Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders

[Full title: Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review]

Review Article This work is licensed under a CC BY 4.0 License International Research Journal of Ayurveda & Yoga Vol. 5 (5),156-164, May, 2022 ISSN: 2581-785 X; https:/ /irjay.com/ DOI: 10.47223/IRJAY.2022.5526 Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review M.N.S Marasingha, 1 Nisha Kumari Ojha 2 1-MD Scholar, Department of Kaumarbhritya, National Institute of Ayurveda, deemed to be University, Jaipur 2-Associate Professor and Head of the Department, Department of Kaumarbhritya, National Institute of Ayurveda, deemed to be University, Jaipur INTRODUCTION In any culture where children are the most precious possession, their physical and mental well-being is the uttermost expectation. Therefore, the whole development of children is the responsibility of today. The continuous growth of the knowledge system will prove the protection of the future, and research can contribute a lot to it. Article Info Article history: Received on: 23-04-2022 Accepted on: 24-05-2022 Available online: 31-05-2022 Corresponding author- M.N.S Marasingha, MD Scholar, Department of Kaumarbhritya, National Institute of Ayurveda, deemed to be University, Jaipur Email: - dr.marasingha@gmail.com ABSTRACT: Today development disabilities are emerging as a new problem of society. While disability is discussed particularly in children, about a quarter of chronic childhood problems are neurological in origin. Disability treatment and management in the world is a big challenge. The Ayurveda medicine (like Vatashamaka drug and Medhya drug) and along with Panchkarma procedures will help at possible level for the rehabilitation towards lives with potential of independence. Samvardhana Ghrit is mentioned in the Lehadhyaya chapter of the Kashyapa Samhita. It is used to promote healthy growth of child without interference from disease, as well as to improve or treat impaired conditions in children who are Pangu (lame), Muka (dumb), Ashruti (deaf), and Jada (idiot). Aim: To evaluate the efficacy of Samvardhana ghrit in the management of childhood disability disorders. Materials and Methods: A literature review was conducted with the help of many important Ayurvedic and Modern textbooks, and article published in various journals. Result and discussion: Present review reveals that the ingredients of Samvardhana Ghrit have action on the brain and nervous system. Further, as the formulation is in ghrit form, it can easily cross the blood brain barrier and show its effect. Conclusion: Samvardhana Ghrit can be used for the management of childhood disability disorder. However, additional panchakarma and physiotherapy may provide additional benefit to the patients. Key words: samvardhana ghrit , ayurveda , disability disorder , childhood

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 157 Ayurveda is not only a medical system but also a body of practicable knowledge that enhances the quality of life of living beings. Constant research studies in Ayurveda are important and validated, so it has enough strength in its fundamentals. Currently, development disabilities are an emerging health issue, and disease in childhood with a neurological origin is proportionally high among them. In Ayurveda, the childhood disability condition is vividly described in several chapters in the text. Phakka 1 (developmental delay due to nutritional causes or secondary to disease) Pangulya (lame) Mukatva 2 (dump) Jadatva (Stiff body parts) Ekanga Roga 3 (disease affecting single part of the body) Sarvanga roga 4 (disease affecting a single part of the body) Pakshaghata 5 (paralysis) are similar conditions that come under the related ailments. Disability is a neurological condition which is directly involved in the function of the Nerve system of the body and the mechanism of controlling, regulating and coordinating is get affected. Samvardhana ghrit 6 is highly recommended for the smooth and rapid growth of a healthy child, as well as for improving or treating impaired conditions in those who are pangu (lame), muka (dumb), Ashruti (deaf), and Jada (blind) (idiot) which is frequently seen in childhood disability disorders. MATERIAL AND METHODS This review is conducted using a complete and organized search of the available literatures in Ayurveda texts and published articles. The searches were performed using various databases, including PubMed, Scopus, MedLine, Google Scholar and others. The keywords used for the search included, medhya , samvardhana ghrit , disability , balya and brimhana. RESULT- Table No 01: Ayurvedic Pharmacology of Ingredients of Samvardhana ghrit Effect of Samvardhana ghrit on Cerebral Palsy A significant number of studies on Cerebral Palsy in children which is a major cause of childhood disability document the significant effect of Samvardhana ghrit. 17,18,19,20 Pharmacological action: Khadira: The methanol extract of A. catechu showed potential in the management of neurodegenerative diseases (Alzheimer’sdisease) via the anticholinesterase effect and significant antioxidant effect 21 Arjuna: DNA damage protection and free radical scavenging action Ethanolic extracts and its fractions used to DNA stand breakage assay and come assay analysis by using of PBR 322 plasmid and rat adrenal PC-12 cells was examined Maximum inhibition of DPPH, hydroxyl, ABTS nitric oxide radicals and metal chelation was observed in ethyl acetate fraction. T.arjuna extract ameliorate various impairments associated with DNA damage free radical formation 22 Sida cordifolia: In Neurodegenerative Disease The plants in rasayana is S.cordifolia which is used clinically in the treatment of neurodegenerative diseases. These plants are generally characterized by processing strong antioxidant activity. Free radicals have been extensively reported to be implicated in neurodegenerative diseases 23 . Alleviation of Neurodegenarative Disease Symptoms In an investigation, the aqueous fractions well as its sub – fraction, including the hexaneschloro form and the aqueous ones were assessed for their effects on the rotenone induced biochemical, neurochemical, histopathologial, and behavioural changes in rat model. These signs of the disease were substantially diminished. The reduction in the level of dopaminin the midbrain region was reversed on cotreatment with aqueous extract. This effect is possibly mediated by the ant oxidative properties of the aqueous extracts 24 . Kebuk ( Costus specious ): Adaptogenic activity The effect of alcoholic extract of Costus specious rhizomes and leaves on stress induced change in brain neurotransmitters and enzyme monoamine oxidase levels in albino rats. The extracts were found to possess normalizing activity against cold immobilization stress induced change in norepinephrine (NE), dopamine (DA), 5 hydoxy tryptamine(5-HT), 5-hydroxy indole acid(5- HIAA). The results obtain provide biochemical evidence for ant stress activity of the tested extract 25 DISCUSSION According to Charaka, every drug either acts via rasa, guna, vipaka, virya, or prabhava . Hence, in this formulation, a powerful factor 26 among the above should be investigated to find its probable mode of action.

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 158 All most all the ingredients of Samvardhana ghrit possess Madhura rasa as the main rasa while as anurasa Tikta , Katu , and Kashaya rasa are present. Prominent Guna of the ingredients can be distinguished as Snigdha , and Guru guna , Sheeta as Virya , Madhura as predominant Vipaka can be identified. Kapha - Pitta , Vata - Pitta dosha karma are prominant with Medhya and Balya actions. Further, Ghrita and Kshira are equally effective for higher functions of brain such as Medhya 27 , Medhavardhaka 28 , Rasayana 29,30 etc. According to the analysis of rasa present in individual drugs, the majority of drugs (46%) have Madhura rasa . The combination of Prithvi and Jala mahabhuta creates Madhura rasa . Mamsa dhatu's panchabhautika composition is similar to Madhura rasa. As a result of the Samanya Vridhikarna law, Madhura rasa is able to aid in the growth and proper nourishment of muscular tissue. Madhura rasa shows Balya , Jeevaniya , Sarvadhatu Vardhaka , Brimhana , Preenana and Sthairyakarana actions. As a result, Madhura rasa appears to be capable of providing proper nourishment to neurons in order to take up a load of already damaged neurons. Madhura rasa with combination of Tikta and Katu rasa may help in the proper development of neuron synapses, results a regeneration process in neuronal precursor cells due to its penetrating strength. Due to the agneya nature of katu rasa it involved in Indriyautojetaka (receiving information from the senses) action, Margana vivraunati (proper channelization and replacement of damaged neurons), and Agnidipana (secretion of hormones in synaptic vesicles). Hence, it is conceivable that it could provide stimulation in the areas of brain where cells can regenerate, particularly the hippocampal region. Graph No. 1 Guna When the guna of all the ingredients of the study drug is considered, 42.8 percent of the drugs have Snigdha guna and 30 percent have Laghu guna , bringing the total to 28.8 percent. Snigdha guna improves the qualities of Tarpaka kapha (helps to restore and strengthen the functional brain). Laghu guna's effect improves an individual's utsaha (enthusiasm) and sphurti (energy). Graph No. 2 Virya Sheeta virya shows stambhana (holding) and sthairikarana kriya (stability) may restrict the excessive neuronal discharge that is seen in case of convulsions. Graph No. 3 Vipaka When considering the Vipaka of all of the ingredients, 60% of the drugs have Madhura vipaka and 40% have Katu vipaka . Madhura vipaka increases all sharira dhatus , including brain and muscular tissues, nourishes manas and indriya , relieves vitiated Pitta and Vata doshas , improve vital strength, and gives firmness to the body. On the other hand, Katu vipaka stimulates all sense organs to perceive their respective objects by increasing overall metabolism in the body, proper enzymatic secretions, and thus minimizing nutrient deficiencies. The Medhya drugs (acting on CNS) are Katu and Madhura vipaka predominantly Graph No. 4 Prabhava Medhya , Balya , and Rasayana are prabhava of drug Samvardhana ghrit . Medhya drugs work primarily through their 'Achintya virya ,' or prabhava . This suggests that these drugs have a direct effect on medha (intellect). The precise mode of action of these medhya drugs is unknown, but these drugs finally increase the overall functional capacity of the brain through any of these mechanisms: increased perfusion, metabolism, and improved chemical imbalance in the brain. Rasayana drugs are said to increase all sharira dhatus (tissues) quantitatively and qualitatively. Balya drugs offer strength to the body that is ailing as a result of chronic disease. The Brimhana drug enhances the production of healthy dhatus in the body. Dosha shaman Samvardhana ghrit possesses vata-pitta shamaka , kapha pitta shamaka , and tridosha shamaka have been balanced by this drug. As a result, the drug possesses excellent Vatahara properties that are supposed to vitiated in neurological disorders Pharmacodynamic properties related to the application of Samvardhana ghrita Lipid Solubility Drugs that dissolve easily in fats and can be absorbed quickly from the gut can easily move into the CSF and the brain. Ghrita , which is a fat, is quickly absorbed and distributed in the target areas of the body 31 The Blood- Brain Barrier (BBB) selectively allows lipids and lipidsoluble drugs to pass through it.

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 159 Ketogenic effect This method is commonly used in seizure disorders. Ghrita has phospholipids, fatty acids, and other nutrients that support to fix neurotransmitters that are in imbalance state. This diet causes a ketogenic effect in the body, which prevents seizures and indirectly causes brain damage. Saindhava Lavana (Rock salt) The following are some of Saindhava Lavana's evidencebased research studies: 1 Sodium is required for action potential generation and transmission in neurons and muscle fibers. " 2 BBB (Blood Brain Barrier) crossing is possible at the ionic stage. It makes it easier for Ghrita , a substance that dissolves in fat, to move from the bloodstream to the brain tissue. 3 Sodium (Na) is the most common ion in the extracellular fluid (ECF). It makes up almost half of the osmolarity of ECF. 4 High osmotic pressure can cause the endothelial cells in capillaries to shrink, which opens up the spaces between the tight junctions of endothelial cells and makes the BBB more porous.As a result, drugs can enter the tissues of the brain.The effect of Sanvardhana Ghrita can be further classified on principle of modern perspective as follows. • Drugs capable of regenerating neurons -A. catechu has shown promise in the treatment of neurodegenerative diseases due to its anticholinesterase activity and significant antioxidant effect 32 ; S.cordifolia is a plant that is used in the treatment of neurodegenerative diseases. These plants are distinguished by their high antioxidant activity. Free radicals have been extensively linked to neurodegenerative diseases 33 The hydroalcoholic extract of the leaves induced CNS depression in mice, this effect was also evidenced from reduction of the motor activity of the animals, nevertheless, without interfering with motor coordination 34 • Drugs showing the effect on Anti-inflammatory activity are Khadira :- According to the findings, 57 extract containing both baicallin and (-) catechin directly inhibits the production of inflammatory fatty acids by acting on the COX and LOX enzymes 35 . Prishniparni:- It has antiinflammatory properties due to the stabilisation of COX-2 lysosomal membrance 36 .Arjuna:- Immunomodulatory activity and Anti-inflammatory 37 Kebuka :- It has a significant anti-inflammatory effect 38 • Drugs showing effect on Anti-Oxidant Activity are Khadira:- Catechin, rutin, and isorhamnetin are free radical scavengers that contribute significantly to Acacia catechu's bio potency 39 Prishniparni:- Significant antioxidant activity has been linked to the presence of phenol derivatives, flavonoids, sterols, and terpenes 40 Arjunagenin has been the most active compound compared to the others and has a moderate inhibitory effect on the process of respiratory oxyburst, with an IC 50 value of 60 g/mg 41 Kubuka:- N.C. Vijayalakshmi investigated the polyphenol content and antioxidant activity of various parts of Costus speciosus 42 CONCLUSION Present review reveals that Samvardhana ghrit can be used as oral medicine for the management of disability disorders of children as indicated by Kashyapa However, panchakarma and physiotherapy may provide additional benefit to the patients. Acknowledgements- Nil Conflict of Interest – None Source of Finance & Support - Nil ORCID M.N.S Marasingha https://orcid.org/ 0000-0003-4250-3207 REFERENCES 1 Sharma H, Vriddha Jivaka, Kashyapa. Reprint ed. Varanasi: Kashyapa Samhita, Chikitsa Sthan, Phakka Chikitsa adhyaya, with Vidhyotini Hindi commentary; Chaukhambha Sanskrit Sansthan; 2010 p. 207-211 2 Shastry K Vidyotini Hindi Commentary on Charaka Samihta Part II Chikistha Sthan Chapter 28/72 Chaukhambha Sanskrit Sansthan; 2010 3 Shastry K, Vidyotini Hindi Commentary on Charaka Samihta Part II Chikistha Sthan Chapter 28/54 Chaukhambha Sanskrit Sansthan; 2010 4 Shastry K Vidyotini Hindi Commentary on Charaka Samihta Part II Chikistha Sthan Chapter 28/55 Chaukhambha Sanskrit Sansthan; 2010 5 Shastry K, Vidyotini Hindi Commentary on Charaka Samihta Part II Chikistha Sthan Chapter 28/72 Chaukhambha Sanskrit Sansthan; 2010

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Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 161 35 Heller a, Koch T, Schmeck J, Van Ackern K: Lipid mediators in inflammatory disorders, Drugs 1998; 55:487- 496. 36 Olufemi AO, Omoniyi YK, Akinyinka AA, Ibitayo AM, Mechanistic evaluation of toxicity, antiociceptive, antiinflammatory and antioxidant actions of leaf extract of Uraria Pict. LAASUJ Med Sci 2016; 1:1-10. 37 Singh M.P, Himadri Panda. Medicinal Herbs with their Formulations, Daya Publishing House, Deli 2005. Page 766. 38 Binny K, Sunil Kumar G, Dennis Thomas, Journal of Basic and Clinical Pharmacy, 2010. 39 Hazra B, Journal of coplementry and intergrative medicine vol.7/2010/ issue 1. 40 Arka G, Anindita K, Ankit S Kumar SA, Kumar MS, Preliminary evauation of hepatoptoprotective potential of the polyherbal formulation. L Intercult Ethanopharacol 2015; 4: 118-24. 41 Pawar R.S, Bhuani K.K. Effect of oleananetriter penoids from Terminalia arjuna : Cardioprotective drug on the process of respiratory oxyburst. Phytomedicene, 2005; 12:381-393. 42 Vijayalakshmi, N.C. Sarada, Fitoterapia, Mechanistic evaluation of toxicity, antiociceptive, anti-inflammatory and antioxidant actions of leaf extract of Uraria 2008, 79(3), 197-198. How to cite this article: Marasingha M.N.S, Ojha NK “Role Of Samvardhana Ghrit In The Management Of Childhood Disability Disorders: A Review” IRJAY.[online]2022;5(5);156-164. Available from: https://irjay.com DOI linkhttps://doi.org/10.47223/IRJAY.2022.5526

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 162 Table No 01: Ayurvedic Pharmacology of Ingredients of Samvardhana ghrit Name Rasa Guna Virya Vipaka Doshaghnata Karma (Pharmacological actions) Kadira Tikta, Kashaya Lagu Ruksha Sheeta Katu Kaphapittahara Grahi, Pachana, Kushthagna, Raktapitta Prashamana, Kasahara, Dantya, Krimigna, Jvarahara, Vranaropana 7 Prishniparni Madura Tikta Lagu Snigdha Ushna Madhura Tridoshahara Vatahara, Nadibalya, Balya, Vrishya, Vathasulahara. Deepana, Anulomana, Grahi, Trishnashamaka, Angamarda prashaman, Sonithasthapana, Sothahara, Muthra Jawaragna, Haridya, Sandhaniya 8 Bala Madura Snigdha, Guru Sheeta Madhura Vata Pitta Shamaka Balya, Rasayana, Ojaskara, Vedanasthpan, Vrsya, Pramehagna, Vidhagna, Sothahara, Vathashulahara, Hardaya, Muthrala, Snehana, Raktapittahara, Sangrahana, Grahi, Vrsya 9 Arjuna Kasaya Sheeta, Lagu Ruksha Sheeta Katu Kapha pitta nashaka Balya, Visagna, Medohara, Raktha sthambana, Muthra sangrahaniya, Jaragna, Balya, Visagna, Ksataksaya hara, Bhagnasabdhanakara and raktadosahara 10 . Athibala Madura Snigdha Sheeta Madura Vata Pitta Shamaka Balya, Rasayana, Vrsya, Raktapittahara, Sangrahana, Grahi 11 . Kebuka Tiktha Laghu Ruksha Sheeta Katu Kapa pitta shamaka Pittahara, Kaphahara, Garbsya Sankochaka, Grahi, Deepana, Pachana, Hridya, Raktashodhaka, Krimighna 12 Kshira Madura Snigdha, Guru Pichchils Sheeta Madura Vata pitta shamaka Balya, Medhya, Jeevaniya, Stanyakara, Prinana, Manaskara, Raktapittanasana 13 , angapushtiprada (gives nourishment to the body) 14 Sahindava Lavana Snigdha, Ushna, Tikshna Snighdh, Laghu, Hima, Sukshma Anushn a Sheeta Madura Tridoshahara Deepaniyatama, Deepana, Pachana, Ruchya, Vrishya, Netryam 15 Ghrita Madura Snigdha, Guru Sheeta Madura Vata pitta shamaka Swarya, Dipana, Oja-Teja-Bala- Ayushya vriddhikar, Vrishya, Medhya, Vayasthapan, Chakshushaya, Rakshoghna 16

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 163 Graph No. 1 Graph No. 2 Madhura 46% Kashaya 23% Tikta 23% Lavana 8% Ayurvedic Pharmacology of Ingredients Rasa Madhura Kashaya Tikta Lavana 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 25.00% 20.00% 30.00% 5.00% 5.00% 5.00% 5.00% 5.00% Ayurvedic Pharmacology of Ingredients Guna

Marasingha et. al “Role of Samvardhana Ghrit in the Management of Childhood Disability Disorders: A Review” : 2022; 5 (5):156-164 164 Graph No. 3 Graph No. 4 Seetha 90% Usna 10% Ayurvedic Pharmacology of Ingredients Virya Seetha Usna Katu 30% Madhura 70% Ayurvedic Pharmacology of Ingredients Vipaka Katu Madhura

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Ayurveda, Balya, Ghrita, Brimhana, Panchakarma, Pangulya, Katuvipaka, Madhuravipaka, Vatapitta, Kashyapasamhita, Madhurarasa, Saindhavalavana, Brain, Nervous system, Nerve system, Rapid growth, Impaired condition, Healthy growth, Anti-inflammatory activity, Antioxidant activity, Anti-inflammatory, Anti oxidant activity, Blood brain barrier, Cerebral palsy, Snigdha guna, Neurological disorder, Physiotherapy, Pharmacological action, PubMed, Google Scholar, Medhya drug, Adaptogenic activity, Rasayana drug, Sida cordifolia, Neurodegenerative disease, Panchkarma Procedure, Sheeta virya, Vatahara properties, Childhood disability, Lipid solubility, Neurological condition, Modern Textbooks, Balya drugs, Dosha shaman, SCOPUS, Medline, Kapha - Pitta, Vatashamaka drug, Available literature, Additional benefit.