 25% patients did primary education, 25% did SSLC,45% studied till PUC, and 5% were Graduates. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  49 
  • 63. Observations OCCUPATION:Table no.11: Incidence according to Occupation Occupation Group-A Group-B Total % House Wife 9 7 16 80 Professional 0 1 1 5 Daily Wages 1 2 3 15 Total 10 10 20 100Graph no.5: Incidence according to Occupation 80 60 Hwife 40 Professional Daily Wage 20 0 Gr-A Gr-B Total % Of the 20 patients in study group, 80% were House wives, 15% were daily wageworkers and 5% were Professionals. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  50 
  • 64. Observations DIET:Table no.12: Incidence according to diet Diet Group-A Group-B Total % Veg 2 1 3 15 Mixed 8 9 17 85 Total 10 10 20 100Graph no.6 : Incidence according to diet 90 80 70 60 50 Veg 40 Mixed 30 20 10 0 Gr-A Gr-B Total % Among the 20 patients included in the study 15% of the patients were consumingvegetarian food, while 85% were of mixed diet. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  51 
  • 65. Observations HABITS:Table no.13: Incidence according to habits: Habbits Group-A Group-B Total % Coffee 4 3 7 35 Tea 3 5 8 40 Both C/T 1 2 4 15 NO Addiction 2 0 1 10 Total 10 10 20 100Graph no.7: Incidence according to habits: 40 35 30 25 Coffee 20 Tea Both C/T 15 No Addiction 10 5 0 Gr-A Gr-B Total % Among 20 Patients 35% had the habit of taking coffee, 40% use to take Tea, 15%addicted to both and 10% had no addiction. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  52 
  • 66. Observations HABITAT:Table no.14: Incidence according to Habitat Habitat Group-A Group-B Total % Urban 2 4 6 30 Rural 8 6 14 70 Total 10 10 20 100Graph no.8: Incidence according to Habitat 70 60 50 40 Urban 30 Rural 20 10 0 Gr-A Gr-B Total % Among 20 Patients in the study, 70% were from rural area and rest 35% were fromUrban area. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  53 
  • 67. Observations PARITY:Table no.15: Incidence according to Parity. Parity Group-A Group-B Total % Primi 4 6 10 50 Second 4 2 6 30 Third 2 2 4 20 Total 10 10 20 100Graph no.9: Incidence according to Parity. 50 45 40 35 30 Primi 25 Second 20 Third 15 10 5 0 Gr-A Gr-B Total % Among 20 Patients in the study group, 50% were of primi para, and 50% weremulties (30% were of second parity, and 20% were of third parity). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  54 
  • 68. Observations PRAKRUTHI:Table no.16:Incidence according to Prakruthi. Prakruthi Group-A Group-B Total % V-P 2 2 4 20 V-K 3 4 7 35 K-P 5 4 9 45 Total 10 10 20 100Graph no.10: Incidence according to Prakruthi. 45 40 35 30 25 V-P 20 V-K 15 K-P 10 5 0 Gr-A Gr-B Total % Among 20 Patients in the study group, Maximum distribution of 45% of ladies seenfrom the kapha-pitta prakruthi, 35% from vata- kapha prakruthi and 20% from the vata-pitta prakruthi. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  55 
  • 69. Observations SARA:Table no.17: Incidence according to Sara. Sara Group-A Group-B Total % Pravara 1 5 6 30 Madyama 5 5 10 50 Avara 4 0 4 20 Total 10 10 20 100Graph no.11: Incidence according to Sara. 50 45 40 35 30 Pravara 25 Madyama 20 Avara 15 10 5 0 Gr-A Gr-B Total % Among 20 patients 50% are of madhyama sara, 30% are of pravara sara and 20% ofpatients are of avara sara. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  56 
  • 70. Observations SAMHANANA:Table no.18: Incidence according to Samhanana Samhanana Group-A Group-B Total % Pravara 1 5 6 30 Madyama 7 5 12 60 Avara 2 0 2 10 Total 10 10 20 100Graph no.12: Incidence according to Samhanana 60 50 40 Pravara 30 Madyama 20 Avara 10 0 Gr-A Gr-B Total % Among 20 Patients 60% patients are of Madhyama samhanana, 30% had pravaraSamhanana and 10% had avara Samhanana. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  57 
  • 71. Observations SATMYA:Table no.19 : Incidence according to Satmya Sathmiya Group-A Group-B Total % Pravara 3 2 5 25 Madyama 4 3 7 35 Avara 3 5 8 40 Total 10 10 20 100Graph no.13: Incidence according to Satmya 40 35 30 25 Pravara 20 Madyama 15 Avara 10 5 0 Gr-A Gr-B Total % Among 20 Patients 40% patients are of Avara satmya, 35% had Madhyama satmya and25% had pravara satmya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  58 
  • 72. Observations SATWA:Table no.20: Incidence according to Satwa Satwa Group-A Group-B Total % Pravara 5 6 11 55 Madyama 4 1 5 25 Avara 1 3 4 20 Total 10 10 20 100Graph no.14: Incidence according to Satwa 60 50 40 Pravara 30 Madyama 20 Avara 10 0 Gr-A Gr-B Total % Among 20 patients 55% had pravara satwa, 25% had madhyama satwa and 20%hadavara satwa. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  59 
  • 73. Observations AHARA SHAKTHI:Table no.21: Incidence according to Aharashakti. Ahara Shakthi Group-A Group-B Total % Pravara 7 6 13 65 Madyama 2 4 6 30 Avara 1 0 1 5 Total 10 10 20 100Graph no.15: Incidence according to Aharashakti. 70 60 50 40 Pravara 30 Madyama 20 Avara 10 0 Gr-A Gr-B Total % Among 20 patients 65% are of pravara ahara shakti, 30% are of madhyama aharashakti and 5% are of avara ahara shakti A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  60 
  • 74. Observations VYAYAMA SHAKTHI:Table no.22 :Incidence according to Vyayama Shakti Vyayama Group-A Group-B Total % Shakthi Pravara 8 8 16 80 Madyama 1 2 3 15 Avara 1 0 1 5 Total 10 10 20 100Graph no.16: Incidence according to Vyayama Shakti 80 70 60 50 Pravara 40 Madyama 30 Avara 20 10 0 Gr-A Gr-B Total % Among 20 patients 80% had pravara vyayama shakti, 15% had madhyama vyayamashakti and 5% had avara vyayama shakti. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  61 
  • 75. Observations PRAMANA:Table no.23 : Incidence according to Pramana. Pramana Group-A Group-B Total % Pravara 3 5 8 40 Madyama 5 4 9 45 Avara 2 1 3 15 Total 10 10 20 100Graph no.17 : Incidence according to Pramana. 45 40 35 30 25 Pravara 20 Madyama Avara 15 10 5 0 Gr-A Gr-B Total % Among 20 Patients 45% of patients are of madhyama pramana, 40% had Uttamapramana and 15% had hina pramana. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  62 
  • 76. Observations APPATITE:Table no.24: Incidence according to Appetite Grade Group A Group B Total Percentage 0 3 5 8 40 1 2 1 3 15 2 4 4 8 40 3 1 0 1 5 Total 10 10 20 100Graph no.18: Incidence according to Appetite 40 35 30 25 0 20 1 2 15 3 10 5 0 Gr-A Gr-B Total % Among 20 patients 40% of patients showed reduced appetite, 15% had mild appetiteand 40% had moderate appetite and 5% had good appetite before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  63 
  • 77. Observations BOWEL HABITS:Table no.25 : Incidence according to Bowel habits before treatment. Group A Group B Total Percentage 10 9 19 95 0 1 1 5 Total 10 20 100Graph no.19: Incidence according to Bowel habits before treatment. 100 90 80 70 60 50 R C 40 30 20 10 0 Gr-A Gr-B Total % Among 20 Patients 95% of patients had regular bowel habits and 5% had constipationbefore treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  64 
  • 78. Observations MICTURATION:Table no.26: Incidence according to Micturation. Group A Group B Total Percentage 9 6 15 75 1 3 4 20 0 1 1 5 Total 10 20 100Graph no.20: Incidence according to Micturation. 80 70 60 50 40 30 20 10 0 Gr-A Gr-B Total % Among 20 patients 75% of patients had micturation 5-6 times a day, 20% hadmicturation 6 -7times a day, and 5% had micturation 4-5 times before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  65 
  • 79. Observations ABDOMINAL PAIN:Table no.27: Incidence according to intensity of abdominal pain. Grade Group A Group B Total Percentage 0 1 4 5 25 1 2 2 4 20 2 4 4 8 40 3 3 0 3 15 Total 10 10 20 100Graph no.21: Incidence according to intensity of abdominal pain. 40 35 30 25 0 20 1 2 15 3 10 5 0 Gr-A Gr-B Total % Among 20 Patients 40% of patients had moderate abdominal pain, 25% had no pain,20% had mild abdominal pain and 15% had severe abdominal pain before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  66 
  • 80. Observations STRENGTH :Table no.28: Incidence according to Strength. Grade Group A Group B Total Percentage 0 9 9 18 90 1 1 1 2 10 2 0 0 0 0 Total 10 10 20 100Graph no.22: Incidence according to Strength. 90 80 70 60 50 0 40 1 2 30 20 10 0 Gr-A Gr-B Total % Among 20 patients 90% of patients had reduced strength and 10% had moderatestrength before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  67 
  • 81. Observations LACTATION:Table no.29: Incidence according to Lactation. Grade Group A Group B Total Percentage 0 9 10 19 95 1 1 0 1 05 Total 10 10 20 100Graph no 23: Incidence according to Strength. 120 100 80 60 40 20 0 Gr-A Gr-B Total % Among 20 patients 95% of patients had inadequate or no lactation and 5% hadpresented with colostrum secretion before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  68 
  • 82. Observations BACK ACHE:Table no.30 Incidence according to severity of Back ache. Grade Group A Group B Total Percentage 0 5 4 9 45 1 0 3 3 15 2 1 2 3 15 3 4 1 5 25 Total 10 10 20 100Graph no.24 Incidence according to severity of Back ache. 45 40 35 30 0 25 1 20 2 15 3 10 5 0 Gr-A Gr-B Total % Among 20 patients 45% of patients had no back ache, 25% had severe back ache,and 15% had mild and moderate degree of backache before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  69 
  • 83. Observations ABDOMINAL WALL THICKNESS:Table no.31: Incidence according to abdominal wall thickness. Grade Group A Group B Total Percentage 0-1 1 1 2 10 1-2 2 1 3 15 2-3 5 4 9 45 3-4 2 4 6 30 Total 10 10 20 100Graph no.25: Incidence according to abdominal wall thickness. 45 40 35 30 0-1 25 1--2 20 2--3 15 3--4 10 5 0 Gr-A Gr-B Total % Among 20 patients 45% of patients had abdominal wall thickness with in 2-3cms and30% had with in 3-4cms and 15% had with in 1-2cms and 10% had within 0-1cms beforetreatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  70 
  • 84. Observations HEIGHT OF UTERUS:Table no.32: Incidence as per height of Uterus Grade Group A Group B Total Percentage 10-15 0 2 2 5 16-20 7 5 12 60 21-25 3 3 6 35 Total 10 10 20 100Graph no.26: Incidence as per height of Uterus 60 50 40 10--15 30 15--20 20-25 20 10 0 Gr-A Gr-B Total % Among 20 patients 60% of patients had height of uterus within 20-30cms and 40%had within 10-20cms from symphysis pubis before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  71 
  • 85. Observations LOCHIAL DISCHARGE:a)BLEEDINGTable no.33: Incidence according to colour of Lochial discharge. Grade Group A Group B Total Percentage 0 7 6 13 65 1 3 2 5 25 2 0 1 1 5 3 0 1 1 5 Total 10 10 20 100Graph no.27: Incidence according to colour of Lochial discharge. 70 60 50 40 0 1 30 2 3 20 10 0 Gr-A Gr-B Total % Among 20 patients 65% of patients had lochial discharge with half pads soaked,25% had 2 pads soaked, 5% had each of 3-4 and 4-5 pads soaked before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  72 
  • 86. Observations b) COLOURTable no.34: Incidence according to colour of Lochial discharge Grade Group A Group B Total Percentage 0 0 0 0 0 1 10 10 20 100 Total 10 10 20 100Graph no.28: Incidence according to colour of Lochial discharge 100 90 80 70 60 50 0 40 1 30 20 10 0 Gr-A Gr-B Total % Among 20 Patients complete 100% of patients had bright red colour lochialdischarge before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  73 
  • 87. Observations c) SMELL Table no. 35: Incidence as per smell of Lochial discharge. Grade Group A Group B Total Percentage 0 6 3 9 45 1 4 7 11 55 Total 10 10 20 100Graph no.29: Incidence as per smell of Lochial discharge. 60 50 40 30 0 1 20 10 0 Gr-A Gr-B Total % Among 20 patients 55% had fishy odour and 45% had no odour in lochial dischargebefore treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  74 
  • 88. Observations EPISIOTOMY WOUND HEALING:Table no.36: Incidence according to Episiotomy wound healing. Grade Group A Group B Total Percentage 0 1 0 1 5 1 1 2 3 15 2 1 6 7 35 3 7 2 9 45 Total 10 10 20 100Graph no.30: Incidence according to Episiotomy wound healing. 45 40 35 30 25 0 1 20 2 3 15 10 5 0 Gr-A Gr-B Total % Among 20 patients 45% of patients had severe tenderness, redness, swelling inepisiotomy wound, 35% had moderate tenderness, redness and swelling in episiotomywound, 15% had mild tenderness, redness and swelling in episiotomy wound and 5% hadno tenderness, redness and swelling in their episiotomy wound before treatment. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  75 
  • 89. Results RESULTS Effect of Involution in Group ATable no –37 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 10 20.000 D1 19.550 0.450 1.257 0.398 1.132 0.289 9 20.000 D2 18.650 1.350 1.375 0.435 3.104 0.013 9 20.000 D3 17.300 2.700 2.312 0.731 3.693 0.005 9 20.000 D4 16.200 3.800 2.251 0.712 5.339 <0.001 9 20.000 D5 15.250 4.750 2.372 0.750 6.333 <0.001 9Graph no – 31 GROUP A 25 20 15 GROUP A 10 5 0 BT D1 D2 D3 D4 D5 Group A – On stastically analyzing the effect of treatment on uterine involution it was noted that there is stastically significant change. The mean score of the Involution of Uterus of which was 20.000 before treatment reduced to 19.550 after D1 of treatment, it is 18.650 on D2, then to 17.300 on D3 of treatment, on D4 it is reduced to 16.200, finally it reduced to 15.250 on Discharge of the patient. The change occurred with the treatment is greater than would be expected by chance. The t value being 6.333 and P value <0.001 A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 76
  • 90. Results Effect of Involution in Group BTable no –38 n Mean of Mean of AT d Paired ‘t’ test BT S.D S.E t P df 19.900 D1 19.000 0.900 1.729 0.547 1.646 0.134 910 19.900 D2 17.450 2.450 2.499 0.796 3.100 0.013 9 19.900 D3 15.700 4.200 2.486 0.786 5.344 <0.001 9 19.900 D4 14.300 5.600 2.221 0.702 7.973 <0.001 9 19.900 D5 13.000 6.900 2.079 0.657 10.495 <0.001 9Graph no - 32 GROUP B 25 20 15 GROUP B 10 5 0 BT D1 D2 D3 D4 D5 Group B – The study showed stastically significant changes on the uterine involutionwith the treatment. The mean score which was 19.900 before treatment then changed to19.000, 17.450, 15.700, 14.300, 13.00 after D1, D2, D3, D4 and D5 of treatment, t valueis 10.495 and P value < 0.001. The change that occurred with the treatment is greaterthan would be expected by chance. There is a stastically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 77
  • 91. Results Effect of Involution in Both GroupsTable no –39 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 3.8 -1.8 1.549 0490 2.072 0.053 18 Group B 5.6 2.452 0.775Graph no - 33 GROUP 6 4 2 0 GROUP-A GROUP-B GROUP 3.8 5.6 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.053). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 78
  • 92. Results Effect of Lochial Discharge in Group A Amount of BleedingTable no –40 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E T P df 0.300 D1 2.400 -2.100 1.370 0.433 -4.846 <0.001 910 0.300 D2 2.400 -2.100 0.994 0.314 -6.678 <0.001 9 0.300 D3 1.800 -1.500 0.527 0.167 -9.00 <0.001 9 0.300 D4 1.300 -1.000 0.667 0.211 -4.743 <0.001 9 0.300 D5 1.100 -0.800 0.632 0.200 -4.000 0.003 9Graph no - 34 GROUP A 3 2.5 2 1.5 GROUP A 1 0.5 0 BT D1 D2 D3 D4 D5 On statistically analyzing the effect of treatment on Amount of Lochial Dischargeit was noted the there is a statistically significant change. The mean value was 0.300before treatment which changed to 2.400, 2.400, 1.800, 1.300 and 1.100 respectivelyduring 1st, 2nd, 3rd, 4th and 5th days of delivery respectively. The change that occurredwith the treatment is greater than would be expected by chance. The t value being -4.000and P value 0.003. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 79
  • 93. Results Effect of Amount of Lochial Discharge in Group BTable no –41n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 0.700 D1 2.200 -1.500 1.269 0.401 -3.737 0.005 910 0.700 D2 1.700 -1.000 1.333 0.422 -2.372 0.042 9 0.700 D3 1.300 -0.600 1.075 0.340 -1.765 0.111 9 0.700 D4 1.300 -0.600 1.430 0.452 -1.327 0.217 9 0.700 D5 1.100 -0.400 1.174 0.371 -1.078 0.309 9Graph no - 35 GROUP B 2.5 2 1.5 GROUP B 1 0.5 0 BT D1 D2 D3 D4 D5 On statistically analyzing the effect of treatment on Amount of Lochial Dischargeit was noted the there is a statistically significant change. The mean value was 0.700before treatment which changed to 2.200, 1.300 and 1.100 respectively during 1st, 3rd and5th day of the treatment. The change that occurred with the treatment is greater thanwould be expected by chance. The t value being -1.078 and P value 0.309. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 80
  • 94. Results Effect of Amount of Lochial Discharge in Both GroupsTable no –42 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.000 0.400 0.483 0.153 0.000 1.000 18 Group B 0.600 0.675 0.213Graph no - 36 GROUP 1 0.5 0 GROUP-A GROUP-B GROUP 1 0.6 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 1.000). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 81
  • 95. Results Effect of Colour of Lochial Discharge in Group A Table no –43 n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 1.000 D1 1.000 0.000 0.000 0.000 0.000 1.000 9 10 1.000 D2 1.100 -0.100 0.316 0.100 -1.000 0.343 9 1.000 D3 1.500 -0.500 0.707 0.224 -2.236 0.052 9 1.000 D4 1.700 -0.700 0.483 0.153 -4.583 0.001 9 1.000 D5 2.000 -1.000 0.667 0.211 -4.743 0.001 9 Graph no -37 GROUP A 2.5 2 1.5 GROUP A 1 0.5 0 BT D1 D2 D3 D4 D5 The study showed statistically significant changes in Colour of Lochial dischargewith the treatment. Mean value before treatment was 1.000, which changed to 1.100,1.500, 1.700 and 2.000 respectively in 2nd, 3rd, 4th and 5th day of Treatment. P value is0.001 and t value -4.743. The change that occurred with the treatment is greater thanwould be expected by chance; there is a statistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 82
  • 96. Results Effect of colour of Lochial Discharge in Group B Table no –44n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 1.000 D1 1.000 0.000 0.000 0.000 0.000 1.000 910 1.000 D2 1.100 -0.100 0.316 0.100 -1.00 0.343 9 1.000 D3 1.100 -0.100 0.316 0.100 -1.000 0.343 9 1.000 D4 1.600 -0.600 0.843 0.267 -2.250 0.051 9 1.000 D5 2.000 -1.000 0.943 0.298 -3.354 0.008 9Graph no - 38 GROUP B 2.5 2 1.5 GROUP B 1 0.5 0 BT D1 D2 D3 D4 D5 The study showed statistically significant changes in Colour of Lochial discharge with the treatment. Mean value before treatment was 1.000, which changed to 1.100, 1.600 and 2.000 respectively in 2nd 4thrd and 5th day of Treatment. P value is 0008 and t value -2.250. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant changeA Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 83
  • 97. Results Effect of Colour of Lochial Discharge in Both GroupsTable no –45 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 0.700 0.100 0.483 0.153 0.325 0.749 18 Group B 0.600 0.843 0.267Graph no - 39 GROUP 0.7 0.65 0.6 0.55 GROUP-A GROUP-B GROUP 0.7 0.6 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.749). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 84
  • 98. Results Effect of Odour in Lochial Discharge in Group ATable no –46 n Mean of Mean of AT d Paired ‘t’ test BT S.D S.E t P Df 0.400 D1 0.500 -0.100 0.316 0.100 -1.000 0.343 910 0.400 D2 0.500 -0.100 0.316 0.100 -1.000 0.343 9 0.400 D3 0.400 0.000 0.471 0.149 0.000 1.000 9 0.400 D4 0.400 0.000 0.000 0.000 0.000 1.000 9 0.400 D5 0.400 0.000 0.667 0.211 0.000 1.000 9Graph no – 40 GROUP A 0.6 0.5 0.4 0.3 GROUP A 0.2 0.1 0 BT D1 D2 D3 D4 D5 The change occurred on the Effect of odour of Lochial Discharge by treatmentwas analyzed statistical, which shows that there was no statistical significant change withthe mean value remaining constant through out as 0.400. t value being 0.000 and P valuebeing 1.000. The change that occurred with the treatment is not great enough to excludethe possibility that the difference is due to chance. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 85
  • 99. Results Effect of Odour in Lochial Discharge in Group BTable no –47 n Mean of Mean of AT d Paired ‘t’ test BT S.D S.E t P df 0.700 D1 0.700 0.000 0.000 0.000 0.000 1.000 910 0.700 D2 0.600 0.100 0.316 0.100 1.000 0.343 9 0.700 D3 0.500 0.200 0.422 0.133 1.500 0.168 9 0.700 D4 0.300 0.400 0.516 0.163 2.449 0.037 9 0.700 D5 0.200 0.500 0.527 0.167 3.000 0.015 9Graph no – 41 0.8 0.7 0.6 0.5 0.4 Group B 0.3 0.2 0.1 0 BT D1 D2 D3 D4 D5 The study showed statistically significant changes on the Effect of odour ofLochial Discharge with the treatment. Mean value before treatment was 0.700, itremained same on Day 1 of treatment, which changed to 0.600, 0.500, 0.300 and 0.200on successive Day2, Day3, Day4 and Day 5 of Treatment. P value is 0.015 and t value3.000. The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 86
  • 100. Results Effect of Odour in Lochial Discharge in Both GroupsTable no –48 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 0.000 -0.400 0.516 0.163 0.447 0.660 18 Group B 0.400 0.483 0.153Graph no - 42 GROUP 0.4 0.2 0 GROUP-A GROUP-B GROUP 0 0.4 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.660). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 87
  • 101. Results Effect of Episiotomy Wound Healing in Group ATable no –49 n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 2.400 D1 2.700 -0.300 0.483 0.153 -1.964 0.081 910 2.400 D2 1.900 0.500 1.434 0.453 1.103 0.299 9 2.400 D3 1.300 1.100 1.370 0.433 2.538 0.032 9 2.400 D4 0.700 1.700 1.252 0.396 4.295 0.002 9 2.400 D5 0.300 2.100 1.101 0.348 6.034 <0.001 9 2.400 D30 0.000 2.400 1.075 0.340 7.060 <0.001 9 2.400 D60 0.000 2.400 1.075 0.340 7.060 <0.001 9Graph no - 43 GROUP A 3 2.5 2 1.5 GROUP A 1 0.5 0 BT D1 D2 D3 D4 D5 D30 D60 On analyzing the effect of treatment on Episiotomy wound Healing statistically,it is noted that mean value before treatment was 2.4 which changed to 2.7, 1.9, 1.3, 0.7,0.3, 0.0 in the followup 1,2,3,4,5 days during hospital stay and day 30, and day 60 duringfollow up period respectively. With a t value 6.034 and P value <0.001. The change thatoccurred with the treatment is greater than would be expected by chance; there is astatistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 88
  • 102. Results Effect of Episiotomy wound Healing in Group BTable no –50n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 2.000 D1 2.500 -0.500 0.527 0.167 -3.000 0.015 910 2.000 D2 1.500 0.500 0.707 0.224 2.236 0.052 9 2.000 D3 1.200 0.800 0.919 0.291 2.753 0.022 9 2.000 D4 0.900 1.1000 0.876 0.277 3.973 0.003 9 2.000 D5 0.400 1.6000 0.699 0.221 7.236 <0.001 9 2.000 D30 0.000 2.0000 0.667 0.211 9.487 <0.001 9 2.000 D60 0.000 2.0000 0.667 0.211 9.487 <0.001 9Graph no - 44 GROUP B 3 2.5 2 1.5 GROUP B 1 0.5 0 BT D1 D2 D3 D4 D5 D30 D60 On analyzing the effect of treatment on Episiotomy wound Healing statistically,it is noted that mean value before treatment was 2.0 which changed to 2.5,1.5, 1.2, 0.9,0.4, 0.0 in the followup 1,2,3,4,5 days during hospital stay and day 30, and day 60 duringfollow up period respectively. With a t value 7.236 and P value <0.001. The change thatoccurred with the treatment is greater than would be expected by chance; there is astatistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 89
  • 103. Results Effect of Episiotomy Wound Healing in Both GroupsTable no –51 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.7 0.6 0.675 0.213 0.717 0.482 18 Group B 1.1 0.568 0.180Graph no - 45 GROUP 2 1 0 GROUP-A GROUP-B GROUP 1.7 1.1 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.482). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 90
  • 104. Results Effect of Abdominal Pain in Group ATable no –52 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 1.900 D4 0.200 1.700 1.160 0.367 4.636 0.001 910 1.900 D30 0.000 1.900 0.994 0.314 6.042 <.0.001 9 1.900 D60 0.000 1.900 0.994 0.314 6.042 <.0.001 9Graph no - 46 2 1.5 1 Group A 0.5 0 BT D4 D30 D60 The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change on abdominal pain as compared tobefore treatment using the statistical analysis. The mean value being 1.9 before treatmentand reduced to 0.2, 0.0 respectively on day of discharge and successive follow up oftreatment. The t value remaining 6.042 and P value <0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 91
  • 105. Results Effect of Abdominal Pain in Group BTable no –53n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P Df 1.00 D4 0.000 1.00 0.943 0.298 3.354 0.008 910 1.00 D30 0.000 1.00 0.943 0.298 3.354 0.008 9 1.00 D60 0.000 1.00 0.943 0.298 3.354 0.008 9Graph no - 47 1.2 1 0.8 0.6 Group B 0.4 0.2 0 Bt D4 D30 D60 The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change on Abdominal pain as compared tobefore treatment using the statistical analysis. The mean value being 1.0 before treatmentand reduced to 0.0 on days of selected observation days and successive follow up oftreatment. The t value remaining 3.354 and P value 0.008. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 92
  • 106. Results Effect of Abdominal Pain in Both GroupsTable no –54 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.900 0.900 0.000 0.000 0.000 1.000 18 Group B 1.000 0.000 0.000Graph no -48 GROUP 2 1.5 1 0.5 0 GROUP-A GROUP-B GROUP 1.9 1 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 1.000). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 93
  • 107. Results Effect of Appetite in Group ATable no –55 n Mean of Mean of AT d Paired ‘t’ test BT S.D S.E t P Df 1.3 D4 2.8 -1.500 1.179 0.373 -4.025 0.003 9 10 1.3 D30 2.5 -1.200 1.033 0.327 -3.674 0.005 9 1.3 D60 2.6 -1.300 0.949 0.300 -4.333 0.002 9Graph no -49 GROUP A 3 2.5 2 1.5 GROUP A 1 0.5 0 BT D4 D30 D60 The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change on the interval of the cycle as comparedto before treatment using the statistical analysis. The mean value being 1.3 beforetreatment and reduced to 2.8, 2.5, 2.6 on day of discharge and on day30, day 60 ofsuccessive follow up of treatment respectively. The t value remaining -4.333 and P value0.002. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 94
  • 108. Results Effect of Appetite in Group B Table no –56 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 0.900 D4 2.200 -1.300 0.823 0.260 -4.993 0.001 9 10 0.900 D30 2.500 -1.600 0.966 0.306 -5.237 0.001 9 0.900 D60 2.500 -1.600 0.966 0.306 -5.237 0.001 9 Graph no - 50 GROUP B 3 2.5 2 1.5 GROUP B 1 0.5 0 BT D4 D30 D60 The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change on appetite as compared to beforetreatment using the statistical analysis. The mean value being 0.9 before treatment andreduced to 2.2, 2.5, and 2.5 on day of discharge and on day30, day 60 of successivefollow up of treatment respectively. The t value remaining 5.237 and P value 0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 95
  • 109. Results Effect of Appetite in both GroupsTable no –57 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.200 0.400 0.707 0.224 0.000 1.000 18 Group B 1.600 0.707 0.224Graph no - 51 GROUP 2 1 0 GROUP-A GROUP-B GROUP 1.2 1.6 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 1.000). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 96
  • 110. Results Effect of Bowel Habits in Group ATable no – 58 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 0.000 D1 0.000 0.000 0.000 0.000 0.000 1.000 910 0.000 D2 0.300 -0.300 0.483 0.15 -1.964 0.081 9 0.000 D3 0.600 -0.600 0.516 0.163 -3.674 0.005 9 0.00 D4 0.900 -0.900 0.316 0.100 -9.000 <0.001 9 0.00 D30 1.000 -1.000 0.00 0.00 -INF <0.001 9 0.00 D60 1.000 -1.000 0.00 0.00 0.00 <0.001 9Graph no - 52 1.2 1 0.8 0.6 Group A 0.4 0.2 0 1 2 3 4 30 60 BT D D D D D D On statistically analyzing the effect of treatment on weight reduction it was notedthe there is a statistically significant change. The mean value was 0.000 before treatmentwhich changed to 0.900 on day of discharge and again changed to 1.00 and remainedsame respectively in day 30 during treatment and follow up respectively. The change thatoccurred with the treatment is greater than would be expected by chance. The t valuebeing -9.00 and P value <0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 97
  • 111. Results Effect of Bowel Habits in Group B Table no –59 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 0.100 D1 0.000 0.100 0.316 0.100 1.000 0.343 9 10 0.100 D2 0.300 -0.200 0.632 0.200 -1.000 0.343 9 0.100 D3 0.600 -0.500 0.527 0.167 -3.000 0.015 9 0.100 D4 1.00 -0.900 0.316 0.100 -9.00 <0.001 9 0.100 D30 1.00 -0.900 0.316 0.100 -9.00 <0.001 9 0.100 D60 1.00 -0.900 0.316 0.100 -9.00 <0.001 9 Graph no - 53 GROUP B 1.2 1 0.8 0.6 GROUP B 0.4 0.2 0 BT D1 D2 D3 D4 D30 D60 On statistically analyzing the effect of treatment on weight reduction it was noted thethere is a statistically significant change. The mean value was 0.100 before treatmentwhich changed to 0.300, 0.600, 1.00 on D2, D3, on day of discharge and remained samein day 30 and even in day 60 after treatment.during treatment and follow up respectively.The change that occurred with the treatment is greater than would be expected by chance.The t value being -9.00 and P value <0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 98
  • 112. Results Effect of Bowel Habits in Both Groups Table no –60 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.000 0.100 0316 0.100 -1.000 0.331 18 Group B 0.900 0.000 0.000 Graph no 54 GROUP 1 0.9 0.8 GROUP-A GROUP-B GROUP 1 0.9 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.331). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 99
  • 113. Results Effect of Micturation in Group ATable no –61 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 0.100 D4 2.500 -2.400 0.843 0.267 -9.00 <0.001 910 0.100 D30 2.800 -2.700 0.483 0.153 -17.676 <0.001 9 0.100 D60 2.800 -2.700 0.483 0.153 -17.676 <0.001 9Graph no - 55 GROUP A 3 2.5 2 1.5 GROUP A 1 0.5 0 BT D1 D2 D3 The mean score of treatment on effect of micturation of which was 0.100 beforetreatment changed to 2.5 during the day of discharge of patient, to 2.800 during day 30and day 60 after treatment. When these values were analysed statistically, the differencewas significant with t value -17.676 at the level of p < 0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 100
  • 114. Results Effect of Micturation in Group BTable no –62 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P Df 0.600 D4 2.400 -1.800 1.135 0.359 -5.014 <0.001 910 0.600 D30 2.200 -1.600 1.174 0.371 -4.311 0.002 9 0.600 D60 2.200 -1.600 1.174 0.371 -4.311 0.002 9Graph no - 56 3 2.5 2 1.5 Group B 1 0.5 0 BT D4 D30 D60 The mean score of treatment on effect of micturation of which was 0.600before treatment changed to 2.4 during the day of discharge of patient, to 2.200 duringday 30 and day 60 after treatment. When these values were analysed statistically, thedifference was significant with t value -4.311 at the level of p < 0.002. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 101
  • 115. Results Effect of Micturation in Both GroupsTable no –63 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 2.400 0.600 0.707 0.224 0.361 0.722 18 Group B 1.800 0.516 0.163Graph no - 57 GROUP 3 2 1 0 GROUP-A GROUP-B GROUP 2.4 1.8 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.722). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 102
  • 116. Results Effect of Lactation in Group ATable no –64n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 0.100 D1 0.100 0.000 0.000 0.000 0.000 1.000 910 0.100 D2 0.500 -0.400 0.516 0.163 -2.449 0.037 9 0.100 D3 1.100 -1.000 0.000 0.000 -INF <0.001 9 0.100 D4 1.500 -1.400 0.516 0.163 -8.573 <0.001 9 0.100 D30 1.200 -1.100 0.568 0.180 -6.128 <0.001 9 0.100 D60 1.000 -0.900 0.316 0.100 -9.00 <0.001 9Graph no - 58 GROUP A 1.6 1.4 1.2 1 0.8 GROUP A 0.6 0.4 0.2 0 30 60 T 1 2 3 4 D D D D B D D On statistically analyzing the effect of treatment on Lactation it was noted the there isa statistically significant change. The mean value was 0.100 before treatment whichchanged to 0.100, 0.500, 1.100, 1.500, 1.200, 1.000 during day1, 2, 3, 4, day 30 oftreatment and day 60 of follow up respectively. The change that occurred with thetreatment is greater than would be expected by chance. The t value being -9.00 and Pvalue <0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 103
  • 117. Results Effect of Lactation in Group BTable no –65 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 0.000 D1 0.100 -0.100 0.316 0.100 -1.00 0.343 910 0.000 D2 0.100 -0.100 0.316 0.100 -1.00 0.343 9 0.000 D3 0.900 -0.900 0.316 0.100 -9.00 <0.001 9 0.000 D4 1.000 -1.200 0.422 0.133 -9.00 <0.001 9 0.000 D30 1.500 -1.500 0.527 0.167 -9.00 <0.001 9 0.000 D60 1.400 -1.400 0.516 0.163 -8.57 <0.001 9Graph no - 59 GROUP B 1.6 1.4 1.2 1 0.8 GROUP B 0.6 0.4 0.2 0 30 60 T 1 2 3 4 D D D D B D D On statistically analyzing the effect of treatment on Lactation it was noted thethere is a statistically significant change. The mean value was 0.000 before treatmentwhich changed to 0.100, 0.100, 0.900, 1.000, 1.500, 1.400 during D1, D2, D3, D4, day30 of treatment and day 60 of follow up respectively. The change that occurred with thetreatment is greater than would be expected by chance. The t value being -8.57 and Pvalue <0.001. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 104
  • 118. Results Effect of Lactation in Both GroupsTable no –66 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.100 -0.400 0.422 0.133 -1.406 0.177 18 Group B 1.500 0.527 0.167Graph no - 60 GROUP 2 1 0 GROUP- GROUP- GROUP 1.1 1.5 The difference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.177). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 105
  • 119. Results Effect of Back ache in Group ATable no –67 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 1.400 D4 0.300 1.100 1.449 0.459 2.400 0.040 910 1.400 D30 0.100 1.300 1.418 0.448 2.899 0.018 9 1.400 D60 0.200 1.200 1.549 0.490 2.449 0.037 9Graph no - 61 GROUP A 1.6 1.4 1.2 1 0.8 GROUP A 0.6 0.4 0.2 0 BT D4 D30 D60 On statistically analyzing the effect of treatment on Back ache it was noted thethere is a statistically significant change. The mean value was 0.400 before treatmentwhich changed to 0.300, 0.100 and 0.200 during day 4, day 30 of treatment and day 60of follow up respectively. The change that occurred with the treatment is greater thanwould be expected by chance. The t value being -2.449 and P value 0.037. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 106
  • 120. Results Effect of Back ache in Group BTable no –68n Mean Mean of AT d % Paired ‘t’ test of BT S.D S.E t P df 1.00 D4 0.400 0.600 0.966 0.306 1.964 0.081 910 1.00 D30 0.600 0.400 1.265 0.400 1.00 0.343 9 1.00 D60 0.500 0.500 1.354 0.428 1.168 0.273 9Graph no - 62 GROUP B 1.2 1 0.8 0.6 GROUP B 0.4 0.2 0 BT D4 D30 D60 On statistically analyzing the effect of treatment on Back ache it was noted thethere is a statistically significant change. The mean value was 1.00 before treatmentwhich changed to 0.400, 0.600 and 0.500 respectively during day 4, day 30 of treatmentand day 60 of follow up. The change that occurred with the treatment is greater thanwould be expected by chance. The t value being 1.168 and P value 0.273. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 107
  • 121. Results Effect of Back ache in Both GroupsTable no –69 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.300 0.900 0.316 0.100 -1.555 0.137 18 Group B 0.400 0.966 0.306Graph no - 63 GROUP 2 1 0 GROUP- GROUP- GROUP 1.3 0.4 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.137). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 108
  • 122. Results Effect of Abdominal wall thickness in Group ATable no –70 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 2.180 D4 1.920 0.260 0.267 0.0846 3.074 0.013 9 10 2.180 D30 1.990 0.190 0.296 0.0936 2.029 0.073 9 2.180 D60 2.120 0.060 0.412 0.130 0.461 0.656 9 2.180 D90 2.120 0.060 0.412 0.130 0.461 0.656 9Graph no - 64 GROUP A 2.2 2.15 2.1 2.05 2 GROUP A 1.95 1.9 1.85 1.8 1.75 BT D4 D30 D60 D90 Statistically study shows no significance of treatment on the Abdominal wallthickness. The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is due to chance. The P = 0.656 and t value is 0461. Themean being 2.180 before treatment and 1.920,1.990 during day 4, day 30 of treatmentrespectively and remained 2.120 in the day 60 and day 90 after the treatment. Thepower of the performed test (0.050) is below the desired power of 0.800.Less thandesired power indicates that there are more likely to not detect a difference when oneactually exists A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 109
  • 123. Results Effect of Abdominal wall thickness in Group BTable no –71 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 2.420 D4 2.220 0.200 0.231 0.0730 2.739 0.023 910 2.420 D30 2.240 0.180 0.274 0.0867 2.077 0.068 9 2.420 D60 2.320 0.100 0.316 0.100 1.000 0.343 9 2.420 D90 2.320 0.100 0.316 0.100 1.000 0.343 9Graph no - 65 GROUP B 2.45 2.4 2.35 2.3 2.25 GROUP B 2.2 2.15 2.1 2.05 BT D4 D30 D60 D90 Statistically study shows no significance of treatment on the Abdominal wallthickness. The change that occurred with the treatment is not great enough to exclude thepossibility that the difference is due to chance. The P = 0.343 and t value is 1.00. Themean being 2.420 before treatment and 2.220, 2.420, 2.320 respectively during day 4,day 30 of treatment and in the two successive months following during treatment. Thepower of the performed test (0.050) is below the desired power of 0.800.Less thandesired power indicates that there are more likely to not detect a difference when oneactually exists. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 110
  • 124. Results Effect of Strength in Group ATable no –73 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 0.100 D4 1.00 -0.900 0.316 0.100 -9.00 <0.001 910 0.100 D30 1.900 -1.800 0.422 0.133 -13.50 <0.001 9 0.100 D60 1.900 -1.800 0.422 0.133 -13.50 <0.001 9Graph no - 67 2 1.5 1 Group A 0.5 0 BT D4 D30 D60 The study showed statistically significant changes in strength with the treatment.Mean value before treatment was 0.100, which changed to 1.00, 1.900 on D4 and D30 oftreatment and remained same on day 60 of follow up. P value is <0.001 and t value -13.50. The change that occurred with the treatment is greater than would be expected bychance; there is a statistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 111
  • 125. Results Effect of Strength in Group BTable no –74 n Mean Mean of AT d Paired ‘t’ test of BT S.D S.E t P df 0.100 D4 1.200 -1.100 0.568 0.180 -6.128 <0.001 910 0.100 D30 1.700 -1.600 0.699 0.221 -7.236 <0.001 9 0.100 D60 1.900 -1.800 0.422 0.133 -13.500 <0.001 9Graph no - 68 GROUP B 2 1.5 1 GROUP B 0.5 0 BT D4 D30 D60 The study showed statistically significant changes in strength with the treatment.Mean value before treatment was 0.100, which changed to 1.200, 1.700 and 1.900 onday 4, day 30 of treatment and day 60 of follow up. P value is <0.001 and t value -13.500. The change that occurred with the treatment is greater than would be expectedby chance; there is a statistically significant change. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 112
  • 126. Results Effect of Strength in Both GroupsTable no –75 Groups BT – AT Mean d ‘t’ test S.D S.E M t P df Group A 1.800 0000 0.316 0.1000 1.095 0.288 18 Group B 1.800 0.483 0.153Graph no - 69 Group 2 1 0 Group-A Group-B Group 1.8 1.8 The difference in the mean values of the two groups is not great enough to rejectthe possibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 0.288). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 113
  • 127. Discussion  DISCUSSIONDiscussion on Conceptual Study    After the excitement of being pregnant, after the ecstasy and anxiety of labourand delivery, after the indescribable joy of seeing ones own child, it is reallyawesome challenge to the mother, she has to adopt herself to the new situation and amajor changes in lifestyle122. Puerperial period is a time of transition from non-parent-hood to parent-hood.The process of Physical, physiological and psychological adjustments that take placeafter delivery to puerperium and even beyond is a sort of self healing of bodies ownnature. That is the Recuperation from physical, hormonal and emotional experienceof parturition. As the generative organs return back approximately to their pregravidstate both anatomically and physiologically, followed by changes in other systems ofbody, again super added by psychological adjustments and establishment oflactation123. Both mother and her new born are vulnerable during the postnatal period. Thecare given is the critical opportunity to save them. The puerperial management is themeans where the woman can recuperate physically and emotionally and gainsupervised experience in the care of her infant124. Ayurveda, as usual being explicit, describes this condition as Suthika avastha.That is even the corner stone of womens life is also considered here. OfcourseSuthika is not a rogi, the paricharya explained to suthika in prasavothara kala is likeDinacharya, rutucharya explained for swasta. There are ample changes occurring ingarbhavastha, prasavastha. The chala doshas, kleda, raktha nisruthi, dhatu kshayataand Shunyata of her body after a stage of so called sukha prasava, makes suthikaabala and more prone to get vata vitiating disorders. This delicateness of her bodymakes the necessity of particular mode of life in order to attain her prepregnancyhealth and to rejuvenate herself. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  114 
  • 128. Discussion  ÌmÉmmÉsÉÏ ÌmÉmmÉsÉÏqÉÔsÉ cÉurÉ ÍcɧÉMü lÉÉaÉUå:| rÉuÉaÉÔ SÏmÉlÉÏrÉÉ xrÉÉcNÕûsÉklÉÏ cÉÉåmÉxÉÉÍkÉiÉÉ ||cÉ. xÉÔ. 2/18 There will be reduced agni in abala stree because of shunyata of shareera.The paricharya explained is not easy that weakened suthika should be enforced withenergizing or potent medications. So the regimen will ignite the mandagni, As perAcharya Charaka the yavagu prepared using panchakola drugs is best in doing agnideepana and shula prashamana125. Even the sneha given to her is mixed with dravyaslike pippali, pippalimula, chavya, chitraka, shrungavera, yavani, upakunjika etc. Herethe purpose behind all these formulations is agni deepana and ama pachana. Also toavoid vata prakopa she is administered with abhyantara sneha pana and bahya vatashamaka procedures. The snehapana given to suthika is the form of shamananga sneha. It cannot beshodhananga sneha as sneha and sveda were not followed by any vamana orvirechana procedures and there is no such bahudoshavasta in suthika to go forshodhana karma. Even this cannot be bruhmnanga sneha, as sneha for bruhmanapurpose is given along with food, there is no need for waiting till digestion iscompleted. For nourishing purpose sneha is administered for more time period.Here the suthika is advised with gritha pana only when there is intense hunger. Thedose being prabhuta matra as per paramaya shaktya or capacity of lady considereingher agni, bala, desha and kala. And sneha is not supplemented along with food. Itshould be digested with in 24 hrs. Peyadi krama is followed only after completedigestion of sneha. All these rules and regulation for sneha pana is followed for aperiod of 5-7days duration. With above mentioned therapeutic steps this sneha panaadvised to suthika can only be a shamananga sneha126. The administration of gritha pana is very much necessary as it is pittaanilahara, nourishes all dhatus from rasa to shukra, it is ojaskara, medhya, swara varnaprasadaka, daha shamaka, does shareera bala vriddhi and vayah sthapana. It is verymuch indicated in conditions like kshata ksheena, shosha etc127 and Suthika avastha is A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  115 
  • 129. Discussion seen with all these sensitive conditions. This sneha pana is a very good provider ofcell wall, removes wear and tear, Hence it is considered as a good tissue rebuilder. Sushrutacharya was very much clear in explaining the use of ushna gudodakawith panchakola churna. Since panchakolas are veerya pradhana aushadha dravya,teekshna, ushna in nature with garbhashaya shodaka and garbhashaya sankochakaproperty, removes dusta shonita or sashesha dosha from garbhashaya. So itnormalizes lochial discharges. And also does proper uterine involution, thusminimizing afterpains or makkala shula. ÌuÉSÉËUaÉlkÉÉÌSUrÉÇ aÉhÉÈ ÌmɨÉÉÌlÉsÉÉmÉWûÈ | vÉÉåwÉ aÉÑsqÉ AÇûaÉqÉSï FkuÉïµÉÉxÉ MüÉxÉÌuÉlÉÉvÉlÉÈ|| xÉÑ. xÉÔ. 38/5 The sneha yavagu or ksheera yavagu processed with vidarigandhadi ganadravyas is definitely an electrolyte to suthika stree. These drugs are tridosha hara,reduces vata, maintains pitta, specially beneficial in case of shosha, angamardha,kasa, swasa etc conditions128. Puerperium is seen with anaemia causing dysnea,who is weak, imaciated etc, So the yavagu pana of vidaryadi gana dravya is verymuch beneficial. The yavagu pana129,130,131,132 either in the form of manda or peya orvilaepi all will inturn stimulate agni, is pachaka and grahi hence it is pranadharaka,laghu in nature easily digestible and absorbable, reduces thirst thus it does themaintenance of water balance, is still a good diuretic, shramahara glanihara, doestarpana, bruhmna and prasadana to suthika. As puerperial lady is more prone to get urinary tract infections, and advisedwith adequate water supplementation and timely evacuation of bladder. Even there ismore perspirations and loss of water as suthika is subjected to parisheka which willfurther reduce the urine out put, Here the supplementation of peya, vilaepi etc insuthika paricharya will definitely avoid getting the urinary complaints. The functionof both maintenance of water (thus reducing thirst, dehydration) and diuresis arecounterbalanced. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  116 
  • 130. Discussion  Later the yusha prepared with yava, kola, kulatha etc is again still morebeneficial. This semisolid, protein rich preparation is more nutritive. This yushaeither krutha or akruth will act as agni deepana, rochana, swedajanana, balya, tustipusti sukhaprasadana133,134,135. The laghu annapana, grutha bhargita shaka,mamsarasa advised after twelve days is very much acceptable. This nourishing foodis necessary, and even the agni will be increased so that it will digest this high richnutritive diet. Further in bahya parimarjana paricharya, abhynga, parisheka, acchadana,avagaha etc all are for the purpose of mitigation of vata. The massage given tosuthika either in the form of sthanika udara abhyanga or sarvadaihika abhyanga or theprescribed yoni abhyanga all are very much beneficial. It packed with list ofadvantages. It is jara hara, pusti kara - gives bala to dhatu, shrama hara – reduces thestress and strain of muscles due to excessive stretching, weight bearing and uterinecontractions, vata hara, klesha sahatwa, abhigatha sahatwa, dhadyakrith136 ie, it willdefinitely strengthens the suthika to tolerate after effects of strenuous labour. It givesvery good sleep – swapna kara and also ayushkara. Of course abala stree should not be given with teekshna sweda. But with thedue consideration to give sthirata to her shithila shareera, mrudu sweda in the form ofdrava sweda is advised. Here both parisheka and avagaha are beneficial137,138. Thissu-ushna aushadha jala dhara to suthika or immersing herself in the aushadha yuktajala droni is vata kapha hara does maintenance of pitta, effective in reducing vedanavega, does agnideepti, twak prasannata, sroto nirmalata, dhrudhata to dhatus,removes muscle cramps stiffness in joints, heaviness in body. The indications for thistype of sweda are arsha, ashmari specially shula139. For Suthika with abovementioned benefits this parisheka and avagaha does vedana sthapana. Research works also supports the abhyanga parisheka etc procedures140.Abhyanga or procedure of massaging of the body parts reduces and stabilizesincreased heart rate and blood pressure. improves circulation & endorphins, cause A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  117 
  • 131. Discussion vasodilatation & relaxes the muscles. Endorphins, in fact, are the body’s natural painkillers. Massage through improving circulation & nervous stimulation etc not onlyproduces a local effect but may exert either a stimulating or soothing effect on thebody as a whole. The sudation also is a very good reliever of muscular pain. Theheat allows the blood vessels to become dilated & increase circulation resulting inmore oxygen being allowed to get to the parts of the body. This in turn helps inreduction of local as well as generalized body ache. Advise given to suthika to sit over chair of ushna charmavana filled with balataila is for the purpose of yoni prasadana141. Excessive stretching during the processof labour results in laxiety of perineum, this ushna bala taila helps in regaining thestrength of the pelvic floor. Nubja shayana Abhyanga, Udara vestana, Yoni Swedanausing priyanguka, krushara all will not only does vayu shamana rather prevents vayuvikruthi occurring due to avakasha bhaga in udara. Advise of trivruth manidharana142over the head, is a sort of psychological support to her, that it will protect her andprevent from all bad things. The suthika snana followed by dhupana, and vishrantaare definitely shramahara and vatahara. After the process of delivery the dilated genital tract is more prone to getinfections, Yoni dhupana given is very much beneficial due to its antebacterial effect.The yoni dhupana given will maintain the hygiene of the perineum. Keeps theepisiotomy healthy. Hastens its healing process. Dhupana to the whole body andeven to suthika gara with rakshogna dravyas like Kusta Guggulu, Agaru etc theantiseptic antibacterial drugs also gives the sense of well being. The drugs likekustha, agaru, guggulu used in dhupana karma have the properties like jantughna,kandughna, shothahara, vedana sthapana vrana shodhana, ropana etc Due to the overall effect of Abhyanga, Parisheka, Dhupana not only the blood circulation isincreased, but also the relaxation of muscles will takes place, episiotomy healing isaugumented, perineal tenderness is much reduced. Researches shows that sudationhelps in relieving pain and speed up the healing process. On fumigation, Agaru actsas Pain reliever of the Wounds and Ulcers, Guggulu acts as anti-infective. Also theessential oil of the roots of Kusta and the glycosides are pharmacologically active A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  118 
  • 132. Discussion bodies, which are carminative and strong antiseptic and disinfectant & havingdestructive effect against the streptococcus and staphylococcus bacteria. The Suthika kala or the dauration mentioned for all the above said dieticregime is adhyardha masa, It is the minimum needed period where the lady mustfollow particular mode of life. Avoid contraindicated things. So that suthika willbecome nava stree or rejuvenated completely. As per English calendar, thisadhyardha masa is the period of one and half month duration. or fortyfive days.Considering Hindu sampradaya, one chandramasa is of twentyseven days. Soadhyardha masa comes upto fortyone days. Even according to suryamasa, this periodis of fortyfive days only. The period of confinement or paricharya followed in ourvillages also supports this surya masa and chandramasa. ie, There is a tradition insome villages to follow the period of confinement for fortyone days in case of femalenewborn and this paricharya is up to fortyfive days for the newborn male baby. Even the lady is considered suthika till the period of punarartava darshana.The idea to do the paricharya till restart of menstruation is that for the regaining of thephysiological function of the uterus and even ovaries. Acharya kashyapa hasextended this duration to shanmasa, and has explained the paricharya for one monthperiod. The dhatuparipurnata or nourishment from rasa dhatu to shukra dhatu takes aminimum time period of one month only. Considering the demands of the growingbaby along with recuperation of her own body kashyapa might have extended thissuthika kala. This paricharya is bit elaborated or extended if the prasava is result of MudhaGarbha143. The four months dietic regime must be followed here, is necessarybecause there is already vata vaigunyata in the form of mudha Garbha and is furtheradded by the stress and strain of labour. Charaka acharya has explained themanagement of suthika stree after the mruthgarbha nirharana144. For the purpose ofgarbhashaya shuddhi, to elevate the mood of depressed suthika and to relieve thestress of labour the lady should be advised with sura, seedhu, arista, madira or asavaor any alcoholic drinks as per her strength. This is followed by use of balavardhaka,brumhana, yavagu specially without sneha till vishoshana of kledata in the dosha and A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  119 
  • 133. Discussion dhatu. Later sneha pana, basti, ahara vidhi with deepaneya, jeevaneya, brumhaneyamadhura and vatahara dravya can be followed. The Puerperial management given in modern paralance aims towards strictaseptic condition, supplementation of high calorie nourishing and fiber diet, adequatebed rest, care of bowel, bladder and even medicinal supplementation of Iron, calciumand proteins. All these criteria were fulfilled in the paricharya advised by ouracharyas. Involution and Lochial discharge - Adequate uterine involution with normal Lochial discharge are the prime changes in the puerperium. The drugs like panchakola either with snehapana or yavagu pana or usna gudodaka advised is for the purpose of expulsion of unwanted things or the after births. Dosha samyata - The paricharya is moving towards a state of normalcy of dosha. Abhyanga, parisheka etc all the procedures are vata shamaka, All internal supplementation either in the form of snehapana or yavagu pana or ushna gudodaka pana or yusha pana etc are also vata shamaka again. Yavagu pana, ushna gudodaka will does maintainance of pitta. Mamsarasa, balya brumhana annapana given after 12 days of paricharya all will do kapha vardhana. Dhatu samyata - The supplementation of balanced diet or high calorie food is been fulfilled by the administration of all the ahara given to suthika. The mandadi or yavagu pana or ushna gudodaka, shali bhojana, laghu annapana are the carbohydrate supplementation. There is addition of salt along with panchakola churna in the sneha pana given. Yava, kola, kulatha yusha prepared is a protein supplementation. The sneha yavagu or mamsa rasa given is fatty rich food, usna gudodaka is form of carbohydrate with water, mandadi karma advised does water, electrolyte and carbohydrate supplementation. Yusha with vidaryadi gana dravya is a mineral and vitamin in an electrolyte. The yavagu is either the sneha yavagu or ksheera yavagu becomes good supplementation. The milk is also being added and processed here. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  120 
  • 134. Discussion So all the vital nutrients in the form of Carbohydrates Proteins Fats Vitamins Minerals Salt and Water have been adequately supplemented in the parichaarya. Sthanya uthpathi & vriddhi - The complete or balanced diet given will inturn does rasa dhatu utpatti along with its upadhatu and also uttarothara dhatu poshana. This results in adequate lactation. Manah prasannata - This procedures not only makes her dosha, dhatu, agni in samavastha, but also maintains her psychological stability. Good mental stability in this will definitely avoid puerperial csycosis, one of the common ailments in puerperial period. Personal hygiene - The dhupana karma done as a part of regime or the advise of swasthavritha palana after 12 days of prasava are the measures of maintainance of hygiene or aseptic condition. Reappearance of reproductive cycles- The advise of jeevaneeya, brumhaneya, balya, madhura, vatahara hrudhya annapana to suthika is a sort of administration of anti oxidents or tissue vitalizers. The naveekarana done will also aim towards the preparation for next progeny. Immunomodulation - The paricharya also favours the bio-chemical changes occurring in puerperial period. These are the drugs which does the A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  121 
  • 135. Discussion  immunomodulation in a weakened suthika. There is an increase in humoral antibody response along with increase of cell mediated immune response inthe form of liberation of monocytes in to macrophages, ie, from blood stream to thetissues for the purpose of phagocytosis or to engulf the antigens. In spite of detail elaboration of paricharya, even there is a mention ofgeneral indication and contra indications mentioned by bhavapraksha. Here alongwith advise to follow all hitakara ahara vihara, there is a special mention to avoidvyayama, maithuna, krodha, sheeta maruta sevana etc. As all these apathyas willfurther aggravate the vata. suthika should follow regular abhyanga, sweda, snigdhaalpa pathya bhojana without any tandra or laziness atleast for a period of one month.Then only lady will become sarvatah parishuddha. As suthika is abala with shithila shareera, She is not fit for any shodhanaprocedures, Also there is no bahudosha avastha in lady after delivery. So theseprocedures are not advised any where in suthika avastha. Suthika stree by followingsamanya suthika paricharya will get back all the qualities of swastha.145 The hypertrophied muscle bulk in uterine endometrium will get reduced tonormal size, the abdominal and perineal muscles will regain their tone. The laxiety,loosening of ligaments in joints will become strong elasticity is regained, specially inpelvic sacroiliac joints, vertebral joints. In other words sama suvibhakta asthi sandhiare regained. State of Indreya prasannata, indreya drudhata is attained. The intensityof ruja or any vikaras becomes tolerable to her. ie, karshita shareera due to garbhavriddhi, what ever bala lost during pravahana vedana, kleda raktha nisruthi everything returning to her back will make suthika punah nava stree. After paricharyaSuthika will become tolerable to kshuth, pipasa, vyayama etc. The main modalities or achievements of paricharya ie, Garbhashaya shuddhi,dhatuparipurnata, sthanya vriddhi, punarnavekarana are completely established. Astage of Physical, mental and physiological well being is re-stabilized. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  122 
  • 136. Discussion Discussion on the drugs: The first and the foremost medication given is the Dashamoolajeerakakashaya, there is a classical reference as mentioned in Kashyapa Samhita4,Sharangadhara Samhita6, Yogarathnakara5, Bhaishajya Rathnavali7 and also in BhavaPrakasha8 for dashamoola kashaya in suthika. Kashyapa explains the Jwara haraproperty of dashamoola kashaya in suthika, specially in Kaphaja jwara and Sannipatajwara chikitsa. Usage and indication of Jeeraka in Suthika is mentioned inBhavaprakasha8 and Bruhath Nighantu Rathnakara9. The second formulation beingPanchakola kashaya, Usage of Panchakola churna either with snehapana or vataharakashaya or only with ushna gudodaka in suthika paricharya is very much supported inall Bruhatrayee1,2,3. Almost all the drugs in the group have ushna veerya, katu vipaka, laghuruksha guna and tridoha hara specially kaphavatahara property. These properties ofthe formulation were considered with an added benefit, as also shown by the modernresearches.Probable mode of action of the drug: Panchakola considered to have best deepana pachana function. Agni vardanaproperty is very much needed in suthika and is the first and the foremost aspect ofthis paricharya. The panchakola is the drug of choice in suthika, It is beneficial in allthe form of kashaya kalpana. Either by giving with sneha pana or with yavagu pana orwith ushna gudodaka or in the kashaya form the drug will do miracals in suthika. Katu rasa, teeksha ushna guna, Ushna veerya of the pippali etc drugs willimprove basal metabolic rate by increasing agni. which in turn helps the uptake of thenutrients to all the organs of the body. Infact pippali is one of the best bioavailabilityenhancer. These drugs are also having the effect to improve the dhatu by theirrasayana effect & help to nourish the shunya shareera. This may increase painthreshold of the patient. Suthika by regaining her bala will have proper sthanyautpathi and vriddhi also. The karmas like yoni vishodhana, garbhashaya shodhaka,garbhashaya sankochaka of pippali, chitraka etc drugs relieves the spasmodic A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  123 
  • 137. Discussion contration, establishes normal contraction and retraction thus favoring properinvolution of the uterus, and normalizes lochial discharge. Even prevents gettingfurther abdominal pain. Good involution with good amount of lochial discharge ensures srothoshodhana results in garbha kosta shuddhi. This will make almost half of the workdone. The Kashaya prepared of Panchakola helps in stimulating proper metabolismof the cells and excretion of waste products. This vatanulomana state leading tosubsidence of the pain also. It was observed by research that, by the roots of chitraka there is increase inthe locomotor behavior and central dopaminergic activity of the patients in theirvoluntary activities, by which we can consider that, it helps in relieving pain. Thenagara one among panchakola is not only having anti inflammatory, analgesic activitybut is a very good anti oxidant, Also showed anti thrombolytic activity, Thrombosisof the leg veins and pelvic veins is one of the common and important complicationsin puerperium, this ailment has successfully been avoided by the presence of this drugnagara- Zingiber officinalae. Even pippali, chitraka, chavya have considered to havea good free radical scavenging property. The improved appetite and digestingcapacity will move towards imporving the bala of the mother. With all these richnessof qualities it can be a very good immunomodulator. Dashamoola even though tridoshahara considered as best vatahara, thevatanulomana property is very much needed here for the proper excretion of mala,thus preventing the most common problem of constipation in puerperial women andeven favours excretion of sashesha doshas from garbhashaya, The mutrala effect of gokshura and shothahara, bastirogahara effect ofshyonaka among dashamoola specially favours regaining normal diuresis duringpuerperium, normalizes the frequency of micturation, helps in getting the sensationfor urge of micturation, its complete evacuation. All these are necessary for regainingthe bladder tone. Dashamoola equipped with vrana shodhana, ropana, shothahara, sandhaneyaproperty will enhances the healing of episiotomy. The general debility, body ache, A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  124 
  • 138. Discussion back ache, abdominal pain, pain and tenderness in the sutures all these are taken careby the vedanasthapana, vatahara, shulahara, grahi, vatanulomana etc properties. The sama dosha, sama agni, sama dhatu mala kriya is attained by the drug. Itsbrumhaniya, balya, pushtikara and rasayana properties which will help in the properformation of the Dhatus. It is also medhya, hrudhya in property which will elevatethe manasika factors favouring saumanasya janana in suthika. Increasing agni,proper excretion of mala, mutra and dusta shonita will defenetely increase the generalcondition of the mother, Her debility, weakness will gradually replaced by regainedstrength. All these vital qualities are super added by the sthnya janaka, raktha shodhaka,garbhasaya shotha hara, vedana sthapana and even balya properties of jeeraka. Thedrug also does the functions like kaphavata shamaka, pitta vardhaka, deepana,pachana, rochana, vatanulomana, grahi, mutrala, krimighna, jwaraghna etc It is evenconsidered as katupoustika. This will help in digestion by stimulating Amylase, protease and lipase - thedigestive enzymes, helps in proper digestion of carbohydrates, proteins and fats. Itsignificantly increases the secretion and flow of bile, improves digestion of fats andspeeds up the digestive process. Bile which is rich in bile salts and improves themetabolism of fatty acids. It is also been observed that this drug will enhanceassimilation, enhances the bioavailability of nutrients. All the karmas for enhancingthe bala of the suthika will aim towards the dhatuposhana in her, proper dhatuposhanaand sthanya janana properties will does upadhatu poshana, thus taking care of thelactation, its maintainance in the nurturing mother. Discussion on Patients – The study has been carried out in twenty post delivered ladies, consideringthe common ailments of the woman after child birth. The clinical study or themedications advised can be considered effective only when it provides relief fromher complaints and tackles the all possible complications by prevents them before A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  125 
  • 139. Discussion itself. With this view the medication has been selected in the study. Which showedimprovement in all common complaints as well as symptoms in the New mother. Drugs were selected on the basis of their properties keeping in mind theirprobable mode of action. To evaluate and to compare the efficacy ofDashamoolajeeraka kashaya and Panchakola kashaya in suthika paricharya. The 20patients selected were categorized into 2 groups. In Group A 10 patients were advisedwith Dashamoolajeeraka Kashaya and Group B of 10 patients were advised withPanchakola kashaya with the dose of 90ml thrice a day for period of 1 month. Andwas followed once in month for two times.Discussion on Observations Seen in Patients – Age - In the study, 40% of the patients belonged to the age group of 20-25 yrs,35% from the age group 25-30 yrs, 25% from the age group 30-35 yrs. The age groupbetween 20-35 is the average child bearing period for primi and multis respectively.The Age group between 20-25yrs may be attributed to age of marriage andconceiving soon after marriage. Religion- Maximum of patients that is 80% of them in the study hailed fromthe Hindu community and only 20% from the Muslim community and no patientsfrom the Christian community. However this may be due to Hindu dominantpopulation in this area. Domicile - Maximum no of patients that is 70% of them hailed from the Ruralarea and only 20% from the Urban area. This shows the people belonging to thehabitat and availing the facility of Ayurvedic Treatment. Education– Distribution of 25% from primary educaton, 25% from SSLC,45% from secondary higher education and 5% Graduates. How ever all the patientswere Literates, is the educational status of the ladies in the surrounding area.       Occupation- 80% of the ladies were House wives, 15% were daily wageworkers and 5% were Professionals. Even though all the ladies in the study group A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  126 
  • 140. Discussion were literates, most of women were not highly educateds, and are not doing anyprofessional work, hence more number of house wives were seen. Socio Economic Status - Distribution that is 40% from Middle class 35%from higher class and 25% are of Lower middle class of socioeconomic status wasseen in the study. This shows the status or particular class of people who are havingawareness towards ayurvedic management for delivery and puerperium. Diet- Most of the ladies that is 85% were consuming mixed diet. And only15% were vegetarians. This can be attributed to the food habits of the habitat. Thepeople in the surrounding area were habituated to take mixed diet. Gravida- Equal distribution of both Prime and Multis were taken for thestudy. 50% prime gravida, 30% second gravida, and 20% third gravida wereincluded. More of prime paras in the study were seen shows the awareness of thepeople towards family planning. Prakruthi– Maximum distribution of 45% of ladies seen from the kapha-pitta prakruthi, 35% from vata- kapha prakruthi and 20% from the vata-pittaprakruthi.  As the study conducted area is anupa desha, the even the food habits arealso of kapha pradhana ahara vihara, More number of ladies with kaphapitta orkaphavata prakruthi are observed in the study. Sara & Samhanana – Observing for dhatu sara lakshanas, 50% of studygroup are of madhyama sara, 30% are of pravara sara and 20% of patients are ofavara sara. Even in the observation for samhanana in the study group, it is seen that60% are of Madhyama samhanana, 30% had pravara Samhanana and 10% had avaraSamhanana. The sara and samhanana in the study group is good, most of them werewith susamhata asthi, sandhi, with good dhatu poshana. This shows that the dietaryhabits in this area. Satmya - 40% are of Avara satmya, 35% had Madhyama satmya and 25%had pravara satmya. The avara satmya is because most of ladies preferring only oneparticular taste of the food. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  127 
  • 141. Discussion  Satwa - 55% were of pravara satva, 25% with madhyama satva and 20%seen with avara satva. This shows that the mental status in this area is good and evenvery strong. Ahara Shakthi- 65% of ladies in the study were of pravara ahara shakti,30% are of madhyama ahara shakti and 5% are of avara ahara shakti before andduring the period of pregnancy. This shows that the capacity of intake of food isgood in this study group. Vyayama Shakthi- Most of the ladies that is 80% seen with pravaravyayama shakti, 15% with madhyama vyayama shakti and only 5% with avaravyayama shakti were seen during their prepregnancy period. This shows that thegeneral strength, stamina of the ladies in this sample is good.Discussion on Assessment Criteria before Treatment Appetite – In the study group 40% of patients showed equal distribution ofboth moderate and reduced appetite, 15% presented mild appetite and only 5% withgood appetite before the starting of the treatment. Suthika avastha is seen withagnimandhya. The contractions results in tiredness and weakness ends with reducedappetite. Micturation - Among 20 patients all had regular micturation habits beforetreatment with duration of 5-6 times in 75%, 6-7 times in 20% and 4-5 times a dayin 5% of patients. In order to avoid any possible UTI, or incomplete evacuation ofbladder or to regain the tonicity of bladder and urethral spinter activity. Regularmicturation habits, and action of diueresis for first 3-4 days of puerperium isneccssary. Here in study group most of the patients found with normal urination. Abdominal Pain – Soon after delivery, 40% of patients had moderateabdominal pain, 25% had no pain, 20% had mild abdominal pain and 15% had severeabdominal pain. Uterus becomes contracted, immediately after the process ofdelivery. This process of regular contraction and retraction favours involution ofuterus, discharge of lochia and some times intermittent or occasional abdominal pain. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  128 
  • 142. Discussion  Even in multiparas there may be reduced tone of uterine musculature andlaxiety of abdominal wall results in increased pain during contraction. Thus vigorouscontraction results to expel the retained clot. Such process may sometimes causeabdominal pain. The percentage of pain is more in multiparas. Strength- Among 20 patients 90% of patients had reduced strength and 10%had moderate strength. Contractions and baring down efforts during delivery, whichdefinitely effects the activities of the lady in suthikavastha. The fetal demands duringpregnancy and stressful labour pains, though physiological reduces the strength ofwomen. Lactation - Among 20 patients 95% of patients had inadequate or there is nosecretion from the breast and 5% presented with the colostrum secretion before theadministration of the medication. Certain amount of breast secretion some timesduring the period of pregnancy or soon after delivery is quite common. Sticky yellowsecretion from breasts that is colostrum will start after delivery and the breast milkproper or lactation sets in over a period of 2-3 days after delivery. Most of thewomen experiences Breast engorgement during 3rd or 4th post delivery day due toincrease of prolactin level. Back Ache – Before medication in the study group 25% presented withsevere back ache, 15% showed mild and moderate degree of backache and 45%were asymptamatic. Pregnant lady sustaining her gravid uterus for 9 months ofantenatal period, Superimposed with stress of labour pains and process of deliverywill definitely presents varying degree of back ache soon after delivery. Abdominal Wall Thickness - Among 20 patients as per measurementstaken before the treatment maximum of 45% measured with in 2-3cms, 30% with3-4cms, 15% showed 1-2cms and 10% had within 0-1cm of abdominal wallthickness. Along with increasing in girth of abdomen during pregnancy, there is alsodeposition of subcutaneous adipose tissue, adding to increase in abdominal wallthickness. Most of the postnatal ladies presented with varying degree of abdominalwall thickness measured in cms from vernier calipers. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  129 
  • 143. Discussion  Height of Uterus: - Among 20 patients maximum 60% of showed height ofuterus within 20-30cms and 40% had within 10-20cms. The evacuated uterus soonafter delivery of baby and placenta will becomes well contracted and measures withthe height of 24 weeks gravid uterus or around the umbilical level.Locial Discharge 1) Bleeding - Most of ladies that is 65% had just started with lochialdischarge (with no pads or half pads soaked), 25% presented with mediam bleedingper vagina (with 2 pads soaked), only 5% showed bleeding of 3-4 and 4-5 padssoaked soon after delivery. 2) Colour- 100% of patients had bright red colour lochial discharge. 3)Smell - 55% had fishy odour and 45% had no odour in their lochialdischarge. This shows the normal lochial discharge soon after delivery, withnormalcy in all its parameters like amount, colour and odour of discharge.Episiotomy wound Healing On examining the status of the episiotomy wound, Maximum of 45% ofpatients had severe tenderness, redness, swelling in episiotomy wound, 35% hadmoderate tenderness, redness and swelling in episiotomy wound, 15% had mildtenderness, redness and swelling in episiotomy wound and 5% had no tenderness,redness and swelling in their episiotomy wound. Soon after delivery, freshly stitched, Episiotomy wound will be ofcoursehealthy, But presents with the varying degree of symptoms of its inflammatorychanges started or will start soon, depending on the effect of analgesia.DISCUSSION ON EFFECT OF TREATMENT:Involution of Uterus. Group A – There is positive result in Involution of Uterus with a mean of20.000 before treatment, reduced to 19.550, 18.650, 17.300, 16.200 and 15.250 insuccessive treatment days (1,2,3,4,5) and on the day of discharge respectively. The A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  130 
  • 144. Discussion uterus was totally a pelvic organ on examination during D30 after treatment. P =<0.001 and T=6.333, shows that the treatment was stastically significant. Group B – Here there is good result in involution of Uterus with a mean of19.900 before treatment, 19.000, 17.450, 15.700, 14.300 and 13.000 in successivetreatment days (1,2,3,4,5) and on discharge respectively. Again the uterus was not tobe seen per abdominally on D30 of observation. P = <0.001 and t=10.495, showstreatment is stastically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.053). Good contraction of the uterus after delivery, followed by regular involution,is one of the significant changes in the puerperial women. Process of involution hasbeen markedly effected by any retained bits of placenta or any big clots not beingexpelled completely, This may adversly effect the general condition and may lead toinfection or may cause PPH also. The post delivery uterus has to be sent back to itsoriginal position by regular contraction and retraction. Here the process of involutionhas occurred in normal pace in both the groups. The drugs in Panchakola anddashamoolajeeraka kashaya having teekshna ushna garbhashaya shodhaka,garbhashaya sankochaka properties, favoured the process of involution and made theuterus a completely a pelvic organ. This involution process is better in the Group Bcompared to Group A, even though both the groups have succeeded in proper uterineinvolution.Lochial Discharge Amount of Bleeding - Group A - Study showed a good result over lochial discharge by maintainingits normal amount of bleeding with a mean of 0.300 before treatment, to 2.400, 2.400,1.800, 1.300 1.100 respectively during treatment of D1, D2, D3, D4, D5 afterdelivery. P=0.003 and t = -4.000, shows that the treatment was statisticallysignificant. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  131 
  • 145. Discussion  Group B – Study showed good result in maintaining normal Amount ofLochial Discharge with a mean va 0.700 before treatment, changed to 2.200, 1.700,1.300, 1.300 and 1.100 respectively during D1, D2, D3 D4 and D5 of the treatment.P=0.309 and t -1.078, shows that the treatment was stastically significant. Thedifference in the mean values of the two groups is not great enough to reject thepossibility that the difference is due to random sampling variability. There is not astatistically significant difference between the input groups (P = 1.000).Colour of Bleeding Group A - Study showed a good result colour of lochial discharge with amean of 1.000 before treatment, changed to 1.000, 1.100, 1.500 , 1.700 and 2.000respectively in D1, D2, D3, D4 and D5 of Treatment. P=0.001 and t=-4.743, showsthat the treatment was statistically significant. Group B - The study showed good result in maintaining normal Colour ofLochial discharge with Mean 1.000 before treatment changed to 1.000, 1.100, 1.100,1.600 and 2.000 respectively in D1, D2, D3, D4 and D5 of treatment. P= 0008 and t=-2.250, indicates that treatment is statistically significant. The difference in the meanvalues of the two groups is not great enough to reject the possibility that thedifference is due to random sampling variability. There is not a statisticallysignificant difference between the input groups (P = 0.749). Odour of Bleeding Group A – Study shows that the mean value remaining constant through outas 0.400. t=0.000 and P=1.000, indicates that treatment was stastically insignificant.Group B - Study showed good result in maintaining normal odour of LochialDischarge with Mean 0.700 before treatment to 0.700, 0.600, 0.500,0.300 and 0.200on successive D1, D2, D3,D4 and D5 of Treatment. t= 3.000 P=0.015, shows thattreatment was statistically significant. The difference in the mean values of the twogroups is not great enough to reject the possibility that the difference is due to randomsampling variability. There is not a statistically significant difference between theinput groups (P = 0.660). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  132 
  • 146. Discussion  Early in the puerperium, sloughing of decidual tissue results in a vaginaldischarge of variable quantity, is termed as lochia. Conventional obstetrical wisdomhas for many years taught that lochia lasted for approximately 2 weeks after delivery.Recent studies, however, have indicated that lochia persists for up to 4 weeks andmay stop and resume up to 56days after delivery. Maternal age, parity, infant weightand breast feeding do not influence the duration of lochia. The discharge may bescanty specially following premature delivery. May be excessive in twin andpolyhydroamnios, large placental site delivery. In some pathological conditions,such as anaemia the lochia may be very scanty. In cases of retro flexion of the uterusthe lochia may be retained & get decomposed. Occasionally as in septicemia, theremay be suppression of Lochia. Both the treatment groups showed very good result in normalizing the lochialdischarges including all the subparameters. The amount of lochia is within in normallimits in known in terms of number of pads used. An average 250ml lasts for 10-12days. Healthy lochia stains more deeply in the center than at edges. It is due to thedeposit of the heavier corpuscular element, while the serum exudes to the peripheralarea and stains less deeply. The second sub parameter being colour of lochia,remained arond the normal scale only. (bright red colour – 1-4days, Yellowish orpinkish or pale brownish 5-9 days, pale yellowish white-10-15days). Lastly the thirdsub parameter being odour of lochia also remained within normal barrier.(offensive,fishy or mawkish or even odour less all being normal.) This desired positive result might be due to the teekshna, ushna guna,katurasa, ushna veerya, vatanulomana, garbhashaya sanckochaka, garbhashayashodhaka properties of the drugs used in the treatment groups. Here there is betterresults in Group A compared to group B both in amount and colour of lochia. And interms of odour of the discharge Group B showed better result compared to groupA.Episiotomy wound healing Group A - Study showed a good result over the Healing in Episiotomy with amean of 2.4 before treatment, 2.7, 1.9, 1.3, 0.7, 0.3, 0.0 in successive days oftreatment (1,2,3,4,5) and follow up (D30, D60) respectively. P <0.001 and t =6.034, shows that the treatment was stastically significant. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  133 
  • 147. Discussion  Group B – In the study group mean before treatment was 2.0 which waschanged to 2.5,1.5, 1.2, 0.9, 0.4, 0.0 in respective follow ups(1,2,3,4,5) during andafter treatment. P <0.001 and t = 7.236 which indicates the treatment wasstatistically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.482). The episiotomy taken in order to facilitate the second stage of labour, needsproper and complete healing in the postnatal period so as to make the perineum strongand healthy. The process of wound healing is definitely been influenced by thegeneral health of the puerperium. Good hemoglobin percentage, proper circulation,formation of healthy granulation tissue, local hygiene etc play an important role inhealing of RMLE or LMLE taken. By increasing the digestive capacity, with properabsorption of nutrients will definitely increases the basal metabolism, the circulationis going to improve facilitating the healing process. Both the study groups havesucceeded in healing the episitomy wound of the puerperium. The deepana, pachana,vranaropana, shothahara, sandhaneya, vedanasthapana and tridoshara properties inboth the groups kept the wound healthy and made to heal faster. Here also the GroupA is little ahead compared to group B.Abdominal Pain Group A – There is much reduction in Abdominal Pain with mean 1.9 beforetreatment to 0.2, 0.0 respectively on day of discharge and successive follow up oftreatment. The t= 6.042 and P <0.001, which shows stastical significance. Group B – There is drastic reduction in abdominal pain with mean 1.0 beforetreatment to 0.0 on every observation days and successive follow up. P= 0.008,t=3.354, which indicates the treatment was stastically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 1.000). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  134 
  • 148. Discussion  In primiparas the puerperal uterus tends to remain tonically contracted.Particularly in multiparas, the uterus often contracts vigorously at intervals, givingrise to afterpains. Occassionally these pains are severe enough to require ananalgesic. Afterpains are noticeable particularluy when infant suckles, likely becauseof oxytocin release. To get rid of all sort of abdominal pain, here the lady needsbalya agnivardhaka drugs. By the garbhashaya sankochaka property there may berelieve from spasmodic contraction and normal contraction and retraction of uterus isestablished. There is also less chance for the blood clots to get accumulated ifgarbhashaya shodhaka, vatanulomana property results in proper lochial discharge. Itis more helpful if the sedative effect along with the antispasmodic property of thedrug is given to suthika. All these properties were very much observed in the drugsof the treatment group. Even the desired effect is shown in both the study groups withreduction in the abdominal pain of the puerperial lady. The group A withdashamoolajeeraka kashaya having all the good properties like vatahara, shoolahara,vedana sthapana, grahi, balya, dhatu poshaka etc. showed better result compared togroup B.Appetite Group A - In the study group mean before treatment was 1.3, which waschanged to 2.8, 2.5, 2.6 in respective follow ups during (D4) and after treatment(D30,D60). P= 0.002, t -4.333 which indicates the treatment was stasticallysignificant. Group B – The study showed good result in increasing appetite with a mean0.9 before treatment to 2.2, 2.5, 2.5 in successive follow up during (D4) and aftertreatment (D30, D60) respectively. P= 0.001, t=5.237, which indicates the treatmentwas stastically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 1.000). In the study most of patients presented with reduced appetite before treament,Soon there is marked improvement in the appetite of the patients in both the groups. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  135 
  • 149. Discussion This desired effect is due to deepachana, pachana properties of the drugs used. Eventhe drugs have rochana, vatanulomana, grahi etc properties. All these have showedgood impact on both the study groups. Being teekshna, ushna, deepana, pachanaproperties of panchakola kashaya, much more better result seen in Group B,compared to Group A.Bowel Habits Group A - Study showed a good result over Improving bowel habits withmean 0.0 before treatment, to 0.300, 0.600, 0.900, 1.00 on D2, D3, D4, D30, D60follow up during and after treatment respectively. P<0.001, t =9.00, shows that thetreatment was statistically significant. Group B - Study showed a good result over improving bowel habits withmean 0.100 before treatment, to 0.300, 0.600, 1.0 during(D2, D3, D4)and aftertreatment in every follow up(D30, D60), P<0.001, t=9.00, shows that the treatmentwas stastically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.331). Both the groups showed very good result in regularizing the bowel habits.The Group A with dashamoolajeeraka kashaya showed much better result comparedto Group B with panchakola Kashaya. Due to lack of nutritional fiber rich diet,inadequate water intake, or even due to intestinal atony, puerperium is more prone toget constipation, sometimes fissures and even hemorrhoids. The drugs in the studygroup after increasing appetite and digestive capacity no doubt showed normalizationof bowel. Rather dashamoola is having a good vatanulomana property, resulted inregular, non constipated easy bowel habits.Micturation Group A - In the study group mean before treatment was 0.100, which waschanged to 2.5, 2.8 and 2.8 in respective follow ups during(D4) and aftertreatment(D30, D60). P,0.001 and t = -17.676, which indicates the treatment wasstatistically significant. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  136 
  • 150. Discussion  Group B - Study showed a good result in Micturation habits of patient witha mean of 0.600 before treatment to 2.4, 2.2 and 2.2 in successive months oftreatment (D4) and follow up(D30, D60)respectively. P <0.002 and t = --4.311,shows that the treatment was statistically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.722). Both the treatment groups showed satisfying result along normal diureticaction in the first few days of the puerperium. There is injury and damage to thenerve plexus of bladder during delivery, the over distended bladder with oedematusmucousa makes stasis of urine hence incomplete evacuation. There is always morechance for urinary tract infections in the form of simple acute cystitis or even acutepyelonephritis sometimes. All these probabilities are handled successfully by thetreatment groups. Both the groups showed good result. The micturation has beenregularized in all the patients. There is no incidence of any sort of infection in any ofthe patients in the study. The Group A with dashamoolajeeraka kashaya havinggokshura,shyonaka etc important ingradients with mutrala, shophara, bastirogaharaproperty respectively, might be the cause for showing better result compared to Gr.B.Lactation – Group A - Study showed a good result over increasing lactation with a meanof 0.100 before treatment, 0.1, 0.5, 1.1, 1.5, 1.2, 1.0 in successive treatment(D1,2,3,4) and follow up(D30, D60) respectively. P <0.001and t = -8.018, shows thatthe treatment was statistically significant. Group B - Study showed a good result over increasing Lactation with a meanof 0.000 before treatment, to 0.100, 0.100, 0.900, 1.000, 1.500, 1,400, in successivetreatment(D1,2,3,4) and follow up(D30, D60) respectively. P <0.001 and t = -8.57,shows that the treatment was statistically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.177). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  137 
  • 151. Discussion  Establishment of lactation is one of the important measures in themanagement of puerperium. Desired results are found in both the groups withadequate lactation. There is regular increasing in the babies weight, the hydration,urination defecation every thing is being normal in all the newborn of the study groupmothers. There is no any undue result of either breast engorgement, mastitis, abscessetc. The sthanya utpathi and vridhi both depends on the dhatuposhana and nutritiongiven to the mother. Proper rasa dhatu nirmana favours the formation of sthanya itsupadhatu. Here the score of lactation is improved by the main chemical componentof panchakola. ie, piperine showed results in improving serum levels and also halflife of some nutritional substances like coenzyme Q10 and beta-carotene. It is alsodemonstrated that piperine may act as thermo nutrient, which increases the absorptionfrom gut. The drugs by increasing deepana pachana activity, will definitely increasethe general condition of the mother. In the Study group with the additional drugbeing jeeraka with sthyna janaka property also adds the special effect. The studygroup with panchakola kashaya showed very good result and better result comparedto group A.Back Ache – Group A – Here the study showed good result in relieving back ache withmean before treatment was 0.400, which changed to 0.300, 0.100, 0.200 during (D4)and after successive follow up (D30, D60) of treatment. With t-2.449 and P= 0.037,which shows that the treatment was statistically significant. Group B - Here also there is a good result in relieving from back ache withmean of 1.00 before treatment, to 0.400, 0.600, 0.500 during successive treatment(D4) and followup (D30, D60) period respectively. With P=0.273, t=1.168, whichindicates that the treatment was statistically significant. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.137). A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  138 
  • 152. Discussion  Incidence of backache in the women after delivery is one of the mostcommon problems today. The musculoskeletal system has undergone muchadaptations during the pregnancy period due to the changing position of the graviduterus. Even there is much wear and tear during the process of labour and delivery.Such a overstreatched or altered backbones, muscles, ligaments needs rest to regainits tone and stability. The site of pain in the back after delivery may be at the regionof coccygeal, lumbar, sacroiliac, thoracic vertebra, sometimes cervical vertebra also.Here in the study group this common puerperial problems have been considered asone of the parameters, and the desired effect has been shown in both the study groups.The dashamoolajeeraka kashaya with special properties like vatahara,vedanasthapana, shula prashamana, dhatu poshana, balya, rasayana etc propertiesshowed very good result compared to group B.Abdominal Wall Thickness – Group A- The study showed no reduction in the abdominal wall thicknesswith mean of 2.180 before treatment, changed to 1.920, 1,990 during D4 and D30 oftreatment and remained 2.120 in D60 & D90 of follow up as well. t= 0.461 and P=0.656, which shows that the treatment was not statistically significant. Group B - Here also is no reduction in abdominal wall thickness with meanof 2.420 before treatment, to 2.220, 2.420, 2.320 and 2.320 respectively duringtreatment (D4, D30) and in each successive follow up (D60, D90), P=0.343 andt=1.00, which is confirming that the treatment was not stastically significant. The course of antenatal period, has contributed some amount of deposition ofadipose tissues over the abdomen, back and hips of the pregnant women with thedue increase of body weight of around 12 to 15 kgs. There is increase of abdominalgirth every month due to growth of the fetus, accumulation of subcutaneous fat alsoadds to it. The drugs in the treatment groups were selected with the intension ofreducing the abdominal fat of the postnatal woman. But the study showed negativeresults, there is no such properties in the medications given so that it will reduce theabdominal wall thickness of the mother. This might be due to the lack of karshana orlekhana properties in the drugs given. Instead these drugs were having dhatuposhana, rasayana and balya properties. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  139 
  • 153. Discussion Strength Group A - Study showed a good result over improving strength with a meanof 0.100 before treatment, which increased to 1.00, 1.900,1.900 in successivetreatment (D4,) and follow up(D30, D60) respectively. P <0.001and t = -13.50, showsthat the treatment was statistically significant. Group B - Here also there is a good result in improving the strength by thetreatment. Mean value being 0.100 before treatment, to 1.200, 1.700 and 1.900 onsuccessive treatment (D4) and follow up (D30,D60) respectively. P<0.001, t-13.500,shows that the treatment was significant stastistically. The difference in the mean values of the two groups is not great enough toreject the possibility that the difference is due to random sampling variability. Thereis not a statistically significant difference between the input groups (P = 0.288). Strength is one of the subjective criteria, After the process of strenuouslabour, around 250ml of blood loss, mental stress, emotional stranguability etcduring labour, the newmother definitely will experience loss of strength or weaknessor debility. The whole paricharya itself aims towards regaining the strength of thesuthika. Here considering improvement in strength as one of the criteria, the studygroup showed good results, this might be due to the properties like tridosha hara,deepana, pachana, dhatuposhana, hrudya, medhya, balya etc of thedashamoolajeeraka and panchakola kashaya, and both the groups showed equallygood results. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  140 
  • 154. Conclusion   CONCLUSION AlÉålÉ ÌuÉÍkÉ or different procedures followed including ahara and achara forthe purpose of punarnaveekarana of the stree itself is Suthika paricharya. It is re-tuningor process of rejuvenation done for the purpose of swasthya rakshana. It is the paricharyafollowed in order to protect herself and her infant too. Dashamoolajeeraka Kashaya and Panchakola kashaya given in Suthika is notonly to prevent her from diseases but also to get back all her prepregnancy energy andstamina. The very definition of suthika finds relevance with the definition of puerperiumthat after placental expulsion only the lady can be called as puerpura. Regarding theduration of Suthika also there is similarity that both sciences accept six weeks ofstipulated regimen to be followed. Even the list of complications or diseases by notfollowing proper paricharya are also almost the same. The study has shown fruitful results over increasing appetite, clears the passageof bowel, micturation, and vaginal discharges. Helps in proper involution of the uterus,prevents abdominal pain. Relieves back ache, gives energy and strength. Ensures properepisiotomy healing. Inspite of all benefits to suthika, it does sthanya utpatti and sthanyavriddhi beneficial for the proper growth and development of the newborn. Further evaluation of the action of kashayas for showing negative effect inreducing abdominal wall thickness, whether due to lack of any karshana or lekhanaproperties in drugs used or due to lacunae of not following complete paricharya, ormedications must have been administered for still more number of days. Further studies in the same topic can be carried out in large sample for betterresults, since the sample here was too small. In further studies one should concentrate much on the laboratory findings likeurea and creatinine of puerperial urine, hormonal assessment before and after delivery,haematocrit values and even the period of return of menstruation and ovulation. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya  141 
  • 155. Summary SUMMARY The dissertation entitled “A COMPARATIVE CLINICAL STUDY OFDASHAMOOLAJEERAKA KASHAYA AND PANCHAKOLA KASHAYA INSUTHIKA PARICHARYA. “ is been discussed under headings namely review ofliterature, Methodology, Observation, Results, Discussion and Conclusion.Introduction: Woman in this present era, is struggling between increased responsibilities of herfamily and profession. She does not have time for herself. There is more incidence ofback ache, loss of strength, feeling of weakness and even psychological instability seentoday. To fulfill her responsibilities successfully, she has to be fit and fine. There is morenecessity of Paricharya to such a busy scheduled new Mother. So the present study hasbeen selected.Review of literature: Historical Review: Has been dealt with the origin and reference of SuthikaParicharya from the beginning stage of prevedic period and also the History ofpuerperium. Suthika paricharya: Ayurvedic review, Suthika paricharya has been understoodaccording to different acharyas. The mode of paricharya, importance of the therapiesadministered, stage wise deepana pachana peyadi supplementations, gradualadministering of nourishing diet and landing in swastha vritha palana ie to normalcy,have been dealt. Puerperium: Modern review of Puerperum with the different stage wiseexplanation, Genital and hormonal and systemic changes taking place in puerperialperiod and their management have been dealt with. Drug review: The drugs used in the study have been detail discussed along withits composition and active principles of the extracts by the modern research carried out onthe drug. The action of the drug has been hypothetically concluded due to ushna, A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 142
  • 156. Summaryteekshna gunas, katu rasa, with deepana, pachana, vatanulomana properties doinggarbhasaya sankochana and garbhashaya shodhana improving proper lochial dischargewith good involution of uterus. Also helpful in improving over all general condition andeven lactation of the Mother.Methodology: This explains about method of data collection, inclusion criteria, exclusion criteriaand assessment criteria i e the complete study design involved.Observation: The observations noted through out the study process has been included under thispart of the dissertation work.Results: Statistical significance of the study has been incorporated here. Study has beenfound effective in relieving symptoms like backache and abdominal pain. It has beenproved effective in improving appetite, regularising bowel and micturation habits.Helpful in proper uterine involution, proper and complete Lochial shedding, andsuccessful in improving the strength and Lactation of the mother.Discussion: Here the Role of ahara and achara mentioned in Suthka paricharya were analysed,along with the mode of action of the Dashlamoolajeeraka kashaya and Panchakolakashaya in selected criterias of assessment and also the discussion on the observation andeffect of treatment on patients has been discussed.Conclusion: Conclusion drawn from various sections of the work are given in this part of thedissertation. i e. Both Dashamoolajeeraka kashaya and Panchakola kashaya are equallypotent and can be advised in the Suthika Paricharya. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 143
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  • 170. Annexure  CASE- PROFORMA S.D.M. COLLEGE OF AYURVEDA- UDUPI Department of Prasoothi Tantra and Stree Roga 2007-2010 “A COMPARATIVE CLINICAL STUDY OF DASHAMOOLAJEERAKA KASHAYA AND PANCHACOLA KASHAYA IN SOOTHIKA PARICHARYA."ATURA VIVARA:Name: Serial No:Age: OPD No:Religion: IPD No :Education: DOA:Occupation: DOD:Socioeconomic Status: Diagnosis:Address: Results: Comfortable relief/ Moderate relief / Unchanged.PRADHANA VEDANA:ANUBANDHA VEDANA:POORVA VYADHI VRITTANTA: Specific- Infection / Infertility / Abortion General if any -KOUTUMBIKA VRITTANTA: Family H/o- HTN / DM / TB / ASTHAMAVAIYAKTIKA VRITTANTA: Diet- Veg / Mixed Appetite- Sleep- Sound / Disturbed Bowel- Regular / Irregular Micturation- Habits- Coffee / Tea / Tobacco chewing / others if any. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 157  
  • 171. Annexure RAJO VRITTANTA: Menarche- Menstrual Cycle-PRASAVA VRITTANTA: Married Life- G/P/A/D/LGravida Para Live Birth Abortion Method Sex Year Of No. of the Delivery ChildLMP-EDD- First Stage of Labour- Second Stage of Labour- Third Stage of Labour- GENERAL EXAMINATION: Built - Well / Moderate / Poor Pallor - Conjunctiva - Present / Absent Nail bed- Tongue- Ictrus- Present / Absent BP- mm of Hg Pulse- /min Heart Rate- /min Temperature- F Weight- kg A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 158  
  • 172. Annexure ASTA VIDHA PAREEKSHA: Nadi- Shabda- Mala- Sparsha- Mutra- Druk- Jihwa- Akruti-DASHA VIDHA PAREEKSHA:Prakruti: V / P / K / VP / VK / PK / SAMAVikruti: V / P / KSara: Rasa / Rakta / Mamsa / Meda / Asti / Majja / Shukra / Sarva P / M / ASamhanana: Pravara / Madhyama / AvaraSatmya: Ekarasa / Sarvarasa / Mishra Rasa Pravara / Madhyama / AvaraPramana: Heena / Madhyama / UttamaSatwa: Pravara / Madhyama / AvaraAhara Shakti: Pravara / Madhyama / AvaraVyayama Shakti: Pravara / Madhyama / AvaraVaya: Bala / Madhyama / vriddhaSYSTEMIC EXAMINATION: Respiratory System: Cardiovascular System: Gastro Intestinal System: Central Nervous System:LOCAL EXAMINATION: Examination of External Genitalia- Episiotomy Wound- Healthy / Tender / Swelling / Redness Breast Examination- Breast Engorgement- Present / Absent Colostrum- Present / Absent Breast Milk- Present- adequate / Inadequate Absent. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 159  
  • 173. Annexure DETAILS OF NEWBORN: Sex- Birth weight- Apgar Score- Bowel- Micturation-INVESTIGATION: Blood - Hb% Urine Routine- Albumin if necessary Sugar MicroscopicTREATMENT:Follow up- Once in a month for 2 Months. A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 160  
  • 174. Annexure ASSESSMENT CRITERIA: B/T D/T A/T D1 D2 D3 D4 D5 1M 2MAPPETITEBOWELHABITSMICTURATIONLOCHIALDISCHARGE a) Amount b) Colour c) SmellABDOMINALPAINLACTATIONBACK ACHEABD WALLTHICKNESSSTRENGTHINVOLUTIONOF UTERUSEPISIOTOMYWOUNDHEALINGSignature of the Guide. Signature of the PG Scholar. (Dr. Ramadevi G.) (Dr.G.M.Kavya.) A Comparative Clinical study of Dashamoolajeeraka Kashaya and Panchakola Kashaya in Suthika Paricharya 161