Department of P.G Studies in Manasa Roga

From

Dr Niranjana.H. P.

PreliminaryM D (AYU) Scholar.

Department of P.G Studies in Manasa Roga.

S.D.M College of Ayurveda and Hospital.

Hassan. 573201.

The Registrar

Rajiv Gandhi University of Health Sciences

Karnataka, Bangalore.

Through

The Principal andHead of the department of Manasa Roga,

S.D.M College of Ayurveda, Hassan.

Respected Sir,

Subject: Submission of completed Proforma for Registration of subject for

dissertation.

I hereby request you to kindly register the below mentioned subject against my name for the submission of Dissertation to the Rajiv Gandhi University of Health Sciences,Karnataka,Bangalore for partial fulfillment of M.D.(Ayu).

Title of the Dissertation:

“ROLE OF SATVAVAJAYACHIKITSA AND GUDUCHYADI YOGA IN THE MANAGEMENT OF MADATYAYAJA YAKRIT VIKARA (ALCOHOLIC LIVER DISORDER)”

Here with,I am enclosing completed Proforma of Synopsis for Registration of subject for Dissertation.

Thanking You,

Place:Hassan Yours faithfully,

Date:

(Niranjana H.P.)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA.

BANGALORE

ANNEXURE – II

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

1.NAME OF THE CANDIDATE: NIRANJANA.H.P.

ADDRESS PRELIMINARY M.D (AYU) SCHOLAR.

DEPARTMENT OF P.G STUDIES IN MANASA ROGA.

SDM COLLEGE OF AYURVEDA AND HOSPITAL.

HASSAN – 573201

PERMANENT ADDRESS: S/O MR.H.A.PRABHAKARA.RAO.

NO.03, HOSABALE

POST: HOSABALE.

TALUK: SORABA.

DISTRICT:SHIMOGA

KARNATAKA.

PIN: 577-434.

2.NAME OF THE INSTITUTION: SDM COLLEGE OF AYURVEDA AND

HOSPITAL HASSAN – 573-201

KARNATAKA

3.COURSE OF STUDY IN SUBJECT: M.D.(AYU) IN MANASA ROGA.

4.DATE OF ADMISSIONTO THE

COURSE : 15TH JUNE 2009.

5.TITLE OF THE DISSERTATION : “ROLE OF SATVAVAJAYA CHIKITSA AND GUDUCHYADI YOGA IN THE MANAGEMENT OF MADATYAYAJA YAKRIT VIKARA (ALCOHOLIC LIVER DISORDER)”

6. BRIEF RESUME OF THE STUDY:

6.1 Need For The Study:

Excessive intake of alcohol leads to affliction of heart resulting in exhilaration, passionate desire, erotic stimulation, sense of pleasure and varieties of psychic morbidities of Rajasika and Tamasika nature depending upon the mental attitude of the person and finally resulting in Moha nidra(coma). This type of mental perversion caused by alcohol is called Mada. And whatever supreme for attaining salvation are based on the tranquility of the mind of an individual.Alcohol considerably agitates this mind like a strong wind shakes the tree located on the bank of the river.1.

Madatyaya or the alcoholic dependency is completely based on stability of one’s own Satva. So mind plays an important role in the de-addiction of alcohol.2

Word Madatyaya is composed of two terms i.e. Mada-any exhilarating or intoxicating condition.3Atyaya – suffering.4 Hence suffering from intoxicating drink is known as Madatyaya.

Chronic and excessive alcohol ingestion is one of the major causes of liver disorders across the world. Despite the untoward effect of alcohol, alcoholism is a major problem in India. The different drug abuse surveys have shown the prevalence of alcoholism as 5 to 20 percent worldwide. In India, general population surveys shows the prevalence rate as high as 16 to 50 percent .5 Atleast 20% of the patients in mental settings have alcohol abuse or dependence or withdrawal , including individuals from all socioeconomic conditions and both the genders.6

According to US Census Bureau International Data Base 2004, 106,50,70,607 persons in the world were using alcohol and out of which 78,31,407persons were affected by Alcoholic liver disease.7 It manifests as a clinical spectrum ranging from non specific symptoms to hepatic failure. Classically, alcoholic liver injury comprises three major forms, 1.fatty liver, 2.alcoholic hepatitis and 3.cirrhosis.8

Bhavaprakasha mentions Yakrit-Vruddhi (hepatomegaly) as one of the symptoms of Yakrit Vikara due to excessive intake of Vidahi and Abhishyandi Aharas andMadya (alcohol).9

Ayurveda has many options to treat Madatyaya . All the textsmention Pittahara and Deepana Pachana Dravyas to treat Yakrit-Vikaras. Guduchyadi Yoga mentioned by Charaka comprising of Guduchi (Tinospora cordifolia), Musta(Cyperus rotundus), Patola(Tricosanthes dioica) and Nagara(Gingeber officinalis) may relieve the adverse effects of Madatyaya as well as liver disorders caused by it.10

Satvavajaya Chikitsa may help people to address psychological issues involved in their drinking problem.AstangaHrudaya explains Vismapana, Samsmarana, Priyadarshana,Priyashravana, Geeta,Vadya 11and Charaka advises Harshanee Kriya and restrain from the things which are harmful to body and mind as the treatment modalities in the management of Madatyaya.12

The three therapies i.e. cognitive behavioral coping skills, motivational enhancement therapy and 12 step facilitation approaches of alcoholics anonymous has

been found to be helpful for the people to boost their motivation to stop drinking.

As the number of alcohol related disorders are increasing in the society and till date no study has been conducted , hence it is decided to carry out the present study to evaluate the effect of Guduchyadi Yoga and Satvavajaya Chikitsa in the management of Madatyayaja Yakrit Vikara.

6.2Review of literature

The Dukha produced due to Madya is called as Madatyaya.13
Charakacharya explained types of Madatyaya as Vatapraya,Pittapraya , Kaphapraya and considered the disease as Tridoshaja.14
Vagbhata explains 4 types of Madatyaya viz. Vataja, Pittaja, Kaphaja and Sannipataja.15
Sushruta explains mainly4 types viz. Panatyaya, Paramada, Panajeerna and Panavibhrama. Sushruta used Panatyaya term in place ofMadatyaya and accepts 4 types of Panatyaya viz. Vatakrita, Pittakrita,Kaphakrita and Sarvakrita.16
Acharya Charaka explained the qualities of Satvika , Rajasika and Tamasika Madatyaya rogi as Uttama, Asaumya and Sammohakrodhitha respectively.
In Gadanigraha Acharya Shodala accepted Dvidoshaja Madatyaya also.17
Charaka has mentioned HrudayaVyatha,Aruchi,Trishna,Jrimbha,Sphurana,Vepana,Shrama, Prajagara,Sharirakampa, Chardi,Atisara,Hrillasa,Bhrama, Pralapa 18 etc as symptoms of Madatyaya.
Madyapana will affect all aspects of life i.e., physically, psychologically, socially, economically,occupationally etc.
Sushruta has mentioned Hikka,Jvara, Vamathu, Vepathu, Parshvashoola, Kasa and Bhrama as its Upadrava.19
In allied science they have explained clinical features of alcoholic liver disorders as fatty liver, right upper quadrant discomfort, tender hepatomegaly, nausea, jaundice, abdominal pain, malnutrition, severe illness and ascitis.20
The ingredients of Guduchyadi yoga are Guduchi, Mustha, Patola and Nagara – equal quantity of all these drugs. It acts as Pittahara, Pitta Rechaka and Rakta Prasadaka, Pachaka,Deepaka and plays an important role in Yakrit Vikara and Madatyaya.
Satvavajaya includes Vismapana, Samsmarana, Priyashravanadarshana, Vadya, Geeta and Harshanee kriya.
Charaka has defined Satvavajaya and considerd Jnana, Vijnana, Dhairya, Smriti and Samadhi as techniques of psychological therapies .

6.3 Objective of the study

1. To evaluate the efficacy of Satvavajaya chikitsa in MadatyayajaYakrit Vikara (Alcoholic liver disorder).

2. To evaluate the efficacy of Guduchyadi yoga in MadatyayajaYakrit Vikara (Alcoholic liver disorder).

3. To evaluate the efficacy of combined effect of Satvavajaya Chikitsa and Guduchyadi yoga inMadatyayajaYakrit Vikara (Alcoholic liver disorder).

7. Material and Methods

7.1.Source of data :

45 patients of Madatyaya will be selected from the Out Patient Department and In Patient Department of ManasaRoga of the S D M College of Ayurveda and Hospital, Hassan.

7.2Method of Collection of Data:

45 patients of Madatyaya with liver disorder who fulfills the inclusion criteria will be selected and randomly assignedintothe following 3 groups; each group comprising of 15 patients.

Group A: The patients of this group will be subjected to Satvavajaya Chikitsa daily along with placebo capsule 500 mg starch thrice daily for 1month.Satvavajaya Chikitsa will be carried out as follows:

Jnana- 12 Step facilitation (Atmadi Jnana) approach.

1. We admit we are powerless over alcohol- that our lives have become unmanagable.

2. We believe that a Power greater than ourselves can restore us to sanity.

3. We make a decision to turn our will and our lives over to the care of God as we understand Him.

4. We make a search and fearless moral inventory of ourselves.

5. We admit to God, to ourselves and to another human being the exact nature of our wrong doings.

6. We’re entirely ready to have God remove all these defects of character.

7. We shall humbly ask Him to remove our shortcomings.

8. We shall make a list of all persons we have harmed and become willing to make amends to them all.

9. We shall make direct amends to such people wherever possible, except when to do so would injure them or others.

10. Weshall continue to take personal inventory and when we are wrong, promptly admit it.

11. We will search through prayer and meditation to improve the conscious contact with God as we understood Him, praying only for knowledge of Himfor us and the power to carry it out.

12. After experiencing this, we shall carry this message to alcoholics, and to practice these principles in all their affairs.

Vijnana- Specific information about effect of alcohol on various organs.
Dhairya- Supportive Psychotherapy – motivational enhancement therapy.
Smriti - Methods to cope with high-risk drinking situations and develop social support systems.
Samadhi – Yoga for 30 minutes and Pranayama for 15 minutes daily for 1 month.

Yogasana – Standing Asana- Vrikshasana , Pada Hastasana, Ardha Chakrasana, Trikonasana.

Supine Asana – Pavana Muktasana, Matsyasana.

Prone Asana - Bhujangasana, Dhanurasana.

Sitting Asana – Vajrasana, Ushtrasana, Vakrasana.

Pranayama - Kapalabhati, Bhastrika, Anuloma-Viloma, Shitali, Shithkari and Bhramari.

Dhairya Chikitsa will be also done on 15th and 30th day of treatment.

GroupB: The patients of this group will be given Guduchyadi yoga in the dose of

5 gm, before food with warm waterthricedaily for 1 month.

GroupC: The patients of this group will be subjected to Satvavajaya Chikitsa as mentioned above and simultaneouslyGuduchyadi Yoga will be given in the dose of 5gmbefore food with warm water thrice daily for 1 month

Follow up study:

After stopping the treatment the patients will be asked to attend OPD at the interval of15 days for two months to know whether the relief provided by the therapies is sustained or not.

Diagnostic Criteria:

Diagnosis will be made on the basis of Lakshanas of Alcoholic liver disorder and Madatyayaja Yakrit Vikara.

Fatty liver Yakrit vruddhi

Right upper quadrant discomfort. Manda jvara

Tender hepatomegaly. Mandagni.

Nausea Ksheenabala.

Jaundice Atipandu.09.

Fever and Abdominal pain

Elevated AST (Aspartate amino transferace)

Elevated ALT (Alanine amino transferace)08.

Inclusion Criteria:

1.Patients presenting with symptoms of Madatyaya along with Alcoholic liver

disorder.

2. Age group of 16-70 years of either sex.

Exclusion Criteria:

1.Patients suffering from any Organic brain disorder.

2.Patients suffering from complications of Alcoholic liver disorders.

3.Patients suffering from other types of addictions.

4.Patients suffering from other Systemic or Psychiatric illnesses.

Assessment Criteria:

Assessment of clinical study will be done based on subjective and objective parameters. Self scoring of symptoms of Madatyayaja Yakrit Vikara will be done and self prepared scale will be used for assessment.

Subjective parameters : Objective parameters:

Aruchi. Chardi

Prajagara Manda jvara

HrillasaAtipanduta

Pralapa Atisara

Bhrama Shareera kampa

Mandagni. USG Abdomen

Liver Function Test

Hepatomegaly.

Statistical evaluation of the results will be done by using Unpaired and Paired ‘t’ test.

7.3.Laboratory Investigations

Blood routine

Urine routine

Liver Function Test

USG Abdomen.

7.4 Has ethical clearance been obtained from your institution?. YES.

8.List of References:

1.Charaka: Charaka Samhitha with the ‘Ayurveda deepika’ commentary by Chakrapanidatta edited by Trivikrimatmajena Yadav Sharma, Choukambha Sanskrit Sansthana,Publications,Varanasi, 1994 year edition. Chikitsaasthana 24/39,40,53. page no584-585.

2. Ibid. Chikitsa sthana 24/52-55. page no.585.

3.Sir Monier Williams : A Sanskrit –English dictionary, Motilal Banarasidas publishers, Pvt. Ltd.Delhi. Reprint -1993.Page no. 777.

4. Ibid.Page no 17.

5.Dr. M.S.Bhatia : Essential of Psychiatry, CBS publishers and distributors, New Delhi. 4th edition 2004.Page no. 8.6.

6. Kaplan and Saddock: Comprehensive text book of Psychiatry , 8th edition , volume 1, by Lippincott Williams and Wilkings , Page no.1168.

7. USCensus Bureau International Data Base.2004.

8.Harrison’s Principles of Internal Medicine . Volume.2, 15th edition Published by Times Roman by monotype composition Company. Page no. 1752&1753.

9.BhavaPrakasha : Vidyothini Teeka ,Choukambha Sanskrit Sansthana, Publications, Varanasi. Uttarardha.Chapter.33 ./10.Page no. 346.

10.Charaka: Charaka Samhitha with the ‘Ayurveda deepika’ commentary by Chakrapanidatta edited by Trivikrimatmajena Yadav Sharma, Choukambha Sanskrit Sansthana,Publications,Varanasi, 1994 year edition. Chikitsasthana 24/145.Page no.589.

11.Vagbhata: Astanga Hrudaya , with the Commentaries Sarvanga Sundari of Arunadatta and Ayurveda Rasayana of Hemadri edited by Harishastri Padakar vaidya, Krishnadas Academy, Varanasi. Reprint 2000.Chikitsa stana,7/113-114.Page no.642.

12.Charaka: Charaka Samhitha with ‘Ayurveda deepika’ commentary by Chakrapanidatta edited by Trivikrimatmajena Yadav Sharma, Choukambha Sanskrit Sansthana.Publications. Varanasi, 1994 year edition. Chikitsa sthana 24/194.Page no.590.

13. Ibid. Chikitsa sthana 24/101-106.Page no.587.

14. Ibid. Chikitsa sthana 24/89-97.Page no.587.

15. Vagbhata: Astanga Hrudaya , with the Commentaries Sarvanga Sundari of Arunadatta and Ayurveda Rasayana of Hemadri edited by Harishastri Padakarvaidya, Krishnadas Academy, Varanasi. Reprint 2000.Nidana Stana 6/14..Page.no.487.

16.Sushrutha : Sushrutha Samhitha with the Nibandhasangraha, commentary of Shri Dalhanacharya and the Nyayachandrika Panjika of Shri Gayadasacharya on Nidanasthana , edited by Vaidya Jadavji Trikamji Acharya . Chaukambha Orientalia , Varanasi.7th edition 2002. UttaraTantra 47/17-18.Page.no.743.

17.Vaidya Shodala : Gada nigraha with the Vidyothini Hindi commentary Vol.2 by Sri Indradeva Tripathi, Chaukambha Sanskrit Sanstan,Publications. Varanasi. 3rd edition 1999.Page no.451.

18.Charaka: Charaka Samhitha with the ‘Ayurveda deepika’ commentary by Chakrapanidatta edited by Trivikrimatmajena Yadav Sharma, Choukambha Sanskrit Sansthana. Varanasi,Publications. 1994 year edition. Chikitsa stana 24/101-106.Page no.587.

19. Sushrutha : Sushrutha Samhitha with the Nibandhasangraha, commentary of Shri Dalhanacharya and the Nyayachandrika Panjika of Shri Gayadasacharya on Nidanastana , edited by Vaidya Jadavji Trikamji Acharya . Chaukambha Orientalia , Varanasi.7th edition 2002. UttaraTantra 47/23 .Page.no.743.

20.Davidson’s Principles and Practice of Medicine 19th edition Page no.867.Published by Churchill Livingstone,An imprint of Elsevier Science Limited.

9.SIGNATURE OF CANDIDATE :

10. REMARKS OF GUIDE :

11. NAME AND DESIGNATION OF

11.1 GUIDE : DR.NARAYANA PRAKASH. B. M.D.(AYU)

Professor & H.O.D.

Dept.of PG Studies in Manasa Roga.

S.D.M.College of Ayurveda.

Hassan. (Karnataka)

11.2 SIGNATURE :

11.3 CO-GUIDE : DR.SUHAS KUMAR SHETTY. M.D.(AYU)

Reader,

Dept.of PG Studies in Manasa Roga.

S.D.M.College of Ayurveda.

Hassan. (Karnataka)

11.4 SIGNATURE :

11.5 H.O.D. :DR.NARAYANA PRAKASH. B.M.D.(AYU)

Professor & H.O.D.

Dept.of PG Studies in Manasa Roga.

S.D.M.College of Ayurveda.

Hassan. (Karnataka)

11.6 SIGNATURE :

12.

12.1 REMARKS OF CHAIRMAN

& PRINCIPAL :

12.2 SIGNATURE :