A clinical study in the management of Garbhini Chardi with Dhatripanaka...

[Full title: A clinical study in the management of Garbhini Chardi with Dhatripanaka w.s.r. to Emesis Gravidarum]

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ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 20 A clinical study in the management of Garbhini Chardi with Dhatripanaka w.s.r. to Emesis Gravidarum Dharmista Patel 1 , Rachana H.V. 2 1 Post Graduate Scholar, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India. 2 Associate Professor, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India. I NTRODUCTION Pregnancy is considered as most sensitive part of women’s life. During pregnancy, maternal physiology is under continual adoptions. These, often interlinked, changes affect all the body systems and are affected by the hormonal influences of the placenta and mechanical adaptations required to accommodate the Address for correspondence: Dr. Dharmista Patel Post Graduate Scholar, Department of Prasooti Tantra and Stree Roga, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India. E-mail: misti 81194@gmail.com Submission Date: 16/06/2022 Accepted Date: 21/07/2022 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.7.7.3 growing fetus [1] These serious of physiological changes happening in different stages of pregnancy sometime land in discomfort and trouble. Garbhini Chardi or emesis gravidarum is one among such troublesome result of physiological changes taking place in pregnancy which is having major impact on various aspects of the women’s life, including daily life functioning and quality of life [2] Garbhini Chardi is mentioned as one among the Vyakta Garbha Lakshana along with other Lakshana such as Artava Adarshana , Asyasamsravana , Arochaka , Gurugatrata , Stanamandala Krushnata . These Lakshanas are found in the Garbhini due to the presence of Garbha [3,4] As Chardi is seen as a Vyakta Garbha Lakshana is not associated with much harm on growing fetus & mother, because of which it is considered as physiological disorder, But when it is seen in excess it becomes pathological condition that is Hyperemesis gravidarum in which early intervention is needed to prevent that symptoms severe dehydration, tiredness, A B S T R A C T Background: Health of pregnant women is of at most importance. A series of physiological and psychological changes happen in different stage of women, some of them may end in discomfort and trouble. Ayurveda classics have mentioned Garbhini Chardi as one among the Vyakta Garbha Lakshanas , which can be correlated with emesis gravidarum. Emesis gravidarum is a worldwide common obstetrical problem seen in the first trimester in about 50% of pregnant women. In this condition nausea and vomiting tend to be the start in the morning and frequently continue throughout the day. Altered hormonal and immunological states are considered responsible for the initiation of the manifestations which is probably aggravated by the neurological factors. For such physiological alteration, if proper care is not given, it may lead to complication like tiredness, weight loss, etc. which may affect mother and growing fetus. Aim: To analyze the efficacy of Dhatripanaka in the management of Garbhini Chardi with special reference to Emesis Gravidarum. Method: A randomized open labelled controlled clinical study of two groups consisting 15 patient each in control and trial group. Results: Dhatripanaka was found to be effective in all subjective and objective parameters. Conclusion: Dhatripanaka and Tab. Doxinate is equally effective in Garbhini Chardi w.s.r. Emesis Gravidarum. Key words: Garbhini Chardi, Emesis gravidarum, Dhatripanaka, Pregnancy

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 21 weight loss congenital defects in fetus, premature labour etc which may affect the growing fetus [5] Acharya Harita has also mentioned about Hrullasa and Chardi as one among the Garbha Vyadhi , [6] hence proper care has to be taken in the initial stage only to assure a safe motherhood as well as a healthy progeny in her womb. According to Ayurvedic classics, Garbhini Chardi is explained due to various physiological and pathological causes’ i.e., Vatavaigunya , Dauhruda Avastha and Garbhanimitta . While explaining regarding Chikitsa of Garbhini Chardi Acharya have mentioned that the Garbhini should be given things that are easily palatable, Hrudya and the things which she likes [8] Panaka Kalpana is having good palatability which can be easily prepared and it’s liked by Garbhini . Dhatripanaka which is prepared from Amalaki , Draksha , Khanda Sharkara and honey are easily available in market and liked by Garbhini as it is having Hrudya , Ruchikara properties. The metabolism and absorption of the medicine starts from the month itself because of the presence of glucose and fructose in the formulation moreover drugs like Madhu , Drakha and Khandasarkara in the formulation are having Chardighna property. Dhatripanaka is having good palatability and can be easily prepared hence this present formulation is taken for the study. O BJECTIVES OF THE S TUDY 1 To evaluate the efficacy of Dhatripanaka in Garbhini Chardi . 2 To re-evaluate the efficacy of Tab. Doxinate in Garbhini Chardi . 3 To do conceptual study of Garbhini Chardi . 4 To compare the efficacy of Dhatripanaka and Tab. Doxinate in Garbhini Chardi . M ATERIALS AND M ETHODS Since the present study was a controlled study two drugs i.e., a standard and the test drug was selected, they are: 1 Tablet Doxinate 2 Dhatripanaka Dhataripanaka ingredients are Amalaki, Khanda Sarkara, Draksha, Madhu. Amalaki Churna and Khanda Sharkara Churna preparing was prepared at Department of Rasa Shastra and Bhaishajya Kalpana , Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru. Procedure of preparation of Dhatripanaka was explained to the patient. Patient was provided with Dhatri churna, Draksa, Khanda Sarkara and Madhu and was asked to prepare the Dhatripanaka by them. Sampling method and research design Source of data A series of 30 subjects with Garbhini Chardi were randomly selected, from the OPD and IPD of Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru. The selected 30 patients were divided into 2 equal groups of 15 patients. A detailed Proforma were prepared considering all points pertaining to the study were prepared. The parameters considered for the study was scored on the basis of Standard methods and were analysed statistically. Research design It is an open labelled controlled clinical study with pre and post-test design, where 30 subjects with Garbhini Chardi were selected for the study. Daignostic Criteria ▪ Garbhini with Nausea. ▪ Garbhini with vomiting. Lab Investigations 1 CBC 2 USG 3 Urine routine and microscopic Inclusion Criteria 1 Subjects having confirmed diagnosis of pregnancy. 2 Subjects presenting the classical symptoms of Garbhini Chardi .

[Find the meaning and references behind the names: Mild, Dose, Trail, Sira, Shira, Grade, Shula, Red, Shosha, Table, Brama, Talu, Positive]

Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 22 3 Subjects presenting with symptoms of Emesis Gravidarum. 4 Subjects diagnosed as Garbhini Chardi in all trimester pregnancy. 5 Primigravida and multigravida. Exclusion Criteria 1 Subjects with Hyperemesis gravidarum. 2 Vomiting caused due Intestinal infestation, Urinary tract infection. 3 Vomiting caused due to Peptic ulcer, Appendicitis. 4 Vomiting caused due red degeneration fibroid, Twisted Ovarian tumor 5 COVID-19 Positive Table 1: Showing Intervention in both the groups S N Grou p Group Medication Dose No. of patient s Day s 1. Grou p A Trail group Dhatripanak a 50 ml QID 15 15 Day s 2. Grou p B Contro l Group Tab. Doxinate 10 m g BD 15 15 Day s Assessment Criteria Subjective Parameters ▪ Aversion to smell ▪ Agnimandya ▪ Alasya ▪ Anidra ▪ Angamarda ▪ Brama ▪ Daurbalya ▪ Talu shosha ▪ Jihwa shosha ▪ Shira shula Objective Criteria ▪ PUQE Form Table 2: Showing Grading of subjective criteria Aversion to smell Grade 0 Absent Grade 1 Present Alasya Grade 0 Absent Grade 1 Present Agnimandya Grade 0 Absent Grade 1 Present Agnamarda Grade 0 Absent Grade 1 Present Brama Grade 0 Absent Grade 1 Present Daubalya Grade 0 Absent Grade 1 Present Talu Shosha Grade 0 Absent Grade 1 Present Jihwa Shosha Grade 0 Absent Grade 1 Present Shira Shula Grade 0 Absent Grade 1 Present Agnimandya Grade 0 Absent Grade 1 Present Table 3: Showing Grading of PUQE form Parameter Finding Points PUQE Form Score Not at all 0 Mild 1

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 23 Moderate 2 Severe 3 O BSERVATIONS All the 30 patients who approached the OPD and IPD of Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru. All the patients were the fresh case and were not initiated on other allopathic and Ayurvedic drugs. Among 30 patients maximum number of subjects i.e., 13 subjects (43%) and 12 subjects (40%) belongs to the age group of 20 -24 years and 25 -29 years respectively followed by 4 subjects (13.33%) belongs to age group of 30 - 34 years and 1 subject (6.66%) belongs to 35 - 39 years of age group. The observation on the distribution of occupation revealed that among 30 subjects, 24 subjects (80%) were housewife and 6 subjects (6%) were students. Among 30 subjects, 28 subjects (93.3%) belonged to Hindu and 2 subjects (6.7%) belonged to Christian community. Observation on Education revealed that Among 30 subjects, maximum number of 15 subjects (50.0%) had educational status of high school, 11 subjects (36.6%) had graduation & above and 4 subjects (13.3%) had Primary school. The socioeconomic status in patient of Garbhini Chardi - Among 30 subjects, maximum number of 23 subjects (76.6%) belonged to middle class, 2 subjects (16.6%) belonged to lower class and 1 subject (6.6%) belonged to higher middle class. On considering the habitat, it was found that among 30 subjects, 18 subjects (60.0%) were from Rural and 12 (40.0%) were from urban. The dietary pattern in the patient with Garbhini Chardi found that maximum number of 21 subjects (70.0%) were consuming mixed diet and 9 subjects (30.0%) were vegetarian. The incidence of Prakruti it was observed that maximum number of subject i.e., 16 (53.33%) were having Pitta - Kaphaj Prakruti followed by 8 (26.66%) subjects having Vata-Pittaj Prakruti and 6 (20.00%) subjects having Vata- Kaphaj Prakruti . Among 30 subjects’ maximum number of subj ects i.e., 22 (73%) were having Avara Ahara Sakti , 8 (26%) subjects were having Madhyama Ahara Sakti . The observation based on Ahara Sakti it was revealed that among 30 subjects’ maximum number of subjects i.e., 22 (73%) were having Avara Ahara Sakti , 8 (26%) subjects were having Madhyama Ahara Sakti . The incidence of gravida, among 30 subjects, maximum number of patients i.e. 21 (70%) subjects were Primi gravida and 09 (30%) subjects were Multi gravida. The distribution of patients based on Trimester, among 30 subjects, maximum number of patients i.e., 22 (73.33%) subjects were in 1 st trimester followed by 06 (20%) subjects in 2 nd trimester and 02 (6.66%) subjects were in 3 rd trimester. In the present study for subjective parameter statistical analysis was done using Friedman’s test within the group and Mann Whitney U test between the groups. Table 4: Showing effect on Aversion to Smell in Group A and Group B. Aversio n to smell Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.73 .45 8 0.00 1 (HS) 1.87 .35 2 0.00 1 (HS) 0.367 (NS) 15 th day 1.40 .50 7 1.53 .51 6 30 th day 1.27 .45 8 1.20 .41 4 Table 5: Showing effect on Agnimandya in Group A and Group B. Agniman ya Group A (N = 15) Group B (N =15) P value betwe en the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.87 .35 2 <0.0 01 (HS) 1.80 .41 4 0.09 6 (NS) 0.004 (S) 15 th day 1.27 .41 4 1.60 .50 7 30 th day 1.13 .35 2 1.40 .50 7

[Find the meaning and references behind the names: Bram, Shosh]

Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 24 Table 6: Showing effect on Brama in Group A and Group B. Bram a Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.40 .50 7 0.00 1 (HS) 1.33 .48 8 0.00 2 (S) 1.00 (NS) 15 th day 1.00 .00 0 1.00 .00 0 30 th day 1.00 .00 0 1.00 .00 0 Table 7: Showing effect on Angamarda in Group A and Group B. Angamar da Group A (N = 15) Group B (N =15) P value betwe en the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.47 .51 6 0.00 4 (S) 1.13 .35 2 0.39 2 (NS) 0.775 (NS) 15 th day 1.13 .35 2 1.17 .25 8 30 th day 1.07 .25 8 1.07 .25 8 Table 8: Showing effect on Talu Shosha in Group A and Group B. Talu Shosh a Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.33 .48 8 0.02 (S) 1.27 .45 8 0.02 9 (S) 0.061 (NS) 15 th day 1.00 .00 0 1.20 .41 4 30 th day 1.00 .00 0 1.00 .00 0 Table 9: Showing effect on Jivha Shosha in Group A and Group B. Jivha Shosh a Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.47 .51 6 0.00 1 (HS) 1.27 .45 8 0.02 9 (S) 0.061 (NS) 15 th day 1.07 .25 8 1.20 .41 4 30 th day 1.00 .00 0 1.00 .00 0 Table 10: Showing effect on Shira Shoola in Group A and Group B. Shira Shool a Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P valu e 0 th day 1.27 .45 8 0.01 9 (S) 1.27 .45 8 0.01 9 (S) 1.00 (NS) 15 th day 1.07 .25 8 1.07 .25 8 30 th day 1.00 .00 0 1.00 .00 0 Table 11: Showing PUQE in Group A and Group B. PUQ E FOR M Group A (N = 15) Group B (N =15) P value betwee n the groups Mea n SD P valu e Mea n SD P value 0 th day 2.20 .56 1 0.67 9 (NS) 2.33 .48 8 <0.00 1 (HS) 1.00(NS ) 15 th day 1.13 .74 3 0.87 .83 4 30 th day 0.53 .74 3 0.87 .74 3

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 25 Table 12: Effect on different parameter after treatment and follow-up in Group A. Parameter Group A 15 th Day (AT) 30 th Day (FU) Mean SD ESD Mean SD ESD Aversion to smell A 1.40 ± 507 0.2 (S) 1.27 ± 458 0.1(T) B 1.53 ± 516 1.20 ± 414 Agnimandya A 1.27 ± 414 0.7 (M) 1.13 ± 352 0.6(M) B 1.60 ± 404 1.40 ± 507 Alasya A 1.20 ± 507 1(L) 1.07 ± 458 0.6(M) B 1.73 ± 458 1.40 ± 507 Table 13: Effect on PUQE after treatment and followup in Group A. Parameter Group A 15 th Day 30 th Day Mean SD ESD Mean SD ESD PUQE Form A 1.13 ± 743 0.3 (S) .53 ±743 0.4 (S) B .87 ± 834 .87 ±743 DISCUSSION Dhatripanaka is an Ayurvedic preparation mentioned in Bhaishajya Ratnvali in Chardiroga Chikitsa . The ingredients of Dhatripanaka are Amalaki, Draksha, Khanda Sharkara and Madhu.Amalaki is having Amla Pradhana Pancha Rasa , Madhura Vipaka and Sheeta Virya which is Hydrya Ruchikara, Rasayana and Vrushya property [8] hence it is easily palatable and Dhatu Pushtikara , Amalaki is Tridosha Shamaka but mainly Pittashamaka which will reduce the excessive Gastric secretion and hence reduces the Quantity of vomiting. Amla Rasa which is the Pradhana rasa in Amalaki is having Lalastrava Kara, Rochana, Deepana , Pachana and Vata Anulomana properties [9] which will reduces the associated complaints of Garbhini Chardi like Aruchi, Agnimandya, Jihva And Talu Shosha. Draksha is having Madhura Rasa, Madhura Vipaka and Sheeta Virya having Kapha Pittahara , Vrushya and Shramahara Properties , [10] Madhura Rasa act as Brumhara and Tarpana 97 and help in reducing the symptoms like tiredness and Giddiness which is the most common symptoms associated with Garbhini Chardi and it also helps in Dhatu Poshana . With the Presence of honey and sugar it becomes easily palatable. All the drugs in the formulation contains Glucose and Fructose due to which there will be reduction in the Carbohydrate starvation thus it will breaks the vicious cycle of vomiting and prevent the further episode of vomiting. Thus Dhatripanaka with its Agnideepana, Amapachana, Brumhana, Tarpana, Ruchikara and Rasayana Property maintains the Doshas in normacaly and thereby helps in controlling the vomiting and also helps in nourishment of Garbha and Garbhini . PUQE FORM PUQE FORM (The Pregnancy Unique Quantification of Emesis) is a scoring system to quantify the severity of nausea and vomiting in pregnancy. Nausea and vomiting in pregnancy is due to Dwaridaja Awastha, Vata Vaigunya and Apanna Satwa . According to modern point of view, it is due to the hormone produced by the Placenta called Human chorionic gonadotropin (HCG).The level of HCG is peak between 12 to 14 week of gestation hence incidence of Emesis gravidarum is more during that period . Effect of treatment in Group A: In this study, within the group A when we compared the effect of Dhatripanaka on PUQE FORM before and after treatment, relief was found in the symptom with the decrease in mean value but it was noted as statistically insignificant with p value 0.679 and when it was compared after the treatment and follow up, the mean values had decreased which was statistically significant with p value 0.05.

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 26 The Kashaya property of Amalaki and Madhu act as Sthambaka and reduces the Chardivega . The Pittashamaka property of the drug reduces the excessive gastric secretions thereby reduces the Quantity of vomiting. Draksha acts as anti-vomiting by reducing gastric pressure as Draksha is rich in fibbers, it is known to increase gastric emptying hence the increase gastric emptying may reduce the gastric pressure and retrograde flow of stomach content to oesophagus. The formulation act as oral rehydration due the presence of glucose, fructose and sucrose which breaks the vicious cycle of Emesis gravidarum and maintain the state of nutrition in pregnant women. Effect of treatment in Group B: In this study, within the group B when we compared the effect of Tablet Doxinate on PUQE FORM before and after treatment, the mean values have decrease and the difference was statistically highly significant with p value 0.001 and when it was compared after the treatment and follow up, the values have increase but difference was found statistically insignificant with p value 0.9. Doxylamine is an antihistamine that blocks H 1 receptors. In general, antihistamines directly inhibit the action of histamine at the H 1 receptor and indirectly affect the vestibular system, decreasing stimulation of the vomiting centre. Muscarinic receptor inhibition may also play a role in antihistamine antiemetic activity. Pyridoxine (vitamin B 6 ) is a water-soluble vitamin that is an essential coenzyme for the metabolism of amino acids, lipids, and carbohydrates. Agnimandya Pregnancy is considered as Kapha Prakopa Avastha due to which there is impaired function of Agni and Vayu . Vitiation of Vata and Kapha Dosha leads to Agnimandya which in turns leads to Chardi, Hridyavyatha and Adhamana . According to modern science, the pregnancy hormone progesterone relaxes the intestinal muscle and oesophageal sphincter and causes alterations in the gastrointestinal motility so these symptoms such as heartburn, nausea, vomiting and constipation occurs . Effect of treatment in Group A: In this study, within the group A when we compared the effect of Dhatripanaka in Agnimandya before and after treatment, relief was found in the symptom with the decrease in mean value which was statistically highly significant with p value <0.001 and when it was compared after the treatment and follow up, when it was compared after the treatment and follow up, the values remained the same showing sustained effect of the treatment. The drug like Amalaki, Draksha, Madhu are having Agnideepana and Amapachana and Ruchikara property thereby showing relief in Agnimandya. Effect of treatment in Group B: In this study, within the group B when we compared the effect of Tablet Doxinate on Agnimandya before and after treatment, the mean values have decrease but the difference was found statistically non-significant with p value 0.317 and when it was compared after the treatment and follow up, the values have decreased than initial but difference was found statistically insignificant with p value 0.157. Alasya During Pregnancy Rasadhatu of Garbhini is used for three functions i.e., for Garbha Poshana, Stanya formation and for her own Poshana. Garbhini Chardi leads to Rasa Kshaya therefore the is a deficiency of nutritional requirement of Garbhini causing Alasya moreover the hormone Progesterone depresses the CNS which can lead to tiredness. Effect of treatment in Group A: In this study, within the group A when we compared the effect of Dhatripanaka in Alasya before and after treatment, 100% relief was found in the symptom with the decrease in mean value which was found to statistically highly significant with p value 0.00 and when it was compared after the treatment and follow up, the values remains the same showing sustained effect of the treatment. Effect of treatment in Group B: In this study, within the group B when we compared the effect of Tablet Doxinate on Alasya before and after treatment, the mean values have decrease but the difference was found statistically non-significant with p value 0 . 102

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 27 and when it was compared after the treatment and follow up, the values have decrease than initial but difference which was found to be statistically significant with p value 0.02. Daurbalya and Brama Emesis gravidarum causes loss of fluids and electrolytes leading to fatigue and giddiness moreover due to the production of hormone relaxin during pregnancy there will be relaxation of blood vessels leading to increase in blood flow. Effect of treatment in Group A: In this study, within the group A when we compared the effect of Dhatripanaka in Daurbalya and Bhrama before and after treatment, relief was found in the symptom with the decrease in mean value which was found to statistically significant with p value 0.01 and 0.014 respectively and when it was compared after the treatment and follow up, the values remains the same showing sustained effect of the treatment. This could be due to the Madhurarasa which act as Brumhara and Tarpana and help in reducing the symptoms like tiredness and Giddiness. The Drug like Amalaki and Draksha possess Rasayana and Vrushya property which will help in Dhatuposhana. Effect of treatment in Group B: In this study, within the group B when we compared the effect of Tablet Doxinate in Daurbalya and Brama before and after treatment, the mean values have decrease was found statistically significant with p value 0 . 02 and when it was compared after the treatment and follow up, the values remains the same showing sustained effect of the treatment. Talu Shosha and Jivha Shosha Effect of treatment in Group A: In this study, within the group A when we compared the effect of Dhatripanaka in Talushosha and Jivhashosha before and after treatment, relief was found in the symptom with the decrease in mean value which was found to statistically significant with p value 0.042 and 0.02 respectively. This could be because of the drug like Draksha, honey and Khandasarkara in the formulation are having chemical components such as D - Glucose and D - Fructose which help in oral rehydration and giving relief in the symptom. Effect of treatment in Group B: In this study, within the group B when we compared the effect of Tablet Doxinate in Talushosha and Jivhashosha before and after treatment, the mean values have decrease but it was not found statistically significant with p value 0 . 0257 and 0.257 respectively and when it was compared after the treatment and follow up, relief was found in the symptom with the decrease in mean value which was found to statistically significant with p value 0.032 and 0.032 respectively. Overall effect of treatment Group A i.e., Dhatripanaka due to its Sthambaka, Agnideepaka, Amapachaka, Rochaka, Brumahiya , Tarpaniya, Shrama and Trishnanighraniya properties helps in relief of Emesis gravidaram and its associated symptoms like Agnimandya, Alasya, Brama, Daurbalya, Talu and Jivha shosha . Group B i.e., Tablet Doxinate contains Doxylamine and pyridoxine due to its anti-histaminic action helped in controlling nausea, vomiting and dizziness. The another drug Pyridoxine helps in metabolism of amino acids, lipids and carbohydrates due to which relief was found in symptoms like Daurbalya and Brama. The effect size difference for Group A in comparison to Group B in PUQE FORM is 0.3 which falls under small size band which indicates the clinical difference efficacy of the treatment of group B is marginally better than group A. Thus, Null hypothesis is accepted. CONCLUSION The present study was completed with 30 patients randomized into 2 groups comprising 15 subjects each group - Subject in Trail group (Group A) were treated with Dhatripanaka and Subjects in control group (Group B) were treated with Tablet Doxinate. The interventions were administered for a span of 15 days and both Objective and Subjective parameters of Garbhini Chardi w.s.r. Emesis Gravidarum were assessed on 0 th day, 15 th day and 30 th day and observations were noted. Statistical analysis for

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Dharmista Patel et al. Management of Garbhini Chardi with Dhatripanaka ISSN: 2456-3110 ORIGINAL ARTICLE August 2022 Journal of Ayurveda and Integrated Medical Sciences | August 2022 | Vol. 7 | Issue 7 28 objective parameters was done using Repeated period ANOVA test and Mann Whitney U test for within the group and between the group respectively. Statistical analysis for Subjective parameter was done using Friedman’s test within the group and Man Whitney U test between the groups . In this Clinical study Group A (trail group) showed significant Result in subjective parameter and in objective parameter Group A (control group) showed clinical improvement but it was statistically non-significant whereas Group B showed Significant result in objective parameter. Since clinical effect size between the group in objective parameter is small (0.3). Null hypothesis has been accepted i.e., Dhatripanaka and Tab. Doxinate is equally effective in Garbhini Chardi w.s.r. Emesis Gravidarum. REFERENCES 1 Talbot Laura, MacLennan Kristy. Physiology of pregnancy: Anaesthesia & intensive care medicine. 2016, July: 341 -345. 2 Nina Nuanagchamnong, Jennifer Niebyl. Doxylamine succinate-Pyridoxine hydrochloride for the management of nausea and vomiting in pregnancy: Int J Women’s Health. 2014 Apr 12: 401 - 409. doi:/10.5830/CVJA-2016-02. 3 Agnivesha, Charaka Samhita of Acharya Charaka, Dridhabala Krit, edited by Jadavji Trikamji Acharya. Shareerasthana. Ch.4, Ver.20. 2 nd edition, Varanasi: Chaukhambha Surbharrati Prakashan; 2009. p.319. 4 Shushruta, Shushruta Samhita with the Nibandha Sangraha Commentary of Acharya Dalhana, edited by Jadavji Trikamji Acharya. Shareerasthana.Ch.3. Ver.13 - 14. 2 nd edition, Varanasi: Chaukhambha Surbharrati; 2007.p.33. 5 Vikanes, Å.V., Støer, N.C., Magnus, P. et al. Hyperemesis gravidarum and pregnancy outcomes in the Norwegian mother and child cohort - a cohort study. BMC Pregnancy Childbirth 13, 169 (2013). https://doi.org/10.1186/1471-2393-13-169. 6 Harita, Harita Samhita, edited by Pandit Hariprasad Tripathi. Ch. 15, Ver.1-2. Reprint edition, Varanasi: Choukhambha Krishnadas Academy; 2005.p.524. 7 Agnivesha, Charaka Samhita of Acharya Charaka, Dridhabala Krit, edited by Jadavji Trikamji Acharya. Shareera sthana.Ch.8, Ver.22. 2 nd edition, Varanasi: Chaukhambha Surbharrati Prakashan; 2009. p.930. 8 Laveker GS, Padhi MM, Mangal AK, Joseph GV, Raman K Selvarjan S, et al. Database on medicinal plant used in Ayurveda, central council for research in Ayurveda and Siddha. Department of Ayush Ministry of Health & family welfare, Government of India. Volume 1. New Delhi: Central Council for Research in Ayurveda & Siddha; 2005. p 214. 9 Rabb Umakant N. Shadrasas (six types of tastes) according to different ayurvedic texts - a literary survey. Galore International Journal of Health Sciences & Research. 2019; 4(2): 42 -48. 10 Laveker GS, Padhi MM, Mangal AK, Joseph GV, Raman K Selvarjan S, et al. Database on medicinal plant used in Ayurveda, central council for research in Ayurveda and Siddha. Department of Ayush Ministry of Health & family welfare, Government of India. Volume 3. New Delhi: Central Council for Research in Ayurveda & Siddha; 2005. p 218. ******************************* How to cite this article: Dharmista Patel, Rachana H.V. A clinical study in the management of Garbhini Chardi with Dhatripanaka w.s.r. to Emesis Gravidarum. J Ayurveda Integr Med Sci 2022;7:20-28. http://dx.doi.org/10.21760/jaims.7.7.3 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 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 (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Amalaki, Alasya, Draksha, Agnimandya, Rasashastra, Rasakshaya, Garbhaposhana, Dhatuposhana, Amlarasa, Shirahshula, Madhurarasa, Talushosha, Aharashakti, Pregnant women, Ayurvedic Science, Statistical analysis, Group A, Age-group, Inclusion criteria, Exclusion criteria, Clinical study, Kapha Prakopa, Clinical improvement, Subjective parameter, Vata and Kapha Dosha, Objective parameter, Ayurvedic Drug, Gastrointestinal motility, Null hypothesis, Controlled clinical study, Sheeta virya, Friedman's test, Garbhini Chardi, Emesis Gravidarum, Mixed diet, Physiological change, Vata Vaigunya, Hyperemesis gravidarum, Pyridoxine, Mean value, Human chorionic gonadotropin, Ayurveda Classic, HCG, Vyakta Garbha Lakshana, 1st trimester, Mann-Whitney U-test, Group B, Oesophageal sphincter.