Effect of Virechana along with Shamana Aushadhis in the management of Gulma -...

[Full title: Effect of Virechana along with Shamana Aushadhis in the management of Gulma - A Case Study]

CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 319 Effect of Virechana along with Shamana Aushadhis in the management of Gulma - A Case Study Vd. Rohini A. Kathale 1 , Vd. Sharmili V. Suryavanshi 2 , Vd. Prasad V. Kulkarni 3 1 Post Graduate Scholar, 2 Professor and HOD, 3 Assistant Professor, Dept. of Kayachikitsa, Dept. of Kayachikitsa, Govt. Ayurveda College, Nanded, Maharashtra, INDIA. I NTRODUCTION Gulma is a disease of Mahasrotasa where Vatadosha vitiation is mainly observed [1] Because of its shape like Gulma (Shrub or Bush) disease is named as Gulma. [2] Charaka describes Gulma as vitiated Vatadosha taken Sthanasamshraya in Gulmasthana and manifested symptoms like Shopha (swelling) and Shoola (pain) is called as Gulma. [3] Gulma is abdominal lump which is caused due to aggravation and encapsulation of Vatadosha which spreads widely like the shrubs and having basic pathogenesis of Shotha and cardinal symptom Shoola . Acharya Charaka described five types of Gulma viz. Vatagulma , Pittagulma, Kaphagulma, Nichayagulma and Raktagulma in all these types Vatadosha is the first Address for correspondence: Vd. Rohini A. Kathale Post Graduate Scholar, Dept. of Kayachikitsa, Dept. of Kayachikitsa, Govt. Ayurveda College, Nanded, Maharashtra, INDIA. E-mail: drrohinikathale.2017@gmail.com Submission Date: 13/01/2021 Accepted Date: 08/01/2021 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CCby-NC-SA aggravated factor, so in the case of Gulma , all the measures for pacification of Vata should be administered properly because after Vayu is controlled over, other aggravated Doshas can be alleviated even with small remedies [4] Present case was having Katurasa Atisevan a, Ruksha Ahara Sevana, Atishrama, Atapa Sevana and Bharwahan (weight lifting) these Hetus , and had severe lower abdominal pain ( Adhoudarshoola ) with local tenderness (Sparshasahatwa) and low back pain (Katishoola) . As Shoola and local tenderness was there she was diagnosed with Vatapittaja Gulma . So, the case was treated by Virechana along with Shamana Chikitsa which is discussed. Patient has got significant relief in all her symptoms in the span of one month only. M ATERIAL AND M ETHODS A clinical case study at Government Ayurveda Hospital, Nanded, Maharashtra . Virechana along with Shamana Aushadhis were given to the patient having sign and symptoms of Vatapittaja Gulma. C ASE R EPORT Primary data Patient name - XYZ Age /sex - 19 years / female OPD/IPD No. - 54931/2787 A B S T R A C T Gulma is a disease of Mahasrotasa where there is marked vitiation of Vatadosha . It is named Gulma , because its shape resembles Shrub or Bush. In the case of Gulma , all the measures for pacification of Vata should be administered properly because after Vayu is controlled over, other aggravated Doshas can be alleviated easily. In present article case of Vatapittaja Gulma treated with Virechana along with Shamana Chikitsa is discussed. Patient has got significant relief in all her symptoms in the span of one month only. Key words: Vatapittaja Gulma, Lakshanika Chikitsa, Virechana, Shamana Aushadhi.

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 320 Date of admission – 31 st December 2020 Address - Mukhed, Nanded, Maharashtra. Occupation - Student and farming Table 1: Present complaint with duration SN Present complaints Duration 1. Adhoudarshoola (lower abdominal pain) 4 month 2. Sparshasahatwa (Local tenderness) 4 month 3. Katishoola (low back pain) 4 month 4. Aniyamit Rajapravartan (irregular menses) 4 month 5. Anannaabhilasha 2 month Past history of illness No H/O DM/ HTN/ Bronchial asthma H/O jaundice - 2 times since 5 years ago H/O Chikungunya - before 7 years H/O recurrent tonsillitis - 3 years back Menstrual history Irregular (after each 40-45 days,5 days menstrual flow), painful, heavy bleeding. Present history A 19-year female patient was apparently healthy before 4 months. Gradually she observed symptoms like irregular menstruation and abdominal pain during menses. But after some days her symptoms increased and there was continuous Adhoudarshoola (lower abdominal pain), Sparshasahatwa (local tenderness), Katishoola (low back pain), Aniyamit Rajapravartan (irregular menses). For this she consulted the general physician where she was treated with modern medicines and hormonal pills for 1 months due to which she got temporary relief in symptoms. When she stopped medicine, symptoms reappeared. So, she came to OPD of Government Ayurveda Hospital Nanded, Maharashtra, where she was diagnosed with Vatapittaja Gulma and to rule out any acute pathology ultrasonography was suggested which revealed F/S/O right ovarian cyst. Mostly S/O hemorrhagic cyst. Non obstructing calculus in left kidney. Keeping in mind the main symptoms and history she was treated according to the Chikitsa Siddhant for Vata and Pitta Dosha. Table 2: Samanya Parikshana 1. Nadi 84/min 2. Mala 1 veg / day complete bowel evacuation 3. Mutra 4-5 veg/ day 4. Jivha Saam 5. Shabda Spashta 6. Sparsha Samshitoshna 7. Drik Samyaka 8. Aakruti Krusha Table 3: General physical and systemic examination Srotas Parikshana ▪ Annavahsrotas - Anannaabilasha ▪ Mahasrotasa - Adhoudarshoola (lower abdominal pain) , Sparshasahatwa (local tenderness) ▪ Artavavahashrotas - Aniyamita Rajapravartan (irregular menses), Katishoola (low back pain) General condition Good Fever Afebrile Blood pressure 110/70 mmHg Pulse 84/min RS Air entry B/L equal and clear CVS S 1 S 2 Normal CNS Conscious and oriented to time, place and person P/A Tenderness in right iliac fossa

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 321 Nidana Panchaka ▪ Hetu - Katurasaatisevan, Ruksha Ahara Sevana, Atishrama and Bharwahan (weight lifting) ▪ Purvaroopa - irregular menstruation and abdominal pain during menses ▪ Rupa - Adhoudarshoola (lower abdominal pain), Katishoola (low back pain), Aniyamitrajapravartan (irregular menses), Anannabhilasha ▪ Upashaya - Upashayanugami ▪ Samprapti Nidana Sevana like Katurasaati Sevana, Rukshaahara Sevana, Atishrama, Atapasevan and Bharwahan (weight lifting) → Vata and Pitta Dosha Vridhhi → Vata and Pitta Dosha takes Sthanasamshraya in Mahasrotasa → Hardens (Kathinya) due to dryness (Rukshaguna) and causes inflammation due to Pitta Dosha which form mass in Vatashtana → Lakshanotpatti (Shoola) → causes Vatapittaja Gulma Samprapti Ghataka ▪ Dosha - Vata and Pitta ▪ Srotas - Mahasrotas, Annavahsrotas and Artavavaha Strotas ▪ Srotodusti Prakara - Granthi Utpatti ▪ Adhisthana - Mahasrotas ▪ Rogamarg - Abhyantara ▪ Sadhyasadhyatva - Sukhasadhya Treatment plan 1. Nidanaparivarjan 2. Lakshanikachikitsa 3. Virechana 4. Shamanaaushadhis 1. Nidanaparivarjana Patient was advised to avoid Katurasaati Sevana , Rukshaaharasevana, Atishrama, Atapasevana and Bharwahana (weight lifting). 2. Lakshanika Chikitsa As patient was complaining severe abdominal pain and low back ache so to subside pain Lakshanika Chikitsa was given. Table 4: Lakshanika Chikitsa SN Drug Dose Anupana 1. Kuberaksha Vati [5] 250 mg twice daily Warm water 2. Danwanter Gutika [6] 250 mg twice daily Warm water 3. Devadar ( Cedrus deodara ) [7] and Shunthi ( Zingiber officinale ) [8] Lepa on Udarpradesha followed by hot water bag fomentation. Twice daily - 4. Gandharva Haritaki [9] 5 gm HS with warm water Warm water 3. Virechana - There was Vata and Pitta Dosha were mainly vitiated, Virechana was given as it is common Shodhana Upakrama for both of them . Table 5: Virechana Karma Days Treatment modality Drugs used Details Purvakarma Day 1- 6 Snehapana D 1 - 30 ml D 2 - 45 ml D 3 - 60 ml D 4 - 75 ml D 5 - 120 ml D 6 - 170 ml Dadimadya Ghruta [10] Sharira Snehana and Gulma Nashana Day 7 th and 8 th day Snehaviram a - - Pradhana Karma 9 th day Sarvanga Snehana Sarvanga Nadi Sweda Virechana Yoga Trivrutta Avaleha [11] 40 gm given empty stomach at morning Hridyam Virechan Virechanv ega - Total 17 Bruhatveg a – 9 Madhyam vega - 8 Paschat Karma Day 10 to Sansarjana Krama Day - 1 Evening - Agni Sandhuksh

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 322 12 th given for 3 days [12] Akruta Mudga Yusha Day - 2 Morning - Akruta Mudga Yusha Evening - Akruta Krushara made with M udga and Rice Day - 3 Morning – Akruta Krushara made with Mudga and Rice Evening - Sakruta Krushara made with Mudga and Rice Day - 4 Normal diet anartha 4. Shamana Aushadhis - Given for 15 days after Sansarjana Krama. Table 6: Shamana Aushadhis SM Drug Dose Sevana Kala 1. Bala Taila [13] As per required for Sarvanga Abhyanga At morning/ evening 2. Kshirashatapala Ghruta [14] 30 ml with warm water Rasayanakali 3. Varunadi Kashayam [15] 15 ml twice a day Apanakali 4. Devadaru Shunthi Lepa Udarpradesha Twice a daily - 5. Sutashekhar Rasa [16] 500 mg + Shankha Trice a day Bhojanottara Basma [17] 250 mg + Shouktik Bhasma [18] 250 mg R ESULTS There was significant relief in symptoms like Adhoudarshoola (lower abdominal pain), Sparshasahatwa (local tenderness), Katishoola (low back pain). There were significant changes in ultrasonography of abdomen and pelvis. USG Report Before treatment USG Report After treatment

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 323 Table 7: Changes in signs and symptoms S N Symptoms Before treatm ent After Laksha nik Chikits a After Virecha na with Sansarj ana Krama After 7 days of Sham ana Ausha dhi After 15 days of Sham ana Ausha dhi 1. Adhoudars hoola (lower abdominal pain) ++++ +++ ++ + _ 2. Sparshasah atwa (local tenderness ) ++++ ++++ + - - 3. Katishoola (low back pain) ++++ ++++ ++ + - 4. Aniyamita Rajapravar tan (irregular menses) ++ ++ ++ ++ + 5. Anannabhil asha ++ ++ - - - (++++)- Severe presentation of symptom, (+++) – Moderate presentation of symptom, (++)- Mild presentation of symptom, (+)- least/sometimes presentation of symptom, (-)- no symptoms. DISCUSSION When patient came to our institute, she was having severe lower abdominal pain ( Adhoudarshoola ), low back pain ( Katishoola ). She also had irregular menses, Sparshasahatwa (local tenderness) and Anannaabhilasha . As she was suffering from pain so first Shoolaghna Chikitsa was given by which she got mild relief in lower abdominal pain only. But after Virechana there was significant relief in most of symptoms. Then she was treated with Samana Aushadhis to normalize the Doshas left behind after Shodhana. Table 8: Lakshanik Chikitsa Drug Composition Mode of action Kuberaksha Vati Latakaranja, Rason, Hinga, Shunthi Kaphavatashamak, usnatikshna, vedanasthapana, artavajanan and uttejaka Dhanwanter Gutika Ela, Abhaya, Ajaji, Bruhati, Jeeraka, Kankola, Bhunimba, Rudraksha, Devadaru, Karpoora; Jiraka Kashaya, Rosa centifolia VataAnuloman Devadar ( Cedrus deodara ), Shunthi ( Zingiber officinale ) Lepa Devadar Churna, Shunthi Churna Shoolaghna, vatanuloman, vibandahara Gandharva Haritaki Churna Haritaki, Erand Tail, Sunthi Saindhav, Pippali Vatanuloman, mild laxative Snehapana Dadimadyaghruta - Dadimadyaghruta was used for Oleation of body (Sharira Snehan) with Abhyantar Snehapan before Shodhana. As Acharya Charaka has described Dadimadyaghruta as Gulmanashan. Virechana Trivrutta Avaleha - as in Vatadosha Chikitsa Upakrama Acharya Vagbhata told that Vatadosha requires Mruddu Samshodhana (mild purification) because excess Shodhana might leads to vitiation of Vatadosha. [19] And Virechana is most effective mode of management for Pitta Dosha. [20] So Trivrut Avaleha was used as Virechana Yoga which is mild and Hridyam . Sansarjana Krama After Shodhana procedure there is occurrence of Jatharagnimandya , so to stimulate and maintain Jatharagni , Sansarjankram was advised, patient had

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 324 Madhyam Shuddhi so Sansarjankram was given for three days Shamana Aushadhi 1 Bala Taila Abhyanga - Balataila is excellent curative of Vata disorders, so it was used for Sarvanga Abhyanga 2 Shatapala Ghruta - Shatapalaghruta is described as Gulmnashana and it normalises Jatharagni by Acharya Charaka . It also overcome the vitiated Vata and Pittadosha . So, it was used as Shamana Sneha . 3 Varunadi Kashayam - Varunadi Kashaya is Gulmnashana and Antavidhradhi Nashana as described by Acharya Vagbhata 4 Sutashekhsar Rasa 500 mg + Shankhabasma 250 mg + Shouktika Bhasma 250 mg is used as Vatapittanashana and works on Grahani to improve function of Jatharagni. CONCLUSION Vatapittaja Gulma can be successfully managed with Ayurvedic treatment. In present case study Snehapana followed by Virechan and Shamana Aushadhis was given to treat Vatapittaja Gulma which gave significant relief to patient with remarkable changes in ultrasonography report. REFERENCES 1 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013. Nidanastana Adhyaya 3 shlok no. 7, page no 209 2 Charaka Samhita, Vaidya YadavajiTrikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013. Nidanastana Adhyaya 3 shlok no. 7 (chakrapani tika), page no 209 3 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi,2013. Sutrastana Adhyaya 18 shlok no. 29, page no.107 4 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi,2013. Nidanastana Adhyaya 3 shlok no.17, page no 211 5 Dr Sampada Sandeep Sant, Role of Kuberaksha Vati on Polycystic Ovarian Syndrome.10/09/16 www.ijapc.com Vol. 5 Issue 2, page no. 380-388 6 Sahasrayogam, Dr.R amniwas Sharma, Chowkhmbha Surbharati Prakashana, Varanasi, 2007. Gutikaprakarana, page no. 247 7 Bhavaprakasha Nighantu, Ganga Sahaya Pandey Krushnachandra Chunekar, Chowkhmbha Visvabharati Prakashana, Varanasi,2006. Karpuradivarga, page no. 196 8 Bhavaprakasha Nighantu, Ganga Sahaya Pandey Krushnachandra Chunekar, Chowkhmbha Visvabharati Prakashana, Varanasi,2006. Haritakyadivarga, page no. 13 9 Shah NC. Bharat Bhaishyajya Ratnakar, B. Jain publishers, New Delhi. 1 st edition Vol Ⅰ - Vol Ⅴ . 10 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013. Chikitsasthana Adhyaya 16 shlok 45, page no 527 11 Sartha Vagbhata, Garde Ganesha, Chowkhmbha Surbharati Prakashana, Varanasi, 2011. Kalpasthanaadhyaya 2 shlok 9, page no 338. 12 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013. Siddhisthana Adhyaya 1 shlok 12, page no 679 13 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013.Chikitsasthana Adhyaya 28 shlok 156, page no 623 14 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi,2013. Chikitsasthana Adhyaya 5 shlok 147-48, page no 443 15 Sartha Vagbhata, Garde Ganesha, Chowkhmbha Surbharati Prakashana, Varanasi, 2011. Sutrasthana Adhyaya 15 shlok 21-22, page no 67. 16 Ayurvediya Aushadhi Gunadharmashasra, Vaidya Panchanan, Gangadher Shastri, Gopalrao Gune, Part 5 th page no 567 17 Ayurvediya Aushadhi Gunadharmashasra, Vaidya Panchanan, Gangadher Shastri, Gopalrao Gune, Part 1 st , page no 134

Vd. Rohini A. Kathale et al. Effect of Virechana along with Shamana Aushadhis in Gulma ISSN: 2456-3110 CASE REPORT Jan-Feb 2021 Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb 2021 | Vol. 6 | Issue 1 325 18 Ayurvediya Aushadhi Gunadharma Shastra, Vaidya Panchanan, Gangadher Shastri Gopalrao Gune, Part 1 st , page no 137 19 Sartha Vagbhata, Garde Ganesha, Chowkhmbha Surbharati Prakashana, Varanasi, 2011. Sutrasthana adhyaya 13 shlok 1, page no 60. 20 Charaka Samhita, Vaidya Yadavaji Trikamaji Acharya, Chowkhmbha Surbharati Prakashana, Varanasi, 2013. Sutrasthana adhyaya 20 shlok 16, page no 115 ******************************* How to cite this article: Vd. Rohini A. Kathale, Vd. Sharmili V. Suryavanshi, Vd. Prasad V. Kulkarni. Effect of Virechana along with Shamana Aushadhis in the management of Gulma - A Case Study. J Ayurveda Integr Med Sci 2021;1:319-325. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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