From,
Dr Shende Amol Govindrao,
Preliminary M.D. (AYU) Scholar,
Department of postgraduate studies in Kaumarabhritya,
S.D.MCollege of Ayurveda and Hospital,
Hassan 573201.
To,
The Registrar,
RajivGandhiUniversity of Health Sciences,
Bangalore, Karnataka.
Through,
The Principal and Head of the department of Kaumarabhritya,
S.D.MCollege of Ayurveda and Hospital,
Hassan-573201.
Subject: Submission of completed Proforma for Registration of subject for
Dissertation.
Respected Sir,
I request you to kindly register the mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka, and Bangalore for partial fulfillment of M.D (Ayu).
Title of the Dissertation:
“CLINICAL STUDY ON AVARTAKI PUSHPA VATI IN THE MANAGEMENT OF SHAIYYAMUTRA.”
Here with, I am enclosing completed Proforma of Synopsis for Registration of subject for Dissertation.
Thanking You,
Yours faithfully,
Place: Hassan
Date: Shende Amol Govindrao
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE – II
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT OF DISSERTATION
1. NAME OF THE CANDIDATE : AMOL.G.SHENDE
AND ADDRESS PRELIMINARY M.D (AYU)
SCHOLAR, DEPARTMENT OF P.G STUDIES IN KAUMARABHRITYA
PERMANENT ADDRESS : S/O SHRI GOVIND
TULSHIRAM SHENDE”
AT/POST TAL: INDAPUR
DISTRICT: PUNE 413106
MAHARASHTRA
2. NAME OF THE INSTITUTION: SDMCOLLEGE OF AYURVEDA ANDHOSPITAL HASSAN – 573201
KARNATAKA
3. COURSE OF STUDY & : M.D(AYU)KAUMARABHRITYA
SUBJECT
4. DATE OF ADMISSION : 15TH JUNE 2009
TO THE COURSE
5. TITLEOF THE TOPIC: “CLINICAL STUDY ON
AVARTAKI PUSHPA VATI IN
THE MANAGEMENT OF SHAIYYAMUTRA”
6. BRIEF RESUME OF INTENDED WORK
6.1 NEED FOR THE STUDY:
Shaiyyamutra that is nocturnal enuresis is oneamong the common problem in the school going children. About 7% of male and 3% of female children fail to adapt diurnal and nocturnal control of bladder by the age of 4-5 year. Among them 15% of children gain their bladder control each year further.1There was77% risk of having nocturnal enuresis with significant past history of parents. The risk declines to 43%withpast history of one parent and to 15% without past history.2
Nocturnal Enuresis is involuntary passingof urine during sleep occurring after the age by which bladder control should have been established i.e. in between 4-5 year. However it is observed that incidence of enuresis is more common in male children than female children with ratio of 3:1. Medical intervention is required if bed wetting persists beyond the age of 5 year. However factors like psychology, delayed development, bladder controlcapacity andimproper toilettrainingshould be also kept in mind.3
The disease is neuro-psycho-somatic in nature and the cause is said to be the delayed maturation of neurological mechanism involved in the bladder control, stressfulenvironment, lack of attention, love concern and familial conflicts.4
Shaiyyamutra was explained in Ayurvedic Classics with respect to its clinical features and treatment. A drug which is nervine tonic and able to increase bladder control and tone of bladder muscles with Grahi, Stambhana and Mutrasangrahaniya properties can be able to reverse the pathology of Shaiyyamutra. With this intention Avartaki Pushpawhich is Grahi & Stambhana, Mutrasangrahaniya5has been taken for the present study.Hence present work will be an effort to evaluate the efficacy of Avartaki Pushpa Vati in Shaiyyamutra.
6.2 REVIEW OF LITERATURE:
The word Shaiyyamutra denotes thatchild unknowingly passes urine during the sleep at night due to the influence of the Doshik factor.6
NocturnalEnuresis refers to bed wetting after the age of 5 years. Primary enuresis and secondary enuresis are the two clinically recognized types.Child has never been dry at nightin primary type while insecondary established control of bladder later gets disrupted by stressful environmental events.
Lack of family attention love, concern,security, family conflicts, maladjustments, learning problems, scholasticproblems, siblingrivalry, fear etc are the significant predisposing factors for the Shaiyyamutra. An erratic handling of situation by uneducated parents causes further anxiety to the child, making the problem further complicated.Some of the physical factor like genitourinary infection,and anatomical variationfurther adds to the severity of the problem.7
Avartaki Pushpa is Kapha, Pitta Shamak,Stambhaka, andMutrasangrahaniya.In Kaiyadeva Nighntu AvartakiPushpa is mentioned as Premehara, Grahi and Stambhana8.9, 10, 11Theflowers arespecially used in nocturnal emission.
LIST OF PREVIOUS WORK:
Earlier to six dissertations works have been done across the country with respect to different aspects of management of Shaiyyamutra.
1)A clinical study on Shaiyyamutra by Dr V P Vyas Dept of Kaumarabhritya. Under the GujaratAyurvedaUniversity, Jamnagar.(1992)
2)A comparative clinical study of Medya Rasayana and Shaiyyamutra Hara yoga’s in the management of Shaiyyamutra by Dr Amit Kataria Dept ofKaumarabhritya. Under the GujaratAyurvedaUniversity, Jamnagar. (2003)
3)To evaluate the effect of Shaiyyamutrahara yoga’s (Bimbi and Maricha) in the management of Shaiyyamutra by Dr Mahalkari Y B Dept of Dravya Guna. Under the Tilak AyurvedaMahavidyalaya Pune, PuneUniversity. (1996).
4)Clinical evaluation of some Ayurvedic drugs in the management of Shaiyyamutra in children by Dr Meenakshi Gupta Dept of Kaumarabhritya. Under the University National Institute of Ayurveda, RajasthanUniversityJaipur (2002).
5)To evaluate the effect of Satwavajaya Chikitsa in Shaiyyamutra by Dr Sudheer B R Dept of Kaumarabhritya. Under the RajivGandhiUniversity of Health Sciences Bangalore(2004).
6)To evaluate the effect of anindigenous drug in Shaiyyamutra by Dr. Pankaj Gore dept of Kaumarabhritya.Under the RajivGandhiUniversity of Health Sciences Bangalore.(2008)
6.3. OBJECTIVE OF THE STUDY:
- To evaluate the effect of Avartaki Pushpa Vati in the management ofShaiyyamutra.
- To evaluate the effect of placebo in the management of Shaiyyamutra.
- To compare the effect of both the above groups.
7. MATERIAL AND METHODS:
7.1 SOURCE OF DATA:
patients presenting with the symptom of Shaiyyamutra will be selected from KaumaraBhritya OPD/IPD of SDMCA & Hospital, Hassan.
The patients will be included for the study based on the inclusion and exclusion criteria and these will be registered as per special Proforma prepared for screening.
7.2 METHODS OF COLLECTION OF DATA:
Diagnostic Criteria:
Bed Wetting after the age of 5 years.
Inclusion Criteria:
- Patients of Shaiyyamutra (Nocturnal enuresis) will selected between the groups of 5-12 years.
- Children with both persistence and regressive type of Nocturnal enuresis.
- Shaiyyamutra due to Behavioral, psychological, stress related factorswere included.
Exclusion Criteria:
- Patients below 5years and above 12 years of age.
- Patients with congenital anomalies of the genito urinary tract especially of the urethral valve.
- Enuresis due to disease of the CNS, Spina-Bifida.
- Diabetes Mellitus and Diabetes insipidus.
- Urinary tract infections Epilepsy etc.
Grouping-
40patients will be divided equally into two groups, each consisting of 20patients, and treatment will be given as per the schedule given below,
GROUP A- (Trial group)
Avartaki Pushpa Vati will be given orally in the dose of 500mg(1 Vati=5oomg)twice daily for two month.
GROUP B- (Control group)
Placebo will be given in similar way as in above treated group.
ASSESSMENT CRITERIA
Patients of Shaiyyamutra in the present study will be assessed based on the following criteria’s with different grading.
- Bed wetting frequency.
- With holding time.
- Nature of sleep and bedwetting.
- Psychological status of the child.
- Physical activities as predisposing factors.
DurationofStudy-
All the patients will be treated for the period of 2 months.
Drug and Dose:
The flowers of Avartaki which is commonly available in tropical area will be collected and dried under shade and made in to Churna (Powder). This Churna will be given Bhavana with Avartaki Pushpa Swarasa and Vati will be preparedeach weighing 500mgs.
Follow up:
During treatment the patients will be asked to attend the OPD at interval of 15 days for 2 monthsto know whether the improvement provided by the drug is sustained.
7.3 LABORATORY INVESTIGATIONS:-
- Routine urine analysis
(a)Urine sugar – by benedict’s qualitative test method.
(b)Albumin – By glacial acetic acid test method.
(c)Microscopic – Examination under low and high power.
- Earlier reports of X-ray of Lumbo-sacral spine, USG of abdomen, and urine culture if requested to excluded other pathology.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION? YES
8. LIST OF REFERENCE:
1)Bherham Richard kliegam, Robert m and Jenson Hal b. (2004) Nelson textbook of pediatrics 17th editionchapter no.20.3 pp 74,
2)American Academy of Family Physicians, Nocturnal enuresis by Carolyn Thiedke, Medical University of South Carolina,2003 67:1499-506,1509-1.
3)Clinical pediatrics general practice by Milind S Shejwal pp 48.
4)I.A.P.textbook of pediatrics published by Jaypee brothers’ medical publisher ltd 2nd edition pp 484.
5)Dravya Guna Vigyaan by Dr Gyanendra Pandey Vol 1 pp 279.
6)Sharangdhara samhita noted by shri.Lakshmipati Tripathi poorva khand 7/185-188 pp 136.
7)7a &7b Text book of pediatrics 7th edition by Suraj Gupte pp 337.
8)Handbook of Dravya Guna Vigyaan by Prof .J. K .Ozha
9)Kaiyadeva Nighantu Aushadi Varga 999-1001 pp 184.
10)Dravya Guna Vigyaan by Dr.A.P.Deshapande, Dr.R.R.Javalekar, Dr.Subhash Rande, Marathi book anmol Prakashan, Pune pp 823.
11)Dravya Guna Vigyaan by Dr.J L N shastry 2nd edition of English version published Chaukhamba oriental year 2004 pp 744 vol 2.
9. SIGNATURE OF THE CANDIDATE:
10.REMARKS OF THE GUIDE:
11. NAMES AND DESIGNATION OF:
11.1 GUIDE: Dr. Shrinidhi K. AcharyaM.D (Ayu) PhD
Reader, Department of P.G Studies in
KaumarabhrityaS.D.M.C.A. & H. Hassan, Karnataka.
11.2 SIGNATURE:
11.3 H.O.D: Dr. Shailaja. U. M.D (Ayu) PhD
Prof. and HOD Department of P.G Studies in KaumarabhrityaS.D.M.C.A. & H. Hassan, Karnataka.
11.4 SIGNATURE:
12. REMARKS OF THE CHAIRMAN
AND PRINCIPAL:
12.1 SIGNATURE: