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ACKNOWLEDGEMENT

On the occasion of the successful completion of this assigned work, I Offer my


salutation to the almighty lord Ganeśa for his blessings.
I would like to express my profound respect and deepest gratitude to my guide Dr.
Shreekanth.U. Dean, Professor & HOD, PG studies in Panchakarma, SDMCA,
Udupi, his keen observation, valuable guidelines gave me considerable confidence to
complete this study.
Words fail miserably when I would like to express my profound respect and
deepest gratitude, towards the most dynamic personality, my role model, a perfectionist,
an ideologist, my co-guide Dr.Niranjan Rao. Professor, Department of PG studies in
Panchakarma, S.D.M.C.A, Udupi. Whose harmonious help, valuable suggestions, close
involvement with this work, his keenness, his perpetual energy and enthusiasm is a great
inspiration in achieving this milestone and for my future life.
I am greatly indebted to our respected madam and I feel proud and privileged to
have her as our teacher. Dr. Rajlakshmi. M.G. Lecturer, department of Panchakarma,
SDM college of Āyurveda & hospital, Udupi
I express my sincere gratitude to Dr. Padma Kiran. Lecturer, department of
Panchakarma, SDM College of āyurveda & hospital, Udupi
I express my sincere gratitude to our respected principal Dr.U.N.Prasad for
supporting me in my P.G education at Udupi.
My sincere thanks to S.D.M. Education society Ujire, for giving me an
opportunity for my post graduation education.
I would like to thank my friends Dr.Praveen V Devarushi, Dr.VinayKumar.K.N,
Dr.Prajwal N, Dr.Avinash Adiga, Dr.PrashanthKumar, Dr. VijayShankar. B. V, Dr.
Amarnath. B. V. B, and Dr.Shridhar gokhale, Dr.Vinay. T. C, Dr.Umesh. J. D.
The generous support from my juniors Dr.Riyas, Dr.Prakash Paltey, Dr.Rahul
Magdum, Dr.Girija.M.N, Dr.Greeshma, is greatly appreciated.

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I thank all the patients and the Panchakarma staffs for their support.
At this moment I express my gratitude to my father Sri. Chandrasekharappa. K,
my mother Smt. Annapoornamma. K. H, my brother Dr.Santhosh. K. C., My uncle Mr.
Rudramuni.R.Y and My aunt Smt. Maithreyi. R.Y. I am highly obliged for their
blessings and support.

Lastly my sincere thanks to all those who have directly or indirectly extended
their help and support for the completion of this dissertation work.

DR. SANDEEP.K.C

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Abbreviations

ABBREVIATIONS

1. Cha. : Charaka Samhita

2. Su. : Sushruta Samhita

3. A.S. : Ashtanga Sangraha

4. A.Hr. : Ashtanga Hridaya

5. B.P. : Bhava Prakasha

6. M.N. : Madava nidana

7. Sha. : Sharangadhara Samhita.

8. B.S : Bhela Samhita

9. H.S. : Harita Samhita

10. Ka. : Kashyapa Samhita

11. Van. : Vangasena

12. Y.R. : Yogaratnakara

13. G.D. : GadaNigraha

14. Bhai.Rat : Bhaishajya Ratnavali

15. Nig.A. : Nighantu Adarsha

16. Su. : Sutra Sthana

17. Ni. : Nidana Sthana

18. Vi. : Vimana Sthana

19. Chi. : Chikitsa Sthana

20. K : Kalpa Sthana

21. Si. : Siddhi Stana

22. Pu. : PurvaKhanda

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Abbreviations

23. M : Madyama Khanda

24. U : UttarKhanda

25. Nig. : Nighantu

26. AT1 : After deepana & Paachana

27. AT2 : After Sneha paana

28. AT3 : After swedana karma

29. AT4 : After Virechana

30. AT5 : After samsarjana krama

31. AT6 : After the follow up period

32. BT : Before treatment

33. Cm : Centimetres

34. d : Difference

35. DC : Differential Count

36. ESR : Erythrocyte Sedimentation Rate

37. CRP : C Reactive Protein

38. RA Factor : Rheumatoid factor

39. Hb : Hemoglobin

40. No. : Number

41. SD : Standard Deviation

42. SEM : Standard Error Mean

43. TC : Total Count

44. Yrs. : Years

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DIACRITICS FOR THE TRANSLITERATION OF SANSKRIT

A AÉ C D E F G L
a ā i ī u ū ṛ e
Lå AÉå AÉæ AÇ AÈ
ai o au aṃ aḥ

Mü ZÉ aÉ bÉ Xû
ka kha ga gha ṅa

cÉ Nû eÉ fÉ gÉ
ca cha ja jha ña

Oû Pû Qû Rû hÉ
ṭa ṭha ḍa ḍha ṇa

iÉ jÉ S kÉ lÉ
ta tha da dha na

mÉ Tü oÉ pÉ qÉ
pa pha ba bha ma

rÉ U sÉ uÉ vÉ wÉ xÉ W
ya ra la va śa ṣa sa ha

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“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF X
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
Abstract

Abstract

The prevalence of the disease Āmavāta/rheumatoid arthritis varies


substantially ranging from 0.3%to 1% of population. Indian data suggests the
prevalence to be around 0.65 to 0.75%. 1to 3% of women develop RA in their life
time. Women affected with 3to 5 times as often as men. Most of the people develop
RA between the ages of 25 to 50.About 60% of RA patients are unable to work 10
years after the onset of their disease. Estimation of life shortening effects of RA varies
from 5 to 10 years. Family history of RA is an important risk factor. First degree
relative’s prevalence rate is 2-3%.
Āmavāta is compared to rheumatoid arthritis for the sake of easy
understanding . Āmavāta is one such disease where in authors categorized the pain as
Vŗiscika damśavat vedana. It is a disorder characterized by Āma doṣa, Vāta doṣa,
Kapha doṣa morbidly. This is a disease where in Rasavaha sŗotas is primarily
involved. Because of this the pain also spreads from one joint to another joint very
quickly. As Rasavaha srotomūla is Hŗidaya it leads to the involvement of whole body
in short span of time. Being a disease of madhyama roga marga, involvement of
marma (Hŗidaya) makes this disease more and more critical. The treatment proper is
also not unidirectional, for e.g: the antagonistic treatment of Kapha doṣa and Vāta
doṣa must be carried out simultaneously, gambīradhātu (asthi), uttanadhātu (rasa),
makes the treatment more a puzzle.
Hence a treatment which should alleviate morbid vāta, pitta, kapha is required
in Āmavāta.
Virecana is one such Śodhana procedure fulfilling the above criteria.

OBJECTIVE OF THE STUDY:


To evaluate the effect of virecana karma in patients suffering from Āmavāta.

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Abstract

Study design :-
It was a single blind clinical study with a pre and post test design in 22 patients
were diagnosed as Āmavāta and fulfilling the criteria. They underwent through the
process of Virecana karma were selected. Patients were subjected to dīpana pācana
with pañcakola curṇa 5gms with hot water before food thrice daily till āmapācana.
After proper āmapacana ārohana snehapāna with murcita gŗitha was administered till
obtaining samyak snigda lakṣana(3-7days). After that they were subjected to
abhyanga with saindavādi taila followed by bāṣpa swedana for 4 days. Virecana was
induced with eraṇda taila 80ml+40ml of triphala kwātha. Patients were subjected to
Saṁsarjana krama based on their śuddi lakṣana. The assessment criteria were noted
before, during and after Saṁsarjana krama.

RESULTS :-
• The average time taken for Samyak Snigdata was 3 days.
• Maximum of 45.45% had madhyama śuddi.
• The patients who are treated with Virecana karma showed significant improvement in
the general symptoms the percentage of improvement is increase from 9.65% during
AT1 to 83% during AT6.
• The assessment of the overall effect of the treatment revealed that 77.27 % of the
patients showed major improvement. And 22.72 %. Of the patients also responded
with minor improvement.

Key words:- Āmavāta, Virecana, Rheumatoid arthritis, Eraṇda taila, Triphala kwātha.

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Table of contents

PAGE NO.
CONTENTS
AKNOWLEDGEMENT VII - VIII

ABBERAVITIONS XIII-X

ABSTRACT XI -XIII

XIII- XIIIXIII
LIST OF TABLES

XIII-XIII
LIST OF FIGURES/GRAPHS

LIST OF CHARTS XIII

INTRODUCTION 1-2

OBJECTIVES 3

PREVIOUS WORKS DONE 4

CHAPTER 1 CONCEPTUAL STUDY 5-32

DISEASE REVIEW 33-53

CHAPTER 2 DRUG REVIEW 54-66

CHAPTER 3 METHODOLOGY 67-76

CHAPTER 4 OBSERVATIONS AND EFFECT OF THERAPIES 77-128

CHAPTER 5 DISCUSSION 129-140

CHAPTER 6 CONCLUSION 141-142

CHAPTER 7 SUMMARY 143-144

BIBLIOGRAPHY 145-161

ANNEXURE

XIII
List of tables

List of tables

TABLE PAGE
DESCRIPTION
NUMBER NUM
1 Detailed description regarding virecana in ayurveda 6-7
2 Indications of virecana karma 9-10
3 Contra-indictions of virecana karma 11-12
4 Classification of virecana dravya 13-14
5 Pūrva, pradhana, pascāt karma of virecana 16-18
6 Dose of virecana drug in its different form 22-23
7 Vaigiki and manaki according to kashyapa 24

8 Peyadi samsarjana krama


26
9 Rasa samarjana 27
10 Virecana vyapat 28
Samyak yoga, ayoga & atiyoga lakshnas of virecana
11 29-30
karma
12 Sāmanya āmavāta lakṣana 37
13 Pravrudda āmavāta lakṣana 38-39
14 Pañcakola curna 54-55
15 Koṣta parikśa drug review. 55
16 Murcita gritha 56
17 Chemical composition of ghee 57
18 Saindavadi taila 57-59
19 Triphala kwatha 60
20 Rasa pañcaka of triphala 61
21 Laingiki feature 70
22 Sex 78
23 Age group 78
24 Religion 79

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List of tables

25 Marital status 79
26 Education 80
27 Socio economic status 80
28 Occupation 81
29 Desha 81
30 Chronicity 82
31 Addiction 82
32 Diet 83
33 Sleep pattern 83
34 Prakrithi 84
35 Satva 84
36 Rasa satmya 85
37 Samhanana 85
38 Sāra 86
39 Abhyavarana śakti 86
40 Jarana śakti 87
41 Vyāyāma śakti 87
42 Vaya 88
43 Deha bala 88
44 Kośta 89
45 Samyak snigdha lakshana 90
46 Dose of snehapāna 90
Total amount of abyantara sneha during the whole course
47 91
of snehapāna
48 Analysis of samyak snigdha lakshana 92
49 Analysis of samyak swinna lakṣana 93
50 Analysis of latency period 93
51 Analysis of duration of virecana 94

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List of tables

52 Analysis of vaigiki shuddhi 94


53 Analysis of maniki of virecana 95
54 Analysis of anthiki of virecana 95
55 Analysis of laingiki lakshana of virecana 96
56a &56b Effect on sandhi śūla 97-98
57a & 57b Effect on sandhishotha 99
58a & 58b Effect on stabdhata 100-101
59a & 59b Effect on tenderness 102
60a & 60b Effect on the range of joint movements 103-104
61a &61b Effect on hand grip power in mm of hg 105
62a &62b Effect of the therapy on foot pressure 106-107
63a & 63b Effect of the therapy on knuckle swelling 108
64a & 64b Effect of the therapy on circumference of arms 109-110
65a & 65b Effect of the therapy on circumference of forearms 111
66a &66b Effect of the therapy on circumference of thighs 112-113
67a & 67b Effect of the therapy on circumference of calf 114
68 Effect on general symptoms 115-116
69a & 69b Effect on total score of general symptoms 117
70a & 70b Effect on general functional disability 118-119
71a & 71b Effect of the therapy on hb% 120
72a & 72b Total wbc count 121
73a & 73b Neutrophils 122
74a &74b Lymphocytes 123
75a & 75b Esinophils 124
76a & 76b Effect on ESR 125
77a &77b Effect on RA factor 126
78a & 78b C reactive protein 127
79 Overall effect of the treatment 128

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List of graphs

LIST OF GRAPHS

Name of the graph Page no


1 Sex 78
2 Age group 78
3 Religion 79
4 Marital status 79
5 Education 80
6 Socio economic status 80
7 Occupation 81
8 Desha 81
9 Chronicity 82
10 Addiction 82
11 Diet 83
12 Sleep pattern 83
13 Prakrithi 84
14 Satva 84
15 Rasa satmya 85
16 Samhanana 85
17 Sāra 86
18 Abhyavarana śakti 86
19 Jarana śakti 87
20 Vyāyāma śakti 87
21 Vaya 88
22 Deha bala 88
23 Kośta 89
24 Samyak snigdha lakshana 90
25 Dose of snehapāna 90
26 Total amount of abyantara sneha during the whole course 91
27 Analysis of samyak snigdha lakshana 92

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List of graphs

28 Analysis of samyak swinna lakṣana 93


29 Analysis of latency period 93
30 Analysis of duration of virechana 94
31 Analysis of vaigiki shuddhi 94
32 Analysis of maniki of virechana 95
33 Analysis of anthiki of virechana 95
34 Analysis of laingiki lakshana of virechana 96
35 Effect on sandhi śūla 98
36 Effect on sandhishotha 100
37 Effect on stabdhata 101
38 Effect on tenderness 103
39 Effect on the range of joint movements 104
40 Effect on hand grip power in mm of hg 106
41 Effect of the therapy on foot pressure 107
42 Effect of the therapy on knuckle swelling 109
43 Effect of the therapy on circumference of arms 110
44 Effect of the therapy on circumference of forearms 112
45 Effect of the therapy on circumference of thighs 113
46 Effect of the therapy on circumference of calf 115
47 Effect on general symptoms 116
48 Effect on total score of general symptoms 118
49 Effect on general functional disability 119
50 Effect of the therapy on hb% 120
51 Effect of the therapy on Total wbc count 121
52 Effect of the therapy on Neutrophils 122
53 Effect of the therapy on Lymphocytes 123
54 Effect of the therapy on Esinophils 124
55 Effect of the therapy on Effect on ESR 125
56 Effect of the therapy on Effect on RA factor 126
57 Effect of the therapy on C reactive protein 127
58 Effect of the therapy on The overall effect of the 128

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List of charts

List of charts

Chart
Description Page num
number

1 Sweat production 22

2 Samsrjana krama 25

3 Mode of action of virechana 32

4 Schematic representation of Samprapthi 41

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INTRODUCTION
Introduction

INTRODUCTION

“Care of a person’s health is significant in determining his length of existence


as a human being”- Anonymous.
If we go by the definition of the health by World Health Organization which
states : “Health is a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity”. Rheumatoid arthritis is one such disease
which may affect all the three i.e. Physical, mental and also social well-being of an
individual.
Rheumatoid arthritis is an autoimmune disease that causes chronic
inflammation of the joints which can also occur in tissues around the joints, such as
the tendons, ligaments, and muscles. Autoimmune diseases are illnesses which occur
when the body tissues are mistakenly attacked by its own immune system. The
immune system is a complex organization of cells and antibodies designed normally
to "seek and destroy" invaders of the body, particularly infections. Patients with these
diseases have antibodies in their blood which target their own body tissues, where
they can be associated with inflammation.
While rheumatoid arthritis is a chronic illness, meaning it can last for years,
patients may experience long periods without symptoms. Typically, however,
rheumatoid arthritis is a progressive illness that has the potential to cause joint
destruction and functional disability. The joint inflammation of rheumatoid arthritis
causes swelling, pain ,stiffness, and redness in the joints.
In some patients with rheumatoid arthritis, chronic inflammation leads to the
destruction of the cartilage, bone and ligaments causing deformity of the joints.
Damage to the joint can occur early in the disease and be progressive. Moreover,
studies have shown that the progressive damage to the joints does not necessarily
correlate with the degree of pain, stiffness, or swelling present in the joints.
The prevalence of the disease varies substantially ranging from 0.3%to 1% of
population. Indian data suggests the prevalence to be around 0.65 to 0.75%. 1to 3% of
women develop RA in their life time. Women affected with 3 to 5 times more often
than men. Most of people develop RA between the ages of 25 to 50.About 60% of RA
patients are unable to work 10 years after the onset of their disease. Estimation of life

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Introduction

shortening effects of RA varies from 5 to 10 years. Family history is an important risk


factor. First degree relative’s prevalence rate is 2-3% 2.

Āmavāta & rheumatoid arthritis may be compared for the sake of better
understanding. Āmavāta is one such disease where in authors categorized the pain as
Vŗischika damśavat vedana. It is a disorder characterized by Āma doṣa, Vāta doṣa,
Kapha doṣa morbidly. This is a disease where in Rasavaha sŗotas is primarily
involved. Because of this the pain also spreads from one joint to another joint very
quickly. As Rasavaha srotomūla is Hŗidaya it leads to the involvement of whole body
in short span of time. Being a disease of madhyama roga mārga, involvement of
marma (Hŗidaya) makes this disease more and more critical. The treatment proper is
also not unidirectional, for e.g: the antagonistic treatment of Kapha doṣa and Vāta
doṣa must be carried out simultaneously, gambiradhātu (asthi),uttānadhatu
(rasa),makes the treatment more a puzzle.
Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required
in āmavāta
Virechana is one such śodhana procedure fulfilling the above criteria.
(Ch.Su. 16/20.) Caraka has said that the doṣas controlled by Samśamana are
having the possibility of reoccurrence while such a prospect is absent when the doṣas
are managed by Samśodhana.
Only one treatment protocol will not help to curtail the disease. The author
opines that a full planned course of śodhana measures like vamana, virecana, basti
along with the use of other external and internal treatments will help over a period of
time to curb this grave disease.

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OBJECTIVES
OF THE STUDY
Objective of the study

Objective of the study.

To evaluate the effect of virechana karma in the patients suffering from


Āmavāta.

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Previous works done

PREVIOUS WORKS DONE

 Sharma Gaurava K C – A clinical and comparative study of Ama and Free

radicals theory w.s.r. to Amavata, Dept of Basic Principle 2001, Gujarat

Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

 Acharya Shrinivasa – A clinical study on the role of Virechana and Karma

Basti in the mang. Of Amavata, Dept of Kayachikitsa. 1988, Gujarat Ayurved

University, I.P.G.T & R.A Jamanagar, Gujarat.

 Bhatkoti Mayank – A comparative clinical study of Vaitarana Basti and

Virechana Karma in the mang. of Amavata, Dept. of Panchakarma. 2005,

Gujarat Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

 Jhala Jigisha V – A clinical study on the role of Virechana and Dashamoola

kshara Basti in the mang. of Amavata, Dept. of Kayachikitsa. 1995, Gujarat

Ayurved University, I.P.G.T & R.A Jamanagar, Gujarat.

 Rao sandeep.B.H. - Evaluation of vamana karma in amavata. Dept of

Panchakarma 2007, SDMCA, Kuthpady, Udupi, Rajiv Gandhi university of

health sciences. Karnataka.

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CONCEPTUAL STUDY
The concept of virecana karma

THE CONCEPT OF VIRECANA KARMA

In Āyurveda the management of a diseases in general, can be broadly


grouped in to " “śodhana " and "śamana" line of treatments. The śodhana is intended
to eliminate excessively vitiated Doṣa out of the body and thereby eradicating disease
as a whole, while the later is directed towards palliation of vitiated Doṣa. However,
Āyurvedic classics give paramount importance to the śodhana therapy, owing to its
credential of providing a complete cure, because Caraka says that the Doṣas subdued
by Langhana and Pācana therapies may provoke, but in case of Śodhana, there is
seldom possibility of such recurrence 3(Cha. Su. 16 : 20).

Pañcakarma presents an unique approach of Āyurveda to therapy with


specially designed for internal purification of the body . Such a purification permits
the biological system to return to normalcy & to attain homeostasis & also facilitates
the desired pharmacokinetic effect of curative remedies administered thereafter. It
eliminates toxins & malas ,cleans the macro& micro channels, maximizes the
absorption , metabolism of nutrients, drugs & helps in minimizing their dose &
toxicity.
Pañcakarma can be considered as a Promotive, Preventive, Curative & Rehabilitative
procedure. According to Ancient Āyurvedic scholars, the elimination of the waste
products of the body are termed as Apakarśana, which means Śodhana. This is not
only of great utility in treating a disease but is also advisable in healthy persons as a
preventive measure.
Two accessory measures carried out before (Purva) and after (Pascat)
performing the Pancakarmas are also considered as the part of Pancakarma therapy. In
the classics the Śodhana is specially indicated in Bahu doṣavastha as a curative
measure and in Rutucarya as a preventive measure and prior to Rasāyana Prayoga as a
promotive measure4. (Cha. Su. 7/46, Ca. Su. 16/12-19, Ca. Ci.1/1-24).

When compared to Vamana , the Virecana karma is less stressful,


complications could be managed efficiently. So it is widely used as Śodhana therapy

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The concept of virecana karma

in routine. It is more acceptable to all classes of patients. In an addition to the


acceptability and popularity, the Virecana is considered as the best treatment for
morbid Pitta Doṣa. It is a complete therapeutic measure, which has systemic as well as
local effects. This fact is further supported by the word “Virecana”. Its wide range of
indications, the special classical method and mode of action are given in Āyurvedic
classics.

HISTORICAL ASPECT OF VIRECANA:


PURANA: Among purāna’s Garuda & Agni purāna has a great significance. We can
find traditional method of diagnosis along with Pañcakarma treatment.

MANU SṀRITI: In Certain procedures where ghŗita is administered orally after the
completion of Vamana karma, Virecana & Snāna has been found. In Candogya
Upaniśad, Śankara bhaśya, śiśupāla vadha, Megha dhuta, scattered references
regarding Śodhana followed by Samśamana therapy for the normalcy of Doṣas has
been found.

1. Kasika5 : It is explained that Pañcakarma was the common method of treatment


which is prescribed as Pūrvakarma such as Snehana, Svedana and Pañcakarma,
AnnaSaṁsarjana etc.
2. Agnipurāna6: Virecana karma is emphasised as the treatment in various
diseases and Trivṛit is considered as best virecana drug. But the detailed
description of Virecana is not found.

Table No:1 Detail description regarding Virecana in Āyurveda

DRUGS
COMPLICA
PROCEDURE
VIRECAN TION &
VIRECAN ,
A KALPA/ TREATMEN
BOOK A DRUG BENEFITS
STHĀNA YOGA T
(Chapters/ (Chapters/
(Chapters/ Chapters/Ślok
Śloka) Śloka)
Śloka) a
1/77,75 ;
15/
2/9,10; 15/ 13 ;
17,18,16,22;
Sūtrasthāna 4/13 15/7; - 16/ 5-10 ,
16/ 17-19
25/40 22-26

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Caraka
Vimanasthana 8/136 - - -
saṁhita
kalpasthāna 1/6 7-12 1/3, 4,5. ;12 12

Siddhisthāna - - 1; 2/11,12,13. 6
38/30 ; 44
Suśrut Sūtrasthāna - -
39/ 4
saṁhita
Cikitsasthāna - - 33/19-47 34
Sūtrasthāna 15/2 - 18 18
Astānga
Kalpasthāna - 2 - 3
hŗidaya
13/2;14/3-
Sūtrasthāna - 27 27
4;15/6
Astānga
Sangraha Kalpasthāna - 2 - 3

Sūtrasthāna - - 4 ; 21 ; 23;25 -

Kalpasthāna - 7 ; 8 ; 9. - -
Bhela
saṁhita Siddhisthāna - - - 1;4

Śarang- purvakhanda 4 - - -
adhara
saṁhita Uttarakhanda
Detailed description about virecana karma
Vangas-
ena Virecana
Detailed description about virecana karma
saṁhita ādhikara
Bhavapra
Nighantu Part - 5 5 5
kāśa
Cakra -
- - 71 71 71
dutta
Sūtrasthāna - - 24 -

Kāśyapa Siddhisthāna - - 2;3;7 -


saṁhita
Khilasthāna - - 7 7

Etymology
(1) Virecana7 V+Ric+ Nic , lytu-malade: nissernam ......(Vacaspathyam).
(2)Virecanaha8 : V+Ric+Nic, lytu-Viśeśena recathete ...... (Śabdakalpadruma)

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The word Virecana is derived from the ‘Ric’ dhātu ,‘Nic’ &’Lyut’ pratyaya &with
‘Vi’ upasarga.
It also means Maladehe nissāranam i.e. expelling out the malas.
"Ricir" - evacuation
"Ric" - Viyojana (separation)

Virecana word is derived from the ‘Ric’ dhātu, ‘Ric’ meaning – To empty , evacuate,
leave, give up9.

Definition:
 iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉ xÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....|10 (Cha.Ka.1/4)

The act of expelling doṣas through Adhobhaga is known as Virecana.


 ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉ ÌlÉ:xÉÉUhÉÇ ...|11 ( A.Hr.Su.1/25)

The procedure in which the drug is administered through orally which acts on
morbid doṣas, specifically on Pitta and expels them out through anal route.
 ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |

UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||12 (Sha.Pu.4/6)

The procedure where the morbid Doṣas expel out in the form of Drava either
in the pakva or apkva state.
 ÌmɨÉå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ zsÉåwqÉhÉÏÌiÉ |13 (A.Sa.Su.27/4)

urÉMÑüsÉÉlÉç xÉͳÉmÉÉiÉÉåijÉÉlÉç mÉæ̨ÉMüÉlÉç MüTü ümÉæ̨ÉMüÉlÉç |

xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç ||14 (Ka.Si.7)


15
Virecana is the best line of treatment modality for pitta Doṣa ,
(Cha.Su.25/40) also it can act on kaphasamsrusta pitta or pittasthanagat kapha. And
moreover in case of Vātasyopakrama mŗidu śodhana indicated which refers to mŗidu
virecana karma16(A.Hr.Su.13/1). Hence Virecana is the major line of treatment for
morbid pitta Doṣa & also it acts on morbid kapha &Vāta Doṣa. Thus the action of
Virecana can be observed on all the tridoṣas.

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Synonyms of Virecana:
The following terms were used different texts in different contexts for the
virecana, these are all may be considered as synonyms for the virecana.
• Vireka, Recana, Adhobhāgahara.
• Anulomana 17 (cha.Su.16/16)

Table No:2 Indications and Contraindications of Virecana Karma

INDICATIONS
A.S.20 Sha.S.U23
Virecana Ch.Si18 Sus.Chi19 A.Hr.21 K.Si.22
27 /8 4/6-10
Yogya 2/13 33/32 18/8-9 7

Prānavaha sŗotoduhti vikāra


Śwāsa + - - - - -
Kāsa + - - - - -
Parśvaruja + - - - - -
Annavaha sŗotoduhti vikāra

Aruci + + + - - +
Avipāka + - + - - -
Visucika + + + - - +
Alasaka + + + - - -
Chardi + + + + - +
Udakavaha sŗotoduśti vikāra

Udara + + + + - +
Rasa pradoṣaja vikāra

Pāndu + + - - + +
Jwara + + + + - +
Aruci + + - - - +
Avipāka + - + - - -
Hŗidroga + + - - + +
Rakta pradoṣaja vikāra

Kāmala + - - + + -
Vidradhi - + + + - +
Netradāha + + - - - +
āsyadaha + + - - - +
Vātarakta + + + + - +

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Kustha + + - + + +
Paittika
+ + + - - -
vyadhi
Visarpa + + - - + -
Pliha + + + + - +
Vyanga + - + + - -
Nilika + - - + - -
Urdva
+ + + + + -
Raktapitta

Māmsa pradoṣaja vikāra


Arbuda + + - - - -
Galaganda + - - - - -
Meda pradoṣaja vikāra
Prameha + + - + + +
Yoni Doṣa + + + + - +
Retodoṣa + - + + - -
Mūtravaha sŗotoduhti vikāra
Mutrāghāta + + + + - +
Puriśavaha sŗotoduṣhti vikāra
Arśa + + + + + +
Bhagandara + + + - - +
Udāvarta + - + + +
Vibhandha - + + + + -
Pakvaśaya
+ + + + - -
śūla
Other

Visphota - - - - + B.SU.21/3 +

Vātavyadhi - - - - + B.SU.21/3 +
Garaviśa - + + + + +

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Table No: 3 CONTRA-INDICTIONS

Ch.Si2 2
A.S.26 27
K.Si. Śa.S.U29
Virecana 4
Sus.Chi A.Hr. 28
5
(27/8) (4/6-10)
Yogya 33/32 (18/8-9)
(2/13) (7)
Physiological condition
Langitha + - + - - -
Upavāsita + - - - - -
Durbalendriya + - - - - -
Durbala + - - - + -
Alpāgni + + + + - +
Śranta + + - - - +
Pipāsita + + - - - +
Karmabharadhvaha
+ + - - - -
ta
Daruna koshtha + - + + - -
Kshama + - - - - -
Kāmadivyagra + + - - - -
Bhakta + + - - - -
Sukumāra - - - - + -
Navaprasuta - + - - - +
Rathri Jāgarana - - + - - -
Atirukśa + - + - - +
Bhayoptapta - + - - - +
Cinta prasaktha + - - - - -
Maithuna prasaktha + - - - - -
Adhyayana
+ - - - - -
prasaktha
vyāyāma prasaktha + + - + - -
Garbhini + + - - - -
Age related condition
Vriddha + + - - - +
Bāla + + - - - +

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Pathological condition
Kśatkśina + + - - - +
Atikriśa + - - - + -
Atisthula + + - - + +
Muktanala + - + - - -
Atisāra - - + + - -
Adhoga Raktapitta + + + + - -
śoṣa - - - - - -
Rājayakśma - - + - - -
Urustambha - - - - + -
Madātyaya + + + - - +
Tāluśośa - - - - + -
Hŗidroga - - - - + -
Traumatic condition
Abhighāta + - - - - -
Subhaga + - - - - -
Kśataguda + + + - - -
śalyardita + + + + - +
Saama condition
Nava Jwara + + + + - +
Nava Pratiśyāya - + - - - -
Some vaataroga condition
Kevala Vātaroga - - - - + -
Hanugraha - - - - + -
Ardita - - - - + -
Pūrva karma related condition
Nirudha + - + - - -
Atisnigdha + + + + - +
Anupasnigdha - - - - + -
Pakṣahata - - - - + -

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CLASSIFICATION OF VIRECANA DRAVYA


In Āyurvedic classics, the main drugs for Virecana have been described in the
chapters dealing with Pancakarma. In addition to it, numerous scattered references are
available in the literature regarding Virecana action of drugs :
Cha. Su. 1; Cha. Su. 2; Cha. Su. 9; Cha. Su. 4; Cha. K. 7 to 12; Cha. Su. 13; Cha. Su,. 25.;
Su. Su. 38, 39, 44.; A. S. Su. 6, 7, 12, 13, 14, 15, 17; A.S.K. 2, 3; A.H. Su. 5, 6, 9, 15; A.H.K. 2; Sa.
Pu. 4; Sa. U. 4
Table No: 04
S
L
. DRUG
N
O

Animal
Milk,Takra,Mastu, Urine 30 (A.S.Su.14/3)
origin
Hastidanti,Vaca,Śymatrivrit,Adhoguda,
Saptala,Śveta,,Gavakśi,jyotiśmati,
Pratyagshreni,Danti,Bimbi,Śanapuśpi,
31
Ajagandha,Dravanti,Kśirini (cha.su1/77-
78)
Citraka,Kinihi,Kuśa,Kaśa,Tilvaka, Śankhini
Moola 32
(Sus.Su.39/4)
Vruchiva,Hrusvapancamoola,Punarnava,Pal
nkaśa,Vaastuka,Śaka. 33(A.S.Su.14/3)
Śankhini, Vidanga, AnupMadhuyasti,
Sthalaja Madhuyasti , karanjadvaya ,
Abhaya, Anthakotarapuśpi, Kampillaka
Aragvadha 34 (cha.su 1/80-82)
Puga,Saptacada,Arka,Triphala,Nilini,
1
Eraṇda35 (Sus.Su.39/4)
Phala
Plant Pilu,Priyal,Kaval,Badar, Karkandhu,
origin Kaśmarya, Paruśaka, Drakśa36 (A.S.Su.14/3)
Saptacada,jyotiśmati,Mahavrukśa.
Kśīra Arka 37 (Sus.Su.39/4)
Svarasa Karavellaka 38 (Sus.Su. 44/4)

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Tvak Tilvaka,Patala,Ramyaka,Kampillka.39
Taila Eraṇda tail 40 (Sus.Su. 44/4)
Patra Pootik,Aragvadha 41 (Sus.Su.39/4)
Phalaraja Kampillka.42 (Sus.Su.39/4)

M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç |


Anuloman
a iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ ||

qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:|


Bhedana
ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉ ||

mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç |


Samsrana
2 lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç ||

ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |


(Sha.Pu.4/4
Based on32

Recana
Action

UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||

Mŗidu
relation Based on intensity of

Drakṣa, kṣīra, Uśnambu, Eraṇda tail


Virecaka
Madhyama
3 Trivrut, Katuki, Aragvadha
(Sha.U.4/14)

Virecaka
with fat as action44

Tikśna
Snūhi, Danti, Svarnakśeri
Virecaka
With
Rukśa Virecana E.g.- Eraṇda taila +Triphala Kvatha 46
Sneha
Cha.Si.6/9

4
45

Without
media

Snigdha Virecana E.g. - Triphala Kvatha


Sneha
In
Fermented

Madhya,Dhanyamla 47 (A.S.Su.14/3)
Virecana

5
Souvīrak,Tuśodaka 48 (Cha.Su.27/191)
Kalpa

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All the Virecana drugs can be classified as plant & animal origin depending on
their source of drug. Based on presence of Adhobhāgahara property in different parts,
these can be further subdivided as moolini, Phalini etc.Eg.Trivrut root bark had
Virecaka property, Jayapāla fruits have Virecaka property etc.

1) Depending on pharmaodynamic action of drug on Doṣa, Mala these drugs are


classified as Anulomana, Bhedana, Saṁsrana, Recana.

2) Among all virecana dravya some are drastic purgative while some are mild &
moderate in nature. So depending on the nature of intensity of drugs, these can be
classified under Mŗidu Virecaka, Madhyama Virecaka & Tikśna Virecaka.

3) Addminstration of virecana karma through virecaka dravya with Sneha and /or
without Sneha depends on preoperative procedure especially Snehana i.e in
Atisnigdha person select Without sneha (Rukśa) Virecana and for Anatisnigdha
select with Sneha (snigdha)Virecana.

Procedure of Virecana:
The procedure of Virecana classified under three headings, which are as follows

pūrva karma

pradhāna karma

pascāt karma 49
(Sus.Su. 5/3)

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Pūrva, Pradhana, Pascāt Karma of Virecana


Table No:05

Śali.Mudga,Māśa,Yava,Tila,
āhāra
Dugdha,GrithaUśana jala, Māmsa etc.

Dīpananīya,Pācanīya,
Dravya Upaśamanīya,Vātahara,Sneha,
Auoṣadha Svedana ,Virecana drugs like Drākśa,
Triphala, Suovīraka etc.

Sambhāra Acamani, Śarava,Darvi, ghata,etc.utennsils


Samgraha .Bed,Chairs etc.for patient to rest. Kartari etc.Cutting
50 Equipm
instrument. Tula, Manabhanda, Dhumanetra, Sutra,
-ents
Karpasa etc.

Before performing Virecana karma it is necessity to know


Ātura patient fitness in terms of his/her Doṣa, Duśya, Atura Bala kāla,
Parīkśa 51
Deśa, Agni, koṣta, Śaīra & āhāra Sātmya, Satva etc. For the
proper adminstration of Vercana karma.

Pūrva cikitsa Vamana karma & Basti Cikitsa

Āma is considered as one among the


etiological factors of the diseases, & Śodhana
in āma condition is pretty much
Dīpana and
contraindicated. So it is necessary to
Pācana52
administration of dīpana & Pācana drvyas
I. before the virecana to attain nirāma state.
Śodhananga snehana in terms of sehapāna
Snehapāna53 Should be performed before vercana karma,
which helps in liquefaction & in bringing the
Atura
Doṣas from śākha to koṣta.

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Siddhata Snehana followed by Svedana in terms of


Sarvānga sveda is helpful to extract the
Svedana 54
morbid Doṣa from Sūkśma sŗotas, it controls
Vāta Doṣa. Thus it helps to move the morbid
Doṣa from śākha to koṣta.
After Samyak snigdh lakṣana 3 days of gap should be there &
during this time patient should consume the laghu Drava, Uśna,
Diet55
Anabhiśandhi, Na atisnigdha, Asankara āhāra. But Kapha
vardhaka Āhāra is to be strictly avoided.

Dose of virecana drug varies according to different author. It


Mātra depends upon the Koṣta, Deśa, Vaya etc. & also Kalpa of the
Viniscay prescribed medicine to induce virecana.

On the day of Virecana patient should assess in


Assessment
terms of his stable mind, good & undisturbed
&
sleep, proper digestion of previous night food,
preparation
then perform Svastivacana, Homa, Bali,
patient
Mangala kārya.

Administr-
ation of
Virecana Once Ślema kāla over & Pitta kāla .
Administrati
yoga57 Select uttama mahurta, Tithi, Nakśatra then
-on of Drug
advice patient to consume selected Virecana
drug58.(Cha.su.15/7)

Auṣadha Vātanulomana, Svasthya, Kśudha, Triśna,


Jirṇa Sumanaska ,Indriya Laghuta and Udgara
Lakṣana Śuddi59.(Cakradatta.jvara /57)
II
AJirṇa Klāma, Dāha, Angasadana, Bhrama, Murca, Śiro
Observati-
Auṣadha ruja, Arati, Balāhani60.
ons
lakṣana (Cakradatta.jvara /57)
Sequential expulsion of Vit, Pitta.Kapha through
Hŗitadoṣa rectal route & features such as Dourbalya,

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Lakṣana61 Laghutha, and Karśya are indicative of


Hŗithadoṣa lakṣana .

Śuddi Pravara Madhyama Avara

Laingiki Samyak virecana lakshna

20
Antiki 30 Vegas 10 Vegas
Vegas
Śuddi
Lakṣana62 Vaigiki 4 Prasth 3 Prasth 2 Prasth

Kaphānt
Maniki Kaphānta Kaphānta
a

Virecana
Any improper function of Bheśaja Catuśpada
Vyapat63
leads to Virecana Vyapat.

Immediate
Pascat
Washing the hands, feet and face64. (Cha.Su.15/17)
karma

Peyādi Saṁsarjana65 (Cha.Si.1/11)


Remote Saṁsarjana
Tarpaṇādi krama 66 (Cha.Si.6/25)
h tk

3 Pascat Krama
karma Rasa Saṁsarjana krama67 Cha.Si.12/6-8)
P

Before initiating any Pañcakarma procedure Physician should collect all the
required things like Mudga, Māśa etc.food articles; Drākśa, Triphal, Dīpanānīya etc.
Medicines and measuring, cutting etc. equipments. By all these things one can carry
out proper procedure & can able to handle any sort of complications arises during &
after the procedure68. (Cha.su.15/7)

To get success in Śośana karma, Viadhya must examine the patient properly.
Because factors like selection of particular procedure, medicine, Dose of medicine
etc. mainly depends on patient69. (cha.Si.3/6)

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In Patient whom Virecana is necessity but in such patient if dominance of


kapha or Vāta doṣa and Krūra Koṣta is their, then one should plan first to expel kapha
doṣa through Vamanakarma and/ administration of Basti Cikitsa to mitigate Vāta
doṣa. Otherwise these may pave for manifestation of complication during & after the
Virecana Karma in terms of Pravāhika, Gourava and Ayoga
respectively70.(Cha.ka.12/79-80) Śodhana karma differs from Śamana karma in terms
of expulsion of morbid Doṣas out of body where as Śamana karma mitigates such
Doṣas inside the body only without expelling it out of the body71.(A.Hr.Su.14/6)
Hence it is necessity that the presence of morbid Doṣas in Koṣta to expel out
i.e. if such Doṣas are there in Śakha these should be bring to koṣta which can be
achieved through Snehana & Svedana karma72. (Cha.Su.28/33). Before administration
of Śodhanaaga Snehana it is necessary to assess the status of Agni & Sāma ,Nirāma
condition. Based on it one should plan for Dīpana – Pācana prescription and then it is
followed by Snehapāna. Depending upon morbid doṣa involved in disease one should
select Sarvānga sveda for E.g. In Kapha doṣa select uśma Sveda, in Pitta Samsraśta
condition select Drava Sveda like Pariśeka & Avagāha73 (Sus.Chi.33/14)

Since Virecana is prime line of treatment for Pitta Doṣas74 (Cha.Su.25/40),


hence the care should be taken that Āmāśaya must be free from Kapha Doṣas, or else
Virecaka dravya adminstererd for virecana karma may lead to Vamana as
complication75. (Sus.Chi.34/5). Therefore physician must plan all the measures
which are not Kaphakāraka like administration of virecaka drug on 4th day of samyaka
snigdha lakṣana appears76(Cha.Su.14//80) & during this period patient is advised to
consume Laghu, Uśana, Drava etc. quality predominant food77. (A.S.Su.27/28)

Even though there are various reference are available regarding fixed
dosage of different forms of Virecana drug but these are applicable for patient with
Madhyam Koṣta-Bala-Vaya only78 (Cha.ka.12/86). So dose of Virecana drug of an
individual is, the one which expels only morbid Doṣa out of the body without
manifesting any undue complications.79 (Cha.su.15/10).

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Importance of Snehapāna:
Dīptāgni, pariśuddha kostha, pratyagradhātu, balavarna, drida indriyata,
mandajara & śatayu are the benefits of snehapāna 80
.(A.H.Su 16/46) Snehana is
beneficial in durbalāgni state to enhance it. Hence prior to snehapāna śodhana is
contraindicated. If we try to remove the doṣas from rukśa śarīra, then there may be
possibility of lodging the Doṣa due to rukśata in sŗotas.
In our body, each & every cell has got cell membrane which is made of lipid
substances & is permeable to lipids & impermeable to water soluble molecules. The
permeability permits the snehana dravyas inside the cytoplasm through cell membrane
& this process takes place by simple or lipid diffusion. During snehapāna ghī which is
administered has got saturated fatty acids & hence increases the cholesterol level.

Saturation kinetics: When the number of molecules inside the cell increase so much
that all the carrier proteins are occupied, the saturation point is reached, i.e. further
increase of the molecules will not cause any further rise in the rate of transport. The
above concept adds to the point to the action of malodhīrana which is not possible
when the administered sneha reaches more than the saturation point.

Svedana: The qualities of Svedana drugs are Uśna, tikśna, sara, snigdha, rukśa,
81
sukśma, drava, sthira & guru (Ch.Su.22/16) . The actions obtained by these gunas
includes: The action of svedana is performed by uśna guna & tikśna guna does
śodhana of Doṣas, sara guna doṣaśamana, rukśa guna does śośana, vivarana by
sukśma guna, stambha is relived by uśna guna, vilodhana by drava guna, dhārana
karma by sthira guna 82, 83 (A.H.Su.1/18 -Hemādri).
Addition of liquification of doṣas occurs due to svedana, by the virtue of its
drava guna & śodhana by tikśna guna which enters into minute sŗotas by its suśhma
guna. The āgneya property of tikśna & uśna gunas produce pāka & srāva.
Due to snehana, kledana of doṣas takes place & svedana does liquefaction
thereby they are brought to koṣta. The function of sveda is to produce kleda in the
body. Kleda is the product of jala in the body & it should be removed out. The final
product of jala dhātu is ap dhātu & kitta is kleda. The mula of svedavaha sŗotas is
medas & romakūpa. Sthūla medas produces the function of snehana & its mala causes
svedana. Svedana pacifies Vāta & enhances agni.

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Mode of action of Svedana: 84 (A.H.Su.17/29)


The Klinna doṣas which are present either in koṣta, dhātu, sŗotas & śakhas &
asthi (which includes madhyama roga marga) are liquefied by svedana & brought to
koṣta, thereby eliminated through śodhana karma.
In short, snehana softens Doṣas & localizes them. Svedana liquefies those
doṣas due to its uśna & tikśna properties. The fluid is defined as dravata, prakledana,
ālodana drava i.e. the fluid properties will make things to move & causes klinnata of
the body. Then only the doṣas will reach to the koṣta & they will be removed either by
vamana or by virecana.
Mode of action of Svedana / sweat production:85
Heat has thermal effect on blood vessels, nerves. There will be increased
metabolic acting on the walls of the capillaries & arterioles causing dilatation of these
vessels. Sun light has a direct effect on blood vessels, causing vasodilatation in
superficial tissues where there is more heating. Due to vasodilatation there is an
increased flow of blood through the area, so that the necessary oxygen & nutritive
materials are supplied & waste products are removed. Heat reaches to subcutaneous
region & through the blood conveys the heat to the entire body. The capillaries will be
dilated; the sweat glands will be stimulated & local temperature rises. The resultant
action is appearance of perspiration. The sweat produced from the skin (through roma
kupas), will enhance the colouration of skin & softness. Sweat regulates heat & water
balance of the body. The muscles are supplied with parasympathetic nerves. Since the
centre is situated in anterior hypothalamus, by its stimulation sweat is formed. The
skin is stimulated by hot rays of sun & thereby perspiration results. Excessive
exposure may lead to oedema or sun burns in sensitive skin which is a local effect.
The general effects are produced in proportion to intensity & duration of exposure to
sun rays. During this process, there will be increased elimination of heat, excess
perspiration & signs of ordinary fever.

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Total effects observed are:


Chart No:01

Thermal effects

Hyperaemia of skin & subcutaneous


vessels - Erythema

Stimulation of sweat glands

Sweat production

Table No :06 DOSE OF VIRECANA DRUG IN ITS DIFFERENT FORMS

FORM
OF
koṣta DOSE Sus86,87 Sha88 Van89
MEDICI-
NE

Krūra Uttama Tikśana Tikśana 1 pala


Madhyam Madhyam Madhya Madhya ½ pala
1 Any form Mrudu Hīna Mrudu Mrudu 1 Karśa
Krūra Uttama 8 Karśa
Madhyama Madhyama 1 Anjali 4 Karśa
2 pala
2 Kwātha Mrudu Hīna (4 pala) 2 Karśa
Krūra Uttama - 2 Karśa
Madhyama Madhya 1 Karśa 1 Karśa
1 Karśa
3 Curna Mrudu Hīna - ½Karśa
Krūra Uttama - 8 Karśa
Madhyama Madhyama - 4 Karśa
1 pala
4 Svarasa Mrudu Hīna - 2 Karśa
Krūra Uttama - -

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5 Kalka Madhyama 1 Karśa


Madhyama 1 Karśa
a
Mrudu Hīna - -
Krūra Uttama - - -
Madhyama Madhyama - 1 Karśa -
6 Modaka
Mrudu Kanīya - - -
Krūra Uttama 8 Karśa -
Hima&
7 Madhyama Madhyama 1 Anjali 4 Karśa -
phanta
Mrudu Hīna (4 pala) 2 Karśa -
- - - -
2 Karśa
- - - -
8 Sneha or1 pala
- - - -
Mrudu - - - 2 pala
Madhyama - - - 4 pala
9 Uśna jala
Krūra - - - 8 pala

Pradhana Karma includes administration of Virecana yoga and observations of


Auṣadha Jirṇata-Ajiranata, Śuddi Lakṣanas and management of Vyāpat if occurs.
If the patient is fit for Virecana karma on the day of Virecana karma, after
performing the Sarvānga sveda90 (Cha.Su.14//80) and the patient is advised to be in
empty stomach. Afterwards during the initial phase of Pitta kāla one should
administered selected particular virecana yoga with appropriate dose & anupāna91.
(A.S.Su.27/28). It is difficult to standardised time of the initial phase of Pitta kāla as
it mainly depends on movement of sun & sunrise which is varying from one place to
another place and season to season. If drug is adminsterd in śeṣlma kāla and/or after
consuming food then, kaphadoṣa may cause āvarana over grahani resulting in
mandhāgni, gourava, Śūla, Admāna & even Vamana may be seen as a complication92.
(A.S.Su.27/31-32)
Just after the administration of Virecana Yoga, cold water should sprinkled on
the face to avoid nausea/vomiting. Patient is asked to rinse mouth thoroughly with the
hot water and asked to smell the fragrance of jambīra or Surabhi etc. whichever
he/she likes. Advised to stay in nirvāta place, be in comfortable position and should

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not sleep, shouldn’t suppress the natural urges; should consume hot water little by
little93. (A.Sa.Su.27/36)
Viadhya should concentrate on the manifestation of lakṣana of Jirṇa-AJirṇa
Auṣadha, Śuddi and Vyapat.If VirecanaVega is not initiated then asks the patient to
consume uśna jala in small dose & perform Tāpa Sveda with help of palm over
abdominal region which may help to stimulate peristaltic movement94. (A.S.Su.27/38)
Once Jīrna Lakṣana are appears but still only small amount of morbid doṣa are
expel or not yet all, then Physician should administer one more dose of Virecana drug
depending patient bala. But if its administered in the ajirṇa avastha of previously
consumed medicine, it causes atiyoga. Or if Aushadhi Jirṇa Lakṣanas are elicited, but
if the Hŗitadoṣa Lakṣanas are not found then Virecana Yoga should be given on the
next day. Even then if the Virecana does not occur, then after 10 days one should plan
to re-administration of Virecana karma i.e. again Snehana and Svedana should be
performed and thereafter Virecana drug should be administered95(A.S.Su.27/38)
Finally śuddi lakṣana must be assessed in terms of Subjective parameters like
Laingiki & Antiki & Objective Parameters like Vaigiki &Maniki. But among these
more importance should be given to Laingiki Śuddi96. (Cha.Si.1/13-14)
Kaśyapa Acārya being a Paediatrician, to practise Virecana Karma specially
for Bāla he has been identified. Mrudu and/ Sukha type of virecana and Maniki &
Vaigiki parameters97 i.e. (Ka.Si.3)
Table No : 07
Śuddi Pravara Madhyama Avara
Vaigiki 3 2 1
Maniki 3Prastha 2 Prastha 1 Prastha

Once it is confirmed that Virecana Vegas are stoped, then the patient is
advised to wash his hands, feet and face98. (Cha.Su.15/17). Also advised to avoid
aśta mahādoṣa bhavas i.e.1.Ucabhāśana, 2.Rathakśobha, 3.Aticankramana,
4.Atiāsana, 5.Adhyaśana, 6.Ahita bhojana, 7.Diwāswapna, 8.Maithuna99.
(Cha.Si.12/11-12). Based on Śuddi lakṣana especially Vaigiki advise patient to
follow Saṁsarjana krama.

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Saṁsarjana Krama
Chart No : 02

Peyādi101
(Cha.si.1/11)
Anna Smsarjana
[chakrapani100
(Cha.Chi.2/75)
Tarpanādi102
(Cha.Si.6/25)
Samsarjana Krama

Madhurādi
Rasa Samarjana Shad rasa103
(Cha.Si.12/ 7-8)

Saṁsarjana krama should be planned after considering the type of śuddi. If in


case of Samyak Śodhana occurs but complete Doṣa are not expelled then advise
patient to consume Yavagu etc. food along with Antarpāna (Kaśaya pāna ) so that
there will be mitigation of Koṣtaupalepak Doṣa i.e. remaining doṣa104.
(Cha.Ka.12/66).
If the proper Virecana does not occur at that time instead of Peyādi Krama,
Tarpaṇa should be indicated since Peyādi by virtue of their Abhiśandhi property
causes Sŗotas obstruction. It is also recommended that the persons addicted to
alcohol, having Vāta Pitta Prakrti and if Kapha and Pitta are dominant even after
Virecana Karma. And Cakŗapāni mentioned that in place of Peya and Vilepi, Svacha
and Ghana Tarpaṇa should be given respectively105. (Cha.Si.6/25) While Arunadatta
described as Lāja Saktu & Māmsarasodana in Prathama & Dvitīya Annakāla
respectively106. (A.Hr.Su.18/46)
Suśruta has mentioned his opinion regarding the Saṁsarjana krama that:
Depending upon the hŗita doṣa pramana, āhāra vidhi changes. He considers 3
prāmana of doṣa harana i.e. 1 prastha, 1/2 adhaka & 1 adhaka which is avara,
madhyama & uttama prāmana respectively (Su.Chi.39/6-7) 107

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The food substances which are prescribed for Saṁsarjana krama includes:
1. Swalpa tandula yavagu
2. Vilepi
3. Sneha & lavana rahita mudga yuśa (akrita)
4. Half of quantity of cooked rice with mudga yuśa.
5. Krita yuśa along with 3/4th quantity of cooked rice.
6. Lava, kriśna mriga susamskrita māmsarasa is also given.
The above diet in avara, madhyama & pravara śuddi is 1,2 & 3 annakāla
respectively .108 (Su.Chi.39/8-11). Suśruta opines that according to bala viśeśa
Saṁsarjana krama viśeśa can be appreciated, i.e. if tīkśna bala is present then 3 āhāra
krama, in madhyama bala 2 āhāra krama, in mŗidu bala persons 1 āhārakrama is
mentioned (Su.Chi.39/17-18)109.
Table No: 08 Peyādi Saṁsarjana Krama110(Cha.si.1/11)
ÌSlÉ MüÉsÉ A³ÉMüÉsÉ mÉëkÉÉlÉ vÉÑkSÏ qÉkrÉqÉ vÉÑkSÏ ÌWûlÉ vÉÑkSÏ

mÉëjÉqÉ mÉëÉiÉ: - - -

xÉÉrÉÇ 1 mÉårÉÉ mÉårÉÉ mÉårÉÉ

̲iÉÏrÉ mÉëÉiÉ: 2 mÉrÉÉ mÉårÉÉ ÌuÉsÉåmÉÏ

xÉÉrÉÇ 3 mÉårÉÉ ÌuÉsÉåmÉÏ M×üiÉÉM×üiÉ rÉÔwÉ

iÉ×iÉÏrÉ mÉëÉiÉ: 4 ÌuÉsÉåmÉÏ ÌuÉsÉåmÉÏ M×üiÉÉM×üiÉ

xÉÉrÉÇ 5 ÌuÉsÉåmÉÏ AM×üiÉ rÉÔwÉ qÉÉÇxÉUxÉ

xÉÉqÉÉlrÉ pÉÉåeÉlÉ

cÉiÉÑjÉï mÉëÉiÉ: 6 ÌuÉsÉåmÉÏ M×üiÉ rÉÔwÉ -

xÉÉrÉÇ 7 AM×üiÉ rÉÔwÉ AM×üiÉ qÉÉÇxÉUxÉ -

mÉÇcÉqÉ mÉëÉiÉ: 8 M×üiÉ rÉÔwÉ M×üiÉ qÉÉÇxÉUxÉ -

xÉÉrÉÇ 9 M×üiÉ rÉÔwÉ xÉÉqÉlrÉ pÉÉåeÉlÉ -

wÉ ¸ mÉëÉiÉ: 10 AM×üiÉ qÉÉÇxÉUxÉ - -

xÉÉrÉÇ 11 M×üiÉ qÉÉÇxÉUxÉ - -

xÉmiÉqÉç mÉëÉiÉ: 12 M×üiÉ qÉÉÇxÉUxÉ - -

xÉÉrÉÇ 13 xÉÉqÉÉlrÉ pÉÉåeÉlÉ - -

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To maintain the normal status of Doṣa especially in Āmāśaya & Pakwāśaya,


rasa Saṁsarjana krama is identified in classics. Here particular Rasātmaka food
articles are given to patient with proper order & this can be consumed along with
Peyādi Saṁsarjana krama or after it.
Table No : 09 Rasa Samarjana

ACARYA Rasa Effect on Doṣa

ÎxlÉakÉ,AqsÉ,xuÉÉSÒ mÉYuÉÉvÉrÉ ÎxjÉiÉ uÉÉiÉmÉëvÉqÉlÉÉjÉï

AqsÉ, sÉuÉhÉ EkuÉïÎxjÉiÉ AÎalÉ xÉÇkÉѤÉhÉÉjÉï

Caraka111
xuÉÉSÒ, ÌiÉ£ü ÌmɨÉvÉqÉlÉÉjÉï

MüwÉÉrÉ, MüOÒû ÌmɨÉÉåkuÉïÎxjÉiÉMüTü mÉëvÉqÉlÉÉjÉï

xuÉÉSÒ, ÌiÉ£ü mÉëuÉ×kSÉÎalÉWåûiÉÑuÉÉiÉÌmɨÉxjÉÉuÉeÉrÉÉjÉïqÉalÉå: xÉqÉÏMüUhÉÉjÉï

ÎxlÉakÉ,AqsÉ,sÉuÉhÉ,MüOÒû uÉÉiÉMüTüÉuÉeÉrÉÉjÉïqÉalÉå:xÉlkÉѤÉhÉÉjÉï
Suśruta112
xuÉÉSÒ, ÌiÉ£ü ÌmɨÉuÉÉiÉÉuÉeÉrÉÉjÉï

Thus after the Virecna karma patient should follow aśta mahadoṣa bhavas and
diet properly still Prakritagata Lakṣana seen. These are when patient able to consume
and digest all shad Rasa yukta āhāra, proper functioning of all sense organ, normalise
of bowel habits & micturation, regaining of strength ,Satvavaan113 (Cha.Si.12/9)

Tarpaṇādi krama:
According to Caraka the following criterias are selected for tarpaṇādi krama:
Alpa śuddi of kapha & pitta , In alcoholic patients , In Vāta pitta prakriti individuals
(Ch.Si.6/25), Hīna śuddi (Su.Chi.39/13).
Reason for tarpaṇādi krama is that, the Peyādi krama causes abhiśyanda &
aggravates kapha doṣa (Su.Chi.39/13). Hence in the place of peya-swacha tarpaṇa,
vilepi is replaced by ghana tarpaṇa (Cakrapani on Ch.Si.6/25). According to Jejjata,
mudga yuśa & māmsa rasa are indicated in 1st , 2nd & 3rd annakāla respectively.

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Sequence of rasa used in Saṁsarjana krama:


According to Caraka, for agni sandhukśanartha: initially snigdha, amla,
madhura &hŗidya dravyas are used to pacify Vāta, āmla & lavana is used to enhance
the agni, madhura & tikta rasa for pitta śamana. Later to pacify kapha kaśaya & katu
rasa should be used (Chakrapani on Ch.Si.12/6-8).
According to Suśruta, initially swadu, tikta rasa should be given to pacify Vāta
pitta & to increase agni, later snigdha, amla, lavana, katu is taken to pacify Vāta &
kapha & to boost agni. To pacify Vāta pitta generated due to previous rasas, madhura
& tikta rasa is used in next series. Later kaśaya & katu rasa should be used to pacify
kapha & pitta situated in upper part (Dalhana on Su.Chi.39/18-19). Rukśa & snigdha
is used as vyatyasa krama (alternatively) & the same is followed in further days. The
intention is to make practice to śodhita body & to have abhyasa of all rasa in these
days. It is even appropriate to continue further for few days while taking normal diet.
Table No :10 Virecana Vyapat
Sl. Caraka114 Sushruta115 Vagbhata116
Vyapat lakshna
No. (Cha.Si.6/29) (Sus.Chi.34/3) (A.Sa.Ka.3)
1 Adhmana + + +
2 Parikartika + + +
3 Parisrava + + +
4 Hrdgraha + - +
5 Gatragraha + - Sarvāngagraha
6 Jivādāna + + +
Guda
7 Vibhramśa + -
Vibhramśa
8 Stambha + - -
9 Klama + - -
10 Upadrava + - -
11 Hīna Aushadhitva - + -
12 Vāta Ṣūla - + Vedana
13 Ayoga - + +
14 Atiyoga - + +
15 Hŗidaya-Upasarana - + -
16 Vibandha - + -

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17 Pravāhika - + +
18 Visamjnata - - +
19 Vamana - + +

Table No:11 Samyak yoga, Ayoga & Atiyoga lakshnas of virecana karma
Sl. Ch.117 Sus.118 A.Hr.119
Lakṣana
no (Si.1/17-19) (Chi.33/24-26) (Su.18/38-40)
Samyak yoga lakṣana of virecana
1. Sŗoto Viśuddi + - -
2. Indriya Prasāda + + -
3 Laghuta + + -
4 Agnivrddhi + - -
5 Anāmayatva + + -
Kramāt Vit Pitta
6 + + -
Kaphagamana
7 Vātanulomana - + -
Absence of Ayoga
8 - - +
lakṣanas

Ayoga lakṣanas of virecana karma


1 Kapha Prakopa + + +
2 Pitta Prakopa + + +
3 Vāta Prakopa + - -
4 Agnimāndya + + -
5 Gaurava + + -
6 Pratiśyāya + - +
7 Tandra + - -
8 Cardi + - -
9 Aruci + + +
10 Vāta Pratilomana + - Vātagraha
11 Dāha - + +
12 Hŗdaya Aśuddi - + +

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13 Kukśi Aśuddi - + +
14 Kandu - + +

Atiyoga lakshnas of virecana karma


1 Kapha Kśaya Vikara + + -
2 Pitta Kśaya Vikara + - -
3 Rakta Kśaya Vikara + - -
4 Anilothaha + - -
5 Supti + - -
6 Angamarda + - -
7 Klama + - -
8 Vepathu + - -
9 Nidra + - -
10 Balabhava + - -
11 Tamah Praveśa + - -
12 Unmāda + - -
13 Hikkā + - -
14 Mūrca - + -
15 Guda Bhramsa - - -
Kapha,Pitta,Rahita
16 - - +
ŚvetaUdaka Nihssarana
Kapha,Pitta,Rahita
17 - - +
LohitaUdaka Nihssarana
MāmsaDhavanavat
18 - - +
udaka srava
19 Medokhandavat Srava - - +
20 Triśna - - +
21 Bhrama - - +
22 Netrapraveśanam - - +

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The concept of virecana karma

Cakrapani explains though Ayoga, Atiyog and Mithyayoga are described


everywhere accordingly in the text, but in case of vamana & virecana there is no need
to consider Mithyayoga as a separate entity.
In these procedures, expulsion occur in 4 different ways
Atipravruti – Excessive expulsion. (Elimination)
Asamyak pravruti – Expulsion by improper way.
Apravruti – Cessation of process of expulsion or improper elimination.
Alpapravruti – Expulsion in lesser quantity.
Here apravruthi & alpa pravruthi are included in ayoga. As asamyak Pravrutthi
means expulsion through opposite route, it indicates that expulsion of vitiated doṣa is
not in a quantity, which is expected, so it must be considered under the term of ayoga
and not mithyayoga120. (Cha.Si.6/29-30)
MODE OF ACTION OF VIRECANA
In Caraka saṁhita we get a brief description on how the Virecana dravya acts
in the body which is as follows. The drugs which are Uśna, Tikśna, Śukśma, Vyavāyi
and Vikāsi reach to the heart by virtue of their potency and circulate through the large
and small Sŗotas due to its Sukśma and Vyavayi properties and pervade entire body.
Then they liquefies the morbid elements by virtue of their āgneya Guna and crumbles
them by virtue of its Tikśna Guna. Then this liquefies and crumbled mass Looses
contact with the wall and the channels in the unctuous body, just like the honey, not
adhered to the unctuous vessel. This morbid mass now passes through the minute
capillaries and moves towards koṣta by virtue of the Anu, Pravana Bhāva of the drug
and ultimately reaches the Āmaśaya. From here it forces the morbid factors through
the anal route due to the Bhautika predominancy of Jala and Prithvi and Adhobhaga
Prabhava121 (Ch. K.1/4)

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Chart No: 03

Virechana dravya
(Uṣna,Tikṣna, Shukṣma, Vyavāyi and Vikasi )

REACHES Hridaya

Circulate through the large and small Srotas


(By the virtue of their potency)

penetrate entire body


(Sukṣma and Vyavāyi properties)

Liquefies the morbid elements


(āgneya Property )

Crumbles the morbid elements


(Tīkṣna Property)

Looses contact with the wall and the channels in the unctuous body,Just
like the honey, not adhered to the unctuous vessel.

Passes through the minute capillaries and moves


towards kośta ultimately reaches the āmāśaya
(By Anu, Pravana Bhāva of the drug )

Expulsion the morbid factors through the anal orifice


(Bhautika predominancy of Jala and Prithvi and Adhobhāga Prabhāva )

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DISEASE REVIEW
The concept of Āmavāta

ĀMAVĀTA

As the term indicates, the term ‘Āmavāta’ comprises of two words Āma and
Vāta. Āma being the centre phenomena of the disease which is not less associated
with the Vāta thus causing the disease Āmavāta. Here Āma plays major role in the
manifestation of the disease. Also it is considered to be the root cause of the
maximum number of disease as per the Āyurvedic text.

Āmavāta was first described as an independent disease in mādhava nidāna.It is


a disease of madhyama roga mārga.It effects sandhi and hridaya marma. As the name
suggest āma and vāta are the two predominant pathogenic factors along with tridoṣic
vitiation.

DEFINITION OF ĀMA :-

1. FwqÉhÉÉã AsmÉ oÉsÉiuÉãlÉ kÉÉiÉÑ qÉɱqÉmÉÉÍcÉiÉqÉç |

SÒ¹qÉÉqÉÉvÉrÉaÉiÉÇ UxÉqÉÉqÉÇ mÉëcɤÉÇiÉã || A.WØû xÉç 13/25

2. AÉqÉqɳÉUxÉÇ MãüÍcÉiÉç,MãüÍcɨÉÑ qÉsÉ xÉÇcÉrÉqÉç |

mÉëjÉqÉÇ SÉãwÉ SÒÌ¹Ç cÉ MãüÍcÉSÉqÉÇ mÉëcɤÉiÉã ||

3. AÉWûÉUxrÉ UxÉÈ vÉãwÉÉã rÉÉã lÉ mÉYuÉÉã AÎalÉsÉÉbÉuÉÉiÉç |

xÉ qÉÔsÉÇ xÉuÉï UÉãaÉÉhÉÉqÉÉqÉÇ CirÉÍpÉkÉÏrÉiÉã ||

Due to the decreased digestive capacity of agni in āmaśaya,the undigested and


vitiated rasa dhātu formed and is called as āma.It is also considered as mala
sanchaya,apakva anna rasa which is the root cause for all disease.
Here, the 3 different opinions about Āma are compiled by Vijaya Rakśita. First view
is about the improperly digested food and the second describes the accumulation of
Malas in the different parts of the body. According to the third view, the first stage of
Doṣa Duśti is Āma
Further to understand ‘Āma’ in better way it can be studied separately under
the following headings.
Āma produced due to
 Jatarāgni Māndyajanya

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 Dhātwāgni Māndyajanya

 Bhutāgni Māndyajanya

 Accumulated Malajanya

 Toxic Āma produced due to interactions of virulently vitiated Doṣas Initial

stage of Doṣic vitiation

VYUTPATTI OF ĀMAVĀTA :-

AÉqÉãlÉ SÒ¸Éã uÉÉiÉ AÉqÉuÉÉiÉ | vÉÉ.xÉ.mÉëç 7/41

AÉqÉålÉ xÉÌWûiÉÉå uÉÉiÉ AÉqÉuÉÉiÉ | qÉÉ.ÌlÉ.25/2 qÉkÉÑMüÉåwÉ

AÉqÉÇ cÉ uÉÉiÉÇ cÉ AÉqÉuÉÉiÉqÉç | qÉÉ.ÌlÉ.25/2 qÉkÉÑMüÉåwÉ

AÉqÉÉã AmÉÉMü WãûiÉÑÈ uÉÉiÉÈ xuÉlÉÉqÉYrÉÉiÉ UÉãaÉÌuÉvÉãwÉÈ | vÉç.Mç. .SØ

rÉ²É AÉqÉ xÉÇmÉ×£üÉã uÉÉiÉ AÉqÉuÉiÉÈ | vÉÉ.xÉ.mÉëç 7/41

AÉqÉãlÉ rÉÑ£üÉã uÉÉiÉ AÉqÉuÉÉiÉ È| vÉÉ.xÉ.mÉëç 7/41

xÉ sɤÉhÉ ÌuÉÌwÉ¹É uÉÉiÉUÉãaÉÌuÉvÉãwÉã | uÉæ.vÉç.ÍxÉ

Here involvement of two factor āma association with vāta. Āma is resulting
from improper digestion which further cause duśti of vāta leading to the disease
Āmavāta.

DEFINITION OF ĀMAVĀTA:-

rÉÑaÉmÉiÉç MÑüÌmÉiÉÉuÉliÉ: ̧ÉMüxÉÎlkÉmÉëuÉåvÉMüÉæ |


xiÉokÉÇ cÉ MÑüÂiÉå aÉɧÉÇ AÉqÉuÉÉiÉ: xÉ EcrÉiÉå || qÉÉ.ÌlÉ.25/5 qÉkÉÑMüÉåwÉ

Āmavāta is a disease where the vitiated āma with vāta is lodged in trika sandhi
area leading to stabdata.

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NIDĀNA PAÑCHAKA OF ĀMAVĀTA

NIDĀNA :-

Madavakara explains the etio-pathogenesis of Āmavāta as follows 122

• Virudha āhāra
• Virudha chesta
• Mandāgni
• Nischalata

Indulging in vyayāma soon after snigdha āhāra


Indulging in above said nidānas agnimandya takes place which leads to
production of āma rasa in the body. Even vāta doṣa gets vitiated due to above nidāna
and āma .This āma circulates in the body due to this vitiated vāta and gets lodges in
śleśma sthana mainly sandhi leading to Āmavāta.
Ahāraja Karanas:
The quality of food articles which cause the production of Āma is as follows:
Not only the nidānas of food, in respect of quantity alone causes Āma but
also the use of food and drinks which are Guru, Rukśa, Śīta, śuśka, Dwista,
Vistambhi, Vidāhi Viruddha and taken untimely
According to Suśruta it consists of excess intake of water and consuming
Viśamāsana are main causes for improper digestion, even to lighter foodstuffs in time.
10
Viśamāsana is one, which is Matrātadhika (excess of quantity), or Alpah (less) than
the required quantity and either prior to the fixed Annakāla or later as defined by
Charaka.
Viharaja Kāranas:
Sandhārana (suppressing natural urges), Swapnavipanyaya are Vihāraja
Kāranas.
Mānsika Karanas:
While afflicted with Psychic emotions such as Kāma, Krodha , Lobha , Moha ,
Irśa, Śoka , Hree , Udvega , Bhāya, Upataptāmanasa comprise Manasika Karāmas
producing Āma in the body. This is because in Swasthavritta told that while eating
concentration is also necessary so as to get benefit of food. Otherwise proper
digestion will not be taking place, but leads to Āma

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Pūrva rūpa:-
Pūrvarūpa is indicator of the arrival of disease. They sometimes simulate the
symptoms of actual disease and sometimes not, but in any case they indicate
occurrence of an ailment.
Though the Pūrvarūpa of Āmavāta is not explained in the Samhitas, we can
consider few of the Sāmanya Āmavāta Lakṣanas as its Pūrvarūpa. It is understood
from Āyurvedic classics that some of the Pūrvarūpa may continue as Sāmanya
Lakṣana of any disease.

Before the manifestation of Āmavāta formation of āma and vitiation of vāta


doṣa is important. So before the lakṣanas of Āmavāta is manifested we will see the
lakṣanas pertaining to the āma uthpatti and getting involved with vāta is seen. These
may be considered as Pūrvarūpa. The āma lakṣanas like sŗotoroda, balabramśa
,gaurava, anilamoodata, alasya, apakti, niśteeva, aruchi are seen.123
Vangasena mentioned lakṣanas like ajeerna, śiroruja,gatraruja as Pūrva rūpa of
Āmavāta124.
Avyakta lakṣana of the vyadhi is also considered as Pūrva rūpa as per caraka125.

Rūpa :-
Specific signs and symptoms of a disease when manifested distinctly are
considered as Rūpa Avastha or Lakṣana of a disease. Rūpa is one of the key tools in
arriving at the diagnosis.
After the completion of Sthana samsraya Āmavāta is produced and the
symptoms are called as rūpa.
The complete vyakta lakṣana of a disease is rūpa.
In case of Āmavāta rūpa can be put under 4 headings
1.pratyatma lakṣana
2.sāmanya lakṣana
3.doṣanubanda lakṣana
4. pravrudda Āmavāta lakṣana.

Gatra stabdhata is considered as th pratyatma lakṣana of Āmavāta126.

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127,128,129,130,131,132
Sāmanya lakṣana:-

Table No: 12 Sāmanya Āmavāta lakṣana

LAKṣANA M.N B.P Y.R G.N HS VGA


Angamarda
+ + + + - +
Aruchi
+ + + + - +
Truṣna
+ + + + - +
Alasya
+ + + + - +
Gourava
+ + + + - +
Jwara
+ + + + + +
Apaka
+ + + + - +
Angasoonata
+ + + + - +
Vikunchana of Manya
- - + + - -
Vikunchana of Prushata
- - + + - -
Vikunchana of Kati
- - + + - -
Vikunchana of Jānu
- - + + - -
Vikunchana of Trika
- - + + - -
Saśabda Gatra
- - + + - -
Srasta Gatra
- - + + - -

133
Dośānubanda lakṣana

 Vātānubnda causes------ In Vātaja type of Āmavāta, Śūla will be the


predominant symptom. This can be well correlated to the Śīta and Cala
Guna of Vayu. In Āmavāta, the path of the Vāta is obstructed due to Āma.
Hence the characteristics feature of Vāta-śūla will be more.
 Pittānubanda causes ----- Symptoms Raga and Dāha are indicative of
Pittaja Āmavāta. These are due to the Teekśna, Uṣna Guna of Pitta.

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 Kaphanubanda causes----- Symptoms Sthaimitya, Guruta, Kandu indicate


the dominance of Kapha. Sthaimitya is produced due to Picchila, Sthira
and Śīta Guna of vitiated Kapha. As Āma and Kapha have similar
qualities, Guruta and Kandu are seen in the Sandhis.
 Samsargaja: Mixed symptoms of Vātaja and Pittaja, Vātaja and Kaphaja,
Pittja and Kaphaja are seen.
Sannipātika: In Sannipātika type of Āmavāta, symptoms of all the three Doṣas are
profoundly seen.
Pravrudda Āmavāta lakṣana : 134,135,136,137,138,139

Table NO: 13 Pravrudda Āmavāta lakṣana

LAKṣANA M.N B.P Y.R G.N HS VGA


Sa Ruk Śotha Hasta
+ + + + - +
Sa Ruk Śotha Pada
+ + + + - +
Sa Ruk Śotha Śira
+ + + + - +
Sa Ruk Śotha Gulpha
+ + + + - +
Sa Ruk Śotha Trika
+ + + + - +
Sa Ruk Śotha Janu
+ + + + - +
Sa Ruk Śotha Uru
+ + + + - +
Agnidourabalya
+ + + + - +
Praseka
+ + + + + +
Utsaha Hani
+ + + + - +
Vyrasya
+ + + + - +
Dāha
+ + + + - +
Bahumutrata
+ + + + - +
Kuśikadhinata
+ + + + - +

+ + + + - +
Kukśiśūla
Nidraviparyaya + + + + - +

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Trut
+ + + + - +
Chardi
+ + + + - +
Brama
+ + + + - +
Mūrcha
+ + + + - +
Hrutgraha
+ + + + - +
Vitvibhandha
+ + + + - +
Jadyata
+ + + + - +
Antrakūjana
+ + + + - +
Anaha
+ + + + - +
Sandhi Śotha
- - - - + -
Peeta and Uṣna Chardi
- - - - + -
Trika Vyadha
- - - - + -
Prushta Vedana
- - - - + -
Manya Vedana
- - - - + -
Āma Atisara
- - - - + -
Anga Vaikalya
- - - - + -
Vrishchika damshavat
Ruja + + + + - +

Types of Āmavāta:-

Śarangadara mentions four types of Āmavāta according to the involvement of


Doṣas140.
1.Vātaja
2.Pittaja
3.Kaphaja
4.Sannipātaja
Acharya harita while explaining about the Āmavāta mentions 4 types 141.

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 Viśtambhi: This type of Āmavāta presents with Śareera Guruta, Adhmana,

and Basti Śūla.


 Gulmi Āmavāta: Āmavāta having Jatara garjana, Gulmavat peeda and Kati

jadata is called as Gulmi.


 Snehi: Here Gātra snigdhata, Jadhya, Mandāgni and excretion of Vijala and

Snigdha āma are characteristic.


 Pakva āma: This variety of Āmavāta presents with excretion of śyava vijala

pitta and Pakva āma along with Śrama and Klama.


Based on Duration:
Based on the general principle of duration, Āmavāta can be of two types.
 Naveena: If the duration of disease is not more than one year, it is called

Naveena Āmavāta which is Sādhya.


 Purāna: If the duration of Āmavāta is more than one year, it is called Purana

Āmavāta which is difficult to treat.

UPAŚAYA-ANUPAŚAYA:-

The upaśaya Anupaśaya helps the physician to diagnose a disease when he is


confused with symptoms .So the physician by looking into the upaśaya –Anupaśaya
should gain the Gudaling of the vyadhi142.
Upaśaya:
Āhāra, Auśada, Vihāra which are responsible for relief from the symptoms of
a disease are known as upaśaya. That which aggravate the condition is known as
aupaśaya143.
The symptoms of Āmavāta like sandhi śūla ,jwara,angamarda alleviate by using
uśana,tikśna, rūkśa, tikta ,katu. deepana, laghu āhāra,and uṣna vihāra. Langana
increase the agni,which helps in digestion the causative factor āma and normalizes the
symptoms like guruta, praśeka, aruchi,So here kaphagna and apatarpana measures are
adopted
Anupaśaya:
Santarpana aggravates the disease condition by increasing āmavriddhi.
Śīta,guru,snighda āhāra,snigdha sveda leads to increase of the condition.They cause
SŖOToabhiśyanda. Cloudy weather,morning hours ,Śīta kala are also anupaśaya.

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Chart NO: 4.
Schematic representation of Saṁprāpthi :-

SANCHAYA Vāta prakopaka Agni


nidāna māndyajanya

Vāta prakopa Agni māndhya

PRAKOPA
Vāta duśti Āma uthpathi

Sāma vātādhi
PRASARA doṣa

Dhamani
Pratipadyath

STHĀNA
SAMŚRAYA Trika sandhi
[kavaigunya]

VYAKTHA Saruja
śotha

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Saṁprāpthi:- 144
Indulgence in nidāna by those who have mandāgni,the āma is produced in the
āmaśaya.This āma. Associating itself with vāta,moves throughout the body with help
of vitiated vāta, and gets lodged in śleṣma sthāna mainly sandhis because of
kavaigunya present over there. This circulating āma in the dhamani vitiates the
normal vāta pitta kapha doṣas. This cause sŗoto-abhiśyandi, athi pichila, sŗotoroda.
leading to symptoms like aśudaurbalya, gaurava in hrudaya,sandhi śota,sthabdata,
śūla.
SĀDHYASĀDHYATA:-

According to charaka sadhyāSādhyata plays a very important role in selecting


the patients. By this chance of losing fame and money will be minimum145.
According to mādhavakara Āmavāta is a krichraSādhya vyadhi146. It may be curable
in the initial stage. As it becomes pravrudha it is difficult to cure. Treating āma and
vāta is much more difficult because of their opposite nature.
Āmavāta with ekaDoṣaja with few lakṣanas of recent origin is
Sādhya147.pakwaāma type described by haritha is sukasādya148. Dwidoṣaja with many
nidānas, lakṣanas, and not of recent origin is yapya.
Tridoṣaja associated with sarvānga śotha, sarvadehachara,and snehi
āma,vistambi,gulmi type is kaśta Sādhya149.

PATHYA-APATHYA

mÉjrÉ mÉjÉÉå AlÉmÉåiÉqÉç rɱccÉÉå£üÇ qÉlÉxÉÈ ÌmÉërÉqÉç|

rÉccÉÉÌmÉërÉqÉmÉjrÉÇ cÉ ÌlÉrÉiÉÇ iÉ³É sɤÉrÉåiÉç || cÉç.xÉç.25/45

The drug and regimen which do not adversely affect the body and mind are
regarded as wholesome, those which affect them considered to be unwholesome. In
vaidhyakeeya subhaśitha it is told that there is no need to take any medicine for the
disease if one follows the pathya ,and there is no need to take medicine for the one
who does not follow the pathya,as it is not giving any benefit.

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PATHYA:-
Hārita explains that the pathya told in jwara roga should also be considered in
Āmavāta as in both the disease involvement of rasavaha sŗotas is there150. All the
āhāra vihāra which are Vāta Kapha hara, Āmapāchaka, Agnivardaka are useful.Yava
,kulatha, śyāmaka, kodrava, rakthaśali, vastuka, śigru, karavaellaka, patola, ārdraka,
laśuna, uṣnajala, takra, jāngala mamsa. Panchakola siddha jala,katu tikta phala,
gokśura,varuna,arishtaka, purāna śhāli, sauveera, punarnava, lavamamsa processed in
takrakulatha yuśa ,jeerna Madhya.balataka.151,152
APATHYAS:-
The āhāra vihara which cause agnimandya, abhiśyandana, all the nidānas
which are Vāta and Kapha kara in nature is apathya to Āmavāta.
Dadhi,matsya,guda,kśeera, mahapistaka, duśta jala, virudhaśana, satmya, viśamaśana,
guru adhiśyandaāhāra,vegadharana, jagarana, nischeśtata,Dwidala danya, goulya,
taila, Śītala jala snana, uṣna drava. 153,154
CHIKITSA--

sÉÇbÉlÉÇ xuÉåSlÉÇ ÌiÉ£üÇ SÏmÉlÉÉÌlÉ MüOÕûÌlÉ cÉ |


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The treatment modalities for Āmavāta listed by Yogaratnakara and Chakradatta can
be organized into three groups,

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The concept of Āmavāta

shodhana

langhana shamana

treatment

Āmapācana:
The first step in the management of Āmavāta is Āmapachana, as it is the first
step in the general management of all the diseases and as Āma is the prime pathogenic
factor in Āmavāta.
Langhana:155
In the management of Āmavāta, Upavasa is the ideal line of treatment.
53
Bhavaprakaśa in the context of Jwara, considers Langhana as Upavāsa. As both
Jwara and Āmavāta are Āmāśayotha diseases,Upavāsa (AnaśanamUchyate) can be
considered as the ideal method of Langhana in Āmavāta also. This is also because of
unsuitability of the other methods of Langhana, analysed below.
o Chatuśprakara samśudhi, cannot be employed because Samśodhana is
contraindicated in the Sāmavastha of a disease. Pipasa cannot be employed
because in morbid patients Jala is Pranadharaka Maruta and Atapa Sevana are
less efficient for Jatharagni impairment when compared to Upavāsa.
o Deepana, Pachana cannot be employed as Agni affected by Āma is incapable
of Doṣa, Āhāra and Oushadha Pachana. Vyayāma is incompatible in the
disease Āmavāta.
For these reasons, Upavāsa is the ideal method of achieving Langhana in
Āmavāta, which can be achieved by Anaśana or Alpabhojana. The Langhana thus
achieved will have Āmapachaka effects at the Koṣta level as well as Sārvadaihika
level
Svedana:
The definition of Sveda includes its benefits, viz. Stambha, Gourava and
Śītagna. Since these are antagonistic to the qualities of Kapha and Āma, Svedana has
an important role to play in the treatment of Āmavāta. Snigdha Sveda, Rukśa Sveda

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The concept of Āmavāta

and Ekangasveda, Sarvāngasveda are the two fold classifications of Sveda and in
Āmavāta, the Rukśa type of Sveda should be administered for the following reasons;

The pathogenesis of Āmavāta involves spread of Āma and Vāta to the
Sleśmasthana, specifically Āmaśaya and Sandhi.In all conditions of
Āmaśayagata vāta, Rukśa sveda should be administered. As disease is localized
in Sandhipradeśa, Ekangasveda is ideal. The Rukśasveda can be advised to the
affected Sandhi using Valukapottali or Rukśopanaha.
Tiktam Deepanani Katuni Cha:
Administration of Tikta, Katu Deepana oushadhis in Āma achieves
Āmapachana both at the Koṣta level and Sarvadaihika level. The methods used for
Āma Pachana are potentially Vātaprakopaka. But as Langhana is indicated in Sāma
Vāta condition the danger of Vāta Prakopa is minimal because, the Āmapachana
methods of Langhana, Svedana and Tikta Katu Deepana drugs are administered only
until Nirāmavastha is achieved. After this, Nirāma Doṣas have to be eliminated from
the body by śodhana. The śodhana methods which can be employed are Virechana
and Basti.

Virechana:
Virechana is the best preferred form of Śodhana in Āmavāta because Vāmana
(Ullekhana), (Ullekhana) though indicated by Charaka in Āmachikitsa is unsuitable
here as it aggravates the symptoms of Āmavāta caused by Pratilomagati of Vayu like
ānaha, Vibandha and āntrakūjana. They can best be relieved by Virechana..

Basti:
Basti forms the second method of Śodhana. Both Niruha and Anuvāsana
Bastis should be employed here. The Niruha Basti does the śodhana of the Doṣas
brought to Pakvaśaya and the Anuvasāna Basti alleviates Prakupita vāta as a
consequence of Niruha Basti.

Śamana Snehapana:
This is a third component in the plan of management of Āmavāta. The
objective of Snehapāna here is śamana. It is important to administer Sneha only after

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The concept of Āmavāta

the disease has become Nirāma. śamana Snehapana in Āmavāta provides the
following benefits;
o Snehapana prevents the aggravation of Vāta and Rukśata as a result of the
previously employed therapeutic measures.
o It helps in increasing the Bala of the patient who has been debilitated as a
result of previously employed therapeutic measures. śamana Sneha stimulates
the Agni which is an important component in the treatment of Āmavāta.
o Since the Snehapana has been prescribed in Asthi Majja Gata Vāta, it can be
comfortably used in Āmavāta. Vātaharana is the inherent property of Sneha,
an essential requirement in the treatment of Āmavāta.

SĀPEKŚA NIDĀNA
Sapekśa nidāna is the comparison of diseases having look alike feature.Āmavāta is a
painful joint disorder which has to be differentiated from other painful joint diseases
like,
1. VĀTA RAKTA:- 156
In this disease as the name suggest involvement of rakta plays important role in
causing disease. Main feature of the disease is, it affects classically the big toe with
some skin manifestation. Pain will be like akūviśa
2. SANDHIGATA VĀTA:-157
Here swelling occurs like air filled bladder in touch and pain during contraction
and extension of limb.

3. KOŚTUKA ŚĪRŚA:-158
It is mainly due to vāta and śonitha.It effect only knee joint. Pain is severe and the
shape of joint is śrigala mastakavath.( head of a jackal)

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Rheumatoid Arthritis

RHEUMATOID ARTHRITIS: 159

Definition:

Rheumatoid Arthritis is a chronic disease, cause of which is unknown. It

persists with inflammatory synovitis, usually involving peripheral joints in a

symmetric distribution – apart from variety of systemic manifestations. Cartilage

destruction due to synovial inflammation and bone erosions are important findings in

this disease. Many times course of the disease may be quiet variable. Starting from

only a minimal joint damage to a progressive polyarthritis marked functional

impairment are seen during varied course of Rheumatoid Arthritis.

Epidemiology and genetic factors

RA is prevalent throughout the world and involves all ethnic groups .The

figures of prevalence vary substantially ranging from 0.3% to 1% of the population

Indian data suggests the prevalence to be around 0.65% to 0.75% of the population. 1-

3%of women may develop RA in their life time .Initial studies RA was shown to be

association with HLA DH4 haplotype.In recent studies HLA-B1 gene association has

been suggested particularly in patients with extra articular manifestation .It alleles

determine disease progression and severity.RA can run in families with such genetic

predisposition.

Etiology:

Cause of Rheumatoid Arthritis remains unknown. Some suspect as

manifestation of the response to an infection agent in a genetically susceptible host. A

number of causative agents have been suggested, including Mycoplasma, Epstein-

Barr Virus (EBV), cytomegalo virus, Pasvo virus and rubella virus, but convincing

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Rheumatoid Arthritis

evidence that these or other infections agents cause RA has not emerged. One

possibility is that there is persistent infection of articular structures or retention of

microbial produces in the synovial tissues, which generates a chronic inflammatory

response. Autoimmune mechanism related to the connective tissue more particularly

the sinovium is mostly accepted as the pathology of the illness.

Clinical manifestations:

Usually RA is a chronic polyarthritis. Begins with fatigue, anorexic,

generalized weakness and vague muscle skeletal symptoms, until the appearance of

synovitis becomes apparent – which persist for weeks or months together. Specific

symptoms usually appear gradually as several joints, especially of the hands, wrists,

knees and feet, become affected in a systematic fashion. About 10% of the patients

start the disease acutely, with rapid development of polyarthritis, often accompanied

by constitutional symptoms including fever lymphadenopathy and splenomegaly. In

one third of patients, symptoms may initially be confined to one or a few joints

though symmetric pattern is more typical even some cases are seen with asymmetric

fashion.

Articular manifestations of RA:-

The wrist are most commonly affected among all patients .The metacarpo

phalngeal and proximal interphalngeal joints are frequently involved, classical

deformities seen in the hands are ulnar deviation ,rupture of extensor tendons,swan

neck deformities and Boutonniere’s deformities .In shoulder only objective finding is

loss of motion .Elbows being a superficial joints, inflammation can be detected early

enough. In hips early manifestation do not become apparent as the point is deep

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Rheumatoid Arthritis

seated. Knees are involved very commonly in RA and detected easily .Popliteal cyst

[baker’s cyst] may be associated with rupture into the calf muscle, producing pain,

swelling and tenderness in the calf .Foot and ankle are weight baring structures

commonly involved in RA .The Metatarsophalngeal ,talonavicular and ankle joint

affection leads to ‘cock up’ deformities of the toes and subluxations of the meta tarso

phalngeal heads on the soles .

Extra articular manifestations :-

RA being a systemic disease, many patients experience malaise and fatigue.

Early morning stiffness is a characteristic event and may last till afternoon depending

on severity.The extra articular manifestation like

Systemic –Low grade fever, loss of appetite, loss of weight.

Musculoskeletal – Muscle wasting, bursitis, teno synovities .

Skin- Subcutaneous nodules, ulcers, vasculitis.

Eye – Sicca syndrome, episcleritis .

Respiratory – pleural effusion, Bronchiolitis, fibrosing alveolitis .

Cardic- Pericarditis ,Myocarditis ,endocarditis

Haematological –Anaemia ,thrmbocytosis ,splenomegaly .

Neurlogical - Cervical compression, peripheral neuritis

Diagnosis:

It has been estimated in general that the diagnosis of RA takes about 9

months. However it is easier where typical manifestations. On the other hand typical

manifestations may be delayed up to 2 years of onset. The typical picture of bilateral

symmetric inflammatory poly arthritis involving small and large joints in both the

upper and lower extremities with sparing of the axial skeleton except the cervical

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Rheumatoid Arthritis

spine suggests the diagnosis. Constitutional features like morning stiffness support the

diagnosis. Same way subcutaneous nodules start appearing give more affirmation.

Additionally, the presence of Rheumatoid factor, inflammatory synovial fluid with

increased numbers of Polymorph nuclear Leucocytes and radiographic findings of

juxta articular bone demineralization and erosions of the affected joints substantiate

the diagnosis. To solve this difficulty American Rheumatism Association (ARA)

proposed criteria for its diagnosis in 1987 revised criteria.

The diagnosis is somewhat more difficult early in the course when only

constitutional symptoms or intermittent arthralgias or arthritis in an asymmetric

distribution may be present. A period of observation may be necessary before the

diagnosis can be established. A definite diagnosis of RA depends predominantly on

characteristic clinical features and the exclusion of other inflammatory processes. The

isolated finding of a positive test for RA factor or an increased E.S.R are accessory

especially in an older person with joint pain, but should not its

Laboratory investigation:-

There is no specific diagnostic test to confirm the diagnosis of RA .The extent

of elevated ESR and CRP should be a good measure of the intensity of the disease .Rh

factor is present in about 75 %of the patients.

Treatment:- Goals of treatment of RA is

• Relief of symptoms

• Preservation of function.

• Preservation of structural damage and deformity.

• Maintenances of patient’s normal life style.

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Rheumatoid Arthritis

Recent data suggests that an RA patient has a reduced life style expectancy of 7.5 -10

years. Also deformity occurs rapidly and often within 6 months to 2 years from the

start of the disease.The analgesics and NSAID’s are not enough and disease

modifying anti rheumatic drugs [DMARD] need to be introduced early enough in the

treatment of RA.

NSAID:-It makes little difference which NSAID is used but recently COX-2

inhibitors [Celecoxib and Rofecoxib] are claimed to have better gastric tolerability.

CORTICOSTEROIDS: - A small dose of 5mg to 7.5mg of oral Prednisolone daily as a

routine. Classical indications of use of corticosteroids in RA are acute disease and

flare ups, bridge therapy while waiting for response of DMARD’s vasculitis and old

age.

DMARD: - The treatment of choice is the use of DMARD s early RA as well

In early and mild RA Chloroquine or Hydroxyl Chloroquine may suffice .In moderate

to severe RA, Methotrexate alone ,Sulphasalazine alone or a three drug combination

of Chloroquine ,Sulphasalazine and Methotrexate used.Cytotoxic drugs may be used

if this combination fails .

Biological agents

Recently, tumour necrosis factor for blocking monoclonal antibodies have

been introduced .The most successful ones are etanercept and infliximab .Etanercept

25 mg s/c twice a weak .Infliximab 3-4 mg /kg body weight by iv on day 1st ,14th,

and 60th and repeated every 60th days.

Surgical treatment:-

Surgical treatment can be offered to patients by way of synovectomy

Joint replacement: - To remove pain, improve and preserve joint function.

Tendon reconstruction: - For damaged tendon by attaching an intact tendon to it .

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Rheumatoid Arthritis

Persistent pain deformity and difficulty in activities of daily living are the main

indication for surgery.

Prognosis

RA is a chronic disease undergoing exacerbation and remissions if left

untreated. Generally speaking, the disease is progressive and could lead to joint

deformities. With treatment remissions can be induced and deformities can be

prevented though not always. Factors associated with poor prognosis

- Insidious polyarticular onset.

- Male patient.

- Extra articular manifestation.

-Functional disability one year after the disease has started.

-Substantially raised concentration of Rh factor.

- Presence of HLA –DR4.

-Radiographic evidence of erosions within 3 years of start of the disease.

Differential diagnosis

RA differentiated from other diseases having similar features like joint

features like joint pain etc signs and symptoms and biochemical investigations.

Gout:-It is a true crystal deposition disease.In pathological investigation high

serum uric acid level is present .Acute gout causing swelling, erythema, extreme pain

and tenderness in first metatarso-phalngeal joint.

Osteoarthritis:-Mainly related to movement and weight bearing joint, usually

only one or few joints involved, joint crepitation seen. RAfactor negative,ESR usually

normal.

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Rheumatoid Arthritis

Systemic lupus erythematosis: - It is characterized by the presence of

numerous auto antibodies, malar rash, discoid rashes present, chronic inflammatory

arthritis, photosensitivity present.Involvement of more than one system is seen.

Rheumatic fever:-First attacks are usually under 15 years of age in 70 of

case. It is characterized by fleeting type of joint pain with sustained fever.

Myocarditis; Endocarditic may be present. ASO titer usually positive.

Septic arthritis: - Hip and knee are more affected with abrupt onset of pain

and swelling. Joint is held in flexion and movement is restricted.

Psoriatic arthritis:- It is a type of inflammatory arthritis that affects people

suffering from the chronic skin condition psoriasis. It also cause tendinitis and a

sausage-like swelling of the digits known as dactilytis.

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DRUG REVIEW
Drug profile

Drug review

FOR THE PRESENT STUDY 5 GROUPS OF DRUGS WERE USED :

Drug for pācana& dīpana

Drug for the koṣta parikśa

Drug for sneha pāna

Drug for svedana karma

Drug for Virecana karma

1.Drug for pācana & dīpana


Table NO: 14 pañcakola curṇa 160
Properties and therapeutic effect of the individual drugs in pañcakola curṇa:

Latin Doṣagna
Name Rasa Guna Virya Vipaka Karmukata
Name ta

Dīpana,
Lagu, triptigna,
Piper AnUśnaŚīt Kaphavā
Pippali Katu snigdha, Madhura vātanulomana,
longum a ta
tīkśna Mruduvirecana,
balya, rasayana
Dīpana,
Lagu, triptighna,
Pippali Piper AnuśnaŚīt Kaphavā
Katu snigdha, Madhura vātanulomana,
moola longum a ta
tīkśna Mruduvirecana,
balya, rasayana

Dīpaka, pacaka
Piper Lagu, Kaphavā
Cavya Katu Uśna Katu śoolapraśamana
caba rookśa ta
vātanulomana

Plumbago Lagu, Dīpaka, pacaka


Kaphavā
Citraka zeylanicu Katu rookśa Uśna Katu śoolapraśamana
ta
m tīkśna vātanulomana

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Drug profile

Dīpana, pacana
Zingiber Lagu, Kaphavā
Nagara Katu Uśna Katu śūlapraśamana
officinale snigdha ta
vātanulomana

2. DRUG FOR THE KOSTA PARIKŚA :-


Triphala curṇa 10 gm with hot water is advised for one day in the morning.
Table NO: 15 Koṣta parikśa drug review.
Cemical
Drug Rasa Guna vīrya Vipaka Compositi Karma
on
Lavanavarjith
Haritaki Tridoṣahara,
a Chebulagic
(terminal Laghu Madhur srotośodana
Pancarasa. Uśna acid,corlia
a Rukśa a Pramehagna,
Kaśayarasa gin,tanin
Chebula) kustagna,,jwaragna
pradhana
Amlaki Lavanavarjith Tridoṣahara
Guru, Gallic
(emblica a pancarasa, Madhur pramehagna,
Rukśa Śīta acid,tannic
officinali Amlarasa a kustagna,
Śīta acid,vit-c
s) pradhana śotagna,rasayana
Vibhitaki
Tanin,galic Tridoṣahara,kapha
(terminal Laghu Madhur
Kaśaya Uśna acid,ethyl vikara medo vikara,
a Rukśa a
gallate rasa vikara hara
Bellirica)

Triphala is having the properties like kapha pittagna ,kuśta mehahara, sara
guna,cakśuśya,dīpana ,ropana .rasayana.
3 . Drug for snehapāna 161
Drug for the snehapāna is mūŗcita ghrita: --Ama is one such entity which is
not only seen in śarira but also in dravya, so the ideal formulation śould be free from
ama. Gritha mūrcana is the technique to remove the ama present. The esters present in
the raw ghī hinders the absorption as well as it won’t allow other active principles to
mingle with the lipid molecule. Mūrcana process removes these unwanted esters.
Table NO: 16 mūŗcita gritha:

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Drug profile

Drug Rasa Guna vīrya Vipaka Karma

ghrita Madhura SnigdhaŚīta Śīta Madhura vāta pittahara

Tri phala -- ---- --- --- -----

Haridra
Tikta katu Rukśa laghu Uśna Katu Kaphavāta śamaka
Curcumalonga

Matulunga Laghu snigdha Kapha vāta hara, dipana


Amla Uśna Amla
Citrus medica tikśna hrudya rucya

Ghrita is said to be the best among all snehadravya.it is tridoṣa śamaka. It has
the quality to gain the property of drugs when it is processed with any drug without
loosing its original property. It is also a best rasayana. It can be used in large amount

as it is satmya and also it is better administered as it is routinely used162 .


Ghee: -163
Ghee is the animal product obtained from milk of mammalian especially
from cow, sheep, goat, and buffalo. The quality of ghee may differ from each other,
but basic qualities remain the same. Ayurveda also mentions different features to each
animal. Among these the cow’s ghee is considered as the best. Clarified milk fat is
known as ghee, it is prepared by heating butter or cream to just over 100 degree c to
remove water content from it. The residue is filtered out as it is pure ghee. Its melting
point is 33-37 degree c. Ghee is stored for long period as it resists spoilage by micro
organisms. Ghee has 8 percent lower saturated fatty acids which makes its
digestibility easy. Its absorption rate is 96 percent .the lipophilic nature of ghee
facilitates entry of the formulation into the cells and its delivery to the mitocondria
and nuclear membrane, because cell membrane also contains lipids.

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Drug profile

Chemical composition of cow’s ghee:


Table NO: 17
Triglycerides 97-98%, Diglycerides 0.25-1.4% Monoglycerides 0.16-0.038%
Ketoacidglyceride0.015- Glycerylesters0.011-
Free fatty acids 0.1 to 0.44%
0.018% 0.015%,
Phospholipids 0.2-1.0% Steroles 0.22-0.41% Vit a 2500 i.v./100 gm
Vitd=8.5x10.7gm/100 gm Vite 24x10.3 gm/100 gm Vit k - 1 x 10.4 gm/1100 gm
Butric acid 4.5 - 6.0% Caproic acid 1.0 - 1.36% Caprylic acid 0.9-1%
Capric acid 1.5-1.8% Lauric acid 6-7%, Myristic acid 21-23%,
Palmitic acid 19-19.5% Stearic acid 11-11.5% Arachidic acid 0.5-0.8%
Oleic acid 27-27.5%, Linoleic acid 4-5%.

in the present study mūŗcita gritha was prepared using cow’s ghee and used for
snehapana.
4. Drug for svedana karma
Drug selected for abhyanga - saindavadi taila 164 (bhi,ra. 29/221)
Table no: 18 RASAPANCAKA OF SAINDHAVADI TAILA.

Properties
Drug Latin name Rasa Guna Virya Vipaka Karma
Laghu, Tridoṣa Śamaka
Saindhava Madhur Snigdh Śīta Dīpana,Pācana
Katu
Lavana a Rucya,Vruśya

Lagu
Devadaru Cedrus deodara Tikta Uśna Katu Vedanastapaka
Nigdh

Acorus Katu Medhya


Vaca Lagu Uśna Katu
calamus Tikta Lekhana
Zingiber Laghu Truptighna
Katu Uśna Madura
Śunti officinale snigda Dīpana
Myrica nagi Laghu Rucya,
Tikta Uśna Katu
Katphala thumb Tiksna Vedanasthapana

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Drug profile

Anethum sowa
Katu Snigdh Uśna Katu Dīpana,
Śatahwa kurz

Rukśa,
Musta Cyperus Tikta,
Laghu, Śīta Katu Dipana-pācana
rotundus linn Katu

Piper Lagu Dīpana


Katu Uśna Katu
Cavya retrofractum Rukśa

Polygonatum Rasayana, balya


Medha Madhura Guru Śīta Madhura
cirrhifoliumm
Croton tiglian Virecana,
Jayapala Katu Guru Uśna katu
linn Dīpana

Operculina Tikta, Laghu, Virecana


Trivrith Uśna Katu
turpeethum Katu Rukśa

Hiijala Barringtonia Tiktha Laghu, Uśna Vātahara,


Katu
twak acutangula katu, rukśa viśagna,

Pavonia Laghu Balya, dīpana


Netra bala Tikta Śīta Katu
odorata Rukśa pācana, pittahara

Lagu
Plumbago Dīpana
Citraka Katu Rukśa Uśna Katu
zeylanica Lekhana
tikśna

Bramhana Clerodendron Laghu


Tikta Uśna Katu Dīpana pācana
estika siphonatus

Kaempferia Tikśna
Śati Tikta Uśna Katu Ruciprada
galangal linn

Emblica Katu Lagu Katu Kuśtagna


Vidanga Uśna
Ribes Kaśay Uśan Krimighna

Guru
Gkycyrrhiza Tridoṣa hara,
Madhuka Madhura snigdh Śīta Madhura
glabra linn rasāyana, vruśya
a

Vāta, kapha hara


Katu Laghu,
Renuka Vitex negundo Uśna Katu śulahara śopha
tikta rukśa
hara

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Drug profile

Katu Lekhana
Aconitum
Tikta Uśna Uśna Katu Samgrahak
Ativiśa Hetrophyllum
Dīpana

Recana,
Ricinus Snigdh
Eraṇda Madura Uśna Madura Vriśya
communis linn a

Ambasta Cissampelos Tikta Laghu, Uśna Katu Vāta kapha hara,


pariera linn tīkśna grahi, balya
Indigofera Tikta Laghu, Uśna Katu Kapha vāta hara
Nilini tinctoria linn Rukśa

Danti-mula Baliospermumon Katu Guru,tik Uśna Katu Recana,


tanum sna Dipana

Marica Piper nigrum Katu Laghu Uśna Uśna Śirovircana


snigda

Carum Katu Lagu Uśna Katu Dīpana


Ajamoda roxburghian Tikta Rukśa tikśna

Pippali Piper longum Katu Laghu Uśna Madura Dīpana truptighna


tikśna
Tikta Lagu Uśna Katu Sukra śodaka
Kuśta Saussurea lappa Katu rukśa Lekhana

Rasna Alpinia Tikta Guru Uśna katu Ama pācana


officinarum
hance
Pippali Piper longum Katu Lagu Uśna Katu Dīpana
Mula Rukś

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Drug profile

5. Drug for virecana karma


165
Eraṇda taila + triphala kwatha
Triphala 166
As the name itself implies that, it is nothing but the combination of three fruits i.e.
Amalaki, bhibitaki, and haritaki.(su.su.38/56-57).but some sort of controversy arises
among the later authors regarding the quantification of these drugs whic is tabulated
as follows167,168
Table NO: 19

Sl. Madanpala Bhāvaprakaśa


Drug Yoga ratnakar
No. Nighantu

01 Haritaki One 3 part 1part

02 Bibhitaki Two 6 part 1part

03 Amalaki Four 12 part 1part

Rasa pancaka of triphala :


Table NO: 20
Chemical
Drug Rasa Guna Vīrya Vipāka Compositi Karma
on
Lavanavarjith
Haritaki Chebulagi Tridoṣahara,
a
(terminal Laghu c srotośodana
Pancarasa. Uśna Madhura
a Rukśa acid,corlia Pramehagna,
Kaśayarasa
Chebula) gin,tanin kustagna, jwaragna
pradhana
Amlaki Lavanavarjith Tridoṣahara
Guru, Gallic
(emblica a pancarasa, pramehagna,
Rukśa Śīta Madhura acid,tannic
officinali Amlarasa kustagna,
Śīta acid,vit-c
s) pradhana śotagna,rasayana
Vibhitaki Tanin,gali
Tridoṣahara,kapha
(terminal Laghu c
Kaśaya Uśna Madhura vikara medo vikara,
a Rukśa acid,ethyl
rasa vikara hara
Bellirica) gallate

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Drug profile

Triphala is having the properties like kapha pittagna, kuśta mehahara, sara guna,
cakśuśya, dīpana ,ropana .rasayana.
Actions of triphala169
Actions (a.hr.su 6/159)
Dermatological disorder - kuśta
Metabolic disorder - prameha,sthoulya
Git disorder - malabddhata, agnimandya
E.n.t. disorder - disease related to netra
Chemical composition of triphala 170
Tannins>25%
Function -detoxification
Each of the three herbal fruits of triphala takes care of the body by gently
promoting internal cleansing of all conditions of stagnation and excess while at the
same time it improves digestion and assimilation.
Among Tibetians, haritaki is so highly revered for its purifying attributes that it is the
small fruit that is depicted in the hands of the "medicine buddha" in their sacred
paintings or tankas. Of the three fruits, haritaki is the most laxative and contains
anthroquinones similar to those found in rhubarb and cascara.
How is triphala different from other kinds of laxatives? There are two primary
types of herbal laxatives. One is called a purgative and includes herbs such as senna,
rhubarb, leptandra, buckthorne and cascara. These often contain bitter principles in
the form of anthroquinones which work by stimulating the peristaltic action of the
intestinal lining, either directly or by promoting the secretion of bile through the liver
and gall bladder.
The second type of laxative is a lubricating bulk laxative, including demulcent
herbs such as psyllium and flax seed. This is more nutritional and usually does not
have any significant direct effect on either the liver or the gall bladder171

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Drug profile

Eraṇda taila:172

Ricinus Communis173
English: CastorBean, castoroil plant
Hindi: Endi
Sanskrit: Eraṇda
The plant has been cultivated for over 6000 years and was a source of oil for
lamps and cosmetics in ancient Egypt. The toxicity of the plant has been well
publicised as a result of a political assassination in London that was carried out using
an umbrella tipped with the plant's main toxin, ricin. Greek physicians of the first
century AD regarded the oil as suitable only for external application, a view which
persisted until the 18th century, when it was listed in many pharmacopoeias as a
purgative. The generic name is from the Latin ricinus, meaning 'tick', because the
mottled seeds of the plant are similar in śape to these insects. The Egyptian Ebers
papyrus of c. 1500 BC lists the plant.
Habitat

The castor oil plant is probably native to eastern Mrica, but it is cultivated in
hot climates around the world, especially India and other parts of southern Asia. It is
also widely naturalised.
Botanical description
A tall, glaucus, branched śrub, reaching up to 4 m in height (Plate 51). The
stem is erect and hollow, greyiś-green when young and becoming browniś-red when
older. The leaves are petioled, green and occasionally frosted blue or red, and
arranged in a spiral. The blade is peltate, usually divided into palmate, ovate-oblong
or Ian ceo late lobes up to 60 cm in diameter. The ribs are palmate and the margins
irregularly serrate. The inflorescences are terminal panicles,15-50 cm long, with the
female flowers in the upper section of the inflorescence. The perianth is divided into
five lobes and the style has three red, doubly split stigma branches. The male flowers
bear numerous, heavily branched stamens with up to 1000 separate bursting anthers.
The fruit capsule is soft and prickly or smooth and grooved, 1-2.5 cm in diameter. The
capsule bursts open when ripe, śowing the large, brightly speckled seeds. Castor oil is
fatty oil obtained from the seeds.

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Drug profile

Parts used
Oil, leaves, seeds and root.
Traditional and modern use
Castor oil is used internally in folk medicine for acute constipation, intestinal
inflammation, for removal of worms, rheumatism and as a form of birth control. The
extracts of the seeds are also used for this purpose. The oil is used externally for
inflammatory skin disorders, furuncles, carbuncles, abscesses, inflammation of the
middle ear and headaches. In Chinese medicine oil is used to treat sore throat, facial
paralysis, dry stool, furuncles, ulcers and festering inflammation of the skin. The
leaves are used as an emmenagogue, antiinflammatory and febrifuge and the root has
been used to treat liver diseases and various forms of inflammation.
Ethnoveterinary usage
It is used as feed after detoxification.
Major chemical constituents
Phytosterols
Brassicasterol, campesterol, β-Sitosterol, β amyrin, lupeol and derivatives are
present in the aerial parts.
Flavonoids, coumarins and phenolic acids Epicatechin, corilagin, ellagic,
gallic, chlorogenic and neo-chlorogenic acids, hyperoside, kaempferol, quercetin,
isoquercetin and rutin, 6,7-dihydroxy-8 methoxy coumarin and 6,8-dihydroxy-3,4-
dimethoxy coumarin3-6 are all present in the aerial parts.
Alkaloid
Ricinine is present in the seed.
Proteins
Ricin-A, B, C, D and E, and IX-, β- andy ricin8-1° have been found in the
seed,
Fatty acids
Ricinoleic acid is the main component of the oil, together with linoleic,
palmitic, oleic and stearic acids.
Medicinal and pharmacological activities
Lipolytic activity: Ricin śowed lipolytic activity on neutral lipids both in emulsions
and in a membrane-like model. The activity was found to be proportional to ricin and
substrate concentrations and to be pH and galactose dependent. These data support the
idea that a lipolytic step may be involved in the process of cell poisoning by ricin.
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Antibacterial activity: Various types of extracts exhibit antibacterial activity,


including an ethanolic extract of an in vitro callus culture of Ricinus communis which
śowed activity against six bacterial strains, The methanol extract of the root was
active against Staphylococcus aureus and produced weak activity against Śigella
boydii. II The ethanol extract of the dried leaf was active against Bacillus subtilis as
well as. Staphylococcus aureus and an acetone extract against Serratia marcescens,
Śigella flexneri, Escherichia coli, Pseudomonas aeruginosa, Salmonella typhi and
others. The water extract was active on E. Coli.
Anthelmintic adivity: Potent anthelmintic activity was observed from a tissue
culture of the plant against Mesocestoides corti and Taenis crassiceps.
Immunomodulating activity: Peptides from the seeds have been used in the
preparation of immunomodulating drugs controlling the production of tumour
necrosis factor (TNF).
Central nervous system (CNS) stimulant: An extract of the pericarp of the
castor bean showed typical CNS stimulant effects when administered to mice. The
animals became exophthalmic, presented tremors and clonic seizures, and died a few
minutes after receiving high doses of the extract. At lower doses, the extract improved
memory consolidation and showed some neuroleptic like properties, including a
decrease in exploratory behaviour and catalepsy. Similar properties were also
observed using ricinine, a neutral alkaloid isolated from the extract. The therapeutic
index of ricinine is of the order of 200 and it may therefore be a promising cognition-
enhancing drug.
Laxative effects: Castor oil has been used since ancient times as a laxative,
the active principle being ricinoleic acid. This hydroxylated, long-chain fatty acid has
multiple effects on the intestinal mucosa, resulting in fluid secretion. Mucosal effects
were considered to be due to enteritis or interference with cellular metabolism but
more recent studies have revealed that castor oil increases mucosal permeability,
associated with release of eicosanoids, platelet-activating factor, other autacoids and
nitric oxide. In addition, ricinoleic acid disrupts normal intestinal motility. The
combination of these effects on the mucosa and smooth muscle of the gut is thought
to account for its laxative action. Castor oil decreases fluid absorption and increases
secretion in the small intestine and colon and decreases activity of the circular smooth
muscle, which is believed to produce an increase in intestinal transit. The mechanism
by which it produces the effect on the gut may involve inhibition ofNa+ and K+-
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ATPase, activation of adenylate cyclase, stimulation of prostaglandins and nitric


oxide biosynthesis. Castor oil changes the intestinal permeability and causes
histological abnormalities, but these alterations are not essential for the laxative
effect. Platelet-activating factor (PAF) is most likely one of the mediators of castor oil
induced damage, while nitric oxide has a protective role possibly by reducing PAF
biosynthesis. Other properties may be due to the presence of lectins which interfere
with bacterial adhesion.
Antiinflammatory activity: The petroleum ether extract exhibited significant
antiinflammatory activity against induced rat paw arthritis and was safe up to a dose
of 1 glkg PO. A water extract of the root bark śowed analgesic activity when
administered to rats, using the tail-flick response to radiant heat.

Hepatoprotective activity: The alcoholic extract of the leaf śowed activity


against galactosamine- and paracetamol-induced hepatotoxicity in rats. N-
demethylricinine, isolated from the butanol fraction, was found to be the active
compound. It restored the altered levels of several enzymatic and non enzymatic
parameters in the serum and liver and in hepatocytes isolated from paracetamol-
treated rats, the compound reversed the biochemical changes produced by
galactosamine. It was also found to possess significant choleretic and anticholestatic
effects.
Abortifacient and contraceptive activity: The oil śowed abortifacient
activity when taken orally by pregnant women. Extracts of the seed have been tested
in women and found to produce long-term contraception.

Anticonvulsant activity: The ethanol extract of the freś root, administered to


mice at variable dosage levels, was active against phenmetrazole-ind uced
convulsions.

Diuretic effects: Ethanol extracts of the seed and an aqueous extract of the
aerial parts produced diuresis when administered intragastrically to rats.

Antifilarial and nematocidal activity: Methanol extract of the dried leaf was
effective against Onchocerca volvulus. Castor leaves alone, or in combination with
different levels ofN, P and K-enhanced plant growth fertilisers, reduced the nematode
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Drug profile

population.

Antiamoebic activity: Ethanol:water (1: 1) extracts of the root and stem in


broth culture were active against Entamoeba histolytica.

Antischistosomal activity: The seed oil, when administered intragastrically to


mice at a dose of 0.3 mllday for 7 days, śowed activity against Schistosoma mansonii.

Antioxidant effects: Ricinus communis extract produced an inhibition of aryl


hydrocarbon hydroxylase (AHH) activity and HZ02 production by lindane-induced
mouse hepatic micro somes, indicating the antioxidant activity of the plant. The
methanol extract of the seed also demonstrated strong antioxidant activity.
Ayurvedic properties
Rasa: Madhura, katu,. Kaśaya.
Guna: Guru, snigdha, riśna, sukśma
Vīrya: Uśna
Vipaka: Madhura
Doṣa: Pacifies kapha and vāta
Eraṇda taila & triphala curṇa :174 As Bowel Cleansers - Benefits of
Natural Bowel Cleansers Bowel cleanser can simply be defined as the one that can
cleanse the bowel, the intestines. The intestines face lots of difficulties and troubles
during their functioning. This is because what we eat or consume daily not necessarily
to be of good condition; unknowingly we may consume the food that is not so
compatible with our digestive system and this food may then create some problem or
alteration in intestinal functioning.
Haritaki, an Ayurvedic herb is very useful and considered to be a bowel cleanser.
When haritaki is combined with two other fruits namely; bibhitaki and amalaki-it
makes a wonderful formula called triphala or trifala. Triphala is considered to be the
most powerful formula as natural bowel cleanser. Triphala is available in the
powdered form and you can also have it in capsules/pills form.
Another such natural bowel cleanser is herb called as Eraṇda. This works as bowel
regulator and helps in getting rid of bodily toxic materials present in the intestines.
However, the dosage of eraṇda taila depends upon the condition and also upon the
patient’s tolerance.
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METHODOLOGY
Methodology

Āmavāta is a disease having the predominance of Vāta doṣa,


concurrently involvement of morbid Kapha and Āmadoṣa must be also taking into
consideration. The therapeutic approach should be on Vāta doṣa, Kapha doṣa,
correction of Āmadoṣa and of course the treatment of Agni viz. Pitta. Hence a
treatment which should alleviate morbid vāta, pitta, kapha is required in Āmavāta.
Virecana is one such Śodhana procedure. The line of treatment for Āmavāta includes
virecana karma. Keeping the above said factors about Āmavāta, the virecana karma is
taken for the study.

OBJECTIVE OF THE STUDY:

To evaluate the effect of virecana karma in patients suffering from Āmavāta.

PATIENTS AND METHODS:-


Source of the data:-
Patients who were attending the OPD & IPD of S.D.M āyurveda hospital
udupi fulfilling the criteria of selection were incorporated in the study irrespective of
the caste, sex, race & religion. Patients were examined clinically. For this study 20
patients were selected
Method of collection of the data:-
It is a single blind study to assess the efficacy of virecana karma in the
management of Āmavāta.
A detailed proforma was prepared considering the points pertaining to history, signs,
symptoms & examinations as mentioned in āyurvedic classics and allied sciences to
confirm the diagnosis.
Inclusion criteria:
 patients aged between 16 to 60 years
 patients suffering from Āmavāta
 patients who are fit for Virecana karma.
Exclusion criteria:

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Methodology

 All connective tissue disorders other than rheumatoid arthritis


 Any other systemic disorders
 Patients who are unfit for virecana karma
Study design :
It is a single blind study to assess the pre test and post test study design where
minimum of 20 patients suffering from Āmavāta will be selected and virecana karma
is done.
Duration of the follow up – 7 days
Total duration of the study – 25 days (MAX).
INTERVENTION:
PŪRVAKARMA
1) Dīpana – Pācana :
8-10 grams of PAÑCAKOLA cūrna with sukhośna jala was administered to
patients depending on their status of Agni in terms of Sāma and Nirāmata for 3-7 Days
till Nirāma Lakṣanas are seen.
2) Snehana :
The MŪRCITA gritha was given to all the patients. The initial dose was 25ml
(Hrisiyasi matra) with Luke warm water AS ANUPĀNA in early morning, after
the digestion of the last night meal.
During this period the patients were advised to consume little quantity of hot water
in between and to follow all the restriction of Snehapāna in terms of diet (Time of food
intake, Nature of food) , Sleep (Avoid Divasvapna & Rathri jagaran) etc.
Thus Ārohanakarma Snehapāna was administered still samyak snigdha lakṣana arises in all
the patients. Then patients were constantly observed for the appearance of Sneha Jīryāmana,
Sneha Jīrna features. Based on the time of Snehajīrna lakṣana the dose of Sneha for next day
was decided.
As soon as Samyak Snigdha Lakṣana are seen, the Snehapāna was stopped.

3) Svedana :
Once samyak snigdha lakṣana appears then, from next day Sarvānga
Abhangya with saindhavādi Taila followed by bhāṣpa svedana
Thus Bhaya Snehan and Svedan was performed for 4 days and during this period
patient was advised to avoid consumption of Kaphakara Ahara and Vihara.

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Methodology

PRADHĀNA KARMA-
The virecana yoga of eraṇda taila & Triphala kwatha is given. (40ml- triphala
kwatha+ 80ml- eraṇda taila).
On the 4th day depending upon the rogi & roga bala Virecana Yoga of triphala
kwatha + eraṇda taila. After the bhāṣpa sveda procedure, ascertain the patient for
proper digestion of previous night meal. Then above mentioned Virecana yoga was
administered to patient on empty stomach in the morning hours in between 9.30 AM –
10.00 AM. (Ślema Kalagate gnatva).
Before & after virecana karma, vitals like Temperature, Pulse, Respiratory
rate, B.P were recorded & monitored the patients till the process of virecana was
over.
Then Patient was advised all the restriction and regulation on the day of
Virecana karma. Finally śuddi lakṣana in terms of Laingiki, Vaigiki, āntiki, and
Māniki were assessed.
PAŚCĀT KARMA
The Virecana was executed successfully in all the patients for deciding the
śuddI, Laingiki, Vaigiki, āntiki and Māniki parameters were considered.
After the successful completion of Virecana, the patients were asked to follow all the
precautions related to Virecana.
Then Samsarjana Krama was adviced for 3/5/7 days. It is decided on the basis of
śuddi lakṣana and it was started on the same evening of the pradhāna karma.
Assessment criteria:
Sign and Symptoms of Samyak and Asamyak Virecana.
 Patients were evaluated for severity of the illness during and after the
intervention
Subjective parameters:
 Symptoms of Āmavāta as explained in āyurvedic literature.
 Symptoms of rheumatoid arthritis acc to the criteria approved by ARA
 Symptoms of samyak virecana lakṣanas i.e. laingiki & antiki.

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Methodology

Laingiki features
All the Lainiki features were identified as immediate and remote features on
the basis of their time of appearance during and after the Virecana karma.

Table NO: 21

Sl. Immediate features Late Manifestation


1 KaleVegapravarthnam Indriya prasada
2 Daurbalya Agnivrudhi
3 Karśyata Anāmayatva
4 Vātanulomana Sŗoto śuddi
5 Vit,Pitta, kapha, vāta -
kramaśanissarana

ĀNTIKI FEATURE:
Āntiki feature was identified at the end of Virecana karma based on the colour,
consistency etc. parameters of Stool and finally depending on observation it was
documented as Pittānta / Kaphānta / Aoushadhānta/ Malānta/ Vātānta.

Objective Parameters:-
1.Signs of Samyak and Asamyak Virecana Lakśanas i.e.vaigiki and Māniki.
1. Vaigiki feature
It is nothing but total number of motion passed by patient after administration
of Virecana medicine still the cessation of Vega. In all the cases first one Vega was
left for counting and from second Vega the actual counting of Vega done till the end
of (stoppage) of last Vega. Thus finally total number of Vegas were documented as
Vaigiki feature for the present study.

2. Māniki feature
In present study during the each time of defecation the stool and urine was
collected and then it was measured and documented separately. Thus it was
performed after each Vega except first Vega. Then finally the value of total quantity
of stool and urine added to obtain total amount of output. Apart from this total amount
of water consumed(Anupāna) by patient after passing each Vega was documented and
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Methodology

it was considered as the total amount of input. Afterwards the difference between total
amount of output and input was calculated and documented as Māniki feature in terms
of milliliters.
OBJECTIVE PARAMETERS:
• Joints(for movement, tenderness, temperature,
Swelling)
• Ring test.
• Grip test.
• Foot pressure.
• Circumference.
• Goniometry test.

SUBJECTIVE PARAMETERS:
1. Pain in the joints:
Symptom Grading
No pain 0
Mild (on motion only) 1
Moderate (at rest) 2
Severe (wakes patient from sleep) 3
2. Morning stiffness (duration in hours):
Symptom Grading
0-5 min. 0
5 min. - 2 hrs. 1
2 - 8 hrs. 2
8 hrs. or more 3
3. Swelling in the joints:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3

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Methodology

4. Redness:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3
5. Warmth:
Symptom Grading
Absent 0
Mild 1
Moderate 2
Severe 3
6. Tenderness in the joints:
Symptom Grading
No tenderness 0
Says tender 1
Patient winces 2
Winces and withdraws 3
Not allowed to be touched 4

7. Alasya:
Symptom Grading
Fully active 0
Mild laziness, slow initiative in work 1
Initiative in some works, absent in others 2
Absolute lack of initiative even though capacity for work exists 3

8. Dourbalya:
Symptom Grading
No feeling of weakness 0
Slight weakness 1
Feeling of weakness but ability unimpaired 2
Ability to do duties affected 3

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Methodology

9. Knuckle swelling:
Jewellers rings were used to measure the knuckle swelling. The ring which
passes through knuckle with least resistance was noted. Any change in the number of
the ring after the treatment was recorded.
10. Muscle wasting:
The circumference of arm, fore arm, thigh and calf were measured in cms
using a measuring tape both before and after treatment to have an objective view of
muscle wasting.
11. Malabaddhata/Vibandha (Constipation):
Symptom Grading
Absent 0
Slight with one motion per day 1
Marked constipation with one motion after two days or more 2
12. Jwara (in degree Fahrenheit):
Symptom Grading
No fever 0
Mild (990 F-1010 F) 1
Moderate (1010 F-1030 F) 2
Severe (>1030 F) 3
13. Sadana - fatigue:
Symptom Grading
No fatigue 0
Works full-time despite some fatigue 1
Patient must interrupt to rest 2
Fatigued at rest 3
14. Bahumūtrata (frequency of micturition per 24 hours):
Symptom Grading
Absent (less than 4 times/24 hrs) 0
Mild (upto 6 times/24 hrs) 1
Moderate (6-10 times/ 24 hrs) 2
Severe (> 10 times/ 24 hrs) 3

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Methodology

15. Chardi (frequency of bouts per 24 hours):


Symptom Grading
Absent 0
Mild (upto 2 vegas/24 hrs) 1
Moderate (2-4 vegas/24 hrs) 2
Severe (4 vegas/24 hrs) 3

16. The other symptoms like Angamarda, Aruci, Gourava, Brama, Kukśiśoola,
Hrithgraha, Anaha, Praseka, Triśna, Hasta pada daha, Kandu are scored as mentioned
below.
Grading
No symptoms 0
Mild symptoms 1
Moderate symptoms 2
Severe symptoms 3

FUNCTIONAL ASSESSMENT:
To assess the objective improvements following functional assessments were
carried out in patients of Āmavāta.
Grip strength: The patient’s ability to compress the inflated ordinary
Sphygmomanometer cuff under standard conditions to assess the functional capacity
of effected upper limb, both before and after treatment.
Foot pressure: Foot pressure was recorded both before and after treatment by
the ability of the patient to press a weighing machine, to an objective view of
functional capacity of lower limb.
Range of joint movement: By using the Goniometer the range of movement
of all effected joints was noted both before and after treatment.
General functional capacity:
• Complete ability to carry on all usual duties without handicap 1
• Adequate normal activity despite handicap of discomfort or limited joint
movement 2
• Limited only to little or none of the usual occupation or self care 3
• Bedridden or confined to wheel chair, little or no self care 4

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Methodology

Overall assessment of the treatment:


The overall effect of the therapies assessed on the basis of criteria laid down
by ARA (1967) was adopted. The results are classified as four groups as listed below.
Grade I: Complete remission
• No systemic signs of rheumatoid activity.
• No sign of inflammation.
• No evidence of activity in any extra articular process, including nodules, tino-
vaginitis and iritis.
• No lasting impairment of joint mobility other than that associated with
irreversible changes.
• No elevation of erythrocyte sedimentation rate.
• Articular deformity or extra articular involvement due to irreversible changes
may be present.
Grade II: Major improvement
• No systemic sign of rheumatoid activity, with the exception of an elevated
sedimentation rate and vasomotor imbalance.
• Major signs of inflammation resolved, such as heat, redness of joint structures.
• No new rheumatoid process of intraarticular or extraarticular structures.
• Minimum joint swelling may be present.
• Impairment of joint mobility associated with minimum residual activity may
be present.
• Articular deformity or extra articular involvement due to irreversible changes
may be present.
Grade III: minor improvement
Any decrease in the signs of rheumatoid activity inadequate to fulfill the
criteria of grade II.
• Diminution of systemic signs of rheumatoid activity.
• Signs of joint inflammation only partially resolved.
• No evidence of extension of rheumatoid activity into additional articular or
extra articular structures.
• Decreased but not minimum joint swelling present.
• Impairment of joint mobility may be present.

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Methodology

• Articular deformity or extraarticular involvement due to irreversible changes


may be present.
Grade IV: Un improvement or progression
• Undiminished signs of rheumatoid activity, regardless of functional capacity.
• Exacerbation of any previously involved joint or joints, or development of
sites of rheumatoid activity.
• Roentgenologic changes indicative of progression of the rheumatoid process,
excepting hypertrophy changes.
• In the presence of one or more of the aforesaid criteria, involvement in other
features, including a normal or lowered ESR, not significant.
Total Duration of study: 25 days (max).
Patients were administered with Triphala Curṇa in the dose of 10 gms in the
morning with hot water for a day for the assessment of koṣta. After assessing koṣta,
pañca kola curṇa in the dose of 8-10 gms three times a day with 100 ml of hot water
before food till the appearance of nirāma lakṣanas. On the first day of Snehapāna
patients were given test dose 25ml of mūrcita gŗitha at around 6.00 to 6.30 am. From
second day onwards dose of gŗitha was decided on the basis of jīryamaana , jīrna
lakṣana .Thus the dosage of gŗitha was not fixed and the dose varied from person to
person. When the Subject attains samyak snigdha lakṣanas three days gap was given
and virecana is given on the fourth day . Saṁsarjana krama is advised according to
śuddi.
 Patients are diagnosed on the basis of signs and symptoms of Āmavāta and
criteria as approved by ARA, 1987 revision.
 Joints [for movements, tenderness, temperature, swelling]
 Ring test
 Grip test
 Foot pressure
 Circumference
Investigations: -

Blood - H.b%, T.C,. D.C, E.S.R ., R A Factor, C Reactive. Protien.

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OBSERVATIONS
Observations

OBSERVATIONS

A total of 22 patients fulfilling the inclusion criteria were taken for this study.
Statistical analysis was done with SPSS PASW STASTISTICS version 18.0.0
(release - Jul 30, 2009) the observations and the results as well as statistical analysis
of these are elaborated below.

Number of Individuals registered for the Study – 22

Number of Individuals completed the Study – 22

Number of Dropouts – Nil

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Observations

SEX:
Table No:22 Graph No:01
NO OF 100.00%
SEX %
PATIENTS 80.00%
60.00%
MALE 02 9.09 % 40.00%
20.00%
20 90.90% 0.00%
FEMALE
males females

Among the 22 patients of this study 90.90% patients were females and 9.09% patients
were males.

AGE GROUP:
Table No:23 Graph No:2
NO OF 40.00%
AGE %
PATIENTS 30.00%
16-25 1 4.54 % 20.00%
26-35 6 27.27 % 10.00%
36-45 7 31.81 %
0.00%
46-55 6 27.27 %
16-25 26-35 36-45 46-55 55-60
55-60 2 9.09%

Out of 22 patients of Āmavāta studied in this work, 31.81% patients were belonged to
the age group of 36-45 years, 27.27% patients each in age group of 26-35years and
27.27 % were belonged 46-55 years., 9.09%patient from the age group of 55-60 years.
4.54% patients from 15-25 years.

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Observations

RELIGION:
Table No:24 Graph No:3
NO OF 100.00%
RELEGION %
PATIENTS
80.00%
90.90
HINDU 20 60.00%
%
CHRISTIAN 02 9.09 % 40.00%
20.00%
0.00%
HINDU CHRISTIAN

Among 22 patients of these series maximum 90.90% of patients were belonged to the
Hindu community, and 9.09% from Christian religion.

MARITAL STATUS:
Table No:25 Graph No:4

MARITAL NO OF 100.00%
% 80.00%
STATUS PATIENTS
60.00%
MARRIED 19 86.36 % 40.00%
20.00%
UNMARRIED 03 13.64 % 0.00%
MARRIED UNMARRIED

Out of 22 patients of Āmavāta studied in this work. Maximum 86.36 % of patients


were married. And 13.64% were unmarried.

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Observations

EDUCATION :
Table No:26 Graph No:5
NO OF 45.00%
EDUCATION % 40.00%
PATIENTS 35.00%
30.00%
UNEDUCATED 4 18.19 % 25.00%
20.00%
PRIMARY 5 22.72% 15.00%
10.00%
METRIC 4 18.19 % 5.00%
0.00%
GRADUATE 9 40.90 %

Out of 22 patients of Āmavāta studied in this work, maximum 40.9% were graduates,
22% of the patients were studied up to primary school, 18.19 % were studied up to
metric. And 18.19% were uneducated

SOCIO ECONOMIC STATUS:


Table No:27 Graph No:6
SOCIO 40.00%
NO OF
ECONOMIC % 35.00%
PATIENTS 30.00%
STATUS 25.00%
20.00%
Poor 3 13.64 % 15.00%
Lower 10.00%
4 18.18 % 5.00%
middle class 0.00%
Middle class 6 27.27 %
Upper
8 36.36 %
middle class
Rich 1 4.55 %

Out of 22 patients of Āmavāta studied in this work, 36% of the patients belonged to
upper middle class , 27.27% belonged to middle class, 18.18% belonged to lower
middle class, 13.64% belonged to poor, and 4.55% belonged to rich class.

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Observations

OCCUPATION :

Table No:28 Graph No:7


NO OF 70.00%
OCCUPATION %
PATIENTS
60.00%
HOUSE
13 59.09 % 50.00%
MAKER
ENGINEER 2 9.09% 40.00%

TEACHER 1 4.54% 30.00%

BANK 20.00%
2 9.09%
EMPLOYEE 10.00%
NUN 1 4.54% 0.00%
LABOR 1 4.54%

STUDENT 1 4.54%

BUSINESS 1 4.54%

Out of 22 patients of Āmavāta studied in this work, it was observed that maximum
number of patients were house makers I.e. 59.09%. 9.09 % were engineers and bank
employees, and 4.54% were teachers, nun,labour, student and business people

DESHA
Table No:29 Graph No:8
NO OF 100.00%
DESHA % 80.00%
PATIENTS 60.00%
40.00%
JANGALA 2 9.09 % 20.00%
0.00%
ANUPA 17 77.28 %

SADHARANA 3 13.63 %

Out of 22 patients of Āmavāta studied in this work 77.28% of the patients belonged to
anupa desha, 13.63% belonged to sadharana desha, and 9.09% belonged to jangala
desha

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Observations

CHRONICITY:
Table No:30 Graph No:9
NO OF 70.00%
CHRONICITY % 60.00%
PATIENTS
50.00%
LESS THAN 6 40.00%
1 4.5 % 30.00%
MONTHS 20.00%
10.00%
6-12 MONTHS 14 63.63 % 0.00%
MORE THAN Less than 6-12 More than
7 31.81 % 6 months months 1 year
1 YEAR

Out of 22 patients of Āmavāta studied in this work maximum patients were suffering
from the disease since 6 to 12 months i.e. 63.63%. and 31.81% suffered since more
than 1 year. And 4.5 % were within 6 months

ADDICTION :
Table No:31 Graph No:10
NO OF 100.00%
ADDICTION %
PATIENTS 80.00%
60.00%
COFFEE /
20 90.90 % 40.00%
TEA 20.00%
0.00%
TOBACCO 2 9.09 %
Coffee / tea tobacco

Out of 22 patients of Āmavāta studied in this work, 90.9% were addicted to coffe/tea.
And 9.09% were addicted to tobacco

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Observations

DIET :
Table No:32 Graph No:11
NO OF 100.00%
DIET %
PATIENTS
50.00%
MIXED 18 81.81%
0.00%

VEG 4 18.18 % Mixed VEG

Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed diet and
18.18%vegitarians

SLEEP PATTERN :
Table No:33 Graph No:12
SLEEP NO OF 100.00%
%
PATTERN PATIENTS
50.00%
SOUND 4 18.18 %
0.00%
DISTURBED 18 81.81 % DISTURBED SOUND

Out of 22 patients of Āmavāta studied in this work maximum 81.81% had disturbed
sleep and 18.18% had sound sleep.

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Observations

PRAKRITHI :

Table No:34 Graph No:13


NO OF 50.00%
PRAKRITHI %
PATIENTS 40.00%
30.00%
VĀTA
10 45.45 % 20.00%
KAPHA 10.00%
KAPHA 0.00%
3 13.63 % Vata kapha Kapha pitta Vata pitta
PITTA
VĀTA PITTA 9 40.90 %

Maximum of 45.45% of the patients Belonged to Vāta kaphaja prakrithi, 40.9% were
Vāta pittaja prakrithi and remaining 13.36% were kapha pittaja.

SATVA :
Table No:35 Graph No:14
NO OF 60.00%
SATVA %
PATIENTS 40.00%
20.00%
PRAVARA 2 9.09 % 0.00%

MADHAYAMA 12 54.54 %

AVARA 8 36.36 %

Maximum of 54.54% of the patients were of madhyama satva, 36.3% were avara and
9.09% were of pravara satva

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Observations

RASA SATMYA :
Table No:36 Graph No:15
NO OF 70.00%
RASA % 60.00%
PATIENTS 50.00%
40.00%
MADHURA 13 59.09 % 30.00%
20.00%
10.00%
AMLA 5 22.72 % 0.00%

LAVANA 3 13.63 %

KATU 1 4.54 %

Maximum of 59.09 %were of madhura rasa satmya, and 22.72% were AMLA rasa
satmya 13.63 % were lavana rasa satmya and 4.54% were katu rasa satmya.

SAMHANANA :
Table No:37 Graph No:16
NO OF 80.00%
SAMHANANA %
PATIENTS 60.00%
40.00%
PRAVARA 4 18.18 % 20.00%
0.00%

MADHAYAMA 15 68.18 %

AVARA 3 13.63 %

Maximum of 68.18% of the patients were of madhyama samhanana, 18.18% were


pravara, 13.63% were 13.63%.

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Observations

SĀRA :

Table No:38 Graph No:17


NO OF 100.00%
SĀRA %
PATIENTS 80.00%
60.00%
TWAK 17 77.27 % 40.00%
20.00%
RAKTA 2 9.09 % 0.00%
TWAK RAKTA MAMSA
MAMSA 3 13.63 %

Maximum of 77.27 % patients were twak Sāra, and 9.09% of rakta Sāra and 13.63 %
māmsa Sāra .

Abhyavaraṇa śakti
Table No:39 Graph No:18
Abhyavaraṇa NO OF 80.00%
%
ŚAKTI PATIENTS 60.00%
40.00%
Madhayama 14 63.63 % 20.00%
0.00%
Avara 8 36.36 % Madhayama avara

Maximum of 63.63% patients were having madhyama abhyvarana śakti and 36.36%
were having avara abhyvarana śakti.

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Observations

jaraṇa śakti :
Table No:40 Graph No:19
NO OF 70.00%
jaraṇa śakti %
PATIENTS 60.00%
50.00%
pravara 8 36.36 % 40.00%
30.00%
madhayama 5 22.72 %
20.00%
10.00%
avara 9 40.90 %
0.00%
Madhayama avara

Maximum of 40. 9% patients had avara jaraṇa śakti, 36.36 % had pravara jaraṇa śakti
And 22.72% patients had madhyama jaraṇa śakti

VYĀYĀMA ŚAKTI :

Table No:41 Graph No:20

VYĀYĀMA NO OF 80.00%
%
ŚAKTI PATIENTS 60.00%
40.00%
MADHAYAMA 9 40.90% 20.00%
0.00%
AVARA 13 59.09 % Madhayama avara

Out of 22 patients taken for this study, Maximum of 59.09% patients had madhyama
vyāyāma śakti and the remaining 40.9 % had avara vyāyāma śakti.

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Observations

VAYA :

Table No:42 Graph No:21


NO OF 60.00%
VAYA %
PATIENTS 50.00%
40.00%
Vriddi 1 4.54 % 30.00%
20.00%
10.00%
Yauvana 3 13.63 % 0.00%

Sampurnata 7 31.81%

hani 11 50%

It is observed that MAXIMUM of 50% of the patients taken for this study belongs to
hani, 31.81% belongs to sampurnata, 13.63% belongs to yauvana, and 4.54% belongs
to vriddi.

DEHA BALA :
Table No:43 Graph No:22
NO OF 100.00%
DEHA BALA % 80.00%
PATIENTS 60.00%
40.00%
PRAVARA 1 4.5 % 20.00%
0.00%
MADHAYAMA 17 77.27 %

AVARA 4 18.18 %

Out of 22 patients taken for this study it is observed that maximum of 77.27% patients
had madhyama deha bala, 18.18% patients had avara deha bala and 4.5% had
pravara dehabala.

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Observations

KOṣTA :

Table No:44 Graph No:23

NO OF 80.00%
KOṣTA %
PATIENTS 60.00%
40.00%
MRIDHU 7 31.81 %
20.00%
0.00%
MADHAYAMA 15 68.18 % mridhu Madhayama

Out of 22 patients taken for this study it is observed that maximum of 68.18% of the
patients had madhyama koṣta and 31.81% had mridhu koṣta

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RESULTS
Effect of the therapy

Effect of the therapy

Distribution of patients according to days of appearance of samyak snigdha Lakṣana

Table no: 45 Graph no :24

No of days No of % 50.00%
patients
3 10 45.45% 40.00%
4 10 45.45% 30.00%
5 2 9.09%
20.00%

10.00%

0.00%
3 4 5

Out of 22 patients of Āmavāta studied in this work about 45.5% of the patients
developed samyak snigdhaLakṣana on 3rd and same amount of patients developed it
on the 4th day and only about 9.09% required 5 days of sneha pāna to attain the
samyak snigdha Lakṣanas.

Distribution of patients according to dose of snehapāna


Table no:46 Graph no : 25

Total 250
Number Mean sneha
day of
dosage require 200
Patients
d
150
1st day 22 25ml 625 ml
61.3 1350 100
2nd day 22
ml ml
105.6 2325 50
3rd day 22
ml ml
0
1650
th
4 day 12 137 ml 1st day 2nd day 3rd day 4th day 5th day
ml
5th day 2 200 ml 400 ml

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Effect of the therapy

Out of 22 patients of Āmavāta studied in this work on the first day all the patients
took 25ml of sneha, on the second day depending on the digestion of the sneha the
increased dose is fixed & the mean of sneha required on the 2nd day for all the 22
patients was 61 ml, on 3rd day 105.6 ml, 12 patients took the sneha on 4th day and the
mean was 137ml. 2 patients required the sneha on the 5th day and the mean was
200ml.. A total of 6350ml of sneha was needed to achieve the samyak snigda Lakṣana
of 22 patients.

Total amount of abyantara sneha during the whole course of snehapāna

Table no :47 Graph no :26

35.00%
Dose (In ml) No. of patients %
30.00%
25.00%
100-200 ML 6 27.27 %
20.00%

201-300 ML 07 31.81 % 15.00%


10.00%
301-400 ML 07 31.81% 5.00%
0.00%
401-500 ML 00 00

501-600 ML 02 9.09 %

Out of 22 patients of Āmavāta studied in this work maximum of 31.81 % of the


patients took anything between 201-300ml and the same number of patients took 301-
400ml and 27% of the patients required anything between 100-200ml and about
9.09% patient needed 500-600ml of total sneha pāna

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Effect of the therapy

Analysis of samyak snigdha Lakṣana

Table NO: 48

Lakṣana No of patients %

Adhastat snehadarsana 22 100%


Twaksnigdata 22 100%
Gatramardava 10 45.45%
Snehodvega 19 86.36%
Klama 16 72.72%
Vatanulomana 22 100 %
Angalagava 09 40.09%
Śaitilya 03 13.63%

Graph no :27

120%
100%
80%
60%
40%
20%
0%
lakṣana

Among the 22 no of patients all the patients developed adastat sneha darśana,twak
snigdhata,vātanulomana features. And about 13.63% of the patients developed śaitilya
feature.

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Effect of the therapy

Analysis of samyak Svinna lakṣana:


Table NO: 49 Graph no :28

120.00%
Svinna Number of
lakṣana Patients 100.00%
%
80.00%
18.18 60.00%
04 40.00%
Śula Viparame
%
20.00%
Stambha 01 4.5% 0.00%
nigraha
31.81
Gourava 07
nigraha %

Sveda 22 100%
Pradurbhava

Among the 22 patients 100% of the patients developed sveda pradurbhava feature and
4.5% patient developed stambha feature.

Analysis of latency period:


Table NO:50 Graph no :29

Time Latency % 90%


In period 80%
minutes 70%
60%
1-30 00 00%
50%
40%
31-60 2 9.09% 30%
20%
61-90 17 77.27% 10%
0%
1- 30 MIN 31-60 61-90 91-120
91-120 03 13.63%
MIN MIN MIN

The time required for the manifestation of the first Virecana Vega after the
administration of Virecana drug may be called as Latency period. In the present study,
Out of 22 patients, maximum number of patients i.e. 77.27% the latency period was
between 61-90 minutes, where as in minimum of 9.09% of patient’s latency period
was between 31-60 minutes.
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Effect of the therapy

Analysis of Duration of Virecana


Table NO: 51 Graph no :30

Duration of Number of 70.00%


Virecana patients 60.00%
% 50.00%
(min.)
40.00%
120-240 02 9.09% 30.00%
20.00%
241-360 13 59.09% 10.00%
0.00%
361-480 03 13.63%

481-600 04 18.18%

The duration is calculated from the appearance of the first vega to that of last vega.
Out of 22 patients i.e. 59.09% the duration of onset & stoppage of Virecana was
between 241 to 360min (4 – 6 hours).

Analysis of Vaigiki Śuddi


Table NO: 52 Graph no :31

No of % 60%
Vaigiki Śuddi
Patient 50%
Pravara 40%
(21-30) 00 00%
30%

Madhyama 45.45 20%


(11-20) 10 10%
%
0%
Avara 54.54 PRAVARA (21- MADHYAMA AVARA(1-10)
(1-10) 12
% 31) (11-20)

Out of 22 patients maximum of 54.54% of the patients had avara śuddi and 45.45%
had madhyama śuddi.

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Effect of the therapy

Analysis of Maniki of Virecana

Table NO:53 Graph no :32

60.00%
Maniki Number
of 50.00%
In ml %
patients
40.00%

Deficit up to 02 9.09% 30.00%


300 ML 20.00%
001- 300 04 18.18% 10.00%
ML 0.00%
301- 500 ML 12 54.54% Deficit 001- 301- 501-
up to 300 300 ML 500 ML 700 ML
501- 700 ML 04 18.18% ML

Out 22 patients, in 2 patients Manaki feature was negative i.e. deficit where as in 12
number of patient it was in ranges between 301-500 ml and in 4 patients it was about
1-300ml and in 4 patients it was about 501-700ml.

Analysis of Anthiki of Virecana


Table NO: 54 Graph no :33

45.00%
Numberof 40.00%
Patient 35.00%
Anthiki %
30.00%
25.00%
7 31.81% 20.00%
Kaphanta
15.00%
10.00%
02 9.09% 5.00%
Pittanta
0.00%
Drava 09 40.09%
malanta
04 18.18%
Aushdhanta

In maximum number of patient i.e. 40.09% exhibited drava malanta virecana , about
31.81% of the patients had kaphanta Virecana and 18.18% had auṣadanta and 9.09%
had pittanta virecana.

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Effect of the therapy

Analysis of Laingiki Lakṣana of Virecana


Table NO:55

Num of
Laingiki Lakṣana %
Patients

Laghuta 20 90.90%

Agnivrddhi 16 72.72%

Vatanulomana 18 81.81%

Kramat Vit, Pitta Kaphagamana 7 31.81%


Dourbalya 21 95.45%

Karsyata 13 59.09%

Kśut 10 45.45%

Triśna 07 31.81%

Graph no :34

120.00%
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%

Dourbalya is a laingiki feature observed in maximum number of patients

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Effect of the therapy

Effect on the Cardinal signs and symptoms of Amavata:-


The administration of virecana karma showed the following results:

Effect on Sandhi śūla

Table NO:56 a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 2.7727 22 .42893 .09145

AT1 2.5000 22 .59761 .12741

BT 2.7727 22 .42893 .09145

AT2 2.4091 22 .59033 .12586

BT 2.7727 22 .42893 .09145

AT3 1.9545 22 .65300 .13922

BT 2.7727 22 .42893 .09145

AT4 1.5000 22 .59761 .12741

BT 2.7727 22 .42893 .09145

AT5 1.3636 22 .49237 .10497

BT 2.7727 22 .42893 .09145

AT6 1.3182 22 .47673 .10164

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Effect of the therapy

Table NO: 56 b

Paired Differences

95% Confidence
Sig. (2-
Std. Std. Interval of the t df
tailed)
Mean± % Deviati Error Difference
on Mean
Lower Upper

BT - AT1 .2727 9.836% .55048 .11736 .02866 .5168 2.324 21 P = 0.030

BT - AT2 .3636 13.11% .58109 .12389 .10600 .6212 2.935 21 P = 0.008

BT - AT3 .8181 29.50% .66450 .14167 .52356 1.1128 5.775 21 P = <0.001

BT - AT4 1.2727 45.9% .63109 .13455 .99292 1.5525 9.459 21 P = <0.001

BT - AT5 1.4090 50.81% .50324 .10729 1.1859 1.6322 13.133 21 P = <0.001

BT - AT6 1.4545 52.45% .59580 .12703 1.1903 1.7187 11.451 21 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 = 0.030), (P=0.008) and at (P=<0.001)

BT- before treatment, AT1 – after deepāna & pachana, AT2- after snehana, AT3- after
svedana, AT4 – after virecana, AT5 – after samsarjana karma, AT6- after the follow up

There was significant reduction in the sandhi ŚŪLA .The improvement was of 9.83% during
AT1 and during AT4 the improvement was 45.9, and 50.81% during AT5, and 52.45%
during AT6

Graph No :35

sandhi śūla
3
2.5
mean value

2
1.5
1
0.5
0
BT AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

Effect on Sandhiśotha:

Table NO:57a

Paired Samples Statistics


Std. Error
Mean N Std. Deviation
Mean
BT 2.4545 22 .50965 .10866
AT1 2.1818 22 .39477 .08417
BT 2.4545 22 .50965 .10866
AT2 2.1364 22 .46756 .09968
BT 2.4545 22 .50965 .10866
AT3 1.9091 22 .42640 .09091
BT 2.4545 22 .50965 .10866
AT4 1.5909 22 .50324 .10729
BT 2.4545 22 .50965 .10866
AT5 1.5000 22 .51177 .10911
BT 2.4545 22 .50965 .10866
AT6 1.0000 22 .00000 .00000

Table NO:57b

Paired Samples Test


Paired Differences
95% Confidence
Std. Sig. (2-
Std. Interval of the t df
Mean± % Error tailed)
Deviation Difference
Mean
Lower Upper

BT - AT1 .27273 11.11 .45584 .09719 .07062 .47484 2.806 21 P = 0.011


BT - AT2 .31818 12.96 .56790 .12108 .06639 .56997 2.628 21 P = 0.016
BT - AT3 .54545 22.22 .50965 .10866 .31949 .77142 5.020 21 P = <0.001
BT - AT4 .86364 35.18 .71016 .15141 .54877 1.17850 5.704 21 P = <0.001
BT - AT5 .95455 38.88 .65300 .13922 .66502 1.24407 6.856 21 P = <0.001
BT - AT6 1.45455 59.26 .50965 .10866 1.22858 1.68051 13.387 21 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 = 0.011) (P=0.016) (P = <0.001)

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Effect of the therapy

Graph no :36

SANDHI śotha
3
2.5

MEAN VALUE
2
1.5
1
0.5
0
BT AT1 AT2 AT3 AT4 AT5 AT6

There was significant reduction in the sandhi śotha i.e during AT1 the improvement
was seen at 11.11% , during AT4 35.18 and during AT6 59.26% of improvement is
seen.

Effect of the therapy on Stabdhata:

Table NO:58a

Paired Samples Statistics


Mean N Std. Deviation Std. Error Mean
BT 1.9545 22 .65300 .13922
AT1 1.9091 22 .61016 .13009
BT 1.9545 22 .65300 .13922
AT2 1.7273 22 .63109 .13455
BT 1.9545 22 .65300 .13922
AT3 1.5455 22 .59580 .12703
BT 1.9545 22 .65300 .13922
AT4 1.2273 22 .52841 .11266
BT 1.9545 22 .65300 .13922
AT5 1.0909 22 .52636 .11222
BT 1.9545 22 .65300 .13922
AT6 .8182 22 .39477 .08417

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Effect of the therapy

Table NO:58b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean± % Deviatio Error tailed)
Difference
n Mean
Lower Upper

BT - AT1 .04545 2.32 .37509 .07997 -.12085 .21176 .568 21 P = 0.576


BT - AT2 .22727 11.62 .52841 .11266 -.00701 .46156 2.017 21 P = <0.057
BT - AT3 .40909 20.93 .50324 .10729 .18597 .63221 3.813 21 P = <0.001
BT - AT4 .72727 37.2 .63109 .13455 .44747 1.00708 5.405 21 P = <0.001
BT - AT5 .86364 44.18 .63960 .13636 .58005 1.14722 6.333 21 P = <0.001
BT - AT6 1.13636 58.13 .56023 .11944 .88797 1.38475 9.514 21 P = <0.001

There was significant reduction in the stabdata i.e. 11.6% of improvement is seen
during AT2, 20.93% during AT3, 37.2% during AT4, 44.1% during AT5 and 58.13%
of improvement is seen during AT6

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)

Graph no : 37

STABDHATA
2.5
2
MEAN VALUE

1.5
1
0.5
0
BT AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy on Tenderness:

Table NO: 59a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 2.4091 22 .73414 .15652


AT1 2.2273 22 .68534 .14612
BT 2.4091 22 .73414 .15652
AT2 2.0000 22 .69007 .14712
BT 2.4091 22 .73414 .15652
AT3 1.6818 22 .71623 .15270
BT 2.4091 22 .73414 .15652
AT4 1.2727 22 .88273 .18820
BT 2.4091 22 .73414 .15652
AT5 1.0455 22 .72225 .15398
BT 2.4091 22 .73414 .15652
AT6 .6818 22 .64633 .13780

Table NO:59b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean± % Deviatio Error tailed)
Difference
n Mean
Lower Upper

BT - AT1 .18182 7.5% .50108 .10683 -.04035 .40399 1.702 21 P = 0.104


BT - AT2 .40909 16.98 .66613 .14202 .11375 .70443 2.881 21 P = 0.009
BT - AT3 .72727 30.18 .63109 .13455 .44747 1.00708 5.405 21 P = <0.001
BT - AT4 1.13636 55.65 .71016 .15141 .82150 1.45123 7.505 21 P = <0.001
BT - AT5 1.36364 56.60 .58109 .12389 1.10600 1.62128 11.007 21 P = <0.001
BT - AT6 1.72727 71.6 .76730 .16359 1.38707 2.06747 10.559 21 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)
There was a significant reduction in the tenderness is observed. During AT2 16.9%,
AT3 30%, AT4 55% , AT5 56.6% and AT6 71.6% of improvement is observed.

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Effect of the therapy

Graph no :38

TENDERNESS
3
2.5
MEAN VALUE
2
1.5
1
0.5
0
BT AT1 AT2 AT3 AT4 AT5 AT6

Effect on the Range of joint Movements:

Table NO:60a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 4416.8182 22 492.17096 104.93120

AT1 4456.3636 22 459.20786 97.90345

BT 4416.8182 22 492.17096 104.93120

AT2 4672.7273 22 416.14079 88.72152

BT 4416.8182 22 492.17096 104.93120

AT3 4802.7273 22 404.52420 86.24485

BT 4416.8182 22 492.17096 104.93120

AT4 4896.3636 22 372.38671 79.39311

BT 4416.8182 22 492.17096 104.93120

AT5 5036.8182 22 343.75221 73.28822

BT 4416.8182 22 492.17096 104.93120

AT6 5109.5455 22 355.85547 75.86864

Table NO:60b

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Effect of the therapy

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Mean Interval of the t df
% Deviati Error tailed)
± Difference
on Mean
Lower Upper
AT1 -BT 39.54 0.89 78.7689 16.793 -74.469 -4.6212 -2.355 21 P = 0.028
AT2 -BT 255.90 5.79 144.309 30.766 -319.892 -191.925 -8.318 21 P = <0.001
AT3-BT 385.90 8.7 159.244 33.950 -456.513 -315.304 -11.367 21 P = <0.001
AT4-BT 479.54 10.85 195.142 41.604 -566.066 -393.023 -11.526 21 P = <0.001
AT5-BT 620.00 14.03 215.495 45.943 -715.545 -524.454 -13.495 21 P = <0.001
AT6-BT 692.72 15.68 218.766 46.641 -789.723 -595.731 -14.852 21 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)

There was a significant improvement is seen in the range of joints movement AT1
showed 0.89% and AT6 showed 15.68% of improvement .

Graph no :39

RANGE OF MOVEMENTS
20.00%

15.00%
percentage

10.00%

5.00%

0.00%
AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

Effect of the therapy on HAND GRIP power in mm of Hg:

Table NO:61a

Paired Samples Statistics


Std. Error
Mean N Std. Deviation
Mean
BT 77.4545 22 10.22009 2.17893
AT1 77.8182 22 10.43637 2.22504
BT 77.4545 22 10.22009 2.17893
AT2 83.5455 22 14.47404 3.08588
BT 77.4545 22 10.22009 2.17893
AT3 86.9091 22 14.45818 3.08249
BT 77.4545 22 10.22009 2.17893
AT4 89.2727 22 14.98629 3.19509
BT 77.4545 22 10.22009 2.17893
AT5 93.5455 22 17.66279 3.76572
BT 77.4545 22 10.22009 2.17893
AT6 97.4545 22 19.23471 4.10085

Table NO:61b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Mean Interval of the t df
% Deviati Error tailed)
± Difference
on Mean
Lower Upper
BT - AT1 -.3636 0.46 1.0021 .2136 -.8079 .08070 -1.702 21 P = 0.104
BT - AT2 -6.090 7.86 6.0624 1.2925 -8.778 -3.4029 -4.712 21 P = <0.001
BT - AT3 -9.454 12.20 5.7298 1.2216 -11.990 -6.9140 -7.739 21 P = <0.001
BT - AT4 -11.81 15.25 6.6162 1.4105 -14.751 -8.8847 -8.378 21 P = <0.001
BT - AT5 -16.09 20.77 9.1646 1.9539 -20.154 -12.027 -8.235 21 P = <0.001
BT - AT6 -20.00 25.82 11.041 2.3539 -24.895 -15.104 -8.496 21 P = <0.001

Improvement is seen after AT1 is 0.46% statistically significant at p=0.104 and after AT6
25.82% The change that occurred with the treatment is greater than would be expected
by chance; there is a statistically significant change (P<0.001)

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Effect of the therapy

Graph no : 40

HANDGRIP
30.00%

percentage
20.00%

10.00%

0.00%
AT1 AT2 AT3 AT4 AT5 AT6

EFFECT OF THE THERAPY ON FOOT PRESSURE


Table NO:62a

Paired Samples Statistics


Std. Std. Error
Mean N
Deviation Mean
BT 31.8636 22 4.31272 .91948
AT1 32.3636 22 4.21500 .89864
BT 31.8636 22 4.31272 .91948
AT2 35.3182 22 4.34672 .92672
BT 31.8636 22 4.31272 .91948
AT3 36.0000 22 5.00476 1.06702
BT 31.8636 22 4.31272 .91948
AT4 37.2273 22 5.07029 1.08099
BT 31.8636 22 4.31272 .91948
AT5 39.0909 22 5.45029 1.16201
BT 31.8636 22 4.31272 .91948
AT6 40.2727 22 6.53330 1.39290

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Effect of the therapy

Table NO: 62b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Mean Interval of the t df
% Deviati Error tailed)
± Difference
on Mean
Lower Upper

BT - AT1 -.5000 1.56 .85912 .18317 -.88091 -.11909 -2.730 21 P = 0.013


BT - AT2 -3.454 10.84 1.56532 .33373 -4.14857 -2.76052 -10.351 21 P = <0.001
BT - AT3 -4.136 12.98 1.78073 .37965 -4.92589 -3.34683 -10.895 21 P = <0.001
BT - AT4 -5.363 16.83 2.57359 .54869 -6.50470 -4.22257 -9.775 21 P = <0.001
BT - AT5 -7.227 22.68 3.82886 .81632 -8.92489 -5.52965 -8.854 21 P = <0.001
BT - AT6 -8.409 26.39 3.81300 .81293 -10.0996 -6.71850 -10.344 21 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)

There is significant improvement is seen in the foot pressure after AT1 the
improvement is seen at 1.56% which is statistically significant at P= 0.013 and after
AT6 the improvement was of 26.39%

Graph no : 41

FOOT PRESSURE
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

Effect of the therapy on KNUCKLE SWELLING

Table NO:63a

Paired Samples Statistics


Mean N Std. Deviation Std. Error Mean
BT 113.1364 22 5.87404 1.25235
AT1 113.0000 22 5.87164 1.25184
BT 113.1364 22 5.87404 1.25235
AT2 111.5455 22 6.13908 1.30886
BT 113.1364 22 5.87404 1.25235
AT3 109.8636 22 5.90638 1.25924
BT 113.1364 22 5.87404 1.25235
AT4 108.5000 22 6.36770 1.35760
BT 113.1364 22 5.87404 1.25235
AT5 108.2273 22 6.30896 1.34508
BT 113.1364 22 5.87404 1.25235
AT6 108.2273 22 6.30896 1.34508

Table NO:63b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviati Error tailed)
Difference
on Mean
Lower Upper

BT - AT1 .13636 0.1204 .46756 .09968 -.07094 .34367 1.368 21 P = 0.186


BT - AT2 1.5909 1.4 1 1.05375 .22466 1.12370 2.05812 7.081 21 P = <0.001
BT - AT3 3.2727 2.89 2.33364 .49753 2.23805 4.30741 6.578 21 P = <0.001
BT - AT4 4.6363 4.09 2.68231 .57187 3.44709 5.82563 8.107 21 P = <0.001
BT - AT5 4.9090 4.3390 2.70641 .57701 3.70913 6.10905 8.508 21 P = <0.001
BT - AT6 4.9090 4.3390 2.70641 .57701 3.70913 6.10905 8.508 21 P = <0.001

The change that occurred with the treatment is not great enough to exclude the possibility that the
difference is due to chance (P = <0.001),

The improvement is seen with only 0.12% after AT1 and 4.9% after AT6.

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Effect of the therapy

Graph no : 42

KNUCKLE SWELLING
114
113
112
111
MEAN 110
109
108
107
106
105
BT AT1 AT2 AT3 AT4 AT5 AT6

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS

Table NO: 64a

Paired Samples Statistics


Std. Std. Error
Mean N
Deviation Mean
BT 39.1818a 22 2.30189 .49076
AT1 39.1818a 22 2.30189 .49076
BT 39.1818 22 2.30189 .49076
AT2 38.5909 22 2.36359 .50392
BT 39.1818 22 2.30189 .49076
AT3 37.8182 22 1.99132 .42455
BT 39.1818 22 2.30189 .49076
AT4 37.2273 22 2.04548 .43610
BT 39.1818 22 2.30189 .49076
AT5 37.0455 22 2.03487 .43384
BT 39.1818 22 2.30189 .49076
AT6 37.0455 22 2.03487 .43384

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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Effect of the therapy

Table NO: 64b

Paired Samples Test

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviat Error tailed)
Difference
ion Mean
Lower Upper

BT - AT1 .59091 1.508% .50324 .10729 .36779 .81403 5.508 21 P = <0.001


BT - AT2 1.36364 3.480% .65795 .14028 1.07192 1.65536 9.721 21 P = <0.001
BT - AT3 1.95455 4.988% .84387 .17991 1.58039 2.32870 10.864 21 P = <0.001
BT - AT4 2.13636 5.452% .77432 .16508 1.79305 2.47968 12.941 21 P = <0.001
BT - AT5 2.22727 5.6% .75162 .16025 1.89402 2.56052 13.899 21 P = <0.001
BT - AT6 2.22727 5.6% .75162 .16025 1.89402 2.56052 13.899 21 P = <0.001

Here after dīpana and paachana i.e. AT1 there is no difference in the improvement.
The correlation and t cannot be computed because the standard error of the difference
is 0.

After AT6 5.6% of the improvement is seen, The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001)

Graph no : 43
CIRCUMFERENCE
40
39
38
MEAN

37
36
35
BT AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF FOREARMS

Table NO: 65a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 32.5455 22 2.46359 .52524


AT1 32.4545 22 2.50195 .53342
BT 32.5455 22 2.46359 .52524
AT2 31.8182 22 2.28111 .48633
BT 32.5455 22 2.46359 .52524
AT3 31.2727 22 2.45302 .52299
BT 32.5455 22 2.46359 .52524
AT4 30.9545 22 2.39995 .51167
BT 32.5455 22 2.46359 .52524
AT5 30.8636 22 2.37638 .50665
BT 32.5455 22 2.46359 .52524
AT6 31.0909 22 2.28680 .48755

Table NO: 65b

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviati Error tailed)
Difference
on Mean
Lower Upper

BT - AT1 .09091 0.279 .29424 .06273 -.03955 .22137 1.449 21 P = <0.162


BT - AT2 .72727 2.234 .88273 .18820 .33589 1.11866 3.864 21 P = <0.001
BT - AT3 1.27273 3.910 .76730 .16359 .93253 1.61293 7.780 21 P = <0.001
BT - AT4 1.59091 4.888 .66613 .14202 1.29557 1.88625 11.202 21 P = <0.001
BT - AT5 1.68182 5.167 .99457 .21204 1.24085 2.12279 7.931 21 P = <0.001
BT - AT6 1.45455 4.4692 .80043 .17065 1.09965 1.80944 8.523 21 P = <0.001

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Effect of the therapy

As the table shows after AT1 0.2% of the improvement at P=<0.162 and after AT6 4.4% of
improvement is seen The change that occurred with the treatment is greater than would be expected
by chance; there is a statistically significant change (P = <0.001)

Graph no :44

CIRCUMFERENCE
33
32.5
32
MEAN

31.5
31
30.5
30
BT AT1 AT2 AT3 AT4 AT5 AT6

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF THIGHS

Table NO:66a

Paired Samples Statistics

Mean N Std. Deviation Std. Error Mean

BT 77.3636 22 4.63471 .98812


AT1 77.2727 22 4.64124 .98952
BT 77.3636 22 4.63471 .98812
AT2 76.7273 22 4.91045 1.04691
BT 77.3636 22 4.63471 .98812
AT3 75.8182 22 5.20656 1.11004
BT 77.3636 22 4.63471 .98812
AT4 75.1364 22 4.99805 1.06559
BT 77.3636 22 4.63471 .98812
AT5 74.8636 22 5.03602 1.07368
BT 77.3636 22 4.63471 .98812
AT6 75.0909 22 5.11682 1.09091

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Effect of the therapy

Table NO: 66b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviatio Error tailed)
Difference
n Mean
Lower Upper

BT - AT1 0.0909 1.1751 0.2942 .06273 -.03955 .22137 1.449 21 P = <0.162


BT - AT2 0.6363 0.822 0.9534 .20328 .21362 1.05911 3.130 21 P = <0.005
BT - AT3 1.5454 1.9975 1.4712 .31367 .89315 2.19776 4.927 21 P = <0.001
BT - AT4 2.2272 2.878 1.7976 .38326 1.43023 3.02431 5.811 21 P = <0.001
BT - AT5 2.5000 3.231 1.8452 .39340 1.68188 3.31812 6.355 21 P = <0.001
BT - AT6 2.2727 2.878 1.7776 .37900 1.48454 3.06091 5.997 21 P = <0.001

After AT1 only 1.17% of improvement is seen at P= <0.162 and after AT6 2.8% of
the improvement is seen .The change that occurred with the treatment is greater than
would be expected by chance; there is a statistically significant change (P = <0.001)

Graph no : 45

CIRCUMFERENCE
78
77.5
77
76.5
76
MEAN

75.5
75
74.5
74
73.5
BT AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF

Table NO: 67a

Paired Samples Statistics


Mean N Std. Deviation Std. Error Mean
BT 47.0455 22 2.91919 .62237
AT1 46.8182 22 2.87247 .61241
BT 47.0455 22 2.91919 .62237
AT2 45.1818 22 3.15680 .67303
BT 47.0455 22 2.91919 .62237
AT3 44.1818 22 3.54073 .75489
BT 47.0455 22 2.91919 .62237
AT4 43.0909 22 3.03800 .64770
BT 47.0455 22 2.91919 .62237
AT5 42.6818 22 3.01404 .64259
BT 47.0455 22 2.91919 .62237
AT6 42.2273 22 3.13098 .66753

Table NO: 67b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviatio Error tailed)
Difference
n Mean
Lower Upper

BT - AT1 .22727 0.482 0.6853 0.14612 -.07659 .53114 1.555 21 P = <0.135


BT - AT2 1.8636 3.961 1.3556 0.28902 1.26260 2.46468 6.448 21 P = <0.001
BT - AT3 2.8636 6.086 1.8072 0.38531 2.06234 3.66494 7.432 21 P = <0.001
BT - AT4 3.9545 8.405 1.7314 0.36914 3.18687 4.72222 10.713 21 P = <0.001
BT - AT5 4.3636 9.275 1.8138 0.38671 3.55942 5.16785 11.284 21 P = <0.001
BT - AT6 4.8181 10.241 1.8679 0.39824 3.98999 5.64638 12.099 21 P = <0.001

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Effect of the therapy

After AT1 only 0.48% of improvement is seen at P=<0.135 and after AT6 10.2% of
improvement is seen .

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)

Graph no :46

CIRCUMFERENCE
48
46
44
MEAN

42
40
38
BT AT1 AT2 AT3 AT4 AT5 AT6

EFFECT ON GENERAL SYMPTOMS

Table NO:68

Mean Score
d %
Symtoms
BT AT1 AT2 AT3 AT4 AT 5 AT6

1.181 .590 .272 .227 1.7272


Aruchi 1.9545 1.6818 .7273 88.37
8 9 7 3 7

Malabadha .045 .045 .045


.6364 .5909 .5000 .4091 .59091 92.85
ta 5 5 5

1.545 1.181 .681 .545 .409 1.8181


Angamarda 2.2273 2.0000 81.63
5 8 8 5 1 8

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Effect of the therapy

1.045 .409 .409 .363 1.4545


Sadana 1.8182 1.3636 .8636 79.99
5 1 1 6 5

.636 .636 .545 1.1818


Alasya 1.7273 1.6364 .9091 .9091 68.42
4 4 5 2

.545 .590 .454 1.1818


Anaha 1.6364 1.5909 .9545 .9091 72.22
5 9 5 2

1.090 .409 .318 .272 1.4545


Praseka 1.7273 1.6818 .9545 84.20
9 1 2 7 5

1.4091 1.363 .590 .045 .000 1.4090


Truśna 1.4091a a .6364 100
6 9 5 0 9

Hasta Pada 1.5909 1.318 .545 .272 .136 1.4545


1.5909a a .7727 91.42
daha 2 5 7 4 5

0.00 0.00 0.00


Jwara .3636 0.000 0.000 0.000 .3636 100
0 0 0

Śareera 1.409 1.136 .863 .454 .409 1.4545


1.8636 1.772 78.05
gowrava 1 4 6 5 1 5

a. The correlation and t cannot be computed because the standard error of the difference
is 0

Graph no : 47

2.5
2
1.5
1
0.5
BT
MEAN

0
AT6

GENERAL SYMPTOMS

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Effect of the therapy

Effect on Total score of General symptoms:-

Table NO: 69a

Paired Samples Statistics


Std. Error
Mean N Std. Deviation
Mean
BT 1.5413 11 .55910 .16857
AT1 1.3925 11 .58322 .17585
BT 1.5413 11 .55910 .16857
AT2 1.0289 11 .44642 .13460
BT 1.5413 11 .55910 .16857
AT3 .7727 11 .33587 .10127
BT 1.5413 11 .55910 .16857
AT4 .5207 11 .21642 .06525
BT 1.5413 11 .55910 .16857
AT5 .3265 11 .22528 .06792
BT 1.5413 11 .55910 .16857
AT6 .2603 11 .19294 .05817

Table NO:69b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviat Error tailed)
Difference
ion Mean
Lower Upper

BT - AT1 0.1488 9.65% .15623 .04711 .04388 .2537 3.160 10 P = <0.010


BT - AT2 0.5124 33.24% .27279 .08225 .32914 .6956 6.230 10 P = <0.001
BT - AT3 0.7686 49.86% .28053 .08458 .58014 .9570 9.087 10 P = <0.001
BT - AT4 1.020 66.21 % .42667 .12865 .73398 1.3072 7.934 10 P = <0.001
BT - AT5 1.214 78 % .41714 .12577 .93463 1.4951 9.659 10 P = <0.001
BT - AT6 1.280 83% .44295 .13356 .98341 1.5785 9.591 10 P = <0.001

The patients who are treated with Virecana karma showed significant improvement in
the general symptoms the percentage of improvement is increase from 9.65% during
AT1 to 83% during AT6.

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)
DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI
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Effect of the therapy

Graph no :48

90.00%
80.00%
70.00%
60.00%
50.00% TOTAL EFFECT ON
40.00% GENERAL SYMPTOMS are
30.00% shown in the percentage
of improvement
20.00%
10.00%
0.00%
AT1 AT2 AT3 AT4 AT5 AT6

Effect on general FUNCTIONAL DISABILITY :

Table NO: 70a

Paired Samples Statistics


Std. Std. Error
Mean N
Deviation Mean
BT 2.8636 22 .35125 .07489
AT1 2.5909 22 .59033 .12586
BT 2.8636 22 .35125 .07489
AT2 2.3636 22 .65795 .14028
BT 2.8636 22 .35125 .07489
AT3 1.3182 22 .56790 .12108
BT 2.8636 22 .35125 .07489
AT4 .6818 22 .71623 .15270
BT 2.8636 22 .35125 .07489
AT5 .3182 22 .47673 .10164
BT 2.8636 22 .35125 .07489
AT6 .1818 22 .39477 .08417

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Effect of the therapy

Table NO: 70b

Paired Samples Test


Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviati Error tailed)
Difference
on Mean
Lower Upper

BT - AT1 .27273 9.5 .55048 .11736 .0286 .51680 2.324 21 P = 0.030


BT - AT2 .50000 17.460 .59761 .12741 .2350 .76497 3.924 21 P = <0.001
BT - AT3 1.54545 53.953 .67098 .14305 1.2479 1.8429 10.803 21 P = <0.001
BT - AT4 2.18182 76.19 .73266 .15620 1.8569 2.5066 13.968 21 P = <0.001
BT - AT5 2.54545 88.87 .50965 .10866 2.3194 2.7714 23.426 21 P = <0.001
BT - AT6 2.68182 93.651 .47673 .10164 2.4704 2.8931 26.386 21 P = <0.001

The patients who are treated with Virecana karma showed significant improvement in
the general functional disability improvement is increased from 9.5% during AT1 at
p=0.030 to 93.6% during AT6.
The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)

Graph no :49

100.00%

80.00%
EFFECT ON
60.00% GENERAL
FUNCTIONAL
40.00% DISABILITY ,
DEPECTED IN THE
20.00% PERCENTAGE OF
0.00% IMPROVEMNT
AT1 AT2 AT3 AT4 AT5 AT6

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Effect of the therapy

Effect on Hematological Values:

1. HB%

Table NO:71a
paired Samples Statistics

Std. Std. Error


Mean N
Deviation Mean
BT 11.4273 22 1.42826 .30451
AT 11.1682 22 1.63398 .34837
Table NO:71b

Paired Samples Test

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviati Error tailed)
Difference
on Mean
Lower Upper
BT -
.25909 2.267 % 0.75177 .16028 -.07422 .59241 1.617 21 P=0.121
AT

The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.121)
The mean value of Hb% BT was 11.42 and the reduction in the value is seen during
AT i.e 11.168. difference is of 2.26%

Graph no :50

Hb %
BT AT

11.4273

11.1682

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Effect of the therapy

2. TOTAL WBC COUNT

Table NO:72a

Paired Samples Statistics


Std. Std. Error
Mean N
Deviation Mean
BT 9265.9091 22 2800.52658 597.07427
AT 7670.4545 22 2248.63234 479.41003

Table NO:72b

Paired Differences
% 95% Confidence
Std. Std. Interval of the
Deviatio Error Difference Sig. (2-
Mean n Mean Lower Upper t df tailed)
BT - AT 1595.4 17.21 3418.29 728.7829 79.8674 3111.04 2.18 21 P=0.040

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = 0.040).
The mean value of total WBC during BT was 9265.9 and the reduction in the value is
seen during AT is 7670.45 difference is of 17.21%

Graph no : 51

TOTAL WBC COUNT


BT AT
9265.9091
7670.4545

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Effect of the therapy

3. NEUTROPHILS

Table NO:73a
Paired Samples Statistics

Std. Std. Error


Mean N
Deviation Mean
BT 72.2727 22 7.29763 1.55586
AT 70.4091 22 4.10179 .87450

Table NO:73b

Paired Differences
95% Confidence
Std. Sig. (2-
Std. Error Interval of the t df
Mean % Deviat tailed)
Mean Difference
ion
Lower Upper

BT - AT 1.86364 2.57 7.8999 1.68427 -1.63900 5.36627 1.106 21 P=0.281

The mean value of total neutrophils during BT was 72.27 and the reduction in the
value is seen during AT is 70.409 difference is of 2.57%
The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.281)

Graph no : 52

NEUTROPHILS
BT AT

72.2727

70.4091

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LYMPHOCYTES

Table NO:74a Paired Samples Statistics

Std. Std. Error


Mean N
Deviation Mean
BT 25.6364 22 7.34552 1.56607
AT 26.9091 22 3.82858 .81626

Table NO:74b

Paired Differences
95% Confidence
Std. Sig. (2-
Std. Error Interval of the t df
Mean % Deviatio tailed)
Mean Difference
n
Lower Upper
BT - 4.9
-1.2727 8.0898 1.72476 -4.85957 2.31412 -.738 21 P=0.469
AT %

The mean value of total lymphocytes during BT was 25.63 and the increase in the
value is seen during AT is 26.909 difference is of 4.9%
The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.469)

Graph no : 53

LYMPHOCYTES
BT AT

26.9091

25.6364

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Effect of the therapy

Esinophils
Table NO: 75a

Std. Std. Error


Mean N
Deviation Mean
BT 3.8636 22 3.21152 .68470
AT 4.4091 22 3.97203 .84684

Table NO:75b

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviati Error tailed)
Difference
on Mean
Lower Upper

BT - AT -.54545 14.11 1.50324 .32049 -1.21196 .12105 -1.702 21 P=0.104

The mean value of total esinophils during BT was 3.86 and the increase in the value
is seen during AT is 4.409 difference is of 14.11%
The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.104)

Graph no : 54

ESINOPHILS
BT AT
4.4091

3.8636

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Effect of the therapy

EFFECT ON ESR:

Table NO:76a

Paired Samples Statistics

Std. Std. Error


Mean N
Deviation Mean
BT 55.3636 22 29.91026 6.37689
AT 36.1364 22 20.56881 4.38528

Table NO:76b

Paired Differences
95% Confidence
Std. Std. Sig. (2-
Interval of the t df
Mean % Deviatio Error tailed)
Difference
n Mean
Lower Upper
34.7
BT - AT 19.227 15.8322 3.3754 12.2076 26.2469 5.696 21 P=<0.001
2
The mean value of total ESR during BT was 55.36 and the reduction in the value is
seen during AT is 36.13 difference is of 34.72%

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)

Graph no : 55

ESR
BT AT
55.3636

36.1364

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Effect of the therapy

EFFECT ON RA factor

Table NO:77a

Paired Samples Statistics


Std. Std. Error
Mean N
Deviation Mean
BT 29.8636 22 29.09088 6.20220
AT 17.5045 22 17.51811 3.73487

Table NO:77b

Paired Samples Test


Paired Differences
95% Confidence
Std. Sig. (2-
Std. Interval of the t df
Mean % Error tailed)
Deviation Difference
Mean
Lower Upper
BT - AT 12.359 41.38% 15.067 3.212 5.67839 19.03980 3.847 21 P=<0.001

The mean value of total RA factor during BT was 29.86 and the reduction in the
value is seen during AT is 17.504 difference is of 41.38%
The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001)

Graph no :56

RA FACTOR
BT AT

29.8636
17.5045

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Effect of the therapy

Effect on C Reactive Protein

Table NO:78a

Paired Samples Statistics


Std. Std. Error
Mean N Deviation Mean
BT 20.2522 22 17.08803 3.56310
AT 10.5783 22 9.78672 2.04067

Table NO:78b

Paired Samples Test


Paired Differences
% 95% Confidence
Std. Interval of the
Std. Error Difference Sig. (2-
Mean Deviation Mean Lower Upper t df tailed)
BT - AT 9.67391 47.767 12.50266 2.60699 4.26736 15.08047 3.711 21 P=<0.001

The mean value of total C Reactive Protein during BT was 20.252 and the reduction
in the value is seen during AT is 10.578 difference is of 47.578%

The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = 0.001)

Graph no : 57

C.R.P
BT AT

20.2522

10.5783

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Effect of the therapy

THE OVERALL EFFECT OF THE TREATMENT

The assessment of the overall effect of the treatment revealed that 77.27 %
(17) of the patients showed major improvement. And the patients also responded with
minor improvement was 22.72 % (5). All the patients studied in this Virecana karma
study showed different degrees of remission. The details are given in the Table No.
and Graph No.

Table no :79

improvement No of patients %
Major 17 77.27%
Minor 5 22.72%
No improvement 0 0

Graph no :58

OVERALL EFFECT OF THE TREATMENT

23%

MAJOR IMPROVEMENT
MINOR IMPROVEMENT

77%

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DISCUSSION
Discussion

Discussion

Āmavāta affects the Sandhi and Hŗidaya Marma, which form a part of
Madhyama Roga Mārga. Though Āma and Vāta are the chief pathogenic factors, the
disease represents the vitiation of TriDoṣa. The affliction of Sandhi (of which Asthi is
a component) by Vāta and association with Āma, reflects the role of homogenous
Doṣa and Dūśya (Tulya Doṣa Dūśya) in the causation of this disease. Moreover, the
chief pathogenic factors i.e. Āma and Vāta being contradictory in character, pose
difficulty in planning the line of treatment. Mandāgni is a prerequisite factor for the
initiation of the Samprāpti of āmavāta. Thus, Aāhyantara Roga Mārga also plays a
vital role in causation of this disease. Primarily the Samprāpti originates in the
Annavaha Sŗotas, then spreads through the Madhyama Roga Mārga with special
predilection for Sleśmasthāna, thus āmavāta manifests as a systemic disease. Rasa,
Asthi and Majja Dhatus are primarily involved, but Māmsa and Snāyus are also
affected later. Āmavāta & rheumatoid arthritis may be compared for the sake of
clinical aspects. Āmavāta is one such disease where in authors categorized the pain as
Vrischika damśavat vedana. It is a disorder characterized by Āma Doṣa, Vāta Doṣa,
Kapha Doṣa morbidly. the antagonistic treatment of Kapha Doṣa and Vāta Doṣa
must be carried out simultaneously, gambiradhātu (asthi),uttānadhātu (rasa),makes the
treatment more a puzzle.
Hence a treatment which should alleviate morbid Vāta, pitta, kapha is required in
āmavāta. Virecana is one such Shodhana procedure fulfilling the above criteria.

Clinical study : A total of 22 patients fulfilling the inclusion criteria were taken
for this study. Statistical analysis was done with (SPSS) PASW STASTISTICS
version 18.0.0 (release - Jul 30, 2009) the observations and the results as well as
statistical analysis of these are elaborated below.

Number of Individuals registered for the Study – 22

Number of Individuals completed the Study – 22

Number of Dropouts – Nil

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Discussion

Discussion on observations (Demographic Data):

AGE : Out of 22 patients of Āmavāta studied in this work, 31.81% patients were
belonged to the age group of 36-45 years, 27.27% patients each in age group of 26-
35years and 27.27 % were belonged 46-55 years., 9.09%patient from the age group of
55-60 years. 4.54% patients from 15-25 years. Table No:22. graph no:1

SEX: Among the 22 patients of this study 90.90% patients were females and 9.09%
patients were males this corresponds to the Rheumatologists opinion that it is seen
more in the females. Table No:23. graph no:2

RELIGION: Among 22 patients of these series maximum 90.90% of patients were


belonged to the Hindu community, and 9.09% from Christian religion. This shows
geographical predominance of Hindus in and around Udupi area. The details are
elaborated in the Table No:24. Graph no:3

MARITAL STATUS: Out of 22 patients of Āmavāta studied in this work. Maximum


86.36 % of patients were married. And 13.64% were unmarried. Table No:25 graph
no:4

EDUCATION: Out of 22 patients of Āmavāta studied in this work, maximum 40.9%


were graduates, 22% of the patients were studied up to primary school, 18.19 % were
studied up to metric. And 18.19% were uneducated. But from the above said data no
definite conclusion can be drawn regarding education with disease.

Table No:26. graph no:5

SOCIO-ECONOMIC STATUS: Out of 22 patients of Āmavāta studied in this work,


36% of the patients belonged to upper middle class , 27.27% belonged to middle
class, 18.18% belonged to lower middle class, 13.64% belonged to poor, and 4.55%
belonged to rich class.

Table No:27 graph no:6

OCCUPATION: Out of 22 patients of Āmavāta studied in this work, it was observed


that maximum number of patients were house makers I.e. 59.09%. 9.09 % were
engineers and bank employees, and 4.54% were teachers, nun,labour, student and
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Discussion

business people . As in the study more of the home makers were observed who can
be considered under manual labour category, they have a more of physical work
which may provoke Vāta Doṣa. Table No:28. Graph no:7

DEṣA: Out of 22 patients of Āmavāta studied in this work 77.28% of the patients
belonged to ānupa deṣa, 13.63% belonged to sadhārana deṣa, and 9.09% belonged to
jangala deṣa

The ānupa Desha which is having predominance of Kapha Doṣa, this shows the
relation of ānupa desha one among the factor influencing in the disease. The details
are shown in the Table No:29. Graph no:8

CHRONICITY OF DISEASE: Out of 22 patients of Āmavāta studied in this work


maximum patients were suffering from the disease since 6 to 12 months i.e. 63.63%.
and 31.81% suffered since more than 1 year. And 4.5 % were within 6 months. The
details are shown in the Table No:30 graph no:9

ADDICTION: Out of 22 patients of Āmavāta studied in this work, 90.9% were


addicted to coffe/tea. And 9.09% were addicted to tobacco. As shown in the Table
No:31 graph no:10

DIET: Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed diet
and 18.18%vegitarians. The diet plays an important role in causing the disease.The
ahara which are Guru, Abhisyandi etc which may provoke both Kapha and āma. This
favors the āmavāta Nidāna. As shown in the Table No:32 graph no:11

SLEEP PATTERN: Out of 22 patients of Āmavāta studied in this work maximum


81.81% had disturbed sleep and 18.18% had sound sleep. The disturbed sleep was
due to pain .The details are shown in the Table No:33 graph No:12

PRAKRITI: Maximum of 45.45% of the patients belonged to Vāta kaphaja prakrithi,


40.9% were Vāta pittaja prakrithi and remaining 13.36% were kapha pittaja. As
shown in the Table No: 34 graph No:13

SATVA: Maximum of 54.54% of the patients were of madhyama satva, 36.3% were
avara and 9.09% were of pravara satva. But no definite conclusion can be drawn from
this data the details are shown in the Table No35: graph No:14

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Discussion

RASA SĀTMYA: Maximum of 59.09 %were of MADHURA rasa sātmya, and


22.72% were amla rasa sātmya 13.63 % were lavana rasa sātmya and 4.54% were
katu rasa sātmya. As shown in the Table No:36 graph No:15

SAMHANANA: Maximum of 68.18% of the patients were of madhyāma samhanana,


18.18% were pravara, 13.63% were 13.63%. The details are shown in the Table
No:37 graph No:16

SARATAHA: Maximum of 77.27 % patients were twak Sāra, and 9.09% of rakta
Sāra and 13.63 % māmsa Sāra . The details are shown in the Table No:38 Graph
No:17

ABHYAVARANA ŚAKTI : Maximum of 63.63% patients were having madhyama


abhyvarana śakti and 36.36% were having avara abhyvarana śakti. The details are
shown in the Table No:39 Graph No:18

JARANA ŚAKTI : out of 22 patients Maximum of 40. 9% patients had AVARA


jarana śakti, 36.36 % had pravara jarana śakti And 22.72% patients had madhyama
jarana śakti. The details are shown in the Table No:40 Graph No:19

VYĀYĀMA ŚAKTI : Out of 22 patients taken for this study, Maximum of 59.09%
patients had madhyama vyāyāma śakti and the remaining 40.9 % had avara vyāyāma
śakti. From above said data it may be noticed like due to the disease nature the
patients functional ability reduced and and therefore vyāyāma śakti also. The details
are shown in the Table No:41 Graph No:20

VAYA : It is observed that maximum of 50% of the patients taken for this study
belongs to hāni, 31.81% belongs to sampūrṇata, 13.63% belongs to yauvana, and
4.54% belongs to vriddi. This shows that people of age group between 40 to 70 are
more prone for this disease. The details are shown in the Table No:42 Graph No:21

DEHA BALA : Out of 22 patients taken for this study it is observed that maximum of
77.27% patients had madhyama deha bala, 18.18% patients had avara deha bala and
4.5% had pravara dehabala. The details are shown in the Table No:43 Graph No:22

KOŚTA :Out of 22 patients taken for this study it is observed that maximum of
68.18% of the patients had madhyama kośta and 31.81% had mridhu kośta. The
details are shown in the Table No:44 Graph No:23
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Discussion

EFFECT OF THE THERAPY

Effect of dīpana & pācana.

For the present study pañcakola churṇa was selected Pañcakola chūrṇa is
administered initially for the purpose of achieving Āmapāchana. This herbal
combination is said to possess Katu rasa, Katu vipāka and Uśna vīrya and therefore
likely to render Āmapāchana in patients suffering ĀmaVāta. Moreover, Āmapāchana
is considered to be an essential procedure before administering the Shodhana
treatment. With this rationality Pañcakola chūrṇa was opted to bring about Āma
Pācana in the present study.

Observation of snehapāna : snehapāna was started with mūrchita gritha & the
dose was 25 ml. (hŗasiyasi mātra). On the basis of the time taken to digest on the first
day of sneha, a subsequent dose of Ghrita was planned. The Sneha was given in
ārohana Mātra till the patients developed Samyak Snigdha lakṣanas or upto maximum
of seven days, whichever is earlier. The average days of Samyak Snigda lakṣanas was
observed in patients were three days.

Out of 22 patients of Āmavāta studied in this work on the first day all the
patients took 25ml of sneha, on the second day depending on the digestion of the
sneha the increased dose is fixed & the mean of sneha required on the 2nd day for all
the 22 patients was 61 ml, on 3rd day 105.6 ml, 12 patients took the sneha on 4th day
and the mean was 137ml. 2 patients required the sneha on the 5th day and the mean
was 200ml.. The details are shown in the Table No:47 Graph No:26 A total of
6350ml of sneha was needed to achieve the samyak snigda lakṣana of 22 patients.

Among the 22 no of patients all the patients developed adastāt sneha


darśana,twak snigdhata,Vātanulomana features. And about 13.63% of the patients
developed shaitilya feature The details are shown in the Table No:48 Graph No:27.
During the snehapāna with mūrchita gŗitha there was marked reduction in the Pain,
Tenderness, Swelling, Stiffness was observed. There was improvement in the agni.
Maximum Samyak snigdha lakṣanas were seen on 3rd day,by this the concept of
Goodartha dīpika tīka of Sharangadara that the gritha has to be taken for 3
days(Gritham trayam) is well understood.

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Discussion

Observation of Svedana Karma: - It provides kinetic energy by uśna guna to those


Doṣas which are ready to vacate from their site of adhesion to the nearest site. Hence
combined action of snehana & svedana makes the detachment from the śākha & helps
to attach or to move towards kośta for easy evacuation. A specific ideology behind it
is to remove the adherence of Doṣas which are present in each & every corner of the
body so as to purify the whole system. Lightness of the body is achieved & also it
enhances the peripheral circulation. Due to production of heat the toxic metabolites
are carried by the blood & are brought to G.I.T. after the snehana karma abhyanga is
done with saindhāvadi taila followed by baṣpa svedana.

Among the 22 patients 100% of the patients developed sweda prādurbhāva feature
and 4.5% patient developed stambha feature. The details are shown in the Table
No:49 Graph No:28

3 days of gap period: Considering the classics bāhya abhyanga & svedana are
performed in 3 days of gap period & especially for the purpose of virecana to attain
manda kapha stage, gap is highly necessary.
Observation of Virecana karma : Virecana: Said to be useful for pitta elimination
from its site. Since ūrdhwa & adho āmaśayas are specific sites for elimination of
kapha & pitta respectively, whatever the Doṣas are eliminated through pakwāśaya is
the nearest route.

The properties such as uśna, tīkśna, sūkshma, vyavāyi, vikāsi helps for
irritating the mucosa of stomach as well as intestine & also enhances the speed of
action. Depending upon the extent of vitiation & potency of the drug, the elimination
of pitta occurs. Eraṇda taila possesses snigdha, tīkśna, sūkshma guna and uśna vīrya,
it is kapha vāta hara and rechana. drugs which does virecana having dominance of
prithvi & ambu mahābhūta along with adhobhāgahara prabhāva.
The very process induces inflammation; there will be accumulation of fluids in
extra & Intra cellular spaces. These fluids are highly toxic, since the so called waste
products of the body from each & every cell is found. The toxic products of
metabolism are dragged by process of snehana & svedana in liquid form, through
virecana they are eliminated out of the body.
Criteria to assess samyak virikta lakṣanas are useful in deciding further
procedures like samsarjana krama & to stop the further procedure. Constant watch is

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Discussion

necessary throughout the process, to know about ati or ayoga lakṣanas. Since blood
carries the waste materials in this process, purification of blood also takes place. End
products of metabolism which tends to accumulate will also be eliminated.
Electrolytes like sodium, potassium, bicarbonates are maintained. Since purification
occurs, the cells & tissues are rejuvenated & helps in improving the absorption
capacity of the intestines & improve health.
LATENCY PERIOD: Time required for the manifestation of the first Virecana Vega
after the administration of Virecana drug may be called as Latency period. In the
present study, Out of 22 patients, maximum number of patients i.e. 77.27% the
latency period was between 61-90 minutes, where as in minimum of 9.09% of
patient’s latency period was between 31-60 minutes. The details are shown in the
Table No:50 Graph No:29

DURATION OF VIRECANA: The duration is calculated from the appearance of


the first vega to that of last vega. Out of 22 patients i.e. 59.09% the duration of onset
& stoppage of Virecana was between 241 to 360min (4 – 6 hours). The details are
shown in the Table No:51 Graph No:30

ANALYSIS OF VAIGIKI ŚUDDI: Out of 22 patients maximum of 54.54% of the


patients had avara śuddi and 45.45% had madhyama śuddi. The reason for this may
be interpreted as the dose of the Virecana dravya which is taken for this study is less
i.e. 40ml of triphala kwātha and 80ml of eraṇda taila. The details are shown in the
Table No:52 Graph No:31

ANALYSIS OF MĀNIKI OF VIRECANA: Out 22 patients, in 2 patients Māniki


feature was negative i.e. deficit where as in 12 number of patient it was in ranges
between 301-500 ml and in 4 patients it was about 1-300ml and in 4 patients it was
about 501-700ml. The details are shown in the Table No:53 Graph No:32

ANALYSIS OF ANTHIKI OF VIRECANA: In maximum number of patient i.e.


40.09% exhibited drava malānta virecana , about 31.81% of the patients had kaphānta
Virecana and 18.18% had auṣadanta and 9.09% had pittānta virecana. The details are
shown in the Table No:54 Graph No:33

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Discussion

Analysis of Laingiki Lakṣana of Virecana:Dourbalya is a laingiki feature observed


in maximum number of patients after the Virecana karma. The details are shown in
the Table No:55 Graph No:34

Effect on Cardinal signs and symptoms of ĀmaVāta:-

EFFECT ON SANDHI ŚŪLA: There was significant reduction in the sandhi śūla
.The improvement was 45.9% during AT4, and 50.81% during AT5, and 52.45%
during AT6. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001) as shown
in Table No.56a,56b and Graph No.35

EFFECT ON SANDHIŚOTHA : There was significant reduction in the sandhi śotha


i.e 59.26 % of improvement is seen during AT6.The change that occurred with the
treatment is greater than would be expected by chance; there is a statistically
significant change (P = <0.001) as shown in the Table No.57a,57b and Graph No.36

EFFECT ON STABDHATA: There was significant reduction in the stabdata i.e.


11.62% of improvement is seen during AT2, 20.93% during AT3, 37.2% during
AT4, 44.18% during AT5 and 58.13% of improvement is seen during AT6. The
change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001) as shown in the Table
No.58a,58b and Graph No.37

EFFECT ON TENDERNESS: There was a significant reduction in the tenderness is


observed. during AT3 30.18%, AT4 55.65% , AT5 56.60% and AT6 71.6% of
improvement is observed. The change that occurred with the treatment is greater than
would be expected by chance; there is a statistically significant change (P = <0.001)
as shown in the Table No.59a,59b and Graph No.38

EFFECT ON THE RANGE OF JOINT MOVEMENTS: There was a significant


improvement is seen in the range of joints movement AT1 showed 0.89% and AT6
showed 15.6% of improvements. The change that occurred with the treatment is
greater than would be expected by chance; there is a statistically significant change
(P = <0.001) as shown in the Table No.60a,60b and Graph No.39

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Discussion

EFFECT ON HAND GRIP POWER IN MM OF HG: Improvement is seen during


AT1 is 0.46% statistically significant at p=0.104 and during AT6 25.82%. The
change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001) as shown in the Table
No.61a,61b and Graph No. 40

EFFECT OF THE THERAPY ON FOOT PRESSURE: There is significant


improvement is seen in the foot pressure during AT1 the improvement is seen at
1.56% which is statistically significant at P= 0.013 and during AT6 the improvement
was of 26.39%. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001) as shown
in the Table No. 62a,62b and Graph No.41

EFFECT OF THE THERAPY ON KNUCKLE SWELLING: The improvement is


seen with only 0.12% during AT1 and 4.9% during AT6. The change that occurred
with the treatment is not great enough to exclude the possibility that the difference is
due to chance (P = <0.001), as shown in the Table No.63a,63b and Graph No.41

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF ARMS: Here after


dīpana and pācana i.e. AT1. The correlation and t cannot be computed because the
standard error of the difference is 0. And during AT6 5.6% of the improvement is
seen The change that occurred with the treatment is greater than would be expected by
chance; there is a statistically significant change (P = <0.001) as shown in Table
No.64a,64b and Graph No. 42

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF FOREARMS:


During AT1 = 0.2% of the improvement is seen at P=<0.162 and during AT6 4.4%
of improvement is seen. The change that occurred with the treatment is greater than
would be expected by chance; there is a statistically significant change (P = <0.001)
as shown in Table No. 65a,65b and Graph No.43

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF THIGHS: During


AT1 only 1.17% of improvement is seen at P= <0.162 and during AT6 2.8% of the
improvement is seen .The change that occurred with the treatment is greater than

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Discussion

would be expected by chance; there is a statistically significant change (P = <0.001).


as shown in Table No.66a,66b and Graph No. 45

EFFECT OF THE THERAPY ON CIRCUMFERENCE OF CALF: During AT1


only 0.48% of improvement is seen at P=<0.135 and during AT6 10.2% of
improvement is seen .The change that occurred with the treatment is greater than
would be expected by chance; there is a statistically significant change (P = <0.001).
as shown in Table No.67a,67b and Graph No. 46

EFFECT ON TOTAL SCORE OF GENERAL SYMPTOMS:- The patients who


are treated with Virecana karma showed significant improvement in the general
symptoms the percentage of improvement is increase from 9.65% during AT1 to 83%
during AT6. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001) as shown
in Table No.69a,69b and Graph No. 48

EFFECT ON GENERAL FUNCTIONAL DISABILITY: The patients who are


treated with Virecana karma showed significant improvement in the general
functional disability improvement is increased from 9.5% during AT1 at p=0.030 to
93.6% during AT6. The change that occurred with the treatment is greater than would
be expected by chance; there is a statistically significant change (P = <0.001). as
shown in Table No.70a,70b and Graph No.49

EFFECT ON HEMATOLOGICAL VALUES:-

EFFECT ON HEMOGLOBIN PERCENTAGE:- The mean value of Hb% BT was


11.42 and the reduction in the value is seen during AT i.e 11.168. difference is of
2.26%. The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.121). as shown in Table
No.71a,71b and Graph No. 50

EFFECT ON TOTAL WBC COUNT: The mean value of total WBC during BT
was 9265.9 and the reduction in the value is seen during AT is 7670.45 difference is
of 17.21%. The change that occurred with the treatment is greater than would be

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Discussion

expected by chance; there is a statistically significant change (P = 0.040). as shown in


Table No.72a,72b and Graph No.51

EFFECT ON NEUTROPHILS: The mean value of total neutrophils during BT


was 72.27 and the reduction in the value is seen during AT is 70.409 difference is of
2.57%. The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.281). as shown in Table
No.73a,73b and Graph No.52

EFFECT ON LYMPHOCYTES : The mean value of total lymphocytes during BT


was 25.63 and the increase in the value is seen during AT is 26.909 difference is of
4.9%. The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.469). as shown in Table
No.74a,74b and Graph No.53

EFFECT ON ESINOPHILS: The mean value of total esinophils during BT was


3.86 and the increase in the value is seen during AT is 4.409 difference is of 14.11%
The change that occurred with the treatment is not great enough to exclude the
possibility that the difference is due to chance (P = 0.104). as shown in Table
No.75a,75b and Graph No.54
EFFECT ON ESR: The mean value of total ESR during BT was 55.36 and the
reduction in the value is seen during AT is 36.13 difference is of 34.72%. The
change that occurred with the treatment is greater than would be expected by chance;
there is a statistically significant change (P = <0.001). as shown in Table No.76a,76b
and Graph No.55
EFFECT ON RA FACTOR: The mean value of total RA factor during BT was
29.86 and the reduction in the value is seen during AT is 17.504 difference is of
41.38%. The change that occurred with the treatment is greater than would be
expected by chance; there is a statistically significant change (P = <0.001). as shown
in Table No.77a,77b and Graph No. 56
EFFECT ON C REACTIVE PROTEIN : The mean value of total C Reactive
Protein during BT was 20.252 and the reduction in the value is seen during AT is
10.578 difference is of 47.578%. The change that occurred with the treatment is

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“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF 139
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
Discussion

greater than would be expected by chance; there is a statistically significant change


(P = 0.001). as shown in Table No.77a,77b and Graph No.58
From above observations it is clear that the patients of āmavāta who are
treated with Virecana karma shown good response to the treatment with regards to
cardinal symptoms of āmavāta, general symptoms of āmavāta, clinical parameters,
hematological investigations and overall effect of the treatment. The improvement
was marked soon after the Ābhyantara Snehapāna and Svedana Then improvement
was Satisfactory after soon Virecana. But again there was good improvement noted
after the Saṁsarjama krama and also after the follow up period. Most of these
improvements are found to be statistically significant as per the paired ‘t’ test.

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF 140
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
COCLUSION
Conclusion

Conclusion

Conclusion is the essence of any study. A study from which no conclusions


are drawn, then it turns out to be futile. Hence conclusion is the determination
established by investigating in various ways & deducting by means of various
reasons. Hence after the completion of this study the following conclusions are drawn,
based on the study sample:

Conceptual study:
 Importance for Śodana highlighted in all the classics in treating Āmavāta.
 Virecana is beneficial in treating Āmavāta.
 Virecana karma is one among the lines of treatments explained for
Āmavāta

Observations:
 Among the 22 patients of this study it was observed that maximum of
90.90% patients were females.
 31.81% patients were belonged to the age group of 36-45 years.
 59.09% of the patients were house makers I.e. Physically strenuous work
pattern.
 77.28% of the patients belonged to ānupa deśa.
 Out of 22 patients of Āmavāta studied in this work 81.81% were of mixed
diet and 18.18%vegitarians.
Results:
 45.5% of the patients developed samyak snigdhalakśana on 3rd and same
number of patients developed it on the 4th day.
 A total of 6350ml of sneha was needed to achieve the samyak snigda Lakṣana
of 22 patients.
 100% of the patients attained the Samyk Snigda Lakṣana s like Vatānulomana,
twak snigdata, Adastāth sneha darśana.

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF 141
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
Conclusion

 Out of 22 patients, maximum number of patients i.e. 77.27% the latency


period was between 61-90 minutes.
 Out of 22 patients maximum of 54.54% of the patients had avara śuddi and
45.45% had madhyama śuddi.
 In maximum number of patients i.e. 40.09% exhibited drava malānta virecana
, about 31.81% of the patients had kaphānta Virecana and 18.18% had
auśadānta and 9.09% had pittānta Virecana.
 There was significant reduction in sandhi śula(52.45)%, sandhi
śotha(59.26%), tenderness(71.6%), stabdhata(58.13%).
 General symptoms of Āmavāta were decreased significantly by 83%
 General functional disability aspect is improved by 93.6% during AT6.
 Range of joint Movements was improved by 15.68%
 Hand grip power was improved significantly by 25.82%
 Foot Pressure was improved significantly by 26.39%
 Knuckle swelling was reduced by 4.33%
 Significant changes were seen over Hematological values- Hb% 2.267%,
o TC 17.21%, ESR 34.72%,
o RA Factor 41.38% and C Reactive Protein 47.767%.

After going through the available data, author opines that instead of going
through upavāsa or such measures, virecana will yield maximum benefits in the
patients of Āmavāta. Further other Śodhana procedures like vamana, Basti are to be
employed at an appropriate time to achieve the complete relief from the disease.

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF 142
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SUMMARY
Summary

SUMMARY

Summary provides a whole theme of the study & anything in research needs to
be summarised & put it in a nutshell, so that a further progress in the subject or any
part of the matter can be considered in future for the benefit of the similar patients.
Having such a background in our mind, a prospective study entitled, “A
CLINICAL STUDY TO ASSESS THE ROLE OF VIRECHANA KARMA IN THE
MANAGEMENT OF ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS” was
planned.
The summary comprises of seven parts, viz. conceptual study, Conceptual Study of
Virechana Karma and Amavata, Drug Profile, Methodology, Clinical Study-Result,
Discussion, Summary and Conclusion.

Chapter (1):

Historical review deals with the historical aspect related of Virechana process,
etymology and definition of Virechana and indications-contraindications explained a glimpse
on utility of Virechana Karma in various conditions obtained from several texts. Virechana
Karma was studied under three major divisions as Purvakarma, Pradhanakarma and Pascata
Karma. Vyapad of Virechana karma is briefly discussed. "Mechanism of Virechana
discussed as per Ayurvedic principles and also briefly a review according to current practice
of physiology.

Conceptual study of Amavata includes Etymology, Definition, Nidana, Lakshana,


Samprapti, Upadrava, Upashayaanupashaya, Pathyapathya and Rheumatological Correlation
to rheumatoid Arthritis.

Chapter (2):

Explains the properties of drugs used for Deepana Pachana, Koshta pareeksha,
Snehapana, abhyanga , bashpa Sweda, Virechana.

Chapter (3):

The materials and methods adapted for the study are described here.

This chapter deals with the

 Protocol of the study- objective of the study.


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Summary

 Inclusion and exclusion criteria of the patients.


 Intervention and criteria of assessment.
 Review of previous works done on Virechana karma and Amavata.
Chapter (4):

The observation made on demographic incidence of age, sex, habits etc are presented
in the form of diagrams. The results of the clinical study are presented with statistical analysis
in the form of tables and brief narrations.

Chapter (5):

Discussion, deals with the discussion of entire thesis. The conceptual part of
Virechana and its action on Amavata are explained. Clinical data is discussed in details. The
result obtained in clinical study, as well as Observations in it are discussed with relevant
arguments.

Chapter (6):

Conclusion, the conclusion of whole clinical study and Virechana is explained in this
chapter.

Chapter (7):

Summary, summarized the whole thesis.

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BIBLIOGRAPHY
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


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ANNEXURE
annexure

DEPARTMENT OF PANCHAKARMA. SDMCA UDUPI


A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE
MANAGEMENT OF ĀMAVĀTA W.S.R TO RHEUMATOID ARTHRITIS.

Guide: Dr. SHREEKANTH. U. Co- Guide: Dr. NIRANJAN RAO

Researcher: Dr. Sandeep. K. C

Name : Serial No :
Age :
Sex :M/F OPD No :
Religion :H/M/C/O IPD No :
Education : UE / P / M / MS / GR / PG DOA :
Marital Status : UM / M / D / W DOD :
Social Status : VP / P / LM / M / UM / RVR Diagnosis :
Occupation : Result :
Desha : Anupa / Jangala / Sadarana
Postal Address :

MAIN COMPLAINTS : multiple joints pain

BT-Before treatment, AT1-After amapachana,


AT2-Aftrer Snehapana, AT3-after svedana,
AT4-After virecana (evening), AT5-After samsarjana krama,
AT6-After follow up period.

SYMPTOMS Duration BT AT 1 AT 2 AT 3 AT 4 AT5 AT6


Stabdatha
Aruchi
Mala Bhaddatha
Angamarda
Sadana
Alasya
Hrutgraha
Anaha
Preseka
Truśna
Hasta-Pada Daha
Bahumūtrata
Kukśi Śūla
Chardi
Bhrama
Śareera Bhara
Antrakūjana
Kandu
Anga śūnata

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

HISTORY OF PRESENT ILLNESS:


Onset: insidious / gradual / sudden
Sequence of joint involvement:
1……Since……2……Since……3……Since……4……Since……
5……Since……6……Since……7……Since……8……Since……
Course: Progressive / receding / relapsing / stationery
Aggravating factors:
Relieving factors:
Symmetry of joint involvement: 1 2 3 4 5 6

HISTORY OF PAST ILLNESS:

FAMILY HISTORY:

TREATMENT HISTORY:
Drugs Dosage Duration Details
NSAID’S
STEROIDS
OTHERS

PERSONAL HISTORY:
Vyasana: Coffee/Tea…… Alcohol…… Cigarette…… Tobacco Chewing…… Others……
Duration: Since………Occational / Regular / Stopped / Reduced / Continued
Ahara: Veg / Mixed
Samasana / Visamasana / Adyasana / Anasana
Dominant Rasa - M / A / L / K / T / Ka
Dominant Guna – R / S / U / Sh / G / L
Nature of work: Manual /Sedentary / Labour / Traveling / Walking / Studying / Sitting/Day/Night.
Viśrama: ……Hours Proper / Less / Excessive
Vyayama: No / Proper / Excessive / Irregular
Nidra: Sound / Disturbed Night …… Day ……Difficulty in falling Asleep / Staying Asleep
Bowel: Frequency ……… Consistency ………… Colour
Micturation: ………Frequency………quantity………

OBSTETRIC HISTORY:
No. of delivery ……. Normal…… Surgical Intervention……
Abortions …… Miscarriages …… Last Delivery ……
DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI
“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
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annexure

Years Back……

GYNAECOLOGICAL HISTORY:
Menstrual cycle: …… Regular / Irregular / Menarche …… years
Bleeding ….. days Menorrhagia / Metrorrhagia / Dysmenorrhoea / Leucorrhoea
Menopause since……years

GENERAL EXAMINATION: DAŚAVIDHA PARIKŚA


Pulse …… / min Prakrutitah:V/P/K/VP/VK/PK/VPK
B.P …… mm / Hg Vikrutitah: P / M / A
Dośa :
Duśya :
Srotas :
Udbavasthana :
Sancharasthana :
Vyakthasthana :
Temperature……F Satwatah: P/M/A
Respiratory rate…… / min Saratah: P/M/A
Nourishment: G / F / P Satmyatah: P / M / A
Built: Samhanatah: P / M / A
Nails: Ahara Śaktitah: Abyavaharana: P / M / A
Conjunctiva: JaranaŚaktitah: P / M / A
Sinuses: Vyayama Śaktitah: P / M / A
Lymph nodes: Pramanatah: P/M/A
Deformities: Height …… cms
Contractures: Weight …… Kgs
Nodules: Y / N Vayataha; Bala / Madya / Vradha
Others:

SYSTEMIC EXAMINATION:
CNS :
CVS :
RS :
GUS :
P/A :
LOCOMOTOR SYSTEM

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

ASSESSMENT CRITERIA-FUNCTIONAL TEST


Joint Motion BT 1 2 3 4 5 6
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
Flexion
Extension
Shoulder Abduction
Adduction
Lat. Rot.
Medi. Rot.
Elbow Flexion
Extension
Forearm Supination
Pronation
Uln. Devi.
Wrist Radi.
Devi.
Flexion
Extension
Flexion
Extension
Hip Abduction
Adduction
Lat. Rot.
Medi. Rot
Extension
Knee
Flexion
Ankle Plant.
Flex.
Dorsi.
Flex.
Inversion
Foot
Eversion
MCP1 Flexion
Extension
Abduction
Adduction
MCP2 Flexion
Extension
Abduction
Adduction
MCP3 Flexion
Extension
MCP4 Flexion
Extension
Abduction

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

Adduction
MCP5 Flexion
Extension
Abduction
Adduction
PIP1
PIP2
PIP3
PIP4
DIP1
DIP2
DIP3
DIP4
Flexion
TOE
Extension
Spine Flexion
Extension
Neck Lat. Bend.
Rotation

RING TEST
No. BT 1 2 3 4 5 6
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
1
2
3
4
5
BT 1 2 3 4 5 6
TEST
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
Grip Test
Foot Pressure
Gen.
Functions

Circumference BT 1 2 3 4 5 6
Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt Rt Lt
Arm
Forearm
Thigh
Calf
INVESTIGATION:
Test BT AT

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

HB%
T.L.C
D.C / N
D.C / L
D.C / E
D.C / B
D.C / M
E.S.R
RA Factor
C reactive protein

JOINT EXAMINATION
Pain Swelling Stiffness
Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6
Rt
DIP Lt
Rt
PIP Lt
Rt
WRI Lt
Rt
ELB Lt
Rt
SH Lt
Rt
DIP Lt
Rt
PIP Lt
Lt
Rt
ANK Lt
Rt
KN Lt
Rt
HIP Lt
Rt
TMJ Lt
Rt
STC Lt
Rt
ARC Lt
SPINE
C/T/L/S

Tenderness Warmth Redness


Joints BT 1 2 3 4 5 6 BT 1 2 3 4 5 6 BT 1 2 3 4 5 6
Rt
DIP
Lt
Rt
PIP
Lt
Rt
WRI
Lt
Rt
ELB
Lt
Rt
SH
Lt
Rt
DIP
Lt

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

Rt
PIP
Lt
Lt
Rt
ANK
Lt
Rt
KN
Lt
Rt
HIP
Lt
Rt
TMJ
Lt
Rt
STC
Lt
Rt
ARC
Lt
SPINE
C/T/L/S

TREATMENT SCHEDULE:

PŪRVA KARMA:

Administration of Dīpana Pachana: panchakola chūrna with Uśna Jala


Dose.........mg /OD /BD/TDS/QDS/HS for....days
Kośta parikśa- Triphala chūrna - Dose.........mg Time-
No.of malapravriti: ..........
Kośta--------------

SNEHAPANA VIDHI:
Name of Sneha given- mūrchitha gritha with Uśana jala as Anupaana

SNEHAPANA

Date
Time
Quantity
Time of
Snehajeernata

Sneha jeeryamana Lakṣanas

LAKSHAN Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7


Śiroruk
Bhrama
Niśtiva
Mūrcha
Saad
Aruchi
DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI
“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

Klama
Triśana
Daha
Snehaudgar
Arati

Sneha jeerna Lakṣanas

LAKṣANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7


Triśana
Kśudha
Udgaraśudhi
Śiralaghavata
Vatanulomata

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

Samyak snigdha Lakṣanas

LAKṣANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7


Vatanulomata
Agnideepti
Snigdha
asamhata
varcha
Gatramardava
Twaksnigdhata
Snehodvega
Klama
Śitya
Angalaghava

VIŚRAMA KALA:
Sarvanga abhyanga with saindhavadi taila followed by bhaśpa sveda.

SAMYAK SWINNA LAKṣANAS


LAKṣANAS Day-1 Day-2 Day-3 Day-4
Śeetoparam
Śūloparam
Stambhanigraha
Gouravanigraha
Mardavata

PRADHANA KARMA:
Administration of virecana yoga
Triphala kwatha (40ml) + eranda taila (80ml)
Time of administration of Virecana Dravys-….......

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

1] MANIKI
No. of Time Colour Consistency QUANTITY Water Urine
OF
Vega Consumed
Virikta
Dravys
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Input (water consumed) = ml

Output of vrikta dravyas = ml

Output of urine = ml

Manki= Total output – total input = ml

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

SAMYAK VIRIKTHA LAKṣANA


Samyak Yoga Ati Yoga Ayoga
Srotośuddi Supti Agnimandya
Indriya prasada Angamarda Chardi
Laguta Klama Tandra
Agnivrudhi Bhrama Chardi
Anamayatva Balaabhava Aruchi
Vitkapha vata
Nidraabhava NaVata Pratilomata
kramaśanissarana
Vatanulomana Tama Praveśa Daha
Daurbalya Netra praveśa Kukśiaśudhi
Karśyata Mūrcha Kandu
Hridhvarna śudhi Unmada Vitsanga
Kśuth Hikka Mūtrasanga
Thriśna Chima chimayana Pidika
KaleVegapravarthnam Pipilika sancharaivaange Mandalotpthi
Hridayodveśtana Pitika
Jarjaribhava Vidaha
Viśangnatva śtevana
Jalabasa Kukśiśūla
Śūnyata Nabhistabdata
Śanka Sankocha
Śopha
Parśwa Śūla
Guda Śūla
Parikartika
Angamarda
Gudanissarana
Gudabramśa
Kapha Pitarahita sweta
Udakanissarana
Kapha Asrapittaan
LakśayaLakṣana
Mamsadhavana Vatudaka
Nissarana
MedhoKhanda Vatsrava

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”
annexure

ANTHAKI
VEGAKI
MANAKI
LYNGIKI
OBSERVATION

OBSERVATION OF VITAL DATA & WEIGHT

Time Pulse Blood Pressure Resp.Rate Weight

PASCĀT KARMA
Diet Regimen
NO. OF ANNAKALAS
Pravara Śuddi Madhyama Śuddi Avara Śuddi
Peya
Vilepi
Akrita Yuśa
Krita Yuśa

CONDITION OF THE PATIENT AFTER TREATMENT

COMPLETE REMISSION MAJOR IMPROVEMENT


MINOR IMPROVEMENT No Improvement / PROGRESSION

Signature of scholar: signature of guide:

DEPARTMENT OF PG STUDIES IN PAÑCAKARMA, SDMCA, UDUPI


“A CLINICAL STUDY TO ASSESS THE ROLE OF VIRECANA KARMA IN THE MANAGEMENT OF
ĀMAVĀTA w.s.r TO RHEUMATOID ARTHRITIS”