A comparative clinical study on Brihmana effect of Ashwagandhaadya Ghrita...

[Full title: A comparative clinical study on Brihmana effect of Ashwagandhaadya Ghrita Snehanapana and Matra Basti in Karshya w.s.r. to Under Weight]

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[Find the meaning and references behind the names: Suresh, Varsha, Patil, Pala, Good, Sama]

ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 17 A comparative clinical study on Brihmana effect of Ashwagandhaadya Ghrita Snehanapana and Matra Basti in Karshya w.s.r. to Under Weight Dr. Vijaylaxmi B. Patil, 1 Dr. Suresh N. Hakkandi, 2 Dr. Manjunath P. Akki 3 1 Post Graduate Scholar, 2 Professor and HOD, 3 Professor, Dept. of Panchakarma, SJG Ayurvedic Medical College & Hospital, Koppal, Karnataka, INDIA. I NTRODUCTION Ayurveda basically deals with Shodana and Shamana procedures as basic elements of treatment. Panchakarma aspires the principles of Shodana therapy which helps in the complete elimination of vitiated Doshas from the body, which prevents the reoccurrence of diseases completely [1] Acharya Charaka defines Swastha as person having Sama Mamsa Pramana, Sama Samhanana and Drudendriya Address for correspondence: Dr. Suresh N. Hakkandi Professor and HOD, Dept. of Panchakarma, SJG Ayurvedic Medical College & Hospital, Koppal, Karnataka, India. E-mail: sureshhakkandi@gmail.com Submission Date: 12/11/2018 Accepted Date: 08/12/2018 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.3.6.3 and the word Physique has also its unique meaning as proper shape and size of the body of an individual [2] As it is said that “Life is not so bad if you have plenty of luck, a good physique and not too much of imagination” hence a proper physique plays a important role in the life of an individual As per the WHO assessment there is a significant decreasing trends in the prevalence of underweight were observed among both men (2.2% to 1.0%) and women (5.7% to 2.5%) aged between 20 to 70 years in developed country where as the prevalence rate in developing countries like India is 22.7%. It is not significantly different between women and men, but still at all survey time periods women are fond to be more likely to be underweight than men [3] Karshya is Aptarpanajanya and Vataja Nanatmaja Vyadhi and Nidanas like Vegavarodha, Panchakarma Kriyatiyoga, Rookshanna Sevana, Shoka etc., leads to Krishata. [4] Features of Karshya as per classics Shushkasphik, Udara, Greeva, Dhamanijala Santata, A B S T R A C T Background: Karshya as per classics has Shushkasphik, Udara, Greeva, Dhamanijalasantata, Twagasthishesha, Kshuda, Pipasa, Sheeta, Ushna, Vayu, Varsha, Bharadan Asahishnuta and it is similar to the clinical features of under-weight/under nourishment includes loss of weight, muscle wasting, loss of subcutaneous fat, stress, fatigue and general weakness. Materials and Methods: The study was conducted as a randomized clinical trial and carried out in the Dept. of Panchakarma during the year 2016 - 2018. Patients with Dourbalya and anxious to gain weight were included in the study. Their age group was in between 18-45 years. 30 patients who fulfilled the inclusion and exclusion criteria were selected for the study. Patients were randomly allocated into two groups. Group A and Group B. In patients of Group A, Ashwagandhadya Ghrita as Brimhana Snehana 1 Pala i.e. 48 ml daily in two divided doses for 15 days with Ushnodaka . In Group B, Ashwagandhadya Ghrita as Matra Basti i.e. 50 ml daily for 15 days. Results: Statistically, Body weight is highly significant at the level of p<0.001. In Matra basti group in comparison to Snehapana group. Key words: Karsya, Body Weight, Aswagandha Ghrita, Brumhana Snehapana, Matra Basti.

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[Find the meaning and references behind the names: Bala, Kalpana]

Dr. Vijaylaxmi B. Patil et.al. A clinical study on Brihmana effect of Ashwagandhaadya Ghrita in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 18 Twagasthi Shesha, Kshuda, Pipasa, Sheeta, Ushna, Vayu, Varsha, Bharadan Asahishnuta and it is similar to the clinical features of under-weight/under nourishment includes loss of weight, muscle wasting, loss of subcutaneous fat, stress, fatigue and general weakness [5],[6],[7] Therefore if left untreated it leads to Atikarshya which in turns causes Shvasa, Kasa, Shosha, Pliha, Gulma, Raktapitta, Agnimandya, Bala Kshaya, Mamsa Kshaya, Ojo Kshaya and finally leads to death [8] In modern science it is treated with drugs which increase the appetite either as their primary effect or as a side effect such as antacids like pantaprazole, antidepressants, mirtazapine or amitriptyline, antipsychotics particularly chlorpromazine, tetrahydro cannabinol, all present an increase in appetite as a side effect. Other drugs which may increase appetite include certain benzodiazepines or Vit B supplements, sufficient nutritional diet is advised [9] All these drugs produce neurotoxicity, nephrotoxicity and hepatotoxicity. Hence for the safer side and better improvement in underweight our classics explains various treatment modalities which are Brihmana and Laghu Santarpana [10] There is increasing curiosity and awareness about Ayurveda and its various branches, not only in India but also throughout the world. However, Panchakarma has attracted more than any other branch. In Vatavyadhi Chikista, Snehana and Basti Karma are considered as the prime line of treatment [11] Hence the present study is taken to compare the Brihmana effect of Ashwagandhaadya Ghrita Snehanapana and Matra Basti in the management of Karshya The selected drug Ashwagandhaadya Ghrita described in Chakradatta indicated for Mamsa Vriddi, Balya and Vrishya is taken for the treatment [12] O BJECTIVES OF THE STUDY To compare the efficacy of Brumhana Snehapana and Matra Basti in Karshya . M ATERIALS AND M ETHODS Source of data Patients anxious to gain weight are selected with preset criteria from the OPD of SJGAMC and Hospital, Koppal. 30 patients willing to treatment procedure in the study were selected based on the clinical features of Karshya ( Dourbalya, Panduta ) considering the inclusion and exclusion criteria. Inclusion criteria 1 Patients suffering from Karshya with classical signs and symptoms 2 Patient indicated for Brumhana Snehapana and Matra Basti Karma. 3 Patients of either sex with age group between 18- 45 years. Exclusion criteria 1. Ayogya for Brimhana Snehana and Matra Basti Karma. 2 Other systematic conditions like DM, HTN, TB, Respiratory disorders etc. Research design It’s a Randomized clinical trial, in which 30 patients of Karshya were distributed randomly into two groups of 15 members each named Group A and Group B. Investigations Hb% Duration of study Ashwagandaadhya Ghrita Brimhana Snehana 1 Pala i.e. 48 ml daily in two divided doses for 15 days. Ashwagandaadhya Ghrita as Matra Basti i.e. 50 ml daily for 15 days. Follow Up : 30 days Preparation of the trial drugs Ashwagandha roots were freshly collected and dried are collected and Ghrita was prepared in Rasashastra and Bhaisajya Kalpana Dept. of S.J.G.A.M.C and

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[Find the meaning and references behind the names: Deep, Min]

Dr. Vijaylaxmi B. Patil et.al. A clinical study on Brihmana effect of Ashwagandhaadya Ghrita in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 19 Hospital, Koppal. As per standard procedure mentioned in classics as followed Table 1: Ingredients of Ashwagandaadhya Ghrita. SN Sanskrit Name Botanical Name Proportion 1. Ashwagandha Withania somnifera Kalka = 1 part Kwatha = 16 parts 2. Go-ghrita Cow’s Ghee 4 parts 3. Ksheera Milk 8 parts Procedure: Brimhana Snehapana Materials required A clean Vessel Measuring Apparatus, Stove, Saindhava, Lemon. Poorva Karma Deepana - Pachana is administered with Vaishvanara Churna orally till the Nirama Dosha Avastha and enhancement of Agni Bala. Pradhana Karma The patient asked to wash his / her mouth with warm water, 24 ml Ghrita taken in a steel glass given to the patient, late during the morning hours approximately in between 7-8 am at the regular time of food intake when the patient is hungry. Advise them to close the eyes and nostrils if any aversion towards smell and appearance of Ghrita . After drinking Ghrita a lemon was given to the patient for smell to avoid nausea, same procedure is repeated in the evening hours around 6 pm for 15 days. Paschat Karma Advise the patient to have milk and all Brimhaniya Ahara. Matra Basti Poorva Karma The patients were instructed to come after taking light diet and after elimination of stool and urine. The patients were also advised not to take diet more than ¾ th of routine quantity. The patients were subjected to Sthanika Mrdu Abhyanga and Swedana prior to administration of Matra Basti. Abhyanga : The Sthanika Abhyanga over abdomen for 10 min done by Sukoshna Tila Taila. Swedana : After Snehana , the patient were subjected for Nadi Sweda about 5 min. Pradhana Karma After this Purvakarma the patient was advised to lie down on left lateral position without pillow on the Abhyanga table, the patient was asked to keep his / her left hand below the head. Anal region was anointed with small quantity of Tila Taila. Ashwagandhaadya Ghrita 48 ml was taken in Basti syringe, There after the nozzle of Basti syringe was oleated with Ashwagandhaadya Ghrita . After removing the air from enema syringe, nozzle was inserted into the anus of the patient up to the length of 4 inches. The patient was asked to take deep breath and not to shake his body while introducing the Basti and drug. The entry of Vayu inside the Guda was avoided by leaving little amount of Ghrita in basti syringe. Paschat Karma After the administration of Basti , the patient was advised to lie in supine position with hand and legs spread over the table. There after both legs were raised and slightly flexed in knee joint for few times, gently tapped over the hips and the palms and soles were rubbed. After 10 minutes patient was advised to get up from the table and take rest in his bed and also not to sleep. Regimen All the patients of two groups were strictly instructed to avoid the Aharas and Viharas which make the Kopa of Vata Dosha by making them understand about the regimen to be followed during the treatment period. O BSERVATION AND R ESULTS The patients were assessed based on the assessment criteria at the following stages; Before the Treatment, On the 15 th day of the Procedure, On the 30 th day after the Procedure.

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[Find the meaning and references behind the names: Shakti, Kala]

Dr. Vijaylaxmi B. Patil et.al. A clinical study on Brihmana effect of Ashwagandhaadya Ghrita in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 20 Assesment Criteria Body weight BMI HB% Overall Assessment of the therapy Table 2: Showing Assessment of the Therapy Effect Percentage Complete cure 100 Marked Response 67-99 Moderate Response 34-66 Mild Response 1-33 No response 0 DISCUSSION Among 30 patients, 12 Patients (40%) belonged to age group from 25-31 years, 11 Patients (37%) belonged to age group from 18-24 years. Among 30 patients, 18 Patients (60%) were Female, 12 Patients (40%) were Male. Among 30 Patients, 17 Patients (57%) were Students, 6 Patients (20%) were official and 7 Patients were of other Occupation. Among 30 patients, 10 patients (33%) had Tikshnaagni , 9 Patients (30%) had Mandagni and 5 Patients (16%) had Vishamagni . 21 Patients (70%) were of Vata Pitta , 5 Patients (17%) were of Pitta Vata Prakruti and 4 Patients (13%) were of Vata Kapha. Among 30 Patients, 12 Patients (40%) had Madhyama Koshta , 11 Patients (37%) had Krura Koshta and 7 Patients (23%) had Mrudu Koshta. Among 30 Patients, 16 Patients (53%) had Madhyama and 10 Patients (33%) had Avara Abhyavarna Shakti and 4 Patients (14%) had Pravara Among 30 Patients, 10 Patients (67%) had Madhyama and 10 Patients (33%) had Avara Jarana Shakti. Among 30 patients, 25 Patients (83%) had Disturbed sleep and 5 Patients (17%) had Sound sleep. Assessment on 15 th day Dourbalya on the 15 th day of therapy in the Snehapana and Matra Basti group. There was marked decrease in the Dourbalya . There is no much change in Hb% noted in Snehapana group compared to Matra Basti group. Internal medications, Dietary restrictions and rest are necessary to replenish the Dhatus and Bala after treatment, thus improving the general well being. Assessment on the 30 th day On the 30 th day assessment of the management of Brimhana Snehapana, Matra Basti there is Statistically Dourbalya, Body weight, BMI, significant. Reduction in Dourbalya (about 93% in group B, 61% in group-A). Shows the importance of Parihara Kala which has been given importance in classics. Discussion of Dourbalya The results obtained out of 15 patients the mean of before treatment was 1.20 which was reduced after treatment to 0.53 this denotes the p<0.01 which is of significant result. After the treatment the follow up is observed for 30 days where the mean value 1.20 was reduced to 0.47 indicative of p value <0.01 denotes significant results which concludes that as the treatment progresses with follow up the Dourbalyata of the patient was started reducing periodically. It was observed that when compared to Group A, Group B was showing significant results than that of Group A. it was might be due to absorption phenomenon. Discussion of body weight As per the obtained results the mean before treatment 42.45 shifted to mean after treatment to 43.72 this gives at p<0.001 indicative of highly significant results and with the follow up it is shifted from 42.45 to 44.53 this shows Brimhana Snehana gave significant results as per statistical data, but generally the body weight not raises soon after the treatment after some stipulated time with proper Pathya it uplifts the body weight. In Group B body weight was increased from 43.60 to 46. 15 after treatment it is highly significant p<0.001 and it was increased from 43.60 to 47.50 after follow up it is highly significant p<0.001. Discussion of BMI The BMI of Group A owing results from 17.05 to 17.56 which is of <0.001 p value which is showing significant result after the follow up it shifted to 17.87 from

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[Find the meaning and references behind the names: Mark, Ayu, Rasa, Sneha]

Dr. Vijaylaxmi B. Patil et.al. A clinical study on Brihmana effect of Ashwagandhaadya Ghrita in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 21 17.05 of p value <0.001. The result obtained for the BMI is not upto the mark even though there is raise in body weight. If patient follows follows the treatment and Pathya for longer time then there might marked raise in BMI. In Group B BMI was increased from 16.87 to 17.85 after treatment , it is highly significant p<0.001 and it was increased from 16.87 to 18.40 after follow up (AF), it is highly significant p<0.001. But when the same is compared in between the Group A and Group B it is insignificant at p value >0.05. Discussion on Hb% The Hb% in Group A was increased from 11.77 to 11.99 after treatment, it is moderately significant at p<0.05 and it was increased from 11.77 to 12.11 after follow up, it is significant at p<0.01 As the drugs were intending to increase the muscle bulkiness where it is concentrating on Mamsa Dhatu and Rasa Dhatu but there is not much good results were obtained in Group A during treatment so we can say that further if treatment was continued it might have increased the heamoglobin levels. In Group B Hb% was increased from 11.85 to 12.11 after treatment (AT), it is highly significant at p<0.001 and it was increased from 11.85 to 12.17 after follow up (AF), it is moderately significant p<0.05. The results of Matra Vasti treatment were little more when compared to Group A. But the drug can’t increase the Hb in both the groups may be due to Prithvi Mahabutha predominant in all the drugs. Our intention was to increase the muscle bulkiness by giving Brimaniya Dravya’s, so they would do Rasa and Mamsa Brimhana because of Prithvi Mahabhuta predominance and owing to Shleshma Vridhi that does Samhanana of Mamsa Dhatu. Probable mode of action Ashwagandha is having Vata-Kaphahara, Balya, Rasayana, Shukrala properties. Go-Dugdha is Vata- Pitta Shamaka and it is having Balya, Brimhana, Rasayana, Sandhanakara, Asthapana, Vayah- Sthapana, Ojovardhaka, Jivaniya, Medhya properties. Go-Ghrita is Vata Pitta shamaka, Kaphakara . It is having Rasa, Shukra, Oja Vardhana, Mrudukara, Swarya, Varnaprasadaka, Dhee, Smriti, Medha, Agni, Bala, Ayu, Kanti, Vardhaka, Chakshushya, Vishaghna, Rasayana, Vayasthapana properties. Brimhana Snehana The Karma of Brimhana Snehapana as it is mentioned in classics that it will do Brimhana of Shareera , which brings Brihatva to the Shareera is called Brimhana . The drugs having qualities of Prithvi and Jalamahabhuta which increases Shleshma in the body. By giving the Brimhana Snehana Agnisndhukshana takes place thus proper metabolism and assimilation is observed. The Ashrayaashrayi Bhava states that Kapha pocessesss almost all the Dhatus . The Brimhana drugs will nurture the Kapha Dosha in turn it supports and nourishes Rasa, Mamsa, Meda, Majjaa, Shukra, so we claim Shareera Pustikara Bhavas is attained. Matra Vasti The drugs administered though the rectal route i.e, Pakvashaya Gata Basti directly act over the Udbhava Sthana of Vata Vyadhi including Sandigatavata , as Pakvashaya is considered as Udbhava Sthana of Vata Vyadhi. Acharya Charaka opines that, Gudavalies will be relaxed, and also Grahani and Guda present in Vama Parshwa (Left side). So Basti Dravya reaches these organs easily, if the patient receives Basti in left lateral position. Agni may act over the Sneha , administered through Matrabasti and help in the action of that Sneha Dravya. CONCLUSION Karshya being Anapatarpana Vyadhi commonly associated with Dhatukshaya conditions specifically at Sphik, Uadara, Greevashushkata and many more is a prominent feature in manifestation. Here for Brimhana, Ashwagandhaadya Ghrita was selected, in two variant forms such as Snehapana and Matrabasti respectively. Hence the drug Ashwagandhaadya Ghrita is suitable and proved as standard in the management of Karshya . This Ghrita is mentioned in classics to increase Rasadi Saptadhatus generally, realizing ought to be the need of the hour study was

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[Find the meaning and references behind the names: Sharma, Bhagwan, Nil, Med, Suraj]

Dr. Vijaylaxmi B. Patil et.al. A clinical study on Brihmana effect of Ashwagandhaadya Ghrita in Karshya. ISSN: 2456-3110 ORIGINAL ARTICLE Nov-Dec 2018 Journal of Ayurveda and Integrated Medical Sciences | Nov - Dec 2018 | Vol. 3 | Issue 6 22 chosen for study. Both the procedures are safe and no severe complications were observed. But in Snehapana patient’s oral non-acceptability due to non-palatability is observed. Where as in Matrabasti is found very effective. REFERENCES 1 Vaidya Bhagwan Dash. Charaka samhita. Sutrasthana 16/11, Varanasi, Chaukhamba Sanskrit series 2014.P.no-303. 2 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Sutra Sthana 21/18, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 117. 3 http://www.who.int/home-page/ 4 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Sutra Sthana 21/10-13, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 117. 5 Vaidya Yadavji Trikamji, Sanskrit commentary, Sushruta Samhita, Sutra Sthana 15/33, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 74. 6 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Sutra Sthana 21/15, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 117. 7 Suraj Gupte,Pediatric Nutrition and Nutritional Deficiency States. In: The short textbook of pediatrics, 10 th edition. Newdelhi: Jaypee brothers medical publishers 2004 8 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Sutra Sthana 21/14-15, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 117. 9 http://en.m.wikipedia.org/wiki/Underweight 10 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Sutra Sthana 21/20, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 117. 11 Vaidya Yadavji Trikamji, Sanskrit commentary, Charaka Samhita, Chikitsa Sthana 28/75-82, New delhi; Chaukambha Samskrit Pratistana,reprint-2014,Page no 620. 12 Acharya P.V.Sharma, Chakradatta, Chikitsa Sangraha 22/93, Delhi, Chaukambha Orientalia, Edition 2007, Page no.194. ******************************* How to cite this article: Dr. Vijaylaxmi B. Patil, Dr. Suresh N. Hakkandi, Dr. Manjunath P. Akki. A comparative clinical study on Brihmana effect of Ashwagandhaadya Ghrita Snehanapana and Matra Basti in Karshya w.s.r. to Under Weight. J Ayurveda Integr Med Sci 2018;6:17-22. http://dx.doi.org/10.21760/jaims.3.6.3 Source of Support: Nil, Conflict of Interest: None declared.

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