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INDEX – GJRMI - Volume 4, Issue 7, July 2015 INDIGENOUS MEDICINE Ayurveda – Bhaishajya Kalpana EVALUATION ON EFFICACY OF DASHANGA LEPA (WITH SANDALWOOD) & DASHANGA LEPA (WITH RED SANDALWOOD) ON PATIENTS OF MUKHADUSHIKA WITH SPECIAL REFERENCE TO ACNE VULGARIS Sawant R S*, Zinjurke B D
135–146
Review Article – Ayurveda – Dravya Guna ANTIPYRETIC HERBAL FORMULATION WITH SPECIAL REFERENCE TO KWATHA KALPANA OF SARNGADHARA SAMHITA Vidhya Unnikrishnan*, K Nishteswar
147–161
COVER PAGE PHOTOGRAPHY: DR. HARI VENKATESH K R, PLANT ID – UNRIPE FRUITS OF RAAJAPAATHA – CYCLEA PELTATA (LAM.) HOOK.F. & THOMSON* OF THE FAMILY MENISPERMACEAE PLACE – KOPPA, CHIKKAMAGALUR DISTRICT, KARNATAKA, INDIA *BOTANICAL NAME VALIDATED FROM www.theplantlist.org AS ON 03/08/2015
Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 7 | July 2015 | 135–146 ISSN 2277-4289 | www.gjrmi.com | International, Peer reviewed, Open access, Monthly Online Journal
Research article EVALUATION ON EFFICACY OF DASHANGA LEPA (WITH SANDALWOOD) & DASHANGA LEPA (WITH RED SANDALWOOD) ON PATIENTS OF MUKHADUSHIKA WITH SPECIAL REFERENCE TO ACNE VULGARIS Sawant R S1*, Zinjurke B D2 1
Assistant Professor, Department of RSBK, Smt. KGMP Ayurved College & Hospital, NSB Road, Charni Road, Mumbai, India 2 Assistant Professor, Department of Swasthavritta, Smt. KGMP Ayurved College & Hospital, NSB Road, Charni Road, Mumbai, India *Corresponding Author: Email: drranjeet.sawant@gmail.com; Contact no:+91 9270 60 3639
Received: 25/05/2015; Revised: 20/07/2015; Accepted: 23/07/2015
ABSTRACT Mukhadushika affects in young age, mainly on the face, it is having pain, pustules and destroys luster of face, in modern Science it is known as Acne vulgaris. Mukhadushika affects almost 90% of the population in their lifetime and many cases leads to permanent scarring. Change in diet pattern, i.e., spicy food, junk food, increasing habit of eating bakery products, pollution, mental stress, excessive sweating & young age are the causes for acne or Mukhadushika. In this single blind trial, investigator has made groups and divided participants into two as Group A & B. Group A and B received Dashanga Lepa (with Red Sandalwood) & Dashanga Lepa (With Sandalwood) respectively to apply daily once on face at home for 2 weeks. At the end of study, it is observed that Dashanga lepa with sandalwood is more effective than Dashanga lepa with red sandalwood in reducing surface area of Acne.
KEYWORDS: Mukhadushika, adolescents, acne, Dashanga lepa
Cite this article: Sawant R S, Zinjurke B D (2015), EVALUATION ON EFFICACY OF DASHANGA LEPA (WITH SANDALWOOD) & DASHANGA LEPA (WITH RED SANDALWOOD) ON PATIENTS OF MUKHADUSHIKA WITH SPECIAL REFERENCE TO ACNE VULGARIS, Global J Res. Med. Plants & Indigen. Med., Volume 4(7): 135–146
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 7 | July 2015 | 135–146
INTRODUCTION According to Ayurveda, an eruption looks like Shalmali [Salmalia malabarica] spines & appearing on Vaktra (face). Doshas involved are Kapha, Vata & Shonita (Ambikadutta shastri, 2005). These signs particularly appeared in the youth and generally considered as Acne Vulgaris. It is also known as Yuvanpidaka means found in young age. Acne Vulgaris lesions are more commonly known as pimples, whiteheads, blackheads or zits. These lesions occur when there is a change in the skin cell units known as pilo-sebaceous unit that contains sebaceous glands, a substance called sebum and a hair follicle. When dead skin cells build up and clog these units, a breakout or lesion is likely to occur (Britton et al., 2010). In Ayurveda this disease has been described under Kshudra Roga (Ambikadutta shastri, 2005) as ‘Mukhadushika’ and many formulations have been advocated to alleviate this problem. Dashanga lepa is mentioned in Sharangadhara Samhita Uttar Khanda for treatment of Kushtha (Skin disorders), Visarpa
(Herpes) & Shotha (Swelling) (Brahmanand Tripathi, 2006). Acne affects the Twacha (skin) and Rakta dhatu (blood), so it was decided to use the said lepa as a trial drug. In Purva khanda of Sharangadhara Samhita, it is mentioned that for Kashaya & Lepa preparation Rakta Chandana i.e. Pterocrpus santalinus Linn. should be used (Brahmanand Tripathi, 2006). So a study was planned to prepare Dashanga lepa (with Red Sandalwood) & Dashanga Lepa (with Sandalwood) to carry out trial to evaluate their efficacy in bringing down the symptoms in the cases of Mukhadushika. MATERIALS & METHOD Procurement of Raw material Raw Materials were procured by All India Pharmacy Store, Paydhonie, Mumbai, (M.S), India. All the drugs were authenticated by pharmacognosist at Dept. of Dravyaguna, Smt. KGMP Ayurved College & Hospital, Mumbai, Maharashtra State, India. Their identification is summarized in [Table 1 & 2].
Contents of the Formulation Table no. 1. Ingredients of Dashanga Lepa (with Red Sandalwood) Contents Latin Name Part used Proportion Albizzia lebbeck Benth. Skin 1 part Shireesha Glycyrrhiza glabra Linn. Root 1 part Yashimadhu Valeriana walichii DC. Bark 1 part Tagar 1 part Rakta Chandana Pterocarpus santalinus Linn. f. heartwood Elettaria cardamomum Maton. Fruit 1 part Ela Nardostachys jatamansi DC. Root 1 part Jatamansi Curcuma longa Linn. Rhizome 1 part Haridra Berberis aristata DC. Bark 1 part Daruharidra Saussurea lappa C. B. Clarke Rhizome 1 part Kushtha Vetiveria zizanioides Root 1 part Usheera
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Table no. 2. Ingredients of Dashanga Lepa (with Sandalwood) Contents Latin Name Part used Proportion Albizzia lebbeck Benth. Skin 1 part Shireesha Glycyrrhiza glabra Linn. Root 1 part Yashimadhu Valeriana walichii DC. Bark 1 part Tagar Santalum album Linn. f. heartwood 1 part Chandana Elettaria cardamomum Maton. Fruit 1 part Ela Nardostachys jatamansi DC. Root 1 part Jatamansi Curcuma longa Linn. Rhizome 1 part Haridra Berberis aristata DC. Bark 1 part Daruharidra Saussurea lappa C. B. Clarke Rhizome 1 part Kushtha Vetiveria zizanioides Root 1 part Usheera
Method of preparation of Lepa The above mentioned drugs were powdered individually in a mortar – pestle to get fine powder. Equal quantities of powders of individual drugs were taken in a vessel and mixed with normal water to make them into a Lepa or paste form (Brahmanand Tripathi, 2006). This Lepa is advised to apply over the face. STUDY DESIGN Ethical clearance - Institutional Ethics Committee Approval and Regulatory Compliance Before the initiation of the study, the study protocol and related documents were reviewed and approved by Institutional Ethics Committee at Smt. KGMP Ayurved College & Hospital, Mumbai, Maharashtra State, India. The study was conducted in accordance with Schedule Y of Drugs and Cosmetics act, India, amended in 2005 and ICMR ethical guidelines for biomedical research on human participants 2006 (IEC Clearance no KGMP/NOTICE/1263/2009 Dated12.04.2014). No. of patients- Total 60 participants were registered in this trial. (30 patients in each group) The study was carried out in following steps:-
After diagnosis these 60 patients were randomly divided into two groups and were subjected to Lepa Therapy. Group A In this group, Dashanga Lepa (With Red Sandalwood) was given for application. Group B In this group, Dashanga Lepa (With Sandalwood) was given for application. Inclusion criteria Ages 14–25 years; Signed informed consent prior to any study-mandated procedure. Willing to comply with daily protocol. Having sign & symptoms of Mukhadushika. Exclusion Criteria Patient requiring acute medical care. Active malignancy, autoimmune condition, or treatment with immunosuppressive drugs Patients having psoriasis, Leprosy, Diabetic & non-healing, infective wound, or infective skin diseases Major Burns, wet eczema, etc. ASSESSMENT CRITERIA Surface area – measured in cms2 Texture of skin – Dry or Moist Pain, Discharge, Burning – Absent or Present Overall effect of Therapy – VAS (Visual Analogue Scale) – 0 to 10
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Investigational Product Description Dosage form Route of administration
1. Group A - Dashanga Lepa (With Red Sandalwood) 2. Group B - Dashanga Lepa (With Sandalwood) Lepa Local application 20 gm each. Once a day. After 7 days 2 weeks
Single application Daily application Follow up Total Duration Method of application of Lepa: It is having three steps: Poorva Karma: The patient was asked to wash the face with lukewarm water prior to application of Lepa. Pradhana Karma: Required quantity of powder was taken and normal water was added in sufficient amount to convert it in to Lepa form. The patients were advised to apply Lepa in the opposite direction to hair roots, all over the face. The Lepa was applied with a uniform thickness of one fourth of once own thumb width (about 1/4th of an inch). Lepa was applied in morning (between 7 and 10 am) and it should be applied over the face for at least forty five minutes to one hour or until Lepa gets dried up) (Brahmanand Tripathi, 2006). Parameter
Male Female 14-20 >20 Vegetarian Mixed Tea No Habit
Paschat Karma: After the drying up of the Lepa, the patients were asked to wash the face with normal water and were advised to take routine diet. Analysis of Data: For parametric data, Student’s Paired & Unpaired ‘t’ test was used, whereas nonparametric data was evaluated using Fisher’s exact test using statistical software Graph pad Instate 3. p<0.05 will be considered as level of significance. OBSERVATION & RESULTS A total number of 60 patients (30 patients per group) having signs & symptoms of Mukhadushika were selected for study. All 60 patients completed study. Demographic observations tabulated are as follows:
Group A Sex 13 17 Age (yrs) 18 12 Diet 22 8 Habit 11 19
Group B
Total
10 20
23 37
24 6
42 18
21 9
43 17
14 16
25 35
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Distribution of patients according Gradation of Mukhadushika
to
Effect of Trial Drug on Mukhadushika (Area affected) - Group B
The patients recruited in this trial were distributed according to gradation of Mukhadushika are shown in following [Figure 1].
Mean area affected by Mukhadushika in Group B before treatment was 9.49 + 5.0 which was reduced to 6.90 + 3.98 after treatment. The two-tailed P value is < 0.0001, considered extremely significant [Table 4].
Effect of Trial Drug on Mukhadushika (Area affected) - Group A
Comparison of Effect of Trial Drug on Acne surface area between Group A & B
Mean area affected by Mukhadushika in Group A before treatment was 9.57 + 7.58 which was reduced to 8.76 + 6.57 after treatment. The two-tailed P value is 0.1487, considered not significant [Table 3].
When both groups are compared statistically with unpaired t test for their outcome reveals that trial drug in group B show Significant changes over Group A. The twotailed P value is 0.1900, considered not significant [Figure 2 &Table 5].
Figure 1: Graphical presentation showing Distribution of patientsâ&#x20AC;&#x2122; according to gradation of Mukhadushika Distribution of patients according to gradation of Mukhadushika 25
No. of Patients
25 17
20 15
13 Group A
10
5
Group B
5
0
0
0 Grade I
Grade II
Grade III
Grade of Acne
Table 3: Effect of Trial Drug on Acne surface area in Group A Parameter
After Treatment 8.758
Difference
Mean
Before Treatment 9.567
Std deviation
7.558
6.565
2.984
Std error
1.380
1.199
0.5448
0.8083
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Table 4: Effect of Trial Drug on Mukhadushika surface area in Group A Parameter
Before Treatment
After Treatment
Difference
Mean
9.492
6.900
2.592
Std deviation
5.004
3.975
3.128
Std error
0.9136
0.7257
0.5710
Figure 2: Graphical presentation showing Comparison of Effect of Trial Drug on Mukhadushika surface area (Group A & B)
Surface area (Cm2)
Comparison of Effect of Trial Drug on Mukhadushika surface area (Group A & B) 9.57 10 8 6 4 2 0
9.49
8.76
6.9 BT AT
Group A
Group B
Table 5: Comparison of Effect of Trial Drug on Acne surface area Parameter
Group A
Group B
Mean
8.758
6.900
Std deviation
6.565
3.975
Std error
1.199
0.7257
Effect of Trial drug on Texture of Skin in Group A
Effect of Trial drug on Texture of Skin in Group B
The texture of skin was recorded as dry & moist. At the beginning texture of skin was moist in 28 patients & dry in two patients. At end of study texture of skin was moist in 29 patients & dry in one patient. Fisher's Exact Test applied & it was observed that the twosided P value is 1.0000, considered not significant [Table 6].
The texture of skin was recorded as dry & moist. At the beginning texture of skin was moist in 28 patients & dry in 2 patients. At end of study texture of skin was moist in 26 patients & dry in 4 patients. Fisher's Exact Test applied & it was observed that The two-sided P value is 0.6707, considered not significant [Table 7].
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Effect of Trial drug on Pain at site of Mukhadushika in Group A
Effect of Trial drug on Pain at site of Mukhadushika in Group B
The pain at the site of Mukhadushika was recorded as present & absent. At the beginning pain was absent in 25 patients & present in 5 patients. At end of study pain was absent in 26 patients & dry in 4 patients. Fisher's Exact Test applied & it was observed that two-sided P value is 1.0000, considered not significant [Table 8].
The pain at the site of Mukhadushika was recorded as present & absent. At the beginning pain was absent in 27 patients & present in 3 patients. At end of study no change was found. Fisher's Exact Test applied & it was observed that the two-sided P value is 1.0000, considered not significant [Table 9].
Table 6: Effect of Trial drug on Texture of Skin in Group A
BT AT Total
Moist 28 (47%) 2 (3%) 30 (50%)
Dry 29 (48%) 1 (2%) 30 (50%)
Total 57 (95%) 3 (5%) 60 (100%)
Table 7: Effect of Trial drug on Texture of Skin in Group B
Moist Dry Total
BT 28 (47%) 2 (3%) 30 (50%)
AT 26 (43%) 4 (7%) 30 (50%)
Total 54 (90%) 6 (10%) 60 (100%)
Table 8: Effect of Trial drug on Pain at site of Mukhadushika in Group A
Absent Present Total
BT 25 (42%) 5 (8%) 30 (50%)
AT 26 (43%) 4 (7%) 30 (50%)
Total 51 (85%) 9 (15%) 60 (100%)
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Table 9: Effect of Trial drug on Pain at site of Mukhadushika in Group B
Absent Present Total
BT 27 (45%) 3 (5%) 30 (50%)
AT 27 (45%) 3 (5%) 30 (50%)
Total 54 (90%) 6 (10%) 60 (100%)
Effect of Trial drug on Discharge in Mukhadushika in Group A
Effect of Trial drug on Mukhadushika in Group A
The discharge at the site of acne was recorded as present & absent. At the beginning discharge was absent in 25 patients & present in 5 patients. At end of study it was absent in 27 patients & present in 3 patients. Fisher's Exact Test applied & it was observed that the two-sided P value is 0.7065, considered not significant [Table 10].
Burning was recorded as present and absent. At the beginning of trial burning was present in 05 patients whereas it was absent in 25. At the end of study i.e. at day 15th no change was found. The two-sided P value is 1.0000, considered not significant [Table 12].
Effect of Trial drug on Discharge in Acne in Group B The discharge at the site of acne was recorded as present & absent. At the beginning discharge was absent in 25 patients & present in 5 patients. At end of study it was absent in 27 patients & present in 3 patients. Fisher's Exact Test applied & it was observed that the two-sided P value is 0.7065, considered not significant [Table 11].
Effect of Trial drug on Mukhadushika in Group B
Burning
Burning
Absent Present Total
in
Burning was recorded as present and absent. At the beginning of trial burning was present in 05 patients whereas it was absent in 25. At the end of study i.e. at day 15th burning present in 03 patients & absent in 27 patients. The two-sided P value is 0.7065, considered not significant [Table 13].
Table 10: Effect of Trial drug on Discharge in Mukhadushika in Group A BT 25 (42%) 5 (8%) 30 (50%)
in
AT 27 (45%) 3 (5%) 30 (50%)
Total 52 (87%) 8 (13%) 60 (100%)
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Table 11: Effect of Trial drug on Discharge in Mukhadushika in Group B
Absent Present Total
BT 25 (42%) 5 (8%) 30 (50%)
AT 27 (45%) 3 (5%) 30 (50%)
Total 52 (87%) 8 (13%) 60 (100%)
Table 12: Effect of Trial drug on Burning in Mukhadushika in Group A
Absent Present Total
BT 25 (42%) 5 (8%) 30 (50%)
AT 25 (42%) 5 (8%) 30 (50%)
Total 50 (83%) 10 (17%) 60 (100%)
Table 13: Effect of Trial drug on Burning in Mukhadushika in Group B
Absent Present Total
BT 25 (42%) 5 (8%) 30 (50%)
Overall Effect of trial drug on Mukhadushika by visual analogue scale (Group A) Visual Analogue Scale was recorded at initial stage & end of study. The mean score of VAS at initial stage was 7.333 + 12.01 which was increased to 38.667 + 15.02. It shows encouraging results within individuals / patient after using trial drug. The two-tailed P value is < 0.0001, considered extremely significant [Table 14]. Overall Effect of trial drug on Mukhadushika by visual analogue scale (Group B) Visual Analogue Scale was recorded at initial stage & end of study. The mean score of
AT 27 (45%) 3 (5%) 30 (50%)
Total 52 (87%) 8 (13%) 60 (100%)
VAS at initial stage was 1.667 + 6.47 which was increased to 47.167 + 12.01. It shows highly encouraging results within individuals / patient after using trial drug. The two-tailed P value is < 0.0001, considered extremely significant [Table 15]. Comparison of Effect of trial drug on Mukhadushika by visual analogue scale (Group A & B) When both groups are compared statistically with unpaired t test for their outcome reveals that trial drug in group B show highly encouraging results over Group A. The two-tailed P value is 0.0187, considered significant [Figure 3 &Table 16].
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Table 14: Overall Effect of trial drug on Mukhadushika by VAS (Group A) Parameter
Before Treatment
After Treatment
Mean
7.333
38.667
Std deviation
12.015
15.025
16.132
Std error
2.194
2.743
2.945
Difference 31.333
Table 15: Overall Effect of trial drug on Mukhadushika by VAS (Group B) Parameter
Column A
Column B
Difference
Mean
1.667
47.167
Std deviation
6.477
12.012
14.524
Std error
1.183
2.193
2.652
45.500
Figure 3: Graphical presentation showing Comparison of Effect of Trial Drug on Acne by visual analogue scale (Group A & B) Comparison of Effect of trial drug on Acne vulgaris by visual analogue scale (Group A & B)
50 45
40 Mean VAS Score
35 30
BT
25
AT
20 15 10 5 0 Group A
Group B
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Table 16: Summary of Data Parameter Column A Column B 38.667 47.167 Mean 15.025 12.012 Std deviation 2.743 2.193 Std error DISCUSSION In Sharangadhara Samhita, it was mentioned that Rakta Chandana should be used for preparation of Kashaya (decoction) & Lepa (External Application). Dashanga Lepa also contains Raktachandana as one of the ingredient. At the same time, Bhavaprakasha indicates no direct role of Chandana & Rakta chandana in skin disorders or Mukhadushika but both are mean to be blood purifier & pitta shamaka (Vishwanath Dwivedi, 1974). The studies available also indicated role of sandalwood in more in curing skin lesions (Sharma, Navin Kumar, 2013). Sandalwood powder is used widely in preparations of Face packs than Red Sandalwood (Grace, X & Fatima, 2014). So, the present study was conducted to evaluate efficacy of Dashanga Lepa (with Red sandalwood) & Dashanga Lepa (with sandalwood) on patients of Mukhdushika with special reference to Acne vulgaris. The study was divided in two groups. Mean area affected by Mukhadushika in Group A before treatment was reduced but not considered to be significant. The texture of skin was recorded as dry & moist. Moisture of skin was maintained in this group indicates that Dashanga Lepa with Red sandalwood doesn’t cause any dryness if used frequently. The pain at the site of acne was unchanged at end of study showing no role of lepa in reducing pain. Dashanga Lepa with Red sandalwood doesn’t cause any augment in discharge but in some cases it showed reduction in discharge. Burning was present in 05 patients which was unchanged at the end of study. The mean score of VAS at initial stage was increased showing encouraging results within individuals / patient after using trial drug. Mean area affected by Acne vulgaris in Group B before treatment was reduced
significantly. The presence of Sandal wood Dashanga Lepa has augmented the results to reduce the affected area in Acne. The texture of skin was changed from moist to dry in some patients. No change was found in pain at the site of acne. Dashanga Lepa with sandalwood doesn’t cause any augment in discharge but in some cases it showed reduction in discharge. Burning was present in 05 patients which was unchanged at the end of study. Visual Analogue Scale Score was increased at the end of study. It shows highly encouraging results within individuals / patient after using trial drug. When both groups are compared statistically for effect on surface area of Acne with unpaired t test for their outcome reveals that trial drug in group B show Significant changes over Group A. These changes might be due to presence of Sandalwood in Dashanga Lepa which along with turmeric showed excellent results in reducing affected area of Acne. Both the trial drugs showed minimal effects on symptoms like texture of skin (dry/moist), pain & discharge in Acne. But when both groups are compared statistically for effect on VAS (Visual Analogue Scale) with unpaired t test for their outcome reveals that trial drug in group B show highly encouraging results over Group A. CONCLUSION The study concludes both drugs Dashanga Lepa (with Red sandalwood) & Dashanga lepa (with sandalwood) are effective and safe to use in patients with Acne Vulgaris. Dashanga lepa (with sandalwood) is more effective than Dashanga Lepa (with Red sandalwood) in reducing surface area of Acne according to the present study.
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REFERENCES Ambikadutta Shastri (2005). Sushruta sahmita, hindi translation. Reprint; Chaukambha Sanskrit Sansthana; Varanasi, India. 2005. p. 4, 281, 287. Brahmanand Tripathi (2006). Sharangashara, Hindi commentary, Reprint, Chaukhamba Surabharati Publication, Varanasi, India. 2006. p. 18, 391 Britton (2010) the editors Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston; illustrated by Robert (2010). Davidsons principles and practice of medicine. 21sted. Edinburgh: Churchill Livingstone/Elsevier. pp. 1267–1268.
Source of Support: NIL
Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, Elewski BE. (2007) The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008 Jan;58(1):56–9. Grace, X. Fatima, (2014). "Preparation and evaluation of herbal face pack." Adv J Pharm Life sci Res, 2014 2;3:1–6 Sharma, Navin Kumar, (2013). "Evaluation of Antimicrobial, Safety and Efficacy of Medimix bathing bar with Sandal and Eladi oil." Egyptian Dermatology Online Journal 9.2 (2013): 1. Vishwanath Dwivedi (1974). Bhavaprakasha Nighantu, hindi commentary, 8th ed. Motilal Banarasidas Publications, New Delhi, India. 1974. p. 98–102.
Conflict of Interest: None Declared
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Review Article ANTIPYRETIC HERBAL FORMULATION WITH SPECIAL REFERENCE TO KWATHA KALPANA OF SARNGADHARA SAMHITA Vidhya Unnikrishnan1*, K Nishteswar2 1
Ph.D Scholar, Department of Dravyaguna, IPGT & RA, Jamnagar, Gujarat, India Professor and HOD, Department of Dravyaguna, IPGT & RA, Jamnagar, Gujarat, India *Corresponding Author: E mail: drvidya.unni@gmail.com 2
Received: 24/05/2015; Revised: 10/07/2015; Accepted: 25/07/2015
ABSTRACT Jwara (fever) was extensively dealt in ayurvedic classics. Various types of fevers like sannipatajwara, vishamajwara, jeernajwara, punaravartakajwara refer to typhoid, malaria, chronic fever, relapsing fever of bacterial viral and parasitic in origin. Sarngadhara samhita (13th century) a medieval treatise mainly dealt pharmaceutics of Ayurveda and mentioned single, simple and polyherbal formulations in different dosage forms like swarasa (juice), kalka (paste), kwatha (decoction), phanta (hot infusion) and hima (cold infusion). Out of all the dosage forms kwatha chapter contains highest number of antipyretic formulations. In the present review an attempt has been made to re-identify the herbs included in these formulations by taking into consideration the interpretations given by Adhamalla (14th AD) who has written a very lucid commentary on Sarngadhara samhita. This exercise may help to develop safe and effective herbal antipyretics which are not yet developed for rendering symptomatic relief in pyrexia KEYWORDS: Jwara, Herbal Antipyretics, Sarngadhara samhita
Cite this article: Vidhya Unnikrishnan, K Nishteswar (2015), ANTIPYRETIC HERBAL FORMULATION WITH SPECIAL REFERENCE TO KWATHA KALPANA OF SARNGADHARA SAMHITA, Global J Res. Med. Plants & Indigen. Med., Volume 4(7): 147–161
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INTRODUCTION Charaka samhita (1000BC), for the first time attempted to introduce one group consisting of 10 drugs under the name Jwarahara dasaimani. The group consists of medicinal plants namely, Sariva (Hemidesmus indicus R.Br.), Sarkara (Themeda arundinacea (Roxb.) A.Camus), Pata (Cissampelos pareira Linn.), Manjishta (Rubia cordifolia Linn.), Draksha (Vitis vinifera Linn), Peelu (Salvadora persica Linn), Parooshaka (Grewia asiatica Linn), Abhaya (Terminalia chebula Retz.), Amalaka (Emblica officinalis Gaertn.) and Vibheetaka (Terminalia bellirica (Gaertn.) Roxb.) (Charaka samhita sutrasthana 4/39) (Trikamji Yadavji, 2011). The drugs of this group can be prescribed for symptomatic relief from fever and also employed in the management of various infectious fevers. Charaka observes that jwara (fever) accompanies every individual at the time of birth and death (Charaka samhita chikitsa 3/25) (Trikamji Yadavji, 2011). Sarngadhara has enumerated 25 types of fever basing on Tridosha (three biohumors), onset of fever and psychic factors like fever, anger, toxic substances, pungent smells and subtle organisms(Sarngadhara samhita pradhamakhanda 7/2–6) (P. Sastri, 2005). All these varieties can be categorized under Susrutha’s Ashtavidhajwara (8 varieties of fever). The psychological factors like kama (desire or lust), Krodha (anger), bhaya (fear), vidwesha (hatredness) etc also initially vitiate Tridoshas (vayu, pitta and kapha) which are the prime factors in most of the diseases including jwara. It is also observed that jwara is the prime condition which proceeds before the manifestation of most of the diseases. Improper diet and behavior leads to hypofunction of agni (Digestive and metabolic factors), is considered as sole cause of jwara which results in imbalance of functions of deha (body), indriya (sensory organs), and bala (immunity) in the form of irritation and burning sensation of whole body.
Fever is rise in body temperature which occurs following infection and inflammation, and may be produced by a wide variety of organisms including bacteria, viruses, fungi, yeast and protozoa and by many inflammatory and related reactions such as tissue damage and necrosis, malignancy, antigen-antibody reactions and tissue graft rejection. Fever is classified on the pattern of temperature changes (A.S Milton, 1976). Although fever benefits the nonspecific immune response to invading microorganisms, it is also viewed as a source of discomfort and is commonly suppressed with antipyretic medication. An antipyretic is a type of medication that will prevent or reduce fever by lowering body temperature from a raised state. They will not affect normal body temperature if the patient does not have a fever. In the present review an attempt has been made to re-identify the herbs included in the antipyretic kwatha formulations of Sarngadhara samhita by taking into consideration the interpretations given by Adhamalla (14th AD). In the light of these information and modern scientific validations a new herbal antipyretic formulation is suggested for rendering symptomatic relief in pyrexia. MATERIALS & METHODS Sarngadhra samhita with Adhamalla commentary, other Ayurvedic classics, journals and websites were consulted to compile the specific information about antipyretic drugs. Sarngadhara samhita denoted in total 38 decoctions for the management of fever (Table1). After a systematic analysis, 65 drugs were botanically identified from these 38 Jwaraharakwathayogas. Guduchi (Tinospora cordifolia (Thunb.) Miers) and Sunti (Zingiber officinale Roscoe) are included in most of these Kwathayogas. Adhamalla, the versatile commentator has furnished some information with regard to identification of these herbs and their part to be used (Table 2).
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Table 1- Decoctions mentioned in Sarngadhara samhita with number of herbs (Sarngadhara samhita Madhyamakhanda Chapter.2) (P. Sastri, 2005) No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Name of the formulation Guduchyadikwatha Guduchyadikwatha Saliparnyadikwatha Kasmaryadikwatha Katphaladikwatha Parpatadikwatha Drakshadikwatha Parpatakwatha Parpatachandanadikwatha Beejapooradikwatha Bhoonimbadikwatha Patoladikwatha Panchabhadrakwatha Laghukshudradikwatha Aragvadadikwatha Amritashtakakwatha Patoladikwatha Kantakarikwatha Dasamoolakwatha Abhayadikwatha Ashtavimsatiganakwatha Ashtadasangakwatha Katphaladikwatha Nidigdhikadikwatha Devadarvyadikwatha Brihatkshudradi Mustadikwatha Patoladikwatha Guduchyadikwatha Devadarvyadikwatha Brihatguduchyadikwatha Nagaradikwatha Hreeberadikwatha Vasadikwatha Vasadikwatha Shadangapana Panchamoolipaya Trikantakapaya
Indication No.of herbs Sarvajwarahara 5 Vatajwarahara 3 Vatajwarahara 5 Vatajwarahara 5 Pittajwarahara 5 Pittajwarahara 6 Pittajwarahara 6 Pittajwarahara 1 Pittajwarahara 4 Sleshmajwarahara 4 Sleshmajwarahara 8 Sleshmajwarahara 8 Vatapittajwarahara 5 Kaphavatajwarahara 4 Vatakaphajwarahara 5 Pittasleshmajwarahara 8 Pittasleshmajwarahara 6 Sarvajwarahara 5 Vatakaphajwara 10 Tridoshajwarahara 14 Sarvajwarahara 28 Sannipatajwarahara 18 Tridoshajwarahara 11 Jeernajwara 3 Jeernajwara 20 Seethajwarahara 16 Vishamajwarahara 5 Ekahikajwarahara 8 Tritiyakajwara 6 Chaturthikajwarahara 6 Jwaraatisaranasana 14 Jwaraatisaranasana 5 Jwaraghna 12 Sleshmapittajwarahara 3 Jwarakasahara 3 Pipasa, Jwaranasana 6 Jwaranasana 5 Kaphajwarahara 5
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Table 2- Interpretation of herbs given by Adhamalla (Sarngadhara samhita Madhyamakhanda Chapter.2) (P. Sastri, 2005) No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44.
Name of the drug Arishta Padmaka Padmam Sariva Vasaka Vrisha Tikta Kairata Dhanvayasha Priyangu Kritamalaka Beejapoora Sipha Mahoushadham Nagaram Granthikam Sati Abda Chandana Indrayava Brhatidvayam Agnimantha Kasmari Ambuda Rohisha Sringi Nidigdhika Kshudra Bharngi Poushkaram Dhatri Samyaka Siva Pathya Vatsaka Kutajatvak(Abhavadravya) Parpata Mahadaru Gajapippalika Kritamalaka Chinna Amrita Hreeberam Udeechya Renuka
Interpretation Nimba Padmakam Kashtam Padmakesaram Anantamoolam Atarooshaka Vasaka Katurohini Bhoonimba Duralabha Latapriyanguphala Rajavriksha Matulanga Jata Sunthi Sunthi Pippalimoolam Karchoorabheda Mustha Raktachandana Kutajabeejam Kantakaridvayam Arani Gambhari(moolam) Musta Gandhatrina Karkatakasringi Laghukandakarika Laghukantakarika Brahmanayashtika Pushkaramoolam Amalaki Kritamalaka Haritaki Haritaki Kutajatvak Sakrabheejam Dvigunam Katupatra Devadaru Chavikaphalam Aragvadhaphalam Guduchi Guduchi Valakam Valakam Kounti
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The same drugs are used under various names in different kwathayogas. Table 2 helps in the identification of these herbs. The synonym Tikta is used for Katurohini. Kairata is identified as Bhunimba. Whenever Chandana is mentioned in Kwathayogas, Adhamalla advocates the use of Raktachandana. He mentions the use of Latapriyanguphala for Priyangu and
Gambharimoola for Gambhari. Gajapippali is identified as Chavikaphala. Adhamalla mentions the use of Sakrabeeja as a substitute for Kutajatvak. The quantity of sakrabeeja to be used should be twice that mentioned for kutajatvak. The botanical identification of the herbs used and their modern scientific validations supporting antipyretic activities are furnished in Table 3.
Table 3: Botanical identification of drugs in Jwarahara Kwatha Yogas. No 1. 2. 3.
4. 5.
6. 7.
8. 9. 10.
11. 12. 13.
14. 15.
Drug Ativisha
Botanical name Activities Reported Aconitum heterophyllum Wall. ex Antimicrobial (Nidhi srivastava et Royle al., 2011) Prativisha Aconitum palmatum D.Don -Vacha Acorus calamus Linn. Antipyretic (Arul Daniel J et al., 2014), Antiviral, Antibacterial (Devi and Ganjewala 2009), Antiplasmodial, Antifungal Vasa, Adhatoda vasica Nees. Antibacterial (Patel VK et al., 1984), Vasaka,Vrisha Antifungal, Antiviral, Antimalarial Bilwa Aegle marmelos Corr. Antipyretic (Arul V et al., 2005), Antifungal, Antibacterial, Antiviral (coxsackieviruses) (Badam L et al., 2002), Duralabha, Alhagi camelorum Fisch. Antipyretic, Antibacterial (Sulaiman Dusparsa GM 2014) Bhunimba, Kairata Andrographis paniculata Anti-malarial (Najib Nik A et al., (Burm.f.) Wall. ex Nees 1999), filaricidal, Antiviral (Wiart C et al., 2005) Ajamoda, Apium graveolens Linn Antibacterial (Baananou S et al., Deepyaka 2013) Satavari Asparagus racemosus Willd. Antipyretic (Vasundra et al., 2013), Antibacterial Nimba, Arishta Azadirachta indica A.Juss. Antipyretic (Okpanyi SN et al., 1981), Antibacterial (Kunjal S. Mistry et al., 2014), Antifungal Sarshapa Brassica campestris Linn Antibacterial (Yasmin et al., 2009) Priyangu Callicarpa macrophylla Vahl Antipyretic, Antibacterial (Yadav V et al., 2012) Arka Calotropis procera Antipyretic (Chitme HR et al., (Aiton) W.T.Aiton 2005), Antibacterial (Abdulmoniem MA et al., 2012) Krishna jeeraka Carum carvi Linn Antibacterial (Nicola S et al., 2005), Antifungal Aragvadha, Cassia fistula Linn Antibacterial, antifungal (Bhalodia Samyaka, NR et al., 2012) antipyretic (Patel N Kritamalaka et al., 2010), antiviral (RC Agarwal et al., 2012)
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16.
Devadaru
Cedrus deodara (Roxb.) G.Don
17.
Pata
Cissampelos pareira. Linn
18.
Beejapoora
Citrus medica Linn
19.
Bharngi
Clerodendrum serratum Linn
20.
Dhanyaka
Coriandrum sativum Linn
21.
Ajaji
Cuminum cyminum Linn
22.
Rohisha
23.
Ambuda, Musta
Cymbopogon (Roxb.) Wats. Cyperus rotundus Linn
24.
Salaparni
Desmodium gangeticum (L.) DC
25.
Vidanga
Embelia ribes Burm.f.
26.
Amalaki, Dhatri
Emblica officinalis Gaertn.
27.
Hingu
Ferula foetida Linn
28.
Parpata
29. 30.
Trayamana Madhuka
Fumaria indica (Hausskn.) Pugsley Gentiana kurroo Royle. Glycyrrhyza glabra Linn
31.
Kasmari
Gmelina arborea Roxb.
32.
Sati
33.
Sariva
Hedychium spicatum Sm. A.Rees Hemidesmus indicus R.Br
34.
Kutaja, Indrayava
35.
Pushkara, Poushkara Murva
36.
martinii
in
Holarrhena antidysenterica (Linn.) Wall. Inula racemosa Hook.f. Marsdenia tenacissima Wight & Arn
Antibacterial (chopra AK et al., 2004); Antiviral, Antimalarial (Makhaik M et al., 2005) Antipyretic (Reza HM et al., 2014), Antibacterial, Antimalarial, Antifungal, Antiyeast (Arora Manu et al., 2012) Antimicrobial (Kabra AO et al., 2012) Antipyretic (Narayanan N et al.,1999), Antibacterial (Poornima BS et al., 2015) Antibacterial, Antifungal (Xin-Zhi Cao et al., 2012) Antibacterial (Nicola S et al., 2005), Antifungal Antibacterial, Antifungal (Prashar A et al., 2003) Antipyretic (Gupta mradu et al., 2013), Antibacterial, Antiviral Antibacterial, Antiviral (Ganjhu R.K et al., 2014) Antipyretic, Antibacterial (Mohammad Alam Khan et al., 2010) Antipyretic (Gupta mradu et al., 2013), Antimicrobial, Antifungal Antibacterial (Mohammad Mehdi Fani et al., 2015) Antibacterial, Antifungal, Antipyretic (Gupta PC et al., 2012) Antibacterial (Baba SA et al., 2014) Antiviral: (encephalitis), Antimicrobial, Antipyretic (Asha roshan et al., 2012) Antibacterial (El Mahmood AM et al., 2010), Antipyretic (Pravat KP et al., 2011) Antibacterial, Antifungal, (Sravani T et al., 2011) Antipyretic (Lakshman K et al., 2006) Antiplasmodial, Antibacterial (Snehadri sinha et al., 2013) Antibacterial, Antifungal (PD Lokhande et al., 2007) --
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37.
Katphala
38.
40.
Syonaka, Sookanasa Hreeberam, Valakam, Udichya Katuki, Tikta
41.
Renuka
Piper aurantiacum Wall. ex C. DC --
42. 43.
Chavya Pippali, Pippalimoolam
Piper chaba Trel. & Yunck. Piper longum Linn
44.
Maricham
Piper nigrum Linn
45.
Karkatasringi
Pistacia integerrima J.L.Stewart ex Brandis
46.
Sreyasi
47.
Chitraka
Pluchea lanceolata (DC.) Oliv. & Hiern Plumbago zeylanica Linn
48.
Agnimantah
Premna integrifolia Linn
49. 50.
Prunus cerasoides D.Don Pterocarpus santalinus Linn.f.
51.
Padmakam Chandana, Raktachandana Kushta
52. 53.
Bala Brihati
Sida cordifolia Linn Solanum indicum Linn
54. 55.
Kshudra, Kantakari Patala
Solanum xanthocarpum Schrad. & H. Wendl. Stereospermum suvaveolens DC (S. colais)
56.
Kiratatikta
Swertia chirayita Fleming) H. Karst.
57.
Vibhitaka
Terminalia bellirica Roxb.
39.
Myrica nagi Thunb.
Antipyretic, Antifungal, Antibacterial (Chandra S et al., 2012) Oroxylum indicum Antimicrobial (LG Radhika et al., (L.) Benth. ex Kurz 2011) Pavonia odorata Willd. Antibacterial, Antifungal (Seems Nakhare et al., 1992) Picrorrhiza kurrooa Royle ex Antipyretic (A Rajani et al., 2014), Benth Antibacterial
Saussurea lappa C.B Clarke
(Roxb.
Antipyretic (Seewaboon et al., 2012) Antibacterial, Antifungal (Maitreyi Zaveri et al., 2010), Antipyretic (Evan Prince Sabina et al., 2013) Antipyretic (A.Nagateja Pavan et al.,2013), Antimicrobial (S.K Shiva rani et al., 2013) Antimicrobial (Ghias Uddin and Abdur Rauf 2012), Antipyretic (Rauf A et al.,2014) Antimalarial (Mohanty S et al., 2013) Antiplasmodial (Paiva SR et al., 2003), Antibacterial (Jeyachandran R et al., 2009) Antibacterial (Karmakar et al., 2011) Antibacterial (B C Sharma 2013) Antimicrobial (BK Manjunatha et al., 2006) Antibacterial, Antiviral (Chen HC et al., 1995) Antimicrobial (Mahesh et al., 2008) Antipyretic (Prasanta kumar et al., 2014), Antibacterial Antipyretic, Antibacterial (Patil and Wadhava 2013) Antipyretic (M pharm TB et al., 2010), Antibacterial
ex Antipyretic, Antifungal, Antibacterial, Antimalarial (P Joshi et al., 2005) Antiviral (H Verma et al., 2008) Antimicrobial (K.M. Elizabeth, 2005)
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58.
59.
60. 61. 62. 63. 64. 65.
Abhaya, Harithaki
Siva, Terminalia chebula Retz
Antibacterial, Antifungal (Mary grace et al., 2013) Antiviral (Kim et al., 2001) Amrita, Guduchi, Tinospora cordifolia (Thunb.) Antipyretic (Gupta mradu et al., Chinna Miers 2013), Antimicrobial, antiviral (Jitendra et al.,2014) Gokshura, Tribulus terrestris Linn Antibacterial, Antiviral, Antipyretic Trikantaka (Baikuntha Prusty et al., 2013) Patola Trichosanthes dioica Roxb. Antipyretic (M Badrul Alam et al., 2011), Antimicrobial Prisniparni Uraria picta (Jacq.) DC. Antimicrobial (Rahman MM et al., 2007) Usira Vetiveria zizanioides (Linn).Nash Antipyretic (Narkhede M. B et al., 2012), Antibacterial Draksha, Gostana Vitis vinifera Linn Antimicrobial (Oliveira DA et al., 2013), Antiviral Shunti, Nagara, Zingiber officinale Roscoe Antipyretic (Christian D et al., Viswa, 2014) Antibacterial, Antiviral Viswabheshajam, (Chang JS et al., 2013) Mahoushadha
DISCUSSION Fever occurs as a result of changes in the central control of deep body temperature produced by pyrogenic substances released following infection and inflammation. An antipyretic is a type of medication that will prevent or reduce fever by lowering body temperature from a raised state. They will not affect normal body temperature if the patient does not have a fever. Fever has been described under Jwara in Ayurvedic texts. Jwara may occur as an independent disease or as symptom or complication of some other diseases. In Jwararoga the aggrevated doshas get accumulated in amashaya due to the dysfunction of agni (energy responsible for digestive and metabolic processes), leading to formation of ama (improperly metabolized toxic component) due to vitiation of rasa dhatu, which circulates in whole body along with rasa and obstructs the swedavaha strotas. Thus a drug to pacify Jwara must have the capacity to remove ama as well as obstruction of swedavaha strotas. In Jwara, Agni (Pitta) is thrown out from the koshta to the sakhas resulting in an increase in body temperature.
Among the shadrasaâ&#x20AC;&#x2122;s tikta rasa possess jwarahara property. It is deepana, pachana and lekhana. Most of the drugs mentioned in the jwrarahara kwathas of sarngadhara samhita possess tikta rasa. Among the 38 jwarahara kwathayogas maximum numbers of drugs are included in Ashtavimsathigana kwatha, which contains 28 drugs. Certain drugs namely Guduchi, Sunthi, Kantakaridvaya, Musta, Parpata, Katuki, Pippalimoola, Pata, Bhunimba and Vasa are repeatedly included in most of the formulations. Guduchi and Sunthi are included in 18 jwarahara kwathayogas. Considering the wide range utility of Guduchi as an antipyretic drug it was given the name jwaravinasini by nighantukaras (Madhava nidana 1/38) (H.H Tripadi, 2009). Sunthi with its excellent amapachana property helps in the samprapti vighatana of jwara. Indrayava the seed of Kutaja is included in 7 formulations where as kutajatvak is included only in 2 formulations. From a thorough review of the drugs enlisted above, it is explicit that all the jwarahara kwathas of Sarngadhara samhita are an excellent combination of drugs having
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antipyretic, antibacterial, antimalarial activities.
antiviral
and
Basing on the critical review and analysis carried out with regard to herbs mentioned in kwathakalpana of Sarngadhara samhita and scientific validation produced on these herbs
the following formulation is designed for the symptomatic management of fever (Table 4). Dosage form: Powder Dose 2–3g
Table 4: Formulation designed for fever based on Critical review of Kwatha Kalpana of Sarngadhara No 1 2 3 4 5 6
Drug Guduchi Sunthi Musta Bhunimba Pata Vasa
Botanical name Tinospora cordifolia (Thunb.) Miers Zingiber officinale Roscoe Cyperus rotundus Linn Andrographis paniculata (Burm.f.) Wall ex Nees Cissampelos pariera Linn Adhatoda vasica Nees
The drugs should be triturated with Amalakyadiganakwatha containing Amalaki, Haritaki, Pippali and Chitraka. Amalakyadigana showed significant antipyretic effect in experimental animals (Manoj Timbadiya, 2013). Charaka samhita recorded certain magico religious prescriptions in the management of Vishamajwara (malaria is included under this category) viz tying sahadevi root, chanting Vishnusahasranama etc. The treatise also noted that fever which is not relieved by any therapeutic measures will be relieved by sadhudarshana (seeing the holymen). These observations recorded, require proper scientific scrutiny to find out the influence of psychic factors against pyrogens.
CONCLUSION A proper analysis of the evidence based activity of the herbs mentioned in kwatha kalpana of Sarngadhrasamhita shows that these herbs can act as effective antipyretic agents. This knowledge may be helpful to formulate a safe and dependable therapeutic regimen for fever, which is still not available in the herbal drug market. The Antipyretic herbal formulation is suggested consisting of Guduchi, Sunthi, Musta, Bhunimba and Pata (Amalakyadiganakwatha bhavita churna) for the management of febrile conditions.
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Global J Res. Med. Plants & Indigen. Med. | Volume 4, Issue 7 | July 2015 | 147–161
Seewaboon Sireeratawong, Arunporn Itharat, Nusiri Lerdvuthisopon, Pritsana Piyabhan, Parirat Khonsung,Supot Boonraeng, and Kanjana Jaijoy (2012) Anti-Inflammatory, Analgesic, and Antipyretic Activities of the Ethanol Extract of Piper interruptum Opiz. and Piper chaba Linn, International Scholarly Research Network ISRN Pharmacology Snehadri Sinha, Aishwarye Sharma, P. Hemalatha Reddy, Brijesh Rathi, N.V.S.R.K. Prasad, Amit Vashishtha (2013) Evaluation Of Phytochemical And Pharmacological Aspects Of Holarrhena Antidysenterica (Wall.): A Comprehensive Review, Journal Of Pharmacy Research 6(4): 488–492 Sravani T, Padmaa M Paarakh (2011) Hedychium spicatum Buch.Ham. – An Overview Pharmacologyonline 2: 633– 642
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Yadav V, Jayalakshmi S, Singla RK, Patra A. (2012) Evaluation of Antibacterial Activity of Callicarpa macrophylla Vahl. Stem Extracts. Webmed Central Ayurvedic Medicine; 3(8):WMC003651 doi: 10.9754/journal.wmc.2012.003651
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