6. Brief Review of Intended Work

6. BRIEF REVIEW OF INTENDED WORK:

6.1 NEED FOR THE STUDY:

Pandu is one of the wide-spread disease in India , especially among the poor and more common in women of reproductive age due to menstrual blood loss which varies from woman to woman and from cycle to cycle1 .Iron deficiency is the commonest nutritional deficiency world over and its prevalence is highest in India . In India 45% adult females, 30% adult males , 80% pregnant females and 60% children have iron deficiency anaemia2. Globally 50% of anaemia is attributed to iron deficiency and account for 8,41,000 deaths annually worldwide .Africa and parts of asia bear 71% of global mortality burden. North America represents only 1.4% of total morbidity and mortality associated with iron deficiency anaemia3. In view of this high prevalence , iron deficiency could be detected in many asymptomatic individuals and patients presenting with diseases other than anaemia .

So the study has been taken up to evaluate the efficacy of Taramandura guda in pandu. Even though a lot of preparations are available in modern medicine for iron deficiency anaemia ,they are associated with adverse and unplesant effects like gastritis, altered bowel movements et. On the other hand the proposed trial yoga Taramandura guda is an ayurvedic classical yoga described in Baishajya Ratnavali shoolaroga chikitsa prakarana and Chakradatta parinamashoola adhikara , appears to be safe since it contains triphala, trikatu, chavya, chitraka , vidanga, mandura basma , guda and gomutra which are routinely used in practice . Also Taramandura guda is relatively cheaper and not many researches have been carried out to evaluate the efficacy of Taramandura guda in pandu particularly in women of reproductive age group who are the common victims of this malady .

In the back drop of this the present study titled “A clinical study on the effect of Taramandura guda in pandu w.s.r. to iron deficiency anaemia among women’’ has been designed .

HYPOTHESIS -

The yoga Taramandura guda contains vidanga , chitraka , chavya , triphala , trikatu , Mandura bhasma , gomutra and guda . Among them guda and mandura basma are natural sources of iron , these two and pippali are specifically indicated in pandu . Vidanga is best krimigna , triphala is rasayana and vatanulomaka and the dravyas like vidanga, chitraka, chavya, trikatu and gomutra are ushna,tikshna,deepana,pachana in action thus helps in removing srothoavarodha which is the main cause for manifestation of pandu4 This way Taramandura guda helps in samprapti vigatana and reduces the vyadhi lakshana.

Further this yoga is mentioned in two classics Baishajya Ratnavali and Chakradatta. Based on these apta vachanas the present clinical study is designed -

“TO EVALUATE THE EFFICACY OF TARAMANDURAGUDA IN PANDU

W.S.R. TO IRON DEFICIENCY ANAEMIA AMONG WOMEN ” .

PREVIOUSLY DONE RESEARCHES

Evaluation of effect of Guda nagaradi vati in pandu by Dr Iranna in year 2001,Dept of Kayachikitsa D.G.M.A.M.C Gadag.
Evaluation and comparative efficacy of arohana and sadharana karma snehapana in pandu by Dr Aneesh J. Dept of panchakarma D.G.M.A.M.C Gadag year 2008.
Evaluation of efficacy of patola panchanga churna in pandu w.s.r to iron deficiency anaemia by Dr Shrikant P. year 2008 Dept of Dravyaguna D.G.M.A.M.C Gadag.
A comparative pharmaco-analytical study of shuddha kaseesa basma on pandu -1997 ,Jamnagar.
Clinical study on effect of datri louha on pandu – Dr. Shakunthala G. N-1998, GAMC Mysore .
Evaluation of effect of shuddha kaseesa and loha basma in pandu w.s.r to iron deficiency anaemia – a comparative study- 2002- Dr.Lobo Zenica – GAMC Mysore.
Clinical evaluation of vidangadi lauha forte in treatment of pandu roga by Dr Chaturvedi V. S ,year-1989, BHU, Varanasi ,
A clinical study on effect of triphala mandura yoga in pandu by Dr Anuradha D , year – 2004, govt ayurvedic college , vijaywada,Hyderabad.
Experimental and clinical studies of chitraka W.R.S to panduroga by Dr Shashidaran K , year- 1987, govt ayurvedic college , Tiruvananthapuram.
A comparative study on effect of datri avaleha and kaseesa basma in pandu , by Dr Tubaki Basavaraj year 2002 , SDM Udupi .
Preparation of abraka basma and its clinical study in pandu by Dr Sujatha K , year 2003 , SDM Udupi .
Preparation of louha basma and its clinical study on pandu by Dr Sangolga Bandappa , year 2004 , SDM Udupi .

6.2 REVIEW OF LITRATURE:

· The description of pandu in detail is available in all bruhatrayees and laghutrayees.

· Acharya Charaka has explained pandu under panduchikitsadhyaya in CHA.CHI.16 5

· Acharya Suruta has explained pandu under pandurogapratishedhadhyaya in SU.UT.44. 6

· Acharya Vagbata has explained pandu under pandurogashophavisarpanidana7 and pandurogachikitsa8 in A.H.NI.13 and A.H.CHI. 16 respectively.

· In Madhavnidana there is reference about pandu in Pandurogakamalakumbhakamala nidana in M.NI.8. 9

· In Sharangdhara samhita ,only types of pandu have been explained in Rogabheda parichaya in Sharangadhara purva khanda 7 th chapter and formulations for pandu has been given. 10

· In Yogaratnakara also there is detailed explanation of pandu its types and sadhyasadhyata in Yogaratnakara purva khanda panduroga nidhana11 and panduroga chikitsa. 12

· There is a reference of panduroga in Bhaishajya ratnavali13, Chakradatta, 14 Haritasamhita15,16 and Kashyapa samhita 17..

· The yoga Taramandura guda is explained in both Baishajya ratnavali18 and Chakradatta 19 in bai.ra.30/181-186 and chakradatta.27/36-41 respectively.

· In modern medical literature also a lot of information is available about iron deficiency anaemia in Harrison’s text book of medicine3 , API text book of medicine2 , Davidson ‘s principle and practice of medicine20 , etc .

6.3 AIMS AND OBJECTIVES OF STUDY:

a) To evaluate the clinical efficacy of Taramandura guda in pandu among women patients of reproductive age group -20- 35 yrs.

b) To study pandu roga in detail from ayurvedic and modern perspectives.

7. MATERIAL AND METHODS:

7.1 Source of Data:

a. Subject: Patients suffering from pandu will be selected from OPD & IPD of D.G.M.A.M.C. &H, Gadag after fulfilling the inclusion and exclusion criteria.

b. Literary: Literary aspect of the study will be collected from classical Ayurvedic and Modern books and will be updated with recent medical journals.

c. Selection of Drugs: The trial drugs will be collected from local market after properly identified.

d. Preperation of Medicine:

1) TARAMANDURAGUDA21

Ingredients:

SL.No. / SanskritName / Latin Name / Quantity
1) / Vidanaga / Embelia ribes / 1 part
2) / Chitraka / Plubago zeylanica / 1 part
3) / Chavya / Piper chaba / 1 part
4) / Haritaki / Terminalia chebula / 1 part
5) / Vibitaki / Terminalia bellerica / 1 part
6) / Amalaki / Emblica officinalis / 1 part
7) / Shunti / Zingiber officinale / 1 part
8) / Maricha / Piper nigrum / 1 part
9) / Pippali / Piper longum / 1 part
10) / Mandurabasma / ------/ 9 parts
11) / Gomutra / ------/ 18 parts
12) / Guda / ------/ 9 parts

Preparation of the medicine is done as per “The Ayurvedic Formulary Of India” .

7.2. METHOD OF COLLECTION OF DATA:

a) Study Design: Simple clinical study with pre and post treatment

assessment.

b) Sample size: 30 patients in a single group .

c) Inclusion Criteria:

1. Female patients of pandu between the age group of 20 – 35 years.

2. Hb% below 11.5 gm/ dl.

d) Exclusion criteria

1. Known cases of thalassemia , sickle cell anaemia , pernicious anaemia

2. Anaemia associated with any malignancy .

3. Patients under chemotherapy and radiation treatment, etc.

4. Pregnant women and lactating mother .

e) Criteria for Diagnosis:

The Diagnosis is mainly based on clinical presentation of the patients, according to signs & symptoms mentioned in classical Ayurvedic texts, which are described under subjective and objective parameters.

f) Posology:

Taramandura guda :- 500 mg thrice a day21 with

anupana of sukoshna jala .

g) Study duration :

1. Taramandura guda :- 40 days .

2. Follow up for 30 days.

3. Total duration 70 days.

7.3. ASSESSMENT OF RESULTS:

Assessment of results will be done on subjective and objective parameters of base line data to pre and post medication data comparing with gradation. The data of the study will be analyzed statistically by paired `t` test.

A. Subjective parameters :

The Symptoms of Pandu as described in the Charaka Chikitsa are taken as subjective parameters - 22

Panduta
Dourbalya
Srama
Pindikodwestana
Bhrama
Gatrashoola
Arohanaayasa
Aruchi
Shoonakshi koota

B. Objective parameters :

1. Hb%

2. RBC

3. PCV

4. MCHC

5. MCV

6. Serum Iron

7.4. INVESTIGATION :

1. Hb%

2. RBC

3. PCV

4. MCHC

5. MCV

6. Serum Iron

7.5. ETHICAL CLEARANCE : .Obtained and enclosed .

8.References :

Siddharth N Shah , M .Paul Anand, Vidya N. Acharya, S.K. Bichile, Dilip.R. Karnad, Sandhya A.Kamath ed. API Text book of Medicine, Iron Deficiency Anaemia, edition 7, The Association of Physicians of India , Mumbai , page no 930.
Siddharth N Shah , M .Paul Anand, Vidya N. Acharya, S.K. Bichile, Dilip.R. Karnad, Sandhya A.Kamath ed. API Text book of Medicine, Iron Deficiency Anaemia, edition 7, The Association of Physicians of India , Mumbai , page no 931.
Harison’ s Principles of Internal Medicine ,vol 1, section 2, chap 98, edition 17, page no 630 .
Pt.Kashinath Shastri and Dr.Gorakha Natha Chaturvedi ed . vidyothini hindi commentary charaka samhitha chikitsa sthana ,chap 16,shloka 26,edited and reprint -2009, Chaukambha Bharathi Academy, Varanasi-221001,page-460.
Pt.Kashinath Shastri and Dr.Gorakha Natha Chaturvedi ed . vidyothini hindi commentary charaka samhitha chikitsa sthana ,chap 16,shloka 26,edited and reprint -2009, Chaukambha Bharathi Academy, Varanasi-221001,page-476.
Kaviraj Ambikadutta Shastri ed. Ayurveda Tattva Sandipika hindi commentary Sushrutha Samhitha Uttara Tantra ,chap-44, edition and reprint-2009, chaukambha prakashan , Varanasi-221001, page-363.
Vaidya Yadunandana Upadyaya ed. vidyothini hindi commentary , Astanga Hridaya , nidana sthana ,chap-13, edition and reprint -2009,chaukamba prakashana , Varanasi -221001, page-362.
Vaidya Yadunandana Upadyaya ed. vidyothini hindi commentary Astanga Hridaya, chikitsa sthana, chap- 16, edition and reprint- 2009, chaukamba prakashana, Varanasi-221001,page-539.
Acharya Narendranath Shastri ed. Madhukosha sanskrit commentary , Madava nidhana ,chap-8 , edition and reprint -2009, Mothilal Banarasidas , Delhi, page-244.
Dr. Brahmanand Tripati ed. Dipika hindi commentary , Sharangadhara samhitha, purvakhanda,chap 7, shloka-19, edited and reprint -2010, chaukamba surabharathi prakashan , Varanasi – 221001, page-93.
Bishakratna Shri Bramhashankar Shastry ed. vidyothini hindi commentary , Yogaratnakara purvardha, panduroganidhana , edited and reprint -2005 , chaukambha sanaskrit sansthan, Varanasi 221001 , page 336.
Bishakratna Shri Bramhashankar Shastry ed. vidyothini hindi commentary , Yogaratnakara purvardha, panduroga chikitsa, edited and reprint -2005 , chaukambha Sanskrit sansthan , Varanasi – 221001
Kaviraj Ambikadutta Shastry ed. Vidyothini hindi commentary Baishajya Ratnavali , panduroga chikitsa prakarana , edition 18 , chaukamba Sanskrit sansthan, Varanasi 221001 , page 373.
Priyavat Sharma ed. and translated Chakradatta , chap 8 , edition 2 , chaukamba publishers , Varanasi 221001 , page 106.
Vaidya Jaimini Pandey ed. and translated Nirmala hindi commentary , Haritha samhitha , triteeya sthana chap 8 , edition 2010, Chaukambha Vishwabarathi , Varanasi 221001, page 272.
Vaidya Jaimini Pandey ed. and translated Nirmala hindi commentary Haritha samhitha , triteeya sthana chap 14 , edition 2010, Chaukamba Vishwabarathi, Varanasi 2221001 .
Prof. P V Tevari ed. kashyapa samhitha sutrasthana , chap- 25 shloka 34, 35 , edited and reprint – 2002 , Chaukambha Vishwabarathi , Varanasi- 221001. Page 56.
Kaviraj Ambikadatta Shastry ed. Vidyothini hindi commentary , Baishajya Ratnavali , chap 30, shloka 181-186, edition 18 , Chaukamba Sanskrit sansthan – 221001 .
Priyavrat Sharma ed. and translated Chakradatta , chap 27 , shloka 36-41, edition 2 , Chaukamba publishers Varanasi 221001 . page 106.
Nicholas A. Boon, Nicki R . Collledge, Brain R . Walker, John A.A. Hunter ed. Davidson’s Principles and Practice of Medicine, chap 24, edition 20, page no -1025 .
The Ayurvedic Formulary Of India , Part 2, edition 1 , The Controller of Publications Civil Lines , Delhi -110054, page no 216.
Pt.Kashinath Shastry and Dr. Gorakhanath Chaturvedi ed. Vidyothini hindi commentary, Charaka Samhita ,chikitsa sthana, chapter 16, shloka 14-16 , Edition 8 , 2004 , Chaukhamba bharati academy, Varanasi 221001, page no. 488.

9. SIGNATURE OF CANDIDATE :

(DR.RASHMI.T.M)

10. REMARKS OF GUIDE : May be approved,as the project is specific segment oriented on pandu roga with Taramanduraguda

11. NAME AND DESIGNATION :

11.1. GUIDE : DR. SURESH BABU. S.,

MD (AYU),

PROFESSOR AND HEAD OF DEPARTMENT OF KAYACHIKITSA,

D.G.M.A.M.C, P.G.S & R.C.,

GADAG

11.2. SIGNATURE :

11.5. HEAD OF THE DEPARTMENT : DR. SURESH BABU. S.,

MD (AYU),

PROFESSOR AND HEAD OF DEPARTMENT OF KAYACHIKITSA,

D.G.M.A.M.C, P.G.S & R.C.,

GADAG

11.6 SIGNATURE :

12.1 . REMARKS OF THE CHAIRMAN AND PRINCIPAL:

The above synopsis is scrutinized by Post graduate studies and research centre committee of Shree D.G.M Ayurvedic medical college and hospital,Gadag and submitted for registration as a subject of dissertation at R.G.U.H.S,Banglore

12.2. SIGNATURE :

Dr. G.B. PATIL.

Principal / C.M.O.