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“EVALUATION OF EFFICACY OF KALAMEGHA (ANDROGRAPHIS
PANICULATA NEES.) IN THE MANAGEMENT OF AMLAPITTA
A CLINICAL STUDY”
By
Dr. JAYA. MALAGOUDAR
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 Guna
Under the Guidance of
Prof Dr. G.V.Mulagund M.D. (Ayu)
And Co-guidance of
Dr. Shashikant.B. Nidagundi M.D. (Ayu)
Department of Dravya Guna Post Graduate Studies & Research Centre
D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2006-2009
D.G.M.AYURVEDIC MEDICAL COLLEGE
POST GRADUATE STUDIES AND RESEARCH CENTRE
GADAG - 582 103
This is to certify that the dissertation entitled “Evaluation of Efficacy of
Kalamegha (Andrographis paniculata Nees.) In the Management of Amlapitta A
Clinical Study” is a bonofide reseach work done by Dr. Jaya. Malagoudar 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. Shashikanth.B. Nidagundi. M.D. (Ayu)
Co- Guide, Lecturer
Dept. of 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 CENTRE
GADAG, 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
Kalamegha (Andrographis Paniculata Nees.) In the Management of Amlapitta A
Clinical Study” is a bonofide reseach work done by Dr. Jaya.Malagoudar under the
guidance of Dr. G. V. Mulagund, M.D. (Ayu), Professor & H.O.D. Dept of Dravya
Guna 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. M.D. (Ayu)
Professor & HOD,
Dept. of Dravya Guna.
Date:
Place: Gadag
Declaration by the candidate
I here by declare that this dissertation / thesis entitled “Evaluation of Efficacy
of Kalamegha (Andrographis Paniculata Nees.) In the Management of Amlapitta A
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. Shashikanth.B.
Nidagundi, M.D.(Ayu), Lecturer in Dept. of Dravya Guna, DGMAMC, PGS&RC,
Gadag.
Date :
Place : Gadag (DR. JAYA.MALAGOUDAR)
© 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 (DR.JAYA.MALAGOUDAR)
© Rajiv Gandhi University of Health Sciences, Karnataka
i
ACKNOWLEDGEMENT
This is a moment of great pleasure and contentment for me as writing
acknowledgment is the last phase in completion of this research work. At the onset
my devotional pranamas to His Holiness Sri Jagadguru Abhinava Shivananda
Swamiji, Shivananda math, Gadag.
I take this glorious opportunity to acknowledge with deep sense of gratitude to my
guide Dr .G.V. Mulagund MD (Ayu), Professor, Head of the Dept, Department of post
graduate studies and research center (Dravyaguna), D.G.M.A.M.C, Gadag for his
valuable guidance and close supervision during the entire phase of the study.
I take this opportunity to acknowledge with the deep sense and gratitude to
Dr. Kuber. Sankh. MD (Ayu), Asst. Professor, Department of post graduate studies and
research center(Dravyaguna),D.G.M.A.M.C,.Gadag for their valuable guidance and
critical suggestions during the entire phase of the study.
My profound gratitude to my co-guide Dr. Shashikanth. B. Nidagundi MD (Ayu),
Lecturer, Department of Post graduate studies and research center (Dravyaguna)
D.G.M.A.M.C, Gadag for their good and valuable guidance through out this
dissertation work.
With profound sense of gratitude, I express my sincere thanks to Dr. G.B. Patil,
Principal, D.G.M.A.M.C. Gadag. I thank Sri. S.B. Saunshi, Chairman and all the
committee members for their constant encouragement, facilities and moral support
during my post graduate study.
I offer my sincere thanks to Dr. G.S Hiremath M.D (Ayu) Professor and HOD, Dept of
Dravyaguna D.G.M.A.M.C.Gadag.
I express my gratitude to the principal, Professor Dr. S.S. Hiremath.M.D (Ayu),
management committee and my colleagues, of B.V.V.S Ayurvedic medical college,
Bagalkot, for their encouragement and support.
ii
I render my sincere thanks to Principal, Professar Dr. I. S. Muchchandi,
Professor, Y. Shrinivas, Dept of pharmacognosy and phytochemistry,
V.M. Chandrashaker Asst. Professor, Dept of pharmacology and M. pharma P.G
Scholars of Hanagal Shri Kumareshwar college of pharmacy, Bagalkot for their
valuable guidance and timely help I have been able to complete this work.
I am extremely thankful to my teacher Dr. A.M. Goudar, and other U.G teachers of
S.V.M Ayurvedic Medical College Ilkal, for their encouragement and support during
my study.
I wish to add my warmest thanks to my PG teaching faculty, Dr.K.S. Paraddi,
Dr. B.G. Swamy, Dr.M.C. Patil, Dr.K.S.R. Prasad, Dr. Shashidhar Doddamani,
Dr. Santosh Belavadi, Dr. Jagadish Mitti, Dr. Raghavendra Shettar, Dr. Girish.N.
Danappagoudar Dr. Samudri, Dr. Yasmin, Dr. Mulki Patil, Dr.Veena Kori, and
Dr. Ashok Patil, for their valuable suggestions and timely help made me to complete
this dissertation work successfully.
I am very much grateful to Dr. Yerigeri, R.M.O. DGMAMC, Gadag and to all the
lecturers, house surgeons, hospital staff and non teaching staff for their timely
assistance in completion of this work.
I sincere thank P.M. Nandakumar, statistician and Sri. V.M. Mundinamani,
Librarian, Smt. P.K. Belavadi and other office staff for their timely help during my
study.
Special thanks to my senior friends Dr. Shivaleela, Dr. Ashwini, Dr. Shalini, and
Dr. Kataraki for their help and co-operation during the study.
I extend my gratefulness and sincere heart felt gratitude to my colleagues
Dr. Kalavati, Dr. Savita, Dr. Mukta, Dr. Kavita, Dr, Sarvamangala, Dr. Anupama,
Dr. Veena, Dr. Vijayalaxmi, Dr. Mukta Hiremath, Dr. P.V.Joshi, Dr. Ravi, for their
timely support and encouragement got during the course. I am very thankful to my
junior friends Dr. Asha, Dr. Sevantika, Dr. C.C.Hiremath, Dr. Bupesh, Dr. Pushpa,
Dr. Triveni, Dr. Shrikant, for their help and co-operation during the study.
iii
I wish to thank Principals of Rajeev Gandhi D.Ed College, Anglo Urdu D.Ed
College and Parshwanath D.Ed. College, Gadag and all my patients and their
assistants for their co-operation during my clinical study.
I pick up this precious moment for appreciation of my mother and sisters; they are the
cause for me to take this noble profession and shaped me into what I am today. I have
not been able to find words enough, to express my sentiments of love, respect and
gratitude to my parent in-laws and all my near and dear one.
My special thanks to Dr. R.R.Kulkarni M.D (Ayu) and his family for their
co-operation, moral support and valuable suggestions during my documentation work.
I am also thankful to librarian, Smt. Seema Somashekhar and her family for their
co -operation during this work.
I never forget the fragrance of love and sacrifice shown by my husband
Dr. Rajkumar M.D (Ayu) for his kind advice, help and moral support. Cheerful face of
my lovely son chi. Dhanvantari (Preetam), Ananya, Rani and Rutu made me to reach
the destiny of the course.
I in this special moment should be very thankful to Dr.Raghu, and all my family
members, Dr Budihal, Mr.Santosh. M.Y. Mr.Gangadhar, and Mr.Basu.K their help
not only in this work, also through out my P.G. Studies.
I thank to all my senior, junior colleagues for their timely suggestions and help.
And also my friend late Dr. Shivakumar for his help to this valuable project.
Lastly I acknowledge my thanks to those who have directly or indirectly extended
their support for the completion of my work.
Place: Gadag Dr. Jaya. Malagoudar.
Date:
v
ABSTRACT Title: Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the
management of Amlapitta- a clinical study.
Introduction: Kalamegha one among the controversial drugs coming under the study of Dravya
Guna Vijnana, possessing tikta rasa pradhanata and claimed to have a beneficial effect
in pittaja and kaphaja vikaras, was studied under the light of the previous scholarly
works and the controversy was been settled and the drug Andrographis paniculata
Nees. was considered for the present study to assess its efficacy in the management of
Amlapitta, which can be supported by the presence of a bitter principle
Andrographolide; the active principle of the drug a potent component having
antiulcer, antiinflammatory, analgesic, hepatoprotective etc, activities.
Objectives:
1) Pharmacognostical evaluation of Kalamegha. Preliminary phytochemical
study, macroscopical evaluation, microscopical evaluation, standardization
and validation of Kalamegha.
2) To evaluate the efficacy of Kalamegha panchanga churna in Amlapitta.
Materials and Methods: The genuine drug Kalamegha (Andrographis paniculata Nees.) was collected and its
powder was prepared and was subjected for priliminary phytochemical study,
macroscopial and microscopial study for its standardisition and validation. The
panchanga churna was administered to 30 patients diagnosed as suffering from
Amlapitta in a dosage of 2gms bid for 30 days with sukhoshna jala, to assess the
efficacy of Kalamegha in the management of Amlapitta.
vi
Observation and Results: It was noticed that in some cases chemical constituents fail to answer their presence in
preliminary tests due to other reasons. However The Rf value of Andrographis
paniculata Nees. for flovonoids was found to be 0.641. The drug proved to possess
statistically significant response in managing the Amlapitta, while it was reported
from all the patients regarding poor palatability due to its bitter taste.
Conclusion:
From the present study it was concluded, that Andrographis paniculata Nees. can be
considered as the authentic botanical source for Kalamegha that helps in decreasing
the Amlapitta by its properties and actions like tiktarasa, deepana, ruchikara, pittahara
and rechana. And is effective in reducing the symptoms which are statistically
significant.
Key Words:
Kalamegha, Amlapitta, Andrographis paniculata Nees. and Andrographolide.
iv
ABBREVIATION A.P.V.M.G - Ayurvedic Pharmacology by V.M.Gogte
B.P - Bhavaprakasha Nighantu
D.G.G.P - Dravyaguna Vignana by Dr Gyanendra Pandey
D.G.H - Dravyaguna Hastamalaka
D.G.J.L.N.S - Dravyaguna Vignana by Dr J.L.N.Sastri
D.G.P.V.S - Dravyaguna Vignana by P.V.Sharma
I.M.M - Illustrated Manual of Herbal Drugs
I.M.P - Indian Medicinal Plants
K.S - Kashyapa Samhita
M.N - Madhava Nidhana
P.N - Priya Nighantu
T.W.I - The Wealth of India
Y.R - Yoga Ratnakar
vii
LIST OF TABLES
Table No.
Title of the Table
Page No
1. Synonyms according to recent authors 7
2. Classification of the drug Kalamegha 8
3. Rasa panchaka according to different authors 15
4. Doshaghnata according to different authors 15
5. Karmas according to different authors 16
6. Rogaghnata according to different authors 16
7. Prayojya anga according to different authors 20
8. Matra according to different authors 20
9. Vishistha yogas 20
10. Showing the nidana of Amlapitta 39
11. Showing the symptoms of Amlapitta 40
12. Rasa of Kalamegha perceived by 25 volunteers 75
13. Organoleptic studies of physical and sensory characteristics of
successive solvent extraction of Andrographis paniculata Nees.
75
14. Preliminary tests for primary and secondary metabolites 78
15. Distribution of patients based on Age 82
16. Distribution of patients based on Sex 83
17. Distribution of patients based on Religion 84
18. Distribution of patients based on Occupation 85
19. Distribution of patients based on Economical status 86
20. Distribution of patients based on Diet 87
21. Showing the Chief Complaints of 30 treated cases 88
22. Showing the Response to Avipaka at the end of Treatment 90
23. Showing the Response to Avipaka at the end of Follow-Up 90
24. Showing the Response to Klama at the end of Treatment 91
25. Showing the Response to Klama at the end of Follow-Up 91
26. Showing the Response to Utklesha at the end of Treatment 92
27. Showing the Response to Utklesha at the end of Follow-Up 92
viii
28. Showing the Response to Tiktodgara at the end of Treatment 93
29. Showing the Response to Tiktodgara at the end of Follow-Up 93
30. Showing the Response to Amlodgara at the end of Treatment 94
31. Showing the Response to Amlodgara at the end of Follow-Up 94
32. Showing the Response to Gourava at the end of Treatment 95
33. Showing the Response to Gourava at the end of Follow-Up 95
34. Showing the Response to Hritdaha at the end of Treatment 96
35. Showing the Response to Hritdaha at the end of Follow-Up 96
36. Showing the Response to Kanthadaha at the end of Treatment 97
37. Showing the Response to Kanthadaha at the end of Follow-Up 97
38. Showing the Response to Aruchi at the end of Treatment 98
39. Showing the Response to Aruchi at the end of Follow-Up 98
40. Showing the Response to Chardi at the end of Treatment 99
41. Showing the Response to Chardi at the end of Follow-Up 99
42. Showing the Response to Over all at the end of Treatment 100
43. Showing the Response to Over all at the end of Follow-Up 100
44. Showing Number of Patients with Degree of severity Before
Treatment, After Treatment and at the End of Follow-up for individual
variables and over-all severity of the disease.
101
45. Showing Statistical analysis for individual variables and over-all
severity of the disease
102
46. Showing response to the individual variables and overall status of the
disease after treatment and at the end of the follow up
103
ix
LIST OF CHARTS Chart No.
Title of the Chart
Page No
1. Distribution of patients based on Age 82
2. Distribution of patients based on Sex 83
3. Distribution of patients based on Religion 84
4. Distribution of patients based on Occupation 85
5. Distribution of patients based on Economical status 86
6. Distribution of patients based on Diet 87
7. Showing the Chief Complaints of 30 treated cases 89
8. Showing the Response to Avipaka at the end of Treatment 90
9. Showing the Response to Avipaka at the end of Follow-Up 90
10. Showing the Response to Klama at the end of Treatment 91
11. Showing the Response to Klama at the end of Follow-Up 91
12. Showing the Response to Utklesha at the end of Treatment 92
13. Showing the Response to Utklesha at the end of Follow-Up 92
14. Showing the Response to Tiktodgara at the end of Treatment 93
15. Showing the Response to Tiktodgara at the end of Follow-Up 93
16. Showing the Response to Amlodgara at the end of Treatment 94
17. Showing the Response to Amlodgara at the end of Follow-Up 94
18. Showing the Response to Gourava at the end of Treatment 95
19. Showing the Response to Gourava at the end of Follow-Up 95
20. Showing the Response to Hritdaha at the end of Treatment 96
21. Showing the Response to Hritdaha at the end of Follow-Up 96
22. Showing the Response to Kanthadaha at the end of Treatment 97
23. Showing the Response to Kanthadaha at the end of Follow-Up 97
24. Showing the Response to Aruchi at the end of Treatment 98
25. Showing the Response to Aruchi at the end of Follow-Up 98
26. Showing the Response to Chardi at the end of Treatment 99
27. Showing the Response to Chardi at the end of Follow-Up 99
28. Showing the Response to Over all at the end of Treatment 100
29. Showing the Response to Over all at the end of Follow-Up 100
x
LIST OF PHOTOGRAPHS
Plate No. Fig No Title
1. Habit
2. Leaf
3. Stem
4. Inflorescence
5. Flower
1 Description of plant
6. Fruit
7. TS of Stem
8. TS of Stem Enlarged
9. TS of Root
10. TS of Root Enlarged
11. TS of Leaf
2 Pharmacognostic Studies
12. TS of Leaf Enlarged
13. Soxhlet Extractor
14. Petroleum Ether Extract
15. Benzene Extract
16. Chloroform Extract
17. Ethanol Extract
3 Preliminary Phytochemical Studies
Successive Solvent Extraction
18. Aqueous Extract
19. Powder Microscopy
20. Solute System
21. Silica Plate
22. Solvent Systems
23. Flovanoid
4 Standardization and Validation
24. Alkaloid and Flavanoid
5 Kalamegha Panchanga Churna 25. Kalamegha Panchanga Churna
CONTENTS Page Numbers
Acknowledgement. i - iii
Abbreviations iv
Abstract v - vi
List of Tables vii - viii
List of Charts ix
List of Photographs x
Introduction 1 - 3
Objective 4
Drug review 5 - 29
Disease review 30 - 50
Methodology 51 - 74
Observation and results (Pharmacognostic) 75 - 80
Observation and results (Clinical Study) 81 - 103
Discussion 104 – 115
Conclusion 116
Future prospects 117
Summary 118 – 119
Bibliography 120 - 136
ANNEXURE
Table No I Demographic data
Table No II Chief complaints
Table No III Associated complaints
Table No IV Nidana (Etiology)
Master Chart
Table No V Chief complaints with Gradings
Clinical Proforma
Shloka
Introduction
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
1
INTRODUCTION
Man has been using vegetal materials for medicinal purposes since hoary past. It may be
difficult to determine how and where this aspect of man-plant relationship started, but it
is undeniable that on the basis of empirical experience of generations, human societies
developed certain systems of herbal medicines.
The world of plants is not evolved spontaneously. Through centuries, the science has
gradually developed with new experience getting incorporated and old principles which
could not stand the test of authenticity being discarded.
On the basis of “Jagathyevamanaushadam” (Vagbhata) i.e., every material substance
existing in the universe is composed of medicine.
Health is considered to be the moolam for achieving Chaturvidha Purushartha, namely,
dharma, artha, kama and moksha.
The ahara has got major role in the nourishment of the body and also causing the disease.
Greater significance is given to pathya that is hitaahara sevana which not only nourishes
the dhatus but also maintain the equilibrium of doshas. It has been also explained that the
apathya that is ahitaahara sevana is the causative factor for the vitiation of dosha, dhatu
resulting in the menifestation of diseases.
Introduction
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
2
The main cause for several diseases, which we are witnessing today, is considered to
ahitaahara sevana. The disease Amlapitta is no exception to this condition.
Life style in modern era has rendered lot of stress on human being and modern
mechanical lifestyle may not permit all the people to adopt a systematic diet, which
ultimately results in several gastrointestinal disorders. Excessive consumption of amla,
katu, teekshna ahara that is faulty dietary habits, addictions like alcohol, smoking,
tobacco chewing and other psychological factors like stress, strain also contributes in
causing the Amlapitta disease. Annavaha srotas in general, Amashaya in particular being
the principle site of the disorder.
Most of the diseases arrised from the abnormal functioning of agni, especially by its
mandagni state. “Rogasarvepi mandagnou.” Because of mandagni, the ingested food
will not digest properly and becomes apakwa and leads to the formation of ama, which is
the basic factor for the manifestation of several disorders.
The chikitsa sutra for Amlapitta explained in the Ayurvedic classics includes Vamana
and Virechana for urdvagati and adhogati of doshas respectively. The basic principles of
the treatment namely nidana parivarjana and samprapti vighatana are also applicable in
the treatment of Amlapitta.
There are abundant herbal and herbo mineral preparations available in the market for
early relief of Amlapitta, but drugs have not yet been developed properly for the
complete cure of the disease. Usually most of the cases treated by shamana chikitsa with
Introduction
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
3
different formulations, where chances of recurrence are more, so first priority is to treat
the underlying cause of the disease. Treatment should be aimed at restoring and
maintenance of good health without any artificial aids and, relief from the discomfort
associated with Amlapitta.
Keeping this view in mind an attempt was made to search an ideal drug having the
properties of pittahara, acting on agni and which should be easily available and
economic. Hence, the drug Kalamegha (Andrographis paniculata Nees.) has been
selected for the study.
Objectives
“Evaluation of efficacy of Kalamegha (Andrographis paniculat Nees.) in the management of Amlapitta- a clinical study. ”
4
OBJECTIVES
1) Pharmacognostical evaluation of Kalamegha. Preliminary phytochemical
study, macroscopical evaluation, microscopical evaluation, standardization
and validation of Kalamegha.
2) To evaluate the efficacy of Kalamegha panchanga churna in Amlapitta.
Review of Literature (Drug Review)
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
5
A) DRUG REVIEW:
THE PLANT KALAMEGHA:
The plant is indigenous to India and has been used in Indian systems of medicine
since time immemorial. It is also known as ‘Rice bitters’ in West Indies and ‘King of
bitters’ or Chiretta in England.1
The fresh and dried leaves of the herb and the juice extracted from this are official
drugs in Indian Pharmacopoeia and Chinese Pharmacopoeia.2
The herb is the well known drug Kalamegha or green chiretta, and forms the principal
ingredient of a reputed household medicine, used as a bitter tonic and febrifuge.3
HISTORICAL ASPECT OF THE DRUG:
Vedic Kala (2000-1000BC): No particular reference is available.
Samhita Kala (1000BC-500AD):
Caraka Samhita – It is not mentioned in Caraka samhita.
Sushruta Samhita – It is not mentioned in Sushruta samhita.
Asthanga Sangraha – No particular reference is available.
Asthanga Hridayam – The word Kalamegha is not mentioned.
Sharangadhara Samhita – It is not described in Sharangadhara samhita.
Madhava Nidana – Not found any references.
Review of Literature (Drug Review)
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
6
Nighantu Kala:
Dhanvantari Nighantu (11th century AD) -No particular reference is available.
Madanapal Nighantu (1374 AD) - No particular reference is available.
Raja Nighantu (14th century AD) - No particular reference is available.
Kaiyadeva Nighantu (1425 A.D.) - No particular reference is available.
Bhavaprakasha Nighantu (16th century AD) - No particular reference is
available
Shaligrama Nighantu (19th centuryAD) - No particular reference is available.
Nigantu Adarsha (1928A.D.) - No particular reference is available.
Priya Nighantu (1983 A.D.): Here the word Kalamegha has been mentioned
under the heading Shatapushpadi varga. Different synonyms, properties,
actions and rogaghnata are also mentioned. The source plant is Andrographis
paniculata Nees.4
Adhunika Kala :
It has been noted that Andrographis paniculata Nees. is popularly known as
Bhunimba in MP and Nagpur area and as Chirayata in the Bihar forests.5
KALAMEGHA NIRUKTI:6
The word Kalamegha is derived from “Vangeeya Sampradaya”. From distance it
appears like a cloud of sky blue colour, hence it is called as Kalamegha.
Fruits of Kalamegha are like yava (barley) and very bitter.
Review of Literature (Drug Review)
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
7
Table No 1 - SYNONYMS ACCORDING TO RECENT AUTHORS
SYNONYMS P.N7 D.G.H8 D.G P.V.S9
A.P V.M.G10
D.G G.P11
D.G. J.L.N.S12 I.M.P13 I.M.M14 T.W.I15
Bhunimba + - + - + + + + + Kalamegha + + + + + + + + + Kalpanatha + + - + + - - - - Kirata - - - - - - + + + Mahatikta - - - - - - - + - Yavakaraphala + - - - - + - - - Yavatikta - + - + + + - - - Shankhini - - - - + - - - -
EXPOSITION OF THE SYNONYMS:
Bhunimba –It is very small shrub, very bitter in taste like nimba.
Kalamegha –Appears like cloud of blue sky.
Kirata –It is called as kirata in some areas of India.
Mahatikta –Plant very bitter in taste.
Yavatikta –Fruits are yava in shape and very bitter.
Yavaakaraphala –Fruits are like indrayava or yavas.
BOTANICAL NAME: 16
Andrographis paniculata Nees.
ETYMOLOGICAL DERIVATION:
Andrographis = denoting male, andro = male, paniculata = having an
inflorescence the axis of which is divided into branches bearing two or more
flowers.
Panicula = tuft, a loose cluster of flowers.17
Review of Literature (Drug Review)
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
8
FAMILY: ACANTHACEAE
(akanthos – thorn)
KULA: VASAKULA 18
CLASSIFICATION OF THE DRUG KALAMEGHA:
The ancient authors classified the drugs on the basis of their morphological
characters, properties, pharmacodynamics as well as therapeutic values. The
classification goes as follows,
Table No 2- CLASSIFICATION OF THE DRUG KALAMEGHA:
Text Varga Name
Priya Nighantu19 Shatapushpadi varga Kalamegha
In the botanical floras and glossaries, the Kalamegha is identified as Andrographis
panicalata Nees.
Indian materia medica, Indian medicinal plants, Flora of presidency of Madras,
Flora of Chikkamangalur district, Wealth of India, Materia Medica of Hindus,etc in
all text Andrographis paniculata Nees. is included in the Acanthaceae family.
VARIETIES:
No particular varieties are available in Classics and Nighantus.According to Indian
medicinal plants, vol-2 and there are 4 genuses of Andrographis Wall. available.
1) Andrographis altata Nees.
2) Andrographis echioides Nees.
3) Andrographis lineata Nees.
4) Andrographis paniculata Nees. 20
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VERNACULAR NAMES: 21
Arabic : Qasabhuva, Qasebazzarirah.
Bengal : Kalamegh, Mahatita.
Canarese : Kreata, Nelabevinagida.
Deccan : Charayetah, Kalaphnath.
English : Creat.
Gujarati : Kariyatu, Kiryata, Kiriyati, Olikiriyat.
Hasada : Kalameg .
Hindi : Charayetah, Kiryat, Mahatika.
Java : Sadilata.
Malayalam : Kiriyattu, Nalaveppu.
Marathi : Olenkirayat.
Persian : Nainehavandi.
Sadani : Bhuinim.
Sanskrit : Bhunimba, Kirata.
Sinhalese : Hinbinkohomba, Ninbinkohomba.
Tamil : Nelavembu, Shiratkuchi.
Telagu : Nelavemu.
Uanadi : Creat.
TAXONOMICAL CLASSIFICATION: 22
Kingdom - Plantae.
Divisions - Angiospermeae.
Class - Dicotyledoneae.
Subclass - Gamopetalae.
Series - Bicarpellatae.
Cohort - Personales.
Family - Acanthaceae.
Genus - Andrographis.
Species - Paniculata .
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FAMILY FEATURES: 23, 24, 25
Habit
Plants are herbs, shrubs and sometimes climbers. Cystoliths are often present in the
stem and leaf.
Leaves
These are simple, opposite and exstipulate.
Inflorescence
This is a spike or a cyme, or sometimes a raceme. In some species, the flowers are in
axillary clusters. They are rarely solitary.
Flowers
These are zygomorphic, bilabiate or oblique, bisexual and hypogynous. They often
have conspicuous bracts and bracteoles, the latter often large and sometimes spiny.
Calyx
The sepals are (5), rarely (4), and united.
Corolla
The petals are (5) connate in a two lipped or oblique corolla, and are twisted or
imbricate in the bud.
Androecium
The stamens are 2 or 4 (didynamous) and if epipetalous disc, is often conspicuous.
Gynoecium
This is syncarpous, the carpels being (2). The ovary is 2 celled, superior, with 2 to
many ovules in each cell. The placentation is axile. There are 2 stigmas.
Fruit
The fruit is a 2 valved capsule.
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Seeds
In most cases, these are supported on curved hooks (jaculators). These press the fruit
from inside, which bursts with a sudden jerk and scatters the seeds.
Floral formula – %♀ K (5) C (5) A2 or 4 G(2)
Floral Diagram -
Acanthaceae is related to scrophulariaceae, but is distinguished from it by the
presence of copious bracts and bracteoles, often unequal posterior sepal, loculicidal
capsule dehiscing to the very base, the presence of jaculators, the absence of
endosperm, frequent presence of cystolith etc. It is also related to labiatae and
verbenaceae.
MORPHOLOGY: 26, 27
Habit
An erect, branched annual herb 0.3 – 0.9m. high, branches sharply quandrangular.
Leaves
5 – 7.5 by 1.2 – 2.5cm, lanceolate, acute, glabrous, slightly undulate, pale beneath,
base tapering, main nerves 4 – 6 pairs, slender, petioles 0 – 6mm long.
Inflorescence
Panicles.
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Flowers
Small, solitary, distant, in lax spreading axillary and terminal racemes or panicles, the
whole forming large pyramidal paniculate inflorescence, bracts 2.5mm, long,
lanceolate, bracteoles similar or 0, pedicels 0.8 – 4mm. long, glandular pubescent.
Calyx
3mm. long, sepals equal 5 in numbers, linear-lanceolate, glandular pubescent.
Corolla
Rose coloured, 1cm. long hairy outside, 2 lipped rather more than half way down,
tube 5mm. long, slightly enlarged below the limb upper lip 4mm. long, oblong, 2-
toothed at the apex, lower lip equal in length, deeply 3 lobed, the lobes 2.5mm. long,
linear oblong, sub obtuse.
Androecium
Filaments flattened, hairy in the upper part, stamens 5 in numbers, anthers bared at the
base.
Gynoecium
Ovary glabrous, style slightly pubescent.
Fruit
Capsules 20 by 3mm. linear – oblong, acute at both ends.
Seeds
Numerous, subquadrate, osseous rugosely pitted, glabrous yellowish brown.
PHARMACOGNOSTIC FEATURES ANDROGRAPHIS PANICULATA: 28
MACROSCOPIC:
Habit
An erect, glabrous, annual, much branched herb up to 90cm high, branches sharply
quadrangular; often narrowly winged in the upper part.
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Leaves
Simple, opposite, short petioled, 2-7cm. long and 1-3cm. wide, lanceolate, glabrous,
slightly undulate, pale beneath; base tapering; main nerves 4-6 pairs, slender; petioles
0-6mm. long.
Inflorescence
Panicles
Flowers
Flowers pink in solitary, axillary and terminal panicles.
Fruits
Capsules erect, linear-oblong, compressed, longitudinally furrowed on the broad
faces, thinly glandular hairy.
Seeds
Numerous, sub-quadrate.
MICROSCOPIC:
Stem
Microscopically it is characterized by the presence of glandular and non glandular
hairs, collenchyma located at the corners, secondary phloem with mainly acicular
fibres, xylem fibres elongated and thickened vessels with scalariform and spiral
thickenings, pith composed of parenchyma cells containing small acicular crystals of
calcium oxalate.
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Leaf
In transverse section of the leaf shows a dorsiventral structure with cuticularised
upper epidermis, rarely having stomata. Hairs are glandular, disc shaped, multicellular
with vertical walls. Stomata are abundant on lower epidermis and are of
caryophyllaceous type. Both the epidermis show presence of cystolith of various
forms which are round and elongated or blunt at both ends. Palisade is single layered,
spongy mesophyll 4-6 layered. Midrib appears triangular to oblong in cross section
and its vascular strand shows phloem located on dorsal side and xylem on ventral
side.
QUANTITATIVE STANDARDS: 29
Physical constants are, foreign organic matter: not more than 2.0%, ash: not more than
15.0%, acid insoluble ash: not more than 3.0 %, Alcohol soluble extractive: not less
than 8.0 %, Alcohol (60%) soluble extractive: not less than 24.0 %, water soluble
extractive: not less than 20.0 %.
HABITAT: 30, 31
Plant is found throughout Ceylon and India, in plantal or in wild state, especially in
West Bengal. It is abundantly scattered in rural areas. Generally it is found in gardens
and waste places, Central India, Kerala, Assam, Andhra Pradesh, Bihar, West Bengal
and other provinces in India.
RASAPANCHAKA OF KALAMEGHA:
The action of a drug is inevitably based on the Rasapanchaka of that drug.
Charaka and Sushruta opines that the drugs execute their actions some with
rasas, some with gunas, some with virya and some with vipaka and prabhava.
Vagbhata stated that though rasadi are antagonist to each other, they acts on different
doshas and dushyas without interfering the other properties.
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The ‘Rasa-panchaka’ of Kalamegha according to different lexicons is as follows,
Table No 3 – RASA PANCHAKA ACCORDING TO DIFFERENT AUTHORS
REF RASA GUNA VIRYA VIPAKA
P.N 32 Tikta Laghu Ruksha
Ushna -
D.G.H 33 Tikta Laghu Ruksha
Ushna Katu
D.G. P.V.S 34 Tikta Laghu Ruksha
Ushna Katu
A.P V.M.G35 Tikta Laghu Ruksha
Ushna Katu
D.G. G.P 36 Tikta Laghu Ruksha
Ushna Katu
D.G J.L.N.S37 Tikta Laghu Ruksha
Ushna Katu
DOSHA KARMA OF KALAMEGHA:
Action of Kalamegha on doshas.
Table No 4 – DOSHAGHNATA ACCORDING TO DIFFERENT AUTHORS
REF. PITTAHARA KAPHAHARA P.N38 + + D.G.H 39 + + D.G .P.V.S 40 + + A.P. V.M.G 41 + + D.G .G.P 42 + + D.G. J.L.N.S43 + +
SAMANYA KARMAS OF THE PLANT KALAMEGHA:
The dravyas perform certain actions in the body by virtue of their qualities.
The plant Kalamegha has several actions when it is either administered alone or
in combination with other drugs.
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The different actions mentioned by different authors are tabulated below:
Table No 5 – KARMAS ACCORDING TO DIFFERENT AUTHORS
ROGAGHNATA OF THE PLANT KALAMEGHA:
Success in treatment signifies the correct application of all therapeutic majors.
To select the right medicine which is made for health and to relieve the
disease, the knowledge of therapeutic action of the drug has an important role.
We can observe that Kalamegha is mainly used in Agnimandya, Udararoga,
Kamala,Yakruttaroga.
Table No 6 – ROGAGHNATA ACCORDING TO DIFFERENT AUTHORS
ROGAS P.N 50 D.G.H 51 D.G.
P.V.S 52 A.P.
V.M.G 53 D.G. G.P 54
D.G. J.L.N.S 55
Aamadosha - - - - - - Agnimandya - - + - - - Gulma - - - - + - Jwara + - - - - + Kamalaa - - - + - + Krimiroga + - + + - + Kushtaroga + - - + + + Pandu - - - - - + Raktavikara - - + - - - Shotha - - - - - + Udararoga - - - - - + Vibanda - - + - - - Vishajanya - - - - - - Vishama jwarahara
- - + - - -
Vrana - - - - - + Yakruttaroga + - + + - -
KARMAS P.N44 D.G.H45 D.G.
P.V.S46 A.P.
V.M.G47 D.G. G.P48
D.G. J.L.N.S49
Deepana + + + + + + Pitta shamaka - - + - - - Rakta shodhaka - - + - - - Rechana - - + + + - Ruchikara - - - - - - Swedana + + - - - - Vishodhani - - - - - - Yakruttejaka - - + + + -
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PHYTOCHEMISTRY:
Major – 0.5 – 0.9% andrographolide, a diterpene lactone. Minor – Include diterpene
lactones viz, andrograpanin, deoxyoxoandrographolide. Glycosides viz,
neoandrographolide and andrographiside. Flavonols viz, oroxylin, wogonin,
andrographidines A, B, C, D, E & F. 56
Analysis of the whole plant gave the following lactones (dry basis):
Andrographolide, 0.6, 14-deoxy-11-oxo-andro-grapholide [ C20H28O5 , mp 98-100˚),
0-12; 14 – deoxy – 11, 12 – didehydroandrographolide [ C20H30O4, mp 203-04˚ ),
0,06, 14-deoxyandrographolide [ C20H30O4, mp 175˚ ), 0.02%, and a non bitter
constituent, neoandrographolide [ C26H40O8, mp 167-168˚] , 0.005 %.
The leaves contain andrographolide (yield, 1%). From the petroleum ether extract of
the leaves from Bangladesh, the following have been isolated: -, -unsaturated
lactone, homoandrographalide [C22H32O3, mp 115˚], andrographosterol [C23H38O, mp
135˚],andrographane [C40H82, mp 67-68˚],andrographone [C32H64O, mp 85˚], a war,
two esters containing hydroxyl groups.
The roots gave apigenin-7, 4-di-o-methyl ether, andrographolide and a new natural
flavone, 5-hydroxy 7, 8, 2, 3-tetra methoxyflavone [C19H18O7, mp 150-51˚, yield
0.006%]]. They also contain a monohydroxytrimethyflavone,andrographin C18H16O6,
mp 190-91˚ and a dihyroxy-di-methoxyflavone, panicalin[C17H14O6, mp 263-64˚].
The presence of -sistosterol is also reported. 57
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THERAPEUTIC USES:
1. The expressed juice of the leaves, together with certain spices, such as
Cardamoms, cloves, cinnamon etc, is dried in the sun and made into little
globules, which are prescribed for infants to relieve griping irregular stools and
loss of appetite, flatulence, and diarrhea. 58, 59
2. A decoction of the plant is a blood purifier. It is used as a cure for torpidity of
Liver and jaundice, neuralgia and constipation. It forms the major constituent of
the Ayurvedic drug.60
3. Switradilepa, which is effective in treating vitilago- a dermatological disease. 61
4. A decoction or infusion of the leaves is useful in general debility, dyspepsia.
5. The leaves and roots are also used as febrifuge, stomachic, cholagogue,
anathematic.
6. A tincture of the root is stimulant and aperients.
7. The decoction of the plant is used in high blood pressure and anemia.
8. The hot water extracts of leaf stem are used as a powerful tonic. 62, 63
USES OF KALAMEGHA IN DIFFERENT SYSTEMS:
Unani: 64, 65
The plant is used in Unani system of medicine as blood purifier.
Homeopathy: 66
It is also used in homeopathy system of medicine as a febrifuge and hepatoprotective
medicine.
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FOLK USES:
1. It is bitter shrub, well known under the name Kalamegha, and forms the principal
ingredient of a household medicine called Alvi, which is extensively used in
Bengal. 67,68
2. A paste of its dried roots with haridra into equal proportions is made with water,
Which is applied for itching and on skin rashes.
3. Its leaves are much used in flatulence by the Nat and Musher people in Uttar
Pradesh (Ahmed, 1995).
4. In central India, half cup of the plant decoction is taken in the morning and
evening for 7-8 days to cure malaria (Saini, 1996).
5. A decoction of entire plant is also given to children as a house-hold remedy to
cure the worms.
6. The juice extracted from its leaves, is mixed with coconut water and given orally
in Kerala also for worms (Augustin and Shivadasan, 2004).
7. According to Barthakuret. Et al, 2004, in Assam. People take a decoction of its
shoots in about 10 gms quantity twice daily for 4-5 days in acute jaundice due to
hepatitis associated with hepatomegaly. For children honey or sugar is added to
mask the bitter taste of the recipe.
8. Besides in Chattisgarh state, about 250 leaves of the plant are boiled with water
and one glassful is taken twice a day for 3 days in intermittent fever (Tirkey,
2004). 69
9. The Yanaders, a wonder gipsy tribe in the Madras Presidency, constantly carry a
supply of pills made of creat fresh leaves, and the pulp of the ripe tamarind,
which they consider antidotal to the venom of the Cobra. A pill made into a paste
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with water is applied to the bitten part and some of it is put into the eyes, two
pills are given for a dose every hour or two internally.
10. A saturated infusion of the whole plant in a dose of about half a pint is
administered to fever patients by the Mundas of chota Nagapur. It is considered
as a specific. (Encyclopedia Mundarica)
11. Green leaves with the leaves of Indian birthwort (Aristolochia indica) and the
fresh inner root bark of country Sarsaparilla, made into an electuary, is used by
Hakims as a tonic and alterative in Syphilitic cachexia and foul Syphilitic
ulcers.70
Table No 7 – PRAYOJYA ANGA ACCORDING TO DIFFERENT AUTHORS
PRAYOJYA ANGA
D.G.H71 D.G. P.V.S72
D.G. G.P73 D.G.
J.L.N.S74 A.P. V.M.G75
Panchanga + + + + +
Table No 8 – MATRA ACCORDING TO DIFFERENT AUTHORS
MATRA D.G.H76 D.G. P.V.S77
D.G. G.P78 D.G.
J.L.N.S79 A.P.
V.M.G80 Churna (gms) 0.5-1 1-3 1-3 1-3 1-3 Swarasa (ml) 2-5 5-10 5-10 5-10 5-10 Kwatha (ml) 20-40 20-40 20-40 20-40 20-40 Tarala Satva (ml) -- 0.5-1 0.5 0.5 0.5 Ghana Satva (gm) -- -- -- -- --
Table No -9 VISHISTHA YOGAS:
SL NO YOGAS 1 Shvitradilepa 2 Kalamegha tarala satva 3 Kalamegha navayasachurna 4 Kalameghasava 5 Kalamegha swarasa 6 Kalamegha kwatha 7 Kalamegha panchanga churna 8 Kalamegha vati
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COLLECTION:
The whole plant is used for medicinal purpose. At the end of the rainy season and
before winter, the plant is collected and dried in shade, before use.
CULTIVATION:
It grows throughout India in moist and shaded places in the plains. It is an annual herb
cultivated to some extent in Assam and Bengal.81
It prefers sunny situations. The seeds are sown in May-June. The seedlings are
transplanted at a distance of 60 X 30 cm. 2 or 3 irrigations are given during dry
period. Flowering occurs during August-November, followed by fruiting. The crop is
harvested during February-March by uprooting the whole plant. The plants are dried
in shade. 82
MODE OF PROPAGATION:
It can be propagated by seeds or cuttings. 83
PEST AND DISEASES:
It is hardy plant and is not attacked by any pests and diseases of a serious nature. 84
HARVESTING AND STORAGE:
The crop is ready for the first harvest after about 90 to 120 days of sowing when the
plants start flowering. At this stage they are harvested by cutting the plants at the
base, leaving about 10-15 cm of the stem for regeneration. The regenerated plants are
ready for harvest in about 60 days of the previous harvest. Totally 2 to 3 harvests can
be made in a year. As a perennial crop, one in August and second in November /
December. Crop remains dormant during winter. At the flower initiation, active
principle andrographolide is high in leaves. Sometimes, the whole plant is also
harvested after about 6 months. After harvesting the plants are dried under shade for
3-4 days before storage. 85
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PRODUCTION AND YIELD:
The average yield is about 2 to 2.5 tonnes/ ha of dry herb86
MARKETING AND TRADE:
According to estimation, the demand of kalamegh by herbal industries and ayurvedic
drug producer of Maharashtra is nearly 16-18 tonnes in 2001-2002. The natural
remedies (P) Ltd., Bangalore is required nearly 11.5 t Kalamegh as crude drug in
1999-2000. Annual production of kalmegh is nearly 5000 Mts vis-à-vis their 20%
consumption by Indian ayurvedic pharmaceutical industries in 1999 (Source ADMA,
Mumbai. The current market price of herbage is Rs. 15-20 per kg. 87
ECONOMICS OF CULTIVATION:
The markets of kalamegh and their products are highly volatile. The economics (per
ha) worked out here are subject to fluctuations, depending upon time and place. 88
ADULTERANTS:
Andrographis paniculata is also adulterated with Andrographis echioides Nees, found
in tropical India and in dry districts of Maharashtra, Rajasthan and Tamil Nadu.
However, both Sweritia chirayita and Andrographis echioides are devoid of
andrographolide, the major bioactive constituent of Andrographis paniculata. 89
SUBSTITUTES:
The drug is often substituted for or mixed with the genuine ‘Chirata’ Swertia chirayita
but can be distinguished from the latter easily by the green colour of its stem,
numerous erect, slender, opposite branches and its lanceolate green leaves. 90
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CONTROVERSY STUDY: Points to rule out the controversy:
1. Bhunimba is said to be the synonym of Kiratatikta and Kalamegha in samhita kala
and nighantu kala.
2. According to Bapalal Vaidya, while explaining the controversy of Kalamegha, he
has considered bhunimba is Andrographis paniculata. Nees. (Fam-Acanthaceae).
And is the kalamegha.of Bengal and kirayata of Gujarat it can’t be identified as
kiratatikta (Swertia chirayita, Fam Gentianaceae).
3. Bhunimba is accepted as a synonym of kiratatikta (chirayata – Swertia species)
and Andrographis paniculata is sold in the market as its substitute or adulterant or
by the name of Deshi-chiraaitaa and kalamegha also. A. paniculata is locally
known as bhunimba in Madhya Pradesh and bhunimo in Orissa.
4. According to Dhanvantari Nighantu, Madanapala Nighantu, Kaiyadeva Nighantu,
Raja Nighantu, Shaligrama Nighantu, the word yavatikta is mentioned. Bhunimba,
yavakaraphala, and kirata are synonyms mentioned to it.
5. There is one word saptalika Sushruta samhita but the commentator has treated
saptalika as yavatikta, (Andrographis paniculata -kalamegha). Personally Bapalal
Vaidya & P.V Sharma would like it as a diminutive form of saptala.
6. Other bitter species of swertia may also be used. Mostly are found in high
himalayan regions so called kirata tikta apart from this certain other bitter plants
of other genera are also used. The common name is Deshi chirayita (Andrographis
paniculata Nees. ) designated as separate drug bhunimba.
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By considering the above points it can be concluded that,
1. Bhunimba which is mentioned in Samhita kala, Nighanta kala is not
Kalamegha. Bhanimba and Kalamegha are two separate plants.
2. According to Bapalal Vaidya, bhunimba is Adrographis paniculate Nees. This
is the regional language variation.
3. The Deshiya- Chirayata (A. Panicalata Nees) can be sold in the market as a
Substitute and adulterant to the kiratatikta. Due to this region bhunimba is
called As Kalamegha, but both are different plants.
4. Yavatikta can be considered as one of the synonyms of Kalamegha that is due
to yavakara phala. So yavatikta and Kalamegha are two different plants.
5. Yavatikta, Saptala, which are mentioned by Bapalala Vaidya and P.V.Sharma
are not Kalamegha (Adrographis paniculate Nees.).
6. Finally it can be concluded that Kalamegha which is mentioned in Ayurvedic
texts can be considered as Andrographis paniculata Nees, which belongs to
the family Acanthaceac.
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RESEARCH PROFILE: 91
Pharmacognostic studies:
The macro and microscopic characteristics of the stem, leaves and floral parts of the
plant have been described. The quantitative microscopic studies of the leaves with
respect to palisade ration, stomatal index and vein-islet number have also been
conducted (Prasad and Gupta. 1957).
Ethno botanical studies: The plant is used as
1. Stomachic, blood purifier and liver tonic. (Chandra et al., 1985, 1987).
2. Jaundice (Reddy, 1986, 1988).
3. Fever, anemia and scabies (Singh and Singh, 1992 ;).
4. Infective hepatitis (Vedavathy and Rao, 1995).
5. Used as a tonic, febrifuge, antidysenteric, antipyretic, anthelmintic, wormicidal and
dyspepsia (Jha et al. 1997).
6. Flatulence (Ahmad, 1995).
7. Wound healing (Borthakur et al., 1996).
8. Oedema (Reddy et al., 1991) etc.
Chemical studies:
Andrographolide, a trihydroxy lactone and the bitter principle of the plant was
isolated as early as 1911. The plant was later investigated by Moktader andGuha-
Sircar (1939) who reported a structure not consistent with earlier report. It was later
established that andrographolide was a trihydroxy lactone with one tertiary hydroxy
group (Chakravarti and Chakravarti, 1952). Structure of andrographolide was finally
confirmed as a bicyclic diterpenoid lactone (Cava et al., 1965).
Four diterpenes, andrgrapholide, neoandrgrapholide, deoxyandrgrapholide and
andrgraphiside were isolated from the n-butanol fraction of the alcoholic extract of the
plant (Gupta et al., 1990). The methanol soluble portion of the benzene extract of the
plant yielded carvacrol and eugenol along with myristic acid, hentriacontane and
tritriacontane(Ojha., 1983).
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The polyphenols obtained from the mother liquor after removal of andrographolide
from the leaves were identified as caffeic, chlorogenic and a mixture of dicaffeol and
quinic acids (Satyanarayana et al., 1978).
The root yielded a new flavone (5-hydroxy-7,8.2’3- tetramethoxyflavone) found to be
identical with mono-0-methylwightin along with apigenin-7,4’-di-0-methyl ether
andandrgrapholide (Govindachari et mal., 1969); two new flavonoids, 5-hydroxy-7.8-
dimethoxyflavonone and 5-hydroxy-3.7.8.2’-tetramethoxyflavonone in addition to the
known flavonoid. 5-hydroxy-7.8-dimethoxyflavone (7-0-methylwogonin) (Gupta et
al., 1983): a new glycoside. 2’, 5-dihydroxy-7.8-dimethoxyflavone-2’-0-β-D-
glucoside, 3β-hydroxy-5-stigmasta-9(11).22(23)-diene (Gupta et al.,1996). Bhardwaj
et al., (1981.1990) reported the synthesis of 5-hydroxy-7.8.2’-trimethoxyflavone:
5.2’-dihydroxy-7.8-dimethoxyflavone and 3.7.8.2’-tetramethoxy-5-hydroxyflavone
isolated by foreign workers (Biswas and Chowdhury, 1972: Jalal et al., 1979).
Toxicology:
Leaves and stem extracts may cause gastric discomfort, vomiting and loss of appetite
when given orally in large doses. Injection of the crude drug (extract of leaves and
stem) extract may lead to anaphylactic shock.
Andrographolide showed reproductive toxic effects in male albino rats. Leaves, when
fed to male albino rats, andrographolide present in it, because the arrest of
spermatogenesis by preventing cytokinesis of the dividing spermatogenic cell lines.
Pharmacological studies: Antihepatotoxic, hepatoprotective, antimalarial, cholinergic, cardiovascular,
Anti-inflammatory,antialergic,antimicrobial, antipyretic, immunostimulant, anti-HIV,
antiulcer,antispermatogenic,antidiarrhoeal,filaricidal,antifertility,hypotensive,
choleretic,antiphoid,anti-fungal,anti-biotic,antioxidant, antihyperglycaemic, analgesic.
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Plant extract increased biliary flow and liver weight in rat and decreased hexobarbital
induced sleeping time.
Hepatoprotective
The aqueous extract of the plant [each 5 ml of the extract contained ‘Kalamegh’ I.P.
containing 5 percent andrographolide (1 ml) in a dose of 3.75 ml/kgp.o. once a day for
5d was studied on the biliary flow, liver weight and hexobarbital-induced sleeping
time in rats. The extract was reported to increase biliary flow and liver weight and
decreased the duration of action of the hexobarbital. When compared with
Phenobarbital it was less potent at the dose employed (Chaudhuri, 1978).
The crude aqueous extract (2 per cent) of the plant showed inactivation of HBsAg
positive serum samples in in vitro studies in 48-120h at 37°C which was tested by
counter immunoelectrophoresis and latex agglutination methods (Jayaram et al.,
1989). However, Mehrotra et al., (1990) could not detect any anti-HBsAg activity in
andrographolide in in vitro studies.
Antiulcer
Apigenin 7, 4’-di-O-methyl ether, the flavone isolated from the root was tested for its
antigastric ulcer property in various animal models. The animals received a
suspension of the compound orally in doses of 5, 10 and 50 mg/kg. The flavone
produced a significant dose-dependent antiulcer activity in Shay rats, histamine-
induced ulcer in guinea pigs and in aspirin-induced ulcers in rats. It was suggested
that the antisecretory activity and a protective effect on the gastric mucosa might be
responsible for the antiulcer action of the flavone (Viswanathan et al., 1981).
Andrographolide possessed significant (p<0.05) antiulcerogenic activity at doses of
100 and 300 mg/kg bw administered orally in aspirin-induced ulceration in rats
(Madav et al., 1994).
Anti-inflammatory
The aqueous extract of the plant at a dose of 20 mg/ 100 gm bw orally in rats inhibited
carrageenin-induced oedema (65.3 per cent) after three hours as compared to the
control rats. The percentage of inhibition of the inflammation in the group treated
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with pheylbutazone (Standard) in the dose of 10 mg /100 g bw orally was 76.5 per
cent (Tajuddin et al., 1983).
Antipyretic
The plant juice (2 ml/100g bw orally) showed antipyretic activity in yeast-induced
pyrexia in rats. The extract administered even after 5h of yeast also reduced pyrexia.
The control rats were fed saline (Kanniappan et al., 1991). In another study, the
watery solution of the ethanolic extract of the plant (500 mg/kg bw) produced
antipyretic activity against yeast-induced pyrexia. The results were comparable in
efficacy to that of 200 mg/kg of aspirin (Vedavathy and Rao, 1991).
Andrographolide (100 and 300 mg/kg bw orally) produced a significant (p<0.05)
antipyretic effect 3h of administration in Brewers yeast-induced pyrexia in rats
(Madav et al., 1994).
Analgesic
Andrographolide at 300 mg/kg dose administered orally showed significant (p<0.05)
analgesic activity in acetic acid-induced writhing in mice and Randall Selitto’s test in
rats. It was devoid of any analgesic activity (at 30, 100 and 300 mg/kg, administered
orally) in hot plate test in mice (Madav et al., 1994).
Antidiarrhoeal
The alcoholic extract of the plant exhibited significant antidiarrhoeal activity against
Escherichia coli enterotoxins in animal models. The activity was further located in n-
butanol fraction, which contained four diterpenes, andrographolide,
neoandrographolide, deoxyandrographolide and andrographiside. Among the four
diterpenes andrographolide, neoandrographolide showed similar activity to
loperamide against Escherichia coli enterotoxins. Andrographolide was found to be
superior against ST enterotoxins, the most common cause of epidemics of neonatal
diarrhoea (Gupta et al., 1990).
In another study, the alcoholic, hexane, chloroform, butanol and aqueous extract of
the plant showed significant antisecretory activity against Escherichia coli enter toxin
induced secretory response in rabbit and guinea pig ileal loop models at a dose of 300
mg/loop (Gupta et al., 1993).
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Antihelmintic
The aqueous extract of the plant showed nematicidal activity against the root knot
nematode Meloidogyne incognita on tomato both in vitro and in pot (Mukherjee and
Sukul, 1978: Goswami and Vijayalakshmi, 1986).
The crude extract of the leaves revealed 100 per cent mortality of soil nematodes
within 12h of treatment. The other parts of the plant also had some activity
(Bandyopadhyay et al., 1986).
General studies
The aqueous extract of the powdered stems and root were found to be devoid of any
blood anticoagulant principle (Pillai et al., 1957).
The effect of the alcoholic extract of the plant (at dose of 100 mg/25 g i.p. and 50
mg/25 g i.p) on cobra venom-induced death in mice was studied. The extract
prolonged the life time of venom injected animals as compared to the controls
(saline). The extract prolonged the life time of cobra victims by an unknown
mechanism (Nazimudeen et al., 1978)
Clinical studies:
Vitiligo
A. paniculata is one of the constituents of Ayush-57, an Ayurvedic drug containing
the plants Plumbago rosea, Terminalia belerica, T. chebula, Emblica officinalis and
other constituents, which has been reported to be beneficial in some cases of vitiligo
(Rao et al 1980).
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B. DISEASE REVIEW:
HISTORICAL REVIEW:
VEDIC PERIOD:
There are no references of Amlapitta in Vedic period.
SAMHITA PERIOD:
In Samhita kala there are few references about Amlapitta which are available.
In the context of Brahatrayee, Amlapitta has not been mentioned as separate disease.
Few scattered references are available.
Lagutrayee and other text, have described this disease in separate chapters.
In Charaka Samhita, while explaining about qualities of dugda, it has been mentioned
as pathya in Pandu roga, Amlapitta etc diseases.92
There is also a reference that the excessive use of kulattha causes Amlapitta. 93
While mentioning the ill effects caused due to excessive use of lavana rasa, there is a
statement that it provokes pitta, lohita pitta, Amlapitta and similar other conditions. 94
Amlapitta also mentioned in the context of ill effects of the vidhi viruddha ahara
sevana. 95 There is also a reference available regarding it. Rajamasha is more
beneficial in Amlapitta disorder. 96
There is also a reference that when gora anna visha combines with pitta, it produces
daha, trishna, mukhamaya, Amlapitta and other pittaja disorders. 97
In Sushruta Samhita we get a reference that is “Vidagdham chamlamevacha”
Commentary on Dalhana teeka by Gayadas says,
“Vidagdham pittamamla pittamiti rogavishesha kare. Chinmanyantae.”
Vagbhata has mentioned that excessive use of kulattha causes Amlapitta. 98
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In Kashyapa Samhita Khila sthana 16th chapter, detailed description about Amlapitta
is available. He deals with the nidana, laxana, chikitsa, upadrava and sadhyasadhyata
of Amlapitta.
In Madhava Nidana of Madhavakara, he mentioned nidana, swarupa, laxana, bheda,
sadhyasadhyata and dosha samsarga of Amlapitta in 51st chapter.
In 10th chapter of Bhavaprakasha, Bhavamisra deals in detail about the nidana, laxana,
bheda, sadhyasadhyata of Amlapitta along with its treatments.
Types of Amlapitta and few yogas useful in Amlapitta are seen to be explained by
Sharangadhara.
In Amlapittadhikara of Bhaishajyaratnavali and 52nd chapter of Chakradatta, detailed
description about chikitsa and pathyapathya of Amlapitta is seen.
In Yogaratnakara description of nidana, samprapti, rupa, prakara, sadhyasadhyata,
chikitsa and pathyapathya of Amlapitta is available in Amlapitta nidana chapter.
Vanga sena explained nidana, laxana, bheda, sadhyasadhyata, chikitsa of Amlapitta in
his Chikitsasara sangraha.
6th Chapter of Siddhanta Nidana by Gananath Sen, brief explaination about nirukti,
nidana, samprapti, laxanas, upadravas and sadhyasadhyata of Amlapitta is available.
Basavarajeeyam deals about nidana panchaka and treatment aspects of Amlapitta in
saptama prakarana.
Harita deals with nidana and chikitsa of Amlapitta in 24th chapter of Tritiya sthana.
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NIGHANTU KALA:
Nighantu Ratnakara, a description about nidana, laxana, bheda, sadhyasadhyata and
chikitsa of Amlapitta is available.
Gadanigraha of Shodala deals with nidana, lakshana, prakara, sadhyasadhyata,
chikitsa aspects of Amlapitta in the 38th chapter of Kaya chikitsa khanda.
NIRUKTI:
Amlapitta comprises of two components that is Amla and Pitta.
These two conjoined term which conveys the idea of the disease Amlapitta.
Amla is derived from: Am+Kla+Ach pratyaya.
The word Amla is commonly been used to express one among Shadrasas.
Second component of the term pitta is derived from the Dhatu,
“Tap” to heat or to burn. This term is seen to have three meanings; namely;
Tap-santape, refers to the generation of heat. 99
Tap-dahe, refers to the act of burning of the nutrition consumed.
Tap-aishwarye, refers to that factor which is responsible to make one achieve the
eight kinds of benefits.
These references are obtained from Siddhanta Kaumudi.
Pitta : Api + Do + Kla Ape A kara lopa.
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PARIBHASHA:
Chakrapanidatta in his commentator on Charaka Samhita defines Amlapitta as
“Amlapittam cheti amlagounodriktam pittam”. 100
Means the pitta acquiring more of amla guna is known as Amlapitta.
Acharya Kashyapa explains that the Vidagdha anna rasa turns to shukta, and this
retained in amashaya and produces Amlapitta.
Srikanthadatta and Vijayarakshita, the famous commentator of Madhava Nidana said
that
“Vidahyadamlagunodriktam pittam Amlapittam.” 101
Means the condition of pitta in which the udriktata of amla guna along with vidaha is
noticed, should be called as Amlapitta
In Madhava Nidana of Madhavakara, it is defined as,
“Avipakaklamotkleshatikthamlodgaragauravaihi
HruthkanthadaharuchibhischAmlapittamvadedbhishak.” 102
A particular disease in which there is avipaka, klama, utklesha, tiktodgara, amlodgar,
gaurava, hriddaha, kanthadaha and aruchi are seen is suppose to be Amlapitta.
According to Nirukta Shastra, a particular disease in which the amla property of pitta
is increased along with pitta itself is defined as Amlapitta.
Vachaspati has described that, Amlapitta is a disease where pitta leads to sour taste
and in such state what ever is eaten is transferred into amla rasa.
“Amlamvidagdham cha tat pittam Amlapittam.” 103
When the definition of Amlapitta is summarised, it can said that a particular
pathological condition in which the pitta exceeds its normal level in terms of amlatha,
is Amlapitta.
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PARYAYAS (SYNONYMS) The commentator of Asthanga Sangraha Indu affirms the paryayas of Amlapitta as,
1. Prameelakam
2. Amlapitta
3. Pitta visuchika
Yogaratnakara and Kashyapa104 have used the terms Pittamla and the suktata as the
synonyms of Amlapitta though they have not directly described Amlapitta.
The following terms can be taken as important synonyms of Amlapitta. They are
1. Prameelakam
2. Amlapitta
3. Pitta vishoochikam
4. Pittamla
5. Shuktaka
6. Amlaka
7. Amleeka
Prameelakam:
This pachyamana vidagdha annarasa immediately provokes Pittadi Doshas and
consequently in its turn vitiates Rakta etc., there by producing mukha vairasya,
hritshula, sadana. Continuous lavana tiktamla chardi, daha, atinidra, malabaddhata,
vivarnata, shosha, aruchi, restlessness as uneasiness and watering in the mouth
(praseka). All the symptoms stated in prameelakam. In Asthanga sangraha, we find
this term under kaphaja vyadhis and some authors read and term atinimitya as
prameelaka.
Amlapitta:
The implication of the term Amlapitta signifies the abnormal state of Pitta especially
by its Amla guna.
Pitta visoochikam:
This may pertain to both the types of Amlapitta urdwaga and adhoga Amlapitta,
where their respective cardinal features are urdhwapravritti (vamana) and
Adhapravrutti (atisara) of Pitta discordance associated with burning sensation.
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Pittamla:
This term would imply the sense of the term Amlapitta.
Shuktaka:
Means amlodgar (acid or sour eructation)
Amlaka:
Refers to one of the nanatmaja vyadhi of Pitta. This produce antardaha (kostha daha)
Hridaya shula and amlodgar.
Amleeka:
Means Amlodgar and would refer to one of the lakshanas of saama pitta, the factor
from which Amlapitta is produced.
BHEDAS (CLASSIFICATION) :
Amlapitta has been classified under the distinct heading viz.-
CLASSIFICATION OF AMLAPITTA:
Based on gati 105, 106, 107 Based on Doshasamsarga Based on Dosha’s
Urdhwaga Adhoga M.N108 & B.P109 Y.R110 Kashyapa111 Sharangadhara112
Sanila Sanila
Sanilakapha Sanilakapha Vataja Vataja
Sakapha Sakapha Pittaja Shleshmaja
Kapha pittaja Kaphaja Shleshmajavataja
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In the process of genesis of Amlapitta pathology it is necessary to consider the organs
in concern. Specifically stomach and intestine have its impact on the genesis of
Amlapitta. Here a stretch has been given towards Amashaya
AMASHAYA:
Chakrapani has commented that Amashaya is divided into two parts as upper and
lower. The upper part is the seat of kapha and the lower part is for the pitta. 113
Sushruta says upper connection to the Anna Nadi as Argala or Amashaya Dwara. This
latter is also known as Grahani Sushruta has very clearly stated that Amashaya is seat
of Kapha.
ANNAVAHA SROTAS: 114
It may be recalled that the terms are mahasrotas, kostha, Amashaya, Pakwashaya,
Kshudrantra, Brihadantra etc., were used to designate the gastrointestinal tract with
which the Pachakapitta is immediately concerned.
Charakacharya’s opinion about the moolas of Annavaha Srotas has relevance here.
According to him its moolas are,
1. Vama Parshwa
2. Amashaya
With out going to a detailed anatomical substation on Annanalika or esophagus and
the urdwa amashaya (stomach) may be taken in this connection of the reference made
by Charaka in 2nd chapter of his vimansthana.
PITTADHARAKALA: 115
The inner layer of the Amashaya called (relatively present more in Grahani) as
Pittadharakala also known as Grahani. It separates sara, kitta and activity of it
depends upon Agni. The Pachakapitta produced by Pittadharakala, which is situated
nearer to amashaya.
AGNI: 116, 117
The Agni otherwise Kayagni described as Pitta by Sushruta. Even Charaka has
mentioned Pitta is the form of Agni. Human body is made by Pancha mahabootas but
Pitta is having more qualities of Ap and prithvi mahabootas. This agni or Pitta digests
food ingested and it is said Bhagwan. Agni has the qualities as Rooksha, neither drava
or Ghana and moves upwards. There are four functional types of Agni. They are
Mandagni, Teekshnagni, Vishamagni and Samagni .
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AHARA PACHANA
Chiefly Pachakapitta digests indigested food. And the seven Dhatwagnies are also
takes parts in intermediate metabolism. The food mainly undergoes three stages or
avasthas. They are:
1. Prathamana Avastha or Madhura Avastha
2. Dviteeyavastha or Amlavastha
3. Triteeyavastha or Katu avastha.
The non-homologous foods indigested subjected for mastication in mouth and
physical constitutions of food is vigorously changed in stomach because of its
movements in stomach Pachakapitta or Acchapitta (Hydrochloric Acid) changes
further its constitution chemically and starts the non homologous food transformation
into homologous.
Lavana Rasa in malaroopa Kapha is subjected for madhura vipaka118 in due course. In
pachchamanavastha, the partly digested food being propelled from urdwa amashaya
into the Adhoamashaya enters into amlapaka due to the predominance of Pitta. These
stages include two important stages as amlarasa. Padharthas gets digested and
secretion of digestive juices in to Amashaya takes places. The outcome of this stage
of digestion in the production of Vidagdha Ahara. 119
The word “Vidagdha” is interpreted as pakwapakwam the partly or not fully digested.
The implication here is that the food in this state is not yet fit for absorption and
utilization in metabolic process to dhatwagni paka.
The Amlabhava stage:
In this stage the digestive juices are acidic in nature due to the presence of
Hydrochloric acid. Whereas the bile , pancreatic juice act in an alkaline medium only.
Amlavastha in the digestive process indicates three important aspects.
1. The partly digested food, which moves down into the Adhoamashaya, is capable
of stimulating abundant production of clear Pitta of Amla states.
2. The dietary articles whose constitutes are Amla in taste are digested in this stage.
3. The Rasa of the end products in this stage are Amla.
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PACHAKAPITTA: 120, 121
Ayurveda Acharyas affirmed every state of disease, which is developed because of
impaired Agni. There fore treating Agni it self said as treating the whole body.
The Pachakapitta is said to be located in the interior of the Amashaya and
Pakwashayas. These two Ashayas are separated by Argalam. Inner layer of these two
Ashayas is said as Pittadharakala by which produce Pachakapitta. This is
Pittadharakala known as Grahani as it retains food till the time of completion.
FUNCTIONS OF PACHAKAPITTA: 122, 123
Kosthagni is the leader of all the factors is consideration to that of digestion in living
beings. 68 It gives life span, complexion, vitality, vital essence, good health, glow,
luster, plumpness, enthusiasm, heat and life breaths are developed from dehagni, it is
added that who maintain antaragni good he never be victim of disease. Sushruta stated
that the integrity of Grahani depends upon Agni, therefore Agni or the Pachakapitta
is said as one of the major component in maintenance of health in living beings.
SAMANA VATA: 124,125,126
Samanavata is located nearer to the Agni (Pachakapitta) and Amashaya. Capable of
digesting all the varieties of food ingested by man. It helps in dividing to sara and
kitta then it propels kitta later parts of annavaha srotas .
KLEDAKA KAPHA: 127
Kledakakapha is located in the Amashaya. It disintegrates breaks and liquefies the
food kledakakapha it is said to be one of the protective mechanisms against
Hydrochloric acid secreted in to stomach.
NIDANA PANCHAKA:
Even though some disease may be diagnosed by a single among these five (nidana,
poorvarupa, rupa, upashayanupashaya and samprapti.), it is better to go through all the
five. Not only for diagnostic purpose, it even helpful in the treatment aspect,
“Sanskepathaha kriyayogo nidanaparivarjanam128 and “Samprapti vigatanameva
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chikitsa”, which are fundamental principles of chikitsakarma. And even helpful in
knowing the sadhyasadhyata of the disease.
NIDANA: 129,130,131
The general causes which are responsible for provoking pitta are also responsible for
causing the disease Amlapitta. Because the vitiated dosha here is pitta. So generally
food and habits which are responsible for the vitiation of pitta are responsible for the
Amlapitta disease.
Along with these, vata and kapha are also having a role in the causation of Amlapitta,
particularly in the vataja, kaphaja, vatakaphaja types of Amlapitta, where these doshas
are in the anubandha or samsarga state.
By going through the classics the nidana of Amlapitta disease may be classified
under,
Ahara sambhandi
Viharasambhandi
Anya, which includes kala, desha, manasika vikaras etc.
The causative factors responsible for Amlapitta related to the food articles that is,
annapana are considered under ahara sambandhi and others regarding the non-
congenial activities like diwaswapna, vegadharana, atisnana etc are considered under
vihara sambandhi nidana.
Anya includes kala like Varsha-Sharad rutu, desha like Anupadesha, manasika vikaras
like krodha, irsha etc. which are generally pittaprakopaka in nature.
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Table No- 10 SHOWING THE NIDANA OF AMLAPITTA
Sl.No NIDANA 1. Abhishyandi. 2. Adhika dravapadartha sevanam. 3. Adhyasana. 4. Ajeerna. 5. Ama. 6. Amla bhojanam. 7. Amlapadartha sevanam. 8. Antarodakapanam. 9. Apakwa madhyam. 10. Apakwa ksheeram. 11. Atiavagaham. 12. Atiruksha bhojanam. 13. Atisnanam. 14. Atisnigdha bhojanam. 15. Atiushna bhojana. 16. Brustha dhanyam. 17. Divaswapna. 18. Dusthanna bhojanam. 19. Guru bhojanam. 20. Ikshu vikaras. 21. Kulutham. 22. Paryushita bhojanam. 23. Phanitham. 24. Pisthannabhojana. 25. Pitta prakopa anna pana. 26. Pruthuka. 27. Pulaka (tusha). 28. Vegadharanam. 29. Vidahi padartha sevanam. 30. Viruddhashana.
Charaka stated that kulattha sevana, lavana rasa adhika sevana and viruddha
(unwholesome) aharasevana are the causative factors for Amlapitta.
There is no specific commentary of sannikristha and viprakristha karanas for
Amlapitta. Viruddha, dustha, amla, vidahi, pittaprakopaka anna pana etc may be
sannikristha karana and Varsha rutu may be considered as viprakristha karana.
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POORVA RUPA:
Before dealing with rupa of Amlapitta, it is necessary to deal with the poorvarupa of
that disease.
There are supposed to be the symptoms which indicates or forecast the probable
development of Amlapitta in near further. These symptoms occur during the
sthanasamshraya stage of the pathogenesis. 132 Infact, the Ayurvedic classics do not
mentioned the poorvarupa of Amlapitta. Still however the lower intensity of the
symptoms may be considered here as the poorvarupa of Amlapitta.
RUPA: 133,134
The rupas of Amlapitta has been separately mentioned in the classics.
GENERAL SYMPTOMS (SAMANYARUPA):
These are the symptoms, which develop during the vyakta stage of pathogenesis of
Amlapitta and these indicate the onset of the disease.
Table No-11 SHOWING THE SYMPTOMS OF AMLAPITTA.
No. LAXANAS K.S135 M.N136 B.P137 Y.R138
1. Amlodgara. + + + +2. Amlotklesha. + - - -3. Angasada. + - - -4. Antrakujana. + - - -5. Aruchi. - + + +6. Atisara. - + + +7. Avipaka. - + + +8. Chardi. - + + +9. Gourava. - + + +10. Gurukosthata. + - - -11. Hrid daha. - + + +12. Hrid shula. + - - -13. Kanthavidaha. + + + +14. Klama. - + + +15. Romaharsha. + - - -16. Shiroruk. + - - -17. Tiktodgara. - + + +18. Udgaradmana. + - - -19. Urovidaha. + - - -20. Utklesha. - + + +21. Vidbheda. + - - -
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SPECIAL SYMPTOMS (VISHISTHA RUPA):
These are also the symptoms which develop during the vyakta stage of Amlapitta. But
they differ from the general symptoms in the sense that these show the relationship
with particular individual dosha or combined doshas, where as the general symptoms
do not do so. More ever, by means of these symptoms Amlapitta can be differentiated
from the other disease, which is having the similar type of symptoms.
UPASHAYANUPASHAYA: 139,140
Here in case of Amlapitta, Kashyapa explained about upashaya for vataja, pittaja,
kaphaja Amlapitta. In vataja Amlapitta snigdha ahara, in pittja Amlapitta sheeta ahara
and in kaphaja Amlapitta ruksha ahara are said to be as upashaya. 141 The anupashaya
of Amlapitta are not mentioned in texts. But however the causative factors and
aggravating factors themselves may be taken as anupashaya.
SAMPRAPTI OF AMLAPITTA: 142,143,144
According to Charaka: Even though the detailed description of Amlapitta is not
available regarding Amlapitta in Charaka Samhita, but while describing the Grahani
chikitsa explained that the pitta which gets amlatva in its quality can be taken as
Amlapitta. And also while going through it, Acharya explained that the pachakagni
gets vitiated due to its own vitiating factors. This dushitagni looses its capacity to
digest even a small amount of food, (Laghu ahara). The ahara being undigested gets
shuktatwam and acts like visha. This amavisha causes the ajeerna. The undigested
food which is in the form of amavisha, when combines with vitiated pitta then daha,
trishna, diseases of mouth, Amlapitta and other pittavikaras will occurs. 145
Acharya Kashyapa explained the samprapti of Amlapitta in detail. Due to nidana
sevana doshas become aggravated and affects the agni to produce jatharagnimandya,
and hence the ahara, which is consumed, becomes attaining the state of vidagdhata.
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This vidagdha amarasa later undergoes shuktapaka in amashaya. In this condition
whatever the food consumed is converted into vidagdhata by dushitapitta (vidagdha
pitta). This condition is known as Amlapitta.146
Kashyapa explained the samprapti of Amlapitta by giving an example. i.e, when curd
is in vessel if we pour milk in that, soon after it gets converted into curd. In the same
way when Rasadhatu is amlayukta if consumed anything then it converts itself into
vidagdha and shuktata. 147
According to Madhavanidana, Madhavakara explains the samprapti of Amlapitta.
That is the pitta which is already sanchita (accumulated) due to its self aggravating
factors further attains vidagdhata due to consuming the viruddha, dustha, amla,
vidahi, pitta prakopaka ahara pana and kala etc and produces the symptoms like
hritkanthadaha, avipaka, klama, utklesha, tikta amlodgara, gourava, aruchi, chardi etc.
148 When dushita dosha traveling shukta ahara towards urdhvabhaga i.e., amashaya,
the condition said to be Urdhvaga Amlapitta and if traveling towards adhobhaga, the
condition said to be Adhoga Amlapitta.
In terms of Kriyakala the samprapti has got its stages and it attains these stages for a
complete manifestation of the disease. They are chaya, prakopa, prasara,
sthanasamshraya (which leads to Dosha-Dushya Sammurchana) and further
vyaktavastha and finally Bhedavastha.
The reason for their settlement at a particular site i.e., sthanasamshraya has been
explained as “Khavaigunya”, which acts as obstruction in the spreading of the vitiated
doshas.
The process of the production of disease by, spreading vitiated doshas is called
pathogenesis or samprapti. That pathogenesis is discussed on the basis of Sankhya,
Vidhi, Vikalpa, Pradhanya and Bala Kala vishesha.
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SAMPRAPTI GHATAKA OF AMLAPITTA: 149
Dosha Pittapradhana kapha
Dushya Rasadhatu
Agni Pachakagnimandyata
Srotas Annavaha, rasavaha and raktavaha
Srotodusthi Sanga, vimargagamana
Udbhavasthana Amashaya
Sancharasthana Mahasrotas (Annavaha srotas)
Vyaktasthana Amashaya
Samutthana Amashaya samuttha
Avastha Sama
Rogamarga Abhyantara
Adhisthana Shareera
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PATHOGENESIS OF AMLAPITTA:
By going through the etiological factors of Amlapitta, it will be quite evident that
Amlapitta may be produced by different factors. These factors if initialized
individually or collectively in both the conditions, Amlapitta may be produced and on
the basis of the definition of samprapti according to Ayurveda the pathogenesis of
Amlapitta may be presented in adiagrammatic scheme as under.
DIAGRAMATIC PRESENTATION OF AMLAPITTA SAMPRAPTI:
Pittaprakopaka nidana sevana vata and Kaphakaraka nidana
Pittasya amlaguna vriddhi vata and kapha vriddhi
Pittasya vidagdhavastha jatharagnimandya
Vidhagdha anna
Shuktapaka in amashaya
Aruchi, avipaka, utklesha,chardi
Tikta – amlodgaradi laxana utpatti
Amlapitta
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UPADRAVA: 150
Kashyapa explained upadravas of Amlapitta, namely jwara, atisara, pandutwa, shula,
shotha, aruchi and bhrama.
The occurance of these in Amlapitta, and in case of ksheena dhatu made the latter
asadhya or incurable.
In sidhanta nidana, they mentioned eleven upadravas of Amlapitta. Namely
sheetapitta, udarda, kotha, kandu, mandala, vicharchika, visphota, peedaka, urdhvaga
raktapitta, adhoga raktapitta and grahani.
SADHYASADHYATA: 151
In case of Amlapitta, Navotthita (early stage) is curable with efforts. When it will
becomes chronic and continuous, considered to be yapya or curable with difficulty in
a person who adopts wholesome diets and controlling the self. If Amlapitta
accompanied with complications then it becomes yapya or asadhya.
CHIKITSA VIVECHANA: 152,153
The first obvious requirement before proceeding to the treatment is the diagnosis of
the clinical variety to which a given case of Amlapitta belongs. That is,
“Rogamadou pareekshet tatonantharamoushadam.”
A careful enquires has to be made to ascertain the cause or causes responsible for the
disease. So that to adopt a principle “Nidana parivarjana meva chikitsa”. 154 Which
is applicable to every disease.
The primary importance of chikitsa lies in breaking up of Samprapti and the integrate
factors of it. There is a general principle in Ayurveda i.e.,
“Samprapti Vighatanameva chikitsa”.
It means separating the components of factors of pathogenesis.
Chikitsa Karma of a disease is adopted according to Rogibalam and Rogabalam.
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The below mentioned general principles should be taken in to consideration for
treating any disease.
“Samshodhanam Samshamanam, Nidanasya Cha varjanam l Etavat Bhishaje
Karayam Roge roge yatha vidhi” 155
Hence it is stated that Samshodhana, Samshamana and Nidana parivarjana have to be
applied based on suitability in all the diseases and Amlapitta cannot be an exception
to this principle.
NIDANA PARIVARJANA:
Whatever might be the chikitsakrama either Shodhana karma or Shamankarma,
nidana parivarjana is outstanding here. In the context of Amlapitta chikitsa, Acharya
Kashyapa explained about nidana varjana, texts have laid greater significance to this.
To be more prices amla, ushna, vidhagdha, teekshna, katu, padartha should be
avoided in Amlapitta.
SAMSHAMANA CHIKITSA: 156,157
It includes Langhana, Laghubhojana and usage of various dravyas, which possess the
properties of pachana, deepana have to be administered. Apart from this all the
pittashamaka dravyas specifically acting on annavaha srotas like amalaki, shatavari
yasthimadhu, guduchi, shukti, shanka etc. have to be administered. In all Ayurvedic
texts, there is explaination to take tikta rasa pradhana ahara, aoushadha and pana in
Amlapitta. Madhura ahara and madhura takrapanam also help in relieving Amlapitta.
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SAMSHODHANA CHIKITSA:
In order to dislodge ama, shamana have to be used only after shodhana in the
treatment of Amlapitta.
The shodhana procedures indicated in the treatment of Amlapitta are, Vamana,
Virechana, Asthapana basti and Raktamokshana. These are adopted by considering
the doshanubhanda, rogibala, rogabalam etc.
In Amlapitta chikitsa, Acharya Kashyapa, Bhavamishra and Yogaratnakara have
mentioned the line of the treatment as vamana, virechana and shamana therapy.
In Bhaishajya ratnavali and Chakradatta there is a mention of vamana, virechana,
anuvasana and asthapana basti in the context of Amlapitta chikitsa. 158
Raktamokshana is explained in Yogaratnakara and by Vangasena.
In case of Bahudoshavastha and depending upon rogibalam doshanubandhata. The
general principle is to do vamana, if the doshas are sited in urdhva amashaya and to
adopt virechana karma if the doshas are sited in adho amashaya. 159 Because the main
objective of treatment in amashayottha vyadhis including Amlapitta is to expel the
doshas from nearest route i.e., by vamana and virechana karma. According to this
principle Acharyas mentioned vamana karma in urdhvaga Amlapitta and virechana
karma in adoga Amlapitta.
After the vamana virechana, bastikarma has to be done to cleanse the residual morbid
matters. Whenever vata is predominant dosha anuvasana basti is usual procedure
followed before giving asthapana basti.
When the doshas do not subside by above-mentioned procedures, Acharya Vangasena
advised to adopt raktamokshana procedure. This procedure is beneficial in Amlapitta
associated with kotha, mandala laxanas that synchronizing raktadusthi.
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PATHYAPATHYA:
The ancient acharyas have given much more importance to patyapathya of each and
every disease.
The term pathya means, the one, which is compatible to health, and the one, which is
not conductive to health,160 is called apathya.
The pathya can be merely correlates with upashaya and sathmya.
Only adopting pathya or wholesome regimen can cure diseases. But without following
pathya, which comprises of wholesome ahara, vihara and charya, any amount of
medicine may not help in curing the disease.
So pathya plays an important role in curing the disease.
The following are pathyas mentioned in Amlapitta.
Laghu bhojana, purana shali, purana yava, purana godhuma, mudgayusha, lajasaktu.
The jangala mamsarasa, kalaya shaka, karanja rasa, goghrita, and other than these the
drugs which are having tikta rasa pradhana and laghu in property.
Tikta rasa pradhana ahara and paneeya are more beneficial in Amlapitta. 161
The drugs, which are not having vidahi property and the foods, which are sathmya to
the body, are considered as pathya. 162
Karkota, karavella, patola, nimba, kushmanda, kapittha, dadima, all sorts of food and
drinks having the property of pacifying kapha and pitta are considered as pathya. 163
The drugs, which provokes pitta dosha and kapha dosha as well as vitiates the agni are
considered as apathya for Amlapitta. Navadhanya, pittaprakopaka ahara,
vegavarodha, tila, masha, kulatta, amla katu padartha sevana, danyamla, atilavana,
barjitha padartha, dadhi, dhoomapana, and madhya sevana are considered to be
apathya for Amlapitta
The responsible factors of Amlapitta are also acts as apathya.
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Kashyapa suggests change of place or environment and rehabilitation in new to
protect life for four fold achievements. 164
NIDANARTHAKARA ROGA:
However there is no any direct explanation regarding the nidanarthakara roga for
Amlapitta. But still some diseases like ajeerna, vidagdajeerna, shleshmaja krimi roga,
may be considered as nidanarthakara roga for Amlapitta.
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PHARMACOGNOSTIC STUDIES:
Due to vast gap in the development of Ayurvedic system in the country and non
availability of original literature proper descriptions and gradual decline of expert in
the system itself, the identification of drug has become an enigma. The traditional
system of medicine in the third world are confronted with problems like establishing
standard appropriate references for fixing specifications, identity, purity, strength,
good manufacturing etc. Hence, it is necessary to adopt some methods available in
other sciences to assess this crude drug, they are taxonomic, phytochemistry,
pharmacognosy, pharmacology etc.
The previous observation concentrates on evaluation of macroscopic and microscopic
characteristic features of stem, root and leaf of Andrographis paniculata Nees.
Macroscopic study: Observations are,
Leaves – Simple, opposite, short petioled.
Stem - Quadrangular.
Inflorescence – Panicles.
Flowers – Racemes or panicles.
Fruits – Capsules erect, compressed, thinly glandular hairy.
Seeds – Numerous, sub-quadrate.
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Microscopic study:
Materials:165
Napkin, watch glass, test tubes, painting brush, a sharp razor blade, micro slides,
cover slips, a beaker full of water, a dropper, filter paper/blotting paper, stains, drug
sample, forceps, needles etc.
Method: 166
For the stem/root of the drug, cut a cylindrical portion which is almost straight and cut
off both edges so as to make the edge surface smooth. This sample is ready for section
cutting. Hold the sample vertical between the first, second finger and the thumb and
move the blade back and forth from one to the other, obtaining fine slices. Take
sufficient number of sections, as all sections will not be very fine and uniform.
Transfer the sections to a watch glass containing water with the help of the brush.
Reject thick and oblique one.
Similarly, cut sections of the leaf in the block of pith which shall give sections of the
leaf when separated from pith. Transfer the sections to a watch glass with a brush.
Microscopic characteristic features of stem, root and leaf are,
Anatomy of stem:
Anatomy of young stem in ground plan reveals that, the stem is rectangular and
differentiated in to three regions; epidermis, cortex & stele.
Epidermis:
It is outermost layer of stem made up of single layered parenchyma tissue. The cells
are barrel shaped, compactly arranged without any intercellular space. Epidermis is
covered by thick cuticle.
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Cortex:
Epidermis is followed by cortex. In young stem it is differentiated into three regions;
hypodermis, general cortex and endodermis. Hypodermis is 2-3 layered,
collenchymatous. General cortex is parenchymatous. Endodermis is single layered,
parenchymatous.
Stele:
In young stem it is bounded by single layered parenchymatous pericycle. Vascular
bundles are conjoint, collateral and open. They are capped by multicellular
sclerenchymatous bundle cap. Metaxylem towards periphery and protoxylem towards
pith (Endarch). Phloem is towards pericycle. In between xylem and phloem there is
strip of cambium. Pith is large parenchymatous.
Matured stem shows secondary growth in the stelar region, hence xylem tissue
differentiated as secondary xylem, more in quantity. Phloem is crushed due to
pressure created in the stele due to addition of xylem elements.
Anatomy of root:
The root system is taproot system. Anatomy of young primary root reveals that,it is
differentiated into three regions; epiblema, cortex and stele.
Epiblema:
Is an outer most, single layered in thickness, cells are parenchymatous, thin walled
with unicellular hairs.
Cortex:
Cortex is differentiated in to multicellular parenchymatous general cortex and single
layered endodermis. The cells of endodermis having Casparian strips.
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Stele:
Stele is bounded by single layered parenchymatous pericycle. The xylem and phloem
tissue arranged in separate radii, hence known as radial type. Xylem is in tetrarch
condition, similar to typical to dicots. Metaxylem towards pith and protoxylem
towards pericycle (Exarch). Pith is small or absent.
Mature root shows a secondary growth as stem, because of this reason large amount
of xylem is seen in the stele. Epidermis is also ruptured due to same.
Anatomy of the leaf:
The anatomically as in typical dicots, leaf is dorsiventral, is differentiated into
epidermis and mesophyll tissue.
Epidermis:
As in typical dicots, the leaf covered by two epidermises, upper and lower. Both are
single layered, parenchymatous and covered with thick cuticle. Lower epidermis
having more stomata than upper epidermis.
Mesophyll tissue:
It is differentiated into palisade parenchyma towards upper half of the leaf and spongy
towards lower half. Both the cells having chloroplasts hence are photosynthetic in
function.
The vascular bundles are conjoint, collateral having xylem towards the upper side and
phloem towards the lower side. Vascular bundles are covered by parenchymatous
bundle sheath.
The midrib is prominent, the upper region is of pyramid shape, while the lower region
is bluntly rounded the leaf being dorsi-ventral, the midrib is covered on dorsal side by
an upper epidermis consisting of rectangular cells arranged continuously and covered
on outer side by a thin continuous layer of cuticle. The lower epidermis is
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discontinuous due to the presence of superficial stomata placed at a distance. Below
the epidermis there is a collenchymatous hypodermis.
DETERMINATION OF TASTE:
In almost all the texts, the taste of Kalamegha is mentioned as tikta. The taste by
tongue is the best method of identifying any taste. Hence, an experiment of volunteer
method determination of taste by tongue was followed. Twenty-five healthy
volunteers were selected and requested to clean and wash their mouth by cold water
and gave the panchanga powder of Kalamegha to examine the pradhana and anurasa.
The data obtained shows the determination of taste according to their priority.
PRELIMINARY PHYTOCHEMICAL SCREENING: 167
The plant may be considered a biosynthetic laboratory, not only for the chemical
compounds such as carbohydrates, proteins and lipids that are utilized as food by
man, but also for a multitude of compounds like glycosides, alkaloids, volatile oils,
tannins, etc., that exert a physiologic effect. The compounds that are responsible for
therapeutic effects are usually the secondary metabolites. A systematic study of a
crude drug embraces through consideration of both primary and secondary
metabolites derived as a result of plant metabolism. The plant material may be
subjected to preliminary phytochemical screening for the detection of various plant
constituents on the following lines.
Methodology
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Successive solvent extraction:
1. Extract about 500 g of the air-dried powdered plant material successively with the
following solvents in a Soxhlet extractor.
a) Petroleum ether (60°C)
b) Benzene (80.1°C)
c) Chloroform (50°C)
d) Ethanol 99.9% (82.3°C)
Each time before extracting with the next solvent, dry the powdered material in air-
oven below 50°C.
2. Finally, macerate and homonize the drug with chloroform water for 24 hours to
obtain the aqueous extract.
3. Concentrate each extract by distilling off the solvent and then evaporating to
dryness on the water-bath.
4. Weight the extract obtained with each solvent and calculate its percentage in terms
of the air-dried weight of the plant material. Also note the weight and consistency
of the extract.
Weight of the extraction = extraction obtained X 100 / weight of the sample.
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Preliminary tests:
The preliminary tests were made by using the five different extracts of Andrographis
paniculata Nees. panchanga.
A. Proteins:
1. Biuret test:
2 ml of 10% copper sulphate solution was added to 2 ml. of test solution, mixed well
and 2 drops of 1% CuSO4 solution was added. Violet or pink colour indicates the
presence of two or more peptide bond of proteins.
2. Ninhydrin test:
1 ml. of 0.1% freshly prepared ninhydrin solution was added to 4 ml. of the test
solution, which should be neutral pH. The contents were mixed and boiled for a
minute and was allowed to cool. Violet or purple coloured solution indicates the
presence of aminoacids and proteins.
3. Xanthoproteic test:
1 ml. of conc. HNO3 was added to 5 ml. of the solution. The contents were boiled and
cooled. Appearance of yellow colour indicates the presence of nitro derivatives of
aromatic-aminoacids. To this solution 40% of NaOH was added. A deep orange
colour solution indicates the presence of sodium salts of nitro derivatives of aromatic
aminoacids.
4. Hopkins-Cole test:
Two ml of glacial acetic acid was added to 2 ml of the test solution and mixed well.
To this 2 ml conc. H2SO4 was added carefully along the sides of the test tube. The
formation of violet ring in the junction of two liquids indicates the presence of indole
group of tryptophan.
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5. Sulphur test:
Two ml of 40% NaOH solution and 10 drops of 2% lead acetate solution were added
to the 2 ml of solution and the contents were boiled for a minute and cooled back.
Precipitate indicates the presence of sulphur containing amino acids of proteins.
Carbohydrates test for starch:
a) Molisch’s test:
Two drops of Molisch’s reagent was added along the sides of the test tube. At the
junction of two liquids a red cum violet coloured ring indicates the presence of
carbohydrates.
b) Iodine test:
Fehling’s test:
One ml of Fehling’s solution “A” and one ml of Fehling’s solution “B” were
added to 1 ml of test solution. The contents were mixed well and boiled for a
minute. Yellow or brownish-red ppt indicates the presence of the reducing
sugars.
Benedict’s test:
Two ml of Benedict’s reagent was added to five drops of the test solution.
Boiled for a minute in a water bath and cooled, yellow, red or green colour
precipitate indicates the presence of reducing sugars.
Non-reduction sugar such as sucrose:
a) Benedict’s test:
Benedict’s test showing no characteristic colour formation indicates the presence of
non-reducing sugars in the test solutions.
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Tannins:
a) Gelatin test:
The solution was evaporated to dryness and the residue was dissolved in gelatin 2%.
To this, salt solution (10% NaCl) was added. A white precipitate was obtained which
indicates the presence of tannins.
Anthocyanins:
a) Aqueous NaOH test:
1 ml of aqueous NaOH solution was added to the 1 ml test solution, formation of blue
to violet colour indicates the presence of anthocyanins.
b) Conc H2SO4 test:
1 ml of Conc H2SO4 was added to the 1 ml test solution, formation of yellow to
orange colour indicates the presence of anthocyanins.
Glycosides:
a) Molisch’s test:
1 ml of Molisch’s reagent and 1 ml of Conc H2SO4 was added to the test solution,
formation of reddish violet colour ring at the junction of the two liquids indicates the
presence of glycosides.
b) Conc H2SO4 test:
1 ml of Conc H2SO4 solution was added to the 1 ml of solution and was allowed to
stand for 2 minutes. Formation of reddish colour indicates the presence of glycosides.
c) Keller-kiliani test:
The test solution was dissolved in glacial acetic acid boiled for a minute and cooled.
To this solution 2 drops of ferric chloride solution was added, the contents were
transferred to a test tube containing 2 ml. of concentrated sulphuric acid. A reddish
Methodology
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brown colour ring was observed at the junction of two layers indicating the presence
of glycosides (Gokhale et al 1993).
Saponin:
a) Foam test:
Extract is shaken vigorously with distilled water in a test tube. Honey comb like foam
produced, persists for few minutes. It confirms the presence of Saponin.
Flavanoids:
a) Flavanoids test:
The presence of flavanoids is detected by the development of scarlet and cherry red
colour in alcoholic extract when a few drops of sulphuric acid with few magnesium
turnings were added to the test solution. These colours usually indicate flavanoids.
Scarlet colour indicates flavones deep cherry red colour indicates the presence of
flavanoids.
Pew’s test (Zn/Hcl) for dihydroflavonols:
A pinch of zinc powder and 5 drops of 5 NHcl were added to the test solution. It gives
a deep purple red (dihydroquercetin) or cherry red (dihydrokaemfeol) colours (Pew,
1948). Flavones, dihydrochalocones and other flavanoids gives at most pinkish or
brownish colour (Dey and Harborne, 1989).
Shinoda test (Mg/Hcl):
This test is applied in the same way as Zn/HCl, but magnesium powder was used
instead of Zinc. The development of a deep-red or magenta colour of the solution is
an indication for the presence of flavone dihydroflavanol. Dihydrochalcones and other
flavanoids do not react with the reagent (Dey and Harborne, 1989).
Methodology
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61
Aqueous NaOH solution:
1 ml of aqueous NaOH solution was added to the 1 ml test solution. Formation of
yellow colour indicates the presence of flavanoids.
Conc H2SO4 test:
1 ml of Conc H2SO4 was added to 1 ml test solution, formation of red colour indicates
the presence of flavanoids.
Phenols:
a) Phenol test:
When 0.5 ml of Fecl3 solution was added to 2 ml of test solution, formation of an
intense colour indicates the presence of phenols.
Steroids:
a) Salkowski test:
A wine red colour was developed when chloroform H2SO4 were added to the test
solution, it indicates the presence of Steroidal nuclei.
b) Liberman and Burchard test:
The blue-green colour was developed in the test solution when treated with 50%
H2SO4 and acetic anhydride to the test solution indicates positive reaction for steroids.
Alkaloids:
The various extracts were mixed well with ammonia and then extracted with
chloroform, the chloroform solution is then extracted with 0.1N HCl and filtered. The
filtrate was used for further test.
a) Mayer’s test:
The filtrate when mixed with few drops of Meyer’s reagent gives creamy white
precipitate.
Methodology
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b) Wagner’s test:
The filtrate when mixed with few drops of Wagner’s reagent gives reddish brown
coloured precipitate.
c) Dragendroff’s test:
The filtrate when added with few drops of Dragendroff’s reagent gives orange red
colour.
Estimation of Flavanol:
The total amount of flavanol was estimated by Swain and Hillis (1959 method).
Proceedure:
500 mg of plant material was extracted with 10 ml of methanol. 1 ml of plant extract
was taken in a test tube and diluted to 4 ml with distilled water within 10-15 secs. To
this ‘4 ml’ of vanillin reagent (freshly prepared) and 2 ml of distilled water were
added. Shake the contents of the test tube and keep the test tube in a water bath at a
temperature below 35oC for 20-30 minutes. The test tubes were kept at room
temperature, for exactly 15 minutes obtained a strong red colour. The observance was
measured at 500 nm and calculated the flavanoid contents by using a standard curve
prepared with phloroglucinol of different concentrations.
Estimation of total Tannin by Folin Denis method (Schanderi, 1970):
Proceedure:
0.5 gms of the powdered material was transferred to a 250 ml conical flask. 75 ml of
distilled water was added. The flask was heated gently and boiled for 30 minutes,
centrifuged at 2,000 rpm for 20 mins and collected the supernatant in 100 ml
volumetric flask and made up the volume.
Methodology
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One ml of the sample extract was transferred to a 100 ml volumetric flask containing
75 ml of water, added 5 ml of Folin-Denis reagent, 10 ml of sodium carbonate
solution and diluted to 100 ml with distilled water and shaken well. The blue colour
intensity was measured in a spectrophotometer. Read the absorbance at 700 nm after
30 mins and make a 30 times dilution of the sample with distilled water and prepare a
standard graph by using 0-100 mg tannic acid. Calculate the tannin content of the
samples as tannic acid equivalents from the standard graph expressed as mg/100mg.
STANDARDISATION AND VALIDATION:
PHYSICO-CHEMICAL TESTS: 168
Determination of moisture content:
Materials:
Petri plates, Physical balance, Desiccators, Oven.
Method:
2 gms of the sample was taken in the previously weighed Petri plates. Petri plates
were kept in the oven maintained at 1100c for drying. After 3 hours Petri plates were
taken out and weight was noted down. This procedure was repeated for 4-5 times
until the constant weight is reached.
% Moisture = difference in weights X 100/ weights of the sample.
Methodology
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Determination of ash content:
Materials:
Silica crucible, Physical balance, Desiccators, Bunsen burner.
Method:
Weight of the empty crucible was noted down. 2 gms of the sample was taken in the
previously weighed crucible and was heated on a Bunsen burner until it turned into
ash. It was then cooled in desiccators and weighed.
% Ash = difference in weights X 100/ weight of the sample.
Determination of water insoluble ash:
Materials:
Silica crucible, Hot water, Ash less filter paper (what Mann No.42), Desiccators.
Method:
The ash obtained from the above test was dissolved in H2O and filtered. The water
insoluble as collected on the filter paper was heated again on the Bunsen burner until
it turned into ash. The crucible was cooled in the desiccators and weighed.
% Water insoluble ash = difference in weights X 100 / weight of the sample.
Determination of acid insoluble ash:
Material:
Silica crucible, 25% Hcl, Ash less filter paper (what Mann no.42), Desiccators.
Method:
The water insoluble ash obtained is dissolved in 15ml of 25% HCL and then filtered.
The acid insoluble ash collected on the filter paper was heated again. The crucible
was cooled in the desiccators and weighed.
% Acid insoluble ash = difference in weights X 100 / weight of the sample.
Methodology
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Determination of water soluble extractive:
Materials:
Volumetric flask, Distilled water, Chloroform, Filter paper, Evaporating dishwater
bath, Oven, Desiccators, Physical balance.
Method:
5 gms of the powder was taken in the volumetric flask. Few drops of chloroform were
added to avoid the fungal attack; subsequently 100 ml of distilled water was added. It
was kept for 24 hours, shaking frequently during the first six hours. The solution was
filtered the next day and 25 ml of this filtrate was evaporated in a previously weighed
evaporating dish on a water bath. Later it was dried in the oven at 1100c to remove the
traces of water. Weights were noted.
% Water soluble extractive = difference in weights X 100 / weight of the sample.
Determination of alcohol soluble extractive:
Materials:
Volumetric flask, Evaporating dishwater bath, Oven, Physical balance.
Method:
5 gms of the powder was taken in the volumetric flask. 100 ml of alcohol was added
to it, flask was kept for 24 hours, shaking frequently during the first six hours. The
solution was filtered the next day and 25 ml of this filtrate was evaporated in a
previously weighed evaporating dish on a water bath. Later it was dried in the oven at
1100c to remove the traces of alcohol. Constant weights were noted down.
% Alcohol soluble extractive = difference in weights X 100 / weight of the sample.
Methodology
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Determination of foreign matter:
Materials:
Microscope, Thin paper.
Method:
2 gm. of plant material spread on a thin layer of paper. To sort into different groups of
foreign matters, it has to be examined by using a magnifying 10x and foreign matters
are picked out and the percentage is recorded.
Foreign matter = difference in weights X 100 / weight of the sample
Evaluation of powder drug by microscopy: 169
Procedure:
Take Kalamegha panchanga churna in the watch glass.
Add few ml of Chloral hydrate to clear the powder and boil for a minute to
remove Chloral hydrate.
Then add equal amount of Phloroglucinol and HCL acid & wait for 2 minutes.
Prepare glass smear of the sample.
Add a drop of glycerin & place a cover slip.
Observed under low power microscope 10 xs.
Methodology
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Identification of Crude Drug by Thin Layer Chromatography A. For Alkaloids170 Sample: Andrographis paniculata Nees. (Crude powder)
1. Solvent system: Chloroform: Methanol 70 : 10
Detection : Sulfuric acid reagent, (heat at 100C for 3-5 min), visualized at normal light.
2. Solvent system: Acetone: Chloroform: Benzene.
4 : 4 : 1 Detection : Vanillin sulfuric acid reagent. 1% of Ethanolic vanillin - solution 1 10% of Ethanolic sulfuric acid – solution 2 The plates are sprayed with 100ml solution-1 and immediately followed by 10 ml of solution-2, heat at 110C for 5-10 min, evaluate in normal light. 3. Observation:
Solvent system
Rf value = Distance traveled by solute (a) Distance traveled by solvent (b)
B. For Flavonoids171 Preparation of the Extracts:
Powder drug (1gm) is extracted with 10ml methanol for 5 min on water bath at about
60C and then filtered; 20-30 µl is used for chromatography (flavonoid content 0.5%-
1.5%) These rapid methods extract both lipophilic and hydrophilic flavonoids.
Adsorbent: - Silica gel 60 F254 precoated TLC plate (Merck, Germany). Solvent system:
1. Ethyl acetate : formic acid : glacial acetic acid : water 100 : 11 : 11 : 26
Rf value = Distance traveled by solute (a) Distance traveled by solvent (b)
Methodology
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PREPARATION OF MEDICINE:
Drug:
Kalamegha panchanga- Andrographis paniculata Nees. is taken for the clinical trial.
Collection of raw materials:
Botanically identified Kalamegha was collected from area surrounding Gadag,
Bagalkot and Dharwad.
Method of preparation:
The method of preparation of churna according to Sharangadhara Samhita
(6th chapter, Churna Kalpana) was adopted.
Kalamegh Panchang Churna:
1. Four Kgs of Kalamegha, taken in completely dry form.
2. It was pounded well in “Ulukhala Yantra” ( Pounding Machine)
3. Powdered well in Pulverisers.
4. Sieved through 120 no sieve.
5. Then it was stored in air tight container.
Place of preparation of medicine:
The churna was prepared in Post Graduation Research Studies Department of Dravya
Guna, D G M Ayurvedic Medical College Gadag.
Methodology
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CLINICAL STUDY:
AIM OF THE STUDY:
The aim of the study was to evaluate the therapeutic effect of Kalamegha
(Andrographis paniculata Nees.) in patients suffering from Amlapitta.
MATERIALS AND METHODS
Source of data:
Thirty patients diagnosed as Amlapitta were taken for the study from the P.G.S &
R.C., O.P.D/I.P.D of DGM Ayurveda Medical College and Hospital, Gadag, and
patients attended the camp conducted at Anglo urdu D.Ed college, Parshwanath D.Ed
college and Rajiv Gandhi D.Ed college Gadag.
Method of collection of data:
It was a single blind clinical study with 30 patients diagnosed as Amlapitta of either
sex were be selected for the study randomly.
Inclusion criteria:
Classical signs and symptoms of Amlapitta.
Patients aged between 15-60 years of both sex.
Exclusion critera:
Associated with other systemic disorders.
Associated with Ama.
Methodology
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Investigations:
Red blood cell count
Stool test
Bile test
Other relevant investigations if required
Intervention:
All the patients were treated with 4 gms. Kalamegha panchanga churna.
Anupana: Sukoshna Jala
Administration time: After food
Frequency: 2 gms. B.D.
Duration: 30 days.
Follow-up period: 15 days.
Subjective parameters
As designated in classical tests
Avipaka Klama
Utklesha Tiktodgara
Amlodgara Gourava
Hriddaha Kanthadaha
Aruchi Chardi
Objective parameters
Red blood cell count
Stool test
Bile test
Methodology
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Method of evaluation:
A special proforma will be prepared with all the points of history taking and
examination based on the criteria mentioned in Ayurvedic classics and the
contemporary science. Relevant classical signs and symptoms will be adopted for
diagnosis to assess the improvement. The parameters of signs and symptoms will be
scored on the basis of standard method for statistical analysis. Following were the
criteria for assessment.
Assessment criteria:
Avipaka:
• Absent - 1
• Irregular digestion - 2
• Indigestion associated with nausea - 3
• Indigestion associated with chardi and bhakta dwesha - 4
Klama:
• Absent - 1
• Fatigue due to excretion and relieved by rest - 2
• Fatigue without excretion, more in the morning - 3
• Fatigue associated with heaviness - 4
Utklesa:
• Absent - 1
• In relation with specific food - 2
• In relation with normal food - 3
• Associated with chardi - 4
Methodology
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Tiktodgara:
• Absent - 1
• Associated with avipaka - 2
• Associated with hrillasa - 3
• Associated with kanthadaha - 4
Amlodgara:
• Absent - 1
• Associated with avipaka - 2
• Associated with hrillasa - 3
• Associated with kanthadaha - 4
Gourava:
• Absent - 1
• Feel of heaviness in the early morning - 2
• Feel of heaviness associated with avipaka - 3
• Feel of heaviness associated with klama - 4
Hritdaha:
• Absent - 1
• Retrosternal discomfort - 2
• Associated with pain - 3
• Associated with gastric regurgitation - 4
Kanthadaha:
• Absent - 1
• Associated with avipaka - 2
• Associated with utklesha - 3
• Associated with gastric regurgitation - 4
Methodology
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Aruci
• Absent - 1
• Loss of interest in intake of food - 2
• Aversion to the food - 3
• Nausea and sometimes vomiting after intake of food - 4
Chardi
• Absent - 1
• Vomiting of bilious contents - 2
• Excess mucous secretion along with undigested food - 3
• Vomiting of indigested food taken before 24 hours - 4
Statistical analysis:
Mean, S.D, P value, t value were calculated.
CRITERIA FOR OVERALL ASSESSMENT
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 results have been classified in following grades.
Individual variables: CI-1 Encouraging 1 degree reduction in the severity from initial severity. CI-2 Good 2 degree reduction in the severity from initial severity. CI-3 Excellent 3 degree reduction in the severity from initial severity. CS Stable No change in the severity from initial severity. CD Deteriorated Increase in the severity from initial severity
Methodology
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Overall severity: CI-1 Encouraging 1-10 degree reduction in the severity from initial severity. CI-2 Good 11-20 degree reduction in the severity from initial severity. CI-3 Excellent 21-30 degree reduction in the severity from initial severity. CS Stable No change in the severity from initial severity. CD Deteriorated Increase in the severity from initial severity
Observation and Results (Pharmacognostic)
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Determination of taste:
Table No-12 RASA OF KALAMEGHA PERCEIVED BY 25 VOLUNTEERS.
No. Volunteers Pradhanarasa Anurasa 1 10 Tikta Katu 2 10 Tikta Katu 3 5 Tikta Katu
The table exhibits the rasa of the drug Kalamegha by taste by tongue examination. It
was observed that tiktarasa as pradhana rasa and katu rasa as anurasa. The results
shows tikta is the pradhana rasa of Kalamegha.
Table No -13 ORGANOLEPTIC STUDIES OF PHYSICAL AND SENSORY
CHARACTERISTICS OF SUCCESSIVE SOLVENT EXTRACTION OF
ANDROGRAPHIS PANICULATA NEES.
Name of the solvent
Nature Colour Odour Wt. of extract
in %. Petroleum ether Sticky Green Characteristic 30 Benzene Sticky Dark green Characteristic 20 Chloroform Sticky Dark green Characteristic 20 Ethanol Non Sticky Light green Characteristic 20 Aqueous Non Sticky Dark green Characteristic 40
Preliminary tests for primary and secondary metabolites:
In the present study preliminary phytochemical observations were carried out on
panchanga part of Andrographis paniculata Nees. It was noticed that in some cases
chemical constituents fail to answer their presence in preliminary tests due to other
reasons. However, detail results are as under:
Observation and Results (Pharmacognostic)
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1) Proteins test:
Petroleum ether, benzene and ethanol extracts have showed positive result by
producing deep orange colour in xanthoprotic test. All five successive solvent extracts
have showed the formation of violet ring with Hopkin’s cole test and the formation of
precipitate with sulphur test.
2) Carbohydrates test for starch:
All five successive solvent extracts have showed the positive result by formation of
red cum violet ring with Molisch’s test, the formation of deep colour in iodine test and
yellow colour precipitate in Benedict’s test, petroleum ether and benzene extracts
have shown brownish red precipitate in Fehling’s test.
3) Benedict’s test for non reducing sugars:
Aqueous extract has shown positive result with Benedict’s test.
4) Tannin test:
The Tannins were absent in all the extracts.
5) Anthocyannin test:
Benzene, aqueous and chloroform extracts have shown positive result by producing
blue to violet colour with Aqueous NaOH test.
6) Glycoside test:
The petroleum ether and benzene extract gave reddish violet colour ring at junction
with Molisch’s test. All five successive solvent extracts gave reddish colour solution
with Conc H2SO4 test and reddish brown colour in Keller-kiliani test except benzene
extract.
Observation and Results (Pharmacognostic)
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7) Saponin test:
The foam test for saponin gave positive results for all extracts.
8) Flavanoid test:
Only ethanol extract has shown positive result by producing cherry red with flavonoid
test, aqueous extract has shown positive result by producing deep purple with Shinoda
test. Benzene and chloroform extracts have shown positive result by producing yellow
colour with aqueous NaoH test. Petroleum ether and benzene extracts have shown
positive result by producing red colour with Conc H2SO4 test.
9) Phenols:
All the extracts showed positive results by producing intense colour for phenol test.
10) Steroid test:
The petroleum ether, benzene, ethanol and aqueous extract have responded positively
by producing red colour by Salkowski test and Liberman Buchard test but the
chloroform extract has failed to respond positively.
11) Alkaloid test:
All the extracts showed positive results by producing reddish brown precipitate in
Wagner’s reagent and creamy white precipitate in Mayer’s reagent except aqueous
extract and all the extracts showed positive result by producing orange red colour
precipitation in Dragendroff’s reagent.
Observation and Results (Pharmacognostic)
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Table No-14 PRELIMINARY TESTS FOR PRIMARY AND SECONDARY
METABOLITES
Sl. No
Tests Pet ether
Benzene Chloroform Ethanol alcohol
Aqueous extract
1 Tests for proteins a) Biuret test b) Ninhydrin test c) Xanthoproteic test d) Hopkins-Cole test e) Sulphur test
-ve -ve +ve +ve +ve
-ve -ve +ve +ve +ve
-ve -ve -ve +ve +ve
-ve -ve +ve +ve +ve
-ve -ve -ve +ve +ve
2 Carbohydrates Test for starch a) Molisch’s test b) Iodine test c) Fehling’s test d) Benedict’s test
+ve +ve +ve +ve
+ve +ve +ve +ve
+ve +ve -ve +ve
+ve +ve -ve +ve
+ve +ve -ve +ve
3 Non-reduction sugar such as sucrose a) Benedict’s test
-ve
-ve
-ve
-ve
+ve
4 Tests for Tannins a) Gelatin test
-ve
-ve
-ve
-ve
-ve
5 Anthocyanins a) Aqueous NaOH test b) Conc H2SO4 test
-ve -ve
+ve -ve
+ve -ve
-ve -ve
+ve -ve
6 Glycosides a) Molisch’s test b) Conc H2SO4 test c) Keller-kiliani test
+ve +ve +ve
+ve +ve -ve
-ve +ve +ve
-ve +ve +ve
-ve +ve +ve
7 Saponin a) Foam test
+ve
+ve
+ve
+ve
+ve
8 Flavanoids a) Flavanoids test b) Pew’s test c) Shinoda test d) Aqueous NaOH sol e) Conc H2SO4 test
-ve -ve -ve -ve +ve
-ve -ve -ve +ve +ve
-ve -ve -ve +ve -ve
+ve -ve -ve -ve -ve
-ve +ve +ve +ve -ve
9 Phenols a) Phenol test
+ve
+ve
+ve
+ve
+ve
10 Steroids a) Salkowski test b) Libermann and Burchard test
+ve +ve
+ve +ve
-ve -ve
+ve +ve
+ve +ve
11 Alkaloids a) Mayer’s test b) Wagner’s test c) Dragendroff’s test
+ve +ve +ve
+ve +ve +ve
+ve +ve +ve
+ve +ve +ve
-ve +ve +ve
Observation and Results (Pharmacognostic)
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Standardization and validation:
Result:
Physico-chemical analysis:
Test Observation
Moisture content 6.55%
Total ash content 9.25%
Water insoluble ash 0.83%
Acid insoluble ash 1.00%
Successive extractive values:
Test Observation
Water soluble extractive value 14.4%
Alchol soluble extractive value 16.0%
Test for extraneous material:
Test Observation
Foreign matter 0.00
Evaluation of powder drug by macroscopy:
Observation Test
Colour Light greenish
Odour Characteristic
Taste Very bitter
Observation and Results (Pharmacognostic)
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Evaluation of powder drug by microscopy:
Observation- Vascular bundles are seen.
Identification of Crude Drug by Thin Layer Chromatography
A. For Alkaloids
Observation:
1. Solvent system:
Rf value = Distance traveled by solute (a) Distance traveled by solvent (b) = 3.2 = 0.711 4.5
2. Solvent system Rf value = Distance traveled by solute (a) Distance traveled by solvent (b) = 0.7 = 0.155 4.5
Result:
The Rf value of Andrographis paniculata for Chloroform : Methanol and Acetone :
Chloroform : Benzene. System was found to be 0.711 and 0.155 respectively
B. For Flavonoids
Observation: Solvent system:
Rf value = Distance traveled by solute (a) Distance traveled by solvent (b) = 3.4 = 0.641 5.3
Detection: Flavonoids
Result- The Rf value of Andrographis paniculata for flovonoids was found to be 0.641.
Observation and Results (Clinical Study)
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CLINICAL STUDY: The present clinical study was meant for “Evaluation of efficacy of Kalamegha
(Andrographis paniculata Nees.) in the management of Amlapitta- a clinical
study.” Total 38 patients were diagnosed as Amlapitta, out of them only 30
patients were included. All the patients were assessed before and after treatment.
Both subjective and objective changes were recorded according to the case sheet.
The data was collected as follows,
Section- “A” - Demographic data Section- “B” - Data related to disease Amlapitta. Section- “C” – Data related to the treatment.
Observation and Results (Clinical Study)
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Section- “A” - Demographic data: In the present clinical study 30 patients of Amlapitta were included. The age group
was between 20 to 60 years.
Table No- 15 Distribution of patients based on Age:
AGE No of Patients % 20-29 13 43.33 30-39 8 26.66 40-49 8 26.66 50-59 1 3.33
Out of 30, 13 (43.33) were in the age group of 20-29 years, 08 (26.66) were in the age
group of 30-39 years, 08 (26.66) were in the age group of 40-49 years and 1 (3.33)
were in the age group of 50-59 years.
Chart No 1 Distribution of patients based on Age:
13
43.33
8
26.66
8
26.66
13.33
0
5
10
15
20
25
30
35
40
45
20-29 30-39 40-49 50-59
no
%
Observation and Results (Clinical Study)
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Table No. 16 Distribution of patients based on Sex:
SEX No of Patients % Male 14 46.66 Female 16 53.33
Female patients were predominated in this study i.e., 16 (53.33) with male 14 (46.66).
Chart No 2 Distribution of patients based on Sex:
14
46.66
16
53.33
0
10
20
30
40
50
60
male female
no
%
Observation and Results (Clinical Study)
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Table No-17 Distribution of patients based on Religion
RELIGION No of Patients % Hindu 17 56.66 Muslim 13 43.33 Christian 00 0 Other 00 0 An attempt was made to understand the religious influence in this disease. Hindu,
Muslim and Christian were included in this study. In this study maximum patients
17(56.66) are Hindu their followed by 13(43.33) are Muslims, there is no one
Christian and others.
Chart No 3 Distribution of patients based on Religion:
17
56.66
13
43.33
0 0 0 00
10
20
30
40
50
60
hindu muslim christian others
no
%
Observation and Results (Clinical Study)
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Table No-18 Distribution of patients based on Occupation:
OCCUPATION No of Patients % Sedentary 07 23.33 Active 13 43.33 Labor 10 33.33 Others 0 0 Occupation can give the idea of nature of work, out of treated 30 patients maximum
patients 13 (43.33) were active group followed by 10 (33.33) were labor group and
remaining 7 (23.33) sedentary group.
Chart No 4 Distribution of patients based on Occupation:
7
23.33
13
43.33
10
33.33
0 00
5
10
15
20
25
30
35
40
45
sedentary active labor Others
no
%
Observation and Results (Clinical Study)
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Table No-19 Distribution of patients based on Economical status:
ECONOMICAL STATUS No of Patients % Poor 13 43.33 Middle 17 56.66 Higher 0 00 This status had an impact over this disease process.In this study most of the patients
17 (56.66) in the middle class and 13 (43.33) patients are low economical status or
poor.
Chart No 5 Distribution of patients based on Economical status:
13
43.33
17
56.66
0 0
0
10
20
30
40
50
60
poor middle higher
no
%
Observation and Results (Clinical Study)
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Table No-20 Distribution of patients based on Diet:
DIET No of Patients % Vegetarian 16 53.33 Mixed 14 46.66 According to Ayurveda, diet is an important factor for the production of the disease in
this study, out of 30 treated patients 16 (53.33) were vegetarian compared to 14
(46.66) were mixed diet habits.
Chart No 6 Distribution of patients based on Diet:
16
53.33
14
46.66
0
10
20
30
40
50
60
vegeterian mixed
no
%
Observation and Results (Clinical Study)
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Section B: Data related to disease: Table No-21 Showing the Chief Complaints of 30 treated cases.
COMPLAINTS No of Patients % Avipaka 30 100 Klama 30 100 Utklesha 23 76.66 Tiktogdara 30 100 Amlodgara 21 70 Gourava 21 70 Hritdaha 28 93.33 Kanthadaha 29 96.66 Aruchi 30 100 Chardi 25 83.33 In this study all the 30 patients were complained about avipaka, klama, tiktogdara and
aruchi, 29 patients were complained about the kanthadaha, 28 patients were
complained about the hritdaha, 25 patients were complained about the chardi, 23
patients were complained about the utklesha and 21 patients were complained about
the amlodgara and gourava.
Observation and Results (Clinical Study)
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Chart No 7 Showing the Chief Complaints of 30 treated cases:
30
30
23
30
21
21
28
29
30
25
100
100
76.66
100
70
70
93.33
96.66
100
83.33
avipaka
klama
utklesha
tiktogdara
amlodgara
gourava
hritdaha
kanthadaha
aruchi
chardi
%
no
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Section C: Data related to Response of Treatment Table No-22 Showing the Response to Avipaka at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 4 13.33 Encouraging 18 60.00 Stable 8 26.66 Deteriorated 0 0 Chart No 8. Showing the Response to Avipaka at the end of Treatment
0 0 413.33
18
60
8
26.66
0 00
1020
3040
5060
excellent good encouraging stable deteriorated
no
%
Table No-23 Showing the Response to Avipaka at the end of Follow-Up
RESPONSE No of Patients % Excellent 3 10 Good 10 33.33 Encouraging 14 46.66 Stable 3 10 Deteriorated 0 0 Chart No 9. Showing the Response to Avipaka at the end of Follow-Up
310 10
33.33
14
46.66
310
0 00
10
20
30
40
50
excellent good encouraging stable deteriorated
no
%
Observation and Results (Clinical Study)
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Table No-24 Showing the Response to Klama at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 11 36.66 Encouraging 11 36.66 Stable 8 26.66 Deteriorated 0 0 Chart No 10. Showing the Response to Klama at the end of Treatment
0 0
11
36.66
11
36.66
8
26.66
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Table No-25 Showing the Response to Klama at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 12 40 Encouraging 12 40 Stable 6 20 Deteriorated 0 0 Chart No 11. Showing the Response to Klama at the end of Follow-Up
0 0
12
40
12
40
6
20
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Observation and Results (Clinical Study)
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Table No-26 Showing the Response to Utklesha at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 12 40 Encouraging 10 33.33 Stable 8 26.66 Deteriorated 0 0 Chart No 12. Showing the Response to Utklesha at the end of Treatment
0 0
12
40
10
33.33
8
26.66
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Table No-27 Showing the Response to Utklesha at the end of Follow-Up
RESPONSE No of Patients % Excellent 4 13.33 Good 11 36.66 Encouraging 8 26.66 Stable 7 23.33 Deteriorated 0 0 Chart No 13. Showing the Response to Utklesha at the end of Follow-Up
0 0
12
40
12
40
6
20
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
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Table No-28 Showing the Response to Tiktodgara at the end of Treatment
RESPONSE No of Patients % Excellent 3 10 Good 6 20 Encouraging 9 30 Stable 12 40 Deteriorated 0 0 Chart No 14. Showing the Response to Tiktodgara at the end of Treatment
3
106
20
9
30
12
40
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Table No-29 Showing the Response to Tiktodgara at the end of Follow-Up
RESPONSE No of Patients % Excellent 4 13.33 Good 8 26.66 Encouraging 10 33.33 Stable 8 26.66 Deteriorated 0 0 Chart No 15. Showing the Response to Tiktodgara at the end of Follow-Up
4
13.338
26.66
10
33.33
8
26.66
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
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Table No-30 Showing the Response to Amlodgara at the end of Treatment
RESPONSE No of Patients % Excellent 2 6.66 Good 12 40 Encouraging 5 16.66 Stable 11 36.66 Deteriorated 0 0 Chart No 16. Showing the Response to Amlodgara at the end of Treatment
26.66
12
40
5
16.6611
36.66
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Table No-31 Showing the Response to Amlodgara at the end of Follow-Up
RESPONSE No of Patients % Excellent 5 16.66 Good 10 33.33 Encouraging 6 20 Stable 9 30 Deteriorated 0 0 Chart No 17. Showing the Response to Amlodgara at the end of Follow-Up
5
16.66
10
33.33
6
20
9
30
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
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Table No-32 Showing the Response to Gourava at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 8 26.66 Encouraging 12 40 Stable 9 30 Deteriorated 1 3.33 Chart No 18. Showing the Response to Gourava at the end of Treatment
0 0
8
26.6
12
40
9
30
1 3.330
10
20
30
40
excellent good encouraging stable deteriorated
no
%
Table No-33 Showing the Response to Gourava at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 12 40 Encouraging 8 26.66 Stable 10 33.33 Deteriorated 0 0 Chart No 19. Showing the Response to Gourava at the end of Follow-Up
0 0
12
40
8
26.66
10
33.33
0 00
10
20
30
40
excellent good encouraging stable deteriorated
no
%
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Table No-34 Showing the Response to Hritdaha at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 2 6.66 Encouraging 17 56.66 Stable 11 36.66 Deteriorated 0 0 Chart No 20. Showing the Response to Hritdaha at the end of Treatment
0 0 26.66
17
56.66
11
36.66
0 00
10
20
30
40
50
60
excellent good encouraging stable deteriorated
no
%
Table No-35 Showing the Response to Hritdaha at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 7 23.33 Encouraging 18 60 Stable 5 16.66 Deteriorated 0 0 Chart No 21. Showing the Response to Hritdaha at the end of Follow-Up
0 07
23.3318
60
5
16.66
0 00
10
2030
40
50
60
excellent good encouraging stable deteriorated
no
%
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Table No-36 Showing the Response to Kanthadaha at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 0 0 Encouraging 25 83.33 Stable 5 16.66 Deteriorated 0 0 Chart No 22 Showing the Response to Kanthadaha at the end of Treatment
0 0 0 0
25
83.33
516.66
0 00
20
40
60
80
100
excellent good encouraging stable deteriorated
no
%
Table No-37 Showing the Response to Kanthadaha at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 2 6.66 Encouraging 24 80 Stable 4 13.33 Deteriorated 0 0 Chart No 23. Showing the Response to Kanthadaha at the end of Follow-Up
0 0 2 6.66
24
80
413.33
00
20
40
60
80
excellent good encouraging stable deteriorated
no
%
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Table No-38 Showing the Response to Aruchi at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 0 0 Encouraging 20 66.66 Stable 10 33.33 Deteriorated 0 0 Chart No 24. Showing the Response to Aruchi at the end of Treatment
0 0 0 0
20
66.66
10
33.33
0 00
20
40
60
80
excellent good encouraging stable deteriorated
no
%
Table No-39 Showing the Response to Aruchi at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 13 43.33 Encouraging 17 56.66 Stable 0 0 Deteriorated 0 0 Chart No 25. Showing the Response to Aruchi at the end of Follow-Up
0 0
13
43.33
17
56.66
0 0 0 00
10
2030
40
50
60
excellent good encouraging stable deteriorated
no
%
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Table No-40 Showing the Response to Chardi at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 4 13.33 Encouraging 15 50 Stable 11 36.66 Deteriorated 0 0 Chart No 26. Showing the Response to Chardi at the end of Treatment
0 04
13.33 15
50
11
36.66
0 00
10
20
30
40
50
excellent good encouraging stable deteriorated
no
%
Table No-41 Showing the Response to Chardi at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 8 26.66 Encouraging 15 50 Stable 7 23.33 Deteriorated 0 0 Chart No 27. Showing the Response to Chardi at the end of Follow-Up
0 08
26.66
15
50
7
23.33
0 00
10
20
30
40
50
excellent good encouraging stable deteriorated
no
%
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Table No-42 Showing the Response to Over-All at the end of Treatment
RESPONSE No of Patients % Excellent 0 0 Good 9 30 Encouraging 21 70 Stable 0 0 Deteriorated 0 0 Chart No 28. Showing the Response to Over-All at the end of Treatment
0 09
3021
70
0 0 0 00
20
40
60
80
excellent good encouraging stable deteriorated
no
%
Table No-43 Showing the Response to Over-All at the end of Follow-Up
RESPONSE No of Patients % Excellent 0 0 Good 24 80 Encouraging 6 20 Stable 0 0 Deteriorated 0 0 Chart No 29. Showing the Response to Over-All at the end of Follow-Up
0 0
24
80
6
20
0 0 0 00
20
40
60
80
excellent good encouraging stable deteriorated
no
%
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Table No-44 Showing Number of Patients with Degree of severity Before Treatment, After Treatment and at the End of Follow-up for individual variables and over-all severity of the disease.
Variable ▼ Severity ► Normal Mild Moderate Severe
BT 00 13 13 04 AT 06 22 02 00 Avipaka EF 22 08 00 00 BT 00 12 08 10 AT 05 25 00 00 Klama EF 08 22 00 00 BT 07 05 10 08 AT 15 15 00 00 Utklesha EF 23 07 00 00 BT 00 14 09 07 AT 07 23 00 00 Tiktodgara EF 15 15 00 00 BT 09 04 08 09 AT 19 10 01 04 Amlodgara EF 24 06 00 00 BT 09 08 13 00 AT 23 07 00 00 Gourava EF 28 02 00 00 BT 02 16 12 00 AT 11 19 00 00 Hritdaha EF 22 08 00 00 BT 01 11 18 00 AT 08 22 00 00 Kanthadaha EF 11 19 00 00 BT 00 14 16 00 AT 04 26 00 00 Aruchi EF 27 02 00 00 BT 05 14 11 00 AT 17 13 00 00 Chardi EF 25 05 00 00 BT 00 03 25 02 AT 01 28 01 00 Over-all EF 04 26 00 00
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Table No-45 Showing Statistical analysis for individual variables and over-all severity of the disease.
Variable ▼ Mean SD ‘t’ Value ‘P’
Value significance
BT 2.70 0.70 ------ ------ AT 1.86 0.50 8.53 0.0003 HS Avipaka EF 1.26 0.44 7.88 0.0005 HS BT 2.93 0.87 ------ ------ AT 1.83 0.37 4.77 0.0049 S Klama EF 1.73 0.44 9.99 0.0001 HS BT 2.63 1.13 ------ ------ AT 1.50 0.50 8.04 0.0004 HS Utklesha EF 1.23 0.43 4.96 0.0042 S BT 2.76 0.81 ------ ------ AT 1.76 0.43 3.65 0.0147 S Tiktodgara EF 1.50 0.50 4.17 0.0087 S BT 2.56 1.22 ------ ------ AT 1.40 0.56 5.57 0.0025 S Amlodgara EF 1.20 0.40 5.57 0.0025 S BT 2.13 0.86 ------ ------ AT 1.23 0.43 5.93 0.0019 S Gourava EF 1.06 0.25 8.04 0.0004 HS BT 2.33 0.60 ------ ------ AT 1.63 0.49 5.57 0.0025 S Hritdaha EF 1.26 0.44 3.44 0.0183 NS BT 2.56 0.56 ------ ------ AT 1.73 0.44 11.14 0.0001 HS Kanthadaha EF 1.63 0.49 7.51 0.0006 HS BT 2.53 0.50 ------ ------ AT 1.86 0.34 5.57 0.0025 S Aruchi EF 1.10 0.30 7.51 0.0006 HS BT 2.20 0.71 ------ ------ AT 1.43 0.50 5.97 0.0015 S Chardi EF 1.16 0.37 5.97 0.0015 S BT 25.36 3.52 ------ ------ AT 16.26 2.82 6.47 0.0031 S Over-all EF 13.16 1.96 6.50 0.0037 S
Observation and Results (Clinical Study)
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Table No-46 Showing response to the individual variables and overall status of the disease after treatment and at the end of the follow up.
Variable ▼ Excellent Good Encouraging Stable Deteriorated
AT 0 4 18 8 0 Avipaka
EF 3 10 14 3 0 AT 0 11 11 8 0
Klama EF 0 12 12 6 0 AT 0 12 10 8 0
Utklesha EF 4 11 8 7 0 AT 3 6 9 12 0
Tiktodgara EF 4 8 10 8 0 AT 2 12 5 11 0
Amlodgara EF 5 10 6 9 0 AT 0 8 12 9 1
Gourava EF 0 12 8 10 0 AT 0 2 17 11 0
Hritdaha EF 0 7 18 5 0 AT 0 0 25 5 0
Kanthadaha EF 0 2 29 4 0 AT 0 0 20 10 0
Aruchi EF 0 13 17 0 0 AT 0 4 15 11 0
Chardi EF 0 8 15 7 0 AT 0 9 21 0 0
overall EF 0 24 6 0 0
Discussion
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104
DISCUSSION
Since time immemorial Ayurveda has contributed a comprehensive package of
therapies and formulation for different ailments, but with the time many a things have
changed significantly, including the life style of the humans, ecological conditions,
spectra of the etiological factors and even up to the phenotype changes in many of the
herbal sources.
With present day life style, where in every individual is tested under the stress, strain
and many other viable factors to prove one self fit for survival. In the mean time one
has forgotten the basic rules and regulations of healthy living that has led him to
suffer from different ailments apart from it every one is in need of instant relief; for
which they submit themselves for different drugs and therapies, without knowing their
adverse effects.
Amlapitta, one among the disease or as a complaint is most common now a day,
which is affecting the individuals irrespective of age, sex, etc. but more of the time the
erroneous life style of the individuals fortified with the stress drags one into the
vicious cycle of the discomfort. Amlapitta which is caused mainly due to the pitta
dosha and vikriti in annavaha srotas is also associated other doshas. The treatment for
which is systemic shodhana followed by proper shamana oushadhis and pathya
palana, all of them those are not possible for every one and most of them rushes to the
instant remedies without being aware about the harmful effects.
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
105
Drug being one among the chikitsa chatushpada and the armor of the physician. The
drug occupies a pre-eminent position in the requisite for achieving the success of
treatment. Appropriate reference regarding Kalamegha is not available in the samhitas
and also in most of the scripts of Nighantu kala. Only a brief reference regarding it is
available in Priya Nighantu, where in it has been mentioned under Shatapushpadi
varga, with its different synonyms and properties.
At different places and regions, drugs with different names; such as Bhunimba, Kirata
are used, those having similar properties mentioned for Kalamegha and possessing the
similar therapeutic values. This has led to a great controversy regarding the entity of
Kalamegha.
Kalamegha which has synonym as Mahatikta, Yavatikta indicates the pradhanata of
tikta rasa in it and that has been indifferently accepted by all the authors and also all
authors opine similar with guna as laghu ruksha, virya as ushna and vipaka as katu.
Based on these rasa guna virya vipaka it can be presumed to posses pittahara and
kaphahara properties.
Kalamegha with its rasa panchaka performs a multi dimensional activities on the body
starting from deepana to the extent of sroto shodhana. These karmas have established
it with a great therapeutic value.
Considering the vast gap between present and ancient time were Kalamegha was first
explained. Many of the scholars have worked to resolve the controversy and have
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
106
come up with there opinion. With reference of these studies Andrographis paniculata
Nees. that resembles a lot with Kalamegha was considered for the study.
Andrographis paniculata Nees. a bitter tasting herb which can be easily identified by
its morphological features and that grows almost in all areas of tropical regions has
been subjected for many research oriented studies by different scholars in the form of
pharmacognostic, ethno botanical, chemical, pharmacological, toxicological, clinical
studies etc. that have revealed a flavonoid Andrographolide, a tri hydroxy lactone as
the bitter principle of the plant as its active principle possesses a wide variety of
pharmacological properties which seeks interest toward its detail study and the study
was framed with the objective of pharmocognostical evaluation, preliminary
phytochemical study, macroscopical evaluation, microscopical evaluation,
standardization and validation of Kalamegha with a clinical study to evaluate its
efficacy in Amlapitta.
In adhunika kala, it has been noted that is Andrographis paniculata Nees. is popularly
known as Bhunimba in M P and Nagapur area and as Chirayata in the Bihar forests.
Karmas of Kalamegha according to different Ayurvedic texts deepana, ruchikara,
swedana, jwaraghna, krimighna, pittashamaka, yakrut uttejaka etc.and also indicated
in krimiroga, kushtaroga,Amadosha, Kamala etc. The leaves and roots are also used
as febrifuge, stomachic, cholagogue, anthelmintic, stimulant, aperients and powerful
tonic.
It is a bitter shrub, used in folk medicine for the treatment of itching, skin rashes,
flatulence, malaria, worms, jaundice, intermittent fever etc, and forms the principal
ingredient of household medicine called Alvi, extensively used in Bengal.
Discussion
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107
The plant is used in Unani system of medicine as blood purifier, in Homeopathy
system of medicine as febrifuge and hepato-protective.
Gastric discomfort, vomiting and loss of appetite may be caused by the large oral
doses of the drug. Injection of the crude drug extract may lead to anaphylactic shock.
Bhunimba is said to be the synonym of Kiratatikta but in recent literature viz,
Standard Nomenclature of Ayurvedic Medicinal Plants, published by CCRAS,
Bruhattrayi of vegetable drugs by Singh and Chunekar and Dravyaguna vignana part
II, by P.V.Sharma, bhunimba is described as a separate entity and identified as a
Andrographis paniculata Nees. Moreover, in Bhaishajyaratnavali both the drugs
found mention in different formulations, indicating that kiratatikta and bhunimba are
separate entities.
Chakrapanidatta in his commentator on Charaka Samhita defines amlapitta as
“Amlapittam cheti amlagounodriktam pittam”.
Means the pitta acquiring more of amla guna is known as Amlapitta.
Acharya Kashyapa explains that the Vidagdha anna rasa turns to shukta, and this
retained in amashaya and produces Amlapitta.
Srikanthadatta and Vijayarakshita, the famous commentator of Madhava Nidana said
that, “Vidahyadamlagunodriktam pittam amlapittam.”
Means the condition of pitta in which the udriktata of amla guna along with vidaha is
noticed, should be called as Amlapitta.
Discussion
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108
In Madhava Nidana of Madhavakara, it is defined as
“Avipakaklamotkleshatikthamlodgaragauravaihi
Hruthkanthadaharuchibhischamlapittamvadedbhishak.
A particular disease in which there is avipaka, klama, utklesha, tiktoudgara, amlodgar,
gourava, hriddaha, kantadaha and aruchi are seen is suppose to be Amlapitta.
The general causes which are responsible for provoking pitta are also responsible for
causing the disease Amlapitta, because the vitiated dosha here is pitta. So generally
food and habits which are responsible for the vitiation of pitta are responsible for the
Amlapitta disease.
Along with these, vata and kapha are also having a role in the causation of Amlapitta,
particularly in the vataja, kaphaja, vatakaphaja types of Amlapitta, where these doshas
are in the anubandha or samsarga state.
Whatever might be the chikitsakrama either Shodhana karma or Shamankarma,
nidana parivarjana is outstanding here. In the context of amlapitta chikitsa, Acharya
Kashyapa explained about nidana varjana, texts have laid greater significance to this.
To be more prices Amla, Ushna, Vidagdha, teekshna, katu, padartha should be
avoided in Amlapitta.
It includes Langhana, Laghubhojana and usage of various dravyas, which possess the
properties of pachana, deepana have to be administered. Apart from this all the
pittashamaka dravyas specifically acting on Annavaha srotas like Amalaki, shatavari
yasthimadhu, Guduchi, Shukti, Shanka etc. have to be administered. In all Ayurvedic
texts, there is explaination to take tikta rasa pradhana ahara, aoushadha and pana in
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
109
Amlapitta. Hence, for this purpose Kalamegha(Andrographis paniculata Nees.) which
is considered one of the best pittahara,tikta,deepan drug is selected for the study.
Pharmacognostic Evaluation:
Drug was selected after morphologically confirming the identity by macroscopic
study.
The macro and microscopic characteristics of the stem, leaves and floral parts of the
plant have been described. The stem is green, woody, annual and erect up to 1m high,
bearing numerous branches. The upper part is distinctly quadrangular with four bulges
arising in the four corners, while the lower part is somewhat rounded and possessing
at the nodes of the basal region adventitious roots which are green, thin, slender and
hard. The leaves are exstipulate, lanceolate having slightly undulate entire margin and
tapering base. The apex is acuminate. The leaves are opposite having reticulate
venation.
Microscopically, the epidermis of the stem possesses glandular and non glandular
hairs and stomata of caryophyllaceous type. The cortex consists of collenchymatous
strands below the epidermis and in between the bulges. This is followed by a distinct
endodermis. The phloem is characterized by acicular fibers at older stage of the plant.
The vascular bundle is represented by an ectophloic siphon stele. The leaves possess a
small winged petiole. Glandular and non glandular hairs are present on both surfaces
of the lamina while caryophyllaceous type of stomata occurs only on the lower
surface of the leaf. The midrib varies in outline at different parts of the leaves. The
cystoliths are present in the epidermal and cortical regions of the stem and epidermis
of the leaves, bracts, bracteoles and sepals of the flower. Small acicular crystals of
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
110
calcium oxalate occur in the pith and cortical cells of the stem and the leaves. The
different parts of the flower possess characteristic glandular and non glandular hairs.
Preliminary phytochemical Studies:
Phytochemistry (phyton-plant) is the chemistry dealing with plants or plant products
or natural products (chemistry of natural products). Natural products comprise
different chemical constituents. These chemical constituents may be therapeutically
active or inactive.
The ones which are active are called as active constituents or active principles
(alkaloids, glycosides etc.). The inactive ones are called inert chemical constituents
(starch, cellulose etc.). Such inert constituents though they possess no
pharmacological or therapeutical activity, are essential for the normal physiological
processes.
In the recent times photochemistry has undergone significant development as a
distinct discipline.
It is concerned with the enormous variety of substances that are synthesized and
accumulated by plants and deals with the structural elucidation of these substances the
technology involving extraction, purification and characterization of pharmaceuticals
from natural-sources is the significant contribution to the advancement of natural and
physical science. The indigenous system to be internationally acceptable, it is
necessary to obtain phytochemical, biochemical in vitro clinical data.
The phytochemical screening of aminoacids, nonprotein aminoacids, pyrolizidine
alkaloids, polyacetylene, steroidal-sapogenins, glycosides, triterpenoids, bitter
compounds are undertaken.
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
111
Carbohydrates:
Carbohydrates are among the first products to arise as a result of photosynthesis. They
constitute a large proportion of the plant biomass and are responsible, as cellulose for
the rigid cellular frame work and as starch for providing an important food reserve.
Carbohydrates in general and glucose in particular are an important source of energy
for cells; they are also called as “metabolic fuels”
Glycosides:
A number of medicinal plants contain complete organic molecular which are in
conjugation with sugar moieties, mostly monosaccharides. Such compounds are
called as glycosides and exert therapeutically significant effects on humans and
animals. Many glycosides are used in traditional and modern medicines because of
their cardiotonic, purgative, antirheumatics, analgesic, appetizer, liver stimulant,
antacid, vermifuge and other useful actions.
Tannins:
Tannins are one of the most widely occurring groups of natural substances in plants.
They are used in medicine for allied purposes or as mild antiseptics, in treatment of
diarrhea and to check small haemorrhages.
Proteins:
Proteins are complex nitrogenous organic substances of plant and animal origin. Apart
from the fact that they are essential foodstuffs like carbohydrates and fats, they also
provide very important group of therapeutically active compounds such as harmones,
enzymes. They are easily extractable from plant sources.
Triterpenoids:
Triterpenoids are compounds with a carbon skeleton based on six isoprene units, these
are colourless, crystalline with often high melting point. These compounds are
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
112
divided into four compounds they are true triterpenoids, steroids, saponins and cardiac
glycosides. Triterpenoids are notable for their taste properties particularly their
bitterness.
Steroidal sapogenins:
Steroidal sapogenins are more important as they are used as raw-material for the
synthesis of the various medicinally useful steroids like Cardiac glycosides and
corticosteroids. Due to their pharmaceutical importance many plants have been
screened for steroidal sapogenins.
Standardization and Validation:
Ash values:
Used to determine quality and purity of a crude drug.
Ash contains inorganic radicals like phosphates, carbonates, calcium, magnesium etc.
Some times, inorganic variables like calcium oxalate, silica, carbonate of the drug
affects total ash value. Such variables are then removed by treating with acid and
insoluble ash.
Extractive valves:
Useful for evaluation of crude drug. Give idea about the nature of the chemical
constituents, soluble in that particular solvent used for extraction.
Evaluation powder drug by microscopy:
The microscopic examination of crude drug aims at determination of the chemical
nature of the cell wall along with the determination of the form and chemical nature
of the cell contents. Thus it determines the size, shape and relative structure of the
different cells and tissues in a plant drug. A dried material often requires softening
before preparation for microscopic studies. It may be done by exposing the sample in
moist condition (for leaves & flowers) or boiling in water (for roots & barks).
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
113
Clinical study:
30 patients of Amlapitta, diagnosed according to classical signs and symptoms and
those willing to participate in the clinical study were selected incidentally, irrespective
of age, caste, religion based on inclusion and exclusion criteria.
Patients were subjected for preliminary examination and are graded for the severity
for individual subjective parameter and over all severity of the disease; based on four
point scale i.e. (1 Normal, 2 Mild, 3 Moderate and 4 Severe) and patients were
subjected for lab investigations for RBC count, stool test and bile test, before
treatment, after treatment and at the end of the follow-up. The chart of grading of
subjective parameters is provided along with individual proforma foe precise grading
of the parameters.
After preliminary examinations and with a written consent, the patients were
administered with Kalamegha panchanga churna 2gm twice daily after meals with
sukhoshna jala and the patients were advised to follow the diet and also to discontinue
the medicine if feels any discomfort and to report immediately.
The patients were again subjected for the examination for reassessing the response of
the treatment, i.e. after 30 days of satisfactory medication and were advised for 15
days follow up without any medication. The data was collected at the end of the
follow up.
The data thus collected BT, AT and EF were subjected for statistical analysis by
calculating mean, standard deviation, t value and P value and thus the efficacy of
Kalamegha in the management of Amlapitta was evaluated.
In the present clinical study the observation done reveals that, most of the patients
falls under the age 20-50 years, which strongly suggests the influence of stress as a
causative factor of Amlapitta. No significance difference between male and female
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
114
proportion suggest that Amlapitta has almost equal incidence in both sex and is not
sex oriented.
In the present study all the patients belonged to either Hindu or Muslim religion,
which cannot be claimed as the size of the sample and the area of population covered
are too small to conclude on it, hence it may require a large sample size collected
from different regions of the population.
More number of patients in the active working group and students group, may
indicate that as they need to be more competitive to be ahead than others, that yields
them to stress factor leading to Amlapitta.
With socio-economical status the study with its sample size may not be sufficient to
claim zero percentage sufferers from the upper class, or it may be the cause that
people of that status may not feel themselves interested to involve in such clinical
study, the incidence may be confirmed with a large sample study.
There is no significant difference observed in the diet pattern with respect to
vegetarian or a mixed one.
In the present clinical study all the patients received the prescribed dosage of
Kalamegha panchanga churna for all 30 days without the discontinuity, but almost all
complained about the palatability in the form of churna due to its extreme bitterness.
But no one complained about any form of adverse effect, hence the drug can be given
in same dosage with more compliant form to the patients for better acceptance.
Patients had shown highly significance in the reduction of avipaka after the treatment,
and even at the end of follow up.
Patients had shown significance in the reduction of klama after the treatment, and
highly significance at the end of follow up.
Discussion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
115
Patients had shown highly significance in the reduction of utklesha after the
treatment, and significance at the end of follow up.
Patients had shown significance in the reduction of tiktodgara after the treatment, and
even at the end of follow up.
Patients had shown significance in the reduction of amlodgara after the treatment, and
even at the end of follow up.
Patients had shown significance in the reduction of gourava after the treatment, and
highly significance at the end of follow up.
Patients had shown significance in the reduction of hritdaha after the treatment, and
non significant change at the end of follow up.
Patients had shown highly significance in the reduction of kanthadaha after the
treatment, and even at the end of follow up.
Patients had shown significance in the reduction of aruchi after the treatment, and
highly significance at the end of follow up.
Patients had shown significance in the reduction of chardi after the treatment, and
even at the end of follow up.
Patients had shown significance in the reduction of over all severity of the disease
after the treatment, and even at the end of follow up.
Kalamegha, which possess tikta rasa, laghu, ruksha guna, ushna veerya and katu
vipaka with deepaka, pachaka, pitta shamaka, rechaka, ruchikara, srotoshodhani and
yakruttejaka properties has established a significant effect on reducing the severity of
Amlapitta. The tikta rasa of Kalamegha is the most potent factor in relieving the
complaints of Amlapitta, which can be supported by the presence of the flavonoid
Andrographolide, a tri hydroxy lactone a bitter principle which has Antiulcer, Anti-
inflammatory, Analgesic properties that proves to be most beneficial in Amlapitta.
Conclusion
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
116
CONCLUSION Through the above studies we have come to the following conclusions,
1. No descriptions are available in samhitas and sangraha granthas, Priya nighatukara is
pioneer who has mentioned Kalamegha.
2. The active principal of Kalamegha is Andrographolide, but kiratatikta is devoid of
Andrographolide.
3. Andrographis paniculata Nees. can be considered as the authentic botanical source
for Kalamegha.
4. Kalamegha panchanga churna helps in decreasing the Amlapitta by its properties and
actions like tiktarasa, deepana, ruchikara, pittahara and rechana.
5. Kalamegha panchanga churna is effective in reducing the symptoms which are
statistically significant in Amlapitta.
6. From the findings of the clinical study and with the help of references available in the
texts, it can be concluded that Kalamegha (Andrographis paniculata. Nees.) is
effective in Amlapitta.
Future Prospects
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
117
FUTURE PROSPECTS
Though these 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.
1. The study should be conducted on the large scale to obtain more promising and
long lasting results.
2. The study with the reduced dose or in other form of formulation / dosage can also
be tried.
3. The efficacy of the drug can also be evaluated in the chronic Amlapitta patients.
Summary
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
118
SUMMARY
This dissertation entitled “Evaluvation of efficacy of Kalamegha (Andrographis
peniculata Nees.) in the management of Amlapitta- a clinical study.” Comprises of
literary review, pharmacognostic study, preliminary phytochemical studies,
standardization and validation,clinical study,discussion, summary and conclusion.
LITERARY REVIEW:
Deals with the literary review of the drug and the disease.
DRUG REVIEW:
Drug review deals with brief historical aspects, Kalamegha nirukthi, synonyms,
etymological derivation of synonyms, botanical name with derivation, classification,
varieties, vernacular names, taxonomical classification, Family features, morphology,
pharmacognostic features, quantitative standards, habitat, rasapanchaka,
doshaghnata, karma vignana, rogaghnata, phytochemistry, therapeutic uses, uses in
Unani and Homeopathy, folk uses, prayojya anga, matra, vishistha yogas, collection,
cultivation, mode of propagation, pest and diseases, harvesting and storage,
production and yield, marketing and trade, economics of cultivation, adulterants,
substitutes and controversy study.
DISEASE REVIEW:
It deals with historical review of Amlapitta, nirukti and paribhasha, paryaya,
bheda,amashaya, annavaha srotas, pittadhara kala, agni, aharapachana, pachakapitta
and karya, samanavata and kledakakapha, nidan panchaka, samprapti and samprapti
ghathakas,upadrava, sadhyasadhyata, sapekshanidan, chikitsa vivechana, patyapatya,
upashayanupashaya and nidanarthakara for Amlapitta.
Summary
“Evaluation of efficacy of Kalamegha (Andrographis paniculata Nees.) in the management of Amlapitta- a clinical study. ”
119
PHARMACOGNOSTIC STUDY:
Comprises two parts,
Part-A:
Pharmacognostic and Preliminary phytochemical study, under pharmacognostic
study, the drug Kalamegha was colleted from the locality of Gadag, Bagalkot,
Dharwad and their identity authenticated macroscopically by organoleptic studies.
The macroscopic and microscopic structures of stem, root and leaf are elaborated
here.
Part-B:
Comprises of determination of taste.
STANDARDIZATION AND VALIDATION:
Comprises of standardization and validation studies, such as physico-chemical
analysis, poweder microscopy and TLC study.
CLINICAL STUDY:
Comprises of clinical study which was evaluation of efficacy of Kalamegha
(Andrographis peniculata Nees.) in the management of Amlapitta- a clinical study.
DISCUSSION:
Here the discussion of the drug review, disease review, clinical study, interpretation
of results along with clinical study conducted. The observations and results related to
the study are discussed.
CONCLUSION:
Conclusions are drawn based on the study.
i
Table No I- Demographic data of “Evaluation of efficacy of KALAMEGHA in Amlapitta”
SEX RELIGION OCCUPATION ECONOMIC STATUS FOOD Sl.
No OPD No.
AGE (YRS) M F H M C O 1 2 3 4 P M H V M
1 DGPG02 20 + + + + + 2 DGPG12 22 + + + + + 3 DGPG17 25 + + + + + 4 DGPG24 28 + + + + + 5 DGPG19 22 + + + + + + 6 DGPG36 36 + + + + 7 DGPGA1 22 + + + + + 8 DGPGA6 28 + + + + + 9 DGPGA3 40 + + + + + 10 DGPGA24 55 + + + + + 11 DGPGA2 28 + + + + + 12 DGPGA29 30 + + + + + 13 DGPGA36 29 + + + + + 14 DGPGA40 25 + + + + + 15 DGPGA44 20 + + + + + 16 DGPGB3 22 + + + + + 17 DGPGB9 22 + + + + + 18 DGPGB30 49 + + + + + 19 DGPGB43 45 + + + + + 20 DGPGB56 35 + + + + + 21 DGPGB66 37 + + + + + 22 DGPGB57 49 + + + + + 23 DGPGB64 42 + + + + + 24 DGPGB68 32 + + + + + 25 DGPGB71 38 + + + + + 26 DGPGB67 45 + + + + + 27 DGPGB76 48 + + + + + 28 DGPGB78 45 + + + + + 29 DGPGB119 35 + + + + + 30 DGPGB245 38 + + + + +
M=MALE, F=FEMALE, H=HINDU, M=MUSLIM, C=CHRISTIAN, O=OTHERS, 1=SEDENTARY, 2=ACTIVE, 3=LABOR, 4=OTHER, P=POOR, M=MIDDDLE,
H=HIGHER MIDDLE & HIGHER CLASS, V=VEG, M=MIXED.
ii
Table No II–Chief complaints of “Evaluation of efficacy of KALAMEGHA in Amlapitta”
1 2 3 4 5 6 7 8 9 10 Sl.No OPD No. B A E B A E B A E B A E B A E B A E B A E B A E B A E B A E
1 DGPG02 + + - + + + - - - + + + - - - - - - + - - + - - + + - + - - 2 DGPG12 + + + + + + - - - + + + + + + + + + + + + + + + + + - + - - 3 DGPG17 + - - + - - + + - + - - + + + + - - + - - + + + + - - + - - 4 DGPG24 + + + + + + + + - + + + + - - + + - + - - + + + + + - + - - 5 DGPG19 + + + + - - + + - + + + + + + + - - + + - + + + + + - + + - 6 DGPG36 + + + + + - + - - + + + + + - - - - + + + + + + + + - + + - 7 DGPGA1 + + + + + + + + + + + - + + + + + - + - - + + - + + + + - - 8 DGPGA6 + + + + + + + + - + + + + - - - - - + + - + + + + + - + + + 9 DGPGA3 + + - + + + + - - + + - + - - + - - + + + + + + + + - + + + 10 DGPGA24 + + + + + + + + + + - - - - - - - - + + - + + + + + - + + + 11 DGPGA2 + + - + + + + - - + + + + + + + - - + + + + + + + + - + - - 12 DGPGA29 + + - + + + + + - + + + + - - + - - + + - + + + + + + + - - 13 DGPGA36 + + - + + + + + + + + - + - - + + - + + + + + - + + - + + - 14 DGPGA40 + + - + + + + + + + + + + + - - - - + + + + + + + + - - - - 15 DGPGA44 + + - + + + + - - + + - - - - + - - + + - + + + + + - + - - 16 DGPGB3 + + - + + + + + - + + + + + + - - - + + - + + + + + - - - - 17 DGPGB9 + + - + + + + + + + + - - - - - - - + + - + + + + + - - - - 18 DGPGB30 + + - + + + - - - + + - - - - + - - + - - + - - + + - + - - 19 DGPGB43 + - - + - - + - - + - - + + - + - - + - - + - - + - - + - - 20 DGPGB56 + - - + + - - - - + - - - - - + - - + - - + - - + + - + - - 21 DGPGB66 + - - + - - + + - + - - - - - - - - + - - + - - + - - + - - 22 DGPGB57 + - - + - - + - - + - - - - - + - - + - - + - - + - - + - - 23 DGPGB64 + - - + + + - - - + - - + - - + - - - - - - - - + + - - - - 24 DGPGB68 + + - + + + + - - + + + + - - + - - + + - + - - + + - + + - 25 DGPGB71 + + - + + + - - - + + + + + - + - - + + - + + + + + - + + - 26 DGPGB67 + + + + + + + + + + + + + + - - + - + + + + + + + + + + + + 27 DGPGB76 + + - + + + - - - + + - + - - + - - + + - + + + + + - + + + 28 DGPGB78 + + - + + + + + - + + + - - - + + + - - - + + - + + - - - - 29 DGPGB119 + + - + + + + - - + + + + - - + + - + + + + + + + + - + + - 30 DGPGB245 + + - + + + + + + + + - + - - + - - + + - + + + + + - + + -
1=AVIPAKA, 2=KLAMA, 3=UTKLESHA, 4=TIKTODGARA, 5=AMLODGARA, 6=GOURAVA, 7=HRIDDAHA, 8=KANTHADAHA, 9=ARUCHI, 10 =CARDI.
iii
Table No III–Associated complaints of “Evaluation of efficacy of KALAMEGHA in Amlapitta”
1 2 3 4 5 6 7 8 9 10 11 12 13 Sl.No OPD No.
B A B A B A B A B A B A B A B A B A B A B A B A B A 1 DGPG02 + - + - + - + - - - + - + - - - + - - - - - + - + - 2 DGPG12 - - + - - - - - - - - - + - - - + - + - - - + - + - 3 DGPG17 - - - - + - + - - - - - + - - - + - - - - - + - - - 4 DGPG24 - - - - + - + - - - - - + - - - + - + - - - + - - - 5 DGPG19 - - + - + - + - - - - - + - - - - - - - - - + - - - 6 DGPG36 + - + - + - + - - - - - + - - - + - + - - - + - - - 7 DGPGA1 - - - - + - - - - - - - + - - - - - - - - - + - - - 8 DGPGA6 + - + - + - + - - - - - + - - - + - + - - - + - + - 9 DGPGA3 - - - - - - - - - - - - - - - - + - - - - - + - - - 10 DGPGA24 + - + - - - - - - - + - + - + - + - - - - - - - - - 11 DGPGA2 - - - - + - + - - - + - + - - - + - + - - - + - - - 12 DGPGA29 + - + - + - + - - - + - + - - - + - + - - - + - - - 13 DGPGA36 + - + - + - + - - - - - + - - - + - + - - - + - - - 14 DGPGA40 + - + - - - - - - - - - + - - - + - + - - - + - - - 15 DGPGA44 - - - - + - + - - - - - + - - - + - - - - - + - + - 16 DGPGB3 - - + - + - + - - - - - + - - - + - + - - - + - + - 17 DGPGB9 + - - - + - + - - - - - + - - - + - + - - - + - + - 18 DGPGB30 + - + - + - + - - - - - + - - - + - + - - - + - + - 19 DGPGB43 - - + - + - + - - - - - + - - - - - - - - - + - - - 20 DGPGB56 - - - - + - - - - - - - + - - - + - + - + - + - + - 21 DGPGB66 - - + - + - - - - - - - + - - - - - - - + - + - + - 22 DGPGB57 - - - - + - - - - - - - + - - - - - - - + - + - + - 23 DGPGB64 - - - - - - - - - - - - + - - - - - + - + - + - - - 24 DGPGB68 + - + - + - + - - - + - + - - - + - + - - - + - - - 25 DGPGB71 - - + - + - - - - - - - + - - - - - - - + - + - - - 26 DGPGB67 - - - - + - + - - - - - - - + - + - - - + - + - + - 27 DGPGB76 - - - - - - - - - - - - + - - - + - - - + - + - - - 28 DGPGB78 - - - - + - - - - - - - + - - - - - - - + - + - - - 29 DGPGB119 - - - - - - - - - - - - + - - - + - + - + - + - - - 30 DGPGB245 + - + - + - + - - - - - + - - - + - - - + - + - + -
1=KUKSIDAHA, 2=SIRASHULA, 3=HASTADAHA, 4=PADADAHA, 5=JWARA, 6=KANDU, 7=HRILLASA, 8=KOTHA, 9=AGNIMANDHYA,
10=ROMAHARSHA, 11=PIDAKA 12=MUKHALEPA, 13=NIDRADHIKYA
iv
Table No IV–Nidana (Etiology) of “Evaluation of efficacy of KALAMEGHA in Amlapitta”
Aahara Vihara OthersA5Sl.No OPD No
A1 A2 A3 A4 a b
V1 V2 V3 V4 V5 V6 V7 V8 V9 O1 O2 O3 O4 O5 O6
1 DGPG02 + + + + + + - + + - + + - + + + + + + - +2 DGPG12 + + + + + + + + + - + + - + + + + + + + +3 DGPG17 + + + + + + - + + - + + - + + + + + + + +4 DGPG24 + + + + + + + + + - + + - - - + + + + + +5 DGPG19 + + + + + + - + + + + + - - + + + + + + +6 DGPG36 + + + + + + - + + + + + - - + + + + + - +7 DGPGA1 + + + + + + - + + - + + - - + + + + + - +8 DGPGA6 + + + + + + - + + - + + - - + + + + + - -9 DGPGA3 + - + + + + - - + - + - - - + + + + + - -10 DGPGA24 + - - + + - + - + + - + - - - + + - + - -11 DGPGA2 + + + + + + - + + - + + - - + + + + + + +12 DGPGA29 + - + + + + + + + + + + - - + + + + + - -13 DGPGA36 + - + + + + + + - + + + - - + + + + + - -14 DGPGA40 + - + + + + + + + - + + - - + - + + + - -15 DGPGA44 + - + - + - - + + - + + - - + - + + + - -16 DGPGB3 + - + + + + - + + - + + - - + + + + + - -17 DGPGB9 + - + + + + - - + - + - - - + - - + + - -18 DGPGB30 - - + + + + - - + - + + - - + + + + + - -19 DGPGB43 + - + + + + - - - - - - - - + + + + + - -20 DGPGB56 + - + + + + - - + + + - - - + - + + - - -21 DGPGB66 - - - + + + - - - + + + - - + - + + + - -22 DGPGB57 + - + + + + - - + + + - - - + + + - + - -23 DGPGB64 - - + + + + - - + + + - - - + + + + + - -24 DGPGB68 + + + + + + + + + + + - + - + + + + + + +25 DGPGB71 + - + + + + - + + + + - + - + + + + + + +26 DGPGB67 + - + + + + + - + + + - + - + + + + + - -27 DGPGB76 + - + + + + + - - + + - - - + + + + + - -28 DGPGB78 - - + + + + + + + + + - - - + + + + + + +29 DGPGB119 + - + + + + + + + + + - - - + + + + + - -30 DGPGB245 + + + + + + + + + + + + - - + + + + + + +
A1=VIRUDDA AHARA, A2=DUSTA AHARA, A3=AMLA, A4 =VIDAHI, A5=PITTAVRUDDIKARA (a=Masha, b=Kulattha), V1=DOOMRAPANA,
V2= ATAPASEVANA, V3=JAGARANA, V4=ATIMAITHUNA, V5=PARISHRAMA, V6=VEGADHARANA, V7=MADYAPANA, V8=ATISNANA AVAGAHA, V9=RUTU (VARSHA, SHARAT), O1=KRODHA, O2=CHINTA, O3=BHAYA, O4=SHOKHA, O5=CORTICO STEROIDS, O6=NSAID’S
v
Table No V–Chief complaints (grading) of “Evaluation of efficacy of KALAMEGHA in Amlapitta”
1 2 3 4 5 6 7 8 9 10 Sl.No OPD No. B A E B A E B A E B A E B A E B A E B A E B A E B A E B A E
1 DGPG02 2 2 1 4 2 2 1 1 1 2 2 2 1 1 1 1 1 1 2 1 1 2 1 1 2 2 1 2 1 1 2 DGPG12 3 3 2 3 2 2 1 1 1 2 2 2 4 3 2 2 2 2 3 2 2 3 2 2 3 2 1 3 2 1 3 DGPG17 2 1 1 2 1 1 3 2 1 2 1 1 4 2 2 2 1 1 2 1 1 2 2 2 2 1 1 2 1 1 4 DGPG24 2 2 2 4 2 2 4 2 1 3 2 2 4 1 1 3 2 1 3 1 1 3 2 2 3 2 1 3 1 1 5 DGPG19 2 2 2 2 1 1 3 2 1 3 2 2 3 2 2 3 1 1 3 2 1 3 2 2 2 2 1 2 2 1 6 DGPG36 4 2 2 2 2 1 2 1 1 2 2 2 2 2 1 1 1 1 3 2 2 3 2 2 3 2 1 3 2 1 7 DGPGA1 3 2 2 3 2 2 3 2 2 4 2 1 3 2 2 3 2 1 3 1 1 3 2 1 3 2 2 3 1 1 8 DGPGA6 2 2 2 2 2 2 4 2 1 4 2 2 3 1 1 1 1 1 2 2 1 3 2 2 2 2 1 2 2 2 9 DGPGA3 2 2 1 4 2 2 3 1 1 3 2 1 3 1 1 3 1 1 3 2 2 3 2 2 3 2 1 3 2 2 10 DGPGA24 3 2 2 2 2 1 4 2 2 3 1 1 1 1 1 1 1 1 3 2 1 3 2 2 3 2 1 3 2 2 11 DGPGA2 3 2 1 4 2 2 2 1 1 4 2 2 4 2 2 2 1 1 3 2 2 3 2 2 3 2 1 2 1 1 12 DGPGA29 3 2 1 2 2 2 4 2 1 2 2 2 3 1 1 2 1 1 2 2 1 3 2 2 3 2 2 2 1 1 13 DGPGA36 3 2 1 2 2 2 4 2 2 3 2 1 3 1 1 3 2 1 2 2 2 3 2 1 2 2 1 3 2 1 14 DGPGA40 4 3 1 4 2 2 4 2 2 2 2 2 4 2 1 1 1 1 3 2 2 3 2 2 3 2 1 1 1 1 15 DGPGA44 3 2 1 3 2 2 3 1 1 3 2 1 1 1 1 3 1 1 2 2 1 3 2 2 3 2 1 3 1 1 16 DGPGB3 2 2 1 2 2 2 3 2 1 2 2 2 4 2 2 1 1 1 2 2 1 2 2 2 2 2 1 1 1 1 17 DGPGB9 4 2 1 4 2 2 3 2 2 2 2 1 1 1 1 1 1 1 3 2 1 3 2 2 3 2 1 1 1 1 18 DGPGB30 3 2 1 2 2 2 1 1 1 2 2 1 1 1 1 2 1 1 2 1 1 2 1 1 2 2 1 2 1 1 19 DGPGB43 2 1 1 2 1 1 2 1 1 3 1 1 4 2 1 3 1 1 2 1 1 2 1 1 2 1 1 3 1 1 20 DGPGB56 2 1 1 3 2 1 1 1 1 4 1 1 1 1 1 2 1 1 2 1 1 2 1 1 2 2 1 2 1 1 21 DGPGB66 3 1 1 3 1 1 4 2 1 4 1 1 1 1 1 1 1 1 2 1 1 2 1 1 2 1 1 2 1 1 22 DGPGB57 2 1 1 2 1 1 3 1 1 2 1 1 1 1 1 3 1 1 2 1 1 2 1 1 2 1 1 2 1 1 23 DGPGB64 2 1 1 4 2 2 1 1 1 4 1 1 4 1 1 2 1 1 1 1 1 1 1 1 2 2 1 1 1 1 24 DGPGB68 2 2 1 3 2 2 3 1 1 2 2 2 3 1 1 2 1 1 2 2 1 2 1 1 3 2 1 2 2 1 25 DGPGB71 3 2 1 4 2 2 1 1 1 3 2 2 4 2 1 3 1 1 2 2 1 3 2 2 3 2 1 2 2 1 26 DGPGB67 3 2 2 3 2 2 4 2 2 2 2 2 2 2 1 1 2 1 2 2 2 3 2 2 3 2 2 2 2 2 27 DGPGB76 4 2 1 4 2 2 1 1 1 2 2 1 2 1 1 3 1 1 3 2 1 3 2 2 3 2 1 3 2 2 28 DGPGB78 2 2 1 3 2 2 2 2 1 3 2 2 1 1 1 3 2 2 1 1 1 2 2 1 2 2 1 1 1 1 29 DGPGB119 3 2 1 2 2 2 2 1 1 4 2 2 2 1 1 3 2 1 2 2 2 3 2 2 2 2 1 2 2 1 30 DGPGB245 3 2 1 4 2 2 3 2 2 2 2 1 3 1 1 3 1 1 3 2 1 2 2 2 3 2 1 3 2 1
1=AVIPAKA, 2=KLAMA, 3=UTKLESHA, 4=TIKTODGARA, 5=AMLODGARA, 6=GOURAVA, 7=HRIDDAHA, 8=KANTHADAHA, 9=ARUCHI, 10 =CARDI.
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124. Shastri K.A., editor, Sushruta Samhita of Sushruta, 11th edition, Varanasi: Chaukhambha Sanskrit Sansthana, 1997 (I): P.31 125. Gupta K.A., editor, Astanga Sangraha of Vagbhata, reprinted, Varanasi: Krishnadas Academy, 1993 (I): P.368 126. Pendy. G.,editor Charaka samhita of Agnivesh with Ayurveda Deepika
Commentary of Chakrapanidatta and vidhyotini hindi commentary of Shastri.
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127. Gupta K.A., editor, Astanga Sangraha of Vagbhata, reprinted, Varanasi: Krishnadas Academy, 1993 (I): P.370 128. Shastri K.A., editor, Sushruta Samhita of Sushruta, 11th edition, Varanasi: Chaukhambha Sanskrit Sansthana, 1997 (II): P.11 129. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
130. Gupta K.A., editor, Astanga Sangraha of Vagbhata, reprinted, Varanasi: Krishnadas Academy, 1993 (I): P.170 131. Shastri. B, editor. Yogaratnakara, 7th edition, Varanasi, Chaukhambha Sanskrit Sansthana, 1999: P.237
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Chaukhambha Sanskrit Bhawan, 2002: P.336
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Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
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Chaukhambha Sanskrit Bhawan, 2002: P.336
136. Shastri S., Upadhayya Y, editors Madhava Nidanam of Madhavakara with
Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
Sansthan, 1994 :(I) P.171
137. Mishra B.S., Vaishya R., editors Bhavaprakasha of Bhavamishra 9th edition, Varanasi:Chaukhambha Sanskrit Sansthana 2000(II) Chikitsa prakarana:P.121 138. Shastri. B, editor. Yogaratnakara, 7th edition, Varanasi, Chaukhambha Sanskrit Sansthana, 1999: P.235 139. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
140. Shastri S., Upadhayya Y, editors Madhava Nidanam of Madhavakara with
Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
Sansthan, 1994 :(I) P.170
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141. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
142. Shastri. B, editor. Yogaratnakara, 7th edition, Varanasi, Chaukhambha Sanskrit Sansthana, 1999: P.237 143. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
144. Shastri S., Upadhayya Y, editors Madhava Nidanam of Madhavakara with
Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
Sansthan, 1994 :(I) P.170
145. Pendy. G.,editor Charaka samhita of Agnivesh with Ayurveda Deepika
Commentary of Chakrapanidatta and vidhyotini hindi commentary of Shastri.
K. 6th edition, Varanasi: Chaukhambha Sanskrit Sansthana, 2000 :(II) P.460
146. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
147. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
148. Shastri S., Upadhayya Y, editors Madhava Nidanam of Madhavakara with
Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
Sansthan, 1994 :(I) P.170
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commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
150. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
151. Shastri S., Upadhayya Y, editors Madhava Nidanam of Madhavakara with
Madhukosha Commentary 23rd edition, Varanasi: Chaukhamb Sanskrit
Sansthan, 1994 :(I) P.172
152. Priyavat Sharma.,editor, Chakradatta, 2nd edition, Varanasi: Chaukhambha Publishers, 1998: P.295 153. Shastri. B, editor. Yogaratnakara, 7th edition, Varanasi, Chaukhambha Sanskrit Sansthana, 1999: P.239 154. Satyapal. B., editor Kasyapa Samhita of Vrddha Jivaka with vidyotini hindi
commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.336
155. Pendy. G.,editor Charaka samhita of Agnivesh with Ayurveda Deepika
Commentary of Chakrapanidatta and vidhyotini hindi commentary of Shastri.
K. 6th edition, Varanasi: Chaukhambha Sanskrit Sansthana, 2000 :(I) P.620
156. Priyavat Sharma.,editor, Chakradatta, 2nd edition, Varanasi: Chaukhambha Publishers, 1998: P.295 157. Shastri. B, editor. Yogaratnakara, 7th edition, Varanasi, Chaukhambha Sanskrit Sansthana, 1999: P.239 158. Priyavat Sharma.,editor, Chakradatta, 2nd edition, Varanasi: Chaukhambha Publishers, 1998: P.412
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Publishers, 1998: P.412
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Commentary of Chakrapanidatta and vidhyotini hindi commentary of Shastri.
K. 6th edition, Varanasi: Chaukhambha Sanskrit Sansthana, 2000 :(I) P.324
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commentary of Pandit Hemaraja Sharma. 18th edition, Varanasi:
Chaukhambha Sanskrit Bhawan, 2002: P.337,338
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2005. P. 12
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1
RESEARCH PROFORMA DEPARTMENT OF POST GRADUATE STUDIES IN DRAVYAGUNA
D.G.M. AYURVEDIC MEDICAL COLLEGE GADAG CLINICAL EVALUATION OF EFFECT OF KALAMEGHA CHURNA
(ANDROGRAPHIS PANICULATA) IN CASES OF AMLAPITTA.
Guide Dr. G.V. Mulagund M.D (Ayu), Scholar: Dr. Jaya. H. Malagoudar Prof. & H.O.D. Co- Guide Dr. Shashikant. B. Nidagundi M.D (Ayu), Lecturer 1) Name of the Patient
2)Father’s / husband’s name
Sl.No
3) Sex Male Female OPD No
4) Age Years IPD No
5) Religion Hindu Muslim Christian Other
6) Occupation Sedentary Active Labour
7) Marital status Married Unmarried Widow
8) Economical status Poor Middle Higher middle Higher class
9) Address
Contact No: Pin
10) Selection Included Excluded
11) Schedule Initiation
Date
Completion
Date
Well responded Moderately responded 12) Result
Responded Not responded Discontinued
13) INFORMED CONSENT I Daughter/Wife of am
exercising my free will, to participate in above study as a subject. I have been informed to my satisfaction,
by the attending physician the purpose of the clinical evaluation and nature of the drug treatment. I am also
aware of my right to about of the treatment schedule, at any time during the course of the treatment.
EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _______________________ £À£Àß ¸ÀéEZÉÒ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw. ¥Àæ¸ÀÄÛvÀ
£ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ 0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ
»AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å«zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.
gÉÆÃV0iÀÄ gÀÄdÄ / Patient's Signature
2
14. CHIEF COMPLAINTS WITH DURATION:
S.No Complaints Duration Remarks 1. Avipaka 2. Klama 3. Utklesa 4. Tiktodgara 5. Amlodgara 6. Gourava 7. Hritdaha 8. Kanthadaha 9. Aruci 10. Cardi
Colour: Consistency: Contents: Taste:
15. ASSOCIATED COMPLAINTS:
S.No Associated complaints Duration Remarks 1. Kuksidaha 2. Sirasula 3. Hastadaha 4. Padadaha 5. Jwara 6. Kandu 7. Hrillasa 8. Kotha 9. Agnimandhya 10. Romaharsa 11. Pidaka 12. Mukhalepa 13 Nidradhikya
16. HISTORY OF PRESENT ILLNESS:
17. HISTORY OF PAST ILLNESS:
18. DRUG HISTORY: Other system of medications.
Since how long
3
19. FAMILY HISTORY:
20. PERSONAL HISTORY:
Diet:
o Nature: Veg/Mix.
o Food Habits: Samasana/Visamasana/Adhyasana/Pramitasana.
o Aggravating diet:
o Rasa Pradhana: M / A / L / K / T / Ks / Sarva Rasa.
o Addictions:
Beedi/Cigarette……no.s/day; since……years.
Tobacco chewing/Snuff: since…….years.
Coffee/ Tea: ………no. of cups/day. Since ……years.
Alcohol: ……..ml./day. Since ………years.
Others:
No habits:
o Exercise: Regular/Irregular/Occasional/Only routine work.
Sleep: Sound/Irregular/Disturbed/Delayed.
Night……….Hrs. Day…………Hrs.
Bowel: Regular/Irregular/Constipation/Loose/Soft/Constipated.
No. of frequency…………..times/day.
Micturation: Regular/Irregular………….times/day.
Occupational history:
Sedentary/Moderate/Heavy
Nature of work: Physical/Mental
Time of work: Day/Night/Day Night…Hrs.
21. SOCIAL HISTORY:
Hygienic condition of residency: Poor / Moderate / Good
22. GYNECOLOGICAL HISTORY:
Menarche: Years Regular / Irregular Menopause: Yes/ No
Issues: Miscarriage / Abortions
History of gynecological medication / surgery.
4
23. GENERAL EXAMINATION:
01 Pulse 02 B.P. 03 Temp. 04 R.R. 05 weight 06 Height
a. Dashavidha pareeksha
Prakruti V P K VP VK PK VPK
Sara Pravar Avara Madhyama
Samhana Susamhita Asamhita Mudhyana samhita
Praman Height in cm Weight in kg
Satmya Ekarasa Sarvarasa Ruksha Sneha
Satwa Pravar Avara Madhyam
Aharshakti Abhyavabharan Jarana
Vyayam shakti
Pravar Avara Madhyam
Vaya Bala Yauvan Vardhakya
b. Asthasthana
Nadi Dosha Mutra Pravritti Gati Varna Purnata Gandha Spandana Katinya Jihwa Adra Shushka Mala Sama Nirama Lepa Nirlepa Shabdha Sparsha Sheeta Ushna Drik Akriti
5
24. SYSTEMIC EXAMINATION:
a. Respiratory system:
b. Cardio vascular system:
c. Central nervous system:
d. Gastro intestinal system:
i. Inspection:
Mouth: Stomatitis/Other/Normal. Shape: Distended/Scaphoid/Bulging Of Flanks/Normal. Umbilicus: Inverted/Averted/Normal. Surface: Smooth/Glossy/Scar/Wrinkles/Pigmentation/Striae. Asymmetrical bulging: Epigastric/ Hypogastric/ Umbilical/ Lumbar/ Hypochondrial/ Iliac/None. Movement: Symmetrical/ Paradoxical. Pulsation: Visible/Invisible.
ii. Palpation: Superficial-region of tenderness……… Hyperasthesia: Present/ Absent/Site… Muscle guard: Rigid/Normal
Liver: Palpable/Tender/Normal. Spleen: Palpable/Tender/Normal. Kidney: Palpable/Tender/Normal. Colon: Palpable/Tender/Normal. Any other mass: Present/Absent.
iii. Percussion:
Srotas examination:
Annavaha Srotas: Aruci/ Avipaka/ Cardi/ Anannabhilasha/ Prakritha
Rasavaha Srotas: Angasada/ Praseka/ Alasya/ Gaurava/ Bhrama/ Sosa/ Glani/
Pandu/ Asraddha/ Asyavairasya/ Arasagnata/ Prakritha.
Purisavaha Srotas: Atidrava/ Atigratitha/ Bahula/ Alpalpa/ Sasabda/ Sasula
Malapravritti /Prakritha.
Other Srotas: Prakrita/ Vaikrita.
6
25. EXAMINATION OF VYADHI: a. Nidana
AHARA VIHARA OTHERS Viruddha Dhumrapana Krodha
Dusta Atapasevana Chinta Amla Jagarana Bhaya Vidahi Atimaithuna Shoka
PittaVriddhi kara Parishrama Cortico steroids (a) Masha Vegadharana NSAID's (b) Kulatta Madyapana
Atisnana/Avagaha Ritu (varsha/sharad)
b. Samprapti
Dosha Dushya Adhistana Srotas Srotodusti Rogamarga
c. Samanya Roopam
B A B A Avipaka Klama Utklesha Tiktodgara Amlodgara Gowrava Hritdaha Kanthadaha Aruchi Vidbheda Shirashoola Hrutshoola Adhmana Angasada Antrakoojana Urodaha Romaharsha
d.Gatianusara Roopam
Adhoga Amlapitta B A Urdhwaga Amlapitta
Trishna B A B A Daha Harita Peeta Moorcha Neela Krishna Bhrama Rakta Raktabha Moha Amla Mamsodaka
Gudasrava
Van
ta
Pichchila Swascha sleshma vamana
Hrillasa Amlodgara Tiktodgara Kotha Aruchi Jwara Mandagni Kanthadaha Kushidaha Romanchana Karadaha Charanadaha Sweda Shiroruja Kandu Peetavarna Mandala Pidika Gatra Roga
7
e.Doshanusara Roopam
VATAJA B A KAPHAJA B A VATAKAPHAJA B A Shoola Gurukosta Tikta amoldgara Angasada Vamana Katukodgara Jhrumba Kapha nistivana Hrutdaha Kampa Aruchi Kushidaha Pralapa Mukha lepa Kanthadaha Murcha Kandu
Chimchimayamana Gowrava KAPHAPITTAJA Krushata Jadata Bhrama
Gat
ra
Harshata Gat
ra
Sheetata Moorcha Avasada Balanasha Aruchi Chitta vibhrama Kayagninasha Vamana Pramoha Nidradhikyata Alasya Tamah pravesha PITTA Shiro vedana Darshana vibhrama Bhrama Praseka Daha Mukhamadhurya f. Upashaya and Anupashaya
Upashaya B A Anupashaya B A Samashana Viruddhashana Madhura rasa, sheeta virya and avidahiahara
Amla, vidahi, pitta vriddhikara ahara and kulatta sevana
Vishranti Parishrama Manoharsha Chinta, krodha,bhaya g. Upadrava B A B A Jwara Atisara Pandu Shoola Shotha Bhrama Dhatukshaya Aruchi h.Sadhyasadhyata
Sadhya Asadhya Navam Chirakari
26. INVESTIGATION:
Red blood cell count Stool test Bile test
8
27. TREATMENT:
Kalamegha churna
1) Matra – churna 4 gms in divided doses
2) Anupana – Sukoshna jala
3) Duration of treatment – 30 days
4) Follow up – 6thday, 12thday, 18thday, 24thday, 30th day
28. CLINICAL EVALUATION OF THE SYMPTOMS OF AMLAPITTA
For subjective parameters each symptom has been graded or scored with
following rating method.
Sl.No Symptoms / Complaints (Severity) Severity scores 1 No Symptoms / Complaints 1 2 Mild Symptoms / Complaints 2 3 Moderate Symptoms / Complaints 3 4 Severe Symptoms / Complaints 4
Subjective parameters
Symptoms Severity Before Treatment After Treatment End of the Follow-
Up Avipaka Klama Utklesa Tiktodgara Amlodgara Gourava Hritdaha Kanthadaha Aruci Cardi Colour: Consistency: Contents: Taste:
Over all Over all severity of the disease. Normal : 10
Mild : 11-20
Moderate : 21-30
Severe : 31-40
9
29. ASSESSMENT CRITERIA:
All patients to be assessed once a week during the 30-day medication period.
There after, follow-up consisted of fortnightly assessments. All the
observations will be recorded in the proforma.
GRADING OF THE SUBJECTIVE PARAMETERS
Symptom Normal
(1) Mild (2)
Moderate (3)
Severe (4)
Avipaka Absent Irregular digestion Indigestion associated with Nausea
Indigestion associated with Chardi and Bhakta Dwesha
Klama Absent Fatigued due to excretion and relieved by rest
Fatigued without excretion, more in the morning
Fatigue associated with heaviness
Utklesa Absent In relation with specific food
In relation with normal food
Associated with chardi
Tiktodgara Absent Associated with Avipaka
Associated with Hrillasa
Associated with Kanthadaha
Amlodgara Absent Associated with Avipaka
Associated with Hrillasa
Associated with Kanthadaha
Gourava Absent Feel of heaviness in the early morning
Feel of heaviness associated with Avipaka
Feel of heaviness associated with Klama
Hritdaha Absent Retrosternal discomfort
Associated with pain
Associated with Gastric regurgitation
Kanthadaha Absent Associated with Avipaka
Associated with Utklesha
Associated with Gastric regurgitation
Aruci Absent Loss of interest in intake of food
Aversion to the food
Nausea and sometimes vomiting after intake of food
Cardi Absent Vomiting of Bilious contents
Excess mucous secretion along with undigested food
Vomiting of indigested food taken before 24 hours
Signature of Guide Signature of Co -Guide Signature of Scholar
1
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