6. BRIEF REVIEW OF INTENDED WORK
6.1) NEED FOR STUDY :
Movement is an important characteristic of all living organisms. Vata is prime among doshas and responsible for all type of movements1. Almost all functions viz.Gati, Vak praruttti, Akunchana, Unmesha, Gatra prasarna etc. are done by prakrutaVata2. The vikruti of prakrut karma of Vata occurs because of externally mediated agents. Mainly vikriti in these karma seen in Pakshaghata which is one among the 80 vata nanatmaja vikara3 It is consider one among the Mahagada,which is capable of making chesta hani and karmendriya kriyahani.
The paksha means half of the body, aghata means loss or injury4when aggravated vata affects one side of the body either right or left cause immobility of that side, in association with pain and loss of speech then the ailment is called Pakshaghata5.
The management of Pakshaghata can be done by oral administration of vatashamaka dravya. The abhighata to shiromarma cause vata vyadhi.As nasa is considered as path way of shiras so Nasya is best chikista for vatavyadhi. Which are due to shiromarma abhighata.
Considering all above said, present study is undertaken to minimise disease Pakshaghata and its after effects by internal administration and Nasya of trial drug(i.e Mashadi yoga).
6.2) REVIEW OF LITERATURE
The disease Pakshaghata is explained under the headings of vatavyadhi in the classical texts of Ayurveda like Charaka samhita7, Shusruta samhita8, Astanga hrudaya9, Sharangadhara samhita10, Madhava nidana11, Bhava prakasha12, Kashyapa samhita13, Vangasena samhita14, Bhaishajya ratnavali15, Yoga ratnakara16, Chakra dutta17, Sahasra yoga18are mentioned Pakshaghata disease and treatment.
Mashadi yoga Nasya is mentioned in Sharanghadhar samhita, is said to be time tested this yoga contains mainly vata shamaka drvya. Which is main culprit to cause Pakshaghata.
Chakra dutta advocates the similar combination as oral administration20too. Thus an effort to compare the efficacy of Mashadiyoga through Nasya and oral administration is made here.
6.3) AIMS AND OBJECTIVES OF STUDY
a) To evaluate the efficacy of Mashadiyoga by Nasya in Pakshaghata.
b) To evaluate the efficacy of Mashadiyoga kwata in Pakshaghata.
c) To compare the efficacy of above a & b.
7. MATERIALS AND METHODS
7.1) a) SOURCE OF DATA : Patient’s will be selected from OPD andIPD of DGAMC and hospital after fulfilling the preset inclusion and exclusion criteria.
b) LITERARY : Required literary information for the intended study will is procured from both the Ayurvedic and contemporary books and updated with recent journals of both faculties.
c) TRIAL DRUG :
Group A–Mashadhiyoga kwatha intenally.
Group B- MashadhiyogaNasya (Avartita).
7.2) COMPOSITION OF TRIAL DRUG
The composition of Mashadiyoga is as follows. In case of non availability of any of ingredient substitutes are taken according to classical reference.
S.N / SANSKARIT NAME / BOTANICAL NAME / PROPORTION1 / Masha / Phaseolus mungo / 1Part
2 / Atmagupta / Mucuna prurita / 1Part
3 / Rasna / Pluchea lanceolata / 1Part
4 / Bala / Sida cardfolia / 1Part
5 / Urubuka / Ricinus cummunis / 1Part
6 / Rohisha / Cymbopogon martini / 1Part
7 / Ashwagandha / Withania somnifera / 1Part
8 / Hingu / Ferula narthex / 1Gram
9 / Saindhava Lavana / Rock salt / 1Gram
7.2 ) b)PREPARATION OF THE MEDICINE
All the constituent of the Mashadiyoga is collected from the local area after proper identification. The useful parts and the ratio of the individual drugsare according to the reference.Preparation will be undertaken with Good Manufacturing Practice.The kwatha and Taila are preparedaccording to classical text instructions21.
7.3)METHODS OF COLLECTION OF DATA
a)STUDY DESIGN : A Simple random sampling Comparative clinical observation.
b)SAMPLE SIZE: The study is undertaken in two groups.
1. In group A minimum of 15patientsare taken for Oral administration.
2. In group B minimum of 15patientsare taken for Nasya.
c)EXCLUSIVE CRITERIA
1. Congenital cerebral palsy - ICD 10 G8022
2. Infantile cerebral palsy – ICD 10 G80
3. The patient with secondary systemic involvement
4. Patient suffering with any other systemic disorder viz.
a)Renal failure,
b) Hepatic disorders
c) Endocrine systemic disorders
7.3) d) INCLUSIVE CRITERIA
- Patient belongs to either gender are included
- Age group of 30-70Years are included
- Patients with classical sign and symptoms of Pakshaghata are included
a)Chesta nivrutti and Ruja in dakshina pradesh
b)Chesta nivrutti and Ruja in Vama pradesh
c)Vak stambha
d)Sankocha and shoola in pada.
e)Sankocha and shoola in hasta.
- Flaccid hemiplegia– ICD 10 G82
- Spastic hemiplagia ” ”
- Unspecified hemiplegia ” ”
e)DIAGNOSIS
Patients are diagnosed clinicallyby symptoms and ruled out the exclusions through laboratory investigations and Examination.
f)POSOLOGY
Group A –Mashadi Kwatha orally - 96ml/ 24 hrs in divided doses i.e. 48ml BD23
Group B –Mashadi Taila Nasya -8drops 24in each nostrils for 7dayscontinuously followed by 3 days rest done for Three Avritti i.e. 1 to 7 days Nasya, 3 days rest, 11 to 17 days Nasya, 3 days rest, 21 to 27 days Nasya, 3 days rest.
g)STUDY DURATION
Group A - Abhyantara - Thirty days
Group B - Nasya - Mashadi Taila Nasya -8drops in each nostrils for 7days
continuously followed by 3 days rest. Administred for
Three Avritti i.e. 7+3 x 3 = 30 days
h) Follow up - Thirtydays
i) ASESSMENT OF RESULTS
The subjective and Objective parameters of base line data to post medication data compared for assessment of the final results. All the results areanalysed statistically for signification using unpaired ‘t’-test.
a)Subjective parameter : Signs and Symptoms of Pakshagha are considered as -
- Chesta nivrutti and Ruja in dakshina pradesh
- Chesta nivrutti and Ruja in Vama pradesh
- Vak stambha
- Sankocha and shoola in pada.
- Sankocha and shoola in hasta.
b) Objective parameter :
1. Stroke recovery score card25
2. The Barthel index 26
3. Grip test
7.4)INVESTIGATION
1. Random Blood Sugar
2. Platelet count
3. Prothrombin Test
4. Complete urine examination
7.5 Ethical Clearance:
Yes Obtained and enclosed
8)LIST OF REFERENCE
1)P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 17/18 edition-7th 2001, pub: choukambha orientalia , varanasi, page no. 124
2)Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasipage no.19
3)P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 20/11 edition-8th 2004pub: choukambha orientalia , varanasi, page no. 269
4)Raja Radhakant Dev edited Shabda kalpa drooma threetya khanda edition 1996 pub: choukambha Sanskrit series office varanasi, page no. 61.
5)P.V. Sharma edited Charakasamhita vol-I chikitsta stana chapter 28/53-55 edition-8th 2004, pub: choukambha orientalia , varanasi, page no. 35
6)Ram karan sharma edited Charaka samhita vol-VIsiddhistana chapter 9/4 edition 2nd 2005, pub: choukambha Sanskrit series office varanasi page no.326
7)Ram karan sharma edited Charaka samhita vol-V chikitsa stana chapter 28/53-55 edition 2nd 2001, pub: choukambha Sanskrit series office varanasi page no. 35
8)Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.13
9)Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125
10)Parashuram Shastri edited Sharangadhara samhita uttara khanda chapter 8/36-37 edition 3rd 1983 Pub: choukambha orientalia , varanasi, page no. 344
11)G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.397
12)K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341
13) P.V. Tivari edited kashypa samhita sutrastana chapter 27/28 edition reprint 2003 pub: choukambha vishvabharati varanasi page no.68
14) Nirmal Saxena edited Vangsena samhita vol-I chapter 28/210-211 edition 2001, Pub: choukambha Sanskrit series office varanasi page no.415
15) Rajeshwari dutta shastri edited Bhaishagya ratnavali chapter 26 edition 18th revised 2005 Pub: choukambha orientalia , varanasi, page no. 531
16) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518
17) P.V. Sharma edited Chakra dutta vata vyadi chikista chapter 22/24-25 edition 2nd 1998 Pub : choukambha orientalia , varanasi, page no. 186
18) Rama nivas sharma et alleditedSahasra Yoga, taila prakarana edition 2nd Oct 1990 Pub: choukambha orientalia , varanasi, page no. 80
19)Parashuram Shastri edited sharangadhara samhita uttara khanda chapter 8/36-37edition 3rd 1983 Pub: choukambha orientalia , varanasi, page no. 344
20) P.V. Sharma edited chakra duttavata vyadi chikista 22/28 edition-2nd 1998 pub: choukambha orientalia , varanasi, page no. 186
21)K.R. Srikant murthy edited Astang hrudaya vol-I chapter 20/9-10 edtion 1st 1991, Pub: Krishnadas academy varanasi page no. 257.
22)International statistical classification of diseases and related Health problems, 10th revision, version for 2003, PP-131.
23)K.R. Srikant murty edited Bhavaprakasha madyam khanda vol-II chapter 24/209 edtion 2002 Pub: Krishnadas academy varanasi page no. 341
24)Parashuram Shastri edited Sharangadhara samhita Uttara khanda chapter 8/36-37 edition 3rd 1983 Pub: choukambha orientalia , varanasi,PP- no.344
25)National stroke association . center.org/trials/scales/scales overview.htm
26)Mahoney.FI, Barthel.D.Functional evaluation. “The Barthel index” meryland state medical Journal 1965:14.56-61.
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