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Vishamajwaram kc029 gdg
Vishamajwaram kc029 gdg
Vishamajwaram kc029 gdg
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Evaluation of the efficacy of THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER By MANGALAVVA .B. PATIL, Department of Kayachikitsa, Post graduate studies and research …

Evaluation of the efficacy of THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER By MANGALAVVA .B. PATIL, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • 1. Evaluation of the efficacy ofTHE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER By MANGALAVVA .B. PATIL Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. V. Varada Charyulu M.D. (Ayu) (Osm) Dr. R.V.Shettar M.D. (Ayu) Department of Kayachikitsa Post Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2002-2005
  • 2. D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OFTHE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCETO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”in partial fulfillment of the requirement for the post graduation degree of “AyurvedaVachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,Bangalore, Karnataka.Dr. R V SHETTAR Dr. V. VARADA CHARYULU M.D. (Ayu) M.D. (Ayu) (Osm)Co- Guide GuideLECTURER IN KAYACHIKITSA Professor & HODDGMAMC, PGS&RC, Gadag Dept. of KayachikitsaDate: PGS&RCPlace: Gadag Date: Place: Gadag
  • 3. J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGE POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103 Endorsement by the H.O.D, Principal/ head of the institution This is to certify that the dissertation entitled “EVALUATION OF THE EFFICACY OFTHE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCETO MALARIAL FEVER” is a bonafide research work done by “MANGALAVVA .B. PATIL”under the guidance of Dr. V. VARADA CHARYULU, M.D. (Ayu) (Osm), Professor & HODand Dr. R V SHETTAR, M.D. (Ayu), in partial fulfillment of the requirement for the postgraduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev GandhiUniversity of Health Sciences, Bangalore, Karnataka.. (Dr. V. Varada charyulu) (Dr. G. B. Patil) Professor & HOD Principal, Dept. of Kayachikitsa DGM Ayurvedic Medical College, PGS&RC Gadag Date: Date: Place: Gadag Place:
  • 4. Declaration by the candidate I here by declare that this dissertation / thesis entitled “EVALUATION OF THEEFFICACY OF THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIALREFERENCE TO MALARIAL FEVER” is a bonafide and genuine research work carried outby me under the guidance of Dr.V.Varada Charyulu M.D.(Ayu) and Dr. R.V.Shettar, M.D.(Ayu), lecturer in Kayachikitsa, DGMAMC, PGS&RC, Gadag.DatePlace MANGALAVVA .B. PATIL
  • 5. Copy right Declaration by the candidate I here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis in print orelectronic format for the academic / research purpose.DatePlace MANGALAVVA .B. PATIL© Rajiv Gandhi University of Health Sciences, Karnataka
  • 6. I express my deep gratitude to my guide Dr. V. Varadacharyulu M.D.(Ayu), Professor andH.O.D., for his timely advises and encouragement in every step of my success. I express my gratefulness to my co-guide Dr R. V. Shettar, M.D (Ayu) lecturer inKayachikitsa, for his time to time help and critical suggestions associated with expert guidance at thecompletion of this dissertation. I express my thankfulness to beloved principal Dr. G. B. Patil, Principal for hisencouragement as well as providing all necessary facilities for this research work. I express my profound sense of acknowledgement to various departments H.O.D.s, teachersand colleagues of sister concern departments along with the ministerial and sub staff of the D.G.M.Ayurvedic Medical College, Gadag. I express my sincere thanks to Dr. K. Shiva Rama Prasad, Dr. Shashidar. H. Doddamani, Dr.Kuber Sankh, Dr. P. Shivaramudu, Dr. M.C. Patil, Dr. Santhosh Belavadi, Dr. Mulkipatil and DrKona. I express my sincere thanks to Mr. Nandakumar for his help in statistical analysis of results. Aspecial thanks on this regard to Dr. Danappagoudar for his valuable support at the preparation of thedrug. I express my deepest gratitude to my beloved parents, Sri B.H.Patil and smt G.B. Patil, andmy husband Sri Shivkumargouda S.Patil, who supported me all the time. I express my sincere thanksto one and all of my relatives and well wishers Dr. D.M.Patil, Dr. Meenakshi, Dr. Shankargouda,Dr. Chetan, Dr. Joshi. D.P, All my colleagues and Harun Kowshik, Smt Valli Shree for their co-operation at all times. At first my sincere thanks to the subjects who co-operated at my dissertation, with out ofthem it would have been not a success.Place: Dr. MANGALAVVA .B. PATILDate: Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
  • 7. Evaluation of the efficacy of the Bharangyadi Ghana Vati in Vishamajwara with special reference to malarial fever Dr. MANGALAVVA .B. PATIL Abstract Vishamajwara vis-à-vis Malaria or a disease resembling malaria has been notedfor more than 4,000 years. Vishamajwara characterised by visamarambha (irregularonset). Dalhana consider bhutas (Keetanu – Parasites) responsible to produceVishamajwara. Cough may be a presenting feature of malaria with severe anaemia canbe a presenting feature of malaria. In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in otherjwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get thedifferent Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara,Triteeyak jwara, Chaturthak jwara and Chaturthak jwara. In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi andKirata Tikta. Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara,Deepaka, Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and AmaharaDravyas are used in the Bharangyadi Ghana Vati. Present study registers 30 patients, out of 68 approached patients. The remaining26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusivecriteria were included in the study. The observation of the jwramukta Lakshana shows that the effect of theBharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is admissible.All theparameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance.. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
  • 8. Table of contents Heading Page numberChapter - 1 Introduction 1 to 6Chapter –2 Objectives 7 to 8Chapter –3 Review of literature 9 to 87Chapter –4 Methodology 88 to 107Chapter –5 Results 108 to 139Chapter –6 Discussion 140 to 157Chapter –7 Conclusion 158 to 163Chapter –8 Summary 164 to 164 Bibliographic References I to X Annex – Case sheet 1 to 6 Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
  • 9. List of figuresSno Figures heading Page1 Photograph of Parvateeya Mashaka 102 Geographical distribution of the Malaria 133 Postal Stamp released by Government of India on the occasion of 24 Malaria control4 Life cycle schematic diagram 375 Sporogonic and Erythrocytic cycles of Malaria 386 Exogenous and Endogenous Phases of Malaria 397 Ingredients of Bharangyadi Ghana Vati 688 Laboratory diagnosis of malaria fever 989 Finished Product of Bharangyadi Ghana Vati 108 List of Flow chartsSno Flow charts heading Page1 Classification of aetiology of Vishamajwara 462 Schematic diagram of Vishamajwara Samprapti 59 Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
  • 10. List of graphsSno Graph heading Page1 Distribution of patients by Age 1092 Distribution of patients by Age- gender 1113 Distribution of patients by Gender 1124 Distribution of patients by Religion 1135 Distribution of patients by Occupation 1156 Economic status distribution Vs Vishamajwara vis-à-vis Malaria 1167 Distribution of patients by Economic status 1178 Distribution of patients by Hygienic Condition 1199 Distribution of patients by Diet 12010 Distribution of patients by presenting complaints 12111 Distribution of patients by Associated features 12312 Distribution of patients by type of Jwara 12413 Distribution of patients by Pranavaha sroto dusti Lakshana 12514 Distribution of patients by Rasavaha sroto dusti Lakshana 12615 Distribution of patients by Annavaha sroto dusti Lakshana 12716 Distribution of patients by Swedavaha sroto dusti Lakshana 12817 Distribution of patients by Nidana 13018 Distribution of patients by Poorva Roopa 13119 Distribution of patients by Jwaramukta Lakshana 13220 Aniyamita Jwara (mean) in Vishamajwara 13321 Graph the temperatures (mean) in Vishamajwara 13522 Distribution of patients by Result in Vishamajwara 137 Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
  • 11. List of tablesSno Table Heading Page1 Showing the Dosha pradhanyata in Malaria 552 Duration and vega in different jwaras 583 Showing the Vishamajwara vishista Lakshana 604 Distribution of patients by Age 1095 Distribution of patients by Age- gender 1106 Distribution of patients by Gender 1127 Distribution of patients by Religion 1138 Distribution of patients by Occupation 1149 Distribution of patients by Economic status 11710 Distribution of patients by Hygienic Condition 11811 Distribution of patients by Diet 11912 Distribution of patients by presenting complaints 12113 Distribution of patients by Associated features 12214 Distribution of patients by type of Jwara 12315 Distribution of patients by Pranavaha sroto dusti Lakshana 12516 Distribution of patients by Rasavaha sroto dusti Lakshana 12617 Distribution of patients by Annavaha sroto dusti Lakshana 12718 Distribution of patients by Swedavaha sroto dusti Lakshana 12819 Distribution of patients by Nidana 12920 Distribution of patients by Poorva Roopa 13021 Distribution of patients by Jwaramukta Lakshana 13222 Evaluation of Subjective Parameters 13323 Evaluation of objective Parameters 13424 Showing the temperatures (mean) in Vishamajwara 13525 Distribution of patients by Result in Vishamajwara 13626 Statistical analysis of the clinical parameters at the end of treatment (21 137 days)27 Statistical analysis of the objective parameters at the end of treatment 138 (21 days)28 Statistical analysis of the clinical parameters at the end of follow-up (36 138 days)29 Describing the pharmacological properties of Bharangyadi Ghana Vati 14530 Describing the Chemical constituents and Indications of individual 146 components of Bharangyadi Ghana Vati Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
  • 12. Chapter –1 Introduction “ osquito makes man Eunuch”, is popular dialogue of the film actor.Fact is that the mosquito really conquers the eco-symphony of the earth and disturbed muchand more of human life. Now a day an average spending of human on mosquito repellentsare sufficient to maintain a family. Asian, African, etc, tropical countries are badly effectedby this small tiny untidy creature and Governments are fallen because of the same. Vishamajwara, a most popular Ayurvedic term in turn of modern medicalterminology co-related to malarial fever, is a protozoan disease caused by genusplasmodium and transmitted to man by certain species of infected female anophelesmosquito. Indias geographic position and climatic conditions are favourable for thetransmission of malaria. Frequently people living in the endemic areas are prone for thisinfection. Out of 300-500 million clinical cases around 100 countries and one million deathsdue to malarial malady are noticed globally. The 38th world health assembly in 1985 recommended that, malaria control shouldbe developed as an integral part of the national primary health care systems. 1-2-3 Vishamajwara is irregular (inconsistent) in its arambha (nature of onsetcommitment), kriya (action production of symptoms) and kala (time of appearance) and 4-5-6possesses anushanga (persistence for long periods) . As on today, the malarial parasitehas developed resistance to chloroquine compounds, which are used vividly for the pastthree decades. The emergence of multiple-drug resistant strains of malaria, which has accompanied Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
  • 13. each new class of anti-malarial drugs, is one of most significant threat to the health of peoplein tropical countries. While there is widespread agreement that a fresh approach to theprevention and treatment of malaria is urgently needed, solutions have tended to focus onthe development of new classes of drugs. More recently, there has been an emphasis onpromoting combination therapy of existing drugs as a means of preventing resistance. Historically, however, local communities in tropical regions have used local flora asa means of preventing and treating malaria (Kirby, 1997). It can be argued that thesetraditional medicines, based on the use of whole plants with multiple ingredients or ofcomplex mixtures of plant materials, constitute combination therapies that may well combatthe development of resistance to anti-malarial therapy.Resistance, synergism and traditional medicines Medical science is beginning to recognise aspects of synergy, complexity andpotentiation in malaria therapy. At the same time, little significance is as yet being given tothe obvious point that all of the major anti-malarial have been derived from plants, oftenbased on traditional knowledge about the effects of the plants against fever, or specifically,malaria. The call to combine anti-malarials overlooks the fact that combination existed inthe traditional formulations before the process of extraction took place. In view of this, itmust be asked whether any pre-existing synergism, and hence challenge to the developmentof resistance, may have been lost in the process of extraction, isolation and synthesis of newmolecules. For instance, the artemisinin drugs (artesunate, artemehter, dihydroartemisinin) arederived from artemisia annua, used in traditional Chinese medicine as an antipyretic. Anexamination of traditional Chinese medical knowledge and practice would reveal that it was Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
  • 14. usual for this plant to be used in combination with others in the treatment of fevers. In thedevelopment of the new artemisinin drugs, not only has this been overlooked, but thecomplex of alkaloids in the plant itself have been sacrificed for the purpose of isolation of aso-called single active ingredient. Indeed, flavinoids in Artemisia annua, which arestructurally unrelated to the anti-malarial drug artemisinin, enhance the in vitroantiplasmodial activity of artemisinin 7. Elsewhere, synergism has been observed between the alkaloids of the anti-malarialplant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-parasitic activity than any of the six alkaloids isolated subsequently. In studies on anti-malarial plants from Madagsacar, the alkaloids bisbenzylisoquinoline , novel pavine andbenzyl tetrahydroisoquinolines all were found to potentiate the anti-parasitic activity ofchloroquine in vitro and, in some case, in vivo. Preparations of these plants are currentlybeing tested as adjutants to chloroquine therapy in Madagascar (Kirby, 1997). In Uganda,there is data from clinical case reports that a traditional Ugandan herbal remedy is effectiveagainst malaria. (Bitawha et. al., 1997) Utilisation of traditional medicine is widespread in developing countries and theefficacious of many traditional treatments have been well documented, including in skindisease, malaria and other disorders. Despite growing policy interest in traditional medicine,and the seminal 1997 Dakar meetings on malaria recommending research into herbal anti-malarial, there has been almost no research into the clinical effectiveness of herbal remediesas they are used in real life. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
  • 15. The research initiative for traditional anti-malarial methods (RITAM) To redress this situation, a partnership was established in December 1999 betweenthe Global Initiative For Traditional Systems (GIFTS) of Health, the Tropical DiseaseResearch Programme of WHO and individual scientists, traditional health practitioners andothers to investigate evaluate and, where appropriate, develop traditional herbal medicines tocombat malaria. It is the Research Initiative for Traditional Anti-malarial Methods (RITAM) Many people live in malarious regions, traditional herbal medicines may be the onlycourse of treatment available. Therefore, research into, promoting and increasing theunderstanding of the nature of crude plant derived medicines are key research priorities.Plants are usually identified for study on the basis of a traditional reputation foreffectiveness, usually for treating or preventing malaria and other fever related conditions. In designing new treatments, drugs and public health programmes in developingcountries, it can be considered unscientific to cast aside traditional knowledge and wisdomafter cursory review, on the assumption that modern methods of analysis and explanation aresuperior. RITAM members have developed four specialist groups to implement a researchstrategy designed to make a significant contribution to malaria control programmes: 1. Policy, advocacy and funding 2. Pre-clinical studies 3. Clinical development 4. Repellence and Vector Control 8 The Indian Systems of Medicine & Homoeopathy is popular in a large number ofStates in the country. There are separate Directorates of ISM&H in 18 States. Ayurveda, Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
  • 16. Homeopathy, Unani, Yoga & Naturopathy and Siddha systems together called as IndianSystems of Medicine. These systems have become part of the culture and traditions of ourcountry 9. Drug resistance to chloroquine in P. falciparum was reported in India for the firsttime from Assam in 1973. Since then the foci of resistance have spread to many more statesall over India. The situation has further deteriorated in the recent past due to parasitebecoming resistant to other available drugs in addition to chloroquine. Sulphadoxine-pyrimethamine, a second line drugs for P. falciparum is not effective for P. vivax malaria.Quinine is still effective but as oral monotherapy it has limited role in mild malaria becauseof 7-day regimen. Mefloquine and artemisinin have specific indications. Therefore, newdrugs and treatment strategies need to be developed as a priority. Development of new drugs involves extensive pre clinical and toxicological studiesfollowed by well-planned clinical trials. At MRC, a number of new drugs have beenscreened in clinical trials for evaluation of safety and efficacy. Based on these data, thedrugs have been registered with Drugs Controller General of India for commercialmarketing and also for use in national programme underAyush-64 Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extractof bark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seedpulp–3 parts). The drug was patented by the Central Council of Ayurveda and Siddha and toconfirm the efficacy in well designed scientific trial, open prospective, non-crossover, Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
  • 17. randomised clinical trial was conducted in P. vivax malaria patients at the Centre in 10.collaboration with NAMP Results showed that with Ayush-64 cure rate on Day 28 was48.9% at a dose of 1 g three times a day for 5–7 days as against 100% with chloroquine1500 mg over three days 11. Ayurvedic herbs have an important role in the treatment of malarial fever. Even thechloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogashave been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,low-priced and has no proved adverse effects 12 against malarial fever. Thus the present study has been under taken as “Evaluation of the efficacy of theBharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. A fewnumbers of clinical trials have been conducted in different Ayurvedic institutes in India,regarding Vishamajwara. These are as follows - Year / scholar Title Institute name1980 M.V. Chari Clinical and experimental study of medicinal Gujrat Ayurveda plants in the treatment of malaria. university, jamnagar.1981 M.V. Chari A double blind clinical trial with ayush. 64 an Do Ayurvedic drug in P. vivax malaria.1981 K.D. Sharma Clinical trial of ayush 64 in case of malaria C.C.R.A.&S. New delhi1982 Kanaka rai dal A study of management of Vishamajwara G.A.U. Jamnagar1982 Jagabandhu Clinical study of panchatikta ghaanabati on G.A.M. Puri. (orissa)das Vishamajwara1985 Kishore panda “therapeutic evaluation of Kiratatikta ghanabati Do on Vishamajwara”1994 B. Baliarsingh “clinical trial on ajajiguda yoga in Do Vishamajwara vis-à-vis malaria1991 Deshmukh 54 Anaetiopathological study on the management Kerala university of vishama jwara with bnuranggadi kwata trivendrum1983 mahant Ushna jwara Governmentdhaneshwar Ayurvedic college hyderabad Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
  • 18. Chapter -2 Objectives resent study bears the following objectives - 1. To evaluate the efficacy of the Bharangyadi Ghanavati in Vishamajwara (Malarial fever) 2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara (Malarial fever) 3. To evaluate the anti-malarial properties of Bharangyadi Ghanavati in Vishamajwara (Malarial fever) Detailed discussion of above mentioned objectives are as under –1. To evaluate the efficacy of the Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) Many herbal compounds and herbo-mineral compounds are listed in Ayurveda topacify the Jwara, especially Vishamajwara. Ayurveda offers more importance to that of therise of temperature, which is a protective and also pathological identity of the any ailment Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 7
  • 19. present in the body. The jwara called as fever may not be a big problem from thecontemporary but as par Ayurveda it is a primary symptom and a disease also some times acomplication. This particular condition needs through emphasis and management. In thisprocess a laboratory identified malarial parasite expression as fever i.e. Vishamajwara isextensively studied and the efficacy of the Bharangyadi Ghana Vati in Vishamajwara isemphasized.2. To evaluate the antipyretic properties of Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) The main aim of the study is to see the antipyretic effect of the selected drug,Bharangyadi Ghana Vati in Vishamajwara. The fever is rise in body temperature. Thisprimary symptom which give the inconvenience is to be forbidden at the earliest to providecomfort to the patient. Thus the antipyretic effect is specially studies under the guide lines ofAyurveda in comparison with that of the contemporary medicine.3. To evaluate the anti-malarial properties of Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) The chosen drug Bharangyadi Ghana Vati is assumed as a best medicament at therelieving the jwara i.e. fever by all means. Its antipyretic effects also a sure thing. But manya times a doubt is raised is whether any Ayurvedic drug acts as anti-microbial, anti-viral oranti-malarial? To achieve the answer for the above raised question and to strengthen theAyurvedic glory to establish Ayurvedic scientific grounds the evaluation of the anti-malarialproperties were under taken as one of the objectives of the study. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 8
  • 20. Chapter -3 Literary review yurveda is a perfect science of life and consists of a body of mostremarkable knowledge on the internal mechanism of human health and longevity, onmedicinal herbs and therapeutic roots, on the efficacious treatment of human ills byeradicating from the human system the very sources of their causation. This great medicalscience and humanity’s most ancient and finest preventive school of practical medicine,which has been practised in India, century after century for over four thousand years, byexpert Vaidyas. To those who claim to have a knowledge of this ancient medicinal scienceenriched by the happy results of the researches and advancement made by eminent Vaidyasin succeeding ages, its superior merits over the Western systems of medicine, and itsimmense value, do not need any delineation. Such names of the great pioneers who added tothe development of the science of Ayurveda, as Vagbhata, Madhava, Jivaka and BhavaMishra of Banaras are well known. Ayurveda has a significant name. It is the knowledge of the science, which ensureshealth and longevity. It is in no way inferior to other systems. The Ayurvedic doctors hadvery great influence in the field of medicine. Charaka, Sushruta, Vagbhata, Madhava Nidhanare the well-known scientific books on Indian Medicine. This glorious system of medicinefell into disease owing to lack of State support and facilities for proper study, training andresearch. Susruta, while classifying different insects expands the mosquitoes as five varieties.They are Samudra Mashaka, Parimandala Mashaka, Hasti Mashaka, Krishna Mashaka and Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 9
  • 21. Parvateeya Mashaka. Out of these the last Parvateeya Mashaka are more toxic and fatal innature. The symptoms of this type resemble with the malarial fever of present discussion 13. Figure –1 Photograph of Parvateeya Mashaka Malaria is a protozoal disease transmitted by the Anopheles mosquito, caused byminute parasitic protozoa of the genus Plasmodium, which infect human and insect hostsalternatively. It is a very old disease and prehistoric man is thought to have suffered frommalaria. It probably originated in Africa and accompanied human migration to theMediterranean shores, India and South East Asia. In the past it used to be common in themarshy areas around Rome and the name is derived from the Italian, (mal-aria) or "bad air";it was also known as Roman fever. Today some 500 million people in Africa, India, SouthEast Asia and South America are exposed to endemic malaria and it is estimated to causetwo and a half million deaths annually, one million of which are children. Fishermen and traders, long before British colonisation, probably introduced thedisease into northern Australia and in the past malaria were not uncommon in the northernparts of the country. In Western Australia an explosive outbreak of falciparum malariaoccurred at Fitzroy Crossing in 1934 which at first was mistaken for influenza and resulted Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 10
  • 22. in 165 deaths. WHO declared Australia free of malaria in 1981, however since that time 9patients have contracted locally acquired malaria. The so called "airport malaria" has become a problem in recent years. A publicanworking in an establishment close to Londons Heathrow Airport became acutely ill and wasfound to be suffering from falciparum malaria, he had never been out of the country. A ladydriving her car past the same airport became ill with malaria although she too had neverbeen out of the country. Four workers unloading a cargo plane at Amsterdam airport becameinfected with malaria. It is assumed that infected mosquitoes were carried on planes fromAfrica and released at the destination airport. While it was recognised that the Anopheles mosquito played a key role in thetransmission of the disease it was not until 1948 that all the stages in its life cycle wereidentified. The parasite undergoes a development stage in the mosquito and the female of thespecies requires a blood meal to mature her eggs. She bites a human and injects materialfrom her salivary glands, which contains primitive malarial parasites called sporozoites,before feeding. These sporozoites circulate in the blood for a short time and then settle in theliver where they enter the parenchymal cells and multiply; this stage is known as pre-erythrocytic schizogony. After about 12 days there may be many thousands of youngparasites known as merozoites in one liver cell the cell ruptures and the free merozoitesenter red blood cells. The blood stages of the four species of malaria can be seen in thesection on diagnosis. In the case of P. vivax, and P.ovale the liver cycle continues andrequires a course of primaquine to eliminate it. P.falciparum on the other hand does not havea continuing liver cycle. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 11
  • 23. In the red blood cells the parasites develop into two forms, a sexual and an asexualcycle. The sexual cycle produces male and female gametocytes, which circulate in the bloodand are taken up by a female mosquito when taking a blood meal. The male and femalegametocytes fuse in the mosquitos stomach and form oöcysts in the wall of the stomach.These oöcysts develop over a period of days and contain large numbers of sporozoites,which move to the salivary glands and are ready to be injected into man when the mosquitonext takes a meal. In the asexual cycle the developing parasites form schizonts in the redblood cells which contain many merozoites, the infected red cells rupture and release a batchof young parasites, merozoites, which invade new red cells. In P.vivax, P.ovale and probablyP.malariae, all stages of development subsequent to the liver cycle can be observed in theperipheral blood. However, in the case of P.falciparum only ring forms and gametocytes areusually present in the peripheral blood. Developing forms appear to stick in the bloodvessels of the large organs such as the brain and restrict the blood flow with seriousconsequences. While all four species have a haemolytic component i.e. when a new brood ofparasites break out of the red blood cell this is usually of little consequence. The exception isfalciparum malaria where the parasites multiply very rapidly and may occupy 30% or moreof the red blood cells causing a very significant level of haemolysis. One reason for this isthat P.falciparum invades red cells of all ages whereas P.vivax and P.ovale prefer youngerred cells, while P.malariae seeks mature red cells. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 12
  • 24. Figure –2 Geographical distribution of the MalariaHistory of malaria Malaria or a disease resembling malaria has been noted for more than 4,000 years.From the Italian for "bad air," malaria has probably influenced to a great extent humanpopulations and human history.Ancient History (2700 BCE-340 CE) The symptoms of malaria were described in ancient Chinese medical writings. In2700 BC, several characteristic symptoms of what would later be named malaria weredescribed in the Nei Ching, (The Canon of Medicine. Nei Ching was edited by EmperorHuang Ti). Malaria became widely recognised in Greece by the 4th century BCE, and it wasresponsible for the decline of many of the city-state populations. Hippocrates noted theprincipal symptoms. By the age of Pericles, there were extensive references to malaria in theliterature and depopulation of rural areas was recorded. In the Susruta, a Sanskrit medical Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 13
  • 25. treatise, the symptoms of malarial fever were described and attributed to the bites of certaininsects. A number of Roman writers attributed malarial diseases to the swamps. In China, during the second century BCE, the Qinghao plant (Artemisia annua L)was described in the medical treatise, 52 Remedies, found in the Mawangdui Tomb. In 340CE, the anti-fever properties of Qinghao were first described by Ge Hong of the East YinDynasty. Chinese scientists isolated the active ingredient of Qinghao in 1971. Known asartemisinin, it is today a very potent and effective anti-malarial drug, especially incombination with other medicines.Quinine (Early 17th Century) Following their arrival in the New World, the Spanish learned of a medicine used forthe treatment of fevers. Spanish Jesuit missionaries in South America learned of a medicinalbark from indigenous Indian tribes. With this bark, the Countess of Chinchón, the wife ofthe Viceroy of Peru, was cured of her fever. The bark from the tree was then called Peruvianbark and the tree was named Cinchona after the countess. The medicine from the bark isnow known as the antimalarial, quinine. Along with artemisinin, quinine is one of the mosteffective antimalarial drugs available today.Discovery of the Malaria Parasite (1880) Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,Algeria, was the first to notice parasites in the blood of a patient suffering from malaria.This occurred on the 6th of November 1880. For his discovery, Laveran was awarded theNobel Prize in 1907. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 14
  • 26. Differentiation of Species of Malaria (1886) Camillo Golgi, an Italian neurophysiologist, established that there were at least twoforms of the disease, one with tertian periodicity (fever every other day) and one withquartan periodicity (fever every third day). He also observed that the forms produceddiffering numbers of merozoites (new parasites) upon maturity and that fever coincided withthe rupture and release of merozoites into the blood stream. He was awarded a Nobel Prizein Medicine for his discoveries in neurophysiology in 1906.Naming of Human Malaria Parasites (1890,1897) The Italian investigators Giovanni Batista Grassi and Raimondo Filetti firstintroduced the names Plasmodium vivax and P. malariae for two of the malaria parasitesthat affect humans in 1890. Laveran had believed that there was only one species, Oscillariamalariae. An American, William H. Welch, reviewed the subject and, in 1897, he named themalignant tertian malaria parasite, P. falciparum. There were many arguments against theuse of this name, however, the use was so extensive in the literature that a change back tothe name given by Laveran was no longer thought possible. In 1922, John William WatsonStephens described the fourth human malaria parasite, P. ovale.Discovery That Mosquitoes Transmit Malaria Parasites (1897-1898) On August 20th, 1897, Ronald Ross, a British officer in the Indian Medical Service,was the first to demonstrate that malaria parasites could be transmitted from infectedpatients to mosquitoes. In further work with bird malaria, Ross showed that mosquitoescould transmit malaria parasites from bird to bird. This necessitated a sporogonic cycle (thetime interval during which the parasite developed in the mosquito). Thus, the problem of Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 15
  • 27. malaria transmission was solved. For his discovery, Ross was awarded the Nobel Prize in1902.Discovery of the Transmission of the Human Malaria Parasites (1898-1899) Led by Giovanni Batista Grassi, a team of Italian investigators, which includedAmico Bignami and Giuseppe Bastianelli, collected Anopheles claviger mosquitoes and fedthem on malarial patients. The complete sporogonic cycle of Plasmodium falciparum, P.vivax, and P. malariae was demonstrated. In 1899, mosquitoes infected by feeding on apatient in Rome were sent to London where they fed on two volunteers, both of whomdeveloped benign tertian malaria.The Panama Canal (1905-1910) The construction of the Panama Canal was made possible only after yellow fever andmalaria were controlled in the area. These two diseases were a major cause of death anddisease among workers in the area. In 1906, there were over 26,000 employees working onthe Canal. Of these, over 21,000 were hospitalised for malaria at some time during theirwork. By 1912, there were over 50,000 employees, and the number of hospitalised workershad decreased to approximately 5,600. Through the leadership and efforts of WilliamCrawford Gorgas, Joseph Augustin Le Prince, and Samuel Taylor Darling, yellow fever waseliminated and malaria incidence markedly reduced through an integrated program of insectand malaria control.The U.S. Public Health Service (USPHS) and Malaria (1914-1942) During the U.S. military occupation of Cuba and the construction of the PanamaCanal at the turn of the 20th century, U.S. officials made great strides in the control ofmalaria and yellow fever. In 1914 Henry Rose Carter and Rudolph H. von Ezdorf of the Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 16
  • 28. USPHS requested and received funds from the U.S. Congress to control malaria in theUnited States. Various activities to investigate and combat malaria in the United Statesfollowed from this initial request and reduced the number of malaria cases in the UnitedStates. The USPHS established malaria control activities around military bases in themalarious regions of the southern United States to allow soldiers to train year round.The U.S. Tennessee Valley Authority (TVA) - The Integration of Malaria Control withEconomic Development (1933) U.S. President Franklin D. Roosevelt signed a bill that created the TVA on May 18,1933. The law gave the federal government a centralised body to control the Tennesseerivers potential for hydroelectric power and improve the land and waterways fordevelopment of the region. An organised and effective malaria control program stemmedfrom this new authority in the Tennessee River valley. Malaria affected 30 percent of thepopulation in the region when the TVA was incorporated in 1933. The Public Health Serviceplayed a vital role in the research and control operations and 1947 essentially eliminated thedisease. Controlling water levels and insecticide applications reduced Mosquito breedingsites.Chloroquine (1934, 1946) A German, Hans Andersag discovered chloroquine, in 1934 at Bayer I.G.Farbenindustrie A.G. laboratories in Eberfeld, Germany. He named his compound resochin.Through a series of lapses and confusion brought about during the war, chloroquine wasfinally recognised and established as an effective and safe anti-malarial in 1946 by Britishand U.S. scientists. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 17
  • 29. Dichloro-diphenyl-trichloroethane (DDT) (1939) A German chemistry student, Othmer Zeidler, synthesized DDT in 1874, for histhesis. Paul Müller in Switzerland did not discover the insecticidal property of DDT until1939. Various militaries in WWII utilised the new insecticide initially for louse-bornetyphus. DDT was used for malaria control at the end of WWII after it had proven effectiveagainst malaria-carrying mosquitoes by British, Italian, and American scientists. Müller wonthe Nobel Prize for Medicine in 1948.Malaria Control in War Areas (MCWA) (1942-1945) MCWA was established to control malaria around military training bases in thesouthern United States and its territories, where malaria was still problematic. Many of thebases were established in areas where mosquitoes were abundant. MCWA aimed to preventreintroduction of malaria into the civilian population by mosquitoes that would have fed onmalaria-infected soldiers, in training or returning from endemic areas. During theseactivities, MCWA also trained state and local health department officials in malaria controltechniques and strategies.CDC and Malaria (1946-present) CDCs mission to combat malaria began at its inception on July 1, 1946. TheCommunicable Disease Centre, as CDC was first known, stemmed from MCWA. Thus,much of the early work done by CDC was concentrated on the control and eradication ofmalaria in the United States. With the successful reduction of malaria in the United States,the CDC switched its malaria focus from eradication efforts to prevention, surveillance, andtechnical support both domestically and internationally. This is still the focus of CDCsMalaria Branch today. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 18
  • 30. Eradication of Malaria in the United States (1947-1951) The National Malaria Eradication Program, a co-operative undertaking by state andlocal health agencies of 13 Southeastern states and the CDC, originally proposed by LouisLaval Williams, commenced operations on July 1, 1947. By the end of 1949, over 4,650,000house-spray applications had been made. In 1947, 15,000 malaria cases were reported. By1950, only 2,000 cases were reported. By 1951, malaria was considered eradicated from theUnited States.Eradication Efforts Worldwide: Success and Failure (1955-1978) With the success of DDT, the advent of less toxic, more effective synthetic anti-malarials, and the enthusiastic and urgent belief that time and money were of the essence,the World Health Organisation (WHO) submitted at the World Health Assembly in 1955 anambitious proposal for the eradication of malaria world wide. Eradication efforts began andfocused on house spraying with residual insecticides, anti-malarial drug treatment, andsurveillance, and would be carried out in 4 successive steps: preparation, attack,consolidation, and maintenance. Successes included eradication in nations with temperateclimates and seasonal malaria transmission. Some countries such as India and Sri Lanka hadsharp reductions in the number of cases, followed by increases to substantial levels afterefforts ceased. Other nations had negligible progress (such as Indonesia, Afghanistan, Haiti,and Nicaragua). Some nations were excluded completely from the eradication campaign(most of sub-Saharan Africa). The emergence of drug resistance, widespread resistance toavailable insecticides, wars and massive population movements, difficulties in obtainingsustained funding from donor countries and lack of community participation made the long- Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 19
  • 31. term maintenance of the effort untenable. Completion of the eradication campaign waseventually abandoned to one of control.Fall of Roman Empire because of Malaria Could ancient childrens burial ground contain clues about how one of the worldsgreatest empires came to an end? Andrew Thompson explores the theory that malaria wasthe silent killer responsible for the fall of Rome. A British scientist proved conclusively that the most dangerous type of malaria was akiller in imperial Rome. The scientist relied on the latest DNA techniques that arerevolutionising the understanding of the role of disease in ancient times. The malarial DNAfrom a Roman site, dating from around AD 450, is the oldest definite evidence of malaria inhistory. The finding of malaria was a remarkable and complicated piece of detective work,which spanned the last ten years. At its height, the Roman Empire stretched from Scotland in the NorthernHemisphere to the deserts of Africa in the south. The empire lasted for over 500 years,although its eastern part, the Byzantine Empire, lasted for several more centuries. When theempire collapsed, hordes of barbarian armies, including the infamous Vandal pirates invadedItaly throughout the fifth century AD. Rome was transformed from a bustling city ofmillions to a provincial town of a few thousand, surrounded by swamps. The anarchy of theDark Ages had begun. Although there has been no shortage of theories, it has never been clear why Romebecame so vulnerable to foreign invaders at this time. Political instability, the collapse offood supplies to Rome, and even the infamous lead in the water supplies have all been Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 20
  • 32. implicated. Historians have generally agreed that Romes downfall was due to a combinationof many factors 14.Past and present of Malaria Mosquitoes probably originated in Africa (along with mankind), and fossils ofmosquitoes up to 30 million years old, show that the malaria vector, the malaria mosquito,was present well before the earliest history. Hippocrates, a physician born in ancient Greece,today regarded as the "Father of Medicine", was the first to describe the manifestations ofthe disease, and relate them to the time of year and to where the patients lived. Before this,the supernatural was blamed. The association with stagnant waters (breeding grounds for theAnopheles mosquito) led the Romans to begin drainage programs, the first interventionagainst malaria. The first recorded treatment dates back to 1600, when the bitter bark of the Cinchonatree in Peru was used by the native Peruvian Indians. By 1649, the bark was available inEngland, as "Jesuits powder," so that those suffering from "agues" might benefit from thechemical substance quinine, which it contained. Not until 1889 was the protozoal (singlecelled parasite) cause of malaria discovered by Alphonse Laveran working in Algeria, andonly in 1897 was the Anopheles mosquito demonstrated to be the vector for the disease byRonald Ross 15. It was the army surgeon, Ronald Ross, who undertook the experimental testing of themosquito-theory, proposed by both Laveran and the investigator, Patrick Manson. Thesolution came from India, while Ross was commissioned in the Indian Medical Service, andin the late 1890s the mosquito hypothesis could be established. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 21
  • 33. Malaria Control Operation The discovery of the insecticide DDT in 1942, by Paul Müller the Nobel PrizeLaureate in Physiology or Medicine, 1948, and its first use in Italy in 1944, made the idea ofglobal eradication of malaria seem possible. Subsequently, widespread systematic controlmeasures such as spraying with DDT, coating marshes with paraffin (to kill Anophelesmosquito larvae), draining stagnant water, and the widespread use of nets and cheap,effective drugs such as chloroquine were implemented - with impressive results. Despiteinitial success, there was a complete failure to eradicate malaria in many countries due to anumber of factors. Although technical difficulties such as mosquito and parasite drugresistance have played a part, the main failure to reduce the disease is probably due to socialand political factors preventing efficient application of control measures. Despite the setbacks, up until 1969, when the global eradication policy was finallyabandoned, the following European countries had managed to completely eradicate endemicmalaria by interrupting transmission: Hungary, Bulgaria, Romania, Yugoslavia, Spain,Poland, Italy, Netherlands and Portugal. From the early 1970s, the malaria situation has slowly and progressively deterioratedand reduced control measures between 1972 and 1976, due to financial constraints, led to amassive 2-3 fold increases in cases globally. Spraying never truly eradicated the mosquitoesanywhere, and the reduction in the more persistent P. vivax infections were much less thanfor P. falciparum - though the latter returned in much greater strength as control measureswaned. The growing interchange of populations between countries where malaria isprevalent and malaria free countries is responsible for the continuous increase in the numberof imported malaria cases in European countries, and causes serious concern because of Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 22
  • 34. possible epidemic focal resurgence in receptive areas such as the Mediterranean. Since1976, several new pockets of malaria transmission have evolved, and a WHO 1980 reportrecommended that countries, which had become non-malarious should maintain at least onemalaria vigilance unit. The World Health Organization (WHO) warned about increased risk of vector-borne diseases such as malaria and dengue fever across tsunami-affected areas in SoutheastAsia. Nearly four weeks after the disaster struck the region on 26 December, theorganization is strengthening its disease surveillance, as stagnant water conditions createconditions for mosquito vectors to multiply to sufficient levels to potentially cause severepublic health problems. Most affected countries in the region are endemic for dengue fever and malariaexcept the Maldives, which has no malaria cases but does have dengue cases. With the onsetof the rainy season, particularly in Indonesia and Sri Lanka, a rise in the cases can beexpected at this time of the year 16. According to the World Health Organisation, the following statistics reveal thespread of malaria in the world. Africa: Ninety-seven million cases of malaria a year. Thetropical region’s leading killer of children claims five percent under five. Latin America:One million cases a year. The settlement of people in mosquito-infested rain forests in Brazilhas exposed millions to the disease. Asia: Nine million cases a year. New, hard-to-treatstrains are rapidly gaining ground 17.Malaria control – philately It is fantasising for a researcher to observe in various angles, the topic chosen. TheMalaria, a disease caused by an insect placed it self in the philately because of its Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 23
  • 35. importance. No other country other than India releases a stamp on a Mosquito. The Malariaeradication programme is to be recollected and on the occasion 4 Annas (25 Paise) stamp isreleased by the Indian Postal Department is shown below. Figure – 3 Postal Stamp released by Government of India on the occasion of Malaria controlEpidemiology Malaria is primarily a disease of the tropics and subtropics and is widespread in hothumid regions of Africa, Asia and South and Central America. The disease was alsocommon in many temperate areas including the USA, Europe and northern Eurasia andAsia, but has been eradicated. In many areas, which previously had malaria under control, 18.are experiencing resurgence The four human malarial species exhibit an overlappinggeographical distribution (Box). P. vivax and P. falciparum are the most commonlyencountered species with P. vivax being the most wisespread geographically. Mixedinfections are common in endemic areas. "Everything about malaria is so moulded by localconditions that it becomes a thousand epidemiological puzzles." Hackett (1937) The above quote emphasises the complexity of malaria and the many facets thedisease exhibits. Different communities will experience different malaria and consequently Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 24
  • 36. different control and treatment strategies may be necessary. The intricate interactionsbetween host, parasite, and vector are the major factors in this epidemiological complexity. The fundamental problem of developing drugs for tropical diseases are too expensivefor widespread use of poor countries. Ayurveda may contribute a lot for the utilisation of ourown resources. The Ayurvedic method of treatment in Vishamajwara has been claimedeffective either in single/compound drug therapy. Sudarsana Churna has been used for thetreatment of Vishamajwara since Sarangadhara period (1400 A.D). Even the contemporaryAyurvedic practices the same is considered as very effective and potent treatment modalityin Vishamajwara of “all types”. It also claimed to be effective any kind of jwara includingmalarial fever as diagnosed by modern clinical-parasitology. Vishamajwara, literally meaning irregular fever, is very vast. It may be remittenttype or intermittent type as keetanu (micro-organisms) have been incriminated as one of thecauses of Vishamajwara. The major cardinal symptoms of Vishamajwara i.e. Fever withchill and rigor have been observed to be present in other disease including Malaria, which isa protozoal disease caused by plasmodia group of organism and transmitted to manprimarily by certain species of infected female anopheles mosquitoes 19.Jwara (fever) and Vishamajwara (Malaria) Ayurveda mentioned jwara as the synonym of the disease or a febrile condition.“From among all disorders fever deserves to be described fist, it being the foremost of allsomatic diseases”. Charaka mentioned jwara afflicts body, mind and sense organs, regulatesthe well being of life. Chakrapani described jwara as “jwarayati santapayati” i.e. diseaseassociated with burning manifestation is known as jwara 20-21. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 25
  • 37. The disease Vishamajwara is included under the jwara roga in Ayurveda. Jwara is abroad term, which has versatile meaning. If we analyse the etymological derivation of theterm we see that the word jwara is derived from the “jr” or “jya”. The jr. indicates vayohanior loss of life span. It indicates the state of cellular destruction produces more temperature. 22 Vishamajwara characterised by visamarambha (irregular onset) visama kriya 23(alternative feeling of hot and cold) and visamakala (irregular duration of sufferings) ofjwara. Susruta believed this to be caused by agantuka Karana or parahetu (external factor) 24.This parahetu is more cleared by commentator Dalhana as bhutabhisanga. Bhutabhisanga 25can be correlated with parasitic infection as discussed in modern medicine.History and background of VishamajwaraVAIDAIC PERIOD: Jwara is the term originated by the anger of Rudra. Rudra is known as god ofdestruction in Hindu mythology. Jwara is the king of all diseases and known by differentterms in various animals also i.e. Pakala for the jwara of elephants and abhitapan for horses’etc. Vishamajwara is the varieties of jwara, which can be identified by its peculiarity ofvisamata (irregularity) 26. The description of Vishamajwara was known from ancient era. In “UPANISHAD”(400B.C) visamajwara is described as “TAKMAN”. It is described that the jwara havingdahana and shosana properties, which attacks like fire (Agni) and they’re by the patient runslike a mad. For it’s relief chanting of mantras has been described to pray God 27. Atharva Veda has also described Vishamajwara causes that in the body like Agni (fire)patients feels very much uneasiness and sometime comes in the state of pralapa (delirium)and die. The attack of triteeyaka and santatajwara follows in sarat (autumn), varsa (rainy Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 26
  • 38. season) and grishma kala (summer season) or in the state of sheeta and ruksha. AtharvaVeda described the following types of Vishamajwara 28. These are - 1. Triteeyaka 2. Chaturthaka 3. Satataka 4. Sharada 5. Grishmika 6. Varsakalika Atharva-Veda is also described that takman is a periodic fever manifested with rigor,trembling and pain particularly in head. It is accompanied by debility and cough and ends inpallor or yellow-ness. It is endemic in particular places like Manjavan, Mahavrsa, Gandhara,Anga and Magadha 29. It is a clear picture of Vishamajwara of malarial origin. Sayana calls it sitajwara.,sitajanka (chill fever) 30 and kricchra jivanakrit (making life troubled). Whitney translates itas ‘fever’31.Synonyms in Vedas The synonyms of jwara are tapah, shushmi, Shoka, abhishoka, rudraha, papma,amarthya vigadh, vyangah, sheersha, parbheta and sochi etc. mentioned in the Veda are saidto be developed due to rudrakopa 32.Samhita & Sangraha kala Wide description of Vishamajwara is found in Samhita granthas like, Charaka,sushrut, bhela, harita, kashyapa, Madhava, sarangadhara, bhavaprakash, yogaratnaka etc.Kashyapa considered that in the Vishamajwara specific properties of jwara are found in a Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 27
  • 39. irregularity manner. He enumerated the Vishamajwara as follows santataka, satataka,anyeduska, triteeyaka and chaturthaka considering the days of its onset. According toKashyapa the aetiology lies as - if one takes exercise, heavy meal, unsuitable diet, excessdrinking of water or milk, blackgram preparation, recent curd, paste of tila, village animalflesh, virudhahara (incompatible food), day sleeping and takes much food before thedigestion during the period of jwara temperature goes on rising and attains the stage ofVishamajwara. He also described not to take Kashaya during the Amavastha orTarunavastha of jwara etc. which may leads to Vishamajwara 33. Bhaluki considered that thejwara that comes with cold or hot stage with temperature rise or low is uncertain inVishamajwara 34. 35 Charaka described that all the Vishamajwara are tridoshaja in origin. Susrutaconsidered that the Vishamajwara occurs due to Tridosha but Vata is the dominant Dosha.He considered the Agantuka Karana (external cause) of which bhutabhishanga constituteone of the variety in the main aetiology for Vishamajwara 36. Vagbhata defined Vishamajwara, as the jwara is irregular in respect to its onset,suffering and symptoms. The mandagni during adanakala is one of the important causes ofVishamajwara. He also advocated if an emaciated patient who takes irregular diet duringconvalescent period in spite of residual of small quantity of Dosha may causesVishamajwara 37. 38 According to Hareeta the Vishamajwara is five types such as vataja, ekaikajwara,dwahieka jwara, triahika jwara, chaturthakjwara. Chakrapani opinions, the poisonous insectsmay be considered under the word bhuta. Dalhana consider bhutas responsible to produceVishamajwara. Madhavkara 39 views as bhuta plays an important role for Vishamajwara too. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 28
  • 40. In Amarkosh the bhuta means keetanu. Jejjata considered Vishamajwara astridoshaja in origin. Most of the authors considered five types of Vishamajwara.Bhavamishra and Madhavakara have included pralepaka jwara also in the group ofVishamajwara.Clinical Features of Malaria Fever is the commonest reason for hospital attendance in rural India. In recent past,Malaria was the main reason for fever. Even today, probably malaria may rank first.Outbreaks of fever are regularly reported from health workers and health institutions. Now-a-days after malaria, dengue fever has become important cause of fever outbreaks 40. Malaria is a febrile illness characterised by fever and related symptoms. However itis very important to remember that malaria is not a simple disease of fever, chills and rigors.In fact, in a malarious area, it can present with such varied and dramatic manifestations thatmalaria may have to be considered as a differential diagnosis for almost all the clinicalproblems! Malaria is a great imitator and trickster, particularly in areas where it is endemic. All the clinical features of malaria are caused by the erythrocytic schizogony in theblood. The growing parasite progressively consumes and degrades intracellular proteins,principally haemoglobin, resulting in formation of the malarial pigment and hemolysis ofthe infected red cell. This also alters the transport properties of the red cell membrane, andthe red cell becomes more spherical and less deformable. The rupture of red blood cells bymerozoites releases certain factors and toxins (such as red cell membrane lipid, glycosylphosphatidyl inositol anchor of a parasite membrane protein), which could directly inducethe release of cytokines such as TNF and interleukin-1 from macrophages, resulting in chillsand high grade fever. This occurs once in 48 hours, corresponding to the erythrocytic cycle. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 29
  • 41. In the initial stages of the illness, this classical pattern may not be seen because there couldbe multiple groups (broods) of the parasite developing at different times, and as the diseaseprogresses, these broods synchronise and the classical pattern of alternate day fever isestablished. It has been observed that in primary attack of malaria, the symptoms mayappear with lesser degree of parasitemia or even with sub-microscopic parasitemia.However, in subsequent attacks and relapses, a much higher degree of parasitemia is neededfor onset of symptoms. Further, there may be great individual variations with regard to thedegree of parasitemia required to induce the symptoms. The first symptoms of malaria after the pre-patent period (period betweeninoculation and symptoms, the time when the sporozoites undergo schizogony in the liver)are called the primary attack. It is usually atypical and may resemble any febrile illness. Asthe disease gets established, the patient starts getting relapse of symptoms at regularintervals of 48-72 hours. The primary attack may spontaneously abort in some patients andthe patient may suffer from relapses of the clinical illness periodically after 8-10 days owingto the persisting blood forms of the parasite. These are called as short term relapses(recrudescences). Some patients will get long term relapses after a gap of 20-60 days ormore and these are due to the reactivation of the hypnozoites in the liver in case of vivax andovale malaria. In falciparum and malariae infections, recrudescences can occur due topersistent infection in the blood.Atypical featuresIn an endemic area, malaria often presents with atypical manifestations.Atypical features are more common in the following situations: • Falciparum malaria Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 30
  • 42. • Early infection • Patients at extremes of age • Patients who are immune-compromised (extremes of age, malnourished, AIDS, tuberculosis, cancers, on immunosuppressive therapy etc.) • Patients on chemoprophylaxis for malaria • Patients who have had recurrent attacks of malaria • Patients with end stage organ failure • Last but not the least, pregnancy.Atypical fever: In an endemic area, it is rather unusual to find cases with typical fever pattern. Somepatients may not have fever at all and may present with other symptoms listed below. Manypresent with fever of various patterns - low grade to high grade, with or without chills,intermittent to continuous, or even as cases of prolonged fever. In the initial stages of theillness, fever may be quotidian, with more than one spike per day and this is due to thedevelopment of multiple broods of the parasite. As the disease progresses, these broods getsynchronised and the fever tends to be more uniform. However in cases of P. falciparummalaria and mixed infections, this pattern of multiple spikes may continue.Headache: Headache may be a presenting feature of malaria, with or without fever. It can beunilateral or bilateral. Some times the headache could be so intense that it may mimic intra-cranial infections or intra-cranial space occupying lesions. It may also mimic migraine,sinusitis etc. Presence of projectile vomiting, papilloedema, neck stiffness and focalneurological signs would suggest other possibilities. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 31
  • 43. Body ache, backache and joint pains: These symptoms are fairly common in malaria. These can occur even during theprodromal period and at that stage these are generally ignored and diagnosis of malaria isimpossible owing to lack of peripheral parasitemia. They are also common accompanimentsof the malaria paroxysm. Sometimes, malaria may present only with these symptoms,particularly in cases of recurrent malaria.Dizziness, vertigo: Some patients may present with dizziness or vertigo, with or without fever. Theymay also have associated vomiting and/or diarrhoea. This may mimic labyrinthitis,Mennieres disease, vertebro-basilar insufficiency etc. Rarely patients may present withswaying and cerebellar signs. Drugs like chloroquine, quinine, mefloquine and halofantrinecan also cause dizziness, vertigo, and tinnitus.Altered behaviour, acute psychosis: Patients may present with altered behaviour, mood changes, hallucinosis or evenacute psychosis, with or without fever. Malaria may be detected accidentally in such casesand they improve completely with anti malarial therapy. Altered behaviour may also be dueto high grade fever or drugs. Antimalarial drugs like chloroquine, quinine, mefloquine andhalofantrine can cause restlessness, hallucinations, confusion, delirium or even frankpsychosis.Altered sensorium: Patients with P. falciparum malaria may present with altered sensorium due to severeinfection, hypoglycemia, electrolyte imbalance due to vomiting or diarrhoea (particularly theelderly), hyperpyrexia, subclinical convulsions etc. Differential diagnosis will include acute Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 32
  • 44. encephalitis, meningitis, metabolic encephalopathy etc. As a rule of the thumb, malariashould be considered a possibility in all cases of acute neuropsychiatric syndromes and incases of proven malaria, other possibilities should be considered in the presence ofpapilloedema, increasesd ICT, neck stiffness and focal deficits.Convulsions, coma: Patients with cerebral malaria present with generalised seizures and deepunarousable coma. Sometimes one single fit can precipitate deep, unarousable coma. Thesecould also be due to hypoglycemia and all patients presenting with these manifestationsshould be administered 25-50% dextrose immediately. Drugs like chloroquine, quinine,mefloquine and halofantrine may also trigger convulsions.Cough: Cough may be a presenting feature of malaria, particularly P. falciparum infection.Patient may have pharyngeal congestion and features of mild bronchitis. Patients who havepersistent cough and/or fever even after clearance of parasitemia should be evaluated forsecondary bacterial pneumonias/ bronchopneumonia and bronchitis.Breathlessness: In severe falciparum malaria, patients may present with history of breathlessness,due to either severe anemia or non-cardiogenic pulmonary oedema. Secondary respiratorytract infections and lactic acidosis are other rarer causes for tachypnoea and/orbreathlessness in these patients. Patients with pre-existing cardio-vascular or pulmonarycompromise may deteriorate or even die if they suffer from severe malaria. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 33
  • 45. Chest pain: Acute retrosternal or precordial pain may be presenting feature of malaria. It mayradiate to the left or right shoulder tips or arms. It is due to rapid increase in the splenic sizeand perisplenitis. This pain may mimic acute myocardial infarction, pleurisy, neuralgia etc.Coupled with breathlessness, sweating and hypotension (algid malaria), the picture will veryclosely resemble that of acute MI.Acute abdomen: Patients can present with acute abdominal pain, guarding and rigidity, mimickingbowel perforation, acute appendicitis, acute cholecystitis, ureteric colic etc.Weakness: Sometimes patients may present with history of weakness, malaise and prostration.On examination they may have significant pallor, hypotension, dehydration etc. Algidmalaria may present like this and the patient may not have fever at all. Chloroquine is alsoknown to cause profound muscular weakness and a new disease called macrophagicmyofaciitis has been described in patients receiving chloroquine.Vomiting and diarrhoea: Malaria can present as a case of acute gastroenteritis with profuse vomiting andwatery diarrhoea (Choleraic form). Vomiting is very common in malaria and is due to highgrade fever, the disease itself or even drugs. Vomiting may pose problems in administeringantimalarial treatment. These could also be due to drugs like chloroquine and due tosecondary bacterial or amebic colitis. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 34
  • 46. Jaundice: Patients may present with history of yellowish discoloration of eyes and urine. Mildjaundice is fairly common in malaria and may be seen in 20-40% of the cases. Deeperjaundice with serum bilirubin of more than 3 mg/dL is seen in severe P. falciparum malariaand is associated with anemia, hyperparasitemia and malarial hepatitis with elevated serumenzymes. Malaria must be considered as a differential diagnosis for all cases of jaundice in amalarious area.Pallor: Severe anemia can be a presenting feature of malaria. It is usually normocyticnormochromic. It may pose special problems in pregnancy and in children. Pre-existingnutritional anemia may be aggravated by malaria.Puffiness of lids: Occasionally patients may present with puffiness of lids, with or without renaldysfunction.Secondary infections: Malaria produces significant immune suppression and this can result in secondaryinfections. Common among them are pneumonia, aspiration bronchopneumonia (in theelderly), urinary tract infection, colitis etc. Meningitis and enteric fever have also beenreported. In falciparum malaria, severe infection can lead to septicaemic shock (algidmalaria). Persistence of fever, neutrophilic leucocytosis and focal signs of infection shouldalways alert the clinician to this possibility of secondary infections. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 35
  • 47. Hepatosplenomegaly: Patients can present with enlargement of liver and/or spleen, tender or non-tender,with or without fever. Rapid enlargement of spleen or liver in malaria can cause acute painin the abdomen or chest. Generally, organomegaly is noticed in the second week of malarialillness. However, in cases of relapse or recrudescence, it may be present earlier. Also, inimmune compromised patients splenomegaly may be absent. In pregnancy, particularlysecond half, splenomegaly may be smaller or an enlarged spleen may regress in size due toimmune suppression. Although splenomegaly is a cardinal sign of malaria, absence ofsplenomegaly does not rule out the possibility of malaria.Combinations of the above: Patients can frequently present with various combinations of the above mentionedsymptoms and signs, further confusing the picture. This list is not exhaustive and malaria may present in many other ways. In all theabove listed situations, patients may not have associated fever, thus confusing the picture. Insome, fever may follow these symptoms. Therefore, one should not wait for the typicalsymptoms of malaria to get a blood test done; it is always better to do a smear wheneverreasonable doubt exists.Pathophysiology of Malaria: The bite of an infected mosquito introduces asexual forms of the parasite, calledsporozoites, into the bloodstream. Sporozoites enter the hepatocytes and form schizonts,which are also asexual forms. Schizonts undergo a process of maturation and multiplicationknown as preerythrocytic or hepatic schizogony. In Plasmodium vivax and Plasmodium Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 36
  • 48. ovale infection, some sporozoites convert to dormant forms called hypnozoites, which cancause disease after months or years. Preerythrocytic schizogony takes 6-16 days, and results in the host cell bursting andreleasing thousands of merozoites into the blood. Merozoites enter the erythrocytes andinitiate another asexual reproductive cycle, known as erythrocytic schizogony. The parasitepasses successively through the stages of trophozoite and schizont, ultimately giving rise toseveral merozoites. On maturation of these merozoites, the erythrocyte ruptures, releasingthe merozoites and multiple antigenic and pyrogenic substances into the bloodstream. Thesemerozoites again infect new erythrocytes. After a few cycles of this erythrocytic schizogony,some merozoites differentiate into the sexual forms: the male and female gametocytes. Amosquito that takes a blood meal from a patient with gametocytemia acquires these sexualforms and plays host to the sexual stage of the plasmodial life cycle. Figure – 4 Life cycle schematic diagram Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 37
  • 49. Figure –5 Sporogonic and Erythrocytic cycles of Malaria Rupture of a large number of erythrocytes at the same time releases a large amountof pyrogens, which causes the paroxysms of malarial fever. The periodicity of malarial feverdepends on the time required for the erythrocytic cycle and is definite for each species.Plasmodium malariae needs 72 hours for each cycle, leading to the name quatrain malaria.The other 3 species each take 48 hours for one cycle and cause fever on alternate days(tertian malaria). However, this periodicity requires all the parasites to be developing andreleasing simultaneously; if this synchronization is absent, periodicity is not observed 41. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 38
  • 50. Figure – 6 Exogenous and Endogenous Phases of MalariaLife cycle of Malaria The life cycle of all human malaria species consists of two phases a sexual phase(sporogony), with development and multiplication in certain female anopheline mosquitoesand an asexual phase (schizogony) with multiplication in man. The asexual phase in man has two parts, schizogony in the cells of liver(preerythrocytic schizogony or tissue phase) and schizogony in the red cells (erythrocyticschizogony or erythrocytic phase). Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 39
  • 51. Asexual phase in human hostTissue phase Sporozoites are inoculated by infected mosquito into the host and disappear fromcirculation within half an hour. Some enter the parenchymal cells of liver where theyundergo development and multipication, known as pre-erythrocytic schozogony. The tissue schizont which develops from the sporozoite enlarges and the nucleus andcytoplasm divide to form many thousands of merozoites which after 6-16 days rupture theliver cells and invade the circulation, where they enter the red cells by a process ofinvagination. The prepatent period is the time from infection until the appearance ofparasites in the blood and varies with the species of parasite (P. vivax 6-8 days, P. malariae2-16 days, P. ovale 9 days. P. falciparum 51/2 –7 days).Exoerythrocytic schizogony In P. vivax and the P. ovale malaria some of exacoythrocytic trphozortes orginatingfrom sporozoites lie dormant and are known as hypnozoites. After a period of up to 250 daysthey they become active and mature, allowing merozoites to infect red cells and give rise toan erythrocytic phase. This is the mechanism responsible for delayed prepatent periods andrelapses in P. vivax and P. ovale malaria.Erythrocytic phase To enter the red cell the merozoite binds to glycophorin, the major erythrocyticglycoprotein, which is psecific for a particular species of parasite. The apex of merozoitereleases a substance which forms a deep pit in surface of red cells and, maintaining contactbya contact ring, the merozoites are enveloped by the red cell in a vacuole (parasitophorousvacuole) in which it is enclosed. In the red cell the merozoites develop into ringforms which Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 40
  • 52. grow in size to trophozoites absorbing haemoglogin leaving a pigment (haematin orhaemazoin) – a combination of haemoglobin with protein which can be seen as darkgranules. The trophozoite multiplies by schizogony dividing into a number of smallmerozoites varying with species to form mature schizont. The merozoites are released byrupture of red cell membrane and enter new red cells, particularlyyoung red cells. Theerythrocytic phase called schizogonic periodicity, which differs according to the species ofparasite, is responsible for the febrile paroxysms. In the early stages of infection there maybe several broods of parasites developing at different times so that there is no regularperiodicity, but with development of immunity the periodicity settle down and becomesregular.Gametogony After a period some merozoites give rise to two sexually differentiated forms ofgametocytes male (microgamete) and female (macrogamete) which differ in morphology inthe different species of parasite. These gametocytes are taken up by female anophelinemosquitoes and they undergo development.Sexual phase in anopheline mosquitoes In the stomach of mosquito the female gametocyte forms a macrogamete and themale a microgamete. The male gamete nucleus divides and forms a number of long slender,thread like structure or flagellae (exflagellation). These enter the female gamete and fuse toform a zygote, which becoming mobile as an olkinete and penetrating between the epithelialcells leaving the stomach, comes to rest on the outer surface of the stomach wall to form anoocyst, of which there may be several hundreds in one stomach. In the oocyst a largenumber of slender sporozoites form which burst out into the body cavity and enter the Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 41
  • 53. salivary glands ready to be inoculated into a new host at the next blood meal. The durationof cycle in the mosquito is known as the extrinsic incubation period. It varies according tothe temperature being 8-10 days at 28°C, 16 days at 20°C and cannot be completed under15°C.Frequency: • Internationally: Malaria is a major health problem in Africa, Asia, Central America, Oceania, and South America. About 40% of the worlds population live in areas where malaria is common. Approximately 300-500 million cases of malaria occur every year, and 1-2 million deaths occur, most of them in young children. • In the US: Approximately 1000 cases are diagnosed every year, most of them acquired outside the country. Only about 1% of patients acquires the infection in the United States. Usually fewer than 10 deaths are reported in the United States annually.Mortality/Morbidity: • Cerebral malaria: Most of the mortality of malaria is due to this complication of Plasmodium falciparum malaria, an acute illness that is mostly observed in children aged 6 months to 3 years. Early diagnosis and prompt treatment with a drug to which the parasite is susceptible is important to save the life of the child. • Anaemia: Anaemia is so common in malaria that it is considered almost a part of the disease. The degree of anaemia is much greater than can be explained by destruction of parasitized erythrocytes. Malarial anaemia can be quite severe, sometimes causing death. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 42
  • 54. • Repeated frequent seizures: Even without cerebral malaria, a child can experience prolonged, frequent convulsions, which can lead to prostration and death.Race: People of all races are affected, with some exceptions. People of West African originwho do not have the Duffy blood group are not susceptible to P vivax malaria.Sex: Malaria affects females and males equally.Age: Children of all ages living in non-malarious areas are equally susceptible to malaria. Inendemic areas, younger children are repeatedly have and often serious attacks of malaria.The survivors develop partial immunity. Thus, older children and adults often haveasymptomatic parasitemia, i.e., and presence of plasmodia in the bloodstream withoutclinical manifestations of malaria. Most deaths resulting from malaria occur in childrenyounger than 5 years 42.DIFFERENTIAL DIAGNOSIS There are many other conditions that may mimic malaria fever. A careful history andexamination with the aid of the laboratory, when necessary, will often resolve the difficulty.a. Malaria — This may be mistaken for typhoid in countries where both are endemic. Ahistory of previous attacks, the more rapid onset in malaria, the shivering and sweating, thehigh early pyrexia, the relative infrequency of abdominal symptoms and signs, and apositive blood slide all point to a diagnosis of malaria.b. Influenza — Influenza may also be confused with typhoid, but is usually of much morerapid onset with high temperature, severe sore throat, cough, and the absence of a palpablespleen and rose spots.c. Bacillary dysentery — This disease seldom causes much difficulty in diagnosis. Theonset is usually acute, with severe blood diarrhoea, although in mild cases the blood may be Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 43
  • 55. absent. Diarrhoea with blood is rare in early typhoid. The signs and symptoms in dysenteryare usually abdominal and remain so, the mental state and chest being clear.d. Typhus and other rickettsial infections — These conditions should be consideredimportant when considering the differential diagnosis. This is because both typhus andtyphoid can cause a febrile illness with delirium, chest signs, and abdominal discomfort. Intyphus, however, the onset is acute, and the temperature high at an early stage. Shiveringattacks are common at the onset, and prostration is rapid. The rash is quite different (brownish red in colour, and much more profuse). It doesnot fade on pressure, as does the rose spot in typhoid. There is a leucocytosis and the Weil-Felix test becomes significantly positive at about the tenth day.e. Pulmonary tuberculosis and atypical abdominal tuberculosis — These are probablythe most difficult diagnoses to differentiate from typhoid in economically poor countries.The pyrexia and vague symptoms and signs may be very similar. A chest X-ray, orlaboratory confirmation of typhoid, may be the only sure method of diagnosis.f. Brucellosis — This may cause difficulty, but the onset tends to be more insidious. Thepatient is also alert, and a painful joint is frequently present.g. Trypanosomiasis — This condition in endemic areas should also be considered in thedifferential diagnosis.h. There are numerous other diseases — Some other diseases could enter into thedifferential diagnosis category and some of these are illustrated. Suffice to say that there arefew conditions that cannot mimic, or be mimicked by, typhoid fever. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 44
  • 56. Nidana of Jwara: (Aetiology) The causative factor may be sarnikristha Nidana (immediate cause) and/orviprakristha Nidana (distant cause). So these two factors are responsible for vyadhijanaktvaas well as Vyadhi bodhakatva. On the basis of the above all the factors like Bahya (external)as jeevanu, mithya Ahara vihara etc. and the internal factor is vitiated Dosha and dushya.Gananath Sen described the external cause like abhighata (trauma). Jeevanu (parasite ormicrobes) and mithya Ahara-vihara (defective food and habits) are causes forVishamajwara.Role of Ahara and Vihara 43 Unsuitable food and drinks are provocative of Vata. Pitta and Kapha and ultimatelymay cause the development of Vishamajwara. According to Vagbhata if Shodhana is givenin Nava-Jwara cases when there is Indigestion State, aggravated Dosha becomes the causeof Vishamajwara. According to Yadvji Trikamji emaciated and weak patients if take ahitaAhara-vihara in course of time it produces Vishamajwara. So aetiology of Vishamajwara isdiscussed under following heads.Factors relating to Ahara - 1. Kasaya Dravya sevana 2. Ruksha Dravya sevana 3. Ushna drvya sevana 4. Shitambu pana 5. Santarpan Dravya sevana 6. Anupamansa bhakshana 7. Pinaka bhojana Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 45
  • 57. 8. Asatmya Dravya bhojana 9. Virudha Padartha bhojana (antagonist food) 10. Ahita Ahara sevanFactors relating to vihara 1. Visa ausadhi gandha sevan 2. Divaswapna (day sleeping) 3. Mithya vihar (the habits which is not good for health) 4. SorrowfulnessOthers – 1. Aupasargika Karana 2. Rutuparivartana 3. Kroda 4. Bhaya Flow chart -1 Classification of aetiology of Vishamajwara Nija (Internal) Agantuja (External) Abhichara Abhishanga Abhighata Abhishapa Ahara Vihara Dosha Bhutabhishanga Mahabhishanga Kala Prakruti Keetanu Drushya Adrushya (Macroscopic) (Microscopic) Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 46
  • 58. Role of bhuta (Keetanu) in Vishamajwara Susruta believed that Vishamajwara takes place due to agantuka Karana (externalcause). Agantuka is divided into 4 types i.e., abhighata, abhichara, abhishapa and abhisanga.Dalhana considered abhisanga as bhutavisanga. Chakrapani stated poisonous insects may beconsidered as bhuta. According Amarkosha it is keetanu. Therefore the keetanu introducedthe body by its corresponding portan entry and aggravates the doses. The time taken fromthe entry to manifestation of disease is known as sanchaya kala (incubation period). Aftersanchaya the doshas follow their normal pathway to travel for manifestation of diseases. Butin this instance which Dosha is principal may be considered on the type of keetanu and the 44strain of keetanu . Regarding the vectors, Charaka mentions countries which aboundmashaka (mosquitoes), mooshaka (rats) and makshika (flies) as unhealthy 45. In Charaka, itis stated that “unsanitary winds, unsanitary water, unsanitary countries and unsanitaryseasons are cause of catastrophes. Water is considered to be more important than wind, andcountry more important than water and season yet more important than country by virtue oftheir degree of indispensability 46. In this statement one can see the rudimentary concept ofgerm theory and epidemiology.Relation of Dosha in Vishamajwara Ayurvedic doctrine based on the Tridosha theory. The three Doshas are responsiblefor all diseases when they are deranged. The vitiated Dosha after localising in Dhatus of thebody are responsible to produce diseases. Through it is described in all classical texts thatVishamajwara is tridoshaja but Vata plays an important role. Charaka described thatVishamajwara is developed due to vitiation of Tridosha, but according to predominance ofDosha different features of its varieties may be noticed 47. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 47
  • 59. According to Susruta Vishamajwara is due to predominance of Vata and Kapha,because patient feels chill and rigor during first stage. Vagbhata described due to vitiation ofthree Doshas, five types of Vishamajwara occur. Jejjata described Vata plays an importantrole in Vishamajwara where as Pitta and Kapha remain quiescent stage. According toHareeta predominance of Vata, Pitta and Kapha Dosha causes Vatolbana, Pittolbana andKaholbana Vishamajwaras in 14th, 18th and 22nd days respectively. According to Ayurvedicscholars the seat of jwara is stated to Amashaya. The three doshas (samana vayu, pachahakaPitta, Kledakakapha remain in Amashaya in jwara the Pitta is mainly involved withSamanavata and Kledakakapha. Jwara occurs in whole body by the circulation of blood withthe help of Vyanavata. Besides all the factors Pitta plays an important role for producingjwara. So description of Pitta may not be out of place. Tapa (temperature) and daha (burningsensation) are due to Pitta. Pitta regulates the normal body temperature along with otherfunctions also.Role of dushya in Vishamajwara In Vishamajwara the Doshas are not only localised in Rasa Dhatu like other jwara.But Rakta, mamsa, meda asthi and majja Dhatu are also involved subsequently as stated byCharaka, Susruta and Vagbhata in the following manner as regard its seat in particularDhatu. 1. Rasa Dhatu – Santata jwara 2. Rakta Dhatu- Satata jwara 3. Mansa Dhatu – Anyedushka jwara 4. Meda Dhatu – Triteeyak jwara 5. Asthi Dhatu – Chaturthak jwara 6. Majja Dhatu – Chaturthak jwara Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 48
  • 60. Relation of vega in Vishamajwara 48 As a seed lies dominantin the soil and grows up in favourable time, Doshas stay inDhatus and get vitiated in opportune time. The Dosha having attained exacerbation andtimely strength due to weakening of the contracting factor gives to the tertian as well as thequatrain fever. After the paroxysm, the Doshas being weakened stay in their respectiveplaces and being reinforced in their opportune times again give rise to fever.Role of Prakruti Prakruti plays pivotal role in occurrence and prognosis of diseases. According todeha Prakruti the Dosha kalpana is also considered. The Vishamajwara due to Kapha isdifficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are lesspowerful. Similarly Pittolbana is difficult to cure in Pitta Prakruti and Vatolbana is difficultto cure in Vata Prakruti. 49Role of kala in Vishamajwara The rise of temperature at the end of the day, end of the night is due to Vata dosha,the same rises in the mid-day and mid night due to Pitta Dosha. The rise is during morningand evening hours due to Kapha Dosha respectively. Besides these, same disease isproduced in particular season. According to the principles of Ayurveda Vata is aggravated invarsa, Pitta in sharat and Kapha in vasanta. If a person takes “mithya ahar-vihar” in aparticular season the particular Dosha of that season is provacated. The aggravated doshasinteract Rasa and other Dhatu and ultimately produces Vishamajwara.Samprapti (pathogenesis) Jwara is defined as “santapo deha manasa” i.e., body and mind equally disturb infever along with derangement of Agni, Ama, srotaes and rogamargas etc. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 49
  • 61. Role of Agni in Vishamajwara 50 Among the thirteen types of Agni, the Jataragni is most important . It digests thefood and controls all other pittas. The Pachakapitta remains in Grahani and stimulatesdhatwagni. If a person adopts mithya Ahara and vihara for a long time then the imbalanceDosha localised in Amashaya, disturb the functions of the same and displace Agni.Therefore, activity of Agni becomes impaired in Amashaya but enhances in Dhatu.Ultimately there is formation, of Ama Rasa and obstruction of Rasavaha and swedavahasrota giving rice to different clinical features known as jwara roga.Role of Ama in Vishamajwara Ama is defined as undigested food particles, which subjected to less amount of Agnias desired. This Ama is produced in Amashaya as a result of aharapaka. Ama may begrouped into two parts (1) local and (2) systemic. The systemic effects of Ama (Amarasa)which sticky in nature obstruct the fine channels of swedavaha strotas as a result there iselevation of body temperature. On the other hand in bhutabhisanga Vishamajwara, personhaving Bhatubaisamya, Swabhava (immunity) and the Keetanu directly involved the Dhatuand produces agantuka Vishamajwara. 51Role of Srotas in Vishamajwara In Ayurveda all diseases are produced by srotovaigunya. Jwara is due to Annavahasrotavaigunya in general. But in Vishamajwara there is no clear description about particularsrotavaigunya. According to signs, symptoms and site of Dhatus it may be concluded thatudakavaha, swedavaha, rasavaha, raktavaha, mansavaha, medavaha, asthivaha, majja vahaand manavaha Srotas are involved. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 50
  • 62. Role of rogamarga in Vishamajwara Ayurveda described the three rogamarga (pathway of disease) for the manifestationof diseases. The seat of jwara is Amashaya and is one of the organs of kostha (thoraco-abdmino-pelvic cavity). Therefore, jwara is considered as abhyantara rogamargaja Vyadhi. Samprapti is classified in two parts. 1. Samanya Samprapti (general pathogenesis) 2. Visista Samprapti (specific pathogenesis)Samanya Samprapti of Vishamajwara It means six stages of development of disease according to Susruta 52 Sanchaya (stage of accumulation) – in this stage vitiated doshas are localised intheir principal site. On the other hand when a keetanu invade the host then it cannot producedisease. Instantaneously this period may be compared with incubation period of modernmedical science. Prakopa (stage of provocation) – due to lack of proper treatment in the previousstages the Dosha leads this stage. The Pachakapitta being “unmarga gami” tries to migrate toRasa and swedavaha Srotas. Prasara (stage of circulation) – after circulating throughout body by Vata, thisprakopita doshas accumulated depend on the “khavaigunya” only. Therefore production ofdisease is possible only where the disorder of Srotas occurs. Sthana sansraya (stage of localisation) – the vitiated Dosha become localised inrasavaha and swedavaha Srotas owing to previous factors. The premonitory symptoms likearati, shrama, vairasya are found. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 51
  • 63. Vyakta – (manifestation of diseases) – during this stage the vitiated Pachakapittacauses Ushna (hot) stage and Sheeta (cold) stage in the body associated with Vata Doshaand Sheeta Guna of Kapha Dosha. Bheda (stage of classification) – Santata etc, five type of jwara are manifestedowing to involvement of rasadi Dhatu and Kapha sthana.Classification of Vishamajwara according to different Acharyas - There are various opinions regarding the type of Vishamajwara. Primarily it can bedivided into two groups, viz. 53 (I) Arambhat visama – The Vishamajwara which is started as irregular fever from the very onset ; (II) Krita visamajwara – The Vishamajwara which occurs due to apathya sebana (untous dietetics and regimens) of previous jwara. So it is usually considered as relapsing fever. There are mainly five types of Vishamajwara accepted now 54. But there are variousviews on these types of Vishamajwara illustrated below.1. Charaka described five types according to its vega and agamankala i.e., santata, satata, anyeduska, triteeyak and chaturthaka 552. According to Vagbhata santataka, satata, triteeyaka, anyeduska, chaturthaka, and chaturthaka viparyaya. Here be classified the viparjaya as vatadhikya, pittadhikya and kaphadhikya. 563. Susruta advocates as santataka, satata, anyeduska, triteeyaka, chaturthaka, pralepaka and also due to predominance of doshas (anupathyaka jwara madhya samudbhavan) and Vata valasaka.57 Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 52
  • 64. 4. Harita describe as kahika, dwahika, trayahika chaturthaka 585. According to Gananath Sen it is four types such as vatabalasaka, Sleepadika, kalajwara, upadravikjwara.596. Kharanada described as viparita tikhanata santatajwara, anyeduska, triteeyak and chaturthaka7. Kashyapa described it as viparita tikshanata santatajwara, anyeduska, triteeyak and chaturthaka.8. Drudhabala described two types such as triteeyaka and chaturthaka9. Madhavakara viewed that santata, satataka, anyeduska, triteeyaka, chaturthaka. Here triteeyaka is again divided into three types according to predominance of Dosha like kaphapitta. Vatakapha, vatapitta chaturthaka, two types as slesmika and anila. Besides this he described another three types known as chaturthaka, viparjava, vatavalasaka and pralepaka.60Visista Samprapti of Vishamajwara 61 If the mithya Ahara Vihara taken in case of residual fever or during convalescentperiod of jwara it causes Vishamajwara being localised in one or more Dhatu. On the otherhand keetanu may aggravate Dosha in according to balam kalamcha prapya (dependent onthe host strength and climate). But according to Susruta as well as supported byMadhavakara about the pathogenesis of disease stated that if a weak person just after feveradopts unsuitable food and drink, his residual doshas aggravated being afflicted by Vatalocalised in kaphasthana (shira, kantha, hridaya, amasaya) to produce different ofVishamajwara. The five types of Vishamajwara manifested after invading of Rasa, Rakta, Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 53
  • 65. mansa, meda, asthi and majja dhatu and loges at shira, kantha, hridaya, amasaya andrasavaha Srotas, as a result of which the following types of Vishamajwara are produced. 1. Santata – continuous fever – Rasa Dhatu – wall of Amashaya 2. Satata – double quotidian fever – Rakta Dhatu – Amashaya 3. Anyeduska – quotidian fever – mamsa and meda – Hrudaya 4. Triteeyaka – tertian fever – asthidhatu – kantha 5. Chaturthaka – quartan fever – majja Dhatu – shira1) Samprapti of Santatajwara The word santataja jwara means fever in continuos nature. Now it is undercontroversy before the modern Ayurvedic scholar’s deviates from the definition ofVishamajwara. But to overcome the controversy Charaka classified that the“muktanubandhitvam visamatvam”, which means fever with relapsing nature. Then Doshacirculating in body through rasavaha Srotas with the help of Vata and gets localised in theKapha sthana. The period of localisation may vary according to kala prakriti andpredominance of doshas. They also affect dhatus and malas to manifest the diseases. Thesite of santatajwara is rasadhatu and its period is 7 days, 10 days, 12 days according topredominant of Vata Pitta and Kapha respectively. During this period the jwara may eithersubside or kill the patient without appropriate therapeutics intervention 62. According to Harita the period of subsidence of jwara is 14, 18, 22 days inVatolbana, Pittolbana and Kapholbana respectively. During the period the fever may subsideor kill the patients. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 54
  • 66. Dosha pradhanyata – 63The doshapradhanyata in the Santata jwara is tabulated as below. Table –1 Showing the Dosha pradhanyata in Malaria Kala (Rutu) Dushya Prakruti Dosha Vasanta Medas Kapha Kapha Sharad Rakta Pitta Pitta Varsha Asti Vata Vata2) Samprapti of satatajwara The satatajwara is said to be dwikalika (two times) in an ahoratra (24hr). The vitiateddoshas are localised in raktavaha Srotas and aggravated in a day and night. According tokashyap this types of aggravation and remission depends upon the kala, Dosha and dushyas.Dalhana considered jwara be twice in day. Once in a night, because the seat of satatajwara israktadhatu. Raktavaha Srotas is comparatively minute and more distant than rasavahaSrotas. So Dosha gets longer time to enter in Srotas causing Vishamajwara. When doshasmore from rasavaha to raktavaha during this phase there will no be only febrile attack. According to Vagbhata onset of jwara in Vata dosha is at early aparanha (afternoon)and pratyusha (morning and last part of night). Pitta dosha aggravates in midday andmidnight and Kapha Dosha in purbanha (evening hours)Vruddhi Kshayatmaka of satatajwara 64 The heavy Doshas spread all over the body through the channels carrying Rasa andstiffened and give rise to santata jwara (remittent fever). Being unbearable and quick –acting it gets subsides or kills the patients by the period of seven, ten or twelve days. Doshaequal in respect of time, dushya, (affected tissue) and constituents and having no counter Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 55
  • 67. acting factor causes the remitted fever and as such in quite unbearable. In remittent fever, asa rule, Vata etc. also affect in urine and faeces simultaneously as the Dhatus. This fever getssubsides or becomes fatal in periods of a week etc. according to the conditions whether Rasaetc. have been purified completely or not. When they are not purified completely or entirelythe remitted fever gets lodged in the twelve entities (seven Dhatus, three Doshas, urine andfaeces). Thus even after remission on Twelfth Day, it continues hidden for a long timewithout responding to any treatment. Considering all this, the physician should treat the caseof fever. Mostly in such management de-saturating remedy is administered at first.3) Samprapti of Anyeduska jwara Jwara vega occurs once in a whole day or night is called anyeduska jwara. Kashyapanamed it as anusargee and in Veda it is known as “anyeduha”. Vagbhatta considered thatmanasvaha Srotas are very smaller (minute) than raktavaha Srotas. Therefore delay occursbecause of doshas have to reach a longer distance. This doshas circulated all over the bodyslowly and ultimately reach mansavaha Srotas once in a whole day or night.4) Samprapti of Triteeyak jwara The jwara vega occurs once in every third day. Vagbhata considered that the sites ofvitiated doshas are medhadhtu and medavaha Srotas. Dosha gets longer time to entermedavaha Srotas from rasavaha Srotas. So the paroxysm of fever is on every third day.Doshanusara bheda – trika grahi – prusta grahi – shirograhi 65 Triteeyak jwara (Tertian fever) is of three types- 1. Due to Kapha and Pitta stating from trika (sacral region) 2. Due to Vata and Kapha starting from the back 3. Due to Vata and Pitta starting from head. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 56
  • 68. Likewise, the quatrain fever has also two type of characters- one caused by Kaphaand starting from legs and other caused Vata and starting from head.5) Samprapti of Chaturthaka jwara 66 Jwara comes on every fourth day having two days interval between the onset ofevery attack. The site of Dosha in this jwara is said to be majja-Dhatu which is deeper thanother discussed above. So vitiated Dosha takes a longer period to reach there. Thereforeparoxysm of fever is an every fourth day. According to Kasyapa the Dosha which have been localised in shirasthana movestowards kanthas than in one day from kanthasthana to Hrudaya on next day and fromHrudaya to rasadhatu or Amashaya to manifest the jwara on the fourth day. Dosha located inshira and majja Dhatu being provocateur by kala prakriti. Dushya enters into amasaya andproduce Agnimandya. The produced Ama causes srotarodha and responsible forvimargagamana of Jataragni.According to predominance Dosha it has been classified in two types. 1. Kaphadhikya chaturthak jwara 2. Vatadhikya chaturthaka jwara Kaphadhikya chaturthakjwara originates from jangha pradesh and spread all over thebody and vatadhikya chaturbakajwara originates from shira and spread through out the body.Viparijya jwara If the fever comes in its remission period discussed above then it can be regarded asviparjayajwara. The word viparjaya means virudhata/veniyama or parivartana (reverse).Susruta considered it as viparjaya. Charaka and Vagbhata considered for chaturthaka as Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 57
  • 69. “viparyaya jwara” are mainly according to the predominant of Doshas in the particular siteof vitiation. Here it is noted that the vitiated Doshas has no definite place to be localised inany of the five Kapha sthana in Santatajwara, there is no viparyaya because the Dosharemains in all five kaphasthanas. But in case of Anyeduskajwara, if it is comes in remissionperiod than it is known as Anyeduska viparyaya, in Chaturthaka viparyaya jwara vegaoccurs continuously for three days and subside as fourth day. Also the similar process takesplace in Treetiyaka jwara.Duration and vega in different jwaras Table –2 Name of jwara No. of vega PeriodSantata Nirantara(whole time) 7,10 or 12 daysSatata Twice In ahoratra (24hr)Anyeduska Once In ahoratra (24hr)Triteeyaka Once An alternate dayChaturthaka Once On every 4th dayChaturthaka viparjaya Twice In between two days leaving 1st and 4th dayPurvarupa (premonitary symptoms) Any specific premonitory symptoms of Vishamajwara are not found or described inany Ayurvedic literature. As per the general principle the initial appearance of some of thefeatures of Vishamajwara is considered as its purvarupa. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 58
  • 70. Flow chart –2 Schematic diagram of Vishamajwara Samprapti Nidan –nija Agantuka (keetanu) Dosha vaisamya Agni mandya Production of Ama Tridosha being provocateur and mixed with Ama first appeared in Amashaya Srotorodha in Amashaya Localisation of Pachakapitta Circulating in Rasa and Rakta Dhatu Localisation in Rasa and swedavaha Srotas Development of VishamajwaraSantata Satata Anyeduska Triteeyaka Chaturthaka Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 59
  • 71. Table –3 Showing the Vishamajwara vishista Lakshana Lakshana Charaka Susruta Sitilathat (lethergy) + + Gurutha (heavyness) + +Santata Jwara Udveg (excitement) + + Dinata (weakness) + + Gamana (movement) + + Jrumbha (yawning) + Angamarda (malaise) + Aruchi (anorexia) + Daha (burning sensation) + +Satata Jwara Bhrama (vertigo) + + Pralapa (delirum) + + Pidika (pedicles) + Sthivana (spitting) + + Sveda pravriti (sweating) + + Vamana (vomiting) + Pindikidwevasthan (pedicles) + Murati pravriti (urination) +Anyedyushka Jwara Angavisesa (myelgia) + Sweadadhikya (sweating) + Vamana (vomiting) + Aruchi (anorexia) + Glani (sorrow fullness) + + Pralapa (delirum) + Antardaha (internal burning) + Malati pravruti (diarrhoea) + Atisara (diarrhoea) + Vedamntapida (pain) + Anga vikshepa (myelgia) +Truteeyaka Jwara Abhyantara daha (internal burning) + Murcha (fainting) + Swedhikya (excessive sweating) + Pralapa (delirium) + Glani (sorrow fullness) + Dourgandha (foul smell) + Swasa (dyspnoea) + Kasa (cough) + Vamana (vomting) + + Vamana (vomting) + + Vedantaka pida (pedicles) + +Chaturdhaka Angavishada (malaise) + + Jwara Swasa (dyspnoea) + + Hikka (hie-cough) + Abhyathara daha (internal burning) + Asthi sankoch + Agnimanda (dyspepsia) + + Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 60
  • 72. Sadhya sadhyata (prognosis) Sadhya-sadhyata is very important to assess the prognosis of disease before startingtreatment. In a person who is strong, vitiation of Dosha is mild without any complication ofjwara is said to be sadhya. If the jwara developed by strong positive factors which all the sign and symptomsare present, function of indriya (sense organ) are derranged, the disease is considered to beasadhya. If the jwaravega is antarvega, it is said to be kruchhara sadhya (curable withdifficulties) and vaheervega it is sukhasadhya. When the jwara associated with Bhrama,durbala indriya, tikshna jwaravega, durbalata, prabahani, aruchi and function of Indriyasbecome feeble then the jwara is said to be asadhya. The santata jwara if one or two doshas are involved then it is curable but if more twothan kill the patient. The anyedushka, satata. Triteeyak are curable as the doshas lies insuperficial as in Rakta, mansa and meda Dhatu. Chaturthaka is difficult to cure because thedoshas lies in deeper dhatus like asthi, majja leaving to development of other diseases. The bhutavisanga Vishamajwara depends upon baya, bala, Agni, prakriti and theinvovement of dhatus. The symptoms like swash, murcha, chharoli trishna, Atisara,vatagraha hicca, kasha, angaveda are detected than it is said to be asadhya.Management of Vishamajwara in Ayurveda In Ayurveda removal of positive factors as well as measures adopted for themaintenance of Doshic equilibrium is called as Chikitsa. There are 3 types of Chikitsa i.e., 1. Daiva vyapasraya 2. Yukti vyapasraya and 3. Satwavajaya Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 61
  • 73. Yuktivyapasraya joins its popularity now days because of its application of therapeuticsdilemmas in particular ailments. Again this is divided into three parts i.e., 1. Antahparimarjan (internal purification) 2. Bahirparimarjan (external purification and 3. Sastra pranidhana (surgical measures) For each one of those five fevers different kashayas (decoctions) are prescribed.Though bitter drug is prescribed in any kind of fever, in the treatment of Vishamajwaramore emphasis is laid on biter drugs like kirata, guduchi, bharangi, nimba etc. The emphasison bitter medicine is due to the vitiated Dosha (Pitta) though other two Doshas also playsome important role. For Pitta shamana drugs, which are astringent, bitter and sweet areuseful. In high temperature and extreme burning sensation of the body, application of waterand milk externally are recommended for immediate relies. Some lauha preparations likevishamajwarantaka lauha. Sarbajvarahar lauha chandanadilauha etc. will be highly useful incase of anemia after malaria attack. Perusal of various texts of Ayurvedic classics will indicate the following main modeof treatment in Vishamajwara. 1. Kasaya (decoction) (Panchakashaya) 67 2. Ghritams (medicated ghee) 3. Suportive therapy like rasuna yoga 4. Anjana 5. DhupanaThe drug mentioned in the treatment of Vishamajwara can be classified as those. 1. Acting on doshas mainly on Pitta and Kapha (Dosha pratyaneek) Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 62
  • 74. 2. Acting on Dhatu and including organ like liver, spleen, etc. 3. Acting on the disease (Vyadhi pratyaneeka) The drugs having Kashaya and Tikta Rasa by and large from jwaraghna Dravyas likeguduchi (tinospora cordifolia) nimba (azadirachta indica), chandana (santalumalbum),murva (sansvieria roxburghiana), kiratatikta etc. full under the doshagna group.Role of langhana The treatment of ordinary fever, langhana (fasting) swedana (diaphoretics), kala(time factor), yavagu (liquid diet) and tiktarasa (bitter medicines) are indicated. InVishamajwara, langhana and swedana are not recommended.Preventive countermeasures in contemporary practice Preventive countermeasures are divided into three sections: 1. Personal Protective Measures, 2. Chemo-prophylaxis, and 3. Management.1) Personal Protective Measures This section presents measures that prevent mosquitoes from biting and transmittingmalaria. Applications of personal protective measures are effective against a wide range ofdisease vectors, not solely for prevention of malaria. In many military operations, they willbe the only means of protection against biting arthropods. They are the first line of defense,are simple to teach and perform, and enable personnel to remain in endemic areas whilemaintaining their operational capabilities. The major drawback of personal protectivemeasures is dependence on service member compliance. Persuasion by medical personnel,and enforcement by NCOs and commanders is necessary for their continuous proper Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 63
  • 75. application. Medical personnel must circulate among units teaching, examining, andimproving personal protective measure practice, and also reporting their findings to those incharge. Commanders and NCOs must ensure compliance and lead via personal example.DEET Topical repellents are natural or synthetic compounds that repel arthropods. The useof vapor-active skin repellents by U.S. Armed Forces has a long history. It began with theuse of oil of citronella in 1910, continued with the discovery of dimethyl phthalate duringWW II, and led to the development of diethyl toluamide or “DEET” in 1957. The durationof a repellent’s effectiveness decreases with activity, heat, and humidity. Since Anophelesmosquitoes inhabit warm tropical environments, military personnel need to re-applyrepellent frequently to prevent biting. These products were selected based on theireffectiveness. Contrary to public opinion, Avon Skin So Soft R and flea collars are noteffective.Protective Clothing and Netting The basic utility or camouflage uniform treated with permethrin and worn withsleeves down, collars closed and trousers bloused over boots offers excellent protection frommosquitoes. Other types of protective clothing and netting are also available.2) Chemoprophylaxis Choice of regimen is determined by two factors: • Drug resistance in specific locations. • Any allergic or other reaction to the anti-malarial drug of choice, or restriction by job (mefloquine is not authorised for prophylaxis in aviators and divers). Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 64
  • 76. Excellent primary sources of information on malaria drug resistance are the MedicalEnvironmental Disease Intelligence and Counter-Measures (“MEDIC”) compact disc, andthe Navy Environmental and Preventive Medicine Unit responsible for that area of theworld.Prophylactics Four regimens are set out below. The choice depends on the countries, which are tobe visited and possible drug sensitivity of the traveller • Chloroquine can still be used in some regions but is of limited value in many parts of the world. Treatment should be started one week before travelling to, and continued for four weeks after leaving, a malaria endemic area. (Adult dose 300mg weekly taken with a meal, at the same time and on the same day each week). It will suppress but not cure an infection with P. vivax and symptoms may not appear for weeks or months after the traveller has returned home. For children the dose is 5mg/kg base given once a week on the same day each week. Since liquid suspensions for children are no longer available, a tablet has to be divided to provide the appropriate dose. Chloroquine has a bitter taste and should be given to children crushed in a strong flavoured (sweet) drink. Prophylactic drugs in children should not be given without advice from a medical practitioner, preferably one practising from a health travel medical centre. 68 Chloroquine is considered a safe drug for pregnant and lactating women and also for children. However, it is wise to discourage women who are pregnant from travelling to areas where malaria is present because of the difficulties associated with treatment and the risk to the mother and foetus should they get malaria. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 65
  • 77. • Doxycycline is a suitable prophylactic anti-malarial agent to use in high risk areas such as South East Asia. It must not be used in children under 8 years of age nor in pregnant or breast-feeding women. Doxycycline may cause contraceptive pills to be less effective so additional precautions should be taken. It may cause thrush in some women but usually only when taken for long periods. It may cause severe skin photosensitivity in some individuals. Doxycycline - Adult dose 100mg daily. Start 1- 2 days before travelling to a malarious area and continue for 2-4 weeks after leaving. To ensure that the patient is not sensitive to doxycycline it is worthwhile starting treatment 7 days before travelling. It is recommended that it is not taken for longer than three months without a medical review.• Mefloquine (Lariam) is still a widely used prophylactic. It has a long half life and the convenience of a once weekly dose. For adults (more than 45 kg bodyweight) the dose is 250mg base weekly, starting one week before arrival in a malarious area. Side effects have been reported which are generally mild (e.g. Sleep disturbances, gastrointestinal disturbances, dizziness or disturbed sense of balance). A rare but important adverse reaction is acute brain syndrome which occurs in, one in 5,000- 20,000 of those taking the drug. It is not recommended for aircraft pilots or drivers of public transport.• MalaroneTM. This is a combination of atovaquone and proguanil and recent studies have found it a safe and effective prophylactic agent with few side affects. Unfortunately it is expensive and has to be taken daily. It is not suitable for those sensitive to atovaquone or proguanil . Treatment should be started 2 days before Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 66
  • 78. travel and continued for at least 7 days after a period of potential exposure to malaria. • Other possible regimens include daily azithromycin, daily high-dose primaquine and short course tafenoquine.Deterrence/Prevention: • Avoid endemic regions. • Take the proper prophylactic drugs at proper intervals if traveling to endemic regions. • Use topical insect repellent (30-35% diethyltoluamide [DEET]), especially from dusk to dawn. • Wear long-sleeved permethrin-coated clothing if not allergic to permethrin; spray under beds, chairs, tables, and along walls. • Sleep under fine-nylon netting impregnated with permethrin. • Avoid wearing perfumes and colognes. • Seek out medical attention immediately upon contracting any tropical fever or flulike illness. • Chemoprophylaxis is available in many different forms. • The drug of choice is determined by the destination of the traveler and any medical conditions the traveler may have that contraindicate the use of a specific drug. • Before traveling, people should consult their physician or call the CDCs Malaria Hotline to determine the most appropriate chemoprophylaxis. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 67
  • 79. 3) Management Blood schizonticides are the first-line drugs for the treatment of malaria and must bestarted as soon as the diagnosis is made or even suspected. They act on the asexual forms inthe erythrocytes and interrupt clinical attacks. Delay in treatment of P falciparum malariacan lead to development of severe malaria, which has a poorer prognosis thanuncomplicated malaria. Chloroquine, quinine, quinidine, mefloquine, halofantrine, andartemisinin compounds are the rapidly acting drugs that can terminate an acute malariaattack. While chloroquine acts rapidly, resistance is widespread and an accurate travelhistory should be obtained before choosing the anti-malarial drug. P vivax and P ovale have dormant stages (hypnozoites) in the liver, and the treatmentof an episode of malaria requires eradication of these forms also. The classic treatment is a3-day course of chloroquine, followed by a 14-day course of primaquine. A shorter courseof 5 days of primaquine, started with chloroquine, has been described but is associated withhigher relapse rates.Detailed Drug review All the components of the Bharangyadi Ghanavati are explained as under.1) BHARANGI – Clerodendrum Serratum 69-70PLANT PART USED: Roots and leaves.DESCRIPTION: A shrub 0.9-2.4 m high, slightly woody, not very branched, stems bluntlyquadrangular, young parts usually glabrous. It has pink white flower, numerous and striking. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 68
  • 80. PHYTOACTIVE : A sterolglucoside has been isolated. The root bark yields a glycosidic material, 71phenolic in nature . D-mannitol was isolated from the root bark with a yield of 10.9%72 .The powdered stem contains D-mannitol, b-D glucoside of b-sitosterol,b-sitosterol and 73.cetyl alcohol From the bark the sapogenin mixture contains three major triterpenoidconstituents-olconolic acid,queretaroic acid and serratagenic acid.DIRECTIONS FOR USE : An aqueous extract produced a graded block of the responses to histamine onisolated guinea pig ileum. It blocked the histamine-induced contractions of the guinea pig 74tracheal chain preparations without affecting the response to acetylcholine . The saponinisolated from the root bark caused a release of histamine from rat lung tissue 75. Continuousdaily administration of the plant extract in the sensitised guinea pig causes a graduallydeveloping protection against anaphylaxis. The anticholinestrase activity of the saponin wasconfirmed by acetylcholine responses on guinea pig tracheal chain preparation, isolated ratileum and frog rectus muscles 76. The saponin also disrupted the rat peritoneal mast cells andblocked the effect of horse serum antigen 77. A decoction of roots is used in asthma and bronchitis. The leaves are applied in theform of poultice in skin suppurations. The drug is used in fever 78. It is also used in sinusitis.It is recommended in inflammations of the eye.CONTRAINDICATION : In the doses used, no adverse reactions have been reported in man. Larger doses are reactive.FORMULATION AND DOSAGE : Churna : 0.5 - 1.5 gm Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 69
  • 81. 2) MUSTA - Cyperus rotundus Linn 79-86PLANT PART USED : Bulbous root.DESCRIPTION : The plant is a common weed represented by several types growing in India. Theblackish rhizomes are slightly fragrant and in Asia the essential oil they yield is used as aperfume and to repel insects. The branches are long and with three edges. The flowers aretiny.PHYTOACTIVE : The essential oil from C. rotundus contains at least 27 components comprisingsesquiterpene hydrocarbons,epoxides,ketones, monoterpene and aliphatic alcohols and someunindentified constituents. (+) copadiene and (+) epoxyquaine have been detected. Thevarious characteristics of the essential oil obtained from the tubers have been studiedchromatographically and by spectroscopic methods.DIRECTIONS FOR USE : The petroleum ether extract of the roots showed anti-inflammatory activity againstcarrageenin-induced oedema in albino rats. The active fraction was identified as atriterpenoid. The antipyretic activity was demonstrated on pyrexia induced by Brewers yeastin albino rats. A fraction tested on aconitine-induced writhing in mice showed mildanalgesic activity.Antihistaminic and antiemetic activities were shown in experimentalstudies on dogs. Smooth muscle relaxant activity was demonstrated on rabbit ileum. Extractsof rhizomes were inhibitory to the growth of fungi depending on species. Antibacterialactivities of oil and its fractions have been demonstrated against a number of organisms. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 70
  • 82. Clinical trials have shown efficacy of 21, solution of aqueous extract of C. rotundusin 26 patients with conjunctivitis. Traditionally it has been used in the treatment of chronicdiarrhoea. It is found useful in diarrhoea with mucus. It is commonly given in fever. It actsas an antiperspirant and deodorant.CONTRAINDICATION : Safety: In the commonly used dose no adverse reactions have been reported. Malbino mice, no toxic effects of the plant were observed.FORMULATION AND DOSAGE : 1. Mushtadi churna : 1 to 3 gms. b.i.d. 2. Mushtadi kwath : 30 - 60 ml. b.i.d. 3. Mushta kwath : 30 to 60 ml. b.i.d. 4. Mushta oil : topical use.Medicinal Applications 87Action Alterative, anthelmintic, anti-fungal, anti-parasitic, anti-rheumatic, antispasmodic,aphrodisiac, astringent, carminative, demulcent, diaphoretic, diuretic, emmenagogue,galactagogue, refrigerant, stimulant, stomachic, tonicUses (high) blood pressure Fevers bloody stool, urine, and gastritis vomiting blood indigestion breast tumors mal-absorption candida mental health (moodiness, and depression) colds and flu menstrual disorders (pain, cramps, and PMS) colic menopause Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 71
  • 83. convulsions palpitation diarrhoea parasites dysentery vomiting dysmenorrhea The decoction of the roots and tubers are excellent antidote to all poisons. A paste ofthe fresh tubers applied to the breasts acts as an effective galactagogue. The root is oftenused for developing high memory. This herb also harmonizes the liver, spleen, and pancreas.3) PARPATAKA - Fumaria officinalis Linn 88-95PLANT PART USED : Whole plantDESCRIPTION : The plant is of a greyish yellow colour. Leaves greenish, thick and narrow, stemsgreyish yellow, one or two inches long, furrowed and rather quadrangular. Fruit capsules arevery small greyish green, slightly compressed and with a transverse ridge scar to the apex.Flowers are irregular, asymmetrical and either violet or white, seeds small and consist offleshy albumin.PHYTOACTIVE : The plant contains fumaric acid and fumarine. Fumarine exists in irregular 6-sidedcrystals or in monocionic prisms, insoluble in alcohol, chloroform, benzol and amyl alcoholsparingly soluble in water and soluble in ether. Seven alkaloids have been isolated from thealcoholic extract of whole plant.DIRECTIONS FOR USE : The water-soluble portion of 90% ethanolic extract of stem and leaves of Fofficinalis produced a marked relaxant effect on the isolated rabbit ileum, dogs intestine in Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 72
  • 84. situ and on spontaneously contracting isolated uteri of rat, and- guinea pig. It had non-specific spasmolytic action on isolated rat arid guinea pig uterus and dogs tracheal chain. Protopine (5 mglkg iv) the major alkaloid of the plant produced marked relaxation ofintestine in situ of anaesthetized dog without producing any effect on the blood pressure. Arise in biliary flow occurred in the anaesthetised dog4. It is often used in common cold and.fever and also in certain skin disorders. With black pepper it is given in jaundice. It is givento relieve vomiting and thirst in febrile conditions.Remedies For: Diuretic, laxative, alterative, hepatic. Fumitory has long been used in the treatment of skin problems such as eczema andacne. Its action is probably due to a general cleansing mediated via the kidneys and liver.Fumitory may also be used as an eyewash to ease conjunctivitis.CONTRAINDICATION : LD,0 is 1.95 gm/kg in the mouse and 1.28 gm/kg in the rat. When given orally for 3months, it has no effect on the vital organs and produced no haematological disturbances. Itstimulated respiration in both the cat and dog".FORMULATION AND DOSAGE : Fumitory are often combined with Burdock, Cleavers or Figwort. 1. Parpatadikwath : 5 ml. b.i.d. 2. Parpatadyarishta : 5 ml. b.i.d. 3. Parpatachurna : 1 to 2 gms. t.i.d.4. YAVASA (DANVAYAVASA) 96Fagoina arabia Fagoina arabia is amongst the widely used medicinal plants in Pakistan. It is knownby common names "Azghakhi" or "Damiya" in the rural areas of NWFP. Fagoina arabica Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 73
  • 85. belongs to the family Zygophyllaceae (Hooker, 1882). Generally the plant is found on drycalcareous rocks distributed throughout the Mediterranean region to South Africa,Afghanistan, India, Pakistan especially Sindh, Punjab and NWFP (Rizvi et al., 1996). It isthe chief and popular fever remedial source of people in the hilly areas. Its infusion iseffective in sore mouth and for cooling mouth in stomatitis and also purifies the blood andacts as a deobstruent (Said, 1996). People of NWFP specially used it for skin diseases, small pox and for endothermicreaction in the body (Watt, 1972). The twigs of the plant are used as remedy to snakebiteand also applied externally as paste on tumours and for the swellings of neck.5) SHUNTI - Zingiber officinale 97-115Other Names:Ginger; Ardrakam; Shunthi; Adrak; Sunth; black ginger; race ginger; African ginger; sheng jiang;PLANT PART USED : RhizomeDESCRIPTION : A herbaceous rhizornatous perennial, upto 90 cm in height when fully grown. Theherb develops several lateral shoots in clumps. Leazies are 15-30 cm long and 2-3 cm broad,with sheathiiig bases, the blade gradually tapering to a point. The rhizomes are aromatic,thick lobed pale yellow, bearing simple alternate (listichotis narrow, oblong lanceolateleaves.PHYTOACTIVE: Ginger contains 1-2% volatile oil and 5-8% resinous matter, starch and iiiucilage.The oil of ginger is a mixture of over 24 constituents, consisting of monoterpenes(phellandrene,(+) carnphene, cineolc,, citral and borneol) and sesquiterpenes etc(zingiberine, and hisabolene). The pungent component is gingerol formed in the plant from Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 74
  • 86. phenylalaanine, nialoiiate and hexanoate. Minor constituents of an extract are gingreniols,methylgingediol, gingeryldiacetates and methyl gingediacetates.DIRECTIONS FOR USE : Anti-inflammatory activity in carrageenin-induced rat paw oedema has been shown.The active principles - gingerol, and dehydrogingerdione and gingerdione were shown to bepotent inhibitors of prostaglandin synthesis- confirming the mechanism of anti-inflammatory effect. The antirheumatic effects were further confirmed by other inves-tigators. Antihistaminic activity has also been shown in vitroll. The plant inhibits the viriontoxic factor production in infected chorioallantoin membrane and also inhibits the growth ofW.M. - 25d malignant cell-line. Cardiac inotropic activity has been shown in, Dogs andguinea pigs. Ginger was shown to have significant antiemetic and antivertigo effects likedramamine". It has been lised effectively along with Piper nigrum and Piper longum in viralhepatitis". Ginger forms an important constituent of many Ayurvedic formula- tions. It ischiefy used as a home remedy for nausea and dyspepsia.Remedies For: For over 2,500 years, ginger has been an important herb in Asian medicine.Traditionally it has been used to promote cleansing of the body through perspiration, to calmnausea Action: Aromatic, carminative, stimulant to the gastro- intestinal tract, diaphoretic,expectorant, antiemetic, and stomachic, also sialagogue and digestive; Externally, a localstimulant and rubefacient.Ginger is used for:Atherosclerosis, heart disease ConstipationChemotherapy support Incontinence Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 75
  • 87. Migraine headaches FlatulenceMorning sickness ColicMotion sickness SpasmsNausea and vomiting following surgery FeverRheumatoid arthritis Eye diseasesBelching AsthmaLaryngitis ColdsVomiting CoughDigestive System Actions: Ginger is a classic tonic for the digestive tract. Classified as an aromatic bitter, itstimulates digestion. It also keeps the intestinal muscles toned. This action eases the transport of substances through the digestive tract, lesseningirritation to the intestinal walls. Ginger may protect the stomach from the damaging effect ofalcohol and non steroidal anti-inflammatory drugs (such as ibuprofen) and may help preventulcers.Allergies and asthma: Dried ginger can help in the management of allergies and asthma by offsetting theeffect of the platelet-activating factor (PAP). PAP initiates inflammatory processes inallergy and asthma. It was found to become more active after changes in blood chemistrythat occur in a high-fat diet.Atherosclerosis and high cholesterol: Arthritis, bursitis, fibrocystic breasts, lymphedema, and pain. Ginger inhibits theproduction of immune-system components called cytokines. These chemicals are believed tocreate a long-term tendency toward inflammation. Ginger also stimulates blood circulation. These effects of ginger are taken advantageof in treating a number of disorders marked by swelling and pain, such as arthritis. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 76
  • 88. Studies have also shown that ginger can relieve pain without the side effectstypically found when using nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids.Anti-nausea/Anti-vomiting Actions: Research is inconclusive as to how ginger acts to alleviate nausea. Ginger may actdirectly on the gastrointestinal system or it may affect the part of the central nervous systemthat causes nausea. It may be that ginger exerts a dual effect in reducing nausea andvomiting.Parasitic infection Ginger contains a chemical called zingibain that dissolves parasites and their eggs. Inlaboratory trials, ginger extracts have been shown to kill the anisakid worm (a parasiteoccasionally found in raw fish) within sixteen hours. Ginger tea is useful as a supplement intreating schistosomiasis, a parasitic disease.Seizure disorders Ginger protects the body from the hepatotoxic effects of valproic acid (Depakene), acommon treatment for seizure disorders. Ginger, when used on a daily basis, was found toimprove the elevated levels of the liver enzymes alanine amino- transferase (ALT) andaspartate aminotransferase (AST).Action and Uses in Ayurveda and Siddha Ginger is an important herb used in Ayurveda. Ayurveda takes advantage of thefollowing medicinal properties for ginger: Analgesic, anti-emetic, aromatic, aphrodisiac,carminative, diaphorelic, digestive, expectorant, nervine, sialagogue, stimulant. Ayurvedic practitioners consider ginger to be a truly a wonder drug, having so manyhealing properties. It was called the universal medicine. Taken with rock salt it reduces Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 77
  • 89. vayu; with rock candy it reduces Pitta; with honey it reduces Kapha. Thus it can be used toinfluence all tridoshas. Ginger is used in the following ayurvedic remedies: katu rasam, ushna veeryam,vata-kapha-haram, katu- vipaka, lagu, snigdam, pachanam, ruchyam, vrishyam, swaryam,vibhanda haram, in grahani agnimanthyam. amavatham, chardhi, swasam, soolam, arsas,anaham, hrith-rogam, udhara rogam. It is used externally in kapha, swellings, headache.CONTRAINDICATION : With the recommended doses and the use as spice, side- effects are hardly reported.With large doses of some of the active principles CNS depression has been noted inanimals".FORMULATION AND DOSAGE : 1. Adrakkhand : 1 2. Soubhagyasunthipak : 6 - 12 gm b.i.d. 3. Rhizome powder : 0.15 - 1.5 gm b.i.d. / t.i.d. 4. Ginger juice : 2 - 4 ml b.i.d. / t.i.d. 5. Panchasamachurna : 0.75 gm b.i.d. / t.i.d. 6. Samasharkarchurna : 250 - 750 mg t.i.d.6. KIRATATIKTA (BHUNIBHA) Swertia chirata – 116PLANT PART USED : The whole plant is used medicinally, but the root is said to be the most powerful part.DESCRIPTION : The plants is an erect herb, stems are robust 0.6-1.5 m, branching leaves areopposite, broadly lanceolate, acute, lower leaf often much larger, sometimes petioled. Calyxand corolla are four-lobed. Corolla green-yellow and tinged with purple 117. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 78
  • 90. PHYTOACTIVE: The main chemical constituents of this plant are ophelic acid and chiratin. The plant 118-119also contains resins, tannin, gum, carbonates, phosphates and 4 to 6 per cent ash .Anumber of workers have shown that the drug contains bitter glycosidal components, chiratinand amarogentin, swerchirin, phytosterol, also a number of acids and phenolic compounds120-122.DIRECTIONS FOR USE : 123 Anti-inflammatory activity of Swertia chirata has been shown . Islam et al alsonoted such activity against acute inflammation, in rat hind paw 124. Chirata is much prized inIndia as a powerful bitter tonic. Unlike most other medicines of this class it does notconstipate the bowels, but tends to produce a mild laxative affect. It promotes the flow ofbile. It is used as a tonic. In gastrointestinal disorders, like dyspepsia/anorexia it is used asdigestive, febrifuge and laxative. It is particularly useful in fever as a tonic and mildfebrifuge125. It is used to prevent malaria.Medicinal Uses Bitter tonic, stomachic, febrifuge and anthelmintic, appetizer, laxative,alterative, antidiarrhoeic and antiperiodic.Action & Uses in Ayurveda Tikta-rasam, metha veeryam, lagu, ruksham. In sannipatham, swasam, kasam,raktadosham,CONTRAINDICATION : With the doses used no adverse reactions have been reported. No toxic effects inanimals are shown with reasonable doses126. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 79
  • 91. FORMULATION AND DOSAGE : 1. Infusion : 10 - 15 ml b.i.d. 2. Root powder : 3 - 5 gms b.i.d. 3. Mahasudarshan Churna : 2 gms b.i.d. 4. Sudarshan ghanavati : 2 gms b.i.d.7) KUSTA Saussurea lappa 127PLANT PART USED : Roots.DESCRIPTION : It is a tall, stout herb with annual stem and perennial roots. The leaves are large andheart shaped. Roots are used in medicine, which are dug up in autumn. The roots have apungent taste and a characteristic fragrant aromatic odour 128.PHYTOACTIVE : The root of .S. lappa contains essential oils, resins, inulin, tannins, potassium nitrateand an alkaloid, which has been named saussurine. From the etheral extract of the roots, aliquid fraction named Kushtin has been isolated 129.DIRECTIONS FOR USE : The essential oil has antiprotozoal effect in vitro (1 in 10,000 dilution). It also hasantibacterial effects against streptococei and staphylococci. On the isolated heart of therabbit, the essential oil produces positive inotropic and chronotropic effects. The alkaloidsaussurine has a smooth muscle relaxant activity. On rabbit ileum in vitro, Saussurineantagonized the contractions produced by histamine and acetylcholine. On peripheral vessels(perfused car vessels of rabbit) the alkaloid produced initial dilatation followed bysubsequent constriction. The alkaloid did not block the effects of adrenaline and histamine Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 80
  • 92. on the vessels. On guinea-pig tracheal chain, it did relax the broncho-constriction producedby histamine in this preparation. On systemic administration, under experimental conditions, saussurine has a positiveinotropic action on the myocardium. It is. Used as a bronchodilator and antispasmodic, andalso in skin diseases.Medicinal Properties: Action alterative, anthelmintic, antiseptic, antispasmodic, aphrodisiac, aromatic, astringent,carminative, diuretic, expectorant, insecticidal, prophylactic, stimulant, tonicUsesBronchial asthma jaundicecholera leprosycough phlegmdyspepsia rheumatismedema skin diseasesgas hiccup As an ointment it is applied externally to wounds, severe ulcerations, skin diseases, and tumours.CONTRAINDICATION : Maximum tolerated doses were found to be 100 mg/kg in white mice and rats 130.respectively Clinically, gastric irritation and dizziness are occasional side effects seenonly with large doses.FORMULATION AND DOSAGE : As an infusion of the dried root : 20 - 30 ml b.i.d.Agnimukha churna : 5 - 10 gms b.i.d.Root paste : Topical use. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 81
  • 93. 8) PIPPALI - Piper longum Linn. 131PLANT PART USED : Fruit, root and stem.DESCRIPTION : The erect shrub has a thick, jointed and branched rootstock. Leaves are numerous,6.3 to 9.0 cm, broadly ovate or oblong-oval, dark green and shining above, pale and dullbeneath. Fruits are present in a solitary, pedunculate, fleshy spike 2.5 to 3.5 cm long, 5 mmthick, ovoid, oblong, erect, blunt, blackish green in colour and shining. Odour is aromaticand the taste is pungent. 132PHYTOACTIVE : The fruits contain 1% volatile oil, resin, alkaloids piperine and piperlonguminine, awaxy alkaloid N-isobutyldeca-trans-2-trans-4-dienamide and a terpenoid substance. Rootscorain piperine, piperiongumine or piplartine. Dihydrostigmasterol has been isolated 133.DIRECTIONS FOR USE : 134. Antiallergic activity of the fruit has been studied It effectively reduced passivecutaneous anaphylaxis in rats and protected guinea pigs against antigen-inducedbronchospasm; a 30% protection of mast cells was observed in an in-vitro study. Bothalcoholic extract and piplartine extracted from the stems showed significant inhibition of 135ciliary movements of oesophagus of frog . Neogi et al studied the pharmacology ofpiperine.Piperine decreased the rate and amplitude of respiration and showed nonspecificblockade of acetylcholine,histamine and 5-hydroxytryptamine induced spasm on isolated 136guinea pig and rabbit intestine . The oil of fruit has been found to possess significant 137paralytic action on the nerve-muscle preparation of A. lumbricoides . The hepato- Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 82
  • 94. protective effect has been shown in carbon tetrachloride-induced liver damage in rats138. A 139.common use of the fruit is in the prevention of recurrent attacks of bronchial asthmaAnother important indication is in chronic malaria 140. In a study of 240 children with a long 141.term use of fruit 58.3% had decreased severity of attacks In another study 20 childrenwere studied for one year with the same treatment. Eleven had no recurrence. All patientshad strongly positive skin test which became negative in 6 and decreased significantly in 12 142.after five weeks of treatment Along with Piper nigrum and C. officinale it has beenuseful in viral hepatitis 143.UsesAbdominal tumours FlatulenceAsthma GoutBronchitis LaryngitisColds ParalysisCoughs Rheumatic painDigestion SciaticaEpilepsy WormsMedicinal Applications - Action Analgesic, anthelmintic, aphrodisiac, carminative and expectorant. Seed used in cough and throat pain. Root used in paralysis, epilepsy, and stiff joints.Both seeds and root are used for cough, rheumatism, leprosy, and consumption. The herb isalso believed to improve vitality.CONTRAINDICATION : Piper longum is in widespread use for many centuries. The standard doses are welltolerated. No mortality was observed with the powder of the fruit boiled in milk and wateradministered orally to albino rats in a dose of 1 gm/kg;. Acute toxicity studies with piperine,piperlongumine and piperlonguminine were carried out in mice, rat and dog with oral and Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 83
  • 95. intraperitoneal route. In mice, oral LD (50) was 56.2 + 8.0, 110.1 + 7.8 and 115.3 + 9.5 mg/kgwith piperine, piper- lonigumine and piperlonguminine respectively144FORMULATION AND DOSAGE : 1. Fruit powder : 250 mg. to 500 mg. t.i.d. 2. Pippalyasava : 20 ml. b.i.d. 3. Chousastha Pippali : 125 - 500 mg b.i.d.9) BRUHATI - Solanum Indicum Linn 145PLANT PART USED : Root, fruits, seeds.DESCRIPTION : A much branched shrub 0.3-1.5 m high, with large prickles. Stem stout,oftenpurple.Branches covered with minute stellate hairs. Leaves 5-15 by 2.5-7.5 cm ovate inoutline,acute,clothed with simple hairs. Flowers in racemose extra axillary cymes,purplecoloured,clothed with darker purple coloured hairs. Fruit berry 8 mm diameter globose, darkyellow, when ripe. Seeds minutely pitted 146.PHYTOACTIVE : Fruit and root contain wax,fattyacids,and alkaloids solanine and solanidine 147DIRECTIONS FOR USE : Few drops of water extract of the whole plant are administered through nasal routeespecially on Pushya Nakshatra Prostaglandin content of the endometrium from ten womenwas examined before and after 3 months of the drug administration. A significant increase inprostaglandin E and F was observed. 17-oxysteroids in the urine of women patients alsoincreased on exposure to a nasal spray of the drug 148. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 84
  • 96. It is described as useful in asthma, dry cough, and chronic febrile afflictions and alsoin dysuria. The fruit is useful in leueoderma, pruritus and bronchitis. Juice of the leaves withfresh juice of ginger is taken to stop nausea and vomiting.CONTRAINDICATION : In routine doses no untoward effect is found.FORMULATION AND DOSAGE : 1. Bruhatyadikwatha : 15 - 30 ml b.i.d. 2. Dashamulakwatha : 15 - 30 ml b.i.d.10) GUDUCHI - Tinospora cordifolia 149PLANT PART USED : Root, stem, leaves, and satwa (starch).DESCRIPTION : This plant is a glabrous, succulent, climbing shrub, often growing very tall. It sendsdown long aerial roots, which resemble roots except for nodal swellings. The bark is creamywhite to grey, deeply cleft spirally, the space in between being spotted with large rosette likelenticels.150PHYTOACTIVE: Different constituents reported include a glucoside, alkaloids, bitter principles, 151-152-153-154.crystalline components etc The glycoside-giloin, and a non-glucoside-gilenin 155and gilosterol have been found . The bitter principles have been identified as columbin, 156chasmanthin and palmarin. The alkaloid tinosporin , tinosporic acid, and tinosporol havebeen identified in leaves, which are rich in proteins, calcium and phosphorus. Protoberberinealkaloids are found as trace components in many plants of Tinospora spp. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 85
  • 97. DIRECTIONS FOR USE : Studies on induced oedema and arthritis, and on human arthritis proved the anti- 157inflammatory potency of the water extract of this plant . Phase I and Phase II of adjutantinduced arthritis were also inhibited. The anti-inflammatory activity of this plant resemblesthat of nonsteroidal anti-inflammatory agents 158-159. It also has weak antipyretc action and is 160a morphine potentiatorg. It also shows we diuretic action . The hypoglycaemic potentialof this plant has been studied, extensively. Administration of the aqueous extract to alloxaninduced hyper- glycaemic rats and rabbits in a dose of 400 mg/kg body weight inducedreduction in blood sugar". Reduction in blood sugar levels has been reported in adrenaline 161,induced hyperglycaemia in rates as also a favourable glucose tolerance in this rodent 162-163-164.species on exposure to an aqueous extract of T. cordifolia The aqueous extract ofthe stem antagonises the effects of agonists such as 5-hydroxy- tryptamine, histamine,bradyklnin, and prostaglandins El and E2, on the rabbit smooth muscle. This drug relaxesthe intestinal, uterine smooth muscle and inhibits the constrictor response of histamine and 165acetylcholine on smooth muscle . Intravenous exposure, to aqueous extract of T.cordifolia in doses of 5.0, 10.0 and 15.0 mg/kg body weight produces a temporary butmarked fall in blood pressure and bradycardia in anaesthetised dogs. Blood urea levels in 166uraemic dogs and human subjects were also decreased by this drug . The hepato-protective effect of T. cordifolia extract has been studied in carbon tetrachloride inducedliver damage in rats. While acute damage was enhanced by prior exposure to the drug, itproved effective in the prevention of fibrosis, and in stimulating regeneration in hepatic 167tissue . Clinically, this drug has been tried as a therapeutic modality in rheumatoid Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 86
  • 98. 168-169-17-171 172-173 174arthritis , jaundice and in diabetes . Used in compound formulations fortreatment of jaundice, rheumatoid arthritis and diabetes.Medicinal Properties - Action Alterative, antiperiodic, bitter tonic, diuretic, febrifugeUses This herb is used in seminal weakness and urinary affections. It is also a valuabletonic. Other applications of this herb include: fever, gout, jaundice, torpidity of the liver,skin diseases, secondary syphilis, rheumatism, constipation, tuberculosis, and leprosy. It is ablood purifier and may be useful in AIDS and other immune diseases also. It is also beingproposed for cancer patients before and after chemotherapy.CONTRAINDICATION : Found to he nontoxic in acute toxicity studies.FORMULATION AND DOSAGE : 1. Giloy satva : 5 - 15 rati (625-1875 mg) 2. Guduchyadi tailam : Topical use. 3. Guduchyadi kashaya : 60 - 100 ml b.i.d. / t.i.d. 4. Guduchyadi churna : 1 1/2 - 3 gm b.i.d. / t.i.d. Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 87
  • 99. Chapter –4 Methodology “ ishamajwara in term of modern medical terminology co-related tomalarial fever, is a protozoan disease caused by genus plasmodium and transmitted to manby certain species of infected female anopheles mosquito. Indias geographic position andclimatic conditions are favorable for the transmission of malaria. Frequently people living inthe endemic areas are prone for this infection. Out of 300-500 million clinical cases around100 countries and one million deaths due to malarial malady are noticed globally. The 38thworld health assembly in 1985 recommended that, malaria control should be developed asan integral part of the national primary health care systems 175-176-177. Vishamajwara is irregular (inconsistent) in its arambha (nature of onsetcommitment), kriya (action production of symptoms) and kala (time of appearance) and 178-179-180possesses anushanga (persistence for long periods) . As on today, the malarialparasite has developed resistance to chloroquine compounds, which are used vividly for thepast three decades. Ayurvedic herbs have an important role in the treatment of malarial fever. Even thechloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogashave been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,low-priced and has no proved adverse effects 181 against malarial fever. Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charaka Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 88
  • 100. mentioned Vishamajwara and Chakrapani have commented on Vishamajwara as 182.bhutanubanda Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware183.Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected bymicroorganism) 184. Hence infected female anopheline mosquito bite can be considered ascausative factor for Vishamajwara along with other etiological factors. Thus the present study has been under taken as “Evaluation of the efficacy of theBharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”. TheAyurvedic practitioners use Bharangyadi Ghanavati in the management of Vishamajwara,which is explained in Sahasrayoga in Kashaya kalpana. Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati arehaving antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So thecombination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus thiscombination is chosen for the present study.Materials and MethodsMethod of Collection of data1) Patients: Patients suffering from Vishamajwara will be selected from department of Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi Ayurvedic medical college and Hospital by preset inclusion and exclusion criteria.2) Literary: Literary aspect of study will be collected from classical Ayurvedic and modern texts. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 89
  • 101. 3) Study design: Prospective clinical study4) Sample size: A minimum of 30 patients5) Exclusion Criteria – v Patient below 15 years and above 65 years of the age v Patient with complication like severe anaemia v Renal failure v Pulmonary oedema, v Jaundice v Spleenic rupture v Pregnant women v Cerebral Malaria6) Inclusion criteria – v Age of the patients between 15 to 65 years. v Uncomplicated malarial fever v Peripheral smear test for M P must be positive7) Criteria of Diagnosis 1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be the basic diagnostic criteria. 2) Peripheral smear for MP is taken as diagnostic criteria Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 90
  • 102. 8) Posology- Internal - 3 gms in divided doses 1 vati =500 mg, 2 tab thrice a day with Ushna jala9) Study Duration: 21 days and Follow up for 15 days10) Assessment of Result Subjective and objective parameters are taken for the assessment of result.11) Subjective parameters As designated in the classical texts.12) Objective Parameters 1. Thick and thin blood film for malaria. 2. Peripheral smear test for MP 3. Erythrocyte Sedimentation Rate (ESR) 4. Haemoglobin (Hb %) 5. Temperature chart13) Investigations -Diagnostic and Exclusion 1. Thick and thin blood film for Malaria. 2. Peripheral smear 3. Haemoglobin (Hb %) 4. Total Count (TC) 5. Differential Count (DC) 6. Erythrocyte sedimentation rate (E S R) 7. Widal test Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 91
  • 103. 14) Examination of a Vishamajwara Patient vis-à-vis MalariaHistory: Most patients live in or recently have travelled to an endemic area; however, a fewcases are reported each year with no history of such travel. • Determine the patients immune status, age, allergies, other medical conditions, other medications, and pregnancy status. • The patient usually remains asymptomatic for a week or more after the infecting mosquito bite. • Clinical symptoms include the following: • Cough • Fatigue • Malaise • Shaking chills • Arthralgia • Myalgia • Paroxysm of fever, shaking chills, and sweats • The classic paroxysm begins with a period of shivering and chills, which lasts for approximately 1-2 hours, and is followed by a high fever. Finally, the patient experiences excessive diaphoresis, and the body temperature of the patient drops to normal or below normal. • Many patients, particularly early in infection, do not present the classic paroxysm but may have several small fever spikes a day. • Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 92
  • 104. • Less common symptoms include the following: • Anorexia and lethargy • Nausea and vomiting • Diarrhoea • HeadachePhysical examination: • Physical symptoms that may be noted with malaria include the following: • Tachycardia • Fever • Hypotension • Signs of anaemia • SplenomegalyCauses of Malaria tested: There are four species of the genus plasmodium responsible for the malarial parasiteinfections that commonly infect man, P.falciparum, P.vivax, P.malariae and P.ovale. Themost important of these is P.falciparum because it can be rapidly fatal and is responsible forthe majority of malaria related deaths. Malaria occurs in most tropical regions of the world with P.falciparumpredominating in Africa, New Guinea and Haiti. P.vivax is more common on the Indian sub-continent and Central America with the prevalence of these two infections roughly equal inAsia, Oceania and South America. P. malariae is found in most endemic areas especiallysub-Saharan Africa but much less frequently. P. ovale is relatively unusual outside Africaalthough some cases are now being identified in other regions (eg. Southern States of India). Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 93
  • 105. It is also important to recognise that with the relative ease and speed of modern travel andmigration, "imported" cases of malaria may present in any country. Additionally so called"airport malaria" (see History section) has now been identified in a number of countriesincluding the USA, UK, Belgium, and Switzerland. Airport malaria is particularly dangeroussince Clinicians may have little reason to suspect it, if the patient has had no recent travel toareas where malaria is endemic. This may result in a delay before the correct diagnosis ismade and which may lead to death before appropriate treatment can be initiated. Smalloutbreaks of malaria may occur in countries considered free of the disease, such outbreaksare most likely the result of an infected person entering the country asymptomatic and wheresuitable mosquito vectors are present. • Malaria most often is caused by the bite of a female Anopheles species mosquito that is infected with 1 of the 4 species of the protozoan genus Plasmodium. • P vivax: If this kind of infection goes untreated, it usually lasts for 2-3 months with diminishing frequency and intensity of paroxysms. Of patients infected with P vivax, 50% experience a relapse in a few weeks to 5 years after the initial illness. • P ovale: These infections are similar to P vivax infections, although they are usually less severe. A P ovale infection often resolves without treatment. • P malariae: Those infected with this species of Plasmodium remain asymptomatic for a much longer period of time than those infected with P vivax or P ovale. Recrudescence is common in those infected with P malariae. It often is associated with a nephrotic syndrome, possibly resulting from deposition of antibody-antigen complex upon the glomeruli. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 94
  • 106. • P falciparum: The most malignant form of malaria is caused by this species. Infection with P falciparum is not limited to RBCs of a particular age and, hence, represents the highest level of parasitemia among the 4 Plasmodium species. This species also causes vascular obstruction due to its ability to adhere to endothelial cell walls. This property leads to most complications of P falciparum infection. P falciparum can cause cerebral malaria, pulmonary edema, rapidly developing anemia, and renal problems. • Other less common routes of infection are through blood transfusion and maternal- foetal transmission.Dipstick tests In recent years a number of new techniques based on the "dipstick" format, havebecome available for the diagnosis of malaria. These include the ICT-Malaria Pf, OptiMALrand the Kat-Quick kits. The methods are based on the principle of the detection ofplasmodial histidine rich protein-2 (HRP-2) or parasite-specific lactate dehydrogenase(pLDH) which is present in P.falciparum infections. A number of reports claim sensitivitiesand specificities approaching 100% while other reports have claimed up to 6% crossreactivity with sera positive for rheumatoid factor. Some of these "dipstick" methods havebeen extended to include screening for other forms of malaria but to date results have notbeen quite so impressive. Dipstick tests have the potential of enhancing the speed and also the accuracy ofdiagnosing P. falciparum, particularly in non specialised laboratories where inexperiencedor junior staff may be involved, since very little training is required for these techniques. Inthis laboratory we have found the dipstick kits to be very useful screening or confirmatory Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 95
  • 107. tests, especially when there is difficulty in identifying scanty ring forms in blood films. Theyhave proved to be particularly useful out of hours when junior, less experienced staffs havebeen on duty. However dipstick methods are unable to indicate parasite load and in somecountries the cost may be prohibitive. A potential problem with these methods is that thecirculating antigen may be detected for many days (up to 2 weeks in our laboratory) after theelimination of viable parasites from the circulation. It must therefore be remembered that apositive test may not always be due to an active infection. We would like to emphasise, thatwe regard these dipstick methods as useful additional tests to the long established method ofexamining thick and thin blood films (outlined below), which is still regarded as the "goldstandard", NOT as replacement methods. The highest density of malaria occurs in countriesleast able to afford sophisticated and expensive diagnostic tools. Antibodies to malaria can be detected using enzymatic immunoassays orimmunofluorescence techniques. The antibodies to the asexual blood stages appear days toweeks after the infection and may persist for months. Although useful in survey work or forscreening blood donors and reducing wastage, they are of little value in the "acute" malariasituation. 185 Other methods include the QBC II System, Becton-Dickinsons Quantitative BuffyCoat (QBC) method. This involves centrifuging the patients blood in special capillary tubesprecoated with Acridine Orange (AO) in which parasite DNA is stained with AO. A smallprecision moulded plastic float presses the parasitised red cells (which occupy the uppermost part of the red cell column) against the wall of the tube, where they can be viewed byultra violet light microscopy. The sensitivity of this method is claimed to be very high withexperienced users, although some reports suggest that young trophozoites of P. falciparum Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 96
  • 108. and P. vivax, could not be distinguished with any degree of certainty and that confirmatoryblood films should always examined. Additionally special equipment is required, which maypreclude the method from being used in smaller centres. 186 Another relatively new method is the polymerase chain reaction (PCR) which uses anon-isotopically labelled probe following PCR amplification. It is possible to detect <10parasites per 10uL of blood and PCR may yet prove to be a valuable addition to theexamination of blood films for the diagnosis and specification of malaria 187. Once again thespecial equipment required precludes all but the larger centres. Some researchers haveclaimed that PCR (and Elisa) techniques are as sensitive as blood films, however they areinfinitely more expensive, require specialised equipment and take a longer time to complete. Examination of a thick blood film should be the first step since this has theadvantage of concentrating the parasites by 20 fold in comparison to a thin film, althoughthe parasites may appear distorted making species identification difficult. If parasites areseen then the species should be confirmed by the examination of a thin film. Ideally bloodshould be collected when the patients temperature is rising.Preparation of thick and thin blood films: -Thick films:- place a drop of blood in the middle of a clean microscope slide and with thecorner of a second slide spread the drop until it is about 10-15mm in diameter. The thicknessshould be such that it is just possible to see news print through it. Thin films are made in thestandard manner. Allow the films to dry, do not leave on the bench in a laboratory which isnot fly proofed otherwise the film will be eaten. When the films are dry, fix and stain the thin films in the conventional manner but becareful about the pH of the stain, a slightly alkaline stain is recommended (pH 7.2) as an Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 97
  • 109. acid stain may fail to show the parasites. When only a few thick films are to be stained it isbest to use dilute Giemsa stain (1/20), using a staining jar so that the film is in an uprightposition, this will allow any debris to fall to the bottom of the jar. Do not fix the sampleprior to staining. Stains for about 30 minutes, wash gently with clean water and alloweddrying. If available use a positive control. When a large number of thick films requirestaining, Fields stain is preferred because it is very quick. Fields stain comprises twosolutions; a polychrome methylene blue (A) and eosin (B). The solutions are kept in coveredstaining jars. 1. Dip the dry but unfixed film into solution A for 1 or 2 seconds. 2. Remove from solution A and immediately rinse in clean water ( a 250ml beaker with water gently flowing into it is suitable) 3. Dip the film into solution B for 1 or 2 seconds. 4. Rinse in clean water for a few seconds. 5. Place in a vertical position to dry. If films are old or too thick the red cells may not lyse completely in the brief stainingtime. If this is likely dip the film in clean water for a few seconds or until the haemoglobinhas dispersed before staining. Instructions for preparing Fields stain can be found in manylaboratory textbooks. Under the microscope examine the thick film first, using an oil immersion or highdry lens to determine if parasites are present. Be aware of the patients platelet and leucocytecounts. Malaria is usually associated with a normal or reduced leucocyte numbers. Aleucocytosis is only found in terminal cases. Platelet numbers are moderately or markedly Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 98
  • 110. reduced in some 80% of patients with malaria. Parasites may appear distorted if the patienthas been treated or has had inadequate or ineffective prophylaxis.Diagnostic points of P. falciparum:- 1. Red Cells are not enlarged. 2. Rings appear fine and delicate and there may be several in one cell. 3. Some rings may have two chromatin dots. 4. Presence of marginal or applique forms. 5. It is unusual to see developing forms in peripheral blood films. 6. Gametocytes have a characteristic crescent shape appearance. However, they do not usually appear in the blood for the first four weeks of infection. 7. Maurers dots may be present.Diagnostic points P vivax: 1. Red cells containing parasites are usually enlarged. 2. Schuffners dots are frequently present in the red cells as shown above. 3. The mature ring forms tend to be large and coarse. 4. Developing forms are frequently present.Diagnostic points P. Malariae:- 1. Ring forms may have a squarish appearance. 2. Band forms are a characteristic of this species. 3. Mature schizonts may have a typical daisy head appearance with up to ten merozoites. 4. Red cells are not enlarged. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) 99
  • 111. 5. Chromatin dot may be on the inner surface of the ring.Diagnostic points P ovale: 1. Red cells enlarged. 2. Comet forms common (top right) 3. Rings large and coarse. 4. Schuffners dots, when present, may be prominent. 5. Mature schizonts similar to those of P. malariae but larger and more coarse.Lab Studies: • Helpful studies include a CBC, electrolyte panel, renal function tests, pregnancy test, urinalysis, urine and blood cultures, and thick and thin blood smears. • Laboratory diagnosis in the ED may be limited in hospitals that do not have personnel who are well acquainted with malaria or special tests for rapid detection of the disease.Imaging Studies: • A chest x-ray may be helpful if respiratory symptoms are present. • If CNS symptoms are present, a CT scan of the head may be ordered once the patient is stable.Other Tests: • Microhematocrit centrifugation • Using this method with the CBC tube is a more sensitive method of detection of malaria infection. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)100
  • 112. • However, microhematocrit centrifugation does not allow the identification of the species of Plasmodium. To determine that species, a peripheral blood smear must be examined.• Giemsa-stained thick and thin peripheral blood smears • These smears are the criterion standard for malaria detection and should be sent to the laboratory immediately, since malaria is a potentially life- threatening infection. • When reading the smear, 200-300 oil-immersion fields should be examined (more if the patient recently has taken prophylactic medication, because this temporarily may decrease parasitemia). • One negative smear does not exclude malaria as a diagnosis; several more smears should be examined over a 36-hour period.• Fluorescent dyes: Several different dyes allow laboratory results to be obtained more quickly. These methods require the use of a fluorescent microscope.• Polymerase chain reaction • Polymerase chain reaction (PCR) is a very specific and sensitive test for determining if the species of Plasmodium are present in the blood of an infected individual. • PCR is also very effective at detecting the Plasmodium species present in- patients with parasitemias as low as 10 parasites/ml of blood.• ParaSight F (dipstick test) Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)101
  • 113. • This test is useful in detecting only P falciparum infections. It is based on antibody recognition of the HRP-2 antigen of P falciparum and, in most cases, it has been found to be as specific as microscopy studies. • It often is able to detect P falciparum in parasitemias that are below the threshold of reliable microscopic species identification. • The dipstick test is not as effective when parasite levels are below 100 parasites/ml of blood, and the test rarely is negative in those with high parasitemias. For these reasons, always confirm ParaSight F test results with a second type of screening test.Special Concerns: • Pregnancy • Pregnant women, especially primigravid women, are up to 10 times more likely to contract malaria than nongravid women. Gravid women who contract malaria also have a greater tendency to develop severe malaria. • Unlike malarial infection in nongravid individuals, pregnant women with P vivax are at high risk for severe malaria, and those with P falciparum have a greatly increased predisposition for severe malaria as well. • For these reasons, it is important that nonimmune pregnant women in endemic areas use the proper prophylaxis. • If a pregnant woman becomes infected, she should know that many of the antimalarial and antiprotozoal drugs used to treat malaria are safe for use during pregnancy for both the mother and the foetus. Therefore, they should Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)102
  • 114. be used, since the benefits of these drugs much outweigh the risks associated with leaving the infection untreated. • To obtain the latest CDC recommendations for malaria prophylaxis and treatment, call the local Anti-malarial squad. • Paediatrics • In children, malaria has a shorter course, often rapidly progressing to severe malaria. • Children are more likely to present with hypoglycaemia, seizures, severe anaemia, and sudden death, but they are much less likely to develop renal failure, pulmonary oedema, or jaundice. • Cerebral malaria results in neurologic sequelae in 9-26% of children, but of these sequelae, approximately one half completely resolve with time. • Most anti-malarial drugs are very effective and safe in children, provided that the proper dosage is administered. Children commonly recover from malaria, even severe malaria, much faster than adults.Complications: • Most complications are caused by P falciparum, and they may include the following: • Coma (cerebral malaria) • Defined as coma, altered mental status, or multiple seizures with P falciparum in the blood, cerebral malaria is the most common cause of death in malaria patients. If untreated, this complication is lethal. • Even with treatment, 15% of children and 20% of adults who develop cerebral malaria die. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)103
  • 115. • The symptoms of cerebral malaria are similar to those of toxic encephalopathy. • Seizures • Renal failure: As many as 30% of nonimmune adults infected with P falciparum suffer acute renal failure. • Haemoglobinuria (blackwater fever) • Blackwater fever is the passage of dark, Madeira-colored urine. • Haemolysis, haemoglobinemia, and the subsequent haemoglobinuria and hemozoinuria cause this condition. • Noncardiogenic pulmonary oedema: This affliction is most common in pregnant women and results in death in 80% of patients. • Profound hypoglycaemia: Hypoglycaemia often occurs in young children and pregnant women. It often is difficult to diagnose since adrenergic signs are not always present and since stupor already may have occurred in the patient. • Lactic acidosis: This occurs when the microvasculature becomes clogged with P falciparum. If the venous lactate level reaches 45 mg/dl, a poor prognosis is very likely. • Haemolysis resulting in severe anaemia and jaundice • Bleeding (coagulopathy)Consultations: It is recommended that the emergency physician contact an infectious diseaseclinician or the pathologist when confronted with a possible case of malaria based uponhistory and physical examination to ensure proper identification and diagnosis. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)104
  • 116. • To aid in identification of the species of Plasmodium, also notify the pathologist of patient information, including the following: • Determine where the patient has travelled and when the patient returned home. • Determine if the patient has been diagnosed with malaria ever before. If so, find out which species of Plasmodium caused the previous infection. • Determine what medication or prophylaxis the patient has taken, and find out when the last dose was administered. • Determine if the patient has a history of blood transfusion or of non-sterile needle usage. • Identify the date and time that the patients blood sample was drawn and determine what condition the patient was in at that time (eg, patient was symptomatic, any periodicity of symptoms).Prognosis: • Most patients with uncomplicated malaria exhibit marked improvement within 48 hours after the initiation of treatment and are fever-free after 96 hours. • Only P falciparum infection carries a poor prognosis with a high mortality rate if untreated. However, if diagnosed early and treated appropriately, the prognosis is excellent.Uncomplicated malaria The presentation of uncomplicated P. falciparum malaria is very variable andmimics that of many other diseases. Although fever is common, it is absent in some cases.The fever is initially persistent rather than tertian (spikes of fever on alternate days, Fig. 2). Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)105
  • 117. The expectation that P. falciparum malaria should have a tertian fever pattern may lead tothe diagnosis of malaria being missed with a consequent delay in treatment. The fever mayor may not be accompanied by rigors. True rigors are relatively unusual in acute falciparummalaria.Severe malaria (Severe falciparum malaria) Severe malaria is caused by Plasmodium falciparum infection and usually occurs asa result of delay in treating an uncomplicated attack of falciparum malaria. Sometimes,however, especially in children, severe malaria may develop very rapidly. Recognizing andpromptly treating uncomplicated P. falciparum malaria is therefore of vital importance. A patient with severe falciparum malaria may present with confusion or drowsiness withextreme weakness (prostration). In addition, the following may develop: • Cerebral malaria defined as unrousable coma not attributable to any other cause in a patient with falciparum malaria. • Generalised convulsions. • Severe normocytic anaemia. • Hypoglycaemia. • Metabolic acidosis with respiratory distress. • Fluid and electrolyte disturbances. • Acute renal failure. • Acute pulmonary oedema and adult respiratory distress syndrome (ARDS). • Circulatory collapse, shock, septicaemia ("algid malaria"). • Abnormal bleeding. • Jaundice. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)106
  • 118. • Haemoglobinuria. • High fever. • Hyperparasitaemia.15) Trail Drug: The combination and proportion of Bharangyadi Ghanavati is as follows. 1. Bharangi Clerodendrum serratum 1 Part 2. Musta Cyprerus rotundus 1 Part 3. Parpatak Fumaria officinalis 1 Part 4. Yavasa (danvayavasa) Fagonia arabica 1 Part 5. Shunti Zingeber officinale roscoe 1 Part 6. Kiratatikta (Bhunibha) Swertia chirata 2 Part 7. Kusta Saussurea lappa 1 Part 8. Pippali Piper longum 1 Part 9. Bruhati Solanum indicum 1 Part 10. Guduchi Tinospora cardifolia 1 Part15) Preparation of Yoga All the drugs will be identified and collected from local areas. Good manufacturingpractice will be followed for the preparation of Bharangyadi Ghana Vati. All the ingredientsare pondered and powered well to powder. Powder is tabulated and preserved in bottles tillto usage. Drug Course powder is boiled with 16 parts of water over mild fire, till the liquid isreduced to solid part of the quantity. 188-189 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)107
  • 119. Chapter-5 Results resent study registers 30 patients, out of 68 approached patients.Out this, 4 patients were discontinued hence their data has not been included in theassessment. The remaining 26 patients of Vishamajwara viz. Malaria, fulfilling the criteriaof diagnosis and inclusive criteria were included in the study. All the patients were examined before and after the trail, according to the case sheetformat given in the annex. Both the subjective and objective criteria were recorded. The datarecorded are presented under the following headings. A. Demographic data B. Evaluating disease Data C. Result of the Bharangyadi Ghanavati in Vishamajwara viz. Malaria and D. Statistical analysis of the clinical and objective parametersA) Demographic data: The details of Age, Gender, Religion, and Occupation etc. of the 30 patients is asfollows.A1) distribution of patients by AgeAge – gender distributions Observation and Results: An interval of 10 has considered from the ages 15 to 65 as discussed in the methods.In the study it is revealed that malarial fever is common from the ages of 15 onwards and asage advances the samples are settled. At the older age group of 45-65 no patients arereported. Where in 15-25 and 25-35 age groups reported with maximum number of patients,i.e. 14 (46.7%) and 10 (33.3%) respectively. The tabulations are depicted as under. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)108
  • 120. Table- 4 Distribution of patients by Age Discontinued Responded Responded % patients Cured Total Age Not % % % %15 –25 10 33.3 0 0 3 10 1 3.33 14 46.725-35 5 16.7 1 3.33 2 6.67 2 6.67 10 33.335-45 4 13.3 0 0 1 3.33 1 3.33 6 2045-55 0 0 0 0 0 0 0 0 0 055-65 0 0 0 0 0 0 0 0 0 0Total 19 63.3 1 3.33 6 20 4 13.3 30 100 Graph – 1 Distribution of patients by Age 45-55 55-65 35-45 0.00% 0.00% 20.00% 15 –25 46.67% 25-35 33.33% DISTRIBUTION OF PATIENTS BY AGE Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)109
  • 121. Out of the 15-25 category we found that, 10 (33.3%) cured patients, 3 (10 %) notresponded patients and 1 (3.33%) patient discontinued. At the 25-35 category we found that,5 (16.7%) cured patients, 1 (3.33 %) responded patient, 2 (6.67%) not responded patientsand 2 (6.67%) patients discontinued. In the 35-45 age group it is observed that 4 (13.3%)cured patients, 1 (3.33%) not responded and 1 (3.33%) patient discontinued. No othergroups are reported in the study. Another observation regarding the age and gender is made in the study. It is foundthat the distributions of the ages in the genders are also gender dependent. Male gender ispredominant in the study and reveals that it is 24 (80%) and the rest females are only 6(20%). Much of the categories that are subjected to the atmosphere with out time relevanceare exposed to the Vishamajwara vis-à-vis Malaria. The tabulations are depicted as under. Table- 5 Distribution of patients by Age- genderAge Male patients Female patients Total patients Number Percentage Number Percentage Number Percentage 15-25 10 33.33 4 13.33 14 46.67 25-35 10 33.33 0 0 10 33.33 35-45 4 13.34 2 6.67 6 20 45-55 0 0 0 0 0 0 55-65 0 0 0 0 0 0 Total 24 80 6 20 30 100 At the male gender 10 (33.33%) patients are of 15-25 ages, 10 (33.33%) patientsbelongs to 25-35 ages and the rest of 4 (13.34%) patients are in 35-45 age category ofVishamajwara vis-à-vis Malaria. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)110
  • 122. On the other hand the female populations are well protected and are in total only20% in the study of Vishamajwara vis-à-vis Malaria. Out of 6 patients reported 4(13.33%)patients are of 15-25 age group and the rest 2 (6.67%) patients are in 35-45 age group. Nopatients are reported from the 45-55 and 55-65 age groups of either category. Graph –2 Distribution of patients by Age- gender 0 55-65 0 Female 0 Male 45-55 0 2 35-45 4 0 25-35 10 4 15-25 10 0 2 4 6 8 10 12 Distribution of patients by Age- genderA2) Distribution of patients by Gender The male female ratio in the study is 4:1 patients. The percentage of the distributiondoes not show any gender differentiation to get this protozoan-related disease. Theobservations are 24 Patients i.e. (80%) male and 6 patients i.e. (20%) were female. As the results observed, out of 24 (80%) males, 15 (50%) patients cured, 1 (3.33%)patient responded, 4 (13.3%) patients not-responded and 4 (13.3%) patients are discontinuedfrom the study. On the other hand out of 6 (20%) female, 4 (13.3%) patients’ cured and 2 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)111
  • 123. (6.67%) patients not-responded in the study of Vishamajwara vis-à-vis Malaria. Thetabulations and depictions are as under. Table- 6 Distribution of patients by Gender Discontinued Responded Responded % patients Cured Total Gender Not % % % % Male 15 50 1 3.33 4 13.3 4 13.3 24 80 Female 4 13.3 0 0 2 6.67 0 0 6 20 Total 19 63.3 1 3.33 6 20 4 13.3 30 100 Graph - 3 Distribution of patients by Gender Female 20% Male 80% DISTRIBUTION OF PATIENTS BY GENDER Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)112
  • 124. A3) distribution of patients by Religion Table- 7 Distribution of patients by Religion Discontinued Responded Responded % patients Cured TotalReligion Not % % % % Hindu 14 46.67 1 3.33 6 20 4 13.3 25 83.33 Muslim 4 13.34 0 0 0 0 0 0 4 13.34Christian 1 3.3 0 0 0 0 0 0 1 3.3 Others 0 0 0 0 0 0 0 0 0 0 Total 19 63.3 1 3.33 6 20 4 13.3 30 100 Graph- 4 Distribution of patients by Religion Christian Muslim Others 3.33% 13.33% 0.00% Hindu 83.33% Distribution of patients by Religion Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)113
  • 125. At the results observed 25 (83.33%) Hindus, 4 (13.33%) Muslims and 1 (3.33%)Christians are observed in the study. Out of 25 (83.33%) of Hindu patients, 14 (46.66%)patients are cured, 1 (24%) patient responded, 6 (20%) patients not-responded and 4 (13.3%)patients are discontinued. On the other hand the results observed at Muslim community are, out of 4 (13.33%)all 4 (13.33%) patients are cured. 1 (3.3%) patient of Christian is also cured in the study ofVishamajwara vis-à-vis Malaria.A4) Distribution of patients by Occupation Table- 8 Distribution of patients by Occupation Discontinued Occupation % Responded Responded patients Cured Total Not % % % % Labour 9 30 0 0 5 16.7 3 10 17 56.7Agricultu 2 6.67 1 3.33 0 0 0 0 3 10 rist Service 0 0 0 0 1 3.33 0 0 1 3.33 4 13.33 0 0 0 0 0 0 4 13.33 Student 2 6.67 0 0 0 0 1 3.33 3 10Business House 2 6.67 0 0 0 0 0 0 2 6.6 wife Total 19 63.3 1 3.33 6 20 4 13.3 30 100 Occupations are divided in to six groups basically. They are Labour, Agriculture,student, Service, Business and Housewives. More of the patients reported are of labour Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)114
  • 126. group, as they are not well protected and also expose to the unhygienic environment. Theobservations on the basis of occupation are 17 (56.7%) labour, 3 (10%) Agriculture, 4(13.33%) Students, 1 (3.33) Service candidates, 3 (10%) Business people and 2 (6.6%)Housewives as tabulated above. The results of the individual groups are as follows. The major group of labourers outof 17 patients reported, 9 (30%) cured, 5 (16.7%) responded and 3 (10%) discontinued in thestudy. Out of 3 reported Agriculturists 2 (6.67%) cured and 1 (3.33%) responded. At the 4(13.33%) of students are cured and 1 (3.33%) service candidate is not responded to thetreatment. 2 (6.67%) patients of reported Business people are cured and 1 (3.33%)discontinued. 2 (6.67%) Housewives reported are cured. The graphical representation is asfollows. Graph - 5 Distribution of patients by Occupation House wife Student Labour Service 6.67% 13.33% 56.67% 3.33% Business Agriculturist 10.00% 10.00% DISTRIBUTION OF PATIENTS BY OCCUPATION Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)115
  • 127. A5) Distribution of patients by Economic Status The economical condition is a key for the evaluation and prognosis. At the study itis found that distributions are falling from the very poor to rich class people. As theeconomical status is permitting to have more protection the incidences are smaller andminimal. The observations are 15 (50%) very poor, 6 (20%) poor, 5 (16.7%) Lower Middleclass, 3 (10%) higher middle class and 1 (3.33%) of rich class. The tabulation is as under. Graph - 6 Economic status distribution Vs Vishamajwara vis-à-vis Malaria 16 15 14 12 10 8 6 6 4 5 1 2 3 0 0 -2 Very Poor Poor Lower Upper Rich Aristocrat Middle Middle -4 Economic status distribution Vs Vishamajwara vis-à- vis Malaria The results based on economical status are as under. Out of the 15 very poor patients,8 (26.7%) cured, 5 (16.7%) responded and 2 (6.7%) discontinued. At the 6 reported poorpatients, 5 (16.7%) cured and 1 (3.33%) discontinued. At the 5 Lower middle class patients,3 (10%) cured, 1(3.33%) not responded and 1 (3.33%) discontinued. Out of 3 Upper middleclass Vishamajwara patients 2 (6.67%) cured and 1 (3.33%) not responded. One (3.33%) Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)116
  • 128. patient reported from rich class is cured. The graph depicting the victims of Vishamajwaravis-à-vis Malaria at the economical groups is as under. Table -9 Distribution of patients by Economic status Discontinued Economical % Responded Responded patients status Cured Total Not % % % % Very 8 26.7 0 0 5 16.7 2 6.7 15 50 Poor Poor 5 16.7 0 0 0 0 1 3.33 6 20 Lower 3 10 1 3.33 0 0 1 3.33 5 16.7 Middle Upper 2 6.7 0 0 1 3.33 0 0 3 10 Middle Rich 1 3.33 0 0 0 0 0 0 1 3.33 Total 19 63.3 1 3.33 6 20 4 13.3 30 100 Graph-7 Distribution of patients by Economic status Lower Middle Upper Middle Rich 10.00% Very Poor 16.67% 3.33% 50.00% Poor 20.00% Distribution of patients by Economic status Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)117
  • 129. A6) Distribution of patients by Hygienic Condition Hygiene is a very important factor to protect health from external invaders. Thehygiene is categorised as Good, moderate and Mild. At the study it is observed that morepeople are under mild category (23 patients – 76.7%). Moderate (6 patients – 20%) andGood (1 patient – 3.33%) hygiene’s are recorded in addition to above. The tabulation is asunder. Table –10 Distribution of patients by Hygienic Condition Discontinued % Responded RespondedConditionHygienic patients Cured Total Not % % % % Poor 14 46.7 0 0 6 20 3 10 23 76.7Moderate 4 13.3 1 3.33 0 0 1 3.33 6 20 Good 1 3.33 0 0 0 0 0 0 1 3.33 Total 19 63.3 1 3.33 6 20 4 13.3 30 100 As the observations reveals that out of the 23 poor hygiene people attended thestudy, 14 (46.7%) cured, 6 (20%) responded and 3 (10%) patients are discontinued. At themoderate hygiene patients we found that 4 (13.3%) cured and 1 (3.33%) responded and 1(3.33%) discontinued. The patient from the category of good hygienic conditions maintainedreported to (3.33%) cured in the study of Vishamajwara vis-à-vis Malaria. The graphicalrepresentation is as follows. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)118
  • 130. Graph-8 Distribution of patients by Hygienic Condition Moderate Good Poor 20.00% 3.33% 76.67% Distribution of patients by Hygienic ConditionA7) Distribution of patients by Diet Table -11 Discontinued Responded Responded patients Cured Total Diet Not % % % % %Vegetarian 3 10 0 0 2 6.67 2 6.67 7 23.3Mixed diet 16 53.3 1 3.33 4 13.3 2 6.67 23 76.7 Total 19 63.3 1 3.33 6 20 4 13.34 30 100 Diet is an important factor of Dosha provocation and their involvement with thesubjects is to be evaluated. At the present study is noticed that maximum subjects are mixedfood i.e. 23 (76.7%) and the vegetarians are only 7 (23.3%) patients. As we observe out of 7 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)119
  • 131. vegetarians, 3 (10%) cured 2 (6.67%) not-responded and 2 (6.67%) patients discontinued.On the other hand of mixed food consumers 16 (53.3%) patients are cured and 1 (3.33%)responded. 4 reported not-responded and 2 (6.67%) discontinued from the same category.The graphical representation is as follows. Graph-9 Distribution of patients by Diet 2 4 Mixed diet 1 16 23 discotinued 2 2 Not-Reson Vegetarian0 Responded 3 Cured 7 Total 0 5 10 15 20 25 Distribution of patients by DietB) Data related to the disease.B1) Distribution of patients by presenting complaints Many subjective parameters in the form of presenting complaints collected in thestudy. They are listed in the following table. Out of the complaints it is found that aPratyatma Niyata Lakshana, Aniyamita Jwara (100%) is present along with Shira shoola(100%) and Aruchi (100%) for the all patients. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)120
  • 132. Table-12 Distribution of patients by presenting complaintsPresenting complaints Total no of patients Percentage Aniyamita Jwara 30 100 Vepana 28 93.33 Chardi 24 80 Shira shoola 30 100 Aruchi 30 100 Parshwa shoola 6 20 Tandra 5 16.7 Swasa 4 13.33 Anidra 20 66.7 Yakrut Vruddhi 2 6.67 Pleeha Vruddhi 4 13.33 Graph –10 Distribution of patients by presenting complaints Distribution by Presenting Complaints Pleeha Vruddhi 4 Yakrut Vruddhi 2 Anidra 20 Swasa 4 Tandra 5 Parshwa shoola 6 Aruchi 30 Shira shoola 30 Chardi 24 Vepana 28 Aniyamita Jwara 30 0 5 10 15 20 25 30 35 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)121
  • 133. 28 (93.33%) patients reported with Vepana (Shivering), 24 (80%) patients withChardi, 6 (20%) parshwashoola, 5 (16.7%) Tandra, 4 (13.33%) Swasa, 4 (13.33%) PleehaVruddhi and 2 (6.67%) of Yakrut Vruddhi in the study of Vishamajwara vis-à-vis Malaria.The tabulation of the above is depicted as under.B2) Distribution of patients by Associated features Table-13 Associated features Total no of patients Percentage 19 63.33 Trushna 2 6.67 Pralapa 24 80 Anga Gourava 7 23.33 Glani 1 3.33 Asahishnuta 0 0 Dravamala Pravrutti The associated features of the Vishamajwara vis-à-vis Malaria are Trushna, Pralapa,Anaga gowrava, Glani., Asahishnuta and Drava mala Pravrutti. Out of these features inVishamajwara vis-à-vis Malaria, it was found that the Anga Gowrava is more in 24 (80%) ofpatients. The next best complaint seen is Trushna with 19 (63.33%) patients. In further 7(23.335) Glani, 2 (6.67%) Pralapa and 1 (3.33%) Asahishnuta were found. No patientreported with the Drava Mala Pravrutti in the study of Vishamajwara vis-à-vis Malaria. Thetabulations are shown above and the graphical representation is as below. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)122
  • 134. Graph –11 Distribution of patients by Associated features Distribution by Associated features Dravamala 0 Pravrutti Asahishnuta 1 Glani 7 Anga Gourava 24 Pralapa 2 Trushna 19 0 5 10 15 20 25 30B3) Distribution of patients by type of Jwara Table-14 Distribution of patients by type of Jwara Type of Jwara Total no of patients Percentage 4 13.33 Santata (continues) 17 56.67 Satata (Twice in day) 6 20 Anyedyushka (Once in day) 3 10 Truteeyaka (Alternative day) 0 0 Chaturthaka (on every 4th day) 0 0 Viparyaya (Truteeyaka/Chaturthaka) 30 100 Total Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)123
  • 135. The Vishamajwara is one of the Jwaras mentioned from the texts. Various Acharyasclassify the Vishamajwara vis-à-vis Malaria as different. The appearance of the VishamaArambhata, Vaga and Kala are noted here and classified. The divisional expression is asbelow. In this study of Vishamajwara vis-à-vis Malaria many (17 patients –56.67%) areunder the Satata Variety. It was found in the study as – 6 (20%) Anyedushka, 4 (13.33%)Santata and 3 (10%) of Truteeyaka Vishamajwara vis-à-vis Malaria. No Chaturthaka andViparyaya patients were reported. The graphical representation is as follows. Graph –12 Distribution of patients by type of Jwara Chaturdhaka Viparyaya Truteeyaka Santata (on every 4th (Truteeyaka/ (Alternative Chaturdhaka) (continues) day) day) 0.00% 13.33% 0.00% 10.00% Anyedyushka Satata (Twice (Once in day) in day) 20.00% 56.67% Distribution of patients by type of JwaraB4) Distribution of patients by Pranavaha sroto dusti Lakshana In the study of Vishamajwara vis-à-vis Malaria various Srotas are involved. One byone Srotas involvement is explored in the study of Vishamajwara vis-à-vis Malaria. Atpresent the Pranavaha Srotas bears the symptoms of – Kasa, Swasa, Swasa bheda, Chardi, Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)124
  • 136. Urah Shoola and Rakta steevana. As many as 24 (80%) patients reported with chardi inassociation with Kasa (4 patients – 13.33%) and Swasa (4 patients – 13.33%). No patientsare observed with the Urah shoola, Swasa bheda and Rakta steevana. The tabulation andgraph is as follows. Table-15 Distribution of patients by Pranavaha sroto dusti Lakshana Pranavaha sroto dusti Lakshana Total no of patients Percentage 4 13.33 Kasa 4 13.33 Swasa 24 80 Chardi 0 0 Urah shoola 0 0 Swasa bheda 0 0 Rakta Shteevana Graph –13 Distribution of patients by Pranavaha sroto dusti Lakshana Rakta Shteevana 0 Swasa bheda 0 Urah shoola 0 Chardi 24 Swasa 4 Kasa 4 0 5 10 15 20 25 30 Distribution of patients by Pranavaha sroto dusti Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)125
  • 137. B5) Distribution of patients by Rasavaha sroto dusti Lakshana Table-16 Distribution of patients by Rasavaha sroto dusti Lakshana Rasavaha sroto dusti Lakshana Total no of patients Percentage 30 100 Aruchi 12 40 Hrullasa 24 80 Shareera Gourava 20 66.66 Anidra 30 100 Jwara 6 20 Tandra Graph –14 Distribution of patients by Rasavaha sroto dusti Lakshana 30 35 30 30 24 25 20 20 15 12 10 6 5 0 Aruchi Hrullasa Shareera Anidra Jwara Tandra Gourava Distribution of patients by Rasavaha sroto dusti Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)126
  • 138. In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the studyby all 30 patients. 24 (80%) of patients expressed that they possess the Shareera Gowravaand 20 patients (66.66%) Anidra. 12 (40%) patients expressed Hrullasa and 6 (20%) patientswith Tandra. The tabulations and graph is shown as above.B6) Distribution of patients by Annavaha sroto dusti Lakshana Table-17 Distribution of patients by Annavaha sroto dusti Lakshana Annavaha sroto dusti Lakshana Total no of patients Percentage 30 100 Aruchi 24 80 Chardi 0 0 Anannabhilasha 0 0 Annadwesha 0 0 Shoola Graph –15 Distribution of patients by Annavaha sroto dusti Lakshana Shoola 0 Annadwesha 0 Anannabhilasha 0 24 Chardi 30 Aruchi 0 5 10 15 20 25 30 Distribution of patients by Annavaha sroto dusti Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)127
  • 139. Annavaha Srotas is one more major Srotas involved in Vishamajwara vis-à-visMalaria. All patients (100%) show the Aruchi and 24 patients (80%) Chardi as Lakshana inVishamajwara vis-à-vis Malaria. No other categories are recorded in the study. The tableand graph is as above.B7) Distribution of patients by Swedavaha sroto dusti Lakshana Table-18 Distribution of patients by Swedavaha sroto dusti Lakshana Swedavaha sroto dusti Lakshana Total no of patients Percentage 30 100 Asweda 0 0 Atisweda 20 66.67 Daha 22 73.33 Romaharsha Graph –16 Distribution of patients by Swedavaha sroto dusti Lakshana 35 30 30 25 22 20 20 15 10 5 0 0 Asweda Atisweda Daha Romaharsha Distribution of patients by Swedavaha sroto dusti Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)128
  • 140. In Jwara or in Vishamajwara vis-à-vis Malaria, with out involvement of the swedavaha Srotas the jwara doesn’t appear. The sroto dusti Lakshana dictated in Samhitas areobserved here. In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reportedwith Atisweda and 20 (66.66%) patients even with the Daha. 22 (73.33%) patients expressedwith Romaharsha. The tabulation and pictorial expression is shown above.B8) Distribution of patients by Nidana The evaluation of the disease should and must be with the Pancha Lakshana Nidana.Out of the first one is Nidana i.e. etiological factors. The aetiology explained is as under inthe table. Out of those 26 (86.67%) Ahita Bhojana, 24 (80%) Akala Bhojana and 18 (60%)Dustajalapana are observed, which are of dietetic in origin. 16 (53.33%) Rutu Parivartanaand 11 (36.67%) Aupasargika Karana are expressed in the study Vishamajwara vis-à-visMalaria. Apart from the above 19 (63.33%) Krodha and 20 (66.33%) Bhaya alsoenumerated as aetiology in the study. The tabulation and graph is as follows. Table-19 Distribution of patients by Nidana Nidana Total no of patients Percentage 24 80 Akala Bhojana 26 86.67 Ahita Bhojana 18 60 Dushita jalapana 11 36.67 Aoupasargika Karana 16 53.33 Rutu parivartana 19 63.33 Krodha 20 66.67 Bhaya Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)129
  • 141. Graph –17 Distribution of patients by Nidana Bhaya 20 Krodha 19 Rutu parivartana 16 Aoupasargika Karana 11 Dushita jalapana 18 26 Ahita Bhojana 24 Akala Bhojana 0 5 10 15 20 25 30 Distribution of patients by NidanaB9) Distribution of patients by Poorva Roopa Table-20 Distribution of patients by Poorva Roopa Poorva Roopa Total no of patients Percentage 13 43.33 Jrumbha 30 100 Aruchi 24 80 Romaharsha 23 76.67 Sahreera Guruta 10 33.33 Ashrupoorna netra The poorvaroopa is prodromal syndrome of the disease Vishamajwara vis-à-visMalaria. In this common jwara conditions are observed. All (100%) show the Aruchi in the Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)130
  • 142. study. Apart from 24 (80%) Romaharsha, 23 (76.67%) Shareera Gowrava, 13 (43.33%)Jrumbha and 10 (33.33%) of Ashrupoorva netrata are found in the Vishamajwara vis-à-visMalaria study. The graph is as follows. Graph –18 Distribution of patients by Poorva Roopa Ashrupoorna netra 10 Sahreera Guruta 23 Romaharsha 24 30 Aruchi 13 Jrumbha 0 5 10 15 20 25 30 35 Distribution of patients by Poorva RoopaC) Result of the Bharangyadi Ghanavati in Vishamajwara viz. MalariaC1) Distribution of patients by Jwaramukta Lakshana The assessment of the Vishamajwara vis-à-vis Malaria with Bharangyadi Ghana Vatiis done by the subjective and objective parameter assessment. But in Ayurvedajwaramuktata is an important assessment. The jwaramukta Lakshana are enumerated in thestudy of Vishamajwara vis-à-vis Malaria. It is noticed that 20 (66.67%) patients show theSweda pravrutti and Shareera Laghavata. 16 (53.33%) patients expressed Kshudha and 4(13.33%) with Shira kandu, a specific Lakshana of jwara muktata. 2 (6.67%) patients showmukhapaka and 3 (10%) with the Trushna. The observation of the jwramukta Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)131
  • 143. shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria isadmissible. The table and graph is as follows. Table-21 Distribution of patients by Jwaramukta Lakshana Jwaramukta Lakshana Total no of patients Percentage 20 66.67 Sweda pravrutti 20 66.67 Shareera Laghavata 4 13.33 Shirah Kandu 2 6.67 Mukhapaka 3 10 Trushna 16 53.33 Kshudha Graph –19 Distribution of patients by Jwaramukta Lakshana Kshudha 16 Trushna 3 Mukhapaka 2 Shirah Kandu 4 Shareera 20 Laghavata 20 Sweda pravrutti 0 5 10 15 20 25 Distribution of patients by Jwaramukta Lakshana Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)132
  • 144. C2) Evaluation of Subjective Parameters (Bharangyadi Ghanavati in Vishamajwara) The following symptoms of the Vishamajwara are considered for the evaluation ofthe cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria.Their mean grading values are drawn periodically to assess the effect is self explanatory. Table -22Subjective parameter Before 7th day 14th day 21stday Follow Up Treatment Aniyamita Jwara 2.84 1.61 0.53 0.30 0.19 Vepana 0.88 0.61 0.34 0.15 0.03 Chardi 1.38 1.07 0.57 0.26 0.11 Shira shoola 1.92 1.38 0.88 0.26 0.15 Aruchi 1.0 1.0 0.7 0.46 0.11 Parshwa shoola 0.19 0.07 0.07 0 0 Tandra 0.19 0.07 0.03 0 0 Swasa 0.34 0.19 0.07 0.07 0 Anidra 1.30 0.80 0.23 0.19 0 Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03 Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03 Graph –20 Aniyamita Jwara (mean) in Vishamajwara 3.5 3 2.84 Evaluation of Aniyamita Jwara (Mean) 2.5 2 1.5 1.61 1 0.5 0.53 0.3 0.19 0 Before 7th day 14th day 21stday Follow Up -0.5 Treatment -1 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)133
  • 145. As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect ofthe Bharangyadi Ghana Vati for a period of stipulated usage has given relief effectively andas follow up period is advanced fall to a minimal of 0.19 expected to reach absolutenormalcy with in a short while of the follow-up.C3) Evaluation of Objective Parameters (Bharangyadi Ghanavati in Vishamajwara) The following objective parameters of the Vishamajwara are considered for theevaluation of the cumulative effect of the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria. Their mean grading values are drawn periodically to assess the effect. Table -23Objective Before Treatment After Treatment DifferenceparametersMP smear (Positive) 26 7 19 Haemoglobin % 9.195385 9.513077 0.317692 E.S.R 15.65385 11.11538 4.53847 Total Count 6239.038 6080.192 158.846 Neutrofils 54.92308 60.57692 5.65384 Lymphocytes 38.34615 31.5 6.84615 Eosinophil 5.653846 5.769231 0.115385 Monocytes 1.461538 1.192308 0.26923 At the above tabulation various parameters are expressed with their mean values ofbaseline data to that of final data. The most important parameter Malarial Parasite smear testis positive for the all patients those are included in the study. Out of them 19 patients(73.07%) are MP negative at the end of the treatment. Disease prognostic factors such asESR and Total counts are dropped their vales to normalcy. More over the haemoglobin Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)134
  • 146. percentage is improved by 0.317692 mean value. At the differential count of bloodNeutrophills and Eosinophills show marginal increase and lymphocytes and Monocytesshow marginal decrease. The mean vale table is as above.C4) Mean temperature variances The mean temperature variances at the intervals of 7 days are depicted here under inthe form of table and graph. Table –24 Showing the temperatures (mean) in Vishamajwara 0th day 7th day 14th day 21st day 36th day 102.3346 100.7231 99.28462 98.94615 98.86154 Graph –21 Graph the temperatures (mean) in Vishamajwara 103 102.3346 102 Evaluation of Temperature in (Mean) 101 100.7231 100 99.28462 99 98.94615 98.86154 98.6 98.6 98.6 98.6 98.6 98.6 98 97 0th day 7th day 14th day 21st day 36th day Patients were showed significant reduction in fever on 14th day. Nearly half thenumber of patients came to normal temperature and remaining patient are at grade 1 on 21stday cure rate was attained and much changes are not observed during fallow up period. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)135
  • 147. During the fallow up period there was no recurrence also. Linear and slow regression oftemperature were notedC5) Distribution of patients by Result Table-25 Distribution of patients by Result in Vishamajwara Result Total no of patients Percentage 19 63.33 Cured 1 3.33 Responded 6 20 Not Responded 4 13.34 Discontinued 30 100 Total The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria aredeclared after through assessment of the subjective objective parameters. The results for thesake of convenience classified as Cured, Responded, Not Responded and Discontinued. Outof these the discontinued patients are the dropouts in the study. The cured are fulfilling thesatisfactory subjective and objective criteria and must be malarial parasite smear testnegative at the end of the schedule. The responded are satisfactory at the subjectiveparameters and feel comfort by all means but their MP is still positive. The Not-Respondedpatients are of either of the subjective or objective criteria non-fulfilled. Based on this theresults are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4(13.34%) discontinued. The picturesque is drawn is as below. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)136
  • 148. Graph –22 Distribution of patients by Result in Vishamajwara Discontinued Not 13.33% Responded 20.00% Responded Cured 3.33% 63.33% Distribution of patients by ResultD) Statistical analysis of the clinical and objective parametersD1) Statistical analysis of the clinical parameters at the end of treatment (21 days) Table -26S Subjective Mean SD SE t-Value p-Value RemarksN Parameter1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS6 Parshwa shoola 0.231 0.514 0.1 2.31 <0.05 HS7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)137
  • 149. Al the parameters except Pleeha Vruddhi after 21 days of treatment show highlysignificant. The parameter jwara shows more highly significant with high mean net effect.The shira shoola shows more variations. (By comparing t value, p-value and SD).D2) Statistical analysis of the objective parameters at the end of treatment (21 days) Table -27S Objective Mean SD SE t-Value p-Value RemarksN Parameter1 Haemoglobin % 0.313 0.293 0.057 5.49 <0.001 HS2 Total Count 399.615 393.64 77.2 5.176 <0.001 HS3 Neutrofils 6.346 3.52 0.69 9.197 <0.001 HS4 Lymphocytes 6.461 3.022 0.592 10.913 <0.001 HS5 Eosinophills 0.346 0.628 0.123 2.813 <0.05 HS6 Monocytes 0.346 0.485 0.0951 3.638 <0.01 HS7 ESR 4.192 2.953 0.579 7.24 <0.001 HSD3) Statistical analysis of the clinical parameters at the end of follow-up (36 days) Table -28S Parameter Mean SD SE t-Value p-Value RemarksN1 Jwara 2.461 0.646 0.126 19.53 <0.001 HS2 Vepana 0.653 0.481 0.095 6.873 <0.001 HS3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS4 Sjhira shoola 1.576 1.0265 0.201 7.84 <0.001 HS5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS6 Parshwa shoola 0.230 0.514 0.1 2.3 <0.05 HS7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS8 Swasa 0.192 0.567 0.111 1.729 >0.05 NS9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS10 Pleeha Vruddhi 0.038 0.196 0.038 1.0 >0.05 NS Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)138
  • 150. All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show highsignificance. Assume that the drug is not responsible in curing the disease, to test thehypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita Jwara shows moresignificance than the others. The mean net effect of Aniyamita Jwara in subjectiveparameters is more and the Yakrut Vruddhi is less in mean net effect. The parameter Aruchi shows units mean net effect with zero variations i.e. responsein all patients of before to after study. The parameters Aruchi after the treatment have zerovariations. The parameter Chardi, have more net variation but kampa have less net effect. The mean effect of the subjective parameters of Vishamajwara is more after thetreatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi having uniformeffect (by comparing mean SD and coefficient of variations) for the to know the effect ofdrug after the 7 days of treatment. The Aniyamita Jwara again shows high significance withmore net mean effect. The aruchi shows no significance with net less variation and with less net meaneffect as shown in the above table. Among the objective parameters ESR shows high significance than the others, butthere is a least variation in haemoglobin percentage. Among the DC, lymphocytes showmore (high) significance than the others. The nets mean effect in Nutrophils is more withmore variation. But the Eosinophils and Monocytes have equal mean net effect withdifference in the variations (by comparing the “t” and “p” values). Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)139
  • 151. Chapter –6 Discussion “ ever is unwanted rise in body temperature either because of disturbedinternal environment or invasion of exogenous origins. Vishamajwara, a most popularAyurvedic term in turn of modern medical terminology co-related to malarial fever, is aprotozoan disease caused by genus plasmodium and transmitted to man by certain species ofinfected female anopheles mosquito. Indias geographic position and climatic conditions arefavourable for the transmission of malaria. The emergence of multiple-drug resistant strains of malaria, which has accompaniedeach new class of anti-malarial drugs, is one of most significant threat to the health of peoplein tropical countries.Resistance, synergism and traditional medicines Medical science is beginning to recognise aspects of synergy, complexity andpotentiation in malaria therapy. At the same time, little significance is as yet being given tothe obvious point that all of the major anti-malarial have been derived from plants, oftenbased on traditional knowledge about the effects of the plants against fever, or specifically,malaria. Elsewhere, synergism has been observed between the alkaloids of the anti-malarialplant Ancistrocladus peltatum. A total alkaloid extract of this plant had far greater anti-parasitic activity than any of the six alkaloids isolated subsequently. In Uganda, there is datafrom clinical case reports that a traditional Ugandan herbal remedy is effective againstmalaria. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)140
  • 152. Utilisation of traditional medicine is widespread in developing countries and theefficacious of many traditional treatments have been well documented, including in skindisease, malaria and other disorders.The research initiative for traditional anti-malarial methods (RITAM) It is the Research Initiative for Traditional Anti-malarial Methods (RITAM). Manypeople live in malarious regions, traditional herbal medicines may be the only course oftreatment available. Plants are usually identified for study on the basis of a traditionalreputation for effectiveness, usually for treating or preventing malaria and other fever relatedconditions.Clinical development in Indian Systems of Medicine & Homoeopathy The Indian Systems of Medicine & Homoeopathy is popular in a large number ofStates in the country. Ayurveda, Homeopathy, Unani, Yoga & Naturopathy and Siddhasystems together called as Indian Systems of Medicine. Drug resistance to chloroquine in P. falciparum was reported in India for the firsttime from Assam in 1973. Sulphadoxine-pyrimethamine, a second line drugs for P.falciparum is not effective for P. vivax malaria. Development of new drugs involvesextensive pre clinical and toxicological studies followed by well-planned clinical trials.Ayush-64 is a combination of four plants namely Alstonia scholaris (aqueous extract ofbark–1 part) Picrorhiza kurroa Royle (aqueous extract of rhizome–1 part), Swertia chirata(aqueous extract of whole plant–1 part) and Caesalpinia crista Linn (fine powder of seedpulp–3 parts). Many herbal compounds and herbo-mineral compounds are listed in Ayurveda topacify the Jwara, especially Vishamajwara. The jwara called as fever may not be a big Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)141
  • 153. problem from the contemporary but as par Ayurveda it is a primary symptom and a diseasealso some times a complication. Ayurvedic herbs have an important role in the treatment ofmalarial fever. In the treatment of Vishamajwara many yogas have been explained inAyurveda.Vishamajwara vis-à-vis Malaria Ayurveda has a significant name. The symptoms of this type resemble with themalarial fever of present discussion. Malaria is a protozoal disease transmitted by theAnopheles mosquito, caused by minute parasitic protozoa of the genus Plasmodium, whichinfect human and insect hosts alternatively. It is a very old disease and prehistoric man isthought to have suffered from malaria. WHO declared Australia free of malaria in 1981,however since that time 9 patients have contracted locally acquired malaria. The exceptionis falciparum malaria where the parasites multiply very rapidly and may occupy 30% ormore of the red blood cells causing a very significant level of haemolysis. Malaria or a disease resembling malaria has been noted for more than 4,000 years.The symptoms of malaria were described in ancient Chinese medical writings. A number ofRoman writers attributed malarial diseases to the swamps. Vedic literature possesses manymore references of this condition as Vishamajwara. Discovery of the Malaria Parasite in1880 by Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine,Algeria, was the first to notice parasites in the blood of a patient suffering from malaria. AnAmerican, William H. Welch, reviewed the subject and, in 1897, he named the malignanttertian malaria parasite, P. falciparum. In 1922, John William Watson Stephens describedthe fourth human malaria parasite, P. ovale. On August 20th, 1897, Ronald Ross, a Britishofficer in the Indian Medical Service, was the first to demonstrate that malaria parasites Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)142
  • 154. could be transmitted from infected patients to mosquitoes. In further work with bird malaria,Ross showed that mosquitoes could transmit malaria parasites from bird to bird. Thisnecessitated a sporogonic cycle (the time interval during which the parasite developed in themosquito). Thus, the problem of malaria transmission was solved.Vishamajwara The disease Vishamajwara is included under the jwara roga in Ayurveda.Vishamajwara characterised by visamarambha (irregular onset). Atharva Veda described the following types of Vishamajwara. It is a clear picture ofVishamajwara of malarial origin. Susruta considered that the Vishamajwara occurs due toTridosha but Vata is the dominant Dosha. Vagbhata defined Vishamajwara, as the jwara isirregular in respect to its onset, suffering and symptoms. According to Hareeta theVishamajwara is five types such as vataja, ekaikajwara, dwahieka jwara, triahika jwara,chaturthakjwara. Dalhana consider bhutas responsible to produce Vishamajwara. Jejjataconsidered Vishamajwara as tridoshaja in origin.Malaria Control program An organised and effective malaria control program stemmed from this newauthority in the Tennessee River valley. Controlling water levels and insecticide applicationsreduced Mosquito breeding sites. DDT was used for malaria control at the end of WWIIafter it had proven effective against malaria-carrying mosquitoes by British, Italian, andAmerican scientists.Atypical fever - Malaria Some patients may not have fever at all and may present with other symptoms listedbelow. Many present with fever of various patterns - low grade to high grade, with or Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)143
  • 155. without chills, intermittent to continuous, or even as cases of prolonged fever. As the diseaseprogresses, these broods get synchronised and the fever tends to be more uniform. Howeverin cases of P. falciparum malaria and mixed infections, this pattern of multiple spikes maycontinue. The other symptoms are Headache, dizziness or vertigo, with or without fever, may present with alteredbehaviour, mood changes, hallucinosis or even acute psychosis. Due to severe infection,hypoglycaemia, electrolyte imbalance - due to vomiting or diarrhoea (particularly theelderly), subclinical convulsions etc. are also found in malarial fever. Cough may be apresenting feature of malaria with severe anaemia can be a presenting feature of malaria.Secondary infections: Malaria produces significant immune suppression and this can result in secondaryinfections. Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does notrule out the possibility of malaria.Vishamajwara and Ayurveda The vitiated Dosha after localising in Dhatus of the body are responsible to producediseases. Besides all the factors Pitta plays an important role for producing jwara. InVishamajwara the Doshas are not only localised in Rasa Dhatu like in other jwara, theyspread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the differentVishamajwara such as Santata jwara, Satata jwara, Anyedushka jwara, Triteeyak jwara,Chaturthak jwara and Chaturthakviparyaya jwara. The Vishamajwara due to Kapha isdifficult to cure in Kapha Prakruti because in this disease the Vata and Pitta are lesspowerful. The aggravated doshas interacts Rasa and other Dhatu and ultimately producesVishamajwara. The heavy Doshas spread all over the body through the channels carrying Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)144
  • 156. Rasa and stiffened and give rise to santata jwara (remittent fever). Considering all this, thephysician should treat the case of fever.Drug discussion The combination of the compound drug “Bharangyadi Ghana Vati” is discussed inthe literature. The collective properties of the Bharangyadi Ghana Vati with its probablemode of action are discussed here. The following table describes the pharmacologicalproperties of the individual components. Table –29 Describing the pharmacological properties of Bharangyadi Ghana Vati Name of the Rasa Guna Veerya Vipaka Prabhava ingredient1) Bharangi Tikta, Katu Laghu Ushna Katu Jwarahara 190-195 Kashaya ruksha Peenasahara Kasaswasahara Shodhaghna2) Musta Tikta, Katu Laghu Sheeta Katu Jwarahara 196-201 Kashaya ruksha Krumihara Deepanapachaka3) Parpatak Tikta Laghu Sheeta Katu Jwarahara 202-207 sangrahi Raktadoshahara Bhramahara Trushnahara4) Yavasa Tikta, Kashaya, Laghu Sheeta Katu Jwarahara 208-213 Madhura Chardihara Bhramahara Trushnahara5) Shunti Katu Guru, Ushna Katu Kapha hara 214- 219 rooksha, Amavatahara tikshna Hrudrogahara Grahi Panduhara Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)145
  • 157. Name of the Rasa Guna Veerya Vipaka Prabhava ingredient6) Kiratatikta Tikta Laghu, Ushna Katu Jwarahara 220- 225 Rooksha Vranahara Krumighna Raktadoshahara Trushnaghana Swasaghna Kasaghna sannipatajwarahar7) Kusta Tikta, Katu, Laghu, Ushna Katu Raktadoshahara 226- 231 Madhura rooksha, Kustaghna Teekshna Kasaghna8) Pippali Katu Laghu, Anushna Madhura Vatakaphahara 232- 237 Snigdha, sheeta Yogavahi tiksshna Deepana Pachana Rechana Udarahara9) Bruhati Katu, Tikta Laghu, Ushna Katu Jwarahara 238- 243 Rooksha, Kasaswasahara teekshna Agnimandyahara Kustaghna10) Guduchi Tikta, Kashaya, Guru, Ushna Madhura Jwarahara 244- 249 Katu, Madhura Snigdha Mootrakruchrahara Hrudrogahara Tridoshahara Deepaka Sangrahi Rasayana Panduhara Kamalahara Chardihara Amahara Table –30 Describing the Chemical constituents and Indications of individual components of Bharangyadi Ghana Vati Name of the Chemical constituents Indications Preparations ingredient1. Bharangi Hispidulin 7.0 gluco- Jwara, Swasa, kasa, Bharangyadi caronides, Scutellarrin, shotha, krini, daha, kwatha, uncinatone, pctolinarigenin peenasa bharangyadi guda Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)146
  • 158. 2. Musta Cineol +, copadiene, Jwara, krimi, trushna, Musta rishta, copaene, cyperen I & II, Atiusara, kandu, kasa, mustadi kasaya, cypernone, isopathoulenone, nidra nasha, Rakta mustadi vati, cypertoperotundone, etc vikara etc shadunga paneeya3. Parpataka Adlumidiceine (-)- adlumine, Jwara, trushna, Bhrama, Sadanga paneeya (+) bisculline, cocharine mada, Rakta Pitta, parpatadyarista coptisine, cryptopine, Atisara, charadi etc fumaromine, laharmine, parfemdine etc4. Yavasa Galacto, catechin+catechin(- Jwara, kase, Raktapitta, Agasthyavaleha, ), epigallocatechin, and trishna, medaroga, khatiradigutika, leucodelphnidin, B – chardi brama, kusta etc yasa sarkara, phenethylamine etc vasagrita, kalasyadi grutha5. Shunti Dry Ness 80.9, protein 2.6, Jwara, Hrudourbaya, Ardrakakhand, fat 0.9, fibre 2.4, hrutshoola, shlipadha, panchasama carbohydrate 12.3, metals shotha, amavata ,sheetha Churna, 1.2%, calcium 20, Pitta, pandu, Atisara, samasharkara phosphorus 60, iron 2.6 mg, kasa Swasa, Agni Churna, rasnadi each 100 gm other then these mamdhya etc kwatha, iodine chlorine are also soubhagya present vitamin A,B,C are shunthi , shunthi also present sura6. Kiratatikta Amarogentin, gentiopicrin, Sanepata jwara, Rakta Kiratadi kwata, isobellicifolin, decussatin, Pitta, arsas, krimi, kusta, sudharsana chiratol, swerchirin, 7-0 vruna, shotha, trishna, Churna, methyl swertianin mangi daha etc kiratitiktadi ferin, swertianin, kairatinol Churna, swertanone etc kiratarista etc7. Kusta Essential oil, castol , Jwara, kusta, hikka, Kustadi taila, taraxasterol, dehydro kasa, prasava shoola, kustadi curna, costuhactone, sistosterol, ar- hrudroga, visarpa, kusta rasayanam cuscumene, iso kandu, Vata Rakta dihydrocostuslactone costus – lactone etc8. Pippali Volatile oil – 0.8% Hrudhadourbalya, Guda pippali, Piperine – 4-5% pandu, raktavikara, kasa, pippali khada, Pipalatine and sesamine and Swasa, aruchi, Agni pippalyasava, piplasterol- 0.15- 0.18% and mandhya, kshata, jwara. yakartlihari loha, pipalartin-0.13-0.20% piper yakrt pippaladi languminon, steroid, yoga. glycoside Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)147
  • 159. 9. Brahati Glycoside, alkaloid, solanine, Jwara, Swasa, hrdroga, Brihatyadi dulcunarin, carotene, shoola, chardi, kushta, kasaya, carpesterol, solonocurpone, kandu, krimi etc pipapalyadi leha, disogenin, solasodine, vit – C dashamoolarista etc10. Guduchi Tinosporide, cardifalide, Jwara, trishna, Guduchadi tnosparidine, B- sitosterol, Vatarakta, pandu, Churna, cardifol heptacosanol, kamala, chardi, krimi, Guduchadi octacasanol, magnoflarine, kandu, kasa, bhrama, kwata, palmatine. jwaravyadhi amritarista, amrithadi, chandra prabhavati, PanchaTikta Guggu grutam etc From the above tabulations, it is clear that the individual components of theBharangyadi Ghana Vati are effective antipyretic and also acts efficiently over the areas ofco-morbidity. As all ingredients are “Jwaraghna” in its property, there is no discussion of doubtabout the embedded active principles of the individual components. Still it is a bound dutyto discuss its mode of action with regard in this concern.Cumulative action of Bharangyadi Ghana Vati based on Rasa The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa inassociation with that of Katu Rasa. The other two Rasa dominant in the compound areKashaya and Madhura. If the composition is to be brought in the form of formula it can be stated as - Tikta 8 7 4 3.Katu Kashaya Madhura The main functions of the Tikta Rasa are – Soshaka,Kantashodhaka and Prahladanakara. As the fundamental components are of Vayu and Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)148
  • 160. Pruthvi Mahabhuta it possesses the Ruksha, Sheeta and laghu Guna, there by acts as Pittashamaka and Kapha shamaka. Here in this topic of discussion it is very much needed as the disease basically a Pittadominant. The Rasavahasrotas and Rasa Dhatu, which are, predominant dushyas inVishamajwara subjects for the soshana (drying) under the influence of the Tikta Rasa. Thusthe importance of the Tikta Rasa in association with the other Rasa in the pacification of theVishamajwara is substantiated.Cumulative action of Bharangyadi Ghana Vati based on Veerya The components are with the Ushna Veerya in 60% and Sheeta in 30% and anushnaSheeta in 10%. It is said as the Ahara Dravyas are of Rasa pradhana and the AushadhaDravyas are of Veerya pradhana. Apart form the prabhava, which is a most important factor of the medicine, theVeerya needs the discussion. The Bharangyadi Ghana Vati, with the 60% Ushna Veerya init, in a disease which is predominant with the Pitta Dosha (Agneya tatwa) is a pint ofdiscussion. Here the Ushna Veerya Dravyas are specifically sweda janaka pravartakas by nature.The swedavarodhata is the pratyatma niyata Lakshana of the jwara. Thus theswedavarodhata is passified by the Ushna veeraya Dravyas and there by facilitates thethermal regulations in the body. As the thermo regulatory functions withstands the normal functions of the Pitta areresumed. There by the deeptagni, Ama pachana etc, are visualised in the body. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)149
  • 161. Cumulative action of Bharangyadi Ghana Vati based on Prabhava Any compound action is difficult to assess with out noting the individual prabhava ofthe Dravya. At the same time out of any compound medicine few are of prime and rest assupportive. In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and Kiratatikta. The rest of the components are also have the Jwarahara prabhava. Thus the cumulativeaction is a perfect Jwaraghna with the Bharangyadi Ghana Vati is witnessed. As we see the prime drug – Bharangi, on which the name of the medicine is namedBharangyadi Ghana Vati, has the specific Jwarahara (Anti-pyretic) Property in associationwith the upper respiratory tract pacifying principles such as Peenasahara, Kasahara,Swasahara and Shothahara. These are the relative areas of the disease predisposing and theregulating the air hunger at the time of temperature rise makes the Pitta pacification alongwith the Kapha. The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in theVishamajwara needs pacification through medication. The Parpataka and Kusta are suchherbs embedded with the Raktadoshahara property. Parpataka in association is aBhramahara and Trushnahara. In the jwara trushna appears because of the water evaporationdue to BMI rise or the temperature rise. This is nullifies by the parpataka. The second herb is Kusta, which is a Kasa andKusta hara. Kusta is a Rakta vikara, and any invasions over Rakta are capable of vitiatingRakta. Apart from these the main function which is impaired at the Jwara is temperature riseis a factor associated with the Twacha i.e. skin and it is a adhistana of the Kusta. Thus theaction over Twak is substantiated here. Bruhati is another herb, which is acting over the Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)150
  • 162. skin area as kustaghna. Yavasa is chardihara, there by it pacifies the nausea ofVishamajwara. Shunti is Kapha hara, Amavatahara, Hrudrogahara, Grahi and Panduhara. Guduchiis Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi,Rasayana, Panduhara, Kamalahara, Chardihara and Amahara. Out of these herbs thecommon of common is panduharatwatam. In Vishamajwara it is observed that the RaktaDhatu is vitiated and the destruction of the Rakta is witnessed. The destruction of the Raktaleads to pandu in Vishamajwara and there by hepato-speenomegale is appeared. To rule outthe organomegale the Guduchi and sunti are used. A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio-availability of the drug to deep tissues faster and faster. Thus the association of the Pippalimakes that the drug acts faster in Vishamajwara and by its Rechaka property pacifies thePitta, which is a dominant Dosha in the pathogenesis of the Vishamajwara. Apart from thePippalai is Deppana and Pachaka Dravya thus the rectification of the Agni takes place. Another important property of Guduchi is Rasayana along with Jwarahara,Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi, Panduhara,Kamalahara, Chardihara and Amahara properties. The disease penetrates in to the deeptissues as it takes the different shapes of Vishamajwara. The Rasayana property of theAmruta in association with the anti-pyretic property makes the sense at the management ofthe Vishamajwara.Krimiharatwa of Bharangyadi Ghana Vati based In this combination we found Musta and Kiratatikta, as the Krimihara. Theprobability of the action of these over the invaded malarial parasite is to be studied at Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)151
  • 163. laboratory in vitro. Apart from Krimihara property Musta is even deepana and pachanaDravya, there by it acts over Annavahasrotas and Agni. Kiratatikta is such a wonderful drug,it has Jwarahara, Vranahara, Krumighna, Raktadoshahara, Trushnaghana, Swasaghna,Kasaghna and sannipatajwaraharatwa as specific.Cumulative action of Bharangyadi Ghana Vati based on chemical composition v The antipyretic activity of Musta was demonstrated on pyrexia induced by Brewers yeast in albino rats. v Antibacterial activities of Musta oil and its fractions have been demonstrated against a number of organisms. v People of NWFP specially used Yavasa for skin diseases, small pox and for endothermic reaction in the body. v Sunti was shown to have significant antiemetic and antivertigo effects like dramamine". It has been listed effectively along with Piper nigrum and Piper longum in viral hepatitis". Ginger forms an important constituent of many Ayurvedic formula- tions. It is chiefy used as a home remedy for nausea and dyspepsia. v The hepato-protective effect of pippali has been shown in carbon tetrachloride- induced liver damage in rats. A common use of the fruit is in the prevention of recurrent attacks of bronchial asthma. Another important indication is in chronic malaria. v The hepato-protective effect of Guduchi extract has been studied in carbon tetrachloride induced liver damage in rats. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)152
  • 164. v Sunti contains a chemical called zingibain that dissolves parasites and their eggs. In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful as a supplement in treating schistosomiasis, a parasitic disease. v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution). It also has antibacterial effects against streptococei and staphylococci.Observation of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria Present study registers 30 patients, out of 68 approached patients. Out this, 4 patientswere discontinued hence their data has not been included in the assessment. The remaining26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusivecriteria were included in the study.Demographic data of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria v The male female ratio in the study is 4:1 patients. The percentage of the distribution does not show any gender differentiation to get this protozoan- related disease. v More of the patients reported are of labour group, as they are not well protected and also expose to the unhygienic environment. v The economical condition is a key for the evaluation and prognosis. At the study it is found that distributions are falling from the very poor to rich class people. As the economical status is permitting to have more protection the incidences are smaller and minimal. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)153
  • 165. v At the study it is observed that more people are under mild category (23 patients – 76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s are recorded in addition to above. v At the present study is noticed that maximum subjects are mixed food i.e. 23 (76.7%) and the vegetarians are only 7 (23.3%) patients.Subjective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients – 56.67%) are under the Satata Variety. v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for the all patients. v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%) Pralapa and 1 (3.33%) Asahishnuta were found. v As many as 24 (80%) patients reported with chardi in association with Kasa (4 patients – 13.33%) and Swasa (4 patients – 13.33%). v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the study by all 30 patients and 24 (80%) of patients expressed that they possess the Shareera Gowrava. v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with Atisweda and 20 (66.66%) patients even with the Daha. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)154
  • 166. v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à- vis Malaria is admissible. v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect of the Bharangyadi Ghana Vati for a period of stipulated usage has given relief effectively and as follow up period is advanced fall to a minimal of 0.19 expected to reach absolute normalcy with in a short while of the follow-up.Objective analysis of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria v At the above tabulation various parameters are expressed with their mean values of baseline data to that of final data. The most important parameter Malarial Parasite smear test is positive for the all patients those are included in the study. Out of them 19 patients (73.07%) are MP negative at the end of the treatment. Disease prognostic factors such as ESR and Total counts are dropped their vales to normalcy. More over the haemoglobin percentage is improved by 0.317692 mean value. At the differential count of blood Neutrophills and Eosinophills show marginal increase and lymphocytes and Monocytes show marginal decrease. The mean vale table is as above. v Patients were showed significant reduction in fever on 14th day. Nearly half the number of patients came to normal temperature and remaining patient are at grade 1. On 21st day cure rate was attained and much changes are not observed during fallow up period. During the fallow up period there was no recurrence also. Linear and slow regression of temperature were noted. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)155
  • 167. Result of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria v The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are declared after through assessment of the subjective objective parameters. The results for the sake of convenience classified as Cured, Responded, Not Responded and Discontinued. Out of these the discontinued patients are the dropouts in the study. The cured are fulfilling the satisfactory subjective and objective criteria and must be malarial parasite smear test negative at the end of the schedule. The responded are satisfactory at the subjective parameters and feel comfort by all means but their MP is still positive. The Not-Responded patients are of either of the subjective or objective criteria non-fulfilled. Based on this the results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4 (13.34%) discontinued respectively.Mean effect of Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance. Assume that the drug is not responsible in curing the disease, to test the hypothesis we use paired “t” test {as p <0.05). The parameter Aniyamita Jwara shows more significance than the others. The mean net effect of Aniyamita Jwara in subjective parameters is more and the Yakrut Vruddhi is less in mean net effect. v The parameter Aruchi shows units mean net effect with zero variations i.e. response in all patients of before to after study. The parameters Aruchi after the treatment have zero variations. The parameter Chardi, have more net variation but kampa have less net effect. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)156
  • 168. v The mean effect of the subjective parameters of Vishamajwara is more after the treatment but aruchi, Yakrut Vruddhi have same variations, where as Aruchi having uniform effect (by comparing mean SD and coefficient of variations) for the to know the effect of drug after the 7 days of treatment. The Aniyamita Jwara again shows high significance with more net mean effect.v The aruchi shows no significance with net less variation and with less net mean effect as shown in the above table.v Among the objective parameters ESR shows high significance than the others, but there is a least variation in haemoglobin percentage. Among the DC, lymphocytes show more (high) significance than the others.v The nets mean effect in Nutrophils is more with more variation. But the Eosinophils and Monocytes have equal mean net effect with difference in the variations (by comparing the “t” and “p” values). Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)157
  • 169. Chapter – 7 Conclusionv Utilisation of traditional medicine is widespread in developing countries and the efficacious of many traditional treatments have been well documented, including in skin disease, malaria and other disorders.v Many herbal compounds and herbo-mineral compounds are listed in Ayurveda to pacify the Jwara, especially Vishamajwara. Ayurvedic herbs have an important role in the treatment of malarial fever.v Malaria or a disease resembling malaria has been noted for more than 4,000 years. The symptoms of malaria were described in ancient Chinese medical writings.v In 1922, John William Watson Stephens described the fourth human malaria parasite, P. ovale. In further work with bird malaria, Ross showed that mosquitoes could transmit malaria parasites from bird to bird.v The disease Vishamajwara is included under the jwara roga in Ayurveda. Vishamajwara characterised by visamarambha (irregular onset).v It is a clear picture of Vishamajwara of malarial origin. Dalhana consider bhutas (Keetanu – Parasites) responsible to produce Vishamajwara.v Jejjata considered the Vishamajwara is as tridoshaja in origin.v Cough may be a presenting feature of malaria with severe anaemia can be a presenting feature of malaria.v Malaria produces significant immune suppression and this can result in secondary infections.v Splenomegaly is a cardinal sign of malaria, absence of splenomegaly does not rule out the possibility of malaria. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)158
  • 170. v In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara, Triteeyak jwara, Chaturthak jwara and Chaturthak jwara. The aggravated doshas interact Rasa and other Dhatu and ultimately produces Vishamajwara.v The component of the Bharangyadi Ghana Vati bears mainly the Tikta Rasa in association with that of Katu Rasa.v Present study registers 30 patients, out of 68 approached patients. The remaining 26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive criteria were included in the study.v In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and Kirata Tikta. The rest of the components are also have the Jwarahara prabhava. Thus the cumulative action is a perfect Jwaraghna with the Bharangyadi Ghana Vati is witnessed.v Panduhara, Jwarahara, Mootrakruchrahara, Hrudrogahara, Tridoshahara, Deepaka, Sangrahi, Rasayana, Panduhara, Kamalahara, Chardihara and Amahara Dravyas are used in the Bharangyadi Ghana Vati.v The malarial parasite lies at the blood. They’re by the Rakta, as dooshya in the Vishamajwara needs pacification through medication.v The destruction of the Rakta leads to pandu in Vishamajwara and there by hepato- speenomegale is appeared. To rule out the organomegaly the Guduchi and sunti are used.v A Dravya, which is a Yogavahi in the composition (Pippali) makes the bio- availability of the drug to deep tissues faster and faster. Thus the association of the Pippali makes that the drug acts faster in Vishamajwara and by its Rechaka Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)159
  • 171. property pacifies the Pitta, which is a dominant Dosha in the pathogenesis of the Vishamajwara.v Apart from all Deppana and Pachaka Dravyas are used for the rectification of Agni.v In this combination we found Musta and Kiratatikta, as the Krimihara. The probability of the action of these over the invaded malarial parasite is to be studied at laboratory in vitro.v The antipyretic activity of Musta was demonstrated on pyrexia induced by Brewers yeast in albino rats.Antibacterial activities of Musta oil and its fractions have been demonstrated against a number of organisms.v Sunti was shown to have significant antiemetic and antivertigo effects like dramamine". It has been listed effectively along with Piper nigrum and Piper longum in viral hepatitis". Ginger forms an important constituent of many Ayurvedic formula- tions. It is chiefy used as a home remedy for nausea and dyspepsia.v The hepato-protective effect of pippali has been shown in carbon tetrachloride- induced liver damage in rats. A common use of the fruit is in the prevention of recurrent attacks of bronchial asthma. Another important indication is in chronic malaria. The hepato-protective effect of Guduchi extract has been studied in carbon tetrachloride induced liver damage in rats.v Sunti contains a chemical called zingibain that dissolves parasites and their eggs. In laboratory trials, ginger extracts have been shown to kill the anisakid worm (a parasite occasionally found in raw fish) within sixteen hours. Ginger tea is useful as a supplement in treating schistosomiasis, a parasitic disease. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)160
  • 172. v The essential oil of Kusta has antiprotozoal effect in vitro (1 in 10,000 dilution). It also has antibacterial effects against streptococci and staphylococci.v The male female ratio in the study is 4:1 patients. The percentage of the distribution does not show any gender differentiation to get this protozoan-related disease.v More of the patients reported are of labour group, as they are not well protected and also expose to the unhygienic environment.v The economical condition is a key for the evaluation and prognosis. At the study it is found that distributions are falling from the very poor to rich class people. As the economical status is permitting to have more protection the incidences are smaller and minimal.v At the study it is observed that more people are under mild category (23 patients – 76.7%). Moderate (6 patients – 20%) and Good (1 patient – 3.33%) hygiene’s are recorded in addition to above.v At the present study is noticed that maximum subjects are mixed food i.e. 23 (76.7%) and the vegetarians are only 7 (23.3%) patients.v The appearance of the Vishama Arambhata, Vaga and Kala are noted here and classified. In this study of Vishamajwara vis-à-vis Malaria many (17 patients – 56.67%) are under the Satata Variety.v Out of the complaints it is found that a Pratyatma Niyata Lakshana, Aniyamita Jwara (100%) is present along with Shira shoola (100%) and Aruchi (100%) for the all patients.v Out of associative features in Vishamajwara vis-à-vis Malaria, it was found that the Anga Gowrava is more in 24 (80%) of patients. The next best complaint seen Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)161
  • 173. is Trushna with 19 (63.33%) patients. In further 7 (23.335) Glani, 2 (6.67%) Pralapa and 1 (3.33%) Asahishnuta were found.v As many as 24 (80%) patients reported with chardi in association with Kasa (4 patients – 13.33%) and Swasa (4 patients – 13.33%).v In the Rasavaha Srotas Jwara and Aruchi are the major complaints found in the study by all 30 patients and 24 (80%) of patients expressed that they possess the Shareera Gowrava.v In this study Vishamajwara vis-à-vis Malaria, all patients (100%) reported with Atisweda and 20 (66.66%) patients even with the Daha.v It is noticed that 20 (66.67%) patients show the Sweda pravrutti and Shareera Laghavata as Jwaramukta Lakshana. The observation of the jwramukta Lakshana shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is admissible.v As the trend-line drawn to the Aniyamita Jwara (mean values) show that the effect of the Bharangyadi Ghana Vati for a period of stipulated usage has given relief effectively and as follow up period is advanced fall to a minimal of 0.19 expected to reach absolute normalcy with in a short while of the follow-up.v At the above tabulation various parameters are expressed with their mean values of baseline data to that of final data. The most important parameter Malarial Parasite smear test is positive for the all patients those are included in the study. Out of them 19 patients (73.07%) are MP negative at the end of the treatment. Disease prognostic factors such as ESR and Total counts are dropped their vales to normalcy. More over the haemoglobin percentage is improved by 0.317692 mean value. At the differential count of blood Neutrophills and Eosinophills show Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)162
  • 174. marginal increase and lymphocytes and Monocytes show marginal decrease. The mean vale table is as above.v Patients were showed significant reduction in fever on 14th day. Nearly half the number of patients came to normal temperature and remaining patient are at grade 1. On 21st day cure rate was attained and much changes are not observed during fallow up period. During the fallow up period there was no recurrence also. Linear and slow regression of temperature were notedv The results of Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria are declared after through assessment of the subjective objective parameters. The results for the sake of convenience classified as Cured, Responded, Not responded and Discontinued. Out of these the discontinued patients are the dropouts in the study. The cured are fulfilling the satisfactory subjective and objective criteria and must be malarial parasite smear test negative at the end of the schedule. The responded are satisfactory at the subjective parameters and feel comfort by all means but their MP is still positive. The Not-Responded patients are of either of the subjective or objective criteria non-fulfilled. Based on this the results are 19 (63.33%) Cured, 1 (3.33%) responded 6 (20%) Not-Responded and 4 (13.34%) discontinued.v All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance. Among the objective parameters ESR shows high significance than the others, but there is a least variation in haemoglobin percentage. Among the DC, lymphocytes show more (high) significance than the others. (by comparing the “t” and “p” values). Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)163
  • 175. Chapter -8 Summary1. Malaria or a disease resembling malaria has been noted for more than 4,000 years.2. The disease Vishamajwara is included under the jwara roga in Ayurveda.3. Vishamajwara is characterised by visamarambha (irregular onset).4. Dalhana consider bhutas (Keetanu – Parasites) responsible to produce Vishamajwara.5. Cough may be a presenting feature of malaria with severe anaemia.6. In Vishamajwara the Doshas are not only localised in Rasa Dhatu like in other jwara, they spread through Rasa, Rakta, Mansa, Meda, Asthi and Majja to get the different Vishamajwara such as Satata jwara, Santata jwara, Anyedushka jwara, Triteeyak jwara, Chaturthak jwara and Chaturthak jwara.7. Present study registers 30 patients, out of 68 approached patients. The remaining 26 patients of Vishamajwara viz. Malaria, fulfilling the criteria of diagnosis and inclusive criteria were included in the study.8. In this trail drug Bharangyadi Ghana Vati, the prime herbs are – Bharangi and Kirata Tikta.9. It is noticed that the Sweda pravrutti and Shareera Laghavata as Jwaramukta Lakshana are observed shows that the effect of the Bharangyadi Ghana Vati over Vishamajwara vis-à-vis Malaria is admissible.10. All the parameters except Yakrut Vruddhi and Pleeha Vruddhi show high significance.11. Thus it is concluded that the Bharangyadi Ghana Vati in Vishamajwara vis-à-vis Malaria is established. Bharangyadi Ghana Vati in Vishamajwara (Malarial fever)164
  • 176. Bibliographic References1) Park’s Text book of Preventive and social medicine, Page no 189 Published by M/s Banarasidas Bhanot ,16th Edition, Nov 2000,2) Davidson’s principles and practice of medicine, Page no 148-153, Edited by Haslett,chilvers,Hunters,boon, Published By Churchill living stone international 18th Edition 1999,3) Harrison’s principles of internal medicine, 14th Edition 1998 Volume 1, Page 1180)4) Astanga Hridayam Nidan stana 3rd chapter slk no 69, Krishnadas Ayurveda series no 27, Published by Krishnadas Academy Varanasi, 2nd edition 19955) Yogaratnakar with Vaidyprabhahindu commentary Vishamajwara prakaran slk No 1 krishnadas Ayurveda series no 54, Published by Krishnadas academy, 1st edition 1998,6) Bhavprakash By Bhavmishra uttararda Vishamajwara prakaran slk No. 722, shri Kashi Sanskriti series 130,published by chaukhamba Sanskrit sanstan Varanasi 5th edition 19807) Phillipson et al., cited in Kirby, 1997.8) Bodeker & Willcox, 2000, Planning for cost- effective traditional health services in the new century - a discussion paper9) http://www.indus.org/techamr/index.htm#hemed10) Valecha et al., 200011) Epidomology, Clinical Drug trails, pp 92-9512) Sahasrayoga – Kashaya Prakarana, edited by Ramnivas Sharma and Surendra sharma, pakshini prakashan Hyderabad, 2nd edition oct 1990, Page 613) Susruta, Susruta Samhita, Varanasi: Krishnadas Academy; 1980. (Krishnadas Ayurveda series 51), Kalpa 8/36-3714) http://www.bbc.co.uk/Malaria15) Ronald Ross, First published December 9, 2003 Last modified July 1, 2004 Copyright © 2005 The Nobel Foundation Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) I
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  • 182. 166) Singh, K. P. et al.: J. Res. Ind. Med. 10: 9 (1975)167) Rege, N. et al.: Ind. Drugs Sept. 544 (1984)168) Gulati, 0. D. et al.: Rheumatism 17: 76 (1982).169) Kishore, P. et al.: J. Res. Ayur. Siddha 1. 417 (1980).170) Mhaisker, U. B. et al.: Rheumatism 16: 35 (1980).171) Babu, S. R.. Rheumatism 18: 24 (1982).)172) Dwivedi, M. L. et al.: Sachitra Ayurveda 37. 39 (1984).173) Hemadri, K. and S. S. Rao: Ancient Sci. Life 3: 209 (1984)174) Saley, S. R. and S. H. Nalgirkai: Nagarjun 25: 203 (1982)175) Park’s Text book of Preventive and social medicine, Page no 189 Published by M/s Banarasidas Bhanot ,16th Edition, Nov 2000.176) Davidson’s principles and practice of medicine, Page no 148-153, Edited by Haslett,chilvers,Hunters,boon, Published By Churchill lingstone international 18th Edition 1999.177) Harrison’s principles of internal medicine, 14th Edition 1998 Volume 1, Page 1180178) Astanga Hridayam Nidan stana 3rd chapter slk no 69, Krishnadas Ayurveda series no 27, Published by Krishnadas Academy Varanasi, 2nd edition 1995.179) Yogaratnakar with Vaidyprabhahindu commentary Vishamajwara prakaran slk No 1 krishnadas Ayurveda series no 54, Published by Krishnadas academy, 1st edition 1998.180) Bhavprakash By Bhavmishra uttararda Vishamajwara prakaran slk No. 722, shri Kashi Sanskriti series 130,published by chaukhamba Sanskrit sanstan Varanasi 5th edition 1980.181) Sahasrayoga – Kashaya Prakarana, Page 6,edited by Ramnivas Sharma and Surendra sharma, pakshini prakashan Hyderabad,2nd edition oct 1990182) Charaka Samhita Chikitsa stana 3rd Chapter slk no 74, Chakrapanidatta Ayurveda Deepika shri Kashi Sanskrit series no 194,edited by Dr.Gangasahaya pandeya, published by chaukhambha Sanskrit sanstan varanasi.183) Sushruta Samhita Uttara Tantra Dalhanacharya commentary chapter 39 slk no 56, Jaikrishnadas Ayurveda series no34, edited by Vaidya Jadavi Trikanji Acharya Narayan Ram,Acharya Kavytirtha,published by Chaukhmba Orientalia Varanasi,4th edition 1980.184) Madhava Nidana Madhukosha commentary, Jwara Nidana 2 Chapter Slk no.26,36,kashi sanskrit series no 158, edited by Yadunandana upadhyaya, published by chaukhambha Sanskrit sanstan varanasi 26th edition 1996.185) Vox Sanguinis. 73(3):143-8, 1997. Clin & Exp Immunol. 54(1):127-34, 1983186) J Trop Med & Hygene. 96(4):245-8, 1993-Aug187) Am J Trop Med & Hyg. 65(4):355-363. 2001-Oct188) K.R. Srikantaha Murthy (Translator), Sharagdhara Samhita, madhyama khanda, 1st ed, 1984, Chowkhambha Orientalia, Varanasi, chapter 2 sloka 1-2189) Ibid, chapter 8 sloka 1190) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p 354191) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 102192) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p28 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) VII
  • 183. 193) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p210194) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 298195) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 421196) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p248197) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 243198) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p23199) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p252200) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 370201) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 551202) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p560203) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 323204) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p24205) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p204206) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 320207) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 592208) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p533209) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 411210) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p20211) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p182212) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 316213) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 156214) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p1308 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) VIII
  • 184. 215) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 12216) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p85217) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p213218) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 331219) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 871220) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p1184221) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 72222) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p22223) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p165224) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 691225) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 355226) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p1108227) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 91228) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p99229) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p244230) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 572231) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 307232) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p965233) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 15234) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p83235) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p215236) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 275 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) IX
  • 185. 237) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 453238) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p1149239) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 288240) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p33241) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p12-13242) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 282243) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 371244) Dr. K M Nadakarni, Indian Materia Medica Volume I, 3rd Edition 1982, Popular Prakashan Pvt. Ltd, Bombay, p1220245) Bhavamishra, Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, 7th Edition 1984, chaumkhamba Bharati Academy varasnasi, P 269246) Priyavat sharma (editor), Dhanavantari Nighantu, 1st Ed. 1982, Jaykrishana Ayurvedic Series No 40, Chaukhmaba Orientalia Varanasi, p16247) Priyavat sharma and Guruprashad Sharma (editors), Kayyadeva Nighantu, 1st ed., 1979, Chaukhmaba Orientalia Varanasi, p5248) P.V. Sharma, Drvyaguna vijnan, Vol-2, 1993, Chaukhambha Bharati Academy, Varanasi, p 761-763249) J.L.N. Shastri, Dravyaguna Vijnan, vol-2, first ed., Chaukhambha Orientalia, 2004, Varanasi,, p 33,37,39 Bharangyadi Ghana Vati in Vishamajwara (Malarial fever) X
  • 186. Annexure DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA D.G.M.A.M.C.GADAG SPECIAL CASE SHEET FOR EVALUATION OF THE EFFICACY OF THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER Guide: Dr. V. VaradaCharyulu, M.D (Ayu), Scholar: Professor & H.O.D. Kayachikitsa Dr. Manga;a B. Patil Co-guide: Dr. R.V. shettar, M.D (Ayu), 1) Name of the Patient Sl.No 2) Gender Male Female OPD No 3) Age Years IPD No 4) Religion Hindu Muslim Christian Other 5) Occupation Student Service House wife Labour Agriculturist Business 6) Economical status Very Poor Lower- Upper Rich Poor Middle Middle 7) Address Pin 8) Birth data Place of Birth AM Date Month Year Time Hours Minutes PM 9) Hygienic stautus Poor Moderate Good 10) Selection Included Excluded 11) Schedule Initiation Date Completion Date 12) Result Cured Responded Not responded Discontinued 13) INFORMED CONSENT I Son/Daughter/Wife of amexercising my force power of choice here by giving my consent to be included as a subject in this study.I have been informed to my satisfaction, by the attending physician the clinical trail and nature of thedrug treatment and its follow-up. I am also aware of rights to quit out the trail at any time during thecourse of total without giving reasons. Patients Signature Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 1
  • 187. 14) Pradhana Vedana No Complaints Duration Fresh < 3 days < 5 days > 5 days 1 Aniyamita Jwara 2 Vepana (shivering) 3 Agnimandya 4 Chardi 5 Shira shoola 6 Aruchi 7 Parshwa shoola 8 Tandra 9 Swasa 10 Anidra15) Anubandha Vedana No Complaints Before treatment After Fresh < 3 days < 5 days > 5days treatment 1 Trushna 2 Pralapa 3 Dravamala Pravrutti 4 Anga Gowrava 5 Glani 6 Asahishnuta16) Poorva Vyadhi Vruttanta17) Chikitsa Vruttanta18) Vayaktika Vruttanta a) Ahara Vegetarian Mixed food b) Vihara Adhika Vyayama Diwaswapna c) Nidra Normal Disturbed Excess d) Vyasana Tobacco Pan-chewing Smoking Alcohol e) Vyayama shakti Heena Madhyama Uttama f) Mala pravritti Regular Constipated Dravamala pravrutti Colour Frequency g) Mutra pravrutti Normal Burning Colour Odour Frequency h) Raja Pravrutti Regular Irregular Amenorrhoea Painful Menopause i) Mental State Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 2
  • 188. 19) Astastana Pareeksha Nadi Dosha Mutra Pravrutti Gati Varna PurnataAstasthana Gandha Spandana Kathinya Jihwa Ardra Sushka Mala Sama Nirama Lepa Nirlepa Shabda Sparsha Sheeta Ushna Drik Akruti20) Sroto pareekshaSrotas PareekshanaPranavaha sroto dusti Lakshana Kasa Swasa Chardi Urah shoola Swasa bheda Rakta ShteevanaRasavaha sroto dusti Lakshana Aruchi Hrullasa Shareera Gourava Anidra Jwara TandraAnnavaha sroto dusti Lakshana Aruchi Chardi Anannabhilasha Annadwesha ShoolaSwedavaha sroto dusti Lakshana Asweda Atisweda Daha Romaharsha21) General examination Pulse /min Temp °F Respiration rate /min Weight /kgs Height heart rate /min Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 3
  • 189. 22) Systemic examination Srotas Darshana Sparshana Sravana Akotana Prana (RS) Rasa (CVS) Anna (GIT) Any other23) Examination of Organomegale Day 0 Day 7 Day 14 Day 21 Day F1 Day F2 1. Palpable in finger Yakrut (Liver) 2. Tenderness 3. Edge/ Border 4. Nodularity 5. Sharpens 6. Rounded 7. Leafy 1. Palpable 2. Tenderness Pleeha (Spleen) 3. Enlargement 4. Mild 5. Moderate 6. Massive 7. Surface 8. Smooth 9. Hard24) Nidana evaluatedAkala Bhojan Rutu ParivartanaAhita Bhojana KrodhaDooshita jalapana BhayaAupasargika Karana25) Poorva RoopaJrumbha Shareera GurutaAruchi Ashrupurna netraRomaharsha26) Roopa (Lakshana) of VishamajwaraAniyamita Jwara ChardiAgnimandya Parshwashoola Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 4
  • 190. Aruchi Shiroshoola27) Samprapti ghatakaDosha Sroto dusti prakaraDooshaya UdbhavastanaAgni Sanchara stanaSrotas Vyakta stana28) Jwaramukta LakshanaSweda pravrutti Mukha pakaShareera laghuta TrushnaShira kandu Kshudha29) Assessment Day 0 Day 7 Day 14 Day 21 Day F1 Day F2 Aniyamita Jwara Subjective parameters Vepana (shivering) Agnimandya Chardi Shira Gowrava Aruchi Parshwa shoola Tandra Swasa Anidra Haemoglobin % Total count Differential count Objective parameters Lymphocytes Nutrophils Eosioniphils Basophils Monocytes Erythrocyte sedimentation Rate Peripheral smear (MP)30) Investigator’s note:Guide signature Scholar signatureCo-Guide signature Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 5
  • 191. Temperature and Blood Pressure chart Bharangyadi Ghana Vati in Vishamajwara (malarial fever) 6
  • 192. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1.Name of the candidate and : MANGALAVVA .B. PATIL address M. B. PATIL W/O S.S. PATIL 4TH CROSS PANCHAKSHARI NAGAR, GADAG -582 101 2. Name of the institution : Post Graduate Studies and Research center, Dept of Kayachikitsa, D.G.M. Ayurvedic Medical College, Gadag. 3.Course of study and : Ayurveda Vachaspathi M D (Kayachikitsa) Subject 4. Date of Admission : September 2002 5. Title of the Topic : EVALUATION OF THE EFFICACY OF THE BHARANGYADI GHANAVATI IN VISHAMAJWARA WITH SPECIAL REFERENCE TO MALARIAL FEVER6. Brief Review of Intended Work6.1 Need for the Study. Vishamajwara in term of modern medical terminology co-related to malarial fever, is aprotozoan disease caused by genus plasmodium and transmitted to man by certain speciesof infected female anopheles mosquito. Indias geographic position and climatic conditionsare favorable for the transmission of malaria. Frequently people living in the endemic areasare prone for this infection. Out of 300-500 million clinical cases around 100 countries andone million deaths due to malarial malady are noticed globally. The 38th world healthassembly in 1985 recommended that, malaria control should be developed as an integralpart of the national primary health care systems 1.
  • 193. Vishamajwara is irregular (inconsistent) in its arambha (nature of onset commitment),kriya (action production of symptoms) and kala (time of appearance) and possesses 2-3-4anushanga (persistence for long periods) . As on today, the malarial parasite hasdeveloped resistance to chloroquine compounds, which are used vividly for the past threedecades. Ayurvedic herbs have an important role in the treatment of malarial fever. Even thechloroquine is a derivative of herbal origin. In the treatment of Vishamajwara many yogashave been explained in Ayurveda. The composition of Bharangyadi Yoga is easily available,low-priced and has no proved adverse effects 5 against malarial fever. Thus the present study has been under taken as “Evaluation of the efficacy of theBharangyadi Ghanavati in Vishamajwara with special reference to malarial fever”.6.2 Review of Literature Vishamajwara is a type of fever, which is described in all Ayurvedic texts. Charakamentioned Vishamajwara and Chakrapani have commented on Vishamajwara asbhutanubanda6. Susruta affirmed that Aagantuchhanubhandohi praysho Vishamajware7.Madhavakara has also recognised Vishamajwara as Bhutabhishangajanya (infected bymicroorganism) 8. Hence infected female anopheline mosquito bite can be considered ascausative factor for Vishamajwara along with other etiological factors. The Ayurvedic practitioners use Bharangyadi Ghanavati in the management ofVishamajwara, which is explained in Sahasrayoga in Kashaya kalpana. Bharangyadi Ghanavati is a combination of Jwarahara and Krimihara drugs.Bharangi, Kiratatikta are proved as anti malarial drugs. Guduchi, Parpataka and Brahati arehaving antipyretic properties. Shunti, Pippali are the best drugs for the Amapachana. So thecombination of Bharangyadi yoga shows the Vishamajwarahara properties. Thus thiscombination is chosen for the present study.
  • 194. 6.3 Objectives of the study 1. To evaluate the efficacy of the Bharangyadi Ghanavati in Vishamajwara 2. To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara. 3. To evaluate the antimalarial properties of Bharangyadi Ghanavati in Vishamajwara (Malarial fever).7) Materials and Methods7.1 Source of data. a) Patients: Patients suffering from Vishamajwara will be selected from department of Kayachikitsa Post Graduation studies and Research OPD of D G Melmalgi Ayurvedic medical college and Hospital by preset inclusion and exclusion criteria. b) Literary: Literary aspect of study will be collected from classical Ayurvedic and modern texts. c) Trail Drug: The combination and proportion of Bharangyadi Ghanavati is as follows 9 -10-11. 1. Bharangi Clerodendrum serratum 1 Part 2. Musta Cyprerus rotundus 1 Part 3. Parpatak Fumaria officinalis 1 Part 4. Yavasa (danvayavasa) Fagonia arabica 1 Part 5. Shunti Zingeber officinale roscoe 1 Part 6. Kiratatikta (Bhunibha) Swertia chirata 2 Part 7. Kusta Saussurea lappa 1 Part 8. Pippali Piper longum 1 Part 9. Brahati Solanum indicum 1 Part 10. Guduchi Tinospora cardifolia 1 Part
  • 195. d) Preparation of Yoga All the drugs will be identified and collected from local areas. Good manufacturingpractice will be followed for the preparation.7.2 Method of Collection of data a) Study design: Prospective clinical study b) Sample size: A minimum of 30 patients c) Exclusion Criteria – v Patient below 15 years and above 65 years of the age v Patient with complication like severe anemia v Renal failure v Pulmonary oedema, v Jaundice v Spleenic rupture v Pregnant women v Cerebral Malaria d) Inclusion criteria – v Age of the patients between 15 to 65 years. v Uncomplicated malarial fever v Peripheral smear test for M P must be positive e) Criteria of Diagnosis 1) The symptomatalogy of Vishamajwara mentioned in ayurvedic text will be the basic diagnostic criteria. 2) Peripheral smear for MP is taken as diagnostic criteria
  • 196. e) Posology- Internal - 3 gms in divided doses 1 vati =500 mg, 2 tab thrice a day Anupanam- ushnajala f) Study Duration: 21 days and Follow up for 15 days g) Assessment of Result Subjective and objective parameters are taken for the assessment of result. h) Subjective parameters As designated in the classical texts. i) Objective Parameters 1. Thick and thin blood film for malaria. 2. Peripheral smear test for MP 3. Erythrocyte Sedimentation Rate (ESR) 4. Hemoglobin (Hb %) 5. Temperature chart7.3 Investigations Diagnostic and Exclusion 1. Thick and thin blood film for Malaria. 2. Peripheral smear 3. Hemoglobin (Hb %) 4. Total Count (TC) 5. Differential Count (DC) 6. Erythrocyte sedimentation rate (E S R) 7. Widal test7.4 ETHICAL CLEARANCE : Obtained
  • 197. 8 List of Reference 1. a) Park’s Text book of Preventive and social medicine, Page no 189 Published by M/s Banarasidas Bhanot ,16th Edition, Nov 2000. b) Davidson’s principles and practice of medicine, Page no 148-153, Edited by Haslett,chilvers,Hunters,boon, Published By Churchill lingstone international 18th Edition 1999. c) Harrison’s principles of internal medicine, 14th Edition 1998 Volume 1, Page 1180 2. Astanga Hridayam Nidan stana 3rd chapter slk no 69, Krishnadas Ayurveda series no 27, Published by Krishnadas Academy Varanasi, 2nd edition 1995. 3. Yogaratnakar with Vaidyprabhahindu commentary Vishamajwara prakaran slk No 1 krishnadas Ayurveda series no 54, Published by Krishnadas academy, 1st edition 1998. 4. Bhavprakash By Bhavmishra uttararda Vishamajwara prakaran slk No. 722, shri Kashi Sanskriti series 130,published by chaukhamba Sanskrit sanstan Varanasi 5th edition 1980. 5. Sahasrayoga – Kashaya Prakarana, Page 6,edited by Ramnivas Sharma and Surendra sharma, pakshini prakashan Hyderabad,2nd edition oct 1990 6. Charaka Samhita Chikitsa stana 3rd Chapter slk no 74, Chakrapanidatta Ayurveda Deepika shri Kashi Sanskrit series no 194,edited by Dr.Gangasahaya pandeya, published by chaukhambha Sanskrit sanstan varanasi. 7. Sushruta Samhita Uttara Tantra Dalhanacharya commentary chapter 39 slk no 56, Jaikrishnadas Ayurveda series no34, edited by Vaidya Jadavi Trikanji Acharya Narayan Ram,Acharya Kavytirtha,published by Chaukhmba Orientalia Varanasi,4th edition 1980. 8. Madhava Nidana Madhukosha commentary, Jwara Nidana 2 Chapter Slk no.26,36,kashi sanskrit series no 158, edited by Yadunandana upadhyaya, published by chaukhambha Sanskrit sanstan varanasi 26th edition 1996. 9. Indian Materia Medica Volume I – Dr. K M Nadakarni, published by popular Prakashan Pvt. Ltd Bombay 3rd Edition 1982, page no’s 354,428,560,533,1308 1184,1108,965,1149,1120. 10. Bhava Prakasha Nighantu edited by Dr K C Chunekar And G S Panday, published by chaumkhamba Bharati Academy varasnasi, 7th Edition 1984, page no’s 102, 243, 223, 411,13,72,91,15,288,269. 11. Dhanavantari nighantu, Jaykrishana Ayurvedic Series No 40,edited by priyavrut sharma , published by Chaukhmaba Orientalia Varanasi 1st Edition 1982 Page no’s 25,23,24,20,85,22,99,83,32,16.
  • 198. 9 Signature of the candidate (M B Patil)10 Remarks of guide The Medicament Bharangyadi Ghanavati for the proposed study, Evaluation ofefficacy of the Bharangyadi Ghanavati in Vishamajwara with special reference to malarialfever will be very useful because of its availability, efficacy and economical in nature. Henceit is recommended.11. Name and Designation11.1 Guide: Dr V VARADACHARYULU M. D (Ayu) PROFESSOR AND H.O.D. D G M A M C PGS&RC, DGMAMC, GADAG12.2 Signature12.3 Co Guide: Dr R V SHETTAR M.D (Ayu)11.4 Signature11.5 Head of the Department Dr V VARADACHARYULU M D (Ayu) PROFESSOR AND HOD D G M A M C PGS&RC, DGMAMC, GADAG.11.6 Signature12. Remarks of Chairman & Principal:12.1 Signature : Dr. G.B.Patil (Principal/C.M.O.)
  • 199. K
  • 200. “Evaluation of the efficacy ofTHE BHARANGYADI Dissertation submitted to the Rajiv GHANAVATI IN Gandhi University of Health Sciences, VISHAMAJWARA Bangalore, In partial WITH SPECIAL fulfillment of Regulations for the REFERENCE TO award of the DegreeMALARIAL FEVER” By Mangalavva.B.Patil.
  • 201. Department of KayachikitsaPostgraduate Studies and ResearchD.G. Melmalagi Ayurvedic Medical College Gadag - 582 103 Guide Dr. Vangipuram Varadacharyulu Co-Guide Dr. R.V.Shettar
  • 202. Introduction• Mosquito makes man Eunuch.• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever, is a protozoan disease caused by genus plasmodium and transmitted to man by certain species of infected female anopheles mosquito.• Indias geographic position and climatic conditions are favourable for the transmission of malaria.
  • 203. Objectives of the study: -• To evaluate the efficacy of the Bharangyadi Ghanavati in Vishamajwara (Malarial fever)• To evaluate the antipyretic properties of Bharangyadi Ghanavati in Vishamajwara (Malarial fever)• To evaluate the anti-malarial properties of Bharangyadi Ghanavati in Vishamajwara (Malarial fever)
  • 204. Life cycle• "
  • 205. Role of bhuta in Vishamajwara • Susruta believed that Vishamajwara takes place due to agantuka karana (external cause). • Agantuka is divedid in to four types Abhighata Abhichara Abhishapa Abisanga• Dalhana considered Abhisanga as bhutavisanga• Chakrapani stated that poisones insects may becosidered as Bhuta .• According to Amarkosha it is Keetanu.
  • 206. Composition of the trail drug “BHARANGYADI GHANAVATI” Clerodendrum serratum 1 Part1. Bharangi2. Musta Cyprerus rotundus 1 Part3. Parpatak Fumaria officinalis 1 Part4. Yavasa (danvayavasa) Fagonia arabica 1 Part5. Shunti Zingeber officinale roscoe 1 Part6. Kiratatikta (Bhunibha) Swertia chirata 2 Part7. Kusta Saussurea lappa 1 Part8. Pippali Piper longum 1 Part9. Bruhati Solanum indicum 1 Part10. Guduchi Tinospora cardifolia 1 Part
  • 207. Chemical Composition of Bharangyadi Ghana Vati Name of the Chemical Indications Preparations ingredient constituents1.Bharangi Hispidulin 7.0 Jwara,Swasa,kasa Bharangyadi glucocaronides,scut , kwatha, ellrrin,uncinatone, shotha,krimi,daha Bharangyadi pctolinarigenin ,peenasa. guda.2.Musta Cineol+,copadiene, Jwara,krimi,trush Musta rishta, Copaene,cyperen na,Atiusara,kandu mustadi I&II,cypernone,iso ,kasa,nidra kasaya,mustadi pathoulenone,cyper nasha,rakta vikara vati.shadungapan toperotundone,etc eeya
  • 208. 3.Prapataka Adlumidiceine(-)- Jwara,trushna,Bh Sadanga paneeya adlumine,(+)bisculli ramamada,Rakta parpatadyarista ne,cocharine pitta,Atisara,char coptisine,cryptopine adi etc ,fumaromine,laharm ine,parfemdine etc4.Yavasa Galacto,catechin Jwara,kase,Rakta Agasthyavaleha,k +catechin(- pitta,trishna,med hatiradigutika,yas ),epigallocatechi aroga,chardi a n,and brama,kusta etc sarkara,vasagrita, leucodelphnidin, kalasyadi grutha B- phenethylamine etc
  • 209. 5.Shunti Dryness 80.9,protein Jwara,Hrudourbay Ardrakakhand,pan 2.6,fat 0.9,fibre a,hrutshoola,shilp chaasama 2.4,carbohydrate adha,shotha,amav churna,samashrka 12.3,metals1.2%,calciu ata,sheetha,pitta,p ra churna,rasnadi m 20, phosphorus andu,atisara,kasa kwatha,soubhagya 60,iron 2.6mg,each swasa, agni shunthi,shunthisur 100gm other than mamdhya etc a. these iodine chlorine are also present vitamin A,B,C also present.6.Kiratatikta Amarogentin,gentiopic Sanepata jwara, Kiritadi rin,isobellicifolin,decus Rakta pitta, arsas kwata,sudharsana satin,chiratol,swerchiri krimi, kusta. churna,kiratitiktad n,7-0methyl Vruna, shotha, i churna,kiritarista swertianian,kairatinol trishna.daha etc etc swertanone etc
  • 210. 7.Kusta Essential Jwara,kusta,hikka Kustadi oil,castol,taraxasterol,de , kasa,prasava taila,kustadi hydrocostuslactone,sist shoola,hrudroga,v curna,kusta osterol, isarpa,kanduvata rasayanam arcuscumene,iso rakta. dihydrocostuslactone costus-lactone etc8.pippali Volatile oil- Hrudhadourbalya Guda 0.8%,piperine- ,pandu,raktavikar pippali,pippali 4.5%,pipalatine and a,kasa,swasa,aruc khada,pippalayas sesamine hi,agni ava,yakartlihari andpipalsterol-0.15- mandhya,kshata, loha,yakrt 0.18% and pipalartin jwara pippaladi yoga. 0.13-0.20%,piper languminon,steroid,gly coside
  • 211. 9.Brahati Glycoside,alkaloi Jwara,swasa,hrdro Brihatyadi d,solanine,dulcun ga,shoola,chardi,k kasaya, arin,carotene,carp ushta,kandu, pipapalyadi esterol,solonocurp krimi etc leha,dashamoolari one,disogenin,sol sta asodine,vit-C etc10.Guduchi Tinosporide,cardi Jwara, Guduchadi falide,tnosparidin trishna,vatarakta, churna,Guduchad e,B- pandu, i sistosterol,cardifo kamala,chardi,kri kwata,amritarista l mi,kandu,kasa,bh , amrithadi heptacosanol,octa rama,jwaravyadhi chandra casonol,magnofla prabhavati, rine,palmatine. pancha tikta , Guggu grutam etc
  • 212. MATERIAL AND METHODSSource of data Post graduation and research center of Sri D.G.M. Ayurvedic medical college and hospital, Gadag.Sample size 30 patientsResearch Design simple Random clinical TrailDuration 21 daysFollow-up 15 daysPosology Internal - 3 gms in divided doses 1 vati =500 mg, 2 tab thrice a day Anupanam- ushnajala
  • 213. Inclusion criteriaInclusion criteria –• Age of the patients between 15 to 65 years.• Uncomplicated malarial fever• Peripheral smear test for M P must be positive
  • 214. Exclusion criteria • Exclusion Criteria –• Patient below 15 years and above 65 years of the• Patient with complication like severe anemia• Renal failure• Pulmonary oedema,• Jaundice• Spleenic rupture• Pregnant women• Cerebral Malaria
  • 215. Criteria for withdrawals• Deterioration of condition, which needs hospitalization• Subsequent diagnosis of associated diseases• Indulgence in concomitant therapy
  • 216. Special instruction/advice given to patients• To stop smoking, alcohol and other habits• Not to indulge in strenuous exercise• Not to take any other medication except the trial medication.• Not to indulge in sex• To take regulated food and not to have food out side the house.
  • 217. • As designated in the classical texts.
  • 218. Objective parameters• Thick and thin blood film for malaria.• Peripheral smear test for MP• Erythrocyte Sedimentation Rate (ESR)• Hemoglobin (Hb %)• Temperature chart
  • 219. Assessment criteria• Subjective and objective parameters are taken for the assessment of result.
  • 220. Distribution of patients by Age 45-55 55-65 35-45 0.00% 0.00% 20.00% 15 –25 46.67% 25-35 33.33% DISTRIBUTION OF PATIENTS BY AGE
  • 221. Distribution of patients by Gender Female 20% Male 80% DISTRIBUTION OF PATIENTS BY GENDER
  • 222. Distribution of patients by OccupationService Business House wife Labour16.67% 10.00% 6.67% 56.67%Agriculturist 10.00% DISTR IBUTION OF PATIENTS BY OCCUPATION
  • 223. Distribution of patients by Religion Muslim Christian Others 10.00% 3.33% 0.00% Hindu 86.67% Distribution of patients by R eligion
  • 224. Data related to presenting complaints Presenting Total no of patients Percentage complaintsAniyamita Jwara 30 100 Vepana 28 93.33 Chardi 24 80 Shira shoola 30 100 Aruchi 30 100Parshwa shoola 6 20 Tandra 5 16.7 Swasa 4 13.33 Anidra 20 66.7Yakrut Vruddhi 2 6.67Pleeha Vruddhi 4 13.33
  • 225. Evaluation of Subjective Parameters (Bharangyadi Ghanavati in Vishamajwara ) Parameter Before 7th day 14th day 21stday Follow UpAniyamita Jwara 2.84 1.61 0.53 0.30 0.19 Vepana 0.88 0.61 0.34 0.15 0.03 Chardi 1.38 1.07 0.57 0.26 0.11 Shira shoola 1.92 1.38 0.88 0.26 0.15 Aruchi 1.0 1.0 0.7 0.46 0.11Parshwa shoola 0.19 0.07 0.07 0 0 Tandra 0.19 0.07 0.03 0 0 Swasa 0.34 0.19 0.07 0.07 0 Anidra 1.30 0.80 0.23 0.19 0Yakrut Vruddhi 0.03 0.03 0.03 0.03 0.03Pleeha Vruddhi 0.11 0.11 0.11 0.07 0.03
  • 226. Aniyamita Jwara (mean )3.5 3 2.84 Evaluation of Aniyamita Jwara (Mean)2.5 21.5 1.61 10.5 0.53 0.3 0.19 0 Before 7th day 14th day 21stday Follow Up-0.5 Treatment -1
  • 227. Evaluation of Subjective Parameters (Bharangyadi Ghanavati in Vishamajwara) parameters Before After Treatment Difference TreatmentMP smear (Positive) 26 7 19 Haemoglobin % 9.195385 9.513077 0.317692 E.S.R 15.65385 11.11538 4.53847 Total Count 6239.038 6080.192 158.846 Neutrofils 54.92308 60.57692 5.65384 Lymphocytes 38.34615 31.5 6.84615 Eosinophil 5.653846 5.769231 0.115385 Monocytes 1.461538 1.192308 0.26923
  • 228. RESULTS Discontinued Not 13.33%Responded 20.00% Responded Cured 3.33% 63.33% Distribution of patients by Result
  • 229. Statistical analysis of the clinical parameters at the end of treatment (21 days)S/n subjective Mean SD SE t-value P-value Remarks parameter1 Jwara 2.423 0.702 0.137 17.686 <0.001 HS2 Vepana 0.563 0.485 0.095 5.926 <0.001 HS3 Chardi 1.115 0.993 0.194 5.747 <0.001 HS4 Sjhira shoola 1.576 1.0265 0.201 7.840 <0.001 HS5 Aruchi 0.538 0.508 0.099 5.434 <0.001 HS6 pasrswashoola 0.231 0.514 0.1 2.31 <0.05 HS7 Tandra 0.192 0.401 0.078 2.461 <0.05 HS8 Swasa 0.269 0.666 0.131 2.053 >0.05 NS9 Anidra 1.153 0.924 0.181 6.37 <0.001 HS10 Pleeha vruddhi 0.038 0.196 0.038 1.0 >0.05 NS
  • 230. Discussion• The fever is unwanted rise in body temperature either because of disturbed internal environment or invasion of exogenous origins.• Vishamajwara, a most popular Ayurvedic term in turn of modern medical terminology co-related to malarial fever.• Vishamajwara vis-à-vis Malaria• Vishamajwara and Ayurveda
  • 231. Effect of Bhrangyadi Ghanavati on Vishamajwara• Cumulative action of Bharangyadi Ghana vati based on Rasa.• Cumulative action of Bharangyadi Ghana vati based on Veerya.• Cumulative action of Bharangyadi Ghana vati based on Prabhava.• Krimiharatwa of Bharangyadi Ghana vati based
  • 232. • Cumulative action of Bharangyadi Ghana vati based on chemical compositions• Observation of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.• Demographic data of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.• Subjective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
  • 233. • Objective analysis of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.• Result of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.• Mean effect of Bharangyadi Ghana vati in Vishamajwara vis-à-vis Malaria.
  • 234. Recommendations for further study• Same yoga can be repeated by taking a large number of samples with randomized control groups.• The effect of Bharangyadi Ghanavati can be studied along with Shodhana therapy.• The effect of Bharangyadi Ghanavati can be studied on long duration to avoid the reoccurrence of Vishamajwara.
  • 235. Limitations of the study• Sample size is small to generalize the result.• Samples are selected incidentally.• As chosen drug is a compound form it is difficult to specify the action of any individual herb and or to cumulative mode of action.
  • 236. Conclusion• Vishamajwara is the condition, which is almost, resembles the disease Malaria• The etiology of Vishamajwara and Malaria are similar.
  • 237. Conclusion• The Bharangyadi Ghanavati found effective in Vishamajwara.• Bharangyadi Ghanavati Highly effective on P.Falciparum and P.vivax• Bharangyadi Ghanavati is effective in chronic cases of Vishamajwara and more effective in fresh reported cases.
  • 238. Thank you sir

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