RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE – KARNATAKA
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
“A CRITICAL ANALYSIS OF PANDU ROGA w.s.r. to IRON DEFICIENCY ANAEMIA AND ITS MANAGEMENT THROUGH VARDHAMANA PIPPALI RASAYANA ”
BY
Dr. RAGHAVENDRA. P. SHETTAR
1st year MD (Ayu)
DEPARTMENT OF PG STUDIES IN KAYACHIKITSA,
RAJIVGANDHI EDUCATIONAL SOCIETIES’S AYURVEDIC MEDICAL COLLEGE &
PG RESEARCH CENTRE, RON - 582209
GUIDE
Dr. SHARADA.
MD(Ayu)
PROFESSOR AND H.O.D
DEPT. OF P.G. STUDIES IN KAYACHIKITSA,
RAJIVGANDHI EDUCATIONAL SOCITIE’S AYURVEDIC MEDICAL COLLEGE &
PG RESEARCH CENTRE, RON - 582209.
2012 - 2013
RAJIVGANDHI EDUCATIONAL SOCIETIES’S AYURVEDIC MEDICAL COLLEGE & PG RESEARCH CENTRE.
Ron - 582209
Gadag Dist., Karnataka.
From
DR. RAGHAVENDRA. P. SHETTAR
1st Year M.D (Ayu)
Department of Post Graduate Studies in Kaya Chikitsa,
RGES Ayurvedic Medical College, Hospital PG Studies & Research Centre,
Ron, Gadag Dist.
To
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore, Karnataka.
Through, The Principal and Head of the Department of Kaya Chikitsa,
RGES Ayurvedic Medical College, Hospital PG Studies & Research Centre,
Ron - 582209, Gadag Dist.
Respected Sir/Madam,
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, Bangalore for partial fulfillment of M.D. (Ayu) course in Kaya Chikitsa.
TITLE OF DISSERTATION:
“A CRITICAL ANALYSIS OF PANDUROGA w.s.r. to IRON DEFICIENCY ANAEMIA AND ITS MANAGEMENT THROUGH VARDHAMANA PIPPALI RASAYANA”
Here with I am enclosing the completed Proforma for registration of subject for dissertation.
Thanking you,
Date: 26 - 04 - 2013. Yours faithfully,
Place: Ron.
Dr. RAGHAVENDRA. P. SHETTAR.
RAJIVGANDHI UNNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
ANNEXURE – II
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1) Name of Candidate : DR. RAGHAVENDRA. P. SHETTAR.
And
Address (In block Letters) : 1ST YEAR MD (AYU) KAYACHIKITSA
RGES AYURVEDIC MEDICAL COLLEGE HOSPITAL PG STUDIES AND RESEARCH CENTER RON. 582209. DIST- GADAG
Permanent address : POST- BELAVANKI 582202
TALUK- RON
DIST- GADAG, KARNATAKA.
2) Name of the Institution : RGES Ayurvedic medical college Ron.
3) Course of Study & Subject : M.D. (Ayu) IN KAYACHIKITSA.
4) Date of Admission of Course : 25-10-2012
5) Title of the Topic : “CRITICAL ANALYSIS OF PANDUROGA w.s.r. to IRON DEFICIENCY ANAEMIA AND MANAGEMENT THROUGH VARDHAMANA PIPPALI RASAYANA”
6) BRIF RESUME OF INTENDED WORK:
6.1) Need for the study:
Ayurveda says swastha is the state of equilibrium of doshas, normal functioning of dhatus and malas along with the well being of soul and unimpaired senses and cheerful mind. Inequilibrium state of these entities is state of Roga (Disease)1. With the present lifestyle, large portion of the society belongs to the second group (Roga). Most prevailing roga, specially in women and children is “Padu roga.”
The literal meaning of Pandu word is Ketaki dhuli sannibha (Pollen grains of Ketaki flower). The Pandu roga derivation says that patients skin resembles like colour of Pollen grains of Ketaki pushpa. Etiological factors of Pandu roga are like excessive physical exertion, over use of wines, eating mud, day sleep.2 Pandu roga is one of the commonest disease which affects all age groups and It is very commonly present in economically poor people because of under nourishment and malnourishment. Likewise more prevalent in our taluk.
Iron deficiency is the commonest nutritional deficiency world over and its prevalence is highest in India. In India- 30% of adult male, 45% adult female, 80% of pregnants, 60% of children3 have Iron deficiency. It is not merely due to lack of resources, but other poverty related factors such as illiteracy.
There are more number of yogas in Ayurveda for the treatment of Pandu roga, in which Vardhamana Pippali yoga is safe, economical and easily available. Pippali has properties like Balya, Rasayana, Pandu rogagna4. So considering above said properties I selected Vardhamana Pippali Rasayana for the management of Panduroga as my dissertation work.
6.2 Review of Literature:
1. Disease review:
The disease Panduroga Nidana, Samprapti, Lakshana and are explained in,Charaka Samhitha, Chikitsa Sthana8, Susrutha samhitha - uttara tantra5 . Ashtanga Hridaya - Nidana Sthana6, Madhava nidana2, Bhavaprakasha - madhya khandam9,
According to contemporary medical science the disease review is explained; Text book of API TextBook of Medicine3, Harrison’s text Book of internal Medicine10, Text book of Davidson Medicine11.
2. Drug review
The formulation of Vardhamana Pippali Rasayana is explained in Charaka samhita chikitsa sthana 1st chapter 3rd pada4and also there is an direct indication of this yoga in sushruta samhita chikitsa sthana 5th chapter 12th shloka12.
6.3) Previous works done:
1. Dr.Ashwini- A clinical comparative study on the effect of Vidangadi loha and punarnava Mandura in the management of Pandu w.s.r to Iron Defficiency Anaemia, 2005, Ashwini Ayurvedic medical college Davanageri.
2. Dr. Shridhar- A clinical study on effect of Darvyadi churna in Panduroga, 2006, SDM College of Ayurveda, Kuthpady.
3. Dr. Bhagyalakshmi. K - Management of Pandu with Manduradi Yoga w.s.r. to Iron deficiency Anaemia, 2006, Dr A.L.N. Rao Ayurvedic Medical College Koppa.
4. Dr. Girish. S.G- A Clinical management of Iron deficiency anaemia (Pandu roga) through Virechana and shaman. 2006, SDM College of Ayurveda. Kuthpady.
5. Dr. Arun Pratap- A Clinical evaluation of Pranada Gutika in the management of Pandu roga with special reference to Iron Deficiency Anaemia. A L N Rao Ayurvedic Medical College Koppa.
6. Dr. Preethi Kundu- A Clinical study on the effect of Tapyadi loha in the management of Iron Deficiency Anaemia, 2010, Shri Jagadguru Gurusiddeshwara Cooperative Hospital And Research Institute Ghataprabha.
7. Dr. Kaveri. V. Ram- A Clinical evaluation of Indrashani Churna in the management of Pandu roga w. s. r to Iron Deficiency Anaemia. A. L. N. Rao Ayurvedic Medical College Koppa.
6.4) Objectives of the Study
1. To evaluate efficacy of Vardhamana Pippali Rasayana in the management of Pandu roga.
2. To study in details Pandu roga according to Ayurvedic classics
3. To study in details Iron Deficiency Anaemia according to Modern Classics
7) Materials and methods:-
7.1) Source of data:
Study will be carried out on the patients suffering from Pandu roga attending O.P.D of RGES Ayurvedic Medical College & PG Research Centre and special camps will be conducted.
7.2) Method of data collection:
Study will be carried out on the patients fulfilling the criteria of Pandu roga.
a) INCLUSION CRITERIA:
Ø Patients presenting with the signs and symptoms of Pandu roga will be selected.
Ø Patients of either sex with the age group between 25 to 50 years will be selected.
Ø Hb% below 9 gm and above 6 gms selected
b) EXCLUSION CRITERIA:
Ø Hb % below 6 grms%
Ø Anaemia due to any other metabolic disease
Ø Pregnancy
DIAGNOSTIC CRITIRIA:
Signs and symptoms mentioned in Ayurveda for Panduroga
· Panduta
· Dourbalyata
· Hridspandanam
· Bhrama
· Shunakshikuta
· Twak rukshata
· Swasa
· Kasa
· Aruchi
· Pindikodwestana
· Jwara
· Shitilendriyata
· Nidraluta
· Karnaksweda
STUDY DESIGN:
A Observational Clinical study.
SAMPLE SIZE:
Total number of patient taken for the study will be 40 excluding dropouts
POSOLOGY
Patients will be administered Vardhamana Pippali Rasayana in madhyama matra
DOSAGE
On 1st day 6 Pippali (1.8gms) will be given, from second day onwards upto the 13th day 6 pippali will be increased daily. From the 14th day the number of Pippali will be decreased in the same order till it comes to 6 (on the 25th day)
ANUPANA :- Milk
DURATION :- 25 DAYS
FOLLOW UP:- one month
SOURCE OF FORMULATION:
In the form of churna Vardhamana Pippali Rasayana will be prepared in the Rasashastra and Baishajya kalpana dept of RGES Ayurvedic Medical college RON according to classical reference.
ASSESSMENT OF RESULTS
- Depending upon subjective and objective criteria assessment of the responses will be made based on gradation index mentioned below
- Statistical analysis will be made using slandered ‘t’ and ‘f’ test
PARAMETERS OF STUDY:
The improvement provided by therapy will be assessed on the basis of classical signs and symptoms, all the signs and symptoms will be assigned with a score depending upon their severity to assess the effect of the drug objectively.
CRITERIA FOR ASSESSMENT:
Observation of improvement in the lakshanas of the Panduroga will be done based on the following parameters
Grading of the Assessment Criteria:
1. Panduta- Twacha, nakha, netra, jihwa, hastapada
score
Absent -0
Individual 2 of these -1
Individual 3 of these -2
Individual 4 of these -3
All -4
2. Dourbalyata Score
Not present -0
After heavy work relieved soon and tolerate -1
After moderate work relieved soon and tolerate -2
After little work relieved later -3
After little work relieved later but beyond tolerate -4
3. Hridspandanam Score
Not present -0
After heavy work relieved soon and tolerate -1
After moderate work relieved soon and tolerate -2
After little work relieved after -3
After little work relieved later but beyond tolerate -4
Hridspandanam even in resting condition -5
4.Sunakshikuta shotha Score
Absent -0
Mild -1
Moderate -2
Severe -3
5.Aruchi Score
Absent -0
Present -1
6. Pindikodwestana Score
Absent -0
After heavy work -1
After moderate work -2
Without work -3
7. Brama Score
No -0
Mild -1
Moderate -2
Severe -3
8. Swasa Score
No -0
After heavy excretion and reduce after rest -1
After moderate exertion and reduce rest -2
After slight exertion and reduce rest -3
Without exertion and not reduce -4
Objective criteria:
1. Based on Hb% or changes in blood reports Score
12 to 14gms % -0
10 to 12gms % -1
8 to 10gms % -2
6 to 8% -3
2. Serum iron level Score
50 to 170 microgram /dl -0
45 to 49 microgram /dl -1
40 to 44 microgram /dl -2
35 to 39 microgram /dl -3
34 > -4
3. RBC distribution with size increased microcytic hypo chromic anaemia
CRITERIA FOR OVERALL EFFECT OF THERAPHY
Complete Remission / 100% relief in the subjective and objective parameter.Markly Improvement / More than 75% in the subjective and objective parameter.
Moderate Improvement / 50 to 74% relief in the subjective and objective parameter.
Mild Improvement / 25 to 49% relief in the subjective and objective parameter.
Unchanged / Result below 25% was consider as unchanged.
7.3) Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so please describe:
YES
Study will be a human observational study. No animal experimentation will be conducted.
INVESTIGATIONS:
Ø Blood – Hb%, TC, DC, ESR
Ø MCV, PCV, MCHC, MCH
Ø Serum Iron level
Ø Peripheral blood smear
Ø Another investigations if necessary
Ø 7.4) Has ethical clearance been obtained from your institution in case of 7.3?
YES (Copy Enclosed)
8. LIST OF REFERENCES:
1) Professor Ananath Ram Sharma, Astanga Hridaya Sutrasthana, of Acharya Vagbatha, Edited with Hrdvimarsini Hindi Commentary, along with Special Delirations etc, First Print- 2009, Chapter 1st, Sloka- 20, Page-19
2) Dr. K.R. Srikanta Murthy, Madhava Nidana, of Madhavakara, Chawkhambha Oriantalia, Varanasi, English Translation 7th edition 2005, Chapter 8, sloka 2, page no.35.
3) Edited by Siddharth N. Shah. API textbook of medicine, 7thEdition-2003, Published by The Association of Physicians India, 5th Chapter, page no. 930 to 934
4) Dr. P. V. Sharma Professor Charaka Samhita Chikitsa Sthana Hindi translation book, Choukambha Samskrit Pratisthana, Dellhi. Edition reprinted 2012, Chapter 1, pada 3rd, sloka 35, page no. 30
5) Priya Vrat Sharma, Edited and translated, Susrutha samhitha, with English Translation of text and Dalhana’s commentary alongwith critical notes, Reprint 2004, Publisher Chowkhamba Visvabarati, Varanasi, vol-3, Uttara Tantra - Chapter 44, Sloka 3-4, page no448.
6) Dr. K. R. Srikantha moorthy, Ashtanga Hridaya,vagbhats –text, English translation edition reprint 2006, chowkhamba krishnadas academy, Volume 2 - Nidana sthana, Chapter 13, sloka 1-7, page no.122,123,
7) Dr. K. R. Srikantha moorthy, Ashtanga Hridaya,vagbhats –text, English translation edition reprint 2006, chowkhamba krishnadas academy, Volume 2 - Chikitsa sthana, Chapter 16, sloka 15, page no.449.
8) Dr. Ramkaran sharma and vaidhya bhagavan das, Charakasamhita agnivesha’s text with English translation and critical exposition based on chakrapani datta’s ayurveda deepika, chowkhamba Sanskrit series office, Varanasi, edition reprint 2005, Volume 4, Chikitsa sthana, Chapter 16, sloka 7-16, page no.83-85.
9) Dr. K. R. Srikantha moorthy, Bhavaprakasha of Bhavamishra, chowkhamba krishnadas academy, Varanasi English translation, edition 2005, volume 2, madhyama khanda – Chapter 8, sloka 2, page no.202.
10) International Edited by Fauci, Braunwald, Isselbacher, Wilson, Martin, Kasper, Hauser, Lango. Harrison's principles of internal medicine, 14thEdition-1998, Published by Mc Graw Hill, 106th Chapter, page no. 639 to 643
11) Edited by Christopher Haslett, Edwin R. Chilvers, John A.A. Hunter & Nicholas A. Boon. Davidson's principles & practice of medicine, 18thEdition-1999, Publisher Churchill Livingstone an imprint of Harcouet publishers limited, 11th Chapter, page no. 757 to 759
12) Kaviraj Ambikadatta shastri, Sushrutha Samhita, Maharshi Sushruta, Hindi Commentary, 9th eddition 1995 Publisher, Coukambha Sanskrit Samsthana Varanasi, Chikitsasthana Chapter 5 Shloka 12, Page number 31
9) Signature of the candidate :
(Dr. Raghavendra. P. Shettar.)
10) Remark of the Guide : A very safe broad spectrom, cost effective formulation. Vardhamana Pippali Rasayana
for a very common disorders Pandu, which is the need of the hour. Best of luck.
11) Name and designation of :
11.1) Guide : Dr. SHARADA.
MD (Ayu)
PROFESSOR AND H.O.D
DEPT. OF P.G. STUDIES IN KAYACHIKITSA,
RAJIVGANDHI EDUCATIONAL SOCITIE’S AYURVEDIC
MEDICAL COLLEGE & PG RESEARCH CENTRE,
RON - 582209.
11.2) Signature of Guide :
11.5) Head of the Department : Dr. SHARADA.
MD (Ayu)
PROFESSOR AND H.O.D
DEPT. OF P.G. STUDIES IN KAYACHIKITSA,
RAJIVGANDHI EDUCATIONAL SOCITIE’S AYURVEDIC
MEDICAL COLLEGE & PG RESEARCH CENTRE,
RON - 582209.
11.6) Signature of the HOD :
12.1). Remarks of the Chairman & Principal :The above synopsis is scrutinized by the post Graguate Studies and Research center Committee of R.G.E.S Ayurvedic Medical College Ron and submitted for registration as subject of dissertation at R.G.U.H.S Bangalore.
12.2). Signature :