Jan march 2014;vol xx pg 1 74 ever 13414 by JREIM

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THE JOURNAL OF RESEARCH AND EDUCATION IN INDIAN MEDICINE Volume XX : 1

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Jan. - March, 2014

Pretic Effect of Herbomineral Unani Formulation ( Dolabi ) Analysis of the Effect of Laksha Guggulu (An Ayurvedic Formulation) on Fracture Healing in a Rat Model Ramesh Kaundal, Suman Sharma, Sanjeev Sharma and V.K. Gupta Therapeutic Potentials of Minerals in Ancient India: A Review Through Charaka Samhita Chandrashekhar Jagtap, Galib Ruknuddin, Prashant Bedarkar, Biswajyoti Patgiri and P.K. Prajapati Evaluation of Eclectic Therapy on Fasting Blood Sugar in patients of Type-2 Diabetes Mellitus Roohallah Bay, Sujata Vaydia and Fatemeh Bay Memory Loss in Geriatric Age and its Prevention Through Yogic Lifestyle Hetal Amin, Rohit Sharma, M.K. Vyas and R.R. Dwivedi Clinical Evaluation of Varadi Kwatha in the Management of Madhumeha (Type-2 Diabetes Mellitus) - An attempt to provide evidence based data to the classical therapeutic claims Gyaneshwarsing Guddoye, B.K. Dwibedy and O.P. Singh Immediate Hypoglycaemic Effect of Two Selective Hydrotherapeutic Procedures in Non Insulin Dependent Patients of Diabetes Mellitus Sujatha Dinesh and Gangadhara Varma A Critical Understanding of Nutraceutical Aspects of Curd in Ayurveda Priyanka B.V. and Mallika Kurat Jayavarma Impact of Shodhana on Physico-chemical and Chromatographical Profiles of Gunja (Abrus precatorius Linn.) Seeds Sudipta Roy, Rabinarayan Acharya and V.J. Shukla

THE JOURNAL OF RESERCH AND EDUCATION IN INDIAN MEDICINE

EDITORIAL ADVISORY BOARD Editor-in-Chief

Founding Editor

Prof. R. H. Singh

Prof. Suresh Kumar

Distinguished Professor (Kayachikitsa) Formerly: Vice Chancellor, Rajasthan Ayurveda University, Jodhpur Professor and Head, Department of Kayachikitsa Dean, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University, Varanasi (India)

Formerly: Principal, Administrator and OSD, HP Inst. of PG Educ. & Res. in Ayurveda ( RGGPGAC-Paprola), Dean, Faculty of Ayurveda, H.P. University, Shimla Director, Indian Institute of Panchakarma (CCRAS, GoI), Karala OSD (Ay.), Department of Ayurveda, HP Government, Shimla (India).

Chief Editors

Prof. Rana Gopal Singh

Prof. P.V.Tewari

Director, Institute of Medical Sciences Banaras Hindu University, Varanasi

Formerly Professor and Head Dept of Prasuti Tantra, Dean, Faculty of Ayurveda, IMS, BHU, Varanasi

Prof. U.N. Dwivedi Professor of Biochemistry Ex-Vice Chancellor, University of Lucknow UP

Prof. Abhimanyu Kumar

Prof. Rabinarayan Acharya

Prof. Anand Chaudhary

Director, All India Institute of Ayurveda, Delhi DG Incharge, C.C.R.A.S, New Delhi

Professor of Dravyaguna, Institute for PG Teaching & Research in Ayurveda, GAU, Jamnagar, Gujarat

Professor and HOD Department of Rasa Shastra & BK Faculty of Ayurveda, IMS, BHU, Varanasi, UP

Panchakarma Prof. Girish K.J. (Hassan, Karnataka) Research & Education Prof. G.S. Lavekar (Delhi) Pharma. Sciences Prof. R.G. Mali (Ahmedabad) Shalakya Tantra Dr. Manoj Kumar (BHU, Varanasi) Kriya Sharira Dr. Kishor Patwardhan (BHU, Varanasi) Dr. Sanjeev Ojha (CDRI, Lucknow) Prof. M. S. Baghel (GAU, Jamnagar) Prof. Subhash Ranade (Pune) Prof. A. Douglas Kinghorn (USA) Dr. Shrikant Mishra (USA) Prof. N. P. Rai (BHU, Varanasi) Prof. Sanjay Gupta (BHU, Varanasi) Dr. G. S. Badesha (Raipur, Chhattisgarh) Dr. Sudhir Kumar (Chandigarh) Dr. Ramniwas Prasher (Delhi) Dr. Baldev Kumar (NIA, Jaipur) Dr. Anagha Ranade (GAU, Jamnagar) Dr. Samita Puri (Delhi) Dr. Shweta Dewan (NIA, Jaipur) Dr. Neetu Singh (BHU,Varanasi)

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Balroga Prof. Abhimanyu Kumar (AIIA, Delhi) Kayachikitsa Prof. Y.K. Sharma (Paprola, H.P.) Prasuti Tantra Prof. Eena Sharma (Paprola, HP) Shalya-Ortho Prof. Sanjeev Sharma (Paprola, H.P.) Vikriti Vigyan & Rog Nidan Dr. P.S. Byadgi (BHU, Varanasi) Dr. Galib R. (GAU, Jamnagar) Dr. Jagat Kanwar (Australia) Dr. S. K. Sharma (Delhi) Dr. V. N. Pandey (Delhi) Dr. Marc Halpern (California) Prof. Y. B. Tripathi (BHU, Varanasi) Prof. S. I. Nagral (Mumbai) Dr. H. S. Kasture (Ahmedabad) Dr. Ashwinikumar Raut (Mumbai) Dr. Sudhakar Powar (Mumbai) Dr. Kuldeep Singh Panwar (Jalandhar) Dr. Aditya Puri (Hamirpur, H.P.) Dr. Garish Mishra (Varanasi) Dr. Davinder Singh (Hoshirpur) Dr. Vinamra Sharma (BHU, Varanasi)

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THE JOURNAL OF RESEARCH & EDUCATION IN INDIAN MEDICINE Journal of Research and Education in Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy, Complementary and Alternative Medicine, Integrative Medicine, Medicinal and Aromatic Plants, Pharmaceutical Sciences …… An International Quarterly

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J Res Educ Indian Med, Jan.-March 2014; XX (1): 1-66

ISSN 0970-7700 (Linking)

EDITOR-IN-CHIEF

Prof. R.H. SINGH

ABMS, Ph.D, D.Sc.

Distinguished Professor-Kayachikitsa Formerly Vice Chancellor, Rajasthan Ayurveda University; Dean, Faculty of Ayurveda, Institute of Medical Sciences, BHU, Varanasi - 221005 UP (India)

CHIEF EDITOR (SPECIAL ISSUES) Prof. Rana Gopal Singh

MD, DM (BHU)

Director Institute of Medical Sciences, B.H.U. Varanasi 221005 UP (India) E-mail : cheifeditor@jreim.com

CHIEF EDITOR (DRAVYAGUNA)

Prof. Rabinarayan Acharya Ph.D. (GAU)

Professor of Dravyaguna Member Secretary, National Pharmacovigilance programme for ASU drugs Institute for PG Teaching & Research in Ayurveda, Gujarat Ayurved University, Jamnagar-361 008, Gujarat, India

FOUNDING Editor

Prof. Suresh Kumar

M.D.(Ay), Ph.D (BHU)

Formerly Dean, Faculty of Ayurveda, Himachal Pradesh University, Shimla Director, Indian Institute of Panchakarma, CCRAS (AYUSH, MoH&FW, GoI) (Kerala)

CONSULTANT SUBJECT EDITORS Dr. Manoj Kumar

M.S.(Ay.),Ph.D (BHU)

Assistant Professor-Shalakya Tantra Institute of Medical Sciences, BHU, Varanasi - 221005 (India)

Prof. Ravindra G. Mali

M.Pharm, DHMM,

Principal, Shree Swaminarayan College of Pharmacy, Kalol, Gandhinagar (Gujarat)

ADVISORY-EDITORS (INTERNATIONAL) Dr. Jagat Kanwar

M.Sc., Ph.D.

Asso.Professor, Immunology & Cell Biology, Institute for Technology & Research Innovation (ITRI), Deakin University, Victoria - 3217 (Australia)

Dr. Marc Halpern

President, California College of Ayurveda E-mail: drh@ayurvedacollege.com

ASSISTANT EDITORS Dr. Dr. Dr. Dr. Dr. Dr.

Anagha Ranade (GAU, Jamnagar) Neetu Singh (BHU,Varanasi) Rasika Kolhe (GAU, Jamnagar) Samita Puri (CBPCAS, Delhi) Shweta Dewan (NIA, Jaipur) Vinamra Sharma (BHU, Varanasi)

JREIM ADMIN. OFFICE:

Dr. (Mrs.) Laxmi Bhargava Executive Editor

CONTENTS Our Guru ji - Acarya Dr. Rama Nath Dwivedi Suresh Kumar and R.G. Singh

...

Analysis of the Effect of Laksha Guggulu (An Ayurvedic Formulation) on Fracture Healing in a Rat Model Ramesh Kaundal, Suman Sharma, Sanjeev Sharma and V.K. Gupta ... 01-08 Therapeutic Potentials of Minerals in Ancient India: A Review Through Charaka Samhita Chandrashekhar Jagtap, Galib Ruknuddin, Prashant Bedarkar, Biswajyoti Patgiri and P.K. Prajapati ... 09-20 Evaluation of Eclectic Therapy on Fasting Blood Sugar in Patients of Type-2 Diabetes Mellitus Roohallah Bay, Sujata Vaydia and Fatemeh Bay ... 21-27 Memory Loss in Geriatric Age and its Prevention Through Yogic Lifestyle Hetal Amin, Rohit Sharma, M.K. Vyas and R.R. Dwivedi ... 29-35 Clinical Evaluation of Varadi Kwatha in the Management of Madhumeha (Type-2 Diabetes Mellitus) - An attempt to provide evidence based data to the classical therapeutic claims Gyaneshwarsing Guddoye, B.K. Dwibedy and O.P. Singh ... 37-44 Immediate Hypoglycaemic Effect of Two Selective Hydrotherapeutic Procedures in Non Insulin Dependent Patients of Diabetes Mellitus Sujatha Dinesh and Gangadhara Varma ... 45-50 A Critical Understanding of Nutraceutical Aspects of Curd in Ayurveda Priyanka B.V. & Mallika Kurat Jayavarma ... 51-57 Impact of Shodhana on Physico-chemical and Chromatographical Profiles of Gunja (Abrus precatorius Linn.) Seeds Sudipta Roy, Rabinarayan Acharya and V.J. Shukla ... 59-65 Conferences and Fourth coming Events ... 66

Ph.D. (BHU)

E-mail: drlaxmi_ayush_journal@yahoo.com

Standard International ISO Abbreviation of JREIM is: J. Res. Educ. Indian. Med.

J Res Educ Indian Med. Vol. XX (1) Jan.- March 2014

Acharya Dr. Rama Nath Dwivedi M.A., A.M.S. (BHU), Ph.D., D.Sc.

Former Head, Department of Ayurveda, Institute of Medical Sciences, BHU, Varanasi UP (India) Founder Managing Editor The Journal of Research and Education in Indian Medicine - An International Quarterly

Our Guru Ji

Acharya Dr. Rama Nath Dwivedi, who left his earthly abode on January 11, 2014 (Paush Shukla Ekadashi, an auspicious day as per Indian calendar) at the age of around 96 years – was a prime source of inspiration for all of us. “It is eternal victory for the sacred one, from whose hands flows ‘Nectar’, who has patience, who is learned and whose famous form has no fear of aging and death.” He was born in the second decade of the twentieth century in village ‘Arati Dube ka Chhapara’ (Ojhavalia, Balia, U. P.) as the second son of father Pandit Anmol Dubey and mother Paramajyoti Devi. After initial education in a neighbourhood school at ‘Basarikapur’, he moved along with his elder brother Acharya Dr. Hazari Prasad Dwivedi to ‘Shantiniketan’, where he studied for about two years in the inspiring presence of ‘Gurudev Rabindranath Tagore’. He pursued further education at ‘Kashi’ (Varanasi) including ‘Ayurvedacharya in Medicine and Surgery (A. M. S.) Degree at B.H.U., he joined service in Hindu University during regime of ‘Dr. S. Radhakrisnan’ Vice-Chancellor. From 1940 to 1980 (till his retirement), he taught ‘Ayurveda’ to the students and treated a large number of patients in SS Hosptial at BHU by the conventional wisdom of our ancient Rishis, in the true spirit of compliance to the wishes of ‘Mahamana Pandit Madan Mohan Malaviya’, the founder of the Banaras Hindu University. Recognized as ‘Ayurveda Brihaspati’ at young age, our Guru ji , during his selfdisciplined, hard and devoted life, gave knowledge

to thousands of disciples and gift of life to hundreds of thousands people. His day started with early morning bathing in the Ganges (well before the sunrise) followed by daily worship and recitation of ‘ShrimadBhagavata’. He was mostly the first Doctor/ Professor to reach the Hospital or the College. Timely meals and going to bed early, were the features of his daily routine. He authored more than thirty books on Ayurveda, many of which are included in the syllabus of Ayurvedic Colleges. “Pandit Rama Nath Dwivedi is famous as a Doctor with unfailing diagnosis, a prescriber of exactly right medicine and a selfless giver. A much talked about Ayurvedic physician, he is a legend who is the subject of many popular stories told in the region. Guru Ji, always lived the life of a sage and the hardest obstacles in his life used to surrender against his strong will-power. Bathing in the Ganges in the early morning every day at ‘Kedar Ghat’, stepping down and up the steep stairs at the Ghat, visiting the ‘Kedareshwar Mahadev’ temple over there, which he did right from the early age of 19 years to the ripe old age of 90 years, is hardly possible for anyone else. Finally he, with eternal ‘Bhakti-Bhava’, merged into the infinite glow of the Almighty. Prof. Suresh Kumar Former Dean, Ayurveda, Himachal University, Shimla HP (India) Founder Editor JREIM

Prof. Rana Gopal Singh Director, IMS, Banaras Hindu University, Varanasi UP (India) Chief Editor JREIM

J Res Educ Indian Med, Jan.-March 2014; Vol.XX (1): 1-8

ISSN 0970-7700

ANALYSIS OF THE EFFECT OF LAKSHA GUGGULU (AN AYURVEDIC FORMULATION) ON FRACTURE HEALING IN A RAT MODEL RAMESH KAUNDAL,1 SUMAN SHARMA,2 SANJEEV SHARMA3 AND V.K. GUPTA4 P. G. Department of Shalya Tantra 1,2,3 Rajiv Gandhi Govt. P. G. Ayurvedic College, Paprola - 176115 H.P. (India) Department of Veterinary Pathology 4 Dr. G. C. Negi College of Veterinary and Animal Sciences, Palampur - 176062 H.P. (India) Abstract: Objectives: Laksha Guggulu, an Ayurvedic formulation advocated to enhance the fracture healing in ancient Indian texts, was selected to validate its effect on fracture healing on certain scientific parameters like Radiological, Serological and Histopathological studies in an experimental rat model. Methods: Eighteen Wistar rats (Rattus norvegicus) were taken to create identical fractures by a transverse osteotomy of Radial bone of their left fore limb under Ketamine and Xylazine anesthesia (intraperitoneally). Intact ulna acted as an internal splint hence, no other external or internal support to the fractures was given. Post operatively injectable antibiotic (Gentamicin) was given. These osteotomised rats were divided into three groups of six each. Group I rats were given 13.5mg/100gm body weight of the trial drug (Laksha Guggulu) twice daily through oral route. Group II rats were given half of the Group I dose of the trial drug whereas in Group III, no drug was given (Control group). The drug was given oraly with Cowâ&#x20AC;&#x2122;s milk. Total duration of trial was of four weeks. Healing was assessed Radiologically, Biochemically and Histopathologically. Results: Assessment of results was done according to pre-designed protocol and data analysis done statistically. Histopathological and Serological studies revealed significant results in Group I animals as compared to Group II and Group III. Radiologically the difference between the groups was not detectable. Conclusion: Laksha Guggulu has got a definite role in the enhancement of fracture healing by forming early and improved quality of the callus. However, further studies on large sample size, with more advanced investigations like Histomorphometery, Bone turnover markers and Micro CT scanning are required. Keywords: Fracture healing, Histopathology, Laksha Guggulu, Rat model.

Introduction A cursory glance of the available medical treatise reveals that Ayurveda has spread enough thought to the care of injured (Sushruta Samhita). Treatment of skeletal injuries has been given prime importance. As without proper treatment these injuries can disable a person for rest of life. Since Vedic period, surgeons are pondering over skeletal injuries and are trying to overcome their complications. Acharya Sushruta has described detailed etiology, classification, management and prognosis of bone and joint injuries. He has also described various measures including drugs to hasten the healing process.

For the management of fracture, reduction and immobilization are universally required and to be done accordingly (Sushruta Samhita). But attention also be paid to avoid or minimize the forthcoming complications due to fracture itself or immobilization. Reduction in fracture healing time, when achieved will reduce complications. The healing is a natural process and it occurs spontaneously. But sometimes, healing is delayed or bone ends fail to unite because of factors like improper immobilization, deficiency conditions, reduced blood supply to the fractured part, severe soft tissue damage (Abdelhamid H. Elgazzae, 2004), smoking (Mara L. Schenker

1. P.G. Scholar 2. Sr. Lecturer 3. Professor, Shalya Tantra 4. Professor, Department of Veterinary Pathology

Kaundal et al.

et al., 2013), endocrinal disorders and continuous nerve irritation (Henery Turner, 1936). To overcome this problem and to minimize the healing period, various drugs or formulations for local, oral use have been advocated in Ayurvedic literature (Sushruta Samhita, Chakradatta and Yogratnakara). These drugs are claimed to enhance fracture healing process. Laksha Guggulu (Yogratnakara) is one of them which is advocated to promote fracture healing. Laksha Guggulu is a classical Ayurvedic formulation containing Laksha Churna (Shellac powder), Asthishrinkhla (Cissus quadrangularis Linn.), Arjun Twak Churna (Bark powder of Terminalia arjuna), Ashwagandha Churna (Root powder of Withania somnifera), Nagbala Mool Churna (Root powder of Grewia hirsuta) and Guggulu (gum resin of Commiphora mukul). Among these ingredients Cissus quadrangularis Linn. is of utmost importance. Cissus quadrangularis alone is also used as a single drug for promoting fracture healing since ancient times. Its fracture healing potential has also been scientifically validated earlier by Udupa, 1962; Udupa and Prasad, 1964; Chopra et al.,1976. In this study, the scientific evaluation of Laksha Guggulu formulation, as fracture healing drug in a rat model on parameters like radiography, serum alkaline phosphatase and histopathology of fracture callus was planned. Materials and Methods Method of Drug Preparation Well identified ingredients were taken in equal quantity and fine powder of each was prepared separately except Guggulu. All these powered contents were mixed properly. Further, purified Guggulu of equal weight was added and mixed. Laksha Guggulu was prepared in the College Pharmacy as per the Ayurvedic Formulary of India (AFI). Experimental Animals Eighteen Wistar rats (Rattus norvegicus) of either sex more than three months of age,

weighing between 150-250 gm were procured from reliable source. Animals were fed on commercially available standard balanced rat feed. All the animals were acclimatized to laboratory conditions for one week prior to the trial. They were maintained at 12 hrs light cycle with room temperature at 15oC + 5oC in well ventilated animal house. Experimental Protocol For osteotomy purpose, rats were shifted to operation theatre of the department and all the operative works were done under aseptic conditions. Rats were anaesthetized with inj. Ketamine (60mg/kg) and inj. Xylazine (8mg./kg body weight) intraperitoneally. A cranio-medial incision was applied over the left fore-limb and open transverse osteotomy of left radial bone was done. As only radial bone of fore limb was osteotomised (fractured) and ulna acted as a splint. Hence, no external splint was applied. Post operative antibiotic (Inj. Gentamicin by I. M. route 12 hourly) for seventy-two hours of post operative period was given. All doses including antibiotic and trial drug were calculated by using conversion factor i.e. a dose for a rat of 200gm weight = 0.018 × Human adult dose. After creating similar fractures on similar bones in all 18 animals, they were divided into three groups (six animals in each group). To identify each animal they were marked on tail with code number. The cages were also labeled as group I, group II and group III respectively. Group I: This group was fed with Laksha Guggulu dissolved in 1ml of cow’s milk in dose of 13.5 mg per 100gm body weight. The drug was given through intragastric route 12 hourly with the help of soft baby feeding tube of No. 10 size. Group II: Second group was fed with half of the dose of group I, dissolved in 1ml of cow’s milk, given through intragastric route 12 hourly with the help of soft baby feeding tube of No. 10 size.

Effect of Laksha Guggulu on Fracture Healing

Group III: Only 1ml of cow’s milk was given through intragastric route 12 hourly. This group was kept as a control group. Total duration of trial was Four weeks. Investigations used were: 1. X-rays of operated limb. 2. Serum alkaline phosphatase study. 3. Histopathology of the callus. As the operated limb needed to be disarticulated for histopathology, so euthanasia of the animals was inevitable and done according to international guidelines. Inhalation agent Halothane was used in high doses for euthanasia. After euthanizing, blood samples were collected from all the animals, directly from heart for serum alkaline phosphatase study. Craniocaudal and lateral radiographs of osteotomised animal limbs of all the three groups were taken for radiological assessment. Operated limbs were disarticulated and histopathological study of the callus done. The segments were placed in buffered neutral 10% formalin for three days, followed by decalcification with Stewart and Gooding fluid. Specimens were processed for making paraffin blocks and 5-6 micro meter thick tissue sections were stained with Hematoxylene Eosin (H & E) and Masson’s trichrome stains. An eleven point scale based on the amount of fibrous tissue, cartilaginous tissue and woven bone in callus formation was used to evaluate the degree of healing process. Assessment Criteria Radiographic Assessment Cranio-caudal and lateral radiographs were graded on a six point union score (Sano et al. 1999). Zero: Sharp or sclerotic line seen throughout. One: Sharp or sclerotic line in more than 75% of diameter. Two: A well defined osteotomy line extending in both projections. Three: Same as two but in one projection only. Four: Osteotomy faintly seen. Five: Osteotomy not seen.

Histopathological Assessment It was done on the following Eleven Grade scale (Huddleston et al., 2000) i. ii iii. iv. v. vi. vii. viii. ix. x. xi.

All fibrous tissue. More fibrous tissue than cartilage. Fibrous and cartilaginous tissue in equal proportion. Evidence of fibrous tissue with more cartilaginous tissue than woven bone. Evidence of fibrous tissue with equal cartilage and woven bone. Evidence of fibrous tissue with more woven bone than cartilage. Cartilaginous tissue and woven bone in almost equal proportion. Less cartilage and more woven bone. Entirely woven bone. Woven bone and some mature bone. Lamellar (mature) bone.

Serum Alkaline Phosphatase Assessment Blood samples drawn directly from heart were allowed to clot, centrifuged and serum collected. The serum samples analyzed for serum alkaline phosphatase value with semi auto analyzer. Results All the data subjected to statistical analysis (Tables 1-9). All the values were expressed as Mean ± SD. The differences were compared using Students‘t’ test. The p values <0.05 were considered significant. Table 1. Radiographic Assessment of Experimental Animals at the end of trial i.e. after 4 weeks (Gradation on Six point union scale). S. No. 1 2 3 4 5 6 Means

G-I 4 3 3 4 4 5 3.83

Group G-II 3 5 3 3 4 3 3.5

G-III 5 2 4 2 2 2 2.83

Kaundal et al.

Table 5. Comparison of Histopathological assessment of Callus at end of 4 weeks. S. No. 1 2 3

Group

Mean

S.D.

SEM

I II III

6 4 4

5.66 5.25 4.25

0.5164 0.9573 0.5

0.2108 0.4786 0.25

Table 6. Inter Group Comparison

Figure 1. Graphical presentation of mean of Radiographic Gradation of all Groups. Table 2. Comparison of groups for Radiographic assessment at the end of 4 weeks. S. Group. Number Mean S.D. SEM No. 1 I 6 3.83 0.97 0.3960 2 II 6 3.5 0.8366 0.3416 3 III 6 2.83 1.328 0.542

Table 3. Inter group Comparison Group

Group

I I II

II III III

‘t’ value 0.629 1.041 1.047

D.F.

P value

10 10 10

P> 0.05 P> 0.05 P> 0.05

Table 4. Histopathological Assessment of Calluses after 4 weeks.$ S. No. G-I G-II G-III Ì 1 6 4 2 6 6 -Ì 3 6 4 4 4 6 -Ì 4 5 5 5 -Ì 6 5 6 5 Means 5.66 5.25 4.25 Ì $

Indicates that sample couldn’t be obtained for study Gradation on 11 point Histopathological Assessment Scale

Discussion Present study is an effort to assess the effect of Laksha Guggulu in fracture healing in a rat model. Statistical analysis of the results obtained shows that Laksha Guggulu enhances

Group

I I II

II III III

‘t’ value 0.888 4.36 1.852

D.F.

P value

8 8 6

P >0.05 P <0.01 P >0.05

Table 7. Alkaline phosphatase values of experimental animals after 4weeks (all values are in u/l). S. No.

Group-I

Group-II

1 2 3 4 5 6 Means

270 390.4 420.2 396.4 170 370 336.16

319 230.7 162.2 270 180 300 243.65

Group-III (Control) 117.42 186.6 252.3 172.08 144.16 137.2 168.29

Table 8. Comparison of Groups for Serum Alkaline Phosphatase values of all Groups after 4 weeks. No. 1 2 3

G I II III

n 6 6 6

Mean 336.1667 243.65 168.293

S.D. 96.7109 63.875 48.049

SEM 39.48 26.078 19.616

Table 9. Inter Group Comparison Group 1 1 2

Group 2 3 3

‘t’ value 1.95 3.81 2.31

D.F. 10 10 10

P value P <0.05 P< 0.01 P <0.05

the fracture healing process. The comparison of Group-I with other groups shows statistical significant results (Tables 1-9). In radiographic assessment the results obtained are non significant in all groups in comparison to the control group. Inter group

Effect of Laksha Guggulu on Fracture Healing

2.a

2.b

3.a

3.b

4.a

4.b

Kaundal et al.

comparison also shows no significant results (Tables 1-3, Fig. 1). The cause of non significant results might be poorly defined shadow of callus on radiographs. It is hypothesized that the callus so formed has not casted its shadow very well. The analysis of serum alkaline phosphatase value and histopathology of calluses proved the efficacy of appropriate dose of Laksha Guggulu on bone healing. The histopathological study (conducted at College of Veterinary and Animal Sciences Palampur, H.P.) of all groups reveals that the calluses of group-I were containing more part of woven bone (immature bone) than cartilage and fibrous tissue (Fig. 2 a,b). Group-II specimens revealed equal amount of cartilage and woven bone (Fig. 3 a,b). Whereas, group-III showed more amount of fibrous and cartilaginous tissue than woven bone (Fig. 4 a,b). Statistically results were also significant in Group-I than Groups II and III (Tables 4-6, Fig. 5). Hence, it is clear that the drug Laksha Guggulu accelerates fracture healing. The serum alkaline phosphatase is composed of a group of iso-enzymes which originate from liver, bone and to a minor extent from the intestine and placenta. It functions principally at the site of absorption, deposition and excretion of calcium and also phosphorus. In bones it is concentrated at the main points of ossification (i.e. the epiphyseal line and the subperiosteal area). During the active bone destruction (as in fracture) a compensatory stimulation of osteoblasts to replace bone is reflected in an increased intra cellular content of alkaline phosphatase and increased levels in blood stream. During fracture repair, osteoblasts try to fill up the gap and cause increased serum alkaline phosphatase value. The increased serum alkaline phosphatase is also found in patients with certain diseases like Pagetâ&#x20AC;&#x2122;s disease, hyperparathyroidism, rickets, osteoblastic osteogenic sarcoma and diseases of liver. Because, animals used were healthy and screened out for any disease, so the possibility of alkaline phosphatase rise due to any such pathology was ruled out. Hence, the

Fig. 5. Diagram of Mean of Histopathological Assessmentof Callus as per 11 scale grading.

Fig. 6. Diagram of Mean of Alkaline Phosphatase values.

increase in serum alkaline phosphatase value in group-I was due to Laksha Guggulu. The results found were statistically highly significant (Tables 7-9, Fig. 6). Formulation Laksha Guggulu contains Guggulu as a main ingredient. Guggulu is gum resin of a shrub named Commiphora mukul Engl. This resin is having anti-inflammatory, analgesic (Jain and Gupta 2006) as well as bone healing properties (Bhavaprakasha). Another important ingredient of this formulation is Cissus quandrangularis which has been advocated to promote the fracture healing in Ayurvedic classics (Bhava Prakasha). This plant is found to contain vitamins and steroid like various versatile constituents such as flavonoids,

Effect of Laksha Guggulu on Fracture Healing

triterpenoids, vitamin C, stilbene derivatives and many others. (Adsenya et al., 1999). Out of these ascorbic acid, triterpene, Îą-sitosterol, ketosteroids, triterpenoids and calcium were found to have specific effect on the bone healing (Chopra et al., 1975, 1976: Udupa and Prasad 1963 and 1964,). Cissus quandrangularis also contains anti-oxidant and anti microbial properties (Murthy et al., 2003: Deka and Lohan 1994). Arjuna (Terminalia arjuna Roxb.) however, is having cardio-protective properties but the methanol extract also contains analgesic and anti-inflammatory properties (Moulisha Biswas et al., 2011). Studies have also revealed bone healing potential of this plant (Singh H., 1992). Ashwagandha (Withania somnifera (L) Dunal) is mainly an immunomodulator and immunoprotective drug but is also having analgesic properties (Sahni and Srivastava 2011) and some good effect on bone healing (Jaiswal et al., 2004). Grewia hirsuta is a general and nervine tonic (Bhava Prakasha) whereas Laksha (Shellac powder) is also having healing effect upon Kshata (tissue injuries) (Bhava Prakasha). On the basis of the properties of individual ingredients of the formulation under study (Laksha Guggulu) it can be well assumed that this should be helpful in enhancing the bone healing process. This study also revealed that Laksha Guggulu potentiates the bone healing process in rats. Conclusion On the basis of this experimental work it can be concluded that the drug Laksha Guggulu enhanced the fracture healing process and can be used as an adjuvant therapy to promote the fracture healing. However, further studies on large sample size, with more advanced investigations like histomorphometery, Bone turnover markers and Micro CT scanning are required. 1.

References Abdelhamid H. Elgazzae. Orthopedic Nuclear Medicine, Germany, Springer - Verlag Heidlberg, 2004;107. Adesanya, Saburi A., Rene N., Martin M. Therese, Boukamcha, N., Montagnac, A. and Pais M. Stilbene derivatives from Medicinal Plant

10.

11.

12.

13.

14.

15.

-Cissus quadrangularis. J. Nat. Prod. 1999;62:1694-95. Bhavaprakasha Nighantu. Translator and commentator Pandit Shri Vishwanath Dwivedi Shastri, 9th edition.Varanasi, Moti Lal Banarsi Dass,1977. Chakaradatta. Commentary and translation by Prof. P.V. Sharma. (Bhagna Chikitsa 49-12/13). Varanasi, Chaukhambha Subharti Prakashan, 1994. Chopra, S. S., Patel, M. R. and Awadhiya. R. P. Studies of Cissus quadrangularis in experimental fracture repair: a histopathological study. Indian J Med Res 1976;64:1365-68. D.K. Deka and L.C. Lahon. Effect of Cissus quandrangularis in accelerating healing process of experimentally fractured Radius-Ulna of Dog, A preliminary study. Indian Journal of Pharmacology 1994;26:44-45. Henery Turner. Some thoughts on the probable causes of non-union of fractures. J Bone Joint Surg Am 1936;18(3):581-93. Huddleston P.M., Steckelberg J.M., Hansen A.D., Rouse M.S., Bolander M.E. and Patel R. Ciprofloxacin in inhalation of experimental fracture healing. JBJS Am 2000;82:161-73. Jain Anurekha and Gupta V. B. Chemistry and Phrmacological profile of Guggul â&#x20AC;&#x201C; a review: Indian Journal of Traditional Knowledge 2006;5(4):18. K.N.Udupa and Gurucharan Prasad. Biomechanical and calcium 45 studies on the effect of Cissus quandrangularis in fracture repair. Ind Jour Med Res 1964;52. K.N. Udupa and Gurucharan Prasad. Effect of Cissus quadrangularis on the healing of Cortisone treated fractures. Ind Jour Med Res 1963;51. K.N. Udupa and Gurucharan Prasad. Further studies on the effect of Cissus quandrangularis in accelerating fracture healing. Ind Jour Med Res 1964;52. K.N. Udupa. Cissus quandrangularis in fracture healing of fractures a clinical study, Indian Medical Association 1962;38. Mara L. Schenker, John A. Scolaro, Sarah M. Yannascoli, Keith D. Balwin, Samir Mehta and Jaimo Ahn. Smoking Associated with Fracture Non union, Longer Healing times, Presented in AAOS annual meeting on Friday, Mar 22, 2013, Organized by J Bone Joint Surg Am 2013. Moulisha Biswas, Kaushik Biswas, Tarun K. Karan, Sanjib Bhattacharya, Ashok K. Ghosh

16.

17.

18.

19.

Kaundal et al. and Pallab K. Haldar. Evaluation of Analgesic and anti-inflammatory activities of Terminalia arjuna leaf. J of Phytology 2011;3(1):33-38. Murthy, K. N. C., Vanitha, A., Swami, M. M. and Ravishankar G. A. Antioxidant and antimicrobial activity of Cissus quadrangularis Linn. J Med Food 2003;6:99-105. Sano H., Unthoff H.K., Backman D.S. and Yeadong A. Correlation of radiographic measurements with biomechanical test results. Clin Orthop 1999;368:271-78. S. Jaiswal, S.V. Singh, Bhoopendra Singh and H. N. Singh. Plants used for tissue healing of animals. Natural Product Radiance 2004;3(4):284-90. S.S. Chopra, M.R.Patel, L.P.Gupta and I.C. Datta. Studies on Cissus quadrangularis in Experimental fracture repair: Effect on Chemical Parameters in blood. Ind J Med Res 1975;63.

20.

21.

22.

23.

24.

Sahni Y.P. and Srivastva D.M. Analgesic activity of Withania somnifera â&#x20AC;&#x201C; A possible mode of action. Indian Vet Med J 2011;25(2):153-55. Singh H. Terminalia and Coelogyne crista in the repair of canine fracture, Ph. D. Thesis- G.B. Pant University of Agri. & Technology, Pantnagar, 1992. Sushruta Samhita. Nibandhasamgraha (Nidan Sthana 15 and Chikitsa Sthana 3) Dalhan commentary. Varanasi, Chaukhambha Subharti Prakashan 1994. The Ayurvedic Formulary of India. Govt. of India Dept. of AYUSH, Partâ&#x20AC;&#x201C;I, 2nd revised edition Group no. 5 Guggulu. 2000; pg 70. Yogaratnakara. Translator and Commentator (Hindi) Vaidya Shree Laxmipati Shastri, Editor Bhishagratna Shree Brahmshankar Shastri, 4th edition. (Uttraardh - Bhagnachikitsa),Varanasi, Chaukhambha Sanskrit Sansthan, 2004; pg 191.

Address for correspondence: Prof. (Dr.) Sanjeev Sharma, Professor, P.G. Department of Shalya Tantra, Rajeev Gandhi Govt. P.G. Ayurvedic College, Paprola - 176115 Kangra, H.P. (India) E-mail: profsanjeevhp@gmail.com

J Res Educ Indian Med, Jan.-March 2014; Vol.XX (1): 9-20

ISSN 0970-7700

THERAPEUTIC POTENTIALS OF MINERALS IN ANCIENT INDIA: A REVIEW THROUGH CHARAKA SAMHITA CHANDRASHEKHAR JAGTAP,1 GALIB RUKNUDDIN,2 PRASHANT BEDARKAR,2 BISWAJYOTI PATGIRI3 AND P.K. PRAJAPATI4 Department of Rasa Shastra and Bhaishajya Kalpana, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar - 361 008 Gujarat (India) Abstract: Ayurvedic system of medicine has stood the test of time for four millennia or more. Ancient seers found that the drugs from different origin (herbal, metal or animal) are the most suitable tools in maintaining health in the healthy and eradicating diseases in the diseased. The use of metallo-mineral preparations in healthcare is a unique characteristic feature in this system. Processed metals and minerals including Mercury, Lead, Arsenic, Copper etc. were found to be used very frequently by the seers of Indian tradition in different disease conditions with great conviction. It is generally claimed that these metals / minerals gets detoxified during the manufacturing processes, if followed specified guidelines as emphasized in the scriptures of Ayurveda, especially Rasashastra texts. Charaka Samhita, one of the scheduled books of Ayurveda also holds ample references regarding the use of minerals for different purposes, as reflected in this paper. Keywords: Arsenic, Ayurveda, Charaka Samhita, Copper, Minerals.

Introduction Ayurvedic system of medicine is of great antiquity and dates back to about 5000 years BC. Materia Medica of Ayurveda contains drugs belonging to plant, animal and mineral in origin.1 In addition to the single drug recipes, poly-herbal and herbo-mineral formulations have also been incorporated by seers of ancient India who have documented their clinical experiences for passing on to future generations. During the medieval period, with the advent of Rasashastra, certain heavy metals and minerals were incorporated into Ayurvedic therapeutics. Rasashastra, an integral part of Ayurveda, deals with drugs of mineral and metallic origin, their varieties, characteristics, processing techniques, properties, therapeutic uses, possibilities of developing adverse effects and their management etc. in a comprehensive way. Actual development of Rasashastra as an independent branch of learning and therapy started from 8th AD and onwards. Though, the utility of metals and

minerals in therapeutics became more evident from 8th AD, a good deal on the description of metals and minerals, their processing techniques, therapeutic utility etc. can be observed in classics like Charaka Samhita, Sushruta Samhita etc., which belongs to the era much earlier since 8th AD. In due course of time, herbo-mineral and metallic preparations occupied a significant place in Ayurvedic treatment and are now routinely being practiced in different parts of India. The preparations are said to be safe, efficacious even at minute doses and never develop any significant untoward effects2 when manufactured and used as specified in classical texts. Ayurvedic scholars use the metallic preparations frequently in their routine practices and these preparations have been reported to be safe through well designed experimental3 and clinical trials. However, the past decade has witnessed concerns regarding the safety of Ayurvedic herbal, herbo-mineral and metallic preparations by the western medical circles, and

1. Ph.D. Scholar 2. Assistant Professor 3. Associate Professor 4. Professor

Jagtap et al.

this has damaged the reputation of the age-old Ayurvedic heritage.4 The need of the hour is to allay such fears, by creating greater awareness and placing in proper perspective, the context in which these drugs are recommended for use and the methods by which they were used as medicines. The present paper is a simple compilation focusing on the uses of minerals mentioned in Charaka Samhita. This review is expected to give an insight to assume the frequency of usage of minerals during the period of Charaka. Makshika Makshika has been placed under the group of Maharasas in the texts of Rasa Shastra.5 The use of Makshika in therapeutics can be traced back to the period of Samhitas, where Charaka advocated its utility in different disorders like Kusta (skin disorders), Pandu (anaemia) etc. This mineral is mentioned as an esteemed Rasayana,6 possibly because of supplementing some of the vital elements to the body. Makshika is a copper containing chalcopyrite (CuFeS2), is a combination of Copper (>5%), Iron (>20%) and Sulphur (>12%), 7 whereas the Makshika Satva is a combination8 of Cu, Ferric Oxide, Ferrous Oxide, Ca, Na, K, Phosphates and Silica. It is evident from this unique combination of elements that, Makshika is the best Rasayana. Table 1. References of Makshika in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration 1

Chikitsa 7/70

Lelitaka Yoga

Kusta

Chikitsa 7/71

Gandhaka Yoga

Kusta

Chikitsa 16/73

Mandura Vataka

Pandu

Chikitsa 16/78

Leha Yoga

Pandu

Chikitsa 16/82

Yogaraja

Pandu

Utilization in therapeutics : External Application 6

Chikitsa 21/130

Lepa Yoga

Granthi, Visarpa

Chikitsa 26/250

Varti Yoga

Netra Roga

Formulations of Makshika have been advocated to be used in different conditions like Pandu (anaemia), Arsha (haemorrhoides), Meha (diabetes), Shopha (inflammation) etc. and also as a useful rejuvenating drug.9 The normal dose mentioned for Makshika Bhasma is 65-250 mg.10 The formulations mentioned in Charaka Samhita, which contain Makshika as one of the components along with indications for which recommended are given in Table 1. Screening through Charaka Samhita reveals the below important points: Terms like Makshika Dhatu (Chikitsa 7/ 70 and 16/73), Suvarna Makshika (Chikitsa 7/ 71), Makshika (Chikitsa 16/82), Tapi (Chikitsa 16/78) and Tapya (Chikitsa 26/250) were used by Charaka for this mineral. The term Makshika used in few other places has been clarified as Madhu (honey) by the commentator (Chikitsa 7/ 70 and 16/83). Makshika has been defined by commentator Chakrapani as the Dhatu, which is found available on the river banks of Tapi (Charaka Chikitsa 26/250). The version at Charaka Chikitsa 16/ 82 may be emphasizing on the adoption of Shodhana procedure of the minerals, including Makshika etc. prior to their utilization in therapeutics. Shilajatu Shilajatu another drug from Maharasa group is the most important drug in Ayurveda and is used in treating a wide range of diseases. Charaka recognized this drug as vital for Rasayana purposes and says that there is no disease on earth, which cannot be cured with Shilajatu. Further, he goes on emphasizing that the administration of Shilajatu in proper time will impart strength in an individual.11 Classics speak about its origin as an excretion due to heat of sun from the gold and other mineral ores in the mountains and is of the nature of lac.12 Further, Rasa Vagbhata narrates that a sample of Shilajatu which forms into

Minerals in Charaka Samhita - A Review

113, 30/90), Adrijatu (Chikitsa 16/78), Raupyamala (Chikitsa 16/81), Shailasya Jatu (Chikitsa 28/242), Girija (Chikitsa 1-3/64, 21/ 130, 30/148), Shilahvaya (Chikitsa 1-3/65, 26/ 99) etc. for Shilajatu and its types. Formulations of Shilajatu are good antiseptics, pain relievers, expectorants and useful in a wide range of diseases like inflammations, skin diseases, urinary tract infections, renal calculi, diabetes and associated complications etc. The normal dose mentioned for Shilajatu is 250-1000mg.16 The herbo-mineral formulations mentioned in Charaka Samhita, which hold Shilajatu as an ingredient, are placed at Table 2.

Lingakara on fire is genuine. Few other classics say that, a good sample of this element when dropped into pure water from the tip of grass will produce thin fibrils and dissolves completely, emitting the odour of Gomutra.13 As this element is attributed with all the qualities of Rasa, Uparasa, Ratna and Loha, it is used as a great alterative and useful alternative for conquering premature old age.14 Charaka, while classifying the Dravyas depending on the source of origin, has used the term Samala.15 While commenting on this verse, Chakrapani opines that Samala can be considered as slag of Lohas i.e. Shilajatu. The seer used terms like Shilodbheda (Chikitsa 15/ Table 2. References of Shilajatu in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Sutra 21/24

Shilajatu Yoga

Sthaulya

Sutra 24/56

Shilajatu Yoga

Murccha, Mada

Chikitsa 1 - 3/64

Shilajatu Rasayana

Rasayana

Chikitsa 5/97

Shilajatu Prayoga

Vataja Gulma

Chikitsa 12/49

Shilajatu Prayoga

Tridoshaja Shotha

Chikitsa 13/152

Shilajatu Prayoga

Sannipataja Udara Roga

Chikitsa 15/113

Yavagu Yoga

Grahani

Chikitsa 16/78

Leha Yoga

Pandu

Chikitsa 16/81

Yogaraja

Pandu, Kasa, Vishama Jwara

Chikitsa 16/88

Shilajatu Vataka

Pandu, Kusta

Chikitsa 26/99

Shilajatu Yoga

Kaphaja Hridroga

Chikitsa 28/242

Shilajatu Yoga

Avrita Vata

Chikitsa 29/159

Shilajatu Prayoga

Vata Rakta

Chikitsa 30/90

Pushyanuga Churna

Rajo Dosha

Chikitsa 30/148

Shilajatu Prayoga

Reto Dosha

Utilization in therapeutics : External Application

Chikitsa 7/72

Lelitaka Yoga

Kusta

Chikitsa 21/130

Lepa Yoga

Granthi, Visarpa

Chikitsa 23/213

Pancha Shirisha Agada

Visha

Other References

Sutra 1/70

Referred as â&#x20AC;&#x2DC;Samalaahâ&#x20AC;&#x2122;

Classification of Parthiva Dravya

Chikitsa 1 - 3/48

Classification

Types and qualities of Shilajatu

Jagtap et al.

Sasyaka / Tuttha The mineral Sasyaka also known as Tuttha is a popular drug for external application since ancient times. Tuttha bhasma is useful for internal administration. In modern science, it is equated with copper sulphate (CuSO45H2O) familiar as blue Vitriol.17 The aqueous solution is useful to irrigate lesions of Kusta (skin diseases), Arshas (haemorrhoides), Dusta Vrana (non-healing ulcers) etc. The solutions of Sasyaka are also useful in various Netra rogas (eye diseases) as Aschyotana (eye drops). 18 The normal dose mentioned for the Bhasma is 15-30mg. 19 Screening through the classic reveals that, formulations with Sasyaka have often been preferred for topical application. Brief details are placed at Table 3. The term Sasyaka is not available in Charaka Samhita. The Seer has used terms like Amritasanga and Tuttha while referring to this mineral. Commentator, Chakrapani quoted other terms like Karparika Tuttha (Chikitsa 25/117), Kharparika Tuttha (Chikitsa 7/114), Mayura Tuttha (Chikitsa 14/55) and Tuttha (Sutra 3/10) while providing clarification to the term Amritasanga. Probably, these terms are synonymous with each other. But the version of the same commentator as â&#x20AC;&#x153;Dwe Tutthe iti Mayura Tuttham Kharparika Tuttham Chaâ&#x20AC;? (Chikitsa 7/ 108) clarifies that Mayura and Kharparika Tuttha are different from each other.

Gandhaka A pale yellowish mineral of great importance, known as Gandhaka in Ayurveda is the most important Rasa Dravya after Parada (mercury). It is known for its vast range of therapeutic applications since ancient times and there are hardly any preparation in Rasashastra, which does not have Gandhaka or its compound as an ingredient. Thus, it can be said that, it is the most essential element of Rasashastra placed under the group of Uparasa. Because of the peculiar odour of the element, it is described as Gandhaka. The English equivalent for this element sulphur is probably derived from the Sanskrit term Sulbari (antagonistic to copper). When combined with Parada it forms a compound - Kajjali 20 (a fine, black, lusterless powder) which is a basic compound in preparing a number of herbo-mineral / mineral / metallic preparations. Normal dose mentioned for the Shuddha Gandhaka Churna (powder) is 125 to 1000mg.21 Though it is an important mineral from Rasashastra point of view, formulations with Sulphur as a component are rarely found mentioned in Charaka Samhita. On scrutiny, only four references were found in the classic that are placed at Table 4. Terms like Gandha, Saugandhika, Lelitaka are used to refer this mineral. For the term Saugandhika, the commentator, Chakrapani

Table 3. References of Sasyaka in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : External Application

Sutra 3/10

Avachurna Yoga

Kusta

Sutra 3/12

Lepa Yoga

Kusta

Chikitsa 7/114

Kanakaksiri Taila

Krimi, Kandu, Kusta

Chikitsa 7/108

Tikta Ikshwakvadi Taila

Kandu, Kusta

Chikitsa 7/120

Yamaka Yoga

Vipadika

Chikitsa 14/55

Lepa Yoga

Arshahara

Chikitsa 25/117

Varnakara Yoga

Varnakara

Chikitsa 26/250

Sukhavati Varti

Timira Netra Roga

Minerals in Charaka Samhita - A Review

Table 4: References of Gandhaka in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 17/125

Muktadya Churna

Hikka, Shwasa

Utilization in therapeutics : External Application

Sutra 3/10

Avachurna Yoga

Kusta

Chikitsa 7/70

Lelitaka Prayoga

Kusta

Chikitsa 7/71

Gandhaka Yoga

Kusta

opined that, it may be Gandhatrina (variety of grass) (Sutra 3/10), Gandhaka (Sutra 3/10), Manikya Bheda (type of gem) (Chikitsa 17/126). Gairika Another mineral in the group of Uparasa of Rasashastra is Gairika,22 which is familiar for its therapeutic purposes since ages. Charaka classified this mineral under Parthiva Dravya and grouped under Shonitasthapana Gana, while Sushruta used this drug in formulating Maha Sugandhi Agada,23 which is a potent Vishahara (anti-poisonous) agent. Rasa Vagbhata classified Gairika into two basic varieties viz. Swarna and Pashana, the former being the acceptable one. Swarna Gairika is smooth to touch (Snigdha / Masruna), extreme red in color (Atyanta Shonitam), while the latter variety is hard (Kathina) and coppery red (Tamra varna) in color.24 The term Lohitamrit (Chikitsa 23/101) has been interpreted as Gairika by the commentator Chakrapani. In addition, another term Kanchana Gairika was also found mentioned in the classic at Chikitsa 20/32. The cherry red colored mineral is identified as Red Oxide of Iron (Fe2O3) or Hematite, which contains Iron (>16%) as principal constituent,25 because of which the element may be a proven remedy in cases of anaemia. The normal dose mentioned for the Shuddha Gairika is 250-500 mg.26 The formulations mentioned in Charaka Samhita, which hold Gairika as an ingredient are placed at Table 5. Kasisa Kasisa, another mineral mentioned in Rasa classics under Uparasa Varga was frequently

preferred by Charaka for external purposes in conditions like Switra (leucoderma), Khalitya (alopecia), Kusta (skin disorders), Arshas (haemorrhoides) etc. Sushruta classified this element under Ushakadi Gana and advised its use in cases of Ashmari (renal calculi), Mutrakrchra (dysurea) etc. 27 Terms like Salomasho (Sutra 3/4), Romasham (Chikitsa 29/ 152) have been used by Charaka, which have been clarified as Dhatu Kasisam and Kasisam respectively by Chakrapani. It is identified as Green Vitreol (FeSO4 7H2O) or Ferrous Sulphate and a genuine sample contains Iron (>25%) and Sulphur (>15%).28 Kasisa Bhasma is useful in cases of Jwara (pyrexia), Mutrakricchra (dysuria), Ashmari (calculi), Pandu (anaemia), Pliharoga (spleenomegaly), Vrana (ulcers), Switra (leucoderma / vitiligo) etc.29 As the mineral has a good amount of Iron in its composition, it may be proven as a promising remedy in cases of anaemia. The normal dose mentioned for Kasisa Bhasma is 65-250 mg.30 The formulations mentioned in Charaka Samhita, which hold Kasisa as an ingredient are placed at Table 6. Kankshi Kankshi, another familiar mineral in Ayurveda is well recognized with synonyms like Saurashtri, Sphatika, Shubhra etc. Astanga Hridaya advised the internal administration of Kankshi in cases of Hikka, Shwasa etc. 31 Conventionally, this drug is used for dressing of bleeding wounds and as a gargling agent in disorders of oral cavity. The sample with characters like slight yellowish (ishat pita) in

Jagtap et al.

Table 5. References of Gairika in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 4/73

Pana Yoga

Chikitsa 4/79

Pana Yoga

Raktapitta

Chikitsa 20/32

Pana Yoga

Pittaja Chhardi

Chikitsa 20/33

Pana Yoga

Pittaja Chhardi

Chikitsa 20/33

Pana Yoga

Pittaja Chhardi

Chikitsa 23/46

Pana Yoga

Visha

Chikitsa 23/101

Ksharagada

Sarva Visa

Chikitsa 26/210

Khadiradi Gutika

Mukha Roga

Chikitsa 30/91

Pushyanuga Churna

Rajo Dosha

Raktapitta

Utilization in therapeutics : External Application

Sutra 3/5

Pradeha Yoga

Kusta, Kilasa, Dadru

Chikitsa 4/99

Avapidana Nasya

Raktapitta

Chikitsa 21/82

Pradeha Yoga

Visarpa

Chikitsa 23/220

Lepa Yoga

Nakha, Danta Visha

Chikitsa 25/117

Varnakara Lepa

Savarnikarana

Chikitsa 26/232

Netra Varti

Netra Roga

Chikitsa 26/235

Netra Varti

Netra Roga

Other References

Sutra 1/70

Classified under Parthiva Dravya

Sutra 4/18

Grouped under Shonita Sthapana Gana

color, heavy (guru) and shiny (snigdha) should be considered as a genuine variety.32 It is identified as Alum [K2SO4 Al2 (SO4)3 24H2O]33 and is a useful element with wide therapeutic attributes like Vranaghna (wound healing), Chakshushya (helpful in eye diseases), Visarpa (erysipelas), Switra (vitiligo), Vishama Jwara (viral fevers), Mukha Roga (diseases of oral cavity)34 etc. The normal dose of Shuddha Kankshi is 125 - 250 mg.35 The formulations mentioned in Charaka Samhita, which hold Kankshi as an ingredient are placed at Table 7. Charaka used both the terms i.e. Kankshi (Chikitsa 23/54 and 30/121) and Saurashtri (Chikitsa 7/114, 15/138, 30/79 and 30/98) to refer this mineral. Commentator, Chakrapani clarified that, both these terms are synonymous with each other (Chikitsa 23/54). In addition,

he used another term Tuvari Mrittika (Chikitsa 30/79) considering which, it can be said that, these three terms are synonymous. Haritala Haritala is one of the ancient minerals known for its therapeutic properties, which was used externally as well as internally since the period of Samhitas. This mineral is mentioned as Alam in Charaka Samhita and grouped under Parthiva Dravyas. Sushruta classified it under Sthavara (dhatu) Visha. 36 Rasa Vagbhata classified this mineral into two types viz. Patra Tala and Pinda Tala, the former one being the acceptable variety. Patra Tala should be golden yellow in color (swarna varnam), heavy (guru), shiny (snigdha), lustrous (bhasuram) with thin and innumerable flakes (tanu and bahu patram).

Minerals in Charaka Samhita - A Review

Table 6. References of Kasisa in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 26/271

Mahanila Taila

Palita

Chikitsa 29/152

Kalka Yoga

Vatarakta

Utilization in therapeutics : External Application

Sutra 3/4

Pradeha Yoga

Kusta

Sutra 3/5

Pradeha Yoga

Kusta

Sutra 3/10

Avachurna Yoga

Kusta

Sutra 3/15

Lepa Yoga

Kusta

Chikitsa 7/102

Kustadi Taila

Kusta

Chikitsa 7/109

Tikta Ikshwakvadi Taila

Kandu, Kusta

Chikitsa 7/114

Kanaka Kshiri Taila

Krimi, Kandu, Kusta

Chikitsa 7/117

Lepa Yoga

Sidhma

Chikitsa 7/167

Shamana Lepa Yoga

Switra

Chikitsa 21/126

Lepa Yoga

Granthi, Visarpa

Chikitsa 25/115

Lepa Yoga

Twak Janana

Chikitsa 25/117

Varnakara Lepa

Savarnikarana

Chikitsa 26/254

Dristiprada Varti

Dristiprada

Chikitsa 30/79

Dhatakyadi Taila

Yoni Roga

Chikitsa 30/121

Yoni Varti

Yoni Roga

Table 7. References of Kankshi in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 15/138

Kiratadya Churna

Grahani

Chikitsa 23/54

Mrita Sanjivani Agada

Sarva Visha

Chikitsa 30/98

Pana Yoga

Pittaja Asrigdhara

Utilization in therapeutics : External Application

Chikitsa 7/114

Kanaka Kshiri Taila

Krimi, Kandu, Kusta

Chikitsa 30/79

Dhatakyadi Taila

Yoni Roga

Chikitsa 30/121

Yoni Varti

Picchila Yoni

The second variety i.e. Pinda Tala should be devoid of flakes (nishpatram), appears like a mass (pinda sadrusham), heavy (guru) with inferior degree of qualities and on administration, it causes infertility (pushpa haranam) in females.37 Chemically it is identified as Orpiment (As2S3),38 probably derived from latin term Auric Pigmentorum, which means Gold Paint.39

Being an arsenical mineral, it should be administered with great caution. Haritala Bhasma is beneficial in Kustha (skin diseases), Vishama Jwara (viral fever), Vrana (ulcers), Arsha (haemorrhoids), Bhagandara (fistula-in-ano), Apasmara (epilepsy), Visarpa (erysipelas) etc.40

Jagtap et al.

Table 8. References of Haritala in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 17/78

Dhooma Yoga

Hikka, Swasa

Chikitsa 23/54

Mrita Sanjivani Agada

Sarva Visha

Utilization in therapeutics : External Application

Sutra 3/5

Pradeha Yoga

Kusta

Sutra 3/10

Avachurna Yoga

Kusta

Sutra 3/12

Pradeha Yoga

Kusta

Sutra 5/26

Dhooma Yoga

Shiro Virechana

Chikitsa 7/114

Kanaka Ksiri Taila

Krimi, Kandu, Kusta

Chikitsa 9/66

Varti Yoga

Apasmara, Unmada

Chikitsa 14/56

Lepa Yoga

Arsa

Chikitsa 18/69

Dhooma Yoga

Vataja Kasa

Chikitsa 18/74

Dhooma Yoga

Vataja Kasa

Chikitsa 25/114

Lepa Yoga

Twak Janana

Chikitsa 26/196

Pitaka Curna

Mukha Roga

Referred as â&#x20AC;&#x2DC;Alamâ&#x20AC;&#x2122;

Classification of Parthiva Dravya

Other References

Sutra 1/70

The therapeutic dose mentioned for Haritala Bhasma is 30-60 mg.41 The formulations mentioned in Charaka Samhita, which hold Haritala as one of the components, are as shown in Table 8. Charaka used both the terms i.e. Alam and Haritala to refer this mineral. Most of the formulations were mentioned for external use and only two formulations for internal use. Manahshila Manahshila is mineral containing Arsenic and grouped under Uparasa in Rasa classics.42 Charaka extensively used this mineral in formulating compounds for external application as reflected in Sutra Sthana. Rasa Vagbhata classified this mineral into three types viz. Shyamangi, Kanaviraka and Khandakhya, the last variety being the best and acceptable one. Shyamangi is heavy (bharadhya) and available in different colors like Shyama, Rakta and Pita. Kanaviraka is coppery red in color (tamrabha),

lustrous (tejaswini), devoid of yellowish tinge (nirgaura), while Khandakhya variety can be easily broken into powder form (churnibhuta), bright red in color (ati raktangi) and heavy (bhara).43 Chemically it is identified as Realgar - Red Orpiment (As2S2)44 probably derived from Arabic term Rehj - Alghar, which means powder of the caves.45 Because of it being an arsenical mineral, it should be administered with great caution. It is beneficial in Swasa (breathlessness), Kasa (cough), Agnimandya (loss of appetite), Kusta (skin diseases), Jwara (fever) etc.46 The normal dose mentioned for Manahshila is 4-8 mg.47 The formulations mentioned in Charaka Samhita, which hold Manahshila as one of the components, are tabulated in Table 9. Charaka used only one term i.e. Manahshila throughout the classic to refer this mineral. This mineral is frequently preferred by the seer for administration through different routes of drug administration.

Minerals in Charaka Samhita - A Review

Table 9. References of Manahshila in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : Internal Administration

Chikitsa 17/77

Dhooma Yoga

Hikka, Swasa

Chikitsa 17/145

Manahshiladi Ghrta

Hika, Swasa

Chikitsa 18/52

Leha Yoga

Kasa, Hikka, Swasa

Chikitsa 18/69

Dhooma Yoga

Vataja Kasa

Chikitsa 18/71

Dhooma Yoga

Vataja Kasa

Chikitsa 18/73

Dhooma Yoga

Vataja Kasa

Chikitsa 18/74

Dhooma Yoga

Vataja Kasa

Chikitsa 18/75

Dhooma Yoga

Vataja Kasa

Chikitsa 18/130

Dhooma Yoga

Vataja Kasa

Chikitsa 18/146

Dhooma Yoga

Kshataja Kasa

Chikitsa 18/147

Dhooma Yoga

Kshataja Kasa

Chikitsa 18/169

Haritaki Leha

Swasa, Kasa

Chikitsa 20/39

Leha Yoga

Chardi

Chikitsa 23/55

Mrita Sanjivani Agada

Visha

Chikitsa 23/78

Maha Gandha Hasti

Visha

Chikitsa 26/152

Pradhamana Nasya Yoga

Pinasa

Utilization in therapeutics : External Application

Sutra 3/5

Pradeha Yoga

Kusta

Sutra 3/10

Avachurna Yoga

Kusta

Sutra 3/12

Pradeha Yoga

Kusta

Sutra 3/12

Pradeha Yoga

Kusta

Sutra 3/15

Lepa Yoga

Kusta

Sutra 5/26

Dhooma Yoga

Shiro Virechana

Chikitsa 3/306

Anjana Yoga

Vishama Jwara

Chikitsa 7/117

Lepa Yoga

Sidhma

Chikitsa 7/167

Shamana Lepa

Shwitra

Chikitsa 7/170

Lepa Yoga

Kilasa

Chikitsa 23/190

Lepa Yoga

Sarva Shotha, Visha

Chikitsa 23/192

Lepa Yoga

Sarva Visha

Chikitsa 23/213

Pancha Shirisha Agada

Visha hara

Chikitsa 25/114

Lepa Yoga

Twak Janana

Chikitsa 26/196

Pitaka Churna

Mukha Roga

Chikitsa 26/235

Varti Yoga

Netra Roga

Chikitsa 26/250

Anjana Yoga

Netra Roga

Chikitsa 26/252

Sukhavati Varti

Netra Roga

Other References

Sutra 1/70

Classified under Parthiva Dravya

Jagtap et al.

Anjana Anjana Dravyas are those, which are employed as collyrium in eye diseases or otherwise. The importance of Anjana in daily routine has been recognized since vedic times. Anjana is an important part of Dinacharya (Charaka). 48 Rasavagbhata mentioned five different types of Anjanas.49 Detailed descriptions of these five are not found available in Charaka Samhita except information on very few. Sauveeranjana is a lead containing mineral with a chemical formula of PbS with Pb (> 50%).50 This mineral has been equated with Stibnite by few other scholars.51 This mineral has been preferred occasionally in therapeutics (Table 10). The screening reveals that, Anjana Yogas are very rarely mentioned in Charaka Samhita. Anjana has been clarified as Sauveeranjana by Chakrapani at Sutra 1/70. It has also been mentioned that, Suveeraanadibhavam Sauveeram i.e. the one found on the river banks of Suveera should be considered as Sauveeranjana (Sutra 5/15). In addition to Sauveeranjana; other forms of Anjanas like Srotonjana (Chikitsa 20/29), Rasanjana (Sutra 5/15), Pushpanjana (Chikitsa 26/250) are also found mentioned in this classic.

Maharasas (Makshika, Shilajatu and Sasyaka) and all eight Uparasas (Kankushta) 52 in his classic. Interestingly, information on Sadharana rasas was not found in the classic. In addition to these minerals; information on certain salts (lavana dravya), alkaline substances (ksara dravyas) and calcium containing material (jantava dravya) etc. are also found available in Charaka Samhita. These groups were not screened in the current attempt. Charaka advocated utilization of these preparations with great conviction. In recent past, most of the western scientists focus on the toxic nature of metals and minerals like Mercury, Lead, Arsenic etc. A review of Ayurvedic literature reveals that the ancient scholars were aware of this fact and devised various methods such as Shodhana to rid them of their adverse effects, if any. 1.

2. 3.

Table 10. References of Anjana in Charaka Samhita Sr. No.

Reference

Formulation

Therapeutic Uses

Utilization in therapeutics : External Application 1

Sutra 3/5

Pradeha Yoga

Sutra 5/15

Anjana Yoga

Netra Roga

Chikitsa 26/250

Sukhavati Varti

Timira Netra Roga

4. 5.

Kusta, Kilasa, Dadru

Other References 4

Sutra 1/70

Classified under Parthiva Dravya

Conclusion The screening reveals that mineral preparations occupied a significant place in Ayurvedic therapy since antiquity. Overall, it is found that, Acharya Charaka mentioned three

References Charaka Samhita. Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Reprint, Sutra Sthana 1/68, pp 20 (2000). Rasendra Sara Samgraha, Satyartha Prakashika commentary by Satyartha Prakasha, Krishnadas Academy, Varanasi, 1st Ed., 1/4, pp 5 (1994). Anonymous, Safety / Toxicity study report of some Ayurvedic Drugs, Central Council for Research in Ayurveda and Siddha, Dept. of AYUSH, Ministry of Health & Family Welfare, New Delhi (2009). Saper RS, Kales SN et al. Heavy Metal Content of Ayurvedic Herbal Medicine Products, JAMA 2004;292(23):2868-73. Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas publications, New Delhi, Reprint, 2/1, pp 18 (2010). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas publications, New Delhi, Reprint, 2/80, pp 29 (2010). The Ayurvedic Pharmacopoeia of India. 1st Ed., Ministry of Health & Family Welfare, Dept. of AYUSH, Delhi, Part-I, Vol-VII (Minerals & Metals), pp 36-7 (2008). Ayurvediya Rasashastra. Jha CB, Chaukhamba Surabharati Prakashan, Reprint Ed., Varanasi, pp 223 (2003).

Minerals in Charaka Samhita - A Review 9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

Ayurveda Prakasha. Suspashtartha Prakashini Hindi commentary by Gularaj Sharma Mishra, Chaukhamba Bharati Academy, Varanasi, 4/9-10, pp 410 (2007). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 21/29, pp 525 (2000). Charaka Samhita. Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Reprint, Chikitsa Sthana 1/3/65, pp 386 (2000). Charaka Samhita. Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Reprint, Chikitsa Sthana 1/3/56, pp 386 (2000). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulkarni DA, Meharchand Lachhmandas publications, New Delhi, Reprint, 2/114, pp 33-4 (2010). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulkarni DA, Meharchand Lachhmandas publications, New Delhi, Reprint, 2/116, pp 34 (2010). Charaka Samhita. Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Reprint, Sutra Sthana 1/70, pp 20 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 22/87, pp 591 (2000). The Ayurvedic Pharmacopoeia of India. 1st Ed., Ministry of Health and Family Welfare, Dept. of AYUSH, Delhi, Part-I, Vol-VII (Minerals & Metals), pp 45 (2008). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 21/80-3, pp 535 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 21/130, pp 543 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 2/27, pp 16 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 8/39, pp 182 (2000).

22.

23. 24.

25.

26.

27. 28.

29.

30.

31. 32.

33. 34.

35.

Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/1, pp 42 (2010). Sushruta Samhita. Chaukhambha Orientalia, Varanasi, 7th Ed., Kalpa Sthana 6/16, pp 581 (2002). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/46, pp 48 (2010). The Ayurvedic Pharmacopoeia of India. 1st Ed., Ministry of Health & Family Welfare, Dept. of AYUSH, Delhi, Part-I, Vol-VII (Minerals & Metals), pp 5-6 (2008). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 22/119, pp 597 (2000). Sushruta Samhita. Chaukhambha Orientalia, Varanasi, 7th Ed., Sutra Sthana 38/37-38, pp 167 (2002). The Ayurvedic Pharmacopoeia of India. 1st Ed., Ministry of Health & Family Welfare, Dept. of AYUSH, Delhi, Part-I, Vol-VII (Minerals & Metals), pp 19-20 (2008). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 21/231-33, pp 564 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Ed. Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 22/ 242, pp 566 (2000). Ashtanga Hridayam. Collated by Anna Morshwar Kunte, Krishnadas Academy, Varanasi, Reprint Edition, Chikitsa Sthana 4 (2000). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/61, pp 51 (2010). Ayurvediya Rasashastra. Jha CB, Chaukhamba Surabharati Prakashan, Reprint Ed., Varanasi, pp 254 (2003). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/181-3, pp 274-5 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Edited by Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/200-1, pp 276 (2000).

20 36. 37.

38. 39. 40.

41.

42.

43.

44.

Jagtap et al. Sushruta Samhita. Chaukhambha Orientalia, Varanasi, 7th Ed., Kalpa Sthana 2/5, pp 564 (2002). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/66-7, pp 53 (2010). Ayurvediya Rasashastra. Jha CB, Chaukhamba Surabharati Prakashan, Reprint Ed., Varanasi, pp 257 (2003). http://en.wikipedia.org/wiki/Orpiment (last accessed on 19.12.2011 at 10.15 AM) Rasatarangini. Prasadani Commentary by Haridutta Shastri, Ed. Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/ 52-5, pp 252 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Ed. Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/ 56, pp 253 (2000). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/1, pp 42 (2010). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/88-90, pp 57 (2010). Ayurvediya Rasashastra. Jha CB, Chaukhamba Surabharati Prakashan, Varanasi, pp 263 (2003).

45. 46.

47.

48.

49.

50.

51. 52.

http://en.wikipedia.org/wiki/Realgar (last accessed on 19.12.2011 at 10.12 AM) Rasatarangini. Prasadani Commentary by Haridutta Shastri, Ed. Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/ 116, pp 263 (2000). Rasatarangini. Prasadani Commentary by Haridutta Shastri, Ed. Kashinath Shastri, Motilal Banarasidas, New Delhi, 11th Ed., Reprint, 11/ 117, pp 263 (2000). Charaka Samhita. Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Reprint, Sutra Sthana 5/15, pp 39 (2000). Rasaratnasamuccaya. Vigyanabodhini Commentary by Kulakarni DA, Meharchand Lachhmandas Publications, New Delhi, Reprint, 3/97-8, pp 58 (2010). The Ayurvedic Pharmacopoeia of India. 1st edition., Ministry of Health & Family Welfare, Dept. of AYUSH, Delhi, Part-I, Vol-VII (Minerals & Metals), pp 32 (2008). Ayurvediya Rasashastra. Jha CB, Chaukhamba Surabharati Prakashan, Reprint Ed., Varanasi, pp 268 (2003). Charaka Samhita.Ayurveda Dipika Commentary by Chakrapanidutta, Chaukhambha Surbharati Prakashan, Varanasi, Chikitsa Sthana 7/111 pp 456 (2000).

Address for correspondence: Dr. Galib Ruknuddin, Assistant Professor, Department of Rasa Shastra & Bhaishajya Kalpana, IPGT & RA,Gujarat Ayurved University, Jamnagar - 361008 Gujarat (India) Mns No: JREIM-2012-09-034 E-mail: galib14@yahoo.co.in

J. Res. Educ. Indian Med., Jan.-March 2014; Vol. XX (1): 21-27

ISSN 0970-7700

EVALUATION OF ECLECTIC THERAPY ON FASTING BLOOD SUGAR IN PATIENTS OF TYPE-2 DIABETES MELLITUS ROOHALLAH BAY,1* SUJATA VAYDIA2 AND FATEMEH BAY3 Behavioral Sciences Research Center1, Baqiyatallah University of Medical Sciences, Tehran, Iran Department of Alternative Therapy,2 Zoroastrian College, International University for Complementary Medicine, Mumbai, India Department of Education and Psychology,3 Kharazmi University, Tehran, Iran Abstract : Diabetes mellitus is one of the most dangerous diseases in the world. This report presents exploratory research designed and performed at diabetes clinics in Iran. The main aim of the research was to evaluate the effect of Eclectic therapy conducted through Hypnotherapy, Acupressure therapy and Transcendental meditation (TM) on Fasting Blood Sugar (FBS) in comparison with placebo treatment in patients of type-2 diabetes mellitus (DM-II). ‘Convenience sampling’ for the selection of patients who suffered from type-2 diabetes and who were willing to cooperate in this research was used. 20 patients were employed as a sample group. For the collection of data, the identical quasi-experimental design called ‘non-equivalent control group’ system was used. Therapy sessions were carried out for 10 successive days. Each session comprised of 60 to 90 minutes. Prescription included 2 capsules (containing 3 grams of wheat flour each) twice a day for members of the placebo group. The pre-tests, post-tests and followup tests were conducted in a medical laboratory recognized by the Ministry of Health and Medical Education of Iran. The data of this research showed that the mean FBS level in the post-tests and the follow-up tests for the experimental group had been reduced significantly in comparison with the pre-tests, and this result was different from that of the placebo group. The results of this research revealed that eclectic therapy including acupressure therapy, hypnotherapy and transcendental meditation had an effect on the FBS level in patients of DM-II and that eclectic therapy was more effective than the placebo treatment in reducing the FBS level in diabetes mellitus. Keywords: Alternative therapy, Diabetes, Eclectic therapy, Transcendental meditation.

Introduction Diabetes Mellitus is one of the most problematic diseases. Type-2 diabetes mellitus (DM-II) is more severe among patients aged 40 to 60. It usually progresses with age. Diabetic patients must receive great care; otherwise, they will encounter many complications including heart attacks and strokes. The pancreas is a gland that is partly exocrine and partly endocrine. The exocrine part secretes the digestive pancreatic juice and the endocrine part secretes hormones, e.g. insulin.1 Insulin is a polypeptide that is secreted by beta-cells in the Islets of Langerhans of the pancreas.2 Type-2 Diabetes accounts for at least 80% to 90% of all diabetic patients. Diabetes * Corresponding Author

causes a decrease in the ability to absorb insulin, which is referred as insulin resistance. Due to this insulin resistance, the food metabolism and proper utilization of glucose by the body is badly effected.3 According to Gordon, cancer patients practicing meditation reported relief from the side effects of radiation and chemotherapy associated with conventional therapies and enhanced body immune response.4 Williams et al. reported that the current approved treatment for hypertension included transcendental meditation (TM) as a treatment modality.5 Since the early 1980s, the use of psychotherapy as a treatment modality has grown rapidly and this has led to a better and more complete treatment model.6

Roohallah Bay, Sujata Vaydia and Fatemeh Bay

In this research, investigations on the efficacy of a treatment modality combining acupressure therapy with hypnotherapy and TM were conducted (eclectic therapy). Measuring and comparison of the effect of this eclectic therapy on the fasting blood sugar (FBS) level in type-2 diabetic patients with that of a placebo group of patients was done and analyzed. In this research, answer to the following questions were attempted: Does eclectic therapy have an effect on the FBS level in diabetic patients? Is there a difference between the effects of eclectic therapy and placebo treatment on the FBS level in diabetic patients? Do moderator variables (gender, duration of disease and age of patients) have any effect on the FBS level of diabetic patients? This research has addressed two main hypotheses and three minor hypotheses. The main hypotheses of this research are eclectic therapy has an effect on the FBS level of type-2 diabetic patients and there should be a difference between the effects of eclectic therapy and a placebo treatment on the FBS level of type-2 diabetic patients. The minor hypotheses are:That differences exist between the effects of Eclectic therapy and Placebo treatment on the FBS level of type-2 diabetic patients when (1) gender, (2) duration of disease and (3) the age of the patients are considered either individually or as a whole. In this research, the independent variables are ‘Eclectic therapy’ and ‘Placebo treatment’. The dependent variable is the ‘FBS’ level of diabetic patients under study. The rate of ‘studies, social, economic and cultural factors’ the ‘location and the environment of therapy’ and the ‘therapist’ are control variables. Moderator variables are (1) gender, (2) duration of disease suffering and (3) age of the patient.

2. Materials and Methods 2.1. Therapy Methods Following procedures-systems were employed : - TM for relaxation, - Hypnotherapy for relaxation and suggestion (in order to stimulate beta cells) and - Acupressure therapy for the stimulation of the beta cells in the Islets of Langerhans in the pancreas. Diabetic neuropathy is also caused due to liver weakness. If the liver is nomalized by activation with acupuncture (point stimulation), not only does overall digestion improve but diabetic neuropathy and retinopathy can also be avoided. Even though the sugar level is kept under control, side effects are seen in diabetic patients mainly due to continuous stimulation of the pancreas with external medicines. The point of emphasis was to bring the digestive system to its optimum level with acupuncture. For a diagnosed type-2 diabetic patient, initially, the spleen point Sp-3 or Sp-6 is stimulated to influence the pancreas. Along with this, the liver is charged by stimulating Liv-1 point. Once the liver starts functioning at its optimum level, pain in any part of the body diminishes and the bowel movement improves. Along with the liver-1, the lung point Lu-7 is activated to take care of energy circulation in the body. Finally, the brain meridian and the spleen control point P-7 are activated with aim to improve the functioning of the pancreas. Since the stimulation mechanism is controlled by one’s subconscious mind, self-help techniques, such as generating positive thoughts and being sincere, may help to overcome diabetes. 2.2. Materials and Research Methodology Twenty patients were selected from volunteers who were registered at diabetes clinics of Gorgan Panjomeazar Policlinic (Iran). The patients ranged in age from 25 to 60 years. For data collection, we used quasi-experimental designs called “non-equivalent control group.” A placebo group was used instead of a control

Evaluation of Eclectic Therapy on FBS in Diabetes

group. Pre-tests were done on both groups before treatment began, post-tests were done after completion of treatment. Follow-up tests were done two weeks after the last session. Male and female patients were included in both groups, because one of the moderator variables of this research was gender. Treatment was conducted at a room in diabetes clinics of Panjomeazar Policlinic of Golestan Medical Sciences University. For the experimental group (ten patients), 60 to 90 minute meetings, on consecutive days were conducted, while for the placebo group, two placebo capsule containing 3 grams each of wheat flour were used per day (one in the morning and one in the evening). We conducted this program for ten sessions and had one treatment session every day. To measure the effects of therapy, we used pre-tests, post-tests and follow-up tests. The medical tests were done in a laboratory related to the medical organization of Iran and measured the FBS level. In addition, we used the AccueCheck machine to monitor patients. We recorded the daily BS level of patients before and after therapy sessions in both groups. Complete check-ups for the patients were provided one day before starting the first session and one day after the last session. Followup checkup was conducted two weeks after the last session. The tests were done at medical laboratories certified by Golestan Medical Sciences University. Results of these tests were used to compare the placebo and the experimental groups. In this research, statistical methods were used at two descriptive and inferential levels. In descriptive statistics, we used the mean, variance, standard deviation (SD) and also quarter and charts. In inferential statistics, in order to compare the data, we used student’s “t” test and variance analyses. Because of the small sample numbers in this research, the patients in the groups had to be representative of the general population and the groups had to be equal in size. To determine if the groups were representative of the general

population, we used the Kolmogorov-Smirnov Test. To check the equality of variances, we used the ‘Leven Test’, and to survey the quality of changes between the three tests, pre-test, posttest and follow-up test, we used the ‘Duncan Test’. For the survey on the effects of different variables, as well as the passage of time and because the tests were done at different times, we used the repeated measures method. In order to do that, equality of co-variances had to be established, so we used the ‘box test’ and the ‘covariate test’. For the non-existent equality of variances, we used the ‘Huynh-Feldt’, the ‘Greenhouse-Geisse’ and the ‘lower-bound tests’. The data was computarized and statistically analysed using SPSS software. 2.3. Procedure We announced this research at all hospitals, well-being organizations and clinics of Golestan province (Iran). Then, the volunteers for this research were asked to complete a form to get information about the volunteer’s age, gender, duration of disease, drugs used, education levels, other illnesses that they suffered etc. This information was necessary, both to form similar groups to prevent obstructive variable effects and to manage the control and the moderator variables, as well as the obstructive factors. Initially, 252 volunteer diabetic patients were enrolled. Then, by paying attention to the control and moderator variables and for trying to decrease obstructive variables, we invited 49 out of enrolled 252 patients for interviews and checkups. At the time of the interviews, researcher obtained information on the patient’s background, duration of disease, kinds of medicines used and nutrition with lists of daily meals. Then, according to the research design (unequal control groups), experimental group and one placebo group were made. Ultimately, out of 49 patients, 20 volunteers in both groups, were placed while trying to make the two groups similar. Also, according to acupressure therapy principles, physical condition, pulse rates, etc. were checked.

Roohallah Bay, Sujata Vaydia and Fatemeh Bay

In this research, we placed male and female patients in both groups because one of the moderator variables of this research was gender. The duration for all therapy sessions was around 60 to 90 minutes and 10 therapy sessions were conducted for each of the patients in the experimental group. It is important to note that before starting the therapy sessions, all of the patients (both the placebo and the experimental groups) went to the medical laboratory on a specified day (one day before starting the first session of therapy) to take the pre-test. Then, while the experimental group was undergoing therapy, simultaneously the patients of the placebo group were taking placebo capsules. For the experimental groupâ&#x20AC;&#x2122;s patients, eclectic therapy was performed during each session on consecutive days. At the end of therapy for the experimental groupâ&#x20AC;&#x2122;s patients, the patients in the placebo group simultaneously

stopped taking the placebo capsules. Then, on a specified day, all patients of both groups were sent to a medical laboratory for the post-test. In addition, around one week after finishing the therapy sessions, on a specified day, all patients of both groups were sent to the medical laboratory for the follow-up test. 3. Results The data for the FBS levels are as follows: placebo group: FBS 1: 218, FBS 2: 224 and FBS 3: 224 and experimental group: FBS 1: 254, FBS 2: 155 and FBS 3: 166), where FBS 1, 2, and 3 are the mean FBS levels at the pre-test, the posttest and the follow-up test, respectively (Table 1). The effect of time within each group is significant (Table 2). Thus, we can conclude that the FBS level experiences different changes with passing time if we disregard the effects of other moderator variables on the results and if we

Table 1. Data for FBS levels at different times (1, 2 & 3) for different groups and genders. Group F.B.S.1(pre-test)

experiment

Placebo

F.B.S.2(post-test)

experiment

Placebo

F.B.S.3(follow-up test)

experiment

Placebo

Gender

Mean

Std. Deviation

Male

205.8000

48.56645

Female

303.0000

75.77269

Total

254.4000

78.89543

Male

207.0000

39.25557

Female

230.2000

44.26850

Total

218.6000

41.29622

Male

115.8000

42.13312

Female

196.0000

72.14915

Total

155.9000

69.92289

Male

212.2000

27.68935

Female

237.4000

52.91314

Total

224.8000

41.97036

Male

119.0000

41.50904

Female

214.0000

68.99638

Total

166.5000

73.40640

Male

211.0000

32.89377

Female

237.2000

45.83339

Total

224.1000

40.06509

Evaluation of Eclectic Therapy on FBS in Diabetes Table 2. FBS levels between groups and within groups. df

Sig.

Between Groups

5.315

.011

Within Groups

Total

survey the results for only the placebo or the experimental group. Table 1 shows that the FBS levels in both groups varied with time. The minimum FBS level in both groups occurred at the time of the post-test. At the follow-up test, a slight increase was noted, but it was not significant. The pretest FBS level is the highest among the three tests. These results show that eclectic therapy is able to decrease the FBS levels of patients. Table 3 (F=25.21 & P=0.000) indicates different changes in the FBS levels of patients at different times. However, when we surveyed each moderator variable individually after deleting the effects of other variables, we saw that all

significance levels were greater than 0.05. Thus, we could conclude that neither gender nor the age of the patient had a significant effect on the decrease or the increase in the FBS level at different times. Thus, the data indicate that both main hypotheses of this research are correct. 4. Discussion and Conclusion Hypnosis has been successfully used for the treatment of several disorders. In 1996, the National Institutes of Health judged hypnosis to be helpful for the treatment of pain from cancer and other chronic conditions. Several studies have indicated that it can ameliorate acute pain in burn patients, children experiencing bone marrow aspirations, and women in labor. It has also been effective intervention analgesia for the treatment of invasive medical procedures.7 The research findings about meditation results include increased happiness, reduced stress, increased intelligence, increased creativity, improved memory, improved health, reduced high blood pressure, improved relationships, increased

Table 3. Factors and moderator variables. Source

Sig.

Factor 1 – time

Greenhouse-Geisser

1.077

0.029

0.882

Factor 2 – group

Greenhouse-Geisser

1.077

25.218

0.000

Factor 3 – gender

Greenhouse-Geisser

1.077

0.185

0.691

Factor 4 – age

Greenhouse-Geisser

1.077

0.142

0.730

Factor 5 - duration of disease

Greenhouse-Geisser

1.077

0.112

0.761

energy, reduced insomnia, reversal of biological aging, reduced crime and improved quality of life in society. The research has been published in major scientific journals, such as Science, the American Journal of Physiology, Scientific American, Lancet, the Journal of Counseling Psychology, the International Journal of Neuroscience, the Journal of the Canadian Medical Association, the British Journal of Educational Psychology and the Journal of Conflict Resolution.8 Sommer reports that 2000 regular practitioners of transcendental meditation, when compared with 600,000 non-meditators over a

5-year period, had 30.6% fewer mental disorders, 30.4% fewer infectious diseases and greater than 50% less overall health system usage.9 Benson conducted a series of investigations involving men and women in order to examine the effect of transcendental meditation on physiological functions of the body and reported marked physiological changes, including reductions in heart rate, breathing rate, oxygen consumption, blood lactate levels and blood pressure.10 Researchers at the New Mexico State University’s Social Work Department observed a

Roohallah Bay, Sujata Vaydia and Fatemeh Bay

high incidence of diabetes among MexicanAmericans in southern New Mexico. They believed that the use of a short relaxation program could have beneficial effects on the health of those with diabetes and their families. They found that a combination of acupressure and breath awareness help people with diabetes. The study showed that a short stress-relief program including touch therapy could lower blood sugar and improve health in diabetic patients.11 According to Redfield, currently, many humans integrate meditation practices in their programs for health promotion and illness prevention. Over many centuries, Meditation as a method to integrate the concept of mind and body, has been recorded as effective in the form of either practical or religious practices. The procedure of meditation involves the concept of inner stillness and celebrates nature as a revered path to self-knowledge and spiritual enlightenment, leading the person on a satisfying mental journey. The goal of meditation is to empty the mind of thought and let go of the preoccupations that make up the mind’s chatter.12 According to Bricklin, approximately 40% of the U.S. population is using alternative therapies for better health.13 Our study showed different results for the experimental and the placebo groups. The eclectic therapy had a more significant effect than the placebo treatment and this result was independent of gender, duration of disease and age. Thus, our study supports a link between alternative healing therapies and decrease in mean type-2 diabetes. This creates a need for structured programs teaching lifestyle change, nonpharmacologic interventions and alternative therapies in conjunction with conventional treatment.14 The psychological role has always been one of patient’s advocate. If lifestyle changes and alternative healing such as hypnotherapy, transcendental meditation and acupressure therapy are taught to patients, the risk of stroke, heart attack, other disabling side effects of diabetes

and most other diseases will decrease the pharmacological treament. However, there can be adverse side effects with medication. By implementing and teaching holistic healing, the therapist can give patients the foundation to reduce stress in their lives, thereby reducing the need for conventional medical treatment. Therapist can also experience both the benefits and the limitations of these approaches and find ways to use them with their patients. By embarking on these extended courses of study, the clinical results may justify the investment of time and energy.15 The findings of our study have implications for advanced psychological practice, education and health care of diabetic patients and for others who suffer from disease. The implementation of hypnotherapy, acupressure therapy and transcendental meditation classes taught by a psycho-physiologist in the outpatient clinic should be considered at the patient’s first clinic visit. A shift in emphasis from treating to imparting teaching the patient these therapies highlights the psychological function as a guide and teacher; and makes patient care a more fulfilling partnership. All psychologists should have knowledge of holistic healing and implementation of hypnotherapy, transcendental meditation and acupressure therapy. These systems should be taught in the classes at schools of psychology to introduce the concept of alternative healing therapies.14 Our study established eclectic psychophysiological therapy (acupressure therapy, hypnotherapy and transcendental meditation) as important to the type-2 diabetic patient populations as it provides the patient with the power to decrease the FBS Level and to enhance the body’s own capacity for healing. Integration of acupressure therapy, hypnotherapy and transcendental meditation in treatment plans allows a collaborative and democratic relationship between the advanced psycho-physiological practitioner, other health providers and the patient, who then reaps the psychological and physiological rewards of feeling more in control of their own health.

Evaluation of Eclectic Therapy on FBS in Diabetes

Limitations of the study The following limitations prohibit generalizations of study to target populations: The study involved a cross section of 20 participants. The sample size may serve to limit generalizability of the findings. Sample size may not be representative, as samples would only be from Golestan state (Iran) and within limited time frame. Also the sample consisted of volunteering sample of convenience. All ethnicities may not have been represented. Acknowledgments This study was conducted with the approval of the Medical Sciences University of Golestan (Iran) and Zoroastrian College of Mumbai (India). 1. 2. 3. 4. 5.

References Chaurasias B G. Human Anatomy: New Delhi, India, CBS Publishers and Distributors, 2003. Sembulingam K, Sembulingam P. Essentials of Medical Physiology. New Dehli, India, Jaypee Brothers, Medical Publishers (P) LTD, 2008. Guyton C, Hall JE. Text book of Medical Physiology. Tehran, Teimorzadeh Publishers, 2000. Gordon J. Alternative medicine and the family physician. American Family Physician. 1996;54: 2205-22. Williams J, Park L, Kline J. Reducing distress associated with pelvic examinations: A stimulus

6. 7.

9. 10. 11.

12. 13. 14. 15.

control intervention. Women & Health 1992; 18(2):41-53. Goldfried MR, Cstonguay LG. The future of psychotherapy. Integration Psychotherapy 1992; 29:4-10. Lang EV, Benotsch E, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. Surgery:Complications and Treatment. Lancet 2000;355:1486. Orme-Johnson D. Summary of Scientific Research on the Transcendental Meditation and TM-SIDHI Programs. Maharishi International University, Maharishi Vedic Education Development Corporation. Available at http:// www.tm.org/research/summary.html, June 14, 2009. Sommer SJ. Mind-body medicine and holistic approaches. Australian Family Physician 1996; 25:1233-41. Benson H. The Relaxation Response, New York, William Morrow, 1975. Gerald W. Acupressure, Breath Awareness Helps Diabetes Patients. Originally published in Health & Social Work. Vest, New Mexico, 1997; 22:95-100. Redfield SM. The Joy of Meditating, New York,Time-Warner, 1995. Bricklin M. Positive Living and Health. Pennsylvania, PA. Rodale Press, 1990. Bay R. Alternative and Psycho-Physiological Complementary Therapies. Pune, India, Suchak Creations Publication, 2009. Bay R. Explanatory Dictionary of Type 2 Diabetes with Psycho â&#x20AC;&#x201C;Physiological Treatments. Pune, India, Suchak Creations Publication, 2009.

Address for correspondence: Dr. Roohallah Bay, Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. E-mail: ir_psychology@yahoo.com Roohallah Bay, M.A; M.Phil; Ph.D; Post Doctoral Fellow, Sexual and Family Therapy Group, Department of Family Medicine, School of Medical Sciences, University Sians Malaysia.

J. Res. Educ. Indian Med., Jan.-March 2014; Vol. XX (1): 29-35

ISSN 0970-7700

MEMORY LOSS IN GERIATRIC AGE AND ITS PREVENTION THROUGH YOGIC LIFESTYLE HETAL AMIN,1 ROHIT SHARMA,2 M.K. VYAS3 AND R.R. DWIVEDI4 Departments of Basic Principles,1,3,4 Department of Rasashastra and Bhaishajya Kalpana,2 I.P.G.T.& R.A., Gujarat Ayurved University, Jamnagar - 361008 Gujarat (India) Abstract: India is the second largest country in the world with 76 million elderly persons above 60 years of age as of the 2011 Indian census. The elderly population (70 years and above) are projected to increase five fold from 2001-2051. Condition like Alzheimer’s disease, another disorder that causes dementia or a condition that mimics dementia disrupts work, hobbies, social activities and family relationships. Yoga is the ancient science aimed to get eternal happiness through eight limbs that include Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana, Dhyana and Samadhi. All these stimulate and enhance the functioning of the various internal organs and also in boosting overall health. Ageing can be improved with yoga, which prevents accumulation of stress metabolites and keeps the physiology supple. This paper emphasis on memory loss and suggests preventive yogic practices for memory loss in geriatric age. Keywords: Asana, Geriatrics, Memory loss, Yogic lifestyle.

Introduction Memory loss and age-related problems are major issues in Geriatrics. Projections made by the United Nations has indicated that India will have 198 million persons of 60+ in 2030 and 326 million by 2050. In 2016, there will be an estimated 57 million males and 56 million females of 60 plus (1986-90 to 2011-16) (http:/ socialjustice.nic.in/npopcomplete.php). Mild memory impairment is a common, even normal, consequence of the ageing process. It becomes abnormal when it affects an ability of an individual to function normally on a dayto-day basis. The reduced capacity of older people to learn and remember may be caused by stem cells in the brain dividing less frequently, rather than a shortage of neural stem cells as was previously thought (Gunther et al., 2001). Longitudinal studies in the elderly have revealed a gradual decline in the cognitive abilities of older people, but differences between individuals in the rate of decline suggest that at least some of the age-related deterioration is due to the inclusion of subjects with incipient dementia. The elderly 1. Ph.D Scholar 2. Ph.D. Scholar

people may demonstrate an incipient phase for Alzheimer’s disease (AD) is supported by studies in the elderly which have shown evidences of Alzheimer’s disease years before clinical symptoms are evident and this is more common in individuals with memory impairment in old age (Alzheimer’s Association, 2004). Objectives The purpose of this study was to examine directly the relationship between the practice of yoga and its impact on memory loss in geriatric age. The attempt of the study was to identify disease dictated by memory loss and prevention by yogic practices. Major findings of Research studies on Memory loss Some of the early symptoms of many diseases consist of memory loss, confusion regarding time and place, problems with words in speaking or writing as well as changes in mood and personality. Age associated cognitive impairment can be accompanied by depression

3. Associate Professor 4. Professor and HOD

Hetal et al.

and changes in mood (Ownby RL et al., 2006; Rinck and Becker, 2003) and the data suggest that mood disorders can aggravate the processes of cognitive decline (Gualtieri CT et al., 2008). The effect of aging and memory loss on spirituality is less clear, although individuals with early memory loss have often turned to spirituality as an important coping mechanism (Beuscher L et al., 2008). In fact, higher levels of spirituality have been associated with a slower rate of cognitive decline in patients with memory loss (Kaufman Y et al., 2007). Till now not many options in treatment of age-associated memory loss and cognitive impairment are available especially with associated mood-related problems. It may be possible to treat degenerative disorders including Alzheimer’s disease, dementia and depression by stimulating the stem cells’ ability to divide and produce new nerve cells (Anonymous, 2006). According to World Health Organization, 25% of the world population is suffering from mental illnesses. But only 40% of such cases are diagnosed and treated. One million annual suicides are the result of these undiagnosed or missed cases (Anonymous, 2007). Most common causes for these suicides are depression, dementia, anxiety and schizophrenia. These health issues are characterized by memory loss, confusion and disorientation. Prevention of Memory loss through Yoga Yoga is viewed as a physical, mental and spiritual discipline that confers a sound body and mind (Mohan et al., 2002). Two of the physical aims of yoga are Pranayama (breathing techniques) and Asana (posture), while one of the mental aims is the ability to maintain cognitive control, specifically in the areas of attention, memory and arousal control. One general claim is that yoga helps clear the mind and this may have an effect on the ability to attend to relevant stimuli and recall information subsequently (Heriza et al., 2004). Inverted yoga positions have been associated with claims of increased memory and attention due to increased blood

flow to the brain. Yoga can prevent memory lapses by calming person and enhancing concentration. It can also improve powers of recall by increasing circulation to brain. Specifically, two inverted poses are suggested, the Open-Legged Forward Bend and Threading the Needle (Schaeffer et al.,2006). More inverted poses including the headstand and child’s pose are cited as ways to nourish the brain by increasing circulation of blood and oxygen (http:/ /www.womenfitness.net/yoga_ad.htm). A study used both meaningful words and nonsense syllables to test immediate (short-term) verbal memory abilities before and after a one-month period of yoga training for college-aged (15 to 25 years) males and females. The results though incomplete, suggested that yoga did smooth the progress of immediate memory presentation more than the absence of yoga and that the advantage was greater for males than females (Kocher et al.,1979). Elementary school children who engaged in 30 minutes of yogic practices (by following a videotaped yoga session) twice a week for three weeks increased their time on task (paying attention to the teacher or task at hand) during three weeks period and at a later follow-up date, while their classmates’ time on task remained essentially unchanged (Peck et al., 2005). Similar work studied the performance scores of children aged 11 to 16 years on verbal and spatial memory tests for two groups, one attending a yoga camp and the other, a fine arts camp. Both groups were tested initially and after 10 days of their respective interventions. At the final assessment, the yoga group showed a significant increase (43%) in spatial memory while the fine arts and (control group) showed no change. The results suggest that yoga practice, including Asana and Pranayama improve delayed recall of spatial information (Manjunath et al., 2004). Memory span and attention measured before and after yoga training changed positively as a result of yoga training in primary school children (Anantharaman et al.,1984). Yoga has also been utilized with limited positive results in

Prevention of Memory Loss through Yogic Lifestyle

rehabilitation with mentally retarded individuals (Pathak et al., 1984) and in training visual perceptual sensitivity (Manjunath et al.,1999). The effect of yoga shows positive effect on the attention and behavior of boys with Attention-Deficit Hyperactivity Disorder (ADHD) (Jensen et al., 2004). Boys diagnosed with ADHD were assigned to Yoga and Control group. Yoga group includes 20 yoga sessions and cooperative activities, respectively. Both groups were assessed pre and post intervention on the Conners’ Parent andFigure Teacher 7 Scale (Revised) (Conners et al., 1997) and the test of variables of attention (Greenberg et al., 1997). Significant improvements from pre-test to post-test were found for the control group, but not the yoga group on several subscales of the Conners’ Teacher Rating Scales, while the opposite effect was present on several subscales of the Conners’ Parents Rating Scales. Some of the results of this study suggest that yoga may have merit as a complementary treatment for boys with ADHD already stabilized on medication particularly for its evening effect when medication effects were absent. Five cognitive tests (color cancellation, digit forward, digit backward, recognition and visual retention) were done to study the effects of yoga over the time span of an academic year for 12 year old participants. Results showed improvement on most tests from the beginning to the end of the school year in both, a group that regularly participated in yoga and a group that did not. However, the statistical analysis did not directly evaluate the control and yoga groups, stating that the mean score of the yoga group was slightly higher than the control group (Sahasi et al., 1984). Similarly, Anuloma Viloma Pranayama (uninostril breathing) as part of a yoga technique increased spatial memory scores by 84% but did not cause an increase in verbal memory scores (Naveen et al., 1997). Literature review on Memory and Yoga Memory is the capacity to retain and recall information about past and present incidents. It

is the ability to analyze and synthesize the assimilated information and not for storage alone. In Sanskrit, the word ‘memory’ is called as ‘Smriti’. The Yoga Sutra of Patanjali describes Smriti as ‘an experienced object not being lost from the mind’ (Mahaprabhulal Goswami, 2009). Throughout the day, the mind is flooded with many informations, data and new happenings/developments/facts. Thus, mind has its natural way to sieve out only the information that is pertinent or useful. Thus, it is essential to train mind accordingly and ensure a healthy state of functioning. Memory is the latent capacity to retain and recall information, yoga assists in improving memory power through yogic techniques of Asana, Pranayama, Pratyahara etc. The brain functions of attention, cognition, processing of sensory information and visual perception are honed with yogic practices. Patanjali has classified mental functions in to five categories viz. Pramana (means of valid knowledge), Viparyaya (illusion), Vikalpa (imagination), Nidra (sleep) and Smriti (memory) (Mahaprabhulal, 2009). Here, Smriti is recalling of our previously recorded experiences. Perception, illusion, imagination and sleep are registered to find out whether it is matched with any previously stored information. Sometimes this stimulus is generated in the Chitta itself in the form of thoughts. This also triggers the recollection of the past memory. Hatha Yoga emphasizes ‘Chitta Vishranti’ i.e. the tranquility at the level of consciousness (Chamanlal, 1997). Yogic practices like Asana, Pranayama, Dhyana, Om chanting increase the circulation of blood to the brain. It is directly related to awareness and aims at release of tensions working at the level of consciousness (Chitta). This helps calm the mind and enhances concentration skills. Memory lapses can also be prevented through yogic practices that enhance the power of recall. One can draw upon the immense power of the mind with consistent yogic endeavor. Two of the physical steps in yoga practice are Pranayama and Asana while one of the mental

Hetal et al.

aims is the ability to maintain cognitive control, specifically in the areas of attention, memory and arousal control. One common claim is that yoga helps to clear the mind and this may have an effect on the ability to attend to relevant stimuli and recall information subsequently (Heriza et al., 2004).

2. Right breathing - Pranayama 3. Right cleansing - Shuddhi kriya 4. Right diet - Satvika ahara 5. Right mindset - Dhyana There are some yogic techniques that exclusively stimulate the brain and nervous system to improve memory and concentration.

Findings based on Literature review Yoga can help reduce and in some cases eliminate drug dosage and dependence in patients suffering from memory loss, diabetes mellitus, hypertension, epilepsy, anxiety, bronchial asthma, constipation, dyspepsia, insomnia, arthritis, sinusitis and dermatological disorders (http:// health.yahoo.com/health/ency/adam/000760/ _overview). Pranayama and Pratyahara are extremely efficient techniques to divert individual’s attention from the objects of outer environment, to increase every person’s energy potentials and interiorize them, to achieve control of one’s inner functioning. Memory span and attention, measured before and after Yoga training, changed positively (Anantharaman et al., 1984). Omkar meditation increases the efficiency of cells and organs. Omkar recitation is an important and well known yogic practice. It is generally prescribed before and/or after every session of yogic practices (Vishwas et al., 1995).

Asana

Implications There are many yogic techniques that stimulate the brain and nervous system to improve memory and concentration. Yoga provides an excellent tool for improving memory power and fighting forgetfulness. Hatha yoga is a gentle form of yoga that consists of Asana, Pranayama, Dhyana and Om chanting, to achieve clarity of the mind that translates into all round good health. Memory power is given a boost while also improving the ability to maintain focus and concentration. The Five steps of yogic lifestyle for overall well being 1. Right posture - Asana

Inverted postures nourish the brain by increasing circulation of blood and oxygen. Abundant blood is supplied to the brain during practice of Shirshasana. This is to improve memory and for increasing intellectual powers. Exercise boosts circulation, including blood flow to the brain which uses a full 25 percent of the oxygen that enters our lungs (www.yogapoint.com). It also boost brainnurturing chemicals and reduces stress, which has been shown to damage the brain. Physical activity can also ease depression and delay the onset of Alzheimer’s disease. The Asanas using a Drishti (gazing point) especially during balancing postures improves mental concentration. Spine lengthening postures, the forward and back bending poses, activate the spinal column and stimulate the nervous system.

Types of Asana Asana are not aimed at mere toning of the physical body. They are designed to activate energy channels thereby empowering the body from within. During Asana practice, it is important to focus the eyes at the point between the eyebrows which promotes memory power (Udupa et al.,1978). One must gently do away with restless thoughts and be aware of the movements of the body. Following Asana are useful for these purposes which can easily done by senior citizens. 1. Vrikshasana 2. Natarajasana 3. Sarvangasana 4. Matsyasana 5. Bhujangasana 6. Bhadrasana

Prevention of Memory Loss through Yogic Lifestyle

7. Shavasana 8. Padmasana 9. Siddhasana 10. Vajrasana 11. Ustrasana 12. Tadasana etc. Pranayama In Pranayama, the mind is focused on breath as it flows in and out of the body. Oxygen and Prana (energy) levels in mind and body also elevate due to the regulation of breath. Any activity which requires a total concentration of mind will control the breath also. Pranayama aims primarily on the control of mind. AnulomaViloma, Bhastrika, Kapalbhati and Bhramari Pranayama are the best. Pranayama increases concentration as well as nourishes the brain. Yogic breath or Pranayama is an excellent way to revitalize Prana and to train the mind to be present and alert. Pranayama cleanses and strengthens the physical body while calming and clearing the mind (M.M. Gore, 1991). Shuddhi Kriya Tratak Kriya: Improves concentration, memory and mental power (Gheranda Samhita, 1999). It also increases working efficiency and the ability to read otherâ&#x20AC;&#x2122;s mind. Kapalbhati Kriya: Kapalbhati kriya decreases Kapha dosha responsible for the Tamas avarana of the Chitta. After this Kriya the dosha is removed and the Satva guna is elevated resulting improvement in memory (Gheranda Samhita, 1999). This Pranayama supplies pure life energy to the brain. It increases the blood circulation in the brain and removes blood clots thereby improving the memory power. Other than this, the toxic and foreign substances from the body are evacuated (http://yousigma.com/health/ yogaandbenefitssummary.html). Sattvika Ahara A yogic diet ideally follows a Sattvika or pure vegetarian food. A balance of fresh fruit,

vegetables, whole grains, milk, nuts and seeds in combination of both raw and cooked foods can be balanced yogic diet. These foods increases Sattva in the body because they are light, simple and full of necessary nutrients. Such yoga diet and lifestyle increases physical and mental vitality making anybody easier to experience clarity, lightness and peace of mind. Dharana Deshah Bandhah Chittasya Dharana. (Patanjali Yoga Sutra, 2009). It is the practice of fixing the mind to an object for concentration. Daily practice of Dharana reduces the wavering attitude of mind and different kind of peace can be observed throughout the day (Riyaz et al., 2007). Routine practice of Dharana improves memory by controlling fluctuation of thoughts. Dhyana (Meditation) Tatra Pratyaya-Ekatanata Dhyanam (Patanjali Yoga Sutra, 2009). When the mind remains without distraction on an object for a long time, it is called meditation. Dhyana is a state of mind where no sensual thoughts or no contents occupying the mind. It is a step beyond Dharana, requiring even more mental focus and concentration. This practice controls the mind and make it more conscious to pay attention on selected subject which further leads to increase Smriti power by decreasing Chittavritti. Yogic Mudra (Posture) Mudra stimulate Agya Chakra by making concentration on this Chakra which is situated at the centre of the brain and therefore brain starts working speedily and increase memory (Asana Pranayama Mudra Bandha, 2005). Sukshma Vyayama (Light exercise) Memory can also be improved by some light exercise i.e Buddhi and Dhriti vikasaka, Samaran shakati vikasaka and Medha Shakti vikasaka. Types of Sukshma vyayama, reduce the Kapha avarna and balance the Vata Nadi to

Hetal et al.

increase memory and intellectual power (Yogic Sukshma Vyayama, 1906) .

11.

Conclusion Effectiveness of yoga therapy to improve memory, healing of psychosomatic and stressrelated conditions is world wide accepted fact and same stands true in geriatrics also. The positive effect of this therapy is obtained by bridging positive co-ordination between body and mind. Traditional yoga was primarily concerned with spiritual transcendence, yoga therapy aims at holistic treatment of a variety of psychosomatic disorders ranging from memory loss to cognitive disability. The best feature about yoga, which makes it ideal as a tool for enhancing memory is that it utilizes various components to increase overall body and brain function.

12.

2. 3. 4. 5. 6. 7. 8. 9. 10.

References Alzheimer’s Association. Alzheimer’s Disease Statistics. Retrieved November 2, 2004 from the http: //search.alz.org/Resources/FactSheets/ FSAlzheimerStats.pdf accessed on 11th Oct. 2012. Anantharaman et al. A study of Yoga. Journal of Psychological Researches 1984; 28(2):97-101. Anonymous, Dementia: Supporting people with dementia and their health and social care, NICE Clinical Guideline 2006; 102. Anonymous, Memory assessment service for the early identification and care of people with dementia, NICE Commissioning Guide 2007; 609. Beuscher L et al. A literature review of spirituality in coping with early-stage Alzheimer’s disease. J Clin Nurs 2008; 17:88–97. Chamanlal Gautam. Gheranda Samhita, 2nd chapter, Samskriti Samsthana, Nava Jyoti Press, Mathura (1999). Chamanlal Gautam. Hath Yoga Pradipika, 2nd Upadesha 2/14, Samskriti Samsthana, Nava Jyoti Press, Mathura (1997). Conners et al. Conners’ rating scales-revised. Toronto, Canada: Multi-Health Systems 1997; Dhirendra Bhrahmachari. Yogic Sukshma Vyayama, Vishvayatana Yogashrama, Jammu (1906). Greenberg et al. Test of Variables of Attention (TOVA) visual continuous performance test. Los Alamitos, CA: Universal Attention Disorders 1997; 23-34.

13. 14. 15. 16. 17.

18. 19.

20. 21. 22.

23.

24. 25.

26.

Gualtieri CT et al. Age related cognitive decline in patients with mood disorders. Prog Neuro Psychopharmacol Biol Psychiatry 2008; 32:962–67. Gunther, S. and Weber-Mack. The experience of Alzheimer’s Disease: The family’s perspective. Alzheimer’s Care Quarterly 2001; 2(3):1-4. http://yousigma.com/healt h /yogaandbenefitssummary.html assessed on 297-2013. Heriza et al. Yoga: A complete guide to the medical benefits of yoga (yoga for health). Los Angeles,CA: Tarcher 2004; 32(3):57-81. http://health.yahoo.com/health/ency/adam/000760/ _overview accessed on 1/9/2010 http: //socialjustice.nic.in/npopcomplete.php Accessed on 11th Oct. 2012. Jensen et al. The effects of Yoga on the attention and behavior of boys with Attention-Deficit/ hyperactivity Disorder (ADHD). Journal of Attention Disorder 2004; 7(4):205-16. Kaufman Y et al. Cognitive decline in Alzheimer disease: Impact of spirituality, religiosity, and QOL. Neurology 2007; 68:1509-14. Kocher et al. Effect of yogic practices on immediate memory. Society for the National Institutes of Physical Education and Sports Journal 1979; 2(2):36-38. M.M. Gore. Anatomy and Physiology of Yogic Practices. Kanchan Prakashan, Pune 1991; 111-12. Mahaprabhulal Goswami. Patanjala Yoga Sutra: Samadhi Pada ½, Chaukhambha Sanskrit Samsthana, Varanasi (2009). Manjunath et al. Improvement in visual perceptual sensitivity in children following yoga training. Journal of Indian Psychology 1999; 17(2):41-45 Manjunath et al. Spatial and verbal memory test scores following yoga and fine arts camps for school children. Indian Journal of Physiology and Pharmocology 2004; 48(3):353-6 Mohan et al. Yoga for body, breath, and mind: A guide to personal reintegration. Boston, MA:Shambala 2009; 209. Naveen et al. Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psychological Reports 1997; 81(2):555-61. Ownby RL et al. Depression and risk for Alzheimer disease: systematic review, metaanalysis and meta-regression analysis. Arch Gen Psychiatry 2006; 63:530-38

Prevention of Memory Loss through Yogic Lifestyle 27. 28. 29. 30.

Pathak et al. Rehabilitation of mentally retarded through yoga therapy. Child Psychiatry Quarterly 1984; 17(4):153-58 Peck et al. Yoga as an intervention for children with attention problems. School Psychology Review 2005; 34(3):415-24. Rinck M, Becker E. Selective memory and memory deficits in depressed inpatients. Depress Anxiety 2003; 17:197â&#x20AC;&#x201C;206 Sahasi et al. A replicated study on the effects of yoga on cognitive functions. Indian Psychological Review 1984; 33-35.

31. 32. 33. 34. 35.

Satyanand Saraswati. Asana Pranayama Mudra Bandha, Bihar Yoga Vidhyalaya, Munger (Bihar), 2005; 116 Schaeffer et al. Sharpen your memory with yoga. Natural Health 2006; 40(6):14. Udupa KN. Disorders of stress and their management by yoga. Banaras Hindu university, Varanasi, 1978. Vishwas et al. Effect of Omkar Chanting on Concentration, Memory and Level of Fatigue 1995; 45. www.yogapoint.com accessed on 1/9/2010.

Address for correspondence: Dr. Hetal Amin, Ph.D Scholar, Department of Basic Principles, IPGT & RA, Gujarat Ayurved University, Jamnagar -361008 Gujarat (India). E-mail: dr.hetal1985@gmail.com 82-1356596424 of 2013

J Res Educ Indian Med, Jan.-March 2014; Vol. XX (1): 37-44

ISSN 0970-7700

CLINICAL EVALUATION OF VARADI KWATHA IN THE MANAGEMENT OF MADHUMEHA (TYPE-2 DIABETES MELLITUS) - AN ATTEMPT TO PROVIDE EVIDENCE BASED DATA TO THE CLASSICAL THERAPEUTIC CLAIMS

GYANESHWARSING GUDDOYE,1 B.K. DWIBEDY2 AND O.P. SINGH3 Department of Siddhant Darshan,1,2 Department of Kayachikitsa,3 Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi- 221005 U.P. (India) Abstract: The Madhumeha (DM-II) treatment in general all over the world has been primarily focusing on blood glucose control (hypoglycemic effect). In the classical textbooks of Ayurveda, several important subjective signs and symptoms of Madhumeha have been described. However, there are only a few studies that have explored the effectiveness of various formulations on these subjective parameters. Therefore, the present work was planned to evaluate the effect of Varadi kwatha (VK) on both objective and subjective parameters. The VK was chosen because it was economical and hence, accessible to the poor people. It also contains the ingredients mostly with Tikta (bitter) and Kashaya (astringent) Rasa (tastes). 23 diagnosed patients having signs and symptoms of DM-II as per WHO guidelines were enrolled in the study. The patients were given Varadi Kwatha containing the following herbal ingredients: (1) Vatsak (Holarrhena antidysenterica) (2) Triphala (Terminalia chebula, Embelica officinalis, Terminalia belerica) (3) Darvi (Coscinium fenestratum) (4) Mustaka (Cyperus rotundus (5) Beejaka (Pterocarpus marsupium). The patients were given VK in a dose of 24 ml twice a day for 8 weeks. A highly significant improvement was observed in most of the subjective parameters. All the 23 patients showed a good improvement of more than 75% in cardinal symptoms like Prabhuta mutrata, Avila mutrata, Galatalushosha, Daurbalya and Pipasadhikya etc. In terms of biochemical objective parameters, the mean FBS of 207.65±78.43 mg/dl showed a decrease to 162.86 ±72.66 mg/dl and the mean PPBS showed a decrease from 278.89±131.96 mg/dl to 223.30±106.04 mg/dl. Keyword: Ayurvedic treatment, Diabetes mellitus Type-2, Madhumeha, Medicinal plants, Varadi kwatha.

Introduction The management of Madhumeha (Diabetes mellitus Type-2) (DM-II) is generally focused on blood glucose control and it is commonly observed in our day to day practice that most of the modern oral hypoglycemic drugs have side effect such as constipation. It has also been observed that these drugs have only a minimal effect in the management of subjective parameters. In this context, World Health Organization has stated that: 1. 347 million people worldwide have diabetes. 2. In 2004, an estimated 3.4 million people died from consequences of high fasting blood sugar. 3. More than 80% of diabetes deaths occur in low and middle income countries. 4. WHO projects that diabetes will be the 7th 1. Ph.D. Scholar

2. Professor and HOD

leading cause of death in 2030. [http://www.who. int/mediacentre/factsheets/fs312/en/] Considering these facts, the present study was designed with special attention to observe the therapeutical effect of Varadi Kwatha (Sarangadhara Samhita, 2000) on Madhumeha (DM-II). This formulation is predominantly Tikta (bitter) and Kashaya (astringent) and has Laghu (light) and Ruksha (dry) properties. Tables 1 and 2 summarise the ingredients of this formulation, along with their Rasa, Guna, Virya, Vipaka indications and active principles. The test formulation contains the following herbal ingredients: (1) Vatsak (Holarrhena antidysenterica) which is commonly known as Kutaj. It is bitter and pungent in taste having drying property.

3. Assistant Professor

Guddoye, Dwibedy and Singh

It reduces Kaphapitta in the body and has active principles such as conessine, kurchine etc. (2) Haritaki (Terminalia chebula) is predominantly astringent in taste. It is light and dry in properties with a hot potency. It has tannin, chebulinic acid and gallic acid as active principles. (3) Amlaki (Embelica officinalis) is sour in taste predominantly having light, dry and cool properties. It is Tridoshahara and Pitta Shamaka. It has vitamin C, tannic acid and gallic acid as main active principles. (4) Vibhitaki (Terminalia belerica) is astringent in taste predominantly having light and dry properties. It reduces Kapha. It has tannic acid and allic acid as main active principles. (5) Darvi (Coscinium fenestratum) is bitter predominantly having light and dry properties. It reduces Kaphapitta. It has barberine, oleric acid and saponin. Also it is noted that â&#x20AC;&#x153;serum glucose could be significantly reduced by saponinâ&#x20AC;? [http:/ /www.ncbi.nlm.nih.gov/pubmed/12583337] accessed on 14.7. 2013 at 2125 hrs which help to reduce DM. (6) Mustaka (Cyperus rotundus) is bitter, pungent and astringent predominantly. It reduces Kaphapitta. It has an aromatic oil as active principle which aphrodisiac property. (7) Beejaka (Pterocarpus marsupium) is bitter, astringent predominantly having light, dry properties and a hot potency. It reduces Kapha and Vata. It has kinotannin, gallic acid and pyrocatechin as main active principles. Taking the above facts into consideration the present study was carried out with special attention to the therapeutic effect of Varadi kwatha on the objective parameters mentioned in Table 5 as well as the subjective parameters mentioned in Table 4 of Madhumeha (DM-II). Aim and Objective The aim and objective of the present study was to evaluate the effect of Varadi kwatha in Madhumeha (DM-II) on subjective and objective parameters.

Materials and Methods This study was cleared by the Institute ethical committee with clearance letter no. Dean/ 2013-14 EC/273 dated 10.05. 2013 and registration number IC/Ph.D.11/SF/IMS/SD (Ay)/ 401/4853. 1. Patients: For the present study Twenty three diagnosed patients of Madhumeha (DM-II) were registered from out-patient department of Kayachikitsa, SS Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi between January 2012 and July 2012. They were assessed on the basis of signs and symptoms of Madhumeha as per Ayurvedic classics and modern medical science. The patients who were already on allopathic hypoglycemic drugs were excluded and not registered for the study. All the patients were only kept on Varadi kwatha (decoction) during 8 weeks of trial. 2. Drugs: The raw herbs listed in Table 1 were procured from the authentic suppliers from the market. The drugs were further authenticated by the experts from the department of Dravyaguna. Varadi yavkuta (coarse powder) was prepared in the Instituteâ&#x20AC;&#x2122;s Ayurvedic Pharmacy, Faculty of Ayurveda, I.M.S, Banaras Hindu University, Varanasi. 3. Inclusion criteria: Patients of either sex in the age groups between 30 to 65 years with classical symptoms of Madhumeha and who were not taking allopathic hypoglycemic medicine, Table 1. Contents of Varadi kwatha (decoction). Sr. No.

Sanskrit Name

Botanical name

Part Used

Proportion

Vatsaka / Kutaja

Holarrhena antidysenterica

Bark Skin

1 part

Triphala Haritaki Amalaki Vibhitaki

Terminalia chebula Embelica officinalis Terminalia belerica

Fruits

1/3rd part each

Darvi / Daruhridra

Coscinium fenestratum

Stem Arial

1 part

Mustaka / Nagarmotha

Cyperus rotundus

Rhizome

1 part

Beejaka / Vijayasara

Pterocarpus marsupium

Heart Wood

1 part

Varadi Kwatha in Management of Type-2 Diabetes Mellitus

provided they fulfilled other diagnostic criteria for DM-II, were included in the study. 4. Diagnostic criteria: Standard criteria of National Diabetes Data Group and WHO for DM-II was adopted (Adopted by American Diabetic Association) (Dennis L. Kasper et al., 2005). Symptoms of diabetes + random blood glucose 200 mg/dl till 500 mg/dl or fasting blood glucose 126 mg/dl till 375 mg/dl or two hours blood glucose 200 mg/dl (during an oral glucose tolerance test). Along with above criteria, the following subjective signs and symptoms were also considered while registering the patients. Patents showing at least 8 or more signs or symptoms were included in the study: 1. Prabhuta mutrata (M Ni-36/6) 2. Avila mutrata (M Ni-36/6) 3. Pipasadhikya (SS Ni-6/5) 4. Alasya with Utsahahani (CS-Ni-4/47) 5. Kshudhadhikya/Mahashanam (CS Ni-4/51) 6. Pindikodveshthan (SS Ni-6/5) 7. Karapadatala dah (SS Ni-6/6) 8. Karapadatala suptata (CS Ni-4/47) 9. Swedadhikya (M Ni-34/3) 10. Gala talu shosha (CS Ni-4/47) 11. Daurbalya (CS Ni-4/48) 12. Shrama shwasa (M Ni-34/3) 13. Shula (CS Anubhuta base on Ni-4/48) 14. Alasya / Utsahahani (SS Ni-6/6) 15. Klaibya (M Ni-34/3) 16. Nidradhikya (SS-6/5) 17. Purishabadhdhata (SS-6/5) 5. Exclusion criteria: As per American Diabetic Association - accepted by WHO. (Dennis L. Kasper et al., 2005) (a) Patients with juvenile diabetes. (b) Age of patient less than 30 years and more than 65 years. (c) Patients having IDDM and receiving insulin (type 1). (d) Excessive blood glucose (FBS) > 375 mg/dl and (PPBS)>500 mg/dl. (e) Chronic complications [micro vascular and macro vascular] were discarded. 6. Investigations: Biochemical examinations like Blood sugar: Fasting and postprandial,

Lipid profile and Serum creatinine were done in order to assess the functional status of kidney, blood glucose and blood lipid status. These investigations were carried out in the Vikriti Vigyan laboratory of SS Hospital, IMS, BHU, Varanasi. 7. Study design: The present study was a drug interventional study. On the basis of various objective and subjective parameters patients were compared before and after intervention of Varadi kwatha (decoction drug). Management of the Patients Grouping, drug dosage, duration and method of administration, Pathya-apathya. 1. Dose and duration: The patients were provided with the air-tight packets of coarsely powdered dry herbs in a dose of 12 g per packet and were advised to prepare Kwatha in the following manner: For preparing a single dose of Varadi kwatha (decoction), 12g of Varadi yavkuta (course drug) and 240 ml of water were to be taken in a vessel. Then the water was to be boiled and reduced till 24 ml at medium flame. The decoction was then to be filtered and given for 8 weeks in a dose of 24 ml twice a day. 2. Method of administration: All the patients were advised to consume Varadi kwatha (decoction) in a fixed dose of 24 ml twice a day at morning and evening hours in empty stomach (before food) for 8 weeks. 3. Pathya-apathya: Patients were advised to restrict carbohydrate diet and to correct their dietary habits. Mild to moderate exercise as per their capacity was suggested. Also they were advised not to take milk and curd in their diet. 4. Criteria for assessment: Coarsely powdered Varadi drugs were given to the patients every week after recording all the laboratory investigations and noting the changes in subjective parameters like Prabhuta mutrata, Avila mutrata, Pipasadhikya, Alasya with Utsahahani etc.using the specific rating scale at weekly interval.

Guddoye, Dwibedy and Singh Grading of Subjective parameters

Symptom 1. Prabhuta Mutrata (Polyuria) : 1.50 to 2.00 liters / 24 hrs. >2.00 to 2.50 liters / 24 hrs >2.50 to 3.00 liters / 24 hrs >3.00 liters / 24 hrs. 2. Avila Mutrata (Turbidity in urine) : Crystal clear fluid Faintly cloudy or hazy with slight turbidity. Turbidity clearly present and newsprint easily read through test tube. Newsprint not easily read through test tube. Newsprint cannot be visualized through test tube. 3. Pipasaadhika (Polydypsia) : Feeling of thirst 7 – 9 times/24 hours, either/or Intake of water 5 – 7 times/24 hours with quantity 1.5 – 2.0 liter/24 hours. Feeling of thirst 9 - 11 times/24 hours, either/or Intake of water 7 - 9 times/24 hours with quantity 2.0 - 2.50 liter/24 hours Feeling of thirst 11 – 13 times/24 hours, either/or Intake of water 9 – 11 times/24 hours with quantity 2.50 -3.00 liter/24 hours Feeling of thirst >13 times/24 hours, either/or Intake of water >11 times/24 hours with quantity >3.00 liter/24 hours 4. Bahavashi -Kshudha- Adhika (Increase in appetite) : As usual / routine. Slightly increased (1 – 2 meals) Moderately increased (3 – 4 meals) Markedly increased (5 – 6 meals) 5. Bahavashi -Abhyavaharana Shakti (Excess intake of food) : Taking food in normal quantity twice /a day Taking food in excessive quantity twice/ day Taking food in moderate quantity twice in a day Person taking food in less quantity twice in a day Person taking food in less quantity once in a day Person not at all taking food 6. Pindikodveshtana (Cramps) : No cramps Cramps after walking more than 1 km. Cramps after walking ½ km Inability in walking even ½ km 7. Karapadataladaha (Burning sensation in palm and foot) : No suptata Kara-Pada daha incontinuous Kara-Pada daha continuous but bearable and not severe Kara-Pada daha continuous and severe and unbearable 8. Karapadasuptata (Numbness in palm and foot) : No suptata Kara-Pada Suptata incontinuous Kara-Pada Suptata continuous but bearable and not severe Kara-Pada Suptata continuous and severe and unbearable 9. Swedadhikya (Excess perspiration) : Sweating after some strenuous work or in hot and humidity Profuse sweating after moderate work and movement Sweating after little extra work than routine and movement Profuse sweating after routine work Sweating even at rest or in cold climate

Grading 0 1 2 3 0 1 2 3 4 0 1 2 3 0 1 2 3

0 1 2 3 4 5 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 4

After completion of treatment all investigations data were taken again and all objective parameters like FBS, PPBS, Fasting urine sugar, Serum triglyceride, Serum cholesterol, HDL cholesterol, Serum creatinine, LDL, VLDL were utilized for statistical analysis. The patients were asssessed as:- Control (when relief is 100%), Marked improvement(when relief is 75 %), Moderate improvement (when relief is 50-74%), Mild improvement (when relief is 25-49%) and No improvement <25 %) (Table 3) as per percentage relief based on grading.

Symptom 10. Gala talu shosha (Dryness in mouth) : Feeling of mouth dryness 0 time/24 hours Feeling of mouth dryness 1 time/24 hours Feeling of mouth dryness 2 times/24 hours Feeling of mouth dryness >3 times/24 hours 11. Daurbalya (Weakness) : Can do routine exercise/work Can do moderate exercise with hesitancy Can do mild exercise only, with difficulty Cannot do mild exercise too 12. Shrama Shwasa (Dyspnoea) : Dyspnoea after heavy work and walking Dyspnoea after moderate work and walking Dyspnoea after mild work Dyspnoea even at resting condition 13. Shula (Pain) : No pain Pain in joint, routine movements normal Pain in joint, slight limitations of movements Pain in joint, limitations of movements with much reduced activity. 14. Alasya/Utsahahani (General Debility) : No Alasya (doing satisfactory work with proper vigor and in time Doing satisfactory work with late initiation, likes to stand in comparison to walk Doing unsatisfactory work with late initiation, likes to sit in comparison to stand Doing unsatisfactory work with very late initiation, likes to lie down in comparison to sit. Does not want to do work with no initiation, likes to sleep in comparison to lie down 15. Klaibya (Loss of libido) : Normal Decreased frequency with normal performance Decrease frequency with insufficiency No sexual stimulation at all 16. Nidradhikya (Excess of sleep) : Normal and sound sleep for 6 – 8 hrs. /24 hrs. with feeling of lightness and relaxation in the body and mind Sleep> 8 -9 hrs. /24 hrs. with slight heaviness in the body. Sleep >9-10 hrs. /24 hrs. With heaviness in the body associated with Jrimbha. Sleep >10 hrs. /24 hrs. With heaviness in the body associated with Jrimbha and Tandra. 17. Purishabadhdhata/Malaupathijatila bhava (Constipation): Stool passes as per normal schedule Passes stool with strain, sometimes takes purgative Passes stool after more than 24 hours, frequently takes purgative Passes stool after gap of one day, normal purgatives does not work

Grading 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3

0 1 2 3 4 0 1 2 3 0 1 2 3 0 1 2 3

Statistical analysis Mean, percentage relief, S.D, S.E, t and p values have been calculated. Paired ‘t’ test has Table 3. Criteria for assessment of therapy. Description

Grading

Control of the disease

100% relief

Marked improvement

75% relief

Moderate improvement

50% to74% relief

Mild improvement

25% to 49% relief

No improvement

25% relief

Varadi Kwatha in Management of Type-2 Diabetes Mellitus

Table 2. Showing literary review of medicinal plants contained in Varadi kwatha. Characteristics / Medicinal plants name Properties

Haritak*

Amalaki *

Vibhitaki*

Darvi/ Kasthadaru

Mustaka/ Nagarmotha

Beejaka/ Vijaysara

Rasa

Tikta, Katu

Kashaya**

Amla#

Kashaya

Tikta

Tikta, Katu, Kashaya

Kashaya, Tikta

Guna

Ruksha

Laghu Ruksha

Laghu, Ruksha, Shita

Laghu, Ruksha

Virya

Shita

Ushna

Shita

Ushna

Shita

Ushna

Vipaka

Katu

Madhura

Katu

Doshakarm

Kaphapitta shamaka

Tridoshahar & Vata shamaka

Tridosha, har Pitta shamaka

Kapha & Tridoshaghna

Kaphapitta shamaka

Vata kapha shamaka

Prabhava

Nil

Roga

Prameha etc

Prameha

Caksusya

Daurbalya, Agnimandya & Ajirna

Daurbalya, kasaswasa, Aruchi

Prameha, Mutra basti-vikara

Active principles

Conessine Kurchine etc

Tannin, Chebulinic acid etc

Vit C, Tanicacid gallic acid

Tennin, Gallotanic acid

Berberine, oleic acid, saponin

Aromatic oil 0. 5-0. 9%, Aphrodisiac

Kinotannin, galic acid, pyrocatechin

Referances ***

P 373 Vol.2

P 103 Vol.1

P 368 Vol.1

P 201 Vol.2

*=in-Triphala ***=Reference:

P 749 Vol.1

** = Kashaya main & pancha-rasa with lavana varjita

P 640 Vol.2

P 395 Vol.1

# = main & Madhura, Katu, Tikta, Kashaya

Dravyaguna Vigyana by Gynendra Panday, Edition 2004

been used for calculating the â&#x20AC;&#x2DC;tâ&#x20AC;&#x2122; value in the paired data. For the assessment of the effect of the therapy following chief complaints and biochemical parameters have been selected:1. Prabhutamutrata 2.Avila mutrata 3. Pipasa adhika 4. Kshudha adhika 5. Hastapadatala daha 6. Kara-pada suptata 7. Fasting blood sugar 8. Postprandial blood sugar and 9. Serum cholesterol. The overall percentage improvement of each patient was calculated by the following formula:

The result thus obtained from individual patient was categorized as mentioned above.

Nidradhikya, Purisha-badhdhata, Karapadataladaha, Karapadatalasuptata, Swedadhikya. Table 5 shows the effect of Varadi kwatha as follows:- a highly significant (p<0. 001) reduction were observed in FBS and PPBS while significant fall (p<0.05) was observed in fasting urine sugar, serum triglyceride, serum cholesterol, LDL, VLDL and non significant (p>0.05) were observed in serum creatinine and HDL cholesterol. Table 6 shows the %age of improvement of Varadi kwatha in 23 patients where 17 patients (74%) got moderately improved, 6 patients (26%) got improved mildly, No patient (0%) reported control of the disease. No side effect was reported in any of the patients.

Results Table 4 shows the effect of Varadi kwatha as follows: - A highly significant (p<0.001) reduction was observed in Prabhuta mutrata, Avil mutrata, Klaibya, Pipasadhikya, Pindikovestana, Galatalushosha, Daurbalya, Shramashwasa, Kshudhadhikya, Abhyavaranashakti shula, Alasya / utsahahani,

Discussion Explanation of the claimed effect of Varadi kwatha in Madhumeha (DM-II) treatment. There was a significant reduction in Prabhuta mutrata (polyurea), Pipasaadhikya (polydypsia) and Galatalushosha (dryness in mouth) (p<0.001). Varadi kwatha has helped to clear the Ama (toxic substances) which was

Total BT - Total AT X 100 Total BT

Guddoye, Dwibedy and Singh

Table 4. Effect of therapy on Ayurvedic symptoms (subjective parameters) in 23 patients. Sr. No.

1. 2. 3. 4.

Symptoms (Subjective parameters)

Prabhuta Mutrata (Polyuria) Avil Mutrata (Turbidity in urine) Pipasaadhikya (Polydypsia) Kshudhadhikya (Increase in appetite)

17 15 19 16

BT Mean ± SD

AT Mean ± SD

1.82 ± 0.81 1.4 ± 0.83 2.67 ± 0.84 1.50 ± 0.63

0.35 ± 0.49 0.2 ± 0.41 0.39 ± 0.61 0.13 ± 0.34

% Change

80.65 85.71 84.31 92

Diff. BT-AT Mean ± SD

1.47 ± 0.62 ± 1.2 0.77 ± 2.28 0.96 ± 1.38 0.72

9.71 6.00 10.08 7.65

<.001 HS <0.001 HS <0.001 HS <0.001 HS

Abhyavarana shakti (Excess food intake )

1.47 ± 0.64

0.13 ± 0.35

± 1.33 0.72

7.14

<0.001 HS

Pindikovestana (Cramps)

2.06 ± 0.66

0.53 ± 0.62

71.42

± 1.47 0.80

7.58

<0.001 HS

Karapadataladaha (Burning sensation in palm and foot) Karapadatala suptata (Numbness in palm and foot) Swedadhikya (Excess perspiration)

2.00 ± 0.74

0.5 ± 0.52

75.00

± 1.5 0.52

9.95

<0.001 HS

1.88 ± 0.70

0.35 ± 0.49

81.25

± 1.53 0.80

7.88

<0.001 HS

2.18 ±0.81

0.29 ± 0.59

86.49

± 1.88 1.00

7.82

<0.001 HS

1.67 ± 0.90

0.33 ± 0.62

76.00

± 1.27 0.96

5.10

<0.001 HS

2.09 ± 0.87 1.63 ± 0.52

0.40 ± 0.59 0.38 ± 0.52

2.07 ± 0.80 2.43 ± 0.87

0.53 ± 0.52 0.38 ± 0.59

2.14 ± 0.73 1.62 ± 1.12

0.66 ± 0.80 0.23 ± 0.44

1.78 ± 0.83

0 ±0

8. 9. 10

Gala talu shosha (Dryness in mouth)

11.

Daurbalya (Weakness) Shrama shwasa (Dyspnoea)

12. 13. 14. 15. 16. 17.

Shula (Pain) Alasya/utsahahani (General debility) Klaibya (Loss of libido) Nidradhikya (Excess sleep) Purishabadhdhata (Constipation)

22 8 15 21 21 13 9

78.26 76.92 74.19 84.31 75.56 85.71 100

± 1.64 0.90 ± 1.25 0.46 ± 1.53 0.92 ± 2.05 0.80 ± 1.62 0.80 ± 1.38 1.19 ± 1.78 0.83

8.51 7.64 6.49 11.6 9.22 4.18 6.4

<0.001 HS <0.001 HS <0.001 HS <0.001 HS <0.001 HS <0.01 HS <0.01 HS

Abbreviation: HS means Highly significant, S means Significant and NS means Non significant.

accumulated in body as hypergltcemia (refer FBS, PPBS and fasting urine sugar in Table 5). Thus Varadi kwatha could also help in regulating the water balance of the Mutra vaha srotas (urinary system) and mouth dryness. A decrease in FBS, PPBS (p<0.001) and (p<0.05) in fasting urine sugar were noted. The treatment probably has enhanced the metabolism of glucose. Presence of substances like tannic (Table 2) created an acidic PH which helped in reduction of Kapha (unctuous particles) qualities such as

Guruta and Snigdhata in patients. This resulted a proper functioning of Vayu and enhancement of Agni bala finally leading to a reduction (p<0.05) in serum triglyceride, serum cholesterol, LDL and VLDL. As regards to post treatment improvement in Klaibya (loss of libido) (p<0.001), this is effect of Mustaka (Cyperus rotundus) a constituent of Varadi kwatha having aphrodisiac quality (Table 2). Varadi kwatha could also rectify the Srotorodha (blocked channels) and thus can

Varadi Kwatha in Management of Type-2 Diabetes Mellitus

Table 5. Effect of therapy on biochemical (objective parameters) in 23 patients. Sr. No.

Biochemical tests (Objective parameters)

BT Mean ± SD

AT Mean ±SD

% Change

Diff BT-AT Mean ± SD

FBS

207.65 ± 78.43

162.86 ± 72.66

21.57

± 44.78 42.05

5.11

<0. 001 HS

PPBS

278.89 ± 131.96

223.30 ±106.04

19.92

± 55.57 80.32

3.32

<0. 01 HS

Fasting Urine sugar

2.38 ± 1. 19

1.23 ± 1.42

48.39

±1.15 2.08

2.00

<0.05 S

Serum triglyceride

184.30 ± 102.37

156.35 ± 57.33

15.69

± 28.91 70.84

1.96

>0.05 S

Serum cholesterol

199 ± 47.53

188.35 ± 41.84

6.61

± 14.13 27.18

2.49

<0.05 S

HDL cholesterol

37.52 ± 11.17

36.78 ± 10.03

1.97

± 0.74 6.89

0.51

>0.05 NS

Serum creatinine

1.03 ± 0.19

1.00 ± 0.20

2.95

± 0.03 0.13

1.13

>0.05 NS

LDL

124.64 ± 39.68

116.23 ± 34. 80

675

± 8.41 22.67

1.78

<0.05 S

VLDL

36.86 ± 20.47

31.11 ± 11.38

19.18

± 7.07 13.92

2.44

<0.05 S

Abbreviation: HS means Highly significant, S means Significant and NS means Non significant.

Table 6. Overall effect of therapy in 23 patients. Result

Patients (n=23) No of Patients % relief

Control of the disease

Marked improvement

00 00

Moderately improved

Mildly improved

No improvement

Total

100

generate Ruchi, Utsaha and energy. Also a decrease in symptoms like Kshudhadhikya (increase in appetite), Abhyavaranashakti (excess intake of food), Daurbalya (weakness) were noted (p<0.001) (Table 4). Varadi kwatha is presumed to enhance the power of Agni. It also helped in increased utilization of gulucose to release energy. The decoction could have relieved the accumulated Kapha (unctuous particles) due to its Tikta rasa and Kashaya rasa (Table 2). Thus Varadi kwatha helped in increasing the Agni and Prana (bio-energy) and generated Bala (over all strength) in the body. A decrease in Karapadataladaha (burning sensation in palm and foot) (p<0.001) could be credited to Triphala in Varadi kwatha. Triphala has Pitta rechana property. Amalaki (Embelica officinalis) and Mustaka (Cyperus rotundus) are

having Shita virya (cooling potency) (Table 2). A reduction in Karapadatala suptata (numbness in palms and feet) (p<0.001) appears to be due to relieving of the Srotorodha resulting a better supply of nutrition and oxygen to the nerves. A reduction in Shrama shavasa (dyspnoea) (p<0.001) is credited to Tikta and Kashaya rasa predominance and Kaphaghna property of Varadi kwatha (Table 2) which helped to clear the Pranavahasrotas (respiratory channel) thus helped in improvement in the respiratory functions. A reduction in Shula (pain) (p<0.001) was also noted. Varadi kwatha cleared the Srotasas (channels) as mentioned above. Varadi kwatha also facilitated increased utilization of glucose (nutrition) to generate Bala (energy) and tissue repair thus curbs Shula (pain). A relief in Alasya with Utsahahani (general weakness) (p<0.001) was also observed. The Tikta and Kashaya Rasa with Laghu and Ruksha Gunas (Table 2) of the decoction has helped in normalization of vitiated Kapha. Thus could channelize the Vayu (energy force) and rectified the Alasya (lethargy i.e.abnornal lack of energy) resulting in a sence of well being.

Guddoye, Dwibedy and Singh

The Triphala in Varadi kwatha relieved the Purishabadhdhata (constipation) (Table 2). This is mainly due to Anulomaka property of Haritaki (Terminalia chebula) (Table 2) which facilitated the bowel evacuation and relieve of constipation. Limitations of the study The following limitations prohibit generalizations of study to target populations. The study involved a cross section of 23 participants only. The sample size may serve to limit generalization of the findings. Sample size may not be representative, as samples was only from the Kayachikitsa O.P.D. of S.S Hospital within ‘limited time frame of author’s Ph.D. programme. Also the sample consisted of volunteering sample of convenience. All ethnicities may not have been represented. Conclusion Varadi kwatha is an economic Ayurvedic medicine. This herbal medicine has benefited the Type-2 diabetic patients in just 8 weeks of treatment. The medical community can look forward for further scientific evaluation of this herbal drug for improvement of subjective and objective parameters in Madhumeha (Type-2 Diabetes mellitus). 1.

References Charaka Samhita. by Agnivesha edited by Jadavaji Trikamji Aacharya. Nidanasthana (4:47), 5 th edition.Varanasi, Chaukhambha Sanskrit Sansthan, 2001. Charaka Samhita. by Agnivesha edited by Vaidya Jadavaji Trikamji Aacharya. Nidanasthana (4:48), 5th edition. Varanasi, Chaukhambha Sanskrit Sansthan, 2001.

3. 4.

10.

11. 12. 13.

Charaka Samhita. Agnivesha edited by Jadavaji Trikamji Aacharya. Nidanasthana (4:51), Varanasi, Chaukhambha Sanskrit Sansthan, 2001. Health India. http://health.india.com/diseasesconditions/common-queries-about-cholesterollipid-profile-vldl-hdl-triglycerides (26.6.2013) Dennis L. Kasper, Stephen Hauser, Dan Longo, J. Larry Jameson, Anthony S. Fauci: Harrison’s Principles of Internal Medicine. 16th edition. 2005. Madhava Nidana. by Madhukosa, with commentary of Sri Vijayarakshita and Srikanthadatta. Chapter (33:6), 31 st edition. Varanasi, Chaukhambha Sanskrit Sansthan, 2002. Madhava Nidana. by Madhukosa , with commentary of Sri Vijayarakshita and Srikanthadatta. Chapter (34:3), 31 st edition Varanasi. Chaukhambha Sanskrit Sansthan, 2002. Sarangadhara Samhita. by Sarangadhara commentated by Adhamalla’s Dipika and Kasirama’s Gudhartha Dipika. Madhyakhanda, Sloka-108, 4th edition. Varanasi. Chaukhambha Orientalia, 2000. Sushruta Samhita. by Sushruta commentated by Kaviraja Ambikadatta Shastri (Part I and II) Nidanasthana (6:5), 4 th edition. Varanasi, Chaukhambha Sanskrit Sansthan, 2001. Sushruta Samhita. by Sushruta commentated by Kaviraja Ambikadatta Shastri (Part I and II) Nidanasthana (6:6), 14 th edition. Varanasi, Chaukhambha Sanskrit Sansthan, 2001 World Health Organization http://www.who. int/ mediacentre/factsheets/fs312/en/ (25.6.2013) National Center for Biotechnology Information, U.S. NLM http://www.ncbi.nlm.nih.gov/pubmed/ 12583337 (14.7.2013) Dravyaguna Vijnana. Materia Medica, Vegetable drugs. Gyanendra Pandey. Varanasi, Chaukhambha Krishnadas Academy, 2004.

Address for correspondence: Dr. Gyaneshwarsing Guddoye, Ph.D. Scholar, Department of Siddhant Darshan, Institute of Medical Sciences, Faculty of Ayurveda, Banaras Hindu University, Varanasi - 221005 (India). E-mail: ravivaar2002@yahoo.co.in, vaidyaguddoye@gmail.com JREIM-2013-07-020 UID: 82-1372786878

J Res Educ Indian Med, Jan.-March, 2014; Vol. XX (1):45-49

ISSN 0970-7700

IMMEDIATE HYPOGLYCAEMIC EFFECT OF TWO SELECTIVE HYDROTHERAPEUTIC PROCEDURES IN NON INSULIN DEPENDENT PATIENTS OF DIABETES MELLITUS SUJATHA DINESH1 AND GANGADHARA VARMA B.R 2 Division of Natural Therapeutics,1 S.D.M College of Naturopathy and Yogic Sciences,2 Ujire - 574240 Karnataka (India) Abstract: Background and Objectives: Non-Insulin Dependent Diabetes Mellitus (NIDDM) is a costly, complex and chronic disease that is expected to increase in prevalence in the coming decades. Recent population based studies shows the prevalence of NIDDM in south India to be 12.4% in Bengaluru in 2001,16.6% in Hyderabad in 2001,14.3% in Chennai in 2006 and 19.6% in Ernakulum in 2006. Complementary and Alternative Medicine (CAM) modalities are found to be effective in the management of NIDDM. Hydrotherapy is a part of CAM, used in the management of NIDDM. Hence, the present study is planned to evaluate which of the hydro therapeutic treatments has the best immediate hypoglycaemic effect between Gastrohepatic pack and Neutral douche in NIDDM patients. Methods: The patients were selected from S.D.M. Yoga and Nature cure Hospital, Shanthivana, Dharmastala, Karnataka. They were randomly divided into two groups. According to the order in which they were recruited, they were allotted alternatively into two groups. Group-1: The Gastrohepatic pack group of 20 patients and Group-2: The Neutral douche group of 20 patients. Patients were assessed on day 1 and day 2 during which they received Gastrohepatic pack and Neutral douche respectively. Results: The results have shown statistically significant changes in fasting blood glucose levels in Gastrohepatic pack subjects (p=0.02) and post prandial blood glucose levels in Neutral douche subjects (p=0.03) after the intervention period. Conclusion: The present study suggests that Neutral douche and Gastrohepatic pack can play a major role in lowering the raised blood glucose levels in patients with NIDDM. Gastrohepatic pack is relatively better for lowering the blood glucose levels as compared to Neutral douche. Keywords: Complimentary and Alternative Medicine, Hydrotherapy, Naturopathy, NIDDM, Non-insulin dependent diabetes mellitus.

Introduction Non-insulin dependent diabetes mellitus (NIDDM) is a complex and chronic disease that is expected to increase in prevalence in the coming decades.1 The global prevalence of diabetes mellitus is projected to rise from 171 million in 2000 to 366 million in 2030.2 A major part of diabetes burden (75%) will be borne by developing countries3 and India has the second largest number (>61 million) of individuals with NIDDM in the world.4 Surveys on diabetic patients in India estimate that, by the year 2000 India will be home to 32 million diabetics and the numbers may increase to 40.9 million by 2006, 69.9 million 1. Dean

2. P.G. Scholar

by 2025 and 80 million by 2030. 5,6 Recent population based studies shown the prevalence of NIDDM in south India to be 12.4% in Bengaluru in 2001,7 16.6% in Hyderabad in 2001,7 14.3% in Chennai in 2006 8 and 19.6% in Ernakulum in 2006.9 Cardiovascular complications are the leading cause of morbidity and mortality among patients with NIDDM and cardiovascular disease (CVD) risk is 2 to 8 fold higher in the diabetic population than in non-diabetic individuals of a similar age, sex and ethnicity. 10,11 Micro albuminuria and retinopathy are indicators of micro vascular dysfunction, and both predict a poorer outcome in patients with diabetes.12-14

Sujatha Dinesh and Gangadhara Varma

Naturopathic medicine is of greatest interest as it is a whole-system of CAM most closely resembling conventional primary care in scope of practice, but with greater delivery of healthy lifestyle counselling.15 Naturopathy is a system of man building in harmony with the constructive principles of nature on physical, mental, moral and spiritual planes of living and consists of non-invasive treatment modalities like diet therapy, fasting therapy, mud therapy, hydrotherapy, massage therapy, acupressure, acupuncture, chromo therapy, air therapy and magnet therapy.16 Retrospective observational studies also suggest that Naturopathy care and treatment may reduce risk for NIDDM and hypertension, including improved glucose control and reduced blood pressure respectively.18 Hydro therapy is one of the important parts of Naturopathy treatment, which has been proven beneficial in cardiovascular, hemodynamic, cellular immunity, psychological parameters and neonatal growth.19-22 The first line of Naturopathic management in treating NIDDM are Gastrohepatic pack, Neutral douche to whole body, cold hip bath and partial massage to abdomen. Gastrohepatic pack is a treatment modality in hydrotherapy that uses combination of hot and cold treatment. The hot and cold treatment modality has opposite effects on tissue metabolism, blood flow, inflammation, edema and connective tissue extensibility.23 The Neutral douche is a procedure where warm water is given to body with mild pressure, which increases peripheral circulation. Hence, the present study was planned to evaluate the immediate hypoglycemic effect of hydrotherapeutic treatments and to compare Gastrohepatic pack and Neutral douche in patients of NIDDM. Both Fasting blood glucose and Post prandial blood glucose levels were studied.

Materials and Methods Subjects: The patients were selected and registered for study from S.D.M Yoga and Nature Cure Hospital, Shanthivana, Dharmastala, Karnataka (India). They were randomly divided into two groups. 1. The Gastrohepatic pack group of 20 patients and 2. Neutral douche group of 20 patients. The institutional ethical committee approval was obtained for conducting the study. Patients were assessed on day 1 and day 2 during which they received 3 times Neutral douche and 3 times Gastrohepatic pack. Both groups also received their standard treatment regimen of drugs with yoga and dietary prescription. Inclusion criteria 1. Diagnosed subjects of type-2 diabetes mellitus, who have been on oral hypoglycaemic drugs for the past two years. 2. Above the age of 35 years and below the age of 85 years. 3. Both genders were included. Exclusion criteria 1. Patients of Diabetes mellitus on Insulin therapy. 2. Diabetes associated with systemic complications. 3. Females patients during menstruation period. Study design: The study adopts a prepost design. Patients were assessed on day 1 and day 2 during which they received Neutral douche or Gastrohepatic pack with the same diet, exercise and environment. Consent: Signed voluntary informed consent forms were obtained from all subjects before their participation. Trial profile (Flow chart) Assessments: The primary outcome measure was Fasting blood glucose (FBG) and

Effect of GH pack and Neutral douche in Type-2 Diabetes Mellitus

woollen blanket. The duration of treatment is 20 minutes. Neutral douche: Water at a temperature of 45 degree Celsius is made to flow in a pipe with mild pressure. The water is then sprayed on whole body at controlled temperature and pressure.

Trial Profile: Randomly assessed patients for eligibility (n = 42) The subjects who did not meet the inclusion criteria (n = 2)

The number of subjects selected for study (n = 40)

Data analysis Statistical analysis was performed using SPSS version 20.0 for windows. Data were expressed as mean ± SD. Data were tested for normality. Paired sample ‘t’ test and independent sample ‘t’ tests were used to measure the within group difference and between groups differences respectively. Levels of significance were set to 0.05.

Assessments of FPG and PPPG

Gastrohepatic Pack group (n = 20)

Neutral Douche group (n = 20)

Figure 7

Drop outs (n = 0)

1 Day

Assessments of FPG and PPPG

Post prandial blood glucose (PPBG) before and after the trial period. Intervention Gastrohepatic pack: The hot water bag is kept on the abdominal region, covering the epigastric region, left and right hypogastric region, left and right lumbar region and umbilical region. The ice bag covers the region of lumbar vertebrae L2, L3, L4 and L5. The treatment is administered in supine lying position, where the hot fomentation bag is kept over the abdominal region and then the ice bag on lower back region. The pateients are then covered with cotton cloth and wrapped with

Results The results have shown statistically significant changes in fasting blood glucose levels in Gastrohepatic pack subjects (p=0.02) and post prandial blood glucose levels in Neutral douche subjects (p=0.03) after the intervention period. (Table 1). In other cases results are statistically insignificant but have shown reduction in FBS and PPBS levels. Though Gastrohepatic pack has shown relatively better glycemic control as compared to Neutral douche, there is no statistically significant difference between (across) the groups for Fasting blood glucose (FBG) and Post prandial blood glucose (PPBG). Discussion The results of present study suggest that both the gastrohepatic pack and neutral douche have shown significant (p<0.05) effect on glycemic control on Fasting blood glucose and

Table 1. The data comparison within subjects and between subjects Within subjects Variable

Baseline Mean ± SD

Post interventional Mean ± SD

Gastro hepatic Pack

FBSN=20

129.5 ± 41.05

114.4 ± 27.5*

Neutral Douche

FBSN=20

129.9 ± 35.5

114.7 ± 24.9

Gastro hepatic Pack

PPBSN=20

171.2 ± 52.4

157.45 ± 53.25

Neutral Douche

PPBSN=20

153.85 ± 41.2

137.4 ± 38.43*

*=P<0.05

Between subjects Mean diff. ± SE diff.

0.06 ± 7.1 2.7 ± 14.1

Sujatha Dinesh and Gangadhara Varma Figure 2. Effect of Gastrohepatic Pack (1) and Neutral Douche (2) on PPBG

Figure 1. Effect of Gastrohepatic Pack (1) and Neutral Douche (2) on FBG

Glu ucose level mg/dl

114.95

Glu ucose level mg/dl

129.9

129.55

114.7 PRE POST

Post prandial blood glucose. Gastrohepatic pack has shown relatively better glycemic control as compared to neutral douche. A study showed that the application of heat on abdomen causes increased peripheral circulation and significant increase in the muscle tissue total hemoglobin level and muscle tissue oxygen saturation in the vicinity of the sheet application area. Better clinical outcome observed in our test group may be attributed to increase in the peripheral circulation and tissue oxygen saturation, which may be one of the factor in reducing FBG levels.23,24 It is known that the local application of cold induces alterations in thermogenesis mechanism leading to increased metabolic rate.24,25 We speculate that the blood circulation is increased by the hot application and the ice application on lower back used as part of the gastrohepatic pack enhances metabolism, mediated through thermoregulatory changes. The increased blood supply to the abdominal region will undergo metabolism in the liver and other abdominal organs because of the thermoregulatory changes; this might have reduced the fasting blood glucose levels. A study on the usage of low dose Metformin significantly reduced hepatic glucose production in Japanese patients with NIDDM. The efficacy of Metformin on correcting fasting hyperglycemia was strongly associated with reduced hepatic glucose production.25

171.2 157.45

153.85 137.4 PRE POST

The underlying mechanism of the clinical benefits of gastrohepatic pack in the present trial remains to be studied, this particular finding associated with metformin is a worthwhile lead in future explorations. Neutral douche increases peripheral circulation and the pressure of douche might induce metabolism in muscle and skin tissue, thereby increasing glucose uptake in the periphery, this may be the reason for FBG reduction with mild PPBG reduction in the present study. Conclusion The present study suggests that Neutral douche and Gastrohepatic pack can play a important role in lowering the raised blood glucose levels in patients with NIDDM. Gastrohepatic pack is relatively a better tool for lowering the blood glucose levels as compared to Neutral douche. Further studies with bigger sample size are required for more robust conclusions. 1.

2. 3.

` References Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes estimation for the year 2000 and projections for 2030. Diabetes Care 2004; XXVII:1047-53. American Diabetes Association. Economic costs of diabetes in the US in 2007. Diabetes Care 2008;31:597. M.M. Arora, Chander Y and Rai R. Diabetes Mellitus in India Y2K not ok. Medical Journal Armed forces India 2000; LVI:1-2.

Effect of GH pack and Neutral douche in Type-2 Diabetes Mellitus 4. 5. 6.

10.

11.

12. 13.

14.

International Diabetes Federation. Diabetes Atlas, 5th edition. Brussels, Belgium. International Diabetes Federation. 2011. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of Diabetes estimation and projections for 2030. Diabetes Care 2004. Sicree R, Shaw J and Zimmet P. Diabetes and impaired glucose tolerance. Diabetes Atlas. International Diabetes Federation, 3rd edition. Belgium, International Diabetes Federation. 2006;15-103. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, A.K. Das, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia 2001;XLIV:1094-101. V.U. Menon, K.V. Kumar, Gilchrist A, T.N. Sugathan, K.R. Sundaram, Nair V, et al. Prevalence of known and undetected diabetes and associated risk factors in central Kerala ADEPS. Diabetes Res Clin Pract 2006;LXXVII:289-94. Mohan V, Deepa M, Deepa R, C.S. Shantirani, Farooq S, Ganesan A. Secular trends in the prevalence of diabetes and glucose tolerance in urban South India - the Chennai Urban Rural Epidemiology Study (CURES-17). Diabetologia 2006;49:1175-8. S.M. Haffner, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in patients with type-2 diabetes and in nondiabetic patients with and without prior myocardial infarction. N Engl J Med 1999;339:229-34. Brun E, Nelson N, Bennett P, Imperatore G, Zoppini G, Verlato G. Diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care 2000;23:1119–23. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care 2008;31(3):596–615. The Diabetes Control and Complications Trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86. Rajala U, Pajunpaa H, Koskela P, KeinanenKiukaanniemi S. High cardiovascular disease mortality in patients with visual impairment caused by diabetic retinopathy. Diabetes Care 2000;23:957- 61.

15.

16.

17.

18.

19. 20.

21.

22.

23.

24. 25.

Klein R, B.E. Klein, S.E. Moss, K.J. Cruickshanks. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol 1999;117:1487-95. Bradley R, Kozura E, Buckle H,Kaltunas J, Tais S, Standish L. Description of clinical risk factor changes during naturopathic care for type 2 diabetes. J Altern Complement Med 2009;15:633-38. Digiesi V, Cerchiai G, Mannini L, Masi F, Nassi F. Hemorheologic& blood cell changes in humans during partial immersion with a therapeutic method in 38oC water. Minerva Med 1986;77 (30-31):1407-11. Blazickova S, Rovensky J, Koska J, Vigas M. Effect of hyperthermic water bath on parameters on cellular immunity. Int J Clin Pharmacol Res 2000;20(1-2):41-6. W.N. Robiner. Psychological & physical reactions to whirlpool baths. J Behav Med 1990;13(12):157-73 Zhao S, Xie L, Hu H, Xia J, Zhang W, Ye N, Chen B. A study of neonatal swimming (water therapy) applied in clinical obstetrics. J Matern Fetal Neonatal Med 2005;17(1):59-62. Scott Nadler F, Kurt Weingand, Roger Kruse J. The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician 2004;(7):395-99. Ryan Bradley, Karen J Sherman, Sheryl Catz, Carlo Calabrese, Erica B Oberg, Luesa Jordan, Lou Grothaus, Dan Cherkin. Adjunctive naturopathic care for type-2 diabetes: patient reported and clinical outcomes after one year. BMC Complementary and Alternative Medicine 2012;12:44. YoshinaoNagashima, MichihitoIgaki, Atsushi Suzuki, Shuichi Tsuchiya, Yoshimi Yamazaki, Michiko Hishinuma, Sachiko Oh-ishi, MasatakaMajima. Application of a Heat- and Steam-Generating Sheet Increases Peripheral Blood Flow and Induces Parasympathetic Predominance. Evidence-Based Complementary and Alternative Medicine 2011;(13):1-13. Arthur Guyton, John Hall. Text book of Medical Physiology. Elsevier Inc. 2006. Mitsuyoshi Takahara, Hideaki Kaneto, Naoto Katakami, MunehideMatsuhisa, Iichiro Shimomura. Effect of metformin on hepatic glucose production in Japanese patients with type-2 diabetes mellitus. Endocrine Journal 2012;59 (9):845-47.

Address for correspondence: Dr. Sujatha Dinesh, Dean, Division of Natural Therapeutics, S.D.M College

of Naturopathy and Yogic Sciences, Ujire-574240 Karnataka (India). E-mail: drsujathadinesh2@gmail.com 82-1373107667_RVZ-4

J Res Educ Indian Med, Jan.-March 2014; Vol. XX (1): 51-57

ISSN 0970-7700

A CRITICAL UNDERSTANDING OF NUTRACEUTICAL ASPECTS OF CURD IN AYURVEDA PRIYANKA B.V.1 AND MALLIKA KURAT JAYAVARMA2 Department of Samhita and Siddhanta, S.D.M. College of Ayurveda and Hospital, Hassan - 573201 Karnataka (India) Abstract: Background: Curd is a popular milk product prepared indigenously in most household and is widely available commercially. It has high nutraceutical values and finds a very prominent position in Indian culture, food habits and religious ethos. Curd by its nature has; Madhuraamlarasa (sweetish sour taste), Amlavipaka (sour post digestion taste), Guru (heavy to digest), Ushnavirya (hot in potency) and is Abhishyandi (coats over the channels carrying Dosha, Dhatu and Mala). Ayurveda proposes certain rules for its consumption and specify some adjuvant to contradict its ill effects. It is enumerated as etiology for Kleda (dampness) predominant diseases. On the other hand it is also useful as Pathya (diet) in diseases as well as, an ingredient in medicinal preparations. Research throws light on yogurt, saying it is endowed with large variety of bacteria that provide a number of health benefits such as lowering the low density lipid, hypertension and preventing certain disorders. Aims: To critically understand the nutraceutical aspects of curd based on available literature in Ayurveda and biomedical researches. Settings and Design: Conceptual critical review. Methods and Materials: Literature search of authoritative texts of Ayurveda and probable hypothesis is framed; conclusion is drawn based on current research. Results: Available research on yogurt provides evidence of its health benefits based on its calcium content and probiotic value. Some studies have established the medicinal properties of curd, but detrimental consequences which are repeatedly avowed in Ayurveda have not been taken up yet. Conclusion: Owing to the nutraceutical value of curd its use has been recommended as diet in chronic disease. Keywords: Ayurveda, Curd, Nutraceutical value of curd.

Introduction The science nutraceuticals deals with food or constituents of food that provide medical or health benefits including the prevention and treatment of disease.[1] Curd possessing number of medicinal values, holds a primary position in Indian diet and culture, which is also evident in Vedic literature, gives an idea that the techniques of curd preparation and its health benefits were well-known to people. In present era, curd and yogurt are considered as the best source of probiotic products. In this article an attempt is made to analyze the nutraceutical value of different types of curd based on its source, taste and its usage either in external, internal medicine or purificatory therapy with due respect to researches in contemporary sciences.

Curd by its nature is sweetish sour in taste, hot in potency, sour in post digestive taste and heavy to digest.[2] The attributes of curd varies according to type and nature of milk and its inoculation time for fermentation. Attributes of milk like Snigdha (unctuousness) varies in accordance with the habitat of animals and time of milking, for instance, milk of low altitude animal or that which is collected during morning is heavy. These specifications are also applicable to curd as it is a byproduct of milk itself. Though both possess similar properties curd is more Abhishyandi and Guru (heavy), which is proved by gastric emptying time (liquid phase is shorter for milk [35min] than curd [60min]).[3] Curd prepared from boiled milk possesses qualities like relishing, promotes Dhatu, digestive power, strength and also pacifies Vata and Pitta.

1. Post Graduate Scholar, Department of Samhita and Siddhanta

2. Professor and Dean Academics

Priyanka B .V. and Mallika Kurat Jayavarma

This is re-established by percentage of total nitrogen and ammonia found less in curd prepared out of boiled milk than of unboiled milk[4] (Table 2). Whereas the curd which is filtered (Parisrita) reduces Vata, increases Kapha, also creates interest in food and produces nourishing action.[5] Properties based on rate of fermentation Various types of curd are cited such as Mandaka (unfermented curd), Madhura (sweet), Madhura amla (sweetish sour), Amla (sour) and Atyamla (sourer). Sweet curd by its hot potency, sweet taste during post digestion and unctuous quality mitigates Vata. However it aggravates Kapha, Meda and Shukra by its unctuousness and heaviness qualities.[6] Sour curd aggravates Pitta, and possesses Grahi (water absorbing action) by its hot potency (Virya) and sour post digestive effect (Vipaka). A study carried out shows that the nitrogen percentage, dialyzable nitrogen and ammonia respectively increase to 0.144, 0.060 and 9.74% on 7th day of fermentation. When it was compared with buffalo curd on 7th day it showed significantly high values of nitrogen. This proves sourer curd is more detrimental to health in comparison with sweet or sour curd (1st day) (Table 1 and 2).[4] Table 1. Nitrogen percentage in curd on 1st and 7th day of fermentation Product

Total N %

NPN %

Protein %

Dialisable

Nitrogen %

Amonia Nitrogen mg%

Cow milk @

0.56

0.048

0.512

0.017

0.24

Curd 1st day

0.57

0.073

0.497

0.027

9.79

Curd 7th day

0.55

0.144

0.406

0.060

Buffalo milk @

0.65

0.038

0.612

0.021

0.16

Curd 1st day

0.65

0.052

0.598

0.22

12.20

Curd 7th day

0.66

0.081

0.579

0.034

9.74

Buffalo milk#

0.64

0.040

0.600

0.023

0.36

Curd 1st day

0.65

0.059

0.591

0.026

13.86

Curd 7th day

0.63

0.057

0.573

0.029

12.45

@- Unboiled #-Boiled, x- not observed

Usefulness in multiple forms Action of curd again differs according to its part used, as with cream (Sara), curd mitigates Vata, increases Kapha and Shukra, thereby produces Vrushya action through increased production and improved ejaculation of semen. However in general the entity which increases Shukra is heavy and possesses Brumhana action. Whereas curd without cream possesses properties like astringent preceding taste (Anurasa), dry, light ; improves taste and digestive fire; performs Grahi (absorbs water) and Vistambikarma (constipated). The supernatant layer of curd (Mastu) also known as Manda is sour, sweet and astringent in taste, clears the channel, produces nourishment, strength, creates interest in food, relishing in nature and breaks the stool. It can be prepared with properly formed curd, whose quality resembles butter milk.[7] Nutraceutical value based on source Based on the source of milk there are eight types of curd viz. cow, buffalo, goat, camel, sheep, mare, human and she-elephant. Goat curd reduces all three humors and stimulates digestion; being light than cowâ&#x20AC;&#x2122;s curd possesses softer and smaller casein molecules. Hence it helps to overcome the conditions like hemorrhoids, dyspnoea, tuberculosis and cough etc. Moreover several studies proved that, it stimulates the mucosal immune system and improves the defense mechanism against intestinal and respiratory infections in a mouse immune suppression model. [8,9] Also some studies established that it is beneficial in producing GABA and ACE-inhibitor to counteract high blood pressure.[10] Buffalo curd is Snigdhatama, it increases Kapha to a larger extent, and thereby reduces Vata. Hence, it is also useful in insomnia which is caused by aggravation of Vata. Supportive to this, a study proved that it consists of casein and fat, double the quantity of cow curd (Table 2). Camelâ&#x20AC;&#x2122;s curd is alkali in taste, hot in potency and pungent post digestive taste, but

A Conceptual Review on Curd Table 2. Quality of boiled and unboiled buffalo milk curd on 1st and 7th Day of Fermentation Product

Sp.gr

Total solid (Protein & Fat)

Acidity

Volatile acid (mk.OIN NaoH *)

Alcohol (% by vol)

Buffalo milk @

0.65

0.038

0.612

0.021

00.16

Curd 1st day

0.65

0.052

0.598

0.220

12.20 09.74

Curd 7th day

0.66

0.081

0.579

0.034

Buffalo milk #

0.64

0.040

0.600

0.023

00.36

Curd 1st day

0.65

0.059

0.591

0.026

13.86

Curd7th day

0.63

0.057

0.573

0.029

12.45

@- unboiled #-Boiled * for 100gm

reduces Vata thereby overcomes the diseases like piles, skin disease, worm and ascitis. Now a days camel milk is used to treat diabetes (as it contains insulin like molecules) and to strengthen cellular immune response, antimicrobial activity.[11] However regarding camel curd no research is evident to prove its beneficial effect. Sheep curd is sweet in both taste and post digestive effect, accordingly increases all Dosha, but is considered as wholesome for diseases like hematological disorders, inflammatory diseases, wound and gouty arthritis. On the other hand it is comprehensively established to contain excess of total solids and major nutrients than the milk of goat and cow. There are no researches to prove the nutraceutical aspect of other curd, but authoritative texts of Ayurveda provide information regarding their attributes as follows. Mareâ&#x20AC;&#x2122;s curd is astringent in taste, hot in potency, pungent in post digestive effect, in addition possesses attributes like rough, light and Abhishyandhi, thereby it increases Vata. Human milk curd is sweet in taste and post digestive effect; heavy thereby reduces Vata, Pitta, considered best for eyes. Whereas elephant curd is astringent in taste and pungent in post digestive effect, hot in potency, light in quality there by reduces Kapha. Among eight types, cowâ&#x20AC;&#x2122;s curd being common diet and ingredient in medicaments, this article contains explanations regarding nutraceutical value of the same. However yogurt is artificially prepared curd, thus which is used as a substitute in diet and medicine.

In internal medicaments In Antarparimarjanachikitsa (internal treatment), curd is useful as diet, adjuvant and as ingredient in various therapeutic formulations. It is useful in diseases of vitiated Vata, Amashaya (pathogenesis involving stomach), Rasavahasrotos (channels which carry Rasa) and in Jeerna or Pakvaavasta (chronic) (Table 3). If it is used judiciously cures conditions like anorexia, intermittent fever, diarrhoea, emaciation, rhinitis,[12] vomiting,[13] dry cough,[14] irritable bowel syndrome[15] and haemorrhoids.[16] Further logical interpretation of the curd usage in above illustrated diseases is explained as follows. Taste enhancing (Rochishnu) and saliva promoting (Praseka due to Kaphavruddhi) property is appreciated with curd, which is comprehensively attributed to its acidic taste, sodium and calcium ions.[17] Curd is indicated in intermittent fever (Vishamajvara), caused by Vata, Kapha or Vatakapha. Based on its nature of presentation different febrile conditions like typhoid can also be included under Vishamajvara. An in vitro study claims that, certain probiotic strains present in yogurt can inhibit the growth and adhesion of a range of entero-pathogens like Salmonella.[18] Curd by its hot potency does the digestion of Ama,[19] there by relieves the condition Pinasa (acute and chronic rhinitis). A similar approach is found in naturopathy and other systems of medicine attribute the beneficial effect of decreasing intensity of allergy to increased immunoglobulin. But impact of curd on long term usage is not yet evaluated. In diseases of gastrointestinal tract like diarrhoea, irritable bowel syndrome and hemorrhoids curd is widely indicated. A study has established its beneficial effect in preventing and treating the acute diarrhoea caused by rotaviruse in children, curd is also useful as a diet in lactose intolerance.[20] Improper functioning of Medodhatvagni which is a part of pathogenesis in hypercholesterolemia (Apacitameda), curd can be a choice, as it influences Dhatvagni.

Priyanka B .V. and Mallika Kurat Jayavarma Table 3. Therapeutic usage of curd Disease

Vatikapravahika (dysentery due to Vata)

Method of curd usage Curd along with sour pomegranate fruit and ghee (Bahusneha).

Sapravahikaatisara (dysentery with diarrhea)

Curd, oil, ghee and milk in equal quantity.

Varchakshaya (decreased stool quantity)

Black gram, barley and sour fruit juice processed with ghee, oil and curd.

Vatajachardhi (vomiting due to Vata)

Coriander decoction is prepared with curd, then with equal part of water or milk.

Vatajahridroga (heart disease due to Vata)

Oil prepared with Rasna, Jeevaka etc. with four parts of curd.

Katina pureeshayuktaarshas (hard stool in hemorrhoids)

Ghee and oil processed with asafoetida and mixed with upper layer of curd.

Urusthambha (stiffness of thigh)

Liquid portion of curd is used as adjuvant for Gunja, Madana, Danti.

Pureeshajakrimi (worms)

Liquid portion of curd with Trapu.

Raktapitta (bleeding disorder)

Karanjabeeja and salt with liquid portion of curd.

Raktatisara (blood mixed diarrhea)

Bastamamsa with curd or gruel prepared with curd or creamy curd with honey.

Rajayakshma (tuberculosis)

Creamy curd along with pomegranate juice and large amount of ghee.

Udara (ascitis associated with constipation)

Narayanachurna with liquid portion of curd.

Arshas (haemorrhoids)

Curd with cream.

Vatajaasrugdhara (menorrhagia due to Vata)

Curd with honey or sugar.

Vatapradhanakasa (dry cough )

Curd.

Shvasa (bronchial asthma )

Ghee prepared out of liquid portion of curd and Dashamoola.

A research study illustrates that, the healthy bacteria present in yogurt (L. acidophilus) assimilates cholesterol by enzymatic deconjugation, consequently decreases the low density lipid.[21] In individuals who are lean by nature (Sahaja) or emaciated due to chronic disease, curd improves metabolic process. It is proved to be beneficial in protein energy malnutrition. The above mentioned explanations have been proposed and proved by Ayurveda and other science. However in addition to this, advanced studies prove yogurt (with Lactobacillus acidophilus) as effective in decreasing candidal colonization on daily ingestion of eight ounce,[22] thereby prevents bacterial vaginosis.[23] Curd is found effective in relieving hypertension as it shows antioxidative effect by inhibiting angiotensin.[24]

In Rasayana and Vajeekarana Curd is attributed with rejuvenating property, hence used in preparations as ingredient and adjuvant. However it is also considered as Apathya (unwholesome) during administration of Lashuna (Allium sativum). As curd is known for action of enhancing taste and adds flavor to food, also a good aphrodisiac, thus it is useful in preparations of Vajeekarana. In external medicaments Curd is useful in Bahirparimarjana chikitsa (external treatment) as adjuvant for Lepa (external application),[25] Seka (pouring)[26] and Prakshalana (washing)[27] in diseases like gouty arthritis, Urusthamba etc. The main reason for its usage may be as a base for preparations and also provides coolness.

A Conceptual Review on Curd

In Panchakarma In Panchakarma (five purificatory therapy) various medicated curd preparations are mentioned for conducting emesis and purgation like Jeemutakalpa, [28] Iksvakukalpa, [29] Aragwadakalpa, [30] Tilvakakalpa, [31] Saptalashankhinikalpa,[32] Sudhakalpa [33] and Dantidravantikalpa.[34] It is also used as a processing agent for Madana [35] (Randia dumetorum). It is one of the ingredients for enema preparation iin both Niruha (decoction enema) like Prasrutayougika basti [36] and Anuvasana (oil enema). Supernatant portion of curd possesses Vidbeda and Vatanulomana property; hence it is useful in most of purgative formulation. Similarly useful in the formulations of emesis as it increases Kapha by its Abhishyanda, Guru and Snigdha properties. As an ingredient in various formulations Curd is used in various preparations like Cangerighrita, [37] Pancagavyaghrita, [38] Dashamoolaghrita, [39] Mulakadyataila, [40] Agurvaditaila, [41] Balataila [42] and Takrarista.[43] In many of the oil/ghee preparations, the combination of curd and milk used is an exception to Viruddha, as it aims at relieving the disease by acting against the Dosha. Harmful effects of curd Though curd is found beneficial in many ways, still it should not be consumed daily (Nitya asevanadravya),[44] as it alters the digestion and leads to different ailments like herpes, bleeding disorder, skin disease, anemia, giddiness, jaundice,[45] edema and diabetes.[46] It is also contraindicated in diseases like gouty arthritis[47] and disorders of oral cavity. Hence there are specifications for addition of adjuvant to curd like ghee, honey, sugar, Indian gooseberry, green gram soup as a diet and medicine, which supports Aghrutasharkaraihi (without adjuvant curd should not be consumed). However their is no scientific research data to support the same.

Conclusion Historical review reveals that curd has been used as a diet. Its usage was popularized when there was need for preserving milk in different forms for obtaining certain therapeutic values which were originally absent in milk. Curd which is sweet in taste and prepared out of boiled cowâ&#x20AC;&#x2122;s milk is considered best as compared to its other varieties. It is useful as diet, medicine, adjuvant and processing agent in many disorders, if administered judiciously. Key Message: Curd is a common dietary supplement used habitually by people across the world. It endows wide spectrum of application in preparing medicaments and treating aliments.

4. 5. 6.

References Stephen Defelice. Foundation for Innovation in Medicine, Cited on [18 Jan 2013]. Available from: http://www.clemson.edu/NNC/ what_are_nutra.html Sushruta Samhita. Sushruta, Dalhana Sanskrit commentary, Acharya YT, Sutra Sthana, Drava Dravyavidhi Adhyaya (45:81-3),Varanasi. Chaukhambha Surbharati Prakashana, 2007. Mahe S, Marteau P, Huneau JF, Thuillier F et al. Intestinal nitrogen and electrolyte movements following fermented milk ingestion in man. Br J Nutr 1994;71(2):169-80. Asha K V. The toxicity study on Dadhi (Curd), (3:71-3), Trivendrum, Govt. Ayurvedic College, Kerala University, Thiruvananthapuram, 1989. Rajanigantu, Tripathi Indradeo Vishvanatha. Ksheeradi Varga, 1st edition. Varanasi, Krishnadasa Academy, 1982: pg 513. Sushruta Samhita. Sushruta, Dalhana Sanskrit commentary, Acharya YT, Sutra Sthana, Drava Dravyavidhi Adhyaya (45: 81-82),Varanasi. Chaukhambha Surbharati Prakashan, 2007. Astanga Hrudayam. Vagbhata. Srvangasundara of Arunadatta & Ayurveda Rasayana of Hemadri Sanskrit commentary, Paradakara HS, Sutra Sthana, Drava Dravyavijnaniya Adhyaya (5:29-32), Varanasi.Choukhambha Orientalia, reprint 2005. Astanga Hrudayam. Vagbhata, Srvangasundara of Arunadatta & Ayurveda Rasayana of Hemadri Sanskrit commentary, Paradakara HS, Sutra Sthana, Drava Dravyavijnaniya Adhyaya (Commentary

10.

11.

12.

13.

14.

15.

16.

17.

18.

Priyanka B .V. and Mallika Kurat Jayavarma on 5:29-32),Varanasi, Choukhambha Orientalia, reprint 2005. Salva S, Nunez M, Villena J, Ramon A, Font G, Alvarez S. Development of a fermented goatsâ&#x20AC;&#x2122; milk containing Lactobacillus rhamnosus: in vivo study of health benefits. Sci Food Agric 2011;91: 2355-62. Minervini F, Bilancia MT, Siragusa S, Gobbetti M, Caponio F. Fermented goatsâ&#x20AC;&#x2122; milk produced with selected multiple starters is a potentially functional food. Food Microbiol 2009;26:559-64. Ahmed Ali Al-Alawi, Louis C. Laleye. Characterization of Camel Milk Protein Isolates as Nutraceutical and Functional Ingredients, Collaborative Research Project SQU/UAEU CL/ SQU-UAEU/01/08 SQU/UAEU 01-06-60/08, Available from http://www.squ.edu.om/ committee/ report/ Characterization of Camel M ilk Protein Isolates as Nutraceutical and%20 Functional IngredientsU Sushruta Samhita. Sushruta, Dalhana Sanskrit commentary, Acharya YT, Sutra Sthana, Drava Dravyavidhi Adhyaya (45:65), Varanasi, Chaukhambha Surbharati Prakashana, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, ChardiChikitsa Adhyaya (20:24), Varanasi,Chaukhambha Surbharati Prakashana, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Kasa Chikitsa Adhyaya (18:82), Varanasi, Chaukhambha Surbharati Prakashana,2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Grahani Chikitsa Adhyaya (15:114), Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Arsha Chikitsa Adhyaya (14:47), Varanasi, Chaukhambha Surbharati Prakashan, 2007. Sushruta Samhita. Sushruta, Dalhana Sanskrit commentary, Acharya YT, Sutra Sthana, Drava Dravyavidhi Adhyaya (45:65),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Babaee N, Atefeh G, Samir Z et al. Effects of milk curd on saliva secretion in healthy volunteer compared to baseline, 2% pilocarpine and equivalent pH adjusted acetic acid solutions.Indian Journal of Dental Research 2013; cited on 18 Jan 2013.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

Morita H. Preliminary human study for possible alteration of serum immunoglobulin E production in perennial allergic rhinitis with fermented milk prepared with Lactobacillus gasseri, TMCO356. Microbiol Immunol 2006; 50(9):70-76.Cited on [18 Jan 2013]. Available from: http:// www.ncbi.nlm.nih.gov/pubmed/16985291 Labayen I, Forga L, Gonzalez A, LenoirWijnkoop I, Nutr R, Martinez JA. Relationship between lactose digestion, gastrointestinal transit time and symptoms in lactose malabsorbers after dairy consumption. Ailment Pharmacol Therapy. 2001;15:543-49. Ataie-Jafari A, Larijani B, AlaviMajd H, Tahbaz F. Cholesterol-lowering effect of probiotic yogurt in comparison with ordinary yogurt in mildly to moderately hypercholesterolemic subjects. Cited on [18 Jan 2013].Available from http:// www.ncbi.nlm.nih.gov/pubmed/19229114. Hilton E, Isenberg HD, Alperstein P et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116(5):353-7. Cited on [18 Jan 2013]. Available from http:// www.ncbi.nlm.nih.gov/pubmed/1736766 Robert S, Uwe-Thomas D, Lactobacillus acidophilus and Yogurt in the Prevention and Therapy of Bacterial Vaginosis on [18 Jan 2013]. Available from http://www.sciencedirect.com/ science/article/pii/S095869469800096X Effect of Administration of Fermented Milk Containing Whey Protein Concentrate to Rats and Healthy Men on Serum Lipids and Blood Pressure. Cited on [18 Jan 2013]. Available from http://www.sciencedirect.com/science/article/pii/ S0300908498800229 Astanga Hrudayam. Vagbhata , Srvangasundara of Arunadatta & Ayurveda Rasayana of Hemadri Sanskrit commentary, Paradakara HS, Uttara Sthana, Vranapratisheda Adhyaya (25:36), Varanasi, Choukhambha Orientalia, reprint 2005. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Vatarakta Chikitsa Adhyaya (29:127), Varanasi, Chaukhambha Surbharati Prakashana, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Madatyaya Chikitsa Adhyaya ( 24:114), Varanasi, Chaukhambha Surbharati Prakashana, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Jeemutakalpa Adhyaya (2:6),Varanasi, Chaukhambha Surbharati Prakashan, 2007.

A Conceptual Review on Curd 29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Ikshvaku Adhyaya (3:8), pg.657, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Aragvadha Adhyaya (8:9-10), pg.666, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Tilvaka Adhyaya (9:6),pg.667, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Sudhakalpa Adhyaya (10:11-2),pg.668, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, Saptalashankini Adhyaya (11:9-10), pg.669, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, DantidravantiAdhyaya(12:36),pg.671,Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Kalpa Sthana, MadanakalpaAdhyaya(1:14),pg.654,Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Siddhi Sthana, Prasrutayogiyamsiddhi Adhyaya 8:41), pg.715, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Atisara Chikitsa Adhyaya (19:42-3), pg.551, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana,

39.

40.

41.

42.

43.

44.

45.

46.

47.

Apasmara Cikitsa Adhyaya (10:18-24), pg.475, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Grahani Cikitsa Adhyaya (15:82-6),pg.518, Varanasi, Chaukhambha Surbharati Prakashan, 2007; Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Vatavyadhi Adhyaya (28:136),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Jvarachikitsa Adhyaya (3:267),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Vatavyadhi Adhyaya (28:149),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Chikitsa Sthana, Grahani Chikitsa Adhyaya (15:112-6),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Sutra Sthana, Matrashitiya Adhyaya (5:10-1),Varanasi, Chaukhambha Surbharati Prakashan, 2007. Charaka Samhita. Agnivesha, Cakrapani Sanskrit commentary, Acharya YT, Sutra Sthana, Navegandharaniya Adhyaya (7:62), Varanasi, Chaukhambha Surbharati Prakashan, 2007. Astanga Hrudayam, Vagbhata, Srvangasundara of arunadatta & Ayurveda Rasayana of Hemadri Sanskrit commentary, Paradakara HS, Sutra Sthana, Dravadravya Vijnaneeya Adhyaya (5:30), Varanasi, Choukhambha Orientalia, reprint 2005. Charaka Samhita. Agnivesha, Sanskrit commentary, Acharya YT, Cikitsa Sthana, VatashonitacikitsaAdhyaya (29:6), Varanasi, Chaukhambha Surbharati Prakashan, 2007.

Address for correspondence: Dr. Mallika Kurat Jayavarma, Professor & Dean Academics, Department of Samhita and Siddhanta, S.D.M. College of Ayurveda and Hospital, Hassan, Karnataka (India). E-mail: drmallikakj@gmail.com JREIM UID 82-1375946427

J Res Educ Indian Med Jan.-March 2014;Vol. XX (1):59-65

ISSN 0970-7700

IMPACT OF SHODHANA ON PHYSICO-CHEMICAL AND CHROMATOGRAPHICAL PROFILES OF GUNJA (Abrus precatorius Linn.) SEEDS SUDIPTA ROY,1 RABINARAYAN ACHARYA2 AND V. J. SHUKLA3 Department of Dravyaguna,1,2 and Pharmaceutical Laboratory,3 Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar - 361008 Gujarat (India). Abstract: Gunja (Abrus precatorius Linn.) has been described under the category of Upavisha (semi poisonous) in Ayurveda. Certain compound formulations, containing Gunja as an ingredient like Gunjaditaila, Kanakakshiritaila, Siddharthakaghrita, Kakadanighrita, Agnigarbha Rasa, Karpuragunja Rasa, Garudagad Rasa and Gunjagarbha Rasa are well practiced in Ayurveda. Seeds of Gunja are frequently used and strictly recommended to be used after proper Shodhana (processing) in presence of specified liquid media like Godugdha, Goghrita, Kanji etc. Gunja Shodhana in this study has been carried by following the standard methods explained in Ayurvedic Formulary of India (AFI). The study reveals that purified samples in presence of Kanji (sour gruel) and water showed changes in physico-chemical parameters in comparison to raw drugs. In HPTLC analysis, different Rf values were detected before and after purification indicating change in the nature of the shodhita drugs. Keywords: Abrus precatorius Linn, Gunja, Kanji, Poisonous plants, Shodhana.

Introduction The use of poisons in therapeutics has been recorded in ancient Ayurvedic classical texts. Acharya Charaka has elaborately mentioned various poisoning symptoms and their management (Charaka).[1] Acharya Sushruta has classified categorically various sources of poison and described accordingly (Sushruta).[2] Even today, these poisonous plants, after purification are in practice widely as a medicament in a number of diseases. Description of Gunja, one of the Upavisha, can be traced in Samhita, Nighantu as well as in Rasagranthas. In few Ayurvedic texts, it has been said that, white seeds of Gunja are more potent (Rasatarangini)[3] and recommended in cases of gonorrhea, stiffness of shoulder joints, sciatica and paralysis. It is also used as an emetic and abortificient agent (Anand R. Attal, Kishor V).[4]

Though Gunja is described under the Upavisha its seeds have been used successfully in different Ayurvedic formulations after proper Samskara known as Shodhana (Rasatarangini,[3] Gogte VM).[5] Effect of shodhita Gunja seed kernels with cowâ&#x20AC;&#x2122;s milk or kanji has been reported in previous works (Gautam DS et al.).[6] Literature revealed that specific media is used for Shodhana of specific substances (Ilanchezhian R. et al.). [7] Certain studies have also shown that the toxic substances present in the plant drugs are reduced (Swarnendu Mitra et al,)[8] Patel Yogesh et al.) [9] and transferred into the media during the Shodhana process, rendering the drug non toxic (Sarkar PK). [10] Though a specific Shodhana method of Gunja seed has been recommended by the Ayurvedic Formulary of India (AFI),[11] but published data related with the impact of this

1 M. Pharma Scholar 2. Associate Professor 3. Head, Pharmaceutical Laboratory

Roy, Acharya and Shukla

Shodhana process on different physico-chemical and chromatographical parameter is lacking. Hence, a study has been planned to evaluate the impact of Shodhana of Gunja through kanji and water and develop physico-chemical and HPTLC profile. Materials and Methods - Shodhana procedure: A.F.I[11] - Principle: Swedana (boiling) - Ingredients: Ashuddha Gunja seeds (KR): 300g (100g for each batch) - Kanji: 16.5 litres (5.5 litres for each batch). Collection of Drug Gunja (Abrus precatorius Linn.) was identified by medicinal plants taxonomist. Different flora and its mature seed were personally collected from surrounding area of Jamnagar, in their natural habitat, during the month of November-January, 2012. Selection of Seed Damaged (broken) and discolored (faded) seeds were rejected from the study. Remaining seeds were dropped into a beaker containing water. The seeds that floated on the surface of water were also rejected. Only the seeds that settled in water at the bottom of the beaker were dried in air. The dried seeds were considered as Raw Gunja Seeds (RGS) and subjected to the process of Shodhana. Preparation of Media Kanji was prepared in the departmental laboratory, following standard procedure as described in Ayurvedic Pharmacopoeia of India (API).[15] Equipment for Shodhana (Purification) Stainless steel vessel (20cm x 30cm); capacity of 7l, used as Dolayantra (vessel for the purification procedure), Stainless steel rod (28cm), Stainless steel vessel (48cm x 30cm x 7cm); capacity of 3l, Cotton threads 30cm in length, Measuring cylinder (capacity of 1l), Muslin cloth (45cm x 45cm), Digital weighing

machine, Digital induction cooker, stainless steel spatula (length: 30cm) and measuring cylinder (10ml, 25ml). Procedure 100g of raw Gunja seeds (RGS) were kept in a muslin cloth and made into a pottali, suspended in a steel vessel and kanji was filled up to complete immersion of pottali. Swedana procedure was followed as described in the classics (Rasatarangini).[3] The procedure was carried-out over an induction cooker, for three hours at 100οC. Total 5.5 litres of kanji were utilized for one batch. After boiling for three hours, the seeds were taken out from pottali and washed with lukewarm water. After washing with lukewarm water seed coat was removed carefully and kept on a paper sheet, for shade drying. Same procedure was carried out for all the three batches. After proper drying, the seeds were collected and stored in air tight container and labelled as ‘Kanji Shodhita Gunja Seeds’ (KSGS). Same procedure of Swedana was followed in another group of seeds in presence of RO water and that product (seeds) was labelled as ‘Water Shodhita Gunja Seeds’ (WSGS). Preparation of Sample All the three samples (RGS, KSGS and WSGS) were powdered separately with mechanical grinder and passed through 60#. Physico-chemical Parameters Assessment of the parameters such as foreign matter, moisture content, ash value, acid insoluble ash, pH, water soluble extractive, alcohol soluble extractive, foaming index and swelling index were carried out by following standard procedures recommended by Ayurvedic pharmacopoeia of India (Ayurvedic Pharmacopoeia of India (API),[15] D.R.Lohar).[16] HPTLC study Equipments for HPTLC A CAMAG (Switzerland) HPTLC system equipped with a sample applicator Linomat V sample applicator was used for application of

Physico-chemical and Chromatographical profiles of Abrus precatorius Linn.

samples. CAMAG Scanner III, Reprostar and Wincats 4.02 were used for scanning the plates. CAMAG twin through glass chamber was used for developing the plates. Chemicals Pre-coated silica gel 60 F254 TLC aluminium plates (10Ă&#x2014;10cm, 0.2mm thick), AR grade toluene, ethyl acetate, glacial acetic acid, methanol were obtained from M/S Merck Ltd. Mumbai, India (Anonymous, Planner Chromatography).[12] Samples for HPTLC The extract of all three samples (RGS, KSGS and WSGS) for HPTLC, were made in same process as mentioned below. Methanolic extract - 2g of sample was macerated with 20ml methanol for 24 hrs. and filtered. Filtrate was concentrated to 5ml and used for spotting. The samples were titled as Track-1, Track-2 and Track-3. Track-1 : Methanolic extract of RGS. Track-2 : Methanolic extract of KSGS. Track-3 : Methanolic extract of WSGS. Mobile phase:Toluene: Ethyl acetate: Glacial acetic acid (6.5: 3.5: 0.2) Detection: Spray with Vanilline-H2SO4. Chromatographic Conditions Detection: Deuterium lamp, Tungsten lamp. Data System: Win cats software. The developed plate was scanned to obtain densitogram in visible range from 600nm to 800nm with 100 nm interval. The developed plate was scanned to obtain densitogram in visible range from 600 nm to 800 nm with 100 nm interval. Results and Discussion The toxic principles present in the plant drugs are also reported as their active

constituents (Swarnendu Mitra et al.)[8] Patel Yogesh et al.) [9] Therefore, it is not desirable to expel them out completely from the drugs. The main aim of Shodhana process is to reduce the toxic constituents to some extent or by potentiating their chemical transformation to nontoxic or relatively less toxic substances. There may be some new principles added during shodhana process to the drugs, which are responsible for enhancing their biological efficacy. Hence, maximum beneficial effect can be obtained by administering the shodhita drugs within their therapeutic dosage limit. In this study, Shodhana of Gunja seed was carried out by standard method as mentioned in Ayurvedic Pharmacopoeia of India. [15] Each Shodhana procedure was repeated for three times to establish the validation of the pharmaceutical processing. Shodhana of Gunja was performed by the process of Swedana (boiling) in Kanji, for three hours. Same process was followed for Swedana in water (as a control). Principles of Swedana methods are the extraction process where the solvent enters through the pores into the cells resulting in the swelling of the tissues and solution of the soluble constituents takes place within the cells, then there is escape of dissolved material through the solvent boundary layer by the process of diffusion - finally separation of the solution from the drug occurs. The rate of extraction depends mainly on the temperature and concentration gradient across the cell membrane. The rate of extraction and solubility is increased by elevation of temperature. Rising temperature increase the concentration gradient across the cell membrane thereby increase mass transfer of active principles from solid material to the solvent (Carter SJ, et.al.).[13] During Shodhana of Gunja, change in colour of the liquid media was noticed (Table 1) and it might be due to the removal of colour containing materials from the endosperm of the seeds. Changes in organoleptic characters of Gunja seeds were also noticed and the percentage of final weight obtained and the percentage of

Roy, Acharya and Shukla

Track-1 HPTLC for Methanolic extract of RGS. Track-2 HPTLC for Methanolic extract of KSGS. Track-3 HPTLC for Methanolic extract of WSGS.

Fig-1. Track 1 ( 366nm ) Fig-2. Track 2 ( 366nm ) Fig-3. Track 3 ( 366nm ) Fig-4. Track 1 ( 254nm ) Fig-5. Track 2 ( 254nm ) Fig-6. Track 3 ( 254nm )

Physico-chemical and Chromatographical profiles of Abrus precatorius Linn.

Fig-07. Multiple tracks ( 254nm ) Fig-09. U.V.Spectral comparison Rf 0.28 T-1,2,3 Fig-11. U.V.Spectral comparison Rf 0.92 T-1,2,3

weight lost during each batch of Shodhana processes are duly calculated and presented accordingly. Greater yield (91.66%) and minimum weight loss (8.34%) were found after Shodhana with water, whereas, lesser yield (88.2%) and greater weight loss (11.8%) were found after Shodhana with Kanji. It might be due to the extraction of more soluble mass from the seeds by Kanji (Table 2). The reddish cream coloured powder of raw seeds turned into yellowish brown in colour in case of Kanji shodhita Gunja seed

Fig-08. Multiple Tracks (366nm) Fig-10. U.V.Spectral comparison Rf 0.32 T-1,2,3

and Ash colour in case of water shodhita Gunja seed after processing (Table 1). In case of physico-chemical study, it was observed that, after purification, the colour of all samples was changed (Table 3). The moisture content of Kanji shodhita Gunja seed was comparatively lower than the raw and water shodhita Gunja seed (Table 3). Ash value was decreased in case of all samples after purification. Ash values in Kanji purified seeds were comparatively less than that of the water shodhita and raw Gunja

Table 1. Organoleptic characters of raw & Kanji sodhita and water sodhita Gunja seeds powder Sample

Colour

Odour

Taste

Appearence

RGS

Reddish cream

Typical

Bitter

Smooth and shiny

2 3

KSGS WSGS

Yellowish brown Ash colour

Characteristic of Kanji Typical

Sour and bitter Bitter

Dull Dull

RGS= Raw gunja seed; KSGS= Kanji sodhita Gunja seed; WSGS= Water shodhita Gunja seed

Roy, Acharya and Shukla

Table 2. Effect of Shodhana on yield of final product after shodhana with kanji and water. Sample

Initial Quantity(G)

Final Weight (Avg.)(G)

Percentage of Weight Loss(%)

KSGS

100

88.2

11.8%

WSGS

100

91.66

8.34%

KSGS= Kanji sodhita Gunja seed; WSGS= Water sodhita Gunja

Table 3. Physicochemical parameters of raw and purified Gunja seeds Test Parameters

RGS

KSGS

WSGS

Description

Yellowish brown

Ash colour

Foreign matter

Outer coat Red with Nil

Nil

Moisture content

9.5%

7.726%

9.49%

Ash value

4.944%

1.971%

4.096%

Acid insoluble ash

1.5%

0.19%

0.54%

pH (pH paper)

5.5

Water soluble extractive value

10.35%

6.27%

6.087%

Alcohol soluble extractive value Foaming index Swelling index

1.5%

0.89%

0.39%

<100 3 ml

<100 3ml

<100 3.5ml

RGS= Raw gunja seed; KSGS= Kanji sodhita Gunja seed; WSGS= Water shodhita Gunja seed

Table 4. Rf value in Short UV 254 nm of all samples Sample

No. of Spots

RGS

KSGS

WSGS

Rf Value

0.01, 0.04, 0.11,0.20, 0.24,0.27, 0.46, 0.90 0.01, 0.03, 0.25, 0.40, 0.55, 0.70, 0.88 0.01, 0.26, 0.88, 0.91

RGS= Raw gunja seed; KSGS= Kanji sodhita Gunja seed; WSGS= Water shodhita Gunja seed

Table 5. Rf value in long UV 366nm of all three samples Sample

No. of Spots

Rf Value

RGS

0.01, 0.05, 0.08, 0.25, 0.41, 0.91

KSGS

0.01, 0.03, 0.09, 0.25, 0.31, 0.40,0.55, 0.69, 0.88, 0.91

WSGS

0.01, 0.40, 0.47, 0.87, 0.93

RGS= Raw gunja seed; KSGS= Kanji sodhita Gunja seed; WSGS= Water shodhita Gunja seed

seed (Table 3). Water soluble extractive in Kanji shodhita Gunja seed was comparatively lower than raw Gunja seed but higher than the water shodhita Gunja seed. pH value of all samples was found in between 5 to 5.5 (Table 3). According to some experts the, acidic pH indicates Ushnavirya (Shiva Charan Dhyani).[14] Lower pH value indicates more acidic in nature, which is more capable to inhibit microbes. In HPTLC study, at short UV (254nm), Raw Gunja seed, Kanji shodhita Gunja seed and water shodhita Gunja seed showed 8, 7 and 4 spots respectively.(Table-4) (Fig.-4,Fig.-5, Fig.-6 & Fig.-7). Among which same Rf value (0.01) was found in all the three samples, indicating the presence of one similar component in all three samples. At long UV (366nm), Kanji shodhita Gunja seed showed maximum number of spots (10 spots), indicating presence of more number of components in comparison to the other two samples (RGS and WSGS). One same Rf value (0.01) was found in all three samples.(Table-5) (Fig.-1, Fig.-2, Fig.-3 & Fig.-8). From the spectral comparison (Fig.-9, Fig.10 & Fig.-11) same Rf values were found in all three samples (0.28, 0.32 & 0.92). After spraying with vanillin-H2SO4, RGS, KSGS and WSGS showed 2(0.71, 0.94), 4(0.15, 0.60, 0.67, 0.94) and 3(0.60, 0.69, 0.94) spots, respectively Conclusion The present work highlights the impact of Shodhana on Gunja seed with different liquids with special focus on physico-chemical and chromatographical profiles. From the study, it can be concluded that Kanji is a better Shodhana media than water. The observed different Rf values in HPTLC study reveals that, different components are present in all different samples. Besides this, same Rf values also found in all three samples which indicates the presence of similar components in all three samples.

Physico-chemical and Chromatographical profiles of Abrus precatorius Linn.

Further, higher studies using sophisticated technologies are needed to evaluate the characterization of different components in different samples and their utility in therapeutics. Acknowledgements The authors are thankful to the Director, Institute for Post Graduate Teaching & Research in Ayurveda for providing facilities to carry out the research work. They are also thankful to the staff of pharmaceutical laboratory for help and guidance. 1. 2. 3. 4.

5. 6. 7.

References Charaka Samhita. Sutra Sthana 1/53. Ed. Dwivedi L., 1st edition. Varanasi, Chowkhambha Sanskrit Series Office, 2007. Susruta Samhita. Sutra Sthana 15/47. Ed. Dwivedi. L, 3rd edition. Varanasi, Chowkhambha Sanskrit Series Office, 2003. Rasatarangini. by Pranacharja Shri Sadananda Sharma, Pandit Kashinath Shastri, Delhi, Motilal Banarasidas, 2009; pg 727-733. Anand R. Attal, Kishor V. Otari, Rajkumar V. Shete, Chandrashekhar. D. Upasani, Tanaji D. Nandgude. Abrusprecatorius Linnaeus: A Phytopharmacological Review. Journal of Pharmacy Research 2010; 3(11): 2585-87. Gogte VM. Ayurvedic Pharmacology & Therapeutic Uses of Medicinal Plants. 1st edition. Mumbai, Bharatiya Vidya Bhavan, 2000. Davnath Singh Gautam, R. Banerji, S. Mahrotra. Effect of shodhana on the toxicity of Abrus precatorius. Ancient Science of Life 1998; 18:2. Ilanchezhian R, Roshy Joseph C, Rabinarayan Acharya. Importance of media in shodhana

10. 11. 12. 13. 14. 15.

16.

(Purification/Processing), Ancient Science of Life 2010; 30(2):27-30. Swarnendu Mitra, V. J. Shukla, Rabinarayan Acharya. Effect of Shodhana (processing) on Kupeelu (Strychnos nux-vomica Linn.) with special reference to strychnine and brucine content. AYU 2011;(3) July Sept. www.ayujournal.org. Patel Yogesh, Bhat Savitha D, Acharya Rabinarayan, B.K.Ashok and Shukla V.J. Role of Shodhana on analytical parameters of Dhatura innoxia Mill. and Dhatura metel Linn. seeds. IJRAP 2010;1(2):249-54. Sarkar PK. Evaluation of Shodhana Process and Antidotal Study on Vatsanabha. Gujarat Ayurved University, Jamnagar, Ph.D. Thesis 2008. The Ayurvedic Formulary of India. 1st edition. New Delhi, Government of India. Department of AYUSH, 1978; pg172. Anonymous. Planner Chromatography, Modern Thin layer Chromatography, Switzerland. 1999; pg 2-16. Carter SJ. Cooper and Gunnâ&#x20AC;&#x2122;s.Tutorial Pharmacy, 6th edition. Delhi, CBS Publishers & Distributers, 2000. Shiva Charan Dhyani, Dravyaguna Sidhanta, 1st edition. Varanasi, India, Krishnadas Academy, 1986. Ayurvedic Pharmacopoeia of India (API). PartII, Vol-II, Appendices-2, First edition. New Delhi, Government of India, Ministry of Health and Family Welfare, Department of AYUSH, 2008; pg159-61. Lohar D.R. Protocol for Testing, Ayurvedic, Siddha, Unani medicines, government of India, Depertment of AYUSH, Ministry of Health & F a m i l y We l f a r e , P h a r m a c o p o e i a l Laboratory for Indian Medicines, Ghaziabad, 30th March 2007.

Address for correspondence: Dr. R.N.Acharya, Professor, Department of Dravyaguna, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar (India). E-mail: drrnacharya@gmail.com UID JREIM-2012-06-029

J. Res. Educ. Indian Med., 2014; Vol. XX (1):66

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