A Clinical Study to evaluate the effect of Kshirbala Taila Basti in the...

[Full title: A Clinical Study to evaluate the effect of Kshirbala Taila Basti in the management of Karshya in school going children]

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[Find the meaning and references behind the names: Bala, Sharma, Low, Rakesh, Ayu, Kumari, Chaudhary, Jan]

ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 5 A Clinical Study to evaluate the effect of Kshirbala Taila Basti in the management of Karshya in school going children Shiksha Kumari, 1 Minakshi Chaudhary, 2 Rakesh Sharma 3 1 Lecturer, Dept. of Kaumarbhritya, Saraswati Ayurvedic Hospital & Medical College, Gharuan, Mohali, Punjab, 2 Lecturer, 3 Professor and Head, Dept. of Kaumarbhritya, R.G.G.P.G. Ayurvedic College, Paprola, Himachal Pradesh, India. I NTRODUCTION Karshya [1-4] is the disease comparable with under nutrition which can be a Swatantra Vyadhi or it can also manifest along with other diseases as a prestige symptom of complication. It is an Apatarpana Janya Vyadhi where Vatadosha plays a very important role in the pathogenesis. Malnutrition results from the interaction of poor-quality diets and poor-quality health and care environments and behaviours. In today’s busy era people are not able to follow proper diet and life-style, so are their children leading to disturbed gastrointestinal and metabolic functions. Address for correspondence: Dr. Shiksha Kumari Lecturer, Dept. of Kaumarbhritya, Saraswati Ayurvedic Hospital & Medical College, Gharuan, Mohali, Punjab, India. E-mail: shiksha 90 ayu@gmail.com Submission Date : 06/01/2018 Accepted Date: 10/02/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.v 3 i 01.11632 So, according to Ayurveda fundamentals not giving thought to Pathya-Apathya leads to Agni-Dushti at all levels leading to improper nourishment of the Dhatus resulting in manifestation of Karshya. In India around ¾ th of our paediatric population is suffering from one or other nutritional deficiencies which can be termed as Karshya . About 75-80% of hospitalized children suffer from some degree or type of malnutrition. Under-nutrition jeopardizes children’s survival, growth and development, and it slows national progress towards achieving development goals. Although great improvements have been made within the past few years, there still remains a great number of malnutrition related illnesses that are still present in the country and remains a major public health issue. The Rapid Survey on Children (RSoC) a survey performed between the year 2013 and 2014 reports that 38.7% are considered stunted ( low height for age), 29.4% are considered underweight (low weight for age), 15% are considered wasted (low weight for height). According to NFHS-4, in India, 38.4% children under the age of five years are stunted; 35.7% children under five are underweight; and nearly 21% children under five are wasted out of which 7.5% are severely wasted or suffer from severe acute A B S T R A C T In India around ¾ th of our paediatric population is suffering from one or other nutritional deficiencies which can be termed as Karshya . About 75-80% of hospitalized children suffer from some degree or type of malnutrition. Lots of attempts have been made to minimize this at National level. For this the immunization plans and milk distribution or midday meal to school going children alone will not be sufficient. Ayurveda can play major role in providing health to children. In Ayurveda, Balya and Brumhana Chikitsa for undernourished children is an interesting area in the field of Kaumarbhritya and since the prevalence of this disease in present scenario is more. Key words: Karshya, Matra Basti, Kshira Bala Taila, Under Nutrition, Agni Dushti.

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[Find the meaning and references behind the names: Tamil, Rajiv, Main, Sam, Shakti]

Shiksha Kumari et.al. A Clinical Study to evaluate the effect of Kshirbala Taila Basti in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 6 malnutrition (SAM). India contributes to one-third of severely wasted children under five in the world. The 2015 Global Hunger Index (GHI) report ranked India 20 th amongst leading countries with a serious hunger situation. Amongst south Asian nations, it ranks third behind only Afghanistan and Pakistan with a GHI score of 29.0 (“serious situation”). In India, 60% of children with SAM fewer than five years live in 6 states: Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Maharashtra and Tamil Nadu. In this study, Balya and Brumhana Chikitsa in the form of Ksheerbala Taila Matra [5] Basti was given to 20 children fulfilling the criteria of Karshya and has given promising results after 21 days of administration of Basti with both local and systemic effects resulting in weight gain in nonweight gaining type cases A IMS AND O BJECTIVES To study the clinical efficacy of Kshirbala Taila Basti in the management of Karshya. M ATERIALS AND M ETHODS Study was carried out on 20 patients in Rajiv Gandhi Govt. Post Graduate Ayurvedic College Paprola, Himachal Pradesh. Inclusion criteria 3 to 16 Years children irrespective of sex, education and socio-economic status with poor weight gain, poor growth, lean and thin body as per IAP and Children fulfilling the description of Karshya described in our texts like Sushkasphika, Sushkaudara, Sushkagriva, Dhamani Jala Darshanam etc. Exclusion criteria Children with any physical disability or, infectious diseases like TB, congenital and hereditary problems, malignancies and below or above the mentioned age group. Treatment Schedule Duration of intervention - 1 month (Total 21 Matrabasti ) Patients were divided in three classes on the basis of age range, 3-5 yr : 30 ml 6-9 yr : 45 ml 10-16 yr : 60 ml Follow up - Weekly and after completion of trial O BSERVATIONS AND R ESULTS A. Effect of therapy on subjective parameters 1. Daurbalya : On this parameter the result showed highly significant (p<0.001) effect with 61.9% improvement. Kshirabala Taila having Brumhana effect and rectal route helps in evacuating waste product and by increasing synthesis of nutrient. 2. Kshudha : The effect on Kshudha was highly significant (p<0.001) and the relief was 93.02%. Basti of Kshirabala Taila having Agnidipti property and Basti itself cause Vata Samana and helps in increasing Jarana Shakti which is the main factor for Agnidushti in Karshya Roga . 3. Dhamani Jala Darshanam: Dhamani Jala Darshana was reduced by 41.37% which is highly significant (p<0.001). 4. Sthula Parva: Showed significant effect (p<0.05) on reducing Sthula Parva and the relief in percent was 13.8%. 5. Nidra: On this parameter patients showed highly significant result (p<0.001) with 71.42% improvement 6. Constipation: After the therapy highly significant effects (p<0.008) were observed with 100% relief in constipation. Impairments in Agni i.e. Mandagni is main cause for disturbed bowel habit i.e. constipation and diarrhea. Basti by virtue of Agnidipti maintains the Agni and Bastidravya itself causes Malapaham i.e. elimination of toxic substance from the body and pacify Vata which also ultimately balances Agni and helps in regularizing the bowel habit. 7. Kapola Gata Vasa: Showed highly significant effect (p<0.001) and improvement in percentage was 35.13%.

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Shiksha Kumari et.al. A Clinical Study to evaluate the effect of Kshirbala Taila Basti in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 7 B. Effect of therapy on Objective Parameters 1. Weight: Highly significant weight gain was noticed with the percentage improvement of 9.8%. It might be due to acceleration of the body growth as a result of Brumhana therapy which was achieved by correcting Agnidushti followed by increasing food intake due to Deepana Karma. 2. Height: An increase in height has been observed in the present study, it might be due to their growing period because all the patients belong to the age group of 3-16 year. 3. Mid-Arm Circumference: Increment in mid-arm circumference was 7.1% which was highly significant. The drug has positive effect on formation of all the Dhatus as it potentiates Agni , relieves obstruction of Srotas and harmonizes Dhatvagni functions. 4. Chest Circumference: Chest circumference was increased by 1.2% with significant result. It indicates that anabolic effect has been started in the patient and increase in chest circumference appears to be due to musculature growth only. 5. Head Circumference: The effect on head circumference was insignificant (p>0.05) with 0% improvement. 6. Mid-Thigh Circumference: Increment in mid-thigh circumference was 3.7% which was highly significant. 7. Mid-Calf Circumference: Increment in mid-calf circumference was statistically highly significant with percentage improvement of 5.3%. Overall Effect of Therapy Among total 20 patients, 40% patients showed moderate improvement while 30% patients showed mild improvement followed by only 3% patients showed marked improvement with no improvement in rest 3% of patients DISCUSSION Karshya is an Apatarpana Janya Vyadhi so, its management is done by Santarpana (Brumhana). [6-14] Karshya being a Vata Pradhana Vyadhi , mainly occurring due to Dhatukshaya . So as general line of treatment i.e. Vata Upakrama can be adopted [15] As specific line of treatment all the Acharyas observed importance of Brumhana therapy. The principle of management of Karshya should be in the following manner; Nidanaparivarjana, Samshodhana, Samshamana, Ahara, Vihara . In case of management of Atikarshya, Acharya Charaka rightly advised administration of Mridu Samshodhana as per the requirements . Considering the above mentioned fact Brumhana therapy in the form of Kshirabala Taila Basti has been administered in the patients of Karshya. The Basti is given to Vatasthana and so it can alleviate the Vata at its own site. As the Vata is brought under control the disease is itself cured, because without the major causative factor, the disease itself does not have any existence [16] Kshirabala Taila having Deepana property helps in Agnidipti , Srotoshodhaka property maintains integrity of Srotas. The Brumhana property is directly responsible for Dhatuabhivardhana. Ksheerbala Taila while introducing through rectal route ‘ Bastichikitsa’ , also act on distinct part along with local action Ayurveda mentioned that Ushna, Snigdha, Vataghana, Balya, Brihmana etc. characteristics of Kasheerbala Taila suppress Vayu. And on correlation with modern concept fatty oils in Ksheerbala Taila enhance the absorption of Taila from rectum mucosa which is responsible for efficient cure of Vatvyadhi Karshya. Ksheerbala Taila introduced through ano-rectal route reaches the large intestine where it increases the peristalsis of the intestine, thus helping in the removal of waste products from the body resulting in Mridu Samshodhana. It also helps in maintaining the intestinal flora providing probiotic effect. CONCLUSION Based on the above findings it can be presumed that though the formulation has the qualities of increasing Kapha and Medas and decreasing Vayu, its action is

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[Find the meaning and references behind the names: Shri, Indu, Hari, Dutt, Nil, Med, Prakashan]

Shiksha Kumari et.al. A Clinical Study to evaluate the effect of Kshirbala Taila Basti in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2018 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2018 | Vol. 3 | Issue 1 8 only to the extent of alleviating the clinical symptoms of Krishta which is the objective of the study and bring the undernourished children to the state of normalcy. All the cases are of non-weight gaining type but not in the state of weight losing. Further weight gain after treating with this formulation can be possible with proper nutrition in the form of food as no any medicine can be a substitute to the food, an essential factor for growth. REFERENCES 1 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Sutrasthana 21/13-15. 2 Ambika Dutt Shastri. Sushruta Samhita, Hindi commentary - Ayurveda tattvasandipika, Chaukhambha Sanskrit Sansthan, Edition-Reprint 2010, Sutarasthana 15/39 3 Vriddha vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012, Sutrasthana 24/53 4 Bhavprakash by Bhavmishra, Vidyotini commentary, Fifth edition, Chaukhamba Sanskrit Sansthan, Varanasi, Madhya Khanda, Chikitsa 40/3 5 Sahasrayoga samgrah Vatarogadhikara 6 Namjoshi M. Concept of Brimhana w.s.r. to Karshya [PG thesis]. Jamnagar: Gujarat Ayurveda University; 1994. 7 Namjoshi M. Concept of Brimhana w.s.r. to Karshya [PG thesis]. Jamnagar: Gujarat Ayurveda University; 1994. 8 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Sutrasthana 22/10 9 Vriddha Vagbhata, Ashtanga Samgraha with the Shashilekha commentary of Indu, edited by Dr.Shivprasad Sharma, Varanasi: Chowkhamba Sanskrit Series Office, Ed. 3 rd 2012, Sutrasthana 24/4 10 Vagbhata. Ashtanga Hridaya, with commentaries of Arunadutta and Hemadri, edited by Pt. Hari Sadasiva Sastri Paradakara. Varanasi: Chaukhambha Surbharati Prakashan, Ed. Reprint 2010, Sutrasthana 14/2 11 Vaidya Jadavji Trikamji, Narayanacharya Kavyatirtha, Sushruta Samhita of Sushruta with the Nibandhasamgraha commentary of Shri Dalhanacharya Chaukhambakrishnadas Academy Varanasi, Reprint year 2004, Sutrasthana 45/202/63. 12 Vagbhata. Ashtanga Hridaya, with commentaries of Arunadutta and Hemadri, edited by Pt. Hari Sadasiva Sastri Paradakara. Varanasi: Chaukhambha Surbharati Prakashan, Ed. Reprint 2010, Sutrasthana 14/2 13 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Sutrasthana 22/13-14 14 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Sutrasthana 21/20 15 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Vimansthana 6/16 . 16 Kashinath Shastri, Gorkhnath Chaturvedi, Charak Samhita Hindi commentary- Vidyotini, Chaukhambha Bharti Academy, Reprint 2010, Sutrasthana 16/28,29,30. ******************************* How to cite this article: Shiksha Kumari, Minakshi Chaudhary, Rakesh Sharma. A Clinical Study to evaluate the effect of Kshirbala Taila Basti in the management of Karshya in school going children. J Ayurveda Integr Med Sci 2018;1:5-8. http://dx.doi.org/10.21760/jaims.v 3 i 01.11632 Source of Support: Nil, Conflict of Interest: None declared.

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Dhatu, Balya, Matra-basti, Nidra, Kshudha, Daurbalya, Agnidushti, Basti, Karshya, Samshamana, Agnidipti, Dhatukshaya, Brihmana, Vatadosha, Weight, Constipation, Height, Under nutrition, Deepana Karma, Deepana, Brumhana therapy, Vata Pradhana Vyadhi, Mid Arm Circumference, Brumhana Chikitsa, Chest Circumference, Swatantra Vyadhi, Srotoshodhaka Property.