GJRMI - Volume 5, Issue 4, April 2016 by Dr. Hari Venkatesh.K.Rajaraman

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INDEX – GJRMI - Volume 5, Issue 4, April 2016 INDIGENOUS MEDICINE Ayurveda – Dravya Guna CLINICAL EVALUATION OF OPUNTIA ELATIOR MILL. (NAGAPHANI) FRUIT IN THE MANAGEMENT OF PANDU WITH SPECIAL REFERENCE TO GERIATRIC ANAEMIA Shantanu Sanyal, Shashikant Prajapati*, Anagha Ranade, Rabinarayan Acharya, Mandip Goyal

114–120

Ayurveda – Siddhanta – Review CONCEPT OF VEGADHARANA IN VIEW OF PREVALENCE OF DISEASES IN FEMALES Suramya Suresh*, Akhilesh Shukla, Haroon Irshad, Leena P Nair, Jaya Shankar Mund

121–128

Ayurveda – Dravya Guna – Short Communication SCREENING OF ANTIMICROBIAL ACTIVITY OF MOCHARASA (BOMBAX CEIBA L.) Sanjivani Samadhan Shekokar*, SV Shete

129–136

Ayurveda – Dravya Guna – Case Study A CASE STUDY ON THE AYURVEDIC MANAGEMENT KARPASASTHYADI TAILA NASYA AND PHYSIOTHERAPY Krishnaprabha A*, Ratnaprava Mishra, Krishna Kumar K

APABAHUKA

WITH 137–145

Cover Page Photography: Dr. Hari Venkatesh K.R. Plant ID: Flower of Oxalis corniculata L.* of the family Oxalidaceae Place: Off Kanakapura Road, Bangalore, Karnataka, India *Botanical Name validated from www.theplantlist.org as on 25/04/2016

Research article CLINICAL EVALUATION OF OPUNTIA ELATIOR MILL. (NAGAPHANI) FRUIT IN THE MANAGEMENT OF PANDU WITH SPECIAL REFERENCE TO GERIATRIC ANAEMIA Shantanu Sanyal1, Shashikant Prajapati2*, Anagha Ranade3, Rabinarayan Acharya4, Mandip Goyal5 1

MD scholar, Dravyaguna Department, IPGT&RA, Gujarat Ayurved University, Jamnagar- 361 008, Gujarat, India 2,3 PhD scholar, Dravyaguna Department, IPGT&RA, Gujarat Ayurved University, Jamnagar- 361 008, Gujarat, India 4 Professor, Dravyaguna Department, IPGT&RA, Gujarat Ayurved University, Jamnagar- 361 008, Gujarat, India 5 Assistant professor, Kayachikitsa Department, IPGT&RA, Gujarat Ayurved University, Jamnagar- 361 008, Gujarat, India *Corresponding Author: E-mail: prajapatishashikant79@gmail.com

Received: 11/02/2016; Revised: 25/03/2016; Accepted: 15/04/2016

ABSTRACT Anaemia is one of the very common dietary deficiency diseases characterized by reduction of red blood corpuscles and haemoglobin in the blood. Prevalence of geriatric anaemia is on increase in India (17.7–89%). Among traditional systems, Ayurveda mentions a disease condition named ‘Pandu’ which has a close resemblance to anaemia. Fruits of Opuntia elatior (Nagaphani) are being used by the local people of Gujarat, irrespective of age to combat anaemia and general debility irrespective of age. There is a need to validate this traditional practice to manage anaemia. The present open label clinical study was carried out on 31 patients of geriatric population diagnosed with Pandu. The patients were administered with fruit juice of O. elatior in a dose of 20 ml twice daily before meals for 30 days. The test drug was found effective in the management of Pandu by significantly relieving the cardinal symptoms of Pandu like Bhrama (giddiness), Panduta (pallor), Shwasa (dyspnoea on exertion), Daurbalya (weakness) and Pindikodwesthana (cramps in calf muscles). Statistically significant increase in Hb% level of these patients was also reported. KEY WORDS: Geriatric anaemia, Nagaphani, Opuntia elatior, Pandu

Cite this article: Shantanu Sanyal, Shashikant Prajapati, Anagha Ranade, Rabinarayan Acharya, Mandip Goyal (2016), CLINICAL EVALUATION OF OPUNTIA ELATIOR MILL. (NAGAPHANI) FRUIT IN THE MANAGEMENT OF PANDU WITH SPECIAL REFERENCE TO GERIATRIC ANAEMIA, Global J Res. Med. Plants & Indigen. Med., Volume 5(4): 114–120

Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI ||

Global J Res. Med. Plants & Indigen. Med. | Volume 5, Issue 4 | April 2016 | 114–120

INTRODUCTION

MATERIALS AND METHODS

Recently, geriatric anaemia is one among the public health crisis. Its prevalence in 164 million elderly, who constitute 23.9% of the elderly population, suffering from anaemia globally and in India, it is estimated to be about 17.7–89% (Vijai Tilak et al., 2012). Many of the elderly, used to prefer traditional medicine for their various health problems (Zabidah Ismail et al., 2005). O. elatior (Nagaphani) (Saxena H O et al., 1995) is a frequently available plant in Gujarat region and its fruits are being consumed by local people of all age group of Gujarat, to manage anaemia and general debility (Shashikant Prajapati et al., 2015). Literature review shows that ripen fruits of O. elatior is a rich source of nutrients and vitamins (Sawaya W N et al., 1983; Teles F et al., 1984) and are eaten fresh, dried or preserved in jams, syrups or processed into candy – like products (Hoffman W, 1980; Kuti J O, 2004). In asthma, its baked fruits are administered internally once in a day for a week (Patil G G et al., 2008), pulp of one ripe fruit is used for burning sensation in the stomach (Kumar S et al., 2008); fruits are first heated and then powdered, about 5g powder consumed at morning for 10–15 days in rheumatism (Patil D A et al., 2011); juice of 7– 8 fruits mixed with 50g jiggery is taken orally by the tribal ladies for 2–3 days to develop complete sterility (Anita J et al., 2007). Fruit of O. elatior has been reported safe during toxicity study (Shantanu KS et al., 2015) and has been proved for its hematinic activity (Chauhan S P et al., 2014), analgesic (Chauhan S P et al., 2015a) and anti-asthmatic activity (Chauhan S P et al., 2015b) in animal experimental models.

The study was started after taking approval of Institutional Ethics committee (No.PGT/7A/Ethics/2013-14/1767 Dt.10-09-2013) and registered in CTRI (CTRI/2014/11/005217) retrospectively.

Though ripe fruits of O. elatior are used frequently for the management of anaemia as a nutritional supplement, it has not been evaluated for its clinical efficacy in a systemic and scientific way. Hence, the present study was designed to validate folklore claim of efficacy of fruit juice of Opuntia elatior in the management of Pandu, in geriatric population.

Drug preparation Freshly collected fruits were thoroughly washed with adequate amount of tap water and the bunch of thorn over the fruits were neatly plucked using forceps. Following this, the outer skin of fruits was removed and the remaining parts of fruits were macerated and the resultant juice obtained was passed through sieve and filtered. The residue consisted of the sludge and seeds were separated. The filtered juice was preserved by addition of 1 gm sodium benzoate per one litre of juice. Posology Fruit juice of O. elatior was given in the dose of 20 ml per day (orally) in two divided dose twice daily before meals mixed with equal quantity of lukewarm water for 30 days. In this study, total 31 patients were registered; among them 30 patients completed the treatment and one patient dropped out of the study due to personal reason. Criteria for selection of patients Patient irrespective of sex, age between 60– 80 years with classical symptoms of Pandu were selected for the present study. Patients suffering from any systemic diseases like hypertension, diabetes mellitus, tuberculosis, cancer and age below 60 years & above 80 years and severe case of Pandu with complications were excluded. Investigations like; routine haematological (Hb%, T. L. C., D. L. C., T RBC (mil/cumm), MCV (fl), MCH (Pg), MCHC (gm/dl), Platelet count) and bio-chemical parameters (Blood sugar (mg/dl), S.creatinine (mg/dl), S.urea (mg/dl), S.protein (gm/dl), S.albumin (gm/dl), S.G.P.T(IU/L), S.G.O.T(IU/L) etc.) were conducted to assess the general health

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Global J Res. Med. Plants & Indigen. Med. | Volume 5, Issue 4 | April 2016 | 114–120

condition of patients, both before and after the treatment in the pathology laboratory of the institution.

OBSERVATIONS AND RESULTS Daurbalya (weakness) was found in 90.32% patients, Panduta (pallor) was observed in 67.74% patients, Bhrama (giddiness) and Shrama (fatigue) were observed in 58.06% patients. Shwasa (dyspnoea on exertion) was observed in 54.84%. Pindikodwesthana (cramps in calf muscles) and Hridspandana (palpitation) was observed in 45.16% and 6.45% patients respectively. This study shows statistically significant improvement in all the chief complaints except Hridspandana (palpitation). Highest 47.83% improvement was seen in Bhrama followed by Panduta 47.22% (Table 1).

Criteria for assessment A clinical research proforma was specially designed based on the classically reported signs and symptoms of Pandu for the assessment of the effect of the drug on subjective clinical parameters. Assessment of the effect of treatment was done on the basis of improvement in signs and symptoms of Pandu on the basis of specific scoring pattern and Paired ‘t’ test was used to assess the effect of therapy within group in subjective as well as objective parameters. Statistical calculations were made with the help of Sigmastat 3.5 software and Instat 3 software. The results were interpreted as; Insignificant P > 0.05, Significant P < 0.05, Significant P < 0.01, Highly Significant P < 0.001

In Haematology parameters, significant improvement was seen in Haemoglobin level 1.76%. TLC, Neutrophil, Total RBC, platelet, MCH, MCHC, PCV showed marked increase but changes were non-significant. Lymphocytes, ESR, eosinophil, monocytes, and MCV levels were decreased but statistically insignificant (Table 2). Significant decrease in the Blood sugar 4.03% and serum creatinine level 7.67% was observed in the study. Non-significant, but marked decrease was found in Serum urea 12.46% and SGOT 7.54% levels. SGPT level 1.09% was increased slightly, but the level of increase was statistically non-significant (Table 3). Overall effect of therapy showed that, 30% patients remained unchanged, 60% showed mild improvement and 10% had improvement (Table 4).

Assessment of overall effect of therapy The total effect of therapy was assessed considering overall improvement in sign and symptoms. • Complete remission: 100% • Marked improvement: 76–99% • Improvement: 51–75% • Mild improvement: 26–50% • Unchanged: Below 25%.

Table 1: Effect of O. elatior fruit juice on chief complaints Chief complaints Panduta (pallor) Bhrama (giddiness) Dourbalya (weakness) Hridspandana (palpitation) Pindikodwesthana (cramps in calf muscles) Shrama (fatigue) Shwasa (dyspnea on exertion)

Mean BT 1.71 1.28 2.37 1.5 1.77 1.77 2.56

AT 0.905 0.67 1.3 1.5 1.14 0.94 1.38

Difference %Change 0.81 0.61 1.07 0.0 0.64 0.82 1.19

Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI ||

47.22% 47.83 45.31 0000 36 46.67 46.34

6.17 5.1 8.23 0.00 3.8 6.42 5.7

<0.001 <0.001 <0.001 >0.05 <0.001 <0.001 <0.001

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Table 2: Effect of O. elatior fruit juice on haematological parameters Parameters

Difference

Mean BT 12.10 6783.33 58.53 34.67 3.93 4.244 290.80 28.67 2.87 85.94 28.79 33.48 36.16

Hb TLC Neutrophil Lymphocyte Eosinophil TRBC Platelet ESR Monocytes MCV MCH MCHC PCV

AT 12.31 7000 61.20 32.63 3.5 4.296 297.1 23.47 2.67 85.35 28.89 33.65 36.56

0.21 216.67 2.67 2.03 0.43 0.0523 6.33 5.20 0.20 0.59 0.11 0.18 1.641

% Change

1.76 3.19 4.56 5.87 11.02 1.23 2.18 18.14 6.98 0.69 0.37 0.53 1.10

2.86 1.31 1.54 1.51 0.78 0.73 0.99 1.209 1.649 1.003 0.40 1.26 1.64

<0.001 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05

Table3: Effect of O. elatior fruit juice on biochemical Parameters Parameters Blood sugar Creatinine S.urea SGPT SGOT

Difference

Mean BT 95.93 1.04 30.77 18.40 31.83

AT 92.07 0.96 26.93 18.60 29.43

3.87 0.08 3.83 0.20 2.4

% Change 4.03 7.67 12.46 1.09 7.54

2.533 2.262 1.815 0.171 1.682

P< 0.01 P< 0.01 >0.05 >0.05 >0.05

Table 4: Total effect of therapy on 30 patients of Pandu Group open level Total %change

Unchanged (0–25%) 9 30

DISCUSSION Panduta symptom was observed in 67.74% patients. Varna (complexion) and Prabha (aura) are the properties of Raktadhatu (channels that carry the blood) and Pittadosha, particularly the Bhrajaka and Ranjaka Pitta (types of Pitta). It is also the property of Ojas (purest part of the seven Dhatu) as more and more Ojakshaya, Raktakshaya and

Mild improvement (26–50%) 18 60

Improvement (51–75%) 3 10

Pittaprakopa occurs the patient becomes Hataprabha or Panduta appears. Significant result (P<0.001) was seen may be because of O. elatior being Madhurarasa (sweet taste) predominance and Snigdhaguna (unctuous) dominant must have led to pacification of Rukshata of Vata (dryness produced by Vata) and Tikshnata of Pitta (penetrating by Pitta) thereby replenishing Rasadhatu (channels that carry the nutrient body fluid) (Hemil Patel,

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2015). Bhrama was found in 53.33% patients showing that it is also a very common presenting symptom. Maximum relief was observed in 47.83% which was highly significant (P<0.001). Daurbalyata was present in 93.33 % patients. The test drug showed highly significant results (p < 0.001) with 45.31% improvement. Dhatukshaya, Ojakshaya as well as Raktalpta (loss of blood) may cause the debility or in other words Daurbalya. When there is a condition of decrease in number of RBCs, metabolic activities hastened and if this condition persists for a long period, debility appears (Kavitha M et al., 2014). O. elatior being Madhurarasa dominant, drug probably reduces Pitta and replenishes Rasadhatu, So increase in Prinana (nutrient) by Rasadhatu to further Dhatu leads in Dhatuvriddhi. Increase in Uttarottara Dhatuvruddhi leads to relief in Daurbalya (Charaka Samhita, 2011). The cells in the blood are responsible for supplying oxygen to body tissues, which is very necessary for the normal metabolic activities. Hridspandana was observed in 6.45% patients. Palpitation in Panduroga is due to lack of proper nourishment and Raktalpata due to which heart has to pump quickly so as to provide rapid blood flow to body tissues. In this study patients had no relief from Hridspandana. Pindikodewshtanama was noted in 53.33% patients. The test drug showed significant results with 36% improvement. Regarding the effect of therapy, drug is having Pittashamaka (Pitta pacifying) property reduces Pitta and corrects Rasadhatu. It also reduces Vatadosha due to its Madhurarasa. So, decrease in Vata and increase in normal Rasadhatu results in proper circulation to periphery which finally results in relief from Pindikodvestana. Shrama was found in 58.06% patients showing that it is also a very common presenting symptom in Pandu. 46.67% relief was observed with highly significant (P<0.001) improvement. Shwasa was observed in 54.84% patients. 46.34% relief was observed with highly significant (P<0.001) results. Shwasa in Pandu is due to lack of proper nourishment and Raktalpata due to which respiratory organs have to work quickly so as to provide rapid blood flow to body tissues and that is the reason of Shwasa. An increase in Hb% (1.76%) was observed in

patients. Oxygen carrying capacity of RBCs resulting increased. Haemoglobin is an important parameter to be assessed in case of Anaemia. The treatment with trial drug was found to be effective in increasing the Hbgms% (1.76%), which was statistically significant. Total Red Blood Cell count is another important investigation in case of Anaemia. An increase by 1.23% in TRBC was found but it was statistically insignificant. This may be due to small sample size of the present study. MCV (Mean Corpuscular Volume) was decreased by 0.69%. Increase of 0.377% was seen in MCH (Mean Corpuscular Haemoglobin). 0.53% & 1.10% increase seen in MCHC (Mean Corpuscular Haemoglobin Concentration) and PCV (Packed cell volume) respectively. Platelet count was increased by 2.18%. All observed data of the above parameters were found statistically insignificant, which may be due to sample error or small sample size. ESR (Erythrocyte Sedimentation Rate) is one of the important investigations among all haematological investigations. Result showed 18.14% decrease but statistically insignificant. Improvement in parameters suggests O. elatior fruit juice improves the iron metabolism, erythropoiesis and quality of RBCs. Significant decrease in the blood sugar value 4.03% and serum creatinine value 7.67% was observed. Nonsignificant, but marked decrease was found in serum urea 12.46% and SGOT 7.54 % levelswhich imply the non-toxic nature of O. elatior. SGPT level 1.09% increased but this change was statistically insignificant. CONCLUSION Opuntia elatior fruit provides significant effect in relieving classical symptoms of Pandu like Panduta, Daurbalya, Bhrama, Shrama, Pindikodweshtana and Shwasa. It increases the Hbgm% significantly. It can be concluded that Opuntia elatior fruit juice (ripen) is effective in management of Pandu among old age, thus, validating the folklore claim. Further clinical study on large sample geriatric patients of anaemia may be carried out to establish Opuntia elatior fruit a suitable, economic, safe and effective drug.

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Global J Res. Med. Plants & Indigen. Med. | Volume 5, Issue 4 | April 2016 | 114–120

REFERENCES Anita Jain, Katewa S S, Galav P K, Ambika Nag (2007). Unrecorded Ethno medicinal Uses of Biodiversity from Tadgarh Raoli Wildlife Sanctuary, Rajasthan, India. Acta Botanica Yunnanica; 29 (3): 337–344. Chauhan Sanjay P, Sheth N R (2014). Haematinic evaluation of fruits of Opuntia elatior Mill on mercuric chloride induced anaemia in rats. International Journal of Research in Ayurveda and Pharmacy. Jan-Feb; 5 (1): 115–122. ChauhanSanjay P, Sheth Navin R, Suhagia Bhanubhai N (2015a). Analgesic and Anti‑inflammatory action of Opuntia elatior Mill fruits. Journal of Ayurveda & Integrative Medicine. April-June; 6 (2): 75–81. Chauhan Sanjay P, Sheth Navin R, Suhagia B N (2015b). Evaluation of bronchodilatory properties of fruits of Opuntia elatior Mill. Egyptian Pharmaceutical Journal; 14: 44–49. Hemil Patel (2015). A Pharmaco-clinical evaluation of Raktavardhaka (haematinic) effect of Opuntia elatior Mill fruit.March. MD Thesis submitted to Gujarat Ayurved University, Jamnagar. Hoffman W (1980). The many uses of prickly pears (Opuntia elatior Mill) in Pern and Mexico. Plant resources and Development; 12: 58–68. Kasinatha Sastri, Gorakhnatha Chaturvedi (2011), Editor of Charaka Samhita. Vidyotini Hindi commentaries Chikitsasthana Chap 15 verse16–17 Varanasi: Chaukhambha Bharati Academy, pp-456.

Kavitha M, Mahendra Singh, Ishwar Chandra Rai, Richa Singh, Ajit Kumar Shasamal, Sangita Prusty (2014). Concept of Pachaka Pitta in Pandu Roga and Its Management by Navayasa Choorna. World Journal of Pharmacy and Pharmaceutical.Feb; 3 (3): 1263– 1272. Kumar S, Parveen F, Goyal S and Chauhan A (2008). Indigenous herbal coolants for combating heat stress in the hot Indian arid zone. Indian journal of traditional knowledge; 7 (4): 679–682. Kuti J O (2004). Antioxidant compounds from four Opuntia cactus pear fruits varieties, Food chemistry; 85: 527–533. Patil

D A, Ahir Rao Y A (2011). Ethnomedicinal knowledge of plants used by local people in Buldhana district of Maharashtra, India. Journal of Ecobiotechnology; 3 (3): 11–17.

Patil G G, Mali P Y, Bhadane V V (2008). Folk remedies used against respiratory disorders in Jalgoan district, Maharashtra. Natural product radiance; 7 (4): 354–358. Sawaya W N, Khatchadourin H, Safi W, Al – Muhammed H M (1983). Chemical characterization of prickly pear pulp, Opuntia ficus, O. indica Linn and manufacturing of prickly pear jam. Journal of Food Technology; 18: 183– 193. Saxena H O (1995), The Flora of Orissa- Vol.2, Bhubaneswar: Orissa Forest Development Corporation Ltd, pp761– 762.

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Shantanu K S (2015). Toxicological study of Opuntia elatior Mill., Fruit (ripen) juice: A folklore medicinal plant. International Journal of Green Pharmacy; 9(4): S39–S44. Shashikant Prajapati, Harisha C R, Rabinarayan Acharya (2015). Pharmacognostic evaluation of stem of Opuntiaelatior Mill. (Nagaphani). European Journal of Biomedical and Pharmaceutical sciences; 2 (2): 351–357. Teles F, Stull J, Brown W, Whitting F (1984). Amino and organic acids of prickly pear

Source of Support: NIL

cactus (Opuntia ficus, O. indica L). Journal of the Science of Food and Agriculture; 35: 421–425. Vijai Tilak, Ragini Tilak (2012). Geriatric anaemia- A public health crisis in haematology. Indian Journal of Preventive and Social Medicine; 43 (2): 153–157. Zabidah Ismail (2005). Usage of Traditional Medicines among Elderly and the Prevalence of Prednisolone Contamination. Malaysian J Med Sci. Jul; 12 (2): 50–55.

Conflict of Interest: None Declared

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Review article CONCEPT OF VEGADHARANA IN VIEW OF PREVALENCE OF DISEASES IN FEMALES Suramya Suresh1*, Akhilesh Shukla2, Haroon Irshad3, Leena P Nair4, Jaya Shankar Mund5 1

PG Scholar, Department of Samhita, Sanskrit and Siddhanta, Amrita School of Ayurveda, Clappana P.O., Kollam Dist, Kerala – 690525 2,3,4 Assistant professor, Department of Samhita, Sanskrit and Siddhanta, Amrita School of Ayurveda, Clappana P.O., Kollam Dist, Kerala – 690525 5 Professor & HOD, Department of Samhita, Sanskrit and Siddhanta, Amrita School of Ayurveda, Clappana P.O., Kollam Dist, Kerala – 690525 *Corresponding author: E-mail: drsuramyasuresh@gmail.com

Received: 20/02/2016; Revised: 30/03/2016; Accepted: 10/04/2016

ABSTRACT Human body is the most evolved and sophisticated system which has its own purificatory mechanism to eliminate the toxic waste substances produced inside it, thus maintaining homeostasis. The Vegas (natural urges) described in Ayurveda is an excellent example of this. Suppression of these Vegas (natural urges) is considered as one of the main causes of almost all the diseases by ancient Ayurvedic classics. Now-a-days due to busy life and heavy work load, people often suppress the nature‟s call. If it is suppressed regularly it will produce long standing consequences. 13 such Vegas are explained in Ayurvedic texts which should not be suppressed at any cost. Due to stressful life and responsibilities females are more prone to this situation. Many diseases are produced in females due to vitiation of Vata dosha which in turn is caused by Vegadharana. Awareness is to be generated to prevent this condition. The present review highlights the complications in females due to Vegadharana and some preventive steps. KEY WORDS: Vegas, Suppression of natural urges, Vegadharana, prevalence of diseases in females

Cite this article: Suramya Suresh, Akhilesh Shukla, Haroon Irshad, Leena P Nair, Jaya Shankar Mund (2016), CONCEPT OF VEGADHARANA IN VIEW OF PREVALENCE OF DISEASES IN FEMALES, Global J Res. Med. Plants & Indigen. Med., Volume 5(4): 121–128

Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI ||

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INTRODUCTION: Recently the diseases which are coming under the heading of „idiopathic origin‟ like idiopathic neuropathies are increasing (Idiopathic Neuropathy Overview, 2016). This means many of the concepts regarding etiological factors are still unexplored. One among them is concept of Vegadharana (suppression of natural urges). It is a fundamental and unique concept explained in Ayurveda and is considered as the root cause for many of the diseases (Y.T. Acharya, 2012). Evacuation of natural urges in the proper time and place is essential for the maintenance of perfect health. Vegas (natural urges) are created naturally to eliminate the toxins produced in our body. Initiation of Vega are normal body activities through which unwanted body materials are excreted, this is a process timely carried out at regular intervals & controlled by complex nervous mechanism, suppression of which not only stops the elimination of waste products but also brings strain and abnormalities of nervous mechanism causing many diseases. Vegasandharanam anarogyakaranam ie It is considered as the most important one among that which causes ill health to our body (Y.T Acharya, 2007). So it is very important to respond to these urges for maintaining the homeostasis of the body. Nowa- days, due to busy and stressful lifestyle and in the dream of achieving the big targets in short period, people are suppressing some or most of the natural urges of the body. Females are more subjected to this condition. Women‟s health is directly related to the health of the society. So this study is to highlight the effect of vegadharana on female health & to explore the concept of vegadharana in females and health hazards produced in females by suppression of mootra (urge of micturition/ urination), purisha (urge of defecation), kshut (urge of hunger), trishna (urge of thirst) and nidra vegas (urge of sleep).

DEFINITION OF VEGADHARANAM AND LIST OF ADHARANIYA VEGAS The term Vegadharanam consists of 2 words- Vega and Dharana. The term Vega means “natural urge” and the term Dharana means “suppression”.-According to Acharya Chakrapani, commentator of Charaka Samhita “Vegah pravarttyunmukatvam mutrapurishadinaam” means expulsion of manifested natural urges like urination, defecation etc. (Y.T. Acharya, 2012). Maharshi Charaka has mentioned 13 Adharaniya Vega (non suppressible natural urges). In addition to that Vagbhatacharya and Susrutacharya has mentioned 14th Vega which should not be suppressed. The list of Adharaniya Vega (non suppressible natural urges) is given below in Table No. 1. Natural urges in female Females are more prone to the suppression of urges due to many factors. Acharya Charaka has explained 3 reasons for this They are dependent on social culture and surroundings. Lack of awareness in females also adds on to the situation. Responsibilities of the family also play a major role (Y.T. Acharya, 2007). Apart from these nowadays unhygienic toilets and busy work schedule force females to avoid her bodily needs, this in turn will prove harmful to her in future (Toilets for health, 2016). Eventhough all the vegas are being suppressed by females, Mutra, Purisha, Kshudha (kshut), Trishna and Nidra Vegas are highlighted in this article.

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Table 1: Showing the list of Vega in different Ayurveda Classics (Y.T. Acharya, 2007; Y.T. Acharya, 2008; H. S. Shastri Paradakara, 2010; Brahmasankara Misra, 2012; Brahmasankar Shastri, 2013; P.V.Sharma, 2008)

S.No 1 2. 3. 4. 5. 6. 7. 8 9 10 11 12 13

Non-suppressible urges Mutra Vega (urge of micturition/ urination) Purisha Vega (urge of defecation) Shukra Vega (urge of ejaculation) Apanavata Vega (urge of flatus) Chardi Vega (urge of vomiting) Kshavathu Vega (urge of sneezing) Udgara Vega (urge of eructation) Jrumbha Vega (urge of yawning) Kshudha Vega (urge of hunger) Trushna Vega (urge of thirst) Bashpa Vega (urge of crying) Nidra Vega (urge of sleep) Shramashwas Vega (urge of breathing caused by over exertion) 14 Kasa vega (urge of coughing) 15 Kapha vega 16 Pitta vega

C.S. + + + + + + + + + + + + +

S.S. + + + + + + + + + + + + +

A.H. + + + + + + + + + + + + +

B.P. + + + + + + + + + + + + +

Y.R. + + + + + + + + + + + + +

B.S + + + + + + + +

+ +

C.S. (Charaka Samhita), SS (Sushruta Samhita), A.H. (Asthanga Hridaya), B.P. (Bhavaprakasha), Y.R. (Yogaratnakara), B.S. (Bhel Samhita)

OBSERVATIONS AND DISCUSSION Effects of Mootra Vega Dharana (suppression of urge of urination): Suppression of it can cause pain in urinary bladder, difficulty in micturition, head ache, urinary calculi etc. (Yadavji Trikamji Acharya, 2007; Yadavji Trikamji Acharya, 2010; Yadavji Trikamji Acharya, 2012). It can be correlated to the symptoms of the urinary tract infection which is very common among females now a day (Urinary tract infections, 2016). While sitting in a meeting or busy with the works, nature‟s call will be avoided by people. Some people will be embarrassed to use office bathrooms. They will be rather unaware of the serious consequences of their carelessness (“Holding your pee”, 2012). The normal functioning bladder capacity in adults in about 300–400 ml. Holding urine inside the bladder for a long time will lead to

the stretching of the bladder. When the bladder is full, the automatic feedback mechanism in the bladder sends signal to the brain and the person will have a feeling to void the urine. When the urine is retained in the bladder for a longer time, it can lead to the growth of bacteria in it which in turn can lead to infection (“Holding your pee”, 2012). Purisha Vega Dharana (suppression of urge of defecation): Having normal bowel moments are always recommended for healthy life and make the colon free from unwanted wastage. Suppression can cause pain in pakvashaya (colon), headache, restriction in evacuation of feces and flatus, muscle cramps in leg, abdominal distension (Yadavji Trikamji Acharya, 2007; Yadavji Trikamji Acharya, 2010; Yadavji Trikamji Acharya, 2012). Avoiding bowel movement can also lead to constipation which is potent cause of many

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health hazards (Ben kim, 2013). As food moves through the colon, the colon absorbs water from the food while it forms waste products, or stool (Holding off on number two, 2012). If stool remains in the rectum longer than its normal time, water will be absorbed from the stool. Thus stools become usually hard, dry, small in size and difficult to eliminate leading to constipation. The person will experience pain during defecation. Holding the defecation reflex can also lead to painful side effects like including Arshas (hemorrhoids) or anal fissures (tears in the skin around the anus). These may be produced when the person strains to have a bowel movement (Holding off on number two, 2012). The prevalence rate of constipation is more in females than in males (Irvine EJ et al., 2002). Female gender, increasing age, socioeconomic status and educational level seemed to affect constipation prevalence (Mugie S M et al., 2010). Kshut Vega Dharana (suppression of urge of hunger) The word “hunger” is defined as a sensation of needing food (N.W. Read, 1992). The desire for food is called hunger. Suppression of urge of hunger lead to emaciation, weakness, changes in bodily complexion, malaise, anorexia, giddiness, abdominal colic, drowsiness etc. (Yadavji Trikamji Acharya, 2007; Yadavji Trikamji Acharya, 2010; Yadavji Trikamji Acharya, 2012). If a person avoids the urge of hunger, it will lead to ketosis i.e. elevated levels of ketone bodies in your system. Ketone bodies are produced from fatty acids when liver glycogen is entirely depleted, and are used for energy (Now entering Starvation mode, 2014). Main energy source for brain is the food we take. Thus decreased intake of food will lead to deranged functioning of the brain. Nutritional deficiency may be a complication of suppressing the urge of hunger. Nutritional deficiencies, known as malnutrition, are the result of our body not getting enough of the nutrients it needs (Nutritional deficiencies, 2015). Females are more affected by the threat of nutritional deficiencies (Elizabeth.I.Ransom & Leslie.K.Elder, 2003). The most prevalent

nutritional deficiency worldwide among females is iron deficiency anemia. In females monthly blood loss and pregnancy is the main cause for the deficiency. Untimely food intake also leads to the same condition. Similarly Vitamin A is essential for normal functioning of eye and reproductive health in males and females. Its deficiency can lead to alterations in these factors. Vitamin B1 (thiamine) deficiency can cause weight loss, fatigue, and nerve and muscle damage. Vitamin B-9 (Folate) is essential for the fetal development and also for the development of child‟s brain and spinal cord. Deficiency of it will lead to birth anomalies, growth problems etc. Calcium is yet another nutrient which is very essential for production of bone and teeth. It also helps in proper functioning of heart, muscles etc. If your dietary calcium intake is less than the bodily requirement body will take the calcium from bones leading to decrease in bone density. The complications of calcium deficiency such as low bone mass, weakening of bones due to osteoporosis, convulsions, and abnormal heart rhythms and even can be life-threatening (Nutritional deficiencies, 2015). Many of these deficiency disorders are seen in females who avoid taking food when needed which in turn will hamper their physical health as well as reproductive health. Inadequate food intake for a longer time may also lead to mild to severe psychological disturbances (Akhilesh Shukla et al., 2015). Trishna vega Dharana (Suppression of urge of thirst) Suppression of thirst causes dryness of the throat and mouth, deafness, exhaustion, weakness and sammoha (unconsciousness) (Yadavji Trikamji Acharya, 2007; Yadavji Trikamji Acharya, 2010; Yadavji Trikamji Acharya, 2012). Dehydration is the adverse consequence of inadequate water intake. Thirst is the craving for fluids, resulting in the basic instinct of animals to drink. It is an essential mechanism involved in fluid balance in our body. Thirst is produced when there is depletion in intracellular or extracellular fluid

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volume (Michael J. McKinley & Alan Kim Johnson, 2004). Suppression of urge of thirst causes fatigue, asthma or other respiratory ailments, high cholesterol, high BP, digestive disorders, skin disorders etc. Mild to moderate dehydration will lead to symptoms like dry, sticky tongue, excess tiredness, dry skin etc whereas severe dehydration shows extreme thirst, low blood pressure, rapid heartbeat, rapid breathing, fever etc, in severe cases it can even lead to unconsciousness. (Lizette Borelli, 2015; Mercola, 2016) Nidra vega Dharana (suppression of urge of sleep) Suppression of urge of sleep causes delusion, too much yawning, malaise, squeezing pain all over the body, drowsiness, lassitude, headache and heaviness in the head and eyes (Yadavji Trikamji Acharya, 2007; Yadavji Trikamji Acharya, 2010; Yadavji Trikamji Acharya, 2012). Sleep has an effect on almost all the systems in our body including endocrine, digestive, nervous systems etc especially in females. Sleep has an effect on the release of sex hormones and it also encourages puberty & fertility. Consequently, women who work at night and tend to lack sleep are therefore, more likely to have trouble conceiving or to miscarry. According to some experts lack of sleep can be considered as the cause for depression after childbirth (postpartum blues) (“Your guide to Healthy sleep”, 2005). According to Dr. Jim Home, women need more sleep than men as they multitask and use their brain more than men (“Do women need more sleep than men?”, 2012). Studies have proven that deficiency of sleep alters activity in some parts of brain. Sleep deprivation is considered as one among the main causes for obesity. Sleep loss increases appetite as it causes an increase in the level of ghrelin (appetite stimulating hormone) and decrease in the level of leptin (satiety inducing hormone).

It increases the affinity of a person towards fat and carbohydrate rich food leading to obesity (“Sleep Obesity Prevention Source”, 2015). According to various studies, a higher BMI is strongly linked to short sleep in children. It brings about changes in human eating behavior. It deranges the release of the growth hormone affecting muscle mass development, tissue repair, puberty and fertility. Sleep deprivation triggers the release of adrenaline, cortisol and other stress hormones, leading to an increased risk of cardiovascular disease. Sleep deprivation can affect the judgement capacity of a person. Studies have proved that normal sleep will protect nervous tissue by producing some chemicals (Viatcheslav Wlassoff, 2014). Lack of sleep may increase the risk of death. Prevention is better than cure. Even though Ayurveda is a science which deals with two aspects- curative and preventive, it gives more emphasize on its preventive aspects. Considering these facts we must think of some preventive steps to avoid these ailments which will produce severe health hazards especially in females. Awareness is to be generated in the society to prevent this type of ailments in females. PREVENTIVE MEASURES The women should be educated about the serious consequences which will be harmful to their future health. Awareness given to a female is not only helpful to her but also to her future generations and the society as a whole. Hygienic toilets are to be provided in public places. Many a times absence of hygienic toilets lead to the suppression of urges especially by females. Support and help of the family is to be assured to reduce the work load of females. Participation of the family in her works will reduce her work and there by provide time for her bodily needs. Adequate intervals should be given to females during working hours in their work places.

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Table: 2 - Showing the Suppression of Natural urges and their effect on female health Natural Urges Forceful suppression of natural urges

Diseases Caused Sutika roga (post-natal disorders), Pandu (anemia), Ardhavabhedaka (hemicrania), Udavarta (-dysmenorrhoea), Apasmara (epilepsy), Yoni Shosha (dryness of vagina), Ajirna (indigestion), Vata vyadhi (diseases of Vata) Forceful suppression or expulsion of urge of Arsha (haemorrhoids) micturition and defecation Kustha (Skin disease) Suppression of Urge of Vomiting Upapluta, Gulma (phantom tumour ) Suppression of Urge of Vomiting and breath Paripluta, Kasa Suppression of Urge of Sneeze Grahani (irritable bowel syndrome), udavarta Suppression of hunger (upward movementof vata), Karshya (emaciation) Copulating while having the urge of Mutravaha srotas dushti (vitiation of channels carrying urine), micturition Suppression of natural urges by Garbhini Garbhopaghata (death of the fetus inside the uterus, abortion or cachexia of the fetus) (pregnant)

CONCLUSION Vegadharana is a concept elaborately explained in Ayurveda. It is considered as the most important among those which causes ill health to a person. Women are the most susceptible group for this condition due to many of the reasons like responsibilities, lack of awareness etc. Innumerable consequences can be observed in female health because of the negligence towards the natural urges. Most of these diseases are difficult to be managed due

to shyness or financial problems. According to Benjamin Franklin “An ounce of prevention is worth a pound of cure.” So prevention should be given more importance which is easier than disease management. Many research studies had been done on this subject. But many areas like effect of vegadharana on gynaecological health of females etc are still remaining unexplored. These are to be thoroughly studied and understood to protect female health which is very much essential for a healthy society.

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Ben Kim (2013), How to Have Healthy Bowel Movements retrieved on february 13, 2016 from http://drbenkim.com/colonclean-healthy.html. Brahmasankar Sastri (2013), Yogaratnakara, Reprint edition, Chaukhambha publications Varanasi, uttarardha, sutra 1, page 18.

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Brahmasankara Misra And Rupalalaji Vaisya (2004), Bhavaprakasha of Bhavamisra, eleventh edition Chaukhambha orientalia Sanskrit Series, Varanasi, uttarardha madhyamakhanda, Chapter 31 sutra 1, page 332 Do women need more sleep than men? (2012) retrieved on february 16, 2016 from https://sleepfoundation.org/sleepnews/do-women-need-more-sleep-men. Elizabeth.I. Ransom and Leslie.K.Elder, (2003), Nutrition of Women and Adolescent Girls: Why It Matters retrieved on april 8 2016 from http://www.prb.org/Publications/Article s/2003/Nutrition of Women andAdolescent Girls Why It Matters.aspx Holding off on number two (2012) retrieved on february 8, 2016 from http://goaskalice.columbia.edu/answere d-questions/holding-number-two Holding Your Pee: Health Risks From Ignoring Nature's Call (2012) retrieved on february 7, 2016 from http://www.huffingtonpost.ca/2012/02/2 7/holding-your-pee-health_n_1299435.html Idiopathic neuropathy overview (2016), retrieved on April 6, 2016 from http://www.healthline.com/health/idiop athic-neuropathy Irvine EJ, Ferrazzi S, Pare P,Thompson WG, Rance L (2002), Health-related quality of life in functional GI disorders: Focus on constipation and resource utilization. Am J Gastroenterol; 97:1986–93

Lizette Borelli (2015), Lack of drinking water deteriorates human body. Adverse effects of dehydration retrieved on february 7, 2016 from http://www.medicaldaily.com/pulse/lac k-drinking-water-deteriorates-humanbody-adverse-effects-dehydration329640 Mercola (2016), What Happens to Your Body When You’re Dehydrated, Retrieved february 8, 2016 from http://articles.mercola.com/dehydrationsymptoms.aspx Michael J. McKinley, Alan Kim Johnson (2004), The Physiological Regulation of Thirst and Fluid Intake Vol. 19 no. 1, 1–6. Mugie S.M, Benninga M.A, Di Lorenza C (2011), Epidemiology of constipation in children and adults, a systematic review doi: 10.1016/j.bpg.2010.12.010. Now Entering Starvation Mode: What Happens To Your Metabolic Processes When You Stop Feeding Your Body (2014), retrieved february 7, 2016 from http://www.medicaldaily.com/nowentering-starvation-mode-whathappens-your-metabolic-processeswhen-you-stop-feeding-280666 Nutritional deficiencies (malnutrition) (2015) retrieved february 2, 2016 from http://www.healthline.com/health/maln utrition. Read N.W., (1992), Role of gastrointestinal factors in hunger and satiety in man, Proc Nutr Soc, 1992 May;51(1):7–11.

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Shastri Paradakara H. S. (2010), Astanga Hridaya with Sarvangasundara and Ayurveda Rasayana commentary by Arunadatta and Hemadri, Reprint edition, Chaukhambha Surabharati Prakashana, Sutrasthana Chap 4, Sutra 1

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Sharma P.V., (2008), Bhela Samhita, Reprint edition Chaukhambha publications, Varanasi, chapter 6, sutra1,2 Toilets for health (2016), retrieved on april 7, 2016 from http://en.hesperian.org/hhg/New_Where _There_Is_No_Doctor:Toilets_for_Heal th_(Sanitation) Urinary tract infections (2016), retrieved on April 4, 2016 from http://www.memd.me/conditions/urinar y-tract-infections/

Yadavji Trikamji Acharya (2010), Ashtangahrudaya with Sarvangasundara and Ayurveda Rasayana commentary by Arunadatta and Hemadri, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Sutrasthana Chap 4, Sutra 22, page 56 Yadavji Trikamji Acharya (2012), Sushruta Samhita with Nibandasamgraha commentary by Dalhana, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Uttarasthana, Chapter 55, Sutra 3-16; page 776â&#x20AC;&#x201C;777 Your Guide To Healthy Sleep (2005), retrieved on 10-2-16 from https://www.nhlbi.nih.gov/files/docs/pu blic/sleep/healthy_sleep.pdf.

Source of Support:

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Conflict of Interest: None Declared

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Short communication SCREENING OF ANTIMICROBIAL ACTIVITY OF MOCHARASA (BOMBAX CEIBA L.) Sanjivani Samadhan Shekokar1*, SV Shete2 1

Associate Professor, Department of Dravya Guna, Government Ayurveda College, Nanded, Maharashtra, India 2 H.O.D., Microbiology Dept., Netaji Subashchandra Bose Science College, Nanded, Maharshtra, India *Corresponding Author: E-mail: drsanjivanisshekokar@rediffmail.com

Received: 08/03/2016; Revised: 01/04/2016; Accepted: 16/04/2016

ABSTRACT Human being uses plants for food as well as for curing the natural vagaries like diseases since ancient times. Many drugs derived from plant molecules acts as antibacterial or antifungal drugs. Drugs like Mocharasa (gum of BOMBAX CEIBA L.) are being used to treat infectious diseases like diarrhoea, dysentery, cholera since many centuries. The study of antimicrobial activity of Mocharasa aqueous extracts invitro was assessed against certain microorganisms using the agar disc diffusion method. Samples of Mocharasa were collected from tree source. Antimicrobial activity of Mocharasa was carried out with different strains of bacteria such as Salmonella typhii, Staphylococcus aureus, Shigella dysentrae, and Escherichia coli. The diameter of inhibition zone was used as indicators of antimicrobial activity. Observation on the basis of diameter of zone of inhibition on the petri dishes was noted & the area was calculated and comparison was done. Staphylococcus aureus and Salmonella typhii were having a good zone of inhibition ranging between 15–17 mm in diameter whereas Shigella dysentrae and Escherichia coli were having no zone of inhibition. The study showed that Mocharasa is effective in the studied concentration in Staphylococcus aureus and Salmonella typhii and not in Shigella dysentrae and Escherichia coli. KEY WORDS: Mocharasa, Pravahika, Atisara, Salmonella typhii, Shigella dysentrae, Escherichia coli, Staphylococcus aureus, Antibacterial activity, zone of inhibition

Cite this article: Sanjivani Samadhan Shekokar, SV Shete (2016), SCREENING OF ANTIMICROBIAL ACTIVITY OF MOCHARASA (BOMBAX CEIBA L.). Global J Res. Med. Plants & Indigen. Med., Volume 5(4): 129–136

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Global J Res. Med. Plants & Indigen. Med. | Volume 5, Issue 4 | April 2016 | 129–136

INTRODUCTION The use of herbs as medicine is the oldest form of healthcare known to humanity and has been used in all cultures throughout history (Barnes J et al., 2007). Early humans recognized their dependence on nature for a healthy life and since that time humanity has depended on the diversity of plant resources for food, clothing, shelter, and medicine to cure myriads of ailments. Primitive human treated illness by using plants, animal parts, and minerals that were not part of their usual diet. Herbal medicines are in great demand in both developed and developing countries as a source of primary health care owing to their attributes having wide biological and medicinal activities, high safety margins and lesser costs. Herbal molecules are safe and would overcome the resistance produced by the pathogens as they exist in a combined form or in a pooled form of more than one molecule in the protoplasm of the plant cell (Lai PK & Roy J, 2004). Even with the advent of modern or allopathic medicine, (Balick, 1996) have noted that a number of important modern drugs have been derived from plants used by indigenous people. Due to the increasing drug resistance of the bacteria (Joseph Gangoué-Piéboji1 et al., 2009) by frequent use of antibiotics there is increased risk of diseases so now it’s time to explore new alternatives to the newer antibiotics from plant sources. The antimicrobial compounds found in plants may prevent bacterial infections by different mechanisms than the commercial antibiotics and therefore may have clinical value in treating resistant microorganism strains (Eloff, 1999). The indiscriminate use of antibiotics has resulted in many bacterial pathogens rapidly becoming resistant to a number of originally discovered antimicrobial drugs (Barbour et al., 2004). There is, thus, a continuous search for new antibiotics, and medicinal plants may offer a new source of antibacterial agents.

Many antibiotics have lost effectiveness against common bacterial infections because of increasing drug resistance (Perez et al., 1990; Barie, 1998; Domin, 1998; Okeke et al., 2005). Indiscriminate, inappropriate, and prolonged use of antibiotics have selected out the most antibiotic-resistant bacteria (Van Waaig & Nord, 2000; Petrosillo & Pantosti, 2002). Microbiological assay is a process of analysing the changes of inhibition of growth of bacteria by measured concentration of the drugs to be examined. The inhibition of microbial growth under standardized conditions is generally utilized for demonstrating the therapeutic efficacy of antibiotics (R. Aanathanrayan, 2005). Human beings have used plants for the treatment of diverse ailments for thousands of years (Sofowara, 1982; Hill, 1989). Ayurveda has references of use of plant drugs in many diseases which are now differentiated as bacterial, fungal, systemic, organic, etc. So, to assess the efficacy of plant drug in the diseases caused by bacteria a study was planned to assess the effect of Mocharasa (Gum of Bombax Ceiba L.,) in bacterial invasion like Atisara (Diarrhoea), Pravahika (dysentrae), Grahani (irritable bowel syndrome) and causative bacterial strains like Salmonella typhii, Shigella dysentrae, Staphylococcus aureus and Escherichia coli, commonly occurring in the intestine and causing similar symptoms were selected for the invitro antimicrobial activity study. Mocharasa known as Shalmali Niryasa, is described to be used preferably in diseases like Pravahika, Atisara, Grahani, Raktaja Atisara, etc (Chunekar, 2002) which shows similar symptoms to bacillary dysentery or diarrhoea. According to the modern concepts, these diseases are supposed to be bacterial in origin. Mocharasa has been proved to be a potent anti diarrhoeal drug so diarrhoea causing bacterial strains was selected to assess the efficacy (Shingh, 1982).

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MATERIALS AND METHODS Plant Materials Various samples of Mocharasa were procured from various Market areas of India, out of these some were heavier in weight, reddish brown in colour, stout/solid and were opaque. Some samples were collected from tree source from forest area of Sitakhandi forest, Tq. Bhokar, Dist. Nanded (M.S.) and forest area of Kolhapur region (M.S.). All these samples were sent to National Institute of Science Communication And Information Resources, Raw Materials Herbarium and

Museum, New authentication.

Delhi

(NISCAIR)

for

Two samples authenticated by National Institute of Science Communication and Information Resources, Raw Materials Herbarium and Museum, New Delhi (NISCAIR) as Mocharasa, (dried gum of Bombax ceiba L.) were taken for the antibacterial activity study which were, dark brown, hollow and light in weight. These samples were collected from from Bhokar forest named as sample A1 and from Kolhapur forest named as sample A2.

Fig.1 shows various samples collected from different places for the antibacterial activity study.

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Selection activity

Bacteria

for

antibacterial

Many different strains of bacteria (Duguid, 1975) are present in human gut and production of diseases depends mainly on either colonization or by previous or new acquisition of bacteria. The bacterial strains were selected on the basis of common symptoms caused by bacteria like diarrhoea, dysentrae and are also found in the intestinal tract such as- Salmonella typhii, Shigella dysentrae, Staphylococcus aureus and Escherichia coli. All strains of bacterial cultures were procured from the Department of Microbiology, Netaji subash Chandra Bose, Science College, Nanded, Maharashtra. The antibacterial activity study was carried out in Microbiology dept, NSB College, Nanded, Maharashtra, India. METHODOLOGY Preparation of extraction: The selected Mocharasa samples named as A1 and A2 samples were powdered and water extract was prepared by dissolving the powdered drug in water in shaker machine, kept shaking for 6 hours and standing for 18 hours, filtered after 24 hours and dried in petri dish to make 10% aqueous extract. Dried extracts of both the samples were taken for the study and DMSO i. e. Dimethyl sulphate was used as Control. Composition of media: Nutrient Agar media as - Peptone- 1 gm, 1Meat extract - 0.5 gm, Sodium Chloride (NaCl) - 0.3 gm, Distilled water (H2O) – 100 ml (pH – 7.2), Agar–agar - 2.5 gm (Ananthnarayan, 2014) Preparation of nutrient agar An amount of 24.8 g of nutrient agar was weighed into a conical flask. One thousand millilitres of distilled water was added and the mixture was melted over a Bunsen flame. The mixture was then poured into test tubes, 20 ml

each and plugged with cotton wool. The cotton wool was covered with cellophane and the test tubes were autoclaved at 1.1 kg/cm3 steam pressure for 15 min. The nutrient agar was then stabilized in an electric water bath at 45°C for 15 min before use. Microbiological assay of antibiotics Disc diffusion method was used for the antimicrobial assay (Ananthnarayan, 2005; Gislene, 2000). Temperature control as required in different stages of a microbial assay was used during culturing of microorganism and preparing its inoculums, and during incubation in a plate assay. Glass petri dishes (approximately 20 × 100 mm) having covers of suitable material were sterilized and used. For assay, holes of 5 to 8 mm in diameter were bored in the medium with a sterile borer. The agar disc diffusion method was employed in the assay. Twenty millilitres of stabilized nutrient agar was seeded with microorganisms, palmed and poured into a Petri dish to solidify. A cork borer of 8 mm in diameter was used to make wells in the agar. With the aid of a syringe, the wells were filled with different concentrations of the plant extracts. The extract was allowed to diffuse for 30 minutes and the plates were incubated at 37°C for 24 h. The zone of inhibition of the extract, the clear area around the well was measured in millimetres (mm) using a ruler after 24 h of incubation. The diameters of the circular inhibition zones were measured in mm with the help of a scale and the results were calculated. Quantity of samples used- 0.1 ml Dose of compound- 10% water extracts Well size- 8 mm The observations of the study are as shown in Fig.2 and obtained measurements of antibacterial activity as shown in table 1.

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Fig. 2 Antibacterial activity of Mocharasa

A1- Bhokar and A2 - Kolhapur Samples 10% aqueous extract used OBSERVATIONS Table 1- Showing Diameter of inhibition Zones (DIZ) of the test samples on the bacteria used. Sr. no.

Sample

Conc. Extracts

Escherichia coli

Salmonella typhii

Staphylococcus Aureus

Shigella dysetrae

0.1ml

−ve

15mm*

17mm*

−ve

0.1ml

−ve

15mm*

18mm*

−ve

*IZ = Inhibition zone (mm), −ve = No antibacterial activity

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Results obtained were as follows, 1) Staphylococcus aureus and Salmonella typhii were having a good zone of inhibition on bacteria. 2) Shigella dysentrae and Escherichia coli were having no zone of inhibition.

stambhana (preventing further loss of fluids in the form of liquid stools) in Atisara (diarrhoea) and pravahika (dysentery) (Sharma, 2006). The phyto constituents like Tannin, tanic acid may also have played role in inhibition of the above bacteria.

So antibacterial activity of Mocharasa was found positive on Staphylococcus aureus and S. typhii and negative on E. coli and S. Dysentrae (as shown in table 1).

CONCLUSION

DISCUSSION The extract of Bombax ceiba L. Gum i.e. Mocharasa showed some levels of inhibitory activity against Salmonella typhii and Staphylococcus aureus by inhibiting their growth. This suggests that the extract contained antimicrobial substances like tannin, Catechol, Tannic acid, Galic acid, (Hisanori Akiyama et al., 2001) which are responsible for the antibacterial activity. The effect of the plant extract varied from one microorganism to another. Salmonella typhii and Staphylococcus aureus were only susceptible to the extract than the rest of the microorganisms. The activity of the plant extract may be dependent on the increasing concentration. Although the antimicrobial activities for 10% extract occurred to be positive and good for the Salmonella typhii and Staphylococcus aureus. But, there was no significant effect on the inhibition of Escherichia coli and Shigella dysentrae. May be the increasing concentration of the extract may show inhibitory effect on these bacteria as Mocharasa is used in Piccha basti (a type of enema) in Atisara (diarrhoea) and Pravihaka (dysentry) very effectively. Properties of Mocharasa are kashaya rasa (Astringent), sheeta virya which helps in for shoshana (reabsorption of fluids in the bowel),

Out of the four types of bacteria used for study, Staphylococcus aureus and Salmonella typhii cultured plates were having a good zone of inhibition of bacteria whereas plates cultured with Shigella dysentrae and Escherichia coli were having no zone of inhibition. This shows Mocharasa extract is having antibacterial activity against salmonella typhii and Staphylococcus aureus with 10 % extract calculated on the basis of increased diameter of inhibition zone but had no bacteria inhibiting activity in this concentration of drug. So this proves the efficacy of Mocharasa as an antimicrobial drug on Staphylococcus aureus & Salmonella typhii more strongly as compared to the other strains and hence Mocharasa can be a promising drug to be used in bacterial infections of the GIT. Further Scope of the study: 1. The study is done using only two samples so number of samples and different strain of bacteria can be studied. 2. The study can be conducted by using modern allopathic drugs as control group. 3. 20%, 40%, 60% of extraction to be used to study the antibacterial activity in Shigella dysentrae and Escherichia coli. 4. Clinical trial should be conducted, to analyze its efficacy on clinical subjects.

REFERENCES Aanathanrayan R, Jayaram CK, (2005, 2014) Text Book of Microbiology, 4th edition, Orient Longman Ltd., Hyderabad, page no. 133 and page no.40.

Barnes J MD, Anderson LA, Phillipson JD (2007) Official Methods of Analysis of AOAC International journal, AOAC International, 18th edition, AOAC International.

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Chunekar KC, Pandey GS (2002), vatadi varga, Bhavprakash Nighantu, Chawkhamba Bharati Academy, 1st Reprint edition, 57. Dey NC (1967), Medical Bacteriology, 5th & 6th edition, Allied Agency Calcutta. Doughari, J.H. & Obidah, J.S. (2008) Antibacterial potentials of stem bark extracts of Leptadenia lancifoli against some pathogenic bacteria, Pharmacologyonline, 3: 172–180. Doughari, J.H.; Human, I.S, Bennade, S. & Ndakidemi, P.A. (2009) Phytochemicals as Chemotherapeutic agents and antioxidants: Possible solution to the control of antibiotic resistant verocytotoxin producing bacteria. Journal of Medicinal Plants Research, 3(11): 839–848. Dhar DN, Munjal RC (1976), Chemical examination of the seeds of Bombax malabaricum, planta med. Mar, 19(2): 148–50. Drik van der waijj, Nord, (2000), International journal of antimicrobial agents, 12/2000; 16(3):191–7 Duguid P, Robert Cruckshank, Marmoin BP, Medical Microbiology, Vol- II, 12th edition, Churchill Living Stone Edinburg publication, London. Eloff JN (1999). The antibacterial activity of 27 Southern African members of the Combretaceae. S. Afr. J Sci. 95: 148– 152. Gislene G. F. Nascimento; Juliana Locatelli; Paulo C. Freitas; Giuliana L. Silva, (2000) Plant Extracts And Phytochemicals On Antibiotic-Resistant Bacteria, Brazilian Journal Of Microbiology, Vol.31, No.4.

Hisanori Akiyama, Kazuyasa Fujii, Osamu Yamasaki, Takashi Oono & Keiji Iwatsuki (2001), Antibacterial action of several tannins against Staphylococcus aureus, J. Antimicrob. Chemother. 48 (4): 487–491. doi: 10.1093/jac/48.4.487 Joseph Gangoué-Piéboji, Noelly Eze, Arnaud Ngongang Djintchui, Bathélémy Ngameni, Nolé Tsabang,…..Moreno Galleni, (2009), The in-vitro antimicrobial activity of some traditionally used medicinal plants against beta-lactam-resistant bacteria, J Infect Dev Ctries; 3(9):671–680. James Hamuel Doughari, Phytochemicals: Extraction Methods, Basic Structures and Mode of Action as Potential Chemotherapeutic Agents, page no. 8 Lai, P.K. and Roy, J. (2004) Antimicrobial and Chemopreventive Properties of Herbs and Spices. Current Medicinal Chemistry, 11,1451–1460. Niranjan GS, Gupta PC (1973), Anthocyanins from the flowers of Bombax malabaricum, Planta Med. Oct, 24(4): 96–9. Sharma P ( 2006), Dravyaguna Vidnyan Vol-II, edition 3rd, Chaukhamba Bharati Prakashan, Varanasi, Page No. 491– 492. Shingh KP and Chaturvedi (1982), Study of anti-diarrhoel effect of Bombax malabaricam, Journal, Vol.-25, p.p. 130–135. Saleem R, Ahmad M, Hussain SA, Qazi AM, Ahmad SI,......Husnain SN. (1999), Hypotensive, hypoglycemic and toxicological studies on the flavonol, cglycoside shamimin from Bombax ceiba. Planta Med. Hamdard University Karachi, Pakistan, May; 65(4): 331–4

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Shahat AA Hassan RA, Nazif NM, Van Miert S, Pieters L....... Vlietinck AJ (2003), Isolation of mangiferin from Bombax malabaricum and structure revision of Shamimin, Dept. of pharmaceutical sciences, National Research Centre Dokki, Cairo, Egypt. Planta Med. Nov; 69(11):1068–70. Taylor PW, Stapleton PD, Luzio JP (2002). New ways to treat bacterial infections. Drug. Discov. Today 7: 1086–1091. Us Pati & Kurude, (2000), Antibacterial activity screening methods for evaluation of natural products, regional station, Indian veterinary research institute, Palampur, HP. Source of Support: NIL

Wang YC, Huang TL (2005), Screening of anti-Helicobacter pylori herbs deriving from Taiwanese folk medicinal plants, Dept. of Food Science, National Chung Hsing, University, 250, Kukuang Road, Taichung 40227, Taiwan, FEMS Immunol Med. Microbial, Feb 1; 43(2): 295–300. You YJ, Nam NH, Kim Y, Bae KH, Ahn BZ (2003), Antiangiogenic activity of lupeol from Bombax ceiba, College of Pharmacy, Chungnam National University, Taejon 305–764, Korea. Phytother Res. April; 17(4): 341–4.

Conflict of Interest: None Declared

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Case Study A CASE STUDY ON THE AYURVEDIC MANAGEMENT OF APABAHUKA WITH KARPASASTHYADI TAILA NASYA AND PHYSIOTHERAPY Krishnaprabha A1*, Ratnaprava Mishra2, Krishna Kumar K3 1

P.G. Scholar, Department of Kayachikitsa, Amrita School of Ayurveda, Kollam, Kerala - 6090525, India Professor & HOD, Department of Kayachikitsa, Amrita school of Ayurveda, Kollam, Kerala – 6090525, India 3 Associate Professor, Department of Kayachikitsa, Amrita School of Ayurveda, Kollam, Kerala – 6090525, India *Corresponding Author: E-mail: kribha90@gmail.com 2

Received: 13/02/2016; Revised: 30/04/2016; Accepted: 20/04/2016

ABSTRACT In the fast developing technological era, most of the diseases may not be life threatening but hamper day to day life and human productivity. Apabahuka is one among those diseases which is painful and affects the normal routine life style of an individual. It is one among the Vatavyadhi which affects the normal functioning of the upper limbs. Nasya is one of the important procedures of classical Panchakarma therapy mentioned in classics for managing Apabahuka. We hereby report a case of Apabahuka (complaints of severe pain & stiffness, over the back of neck associated with restricted movement of left hand) which was treated for two months under a private orthopedic surgeon with no significant relief and later treated with Ayurveda. The Ayurveda treatment plan includes Nasya with Karpasasthyadi Taila and physiotherapy for a period of 16days (After 7days an interval of 2days was given, again the treatment was continued for another 7days). Substantial clinical improvement was reported in quality of life after 16 days of the treatment. During the treatment all the signs and symptoms of the patients reduced to a greater extent. KEY WORDS: Vatavyadhi, Apabahuka, Nasya, Vyaayama, Karpasasthyadi Taila

Cite this article: Krishnaprabha A, Ratnaprava Mishra, Krishna Kumar K (2016), A CASE STUDY ON THE AYURVEDIC MANAGEMENT OF APABAHUKA WITH KARPASASTHYADI TAILA NASYA AND PHYSIOTHERAPY, Global J Res. Med. Plants & Indigen. Med., Volume 5(4): 137–145

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INTRODUCTION “If your lifestyle does not control your body, eventually your body will control your life style”-This is a very relevant quote concerning the young generation. Stressful life, job pattern, travelling, workouts or ageing; all these can lead us to one most common health problem, i.e. shoulder pain. It is one health issue that makes us restless and if not taken care of, results in making our routine terrible. Shoulder pain is the third most common cause of musculoskeletal consultation in primary care.1% of adults with new shoulder pain consults their General Practitioner each year (Urwin M, Symmons D et al., 1998) Economy of country relies on its work force. Apabahuka is one of such disease which hampers the day to day activity of an individual. The fact that Vatavyadhi is one amongst the Asta-maha gada (8 major diseases) (Y.T. Acharya, 2005) makes it selfexplanatory regarding the consequences caused by Apabahuka. In the modern point of view under vatavyadhi, the diseases involving neurological, musculo-skeletal, psychosomatic and gastro-intestinal system disorder may be considered. It indicates the wide-ranging involvement of vata in various systems of body. Apabahuka is a vata vyadhi localizing around the amsa pradesa (shoulder region) and thereby causing soshana (wasting/weakness) of amsa bandha (shoulder joint) as well as akuncana of sira (Y.T. Acharya, 2005) at this site leading to symptoms like bahupraspandita hara (affects normal activities of the hand) (Acharya Vaidya Harisastri, 2014). Amsa Shosha (muscle wasting) can be considered as the preliminary stage of the disease where loss or dryness of the Shleshaka kapha from the shoulder joint occurs. In the next stage, due to the loss of Shleshaka kapha (a type of the kapha humor) symptoms like shoola (pain) during movement, amsa stabdada (restricted movement) etc. are manifested (Das et al., 2010). An exact modern correlation may not be accurate to explain the condition of Apabahuka, but still diseases like Adhesive capsulitis,

Rotator cuff injury, Bicipital tendonitis etc may be considered based on clinical features. Nasya (a special treatment procedure in Ayurveda to instil drops through the nostrils) is the most important procedure, as it is mentioned for managing urdhwajatru gata rogas (diseases affecting the regions above shoulders) (Acharya Vaidya Harisastri, 2014). So in some places it has been given first place in the sequence of panchakarma (the 5 purification therapies), for eg: in the chapter of Apamarga Tanduliya of Caraka samhitha, sutrasthana. All the Brihatrayees (the 3 major lexicons of Ayurveda) has mentioned in detail about the role of Nasyakarma in managing Apabahuka. Nasa (nose) is told as dwara (gateway) for Shiras (head). Also the drug administered through the nose nourishes the Shiras (head), Skandha (shoulder), Greeva (neck), Vaksha (chest) (Acharya Vaidya Harisastri, 2014). Hence an effort had been made to evaluate the efficacy of Nasya along with vyaayama (physiotherapy) in the management of Apabahuka. MATERIALS & METHODS A 50 year-old female patient of vata kaphaja prakriti visited the Kayachikitsa O.P.D, Amrita school of Ayurveda, Kerala, India on 3rd November 2015 with M.R.D no: 60317, with complaints of shoola (severe pain), stambha (stiffness), over the back of neck associated with restricted movement of left hand for three months. There was no obvious history of trauma, except the strenuous house hold work. She had regular appetite and bowel movement was normal. The pain aggravated during activities, cold climate, especially in the evenings or night hours. Patient got mild relief from the symptoms after taking rest and heat application. On examination, it was elicited that the patient had restricted Range of movements (ROM) of the Left shoulder joint and maximum tenderness was noticed at the head of humerus with no obvious swelling. The Apley scratch Test was found to be positive.

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There was a history of treatment for the same complaint under a private orthopaedic surgeon for last two months with no significant relief. Routine blood investigations including RA (Rheumatoid arthritis) factor and X-ray examination of hand were done by the surgeon and all investigations were found within normal range. TREATMENT PROTOCOL After careful assessment and examination, patient was subjected for Nasyakarma with karpasasthyadi Taila and physiotherapy for a period of 16 days (two consecutive seven days of Nasya and physiotherapy with a gap of 2 days in b/w). Assessment was done on the subjective and objective parameters before and after treatment. A special scoring pattern was prepared for the assessment of subjective parameters. Pain (amsa sandhi soola) was assessed by Visual Analogue scale (0–10scale). Other symptoms like Bahusosha (wasting) or sopha due to involvement of kapha dosha (swelling) was measured by assessing arm circumference and range of movements by Goniometer.

Trikatu choornam (powder of Zingiber officinale, Piper longum & piper nigrum), five grams twice daily with hot water for three days for the purpose of deepana (digestive) and pachana (carminative). Then, Nasyakarma was done by assessing roga bala (Strength of the disease), rogi bala (Strength of the pathient) and whether the patient is fit for the therapy. The Nasya karma was done with proper poorva, pradhana and paschat karma (3 stages of treatment procedure) (shivprasad Sharma, 2006). In this patient, the matra (dose) adopted for Nasya was 8 bindus (drops) which was a madhyama matra (moderate dosage) (Acharya Vaidya Harisastri, 2014). As already mentioned, Nasya karma was done for a total period 16 days; i.e after seven days of therapy patient was advised to take rest for two days and again the therapy was continued for another seven days. The ingredient details of Karpasasthyadi taila has been enlisted in Table:1. It also contains Tila taila (sesame oil) and Ajaksheeram (Goat’s milk).

On the day of admission, after taking written informed consent, the patient was given Table-1: Key ingredients of karpasasthyadi taila with Botanical Name & Family name Sl No

Drug

Botanical Name

Family Name

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Karpasa asthi Bala Masha Kulatha Devadaru Rasna Kushta Sarsapa Nagara Satahwa Pippalimoola Chavya Sigru Punarnava

Gossypium herbaceum Linn Sida cordifolia Linn. Teramnus labialis spreng Dolichos biflorus Linn. Cedrus deodara Roxb. Pluchea lanceolata DC. Saussurea lappa (Decne.) Sch.Bip. Brassica juncea (L.) Czern. Zingiber officinale Roscoe Anetum sowa Roxb. Ex Fleming Piper longum L. Piper chaba Hunter Moringa oleifera Lam. Boerhavia diffusa L.

Malvaceae Malvaceae Fabaceae Fabaceae Pinaceae Zingiberaceae Asteraceae Brassicaceae Zingiberaceae Apiaceae Piperaceae Piperaceae Moringaceae Nyctaginaceae

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Karpasasthyadi taila is a Vata-kaphahara and Brihmana yoga mentioned in sahasrayoga and is indicated in the form of Nasya in conditions like Apabahuka. (Aravattazhikathu K.V Krishnan et al., 2012). Among the physiotherapy, Heat therapy which decreases joint stiffness and reduces pain

along with exercises such as pulley exercise, wheel exercise were advised for the patient. The overall reduction in symptoms was graded based on patient’s presentation and physician’s observation and were documented before and after treatment. The method of gradation and assessment has been explained in Table 2 & 3.

Table 2 (a, b, c & d): Criteria for assessment-subjective 2a. Shoola (Pain) GRADE DURATION OF PAIN 0 1 2 3 4

GRADE 0 1 2 3 4

Nil/absent 1–4hrs/day 5–8hrs/day 9–12hrs/day More than 12hrs/day

2b. shoola Teevrata (Severity of pain) SEVERITY OF PAIN No pain Mild pain on movements (I am aware only if I pay attention to it) Severe pain on movements (I can ignore at times, and can do my daily activities) Continuous severe (I cannot ignore but sometimes I cannot do my usual activity) Severe intolerable (excruciating), I can’t do anything ,forced to take rest and medicine

GRADE

2c. Tenderness TENDERNESS

0 1

No tenderness Mild tenderness on palpation

2 3

Mild tenderness with grimace Severe tenderness with withdrawal

2d. Visual analogue scale (0-10 SCALE) No pain 0 Mild pain 1-3 Moderate pain 4-7 Severe pain 8-10 In the X-axis days plotted, and in Y-axis,pain gradient was marked

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TABLE 3 (a & b): Criteria for assessment-objective CIRCUMFERENCE

3a. Amsa sosha (Muscle wasting) Before After Treatment(BT) Treatment(AT) Right Left Right Left

Follow up Right Left

MID ARM ELBOW CERVICAL

MOVEMENTS

3b. Range of movements BT AT(DEGREE) (DEGREE) 7TH Day 14TH Day

21st Day

28th Day

FLEXION EXTENSION ABDUCTION ADDUCTION INT. ROTATION EXT.ROTATION

RESULTS AND DISCUSSION With these sixteen days of treatment, patient got tremendous relief from pain and stiffness and marked improvement in the Range of movements (ROM) in the affected hand without any untoward effect. The gradations of the symptoms are shown in tables 4 and 5. There was significant reduction in pain on assessment with VAS pain scale also. The visual analogue scale plotted above represents the pain grade of the patient on 1st, 7th, 14th, 21st, 28th days respectively. On the very first day the pain grade was 9(severe pain). On the 7th day of Nasya and physiotherapy the pain grade became 7 (moderate pain). The 14th day of assessment shows that the symptoms have considerably reduced and the VAS has become 2 (Mild pain). The follow up on 21st day has made the pain scale to 1 (Mild pain) and on the 28th day the patient had no pain or any symptoms. The legendary Acharyas has described the mode of action of Nasya karma. The drugs administered will reach the Shringataka marma

(a vital point in the body) and spread through the opening of the shiras of the eyes, ears, throat, and finally to the head. The Shringhataka marma, is a sira marma, situated at the site of the union of the siras, supplying to the nose, ear, eye, and tongue. (Shivprasad Sharma 2012). Acharya Charaka, while explaining the indication for nasya in siddhisthana, has emphasized that the nasya drug usually acts through absorption by the Shringataka marma. After absorption of the drug, it acts on the diseases of Skanda, Amsa, and Greeva and the doshas are expelled from the shira pradesha. Hence the Nasya karma is one of the therapeutic procedures of the pancha karma, wherein the drug is administered through the nasal route. The absorption of the drugs is carried out in three media. They are, Through blood circulation Through pooling into the venous sinuses of the brain via the inferior ophthalmic veins Through absorption into the cerebrospinal fluid (Mamta et al., 2015).

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TABLE 4: Criteria for assessment-subjective BT DAY-7 4 2 1.Shoola 2 2.Shoola teevrata 4 3 2 3.Tenderness

DAY-14 1 1 0

DAY-21 1 1 0

DAY-28 0 0 0

4.Figure-1 Vas Pain Scale

VAS SCALE 10 9 8 7 6 5 4 VAS SCALE

3 2

1 0 1

X-AXIS-NO OF DAYS OF TREATMENT Y-AXIS-PAIN SCALE

TABLE 5 (a & b): Criteria for assessment-objective CIRCUMFERENCE MID ARM ELBOW CERVICAL

5a. Amsa sosha or sopha (Muscle wasting/swelling) Before Treatment (BT) After Treatment (AT) Follow up Right Left Right Left Right Left 30cm 31.5cm 29.6cm 30.5cm 29.5cm 30cm 28cm 28cm 28cm 28cm 28cm 28cm 35.4cm 35cm 35cm

MOVEMENTS FLEXION EXTENSION ABDUCTION ADDUCTION INT. ROTATION EXT.ROTATION

5b. Range of movements BT (DEGREE) AT (DEGREE) 7TH Day 14TH Day 21st Day 140 154 160 160 40 44 50 50 135 140 145 145 40 45 45 48 75 80 85 85 80 85 90 90

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28th Day 160 48 145 48 85 90

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Along with the small emissary veins entering the cavernous sinuses of the brain, a pair of venous branches (emerging from the alae nasi) will drain into the facial vein. Neither the facial vein nor the ophthalmic veins have any valves. Therefore, there are more chances of the blood draining from the facial vein into the cavernous sinus in the lowered head position. The nasal cavity directly opens into the frontal, maxillary, and sphenoidal air sinuses. The epithelial layer is also continuous throughout the length. The momentary retention of the drug in the nasopharynx and the suction, causes oozing of the drug material into the air sinuses. These sites have rich blood vessels entering the brain and meninges through the existing foramens in the skull. So, there are better chances of drug transportation via this path. The shringataka marma has been explained by recent authors as the middle cephalic fossa of the skull consisting of paranasal sinuses, meningial vessels, and nerves. One can see the truth of the narration made by Vagbhata here the drug administered enters the paranasal sinuses, that is, the Shringataka, where the ophthalmic vein and the other veins spread out. The sphenoidal sinuses are in close relation with the intracranial structures. Thus, there may be a so far undetected root between the air sinuses and the cavernous sinuses, establishing the transudation of fluids as a whole. The mentioning of the Shringataka in this context seems to be more reasonable. As the procedure of nasya itself involves massaging and fomenting over many marmas existing on the face and head, this also helps in alleviation of marmaksobha and vatashamana (Mamta et al., 2015) REFERENCES Acharya Vaidya Harisastri paradakara (2014), Ashtanga Hridaya, with commentaries of sarvanga sundari of Arunadatta and Ayurveda Rasayana of Hemadri, Reprint Tenth edition, Varanasi, Nidana sthanam Chp:15/43,Pp-534, sutra

The action of nasya karma depends upon the dravya used in it. Brihmana nasya provides nourishment to the shiroindriya and other organs and alleviates the vitiated Vata. Hence, it is useful in Vatajanya ailments. To conclude, nasya karma helps in Apabahuka by its Vatashamana and Brumhana karma. In other words, the karpasasthyadi taila acts as an antiinflammatory, nutritive and provides nourishment to the nerves. Also in the text of Yoga Ratnakara, vatavyadhi chikitsa, the author mentions exercise therapy (physiotherapy) after oleation with medicated drugs i.e. â&#x20AC;&#x153;masha taila rasonabhyam bahvoscha parivartanathâ&#x20AC;? in the management of Apabahuka (Lakshmipati Shastri, 2014). From this the need of vyaayama (physiotherapy) in the management of Apabahuka is clearly highlighted. CONCLUSION The chikitsa sootra of Apabahuka itself has highlighted the importance of Nasyakarma in managing the condition. As karpasasthyadi taila is a Brihmana and vata-kapha hara yoga. It was administered as Nasya along with physiotherapy to improve the mobility of the shoulder joint. As the case showed marked relief from symptoms such as pain, swelling, tenderness, restricted range of movements within 16 days of management, it can be concluded that, this treatment modality can be prescribed as a Standard procedure considering its effectiveness and safe therapeutic regimen for Apabahuka. A large scale clinical study must be conducted to establish the efficacy of this modality of treatment with longer follow ups. sthanam Chp:20/1, Pp-287, Chp: 20/9, Pp 289; Chp: 20/39, Pp-294 Aravattazhikathu K.V Krishnan vaidyar and Anekkaleelil S.Gopala pillai with sujana priya (2012), Sahasrayogam, 31st edition, Malayalam vyakhyanam, vidhyarambam publishers, Taila prakaranam, Pp-287

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Global J Res. Med. Plants & Indigen. Med. | Volume 5, Issue 4 | April 2016 | 137–145

Banamali Das, Ravi Ganesh M, P. K. Mishra, Gurucharan Bhuyan (2010), Marsha nasya in Apabahuka, Ayu journal (vol 31,Issue-4), DOI: 10.4103/09748520.82048

Shivprasad Sharma (2012), vridha vagbhatta Ashtanga samgraha Shasilekha Sanskrit commentary, 3rd edition, Chaukamba Publications, Varanasi, Sutrasthana (Chap 29) Pp-223

G.D.

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Singhal,K.R. Sharma,S.N. Tripathi (2010), Madhava-Nidana: (Rogaviniscaya) of Sri Madhavakara; Ayurvedic Clinical Diagnosis, Published by Chaukhamba Sanskrit Pratishthan, Varanasi, (Chap 22)

Lakshmipati Shastri (2014), Yogaratnakara with Vidyotini Hindi teeka edited by Bhishagratna Brahma Sankar Shastri, 7th edition, Chaukamba Publications, New Delhi, (Chap Vatavyadhi Nidanam),Pp-516 Mamta Tiwari, Pankaj Nigam, Anurag Pandey (2015), The significant role of nasya in the management of avabahuka, European Journal of Biomedical and Pharmaceutical sciences (Volume: 2 Issue: 4, 1060–1066 Shivprasad Sharma (2006) vridha vagbhatta Ashtanga Hridaya with Shasilekha Sanskrit commentary, 3rd edition, Chaukamba Publications, Varanasi, Sutrasthana (Chap 20)

SOURCE OF SUPPORT:

NIL

Y.T. Acharya (2005), Susrutha Samhitha of Acharya Susrutha with Nibandasangraha commentary of Sri Dalhanacharya and the Nyayachandrika Panjika of Sri Gayadasacharya, 6th edition, Chaukamba Orientalia Varanasi, Sutra sthanam, chp:33/4,Pp144, Nidana sthanam,chp:1/82.Pp-269 Y.T. Acharya (2012), Sushrutasamhita with Nibandasamgraha commentary by Dalhana, Reprint edition, Chaukhamba Sanskrit Sansthan, Varanasi, Nidanasthana (Chap 1), Chikitsasthana (Chap 40)

CONFLICT OF INTEREST: None declared

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