From,

DR. CHETTIAR SANDHYA S.

M D. (Ayu) Scholar

Department of Post Graduate Studies in PANCHKARMA

Dr.B.N.M.E Trust’s ShriMallikarjunSwamiji

Post Graduate and Research Centre.

Smt. SushiladeviNagur Colony, College Road,

Bijapur – 586101.

To,

THE REGISTRAR,

RajivGandhiUniversity of Health Sciences, Karnataka

BANGALORE.

Through,

THE PRINCIPAL AND HEAD OF THE DEPARTMENT OF PANCHKARMA,

Dr.B.N.M.E Trust’s ShriMallikarjunSwamiji

Post Graduate and Research Centre,

Smt. SushiladeviNagur Colony, College Road,

Bijapur – 586101.

Respected Sir.

Sub: “Submission of completed Proforma for registration of subject for

Dissertation”

I 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 the partial fulfillment of M.D. (Ayurveda) in Panchkarma.

TITLE OF DISSERTATION

“TO EVALUATE THE EFFECT OF MATRA BASTI AND TIKTA KSHEERA BASTI ON ASTHIKSHAYA W.S.R. TO OSTEOPOROSIS.”

Here with I am enclosing completed Proforma for the registration of the subject for Dissertation

Thanking you,

Yours faithfully,

Place: Bijapur

Date: 27-04-2012 (Dr. CHETTIAR SANDHYA S M. D.(Ayu) Scholar)

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE: DR. CHETTIAR SANDHYA S.

M D. (Ayu) Scholar

AND ADDRESS

D/O Mr. T.SEKAR,

SHRI HARI TWINS BUNGLOW PART1,

OPP ALOK-5

NIRANTH CJHAR RASTA,

VASTRAL,AHMEDABAD-382415

GUJARAT.

2. NAME OF THE INSTITUTION:Dr.B.N.M.E TRUST’S

SHRI MALLIKARJUN SWAMIJI

POST GRADUATE AND

RESEARCH CENTRE

BIJAPUR - 586101

3. COURSE OF STUDY AND:AYURVEDA VACHASPATI
SUBJECT MD (AYU) IN PANCHAKARMA

4. DATE OF ADMISSION TO:20-08-2011

THE COURSE

5. TITLE OF THE TOPIC: TO EVALUATE THE EFFECT OF

MATRA BASTI AND TIKTA

KSHEERA BASTI ON ASTHIKSHAYA

W.S.R. TO OSTEOPOROSIS

6.) BRIEF RESUME OF THE INTENDED WORK.

6.1) NEED FOR STUDY:

According to Ayurveda, diseases occur due to dhatuvaishamyatadhatusamya maintains normalcy. Asthikshaya is taken as one among correlation for osteoporosis by CCRAS. According to principle of aashrayaaashrayibhava mentioned by vagbhatta, asthi and vata are aashrayaaashrayi and both are inversely proportional to each other which meansvatavruddhi causes asthikshaya. Charaka in chikitsasthana has mentioned that vayuakasha causes saushiryata of asthi and this two mahabhuta are present in vata, hence in case of vatavruddhi there will be increased saushiryata in asthi and hence called as asthisaushirya also.

Osteoporosis is one among the ailment that is mostly overlooked by the clinician as it is usually asymptomatic and usually patient is unaware of the disease until they come through an unexpected fracture. This is hence known as SILENT KILLER DISEASES.

Statistics shows that in 2003, 2.5 crore women in India had osteoporosis. This is expected to raises by 1 crore in next decade and ratio all over world is around 20 crore. India is expected to have 20 crore senior citizen in approximate till year 2015. As the ageing and early menopause syndrome are an important cause of osteoporosis, day by day its occurrence will go on increasing, until any serious measure to correct it are taken.

Osteoporosis is defined as the reduction of bone mass or density or presence of fragility. According to modern, prevention of osteoporosis is said to be easier than treatment. It includes post menopausal estrogen replacement (0.625 mg of conjugated estrogen) which helps in decreasing rate of bone loss, calcium ingestion (1000-1500 mg) daily, calcium injection (which prevents osteoclast action), biphosphonate to reduce osteoclast activity and to decrease the rate of bone loss. The treatment for these ailments costs approximately 7 billion in U.K. and 14 dollar in U.S.A.

As per W.H.O., osteoporosis is to be diagnosed based on bone mineral content and bone mineral density, reduction in BMC & BMD distrubts the microarchitecture.

Line of treatment mentioned for asthidhatupradoshajavyadhis are usage of tiktakaksheeraghrutabasti along with swayonidravya usage. Basti is said to be pradhana and ardhachikitsa for vatavyadhi. Hence here basti is taken as line of treatment. Among various bastimatrabasti is one which has minimum complications and matra is also competent enough for being prescribed in vruddhaavastha.

In asthidhatupradoshajavyadhicharaka has also mentioned use of tiktakaksheerabasti, where ksheera makes the bastimrudu, it is the variation of niruhabasti and form of prasrutayogikabasti.

Ayurveda thus have its upper hand in treating asthikshaya, as tiktasnigdhadravya thus used for treatment helps in new osteoid formation for remodelling of bone. Hence this study will be undertaken to evaluate the effect of matrabasti and tiktaksheerabasti on asthikshayaw.s.r. to osteoporosis.

6.2) REVIEW OF LITERATURE:

LAKSHANA OF ASTHIKSHAYA:

  1. Charaka in sutrasthana has explained in detail where both asthikshayamajjakshayalakshana coincide which are keshasmasrunakhalomadwijaprapatanam, shrama, sandhisaithilya, shiriyantaasthi, laghuta of asthi, vataroga etc.1
  2. Susrutha in sutrasthana gives detail description of asthikshayalakshana such as asthishoola, dantanakha bhanga.2
  3. Susrutha in nidanasthana mentions asthishosha as lakshana of asthigata vata.3
  4. In astangahrudayavagbhatta gives detail description of asthikshaya and majjakshayalakshana as asthitoda, asthishosha, dantakeshanakhabhangasadana here saushirya is said to be sarandhratva.4
  5. Harita has mentioned asthikshayalakshana under rajayakshmavyadhi as atimandachesta, mandaveerya, krushata, angabhanga, parushata, shopha.5

CHIKITSA OF ASTHIKSHAYA:

  1. In charakasutrasthana line of treatment for asthidhatupradoshajavyadhi is mentioned as basti which is given by formulated tiktaksheera or tiktaka ghruta.6
  2. Susrutha in sutrasthana mentions in kshayaavastha, swayonidravya of that particular dhatu is pratikara.7
  3. Vagbhatta has mentioned ksheeraghrutatiktasamyutabasti to be used means ksheera and ghruta which is tikta rasa siddha to be combined and used.8

YOGAS:

  1. In BhaisajyaRatnavali we find mentioning about panchatiktaguggulughruta to be used in vatavyadhi and asthisandhigata vyadhi.9

OSTEOPOROSIS

  1. Description of osteoporosis with its treatment is mentioned in Harrison’s textbook of internal medicine.10
  2. The clear symptoms of osteoporosis are mentioned in Golwala’s medicine for students as low back pain, kyphosis, and loss of height.11
  3. The complete treatment principle with diagnostic criteria and type in detail are mentioned in API textbook of medicine.12
  4. Prevention towards osteoporosis is mentioned in “The National medical series for Independent Study” as post menopausal estrogen therapy and calcium intake.13
  5. Osteoporosis has been classified statistically as follows by ICD 1014
  6. Postmenopausal osteoporosis
  7. Postoophorectomy osteoporosis.
  8. Osteoporosis of disuse.
  9. Postsurgical malabsorbtion osteoporosis.
  10. Drug induced osteoporosis.
  11. Idiopathic osteoporosis.
  12. Senile osteoporosis.
  13. Osteoporosis unspecified.

PREVIOUS WORK DONE:

  1. KapadiAnagaha L: - Asthidhatugatavatameinpanchatiktakaguggulughrutaprayogachikitsatmakaadhyayana, Smt. K.G.M. PunarvasuAyurvedic College, Mumbai University, Mumbai- 2001.
  2. Sharma P.K.:- Samanagunaabhyaso hi dhatunamvruddhikaranamsiddhantapushtyarthakshayajavikaronmeintiktakaksheerasarpiupahitaniva sutra kesamikshatmakaadhyayana, National Institute of Ayurveda, Jaipur-2001.
  3. NikamSmita:- To study the effect of tiktaksheerabasti in asthidhatugatavata, AyurvedMahavidyalaya, Pune-2002.
  4. KathawateRahul:- To study efficacy of chandanabalalakshaditailamatrabasti in asthikshaya, TilakAyurvedMahavidhyalaya, Pune-2003
  5. Shelly Divyadarshini;- Critical and comparative study of asthivahasrotasw.s.r. to asthikshaya,.N.KJabshettyAyurved Medical College, Bidar-2004.

6.3) OBJECTIVES OF STUDY:

  1. To study in detail about asthikshaya.
  2. To study briefly about osteoporosis.
  3. To study in detail about basti.
  4. To evaluate the effect of matrabasti and tiktaksheerabasti on asthiksahyaw.s.r. to osteoporosis.

7) MATERIALS AND METHODS:

LITERARY SOURCE:

  • Classical textbook of Ayurveda.
  • Related allopathic textbook of medicine.
  • Articles published from reputed journal.
  • Related source of data from internet.

DIGNOSTIC CRITERIA:

  • Parameter for diagnostic purpose depends on classical signs & symptoms.
  • Bone mineral density.

PARAMETERS

SUBJECTIVE PARAMETERS:

  • Shrama.
  • Sandhisaithilya.
  • Asthisandhishoolabheda.
  • Dantanakhakeshasmashrubhanga.

OBJECTIVE PARAMETERS:

  • BONE MINERAL DENSITY (W.H.O. criteria for osteoporosis)

T-score

Normal =-1

Osteopenia =-1 to -2.5

Osteoporosis=less than or equal to -2.5

Severe osteoporosis=less than -2.5 with fracture

CLINICAL SOURCE:

Asthikshaya patients are diagnosed on the basis of clinical symptoms & BMD test from OPD, IPD and camps conducted by Dr. B.N.M.E.Trust, ShriMallikarjunaSwamiji Post Graduate & Research Centre, Bijapur.

7.2) METHOD OF COLLECTION OF DATA:

STUDY DESIGN:

Diagnosed patient of asthikshaya in age group between 40-70 years irrespective of sex, occupation and socioeconomic status from OPD, IPD and Camps conducted by Dr.B.N.M.E.Trust, ShriMallikarjunaSwamiji Post Graduate & Research Centre, Bijapur.

Minimum 30 patients are selected and dropouts excluded. Then patients are assigned into two groups i.e. Group A and Group B. The evaluation of effect will be done based on subjective and objective parameter. Statistical analysis will be carried out by using student t-test under consultation of biostatistician.

INCLUSIVE CRITERIA:

  1. Patients will be selected between the age group of 40-70 years.
  2. Patient representing with classical features of asthikshaya.
  3. Patient of both sex are taken.
  4. Patient of osteoporosis diagnosed by BMD test.

EXCLUSIVE CRITERIA:

  1. Patient below the age of 40 and above 70 years.
  2. Patient suffering from any systemic disorder like DM, HTN, Endocrinal disorders, Paget’s disease, Cushing syndrome etc.
  3. Patient suffering from pathological osteoporosis or any neoplasm or osteoporosis related to systemic disorders.
  4. Osteoporosis associated with fracture.

7.3) DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED?

YES,

INVESTIGATION:Bone mineral density (BMD)

(Before and after treatment)

INTERVENTION: Conducted on patient diagnosed as asthikshaya.

Randomly selected patients will be assigned in two groups. Group A and Group B having 15 patients in each group.

GROUP A:

Sample size:15 patients

Method:Matrabasti

Duration : 25 days

Purva karma:Preparation of basti yoga

Saindhavalavana heated red hot and dipped in ghruta till whole saindhava dissolves.

Matra of panchatiktakaguggulughruta = 1 ½ pala = 72 ml

Matra of saindhavalavana = 1 karsha = 10 gm

Preparation of patient:

Sthanikaabhyanga.

Sthanikasweda.

Intake of laghubhojana.

Pradhana karma:Matrabasti administered

Paschat karma: Hitting over buttocks

Gently massaging over abdomen

Raising both leg slightly above and patting over feet.

Giving gentle massage over body so that patient

feels sleepy.

Bastipratyagamana should be observed

Nireekshana of samyakaanuvasana and

snehajeernalakshana

Treatment duration:8 days

Post treatment :On 25th day

follow up

GROUP B:

Sample size:15 patients

Method:Tiktaksheerabasti

Duration : 25 days

Purva karma:Preparation of basti yoga

Madhu= 1 prasruta

Saindhava= 1 aksha

Ghruta= Goghruta 2 prasruta

Kalka= Rasanakalka 20 gms

Kasaya= Panchatikta + ksheera = 3 prasruta

Total quantity = 6 prasruta

Preparation of patient:

Sthanikaabhyanga.

Sthanikasweda.

Pradhana karma:Tiktaksheerabasti administration.

Paschat karma ;Patient should rest for a while till bastipratyagamanakala

andnireekshana followed with pathyabhojana.

Treatment duration:8 days

Post treatment:On 25th day

follow up

SUBJECTIVE ASSESSIVE PARAMETERS:

SHOOLA
(ASTHI PRADESHA) / SPARSHA
ASAHYATA / DAURBALYA/
SHRAMA / SANDHI
SAITHILYATA
GRADE 0 / - / - / - / Pain
GRADE 1 / Mild / Mild / No strenuous activity / Pain and swelling
GRADE 2 / Discomfort / Wincing of face on pressure / Moderate activity / Pain ++
Swelling ++
GRADE 3 / Distress / Wincing of face and drawing affected part back / Only mild activity / Pain +++
Swelling+++
Crepitus +
GRADE 4 / Horrible / Resist touch / Even mild activity can be performed / Pain ++++
Swelling ++++
Crepitus ++
Tenderness +

7.4) HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

YES,

Ethical committee has recommended this project and advised to inform the patient about the risk involved & to take the consent of the patient participating in this clinical study.

8.) LIST OF REFERENCES:

  1. Charakasamhita : ShrimadAgniveshaPranitaCharaka, Drudhabalapratisamskruta, Chakrapaniduttavirachita, YadavjiTrikamjiAcharya, P.V. Sharma, Chaukhambha Sanskrit Sansthan, Varanasi, Part-1. (reprint-2009), Sutrasthana, 17th chapter, sloka 67-68, (pp no.240)
  2. SusrutaSamhita : MaharshiSusrutavirachita, DalhanaAcharyanibandhasamgraha, Gayadasvirachita, Chaukhambha Sanskrit Sansthan,Varanasi (reprint-2009), Sutrasthana 15th chapter, sloka 9 (pp no. 69)
  3. SusrutaSamhita : MaharshiSusrutavirachita, Dalhanaacharyanibandhasamgraha, Gayadasvirachita, Chaukhambha Sanskrit Sansthan, Varanasi (reprint-2009), Nidanasthana, 1st chapter, sloka 28 (pp no. 261)
  4. Astangahrdaya : ShrimadVagbhattavirachitaArunaduttavirachita “Sarvangasundari” Hemadripranita “Ayurvedarasayana” PanditHarishastri, ChaukhambhaKrishnadas Academy, Varanasi (reprint-2006), Sutrasthana 11th chapter sloka 19th (pp no. 185)
  5. HaritaSamhita : (Harihindivyakhyasahit) PanditHaridas Prasad Tripathi, ChaukhambhaKrishnadas academy, Varanasi, 1st edition-2005, Tritiyasthana, chapter 9 sloka 22, (pp no. 264)
  6. Charakasamhita : ShrimadAgniveshaPranita, CharakaDrudhabalapratisamskruta, Chakrapaniduttavirachita, YadavjiTrikamjiAcharya, P.V. Sharma Chaukhambha Sanskrit Sansthan,Varanasi, part-1 (reprint-2009), Sutra-sthana, chapter 28, sloka 27, (pp no.432)
  7. SusrutaSamhita : MaharshiSusrutavirachita, DalhanaAcharyanibandhasamgraha, Gayadasvirachita, Chaukhambha Sanskrit Sansthan,Varanasi (reprint-2009), Sutrasthana, chapter 15, sloka 10, (pp no. 69)
  8. Ashtangahrdaya : ShrimadVagbhatavirachita, Arunaduttavirachita “Sarvangasundari” Hemadripranita “Ayurvedarasayana” PanditHarishastri, ChaukhambhaKrishnadas Academy, Varanasi (reprint-2006), Sutrasthana, chapter11 sloka 31 (pp no. 187)
  9. BhaisajyaRatnavali :ShriGovindadasavirachita, BhisagratnaShriBhramankarParishkrtyavyakhyakarkavirajShriAmbikaduttShastriChaukhambha Sanskrit Samsthan (11th edition-1993) chapter 54, sloka 233-236, (pp no. 632).
  10. Harrisons textbook of Internal Medicine 15th edition, volume-2, chapter-12 ,342 (pp no. 2226-2236)
  11. Golwala medicine for student (Apsi. F. Golwala), 17th edition (pp no. 778).
  12. API textbook of medicine, 6th edition-1999, section XVIII, 4th chapter (pp no 1097).
  13. The National medical series for independent study by Allen R. Myers, B.I.Waverlypvt. Ltd. (New Delhi) 2nd edition, medicine chapter 9th 8(B), (pp no. 455-457).
  14. ICD-10 Interrnational Statistical Classification of Diseases and Related Health Problems, Tenth revision, volume1, 2003. (pp-667)
  15. Ayu journal volume 30 no.2 (Apr.-Jun. 2009) S.KaldimattiSubbanaGowda – Tiktaksheerabastiajasthibhasma in Osteoporosis (pp no. 131-141).
  16. Researches in Ayurveda by Dr M.S.Baghel 2005.

9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE :

11. NAME AND DESIGNATION OF :

11.1 GUIDE : Dr.R.N.GENNUR

M.D.(AYU)

Professor, Dept of Panchakarma

Dr.B.N.M.E Trust’s

ShriMallikarjunSwamiji

Post Graduate & Research Centre

BIJAPUR – 586101

11.2 SIGNATURE :

11.3 CO GUIDE :

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT :Dr.R.N.GENNUR

M.D.(AYU)

H.O.D, Dept of Panchakarma

Dr.B.N.M.E Trust’s

ShriMallikarjunSwamiji

Post Graduate & Research Centre

BIJAPUR – 586101

11.6 SIGNATURE :

12.

12.1 REMARKS OF THE CHAIRMAN :

AND PRINCIPAL

12.2 SIGNATURE :