world journal of pharmaceutical sciences comparative clinical · pdf file ·...

*Corresponding Author Address: Dr. Rajpoot Ranjana, Clinical Expert, Shri Babu Singh Jay Singh Ayurvedic Medical College and

Hospital, Farrukhabad, UP, India: E-Mail: [email protected]

World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086

Published by Atom and Cell Publishers © All Rights Reserved

Available online at: http://www.wjpsonline.org/

Original Article

Comparative clinical evaluation of Shriphaladi Yog & Kukshi Vasti in the management

of irritable bowel syndrome

Rajpoot Ranjana1*, Tripathi J.S.2, and Tiwari S.K3

1Clinical Expert, Shri Babu Singh Jay Singh Ayurvedic Medical College and Hospital, Farrukhabad, UP, India 2Head, Department of Kayachikitsa, Faculty of Ayurveda, IMS BHU, Varanasi, India 3Former Head, Department of Kayachikitsa, Faculty of Ayurveda, IMS BHU, Varanasi, India

Received: 27-08-2016 / Revised: 30-09-2016 / Accepted: 01-10-2016 / Published: 01-10-2016

ABSTRACT

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder in which abdominal pain is associated with

defecation or a change in bowel habit. Psychological and somatic management is also desirable in IBS due to

depression or anxiety. In Ayurveda, most of the symptoms of vatik grahani resembles with IBS. In vatik

grahani, due to mandagni, food remain undigested which get fermented called as ama. Saman avrit apan vayu is

responsible for abnormal gut motility. In vatik grahani, manasah sadanam (depressed mood) indicate

involvement of C.N.S. Thus study for IBS was carried out on 70 randomly selected patients at Sir Sundarlal

Hospital, Banaras Hindu University. The drug shriphaladi yog in dose of 5 Gms. T.D.S. after meal and the

kukshi vasti using shriphaladi taila were given to the patient. The synergistic effect of oral drug and therapeutics

procedure demonstrated significant results in effective management of IBS. Therefore, this study may be

extended for large scale clinical trials.

Key words: IBS, Vatik grahani, Gut motility, Shriphaladi yog, Shriphaladi taila, Kukshi vasti

INRODUCTION

Irritable bowel syndrome is a functional

gastrointestinal psychosomatic disorder [1]

comprises symptoms [2] like abdominal pain and

gas formation, is associated with defecation or a

change in bowel habit. IBS syndrome is a relapsing

functional bowel disorder in the absence of

structural pathology, defined by symptom-based

diagnostic criteria (Rome III criteria [3]). In IBS,

symptoms are exacerbated or initiated by

psychological stress [4] (or stressful life event).

Generally half of the patients of IBS complain

dyspepsia, heart burn, nausea and vomiting. This

suggests that upper GIT apart from colon is also

involved. The cause of IBS is poorly understood

because of the clandestine involvement of brain.

The new Rome IV criteria [5] have begun to shift

away from current term “functional G.I disorder”

towards disorder of gut brain axis. The

classification [6] of IBS is of four types i.e. IBS-D,

IBS-C, IBS-M, IBS-I. In IBS, most of the patients

are alternate between episodes of diarrhoea and

constipation. In ayurveda, Acharaya Charaka told

that sharir & manas doshas are mutually dependent.

Therefore sharirik disease transform into the manas

disease & vice-versa after chronic illness. The

etiopathogenesis & symptoms of IBS suggest the

involvement of vata dosha. In Ayurvedic literature,

vatik grahani[7] very nearly resembles with IBS on

the basis of their common symptoms. Therefore

understanding of the patho-physiological condition

of IBS, according to the fundamental principles of

Ayurveda, is needed. So the principle of

management for IBS consists of agnivardhan,

amanirharan & vatanuloman. Since vatik grahani is

one of the symptoms of samana avritta apana

vayu[7]. Therefore it can be concluded that I.B.S

(Vatik Grahani) has vata as main dosa which plays

important role for gut motility by ENS. Presence of

other doshas likes pachak pitta and kledak kapha

leads to agnidusti, mainly mandagni responsible for

the appearance of IBS symptoms.

Hence the epidemiological and clinical studies

were conducted to find out the management of IBS

from ayurvedic drug & therapeutic procedures and

the existing standard allopathic drug.

Rajpoot et al., World J Pharm Sci 2016; 4(10): 86-96

87

The objectives of this study were as follows

1. To evaluate the efficacy of Shriphaladi yog in

IBS

2. To evaluate the efficacy of kukshi vasti in IBS

3. To evaluate the synergetic effect of

Shriphaladi yog & kukshi vasti in IBS

4. To compare the efficacy of these group with

standard modern drug.

Since IBS is a disorder of intestinal motor

dysfunction with increased sensitivity to stimuli

arising from gut & psychological factors hence

drug for IBS management must have deepan

pachan vatanuloman and medhya properties. The

drug Shriphaladi Yog (shriphal nagarmotha,

guduchi, patalgaruni shankhpushpi)[8] is an

effective formulation which is able to control and

regularize the symptoms of IBS. The specifically

tailored kukshi vasti[9] using shriphaladi taila

restore the physiological functions of apana &

saman vata. Synergistically the ayurvedic trial drug

and procedure subsides the main culprit producing

the symptoms of IBS.

MATERIAL AND METHODS

The collection of unbiased data and its logical

analysis is crucial necessity for any scientific study.

The use of correct methods and statistical tools

become vital for not only the clear analysis and the

assessment of efficacy of findings but also the

capable to generalize the conclusion.

Clinical study: The control randomized clinical

study has been conducted by selecting the patient

on the basis of the following inclusion and

exclusion criteria

Inclusion Criteria

1. Presence of three or more of the cardinal feature

of IBS fulfilling Rome III criteria. Re-

occurrence of abdominal pain or discomfort at

least 3 days in a month since last three month,

associated with two or more of the following:

Improvement with the defecation

Onset associated with change in frequency

of stool

Onset is associated with a change in form of

stool viz. pain abdomen

Feeling of incomplete evacuation

Abdominal distension

Mucus in stool

2. Symptoms present for a minimum period of 12

months and age group from 18-60

3. All clinical examination, hematology and

radiological findings are normal in lower and

upper gastro intestinal tract

Exclusion Criteria

1. Symptoms compatible with IBS but having

organic pathology

2. Presence of other systemic diseases or mental

disorders requiring treatment e.g. crohn’s

disease, ulcerative colitis and carcinoma of

rectum and colon

3. Cases of active dysentery

4. Patients who are on psychotropic drugs or

under the influence of drug abuse

Demographic & Constitutional Profile: The

demographic profile included name, age, sex,

marital status, education, occupation, socio-

economic status, address, rural or urban, dietary

habit, addiction, family history, chronicity, deha

prakriti, manas prakriti, manobala (sattva),

treatment history, incidence of symptoms of

patients.

Selection of Cases: 70 cases recruited under the

present study were selected from the Kayachikitsa

O.P.D and I.P.D., Sir Sunderlal Hospital, I.M.S.,

B.H.U., Varanasi between Sept. 2011 and Oct

2012. The 65 numbers of patients were screened

for the diagnosis clinically.

The Study Groups: Following inclusion and

exclusion criteria the 70 patients were selected and

registered for the study, only 65 patients, turned up

for full follow-ups. They were sorted into four

groups.

a) The first group-A comprised of 20 patients

who were put on the drug shriphaladi Yog

(Shriphala, Guduchi, sankhapusphi, patal

garudi, nagarmotha, each in equal quantity)

for 45 days (All 20 pt. turned up for full

follow up)

b) The second group-B comprised of 20 patients

who were given kukshi vasti with shriphaladi

taila for 15 days. (Out of 20 patients 18 were

turned up for full follow up)

c) The third group- C comprised of 20 patients

who were put on combination of shriphalidi

yog and kukshi vasti for 15 days. (Out of 20

patients 18 turned up for full follow up)

d) The fourth group-D comprised of 10 patients

who were put on combination of

chlordiazepoxide (5 mg) + clidinium bromide

(2.5 mg) one tablet T.D.S for 45 days. (Out of

10 patients 9 were turned up for full follow

up)

Therapeutic Procedure of Kukshi Vasti: Kukshi

vasti is unique and effective therapeutic procedure

for IBS patient. In this procedure, an herbal paste

(mixture of equal quantities of urda dal flour and

wheat flour) is used to make a boundary of 2 inch

height and 3 inch radius is made over the


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abdominal region around the umbilicus. The 400

ml lukewarm shriphaladi taila is gradually poured

over the umbilical region. After 15 min, this oil

with the help of cotton is removed and again

heated, same procedure was repeated two times.

Total three cycles each of 15 min is needed, so the

total procedure takes 45 minutes. The whole oil is

removed, along with the boundary and a clockwise

gentle massage for 5-8 minutes was done. Patient is

advised to take rest for half hour. After the half

hour patient can take light easy digestible food with

luke warm drinking water, and also can travel.

Final assessment of the efficacy of different

treatments: The improvement was assessed on the

basis of relief in the sign and symptoms of the

disease. Patients were assessed on subjective

improvement and symptomatic improvement

Statistical Analysis: Paired ‘T’-test was applied to

assess the effect of drug before and after treatment

and One way ANOVA was employed to infer any

significant difference among the groups. If that test

resulted in significant difference, “Post Hoc test”

was applied to find out the pair wise difference.

RESULTS

Demographic & Constitutional Study Result

Incidence of Age, Sex

The young age group 18-30 years (42.86 %) and

middle age group 31-45 years (37.14 %) are more

affected than the age group 46-60 years (15.7 %)

and older age group 61 year or more (4.3%). More

IBS incidence has been found men (60%) than

women (40%). (Refer Table 1)

Incidence of Habitat

Rural populations (60%) are more affected than

urban population (40%). (Refer Table 2)

Incidence of Marital Status

The married persons (70 %) have more chances of

occurrence of IBS than unmarried persons (29 %)

while only 1 % belongs to other category. (Refer

Table 3)

Incidence of Dietary habit

The vegetarians (56 %) are more affected than non-

vegetarians (44 %). (Refer Table 4)

Incidence of Occupational Status

The students (28.6 %) and housewives (27.1 %) are

more affected than servicemen (20 %) and

businessman (15.6 %) whereas farmers (8.6 %) are

very less affected. (Refer Table 5)

Incidence of Socio-Economic Status

The middle socio economic class (55.72 %) is more

affected than poor socio economic class (30 %) and

rich socio economic (14.28 %). Also educated

patients (73.44%) are more affected than totally

uneducated patients (28.56 %) (Refer Table 6)

Incidence of family history

The majority (87.14) of the persons do not have

any family history of IBS disease. It may be

explained from above data that IBS is a not

inherited from generations. (Refer Table 7)

Incidence of Addiction

The patients (57 %) having no addiction are more

affected than addiction (43%). Also 17.1% of IBS

cases were reported for betel & tobacco chewing

persons. (Refer Table 8)

Incidence of Constitutional Status

The average persons built (50%) are more affected

than thin persons (21.43%), robust persons (17.14

%) and obese persons (11.43%). (Refer Table 9)

Incidence of Distribution of Chronicity

Patients having illness from 4-6 years (51.50%), 1-

3 years (32.80%), 7-9 years (11.40%), & and above

10 years (4.30%) were listed which suggest that

IBS is chronic disease. (Refer Table 10)

Incidence of Manas Prakriti

Rajasa prakriti persons (68.6%) are more affected

than tamasa (22.9%) & sattvika (8.5 %) prakriti

(Refer Table 11)

Incidence of Manobala (Sattva)

The madhyama manobala (59 %) persons are more

affected than pravar (12.20 %) & avar manobala

(28.80 %). (Refer Table 12)

Incidence of Deha Prakriti

The persons having vataja-pittaja (44.30 %) and

vataja-kaphaja (22.90%) are more affected this

indicates that the vata parkiriti is more responsible

for IBS disease. (Refer Table 13)

Incidence of Treatment History

Out of 70 patients 62.90 % took modern medicine

and 17.10 % ayurvedic medicine with modern

medicine but could not relieved. 7.10 % patients

took medicine of all systems (Refer Table 14)

Incidence of Symptoms

The gas formation, frequency of stool, mucoid

stool, and feeling of incomplete evacuation are

found in maximum patients. Constipated bowel,

abdomen pain, tenasmus and heaviness in lower

abdomen are found in 70-80 % patients whereas

anxiety (46.15%) and depression (49.23%) were

reported in patients (Refer Table 15)

Clinical Study & Therapeutics Trials Results

Effect on Abdominal Pain

In group A, B, C, D, t values were 5.900(p<0.001),

3.071(p<0.05), 4.267(p<0.001), 4.128 (p<0.05)

respectively. The group C has slightly better than

group A, B, D (Refer Table 16).

Effect on Tenusmus

In group A, B, C, D, t values were 2.651 (p<0.05),

6.46 (p<0.001), 6.2 (p<0.001) and 1.955 (p>0.05)

respectively. The group C has responded better as

compared to group A, group B and outstanding as

compared to group D (Refer Table 17).


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Effect on Gas Formation


8.892 (p<0.001), 8.332 (p<0.001) and 3.051

(p<0.05) respectively. The group C has responded

better as compared to group A, group B and

outstanding as compared to group D (Refer Table

18)

Effect on frequency of stool


9.436 (p<0.001), 9.914 (p<0.001) and group D, 3.5

(p<0.05) respectively. The group C has responded

better as compared to group A, group B and

outstanding as compared to group D (Refer Table

19).

Effect on Mucoid Stool


9.127 (p<0.05), 7.459 (p<0.001) and group D,

4.914 (p<0.05) respectively. The group C has

responded better as compared to group A, group B

and outstanding as compared to group D (Refer

Table 20).

Effect on Constipated Bowel


4.274 (p<0.05), 5.359 (p<0.001) and group D,

3.250 (p<0.05) respectively. Hence group C has

responded better than group B and outstanding as

compared to group A & group D (Refer Table 21).

Effect on Anxiety


2.062 (p>0.05), 3.335 (p<0.05) and 2.683 (p<0.05)

respectively. Hence group C & group D has

responded better as compared to group A & group

B (Refer Table 22).

Effect on Depression In group A, B, C, D, t values were 3.760 (p<0.05),

group B, t value was 2.755 (p<0.05), group C, t

value was 2.364 (p<0.05) and group D, t value was

1.793 (p<0.05). Hence the entire Group has

responded upto a certain extent but not able to

provide relief more than 55 % (Refer Table 23).

Effect on feeling of complete evacuation


7.210 (p<0.001), 4.653 (p<0.001) and 3.024

(p<0.05). Hence group C has responded better as

compared to group A, B & D (Refer Table 24).

Inter Group Comparison and Pair wise Group

Comparison

On inter group comparison (one way annova), the

treatment for the tenasmus, gas formation, feeling

of incomplete evacuation was statistically

significant and highly significant in case of

frequency of stool, mucoid stool, constipated

bowel, feeling of incomplete evacuation whereas

depression, abdomen pain, anxiety, was not found

significant (refer table 25). In pair wise comparison

for treatment, no group was found better than other

for abdominal pain, anxiety and depression

whereas treatment group C to group D performed

significantly better in case of tenasmus and feeling

of incomplete evacuation. In case of gas formation,

frequency of stool, constipated bowel the treatment

group A to group D performed significantly better

and highly significant in case of mucoid stool. In

case of gas formation and mucoid stool, the

treatment group B to group D performed

significantly better and highly significant in case of

Frequency of stool and constipated bowel. In case

of tenasmus and feeling of incomplete evacuation

the treatment group C to group D performed better

and highly significant in case of gas formation,

frequency of stool, constipated bowel, mucoid stool

(refer table 26).

DISCUSSION

In the demographic, constitutional & clinical study

shows that the IBS affects mostly Young & middle

aged people, married people, urban & semi urban

people, vegetarian persons. Service men,

housewives, & students, educated and middle class

peoples, average and thin build persons, madhyama

and avara manobala (sattva), vata-pittaj

predominant deha prakriti people, rajas

predominant manas prakriti persons. In the clinical

studies the result of group C i.e. the drug

combination of shriphaladi yog and kukshi vasti

and group B i.e. the drug kukshi vasti with

shriphaladi taila and group A i.e. drug shriphalidi

yog showed encouraging as compared to group D

i.e. combination of chlordiazepoxide (5 mg) +

clidinium bromide (2.5 mg) one tablet T.D.S. The

mean grade score of symptoms except abdominal

pain, depression and anxiety before and after the

treatment with the drug combination of shriphaladi

yog and kukshi vasti showed highly significant

improvement as compared to drug combination of

chlordiazepoxide (5 mg) + clidinium bromide (2.5

mg) one tablet T.D.S. whereas the modern drug

also showed significant improvement in abdominal

pain, depression and anxiety. The inter group

comparison between group C was treated with

combination of shriphalidi yog and kukshi vasti

showed highly significant response over group D

except abdomenal pain, anxiety and depression

which was treated with combination of

chlordiazepoxide (5 mg) + clidinium bromide (2.5

mg) one tablet T.D.S. This study reveals that

combination of shriphalidi yog and kukshi vasti are

claimed to be very effective against the gut

motility, tonicity of intestinal muscles, restores the

physiological functions of the intestine & bowel,

and regularizes bowel movement.

CONCLUSION

This present study concluded that the synergistic

effect of ayurvedic drug and therapeutic procedure

alleviate IBS symptoms most effectively with

respect to standard modern drug. The medhya drug


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guduchi & sankhpushpi in shriphaladi yog calm the

anxiety of patients, relieves the depression

symptoms by acting on CNS which finally

stabilizes the ENS. The individual drug of

shripahaldi yog having deepan, pachan and

vatanuloman properties normalize the status of agni

& vayu. Our samhitas explains that oil is the best

sneh for vitiated vata dosha, so luke warm

shriphaladi taila poured over the umbilicus (Nabhi)

to get absorbed. As Acharya Sushurta said that

nabhi is the moola of all siras also vata vaha siras.

The absorbed oil pacifies the vitiated vata in

vatavaha siras which also normalizes the vata in

grahani lead to stabilization of physiological

function of vata. Finally shriphaladi taila relieved

disturbed myentric & meissner’s plexus function &

spasm of intestinal muscles.

Table 1: Showing incidence of age and sex in 70 patients of IBS

Age Group Male Female Total

Numbers Percentage Numbers Percentage Numbers Percentage

18-30 21 30 9 12.86 30 42.86

31-45 12 17.14 14 20 26 37.14

46-60 7 10 4 5.7 11 15.7

Above 60 2 2.86 1 1.44 3 4.3

Total 42 60 28 40 70 100

Table 2: Showing place of residence in 70 patients of IBS

Place of Residence No of Patients Percentage

Urban 28 40

Rural 42 60

Total 70 100

Table 3: Showing incidence of marital status of in 70 patients of IBS

Marital Status No of Patients Percentage

Married 49 70

Unmarried 20 29

Widow or Widower 1 1

Total 70 100%

Table 4: Showing incidence of dietary habit in 70 patients of IBS

Dietary Habit No of Patients Percentage

Vegetarian 39 56

Non Vegetarian 31 44

Total 70 100

Table 5: Showing occupational status of 70 patients of IBS

Occupational Status No of Patients Percentage

Servicemen 14 20

Farmers 6 8.6

Businessman 11 15,6

Housewives 19 27.1

Students 20 28.6

Total 70 100

Table 6: Showing socio-economic status of 70 patients of IBS

Economy Uneducated Educated Total

Below Graduate Above graduate

Nos Percentage Nos Percentage Nos Percentage Nos Percentage

Poor 8 11.43 7 10 6 8.57 21 30

Medium 10 14.58 13 18.57 16 22.57 39 55.72

Rich 2 2.85 3 4.29 5 7.14 10 14.28

Total 20 28.56 23 32.96 27 38.48 70 100


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Table 7: Showing incidence of family history of 70 patients of IBS

Family History No of Patients Percentage

Present 9 12.86

Absent 61 87.14

Total 70 100

Table 8: Showing incidence of addiction of 70 patients of IBS

Habit No

Addiction

Addiction Total

Alcohol Tobacco chewing Smoking Betel & Tobacco

No of Patients 37 10 8 3 12 70

Percentage 53 4714.3 11.4 4.2 17.1 100

Table 9: Showing constitutional status of 70 patients of IBS

Constitutional Status No of Patients Percentage

Obese 8 11.43

Robust 12 17.14

Average 35 50

Thin 15 21.43

Total 70 100

Table 10: Showing distribution of chronicity s of 70 patients of IBS

Distribution of chronocity (Years) No of Patients Percentage

1-3 23 32.80

4-6 36 51.50

7-9 8 11.40

Above 10 years 3 4.30

Total 70 100

Table 11: Showing incidence of manas prakriti of 70 patients of IBS

Manas Prakriti No of Patients Percentage

Sattvika 6 8.50

Rajasa 48 68.60

Tamasa 16 22.90

Total 70 100

Table 12: Showing incidence of manobala (sattva) of 70 patients of IBS

Manobala No of Patients Percentage

Pravar 9 12.20

Madhyama 41 59

Avar 10 28.80

Total 70 100

Table 13: Showing incidence of deha prakriti of 70 patients of IBS

Deha Prikriti No of Patients Percentage

Vataja 8 11.40

Pittaja 3 4.30

Kaphaja 7 10

Vataja-Pittaja 31 44.30

Vataja-Kaphaja 16 22.90

Pittaja-kaphaja 5 7.10

Total 70 100


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Table 14: Showing incidence of treatment history of 70 patients of IBS

Treatment History No of Patients Percentage

Ayurveda 12 11.40

Modern 44 62.90

Ayurveda & Modern 8 17.10

Ayurveda, Homeopathy, Modern & Unani 5 7.10

No treatment 1 1.40

Total 70 100

Table 15: Showing sign & symptoms of patients of IBS

Clinical Features Group A Group B Group C Group D Total

N % N % N % N % N %

Abdomen Pain 18 90 11 61.11 13 72.22 8 88.89 50 76.92

Tenasmus 13 65 15 83.33 16 88.89 7 77.78 51 78.46

Gas formation 20 100 17 94.44 18 100 9 100 64 98.46

Frequency of stool 19 95 17 94.44 18 100 9 100 63 96.92

Mucoid Stool 16 80 17 94.44 18 100 9 100 60 92.31

Constipated Bowel 12 60 13 72.22 15 83.33 8 88.89 48 73.85

Anxiety 8 40 6 33.33 10 55.56 6 66.67 30 46.15

Depression 12 60 8 44.44 8 44.44 4 44.44 32 49.23

Feeling of incomplete

evacuation 19 95 16 88.89 17 94.44 8 88.89 60 92.31

Table 16: Showing changes in abdominal pain among different groups in therapeutic trials

Groups Mean ±SD of scores Within the group comparison %Relief

BT AT BT-AT

A 1.90±1.165 0.45±0.510 t=5.900, p<0.001(HS) 76.31

B 1.28±1.776 0.33±0.594 t=3.071, p<0.05(S) 73.91

C 1.56±1.381 0.33±0.485 t=4.267, p<0.001(HS) 78.57

D 2.11±1.167 0.56±0.527 t=4.128, p<0.05(S) 73.68

Table 17: Showing changes in tenasmus among different groups in therapeutic trials

Groups Mean ±SD of scores Within the group comparison % Relief

BT AT BT-AT

A 1.40±1.231 0.95±0.826 t=2.651, p<0.05(S) 32.14

B 2.11±1.530 0.61±0.698 t=6.460, p<0.001(HS) 71.05

C 2.00±1.237 0.28±0.461 t=6.200, p<0.001(HS) 86.11

D 1.89±1.453 1.00±1.00 t=1.955, p>0.05(NS) 47.06

Table 18: Showing changes in gas formation among different groups in therapeutic trials


BT AT BT-AT

A 2.95±1.099 0.75±0.550 t=7.678, p<0.001(HS) 74.57

B 3.17±1.339 0.94±0.639 t=8.892, p<0.001(HS) 70.18

C 2.83±1.098 0.50±0.618 t=8.332, p<0.001(HS) 82.15

D 2.89±1.167 1.67±1.00 t=3.051, p<0.05(S) 42.31

Table 19: Showing changes in frequency of stool with different groups in therapeutic trials


BT AT BT-AT

A 1.80±0.875 0.50±0.513 t=6.469, p <0.001(HS) 72.97

B 1.50±0.786 0.22±0.428 t=9.436, p<0.001(HS) 85.19

C 2.17±1.043 0.11±0.323 t=9.914, p<0.001(HS) 94.87

D 1.89±0.782 1.11±0.601 t=3.50, p<0.05(S) 41.18


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Table 20: Showing changes in mucoid stool among different groups in therapeutic trials


BT AT BT-AT

A 1.60±1.142 0.35±0.587 t=5.483, p<0.001(HS) 78.12

B 2.94±1.392 0.61±0.502 t=9.127, p<0.001(HS) 79.25

C 2.11±1.132 0.11±0.323 t=7.459, p<0.001(HS) 94.74

D 2.89±0.601 1.44±0.726 t=4.914, p<0.05(S) 50.00

Table 21: Showing changes in constipated bowel with different groups in therapeutic trials


BT AT BT-AT

A 1.05±0.999 0.65±0.745 t=2.629, p<0.05(S) 38.10

B 1.33±1.283 0.39±0.608 t=4.274, p<0.05(S) 70.83

C 1.50±1.043 0.33±0.485 t=5.359, p<0.001(HS) 77.78

D 3.11±1.537 1.167±1.118 t=3.250, p<0.05(S) 46.43

Table 22: Showing changes in anxiety among different groups during therapeutic trials


BT AT BT-AT

A 0.75±1.118 0.40±0.681 t=2.667, p<0.05(S) 46.67

B 0.72±1.227 0.39±0.608 t=2.062, p>0.05(NS) 46.15

C 1.00±1.138 0.39±0.461 t=3.335, p<0.05(S) 61.11

D 1.56±1.333 0.56±0.882 t=2.683, p<0.05(S) 64.29

Table 23: Showing changes in depression among different groups in therapeutic trials


BT AT BT-AT

A 1.50±1.433 0.70±0.733 t=3.760, p<0.05(S) 53.33

B 1.28±1.638 0.72±1.018 t=2.755, p<0.05(S) 43.28

C 0.72±0.958 0.33±0.594 t=2.364, p<0.05(S) 53.85

D 1.44±1.810 0.67±1.00 t=1.793, p >0.05(NS) 53.85

Table 24: Showing changes in feeling of incomplete evacuation among different groups


BT FUIII BT-FUIII

A 2.05±0.887 0.90±0.641 t=7.667, p<0.001(HS) 56.10

B 2.11±1.367 0.83±0.786 t=7.210, p<0.001(HS) 60.53

C 1.56±1.042 0.33±0.485 t=4.653, p<0.001(HS) 78.57

D 2.56±1.130 1.22±1.394 t=3.024, p<0.05(S) 52.17

Table 25: Showing between group comparison of symptoms before and after treatment

Between Group Comparison

BT AT

Abdominal Pain F=0.962, p>0.05 F=0.507, p>0.05

Tenasmus F=1.035, p>0.05 F=3.329, p<0.05

Gas Formation F=0.264, p>0.05 F=6.400, p<0.001

Frequency of stool F=1.689, p>0.05 F=10.856, p<0.001

Mucoid F=5.190, p<0.05 F=13.797 p<0.001

Constipated Bowel F=6.706, p<0.05 F=8.120 p<0.001

Anxiety F=1.197, p>0.05 F=0.142 p>0.05

Depression F=1.052, p>0.05 F=0.870 p>0.05

Feeling of complete evacuation F=1.781, p>0.05 F=3.052, p<0.05


94

Table 26: Showing pair wise group comparison of symptoms before and after treatment

Post-Hoc Test

BT AT

Abdominal Pain - -

Tenasmus - Group C to Group D (p<0.05)

Gas Formation

-

Group A to Group D (p<0.05);

Group B to Group D (p<0.05);

Group C to Group D (p<0.001)

Frequency of stool

-




Mucoid

-




Constipated Bowel

-




Anxiety - -

Depression - -

Feeling of complete evacuation - Group C to Group D (p<0.05)

Figure 1: Showing incidence Figure 2: Showing incidence Figure 3: Showing incidence

of age & sex of habitat in different groups of marital status


of dietary habit of occupational status of economic status


95

Figure 7: Showing incidence Figure 8: Showing incidence Figure 9: Showing incidence of

body built of family history of addiction


of chronicity of deha prakriti of manas prakriti


of manobala of treatment history in trial of clinical

symptomatology patients

Figure 16: Showing mean Figure 17: Showing mean Figure 18: Showing mean

grade score of abdomen grade score of tenasmus grade score of gas formation

pain in different groups in different groups before in different of groups before &

before & after treatment & after treatment after treatment


96


grade score of stool frequency grade score of mucus grade score of constipation

in different groups in different groups before in different of groups before &

before & after treatment & after treatment after treatment


grade score of anxiety grade score of depression grade score of incomplete

in different groups in different groups before evacuation in different of

& before & after treatment & after treatment groups before after treatment

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