Garbhini chardi-psr

Abbreviations

“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”

List of Abbreviations (Ayurvedic)

According to Reference Books

1. A. H. Astanga Hridaya

2. A. S. Astanga Samgraha

3. A. K. Amara Kosha

4. S. S. Sushruta Samhita

5. B. P. Bhavaprakasha

6. H. S. Harita Samhita

7. C. S. Charaka Samhita

8. C. D. Chakra Dutta

9. Ckr. Chakrapani

10. Dl. Dalhana

11. K. S. Kashyapa Samhita

12. K. N. Kaiyyadeva Nighantu

13. M. Ni. Madhava Nidana

14. S. K. D. Shabda Kalpa Druma

15. Y. R. Yogaratnakara

16. Sh. S. Sharangdhara Samhita

17. Vag. Vagbhatta

18. Chi. Chikitsa Sthana

19. Ind. Indriya Sthana

Abbreviations


20. Ka. Kalpa Sthana

21. Ni. Nidana Sthana

22. Su. Sutra Sthana

23. Ut. Uttara Sthana

24. Sha. Shareera Sthana

25 Hb Hemoglobin

26 CTZ Chemo receptor trigger zone

27 & and

28 UTI Urinary tract infection

29 syn Syndrome

30 Int Intestinal

31 HCG Human chorionic Gonadotrophine

32 OCP’S Oral contraceptive pills

33 UOS Upper oesophageal sphincter

34 LOS Lower oesophageal sphincter

35 ATP Adenosine triphosphophate

36. AMP Adenosine monophosphate

37. CNS Central nervous system

38. GIT Gastro intestinal tract

39. LFT Liver function test

40 SGOT Serum glutamic oxaloacetic transaminase

Abbreviations


41. SGPT Serum glutamic pyruvic transaminase

42. ECG Electro cardiograph

43. USG Ultra sonography

44. HT3 Hydroxy triptane

45. U.S United states

46. hrs hours

47 kg Kilograms

48. % Percentage

49 RBC Red blood corpuscles

50. WBC White blood corpuscles

51 HLA Human Lymphocyte antigen

ABSTRACT

Title - “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini

Chardi”.

Garbhini chardi or Morning sickness is a worldwide problem in the pregnant

women. About 50-80% of pregnant women suffer from this. The common symptoms are

nausea, vomiting & occasional sickness on rising in the morning. It may however occur

at other times of the day. Altered hormonal & immunological states are responsible for

initiation of the manifestations which is probably aggravated by the neurogenic factors.

Whatever may be the cause of initiation unless it is not quickly rectified features of

dehydration & carbohydrate starvation occurs leading to a vicious cycle of vomiting.

Under these circumstances practitioners are in need of alternative, safe, economic &

nontoxic medicine to treat the morning sickness. Dadima Avaleha is one such drug which

can be used in morning sickness safely.

Objectives: 1. To do conceptual study of Garbhini chardi.

2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.

Study design: This research work is a single blind clinical study with pre test and post test design.

30 Patients fulfilling above criteria were assigned in to two groups.

Group A – Dadimaavaleha for 21 days. Dose-24gms with divided dose of 8gms T.I.D. with lukewarm water

Group B – Placebo for 21 days. 24gms with divided dose of 8gms T.I.D. with lukewarm water

Result: Dadimaavaleha was effective in treating Chardi Vega, Hrullasa, Anannabhilasha

& Quantity of Vomitus.

Key words: Garbhini, Dourhrda avamana, Aapanna satwa, Shamana chikitsa, Agnimandya,

Hrullasa, Chardi, Dadima Avaleha.

ACKNOWLEDGENMENT

MY GRATITUDE:

With a bowed Head to the Almighty,

With folded Hands to Revered Teachers

And a warm Heart to My Parents, Husband & Friends.

With profound gratitude, I am greatly indebted to my

revered teacher and guide, Dr. Mamatha. K.V, M.D (Ayu) Prof., Dept.

of Prasooti tantra & stree roga, S.D.M.C.A., Udupi, who has not only

guided me to complete my research work, but has always been a

source of inspiration and encouragement in all stages of my tenure

of Post Graduate education. Her great patience and fortitude has

helped me immensely in completing my work successfully.

I am ever grateful to my Co-guide Dr. Suchetha

Kumari, M. D. (Ayu), Asst. Prof., Department of Prasooti Tantra and

Stree Roga, S.D.M.C.A., Udupi, for her encouragement, help, valuable

suggestions and critically reviewing this study.

My eternal gratitude to Dr. V. N. K. Usha, M. D. (Ayu),

Prof. & Head of Department of Prasooti Tantra and Stree Roga,

S.D.M.C.A., Udupi, for her continuous inspiration and valuable

suggestions.

I express my heartfelt thanks to Dr. Ramadevi, Dr.Vidya

Ballal for their support and help in the clinical study of this work.

I offer my sincere thanks to Dr.U.N.Prasad, Principal

S.D.M.C.A., Udupi,, Dr.K.R.Ramachandra, Vice Principal, S.D.M.C.A.,

Udupi,.

I offer my sincere thanks to Dean of P.G Faculty Dr.Srikant.U

for their encouragement and guidance.

I thank Dr. Y. N. Shetty, Medical Superintendent, Dr.Krishna

bai & Dr.Veena Mayya and all the staff of S. D. M. Hospital, Udupi.

My eternal gratitude to Dr. Murali Krishna manager,

Dr.Mohan and all other staff of S. D. M. A. Pharmacy, Udupi.

I thank Sri Harish Bhat, Librarian, S. D. M. C. A., and his

staff for providing necessary books in time.

I heartily convey my thanks to my Uncle N.S. Hiremath, my

Grandmother, Mother, my inlaws, Husband, Brother & sisters who

inspired me to do my post graduation.

Lastly I thank all my friends Dr.Shilpa, Dr. Vijayalakshmi,

Dr.Shubha, Dr.Kavya, Dr. Sukanya, Dr. Prakash, Dr. Vinod & all my

seniors & juniors without whome this work would not be complete. Date- Dr.Sujatha.B.S

Contents


CONTENTS PAGE.NO

1 Certificates

2 Acknowledgment

3 Contents

4 List of Abbreviations

5 List of Tables

6 List of Diagrams

7 List of Graphs

8 INTRODUCTION 1‐2

9 OJECTIVE OF STUDY 3

10 CONCEPTUAL STUDY Historical Review Review of Garbhini chardi Drug Review

4‐50

11 CLINICAL STUDY Materials & methods Observations Results

51‐86

12 DISCUSSION 87‐97

13 SUMMARY & CONCLUSION 98‐101

14 BIBILOGRAPHY 102‐106

15 CASEPROFORMA

List of Tables


List of Tables in different chapters

Table No.1 Nidanas of chardi

Table No.2 Vishista Nidanas of chardi

Table No.3 Purvarupa of chardi

Table No.4 Roopa of Vataja chardi

Table No.5 Roopa of Pittaja chardi

Table No.6 Roopa of Kaphaja chardi

Table No.7 Roopa of Sannipataja chardi

Table No.8 Asadya lakshanas

Table No.9 Showing rasa, guna, veerya,vipaka & karma of the drug

Table No.10 Showing botanical description of drugs

Table No.11 Distribution of patients based on age

Table No.12 Distribution of patients based on Religion

Table No.13 Distribution of patients based on Occupation

Table No.14 Distribution of patients based on Education

Table No.15 Distribution of patients based on Habitat

Table No.16 Distribution of patients based on Gravida

Table No.17 Distribution of patients based on Nausea

Table No.18 Distribution of patients based on Vomiting

Table No.19 Distribution of patients based on Frequency of vomiting

Table No.20 Distribution of patients based on Quantity of vomitus

Table No.21 Distribution of patients based on content of vomitus

Table No.22 Distribution of patients based on Ananabhilasha

Table No.23 Distribution of patients based on Alasya

List of Tables


Table No.24 Distribution of patients based on Angamarda

Table No.25 Distribution of patients based on Anidra

Table No.26 Distribution of patients based on Agnimandya

Table No.27 Distribution of patients based on Brama

Table No.28 Distribution of patients based on Daurbalya

Table No.29 Distribution of patients based on Talu Shosha

Table No.30 Distribution of patients based on Jihwa Shosha

Table No.31 Distribution of patients based on Tandra

Table No.32 Distribution of patients based on Shira Shoola

Table No.33 Distribution of patients based on Family history

Table No.34 Distribution of patients based on Diet

Table No.35 Distribution of patients based on Appetite

Table No.36 Distribution of patients based on Sleep

Table No.37 Distribution of patients based on Mala Pravruti

Table No.38 Distribution of patients based on Prakruti

Table No.39 Distribution of patients based on Vikruti

Table No.40 Distribution of patients based on Saara

Table No.41 Distribution of patients based on Samhanana

Table No.42 Distribution of patients based on Pramana

Table No.43 Distribution of patients based on Satwa

Table No.44 Distribution of patients based on Satmya

Table No.45 Distribution of patients based on Ahara Shakti

Table No.46 Distribution of patients based on Vyayama Shakti

Table No.47 Effect of chardi vega in group A

List of Tables


Table No.48 Effect of chardi vega in group B

Table No.49 Comparison of Chardi vega within the groups

Table No.50 Effect of Hb% in group A

Table No.51 Effect of Hb% in group B

Table No.52 Comparison of Hb% within the groups

Table No.53 Effect of weight in group A

Table No.54 Effect of weight in group B

Table No.55 Comparison of weight within the groups

Table No.56 Effect of Ananabhilasha in group A

Table No.57 Effect of Ananabhilasha in group B

Table No.58 Comparison of Ananabhilasha within the groups

Table No.59 Effect of Nausea in group A

Table No.60 Effect of Nausea in group B

Table No.61 Comparison of Nausea within the groups

Table No.62 Effect of Quantity of vomitus in group A

Table No.63 Effect of Quantity of vomitus in group B

Table No.64 Comparison of Quantity of vomitus within the groups

List of Tables


List of Diagrams

Graph No.1 Incidence according to age

Graph No.2 Incidence according to Religion

Graph No.3 Incidence according to Occupation

Graph No.4 Incidence according to Education

Graph No.5 Incidence according to Habitat

Graph No.6 Incidence according to Gravida

Graph No.7 Incidence according to Vomiting

Graph No.8 Incidence according to Frequency of vomiting

Graph No.9 Incidence according to Quantity of vomiting

Graph No.10 Incidence according to Content of vomitus

Graph No.11 Incidence according to Ananabhilasha

Graph No.12 Incidence according to Alasya

Graph No.13 Incidence according to Angamarda

Graph No.14 Incidence according to Anidra

Graph No.15 Incidence according to Agnimandya

Graph No.16 Incidence according to Brama

Graph No.17 Incidence according to Daurbalya

Graph No.18 Incidence according to Talu Shosha

Graph No.19 Incidence according to Jihwa Shosha

Graph No.20 Incidence according to Tandra

Graph No.21 Incidence according to Shirashoola

Graph No.22 Incidence according to Habitat

Graph No.23 Incidence according to Family history

Graph No.24 Incidence according to Diet

List of Tables


Graph No.25 Incidence according to Appetite

Graph No.26 Incidence according to Sleep

Graph No.27 Incidence according to Mala Pravruti

Graph No.28 Incidence according to Prakruti

Graph No.29 Incidence according to Vikruti

Graph No.30 Incidence according to Saara

Graph No.31 Incidence according to Samhanana

Graph No.32 Incidence according to Pramana

Graph No.33 Incidence according to Satwa

Graph No.34 Incidence according to Satmya

Graph No.35 Incidence according to Ahara Shakti

Graph No.36 Incidence according to Vyayama Shakti

Graph No.37 Effect of chardi vega in both the groups

Graph No.38 Comparison of chardi vega within the groups

Graph No.39 Effect of Hb% in both the groups

Graph No.40 Comparison of Hb% within the groups

Graph No.41 Effect of weight in both the groups

Graph No.42 Comparison of weight within the groups

Graph No.43 Effect of Ananabhilasha in both the groups

Graph No.44 Comparison of Ananabhilasha within the groups

Graph No.45 Effect on Nausea in both the groups

Graph No.46 Comparison of Nausea within the groups

Graph No.47 Effect on quantity of vomitus in both the groups

Graph No.48 Comparison of Quantity of vomitus within the groups

List of Tables


List of Flow Charts

Chart No.1 Flow chart showing types of chardi

Chart No2 Flow chart showing Samprapti of chardi

Chart No.3 Flow chart showing Upadrava of Chardi

Chart No.4 Flow chart showing Physiology of vomiting

Chart No.5 Flow chart showing Act of vomiting

Chart No.6 Flow chart showing Causes of vomiting

Chart No.7 Flow chart showing Cycle of vomiting

Chart No.8 Flow chart showing Management of Vomiting

List of Pictures

SI.NO NAMES

1. Physiology of vomiting

2. Dadima

3. Shunti

4. Pippali

5. Maricha

6. Manjista

7. Pata

8. Nimba

9. Lavanga

10 Ativisha

11. Vamshalochana

List of Tables


12 Danyaka

13 Jeeraka

14 Haritaki

15 Ajamoda

16 Jatiphala

17 Madhu

18 Sharkara

19 Preparation of Dadima Avaleha

20 Formation of Leha

Introduction

INTRODUCTION

Pregnancy is a unique, exciting & joyous time in a women’s life, as it highlights

the women’s amazing creative & nurturing power. The growing fetus depends entirely on

its mother’s body for all its needs. So pregnant women must take measures to remain

healthy & well nourished to have a healthy child which is a motive of every human

being.1 Many demands are made during pregnancy as a consequent upon the rapidly

growing fetus. To meet these requirements the maternal internal system has to undergo

certain changes to create conditions favorable to the fetus.2 As a result certain

physiological changes take place among which Garbhini Chardi or emesis gravidarum is

one. However this natural phenomenon turns into nightmare when she suffers from hyper

emesis which may affect the growing fetus as well as health of the mother.3

Garbhini Chardi is mentioned as vyakta garbha laxana along with other laxanas

like Artava adarshana, asyasamsravana, arochaka, gurugatrata, stanamandala krushnata

etc.4,5. All these laxanas are seen due to the presence of Garbha. When Chardi is seen as a

laxana there is no much harm on growing fetus & mother, because of which it is

considered as Physiological. But when it is seen in excess it becomes pathological where

early intervention is needed to prevent this as it causes severe dehydration, tiredness,

weight loss etc which may affect the growing fetus. So one should take care to treat these

conditions in initial stage & prevent complications as aim of every obstetrician is to give

healthy child to a healthy mother. In classics Acharyas have mentioned that pregnant

women should be taken care like a pot filled with oil is carried with more caution as

slight oscillation may cause spilling of oil from it.6 Similarly hyper emesis in certain

women produces severe adverse affect on fetus & the mother where decision is taken to

terminate pregnancy to save life of the mother.

While explaining regarding chikitsa in Garbhini Acharyas have mentioned that

she should be given things which are easily palatable, Hrudya & the one which is liked

by her.6 Lehya which is one among the four types of food items is having good

palatability because of sweetening agents present in this & is liked by Garbhini. The

metabolism & absorption of medicine in this form starts from the mouth itself because of

presence of glucose, Fructose etc.7 Vomiting in pregnancy is seen mainly due to

“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 1

Introduction

carbohydrate starvation. As Honey & sugar is seen more in Lehya preparation along with

medicines it helps in supplementing carbohydrates. So acceptance of Avalehya in

Garbhini is more compared to other form of medicines. In today’s world Avalehya is

gaining rapid importance since it is easily consumable, rich in taste & is also having high

dietic value.7

Dadima is easily available in the market, liked by everyone especially by pregnant

women as it is Hrudya, ruchi vardaka, ahara pachaka, Rakta vardaka. So this was selected

for the study.


Objectives of the study

OBJECTIVES OF THE STUDY

1. To do conceptual study of Garbhini chardi.


“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page3

Historical Review


HISTORICAL REVIEW

xÉÉåÅrÉÇ AérÉÑuÉåïS zÉÉxuÉiÉÉå ÌlÉÌSïxrÉiÉå AlÉÉÌSiuÉÉiÉç | xuÉpÉÉuÉ xÉÇÍxÉ¬è sÉ¤ÉiuÉÉiÉç pÉÉuÉ xuÉpÉÉuÉ ÌlÉirÉiuÉÉiÉç |8

Ayurveda, the science of life which has no begining, deals with the things

which are inherent in nature & is eternal. This holistic science is known since

prevedic, Vedic Period & practiced till today in preventing & curing the upcoming

diseases.

Pre Vedic Period: - 2700-500 BC

References regarding Garbhini or Garbhini chardi are not found.

Vedic Period: - 2500 BC

Among the 4 Vedas Ayurveda is considered as upaveda of Atharva Veda.

References regarding Garbhini, Sutika are found, which shows that they had

knowledge regarding all these, but much of the explanation is not found. Garbha

stapaka Aushadi’s & its use is explained.

In Upanishads & Puranas:-13

Padma Purana: - Explanations regarding development of garbha the food & regimen

Which must be followed by Garbhini is told.

Vishnu Purana: - Chardi is explained as one of the somatic disorder but reference

Regarding Garbhini chardi is not found.

Agni Purana: - It contains materials pertaining to all branches of Indian tradition &

Culture including medicine. Description regarding development of garbha is found.

Garuda Purana: - Description regarding development of the fetus & formation of body

is explained.

In Ramayana & Mahabharata:-

Reference regarding Garbhini & Garbha is found. But references about Garbhini

chardi is not found.

Samhita Period: - (1000BC- 500AD)

Historical Review


Charaka Samhita:–

Acharya Charka has mentioned chardi as one among vyakta garbha laxana in sharera

Sthana & included it under Dwistarthaja i.e. Dauhrudaja type. A separate chapter on

Chardi is available in chikitsa sthana where nidana, Purvarupa, roopa, samprapti &

Chikitsa for chardi is mentioned.4

Sushruta samhita:-

Acharya Susrutha opines chardi as one of the Vyakta garbha laxana. He considers

Aapanna Satwa as nidana for chardi. Dalhana commenting mentions apanna satwa

means Garbhini. 5

Astanga sangraha / Astanga Hridaya :-

Both Vagbhatas mentioned chardi as vyakta garbha laxana & there explanation is

similar to that of Susrutha.9

Sangraha Kala: - (500AD- 1700AD)

Madava nidana:-

A separate chapter is available which explains chardi & its management. While

explaining about nidanas of chardi Garbhini is explained as one among the cause for

chardi.10

Bhava prakasha:-

He has also mentioned chardi as one of the vyakta garbha laxana. His opinion is same

as that of Susrutha.11

Yogaratnakara:-

Explanation regarding chardi & its management is found, but references for Garbhini

Chardi is not available.12

Kashyapa Samhita:-

Much of the explanations about Garbhini & diseases seen in garbhavastha is

explained by Kashyapa. He explains Garbhini chardi, its types & management

accordingly in Khilasthana. 14

Haritha Samhita:-

Historical Review


Chardi is explained as one among the astagarbha Upadrava by Harita. Nidana, laxana

& Chikitsa of these Upadrava are mentioned in same chapter.15

Vangasena:-

His explanation is same as that of Susrutha.16

Previous work done -17

1. Dr.A.A.Shitre - .A study on effect of Mayura picchamasi in garbhinichardi,

Ayurveda mahavedyalaya pune, Pune University in 1991.

2. Dr.Sonagara -.A clinical study on Garbavasttajanya chardi, G.A.U Jamnagar

in 1993.

3. Dr.S.S Mohite -Garbhinichardi – Haritaki anupana madhu, Ayurveda

mahavidyalaya pune, Pune University in 1994.

4. Dr. Hemavati S.K -The control study of Mathulunga Avaleha in management

of garbhinichardi, SDMCA Udupi, RGUHS Karnataka in 2005

Disease Review

GARBHINI CHARDI

During pregnancy many demands are made by the growing fetus, to meet these

requirements maternal system has to undergo certain changes.2 As a consequence there is

manifestation of certain conditions among which Garbhini chardi is one such condition

seen in early trimester. It is mentioned as one of the vyakta garbha laxana in classics.

There is no separate chapter regarding Garbhini chardi, it can be considered under chardi

which is elaborately explained in our classics, as Acharya Kashyapa has mentioned that

euÉUÉ±ÉlÉÉÇ ÌuÉMüÉUÉhÉÉÇ rÉ§É rÉ§ÉåWû sÉ¤ÉhÉqÉç |

A³ÉÉSÉlÉÉÇ mÉëuÉ¤rÉÉÍqÉ iÉe¥ÉårÉ aÉÍpÉïhÉÏwuÉÌmÉ || (MüÉ. xÉÇ. ÎZÉ. 10)

There is no difference in physical & psychological disorder of a pregnant woman

from any other individual i.e. the child of 2 yrs till old man as the doshas & dusyas of the

body are same. She also exhibits similar symptology for all the diseases. So

eitiopathogenesis of Chardi in Garbhini is same as that seen in other individuals but only

the principle of treatment differs as she is considered as sukumari. 18

VYUTPATTI:-19

The word “chardi” is a stree linga pada.

It is derived from two words i.e. ‘chad’ dhathu & ‘inn’ pratyaya.

The word ‘Chardh’ is again formed by two words

‘Chad’- Means to fill. ‘

Ardh’- Means discomfort.

The one which fills the mouth & comes out causing discomfort to the body is called

chardi.

NûSïrÉÌiÉ Nû±ïiÉå CÌiÉ uÉÉ | NûSï uÉqÉlÉå (zÉ.Mü.SìÓqÉ)

NIRUKTI:-


Disease Review

AÉqÉÉzÉrÉÉiÉç qÉÑZÉqÉÉaÉåïhÉ SÉåzÉÉhÉÉÇ oÉÌWûaÉïqÉlÉqÉç |

(cÉ.ÍcÉ.) 20

Vitiated doshas present in amashaya come out through the mukha marga called as chardi.

NûÉSrÉÌiÉ qÉÑZÉqÉç, ASïrÉÌiÉ cÉÉ…¡ûÉlÉÏÌiÉ cNûÌSïÈ |

NûÉSrÉ³ÉÉlÉlÉÇ uÉaÉæUSïrÉ§É…¡ûpÉleÉlÉæÈ | (qÉSÒMüÉåwÉ) 21

ÌlÉÂcrÉiÉå cNûÌSïËUÌiÉ SÉåwÉÉå uÉY§ÉÇ mÉëkÉÉÌuÉiÉÈ |

(xÉÑ.E.49/6) 22

The vitiated doshas rush up to the mouth after covering whole of it & comes out with

great force causing body ache called as chardi.

PARYAYA:-23

Vantaou, Vamana,

Vamatu, Vamihi,

Chardika, Utkasika,

Chardanam, Udgaraha.

NIDANA:-

Avoidance of the etiological factors of the disease comprises the prime line of

treatment in Ayurveda.

The various causative factors mentioned by different Acharyas can be

summarized under three major headings -

i) Aharataha

ii) Viharataha

iii) Nidanarthakara rogajanya

i) Aharataha: -

Ahara plays a vital role not only in maintaining the health but is equally

responsible for the causation of the disease if taken in improper way. Various etiological

factors related to food are:

Excessive intake of Atidrava, Atisnigda, Ahrudya, Atilavana, Akala, Atimatra,

Asatmya, ahara (Sushruta, Ashtanga Hridaya, Madhava Nidana, Bhavaprakash


Disease Review

Vangasena, Yogaratnakara).All these factors leads to Agnimandya which further leads to

ahara dusti which in turn causes Vikruti of vatadi tridosha leading to Chardi.22

ii) Viharataha: -

Shrama, Kshaya,

Manogata Karana:

Krodha, chinta, bhaya, shoka

Krodha produces Vatapitta prakopa. Chinta, Shoka and krodha produce

Vataprakopa. Krodha, Bhaya and shoka produce Pitta prakopa. All these factors & dusta

Ahara rasa in Garbhini causes chardi.

iii) Nidanarthakara Roga: -

Aapannasatwa (Garbhini acc to Dalhana), Krumi.

Acharya Susrutha while explaining Nidana of chardi has mentioned

Aapannasatwa as one of the cause, Dalhana on commenting has told that Aapannasatwa

means “Garbhini”. Which means presence of Garbha is one of the cause for chardi. He

also mentions Dauhruda avamana as one of the causative factor.

Acharya Yogaratnakara, Sarangadara, Vangasena etc followed Sushruta.

Madhukosa has explained that along with “Aapannasatwa” Vata Vaigunya due to

presence of garbha is a cause for chardi.

Acharya Harita has explained Chardi as one of the Upadrava of garbha, where the

cause for chardi is the presence of garbha.

From all the above explanations we find three main causative factors for Garbhini

chardi i.e.

1. Aapannasatwa (Garbhini)

2. Dauhruda avamana

3. Vatavaigunya due to presence of garbha.

Aapannasatwa: - Presence of garbha itself is one of the causes for chardi.


Disease Review

Dauhruda avamana: - During pregnancy women develops desire for certain foods &

articles. If her desires are not fulfilled then that may lead to vata vruddi which vitiate

manasika & other doshas leading to chardi.

Vata Vaigunya: - During pregnancy the poshana of the garbha takes place through the

rasas of the mother because of which dhathu shitilata may be seen which may lead to vata

Vaigunya. This vitiated vata along with other doshas may expel out through the mukha

marga in the form of chardi.

NIDANA Table No.1 Nidanas of Chardi

Sl.

No. Laxana Su.S A.S A.H MA.N Y.R Van

1. Atidrava, + - - - + +

2. Atisnigda, + + + - + +

3. Atilavana rasa sevana + + + - + +

4. Akala + - - - + +

5. Atimatra, + - - - + +

6. Asatmya, + - - - + +

7. Ajeerna. + + + + + +

8. Ama. + + + - + _

9. Shrama, + + + + + _

10. Kshaya + + + + + -

11. Ahrudya - + + - - +

12. Chinta, + + + - + -

13. Bhaya, + + + - + +

14. Shoka - + + + + +

15. Aapannasatwa + + + + + +

16. Krumi + + + + + +

17. Atidruta - - - + - +


Disease Review

Vishista Nidana according to Charakacharya –

Table No.2 Vishista Nidanas of chardi 24

Vataja Chardi Vyayama, Tikshna aushada, Shoka, Bhaya, Roga, Upavasa, Atikrusha.

Pittaja Chardi Ajeerna, Vdahi ahara bhojana, Atyadika ushna Ahara sevana. Kaphaja Chardi Snigdha, Atiguru, Vidahi ahara sevana, Diwaswapna. Sannipataja Chardi Sarva rasa ahara sevana, Amapradosha, Rutuvipareeta ahara

sevana. Dwistarthaja Chardi Dwista, Vipareeta, Apavitra, Maleena, Aprasanna ahara

sevana.

PURVAROOPA:-24

mÉëxÉåMüÉå ¾ÒûSrÉÉåiYsÉåzÉÉå pÉ£üxrÉÉlÉÍpÉlÉlSlÉqÉç mÉÔuÉïÂmÉÇ

qÉiÉÇ NûÌSï | (xÉÑ.E.49/8) Table No.3 Purvarupa of chardi

Laxana Ca Su M.Ni A.S A.H Vanga Y.R

1. Hrudayautklesha + + + + + + +

2. Kaphapraseka + + + + + + +

3. Annadwesha + + + + + + +

4. Udgararodha - - + + + + +

BHEDA:- 24

Acharya Charaka, Susrutha, Madhava nidana, Vagbhata, Y.R, Vangasena have

considered Dauhrudaja Chardi among Agantuja type & mentioned that they must be

identified by the lakshanas of all the doshas & treated accordingly.


Disease Review

1. Flow chart of types of chardi.

Chardi

Vataja Pittaja Kaphaja Sannipataja Agantuja

1. Krimija

2. Dauhrdaja

3. Amaja

4. Bibatsaja

5. Asatmyaja

Dauhrudaja

Vataja Pittaja Kaphaja Sannipataja

Acharya Sharangadara has mentioned 7types of Chardi & included Garbhadana as one of

the type.

Chardi25

Vataja Pittaja Kaphaja Sannipataja Krumija Garbhadana Grunya


Disease Review

ROOPA:-

Table No.4 Roopa of Vataja Chardi

VATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R

Hrutparshvapeda + + + + + + +

Mukhashosha + _ + _ _ + +

Kasa + _ + + + + +

Swarabheda + _ + + + + +

Shabdaprabalaudgara + + + + + + +

Alpamatra + + + + + + +

Pheneela + + + + + + +

Krushna Varna + _ _ + + + +

Kashayarasa + + + + + + +

Srantha - + + + + + +

Shosha - _ _ + + _ +

Table No.5 Roopa of Pittaja chardi

PITTAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R

Murcha + + + + + + +

Pipasa + _ + + + _ +

Mukhashosha + _ + + + _ +

Santapa + + + + + + +

Bramha + _ + + + + +

Peeta, Harita, varna + + + + + + +

Ushnayukta + + + + + + +

Tikta rasa + + _ + + _ +

Daha + + + + + + +

Ksharodaka - _ _ _ _ + _


Disease Review

Table No.6 Roopa of Kaphaja chardi

KAPHAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R

Tandra + _ + _ _ + +

Madhurata + + + + + + +

Kaphapraseka + _ + _ _ + +

Santosha + _ _ _ + + +

Nidra + _ + _ _ + +

Aruchi + + + + + + +

Gourava + + + + + + +

Lomaharsha + + + + + + +

Alparuja + _ + _ _ + +

Swetavarna _ + _ _ _ _ +

Snigda _ _ _ + + + _

Adikamatra _ + _ _ _ _ _

Hrullasa _ _ _ + + _ _

Tandra _ _ _ + + _ _


Disease Review

Table No.7 Roopa of Sannipataja chardi

SANNIPATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R

Shula + _ + _ _ + +

Avipaka + _ + + + + +

Aruchi + _ + _ _ + +

Daha + _ _ _ + + +

Trushna + _ + _ _ + +

Swasha + _ + + + + +

Murcha + _ + + + _ +

Sarva Varna yukta + _ + + + + +

Moha _ _ _ _ _ _ +

SAMPRAPTI:-

Samprapti involves dosha dushya sammurcchana and the subsequent

manifestation of the disease. Hence an indepth scrutiny into the different angles becomes

necessary by which the clarity of the disease process is established. This alone enables us

to efficiently manage or cure the disease as samprapti vighatana is Chikitsa.


Disease Review

2. Flow chart showing samprapti of chardi26

Garbhini stree due to Garbha utpeedana &

Atidravadi nidana sevana

Vatadi shareerika dosha prakopa Manasika dosha prakopa

Dauhruda avamana

Udanavruta apana, Vyana Vata vruddi

Kapha Pitta prerana

Amashaya stitha aahara dusti (Agnimandya)

Vimargagamana of vrudda dosha

Mukha achadana, poorana

Chardi

During pregnancy due to garbha peedana or due to Dauhruda avamana there is Vata

prakopa which further vitiates Kapha, Pitta & ahara rasa. Due to dosha utklesha they are

forcibly expelled through the mouth with the help of Vata resulting in Chardi.


Disease Review

Samprapti ghataka

Dosha – Udana, apanna, vyana, Kapha & Pitta.

Dushya - Rasa (Ahara rasa)

Srotas – Annavaha & Rasavaha

Agni – Jatharagni, Rasadhatwagni

Ama - Jatharagni, Rasadhatwagnijanya Ama

Adhistana – Amashaya

Vyakta sthana- Mukha

Srothodusti – Sanga, Vimargagamana

Vyadi avastha – Ama

Sanchara sthana – Rasavahini

Rogamarga – Abyantara

Sadyasadyatha – Sadya

Nidana panchaka

Chaya – Aharaja, viharaja & Manasika nidana sevana leads to Chaya of vatadi dosha.

Prakopa – Further exposure to same kind of nidana & Dauhruda avamana leads to

vitiation of vatadi three dosha.

Prasara – Aggravated vatadi dosha & ahara rasa move towards Amashaya.

Sthanasmsraya – These vitiated dosha come out from Amashaya through mukha marga

Vyakta – In the form of Chardi.


Disease Review

ASADYA LAXANAS:-

Table No.8 Laxanas of Upadrava

SI NO

laxanas C.S S.S Y.R Van

1. Vit,Sweda,Mutra,Ambuvaha srota avarodha

+ - + +

2. Vinmutra ganda varna chardi

+ - + +

3. Shonita & pooya yukta + + + +

4. Swasa, Kasa etc - + + +

Acharya Charaka, Susrutha, Y.R, Vangasena have explained that there is

obstruction to Sweda, Mutra & Ambuvaha Srotas. Due to this obstruction they move in

upward direction because of which the chardi which comes out contains the Varna and

gandha of mutra, sweda etc. When Chardi is seen in excess times then it may be

associated with Shonita or pooya which may lead to kasa, swasa, hrudrogadi etc laxanas.

These above features are seen in condition called hyper emesis where there is presence of

excess vomiting which may be sometimes mixed with blood & due to severe dehydration

there is presence of Ketone bodies in urine & smell of acetone may be seen through the

breath. Person becomes weak & emaciated if they are left untreated then they enter into

the stage of coma which may eventually lead to death.

In ancient times people used to neglect these conditions or used to approach

vaidyas in later condition which were not treatable & patient used to die. So Acharyas

have mentioned them as Asadya laxanas. But in present era due to public awareness &

regular antenatal care they are diagnosed earlier & with good advancement of medicines

& rehydration therapy these conditions can be controlled, but certain side effects on fetus

as well as on mother is seen.


Disease Review

UPADRAVA:-24

1. Kasa

2. Swasa

3. Jwara

4. Hikka

5. Trushna

6. Vaichintya

7. Hridroga

8. Tamaka swasa

3. Flow chart showing samprapti of Upadrava.

These conditions are seen as a complication due to excess vomiting.

Excess chardi

Vata prakopa

Urdwagamana of vata

Along with Chardi Trusna, Kasa, swasa Hridroga

Vaichintya

Death


Disease Review

CHIKITSA:-

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iÉjÉÉ aÉpÉï¶É lÉÉUÏ cÉ uÉkÉïiÉå U¤rÉiÉåÅÌmÉ cÉ | (MüÉ.ÎZÉ.10/3) 27

Even though Acharya Kashyapa has mentioned that the diseases occurring in

pregnant women is same as that of non pregnant women, the principles of treatment

differs from that of general chardi. There they have mentioned langana & shodhana as

line of treatment, which cannot be given to the pregnant women. Hence gentle treatment

should be given which helps to cure the disease & also maintains the growth of fetus.

Pregnant women should be treated just like a pot which is filled with oil because the

slightest movement will cause spilling of oil from the pot. Similarly slight excitement

may cause problem to the fetus.

AlÉÑMÔüsÉÉåmÉcÉÉUåhÉç rÉÉÌiÉ Ì²¹ÉjÉïeÉÉ zÉqÉqÉç | (A.xÉÇ.ÍcÉ.8/13)28

Dwistarthaja chardi should be treated by providing agreeable foods & drinks which helps

to cure the condition & also maintains pregnancy.

SÉæ¾ÒûÌSÇ MüÉÌXû¤ÉiÉæÈ TüsÉæÈ | (xÉÑ.E.49/25)29

If desires of dourhda is not fulfilled there may be dhathu Kshaya as she will not

consume food properly which leads to Vata vruddhi leading to chardi. So the line of

treatment should be stambana & bramhana which helps to control vomiting & provide

nutrition for the fetus. So the preparations made up of a drug which specifies vatadi

doshas, laghu, Hrudya, Agnideepaka, Dhathu vardaka should be used. Preparations in the

form of Leha, Churna, and Syrups etc which are pleasant & easily palatable to Garbhini

are beneficial.

Among all Acharyas, Kashyapa is one who has mentioned management of

doshaja chardi in antarvatnichikitsadyaya but has not specified its use as only in Garbhini

chardi. 30


Disease Review

Vataja chardi:-

‐ Leha prepared with Matulunga rasa, laja, kola, dadima rasa, sharkara, anjana &

madhu.

‐ A salt free soup prepared with juice of Matulunga, meat of goat or buffalo with

dadima rasa & appetizing articles.

Pittaja chardi:-

‐ Caturjata Kalka is added with tandulodaka along with laja, sugar, madhu, &

sugandha pushpa.

‐ Laja peya along with sugar & honey.

Kaphaja chardi:-

‐ Phanta prepared with tender leaves of Amra & jamboo along with honey.

‐ Soup prepared with Mudga, medicated with seeds of dadima mixed with salt &

butter.

Sannipataja chardi:-

‐ Here according to predominance of doshas combined treatment should be given.

Krimija chardi:-

‐ Kwatha prepared with mula of punarnava & bhadradaru along with honey should

be used.

Harita has mentioned use of bilva fruit along with curd or sugar. Vatsaka, pippali, shunti

& amalaki fruit can also be used.

Acharya Susrutha, Y.R, Vangasena have explained use of saindava lavana & ghruta in

Vataja chardi.

‐ Three types of lavana mixed with Ksheerodaka.

‐ Yusha prepared with mudga, Amalaki, Saindava along with panchamula kashaya.


Disease Review

Pittaja chardi:-

‐ Yavagu prepared with Laja, Yava, Mudga, along with honey should be used.

‐ Yusha prepared with Sugandhita, Madhura or Tikta dravya should be used.

‐ In case of Pittaja chardi associated with daha & Trushna draksha rasa along with

honey should be used.

‐ Haritaka churna along with madhu should be given, Because of which doshas

move out through down ward movement & chardi is controlled.

Kaphaja chardi:-

‐ Vidanga, Triphala, Trikatu churna along with madhu should be used for licking.

‐ Aragvadha khashaya, chardi nirahana gana dravya khashaya should be taken

along with honey.

Sannipataja chardi:-

‐ Guduchi phanta should be mixed with honey & should be taken internally.

‐ Masura sathhu is done mardana with honey & taken along with dadima rasa.

‐ Mayura piccha basma along with honey cures Upadrava yukta chardi.

Acharya Yogaratnakara has mentioned –

‐ Dhanyaka Kalka along with tandulodaka & sugar.

‐ Bilva majja mixed with liquid prepared from laja.

‐ Decoction of shunti & bilva mixed with flour of parched barley is beneficial in

both vomiting & diarrhea.

Preparations used in chardi chikitsa:- 31

Kwatha :- Parpatadi Kwatha (p)

Guduchyadi Kwatha (p)

Mudga Kwatha (p)


Disease Review

Hima :- Marichadi Hima

Guduchi Hima

Phanta :- Amradi phanta

Churna :- Vidangadi churna (k)

Eladi churna (sa)

Vati :- Sootashekar

Chardi ripu

Avaleha :- Chandanavaleha (p)

Makshikadi Avaleha

Laja saktavavaleha

Koladi Avaleha (sa)

Sharkara :- Dadima sharkara

Yusha :- Lajjadi yusha (p)

Panaka :- Chandana panaka (p)

Dhatriphaladi panaka (sa)

Dhupa :- Jeerakadi dhupa (sa)

Pisti :- Pravala pisti

Mukta pisti

Arka :- Pudina Arka

Ghruta :- Jeevaneeya ghruta

Padmakadi ghruta

Patoladi ghruta (kp)

Bhasma :- Mayura puccha bhasma

Swarnamakshika bhasma

Rasa :- Jirakadi rasa


Disease Review

Vamanamruta rasa (sa)

Vantitihd rasa, Chardyantaka rasa

Pathya Apathya -

Ahara Pathya Apthya

Vegetables Nimba

Dhanyaka

Fruits Dadima Bimbi Phala

Badara

Amra

Jambeera

Amalaki

Draksha

Nareekela

Spices Shunti (min. qty.) Shunti (large dose)

Mareecha

Cereals Yava Indrayava

Shali shastika

Foods Manoonukula Prakruti Viruddha

Satmya ahara

Drinks Coconut water Excess liquid &

Mamsa rasa Dushita jala

Chikitsa Shamana Shodhana

Dairya, Sneha Chinta, Bhaya

Counseling Shoka.


Disease Review

Vihara Pathya Apathya

All Manoanukula karya ExcesVyayama, Exertion

Like Praying, Meditation Bibhatsya vastu darshana

Yoga, Walking. Leading to fear & sudden emotions

Listening to good music,

Good words. Riding vehicle,

Hitakara rasa gandha sevana Lifting heavy weights.


Disease Review

VOMITING

Vomiting is considered as one of the symptom of many diseases especially of

gastro intestinal tract rather than a separate disease entity. It is present as a cardinal

symptom in many diseases which helps in diagnosis. Nausea & Vomiting are seen

together in many diseases/conditions among which pregnancy is one such condition

where with history of amenorrhea & presence of nausea & vomiting it was diagnosed that

women is pregnant . It is present in most mammals except rodents, a species that lacks

the vomiting centre.

The word Nausea is derived from the Greek word “naus” meaning “ship” & the

Latin word “nauta” meaning sailor & thus originally carried the idea of sickness from sea

travel. 32

Definition:-

It can be defined as the process by which the contents of the upper gut are

expelled to the exterior through the mouth. It helps in removing unwanted & irritating

materials out of the body. 33

It is also defined as a forcible expulsion of the contents of upper G.I. tract through

the mouth. The strongest stimuli include unpleasant sights & dizziness or irritation &

distension of the stomach.

Causes of Vomiting:- 34

‐ Indulgence of foods which are very fatty, unpleasant, very watery & salty.

‐ Taking meals at odd times, in excess quantity.

‐ Infection by worms.

‐ Pregnancy

‐ Sight of terrific, fearsome, ugly & unpleasant things.

‐ Ingestion of toxins i.e. food poisoning.


Disease Review

‐ Gastritis, peptic ulcer with or without pyloric stenosis, dyspepsia, intestinal

obstruction etc.

‐ Raised intra cranial tension, meningial irritation, motion sickness, encephalitis,

labrynthitis, and migraine.

‐ Acute hepatitis.

‐ Psychogenic vomiting.

‐ Drugs which produce gastritis, over dose of digitalis etc.

Physiology of vomiting 35

4. Flow chart showing Physiology of vomiting.

CORTEX SMELL, PAIN, SIGHT STIMULI

CTZ

VOMITING CENTRE CEREBELLUM

GIT INNER EAR

G.I.IRRITATION, VEGAL STIMULATION

INFECTION, DRUGS

RADIATION. MOTION SICKNESS


Disease Review

Different connections of the vomiting centre

Vomiting which is accompanied by complex movements is being controlled by

the vomiting centre. There are multiple pathways that stimulate vomiting, i.e. afferent &

efferent pathway which are carried by both vagus & sympathetic nerves. Among these

afferent impulses play major role in stimulating vomiting. The major relay station in this

pathway is the CTZ (chemo receptor trigger zone) which is situated in the lateral border

of area postrema of the medulla oblongata & is unprotected by the blood brain barrier &

other is the solitary tract nucleus. CTZ being a purely sensory relay station is capable of

initiating vomiting even in absence of vomiting centre. Disturbed equilibrium leads to

generation of impulses from vestibular apparatus which reach the vomiting centre

through cerebellum. Various unpleasant sensory stimuli such as bad odor, ghastly sight,

pain & fear stimulates vomiting acting through the higher centre.

Nausea & vomiting due to olfaction pathway:- 36

Major portion of the nasal cavity is covered by the olfactory mucosa; the receptor

cells for the smell sensation are present in this mucosa, when the odorant substance

comes in contact with olfactory surface that covers cilia & then diffuses into the mucosa


Disease Review

by binding with the receptor that protrudes through the ciliary membrane. This activates

adenyl cyclase that is attached to the insight of the ciliary membrane. Which intern

converts intracellular ATP into c-AMP. This causes sodium ions to pour into the receptor

of cell cytoplasm, thus exciting the olfactory neuron system & transmitting action

potential into the CNS by way of an olfactory nerve.

ACT OF VOMITING

The vomiting act encompasses three types of outputs initiated by CTZ.

‐ Increased salivation to protect the enamel from the gastric acid.

‐ Retro peristalsis movement which starts from the middle of the small intestine &

moves upward sweeping all the contents into the stomach through the relaxed

pyloric stinosis.

‐ A lowering of intra thoracic pressure, coupled with an increased in abdominal

pressure making abdominal muscles to contract & propels stomach contents into

esophagus as the esophageal sphincter relaxes causing vomiting which is followed

by retching .

5. Flow chart showing act of vomiting:- 37

Taking a deep breath.

Raising the hyoid bone & larynx to pull the UOS open

Closing of the glottis-prevents aspiration in the trachea.

Soft palate lifted to close the posterior nares

Subsequently strong downward contraction of diaphragm.

Simultaneous contraction of abdominal wall muscles.

Squeeze stomach to build up high intra gastric pressure


Disease Review

Finally LES relaxes allowing expulsion of gastric contents upwards.

MORNING SICKNESS

Definition: -38

Morning sickness is the nausea & vomiting scene in women during pregnancy in

early trimester. All though it is more common in the morning it can last for all the day in

some women.

Prevalence of Nausea & vomiting in pregnancy:- 38

It is one of the common conditions & affects 70 - 85 % pregnant women. Around

30-50 % of pregnant women have episode of vomiting while 30-90 % of women

experience nausea alone.

Etiology:- 38

The exact cause remains unknown but various theories have been proposed which

leads to nausea & vomiting during pregnancy.

HORMONAL THEORY :-38

Progesterone: - It is the pregnancy dominating hormone which helps in maintain

pregnancy by producing softening effect on the muscular system thus preventing uterine

contraction. This softening effect is also seen on muscles of stomach of intestines which

leads to slow emptying of stomach giving rise to excess gastric secretion which may

cause vomiting.

HCG (Human chorionic Gonadotrophine) :- During pregnancy level of HCG

dramatically rises, peaks & diminishes from week 5-15 of pregnancy. At the same time

we find morning sickness in most of the women raises, peaks & diminishes. It may be

because of high level of HCG in the blood stream activates the vomiting centre in the

brain which causes vomiting.

Estrogen ;- It is known to produce nausea & vomiting as seen in women on OCP’S.

Vomiting is more common when oestradiol levels are increased & vice versa is also true.


Disease Review

Psychogenic theory: - Psychiatric illness, Conversion of somatization disorder or

depression during pregnancy directly stimulate higher centers & leads to nausea &

vomiting.

Vestibular & olfaction: - Hyperactivity of olfaction & disturbed equilibrium in

vestibular apparatus may lead to nausea & vomiting during pregnancy.

Infection: - Presence of Helicobacter pylori in the stomach may cause nausea &

vomiting during pregnancy.

Adrenal insufficiency: - In normal pregnancy certain morphological changes are seen in

the adrenal gland. There is decrease in the size of adrenal compared to that of the non

pregnant. Metabolic clearance is lowered during pregnancy because of which the serum

level of sodium, chloride, bicarbonate & glucose are below normal level, but serum

potassium level is elevated. This may result in weakness, anorexia, nausea & vomiting.

Immunological basis: - Maternal recognition of pregnancy is brought by the way of

signals generated by the trophoblast that act upon the maternal ovary. The immunological

acceptance of semiallogenic tissue of the concepts is modulated by the regulation of HLA

i.e. Human Lymphocyte antigen expressed by trophoblast. This may sometime trigger

vomiting during pregnancy.

Toxins: - How far this theory is true is not yet known. It is said that vomiting seen in

early trimester helps to protect the developing fetus by encouraging the mother to avoid

dangerous or toxic food intake. It is a kind of defense mechanism seen due to the

presence of fetus to protect itself.

Other causes;-39

‐ Family history of emesis or hyper emesis.

‐ Most common in unplanned pregnancies.

‐ In women with high dietary intake of saturated fat before pregnancy.

‐ Most common in women with history of motion sickness or migraine.

‐ Women with increased placental mass as in case of multiple pregnancies &

hydatidiform.


Disease Review

‐ Decreased levels of calcium & glycogen in mother leads to morning sickness.

‐ Smoking & Alcohol.

Causes of vomiting in pregnancy –40

6. Flow chart showing causes of Vomiting.

Morning Sickness

Early pregnancy Late pregnancy

Related to pregnancy Associated with pregnancy

Simple vomiting Hyper emesis

Medical Surgical Gynecological

1. Intestinal infection 1.Appendicitis 1.Twisted ovarian syn

2. UTI 2.Peptic ulcer 2.Fibrod Degeneration

3. Hepatitis 3.Int.Obstruction

4. Diabetic Ketoacidosis 4.Cholecystitis

5. Uremia


Disease Review

The different causes of vomiting such as appendicitis, Gastroenteritis,

Cholecystitis, Pancreatitis, intestinal obstruction & pylonephritis should be considered. In

selected patients with additional clinical features appropriate investigations to exclude an

underlying cause may be indicated. Once a diagnosis of hyper emesis has been reached

then associated conditions of multiple pregnancies & hydatidiform mole should be sought

by clinical examination & an ultrasound scan of the uterus. When these conditions have

been excluded, it is possible to feel confident that one is dealing with specific idiopathic

hyper emesis of an otherwise normal singleton pregnancy.

Whatever may be the cause of initiation of vomiting unless it is not quickly

rectified features of dehydration & carbohydrate starvation supervene & a vicious cycle

of vomiting appears.

7. Flow chart showing Cycle of vomiting- 40

Vomiting

Carbohydrate starvation

Ketoacidosis

Vomiting

Symptoms:- 39

In case of simple vomiting- ‐ Nausea, Vomiting & occasional sickness on rising in the morning.

‐ The Vomitus is small, clear or bile stained, Sometimes associated with food.

‐ Persistent vomiting shortly after eating or drinking even water is seen.

‐ Nutrition does not suffer.

In case of severe vomiting –

‐ Vomiting is increased in amount & frequency.


Disease Review

‐ Vomitus may be coffee brown or mixed with blood.

‐ Weight loss may be seen.

‐ Oliguria.

‐ Epigastric pain.

‐ Constipation may occur.

‐ Person is unable to do any activities.

‐ Giddiness & tiredness is present.

Signs – 39

If emesis is not treated earlier then features of severe vomiting such as dehydration &

Ketoacidosis is seen which may lead to

‐ Dry coated tongue.

‐ Sunken eyes.

‐ Skin becomes lusterless & in elastic.

‐ Anxious look.

‐ Acetone smell in breath.

‐ Increased pulse rate 120 or more/minute.

‐ Tachycardia.

‐ Hypotension.

‐ Features of peripheral neuritis may be seen.

‐ Appearance of Jaundice as a late feature.

Consequences – ‐ Due to severe vomiting patient may develop frustration which may lead to

depression. ‐ A feel of being neglected may develop. ‐ There may be adverse effect on family relationships. ‐ She might take decisions of not to have another child. ‐ Effect on physical, Social & Psychological state of the pregnant women on fetus

& on her family. ‐ Fear of severe morbidity & mortality may be seen.


Disease Review

Metabolic, Biochemical & Circulatory Changes due to severe vomiting – 40

Metabolic changes: - Due to excess vomiting patient develops fear for intake of food

thinking that it further aggravates vomiting. Because of inadequate food intake there is

depletion in glycogen level, for the energy supply fat reserve is called upon. There is in

complete oxidation of fat due to low carbohydrate because of which there is

accumulation of ketone bodies in the blood. The acetone is ultimately excreted through

the kidney & breath. There is also increase in tissue protein metabolism resulting in

excessive excretion of non protein nitrogen in urine.

Biochemical changes: - Due to excess vomiting there is loss of water & salts from the

body which results in fall of plasma sodium, potassium & chloride. Hepatic dysfunction

results in acidosis & ketosis with rise in blood urea, uric acid, hypoglycemia,

hypoprotienamia, hypovitaminosis & rarely hyperbilirubinaemia.

Circulatory changes: - There will be increase in hemo concentration which will further

lead to rise in Hemoglobin levels, RBC, WBC & haematocrit values.

Complications due to severe vomiting:- 40

‐ Neurological complication like wernick’s encephalopathy, peripheral neuritis,

Korsakoff’s psychosis may be seen.

‐ Esophageal tear or rupture.

‐ Stress ulcer may develop in the stomach. ‐ Spleenic avulsion. 39

‐ Jaundice.

‐ Renal failure.

‐ Psychological morbidity in the form of depression or somatization may be seen.

‐ Death from nausea & vomiting of pregnancy is rare but may occur due to the

complications of hyper emesis.

Effect on Fetus:-39

Mild to moderate vomiting has no much effect on fetus.

In severe vomiting there is higher incidence of low birth weight in about 30% of women

who lose weight in pregnancy.


Disease Review

Investigation:-

In simple vomiting

– Blood group

– Hb %

– Urine routine

– USG if necessary

In severe vomiting

‐ Hb % / Haematocrit values

‐ Serum electro light values

‐ LFT (SGOT, SGPT, Bilirubin)

‐ Urine analysis its quantity, color, specific gravity, ketone bodies, bile pigments,

chlorides.

‐ Opthalmoscopic examination

‐ ECG

‐ USG

Management:-39

In simple vomiting

‐ Assurance.

‐ Taking water, dry toast or biscuit before getting up from the bed.

‐ Eating several meals during a day instead of three big once because empty

stomach can cause nausea & vomiting.

‐ Fatty food must be avoided as they can worsen the condition.

‐ Food rich in carbohydrate must be taken.

‐ Drinking plenty of fluids is necessary as they help in replacing lost fluids &

neutralize stomach secretions.

‐ Foods with smell which bother must be avoided.

‐ Drinking ginger tea or ginger ale is beneficial.

‐ Eating crackers every morning 20 min. before getting out of bed.

‐ Wearing one or two acupressure wrist bands to prevent motion sickness.


Disease Review

‐ Avoiding stress.

‐ Wearing loss fitting clothes.

‐ Extra sleeping.

‐ Doing activities which are pleasing to the mind.

‐ Drugs like multivitamin supplementation, pyridoxine 25mg 8th hourly,

doxalamine10mg + pyridoxine 10mg for three to four times a day can be taken.

Hyperemisis:- 40

‐ The principle of management is to correct fluids, electrolyte & other metabolic

disturbances effectively.

‐ Hospitalization, Laboratory investigations.

‐ To prevent or detect at the earliest about the complication that may arise & treat

them.

PHARMACOLOGICAL PRINCIPLES OF MANAGEMENT OF NAUSEA &VOMITING35

The antiemetic agents are classified as:

1) Anticholinergics

2) Antihistaminics

3) Antidopaminergics

4) Anti 5 HT3

5) Miscellaneous.

Anticholinergics

Block afferent impulses to vomiting center by anticholinergic action

Mild sedative action also contributes to antiemetic effect

E.g. Scopolamine

Antihistaminic

Action on vomiting centre & mild sedative effect


Disease Review

E.g. Cyclizine: Available as Cyclizine hydrochloride (Marzine)

Dose: - 50mg (oral)

Action: - H1 receptor antihistaminic agent

- Action prolonged

- Mainly used for motion sickness

Meclizine: Available as Meclizine hydrochloride.

Dose: - 25 – 50 mg oral

Action: - Action longer than Chlorcyclizine mainly used for motion sickness.

Promethazine hydrochloride (Phenargan):

Dose: - 12.5 – 25 mg

Action: - Longer duration of action

- Produces marked sedation

Promethazine chlorotheophyllinate (Avomine):

Dose: - 25-75 mg

Action: - Used mainly in motion sickness. Superiority over Promethazine is doubtful.

Antidopaminergic

Act on CTZ by selectively depressing CTZ.

E.g. Chlorpromazine

Available as:

Chlorpromazine hydrochloride (Largactil)

Tab - 10, 25, 50, 100 mg

Syp - 25 mg (adults) per ml

Daily dose: Varies according to condition of patient.

Range 25 mg to 1000mg.

And related drugs- Metoclopramide

Domperidone


Disease Review

Anti 5 HT3

Block the 5 HT3 receptors & thus prevent vomiting. Ex - Ondansetron and Granisetron.

Miscellaneous

Buterophenones - Droperidol & Haloperidol have significant antiemetic effect by

antagonism of dopamine receptors.

8.Flow chart showing Management of Emesis & Hyper emesis. 38

Gestational Emesis

Reassurance, rest, Dietary Manipulation

Persisting Emesis

Stable weight, Minimal ketosis

Weight loss, Ketosis Normal fetal growth

*Electrolyte hydration Routine prenatal care

*Dietary Manipulation

*Laboratory evaluation

Hospitalization,

Electrolyte replacement,

Psychological & Pharmacological support.

Termination of pregnancy, if necessary in case of complications.


Disease Review

Final Impact 38

Recent studies on effect of nausea & vomiting on pregnancy has shown following

reports.

‐ About 35% of women with nausea & vomiting in pregnancy are unable to work.

The average loss of work time is said to be 62hrs.

‐ A study on quality of life variables found that pregnant women with mild to

moderate nausea vomiting are unable to care for young children or perform house

hold tasks & daily activities.

‐ The mother risk programme at the hospital for sick children in U.S. has reported

that nausea & vomiting is often cited as a reason for pregnancy termination by

therapeutic abortion, on the other hand some studies have associated nausea &

vomiting with good pregnancy out come.

‐ Moderate nausea & vomiting have been found to lower the risk of miscarriage

.This protective effect is absent in mothers not suffering from nausea & vomiting

during pregnancy which indicates lower levels of estrogen.


Drug Review

DRUG REVIEW

The use of plants as medicine can be seen in almost all the ancient

civilizations of India, Egypt etc. In India from Vedic period plants have been

considered as principle remedy for the mitigation and cure of diseases.

Various plant remedies have been evaluated in Ayurveda for the management

of diseases. The Indian sages discovered drugs, invented combinations,

studied potential toxic effects and prescribed therapeutic uses long ago. This

was based on the observations of the effect of drug on human beings and

animals. Large numbers of drugs used in a similar manner have been found

from Vedic period itself.

As research is the scientific and diligent study, this herbal preparation

of Dadimaavaleha is taken for clinical experimentations in order to establish

facts and analyze their significance in Garbhini chardi.

Ingredients of Dadimaavaleha:41

1. Dadima – 1Kg 11.Nimba patra- 50gms

2. Nagara – 50gms 12.Manjistha- 50gms

3. Pippali - 50gms 13.Kuta shalmali- 50gms

4. Pippali mula – 50gms 14.Pata- 50gms

5. Danyaka- 50gms 15.Lavanga- 50gms

6. Ajamoda- 50gms 16.Ativisha- 50gms

7. Jatiphala -50gms 17.Jeeraka- 50gms

8. Jatipatra – 50gms 18.Haritaki- 50gms

9. Maricha- 50gms 19.Madhu- 50gms

10. Vamshalochana- 50gms 20.Grutha- 50gms

Water – 4lit

Sugar – 1 kg

Madhu- 1kg

Ghrutha – 1kg

“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page

41

Drug Review

Table No: 9 Showing rasa, guna, veerya,vipaka & karma of the drugs 42,43,44

Sl. No Dravya Rasa Guna Veerya Vipaka Doshagnata

1. Dadima Madhura, amla, Kashaya Laghu, snigdha Ushna Madhura/A

mla Tridoshahara

2. Shunti Katu Laghu, Snigdha Ushna Madhura Kapha vata shamaka

3. Pippali Katu Laghu, Theekshna, Snigdha Sheetha Madhura Kapha vata

shamaka

4. Pippalimoola Katu Laghu, Ruksha, Theekshna Ushna Katu Kapha vata

shamaka

5. Danyaka Madhura, Kashaya Laghu, Snigdha Sheetha Madhura Pitta shamaka

6. Ajamoda Tikta, Katu Laghu Ushna Katu Kapha vata shamaka

7. Jatiphala Tikta, Katu Theekshna, Ushna Ushna Katu Kapha vata shamaka

8. Jatipatra Tikta, Katu Theekshna, Ushna Ushna Katu Kapha vata shamaka

9. Jeeraka Tikta, Katu Laghu, Ruksha Ushna Katu Kapha vata shamaka

10 Maricha Katu Laghu, Theekshna Ushna Katu Kapha shamaka

11 vamshalochana

Madhura, Kashaya Laghu, Ruksha Sheetha Madhura Kapha pitta

shamaka

12 Nimba patra Tikta, Kashaya Laghu, Ruksha Sheetha Katu Kapha pitta shamaka

13 Manjista Madhura, Kashaya Guru Ushna Katu Kapha

shamaka

14 Kuta shalmali Kashaya Snigdha Sheetha Katu Pitta vata shamaka

15 Pata Tikta kashaya Laghu, Ruksha Sheetha Katu Tridoshahara

16 Lavanga Tikta,Katu Laghu, Theekshna Sheetha Katu Kapha pitta nashaka

17 Ativisha Katu,Tikta Laghu, Ushna Katu Kapha pitta shamaka

18 Haritaki

Pancharasa(lavana varjitha),

Kashaya pradhana

Laghu, Ruksha Ushna Madhura Tridoshahara

19 Grutha Lavana, Katu Ruksha, Theekshna Ushna - Kapha vata shamaka

20 Madhu Madhura, Kashaya

Lagu,Ruksha, sheetala, Sheetha - Kapha pitta

shamaka

21 Sharkara Madhura Sheetala,snigda Guru Sheetha - Pitta shamaka

22 Guda Madhura Guru,snigdha Sheetha - Pitta shamaka


42

Drug Review

Table No: 10 Showing botanical description of drugs

SI.No

Dravya

Botanical Name Family Karma Chemical Composition

1. Dadima Punnica granatum Punicaceae

Hrdhya, Tridoshahara, Shukrala.

Fruits contain -Tannins, Pu icalin, Punicalagin. Seeds contain -estrone,vpunicic acid.

2. Shunti Zingiber officinale

Zingiberaceae

Shothahara, rakta shodhana

Shigarol,Gingerol,Protein 2.3%, fat 0.9%, Carbohydrate 12.3%, Minerals 1.2%, Calcium 20%, Phosphorous 60%, Iron 2.6mg/100g, Iodine and fluorine trace

3. Pippali Piper longum Piperaceae Rakta vardhaka,

rakta shodhana

Piperine 0.15%, Piplartine 0.16%, Piperlogumine and piperlonguminine

4. Pippalimoola

Piper longum Piperaceae

Deepana, Pachana, Vata anulomana, Krimihara,

Piperine 0.15%, Piplartine 0.16%, Piperlogumine and piperlonguminine

5. Danyaka Coriandrum sativum

Umbelliferae

Deepana, Hrdhya, Balya,Vrsya

Protein 14.1%, fat 21.8%, Carbohydrate24.6%, Minerals1.2%, Calcium1.5%, Iron28.8mg/100g, Phosphorous0.39%.

6. Ajamoda Trachyspermum ammi

Umbelliferae

Rakta prasadana, Shothahara, Varnya

Protein 18.1%, fat 16.1%, Carbohydrate21.6%, Minerals1.2%, Calcium0.63%, Iron18.6mg/100g, Raboflavin0.28, Nicotinic acid.

7. Jatiphala Myristica fragrans

Myristicaceae

Deepana,Rochana, Vrsya, Svarya

Myristic acid, Cyanadin, Lignans, Neolignans, Safrole.

8. Jatipatra Myristica malabaricum

Myristicaceae

Deepana,Rochana,

Vrsya, Svarya

Pectin, Glyceroid, Myristic acid.

9. Jeeraka Cuminum cyminum

Umbelliferae

Rakta shodhana, agni deepaka,

Cuminin, diacyl glycerol, isoimpinellin,P-


43

Drug Review

cymene,isoimperatorin.

10. Maricha Piper nigrum Piperaceae

Deepana, Pachana, sroto shodhana, krimihara, raktothklesha

Protein 11.5%, fat 6.8%, Calcium 4.6%, mineral matter 4.4%, Phosphorous, Iron 3.2mg, Vitamin A, Nicotinic acid 1.4 mg/100g, oxalic acid 0.4-3.4%

11. vamshalochana

Bambusa arundinaceae

Poaceae Balya Methylanthraquinones, Fucosterol

12. Nimba patra

Azardirachta indica Meliaceae Deepana,

Krumihara

Azardirectin, azadirone, nimbin, nimbandiol, nimbolide.

13. Manjista Rubia cardifolia Rubiaacea Varnya,shothahar

a

Rubifolic acid,rubiatrol, rubicoumaric acid, rubimallin,alizarin, purpurin.

14. Kuta shalmali

Eriodendron anfractuosum

Bombocaceae

Shothahara, 44akta shodhana

Galli acid, tannic acids,D-galactopyranose.

15. Pata Oroxylum indicum

Bignonaceae

Rakta vardhaka, 44akta shodhana

Baicalein, tetulin,aloeemodin, b-sitosterol.

16. Lavanga Syzygium aromaticum

Myrtaceae Deepana, Pachana, Vata anulomana,

B-caryophyllene, Furfural, valeraldehyde, methylbenzoate, Methyl alcohol.

17. Ativisha Aconitum hetrophyllum

Ranunculaceae

Visha hara, deepana, Pachana

Atidine, heterophyllisine, letisinone,B-sitosterol, carotene.

18. Haritaki

Terminalia chebula

Combretaceae

Hrdya, Rasayana Anulomana

Fruits contains Tannic acid, chebulinic acid, gallic acid.

19 Madhu Fructose 45%, glucose 35% Traces of minerals.


44

Drug Review

RESEARCH WORKS DONE:- Dadima:-45

Pomegranate contains isopelletierine, Methylisopelletierine, Pelletierine,

Pseudopelletierine and tannins. Its known effects are to shrink tissues, prevent secretion

of fluids and destroy intestinal worms. It is speculated to treat stasis ulcers.

Dried fruit peel alcoholic extract & decoction administered in rats had intestinal anti

secretory activity

Shunti:-46

Ginger was found to be superior to dimenhydrinate in preventing motion sickness

and the Gingerols and shogaols were identified as the main antiemetic principles. Studies

suggest that the action of ginger modulated vestibular impulses to the autonomic centers

of the central nervous system.

In a study of 30 pregnant women, in a double-blind randomized cross-over trial,

it was observed that powdered root ginger was superior to placebo in reducing the

symptoms of hyper emesis gravidarum (morning sickness).

Ginger, rhizome of Zingiber officinale, has been used for antiemetic effect.

Several Components of ginger such as gingerol, shogaol and galanolactone have been

shown to have Anti-5HT activity in isolated guinea pig ileum. Galanolactone is a

competitive antagonist predominantly at ileal 5-HT3 receptors.

The pungent principles, including gingerop and zingerone, demonstrated in vitro

effects in Scavenging the superoxide and hydroxyl radicals and inhibiting lipid

peroxidation. Humoral immunity was enhanced, as shown by humoral antibody titer, and

cell-mediated response was also stimulated in leukocyte migration inhibition tests.


45

Drug Review

Rhizome of Zingiber containing shogaols 5-biphenyl, 6-phenylpropanoids,

gingerols (50 mg/kg b. wt.) Showed improved anti-emetic activity in frogs.

Oral doses of shogaol accelerated intestinal transit in rats. Also an extract of

ginger, and Isolated shogaol and gingerols enhanced gastrointestinal motility in mice

after oral doses.

Pharmacological study of Myrestica fragrans crude suspension increased

intestinal tone while (PE) petroleum ether had no such effect on guinea pig ileum.

Jatiphala:-47

A preliminary study conducted on the effect of alcoholic extract of pippali

rasayana on serum Proteins in rabbits showed a significant increase in body weight.

Pippali, Dhanyaka:-48

The effect of spices on the secretion and composition of saliva in humans

observed that red Pepper, ginger, capsicum, black pepper, coriander and mustard

enhanced the secretion of saliva and activity of salivary amylase. Further the saliva

stimulating capacity was greatest for red Pepper and mustard among these spices.

Harikati:-49

Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents of

stomach earlier. So it can be used as adjuvant with other drugs that interfere with gastric

motility as Antihistaminics like drugs.


46

Drug Review

DADIMA

SHUNTI

PIPPALI

MARICHA


47

Drug Review

MANJISTA PATA

NIMBA LAVANGA

ATIVISHA VAMSHALOCHANA


48

Drug Review

DANYAKA JEERAKA

HARITAKI AJAMODA

JATIPHALA MADHU

SHARKARA


49

Drug Review

Preparation of Dadima Avaleha


50

Materials & methods

MATERIALS AND METHODS

The present study ‘A clinical study on effect of Dadima Avaleha in the

management of Garbhini Chardi’ was carried out on 30 patients attending the O.P.D. and

I.P.D sections of Prasooti Tantra & Stree Roga Department, S.D.M. Ayurveda Hospital,

Udupi.

Aims and Objectives of the Study

1. To do conceptual study of Garbhini chardi.


Source of data:

About 30 patients in O.P.D & I.P.D of S.D.M Ayurveda Hospital, Kutpady, Udupi

Karnataka diagnosed as Garbhini chardi were taken for study.

Inclusion criteria:

*Patients between 20-35 years of age.

*Patients diagnosed as Garbhini chardi in first trimester of pregnancy.

Exclusion criteria:

*Patients in whom chardi seen in second & third trimester.

*Patients with hyper emesis gravidarum.

*Patients with twin pregnancy & vesicular mole.

*Vomiting caused due to other systemic disorders like peptic ulcer, appendicitis etc.

Assessment criteria:

- Number of Vegas.

- Quantity of Vomitus.

- Aversion to smell

- Improvement in weight

- Improvement in Hb%.

- Improvement in nausea


51

Materials & methods

Final assessment:

Cured – Complete cessation of nausea & vomiting.

Improved – Reduction in quantity & quality of Vomitus.

No change – No change in complaint.

Aggravated – Symptoms became more severe than before.

Investigations:

Urine pregnancy test.

Hb %.

Urine routine.

USG(if necessary)

Intervention:

Patients fulfilling above criteria were assigned to two groups.

Group A – Dadimaavaleha for 21 days. Dose‐24gms with divided dose of 8gms T.I.D. with

lukewarm water

Group B – Placebo for 21 days.

Follow up period: Patients will be asked to follow up for once in a week for 3 weeks.

Materials taken for the study are:41

Collection of drugs:

All the drugs were collected and prepared by S.D.M. Ayurveda Pharmacy, Udupi,

Karnataka.

Methods of preparation:

Ingredients of Dadimaavaleha:

1. Dadima – 1Kg 11.Nimba patra- 50gms

2. Nagara – 50gms 12.Manjistha- 50gms

3. Pippali - 50gms 13.Kuta shalmali- 50gms

4. Pippali mula – 50gms 14.Pata- 50gms

5. Danyaka- 50gms 15.Lavanga- 50gms

6. Ajamoda- 50gms 16.Ativisha- 50gms


52

Materials & methods

7. Jatiphala -50gms 17.Jeeraka- 50gms

8. Jatipatra – 50gms 18.Haritaki- 50gms

9. Maricha- 50gms 19.Madhu- 50gms

10. Vamshalochana- 50gms 20.Grutha- 50gms

Water – 4lit

Sugar – 1 kg

Madhu- 1kg

Ghrutha – 1kg

One Kg of Dadima is taken to which 4lit of water is added & kept on fire. Kashaya is

prepared. To this Kashaya 1Kg of sugar is added. After formation of paka all the

ingredients are added in the powder form & mixed well. After swanga sheeta Honey &

Grutha is added & mixed well.

Group-B

Guda Paka - One Kg of purana guda is taken to which quantity sufficient of water is

added & kept on fire until paka siddha laxana is seen.

Research Design:

It is a comparative clinical study with pre test and post test design. Patients were

registered in a detailed proforma containing details of history, examination. Diagnosis

was done according to classical procedures and modern instruments were also employed.

Registered patients were randomly placed under two groups.


53

Observations and Results

OBSERVATIONS AND RESULTS

Total of 30 patients were taken for the clinical study and were randomly allocated into group A and B 0f 15 patients each.

1) Generalized observations for overall patients :

TABLE NO :11– DISTRIBUTION OF PATIENTS BASED ON AGE GRAPH NO: 1

No. of patients Age

Group A % Group B %

Total Percentage

20-23

years

03 20% 03 20% 06 20%

24-27

years

06 40% 05 33.33% 11 36.66%

28-31

years

06 40% 06 40% 12 40%

32-35

years

00 00 01 6.66% 01 3.33%

0

5

10

15

20

2530

35

40

Gr‐A Gr‐B Total %

20‐23

24‐27

28‐31

32‐35

Among 30 patients selected for the study, 40% of patients were in the age group

between 28 to 31 years, 36.66% of patients were in the age group between 241to 27

years, 20% of patients were in the age group between 20 to 23 years. 3.33% patients were

present in the age group between 32 to 35 years.


54


TABLE NO: 12– DISTRIBUTION OF PATIENTS BASED ON RELIGION GRAPH No:2

No. of patients RELIGION

Group A % Group B %

Total Percentage

Hindu 12 80% 12 80% 24 80% Muslim 03 20% 02 13.33% 05 16.66% Christian 00 00 01 6.66% 01 3.33%

01020304050607080


HINDU

MUSLIM

CHRISTAIN

Among the 30 patients selected for the study, 80% of patients were Hindus and 16.66%

were Muslims & 3.33% were Christians.

TABLE NO : 13– DISTRIBUTION OF PATIENTS BASED ON OCCUPATION

GRAPH No: 3 No. of patients Occupation Group A Group B

Total Percentage

House wife 15 15 30 100% Service 00 00 00 00%

0

20

40

60

80

100


H.W

SERVICE

Among the 30 patients selected, 100% patients were house wives


55


TABLE NO: 14– DISTRIBUTION OF PATIENTS BASED ON EDUCATION

GRAPH NO: 4

No. of patients Education Group A Group B

Total Percentage

Primary 10 06 16 53.33% Secondary 04 06 10 33.33% Graduation 01 03 04 13.33%

0

10

20

30

40

50

60


PRIMARY

SECONDARY

GRADUATION

Among the 30 patients selected for the study, the maximum incidence of 53.33% had

primary education,33.33% had secondary education & 13.33% were graduated.

TABLE NO :15– DISTRIBUTION OF PATIENTS BASED ON HABITAT

GRAPH NO:5

No. of patients Habitat Group A Group B

Total Percentage

Rural 14 12 26 86.66% Urban 01 03 04 13.33%

0

20

40

60

80

100


RURAI

URBAN

Among the 30 patients selected for the study, the maximum patients of 86.66% were

from rural area & 13.33% were from urban area.


56


TABLE NO : 16– DISTRIBUTION OF PATIENTS BASED ON GRAVIDA

GRAPH NO:6

No. of patients Gravida Group A Group B

Total Percentage

Primi 10 09 19 63.33% Multi 05 06 11 36.66%

0

10

20

30

40

50

60

70


PRIMI

MULTI

Among the 30 patients selected for the study, the maximum patients of 63.33% were primy gravida & 36.66 % were multi gravida.

TABLE NO : 17– DISTRIBUTION OF PATIENTS BASED ON NAUSEA GRAPH NO:7

No. of patients Nausea Group A Group B

Total Percentage

Present 14 15 29 96.66% Absent 01 00 01 3.33%

0

20

40

60

80

100


PRESENT

ABSENT

Among the 30 patients selected for the study, the maximum patients of 96.66% had nausea & in 3.33% nausea was absent.


57


TABLE NO: 18– DISTRIBUTION OF PATIENTS BASED ON VOMITING

GRAPH NO:8

No. of patients Vomiting Group A Group B

Total Percentage

Present 15 14 29 96.66% Absent 00 01 01 3.33%

0

20

40

60

80

100


PRESENT

ABSENT

Among the 30 patients selected for the study, the maximum patients of 96.66% had vomiting & in 3.33% vomiting was absent.

TABLE NO: 1 9– DISTRIBUTION OF PATIENTS BASED ON FREQUENCY OF VOMITING

GRAPH NO:9

No. of patients Freq.of Vomiting Group A Group B

Total Percentage

1-2 times 05 02 07 23.33% 2-5 times 08 10 18 60% >5 times 03 02 05 16.66%

0

10

20

30

40

50

60


1‐2times

2‐5times

>5times

Among the 30 patients selected for the study, the maximum patients of 60% had vomiting for 2-5 times,23.33% of patients had 1-2 times & in 16.66%patients vomiting was for more than 5 times.


58


TABLE NO : 20– DISTRIBUTION OF PATIENTS BASED ON QUANTITY OF VOMITUS

GRAPH NO:10

No. of patients Quantity of

Vomitus Group A Group B Total Percentage

< 50 ml 01 01 02 6.66% 50-100 ml 08 06 14 46.66% 100-150 ml 07 04 11 36.66% >150 ml 00 03 03 10%

0

10

20

30

40

50


<50ml

50‐100ml

100‐150ml

>150ml

Among the 30 patients selected for the study, the maximum patients of 46.66% had quantity of 50-100ml, 36.66% of patients had 100-150ml, in 10% patients quantity was more than 150 ml & in 6.66% patients it was less than 50ml.


59


TABLE NO 21 – DISTRIBUTION OF PATIENTS BASED ON CONTENT OF VOMITUS GRAPH NO:11

No. of patients Content of Vomitus Group A Group B

Total Percentage

Saliva, Gastric Juice

02 01 03 10%

All 13 14 27 90%

0

20

40

60

80

100


SA &GJ

ALL

Among the 30 patients selected for the study, the maximum patients of 90% had vomitus containing all i.e saliva, gastric juice & food.10% of patients had only saliva & gastric juice in vomitus.

TABLE NO: 22– DISTRIBUTION OF PATIENTS BASED ON ANNANABHILASHA

GRAPH NO:12

No. of patients Aversion Group A Group B

Total Percentage

Present 14 10 24 80% Absent 01 05 06 20%

0

20

40

60

80


PRESENT

ABSENT

Among the 30 patients selected for the study, the maximum patients of 80% had Aversion to smell & food & in 20% of patients it was absent.


60


TABLE NO : 23– DISTRIBUTION OF PATIENTS BASED ON ALASYA GRAPH NO:13

No. of patients Alasya Group A Group B

Total Percentage

Present 09 10 19 63.33% Absent 06 05 11 36.66%

0

10

20

30

40

50

60

70


PRESENT

ABSENT

Among the 30 patients selected for the study, the maximum patients of 63.33% had Alasya as a symptom & in 36.66% of patients it was absent.

TABLE NO : 24– DISTRIBUTION OF PATIENTS BASED ON ANGAMARDA GRAPH NO:14

No. of patients Angamarda Group A Group B

Total Percentage

Present 02 03 05 16.66% Absent 13 12 25 83.33%

0102030405060708090


PRESENT

ABSENT

Among the 30 patients selected for the study, the maximum patients of 83.33% had no Angamard as a symptom & in 16.66% of patients it was present.


61


TABLE NO: 25– DISTRIBUTION OF PATIENTS BASED ON ANIDRA GRAPH NO:15

No. of patients Anidra Group A Group B

Total Percentage

Present 02 01 03 10% Absent 13 14 27 90%

0102030405060708090


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 90% Anidra as a symptom was absent & in 10% of patients it was present.

TABLE NO: 26– DISTRIBUTION OF PATIENTS BASED ON AGNIMANDYA GRAPH NO:16

No. of patients Agnimandya Group A Group B

Total Percentage

Present 14 09 23 76.66% Absent 01 06 07 23.33%

0

20

40

60

80


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 76.66% had Agnimandya as a symptom was & in 23.33% of patients it was absent.


62


TABLE NO : 27– DISTRIBUTION OF PATIENTS BASED ON BRAMA GRAPH NO:17

No. of patients Brama Group A Group B

Total Percentage

Present 10 09 19 63.33% Absent 05 06 11 36.66%

0

10

20

30

40

50

60

70


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 63.33% had Brama as a symptom & in 36.66% of patients it was absent.

TABLE NO: 28 – DISTRIBUTION OF PATIENTS BASED ON DAURBALYA GRAPH NO:18

No. of patients Daurbalya Group A Group B

Total Percentage

Present 13 14 27 90% Absent 02 01 03 10%

0102030405060708090


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 90% Daurbalya was present as a symptom & in 10% of patients it was absent.


63


TABLE NO: 29– DISTRIBUTION OF PATIENTS BASED ON TALU SHOSHA GRAPH NO:19

No. of patients Talu Shosha Group A Group B

Total Percentage

Present 04 02 06 20% Absent 11 13 24 80%

0

10

20

30

40

50

60

70

80


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 80% Talushosha as a symptom was absent & in 20% of patients it was present.

TABLE NO: 30 – DISTRIBUTION OF PATIENTS BASED ON JIHWA SHOSHA

GRAPH NO:20

No. of patients Jihwa Shosha Group A Group B

Total Percentage

Present 04 01 05 16.66% Absent 11 14 25 83.33%

0102030405060708090


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 83.33% Talushosha as a symptom was absent & in 16.66% of patients it was present.


64


TABLE NO: 31 – DISTRIBUTION OF PATIENTS BASED ON TANDRA GRAPH NO:21

No. of patients Tandra Group A Group B

Total Percentage

Present 04 01 05 16.66% Absent 11 14 25 83.33%

0

20

40

60

80

100


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 83.33% Tandra as a symptom was absent & in 16.66% of patients it was present.

TABLE NO: 32– DISTRIBUTION OF PATIENTS BASED ON SHIRA SHOOLA GRAPH NO:22

No. of patients Shira Shoola Group A Group B

Total Percentage

Present 05 04 09 30% Absent 10 11 21 70%

0

10

20

30

40

50

60

70


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 70% Shirashoola as a symptom was absent & in 30% of patients it was present.


65


TABLE NO: 33 – DISTRIBUTION OF PATIENTS BASED ON FAMILY HISTORY GRAPH NO:23

No. of patients Family History Group A Group B

Total Percentage

Present 08 08 16 53.33% Absent 07 07 14 46.66%

0

10

20

30

40

50

60


PRESENT

ABSENT

Among the 30 patients selected for the study, in maximum patients of 53.33% had family history of vomiting in pregnancy & in46.66% patients it was absent.

TABLE NO: 34– DISTRIBUTION OF PATIENTS BASED ON DIET GRAPH NO:24

No. of patients Diet Group A Group B

Total Percentage

Veg 00 01 01 3.33% Mixed 15 14 29 96.66%

0

20

40

60

80

100


VEG

MIXED

Among the 30 patients selected for the study, maximum patients of 96.66% are having mixed diet & 3.33% are having vegetarian diet.


66


TABLE NO: 35– DISTRIBUTION OF PATIENTS BASED ON APETITE GRAPH NO:25

No. of patients Apetite Group A Group B

Total Percentage

Good 04 04 08 26.66% Moderate 06 06 12 40% Reduced 05 05 10 33.33%

0

5

10

15

20

25

30

35

40


GOOD

MODERATE

REDUCED

Among the 30 patients selected for the study, maximum patients of 40% are having Moderate apetite, 33.33% of patients had Reduced apetite & in 26.66% patients apetite was fond Good.

TABLE NO: 36– DISTRIBUTION OF PATIENTS BASED ON SLEEP

GRAPH NO:26

No. of patients Sleep Group A Group B

Total Percentage

Sound 14 13 27 90% Disturbed 01 02 03 10%

0

20

40

60

80

100


SOUND

DISTURBED

Among the 30 patients selected for the study, maximum patients of 90% had sound sleep, 10% of patients had disturbed sleep.


67


TABLE NO: 37 – DISTRIBUTION OF PATIENTS BASED ON MALA PRAVRUTI

GRAPH NO: 27 No. of patients Mala

Pravruti Group A Group B Total Percentage

Regular 09 14 23 76.66% Irregular 06 01 07 23.33%

0

10

20

30

40

50

60

70

80


REGULAR

IRREGULAR

Among the 30 patients selected for the study, maximum patients of 76.66% had regular Mala pravrutti, 23.33% of patients had irregular Mala pravrutti.

TABLE NO: 38 – DISTRIBUTION OF PATIENTS BASED ON PRAKRUTI GRAPH NO: 28

No. of patients Prakruti Group A Group B

Total Percentage

Vata Pitta 04 02 06 20% Pitta Kapha 06 04 10 33.33% Kapha Vata 05 09 14 46.66%

0

10

20

30

40

50


VATA PITTA

PITTA KAPHA

KAPHA VATA

Among the 30 patients selected for the study, maximum patients of 46.66% were of Kapha Pitta Prakruti, 33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti


68


TABLE NO: 39– DISTRIBUTION OF PATIENTS BASED ON VIKRUTI

GRAPH NO : 29

No. of patients Vikruti Group A Group B

Total Percentage

Vata Pitta 02 04 06 20% Pitta Kapha 04 03 07 23.33% Kapha Vata 08 08 16 53.33% Tridoshaja 01 00 01 3.33%

0

10

20

30

40

50

60


VATA PITTA

PITTA KAPHA

KAPHA VATA

TRIDOSHAJA

Among the 30 patients selected for the study,in maximum patients of 53.33% Kapha vata vikruti was seen, in 23.33% Pitta Kapha vikruti was seen, in 20% of patients pitta vata vikruti was present & in 3.33% Tridoshaja vikruti was present.


69


TABLE NO: 40 – DISTRIBUTION OF PATIENTS BASED ON SAARA

GRAPH NO: 30

No. of patients Saara Group A Group B

Total Percentage

Rasa 01 02 03 10% Mamsa 03 05 08 26.66% Asthi 04 03 07 23.33% Rasa+Mamsa 04 02 06 20% Rakta+Mamsa 01 01 02 6.66% Mamsa+Asthi 01 01 02 6.66% Rakta+Asthi 01 01 02 6.66%

0

5

10

15

20

25

30


RASA

MAMSA

ASTHI

RASA+MAMSA

RAKTA+MAMSA

MAMSA+ASTHI

RAKTA+ASTHI

Among 30 patients taken for study maximum of 26.66% of patients were of mamsa saara,23.33% were of asthi saara,20% were of rasa & mamsa saara,10% were of Rasa saara, 6.66% of patients were of Rakta Mamsa, Rasa mamsa, Mamsa asthi respectively.


70


TABLE NO: 41– DISTRIBUTION OF PATIENTS BASED ON SAMAHANANA GRAPH NO:31

No. of patients Samhanana Group A Group B

Total Percentage

Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00%

0

20

40

60

80

100


PRAVARA

MADYAMA

AVARA

Among the 30 patients selected for the study, maximum of 100% of patients were of Madhyama Samhanana.

TABLE NO: 42– DISTRIBUTION OF PATIENTS BASED ON PRAMANA

GRAPH NO: 32

No. of patients Pramana Group A Group B

Total Percentage

Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00%

0

20

40

60

80

100


PRAVARA

MADYAMA

AVARA

Among the 30 patients selected for the study, maximum of 100% of patients were of Madyama Pramana.


71


TABLE NO: 43– DISTRIBUTION OF PATIENTS BASED ON SATWA

GRAPH NO : 33

No. of patients Satwa Group A Group B

Total Percentage

Pravara 00 00 00 00% Madhyama 14 15 29 96.66% Avara 01 00 01 3.33%

0

20

40

60

80

100


PRAVARA

MADYAMA

AVARA

Among the 30 patients selected for the study, maximum of 96.66% of patients were of Madhyama Satwa, 3.33% of patients were of Avara satwa.

TABLE NO: 44– DISTRIBUTION OF PATIENTS BASED ON SATMYA

GRAPH NO: 34 No. of patients Satmya Group A Group B

Total Percentage

Madhura 05 05 10 33.33% Amla 02 03 05 16.66% M+A 01 01 02 6.66% Katu 02 03 05 16.66% Katu+Amla 03 00 03 10% Sarva 02 03 05 16.66%

0

5

10

15

20

25

30

35


MADHURA

AMLA

MADURA+AMLA

KATU

KATU+AMLA

SARVA


72


Among the 30 patients selected for the study, maximum of 33.33% had satmyata for Madhura rasa, 16.66% of patients had satmyata for Amla rasa, Katu rasa, Sarva rasa respectively,10% of patients had satmyata for Katu Amla rasa,6.66% 0f patients had satmyata for Madhura & Amla rasa.

TABLE NO: 45– DISTRIBUTION OF PATIENTS BASED ON AHARA SHAKTI

GRAPH NO : 35

No. of patients Ahara Shakti Group A Group B

Total Percentage

Pravara 02 00 02 6.66% Madhyama 09 11 20 66.66% Avara 04 04 08 26.66%

0

10

20

30

40

50

60

70


PRAVARA

MADYAMA

AVARA

Among the 30 patients selected for the study, maximum of 66.66% had Madhyama aahara Shakti, 26.66% 0f patients had Avara ahara Shakti, and 6.66% had Pravara ahara Shakti.


73


TABLE NO: 46 – DISTRIBUTION OF PATIENTS BASED ON VYAYAMA SHAKTI GRAPH NO : 36

No. of patients Vyayama

Shakti Group A Group B Total Percentage

Pravara 01 00 01 3.33% Madhyama 12 12 24 80% Avara 02 03 05 16.66%

0

10

20

30

40

50

60

70

80


PRAVARA

MADYAMA

AVARA

Among the 30 patients selected for the study, maximum of 80% had Madhyama Vyayama Shakti, 16.66% 0f patients had Avara Vyayama Shakti, and 3.33% of patients had Pravara Vyayama Shakti.


74

Result

RESULTS TABLE NO: 47 1.EFFECT OF CHARDI VEGA IN GROUP A:

Paired ‘t’ test Mean of BT

Mean of AT d

S.D S.E t P df

1.600 AT1 1.533 0.0667 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.0909 11.000 <0.001 14

TABLE NO :48 EFFCET OF CHARDI VEGA IN GROUP B:


Mean of AT d

S.D S.E t P Df

2.267 AT1 1.867 0.400 0.743 0.192 2.449 0.0028 14 2.267 AT2 1.533 0.733 0.640 0.165 4.036 0.001 14 2.267 AT3 1.200 1.267 0.414 0.107 6.959 <0.001 14 2.267 AT4 0.933 1.333 0.704 0.182 6.325 <0.001 14

GRAPH NO: 37

0

0.5

1

1.5

2

2.5

BT AT1 AT2 AT3 AT4

GR-AGR-B


75

Result

Group A: The mean score of the symptom of which was 1.600 before treatment reduced

To 1.533 after treatment, reduced to 0.733 in first follow up, further reduced to 0.333 in

second follow up and further reduced to 0.133 in final follow up . When these values

were analyzed statistically, the difference was significant at the level of p = < 0.001.

Group B: The mean score of the symptom of which was 2.267 before treatment reduced

To 1.867 after treatment, reduced to 1.533 in first follow up, further reduced to 1.200 in

second follow up and further reduced to 0.933 in final follow up . When these values

were analyzed statistically, the difference was significant at the level of p = < 0.001.

TABLE NO :49 COMPARISION OF CHARDI VEGA WITHIN THE GROUPS:

‘t’ test Groups

Mean d

S.D S.E M t P df

Group A 0.133 0.352 0.0909 Group B 0.333

-0.200 0.617 0.159

-1.090

0.285 28

GRAPH NO :38

0

0.5

1

1.5

2

2.5

BT AT

GR-AGR-B

The difference in the mean values of the two groups is not great enough to reject the

possibility that the difference is due to random sampling variability. There is not a

statistically significant difference between the input groups (P = 0.061).


76

Result

TABLE NO : 50 2) EFFECT OF Hb %IN GROUP A:


Mean of AT d

S.D S.E t P df

11.297 BT 11.297 0.366 0.0945 =0.941 14 11.297 AT 11.283

0.013 0.681 0.176

0.0752 =0.941 14

TABLE NO :51 EFFECT OF Hb %IN GROUP B:


Mean of AT D

S.D S.E T P df

11.717 BT 11.717 0.800 0.990 0.256 4.413 =0.021 14 11.717 AT 10.917 0.800 0.910 0.235 4.413 =0.021 14

GRAPH NO:39

10.4

10.6

10.8

11

11.2

11.4

11.6

11.8

BT AT

GR-AGR-B


77

Result

Group A: The mean score of the symptom of which was 11.297 before treatment

reduced To 11.283 after treatment,

The change that occurred with the treatment is not great enough to exclude the possibility

that the difference is due to chance (P = 0.237)

Group B: The mean score of the symptom of which was 11.717 before treatment

reduced To 10.917 after treatment,



TABLE NO : 52 EFFCTS OF HB% IN BOTH GROUPS:

‘t’ test Groups

Mean d

S.D S.E M t P df

Group A 11.283 0.681 0.176 Group B 10.917

0.367 0.910 0.235

1.250 0.222 28

GRAPH NO:40

10.4

10.6

10.8

11

11.2

11.4

11.6

11.8

BT AT

GR-AGR-B





78

Result

TABLE NO :53

3. EFFECT OF Wt IN GROUP A:

Paired ‘t’ test Mean

of BT Mean of AT d

S.D S.E T P df

52.867 AT1 53.000 -0.133 9.000 2.324 -1.468 0.164 14 52.867 AT2 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT3 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT4 52.933 -0.066 9.114 2.353 -0.564 0.582 14

TABLE NO : 54 EFFECT OF Wt IN GROUP B:

Paired ‘t’ test Mean of BT Mean of AT d

S.D S.E T P df

51.733 AT 51.800 -0.066 8.274 2.136 -0.435 =0.670 9

51.733 AT1 51.733 0.00 8.250 2.130 0.000 =1.000 9 51.733 AT2 51.733 0.00 8.250 2.130 0.00 =1.000 9 51.733 AT3 51.733 0.00 8.250 2.130 0.00 =1.000 9

GRAPH NO : 41

5151.251.451.651.8

5252.252.452.652.8

5353.2

BT AT1 AT2 AT3 AT4

GR-AGR-B

Group A:


79

Result

The mean score of the symptom of which was 52.867 before treatment increased to To

53.000 after treatment, & was decreased to 52.933 which was maintained same in all the

follow ups. When these values were analyzed statistically, the difference was not

significant at the level of p = 0.582



Group B:The mean score of the symptom of which was 51.733 before treatment

increased To 51.800 after treatment, which was again reduced to 51.733 & remained

same in all the follow ups. When these values were analyzed statistically, the difference

was not significant at the level of p = 1.000



TABLE NO : 55

COMPARISION OF Wt WITHIN THE GROUPS:

‘t’ test Groups

Mean D

S.D S.E M t P df

Group A 52.933 9.114 2.353 Group B 51.733

1.200 8.250 2.130

0.378 0.708 28

GRAPH NO: 42

5151.251.451.651.8

5252.252.452.652.8

5353.2

BT AT

GR-AGR-B


80

Result




TABLE NO : 56 4. EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP A

Paired ‘t’ test Mean of BT Mean of ATe d

S.D S.E t P Df

1.867 AT1 1.667 0.200 0.915 0.236 1.871 =0.082 14 1.867 AT2 1.067 0.800 1.082 0.799 4.583 <0.001 14 1.867 AT3 0.867 1.000 0.640 0.165 4.583 <0.001 14 1.867 AT4 0.400 1.467 0.507 0.131 5.735 <0.001 14

TABLE NO : 57 EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP B


S.D S.E t P Df

1.733 AT1 1.533 0.200 1.125 0.291 1.871 =0.082 14 1.733 AT2 1.267 0.467 0.884 0.228 2.824 =0.014 14 1.733 AT3 0.933 0.800 0.799 0.206 3.292 =0.005 14 1.733 AT4 0.467 1.267 0.467 0.516 4.750 <0.001 14

GRAPH NO: 43

00.20.40.60.8

11.21.41.61.8

2

BT AT1 AT2 AT3 AT4

GR-AGR-B


81

Result

Group A: The mean score of the symptom of which was 1.867 before treatment reduced

To 1.667 after treatment, which was again reduced to 1.067 after first follow up & again

reduced to 0.867 after second follow up & finally reduced to 0.400 at last follow up.

When these values were analyzed statistically, the difference was significant at the level

of (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)

Group B The mean score of the symptom of which was 1.733 before treatment reduced




of (P = <0.001)



TABLE NO : 58 COMPARISION OF EFFECT OF ANNANABHILASHA WITHIN THE GROUPS:

‘t’ test Groups

Mean d

S.D S.E M T P df

Group A 0.400 0.507 0.131 Group B 0.467

0.00 0.516 0.133

-0.0667 =0.724 28

GRAPH NO : 44

0

0.5

1

1.5

2

BT AT

GR-AGR-B


82

Result




TABLE NO : 59

5. EFFECT OF TREATMENT ON NAUSEA IN GR-A


S.D S.E T P Df

1.600 AT1 1.533 0.067 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.090 11.000 <0.001 14

TABLE NO : 60 EFFECT OF TREATMENT ON NAUSEA IN GR-B


S.D S.E T P Df

2.000 AT1 1.600 0.400 0.737 0.190 4.583 <0.001 14 2.000 AT2 1.133 0.867 0.640 0.165 6.959 <0.001 14 2.000 AT3 0.600 1.400 0.632 0.163 12.220 <0.001 14 2.000 AT4 0.333 1.667 0.617 0.159 11.297 <0.001 14

GRAPH NO : 45

0

0.5

1

1.5

2

2.5

BT AT1 AT2 AT3 AT4

GR-AGR-B


83

Result

Group A The mean score of the symptom of which was 1.600 before treatment reduced




of (P = <0.001)







of (P = <0.001)



TABLE NO: 61

COMPARISION OF EFFECT OF NAUSEA WITHIN THE GROUPS:

‘t’ test Groups

Mean D

S.D S.E M t P Df

Group A 0.133 0.352 0.090 Group B 0.333

-0.200 0.617 0.159

-1.090

=0.285 28

GRAPH NO : 46

0

0.5

1

1.5

2

2.5

BT AT

GR-AGR-B


84

Result




TABLE No : 62 6.EFFECT ON QUANTITY OF VOMITUS IN GROUP A :


S.D S.E T P df

2.400 AT1 1.933 0.467 0.632 0.163 3.500 =0.004 14 2.400 AT2 1.867 0.533 0.640 0.165 4.000 =0.001 14 2.400 AT3 1.400 1.000 0.507 0.131 7.246 <0.001 14 2.400 AT4 1.200 1.200 0.676 0.175 6.874 <0.001 14

TABLE NO : 63 EFFECT ON QUANTITY OF VOMITUS IN GROUP A :


S.D S.E T P df

2.533 AT1 2.133 0.400 0.640 0.165 3.055 =0.009 14 2.533 AT2 1.933 0.600 0.594 0.153 4.583 <0.001 14 2.533 AT3 1.667 0.867 0.617 0.159 4.516 <0.001 14 2.533 AT4 1.533 1.000 0.743 0.192 7.246 <0.001 14

Graph no : 47

0

0.5

1

1.5

2

2.5

3

BT AT1 AT2 AT3 AT4

GR-AGR-B

Group A The mean score of the symptom of which was 2.400 before treatment reduced



85

Result



of (P = <0.001)







of (P = <0.001)



TABLE NO :64 COMPARISION OF EFFECT OF QUANTITY WITHIN THE GROUPS:

‘t’ test Groups

Mean D

S.D S.E M t P df

Group A 1.200 0.676 0.175 Group B 1.533

-0.133 0.743 0.192

-1.285

=0.209 28

Graph no : 48

0

0.5

1

1.5

2

2.5

BT AT

GR-AGR-B



statistically significant difference between the input groups (P = 0.209)


86

Discusssion

“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 87

DISCUSSION

Pregnancy & childbirth have been given an extraordinary status as an expression

of both the human & the sacred simultaneously. All her needs must be fulfilled as one

life participates in the creation of another & care must be taken to bring this new life into

the world. Many physiological changes are taking place in women from puberty till

Menopause. Changes taking place during pregnancy is a unique process & experience in

women’s life as it created for the new budding life. As a consequence to these changes

certain conditions manifest among which Garbhini chardi or emesis gravidarum is one. In

olden days women with history of amenorrhea & vomiting were diagnosed as being

pregnant. This clearly explains that vomiting was present in most of the pregnant women.

In present era people have become more optimistic towards their child. So, even with

simple vomiting people rush to their obstetrician with the view that it should not produce

any harm to the fetus. In some women it so happens that with the fear of vomiting they

do not consume any food which further leads to carbohydrate starvation & vicious cycle

of vomiting begins which may affect both child & mother. Thus it is necessary to treat

emesis gravidarum & prevent women from suffering through hyper emesis.

Garbhini Chardi is explained as one of the “Vyakta garbha laxana”. Explanations

or description for “Garbhini chardi” as a separate disease is not available. It is a coined

term used for chardi seen during pregnancy. While explaining Chardi Vyadi Acharyas

have mentioned Garbhini chardi as one among the type of Agantuja chardi. Acharya

Kashyapa while explaining Garbhini Vyadhis has told that Nidana, laxana & samprapti is

same in Garbhini & other people as dosha & dhathu remains the same but only principle

of treatment differs as vigorous treatment like Shodhana & langana cannot be given in

Garbhini. Thus Shamana line of treatment is adopted in the present study.

In the present study, a detailed description of Garbhini Chardi is done with all its

nidana, lakshanas samprapti, samprapti ghatakas, Chikitsa etc. The effect of drug as

evidenced in the clinical trials were recorded along with detailed case history.

Discusssion


Discussion on Garbhini Chardi

Nidana –Aapanna satwa, Dauhruda avamana & Vata Vaigunya due to Garbha utpeedana

are mentioned as a cause for Chardi. This clearly explains that presence of garbha is a

cause for Garbhini chardi. In the early trimester garbha is said to be in amavastha as it is

in the stage of formation due to which many changes are taking place in the internal

system. On the other hand women start consuming excessive food so as to keep her

healthy & nourish the fetus. Due to these physiological changes & sudden change in the

dietary habits leads to indigestion which may cause vomiting. If she is suffering from

agnimandya before conception then this may further aggravate the existing condition. In

Garbhini avastha women develops desire for certain food or article if these desires are not

fulfilled then this may lead to shoka, krodha or chinta which may cause Vata Vikruti &

lead to chardi. Incidence from the study have proven that Primies are more likely to

suffer from vomiting as it is a new experience where she has a sort of fear & happiness in

her which may lead to manasika dosha prakopa this psychologic responses can interact

and exacerbate the physiology of nausea and vomiting during pregnancy. If chardi is seen

in excess then she may stop consuming taking food with a view that it may control it. By

doing so it further vitiates Vata & vicious cycle of vomiting is seen. During pregnancy

there is increased sensitivity for smell perception thus certain odors cause sensation of

nausea or vomiting.

Samprapti: - Due to Atidravadi nidana sevana & Dauhruda avamana shareerika &

manasika dosha Vikruti takes place which leads to Vata vruddi, which further causes

Agnimandya & formation of ama which leads to ahara dusti & further vitiates other

doshas. Due to dosha utklesha it is expelled out from the body in the form of chardi. It is

explained in classics that Samprapti vighatana is chikitsa. Thus all measures should be

taken to control vomiting.

Chikitsa: - While mentioning chikitsa for Garbhini Vyadhis Acharyas have mentioned

that she should be treated with soft, sweet, cold, pleasing & gentle drugs, dietics &

Discusssion


behavior. Vigorous treatment like shodhana & langana cannot be given to Garbhini, thus

Shamana method of treatment is adopted.

In Garbhini stree due to the nourishment of fetus, there is dhatu Kshaya which leads to

Vata vruddi. So bruhmana dravyas has to be taken by her. The plan of treatment should

be such that it should nourish the garbha as well as control Chardi.

So the line of treatment is to treat all these conditions.

- To fulfill the needs of Dauhruda:

A³ÉÍqÉ¹Ç ½ÑmÉÌWûiÉÍqÉ¹æaÉïlkÉÉÌSÍpÉÈ mÉ×jÉMçü |

SåWåû mÉëÏhÉÉÌiÉ aÉlkÉÉSÏlÉç bÉëÉhÉÉÌSlÉÏÌSìrÉÉÍhÉ cÉ |

(cÉ.ÍcÉ.15/10)

All dravyas are made up of pancha mahabhuta similarly is the garbha. When person

consume the food which is Hitakara, priya, endowed with Roopa, Rasa, Gandha, Sparsha

then that ahara does the poshana of the dhatus & indriyas. Similarly the food that is

consumed by the Garbhini nourishes the garbha. Thus all the desires of dourhrda must be

fulfilled.

- Aapanna satwa & dourhrda must be treated with priya vachana, ahara & Vihara

which provides her with physical & mental support.

- To cure Agnimandya, ama conditions one should use the drugs which are

deepana, pachana, Hrudya, Trushna nigrahana & dahashamaka properties which

helps to treat ama as well as maintain pregnancy.

Upadrava –

Due to excess vomiting there is obstruction to Sweda, Mutra & Ambuvaha Srotas .Due to

this obstruction there is Vata vruddi which carries them in upward direction because of

which the chardi which comes out contains the Varna & gandha of mutra, sweda etc.

Discusssion


When there is increased frequency of Chardi then it may be associated with Shonita

which may lead to kasa, Hrudrogadi laxanas. Hence these conditions are not treatable.

From this above explanation it can be said that Chardi mentioned as vyakta garbha laxana

can be taken as emesis gravidarum & that mentioned by Harita as Upadrava can be taken

as Complications of hyper emesis.

Discussion on drug review: -

While explaining regarding chikitsa in Garbhini Acharyas has mentioned that she should

be treated with the things which are easily palatable, Hrudya & the one which is liked by

her. Lehya which is one among the four types of food items is having good palatability

because of sweetening agents present in this & is liked by Garbhini. Even though there

are many formulations available for treating Garbhini Chardi Dadima Avaleha is selected

because it has the properties of Agnideepaka, Amapachaka, Vatanulomaka, Hrudya,

Balya, and Dhatu vardaka, Krimihara etc which does the samprapti vighatana of Chardi

& helps in curing it.

Probable mode of action:

Dadima Avaleha contains Dadima, Madhu & Sharkara in more quantity which is having

Amla, madhura rasa, sheeta veerya , madhura vipaka & kapha pitta shamaka property.

Its prakshepaka dravyas are shunti, Maricha, Pippali, Pippali mula,etc.. All these drugs

contain shad rasas among which Tikta & Katu rasa are Pradhana, they pocess laghu ,

ruksha guna, Ushna veerya & Kapha Vata shamaka property.

With the presence of honey & sugar in the drug it becomes palatable & absorption of the

drug in the form of lehya starts from the mouth as the taste receptors are stimulated which

helps in excessive secretion of saliva & mix with it. It is readily assimilated & accepted

by the stomach hence absorption of the nutrients take place. As vomiting is caused due to

carbohydrate starvation presence of fructose, glucose in the drug helps to supplement it

thus preventing vomiting.

Discusssion


- A study conducted on Dried fruit peel alcoholic extract & decoction

administered in rats had intestinal anti secretory activity thus Dadima acts by

preventing excessive secretions from the intestines there by preventing

regurgitation of the food which is caused due to mucosal irritation because of

these secretions.

- Rhizome of zingiber containing shogaols,gingerols showed improved anti emetic

activity in frog. It is best in vomiting caused due to motion sickness & in emesis

gravidarum. It action is by modulating vestibular impulses to the autonomic

centers of the central nervous system & also by increasing the intestinal motility

by preventing stasis of food in the stomach for longer time.

- Pharmacological study of Myrestica fragrans in suspension form showed

increased intestinal tone on guinea pig ileum.

- The effect of spices on the secretion and composition of saliva in humans

observed that red Pepper, ginger, black pepper, coriander and mustard enhanced

the secretion of salivaand activity of salivary amylase. These drugs do

agnideepana & increases perception for taste.

- Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents of

stomach earlier. So it can be used as adjuvant with other drugs that interfere with

gastric motility as Antihistaminics like drugs. It acts like vatonulomaka & helps in

controlling Vata there by controlling chardi.

Action of Madhura rasa on chardi – Drugs like Dadima, Danyaka, Manjista, Madhura &

sharkara contains Madhura rasa .This rasa acts as Brumhana & tarpana which does pitta

shamaka & helps in nourishing the dhathus there by doing poshana of the garbha.

Action of Tikta rasa on chardi – Drugs like Ajamoda, Jati phala, Jeeraka, Maricha,

Nimba, Pata, Lavanga contains Tikta rasa .Even though Tikta rasa is swadarahita it

increases perception of taste by activating the taste receptors. It acts as Agni deepaka,

Ahara pachaka, Daha shamaka, Trushna nigrahana, Krumi hara & maintains texture of

Twak & Mamsa. In Garbhini Chardi patient’s complaints of Aruchi, Agnimandya, Daha,

Discusssion


Trushna & dryness of mouth. Tikta rasa by its action helps in curing all these laxanas &

helps in controlling vomiting.

While explaining chikitsa for chardi all the Acharyas have mentioned use of Kashaya &

yusha prepared out of Tikta rasa dravyas like Guduchi, Nimba, Danyaka etc probably

because of chardi hara property of this rasa.

Action of Katu rasa on Chardi – Drugs like shunti, Pippali, Maricha, Ativisha contains

Katu rasa. It acts as Mukha shodaka, Agnideepaka, dathuposhaka, indriya prasadaka,

srotovisrutikaraka & kapha shamaka. By mukha shodaka property it cures Aruchi by

increasing the perception of taste. By Agnideepana property it cures ama & does ahara

pachana which helps in formation of rasadi dhatus by which proper poshana to the garbha

is maintained.

Some of the drugs like shunti, Danyaka, Maricha, Ajamoda, Honey contain calcium, iron,

Carbohydrate , vitamins like B,C etc these are very much essential during pregnancy as

there is increased demand of these during pregnancy. This will also help for the proper

development of the fetus & she will not suffer from vomiting, anemia etc conditions

during pregnancy

Thus dadima Avaleha with its property of Bruhmana, Ruchivardhaka, Agnideepaka,

Amapachaka, Dhatu poshaka maintains Vata in normal proportion there by controlling

chardi & nourishing garbha.

Mode of action of guda paka:

It is having Madhura rasa, Madhura vipaka, guru guna & sheeta veerya, It is having

special qualities like ruchikara, raktakara, rasayana, vrushya which is not only palatable

but also helps in dhatu vruddi. It acts like Brumhana & does dhatu poshana which helps

in nourishing the fetus.

Discusssion


Discussion on methodology, observations and results

It is a single blind clinical study with a pre test and post test design. Here 30 patients

between the age group of 20-35years were randomly selected from the OPD and IPD of

SDM hospital of Ayurveda, Udupi. The test group comprising of 15 patients, dadima

Avaleha was given and for another group of 15 patient’s placebo was given & the results

are compared.

General Description of the patients:

45 patients were registered for the study out of whom, 14 dropped out in due

course, 2 patients underwent MTP as it was diagnosed as blighted ovum, 1 patient had

miscarriage, 1patient had twin pregnancy which was diagnosed later & was excluded

from the study.

Incidence studies of all the registered patients are as follows

1) Age incidence: Patients within the age group of 20-35yrs were selected for the study as

it is the active reproductive phase. Among which 40% of patients were in the age group

between 28 to 31 years.

2) Religion: In this study 80% of patients were Hindus and Study records larger number

of Hindus, when compared to other religions. Data reflects more on the geographical

predominance of a particular sector, Hindus being dominant in & around Udupi.

3) Socio economic status & Occupational Incidence: Maximum no of patients was of low

socio economic status & 100% patients were house wives.

4) Educational Status: In the study 53.33% of patients had primary education, i.e. they

have completed their education till high school.

Discusssion


5) Habitat Incidence: In the study maximum patients of 86.66% were from rural area than

urban area as our hospital is located in rural area.

6) Parity: In the study 63.33% were primy gravida & 36.66 % were multi gravida.

Maximum patients were primigravida as incidence of vomiting in pregnancy is more in

primies than in multies. Even this study proves the same.

7) Dietary Incidence: In the study 96.66% are having mixed diet. This will explain the

prevalent food pattern in this region. The food which they consume contains more of fat

& excessive intake of fatty substances is one of the causes for vomiting in pregnancy.

8) Family History: In the present study maximum patients of 53.33% had family history

of vomiting in pregnancy & in 46.66% patients it was absent. Persons with family history

of vomiting are more likely to suffer from vomiting in there pregnancy.

9) Sleep pattern: Maximum patients of 90% had sound sleep, 10% of patients had

disturbed sleep.

10) Incidence on Agni: Maximum patients of 76.66% had Agnimandya as a symptom &

in 23.33% of patients it was absent. It leads to improper formation of ahara rasa because

of which nourishment to the fetus is reduced which may further lead to abortion or IUGR

like conditions. So it is important to treat this in initial stage before embarking on

pregnancy.

11) Incidence of Prakruti: Maximum patients of 46.66% were of Kapha Pitta Prakruti,

33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti.

12) Incidence of Vikruti: In the study maximum patients of 53.33% had Kapha Vata

Vikruti

As Vitiated Pitta & Kapha causes Agnimandya, this will lead to formation of ama. This

ama causes ahara dusti leading to Chardi.

Discusssion


13) Incidence on Saara: In the study maximum of 26.66% of patients were of mamsa

saara.

14) Incidence on Satwa: Maximum of 96.66% of patients was of Madhyama Satwa,

3.33% of patients were of Avara satwa. This shows that satwa also play role in persons

suffering from vomiting.

15) Incidence on Samhanana: Maximum of 100% of patients was of Madhyama

Samhanana.

17) Incidence on aharashakti: Maximum no of patients had Madhyama & Avara ahara

Shakti. This may be because of Agnimandya where digestion capacity is reduced.

18) Incidence on vyayamashakti: Most of the patients had Madhyama Vyayama Shakti.

19) Incidence on symptoms: Maximum of patients had symptoms like Aruchi in 40%,

Hrullasa in 96.66%, Alasya in 63.33%, dourbalyata in 90%, Brama in 63.33%; these are

laxanas of Ama which are caused due to Agnimandya which may lead to Vikruti of Vata

which may further lead to problems like pregnancy loss, IUGR, Eclampsia & obstructed

labor in later stages. So anulomana of Vata is given prime importance throughout

pregnancy.

Effect of therapy-

Effect of treatment was assessed both clinically as well as based on laboratory

parameters. Clinical features and hemoglobin percentage were assessed before, after

treatment and on follow up.

Discusssion


Effect of treatment on individual signs and symptoms

Chardi Vega-

The mean score of the symptom which was 1.600 before treatment was reduced to

0.133after treatment. The change was found to be statistically significant. As dadima

Avaleha processes Agnideepaka & Vatanulomaka properties gradual reduction in chardi

Vega was seen. As Urdvagaman of Vata causes chardi its anulomana cures it.

Hemoglobin percentage –

The mean score of Hemoglobin before treatment was 11.283 which was increased to

11.297 after treatment. The change was found to be statistically significant. As Dadima

Avaleha contains dadima in excess quantity & it has a property of Raktavardhaka

because of which improvement in Hb% is seen.

Weight –

The mean score of the symptom of which was 52.057 before treatment reduced To 52.00

after treatment, & was maintained same in all the follow ups. As the duration of treatment

& sample size was small the effect could not be seen. Hence the result is inconclusive.

Ananabhilasha -

The mean score of the symptom of which was 1.667 before treatment reduced to 0.467 at

last follow up. The change was found to be statistically significant .Dadima Avaleha has

the property of Amapachaka, Agni deepaka & Vatanulomaka property it was found

effective.

Nausea –

The mean score of the symptom of which was 2.000 before treatment reduced to 0.467 at last

follow up. The change was found to be statistically significant. It is Hrudya,

ruchivardhaka, Madhura rasayukta & liked by Garbhini.

Discusssion


Quantity of vomitus –

The mean score of the symptom of which was 2.400 before treatment reduced to 1.200 at last

follow up. The change was found to be statistically significant. As dadima Avaleha

processes Agnideepaka & Vatanulomaka properties gradual reduction in quantity of

chardi was seen.

Conclusion


CONCLUSION

Conclusion is the total extort that is obtained from the work done to complete the study.

Whatever was explained earlier are the particular facts and reasons that are supported by

the obtained evidences / data as well as textual references. The conclusions are made

from observations seen in the present study.

- Even though Garbhini chardi is mentioned as a vyakta garbha laxana, it can be

seen as a separate disease were its nidana, laxana & samprapti are same as that of

samanya chardi.

- The principle line of treatment is to treat Garbhini with priya vachana, ahara &

Vihara along with Shamana chikitsa.

- Among all the shad rasas Amla & Tikta rasa dravyas have better action in

controlling chardi.

- Garbhini chardi mentioned as vyakta garbha laxana can be correlated to emesis

gravidarum & that mentioned as Upadrava can be correlated to complications of

hyper emesis.

- In emesis gravidarum along with medication, dietary manipulation, bed rest, &

assurance help in controlling it.

- Dadima Avaleha which is palatable, nutritious & having good dietic value was

effective in reducing Chardi Vega, Hrullasa, Ananabhilasha, Agnimandya, Aruchi

& Malavarodha.

With the current study following results were obtained & it can be concluded as:-

- In controlling chardi Vega trail group was found more effective than control

group proving retention of food for more time.

- Dadima Avaleha having Rakta vardaka property showed slight raise in Hb%

where as in control group it was found reduced.

- Both the Trial & control group did not show any effect in weight gain instead it

was effective in maintaining it. This shows that the drug has no adverse effect

concern to weight.

Conclusion


- Trail group was better in controlling Ananabhilasha compared to control group.

Hence dadima Avaleha proved to be more effective.

- The effect of both dadima Avaleha & control group proved significant in

controlling Nausea.

- Dadima Avaleha was better in reducing quantity of vomitus compared to the

control group. Hence it proved to be more effective.

By the clinical trial on 30 patients with 15 patients each in Group A- Dadima Avaleha &

Group B –Guda paka, the results in group A was more effective in reducing Chardi Vega,

Anannabhilasha, Nausea & quantity of vomitus. Group B was better in improving nausea.

Both the groups were effective in maintaining the weight.

Summary

SUMMARY

The present dissertation study entitled as “A CLINICAL STUDY ON EFFECT OF DADIMA AVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI” is planned with the following aim and objectives

1. A conceptual study of Garbhini chardi.

2. To evaluate the efficacy of Dadima Avaleha.

The whole study was elaborated in 5 parts.

o Review of literature.

o Clinical study

o Discussion

o Conclusion

o Summary

Review of literature

It contains of 2sections, first section comprises of historical review of garbha, Garbhini &

all the drugs that are included in this study.

The second section contains –Garbhini Chardi with its nidana, samprapti, chikitsa with

the drug review of the concerned drugs.

It also includes the modern view of emesis & hyper emesis

Clinical study: 30 patients diagnosed as Garbhini chardi were randomly selected and

divided in to 2 groups each. Criteria of inclusion, exclusion and assessment with

parameters are given. The data recorded from the observations and results obtained at the

end of therapy are represented in tabular and graphical form. The results of statistical

analysis by applying paired‘t’ test and unpaired‘t’ test are mentioned.


Summary

Discussion: In this part, discussion is made on the concept of disease from references

collected and compiled from Ayurvedic and modern texts. Discussion on the data of

observations obtained from patients along with the effect of therapy is done.

A probable mode of action of dadima Avaleha on the basis of its rasapanchaka, active

chemical constituents is drawn on the basis of discussion on the whole study:

Conclusion:

• Significant results were seen in the criteria like Chardi Vega, Hrullasa,

Ananabhilasha & Quantity of Vomitus.

• This study would be considered more genuine when a large sample will be taken

for the study.


Table Showing Demographic Data

CASE NO. AGE

SEX

RELIGION SES OCCUPATION

DIET

M H M C L M U A S L V M 52056 38 + + - - - - + + - - + - 148250 29 + + - - - + - - - + - + 158739 35 + + - - + - - - - + - + K. Vasu 40 + + - - + - - - - + - + Abdul Aziz 32 + - + - + - - - - + - + Gopal 29 + + - - - + - - - + - + Jaya 37 + + - - + - - - - + - + Imtiazkhan 27 + - + - + - - + - - - + Devdas Puthran

35 + + + - + - - - - + - +

Joseph 40 + - - + + - - - - + - + Javed 23 + - + - + - - + - - - + Chiranjeevi 31 + + - - - + - + - - - + Shekhar 35 + + - - + - - - - + - + Praveen Kumar

40 + + - - - + - + - - - +

CASE PROFORMA

“A CLINICAL STUDY ON EFFECT OF DADIMAAVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI”

GUIDE: Dr. Mamatha K.V., M. D. CO-GUIDE: Dr.Sucheta ,M.S(Ayu) AATURA VIVARA:- NAME: SERIAL NO: AGE: O.P.D .NO: RELIGION: I.P.D.NO: EDUCATION: D.O.A. : OCCUPATION: D.O.D. : SOCIO ECONOMIC STATUS: PLACE: ADDRESS: DIAGNOSIS: RESULT: PRADANA VEDANA: - CHARDI HRULLASA ARUCHI VEDANA SAMUCCHAYA- EARLY MORNING AFTERNOON NIGHT FREQUENCY QUANTITY VOMITUS

ANUBANDA VEDANA:- ALASYA – ANGAMARDA - ANIDRA - AGNIMANDYA - BRAMHA- BALAKSHAYA – DOURBALYA - TALUSHOSHA- JIHWASHOSHA- TANDRA – SHIRASHOOLA - VEDANA VRUTTANTA:- ONSET:- DURATION;- PRECIPITATING FACTOR:- AGGRAVATING FACTOR;-

Food SMELL

RELIVING FACTORS:- Food Season Clothing

Other measures TREATMENT RECEIVED:- RESPONSE TO PREVIOUS TREATMENT:-

POORVA VYADI VRUTTANTA:- GENARAL – HPT/ DM/ ASTHAMA/ TB SPECIFIC – INFERTILITY/ABORTION SURGICAL INTERVENTION – KOUTUMBIKA VRUTTANTA:- TB DM HTN ASTHAM AIDS SYPHILLIS FATHER MOTHER HUSBAND SIBLINGS VAIYAKTIKA VRITTANTA:- AHARA – V/M DIETIC HABITS –SAMA/VISHAMA HABITS – TEA/ COFFE/ TOBACCO/ SMOKING RASA SAMBANDI – M/A/L/K/T/K APPETITE – A/M/P NIDRA – S/D MALA PRAVRUTTI – R/IR RAJO VRUTTANTA :- PRATHAMA RAJO PRAVRUTTI KALA – RAJO PRAVRUTTI – SRAVA KALA- ASSOCIATED WITH PAIN- ANTIMA RAJO PRAVRUTTI DINANKA- PRASAVA VRUTTANTA :- VAIVAHIKA KALA- L.M.P.- E.D.D- GRAVIDA PARA ABORTION LIVE DEAD M.O.DEL PER.PERIOD BREAST.F CONTRASEPTIVE HISTROY:-

SAFE METHOD – CONTRASEPTIVE PILLS- IUCD- GENERAL EXAMINATION:- BUILT – NOURISHMENT – HEIGHT – WEIGHT – PULSE – ICTERUS – TEMPRATURE – RESPIRATORY RATE – B.P- H.R –

i. General Examinations

CVS RS CNS ii. Systemic examination GIT CVS Others

Prakruti Vyayama shakti iii. Dashavidha pariksha Saara Aahara shakti

Abhyavaharana Jarana Samhanana Vaya Pramana Desha Satwa Vikriti

Saatmya

SAMPRAPTIGHATAKA:-

Nidaana Dosha

Dooshya- dhatu mala

Strotas Srotodusti prakaara Investigations:-

Udbhava staana Sanchara staana Vyakta staana Urine

pregnancy test - Adhistaana Rogamarga Vyadhi prakaara Sadhya/ krachrasadhya/ asaadhya Blood Hb% - Sampraapti

Urine Routine - USG - 2. Assessment Criteria Scorings

3. Complications 4 Results

Nausea only 0 Nil 0 <50ml 1 Mild -

<2times 1

50-100ml 2 Moderate- 2-5times

2

QUANTITY OF VOMITUS

>100ml

CHARDI VEGA

Severe >5times

3 3

Nil 0 Nil 0 Mild -1/2 kg 1 Mild- 1 Moderate ½-1kg

2 Moderate 2

IMPROVEMENT IN WEIGHT

More- 1kg

NAUSEA

3 Severe 3

Nil 0 Nil 0 Mild -0.25gm

1 Mild-nausea 1

Moderate ½-1gm

2 Moderate – vomiting 1-2times

2

IMPROVEMENT IN Hb%

More-> 1gm

AVERSION TO SMELL

3 Severe – vomiting >2times

3

Completely cured Partially cured Not reduced condition is same Aggravated Association of complications if any

5. Conclusions Date: Signature: Observation Table

Symptoms BT AT1 AT2 AT3 AT4

Nausea

Chardi vega

Content of vomitus

Improvement in hb%

Improvement in weight

Aversion to smell

Giddiness

Tiredness

Quantity of vomitus

Appetite

Signature of guide: Signature of student :

Bibilography

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Documents

Garbhini chardi-psr