garbhini chardi-psr
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A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi, Sujatha, B S, Department of post graduate studies in Prasooti Tantra & Stree roga, S. D. M. COLLEGE OF AYURVEDA, UDUPITRANSCRIPT
Abbreviations
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
List of Abbreviations (Ayurvedic)
According to Reference Books
1. A. H. Astanga Hridaya
2. A. S. Astanga Samgraha
3. A. K. Amara Kosha
4. S. S. Sushruta Samhita
5. B. P. Bhavaprakasha
6. H. S. Harita Samhita
7. C. S. Charaka Samhita
8. C. D. Chakra Dutta
9. Ckr. Chakrapani
10. Dl. Dalhana
11. K. S. Kashyapa Samhita
12. K. N. Kaiyyadeva Nighantu
13. M. Ni. Madhava Nidana
14. S. K. D. Shabda Kalpa Druma
15. Y. R. Yogaratnakara
16. Sh. S. Sharangdhara Samhita
17. Vag. Vagbhatta
18. Chi. Chikitsa Sthana
19. Ind. Indriya Sthana
Abbreviations
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
20. Ka. Kalpa Sthana
21. Ni. Nidana Sthana
22. Su. Sutra Sthana
23. Ut. Uttara Sthana
24. Sha. Shareera Sthana
25 Hb Hemoglobin
26 CTZ Chemo receptor trigger zone
27 & and
28 UTI Urinary tract infection
29 syn Syndrome
30 Int Intestinal
31 HCG Human chorionic Gonadotrophine
32 OCP’S Oral contraceptive pills
33 UOS Upper oesophageal sphincter
34 LOS Lower oesophageal sphincter
35 ATP Adenosine triphosphophate
36. AMP Adenosine monophosphate
37. CNS Central nervous system
38. GIT Gastro intestinal tract
39. LFT Liver function test
40 SGOT Serum glutamic oxaloacetic transaminase
Abbreviations
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
41. SGPT Serum glutamic pyruvic transaminase
42. ECG Electro cardiograph
43. USG Ultra sonography
44. HT3 Hydroxy triptane
45. U.S United states
46. hrs hours
47 kg Kilograms
48. % Percentage
49 RBC Red blood corpuscles
50. WBC White blood corpuscles
51 HLA Human Lymphocyte antigen
ABSTRACT
Title - “A Clinical Study on effect of Dadimaavaleha in the management of Garbhini
Chardi”.
Garbhini chardi or Morning sickness is a worldwide problem in the pregnant
women. About 50-80% of pregnant women suffer from this. The common symptoms are
nausea, vomiting & occasional sickness on rising in the morning. It may however occur
at other times of the day. Altered hormonal & immunological states are responsible for
initiation of the manifestations which is probably aggravated by the neurogenic factors.
Whatever may be the cause of initiation unless it is not quickly rectified features of
dehydration & carbohydrate starvation occurs leading to a vicious cycle of vomiting.
Under these circumstances practitioners are in need of alternative, safe, economic &
nontoxic medicine to treat the morning sickness. Dadima Avaleha is one such drug which
can be used in morning sickness safely.
Objectives: 1. To do conceptual study of Garbhini chardi.
2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.
Study design: This research work is a single blind clinical study with pre test and post test design.
30 Patients fulfilling above criteria were assigned in to two groups.
Group A – Dadimaavaleha for 21 days. Dose-24gms with divided dose of 8gms T.I.D. with lukewarm water
Group B – Placebo for 21 days. 24gms with divided dose of 8gms T.I.D. with lukewarm water
Result: Dadimaavaleha was effective in treating Chardi Vega, Hrullasa, Anannabhilasha
& Quantity of Vomitus.
Key words: Garbhini, Dourhrda avamana, Aapanna satwa, Shamana chikitsa, Agnimandya,
Hrullasa, Chardi, Dadima Avaleha.
ACKNOWLEDGENMENT
MY GRATITUDE:
With a bowed Head to the Almighty,
With folded Hands to Revered Teachers
And a warm Heart to My Parents, Husband & Friends.
With profound gratitude, I am greatly indebted to my
revered teacher and guide, Dr. Mamatha. K.V, M.D (Ayu) Prof., Dept.
of Prasooti tantra & stree roga, S.D.M.C.A., Udupi, who has not only
guided me to complete my research work, but has always been a
source of inspiration and encouragement in all stages of my tenure
of Post Graduate education. Her great patience and fortitude has
helped me immensely in completing my work successfully.
I am ever grateful to my Co-guide Dr. Suchetha
Kumari, M. D. (Ayu), Asst. Prof., Department of Prasooti Tantra and
Stree Roga, S.D.M.C.A., Udupi, for her encouragement, help, valuable
suggestions and critically reviewing this study.
My eternal gratitude to Dr. V. N. K. Usha, M. D. (Ayu),
Prof. & Head of Department of Prasooti Tantra and Stree Roga,
S.D.M.C.A., Udupi, for her continuous inspiration and valuable
suggestions.
I express my heartfelt thanks to Dr. Ramadevi, Dr.Vidya
Ballal for their support and help in the clinical study of this work.
I offer my sincere thanks to Dr.U.N.Prasad, Principal
S.D.M.C.A., Udupi,, Dr.K.R.Ramachandra, Vice Principal, S.D.M.C.A.,
Udupi,.
I offer my sincere thanks to Dean of P.G Faculty Dr.Srikant.U
for their encouragement and guidance.
I thank Dr. Y. N. Shetty, Medical Superintendent, Dr.Krishna
bai & Dr.Veena Mayya and all the staff of S. D. M. Hospital, Udupi.
My eternal gratitude to Dr. Murali Krishna manager,
Dr.Mohan and all other staff of S. D. M. A. Pharmacy, Udupi.
I thank Sri Harish Bhat, Librarian, S. D. M. C. A., and his
staff for providing necessary books in time.
I heartily convey my thanks to my Uncle N.S. Hiremath, my
Grandmother, Mother, my inlaws, Husband, Brother & sisters who
inspired me to do my post graduation.
Lastly I thank all my friends Dr.Shilpa, Dr. Vijayalakshmi,
Dr.Shubha, Dr.Kavya, Dr. Sukanya, Dr. Prakash, Dr. Vinod & all my
seniors & juniors without whome this work would not be complete. Date- Dr.Sujatha.B.S
Contents
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
CONTENTS PAGE.NO
1 Certificates
2 Acknowledgment
3 Contents
4 List of Abbreviations
5 List of Tables
6 List of Diagrams
7 List of Graphs
8 INTRODUCTION 1‐2
9 OJECTIVE OF STUDY 3
10 CONCEPTUAL STUDY Historical Review Review of Garbhini chardi Drug Review
4‐50
11 CLINICAL STUDY Materials & methods Observations Results
51‐86
12 DISCUSSION 87‐97
13 SUMMARY & CONCLUSION 98‐101
14 BIBILOGRAPHY 102‐106
15 CASEPROFORMA
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
List of Tables in different chapters
Table No.1 Nidanas of chardi
Table No.2 Vishista Nidanas of chardi
Table No.3 Purvarupa of chardi
Table No.4 Roopa of Vataja chardi
Table No.5 Roopa of Pittaja chardi
Table No.6 Roopa of Kaphaja chardi
Table No.7 Roopa of Sannipataja chardi
Table No.8 Asadya lakshanas
Table No.9 Showing rasa, guna, veerya,vipaka & karma of the drug
Table No.10 Showing botanical description of drugs
Table No.11 Distribution of patients based on age
Table No.12 Distribution of patients based on Religion
Table No.13 Distribution of patients based on Occupation
Table No.14 Distribution of patients based on Education
Table No.15 Distribution of patients based on Habitat
Table No.16 Distribution of patients based on Gravida
Table No.17 Distribution of patients based on Nausea
Table No.18 Distribution of patients based on Vomiting
Table No.19 Distribution of patients based on Frequency of vomiting
Table No.20 Distribution of patients based on Quantity of vomitus
Table No.21 Distribution of patients based on content of vomitus
Table No.22 Distribution of patients based on Ananabhilasha
Table No.23 Distribution of patients based on Alasya
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
Table No.24 Distribution of patients based on Angamarda
Table No.25 Distribution of patients based on Anidra
Table No.26 Distribution of patients based on Agnimandya
Table No.27 Distribution of patients based on Brama
Table No.28 Distribution of patients based on Daurbalya
Table No.29 Distribution of patients based on Talu Shosha
Table No.30 Distribution of patients based on Jihwa Shosha
Table No.31 Distribution of patients based on Tandra
Table No.32 Distribution of patients based on Shira Shoola
Table No.33 Distribution of patients based on Family history
Table No.34 Distribution of patients based on Diet
Table No.35 Distribution of patients based on Appetite
Table No.36 Distribution of patients based on Sleep
Table No.37 Distribution of patients based on Mala Pravruti
Table No.38 Distribution of patients based on Prakruti
Table No.39 Distribution of patients based on Vikruti
Table No.40 Distribution of patients based on Saara
Table No.41 Distribution of patients based on Samhanana
Table No.42 Distribution of patients based on Pramana
Table No.43 Distribution of patients based on Satwa
Table No.44 Distribution of patients based on Satmya
Table No.45 Distribution of patients based on Ahara Shakti
Table No.46 Distribution of patients based on Vyayama Shakti
Table No.47 Effect of chardi vega in group A
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
Table No.48 Effect of chardi vega in group B
Table No.49 Comparison of Chardi vega within the groups
Table No.50 Effect of Hb% in group A
Table No.51 Effect of Hb% in group B
Table No.52 Comparison of Hb% within the groups
Table No.53 Effect of weight in group A
Table No.54 Effect of weight in group B
Table No.55 Comparison of weight within the groups
Table No.56 Effect of Ananabhilasha in group A
Table No.57 Effect of Ananabhilasha in group B
Table No.58 Comparison of Ananabhilasha within the groups
Table No.59 Effect of Nausea in group A
Table No.60 Effect of Nausea in group B
Table No.61 Comparison of Nausea within the groups
Table No.62 Effect of Quantity of vomitus in group A
Table No.63 Effect of Quantity of vomitus in group B
Table No.64 Comparison of Quantity of vomitus within the groups
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
List of Diagrams
Graph No.1 Incidence according to age
Graph No.2 Incidence according to Religion
Graph No.3 Incidence according to Occupation
Graph No.4 Incidence according to Education
Graph No.5 Incidence according to Habitat
Graph No.6 Incidence according to Gravida
Graph No.7 Incidence according to Vomiting
Graph No.8 Incidence according to Frequency of vomiting
Graph No.9 Incidence according to Quantity of vomiting
Graph No.10 Incidence according to Content of vomitus
Graph No.11 Incidence according to Ananabhilasha
Graph No.12 Incidence according to Alasya
Graph No.13 Incidence according to Angamarda
Graph No.14 Incidence according to Anidra
Graph No.15 Incidence according to Agnimandya
Graph No.16 Incidence according to Brama
Graph No.17 Incidence according to Daurbalya
Graph No.18 Incidence according to Talu Shosha
Graph No.19 Incidence according to Jihwa Shosha
Graph No.20 Incidence according to Tandra
Graph No.21 Incidence according to Shirashoola
Graph No.22 Incidence according to Habitat
Graph No.23 Incidence according to Family history
Graph No.24 Incidence according to Diet
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
Graph No.25 Incidence according to Appetite
Graph No.26 Incidence according to Sleep
Graph No.27 Incidence according to Mala Pravruti
Graph No.28 Incidence according to Prakruti
Graph No.29 Incidence according to Vikruti
Graph No.30 Incidence according to Saara
Graph No.31 Incidence according to Samhanana
Graph No.32 Incidence according to Pramana
Graph No.33 Incidence according to Satwa
Graph No.34 Incidence according to Satmya
Graph No.35 Incidence according to Ahara Shakti
Graph No.36 Incidence according to Vyayama Shakti
Graph No.37 Effect of chardi vega in both the groups
Graph No.38 Comparison of chardi vega within the groups
Graph No.39 Effect of Hb% in both the groups
Graph No.40 Comparison of Hb% within the groups
Graph No.41 Effect of weight in both the groups
Graph No.42 Comparison of weight within the groups
Graph No.43 Effect of Ananabhilasha in both the groups
Graph No.44 Comparison of Ananabhilasha within the groups
Graph No.45 Effect on Nausea in both the groups
Graph No.46 Comparison of Nausea within the groups
Graph No.47 Effect on quantity of vomitus in both the groups
Graph No.48 Comparison of Quantity of vomitus within the groups
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
List of Flow Charts
Chart No.1 Flow chart showing types of chardi
Chart No2 Flow chart showing Samprapti of chardi
Chart No.3 Flow chart showing Upadrava of Chardi
Chart No.4 Flow chart showing Physiology of vomiting
Chart No.5 Flow chart showing Act of vomiting
Chart No.6 Flow chart showing Causes of vomiting
Chart No.7 Flow chart showing Cycle of vomiting
Chart No.8 Flow chart showing Management of Vomiting
List of Pictures
SI.NO NAMES
1. Physiology of vomiting
2. Dadima
3. Shunti
4. Pippali
5. Maricha
6. Manjista
7. Pata
8. Nimba
9. Lavanga
10 Ativisha
11. Vamshalochana
List of Tables
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi”
12 Danyaka
13 Jeeraka
14 Haritaki
15 Ajamoda
16 Jatiphala
17 Madhu
18 Sharkara
19 Preparation of Dadima Avaleha
20 Formation of Leha
Introduction
INTRODUCTION
Pregnancy is a unique, exciting & joyous time in a women’s life, as it highlights
the women’s amazing creative & nurturing power. The growing fetus depends entirely on
its mother’s body for all its needs. So pregnant women must take measures to remain
healthy & well nourished to have a healthy child which is a motive of every human
being.1 Many demands are made during pregnancy as a consequent upon the rapidly
growing fetus. To meet these requirements the maternal internal system has to undergo
certain changes to create conditions favorable to the fetus.2 As a result certain
physiological changes take place among which Garbhini Chardi or emesis gravidarum is
one. However this natural phenomenon turns into nightmare when she suffers from hyper
emesis which may affect the growing fetus as well as health of the mother.3
Garbhini Chardi is mentioned as vyakta garbha laxana along with other laxanas
like Artava adarshana, asyasamsravana, arochaka, gurugatrata, stanamandala krushnata
etc.4,5. All these laxanas are seen due to the presence of Garbha. When Chardi is seen as a
laxana there is no much harm on growing fetus & mother, because of which it is
considered as Physiological. But when it is seen in excess it becomes pathological where
early intervention is needed to prevent this as it causes severe dehydration, tiredness,
weight loss etc which may affect the growing fetus. So one should take care to treat these
conditions in initial stage & prevent complications as aim of every obstetrician is to give
healthy child to a healthy mother. In classics Acharyas have mentioned that pregnant
women should be taken care like a pot filled with oil is carried with more caution as
slight oscillation may cause spilling of oil from it.6 Similarly hyper emesis in certain
women produces severe adverse affect on fetus & the mother where decision is taken to
terminate pregnancy to save life of the mother.
While explaining regarding chikitsa in Garbhini Acharyas have mentioned that
she should be given things which are easily palatable, Hrudya & the one which is liked
by her.6 Lehya which is one among the four types of food items is having good
palatability because of sweetening agents present in this & is liked by Garbhini. The
metabolism & absorption of medicine in this form starts from the mouth itself because of
presence of glucose, Fructose etc.7 Vomiting in pregnancy is seen mainly due to
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 1
Introduction
carbohydrate starvation. As Honey & sugar is seen more in Lehya preparation along with
medicines it helps in supplementing carbohydrates. So acceptance of Avalehya in
Garbhini is more compared to other form of medicines. In today’s world Avalehya is
gaining rapid importance since it is easily consumable, rich in taste & is also having high
dietic value.7
Dadima is easily available in the market, liked by everyone especially by pregnant
women as it is Hrudya, ruchi vardaka, ahara pachaka, Rakta vardaka. So this was selected
for the study.
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 2
Objectives of the study
OBJECTIVES OF THE STUDY
1. To do conceptual study of Garbhini chardi.
2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page3
Historical Review
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 4
HISTORICAL REVIEW
xÉÉåÅrÉÇ AérÉÑuÉåïS zÉÉxuÉiÉÉå ÌlÉÌSïxrÉiÉå AlÉÉÌSiuÉÉiÉç | xuÉpÉÉuÉ xÉÇÍxɬè sɤÉiuÉÉiÉç pÉÉuÉ xuÉpÉÉuÉ ÌlÉirÉiuÉÉiÉç |8
Ayurveda, the science of life which has no begining, deals with the things
which are inherent in nature & is eternal. This holistic science is known since
prevedic, Vedic Period & practiced till today in preventing & curing the upcoming
diseases.
Pre Vedic Period: - 2700-500 BC
References regarding Garbhini or Garbhini chardi are not found.
Vedic Period: - 2500 BC
Among the 4 Vedas Ayurveda is considered as upaveda of Atharva Veda.
References regarding Garbhini, Sutika are found, which shows that they had
knowledge regarding all these, but much of the explanation is not found. Garbha
stapaka Aushadi’s & its use is explained.
In Upanishads & Puranas:-13
Padma Purana: - Explanations regarding development of garbha the food & regimen
Which must be followed by Garbhini is told.
Vishnu Purana: - Chardi is explained as one of the somatic disorder but reference
Regarding Garbhini chardi is not found.
Agni Purana: - It contains materials pertaining to all branches of Indian tradition &
Culture including medicine. Description regarding development of garbha is found.
Garuda Purana: - Description regarding development of the fetus & formation of body
is explained.
In Ramayana & Mahabharata:-
Reference regarding Garbhini & Garbha is found. But references about Garbhini
chardi is not found.
Samhita Period: - (1000BC- 500AD)
Historical Review
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 5
Charaka Samhita:–
Acharya Charka has mentioned chardi as one among vyakta garbha laxana in sharera
Sthana & included it under Dwistarthaja i.e. Dauhrudaja type. A separate chapter on
Chardi is available in chikitsa sthana where nidana, Purvarupa, roopa, samprapti &
Chikitsa for chardi is mentioned.4
Sushruta samhita:-
Acharya Susrutha opines chardi as one of the Vyakta garbha laxana. He considers
Aapanna Satwa as nidana for chardi. Dalhana commenting mentions apanna satwa
means Garbhini. 5
Astanga sangraha / Astanga Hridaya :-
Both Vagbhatas mentioned chardi as vyakta garbha laxana & there explanation is
similar to that of Susrutha.9
Sangraha Kala: - (500AD- 1700AD)
Madava nidana:-
A separate chapter is available which explains chardi & its management. While
explaining about nidanas of chardi Garbhini is explained as one among the cause for
chardi.10
Bhava prakasha:-
He has also mentioned chardi as one of the vyakta garbha laxana. His opinion is same
as that of Susrutha.11
Yogaratnakara:-
Explanation regarding chardi & its management is found, but references for Garbhini
Chardi is not available.12
Kashyapa Samhita:-
Much of the explanations about Garbhini & diseases seen in garbhavastha is
explained by Kashyapa. He explains Garbhini chardi, its types & management
accordingly in Khilasthana. 14
Haritha Samhita:-
Historical Review
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 6
Chardi is explained as one among the astagarbha Upadrava by Harita. Nidana, laxana
& Chikitsa of these Upadrava are mentioned in same chapter.15
Vangasena:-
His explanation is same as that of Susrutha.16
Previous work done -17
1. Dr.A.A.Shitre - .A study on effect of Mayura picchamasi in garbhinichardi,
Ayurveda mahavedyalaya pune, Pune University in 1991.
2. Dr.Sonagara -.A clinical study on Garbavasttajanya chardi, G.A.U Jamnagar
in 1993.
3. Dr.S.S Mohite -Garbhinichardi – Haritaki anupana madhu, Ayurveda
mahavidyalaya pune, Pune University in 1994.
4. Dr. Hemavati S.K -The control study of Mathulunga Avaleha in management
of garbhinichardi, SDMCA Udupi, RGUHS Karnataka in 2005
Disease Review
GARBHINI CHARDI
During pregnancy many demands are made by the growing fetus, to meet these
requirements maternal system has to undergo certain changes.2 As a consequence there is
manifestation of certain conditions among which Garbhini chardi is one such condition
seen in early trimester. It is mentioned as one of the vyakta garbha laxana in classics.
There is no separate chapter regarding Garbhini chardi, it can be considered under chardi
which is elaborately explained in our classics, as Acharya Kashyapa has mentioned that
euÉUɱÉlÉÉÇ ÌuÉMüÉUÉhÉÉÇ rÉ§É rɧÉåWû sɤÉhÉqÉç |
A³ÉÉSÉlÉÉÇ mÉëuɤrÉÉÍqÉ iÉe¥ÉårÉ aÉÍpÉïhÉÏwuÉÌmÉ || (MüÉ. xÉÇ. ÎZÉ. 10)
There is no difference in physical & psychological disorder of a pregnant woman
from any other individual i.e. the child of 2 yrs till old man as the doshas & dusyas of the
body are same. She also exhibits similar symptology for all the diseases. So
eitiopathogenesis of Chardi in Garbhini is same as that seen in other individuals but only
the principle of treatment differs as she is considered as sukumari. 18
VYUTPATTI:-19
The word “chardi” is a stree linga pada.
It is derived from two words i.e. ‘chad’ dhathu & ‘inn’ pratyaya.
The word ‘Chardh’ is again formed by two words
‘Chad’- Means to fill. ‘
Ardh’- Means discomfort.
The one which fills the mouth & comes out causing discomfort to the body is called
chardi.
NûSïrÉÌiÉ Nû±ïiÉå CÌiÉ uÉÉ | NûSï uÉqÉlÉå (zÉ.Mü.SìÓqÉ)
NIRUKTI:-
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 7
Disease Review
AÉqÉÉzÉrÉÉiÉç qÉÑZÉqÉÉaÉåïhÉ SÉåzÉÉhÉÉÇ oÉÌWûaÉïqÉlÉqÉç |
(cÉ.ÍcÉ.) 20
Vitiated doshas present in amashaya come out through the mukha marga called as chardi.
NûÉSrÉÌiÉ qÉÑZÉqÉç, ASïrÉÌiÉ cÉÉ…¡ûÉlÉÏÌiÉ cNûÌSïÈ |
NûÉSrɳÉÉlÉlÉÇ uÉaÉæUSïrɧɅ¡ûpÉleÉlÉæÈ | (qÉSÒMüÉåwÉ) 21
ÌlÉÂcrÉiÉå cNûÌSïËUÌiÉ SÉåwÉÉå uÉY§ÉÇ mÉëkÉÉÌuÉiÉÈ |
(xÉÑ.E.49/6) 22
The vitiated doshas rush up to the mouth after covering whole of it & comes out with
great force causing body ache called as chardi.
PARYAYA:-23
Vantaou, Vamana,
Vamatu, Vamihi,
Chardika, Utkasika,
Chardanam, Udgaraha.
NIDANA:-
Avoidance of the etiological factors of the disease comprises the prime line of
treatment in Ayurveda.
The various causative factors mentioned by different Acharyas can be
summarized under three major headings -
i) Aharataha
ii) Viharataha
iii) Nidanarthakara rogajanya
i) Aharataha: -
Ahara plays a vital role not only in maintaining the health but is equally
responsible for the causation of the disease if taken in improper way. Various etiological
factors related to food are:
Excessive intake of Atidrava, Atisnigda, Ahrudya, Atilavana, Akala, Atimatra,
Asatmya, ahara (Sushruta, Ashtanga Hridaya, Madhava Nidana, Bhavaprakash
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 8
Disease Review
Vangasena, Yogaratnakara).All these factors leads to Agnimandya which further leads to
ahara dusti which in turn causes Vikruti of vatadi tridosha leading to Chardi.22
ii) Viharataha: -
Shrama, Kshaya,
Manogata Karana:
Krodha, chinta, bhaya, shoka
Krodha produces Vatapitta prakopa. Chinta, Shoka and krodha produce
Vataprakopa. Krodha, Bhaya and shoka produce Pitta prakopa. All these factors & dusta
Ahara rasa in Garbhini causes chardi.
iii) Nidanarthakara Roga: -
Aapannasatwa (Garbhini acc to Dalhana), Krumi.
Acharya Susrutha while explaining Nidana of chardi has mentioned
Aapannasatwa as one of the cause, Dalhana on commenting has told that Aapannasatwa
means “Garbhini”. Which means presence of Garbha is one of the cause for chardi. He
also mentions Dauhruda avamana as one of the causative factor.
Acharya Yogaratnakara, Sarangadara, Vangasena etc followed Sushruta.
Madhukosa has explained that along with “Aapannasatwa” Vata Vaigunya due to
presence of garbha is a cause for chardi.
Acharya Harita has explained Chardi as one of the Upadrava of garbha, where the
cause for chardi is the presence of garbha.
From all the above explanations we find three main causative factors for Garbhini
chardi i.e.
1. Aapannasatwa (Garbhini)
2. Dauhruda avamana
3. Vatavaigunya due to presence of garbha.
Aapannasatwa: - Presence of garbha itself is one of the causes for chardi.
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 9
Disease Review
Dauhruda avamana: - During pregnancy women develops desire for certain foods &
articles. If her desires are not fulfilled then that may lead to vata vruddi which vitiate
manasika & other doshas leading to chardi.
Vata Vaigunya: - During pregnancy the poshana of the garbha takes place through the
rasas of the mother because of which dhathu shitilata may be seen which may lead to vata
Vaigunya. This vitiated vata along with other doshas may expel out through the mukha
marga in the form of chardi.
NIDANA Table No.1 Nidanas of Chardi
Sl.
No. Laxana Su.S A.S A.H MA.N Y.R Van
1. Atidrava, + - - - + +
2. Atisnigda, + + + - + +
3. Atilavana rasa sevana + + + - + +
4. Akala + - - - + +
5. Atimatra, + - - - + +
6. Asatmya, + - - - + +
7. Ajeerna. + + + + + +
8. Ama. + + + - + _
9. Shrama, + + + + + _
10. Kshaya + + + + + -
11. Ahrudya - + + - - +
12. Chinta, + + + - + -
13. Bhaya, + + + - + +
14. Shoka - + + + + +
15. Aapannasatwa + + + + + +
16. Krumi + + + + + +
17. Atidruta - - - + - +
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Vishista Nidana according to Charakacharya –
Table No.2 Vishista Nidanas of chardi 24
Vataja Chardi Vyayama, Tikshna aushada, Shoka, Bhaya, Roga, Upavasa, Atikrusha.
Pittaja Chardi Ajeerna, Vdahi ahara bhojana, Atyadika ushna Ahara sevana. Kaphaja Chardi Snigdha, Atiguru, Vidahi ahara sevana, Diwaswapna. Sannipataja Chardi Sarva rasa ahara sevana, Amapradosha, Rutuvipareeta ahara
sevana. Dwistarthaja Chardi Dwista, Vipareeta, Apavitra, Maleena, Aprasanna ahara
sevana.
PURVAROOPA:-24
mÉëxÉåMüÉå ¾ÒûSrÉÉåiYsÉåzÉÉå pÉ£üxrÉÉlÉÍpÉlÉlSlÉqÉç mÉÔuÉïÂmÉÇ
qÉiÉÇ NûÌSï | (xÉÑ.E.49/8) Table No.3 Purvarupa of chardi
Laxana Ca Su M.Ni A.S A.H Vanga Y.R
1. Hrudayautklesha + + + + + + +
2. Kaphapraseka + + + + + + +
3. Annadwesha + + + + + + +
4. Udgararodha - - + + + + +
BHEDA:- 24
Acharya Charaka, Susrutha, Madhava nidana, Vagbhata, Y.R, Vangasena have
considered Dauhrudaja Chardi among Agantuja type & mentioned that they must be
identified by the lakshanas of all the doshas & treated accordingly.
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1. Flow chart of types of chardi.
Chardi
Vataja Pittaja Kaphaja Sannipataja Agantuja
1. Krimija
2. Dauhrdaja
3. Amaja
4. Bibatsaja
5. Asatmyaja
Dauhrudaja
Vataja Pittaja Kaphaja Sannipataja
Acharya Sharangadara has mentioned 7types of Chardi & included Garbhadana as one of
the type.
Chardi25
Vataja Pittaja Kaphaja Sannipataja Krumija Garbhadana Grunya
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ROOPA:-
Table No.4 Roopa of Vataja Chardi
VATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R
Hrutparshvapeda + + + + + + +
Mukhashosha + _ + _ _ + +
Kasa + _ + + + + +
Swarabheda + _ + + + + +
Shabdaprabalaudgara + + + + + + +
Alpamatra + + + + + + +
Pheneela + + + + + + +
Krushna Varna + _ _ + + + +
Kashayarasa + + + + + + +
Srantha - + + + + + +
Shosha - _ _ + + _ +
Table No.5 Roopa of Pittaja chardi
PITTAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R
Murcha + + + + + + +
Pipasa + _ + + + _ +
Mukhashosha + _ + + + _ +
Santapa + + + + + + +
Bramha + _ + + + + +
Peeta, Harita, varna + + + + + + +
Ushnayukta + + + + + + +
Tikta rasa + + _ + + _ +
Daha + + + + + + +
Ksharodaka - _ _ _ _ + _
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Table No.6 Roopa of Kaphaja chardi
KAPHAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R
Tandra + _ + _ _ + +
Madhurata + + + + + + +
Kaphapraseka + _ + _ _ + +
Santosha + _ _ _ + + +
Nidra + _ + _ _ + +
Aruchi + + + + + + +
Gourava + + + + + + +
Lomaharsha + + + + + + +
Alparuja + _ + _ _ + +
Swetavarna _ + _ _ _ _ +
Snigda _ _ _ + + + _
Adikamatra _ + _ _ _ _ _
Hrullasa _ _ _ + + _ _
Tandra _ _ _ + + _ _
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Table No.7 Roopa of Sannipataja chardi
SANNIPATAJACHARDI Ca Su M.Ni A.S A.H Vanga Y.R
Shula + _ + _ _ + +
Avipaka + _ + + + + +
Aruchi + _ + _ _ + +
Daha + _ _ _ + + +
Trushna + _ + _ _ + +
Swasha + _ + + + + +
Murcha + _ + + + _ +
Sarva Varna yukta + _ + + + + +
Moha _ _ _ _ _ _ +
SAMPRAPTI:-
Samprapti involves dosha dushya sammurcchana and the subsequent
manifestation of the disease. Hence an indepth scrutiny into the different angles becomes
necessary by which the clarity of the disease process is established. This alone enables us
to efficiently manage or cure the disease as samprapti vighatana is Chikitsa.
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2. Flow chart showing samprapti of chardi26
Garbhini stree due to Garbha utpeedana &
Atidravadi nidana sevana
Vatadi shareerika dosha prakopa Manasika dosha prakopa
Dauhruda avamana
Udanavruta apana, Vyana Vata vruddi
Kapha Pitta prerana
Amashaya stitha aahara dusti (Agnimandya)
Vimargagamana of vrudda dosha
Mukha achadana, poorana
Chardi
During pregnancy due to garbha peedana or due to Dauhruda avamana there is Vata
prakopa which further vitiates Kapha, Pitta & ahara rasa. Due to dosha utklesha they are
forcibly expelled through the mouth with the help of Vata resulting in Chardi.
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Samprapti ghataka
Dosha – Udana, apanna, vyana, Kapha & Pitta.
Dushya - Rasa (Ahara rasa)
Srotas – Annavaha & Rasavaha
Agni – Jatharagni, Rasadhatwagni
Ama - Jatharagni, Rasadhatwagnijanya Ama
Adhistana – Amashaya
Vyakta sthana- Mukha
Srothodusti – Sanga, Vimargagamana
Vyadi avastha – Ama
Sanchara sthana – Rasavahini
Rogamarga – Abyantara
Sadyasadyatha – Sadya
Nidana panchaka
Chaya – Aharaja, viharaja & Manasika nidana sevana leads to Chaya of vatadi dosha.
Prakopa – Further exposure to same kind of nidana & Dauhruda avamana leads to
vitiation of vatadi three dosha.
Prasara – Aggravated vatadi dosha & ahara rasa move towards Amashaya.
Sthanasmsraya – These vitiated dosha come out from Amashaya through mukha marga
Vyakta – In the form of Chardi.
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ASADYA LAXANAS:-
Table No.8 Laxanas of Upadrava
SI NO
laxanas C.S S.S Y.R Van
1. Vit,Sweda,Mutra,Ambuvaha srota avarodha
+ - + +
2. Vinmutra ganda varna chardi
+ - + +
3. Shonita & pooya yukta + + + +
4. Swasa, Kasa etc - + + +
Acharya Charaka, Susrutha, Y.R, Vangasena have explained that there is
obstruction to Sweda, Mutra & Ambuvaha Srotas. Due to this obstruction they move in
upward direction because of which the chardi which comes out contains the Varna and
gandha of mutra, sweda etc. When Chardi is seen in excess times then it may be
associated with Shonita or pooya which may lead to kasa, swasa, hrudrogadi etc laxanas.
These above features are seen in condition called hyper emesis where there is presence of
excess vomiting which may be sometimes mixed with blood & due to severe dehydration
there is presence of Ketone bodies in urine & smell of acetone may be seen through the
breath. Person becomes weak & emaciated if they are left untreated then they enter into
the stage of coma which may eventually lead to death.
In ancient times people used to neglect these conditions or used to approach
vaidyas in later condition which were not treatable & patient used to die. So Acharyas
have mentioned them as Asadya laxanas. But in present era due to public awareness &
regular antenatal care they are diagnosed earlier & with good advancement of medicines
& rehydration therapy these conditions can be controlled, but certain side effects on fetus
as well as on mother is seen.
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UPADRAVA:-24
1. Kasa
2. Swasa
3. Jwara
4. Hikka
5. Trushna
6. Vaichintya
7. Hridroga
8. Tamaka swasa
3. Flow chart showing samprapti of Upadrava.
These conditions are seen as a complication due to excess vomiting.
Excess chardi
Vata prakopa
Urdwagamana of vata
Along with Chardi Trusna, Kasa, swasa Hridroga
Vaichintya
Death
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CHIKITSA:-
xÉÔ¤qÉÉÇ ÍcÉÌMüixÉÉÇ uɤrÉÉÍqÉ aÉÍpÉïhÉÏlÉÉÇ ÌuÉpÉÉaÉzÉÈ |
iÉjÉÉ aÉpÉï¶É lÉÉUÏ cÉ uÉkÉïiÉå U¤rÉiÉåÅÌmÉ cÉ | (MüÉ.ÎZÉ.10/3) 27
Even though Acharya Kashyapa has mentioned that the diseases occurring in
pregnant women is same as that of non pregnant women, the principles of treatment
differs from that of general chardi. There they have mentioned langana & shodhana as
line of treatment, which cannot be given to the pregnant women. Hence gentle treatment
should be given which helps to cure the disease & also maintains the growth of fetus.
Pregnant women should be treated just like a pot which is filled with oil because the
slightest movement will cause spilling of oil from the pot. Similarly slight excitement
may cause problem to the fetus.
AlÉÑMÔüsÉÉåmÉcÉÉUåhÉç rÉÉÌiÉ Ì²¹ÉjÉïeÉÉ zÉqÉqÉç | (A.xÉÇ.ÍcÉ.8/13)28
Dwistarthaja chardi should be treated by providing agreeable foods & drinks which helps
to cure the condition & also maintains pregnancy.
SÉæ¾ÒûÌSÇ MüÉÌXû¤ÉiÉæÈ TüsÉæÈ | (xÉÑ.E.49/25)29
If desires of dourhda is not fulfilled there may be dhathu Kshaya as she will not
consume food properly which leads to Vata vruddhi leading to chardi. So the line of
treatment should be stambana & bramhana which helps to control vomiting & provide
nutrition for the fetus. So the preparations made up of a drug which specifies vatadi
doshas, laghu, Hrudya, Agnideepaka, Dhathu vardaka should be used. Preparations in the
form of Leha, Churna, and Syrups etc which are pleasant & easily palatable to Garbhini
are beneficial.
Among all Acharyas, Kashyapa is one who has mentioned management of
doshaja chardi in antarvatnichikitsadyaya but has not specified its use as only in Garbhini
chardi. 30
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Vataja chardi:-
‐ Leha prepared with Matulunga rasa, laja, kola, dadima rasa, sharkara, anjana &
madhu.
‐ A salt free soup prepared with juice of Matulunga, meat of goat or buffalo with
dadima rasa & appetizing articles.
Pittaja chardi:-
‐ Caturjata Kalka is added with tandulodaka along with laja, sugar, madhu, &
sugandha pushpa.
‐ Laja peya along with sugar & honey.
Kaphaja chardi:-
‐ Phanta prepared with tender leaves of Amra & jamboo along with honey.
‐ Soup prepared with Mudga, medicated with seeds of dadima mixed with salt &
butter.
Sannipataja chardi:-
‐ Here according to predominance of doshas combined treatment should be given.
Krimija chardi:-
‐ Kwatha prepared with mula of punarnava & bhadradaru along with honey should
be used.
Harita has mentioned use of bilva fruit along with curd or sugar. Vatsaka, pippali, shunti
& amalaki fruit can also be used.
Acharya Susrutha, Y.R, Vangasena have explained use of saindava lavana & ghruta in
Vataja chardi.
‐ Three types of lavana mixed with Ksheerodaka.
‐ Yusha prepared with mudga, Amalaki, Saindava along with panchamula kashaya.
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Pittaja chardi:-
‐ Yavagu prepared with Laja, Yava, Mudga, along with honey should be used.
‐ Yusha prepared with Sugandhita, Madhura or Tikta dravya should be used.
‐ In case of Pittaja chardi associated with daha & Trushna draksha rasa along with
honey should be used.
‐ Haritaka churna along with madhu should be given, Because of which doshas
move out through down ward movement & chardi is controlled.
Kaphaja chardi:-
‐ Vidanga, Triphala, Trikatu churna along with madhu should be used for licking.
‐ Aragvadha khashaya, chardi nirahana gana dravya khashaya should be taken
along with honey.
Sannipataja chardi:-
‐ Guduchi phanta should be mixed with honey & should be taken internally.
‐ Masura sathhu is done mardana with honey & taken along with dadima rasa.
‐ Mayura piccha basma along with honey cures Upadrava yukta chardi.
Acharya Yogaratnakara has mentioned –
‐ Dhanyaka Kalka along with tandulodaka & sugar.
‐ Bilva majja mixed with liquid prepared from laja.
‐ Decoction of shunti & bilva mixed with flour of parched barley is beneficial in
both vomiting & diarrhea.
Preparations used in chardi chikitsa:- 31
Kwatha :- Parpatadi Kwatha (p)
Guduchyadi Kwatha (p)
Mudga Kwatha (p)
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Hima :- Marichadi Hima
Guduchi Hima
Phanta :- Amradi phanta
Churna :- Vidangadi churna (k)
Eladi churna (sa)
Vati :- Sootashekar
Chardi ripu
Avaleha :- Chandanavaleha (p)
Makshikadi Avaleha
Laja saktavavaleha
Koladi Avaleha (sa)
Sharkara :- Dadima sharkara
Yusha :- Lajjadi yusha (p)
Panaka :- Chandana panaka (p)
Dhatriphaladi panaka (sa)
Dhupa :- Jeerakadi dhupa (sa)
Pisti :- Pravala pisti
Mukta pisti
Arka :- Pudina Arka
Ghruta :- Jeevaneeya ghruta
Padmakadi ghruta
Patoladi ghruta (kp)
Bhasma :- Mayura puccha bhasma
Swarnamakshika bhasma
Rasa :- Jirakadi rasa
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Vamanamruta rasa (sa)
Vantitihd rasa, Chardyantaka rasa
Pathya Apathya -
Ahara Pathya Apthya
Vegetables Nimba
Dhanyaka
Fruits Dadima Bimbi Phala
Badara
Amra
Jambeera
Amalaki
Draksha
Nareekela
Spices Shunti (min. qty.) Shunti (large dose)
Mareecha
Cereals Yava Indrayava
Shali shastika
Foods Manoonukula Prakruti Viruddha
Satmya ahara
Drinks Coconut water Excess liquid &
Mamsa rasa Dushita jala
Chikitsa Shamana Shodhana
Dairya, Sneha Chinta, Bhaya
Counseling Shoka.
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Vihara Pathya Apathya
All Manoanukula karya ExcesVyayama, Exertion
Like Praying, Meditation Bibhatsya vastu darshana
Yoga, Walking. Leading to fear & sudden emotions
Listening to good music,
Good words. Riding vehicle,
Hitakara rasa gandha sevana Lifting heavy weights.
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VOMITING
Vomiting is considered as one of the symptom of many diseases especially of
gastro intestinal tract rather than a separate disease entity. It is present as a cardinal
symptom in many diseases which helps in diagnosis. Nausea & Vomiting are seen
together in many diseases/conditions among which pregnancy is one such condition
where with history of amenorrhea & presence of nausea & vomiting it was diagnosed that
women is pregnant . It is present in most mammals except rodents, a species that lacks
the vomiting centre.
The word Nausea is derived from the Greek word “naus” meaning “ship” & the
Latin word “nauta” meaning sailor & thus originally carried the idea of sickness from sea
travel. 32
Definition:-
It can be defined as the process by which the contents of the upper gut are
expelled to the exterior through the mouth. It helps in removing unwanted & irritating
materials out of the body. 33
It is also defined as a forcible expulsion of the contents of upper G.I. tract through
the mouth. The strongest stimuli include unpleasant sights & dizziness or irritation &
distension of the stomach.
Causes of Vomiting:- 34
‐ Indulgence of foods which are very fatty, unpleasant, very watery & salty.
‐ Taking meals at odd times, in excess quantity.
‐ Infection by worms.
‐ Pregnancy
‐ Sight of terrific, fearsome, ugly & unpleasant things.
‐ Ingestion of toxins i.e. food poisoning.
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‐ Gastritis, peptic ulcer with or without pyloric stenosis, dyspepsia, intestinal
obstruction etc.
‐ Raised intra cranial tension, meningial irritation, motion sickness, encephalitis,
labrynthitis, and migraine.
‐ Acute hepatitis.
‐ Psychogenic vomiting.
‐ Drugs which produce gastritis, over dose of digitalis etc.
Physiology of vomiting 35
4. Flow chart showing Physiology of vomiting.
CORTEX SMELL, PAIN, SIGHT STIMULI
CTZ
VOMITING CENTRE CEREBELLUM
GIT INNER EAR
G.I.IRRITATION, VEGAL STIMULATION
INFECTION, DRUGS
RADIATION. MOTION SICKNESS
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Different connections of the vomiting centre
Vomiting which is accompanied by complex movements is being controlled by
the vomiting centre. There are multiple pathways that stimulate vomiting, i.e. afferent &
efferent pathway which are carried by both vagus & sympathetic nerves. Among these
afferent impulses play major role in stimulating vomiting. The major relay station in this
pathway is the CTZ (chemo receptor trigger zone) which is situated in the lateral border
of area postrema of the medulla oblongata & is unprotected by the blood brain barrier &
other is the solitary tract nucleus. CTZ being a purely sensory relay station is capable of
initiating vomiting even in absence of vomiting centre. Disturbed equilibrium leads to
generation of impulses from vestibular apparatus which reach the vomiting centre
through cerebellum. Various unpleasant sensory stimuli such as bad odor, ghastly sight,
pain & fear stimulates vomiting acting through the higher centre.
Nausea & vomiting due to olfaction pathway:- 36
Major portion of the nasal cavity is covered by the olfactory mucosa; the receptor
cells for the smell sensation are present in this mucosa, when the odorant substance
comes in contact with olfactory surface that covers cilia & then diffuses into the mucosa
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by binding with the receptor that protrudes through the ciliary membrane. This activates
adenyl cyclase that is attached to the insight of the ciliary membrane. Which intern
converts intracellular ATP into c-AMP. This causes sodium ions to pour into the receptor
of cell cytoplasm, thus exciting the olfactory neuron system & transmitting action
potential into the CNS by way of an olfactory nerve.
ACT OF VOMITING
The vomiting act encompasses three types of outputs initiated by CTZ.
‐ Increased salivation to protect the enamel from the gastric acid.
‐ Retro peristalsis movement which starts from the middle of the small intestine &
moves upward sweeping all the contents into the stomach through the relaxed
pyloric stinosis.
‐ A lowering of intra thoracic pressure, coupled with an increased in abdominal
pressure making abdominal muscles to contract & propels stomach contents into
esophagus as the esophageal sphincter relaxes causing vomiting which is followed
by retching .
5. Flow chart showing act of vomiting:- 37
Taking a deep breath.
Raising the hyoid bone & larynx to pull the UOS open
Closing of the glottis-prevents aspiration in the trachea.
Soft palate lifted to close the posterior nares
Subsequently strong downward contraction of diaphragm.
Simultaneous contraction of abdominal wall muscles.
Squeeze stomach to build up high intra gastric pressure
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Finally LES relaxes allowing expulsion of gastric contents upwards.
MORNING SICKNESS
Definition: -38
Morning sickness is the nausea & vomiting scene in women during pregnancy in
early trimester. All though it is more common in the morning it can last for all the day in
some women.
Prevalence of Nausea & vomiting in pregnancy:- 38
It is one of the common conditions & affects 70 - 85 % pregnant women. Around
30-50 % of pregnant women have episode of vomiting while 30-90 % of women
experience nausea alone.
Etiology:- 38
The exact cause remains unknown but various theories have been proposed which
leads to nausea & vomiting during pregnancy.
HORMONAL THEORY :-38
Progesterone: - It is the pregnancy dominating hormone which helps in maintain
pregnancy by producing softening effect on the muscular system thus preventing uterine
contraction. This softening effect is also seen on muscles of stomach of intestines which
leads to slow emptying of stomach giving rise to excess gastric secretion which may
cause vomiting.
HCG (Human chorionic Gonadotrophine) :- During pregnancy level of HCG
dramatically rises, peaks & diminishes from week 5-15 of pregnancy. At the same time
we find morning sickness in most of the women raises, peaks & diminishes. It may be
because of high level of HCG in the blood stream activates the vomiting centre in the
brain which causes vomiting.
Estrogen ;- It is known to produce nausea & vomiting as seen in women on OCP’S.
Vomiting is more common when oestradiol levels are increased & vice versa is also true.
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Psychogenic theory: - Psychiatric illness, Conversion of somatization disorder or
depression during pregnancy directly stimulate higher centers & leads to nausea &
vomiting.
Vestibular & olfaction: - Hyperactivity of olfaction & disturbed equilibrium in
vestibular apparatus may lead to nausea & vomiting during pregnancy.
Infection: - Presence of Helicobacter pylori in the stomach may cause nausea &
vomiting during pregnancy.
Adrenal insufficiency: - In normal pregnancy certain morphological changes are seen in
the adrenal gland. There is decrease in the size of adrenal compared to that of the non
pregnant. Metabolic clearance is lowered during pregnancy because of which the serum
level of sodium, chloride, bicarbonate & glucose are below normal level, but serum
potassium level is elevated. This may result in weakness, anorexia, nausea & vomiting.
Immunological basis: - Maternal recognition of pregnancy is brought by the way of
signals generated by the trophoblast that act upon the maternal ovary. The immunological
acceptance of semiallogenic tissue of the concepts is modulated by the regulation of HLA
i.e. Human Lymphocyte antigen expressed by trophoblast. This may sometime trigger
vomiting during pregnancy.
Toxins: - How far this theory is true is not yet known. It is said that vomiting seen in
early trimester helps to protect the developing fetus by encouraging the mother to avoid
dangerous or toxic food intake. It is a kind of defense mechanism seen due to the
presence of fetus to protect itself.
Other causes;-39
‐ Family history of emesis or hyper emesis.
‐ Most common in unplanned pregnancies.
‐ In women with high dietary intake of saturated fat before pregnancy.
‐ Most common in women with history of motion sickness or migraine.
‐ Women with increased placental mass as in case of multiple pregnancies &
hydatidiform.
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‐ Decreased levels of calcium & glycogen in mother leads to morning sickness.
‐ Smoking & Alcohol.
Causes of vomiting in pregnancy –40
6. Flow chart showing causes of Vomiting.
Morning Sickness
Early pregnancy Late pregnancy
Related to pregnancy Associated with pregnancy
Simple vomiting Hyper emesis
Medical Surgical Gynecological
1. Intestinal infection 1.Appendicitis 1.Twisted ovarian syn
2. UTI 2.Peptic ulcer 2.Fibrod Degeneration
3. Hepatitis 3.Int.Obstruction
4. Diabetic Ketoacidosis 4.Cholecystitis
5. Uremia
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The different causes of vomiting such as appendicitis, Gastroenteritis,
Cholecystitis, Pancreatitis, intestinal obstruction & pylonephritis should be considered. In
selected patients with additional clinical features appropriate investigations to exclude an
underlying cause may be indicated. Once a diagnosis of hyper emesis has been reached
then associated conditions of multiple pregnancies & hydatidiform mole should be sought
by clinical examination & an ultrasound scan of the uterus. When these conditions have
been excluded, it is possible to feel confident that one is dealing with specific idiopathic
hyper emesis of an otherwise normal singleton pregnancy.
Whatever may be the cause of initiation of vomiting unless it is not quickly
rectified features of dehydration & carbohydrate starvation supervene & a vicious cycle
of vomiting appears.
7. Flow chart showing Cycle of vomiting- 40
Vomiting
Carbohydrate starvation
Ketoacidosis
Vomiting
Symptoms:- 39
In case of simple vomiting- ‐ Nausea, Vomiting & occasional sickness on rising in the morning.
‐ The Vomitus is small, clear or bile stained, Sometimes associated with food.
‐ Persistent vomiting shortly after eating or drinking even water is seen.
‐ Nutrition does not suffer.
In case of severe vomiting –
‐ Vomiting is increased in amount & frequency.
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‐ Vomitus may be coffee brown or mixed with blood.
‐ Weight loss may be seen.
‐ Oliguria.
‐ Epigastric pain.
‐ Constipation may occur.
‐ Person is unable to do any activities.
‐ Giddiness & tiredness is present.
Signs – 39
If emesis is not treated earlier then features of severe vomiting such as dehydration &
Ketoacidosis is seen which may lead to
‐ Dry coated tongue.
‐ Sunken eyes.
‐ Skin becomes lusterless & in elastic.
‐ Anxious look.
‐ Acetone smell in breath.
‐ Increased pulse rate 120 or more/minute.
‐ Tachycardia.
‐ Hypotension.
‐ Features of peripheral neuritis may be seen.
‐ Appearance of Jaundice as a late feature.
Consequences – ‐ Due to severe vomiting patient may develop frustration which may lead to
depression. ‐ A feel of being neglected may develop. ‐ There may be adverse effect on family relationships. ‐ She might take decisions of not to have another child. ‐ Effect on physical, Social & Psychological state of the pregnant women on fetus
& on her family. ‐ Fear of severe morbidity & mortality may be seen.
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Disease Review
Metabolic, Biochemical & Circulatory Changes due to severe vomiting – 40
Metabolic changes: - Due to excess vomiting patient develops fear for intake of food
thinking that it further aggravates vomiting. Because of inadequate food intake there is
depletion in glycogen level, for the energy supply fat reserve is called upon. There is in
complete oxidation of fat due to low carbohydrate because of which there is
accumulation of ketone bodies in the blood. The acetone is ultimately excreted through
the kidney & breath. There is also increase in tissue protein metabolism resulting in
excessive excretion of non protein nitrogen in urine.
Biochemical changes: - Due to excess vomiting there is loss of water & salts from the
body which results in fall of plasma sodium, potassium & chloride. Hepatic dysfunction
results in acidosis & ketosis with rise in blood urea, uric acid, hypoglycemia,
hypoprotienamia, hypovitaminosis & rarely hyperbilirubinaemia.
Circulatory changes: - There will be increase in hemo concentration which will further
lead to rise in Hemoglobin levels, RBC, WBC & haematocrit values.
Complications due to severe vomiting:- 40
‐ Neurological complication like wernick’s encephalopathy, peripheral neuritis,
Korsakoff’s psychosis may be seen.
‐ Esophageal tear or rupture.
‐ Stress ulcer may develop in the stomach. ‐ Spleenic avulsion. 39
‐ Jaundice.
‐ Renal failure.
‐ Psychological morbidity in the form of depression or somatization may be seen.
‐ Death from nausea & vomiting of pregnancy is rare but may occur due to the
complications of hyper emesis.
Effect on Fetus:-39
Mild to moderate vomiting has no much effect on fetus.
In severe vomiting there is higher incidence of low birth weight in about 30% of women
who lose weight in pregnancy.
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Disease Review
Investigation:-
In simple vomiting
– Blood group
– Hb %
– Urine routine
– USG if necessary
In severe vomiting
‐ Hb % / Haematocrit values
‐ Serum electro light values
‐ LFT (SGOT, SGPT, Bilirubin)
‐ Urine analysis its quantity, color, specific gravity, ketone bodies, bile pigments,
chlorides.
‐ Opthalmoscopic examination
‐ ECG
‐ USG
Management:-39
In simple vomiting
‐ Assurance.
‐ Taking water, dry toast or biscuit before getting up from the bed.
‐ Eating several meals during a day instead of three big once because empty
stomach can cause nausea & vomiting.
‐ Fatty food must be avoided as they can worsen the condition.
‐ Food rich in carbohydrate must be taken.
‐ Drinking plenty of fluids is necessary as they help in replacing lost fluids &
neutralize stomach secretions.
‐ Foods with smell which bother must be avoided.
‐ Drinking ginger tea or ginger ale is beneficial.
‐ Eating crackers every morning 20 min. before getting out of bed.
‐ Wearing one or two acupressure wrist bands to prevent motion sickness.
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‐ Avoiding stress.
‐ Wearing loss fitting clothes.
‐ Extra sleeping.
‐ Doing activities which are pleasing to the mind.
‐ Drugs like multivitamin supplementation, pyridoxine 25mg 8th hourly,
doxalamine10mg + pyridoxine 10mg for three to four times a day can be taken.
Hyperemisis:- 40
‐ The principle of management is to correct fluids, electrolyte & other metabolic
disturbances effectively.
‐ Hospitalization, Laboratory investigations.
‐ To prevent or detect at the earliest about the complication that may arise & treat
them.
PHARMACOLOGICAL PRINCIPLES OF MANAGEMENT OF NAUSEA &VOMITING35
The antiemetic agents are classified as:
1) Anticholinergics
2) Antihistaminics
3) Antidopaminergics
4) Anti 5 HT3
5) Miscellaneous.
Anticholinergics
Block afferent impulses to vomiting center by anticholinergic action
Mild sedative action also contributes to antiemetic effect
E.g. Scopolamine
Antihistaminic
Action on vomiting centre & mild sedative effect
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Disease Review
E.g. Cyclizine: Available as Cyclizine hydrochloride (Marzine)
Dose: - 50mg (oral)
Action: - H1 receptor antihistaminic agent
- Action prolonged
- Mainly used for motion sickness
Meclizine: Available as Meclizine hydrochloride.
Dose: - 25 – 50 mg oral
Action: - Action longer than Chlorcyclizine mainly used for motion sickness.
Promethazine hydrochloride (Phenargan):
Dose: - 12.5 – 25 mg
Action: - Longer duration of action
- Produces marked sedation
Promethazine chlorotheophyllinate (Avomine):
Dose: - 25-75 mg
Action: - Used mainly in motion sickness. Superiority over Promethazine is doubtful.
Antidopaminergic
Act on CTZ by selectively depressing CTZ.
E.g. Chlorpromazine
Available as:
Chlorpromazine hydrochloride (Largactil)
Tab - 10, 25, 50, 100 mg
Syp - 25 mg (adults) per ml
Daily dose: Varies according to condition of patient.
Range 25 mg to 1000mg.
And related drugs- Metoclopramide
Domperidone
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Anti 5 HT3
Block the 5 HT3 receptors & thus prevent vomiting. Ex - Ondansetron and Granisetron.
Miscellaneous
Buterophenones - Droperidol & Haloperidol have significant antiemetic effect by
antagonism of dopamine receptors.
8.Flow chart showing Management of Emesis & Hyper emesis. 38
Gestational Emesis
Reassurance, rest, Dietary Manipulation
Persisting Emesis
Stable weight, Minimal ketosis
Weight loss, Ketosis Normal fetal growth
*Electrolyte hydration Routine prenatal care
*Dietary Manipulation
*Laboratory evaluation
Hospitalization,
Electrolyte replacement,
Psychological & Pharmacological support.
Termination of pregnancy, if necessary in case of complications.
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Disease Review
Final Impact 38
Recent studies on effect of nausea & vomiting on pregnancy has shown following
reports.
‐ About 35% of women with nausea & vomiting in pregnancy are unable to work.
The average loss of work time is said to be 62hrs.
‐ A study on quality of life variables found that pregnant women with mild to
moderate nausea vomiting are unable to care for young children or perform house
hold tasks & daily activities.
‐ The mother risk programme at the hospital for sick children in U.S. has reported
that nausea & vomiting is often cited as a reason for pregnancy termination by
therapeutic abortion, on the other hand some studies have associated nausea &
vomiting with good pregnancy out come.
‐ Moderate nausea & vomiting have been found to lower the risk of miscarriage
.This protective effect is absent in mothers not suffering from nausea & vomiting
during pregnancy which indicates lower levels of estrogen.
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Drug Review
DRUG REVIEW
The use of plants as medicine can be seen in almost all the ancient
civilizations of India, Egypt etc. In India from Vedic period plants have been
considered as principle remedy for the mitigation and cure of diseases.
Various plant remedies have been evaluated in Ayurveda for the management
of diseases. The Indian sages discovered drugs, invented combinations,
studied potential toxic effects and prescribed therapeutic uses long ago. This
was based on the observations of the effect of drug on human beings and
animals. Large numbers of drugs used in a similar manner have been found
from Vedic period itself.
As research is the scientific and diligent study, this herbal preparation
of Dadimaavaleha is taken for clinical experimentations in order to establish
facts and analyze their significance in Garbhini chardi.
Ingredients of Dadimaavaleha:41
1. Dadima – 1Kg 11.Nimba patra- 50gms
2. Nagara – 50gms 12.Manjistha- 50gms
3. Pippali - 50gms 13.Kuta shalmali- 50gms
4. Pippali mula – 50gms 14.Pata- 50gms
5. Danyaka- 50gms 15.Lavanga- 50gms
6. Ajamoda- 50gms 16.Ativisha- 50gms
7. Jatiphala -50gms 17.Jeeraka- 50gms
8. Jatipatra – 50gms 18.Haritaki- 50gms
9. Maricha- 50gms 19.Madhu- 50gms
10. Vamshalochana- 50gms 20.Grutha- 50gms
Water – 4lit
Sugar – 1 kg
Madhu- 1kg
Ghrutha – 1kg
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Drug Review
Table No: 9 Showing rasa, guna, veerya,vipaka & karma of the drugs 42,43,44
Sl. No Dravya Rasa Guna Veerya Vipaka Doshagnata
1. Dadima Madhura, amla, Kashaya Laghu, snigdha Ushna Madhura/A
mla Tridoshahara
2. Shunti Katu Laghu, Snigdha Ushna Madhura Kapha vata shamaka
3. Pippali Katu Laghu, Theekshna, Snigdha Sheetha Madhura Kapha vata
shamaka
4. Pippalimoola Katu Laghu, Ruksha, Theekshna Ushna Katu Kapha vata
shamaka
5. Danyaka Madhura, Kashaya Laghu, Snigdha Sheetha Madhura Pitta shamaka
6. Ajamoda Tikta, Katu Laghu Ushna Katu Kapha vata shamaka
7. Jatiphala Tikta, Katu Theekshna, Ushna Ushna Katu Kapha vata shamaka
8. Jatipatra Tikta, Katu Theekshna, Ushna Ushna Katu Kapha vata shamaka
9. Jeeraka Tikta, Katu Laghu, Ruksha Ushna Katu Kapha vata shamaka
10 Maricha Katu Laghu, Theekshna Ushna Katu Kapha shamaka
11 vamshalochana
Madhura, Kashaya Laghu, Ruksha Sheetha Madhura Kapha pitta
shamaka
12 Nimba patra Tikta, Kashaya Laghu, Ruksha Sheetha Katu Kapha pitta shamaka
13 Manjista Madhura, Kashaya Guru Ushna Katu Kapha
shamaka
14 Kuta shalmali Kashaya Snigdha Sheetha Katu Pitta vata shamaka
15 Pata Tikta kashaya Laghu, Ruksha Sheetha Katu Tridoshahara
16 Lavanga Tikta,Katu Laghu, Theekshna Sheetha Katu Kapha pitta nashaka
17 Ativisha Katu,Tikta Laghu, Ushna Katu Kapha pitta shamaka
18 Haritaki
Pancharasa(lavana varjitha),
Kashaya pradhana
Laghu, Ruksha Ushna Madhura Tridoshahara
19 Grutha Lavana, Katu Ruksha, Theekshna Ushna - Kapha vata shamaka
20 Madhu Madhura, Kashaya
Lagu,Ruksha, sheetala, Sheetha - Kapha pitta
shamaka
21 Sharkara Madhura Sheetala,snigda Guru Sheetha - Pitta shamaka
22 Guda Madhura Guru,snigdha Sheetha - Pitta shamaka
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Drug Review
Table No: 10 Showing botanical description of drugs
SI.No
Dravya
Botanical Name Family Karma Chemical Composition
1. Dadima Punnica granatum Punicaceae
Hrdhya, Tridoshahara, Shukrala.
Fruits contain -Tannins, Pu icalin, Punicalagin. Seeds contain -estrone,vpunicic acid.
2. Shunti Zingiber officinale
Zingiberaceae
Shothahara, rakta shodhana
Shigarol,Gingerol,Protein 2.3%, fat 0.9%, Carbohydrate 12.3%, Minerals 1.2%, Calcium 20%, Phosphorous 60%, Iron 2.6mg/100g, Iodine and fluorine trace
3. Pippali Piper longum Piperaceae Rakta vardhaka,
rakta shodhana
Piperine 0.15%, Piplartine 0.16%, Piperlogumine and piperlonguminine
4. Pippalimoola
Piper longum Piperaceae
Deepana, Pachana, Vata anulomana, Krimihara,
Piperine 0.15%, Piplartine 0.16%, Piperlogumine and piperlonguminine
5. Danyaka Coriandrum sativum
Umbelliferae
Deepana, Hrdhya, Balya,Vrsya
Protein 14.1%, fat 21.8%, Carbohydrate24.6%, Minerals1.2%, Calcium1.5%, Iron28.8mg/100g, Phosphorous0.39%.
6. Ajamoda Trachyspermum ammi
Umbelliferae
Rakta prasadana, Shothahara, Varnya
Protein 18.1%, fat 16.1%, Carbohydrate21.6%, Minerals1.2%, Calcium0.63%, Iron18.6mg/100g, Raboflavin0.28, Nicotinic acid.
7. Jatiphala Myristica fragrans
Myristicaceae
Deepana,Rochana, Vrsya, Svarya
Myristic acid, Cyanadin, Lignans, Neolignans, Safrole.
8. Jatipatra Myristica malabaricum
Myristicaceae
Deepana,Rochana,
Vrsya, Svarya
Pectin, Glyceroid, Myristic acid.
9. Jeeraka Cuminum cyminum
Umbelliferae
Rakta shodhana, agni deepaka,
Cuminin, diacyl glycerol, isoimpinellin,P-
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Drug Review
cymene,isoimperatorin.
10. Maricha Piper nigrum Piperaceae
Deepana, Pachana, sroto shodhana, krimihara, raktothklesha
Protein 11.5%, fat 6.8%, Calcium 4.6%, mineral matter 4.4%, Phosphorous, Iron 3.2mg, Vitamin A, Nicotinic acid 1.4 mg/100g, oxalic acid 0.4-3.4%
11. vamshalochana
Bambusa arundinaceae
Poaceae Balya Methylanthraquinones, Fucosterol
12. Nimba patra
Azardirachta indica Meliaceae Deepana,
Krumihara
Azardirectin, azadirone, nimbin, nimbandiol, nimbolide.
13. Manjista Rubia cardifolia Rubiaacea Varnya,shothahar
a
Rubifolic acid,rubiatrol, rubicoumaric acid, rubimallin,alizarin, purpurin.
14. Kuta shalmali
Eriodendron anfractuosum
Bombocaceae
Shothahara, 44akta shodhana
Galli acid, tannic acids,D-galactopyranose.
15. Pata Oroxylum indicum
Bignonaceae
Rakta vardhaka, 44akta shodhana
Baicalein, tetulin,aloeemodin, b-sitosterol.
16. Lavanga Syzygium aromaticum
Myrtaceae Deepana, Pachana, Vata anulomana,
B-caryophyllene, Furfural, valeraldehyde, methylbenzoate, Methyl alcohol.
17. Ativisha Aconitum hetrophyllum
Ranunculaceae
Visha hara, deepana, Pachana
Atidine, heterophyllisine, letisinone,B-sitosterol, carotene.
18. Haritaki
Terminalia chebula
Combretaceae
Hrdya, Rasayana Anulomana
Fruits contains Tannic acid, chebulinic acid, gallic acid.
19 Madhu Fructose 45%, glucose 35% Traces of minerals.
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Drug Review
RESEARCH WORKS DONE:- Dadima:-45
Pomegranate contains isopelletierine, Methylisopelletierine, Pelletierine,
Pseudopelletierine and tannins. Its known effects are to shrink tissues, prevent secretion
of fluids and destroy intestinal worms. It is speculated to treat stasis ulcers.
Dried fruit peel alcoholic extract & decoction administered in rats had intestinal anti
secretory activity
Shunti:-46
Ginger was found to be superior to dimenhydrinate in preventing motion sickness
and the Gingerols and shogaols were identified as the main antiemetic principles. Studies
suggest that the action of ginger modulated vestibular impulses to the autonomic centers
of the central nervous system.
In a study of 30 pregnant women, in a double-blind randomized cross-over trial,
it was observed that powdered root ginger was superior to placebo in reducing the
symptoms of hyper emesis gravidarum (morning sickness).
Ginger, rhizome of Zingiber officinale, has been used for antiemetic effect.
Several Components of ginger such as gingerol, shogaol and galanolactone have been
shown to have Anti-5HT activity in iso- lated guinea pig ileum. Galanolactone is a
competitive antagonist predominantly at ileal 5-HT3 receptors.
The pungent principles, including gingerop and zingerone, demonstrated in vitro
effects in Scavenging the superoxide and hydroxyl radicals and inhibiting lipid
peroxidation. Humoral immunity was enhanced, as shown by humoral antibody titer, and
cell-mediated response was also stimulated in leukocyte migration inhibition tests.
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Drug Review
Rhizome of Zingiber containing shogaols 5-biphenyl, 6-phenylpropanoids,
gingerols (50 mg/kg b. wt.) Showed improved anti-emetic activity in frogs.
Oral doses of shogaol accelerated intestinal transit in rats. Also an extract of
ginger, and Isolated shogaol and gingerols enhanced gastrointestinal motility in mice
after oral doses.
Pharmacological study of Myrestica fragrans crude suspension increased
intestinal tone while (PE) petroleum ether had no such effect on guinea pig ileum.
Jatiphala:-47
A preliminary study conducted on the effect of alcoholic extract of pippali
rasayana on serum Proteins in rabbits showed a significant increase in body weight.
Pippali, Dhanyaka:-48
The effect of spices on the secretion and composition of saliva in humans
observed that red Pepper, ginger, capsicum, black pepper, coriander and mustard
enhanced the secretion of saliva and activity of salivary amylase. Further the saliva
stimulating capacity was greatest for red Pepper and mustard among these spices.
Harikati:-49
Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents of
stomach earlier. So it can be used as adjuvant with other drugs that interfere with gastric
motility as Antihistaminics like drugs.
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Drug Review
DADIMA
SHUNTI
PIPPALI
MARICHA
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Drug Review
MANJISTA PATA
NIMBA LAVANGA
ATIVISHA VAMSHALOCHANA
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Drug Review
DANYAKA JEERAKA
HARITAKI AJAMODA
JATIPHALA MADHU
SHARKARA
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Drug Review
Preparation of Dadima Avaleha
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Materials & methods
MATERIALS AND METHODS
The present study ‘A clinical study on effect of Dadima Avaleha in the
management of Garbhini Chardi’ was carried out on 30 patients attending the O.P.D. and
I.P.D sections of Prasooti Tantra & Stree Roga Department, S.D.M. Ayurveda Hospital,
Udupi.
Aims and Objectives of the Study
1. To do conceptual study of Garbhini chardi.
2. To evaluate efficacy of Dadima Avaleha in Garbhini chardi.
Source of data:
About 30 patients in O.P.D & I.P.D of S.D.M Ayurveda Hospital, Kutpady, Udupi
Karnataka diagnosed as Garbhini chardi were taken for study.
Inclusion criteria:
*Patients between 20-35 years of age.
*Patients diagnosed as Garbhini chardi in first trimester of pregnancy.
Exclusion criteria:
*Patients in whom chardi seen in second & third trimester.
*Patients with hyper emesis gravidarum.
*Patients with twin pregnancy & vesicular mole.
*Vomiting caused due to other systemic disorders like peptic ulcer, appendicitis etc.
Assessment criteria:
- Number of Vegas.
- Quantity of Vomitus.
- Aversion to smell
- Improvement in weight
- Improvement in Hb%.
- Improvement in nausea
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Materials & methods
Final assessment:
Cured – Complete cessation of nausea & vomiting.
Improved – Reduction in quantity & quality of Vomitus.
No change – No change in complaint.
Aggravated – Symptoms became more severe than before.
Investigations:
Urine pregnancy test.
Hb %.
Urine routine.
USG(if necessary)
Intervention:
Patients fulfilling above criteria were assigned to two groups.
Group A – Dadimaavaleha for 21 days. Dose‐24gms with divided dose of 8gms T.I.D. with
lukewarm water
Group B – Placebo for 21 days.
Follow up period: Patients will be asked to follow up for once in a week for 3 weeks.
Materials taken for the study are:41
Collection of drugs:
All the drugs were collected and prepared by S.D.M. Ayurveda Pharmacy, Udupi,
Karnataka.
Methods of preparation:
Ingredients of Dadimaavaleha:
1. Dadima – 1Kg 11.Nimba patra- 50gms
2. Nagara – 50gms 12.Manjistha- 50gms
3. Pippali - 50gms 13.Kuta shalmali- 50gms
4. Pippali mula – 50gms 14.Pata- 50gms
5. Danyaka- 50gms 15.Lavanga- 50gms
6. Ajamoda- 50gms 16.Ativisha- 50gms
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Materials & methods
7. Jatiphala -50gms 17.Jeeraka- 50gms
8. Jatipatra – 50gms 18.Haritaki- 50gms
9. Maricha- 50gms 19.Madhu- 50gms
10. Vamshalochana- 50gms 20.Grutha- 50gms
Water – 4lit
Sugar – 1 kg
Madhu- 1kg
Ghrutha – 1kg
One Kg of Dadima is taken to which 4lit of water is added & kept on fire. Kashaya is
prepared. To this Kashaya 1Kg of sugar is added. After formation of paka all the
ingredients are added in the powder form & mixed well. After swanga sheeta Honey &
Grutha is added & mixed well.
Group-B
Guda Paka - One Kg of purana guda is taken to which quantity sufficient of water is
added & kept on fire until paka siddha laxana is seen.
Research Design:
It is a comparative clinical study with pre test and post test design. Patients were
registered in a detailed proforma containing details of history, examination. Diagnosis
was done according to classical procedures and modern instruments were also employed.
Registered patients were randomly placed under two groups.
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Observations and Results
OBSERVATIONS AND RESULTS
Total of 30 patients were taken for the clinical study and were randomly allocated into group A and B 0f 15 patients each.
1) Generalized observations for overall patients :
TABLE NO :11– DISTRIBUTION OF PATIENTS BASED ON AGE GRAPH NO: 1
No. of patients Age
Group A % Group B %
Total Percentage
20-23
years
03 20% 03 20% 06 20%
24-27
years
06 40% 05 33.33% 11 36.66%
28-31
years
06 40% 06 40% 12 40%
32-35
years
00 00 01 6.66% 01 3.33%
0
5
10
15
20
2530
35
40
Gr‐A Gr‐B Total %
20‐23
24‐27
28‐31
32‐35
Among 30 patients selected for the study, 40% of patients were in the age group
between 28 to 31 years, 36.66% of patients were in the age group between 241to 27
years, 20% of patients were in the age group between 20 to 23 years. 3.33% patients were
present in the age group between 32 to 35 years.
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Observations and Results
TABLE NO: 12– DISTRIBUTION OF PATIENTS BASED ON RELIGION GRAPH No:2
No. of patients RELIGION
Group A % Group B %
Total Percentage
Hindu 12 80% 12 80% 24 80% Muslim 03 20% 02 13.33% 05 16.66% Christian 00 00 01 6.66% 01 3.33%
01020304050607080
Gr‐A Gr‐B Total %
HINDU
MUSLIM
CHRISTAIN
Among the 30 patients selected for the study, 80% of patients were Hindus and 16.66%
were Muslims & 3.33% were Christians.
TABLE NO : 13– DISTRIBUTION OF PATIENTS BASED ON OCCUPATION
GRAPH No: 3 No. of patients Occupation Group A Group B
Total Percentage
House wife 15 15 30 100% Service 00 00 00 00%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
H.W
SERVICE
Among the 30 patients selected, 100% patients were house wives
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Observations and Results
TABLE NO: 14– DISTRIBUTION OF PATIENTS BASED ON EDUCATION
GRAPH NO: 4
No. of patients Education Group A Group B
Total Percentage
Primary 10 06 16 53.33% Secondary 04 06 10 33.33% Graduation 01 03 04 13.33%
0
10
20
30
40
50
60
Gr‐A Gr‐B Total %
PRIMARY
SECONDARY
GRADUATION
Among the 30 patients selected for the study, the maximum incidence of 53.33% had
primary education,33.33% had secondary education & 13.33% were graduated.
TABLE NO :15– DISTRIBUTION OF PATIENTS BASED ON HABITAT
GRAPH NO:5
No. of patients Habitat Group A Group B
Total Percentage
Rural 14 12 26 86.66% Urban 01 03 04 13.33%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
RURAI
URBAN
Among the 30 patients selected for the study, the maximum patients of 86.66% were
from rural area & 13.33% were from urban area.
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Observations and Results
TABLE NO : 16– DISTRIBUTION OF PATIENTS BASED ON GRAVIDA
GRAPH NO:6
No. of patients Gravida Group A Group B
Total Percentage
Primi 10 09 19 63.33% Multi 05 06 11 36.66%
0
10
20
30
40
50
60
70
Gr‐A Gr‐B Total %
PRIMI
MULTI
Among the 30 patients selected for the study, the maximum patients of 63.33% were primy gravida & 36.66 % were multi gravida.
TABLE NO : 17– DISTRIBUTION OF PATIENTS BASED ON NAUSEA GRAPH NO:7
No. of patients Nausea Group A Group B
Total Percentage
Present 14 15 29 96.66% Absent 01 00 01 3.33%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, the maximum patients of 96.66% had nausea & in 3.33% nausea was absent.
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Observations and Results
TABLE NO: 18– DISTRIBUTION OF PATIENTS BASED ON VOMITING
GRAPH NO:8
No. of patients Vomiting Group A Group B
Total Percentage
Present 15 14 29 96.66% Absent 00 01 01 3.33%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, the maximum patients of 96.66% had vomiting & in 3.33% vomiting was absent.
TABLE NO: 1 9– DISTRIBUTION OF PATIENTS BASED ON FREQUENCY OF VOMITING
GRAPH NO:9
No. of patients Freq.of Vomiting Group A Group B
Total Percentage
1-2 times 05 02 07 23.33% 2-5 times 08 10 18 60% >5 times 03 02 05 16.66%
0
10
20
30
40
50
60
Gr‐A Gr‐B Total %
1‐2times
2‐5times
>5times
Among the 30 patients selected for the study, the maximum patients of 60% had vomiting for 2-5 times,23.33% of patients had 1-2 times & in 16.66%patients vomiting was for more than 5 times.
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Observations and Results
TABLE NO : 20– DISTRIBUTION OF PATIENTS BASED ON QUANTITY OF VOMITUS
GRAPH NO:10
No. of patients Quantity of
Vomitus Group A Group B Total Percentage
< 50 ml 01 01 02 6.66% 50-100 ml 08 06 14 46.66% 100-150 ml 07 04 11 36.66% >150 ml 00 03 03 10%
0
10
20
30
40
50
Gr‐A Gr‐B Total %
<50ml
50‐100ml
100‐150ml
>150ml
Among the 30 patients selected for the study, the maximum patients of 46.66% had quantity of 50-100ml, 36.66% of patients had 100-150ml, in 10% patients quantity was more than 150 ml & in 6.66% patients it was less than 50ml.
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Observations and Results
TABLE NO 21 – DISTRIBUTION OF PATIENTS BASED ON CONTENT OF VOMITUS GRAPH NO:11
No. of patients Content of Vomitus Group A Group B
Total Percentage
Saliva, Gastric Juice
02 01 03 10%
All 13 14 27 90%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
SA &GJ
ALL
Among the 30 patients selected for the study, the maximum patients of 90% had vomitus containing all i.e saliva, gastric juice & food.10% of patients had only saliva & gastric juice in vomitus.
TABLE NO: 22– DISTRIBUTION OF PATIENTS BASED ON ANNANABHILASHA
GRAPH NO:12
No. of patients Aversion Group A Group B
Total Percentage
Present 14 10 24 80% Absent 01 05 06 20%
0
20
40
60
80
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, the maximum patients of 80% had Aversion to smell & food & in 20% of patients it was absent.
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Observations and Results
TABLE NO : 23– DISTRIBUTION OF PATIENTS BASED ON ALASYA GRAPH NO:13
No. of patients Alasya Group A Group B
Total Percentage
Present 09 10 19 63.33% Absent 06 05 11 36.66%
0
10
20
30
40
50
60
70
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, the maximum patients of 63.33% had Alasya as a symptom & in 36.66% of patients it was absent.
TABLE NO : 24– DISTRIBUTION OF PATIENTS BASED ON ANGAMARDA GRAPH NO:14
No. of patients Angamarda Group A Group B
Total Percentage
Present 02 03 05 16.66% Absent 13 12 25 83.33%
0102030405060708090
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, the maximum patients of 83.33% had no Angamard as a symptom & in 16.66% of patients it was present.
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Observations and Results
TABLE NO: 25– DISTRIBUTION OF PATIENTS BASED ON ANIDRA GRAPH NO:15
No. of patients Anidra Group A Group B
Total Percentage
Present 02 01 03 10% Absent 13 14 27 90%
0102030405060708090
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 90% Anidra as a symptom was absent & in 10% of patients it was present.
TABLE NO: 26– DISTRIBUTION OF PATIENTS BASED ON AGNIMANDYA GRAPH NO:16
No. of patients Agnimandya Group A Group B
Total Percentage
Present 14 09 23 76.66% Absent 01 06 07 23.33%
0
20
40
60
80
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 76.66% had Agnimandya as a symptom was & in 23.33% of patients it was absent.
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Observations and Results
TABLE NO : 27– DISTRIBUTION OF PATIENTS BASED ON BRAMA GRAPH NO:17
No. of patients Brama Group A Group B
Total Percentage
Present 10 09 19 63.33% Absent 05 06 11 36.66%
0
10
20
30
40
50
60
70
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 63.33% had Brama as a symptom & in 36.66% of patients it was absent.
TABLE NO: 28 – DISTRIBUTION OF PATIENTS BASED ON DAURBALYA GRAPH NO:18
No. of patients Daurbalya Group A Group B
Total Percentage
Present 13 14 27 90% Absent 02 01 03 10%
0102030405060708090
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 90% Daurbalya was present as a symptom & in 10% of patients it was absent.
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Observations and Results
TABLE NO: 29– DISTRIBUTION OF PATIENTS BASED ON TALU SHOSHA GRAPH NO:19
No. of patients Talu Shosha Group A Group B
Total Percentage
Present 04 02 06 20% Absent 11 13 24 80%
0
10
20
30
40
50
60
70
80
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 80% Talushosha as a symptom was absent & in 20% of patients it was present.
TABLE NO: 30 – DISTRIBUTION OF PATIENTS BASED ON JIHWA SHOSHA
GRAPH NO:20
No. of patients Jihwa Shosha Group A Group B
Total Percentage
Present 04 01 05 16.66% Absent 11 14 25 83.33%
0102030405060708090
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 83.33% Talushosha as a symptom was absent & in 16.66% of patients it was present.
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Observations and Results
TABLE NO: 31 – DISTRIBUTION OF PATIENTS BASED ON TANDRA GRAPH NO:21
No. of patients Tandra Group A Group B
Total Percentage
Present 04 01 05 16.66% Absent 11 14 25 83.33%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 83.33% Tandra as a symptom was absent & in 16.66% of patients it was present.
TABLE NO: 32– DISTRIBUTION OF PATIENTS BASED ON SHIRA SHOOLA GRAPH NO:22
No. of patients Shira Shoola Group A Group B
Total Percentage
Present 05 04 09 30% Absent 10 11 21 70%
0
10
20
30
40
50
60
70
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 70% Shirashoola as a symptom was absent & in 30% of patients it was present.
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Observations and Results
TABLE NO: 33 – DISTRIBUTION OF PATIENTS BASED ON FAMILY HISTORY GRAPH NO:23
No. of patients Family History Group A Group B
Total Percentage
Present 08 08 16 53.33% Absent 07 07 14 46.66%
0
10
20
30
40
50
60
Gr‐A Gr‐B Total %
PRESENT
ABSENT
Among the 30 patients selected for the study, in maximum patients of 53.33% had family history of vomiting in pregnancy & in46.66% patients it was absent.
TABLE NO: 34– DISTRIBUTION OF PATIENTS BASED ON DIET GRAPH NO:24
No. of patients Diet Group A Group B
Total Percentage
Veg 00 01 01 3.33% Mixed 15 14 29 96.66%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
VEG
MIXED
Among the 30 patients selected for the study, maximum patients of 96.66% are having mixed diet & 3.33% are having vegetarian diet.
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Observations and Results
TABLE NO: 35– DISTRIBUTION OF PATIENTS BASED ON APETITE GRAPH NO:25
No. of patients Apetite Group A Group B
Total Percentage
Good 04 04 08 26.66% Moderate 06 06 12 40% Reduced 05 05 10 33.33%
0
5
10
15
20
25
30
35
40
Gr‐A Gr‐B Total %
GOOD
MODERATE
REDUCED
Among the 30 patients selected for the study, maximum patients of 40% are having Moderate apetite, 33.33% of patients had Reduced apetite & in 26.66% patients apetite was fond Good.
TABLE NO: 36– DISTRIBUTION OF PATIENTS BASED ON SLEEP
GRAPH NO:26
No. of patients Sleep Group A Group B
Total Percentage
Sound 14 13 27 90% Disturbed 01 02 03 10%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
SOUND
DISTURBED
Among the 30 patients selected for the study, maximum patients of 90% had sound sleep, 10% of patients had disturbed sleep.
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Observations and Results
TABLE NO: 37 – DISTRIBUTION OF PATIENTS BASED ON MALA PRAVRUTI
GRAPH NO: 27 No. of patients Mala
Pravruti Group A Group B Total Percentage
Regular 09 14 23 76.66% Irregular 06 01 07 23.33%
0
10
20
30
40
50
60
70
80
Gr‐A Gr‐B Total %
REGULAR
IRREGULAR
Among the 30 patients selected for the study, maximum patients of 76.66% had regular Mala pravrutti, 23.33% of patients had irregular Mala pravrutti.
TABLE NO: 38 – DISTRIBUTION OF PATIENTS BASED ON PRAKRUTI GRAPH NO: 28
No. of patients Prakruti Group A Group B
Total Percentage
Vata Pitta 04 02 06 20% Pitta Kapha 06 04 10 33.33% Kapha Vata 05 09 14 46.66%
0
10
20
30
40
50
Gr‐A Gr‐B Total %
VATA PITTA
PITTA KAPHA
KAPHA VATA
Among the 30 patients selected for the study, maximum patients of 46.66% were of Kapha Pitta Prakruti, 33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti
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Observations and Results
TABLE NO: 39– DISTRIBUTION OF PATIENTS BASED ON VIKRUTI
GRAPH NO : 29
No. of patients Vikruti Group A Group B
Total Percentage
Vata Pitta 02 04 06 20% Pitta Kapha 04 03 07 23.33% Kapha Vata 08 08 16 53.33% Tridoshaja 01 00 01 3.33%
0
10
20
30
40
50
60
Gr‐A Gr‐B Total %
VATA PITTA
PITTA KAPHA
KAPHA VATA
TRIDOSHAJA
Among the 30 patients selected for the study,in maximum patients of 53.33% Kapha vata vikruti was seen, in 23.33% Pitta Kapha vikruti was seen, in 20% of patients pitta vata vikruti was present & in 3.33% Tridoshaja vikruti was present.
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Observations and Results
TABLE NO: 40 – DISTRIBUTION OF PATIENTS BASED ON SAARA
GRAPH NO: 30
No. of patients Saara Group A Group B
Total Percentage
Rasa 01 02 03 10% Mamsa 03 05 08 26.66% Asthi 04 03 07 23.33% Rasa+Mamsa 04 02 06 20% Rakta+Mamsa 01 01 02 6.66% Mamsa+Asthi 01 01 02 6.66% Rakta+Asthi 01 01 02 6.66%
0
5
10
15
20
25
30
Gr‐A Gr‐B Total %
RASA
MAMSA
ASTHI
RASA+MAMSA
RAKTA+MAMSA
MAMSA+ASTHI
RAKTA+ASTHI
Among 30 patients taken for study maximum of 26.66% of patients were of mamsa saara,23.33% were of asthi saara,20% were of rasa & mamsa saara,10% were of Rasa saara, 6.66% of patients were of Rakta Mamsa, Rasa mamsa, Mamsa asthi respectively.
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Observations and Results
TABLE NO: 41– DISTRIBUTION OF PATIENTS BASED ON SAMAHANANA GRAPH NO:31
No. of patients Samhanana Group A Group B
Total Percentage
Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRAVARA
MADYAMA
AVARA
Among the 30 patients selected for the study, maximum of 100% of patients were of Madhyama Samhanana.
TABLE NO: 42– DISTRIBUTION OF PATIENTS BASED ON PRAMANA
GRAPH NO: 32
No. of patients Pramana Group A Group B
Total Percentage
Pravara 00 00 00 00% Madhyama 15 15 30 100% Avara 00 00 00 00%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRAVARA
MADYAMA
AVARA
Among the 30 patients selected for the study, maximum of 100% of patients were of Madyama Pramana.
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Observations and Results
TABLE NO: 43– DISTRIBUTION OF PATIENTS BASED ON SATWA
GRAPH NO : 33
No. of patients Satwa Group A Group B
Total Percentage
Pravara 00 00 00 00% Madhyama 14 15 29 96.66% Avara 01 00 01 3.33%
0
20
40
60
80
100
Gr‐A Gr‐B Total %
PRAVARA
MADYAMA
AVARA
Among the 30 patients selected for the study, maximum of 96.66% of patients were of Madhyama Satwa, 3.33% of patients were of Avara satwa.
TABLE NO: 44– DISTRIBUTION OF PATIENTS BASED ON SATMYA
GRAPH NO: 34 No. of patients Satmya Group A Group B
Total Percentage
Madhura 05 05 10 33.33% Amla 02 03 05 16.66% M+A 01 01 02 6.66% Katu 02 03 05 16.66% Katu+Amla 03 00 03 10% Sarva 02 03 05 16.66%
0
5
10
15
20
25
30
35
Gr‐A Gr‐B Total %
MADHURA
AMLA
MADURA+AMLA
KATU
KATU+AMLA
SARVA
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Observations and Results
Among the 30 patients selected for the study, maximum of 33.33% had satmyata for Madhura rasa, 16.66% of patients had satmyata for Amla rasa, Katu rasa, Sarva rasa respectively,10% of patients had satmyata for Katu Amla rasa,6.66% 0f patients had satmyata for Madhura & Amla rasa.
TABLE NO: 45– DISTRIBUTION OF PATIENTS BASED ON AHARA SHAKTI
GRAPH NO : 35
No. of patients Ahara Shakti Group A Group B
Total Percentage
Pravara 02 00 02 6.66% Madhyama 09 11 20 66.66% Avara 04 04 08 26.66%
0
10
20
30
40
50
60
70
Gr‐A Gr‐B Total %
PRAVARA
MADYAMA
AVARA
Among the 30 patients selected for the study, maximum of 66.66% had Madhyama aahara Shakti, 26.66% 0f patients had Avara ahara Shakti, and 6.66% had Pravara ahara Shakti.
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Observations and Results
TABLE NO: 46 – DISTRIBUTION OF PATIENTS BASED ON VYAYAMA SHAKTI GRAPH NO : 36
No. of patients Vyayama
Shakti Group A Group B Total Percentage
Pravara 01 00 01 3.33% Madhyama 12 12 24 80% Avara 02 03 05 16.66%
0
10
20
30
40
50
60
70
80
Gr‐A Gr‐B Total %
PRAVARA
MADYAMA
AVARA
Among the 30 patients selected for the study, maximum of 80% had Madhyama Vyayama Shakti, 16.66% 0f patients had Avara Vyayama Shakti, and 3.33% of patients had Pravara Vyayama Shakti.
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Result
RESULTS TABLE NO: 47 1.EFFECT OF CHARDI VEGA IN GROUP A:
Paired ‘t’ test Mean of BT
Mean of AT d
S.D S.E t P df
1.600 AT1 1.533 0.0667 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.0909 11.000 <0.001 14
TABLE NO :48 EFFCET OF CHARDI VEGA IN GROUP B:
Paired ‘t’ test Mean of BT
Mean of AT d
S.D S.E t P Df
2.267 AT1 1.867 0.400 0.743 0.192 2.449 0.0028 14 2.267 AT2 1.533 0.733 0.640 0.165 4.036 0.001 14 2.267 AT3 1.200 1.267 0.414 0.107 6.959 <0.001 14 2.267 AT4 0.933 1.333 0.704 0.182 6.325 <0.001 14
GRAPH NO: 37
0
0.5
1
1.5
2
2.5
BT AT1 AT2 AT3 AT4
GR-AGR-B
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Result
Group A: The mean score of the symptom of which was 1.600 before treatment reduced
To 1.533 after treatment, reduced to 0.733 in first follow up, further reduced to 0.333 in
second follow up and further reduced to 0.133 in final follow up . When these values
were analyzed statistically, the difference was significant at the level of p = < 0.001.
Group B: The mean score of the symptom of which was 2.267 before treatment reduced
To 1.867 after treatment, reduced to 1.533 in first follow up, further reduced to 1.200 in
second follow up and further reduced to 0.933 in final follow up . When these values
were analyzed statistically, the difference was significant at the level of p = < 0.001.
TABLE NO :49 COMPARISION OF CHARDI VEGA WITHIN THE GROUPS:
‘t’ test Groups
Mean d
S.D S.E M t P df
Group A 0.133 0.352 0.0909 Group B 0.333
-0.200 0.617 0.159
-1.090
0.285 28
GRAPH NO :38
0
0.5
1
1.5
2
2.5
BT AT
GR-AGR-B
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.061).
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Result
TABLE NO : 50 2) EFFECT OF Hb %IN GROUP A:
Paired ‘t’ test Mean of BT
Mean of AT d
S.D S.E t P df
11.297 BT 11.297 0.366 0.0945 =0.941 14 11.297 AT 11.283
0.013 0.681 0.176
0.0752 =0.941 14
TABLE NO :51 EFFECT OF Hb %IN GROUP B:
Paired ‘t’ test Mean of BT
Mean of AT D
S.D S.E T P df
11.717 BT 11.717 0.800 0.990 0.256 4.413 =0.021 14 11.717 AT 10.917 0.800 0.910 0.235 4.413 =0.021 14
GRAPH NO:39
10.4
10.6
10.8
11
11.2
11.4
11.6
11.8
BT AT
GR-AGR-B
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Result
Group A: The mean score of the symptom of which was 11.297 before treatment
reduced To 11.283 after treatment,
The change that occurred with the treatment is not great enough to exclude the possibility
that the difference is due to chance (P = 0.237)
Group B: The mean score of the symptom of which was 11.717 before treatment
reduced To 10.917 after treatment,
The change that occurred with the treatment is not great enough to exclude the possibility
that the difference is due to chance (P = 0.021)
TABLE NO : 52 EFFCTS OF HB% IN BOTH GROUPS:
‘t’ test Groups
Mean d
S.D S.E M t P df
Group A 11.283 0.681 0.176 Group B 10.917
0.367 0.910 0.235
1.250 0.222 28
GRAPH NO:40
10.4
10.6
10.8
11
11.2
11.4
11.6
11.8
BT AT
GR-AGR-B
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.336).
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Result
TABLE NO :53
3. EFFECT OF Wt IN GROUP A:
Paired ‘t’ test Mean
of BT Mean of AT d
S.D S.E T P df
52.867 AT1 53.000 -0.133 9.000 2.324 -1.468 0.164 14 52.867 AT2 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT3 52.933 -0.066 9.114 2.353 -0.564 0.582 14 52.867 AT4 52.933 -0.066 9.114 2.353 -0.564 0.582 14
TABLE NO : 54 EFFECT OF Wt IN GROUP B:
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E T P df
51.733 AT 51.800 -0.066 8.274 2.136 -0.435 =0.670 9
51.733 AT1 51.733 0.00 8.250 2.130 0.000 =1.000 9 51.733 AT2 51.733 0.00 8.250 2.130 0.00 =1.000 9 51.733 AT3 51.733 0.00 8.250 2.130 0.00 =1.000 9
GRAPH NO : 41
5151.251.451.651.8
5252.252.452.652.8
5353.2
BT AT1 AT2 AT3 AT4
GR-AGR-B
Group A:
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Result
The mean score of the symptom of which was 52.867 before treatment increased to To
53.000 after treatment, & was decreased to 52.933 which was maintained same in all the
follow ups. When these values were analyzed statistically, the difference was not
significant at the level of p = 0.582
The change that occurred with the treatment is not great enough to exclude the possibility
that the difference is due to chance (P = 0.582)
Group B:The mean score of the symptom of which was 51.733 before treatment
increased To 51.800 after treatment, which was again reduced to 51.733 & remained
same in all the follow ups. When these values were analyzed statistically, the difference
was not significant at the level of p = 1.000
The change that occurred with the treatment is not great enough to exclude the possibility
that the difference is due to chance (P = 1.000)
TABLE NO : 55
COMPARISION OF Wt WITHIN THE GROUPS:
‘t’ test Groups
Mean D
S.D S.E M t P df
Group A 52.933 9.114 2.353 Group B 51.733
1.200 8.250 2.130
0.378 0.708 28
GRAPH NO: 42
5151.251.451.651.8
5252.252.452.652.8
5353.2
BT AT
GR-AGR-B
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Result
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.708).
TABLE NO : 56 4. EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP A
Paired ‘t’ test Mean of BT Mean of ATe d
S.D S.E t P Df
1.867 AT1 1.667 0.200 0.915 0.236 1.871 =0.082 14 1.867 AT2 1.067 0.800 1.082 0.799 4.583 <0.001 14 1.867 AT3 0.867 1.000 0.640 0.165 4.583 <0.001 14 1.867 AT4 0.400 1.467 0.507 0.131 5.735 <0.001 14
TABLE NO : 57 EFFECT OF TREATMENT ON ANANABHILASHA IN GROUP B
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E t P Df
1.733 AT1 1.533 0.200 1.125 0.291 1.871 =0.082 14 1.733 AT2 1.267 0.467 0.884 0.228 2.824 =0.014 14 1.733 AT3 0.933 0.800 0.799 0.206 3.292 =0.005 14 1.733 AT4 0.467 1.267 0.467 0.516 4.750 <0.001 14
GRAPH NO: 43
00.20.40.60.8
11.21.41.61.8
2
BT AT1 AT2 AT3 AT4
GR-AGR-B
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Result
Group A: The mean score of the symptom of which was 1.867 before treatment reduced
To 1.667 after treatment, which was again reduced to 1.067 after first follow up & again
reduced to 0.867 after second follow up & finally reduced to 0.400 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
Group B The mean score of the symptom of which was 1.733 before treatment reduced
To 1.533 after treatment, which was again reduced to 1.267 after first follow up & again
reduced to 0.933 after second follow up & finally reduced to 0.467 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
TABLE NO : 58 COMPARISION OF EFFECT OF ANNANABHILASHA WITHIN THE GROUPS:
‘t’ test Groups
Mean d
S.D S.E M T P df
Group A 0.400 0.507 0.131 Group B 0.467
0.00 0.516 0.133
-0.0667 =0.724 28
GRAPH NO : 44
0
0.5
1
1.5
2
BT AT
GR-AGR-B
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82
Result
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 1.000).
TABLE NO : 59
5. EFFECT OF TREATMENT ON NAUSEA IN GR-A
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E T P Df
1.600 AT1 1.533 0.067 0.516 0.133 1.000 =0.334 14 1.600 AT2 0.733 0.867 0.458 0.118 9.539 <0.001 14 1.600 AT3 0.333 1.267 0.488 0.126 10.717 <0.001 14 1.600 AT4 0.133 1.467 0.352 0.090 11.000 <0.001 14
TABLE NO : 60 EFFECT OF TREATMENT ON NAUSEA IN GR-B
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E T P Df
2.000 AT1 1.600 0.400 0.737 0.190 4.583 <0.001 14 2.000 AT2 1.133 0.867 0.640 0.165 6.959 <0.001 14 2.000 AT3 0.600 1.400 0.632 0.163 12.220 <0.001 14 2.000 AT4 0.333 1.667 0.617 0.159 11.297 <0.001 14
GRAPH NO : 45
0
0.5
1
1.5
2
2.5
BT AT1 AT2 AT3 AT4
GR-AGR-B
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83
Result
Group A The mean score of the symptom of which was 1.600 before treatment reduced
To 1.533 after treatment, which was again reduced to 0.733 after first follow up & again
reduced to 0.333 after second follow up & finally reduced to 0.133 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
Group B The mean score of the symptom of which was 2.000 before treatment reduced
To 1.600 after treatment, which was again reduced to 1.133 after first follow up & again
reduced to 0.600 after second follow up & finally reduced to 0.333 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
TABLE NO: 61
COMPARISION OF EFFECT OF NAUSEA WITHIN THE GROUPS:
‘t’ test Groups
Mean D
S.D S.E M t P Df
Group A 0.133 0.352 0.090 Group B 0.333
-0.200 0.617 0.159
-1.090
=0.285 28
GRAPH NO : 46
0
0.5
1
1.5
2
2.5
BT AT
GR-AGR-B
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84
Result
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.566).
TABLE No : 62 6.EFFECT ON QUANTITY OF VOMITUS IN GROUP A :
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E T P df
2.400 AT1 1.933 0.467 0.632 0.163 3.500 =0.004 14 2.400 AT2 1.867 0.533 0.640 0.165 4.000 =0.001 14 2.400 AT3 1.400 1.000 0.507 0.131 7.246 <0.001 14 2.400 AT4 1.200 1.200 0.676 0.175 6.874 <0.001 14
TABLE NO : 63 EFFECT ON QUANTITY OF VOMITUS IN GROUP A :
Paired ‘t’ test Mean of BT Mean of AT d
S.D S.E T P df
2.533 AT1 2.133 0.400 0.640 0.165 3.055 =0.009 14 2.533 AT2 1.933 0.600 0.594 0.153 4.583 <0.001 14 2.533 AT3 1.667 0.867 0.617 0.159 4.516 <0.001 14 2.533 AT4 1.533 1.000 0.743 0.192 7.246 <0.001 14
Graph no : 47
0
0.5
1
1.5
2
2.5
3
BT AT1 AT2 AT3 AT4
GR-AGR-B
Group A The mean score of the symptom of which was 2.400 before treatment reduced
To 1.933 after treatment, which was again reduced to 1.867 after first follow up & again
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page
85
Result
reduced to 1.400 after second follow up & finally reduced to 1.200 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
Group B The mean score of the symptom of which was 2.533 before treatment reduced
To 2.133 after treatment, which was again reduced to 1.933 after first follow up & again
reduced to 1.667 after second follow up & finally reduced to 1.533 at last follow up.
When these values were analyzed statistically, the difference was significant at the level
of (P = <0.001)
The change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001)
TABLE NO :64 COMPARISION OF EFFECT OF QUANTITY WITHIN THE GROUPS:
‘t’ test Groups
Mean D
S.D S.E M t P df
Group A 1.200 0.676 0.175 Group B 1.533
-0.133 0.743 0.192
-1.285
=0.209 28
Graph no : 48
0
0.5
1
1.5
2
2.5
BT AT
GR-AGR-B
The difference in the mean values of the two groups is not great enough to reject the
possibility that the difference is due to random sampling variability. There is not a
statistically significant difference between the input groups (P = 0.209)
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page
86
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 87
DISCUSSION
Pregnancy & childbirth have been given an extraordinary status as an expression
of both the human & the sacred simultaneously. All her needs must be fulfilled as one
life participates in the creation of another & care must be taken to bring this new life into
the world. Many physiological changes are taking place in women from puberty till
Menopause. Changes taking place during pregnancy is a unique process & experience in
women’s life as it created for the new budding life. As a consequence to these changes
certain conditions manifest among which Garbhini chardi or emesis gravidarum is one. In
olden days women with history of amenorrhea & vomiting were diagnosed as being
pregnant. This clearly explains that vomiting was present in most of the pregnant women.
In present era people have become more optimistic towards their child. So, even with
simple vomiting people rush to their obstetrician with the view that it should not produce
any harm to the fetus. In some women it so happens that with the fear of vomiting they
do not consume any food which further leads to carbohydrate starvation & vicious cycle
of vomiting begins which may affect both child & mother. Thus it is necessary to treat
emesis gravidarum & prevent women from suffering through hyper emesis.
Garbhini Chardi is explained as one of the “Vyakta garbha laxana”. Explanations
or description for “Garbhini chardi” as a separate disease is not available. It is a coined
term used for chardi seen during pregnancy. While explaining Chardi Vyadi Acharyas
have mentioned Garbhini chardi as one among the type of Agantuja chardi. Acharya
Kashyapa while explaining Garbhini Vyadhis has told that Nidana, laxana & samprapti is
same in Garbhini & other people as dosha & dhathu remains the same but only principle
of treatment differs as vigorous treatment like Shodhana & langana cannot be given in
Garbhini. Thus Shamana line of treatment is adopted in the present study.
In the present study, a detailed description of Garbhini Chardi is done with all its
nidana, lakshanas samprapti, samprapti ghatakas, Chikitsa etc. The effect of drug as
evidenced in the clinical trials were recorded along with detailed case history.
Discusssion
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Discussion on Garbhini Chardi
Nidana –Aapanna satwa, Dauhruda avamana & Vata Vaigunya due to Garbha utpeedana
are mentioned as a cause for Chardi. This clearly explains that presence of garbha is a
cause for Garbhini chardi. In the early trimester garbha is said to be in amavastha as it is
in the stage of formation due to which many changes are taking place in the internal
system. On the other hand women start consuming excessive food so as to keep her
healthy & nourish the fetus. Due to these physiological changes & sudden change in the
dietary habits leads to indigestion which may cause vomiting. If she is suffering from
agnimandya before conception then this may further aggravate the existing condition. In
Garbhini avastha women develops desire for certain food or article if these desires are not
fulfilled then this may lead to shoka, krodha or chinta which may cause Vata Vikruti &
lead to chardi. Incidence from the study have proven that Primies are more likely to
suffer from vomiting as it is a new experience where she has a sort of fear & happiness in
her which may lead to manasika dosha prakopa this psychologic responses can interact
and exacerbate the physiology of nausea and vomiting during pregnancy. If chardi is seen
in excess then she may stop consuming taking food with a view that it may control it. By
doing so it further vitiates Vata & vicious cycle of vomiting is seen. During pregnancy
there is increased sensitivity for smell perception thus certain odors cause sensation of
nausea or vomiting.
Samprapti: - Due to Atidravadi nidana sevana & Dauhruda avamana shareerika &
manasika dosha Vikruti takes place which leads to Vata vruddi, which further causes
Agnimandya & formation of ama which leads to ahara dusti & further vitiates other
doshas. Due to dosha utklesha it is expelled out from the body in the form of chardi. It is
explained in classics that Samprapti vighatana is chikitsa. Thus all measures should be
taken to control vomiting.
Chikitsa: - While mentioning chikitsa for Garbhini Vyadhis Acharyas have mentioned
that she should be treated with soft, sweet, cold, pleasing & gentle drugs, dietics &
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 89
behavior. Vigorous treatment like shodhana & langana cannot be given to Garbhini, thus
Shamana method of treatment is adopted.
In Garbhini stree due to the nourishment of fetus, there is dhatu Kshaya which leads to
Vata vruddi. So bruhmana dravyas has to be taken by her. The plan of treatment should
be such that it should nourish the garbha as well as control Chardi.
So the line of treatment is to treat all these conditions.
- To fulfill the needs of Dauhruda:
A³ÉÍqÉ¹Ç ½ÑmÉÌWûiÉÍqɹæaÉïlkÉÉÌSÍpÉÈ mÉ×jÉMçü |
SåWåû mÉëÏhÉÉÌiÉ aÉlkÉÉSÏlÉç bÉëÉhÉÉÌSlÉÏÌSìrÉÉÍhÉ cÉ |
(cÉ.ÍcÉ.15/10)
All dravyas are made up of pancha mahabhuta similarly is the garbha. When person
consume the food which is Hitakara, priya, endowed with Roopa, Rasa, Gandha, Sparsha
then that ahara does the poshana of the dhatus & indriyas. Similarly the food that is
consumed by the Garbhini nourishes the garbha. Thus all the desires of dourhrda must be
fulfilled.
- Aapanna satwa & dourhrda must be treated with priya vachana, ahara & Vihara
which provides her with physical & mental support.
- To cure Agnimandya, ama conditions one should use the drugs which are
deepana, pachana, Hrudya, Trushna nigrahana & dahashamaka properties which
helps to treat ama as well as maintain pregnancy.
Upadrava –
Due to excess vomiting there is obstruction to Sweda, Mutra & Ambuvaha Srotas .Due to
this obstruction there is Vata vruddi which carries them in upward direction because of
which the chardi which comes out contains the Varna & gandha of mutra, sweda etc.
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 90
When there is increased frequency of Chardi then it may be associated with Shonita
which may lead to kasa, Hrudrogadi laxanas. Hence these conditions are not treatable.
From this above explanation it can be said that Chardi mentioned as vyakta garbha laxana
can be taken as emesis gravidarum & that mentioned by Harita as Upadrava can be taken
as Complications of hyper emesis.
Discussion on drug review: -
While explaining regarding chikitsa in Garbhini Acharyas has mentioned that she should
be treated with the things which are easily palatable, Hrudya & the one which is liked by
her. Lehya which is one among the four types of food items is having good palatability
because of sweetening agents present in this & is liked by Garbhini. Even though there
are many formulations available for treating Garbhini Chardi Dadima Avaleha is selected
because it has the properties of Agnideepaka, Amapachaka, Vatanulomaka, Hrudya,
Balya, and Dhatu vardaka, Krimihara etc which does the samprapti vighatana of Chardi
& helps in curing it.
Probable mode of action:
Dadima Avaleha contains Dadima, Madhu & Sharkara in more quantity which is having
Amla, madhura rasa, sheeta veerya , madhura vipaka & kapha pitta shamaka property.
Its prakshepaka dravyas are shunti, Maricha, Pippali, Pippali mula,etc.. All these drugs
contain shad rasas among which Tikta & Katu rasa are Pradhana, they pocess laghu ,
ruksha guna, Ushna veerya & Kapha Vata shamaka property.
With the presence of honey & sugar in the drug it becomes palatable & absorption of the
drug in the form of lehya starts from the mouth as the taste receptors are stimulated which
helps in excessive secretion of saliva & mix with it. It is readily assimilated & accepted
by the stomach hence absorption of the nutrients take place. As vomiting is caused due to
carbohydrate starvation presence of fructose, glucose in the drug helps to supplement it
thus preventing vomiting.
Discusssion
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- A study conducted on Dried fruit peel alcoholic extract & decoction
administered in rats had intestinal anti secretory activity thus Dadima acts by
preventing excessive secretions from the intestines there by preventing
regurgitation of the food which is caused due to mucosal irritation because of
these secretions.
- Rhizome of zingiber containing shogaols,gingerols showed improved anti emetic
activity in frog. It is best in vomiting caused due to motion sickness & in emesis
gravidarum. It action is by modulating vestibular impulses to the autonomic
centers of the central nervous system & also by increasing the intestinal motility
by preventing stasis of food in the stomach for longer time.
- Pharmacological study of Myrestica fragrans in suspension form showed
increased intestinal tone on guinea pig ileum.
- The effect of spices on the secretion and composition of saliva in humans
observed that red Pepper, ginger, black pepper, coriander and mustard enhanced
the secretion of salivaand activity of salivary amylase. These drugs do
agnideepana & increases perception for taste.
- Haritaki has proven gastro kinetic effect i.e. it helps in moving the contents of
stomach earlier. So it can be used as adjuvant with other drugs that interfere with
gastric motility as Antihistaminics like drugs. It acts like vatonulomaka & helps in
controlling Vata there by controlling chardi.
Action of Madhura rasa on chardi – Drugs like Dadima, Danyaka, Manjista, Madhura &
sharkara contains Madhura rasa .This rasa acts as Brumhana & tarpana which does pitta
shamaka & helps in nourishing the dhathus there by doing poshana of the garbha.
Action of Tikta rasa on chardi – Drugs like Ajamoda, Jati phala, Jeeraka, Maricha,
Nimba, Pata, Lavanga contains Tikta rasa .Even though Tikta rasa is swadarahita it
increases perception of taste by activating the taste receptors. It acts as Agni deepaka,
Ahara pachaka, Daha shamaka, Trushna nigrahana, Krumi hara & maintains texture of
Twak & Mamsa. In Garbhini Chardi patient’s complaints of Aruchi, Agnimandya, Daha,
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 92
Trushna & dryness of mouth. Tikta rasa by its action helps in curing all these laxanas &
helps in controlling vomiting.
While explaining chikitsa for chardi all the Acharyas have mentioned use of Kashaya &
yusha prepared out of Tikta rasa dravyas like Guduchi, Nimba, Danyaka etc probably
because of chardi hara property of this rasa.
Action of Katu rasa on Chardi – Drugs like shunti, Pippali, Maricha, Ativisha contains
Katu rasa. It acts as Mukha shodaka, Agnideepaka, dathuposhaka, indriya prasadaka,
srotovisrutikaraka & kapha shamaka. By mukha shodaka property it cures Aruchi by
increasing the perception of taste. By Agnideepana property it cures ama & does ahara
pachana which helps in formation of rasadi dhatus by which proper poshana to the garbha
is maintained.
Some of the drugs like shunti, Danyaka, Maricha, Ajamoda, Honey contain calcium, iron,
Carbohydrate , vitamins like B,C etc these are very much essential during pregnancy as
there is increased demand of these during pregnancy. This will also help for the proper
development of the fetus & she will not suffer from vomiting, anemia etc conditions
during pregnancy
Thus dadima Avaleha with its property of Bruhmana, Ruchivardhaka, Agnideepaka,
Amapachaka, Dhatu poshaka maintains Vata in normal proportion there by controlling
chardi & nourishing garbha.
Mode of action of guda paka:
It is having Madhura rasa, Madhura vipaka, guru guna & sheeta veerya, It is having
special qualities like ruchikara, raktakara, rasayana, vrushya which is not only palatable
but also helps in dhatu vruddi. It acts like Brumhana & does dhatu poshana which helps
in nourishing the fetus.
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 93
Discussion on methodology, observations and results
It is a single blind clinical study with a pre test and post test design. Here 30 patients
between the age group of 20-35years were randomly selected from the OPD and IPD of
SDM hospital of Ayurveda, Udupi. The test group comprising of 15 patients, dadima
Avaleha was given and for another group of 15 patient’s placebo was given & the results
are compared.
General Description of the patients:
45 patients were registered for the study out of whom, 14 dropped out in due
course, 2 patients underwent MTP as it was diagnosed as blighted ovum, 1 patient had
miscarriage, 1patient had twin pregnancy which was diagnosed later & was excluded
from the study.
Incidence studies of all the registered patients are as follows
1) Age incidence: Patients within the age group of 20-35yrs were selected for the study as
it is the active reproductive phase. Among which 40% of patients were in the age group
between 28 to 31 years.
2) Religion: In this study 80% of patients were Hindus and Study records larger number
of Hindus, when compared to other religions. Data reflects more on the geographical
predominance of a particular sector, Hindus being dominant in & around Udupi.
3) Socio economic status & Occupational Incidence: Maximum no of patients was of low
socio economic status & 100% patients were house wives.
4) Educational Status: In the study 53.33% of patients had primary education, i.e. they
have completed their education till high school.
Discusssion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi Page 94
5) Habitat Incidence: In the study maximum patients of 86.66% were from rural area than
urban area as our hospital is located in rural area.
6) Parity: In the study 63.33% were primy gravida & 36.66 % were multi gravida.
Maximum patients were primigravida as incidence of vomiting in pregnancy is more in
primies than in multies. Even this study proves the same.
7) Dietary Incidence: In the study 96.66% are having mixed diet. This will explain the
prevalent food pattern in this region. The food which they consume contains more of fat
& excessive intake of fatty substances is one of the causes for vomiting in pregnancy.
8) Family History: In the present study maximum patients of 53.33% had family history
of vomiting in pregnancy & in 46.66% patients it was absent. Persons with family history
of vomiting are more likely to suffer from vomiting in there pregnancy.
9) Sleep pattern: Maximum patients of 90% had sound sleep, 10% of patients had
disturbed sleep.
10) Incidence on Agni: Maximum patients of 76.66% had Agnimandya as a symptom &
in 23.33% of patients it was absent. It leads to improper formation of ahara rasa because
of which nourishment to the fetus is reduced which may further lead to abortion or IUGR
like conditions. So it is important to treat this in initial stage before embarking on
pregnancy.
11) Incidence of Prakruti: Maximum patients of 46.66% were of Kapha Pitta Prakruti,
33.33% of Pitta Kapha Prakruti, 20% were of Vata Pitta Prakruti.
12) Incidence of Vikruti: In the study maximum patients of 53.33% had Kapha Vata
Vikruti
As Vitiated Pitta & Kapha causes Agnimandya, this will lead to formation of ama. This
ama causes ahara dusti leading to Chardi.
Discusssion
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13) Incidence on Saara: In the study maximum of 26.66% of patients were of mamsa
saara.
14) Incidence on Satwa: Maximum of 96.66% of patients was of Madhyama Satwa,
3.33% of patients were of Avara satwa. This shows that satwa also play role in persons
suffering from vomiting.
15) Incidence on Samhanana: Maximum of 100% of patients was of Madhyama
Samhanana.
17) Incidence on aharashakti: Maximum no of patients had Madhyama & Avara ahara
Shakti. This may be because of Agnimandya where digestion capacity is reduced.
18) Incidence on vyayamashakti: Most of the patients had Madhyama Vyayama Shakti.
19) Incidence on symptoms: Maximum of patients had symptoms like Aruchi in 40%,
Hrullasa in 96.66%, Alasya in 63.33%, dourbalyata in 90%, Brama in 63.33%; these are
laxanas of Ama which are caused due to Agnimandya which may lead to Vikruti of Vata
which may further lead to problems like pregnancy loss, IUGR, Eclampsia & obstructed
labor in later stages. So anulomana of Vata is given prime importance throughout
pregnancy.
Effect of therapy-
Effect of treatment was assessed both clinically as well as based on laboratory
parameters. Clinical features and hemoglobin percentage were assessed before, after
treatment and on follow up.
Discusssion
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Effect of treatment on individual signs and symptoms
Chardi Vega-
The mean score of the symptom which was 1.600 before treatment was reduced to
0.133after treatment. The change was found to be statistically significant. As dadima
Avaleha processes Agnideepaka & Vatanulomaka properties gradual reduction in chardi
Vega was seen. As Urdvagaman of Vata causes chardi its anulomana cures it.
Hemoglobin percentage –
The mean score of Hemoglobin before treatment was 11.283 which was increased to
11.297 after treatment. The change was found to be statistically significant. As Dadima
Avaleha contains dadima in excess quantity & it has a property of Raktavardhaka
because of which improvement in Hb% is seen.
Weight –
The mean score of the symptom of which was 52.057 before treatment reduced To 52.00
after treatment, & was maintained same in all the follow ups. As the duration of treatment
& sample size was small the effect could not be seen. Hence the result is inconclusive.
Ananabhilasha -
The mean score of the symptom of which was 1.667 before treatment reduced to 0.467 at
last follow up. The change was found to be statistically significant .Dadima Avaleha has
the property of Amapachaka, Agni deepaka & Vatanulomaka property it was found
effective.
Nausea –
The mean score of the symptom of which was 2.000 before treatment reduced to 0.467 at last
follow up. The change was found to be statistically significant. It is Hrudya,
ruchivardhaka, Madhura rasayukta & liked by Garbhini.
Discusssion
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Quantity of vomitus –
The mean score of the symptom of which was 2.400 before treatment reduced to 1.200 at last
follow up. The change was found to be statistically significant. As dadima Avaleha
processes Agnideepaka & Vatanulomaka properties gradual reduction in quantity of
chardi was seen.
Conclusion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 100
CONCLUSION
Conclusion is the total extort that is obtained from the work done to complete the study.
Whatever was explained earlier are the particular facts and reasons that are supported by
the obtained evidences / data as well as textual references. The conclusions are made
from observations seen in the present study.
- Even though Garbhini chardi is mentioned as a vyakta garbha laxana, it can be
seen as a separate disease were its nidana, laxana & samprapti are same as that of
samanya chardi.
- The principle line of treatment is to treat Garbhini with priya vachana, ahara &
Vihara along with Shamana chikitsa.
- Among all the shad rasas Amla & Tikta rasa dravyas have better action in
controlling chardi.
- Garbhini chardi mentioned as vyakta garbha laxana can be correlated to emesis
gravidarum & that mentioned as Upadrava can be correlated to complications of
hyper emesis.
- In emesis gravidarum along with medication, dietary manipulation, bed rest, &
assurance help in controlling it.
- Dadima Avaleha which is palatable, nutritious & having good dietic value was
effective in reducing Chardi Vega, Hrullasa, Ananabhilasha, Agnimandya, Aruchi
& Malavarodha.
With the current study following results were obtained & it can be concluded as:-
- In controlling chardi Vega trail group was found more effective than control
group proving retention of food for more time.
- Dadima Avaleha having Rakta vardaka property showed slight raise in Hb%
where as in control group it was found reduced.
- Both the Trial & control group did not show any effect in weight gain instead it
was effective in maintaining it. This shows that the drug has no adverse effect
concern to weight.
Conclusion
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 101
- Trail group was better in controlling Ananabhilasha compared to control group.
Hence dadima Avaleha proved to be more effective.
- The effect of both dadima Avaleha & control group proved significant in
controlling Nausea.
- Dadima Avaleha was better in reducing quantity of vomitus compared to the
control group. Hence it proved to be more effective.
By the clinical trial on 30 patients with 15 patients each in Group A- Dadima Avaleha &
Group B –Guda paka, the results in group A was more effective in reducing Chardi Vega,
Anannabhilasha, Nausea & quantity of vomitus. Group B was better in improving nausea.
Both the groups were effective in maintaining the weight.
Summary
SUMMARY
The present dissertation study entitled as “A CLINICAL STUDY ON EFFECT OF DADIMA AVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI” is planned with the following aim and objectives
1. A conceptual study of Garbhini chardi.
2. To evaluate the efficacy of Dadima Avaleha.
The whole study was elaborated in 5 parts.
o Review of literature.
o Clinical study
o Discussion
o Conclusion
o Summary
Review of literature
It contains of 2sections, first section comprises of historical review of garbha, Garbhini &
all the drugs that are included in this study.
The second section contains –Garbhini Chardi with its nidana, samprapti, chikitsa with
the drug review of the concerned drugs.
It also includes the modern view of emesis & hyper emesis
Clinical study: 30 patients diagnosed as Garbhini chardi were randomly selected and
divided in to 2 groups each. Criteria of inclusion, exclusion and assessment with
parameters are given. The data recorded from the observations and results obtained at the
end of therapy are represented in tabular and graphical form. The results of statistical
analysis by applying paired‘t’ test and unpaired‘t’ test are mentioned.
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 98
Summary
Discussion: In this part, discussion is made on the concept of disease from references
collected and compiled from Ayurvedic and modern texts. Discussion on the data of
observations obtained from patients along with the effect of therapy is done.
A probable mode of action of dadima Avaleha on the basis of its rasapanchaka, active
chemical constituents is drawn on the basis of discussion on the whole study:
Conclusion:
• Significant results were seen in the criteria like Chardi Vega, Hrullasa,
Ananabhilasha & Quantity of Vomitus.
• This study would be considered more genuine when a large sample will be taken
for the study.
“A Clinical Study on effect of Dadimaavaleha in the management of Garbhini Chardi” Page 99
Table Showing Demographic Data
CASE NO. AGE
SEX
RELIGION SES OCCUPATION
DIET
M H M C L M U A S L V M 52056 38 + + - - - - + + - - + - 148250 29 + + - - - + - - - + - + 158739 35 + + - - + - - - - + - + K. Vasu 40 + + - - + - - - - + - + Abdul Aziz 32 + - + - + - - - - + - + Gopal 29 + + - - - + - - - + - + Jaya 37 + + - - + - - - - + - + Imtiazkhan 27 + - + - + - - + - - - + Devdas Puthran
35 + + + - + - - - - + - +
Joseph 40 + - - + + - - - - + - + Javed 23 + - + - + - - + - - - + Chiranjeevi 31 + + - - - + - + - - - + Shekhar 35 + + - - + - - - - + - + Praveen Kumar
40 + + - - - + - + - - - +
CASE PROFORMA
“A CLINICAL STUDY ON EFFECT OF DADIMAAVALEHA IN THE MANAGEMENT OF GARBHINI CHARDI”
GUIDE: Dr. Mamatha K.V., M. D. CO-GUIDE: Dr.Sucheta ,M.S(Ayu) AATURA VIVARA:- NAME: SERIAL NO: AGE: O.P.D .NO: RELIGION: I.P.D.NO: EDUCATION: D.O.A. : OCCUPATION: D.O.D. : SOCIO ECONOMIC STATUS: PLACE: ADDRESS: DIAGNOSIS: RESULT: PRADANA VEDANA: - CHARDI HRULLASA ARUCHI VEDANA SAMUCCHAYA- EARLY MORNING AFTERNOON NIGHT FREQUENCY QUANTITY VOMITUS
ANUBANDA VEDANA:- ALASYA – ANGAMARDA - ANIDRA - AGNIMANDYA - BRAMHA- BALAKSHAYA – DOURBALYA - TALUSHOSHA- JIHWASHOSHA- TANDRA – SHIRASHOOLA - VEDANA VRUTTANTA:- ONSET:- DURATION;- PRECIPITATING FACTOR:- AGGRAVATING FACTOR;-
Food SMELL
RELIVING FACTORS:- Food Season Clothing
Other measures TREATMENT RECEIVED:- RESPONSE TO PREVIOUS TREATMENT:-
POORVA VYADI VRUTTANTA:- GENARAL – HPT/ DM/ ASTHAMA/ TB SPECIFIC – INFERTILITY/ABORTION SURGICAL INTERVENTION – KOUTUMBIKA VRUTTANTA:- TB DM HTN ASTHAM AIDS SYPHILLIS FATHER MOTHER HUSBAND SIBLINGS VAIYAKTIKA VRITTANTA:- AHARA – V/M DIETIC HABITS –SAMA/VISHAMA HABITS – TEA/ COFFE/ TOBACCO/ SMOKING RASA SAMBANDI – M/A/L/K/T/K APPETITE – A/M/P NIDRA – S/D MALA PRAVRUTTI – R/IR RAJO VRUTTANTA :- PRATHAMA RAJO PRAVRUTTI KALA – RAJO PRAVRUTTI – SRAVA KALA- ASSOCIATED WITH PAIN- ANTIMA RAJO PRAVRUTTI DINANKA- PRASAVA VRUTTANTA :- VAIVAHIKA KALA- L.M.P.- E.D.D- GRAVIDA PARA ABORTION LIVE DEAD M.O.DEL PER.PERIOD BREAST.F CONTRASEPTIVE HISTROY:-
SAFE METHOD – CONTRASEPTIVE PILLS- IUCD- GENERAL EXAMINATION:- BUILT – NOURISHMENT – HEIGHT – WEIGHT – PULSE – ICTERUS – TEMPRATURE – RESPIRATORY RATE – B.P- H.R –
i. General Examinations
CVS RS CNS ii. Systemic examination GIT CVS Others
Prakruti Vyayama shakti iii. Dashavidha pariksha Saara Aahara shakti
Abhyavaharana Jarana Samhanana Vaya Pramana Desha Satwa Vikriti
Saatmya
SAMPRAPTIGHATAKA:-
Nidaana Dosha
Dooshya- dhatu mala
Strotas Srotodusti prakaara Investigations:-
Udbhava staana Sanchara staana Vyakta staana Urine
pregnancy test - Adhistaana Rogamarga Vyadhi prakaara Sadhya/ krachrasadhya/ asaadhya Blood Hb% - Sampraapti
Urine Routine - USG - 2. Assessment Criteria Scorings
3. Complications 4 Results
Nausea only 0 Nil 0 <50ml 1 Mild -
<2times 1
50-100ml 2 Moderate- 2-5times
2
QUANTITY OF VOMITUS
>100ml
CHARDI VEGA
Severe >5times
3 3
Nil 0 Nil 0 Mild -1/2 kg 1 Mild- 1 Moderate ½-1kg
2 Moderate 2
IMPROVEMENT IN WEIGHT
More- 1kg
NAUSEA
3 Severe 3
Nil 0 Nil 0 Mild -0.25gm
1 Mild-nausea 1
Moderate ½-1gm
2 Moderate – vomiting 1-2times
2
IMPROVEMENT IN Hb%
More-> 1gm
AVERSION TO SMELL
3 Severe – vomiting >2times
3
Completely cured Partially cured Not reduced condition is same Aggravated Association of complications if any
5. Conclusions Date: Signature: Observation Table
Symptoms BT AT1 AT2 AT3 AT4
Nausea
Chardi vega
Content of vomitus
Improvement in hb%
Improvement in weight
Aversion to smell
Giddiness
Tiredness
Quantity of vomitus
Appetite
Signature of guide: Signature of student :
Bibilography
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