GJRMI - Volume 5, Issue 8, August 2016 by Dr. Hari Venkatesh.K.Rajaraman

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INDEX – GJRMI - Volume 5, Issue 8, August 2016 INDIGENOUS MEDICINE Ayurveda - Streeroga & Prasuti Tantra EVALUATION OF TRIVRIT AVALEHA WITH REFERENCE TO PHARMACOGNOSTICAL & PHYSICO-CHEMICAL CHARACTERISTICS Rajput Shivshankar*, Mata Shweta, Dei LP, Harisha CR, Shukla VJ

226–234

Ayurveda – Kaumarabhritya - Review POSOLOGY IN AYURVEDA PEDIATRIC PRACTICE - A LITERARY REVIEW S P Kanzode*, V K Kori, Rajagopala S, K S Patel, S P Dhoke

235–243

Cover Page Photography: Dr. Hari Venkatesh K.R. Plant ID: Inflorescence of Naayuruvi (Siddha) / Apamarga (Ayurveda) [Achyranthes aspera L.]* of the family Amaranthaceae; Place: Vriddhachalam, Cuddalore District, Tamil Nadu, India *Botanical Name validated from www.theplantlist.org as on 12/08/2016

Research article EVALUATION OF TRIVRIT AVALEHA WITH REFERENCE TO PHARMACOGNOSTICAL & PHYSICO-CHEMICAL CHARACTERISTICS Rajput Shivshankar1*, Mata Shweta2, Dei LP3, Harisha CR4, Shukla VJ5 1

Ph.D. Scholar, Department of Streeroga and Prasuti Tantra, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008, Gujarat, India. 2 Ph.D. Scholar, Department of Shalakya Tantra, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008, Gujarat, India. 3 HOD & Prof. Department of Streeroga and Prasuti Tantra, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008, Gujarat, India. 4 Head, Pharmacognosy Laboratory, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008, Gujarat, India. 5 Head, Pharmaceutical Chemistry, Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361008, Gujarat, India. *Corresponding Author: E-Mail: shivshankerdr@gmail.com; Mob: +918460819669

Received: 20/06/2016; Revised: 30/07/2016; Accepted: 11/08/2016

ABSTRACT Trivrit Avaleha is a Leha Kalpana-semisolid preparation of drugs, prepared with addition of jiggery and boiled with prescribed decoction. It is indicated specifically for Virechana (purgation) Karma. It has contents like Trivrit (Operculina turpethum (L.) Silva Manso), Trijata (TamalpatraCinnamomum tamala (Buch.-Ham.) T. Nees and Eberm., Tvak- Cinnamomum verum J.Presl., ElaElettaria cadamomum (L.) Maton.), Honey and Sugar. Till date no published data is available on pharmacognostical and analytical profile of Trivrit Avaleha, so present study has been undertaken to evaluate the pharmacognostical and physico-chemical profile of Trivrit Avaleha. The phrmacognostical results of Trivrit Avaleha showed scleroids of Trivrit, broader pitted vessels of Trivrit, brown content of Tvak, oil globules in Ela, epidermal cells of Tamalpatra etc. Physicochemical analysis of Trivrit Avaleha revealed loss on drying 16.23%, Ash value was 1.48%, Water soluble extract was 65.64% etc. In High Performance Thin Layer Chromatography of Trivrit Avaleha revealed 7 spots at 254 nm and 3 spots at 366 nm. The findings of the study will be useful in the standardization of the Trivrit Avaleha. KEYWORDS: HPTLC, Trivrit Avaleha, Pharmacognosy, Physicochemical.

Cite this article: Rajput Shivshankar, Mata Shweta, Dei LP, Harisha CR, Shukla VJ (2016), EVALUATION OF TRIVRIT AVALEHA WITH REFERENCE TO PHARMACOGNOSTICAL & PHYSICO-CHEMICAL CHARACTERISTICS, Global J Res. Med. Plants & Indigen. Med., Volume 5 (8): 226–234

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INTRODUCTION Trivrit (Operculina turpethum (L.) Silva Manso) is a drug which is used mainly for Virechana (purgation) Karma but should be used under medical supervision due to its undesirable effects. About 190 formulations Contain Trivrit as an ingredient and used both internally and externally in 17 different dosage forms and indicated in more than 45 diseased conditions like Gulma (Abdominal lump), Jwara (fever), Udara (abdominal disorders), Krimi (worm infestation), Pandu (anemia) etc. Though highlighted for its adverse effects this drug is also indicated in the management of Streeroga (gynecological diseases) (Kolhe Rasika, Acharya R., 2013). Among them one is Trivrit Avaleha (Atrideva Gupta, 2005). Trivrit Avaleha is a Leha Kalpana. (When Kwatha decoction etc. are reboiled to thick or solid consistency it is known as Rasakriya. The same is known as Leha, Avaleha.) (Sharangdharacharya, 2007). It has contents like Trivrit, Trijata (Cinnamomum tamala (Buch.-Ham.) T. Nees & Eberm., Cinnamomum verum J.Presl ., Elettaria cadamomum (L.) Maton.), Honey and Sugar. Lack of standardization of polyherbal formulations creates difficulty in validating the efficacy and maintaining quality standards of the product. Therefore, proper identification of raw materials at the basic level with the help of microscopic and morphological characteristics and adequate analytical methods are essential to ensure the quality and standardize the prepared medicine. The American Society of Pharmacognosy defines pharmacognosy as "the study of natural product molecules (typically secondary metabolites) that are useful for their medicinal, ecological, gustatory or other functional properties (The American Society of Pharmacognosy, 2016). Ayurvedic Pharmaceutical Sciences has been recently reinforced in Indian pharmacy institute due to global acceptance of Ayurveda. The final effect of any crude drug material will be a product of the interactions between the constituents and the effect of each constituent on its own. To effectively study the existence and effect of

such interactions, scientific studies must examine the effect that multiple constituents, given concurrently, have on the system. One way to indicate strength is standardization to one or several marker compound that is believed to be mainly responsible for the biological effects (American Herbalism, 1992). So, the present study has been undertaken to evaluate the pharmacognostical and physicochemical profile of Trivrit Avaleha. MATERIALS AND METHODS Plant material The raw drugs were obtained from the pharmacy department, GAU, Jamnagar, Gujarat, India. The ingredients, useful part and ratio of drug are mentioned in Table- 1. Pharmacognostical Evaluation: The formulation was identified and authenticated and powder microscopy was done in the pharmacognosy department, IPGT & RA, GAU, Jamnagar, Gujarat, India. The study includes organoleptic evaluation and microscopic evaluation (Anonymous, 1999). They are stored according to SOP of WHO guidelines (World Health Organization, 1996). Preparation of the drug Trivrit Avaleha The formulation was prepared at Pharmacy of Gujarat Ayurved University, Jamnagar, Gujarat, India. Decoction of Trivrit was prepared as mentioned in classics (Sharangdharacharya, 2007). It is added to Trivrit powder and sugar, heated to semisolid consistency. When appropriate Paka was achieved, (Sharangdharacharya, 2007) it was taken away from fire and allowed to cool down. After that it is added with honey and Trijata. No any preservative was used for preparation of Avaleha. Parts of individual drugs in prepared Avaleha are mentioned in Table-1. Microscopic Study: Avaleha was dissolved in water and then particles floating over were examined under

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distilled water for the observation of calcium oxalate crystals and other cellular materials, then stained with Phloroglucinal and conc. HCl (Khandelwal KR., 2008) for the lignified characters, then stained with iodine to observe the starch grains. Raw drugs were separately studied under microscope; the microphotographs of diagnostic characters were taken by using Carl zeiss trinocular microscope (Trease, G.E., Evans, W.C., 1983). Organoleptic Study: Trivrit Avaleha was evaluated for organoleptic characters like taste, odour and colour etc. (Trease and Evans, 1996). Physico-chemical analysis: Physico-chemical Parameters of Trivrit Avaleha like Loss on drying, Ash value, water soluble extract, Alcohol soluble extract, pH and Sugar content were determined as per the API guideline (Anonymous, 1999). HPTLC: Methanol extract of Trivrit Avaleha was used for High performance thin layer chromatography (HPTLC) study. Methanol extract of Trivrit Avaleha was spotted on precoated silica gel GL60254 aluminum plate as 10mm bands by means of a Camag Linomate V sample applicator fitted with a 100 μL Hamilton syringe. Toluene (9ml) and ethyl acetate (1ml) was used for Trivrit Avaleha as a mobile phase. The development time was 30 minutes. After development, Densitometry scanning was performed with a Camag TLC scanner III in reflectance absorbance mode at 254nm and 366 nm under control of Win CATS software (V1.2.1. Camag). (Stahl E., 1969). (Reich E, Schibii A., 2007). Then the plate was sprayed with Anisaldehyde sulphuric acid followed by heating and then visualized in day light. The Rf value and the colors of resolved bands and fingerprinting profiles were recorded.

OBSERVATIONS AND RESULTS Microscopic Study: The diagnostic microscopical characters of individual powder showed scleroids of Trivrit, broader pitted vessels of Trivrit, tannin content of Trivrit, oil globules of Tvak, oil globules of Ela, epidermal cells of Tamalpatra, rosette crystal of Trivrit, fibre of Trivrit, fragments of epidermal cells of Ela, perisperm cells of Ela, cork cells of Tvak, fibers of Tvak, brown content with oil globule of Tvak, black debris of Ela, simple unicellular warty of Tamalapatra, prismatic crystal of Trivrit, lignified stone cells of Tvak, lignified fibers of Tvak, fragment of border pitted vessels of Trivrit etc. are shown in PLATE – 1 (Figure 1– 19) Organoleptic AVALEHA

characters

TRIVRIT

Organoleptic characters of contents of Avaleha like colour, taste and odour were recorded separately and are mentioned. (Table2). Physicochemical tests: Physicochemical analysis of Trivrit Avaleha revealed the loss on drying value was 16.23%, ash value was 1.48%, water soluble extract was 65.64%, alcohol soluble extract was 19.40%, pH was 6. In sugar content test, Total sugar was 28.94%, reducing sugar was 07.25% and non reducing sugar was 21.69%. (Table- 3). HPTLC study results: Chromatographic study (HPTLC) was carried out under 254 and 366 nm UV to establish fingerprinting profile. It showed 07 spots at 254 nm with Rf values and 03 spots at 366 nm with Rf values recorded which may be responsible for expression of its pharmacological and clinical actions (PLATE-2 & 3, Table- 4).

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PLATE 1: Microphotographs of Trivrit Avaleha (Figure 1-19)

Fig.1 Scleroids of Trivrit

Fig.2 Tannin content of Trivrit

Fig.3 Broader pitted vessels of Trivrit

Fig.4 Oil globule of Tvak

Fig.5 Oil globules of Ela

Fig.6 Epidermal cells of Tamalpatra

Fig.7 Rosette crystal of Trivrit

Fig.8 Fibre of Trivrit

Fig.9 Fragments of epidermal cells of Ela

Fig.10 Perisperm cells of Ela

Fig.11 Cork cells of Tvak

Fig.12 Fibers of Tvak

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Fig.13 Brown content with oil globule of Tvak

Fig.14 Black debris of Ela

Fig.15 Simple unicellular warty of Tamalapatra

Fig.16 Prismatic crystal of Trivrit

Fig.17 Lignified stone cells of Tvak

Fig.18 Lignified fibers of Tvak

PLATE 2 Visualisation of Trivrit Avaleha at daylight, 254, 366 nm

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PLATE 3: Densitogram of Trivrit Avaleha at 254 & 366nm.

TABLE 1: Ingredients of Trivrit Avaleha DRUG Trivit

BOTANICAL NAME Operculina turpethum (L.) Silva Manso

PART USED Root

Tamalpatra

Cinnamomum tamala (Buch.-Ham.) T. Nees & Eberm.

Leaves

Tvak

Cinnamomum verum J.Presl

Bark

Ela

Elettaria cadamomum (L.) Maton.

Fruit

Madhu Sharkara

Honey Sugar

-------------

5 10

TABLE-2: Organoleptic characters of Trivrit Avaleha Sr. No. 1 2 3 4

Characters Colour Odour Taste Touch

Observed Brown Sweet Sweet, Astringent Semi-solid

TABLE-3: Physico-chemical evaluation of Trivrit Avaleha Sr. No. 1 2 3 4 5 6

Test Loss on drying Ash Value Water soluble extract Alcohol Soluble extract pH Sugar content Total Sugar Reducing Sugar Non-reducing Sugar

Result 16.2355%w/w 1.4864%w/w 65.64%w/w 19.4%w/w 6 28.94% 07.25% 21.69%

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RATIO 25

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TABLE- 4 HPTLC OF TRIVRIT AVALEHA Wavelength 254 nm 366 nm

Number of spots 7 3

DISCUSSION World Health Organization (WHO) has laid much emphasis on the micro and macro characteristics study of a drug before proceeding to any test (Mandal GD, Nandi AK., 2012). In this preparation, the main content is Trivrit, which is included in the group of ‘ten purgative herbs’ (i.e. Bhedaniya Mahakashaya), group of ‘ten antidote herbs’ (i.e. Vishaghna Mahakashaya), group of ‘ten herbs supportive for therapeutic enema’ (i.e. Ashthapanopaga Mahakashaya) (Brahmanand Tripathi, 2008), group of ‘colon cleanser, antitumor & antidote herbs’ (i.e. Shyamadi Gana) and in the group of ‘herbs eliminating the toxins (i.e. vitiated Dosha) from lower half of the body’ (i.e. Adhobhagahara Gana) (Anantaram Sharma, 2008). Rosette crystals, tannin content, scleroids and prismatic crystal etc. indicates the presence of Trivrit in the present formulation. (K.M. Nadkarni, A. K. Nadkarni, 2007). Oil globules of Ela and Tvak, epidermal cells of Tamalpatra, perisperm cells of Ela, and cork cells of Tvak etc. show presence of all contents of raw drugs in the final product which indicates the genuinity of the final product. In organoleptic features, as sugar is the major part in Trivrit Avaleha, the final product Trivrit Avaleha has sweet taste and sweet odour. The formulation had brown colour; which was due to its contents. In physicochemical parameters, pH of Avaleha was 6 suggesting acidic nature of drugs. As Avaleha was containing significant quantity of sugar,

Max. Rf values 0.04, 0.11, 0.22, 0.36, 0.51, 0.53, 0.93 0.01, 0.21, 0.88 sugar estimation was also considered an important parameter. In this Avaleha, total sugar was found to be 28.94% which suggests more than one fourth part of total contents and helps to improve palatability of the formulation. Ash values of the Avaleha gives an idea about the earthy matter or inorganic composition and other impurities present along with the drug. For the present formulation, Avaleha had very low Ash value i.e. 1.4864% which means impurities are very low. The extractive values are primarily useful for the determination of the nature of the constituents present in a crude drug. High Performance Thin Layer Chromatography showed that the active contents in the formulation are more sensitive for short UV radiation that is 254 nm when compared with long UV radiation that is 366 nm. CONCLUSION In the present investigation, a set of pharmacognostical standardization parameter studies were conducted on Trivrit Avaleha as per pharmacopoeia guidelines. Physicochemical evaluation of Trivrit Avaleha illustrated the specific characters of ingredients which were used in the preparation. All the pharmaceutical parameters analyzed were within the permissible range. These results may be helpful in standardization, identification and in carrying out further research in Trivrit Avaleha based drugs which are used in Ayurveda.

REFERENCES American Herbalism (1992). edited by Michael Tierra Crossings Press.

Anantaram Sharma (2008). Ed. Shushrut Samhita of Maharshi Shushruta. Vol I. Chaukhamba Surbharti Publishers, Varanasi, India.p.338–347.

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Anonymous (1999). The Ayurvedic Pharmacopoeia of India, Part-I, Vol. 1– 4, Govt.bof India, Ministry of Health & Dept. of ISM and H. New Delhi; Dept. of Ayush.p. 142–146, 155–156.

Reich E, Schibii A. (2007). High PerformanceThin Layer Chromatography for the analysis of medicinal plants. Germany: Thieme medical publishers. Inc. p. 129– 60, 206-210, 224–240

Atrideva Gupta (2005). Vidyotini Hindi Commentary, Astanga Hridayam, Kalpasthana 2/9–10, Chaukhambha Samskrita Samsthana, Varanasi.p.509

Sharangdharacharya. (2007). Sharangadhara Samhita, Madhyama Khanda, 8/1 Tra. Himsagar Chandra Murty, Chaukhambha Surabharati series, Varanasi.p.68

Brahmanand Tripathi, Ed. (2008) Charakasamhita of Agnivesha elaborated by Charaka & Drudhabala, Vol I, Chaukhamba Surbharti Publishers, Varanasi, India. 68–101.

Stahl E. (1969). Thin-layer chromatography. 2nd Ed. Springer-Verlag New York, Inc. 175 5th Ave. New York, NY. p. 125 –133.

Khandelwal KR. (2008) Practical pharmacognosy-techniques and experiments. 19th ed. Nirali Prakashan, India.p.26–27.

The American Society of Pharmacognosy. (2016). Retrieved June 2, 2016, from http://www.pharmacognosy.us/what-ispharmacognosy/.

K. M. Nadkarni, A. K. Nadkarni (2007). Ed. Indian Materia Medica, Vol I, Bombay Popular Mumbai.p.691–694.

Trease,

Kolhe Rasika, Acharya r. (2013). Shyama trivrut, a less known but frequently used drug in ayurvedic classics: a review. Global J Res. Med. Plants & Indigen. Med.Volume 2, Issue 11 November.p.772–784 Mandal GD, Nandi AK. (2012) Morphological and anatomical circumscription for the identification of two source plants of aphrodisiac medicine- Chlorophytum borivilianum Santapau and Fernandes and Chlorophytum tuberosum (Roxb.) Baker. Internatonal Journal of Medicinal and Aromatic Plants 2(3): p.406–410.

Source of Support: NIL

G.E., Evans, W.C. (1983) Pharmacognosy, 12th Ed. BailliereTindall, Eastbourne. U.K.p.95– 99, 512–547.

Trease and Evans (1996) Pharmacognosy. 15th Ed., W.B. Sunders Company Ltd. p.569, 570. World Health Organization. (1996) Good Manufacturing Practices: supplementary guidelines for the manufacture of herbal medicinal products. In WHO Expert committee on specifications for Pharmaceutical Preparations. Thirty-fourth report. Geneva. Annex 8.p.1–20

Conflict of Interest: None Declared

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Review article POSOLOGY IN AYURVEDA PEDIATRIC PRACTICE - A LITERARY REVIEW S P Kanzode1*, V K Kori2, Rajagopala S3, K S Patel4, S P Dhoke5 1

PG Scholar, Kaumarbhritya Department, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India Assistant Professor, Kaumarbhritya Department, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India 3 Associate Professor, Kaumarbhritya Department, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India 4 Professor, Kaumarbhritya Department, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India 5 PhD Scholar, Basic Principles Department, IPGT&RA, Gujarat Ayurved University, Jamnagar, Gujarat, India *Corresponding Author:E-mail: sonamkanzode@gmail.com; Mobile: +91 8140978927 2

Received: 13/06/2016; Revised: 15/09/2016; Accepted: 20/09/2016

ABSTRACT Kaumarbhritya is one of branch of Ayurveda which deals with diseases of children and their practical treatment. Dose fixation in pediatric patients is a tedious job for both allopathic and Ayurveda physicians. Success of treatment is based on diagnosis, selection of drug, dose fixation and time of administration for any medical Science. In Ayurveda, the Matra (dose) of a drug has been mentioned in different treatises out of which Acharya Kashyapa is the pioneer of Ayurvedic pediatric medicine and he has well established the pediatric dosing system. Though the technology was not evolved in ancient era, Ayurveda physicians were using different Matras for different dosage forms and also the dose was fixed according to age and many other factors like Satva (mental ability), Prakriti(constitution), Bala (physical strength) etc. This article is aimed to understand the view of ancient sages related to pediatric drug doses from different Ayurveda classics. KEYWORDS: Ayurveda, Dose, Drug, Matra, Pediatrics.

Cite this article: S P Kanzode, V K Kori, Rajagopala S, K S Patel, S P Dhoke (2016), POSOLOGY IN AYURVEDA PEDIATRIC PRACTICE - A LITERARY REVIEW, Global J Res. Med. Plants & Indigen. Med., Volume 5(8): 235â&#x20AC;&#x201C;243

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INTRODUCTION Kashyapa Samhita is the elementary primer of Ayurveda Pediatrics where prime importance is given to the branch of Kaumarbhritya (Pediatrics) and drug doses are described for children according to age. Acharyas (Ancient Ayurveda physicians) have given a general guideline regarding the dose of Churna (herbal powder), Kalka (paste), Kashaya (decoction), Ghrita (Butter oil) etc (Premavati Tiwari, 2013). In pediatric age group most physicians find intricacy while prescribing medicine. As the development of human race occurred step by step, in the same way science of measurement has also evolved. This change can be well noticed by reviewing the ancient and modern drug dosage system. In ancient era two different methods of measuring the objects were in use called Magadha Mana (Ayurvedic metric system) and Kalinga Mana (Ayurvedic metric system). (Bramhananda Tripathi, 2011) and to fix on Matra (dose) the proportion of different substances like Amalaki (Gooseberry), Kola (jujube fruit), Vidanga (false black paper), Anjali (handfull), Anguli (Phalanges) etc was in practice (Bramhananda Tripathi, 2011). As the period progressed, those Manas (Measurements) were replaced by milligrams, grams and milliliter etc. It took a long period from ancient era to modern era for getting these dose transformed into current metric system. In clinical practice sometimes it is found that, though the medicine was selected properly according to condition but still physician do not get expected result in particular cases. The main reason behind it may be due to negligence towards classical dose and its proper understanding. This article is aimed to understand the view of ancient sages related to pediatric drug doses from different Ayurveda classics. MATRA (DOSE) Matra is the full measure of anything or Measure of any kind of quantity, size, duration, number, degree etc. (M.Monier Williams, 2011). Posology is the branch of pharmacology and therapeutics concerned with a determination of the doses of remedies. It is derived from the Greek words “Posos” meaning how much and logos meaning science.

Drug is a French word derived from „Drogue‟ meaning a dry herb. According to WHO (1966) Drug is any substance or product that is used or is intended to be used to modify or explore physiological system or pathological states for the benefit of recipient (K. D. Tripathi, 2010). Drug is a "Natural or synthetic substance which when taken by a human being affects its functioning or structure, and is used in the diagnosis, mitigation, treatment or prevention of a disease or relief of discomfort is called legal drug or medicine. Dose is the quantity of medicine prescribed to be taken at one time. As the dose varies with age, weight, surface area, nature of disease process and functional maturity of child the Modern physicians also countenance paucity to calculate the drug dose for different dosage form. Modern medicines are given in the form of syrup, injections, drops, tablets etc for the easy administration, palatability and efficacy of drug (Meharban Singh, 2011). Similarly in Ayurveda, Panchavidha (5 types), Shadvidha (6 types), Saptavidha (7 types) Kashaya Kalpanas (Drug preparation methods) are described in the section of different dosage forms and these different dosage forms are prearranged to adjust the dose and to solve the issues of palatability and potency. These kalpanas are enlisted below in Table no.1 Dose According To Kashyapa Samhita Among the entire Ayurveda treatise, Kashyapa Samhita is first which placed the Kaumarbhritya (Pediatric) as First branch in eight branches of Ayurveda (V. L. N. Sastry, 2015). According to Acharya Kashyapa, disease is the root cause of troubles and medicine is cause of pleasure. The medicines when used properly it becomes nectar and improperly used drug acts like a poison (Premavati Tiwari, 2013) so, every physician should have the knowledge of disease, drugs as well as dose. These are some general doses according to Kashyapa Samhita which is presented in Table no.2. Acharya Kashyapa also mentioned/described specific doses in different Kalpana for different pediatric age group which are listed in Table no. 3

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Table no. 1. Kalpana according to different Acharya (Acharya P.V. Sharma, 1983; Brahmanand Tripathi, 2011; Ambikadutta Shastry, 2013)

Sr. No. 1

ACHARYA Sharangadhara

2 3

Charaka Sushruta

Kashyapa

KALPANA (Form of medicine) Swarasa (juice), Kalka (paste), Kwatha (decoctions), Hima (cold infusion), Phanta (hot infusion) Swarasa, Kalka, Shrita (decoctions), Shita (cold infusion), Phanta Swarasa, Kalka, Kwatha, Hima, Phanta, Kshirapaka (milk boiled with the drugs) Churna, Shitakashaya (cold infusion), Swarasa, Abhishava (fermented drinks), Phanta, Kalka, Kwatha

Table no.2-general dose of different pediatric age group according to Acharya Kashyapa (Premavati Tiwari, 2013)

Sr.No. 1. 2. 3. 4. 5. 6. 7. 8. 9.

Age Immediately after birth 5–10 days 10–20 days 1month 1–2 months 3 months 4 months 5–6 months 7–8 months

Dose Badariphala Beejatulya (Size equivalent to the seed of Jujube fruit) Slightly increased Equal to half Badariphala (Jujube fruit) Equal to one Badariphala One and half Badariphala Three Badariphala Equal to dry Amalaki (Indian gooseberry) fruit Equal to wet Amalaki fruit More than Amalaki

Table no.3-specific dose for different kalpana according to Kashyapa samhita (Shri Satyapala Bhishagacharya, 2013)

Sr.No. 1.

2. 3. Sr.No. 1. 2. 3. Sr.No. 1. 2. 3.

Churna (Powder) Deepaniya Churna (Appetizer powder) Jeevaniya (Longevity enhancer) and Sanshamaniya (Pacifying powder) Churna Vanama (Emetic) and Virechana (Purgative) Churna Kashaya (Decoction) Dosha Nashaka Kashaya (Vata,Pitta,Kapha eradicating Decoctions) Vamaka and Virechaka Kashaya Deepaniya and Sanshamaniya Kashaya Kalka (Paste) Deepaniya Kalka Jeevaniya and Sanshamaniya Kalka Vamaka and Virechaka

Matra (Dose) Agraparvanguli grahya (The quantity of drug held between fore phalanges of fingers of hand) Double of Deepaniya Churna Matra Half of Deepaniya Churna Matra Matra (Dose) 2 Prasrita (16 Tola=192 ml) 1 Prasrita (96 ml) 2 Prasrita (192 ml) Matra (Dose) 1 Karsh (12 grams) 2 Karsh (24 grams) Half Karsh (6 grams)

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Ghrita Matra Samhita:

According

Kashyapa

Dose According to Sharangadhara and Yoga Ratnakara

For Navajata Shishu (newborn) Matra of Ghrita (ghee) is told as Vidangaphalatulya (equivalent to the size of false black pepper fruit), afterwards the dose is gradually increased. The dose of Ghrita can be increased up to Amalakiphala (size of fruit of Gooseberry) but not more than that (Premavati Tiwari, 2013).

Sharangadhara Samhita (13th AD) is one of the authentic books of Ayurveda where Mana (science of measurement) is discussed in detail. The classic has established the dose from minimal to maximum i.e. from Paramanu (atom) to Tula (100 pala). Also the measuring dose possesses different nomenclature in the form of easily available sources such as Rajika [Brassica juncea (L.) Czern.], Sarshapa (Mustard seed), Vidanga (False black peper) etc. The dose is given in simplified measures as Ratti and Masha which can be easily converted into current metric system. This is the great contribution of this Samhita in Ayurveda posology. Eg. 1 Ratti = 125 mg. Yoga Ratnakara (17th century A.D.) is an important classic for wide description on pediatric drug doses and it follows the Sharangadhara Samhita guidelines. The dose is given below in Table no. 5

Dose According to Sushruta Samhita: In the context of classification of age, Acharya Sushruta has classified the age as Balya (young age), Madhya (adult) and Vriddha (old age) and the group Balya has been further divided into Kshirada (child dependant only on milk), Kshirannada (child dependent upon milk and cereals) and Annada (depending upon cereals) (D.N. Mishra, 2014). Acharya Sushruta has given dose for Kshirada, Kshirannada and Annada Avastha which are enlisted below in table no. 4.

Table No.4-Age specific different drug doses according to Sushruta samhita (Kaviraja Ambikadutta Shastry, 2013)

Sr.No. 1.

2. 3.

Different age group Kshirada (up to 1 year) Kshirannada (1–2 year) Annada (2–16 years)

Matra (Dose) Anguliparvadvaya grahya (The quantity of medicine which adheres in between the apex of thumb and index finger. Honey or ghee should be used as Anupana.) Kolasthi (Medicines in the form of paste shall be given in an amount of size of seed of a kernel of a jujube fruit Kola Matra (Equal to jujube fruit)

Table no.5 - Dose According to Sharangadhara and Yogaratnakara (Brahmananda Tripathi 2010; Indradev Tripathi & Daya Shankar Tripathi, 2011).

Sr.No. 1

Age 1 month

2 4

2 months–1 year 1 year–16 years

For Kwatha (Decoction)

Dose 1 Ratti = 125 mg (Churna, Kalka, Avaleha formulation with ghee, honey, milk, sugar as Anupana) increase by 1 Ratti every month up to 12 months increase by 1 Masha (1.5 gm) every year m (1 Masha–16 Masha=1.5 gm–12.5 gms) It should be given four times of above calculated dose as per age Eg. Dose of Phalatrikadi Kashaya for 1 year old child will be 6gm (6ml)

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Yogaratnakara has given the dose for newborn as one Vidangaphala and later on this dose should be increased as 1 Vidangaphala every month e.g. 2 month 2 Vidangaphala (Indradev Tripathi & Daya Shankar Tripathi, 2011). Dose according to CCRAS: Following table no. 6 shows the dose according to CCRAS. DISCUSSION: In Modern science different formulae like Young‟s Formula, Dilling‟s Formula etc. are in use to calculate dose according to age. Drug doses mentioned in different classics of Ayurveda are given with respect to ancient systems of Mana (Measurement). In ancient era the technology was not evolved, so the framework of measurement was experience based and objects in custom employ were taken as measure of weight eg. Badariphalatulya, Amalakiphalatulya, Vidangaphalatulya etc. Most of the Ayurveda scholars are perplexed regarding these Manas. The biggest query is arises in mind of physician that weight of Vidanga/Amalaki should be taken into account or medicine should be taken same as the shape of fruit of Vidanga/Amalaki etc. The exact weight cannot be assumed because Amalaki, Kola etc fruits have different varieties and also the weight varies with different regions and also all the fruits do not carry same weight. This is the situation these days because of wide genetically modified variants available in the market. In olden days this was not the case. May be Kola has remained the same even in current times., the only standard they had was to take it in the dosage of common fruits available in every region. So only approximation could be expected with the ancient dosing system and not accuracy and with the help of own logic physician should manage doses for different patient. Acharyas were clear in their ways. It is to be taken in the size or weight of the particular drug and not Amla or vidanga as such. The word “tulya” (equivalent) is being used in

quotation, so it becomes more specific to consider shape/ proportion of the particular object rather than weight. Still this opinion can vary from person to person; so a wise physician should use Yukti (logic) in such cases. For Churna matra, Acharya Kashyapa has used Anguli pramana. For this, the pramana of recipient child should be considered and not the mother or guardian. This is clarified by Acharya Kashyapa which comments whenever Mana (measurement) like Prakunch needs to be referred in drug administration then the Pramana(Anthropometrical measurements) of the person who is going to consume the medicine should be considered (B.M.Singh, 2015). In Kashaya matra, the dose of Doshanashaka Kashaya is said to be 2 prasrita i.e. equal to 192 ml. Here, this dose seems to be very heavy in pediatric patients. So dose of Kashaya may be given as maximum dose for 16 years. If, the dose of kashaya is 192 ml in 16 years then for 8years it will be 96 ml and for 4 years it may be 43 ml and for 2 years it may be 20ml approximately. Also this dose should be given in two to three divided doses. Also, dose can be minimized in Alpa Bala (less body strength) and Alpa Satva (less mental strength) child. Sharangadhara and Yogaratnakara guidelines are more comprehensible and acceptable as the dose mentioned in these Samhita can be easily converted into current metric system. The dose is given considering the compound formulation and commonly used Kalpana (formulation) are discussed with their age specific dose. This helps to counteract the uncertainty about pediatric drug doses especially for Ayurveda formulation. Sharangadhara Samhita dose fixation guideline is widely accepted in Ayurveda Posology. So, when the pediatric dose of any dosage form is not mentioned in classics, a wise physician can use this guideline to calculate the pediatric dose i.e. Pediatric Dose = Age in years/ 16 × Adult dose; But this is applicable when adult dose is defined. When adult dose is not defined, the general guidelines given by Acharyas considering the contents of the drug and other parameters such as Dosha

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(humour), Desha (habitat), Kala (time period), Vaya (age), Agnibala (digestive power) etc. physician has to calculate the dose. Some of the

adult doses of different Kalpana are shown below in table no.7.

Table no. 6- Per day dose according to the age of the patients (CCRAS, 2005) Form of medicine Svarasa Kalka Churna Kvatha Hima Vati Bhasma Asava / Arishta Panaka Ghrita Siddha dugdha Shuddha Tankana, gairika etc.

1 month

1 to 5 years

6 to 15 years

Adults

1–3 drops 130 mg 130 mg 1–5 drops 1–5 drops 16–30 mg 8–16 mg 1–5 drops 1–5 drops 1–5 drops 5–10 drops 65–130 mg

5–15 drops 1–2 gm 1–2 g 5–15 drops 5–15 drops 30–130 mg 30–130 mg 5–15 drops 5–15 drops 5–15 drops 1–20 ml 130–250 mg

2–5 ml 2–5 gm 2–3 g 2–5 ml 2–5 ml 13–250 mg 130–250 mg 2–5 ml 2–5 ml 2–5 gm 100–200 ml 250–500 mg

7–14 ml 6–12 gm 3–6 g 14–28 ml 14–28 ml 250–500 mg 250–500 mg 14–28 ml 14–28 ml 12–24 gm 100–250 ml 500mg–1 g

Table no. 7 – Dose of different Kalpana (doses form) according to Sharangadhara Samhita (Prof. K .R. Shrikanta Murthy, 2003) Sr.No. 1 2 3. 4 5. 6. 7.

Kalpana

Dose

Churna (herbal powder) 1 Karsha (12 grams) Vati (pills) 1Karsha (12 grams) Svarasa (juice) Fresh ½ pala -2 Tola (27 ml.), Extracted after boiling-1 Pala (48ml) Avaleha (Confections) 1 Pala Kwatha (Decoction) 2 Pala Ghrita/Taila (oil) 1 Pala (48 ml) Asava Arishta (Fermented 2 Pala (96ml) liquids)

Ayurveda system of medicine, some specifics are given for drug administration in children. In Kshirada Avastha (up to 1 year) medicine should be given to mother as child is totally dependent upon mother for nourishment so drug given by mother indirectly reach up to neonates. Now, it is the wise duty of every pediatrician to look after the nature of disease with its etiology, signs, symptoms and severity. When the disease seems to be originated from

Dushta Stanya (vitiated breast milk) or improper dietary habits of mother, medicine should be given to mother following adult dose. Eg. In Kaphadushta Stanya (vitiated milk due to body humour), Deepana (Appetizer), Pachana (digestive), stanyashodhaka (Milk purifier) medicine given to mother gives relief in child‟s disease. In Some diseases only medicine should be given to child as they having absolute severity and the diseases which

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need prompt treatment to child only such as Ulbaka Vyadhi (equivalent to Pneumonia), Hyperpyrexia etc. In kshirannada Avastha (1 to 2 years) children can eat some semisolid food and also depend on mother for nutrition. So, medicine should be given to both children and mother. in Annada Avastha (2 year to 16 years) weaning of breast milk has been done and child is capable of taking their own food so there is no need to give medicine to mother & so medicine should be given only to the child (Ambikadutta Shastri, 2013). Acharya Sushruta

has specifically mentioned honey or ghee as Sahapana (substance which taken with drug or medicine). From this, it is clear that Acharyas were concerned about the palatability, absorption of drug and rapid action of drug. For the treatment purpose Ayurveda Classics has mentioned various factors to be considered in treatment for successful clinical practice and these factors are very important in dose fixation. These factors are enlisted below in Table no. 8.

Table no.8- Various factors affecting drug dose (Paradkar H.S.S., 2015; Acharya Yadavaji Trikamaji, 2011) Sr. no. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Ayurveda (Modern) Dosha (Physical constitution and nature of disease) Dushya (Part vitiated in body) Bala (Body strength) Kala (Time of administration) Agni (Appetite/Digestive fire) Prakriti (Genetic factors and body constitution) Vaya (Age, body weight, surface area) Vyadhi (Disease) Dravya (Drug) Koshtha (Biological membrane/distribution) Satva (Emotional quotient) Satmya (Tolerance) Rogavastha (Pathological state) Prayoga Marga (Route of administration) Desha (Environment) Ahara Vyavastha (Diet and dietetic practices) Anupana (Mediator/Catalyst)

CONCLUSIONThe knowledge is never static; Stagnation is detrimental so it has to flow continuously, discarding unacceptable things and incorporating newer concept. This revolutionized form is clearly visible in Ayurveda system of Mana. The Magadha Mana and Kaling Mana are stepwise transformed into current metric system to make the Ayurveda posology easily approachable and acceptable. Acharya Kashyapa quotes that “The drug, which does not destroy the patient‟s strength

but destroy the disease potency, should be used till complete eradication of disease.” In continuation to this drug should also be selected after observing various factors like Dosha, Agni, Bala, Vaya, Vyadhi, Kostha, Prakriti, Satmya, Desha, Kala, etc. Dose of medicine selected for the treatment of disease should not be too excess or too low. So, a wise physician anticipating complete cure of disease should have knowledge about classical dose of medicine according to age. Though these factors were mentioned several years ago, they are very close to modern pharmacological

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parameters. Neglecting either of the factors described above while prescribing a drug can hinder the treatment. So, all factors should be examined thoroughly, and treatment should be planned accordingly. Also some doses mentioned in classics seem to be higher in

todays perspective. The reason behind this may be the Bala and Satva of children in ancient period was different as compared to todayâ&#x20AC;&#x;s generation. Research works on the Ayurveda posology, ancient and current aspects should be planned to prevail over the ambiguity.

REFERENCES Acharya Y.T. (2011), Charakasamhita with Ayurvedadipika Commentary by Chakrapani, Reprint edition, Chaukhamba Surbharati Prakashan , Varanasi, p.276 B.M.Singh (2015), Text Book of Bal Roga Kaumarbhritya, Part 1, Chaukhamba Orientalia, Varanasi, p.26 CCRAS (2005), Handbook of Domestic Medicine And Common Ayurvedic Remedies, Central Council for Research in Ayurveda and Siddha (Department of AYUSH), Ministry of Health and Family Welfare( Govt. of India), Published by Council for Research in Ayurveda and Siddha, New delhi, Third Edition. Page no. 349

Kaviraja Shastri Ambikadutta (2013), Sushruta Samhita, Hindi Commentary Ayurvedatatva-Sandeepika by Ambikadutt Shastri, Reprint edition, Chowkhamba Sanskrit Sansthan, Varanasi; Sutrasthana page. 215, Sharirasthana page. 107 M.Monier Williams (2011), A Sanskrit English Dictionary, Edited and Revised by Pandit Ishwar Chandra, Volume 2, Parimal Publication Delhi, Second Edition, , Page no. 1170. Meherban singh , Ashok K Deorari (2015), Drug doses in Children, CBS Publishers and Distributors, New Delhi, Ninghth edition, Page no. 7 P.V.

D.N.

Mishra (2014), Kaumarbhritya, Chaukhamba Sanskrit Pratisthana, Delhi, P.15.

Indradev Tripathi and Daya Shankar Tripathi (2011), Yogaratnakara with Vidyaprabha Hindi Commentary,Chaukhamba Krishnadas Academy, Varanasi. P.839 K.

R. Shrikantha Murthy (2003), Sharangadhara Samhita Translated in English, Chaukhamba Orientalia, Varanasi, Fifth edition, Madhyama Khanda, pages 84, 102, 51, 111, 56, 116, 137

K.D.Tripathi (2010), Essentials of Medical Pharmacology, Jaypee Brothers Medical Publishers, Delhi, Sixth Edition, Reprint, page no. 4

Sharma (1983), Charaka Samhita, Chaukhamba Orientalia, Varanasi, Sutra Sthana, P. 19

Pandit Kashinatha Shastri (2013), Charaka Samhita, Hindi Commentary AyurvedaDipika by Chakrapanidutta Edited by Gangasahaya Pandeya, Reprint, Chaukhamba Sanskrita Sansthana, Varanasi; pg. 660 Paradkar H.S.S. (2015), Astangahridaya of Vagbhata, Sarvangasundara teeka by Arunadatta & Ayurvedarasayana of Hemadri, Reprint Ed., Chaukhamba Surbharati Prakashana, Varanasi,p. 207 Premavati Tewari (2013), Kasyapa samhita, Chaukhambha Vishvabharati publication,Varanasi, khilasthana 3, pages. 449,462,463, 454

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Shri

Satyapala Bhishagacharya (2013), Kashyapa samhita, By Pandit Hemaraja Sharma with The Vidyotini Hindi Commentary and Hindi Translation of Sanskrit Introduction published by Chaukhambha Sanskrit Sansthana, Varanasi, Khilasthana 3, pages.246, 247

Source of Support: NIL

Tripathi Brahmanand (2010), Sharangdhara Samhita, Annoted with Dipika hindi commentary, 2nd edition, Chaukhamba Surbharti Prakashan, Varanasi, Pratham Khana, Pages.12, 13, 29, 84, 85, 125 V.L.N. Sastry, Premavati Tiwari (2015) Kaumarbhrityam (Paediatrics in Ayurveda), Chaukhamba Orientalia, Varanasi, Reprint Edition, Page no. 2 Conflict of Interest: None Declared

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