Evaluation of efficacy of Shunti and Gokshurain Amavata (Rheumatoid Arthritis) –

A Comparative Clinical Study

By

Veena. S. Kori

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the degree of

Ayurveda Vachaspati M.D.In

Dravya GunaUnder the Guidance of

Dr. G.V. MulagundM.D. (Ayu)

and Co- Guidance of

Dr. Kuber SankhM.D. (Ayu)

Department of Dravya GunaPost Graduate Studies & Research Post Graduate Studies & Research CentreCentreD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG

2002-2005

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTREGADAG, 582 103

This is to certify that the dissertation entitled “Evaluation of efficacy of Shunti and

Gokshura in Amavata (Rheumatoid Arthritis)-A Comparative Clinical Study” is a bonafide

research work done by Veena. S. Kori in partial fulfillment of the requirement for the post

graduation degree of “Ayurveda Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka.

Dr. G.V. MULAGUND

M.D. (Ayu)Guide

Professor & HOD

Dept. of Dravya Guna

DGMAMC, PGS&RC, GADAG

Date:

Place: Gadag

Dr. KUBER SANKH

M.D. (Ayu)Co- Guide

Lecturer in Dravya Guna

DGMAMC, PGS&RC, GADAG

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTREGADAG, 582 103

Endorsement by the H.O.D, Principal/ head of the institution

This is to certify that the dissertation entitled “Evaluation of efficacy of Shunti and

Gokshura in Amavata (Rheumatoid Arthritis)-A Comparative Clinical Study” is a

bonafide research work done by Veena. S. Kori under the guidance of Dr. G. V.

MULAGUND, M.D. (Ayu), Professor & HOD and Dr. KUBER SANKH, M.D. (Ayu), in

partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Dravya Guna)” Under Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka.

.

(Dr. G. B. Patil)Principal,

DGM Ayurvedic Medical College,Gadag

Date:Place: Gadag

(Dr. G. V. Mulagund)Professor & HOD

Dept. of Dravya GunaPGS&RC

Date:Place: Gadag

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “Evaluation of

efficacy of Shunti and Gokshura in Amavata (Rheumatoid Arthritis)-A

Comparative Clinical Study” is a bonafide and genuine research work

carried out by me under the guidance of Dr. G. V. Mulagund M.D.(Ayu)

Professor and Dr. Kuber Sankh, M.D.(Ayu), Lecturer in Dravya Guna,

DGMAMC, PGS&RC, Gadag.

Date :

Place : Gadag

(VEENA. S. KORI)

© Copy right

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation/ thesis in print or electronic format for the academic / research

purpose.

Date :

Place : Gadag

(VEENA. S. KORI)

© Rajiv Gandhi University of Health Sciences, Karnataka

ACKNOWLEDGMENT

I express my deep sense of gratitude to my respected guide Professor.Dr. G.V.

Mulagund M.D (Ayu) Head of department of Dravya Guna. D.G.M. Ayurvedic medical college and

postgraduate and research centre, Gadag. He has been very kind to guide me in the

preparation of Thesis and for whose extraordinary efforts, emendous encouragement and

most valuable thought provoking advise made me to complete this work.

I am also grateful to my respected Co-guide Dr. Kuber Sankh M.D.(Ayu) lecturer in

Dravya Guna, PGARC, D.G.M. Ayurvedic medical college, Gadag, for patiently going

through the draft of thesis and correcting with precious remarks, which has been very useful.

I am extremely thankful to our Principal Dr. G.B. Patil for providing all necessary

facilities for this research work.

I am very much grateful to Dr. G. S. Hiremath H. O. D. of Dravya Guna and Dr. S. B.

Nidagundi. Lecturer in department of post graduation studies in Dravya Guna for their

valuable suggestion in this work.

I wish to convey thanks to my respected Lecturers Dr. V.Varadacharyalu, Dr.

Purushottamacharyulu, Dr. M.C.Patil, Dr.K.S.R.Prasad, Dr. Shivaramudu, Dr. Shashidhar

Doddamani, Dr.R.V.Shetter, Dr.Girish Danappagoudar, Dr. Santosh Belavadi, Dr Jagadeesh

Mitti, Dr. U.V. Purad, Dr. B.G. Swamy, Dr. K.S. Paraddi. Dr.S.D.Yerageri, Dr.S.V. Sankanur

and other lectures of our College for their help and suggestions during my post graduation

studies.

I thanks to Mr. T M Nandakumar for his help in statistical evaluation and Professor. B

I Biradar for his help in Botanical aspect of study.

I sincerely thank my beloved classmates Dr. S B Bani, Dr. K.S. Hiremath, Dr. Ashok

Bingi, Dr.Shivakumar Sajjanar, Dr.SunitaG. Dr.S.A.Ronad, Dr.Anand Doddamani, Dr.

Jagadeesh H, Dr.C B Inamdar, Dr. Gangur. Dr.V.S. Hiremath,Dr. B. L. Kalmath, Dr. Mangala

Patil, Dr. Varsha Kulkarni, Dr. Shaila B, and all classmates of other post graduation branches

for their constant co-operation and help.

I wish to convey my thanks to beloved Librarian Shri V.M. Mundinamani and Mr.

S.B. Sureban for providing me essential references in the study. I am thankful to Mr. B.S.

Tippanagoudar and Dr. S.A.Morab lab technician, who extended his co-operation in

investigations.

I am very much grateful to all lecturers, Physicians, house surgeons, hospital staff,

and non teaching staff for their timely assistance in completion of this work.

I am very much grateful to Principal, all the staff members, librarian of

R.G.E.S.A.M.C, Ron for their timely assistance in completion of this work.

I wish to convey my thanks to beloved friends Dr. Deepa Hasbi, Dr. Jyothi, Dr.

Akkamma, Dr. Uma and other U.G. friends for their co-operation.

I am highly indebted to my beloved mother-in-law & father-in-law Smt. and Shri. B.S.

Kotturshatti, my sisters in law Lalita, Akkamahadevi, Sumangala, Ratna, My brother in law

Shivakumar, my parents Smt. and Shri. S.V. Kori, My sisters Rekha, Geeta, and Beena, my

brother Basavaraj Nadagaddi and family, Dr. Mallikarjuna and family, for their love and

affection throughout my carrir.

I am ever thankful to my brothers in law Prof. S.B. Yapalparvi, Shri. Rudresh. Hallur

and Raju Hubballi for their constant moral support encouragement and help throughout my

carrier.

This list is incomplete without remembering my beloved husband Dr. I.B.

Kotturashatti M.D (Ayu) who helped in all respects to complete this valuable dissertation work

and at last its my pleasure to remember my ever loving daughter Srusti for her inspiration.

Lastly I pay my deep homage and tribute to my former teacher late Dr.C.M.

Sarangamath for his support to this valuable project.

Date:

Place: Veena. S. Kori

ABBREVIATION

A.H. Astanga Hrudaya

A.K. Amara kosha

A.P.I. Ayurvedic Pharmacopoeia of India

A.R. Abhidana Ratnamala

A.S. Astanga sangraha

B.P. Bhavaprakasha

B.R. Bhaishajya Ratnavali

BDA Brahat Dravyagunadarsha

BP.N. Bhavaprakasha Nighantu

C.Chi Charaka Samhita Chikitsa Sthana

C.D Chakradatta

C.S. Charaka samhita

D.N. Dhanwantari Nighantu

DG.PV Dravyaguna Vijnana By Priyavrat Sharma

DG.VMG Dravyaguna vijnana By V.M. Gogte

DGHB Dravyaguna Hastamlaka by Banvarilal

DGYt Dravyaguan vijnana By yadavji Trikamji

I.M.M. Indian Materia Medika

I.M.P. Indian Medicinal Plants

K.N. Kaiyadeva Nighantu

M.D. Madava Dravyaguna

M.N. Madanapala Nighantu

M.N Madhava Nidana

Mau.N. Mahausadha Nighantu

N.A. Nighantu Adarsha

R.N. Raja Nighantu

Sha.S.M Sharangadhara Samhita Madhyama Khanda

Su Sushruta Samhita

V.N Vanoushadhi nidarshika

Y.R. Yoga Ratnakar

ABSTRACT

The disease Amavata is named after two major factors Ama and Vata which

effects the sandhi’s. Madhavakara for the first time mentioned this disease as a separate

entity.

Amavata can be correlated with Rheumatoid Arthritis on the basis of symptoms

mentioned in the concerned literatures. Amavata is a chronic progressive systemic

inflammatory disorder that primarily targets the joints of middle age adults. Here

comparative clinical trail has been carried out with the required parameters. Here shunti

(Zingiber officinale) and Gokshura’s (Tribulus terristris) are utilized in the form of

kwatha to find out their comparative efficacy in the Amavata (Chakradatta 25/9).

OBJECTIVES

1. To evaluate the efficacy of the Shunti kwatha in Amavata.

2. To evaluate the efficacy of the Gokshura kwatha in Amavata.

3. To assess the additive efficacy of Shunti Gokshura kwatha (Shuntyadi) in Amavata.

METHOD: In this prospective comparative clinical study, 30 patients randomly selected

and Grouped as A, B and C receiving Shunti kwatha, Gokshura kwatha and Shunti

Gokshura kwatha respectively for the duration of 30 days with dose of 40 ml in the early

morning. Efficacy was assessed by the difference of before and after treatment from the

subjective and objective parameters.

RESULTS : Individually all the 3 groups showed highly significant in subjective as

well as objective parameters. Comparatively group C shows more significant than the

group A and group B.

INTERPRETATION & CONCLUSION :This clinical study is quite obvious that

combination of treatment as provided in Group C that is Shunti Gokshura kwatha has got

edge over the treatment provided in Group A (Shunti kwatha) and group B (Gokshura

kwatha) improvement in all the respect is observed specially in subjective as well as

objective parameters. Shunti and Gokshura kwatha (Group C) is very effective in

Amavata.

KEY WORDS

Amavata; Rheumatoid Arthritis; Shunti (Zingiber officinale);

Gokshura (Tribulus terrestris); Methods; Clinical study; Results;

CONTENTS

Page No

1.1. IntroductionIntroduction 1-2 1-2

2.2. ObjectivesObjectives 3-3 3-3

3.3. Review of literatureReview of literature 4-64 4-64

A) Drug Review 4-38

B) Disease ReviewB) Disease Review 39-64 39-64

4.4. MethodologyMethodology 65-73 65-73

5.5. ResultsResults 74-105 74-105

6.6. DiscussionDiscussion 106-110 106-110

7.7. ConclusionConclusion 111-112 111-112

8.8. SummarySummary 113-113 113-113

9.9. Bibliography Bibliography 114-121 114-121

10. 10. AnnexureAnnexure 122-129 122-129

LIST OF TABLES

Table 1 SHUNTI Page No.

Table 1.1 – Showing synonyms according to different authors. 05

Table 1.2 – Showing Gana and varga according to different classics 06

Table 1.3 – Showing Guna according to different authors 07

Table 1.4 – Showing Karma according to different authors 07

Table 1.5 – Showing Prayoga according to different authors 08

Table 1.6 – Showing use of shunti in different yoga’s. 09-11

Table 2 GOKSHURA

Table 2.1 – Showing synonyms according to different authors 23

Table 2.2 – Showing Gana and varga according to different classics 24

Table 2.3 – Showing Guna according to different authors 25

Table 2.4 – Showing Karma according to different authors 26

Table 2.5 – Showing Prayoga according to different authors 27

Table 2.6 – Showing Prayojyanga according to different authors 27

Table 2.7 – Showing use of Gokshura in different yoga’s. 28-30

Table 3 DISEASE

Table 3.1- Showing samprapti ghataka 49

Table 3.2 – Showing comparison of lakshanas with different Ayurvedic treatises 52

Table 3.3 – Involvement of srotas according to symptoms. 53

Table 4 OBSERVATIONS AND RESULTS Page No.

Table 4.1 – Showing age distribution of 30 patients. 75Table 4.2 – Showing sex distribution of 30 patients. 76Table 4.3- Showing distribution of religion of 30 patients. 77Table 4.4- Showing Distribution of patients according to the occupation. 78Table 4.5- Showing distribution of patients according to the economical status. 79Table 4.6- Showing distribution of patients according to the diet habit. 80Table 4.7- Showing presenting symptoms of thirty patients. 81Table 4.8- Showing duration of the patients in the present study. 83Table 4.9- Showing the affected joints of thirty patients. 84Table 4.10- Showing Agnibala of thirty patients. 85Table 4.11- Showing nidra of thirty patients. 86Table 4.12-Showing prakruti of thirty patients. 87Table 4.13 Showing Grades of sandhi shoola before treatment in Group A ,B & C.88Table 4.14 Showing Grades of sandhi shoola after treatment in Group A, B & C. 88Table 4.15 Showing Grades of sandhi shotha before treatment in Group A, B & C.89Table 4.16 Showing Grades of sandhi shotha after treatment in Group A, B & C. 89Table 4.17 Showing Grades of jwara before treatment in Group A, B & C. 90Table 4.18 Showing Grades of jwara after treatment in Group A, B & C. 90Table 4.19 Showing Grades of stabdata before treatment in Group A, B & C. 91Table 4.20 Showing Grades of stabdata after treatment in Group A, B & C. 91Table 4.21 Showing comparative results of Group A, B & C with sandhishoola. 92Table 4.22 Showing comparative results of Group A, B &C with Sandhishotha. 93Table 4.23 Showing comparative results of Group A, B & C with Jwara.(fever) 94Table 4.24 Showing comparative results of Group A, B & C with Stabdata. 95Table 4.25 Showing statistical analysis of subjective and objective parameters in Group A. 96Table 4.26 Showing statistical analysis of subjective and objective parameters in Group B 97Table 4.27 Showing statistical analysis of subjective and objective parameters in Group C 97

Table 4.28 Showing Anova table for sandhi shoola. 98Table 4.29 Showing Anova table for sandhi shotha. 98Table 4.30 Showing Anova table for jwara. 98Table 4.31 Showing Anova table for stabdata. 98Table 4.32 Showing Anova table for Hb% 99Table 4.33 Showing Anova table for ESR. 99Table 4.33 (a) Showing least significance difference among the groups 99Table 4.34 Showing Anova table for TC. 100Table 4.35 Showing comparative overall assessment of therapeutic response of

Group A, B & C. 101

LIST OF GRAPHS. Page No.

Graph 1- Showing Age distribution of 30 patients. 75

Graph 2 – Showing Sex distribution of 30 patients. 76

Graph 3 – Showing distribution of Religion of 30 patients. 77

Graph 4- Showing distribution of Patients according to the occupation. 78

Graph 5 - Showing distribution of Patients according to the economical status. 79

Graph 6 - Showing distribution of Patients according to the diet habit. 80

Graph 7 - Showing Presenting Symptoms of thirty patients. 82

Graph 8- Showing duration of the patients in the present study. 83

Graph 9 - Showing the affected joint of thirty patients. 84

Graph 10 - Showing Agnibala of thirty patients. 85

Graph 11- Showing Nidra of thirty patients. 86

Graph 12– Showing Prakruti of thirty patients. 87

Graph 13 -Showing comparative results of Group A, B & C with sandhishoola. 92

Graph 14-Showing comparative results of Group A, B &C with Sandhishotha. 93

Graph 15-Showing comparative results of Group A, B & C with Jwara.(fever) 94

Graph 16-Showing comparative results of Group A, B & C with Stabdata. 95

Graph 17 - Showing comparative overall assessment of therapeutic response of Group A,B & C. 101

LIST OF PHOTOGRAPHS

1. Plant shunti

2. Shunti kanda

3. Plant Gokshura

4. Gokshura phala

5. Shunti Choorna

6. Shunti kwatha

7. Gokshura choorna

8. Gokshura kwatha

9. Shunti Gokshura kwatha

MASTER CHARTS Page No.

1. Showing the demographic data 103

2. Showing assessment of Subjective parameters of Group A, B and C 104

3. Showing assessment of Objective parameters of Group A, B and C 105

1

INTRODUCTION

Ayurveda is a science of life with two main objectives maintenance and

promotion of positive health and cure of the diseases. Ayurveda is believed to be

prevalent since 5000 years in India. In 1974 W.H.O. recognized Ayurveda the Indian

traditional medicine and requested to improve the service and availability of Ayurvedic

drugs in our country. This traditional medicine is much popular for curing the most of the

diseases.

Drug being one among the Chikitsa chatushpada and the armour of the physician.

The drug occupies a pre-eminent position in the requisite for achieving the success of

treatment. The drug is given vital importance because of its efficacy, easy availability and

multiple formulation, which helps in achieving on effective treatment which also cost

effective. Since the time immemorial herbs are being used as good as well as for

medicinal purpose and also to making materials like chariot etc.

Amavata is chronic progressive systemic inflammatory disorder that primarily

target the joints of middle aged adults. Over all prevalence of RA in caucasion population

is about 1% with a female to male ratio of 3:1.

Presently the non steroidal Antiinflammatory drugs (NSAIDs) are the mainstay in

this condition how ever they have serious adverse effects and have limitations for a long

term therapy. NSAIDs temporarily control pain and possibility of further damage to joint

increases where as the root cause remains un attended.

In the fast moving world man is stepping forward after success in finding it not

difficult to achieve total health. This is because of in judicious life style like improper

food habits added to this mental factors like greed anger etc.

2

These factors basically disturb the core controller of health. Majority of the

disease result from the abnormal status of Agni. Amavata is one among such disease. It is

a disease that physicians are compelled to combat in their practice very often.

Present available treatment with contemporary science is able to give a temporary

relief to the patients. Amavata often cripples the routine life of the patients. Ayurvedic

approach to this disease aims basically at stabilizing agni which is the root cause. There

by trying to promote a long lasting relief.

Among the various formulation indicated in the management of Amavata, Shunti

(Zingiber officinale rosc) and Gokshura (Tribulus terrestris linn) appear to be cost

effective easily available and there is no substantial adverse effect.

Shunti posses katu rasa. Ushna veerya and Madhura vipaka. It allivates vata and

Kapha dosha. It mitigates shoola and shotha and it is agni deepaka and amapachaka.

Gokshura is tridosha shamaka, rujahara, deepana and shothahara action can be an

effective remedy for Amavata.

The present study aims at a comparative study on the efficacy of Shunti Gokshura

(Shuntyadi kwatha C.D. 25/9) in Amavata.

3

OBJECTIVES

1. To evaluate the efficacy of the Shunti kwatha in Amavata

2. To evaluate the efficacy of the Gokshura kwatha in Amavata

3. To assess the additive efficacy of Shuntyadi kwatha in Amavata.

4

A) DRUG REVIEW

CLASSICAL REVIEW OF THE DRUG SHUNTI

HISTORICAL ASPECT OF THE DRUG

Ardraka is delineated in Agnivesha Grhyasutra Jaimini Brahmana quotes the

name srngabera. Suntha or Shunti described in the Guhya sutras is considered as a type of

Grass but not ginger. Visvabhesaja term is used for water and rice in Rgveda (1/13/20

and 1/137/3). The above mentionings confirm that Ardraka and shunti are relatively new

names not familiar in the ancient times. Mujumdar is of the openion that Adara described

in Rgveda may be Z. officinale1.

SYNONYMS WITH MEANING

• Mahaushada - It promotes the growth of human body.

• Kaphari - That which over comes the disease of Kapha

• Ushna - It is having ushna veerya

• Vishwoushadha - It cures all the diseases

• Vishwabheshaja - It almost cures every disease

• Vishwa - It can be cultivated/available all over the world

• Shunti - Shunti word is used in the sense of Equalizing or to

combat. It may combat Ama dosha or kapha dosha.

• Shringavera - It possesses several sringas (germinating buds) on

Its surface.

• Ardrakam - It will provide moisture to the tongue that is useful

in the treatment of dryness of mouth.

5

Table 1.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORS

Synonyms Cha2 Su3 A.S4 D.N5 M.N6R.N7 K.N8 BP.N9 Mau.

N10A.R. 11

Mahaushadha + - + + + + + + + +

Vishwa - - - + + + - + + +

Nagara + + + + + + + + + +

Vishwabheshaja + - - + + + + + + +

Vishwoushadha - - - + + + + - + -

Shringavera + + + + + + - + + +

Katubhadra - - - + + + + + + +

Ardraka - - - + - + - - - +

Katutkhatam - - - - + - + - + -

Rahucchatra - - - - - - + - - -

Katugranthi - - - - - + - - + -

Katushanam - - - - - + - - + -

Sauparna - - - - - + - - + -

Kaphari - - - - - + - - + -

Shushkadra - - - - - - - - + -

Chandraka - - - - - - - - + -

Chandrabheshaja - - - - - - - - + -

Ushana - - - - - - - + + -

Bheshaja - - - - - - - - + +

Shunti - - - + + + + + + +

6

Table 1.2: GANA AND VARGA : ACCORDING TO DIFFERENT CLASSICS

Charaka Samhita Deepaniya

Truptighna

Arshoghna

Stanyashodana

Trushna nigrahana

Sheeta prashamana

Shoola prashasmana

Aharopayogi varga

Susruta samhita Pippalyadi

Trikatu

Shaka varga

Astanga Sangraha Deepaniya

Truptighna

Arshoghna

Stanya shodana

Trushna nigrahana

Sheeta shamana

Shoola shamana

Pippalyadi

Dhanwantari Nighantu Shatapushpadi varga

Madanapala Nighantu Shuntyadi varga

Raja Nighantu Pippalyadi varga

Kaiyadeva Nighantu Oushadi varga

Bhavaprakasha Nighantu Haritakyadi varga

Mahaushada Nighantu Mahaushada varga

Nighantu Aadarsha Aadrakadi varga

Madava Dravyaguna Vividoushada varga

Abidana Ratnamala Katuskanda

7

GUNA KARMA

Table 1.3: GUNA (PROPERTIES) ACCORDING TO DIFFERENT AUTHORS

GUNA Cha12 Su13 A.Hr14 D.N15 M.N16 R.N17 K.N18 BP.N19

Mau.N20 M.D21 N.A22

Rasa-Katu - + - + + + + + + + +

Guna-Laghu

Snigdha

-

+

+

+

+

+

-

+

+

+

-

+

+

+

+

+

+

+

+

+

-

-

Veerya-Ushna + + + - + + + + + + +

VipakaMadhura + + + - + - + + + + +

Kapha Vataghna

Kaphaghna

+

-

+

-

+

-

-

+

+

-

+

-

+

-

+

-

+

-

+

-

+

-

Table 1.4: KARMA (ACTIONS) ACCORDING TO DIFFERENT AUTHORS

Karma Cha23 Su24 A.Hr25 D.N26 M.N27 K.N28 BP.N29 Mau.N30 M.D.31 BDA32

Vrushya + + + + + + + + + +

Pachana - - - - + + + + - +

Rochana + + + - + + + + + -

Hridya + + + - - + - - + -

Deepana + - + - - + - - + -

Swarya - + - - + + + + - -

Grahi - - + - - + + - - +

Anulomana - - - - - - - - - +

Arshoghna - - - - - - - - - -

8

Table 1.5: PRAYOGA (USES) ACORDING TO DIFFERENT AUTHORS

Prayoga Su33 D.N34 M.N35 R.N36 K.N37 BP.N38 Mau.N39 B D A40 PVS41

Shoola + - + + + + + + -

Udara - + + + + + + - +

Swasa - + + + + + + - +

Kasa - - + - + + + - +

Shlepada - + + + + + + - +

Vibandha + - + - + + + - +

Aruchi - + - - - - - - +

Amavata - - + - - + - - +

Vamana - - + - + + + - +

Arsha - - + - + + + - -

Aanaha + - + - + + + + -

Hridroga - - + - + + + - -

Shotha - - - - - + + - +

Shopa - + + + + - - - -

Pandu - + - - - - - - -

Adhama - - - - - - - - -

Hidma - - - + + - - - -

Hikka - - - - - - - - +

PRAYOJYA ANGA -

Kanda ( Rhizome) 42

9

Table 1.6: USE OF SHUNTI IN DIFFERENT YOGAS

SL No YOGA INDICATION REFERENCE

1. Nagardi grutha Udara roga K&V gulma Cha. Chi 13/115

2. Vidangadi kshara Gulma and Pleeha roga Cha. Chi 13/80

3. Gandiradyarista Shotha, Bagandara, Arsha Cha. Chi 12/29-31

4. Pippalyadi lavana Hrudaya and shotha Cha. Chi. 13/158-161

5. Nilinyadhya choorna Udara roga and gulma Cha. Chi. 13/137

6. Kshara vatika Shotha and Jalodara Cha. Chi. 13/162-164

7. Pippalyadi grutha Arsha Cha. Chi. 14/104

8. Chavyadi grutha Pravahika Cha. Chi. 14/107-109

9. Nagaradhya grutha Arsha. Grahani Cha. Chi. 14/110-112

10. Trushandya grutha Mandagni Cha. Chi. 15/87

11. Nagaradhya choorna Pittaja grahani. Raktapitta Cha. Chi. 15/130-131

12. Bhallataka kshara Hrudroga, pandu, grahani Cha. Chi. 15/177-78

13. Navayasa choorna Pandu. Hrudroga Cha. Chi. 16/70-71

14. Mandoora vataka Pandu Cha. Chi. 16/73-77

15. Datryavaleha Kamala. Pittavikara Cha. Chi. 16/100-101

16. Sauvarchaladi choorna Hikka swasa Cha. Chi 17/109

17. Shuntyadi choorna Tamaka swasa Hikka Cha. Chi. 17/123-124

18. Vidangadi Choorna Vataja kasa Cha. Chi. 18/47

19. Chitrakadi leha Hrudroga, Swasa Cha. Chi. 18/53-56

20. Pushkaramooladi kalka Vataja Hrudroga Cha. Chi. 26/84

21. Nagaradi kwatha Raktapitta pittashoola Sha. S.M. Kha. 2/97

10

SL No YOGA INDICATION REFERENCE

22. Shunti putapaka Amatisara Sha. S.M. Kha. 1/42-43

23. Nagaradi kwatha Jwara, Atisara Sha. S.M. Kha. 2/62

24. Shuntyadi kalka Parinama shoola and Amavata Sha. S.M. Kha. 5/18

25. Shunti kalka Grahani Sha. S.M. Kha. 5/28

26. Panchakola choorna Deepana, Pachana, Anaha Sha. S.M. Kha. 5/13.14

27. Shuntyadi choorna Amatisara Sha. S.M. Kha. 6/46

28. Chitrakadi choorna Gulma, Grahani Sha. S.M. Kha. 6/110-113

29. Gudadi gutika Swasa, Kasa Sha. S.M. Kha. 7/16

30. Yoshadi vati Swasa, Kasa Sha. S.M. Kha. 7/22.23

31. Yogaraj guggulu Tridosha shamaka, Rasayana Sha. S.M. Kha. 7/53-69

32. Pippalyadi grutha Vishamajwara, Pleeharoga Sha. S.M. Kha. 9/19.20

33. Changeri grutha Grahani, Vatavikar Sha. S.M. Kha. 9/21-24

34. Mahaushadi kwatha Vishama jwara C.D. 1/210

35. Nagaradi kashaya Jwara, Atisara C.D. 2/4

36. Nagaradi kwatha Atisara, Shoola C.D. 2/30

37. Shunti grutha Shotha, Amadosha yukta grahani C.D. 4/41

38. Nagaradhya modaka All types of Arsha C.D. 5/27

39. Navayasa loham Pandu, Kusta, Hrudayavikara C.D. 8/10-11

40. Vishwadi leha Vatika kasa C.D. 11/6

41. Kantakari grutha Swarabheda, All types of Kasa C.D. 13/12

42. Chandana kalka Cchardhi C.D. 15/6

11

SL No YOGA INDICATION REFERENCE

43. Mahaushadi kwatha Moorcha and mada C.D. 17/6

44. Amrutadi choorna Amavata, Sandishotha C.D. 25/14

45. Patyadi choorna Shotha, Agnimandya, Amavata C.D. 25/44

46. Trikatukadi varti Anaha and shoola C.D. 29/8.9

47. Varunadi kwatha Vatajanya Ashmari C.D. 34/2.1

48. Shuntyadi kwatha Ashmari, Mutrakrucchra C.D. 34/5.7

49. Nagaradi kashaya Ashmari C.D. 34/28

50. Swadamstradi kashaya Ashmari C.D. 34/30

51. Ashta Dashanga Kwatha Jwara Y R Jwara chi 3rd Shloka

52. Navayasa Choorna Pandu, Hridroga Y R Pandu roga chikitsa -

1st Shloka

12

MODERN REVIEW OF THE DRUG SHUNTI

BOTANICAL NAME: Zingiber officinale (Rosc)

Meaning of Zingiber officinale is -

Zingiber – altered form of the shrungber43

Officinale – sole in shops or used in medicine or in the arts.

VERNACULAR NAME : 44 , 45

v Latin - Zingiber officinalae

v English - Ginger

v Bengal - Sonth

v Maharastra - Sunt

v Telagu - Sonti

v Tamil - Shukku

v Kannada - Vanashunti

v Malayalam - Chukka

v Konkani - Alem

v Punjab - Sonth

v Hindi - Ada, Adrak

v French - Gingembre

v Italian - Zenzero

v Malaya - Alea

v Tulu - Sunthi

v Urdu - Adrak

v Oriya - Adroko

v German - Inqwer

13

TAXONOMICAL CLASSIFICATION OF SHUNTI46

Ø Kingdom - Plantae

Ø Division - Embryophyta siphonogama

Ø Class - Monocotyledons

Ø Order - Scitaminea

Ø Family - Zingiberaceae

Ø Genus - Zingiber

Ø Species - Officinalis

FAMILY CHARACTER – ZINGIBERACEAE. 47

Habit - Herbaceous plants

Root - Fibrous root system

Stem - Usually an underground rhizome may be horizontal or tuberous.

The rhizome periodically produces aerial shoots

Leaf - Leaves may be radical or couline. Petiolate or subsessile. Arrangement of

the leaves is distichous. Leaf base sheathing. Lamina is linear to elliptic

or lanceolate. Venation unicostate parallel A ligule is present between the

petiole and lamina

Inflorescence- Flowering clusters may be present on leafy aerial shoots or on leafless

scapes as in zingiber. The inflorescence is varied. It is a spike head raceme

or panicle.

Flower - Pedicellate or sessile bracteate bracts are of ten coloured and arranged

spirally or in two series flowers are complete trimerous, Zygomarphic,

cyclic, heterochlamydeous, bisexual and epigynous. Flowers are large

brightly coloured and aromatic in some

14

Calyx - Sepals three in number united to form a tube

odd sepal anterior in position. Aestivation valuate.

Corolla - Petals (inner whorl of perianth) three, gamo pentalous forming a corolline

tube. Petals unequal in size. Posterior pental largest covering the

margins of the remaining two. Aestivation valvate petals are brightly

coloured and often delicate

Androecium -Basic number of stamens is six. Arranged in two whorls of three each.

However all except one are sterile. The outer whorl is supposed to have

three stamens of which the anterior one is always absent. The remaining

two are represented by leafy staminodes. Among the three members of

the inner whorl one is a fertile stamen it is epipetalous. The remaining

two members are united to form a petaloid labellum. The labellum closely

apresses the fertile stamen.

Gynoecium - Ovary inferior tricarpellary, syncarpous trilocular with many ovules on

axile placenta. Style is single and is more or less enclosed by the groove of

the fertile stamen. Stigma simple capitate or three lobed. Epigynous

nectar secreting glands are present.

Seeds - Seeds have a meaty endosperm with a straight embryo. An aril is often

Present

15

CHARACTERS OF ZINGIBER OFFICINALAE

MORPHOLOGY (HABIT) 48

Rhizome -Stout tuberous with erect leafy stems 0.6-1.2 m high.

Leaves -Narrow, distichous, subsessile on the sheaths, linear-lanceolate, 1-2cm

Wide, glabrous

Flowers -Greenish with a small dark purple or purplish black lip in radical spikes

3.8 –7.5 cm long and 2.5 cm diameter on peduncles 15-30 cm long.

Stamens -Dark purple as long as the lip, rather shorter than the corolla.

DISTRIBUTION (HABITAT) 49

Ginger is cultivated in many parts of India. On a large scale in the worm, moist

regions. Chiefly in Madras, Cochin and Travancore, and to a somewhat less extent in

Bengal and the Punjab.

PHARMACOGNOSTICAL FEATURES OF SHUNTI50

a) Macroscopic

Rhizome - Drug occurs as entire rhizome or in pieces, rhizome laterally compressed

bearing flattish ovate, oblique branches on upper side, each having a depressed scar its

opex pieces 5-15 cm long, 1.5 – 6.5 cm wide (usually 3-4 cm) and 1-1.5 cm thick,

fracture, short with projecting fibres, transeversely cut surface shows a wide central stele

having numerous grayish cut ends of fibres and yellow secreting cells gingery taste

pungent.

b) Microscopic

Rhizome – Shows a few layered, irregularly arranged, tangentiolly elongated, brown

cells of outer cork and 6-12 rows of thin walled, colourless, radially arranged cells of

inner cork; secondary cortex consisting of hexagonal to polygonal, isodiametric, thin

16

walled parenchymatous cells containing numerous circular to oval starch grains with

striations and hilum at one end idioblasts containing large yellowish to brownish globules

of oleoresin walls of oil cells suberised, numerous closed, conjoint, collateral, cortical

fibro vascular bundles scattered throughout cortical zone, greater number occurring in

inner cortical region, larger bundles consists of 2-7 vessels. Small cells of sieve tube,

polygonal cells of parenchyma and group of fibres; vessels showing reticulate,

scalariform and spiral thickening; fibres septate with a few oblique pores on their walls;

endodermis single layered, free from starch; pericycle single layered enclosing central

stels; stele consisting of thin walled polygonal, isodiametric cells of parenchyma, filled

with abundant starch grains, oleo resin cells similar to those present in cortex;

fibrovascular bundles of two types; those arranged along pericycle in a definite ring are

smaller in sized and devoid of fibres, vessels 2-5 in number, larger bundles found

scattered throughout stele, composed of xylem, phloem parenchyma and sheath of

sclerenchyma.

Powder – Light yellow; shows thin walled parenchymatous cells, septate fibres with

oblique, elongated pits on their walls, reticulate and spiral vessels, oleo resin cells

abundant single starch grains of varying shapes with eccentric hilum, measuring 5-25

micro in diameter.

PHYTOCHEMISTRY51

Ginger consists of volatile oil (1-4%) starch (40-60%) fat, 10% protein (10%)

fibre (5%) inorganic material (6%) residual moisture (10%) an acrid resinous matter (5-

8%) Ginger oil is constituted of monoterpene hydrocarbons, sesquiterpene hydrocarbons,

oxygenated mono and sesquiterpenes and phenyl propanoids.

Sesquiterpene hydrocarbon content of all types of ginger oil from different

countries is found to be same and includes Alpha - zingiberene, Beta - bisabolene

Alpha--farnesene, Beta - sequiphellandrene and curcumene.

17

Aroma and flavour are the main characters of ginger. Aroma is due to fragrant

principles of volatile oil while the flavour, pungency and pharmacological action is

exerted by phenolic ketones of oleoresin. Various components of volatile oil like

isometric terpenic aldehydes like geranial and citral. Which cause the delicate and

lemony aroma. Few sesquiterpeneoil hydrocarbons are believed to exert spicy note

phenolic ketones of oleoresin include gingerols like shogaols is zingerone, paradols.

Gingediols, hexa hydrocurcumin and also O - methyl ethers of these compounds.

Identity Purity and Strength52

Ø Foreign matter - not more than 1 percent

Ø Total ash - not more than 6 percent

Ø Water- soluble ash - not less than 1.5 percent

Ø Alcohol (90%) soluble extractive - not less than 3 percent

Ø Water soluble extractive - not less than 10 percent

CULTIVATION53

The plant of ginger is a perennial herb about 1 meter high with sympodial

branching rhizome. For cultivation the rhizome is cut into pieces and each piece

containing a bud is planted into trenches in well-drained and loamy soil in March and

April.

The plant requires about 80” rainfall per year and if rainfall is inadequate water

may be supplied by irrigation. Collection is done in December or January when the plants

wither after flowering period. Rhizome are carefully dugout, aerial stems, fibrous roots

and buds are removed.

18

They are washed in remove mould and clay attached to them. Rhizome is peeled

on flat surface as well as between the fingers and thoroughly washed in running water.

Drug is then dried completely by keeping in the sun on mats, which are covered over

nights, and in rainy and cloudy seasons. If moisture is present, drug may become mouldy.

After drying it loses about 70% of its weight.

USES OF PLANT IN OTHER SYSTEMS AND COUNTRIES

ACTION AND USES IN SIDDHA54

Katu rasam, Ushna veeryam, Vata kapha haram, Katu vipaka Laghu, Snigdha,

Pachanam, Ruchyam, Vrishyam, Swaryam, Vibhanda harum, in grahani, Agnimathyam,

Amavatham, Cchardhi, Swasam, Soolam, arsas, anaham, hrithrogam, udara rogam.

ACTION AND USES IN UNANI55

The rhizome has sharp taste, pungent, stomachic aphrodisiac, tonic, expectorant,

carminative, removes pain due to cold. Strengthens memory. Removes obstruction in the

vessels, used in nervous diseases, ginger is anthelmintic good in piles, rheumatism,

headache.

In Cambodia56 - The rhizome is given internally as an aromatic tonic externally it

is applied to boils and enlarged glands.

In China and Malaya57 - Ginger is largely used as a condiment and in domestic

medicine. It is prescribed as an adjunct to many tonic and stimulating remedies. The root

skin is used as a carminative and is said to be a remedy for opacity of the cornea.

19

RESEARCH PROFILE

1: Ginger syrup as an antiemetic in early pregnancy.

2: Nausea and vomiting of pregnancy.

3: Gastroprotective activity of ginger zingiber officinale rosc., in albino rats.

The cytoprotective and gastric anti-ulcer studies of ginger have been carried

out in albino rats. Cytodestruction was produced by 80% ethanol, 0.6M HC1, 0.2M

NaOH and 25% NaCl. Whereas gastric ulcers were produced by ulcerogenic agents

including indomethacin, aspirin and reserpine, beside hypothermic restraint

stress and by pylorus ligated Shay rat technique. The results of this study

demonstrate that the extract in the dose of 500 mg/kg orally exert highly

significant cytoprotection against 80% ethanol, 0.6M HC1, 0.2M NaOH and 25% NaCl

induced gastric lesions. The extract also prevented the occurrence of gastric

ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) and hypothermic

restraint stress. These observations suggest cytoprotective and anti-ulcerogenic

effect of the ginger.

4: Prospective comparative study of the safety and effectiveness of ginger for the

treatment of nausea and vomiting in pregnancy.

5: Zingiber officinale (ginger)--an antiemetic for day case surgery.

6: Zingiber officinale does not affect gastric emptying rate. A randomised,

placebo-controlled, crossover trial.

The effect of the powdered rhizome of Zingiber officinale (ginger root) on the

gastric emptying rate was investigated. In a double-blind crossover trial, 16

healthy volunteers were randomly allocated to receive either 1 g of ginger or

20

placebo. Gastric emptying was measured using the oral paracetamol absorption

model. Ingestion of ginger did not effect gastric emptying. The antiemetic

effect of ginger is not associated with an effect on gastric emptying. No

adverse effects were noted.

7: Ginger does not prevent postoperative nausea and vomiting after laparoscopic

surgery.

IMPLICATIONS: The potential antiemetic effect of two different oral doses of the

herbal remedy ginger (Zingiber officinale) to prevent postoperative nausea and

vomiting in 180 patients undergoing gynecologic laparoscopy was investigated in

this randomized, double-blinded trial. Ginger failed to reduce the incidence of

postoperative nausea and vomiting after these procedures.

8: Effects of a ginger extract on knee pain in patients with osteoarthritis.

9: Effect of a ginger extract on pregnancy-induced nausea: a randomised controlled

trial.

References: WWW.PUBMED.COM. PMID: [PubMed - indexed for MEDLINE]

21

CLASSICAL REVIEW OF THE DRUG GOKSHURA

HISTORICAL ASPECT OF THE DRUG

There is no convincing reference of the drug Gokshura in vedic period.

Information of this plant is available from the time of Samhita’s. Various therapeutic uses

of this drug are seen in many classics. Gokshura has been mentioned is various

Nighantu’s.

SYNONYMS AND ITS MEANINGS

1) Bahu kantaka – Which has got many thorns.

2) Bhadra kantaka – That which has got useful thorns.

3) Bhakshata – The fruit which is having thorns is being eaten as a

medicine.

4) Bhakshaka – The fruit which is having thorns is being eaten as a

medicine.

5) Bhakshakanta – The fruit which is having thorns is being eaten as a

medicine.

6) Chanadruma – Its kshupa resembles with chanaka (cicer alietinum)

7) Chanapatraka – The leaves resembles the leaves of Bengal gram

plant.

8) Granthila – The root of which has got nodules

9) Gokshuraka – Its thorn will pinches the legs of cow like knife

10) Gokantaka – The thorns of Gokshura can enter legs of wandering

cows.

11) Kanti – Its fruit having thorns.

12) Kantaka – Its fruit having thorns.

22

13) Kantakatrika – The fruit of which has got three thorns.

14) Kshura – Its thorns are as sharp as kshuraka knife.

15) Ikshugandhika – The smell which comes out from this kshupa

resembles with ikshu

16) Sthala shrunghata – Its fruit resembles with shrungataka (trapa

bespinosa) and it grows on the earth (stala).

17) Swadamstra – Its thorns are as sharp as dogs teeth.

18) Shadanga – a) It has got six parts like root, stem, leaf, flower,

fruit, and seed.

b) All the six parts of it are used for therapeutic

purpose.

19) Swadukantaka – The fruits are sweetish in nature

20) Trika – That which allievaites all the three doshas.

21) Trikantaka – The fruit of which has got three thorns.

22) Palankasha – The fruit of which makes wounds and causes pain.

23) Vyaladamstra – It causes pain which is like wild animal bite. It

easily digests the meat

24) Vanashringara – It is present with the horns (thorns) in the garden.

25) Kanta Phala – Fruits are having Thorns

23

Table 2.1: SYNONYMS ACCORDING TO DIFFERENT AUTHORS

Synonyms Cha58 Su59 A.S60 D.N61 M.N62 R.N63 K.N64 BP.N65

Mau.N66

A.R.67 A.K.68

Gokshura + - + + + + + + + + +

Bhakshyaka - - - + - - + - - - -

Swadu kantaka - - - + + + + + + - +

Gokantaka - - - + + - - + + - +

Bhakshakha - - - + + - - - - - -

Kantakatrika - - - + - - - - - - -

Swadamstra + + + + + + + + + + +

Trikantaka - + - - + - + + + + -

Kantaphala - - - - + - + - - + -

Vyaladamstraka - - - - + + + - - + -

Sthalashrunghata - - - - + + + - + + -

Kshura - - - - + + + + - - -

Kshuranga - - - - - + - - - - -

Kantaka - - - - - + - - - - -

Bhakshya kanta - - - - - + - - - - -

Mahanga - - - - - + - - - - -

Palankasha - - - - - + - + + - +

Kshudrakshura - - - - - + - - - - -

Vanashrunghataka - - - - - + - + - - +

Ikshugandha - - - - - + - + + - +

Trika - - - - + - + - - - -

Kantaka kshura - - - - - - - - - + -

Chanadruma - - - - - + - - - - -

Bahukantaka - - - - - + - - - - -

Shadanga - - - + + - + - - - -

24

Table 2.2: GANA AND VARGA ACCORDING TO DIFFERENT CLASSICS

Charaka samhita Mutra virechaniya

Shothahara

Krimighna

Anuvasanopaga

Sushruta samhita Vidarigandadi

Veeratarvadi

Laghu panchamoola

Kantaka panchamoola

Ashtanga Sangraha Krimighna

Mootravirechana

Shothahara

Vidaryadi

Veerataradi

Laghu panchamoola

Dhanvantari Nighantu Guducchyadi varga

Madanapala Nighantu Abhayadi varga

Raja Nighantu Shatavhadi varga

Kaiyadeva Nighantu Oushadi varga

Bhavaprakasha Nighantu Guducchyadi varga

Mahaushada Nighantu Bilwadi varga

Madava Dravyaguna Vividoushadi varga

Abidana ratnamala Swadu kanda

Nighantu Adarsha Laghugokshuradi varga

Amara kosha Vanoushadi varga

25

BHEDA (VARIETIES) 69

The Gokshura, which we are using in medicines, is of two types. They are,

1. Laghu or Kshudra Gokshura

2. Brihat Gokshura

Charaka and Sushrutha have not mentioned about the varieties. Only Gokshura

has been mentioned.

The name Brihat Gokshura is found in Raja Nighantu. Raja Nighantu mentioned

about Kshudra Gokshura and Gokshura (Brahat). And lastly he claims even both

Gokshsura’s endowed with same properties but Brahat Gokshura is effective.

GUNA KARMA

Table 2.3: GUNA (PROPERTIES) ACCORDING TO DIFFERENT AUTHORS

GUNA D.N70 M.N71 R.N72 K.N.73 BP.N74 Mau.N75

N.A76 BDA77 DG.H78

API79

RASAMadhura - + + + + + + + + +

GUNAGuru GunaSnigdha Guna

--

--

--

--

--

--

--

--

++

++

VEERYASheeta - + + + + + + + + +

VIPAKAMadhura - - - + + - + + + -

DOSHAGHNATATridoshahara

Vatahara

Kaphavata hara

Vatapittahara

+

-

-

-

-

+

-

-

-

-

-

-

+

-

-

-

-

+

-

-

-

+

-

-

-

-

+

-

+

-

-

+

-

-

-

-

-

-

-

-

26

Table 2.4: KARMA (ACTION) ACCORDING TO DIFFERENT AUTHORS

Karma Cha80 D.N81 M.N82 R.N83 K. N84 BP.N85

M.D86

Mau.N87

BDA88 IMM89 API90

Brimhana - + - + - - - + - - +

Vrishya - + - - + - + + + + +

Deepana - + - - + + - - - + -

Pustikruta - - - - + + - + + + -

Balakruta - - + + + + + + - + -

Rasayana - - - + - - - - - -

Mootrala - - - - - - - - + + -

Anulomana - - - - - - - + - -

Vajikara - - - - - - - - - - -

Shothahara + - - - - - - - - - -

Basti Shodhana - + - - + - + - - +

Krimighna + - - - - - - - - - -

Asmarihara - - - - - - - - - +

Rujahara - - - - + - - - - - -

27

Table 2.5: PRAYOGA (USES) ACCORDING TO DIFFERENT AUTHORS

PRAYOGA D.N91 M.N92 R.N93 K.N94 BP.N95 Mau.N96 BDA97 IMM98 YTA99 API100

Shoola + - - - - - - - + +

Hridroga + + - + + + + + - +

Prameha + + + + + + + + + +

Swasa - + - + + + - + + +

Kasa - + - + + + - + + +

Mutrakrichra + + + + + + + + + +

Ashmari - - + - + + + + + +

Arsha - - - - + + - + + +

Shotha - - - - - - - - - -

Vibanda - - - - - - - - - -

Vataroga - - - - - - - - + -

Table 2.6: PRAYOJYANGA ACCORDING TO DIFFERENT AUTHORS

PRAYOJYA

ANGA

V.N101 B.D.A102 Y.T.A103 N.A104 P.V.S105 V.M.G106 D.G.H107 I.M.M108

Panchanga + + - + - + + +

Phala + - + + + + + +

Moola + - + + + + + +

Beeja - + - - - - - -

28

Table 2.7: USE OF GOKSHURA IN DIFFERENT YOGA’SSL

No

YOGAS INDICATION REFERENCE

1. Amrutadya Taila Vatavyadhi Cha.chi 28/158-163

2. Swadamstra Taila All types of Vatajanya roga Cha.chi 28/146-147

3. Swadamstradi gritha Ashmari Cha chi 26/74

4. Gokshuradi yoga Ashmari patana Cha chi 26/62

5. Pashanabhedadi churna Ashmari bhedana and patana Cha chi 26/60-61

6. Shatavaryadi kwatha Pittaja Mutrakrucchra Cha chi 26-50

7. Dashamooladhya gritha Agnideepana, Pachana, Vataghna Cha chi 15/82

8. Agastya Haritaki All types of Kasa, Kshaya,Swasa Cha chi 18/58-62

9. Punarnavadi yoga Ashmari Cha chi 26/63

10. Gokshuradi kwatha Mutrakrucchra,Ushnavata Sha.S.M.Kha 2/107

11. Gokshuradi guggulu Mutrakracchra, Prameha Sha.S.M.kha7/84-87

12. Kamadeva gritha Raktapitta, Mutrakrcchra Sha.S.M.kha9/27-37

13. Dashamoolarista Grahani,Swasa,Kasa,Aruchi Sha.S.M.kha10/79-84

14. Dashamooladi kwatha Parshwa shoola, Shirashoola C.D. 10/10

15. Bhargiguda Swasa,Kasa C.D. 12/25-30

16. Kantakari gritha Swarabheda, All types of kasa C.D. 13/12

17. Bhrangarajadhya grithum Swarabheda, kasa C.D 13/14

18. Chavan prash Kasa, Swasa,Kshataksheena C.D.10/47-54

19. Amrutadi choornam Amavata C.D.25/14

20. Alambushadhya Choorna Amavata, Sandhi shotha C.D. 25/19-22

21. Yogaraja guggulu Amavata, Urustamba C.D. 25/25-30

22. Swadamstra gritha Hrudroga,Shoola, Mutrakrucchra C.D.31/27-30

23. Haritakyadi kwatha Daha, Mutrakrucchra C.D. 32/7

24. Trikantakadi kwatha Ashmari, Mutrakrucchra C.D.32/22

29

SL. NO YOGAS INDICATION REFERENCE

25. Trikantakadya grutha Mutrakrucchra,Ashmari C.D.32/28

26. Sukumarakumarakam

grutha

Mutrakrucchra, Katishoola,

Yonishoola

C.D.32/28

27. Varunadi kwatha Vatajanya ashmari C.D. 34/1

28. Shuntyadi kwatha Ashmari, Mutrakrucchra C.D.34/5-7

29. Pashanabhedadhya gritha Vatajanya ashmari C.D.34/8-10

30. Nagaradi kashay Ashmari C.D.34/28

31. Swadamstradi kashay Ashmari C.D.34/30

32. Swadamstradi panakam Ashmari C.D.34/31

33. Trikantakabeeja choorna Ashmari C.D.34/34

34. Dashamoola kwatha Swasa,Sannipata jwara Y.R.Jwara chikitsa

slk 10

35. Dashamooladya

Astadashanga kwatha

Sannipata jwara, Kasa Y.R.Jwara chikitsa

slk 11

36. Shuntyadi Kwatha Amavata , Katishoola Y R Amavata Chikitsa

slk 1

37. Ashta dashanga kwatha All types of Jwara Y R Sannipata Jwara

Chikitsa slk 3

38. Dashamooladi Kwatha Hrudroga Y R Hrudroga Chikitsa

slk 1

39. Gokshuradi Kwatha Mootrakrucchra Y R Mutrakrucchra

Chikitsa slk 1

40. Trikantakadi Guggulu Mootrakrucchra, Mootraghata Y R Mutrakrucchra

Chikitsa slk 12

41. Dashamoola Kwatha Parshwa Shoola , Jwara B.R. 15/13

42. Agastya Haritaki Rasayana, Vali, Phalita B.R. 15/173-178

43. Trayo Dashanga Guggulu Katigraha , Grudrasi B.R. 26/99-101

44. Mahamasha Taila Pakshaghata, Hanustamba B.R. 26/578-584

45. Maha Vishagarbha Taila Al types of Vatavikaras B.R. 27/140-147

46. Trikantakadi Guggulu Mootrakrucchra, Ashmari B.R. 34/22

47. Datryadi Kwatha Mootrakrucchra B.R. 34/23

48. Haritakyadi Kwatha Mootrakrucchra, Vibanda B.R. 34/27

30

SL

No

YOGAS INDICATION REFERENCE

49. Gokshura Kwatha Mootraghata B.R. 35/4

50. Dashamooli Kwatha Jwara B.P.M 1/413

51. Amrutadya Choorna Amavata B.P.M 26/62

52. Alambushadi Choorna Amavata, Vatarakta B.P.M 26/63-65

53. Gokshuradi choorna Gutika Prameha ,Shotha B.P.M 138/82-87

54. Gokshuradyavaleha Mootradaha, Malabanda B.P.M 38/105-107

55. Truna Panchamooladya

Grutha

Ashmari B.P.M 37/55-57

31

MODERN REVIEW OF THE DRUG GOKSHURA

BOTANICAL NAME: TRIBULUS TERRESTRIS (Linn)

Meaning of Tribulus terrestris109

Tribulus = having three sides

Terrestris = of the ground

VERNACULAR NAMES110

v Latin - Tribulus terrestris

v Hindi - chotagokhru

v English - Caltrops, small caltrops

v Kannada - Neggila mullu

v Gujarat - Betagokhru

v Marathi - Ghokaru

v Tamil - Neringi nerinjal

v Telagu - Chirupalleru, palleru mullu

v Malayalam - Neringil Nerinnil

v Urdu - Gokharu

v Arab - Khara khusk

v Punjab - Kurkundai

v Burma - charatte

v Bengal - Gokhuri

32

TAXONOMICAL CLASSIFICATION OF GOKSHURA111

Ø Kingdom – Plantae

Ø Division – Spermatophyta

Ø Class – Dicotyledonae

Ø Subsclass – Polypetalae

Ø Series – Disciflorae

Ø Order – Geraniales

Ø Family – Zygophyllaceae

Ø Genus – Tribulus

Ø Species – Terrestris

33

FAMILY CHARACTERS – ZYGOPHYLLACEAE112

Shrubs or herbs woody at the base, rarely trees. Branches often jointed at the nodes.

Leaves – opposite or alternate, 2-foliolate or pinnate, rarely 3 – foliolate, not

gland dotted.

Stipules – paired, persistent, often spinescent.

Flowers – rarely blue, hermaphrodite, actinomorphic or Zygomorphic.

Sepals – 5, rarely 4, free or rarely connate at the base, imbricate, rarely

valvate.

Petals – 4-5, rarely absent, hypogynous, free, imbricate or conorted, rarely

valvate.

Disk – mostly present.

Stamens – the same number as to triple the number of the petals, often

unequal in length.

Filaments – free, often with a scale inside.

Anthers – 2 celled, opening lengthwise.

Ovary – superior, sessile or rarely stipitate, usually 4-5 celled, cells rarely

transversely locellate,

Style – simple, short or stigmas sessile

Ovules – 2 or more in each cell, axile.

Fruit – various but never baccate.

Seeds – mostly with some endosperm, embryo as long as the seed, straight

or slightly curved.

34

GENUS CHARACTERS - TRIBULUS113

Branching prostrate herbs, often with silky hairs.

Leaves – Stipulate, opposite (or sometimes alternate by suppression) usually

one of the pair smaller than the other, abruptly pinnate.

Flowers – Solitary pseudoaxillary, white or yellow.

Sepals – 5, imbricate.

Petals – 5,spreading, imbricate, fugacious, disk annular, 10-lobed.

Stamens – 10 (rarely 5), inserted on the base of the disk, the longer opposite

to the petals, the 5 shorter with a small gland outside.

Filaments – Filiform, naked.

Ovary – Sessile, hirsute, 5-12 lobed, 5-12 celled.

Ovules – 1-5 in each cell, superposed.

Style – Short, pyramidal or filiform.

Stigmas – 5-12

Fruit – 5 angled. of 5-12 winged or spinous or tuberculate indehiscent

cocci.

Seeds – Obliquely pendulous, testa membranous, embryo exalbuminous;

cotyledons oval radicle short.

35

MORPHOLOGY114

A procumbent herb : Stems and branches pilose. Young parts silky villous.

Leaves – Opposite, abruptly pinnate, one of each pair usually smaller than

the other, sometimes wanting.

Stipules – Lanceolate, hairy.

Leaflets – 3-6 pairs. 6-12 mm in long , oblong mucronate, sericeo villous

with appressed hairs beneath and more or less so on the upper

surface, base rounded oblique

Petioles – Very short, pilose.

Flowers – Axillary or leaf-opposed, solitary

Pedicels – 1.2-2 cm long slender, hairy

Sepals – 6 mm long lanceolate, acute, hairy.

Petals – 1 cm long, oblong, obovate, claw short, hairy.

Ovary – Bristly.

Style – Short, Stout.

Stigmatic lobes longer than the diameter of the style.

Fruit – Globose, consisting of (usually) 5 hairy or nearly glabrous, often

muriculate, woody cocci each with 2 pairs of hard sharp spines one

pair longer than the other.

Seeds – Several in each coccus with transverse partition between them.

HABITAT115- This trailing plant is common in sandy soil throughout India and Ceylon.

Plentiful in the united provinces and in Madras.

36

PHARMACOGNOSTICAL FEATURES OF TRIBULUS TERRESTRIS116

MACROSCOPIC

Fruit - Fruit is globose 0.5 inch in diameter and 1/3 inch in thickness. Fruit consists of

five densely hairy. Woody. Often-muricate coccii. Each coccus bears two large sharp,

pointed rigid spines directed towards the apex and two smaller. Shorter spines directed

downwards. Colour is yellowish brown. Seeds several in each coccus with transverse

partition between them.

MICROSCOPIC

Fruit - The transvers section of the fruit exhibits five coccii, which are free in the upper

part but united below. In the transverse section five pairs of large spines are seen

distinctly. In coccii epicarp consists of one layer of epidermis with unicellular lignified

trichomes.

Mesocarp is parenchymatous and contains vascular bundles. Rosette crystals of

calcium oxalate are in abundance in mesocarp. Endocarp is lignified and contains five

seeds one in each coccus.

PHYTOCHEMISTRY

The fruits contain furastanol is glycoside which is identical with protodioscin and on

acid hydrolysis it yields spirostanol diosgenin. Further fruits contain sapogenins

diosgenin, rus cogenin and gitogenin of the steroid saponins. Fruits contain three flavone

glycosides. Two glycosides are kampferol 3- rhamnosides and third tribuloside is

kampferol 6”, p-coumaroyal 3. D-glucoside. It contains traces of an alkaloid, fixed oil

and potassiumnitrate.

37

IDENTITY PURITY AND STRENGTH117

v Foreign matter – not more than 2 percent

v Total ash – not more than 15 percent

v Acid-insoluble ash – not more than 2 percent

v Alcohol soluble extractive – not less than 6 percent

v Water-soluble extractive – not less than 10 percent.

USES OF PLANT IN OTHER SYSTEMS AND COUNTRIES

ACTION AND USES IN SIDDHA118

Madhura rasam, seetha veeryam, mootralam, vrishyam, deepanam, balakaram,

pushtikaram, in ashmari, prameham, arshas, mootrakrichram, swasakasam, hridrogam.

ACTION AND USES IN UNANI119,120

Murakabul khuva, diuretic, aphrodisiac, increases, semen, removes stones causes

nuzi in madda, in colic due to heat.

The fruit is sour with bad taste, diuretic removes gravel from the urine and stone

in the bladder. Cures strangury, gleet. The leaves are diuretic, tonic, enrich the blood,

and increase the menstrual flow. Cure gonorrhoea and gleet, a decoction is useful as a

gargle for mouth troubles and painful gums reduce inflammation. The root is good

stomachic and appetizer, emmenagogue, diuretic, carminative, cures lumbago.

In South of France and in the southern countries of Europe the roots and the

leaves are considered tonic and aperient.

In China the fruit is reputed tonic and astringent. It is used for coughs,

spermatorrhoea, scabies, anemia.opthalmia; it is powerful haemostatic, much used in post

partum haemorrhage and in dysenteries; It is a Suto Rheumatism remedy in South Africa.

38

RESEARCH PROFILE

1:Furostanol saponins from Tribulus terrestris.

An HPLC-ELSD-ESI-MS method has been developed for the analysis of the

steroidal saponins in the aerial parts of Tribulus terrestris. Protodioscin, a new saponin

(5,6-dihydroprotodioscin, neoprotodioscin) and their respective sulfates were

detected. The structure of the new compound was elucidated on the basis of NMR

and ESI-MS spectral analysis.

2:Preliminary studies on the diuretic effects of Hygrophila spinosa and Tribulus

terrestris.

3:Some aspects of chemical and pharmacological studies of Tribulus terrestris.

Linn.

4:Tribulus terrestris: preliminary study of its diuretic and contractile effects

and comparison with Zea mays.

5: Effect of Tribulus terrestris on oxalate metabolism in rats.

6:New steroidal glycosides from the fruits of Tribulus terrestris.

7: Study of antihypertensive mechanism of Tribulus terrestris in 2K1C hypertensive

rats: role of tissue ACE activity.

8: Aphrodisiac properties of Tribulus Terrestris extract (Protodioscin) in normal

and castrated rats.

9: Tribulosin and beta-sitosterol-D-glucoside, the anthelmintic principles of

Tribulus terrestris.

10: Effect of saponin from Tribulus terrestris on hyperlipidemia

References: WWW.PUBMED.COM. PMID: [PubMed - indexed for MEDLINE]

39

B) DISEASE REVIEW

HISTORICAL ASPECTS OF AMAVATA

There is no convincing reference to this disease in vedic literatures scattered

nominal mention is found in classical period elaborate description in the medieval period

and above all in depth study of the problem based on the revolutionary changes in the

understanding of disease process brought about by the leap in to electronic era of twenty

first century.

The elaborate description of in this disease as a separate entity is not available in

Charaka Samhita. However the term Amavata is included in some of the therapeutic

indications of drug compounds “Kamsa haritaki” of swayathu chikitsa and “visaladi

phanta” of pandu chikitsa. Further in the 28th chapter while illustrating the Avarana

chikitsa, Amavata word is used to connote Avarana of vata by Ama and also as a

symptom.

Even though no reference of Amavata is found in susruta. The classification and

elaborate description about the anatomy of the joints gives way for better understanding

of the joint diseases in general.

Similarly, Vaghbata also gives no details about this disease entity but while

mentioning the indication of “vatsakadi yoga” and “vyoshadi yoga” is vata vyadhi

chikitsa has included Amavata also.

Madhavakar who gave this disease entity a separate status and devoted a full

chapter. There after, Chakradatta added treatment aspects at length and mentioned the

line of treatment and effective drug remedies.

Like wise, Bhava prakasha, yoga Ratnakara, Bhaisajya Ratnavali and Vangasena

also mentioned some drug compounds for the treatment of Amavata.

40

AMAVATA

The nomenclature of the diseases can be done in many ways. Some

nomenclatures are based on the subjective and objective symptoms. Others are based on

involved dushya and its causative factors. The disease Amavata signifies the underlying

pathological condition in its nomenclature. It is formed by union of two words Ama and

vata.

Definition of Amavata

1. The word Amavata comprised with the words Ama and vata, which can be

generally defined as “Amam cha vatam Amavatam”.

In the same way another description generally can be made as “Amena Samhito

vataha Amavatah” that is the vata dosha associated with Ama creating a disease

known as Amavata.

2. Madhavakara defines as highly vitiated Ama and vata mixed together with other

dosha’s enters the trika sandhi leading to the disease Amavata. 121

AMA IN AMAVATA

The production of Ama is a central phenomenon in Amavata. In Ayurveda, very

much importance is given to the concept of Ama, as the disease itself is also known as

Amaya that is caused by Ama. The presence or absence of Ama that is Samavastha or

Niramavastha decides the line of treatment of the disease.

Etymology of Ama :

• Ama means the undigested or unprocessed matter. 122

• Ama means that is detrimental to groups of srotas. 123

41

Definition of Ama :

The term in ordinary parlance means unripe, uncooked immature and undigested

particles. In the context of Ayurveda this term refers to the events that follows and

factors, which arrives as the consequence of impaired functioning of Agni. It is necessary

to analyze different definitions of Ama given in different texts. Some of which are as

follows.

1) Due to the hypo functioning of Ushma the food that is not completely/properly

digested, yields immature Rasa in Amashaya and due to retention it undergo

fermentation and or putrefaction. This state of Rasa is spoken of as Ama. 124

2) The Adya ahara dhatu is known as Ama, which is undigested and formed due to

hypo functioning of Agni, in Amashaya. 125

3) The matter that has not undergone Vipaka, leads to Durgandha (bad smell), which

is large in quantity, which is picchila (sticky) and which leads to Gatra sadana is

called as Ama. 126

4) The food residue that is not digested due to impairment of Agni is known as Ama

and it is considered as the root caused of all the diseases. 127

Even though both Charaka and Susruta have described the diseases associated with

Ama, Vagbhata was the earliest author to define Ama. Three words from the

definition of Ama as given by Vagbhata require further explanations.

1. Ushma 2. Adya dhatu 3. Amashaya

Ushma : There are different opinions about Ushma. According to Arunadutta ushma

is Agni. Hemadri consider it as Rasagni. Only sreedasapanditha explained Ushma as

Jatharagni. Here dalhana’s statement that Ama is also produced due to

hypofunctioning of the Dhatwagni should also be considered. Therefore Ushma

42

indicate either Jatharagni or Dhatwagni in respect of the genesis of Ama, depending

on the pathological process exhibited.

Adya Dhatu : The fuel of Agni in the development or genesis of Ama is stated as

Adya dhatu. Arundatta consider it as Rasa Dhatu and Hemadri consider it as Rasa

which is not capable of executing its functions and also not capable of transforming in

to Rakta. Chandranandana and Sreedasapanditha consider it as Ahara Rasa. The

identity of Adhya Dhatu depends on the Agni. i.e Agni not only feeble but also not

capable of conducting its normal functions. Therefore the Adhya Dhatu may be Ahara

Rasa, Rasa Dhatu or any other Dhatu.

Amashaya : The word Amashaya has two meanings. Hemadri define Amashaya as a

receptacle of undigested or incompletely digested food. It is also the place where

Ama is produced. Amashya is one of the two places of pithadhara Kala. The Samana

vata secretes pachaka pitta from pithadhara kala for the purpose of digestion of food

due to the stimulation.

Etiology of Ama :

Following can be considered as chief causative factors of Ama128, 129, 130

1. Ahara : Abhojana (not taking meals), Atibhojana (taking meals in excess

quantity), Ajirnabhojana (eating prior to digestion of previous meals)

Vishamasana (taking sometimes in excess and sometimes in less quantity of food)

Asatmya bhojana, viruddha bhojana, Dvishta - Asuchi bhojana, Guru, Ruksha,

Sheeta, Sushka, Vishtambhi and Vidahi bhojana.

2. Iatroghenic Causes : Erroneous administration of Virechana, Vamana sneha

Karma.

3. Vihara : Vegavidharana, Prajagarana, Dukkha Sayya.

43

4. Manasika : Food consumption while afflicated with mental instability due to

Kama, Krodha, Lobha, Moha, Irshya, Shoka, Manodvega, Bhaya etc.

5. Miscellaneous: Adverse Desha, Kala, Rutu (Vaishmya) and Vyadhikarsana

(emaciation due to disease).

Ama visha : 131

The Ama dosha formed by unwholesome food habits like Viruddhasana, Adhyasana,

Ajimasana etc. are known as Ama visha. It is very difficult to treat due to its Asukriya

and opposite natures of treatment of Ama and visha.

Physical properties of Ama132

In physical properties Ama closely aligned to kapha dosha. Drava, Guru, Snigdha,

Picchila, Thantumat, Anekavarna, Durgandha, Avipakwa, and Asamyukta are the

physical properties of Ama. These may be applied to the Ama developed both in gastro

intestinal tract and Dhatus. According to Charaka, Ama has visha sadrusa linga, but there

is no similarity in Guna. Still Ama act like poison. It may also be noticed that the

physiochemical properties of ama resemble those of prithvi and Ap bhutas. Ama has a

tendency for accumulation and blockage of micro channels that is srotorodha.

Symptoms produced due to Ama133

• Srotorodha (Obstruction in Channels)

• Balabramsa (Lowering of immunity or debility)

• Gaurava (feeling of heaviness)

• Anila mudhata (Hindrance to normal path of Vata)

• Alasya (Unwillingness to perform of duties in spite of capability)

• Apakti (indigestion)

• Nisthivana (Accumulation of excessive saliva in mouth)

44

• Mala sangha (constipation)

• Aruchi (Anorexia)

• Klama (Anayasa shrama)

Most of the symptoms are produced either by the hypo functioning of Agni or due to

the obstruction of the srotas by Ama. When Ama is in contact with Dosha and Dushya

they are called as Sama dosha and Sama dushya respectively.

VATA IN AMAVATA

Vata plays an important role in the Samprapti of Amavata so its brief description is

necessary.

Etiology : The tem vata is derived from root “Va” and pratyaya (suffix) “Tan” “Va”

signifies Gati and Gandhana Karma of Vayu.

Guna : Ruksha, Sheeta, Laghu, Sukshma, Chala, Vishada, Dharuna and khara are the

Gunas of Vata. 134, 135

Functions of normal Vata (Karma).

Acharya Charaka has given elaborated explaination about functions of Vata,which

states that vata is responsible for each and every function and movement for all the body

parts. That is “vayu stantra yantra dharaha” (Cha. Su. 12)

Importance of Vata:

Pitta, Kapha, Dhatu and Mala’s are functionless, unless they are brought to the place

by Vata and carry out their functions. Thus Vata governs functions of the all the tissues

of the body. 136

A person whose Vata Dosha is not impended, which is at its own place, not vitiated

nor reduced, that person lives for hundred years without aliment.

45

Vata on account of its quality of subtleness is really the impeller of the other two

humors. When Vata is provoked, it agitates the other two humors and causes occlusion of

the body channels thereby producing disorders. it also leads to the diminution of the body

nutrient fluid and other body elements

The vata plays a predominant part in samprapti of Amavata. By virtue of vitiated

Vata deleterious effects of virulent Ama get manifested in the body.

Nidana for Amavata : 137

Madhavakara has mentioned the specific etiological factors for Amavata.

1. Viruddha Ahara (incompatible food)

2. Viruddha cheshta (Incompatible work)

3. Mandagni (Hypo functioning of agni)

4. Nischala (Lack of exercise)

5. Snigdha Ahara followed by immediate exercise

1. Virudha Ahara (Incompatible food)

Acharya charaka clearly mentions that wholesome diet is an essential factor for

the formations of body and any unwholesome diet is responsible for disease. Wholesome

diet is required to meet the needs of body’s basal metabolism in the form of energy.

Viruddha Ahara (Incompatible food) produces dosha utklesa instead of meeting the basic

needs. Utklishta dosha is abnormal functional states. It they are not eliminated from body

the functions of Agni and Dhatus will be affected.

Afflication of Agni may seriously affects their normal functions. When the

processes of digestion and metabolism are affected, improperly metabolized intermediate

bye products (Ama) are produced in body. The Ama in turn may cause

Dhatwagnimandya.

46

Viruddha is Dhatu pratyanika that is Dhatu virodhaka (Antagonistic to Dhatus ).

Leads to dhatukshaya due to inadequate nourishment of dhatu.

2. Viruddha Chesta : (Incompatible work)

Viruddha chesta is not clerly mentioned in texts, still considering the main theme

of Dosha utklesa due to viruddha, following may be considered as Viruddha chesta.

1. Sheetoshna vyathyasa (Altemate use of heat and cold)

2. Vegavidharana (Suppression of natural urges)

3. Diva swapna (Sleeping day time)

4. Ratri jagarana (Waking at night)

5. Sahasa etc (Over indulgence in heavy works)

3. Mandagni (Hypo functioning of Agni)

Mandagni is the root cause of all diseases. Mandagni i.e diminished digestion and

metabolism always affect pachana or digestion and metabolism. Which are the continous

processes in the body. Ama is the immediate resultant of Mandagni.

4. Nischala (Lack of exercise)

Lack of exercise leads to Kapha dosha vrudhi, leading to Agnimandya.

5. Snigdha Ahara followed by immediate exercise:

Tridosha are not constant but kept on fluctuating according to age, day, night and

after ingestion of food. Chakrapani interprets that the three basic elements increase

during Avastha paka and are producded during Nishta paka.

Due to snigdha Ahara, Kapha Udeerana takes palce in large quantity during Prathama

Avastha paka. Exercise is held responsible for throwing the Dosha from Koshta to

Shakha. Immediate exercise after taking food leads to improper digestion and thus

Apakwa Ahara Rasa is formed.

47

Samprapti of Amavata. 138

In a state of pre-existing Mandagni if a person in exposed to etiological factors

then Ama is formed in Amashya along with vitiation of Vata Dosha. This morbid Ama

circulates in the body propelled by vitiated Vata with the predilection for sleshma sthana.

Here, by the action of Vata dosha,Ama becomes more virulent and reaches Dhamani.In

the Dhamani’s it blends with Vata, Pitta, Kapha and consequently attains various colours,

becomes heavy and viscous. These qualities facilitates srotoabhishyanda and

srotoavarodha. These change in the srotas, endures sthanasamshraya, leading to the the

manifestation of symptoms like Hritgourava, Hritdourbalya and Sandhishotha, Shula etc.

If kapha and pitta are also involved with above symptoms, specific symptoms of these

Dosha will also manifest.

The disease takes its root in Annavaha srotas with the production of Ama the

strength of all the Agni in the body is declined with result of production of Ama.

Rasavaha srotas are the nearest and opened. Hence, these are mainly afflicted. Though

Ama circulates in the whole body, the chief presentation of the disease is in the Kapha

sthanas, due to similarity of Guna of Ama and Kapha. Trika is the main sthana of the

controller Avalambaka Kapha. Also due to specific Nidana sevana and picchilatwa of

Sleshmaka kapha in Sandhis it is the main site of Pathogenesis. Other parts of locomotor

system like muscles, tendons, ligaments are also affected and Gatra graha or Gatra

sthabdhata appears.

48

SAMPRAPTI

Viruddha Ahara + Viruddha Vihara

Agnidushti in amashaya

Formation of Amarasa

Sanchara through Dhamani all over the body by vatadosha

Samadosha Accumalates in the sleshmasthana like

Amashaya, sandhi (Trika), Ura, Shira, Kanta gets contact with other dosha’s

Enters into kostha, Trika sandhi Leads or causes

Stabdhata of sandhi

Sandhi ruja

Sandhi shotha

Apaka, Gourava, Alasya, Angamarda, Trishna, Aruchi, Jwara

AMAVATA

Efficacy of Shunti & Gokshura in Amavata

49

Table 3.1: SAMPRAPTI GHATAKA :

1 Dosha Tridoshaja, mainly Vata (Vyana, Samana, Apana) and Kapha

(Kledaka, Bodhaka, Shleshmaka)

2 Dhatu Rasa, Mamsa, Asthi, Majja

3 Upadhatu Snayu, Kandara

4 Srotas Annavaha, Rasavaha, Asthivaha, Majjavaha

5 Srotodusti Sanga, Vimargagamana

6 Udhbhavasthana Amashaya-Production of Ama

Pakvasaya - Mula sthana of Vata

7 Adhisthana Whole body

8 Vyaktasthana Sandhi (whole body)

9 Avayava Sandhi

10 Vyadhisvabhava Mainly chirakari

11 Sanchara sthana Hridaya, Dhamani, Rasayani

12 Roga marga Madhyama roga marga

13 Agni Jatharagni mandya, Dhatwagni mandya

Efficacy of Shunti & Gokshura in Amavata

50

RUPA OF AMAVATA :

Madhavakara has described the Rupa of Amavata as Samanya and pravrudha

lakshana.

Samanya Rupa : 139

1. Angamarda (Aching all over the body)

2. Aruchi (Loss of taste)

3. Trishna (Thirst)

4. Alasya (lack of enthusiasm)

5. Gourava (Heaviness)

6. Jwara (Fever)

7. Apaka (Indigestion)

8. Angasunata (Swelling of body parts)

Efficacy of Shunti & Gokshura in Amavata

51

PRAVRIDHA RUPA : 140

1. Sandhi Ruja and Sandhi shotha of Hasta-Pada-Sira-Gulpha-Trika-Janu and Uru

(Pain and Inflammatory swelling in the joints)

2. Vruschika damsavata peeda (Pain like scorpion sting)

3. Agni Daurbalya (Weakness of Agni)

4. Praseka (Salivation)

5. Aruchi (Loss of taste)

6. Gourava (Heaviness)

7. Utsahahani

8. Vairasya (anorexia)

9. Daha (Burning sensation)

10. Bahu mutrata (Profuse urination)

11. Kukshi kathinyata

12. kukshi shoola (Pain in Abdomen)

13. Nidra Viparyaya (Loss of sleep)

14. Thrit (Thirst)

15. Chardi (Vomiting)

16. Bhrama (Giddiness)

17. Murcha (Fainting)

18. Hrit graha (Pain in the Heart)

19. Vit Vibandha (Constipation)

20. Jadhyata

21. Antra Kujana (Intestinal gurgling)

22. Anaha (Distention)

Efficacy of Shunti & Gokshura in Amavata

52

Table 3.2: Comparison of Lakshanas with different Ayurvedic treatises:

Sl No. Lakshana M.N. 141 B.P. 142 Y.R. 143

1. Agni dourbalya + + +2. Alasya + + +3. Anaha + + +4. Angamarda + + +5. Angasoonata + + +6. Antra kujana + + +7. Apaka + + +8. Aruchi + + +9. Bahu mutrata + + +10. Bhrama + + +11. Chardi + + +12. Daha + + +13. Gourava + + +14. Hrit graha + + +15. Jadhyata + + +16. Jwara + + +17. Kukshi Kathinyata + + +18. Murcha + + +19. Nidra viparyaya + + +20. Prasekam + + +21. Sandhi Gourava + - -22. Sandhi Ruja + + +23. Sandhi shotha + + +24. Trishna + + +25. Utsaha Hani + + +26. Vairasyam + + +27. Vit vibandha + + +28. Vruschika damsavat peeda + - -

Efficacy of Shunti & Gokshura in Amavata

53

Table 3.3: Involvement of Srotas according to the symptoms

Sl

No.

Srotas Symptoms

1 Annavaha Aruchi, Apaka, Agni Daurbalya, Chardi, Vishuchi, Praseka

2 Udakavaha Trishna

3 Rasavaha Angamarda, Aruchi, Gaurava, Jwara, Agni daurbalya, praseka,

Utsahahani, Vairasya, Hritgraha, Angasunata

4 Medovaha Alasya, Trishna,

5 Majjavaha Sandhi Shoola, Sandhi shotha, Bhrama, Murcha, Jadya,

6 Purishavaha Kukshi Kathinyata, Vit vibandha, Antra Kujana, Anaha

7 Mutravaha Bahumutrata

8 Manovaha Utsahahani, Nidra viparyaya

CLASSIFICATION OF AMAVATA144

According to Dosha ;

Seven types of Amavata mentioned in Madhava Nidana.

1. Vata pradhana : This variety is associated with predominance of shoola; which

is innovating feature of vitiated vata. In Amavata, Shoola is present due to Chala

and Sheeta Guna of Vata.

2. Pitta pradhana : Daha and Raga of the joint are manifested in this type of

Amavata. Due to Ushna and Tikshna Guna of vitiated pitta, Daha occurs in the

joint. The increased circulation may be responsible for appearance of Raga.

3. Kapha Pradhana : Staimitya, Gourava and Kandu are the manifestation of this

variety. Staimitya is the feeling of a wet cloth around the joint. It occurs due to

increased Picchila, Sthira and sheeta Guna of vitiated kapha. Kandu is pathogenic

Efficacy of Shunti & Gokshura in Amavata

54

feature of vitiated Kapha.Due to similarity of guna of vitiated Kapha and Ama

and sroto Abhishyanda, itching sensation is felt at the joint.

4. Vata Pitta pradhana : Associated symptoms of Vata and Pitta arte produced.

5. Vata Kapha Pradhana : symptoms of both Vata and Kapha are produced.

6. Pitta kapha pradhana : This variety is found with mixed symptoms of pitta and

kapha.

7. Sannipatika : Symptoms of all the three Doshas are found in this variety.

On the basis of the severity of the disease Amavata can be classified Samanya

Amavata and pravridha Amavata stage. In samanya stage symptoms are more or less

general and less severe and in Pravridha stage symptoms are prominent and associated

with Upadravas.

UPADRAVA OF AMAVATA145

Madhava Nidana mentioned Upadrava as Jadya, Antra Kujana, Anaha, Trit,

Chardi, Bahumutrata, Shoola Samkocha, and Khanjata etc.

SADHYASADHYATA146

ü If it is affected by a single dosha (Eka doshaja) Sadhya.

ü If it is affected by with two dosha’s (Dwi doshaja) Yapya.

ü It is difficult to manage (Asadhya) the disease where in all three dosha’s

(Sannipatika) and all the parts of the body is affected with the swelling.

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SAMANYA CHIKITSA : 147

Chakradatta was the first to describe the principles and management of Amavata

following these guidelines the later authors advocated further effective remedies.

Ama and Vata, the chief pathogenic factors of Amavata are contradictory in

nature. Only sheeta guna is common in both. The line of treatment and principles

proposed appear firstly to digest the virulent Ama and promote the function of Agni and

then Vata Samaka and Balya Chikitsa are prescribed.

(1) Langhana :

The drug of procedure that generates a sense of lightness (Laghavakara ) in the

body is known as Langhana. 148 Charaka has mentioned ten types of Langhana viz, four

types of Suddhi, Pipasa,Atapa, Pachana, Upavasa and Vyayama. Where as Vagbhata has

recasted langhana in to broad headings of Shodhana and Shamana which are further

divided in to five and seven types respectively. In the treatment of Amavata, Upavasa

from Langhana is preferred in the initial stage that is a kind of Samana chikitsa.

(2) Swedana :

The procedure which alleviates Stambha, Gaurava, Shoola and Sheeta and which

is Sweda kara is Swedana. 149 It is having Ushna, Tikshna, Sara, Snigdha, Ruksha,

Sukshma, Drava, Sthira and guru properties. The swedana brings about pachana, clears

and dilates the channels. Ruksha sweda that is given by means of sand is considered best

for Amavatav, taking of hot water (Ushna jala pana) is also a kind of internal Swedana,

Pachana, Jwaraghna, Srotoshodhana, Balya, Ruchi kara and swedana.

Efficacy of Shunti & Gokshura in Amavata

56

(3) Tikta Katu Rasa :

Tikta and Katu Rasa have the dominance of Vayu Akasha Mahabhuta and Vayu

Tejas respectively. They bring about dipana, Pachana, Rochana and Laghuta in the body.

Katu Rasa is Baddha, Chedaka and Margavivaraka and Kapha samaka. Tikta Rasa is

Vishaghna and Lekhana. Both are kleda and meda Nasaka e.g. Chitraka, Guduchi, Shunti

etc. these drugs are Agnivardhaka and Antagonist to Ama and Kapha.

(4) Virechana:

After langhana and Pachanadi chikitsa, when Dosha are processed and loosened

(Nirama) Virechana should be administerd to eliminate them out of the body. Because the

Dosha may again vitiate after langhana and pachana treatment but once Shodhana

eliminates them, the disease does not recur, as there remains no root cause to induce the

disease. Virechana is indicated in Amavata because of following reasons.

Ø Production of Ama is result of involvement of Pitta Sthana and Kledaka Kapha

both. Kledaka Kapha after leaving its normal site settles at Pitta Sthana, thus

hampering the digestive activity of Pachaka Pitta. Virechana helps in this

condition by two ways.

Ø It removes the Kledaka kapha from the Pitta sthana.

Ø It is the most suited therapy for the sthanika dosha pitta.

Ø Symptoms of Amavata like Anaha, Vibandha, Antra kujana and Katishoola are

indicative of Pratiloma Gati of Vayu, which is made Anulomana by Virechana.

(5) Snehapana :

The process that brings snehana, Vishyandana Mruduta and kleda in the body is

called snehana. 150 Sneha should be used according to the condition (Sama or nirama

Efficacy of Shunti & Gokshura in Amavata

57

vastha) and Bala of the patient. It is specially indicated in the chronic conditions due to

following reasons.

Ø To prevent the provocation of Vata produced by Ama hara Chikitsa.

Ø As a best Balya regimen for the patient who has got reduction of Bala.

Ø Sneha is Agni Dipana.

Ø Sneha is Vata hara and Vatanulomana.

Ø In Asthimajjagata Vata, Snehapana is also indicated so, it may be beneficial in

Nirama stage of Amavata.

(6) Basti :

Basti is the best treatment of vitiated Vata. As the disease attains chronicity

Rukshata increases in the body leading to vitiation of Vata. Niruha Basti in addition acts

as a sothana measure. It is also locally effective for the symptoms like Anaha, Vibandha

etc. Anuvasana Basti is Vata hara and Rukshata hara. Due to intermittent remissions the

disease Amavata is neglected most of the time by patients. Thus, it attains chronicity and

becomes deep rooted (Gambhira). Basti due to its Veerya acts the whole body to alleviate

the disease. Chakrapani has recommended saindhavadi Taila for Anuvasana and Kshara

Basti as Niruha Basti. It acts on the subtle leaves to remove Dosha from the body clearing

the channels and normalizing the body function.

PATHYAPATHYA151, 152

Pathya :

§ Annavarga - Yava, Kulattha, Raktasali, Syamaka, Kodru

§ Saka - Vastuka, Sigru, Karvavellaka, Patola

§ Dugdha Vikara - Ardraka/Lasuna siddha takra

§ Mamsa - Jangala Mamsa

§ Paniya - Tapta Nira

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Bhallataka, Gokshura, Vruddha Daru, Ardraka, Gomutra and Katu, Tikta and

Dipana Dravya are beneficial for Amavata.

Apathya : 153

Dadhi, Mastu, Guda, Kshira, Masha, Viruddha bhojana, Asatmya bhojana,

Vishamasane, Anupa Mamsa, Abhisyandi, Guru, Picchila Dravya.

Vihara - Vegavarodha, Jagarana.

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RHEUMATIOID ARTHRITIS

The understanding of Ayurveda cannot be superimposed with the understanding

of modern medicine. But there is a trend to co-relate Ayurveda with modern medicine.

Moreover in recent years people are deviated towards the evidence based Medicine for

the rational use of our indigenous medical knowledge’s.

Amavata can be co-related with Rheumatoid diseases according to western

medicine. This term Rhuma refers to ‘ A substance that flows’ and probably was derived

from kapha (phlegm) and ancient primary humours. The American committee for the

control of Rheumatism is established in USA for the guidance of these diseases. There

are ten major rheumatic diseases can be included in the group of Rheumatoid disease.

Most important diseases is systemic connective tissue disease among them. This disease

hamper the purposeful motion of a individuals which is depending on the effective

interaction between joint and neuromuscular units attached with it. The important

components take part in musculoskeletal systems are muscles, tendons, ligaments,

cartilages and bones.

Definition of Rheumatoid Arthritis 154

Rheumatoid arthritis is a chronic, systemic, inflammatory disorder of unknown etiology

that is characterised by its pattern of diarthoiridial joint involvement. Its primary site of

pathology is the synovium of the joints. The synovial tissues become inflamed and

prolifeate, forming pannus, which invades bone, cartilage and ligament and leads to

damage and deformities.

Epidemiology- The prevalence of Rheumatoid Arthritis is approximately 0.8 percent of

the population (range 0.3 to 2.1 %); women are affected approximately three times more

often than men) the prevalence increases with age and sex differences diminish in the

older age group. Rheumatoid Arthritis is seen throughout the world and affects all races.

However, the incidence and severity seem to be less in rural sub-saharan Africa and in

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60

Caribbean blacks. The onset is most frequent during the fourth and fifth decades of life

80 percent of all patients developing the disease between the ages of 35 and 50. The

incidence of Rheumatoid Arthritis is more than six times as great in 60 to 64 year old

women compared to 18 to 29 year old women. 155

Etiology-The cause of Rheumatoid Arthritis remains unknown. It has been suggested

that Rheumatoid Arthritis might be a manifestation of the response to an infectious agent

in a genetically susceptible host. 156

Pathology - The earliest change is swelling and congestion of the synoviol membrane

and the underlying connective tissues, which become infiltrated with lymphocytes

(especially CD4 T cells), Plasma cells and macrophages. Effusion of synovial fluid into

the joint space takes place during active phases of the disease. Hypertrophy of the

synovial membrane occurs, with the formation of lymphoid follicles resembling an

immunologically active lymph node. Inflammatory granulation tissue (pannus) spreads

over and under the articular cartilage, which is progressively eroded and destroyed Latter,

fibrous or bony ankylosis may occur. Muscles adjacent to inflamed joints atrophy and

there may be focal infiltration with lymphocytes. 157

Pathogenesis – Immunologic reactions play a major role in the pathogenesis of

rheumatoidc arthritis. The inflammatory reaction in the joints is similar to that in delayed

hypersensitivity reactions. It seems likely that the lymphokines and monokines formed by

the lymphocytes and macrophages in the inflamed joints initiate the inflammation and are

a major cause of the fibrosis and damage to cartilage. Interleukin 1 is believed to be of

particular importance. Chemotactic factors attract the neutrophils in to the synovial fluid.

The phagocytosis of immune complexes by the neutrophils in the joint fluid and the

synovial cells releases lysosomal enzymes and further damages the articular cartilages

and synovium. Activation of compliment adds to the injury. Collagenases formed in the

pannus erode the underlying cartilage. Prostaglandins help cause inflammation and

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61

osteoporosis. Circulating immune complexes formed with the rheumatoid factors are

responsible for the vasculitis and rheumatoid nodules. 158, 159

PATHOGENESIS OF RHEUMATOID ARTHRITIS

Localization of antigens in joints

Antigen by microphages

Activation of helper T cells

Release of intraleukin –2

Cytokenes like IL-4, IL-6, IFN are released by Cd4 cells

Cytokenes increases the expression molecules like ICMA-1, LFA-1, MAC-1 It helps inlocalization of inflammatory cells

Cytokines stimulates, activates and proliferation of

B cells produces antibody producing plasma cells.

These cells produce antibodies against Fc fragment of lgG (RA)

RA factor forms immuno complex with lgG

Production of CA3, C5a C3b and C5, 6,7,8,9

Ca3 and C5a as anapphylotoxins Release of histamines C5,6,7,8,9 is capable of damagecells by drilling pores n their membrane.

Inflitration of neutrophills

Release of oxygen free radicals, inflammatory metabolites, archidomic acid pathwaylikeprostaglndins leutrines metalo-proteins like collagenase.

Damage of articular cartilage demineralization of underlying bond erosion of the jointmargins laxicity of the joint capsule leading to deformity.

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CLINICAL FEATURES160

In the majority of patients the onset is insidious, with joint pain, stiffness and

symmetrical swelling of a number of peripheral joints. Initially pain may be experienced

only on movement of joints, but rest pain and prolonged early morning stiffness are

characteristic features.

In the typical case the small joints of fingers and toes are the first to be affected,

swelling of the proximal, but not the distal, interpharangeal joints gives the fingers a

spindled appearance, and swelling of the metatarsopharangeal joints results in broadening

of the forefoot. Fever, weight loss profound fatigue, anorexia and malaise without joint

symptoms occur less often.

As the disease advances there is a tendency for it to spread to involve wrists,

elbows, shoulders, knees, ankles, subtarsal and midtarsal joints. The advancement of

pathogenesis leads to muscle atrophy, tendon sheath and joint destruction results in

limitation of joint motion, joint instability with anterior subluxation of Metatarso

phalangeal joints in common with ulnar deviation of the fingers in addition to this

lymphadenopathy, osteoporosis muscle weakness and wasting, tenosynovitis, bursitis,

popliteal cysts, sometimes subcutaneous nodules are formed. Apart from this

scleromalacia, keratoconjantivitis, scleritis is found to occur a symptomatic pericordities,

pleural effusion may occur infrequently.

COMPLICATIONS161

Septic arthritis may complicate Rheumatoid Arthritis staphylococcus aureus is

commonly implicated secondary to invasion from an ulcerated nodule. Amyloidosis is a

complication of prolonged active disease.

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CRITERIA FOR THE DIAGNOSIS OF RHEUMATOID ARTHRITIS162

1988 REVISED ACR CRITERIA

Ø Morning stiffness

Ø Arthritis of 3 or more of 14 possible joint areas

Ø Arthritis of hand joints

Ø Symmetrical arthritis

Ø Rheumatoid nodules

Ø Serum rheumatoid factor

Ø Radiographic changes

For the diagnosis of RA four of the seven criteria are required

MANAGEMENT163

The etiology of Rheumatoid arthritis is unknown, and so treatment is empirically

directed towards

• Relief of symptoms

• Suppression of active and progressive disease

• Conservation and restoration of function in affected joints.

These are achieved by combining:

v Treatment of the patient – drugs, rest, physiotherapy surgery

v Modification of the Environment- aids, appliances, housing, occupation,

statutory social benefits

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64

General treatment in the active phase164

Physical rest, anti-inflammatory drug therapy and maintenance exercises are the

corner stones of treatment for exacerbations of Rheumatoid arthritis. The rest form

physical and emotional stress provided by 1-2 week’s in hospital is usually sufficient to

induce marked remission. Symptoms without recourse to strict bed rest. In few patients a

period of complete bed rest may be required to induce a remission. Rest splints can be

used to support a particular painful joint to correct flexion deformities.

Surgical Treatment165

Surgical decompression and synovectomy are needed when corticosteroids and

physical measures have failed to relieve movements of limbs.

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METHODOLOGY

MATERIALS

Source of Data

Literary Source-

Literary aspect of study is collected from classical Ayurvedic texts, Modern texts,

and from Internet.

Drug –

Shunti Kanda [Rhizome]- Zingiber officinalae. Rosc

Gokshura phala [Fruit] – Tribulus terrestris. Linn are taken for the clinical trail.

Collection of Raw Materials –

Good quality Shunti was purchased from the local market of Gadag.

Botanically identified Gokshura was collected in surrounding area of Gadag.

Method of Preparation-

The method of preparation of Kwatha given in Sharangadhara Samhita was

adopted.

Shunti Kwatha-

1. 20 gms of Shunti coarse powder taken in clean stainless steel vessel.

2. Add 160 ml of water to the container containing coarse powder.

3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼

of its quantity

4. Then it was filtered

5. Luke warm quatha was given for consumption

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66

Gokshura Kwatha-

1. 20 gms of Gokshura coarse powder taken in clean stainless steel vessel.

2. Add 160 ml of water to the container containing coarse powder.

3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼

of its quantity

4. Then it was filtered

5. Luke warm quatha was given for consumption

Shunti Gokshura Kwatha-

1. 20 gms [Shunti + Gokshura] of coarse powder taken in clean stainless steel

vessel.

2. Add 160 ml of water to the container containing coarse powder.

3. Place the container on the stove and allow it to boil on mild fire till it reduces to ¼

of its quantity.

4. Then it was filtered.

5. Luke warm quatha was given for consumption

Place of preparation of Medicine-

The preparation of Medicine was done in Post Graduation Research Studies

Department of Dravyaguna. D.G.M.Ayurvedic Medical College. Gadag.

Form of the Medicine

The Medicine was administered in the form of Kwatha.

Efficacy of Shunti & Gokshura in Amavata

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Result of Analysis of physical constants of the drug samples

1) Zingiber officinale rhizome

a. Foreign matter 0.42%

b. Total Ash 8.34%

c. Acid insoluble Ash 1.01%

d. Alcohol soluble extractive 7.02%

e. Water soluble extractive 44.0%

2) Zingiber officinale powder (rhizome)

a. Foreign matter 0.32%

b. Total Ash 8.01%

c. Acid insoluble 0.99%

d. Water soluble extractive 5.2%

e. Alcohol soluble extractive 8.88%

3) Zingiber officinale decoction

a. Description Yellowish brown thick liquid

b. Specific gravity 1.0965

c. Total solids 19.08%w/w

d. Total ash 2.01%

e. Acid insoluble ash Zingiber 0.08%

f. Ph 5.6

4) Tribulus terristris fruits

a. Foreign matter 0.75%

b. Total Ash 10.8%

c. Acid insoluble ash 0.82%

d. Alcohol soluble extractive 7.12%

e. Water soluble extractive 9.68%

Efficacy of Shunti & Gokshura in Amavata

68

5) Tribulus terristris fruit powder

a. Foreign matter 0.5%

b. Total Ash 10.88%

c. Acid insoluble ash 0.78%

d. Water soluble extractive 15.78%

e. Alcohol soluble extractive 14.08%

6) Tribulus terristris decoction

a. Description Green coloured thick liquid

b. Specific gravity 1.052

c. Total solids 15.835%

d. Ph 6.2

e. Total Ash 2.2%

f. Acid insoluble ash 0.3%

Efficacy of Shunti & Gokshura in Amavata

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METHODS

Selection of Sample-

Patients suffering from Amavata were selected from OPD, Department of

Dravyaguna. Post Graduation studies and Research centre, D.G.Melmalgi Ayurvedic

Medical College and Hospital by present inclusion and exclusion criteria.

Criteria for selection of Patient-

v Patients diagnosed as Amavata as per the classics.

v Irrespective of sex [Both male & female patients were considered]

v Patients in between the age group of 15-65 years.

Exclusion Criteria-

Ø Patients below 15 and above 65 years of the age group

Ø Patients with complications and deformity.

Ø Patients with loss of joint function and granthi

Ø Pregnant women and lactating mother

Ø The patients having Rheumatic heart disease, Rheumatic fever

Ø Any other Systemic disorder other than Amavata.

Inclusion Criteria-

• All other conditions other than that of exclusion criteria are included.

• Any doshanubandha

• Without any discrimination of Chronicity.

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70

Lab Investigations

The laboratory investigations were done to diagnose the disease, to exclude the

patient and to know the prognosis of the patient.

Blood- Haemoglobin (Hb %) percentage

Total count of W.B.C. [T.C]

Differential leukocyte count [DLC]

Erythrocyte sedimentation Rate [E.S.R]

Serological- R.A. test

C-Reactive protein [CRP]

Radiology- X-ray

Exclusion – Random Blood sugar

Urine Examination.

Criteria of Diagnosis

• Symptoms mentioned in Ayurvedic texts

• ACR criteria [1988 revised ACR criteria]

• X-ray( If necessary)

• RA test and C-Reactive protein is not considered as diagnostic criteria both sero-

positive and sero-negative cases were included in this study.

Study design

Prospective comparative clinical study

Sample size

A minimum of 30 patients equally distributed in 3 groups.

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71

Groups

§ Group A – Shunti kwatha

§ Group B – Gokshura kwatha

§ Group C – Shunti Gokshura [Shuntyadi] Kwatha.

Posology

1. Shunti – 40 ml of kwatha early morning

2. Gokshura – 40 ml of kwatha early morning

3. Shunti Gokshura – 40 ml of kwatha early morning

Study duration

Duration of the study was 30 days.

The patients were instructed to report every 10 days.

1st Assessment – Before treatment

2nd Assessment – 10th day after treatment

3rd Assessment – 20th day after treatment

4th Assessment – 30th day after treatment [After treatment]

These assessment ware made for the progressive signs after the medication. But

the 1st & 4th [last] assessment were taken for the assessment of results.

Assessments of Results-

Results of the treatment were assessed on difference between the Before and After

treatment. Data of the subjective and objective parameters by using paired ‘t’ test. The

Anova considered here for the readings of after treatment by using completely

randomised design.

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72

Subjective parameters

As designated in classical texts

1. Sandhi shoola [pain]

2. Sandhi shotha [swelling]

3. Jwara [Fever]

4. Stabdata [Morning stiffness]

Objective Parameters

Haemoglobin Percentage [Hb %]

Total count of W.B.C (TC)

Differential leukocyte count [DLC]

Erythrocyte Sedimentation Rate [E S R]

R.A. test

Grades of Subjective Parameters

1. Sandhi Shoola (Pain) -O- No pain

1 – Pain but not difficulty in moving

2- Slightly difficulty in moving

3 – Much difficulty in moving

2. Sandhi Shotha (Swelling)-O – No swelling

1- Slightly obvious

2- Covers well the bony prominence

3 – Much elevated so that joints seems grossly

deformed

3. Jwara [Fever] O- 98.60F

1- 98.70F –99.70F

2- -99.80F –100.80F

3-100.90F and above

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73

4. Stabdata [Morning Stiffness]-O-No stiffness

1-Stiffness within 1 hr

2- Stiffness 1-2 hrs

3- Stiffness for 2 + + hrs

5. Over all Assessment of Results.

As the objective parameters are not suggesting any crucial role in the assessment of

results in this study, so here assessment of results is made only with subjective

parameters

The over all assessment of Results in the present study were grouped into the

following categories

1. Complete remission – Complete subsidence of all the subjective symptoms

irrespective of any degree before the initiation of treatment.

2. Major Improvement – Complete subsidence of 2 or 3 subjective symptoms

irrespective of any degree before initiation of treatment.

3. Minor Improvement – Reduction of 2 or less than 2 degrees of subjective

symptoms or subsidence of only one symptom.

4. Not Responded – No reduction of degrees of subjective symptoms.

Efficacy of Shunti & Gokshura in Amavata

74

OBSERVATION AND RESULTS

The present comparative clinical study was ment for evaluation of efficacy of

shunti and Gokshura in Amavata [Rheumatoid Arthritis]. Total 30 patients were taken

randomly for the above mentioned study. All the patients were taken for the above

mentioned study assessed before and after treatment. Both subjective and objective

changes were recorded according to the proforma of case sheet

The data was collected as follows

Section “A” - Demographic data.

Section “B” - Data related to disease Amavata

Section “C” - Data related to response to the treatment

Efficacy of Shunti & Gokshura in Amavata

75

SECTION “A” DEMOGRAPHIC DATA

1) Age incidence

Present study of Evaluation of efficacy of Shunti and Gokshura in Amavata

[Rheumatoid Arthritis] – A comparative clinical study has the following age incidences.

It suggests that much of the patients fall under the age group in between 36-45.

i.e., 11 (36.67%), 8 (26.67%) patients fall under the age group in between 26-35.

7 (23.33%) patients fall under the age group in between 46-55. Very few patients i.e., 4

(13.33%) fall under the age group in between 56-65.

Table 4.1: Age distribution of 30 Patients

Sl No Age group No of Patients Percentage

1. 15-25 00 00.00%

2. 26-35 08 26.67%

3. 36-45 11 36.67%

4. 46-55 07 23.33%

5. 56-65 04 13.33%

6. Total 30 100%

0

8

11

7

4

0

2

4

6

8

10

12

15-25 26-35 36-45 46-55 56-65

No of Patients

Graph number 1

Age distribution of 30 patients

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76

2) Sex incidence

Evaluation of efficacy of Shunti and Gokshura in Amavata [Rheumatoid Arthritis]

A comparative clinical study has the following data in sex incidence.

From the available data we can draw a conclusion that the incidence of Amavata

is more in female’s i.e., 18 (60%). Where as males are of only 12 (40%). The ratio

reveals in the study is as 2:3 for male and female respectively.

Table 4.2 Sex distribution of 30 patientsSl No Sex No of Patients Percentage

1. Male 12 40%

2. Female 18 60%

3. Total 30 100%

Male40%

Female60%

MaleFemale

Graph number 2

Sex Distribution of 30 patients

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77

3) Incidence of Religion:-

An attempt was made to understand the religious influence in this disease; Hindu,

Muslim and Christians were included in this study. There was no any descrimination of

religion in this study.

In this study maximum patients 28 (93.33%) were Hindu’s and only 2 (6.67%)

patients were muslim. There were no any patients other than these communities were

reported.

Table 4.3: Distribution of religion of 30 patients

Sl No Category No of Patients Percentage

1. Hindu 28 93.33%2. Muslim 02 06.67%3. Christian 00 00.00%4. Others 00 00.00%5. Total 30 100%

0

5

10

15

20

25

30

No of Patients 28 2 0 0

Hindu Muslim Christian Others

Graph number 3Distribution of religion of 30 patients

Efficacy of Shunti & Gokshura in Amavata

78

4) Occupation incidence

Study suggests that the patients out of Housewives occupational group were more

prone to get the Amavata. Out of 30 cases studied 16 (53.33%) patients were in

Housewives category. 9 (30%) were Labor group of occupational category. 3 (10%)

patients were in active group of occupational category and only 2 (6.67%) patients were

in sedentary group of occupational category.

Table 4.4: Distribution of Patients According to the occupation

Sl No Categories No of Patients Percentage

1. Labor 09 30.00%

2. Sedentary 02 06.67%

3. Active 03 10.00%

4. Housewife 16 53.33%

5. Total 30 100%

Labor30%

Sedentary7%

Active10%

Housewife53%

Graph number 4

Distribution of patients according to the Occupation

Efficacy of Shunti & Gokshura in Amavata

79

5) Economical Status

Data collected in the study shows that more values of percentage i.e., 63.33% (19)

patients fall under middle class economical status category.

30.%(9) patients fall under poor class economical status category.

And only 6.67% (2) patients fall under Higher class economical status category.

Table 4.5 : Distribution of Patients according to the Economical status

0 5 10 15 20

Poor

Middle class

Higher class

Aristocrat

No of Patients

Graph number 5

Distribution of Patients according to the Economical status

Sl No Economical Status No of Patients Percentage

1. Poor 09 30.0%

2. Middle class 19 63.33%

3. Higher class 02 6.67%

4. Aristocrat 00 0.00%

5. Total 30 100%

Efficacy of Shunti & Gokshura in Amavata

80

6) Diet [Food Habits]

Distribution of Patients according to the Diet habit.

The food habit distribution in the locality of research has more percentage of

vegetarians in comparison with mixed diet dependents.

The ratio of percentage between vegetarian and mixed diet is 20:10 i.e.,

66.67%: 33.33% respectively.

Table 4.6 : Distribution of Patients according to the Diet habit.

Sl No Category No of Patients Percentage

1. Vegetarian 20 66.67%

2. Mixed diet 10 33.33%

3. Total 30 100%

Vegetarian67%

Mixed diet33%

VegetarianMixed diet

Graph number 6Distribution of Patients according to the Diet [Food Habits]

Efficacy of Shunti & Gokshura in Amavata

81

SECTION ‘B’ DATA RELATED TO DISEASE 7) Complaints presented by treated thirty patients:-

In this study all of the 30 (100%) patients were complained about Sandhi shoola.

(Joint Pain), Sandhi shotha (swelling), jwara (fever), Stabdata (stiffness), most of the

patients 28 (93.33%) were presented the complaint Gowrava (heaviness), Angamarda

(malaise), 26 (86.66%) patients complained Alasya. 25 (83.33%) patients complaints

Apaka (indigestion), 23 (76.66%) patients complained Aruchi (indigestion), only 10

(33.33%) patients complained Trushna (Thirst), Vruschik damshavat pida (Scorpion bite

like pain) was found in 15 (50%) of the patients.

Table 4.7 : Presenting Symptoms of thirty patients

Sl No Complaints No of Patients Percentage

1. Sandhi Shool 30 100%

2. Sandhi Shotha 30 100%

3. Jwara 30 100%

4. Stabdata 30 100%

5. Gowrava 28 93.33%

6. Angamarda 28 93.33%

7. Aruchi 23 76.66%

8. Apaka 25 83.33%

9. Trushna 10 33.33%

10. Alasya 26 86.66%

11. Vruschik damshavat peeda 15 50.00%

Efficacy of Shunti & Gokshura in Amavata

82

Sandhi Shool12%

Sandhi Shotha11%

Jwara11%

Stabdata11%

Gowrava10%

Angamarda10%

Aruchi8%

Apaka9%

Trushna4%

Alasya9%

Vruschik damshavat peeda

5%

Graph number 7

Presenting Symptoms of thirty patients

Efficacy of Shunti & Gokshura in Amavata

83

8) Duration

The duration which patients had their illness ranged from 1 month to more than 2

years.

Maximum patients 11 (36.66%) were suffered in this disease in between 7-12

months duration followed by 9 (30%) patients were suffered in between 13-18 months

duration, 4 (13.33%)patients were suffered in this disease more than 2 yrs duration. 3

(10%) patients were suffered in between 1-6 months of duration and 3 (10%) patients

were suffered in between 19-24 months of duration.

Table 4.8 : Duration of the Patients in the present Study

Sl No Duration No of Patients Percentage

1. 1-6 Months 03 10.00%2. 7-12 Months 11 36.66%3. 13-18 Months 09 30.00%4. 19-24 Months 03 10.00%5. More than 2 yrs 04 13.33%6. Total 30 100%

3

11

9

34

0

2

4

6

8

10

12

1-6 Months 7-12Months

13-18Months

19-24Months

More than 2yrs

Graph number 8Duration of the Patients in the present Study

Efficacy of Shunti & Gokshura in Amavata

84

9) Data of Affected joints

Amavata can affect any joint but in this study maximum patients 10 (33.33%)

affected joints were Ankle and Knee. 8 (26.66%) patients affected joints were all the

joints irrespective of small and big joints.

5 (16.66%) patients affected joints were shoulder, elbow and wrist. 4(13.33%)

patients affected joints were shoulder and elbow. 3 (10%) patients affected joints were

wrist and interphalangeal.

Table 4.9 : Showing the affected joints of thirtypatients

Sl No Affected joints No of Patients Percentage

1. Ankle and knee joints 10 33.33%

2. Shoulder, elbow and Wrist joint 05 16.66%

3. Wrist and interpharengeal joints 03 10.00%

4. Shoulder and elbow 04 13.33%

5. Affected all joints 08 26.66%

6. Total 30 100%

0

5

10

No of Patients 10 5 3 4 8

1.   2.   3.   4.   5.  

Graph number 9

Affected joints of thirty patients

Efficacy of Shunti & Gokshura in Amavata

85

10) Agnibala- Agnibala of thirty patients

This present study a systemic correlation between Agni and Ama was made out.

Maximum patients 22 (73.33%) had mandagni and 8 (26.66%) patients had

Vishamagni.There were no any Patients reported about teekshnagni and samagni.

Table 4.10 : Agnibala of thirty patients

Sl No Agni No of Patients Percentage

1. Manda 22 73.33 %

2. Teekshna 00 0.00%

3. Sama 00 0.00%

4. Vishama 08 26.66%

5. Total 30 100

22

0 0

8

0

5

10

15

20

25

MandaTeekshnaSamaVishama

Graph number 10Agnibala of thirty patients

Efficacy of Shunti & Gokshura in Amavata

86

11) Nidra - Nidra of thirty patients

This present study mode of Nidra in the patients was made out.

Maximum 21 (70%) patients have reported with Nidra Vaishamya and only 9

(30%) patients have reported with Alpa nidra.

Table 4.11 : Nidra of thirty patients

Sl No Nidra No of Patients Percentage

1. Sukha 00 0.00%

2. Alpa 09 30.00%

3. Ati 00 0.00%

4. Vaishamya 21 70.00%

5. Total 30 100%

Graph number 11Nidra of thirty patients

0

10

20

30

No of Patients 0 9 0 21

Sukha Alpa Ati Vaishamya

1.   2.   3.   4.  

Efficacy of Shunti & Gokshura in Amavata

87

12) Prakruti - Prakruti of thirty patients

In Ayurveda prakruti is the fundamental entity in disease process. In this study

maximum patient 12 (40%) screened as Vata kapha prakruti followed by 7 (23.33%) Vata

prakruti 6 (20%) Kapha prakruti patients and Vata pitta prakruti patients were 5 (16.66%).

Table 4.12 : Prakruti of thirty patients

Sl No Prakruti No of Patients Percentage1. Vata 07 23.33%2. Pitta 00 00.00%3. Kapha 06 20.00%4. Vata Pitta 05 16.66%5. Vata kapha 12 40.00%6. Kapha pitta 00 00.00%7. Vata Pitta Kapha 00 00.00%8. Total 30 100%

Graph number 12Prakruti of thirty patients

Graph number 12Prakruti of thirty patients

0

2

4

6

8

10

12

No of Patients 7 0 6 5 12 0 0

Vata Pitta KaphaVata Pitta

Vata kapha

Kapha pitta

Vata Pitta

Kapha

Efficacy of Shunti & Gokshura in Amavata

88

Section C - Data Related To Response To The Treatment

Table 4.13 Showing Grades of Sandhi shoola Before Treatment in Group A, B & C

GradesNo of Patients Group3 % 2 % 1 % 0 %

10 A 6 60% 4 40% - - - -

10 B 4 40% 6 60% - - - -

10 C 7 70 % 3 30% - - - -

3=Much difficulty in moving, 2 = slightly difficulty in moving,

1=Pain but not difficulty in moving, O= No pain.

Table 4.14 Showing Grades of Sandhishoola After Treatment in Group A, B & C

GradesNo of Patients Group0 % 1 % 2 % 3 %

10 A 5 50% 4 40% 1 10% - -

10 B 1 10% 6 60% 3 30% - -

10 C 6 60% 3 30% 1 10% - -

O= No pain, 1=Pain but not difficulty in moving, 2 = slightly difficulty in moving,

3= much difficulty in moving.

Efficacy of Shunti & Gokshura in Amavata

89

Table 4.15 Showing Grades of Sandhishotha Before Treatment in Group A, B & C

GradesNo of Patients Group3 % 2 % 1 % 0 %

10 A 2 20% 7 70% 1 10% - -

10 B 6 60% 4 40% - - - -

10 C 4 40% 6 60% - - - -

3=Much elevated so that joints seems grossly deformed. 2=Covers well the Bony

Prominence, 1=Slightly obvious, O= No Swelling.

Table 4.16 Showing Grades of Sandhishotha After Treatment in Group A, B & C

GradesNo of Patients Group0 % 1 % 2 % 3 %

10 A 6 60% 3 30% 1 10% - -

10 B 7 70% 3 30% - - - -

10 C 7 70% 2 20% 1 10% - -

O= No Swelling, 1=Slightly obvious, 2=Covers well the Bony Prominence,

3=Much elevated so that joints seems grossly deformed.

Efficacy of Shunti & Gokshura in Amavata

90

Table 4.17 Showing Grades of Jwara Before Treatment in Group A, B & C

GradesNo ofPatients

Group3 % 2 % 1 % 0 %

10 A - - 5 50% 5 50% - -

10 B - - 3 30% 7 70% - -

10 C - - 2 20% 8 80% - -

3=100.90F and above, 2=99.80F –100.80F, 1= 98.7 0F –99.70F, O= 98.60F,.

Table 4.18 Showing Grades of Jwara After Treatment in Group A, B & C

GradesNo of Patients Group0 % 1 % 2 % 3 %

10 A 9 90% 1 10% - - - -

10 B 8 80% 2 20% - - - -

10 C 9 9% 1 10% - - - -

O= 98.60F, 1= 98.7 0F –99.70F, 2=99.80F –100.80F,3=100.90F and above.

Efficacy of Shunti & Gokshura in Amavata

91

Table 4.19 Showing Grades of Stabdata Before Treatment in Group A, B & C

GradesNo of Patients Group3 % 2 % 1 % 0 %

10 A 1 10% 6 60% 3 30% - -

10 B 1 10% 5 50% 4 40% - -

10 C 2 20% 6 60% 2 20% - -

3= Stiffness for 2 + +hrs, 2= Stiffness 1-2 hrs, 1=Stiffness within 1 hr,

O=No stiffness,

Table 4.20 Showing Grades of Stabdata After Treatment in Group A, B & C

GradesNo of Patients Group0 % 1 % 2 % 3 %

10 A 6 60% 4 40% - - - -

10 B 4 40% 5 50% 1 10% - -

10 C 8 80% 2 20% - - - -

O=No stiffness, 1=Stiffness within 1 hr, 2= Stiffness 1-2 hrs,

3= Stiffness for 2 + +hrs

Efficacy of Shunti & Gokshura in Amavata

92

Table 4.21 COMPARATIVE RESULTS OF GROUP A, B & C WITH SANDHI

SHOOLA (PAIN)

Group Before treatementTotal No. of patients

Percentage After TreatmentNo. of Patients Relived

Percentage

A 10 100% 5 50%

B 10 100% 1 10%

C 10 100% 6 60%

Graph no 13. SHOWING COMPARATIVE RESULTS OF GROUP A, B & C

WITH SANDHI SHOOLA (PAIN)

In the present study all the patients (30) from all the groups have presented the

subjective symptom sandhishoola with varying degrees. After the treatment the study

reveals that effect of all the three groups have consistent convinced results over snadhi

shoola. In Group A 5(50%) patients completely relived with sandhishoola. In the same

way Group B only 1 (10%) patient completely relived and In Group C 6 (60%) patients

completely relived with sandhishoola.

0

2

4

6

8

10

Before treatement Total No.of patients

10 10 10

After Treatment No. ofPatients Relived

5 1 6

A B C

Efficacy of Shunti & Gokshura in Amavata

93

Table 4.22 COMPARATIVE RESULTS OF GROUP A, B & C WITH SANDHI

SHOTHA (SWELLING)

Group Before Treatment

No. of Patients

Percentage After Treatment

No. of Patients Relived

Percentage

A 10 100% 6 60%

B 10 100% 7 70%

C 10 100% 7 70%

Graph no 14 SHOWING COMPARATIVE RESULTS OF GROUP A, B & C

WITH SANDHI SHOTHA (SWELLING)

All the patients from all the groups have presented the subjective symptom sandhi

shotha before the treatment with varying degrees.

After the treatment in Group A 6 (60%) patients have shown complete relief from

sandhi shotha. In the same way Group B 7 (70%) and in Group C 7 (70%) patients

relived completely from sandhi shotha.

0

2

4

6

8

10

Before TreatmentNo. of Patients

10 10 10

After Treatment No.of Patients Relived

6 7 7

A B C

Efficacy of Shunti & Gokshura in Amavata

94

Table 4.23 COMPARATIVE RESULTS OF GROUP A, B & C WITH JWARA

(FEVER)

Group Before Treatment

No. of Patients

Percentage After Treatment

No. of Patients relieved

Percentage

A 10 100% 9 90%

B 10 100% 8 80%

C 10 100% 9 90%

Graph no 15 SHOWING COMPARATIVE RESULTS OF GROUP A, B & C

WITH JWARA

All the patients from all the groups have presented the subjective symptom jwara

before the treatment with varying degrees (1.2), after treatment most of the patients

relived with jwara that is In Group A 9 (90%) patients, Group B 8(80%) patients and

Group C 9(90%) patients.

0

5

10

Before TreatmentNo. of Patients

10 10 10

After TreatmentNo. of Patientsrelieved

9 8 9

A B C

Efficacy of Shunti & Gokshura in Amavata

95

Table 4.24 COMPARATIVE RESULTS OF GROUP A, B & C WITH STABDATA

(MORNING STIFFNESS)

Graph no 16 SHOWING COMPARATIVE RESULTS OF GROUP A, B & C

WITH STABDATA

(MORNING STIFFNESS)

All the patients from all the groups have presented the subjective symptom

stabdata before treatment with varying degrees.

After treatment in Group A 6(60%) patients. In Group B 4(40%) patients and In

Group C 8(80%) patients have completely relived from stabdata.

Group Before treatment

No. of Patients

Percentage After treatment

No. of Patients Relieved

Percentage

A 10 100% 6 60%

B 10 100% 4 40%

C 10 100% 8 80%

0

2

4

6

8

10

Before treatment No. ofPatients

10 10 10

After treatment No. ofPatients

6 4 8

A B C

Efficacy of Shunti & Gokshura in Amavata

96

RESULTS

30 patients were studied in three groups with 10 paitents in each. Group A

patients were treated with shunti kwatha, Group B patients were treated with Gokshrua

kwatha and Group C patients were treated with Shunti Gokshura kwatha.

The results obtained in the three groups were assessed on the basis of sandhi

shoola, sandhi shotha, jwara, stabdata, Hb%, ESR and Total count.

Table 4.25 Statistical Analysis of subjective and objective parameters in Group A

Parameter Mean S.D S.E ‘t’Value P Value Remarks

Sandhi Shoola 2.00 0.942 0.298 6.711 <0.001 H.S

Sandhi Shotha 1.6 0.843 1.266 6.015 <0.001 H.S

Jwara 1.4 0.516 0.163 8.58 <0.001 H.S

Stabdata 1.4 0.516 0.163 8.58 <0.001 H.S

Hb% 0.72 0.418 0.132 5.45 <0.001 H.S

ESR 16.2 7.22 2.28 7.105 <0.001 H.S

TC 318.3 352.92 111.60 2.852 <0.05 H.S

Subjective and Objective parameters in Group A statistical analysis showed highly

significant

Efficacy of Shunti & Gokshura in Amavata

97

Table 4.26 Statistical Analysis of subjective and objective parameters in Group B

Parameter Mean S.D S.E ‘t’ Value P Value Remarks

Sandhi Shoola 1.2 0.421 0.133 9.02 <0.001 H.S

Sandhi Shotha 2.3 0.483 0.152 15.13 <0.001 H.S

Jwara 1.1 0.316 0.1 11.0 <0.001 H.S

Stabdata 1.0 0.666 0.210 4.76 <0.01 H.S

Hb% 0.58 0.541 0.171 3.39 <0.01 H.S

ESR 11.5 6.346 2.00 5.75 <0.001 H.S

TC 419.0 552.88 174.83 2.39 <0.05 H.S

Subjective and Objective parameters in Group B statistical analysis showed highly

significant

Table 4.27 Statistical Analysis of subjective and objective parameters in Group C

Parameter Mean S.D S.E ‘t’ Value P Value Remarks

Sandhi Shoola 2.0 0.471 0.149 13.42 <0.001 H.S

Sandhi Shotha 2.0 0.666 0.21 9.52 <0.001 H.S

Jwara 1.1 0.316 0.1 11.0 <0.001 H.S

Stabdata 1.8 0.632 0.2 9.0 <0.001 H.S

Hb% 0.728 0.499 0.157 4.636 <0.01 H.S

ESR 15.9 4.818 1.52 10.46 <0.001 H.S

TC 404.0 231.76 73.29 5.512 <0.001 H.S

Subjective and Objective parameters in Group C statistical analysis showed highly

significant

Efficacy of Shunti & Gokshura in Amavata

98

Table 4.28 Anova table for Sandhi shoola

Source of

variation

D.f Sum of

square

Mean sum

of squares

F.value F.Table

value

P.value Remarks

Group 2 2.866 1.433 3.09 3.35 >10.05 N.S

Error 27 12.5 0.463

Total 29 15.366

Table 4.29 Anova table for Sandhi shotha

Source of

variation

D.f Sum of

square

Mean sum

of squares

F.value F.Table

value

P.value Remarks

Group 2 0.2 0.1 0.245 3.35 >10.05 N.S

Error 27 11.0 0.407

Total 29 11.2

Table 4.30 Anova table for Jwara

Source of

variation

D.f Sum of

square

Mean sum

of squares

F.value F.Table

value

P.value Remarks

Group 2 0.066 0.033 0.264 3.35 >10.05 N.S

Error 27 3.4 0.125

Total 27 3.466

Table 4.31 Anova table for Stabdata

Source of

variation

D.f Sum of

square

Mean sum

of squares

F.value F.Table

value

P.value Remarks

Group 2 1.27 0.635 2.123 3.35 >10.05 N.S

Error 27 8.097 0.299

Total 29 9.367

Efficacy of Shunti & Gokshura in Amavata

99

Table 4.32 ANOVA table for the Hb%

Source of

variation

D.f Sum of

square

Mean sum

of squares

F.Value F. table

value

P.value Remarks

Groups 2 2.984 1.492

Error 27 112.724 4.174 0.357 3.35 p>0.05 N.S

Total 29 115.708

Table 4.33 ANOVA table for the ESR

Soruce of

variation

D.f Sum of

squares

Mean sum

squares

F.value F.Table

value

P.value Remarks

Group 2 1482.00 741.0 7.188 3.35 <0.05 H.S

Error 27 2783.2 103.081

Total 29 4265.2

Table 4.33 (a) Least significance difference among the groups.

Groups Mean Difference Difference

C 26.5 * - -

B 23.2* 3.3 + -

A 21.2 5.3+ 2.00+

* Significant + Not Significant

Least significance difference value = L.S.D.

t 0.05 √√ 2s2 E/K

= 2.05√√2x103.08/10

Here the L.S.D Value is 9.3.

Efficacy of Shunti & Gokshura in Amavata

100

Table 4.34 Anova table for the TC

Source of

variation

D.f Sum of

square

Mean sum

of squares

F

value

F.table

value

P.value Remarks

Group 2 63677.27 31838.63 0.02 3.35 >10.05 N.S

Error 27 32252890.1 1194551.48

Total 29 32316567.37

RESULTS

v Here we are comparing mean effect of 3 groups is same or not due to treatment.

For that we use completely randomized design.

v All the parameters except ESR shows non significant, i.e., the mean effect of ESR

in the three groups shows highly significant.

From the table 4.33(a) by using least significant difference value is the parameter,

the group c is more significant than the other(Group A & B).

v If we compare the 3 groups individually the group c shows much response than

the group A & B. [By using paired ‘t’ test as p is <0.001 & ‘t’ values].

v The parameter Hb% in-group A shows highly significant.

v The mean net effect of parameter TC is more in group C.

v Where as the net mean effect in ESR is more in group A.

v The parameter Sandi shotha & Jwara shows highly significant in group B than A

& C [By comparing t values].

v Where as the parameter Sandi shoola highly significant in group C than A & B.

Efficacy of Shunti & Gokshura in Amavata

101

Table no 4.35 Comparative overall Assessment of therapeutic Response of Group A,

B & C

The overall effect of the therapies were assessed as complete remission, Major

improvement, Minor improvement and not responded.

Types of

Response

Group

A

Percentage Group

B

Percentage Group

C

Percentage

Complete

remission

02 20% 01 10% 03 30%

Major

improvement

07 70% 06 60% 06 60%

Minor

improvement

01 10% 03 30% 01 10%

Not responded 0 0 0 0 0 0

Discontinued 0 0 0 0 0 0

Graph no 17 Showing Comparative overall Assessment of therapeutic Response of

Group A, B & C

0

1

2

3

4

5

6

7

Complete remission 2 1 3

Major improvement 7 6 6

Minor improvement 1 3 1

No.of Patients in Group A

No.of Patients in Group B

No.of Patients in Group C

s

Efficacy of Shunti & Gokshura in Amavata

102

The overall effect of the therapies were as mentioned in this Graph no. 17,

3 (30%) patients have got complete remission in Group C compared to 2 (20%) patients

and 1 (10%) patients in Group A and Group B respectively

Major improvement was shown maximum 7 (70%) patients in Group A compared

with Group B & Group C with 6 (60%) patients in both the Groups.

Minor improvement was shown in 3(30%) patients in Group B as compared with

Group A & Group C with only 1(10%) patient in each Group.

There were no patients, which falls under not responded category of assessment,

so it speaks that all the patients of all the three Groups were responded well.

Efficacy of Shunti & Gokshura in Amavata

103

Master Chart 1

Demographic Data of “Evaluation of Efficacy of Shunti and Gokshura in

Amavata (Rheumatoid Arthritis) - A Comparative clinical study

S.No. OPD Age Sex Religion Occupation Economicalstatus

Food

M F H M C O L S A Hw P M H A V M1 4041 32 - + + - - - - - - + - + - - + -2 134 40 + - + - - - + - - - - + - - + -3 1245 30 - + + - - - - - - + - + - - + -4 1747 58 - + + - - - - - - + + - - - - +5 1893 45 + - + - - - + - - - + - - - - +6 1908 45 - + + - - - - - - + - + - - + -7 1481 48 - + + - - - - - - + - + - - + -8 1906 42 + - + - - - + - - - - + - - + -9 2367 50 - + + - - - - - - + - + - - + -10 2584 65 + - + - - - - + - - - + - - + -11 86 39 - + + - - - - - - + - - + - + -12 489 40 - + + - - - + - - - + - - - + -13 473 60 + - + - - - + - - - + - - - + -14 791 56 + - + - - - - - + - - + - - - +15 1368 48 - + + - - - - - - + - + - - + -16 3625 28 + - - + - - - - + - + - - - - +17 3801 28 + - + - - - - - + - + - - - - +18 3802 50 + - + - - - + - - - + - - - - +19 4172 30 + - - + - - + - - - - + - - - +20 2627 36 - + + - - - - - - + - + - - + -21 4570 40 - + + - - - - - - + - + - - - +22 1408 44 + - + - - - + - - - - + - - - +23 1538 47 - + + - - - - - - + - - + - - +24 1039 45 - + + - - - - - - + - + - - + -25 1628 39 - + + - - - - - - + - + - - + -26 1698 48 - + + - - - - - - + - + - - + -27 1792 32 - + + - - - - - - + - + - - + -28 1175 30 - + + - - - + - - - + - - - + -29 2010 27 + - + - - - - + - - + - - - + -30 3179 48 - + + - - - - - - + - + - - + -

M=Male, F=Female, H=Hindu, M=Muslim,C=Christian,O=Others,

L=Labour,S=Sedentry,A=Active,Hw=Housewife,P=Poor,M=Middle,H=High,

A=Aristocrat, V=Vegetarian, M=Mixed diet Group A- No. 1 to 10, Group B No.- 11 to

20, Group C No.- 21 to 30

Efficacy of Shunti & Gokshura in Amavata

104

Master Chart 2

ASSESSMENT OF SUBJECTIVE PARAMETERS OF GROUP A, B AND C

No. O.P.D Sandishoola Sandishotha Jwara StabdataBT AT BT AT BT AT BT AT

1 4041 3 0 2 0 2 0 2 0

2 134 3 1 2 0 1 0 2 03 1245 3 0 2 1 1 0 1 04 1747 2 1 2 1 1 0 1 05 1893 2 0 1 0 1 0 2 16 1908 3 0 3 0 2 0 2 07 1481 3 0 3 1 2 0 1 08 1906 2 1 2 0 2 0 2 19 2367 2 1 2 0 1 0 2 110 2584 3 2 2 2 2 1 3 111 86 2 0 3 0 1 0 2 012 489 2 1 3 0 2 0 1 013 473 3 2 3 1 1 0 1 114 791 2 1 2 0 2 1 2 015 1368 3 2 3 1 1 0 2 116 3625 2 1 2 0 1 0 2 117 3801 2 1 3 0 1 0 1 018 3802 2 1 2 0 1 0 1 119 4174 3 1 3 1 2 1 3 220 2627 3 2 2 0 1 0 2 121 4570 3 1 2 0 1 0 1 022 1408 2 0 2 0 1 0 3 123 1538 3 0 3 1 2 0 2 024 1039 3 1 2 0 1 0 2 025 1628 3 0 3 0 1 0 2 026 1698 3 0 2 0 1 0 3 027 1792 3 1 3 0 1 0 2 028 1175 2 0 2 0 1 0 1 029 2010 3 2 3 2 2 1 2 130 3179 2 0 2 1 1 0 2 0

Group A- No. 1 to 10, Group B No.- 11 to 20, Group C No.- 21 to 30

BT- Before treatment, AT- After treatment

Efficacy of Shunti & Gokshura in Amavata

105

Master Chart 3

ASSESSMENT OF OBJECTIVE PARAMETERS OF GROUP A , B AND C

BT – Before treatment AT- After treatment Hb% - Hemoglobin percentage.ESR – Erythrocyte Sedimentation Rate. TC – Total Count of WBC RA - Rheumatoid Arthritis test, CRP- C-Reactive Protein ,Group A- No.1 to 10, Group B- No. 11 to 20, Group C- No. 21 to 30

No. OPD.No Hb% Gmldl ESR mmof 1st hr TC cell /cumm RA CRPBT AT BT AT BT AT BT AT BT AT

1 4041 7.1 6.0 52 26 7850 8050 +ve +ve weakly +ve weakly +ve2 134 12.2 13.0 33 21 5350 5410 - ve - ve - ve - ve3 1245 7.4 9.0 28 18 4000 5000 - ve - ve - ve - ve4 1747 13.2 14.0 25 14 9350 9350 - ve - ve - ve - ve5 1893 14.0 14.0 48 20 5800 6200 - ve - ve - ve - ve6 1908 9.4 10.0 40 20 5800 6000 - ve - ve - ve - ve7 1481 9.5 10.0 38 18 4500 5000 - ve - ve - ve - ve8 1906 10.0 10.5 40 22 5800 5000 - ve - ve - ve - ve9 2367 11.8 12.5 31 22 4975 4998 - ve - ve + ve + ve10 2584 10.4 11.0 38 30 6350 6350 - ve - ve - ve - ve11 86 11.0 12.5 40 28 8400 6450 - ve - ve weakly

+ veweakly

+ ve12 489 7.9 9.0 32 18 6800 6500 - ve - ve - ve - ve13 473 10.0 10.0 28 20 5100 5000 - ve - ve - ve - ve14 791 13.8 14.0 06 06 6100 5600 - ve - ve - ve - ve15 1368 9.0 9.5 36 26 6895 6710 - ve - ve - ve - ve16 3625 9.5 10.0 38 25 6700 6400 - ve - ve - ve - ve17 3801 9.0 10.0 45 23 5300 4900 - ve - ve - ve - ve18 3802 8.5 9.5 48 28 5000 5175 - ve - ve - ve - ve19 4174 11.0 11.0 36 28 6630 6500 - ve - ve -ve - ve20 2627 9.5 9.5 42 30 7150 7000 + ve + ve + ve + ve21 4570 9.5 11.0 38 19 6850 6400 - ve - ve - ve - ve22 1408 10.0 10.0 28 10 6700 6200 - ve - ve - ve - ve23 1538 13.33 14.0 30 18 6900 7200 - ve - ve - ve - ve24 1039 10.59 11.3 49 25 6400 5900 + ve + ve - ve - ve25 1628 9.0 10.0 40 28 6200 6150 - ve - ve - ve - ve26 1698 10 10.6 40 20 5500 5000 - ve - ve - ve - ve27 1792 9.4 9.5 44 28 5500 4650 + ve + ve weakly

+veweakly+ve

28 1175 9.4 10.0 22 14 5300 5800 - ve - ve - ve - ve29 2010 5.4 6.0 98 80 7900 7600 + ve + ve weakly

+veweakly +ve

30 3179 8.5 10.0 35 23 5890 5800 - ve - ve - ve - ve

Efficacy of Shunti & Gokshura in Amavata

106

DISCUSSION

Drug being one among the chikitsa chatushpada and the armour of the

physician. The drug occupies a pre-eminent position in the requisite for achieving

the success of treatment.

In this study “Evaluation of efficacy of Shunti and Gokshura in Amavata

(Rheumatoid Arthritis] – A comparative clinical study” the treatment of Amavata with

Shuntyadi (Shunti, Gokshura) kwatha was selected from chakradatta.

The drug Shunti is being dealt directly as Amavatahara by Bhavamishra and

Madanapala.And also it is being mentioned as Shoolahara, Agnideepaka, Shothahara,

and Amapachaka by different authors. Even it is being popular with Vishwabheshaja, as

one of the synonym i.e medicine for all ailments. As it is endowed with laghu guna it act

as srotoshodhaka. As it is endowed with katu rasa it supports the line of treatment of

Amavata i.e. “Tikta deepanani katu ni cha”.

The drug Gokshura is delt in Shothahara gana of Charaka i.e which alleviates

Shotha which is one of the main symptoms of Amavata. Gokshura is also mentioned as

Rujahara by Kaiyadeva where Ruja is one of the main symptom of Amavata. Also it acts

as Deepana, Rasayana, Vathahara, which is one of the essential treatment for Amavata.

Hence it supports in treating the deisease Amavata.

The disease Amavata is named after two major pathogenic factors Ama and Vata,

which mainly affects the sandhi’s. Madhavakara for the first time reffered this disease as

a separatge entity. Subsequently Chakradatta and Vangasena gave a good deal of

description regarding this disease and its treatment.

Efficacy of Shunti & Gokshura in Amavata

107

The disease Amavata manifests due to unwholesome diet and regimen, and

hypofunction (mandagni) of agni is also an important factor for the initiation of disease

process.

The samprapti of this disease is originated from annavaha srotas and madhayama

roga marga with special predilation of sleshma sthana. Amavata is affected the

shleshmasthana and migrated to other stanas like sandhi, Asthi, Majja etc Rasa, Asthi and

Majja are primarily involve dushyas, after that mamsa and snayu are also affected.

The Ayurvedic line of treatment profounded by ancient sages are largely depends

upon the stages of the disease. The treatment Shodana, Shamana, Deepana and

Amapachana employed at the outset to check formation of Ama (and to start samprapti

vighatana).

The modern medical science cannot be exactly identical with the understanding of

Ayurveda. Amavata can be co related with the disease Rheumatoid Arthritis in modern

prevalence. The disease Rheumatoid Arthritis is identical with the signs and symptoms of

Amavata.

The study of 30 cases of Amavata was treated with shunti and Gokshura in post

graduation and research centre (Dravya Guna) of Shri D.G.M. Ayurvedic Medical

College, Gadag.

The disease was diagnosed as Amavata based on the signs and symptoms

described in our classics with concentrating more on subjective as well as objective

parameters.

In the present study of 30 patients, most of the patients fall under middle age

group (26-55 yr). Out of which 36.67% (11 pateints) were between the age of 36-45 yrs.

Efficacy of Shunti & Gokshura in Amavata

108

Which suggests the main causative factor for Amavata is Adhika chesta in this age group

peoples.

In this study female patients were dominated (60%) which is identical with

international data.

The study records that the patients out of housewife’s occupational group are

more prone to get Amavata with 16 (53.33%) patients.

The majority of the patients in this study where mandagni 22 (72.33%) which

suggested the production of Ama due to mandagni which is also co-relating with ancient

texts.

According to the prakruti of the patients maximum patients 12 (40%) screened as

vatakapha prakruti. Which is suitable with samprapti as Amavata is mainly due to vata

and kapha disease.

Majority of the signs and symptoms explained in our classics regarding Amavata

were observed in this study. But assessment is made only with subjective parameters i.e

sandhi shoola. Sandhi shotha, Jwara and stabdata which is mentioned in materials and

methods.

All the thirty patients presented with subjective symptom sandhi shoola with

varying degrees before the treatment ( Table no 4.13). After the treatment Group C has

shown a marked result compared with other Groups i.e. 6 (60%) patients completely

relived with sandhi shoola. Group A 5 (50%) patients and in Group B only 1 (10%)

patients relived completely (Table 4.21). Even statistically it is proved that sandhi shoola

is highly significant in Group C than A & B (Table No. 4.27).

Efficacy of Shunti & Gokshura in Amavata

109

The subjective parameter sandhi shotha is best responded in Group B & C with 7

(70%) patients completely relived in both the groups (Table 4.22). As the Gokshura is

said to be shothahara which both the Groups contain.

The subjective parameter Jwara presented with minimum degree before the

treatment in all the Groups (Table 4.17). Which responded well in both the Group A & C

with 9 (90%) patients (Table 4.23). In which the main Shunti consists which is said as

Agnideepaka. Amapachaka.

The relief of stabdata is highly impressive of patients 8 (80%) of Group C Table

4.24. Which have received both Shunti and Gokshura.

The objective parameter Haemoglobin (Hb%) percentage shows highly significant

in all the Groups (P<0.001) (Table no 4.25, 4.26, 4.27).

The objective parameter Erythrocyte Sedimentation Rate (ESR) shows highly

significant in all the 3 Groups where as the net mean effect in ESR is more in Group A.

(Table 4.25, 4.26, 4.27).

The objective parameter total leukocyte count (TC) is increased in some of the

patients with in the normal limits and in most of the patients the total leukocyte count is

observed as decreased in with in the normal limits.

As mentioned in the materials and methods the RA test investigation and

C-Reactive protein were under taken and the patients were selected irrespective of sero

positive and sero negative. There is no change observed in serological examination

before and after the treatment.

Radiological investigation was also undertaken in doubtful condition to exclude

the patient from the study.

Efficacy of Shunti & Gokshura in Amavata

110

The overall effect of the therapies were assessed as complete remission, major

improvement, minor improvement and not responded. (Table 4.35).

From this clinical study it is quite obvious that combination of treatment as

provided in Group C that is Shunti Gokshura kwatha has got edge over the treatment

provided in Group A (Shunti kwatha) and Group B (Gokshura kwatha) improvement in

all the respect is observed specifically in subjective as well as objective parameters.

As the result is found Group C showed 30% of patients as complete remission, as

compared with Group A (20%) and Group B (10%) respectively. And even major

improvement is also not less (60%) in Group C as compared with Group A (70%) and

Group B (60%) respectively. In 10% of patients are observed as minor improvement as

compared with Group A (10%) and Group B (30%) respectively (Table 4.35).

Overall response to the Shunti and Gokshura kwatha (Group C) was exceptionally best.

Efficacy of Shunti & Gokshura in Amavata

111

CONCLUSION

1. Amavata can be correlated with Rheumatoid Arthritis of contemporary science

with the vision of similarity in both pathophysiology as well as clinical

manifestation.

2. Shuntyadi (Shunti, Gokshura) kwatha has been recommended in Amavata by

chakradatta.

3. Shunti and Gokshura is an economical effective drug in Amavata without any

substantial adverse effect.

4. Three preparations of kwatha selected here for the study are found to be effective

in Amavata. This has been proved here clinically with individual three Groups.

5. Shunti kwatha (Group A) showed well response in Amavata with the objective

parameters haemoglobin percentage and Erythrocyte sedimentation rate highly

significant and among the subjective parameters sandhi shoola showed marked

improvement.

6. Gokshura kwatha (Group B) showed well response in Amavata with subjective

parameter Sandhi shotha and Jwara shows highly significant.

7. Anova test with sandhi shoola, sandhi shotha, jwara, stabdata, haemoglobin

percentage, total count showed that difference in improvement noted with these

parameters among the three different groups were statistically non significant.

8. Comparing three groups individually Group C (Shunti Gokshura kwatha) showed

much response than Group A (Shunti kwatha) and Group B (Gokshura kwatha) by

using paired “t” test as P value is < 0.001 and ‘t’ values.

Efficacy of Shunti & Gokshura in Amavata

112

FUTURE PROSPECTIVE

Though this work maximum efforts put to fulfill the subject and achieve the aims

and objective of the present project work. There is still a wide scope to a greater distance

of studies as follows.

Ø Similar study carried with larger sample.

Ø Similar study carried with more duration of treatment.

Ø As the disease has wide range of symptoms one can assess the role of Shunti

and the role of Gokshura in each of the symptoms.

Ø The active components of Shunti and Gokshura can be detected with the help

of Chromatography.

Efficacy of Shunti & Gokshura in Amavata

113

SUMMARY

This study was formulated to evaluate the efficacy of Shunti and Gokshura in

Amavata (Rheumatoid Arthritis) - A comparative clinical study.

Ø The aims and objectives of the present study has been discussed.

Ø The drugs Shunti and Gokshura were reviewed discussed and elaborated explained

from the Ayurvedic and Modern literatures.

Ø The definition, history, etiology, samprapti, laxana and treatment of Amavata

according to the classics and also the definition, epidemology, etiology, Pathogenesis,

clinical features and treatment of Rheumatoid Arthritis were reviewed in the study.

Ø The study was conducted on 30 patients with Equally distributed in 3 Groups A, B &

C. In Group A- Shunti kwatha was administered. In Group B Gokshura kwatha was

administered. In Group C Shunti Gokshura kwatha was administered early morning

for 30 days.

Ø In this study incidence of age, sex, occupation. religion, economical status and diet

incidents were highlighted in the observation.

Ø Almost all the symptoms of Amavata reported in this study and showed response with

all the groups.

Ø Comparing 3 Groups individually Group C (Shunti Gokshura kwatha) showed much

response than Group A (Shunti kwatha) and Group B (Gokshura kwatha) By using

paired ‘t’ test as P value is <0.001 and ‘t’ values.

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Efficacy of Shunti & Gokshura in Amavata

114

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1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 34.71. Madanapala, Madanapala Nighantu Abhayadi varga 2 sloka 59. Ramprasad patiyala

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ed. Varanasi: Krishnadas Academy; 1998. Pg 69.73. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 69-70. P.V. Sharma editor. 1st

ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 16.

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74. Bhavamisra, Bhavaprakasha Nighantu Guducchadi varga sloka 45-46. G.S. Pandeyeditor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 292.

75. Pandit Aryadasa kumar singh, Mahaushadha Nighantu Bilvadi varga 3 sloka 20. ShriIndradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 109.

76. Bapala G. Vaidya, Nighantu Adarsa purvardha Laghu Gokshuradi varga 28.1st ed. Varanasi; Chowkhamba Vidya Bhawana; 1968. Pg 211.

77. Mahendra kumar shastri, Brahat Dravyagunadarsha. 1st edi. Lucknow: Ayurvedic andTibbi Academy UP; 1978. Pg 174.

78. Vaidya Banvarilal Mishra, Dravyaguna Hastamlaka. 3rd ed. Jaipur: Premalata NataniPublication scheme; 1995. Pg 409.

79. The Ayurvedic Pharmacopiea of India Vol-I. 1st ed. New Delhi: Published byGovernment of India. Ministry of Health and Family welfare. Department of Health.1989. Pg 40.

80. Agnivesha, Charaka Samhita sutra sthana chapter 4 Sloka 15,38. Kashinatha shastrieditor. 10th ed. Varanasi: Chowkhamba Bharati Academy; 1982. Pg 82,91.

81. Dhanvantari, Dhanvantari Nighantu Guducchadi varga 1 sloka 103. P.V. Sharma editor.1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 34.

82. Madanapala, Madanapala Nighantu Abhayadi varga 2 sloka 59. Ramprasad patiyalaeditor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 11.

83. Pandit Narahari, Raj Nighantu Shatavhadi varga sloka 43. Indradeo Tripathi editor. 2nd

ed. Varanasi: Krishnadas Academy; 1998. Pg 69.84. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 69-70. P.V. Sharma editor. 1st

ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 16.85. Bhavamisra, Bhavaprakasha Nighantu Guducchadi varga sloka 45-46. G.S. Pandey

editor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 292.86. Madhava, Madhava Dravyagunah Vividoushadi varga 1 sloka 71. P.V. Sharma editor. 1st

ed. Varanasi: Chowkhamba Vidyabhawan; 1973. Pg 6.87. Pandit Aryadasa kumar singh, Mahaushadha Nighantu Bilvadi varga 3 sloka 20. Shri

Indradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 109.88. Mahendra kumar shastri, Brahat Dravyagunadarsha. 1st edi. Lucknow: Ayurvedic and

Tibbi Academy UP; 1978. Pg 174.89. K.M. Nadakarni’s Indian Materia Medica Vol-I. A.K. Nadakarni editor. 3rd ed. Bombay:

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Government of India. Ministry of Health and Family welfare. Department of Health.1989. Pg 40.

91. Dhanvantari, Dhanvantari Nighantu Guducchadi varga 1 sloka 103. P.V. Sharma editor.1st ed. Varanasi: Chowkhamba Orientalia; 1982. Pg 34.

92. Madanapala, Madanapala Nighantu Abhayadi varga 2 sloka 60. Ramprasad patiyalaeditor. 1st ed. Bombay: Khemaraj Shrikrishnadas Prakashan; 1988. Pg 11.

93. Pandit Narahari, Raj Nighantu Shatavhadi varga sloka 43. Indradeo Tripathi editor. 2nd

ed. Varanasi: Krishnadas Academy; 1998. Pg 69.94. Kaiyadeva, Kaiyadeva Nighantu Oushadha varga 1 sloka 69-70. P.V. Sharma editor. 1st

ed. Varanasi: Chaukhamba Orientalia; 1979. Pg 16.95. Bhavamisra, Bhavaprakasha Nighantu Guducchadi varga sloka 45-46. G.S. Pandey

editor. 7th ed. Varanasi: Chowkhamba Bharati Academy; 1984. Pg 292.96. Pandit Aryadasa kumar singh, Mahaushadha Nighantu Bilvadi varga 3 sloka 20. Shri

Indradeva Tripathi editor. 1st ed. Varanasi: Chowkhamba Vidyabhavan; 1971. Pg 109.97. Mahendra kumar shastri, Brahat Dravyagunadarsha. 1st edi. Lucknow: Ayurvedic and

Tibbi Academy UP; 1978. Pg 174.

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98. K.M. Nadakarni’s Indian Materia Medica Vol-I. A.K. Nadakarni editor. 3rd ed. Bombay:Popular Prakashana; 1982. Pg 1230.

99. Y.T. Acharya, Dravyaguna Vijnana Vol-II. Gokshuradi varga 22. 3rd ed. Varanasi:Sharma Ayurveda Mandir; 1978. Pg 122-23.

100.The Ayurvedic Pharmacopiea of India Vol-I. 1st ed. New Delhi: Published byGovernment of India. Ministry of Health and Family welfare. Department of Health.1989. Pg 40.

101.Prof. Ram sushil simha, Vanoushadi Nidarshika. 2nd ed. Lucknow: Uttar Pradesh HindiSamsthan; 1983. Pg 138-39.

102.Mahendra kumar shastri, Brahat Dravyagunadarsha. 1st edi. Lucknow: Ayurvedic andTibbi Academy UP; 1978. Pg 174.

103.Y.T. Acharya, Dravyaguna Vijnana Vol-II. Gokshuradi varga 22. 3rd ed. Varanasi:Sharma Ayurveda Mandir; 1978. Pg 122-23.

104.Bapala G. Vaidya, Nighantu Adarsa purvardha Laghu Gokshuradivarga 28.1st ed. Varanasi; Chowkhamba Vidya Bhawana; 1968. Pg 211.

105.P.V. Sharma, Dravyaguna vijnana Vol-II. 7th ed. Varanasi: Chaukhamba BharatiAcademy; 1983. Pg 634.

106.Vaidya Vishnu Mahadeva Gogte, Ayurvedic Pharmacology And Therapeutic uses ofMedicinal Plants (Dravyaguna Vijnyan). 1st English ed. Mumbai: Bharatiya vidyaBhavana; 2000. Pg 360-63.

107.Vaidya Banvarilal Mishra, Dravyaguna Hastamlaka. 3rd ed. Jaipur: Premalata Natani Publication scheme; 1995. Pg 409.

108.K.M. Nadakarni’s Indian Materia Medica Vol-I. A.K. Nadakarni editor. 3rd ed. Bombay:Popular Prakashana; 1982. Pg 1230.

109.Vaidya Vishnu Mahadeva Gogte, Ayurvedic Pharmacology And Therapeutic uses ofMedicinal Plants (Dravyaguna Vijnyan). 1st English ed. Mumbai: Bharatiya vidyaBhavana; 2000. Pg 361-62.

110.K.R. Kirtikar and B.D. Basu, Indian Medicianl Plants. Vol-I. 2nd ed. Dehra Dun:International Book Distributors; 1999. Pg 421.

111.Theodare cooke CE, The flora of the presidency of Bombay. Vol I 2 nd ed. Bombay:Botanical survey of India; 1967. Pg 170.

112.K.R. Kirtikar and B.D. Basu, Indian Medicianl Plants. Vol-I. 2nd ed. Dehra Dun:International Book Distributors; 1999. Pg 419-420.

113.Ibid.114.Ibid.115.K.M. Nadakarni’s Indian Materia Medica Vol-I. A.K. Nadakarni editor. 3rd ed. Bombay:

Popular Prakashana; 1982. Pg 1230.116.Dr. C.S. Shah and Dr. J.S. Quadry, A Text Book of Pharmacognosy.

11th ed. Ahemedabad: B.S. shah Prakashan; 1995-96. Pg 106-108.117.The Ayurvedic Pharmacopiea of India Vol-I. 1st ed. New Delhi: Published by

Government of India. Ministry of Health and Family welfare. Department of Health.1989. Pg 40.

118.K.M. Nadakarni’s Indian Materia Medica Vol-I. A.K. Nadakarni editor. 3rd ed. Bombay:Popular Prakashana; 1982. Pg 1230.

119.Ibid.120.K.R. Kirtikar and B.D. Basu, Indian Medicianl Plants. Vol-I. 2nd ed. Dehra Dun:

International Book Distributors; 1999. Pg 421-22.

Efficacy of Shunti & Gokshura in Amavata

119

DISEASE REVIEW

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122.Raja Radha kantadeva, Shabda kalpa drooma. Part –I. 3rd ed. Varanasi: Chowkhambasanskirt series; 1967. Pg 180.

123.Sri Taranatha Battacharya, sabdastoma Mahanidi. 3rd ed. Varanasi: ChowkhambaSanskrit series; 1967. pg 67.

124.Vagbhata, Astanga Hradayam with sarvanga sundara commentary by Arunadatta and thevidyotini Hindi commentary by Artideva Gupta. Sutrasthanam Chapter 13 sloka 25.Priyavrat Sharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978. Pg 175.

125.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri.Part –I Chapter 25 sloka 1-5, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 460-61.

126.Ibid127.Ibid128.Agnivesha, Charaka samhita purva Bhaga Vimana Sthana chapter 2

sloka 11. Ayurvedacharya Shri Jayadeva Vidyalankara editor. 9th ed. 1986.Pg 320.

129.Agnivesha, Charaka samhita uttarardha chikitsa stana chapter 15 sloka 42. Sri satyanarayana sastri editor. 18th ed. Varanasi: Chaukhambha Bharati Academy; 1992. Pg 460.

130.Vagbhata, Astanga Hrudayamm with sarvanga sundari commentary Sutrasthana Chapter8 sloka 31-32. Shri.Lalchandra Vaidya editor.Delhi: Motilal Banarasidas publishers; 1st

ed. 1990. Pg 75.131.Vagbhata, Astanga sangraha with sarvanga sundari commentary part I. Sutra stana

chapter 11 sloka 19. Pandit lalchandra shastri Vaidya editor. 2nd ed. Nagapur: ShriBaidhyanatha Ayurveda Bhavana limited; 1981. Pg 471.

132.Vagbhata, Astanga hrdaya with sarvangasundara commentary by Arundatta and thevidyotini hindi commentary by Atrideva Sutrasthanam. Chapter 13 sloka 17. PriyavaratSharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978 Pg 175.

133.Vagbhata, Astanga hrdaya with sarvangasundara commentary by Arundatta and thevidyotini hindi commentary by Atrideva Sutrasthanam. Chapter 13 sloka 23,24 priyavaratSharma editor. 1st ed. Varanasi: Chaukhambha orientalia; 1978 Pg 175.

134.Vrudda Vagbhata , Astanga sangraha Arthaprakashika vyakya by Shri.Govardan SharmaCchangani sutrastana Chapter 1. Shrit Yadavaji Trikamji Acharya editor. 11th ed.Varanasi: Choukhamba Sanskrit sansthana; 1996 Pg 9.

135.Agnivesha, Charaka samhita purva Bhagah sutra stana chapter 12 sloka 3.Ayurvedacharya Shri Jatyadeva vidya lankara editor. 9th ed. Delhi: Motilal Banarasidas;1986. Pg 93.

136.Pandita Sharangadhara, Sharangadhara samhita Purva khanda Chapter 5 sloka 43. Dr.Brahmanand Tripathi editor. 1st ed. Varansi: Chaukhambha Surbharati prakasha; 1990.Pg 60.

137.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri.Part –I Chapter 25 sloka 1-5, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 460-61.

138.Ibid.

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139.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part –I Chapter 25 sloka 6, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 462.

140.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri.Part –I Chapter 25 sloka 7-10, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 462-63.

141.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part –I Chapter 25 sloka 6-10, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 462-63.

142.Bhavamisra, Bhavaprakasha with vidyotini Hindi commentary Part – II chapter 26 sloka7-10. Pandit Sri Brahma Shankara Misra editor. 5th ed. Varanasi: chaukhambha Sanskritsansthana; 1988. Pg 279-282.

143. Yogaratnakarah, Yogaratnakara vidyotini Hindi commentary by Laksmipati sastriPurvarda sloka 1-2. Bhisagratna Brahmasankar sastri editor. 2nd ed. Varanasi: Chowkhamba Sanskrit series office, 1973. Pg 565.

144.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part–I Chapter 25 sloka 11,12, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 463-64.

145.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part–I Chapter 25 sloka 7-10, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 462-63.

146.Madhavakara, Madhava Nidanam with madhukosa Sanskrit commentary by SriVijayaraksita and Srikanthadatta Vidyotini Hidni Commentary by sudarshan shastri. Part–I Chapter 25 sloka 12, Prof. Yadunandana Upadhyaya editor. 30th ed. Varanasi:Chaukhamba Sanskrit sansthana; 2000. Pg 464

147.Chakrapanidatta, chakradatta with Bhavartha sandipini Hidni commentary chapter 25sloka 1. Pandit Brahma shankara Misra editor. 5th ed. Varanasi: chowkhamba Sanskritseries office; 1983. Pg 225-226.

148.Agnivesha, Charaka samhita purva Bhagah sutra sthana Chapter 22 sloka 7.Ayurvedacharya Shri Jayadeva Vidyalankar editor. 9th ed. Delhi: motilal Banarasidas;1986. Pg 181.

149.Agnivesha, Charaka samhita purva Bhagah sutra sthana Chapter 22 sloka 9.Ayurvedacharya Shri Jayadeva Vidyalankar editor. 9th ed. Delhi: motilal Banarasidas;1986. Pg 181.

150.Agnivesha, Charaka samhita purva Bhagah sutra sthana Chapter 22 sloka 8.Ayurvedacharya Shri Jayadeva Vidyalankar editor. 9th ed. Delhi: motilal Banarasidas;1986. Pg 181.

151.Bhaishajya Ratnavali with vidyotini Hidi commentary Chapter 29 sloka 232-234. Shri. Rajeshwaradatta shastry Ayurveda shastracharya editor. 7th ed. Varanasi: Chowkhamba Sanskrit sanstana. Pg 447.

152.Yogaratnakarah, Yogaratnakara vidyotini Hindi commentary by Laksmipati sastri Purvarda sloka 1-2. Bhisagratna Brahmasankar sastri editor. 2nd ed. Varanasi: Chowkhamba Sanskrit series office, 1973. Pg 573.

153.Yogaratnakarah, Yogaratnakara vidyotini Hindi commentary by Laksmipati sastri Purvarda sloka 3,4. Bhisagratna Brahmasankar sastri editor. 2nd ed. Varanasi: Chowkhamba Sanskrit series office, 1973. Pg 573.

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154.Sterling G, Rheumatology secrets. 1st ed. New Delhi: Jaypee Brothers. 1997. Pg 100.155.Harrison’s, principles of International Medicine Vol – II Chapter 313. Fouci, Brauwald,

Isslbachr, wilson, Martin, kasper etal editor. Singapore; Mc Graw Hill; 1998. Pg 1880.156.Harrison’s, principles of International Medicine Vol – II Chapter 313. Fouci, Brauwald,

Isslbachr, wilson, Martin, kasper etal editor. Singapore; Mc Graw Hill; 1998. Pg 1881.157.Davidson’s, Principles and practice of Medicine chapter 20. Christopher Haslett, Edwin

R, Chilvers Nicholas A Boon Nicki R Colledge, John A.A. Hunter, editor. 18th ed. London : Churchill Livingstone; 1999. Pg 837.

158.Boyd’s, A Text Book of Pathology Vol-II Chapter 60. A.C. Ritchie editor. 9th ed. London: Lea and Febiger; 1990. Pg 1925.

159.A.P.I. Text of Book of Medicine. Section XVII, G.S. Sainani , Philip Abraham, F.D. Dastur V.R. Joshi, R.D. Lele, Late P.J. Mehta et al editor. 6th ed. Mumbai: Association of Physicians of India; 1999. Pg 1029.

160.Devidson’s, Principles and practice of Medicine chapter 20. Christopher Haslett, Edwin R, Chilvers Nicholas A Boon Nicki R Colledge, John A.A. Hunter, editor. 18th ed. London : Churchill Livingstone; 1999.Pg 838-839.

161.Devidson’s, Principles and practice of Medicine chapter 20. Christopher Haslett, Edwin R, Chilvers Nicholas A Boon Nicki R Colledge, John A.A. Hunter, editor. 18th ed. London : Churchill Livingstone; 1999. Pg 841.

162.A.P.I. Text of Book of Medicine. Section XVII, G.S. Sainani , Philip Abraham, F.D. Dastur V.R. Joshi, R.D. Lele, Late P.J. Mehta et al editor. 6th ed. Mumbai: Association of Physicians of India; 1999. Pg 1028.

163.Devidson’s, Principles and practice of Medicine chapter 20. Christopher Haslett, Edwin R, Chilvers Nicholas A Boon Nicki R Colledge, John A.A. Hunter, editor. 18th ed. London: Churchill Livingston; 1999. Pg 841.

164.Devidson’s, Principles and practice of Medicine chapter 20. Christopher Haslett, Edwin R, Chilvers Nicholas A Boon Nicki R Colledge, John A.A. Hunter, editor. 18th ed. London : Churchill Livingstone; 1999. Pg 842-843.

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13. CHIEF COMPLAINTS

Sl. No. Complaints Duration Present Absent

01. Sandhi Shoola

02. Sandhi Shotha

03. Stabdata

04. Angamarda

05. Vrischika Damshavata Peeda

06. Gourava

ASSOCIATED SYMPTOMS

Sl. No. Complaints Duration Present Absent

01. Jwara

02. Aruchi

03. Apaka

04. Trushna

05. Alasya

14. HISTORY OF PRESENT ILLNESS :

Mode of onset :

Insidious Acute Systemic Oligo articular

Poly articular Mono articular Symmetrical Asymmetrical

Sequence of joints involved -----------------------------------------------------------------------

Aggravating factors --------------------------------------------------------------------------------

Relieving factors ------------------------------------------------------------------------------------

Nature of disease

Progressive Regressive Constant Intermittent

Routine activities affected

Mild Moderate Severe Not affected

15. FAMILY HISTORY :

16. TREATMENT HISTORY :

Treatment Yes / No Duration Dosage

Antibiotic /

Pain killer

Steroid

External

application

17. PERSONAL HISTORY :

a) Ahara :

Vegetarian Mixed Viruddha Snighdha

b) Jatharagni :

Manda Teekshan Vishama Sama

c) Purisha pravritti :

Vit Vibandha Drava Vit Prakrita Frequency

d) Mutra pravritti :

Frequency Day Night Mootra Daha

e) Nidra :

Sukha Alpa Ati Vaishamya

f) Vyasana :

Smoking Alcohol Tobacco No Habit

18. GENERAL EXAMINATION :

Pulse B. P Temp Resp. Rate

Heart Rate Height Weight

19. ATURA BALA PAREEKSHA :

A) Prakruti :

V P K VP VK PK VPK

B) Sara :

Twaka Rakta Mamsa Meda Asthi Majja Shukra Satwa

C) Samhanana :

Pravara Madhyama Avara

D) Satmya :

Pravara Madhyama Avara

E ) Satwa :

Pravara Madhyama Avara

F) Vyayama Shakti :

Pravara Madhyama Avara

G) Vaya :

Balya Youvana Vruddha

H) Desha :

Jangala Anupa Sadharana

20. SPECIAL EXAMINATION OF JOINTS :

I . Pain a) Mode of onset :

Sudden Gradual

b) Site :

Localised Referred to other joints

c) Character :

Aching Throbbing Pricking

d) Movement Aggravates Pain :

Yes No

e) Relation to weather :

Worst in------------------ weather Aggravates in Full Moon No Moon

II . Morning Stiffness :

Present Absent 0 1 2 3

III . Inspection :

a) Any deformity :

Present Absent

b) Soft tissue swelling :

c) Skin over joint :

Redness Itching Glossiness Oedema

d) Muscle wasting :

Present Absent Above the

effected joint

Below the

affected joint

e) Rheumatoid nodes :

Present Absent

IV . Palpation :

a) Local temperature :

Present Absent

b) Maximum tenderness :

Bone Ligaments Tendon sheath Other

21. LAB INVESTIGATION :

SL. NO. Name of the taste Values

A. Blood

01. ESR mm for 1st hour.

02. Hb Mg %

03. Total count Per cms

04. Differential count of N E B M L

B. Serological Test

01. R . A . Test Positive Negative

02. C. R. P. Positive Negative

C. Urine test

01. Albumin Present Absent

02. Sugar Present Absent

22. TREATMENT PROTOCOL :

Dosage :

23. ASSESMENT OF RESULT :

Subjective

Sl. No. Complaints Before treatment After treatment01. Sandhi Shoola02. Sandhi Shotha03. Jwara04. Stabdata

Objective

Sl. No. Investigation Before treatment After treatment01. Hb%02. E S R mm of 1st hr03. T L C ( WBC)04. D L C05. R A test

24. INVESTIGATORS NOTE :

Signature of Scholar

Signature of Co-guide Signature Of Guide

Grades of Subjective Parameters

1. Sandhi Shoola (Pain) -O- No pain

1 – Pain but not difficulty in moving

2- Slightly difficulty in moving

3 – Much difficulty in moving

2. Sandhi Shotha (Swelling)-O – No swelling

1- Slightly obvious

2- Covers well the bony prominence

3 – Much elevated so that joints seems grossly

deformed

3. Jwara [Fever] O- 98.60F

1- 98.70F –99.70F

2- -99.80F –100.80F

3-100.90F and above

4. Stabdata [Morning Stiffness]-O-No stiffness

1-Stiffness within 1 hr

2- Stiffness 1-2 hrs

3- Stiffness for 2 + + hrs