Management of Garbhini Mukhpaka with Kavala Dharana

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REVIEW ARTICLE February 2024 Journal of Ayurveda and Integrated Medical Sciences | February 2024 | Vol. 9 | Issue 2 109 Management of Garbhini Mukhpaka with Kavala Dharana Arti Yadav 1 , Sucheta Ray 2 , Aswathy K 3 , Ekta Singh Parihar 4 , Priyanka Hajare 5 1 Post Graduate Scholar, Department of Prasuti Tantra Evum Stri Roga, Mansarovar Ayurvedic Medical College Hospital and Research Center, Bhopal, Madhya Pradesh, India. 2 Professor and HOD, 3 Professor, Department of Prasuti Tantra Evum Stri Roga, Mansarovar Ayurvedic Medical College Hospital and Research Center, Bhopal, Madhya Pradesh, India. 4,5 Assistant Professor, Department of Prasuti Tantra Evum Stri Roga, Mansarovar Ayurvedic Medical College Hospital and Research Center, Bhopal, Madhya Pradesh, India. I NTRODUCTION In Ayurveda the stomatitis can be co-related to Mukhapaka and explained by Acharya Sushruta is as follows. Mukhapaka is one of the Mukharoga and occurs in all over the oral cavity. Acharya Kashyapa ; Charak has described it as Mukhapaka, while Acharya Sushruta and Acharya Vaghbhata have described it as Sarvasara. Sarvasara means the disease which have Address for correspondence: Dr. Arti Yadav Post Graduate Scholar, Department of Prasuti Tantra Evum Stri Roga, Mansarovar Ayurvedic Medical College Hospital and Research Center, Bhopal, Madhya Pradesh, India. E-mail: artiyadav 025@gmail.com Submission Date: 13/12/2023 Accepted Date: 22/01/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.2.16 capacity to spread all over the buccal mucosa. सर्वसरास्तु र्ातपित्तकफशोणित निमित्तााः॥ सुश्रुत ( सु नि . 16/66) According to Acharya Sushruta Vataja, Pittaja and Kaphaja Sarvasara ( Mukhapaka ) are the three disorders of Sarvani . Acharya Vagbhatta has mentioned Vataja, Pittaja, Kaphaja, Raktaja and Sannipataja Mukhapaka along with Arbuda , Urdhva Guda and Pootiasyata . Acharya Sharangadhara has also followed the pattern of Acharya Vagbhatta . Acharya Bhavamishra, Acharya Madhava and Yogaratnakara’s classification is similar to Acharya Sushruta. Causes of Mukhapaka Causes of Mukhapaka can be differentiated as: 1) Dosha Dushtikar Hetu 2) Sthana Vaigunyakar Hetu A B S T R A C T It is well known that in pregnancy various physiological and pathological changes occurs. Most of which are reversible after delivery. Due to hormonal changes during pregnancy the changes in oral mucosa are also seen. The reasons for these changes are not well known established. Of all the changes the one most well-known is stomatitis. In Pregnancy hormone fluctuation causes changes in saliva making mouth more susceptible to ulcer. Physical and emotional stress of pregnancy aggravates the factor for mouth ulcer. In Ayurveda this condition is known as Mukhpaka , Acharya Sushruta has described under Mukhroga . Among 65 Mukhroga it comes in Sarvasara Roga and these are of three types. In modern science it is treated by maintaining oral hygiene and by using tropical anaesthetics, antibacterial and anti-inflammatory drugs. Many of these drugs are of unknown adverse effect that cannot be frequently used in pregnant women. In Ayurveda it is treated by various methods like Kwatha, Gandusha , etc. In Kashyapa Samhita this Garbhini Vikara is treated with the administration of Kavala of Haridra and Daruharidra. Then Kavala of Sneha/Sugar added water and of Lodhra Kwath Kawal and at the end dusting of Lodhra Choorna is done, and with intake of powder of Manjistha, Ghrashi, Sariva, Mochras, with honey. Key words: Mukhpaka, Kavalam, Garbhini Mukhpaka.

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Arti Yadav et al. Management of Garbhini Mukhpaka with Kavala Dharana ISSN: 2456-3110 REVIEW ARTICLE February 2024 Journal of Ayurveda and Integrated Medical Sciences | February 2024 | Vol. 9 | Issue 2 110 It includes Aharaja Hetu which causes aggravation of Pitta Doshas in Amashaya and causes Mukhapaka . Hetus like Mansahar, Dugdhahar, Ikshuvikruti causes vitiation of Doshas in Amashaya and thereby causing Mukhapaka . These food factors causing Piita Kaph Dosha vitiation and Rakta Dhatu Dushti. Viharaj Hetu , these causes aggravation of Doshas in Mukha . In case of sleeping in prone position collection of Prakupit Doshas in oral cavity leads to Mukhroga . Same like that in Kavala and Gandush Atiyoga (Milk regurgitation and excessive frothing) irritates oral mucosa and further may lead to Mukhapaka . Samprapti of Mukhrog In Ayurvedic texts no detail description found about Samprapti of Garbhini Mukhapaka . Sushruta Samhita describes in detail; intake of Nidana Sevan causes Sthansanshrya and produce Mukhapaka . In contest of Gharbini, Nidana seven Acharya Charak described in Charak Sharir 4/18 as - तद्यथा - सर्विनतगुरूष्ितीक्ष्िं दारुिाश्च चेष्ााः ; All type of Guru, Ushna, Tikshna and Ruksha food and grossly offensive to decency activities vitiated the Vata, Pitta, Kapha Dosha . These vitiated Doshas Sthansansanshraya in all mouth cavities ( Sarvsar ) and cause the Mukhapaka /mouth ulcers with symptoms of Pain, redness, with burning, sensation, sometimes with itching. Mukha being the Kapha Sthana and due to Nidana Sevana Vata and Pitta get provoked into it, thus vitiating the Kapha too . The Sthanasamshraya (localization) of these vitiated Vata Pitta Pradhana Tridosha in already vitiated Sthanasamshraya and Khavaigunya give rise Dosha-Dushya Sammurchhana which leads to the production of the Poorvarupa of the Vyadhi . This is the Sthanasamshraya stage of Vyadhi . Here the Tikshna, Ushna and Vikasi Gunas of the Nidanas cause Rakta Vidaha and Twaka, Mansa Paka leading to Vranashotha and Vranotpatti which gives raise the symptoms Mukhadaha, Katurasa Asahishnuta . Along with this Ruksha, Khara, Vishada Gunas of the Nidanas decrease the Sthanika Snigdhata, Shlakshnatadi Gunas which give raise the symptoms Mukhashosha and Alparasagyata / Virasagyata . If Nidana Sevana continues two processes occurs simultaneously one is - As the Ruksha Guna further increases leads to Kathinya, Kharata, Shushkata and Stambha in Mukhagata Dhatus . Another is as Ushna, Tikshna, Vikasi Gunas increase lead to recurrent inflammation and ulceration i.e., Vrane Vranah which hampers the proper healing and further due to Sthanastha Kapha Dushti Sandhankarma will not be appropriate, these all together leads to Shukla Kathina, Khara Vranavastu in Mukha giving rise the symptom Mukhapaka . As per modern aspect, Stomatitis is an inflammation of mucous membrane of the mouth. Its types: 1) Traumatic Stomatitis 2) Aphthous Stomatitis 3) Infective Stomatitis On the basis of pathogen stomatitis types area Viral Stomatitis b Bacterial Stomatitis c Fungal Stomatitis Causes: following causes are mentioned as: a Poor oral hygiene b Cheek biting c Poorly fitted oral appliances can cause irritation to the oral mucosa d Taking very hot and cold items e Diseases like measles, pellagra, AIDS. f Nutritional deficiency like vitamin B, vitamin C, iron etc. Stomatitis during Pregnancy It is well known that during pregnancy there are hormonal changes in which most of changes are reversible and there is change in oral mucosa leads to stomatitis. Known as Pregnancy gingivitis and Pregnancy epulis. Other changes like chloasma, tooth surface loss, hyperemesis gravidarum are also associated with the pregnancy.

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Arti Yadav et al. Management of Garbhini Mukhpaka with Kavala Dharana ISSN: 2456-3110 REVIEW ARTICLE February 2024 Journal of Ayurveda and Integrated Medical Sciences | February 2024 | Vol. 9 | Issue 2 111 Changes in the severity of oral mucosa may include, Mucosal changes seen with Anaemia e.g. pallor. Gingival bleeding, which may or may not be associated with Disseminated Intravascular Coagulation (DIC). A IM & O BJECTIVE To study the role of Ayurveda in the management Garbhini Mukhpaka. Management of Garbhini Mukhpaka Acharya Kashyapa have told about Garbhini Mukhpaka [3] अथ चेदत्र गमभवण्या िुखिाको भर्ेददह ॥ १०८ ।। हररद्रादारुनिष्काथं ग्राहयेत् कर्लं तताः । तताः स्िेहेि कृत्र्ा तु तताः स्याच्छकवरोदकि ् ।। १०९ । लोध्रोदकेि कृत्र्ा तु कुयावत्तत्रनतसारिि् । अिनतां च सिंगा च घृषीं िोचरसं तथा ॥ ११० ।। िधुिा सह ( ि ) ििीयात्तताः संिद्यते सुखी । 1 Kavala Dharana: Kavala Dharana of Haridra and Daruharidra 2 The Kavala Sneha and Sakraodaka and at last Lodhra Kwath after that Pratisaran of Lodhra Choorna should be there. 3 With the intake of Sariva, Manjistha, Ghrashi, Mochras Choorna with the honey. Table 1: Details of drug used in Mukhapaka SN Dravya Latin name Family name Part used 1. Haridra Curcuma longa Linn . Zingiberacae Kanda / Rhizome 2. Daruharidra Berberis aristata DC Berberidacea Kanda / Rhizome 3. Lodhra Symplocos racemose roxb . Symplocaceae Twak /Bark 4. Sariva Hemidesmus indicus Apocyanaceae Moola / Roots 5. Manjistha Rubia cordifolia Linn Rubiaceae Moola / Roots 6. Mocharas Salmalia malabarica schott & endl Bombacaceae Niryasa / abstrac 7. Ghrashi Sandigdha - - Table 2: Details of Rasapanchaka of drugs used in Mukhapaka SN Dravya Rasa Guna Veerya Vipaka Karma 1. Haridra Tikta, Katu Ruksha, Laghu Ushna Katu Kapha Vata Shamaka 2. Daruhari dra Tikta, Kashaya Ruksha, Laghu Ushna Katu Kapha Pitta Shamaka 3. Lodhra Kashaya Laghu Ruksha Sheeta Katu Kapha- Pitta Shamaka 4. Sariva Madhura Tikta Guru Snigdha Sheeta Madhu ra Tridosha Shamaka 5. Manjisth a Tikta, Kashaya, Madhura Guru, Ruksha Ushna Katu Vranarop aka 6. Mochras Madhura Laghu, Snigdha Pichhila Sheeta Madhu ra Kapha- Pitta Shamaka Table 3: Pharmacology of drugs used in Garbhini Mukhapaka SN Dravyas Pharmacological Action 1. Haridra The main constituent curcumin: is potent anti-inflammatory agent by supressing the and activation, more potent as antiproliferative agent. 2. Daruharidra Anti Bacterial, Anti Microbial 3. Sneha Act as lubrication

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Arti Yadav et al. Management of Garbhini Mukhpaka with Kavala Dharana ISSN: 2456-3110 REVIEW ARTICLE February 2024 Journal of Ayurveda and Integrated Medical Sciences | February 2024 | Vol. 9 | Issue 2 112 4. Sarkraudaka Act as lubrication, due to Madhur Ras Vata Saman be there. 5. Lodhra Anti - inflammatory, wound healing activity. 6. Sariva Anti-ulcerogenic, anti-microbial 7. Manjistha Potent blood purifier, anti-inflammatory 8. Mochras Choorna Anti-inflammatory DISCUSSION So, with the Kavala Dharana of Haridra- Daruharidra . Haridra will act as Pitharechaka and Vranaropaka , While Daruharidra subside Pain and Itching and together they are Tridosha Shamaka. Sarkaraodak will provide the cooling effect and Ghee will subside burning sensation, Vatta-Pitta Shaman and Deepta the Agni . Internal intake of medicine like Manjistha is Vranaropaka . Sariva is Tridosha Shamaka and Lodhra is Kapha-Pitta Shamaka . Over all the drugs act as Vranaropaka , Tridosha Shamaka and mainly Pradeepta the Agni . In modern prospect we all know that pregnancy maintaining hormone is progesterone carbohydrate origin recent researches had done and found that progesterone is a muscle relaxant hormone which supress the motility of gut there is slow down of digestion process can cause constipation and mouth ulcers also the pregnant women are under iron therapy which also be the reason of constipation the regimen of Mukhapaka told by Acharya Kashayap somehow it works on Agni , which stablished the hormonal balance in pregnant women and Mukhapaka is cured. CONCLUSION Generally, whenever there is discussion about the treatment of pregnant women. The doctors are little bit more concern as well as women’s are also much concerned about medicines and diet. Although the Garbhini Mukhpaka is not very common but one who have, they faces many problems. These natural products are effective medications can be used for the treatment of oral diseases like stomatitis in pregnant lady. These remedies are being practiced in ancient times and are cost effective and easily available. Natural disinfectants mentioned above are also effective and act as antimicrobial agents and healing the ulcers. The combination told by Acharya Kashyap fulfilled the criteria, as we all know the absorption of Kavala will be high and ulcers will be healed rapidly and the internal administration of these medicine will helps in increasing the Agni and improved the digestion which will further reduces the constipation and ultimately resolves stomatitis in pregnancy. So, if these medications are given in proper way they have tremendous result. REFERENCES 1 Susruta Samhita of Sushruta, Vol. 1 & 2, Translated By Prof. K.R. Srikanth Murthy, Edition Second-2004, Published By Chaukhamba Orientalia Publication, Varanasi, U.P. India, Nidansthan Chapter 2 Text Book of Diseases Of Ear-nose- Throat: Dhingra, 2 nd Edition, B.I. Churchill Living Stone Publication At New Delhi, Chapter No.42, Page No.215. 3 Kashyap Samhita by Vraddha Jivaka, Revised by Nepal Rajguru Pandit Hemraja Sharma Published by Jaya Krishna Das The Chawkhamba Sanskrit series office, Banaras I Chap 10 Pg no- 293. 4 Charak Samhita By Agnivesh, Chakrapani Tika, Chaukhamba Orientela 1984, Edited By Yadavji Trikamji Acharya, Chaukhamba Prakashana, Varanasi and Edition: Reprint 2009. Chikitsa Shana 26, Page No. 889 5 Madhav Nidan by Madhavkara- With commentary of madhukosh by vijayrakshit & Shrikanthadatta With extracts From atankdarpan By vachaspati Vaidya, Edited By Vaidya yadhavji Trikamji Acharya-1955 How to cite this article: Arti Yadav, Sucheta Ray, Aswathy K, Ekta Singh Parihar, Priyanka Hajare. Management of Garbhini Mukhpaka with Kavala Dharana. J Ayurveda Integr Med Sci 2024;2:109-112. http://dx.doi.org/10.21760/jaims.9.2.15 Source of Support: Nil, Conflict of Interest: None declared.

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Sushruta-samhita, Mukhapaka, Vatapitta, Kashyapasamhita, Modern science, Oral hygiene, Ayurvedic treatment, Haridra daruharidra, Internal administration, Kavala-dharana, Acharya Sushruta, Nidana Sevana, Ayurvedic text, Acharya Charak, Viharaj Hetu, Acharya Vagbhatta, Acharya Sharangadhara, Oral mucosa, Oral cavity, Tridosha shamaka, Vranaropaka, Acharya Madhava, Aharaja Hetu, Acharya Kashyapa, Poor oral hygiene, Oral disease, Herbal substances, Anti-inflammatory drug, Rakta dhatu dushti, Acharya Bhavamishra.