From,
SUSHMA B.M.
Preliminary M.D (Ayurveda) scholar
Department of post graduate studies in Panchakarma
S.D.M college of Ayurveda and Hospital,
Hassan-573201
To,
The Registrar,
Rajiv Gandhi University of Health Sciences
BANGALORE, Karnataka.
Through:
The Principal and Head of the Department of PG studies Panchakarma
S.D.M. College of Ayurveda & Hospital, Hassan-573201
Subject: Submission of Completed Proforma for Registration of Synopsis for Dissertation.
Respected Sir,
I request you to kindly register the below mentioned subject against my name for the submission of the dissertation to the Rajiv Gandhi University of Health Sciences, Bangalore, for partial fulfillment of M.D. (Ayurveda) in Panchakarma.
THE TITLE OF DISSERTATION: “A COMPARATIVE STUDY ON RUKSHA AND
SNIGDHA VIRECHANA IN THE MANAGEMENT
OF AMAVATA “
Herewith I am enclosing completed proforma for Registration of synopsis for dissertation.
Thanking You,
Yours faithfully,
Date:
Place: Hassan (Sushma B. M.)
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
Annexure II
COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT OF DISSERTATION
1. NAME OF THE CANDIDATE: SUSHMA B. M.
AND ADDRESS PRELIMINARY M.D.(AYU)SCHOLAR, DEPT.OF PG STUDIES IN PANCHAKARMA,
SDM COLLEGE OF AYURVEDA AND HOSPITAL,
HASSAN - 573 201.
PERMANENT ADDRESS: D/O MAHADEVAPPA. B. P.
#1660, H.I.G, E&F BLOCK,
CHURCH ROAD, 1/a CROSS,
RAMAKRISHNA NAGAR,
MYSORE-570023.
2. NAME OF THE INSTITUTION: SDM COLLEGE OF AYURVEDA &
HOSPITALA, HASSAN.
3. COURSE OF STUDY &
SUBJECT : M.D. (Ayurveda.), Panchakarma
4. DATE OF ADMISSION : 28 -05 -2008
TO THE COURSE
5. TITLE OF THE TOPIC : “COMPARATIVE STUDY ON RUKSHA AND
SNIGDHA VIRECHANA IN THE MANAGEMENT OF
AMAVATA”
6. BRIEF RESUME OF THE INTENDED STUDY:
6.1 NEED FOR THE STUDY:
Virechana Karma is Shodhana procedure for vitiated Pitta Dosha; it also relives vitiated Kapha and Vata.6.b Virechana is one of the purificatory procedures mentioned in Amavata treatment. In routine practice, Eranda Taila is being used for Virechana purpose in Amavata, which is Snigdha Virechana but is well supported by classical references5. However, Amavata is a Kapha Vata and Ama Pradhana Vyadhi in which all Ruksha measures like Valuka Sveda, Kshara Basti, Langhana, Deepana are indicated. In Ama formation Snigdha Guna of Ama and that of Kapha are increased so Snigdhata of body also, may be more.
In classical text there is the reference that ‘Rookshastu Snehabhavitan’6.a it does not mean that Snehabhava attained by Snehapana is only to be considered here, it also includes Shareera which is Snigdha due to Dooshita Kapha and Ama. So it can be implied that use of Ruksha Virechana may be more beneficial on Samyak Virechana Lakshana and Amavata Lakshanas. Since Trivrit is having Ruksha Guna Trivrit Choorna is being proposed to be used for Virechana Karma.7.a Hence this study has been undertaken to compare the effect of Ruksha Virechana and Snigdha Virechana in Amavata.
Amavata is well correlated to rheumatoid arthritis in medical science. The prevalence of rheumatoid arthritis is 0.8% in the population, 80% of patients develop the diseases between ages of 35 -50 yrs2.
6.2 REVIEW OF LITERATURE:
Madhavakara explains the etiology, clinical features like Angamarda, Shoonatanga, Gatra Stabdha etc, types and prognosis of Amavata1.
Chikitsa Sutra of Amavata is as follows – Langhana, Svedana, Tikta, Katu and Deepana Dravyas has to be used in Ahara and Chikitsa, Virechana, Snehapana and Basti.5
In this study Indukanta Ghrita will be used for Snehapana.Its ingredients are-
1. Kashaya Dravyas - Putikaranja (Kanda Twak of Holoptelea integrifolia), Devadaru (Heart wood of Cedrus dcodara), Dashamula [Moola of - Shalaparni (Desmodium gangeticum), Prishniparni (Uraria picta), Brihati (Solanum indicum), Kantakari (Solanum surttense), Gokshura (Tribulus terrestris), Bilva (Aegel marmelos), Agnimantha (Clerodendrum phlomidis), Shyonaka (Oroxylum indicum), Kashmarya (Gmelina arborea), Patala (Stereosprmum suavealens)], water and milk.
2. Kalka dravya - Shadushana [Phala of Pippali (Piper longum), Pippali Moola (Piper longum), Moola of Chavya (Piper chaba), Moola Twak of Chitraka (Plumbago eylanica), Rhizome of Nagara (Zingiber officinale), Phala of Marica (Piper nigrum)].
3. Goghrita
4. Indukanta Ghrita is prepared as per Ghrita Kalpana
Anupana – Ushnajala4
Actions and Indications - Vatamaya, Shoola, Balavardhana.
Trivrit [Ipomoea turpethum (Moola Twak)] Choorna 7.a is used for Virechana, which is having following properties- Kashaya, and Madhura Rasa, Ruksha Guna, Katu Vipaka, Kapha-Pitta Shamaka.
Previous research works on virechana in Amavata:
Following research works have been done:
Kamsa Harithaki administered after virechana karma with Trivrith Kvatha and Eranda Taila also provided best relief 9.
Amrita Bhallataka Avaleha administered after Virechana Karma (Triphala Kwatha, Trivruta Choorna, Katuki Choorna and Eranda Taila) provided better relief. So it can be recommended for the management of Amavata 8.
6.3 OBJECTIVE OF STUDY:
· To evaluate the effect of Ruksha Virechana Karma in the management of Amavata.
· To evaluate the effect of Snigdha Virechana Karma in the management of Amavata.
· To compare the effect of Ruksha and Snigdha Virechana Karma in the management of Amavata.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA :
Patients of Amavata will be selected from the O.P.D and I.P.D of S.D.M college of Ayurveda and hospital, Hassan.
7.2 METHODS OF COLLECTION OF DATA:
A special proforma will be prepared by incorporating all aspects of Amavata from Ayurveda as well as modern perspective.
Design of the study :-
A single blind comparative clinical study where 30 selected patients of Amavata will be randomly assigned into two groups of 15 patients in each.
DIAGOSTIC CRITERIA:
The clinical features of Amavata and the base of criteria laid down by American Rheumatologic Association (ARA) 1988 of Rheumatoid arthritis will be taken into consideration for the final diagnosis. Criteria 1-4 must have been present for at least for 6 weeks.
1. Sandhi Stabdata {morning stiffness (>1hr)}
2. Sandhi Shoola and Shotha (arthritis of 3 or more joint areas)
3. Hasta Sandhi Shoola and Shotha (Arthritis of hand joints)
4. Symmetrical arthritis
5. Rheumatoid nodules
6. Serum rheumatoid factor
7. Radiological changes.
Patients with signs and symptoms of Amavata such as – Angamarda, Alasya, Gaurava, Jwara, Dauebalya, Utsahahani, Daha, Nidraviparyaya, Agnimandya, Apaka, Aruchi, Vairasya, Kukshi Kathinata, Kukshi Shoola, Vid Vibadhata.1
INCLUSION CRITERIA:
· Patients between ages 17-65 yrs of either sex.
· Patients having Madhyama Koshta.
EXCLUSION CRITERIA:
· Patients associated with other Vatavyadhi
· Patients of Rheumatoid arthritis who also developed deformity or associated with any other systemic disorder.
· Patient contraindicated for Virechana Karma.
PLAN OF TREATMENT:-
30 patients of Amavata will be randomly divided in 2 groups of treatment. Each group-containing minimum of 15 patients.
Snigdha Virechana Group (SV Group):
Patients of this group will receive
· Pachana- Panchakola5 Phanta 50ml thrice daily before meals will be given till the appearance of Nirama Lakshana.
· Snehapana – Indukanta Ghrita4 with Anupana of Ushna Jala, 7 will be given starting from 30 ml as Hrisiyasi dose and then increasing the dose daily according to the tolerance of the patient.
· Vishrama Kala – Sarvanga Abhyanga with Brihatsaindhavadi Taila4 and Valuka Sweda, during this period light diet will be advised followed for 3 days.
· Virechana Karma – Virechana Karma with Eranda Taila5. Dose of Virechana Yoga will be 60ml followed by Ushna Jala.
· Samsarjana Karma- depending on type of Shuddhi.
Ruksha Virechana Group (RV Group):
In this group patients will receive Pachana, Snehana, Vishrama Kala and Samsarjana Krama same as mentioned in the above group, where as for Virechana Trivrit Choorna 30gm along with Ushna Jala will be given.
ASSESSMENT CRITERIA
The assessment of the effect of the therapies will be done on following parameters. It will be assessed by assigning suitable scores and application of clinical tools.
· Samyak Snehana, Samyak Swedana, Samyak Virechana Lakshanas
· Signs and symptoms of Amavata / Rheumatoid arthritis
· Walking time
· Measurement of joint circumference.
· Knuckle swelling by using jeweler’s ring
· Improvement in hand grip power
· Foot pressure
· Range of joint movement
· General function capacity
· Laboratory investigations:- ESR
The results obtained will be statistically analyzed using paired Student’t’ test.
FOLLOW-UP STUDY:-
After the completion of the course of treatment the patients will be followed at regular intervals of 2 next weeks for the period of 1 month.
7.3 LABORATORY INVESTIGATIONS:-
· Hemoglobin percentage, Total WBC count, Differential count, erythrocyte sedimentation rate.
· RA factor
· ASLO titer & X-ray of joints, where ever necessary
7.4 Has ethical clearance been obtained from the institution? yes
8. LIST OF REFERENCES:
1. Madhavakara–Madhava Nidana with Madhukosha Vyakhya, (ed)Yadunandan Upadhyaya,20th edition , Chaukamba Sanskrit Sansthan, Varanasi, 1993, 25/1-12,pp 460-464.
2. Peter E.Lipsky: Harrison’s principles of internal medicine, McGraw-hill companies, 15th edition,vol ll ,part twelve ,sec ll,312 chapter,pp1928-1937.
3. Davidson’s principles and practice of medicine, Churchill livingstone, an imprint of Harcourt brace & company limited, 18th edition, 1999,12th chapter, pp835-848
4. K.Nishteshwar & R. Vidyanath: Sahasrayogam 1st edition, Chowkamba Sanskrit series,Varanasi, 2006.
5. Priyavrit Sharma: Cakradatta, second edition choukamba publishers, 1998, 25th chapter, 1/139 p 22.
6. Vagbhata:Astanga Hridaya with Sarvanga Sundara commentary by Arunadatta and Ayurveda Rasayana of Hemadri,(ed).Bhisagacharya Hari Shastri Paradkar Vaidya, Krishnadas Academy,2000, Sutra Sthana ,16/37-38,p-251.
6.a Vagbhata: Astanga Sangraha (trans) Prof.K.R.Srikanthamurthy, Chaukambha
Oriental, A House of oriental and Antiquarion books, Varanasi, 9th edition,
2005, Sutrastana, 27/50, p-482.
6. b Sutrastana 27/5
7. Charaka: Charaka Samhitha Hindi translation by Bramhanand Tripathi, chowkamba surabharati prakashan, Vranasi, ed-2004, 13/57,p-275.
7.a Charaka: Charaka Samhitha; Translated with Vaidyamanorama by Acharya
Vidyadhar Shukla and Prof.Ravi Dutt Tripathi; Foreword by Acharya Priy
Vrita Sharma; Chaukamba Sanskrit Pratishthan; Reprinted 2004; Kalpasthana
7/23 p-834
8. Priti Sharma – Jamnagar University, the role of Amritaballataka Avaleha and Virechana Karma in the management of Amavata. P.G thesis, Depatrment of KC, I.P.G.T.R.A, G.A.U.J.M-2006.
9. Sahu Rita .A.K –Jamnagar University, Clinical assessment of the role of Kansa Hareetaki and Virechana in Amavata. P.G thesis, Depatrment of KC, I.P.G.T.R.A, G.A.U.Jamnagar, 2003.
9. SIGNATURE OF THE CANDIDATE :
10. / REMARKS OF GUIDE / :11. / NAME AND DESIGNATION OF :
11.1 / GUIDE / : / DR. GIRISH K. J.
PROFESSOR,
DEPARTMENT OF PG STUDIES IN PANCHAKARMA,
S D M COLLEGE OF AYURVEDA, HASSAN.
KARNATAKA
11.2 / SIGNATURE / :
11.3 / HEAD OF THE DEPARTMENT / : / Dr. ASHWINI KUMAR M.
ASST. PROFESSOR AND HOD
DEPARTMENT OF PG STUDIES,
S D M COLLEGE OF AYURVEDA,
HASSAN,
KARNATAKA
12 / SIGNATURE / :
12.1 / REMARKS OF THE CHAIRMAN AND PRINCIPAL / :
12.2 / SIGNATURE / :