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Dhanyamla bahiparimarjana

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Dhanyamla bahiparimarjana

  1. 1. Dhanyamla Bahiparimarjana Prof. Dr. K. Shiva Rama Prasad 1 , Parimarjana is spectacular word from Ayurvedic literature defined from Shabdha Kalpadruma as – “Parishodhana”1 – a search, colloquially used to clean i.e. Dhavana. Where in the“Marjana” is added with “Anganirmalyokaranam”2, which means the body waste removal process.The “Parimarjana” with a prefix of “Bahi” becomes the “Bahiparimarjana” – a complete externallymodulated waste material removal or cleansing treatment, one out of three main methods oftreatment classifications. The other two are “Antahparimarjana” and “Shastrapranidhana”. The“Pranidhana”3 has a meaning of – “the visualization of the cause of the Sthambha – the obstruction.It other wise refer to the laparotomy exploration and Medinikosha explains it as “Praveshanam” –the entry - of course in to abdomen. Bahiparimarjana Chikitsa explained as – the treatment procedures that are depend upon theexternal touch such as Abhyanga, Sweda, Pradeha, Parisheka, Unmardana, etc4. A close look at thesaid examples makes a classification of the Bahiparimarjana Chikitsa i.e. trans-dermal cleansingmanagement. The former Abhyanga in terms of Bahya sneha is an external oil application whereheat inducted through rubbing. It is in the texts as not to apply any form of external (tropical)managements with out unctuous application, in terms that lubricates and facilitates the absorptionof the tropical management. The second application Sweda is an external heat modulation ortransportation through steam. The rest of the treatment applications include either of these twospecific methods of heat transportations. Commonly these Sneha and Sweda administered before to the chief cleansing methods viz.Panchakarma. However, the real utility of Bahiparimarjana as “Roga Prashamana” visualized onlyafter the completion of the Dosha elimination. This verse observed from the Charaka at the contextof Kusta relay is that the Lepa applied after the eliminative (Samshodhita Ashaya) procedures areeffective5. Human body is not depends upon the Sun heat and very minimal heat is taken from externaland depends upon the internal system to generate the heat required for the body maintenance. TheDosha in the body are always fluctuating in nature enhances or dislodges from its places to give risephysiological or pathological changes in the body. All these changes generally depend upon thetriad of mass, pressure and temperature. Out of these the mass and pressure in the body are constantand the only temperature is the variant subjected for the pressure variances. Thus the managements1 H.O.D., Dept. of Kayachikitsa (PG), DGM Ayurvedic Medical College, Kalasapur Road, Gadag-582103, Karnataka (cell: +91-9448746450), doctorksrprasad@gmail.com Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 1
  2. 2. of Dosha triad either for elimination or for the maintenance requires the cleansing from internallyand even externally, where the externally mediated procedures are not eventually cleansing innature they may be curative. For the same reason the externally mediated - BahiparimarjanaChikitsa methods viz. Sneha and Sweda are not included in the cleansing methods of Panchakarma.These Sneha and Sweda along with the co- procedures are not possessing “Dosha nirharanasamardhya” i.e. eliminative capacity6. Therefore, these procedures administered later to thecleansing are effective to disease relief. In a nut shell, Bahiparimarjana is a Dosha shamana and theAntahparimarjana is Dosha Shodhana or doshavasechana management. Dalhana was the first person to comment over the absorption and pharmaco-dynamics of theexternally mediated unctuous (fatty oil base) materials at the context of Abhyanga. He affirms thateach 100 of matra (32sec approximately) initiated from 300 to 900 takes the oil based medicamentfor the Roma koopa – Twak – Rakta – Mamsa – Medo – Asthi – Majja. At the context he applies anote that the Tridosha diseases of such region are implied to alter with the effect of medicine, as theAbhyanga is Kapha Vata nirodhana 7. At the same place author, refer the Grudhrasi a disease,prevented by the constant use of Abhyanga, which relays the meaning of Bahiparimarjana asprevention and curative but not eliminative method of management. In the procedure ofBahiparimarjana, the absorption is minimal but heat conduction is massive, that affect the blood toflow peripheral to visceral or vice versa. The understanding of contemporary philosophy tells ushow our tradition meets the present day science. Absorption through the skin can be enhanced by suspending the drug in an oily vehicle andrubbing the resulting preparation into the skin. This method of administration is known asinunction i.e. Abhyanga. Because hydrated skin is more permeable than dry skin, the dosage formmay be modified or an occlusive dressing may be used to facilitate absorption. Controlled-releasetopical patches are recent innovations. Finally, intact stratum corneum is an excellent barrier, but indisease states the resistance to absorption is rapidly lost and absorption can be facilitated. The skinacts as a two-way barrier to prevent absorption or loss of water and electrolytes. Few drugs readily penetrate the intact skin. Absorption of those that do is proportional tothe surface area over which they are applied and to their lipid solubility, since the epidermisbehaves as a lipid barrier. Inflammation and other conditions that increase cutaneous blood flowalso enhance absorption. The dermis, however, is freely permeable to many solutes. The diffusioncoefficient indicates the extent to which the matrix of the barrier restricts the mobility of the drug.Increases in the molecular size of the drug will increase frictional resistance and decrease thediffusion coefficient (Franz, 1983); molecules over 1000 daltons usually will not be absorbedeasily into normal adult skin8. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 2
  3. 3. Parameters Controlling Absorption in Bahiparimarjana Chikitsa The absorption of drug into the skin is a function of the nature of the drug, the behaviour ofthe vehicle, and the status of the skin. Three major variables account for differences in the rate ofabsorption or flux of different topical drugs or of the same drug in different vehicles: - The concentration of drug in the vehicle, - The partition coefficient of drug between the stratum corneum and the vehicle, and - The diffusion coefficient of drug in the stratum corneum. Apart from the above the points to be considered are - - Large Surface area enhance absorption - Increase cutaneous blood flow also enhance absorption - Body temperature and blood flow enhance absorption of tropical medicines - Transdermal replacement therapy is not a new invention, exists since the birth of AyurvedaFactor influencing Bahiparimarjana Chikitsa (Topical Therapy)Dosage: An amount of topical medication sufficient to cover affected body surfaces in repeatedapplications must be dispensed or applied to the patient. In Ayurveda much of applications viz.Abhyanga, Sweda, Parisheka and Avagaha are done once in a day.Age: Children have a greater ratio of surface area to mass than adults, and a given amount oftopical drug results in a greater systemic dose. The permeability of childrens skin is increased inpreterm infants (Barker et al., 1987).Regional Anatomic Variation: Permeability is generally inversely proportional to the thickness of the stratum corneum i.e.Avabhasini. However, in certain areas, differences in lipid concentration may affect percutaneousabsorption, depending on an individual drugs lipophilicity (Having an affinity for lipids) orhydrophilicity (Having an affinity for water). Drug penetration is higher on the face, in inter-triginous areas, and especially in theperineum. Thus these areas are minimal exposed to Bahiparimarjana Chikitsa. Consequently,sensitization, irritation, and atrophy from Bio-steroids are more likely to develop in these regions.Altered Barrier Function: In many dermatological diseases, the stratum corneum is abnormal, and barrier function islost. Thus not through rub is indicated, more over many Bahiparimarjana Chikitsa are light intouch. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 3
  4. 4. Application Frequency: Topical agents are often applied twice daily. However, for certain drugs, once-dailyapplication of a larger dose may be as effective as more frequent application of smaller doses. Thestratum corneum may act as a reservoir and allow gradual penetration of a drug into the viable skinlayers over a prolonged period of time.Hydration: Drug absorption is increased with hydration, defined as an increase in the water content ofthe stratum corneum that is produced by inhibiting trans-epidermal loss of water. Methods ofhydration include occlusion with an impermeable film, application of lipophilic occlusive vehiclessuch as Taila, and soaking dry skin before occlusion. Many of the Ayurvedic preparations used inBahiparimarjana Chikitsa are water based or water soluble medicines transformed lipophilicagents.Vehicle: Topical therapy is delivered by various vehicles, most frequently soaks, lotions, solutions,creams, and ointments, progressing in that order from least to most hydrating. The choice ofvehicle may be as important as the active drug. In Ayurveda it is with many vehicles as Kashaya,Taila or Dhanyamla. An experimental modal of Dhanyamla prepared in DGM Ayurvedic Medical College,Gadag for want of multi centric study in 2001 – 2003. It facilitated few single case studies and anextended study over Amavata as Kayaseka. The literature and the procedure followed tostandardize the Dhanyamla are narrated here under.DHANYAMLA 9 Before going into the details of Dhanyamla Kayaseka it is necessary to understand the termDhanyamla. A cursory glance itself reveals that the term “Dhanyamla “ is conjugate of twodifferent words, viz ‘Dhanya’ and ‘Amla’ which in conjugation means ‘fermented cereal’ in abroad sense. All the three major classics of Ayurveda at some instance or other have referred to itsuse at times, singularly or along with other drugs. Maharshi Charaka, Susruta and Vagbhata haveincluded this either in Amlavarga, Santhana kalpana or in Madya vargha. Charaka furthermentioned the drugs used for Dhanyamla in Nadi sweda and Upanaha.Synonyms of Dhanyamla A perusal of the ancient text of the medicine reveals that a number of synonyms have beenattributed to Dhanyamla which in most cases refer to a specific attribute and when takencollectively gives a clear idea about the character and properties of Dhanyamla. Narisimha has inthis context very rightly stated that these synonyms to Dhanyamla are complementary to each other Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 4
  5. 5. and as such there is no difference between ‘Dhanyamla’ and ‘Kanjhika’. ‘Guna deepika’, acelebrated lexicon on medical plants gives the following compilations of synonyms as attributed toDhanyamla. 1. Aranala: ‘Aranalasya rigathownala gandha‘ i.e having acrid fast spreading odour. 2. Abhishuta: ‘shunj abhishave’ i.e made of half cooked cereals. 3. Avanthisoma: prepared out of ‘soma’ found in Avanti Desha. 4. Kulmasha: ‘Kula samsthyana’ i.e having half cooked ‘masha’ or black grain. 5. Kunjala: Indicative of fermented water. 6. Sowveeraka: Found in Sowveera desha. Among these, Sowveerka’ and ‘Avantisoma’ are synonyms pertaining to geographicalpreponderance or indicative of place. Abhishuta, Dhanyamla, KunJala, Kulmasha etc are indicativeof the process of fermentation. Aranala speaks of its acidic odour.Properties of Dhanyamla The known fact that Dhanyamla, amla or sour in taste serves as an aid in delving into otherproperties of the Ama in the sense that since it is Amla in Rasa the associated qualities of AmlaRasa as stated in the classics, viz, Laghu, Ushna, Snigdha, Deepana, Vatanulomana etc. can besafely attributed to it. The properties of Dhanya like Brimhana, Tarpana, Balya and Vatahara arealso supplemented. In brief, Dhanyamla cumulatively possess the following properties. • Rasa - Amla • Guna - Laghu, Snigdha, Teekshna, Sheeta sparsa • Vipaka - Amla • Veerya - UshnaGeneral properties of Dhanyamla Many properties are attributed to Dhanyamla are - Deepana, Pachana, Rochana, Bhedi,Vibhandhahrasa, Hrudya, Klamahara, Angasada hara, Dahajwarahara, Hrudrogahara, Panduhara,Krimighna, Arshohara, Grahanihara, and Bastisulahara. It can be used even for Astapana. Amongother indications for its use, Charaka has specified its use in Daha jwara where in Avagaha of thepatients in Kanji has been recommended10. Same procedure is indicated to relieve pain in Arshas 11even. Further in Rajayakshma when Prathishyaya and Peenasa are super imposed, renders theailment complicated. At this juncture the Nadi sweda with Kanji (Dhanyamla) has beenadvocated12. Since Amla is Sheeta sparsa and acts so in external wage, Charaka has felt safe tovouch for its use externally as Lepa, Seka etc. in Urusthambha also; he mentioned the use of thedrug Dhanyamla 13. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 5
  6. 6. In short while going through the references of the use of Dhanyamla in different context asfound in classics, it is able to conclude that the drugs which are used for the preparation of theDhanyamla and Dhanyamla as such are preferred in Vatarogas and Vatakapha samsargha janyadiseases.Method of preparation of Dhanyamla 14 Dhanyamla can be prepared out of different methods. Many drugs in this yoga are easily getfermented. Traditional physicians of Kerala generally follow present Yoga combination andproportion is obtained from Sahasrayoga is as follows: 1 Tandula (Oryza sativa) 5 parts 2 Pruthuka (Pressed form of Oryza sativa) 5 parts 3 Kulatha Dolichos biflorus) 5 parts 4 Laja (Puffed form of Oryza sativa) 20 parts 5 Kangubeeja (Setaria italica) 4 parts 6 Kodravam (Paspalum scrobiculatum) 2 parts 7 Nagara (Zingiber officinale) 1 part 8 Nimbuka (Citrus acida) 4 parts 9 Dipyaka (Carum roxburgianum) 2 parts 10 Water 100parts On an auspicious day at a time when the astral combinations are favourable, the necessarydrugs and Paraphernalia for the preparation of the Dhanyamla are to be collected. Place a largedeep earthenware pot on an oven and pour 200 Prasthas of boiled water and put the powdered drugs1-9 separately made into loose bundles in clean cloth bags. After putting these drugs into the vessel along with water, it has to be loosely covered witha lid and heated gently and continuously in moderate fire, preferably of paddy husks, for a period of7 days. The paddy husks are to be put under and around the vessel and fired taking every precautionthat the temperature of the water in the vessel does not rise above the boiling point. On the 8th daythe required quantity of the liquid is taken out and added same quantity of hot water. The importantfactors to be recommended during the preparation of Dhanyamla is that - Absolute cleannessshould be maintained and Moderate fire should be kept through out he preparation The details identification and proprties of the Dhanyamla ingredients are as follows -1. TANDULA (N.O. Graminae, L. N. Oryza sativa) : Tandula possesses Madhura and Kashaya Rasa, Madhura Vipaka as Sheeta Veerya. By Guna it is Guru. It alleviates Pitta Dosha and provokes Kapha Dosha. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 6
  7. 7. 2. PRUTHUKA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by little heating and wet pounding of Tandula.3. KULATHA (N.O. Leguminoceae, L.N. Dolichos biflorus): Kulatha possesses Kashaya Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Vidahi and Sara. It acts as Kapha Vatahara. It provokes Pitta Dosha also.4. LAJA (N.O. Graminae, L.N. Oryza sativa): It is made out of Tandula. Prepared by dry frying in a small-mouthed vessel. This process is known to induce Laghu Guna.5. KANGUBIJA (N.O. Graminae, L.N. Setaria italica): Kangubija possesses Kashaya and Madhura Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Guru and Ruksha. It acts as KaphaPitta shamaka and Vata vardhaka. It possesses Sandhaneeya and Vrushya properties.6. KODRAVA (N.O. Graminae, L.N. Paspalum scrobiculatum): Kodrava is of Madhura-Kashaya in Rasa, Katu in Vipaka and Sheeta in Veerya. By Guna it is Laghu and Ruksha. It alleviates Kapha and Pitta Dosha and provokes Vata Dosha.7. NAGARA: Already described in Alambushadi Yoga.8. NIMBUKA (N.O. Rutaceae, L.N. Citrus acida): Nimbuka is of Amla Rasa, Amla Vipaka and Ushna Veerya. By Guna it is Laghu. It pacifies kapha Dosha. It has got Agnideepana, Rochana, Pachana and Trishnanigraha properties.9. DIPYAKA (N. O. Umbelliferae, L.N. Carum roxburgianum): Dipyaka possesses Katu and Tikta Rasa, Katu Vipaka and Ushna Veerya. By Guna it is Laghu, Ruksha. It acts as Samaka for Kapha and Vata Dosha. It has got Shoola Prashamana, Rochana and Krimighna properties. PHYSIOCHEMICAL ANALYSIS REPORT (Analyzed at K.L.E. society’s Pharmacy college, Gadag.) 01. PH = 3.03 02. Specific gravity = 1.01 03. Test for Alkaloids a. Mayer’s Test = Positive b. Hager’s Test = Positive 04. Test for Carbohydrates a. Molish Test = Positive (Carbohydrate present) b. Benedict’s Test = Positive (Reducing sugar present) c. Barfoedt’s Test = Positive (Monosaccherides present) Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 7
  8. 8. Case studies with DhanyamlaPakashaghata: As the Dhanyamla indication is for all Vata Vyadhi, Pakshaghata was tried withinternally for pana and externally with kayaseka. The patient initially with Dakshina Pakshaghatarecovered in 14 days management, without any drawbacks or setbacks.Sandhivata: Eight patients of Sandhivata are undertaken for observational study with DhanyamlaDhara over the Sandhi, which made the patient to have symptomatic relief with in seven days ofcourse. 15Amavata: Nine patients of Amavata were treated with Dhanyamla Kayaseka for 21 days. Theresults obtained with objective and subjective parameters are as follows.1. Comprehensive statements of objective parameters are as follows. % of Parameter Mean Mean Difference improve SN before after of Mean ment SD SE t value p value Remarks Pain in Numerical rating 1 scale 15.22 5.56 9.11 65.77 2.02 1.60 8.12 < 0.001 H. S Pain in Visual Analogue 2 scale 66.67 23.33 34.89 67.05 4.06 2.10 8.19 < 0.001 H. S 3 Swelling of 44 joints 14.67 4.89 7.33 71.80 2.24 1.10 8.87 < 0.001 H. S 4 Swelling of 28 joints 13.22 4.67 7.67 70.62 2.26 1.34 6.36 < 0.001 H. S 5 Tenderness of 28 joints 14.56 6.00 9.67 62.40 2.22 1.16 6.91 < 0.001 H. S 6 Morning stiffness 2.44 1.33 1.67 44.44 0.70 0.20 5.55 < 0.001 H. S 7 Heaviness 1.22 0.33 1.11 77.78 0.67 0.11 8.00 < 0.001 H. S 8 RA index (tenderness) 17.22 6.44 12.78 64.02 2.37 1.69 6.35 < 0.001 H. S Madhavakara index of 9 Amavata 12.78 3.22 13.22 76.35 2.09 1.70 5.59 < 0.001 H. S Anjana nidana index of 10 Amavata 7.56 3.56 6.44 54.78 1.35 0.44 9.07 < 0.001 H. S 11 Basavarajeya index 1.89 1.00 2.11 31.67 1.12 0.35 2.53 < 0.05 H. S Extra articular 12 manifestation 3.33 1.11 2.00 72.09 1.20 0.32 6.86 < 0.001 H. S Global disease assessment 13 (patients) 59.22 18.11 43.00 70.16 3.75 1.80 8.20 < 0.001 H. S Global disease assessment 14 (physicians) 64.44 25.00 37.22 61.94 4.08 1.84 5.92 < 0.001 H. S Ayurvedic health 15 assessment 36.56 20.56 21.11 43.72 1.96 1.00 16.00 < 0.001 H. S Arthritis impact 16 measurement scale 37.33 19.78 18.78 46.44 2.48 1.94 9.06 < 0.001 H. S 17 Physical disability 13.33 5.00 8.22 62.55 1.64 1.00 8.33 < 0.001 H. S 18 Walking time 55.00 45.22 11.00 17.65 1.97 1.06 9.19 < 0.001 H. S 19 Grip strength 86.56 95.44 18.22 9.73 4.01 2.10 3.38 < 0.01 H. S 20 Range of movements 76.89 82.22 4.56 7.34 2.87 0.86 6.16 < 0.001 H. S 21 ESR 41.44 35.56 7.33 17.19 4.53 1.98 6.02 < 0.001 H. S 22 C reactive protein 0.44 0.33 0.44 11.11 0.70 0.11 1.00 > 0.05 N. S 23 Haemoglobin 11.02 11.32 0.10 2.87 0.88 0.16 1.93 > 0.05 N. S 24 Lymphocyte count 37.56 38.78 2.11 3.76 2.64 0.28 4.40 < 0.05 H. S 25 Disease activity score 4.76 2.78 2.47 42.71 0.96 0.19 10.13 < 0.001 H. S Disease activity score - 28 26 joints 6.43 4.27 2.56 35.13 1.06 0.26 8.36 < 0.001 H. S Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 8
  9. 9. 2. Sandhigraha :- In this Group four patients (44%) presented with Grade III and five patients (56%) with Grade II Sandhigraha.After the treatment there was no patients with Grade III and Grade II was reduced from five to three(33%).3. Sandhiruk:- One patient presented with Grade III (11%), four patients with Grade II (44%), and four patients with Grade I(44%). After the treatment Grade II was reduced from four to one (11%) and four patients (44%) got complete relief.4. Sandhisotha:- One patient presented with Grade III (11%) five patients with Grade II (56%) and three patients with Grade I (33%). After the treatment three patients got complete relief (33%) and there were no patients with Grade III. Number of patients in Grade II was reduced from five to one (11%)5. Sparsa asahishnuta:- One patient presented with Grade III (11%) five patients with Grade II (56%) and three patients with Grade I (33%). After the treatment six patients got complete relief (67%) and there were no patients with Grade II and Grade III.6. Gourava :- Two patients presented with Grade II and seven patients with Grade I. After the treatment six patients (67%) got complete relief and there were no patients with Grade II and Grade III.Conclusion: At the virtue of understanding the fundamentals of the Bahiparimarjana Chikitsa - tropicalappliance management, it is very clear that the required cleansing properties such as “Anupravanabhava Utpadakata” is not available with and they are said as only Dosha transport facilitators withthe capabilities of Vishyanda, Paka and Srotomukha Vishodhana, well before to the DoshaShodhana procedure. When Dosha Shodhana is done the same Bahiparimarjana Chikitsa becomespotent to pacify Dosha and said as Dosha shamaka. Dhanyamla is such potent externally mediated,temperature regulated, lipophilicity, moistened, pH regulated (3 approx.), concentration - partitionand diffusion coefficient of drug is maintained along with specific Vata Dosha pacified properties.Dermal applications which are hydrophobic in nature (organic solvents – Dhanyamla) utilized for sustainingprolonged and slow delivery acts on systemic diseases. Thus the Dhanyamla Chikitsa becomes ultimatetreatment Antahparimarjana (internally) and Bahiparimarjana (externally) Chikitsa. Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 9
  10. 10. References1) Raja Radha Kanta Deva, Shabda Kalpa druma, part 3, 3rd ed, 1967, Chowkhamba Sanskrit Series Office, PB No 8, Varanasi -1, pp 622) Ibid, pp 7093) Ibid, pp 709 medina4) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita sutra 11/55, Nirnaya Sagar Press (1941) reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 785) Ibid, Chikitsa, 7/53, pp 4536) Ibid, Sutra, 2/15 – Chakrapani, pp 257) Vaidya Jadavji Trikamji Acharya et.al., Susruta Samhita Chikitsa 24/30 - Dalhana, 8th ed, 2005, Chowkhamba orientalia, PB No 1032, Varanasi, pp 4888) Joel G. Hardman et.al., Goodman & Gilmans THE PHARMACOLOGICAL BASIS OF THERAPEUTICS, 9th ed, 1996, McGraw-Hill, Health Professions Division, New York9) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers, Allepy, 23rd edition April 2000. Pp.12210) Vaidya Jadavji Trikamji Acharya ed, Charaka Samhita Chikitsa 3/259, Nirnaya Sagar Press (1941) reprint, 1984, Chowkhamba Sanskrit sansthan, PB No 139, Varanasi, pp 42211) Ibid, 14/44-47, pp 50812) Ibid, 8/74, pp 46313) Ibid, 27/50-55, 61514) Sahasra yoga Edited by – Shri K. V. Krishnan Vaidyan et.al. Published by Vidyarabham Publishers, Allepy, 23rd edition April 2000. Pp.12215) Shyju Ollakkod under the guidance of Dr. K. Shiva Rama Prasad, Evaluation of comparative efficacy of Alambushadi yoga and Dhanyamla Kayaseka in Amavata (Rheumatoid Arthritis), 2004, Department of Kayachikitsa (PG), Post graduate studies and research centre, D.G. M. AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103 Dhanyamla Bahiparimarjana by Prof. Dr. K. Shiva Rama Prasad 10

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