A Clinical Study To Evaluate The Effect of Yashtavyah Niruha Vasti and Bodhi...

[Full title: A Clinical Study To Evaluate The Effect of Yashtavyah Niruha Vasti and Bodhi Vriksha Kashaya In The Management of Vatarakta w.s.r. To Gout.]

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P a g e | 10 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION International Research Journal of Ayurveda & Yoga An International Peer Reviewed Journal for Ayurveda & Yoga ICV-70.44- ISRA-1.318 VOLUME 4 ISSUE 4 1 PG Scholar Rajiv Gandhi Govt. Post Graduate Ayurvedic College Paprola. Kangra (H.P.) 2 Reader, Deptt. Of Panchkarma , Rajiv Gandhi Govt. Post Graduate Ayurvedic College Paprola .Kangra.(H.P.) 3 Professor & H.O.D. Deptt. Of Panchkarma , Rajiv Gandhi Govt. Post Graduate Ayurvedic College Paprola .Kangra.(H.P.) Corresponding Author :- Dr. Diksha, PG Scholar Rajiv Gandhi Govt. Post Graduate Ayurvedic College Paprola. Kangra (H.P.), Email,id-dikshavashisht 8@gmail.com Article received on 18 th March 2021 Article Accepted 26 th April 2021 Article published 30 April 2021 ABSTRACT: - Introduction : Vatarakta is disease which is caused by vitiation of Vata and Rakta (blood). This disease usually caused by faulty life style 1 . It can be compared with Gouty arthritis due to maximum resembles in the sign and symptoms. In this era Vatarakta (Gout) is very eminent disease with lesser effective treatment. Along with life style modifications effective therapy is the need of the day. Present research work was humble attempt to see the effect of Panchkarma and Shaman aushadh (Pacification therapy) in this disease Methods : In this study 10 patients of Vatarakta (Gout) were selected from OPD of Panchkarma department, RGGPG Ayurvedic college and Hospital Paprola. All patients were treated with Yashtavyah Niruha Vasti along with Bodhi vriksha kashaya panam . Result: The Vasti and Bodhi Vriksha Kashaya were significantly effective in all the symptoms of Vatarkta . Discussion: Vata and Rakta are the main Dosha and Dushya i n disease. Vasti (enema) being most effective in Vata Dosha and Yahtvyah which is main content of Vasti causes Rakta Shaman. Boshivriksha Kashya is effective in Tridosha Prakopa . Thus, this protocol was found significantly effective. Key words : vatarakta , Panchkarma , Kashaya. A Clinical Study To Evaluate The Effect of Yashtavyah Niruha Vasti and Bodhi Vriksha Kashaya In The Management of Vatarakta w.s.r. To Gout. Dr. Diksha 1 Dr. Anil Bhardwaj 2 Prof. Pushpender Singh 3

[Find the meaning and references behind the names: Modern, Pack, Doi, Local, Cite, Raga, Pradhan, Pain, Ayu, Vide, Acharya, Prime, Cases, Under, Major, Heart, Age, Samaka, Given, Shola, Non, Bahya, Willing, Milk, Parts]

P a g e | 11 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION This work is licensed under a creative attribution -Non-commercial-No derivatives 4.0 International License commons How to cite this article: Dr. Diksha, Dr. Anil Bhardwaj, Prof. Pushpender Singh, A Clinical Study To Evaluate The Effect Of Yashtavyah Niruha Vasti And Bodhi Vriksha Kashaya In The Management Of Vatarakta W.S.R. To Gout ” IRJAY, April: 2021, Vol-4, Issue-4;10-18 ; Doi: https://doi.org/10.47223/IRJAY.2021.4417 INTRODUCTION Vatarakta (Gout) is one of the conditions which is resulted by vitiation of Vata Dosha and Rakta Dhatu ( blood) 2 It can be correlated with Gout based on symptomatology and etiology in modern medical science. Vatarakta (Gout) is mentioned as Vata Pradhan Tridoshaj Vyadhi in Ayurvedic text by various Acharyas . It is described as one of the manifestations of vitiated Vata and Rakta (blood) simultaneously. It is the major example of Vataj vyadhi caused by Avaranjanya Pathology 3 . In this disease vitiation of Vata Dosha and Rakta Dhatu (blood) produces complex symptoms like Sandhi shola (Joint pain), Sandhishotha (Joint inflammation), Raga (redness), Kandu (itching) and Sparsh agyatva 4 etc. Detailed description of etiology, pathogenesis and symptoms have been given in Ayurvedic texts. Treatment modalities mentioned in Ayurveda can be divided into two parts Antahparimrjana chikitsa (internal cleansing) and Bahiparimarjana chikitsa. In Antah parimarjana chikitsa (internal cleansing) Virechana (purgation), Vasti (enema) and Rakta mokshana (Bloodletting) 5 are the main Panchkarma procedures and Lepa (pack), Parisheka (stream pouring), Pradeha (local sudation) 6 among Bahya parimarjana chikitsa (external cleansing). Among all of these, Vasti (medicated enema) is given prime importance for treatment of Vatarakta (gout) . Specially Vasti (medicated enema) containing ksheera (milk) are considered very effective as compared to others. Yashtavyah niruha vasti is effective in Vatarkta (gout) as Vasti (medicated enema) pacify Vata and Yashtavyah a is Rakta shamaka . Bodhi Vriksha kashaya is Tridoshaj vatarakta shamaka, explained by Acharya charka . AIMS & OBJECTIVES ❖ To explore Ayurvedic and modern review pertaining to Vatarakta and Gout respectively ❖ To assess the efficacy of Yashtavyah niruha vasti and Bodhi vriksha kwatha in the management of Vatarakta w.s.r. to Gout. ❖ To develop effective Panchkarma therapy for the management of Vatarakta (gout) . MATERIAL & METHOD 1 Ethical Clearance : Ethical clearance was obtained from Institutional Ethical Committee before commencement of clinical trial vide approval letter no. Ayu./IEC/2017/1159. 2 Screening: The OPD and IPD patients of Vatarakta were screened and 10 patients fulfilling the diagnostic and inclusion criteria were enrolled for study. INCLUSION ❖ Patients willing to participate in study. ❖ Patients between age group of 20-60 years of either sex and religion ❖ Only uncomplicated cases of Vatarakta or Gout were taken in the study. EXCLUSION ❖ Patients unwilling to participate in study. ❖ Patients presenting with systemic complications like Ischemic Heart Disease, Uncontrolled Hypertension, Chronic Kidney Disease,

[Find the meaning and references behind the names: Daily, Grams, Plan, Dose, Low, Single, Males, Flame, Time, Vas, Tool, Vii, Grade, Iii, Patient, Days, Pala, Acid, Pan, Honey, Take, Kala, Tail, Nadi]

P a g e | 12 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Uncontrolled Diabetes Mellitus etc.(Any Ayurvedic contraindication) ❖ Pregnancy. ❖ Mentally unstable and substance abused patients ❖ Any other patient considered unfit for study CRITERIA FOR DIAGNOSIS The patients were diagnosed on the basis of Ayurvedic and modern symptomatology mentioned in different Ayurvedic and modern text books. a Following signs and symptoms were considered for the diagnosis as mentioned in classical texts :- i Sandhi Shoola (Joint pain) ii Sandhi Shotha (Swelling of joint) iii Sparsh Asahyata (Tenderness) iv Raaga (Redness) v Twaka Vaivarnya (Discoloration of skin) vi Vidaha (Burning sensation) vii Sparsha agyatva (Numbness) viii Kandu (Itching) ix Sandhivikriti ( Deformity of joint) b.Serum uric acid was considered as investigation based diagnostic tool. Serum uric acid >7 mg/dl in males and >6 mg/dl in females was considered for diagnosis. MANAGEMENT PLAN Number of patients Patients fulfilling the diagnostic criteria were selected randomly from OPD/IPD of Panchkarma department of RGGPG Ayurvedic college and Hospital, Paprola, Distt. Kangra (H.P.) Grouping of patients A single group of 10 patients were selected for present study. Yashtavyah niruha Vasti was administered in kala Vasti rigemen and Bodhivriksha Kashaya orally ❖ Duration of study - 16 days ❖ Follow up - After 16 days Plan of Study ❖ Sthanik abhyanaga with Guduchi tail for 16 days ❖ Dashmoola nadi swedana for 16 days. ❖ Anuvasana vasti with Guduchi tail in dose of 60 ml for 10 days in to Kala Vasti regimen ❖ Yashtavyah niruha vasti in dose of 600 ml for 6 days in Kala Vasti regimen ❖ Bodhi vriksha kashaya pan 80 ml with honey for 16 days once daily Methods Of Preparation Of Yashtavyah Niruha Vasti :- Yashtavyah niruha vasti was prepared as per the classical method. For the preparation of Niruha vasti as initially 2 pala (80 ml ) of honey along with saindhava lavana one karsha (10 gm ) triturated until it became homogenous. Two pala (80 ml) Guduchi tail was added and triturated . Further vasti kalaka dravya ( Pippali, Shatahva ,Madanphala ) 40 gm added and mixed thoroughly .After this Yashtavyah kwatha in quantity 450 ml mixed slowly to form uniform Vasti Dravya . Thereafter Vasti dravya was filtered and collected in Vasti Putaka . Method of preparation of Kwatha (Decoction) : Preparation of Kwatha was done according to Sharangdhara samhita. 40 grams of Yavakuta Bodhi Vriksha Kashaya taken and 8 times water added to it. It was boiled in low flame until reduced up to 80 ml. It was mixed with 5 ml of honey. Patients were advised to take it once in a day in the morning. CRITERIA OF ASSESSMENT ❖ Subjective parameters were assessed before and after the treatment as per grade score. ❖ Serum Uric acid was estimated at the time of inclusion and at follow up after completion of the study 1. SUBJECTIVE CRITERIA: a. Signs and Symptoms The following signs and symptoms were assessed on the basis of severity and grading was done. Pain of the patients was assessed on the basis of Visual Analogue Scale (VAS). i Sandhi Shoola (Joint pain) ii Sandhi Shotha (Swelling of joint) iii Sparsh Ashayata (Tenderness) iv Raaga (Redness)

[Find the meaning and references behind the names: Mild, Severe, Table]

P a g e | 13 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION v Granthi (Tophi) vi Vidaha (Burning sensation) vii Sparsh agyatva (Numbness) viii Kandu (itching) ix Sandhivikriti (deformity ) Table No. 1 – Grading of Signs and Symptoms Sign & Symptoms Status Grades Sandhi Shoola (Joint pain) No pain with work 0 Mild tolerable pain with work 1 Moderate pain with work 2 Severe pain with work 3 Sandhi Shotha (Joint swelling) No swelling 0 Mild swelling 1 Moderate swelling 2 Severe swelling 3 Sparsh Ashayata (Tenderness) No pain on palpation 0 Mild pain on palpation 1 Moderate pain 2 Patient do not allow to palpate 3 Raaga (Redness) No redness 0 Mild redness 1 Moderate redness 2 Severe redness 3 Vidaha (Burning sensation) No burning sensation 0 Mild burning sensation 1 Moderate burning sensation 2 Severe burning sensation 3 Granthi (Tophi formation) No Tophi 0 Tophi in Single Joint 1 Tophi in Multiple Joints 2 Tophi in other sites with joints 3 Sparsh Agyatva (Numbness) No numbness 0 Mild numbness 1 Moderate numbness 2 Severe numbness 3 Kandu (Itching) No itching 0 Mild itching 1 Moderate itching 2 Severe itching 3 Sandhi vikriti (Deformity ) No deformity 0 Mild deformity 1 Deformity uo to 2-3 joints 2 Deformity of more than 3 joints 3

[Find the meaning and references behind the names: Mean]

P a g e | 14 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 2.Objective Criteria: ❖ Serum uric acid was estimated before and after treatment. ❖ VAS scale EFFECT OF THERAPY 1. Subjective Parameters A. Signs and Symptoms Table No. 2 - Effect of therapy on signs and symptoms Signs and Symptoms N Mean Score Mean Difference %age relief SD± SE± t P BT AT Sandhi Shoola (Joint pain) 10 2.7 0.30 2.4 88 % 0.181 0.05 15.98 <0.001 Sandhi Shotha (Joint swelling) 10 2.1 0.100 2.0 95% 0.158 0.050 19.00 <0.001 Sparsh asahtva 10 2.1 0.20 1.90 90% 0.21 0.06 13.50 <0.001 Raga (redness) 10 2.1 0.10 2.00 95% 0.158 0.05 19.00 <0.001 Vidaah (Burning sensation) 8 1.9 0.100 1.8 94% 0.199 0.07 12.71 <0.001 Granthi 1 0.20 0.20 0.00 - 0.00 0.00 - >0.05 Sparsh agayata (numbness) 5 0.70 0.10 0.60 85% 0.237 0.106 12.14 <0.001 Kandu (itching ) 5 0.70 0.10 0.60 85% 0.237 0.106 12.14 <0.001 Sandhi vikriti (Fatigue) - - - - - - - - - 1. Effect of therapy on Sandhi Shoola (joint pain):- All the 10 patients (100%) included under clinical study presented with Sandhishoola. The mean score of Sandhi Shoola before treatment was 2.7 and after treatment it came down to 0.30 giving 88 % reduction in mean score which was statistically highly significant (p<0.001) 2. Effect of therapy on Sandhi Shotha (Joint swelling):- This symptom was present in all (100%) patients. The mean score of Sandhi shotha before treatment was 2.1 and after treatment it came down to 0.100 giving 95.00% reduction in mean score which was statistically highly significant (p<0.001) 3. Effect of therapy on Sparsh asahtva(tenderness) :- The mean score of sparsh asahtva before treatment was 2.1 which declined to 0.2 after treatment, thus reducing the mean score by 90% and was statistically significant (p<0.001) 4. Effect of therapy on Raga (redness) :- The mean score of Raga before treatment was 2.1 which reduced to 0.10 after treatment giving 95% reduction in mean score and was found statistically insignificant (p<0.001)

[Find the meaning and references behind the names: Level]

P a g e | 15 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 5. Effect of therapy on Vidaha (Burning):- The mean score of Vidaha before treatment was 1.9 which came down to 0.1 after treatment giving 94% reduction in mean score and was statistically significant (p<0.001) 6. Effect of therapy on Granthi (Tophi ):- The mean score of Granthi before treatment was 0.20 and it remained unchanged with no percentage relief. Data shows statistically insignificant results at p > 0.05 7. Effect of therapy on Sparsh agyatva ):- The mean score of Sparsh agyatva before treatment was 0.7 and after treatment it came down to 0.10 with 85% reduction in mean score and was statistically significant (p<0.001) 8. Effect of therapy on kandu (itching) :- The mean score of kandu before treatment was 0.7. It reduced to 0.1 after treatment with 85% reduction in mean score and was statistically significant (p<0.001) 9. Effect of therapy on Sandhi vikriti (joint deformity) :- Sandhi vikriti was not present in any of the patients 2. Objective parameter Table No.3 - Effect of therapy on Serun Uric Acid Sr. No N Mean Score Mean Difference %age SD± SE± t P BT AT 1. 10 9.34 6.064 3.276 35.07 1.569 0.496 2.54 <0.05 The mean serum uric acid level before treatment was 9.34 mg/dl and after treatment was 6.064 mg/dl. There was 64.92% reduction in mean score. The reduction in serum uric acid level after the treatment was statistically significant (p <0.05). VAS Scale :- Sr. No N Mean Score Mean Difference %age SD± SE± t P BT AT 1. 10 7.7 1.1 6.6 85.71 0.169 0.053 14.54 <0.001 Effect on VAS Scale:- All of the 10 patients (100%) included in the study were observed with VAS. Mean score before treatment was 7.7 and after treatment it was reduced to 1.1 with difference of 6.60 and %age relief of 85.71%, ‘t’value is 14.54 with p<0.001 which is statistically highly significant Discussion On Effect of Therapy 1. Sandhi Shoola (Joint Pain) :- All the 10 patients (100%) included under clinical study presented with Sandhishoola . The mean score of Sandhi shoola before treatment was 2.7 and after treatment it came down to 0.30 giving 88 % reduction in mean score which was statistically highly significant (p<0.001) . Relief in Sandhi shoola may be due to the analgesic and anti-inflammatory effects of Guggulu, Shunthi and Vidanga.

[Find the meaning and references behind the names: Mode, Guna, Act, Ruk, Path, Normal, Essence, Sira, Turn, Guru, Rasa, Ama, Get, Factor, Able, Quality, Flow, Sama]

P a g e | 16 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION 2. Sandhi Shotha (Joint Swelling) :- This symptom was present in all (100%) patients. The mean score of Sandhi shotha before treatment was 2.1 and after treatment it came down to 0.100 giving 95.00% reduction in mean score which was statistically highly significant (p<0.001) Relief in inflammation can be attributed to Guduchi, Guggulu, Haritaki, Vibhtaki and Shunthi. 3. Sparsh Asahatva :- The mean score of Sparsh asahtva before treatment was 2.1 which declined to 0.2 after treatment, thus reducing the mean score by 90% and was statistically highly significant (p<0.001) 4. Raaga :- The mean score of Raga before treatment was 2.1 which reduced to 0.10 after treatment giving 95% reduction in mean score and was found statistically highly significant (p<0.001) 5. Vidaha :- The mean score of Vidaha before treatment was 1.9 which came down to 0.1 after treatment giving 94% reduction in mean score and was statistically highly significant (p<0.001) 6. Granthi :- The mean score of Granthi before treatment was 0.20 and it remained unchanged with no percentage relief .Data shows statistically insignificant results at p > 0.05 7. Sparsha Agyatva :- The mean score of Sparsh agyatva before treatment was 0.7 and after treatment it came down to 0.10 with 85% reduction in mean score and was statistically significant (p<0.001) 8. Kandu :- The mean score of Kandu before treatment was 0.7. It reduced to 0.1 after treatment with 85% reduction in mean score and was statistically significant (p<0.001) 9. Sandhi Viktriti :- Sandhi vikriti was not present in any of the patients B. OBJECTIVE CRITERIA: The mean serum uric acid level before treatment was 9.34 mg/dl which after treatment was reduced to 6.064 mg/dl. There was 35.07% reduction in mean score. The reduction in serum uric acid level after the treatment was statistically significant (p <0.05). All the 10 patients (100%) included under study were observed with VAS. Mean score before treatment was 7.7 and after treatment it was reduced to 1.1 with difference of 6.60 and %age relief of about 85%, ‘t’value is 14.98 with p<0.001 which was statistically highly significant DISCUSSION (A) Probable Mode Of Action Of Drug In Ayurveda, the mode of action of drug is determined by the dominant pharmacodynamic factor of a particular drug namely, Rasa (essence), Guna (Quality), Virya, (potency) Vipaka (Post digestion effect) and Prabhava (special effect) The drugs act as an antagonist to the involved Dosha and causes Samprapti Vighatan (breaking of pathogenesis) In Samprapti (Pathogenesis) , it is mentioned that vitiated Rakta (blood) obstructs the channels of Vridhh Vata and obstructed Vata Dosha in turn vitiates Rakta Dhatu (blood). Both Vata Dosha and Rakta Dhatu (blood) get Avrita with each other to cause Ruk (pain), Daah (burning sensation), Toda (pricking pain) etc. In this way, Vatarakta (gout)manifests Along with independent vitiation of Vata Dosha and Rakta Dhatu, excessive intake of Ahita Aahar–vihara (unwholesome food-daily regimen) leads to Ama formation which causes Jathraagni and Dhatwaagni Mandatya . With the involvement of Ama with Rakta (blood), Rakta Dhatu gets more vitiated. Normally Rakta has Drava Guna, due to which it is able to flow smoothly in both Dhamani and Sira. But when associated with Ama, it becomes Pichhila ( sticky) and Guru (heavy), causing obstruction in the normal path of Vayu. Due to Guru Guna of Sama Rakta , it moves along with gravity and obstructs path of Vridh Vata in joints. Khavaigunya in Sandhis (joint) and obstructed Vata causes Sthana sanshrya in Twaka (skin) , Mamsa (muscles) and Sandhis (joints). It is manifested as Sandhi shola

[Find the meaning and references behind the names: Just, Ways, Nasa, Nasha, Rout, Evidence, Waka, Goes, Hot, Til, Virtue, Oral, Snigdha, Smooth, Sneha, Deepan, Middle, Bitter, Beta, Bark, Chemical, Cold, Sweet, Bone, Pitta, Oil, Samana, Chi, Good, Katu, Property, Ras, Pass]

P a g e | 17 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION (joint pain), Shotha (inflammation),T waka vaivarnaya (discoloration), Raga (redness), Kandu (itching), Vidaha (burning sensation), Granthi (cyst) etc . The drugs selected for Vasti (enema) are mainly Madhur (sweet) , Katu (bitter) , Tikta (pungent) and Kashaya rasa (astringent). Ushna virya (hot) and having Vata shamaka properties. Vasti contains Ksheer (milk) as Prakshepa dravya which adds to its Vatarakta shamaka property. It is well Known fact in modern science also that drugs administered through rectal rout are more beneficial than oral rout. Rectal mucosa is highly vascularized. Drugs administered in rectum which is unionized and lipid soluble gets readily absorbed in to rectal mucosa. Drugs given through rectal rout absorbed in two ways ❖ The drugs absorbed through superior and middle rectal veins which goes directly to systemic circulation and do not undergo first pass metabolism (hepatic metabolism). ❖ Rectal mucosa has extensive lymphatic circulation which facilitates absorption and systemic exposure of absorbed drugs. ❖ Guduchi tail mentioned in Vatarakta (gout) by almost all Acharya so Guduchi tail is selected for Anuvasana vasti and Niruha vasti . ❖ Murchhita til tail used to prepare guduchi tail which is best among the vegetable origin Sneha dravya . It is considered to have best Vatashamaka properties among other sneha dravya. ❖ Tail has got Ushna(hot), Snighdh (uncoustness), Sukshma properties by virtue of which it reaches deeper Dhatus like Asthi (bone) and Majja (bone marrow) by penetrating through minute channels. Til tail (sesame oil) is Vedana sthapaka (analgesic), Snehana (oleation), Sandhaniya , Deepan a (appetizer), Rasayana (rejuvenator) . It has Tikta rasa (pungent) which possess Deepana (appetizer) and Pachana (digestive) properties. Leading to Jatharagni and Dhatvagni mandata nasha . Guduchi (Tinosporea cordifolia) itself is one of the best drugs for Vatarkta (gout) and it also has anti-inflammatory properties. Madhuyashti (Glycirrhiza glabra) the main content of Vasti(medicated enema) is good Vata and Pitta shamaka dravya . It has Ushna veerya (hot) and Balya (strengthener) properties. Kshe er (milk) used as Prakshepa dravya helps in Vata shamaka . Both having Madhur vipaka and Guru snigdha guna leads to Shamana of Vata and Rakta (blood) simultaneously. Hence Yashtavyah niruha vasti has been selected for present clinical study. (B) Mode Of Action Of Bodhivriksha Kashaya Bodhi vriksha kashaya used as Shamana drug. It contains only one content that is bark of Ashwatha (Ficus religiosa). It is mentioned as best drug in Tridoshaja vatarakta by Acharya Charak a ( Ch.Chi. 29/154 ) . It has Tridosha-shamak a properties. It has Kshaya and Madhura ras which acts as Vata and Pittahara, Sheeta veerya (cold) again leads to Shamana (pacification) of Rakta (blood) Guru Snighdha guna (heavy) and Katu vipaka (bitter) leads to Kaphashamaka property. It has Vedana Sthapaka (analgesic), Raktashodhaka (blood purifier), Mridu virechaka (soft purgation) properties. Chemical constituents are beta sitosterol, lanosterol, bergapton etc. they possess properties like smooth muscle relaxants, anti-inflammatory action which may be responsible for its anti-arthritic property CONCLUSION The conclusion drawn from the clinical study is as follows:- ❖ The present study entitled as “A clinical study to evaluate the effect of Yashtavyah niruha vasti and Bodhi vriksha kashaypanam in the management of Vatarakta w.s.r. to Gout” is just a primitive work and an effort to provide evidence-based efficacy and

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P a g e | 18 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION ❖ safety of time tested Ayurvedic procedures like Vasti (medicated enema) and Kashyapanam. ❖ With our changing habits, the prevalence of Vatarakta (gout) is increasing day by day. It is a metabolic disorder and is associated with many health issues like Obesity, Diabetes Mellitus, Hypertension, CAD and Renal complications. ❖ The Vasti (medicated enema) has shown improvement in most of the clinical features. Reduction in the serum uric acid level was also noticed, results were statistically significant. ❖ No untoward effect was noticed during the study On the basis of above study, it can be concluded that the Vasti (medicated enema) is effective in the management of Vatarakta w.s.r. to Gout. Acknowledgment: Nil Financial Support: Nil. Conflict of Interest: Nil REFERENCES 1. Kaviraj Ambikadutta shashtri , Sushruta samhita , volume -1, Chikitsa Sthana chapter 5 , verse 5. Published by Chaukhamba Sanskrit sansthana, Reprint 2014,pp-675 2. Dr. Bramha nand tripathi Charak Samhita, volume -2, Published by Chaukhamba , Bhartiya acdamy Reprint-2013, Chikitsa Sthana , Adhyay 29 , Verse - 11.pp-564 3 . Dr. Bramha nand tripathi Charak Samhita, volume -2, Chikitsa Sthana , Adhyay 29 , Verse-14. Published by Chaukhamba , Bhartiya acdamy Reprint-2013,pp-765 4. Dr. Bramha nand tripathi Charak Samhita, volume -2, Chikitsa Sthana , Adhyay 29 , Verse-23 Published by Chaukhamba , Bhartiya acdamy Reprint-2013,pp- 435 5. Dr. Bramha nand tripathi Charak Samhita, volume -2, Chikitsa Sthana , Adhyay 29 , Verse-36. Published by Chaukhamba , Bhartiya acdamy Reprint-2013,pp-254 6. Dr. Bramha nand tripathi Charak Samhita, volume -2, Chikitsa Sthana , Adhyay 29 , Verse-88. Published by Chaukhamba , Bhartiya acdamy Reprint-2013,pp-453

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Kashaya, Dosha, Vata, Vatarakta, Rakta, Raktadhatu, Vasti, Vatadosha, Burning sensation, Ayurvedic, Financial support, External cleansing, Modern medical science, Conflict of interest, Mode of action, Life-style, Clinical study, Diagnostic criteria, Ethical Clearance, Gout, Visual analogue scale, Ayurvedic text, Objective Criteria, Joint swelling, Metabolic disorder, Joint pain, Classical method, Sandhi Shoola, Subjective parameter, Sneha Dravya, Sandhi Shotha, Objective parameter, Classical text, Institutional Ethical Committee, Tridosha shamak, Guru guna, Panchkarma, Shamana drug, Mean score, Internal cleansing, Bahiparimarjana Chikitsa, Health issue, Serum Uric Acid, Ayurvedic procedure, Effective therapy, Acharya Charka, Til tail, Bodhi Vriksha Kashaya, Shaman Aushadh, Rajiv Gandhi Govt.