Dr.Sandeep.K.C. 2009-2010

VII

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI “A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF

ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”

ACKNOWLEDGEMENT

On the occasion of the successful completion of this assigned work, I Offer my

salutation to the almighty lord Ganeśa for his blessings.

I would like to express my profound respect and deepest gratitude to my guide Dr.

Udupi, his keen observation, valuable guidelines gave me considerable confidence to

complete this study.

Words fail miserably when I would like to express my profound respect and

deepest gratitude, towards the most dynamic personality, my role model, a perfectionist,

an ideologist, my co-guide Dr.Niranjan Rao. Professor, Department of PG studies in

Panchakarma, S.D.M.C.A, Udupi. Whose harmonious help, valuable suggestions, close

involvement with this work, his keenness, his perpetual energy and enthusiasm is a great

inspiration in achieving this milestone and for my future life.

I am greatly indebted to our respected madam and I feel proud and privileged to

have her as our teacher. Dr. Rajlakshmi. M.G. Lecturer, department of Panchakarma,

SDM college of Āyurveda & hospital, Udupi

I express my sincere gratitude to Dr. Padma Kiran. Lecturer, department of

Panchakarma, SDM College of āyurveda & hospital, Udupi

I express my sincere gratitude to our respected principal Dr.U.N.Prasad for

supporting me in my P.G education at Udupi.

My sincere thanks to S.D.M. Education society Ujire, for giving me an

opportunity for my post graduation education.

I would like to thank my friends Dr.Praveen V Devarushi, Dr.VinayKumar.K.N,

Dr.Prajwal N, Dr.Avinash Adiga, Dr.PrashanthKumar, Dr. VijayShankar. B. V, Dr.

Amarnath. B. V. B, and Dr.Shridhar gokhale, Dr.Vinay. T. C, Dr.Umesh. J. D.

The generous support from my juniors Dr.Riyas, Dr.Prakash Paltey, Dr.Rahul

Magdum, Dr.Girija.M.N, Dr.Greeshma, is greatly appreciated.

Shreekanth.U. Dean, Professor & HOD, PG studies in Panchakarma, SDMCA,

VIII



I thank all the patients and the Panchakarma staffs for their support.

At this moment I express my gratitude to my father Sri. Chandrasekharappa. K,

my mother Smt. Annapoornamma. K. H, my brother Dr.Santhosh. K. C., My uncle Mr.

Rudramuni.R.Y and My aunt Smt. Maithreyi. R.Y. I am highly obliged for their

blessings and support.

Lastly my sincere thanks to all those who have directly or indirectly extended

their help and support for the completion of this dissertation work.

DR. SANDEEP.K.C

Abbreviations

IX DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI

“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”

ABBREVIATIONS

1. Cha. : Charaka Samhita

2. Su. : Sushruta Samhita

3. A.S. : Ashtanga Sangraha

4. A.Hr. : Ashtanga Hridaya

5. B.P. : Bhava Prakasha

6. M.N. : Madava nidana

7. Sha. : Sharangadhara Samhita.

8. B.S : Bhela Samhita

9. H.S. : Harita Samhita

10. Ka. : Kashyapa Samhita

11. Van. : Vangasena

12. Y.R. : Yogaratnakara

13. G.D. : GadaNigraha

14. Bhai.Rat : Bhaishajya Ratnavali

15. Nig.A. : Nighantu Adarsha

16. Su. : Sutra Sthana

17. Ni. : Nidana Sthana

18. Vi. : Vimana Sthana

19. Chi. : Chikitsa Sthana

20. K : Kalpa Sthana

21. Si. : Siddhi Stana

22. Pu. : PurvaKhanda

Abbreviations

X DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


23. M : Madyama Khanda

24. U : UttarKhanda

25. Nig. : Nighantu

26. AT1 : After deepana & Paachana

27. AT2 : After Sneha paana

28. AT3 : After swedana karma

29. AT4 : After Virechana

30. AT5 : After samsarjana krama

31. AT6 : After the follow up period

32. BT : Before treatment

33. Cm : Centimetres

34. d : Difference

35. DC : Differential Count

36. ESR : Erythrocyte Sedimentation Rate

37. CRP : C Reactive Protein

38. RA Factor : Rheumatoid factor

39. Hb : Hemoglobin

40. No. : Number

41. SD : Standard Deviation

42. SEM : Standard Error Mean

43. TC : Total Count

44. Yrs. : Years

X DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


DIACRITICS FOR THE TRANSLITERATION OF SANSKRIT

A AÉ C D E F G L

Lå AÉå AÉæ AÇ AÈ

Mü ZÉ aÉ bÉ Xû

cÉ Nû eÉ fÉ gÉ

Oû Pû Qû Rû hÉ

iÉ jÉ S kÉ lÉ

mÉ Tü oÉ pÉ qÉ

rÉ U sÉ uÉ vÉ wÉ xÉ W

a ā i ī u ū ṛ e

ai o au aṃ aḥ

ka kha ga gha ṅa

ca cha ja jha ña

ṭa ṭha ḍa ḍha ṇa

ta tha da dha na

pa pha ba bha ma

ya ra la va śa ṣa sa ha

Abstract

XI



Abstract

The prevalence of the disease Āmavāta/rheumatoid arthritis varies

substantially ranging from 0.3%to 1% of population. Indian data suggests the

prevalence to be around 0.65 to 0.75%. 1to 3% of women develop RA in their life

time. Women affected with 3to 5 times as often as men. Most of the people develop

RA between the ages of 25 to 50.About 60% of RA patients are unable to work 10

years after the onset of their disease. Estimation of life shortening effects of RA varies

from 5 to 10 years. Family history of RA is an important risk factor. First degree

relative’s prevalence rate is 2-3%.

Āmavāta is compared to rheumatoid arthritis for the sake of easy

understanding . Āmavāta is one such disease where in authors categorized the pain as

Vŗiscika damśavat vedana. It is a disorder characterized by Āma doṣa, Vāta doṣa,

Kapha doṣa morbidly. This is a disease where in Rasavaha sŗotas is primarily

involved. Because of this the pain also spreads from one joint to another joint very

quickly. As Rasavaha srotomūla is Hŗidaya it leads to the involvement of whole body

in short span of time. Being a disease of madhyama roga marga, involvement of

marma (Hŗidaya) makes this disease more and more critical. The treatment proper is

also not unidirectional, for e.g: the antagonistic treatment of Kapha doṣa and Vāta

doṣa must be carried out simultaneously, gambīradhātu (asthi), uttanadhātu (rasa),

makes the treatment more a puzzle.

Hence a treatment which should alleviate morbid vāta, pitta, kapha is required

in Āmavāta.

Virecana is one such Śodhana procedure fulfilling the above criteria.

OBJECTIVE OF THE STUDY:

To evaluate the effect of virecana karma in patients suffering from Āmavāta.

Abstract

XII



Study design :- It was a single blind clinical study with a pre and post test design in 22 patients

were diagnosed as Āmavāta and fulfilling the criteria. They underwent through the

process of Virecana karma were selected. Patients were subjected to dīpana pācana

with pañcakola curṇa 5gms with hot water before food thrice daily till āmapācana.

After proper āmapacana ārohana snehapāna with murcita gŗitha was administered till

obtaining samyak snigda lakṣana(3-7days). After that they were subjected to

abhyanga with saindavādi taila followed by bāṣpa swedana for 4 days. Virecana was

induced with eraṇda taila 80ml+40ml of triphala kwātha. Patients were subjected to

Saṁsarjana krama based on their śuddi lakṣana. The assessment criteria were noted

before, during and after Saṁsarjana krama.

RESULTS :-

• The average time taken for Samyak Snigdata was 3 days.

• Maximum of 45.45% had madhyama śuddi.

• The patients who are treated with Virecana karma showed significant improvement in

the general symptoms the percentage of improvement is increase from 9.65% during

AT1 to 83% during AT6.

• The assessment of the overall effect of the treatment revealed that 77.27 % of the

patients showed major improvement. And 22.72 %. Of the patients also responded

with minor improvement.

Key words:- Āmavāta, Virecana, Rheumatoid arthritis, Eraṇda taila, Triphala kwātha.

Table of contents

XIII

CONTENTS PAGE NO.

AKNOWLEDGEMENT VII - VIII

ABBERAVITIONS XIII-X

ABSTRACT XI -XIII

LIST OF TABLES XIII- XIIIXIII

LIST OF FIGURES/GRAPHS XIII-XIII

LIST OF CHARTS XIII

INTRODUCTION 1-2

OBJECTIVES 3

PREVIOUS WORKS DONE 4

CHAPTER 1 CONCEPTUAL STUDY 5-32

DISEASE REVIEW 33-53

CHAPTER 2 DRUG REVIEW 54-66

CHAPTER 3 METHODOLOGY 67-76

CHAPTER 4 OBSERVATIONS AND EFFECT OF THERAPIES 77-128

CHAPTER 5 DISCUSSION 129-140

CHAPTER 6 CONCLUSION 141-142

CHAPTER 7 SUMMARY 143-144

BIBLIOGRAPHY 145-161

ANNEXURE

List of tables

XIV DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


TABLE NUMBER DESCRIPTION PAGE

NUM 1 Detailed description regarding virecana in ayurveda 6-7

2 Indications of virecana karma 9-10

3 Contra-indictions of virecana karma 11-12

4 Classification of virecana dravya 13-14

5 Pūrva, pradhana, pascāt karma of virecana 16-18

6 Dose of virecana drug in its different form 22-23

7 Vaigiki and manaki according to kashyapa 24

8 Peyadi samsarjana krama

26 9 Rasa samarjana 27

10 Virecana vyapat 28

11 Samyak yoga, ayoga & atiyoga lakshnas of virecana

karma 29-30

12 Sāmanya āmavāta lakṣana 37

13 Pravrudda āmavāta lakṣana 38-39

14 Pañcakola curna 54-55

15 Koṣta parikśa drug review. 55

16 Murcita gritha 56

17 Chemical composition of ghee 57

18 Saindavadi taila 57-59

19 Triphala kwatha 60

20 Rasa pañcaka of triphala 61

21 Laingiki feature 70

22 Sex 78

23 Age group 78

24 Religion 79

List of tables

List of tables

XV DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


25 Marital status 79

26 Education 80

27 Socio economic status 80

28 Occupation 81

29 Desha 81

30 Chronicity 82

31 Addiction 82

32 Diet 83

33 Sleep pattern 83

34 Prakrithi 84

35 Satva 84

36 Rasa satmya 85

37 Samhanana 85

38 Sāra 86

39 Abhyavarana śakti 86

40 Jarana śakti 87

41 Vyāyāma śakti 87

42 Vaya 88

43 Deha bala 88

44 Kośta 89

45 Samyak snigdha lakshana 90

46 Dose of snehapāna 90

47 Total amount of abyantara sneha during the whole course

of snehapāna 91

48 Analysis of samyak snigdha lakshana 92

49 Analysis of samyak swinna lakṣana 93

50 Analysis of latency period 93

51 Analysis of duration of virecana 94

List of tables

XVI DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


52 Analysis of vaigiki shuddhi 94

53 Analysis of maniki of virecana 95

54 Analysis of anthiki of virecana 95

55 Analysis of laingiki lakshana of virecana 96

56a &56b Effect on sandhi śūla 97-98

57a & 57b Effect on sandhishotha 99

58a & 58b Effect on stabdhata 100-101

59a & 59b Effect on tenderness 102

60a & 60b Effect on the range of joint movements 103-104

61a &61b Effect on hand grip power in mm of hg 105

62a &62b Effect of the therapy on foot pressure 106-107

63a & 63b Effect of the therapy on knuckle swelling 108

64a & 64b Effect of the therapy on circumference of arms 109-110

65a & 65b Effect of the therapy on circumference of forearms 111

66a &66b Effect of the therapy on circumference of thighs 112-113

67a & 67b Effect of the therapy on circumference of calf 114

68 Effect on general symptoms 115-116

69a & 69b Effect on total score of general symptoms 117

70a & 70b Effect on general functional disability 118-119

71a & 71b Effect of the therapy on hb% 120

72a & 72b Total wbc count 121

73a & 73b Neutrophils 122

74a &74b Lymphocytes 123

75a & 75b Esinophils 124

76a & 76b Effect on ESR 125

77a &77b Effect on RA factor 126

78a & 78b C reactive protein 127

79 Overall effect of the treatment 128

List of graphs

XVII



Name of the graph Page no 1 Sex 78

2 Age group 78

3 Religion 79

4 Marital status 79

5 Education 80

6 Socio economic status 80

7 Occupation 81

8 Desha 81

9 Chronicity 82

10 Addiction 82

11 Diet 83

12 Sleep pattern 83

13 Prakrithi 84

14 Satva 84

15 Rasa satmya 85

16 Samhanana 85

17 Sāra 86

18 Abhyavarana śakti 86

19 Jarana śakti 87

20 Vyāyāma śakti 87

21 Vaya 88

22 Deha bala 88

23 Kośta 89

24 Samyak snigdha lakshana 90

25 Dose of snehapāna 90

26 Total amount of abyantara sneha during the whole course

91

27 Analysis of samyak snigdha lakshana 92

LIST OF GRAPHS

List of graphs

XVIII



28 Analysis of samyak swinna lakṣana 93

29 Analysis of latency period 93

30 Analysis of duration of virechana 94

31 Analysis of vaigiki shuddhi 94

32 Analysis of maniki of virechana 95

33 Analysis of anthiki of virechana 95

34 Analysis of laingiki lakshana of virechana 96

35 Effect on sandhi śūla 98

36 Effect on sandhishotha 100

37 Effect on stabdhata 101

38 Effect on tenderness 103

39 Effect on the range of joint movements 104

40 Effect on hand grip power in mm of hg 106

41 Effect of the therapy on foot pressure 107

42 Effect of the therapy on knuckle swelling 109

43 Effect of the therapy on circumference of arms 110

44 Effect of the therapy on circumference of forearms

112

45 Effect of the therapy on circumference of thighs 113

46 Effect of the therapy on circumference of calf 115

47 Effect on general symptoms 116

48 Effect on total score of general symptoms 118

49 Effect on general functional disability 119

50 Effect of the therapy on hb% 120

51 Effect of the therapy on Total wbc count 121

52 Effect of the therapy on Neutrophils 122

53 Effect of the therapy on Lymphocytes 123

54 Effect of the therapy on Esinophils 124

55 Effect of the therapy on Effect on ESR 125

56 Effect of the therapy on Effect on RA factor 126

57 Effect of the therapy on C reactive protein 127

58 Effect of the therapy on The overall effect of the

128

List of charts

XIX DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


List of charts

Chart number Description Page num

1 Sweat production 22

2 Samsrjana krama 25

3 Mode of action of virechana 32

4 Schematic representation of Samprapthi 41

INTRODUCTION

Introduction

1



INTRODUCTION

“Care of a person’s health is significant in determining his length of existence

as a human being”- Anonymous.

If we go by the definition of the health by World Health Organization which

states : “Health is a state of complete physical, mental and social well-being and not

merely the absence of disease or infirmity”. Rheumatoid arthritis is one such disease

which may affect all the three i.e. Physical, mental and also social well-being of an

individual.

Rheumatoid arthritis is an autoimmune disease that causes chronic

inflammation of the joints which can also occur in tissues around the joints, such as

the tendons, ligaments, and muscles. Autoimmune diseases are illnesses which occur

when the body tissues are mistakenly attacked by its own immune system. The

immune system is a complex organization of cells and antibodies designed normally

to "seek and destroy" invaders of the body, particularly infections. Patients with these

diseases have antibodies in their blood which target their own body tissues, where

they can be associated with inflammation.

While rheumatoid arthritis is a chronic illness, meaning it can last for years,

patients may experience long periods without symptoms. Typically, however,

rheumatoid arthritis is a progressive illness that has the potential to cause joint

destruction and functional disability. The joint inflammation of rheumatoid arthritis

causes swelling, pain ,stiffness, and redness in the joints.

In some patients with rheumatoid arthritis, chronic inflammation leads to the

destruction of the cartilage, bone and ligaments causing deformity of the joints.

Damage to the joint can occur early in the disease and be progressive. Moreover,

studies have shown that the progressive damage to the joints does not necessarily

correlate with the degree of pain, stiffness, or swelling present in the joints.

The prevalence of the disease varies substantially ranging from 0.3%to 1% of

population. Indian data suggests the prevalence to be around 0.65 to 0.75%. 1to 3% of

women develop RA in their life time. Women affected with 3 to 5 times more often

than men. Most of people develop RA between the ages of 25 to 50.About 60% of RA

patients are unable to work 10 years after the onset of their disease. Estimation of life

Introduction

2



shortening effects of RA varies from 5 to 10 years. Family history is an important risk

factor. First degree relative’s prevalence rate is 2-3% 2.

Āmavāta & rheumatoid arthritis may be compared for the sake of better

understanding. Āmavāta is one such disease where in authors categorized the pain as

Vŗischika damśavat vedana. It is a disorder characterized by Āma doṣa, Vāta doṣa,

Kapha doṣa morbidly. This is a disease where in Rasavaha sŗotas is primarily

involved. Because of this the pain also spreads from one joint to another joint very

quickly. As Rasavaha srotomūla is Hŗidaya it leads to the involvement of whole body

in short span of time. Being a disease of madhyama roga mārga, involvement of

marma (Hŗidaya) makes this disease more and more critical. The treatment proper is

also not unidirectional, for e.g: the antagonistic treatment of Kapha doṣa and Vāta

doṣa must be carried out simultaneously, gambiradhātu (asthi),uttānadhatu

(rasa),makes the treatment more a puzzle.

Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required

in āmavāta

Virechana is one such śodhana procedure fulfilling the above criteria.

(Ch.Su. 16/20.) Caraka has said that the doṣas controlled by Samśamana are

having the possibility of reoccurrence while such a prospect is absent when the doṣas

are managed by Samśodhana.

Only one treatment protocol will not help to curtail the disease. The author

opines that a full planned course of śodhana measures like vamana, virecana, basti

along with the use of other external and internal treatments will help over a period of

time to curb this grave disease.

OBJECTIVES OF THE STUDY

Objective of the study

3 DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


Objective of the study.

To evaluate the effect of virechana karma in the patients suffering from

Āmavāta.

Previous works done



PREVIOUS WORKS DONE

Sharma Gaurava K C – A clinical and comparative study of Ama and Free

radicals theory w.s.r. to Amavata, Dept of Basic Principle 2001, Gujarat

Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

Acharya Shrinivasa – A clinical study on the role of Virechana and Karma

Basti in the mang. Of Amavata, Dept of Kayachikitsa. 1988, Gujarat Ayurved

University, I.P.G.T & R.A Jamanagar, Gujarat.

Bhatkoti Mayank – A comparative clinical study of Vaitarana Basti and

Virechana Karma in the mang. of Amavata, Dept. of Panchakarma. 2005,

Gujarat Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

Jhala Jigisha V – A clinical study on the role of Virechana and Dashamoola

kshara Basti in the mang. of Amavata, Dept. of Kayachikitsa. 1995, Gujarat

Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

Rao sandeep.B.H. - Evaluation of vamana karma in amavata. Dept of

Panchakarma 2007, SDMCA, Kuthpady, Udupi, Rajiv Gandhi university of

health sciences. Karnataka.

CONCEPTUAL STUDY

The concept of virecana karma

5



THE CONCEPT OF VIRECANA KARMA

In Āyurveda the management of a diseases in general, can be broadly

grouped in to " “śodhana " and "śamana" line of treatments. The śodhana is intended

to eliminate excessively vitiated Doṣa out of the body and thereby eradicating disease

as a whole, while the later is directed towards palliation of vitiated Doṣa. However,

Āyurvedic classics give paramount importance to the śodhana therapy, owing to its

credential of providing a complete cure, because Caraka says that the Doṣas subdued

by Langhana and Pācana therapies may provoke, but in case of Śodhana, there is

seldom possibility of such recurrence 3(Cha. Su. 16 : 20).

Pañcakarma presents an unique approach of Āyurveda to therapy with

specially designed for internal purification of the body . Such a purification permits

the biological system to return to normalcy & to attain homeostasis & also facilitates

the desired pharmacokinetic effect of curative remedies administered thereafter. It

eliminates toxins & malas ,cleans the macro& micro channels, maximizes the

absorption , metabolism of nutrients, drugs & helps in minimizing their dose &

toxicity.

Pañcakarma can be considered as a Promotive, Preventive, Curative & Rehabilitative

procedure. According to Ancient Āyurvedic scholars, the elimination of the waste

products of the body are termed as Apakarśana, which means Śodhana. This is not

only of great utility in treating a disease but is also advisable in healthy persons as a

preventive measure.

Two accessory measures carried out before (Purva) and after (Pascat)

performing the Pancakarmas are also considered as the part of Pancakarma therapy. In

the classics the Śodhana is specially indicated in Bahu doṣavastha as a curative

measure and in Rutucarya as a preventive measure and prior to Rasāyana Prayoga as a

promotive measure4. (Cha. Su. 7/46, Ca. Su. 16/12-19, Ca. Ci.1/1-24).

When compared to Vamana , the Virecana karma is less stressful,

complications could be managed efficiently. So it is widely used as Śodhana therapy


6



in routine. It is more acceptable to all classes of patients. In an addition to the

acceptability and popularity, the Virecana is considered as the best treatment for

morbid Pitta Doṣa. It is a complete therapeutic measure, which has systemic as well as

local effects. This fact is further supported by the word “Virecana”. Its wide range of

indications, the special classical method and mode of action are given in Āyurvedic

classics.

PURANA: Among purāna’s Garuda & Agni purāna has a great significance. We can

find traditional method of diagnosis along with Pañcakarma treatment.

HISTORICAL ASPECT OF VIRECANA:

MANU SṀRITI: In Certain procedures where ghŗita is administered orally after the

completion of Vamana karma, Virecana & Snāna has been found. In Candogya

Upaniśad, Śankara bhaśya, śiśupāla vadha, Megha dhuta, scattered references

regarding Śodhana followed by Samśamana therapy for the normalcy of Doṣas has

been found.

1. Kasika5 : It is explained that Pañcakarma was the common method of treatment

which is prescribed as Pūrvakarma such as Snehana, Svedana and Pañcakarma,

AnnaSaṁsarjana etc.

2. Agnipurāna6: Virecana karma is emphasised as the treatment in various

diseases and Trivṛit is considered as best virecana drug. But the detailed

description of Virecana is not found.

Table No:1

Detail description regarding Virecana in Āyurveda

BOOK

STHĀNA

DRUGS PROCEDURE, BENEFITS (Chapters/ Śloka)

COMPLICATION & TREATMENT Chapters/Śloka

VIRECANA DRUG (Chapters/ Śloka)

VIRECANA KALPA/ YOGA (Chapters/ Śloka)

Sūtrasthāna

1/77,75 ; 2/9,10; 4/13 15/7; 25/40

-

15/ 17,18,16,22; 16/ 17-19

15/ 13 ; 16/ 5-10 , 22-26


7



Caraka saṁhita

Vimanasthana 8/136 - - -

kalpasthāna 1/6 7-12 1/3, 4,5. ;12 12

Siddhisthāna - - 1; 2/11,12,13. 6

Suśrut saṁhita

Sūtrasthāna 38/30 ; 39/ 4

44

- -

Cikitsasthāna - - 33/19-47 34 Astānga hŗidaya

Sūtrasthāna 15/2 - 18 18

Kalpasthāna - 2 - 3

Astānga Sangraha

Sūtrasthāna 13/2;14/3-4;15/6

- 27 27

Kalpasthāna - 2 - 3

Bhela saṁhita

Sūtrasthāna - - 4 ; 21 ; 23;25 -

Kalpasthāna - 7 ; 8 ; 9. - -

Siddhisthāna - - - 1 ; 4

Śarang-adhara saṁhita

purvakhanda 4 - - -

Uttarakhanda Detailed description about virecana karma

Vangas-ena saṁhita

Virecana ādhikara

Detailed description about virecana karma

Bhavaprakāśa

Nighantu Part - 5 5 5

Cakra -dutta

- - 71 71 71

Kāśyapa saṁhita

Sūtrasthāna - - 24 -

Siddhisthāna - - 2 ; 3 ; 7 -

Khilasthāna - - 7 7

Etymology

(1) Virecana7 V+Ric+ Nic , lytu-malade: nissernam ......(Vacaspathyam).

(2)Virecanaha8 : V+Ric+Nic, lytu-Viśeśena recathete ...... (Śabdakalpadruma)


8



The word Virecana is derived from the ‘Ric’ dhātu ,‘Nic’ &’Lyut’ pratyaya &with

‘Vi’ upasarga.

It also means Maladehe nissāranam i.e. expelling out the malas.

"Ricir" - evacuation

"Ric" - Viyojana (separation)

Virecana word is derived from the ‘Ric’ dhātu, ‘Ric’ meaning – To empty , evacuate,

leave, give up9.

Definition:

iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉ xÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|10 (Cha.Ka.1/4)

The act of expelling doṣas through Adhobhaga is known as Virecana.

ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉ ÌlÉ:xÉÉUhÉÇ ...|11 ( A.Hr.Su.1/25)

The procedure in which the drug is administered through orally which acts on

morbid doṣas, specifically on Pitta and expels them out through anal route.

ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |

UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||12 (Sha.Pu.4/6)

The procedure where the morbid Doṣas expel out in the form of Drava either

in the pakva or apkva state.

ÌmÉ¨Éå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ zsÉåwqÉhÉÏÌiÉ |13 (A.Sa.Su.27/4)

urÉMÑüsÉÉlÉç xÉÍ³ÉmÉÉiÉÉåijÉÉlÉç mÉæÌ¨ÉMüÉlÉç MüTü ümÉæÌ¨ÉMüÉlÉç |

xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç ||14 (Ka.Si.7)

Virecana is the best line of treatment modality for pitta Doṣa 15,

(Cha.Su.25/40) also it can act on kaphasamsrusta pitta or pittasthanagat kapha. And

moreover in case of Vātasyopakrama mŗidu śodhana indicated which refers to mŗidu

virecana karma16(A.Hr.Su.13/1). Hence Virecana is the major line of treatment for

morbid pitta Doṣa & also it acts on morbid kapha &Vāta Doṣa. Thus the action of

Virecana can be observed on all the tridoṣas.


9



Synonyms of Virecana:

The following terms were used different texts in different contexts for the

virecana, these are all may be considered as synonyms for the virecana.

• Vireka, Recana, Adhobhāgahara.

• Anulomana 17 (cha.Su.16/16)

Table No:2 Indications and Contraindications of Virecana Karma

INDICATIONS

Virecana Yogya

Ch.Si18

2/13 Sus.Chi19

33/32

A.S.20 27 /8

A.Hr.21 18/8-9

K.Si.22

7

Sha.S.U23 4/6-10

Prānavaha sŗotoduhti vikāra Śwāsa + - - - - - Kāsa + - - - - - Parśvaruja + - - - - - Annavaha sŗotoduhti vikāra Aruci + + + - - + Avipāka + - + - - - Visucika + + + - - + Alasaka + + + - - - Chardi + + + + - + Udakavaha sŗotoduśti vikāra Udara + + + + - + Rasa pradoṣaja vikāra Pāndu + + - - + + Jwara + + + + - + Aruci + + - - - + Avipāka + - + - - - Hŗidroga + + - - + + Rakta pradoṣaja vikāra Kāmala + - - + + - Vidradhi - + + + - + Netradāha + + - - - + āsyadaha + + - - - + Vātarakta + + + + - +


10



Kustha + + - + + + Paittika vyadhi + + + - - -

Visarpa + + - - + - Pliha + + + + - + Vyanga + - + + - - Nilika + - - + - - Urdva Raktapitta + + + + + -

Māmsa pradoṣaja vikāra

Arbuda + + - - - -

Galaganda + - - - - -

Meda pradoṣaja vikāra

Prameha + + - + + +

Yoni Doṣa + + + + - +

Retodoṣa + - + + - -

Mūtravaha sŗotoduhti vikāra

Mutrāghāta + + + + - +

Puriśavaha sŗotoduṣhti vikāra

Arśa + + + + + +

Bhagandara + + + - - +

Udāvarta + - + + +

Vibhandha - + + + + -

Pakvaśaya

śūla + + + + - -

Other

Visphota - - - - + B.SU.21/3 +

Vātavyadhi - - - - + B.SU.21/3 +

Garaviśa - + + + + +


11



Table No: 3 CONTRA-INDICTIONS

Virecana

Yogya

Ch.Si2

4

(2/13)

Sus.Chi2

5 33/32

A.S.26

(27/8)

A.Hr.27

(18/8-9)

K.Si. 28

(7)

Śa.S.U29

(4/6-10)

Physiological condition

Langitha + - + - - -

Upavāsita + - - - - -

Durbalendriya + - - - - -

Durbala + - - - + -

Alpāgni + + + + - +

Śranta + + - - - +

Pipāsita + + - - - +

Karmabharadhvaha

ta + + - - - -

Daruna koshtha + - + + - -

Kshama + - - - - -

Kāmadivyagra + + - - - -

Bhakta + + - - - -

Sukumāra - - - - + -

Navaprasuta - + - - - +

Rathri Jāgarana - - + - - -

Atirukśa + - + - - +

Bhayoptapta - + - - - +

Cinta prasaktha + - - - - -

Maithuna prasaktha + - - - - -

Adhyayana

prasaktha + - - - - -

vyāyāma prasaktha + + - + - -

Garbhini + + - - - -

Age related condition

Vriddha + + - - - +

Bāla + + - - - +


12



Pathological condition

Kśatkśina + + - - - +

Atikriśa + - - - + -

Atisthula + + - - + +

Muktanala + - + - - -

Atisāra - - + + - -

Adhoga Raktapitta + + + + - -

śoṣa - - - - - -

Rājayakśma - - + - - -

Urustambha - - - - + -

Madātyaya + + + - - +

Tāluśośa - - - - + -

Hŗidroga - - - - + -

Traumatic condition

Abhighāta + - - - - -

Subhaga + - - - - -

Kśataguda + + + - - -

śalyardita + + + + - +

Saama condition

Nava Jwara + + + + - +

Nava Pratiśyāya - + - - - -

Some vaataroga condition

Kevala Vātaroga - - - - + -

Hanugraha - - - - + -

Ardita - - - - + -

Pūrva karma related condition

Nirudha + - + - - -

Atisnigdha + + + + - +

Anupasnigdha - - - - + -

Pakṣahata - - - - + -


13



CLASSIFICATION OF VIRECANA DRAVYA

In Āyurvedic classics, the main drugs for Virecana have been described in the

chapters dealing with Pancakarma. In addition to it, numerous scattered references are

available in the literature regarding Virecana action of drugs : Cha. Su. 1; Cha. Su. 2; Cha. Su. 9; Cha. Su. 4; Cha. K. 7 to 12; Cha. Su. 13; Cha. Su,. 25.;

Su. Su. 38, 39, 44.; A. S. Su. 6, 7, 12, 13, 14, 15, 17; A.S.K. 2, 3; A.H. Su. 5, 6, 9, 15; A.H.K. 2; Sa.

Pu. 4; Sa. U. 4

Table No: 04 S

L

.

N

O

DRUG

1

Animal

origin Milk,Takra,Mastu, Urine 30 (A.S.Su.14/3)

Plant

origin

Moola

Hastidanti,Vaca,Śymatrivrit,Adhoguda,

Saptala,Śveta,,Gavakśi,jyotiśmati,

Pratyagshreni,Danti,Bimbi,Śanapuśpi,

Ajagandha,Dravanti,Kśirini 31(cha.su1/77-

78)

Citraka,Kinihi,Kuśa,Kaśa,Tilvaka, Śankhini 32 (Sus.Su.39/4)

Vruchiva,Hrusvapancamoola,Punarnava,Pal

nkaśa,Vaastuka,Śaka. 33(A.S.Su.14/3)

Phala

Śankhini, Vidanga, AnupMadhuyasti,

Sthalaja Madhuyasti , karanjadvaya ,

Abhaya, Anthakotarapuśpi, Kampillaka

Aragvadha 34 (cha.su 1/80-82)

Puga,Saptacada,Arka,Triphala,Nilini,

Eraṇda35 (Sus.Su.39/4)

Pilu,Priyal,Kaval,Badar, Karkandhu,

Kaśmarya, Paruśaka, Drakśa36 (A.S.Su.14/3)

Kśīra

Saptacada,jyotiśmati,Mahavrukśa.

Arka 37 (Sus.Su.39/4)

Svarasa Karavellaka 38 (Sus.Su. 44/4)


14



Tvak Tilvaka,Patala,Ramyaka,Kampillka.39

Taila Eraṇda tail 40 (Sus.Su. 44/4)

Patra Pootik,Aragvadha 41 (Sus.Su.39/4)

Phalaraja Kampillka.42 (Sus.Su.39/4)

2

Base

d on

32

Actio

n (S

ha.P

u.4/

4

Anuloman

a

M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç |

iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ ||

Bhedana qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:|

ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉ ||

Samsrana mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç |

lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç ||

Recana ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |

UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||

3

Bas

ed o

n in

tens

ity o

f ac

tion44

(S

ha.U

.4/1

4)

Mŗidu

Virecaka Drakṣa, kṣīra, Uśnambu, Eraṇda tail

Madhyama

Virecaka Trivrut, Katuki, Aragvadha

Tikśna

Virecaka Snūhi, Danti, Svarnakśeri

4

In

rela

tion

with

fa

t

as

med

ia45

C

ha.S

i.6/9

With

Sneha Rukśa Virecana E.g.- Eraṇda taila +Triphala Kvatha 46

Without

Sneha Snigdha Virecana E.g. - Triphala Kvatha

5

Ferm

ente

d Vi

reca

na

Kalp

a

Madhya,Dhanyamla 47 (A.S.Su.14/3)

Souvīrak,Tuśodaka 48 (Cha.Su.27/191)


15



All the Virecana drugs can be classified as plant & animal origin depending on

their source of drug. Based on presence of Adhobhāgahara property in different parts,

these can be further subdivided as moolini, Phalini etc.Eg.Trivrut root bark had

Virecaka property, Jayapāla fruits have Virecaka property etc.

1) Depending on pharmaodynamic action of drug on Doṣa, Mala these drugs are

classified as Anulomana, Bhedana, Saṁsrana, Recana.

2) Among all virecana dravya some are drastic purgative while some are mild &

moderate in nature. So depending on the nature of intensity of drugs, these can be

classified under Mŗidu Virecaka, Madhyama Virecaka & Tikśna Virecaka.

3) Addminstration of virecana karma through virecaka dravya with Sneha and /or

without Sneha depends on preoperative procedure especially Snehana i.e in

Atisnigdha person select Without sneha (Rukśa) Virecana and for Anatisnigdha

select with Sneha (snigdha)Virecana.

Procedure of Virecana:

The procedure of Virecana classified under three headings, which are as follows

49 (Sus.Su. 5/3)

pūrva karma

pradhāna karma

pascāt karma


16



Pūrva, Pradhana, Pascāt Karma of Virecana

Table No:05

I.

Sambhāra

Samgraha 50

Dravya

āhāra

Śali.Mudga,Māśa,Yava,Tila,

Dugdha,GrithaUśana jala, Māmsa etc.

Auoṣadha

Dīpananīya,Pācanīya,

Upaśamanīya,Vātahara,Sneha,

Svedana ,Virecana drugs like Drākśa,

Triphala, Suovīraka etc.

Equipm

-ents

Acamani, Śarava,Darvi, ghata,etc.utennsils

.Bed,Chairs etc.for patient to rest. Kartari etc.Cutting

instrument. Tula, Manabhanda, Dhumanetra, Sutra,

Karpasa etc.

Ātura

Parīkśa51

Before performing Virecana karma it is necessity to know

patient fitness in terms of his/her Doṣa, Duśya, Atura Bala kāla,

Deśa, Agni, koṣta, Śaīra & āhāra Sātmya, Satva etc. For the

proper adminstration of Vercana karma.

Atura

Pūrva cikitsa Vamana karma & Basti Cikitsa

Dīpana and

Pācana52

Āma is considered as one among the

etiological factors of the diseases, & Śodhana

in āma condition is pretty much

contraindicated. So it is necessary to

administration of dīpana & Pācana drvyas

before the virecana to attain nirāma state.

Snehapāna53

Śodhananga snehana in terms of sehapāna

Should be performed before vercana karma,

which helps in liquefaction & in bringing the

Doṣas from śākha to koṣta.


17



Siddhata

Svedana54

Snehana followed by Svedana in terms of

Sarvānga sveda is helpful to extract the

morbid Doṣa from Sūkśma sŗotas, it controls

Vāta Doṣa. Thus it helps to move the morbid

Doṣa from śākha to koṣta.

Diet55

After Samyak snigdh lakṣana 3 days of gap should be there &

during this time patient should consume the laghu Drava, Uśna,

Anabhiśandhi, Na atisnigdha, Asankara āhāra. But Kapha

vardhaka Āhāra is to be strictly avoided.

Mātra

Viniscay

Dose of virecana drug varies according to different author. It

depends upon the Koṣta, Deśa, Vaya etc. & also Kalpa of the

prescribed medicine to induce virecana.

II

Administr-

ation of

Virecana

yoga57

Assessment

&

preparation

patient

On the day of Virecana patient should assess in

terms of his stable mind, good & undisturbed

sleep, proper digestion of previous night food,

then perform Svastivacana, Homa, Bali,

Mangala kārya.

Administrati

-on of Drug

Once Ślema kāla over & Pitta kāla .

Select uttama mahurta, Tithi, Nakśatra then

advice patient to consume selected Virecana

drug58.(Cha.su.15/7)

Observati-

ons

Auṣadha

Jirṇa

Lakṣana

Vātanulomana, Svasthya, Kśudha, Triśna,

Sumanaska ,Indriya Laghuta and Udgara

Śuddi59.(Cakradatta.jvara /57)

AJirṇa

Auṣadha

lakṣana

Klāma, Dāha, Angasadana, Bhrama, Murca, Śiro

ruja, Arati, Balāhani60.

(Cakradatta.jvara /57)

Hŗitadoṣa

Sequential expulsion of Vit, Pitta.Kapha through

rectal route & features such as Dourbalya,


18



Lakṣana61 Laghutha, and Karśya are indicative of

Hŗithadoṣa lakṣana .

Śuddi

Lakṣana62

Śuddi Pravara Madhyama Avara

Laingiki Samyak virecana lakshna

Antiki 30 Vegas 20

Vegas 10 Vegas

Vaigiki 4 Prasth 3 Prasth 2 Prasth

Maniki Kaphānt

a Kaphānta Kaphānta

Virecana

Vyapat63

Any improper function of Bheśaja Catuśpada

leads to Virecana Vyapat.

3

Ph

t k

Immediate

Pascat

karma

Washing the hands, feet and face64. (Cha.Su.15/17)

Remote

Pascat

karma

Saṁsarjana

Krama

Peyādi Saṁsarjana65 (Cha.Si.1/11)

Tarpaṇādi krama 66 (Cha.Si.6/25)

Rasa Saṁsarjana krama67 Cha.Si.12/6-8)

Before initiating any Pañcakarma procedure Physician should collect all the

required things like Mudga, Māśa etc.food articles; Drākśa, Triphal, Dīpanānīya etc.

Medicines and measuring, cutting etc. equipments. By all these things one can carry

out proper procedure & can able to handle any sort of complications arises during &

after the procedure68. (Cha.su.15/7)

To get success in Śośana karma, Viadhya must examine the patient properly.

Because factors like selection of particular procedure, medicine, Dose of medicine

etc. mainly depends on patient69. (cha.Si.3/6)


19



In Patient whom Virecana is necessity but in such patient if dominance of

kapha or Vāta doṣa and Krūra Koṣta is their, then one should plan first to expel kapha

doṣa through Vamanakarma and/ administration of Basti Cikitsa to mitigate Vāta

doṣa. Otherwise these may pave for manifestation of complication during & after the

Virecana Karma in terms of Pravāhika, Gourava and Ayoga

respectively70.(Cha.ka.12/79-80) Śodhana karma differs from Śamana karma in terms

of expulsion of morbid Doṣas out of body where as Śamana karma mitigates such

Doṣas inside the body only without expelling it out of the body71.(A.Hr.Su.14/6)

Hence it is necessity that the presence of morbid Doṣas in Koṣta to expel out

i.e. if such Doṣas are there in Śakha these should be bring to koṣta which can be

achieved through Snehana & Svedana karma72. (Cha.Su.28/33). Before administration

of Śodhanaaga Snehana it is necessary to assess the status of Agni & Sāma ,Nirāma

condition. Based on it one should plan for Dīpana – Pācana prescription and then it is

followed by Snehapāna. Depending upon morbid doṣa involved in disease one should

select Sarvānga sveda for E.g. In Kapha doṣa select uśma Sveda, in Pitta Samsraśta

condition select Drava Sveda like Pariśeka & Avagāha73 (Sus.Chi.33/14)

Since Virecana is prime line of treatment for Pitta Doṣas74 (Cha.Su.25/40),

hence the care should be taken that Āmāśaya must be free from Kapha Doṣas, or else

Virecaka dravya adminstererd for virecana karma may lead to Vamana as

complication75. (Sus.Chi.34/5). Therefore physician must plan all the measures

which are not Kaphakāraka like administration of virecaka drug on 4th day of samyaka

snigdha lakṣana appears76(Cha.Su.14//80) & during this period patient is advised to

consume Laghu, Uśana, Drava etc. quality predominant food77. (A.S.Su.27/28)

Even though there are various reference are available regarding fixed

dosage of different forms of Virecana drug but these are applicable for patient with

Madhyam Koṣta-Bala-Vaya only78 (Cha.ka.12/86). So dose of Virecana drug of an

individual is, the one which expels only morbid Doṣa out of the body without

manifesting any undue complications.79 (Cha.su.15/10).


20



Importance of Snehapāna:

Dīptāgni, pariśuddha kostha, pratyagradhātu, balavarna, drida indriyata,

mandajara & śatayu are the benefits of snehapāna 80.(A.H.Su 16/46) Snehana is

beneficial in durbalāgni state to enhance it. Hence prior to snehapāna śodhana is

contraindicated. If we try to remove the doṣas from rukśa śarīra, then there may be

possibility of lodging the Doṣa due to rukśata in sŗotas.

In our body, each & every cell has got cell membrane which is made of lipid

substances & is permeable to lipids & impermeable to water soluble molecules. The

permeability permits the snehana dravyas inside the cytoplasm through cell membrane

& this process takes place by simple or lipid diffusion. During snehapāna ghī which is

administered has got saturated fatty acids & hence increases the cholesterol level.

Saturation kinetics: When the number of molecules inside the cell increase so much

that all the carrier proteins are occupied, the saturation point is reached, i.e. further

increase of the molecules will not cause any further rise in the rate of transport. The

above concept adds to the point to the action of malodhīrana which is not possible

when the administered sneha reaches more than the saturation point.

Svedana: The qualities of Svedana drugs are Uśna, tikśna, sara, snigdha, rukśa,

sukśma, drava, sthira & guru (Ch.Su.22/16) 81. The actions obtained by these gunas

includes: The action of svedana is performed by uśna guna & tikśna guna does

śodhana of Doṣas, sara guna doṣaśamana, rukśa guna does śośana, vivarana by

sukśma guna, stambha is relived by uśna guna, vilodhana by drava guna, dhārana

karma by sthira guna 82, 83 (A.H.Su.1/18 -Hemādri).

Addition of liquification of doṣas occurs due to svedana, by the virtue of its

drava guna & śodhana by tikśna guna which enters into minute sŗotas by its suśhma

guna. The āgneya property of tikśna & uśna gunas produce pāka & srāva.

Due to snehana, kledana of doṣas takes place & svedana does liquefaction

thereby they are brought to koṣta. The function of sveda is to produce kleda in the

body. Kleda is the product of jala in the body & it should be removed out. The final

product of jala dhātu is ap dhātu & kitta is kleda. The mula of svedavaha sŗotas is

medas & romakūpa. Sthūla medas produces the function of snehana & its mala causes

svedana. Svedana pacifies Vāta & enhances agni.


21



Mode of action of Svedana: 84 (A.H.Su.17/29)

The Klinna doṣas which are present either in koṣta, dhātu, sŗotas & śakhas &

asthi (which includes madhyama roga marga) are liquefied by svedana & brought to

koṣta, thereby eliminated through śodhana karma.

In short, snehana softens Doṣas & localizes them. Svedana liquefies those

doṣas due to its uśna & tikśna properties. The fluid is defined as dravata, prakledana,

ālodana drava i.e. the fluid properties will make things to move & causes klinnata of

the body. Then only the doṣas will reach to the koṣta & they will be removed either by

vamana or by virecana.

Mode of action of Svedana / sweat production:85

Heat has thermal effect on blood vessels, nerves. There will be increased

metabolic acting on the walls of the capillaries & arterioles causing dilatation of these

vessels. Sun light has a direct effect on blood vessels, causing vasodilatation in

superficial tissues where there is more heating. Due to vasodilatation there is an

increased flow of blood through the area, so that the necessary oxygen & nutritive

materials are supplied & waste products are removed. Heat reaches to subcutaneous

region & through the blood conveys the heat to the entire body. The capillaries will be

dilated; the sweat glands will be stimulated & local temperature rises. The resultant

action is appearance of perspiration. The sweat produced from the skin (through roma

kupas), will enhance the colouration of skin & softness. Sweat regulates heat & water

balance of the body. The muscles are supplied with parasympathetic nerves. Since the

centre is situated in anterior hypothalamus, by its stimulation sweat is formed. The

skin is stimulated by hot rays of sun & thereby perspiration results. Excessive

exposure may lead to oedema or sun burns in sensitive skin which is a local effect.

The general effects are produced in proportion to intensity & duration of exposure to

sun rays. During this process, there will be increased elimination of heat, excess

perspiration & signs of ordinary fever.


22



Total effects observed are:

Chart No:01

Table No :06 DOSE OF VIRECANA DRUG IN ITS DIFFERENT FORMS

Thermal effects

Hyperaemia of skin & subcutaneousvessels - Erythema

Stimulation of sweat glands

Sweat production

FORM

OF

MEDICI-

NE

koṣta DOSE

Sus86,87

Sha88

Van89

1

Any form

Krūra Uttama Tikśana Tikśana 1 pala

Madhyam Madhyam Madhya Madhya ½ pala

Mrudu Hīna Mrudu Mrudu 1 Karśa

2

Kwātha

Krūra Uttama

1 Anjali

(4 pala)

8 Karśa

2 pala Madhyama Madhyama 4 Karśa

Mrudu Hīna 2 Karśa

3

Curna

Krūra Uttama

1 Karśa

- 2 Karśa

Madhyama Madhya 1 Karśa 1 Karśa

Mrudu Hīna - ½Karśa

4

Svarasa

Krūra Uttama - 8 Karśa

1 pala Madhyama Madhyama - 4 Karśa

Mrudu Hīna - 2 Karśa

Krūra Uttama - -


23



Pradhana Karma includes administration of Virecana yoga and observations of

Auṣadha Jirṇata-Ajiranata, Śuddi Lakṣanas and management of Vyāpat if occurs.

If the patient is fit for Virecana karma on the day of Virecana karma, after

performing the Sarvānga sveda90 (Cha.Su.14//80) and the patient is advised to be in

empty stomach. Afterwards during the initial phase of Pitta kāla one should

administered selected particular virecana yoga with appropriate dose & anupāna91.

(A.S.Su.27/28). It is difficult to standardised time of the initial phase of Pitta kāla as

it mainly depends on movement of sun & sunrise which is varying from one place to

another place and season to season. If drug is adminsterd in śeṣlma kāla and/or after

consuming food then, kaphadoṣa may cause āvarana over grahani resulting in

mandhāgni, gourava, Śūla, Admāna & even Vamana may be seen as a complication92.

(A.S.Su.27/31-32)

Just after the administration of Virecana Yoga, cold water should sprinkled on

the face to avoid nausea/vomiting. Patient is asked to rinse mouth thoroughly with the

hot water and asked to smell the fragrance of jambīra or Surabhi etc. whichever

he/she likes. Advised to stay in nirvāta place, be in comfortable position and should

5 Kalka Madhyama

Madhyama

a

1 Karśa 1 Karśa

Mrudu Hīna - -

6

Modaka

Krūra Uttama - - -

Madhyama Madhyama - 1 Karśa -

Mrudu Kanīya - - -

7 Hima&

phanta

Krūra Uttama

1 Anjali

(4 pala)

8 Karśa -

Madhyama Madhyama 4 Karśa -

Mrudu Hīna 2 Karśa -

8

Sneha

- - - - 2 Karśa

or1 pala - - - -

- - - -

9

Uśna jala

Mrudu - - - 2 pala

Madhyama - - - 4 pala

Krūra - - - 8 pala


24



not sleep, shouldn’t suppress the natural urges; should consume hot water little by

little93. (A.Sa.Su.27/36)

Viadhya should concentrate on the manifestation of lakṣana of Jirṇa-AJirṇa

Auṣadha, Śuddi and Vyapat.If VirecanaVega is not initiated then asks the patient to

consume uśna jala in small dose & perform Tāpa Sveda with help of palm over

abdominal region which may help to stimulate peristaltic movement94. (A.S.Su.27/38)

Once Jīrna Lakṣana are appears but still only small amount of morbid doṣa are

expel or not yet all, then Physician should administer one more dose of Virecana drug

depending patient bala. But if its administered in the ajirṇa avastha of previously

consumed medicine, it causes atiyoga. Or if Aushadhi Jirṇa Lakṣanas are elicited, but

if the Hŗitadoṣa Lakṣanas are not found then Virecana Yoga should be given on the

next day. Even then if the Virecana does not occur, then after 10 days one should plan

to re-administration of Virecana karma i.e. again Snehana and Svedana should be

performed and thereafter Virecana drug should be administered95(A.S.Su.27/38)

Finally śuddi lakṣana must be assessed in terms of Subjective parameters like

Laingiki & Antiki & Objective Parameters like Vaigiki &Maniki. But among these

more importance should be given to Laingiki Śuddi96. (Cha.Si.1/13-14)

Kaśyapa Acārya being a Paediatrician, to practise Virecana Karma specially

for Bāla he has been identified. Mrudu and/ Sukha type of virecana and Maniki &

Vaigiki parameters97 i.e. (Ka.Si.3)

Table No : 07

Once it is confirmed that Virecana Vegas are stoped, then the patient is

advised to wash his hands, feet and face98. (Cha.Su.15/17). Also advised to avoid

aśta mahādoṣa bhavas i.e.1.Ucabhāśana, 2.Rathakśobha, 3.Aticankramana,

4.Atiāsana, 5.Adhyaśana, 6.Ahita bhojana, 7.Diwāswapna, 8.Maithuna99.

(Cha.Si.12/11-12). Based on Śuddi lakṣana especially Vaigiki advise patient to

follow Saṁsarjana krama.

Śuddi Pravara Madhyama Avara

Vaigiki 3 2 1

Maniki 3Prastha 2 Prastha 1 Prastha


25



Saṁsarjana Krama

Chart No : 02

Saṁsarjana krama should be planned after considering the type of śuddi. If in

case of Samyak Śodhana occurs but complete Doṣa are not expelled then advise

patient to consume Yavagu etc. food along with Antarpāna (Kaśaya pāna ) so that

there will be mitigation of Koṣtaupalepak Doṣa i.e. remaining doṣa104.

(Cha.Ka.12/66).

If the proper Virecana does not occur at that time instead of Peyādi Krama,

Tarpaṇa should be indicated since Peyādi by virtue of their Abhiśandhi property

causes Sŗotas obstruction. It is also recommended that the persons addicted to

alcohol, having Vāta Pitta Prakrti and if Kapha and Pitta are dominant even after

Virecana Karma. And Cakŗapāni mentioned that in place of Peya and Vilepi, Svacha

and Ghana Tarpaṇa should be given respectively105. (Cha.Si.6/25) While Arunadatta

described as Lāja Saktu & Māmsarasodana in Prathama & Dvitīya Annakāla

respectively106. (A.Hr.Su.18/46)

Suśruta has mentioned his opinion regarding the Saṁsarjana krama that:

Depending upon the hŗita doṣa pramana, āhāra vidhi changes. He considers 3

prāmana of doṣa harana i.e. 1 prastha, 1/2 adhaka & 1 adhaka which is avara,

madhyama & uttama prāmana respectively (Su.Chi.39/6-7) 107

Samsarjana Krama

Anna Smsarjana [chakrapani100

(Cha.Chi.2/75)

Peyādi101

(Cha.si.1/11)

Tarpanādi102

(Cha.Si.6/25)

Rasa SamarjanaMadhurādi Shad rasa103

(Cha.Si.12/ 7-8)


26



The food substances which are prescribed for Saṁsarjana krama includes:

1. Swalpa tandula yavagu

2. Vilepi

3. Sneha & lavana rahita mudga yuśa (akrita)

4. Half of quantity of cooked rice with mudga yuśa.

5. Krita yuśa along with 3/4th quantity of cooked rice.

6. Lava, kriśna mriga susamskrita māmsarasa is also given.

The above diet in avara, madhyama & pravara śuddi is 1,2 & 3 annakāla

respectively .108 (Su.Chi.39/8-11). Suśruta opines that according to bala viśeśa

Saṁsarjana krama viśeśa can be appreciated, i.e. if tīkśna bala is present then 3 āhāra

krama, in madhyama bala 2 āhāra krama, in mŗidu bala persons 1 āhārakrama is

mentioned (Su.Chi.39/17-18)109.

Table No: 08 Peyādi Saṁsarjana Krama110(Cha.si.1/11)

ÌÌSSllÉÉ MMüüÉÉssÉÉ AA³³ÉÉMMüüÉÉssÉÉ mmÉÉëëkkÉÉÉÉllÉÉ vvÉÉÑÑkkSSÏÏ qqÉÉkkrrÉÉqqÉÉ vvÉÉÑÑkkSSÏÏ ÌÌWWûûllÉÉ vvÉÉÑÑkkSSÏÏ

mmÉÉëëjjÉÉqqÉÉ mmÉÉëëÉÉiiÉÉ::

xxÉÉÉÉrrÉÉÇÇ

11

--

mmÉÉåårrÉÉÉÉ

--


--


ÌÌ²²iiÉÉÏÏrrÉÉ mmÉÉëëÉÉiiÉÉ::


22

33

mmÉÉrrÉÉÉÉ



ÌÌuuÉÉssÉÉååmmÉÉÏÏ


MM××üüiiÉÉÉÉMM××üüiiÉÉ rrÉÉÔÔwwÉÉ

iiÉÉ××iiÉÉÏÏrrÉÉ mmÉÉëëÉÉiiÉÉ::


44

55




AAMM××üüiiÉÉ rrÉÉÔÔwwÉÉ

MM××üüiiÉÉÉÉMM××üüiiÉÉ

qqÉÉÉÉ ÇÇxxÉÉUUxxÉÉ

xxÉÉÉÉqqÉÉÉÉllrrÉÉ ppÉÉÉÉ ååeeÉÉllÉÉ

ccÉÉiiÉÉÑÑjjÉÉïï mmÉÉëëÉÉiiÉÉ::


66

77


AAMM××üüiiÉÉ rrÉÉÔÔwwÉÉ

MM××üüiiÉÉ rrÉÉÔÔwwÉÉ

AAMM××üüiiÉÉ qqÉÉÉÉ ÇÇxxÉÉUUxxÉÉ

--

--

mmÉÉÇÇccÉÉqqÉÉ mmÉÉëëÉÉiiÉÉ::


88

99



MM××üüiiÉÉ qqÉÉÉÉ ÇÇxxÉÉUUxxÉÉ

xxÉÉÉÉqqÉÉllrrÉÉ ppÉÉÉÉ ååeeÉÉllÉÉ

--

--

wwÉÉ¸̧ mmÉÉëëÉÉiiÉÉ::


1100

1111

AAMM××üüiiÉÉ qqÉÉÉÉ ÇÇxxÉÉUUxxÉÉ


--

--

--

--

xxÉÉmmiiÉÉqqÉÉçç mmÉÉëëÉÉiiÉÉ::


1122

1133


xxÉÉÉÉqqÉÉÉÉllrrÉÉ ppÉÉÉÉ ååeeÉÉllÉÉ

--

--

--

--


27



To maintain the normal status of Doṣa especially in Āmāśaya & Pakwāśaya,

rasa Saṁsarjana krama is identified in classics. Here particular Rasātmaka food

articles are given to patient with proper order & this can be consumed along with

Peyādi Saṁsarjana krama or after it.

Table No : 09 Rasa Samarjana

Thus after the Virecna karma patient should follow aśta mahadoṣa bhavas and

diet properly still Prakritagata Lakṣana seen. These are when patient able to consume

and digest all shad Rasa yukta āhāra, proper functioning of all sense organ, normalise

of bowel habits & micturation, regaining of strength ,Satvavaan113 (Cha.Si.12/9)

Tarpaṇādi krama:

According to Caraka the following criterias are selected for tarpaṇādi krama:

Alpa śuddi of kapha & pitta , In alcoholic patients , In Vāta pitta prakriti individuals

(Ch.Si.6/25), Hīna śuddi (Su.Chi.39/13).

Reason for tarpaṇādi krama is that, the Peyādi krama causes abhiśyanda &

aggravates kapha doṣa (Su.Chi.39/13). Hence in the place of peya-swacha tarpaṇa,

vilepi is replaced by ghana tarpaṇa (Cakrapani on Ch.Si.6/25). According to Jejjata,

mudga yuśa & māmsa rasa are indicated in 1st , 2nd & 3rd annakāla respectively.

ACARYA Rasa Effect on Doṣa

Caraka111

ÎxlÉakÉ,AqsÉ,xuÉÉSÒ mÉYuÉÉvÉrÉ ÎxjÉiÉ uÉÉiÉmÉëvÉqÉlÉÉjÉï

AqsÉ, sÉuÉhÉ EkuÉïÎxjÉiÉ AÎalÉ xÉÇkÉÑ¤ÉhÉÉjÉï

xuÉÉSÒ, ÌiÉ£ü ÌmÉ¨ÉvÉqÉlÉÉjÉï

MüwÉÉrÉ, MüOÒû ÌmÉ¨ÉÉåkuÉïÎxjÉiÉMüTü mÉëvÉqÉlÉÉjÉï

Suśruta112

xxuuÉÉÉÉSSÒÒ,, ÌÌiiÉÉ££üü mmÉÉëëuuÉÉ ××kkSSÉÉÎÎaallÉÉWWåå ûûiiÉÉ ÑÑuuÉÉÉÉiiÉÉÌÌmmÉÉ¨̈ÉÉxxjjÉÉÉÉuuÉÉeeÉÉrrÉÉÉÉjjÉÉïïqqÉÉaallÉÉåå:: xxÉÉqqÉÉÏÏMMüüUUhhÉÉÉÉjjÉÉïï

ÎÎxxllÉÉaakkÉÉ,,AAqqssÉÉ,,ssÉÉuuÉÉhhÉÉ,,MMüüOOÒÒ ûû uuÉÉÉÉiiÉÉMMüüTTüüÉÉuuÉÉeeÉÉrrÉÉÉÉjjÉÉïïqqÉÉaallÉÉåå::xxÉÉllkkÉÉÑÑ¤¤ÉÉhhÉÉÉÉjjÉÉïï

xxuuÉÉÉÉSSÒÒ,, ÌÌiiÉÉ££üü ÌÌmmÉÉ¨̈ÉÉuuÉÉÉÉiiÉÉÉÉuuÉÉeeÉÉrrÉÉÉÉjjÉÉïï


28



Sequence of rasa used in Saṁsarjana krama:

According to Caraka, for agni sandhukśanartha: initially snigdha, amla,

madhura &hŗidya dravyas are used to pacify Vāta, āmla & lavana is used to enhance

the agni, madhura & tikta rasa for pitta śamana. Later to pacify kapha kaśaya & katu

rasa should be used (Chakrapani on Ch.Si.12/6-8).

According to Suśruta, initially swadu, tikta rasa should be given to pacify Vāta

pitta & to increase agni, later snigdha, amla, lavana, katu is taken to pacify Vāta &

kapha & to boost agni. To pacify Vāta pitta generated due to previous rasas, madhura

& tikta rasa is used in next series. Later kaśaya & katu rasa should be used to pacify

kapha & pitta situated in upper part (Dalhana on Su.Chi.39/18-19). Rukśa & snigdha

is used as vyatyasa krama (alternatively) & the same is followed in further days. The

intention is to make practice to śodhita body & to have abhyasa of all rasa in these

days. It is even appropriate to continue further for few days while taking normal diet.

Table No :10 Virecana Vyapat

Sl.

No. Vyapat lakshna

Caraka114

(Cha.Si.6/29)

Sushruta115

(Sus.Chi.34/3)

Vagbhata116

(A.Sa.Ka.3)

1 Adhmana + + +

2 Parikartika + + +

3 Parisrava + + +

4 Hrdgraha + - +

5 Gatragraha + - Sarvāngagraha

6 Jivādāna + + +

7 Vibhramśa + - Guda

Vibhramśa

8 Stambha + - -

9 Klama + - -

10 Upadrava + - -

11 Hīna Aushadhitva - + -

12 Vāta Ṣūla - + Vedana

13 Ayoga - + +

14 Atiyoga - + +

15 Hŗidaya-Upasarana - + -

16 Vibandha - + -


29



17 Pravāhika - + +

18 Visamjnata - - +

19 Vamana - + +

Table No:11 Samyak yoga, Ayoga & Atiyoga lakshnas of virecana karma

Sl.

no Lakṣana

Ch.117

(Si.1/17-19)

Sus.118

(Chi.33/24-26)

A.Hr.119

(Su.18/38-40)

Samyak yoga lakṣana of virecana

1. Sŗoto Viśuddi + - -

2. Indriya Prasāda + + -

3 Laghuta + + -

4 Agnivrddhi + - -

5 Anāmayatva + + -

6 Kramāt Vit Pitta

Kaphagamana + + -

7 Vātanulomana - + -

8 Absence of Ayoga

lakṣanas - - +

Ayoga lakṣanas of virecana karma

1 Kapha Prakopa + + +

2 Pitta Prakopa + + +

3 Vāta Prakopa + - -

4 Agnimāndya + + -

5 Gaurava + + -

6 Pratiśyāya + - +

7 Tandra + - -

8 Cardi + - -

9 Aruci + + +

10 Vāta Pratilomana + - Vātagraha

11 Dāha - + +

12 Hŗdaya Aśuddi - + +


30



13 Kukśi Aśuddi - + +

14 Kandu - + +

Atiyoga lakshnas of virecana karma

1 Kapha Kśaya Vikara + + -

2 Pitta Kśaya Vikara + - -

3 Rakta Kśaya Vikara + - -

4 Anilothaha + - -

5 Supti + - -

6 Angamarda + - -

7 Klama + - -

8 Vepathu + - -

9 Nidra + - -

10 Balabhava + - -

11 Tamah Praveśa + - -

12 Unmāda + - -

13 Hikkā + - -

14 Mūrca - + -

15 Guda Bhramsa - - -

16 Kapha,Pitta,Rahita

ŚvetaUdaka Nihssarana - - +

17 Kapha,Pitta,Rahita

LohitaUdaka Nihssarana - - +

18 MāmsaDhavanavat

udaka srava - - +

19 Medokhandavat Srava - - +

20 Triśna - - +

21 Bhrama - - +

22 Netrapraveśanam - - +


31



Cakrapani explains though Ayoga, Atiyog and Mithyayoga are described

everywhere accordingly in the text, but in case of vamana & virecana there is no need

to consider Mithyayoga as a separate entity.

In these procedures, expulsion occur in 4 different ways

Atipravruti – Excessive expulsion. (Elimination)

Asamyak pravruti – Expulsion by improper way.

Apravruti – Cessation of process of expulsion or improper elimination.

Alpapravruti – Expulsion in lesser quantity.

Here apravruthi & alpa pravruthi are included in ayoga. As asamyak Pravrutthi

means expulsion through opposite route, it indicates that expulsion of vitiated doṣa is

not in a quantity, which is expected, so it must be considered under the term of ayoga

and not mithyayoga120. (Cha.Si.6/29-30)

MODE OF ACTION OF VIRECANA

In Caraka saṁhita we get a brief description on how the Virecana dravya acts

in the body which is as follows. The drugs which are Uśna, Tikśna, Śukśma, Vyavāyi

and Vikāsi reach to the heart by virtue of their potency and circulate through the large

and small Sŗotas due to its Sukśma and Vyavayi properties and pervade entire body.

Then they liquefies the morbid elements by virtue of their āgneya Guna and crumbles

them by virtue of its Tikśna Guna. Then this liquefies and crumbled mass Looses

contact with the wall and the channels in the unctuous body, just like the honey, not

adhered to the unctuous vessel. This morbid mass now passes through the minute

capillaries and moves towards koṣta by virtue of the Anu, Pravana Bhāva of the drug

and ultimately reaches the Āmaśaya. From here it forces the morbid factors through

the anal route due to the Bhautika predominancy of Jala and Prithvi and Adhobhaga

Prabhava121 (Ch. K.1/4)


32



Chart No: 03

Virechana dravya (Uṣna,Tikṣna, Shukṣma, Vyavāyi and Vikasi )

REACHES Hridaya

Circulate through the large and small Srotas(By the virtue of their potency)

penetrate entire body(Sukṣma and Vyavāyi properties)

Liquefies the morbid elements (āgneya Property )

Crumbles the morbid elements(Tīkṣna Property)

Looses contact with the wall and the channels in the unctuous body,Just like the honey, not adhered to the unctuous vessel.

Passes through the minute capillaries and moves towards kośta ultimately reaches the āmāśaya

(By Anu, Pravana Bhāva of the drug )

Expulsion the morbid factors through the anal orifice(Bhautika predominancy of Jala and Prithvi and Adhobhāga Prabhāva )

DISEASE REVIEW

The concept of Āmavāta

33



ĀMAVĀTA

As the term indicates, the term ‘Āmavāta’ comprises of two words Āma and

Vāta. Āma being the centre phenomena of the disease which is not less associated with the Vāta thus causing the disease Āmavāta. Here Āma plays major role in the manifestation of the disease. Also it is considered to be the root cause of the maximum number of disease as per the Āyurvedic text.

Āmavāta was first described as an independent disease in mādhava nidāna.It is

a disease of madhyama roga mārga.It effects sandhi and hridaya marma. As the name

suggest āma and vāta are the two predominant pathogenic factors along with tridoṣic

vitiation.

DEFINITION OF ĀMA :-

1. FwqÉhÉÉã AsmÉ oÉsÉiuÉãlÉ kÉÉiÉÑ qÉÉ±qÉmÉÉÍcÉiÉqÉç |

SÒ¹qÉÉqÉÉvÉrÉaÉiÉÇ UxÉqÉÉqÉÇ mÉëcÉ¤ÉÇiÉã || A.WØû xÉç 13/25

2. AÉqÉqÉ³ÉUxÉÇ MãüÍcÉiÉç,MãüÍcÉ¨ÉÑ qÉsÉ xÉÇcÉrÉqÉç |

mÉëjÉqÉÇ SÉãwÉ SÒÌ¹Ç cÉ MãüÍcÉSÉqÉÇ mÉëcÉ¤ÉiÉã ||

3. AÉWûÉUxrÉ UxÉÈ vÉãwÉÉã rÉÉã lÉ mÉYuÉÉã AÎalÉsÉÉbÉuÉÉiÉç |

xÉ qÉÔsÉÇ xÉuÉï UÉãaÉÉhÉÉqÉÉqÉÇ CirÉÍpÉkÉÏrÉiÉã ||

Due to the decreased digestive capacity of agni in āmaśaya,the undigested and

vitiated rasa dhātu formed and is called as āma.It is also considered as mala

sanchaya,apakva anna rasa which is the root cause for all disease.

Here, the 3 different opinions about Āma are compiled by Vijaya Rakśita. First view

is about the improperly digested food and the second describes the accumulation of

Malas in the different parts of the body. According to the third view, the first stage of

Doṣa Duśti is Āma

Further to understand ‘Āma’ in better way it can be studied separately under

the following headings.

Āma produced due to

Jatarāgni Māndyajanya


34



Dhātwāgni Māndyajanya

Bhutāgni Māndyajanya

Accumulated Malajanya

Toxic Āma produced due to interactions of virulently vitiated Doṣas Initial

stage of Doṣic vitiation

VYUTPATTI OF ĀMAVĀTA :- AÉqÉãlÉ SÒ¸Éã uÉÉiÉ AÉqÉuÉÉiÉ | vÉÉ.xÉ.mÉëç 7/41

AÉqÉålÉ xÉÌWûiÉÉå uÉÉiÉ AÉqÉuÉÉiÉ | qÉÉ.ÌlÉ.25/2 qÉkÉÑMüÉåwÉ

AÉqÉÇ cÉ uÉÉiÉÇ cÉ AÉqÉuÉÉiÉqÉç | qÉÉ.ÌlÉ.25/2 qÉkÉÑMüÉåwÉ

AÉqÉÉã AmÉÉMü WãûiÉÑÈ uÉÉiÉÈ xuÉlÉÉqÉYrÉÉiÉ UÉãaÉÌuÉvÉãwÉÈ | vÉç.Mç. .SØ

rÉ²É AÉqÉ xÉÇmÉ×£üÉã uÉÉiÉ AÉqÉuÉiÉÈ | vÉÉ.xÉ.mÉëç 7/41

AÉqÉãlÉ rÉÑ£üÉã uÉÉiÉ AÉqÉuÉÉiÉ È| vÉÉ.xÉ.mÉëç 7/41

xÉ sÉ¤ÉhÉ ÌuÉÌwÉ¹É uÉÉiÉUÉãaÉÌuÉvÉãwÉã | uÉæ.vÉç.ÍxÉ

Here involvement of two factor āma association with vāta. Āma is resulting

from improper digestion which further cause duśti of vāta leading to the disease

Āmavāta.

DEFINITION OF ĀMAVĀTA:-

rÉÑaÉmÉiÉç MÑüÌmÉiÉÉuÉliÉ: Ì§ÉMüxÉÎlkÉmÉëuÉåvÉMüÉæ |

xiÉokÉÇ cÉ MÑüÂiÉå aÉÉ§ÉÇ AÉqÉuÉÉiÉ: xÉ EcrÉiÉå || qÉÉ.ÌlÉ.25/5 qÉkÉÑMüÉåwÉ

Āmavāta is a disease where the vitiated āma with vāta is lodged in trika sandhi

area leading to stabdata.


35



NIDĀNA :-

NIDĀNA PAÑCHAKA OF ĀMAVĀTA

Madavakara explains the etio-pathogenesis of Āmavāta as follows 122

• Virudha āhāra

• Virudha chesta

• Mandāgni

• Nischalata

Indulging in vyayāma soon after snigdha āhāra

Indulging in above said nidānas agnimandya takes place which leads to

production of āma rasa in the body. Even vāta doṣa gets vitiated due to above nidāna

and āma .This āma circulates in the body due to this vitiated vāta and gets lodges in

śleśma sthana mainly sandhi leading to Āmavāta.

Ahāraja Karanas:

The quality of food articles which cause the production of Āma is as follows:

Not only the nidānas of food, in respect of quantity alone causes Āma but

also the use of food and drinks which are Guru, Rukśa, Śīta, śuśka, Dwista,

Vistambhi, Vidāhi Viruddha and taken untimely

According to Suśruta it consists of excess intake of water and consuming

Viśamāsana are main causes for improper digestion, even to lighter foodstuffs in time. 10 Viśamāsana is one, which is Matrātadhika (excess of quantity), or Alpah (less) than

the required quantity and either prior to the fixed Annakāla or later as defined by

Charaka.

Viharaja Kāranas:

Sandhārana (suppressing natural urges), Swapnavipanyaya are Vihāraja

Kāranas.

Mānsika Karanas: While afflicted with Psychic emotions such as Kāma, Krodha , Lobha , Moha ,

Irśa, Śoka , Hree , Udvega , Bhāya, Upataptāmanasa comprise Manasika Karāmas producing Āma in the body. This is because in Swasthavritta told that while eating concentration is also necessary so as to get benefit of food. Otherwise proper digestion will not be taking place, but leads to Āma


36



Pūrva rūpa:- Pūrvarūpa is indicator of the arrival of disease. They sometimes simulate the

symptoms of actual disease and sometimes not, but in any case they indicate

occurrence of an ailment.

Though the Pūrvarūpa of Āmavāta is not explained in the Samhitas, we can

consider few of the Sāmanya Āmavāta Lakṣanas as its Pūrvarūpa. It is understood

from Āyurvedic classics that some of the Pūrvarūpa may continue as Sāmanya

Lakṣana of any disease.

Before the manifestation of Āmavāta formation of āma and vitiation of vāta

doṣa is important. So before the lakṣanas of Āmavāta is manifested we will see the

lakṣanas pertaining to the āma uthpatti and getting involved with vāta is seen. These

may be considered as Pūrvarūpa. The āma lakṣanas like sŗotoroda, balabramśa

,gaurava, anilamoodata, alasya, apakti, niśteeva, aruchi are seen.123

Vangasena mentioned lakṣanas like ajeerna, śiroruja,gatraruja as Pūrva rūpa of

Āmavāta124.

Avyakta lakṣana of the vyadhi is also considered as Pūrva rūpa as per caraka125.

Rūpa :- Specific signs and symptoms of a disease when manifested distinctly are

considered as Rūpa Avastha or Lakṣana of a disease. Rūpa is one of the key tools in

arriving at the diagnosis. After the completion of Sthana samsraya Āmavāta is produced and the

symptoms are called as rūpa. The complete vyakta lakṣana of a disease is rūpa.

In case of Āmavāta rūpa can be put under 4 headings

1.pratyatma lakṣana

2.sāmanya lakṣana

3.doṣanubanda lakṣana

4. pravrudda Āmavāta lakṣana.

Gatra stabdhata is considered as th pratyatma lakṣana of Āmavāta126.


37



Sāmanya lakṣana:- 127,128,129,130,131,132

Table No: 12 Sāmanya Āmavāta lakṣana

LAKṣANA M.N B.P Y.R G.N HS VGA Angamarda

+ + + + - +

Aruchi + + + + - +

Truṣna + + + + - +

Alasya + + + + - +

Gourava + + + + - +

Jwara + + + + + +

Apaka + + + + - +

Angasoonata + + + + - +

Vikunchana of Manya - - + + - -

Vikunchana of Prushata - - + + - -

Vikunchana of Kati - - + + - -

Vikunchana of Jānu - - + + - -

Vikunchana of Trika - - + + - -

Saśabda Gatra - - + + - -

Srasta Gatra - - + + - -

Dośānubanda lakṣana 133

Vātānubnda causes------ In Vātaja type of Āmavāta, Śūla will be the

predominant symptom. This can be well correlated to the Śīta and Cala

Guna of Vayu. In Āmavāta, the path of the Vāta is obstructed due to Āma.

Hence the characteristics feature of Vāta-śūla will be more.

Pittānubanda causes ----- Symptoms Raga and Dāha are indicative of

Pittaja Āmavāta. These are due to the Teekśna, Uṣna Guna of Pitta.


38



Kaphanubanda causes----- Symptoms Sthaimitya, Guruta, Kandu indicate

the dominance of Kapha. Sthaimitya is produced due to Picchila, Sthira

and Śīta Guna of vitiated Kapha. As Āma and Kapha have similar

qualities, Guruta and Kandu are seen in the Sandhis.

Samsargaja: Mixed symptoms of Vātaja and Pittaja, Vātaja and Kaphaja,

Pittja and Kaphaja are seen.

Sannipātika: In Sannipātika type of Āmavāta, symptoms of all the three Doṣas are

profoundly seen.

Pravrudda Āmavāta lakṣana : 134,135,136,137,138,139

Table NO: 13 Pravrudda Āmavāta lakṣana

LAKṣANA M.N B.P Y.R G.N HS VGA Sa Ruk Śotha Hasta

+ + + + - +

Sa Ruk Śotha Pada + + + + - +

Sa Ruk Śotha Śira + + + + - +

Sa Ruk Śotha Gulpha + + + + - +

Sa Ruk Śotha Trika + + + + - +

Sa Ruk Śotha Janu + + + + - +

Sa Ruk Śotha Uru + + + + - +

Agnidourabalya + + + + - +

Praseka + + + + + +

Utsaha Hani + + + + - +

Vyrasya + + + + - +

Dāha + + + + - +

Bahumutrata + + + + - +

Kuśikadhinata + + + + - +

Kukśiśūla + + + + - +

Nidraviparyaya + + + + - +


39



Types of Āmavāta:-

Śarangadara mentions four types of Āmavāta according to the involvement of

Doṣas140.

1.Vātaja

2.Pittaja

3.Kaphaja

4.Sannipātaja

Acharya harita while explaining about the Āmavāta mentions 4 types 141.

Trut + + + + - +

Chardi + + + + - +

Brama + + + + - +

Mūrcha + + + + - +

Hrutgraha + + + + - +

Vitvibhandha + + + + - +

Jadyata + + + + - +

Antrakūjana + + + + - +

Anaha + + + + - +

Sandhi Śotha - - - - + -

Peeta and Uṣna Chardi - - - - + -

Trika Vyadha - - - - + -

Prushta Vedana - - - - + -

Manya Vedana - - - - + -

Āma Atisara - - - - + -

Anga Vaikalya - - - - + -

Vrishchika damshavat Ruja

+ + + + - +


40



Viśtambhi: This type of Āmavāta presents with Śareera Guruta, Adhmana,

and Basti Śūla.

Gulmi Āmavāta: Āmavāta having Jatara garjana, Gulmavat peeda and Kati

jadata is called as Gulmi.

Snehi: Here Gātra snigdhata, Jadhya, Mandāgni and excretion of Vijala and

Snigdha āma are characteristic.

Pakva āma: This variety of Āmavāta presents with excretion of śyava vijala

pitta and Pakva āma along with Śrama and Klama.

Based on Duration:

Based on the general principle of duration, Āmavāta can be of two types.

Naveena: If the duration of disease is not more than one year, it is called

Naveena Āmavāta which is Sādhya.

Purāna: If the duration of Āmavāta is more than one year, it is called Purana

Āmavāta which is difficult to treat.

UPAŚAYA-ANUPAŚAYA:-

The upaśaya Anupaśaya helps the physician to diagnose a disease when he is

confused with symptoms .So the physician by looking into the upaśaya –Anupaśaya

should gain the Gudaling of the vyadhi142.

Upaśaya: Āhāra, Auśada, Vihāra which are responsible for relief from the symptoms of

a disease are known as upaśaya. That which aggravate the condition is known as

aupaśaya143.

The symptoms of Āmavāta like sandhi śūla ,jwara,angamarda alleviate by using

uśana,tikśna, rūkśa, tikta ,katu. deepana, laghu āhāra,and uṣna vihāra. Langana

increase the agni,which helps in digestion the causative factor āma and normalizes the

symptoms like guruta, praśeka, aruchi,So here kaphagna and apatarpana measures are

adopted

Anupaśaya: Santarpana aggravates the disease condition by increasing āmavriddhi.

Śīta,guru,snighda āhāra,snigdha sveda leads to increase of the condition.They cause

SŖOToabhiśyanda. Cloudy weather,morning hours ,Śīta kala are also anupaśaya.


41



Vāta prakopaka nidāna

Vāta prakopa

Agni māndyajanya

Vāta duśti Āma uthpathi

Agni māndhya

Sāma vātādhi doṣa

Dhamani Pratipadyath

Saruja śotha

Trika sandhi [kavaigunya]

Chart NO: 4. Schematic representation of Saṁprāpthi :-

SANCHAYA

PRAKOPA

PRASARA

STHĀNA SAMŚRAYA

VYAKTHA


42



Saṁprāpthi:- 144

Indulgence in nidāna by those who have mandāgni,the āma is produced in the

āmaśaya.This āma. Associating itself with vāta,moves throughout the body with help

of vitiated vāta, and gets lodged in śleṣma sthāna mainly sandhis because of

kavaigunya present over there. This circulating āma in the dhamani vitiates the

normal vāta pitta kapha doṣas. This cause sŗoto-abhiśyandi, athi pichila, sŗotoroda.

leading to symptoms like aśudaurbalya, gaurava in hrudaya,sandhi śota,sthabdata,

śūla.

SĀDHYASĀDHYATA:-

According to charaka sadhyāSādhyata plays a very important role in selecting

the patients. By this chance of losing fame and money will be minimum145.

According to mādhavakara Āmavāta is a krichraSādhya vyadhi146. It may be curable

in the initial stage. As it becomes pravrudha it is difficult to cure. Treating āma and

vāta is much more difficult because of their opposite nature.

Āmavāta with ekaDoṣaja with few lakṣanas of recent origin is

Sādhya147.pakwaāma type described by haritha is sukasādya148. Dwidoṣaja with many

nidānas, lakṣanas, and not of recent origin is yapya.

Tridoṣaja associated with sarvānga śotha, sarvadehachara,and snehi

āma,vistambi,gulmi type is kaśta Sādhya149.

PATHYA-APATHYA

mÉjrÉ mÉjÉÉå AlÉmÉåiÉqÉç rÉ±ccÉÉå£üÇ qÉlÉxÉÈ ÌmÉërÉqÉç|

rÉccÉÉÌmÉërÉqÉmÉjrÉÇ cÉ ÌlÉrÉiÉÇ iÉ³É sÉ¤ÉrÉåiÉç || cÉç.xÉç.25/45

The drug and regimen which do not adversely affect the body and mind are

regarded as wholesome, those which affect them considered to be unwholesome. In

vaidhyakeeya subhaśitha it is told that there is no need to take any medicine for the

disease if one follows the pathya ,and there is no need to take medicine for the one

who does not follow the pathya,as it is not giving any benefit.


43



PATHYA:- Hārita explains that the pathya told in jwara roga should also be considered in

Āmavāta as in both the disease involvement of rasavaha sŗotas is there150. All the

āhāra vihāra which are Vāta Kapha hara, Āmapāchaka, Agnivardaka are useful.Yava

,kulatha, śyāmaka, kodrava, rakthaśali, vastuka, śigru, karavaellaka, patola, ārdraka,

laśuna, uṣnajala, takra, jāngala mamsa. Panchakola siddha jala,katu tikta phala,

gokśura,varuna,arishtaka, purāna śhāli, sauveera, punarnava, lavamamsa processed in

takrakulatha yuśa ,jeerna Madhya.balataka.151,152

APATHYAS:- The āhāra vihara which cause agnimandya, abhiśyandana, all the nidānas

which are Vāta and Kapha kara in nature is apathya to Āmavāta.

Dadhi,matsya,guda,kśeera, mahapistaka, duśta jala, virudhaśana, satmya, viśamaśana,

guru adhiśyandaāhāra,vegadharana, jagarana, nischeśtata,Dwidala danya, goulya,

taila, Śītala jala snana, uṣna drava. 153,154

sÉÇbÉlÉÇ xuÉåSlÉÇ ÌiÉ£üÇ SÏmÉlÉÉÌlÉ MüOÕûÌlÉ cÉ |

CHIKITSA--

ÌuÉUåcÉlÉÇ xlÉåWûmÉÉlÉÇ oÉxiÉrÉ¶ÉÉqÉqÉÉÂiÉå || Ã¤É xuÉåSÉå ÌuÉkÉÉiÉurÉÉå uÉÉsÉÑMüÉmÉÉåOûsÉåxiÉjÉÉ |

xÉæÇkÉuÉÉ±ålÉÉlÉÑuÉÉxrÉ ¤ÉÉUoÉÎxiÉ : mÉëvÉxrÉiÉå || rÉÉå.Uç AÉqÉuÉÉiÉç.ÍcÉ 17,18

sÉÇbÉlÉÇ xuÉåSlÉÇ ÌiÉ£üÇ SÏmÉlÉÉÌlÉ MüOÕûÌlÉ cÉ |

ÌuÉUåcÉlÉqÉç xlÉåWûmÉÉlÉÇ uÉxiÉrÉ¶ÉÉqÉqÉÉÂiÉå||

xÉælkÉuÉÉ±ælÉÉlÉÑuÉÉxrÉ ¤ÉÉUoÉÎxiÉÇ mÉëvÉxrÉiÉå|| cÉ.Sè 25/1

AÉqÉÇ eÉrÉåssÉÇbÉlÉÇ MüÉåwhÉ mÉårÉÉsÉbuÉ³Éç Ã¤ÉÉæSlÉÌiÉ£ürÉÔwÉæÈ|

ÌlÉÃWûhÉæÈ xuÉåSlÉmÉÉcÉlÉæ¶É xÉÇvÉÉåkÉlÉæÃkuÉïqÉkÉxiÉjÉÉ || rÉÉå.Uç mÉÔuÉÉïkÉï 2

The treatment modalities for Āmavāta listed by Yogaratnakara and Chakradatta can

be organized into three groups,


44



Āmapācana:

The first step in the management of Āmavāta is Āmapachana, as it is the first

step in the general management of all the diseases and as Āma is the prime pathogenic

factor in Āmavāta.

Langhana:155

In the management of Āmavāta, Upavasa is the ideal line of treatment.

Bhavaprakaśa in the context of Jwara, considers Langhana as Upavāsa. 53 As both

Jwara and Āmavāta are Āmāśayotha diseases,Upavāsa (AnaśanamUchyate) can be

considered as the ideal method of Langhana in Āmavāta also. This is also because of

unsuitability of the other methods of Langhana, analysed below.

o Chatuśprakara samśudhi, cannot be employed because Samśodhana is

contraindicated in the Sāmavastha of a disease. Pipasa cannot be employed

because in morbid patients Jala is Pranadharaka Maruta and Atapa Sevana are

less efficient for Jatharagni impairment when compared to Upavāsa.

o Deepana, Pachana cannot be employed as Agni affected by Āma is incapable

of Doṣa, Āhāra and Oushadha Pachana. Vyayāma is incompatible in the

disease Āmavāta.

For these reasons, Upavāsa is the ideal method of achieving Langhana in

Āmavāta, which can be achieved by Anaśana or Alpabhojana. The Langhana thus

achieved will have Āmapachaka effects at the Koṣta level as well as Sārvadaihika

level

Svedana:

The definition of Sveda includes its benefits, viz. Stambha, Gourava and

Śītagna. Since these are antagonistic to the qualities of Kapha and Āma, Svedana has

an important role to play in the treatment of Āmavāta. Snigdha Sveda, Rukśa Sveda

treatment

langhana

shodhana

shamana


45



and Ekangasveda, Sarvāngasveda are the two fold classifications of Sveda and in

Āmavāta, the Rukśa type of Sveda should be administered for the following reasons;

The pathogenesis of Āmavāta involves spread of Āma and Vāta to the

Sleśmasthana, specifically Āmaśaya and Sandhi.In all conditions of

Āmaśayagata vāta, Rukśa sveda should be administered. As disease is localized

in Sandhipradeśa, Ekangasveda is ideal. The Rukśasveda can be advised to the

affected Sandhi using Valukapottali or Rukśopanaha.

Tiktam Deepanani Katuni Cha:

Administration of Tikta, Katu Deepana oushadhis in Āma achieves

Āmapachana both at the Koṣta level and Sarvadaihika level. The methods used for

Āma Pachana are potentially Vātaprakopaka. But as Langhana is indicated in Sāma

Vāta condition the danger of Vāta Prakopa is minimal because, the Āmapachana

methods of Langhana, Svedana and Tikta Katu Deepana drugs are administered only

until Nirāmavastha is achieved. After this, Nirāma Doṣas have to be eliminated from

the body by śodhana. The śodhana methods which can be employed are Virechana

and Basti.

Virechana:

Virechana is the best preferred form of Śodhana in Āmavāta because Vāmana

(Ullekhana), (Ullekhana) though indicated by Charaka in Āmachikitsa is unsuitable

here as it aggravates the symptoms of Āmavāta caused by Pratilomagati of Vayu like

ānaha, Vibandha and āntrakūjana. They can best be relieved by Virechana..

Basti:

Basti forms the second method of Śodhana. Both Niruha and Anuvāsana

Bastis should be employed here. The Niruha Basti does the śodhana of the Doṣas

brought to Pakvaśaya and the Anuvasāna Basti alleviates Prakupita vāta as a

consequence of Niruha Basti.

Śamana Snehapana:

This is a third component in the plan of management of Āmavāta. The

objective of Snehapāna here is śamana. It is important to administer Sneha only after


46



the disease has become Nirāma. śamana Snehapana in Āmavāta provides the

following benefits;

o Snehapana prevents the aggravation of Vāta and Rukśata as a result of the

previously employed therapeutic measures.

o It helps in increasing the Bala of the patient who has been debilitated as a

result of previously employed therapeutic measures. śamana Sneha stimulates

the Agni which is an important component in the treatment of Āmavāta.

o Since the Snehapana has been prescribed in Asthi Majja Gata Vāta, it can be

comfortably used in Āmavāta. Vātaharana is the inherent property of Sneha,

an essential requirement in the treatment of Āmavāta.

Sapekśa nidāna is the comparison of diseases having look alike feature.Āmavāta is a

painful joint disorder which has to be differentiated from other painful joint diseases

like,

SĀPEKŚA NIDĀNA

1. VĀTA RAKTA:- 156

In this disease as the name suggest involvement of rakta plays important role in

causing disease. Main feature of the disease is, it affects classically the big toe with

some skin manifestation. Pain will be like akūviśa

2. SANDHIGATA VĀTA:-157

Here swelling occurs like air filled bladder in touch and pain during contraction

and extension of limb.

3. KOŚTUKA ŚĪRŚA:-158

It is mainly due to vāta and śonitha.It effect only knee joint. Pain is severe and the

shape of joint is śrigala mastakavath.( head of a jackal)

Rheumatoid Arthritis

47



RHEUMATOID ARTHRITIS: 159

Definition:

Rheumatoid Arthritis is a chronic disease, cause of which is unknown. It

persists with inflammatory synovitis, usually involving peripheral joints in a

symmetric distribution – apart from variety of systemic manifestations. Cartilage

destruction due to synovial inflammation and bone erosions are important findings in

this disease. Many times course of the disease may be quiet variable. Starting from

only a minimal joint damage to a progressive polyarthritis marked functional

impairment are seen during varied course of Rheumatoid Arthritis.

Epidemiology and genetic factors

RA is prevalent throughout the world and involves all ethnic groups .The

figures of prevalence vary substantially ranging from 0.3% to 1% of the population

Indian data suggests the prevalence to be around 0.65% to 0.75% of the population. 1-

3%of women may develop RA in their life time .Initial studies RA was shown to be

association with HLA DH4 haplotype.In recent studies HLA-B1 gene association has

been suggested particularly in patients with extra articular manifestation .It alleles

determine disease progression and severity.RA can run in families with such genetic

predisposition.

Etiology:

Cause of Rheumatoid Arthritis remains unknown. Some suspect as

manifestation of the response to an infection agent in a genetically susceptible host. A

number of causative agents have been suggested, including Mycoplasma, Epstein-

Barr Virus (EBV), cytomegalo virus, Pasvo virus and rubella virus, but convincing


48



evidence that these or other infections agents cause RA has not emerged. One

possibility is that there is persistent infection of articular structures or retention of

microbial produces in the synovial tissues, which generates a chronic inflammatory

response. Autoimmune mechanism related to the connective tissue more particularly

the sinovium is mostly accepted as the pathology of the illness.

Clinical manifestations:

Usually RA is a chronic polyarthritis. Begins with fatigue, anorexic,

generalized weakness and vague muscle skeletal symptoms, until the appearance of

synovitis becomes apparent – which persist for weeks or months together. Specific

symptoms usually appear gradually as several joints, especially of the hands, wrists,

knees and feet, become affected in a systematic fashion. About 10% of the patients

start the disease acutely, with rapid development of polyarthritis, often accompanied

by constitutional symptoms including fever lymphadenopathy and splenomegaly. In

one third of patients, symptoms may initially be confined to one or a few joints

though symmetric pattern is more typical even some cases are seen with asymmetric

fashion.

Articular manifestations of RA:-

The wrist are most commonly affected among all patients .The metacarpo

phalngeal and proximal interphalngeal joints are frequently involved, classical

deformities seen in the hands are ulnar deviation ,rupture of extensor tendons,swan

neck deformities and Boutonniere’s deformities .In shoulder only objective finding is

loss of motion .Elbows being a superficial joints, inflammation can be detected early

enough. In hips early manifestation do not become apparent as the point is deep


49



seated. Knees are involved very commonly in RA and detected easily .Popliteal cyst

[baker’s cyst] may be associated with rupture into the calf muscle, producing pain,

swelling and tenderness in the calf .Foot and ankle are weight baring structures

commonly involved in RA .The Metatarsophalngeal ,talonavicular and ankle joint

affection leads to ‘cock up’ deformities of the toes and subluxations of the meta tarso

phalngeal heads on the soles .

Extra articular manifestations :-

RA being a systemic disease, many patients experience malaise and fatigue.

Early morning stiffness is a characteristic event and may last till afternoon depending

on severity.The extra articular manifestation like

Systemic –Low grade fever, loss of appetite, loss of weight.

Musculoskeletal – Muscle wasting, bursitis, teno synovities .

Skin- Subcutaneous nodules, ulcers, vasculitis.

Eye – Sicca syndrome, episcleritis .

Respiratory – pleural effusion, Bronchiolitis, fibrosing alveolitis .

Cardic- Pericarditis ,Myocarditis ,endocarditis

Haematological –Anaemia ,thrmbocytosis ,splenomegaly .

Neurlogical - Cervical compression, peripheral neuritis

Diagnosis:

It has been estimated in general that the diagnosis of RA takes about 9

months. However it is easier where typical manifestations. On the other hand typical

manifestations may be delayed up to 2 years of onset. The typical picture of bilateral

symmetric inflammatory poly arthritis involving small and large joints in both the

upper and lower extremities with sparing of the axial skeleton except the cervical


50



spine suggests the diagnosis. Constitutional features like morning stiffness support the

diagnosis. Same way subcutaneous nodules start appearing give more affirmation.

Additionally, the presence of Rheumatoid factor, inflammatory synovial fluid with

increased numbers of Polymorph nuclear Leucocytes and radiographic findings of

juxta articular bone demineralization and erosions of the affected joints substantiate

the diagnosis. To solve this difficulty American Rheumatism Association (ARA)

proposed criteria for its diagnosis in 1987 revised criteria.

The diagnosis is somewhat more difficult early in the course when only

constitutional symptoms or intermittent arthralgias or arthritis in an asymmetric

distribution may be present. A period of observation may be necessary before the

diagnosis can be established. A definite diagnosis of RA depends predominantly on

characteristic clinical features and the exclusion of other inflammatory processes. The

isolated finding of a positive test for RA factor or an increased E.S.R are accessory

especially in an older person with joint pain, but should not its

Laboratory investigation:-

There is no specific diagnostic test to confirm the diagnosis of RA .The extent

of elevated ESR and CRP should be a good measure of the intensity of the disease .Rh

factor is present in about 75 %of the patients.

Treatment:- Goals of treatment of RA is

• Relief of symptoms

• Preservation of function.

• Preservation of structural damage and deformity.

• Maintenances of patient’s normal life style.


51



Recent data suggests that an RA patient has a reduced life style expectancy of 7.5 -10

years. Also deformity occurs rapidly and often within 6 months to 2 years from the

start of the disease.The analgesics and NSAID’s are not enough and disease

modifying anti rheumatic drugs [DMARD] need to be introduced early enough in the

treatment of RA.

NSAID:-It makes little difference which NSAID is used but recently COX-2

inhibitors [Celecoxib and Rofecoxib] are claimed to have better gastric tolerability.

CORTICOSTEROIDS: - A small dose of 5mg to 7.5mg of oral Prednisolone daily as a

routine. Classical indications of use of corticosteroids in RA are acute disease and

flare ups, bridge therapy while waiting for response of DMARD’s vasculitis and old

age.

DMARD: - The treatment of choice is the use of DMARD s early RA as well

In early and mild RA Chloroquine or Hydroxyl Chloroquine may suffice .In moderate

to severe RA, Methotrexate alone ,Sulphasalazine alone or a three drug combination

of Chloroquine ,Sulphasalazine and Methotrexate used.Cytotoxic drugs may be used

if this combination fails .

Biological agents

Recently, tumour necrosis factor for blocking monoclonal antibodies have

been introduced .The most successful ones are etanercept and infliximab .Etanercept

25 mg s/c twice a weak .Infliximab 3-4 mg /kg body weight by iv on day 1st ,14th,

and 60th and repeated every 60th days.

Surgical treatment:-

Surgical treatment can be offered to patients by way of synovectomy

Joint replacement: - To remove pain, improve and preserve joint function.

Tendon reconstruction: - For damaged tendon by attaching an intact tendon to it .


52



Persistent pain deformity and difficulty in activities of daily living are the main

indication for surgery.

Prognosis

RA is a chronic disease undergoing exacerbation and remissions if left

untreated. Generally speaking, the disease is progressive and could lead to joint

deformities. With treatment remissions can be induced and deformities can be

prevented though not always. Factors associated with poor prognosis

- Insidious polyarticular onset.

- Male patient.

- Extra articular manifestation.

-Functional disability one year after the disease has started.

-Substantially raised concentration of Rh factor.

- Presence of HLA –DR4.

-Radiographic evidence of erosions within 3 years of start of the disease.

Differential diagnosis

RA differentiated from other diseases having similar features like joint

features like joint pain etc signs and symptoms and biochemical investigations.

Gout:-It is a true crystal deposition disease.In pathological investigation high

serum uric acid level is present .Acute gout causing swelling, erythema, extreme pain

and tenderness in first metatarso-phalngeal joint.

Osteoarthritis:-Mainly related to movement and weight bearing joint, usually

only one or few joints involved, joint crepitation seen. RAfactor negative,ESR usually

normal.


53



Systemic lupus erythematosis: - It is characterized by the presence of

numerous auto antibodies, malar rash, discoid rashes present, chronic inflammatory

arthritis, photosensitivity present.Involvement of more than one system is seen.

Rheumatic fever:-First attacks are usually under 15 years of age in 70 of

case. It is characterized by fleeting type of joint pain with sustained fever.

Myocarditis; Endocarditic may be present. ASO titer usually positive.

Septic arthritis: - Hip and knee are more affected with abrupt onset of pain

and swelling. Joint is held in flexion and movement is restricted.

Psoriatic arthritis:- It is a type of inflammatory arthritis that affects people

suffering from the chronic skin condition psoriasis. It also cause tendinitis and a

sausage-like swelling of the digits known as dactilytis.

http://en.wikipedia.org/wiki/Inflammatory�

http://en.wikipedia.org/wiki/Arthritis�

http://en.wikipedia.org/wiki/Tendinitis�

http://en.wikipedia.org/wiki/Dactilytis�

DRUG REVIEW

Drug profile



Drug review

FOR THE PRESENT STUDY 5 GROUPS OF DRUGS WERE USED :

1.Drug for pācana & dīpana Table NO: 14 pañcakola curṇa 160

Properties and therapeutic effect of the individual drugs in pañcakola curṇa:

Name Latin Name Rasa Guna Virya Vipaka

Doṣagnata Karmukata

Pippali Piper longum

Katu Lagu, snigdha, tīkśna

AnUśnaŚīta

Madhura Kaphavāta

Dīpana, triptigna, vātanulomana, Mruduvirecana, balya, rasayana

Pippali moola

Piper longum

Katu Lagu, snigdha, tīkśna

AnuśnaŚīta

Madhura Kaphavāta

Dīpana, triptighna, vātanulomana, Mruduvirecana, balya, rasayana

Cavya Piper caba

Katu Lagu, rookśa

Uśna Katu Kaphavāta

Dīpaka, pacaka śoolapraśamana vātanulomana

Citraka Plumbago zeylanicum

Katu Lagu, rookśa tīkśna


Dīpaka, pacaka śoolapraśamana vātanulomana

Drug for pācana& dīpana

Drug for the koṣta parikśa

Drug for sneha pāna

Drug for svedana karma

Drug for Virecana karma

Drug profile



Nagara Zingiber officinale

Katu Lagu, snigdha


Dīpana, pacana śūlapraśamana vātanulomana

2. DRUG FOR THE KOSTA PARIKŚA :-

Triphala curṇa 10 gm with hot water is advised for one day in the morning.

Table NO: 15 Koṣta parikśa drug review.

Drug Rasa Guna vīrya Vipaka Cemical Composition

Karma

Haritaki (terminala Chebula)

Lavanavarjitha Pancarasa. Kaśayarasa pradhana

Laghu Rukśa Uśna Madhur

a

Chebulagic acid,corliagin,tanin

Tridoṣahara, srotośodana Pramehagna, kustagna,,jwaragna

Amlaki (emblica officinalis)

Lavanavarjitha pancarasa, Amlarasa pradhana

Guru, Rukśa Śīta

Śīta Madhura

Gallic acid,tannic acid,vit-c

Tridoṣahara pramehagna, kustagna, śotagna,rasayana

Vibhitaki (terminala Bellirica)

Kaśaya Laghu Rukśa Uśna Madhur

a

Tanin,galic acid,ethyl gallate

Tridoṣahara,kapha vikara medo vikara, rasa vikara hara

Triphala is having the properties like kapha pittagna ,kuśta mehahara, sara

guna,cakśuśya,dīpana ,ropana .rasayana.

3 . Drug for snehapāna 161

Drug for the snehapāna is mūŗcita ghrita: --Ama is one such entity which is

not only seen in śarira but also in dravya, so the ideal formulation śould be free from

ama. Gritha mūrcana is the technique to remove the ama present. The esters present in

the raw ghī hinders the absorption as well as it won’t allow other active principles to

mingle with the lipid molecule. Mūrcana process removes these unwanted esters.

Table NO: 16 mūŗcita gritha:

Drug profile



Drug Rasa Guna vīrya Vipaka Karma

ghrita Madhura SnigdhaŚīta Śīta Madhura vāta pittahara

Tri phala -- ---- --- --- -----

Haridra Curcumalonga

Tikta katu Rukśa laghu Uśna Katu Kaphavāta śamaka

Matulunga Citrus medica

Amla Laghu snigdha

tikśna Uśna Amla

Kapha vāta hara, dipana

hrudya rucya

Ghrita is said to be the best among all snehadravya.it is tridoṣa śamaka. It has

the quality to gain the property of drugs when it is processed with any drug without

loosing its original property. It is also a best rasayana. It can be used in large amount

as it is satmya and also it is better administered as it is routinely used162.

Ghee: -163

Ghee is the animal product obtained from milk of mammalian especially

from cow, sheep, goat, and buffalo. The quality of ghee may differ from each other,

but basic qualities remain the same. Ayurveda also mentions different features to each

animal. Among these the cow’s ghee is considered as the best. Clarified milk fat is

known as ghee, it is prepared by heating butter or cream to just over 100 degree c to

remove water content from it. The residue is filtered out as it is pure ghee. Its melting

point is 33-37 degree c. Ghee is stored for long period as it resists spoilage by micro

organisms. Ghee has 8 percent lower saturated fatty acids which makes its

digestibility easy. Its absorption rate is 96 percent .the lipophilic nature of ghee

facilitates entry of the formulation into the cells and its delivery to the mitocondria

and nuclear membrane, because cell membrane also contains lipids.

Drug profile



Chemical composition of cow’s ghee: Table NO: 17

Triglycerides 97-98%, Diglycerides 0.25-1.4% Monoglycerides 0.16-0.038%

Ketoacidglyceride0.015-

0.018%

Glycerylesters0.011-

0.015%, Free fatty acids 0.1 to 0.44%

Phospholipids 0.2-1.0% Steroles 0.22-0.41% Vit a 2500 i.v./100 gm

Vitd=8.5x10.7gm/100 gm Vite 24x10.3 gm/100 gm Vit k - 1 x 10.4 gm/1100 gm

Butric acid 4.5 - 6.0% Caproic acid 1.0 - 1.36% Caprylic acid 0.9-1%

Capric acid 1.5-1.8% Lauric acid 6-7%, Myristic acid 21-23%,

Palmitic acid 19-19.5% Stearic acid 11-11.5% Arachidic acid 0.5-0.8%

Oleic acid 27-27.5%, Linoleic acid 4-5%.

in the present study mūŗcita gritha was prepared using cow’s ghee and used for

snehapana.

4. Drug for svedana karma

Drug selected for abhyanga - Table no: 18 RASAPANCAKA OF SAINDHAVADI TAILA.

saindavadi taila 164 (bhi,ra. 29/221)

Drug

Latin name

Properties Rasa Guna Virya Vipaka Karma

Saindhava

Madhur Lavana

Laghu, Snigdha

Śīta

Katu

Tridoṣa Śamaka Dīpana,Pācana Rucya,Vruśya

Devadaru Cedrus deodara Tikta Lagu Nigdh

Uśna Katu Vedanastapaka

Vaca Acorus calamus

Katu Tikta

Lagu Uśna Katu Medhya Lekhana

Śunti

Zingiber officinale

Katu Laghu snigda

Uśna Madura Truptighna Dīpana

Katphala

Myrica nagi thumb

Tikta Laghu Tiksna

Uśna Katu Rucya, Vedanasthapana

Drug profile



Śatahwa

Anethum sowa kurz

Katu Snigdh Uśna Katu Dīpana,

Musta

Cyperus rotundus linn

Tikta, Katu

Rukśa, Laghu,

Śīta Katu Dipana-pācana

Cavya

Piper retrofractum

Katu Lagu Rukśa

Uśna Katu Dīpana

Medha Polygonatum cirrhifoliumm

Madhura Guru Śīta Madhura Rasayana, balya

Jayapala Croton tiglian linn

Katu Guru Uśna katu Virecana, Dīpana

Trivrith Operculina turpeethum

Tikta, Katu

Laghu, Rukśa

Uśna Katu Virecana

Hiijala twak

Barringtonia acutangula

Tiktha katu,

Laghu, rukśa

Uśna

Katu Vātahara, viśagna,

Netra bala Pavonia odorata

Tikta Laghu Rukśa

Śīta Katu Balya, dīpana pācana, pittahara

Citraka Plumbago zeylanica

Katu Lagu Rukśa tikśna

Uśna Katu Dīpana Lekhana

Bramhana estika

Clerodendron siphonatus

Tikta Laghu

Uśna Katu Dīpana pācana

Śati Kaempferia galangal linn

Tikta Tikśna

Uśna Katu Ruciprada

Vidanga Emblica Ribes

Katu Kaśay

Lagu Uśan

Uśna Katu

Kuśtagna Krimighna

Madhuka Gkycyrrhiza glabra linn

Madhura Guru snigdha

Śīta Madhura Tridoṣa hara, rasāyana, vruśya

Renuka Vitex negundo Katu tikta

Laghu, rukśa

Uśna Katu Vāta, kapha hara śulahara śopha hara

Drug profile



Ativiśa

Aconitum Hetrophyllum

Katu Tikta

Uśna Uśna Katu Lekhana Samgrahak Dīpana

Eraṇda Ricinus communis linn

Madura Snigdha

Uśna Madura Recana, Vriśya

Ambasta Cissampelos

pariera linn

Tikta Laghu,

tīkśna

Uśna Katu Vāta kapha hara,

grahi, balya

Nilini

Indigofera

tinctoria linn

Tikta Laghu,

Rukśa

Uśna Katu Kapha vāta hara

Danti-mula Baliospermumon

tanum

Katu Guru,tik

sna

Uśna Katu Recana,

Dipana

Marica Piper nigrum Katu Laghu

snigda

Uśna Uśna Śirovircana

Ajamoda

Carum

roxburghian

Katu

Tikta

Lagu

Rukśa

Uśna

tikśna

Katu Dīpana

Pippali Piper longum Katu Laghu

tikśna

Uśna Madura Dīpana truptighna

Kuśta

Saussurea lappa

Tikta

Katu

Lagu

rukśa

Uśna Katu Sukra śodaka

Lekhana

Rasna Alpinia

officinarum

hance

Tikta Guru Uśna katu Ama pācana

Pippali

Mula

Piper longum Katu Lagu

Rukś

Uśna Katu Dīpana

Drug profile



5. Drug for virecana karma

Eraṇda taila + triphala kwatha 165 Triphala 166

As the name itself implies that, it is nothing but the combination of three fruits i.e.

Amalaki, bhibitaki, and haritaki.(su.su.38/56-57).but some sort of controversy arises

among the later authors regarding the quantification of these drugs whic is tabulated

as follows167,168

Table NO: 19

Sl.

No. Drug Yoga ratnakar

Madanpala

Nighantu

Bhāvaprakaśa

01 Haritaki One 3 part 1part

02 Bibhitaki Two 6 part 1part

03 Amalaki Four 12 part 1part

Rasa pancaka of triphala : Table NO: 20

Drug Rasa Guna Vīrya Vipāka Chemical Compositi

on Karma

Haritaki (terminal

a Chebula)

Lavanavarjith

a Pancarasa. Kaśayarasa

pradhana

Laghu Rukśa

Uśna Madhura

Chebulagi

c

acid,corlia

gin,tanin

Tridoṣahara,

srotośodana Pramehagna,

kustagna, jwaragna

Amlaki (emblica

officinali

s)

Lavanavarjith

a pancarasa, Amlarasa

pradhana

Guru, Rukśa Śīta

Śīta Madhura Gallic

acid,tannic

acid,vit-c

Tridoṣahara

pramehagna,

kustagna,

śotagna,rasayana Vibhitaki (terminal

a Bellirica)

Kaśaya Laghu Rukśa

Uśna Madhura

Tanin,gali

c

acid,ethyl

gallate

Tridoṣahara,kapha

vikara medo vikara,

rasa vikara hara

Drug profile



Triphala is having the properties like kapha pittagna, kuśta mehahara, sara guna,

cakśuśya, dīpana ,ropana .rasayana.

Actions of triphala169

Actions

Dermatological disorder - kuśta

(a.hr.su 6/159)

Metabolic disorder - prameha,sthoulya

Git disorder - malabddhata, agnimandya

E.n.t. disorder - disease related to netra

Chemical composition of triphala 170

Tannins>25%

Function -detoxification

Each of the three herbal fruits of triphala takes care of the body by gently

promoting internal cleansing of all conditions of stagnation and excess while at the

same time it improves digestion and assimilation.

Among Tibetians, haritaki is so highly revered for its purifying attributes that it is the

small fruit that is depicted in the hands of the "medicine buddha" in their sacred

paintings or tankas. Of the three fruits, haritaki is the most laxative and contains

anthroquinones similar to those found in rhubarb and cascara.

How is triphala different from other kinds of laxatives? There are two primary

types of herbal laxatives. One is called a purgative and includes herbs such as senna,

rhubarb, leptandra, buckthorne and cascara. These often contain bitter principles in

the form of anthroquinones which work by stimulating the peristaltic action of the

intestinal lining, either directly or by promoting the secretion of bile through the liver

and gall bladder.

The second type of laxative is a lubricating bulk laxative, including demulcent

herbs such as psyllium and flax seed. This is more nutritional and usually does not

have any significant direct effect on either the liver or the gall bladder171

Drug profile



Eraṇda taila:172

Ricinus Communis173

English: CastorBean, castoroil plant

Hindi: Endi

Sanskrit: Eraṇda

The plant has been cultivated for over 6000 years and was a source of oil for

lamps and cosmetics in ancient Egypt. The toxicity of the plant has been well

publicised as a result of a political assassination in London that was carried out using

an umbrella tipped with the plant's main toxin, ricin. Greek physicians of the first

century AD regarded the oil as suitable only for external application, a view which

persisted until the 18th century, when it was listed in many pharmacopoeias as a

purgative. The generic name is from the Latin ricinus, meaning 'tick', because the

mottled seeds of the plant are similar in śape to these insects. The Egyptian Ebers

papyrus of c. 1500 BC lists the plant.

Habitat

The castor oil plant is probably native to eastern Mrica, but it is cultivated in

hot climates around the world, especially India and other parts of southern Asia. It is

also widely naturalised.

Botanical description

A tall, glaucus, branched śrub, reaching up to 4 m in height (Plate 51). The

stem is erect and hollow, greyiś-green when young and becoming browniś-red when

older. The leaves are petioled, green and occasionally frosted blue or red, and

arranged in a spiral. The blade is peltate, usually divided into palmate, ovate-oblong

or Ian ceo late lobes up to 60 cm in diameter. The ribs are palmate and the margins

irregularly serrate. The inflorescences are terminal panicles,15-50 cm long, with the

female flowers in the upper section of the inflorescence. The perianth is divided into

five lobes and the style has three red, doubly split stigma branches. The male flowers

bear numerous, heavily branched stamens with up to 1000 separate bursting anthers.

The fruit capsule is soft and prickly or smooth and grooved, 1-2.5 cm in diameter. The

capsule bursts open when ripe, śowing the large, brightly speckled seeds. Castor oil is

fatty oil obtained from the seeds.

Drug profile



Parts used

Oil, leaves, seeds and root.

Traditional and modern use

Castor oil is used internally in folk medicine for acute constipation, intestinal

inflammation, for removal of worms, rheumatism and as a form of birth control. The

extracts of the seeds are also used for this purpose. The oil is used externally for

inflammatory skin disorders, furuncles, carbuncles, abscesses, inflammation of the

middle ear and headaches. In Chinese medicine oil is used to treat sore throat, facial

paralysis, dry stool, furuncles, ulcers and festering inflammation of the skin. The

leaves are used as an emmenagogue, antiinflammatory and febrifuge and the root has

been used to treat liver diseases and various forms of inflammation.

Ethnoveterinary usage

It is used as feed after detoxification.

Major chemical constituents

Phytosterols

Brassicasterol, campesterol, β-Sitosterol, β amyrin, lupeol and derivatives are

present in the aerial parts.

Flavonoids, coumarins and phenolic acids Epicatechin, corilagin, ellagic,

gallic, chlorogenic and neo-chlorogenic acids, hyperoside, kaempferol, quercetin,

isoquercetin and rutin, 6,7-dihydroxy-8 methoxy coumarin and 6,8-dihydroxy-3,4-

dimethoxy coumarin3-6 are all present in the aerial parts.

Alkaloid

Ricinine is present in the seed.

Proteins

Ricin-A, B, C, D and E, and IX-, β- andy ricin8-1° have been found in the

seed,

Fatty acids

Ricinoleic acid is the main component of the oil, together with linoleic,

palmitic, oleic and stearic acids.

Medicinal and pharmacological activities

Lipolytic activity: Ricin śowed lipolytic activity on neutral lipids both in emulsions

and in a membrane-like model. The activity was found to be proportional to ricin and

substrate concentrations and to be pH and galactose dependent. These data support the

idea that a lipolytic step may be involved in the process of cell poisoning by ricin.

Drug profile



Antibacterial activity: Various types of extracts exhibit antibacterial activity,

including an ethanolic extract of an in vitro callus culture of Ricinus communis which

śowed activity against six bacterial strains, The methanol extract of the root was

active against Staphylococcus aureus and produced weak activity against Śigella

boydii. II The ethanol extract of the dried leaf was active against Bacillus subtilis as

well as. Staphylococcus aureus and an acetone extract against Serratia marcescens,

Śigella flexneri, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi and

others. The water extract was active on E. Coli.

Anthelmintic adivity: Potent anthelmintic activity was observed from a tissue

culture of the plant against Mesocestoides corti and Taenis crassiceps.

Immunomodulating activity: Peptides from the seeds have been used in the

preparation of immunomodulating drugs controlling the production of tumour

necrosis factor (TNF).

Central nervous system (CNS) stimulant: An extract of the pericarp of the

castor bean showed typical CNS stimulant effects when administered to mice. The

animals became exophthalmic, presented tremors and clonic seizures, and died a few

minutes after receiving high doses of the extract. At lower doses, the extract improved

memory consolidation and showed some neuroleptic like properties, including a

decrease in exploratory behaviour and catalepsy. Similar properties were also

observed using ricinine, a neutral alkaloid isolated from the extract. The therapeutic

index of ricinine is of the order of 200 and it may therefore be a promising cognition-

enhancing drug.

Laxative effects: Castor oil has been used since ancient times as a laxative,

the active principle being ricinoleic acid. This hydroxylated, long-chain fatty acid has

multiple effects on the intestinal mucosa, resulting in fluid secretion. Mucosal effects

were considered to be due to enteritis or interference with cellular metabolism but

more recent studies have revealed that castor oil increases mucosal permeability,

associated with release of eicosanoids, platelet-activating factor, other autacoids and

nitric oxide. In addition, ricinoleic acid disrupts normal intestinal motility. The

combination of these effects on the mucosa and smooth muscle of the gut is thought

to account for its laxative action. Castor oil decreases fluid absorption and increases

secretion in the small intestine and colon and decreases activity of the circular smooth

muscle, which is believed to produce an increase in intestinal transit. The mechanism

by which it produces the effect on the gut may involve inhibition ofNa+ and K+-

Drug profile



ATPase, activation of adenylate cyclase, stimulation of prostaglandins and nitric

oxide biosynthesis. Castor oil changes the intestinal permeability and causes

histological abnormalities, but these alterations are not essential for the laxative

effect. Platelet-activating factor (PAF) is most likely one of the mediators of castor oil

induced damage, while nitric oxide has a protective role possibly by reducing PAF

biosynthesis. Other properties may be due to the presence of lectins which interfere

with bacterial adhesion.

Antiinflammatory activity: The petroleum ether extract exhibited significant

antiinflammatory activity against induced rat paw arthritis and was safe up to a dose

of 1 glkg PO. A water extract of the root bark śowed analgesic activity when

administered to rats, using the tail-flick response to radiant heat.

Hepatoprotective activity: The alcoholic extract of the leaf śowed activity

against galactosamine- and paracetamol-induced hepatotoxicity in rats. N-

demethylricinine, isolated from the butanol fraction, was found to be the active

compound. It restored the altered levels of several enzymatic and non enzymatic

parameters in the serum and liver and in hepatocytes isolated from paracetamol-

treated rats, the compound reversed the biochemical changes produced by

galactosamine. It was also found to possess significant choleretic and anticholestatic

effects.

Abortifacient and contraceptive activity: The oil śowed abortifacient

activity when taken orally by pregnant women. Extracts of the seed have been tested

in women and found to produce long-term contraception.

Anticonvulsant activity: The ethanol extract of the freś root, administered to

mice at variable dosage levels, was active against phenmetrazole-ind uced

convulsions.

Diuretic effects: Ethanol extracts of the seed and an aqueous extract of the

aerial parts produced diuresis when administered intragastrically to rats.

Antifilarial and nematocidal activity: Methanol extract of the dried leaf was

effective against Onchocerca volvulus. Castor leaves alone, or in combination with

different levels ofN, P and K-enhanced plant growth fertilisers, reduced the nematode

Drug profile



population.

Antiamoebic activity: Ethanol:water (1: 1) extracts of the root and stem in

broth culture were active against Entamoeba histolytica.

Antischistosomal activity: The seed oil, when administered intragastrically to

mice at a dose of 0.3 mllday for 7 days, śowed activity against Schistosoma mansonii.

Antioxidant effects: Ricinus communis extract produced an inhibition of aryl

hydrocarbon hydroxylase (AHH) activity and HZ02 production by lindane-induced

mouse hepatic micro somes, indicating the antioxidant activity of the plant. The

methanol extract of the seed also demonstrated strong antioxidant activity.

Ayurvedic properties

Rasa: Madhura, katu,. Kaśaya.

Guna: Guru, snigdha, riśna, sukśma

Vīrya: Uśna

Vipaka: Madhura

Doṣa: Pacifies kapha and vāta

Eraṇda taila & triphala curṇa :174 As Bowel Cleansers - Benefits of

Natural Bowel Cleansers Bowel cleanser can simply be defined as the one that can

cleanse the bowel, the intestines. The intestines face lots of difficulties and troubles

during their functioning. This is because what we eat or consume daily not necessarily

to be of good condition; unknowingly we may consume the food that is not so

compatible with our digestive system and this food may then create some problem or

alteration in intestinal functioning.

Haritaki, an Ayurvedic herb is very useful and considered to be a bowel cleanser.

When haritaki is combined with two other fruits namely; bibhitaki and amalaki-it

makes a wonderful formula called triphala or trifala. Triphala is considered to be the

most powerful formula as natural bowel cleanser. Triphala is available in the

powdered form and you can also have it in capsules/pills form.

Another such natural bowel cleanser is herb called as Eraṇda. This works as bowel

regulator and helps in getting rid of bodily toxic materials present in the intestines.

However, the dosage of eraṇda taila depends upon the condition and also upon the

patient’s tolerance.

METHODOLOGY

Methodology



Āmavāta is a disease having the predominance of Vāta doṣa,

concurrently involvement of morbid Kapha and Āmadoṣa must be also taking into

consideration. The therapeutic approach should be on Vāta doṣa, Kapha doṣa,

correction of Āmadoṣa and of course the treatment of Agni viz. Pitta. Hence a

treatment which should alleviate morbid vāta, pitta, kapha is required in Āmavāta.

Virecana is one such Śodhana procedure. The line of treatment for Āmavāta includes

virecana karma. Keeping the above said factors about Āmavāta, the virecana karma is

taken for the study.

OBJECTIVE OF THE STUDY:

To evaluate the effect of virecana karma in patients suffering from Āmavāta.

PATIENTS AND METHODS:-

Source of the data:- Patients who were attending the OPD & IPD of S.D.M āyurveda hospital

udupi fulfilling the criteria of selection were incorporated in the study irrespective of

the caste, sex, race & religion. Patients were examined clinically. For this study 20

patients were selected

Method of collection of the data:- It is a single blind study to assess the efficacy of virecana karma in the

management of Āmavāta.

A detailed proforma was prepared considering the points pertaining to history, signs,

symptoms & examinations as mentioned in āyurvedic classics and allied sciences to

confirm the diagnosis.

Inclusion criteria: patients aged between 16 to 60 years

patients suffering from Āmavāta

patients who are fit for Virecana karma.

Exclusion criteria:

Methodology



All connective tissue disorders other than rheumatoid arthritis

Any other systemic disorders

Patients who are unfit for virecana karma

Study design : It is a single blind study to assess the pre test and post test study design where

minimum of 20 patients suffering from Āmavāta will be selected and virecana karma

is done.

Duration of the follow up – 7 days

Total duration of the study – 25 days (MAX).

INTERVENTION:

PŪRVAKARMA

1) Dīpana – Pācana :

8-10 grams of PAÑCAKOLA cūrna with sukhośna jala was administered to

patients depending on their status of Agni in terms of Sāma and Nirāmata for 3-7 Days

till Nirāma Lakṣanas are seen.

2) Snehana :

The MŪRCITA gritha was given to all the patients. The initial dose was 25ml

(Hrisiyasi matra) with Luke warm water AS ANUPĀNA in early morning, after

the digestion of the last night meal.

During this period the patients were advised to consume little quantity of hot water

in between and to follow all the restriction of Snehapāna in terms of diet (Time of food

intake, Nature of food) , Sleep (Avoid Divasvapna & Rathri jagaran) etc.

Thus Ārohanakarma Snehapāna was administered still samyak snigdha lakṣana arises in all

the patients. Then patients were constantly observed for the appearance of Sneha Jīryāmana,

Sneha Jīrna features. Based on the time of Snehajīrna lakṣana the dose of Sneha for next day

was decided.

As soon as Samyak Snigdha Lakṣana are seen, the Snehapāna was stopped.

3) Svedana :

Once samyak snigdha lakṣana appears then, from next day Sarvānga

Abhangya with saindhavādi Taila followed by bhāṣpa svedana

Thus Bhaya Snehan and Svedan was performed for 4 days and during this period

patient was advised to avoid consumption of Kaphakara Ahara and Vihara.

Methodology



PRADHĀNA KARMA- The virecana yoga of eraṇda taila & Triphala kwatha is given. (40ml- triphala

kwatha+ 80ml- eraṇda taila).

On the 4th day depending upon the rogi & roga bala Virecana Yoga of triphala

kwatha + eraṇda taila. After the bhāṣpa sveda procedure, ascertain the patient for

proper digestion of previous night meal. Then above mentioned Virecana yoga was

administered to patient on empty stomach in the morning hours in between 9.30 AM –

10.00 AM. (Ślema Kalagate gnatva).

Before & after virecana karma, vitals like Temperature, Pulse, Respiratory

rate, B.P were recorded & monitored the patients till the process of virecana was

over.

Then Patient was advised all the restriction and regulation on the day of

Virecana karma. Finally śuddi lakṣana in terms of Laingiki, Vaigiki, āntiki, and

Māniki were assessed.

PAŚCĀT KARMA The Virecana was executed successfully in all the patients for deciding the

śuddI, Laingiki, Vaigiki, āntiki and Māniki parameters were considered.

After the successful completion of Virecana, the patients were asked to follow all the

precautions related to Virecana.

Then Samsarjana Krama was adviced for 3/5/7 days. It is decided on the basis of

śuddi lakṣana and it was started on the same evening of the pradhāna karma.

Assessment criteria: Sign and Symptoms of Samyak and Asamyak Virecana.

Patients were evaluated for severity of the illness during and after the

intervention

Subjective parameters:

Symptoms of Āmavāta as explained in āyurvedic literature.

Symptoms of rheumatoid arthritis acc to the criteria approved by ARA

Symptoms of samyak virecana lakṣanas i.e. laingiki & antiki.

Methodology



Laingiki features

All the Lainiki features were identified as immediate and remote features on

the basis of their time of appearance during and after the Virecana karma.

Table NO: 21

ĀNTIKI FEATURE:

Āntiki feature was identified at the end of Virecana karma based on the colour,

consistency etc. parameters of Stool and finally depending on observation it was

documented as Pittānta / Kaphānta / Aoushadhānta/ Malānta/ Vātānta.

Objective Parameters:-

1.Signs of Samyak and Asamyak Virecana Lakśanas i.e.vaigiki and Māniki.

1. Vaigiki feature

It is nothing but total number of motion passed by patient after administration

of Virecana medicine still the cessation of Vega. In all the cases first one Vega was

left for counting and from second Vega the actual counting of Vega done till the end

of (stoppage) of last Vega. Thus finally total number of Vegas were documented as

Vaigiki feature for the present study.

2. Māniki feature

In present study during the each time of defecation the stool and urine was

collected and then it was measured and documented separately. Thus it was

performed after each Vega except first Vega. Then finally the value of total quantity

of stool and urine added to obtain total amount of output. Apart from this total amount

of water consumed(Anupāna) by patient after passing each Vega was documented and

Sl. Immediate features Late Manifestation

1 KaleVegapravarthnam Indriya prasada

2 Daurbalya Agnivrudhi

3 Karśyata Anāmayatva

4 Vātanulomana Sŗoto śuddi 5 Vit,Pitta, kapha, vāta

kramaśanissarana

-

Methodology



it was considered as the total amount of input. Afterwards the difference between total

amount of output and input was calculated and documented as Māniki feature in terms

of milliliters.

OBJECTIVE PARAMETERS:

• Joints(for movement, tenderness, temperature,

Swelling)

• Ring test.

• Grip test.

• Foot pressure.

• Circumference.

• Goniometry test.

SUBJECTIVE PARAMETERS:

1. Pain in the joints:

Symptom Grading

No pain 0

Mild (on motion only) 1

Moderate (at rest) 2

Severe (wakes patient from sleep) 3

2. Morning stiffness (duration in hours):

Symptom Grading

0-5 min. 0

5 min. - 2 hrs. 1

2 - 8 hrs. 2

8 hrs. or more 3

3. Swelling in the joints:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

Methodology



4. Redness:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

5. Warmth:

Symptom Grading

Absent 0

Mild 1

Moderate 2

Severe 3

6. Tenderness in the joints:

Symptom Grading

No tenderness 0

Says tender 1

Patient winces 2

Winces and withdraws 3

Not allowed to be touched 4

7. Alasya:

Symptom Grading

Fully active 0

Mild laziness, slow initiative in work 1

Initiative in some works, absent in others 2

Absolute lack of initiative even though capacity for work exists 3

8. Dourbalya:

Symptom Grading

No feeling of weakness 0

Slight weakness 1

Feeling of weakness but ability unimpaired 2

Ability to do duties affected 3

Methodology



9. Knuckle swelling:

Jewellers rings were used to measure the knuckle swelling. The ring which

passes through knuckle with least resistance was noted. Any change in the number of

the ring after the treatment was recorded.

10. Muscle wasting:

The circumference of arm, fore arm, thigh and calf were measured in cms

using a measuring tape both before and after treatment to have an objective view of

muscle wasting.

11. Malabaddhata/Vibandha (Constipation):

Symptom Grading

Absent 0

Slight with one motion per day 1

Marked constipation with one motion after two days or more 2

12. Jwara (in degree Fahrenheit):

Symptom Grading

No fever 0

Mild (990 F-1010 F) 1

Moderate (1010 F-1030 F) 2

Severe (>1030 F) 3

13. Sadana - fatigue:

Symptom Grading

No fatigue 0

Works full-time despite some fatigue 1

Patient must interrupt to rest 2

Fatigued at rest 3

14. Bahumūtrata (frequency of micturition per 24 hours):

Symptom Grading

Absent (less than 4 times/24 hrs) 0

Mild (upto 6 times/24 hrs) 1

Moderate (6-10 times/ 24 hrs) 2

Severe (> 10 times/ 24 hrs) 3

Methodology



15. Chardi (frequency of bouts per 24 hours):

Symptom Grading

Absent 0

Mild (upto 2 vegas/24 hrs) 1

Moderate (2-4 vegas/24 hrs) 2

Severe (4 vegas/24 hrs) 3

16. The other symptoms like Angamarda, Aruci, Gourava, Brama, Kukśiśoola,

Hrithgraha, Anaha, Praseka, Triśna, Hasta pada daha, Kandu are scored as mentioned

below.

Grading

No symptoms 0

Mild symptoms 1

Moderate symptoms 2

Severe symptoms 3

FUNCTIONAL ASSESSMENT:

To assess the objective improvements following functional assessments were

carried out in patients of Āmavāta.

Grip strength: The patient’s ability to compress the inflated ordinary

Sphygmomanometer cuff under standard conditions to assess the functional capacity

of effected upper limb, both before and after treatment.

Foot pressure: Foot pressure was recorded both before and after treatment by

the ability of the patient to press a weighing machine, to an objective view of

functional capacity of lower limb.

Range of joint movement: By using the Goniometer the range of movement

of all effected joints was noted both before and after treatment.

General functional capacity:

• Complete ability to carry on all usual duties without handicap 1

• Adequate normal activity despite handicap of discomfort or limited joint

movement 2

• Limited only to little or none of the usual occupation or self care 3

• Bedridden or confined to wheel chair, little or no self care 4

Methodology



Overall assessment of the treatment: The overall effect of the therapies assessed on the basis of criteria laid down

by ARA (1967) was adopted. The results are classified as four groups as listed below.

Grade I: Complete remission

• No systemic signs of rheumatoid activity.

• No sign of inflammation.

• No evidence of activity in any extra articular process, including nodules, tino-

vaginitis and iritis.

• No lasting impairment of joint mobility other than that associated with

irreversible changes.

• No elevation of erythrocyte sedimentation rate.

• Articular deformity or extra articular involvement due to irreversible changes

may be present.

Grade II: Major improvement

• No systemic sign of rheumatoid activity, with the exception of an elevated

sedimentation rate and vasomotor imbalance.

• Major signs of inflammation resolved, such as heat, redness of joint structures.

• No new rheumatoid process of intraarticular or extraarticular structures.

• Minimum joint swelling may be present.

• Impairment of joint mobility associated with minimum residual activity may

be present.

• Articular deformity or extra articular involvement due to irreversible changes

may be present.

Grade III: minor improvement

Any decrease in the signs of rheumatoid activity inadequate to fulfill the

criteria of grade II.

• Diminution of systemic signs of rheumatoid activity.

• Signs of joint inflammation only partially resolved.

• No evidence of extension of rheumatoid activity into additional articular or

extra articular structures.

• Decreased but not minimum joint swelling present.

• Impairment of joint mobility may be present.

Methodology



• Articular deformity or extraarticular involvement due to irreversible changes

may be present.

Grade IV: Un improvement or progression

• Undiminished signs of rheumatoid activity, regardless of functional capacity.

• Exacerbation of any previously involved joint or joints, or development of

sites of rheumatoid activity.

• Roentgenologic changes indicative of progression of the rheumatoid process,

excepting hypertrophy changes.

• In the presence of one or more of the aforesaid criteria, involvement in other

features, including a normal or lowered ESR, not significant.

Total Duration of study: 25 days (max).

Patients were administered with Triphala Curṇa in the dose of 10 gms in the

morning with hot water for a day for the assessment of koṣta. After assessing koṣta,

pañca kola curṇa in the dose of 8-10 gms three times a day with 100 ml of hot water

before food till the appearance of nirāma lakṣanas. On the first day of Snehapāna

patients were given test dose 25ml of mūrcita gŗitha at around 6.00 to 6.30 am. From

second day onwards dose of gŗitha was decided on the basis of jīryamaana , jīrna

lakṣana .Thus the dosage of gŗitha was not fixed and the dose varied from person to

person. When the Subject attains samyak snigdha lakṣanas three days gap was given

and virecana is given on the fourth day . Saṁsarjana krama is advised according to

śuddi. Patients are diagnosed on the basis of signs and symptoms of Āmavāta and

criteria as approved by ARA, 1987 revision.

Joints [for movements, tenderness, temperature, swelling]

Ring test

Grip test

Foot pressure

Circumference

Investigations: -

Blood - H.b%, T.C,. D.C, E.S.R ., R A Factor, C Reactive. Protien.

OBSERVATIONS

Observations



OBSERVATIONS

A total of 22 patients fulfilling the inclusion criteria were taken for this study.

Statistical analysis was done with SPSS PASW STASTISTICS version 18.0.0

(release - Jul 30, 2009) the observations and the results as well as statistical analysis

of these are elaborated below.

Number of Individuals registered for the Study – 22

Number of Individuals completed the Study – 22

Number of Dropouts – Nil

Observations



SEX: Table No:22 Graph No:01

Among the 22 patients of this study 90.90% patients were females and 9.09% patients

were males.

AGE GROUP:

Table No:23 Graph No:2

Out of 22 patients of Āmavāta studied in this work, 31.81% patients were belonged to

the age group of 36-45 years, 27.27% patients each in age group of 26-35years and

27.27 % were belonged 46-55 years., 9.09%patient from the age group of 55-60 years.

4.54% patients from 15-25 years.

0.00%20.00%40.00%60.00%80.00%

100.00%

males females

0.00%10.00%20.00%30.00%40.00%

16-25 26-35 36-45 46-55 55-60

SEX NO OF

PATIENTS %

MALE 02 9.09 %

FEMALE 20 90.90%

AGE NO OF PATIENTS %

16-25 1 4.54 % 26-35 6 27.27 % 36-45 7 31.81 % 46-55 6 27.27 % 55-60 2 9.09%

Observations



RELIGION:


Among 22 patients of these series maximum 90.90% of patients were belonged to the

Hindu community, and 9.09% from Christian religion.

MARITAL STATUS:


Out of 22 patients of Āmavāta studied in this work. Maximum 86.36 % of patients

were married. And 13.64% were unmarried.

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

HINDU CHRISTIAN

0.00%20.00%40.00%60.00%80.00%

100.00%

MARRIED UNMARRIED

RELEGION NO OF

PATIENTS %

HINDU 20 90.90

% CHRISTIAN 02 9.09 %

MARITAL STATUS

NO OF PATIENTS %

MARRIED 19 86.36 %

UNMARRIED 03 13.64 %

Observations



EDUCATION :


Out of 22 patients of Āmavāta studied in this work, maximum 40.9% were graduates,

22% of the patients were studied up to primary school, 18.19 % were studied up to

metric. And 18.19% were uneducated

SOCIO ECONOMIC STATUS:


Out of 22 patients of Āmavāta studied in this work, 36% of the patients belonged to

upper middle class , 27.27% belonged to middle class, 18.18% belonged to lower

middle class, 13.64% belonged to poor, and 4.55% belonged to rich class.

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%

EDUCATION NO OF

PATIENTS %

UNEDUCATED 4 18.19 %

PRIMARY 5 22.72%

METRIC 4 18.19 %

GRADUATE 9 40.90 %

SOCIO

ECONOMIC

STATUS

NO OF

PATIENTS %

Poor 3 13.64 %

Lower

middle class 4 18.18 %

Middle class 6 27.27 %

Upper

middle class 8 36.36 %

Rich 1 4.55 %

Observations



OCCUPATION :


Out of 22 patients of Āmavāta studied in this work, it was observed that maximum

number of patients were house makers I.e. 59.09%. 9.09 % were engineers and bank

employees, and 4.54% were teachers, nun,labour, student and business people

DESHA


Out of 22 patients of Āmavāta studied in this work 77.28% of the patients belonged to

anupa desha, 13.63% belonged to sadharana desha, and 9.09% belonged to jangala

desha

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

0.00%20.00%40.00%60.00%80.00%

100.00%

OCCUPATION NO OF

PATIENTS %

HOUSE

MAKER 13 59.09 %

ENGINEER 2 9.09%

TEACHER 1 4.54%

BANK

EMPLOYEE 2 9.09%

NUN 1 4.54%

LABOR 1 4.54%

STUDENT 1 4.54%

BUSINESS 1 4.54%

DESHA NO OF

PATIENTS %

JANGALA 2 9.09 %

ANUPA 17 77.28 %

SADHARANA 3 13.63 %

Observations



CHRONICITY:


Out of 22 patients of Āmavāta studied in this work maximum patients were suffering

from the disease since 6 to 12 months i.e. 63.63%. and 31.81% suffered since more

than 1 year. And 4.5 % were within 6 months

ADDICTION :


Out of 22 patients of Āmavāta studied in this work, 90.9% were addicted to coffe/tea.

And 9.09% were addicted to tobacco

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%

Less than 6 months

6-12 months

More than 1 year

0.00%20.00%40.00%60.00%80.00%

100.00%

Coffee / tea tobacco

CHRONICITY NO OF

PATIENTS %

LESS THAN 6

MONTHS 1 4.5 %

6-12 MONTHS 14 63.63 %

MORE THAN

1 YEAR 7 31.81 %

ADDICTION NO OF

PATIENTS %

COFFEE /

TEA 20 90.90 %

TOBACCO 2 9.09 %

Observations



DIET :


Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed diet and

18.18%vegitarians

SLEEP PATTERN :


Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed

sleep and 18.18% had sound sleep.

0.00%

50.00%

100.00%

Mixed VEG

0.00%

50.00%

100.00%

DISTURBED SOUND

DIET NO OF

PATIENTS %

MIXED 18 81.81%

VEG 4 18.18 %

SLEEP

PATTERN

NO OF

PATIENTS %

SOUND 4 18.18 %

DISTURBED 18 81.81 %

Observations



PRAKRITHI :


Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 40.9% were

Vāta pittaja prakrithi and remaining 13.36% were kapha pittaja.

SATVA :


Maximum of 54.54% of the patients were of madhyama satva, 36.3% were avara and

9.09% were of pravara satva

0.00%10.00%20.00%30.00%40.00%50.00%

Vata kapha Kapha pitta Vata pitta

0.00%20.00%40.00%60.00%

PRAKRITHI NO OF

PATIENTS %

VĀTA

KAPHA 10 45.45 %

KAPHA

PITTA 3 13.63 %

VĀTA PITTA 9 40.90 %

SATVA NO OF

PATIENTS %

PRAVARA 2 9.09 %

MADHAYAMA 12 54.54 %

AVARA 8 36.36 %

Observations



RASA SATMYA :


Maximum of 59.09 %were of madhura rasa satmya, and 22.72% were AMLA rasa

satmya 13.63 % were lavana rasa satmya and 4.54% were katu rasa satmya.

SAMHANANA :


Maximum of 68.18% of the patients were of madhyama samhanana, 18.18% were

pravara, 13.63% were 13.63%.

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%

0.00%20.00%40.00%60.00%80.00%

RASA NO OF

PATIENTS %

MADHURA 13 59.09 %

AMLA 5 22.72 %

LAVANA 3 13.63 %

KATU 1 4.54 %

SAMHANANA NO OF

PATIENTS %

PRAVARA 4 18.18 %


AVARA 3 13.63 %

Observations



SĀRA :


Maximum of 77.27 % patients were twak Sāra, and 9.09% of rakta Sāra and 13.63 %

māmsa Sāra .

Abhyavaraṇa śakti


Maximum of 63.63% patients were having madhyama abhyvarana śakti and 36.36%

were having avara abhyvarana śakti.

0.00%20.00%40.00%60.00%80.00%

100.00%

TWAK RAKTA MAMSA

0.00%20.00%40.00%60.00%80.00%

Madhayama avara

SĀRA NO OF

PATIENTS %

TWAK 17 77.27 %

RAKTA 2 9.09 %

MAMSA 3 13.63 %

Abhyavaraṇa

ŚAKTI

NO OF

PATIENTS %

Madhayama 14 63.63 %

Avara 8 36.36 %

Observations



jaraṇa śakti :


Maximum of 40. 9% patients had avara jaraṇa śakti, 36.36 % had pravara jaraṇa śakti

And 22.72% patients had madhyama jaraṇa śakti

VYĀYĀMA ŚAKTI :


Out of 22 patients taken for this study, Maximum of 59.09% patients had madhyama

vyāyāma śakti and the remaining 40.9 % had avara vyāyāma śakti.

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%

Madhayama avara

0.00%

20.00%

40.00%

60.00%

80.00%

Madhayama avara

jaraṇa śakti NO OF

PATIENTS %

pravara 8 36.36 %

madhayama 5 22.72 %

avara 9 40.90 %

VYĀYĀMA ŚAKTI

NO OF PATIENTS %

MADHAYAMA 9 40.90%

AVARA 13 59.09 %

Observations



VAYA :


It is observed that MAXIMUM of 50% of the patients taken for this study belongs to

hani, 31.81% belongs to sampurnata, 13.63% belongs to yauvana, and 4.54% belongs

to vriddi.

DEHA BALA :


Out of 22 patients taken for this study it is observed that maximum of 77.27% patients

had madhyama deha bala, 18.18% patients had avara deha bala and 4.5% had

pravara dehabala.

0.00%10.00%20.00%30.00%40.00%50.00%60.00%

0.00%20.00%40.00%60.00%80.00%

100.00%

VAYA NO OF

PATIENTS %

Vriddi 1 4.54 %

Yauvana 3 13.63 %

Sampurnata 7 31.81%

hani 11 50%

DEHA BALA NO OF PATIENTS

%

PRAVARA 1 4.5 %


AVARA 4 18.18 %

Observations



KOṣTA :


Out of 22 patients taken for this study it is observed that maximum of 68.18% of the

patients had madhyama koṣta and 31.81% had mridhu koṣta

0.00%

20.00%

40.00%

60.00%

80.00%

mridhu Madhayama

KOṣTA NO OF

PATIENTS %

MRIDHU 7 31.81 %


RESULTS

Effect of the therapy

90




Distribution of patients according to days of appearance of samyak snigdha Lakṣana

Table no: 45 Graph no :24

Out of 22 patients of Āmavāta studied in this work about 45.5% of the patients developed samyak snigdhaLakṣana on 3rd and same amount of patients developed it on the 4th day and only about 9.09% required 5 days of sneha pāna to attain the samyak snigdha Lakṣanas.

Table no:46 Graph no : 25

Distribution of patients according to dose of snehapāna

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

3 4 5

0

50

100

150

200

250

1st day 2nd day 3rd day 4th day 5th day

No of days No of patients

%

3 10 45.45%

4 10 45.45% 5 2 9.09%

day Number of Patients

Mean

dosage

Total

sneha

require

d

1st day 22 25ml 625 ml

2nd day 22 61.3

ml

1350

ml

3rd day 22 105.6

ml

2325

ml

4th day 12 137 ml 1650

ml

5th day 2 200 ml 400 ml


91



Out of 22 patients of Āmavāta studied in this work on the first day all the patients

took 25ml of sneha, on the second day depending on the digestion of the sneha the

increased dose is fixed & the mean of sneha required on the 2nd day for all the 22

patients was 61 ml, on 3rd day 105.6 ml, 12 patients took the sneha on 4th day and the

mean was 137ml. 2 patients required the sneha on the 5th day and the mean was

200ml.. A total of 6350ml of sneha was needed to achieve the samyak snigda Lakṣana

of 22 patients.

Table no :47 Graph no :26

Total amount of abyantara sneha during the whole course of snehapāna

Out of 22 patients of Āmavāta studied in this work maximum of 31.81 % of the patients took anything between 201-300ml and the same number of patients took 301-400ml and 27% of the patients required anything between 100-200ml and about 9.09% patient needed 500-600ml of total sneha pāna

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%Dose (In ml) No. of patients %

100-200 ML 6 27.27 %

201-300 ML 07 31.81 %

301-400 ML 07 31.81%

401-500 ML 00 00

501-600 ML 02 9.09 %


92



Analysis of samyak snigdha Lakṣana

Table NO: 48

Graph no :27

Among the 22 no of patients all the patients developed adastat sneha darśana,twak snigdhata,vātanulomana features. And about 13.63% of the patients developed śaitilya feature.

0%20%40%60%80%

100%120%

lakṣana

Lakṣana No of patients %

Adhastat snehadarsana 22 100%

Twaksnigdata 22 100%

Gatramardava 10 45.45%

Snehodvega 19 86.36%

Klama 16 72.72%

Vatanulomana 22 100 %

Angalagava 09 40.09%

Śaitilya 03 13.63%


93



Analysis of samyak Svinna lakṣana:

Table NO: 49 Graph no :28

Among the 22 patients 100% of the patients developed sveda pradurbhava feature and 4.5% patient developed stambha feature.

Analysis of latency period:

Table NO:50 Graph no :29

The time required for the manifestation of the first Virecana Vega after the

administration of Virecana drug may be called as Latency period. In the present study,

Out of 22 patients, maximum number of patients i.e. 77.27% the latency period was

between 61-90 minutes, where as in minimum of 9.09% of patient’s latency period

was between 31-60 minutes.

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

0%10%20%30%40%50%60%70%80%90%

1- 30 MIN 31-60 MIN

61-90 MIN

91-120 MIN

Svinna lakṣana

Number of Patients

%

Śula Viparame 04 18.18

%

Stambha nigraha

01 4.5%

Gourava nigraha

07 31.81

%

Sveda Pradurbhava

22 100%

Time In minutes

Latency period

%

1-30 00 00%

31-60 2 9.09%

61-90 17 77.27%

91-120 03 13.63%


94



Analysis of Duration of Virecana


The duration is calculated from the appearance of the first vega to that of last vega. Out of 22 patients i.e. 59.09% the duration of onset & stoppage of Virecana was between 241 to 360min (4 – 6 hours).

Analysis of Vaigiki Śuddi


Out of 22 patients maximum of 54.54% of the patients had avara śuddi and 45.45% had madhyama śuddi.

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%

0%

10%

20%

30%

40%

50%

60%

PRAVARA (21-31)

MADHYAMA (11-20)

AVARA(1-10)

Duration of Virecana (min.)

Number of patients

%

120-240 02 9.09%

241-360 13 59.09%

361-480 03 13.63%

481-600 04 18.18%

Vaigiki Śuddi No of Patient

%

Pravara (21-30)

00 00%

Madhyama (11-20)

10 45.45

%

Avara (1-10)

12 54.54

%


95



Analysis of Maniki of Virecana

Table NO:53 Graph no :32

Out 22 patients, in 2 patients Manaki feature was negative i.e. deficit where as in 12

number of patient it was in ranges between 301-500 ml and in 4 patients it was about

1-300ml and in 4 patients it was about 501-700ml.

Analysis of Anthiki of Virecana


In maximum number of patient i.e. 40.09% exhibited drava malanta virecana , about

31.81% of the patients had kaphanta Virecana and 18.18% had auṣadanta and 9.09%

had pittanta virecana.

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Deficit up to 300

ML

001-300 ML

301-500 ML

501-700 ML

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%

Maniki

In ml

Number of patients

%

Deficit up to

300 ML

02 9.09%

001- 300

ML

04 18.18%

301- 500 ML 12 54.54%

501- 700 ML 04 18.18%

Anthiki

Numberof Patient

%

Kaphanta 7 31.81%

Pittanta 02 9.09%

Drava malanta

09 40.09%

Aushdhanta 04 18.18%


96



Analysis of Laingiki Lakṣana of Virecana

Table NO:55

Graph no :34

Dourbalya is a laingiki feature observed in maximum number of patients

0.00%20.00%40.00%60.00%80.00%

100.00%120.00%

Laingiki Lakṣana

Num of Patients

%

Laghuta 20 90.90%

Agnivrddhi 16 72.72%

Vatanulomana 18 81.81%

Kramat Vit, Pitta Kaphagamana 7 31.81%

Dourbalya 21 95.45%

Karsyata 13 59.09%

Kśut 10 45.45%

Triśna 07 31.81%


97



Effect on the Cardinal signs and symptoms of Amavata:-

The administration of virecana karma showed the following results:

Effect on Sandhi śūla

Table NO:56 a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 2.7727 22 .42893 .09145

AT1 2.5000 22 .59761 .12741

BT 2.7727 22 .42893 .09145

AT2 2.4091 22 .59033 .12586

BT 2.7727 22 .42893 .09145

AT3 1.9545 22 .65300 .13922

BT 2.7727 22 .42893 .09145

AT4 1.5000 22 .59761 .12741

BT 2.7727 22 .42893 .09145

AT5 1.3636 22 .49237 .10497

BT 2.7727 22 .42893 .09145

AT6 1.3182 22 .47673 .10164


98



Table NO: 56 b

Paired Differences

t df Sig. (2-tailed) Mean± %

Std. Deviati

on

Std. Error Mean

95% Confidence Interval of the

Difference

Lower Upper

BT - AT1

BT - AT2

BT - AT3

BT - AT4

BT - AT5

BT - AT6

.2727 9.836% .55048 .11736 .02866 .5168 2.324 21 P = 0.030

.3636 13.11% .58109 .12389 .10600 .6212 2.935 21 P = 0.008

.8181 29.50% .66450 .14167 .52356 1.1128 5.775 21 P = <0.001

1.2727 45.9% .63109 .13455 .99292 1.5525 9.459 21 P = <0.001

1.4090 50.81% .50324 .10729 1.1859 1.6322 13.133 21 P = <0.001

1.4545 52.45% .59580 .12703 1.1903 1.7187 11.451 21 P = <0.001

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.030), (P=0.008) and at (P=<0.001)

BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehana, AT3- after svedana, AT4 – after virecana, AT5 – after samsarjana karma, AT6- after the follow up

There was significant reduction in the sandhi ŚŪLA .The improvement was of 9.83% during AT1 and during AT4 the improvement was 45.9, and 50.81% during AT5, and 52.45% during AT6

Graph No :35

00.5

11.5

22.5

3

BT AT1 AT2 AT3 AT4 AT5 AT6

mea

n va

lue

sandhi śūla


99



Effect on Sandhiśotha:

Table NO:57a



BT 2.4545 22 .50965 .10866 AT1 2.1818 22 .39477 .08417 BT 2.4545 22 .50965 .10866 AT2 2.1364 22 .46756 .09968 BT 2.4545 22 .50965 .10866 AT3 1.9091 22 .42640 .09091 BT 2.4545 22 .50965 .10866 AT4 1.5909 22 .50324 .10729 BT 2.4545 22 .50965 .10866 AT5 1.5000 22 .51177 .10911 BT 2.4545 22 .50965 .10866 AT6 1.0000 22 .00000 .00000

Table NO:57b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Difference

Lower Upper

BT - AT1 BT - AT2 BT - AT3 BT - AT4 BT - AT5 BT - AT6

.27273 11.11 .45584 .09719 .07062 .47484 2.806 21 P = 0.011

.31818 12.96 .56790 .12108 .06639 .56997 2.628 21 P = 0.016

.54545 22.22 .50965 .10866 .31949 .77142 5.020 21 P = <0.001

.86364 35.18 .71016 .15141 .54877 1.17850 5.704 21 P = <0.001

.95455 38.88 .65300 .13922 .66502 1.24407 6.856 21 P = <0.001

1.45455 59.26 .50965 .10866 1.22858 1.68051 13.387 21 P = <0.001

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.011) (P=0.016) (P = <0.001)


100



Graph no :36

There was significant reduction in the sandhi śotha i.e during AT1 the improvement was seen at 11.11% , during AT4 35.18 and during AT6 59.26% of improvement is seen.

Effect of the therapy on Stabdhata:

Table NO:58a

Paired Samples Statistics Mean N Std. Deviation Std. Error Mean

BT 1.9545 22 .65300 .13922 AT1 1.9091 22 .61016 .13009 BT 1.9545 22 .65300 .13922

AT2 1.7273 22 .63109 .13455 BT 1.9545 22 .65300 .13922

AT3 1.5455 22 .59580 .12703 BT 1.9545 22 .65300 .13922

AT4 1.2273 22 .52841 .11266 BT 1.9545 22 .65300 .13922

AT5 1.0909 22 .52636 .11222 BT 1.9545 22 .65300 .13922

AT6 .8182 22 .39477 .08417

00.5

11.5

22.5

3


MEA

N V

ALU

E

SANDHI śotha


101



Table NO:58b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference

Lower Upper


.04545 2.32 .37509 .07997 -.12085 .21176 .568 21 P = 0.576

.22727 11.62 .52841 .11266 -.00701 .46156 2.017 21 P = <0.057

.40909 20.93 .50324 .10729 .18597 .63221 3.813 21 P = <0.001

.72727 37.2 .63109 .13455 .44747 1.00708 5.405 21 P = <0.001

.86364 44.18 .63960 .13636 .58005 1.14722 6.333 21 P = <0.001

1.13636 58.13 .56023 .11944 .88797 1.38475 9.514 21 P = <0.001 There was significant reduction in the stabdata i.e. 11.6% of improvement is seen during AT2, 20.93% during AT3, 37.2% during AT4, 44.1% during AT5 and 58.13% of improvement is seen during AT6 The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no : 37

0

0.5

1

1.5

2

2.5


MEA

N V

ALU

E

STABDHATA


102



Effect of the therapy on Tenderness:

Table NO: 59a



BT 2.4091 22 .73414 .15652

AT1 2.2273 22 .68534 .14612

BT 2.4091 22 .73414 .15652

AT2 2.0000 22 .69007 .14712

BT 2.4091 22 .73414 .15652

AT3 1.6818 22 .71623 .15270

BT 2.4091 22 .73414 .15652

AT4 1.2727 22 .88273 .18820

BT 2.4091 22 .73414 .15652

AT5 1.0455 22 .72225 .15398

BT 2.4091 22 .73414 .15652

AT6 .6818 22 .64633 .13780

Table NO:59b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


.18182 7.5% .50108 .10683 -.04035 .40399 1.702 21 P = 0.104

.40909 16.98 .66613 .14202 .11375 .70443 2.881 21 P = 0.009

.72727 30.18 .63109 .13455 .44747 1.00708 5.405 21 P = <0.001

1.13636 55.65 .71016 .15141 .82150 1.45123 7.505 21 P = <0.001

1.36364 56.60 .58109 .12389 1.10600 1.62128 11.007 21 P = <0.001

1.72727 71.6 .76730 .16359 1.38707 2.06747 10.559 21 P = <0.001 The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) There was a significant reduction in the tenderness is observed. During AT2 16.9%, AT3 30%, AT4 55% , AT5 56.6% and AT6 71.6% of improvement is observed.


103



Graph no :38

Effect on the Range of joint Movements:

Table NO:60a



BT 4416.8182 22 492.17096 104.93120

AT1 4456.3636 22 459.20786 97.90345

BT 4416.8182 22 492.17096 104.93120

AT2 4672.7273 22 416.14079 88.72152

BT 4416.8182 22 492.17096 104.93120

AT3 4802.7273 22 404.52420 86.24485

BT 4416.8182 22 492.17096 104.93120

AT4 4896.3636 22 372.38671 79.39311

BT 4416.8182 22 492.17096 104.93120

AT5 5036.8182 22 343.75221 73.28822

BT 4416.8182 22 492.17096 104.93120

AT6 5109.5455 22 355.85547 75.86864

Table NO:60b

00.5

11.5

22.5

3


MEA

N V

ALU

E

TENDERNESS


104



Paired Differences

t df Sig. (2-tailed) Mean

± %

Std. Deviati

on

Std. Error Mean


Difference Lower Upper

AT1 -BT AT2 -BT AT3-BT AT4-BT AT5-BT AT6-BT

39.54 0.89 78.7689 16.793 -74.469 -4.6212 -2.355 21 P = 0.028 255.90 5.79 144.309 30.766 -319.892 -191.925 -8.318 21 P = <0.001 385.90 8.7 159.244 33.950 -456.513 -315.304 -11.367 21 P = <0.001 479.54 10.85 195.142 41.604 -566.066 -393.023 -11.526 21 P = <0.001 620.00 14.03 215.495 45.943 -715.545 -524.454 -13.495 21 P = <0.001 692.72 15.68 218.766 46.641 -789.723 -595.731 -14.852 21 P = <0.001

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P<0.001) There was a significant improvement is seen in the range of joints movement AT1 showed 0.89% and AT6 showed 15.68% of improvement .

Graph no :39

0.00%

5.00%

10.00%

15.00%

20.00%

AT1 AT2 AT3 AT4 AT5 AT6

perc

enta

ge

RANGE OF MOVEMENTS


105



Effect of the therapy on HAND GRIP power in mm of Hg:

Table NO:61a



BT 77.4545 22 10.22009 2.17893 AT1 77.8182 22 10.43637 2.22504 BT 77.4545 22 10.22009 2.17893 AT2 83.5455 22 14.47404 3.08588 BT 77.4545 22 10.22009 2.17893 AT3 86.9091 22 14.45818 3.08249 BT 77.4545 22 10.22009 2.17893 AT4 89.2727 22 14.98629 3.19509 BT 77.4545 22 10.22009 2.17893 AT5 93.5455 22 17.66279 3.76572 BT 77.4545 22 10.22009 2.17893 AT6 97.4545 22 19.23471 4.10085

Table NO:61b

Paired Samples Test

Paired Differences


± %

Std. Deviation

Std. Error Mean

95% Confidence Interval of the Difference Lower Upper


-.3636 0.46 1.0021 .2136 -.8079 .08070 -1.702 21 P = 0.104 -6.090 7.86 6.0624 1.2925 -8.778 -3.4029 -4.712 21 P = <0.001 -9.454 12.20 5.7298 1.2216 -11.990 -6.9140 -7.739 21 P = <0.001 -11.81 15.25 6.6162 1.4105 -14.751 -8.8847 -8.378 21 P = <0.001 -16.09 20.77 9.1646 1.9539 -20.154 -12.027 -8.235 21 P = <0.001 -20.00 25.82 11.041 2.3539 -24.895 -15.104 -8.496 21 P = <0.001

Improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and after AT6 25.82% The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P<0.001)


106



Graph no : 40

EFFECT OF THE THERAPY ON FOOT PRESSURE

Table NO:62a


Mean N Std. Deviation

Std. Error Mean

BT 31.8636 22 4.31272 .91948 AT1 32.3636 22 4.21500 .89864

BT 31.8636 22 4.31272 .91948 AT2 35.3182 22 4.34672 .92672

BT 31.8636 22 4.31272 .91948 AT3 36.0000 22 5.00476 1.06702

BT 31.8636 22 4.31272 .91948 AT4 37.2273 22 5.07029 1.08099

BT 31.8636 22 4.31272 .91948 AT5 39.0909 22 5.45029 1.16201

BT 31.8636 22 4.31272 .91948 AT6 40.2727 22 6.53330 1.39290

0.00%

10.00%

20.00%

30.00%


perc

enta

ge

HANDGRIP


107



Table NO: 62b

Paired Samples Test

Paired Differences

t df Sig. (2-tailed)

Mean±

% Std. Deviation

Std. Error Mean


Lower Upper


-.5000 1.56 .85912 .18317 -.88091 -.11909 -2.730 21 P = 0.013

-3.454 10.84 1.56532 .33373 -4.14857 -2.76052 -10.351 21 P = <0.001

-4.136 12.98 1.78073 .37965 -4.92589 -3.34683 -10.895 21 P = <0.001

-5.363 16.83 2.57359 .54869 -6.50470 -4.22257 -9.775 21 P = <0.001

-7.227 22.68 3.82886 .81632 -8.92489 -5.52965 -8.854 21 P = <0.001

-8.409 26.39 3.81300 .81293 -10.0996 -6.71850 -10.344 21 P = <0.001

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P<0.001)

There is significant improvement is seen in the foot pressure after AT1 the improvement is seen at 1.56% which is statistically significant at P= 0.013 and after AT6 the improvement was of 26.39%

Graph no : 41

0.00%5.00%

10.00%15.00%20.00%25.00%30.00%


FOOT PRESSURE


108



Effect of the therapy on KNUCKLE SWELLING

Table NO:63a

Paired Samples Statistics Mean N Std. Deviation Std. Error Mean

BT 113.1364 22 5.87404 1.25235 AT1 113.0000 22 5.87164 1.25184

BT 113.1364 22 5.87404 1.25235 AT2 111.5455 22 6.13908 1.30886

BT 113.1364 22 5.87404 1.25235 AT3 109.8636 22 5.90638 1.25924

BT 113.1364 22 5.87404 1.25235 AT4 108.5000 22 6.36770 1.35760

BT 113.1364 22 5.87404 1.25235 AT5 108.2273 22 6.30896 1.34508

BT 113.1364 22 5.87404 1.25235 AT6 108.2273 22 6.30896 1.34508

Table NO:63b

Paired Samples Test

Paired Differences

t df Sig. (2-tailed) Mean %

Std. Deviation

Std. Error Mean


Lower Upper


.13636 0.1204 .46756 .09968 -.07094 .34367 1.368 21 P = 0.186

1.5909 1.4 1 1.05375 .22466 1.12370 2.05812 7.081 21 P = <0.001

3.2727 2.89 2.33364 .49753 2.23805 4.30741 6.578 21 P = <0.001

4.6363 4.09 2.68231 .57187 3.44709 5.82563 8.107 21 P = <0.001

4.9090 4.3390 2.70641 .57701 3.70913 6.10905 8.508 21 P = <0.001

4.9090 4.3390 2.70641 .57701 3.70913 6.10905 8.508 21 P = <0.001

The change that occurred with the treatment is not great enough to exclude the possibility that the difference is due to chance (P = <0.001),

The improvement is seen with only 0.12% after AT1 and 4.9% after AT6.


109



Graph no : 42

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS

Table NO: 64a



Std. Error Mean

BT 39.1818a 22 2.30189 .49076 AT1 39.1818a 22 2.30189 .49076

BT 39.1818 22 2.30189 .49076 AT2 38.5909 22 2.36359 .50392

BT 39.1818 22 2.30189 .49076 AT3 37.8182 22 1.99132 .42455

BT 39.1818 22 2.30189 .49076 AT4 37.2273 22 2.04548 .43610

BT 39.1818 22 2.30189 .49076 AT5 37.0455 22 2.03487 .43384

BT 39.1818 22 2.30189 .49076 AT6 37.0455 22 2.03487 .43384

105106107108109110111112113114


MEA

N

KNUCKLE SWELLING


110



Table NO: 64b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


.59091 1.508% .50324 .10729 .36779 .81403 5.508 21 P = <0.001

1.36364 3.480% .65795 .14028 1.07192 1.65536 9.721 21 P = <0.001

1.95455 4.988% .84387 .17991 1.58039 2.32870 10.864 21 P = <0.001

2.13636 5.452% .77432 .16508 1.79305 2.47968 12.941 21 P = <0.001

2.22727 5.6% .75162 .16025 1.89402 2.56052 13.899 21 P = <0.001

2.22727 5.6% .75162 .16025 1.89402 2.56052 13.899 21 P = <0.001

Here after dīpana and paachana i.e. AT1 there is no difference in the improvement. The correlation and t cannot be computed because the standard error of the difference is 0.

After AT6 5.6% of the improvement is seen, The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Graph no : 43

35

36

37

38

39

40


MEA

N

CIRCUMFERENCE


111



EFFECT OF THE THERAPY ON CIRCUMFERENCE OF FOREARMS

Table NO: 65a



BT 32.5455 22 2.46359 .52524 AT1 32.4545 22 2.50195 .53342

BT 32.5455 22 2.46359 .52524 AT2 31.8182 22 2.28111 .48633

BT 32.5455 22 2.46359 .52524 AT3 31.2727 22 2.45302 .52299

BT 32.5455 22 2.46359 .52524 AT4 30.9545 22 2.39995 .51167

BT 32.5455 22 2.46359 .52524 AT5 30.8636 22 2.37638 .50665

BT 32.5455 22 2.46359 .52524 AT6 31.0909 22 2.28680 .48755

Table NO: 65b

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


.09091 0.279 .29424 .06273 -.03955 .22137 1.449 21 P = <0.162

.72727 2.234 .88273 .18820 .33589 1.11866 3.864 21 P = <0.001

1.27273 3.910 .76730 .16359 .93253 1.61293 7.780 21 P = <0.001

1.59091 4.888 .66613 .14202 1.29557 1.88625 11.202 21 P = <0.001

1.68182 5.167 .99457 .21204 1.24085 2.12279 7.931 21 P = <0.001

1.45455 4.4692 .80043 .17065 1.09965 1.80944 8.523 21 P = <0.001


112



As the table shows after AT1 0.2% of the improvement at P=<0.162 and after AT6 4.4% of improvement is seen The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no :44

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF THIGHS

Table NO:66a



BT 77.3636 22 4.63471 .98812 AT1 77.2727 22 4.64124 .98952

BT 77.3636 22 4.63471 .98812 AT2 76.7273 22 4.91045 1.04691

BT 77.3636 22 4.63471 .98812 AT3 75.8182 22 5.20656 1.11004

BT 77.3636 22 4.63471 .98812 AT4 75.1364 22 4.99805 1.06559

BT 77.3636 22 4.63471 .98812 AT5 74.8636 22 5.03602 1.07368

BT 77.3636 22 4.63471 .98812 AT6 75.0909 22 5.11682 1.09091

30

30.5

31

31.5

32

32.5

33


MEA

NCIRCUMFERENCE


113



Table NO: 66b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


0.0909 1.1751 0.2942 .06273 -.03955 .22137 1.449 21 P = <0.162

0.6363 0.822 0.9534 .20328 .21362 1.05911 3.130 21 P = <0.005

1.5454 1.9975 1.4712 .31367 .89315 2.19776 4.927 21 P = <0.001

2.2272 2.878 1.7976 .38326 1.43023 3.02431 5.811 21 P = <0.001

2.5000 3.231 1.8452 .39340 1.68188 3.31812 6.355 21 P = <0.001

2.2727 2.878 1.7776 .37900 1.48454 3.06091 5.997 21 P = <0.001 After AT1 only 1.17% of improvement is seen at P= <0.162 and after AT6 2.8% of the improvement is seen .The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no : 45

73.574

74.575

75.576

76.577

77.578


MEA

N

CIRCUMFERENCE


114



EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF

Table NO: 67a



BT 47.0455 22 2.91919 .62237 AT1 46.8182 22 2.87247 .61241

BT 47.0455 22 2.91919 .62237 AT2 45.1818 22 3.15680 .67303

BT 47.0455 22 2.91919 .62237 AT3 44.1818 22 3.54073 .75489

BT 47.0455 22 2.91919 .62237 AT4 43.0909 22 3.03800 .64770

BT 47.0455 22 2.91919 .62237 AT5 42.6818 22 3.01404 .64259

BT 47.0455 22 2.91919 .62237 AT6 42.2273 22 3.13098 .66753

Table NO: 67b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


.22727 0.482 0.6853 0.14612 -.07659 .53114 1.555 21 P = <0.135

1.8636 3.961 1.3556 0.28902 1.26260 2.46468 6.448 21 P = <0.001

2.8636 6.086 1.8072 0.38531 2.06234 3.66494 7.432 21 P = <0.001

3.9545 8.405 1.7314 0.36914 3.18687 4.72222 10.713 21 P = <0.001

4.3636 9.275 1.8138 0.38671 3.55942 5.16785 11.284 21 P = <0.001

4.8181 10.241 1.8679 0.39824 3.98999 5.64638 12.099 21 P = <0.001


115



After AT1 only 0.48% of improvement is seen at P=<0.135 and after AT6 10.2% of improvement is seen .

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)

Graph no :46

EFFECT ON GENERAL SYMPTOMS

Table NO:68

38

40

42

44

46

48


MEA

N

CIRCUMFERENCE

Symtoms

Mean Score

d

%

BT AT1 AT2 AT3 AT4 AT 5 AT6

Aruchi 1.9545 1.6818 1.1818 .7273 .590

9 .272

7 .227

3 1.7272

7 88.37

Malabadhata .6364 .5909 .5000 .4091 .045

5 .045

5 .045

5 .59091 92.85

Angamarda 2.2273 2.0000 1.5455

1.1818

.6818

.5455

.4091

1.81818 81.63


116



a. The correlation and t cannot be computed because the standard error of the difference is 0

Graph no : 47

0

0.5

1

1.5

2

2.5

MEA

N

GENERAL SYMPTOMS

BT

AT6

Sadana 1.8182 1.3636 1.0455 .8636 .409

1 .409

1 .363

6 1.4545

5 79.99

Alasya 1.7273 1.6364 .9091 .9091 .6364

.6364

.5455

1.18182 68.42

Anaha 1.6364 1.5909 .9545 .9091 .5455

.5909

.4545

1.18182 72.22

Praseka 1.7273 1.6818 1.0909 .9545 .409

1 .318

2 .272

7 1.4545

5 84.20

Truśna 1.4091a 1.4091a

1.3636 .6364 .590

9 .045

5 .000

0 1.4090

9 100

Hasta Pada daha 1.5909a 1.5909

a 1.318

2 .7727 .5455

.2727

.1364

1.45455 91.42

Jwara .3636 0.000 0.000 0.000 0.000

0.000

0.000 .3636 100

Śareera gowrava 1.8636 1.772 1.409

1 1.136

4 .863

6 .454

5 .409

1 1.4545

5 78.05


117



Effect on Total score of General symptoms:-

Table NO: 69a


Mean N Std. Deviation Std. Error

Mean

BT 1.5413 11 .55910 .16857

AT1 1.3925 11 .58322 .17585

BT 1.5413 11 .55910 .16857

AT2 1.0289 11 .44642 .13460

BT 1.5413 11 .55910 .16857

AT3 .7727 11 .33587 .10127

BT 1.5413 11 .55910 .16857

AT4 .5207 11 .21642 .06525

BT 1.5413 11 .55910 .16857

AT5 .3265 11 .22528 .06792

BT 1.5413 11 .55910 .16857

AT6 .2603 11 .19294 .05817

Table NO:69b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


0.1488 9.65% .15623 .04711 .04388 .2537 3.160 10 P = <0.010

0.5124 33.24% .27279 .08225 .32914 .6956 6.230 10 P = <0.001

0.7686 49.86% .28053 .08458 .58014 .9570 9.087 10 P = <0.001

1.020 66.21 % .42667 .12865 .73398 1.3072 7.934 10 P = <0.001

1.214 78 % .41714 .12577 .93463 1.4951 9.659 10 P = <0.001

1.280 83% .44295 .13356 .98341 1.5785 9.591 10 P = <0.001

The patients who are treated with Virecana karma showed significant improvement in the general symptoms the percentage of improvement is increase from 9.65% during AT1 to 83% during AT6.

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001)


118



Graph no :48

Effect on general FUNCTIONAL DISABILITY :

Table NO: 70a



Std. Error Mean

BT 2.8636 22 .35125 .07489 AT1 2.5909 22 .59033 .12586

BT 2.8636 22 .35125 .07489 AT2 2.3636 22 .65795 .14028

BT 2.8636 22 .35125 .07489 AT3 1.3182 22 .56790 .12108

BT 2.8636 22 .35125 .07489 AT4 .6818 22 .71623 .15270

BT 2.8636 22 .35125 .07489 AT5 .3182 22 .47673 .10164

BT 2.8636 22 .35125 .07489 AT6 .1818 22 .39477 .08417

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%


TOTAL EFFECT ON GENERAL SYMPTOMS are shown in the percentage of improvement


119



Table NO: 70b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper


.27273 9.5 .55048 .11736 .0286 .51680 2.324 21 P = 0.030

.50000 17.460 .59761 .12741 .2350 .76497 3.924 21 P = <0.001

1.54545 53.953 .67098 .14305 1.2479 1.8429 10.803 21 P = <0.001

2.18182 76.19 .73266 .15620 1.8569 2.5066 13.968 21 P = <0.001

2.54545 88.87 .50965 .10866 2.3194 2.7714 23.426 21 P = <0.001

2.68182 93.651 .47673 .10164 2.4704 2.8931 26.386 21 P = <0.001

The patients who are treated with Virecana karma showed significant improvement in the general functional disability improvement is increased from 9.5% during AT1 at p=0.030 to 93.6% during AT6. The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no :49

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%


EFFECT ON GENERAL FUNCTIONAL DISABILITY , DEPECTED IN THE PERCENTAGE OF IMPROVEMNT


120



Effect on Hematological Values:

1. HB%

Table NO:71a paired Samples Statistics


Std. Error Mean

BT AT

11.4273 22 1.42826 .30451 11.1682 22 1.63398 .34837

Table NO:71b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper

BT - AT

.25909 2.267 % 0.75177 .16028 -.07422 .59241 1.617 21 P=0.121

The change that occurred with the treatment is not great enough to exclude the possibility that the difference is due to chance (P = 0.121) The mean value of Hb% BT was 11.42 and the reduction in the value is seen during AT i.e 11.168. difference is of 2.26% Graph no :50

11.4273

11.1682

Hb %BT AT


121



2. TOTAL WBC COUNT

Table NO:72a



Std. Error Mean

BT AT

9265.9091 22 2800.52658 597.07427 7670.4545 22 2248.63234 479.41003

Table NO:72b

Paired Differences


% Std. Deviation

Std. Error Mean


BT - AT 1595.4 17.21 3418.29 728.7829 79.8674 3111.04 2.18 21 P=0.040

The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.040). The mean value of total WBC during BT was 9265.9 and the reduction in the value is seen during AT is 7670.45 difference is of 17.21% Graph no : 51

9265.90917670.4545

TOTAL WBC COUNT

BT AT


122



3. NEUTROPHILS

Table NO:73a



Std. Error Mean

BT AT

72.2727 22 7.29763 1.55586 70.4091 22 4.10179 .87450

Table NO:73b

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper

BT - AT 1.86364 2.57 7.8999 1.68427 -1.63900 5.36627 1.106 21 P=0.281

The mean value of total neutrophils during BT was 72.27 and the reduction in the value is seen during AT is 70.409 difference is of 2.57% The change that occurred with the treatment is not great enough to exclude the possibility that the difference is due to chance (P = 0.281) Graph no : 52

72.2727

70.4091

NEUTROPHILS

BT AT


123



LYMPHOCYTES

Table NO:74a Paired Samples Statistics


Std. Error Mean

BT AT

25.6364 22 7.34552 1.56607 26.9091 22 3.82858 .81626

Table NO:74b

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper

BT - AT

-1.2727 4.9%

8.0898 1.72476 -4.85957 2.31412 -.738 21 P=0.469

The mean value of total lymphocytes during BT was 25.63 and the increase in the value is seen during AT is 26.909 difference is of 4.9% The change that occurred with the treatment is not great enough to exclude the possibility that the difference is due to chance (P = 0.469) Graph no : 53

25.6364

26.9091

LYMPHOCYTES

BT AT


124



Esinophils

Table NO: 75a


Std. Error Mean

BT AT

3.8636 22 3.21152 .68470 4.4091 22 3.97203 .84684

Table NO:75b

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper

BT - AT -.54545 14.11 1.50324 .32049 -1.21196 .12105 -1.702 21 P=0.104

The mean value of total esinophils during BT was 3.86 and the increase in the value is seen during AT is 4.409 difference is of 14.11% The change that occurred with the treatment is not great enough to exclude the possibility that the difference is due to chance (P = 0.104)

Graph no : 54

3.8636

4.4091

ESINOPHILS

BT AT


125



EFFECT ON ESR:

Table NO:76a



Std. Error Mean

BT AT

55.3636 22 29.91026 6.37689 36.1364 22 20.56881 4.38528

Table NO:76b

Paired Differences


Std. Deviation

Std. Error Mean


BT - AT 19.227 34.72

15.8322 3.3754 12.2076 26.2469 5.696 21 P=<0.001

The mean value of total ESR during BT was 55.36 and the reduction in the value is seen during AT is 36.13 difference is of 34.72% The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no : 55

55.3636

36.1364

ESR

BT AT


126



EFFECT ON RA factor

Table NO:77a



Std. Error Mean

BT AT

29.8636 22 29.09088 6.20220 17.5045 22 17.51811 3.73487

Table NO:77b

Paired Samples Test

Paired Differences


Std. Deviation

Std. Error Mean


Lower Upper

BT - AT 12.359 41.38% 15.067 3.212 5.67839 19.03980 3.847 21 P=<0.001 The mean value of total RA factor during BT was 29.86 and the reduction in the value is seen during AT is 17.504 difference is of 41.38% The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = <0.001) Graph no :56

29.863617.5045

RA FACTOR

BT AT


127



Effect on C Reactive Protein

Table NO:78a


Mean N

Std. Deviation

Std. Error Mean

BT AT

20.2522 22 17.08803 3.56310 10.5783 22 9.78672 2.04067

Table NO:78b

Paired Samples Test

Paired Differences


%

Std. Deviation

Std. Error Mean


Lower Upper

BT - AT 9.67391 47.767 12.50266 2.60699 4.26736 15.08047 3.711 21 P=<0.001 The mean value of total C Reactive Protein during BT was 20.252 and the reduction in the value is seen during AT is 10.578 difference is of 47.578% The change that occurred with the treatment is greater than would be expected by chance; there is a statistically significant change (P = 0.001)

Graph no : 57

20.2522

10.5783

C.R.P

BT AT


128



THE OVERALL EFFECT OF THE TREATMENT

The assessment of the overall effect of the treatment revealed that 77.27 %

(17) of the patients showed major improvement. And the patients also responded with

minor improvement was 22.72 % (5). All the patients studied in this Virecana karma

study showed different degrees of remission. The details are given in the Table No.

and Graph No.

Table no :79

improvement No of patients % Major 17 77.27% Minor 5 22.72% No improvement 0 0

Graph no :58

77%

23%

OVERALL EFFECT OF THE TREATMENT

MAJOR IMPROVEMENT

MINOR IMPROVEMENT

DISCUSSION

Discussion

129



Discussion

Āmavāta affects the Sandhi and Hŗidaya Marma, which form a part of

Madhyama Roga Mārga. Though Āma and Vāta are the chief pathogenic factors, the

disease represents the vitiation of TriDoṣa. The affliction of Sandhi (of which Asthi is

a component) by Vāta and association with Āma, reflects the role of homogenous

Doṣa and Dūśya (Tulya Doṣa Dūśya) in the causation of this disease. Moreover, the

chief pathogenic factors i.e. Āma and Vāta being contradictory in character, pose

difficulty in planning the line of treatment. Mandāgni is a prerequisite factor for the

initiation of the Samprāpti of āmavāta. Thus, Aāhyantara Roga Mārga also plays a

vital role in causation of this disease. Primarily the Samprāpti originates in the

Annavaha Sŗotas, then spreads through the Madhyama Roga Mārga with special

predilection for Sleśmasthāna, thus āmavāta manifests as a systemic disease. Rasa,

Asthi and Majja Dhatus are primarily involved, but Māmsa and Snāyus are also

affected later. Āmavāta & rheumatoid arthritis may be compared for the sake of

clinical aspects. Āmavāta is one such disease where in authors categorized the pain as

Vrischika damśavat vedana. It is a disorder characterized by Āma Doṣa, Vāta Doṣa,

Kapha Doṣa morbidly. the antagonistic treatment of Kapha Doṣa and Vāta Doṣa

must be carried out simultaneously, gambiradhātu (asthi),uttānadhātu (rasa),makes the

treatment more a puzzle.

Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required in

āmavāta. Virecana is one such Shodhana procedure fulfilling the above criteria.

Clinical study : A total of 22 patients fulfilling the inclusion criteria were taken

for this study. Statistical analysis was done with (SPSS) PASW STASTISTICS

version 18.0.0 (release - Jul 30, 2009) the observations and the results as well as

statistical analysis of these are elaborated below.

Number of Individuals registered for the Study – 22

Number of Individuals completed the Study – 22

Number of Dropouts – Nil

Discussion

130



Discussion on observations (Demographic Data):

AGE : Out of 22 patients of Āmavāta studied in this work, 31.81% patients were

belonged to the age group of 36-45 years, 27.27% patients each in age group of 26-

35years and 27.27 % were belonged 46-55 years., 9.09%patient from the age group of

55-60 years. 4.54% patients from 15-25 years. Table No:22. graph no:1

SEX: Among the 22 patients of this study 90.90% patients were females and 9.09%

patients were males this corresponds to the Rheumatologists opinion that it is seen

more in the females. Table No:23. graph no:2

RELIGION: Among 22 patients of these series maximum 90.90% of patients were

belonged to the Hindu community, and 9.09% from Christian religion. This shows

geographical predominance of Hindus in and around Udupi area. The details are

elaborated in the Table No:24. Graph no:3

MARITAL STATUS: Out of 22 patients of Āmavāta studied in this work. Maximum

86.36 % of patients were married. And 13.64% were unmarried. Table No:25 graph

no:4

EDUCATION: Out of 22 patients of Āmavāta studied in this work, maximum 40.9%

were graduates, 22% of the patients were studied up to primary school, 18.19 % were

studied up to metric. And 18.19% were uneducated. But from the above said data no

definite conclusion can be drawn regarding education with disease.

Table No:26. graph no:5

SOCIO-ECONOMIC STATUS: Out of 22 patients of Āmavāta studied in this work,

36% of the patients belonged to upper middle class , 27.27% belonged to middle

class, 18.18% belonged to lower middle class, 13.64% belonged to poor, and 4.55%

belonged to rich class.

Table No:27 graph no:6

OCCUPATION: Out of 22 patients of Āmavāta studied in this work, it was observed

that maximum number of patients were house makers I.e. 59.09%. 9.09 % were

engineers and bank employees, and 4.54% were teachers, nun,labour, student and

Discussion

131



business people . As in the study more of the home makers were observed who can

be considered under manual labour category, they have a more of physical work

which may provoke Vāta Doṣa. Table No:28. Graph no:7

DEṣA: Out of 22 patients of Āmavāta studied in this work 77.28% of the patients

belonged to ānupa deṣa, 13.63% belonged to sadhārana deṣa, and 9.09% belonged to

jangala deṣa

The ānupa Desha which is having predominance of Kapha Doṣa, this shows the

relation of ānupa desha one among the factor influencing in the disease. The details

are shown in the Table No:29. Graph no:8

CHRONICITY OF DISEASE: Out of 22 patients of Āmavāta studied in this work

maximum patients were suffering from the disease since 6 to 12 months i.e. 63.63%.

and 31.81% suffered since more than 1 year. And 4.5 % were within 6 months. The

details are shown in the Table No:30 graph no:9

ADDICTION: Out of 22 patients of Āmavāta studied in this work, 90.9% were

addicted to coffe/tea. And 9.09% were addicted to tobacco. As shown in the Table

No:31 graph no:10

DIET: Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed diet

and 18.18%vegitarians. The diet plays an important role in causing the disease.The

ahara which are Guru, Abhisyandi etc which may provoke both Kapha and āma. This

favors the āmavāta Nidāna. As shown in the Table No:32 graph no:11

SLEEP PATTERN: Out of 22 patients of Āmavāta studied in this work maximum

81.81% had disturbed sleep and 18.18% had sound sleep. The disturbed sleep was

due to pain .The details are shown in the Table No:33 graph No:12

PRAKRITI: Maximum of 45.45% of the patients belonged to Vāta kaphaja prakrithi,

40.9% were Vāta pittaja prakrithi and remaining 13.36% were kapha pittaja. As

shown in the Table No: 34 graph No:13

SATVA: Maximum of 54.54% of the patients were of madhyama satva, 36.3% were

avara and 9.09% were of pravara satva. But no definite conclusion can be drawn from

this data the details are shown in the Table No35: graph No:14

Discussion

132



RASA SĀTMYA: Maximum of 59.09 %were of MADHURA rasa sātmya, and

22.72% were amla rasa sātmya 13.63 % were lavana rasa sātmya and 4.54% were

katu rasa sātmya. As shown in the Table No:36 graph No:15

SAMHANANA: Maximum of 68.18% of the patients were of madhyāma samhanana,

18.18% were pravara, 13.63% were 13.63%. The details are shown in the Table

No:37 graph No:16

SARATAHA: Maximum of 77.27 % patients were twak Sāra, and 9.09% of rakta

Sāra and 13.63 % māmsa Sāra . The details are shown in the Table No:38 Graph

No:17

ABHYAVARANA ŚAKTI : Maximum of 63.63% patients were having madhyama

abhyvarana śakti and 36.36% were having avara abhyvarana śakti. The details are

shown in the Table No:39 Graph No:18

JARANA ŚAKTI : out of 22 patients Maximum of 40. 9% patients had AVARA

jarana śakti, 36.36 % had pravara jarana śakti And 22.72% patients had madhyama

jarana śakti. The details are shown in the Table No:40 Graph No:19

VYĀYĀMA ŚAKTI : Out of 22 patients taken for this study, Maximum of 59.09%

patients had madhyama vyāyāma śakti and the remaining 40.9 % had avara vyāyāma

śakti. From above said data it may be noticed like due to the disease nature the

patients functional ability reduced and and therefore vyāyāma śakti also. The details

are shown in the Table No:41 Graph No:20

VAYA : It is observed that maximum of 50% of the patients taken for this study

belongs to hāni, 31.81% belongs to sampūrṇata, 13.63% belongs to yauvana, and

4.54% belongs to vriddi. This shows that people of age group between 40 to 70 are

more prone for this disease. The details are shown in the Table No:42 Graph No:21

DEHA BALA : Out of 22 patients taken for this study it is observed that maximum of

77.27% patients had madhyama deha bala, 18.18% patients had avara deha bala and

4.5% had pravara dehabala. The details are shown in the Table No:43 Graph No:22

KOŚTA :Out of 22 patients taken for this study it is observed that maximum of

68.18% of the patients had madhyama kośta and 31.81% had mridhu kośta. The

details are shown in the Table No:44 Graph No:23

Discussion

133



EFFECT OF THE THERAPY

Effect of dīpana & pācana.

For the present study pañcakola churṇa was selected Pañcakola chūrṇa is

administered initially for the purpose of achieving Āmapāchana. This herbal

combination is said to possess Katu rasa, Katu vipāka and Uśna vīrya and therefore

likely to render Āmapāchana in patients suffering ĀmaVāta. Moreover, Āmapāchana

is considered to be an essential procedure before administering the Shodhana

treatment. With this rationality Pañcakola chūrṇa was opted to bring about Āma

Pācana in the present study.

Observation of snehapāna : snehapāna was started with mūrchita gritha & the

dose was 25 ml. (hŗasiyasi mātra). On the basis of the time taken to digest on the first

day of sneha, a subsequent dose of Ghrita was planned. The Sneha was given in

ārohana Mātra till the patients developed Samyak Snigdha lakṣanas or upto maximum

of seven days, whichever is earlier. The average days of Samyak Snigda lakṣanas was

observed in patients were three days.

Out of 22 patients of Āmavāta studied in this work on the first day all the

patients took 25ml of sneha, on the second day depending on the digestion of the

sneha the increased dose is fixed & the mean of sneha required on the 2nd day for all

the 22 patients was 61 ml, on 3rd day 105.6 ml, 12 patients took the sneha on 4th day

and the mean was 137ml. 2 patients required the sneha on the 5th day and the mean

was 200ml.. The details are shown in the Table No:47 Graph No:26 A total of

6350ml of sneha was needed to achieve the samyak snigda lakṣana of 22 patients.

Among the 22 no of patients all the patients developed adastāt sneha

darśana,twak snigdhata,Vātanulomana features. And about 13.63% of the patients

developed shaitilya feature The details are shown in the Table No:48 Graph No:27.

During the snehapāna with mūrchita gŗitha there was marked reduction in the Pain,

Tenderness, Swelling, Stiffness was observed. There was improvement in the agni.

Maximum Samyak snigdha lakṣanas were seen on 3rd day,by this the concept of

Goodartha dīpika tīka of Sharangadara that the gritha has to be taken for 3

days(Gritham trayam) is well understood.

Discussion

134



Observation of Svedana Karma: - It provides kinetic energy by uśna guna to those

Doṣas which are ready to vacate from their site of adhesion to the nearest site. Hence

combined action of snehana & svedana makes the detachment from the śākha & helps

to attach or to move towards kośta for easy evacuation. A specific ideology behind it

is to remove the adherence of Doṣas which are present in each & every corner of the

body so as to purify the whole system. Lightness of the body is achieved & also it

enhances the peripheral circulation. Due to production of heat the toxic metabolites

are carried by the blood & are brought to G.I.T. after the snehana karma abhyanga is

done with saindhāvadi taila followed by baṣpa svedana.

Among the 22 patients 100% of the patients developed sweda prādurbhāva feature

and 4.5% patient developed stambha feature. The details are shown in the Table

No:49 Graph No:28

3 days of gap period: Considering the classics bāhya abhyanga & svedana are

performed in 3 days of gap period & especially for the purpose of virecana to attain

manda kapha stage, gap is highly necessary.

Observation of Virecana karma : Virecana: Said to be useful for pitta elimination

from its site. Since ūrdhwa & adho āmaśayas are specific sites for elimination of

kapha & pitta respectively, whatever the Doṣas are eliminated through pakwāśaya is

the nearest route.

The properties such as uśna, tīkśna, sūkshma, vyavāyi, vikāsi helps for

irritating the mucosa of stomach as well as intestine & also enhances the speed of

action. Depending upon the extent of vitiation & potency of the drug, the elimination

of pitta occurs. Eraṇda taila possesses snigdha, tīkśna, sūkshma guna and uśna vīrya,

it is kapha vāta hara and rechana. drugs which does virecana having dominance of

prithvi & ambu mahābhūta along with adhobhāgahara prabhāva.

The very process induces inflammation; there will be accumulation of fluids in

extra & Intra cellular spaces. These fluids are highly toxic, since the so called waste

products of the body from each & every cell is found. The toxic products of

metabolism are dragged by process of snehana & svedana in liquid form, through

virecana they are eliminated out of the body.

Criteria to assess samyak virikta lakṣanas are useful in deciding further

procedures like samsarjana krama & to stop the further procedure. Constant watch is

Discussion

135



necessary throughout the process, to know about ati or ayoga lakṣanas. Since blood

carries the waste materials in this process, purification of blood also takes place. End

products of metabolism which tends to accumulate will also be eliminated.

Electrolytes like sodium, potassium, bicarbonates are maintained. Since purification

occurs, the cells & tissues are rejuvenated & helps in improving the absorption

capacity of the intestines & improve health.

LATENCY PERIOD: Time required for the manifestation of the first Virecana Vega

after the administration of Virecana drug may be called as Latency period. In the

present study, Out of 22 patients, maximum number of patients i.e. 77.27% the

latency period was between 61-90 minutes, where as in minimum of 9.09% of

patient’s latency period was between 31-60 minutes. The details are shown in the


DURATION OF VIRECANA: The duration is calculated from the appearance of

the first vega to that of last vega. Out of 22 patients i.e. 59.09% the duration of onset

& stoppage of Virecana was between 241 to 360min (4 – 6 hours). The details are


ANALYSIS OF VAIGIKI ŚUDDI: Out of 22 patients maximum of 54.54% of the

patients had avara śuddi and 45.45% had madhyama śuddi. The reason for this may

be interpreted as the dose of the Virecana dravya which is taken for this study is less

i.e. 40ml of triphala kwātha and 80ml of eraṇda taila. The details are shown in the


ANALYSIS OF MĀNIKI OF VIRECANA: Out 22 patients, in 2 patients Māniki

feature was negative i.e. deficit where as in 12 number of patient it was in ranges

between 301-500 ml and in 4 patients it was about 1-300ml and in 4 patients it was

about 501-700ml. The details are shown in the Table No:53 Graph No:32

ANALYSIS OF ANTHIKI OF VIRECANA: In maximum number of patient i.e.

40.09% exhibited drava malānta virecana , about 31.81% of the patients had kaphānta

Virecana and 18.18% had auṣadanta and 9.09% had pittānta virecana. The details are


Discussion

136



Analysis of Laingiki Lakṣana of Virecana:Dourbalya is a laingiki feature observed

in maximum number of patients after the Virecana karma. The details are shown in

the Table No:55 Graph No:34

Effect on Cardinal signs and symptoms of ĀmaVāta:-

EFFECT ON SANDHI ŚŪLA: There was significant reduction in the sandhi śūla

.The improvement was 45.9% during AT4, and 50.81% during AT5, and 52.45%

during AT6. The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = <0.001) as shown

in Table No.56a,56b and Graph No.35

EFFECT ON SANDHIŚOTHA : There was significant reduction in the sandhi śotha

i.e 59.26 % of improvement is seen during AT6.The change that occurred with the

treatment is greater than would be expected by chance; there is a statistically

significant change (P = <0.001) as shown in the Table No.57a,57b and Graph No.36

EFFECT ON STABDHATA: There was significant reduction in the stabdata i.e.

11.62% of improvement is seen during AT2, 20.93% during AT3, 37.2% during

AT4, 44.18% during AT5 and 58.13% of improvement is seen during AT6. The

change that occurred with the treatment is greater than would be expected by chance;

there is a statistically significant change (P = <0.001) as shown in the Table

No.58a,58b and Graph No.37

EFFECT ON TENDERNESS: There was a significant reduction in the tenderness is

observed. during AT3 30.18%, AT4 55.65% , AT5 56.60% and AT6 71.6% of

improvement is observed. The change that occurred with the treatment is greater than

would be expected by chance; there is a statistically significant change (P = <0.001)

as shown in the Table No.59a,59b and Graph No.38

EFFECT ON THE RANGE OF JOINT MOVEMENTS: There was a significant

improvement is seen in the range of joints movement AT1 showed 0.89% and AT6

showed 15.6% of improvements. The change that occurred with the treatment is

greater than would be expected by chance; there is a statistically significant change

(P = <0.001) as shown in the Table No.60a,60b and Graph No.39

Discussion

137



EFFECT ON HAND GRIP POWER IN MM OF HG: Improvement is seen during

AT1 is 0.46% statistically significant at p=0.104 and during AT6 25.82%. The


there is a statistically significant change (P = <0.001) as shown in the Table

No.61a,61b and Graph No. 40

EFFECT OF THE THERAPY ON FOOT PRESSURE: There is significant

improvement is seen in the foot pressure during AT1 the improvement is seen at

1.56% which is statistically significant at P= 0.013 and during AT6 the improvement

was of 26.39%. The change that occurred with the treatment is greater than would be


in the Table No. 62a,62b and Graph No.41

EFFECT OF THE THERAPY ON KNUCKLE SWELLING: The improvement is

seen with only 0.12% during AT1 and 4.9% during AT6. The change that occurred

with the treatment is not great enough to exclude the possibility that the difference is

due to chance (P = <0.001), as shown in the Table No.63a,63b and Graph No.41

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS: Here after

dīpana and pācana i.e. AT1. The correlation and t cannot be computed because the

standard error of the difference is 0. And during AT6 5.6% of the improvement is

seen The change that occurred with the treatment is greater than would be expected by

chance; there is a statistically significant change (P = <0.001) as shown in Table


EFFECT OF THE THERAPY ON CIRCUMFERENCE OF FOREARMS:

During AT1 = 0.2% of the improvement is seen at P=<0.162 and during AT6 4.4%

of improvement is seen. The change that occurred with the treatment is greater than

would be expected by chance; there is a statistically significant change (P = <0.001)

as shown in Table No. 65a,65b and Graph No.43

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF THIGHS: During

AT1 only 1.17% of improvement is seen at P= <0.162 and during AT6 2.8% of the

improvement is seen .The change that occurred with the treatment is greater than

Discussion

138



would be expected by chance; there is a statistically significant change (P = <0.001).

as shown in Table No.66a,66b and Graph No. 45

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF: During AT1

only 0.48% of improvement is seen at P=<0.135 and during AT6 10.2% of

improvement is seen .The change that occurred with the treatment is greater than

would be expected by chance; there is a statistically significant change (P = <0.001).

as shown in Table No.67a,67b and Graph No. 46

EFFECT ON TOTAL SCORE OF GENERAL SYMPTOMS:- The patients who

are treated with Virecana karma showed significant improvement in the general

symptoms the percentage of improvement is increase from 9.65% during AT1 to 83%

during AT6. The change that occurred with the treatment is greater than would be


in Table No.69a,69b and Graph No. 48

EFFECT ON GENERAL FUNCTIONAL DISABILITY: The patients who are

treated with Virecana karma showed significant improvement in the general

functional disability improvement is increased from 9.5% during AT1 at p=0.030 to

93.6% during AT6. The change that occurred with the treatment is greater than would

be expected by chance; there is a statistically significant change (P = <0.001). as

shown in Table No.70a,70b and Graph No.49

EFFECT ON HEMATOLOGICAL VALUES:-

EFFECT ON HEMOGLOBIN PERCENTAGE:- The mean value of Hb% BT was

11.42 and the reduction in the value is seen during AT i.e 11.168. difference is of

2.26%. The change that occurred with the treatment is not great enough to exclude the

possibility that the difference is due to chance (P = 0.121). as shown in Table


EFFECT ON TOTAL WBC COUNT: The mean value of total WBC during BT

was 9265.9 and the reduction in the value is seen during AT is 7670.45 difference is

of 17.21%. The change that occurred with the treatment is greater than would be

Discussion

139



expected by chance; there is a statistically significant change (P = 0.040). as shown in

Table No.72a,72b and Graph No.51

EFFECT ON NEUTROPHILS: The mean value of total neutrophils during BT

was 72.27 and the reduction in the value is seen during AT is 70.409 difference is of




EFFECT ON LYMPHOCYTES : The mean value of total lymphocytes during BT

was 25.63 and the increase in the value is seen during AT is 26.909 difference is of




EFFECT ON ESINOPHILS: The mean value of total esinophils during BT was

3.86 and the increase in the value is seen during AT is 4.409 difference is of 14.11%

The change that occurred with the treatment is not great enough to exclude the



EFFECT ON ESR: The mean value of total ESR during BT was 55.36 and the

reduction in the value is seen during AT is 36.13 difference is of 34.72%. The


there is a statistically significant change (P = <0.001). as shown in Table No.76a,76b

and Graph No.55

EFFECT ON RA FACTOR: The mean value of total RA factor during BT was

29.86 and the reduction in the value is seen during AT is 17.504 difference is of

41.38%. The change that occurred with the treatment is greater than would be

expected by chance; there is a statistically significant change (P = <0.001). as shown

in Table No.77a,77b and Graph No. 56

EFFECT ON C REACTIVE PROTEIN : The mean value of total C Reactive

Protein during BT was 20.252 and the reduction in the value is seen during AT is

10.578 difference is of 47.578%. The change that occurred with the treatment is

Discussion

140



greater than would be expected by chance; there is a statistically significant change

(P = 0.001). as shown in Table No.77a,77b and Graph No.58

From above observations it is clear that the patients of āmavāta who are

treated with Virecana karma shown good response to the treatment with regards to

cardinal symptoms of āmavāta, general symptoms of āmavāta, clinical parameters,

hematological investigations and overall effect of the treatment. The improvement

was marked soon after the Ābhyantara Snehapāna and Svedana Then improvement

was Satisfactory after soon Virecana. But again there was good improvement noted

after the Saṁsarjama krama and also after the follow up period. Most of these

improvements are found to be statistically significant as per the paired ‘t’ test.

COCLUSION

Conclusion



Conclusion

Conclusion is the essence of any study. A study from which no conclusions

are drawn, then it turns out to be futile. Hence conclusion is the determination

established by investigating in various ways & deducting by means of various

reasons. Hence after the completion of this study the following conclusions are drawn,

based on the study sample:

Conceptual study: Importance for Śodana highlighted in all the classics in treating Āmavāta.

Virecana is beneficial in treating Āmavāta.

Virecana karma is one among the lines of treatments explained for

Āmavāta

Observations: Among the 22 patients of this study it was observed that maximum of

90.90% patients were females.

31.81% patients were belonged to the age group of 36-45 years.

59.09% of the patients were house makers I.e. Physically strenuous work

pattern.

77.28% of the patients belonged to ānupa deśa.

Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed

diet and 18.18%vegitarians.

Results:

45.5% of the patients developed samyak snigdhalakśana on 3rd and same

number of patients developed it on the 4th day. A total of 6350ml of sneha was needed to achieve the samyak snigda Lakṣana

of 22 patients.

100% of the patients attained the Samyk Snigda Lakṣana s like Vatānulomana,

twak snigdata, Adastāth sneha darśana.

Conclusion



Out of 22 patients, maximum number of patients i.e. 77.27% the latency

period was between 61-90 minutes. Out of 22 patients maximum of 54.54% of the patients had avara śuddi and

45.45% had madhyama śuddi.

In maximum number of patients i.e. 40.09% exhibited drava malānta virecana

, about 31.81% of the patients had kaphānta Virecana and 18.18% had

auśadānta and 9.09% had pittānta Virecana.

There was significant reduction in sandhi śula(52.45)%, sandhi

śotha(59.26%), tenderness(71.6%), stabdhata(58.13%).

General symptoms of Āmavāta were decreased significantly by 83%

General functional disability aspect is improved by 93.6% during AT6.

Range of joint Movements was improved by 15.68%

Hand grip power was improved significantly by 25.82%

Foot Pressure was improved significantly by 26.39%

Knuckle swelling was reduced by 4.33%

Significant changes were seen over Hematological values- Hb% 2.267%,

o TC 17.21%, ESR 34.72%,

o RA Factor 41.38% and C Reactive Protein 47.767%.

After going through the available data, author opines that instead of going

through upavāsa or such measures, virecana will yield maximum benefits in the

patients of Āmavāta. Further other Śodhana procedures like vamana, Basti are to be

employed at an appropriate time to achieve the complete relief from the disease.

SUMMARY

Summary

143



SUMMARY

Summary provides a whole theme of the study & anything in research needs to

be summarised & put it in a nutshell, so that a further progress in the subject or any

part of the matter can be considered in future for the benefit of the similar patients.

Having such a background in our mind, a prospective study entitled, “A

CLINICAL STUDY TO ASSESS THE ROLE OF VIRECHANA KARMA IN THE

MANAGEMENT OF ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS” was

planned.

The summary comprises of seven parts, viz. conceptual study, Conceptual Study of

Virechana Karma and Amavata, Drug Profile, Methodology, Clinical Study-Result,

Discussion, Summary and Conclusion.

Chapter (1):

Historical review deals with the historical aspect related of Virechana process,

etymology and definition of Virechana and indications-contraindications explained a glimpse

on utility of Virechana Karma in various conditions obtained from several texts. Virechana

Karma was studied under three major divisions as Purvakarma, Pradhanakarma and Pascata

Karma. Vyapad of Virechana karma is briefly discussed. "Mechanism of Virechana

discussed as per Ayurvedic principles and also briefly a review according to current practice

of physiology.

Conceptual study of Amavata includes Etymology, Definition, Nidana, Lakshana,

Samprapti, Upadrava, Upashayaanupashaya, Pathyapathya and Rheumatological Correlation

to rheumatoid Arthritis.

Chapter (2):

Explains the properties of drugs used for Deepana Pachana, Koshta pareeksha,

Snehapana, abhyanga , bashpa Sweda, Virechana.

Chapter (3):

The materials and methods adapted for the study are described here.

This chapter deals with the

Protocol of the study- objective of the study.

Summary

144



Inclusion and exclusion criteria of the patients.

Intervention and criteria of assessment.

Review of previous works done on Virechana karma and Amavata.

Chapter (4):

The observation made on demographic incidence of age, sex, habits etc are presented

in the form of diagrams. The results of the clinical study are presented with statistical analysis

in the form of tables and brief narrations.

Chapter (5):

Discussion, deals with the discussion of entire thesis. The conceptual part of

Virechana and its action on Amavata are explained. Clinical data is discussed in details. The

result obtained in clinical study, as well as Observations in it are discussed with relevant

arguments.

Chapter (6):

Conclusion, the conclusion of whole clinical study and Virechana is explained in this

chapter.

Chapter (7):

Summary, summarized the whole thesis.

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http://www.divineremedies.com/ricinus_communis.htm�

ANNEXURE

annexure

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


DEPARTMENT OF PANCHAKARMA. SDMCA UDUPI A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE

MANAGEMENT OF ĀMAVĀTA W.S.R TO RHEUMATOID ARTHRITIS.

Guide: Dr. SHREEKANTH. U. Co- Guide: Dr. NIRANJAN RAO

Researcher: Dr. Sandeep. K. C

Name : Serial No : Age : Sex : M / F OPD No : Religion : H / M / C / O IPD No : Education : UE / P / M / MS / GR / PG DOA : Marital Status : UM / M / D / W DOD : Social Status : VP / P / LM / M / UM / RVR Diagnosis : Occupation : Result : Desha : Anupa / Jangala / Sadarana Postal Address : MAIN COMPLAINTS : multiple joints pain

BT-Before treatment, AT1-After amapachana, AT2-Aftrer Snehapana, AT3-after svedana, AT4-After virecana (evening), AT5-After samsarjana krama, AT6-After follow up period.

SYMPTOMS Duration BT AT 1 AT 2 AT 3 AT 4 AT5 AT6

Stabdatha Aruchi Mala Bhaddatha Angamarda Sadana Alasya Hrutgraha Anaha Preseka Truśna Hasta-Pada Daha Bahumūtrata Kukśi Śūla Chardi Bhrama Śareera Bhara Antrakūjana Kandu Anga śūnata

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HISTORY OF PRESENT ILLNESSOnset: insidious / gradual / sudden

:

Sequence of joint involvement:

1……Since……2……Since……3……Since……4……Since……

5……Since……6……Since……7……Since……8……Since……

Course: Progressive / receding / relapsing / stationery

Aggravating factors:

Relieving factors:

Symmetry of joint involvement: 1 2 3 4 5 6

HISTORY OF PAST ILLNESS

:

FAMILY HISTORY

:

TREATMENT HISTORY Drugs Dosage Duration Details

:

NSAID’S STEROIDS OTHERS

PERSONAL HISTORYVyasana: Coffee/Tea…… Alcohol…… Cigarette…… Tobacco Chewing…… Others……

:

Duration: Since………Occational / Regular / Stopped / Reduced / Continued

Ahara: Veg / Mixed Samasana / Visamasana / Adyasana / Anasana Dominant Rasa - M / A / L / K / T / Ka Dominant Guna – R / S / U / Sh / G / L

Nature of work: Manual /Sedentary / Labour / Traveling / Walking / Studying / Sitting/Day/Night.

Viśrama: ……Hours Proper / Less / Excessive

Vyayama: No / Proper / Excessive / Irregular

Nidra: Sound / Disturbed Night …… Day ……Difficulty in falling Asleep / Staying Asleep

Bowel: Frequency ……… Consistency ………… Colour

Micturation: ………Frequency………quantity………

OBSTETRIC HISTORYNo. of delivery ……. Normal…… Surgical Intervention……

:

Abortions …… Miscarriages …… Last Delivery ……

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Years Back……

GYNAECOLOGICAL HISTORY

Menstrual cycle: …… Regular / Irregular / Menarche …… years

:

Bleeding ….. days Menorrhagia / Metrorrhagia / Dysmenorrhoea / Leucorrhoea

Menopause since……years

GENERAL EXAMINATION:

Pulse …… / min Prakrutitah:V/P/K/VP/VK/PK/VPK

DAŚAVIDHA PARIKŚA

B.P …… mm / Hg Vikrutitah: P / M / A Dośa : Duśya : Srotas : Udbavasthana : Sancharasthana : Vyakthasthana : Temperature……F Satwatah: P / M / A Respiratory rate…… / min Saratah: P / M / A Nourishment: G / F / P Satmyatah: P / M / A Built: Samhanatah: P / M / A Nails: Ahara Śaktitah: Abyavaharana: P / M / A Conjunctiva: JaranaŚaktitah: P / M / A Sinuses: Vyayama Śaktitah: P / M / A Lymph nodes: Pramanatah: P / M / A Deformities: Height …… cms Contractures: Weight …… Kgs Nodules: Y / N Vayataha; Bala / Madya / Vradha Others:

SYSTEMIC EXAMINATION

CNS :

:

CVS : RS : GUS : P/A : LOCOMOTOR SYSTEM

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ASSESSMENT CRITERIA-FUNCTIONAL TEST Joint Motion BT 1 2 3 4 5 6

Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

Shoulder

Flexion Extension Abduction Adduction Lat. Rot. Medi. Rot.

Elbow Flexion Extension

Forearm Supination Pronation

Wrist

Uln. Devi. Radi. Devi.

Flexion Extension

Hip

Flexion Extension Abduction Adduction Lat. Rot. Medi. Rot

Knee Extension Flexion

Ankle Plant. Flex.

Dorsi. Flex.

Foot Inversion Eversion

MCP1 Flexion Extension Abduction Adduction

MCP2 Flexion Extension Abduction Adduction

MCP3 Flexion Extension

MCP4 Flexion Extension Abduction

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Adduction MCP5 Flexion

Extension Abduction Adduction

PIP1 PIP2 PIP3 PIP4 DIP1 DIP2 DIP3 DIP4

TOE Flexion Extension

Spine Flexion

Neck Extension Lat. Bend. Rotation

RING TEST

No. BT 1 2 3 4 5 6 Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

1 2 3 4 5

TEST BT 1 2 3 4 5 6 Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

Grip Test Foot Pressure Gen. Functions

Circumference BT 1 2 3 4 5 6 Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt

Arm Forearm Thigh Calf INVESTIGATION:

Test BT AT

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HB% T.L.C D.C / N D.C / L D.C / E D.C / B D.C / M E.S.R RA Factor C reactive protein

JOINT EXAMINATION

Joints Pain Swelling Stiffness BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6

DIP Rt Lt

PIP Rt Lt

WRI Rt Lt

ELB Rt Lt

SH Rt Lt

DIP Rt Lt

PIP Rt Lt Lt

ANK Rt Lt

KN Rt Lt

HIP Rt Lt

TMJ Rt Lt

STC Rt Lt

ARC Rt Lt

SPINE C/T/L/S

Joints Tenderness Warmth Redness BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6

DIP Rt Lt

PIP Rt Lt

WRI Rt Lt

ELB Rt Lt

SH Rt Lt

DIP Rt Lt

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TREATMENT SCHEDULE: PŪRVA KARMA: Administration of Dīpana Pachana: panchakola chūrna with Uśna Jala Dose.........mg /OD /BD/TDS/QDS/HS for....days Kośta parikśa- Triphala chūrna - Dose.........mg Time- No.of malapravriti: .......... Kośta-------------- SNEHAPANA VIDHI: Name of Sneha given- mūrchitha gritha with Uśana jala as Anupaana SNEHAPANA Date

Time Quantity Time of Snehajeernata

Sneha jeeryamana Lakṣanas LAKSHAN Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Śiroruk Bhrama Niśtiva Mūrcha Saad Aruchi

PIP Rt Lt Lt

ANK Rt Lt

KN Rt Lt

HIP Rt Lt

TMJ Rt Lt

STC Rt Lt

ARC Rt Lt

SPINE C/T/L/S

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Klama Triśana Daha Snehaudgar Arati Sneha jeerna Lakṣanas LAKṣANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Triśana Kśudha Udgaraśudhi Śiralaghavata Vatanulomata

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Samyak snigdha Lakṣanas

LAKṣANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7 Vatanulomata Agnideepti Snigdha asamhata varcha

Gatramardava Twaksnigdhata Snehodvega Klama Śitya Angalaghava VIŚRAMA KALA: Sarvanga abhyanga with saindhavadi taila followed by bhaśpa sveda. SAMYAK SWINNA LAKṣANAS

LAKṣANAS Day-1 Day-2 Day-3 Day-4 Śeetoparam Śūloparam Stambhanigraha Gouravanigraha Mardavata PRADHANA KARMA: Administration of virecana yoga Triphala kwatha (40ml) + eranda taila (80ml) Time of administration of Virecana Dravys-….......

annexure



1] MANIKI No. of Vega

Time Colour Consistency QUANTITY OF

Virikta Dravys

Water Consumed

Urine

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Input (water consumed) = ml Output of vrikta dravyas = ml Output of urine = ml Manki= Total output – total input = ml

annexure



SAMYAK VIRIKTHA LAKṣANA

Samyak Yoga Ati Yoga Ayoga Srotośuddi Supti Agnimandya

Indriya prasada Angamarda Chardi Laguta Klama Tandra

Agnivrudhi Bhrama Chardi Anamayatva Balaabhava Aruchi

Vitkapha vata kramaśanissarana Nidraabhava NaVata Pratilomata

Vatanulomana Tama Praveśa Daha Daurbalya Netra praveśa Kukśiaśudhi Karśyata Mūrcha Kandu

Hridhvarna śudhi Unmada Vitsanga Kśuth Hikka Mūtrasanga

Thriśna Chima chimayana Pidika KaleVegapravarthnam Pipilika sancharaivaange Mandalotpthi

Hridayodveśtana Pitika Jarjaribhava Vidaha Viśangnatva śtevana Jalabasa Kukśiśūla Śūnyata Nabhistabdata Śanka Sankocha Śopha Parśwa Śūla Guda Śūla Parikartika Angamarda Gudanissarana Gudabramśa

Kapha Pitarahita sweta Udakanissarana

Kapha Asrapittaan LakśayaLakṣana

Mamsadhavana Vatudaka Nissarana

MedhoKhanda Vatsrava

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OBSERVATION OF VITAL DATA & WEIGHT Time Pulse Blood Pressure Resp.Rate Weight

PASCĀT KARMA

CONDITION OF THE PATIENT AFTER TREATMENT COMPLETE REMISSION MAJOR IMPROVEMENT

MINOR IMPROVEMENT No Improvement / PROGRESSION

Signature of scholar: signature of guide:

ANTHAKI

VEGAKI

MANAKI

LYNGIKI

OBSERVATION

Diet Regimen NO. OF ANNAKALAS Pravara Śuddi Madhyama Śuddi Avara Śuddi

Peya Vilepi Akrita Yuśa Krita Yuśa

Documents

Dr.Sandeep.K.C. 2009-2010