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An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice), Gangadhar. S. Hadimani, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103
Citation preview
An Evaluation of the Efficacy of
Phalatrikadiyoga in Kamala (Jaundice)
By
Gangadhar. S. Hadimani
As partial fulfillment of post graduation degree M.D.(Ayurveda Vachaspati) Under Rajeev Gandhi University of Health Sciences,
Bangalore, Karnataka
Guide
Dr. K. Siva Rama Prasad M.A. (Jyotish) M.D. (Ayu) (Osm)
Assistant Professor / Reader in Kayachikitsa Department of Kayachikitsa
Post Graduate Studies and research
D.G. Melmalagi Ayurvedic Medical College Gadag - 582 103
Post graduation and research center Kayachikitsa
2000-2003
This is to certify that GANGADHAR. S. HADIMANI has carried out present work
entitled An Evaluation of the Efficacy of Phalatrikadiyoga in Kamala (Jaundice)
under close guidance and supervision. He did this clinical study very sincerely and
methodically. His study, which is presented as a dissertation for the award of M.D.
(Ayurveda Vachaspathi) Kayachikitsa from Rajiv Gandhi University of Health Sciences,
Bangalore is satisfactory.
This study bears ample evidences of original thoughts and expressions and this
dissertation is not an ersatz and has not been formed previously for the award of any
Degree /Diploma or titles in the field of research in Ayurveda.
This dissertation is recommending to be submitted before the adjudicators for
assessment, approval and awarding the M.D. (Ayurveda Vachaspathi) Kayachikitsa.
Date:
Place:
Guide Dr. Siva Rama Prasad Kethamakka
M.D. (Ayu) (Osm) M.A (Jyotish)
Assistant Professor / Reader in Kayachikitsa
Department of Kayachikitsa
Post graduate Studies and research,
D.G. Melmalagi Ayurvedic Medical College
Gadag - 582 103
Acknowledgement I express my deep sense of gratitude to my guide Dr. Siva Rama Prasad
Kethamakka, M.D (Ayu) MA (Astro) Reader / Assistant Professor, Department of
Kayachikitsa, Post Graduate studies and Research, D.G.M Ayurvedic Medical Collage,
Gadag for his much valued guidance, constant support and encouragement throughout
the study.
I acknowledgement my sincere gratitude to Dr. V. Varadacharyulu H.O.D
Department of Kayachikitsa, Post Graduate studies and Research, D.G.M.A.M.C Gadag
for his experts comments critical analysis and affectionate encouragement throughout
the study.
I am very extremely thankful to Dr. G. B. Patil Principal D.G.M Ayurvedic Medical
College and Post Graduate studies and Research, Gadag for his support to post
Graduation study and providing all necessary facilities for this research works.
It gives me pleasure to express my gratitude Dr. S. H. Doddamani,
Dr. R. V. Shetter, Dr. A. K. Panda lecture’s of post graduation research studies in
Kayachikitsa, D.G.M.A.C Gadag for his valuable suggestions and moral support through
the study.
I extend my immense gratitude to Dr. M. C. Patil professor P. G. Rasashastra &
Dr. Kuber Shank, Lecturer in Dravyaguna, Post Graduation studies and research center
D.G.M Ayurvedic Medical College Gadag.
I sincerely remember to my all under graduate professors, Assistant Professors
and lecturers of D.G.M Ayurvedic Medical College, Gadag for there help and
suggestions during my post graduate studies.
The grace of God and blessings of Shree Jagadguru Abhinava Shivananda
Swamiji, it is pleasure to express my thankful to the management committee. Shri
S.B.Sanshi Chairman and members Shri M. S. Mulkipatil, Shri B. S. Patil, Shri. B. C.
Patil, Matoshri Girijamma Melmalagi for providing M.D seat and also helping during
study.
I sincerely thanks to my beloved colleagues Dr. Srinivasreddy CM, Dr. Yasmin
PA, Dr. B.G. Swamy. I am also thankful to all my postgraduate collegues Dr.
B.M.Mulkipatil, Dr. Anil Baccha, Dr. V.N. Kulkarni, Dr. Seetaramaprasad, Dr. G.S.
Hiremath, Dr. Suresh.R.D, Dr. C.V.Rajashekhar, Dr. Shankaragouda, Dr.
Hanumanthagouda, Dr. Shayju, Dr. U. V. Purad for their constant co-operation and help
in the PG study.
My sincere thanks to Shri V.M.Mundinamani, beloved librarian and Mr. S. B.
Sureban for supplying me essential reference in the study. I am thankful to Mr.
Basavaraj, S. Tippanagoudar, and Lab Technician, Dr. Rajashekhar Pawadashettar
pathologist in Gadag who extended his co-operation on investigations.
I thanks to Mr. P. M. Nandakumar for his help in the statistical evaluate. I thank to
Mr. Anjaneyappa. B,, Mr. Shivakumar.G, Dr. Chandahussain, Dr. Girish. N. D,, Dr.
Anand. K. P, Dr. S. S. Patil, Dr. B. K. Hiremath and Dr. P.S.Chavadi support to the
completion of this work.
I express my deep affectionate love to my father Shri. Sadashivappa. G.
Hadimani, Smt. Shantavva, Brother’s, Sisters and my all-family member and relatives for
their love and affection rendered throughout my career.
With deep sense to gratitude I thank all the subjects who participated in this
study.
Gangadhar. S. Hadimani
Ayurveda is a Science it deals with the study of knowledge of life. The aim of this
science is to protect the Human being from various diseases, which acquire by not following
the swasthavritha, The prevention of the disease and curative aspect of disease knowledge
Explanation available in the ancient period. Ayurveda is the Upaveda of Atharvaveda. In
Vedas there is a vivid description of a Vyadhi, which has characterized by yellowish
pigmentation of sclera, tongue, nails, urine and skin etc and with suitable treatment also
explained.
Ayurvedic healthcare system has perfected efficient methods and herbal preparations
to keep the physical, mental and emotional health of a person in its prime throughout life. It is
contrary to current practice of seeking treatment when disease strikes, or waiting to get
medical help till the symptoms manifest. It is a mind, body Medicare system evolved to help
human beings and get maximum benefit out of their lives in a perfectly natural healthy way.
Ayurveda instills in you a view of life that is holistic and congenial to enjoy the
pleasures of life in a sustainable way. This can be achieved without disturbing the rhythm of
your life.
Ayurveda favors administration of natural health care products (of plant, animal,
mineral origin) and their preparations. Generally Ayurvedic Medicare products cause no toxic
or side effects, and hence are totally safe. These are time-tested preparations, which have
been used by many generations. There is no question of tolerance, resistance or addiction
with Ayurvedic health care products.
Day today practice receives number of patients suffering from Kamala (Jaundice)
and its complications as the negligence of Kamala management.
I inspired to take up the Kamala and its management as the dissertation topic as this
ailment is prevalent in this province. Even though there are innumerable recipes in Ayurvedic
literature apart from the contemporary management, I have selected the Phalatrikadiyoga, as
it seems as classical, authentic, economical and easily available mentioned in Bhishajya
Introduction 1
Ratnavali. So the attempt is made in this thesis to evaluate the efficacy of Phalatrikadi yoga
in Kamala on scientific basis.
The Phalatrikadi yoga, contents are, Triphala, Katuki, Nimba, Guduchi, Vasa,
Bhrugaraja, Bhumyamalaki and Chirayata are some of the very frequently these drugs used
in Kamala. In contemporary medical system jaundice is the word analogous with Kamala.
The present study comprise of two parts, the first part is mainly concerned with the
review of the literature regarding Kamala and various aspects of the diseases such as
history, nirukti, paribhasha, Nidana panchaka and Chikitsa etc reviewed and discussed. The
second part consists of details of clinical trial of the efficacy of Phalatrikadi yoga in Kamala. It
comprises of the materials and the methods used for the study and the observations and
results, of the study with detailed discussion over them.
Historical aspect:
Before preceding the subject, it will be very much worth to have a brief historical review
of the individual diseases, understand the subject in better manner. Here historical review
has been classified under four heading they are as follows:
1. Vedic period
2. Samhita period
3. Sangraha period
4. Adhunika period
1.Vedic Period:
Vedas are the oldest testimonials of information regarding to the particular disease
and use of medicinal plants. Atharvaveda is most important Veda among other four Veda. It
is an authentic source of Ayurveda. We found some of the scattered information in mantras
as such diseases of Hridaya, kloma, mastiska, pleeha and Yakrit. It is significantly noticed
about Yakrit vikara’s and explanation of “Yakrit” as well as the disease engendered in
connection with it with elaborated management 1.
Introduction 2
The disease, which is, characterised by the colour pigmentation such as greenish,
yellowish and white etc, Kamala and Pandu appear to have been studied. The term “Harita”
and Halima vilohitawa is referring to Kamala disease. The Atharvaveda mentions turmeric
and yellow birds in which Kamala is charmed to enter, leaving the human by receiving the
mantras. Right therapy also explained in Atharvaveda, the rays of the raising sun in the
morning care the disorders. It may be implicated here it is adopted to cure the diseases like
Hridroga, Harima etc, the colour change is predominantly found.
In Garuda purana and Agni purana there are references of Kamala. Garuda Purana is
at the consideration of that the Kamala as Harima is one of the Nidanarthakara Roga of
Pandu. Red coloured cow milk is very beneficial to disease of Harima 2. Anjana Chikitsa also
explained the management of Kamala 3.
2.Samhita Period:
This is the scientific age of Indian system of Medicine. In this period Charaka
Samhita, Susruta Samhita and Astanga Hridaya are the great literatures. Major literatures of
Ayurveda explain the disease Kamala and it’s management. In Charaka Samhita Kamala is
mentioned as Nidanarthakara Roga of Pandu. The later author Vagbhata explained about
Swatantra Kamala apart from the Paratantra Kamala, which was explained by the Charaka
and Susruta. Kashyapa Samhita author Vrudda Jeevaka also mentioned as the Pitta is the
causative Dosha and the disease is prominent with yellowish discoloration of conjunctiva and
skin.
However the predominant Dosha in both Swatantra and Paratantra Kamala is the
Pitta Dosha. It is significantly noticed that as edification advanced the conditional
management of the disease and draws the attention to words its management by prominent
prophylactic measures by seasonal regimens and adaptations of sequential seasonal
Panchakarma eliminative measures.
Introduction 3
3. Sangraha Kala:
This is the period of commentators and laghutrayees. In this period many of good
compilation works are done, laghutrayees are Madhava Nidana, Bhava Prakasha and
Sharanghadar Samhita, The latter authors like Yogaratnakara, Vangasena explained Nidana,
Lakshana and Chikitsa of Kamala.
Charaka Samhita commentator, Chakrapani in his commentary on Chikitsa 16th
chapter discussed the two-word ruddha marga or rudda patha. He elaborated the patho-
physiological aspect of swetha varchata under the heading kosta shakhashrita Kamala,
where in Shakashrita Kamala is established.
Dalhana, Susruta Samhita commentator, in his ideology on Kamala enrolled the term
Panaki as a variety of Kamala. This term has not been used by any other ancient Acharyas.
Dalhana used synonyms like Kamala, Apanakya, Kumbhavya, Lagharaka, Laghavaka, Alasa,
and Alasakya according to its severity and stages 4. Arunadutta and Hemadri the
commentators of Vagbhata have also commented on the description of shakhashrita Kamala
explained in the Nidana sthana of Astanga Hridaya. Madhavakara included and explained
Kamala and its patho-physiology in the chapter Pandu, considering it as the late stage of
Pandu.
4. Adhunika kala:
The period of after 18th century is called as adhunika kala, many authors such as Dr.
Rama Rakshaka patak, Dr. Ranajit Roy Desai, Dr. Vidhyadhara Shukla etc have compiled
materials from classical texts. In contemporary medicine called it as jaundice, is one of the
liver disorders in modern medical area. Comprehensive studies in this field are made and
they have discovered and established new diseases relating to the liver.
The modern and Ayurvedic concept of Kamala is similar. It is characterised by the
yellowish pigmentation in the conductive, skin and urine etc. both systems explained in
curative method in details certain causative factors, which are responsible for producing the
Introduction 4
varieties of jaundice. The present days more researches are done more and more about the
liver disorders with their management.
The liver is the largest glandular organ in the body, and has more functions than any
other human organ. A person's entire blood supply passes through the liver several times a
day, and at any given time there is about a pint of blood there.
The Liver has a pivotal role in human metabolism.
• The liver produces and secretes bile (to be stored in the gallbladder until needed)
that is used to break down and digest fatty acids.
• It also produces prothrombin and fibrinogen, both blood-clotting factors, and
heparin, a mucopolysaccharide sulfuric acid ester that helps keep blood from
clotting within the circulatory system.
• The liver converts sugar into glycogen, which it stores until the muscles need
energy and it is secreted into the blood stream as glucose.
• The liver synthesises proteins and cholesterol and converts carbohydrates and
proteins into fats, which are stored for later use.
• It also produces blood protein and hundreds of enzymes needed for digestion
and other bodily functions.
• The liver also produces urea, while breaking down proteins, which it synthesises
from carbon dioxide and ammonia. The kidneys eventually excrete it.
• The liver also stores critical trace elements such as iron and copper, as well as
vitamins A, D, and B12.
• The liver is also responsible for detoxifying the body of poisonous substances by
transforming and removing toxins and wastes. There are five main sources of
body toxins and wastes that the liver deals with: toxins from food (traces of
pesticides, preservatives)and alcohol; toxins from outside (drugs, adulterants,
Introduction 5
and environmental pollutants); internally produced chemicals, such as hormones,
that are no longer needed; nitrogen-containing waste left over from protein re-
use; and energy production.
• These toxins and wastes are converted into less harmful substances by the liver
and then eliminated from the body.
Because of the significant role the liver plays in maintaining our health, we must do all
we can to keep it functioning properly.
The liver is a large chemical factory; the heat produced by the chemical changes
taking place in it contributes greatly to the general warming of the body. The liver secretes
bile, which comprises salts and pigments, and aids the digestion of fats. It stores the
substance necessary for the proper functioning of the bone marrow, which manufactures red
blood corpuscles.
It also manufactures the fibrinogen of the blood, stores iron and copper, and
detoxicates the noxious products, which are made in the intestines and absorbed into the
blood. It stores carbohydrates in the form of glycogen.
The liver is one of the largest organs in the body and one of the five major organs,
which are vital to life. A malfunctioning of the liver may not become apparent immediately,
unless, of course, the blood flow through it is impeded or the bile ducts are obstructed. Nor
does it recover quickly once it suffers from a disorder. (Indiangyan.com, Diseases of THE
LIVER &THE CARDIO-VASCULAR SYSTEM)
Kamala (Jaundice)
Jaundice or Kamala is a condition in which there is discoloration of the skin because
of deposition of bile pigment in its deeper layers.
KAMALA VYUTPATTI
The term Kamala is derived by the root ‘kamu’ which means kanti by suffixing Nhin’’
pratyaya is substituted by kalaha thus the term Kamala is kumu + Nhin (kalaha) 5
Introduction 6
Nirukti:
The word Kamala developed and explained as “ kamam kantim harati haridra varnam
lati iti Kamala’”. Here kamam means desire and kanti is the luster, both are diminished in
case of Kamala. Haridra is yellowish discoloration, lati means Runaddati or to get yellowish
discoloration, In other words Kamala is a disease in which an individual looses interest in all
aspects and gets the yellowish discoloration 6.
Klama glano dhatunam nispanna
Kamala shabda shareerendriya glanayati ’’Dhaturupa manjari” 7
Paribhasha:
The term Kamala translated by Sir Monier Williams to give certain meanings
libidinous, luster, dry and sterile soil, desert, a form of Jaundice, excessive secretion of bile or
obstruction of bile etc.
“ Atha kamalati kama shabda
Ayam sadharana shabda vesheshati
Swalpe baktadabhilasha pravartate tam latoti kamala”
The Kamala would be point out to a disease conditions in which hunger and appetite
for food are diminished, simple meaning of Kamala is a disease where there is little or no
desire for food according to Harana Chandra 8.
In sabdha sthoma maha nidhi defined as “kamam Kanthim lunathi iti Kamala”
which means and indicate the diseased condition in which the changes of colour are
visualized. And the term kanthi means to be luster or natural colour of the skin. Haridra and
Harita colours are manifested in the normal skin colour bringing kanthi or luster of the skin in
to abnormal state i.e. yellowish discoloration.
Introduction 7
Yellowish discoloration of the skin, selera, mucous membranes, and excretions due to
hyper biliruibinemia and deposition of bile pigment’s 9 are seen in Kamala i.e. jaundice.
PARYAYA
In classics the different terminology are used for the Kamala.
In Atharvaveda Kamala was known as Harima, Harita, vilohitatwa and Haridraka.
Dalhana while commenting on Susruta reviewed the different stages of Pandu Roga and
declared that Kamala with terminology such as panaki, apanaki, kumbha Kamala,
lagharaka, Alasa, Alasakya etc. These nomenclature gives expression as different stages
of Pandu Roga and therefore all these words even though looks like synonyms of Kamala 10
they are different stages of Kamala. Astanga Hridaya 11 used the word lothara as synonyms
of Kamala.
Chakrapani has used the term “Bahu Pitta Kamala as the synonyms of
kostashkhastrita Kamala and alpa Pitta Kamala as the synonyms of “shakhashrita Kamala 12.
BHEDA 13,14
Charaka has classified the disease Kamala in two types. They are as follows:
1. Kostha shakhashrita Kamala
2. Shakhasharita Kamala
Kamala is considered as a paratantra vyadhi and by some others as swatantra
Vyadhi. Susruta has stated the Kamala is a later stage of Pandu Roga and kumbha Kamala,
lagharaka, Alasa and Haleemaka are it’s different stages.
Thus Kamala can be classified according to the dispersal of Pitta in the body as -
1) Bahu Pitta Kamala or kostha shakhashrita Kamala
2) Alpa Pitta Kamala or shakhashrita Kamala.
Classification of jaundice 15
The classification of jaundice in modern medical science is based on the basis of patho-
physiology and etiology.
Introduction 8
1. Hemolytic jaundice
2. Hepato cellular jaundice
3.Chole static jaundice
4.Congenital non-hemolytic hyper bilirubinaemia.
i. Hemolytic jaundice- Increased bilirubin load from the liver cells.
ii. Hepato cellular and cholestatic jaundice liver disease and large duct obstruction.
Congenital non- hemolytic hyper bilirubinaemia defects in conjugation 16
This dissertation is divided into six chapters, Viz.
1. Introduction
2. Literary Review
3. Drug Review
4. Material and Methods
5. Observations and Results
6. Discussion and Conclusion
This dissertation is appended with References, Bibliography, Master Charts and
Case Sheet at the end.
Introduction 9
The Disease Kamala is Nidanarthakara Roga of Pandu. The Nidana generally
speaking word applied to the etiological factors for the concerned diseases the word Nidana
refers specially to the cause that brings about disease.
The causation of disease considered in many ways:
Nidana has been defined as “sethi karthavyathakar and rgathapadaka hetu”
which means that all such another factors which by deranging dynamic state of doshic un-
equilibrium. All the disease factors to causes the Dosha imbalance and produce disease
“Rogasthu Dosha vaishamyam (Vagbhata)
The etiological factors of Kamala broadly explain in the classics. In fundamental the
indulgence of habits which vitiate Pitta in a person who is already suffering from Pandu
Roga. Susruta and Vagbhata also at the same opinion about etiology for the Kamala106,107.
Chakrapani has expressed affirmation with the above view point he has made a
reference to an unknown author who makes a distinction kosta shakhasritha Kamala, which
represents only an aggravated condition of Pandu Roga and shakhasrita Kamala according
to him some times is an independent disease entity 108.
The below mentioned are the conditions of kosta shakhashrita Kamala and
shakhashrita Kamala can occur in different situations. They are -
a) during Pandu Roga
b) during any other disease of Pitta
c) without any other perceptible diseases
Literary review 10
These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In such
cases all causative factors play their role in vitiating Pitta. This condensation of Pitta of
functional and sensible hyper activity may result in to Kamala from the following Pitta
vitiating ahara, vihara etc109.
Table No:1 Pitta Prakophaka Karan110,111,112.
Charaka Susruta Vagbhata
Ahara Ati amla rasa sevana “ Lavana “ “ Katu “ “ Ushna “ “ Teekshna “ “ Kara “ “ Ajeernabhojana “ “ Vishana ahas “ “ Deergya kala shita “ “ Madya “
Ati katu sevana “ Amla “ “ Lavana “ “ Ushna “ “ Vidagdha “ “ Tilatiala “ “ Peenyaka “ “ Vidahi “ “ Kulatta “ “ Athasi “ “ Harika shakha “ “ Godha matsya “ “ Javika Mamsa “ “ Dadhi,Takra,Kurchika Masthu, sowveeraka,suravikara, Amlapala,Katwa
Ati katu sevana Amla “ Ushna “ Teekshna “ Lavana “ Vidahianna “
Vihara a) Manasika krodha b) Shareerika
Shrama, atapa, Agni Santapa, Ushnavasa
Krodha Shoka Bhaya Ayasa Atimaithunam
Krodha
Acharya Upavasa Dhoomapana Kala
Upavasa Ushnakala Meghante Madhyante Ardharathri Jeetyanne
Sharatrutu Madyanha Ratrayardha Vidaaha Samayeshu
Literary review 11
Tabel No: 2 Katu Rasa Atisevana113,114,115.
Charaka Sushruta Vagbhata
Pumsaptva hrasa
Moha
Glani
Avasada
Datu shithilla
Murcha
Bhrama
Daha, tapa
Balabrasa
Trushna
Shrira kampa
Pricking pain and Roga
utpatti
Bhrama
Mada
Gala, talu and ostasotha
Daha santapa deha
balanasha
Kamphana
Pricking pain
Hasta pada parsha &
Udarashoda
Trushna balakshaya
Murcha
Akunchana
Kampha kati and prusta
Vyapad etc.
Tabel No: 3 Amla Rasa Atisevana116,117,118. Charaka Sushruta Vagbhata
Danta harsha, Trushna,
Romanchana, Kapha
Vilayana, Pitta uruddi,
Mamsa vidahati, Ksheena,
Kshata, Dourbalya, Rakta
dusti, Kshataathihata,
Dagda, Bhagna, Mutrila
Prisarpita, chinna bhima,
Knatha, Urho, Hridayam
paridhaha
Dantaharsa, Nayana
samilana, Roma,
Samavegana, Kapha
vilayana, Sharira saithilya,
Kshata, Abhihata dagda,
dasta Bhagna, rugna,
shoon, prachyatava, motrita
visarpita, chinna,
bhinnavidhota, paridahati,
kantam, urhi, hridayam etc.
Shaithilya, Timira,
Bhrama, Kandu, Pandu
vispra,a Shopha visphata,
Trushna, Jwara
Literary review 12
Tabel No: 4 Lavana Rasa Atisevana119,120,121
Charaka Susruta Vagbhata
Pitta Kopayati Rakta Vardana Pipasa Utapatti Murcha Utapatti Tapa Vruddi Twacha vidar Manisa Pesivikrutti Visha Vruddi Kusta roga Sotha, danta patan Ramsatva Shaktiprasa Indriya Shakti prasa Palita, Khalitya RaktaPitta , Amlapatta Visarpa, vatarakta Vicharachika, Indralupta
Gatra Kondhu Kotha Shopha Vaivanya Punsatva upaghata Upatapa Mukha, Akshipaka Rakta Pitta Vatashanita Amlika etc.
Asrapavana Khalirya Palitya(Kaphala roga) Valeem Trishna Kushta Visha Visarpa Balakshaya etc.
Tabel No: 5 Rakta Prakopaka Hetu122,123.
Charaka Sushruta Ati Teekshna Ati Ushna Madyasevan Ati Lavan Ati Skhara Ati Amlarasa Ati Katurasa Ati Kulatha Ati Udada Ati Tila taila Pidalu Moolika Jalaja Manasa Anupmamsa Dahi, Kanjji Sura, Soaveera Durgandita ahara Diva Svapna Doopa and Atapasevan Vamana Vegadharana
Pitta Prakopaka ahar Ati drava ahara Ati Snigda ahara Ati Guru ahara Diva Svapna Krodha Amala and Atapa sevana Shrama Abhighata Ajeerna Virudda bhojana Adhyasana etc.
Literary review 13
The above mentioned etiological factors provoke Pitta, with their specific qualities.
“Agnireva shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid
having Ushna and teekshna properties enough and sufficient to digest the food.
With the above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing
the functions of liver where mala roopa Pitta is discharged. When hypo functioning of Pitta
(Agni) consequently in turns produce Ama or Amavisha. This Ama corresponds with Rakta
and may produce Kamala.
Pitta has its seat in Rakta has the Ashrayashrayee bhava because are of same
qualities i.e. “Samavaguna”. Some of the above said aetiological factors may adversely act
on Rakta Dhatu with its similar qualities, which can also vitiate of Pitta.
These factors probably disturb Rakta Dhatwagni and when vitiated the prasadamsha
of Rakta Dhatu is not nourished properly. The by-product of Rakta i.e. Pitta is produced in
excess consequently producing bahu Pitta, with results in to “kostashakhashrita Kamala”
According to modern concept, certain bacterial, protozoan infection such as
pneumonia, syphilis, septicemia, typhoid, relapsing fever, damage liver cells. With this liver
cells become inefficient thus favoring the retention of bile pigment and bile salt in the blood.
Some chemical poisons such as arsenic, phospherous, Arosono-benz derivatives
nitrobenzyme lead etc also capable to damage the liver cells. Toxemia of this nature some
times occurring in pregnancy and certain chronic heart disease with congestion may be
because of liver disease and ensuring the jaundice.
Shakhashrita Kamala nidana124
The careful appraisal of distinct clinical features of shakhashrita Kamala would be of
ruddapatha resulted from Kapha occupying the Pitta vaha srotas. The development of this
condition implicated as a result of sroto vimarga gamana. Charaka narrating aetiological
factors of shakhashrita Kamala as under-
Literary review 14
1. Excessive intake of rooksa guna ahara,
2. Sheeta, guru, madura rasa ahara
3. Ati Vyayam and
4. Vega dharana
These Nidana narrated in the Charaka Samhita is represented as below,
Vimargagamana
Srotorodha Srotovaigamya
Kamala a disease of elevated bile in the blood is visualized in so many roots. Out of
them some are due to mechanical obstruction and others are of infectious in origin.
Rudhapatha is of obstructive variety develops because of Pitta vaha Sroto vaigunya
develops from different aetiology is classified and considered as under.
Mechanical obstruction
The excessive intake of ushna, teekshna, katu,madhura and vidhahi ahara provoke
the Pitta . Thus the Pitta is altered in its quality and quantity. The sara and drava gunas of
Pitta diminished and fluid become thickened even hard. This may perhaps be correlated to
the inflammatory condition of the mucosa of bile canaliculae in infective hepatitis.
The obstruction of Pitta marga possible by the intestinal warms and other parasites
there is no reference to obstruction from the krimis. Srotorodha it is a certain pathological
conditions. Created in the stricture of bile duct. It may happen by external pressure or any
growth either inside of out side the passage.
According Charaka causative factors to augment Kapha exchanging in the role to
block the passage. These Doshas when provoked by such causative factors. Vata
preparedly its rooksha guna it dries the Kapha, thus making soft and hard to block the Pitta
vaha marga resulting on vimarga gamana of Pitta. This results in to the shakhashrita
Kamala.
Literary review 15
Samprapti
Samprapti it means the description of pathology of disease. In detail of all the morbid
process that take place in different stages of the disease .It is the periods of Nidana sevana
to the period of Vyadhi janana and continues along with signs and symptoms.
“Tasmada vyadhi janaka dosha vyapar visheshayuktam
Vyadhi janmeha samprapti “125
The disease manifests by Dosha dushya sammurchana when the all evading
Doshas in their provoked state, come into contact with an organ or Srotas that is suffered
Vaigunya, This manifestation of disease preceded the other evaluative stages. The
abnormal increased state of Pitta this is outcome of disturbance in paka of Rakta.
Elsewhere a reference was made to Rakta when it was noted, that a constituent of whole
Rasa and homologue of Pitta.
The ingested food particle digested by Pachakapitta produce ahara-rasa this ahara-
rasa, digested by rasagni after it devised sarabhaga and kittabhaga. arabhaga of Rasa
circulate all over the body by the help of Vyanavata .The ahara Rasa gets colour of
digested by raktagni, Rasa colour will be change and Rakta Dhatu utapatti takes place to
Yakrit and Pleeha “rasad raktam prajayate” In the case of mitya ahara and vihara it vitiate
the Dosha and dushyas Ama rasa obtained if the Rasa carrying Ama visha, along with the
provoked Pitta Dosha get vitiated the moola of Raktavaha Srotas Yakrit and Pleeha, it
produces Rakta pradusaja Vyadhi on combination with Rakta in which Kamala is one out of
such disease. Pitta vriddhi at the level of Rakta paka independently causes Pandu. The
Pitta becomes prominent its ushna and teekshna qualities, thus vitiated Pitta circulate all
over the body when it comes in the contact with the Srotas that has already suffered
vaigunya gets into the circulatory system and mixed with blood this turn with the cause of
Kamala125,126. Because of Pitta ushna and teekshna guna’s of Pitta more of Rakta will be
Literary review 16
take place127, consequently it turns the effect of Yakrit and Pleeha are the main organ’s of
Rakta Dhatu. During the destruction of the Rakta there may from mala of Rakta i.e. Pitta
abnormally in its quantity. This is spread in the all over the body and having lodged in space
between twacha and mamsha, it produces characteristic features like peeta netrata, peeta
twacha and peeta mootrata etc.
Samprapti of kostashakhashrita Kamala
Intake of Pitta vardhaka ahara, viharas and pandurogi
Pitta Sanchaya in kosta
Panchakagni vikruti by increased of teekshna and ushna gunas
Amarasa utapatti
Vitiate the Kapha and Vata Dosha
Circulate all over the body through Rasa Rakta complex
Saman gunas Rakta and Pitta aggravated
Vitiated Pitta Rakta not digest by mamsagni.
Vidagdata takes place in mamsa dhatu vitiated Pitta Rakta and mamsa it leads to yellowish
discolouration of neetra. Twach. Nakha.
Reduction of jeevana kriya of Rakta it leads sharira, dourbalya and indriya dourbalya.
Increased mala rupi Pitta in kosta it gives yellowish and redness of feaces and urine.
Kamala Roga
Literary review 17
Shakhashrita Kamala Samprapti:
Acharya Charaka and Vagbhata described the shakhashrita Kamala. Can be of
either ruddhapatha or vimargagamana128,129.
The sleshma occupying biliary passage prevents the Pitta from entering the kosta
and hence cause Ruddha Pitta, the other hand when Vayu due to it’s conjunction with
Sleshma(Kapha Sammurchitha) dries up the biliary passage. There occurs the
Vimargagamana of Pitta. This is regulation of Jaundice. If the sara and dravagunatas of
Pitta are diminished, the fluid becomes thickened and even hard. A note has to be made in
connection of the responsible factor or predominant factor of asmari. Where the asmari term
used according to Susruta, that the adhistana dosha, or all types of asmaris as Sleshma. It
is associated with Pitta Dosha is becomes hard and get increased size it blocks the marga
and adversly affecting. However the Tridosha are involved in the process. This process
development of asmaris takes place it refer to the one of the factors of Pitta margavarodha
i.e. gallstone.
In shakhashrita Kamala Vata and Kapha are predominant. And not only Pitta is
prevented from passing into the gut but also regurgitated this is vimarga of Pitta. It is taken
back to Rasa Rakta this Pitta not being eliminated in sufficient qualities is found deposited in
the skin conjunctiva, nails and tongue the colour of the feaces is swetha or tilapistanibham.
Samprapti Ghataka
Dosha : Pachakapitta and Ranjakapitta Vyanavata and Kostastha Kapha
Dushya : Rakta, mamsa, twaka,
Agni : Jatharagni and dhatwagni,
Srotas : Raktavaha srotas,
Srotodusti prakar : Sanga and vimargagamana.
Udbhava sthan : Amashaya.
Vyakta sthan : Netra, twaka, Mootra, pureesha, Nakha,etc
Adisthana : Yakrit,
Marga : Bhahya and Abhyantara.
Literary review 18
Ati Rookhsa, sheeta, Guru, swadu, Vyayama, Bala nigraha
Vata and kapha Sanchaya
Agnimandya
Ama Utapatti—it not proper digested by rasagni
Chalaguna of vata and pichala guna of Khapa increased in Kosta,
Vitiated vata vitiates the kapha
Vitiated vata and kapha circulated through the Pitta vaha srotas,
Avarodha of Pitta vaha srotas by the vitiated kapha
Raktagni and Ranjaka Pitta not nourishing the forth coming dhatu.
‘Absence of ranjaka Pitta in kosta due to the avarodha of Pitta vaha Srotas by Kapha-
Samurchana.
Vitiated Pitta due to the avarodha of Kapha circulates on the shakha rather than coming to
the kosta by vitiated Vata.
Peeta netra, nakha, Mootra, Anana and sweta pureesha passed.
Shakhashrita Kamala
POORVA ROOPA
Poorva roopa are the prodromal symptoms which occur before complete
manifestation of the disease poorva roopa appears in the stage of chaturtha Kriyakala which
is said as sthana samshraya.130 The vitiated Doshas at the stage of sthana samashraya will
Literary review 19
manifest the sings and Symptoms of the forth coming disease. Such signs and symptoms
are called premonitory symptoms.
The poorva roopa of Kamala may be fall under the latter category. Since they are
not distinctly pronounced to indicate the same or it at all they may be present in obscure
form Kamala premonitory symptoms not visible.
Roopa131,132.
The roopa stage actual symptoms commences from vyaktavastha this is the fifth
stage of disease. The clear manifestation of the prodromal itself is called as roopa.
Most of all Ayurvedic classics given explanation about disease Kamala is a resultant
of untreated or Chronic Pandu Roga. Later authors give more information about Kamala.
They believe that the Kamala is resultant of untreated Pandu, and further they told that the
Kamala might manifest in normal person also by the excessive in take of Pitta vardhaka
ahara and vihara.
Table No 6 Roopa of Kosta shakhashrita and shakhashrita Kamala133,134.
Kosta shakhashrita Shakhashrita__
Haridra Netra Haridra Netra
Haridra twacha Haridra twacha
Haridra mukha Haridra mootrata
Haridra Nakha Swetha varchastwam
Bhekha varnata Atopa
Rakta peeta mootra Vistambha
Rakta peeta mala Hrudgraha
Daha Parswharti
Avipaka Hikka
Dourbalya Swasa
Sheetalata Aruchi
Aruchi Jwara
Angasada Dourbalya
Literary review 20
Table No 7
The summarization of laxanas according to various text’s. 135, 136, 137, 138, 139, 140.
Sl. No_Lakshanas_ Ch Su AHR MN BP YR
1 Haridra netra_ + + + + + +
2 Haridra twacha + + + + + +
3 Haridra mukha + + + + + +
4 Haridra nakha + + + + + +
5 Haridra mutra +
6 Rakta peeta mutra + - + + +
7 Rakta peeta mala + - + + +
8 Daha + + + + +
9 Avipaka + + + + + +
10 Dourbalya + + - + + +
11 sheetalata +
12 Aruchi + + - + + +
13 Krusha - + - - - +
14 Tandra - + - - - -
15 Balakshaya - + - - - -
16 Trushna - - + - - -
17 Indriyadourbalya + - + + + +
18 Bhekavarana + - + + + +
19 Panduvarnata - + - - - -
Literary review 21
The disease manifestation sites are specifically liver and spleen. Thus it needs to
know about the physiological conditions and possible pathology in accordance with
contemporary medicine.
Shareeram
Kamala according Ayurveda is a disease of Rakta Dhatu, it is explain under context
of Rakta ruddi laxana and Charaka explain under the Rakta pradusaja Vyadhi, Kamala
related organ is a Yakrit, it is a moola of Rakta vaha Srotas all Acharyas has same opine
regarding Srotas 17.
In Kamala the Dosha vitiated is Pitta. The prime symptoms of Kamala is yellowish
discoloration of Netra, twacha, mootra etc because of vitiated Pitta Dosha, Ranjakapitta is
mainly contributory of above-mentioned symptoms. In classic also mentioned Yakrit is a
seat of Ranjakapitta 18,19.
The diagnostic symptoms of shakashrita Kamala is tilapistanibha varchas, which is
due to the absence of Pitta in kosta. The samprapti of shakashrita Kamala is clearly
mentioned in classics, that Kapha obstructs Pitta. So Pitta will not reaches the kosta
resulting tila pistanibham. From above explanation we conclude the Yakrit and Pitta Dosha
involved in disease of Kamala20.
Niukti of Yakrit
The word Yakrit grammatically made up of ‘yaj dhatu, shakerutin pratya in which it
mean dakshinabhaga mamsa khanda. YAJ + SHAKERUTTIN = YAKRIT
Synonyms of Yakrit
Karanda, Kalakam, Kalakhanja, Kalakhanda, Kaleam21 In modern the synonym of
liver is Hepar22. The liver develops from hallow endodermal bud from the foregut during the
3rd week of gestation, from the matruja bhava it is developed.
The utapatti of Yakritis from shonita23
Yakrin is a composition of liver = Medas24
Literary review 22
Yakrit is located at right upper part of the abdomen, which is described by Susruta
and Modern science also. It is consider one of the kostanga it is a largest gland in the body,
it is situated in the upper and right part of the abdominal cavity, it occupying almost whole
right hypochondrium, greater part of epigastrium and extending to the left hypochondrium25.
1. It is exocrine and excreting bile, which goes to the second part of the
duodenumvia the biliary passage.
2. Endocrine by secreting glucose going to blood 26
In the male it commonly weight from 1.4 to 1.8 kg. In female from 1.2 to 1.4 kg with
however, a range of 1.0 to 2.5 kg. It is relatively much larger in the fetus than in the adult. It
is somewhat wedge-shaped, reddish in colour27.
It has five surfaces they are:
1) Anterior surface
2) Posterior surface
3) Superior surface
4) Inferior surface
5) Right surface
Peritoneal relations:
Most of the liver covered by the peritoneum. The areas not covered by peritoneum are
as follows.
a) A triangular ‘bare area on the posterior surface of the right lobe, limited by
the upper and lower layers of the coronary ligament and the right
triangular ligament.
b) The groove for the inferior venacava on the posterior surface of the right
lobe of the liver, between the caudate lobe and the bare area.
c) The fossa for the gall bladder, which lies on the inferior surface of to right
lobe of the quadrate lobe.
Literary review 23
d) The porta hepatis,
e) Along the lines of reflection of peritoneum. A number of peritoneal folds
are attached to the liver, although these folds are called ligaments each of
them is made up only of two layers of the peritoneum, these are as
follows.
The falciform ligament is connected with the antero superior surface of the liver to the
anterior abdominal wall and to the under surface of the diaphragm. The left triangular
ligament connecting the superior surface of the left lobe of the liver to the diaphragm. The
right triangular ligament connects the lateral part of the posterior surface of the right lobe of
the liver to the diaphragm. The coronary ligament having superior and inferior layers, which
enclose the bare area of the liver and the lesser omentum27.
Embryology:
The liver develops from an endodermal bud that arises from the ventral aspect of the
gut, at the point of junction between foregut and midgut, this bud grows into the ventral
mesogastrium and passes through into the septum transversum. It enlarges and soon
shows a division into a larger cranial part called the pars hepatica and a smaller caudal
portion called the pars cystic. The pars hepatica divides into right and left parts each of
which forms one lobe of the liver.
As the right and left divisions of the pars hepatica enlarge and extend into the
septum transeversum. The cells arising from them are broken up into interlacting columns
called hepatic trabeculae. In this process, the umbilical and vitelline veins that lie in the
septum transeversum are broken up to forms the sinusoids of the liver. Sinusoids are also
formed form the mesechyme of septum transeversum.
The endodermal cells of the hepatic bud give rise to the parenchyma of the liver and
to bile capillaries. The mesoderm of the septum transversum forms the capsule and fibrous
tissue basis of the liver.
Literary review 24
The foetal liver is an important center for blood formation large aggregations of blood
forming cells are present between hepatic cells and blood vessels.
Bile formation begins when the fetus is about three months old. The bile is
responsible for the black colour of the first stools (meconium) passed by the new born28.
HISTILOGY OF LIVER30
The liver is both a secretary and excretory glands, it is solid organ consisting of
several lobes. Each lobe is made up of numerous lobules, under the microscope, each
lobule is found to composed of row of polygonal cells radiating from the center. Like the
spokes of wheel the periphery of the lobule being delineated by the presence of portal
triads. The control vein occupies the center. The portal duct and hepatic vein emerge out of
the liver through a connective tissue sheath (Glisson’s capsule). After entering they branch
repeatedly there is frequent hepatic artery and portal vein in the interlobular region, recent
studies the liver cells are arranged in the form of plates having a thickness of single cells
diameter which provide, which provide a honey comb or sponge like structure. Through out
this structure, the cell plates are tunneled by a communicating system of cavities or lacunae.
The lacunae of endothelica cells and phagocytic cells of the RE system are called Kupffer
cells. Electron microscope reveals that kupffer cells may contain phagocytosed substance
and they are elongated structures haveing an irregular outline created nucleus, few
mitochondria and varying separating the sincesaidal wal from the liver cells plates is known
as ‘Disses space.
The flow through the sinusoids is guarded by inlet and outlet sptrincters and the
intermittent flow of is mostly due to presence of these sphincters. In the lover lobule the
sinusoids are drained in the central vein. The interlobular branches of the hepatic artery
also end in the sinusoids directly. The central vein while passing through the long axis of
the lobule, constantly receives sinusoids from all and ultimately leaves the lobule, constantly
Literary review 25
leaves the lobule at it’s base there it join with central vein of the neighboring lobules thus
ends in the large hepatic vein.
Bile is formed and discharged through fine intercellular canaculi into the bile
capillaries, hepatic cells are polygonal in shape and on the average 25 inches in size. 85 %
of hepatic cells being parenchymal type has a clear cells membrane and often binucleated,
and mitosis is rare normally. The cytoplane contains stored glycogen and fat, also
basophilic materials, mitochondria, galgi apparatus granular and agranular material,
mitochendsa endoplasmic reticula and lysosomes are present. Two or more liver cells
separate the excretory system of the liver starts with bile canaliculi, which are lined by single
membrane and the membrane. The membrane is protruded into canaliculus in the form of
microvilli which increases the area for interchanges partial removal of liver in man and
animals results rapid regulation by cell replication. Some hormonal regulations may be
present in the mechanism of rapid regeneration.
Mitochodria contain mostly cytochrome oxidase, suclinoxidase and phospholipids in
large amounts. They can oxides numerous substance substrates including fatty acids and
intermediates of TCA cycle. Mitochondria transport energy releasing in the form of ATP.
The rough surface endoplasmic reticula contain granules, ribosome’s with RNA and
are the seat of protein synthesis. These granules are responsible for basophilia. The
smooth surface endo plasmic reticula are the sites of detoxification of drug conjugation of
bilirubi, synthesis of steroid hormones and enzymes.
The liver cell lysosomes, adjacent to bile canaliculi, are the sites of deposition of
ferrition, lipofuseion, bile pigment and copper and contain many hydralytic enzymes,
pericanalicular dense bodies and pinocyltic vacuoles are also seen.
FORMATION OF BILE AND BILIRUBIN
Bile is both a product of secretion as well as excretion of the liver minute droplets of
bile collect inside the tiny vacuoles of the liver cells and are discharged into the bile
Literary review 26
capillaries through the intercellular canaliculi. The primary bile capillaries start from between
hepatic cells as blind tuloules. They join together repeatedly and form bigger channels and
ultimately come out of the liver as the right and left hepatic ducts. The two ducts unite and
form into the duodenum through the ampulla of Vater, through the same ampulla also the
pancreatic duct commences the cystic duct. Formation of bile by the liver is an active
process but entry of bile into duodenum is intermittent and takes place only after meal31.
Bile secreted continuously from the liver cells and stored in the gall bladder. Bile
contains water, nuclein, pigments neutral fat, fatty acids, ophospholipids, cholesteral and in
organic ions, cholesterol is synthesized in the liver from active acetate, cholesterol is also
excreted from the liver. Bile acids chalic have been considered to be the derivations with
glycine and tausrine. From the compounds glycocholic acid and tourocholic acid
respectively bile salts are the Na- salts of taurocholic acid and glycocholie acid. Bile salts
house got important functions on absorption of fats and also for the emulsification of fats
with concurrent production of a great surface area to enable lipase and other enzymes to act
more efficiently.
Bile pigments are the biliwerdion and bilirubin, these are the excretory products of
hemoglobin of broken down RBC and are formed in the RE system in the various parts of
the body. Bone marrow liver and spleen have been considered to be the site or formation of
the bile pigments32. Bile is essential for life. Although if does not contain any enzyme. Yet
it as a very important digestive juice.
Digestion:
The complete digestion of fats and to some extent of protein and carbohydrates is
done in liver.
Reducing surface tension:
So that fats are converted into exclusion.
Literary review 27
Activating action:
The bile salts by virtue of the cholic acid radical acts as specific activator for different
lipase.
Solvent action:
It serves as a good medium of the interacting fats and fat splitting enzymes.
Absorption:
Bile helps to in the absorption of various substances due to presence of bile salts like
fats iron calcium and lipid soluble vitamin A.D E and K and provitamion carotene.
Excretion:
Certain substances are excreted through bile for instance as some metals like
(a) copper, zinc, mercury
(b) Toxins, bacteria
(c) Bile pigments
(d) Cholesterol and lecithin are probably chiefly excretory products33.
The majority of bilirubin is delivered from the destruction of Red blood cells
Hemoglobin is the iron containing pigment of the red blood cells. The red colour of the R &
C and the blood is due to the presence of the hemoglobin. In normal condition life span of
Red cells are only few months they destroyed by the phagocytosis. The hemoglobin of
these cells broken down into haemosiderin and haemotoidin.
Normally it is also present in certain amount in phagocytes of spleen, liver and bone
marrow and the quantity increased during rapid destruction of RBC on diseased state a
green rise to a yellow brown pigment bilirubin. Haematidins a break down product of
hemoglobin during destruction of RBC and identical to bilirubin34. It is derived from turn over
of the hepatic proteins and from premature distinction of newly formed erythrocytes into the
bone narrow whatever the source of hepogenase oxidized heam to biliverdin. Biliverdina is
first formed and which by reduction forms beliverdina. Beliverbin and biliverdina probably
Literary review 28
combine with plasma and globulin and circulate through the blood stream and enter the
liver. In the diver cells bilirubin and biliverdin are separated from globulin and conjugate with
uridine diphosphate glucuronate to produce monobilirubin and bilirubin glucoronide, the
uridine diphosphate is set free. These compounds enter the duodenum through the bile
duct and then to the intestine. In the large intestine by bacterial action they are changed
into stercobilinogen. Some of urobilinogen is reabsorbed and excreted in the urine as
urobilinogen. The rest is excreted in the faeces as stercobilinogen and stercobilin, which
are responsible for the brown colour of the stool35.
FUNCTIONS OF LIVER 36
Liver is an essential organ of the body. Its functions are numerous which are briefly
summarized below.
I. In connection with blood and circulation
i) Formation of RBC in foetal life
ii) Destruction of RBC in adult life
iii) Store house of the blood and regulates the blood volume
iv) Relation with blood clotting
a) Manufacturing prothrombin and fibrinogen and thus
essential for clotting.
b) Most cells from heparin and prevent intra vascular
clotting
v) It transfers blood from portal to systemic circulation
vi) Manufactures all plasma proteins
vii) Stores the iron, haematinic factor also known as Vit-B12 and
copper and thus helps in the formation of red cells and
hemoglobin.
Literary review 29
II. Manufactures of bile:
Bile is secreted continuously from the liver cells and stored in the gall
bladder.
III. Relation with carbohydrate metabolism
i) Converts honglucose monosacharides into glucose
ii) Converts lactiacid, pyruvic acid and glyceral into glucose and
also glycogen.
iii) Store carbohydrate in the form of glycogen and when the
blood sugar tends to below it mobilizes glycogen
iv) Takes an important part in blood sugar regulations
v) It is the seat of neogulcogenesis
vi) Manufactures fats from carbohydrates.
VI. Relation with fat metabolism
i) It stores fats liver contains about 3% of fat
ii) It helps in the oxidation of fat, releasing energy in the form of
ATP.
iii) Site of synthesis of cholesterol from acetate
iv) Synthesis of phospholipids
v) Synthesises of fats from corbohydrates and proteins
vi) It is the seat of ketone body formation
vii) Unused free fatty acid released from fat depot is converted to
triglycerides and other lipids to meet energy requirement.
V. Relation with protein metabolism:
Main seat of urea and uric acid formation, synthesis of some amino
acid takes place plasma protein manufactured Coagulation factors, in
addition to fibrinogen and prothrombin, are manufactured here.
Literary review 30
VI. Hormone metabolism:
Reduce the circulating adrenal cortical and sex hormones by
digression and conjugation.
VII Relation with vitamins:
i) Manufactures prothrombin with the help of vitamin K
ii) It forms vitamin A from carotene and stores vitamin A and D
iii) Chronic liver disease is always associated with folic acid
deficiency. It is known that the liver converts folate to its active
form tetrahydrofolate.
iv) It is the principal storage organ for Vitamin B12 and in condition
of hepato cellular disease.
VIII Excretory functions
Certain heavy metals are temporarily fixed by the liver cells, which are then excreted
in the bile various toxins, bacteria and drugs are excreted through bile. Cholesterol and bile
pigments are excreted in the bile.
Concept of Pitta in KAMALA:
Kamala is a one of the Pitta predominant disease. It was pointed in Pitta vruddhi
lakshana, it is the responsible colouring factor of peeta in the sense that abnormal colours
such as peeta, Haredra manifestation, they become he characteristic feature of the Kamala
disease, it is recognized due to Pitta vruddhi 37,38,39. While discussing about nanatmaja
vyadhi, Acharyas consider the Kamala as one of the Pittaja nanatmaja vyadhi40.
The production of colour as well as its appreciation brought by Teja mahabhoota, its
chief functioning of paka or transform action. Tejas is the one of the quality of Pitta. Brief
review of physiological functions and quality of this teja mahabhoota vis-a-vis Pitta. It is
necessary to secure an intimate knowledge of prakruta gnana before to the study of
vikrutha41.
Literary review 31
The term Pitta is derived from the root of “Tapa” it is having 3 meaning 42.
1. Tapa santhape- production of heat.
2. Tapadahe – Burning of food particles.
3. Tapacishwarya (sid kammadi) – gaining of powers.
These are represents the functions of Pitta in the body. “Tapa” means to generate
the heat, it refers the burning the ingested (food) materials.
Synonyms of Agni:
Agni, Anala, ushma, Teja etc, These are synonym of Pitta.
Importance of Agni and it’s functions in the body are clearly mentioned in Charaka
Chikitsa sthana Grahini chapter, the commentator of Chakrapani on Agni clearly explain that
the Agni which present in our body is in the form of Pitta.
Agni is under stood as Antaragni that the Agni which is internal to the body.
Antaragni, does not indicates only it is already stated that the Agni which does the function
of paka, dahana etc Charaka has clearly stated that the Agni are Pitta it is digest the food
particle and controls the other Agni.
The questionnaire Pitta and Agni are identical or different has been raised and
answered by Susruta himself, that Pitta is identical to Agni in view of the fact that such
actions as dahana pachana and similar actions performed by fire hence Pitta is known as
Antaragni 43.
According to bruhatraye composition of Pitta is dominated by Agni bhoota the quality
of Pitta are sneha teekshna, ushna, laghu, visra, saram and drava 44,45,46.
Drava and saram which are the quality are predominance of Apa-bhoota, sneha is a
pruthvi mahabhoota, ushna and Teekshna are Teja mahabhoota, laghu is the vaya
mahabhoota, visra is the Akasha mahahoota vagbhat clearly mentioned Pitta is
panchabhouthika and drava consistancy.
Qualities of Pitta:
Literary review 32
Table no: 8
Acharya clearly explain qualities Pitta, varna, gandha, ruchi and sandrata. The
summarization of Pitta guna dharma according to various text’s 47,48,49,50,51,52.
Varna Sandrata Rasa Gandha Guna’s
Charaka Sukla Drava Amla Katu
Visra Ushna, teeksna, sneha.
Sushruta Neela, peeta Drava Amla Katu
Puti Ushna, teeksna
Vagbhata Drava, sneha Amla Katu
Vaigandha Ushna, teeksna, laghu, sara.
Kashyapa Sukla, Aruna Snehayukta Amla Katu
Visra Ushna, teeksna, laghu.
Bhavaprakasha Sukla, Neela Drava
Amla Katu
Ushna, sara.
Sharanghadar Peeta neela
Drava Amla Ushna,Laghu,Snigdata
Seat of Pitta
The Pitta occupies the entire systems of the body. Its location particularly between
Hridaya and Nabhi in general other seats of Pitta presumed sweda, laskiha, rudira,
amasaya, druk, twacha. Among all Nabhi is found to be the particular and specific seat of
Pitta 53.
Charaka and Vagbhata described Amashaya not only as the seat of Kapha it is also
seat of Pitta. Susruta stated clearly that Amashaya is a seat of kapha54. All that is eaten food
will be digested and absorbed in stomach 55.
Amashaya:
According to Chakrapani Ado-Amashaya is the seat of Pitta 56.
Nabhi:
This does not indicates any organ but some authorities consider that Nabhi
represents the “Agnyashaya” which may refer to pancreas which takes a major part in the
Literary review 33
continuance and completion of the digestion in the small intestine. The pancreas because
of its participation in both the digestive and metabolic process may be truly called
Agnyashaya in the locality of Nabhi.
Pavamasaya Madhyaga
This is actually the seat of Pachakapitta one of the five sub divisions of Pitta and also of
Pitta dharakala or grahani57. Pakvamashaya madhyaga- Dalhana widely explains Yakrit
pleeha, Hridaya, druka twacha these are all organs’ seats for Pitta.
Lasika 58:
It is a part of udaka (Apyadravya) which is capable of coagulation. According to
Hemadri lasika is the Rasamala it is located in twak59. Sweda,(sweat) Chakshu and
sparspanendriya (Both sense organs). Chandranandana’s commentary is that Nabhi is
considered as a special seat of Pitta because of its association with Samanavata.
The word Amashaya indicates two meanings
1. It is the seat of immature or unripe or incompletely or partially digested
food even though the ingested food digestion takes from Amashaya.
2. It is the site where in the Ama is generated.
The word “Pakwashaya” denotes the place of completed digestion. Since the Pitta is
located in Amashaya and Pakwashaya, the Rasa of Pitta in Amashaya is Amla and in
Pakwashaya katu Rasa. The anatomical organs located in the umbilical region are the small
intestines, where the digestion is completed. It has to be born in mind that any pain caused
in the small intestine is usually referred and felt in the umbilical region60.
Functions of Pitta
The general functions of Pitta can be summarized as below, and abnormal function
of Pitta we assess by Pitta vruddi lakshana and Kshaya lakshana bases.
Literary review 34
Some of the abnormal conditions are Aruchi, Avipaka, Ajeerna, Abnormal body
temperature, abnormal colour of the body courage, fear, anger, confusion, impairment of
vision etc such are the abnormal function of Pitta.
I. Biological functions
Ruchi ,trishna, pakti, vshala crelish food thirst (digestion and metabolism) (production
of norma body temparature) shut (appetite and hunger) darshana (visual perception) ragkrit
(imparting colour of the rasadhatu converting in to Rakta dhatu and also normal colour to
the skin) prabha (lustre) deha mardhvam (softness of the body) ojakrit (production of ojas)
I. Psychological
II. Medhakrit, buddhi and dhi (aids, intellectual functions, understanding)
III. Prasada (happiness)
IV. Shauryam (courage and valor)
V. Krodham (anger)
VI. Moham (infatuation) 61,62,63,64
In brief above mentioned biological and psychological functions of Pitta. It is
classified into five main categories on the basis of functions and its seat.
Pachakapitta:
Pachana is avikruta Pitta karma this is one of the five varieties of Pitta and an
important one. The life span, complex in vitality good health, enthusiasm, and plumpness
glow vital essences luster heat and the life breaths are derived from the dehagni65.
When this Agni is extinguished, the man dies when a man is endowed with it
adequately, he lives long in good Health, when it is deranged he falls sick therefore the
function of the Agni is said to be the main stay of life66. All other Pitta is originated from Agni,
therefore the increase and decrease of Pitta causes the waxing and waning of the other
Pitta 67.
Literary review 35
The Pachakapitta is produced from the Pittadharakala by the stimulation of
Samanavata, based on the concept of Adharadheya bhana, the integrity of Grahani
depends on the proper function of Agni68. There fore any impairment of Pachakapitta
involves the integrity of the Grahani and vice versa.
Pittadharakala, the source of Pachakapitta is stated to be located in both Amashaya
and Pakwashaya there fore the Pachakapitta secreted in these two places possesses two
different tastes.
1. secreted into Amashaya, it has the Amlarasa that is vidagdha state
2. Secreted in to Pakwashaya it has the katurasa the natural taste of Pitta.
This difference in the Rasa of Pachakapitta secreted into Amashaya and
Pakwashaya is indicated the amlavastha and katu avastha in the process of the digestion of
food. The secretion of Pachakapitta from the Pitta dharakala is controlled by two
mechanisms.
1. Neural through the stimulation by the samanvata
2. Humaral There is abundent production of clear Pitta in the Amlavastha or
pachamanavasta of the digestion the partly digested food stimulates a copious
secretion of the digestive juices.
For a successful completion of the digestion of food, the pachaka Pitta requires the
support of other factors in adition to the action of samanavata 69,70,71.
Malarupa Pitta:
Even through not produced by the kalas of the kostha, but being excreted in to the
kostha to help the digestive processes, this is discussed here mala rupi Pitta is the product
of dhatu parinama from the kittapaka of raktagni on Rakta Dhatu and released from the
Rakta sthana yakrit72.
Since the dhatuparinama / dhatuposhan is a continuos process. The mala rupa Pitta
or bile is produced in liver continuously. The chief biliary components are bile salts and bile
Literary review 36
pigments cholesterol and lecithin, these organic materials make up over 60% of the total
biliary solids. Only bile salts are use full in digestion. These salts aid in digestion and
absorption of fat largely because of their property of lowering the surface tension and the
ability to form chemical compound with fatty acids, thus increasing their solubility bile salts
stimulate peristalsis and there fore have a mild laxative action.
Bile acts as the own stimulant, bile salts are the strongest chologogues. The
malarupi Pitta is also known as malaranjaka Pitta since it imparts colour to the faeces.
The Ancient authorities have not made any mention of the colour, taste, smell and
den0sity of Pachakapitta. The only physical quality of these substances, to which there is
reference, is its dravatva of liquidity. Concept of Pachakapitta pointed to some internal
secretion secreted by the Agnidharakala, in the Grahani (corresponding to the mucosal
glands of duodenum) some of them exercise a regional influence and others systemic,
particularly metabolic. A suggestion was, then made to the secretogogue influence of food,
which had attained amlabhava (acidification) resulting in the secretion and discharge of the
achapita. [Corresponding to combined hepatic bile and pancreatic juice]
Such tests have yielded fairly accurate information as regards their physical qualities
and chemical composition. These are significant in the present context. The secretion,
relevant to the present discussion is bile, which is a yellowish, reddish brown or green fluid
according to the relative preponderance of its two chief pigments. It has a characteristic
musk like odor, a bittersweet taste and alkaline reaction 73.
The physical characteristics and qualities of the Pitta described in ancient Ayurveda
classics striking resemblance to hepatic bile (better still the combined bile and pancreatic
juicy. The payments of bile the bilirubin and biliverdin are essential constituents of the
haemoglobin complex. From this point of view, it may be stated that, Rakta is the seat of
Pitta the bile pigments is also the waste products or mala of the blood. Rakta and Pitta have
identical colour. The truth of this statement will become evident by taking in to consideration
Literary review 37
of the fact that, though bright red in colour if undisturbed. The blood separates into two
parts the lower contains the cells and is opaque and red. While the upper is a clear pale
yellow liquid the plasma. Under the microscope, an enormous numbers of pale yellows disk
the red blood corpuscles floating in a clear colorless fluid can be seen. It is the setting down
of these red cells, which brings about the separation of the blood into two parts, although
yellow when seen individually, they appear red in bulk.
The colour of the hepatic bile is golden yellow this is largely due to its pigments,
when set free into the blood. The bilirubin contributes to the normal colour of the plasma,
both blood and bile have nearly the same characteristics fleshy smell. In addition to the two
factors are initially correlated to the liver and spleen. Pitta may refer to the hepatic bile or
possibly, to the combined bile and pancreatic juice.
This conclusion is further supported by authoritative references made to conditions
caused by abnormal states of functioning of Pitta for example according to Vagbhata an
increase of Pitta cases yellowness of urine, feaces, eyes and skin, increased appetite, thirst
burning sensatioin in the body and insomnia. These signs and symptoms, especially, the
yellowish urine, feaces, skin and eyes are known today, to be due to circulation in excess of
the bile pigments bilirubin a condition described in bilirubinaemia.
The Chakrapani in his commentary reference to shakhaashrita Kamala says that, the
non-excretion of the Pitta, which imparts to feces its characteristic colour mala ranjaka in to
Rakta, is responsible for the swetha varchas or whiteness, among others of the pureesha
(faeces). In this condition this allusion would lend additional support to the thesis that Pitta to
which the physical characteristics and qualities.
RANJAKA PITTA:
Susruta coated Yakrit and pleeha are main seat of Ranjakapitta, in function he has
stated, that it74 confers colour to Rasa i.e., Rasa ragakrit. Vagbhata has on the other hand
identified its location in Amashaya and ascribed to it the same function as Susruta has done.
Literary review 38
According to Ayurvedic view, rasadhatu is stated to contribute to the formation of
Rakta with the help of Ranjakapitta, which is claimed to impart to Rasa, its colour75. In
treatment aspect Susruta coated goat liver with raw drug, together with the Pitta contained
in it, in the treatment of loss of blood in Rakta Pitta. The fact that between them, the
stomach and liver contributes an identical factor the Ranjakapitta essential for formation of
that element which makes the blood appear red, visualized by Susruta and Vagbhata round
about the 4th century BC and 5th Century A.D respectively. Modern workers have
experimentally confirmed it in the late twenties of the present century, during 1926 Minot
and Murphy showed that the liver was the most effective ingredient in the diet for the
treatment of pernicious anemia patients.
Susruta has given Rakta a special place of importance in the physiological and
pathological process. Two points 76 may also recognize the importance of Rakta.
i. Its function of jeevankriya Hemadri on Astanga Hridaya sutra 11/3
transporting and supplying a visista vayu known as prana through the
Rakta (haemoglobin)
ii. Even a minor deficit in the above stated function can initiate the
pathological processes.
In view of the important function of Rakta, a separate Pitta necessarily required for
the production of it. In the formation of raktadhatu, Ranjakapitta assists the raktagni which
synthesis the cellular structure from rasadhatu.
The factor in the liver, which is essential for the maturation of erythrocytes has, since
been demonstrated to be associated with the non protein fraction of the liver substance,
which is known as the antianaemic or haematenic principle. Smith reported that isolation of
an amorphous red principle from proteolised liver, which was effective in pernicious anemia
in very small doses around half a milligram. This material now referred to as B12 has since
Literary review 39
been shown to be a cobalt complex, this is obviously the erythrocyte naturation factor in
pure or nearly pure form.
In text’s we see the seat of Rakta and Ranjakapitta are Yakrit and ‘Pleeha’ both.
Pleeha is a storage house of the erythrocytes and its functions and blood supplies through
its sinuses (spleenic sinuses)
The chemical factor essential for the maturation of erythrocytes has been as already
noted as the liver principle viz. B12, a red cobalt linked enzyme corresponding to
Ranjakapitta.
BHRAJAKA PITTA:
The importance of the skin in the maintenance of the body temperature and colour of
its recognized in Ayurveda and a separate subdivision of Pitta is a located for this function.
Charaka describing under the heading of general function of Pitta, the product of normal and
abnormal temperature and color of the skin is due to the Pitta 85
Susruta and Vagbhata directly mentioned Ranjakapitta its seat and functions. It’s
seat is twak, production of normal and abnormal temperature of body, normal and abnormal
colour, luster etc this is by the paka of substance used for Abhyanga 86,87,88, parisheka lepa
etc. Pitta classified under different groups not only under the five headings they are maturity
quality functions etc89.
1. Based on the state of Maturity:
As immature state in Amashaya with Amlarasa, mature state in pakvasaya with
katurasa.
2. Based on its qualities:
Which is drava and snigdha conducting the normal physiological functions in the
body, Nirdrava and ruksha which is the cause of jwara and other disease.
3. Based on its Paka stage:
a) The prakrita Pitta present in the body with the normal functions.
Literary review 40
b) Malarupa Pitta: waste product produced in the dhatwagni paka by the action of
raktagni on Rakta dhatu, it is excreted into Pakvasaya supporting the digestion in
that region. This malarupa Pitta is an excretion from Yakrit seat of Rakta dhatu
and imparts colour to pureesha and therefore it is also known as malaranjaka
Pitta.
3. Based on the metabolic process:
There is another important classification of the Pitta in the body based on their
function particularly metabolic processes
4. The Anabolic process:
This group consists of 13 types of Pitta, which are concerned with the digestion of
the food, absorption of nutrients and assimilation in the Dhatu the fundamental tissue of the
body.
a) Pachakapitta also known as Jatharagni, Kayagni etc.
b) Bhutagnis – these are four in number, which acts on their own corresponding
bhoutic components of the ingested food.
c) Dhatwagnis: there are seven in number, which incorporate the respective
nutrients into the respective dhatus for their nourishment or replenishment.
d) The Catabolic processes: these are the Amasas of kayagni mentioned only by
Vagbhata. These moieties are distributed in all the dhatus since these are the
amsasa of kayagni their function is similar to that of kayagni i.e. effecting
sanghatabheda the kayagni is located.
PITTA Vs RAKTA
Apart from three Doshas Susruta explain Rakta as 4th dosha90. Susruta as he is one
of the expert surgeon, he has given more importance to Rakta Dhatu. Pitta is mala of rakta
dhatu91 Vata, Pitta, Kapha and Rakta these are essential factors for sharira Utpatti, sthiti and
Nasa92.
Literary review 41
Rakta panchabhoutikatwa : Table No 9
Mahabhuta Gunadarma
1 Prutvi mahabhoota Amagandha
2 Jala “ Dravatva
3 Teja “ Varna
4 Vayu “ Spandana
5 Akasha “ Laghuta
Above-mentioned gunadarma is evidencing of the Rakta panchabhoutikata.
The causative factors for all the diseases are Tridosha mainly they are Vata Pitta and
Kapha. They are susceptible to imbalance and vitiation along with structural and functional
impairment Dhatu.
Rakta Dhatu is the group of organs concerned with the production and maintenance
of Rakta Dhatu. Charaka enumerated Yakrit and pleeha as the root or moola of Rakta vaha
srotas. In addition Acharyas recognized Yakrit and Pleeha as Rakta sthana.
Yakrit is closely related with Rakta Dhatu and Pitta Dosha. It is the origin of
raktavaha srotas and seat of Ranjakapitta. After absorption Rasa is conveyed to Yakrit and
Pleeha, there it is acted upon Ranjakapitta and it is converted into Rakta dhatu93
Charaka has described Sonitaja Roga i.e. disease caused by Rakta there Kamala
has not been included94.charaka sutra sthana and further 28th chapter sutra sthana. Charaka
has described the disease caused by the Doshas when they are situated in morbid state
even Dhatus. Kamala has been included in the disease caused due to the situation of
morbid Doshas in Rakta dhatu95. It is clear from the above observations that Kamala is not a
Raktaja Roga but when morbid Pitta Dosha involves the Rakta then Kamala may be
produced. Rakta is particularly involved in the Samprapti of kosthashrita Kamala96.
Literary review 42
It would be seen the Pitta to which the physical characteristics and qualities of
under discussion are attributed might refer to liver bile and not others. This view find support
from the description of Pitta as the kitta of Rakta “ asrujapittam” and also reference made
by Charaka, Pitta and Rakta possess nearly identical smell and colour. in addition, the
location of these two factors of Yakrit and Pleeha.
The Asruja Pitta m finds direct correlation from modern physiological views it
regards blood. Bile relationships, which can be summarized, are as follows.
1. The pigments of bile, bilirubin and biliverdin are the essential Constituents of
Haemoglobin complex of the erythrocytes from this point of view. It may be
stated that Rakta is the seat of Pitta. This bile Pigments are also of the waste
products or the mala’s of Rakta.
2. Rakta and Pitta are stated to have identical colour. The truth of this Statement
will become the evident by taking into consideration the fact that, though bright
red in colour. If left undisturbed, the blood separates into two parts. The lower
part is opaque and red. While the upper part is yellow liquid plasma, under the
microscope on enormous number of pale yellow discs, the RBC pleasant in a
colorless fluid can be seen. Although yellow when seen individually. The
erythrocytes appear to be red in colour the colour of the hepatic bile is golden
yellowish which is largely due to its pigments bilirubin constituent to the normal
colour of the plasma. Both bile and blood have nearly the same characteristic
fleshy smell. In addition both blood and bile are intimately connected with the
liver and exists.
3. The coloration of Pitta and Rakta may represents the assumption of the normal
relationship that exists between the blood and some of the important constituents
of bile. This can be seen from the fact that the formation of bile consists in the
removal of bilirubin from blood its conversion in the liver its exertion in the bile
Literary review 43
conalienlai. re-absorption of it from the intestine in the form of colorless
compounds the stereto bilonogen, which later is utilised by liver cells for the
production of fresh haemoglobin. The spleen has disposal of red blood
corpuscles can be seen from the fact, that the macrophages present in it convert
the fragmented dust of degenerated red cells into bilirubin, which is transported
to the liver where it is utilised for purposes mentioned above.
Bhutagni
A review of Pitta may refer to Agni. Agni classified Jataragni, Bhutagni and
dhatwagnis. All the Ayurvedic classics have described them-Charaka has described
bhutagni under the process of normal digestive events. In his view, the digestion of food by
Jatharagni leads to the break down sanghatabheda of the former in to five distinct physico-
chemical groups. The Agni mostly present in substances belonging to each group is then
stated to digest the substance of that group, leading to a radical change in their qualities-
vilakshanaguna. Thus food substance are rendered fit for being assimilated into and built up
as part of the corresponding bhutas class of substances present in the Dhatus. This
process of assimilation is stated to be mediated as it was by the seven dhatwagnis, present
in each species of dhatus97.
According Susruta “This animated organism is composed of five Mahabhuta’s and
the food of living organic being necessarily partakes the character of its corporeal
components”. The food, which consists of the five mahabhutas, is digested, in its turn by
the five bhutagnis and each of its principles proceeds to argument it’s own analogue in the
human organism98.
The modern physiology and bio-chemistry that the main purpose of digestion of food
in the elementary Canal is to render it’s different basic components viz starches, fats,
proteins, which are entirely foreign to the body.
Literary review 44
That is ‘Vijatiya’, fit for being converted and utilised by the body as organism.
Specific carbohydrates, fats and proteins that is ‘Sajatiya’ thus the vegetable starch or
cellulose is first broken down in to its elemental form. The glucose towards the end of
intestinal digestion, before the same is rebuilt in the body as organism.
In the same way, fats derived from various plants and animal sources viz. oils, Ghee
etc. are first broken down into their elemental forms viz. fatty acids and glycerol. Before they
are re-synthesized as organism specific lipids, like wise, animal and vegetable protein
derived from external source are also broken down in first into their elemental form viz., the
aminoacids. Before to they are rebuilt in the body as the organism specific proteins viz.,
albumin, fibrinogen most of the globulin and non-essential amino acids. The above part,
some of the aminoacids are also utilised for functional use viz., the Synthesis of enzymes
and some of the hormones.
The bhutagni paka takes place in the Amashaya, actually speaking, the available
descriptions of this paka resemble, in some respects, the events that take place in the Yakrit
and Jatharagnipaka in the adho-Amashaya. The Yakrit it self is functionally and
anatomically related to anthakoshta. The inclusion of it as one among the koshtangas, is
significant. Apart from the fact the Yakrit is located in the kostha interpreted as Mahanimna
or great cavity, in the Madhyasharira or the trunk99. Which in turns it also considered to be
a Kostha, the fact remains, as shown by modern researches on embryology, that it arises as
a diverticulam below the stomach from the region of the intestine which is destined to
become the duodenum.
The endodermal diverticulam grows into a thick walled vesicle from which the liver
tubules and hepatic duct arise. The endodermal duct grows to splanchnic desaderm, which
provides the connective tissue of the liver and its capsule.
The view advanced in the foregoing that, reactions comparable to bhutagnipaka take
place in the Yakrit and not in the Amashaya, derives additional support from some of the
Literary review 45
important, post-digestive functions and metabolic event’s which modern advances have
showed on physiology and biochemistry to takes place in Yakrit. Liver is imediately
concerned with carbohydrates, lipid and protein metabolism. Is so far as the Carbohydrate
metabolism is concerned it converts the Glucose to Glycogen. Segments of Carbon skeleton
portion of total aminoacids metabolized in the body are converted into substances which, in
turn, may be employed for glucose and Glycogen Synthesis. Gluco-neogenesis, fatty acid
are synthesized de novo in this organs, and released to circulation for being deposited in the
adipose tissues, there also, fatty acids of the diet are transformed into a mixture more
closely resembling that of the species. These functions of the liver are important, in the
context of bhutagnipaka. The liver synthesizes cholesterol and esters. In the cause of it’s
steroid metabolism-the liver elaborates cholic acid and couples it with glycine and taunine to
make the bile acids. It activates in the metabolism of individual aminoacids, liver also
fabricates a number of plasma proteins including albumin, fibrenogen , prothrombin and a
major protein of globulins.
Finally there is the secretary role of the liver concerned with the formation of bile. In
this role, the liver prepares the bile salt’s separates bilirubin from proteins with which it is
associated in the plasma, re synthesizes cholesterol and pours these, with other bile-
components, into the biliary capillaries and hence via the connecting duct of the gall bladder.
This has also proved to the route for excretion of serum phosphatase. Vilakshana gunas can
apply only to a complete change over the qualities of ahara dravyas ingested, which do not,
takes place in the adho Amashaya.
Bhutagnipaka is required to process and convert them suitably as pre-homologues of
substances, which compose of the seven Dhatus.
Haemoglobin
Haemoglobin is the iron containing pigment of the red blood corpuscles. The red
coloured of RBC and the blood as well is due to the presence of the haemoglobin. In
Literary review 46
normal condition the life span of red cells are only few months as they are destroyed by
phagaeytes. The haemoglobin of these cells is broken down into haemosiderin and
haemotidin100.
Haemosiderin is desposed in the cytoplasm of phagoutes as granules or an irregular
mass normally it is also present in certain amount in phagocytes of spleen. Liver and bone
marrow and the quantity is increased state. A green pigment, biliverdin is the breakdown
product of haemoglobin on reduction biliverdin gives rise to a yellow brown pigment.
Bilirubin haemotoidine is a breakdown to productions of haemoglobin during reduction of
RBC and its identical to bilirubin. Bilirubin does not contain iron and a very soluble for this
reason it is dissolved in the blood and not stored in the cells and thus it continuously
removed from the liver cell into the bile101.
The loss of haemoglobin will reduce the oxygen carrying capacity of blood thus
producing the anoxia and acidosis. Bile pigments will be produced in larger amount by R E
Cells from the released haemoglobin and in this way additional pressure will be put upon
the liver to deal with them102.
Destruction of RBC103:
When red blood cells are delivered from the bone marrow into the circulatory
system. They normally circulate an average of 120 days before being destroyed. Even
though mature red blood cells do not have nucleus, mitochondria or endoplasmic reticulum,
they do have erythroplasmic enzymes that are capable of metabolizing glucose and forming
small amount of adeasine tri-phosphate. These enzymes also
a. Maintain the pliability of cell membrane.
b. Maintain membrane transport of ions
c. Keep the iron of the cell haemoglobin in the ferrous form rather than the ferric
form.
Literary review 47
d. Prevent the oxidation of the proteins in the red cells even so, with aging the
metabolic systems of the red cells becomes progressively less active, and
the cells become more and more fragile presumably because their life
processes wear out.
Once the red cell membrane becomes fragile the cell rupture during passage
through some tight spot of the circulation. Many of the red cells self distract in the spleen,
where they squeeze through the red pulp of the spleen. Where they squeeze through the
structural trabeulae of the red pulp, through which most of the cells must pass, are only 3
micrometers wide in comparison with the 8-micrometer diameter of the red cell. When the
spleen is removed the number of abnormal red cells and old cells circulating in the blood
increases considerably.
Destruction of Haemoglobin104:
When red blood cells burst and release their haemoglobin the haemoglobin is
phagocytized almost immediately by macrophages in many parts of the body. But especially
by the dupffer cells of the liver and macrophages of the spleen and bone marrow, during the
next few hours to days. The macrophages release the iron from the haemoglobin and pass
it back into the blood to be carried by transferrin either to the bone marrow for production of
new red blood cells or to the liver and other tissues for storage in the form of ferritin. The
porphyrin portion of the haemoglobin molecule is converted by macrophages through a
series of stages, into the bile pigment bilirubin, which is released into the blood and later
secreted by the liver into the bile.
Bilirubin Metabolism105
Bilirubin is an end product of haem coming from haemoglobin and from myglobin
and many respiratory enzymes. Approximately 35 gm haemoglobin are broken down daily
and 300 mg bilirubin are formed production takes place in reticulo endothelial cells.
Literary review 48
These enzymes that converts haem to bilirubin is microsomal haem oxygenase
which has absolute requirements for oxygen and NADPH, cleavage of the prophyrin ring
occurs selectively at the alpha Methane Bridge. The alpha bridge carbon atom is converted
to carbon monoxide and two oxygen atoms, which are derived from molecular oxygen,
replace the original bridge function. The resulting inear tetrapyrrole has the structure of the
IX alpha biliverdin. This is converted further to IX alpha bilirubin by an enzyme, biliverdin
reductase, such a linear pyrole should be water soluble, where as bilirubin is lipid soluble.
The lipid solubility is explained by the structure of IX alpha bilirubin, which has six intra
molecular stable hydrogen bonds. This bonding can be broken by alcohol in the diazo
reaction converting unconjugated bilirubin to conjugated reacting bilirubin. In vivo the stable
hydrogen bonds are altered by asterification of the propionic groups by glucoronic acid.
About 20% of circulating bilirubin is not formed from the haem of mature
erythrocytes. A small portion comes from immature cells in spleen and bone marrow. This
component is increased in haemolytic states. The remainder is formed in the liver from
haem protein such as myoglobin, cyto chromes and unknown sources this component is
increased in pernicious anaemia.
Spleen as Sroto moola
The spleen develops as a collection of mesenchymal cells in the dorsal
mesogastrium some of these cells are contributed by the coelomic epithelium lining the
mesogastrium. The mesenchymal cells differentiate into lymphobyasts and other blood
forming cells.
As the mesenchymal cell proliferate, they form a mass which projects to the left, and
is covered by peritoneum. The dorsal mesogastrium in this region, can now divided into a
part extending from the stomach to the spleen (gastrospleenic ligament) and another part
extending from the spleen to the posterior abdominal wall. The latter part fuses with
posterior abdominal wall with the result that a fold of peritoneum now passes from the
Literary review 49
spleen to the left kidney (lineorenal ligament). As a consequence of this fussion, and as
result of a change in the orientation of the stomach, the spleen comes to lie on the left side
and takes part in forming the left boundary of the lesser sac of periforneum28.
UPADRAVA IN KAMALA
The occurrence of another disease in the wake of a primary disease as a
complication is termed as upadrava 143. It occurs along with manifestations of the disease in
it times other. After Vyadhi prasaman it is develops in some times. Upadravas may prove to
be more trouble some to the patient as they occur when he is in a debilitated condition
hence it is stated that at time updrava is to be treated first.
The upadrava of Kamala as not explain in our classic under Separate and
independent heading When the patient not taken proper treatment and neglecting the
disease. After develops the Kumbha Kamala, it is considered as upadrava of Kamala roga.
it shows sixth kriyakala of the disease Pitta not only remains between the disease Pitta not
only remains between the Twacha and mamsa at external level but it gets into the deeper
dhatus and spreads completely on internal organs particularly in kosta.
The fundamental idea of Anu Sushirata of earthen pots to that of the internalSrotas
as of the organs especially that of Mahasrotas according to Susruta opinion Kumbha
Kamala is a type of Kamala. 144
Astanga Hridaya explained that untreated Kamala leads to the next stage called
Kumbha Kamala. 145
KumbhaKamala lakshana as Follows 145
1. Krishna Peeta Mala
2. Krishna Peeta Mootra
3. Shareera Sotha
4. Charadi
5. Murcha
6. Daha
7. Aruchi
8. Trushna
9. Anaha
10. Tandra
11. Moha
Literary review 50
ARISTA LAKSHANAS
Certain symptoms produced in a disease suggest bad prognosis of the disease.
Description regarding Arista Lakshanas either of Kostashakha Shrita Kamala is not
available in Brahatrayas or in lingutrayas Madhavakar for the first time mentioned Arista
Lakshana of Kumbha Kamala.
Table No 10. 146, 147
Lakshana Ma,ni Bh,Pr
Vomiting + +
Anorexia + +
Nausea + +
Fever + +
Fatigue + +
Dysponea + +
Cough + +
Diarhoea + +
Bhava Prakash has followed Madhavakar and in 8th Chapter of Bhava Prakash,
Uttarardha he has explained Arista lakshana of Kumba Kamala. Here Asadhya Lakshanas
of Kumbha Kamala considered as Arista lakshanas of Kamala.
SADHYASADHYATA 148, 149
The Sadhyasadhyata of a disease would be established before the commencement
of the treatment. It suggests the prognosis of a disease. A disease is called Sukasadhya
when it is new one, having minimum Nidana poorvarupa Roopa, on the otherhand if the
disease is chronic and present with the complication then it is called as Asadhya. The
Literary review 51
complications of Kamala are Krishna Peeta Mala, Mootra, Raktakshi, Mukha, Chardi, Rakta
Vinmutra, Tandra, Moha, Anaha etc.
Upadravayukta Kamala is a kastasadhya and asadhya.
Kumbha Kamala is kastasadhya.
CHIKITSA IN GENERAL
The first obvious requirement before proceeding to treatment is the diagnosis of the
clinical Varity to which a given case of Kamala belong to careful inquiry has to be made to
as certain causes responsible for the disease.
The importance of Chikitsa lies in breaking up Samprapti and the integral factor of it,
Ama is prevalence of all somatic diseases together extent hence every disease must be
examined in greater detail in order to dislodge.
Chikitsa Sutra
Chikitsa Sutra explained in different classic are as fallow –
Mrudhu virechana by using a Tiktarasa dravyas 150. For Kamala adopt a Pitta hara
Chikitsa and also advised Anjana Chikitsa. 152 According to Susruta, It is Considered
Kamala as one of the Pandu Roga and so he advised the same line of treatment for
Kamala. 153
According to yogaratnakar snehana, virechana, Nasya and anjana are the basic line
of treatment for Kamala. From the above classical references we can conclude that the line
of treatment of Kamala.
1. Pachana
2. Snehana
3. Virechana
4. Nasya
5. Anjana
6. Shamana aoushadas
Literary review 52
PACHANA:
One of the main aim of treatment is to bring back the Agni to normal so deepana and
pachana should be done before the proceeding the main line of treatment. This measure is
essential when the treatment is aimed to cure Kostashakashrita Kamala primarily, where as
in case of shakhastrita Kamala the initial phase to bring shakashrita Pitta to kosta Pitta
vardhaka and kaphakar ahara dravya used.
SNEHANA:
Snehana is to be done as a preparative procedure for Virechana. According to
classical text snehapana is continued until alpasnigdha laxanas are produced. In Kamala,
the doshas are adhered in the shaka, so to bring back the Doshas to the kosta the poorva
karma is adopted. The Snehan is one of the Poorva karma by which the Doshas will get
vilayana, so the snehana is to be done before the Virechana karma.
1) Mahatiktaka Ghruta Cha.chi 16/43
2) Panchagavya Ghruta Cha.chi 16/43
3) Kalyanaka Ghruta Cha.chi 16/43
4) Draksha Ghruta Cha.chi 16/52
5) Haridradi Ghruta Cha.chi 16/53
VIRECHANA:
The Ayurvedic classics advised to undertake mrudhu Virechana in Pandu and
Kamala Roga. Virechana therapy specially in Pitta pradhana and Rakta pradushaja
vikaras.Kamala is one of the Pitta pradhan roga. For the Virechana medicine explain in the
classics are Gomutra and Go-dugdha 153
NASYA AND ANJANA:
These therapies are mainly indicating when the Ranjakapitta, gets sthansashraya in
urdwajatruga mainly netra, jivha and becomes too stagnant even after the Virechana in
these conditions Nasya and anjana helps to normalize the Ranjakapitta.
Literary review 53
Nasya : 154 Karkotakamoola, devadhali
Arka mula, Tandulodhaka
Anjana :155,156 Dronapuspi swaras
Nisha, Gairika, dhatri choorna
SHAMAN OUSHADHAS
1. Mandur vataka Y R Panduroga /39,40
2. Phalatrikhadi Kwath Y R Panduroga /30 B/R12/22
3. Navayasa Choorna Y R Panduroga 32 B/R12/22
Cha.Datta 8/11,12
4. Dharvyadhi choorna Y R Panduroga /59
5. Yoshadhi choorna Y R Panduroga/63,64
6. Dhatryadhi Yoga Y R Panduroga/61
7. Lohachurnadi Yoga Y R Panduroga/62
8. Eladi Choorna Y R Panduroga/65
9. Nisha Choorna Y R Panduroga/66
10. Vishalya Prayoga Y R Panduroga/69,70
11. Yogaraja Cha.datta 8/13-19
12. Yoga Panchaka Cha.datta8/28
13. Tryusanadya Mandoor Cha.datta8/36-41
14. Dhatryarista Cha.datta 8/49-51
15. Punarnavadi Mandoor Bha Ma 8/30-34
16. Vasadhi Kashaya B R 12/23
17. Navayasha Loha B R 12/28
18. Nisha Loha B R 12/29
19. Dhatri Loha B R 12/30
20. Vidangadhi Loha B R 12/33
Literary review 54
21. Darvyadhi Loha B R 12/37
22. Trikatrayadhi Loha B R 12/38-43
23. Kamalantaka Loha B R 12/44-51
Pathya Apathya in Kamala 157
Pathyam means that which is compatible to the body. This term used as synonyms
of Chikitsa. Which is not conductive to health is called Apathya.
Charaka Samhita description regarding Pathya for Kamala Puran shali, Yava,
Gudha, Godhuma, Yusha, Mudga, Adhaki, Masoor, Meat juice of jangal creators. Ghruta,
Dugda pathya, Lavana apathya.
Pathya in Shakhashrita Kamala: 158
Charaka has considered certain pathyas to bring back to the vimarga Gamita Pitta
from shaka to kosta by eliminating the avarodha caused by Vata and Kapha. The rice diet
should be given with meat juice of peacock, partridge, Shuskamoolaka yusha,Kulathya,
Matulunga swarasa, Madhu, Trikatuchurna
Literary review 55
The Phalatrikadiyoga is selected from Baishajya Ratnabavali in Pandu Roga
Chikitsa is said as a phalatrikadi kwatha in classic we added two more drugs
Bhrungaraja and Bhumyamalaki. It reduces the Hepatato toxicity. The medicine
described was fortfilled reactionary and reformulated contains the following ingredients:-
Ingredients Parts in ratio
1) Haritaki I part
2) Bibhitaki I part
3) Amalaki I part
4) Guduchi I part
5) Vasa I part
6) Kiratatikta I part
7) Katuki I part
8) Nimbatwaka I part
9) Bhumyamalaki I part
10) Bhrungaraja Swaras Quantity sufficient
The above drugs from 1 to 9 are prepared into powder form separately and then
mixed in above ratio properly all drugs taken in one ratio, after one bhavana given by the
“Bhungaraja Swarsa” well mixture dried and powdered into fine powder. Lastly made
into capsule form. Each capsule containing 500mg of medicine.
Trail drug description 56
HARITAKI 159, 160
Sanskrit : Haritaki
Latin : Terminalia Chebula
Family : Combertaceae
Synonyms : Abhaya, Pathya, Vijaya, Bhishakpriya
Gana : Amalakyadi, Purushakadhi(Su) Prajashtapana,
Jwaragna(Cha)
Vernacular Names:
English : Chebulic Myrobalan
Hindi : Harada, Harre
Kannada : Alalekai
Habitat: This tree is wild in forest of northern India, Central Provinces and Bengal
common in Madras and Mysore.
Pharmacological properties:
Rasa : Kashaya Pradhana(lavanavarjita) Pancharasa
Guna : Laghu, Ruksha
Veerya : Ushana
Vipaka : madhur
Prabhava : Tridhoshahara
Chemical constituent: 161
Important source of tannin, the fruits collected from Madras are very rich in
tannin and large amount of Gallic acid and Chebulic acid.
Pharmacological Action:
Myrobalams are safe and effective purgative, Rashayana, Swas, Kasa,
Prameha, Eye diseases, Kusta, Vruna, Chardi, Sopha, Vatarkata and Cardiac diseases.
Trail drug description 57
Astringent, Stomachic, Purgative.162 Rasayana Netraroga, Twakaroga Kamala, Grahani,
Hikka, Pleeharoga, Gulma Yakritrog, Asmari.163, 164
Part used: Phala
Uses:The fruits are used as a medicine for sore throat by Paris and Sikim Rubbing the
fruits on a rough stone with water mix and carron oil of the Pharmocophia and applied to
the burns and scalds. Scalds rapid cure than when carron oil alone is used.Fruits kept in
a water for night is considered a very cooling wash for the eyes. The ashes mixed with
butter form a good ointment for sores.165
Trail drug description 58
VIBHITAKI 166, 167
Latin : Terminalia Belerica
Synonym : Kalidrum, Bhutavasa, Karsaphala
Gana : Jwarahara,Virechanophaga(Cha) Triphala, Mustadi(Su)
Vernacular Names :
English : Belerica Myrobalans
Sanskrit : Bibhitaki
Hindi : Bhaira, Bahera
Kannada : Tarekai
Habitat: All over Indian forest
Pharmacological properties
Rasa : Kashaya
Guna : Ruksha, Lagu
Veerya : Ushna
Vipaka :madhur
Chemical constituents: The fruits contain about 20 to 30% of tannin and 40 to 45% of
water-soluble extractive. It contains galic acid, ellagic acid, phyllemblen, ethyle gallate
and galloyl glucose. 168
Pharmacological action:
Astringent, tonic, expectorant and laxative.169 Fruits are useful in cough,
hoarseness, eye disease, scorpion sting. Salt and long pepper pulp of the fruits is given
in the form of expectorant in cough, hoarseness, sore through. It is constituent of
triphala prescribed in diseases of liver and gastrointestinal tract and in a large verity of
diseases.170.
Compound I isolated from fraction TB5 of Terminalia belerica and finally
identified as 3,4,5-trihydroxy benzoic acid (gallic acid) was evaluated for its
Trail drug description 59
hepatoprotective activity against carbon tetrachloride (CCl4) - induced physiological and
biochemical alterations in the liver. Administration of compound I led to significant
reversal of majority of the altered parameters. Our results confirm the presence of
hepatoprotective activity in altered parameters. Our results confirm the presence of
hepatoprotective activity in Compound (Anand KK, Singh B, Saxena AK, Chandan BK,
Gupta VN, Bhardwaj V. 3,4,5-Trihydroxy bezoic acid (gallic acid), the hepatoprotective
principle in the fruits of Terminalia belerica-bioassay guided activity. Pharmacol Res
1997 Oct; 36(4):315-321).
Part used: Fruits
Uses: kasa, netra, keshya, madakaraka. Anti microbial activity of Terminalia bellerica
triterpenoids.171
Trail drug description 60
AMALAKI 172, 173
Latin : Embelica officinalis
Synonym : Dhatriphala, sriphala, vayashya, Vrushya
Gana :Vayastaphana, shirovirechana (cha) Triphala, parushakhadi (Su)
Vernacular Names :
English : Embelica Myobalan
Sanskrit : Amalaki
Hindi : Amala
Kannada : Nellekai
Habitat: Uttara bharath, Himalaya parvata, Kashmir, Malaya dveepa
Pharmacological properties
Rasa : Amla pradhana lavana varjita pancharasa
Guna : Ruksha Guru sheeta
Veerya : Sheeta
Vipaka : madhur
Chemical constituents: Amla fruit is a rich natural source of vitamin C, 5% of tannin
and rich in mineral matter like Phosphorus, Iron calcium. The presence of tannin which
relates oxidation of vitamin C.173 The amount of vitamin C in fresh fruits 500mg to 970mg
per 100gm and dry fruits having 256 to 421 mg per 100gm. 174
Pharmacological Action 175: Dried fruits is useful in hemorrhage, diarrhea and
dysentery with iron it is a valuable remedy in anaemia, Jaundice and dyspepsia, a
fermented liquor prepared from root is used in Jaundice, dyspepsia, cough etc.
Part used: Phala
Uses: Activity of Emblica officinalis is said as Raktapitta, daha, chardhi, prameha,
rasayana and shopa. Antimutagenic and anticarcinogenic 176. Antioxidative activity of
Tamarind extract prepared from the seed coat .177, 178
Trail drug description 61
GUDUCHI 179, 180
Latin Name :Tinospora Cardifolia.
Family : Menispermaceae.
Gana :Vayastapan, Dahaprasaman, Truptignagana, StanyaShodhana (Cha)
Patoladi, Guduchyadi, Aragvadhadi, kakolyadi, valli panchamoola(su)
Guduchyadi ( Dha Ni)
Synonyms : Madhuparni, Amruta, chinnaruha.
Varnacular name’s:
English : Gulancha
Hindi :Giloya.
Kannada : Amrutaballi.
Habitat : Occurs in almost all districts of Madras Presidency.
Pharmacological properties:
Rasa : Tikta kashaya,
Guna : Guru, Snigda
Veerya :Ushna
Vipaka :Madhur
Chemical -constituents: Berberine , bitter substance,
Pharmacological action
Antiperiodic, alternative diuretric, stem and root are bitter.It stimulates the bile
secretion, causes constipation tonic', allays thirst, fever, burning sensation, Vomitting
enriches the blood, cures Jaundice, useful in skin diseases the Juice is useful in
diabetes, vaginal and urethral discharges. Low fever and enlarged spleen.181
Outstanding results in people suffering from jaundice have been obtained using a herb
called Tinospora Cordifolia: In 1993, Rege et al. (ibid) used the herb in malignant
obstructive jaundice: half of the group received conventional treatment - drugs and
Trail drug description 62
drainage - the other half were treated with drainage plus T. Cordifolia. After conclusion of
treatment, 50% of the drug-treated group were found to have blood poisoning while none
of the herb treated group developed this problem. After surgery, only 40% of the drug-
treated group survived, whereas an amazing 92.4% 0f those treated with the herb lived.
The hepatoprotective effect of T. Cordifolia has been studied in carbon tetrachloride
induced liver damage in rats. While acute damage was enhanced by prior exposure to
the drug, it proved effective in the prevention of fibrosis, and in stimulating regeneration
of hepatic tissue (Rege, N. et al.: Ind. Drugs Sept. 544 (1984).
Part Used: kandha.
Uses: daha, prameha, kasa, pandu, kamala, kusta, vatarakta, Jwara, krimi 182
Studies:
1. Tinospora Cardifolia and cytotoxic Chemotherapy.183
2. Immuno Modilatory Com pound from Tinospora cardifolia. 184
3. Tinospora Cordifolia induces colony-stimulating activity in serum. 185
4. Study of anti pyretic activity of Guduchi. 186
5. The potential Role of Tinospora cardifolia in cancer therapuetics. 187
Trail drug description 63
VASA 189, 190
Latin : Adhatoda vasica.
Family : Acanthaceae,
Synonyms : Vasaka,vasika, Sinhashya, vrusha,
Gana : Satavahadivarga (R.Ni) Guduchyadivarga (Dha.Ni)
Vernacular names:
English : Malabar rut.
Hindi : Adusa
Kannada : Adasoge.
Habitat : This plant grows in most parts of India, especially in the lower
Himalayan ranges.
Pharmacological Properties:
Rasa : Tikta, kashaya
Guna : laghu Ruksha
Veerya : Sheeta
Vipaka : katu
Chemical Constituents: An odorous volatile principles probably of the nature of
essential oil, fat, resin, a bitter non volatile alkaloid called vasicine, an organic acid
adhotodic acid" sugar, gum, colouring Matter and salt's largest amount of vasicine
Contained in the root bark, and to the extent of 0.25 percent in the leaves. 191
Pharmacological action: Expectorant, diuretric, antispasmodic and alternative Vasiane
has no marked action on the alimentary canal on the Circulation. 192. Adhatoda vasica
acts as a Cholagogue and can be employed in some types of Jaundice. 193
Part used: leaves, roots, bark and flowers.
Uses: Kshaya swasa, Kasa, Rakta pitta,raktapradar, chardhi, kustham, and Jwara, 194
Trail drug description 64
KIRATATIKTA195, 196
Latin :Swerita Chirayata.
Synonyms :Kirat, Kiratatikta, Bhunimba (Mad Ni)
Gana :Tiktagandha, stanyashodhan, Trushnanigrahana(cha)
Aragwadhadi (su)Haritakyadi gana ( Bha Ni )
Vernacular names:
English :Chireta
Hindi :Chirayata
Kannada :Nelabevu
Habitat: It is abundantly available in north India, Kashmir, nephal, Simla, himalaya
and South India.
Pharmacological properties:
Rasa :Tikta
Guna :laghu, ruksha.
Veerya :Ushna
Vipaka :Katu
Chemical constituents: Chiratin a yellow bitter glucoside, resins, gum, carbonates and
phosphates of potash, lime and magnesia, ash 4 to 6 % no tannin. Bitter yellow acid
known as ophelicacid.197 Two bitter glycosides chiratin and amarogentin. 198
Pharmacological action: Bitter tonic, stomachic, febrifuge and anthelmintic
Sannipathajwara, swasam, kasam,raktashodana, thrishnasodhan, kustam, krimi.
Part used : Panchanga
Uses : The plant is bitter, cooling antihelmintic, antipyretic, antiperiodic,
laxative, galactagogue, cures thirst, leucoderma, inflammation, burning sensation, pain
in the body, urinary discomfort, asthama, bronchities. Marphological and
Chromatographic comparison of certain Indian spaces of swerita. 199, 200.
Trail drug description 65
KATUKI 202, 203
Latin : Picrorhiza kurrora.
Family : Scrophulariaceae
Synonym : Katuka, Tikta, Kandharuha, Chakrangi.
Gana : Bhedaniya. lekhaniya, sfanyashodhan, Tiktashandha ( cha)
Patoladi , pippalyadi, mustadi (Su)
Vernacular Names:
English :Picrorhiza.
Hindi : Katuka
Telagu :alam.
Kannada : Katuk Rohini.
Habitat : Common on the Northwestern Himalayas from Kashmir to sikkim.
Pharmacological properties:
Rasa :Tikta.
Guna :Ruksha, laghu.
Veerywa :Sheeta.
Vipaka :Katu
Chemical Constituents: Root contains a glucoside called picrorrhizin, a fairly large
percentage of soluble bitter substances with an acid reaction.
Pharmacological action: In small doses, it is a bitter stomachic and laxative and in
large doses, a cathartic, It is reputed as an antiperiodic and chalagogue.
Picrorrhiza Kurroa is one of the herbs they recommend to support the liver not
only in everyday situations, but in cases where severe viral infections attack: a 1996
study by Vaidya found protection against viral hepatitis, and other studies have
demonstrated its helpfulness in protecting against alcohol (Vaidya (Better Nutrition June
1999 p. 29).
Trail drug description 66
The hepatoprotective activity of picroliv, the irridoid glycoside mixture from
Picrorhiza kuroa, was determined in adult male albino rats. Pretreatment with picroliv
prevented the hepatotoxic effects of paracetamol and galactosamine as evidenced by
varios biochemical and histopathological observations. Maximum hepatoprotective effect
was observed with daily oral doses of 6 and 12 mg/kg for 7 or 8 days. The
antihepatotoxic action of picroliv seems likely due to an alteration in the
biotransformation of the toxic substances resulting in decreased formation of reactive
metabolites (Visen PK, Shukla B, Patnaik GK, Dhawan BN. Andrographolide protects rat
hepatocytes against paracetamol-induced damage. J Ethnopharmacol 1993
Oct;40(2):131-136.
Part's used : Dried rhizome.
Uses : Deepana, bedhana, hridhyam, swasam. Jwaram, Prameha, kasam,
krimi, kustam, laxative. Two dranchms of powdered root given with sugar and warm
water acts as a mild purgative. Picrorrhiza is used as a valuable bitter tonic, antiperiodic,
febrifuge and stomachic, it is laxative in large doses. Alcoholic extract of the root is
found to have antibacterial effect. The drug is found useful in treatment of Jaundice203
Hiccough, blood troubles, burning sensations, leacoderma, Jaundice204
1) Katuki protects against liver disorders205
2) Picroliv protects against alcohol induced chronic hepatotoxicity in Rats206
3) Effect of picroliv on liver regeneration in Rats207
4) Protective effect of picroliv, active constituent of picrorhiza kurrora, against
oxytetracycline induced Hepatic damage208.
5) Studies on indian traditional medicine, picrorhizakurrora and peptic ulcer209.
6) Antiallergic activity of picrorhiza kurrora210.
Trail drug description 67
NIMBA211,212
Latin : Azadirachta Indica
Family : Meliaceae.
Synonyms : Pichumardha,Arista,
Gana : Kandhugna, Tiktaskandha (cha)
Aragwadhadi, Guduchyadi, laksadi (Su)
Varnacular Names:
English : Margosa tree.
Hindi : Neem.
Kannada : Bevu.
Habitat : Indegenous to and cultivated nearly all over india and in Burma.
Pharmacological properties:
Rasa : Tikta. kashaya.
Guna : laghu.
Veerya : Sheet.
Vipaka : Katu.
Chemical constituents: Nimbin, Nimbidin, Nimbosterol , Tanin these are the main
constituent present in Neem.
Pharmacological action: Vomiting, burning sensation near the heart, fatigue, fever,
thirst, bad taste in the mouth, cough. Cures ulcers and inflammations are good for
leprosy. Blood complaints, urinary discharges. Skin disease, tumors etc.,
Part used : Puspha, patra,, twaka, beeja, Taila
Uses: Intermittent fever and general debility, Slight antiseptic, Carbolic lotion in
washing wounds and ulcers. Dried leaves powdered are applied locally to the
anus of children suffering from intestinal worms. Vruna kusta, Netraroga, kasa swasa
kamala.
Trail drug description 68
1) Evaluation of deoiled neem seed kernel extract and neem leaf suspension as growth
regulators for Aedes egypt214
2) Role of Nimba patra swarasa in kamala213.
3) Development of enzyane linked immuno Absorbant Assasy for Azadiracthins215.
4) Influence of Azadiratchta indica leaf extract on the Immunotoxicity of stress and
xenobiotic in experimental animals216.
5) Anti fertility effects of aqueous and steroidal extract of neem leaf in Male wistar rats217
Trail drug description 69
BHUMYAMALAKI218,219
Lantin :Phyllanthus niruri
Family :Euphorbiaceae.
Synonyms : Bahupatra, Bahudhatri.
Gana : Kasahara. Swasahara (cha) Guduchyadivarga (Bha Ni)
Vernacular Names:
Hindi : Jaramla.
Kannada :Guggare kasa.
Habitat : Common in central and southern India, extending to Ceylon.
Pharmacological properties:
Rasa : Tikta , kashauya, Madhura.
Guna : Laghu, Ruksha.
Veerya : Sheeta.
Vipaka : Madhura.
Chemical Constituents: It is having phyllentin
Pharmacological Action: The plants is considered de-obstruent, diuretic, astringent
and cooling. A decoction of plant is administered in Jaundice. liver Stimulant thrust
controls, prameha etc220,221, 221a. Phyllanthus Amaris has been researched for its effects
on hepatitis, and in 1988 Thyagaran et al. (ibid) reported that 22 of 37 cases of Hepatitis
B lost their "carrier" status after using the herb for a month. In the placebo control group
only 1 person out of 23 had equivalent results.
Part used : Panchanga
Uses : Pipasa, kasa, pittaroga, kandhu, kusta222
1) A New receptor liver injury223
2) Efficacy of phyllanus amarus treatment in acute viral Hepatitis A , B and Non
A , Non B an open clinical trial224
Trail drug description 70
BHRUNGARAJA 225,226:
Latin : Eclipta alba.
Family : Compositae.
Synonyms : Markava kesaranjan, kesaraka
Guna : Karaveradhyavarga ( Dha Ni) Guduchyadivarga ( Bha Ni )
Vernacular Names:
English : Kadimulb inta
Hindi : Bhangara.
Kannada : Kadigaraga.
Habitat: This herb is found abundantly throughout India in wet places and plentiful on
the Himalayas.
Pharmacological properties :
Rasa : Katu. tikta
Guna :Ruksha laghu.
Veerya : Ushna.
Vipka :Katu.
Chemical constituents 227: Alkaloids ecliptine.
Pharmacological action: Roots and leaves are largely used alone as in combination
with ajawan seeds in derangement’s of the liver and gall bladder. They have also been
used as substitutes for Taraxacum a reputed and popular liver tonic.
The hepatoprotective effect of the ethanol/water (1:1) extract of Eclipta alba was
studied at subcellular levels in rats against (CCl4) -induced hepatotoxicity. The loss of
hepatic lysomal acid phosphatase and alkaline phosphatase by (CCl4) was significantly
restored by Ea. The study shows that hepatoprotective activity of Ea is by regulating the
levels of hepatic microsomal drug metabolising enzymes.[(Chandan BK, Sharma AK,
Trail drug description 71
Anand KK. Boerhavia diffusa: a study of its hepatoprotective activity. J Ethnopharmacol
1991 Mar;31(3):299-307).
Part used Panchanga.
Uses: keshya, twacharoga, krimi, kasa, Shotha, Pandu, dantaroga, Rasayana,balya,
Netraroga, Siroroga. This fresh plant is applied with sesamun oil in elephantiasis, and
the expressed Juicein affections of the liver and dropsy, when used in large doses, it
acts as an emetic. The Juice of the leaves is given one teaspoonful doses in Jaundice
and fevers. The root is given to relieve the scalding of urine228. Hepatoprotective activity
of Taiwan Folk medicine, eclipta prostrata linn. Against various Hepato toxins indduced
acute Hepato toxicity229
1) A New recipe for liver injury230
2) Chemical Constituents and anti hepxtotoxic activity of Eclipta alba231
PREPARATION OF MEDICINE AND DISPENSING
All the said herbs are collected fresh and pondered well in to fine powder. Later it
is capsulated and bottled in close container. They were made 60 capsules dispensing
packs and distributed to the selected patients periodically.
Trail drug description 72
This clinical study was taken up with the proper understanding of the classical
explanation observation and management of the Kamala. Among the causes of the
Kamala more emphasis and the clinical symptoms of the Kamala are taken in to
consideration.
Objectives of the study:
1) To study the efficacy of "Phalatrikadiyoga " in Kamala
2) To study and evaluate safety and efficacy of Phalatrikadiyoga on certain
biological factors relevant to Kamala and Jaundice.
The material are studied as under:
1) Literary : literary aspects of the study were collected from various Ayurvedic
classics,
2) Magazines and Journals. The information regarding the disease is updated
from Internet search along with above said.
3) Drug:
Materials and Methods 73
The Phalatrikadiyoga is selected from Baishajya ratnavali, in classics in this yoga
under the naming of phalatrikadikwatha. I add two more drugs Bhrungaraja and
Bhumyamalaki these drugs also very beneficial to reduce hepatotoxicity explain in
Indian medicinal plants. (Page No 1362 & page No 949). Here reformulated the
contents of the ingredients.
Ingredients Part in ratio
1) Haritaki 1 part
2) Bibhitaki 1 part
3) Amalaki 1 part
4) Guduchi 1 part
5) Vasa 1 part
6) Kiratatikta 1 part
7) Katuki 1 part
8) Nimbatwaka 1 part
9) Bhumyamalaki 1 part
10)Bhrungaraja quantity sufficient
The above mentioned drugs from 1 to 9 are prepared in to powder separately
and then mixed in above given ratio. One bhavan with Bhrungaraja swaras was given to
the mixture dried and grind into fine powder. At the end it was made into capsule form,
each capsule consists of 500mg of medicine.
All the herbal purchased form Dr Khajarekar Ayurvedic pharmacy, Belgum
preparation was done in DGM Ayurvedic pollege pharmacy under depratmental
guidance. The 500mg capsule are filled in plastic bottles with a label attached.
Mentioning name of the compound in number of capsules, dose of medicine and
Anupana.
3) Patients:
Materials and Methods 74
The patients with the conformed diagnosis of Kamala clinically as well as
laboratory investigations are selected for the study. Patients were selected from the
DGM Ayurvedic medical collage and Hospital Gadag incidental and camp conducted
specially for the disease Kamala.
Methods of collection of Data:
The main criteria for selection of the patients were symptomatolagy and
laboratory (investigation) evidences of the serum bilirubin and other liver function test
values.
A) Inclusion criteria:
The patients of both sexes presenting with the following lakshanas were
selected.
1. Yellowish discoloration of sclera,
2. Yellowish discolouration of urine,
3. Loss of appetite
4. General weakness
5. Body ache
The patients presenting above lakshans two or more were considered clinically
with laboratory evidences of urine bile salts and bile pigments along with liver function
values.
B) Exclusion criteria:
1. The patient below the age of 10 year and above the age of 60 years
2. Drug induced Jaundice
3. Surgical Jaundice
4. Pregnant women
5. Lactating mother
Severe Jaundice patients, complications of Jaundice, who will not agree for the
study also excluded.
C) Study Design:
Prospective open clinical trial
Materials and Methods 75
D) Sample size:
Minimum 20 patients are selected irrespective of sex.
E) Posology :
500mg capsule 2 TDS or 3gms/24hours
Anupan:
Sukoshna jala – Lukewarm water
F) Duration of treatment:
30 days
Assessment of results:
The result of this study will be assessed on the following parameters.
a) Subjective parameters
b) Objective parameters
a) Subjective parameters: The clinical signs and symptoms of Kamala.
1. Netra peetata.
2. Mutra peetata
3. Peeta twakha.
4. Peeta Nakha
5. Aruchi
6. Angasada
7. Dourbalya
8. Daha
9. Hrullasa
10. Chardi
11. Sweta varchata
12. Avipaka.
13. Hruta peeda
14. Hikka
15. Swasa
16. Jwara
17. Kandu
Materials and Methods 76
18. Parswa peeda.
B) Objective Criteria:
The Hematological investigations and urine examination also included before
and after treatment
1) Hb %
2) Serum bilirubin (direct and total)
3) SGPT
4) Serum Alkaline Phosphate
5) Serum total protein
6) Serum Albumin
7) Serum Globulin
8) Urine Bile salts and Bile pigments.
Investigation:
The laboratory investigations are very important for the diagnosis of the
diseases. For the Kamala disease diagnostic purpose
1) Liver function test
2) Hb%
3) Urine bile salts and bile pigments
1) Haemoglobin Estimation:
This is the important one for diagnosing a patient it is anaemia is not. In
Ayurvedic classics also explain under the concept of Pandu Roga adhyaya the
estimation of haemoglobin.
Materials and Methods 77
This is based on conversion of haemoglobin to acid haematin. Which has a
brown colour, fill haemoglobin tube till 20 mark with N/10 Hcl. To this add blood sucked
till the specific mark (20ml) on the haemoglobin pippete and wait for 5-45 minutes.
During this time keep string the mixture, of acid blood in the tube. Add distilled water
until a match is obtained with the brown glass standard provided. Read the lower level
of fluid meniscus on grm % side of blood. Report haemoglobin in grm / 100 ml of
Blood231
Liver function tests232
To confirm the clinical diagnosis and to assess the type of Jaundice laboratory
investigation such as Bio chemical tests are required.
1) Serum Bilirubin: Jaundice will develop bilirubin is excessively reduced produced or
there is impaired hepatic up take and conjugation of bilirubin or it is insufficiently
excreted in to the duodenum normally total serum bilirubin is 0.2 to 0.8 mg/dl. Here total
bilirubin is accumulation or a sum of conjugated and un-conjugated bilirubin.
In hyper bilirubin conditions:
a) If conjugated bilirubin level more than un-conjugated bilirubin level, then its
suggests the jaundice has resulted, either due to hepetic causes or due to post
hepatic cause.
b) Un-conjugated bilirubin level is more then conjugated bilirubin level , then it
Suggests the Jaundice, has resulted due to pre heplatic cause.
c) Test to assess the damage of hepatocytes.
2) Tests to Assess the damage of Hepatocytes:
a) Serum Glutamate pyruvate transminase ( SGPT)
b) Serum Glutamate Oxaloacetate transminase (SGOT)
It is a mitochondrial enzyme released from heart, liver, skeletal muscle and
kidney SGPT - is a cytosalic enzyme also present in liver, Although the absolute amount
of is less than SGOT a greater proportion is present in liver compared with heart and
skleletal muscles.
Materials and Methods 78
SGOT –
It is a mitochondrial enzyme present in large quantities in hearts, liver, skeletal
muscle and kidney and the serum level increase when ever these tissues are acutely
destroyed, presumably due to release from damaged cells.
The Normal values of SGPT 5 - 35 IU/L and SGOT Normal values 5-40 IU/L232
3) Serum Alkaline phosphatese:
Many tissues produce the serum alkaline phosphatese, it rises in cholestasis and
to a lesser extent when liver cells are damaged. The mechanisms of increase are
complex. Synthesis of the alkaline phosphatese by the hepatocytes is increased and
this depends on intact protein and RNA synthesis. Secretion into serum may arise
through linkage from conaliculies in to the sinusoid because of leaky tight junction.
Increased release of phosphatese into sinusoids from the haepatocytes plasma
membrane may. Contribute. The normal value of serum alkaine phosphatase 35 -130
IU/L233
Serum Proteins:
This measurement, in itself, is of little value, serum Albumin and Globulin. The
globulin fraction consist of many proteins that can be separated on electrophoreisis, a
raised globulin fraction, seen in liver disease, is usually due to increased circulating
immunoglobulins. The Albumin is a microsomal enzyme that is present in many tissues
as well as the liver. Its activity can be induced by such drugs as phentyoin and by
alcohol.
If the alkaline phosphate is normal, a raised serum δ-Glutonyl trans peptidase is
a good guide to alcohol intake and can be used as a screening test. Mild elevation of δ-
Glutanyl is common with small alcohol consumption and does not necessarily indicate
liver disease if the other liver bio-chemical tests are normal. In cholestasis the δ-GT
Materials and Methods 79
rises in parallel with the ALP as it has a similar pathway of excretion. This is also true of
the 5-nucleotidase, another microsomal enzymes that can be measured in blood.
Other test’s in this disease like viral markers.
Viruses are a major cause of liver disease. Virological studies have a key role in
diagnosis, maker are available for most common viruses that cause hepatitis234.
Urinary Excretion of Bile Salts and Bile Pigments:
The bile salts are not absorbed in the jejunum, so that the introluminal
concentration in upper gut is high. They pass down the intestine to be observed in the
terminal ileum and are transported back to the liver. This entero hepatic circulation
prevent excess loss of Bile Salt’s235
When liver is damaged, urobilinogen reabsorbed from the intestine, fails to pass
through the liver cells and appears in the urine in a larger amount. Under such
conditions, urine contains considerable amounts of urobilinogen and urobilin, presence
of urobilinogen in urine in excess, there fore, indicates functional deficiency of liver236
OVERALL ASSESSMENT:
For the assessment grades were fixed depending upon the condition. Overall
assessment is made taking into consideration both subjective and objective parameters.
Considering all the above parameters patients are graded in to four groups
depending upon the response to Phalatrikadiyoga. The over all score was considered as
32 based on the subjective (20 symptoms) and objective parameters (12 including visual
scores) excluding the Dosha assessments. Out of 32 scores depending upon the scoring
of individual patient the grading was done is as follows.
Grade Score range Cured Major improvement Minor improvement Unchanged Discontinued
25 to 32 17 to 24 09 to 23 00 to 08 Not appeared for evaluation
Materials and Methods 80
Table No 11. Demographic data of evaluation of the efficacy of Phalatrikadiyoga
Sl. No.
OPD No.
Age (Years)
Sex Udyoga-II Dharma Socio-EconomicStatus
Result
M F a b c d a b c d a b c d a b c d e1 934 38 + - - - - + - + - - + - - - + - - - -2 1056 35 - + - - - + + - - - + - - - + - - - -3 1537 45 + - - - - + - + - - + - - - - + - - -4 1885 11 + - - - + - + - - - - - + - + - - - -5 850 35 - + - - - + - + - - + + - - - + - - -6 885 46 - + + - - - + - - - - + - - - - + - -7 1343 35 + - - - - + + - - - - + - - + - - - -8 4692 22 + - - - + - + - - - - + - - + - - - -9 2023 21 + - - - - + + - - - - + - - + - - - -
10 223 35 - + + - - - + - - - - + - - + - - - -11 3017 11 - + - - + - + - - - - - + - + - - - -12 4885 32 - + - - - + + - - - + - - - + - - - -13 3778 30 - + - - - + - + - - + - - - + - - - -14 2895 42 + - - - - + + - - - - + - - + - - - -15 6950 57 + - - - - + + - - - + - - - + - - - -16 7166 50 - + + - - - + - - - - + - - + - - - -17 3251 27 + - - - - + + - - - - + - - + - - - -18 4563 55 + - - - - + + - - - - + - - + - - - -19 6574 51 + - - + - - + - - - - - + - + - - - -20 5124 48 + - - + - - + - - - - - + - + - - - -
Total 12 8 2 2 3 12 16 4 0 0 7 10 4 0 17 2 1 0 0I. a- Male, b= Female
II. a= House wife , b= Service c= Student d= Labour III. A= Hindu b= Muslim c= Christian d= Other
IV. A= Poor b= Middle c= Rich d= Aristocrat V. A= Cured b= Major improvement c= Minor improvement d-Unchanged e= Discontinued
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Table No.12 Vedana samuchyaya of evaluation of the efficacy of Phalatrikadiyoga
Sl.No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A B A
1 + - + - + - + - + - - - - - + - + - + - + - + - - - + - - - - - + - - - - - - 2 + - + - + - + - + - - - + - + - + - + - + - + - + - - - - - - - - - + - - - + -3 + - + - + - + - + - + - - - + - + - + - + - - - - - - - - - - - - - - - + + + +4 + - - - - - + - + - - - - - + - + - - - + - - - + - + - - - - - - - + - + - - - 5 + - + - - - + - + - - - + - + - - - + - + - - - + - + - - - - - - - + - + - - -6 + + + - + - + + + - + - + - + - + + + - + - + - - - - - - - + + + - - - + - - -7 + - - - - - + - + - - - + - + - + - + - + - - - - - - - - - - - - - + - + - - -8 + - - - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - + - - -9 + - + - - - + - + - - - + - + - + - + - + - - - - - - - - - - - + - - - - - - -
10 + - + - + - + - + - - - + - + - + - - - + - - - + - - - - - - - - - - - - - - -11 + - - - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - + - - -12 + - - - + - + - + - - - + - + - + - + - + - - - - - - - - - - - - - + - + - - -13 + - - - - - + - + - - - + - + - + - + - + - - - - - + - - - - - - - - - - - - -14 + - + - + - + - + - - - - - + - + - + - + - - - - - - - - - - - - - - - - - - -15 + - - - - - + - + - - - - - + - + - + - + - - - - - + - - - + - - - - - + - - -16 + - - - + - + - - - - - - - + - + - + - + - + - - - - - - - + - - - - - - - - -17 + - - - + - + - + - - - - - + - + - + - + - - - - - + - - - - - + - - - + - - -18 + - - - + - + - + - - - - - + - + - + - + - - - - - + - - - - - - - - - + - - -19 + - - - + - + - + - - - + - + - + - + - + - + - + - + - - - + - + - - - - - - -20 + - - - + - + - + - - - - - + - + - + - + - + - - - + - - - + - + - - - + - - -
1= Peeta Netrata, 2=Peeta twakha 3=Peeta Nakha 4=Peeta Mutrata 5= Peeta Purisha 6=Peeta Mukha 7=Daha 8=Avi Paka 9=Dourbalya 10-Angasada 1=Aruchi 12=Sweta Varchata 13=Hruta Peeda 14=Parswa Peeda 15=Hikka 16=Swasa
17=Jwara 18=Chardi 19=Hrullasa 20=Khandu
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Chart - 13 Vayaktika Vruttant
Sl.No. Ahara Vihara Nidra Vyasana Jataragni Kosta
a b a b c d a b a b c a b c d a b c1 - + + - + - - + + + + + - - - + - -2 - + + + + - - + - - - - - + - - + -3 - + + + + - - + - - - - + - - - + -4 + - - - - - + - - - - - - + - - + -5 - + + - + - + - - - - - - + - - + -6 - + + + - - + - - - - - - + - - - +7 - + + + - - + - + + + - - + - - + -8 + - - + + - + - - - - - - + - - + -9 - + + - + - - + + + + - - + - - + -
10 + + + + + - - + - - - - - + - - + -11 + - - - + - - + - - - - - + - - + -12 - + + - + - + - - - - - - + - - - +13 + - + - + - + - - - - - + - - + -14 - + + + + - - + + - + - - + - - + -15 + - - + + + - + - + - - - + - - + -16 + - + + - - + - - - - - - + - - + -17 - + + + - - + - - + + - - + - - + -18 + - - + + - - + - - - - - + - - + -19 + - + - + - - + - - - - - + - - + -20 + - + + + - - + - - - + - + - + - -
Ahara a=Vegitarian, b=Mixed Vihara a=Adhika Vyayama, b=Divaswapna c=Vegadharana d=Adhika Vyavaya
Nidra a=Nidra adhika b=Alpa Vyasana a= Smoking b=Tobacco Chewing c=alcohol
Jataragni a=Vishamagni b=Tikshnagni c=Mandagni d=Samagni
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Table No 14. VIKRUTI PARIKSHA (NIDANA)
Sl.No. Aharaja Karan Viharaja Karana Manasika Karana Nidanart
hakara Karan
A1 A2 A3 A4 A5 A6 A7 A8 A9 B1 B2 B3 B4 C1 C2 C3 C4 C5 C6 d1 1 + - + + - - - + - + + - + - - - - - - -2 + + + - - - - + - + + - + - + - - + - -3 + - + + - - - - - + + - + - - - - + - -4 + + - + - - - - - - - - - - - - - - - -5 + + + - - - - + + + - - - - - - + - -6 - + + - - + + - - + + - - - - - + + - -7 + - + + - - - + + + + - + - - - - - - -8 + + - + - - - + - + - - + - - - - + - -9 + - + + - - - + + - + - + - + - - + +
10 - + + + - - - - - + + - + - - - + + - +11 + - + + - - - + - - - - + - - - - - - -12 + + + - - - - + - + + - - - - - - + - +13 + + + + - - - - - - + - + - - - - - - -14 + - + - + + - + + + + - + - - - - - - -15 + + + + - - - + - + - - + - - - - + - +16 + - + + - - - - - - - - - - - - - - - -17 + - + + - - - - - + + - - - - - - - -18 + - + + - - - - - + - - + - - - - - - -19 + - + + - - - + - + + - + - - - - - - -20 + + + + - - - + - + + - + - - - - - - -
A1=Amla Rasa A2=Lavanarasa A3=Katu Rasa A4=Madhura Rasa A5=Udada A6=Masha A7=Beans A8=Atyusna
A9=Madhyapana B1=Divaswapna B2=Adhika Vyayama B3=Adhika Vyavaya B4=Vegadharan
C1=Kama C2=Krodha C3=Bahaya C4=Shoka C5=Chinta C6=Lobha
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Table No 15
ROOPA OF KOSTA SHAKHASHRITA KAMALA
Sl. No.
OPD 1 2 3 4 5 6 7 8 9 10 11 12
B A B A B A B A B A B A B A B A B A B A B A B A1 934 + - - - + - + - + - + - - - + - - - + - + - + -2 1885 + - - - - - - - + - + - - - - - + - + - + - + -3 850 + - + - + - - - + - + - - - - - - - + - + - + -4 + 1345 - - - - - - - + - + - - - + - - - + - + - + -5 4692 + - - - + - - - + - + - - - - - + - + - + - + -6 223 + - + - + - - - + - + - - - + - - - + - + - + -7 3107 + - - - + - - - + - + - - - - - - - + - + - + -8 4885 + - - - + - - - + - + - - - + - + - + - + - + -9 3778 + - - - - - - - + - + - - - + - + - + - + - + -
10 2895 + - - - + - + - + - + - - - - - - - + - + - + -11 6590 + - - - - - - - + - + - - - - - + - + - + - + -12 3251 + - - - + - - - + - + - - - - - + - + - + - + -13 4563 + - - - + - - - + - + - - - - - - - + - + - + -14 1557 + - + - + - + - + - + - + - + - + - + - + - + -
1=Haridra Netra 2=Haridra Twaka 3=Haridra Nakha 4=Haridra anana 5=Raktapeeta mala 6=Rakta Peetamootra 7=Bhekha Varnatwacha 8=Daha
9=Indriya Dourbalya 10=Avipaka 11=Dourbalya 12=Aruchi
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Table No 16 ROOPA OF SHAKHASHRITA
Sl.No. OPD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
A B B BA B A B A B A B A B A B A A B A B A B A B A A B A B1 1056 + - + - + - + - - - - - + - + - + - - - - - - - - - + - + -2 2023 + - + - + - + - - - - - - - + - + - + - - - - - - - + - + -3 885 + + + + + - + - - - - - - - + + + - - - - - - - + - - - - -4 7166 + - + - - - + - - - - - - - + - + - - - - - - - + - + - - -5 6574 + - + - + - + - - - - - + - + - + - + - - - - - - - + - + -6 5124 + - + - + - + - + - - - + - + - + - + - - - + - + - + - + -
1=Haridra Netra 2=Haridra Mootra 3=Haridra Twaka 4=Sweta Varchata 5=Atopa 6=Vistamba 7=Hrudgraha 8=Dourbalya 9=Agnimandya 10=Parswasoola 11=Hikka 12=Kasa
13=Swasa 14=Aruchi 15=Jwara
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Table No 17. LABORATORY INVESTIGATION MASTER CHART
OPD 1 2 3 4 5 6 7 8
B A B A B A B A B A B A B A B A1 934 1.2 1 1 0.8 45 38 220 204 6.2 6 4.2 4.1 4 3 10.5 12.5 2 1056 9.5 0.889 8.5 0.655 140 35 790 120 6.8 6.5 4.5 4.5 2.3 2 12 113 1537 16.5 1.06 15 1 940 40 570 175 5.8 6 4 4.5 1.8 1.5 10 124 1885 4.6 0.81 2.6 0.654 210 50 260 200 6.5 6.2 4 4 2.5 2.2 11 135 850 11.6 8.5 11.1 7.9 315 39 302 90 9 5.8 5.5 3.5 5 2.3 11.5 126 885 12 8 11 4 300 40 350 261 6 4.9 4 2.7 2 2.2 10 8.447 1343 2.8 0.91 1.5 0.7 100 25 105 92 6.5 6.8 4.2 4.5 2.3 2.3 11 12.58 4692 2.8 0.9 2.1 0.7 42 25 131 128 6.4 6.5 7.6 4 2.5 2.5 12 149 2023 11 2 6.6 1.6 572 75 123 90 5.8 6 3.9 4 1.7 2 11.5 12.5
10 223 1.9 0.8 1.6 0.4 39 15 285 107 5.8 5 4 3.5 1.5 1.5 4.2 5.511 3107 8.3 0.5 5.3 0.2 48 14 271 260 7.5 7.5 4.5 4.2 2.8 2.8 11 1212 4885 1.5 0.89 1.2 0.7 25 15 98 78 6 6.5 3.5 4 2.5 2.5 6.4 813 3778 1.6 0.765 1 0.66 28 20 112 90 6.2 6.6 4 4.6 2.2 2 12.9 12.8 14 2895 2.6 0.6 1.8 0.3 60 22 290 123 5.1 4.2 4 3.8 2.2 2.2 11 1215 6950 3 0.8 2.6 0.7 46 25 138 95 7.8 6.5 5 4 2.9 2.5 7 816 7166 1.6 0.91 1 0.7 25 20 110 75 6 6.5 3.5 3.8 2.5 2 10 1117 3251 4.7 1.5 3.8 0.9 44 42 115 102 6 6 4.8 4.5 2 2 11.8 1318 4563 2.2 0.66 1.1 0.06 186 25 397 81 4.3 6.3 2.2 3.6 2.6 2.7 11 12.6619 6574 4 0.8 2.3 0.7 45 35 240 120 5.2 6 2.8 4 2.4 2 11 1220 5124 3.3 0.9 2 0.6 53 40 120 95 6 5.6 3.4 3 2.6 3 14 13
Total 106.7 33.194 83.1 23.929 3263 640 5027 2586 124.9 121.4 83.6 78.8 50.3 45.2 209.8 227.9
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Table No: 18
Assessment of subjective parameter Evaluation of the Efficacy of Phalatrikadiyoga in Kamala BT
AT BT AT BT AT BT AT BT AT BT ATa a b b c c d d e e f f
1 1 0 1 0 0 0 0 0 1 0 1 02 2 0 1 0 1 0 1 0 1 0 1 03 3 0 3 0 2 0 2 0 2 0 2 04 1 0 1 0 0 0 0 0 2 0 2 05 3 0 2 0 2 0 2 0 2 0 2 06 3 1 3 1 3 0 3 0 3 0 3 07 1 0 1 0 0 0 0 0 2 0 2 08 1 0 1 0 - 0 1 0 1 0 1 09 3 0 3 0 1 0 2 0 3 0 3 0
10 1 0 1 0 1 0 1 0 1 0 2 011 2 0 2 0 1 0 1 0 1 0 2 012 1 0 1 0 0 0 1 0 2 0 2 013 1 0 1 0 0 0 0 0 2 0 1 014 1 0 1 0 1 0 1 0 2 0 1 015 1 0 1 0 0 0 0 0 2 0 2 016 1 0 1 0 0 0 1 0 1 0 2 017 1 0 1 0 0 0 1 0 2 0 2 018 1 0 1 0 0 0 1 0 1 0 2 019 1 0 1 0 0 0 0 0 3 0 2 020 1 0 1 0 0 0 1 0 1 0 2 0T 30 1 28 1 4 0 19 0 35 0 37 0
a=Haridra Netra
c= Peeta Twakha e= Avipaka
b= Haridra Mootrata d= Peeta Nakha
f= Aruchi
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Table No: 19 Assessment of objective parameter
Sl No.
OPDNo Bile Salt Bile Pigment Bile salt Bile pigment Bile Salt Bile Pigment Bile Salt Bile Pigment
1 934 1 1 1 1 0 0 0 02 1056 2 2 1 1 0 0 0 03 1537 3 3 2 2 1 0 04 1885 2 2 0 0 0 0 0 05 850 2 3 2 2 1 0 0 06 885 3 3 2 2 2 0 1 17 1343 0 0 0 0 0 1 0 08 4692 2 2 2 1 0 0 0 09 2023 2 2 2 2 1 0 0 0
10 223 0 1 0 0 0 0 0 011 3107 2 2 1 1 0 0 0 012 4885 0 0 0 0 0 0 0 013 3778 0 0 0 0 0 0 0 014 2895 2 2 1 0 0 0 0 015 6950 1 1 0 0 0 0 0 016 7166 0 0 0 0 0 0 0 017 3251 2 2 1 1 1 0 0 018 4563 2 2 1 0 0 0 0 019 6574 2 2 2 1 1 0 0 020 5124 2 2 2 1 1 0 0 0
Total 30 32 20 15 8 1 1 1
Assessment of Urine Bile salts and Bile Pigment based on +=1,
++=2, +++= 3,
0=Nil
Master charts
89
Table No: 20
Statistical Assessment of parameters of evaluation of the efficacy of Phalatrikadiyoga in Kamala parameters Before
Treatment mean + S.D
After Treatment mean + S.D
Net Mean differenc
e
Net S.D S.E T Value P. Value Remarks C.V. BRx. C.V. A.Rx
Haridra netra 1.85 + 0.745 0.05 + 0.223 1.45 0.759 0.169 8.579 < 0.001 H.S 39.25 43.58
Haridra mootrata
1.A + 0.753 0.05 + 0.223 1.35 0.671 0.15 9 < 0.001 H.S 52.48 43.58
Peeta Twakha 0.6 + 0.883 ------- 0.6 0.883 0.197 3.04 < 0.01 H.S 143.37 -------
Peeta Nakha 0.95 + 0.825 ------- 0.95 0.825 0.184 5.163 < 0.001 H.S 84.70 -------
Avipaka 1.75 + 0.716 ------- 1.75 0.716 0.160 10.937 < 0.001 H.S 39.89 -------
Aruchi 1.85 + 0.587 ------- 1.85 0.587 0.131 14.122 < 0.001 H.S 30.92 --------
Total Bilirubin 5.335 + 4.475 1.659 + 2.278 3.6928 3.8018 0.85 4.34 < 0.001 H.S 81.76 133.829
Direct Bilirubin
4.155 + 4.124 1.196 + 1.772 2.9585 3.409 0.762 3.88 < 0.01 H.S 96.74 24.67
SGPT 163.15 + 229.19 32.5 + 15.059 131.15 221.165 49.45 2.652 < 0.01 H.S 136.92 45.16
SALP 251.35 + 176.72 129.3 + 58.418 122.05 169.161 37.825 3.27 < 0.01 H.S 68.52 44.03
Total Protein 6.27 + 0.957 6.07 + 0.732 0.7 0.773 0.173 4.05 < 0.001 H.S 148.85 117.54
Serum Glb 2.515 + 0.783 2.26 + 0.4185 0.345 0.6039 0.315 1.095 > 0.1 N.S 30.36 18.04
Serum Alb 4.18 + 1.084 3.94 + 0.5 0.73 0.86 0.193 3.78 < 0.001 H.S 25.27 12.39
Hb % 10.395 + 2.145 11.523 + 2.146 1.256 0.427 0.095 13.22 < 0.01 H.S 20.11 18.15
Bile Salt 1.5 + 1.00 0.05 + 0.223 1.45 0.9445 0.211 6.86 < 0.001 H.S 64.97 43.58
Bile Pigment 1.6 + 0.995 0.05 + 0.223 1.55 0.9445 0.221 7.35 < 0.001 H.S 60.59 43.58
HS = Highly Significant, NS = Not significant
Master charts
90
The present clinical trial was meant for “An evaluation of the efficacy of
Phalatrikadiyoga” in Kamala (Jaundice). The patient selected for the age of 10 years to 60
years irrespective of sex.
Total 24 patients were diagnosed as a Kamala out of them, 20 patients were
selected for the clinical trial. All are assessed before and after treatment. Both objective and
subjective changes were recorded.
Age and Sex
Out of 20 patients more number of Patients i.e. 7 (35%) were in the age group of 30-
40 years and 2 (10%) were in the age group of 10-20 years. Male patients are more in this
study that is 12 (60%) were female are 8 (40%) in number. Tabular and graphical
representations are shown as under in table-21 and graph-1.
Observations & Results 91
Table No 21 Table describes the distribution based on Age and Sex.
Sl No.
Age in years
Male % Female % Total %
1 10-20 01 5 01 5 02 10
2 20-30 03 15 00 0 03 15
3 30-40 02 10 05 25 07 35
4 40-50 03 15 01 5 04 20
5 50-60 03 15 01 5 04 20
Total 12 60 08 40 20 100
Below depicted graph describe the above statement distribution based on Age and Sex. Graph No. 1
Observation
An at
present study
of Kamala. I
under went h
belonging to
graphical rep
Female40%
Male60%
based on Religion
tempt was made to under stand the religious influence in this disease, the
explain Hindu & Muslim Communities patient’s are reported with the disease
t doesn’t mean others don’t have this disease. The area in which the study
as this group of populations out of 20 patients recorded 16 (80%) patients
Hindu religion and only 4 (20%) patient belonging to Muslim. Tabular and
resentations are shown as under in table-22 and graph-2.
Observations & Results 92
Table No 22
Table showing the Observation based on Religion
Sl No. Religion No of Patients Percentage 1 Hindu 16 80
2 Muslim 04 20
3 Christian 00 00
4 Other 00 00
Total 20 100
Graph No. 2 Below depicted graph describe the above statement.
Occupation
In this s
study out of 20
Patient each 3
service group.
graph-3.
Christian0%
Muslim20%
Other0%
Hindu80%
tudy we considered four categories of occupations for the convenience of the
patient Maximum 12 (60%) were labour group are affected with disease. 3
(15%) were students and house wife respectively remaining 2 [10%) were
Tabular and graphical representations are shown as under in table-23and
Observations & Results 93
Table No 23
OBSERVATION OF PATIENTS ACCORDING TO THEIR OCCUPATION
Sl No. Occupation No of Patients Percentage 1 Housewife 03 15
2 Service 02 10
3 Student 03 15
4 Labour 12 60
Total 20 100
Graph No.3
Student15%
Service10%
Housewife15%
Labour60%
Socioeconomic status
Economical status had an impact over this disease process as dietetic influences
and food habits make a difference here. In this study most of the patients 9 (45%) in the
Observations & Results 94
Middle class 7 (35%) patients belonging to poor class and 4(20%) patients belonging to
Rich. Tabular and graphical representations are shown as under in table-24and graph-4.
Table No 24. Observation of patients according to the socioeconomic status
Sl No Economical Status
No of patients Percentage
1 Poor 07 35
2 Middle 09 45
3 Rich 04 20
4 Aristocrat 00 00
5 Total 20 100
Graph Distribution based on socioeconomic Condition.
Graph No.4
Diet:
Diet
study as ob
vegetarian
Rich20%
Middle45%
Poor35%
Aristocrat0%
regimen is another important factor for the production of the diseases in the
served with that of economical status. It was observed that the incidence of
and mixed diet users when compared looks resembling. Out of the 20 patients,
Observations & Results 95
10 (50%) were vegetarian and 10 (50%) patients are with mixed diet. Tabular and graphical
representations are shown as under in table-25and graph-5.
Table No 25.
Observations of patients based on diet.
Sl.No. Diet No. of Patients Percentage 1 Vegetarian 10 50
2 Mixed 10 50
Total 20 100
Graph No.5
Observations of patients based on diet.
Habits
Incidence o
Alcohol and Tobac
patients alcohol, s
smoking. Tabular a
Mixed50%
Vegetarian50%
f habits shows that 05(25%) of patients were having the drinking of
co chewing, 04(20%) of patients exposure to the smoking, 03(15%) of
moking and tobacco chewing, 01(5%) of patients tobacco chewing and
nd graphical representations are shown as under in table-26and graph-6.
Observations & Results 96
Table No 26
Observation of patients based on Habits.
Sl.No Habits No of
patients %
1 Alcohol 05 25%
2 Smoking 04 20%
3 Tobacco Chewing 05 25%
4 Alcohol, smoking & Tobacco
Chewing
03 15%
5 Alcohol, Tobacco Chewing 01 05%
6 Smoking, tobacco chewing 00 00%
Graph No.6
Observation of patients based on Habits.
Alcohol27%
Smoking22%
Tobacco Chewing
28%
Alcohol, Tobacco Chewing
6%
Smoking, tobacco chewing
0%
Alcohol, smoking & Tobacco Chewing
17%
Agni In Ayurveda Antaragni Chikitsa is undertaken. More over bhutagni paka is performed
in the liver, the organ related to the disease development. Thus to know the state in the
disease is necessitate. The state of Agni in 18 (90%) patients observed as mamdagni,
Observations & Results 97
01(5%) patient each were in the criteria of vishamagni and tikshnagni. This observation
states that the mandagni causes the disease. Tabular and graphical representations are
shown as under in table-27and graph-7.
Table No 27
Observations of patients based on Agni.
Sl.No. State of Agni No of Patients Percentage 1 Vishamagni 01 5%
2 Tikshnagni 01 5%
3 Mandagni 18 90%
4 Samagni 00 00%
Graph No.7
Kosta:
were b
represe
Vishamagni5%
Tikshnagni5%
Mandagni90%
Samagni0%
The madhayama kosta was present in 16 (80%) of patients, 02 (10%) of each patient
elonging to the kroora and mrudu kosta respectively. Tabular and graphical
ntations are shown as under in table-28and graph-8.
Observations & Results 98
Table No 28 Observations of patients based on Kosta
Sl.No. Kosta No of patients Percentage
1 Kroora 02 10%
2 Mrudu 16 80%
3 Madhayama 02 10%
Total 20 100%
Graph No.8
Madhayam
Nidanartha
Pan
Out of 20 p
patients do
shown as u
K roora10%
Mrudu80%
a10%
kara Roga
du Roga is one of the etiological factors for Kamala as Nidanarthakara Roga.
atients 4 (20%) of patients were with the history of Pandu. Rest of the 16 (80%)
esn’t give any such information. Tabular and graphical representations are
nder in table-29 and graph-9.
Observations & Results 99
Table No 29
Observation of patients based on Nidanarthakara Roga
Sl.No Nidhanrthakhara karan
No of patients Percentage
1 Pandu Roga 4 20 2 None 16 80
Graph No.9
Kamala symptom
Assessme
of these study rev
Mutra, Avipaka a
(70%) patients we
(45%) were parsw
were complained
(20%) patients we
No patients have
shown as under in
None80%
Pandu Roga20%
s
nt of the symptom in Kamala is the subjective parameter study. Symptoms
eals that all the 20 (100%) patients were complained peeta Netrata, Peeta
nd Aruchi. 18 (90%) were complained dourbalya and Angasada and 14
re complained peeta purisha and peeta nakha. 13 (65%) were hrullasa 9
a peeda and 07(35%) were peeta twakha and khandu. 6 (30%) patients
avipaka, sweta varchata and 6 (30%) were Hrutapeeda and chardi. 4
re complained swasa and 2 (10%) patients suffered with peeta mukham.
shown the complaint Hikka. Tabular and graphical representations are
table-30 and graph-10.
Observations & Results 100
Table No 30 Data related to the disease,
Showing the presenting complaints of the patients
Complaints No of patients Percentage 1 Peeta Netrata 20 100 2 Peeta Mutrata 20 100 3 Avipaka 20 100 4 Aruchi 20 100 5 Dourbalya 18 90 6 Angasada 18 90 7 peeta Nakha 14 70 8 peeta Purisha 14 70 9 Hrullasa 13 65 10 Paraswa Peeda 09 45 11 Daha 08 40 12 Peeta Twakha 07 35 13 Khandu 07 35 14 Sweta varchata 06 30 15 jwara 06 30 16 Hrutapeeda 05 25 17 Chardi 05 25 18 Swasa 04 20 19 Peeta Mukha 02 10 20 Hikka 00 00
Graph No.10
Hikka0%
Aruchi9%
Angasada8%
Dourbalya8%
Avipaka9%
Daha4%
Peeta Mukha1%
peeta Purisha6%
Peeta Mutrata9%
peeta Nakha6%
Khandu3%
Chardi2%
jwara3%
Hrullasa6%
Swasa2%
Paraswa Peeda4%
Hrutapeeda2%
Sweta varchata3%
Peeta Twakha3%
Peeta Netrata9%
Observations & Results 101
Types of Kamala
As we have taken randomized study of Kamala the types of Kamala also assessed
here. Out of 20 patients 14 patients are having kostha shakhashrita Kamala and reaming 6
were with shakhashrita Kamala. Tabular and graphical representations are shown as under
in table-31 and graph-11.
Table No 31 Showing the types of kamala
Sl.No Types of Kamala No of patients Percentage 1 Kosta shakhashrita 14 70%
2 Shakashrita 06 30%
Total 20 100%
Graph No.11
Subjec
Here in
texts a
Mutrata
Grade
Shakashrita30%
Kosta shakhashrit
70%
tive parameters
Subjective parameters are the essential readings of the any Ayurvedic research.
this research it was found that all the subjective parameters took from the classical
re standard and seems to be quintessential even in this era. Peeta Netrata, Peeta
, Peeta Twakha, Peeta Nakha, Aruchi and Avipaka are dealt in different grades as
0 =Nil, Grade 1=Mild, Grade 2 = Moderate, Grade 3 = Severe. The grade wise
Observations & Results 102
observations are dealt as under. Tabular and graphical representations are shown as under
in table-32.
Table No 32 Observations and Assessment of subjective parameter
Sl.No Symptoms Gr 3 % Gr 2 % Gr 1 % G 0 % 1 Peeta
Netrata 4 20 2 10 14 70 - -
2 Peeta Mutrata
2 10 3 15 15 73 - -
3 Peeta Twakha
1 05 2 10 5 25 9 45
4 Peeta Nakha
1 05 3 15 10 20 06 30
5 Aruchi 2 10 12 60 6 30 6 Avipaka 3 18 9 45 8 40
Results of Phalatrikadiyoga in Kamala
Results are declared based on the subjective and objective parameters. The data of
the patients in the trail is as under.
Table No 33
Cured Major improvement
Minor improvement
Unchanged Discontinued
1 934 + - - - - 2 1056 + - - - - 3 1537 - + - - - 4 1885 + - - - - 5 850 - + - - - 6 885 - - + - - 7 1343 + - - - - 8 4692 + - - - - 9 2023 + - - - -
10 223 + - - - - 11 3017 + - - - - 12 4885 + - - - - 13 3778 + - - - - 14 2895 + - - - - 15 6950 + - - - - 16 7166 + - - - - 17 3251 + - - - - 18 4563 + - - - - 19 6574 + - - - - 20 5124 + - - - -
17 2 1 0 0
Observations & Results 103
The results cumulatively declared under five headings as, presumed initially. They
are cured, improvements in the major and minor categories and lastly unchanged and
discontinued. The result cured is declared to the patients those who have totally cleared with
the presenting symptoms and free from abnormal or deviated lab investigations such as liver
profile. The number patients under this category with are 17 i.e. 85%. There is no patient
who doesn’t respond to the treatment. Rests of three patients are under major improvement
and minor improvement cadres as 2 and 1 patient respectively. The finalised and
summarized result sheet is as under. Tabular and graphical representations are shown as
under in table-33, 34 and graph-12.
Table No 34 s.No Result Number of patients Percentage 1 Cured 17 85 2 Major improvement 2 10 3 Minor improvement 1 5 4 Unchanged 0 0 5 Discontinued 0 0 Total 20 100
Graph-12 Results of Phalatrikadiyoga in Kamala
Majorimprovement10%
Discontinued0%
Unchanged0%
Minor improvement
5%
Cured85%
Observations & Results 104
The main aim of these work lies in collecting the Concept of Kamala including it’s
Paribasha, Nidana panchaka and it’s management. Ayurveda claims to a number of
effective remedies infract most of the people suffering from the different varieties of
Kamala, many of etiological factors are mentioned for the Jaundice, but till today the
exact cause was not find out.
As a resultant day today practice receives number of patients suffering from
Kamala (Jaundice) and its complications as the negligence of Kamala management. In
contemporary medical system jaundice is the word analogous with Kamala. The
disease, which is, characterised by the colour pigmentation such as greenish, yellowish
and white etc, Kamala and Pandu appear to have been studied.
In Ayurveda it was clearly mentioned that Agni mandya and Pitta vikruti are the
main Causative factor for the Kamala, in this clinical study it was observed that all the 20
patients are shown Agni vikruti, in terms of Pitta vikruti.
Major literatures of Ayurveda explain the disease Kamala and it’s management.
In Charaka Samhita Kamala is mentioned as Nidanarthakara Roga of Pandu. The later
author Vagbhata explained about Swatantra Kamala apart from the Paratantra Kamala,
which was explained by the Charaka and Susruta. However the predominant Dosha in
both Swatantra and Paratantra Kamala is the Pitta Dosha. Dalhana, Susruta Samhita
commentator, in his ideology on Kamala enrolled the term Panaki as a variety of
Kamala.
Total 24 patients were diagnosed as a Kamala out of them, 20 patients were
selected for the clinical trial. The Kamala Roga is seen to independently and also as a
sequel to Pandu Roga. In the present study we have observed that out of 20 patients 6
patients were having Pandu Roga.
Discussion and conclusion 105
In this study it is observed that out of 20 patients, 12 were male and 8 are female
patients. So was concluded that the Male are more prone for the Kamala, the study was
limited to only 20 patient, so for that, this ratio may not amend when it is observed in
large number.
Mentioned etiological factors provoke Pitta, with their specific qualities. “Agnireva
shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid having Ushna
and teekshna properties enough and sufficient to digest the food. With the above-
mentioned Nidana person with vitiated Pitta and Agni is unbalancing the functions of
liver where mala roopa Pitta is discharged. When hypo functioning of Pitta (Agni)
consequently in turns produce Ama or Amavisha. This Ama corresponds with Rakta and
may produce Kamala.
The Alcohol is Considered as one of the etiological factor for the jaundice, in
classes it was explained that ati-madhyapana is one of the causative factor for Kamala.
In this clinical study that was also observed that most of the patient are alcohol habitual.
Aharatmaka karana:
Asatmya ahara sevana, excessive intake of Amla, lavana, katu and madhura
rasa pradhan ahara dravya, rooksha, Guru, sheeta guna ahara padarthas vitiates the
Jatharagni, the hypo functioning of Jatharagni leads to the Kamala. All above-mentioned
etiological factors are responsible on the vitiation of the Pitta. In turn vitiated Pitta,
vitiates the Rakta thus the samprapti of the Kamala begins, As the vitiation of Rakta is
the major step in the pathogenesis, So for it has been counted in the Rakta vaha sroto
vyadhi.
Asatmya sevena means that which is non compatible to the body. Here we can
consider alcohol, smoking and Tobacco chewing are harmful to the body can cause
Kamala.
Discussion and conclusion 106
Thus the asatmya ahara like rooksha and Guru, Guna, Madhur, lavana, Amla
and katu rasa pradhanahara if taken regularly excessive causes Kamala. These are
non-homologous and Causes Rakta and Pitta prakopa. Thus cause Pandu Roga before
to Kamala and Pandu Roga is the causative factors of the Kamala Roga that’s why
Pandu Roga is said as nidanarthakara karan for the Kamala.
Ativyayama:
Excessive vyayama leads to Pitta and Vata Dosha prakopa takes place further it
leads to dhatukshaya, simultaneously impaired the kayagni.
Divaswapana:
Excessive day sleep aggrivates the vata and kapha, it leads to agnimandya.
Vegadharana:
The natural urges like mala, mootra it forcefully control, aggravates Vata Dosha,
vitiated Vata cause Kayaagni vikruti, and leads to mandagni. In this study it was advised
the many patients be reported with divaswapna, adhika vyayama, An advice to the
patients to avoid. Thus shows an improvement in kayagni.
Mansika Karana:
Manasika karanas like stress and strain are not observed in the present study.
So it was concluded that there is no role in the Kamala.
The specific samprapti of Kamala is not mentioned in the classics. Only
shakhashrita Kamala Nidana and samprapti explained from above etiological factors one
can establish the process of pathogenesis as under Pandu Roga in this conditions, the
patient not taken proper medication and indulgence of excessive amount of Pitta
vadhaka aharas are vitiate the Pitta. Dahana, pachan, vivechan karma unbalancing and
not proper nourishing the rasa, raktadi dhatu.
In shakhashrita Kamala excessive intake of Guru, sheeta, Rooksa, Madura rasa
ahara, aggravates the Kapha Vata Dosha, and diminishes the Pitta. Increased slesma
Discussion and conclusion 107
obstruct in the Pitta marga resulting on vimarga gamana of Pitta, this results the
shakhashrita Kamala.
The management of Kamala, more single drug therapy and compound drugs
explained in our classics, about the supremely and relevancy of phalatrikadhiyoga
explained in text, but these drugs are Kamala hara properties and individual drugs
katuki. Bhumyamalaki, Bhrungaraja, Nimba, Guduchi, Haritaki, katuki vasa are also
studied for their hepato-protective properties and the result are encouraging.
Considering the above fact the combination of the drugs given desired effect.
Kamala was successfully, treated with Phalatrikadiyoga. The medicine combination is
also showed the hepato-protective property.
Phalatrikadiyoga is a potent combination to treat Kamala based on it’s
properties and pharmacological action. It is predominately Tikta and Katu rasa, laghu,
rooksha Guna’s Ushna Veerya, Madhura vipaka and Pitta shamaka properties. The
composition is as follows.
1) Haritaki 1 part
2) Bibhitaki 1 part
3) Amalaki 1 part
4) Guduchi 1 part
5) Vasa 1 part
6) Kiratatikta 1 part
7) Katuki 1 part
9) Bhumyamalaki 1 part
10)Bhrungaraja quantity sufficient
The contents of Phalatrikadiyoga drugs were selected by the classical reference
in Baishajya Ratnavali. In this reference Phalatrikhadi kwath was mentioned but the
same ingredients are taken in the form of choorna.
Discussion and conclusion 108
The patients with the conformed diagnosis of Kamala clinically as well as
laboratory investigations are selected for the study. The main criteria for selection of the
patients were symptomatolagy and laboratory (investigation) evidences of the serum
bilirubin and other liver function test values. The patients presenting above lakshans two
or more were considered clinically with laboratory evidences of urine bile salts and bile
pigments along with liver function values. Severe Jaundice patients, complications of
Jaundice, who will not agree for the study also excluded.
The Haritaki is also used as rasayan, safe and anulomana, Astringent,
Stomachic, tonic and anti helmentic. It is also indicated in Kamala, Grahani, Shoola,
Anaha, Pleeha, Bleeding and external ulcers etc.
The Bibhitaki is used as a Astringentum, tonic and laxative,it prescribed in
disease liver and gastro intenstinal tract.
The Amalaki, its best rasayana, Ruchya Deepana, Anulomana, yakridduttejaka
and a good antioxidant used in dyspepsia, Jaundice, Vertigo and prameha.
The Guduchi is a rasayana, it stimulates the bile secretion, thirst, fever burning
Sensation, vomitting, enriches the blood, cures the Jaundice.
The vasa, is a best appetizer, bitter in taste, used in bronchitis, asthma, fever,
blood impurities, cardiac problem and jaundice.
The kiratatikta is bitter, cooling, antihelmintic, antipyretic, laxative,
antiinflammation, burning sensation.
The katuki is Deepana, bedhana, Kasa, krimi, kustam, laxative. Alcoholic extract
of the root is found to have antibacterial effect. The drug is found useful in treatment of
jaundice.
The Nimba is best Pitta shamaka. Used in burning sensation, fever, thirst, ulcers
and inflamation, Raktashodhaka, Netraroga, Kasa and Kamala.
Discussion and conclusion 109
The Bhumyamalaki is considered de-obsruent, diuretic, astringent and cooling.
A decoction of plant is administered in jaundice, liver stimulant thrust controls, prameha.
The Bhrungaraja leaves largely used in liver diseases, it is a keshya, krimi,
kasa, Sotha, Pandu, Rasayana, Kamala and Hepato protective activity.
Synergetic effect of Phalatrikadiyoga on Kamala
i. Deepana and Amapachana.
ii. It restore the Agni vyapara eliminates the vitiated Pachakapitta,
Ranjakapitta, saman and vyanvata and Kledakakapha.
iii. Capable to relieving the ashruka and mamsha dagdata.
Criteria for the selection of Phalatrikadiyoga in Kamala
i. Phalatrikadiyoga is very effective in Kamala.
ii. The ingredients are easily available in the market.
iii. Method of preparation is simple & economical.
iv. Many of the ingredients of Phalatrikadi drugs are clinical proved as
hepato-protective.
Probable mode of action of Phalatrikadiyoga in Kamala
The pharmaco dynamics in Ayurveda is mainly based on the fundamental
doctrine of phanchamahabuta and Tridosha theory, which govern the physico-chemical
and biological phenomena respectively.
Phalatrikadiyoga can reduce the symptoms as well as disease process due to
the various actions of the individual drugs, in the mechanism and action is confined in
the Rasa, Guna, Veerya, Vipaka and Prabhava of the individual drugs.
The Veerya as the potency of drug by which the action is carried out
commentator Chakrapani Explain that the Veerya is two types, chintyam and achintyam,
chintayam which can be inferred and understood, Achintyam which is beyond the
inference of human imagination. Achintya Veerya is known as the prabhava,this special
Discussion and conclusion 110
property which produces action in different forms ascribed audits of Rasa, Guna,
Veerya, Vipaka and Prabhava.
All the drugs of Phalatrikadiyoga have some similarities with respect to their
Rasa, Guna, Veerya and Vipaka. All have katu, tikta rasa and katu vipaka with respect to
guna it can observe that rooksha and laghu are common in these ingredients of the
formulation.
Statement gives clear idea about Karmukata of the drugs. Which have a specific
role to play in this disease.
The Kamala is one of the Pitta and Rakta produshaja vyadhi here Pitta is vitiated
and the help of Tashaya, Tikta and Madura rasa prodhan dravya normalizes it, and
Phalatrikadiyoga is best deepana, Amapachan, Pitta prasaman, and srotovishadhan.
The management of Kamala, more single drug therapy and compound drug’s
explained on our classics, about the supremacy and relevancy of Phalatrikadiyoga
explained in text. These drugs are Kamala hara properties, and individual drugs katuki,
Bhoomyalaki, Bhrungaraja, Nimka, Guduchi are also studied for their hepato protective
properties and the result are encouraging.
Considering the above fact the combination of the drugs given desired effect.
Kamala was successfully, treated as Phalatrikadiyoga. The medicine combination is
also showed the hepto-protective property.
Conclusion
1. Based on the literature a close perusal of the observation and interference the
conclusion drawn from the present study can be presented here, Kamala is
characterised by the yellowish discoloration of sclera, skin, nails, urine and stool.
2. Diagnosis of the disease based on the yellowish discoloration sclera, urine, faeces
and Nails.
Discussion and conclusion 111
3. It is a disease in which Pitta Dosha effect over Rakta and mamsadhatu. It leads to
Kamala.
4. Kamala explains in the classics under the Pandu Roga chapter.
5. Kamala mainly classified two types.
a) Kastashakhastrita b) shakhastrita
6. It is depending upon the dispersal of Pitta in the body.
7. Kasta shakhashrita Kamala is manifested as a sequel Pandu and shakhastrita
Kamala Vata and Kapha Dosha and dushya Rasa, Rakta, which obstructs the
passage of Pitta varga.
8. Kamala may occur independently and sequel of Pandu Roga.
9. The Pitta is in abnormal production during the paka of Rakta Dhatu. Pitta formed,
during the phatu paka of Rakta, it passes through the Rakta sthan of Yakrit and
enters kosta. The bhutagni paka take place in the Yakrit, it derives additional support
from some of the important post digestive functions and metabolic event’s which
have been shown by modern advances on physiology and bio-chemistry to takes
place in Yakrit. The vilakshana gunas can apply to a complete change over the
qualities of ahara dravyas ingested which do not take place in the adho Amashaya,
Bhutagnipaka is required to process and convert them suitably homologues of
substances which compose of the seven dhatus.
10. The Phalatrikadiyoga it repair the Agni vikruti and restore the normally of Agni
vyapar.
11. The probable mode of action of Phalatrikadiyoga acts as a deepana, panchana, and
Pitta prasamana along with Kapha hara quality.
The statistical evaluation of Phalatrikadiyoga in Kamala has shown highly
significance in both the parameters. The parameters studied are shown in table number
20.
Discussion and conclusion 112
Haridra netra, Haridra mootrata, Peeta Nakha, Avipaka, Aruchi, Total Bilirubin
Total Protein, Serum Albumin, Bile Salt and Bile Pigment has shown highly significance
with the P-Value as <0.001.
Haemoglobin percentage, SGPT, Serum Alkaline phosphate, Peeta Twakha and
Direct Bilirubin has shown P-value as <0.01, which is significant. Only Serum Globulin is
not significant with the P-value as > 0.1.
The result cured is declared to the patients those who have totally cleared with
the presenting symptoms and free from abnormal or deviated lab investigations such as
liver profile. The number patients under this category with are 17 i.e. 85%. There is no
patient who doesn’t respond to the treatment. Rests of three patients are under major
improvement and minor improvement cadres as 2 and 1 patient respectively. The
finalised and summarized result is as under.
Results of Phalatrikadiyoga in Kamala
So
can be e
satisfactor
thus the Phalatrikadiyoga is very economical, safe and effective drug hence it
mployed safely in Kamala (Shakashrita and Kostashrita), which gives
y results.
Major improvement
10%
Discontinued0%
Unchanged0%
Minor improvement
5%
Cured85%
Discussion and conclusion 113
Summary
• The modern and Ayurvedic concepts of Kamala are similar.
• The term Kamala is derived by the root ‘kamu’ which means kanti by suffixing Nhin’’
pratyaya is substituted by kalaha thus the term Kamala is kumu + Nhin (kalaha)
• The word Kamala developed and explained as “ kamam kantim harati haridra
varnam lati iti Kamala’”. Haridra is yellowish discoloration, lati means Runaddati or to
get yellowish discoloration, In other words Kamala is a disease in which an individual
looses interest in all aspects and gets the yellowish discoloration.
• The Kamala would be point out to a disease conditions in which hunger and appetite
for food are diminished, simple meaning of Kamala is a disease where there is little
or no desire for food according to Harana Chandra.
• Yellowish discoloration of the skin, selera, mucous membranes, and excretions due
to hyper biliruibinemia and deposition of bile pigment’s are seen in Kamala i.e.
jaundice.
• In classics the different terminology are used for the Kamala.
• In Atharvaveda Kamala was known as Harima, Harita, vilohitatwa and Haridraka.
Dalhana while commenting on Susruta reviewed the different stages of Pandu Roga
and declared that Kamala with terminology such as panaki, apanaki, kumbha
Kamala, lagharaka, Alasa, Alasakya etc. Astanga Hridaya used the word lothara as
synonyms of Kamala.
• Chakrapani has used the term “Bahu Pitta Kamala as the synonyms of
kostashkhastrita Kamala and alpa Pitta Kamala as the synonyms of “shakhashrita
Kamala.
Summary of Phalatrikadiyoga on Kamala 114
• Charaka has classified the disease Kamala in two types.
1. Kostha shakhashrita Kamala
2. Shakhasharita Kamala
• Susruta has stated the Kamala is a later stage of Pandu Roga and kumbha Kamala,
lagharaka, Alasa and Haleemaka are it’s different stages.
• Bahu Pitta Kamala or kostha shakhashrita Kamala Alpa Pitta Kamala or shakhashrita
Kamala are the varieties of Kamala.
• Acharya Charaka and Vagbhata described the shakhashrita Kamala.
• The Disease Kamala is one of Nidanarthakara Roga of Pandu. The etiological
factors of Kamala broadly explain in the classics.
• The below mentioned are the conditions of kosta shakhashrita Kamala and
shakhashrita Kamala can occur in different situations.
• These factors play role in kostashakha shritaKamala or bahu Pitta Kamala. In such
cases all causative factors play their role in vitiating Pitta. This condensation of Pitta
of functional and sensible hyper activity may result in to Kamala from the following
Pitta vitiating ahara, vihara etc.
• The above mentioned etiological factors provoke Pitta, with their specific qualities.
“Agnireva shareere Pittantargatha” Agni has its seat in Pitta. Pitta is composite fluid
having Ushna and teekshna properties enough and sufficient to digest the food.
• With the above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing
the functions of liver where mala roopa Pitta is discharged. When hypo functioning of
Pitta (Agni) consequently in turns produce Ama or Amavisha. This Ama corresponds
with Rakta and may produce Kamala.
Summary of Phalatrikadiyoga on Kamala 115
• Pitta has its seat in Rakta has the Ashrayashrayee bhava because are of same
qualities i.e. “Samavaguna”. The by-product of Rakta i.e. Pitta is produced in excess
consequently producing bahu Pitta, with results in to “kostashakhashrita Kamala”
• Kamala a disease of elevated bile in the blood is visualized in so many roots.
Created in the stricture of bile duct. This results in to the shakhashrita Kamala.
• The abnormal increased state of Pitta this is outcome of disturbance in paka of
Rakta. Pitta vriddhi at the level of Rakta paka independently causes Pandu.
Because of Pitta ushna and teekshna guna’s of Pitta more of Rakta will be take
place, consequently it turns the effect of Yakrit and Pleeha are the main organ’s of
Rakta Dhatu. During the destruction of the Rakta there may from mala of Rakta i.e.
Pitta abnormally in its quantity.
• There occurs the Vimargagamana of Pitta. In shakhashrita Kamala Vata and Kapha
are predominant. And not only Pitta is prevented from passing into the gut but also
regurgitated this is vimarga of Pitta.
• The disease manifestation sites are specifically liver and spleen.
• The liver is the largest glandular organ in the body, and has more functions than any
other human organ. The Liver has a pivotal role in human metabolism.
• The liver secretes bile, which comprises salts and pigments, and aids the digestion
of fats.
• Kamala according Ayurveda is a disease of Rakta Dhatu, it is explain under context
of Rakta ruddi laxana and Charaka explain under the Rakta pradusaja Vyadhi,
Kamala related organ is a Yakrit, it is a moola of Rakta vaha Srotas all Acharyas has
same opine regarding Srotas .
• In Kamala the Dosha vitiated is Pitta. The prime symptoms of Kamala is yellowish
discoloration of Netra, twacha, mootra etc because of vitiated Pitta Dosha,
Summary of Phalatrikadiyoga on Kamala 116
Ranjakapitta is mainly contributory of above-mentioned symptoms. The samprapti of
shakashrita Kamala is clearly mentioned in classics, that Kapha obstructs Pitta. So
Pitta will not reaches the kosta resulting tila pistanibham. From above explanation
we conclude the Yakrit and Pitta Dosha involved in disease of Kamala.
• The mala rupa Pitta or bile is produced in liver continuously. Only bile salts are use
full in digestion. Bile acts as the own stimulant, bile salts are the strongest
chologogues. The malarupi Pitta is also known as malaranjaka Pitta since it imparts
colour to the faeces.
• The physical characteristics and qualities of the Pitta described in ancient Ayurveda
classics striking resemblance to hepatic bile (better still the combined bile and
pancreatic juicy. The payments of bile the bilirubin and biliverdin are essential
constituents of the haemoglobin complex. From this point of view, it may be stated
that, Rakta is the seat of Pitta the bile pigments is also the waste products or mala of
the blood. Rakta and Pitta have identical colour. The blood separates into two parts
the lower contains the cells and is opaque and red. The bilirubin contributes to the
normal colour of the plasma, both blood and bile have nearly the same
characteristics fleshy smell. Pitta may refer to the hepatic bile or possibly, to the
combined bile and pancreatic juice.
• Susruta coated Yakrit and pleeha are main seat of Ranjakapitta, in function he has
stated, that it confers colour to Rasa i.e., Rasa ragakrit. In treatment aspect Susruta
coated goat liver with raw drug, together with the Pitta contained in it, in the
treatment of loss of blood in Rakta Pitta. In view of the important function of Rakta, a
separate Pitta necessarily required for the production of it.
• Charaka describing under the heading of general function of Pitta, the product of
normal and abnormal temperature and color of the skin is due to the Pitta.
Summary of Phalatrikadiyoga on Kamala 117
• Susruta and Vagbhata directly mentioned Ranjakapitta its seat and functions. Pitta
classified under different groups not only under the five headings they are maturity
quality functions etc.
• This malarupa Pitta is an excretion from Yakrit seat of Rakta dhatu and imparts
colour to pureesha and therefore it is also known as malaranjaka Pitta.
• There is another important classification of the Pitta in the body based on their
function particularly metabolic processes
• Apart from three Doshas Susruta explain Rakta as 4th dosha. Pitta is mala of rakta
dhatu Vata, Pitta, Kapha and Rakta these are essential factors for sharira Utpatti,
sthiti and Nasa.
• The causative factors for all the diseases are Tridosha mainly they are Vata Pitta and
Kapha. Rakta Dhatu is the group of organs concerned with the production and
maintenance of Rakta Dhatu. In addition Acharyas recognized Yakrit and Pleeha as
Rakta sthana.
• Yakrit is closely related with Rakta Dhatu and Pitta Dosha. Kamala has been
included in the disease caused due to the situation of morbid Doshas in Rakta dhatu.
It is clear from the above observations that Kamala is not a Raktaja Roga but when
morbid Pitta Dosha involves the Rakta then Kamala may be produced. Rakta is
particularly involved in the Samprapti of kosthashrita Kamala.
• It would be seen the Pitta to which the physical characteristics and qualities of under
discussion are attributed might refer to liver bile and not others. This view find
support from the description of Pitta as the kitta of Rakta “ asrujapittam” and also
reference made by Charaka, Pitta and Rakta possess nearly identical smell and
colour.
Summary of Phalatrikadiyoga on Kamala 118
• The Asruja Pitta m finds direct correlation from modern physiological views it regards
blood. It may be stated that Rakta is the seat of Pitta. This bile Pigments are also of
the waste products or the mala’s of Rakta.
• Rakta and Pitta are stated to have identical colour. If left undisturbed, the blood
separates into two parts. The lower part is opaque and red. The erythrocytes appear
to be red in colour the colour of the hepatic bile is golden yellowish which is largely
due to its pigments bilirubin constituent to the normal colour of the plasma. Both bile
and blood have nearly the same characteristic fleshy smell. In addition both blood
and bile are intimately connected with the liver and exists.
• A review of Pitta may refer to Agni. Liver is imediately concerned with carbohydrates,
lipid and protein metabolism. The liver synthesizes cholesterol and esters. Finally
there is the secretary role of the liver concerned with the formation of bile.
• Haemoglobin is the iron containing pigment of the red blood corpuscles. Liver and
bone marrow and the quantity are increased state. Bilirubin does not contain iron
and a very soluble for this reason it is dissolved in the blood and not stored in the
cells and thus it continuously removed from the liver cell into the bile.
• When red blood cells are delivered from the bone marrow into the circulatory
system. Maintain the pliability of cell membrane.
• Keep the iron of the cell haemoglobin in the ferrous form rather than the ferric form.
• Once the red cell membrane becomes fragile the cell rupture during passage
through some tight spot of the circulation. When the spleen is removed the number
of abnormal red cells and old cells circulating in the blood increases considerably.
• When red blood cells burst and release their haemoglobin the haemoglobin is
phagocytized almost immediately by macrophages in many parts of the body. The
porphyrin portion of the haemoglobin molecule is converted by macrophages
Summary of Phalatrikadiyoga on Kamala 119
through a series of stages, into the bile pigment bilirubin, which is released into the
blood and later secreted by the liver into the bile.
• This measure is essential when the treatment is aimed to cure Kostashakashrita
Kamala primarily, where as in case of shakhastrita Kamala the initial phase to bring
shakashrita Pitta to kosta Pitta vardhaka and kaphakar ahara dravya used.
• Virechana therapy specially in Pitta pradhana and Rakta pradushaja vikaras.Kamala
is one of the Pitta pradhan roga.
• To study the efficacy of "Phalatrikadiyoga " in Kamala
• Drug composition
1) Haritaki 1 part
2) Bibhitaki 1 part
3) Amalaki 1 part
4) Guduchi 1 part
5) Vasa 1 part
6) Kiratatikta 1 part
7) Katuki 1 part
9) Bhumyamalaki 1 part
10)Bhrungaraja quantity sufficient
• The patients with the conformed diagnosis of Kamala clinically as well as laboratory
investigations are selected for the study. The main criteria for selection of the
patients were symptomatolagy and laboratory (investigation) evidences of the serum
bilirubin and other liver function test values.
• The patients presenting lakshans two or more were considered clinically with
laboratory evidences of urine bile salts and bile pigments along with liver function
Summary of Phalatrikadiyoga on Kamala 120
values. Severe Jaundice patients, complications of Jaundice, who will not agree for
the study also excluded.
• Objective Criteria for assessing Kamala are -
1) Hb %
2) Serum bilirubin (direct and total)
3) SGPT
4) Serum Alkaline Phosphate
5) Serum total protein
6) Serum Albumin
7) Serum Globulin
8) Urine Bile salts and Bile pigments.
• As a resultant day today practice receives number of patients suffering from Kamala
(Jaundice) and its complications as the negligence of Kamala management. In
contemporary medical system jaundice is the word analogous with Kamala.
• In Ayurveda it was clearly mentioned that Agni mandya and Pitta vikruti are the main
Causative factor for the Kamala, in this clinical study it was observed that all the 20
patients are shown Agni vikruti, in terms of Pitta vikruti.
• Major literatures of Ayurveda explain the disease Kamala and it’s management. In
Charaka Samhita Kamala is mentioned as Nidanarthakara Roga of Pandu. However
the predominant Dosha in both Swatantra and Paratantra Kamala is the Pitta Dosha.
Dalhana, Susruta Samhita commentator, in his ideology on Kamala enrolled the term
Panaki as a variety of Kamala.
• Total 24 patients were diagnosed as a Kamala out of them, 20 patients were
selected for the clinical trial. The Kamala Roga is seen to independently and also as
Summary of Phalatrikadiyoga on Kamala 121
a sequel to Pandu Roga. In the present study we have observed that out of 20
patients 6 patients were having Pandu Roga.
• Mentioned etiological factors provoke Pitta, with their specific qualities. With the
above-mentioned Nidana person with vitiated Pitta and Agni is unbalancing the
functions of liver where mala roopa Pitta is discharged. This Ama corresponds with
Rakta and may produce Kamala.
• The specific samprapti of Kamala is not mentioned in the classics. In shakhashrita
Kamala excessive intake of Guru, sheeta, Rooksa, Madura rasa ahara, aggravates
the Kapha Vata Dosha, and diminishes the Pitta. Increased slesma obstruct in the
Pitta marga resulting on vimarga gamana of Pitta, this results the shakhashrita
Kamala.
• The management of Kamala, more single drug therapy and compound drugs
explained in our classics, about the supremely and relevancy of phalatrikadhiyoga
explained in text, but these drugs are Kamala hara properties and individual drugs
katuki. Kamala was successfully, treated with Phalatrikadiyoga. Phalatrikadiyoga is
a potent combination to treat Kamala based on it’s properties and pharmacological
action. It is predominately Tikta and Katu rasa, laghu, rooksha Guna’s Ushna
Veerya, Madhura vipaka and Pitta shamaka properties.
• The patients with the conformed diagnosis of Kamala clinically as well as laboratory
investigations are selected for the study. Severe Jaundice patients, complications of
Jaundice, who will not agree for the study also excluded.
• The Nimba is best Pitta shamaka. The Bhrungaraja leaves largely used in liver
diseases, it is a keshya, krimi, kasa, Sotha, Pandu, Rasayana, Kamala and Hepato
protective activity.
Summary of Phalatrikadiyoga on Kamala 122
Synergetic effect of Phalatrikadiyoga on Kamala
i. Deepana and Amapachana.
ii. It restore the Agni vyapara eliminates the vitiated Pachakapitta,
Ranjakapitta, saman and vyanvata and Kledakakapha.
iii. Capable to relieving the ashruka and mamsha dagdata.
• The Kamala is one of the Pitta and Rakta produshaja vyadhi here Pitta is vitiated and
the help of Tashaya, Tikta and Madura rasa prodhan dravya normalizes it, and
Phalatrikadiyoga is best deepana, Amapachan, Pitta prasaman, and srotovishadhan.
• Kamala was successfully, treated as Phalatrikadiyoga. It leads to Kamala.
• Kamala explains in the classics under the Pandu Roga chapter.
• Kamala mainly classified two types.
• Kasta shakhashrita Kamala is manifested as a sequel Pandu and shakhastrita
Kamala Vata and Kapha Dosha and dushya Rasa, Rakta, which obstructs the
passage of Pitta varga.
• Kamala may occur independently and sequel of Pandu Roga.
Results of Phalatrikadiyoga in Kamala
The statistical evaluation of Phalatrikadiyoga in Kamala has shown highly
significance in both the parameters. The parameters studied are shown in table number
20.
Haridra netra, Haridra mootrata, Peeta Nakha, Avipaka, Aruchi, Total Bilirubin
Total Protein, Serum Albumin, Bile Salt and Bile Pigment has shown highly significance
with the P-Value as <0.001.
Haemoglobin percentage, SGPT, Serum Alkaline phosphate, Peeta Twakha and
Direct Bilirubin has shown P-value as <0.01, which is significant. Only Serum Globulin is
not significant with the P-value as > 0.1.
Summary of Phalatrikadiyoga on Kamala 123
The result cured is declared to the patients those who have totally cleared with
the presenting symptoms and free from abnormal or deviated lab investigations such as
liver profile. The number patients under this category with are 17 i.e. 85%. There is no
patient who doesn’t respond to the treatment. Rests of three patients are under major
improvement and minor improvement cadres as 2 and 1 patient respectively. The
finalised and summarized result is as under.
Results of Phalatrikadiyoga in Kamala
So
can be e
satisfactor
Major improvement
10%
Discontinued0%
Unchanged0%
Minor improvement
5%
Cured85%
thus the Phalatrikadiyoga is very economical, safe and effective drug hence it
mployed safely in Kamala (Shakashrita and Kostashrita), which gives
y results.
Summary of Phalatrikadiyoga on Kamala 124
References
1. Atharvaveda 1/22/3
2. Atharvaveda 1/22/3
3. Atharvaveda 4/9/3
4. Sushruta Uttaratantra 44\6
5. Shabdakalpadruma Page No
6. Sushruta Uttara Tantra 44\4
7. Dhaturupamanjari
8. Sushruta Uttartantra 44/5
9. Dorlands Medical Dictionary Page No 431
10. Sushruta Uttaratantra 44/6
11. Astanghahrudayanidana 13/19
12. Charakachikitsa 16/36
13. Charaka Sutra 19/3
14. Charaka Sutra 19/7
15. Devidsonsmedicine7th Edition Page No 498
16. Clinical Medicinekumarandclarks 4th Edition Page No 298
17. Charaka Vimana 5/27
18. Sushruta Sutra 21/9
19. Sushruta Sutra 14/5-6
20. Charaka Chikitsa 16/124
21. Bhava Prakash Poorva Khanda 8/48
22. Grays Anatomy Page No 1374
References I
23. Sharangadara Poorva Khanda 5/82
24. Monier Monier Willams Sanskruta Dictionary Page No 838
25. Grays Anatomy Page No 1374
26. Samar Mitra 1st Part Page No
27. Samar Mitra 1st Part Page No
28. Human Embriology 7th Edition
29. Human Embriology 7th Edition
30. Human Physiology 1st Part Page No 58
31. Human Physiology 1st Part Page No 455/456
32. Human Physiology 1st Part Page No 657
33. Human Physiology 1st Part Page No 446-447
34. Human Physiology 1st Part Page No 21
35. Human Physiology 1st Part Page No 153
36. Human Physiology 1st Part Page No 655-562
37. Charaka Indriya Sthana 1/8
38. Astangha Sangraha Sutra 11/13
39. Sushruta Sutra 15/13
40. Charaka Sutra 12
41. Charaka Chikitsa 15/3
42. Sushruta Sutra 21/5
43. Sushruta Sutra 21/9
44. Charaka Sutra 20/5
45. Sushruta Sutra 42/5
46. Ashtanga Hrudaya Sutra 1/
47. Charaka Sutra 1/60
48. Sushruta Sutra 21/11
49. Sharangadara Poorva 3/120
50. Kasyapa Samhita
51. Charaka Sutra 20/18
52. Sushruta Sutra 21/13
53. Charaka Vimana 2/17
54. Charaka Sutra 20/8
55. Sushruta Sutra 21/6
56. Charaka Sutra 20/8 Chakrapani
References II
57. Astangha Hrudaya Sutra 12/2
58. Essential Basic Ayurvedic Concept Page No 28
59. Charaka Sutra 18/50
60. Charaka Sutra 22/11
61. Ashtangha Hrudaya Sutra 11/23
62. Sushruta Sutra 15/2
63. Charaka Chikitsa 15/3
64. Ibid 15/4
65. Ibid 15/39
66. Sushruta Uttara Tantra 40/170
67. Astangha Hrudaya Sutra 12/10-12
68. Sushruta Sutra 21/9
69. Charaka Chikitsa 15/10
70. Bhavaprakash Poorva 2/178
71. Introduction To Kaya Chikitsa Page No 133
72. Sushruta Sutra 21/10
73. Charaka Chikitsa 15/28
74. Sushruta Sutra 15/6
75. Charaka Sutra 12/11
76. Sushruta Sutra 21/10
77. Astangha Hrudaya Sutra 12/13
78. Bhela Shareera 4/3-5
79. Charaka Sutra 12/11
80. Sushruta Sutra 21/10
81. Ashtanga Hrudaya Sutra 12/14
82. Ashtanga Sangraha Sutra 20/6
83. Essential Basic Concept Of Ayurveda Page No 30-31
84. Sushruta Sutra 21/3
85. Charaka Chikitsa
101. A. Hrudaya Nidana 13/15
102. Charaka Chikitsa 16/34-38
103. Ibid 16/33
104. Charaka Nidana 1/22
References III
105. Sushruta Sutra 21/22
106. Astangha Hrudaya Nidana 1/16
107. Charaka Sutra 25/43 (4)
108. Sushruta Sutra 42/9 (4)
109. Astangha Hrudaya Sutra 10/19
110. Charaka Sutra 26/43
111. Sushruta Sutra 41/9 (2)
112. Astangha Hrudaya Sutra 10/11
113. Charaka Sutra 26/42 (3)
114. Sushruta Sutra 42/14
115. Astangha Hrudaya Sutra 10/13
116. Charaka Sutra 24/5-10
117. Sushruta Sutra 42/14
118. Charaka Chikitsa 16/125
119. Charaka Nidana 1/9 Chakrapani
120. Charaka Chikitsa 16/9-11
121. Ibid 16/34
122. Ibid 16/125-126
123. Astangha Hrudaya Chikitsa 16/46-48
124. Sushruta Sutra 21/33
125. Ibid 21/34
126. Charaka Nidana 1/9
127. Charaka Chikitsa 16/35-37
128. Ibid 16/126-127
129. Ibid 16/35-37
130. Astangha Hrudaya Nidana 13/16
131. Madhava Nidana 8/16-18
132. Bhavaprakasha Madhyama 8/19-20
133. Yogaratnakara Panduroga 18-19
134. Sushruta Uttara Tantra 44/10
135. Charaka Chikitsa 21/40
136. Sushruta Uttara 44/12
137. Astangha Hrudaya Nidana 13/18
138. Charaka Chikitsa 16/37
References IV
139. Madhava Nidana 8/21
140. Bhavaprakash Uttara
141. Charaka Chikitsa 16/37-38
142. Ibid 16/42
143. Ibid 16/40
144. Astangha Hrudaya Chikitsa 16/40
145. Sushruta Uttara 44/15
146. Charaka Chikitsa 16/55
147. Yogaratnakara Panduroga 67
148. Bhavaprakasha Madhyama 8/40
149. Chakradatta 8/26
150. Yogaratnakara Panduroga 71
151. Charaka Chikitsa 16/128
152. Bhavaprakasha Nighantu Page No 7
153. Dravyaguna Vignana 2nd Part Page No 754
154. Kirtikara And Basu Page No 1021
155. Pharmacognosy Page No 215-216
156. Madanapala Nighantu
157. Bhavaprakasha Nighantu Page No 5
158. Kirtikara And Basu Page No 1021
159. Bhavaprakasha Nighantu Page No 9
160. Dravyaguna Vignana 2nd Part Page No 239
161. Pharmacognosy Page No 217
162. Indian Medicinal Plants Page No 1204
163. AAMRA volume 2 Issue 1& 2 1998 Page No 24
164. Bhavaprakasha Nighantu Page No 38 To 41
165. Dravyaguna Vignana 2nd Part Page No 758
166. Pharmacognosy Page No 225
167. Medical & Aromatic Plants Abstract Vol 24/1,02 Page No 16
168. Indian Materia Medica Page No 82
169. AAMRA Vol 1st Issue 3rd Oct, Dec 1997 Page No 76
170. Ibid Page No 92
171. Ibid Page No 92
172. Dravyaguna vignana 2nd part Page No.758
References V
173. Pharmacognosy Page No.225
174. Medical and Aromatic plants abstract vol 24/No.1 2002 Page No.16
175. Indian Materia Medica Page No.82
176. AAMRA vol 1st Issue 3rd Oct-Dec 1997 Page No.76
177. Ibid Page No.92
178. Ibid Page No.92
179. Bhavaprakash Nighantu Page No.270
180. Dravya Guna Vignana 2nd part Page No.761
181. Indian Medicinal plants Page No.78
182. Bhavaprakash Nighantu Page No.269
183. Medicinal & aromatic plants abstract vol.24 No.1 2002 Page No.32
184. Ibid Page No.98
185. AAMRA Vol.2 Issue 1st & 2nd Jan-Jun 1998 Page No.34
186. AAMRA Vol.2 Issue 3rd Jul-Sep 1998 Page No.151
187. AAMRA Vol.2 3rd Issue Jul-Sep Page No.144
188. Bhavaprakash Nighantu Page No.320
189. Dravyaguna Vignana 2nd part Page No.241 to 247
190. Indian Materia Medica Page No.41
191. Ibid Page No.40 to 43
192. Bhavaprakash Nighantu Page No.320
193. Capsule Himalaya Health Digest Oct-Dec 2001 Page No.3
194. Bhavaprakash Nighantu Page No.73
195. Dravyaguna Vignana 2nd part Page No.691
196. Indian Materia Medica Page No.1184
197. Pharmacognosy Page No.207
198. AAMRA 2nd / 3 Jul-Sep 1998 Page No.128
199. Heritage Healing Jan-2002 Page No.6 to 7
200. Bhavaprakash Nighantu Page No.70
201. Dravyaguna vignana 2nd part Page No.441
202. Pharmacognosy Page No.206
203. Indian Medicinal plants Page No.1825
204. Ayurved Vikas Jul-Aug 2001 Page No.58
205. AAMRA 1/3 Octy-Dec 1997 Page No.83
206. Ibid Page No.82
References VI
207. Ibid Page No.90
208. AAMRA 1/3 Jul-Sep 1998 Page No.50
209. AAMRA II / 1st & 2nd Jan-Jul 1998 Page No.9
210. Bhavaprakash Nighantu Page No.329
211. Dravyaguna Vignana 2nd part Page No.141
212. Govt Ayurvedic Medical College Mysore
213. Medicinal & aromatic plants abstract vol.24 No.1 2002 Page No.94
214. AAMRA Vol.II/Issue 3rd Jul-Sep 1998 Page No.118
215. AAMRA Vol II / Issue 1st & 2nd Jan-Jun 1998 Page No.12
216. Ibid Page No.24
217. Bhavaprakash Nighantu Page No.460
218. Dravyaguna Vignana 2nd part Page No.640
219. Indian Materia Medica Page No.949
220. Raja Nighantu Page No.263
221. Bhavaprakash Nighantu Page no.461
221a. Visen PK, Shukla B, Patnaik GK, Dhawan BN. Andrographolide protects rat
hepatocytes against paracetamol-induced damage. J Ethnopharmacol 1993 Oct;40(2):131-
136
222. AAMRA 1 / 3 Oct-Dec 1997 Page No.94
223. Ibid Page No.98
224. Bhavaprakash nighantu Page No.429
225. Dravyaguna Vignana 2nd part Page No.123
226. Indian Materia Medica Page No.469
227. Indian Medicinal Plants Page No.1362
228. AAMRA 1/3 Oct-Dec 1997 Page No.77
229. Ibid Page No.94
230. Medicinal & aromatic plants abstract Vol.24, 1 2002 Page No.69
231. Medicinal Laboratory Technology Page No.173
232. Disease of the biliery system of Sheila Sherlock Page No.20
233. Ibid Page No.19
234. Kumar & Clark Clinical Medicine Page No.293
235. Ibid Page No.248
236. Human physiology 1st part Page No.452
References VII
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Recommended